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pfiy U 1962 ^^ W. ABA^uiy- 



4t« North Juna Sttwt 
Lob Anfflin «. CftUf. 





!Lll^[f 



£rnfsi Tl'flifcer Sdii;>'er 

Jroc^ Element CoUecUofi 

In J^emory of Ray tyman IPilbur. 5W.D- 






1 
1 



DIET IN HEALTH 
AND DISEASE 



BY 



JULIUS [fRIEDENT ALP, H.D, 

cunCia moFBHOJi of DnaASB of tva itoiiach ih nt comoB 

OF FflTIXOUa AVD HIKCIOIBj lALIHHIK* 



AND 

JOHN RUHRAH, M.D. 

*^j— ^**^ nornKnt of nxtCAWS of cHtiintH in Txa coluob 
OF niTuaAiis AUB Btmoiom, kutuiou 



" Tbeae few mlei of diet he thai keqw. BhaU luretj 
find great ease aod speedy rvmedT by il/'— ButTDN 



Second BDitlon, Cbo^Qdblfi Vn^lflcO anD Stilarflco 

FHILADKLPBIA Aia> LONDOK 

W. B. SAUNDERS COMPANY 

1906 



4U Nartk Jm BttMt 
I 4, Calif. 



SeiBp, el «ir otTp«d, prinad, mdenpyriyfateJ Nonubflv, 1904. Reprinted 
JonCr 1905. Rcfiied, tcprfued, uad rKopyrishivd Uif, 1906, 



COPYMCHT, 1906, BY W. B. SAimDUS COMPANY 



«UDTllOTV»fO Wf mM DP 



/ 7 - > 



TO 

mnuiiam ^Bict, A.a>. 

AS A SLIGHT TOKEN OF OUR APPRECIATtON 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 saooees of the first edition of this book seemed to 
indicate tliat it filled a need of the profession. Id 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 salte^ noted the woi^ 
of Chittenden, given a more extended account of Prochownick's 
diet for pr^;nancy complicated by contracted pelvis, and have 
added an account of the diet at water cures, and of Klemperer'e 
work on oxaluria. We have added a revised list of recipes 
and a new set of diet-liste for ready reference at the end of the 
book. 

We are indebted to numeroua friends for critidsms and 
Buggefitions, which have been most helpful, and tnist that iu 
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. 

Uat, 1906. 



PREFACE. 



TntB book liart been prvpaixil to meet the needs of tbfi 
generiil f>ractitiunerT liofipitAl int«rtir, and metllcal eludenl, ts 
well jm for a n-Ti'reuue lmui]UH>k fi>r truiuxiifi^-Hrih^wls. 

The aim vf the Uxik Is enUtvly jinictioLU Wv liave C£- 
deavored Id give a FCttsonaMy concise a<XK>UDt of ihe difterent 
kindfl of food8, timr <!oni|)OHitioD and iiAe^, and ultw to Ml forth 
the principles of diet both in hcslth and dJKvo^o, The greskUir 
]Mit of tbe book isdevoCvd to the tt'wk, nnd wo havi; tried to 
tell tlie doctor how tn feed his [mticni. We lmv<? ^ncovcr the 
liU^nUtiK" of ibo **iilycHa, much of which i^ itiiMxX'^ible to tie 
gt-nonil praciitiuniT, and have given what w?eni« (o u« to be the 
mt>*t tw.*fiiL \Vc tniBt lliat the Ixxtk is simple enough to be 
u^^^l fctr rapid reference by tbe bti«y pmctitiotier, and that tbere 
iH ftiiflieient tielail to mjike th»T way (Omr for the meclieal student 
«nd the iintnitmted hoi^pital intj'm^. We hnve K^thered t<^ 
getber many diet^li^t^ and recipes, wbieh we tru^ will be of 
svrvleo both to the physician antl t** tlie niinw> 

Id tile prepamtifm of this work wc h«vc <^n!rnlted mnny 
books And joumni articles, and we are andt^r obli^^ation to the 
many authors whose nflme« art* mentioned throughout the book 
In conDe4^tion with their oonlribiiUon? Ui llje Hcienec nf dietetio. 

We are especially IndebtMl to I>r, W. O. Atwaler and hm 
collaboralord for much valuable nmunal. We wish to expret<0 
our tkinki! to the publishers, Mtai^ns. W. R. fii^oiinder^ & Co-^ 
for the courtesy tbey have ebown in its prcpnrutioD. 



1 



CONTENTS. 



FAor 

The CHEutffTBV aiO) PHraiOLoay of DiGisTiozr. ... 17 

tHge«tion and Abeorption 20 

IMgeadon 20 

Abaorption 27 

Peculiarities of the Digestion in Infants 31 

MeUbolism 32 

Abaorption of Foods 41 

Quantity of Food Required 46 

American and European Dietariea and Dietary Stand* 

arda 51 

The Infiuence of Various Factors upon the THgeetion 54 

The Relation of Food to Various Inherent Conditiona . 5d 

Clabbes op Foods 63 

Animal Fooda 63 

Milk and Milk Producta 63 

The Modification and Preeerv^on of Milk ... 69 

Efega 76 

Meata and the Meat Preparationa 73 

Fiah 85 

V^etable Fooda 89 

Cereala 90 

Legume? 92 

Roots and Tubers 95 

Green Vegetables 96 

Fruits and Kuts 99 

Fruits 99 

Nuts 101 

Fungi, Atgo, and Lichens 103 

Sugara 103 

Spoea and Condimenta 106 

Fate and Oils 107 

flftlts Ill 

Salt Metabolism and Disease 119 

Beverages and SnuuLAirrB 120 

Water 120 

Mineral Watera 122 

Tea 132 

Coffee 133 

9 



10 



COyTE^TTS. 



BiVEiiAi3E» AND Stimitlakts (^Gfutinutd)* rMB 

(W.m 1S4 

Akohol 1S6 

Alcoholic Beverages 145 

Hpirit* 145 

LLi|UL;ijrs ami Bitten 146 

Mftlt Uquora 148 

Wines IJft 

AlIIou And Thempeutic Use of Mall Uquore and 

Wiuct 165 

Cider 157 

VABIt>Ue FA<TORa IN TEIBIR iJEAfiUIO OK PlET ... - 158 

Concent ml jou of Fcm*iI , , 16ft 

Preeervniion of Fi><m1 159 

Artificial Fi>ih1 Prepiirationi 161 

Artificinl Pmprietary Foode 163 

Cooking of Fiwjtla 165 

EHect of C«uking 167 

Di^eaaoa Oau&cd by Errora in Diel ocd hy Various Food- 

p(jiwiTi8, 169 

Otner Forms of Fooil-poisoiiing 1^0 

MiiJBynt^rasies , . 188 

Food Adulieratiou 194 

Diet u£ a Mcau0 of Diaguods 1G3 

l>iet for Sing©r« and ftpf^jiktra 196 

Diet During AlblcticTnLiniug 166 

IwFAST Fkkuinu . - - 205 

Milk Modificatltm 215 

MethrMU of Practical Value m Modifying Milk . , . 215 

Artificial Feeding 235 

FeeJiug During the Second Year 238 

Diet of St'bool Children 245 

Other Faclow iu Infant Feeding 249 

The Feeding of Sick lofautfl 252 

Gavage 255 

Diet in Diseaeefl of Children • , 25^ 

DiHT FOR Special CoNmrioNa 277 

Diet for the Aged 277 

Diet Dunui; rreguuiicy luid the Puer)>cniim 278 

Diot ID the Special Di^etuee of Pregnancy 282 

6FBCIAI, Methods of Feedij^g - . . . 2€4 

Rectal Feeding 2fi4 

ludiofitiooa for (he Uw of Nutinent Enemata .... 2fi7 

R«<d}>tfifor >'utrieDt Enemaia 288 

Other Methods of NouriehiDg the Body 290 



coyTEyTS. 11 

FAOS 

DlBT IS DiBEABE 293 

Feeding io Fever 297 

Feeding in Infectioua XMeeaRee 30] 

Typhoid Fever 301 

Atypical 309 

Complicated 309 

TyphuB Fever 309 

Small-pox 310 

Scadet Fever 311 

Meafllee 312 

MumpB 313 

Whooping-cough 313 

Influenza 314 

Meningidfi and Cerebroepioal Fever 314 

Diphtheria 316 

EiTsipelafl 317 

Rheumatiem 317 

Afliatdc Cholera 318 

Yellow Fever 321 

Dengue 322 

Malaria 322 

Tetanus 323 

RabiM 324 

Tuborculoflie 324 

Diet in Diseasefl of the Stomach 335 

Special Cures in the Treatment of the Diseaeei of the 

Stomach 351 

Dysphagia 362 

Acute GafltritiB 362 

Chronic GastritJa 364 

Atrophic Catarrh of the Stomach 367 

HypereecretioD 368 

Dilatation of the Stomach 369 

Atony of the Stomach 362 

Ulcer of the Stomach 366 

Hemorrhage 370 

Carcinoma 370 

Gastroptoeis and Enteroptoeia 372 

Nervoua Dieonlera 373 

Hy perch lor hydria or Hyperacidity 374 

Diet in Intestinal Diseawe 378 

Dyspepsia 380 

Acute Catarrh 380 

Chronic Catarrh 381 

Dysentery 383 

Uleeri 384 



12 



COKTESTS. 



MaligriAiit Orowthe , . 384 

Aovjt^ Ititestianl Obstruction 384 

Chronir Intestinnl Olwtmction 38a 

A |)j>em Ileitis 380 

MuconkenjUrziiiuiitt Catarrli S86 

Nerx'oua Alleciions 388 

Heiij'»rrboiib 588 

Chrouic Dinrrhea 389 

Uabitaal OoiistLpatioii 881 

Diet iu Periloiiitifl 89S 

l>iut in Liver Duciifee 393 

Catnrrhal Jnuudice 39(S 

C^nK«ti(m 397 

Acute Yellow Atrophy 398 

AIJflC€fl8 398 

Fauj- Li/er 398 

Amvloid Uver 398 

SypbUw 398 

CSall-atoue Disease 398 

Cirrhoms 401 

Diet ju Diseasm of the Pnticreaa 402 

Diet in DiA^ao^a of lliv Hi^pirtitory Organs 403 

PUuriey 408 

Em|iyema 404 

Laryii^ifloiufl Slridulua 4(H 

Laryijj^ilia 404 

Afttlima 405 

Eiii|i]iy-'4i?n)a 406 

Chronic Bronchitis , , 406 

Heiuorrliage trotn LilD(^ 40ti 

Pueumoniu 407 

Diet 10 Di*on*p* of ihe CiroulAlory Byatem 410 

Disea«*fl of the Heart 410 

Heart LesioDH in Children 414 

Serile Hcjirt 414 

Arteriowileroeis 418 

AneiLTvactk ,,,,..,*,,,.,,.»., 418 

Angina Pecloria 419 

Aodmia 420 

Chbrosis , 421 

Ijbukemin , , 42d 

Purpura Ha:jiiurrlkagi<» ....,...••.. 42o 

Hftmopbilin 426 

Diet iti DiHeiidc^ of the G^uitounDary Syvtem . . . , 428 

Acute Nephritis 435 

€bronio Pan^ncbyntatou* NepHriti* , , , . , i , , 437 



CONTENIS. IS 

CbrODic loteiBtitial Nephriti« 4S9 

Floatiog Kidney 442 

Amyloid Kidney 442 

Fy^itie — PyelonepbritiB 442 

R«oa] and Veac&f Calculi 443 

lithemia— The So-called Dno«cid Diatheoft «... 443 

Gonorrhea 447 

Diet in Dieeaeee of the Nervous System 447 

' Neuralgia 449 

Gastralgla 449 

' Vuc«ral Neuralgia 450 

Migraine 450 

' Insomnia and Disturbed Sleep 451 

Vertigo 451 

Epilepsy 452 

Chorea 463 

Apoplexy 463 

IMet in Various Toxic Condidons 464 

Chronic Morphin-poisoning 464 

Alcoholism 454 

Chronic Lead-poisoning 466 

Weir-Mitchell R«st Cure 456 

Diet for the Insane 464 

Diseases in which Diet is a Primary Factor 466 

Diabetes Mellitus 466 

Dietetic Treatment 473 

Substitutes for Sugar 469 

Substitutes for Bread 490 

Gout and Qoutinees 499 

Rheumatoid Arthritis (Arthrids Deformans) .... 609 

Obesity 509 

Diet for Leanness 530 

Scorbutus or Scurvy 631 

Unclassified Diseases 633 

Exophthalmic Qoiter 633 

Addison's Disease 634 

Osteomalacia 634 

Diet in Diseases of the Skin 634 

Ecxema 536 

UrticariB 636 

Acne 636 

Acne Boeacea 53B 

Pecriasia 538 

Pruritus 638 

Furuuculosu 639 



14 



COSl'E^'TS. 



r4iM 

GnsciAh Otma MO 

Milk Cure 540 

Whey Cure - . Wl 

Kumiffi Cur? . , , Ml 

Yolk Cure &42 

Diet Curtn , d4S 

ThK DlLTL-TIC MaXAGEUENTOF BUKQICAI^ClflES . . . , 545 

Uiot After Operution , , , . 550 

Abhv A^D Navy RATrowe 557 

Amiy Rations 557 

HntioDs wf t*oreign AriMiaa 567 

lirmjtrkf d6£> 

Nas-A- RatioiiE 670 

The (ioupral Me« 572 

The ConimifSarv Store 675 

The PrepamiioD of Food 577 

DlETAKItg IS Pl'BLJC iNSTlTUTlOlfB 578 

Prisou Dietaries 579 

BospiUiJ DietAries 593 

The Johns HopkiDs Ht^spiuJ , 594 

Lfikc«iHc HoBpitul, ClevtUnud, Ohio 594 

Full Diet-Tfthle— Nflvj- Hnapitala . 5W 

Craig Colory of Epileptics 603 

Diet for Chorister Boys m 8t, Fuul's Mum}, Baltimore 603 
Tubermili^^iH Iiilinnitryt Metrupalitaii Hufipiial, Hlaek- 

veWi lalaud , - J 005 

Tuberculo&is Infirnuny 6(W 

Second Hoipital for the Insane nf Marrland for the 

Mouth of April 806 

United 8Ute3 Goveroment Hospital for Uie IiiBaner 

WMhiogUm, D. C 605 

UikU<^ Rtatcs Govemtnetit Hospital for the tneane, 

fit Elizabeth, D, C . . 607 

Bay View A*yhim 609 

Robert Gnrrett Free Hf>RpiUi1 for Chililren, Baltimore 611 

Children's H<iBpital of Boston 613 

OrtatOrraonciStivelHtfipilfllforSiakChildreD. Londott 815 

Recipes 616 

Bovcrag69 616 

Cereal iind Cereid Qruela 617 

length of Time to Cook OereaU 6fiO 

Bread 622 

Vegelahles 62S 

Time^-tahle for Cooking Vt^etabiee in Water .... 62S 

General Rules for Cooking Wgelahles >.''., 623 



CONTENTS. 15 

Recifis {Continued). rioa 

Soupe Without Meat 624 

MiJk Preparationi 625 

Eap 630 

^^B and Milk 631 

Meate 631 

General Rulee for Soups 633 

MethodB of Preparing Kaw Beef 637 

Panopepton 638 

Meat Jelliee Without Gelatin 640 

Bedpcfl for Foods for IMabetdca 642 

The Cheuical Cohp08itiom of Ahesicam Food- 

HATBB1AL8 648 

Explanation of Terma 648 

Cuta of Meat 652 

KaFID REP£BByC£ DTBT-LUTa 684 

Fever 686 

Dyspepaia and Chronic GrastntiB 686 

Dilatation of the Stomach 687 

Atony of the ^mach 687 

Hjperchlorhydria or Hyperacidity 688 

Ulcer of the Stomach 688 

Chronic Diarrhea . 689 

Chronic Constipation 690 

DebUity and Anemia 690 

ObeMty 691 

Diabetee 692 

Gout and OoutineaB .... 692 

Albuminuria 693 

Tubereuloeia 693 

EpUepflv 694 

Diet Afier Normal Confinement 695 

Weights and MEAsuBEa 696 

A Shobt List of Book& ow Food and Dikt 698 

Ikdex 699 





Diet in Health and Disease. 



THE CHEMISTRY AND PHYSIOLOGY OF 
DIGESTION. 

Fucii> Is the matter that u^ takea into tlie hody to siipply 
Doumlim^nt or ta replace tijMLie-waut€. Es^Ty ijhytfictl vuiit 
fioasumefl a part o( tbe force tiiut biLs Ixmmi 4l<;rivei] rn>m fixxl. 
The mnintcnancc ol* the boily-hcat con^tumTi unotluT prt, awl 
ID s^r^wiu^ iiulividuald a curtaia omoutit i-^ uulinxl Id liuiMiog 
up the new tisduce. 

Ffwtl as it U taken into the hody <Hffen* v^ry mtwh in com* 
posrtion from the material that can bo iitiliml in ci*ll-growtJi 
am! in repWm|r the rif^ize-waste. The Ainc'tioD of *li^^H!ioii ia 
flo to alter the tbod tlial it may be absorlied by the blood, nod 
prepare it for as&imilatjoa aatl utilixation by the varioui ti^euos* 
The food of maDkitid \s most varied in nature, differing with 
the sea^onsj and with climated, races, and ccuntrie& 

The study of foodt is a most com^^esc one, and until recently 
few scicntilic invcAtigatioua alon^ tbid \iue bad been made. 
Fortunately^ however, cxperlmentfl are now being oarried on 
the world over^ and it i^ to be bope^.l that the ^nbject of diei in 
health and ia dL^ea^e will soon be lifted out of the vale of eni- 
pjricifiDi where it liaa so long refuted. 

The chemic elements of which the body is compof^ed are sim- 
ilar to thcwo contained in the food-^u0E« generally employed. 
Of the Jirteen or twenty elements cmnt^ined in the body {he 
princi|xil one* aro oxygen, bydrogeu, carbon, nitrogen, calcium, 
pho«phon]K> and aulpbur. These and others that art present in 
f^mall fjunntitiGe form a large number of compound]"- In food< 
thpK^ comjKiiind^ ar« cnort eonvetiiently groups utnW thr h4>ftd- 
iiign fjf pnitein, faU, carbohydrate^, mineral matter, and wa(4»r. 
Allhou^i various c]af&i£cations are in use» this one, owing to iXB 
MDipIicity* is that ]]^DcraIly adopted. 

Water. — Water ent^ro into the oompofiition of every tunii 

1 17 



as CBRMISTRY A2n> PaYSlCLOOY OF DIGESTION, 



in tbe bwl/ and funnj< Diorv tbun CO per ccilL of tht^ ^.^ntiir bodj- 
w<ight «l" a fuU-grown man. As it ia not burned up iu the 
tn^tjibolic procGfij^ej it *\o&i notj hnwever, fumiidb siny energy. 

Sftlte. — Til© partby wjill*, wbirli fnrm nWit *> per cent, of 
tb« bod^'-wcigbt of ao adult man, furoLit little if any energy. 
Tilery are duM Bbtmilnnt iu tbe b<.mi« uuil U^etli, but they u1h> 
tenter inU> tbe amipo^itioTi of otber ti»;si;cs and fluids of the 
body. Tbe princi|iid salt* of the btxly nre calcium [tbtjspbute 
and lh« varioue compounda of potosaiimi, sodium, muguesiuiriy 
aud iron. Tbr nnuend shU^ 111% v<Ty uetn^t^Lry to Hfi]' and befiltli. 

Protein. — Under tbis heading arr included most of the 
nitri]genui)£ fooil -en t» pounds. Viirioue terms bave been applied 
to Uiis ola>^ of fooils, tbe terminology here employed beinp tbat 
retomiiieiMlwi by the Amcrimn A^oeiation of Agricuitural Col- 
Ic^Tw imd K\(ii'nm(jnt Stutions. 

Fn>tciii i^ liiund in both nnimid and vegetable food, familiar 
exarnploB of it lirtn^ tl»' \&m niid gristle of mcjit, tbe white cf 
egg, and tbe gLutt^n <»r grain. ProteinB are divtdt.^] intJ> albti- 
mJnoidf^, gelatlnoid^, and extr^etiver;. 

Albuminoids ini^lude fiurb BuWiim^c^ as tli(? wbitp of f^, 
iht: h^ti part of meat, lb<; curd of milk, and tlic gluten of 
wlieut 

Gdattnolds (railed albnniinoidn by some writers) oowir 
chiefly in the coanective litiBues, as the "collagen" of tendons 
and f^kin and the ot^^in of the bone^. Oclatin !i^ a familiar 
exajiiple tj( this cibiss of proteins. 

The exttnctives contain nitrogen, bnd differ wiilely from 
both iilbiiininmdw aD<l gebtinoids. They arc the princij>al con- 
Ftituentgof l>fer-lea nnd m cut-ex tmcts. V^tnbles contain sub- 
etiuiet^ kntr^wD as amida — for example, aspara^n — vfhich have 
eimitnr properties. 

Tbe proteins, eBpeoiully tbe alhurrniioid^, are uf tlie grf«te*t 
importanoe to the aritroa! economy. They bclp to itiiiUl up new 
tit«uc«; and to repair tbe waste of tJje old ; they arc also burnt 
up in the lx>dv^ and are irn|K>rLint as a source of euer^v and of 
heat. Further, they may bo convcrie<l into fat nud stored in 
tlic Ixnly for ftiture iise, lbi» la^iL fitnetion, however, being of 
minor im|K^>rtaDce. 

P^^(^^in^ funn an wwcntml part of the diet, for without tii^m, 
or wln^r tijcy are supplied in too email t^uiLtitiiy, tho body 
ivaid<*v( uu<I n (M>Dditioii of maluotrlUon toip^rvt^nes. Oarbohy- 
<]m1eA nnd fnt« con not repliiec prcitetnti. A** will \it* shown fur- 
ther oOp they may, by supplying a i^ource of heat and tttergf^ 



CHOtiHTRY AND PHrsiOLOOY OF DSQESTIOS. 19 



protect the protein tmterial, but thfy cap not fulfil the funcUoD 
of repaiHcg ur buiMijig up Lishut-'n, witb liit^ txifjitjoii uf fatty 
tisBUe. PlaDtfi differ frcm auiruulti iu that the fi^rmer uin buUd 
up thw Btnicture tar^y oa iioij-pn>t4;ui BubataiK^n and dcnvc 
th^ir nierogen minply ilireotly from nltii. 

The gelatiooias arc <if complex arn)|)OAitjari, and evidently 
can Dot be «=€d as albuminoids in (he jfrowtli aud repair of 
tlie body. Tliey spiiear to Imve a foad-vatu« r^imilar to tlat 
of the carbohytlmies and late* The extraetivej* are probably 
of no value eKbcr as u ^oiirve of energy or in th(' fommtioo of 
lUMUcB. Tbey uct ua ifiimulanu? and a^ appeiizersj and it ba6 
been Atntcd tliat the Graving 80me iiidividualn have for meat js, 
in iH^liiy, a doMre for tLe eztTactt^'ott. 

CftrboliydTfltes eonlaiu fio iiitrugen, Tbey are oompo«ed 
of €aH>on, hy<lr<»^'n, and i*xygeii» the laat two in llie proportion 
to form watcT — as, for example* Atarcb or *leJ(lrose, 0,11^^,0^ ; 
hence the name, carbohydrates. They include the ftlarcneA, tlie 
Angara, and vegetable fiber or cellulose. Carbohydratea are 
burnt up JD the Inxly, and their energy U changed into hcot or 
utfed up in muscular work; they may nl^w h^ converted into 
fat and be tjtonxl up hi die ImmIv. The superficial fatty lianie 
of the body server aa a dire«t protection ablest cold and as % 
storehonae for h«it and enei^. Starch furuitt only ^bout I pet 
oenL of the iMidy-weight. The ctirl>ohydrat<% on necTonnt of 
their ea^y di^ef^tion and availability^ are the mo8t prolUic »ouroe 
of heat and enerj^y. 

Fat, or hydrocarbon, is an important elemenl of food, wrv- 
in^ the Hiaine purjioee as the carbohydrates, hut more valuable 
weight for weight as a source of energv' than the tatter, but 
being noitlLcr iro easily dij^e^ed nor k> available. Fat ih found Ln 
animal fuod», &uch a.» muil, fish, aud butter, in vegetable ibude, 
oa oilfi, in the various ccicals, and in the kernels of nute. Taken 
OB food in excf^n of the needs of thu' oi^ganiern, fat is usually 
stOTed in the fatty tissue. It fomafl about 15 per (i?nt. of llie 
weij^ht of an average mat, hut there are wide variations in 
iK^llh, Apart from the effects of certain diseases, the ten- 
dency toward IcrtnnejMi or t^^ward the accumulation uf fttt is dc' 
peadi'nl upon jjerwuud habit, licrtdity, etc., more than ujkid the 
t|uantity or quality nf iIk' food taken. Iiidividuul'^ with a ten- 
ilcncy to take on fat Ivrcomc »tout«r on bcin^ ovcrted nod ud 
taking^ too little* mmicular cxt^rei^Kr. 

Kht^t^^iD muintuinfi that tlM ingestion of fut is a (actor in 
pr*> venting m»»<!uhir fatigue. It i» nud that during the 



20 



CBBMiSTRY AND PHYSIOLOGY OF DtOEHTION, 



Franco-Prussian War,, with this eod in view^ the Geriaan 
Emgx^rtjr onk;red ibat eacU buldier receive 250 grauia i;f fat 
baooa a dav. 



DIGESTION AND ABSORPTION, 

DIGESTION, 

The digicstion of food takea place ihrougli a numlwr of 
chemic cliangea brought about in tlie alimentary trncl by Uie 
action of certain uuorgauized ferments iwually known as en- 
zymes, AloDg with theM? chemic cbimgefi ibcre arc, ofccurse^ 
ttlteraticns in the physical jiruperiicd of the fooi], the two com- 
bined alluw^ing the u^'ful part to be m^iQiilatcd while the rc- 
maindt.'r pQ;4gL«a off i^ roAi&e. 

Enzymes.— Eozymeft art^ the prfMbicta of protoplaftmio 
chaoges, and are not endowed with life. They are complex 
nitrogenouB substances, the exact chemic nature of which has 
not been determiDcd. Ilowetl iquIcm the followiug clttBHi- 
fication : 

1. Proteolytic enzymes, or those jn.-ting ii|khi proteins, con- 
verting lljcm into n ^ululle siibt^bince — peptone or proteose. In 
ammals tho pepsin of the gastric juice und the tryp&m of the 
ponorcatic juice are examploe of thin daire, A similar onnytiie 
IS found in plants, in the pineapple family (bromelin) arid in 
the papaw (papain). 

2, Am>IoIytic enzymes, or thoae acting upon starches, con- 
verting ihcm into soluble forms — sugar or sugar and dextrin. 
As ciamplc^ of this cIiihs we huvc, in the animal body : in the 
saliva, plyalin ; in the pincreatic juici', amylopsin ; and in the 
liver^ one cafuiblc of converting glycogen into sng«r. In plants 
there Jj* a similar enKyme, l^inkwn us diii^tasc. 

;j, Fat-splJtting ectrymes. or tlioae nctiog upon the neutral 
&t9, flplitting them up into glycerin and the oorreeponding 
btty Jicid. Steafffiin, present in the piincrentic juice, ia an 
example of tbisclass. Similar enzymeis occur in a number of 
seeiU 

4, Sugar- splitting etizymes, or those having the property 
of converting the ilouble h\tt\ the airigle su^r» — the disticchar- 
ids, such as ^ugiir-ciane and maltose, into the nionoAflcchtLrids^ 
as dextrose and levnloae. Two HUcb enzvmcs are found in tbe 
small intestine. One of these acin nti cane-sugnr, and 15 known 
OH invertia or invertoso; when.-aa the othi^r aot^ on midtosc, and 
ia known as maltase. Other eazyoaea split the mouosskoohnrids. 



OWESTIOy Ayii assorptios. 



SI 



» one tonnH m the tiamefl capable of cbanging tbe blood aud 
tissue sugar (dextrofte) into lactic acid. 

5. CoairttlatlniE cfiz>'mcs. or tboee Batting upon eoluMe pro- 
U;m.s {iriHlpitatin^' thorn in an insoluble form, KcDttiu, the 
inilk-4:un]liiig Jtrmeut of itii- gu^tric jaux, is aa example of tbi^ 
olusfl of rQi!nrmi^F- 

C. Oxldlxlns Enzymes or Oxidases. — Those ^t up oxida- 
tinn prf><VKM9i. Thiy are found in the various orguna and 

A f^iiai Liu <t/ the Entyjiu* (bncerrvd in the PtoccMta t^f Diffc^tion 
and A'u/ri/ion [ifoweHj. 





Whk^n rliloily lontid- 


AFllon^ 


P^taVn (nHntr dU»- 


^livsrj •CKTvtion. 


Cicmverti atordi to lugu 


<M»J- , 




imnltuve). 


AmrlopMn (panofMlic 


PBni.^r«Bt Jc flccnriian. 


ConvurlJi ATarcb to mgu 


Uvvf (UufUuv. 


Unr, 


IdT^rtAM. 


BduJI inU«iin«L 


Convert* ciiii**unir to ^we- 






MfllU««, 


Bmall InlcHlinCt wilU 


ConVCTtK DULttOllB 10 tlCX- 




viry ADd uncrcoiic 


trcicw 






WUACL 


SmtiU tnUAlinc. 


ConvcrtJi Inrtow to doxtron 


(tIjf'Hirlin (•). 




Bpliln ftnd oJEidiKiv dvxlmHb 


LijitLxi; (BiMjttin), 


8pllts neutral fuu to fiEtj 




fnE-twiiiv, bloMl, •!«. 


acidn nnd i^lTctrrin. 


PtlpBlll. 


Q*Atru! juu^- 




Trypftin. 


Hjicmuc Jnice. 


t^phtB prote&nfi ^11(0 ttntpler 

(^rjrtalliii* pmliLctJL 


Er*|HiA, 


Itnull tnU«tLn«. 


Sp]ic« iH>|iloni« intUBimpleT 
S[i1ir4 ppr>i-"inii iintfl nitro- 






Omiifi Af ftiTtoljU^ trn- 


TluitMi gniwntllj. 


IJIJU^ 




»n«)iin hjiHs and unid<^ 






Gnanu. 




fViEir^^rtK Kuanin 10 xuithiii. 


AJ«tuac. 


Ci'iivi-r(it Rjmiu tu l^jp^ 






lanthinn 


OxidiacL 


Lunip^ Uwr. 


Oiui^w oxidation of cu^inic 

fciili^tanrw^ 


CkialiMi 


Many di«u«L 


ox Id, 



Ejizymefl have certain properties in common. They are, for 
tycniTiplo, soluble in water anJ glycerin. They are dcsiroyed at 
a toniptnituR' of from 60^ to 80^ C, and their ai^on h n^ 
Utrdod or entirely (*UHpi?nded by low tempenturefl,— ^>y., by 
frcexiug, — withoiU, ho^rcvcr^ actually cieetroying tJie enKme, 
Tbry an; cliaract^'riz*^! further hy the fiict that sifler a certain 



22 CHEMISTRY ANP PUYiilOLOQY OF DJGESTtOH. 

decree of change haj« been afT^ted tlio products of Uicir activity 
prevent liirtJi&r actioD, m that mo^t uf thorn uiay be mid to 
be iDOompIeti> in tfaiM respect. 

Another curioiu^ iact i» tbat tJie activity of mi eiuyme uf 
not tu prof>ort]oti to tbo amount preAcot. A (riilin^' quantity 
may cffi^ot enormous cbaDge^ and iurroaattij,^ the amouot of 
eniyme augments the ohnnge prodaood, but only to a oertaio 
pniut. uf^'f which the action I^ tbc same whctht^r much or little 
l>e ;iilde(U An t'ii2>'me cao uoL Ik* used ovit ntid nver iifC^in, 
00 it b ulten^tl in some nay and ai> rendered inc:u))ftble of 
ludetirLite actio u. 

It is oominr)n]y believe<l that en/ymes effect Ibeir changes by 
hydroly.HiH ; that is, they caiisi.* tht* stibstaiicc acted upon to lake 
up oac or more nmleciilej^ i>r water, tbc result Ix-ing that tlio 
complex body separator into two eitopler ones. Tflkc, for 
example, the fumilinr example of tbe change id cnnc-sugar: 






How this change if* brought about is not known. 

With this preliminary e<»nsiflerfttion of the enmnes we may 
now [irotM-fO in ihc" Htiidy of iHgestiou, 

Salivary Digestion. — On l>eiug hvkeii iuLu the mout\ 
solid fofMl is ma-^tidtted and bn>ught into oontaot %vtth the 
siilivo, wbiob Is a mixture of the ecwretione of the salivary 
gland* and of the smullpr mueoua or seroiw plands that (»|>cn 
into tlie month. 

Tlje active principle of the saliva is tlic eruyme fdyalm. 
Tliis ferment converts ataireh tiito t^tig^^i a change that \^ not a 
Kiinple process, but one aecom[il)!4h<>d tlirf>ugh a series of inter- 
mediate changes. These ar<? not at present ilionnighly uiider- 
titiKKl, but lliuy pi'obably consist in the alarcb Uikiug up water 
and becoming soluhlt atarLli — amylodcxtrinf which splits up 
iuto deztnn and maltoBo. The dextrin ugain tcki^q up water 
and more maltast? is formtd, Thi?* pi-ocpiw eonlinue^s mitil n\\ 
the dextrin haw l>een converted into malta'^e, or until, owm^ u> 
unfavorable or changed conditions, the fermentation is arnsslcd. 
The dcKtrina formed during this process di^er somewhat in 
their relation to lolling and arc called erytJirodextrin^ which 
givL« a rcl rcai-tif^m with itnlin, and achroodextrin, present- 
ing uu culor rutctiou. Of the liLtter — tbo6e prefeoiing no 



DIGESTION AND ABSOUPTIOy. S8 

oylur reoctioa — (hrrc iitr pr<»bably Mrvcnl prvwnt. The amy- 
lo]»]n of iIhj puniTcatic Juice ncto in a emtifjir wav. 

The Tioniiiil rvttcticjn of the twllvu in lilightl}^ alk«lin«>, but 
it will aol joat as well in a iieutnil nutlium. Atmiigly nllcii- 
]'me syolnuoufi r&tani or entin^ly inhibit iu nctiou, Stroni^ly 
acid Holutions Dot only inhibit it^ iLction, but dcfctroy the fvr- 
meDt, The ftctioo of pytalin otuM, tliereforej ceagc afUjr Lhe 
footi has IxeD in tlie titoitiadi lor a CPrUin IcDgth of timv. 
Baw j^lATx^ k Rdvd upon very slowly, wherea^i Id well-oooked 
starch sugar may be <fot«ctMl afler *?veii one luiuute. Thia It 
clti€ to the fflct that the 8tarch-j;frai]ul«B are Hurruutideti by aii 
cmv^Iop of veg^ubl^^ Jiber (oelluloae) thiit prott-oUt it from thi' 
aeUon of the ferment. On boiling, thi^ cetlutoAe oovmng ia 
broken, aud the »tarch h not omy liberated, but altto t^en 
up vrai«r, rendering it easy of digestion^ (See section on 
Owking,) 

Ga^ric DigCStloa. — Od entering the stomach food it» 
acted upon by tiie ^tric juioe and U changed into rhyme, being 
passed inio the small intestine lu the food ja liquefied. Atten- 
tion amy bete he Gdled to th*^ Aict that food ob^otytion dot^ not 
taJt^ jfUtc>( in the ^ermuph^ It is bcllovod hy many that even 
vater is passed into th« niuall icite^ine for abMirption. 

We owe our fii^t ncM^raU^ knowlwige of the prH?ew of diges- 
tion to the ("JciK^rinKDtfl of Beaumont, made upon Alexia St. 
Martin. The latt^^r !uid l^oen shot in the frt^iniflch, and exhibited 
a gastric K.MiiIn that was well situated for physiologic experi- 
tnenta. In other res|>ecl9 he was a iairly healthy man.* 

Normal gastric Juice Ia a thin almost colorless liquid, with 
a characltristic i-dur and rttrtm^f acid reaction. The acidity 
varies normally frim 40 to 60, that being the numbt^r of cubic 
centimeters of te^t-solution re(|tiirt>d to neutmlize LOO c.c. of 
go^itriD filtrate, but under the inHuenoe of eertain diaeai^M the 
ooidity may l>e very mudi increaseii. grvallydiminiahed,or even 
entirely absent. The acidity of the gastric j nice is due to tlie 
prasenee of free hydrochloric add. Under certain conditions, 
both ill health and in discn^, lactic acid may Ih? found in the 
BtODiaoli. Id addition to free hjdnxtbloric acid, the gmMric 
Juioe oonlains peptin, ii pnitejlytic enzyme acting ualy in v.n acU] 
niediunij au«j rcimin, an etieyme that curdles milk. 

' For the «ccounU of the«c olflaHc oxpfrrimpntfl the rtaU^r is raffrroii to 
BcBQiuoiitV book, 71W l^tinhgy <t/ Dij/ation, publwhed in 1833, uui njbo^ 

qoanUy nprinivd. 



LANE UBRARy. STA.\fOKD UNIVERSIIY 




84 CUKMlSTRy AND FHYSIOLOOr OF DIGESTIOS. ^ 

Pepmn chanps protciiiM into peptonea. The process is a 
eoi[ip]ic^t<Kt one, and m effi^ted gradually. Kuhne*^ iovesti- 
gfttionK hrtve done much to enlighten us on this poinL Ilia 
itirtlujdrt und lerniioolugv have Iwen adopl^nl eitensively by 
re*^r*iil writers, TJie procewt is dew>rib«l a^ foUowa : Th<? pro- 
tein mittiTial IS obmiged 6rgt into tynfonin or arid -album in. If 
thf Wiilicin IS rendered itlkaline, uoid-alhnmin will be precipi- 
tate). The nesct t^tep \» the taking tip of water by syntonin, 
wbtub splits up into several i*oluhle jtrtttArt^ caIW collectively 
prokost'js — albiimose from alhumin ; glohidofie from globulin, et*"^ 
These in turn take up more water, and split up inti another 
eeries of soluMe proteins known ts the secondary proteoses or 
deutcroproieosee. These again uodei^ ibe same prowws and 
foriD peptoDCH. Qtlatluoids are acted upon by iH'p^in lu much 
the saint Wty aa are proteitie. The ioterruediato prodticU have 
b^en t^rmad gttaiotteg or fflufom.'». The end-product U known aa 
gelatin-* peplone. 

liainm cupdieft milk very rapidly at the body-temperature. 
The casein is converted from a soluble protein into & more or 
lesH solid cbtf which gradually bcciimes firmer and expresses all 
the whey that wofi contained in the mai^. The casein of cow*s 
milk precipitates in large Ann clots; that of butnan milk, into 
very fine Bocculeoi particles, which explains the great dilfercnce 
in the dige^libllity of fbe two milks. 

Action of the Oaslric Juice on other Food Elements. — 
Beyond the mechanical alterations that take plaoe from the 
presence of fluid and from the churning movements of the 
stomach, the starches are not actnd upon by the piastric jaice, 
Lusk believes that sugar is inverted in the stomach, whereas in 
realiQ' it undergoes inversion much more completely in the small 
iDlCfltine. In the stomach fats are, for the most part, dissolved 
by tbt body-heat and become Uioiriugbly mixed with the o(her 
food elements by the movemBnts of the stomach. Beyond this 
they remain unchanged. 

Intestinal Digestion. — When the food haA been pojM^ 
into the small intestine, it is acted on simultaneously by three 
secretions — the pancreatic juice, the intestinal juice, and the bile. 
Although the^e secretions, ae stated, act f^igetber, for the sake 
of simplicity each will be considered ecparately. 

Pancreatic Juice. — Our knowledge of the functions of tho 
pancrmtk; juice in obtained largely from ejci3enment«- made ou 
the lower luiimab. In nuiu it i^ntcrs the intefntinc together with 
or closely following or procoding the bile, being miso<l with tho 



DIQBSTiOy Ayj) ABSOItPTIOK 



latter seoretiuo and the fm^cl-toatenal at the Eame time, It is 
alknline in r»rt)i.iii^ nrvl a>iiUxjnri at le^rt three, and prcrbubljr 
more, tntysn*^ — vli.., irvgwin, Amyk»|it4io, rtuipfiiDj aad^ U u 
mid, a milk-iHirdlitig ArrniiTiiL i^iuiilnr in iriiniri. 

Trypnin, — Trypsin U n more ortlvr frrmcnt tJinn U pepsin, 
and acts in :tlkAline, n««tml, or «von in i^lightly octd media. It 
is moot active, liow«ver, in alkaline solutions. The procMA hy 
which peptoned are rormed from proteins; \& similar to tltat of 
peptic dif^tion^ but differs iwmcwhat in detail Trypsin^ how- 
ever, i^ oipable of corrping oq the dig^tioD of peptone fiirtber 
ttiaji is pepsin. The steps of the proce^ eonmst in sepamting 
the peptone into an anfi/x^oru, apeptonDth&tciDnotheacbHloD 
Anther by the ferment, and hemipfptofu^^ whieh is F)plit tip into 
variooA ftun^Jer sub^lance^^ sucb as amid>>^eids and Ditro^-cnoue 
baoco, ^mong tbeec Bimpler eubt^tanoe^ arc loiicin and tyn:i0in. 
JubI what rfile these end-priyiuels P^^y i" the animal economy 
has not been detinilely determined. They do not replace tisfiue- 
waeile, and sre les^ useful sources of energy than is jieptone 
itself^ which is ab&or])ed as such and utilized by the body. 

Howell giree the following scheme, modified from Neumei^ 
ter, to €xplatD graphically tryptic dJgestioD : 

I 



Pp|iinnft 



AcllpcpCCiM 



Bun 



r 



iton« 



Leiidn lymnn Aspftnle ncid yitriiKenoiu b<w«. 

Hie digestion of gel&tinoids is similar to that of the prot«io». 
Try}f6ia pnxluLva j^eLitiu- peptone, whereas pepsin, n* previously 
slated, eeudes t*> act with the formation of getntosc. 

Am^lopnn converts stareh into sugar in tlie mine way that 
ptvalin noes. Inasmnch as ptyaUn di^^tion eeases with the 
('iilraQce cif the foo<l into the stomachy it is impctrtant Uiat the 
Biarchei should be completely digested in the smitll iDtcstine, 
especially as a lar^^ part of the hmt imi] energy eonsumtxl by 
the body is derived from some ibrni of starchy lootl. 

Strnpshj kncwti jil^fo w* lijmfH?. splits up tbc n(.-utml fnt^ into 
glycvrin and free ftitiy udtls. Tliis emiili«irK<4ilion i« uf [luni- 
tBonnt importance in fat^digesCion nnd absorption. The proocsa 



26 CBEMtSTRY ASD PHYSIOLOGY OF DIGESTION. 

now beoomes again one of LydrolysU. The fat takes up water 
BDd .splits up inU) otbiT products. Tb^? following formula 
i*A|>Liiim die |)ru4x«!»: 

ru. oEfcorlit, Pm flitt}- Bcld. 

There are two views cijncerning the ati^ffptlon nf fiiL The 
older view Is that the fat splits or U Ha|>oniflecl only Ut a 8nmll 
extent, the kf^er part of it being emulwitied by the fatty acida 
fi»rnwJ during the splitting-up process. 'Hiis emuUilied tiit ia 
then diix'ctiy iibwjrbwl as neutral fat. The view more recently 
i«h*ptctl U iliut all the fat ia split up into glycerin and fatty 
ncida, whether or not emul»ification hd^ previi>ufily occurred. 
The fatty ncids are saponllied by the aotioa of llic alkaline ealta 
in the iiifeKtine, fhe pr^^bictrf l)eiiig then al^Whrbw!, and hroaght 
into combiaatiou again to form a neutral fat. This reoombina^ 
tion DUiy occur in the epithelial cells of the int^tiDe. Ab the 
action of li[ta&e is reversible, that is, may r^plit up the futs or it 
may cause synthesis of the Bplit prodnt^t^. Lipaj^e is fuimd in 
many tissuts of ti»e body, as liver, rauscle, and inatiimury glands. 
It \h pobsibJv ibut Jat in ^pllt and re-formed many time:^ in the 
proceadeti of nutriti<ai. 

KmulKifioutiuii tukcjc pliuv more rapidly in the prcecnc© of 
bill* and |idncrt*alii? Ilnid tbnn In thr- pn^seuce of |^ncreatic f!nid 
alon€. Aldiojgh hiJe it«clf causes no emulfiificatioi], it nida 
very matcmlly in the procew. 

Intestinal S«cretion, — This h the SL-oretion of the intestinal 
glands, the crypto of Liel>eTkuhn, It is strongly alkaline from 
tlj€ piv«ence of MKlium c4Lrbouut4?, and this may m\ in tht-emuU 
sificatiou of fuu Othemse the intestimtl secretion jirolmbly 
has no action on tliL* pnrtirins or fuL^. The ft-cretjou and the 
walk of the small intcjfitined cnutain three fcrroepts which act 
upon oarbohvdrate^. These are inveriasio, which nets upon cane- 
Hujfar: maltase, which artn iipon multcisf* and deTtnu> and ke- 
ta*<»% which acta upon lactoee. The walls of the iutestini^s con- 
tain ah'^o erpj^Hin and enteroldnase. Erqmn |ir(>bal>ly ooutinut.^ 
or supplements the changes I>^ud hy Iryjisiu. It is supponed 
to act upon the cleutero-albumoi^es and j>ej>tonee. Erej>sin has 
been f*mnd by Vernon In all the tissue--* of the body. It ie 
present in the kidneys in greater qminiities ibarj in the intesti- 
nal mucosa. E'r%(trokh\asf act*^ tipon ihc }iiincrpattc juic't'. Apart 
from the small intestine the panoreatic juicp htx^ uc digcrttive 
aotioo on prot«in»< The explanation nf tliU in tluiD the juice 



OIGESTION Ah'D AB&ORPTtOK. 



37 



coDtaia* a fiub^lance, lrypsinog«d, capable nf l)eing inverted 
ioto ti^psin by the action of entcrokinase Ah hoon a» th« pan* 
crealic juice oomes iu contact with the intestiiml wall the pre- 
vioiuly inert trypsiiio^^eo k cbau|j;eil into liie w^iy active femienl, 
tiyp»m. 

Stcr^ttn, — This IB not an eiityme^ but a definite chemical com- 
pound. It \b Becrete<I by t)ie wall nf the email itilestine when 
midr, arc brought m ountact with il. Secretin Is Mip|K>8ed to be 
ob^iorbeil by the bloody nud being thus carried to tlie puDcreaH, 
excilefi the recretiuti of tbe [Kittcrcatic Juice. An we dcBoeod 
Ibe iQtciftiDal tract the quzi&tity of eo/yme^ contained in the iti- 
ta^imil secretion becomes Emaller. The large mtendne j^ecret^ 
mucus but eooiimiucs. 

Bacterial Changes. — The cban^ea produced by haclcria are 
an extremely importiint factor in dij^ttoti, et[kecui1ly from the 
patbolng^ic ]?taod|Kiint. The ^object can not, however, Kc entered 
upon fitlly here» and for a complete knowledge the tftudent 
should coTii-ult the bpecijil text-book* on bactcriolop}-- Fcr our 
pre^ikt purpoi^c it i» isiillicirnt to my that, in the jsrnall intestine, 
bacfcriu changes are pn»bjibly liniitiil to tbt* curbuhydmtiMi 
Under ubaormal condtlii>ii)<, or when excu^wive quantities of 

frrjtein food art* taktn, putrefaction of the proteins may occur, 
a ibe lur^t.- ifltc^llnc, however, the extreme ulknlinity ovcr- 
come-s ihi* ncidity, jlih) allow* putrclnction of the feces to take 
plaee. The prwhict^ of bsictennl notion are caonyf and oonAiat 
of leucin, tynrjflin, ph^nM, flkatnl. and vrirvMiH nrids nnd ^^le^. 
Some of these, after having undergone certain chan^rt^f^, are ab- 
sorbed anil oxcrctcil n^nin in the urine. It is not definitely 
known just what part tlicy piny in the nutrition of tbc body. 
Judging from the experiment.^ of Iv'iitbil], it i^ reasonably cer^ 
taio, however, that luieterinl action is not ciHteaiiul to uutHtion. 



ABSORPTIOTJ. 

tn order properly to nmferstnnd digcslion and stgflimilation it 
ia D«0GC6UTy to know ^totiu^hin^ of ab!>orptinn. This occurs in 
two ways : eitlMM* by the material nhwiriied entering; directly 
into tiic Wood and jvK^ing tbencM* to the liver, or by its entering 
the bictenlit and ]Hi8«ing thoii<v througli the thonwic duct to 
enter th« blood-current of tb<? lell jugular and ^ubcUvran vcir^. 

AliHorption was formerly K^lieved to lake place to a very 
marked e;itenl in tUt^ f^UimncU. TUht \]vw h now held to lie 
erroneous, probubly little or do ab-u>rpti(ii) Inking place in thia 



28 CUEMt&THY ASD PBYSIOLOQY OF DIGESTION, 



orgaD, AVater, as well it& most other ]iqiiKl«^ mny be nb- 
«orbed fliightly from tbe stotnacb. Alcohol rrny be nbiKirbcd 
in it^ and solutioofl of various wit* may be nlieorbcd slowly. 
CoD(]irD«Dt^ by stimulating tlie mticous m^abrane of tb« 
stomacb, and incr©i«ing thi? Kwrction nf gastrir jiiicc, aid in 
stomach ab«oq)tion. Fsts nre itf>t absorHc<l by the stomach* 
Proteinaaml «iip:nni, if tjtkcii in Bufiiciytitiy concoijtmtofl solti- 
tions, may be ubsorbcil, tlie congestion brought about by tlio 
ii>ic of alcohol or conilitncnt!* aiding the abBoqrtion. On the 
whcjJcj huwover, ubsorptiim from llie alouiaoh la of triflli^ im- 

Absorption in the Intestine. — AH^firption Inkea |ktiu« 
prinoi|Milly in the small int^^tlne. Fond pa&i^j?^ fmm the email 
intestine in from ^\'^ to twenty liciurs. On entmng tte Inrge 
intestine the food is still In a very flnid condition, notwitb- 
^tanrling the lat^ jimonnt "f ab5*»rption of water and silts that 
takes plftce ihiring its possige Uiix>ugh tbe ^nuill inte>=tin€. 

Tile ub^-orptioti of water ts a sptt^ial Jnuc^tion of the intes- 
tinal opithelinm, and ni>t a simple qut^tion of ijt^moslB, 8olu<- 
tmoT* ihot clowly resemble tlie blnotl a? rr^iirdt* alk^iltnity may 
nipidly be absorbwL TLe wuter ubsorbed i^ t/ike» up <lirix:tly 
by the capilloric8| wilbont tii^t passing through the loeteala^ 
althoitf^b if very large cjimntitiej^ are tsiken, this last may occur. 
Our knowledge of intentinal absorption is due largely to the 
eXEM.'riraents of Heidenhain. 

This absorption of water is largely replaced by the afaundaat 
secretion of Uie email intLT^tine 

The protein fwd-mat^rial \% absorbwl chiefly as peptone or 
proteose, but it is very probsiblc tbul ^yutouin, and even pm- 
teiEi»| \i\l*s egg-albumin^ muy Ix? nU^rl>c<l Oirtotly. Peptone 
and (he like nre dinlyyjible, and may ]ms& through dead onuna) 
membranes, but the rate of uhf^rption \s greater than can be 
exptnincl in ibw way. DiiilvBihle proteins, like <^g-nlbnmin^ 
may be ab^iorbed directly, F^t> that absorption as it taken place 
in the intestine is a Fpeciali^ed function of the intej^tinal ept- 
tbeliiimf aitd not a simple problem in physicg. 

The proteins absorbed a»i peptones or proteoses pa^ directly 
into the capillarity, or, at least, tbey do so under certain experi- 
mcnul c<>ndiUoDa> Tbeir presence «id not, however, be demon* 
etratcd In the blood, and if solutiuus of thcan are injected 
expen mentally , th<^y produce poisonous effects- Prom thie it 
may be eeon thnt a clmnge mnst be effeeted in these &iibetAnce« 
during their pa^wge throngh the intef^inal epithelinm. It ia 



DTGESrrOS AXD ABSORPTIOK 



29 



tbc belief of EKHnc tbut the pcptoncit and prot<>aci4-A arc ultatif^cd 
into feenun-albtmiifM, bot tb^tv 18 no definite proof of tbis. 
The pmoefiH would be tlie reverse of The di^^estive prow^se**— 
tlie alwtraetioD of voter and |>olymerization. 

The carbohvciral*fl are absorbed as dettnise of a^ le\Tilose. 
Beztroj^e can Ke demonntxaled in the blood, and if solutioas of 
this snbfltattce are injected directiv into the ctrciihtion, it may 
be utilized by the tissues. The abtwprption of <lextn>ie firrtn 
(Jh? intestine in pnil>ably mt^re tlian a simple prooe^ of ditfiiFsion 
through an animal ni<.-n]bnine, utid it is possible that a «j>ccial 
activity of the intt^tino is hen* brought into play. 

The fats are flW»rbe<l eith<T directly as ^n<h t^v in the form 
of fatty aoidn and ^iaps. The absorption of tlie ^^Dkall droplets 
of fat directly is thought to be a purely meehanical prooeaa. 
The fatty acids are chan^:ed into neutral fatfi, a pnjcess that prob- 
ably takefi place in the epithelial celU of dio intestine. ThelntK 
pftSA for the moft part rJirEX!tly into the lacteala and into the 
dIckhI by way of the thoracic duru 

Abflorption takes pla^^c ia the large intestine, but it is chiefly 
ftn nbeorptioti of water Th« fcocw cntiTrr in a very liquid oon- 
ditinn, and, after making tilnw pn^refu for utmcwt twelve hours, 
the\' reach the rectum in ar almost solid condition. The large 
intestine posseiiaes remarkable powers of absorption, sinoe t^g- 
albumin, milk, and the lite, given in the form of nutrient ene- 
tnata or ex |ieri mentally, may be absorbed info the ^yAlem* 

I/lvcr, — The liver play* an impc^rtant part in thu nutrition 
of the body. Tbia importatice is due largely to the bile whicb 
it aecreu^f and which is an adjuvant to iutestlnal di^"e»itioD,aud 
to the action of tJie liver-cella on the alworbed food-material ob 
it id found in the portal eiroulation- 

The Mle cortaiiu bile*pigmenlx, bite noidf) (glyeocholic and 
taurocholic), choleaterinr lecitiiiR, fats, and nucleo-albiimin. 

The function of the bSe-^gmenta is obscure* Evidently 
ther are wa.«4te-product4 of metabolism. The bile acids are 
believed Uy play an inip4>rtaTit physiologic r^K Tbcy dis- 
solve the chole^i^riu and Iheilitaite the abtiorptioQ of fnt«. 
CholestfTtn Is reganJed as a WHSte-produot formed iu varioua 
iiHtiue», and la excreted by the livcr-c^-ll*, a* well a* by the 
«kin glamlfl, and the mammar\" gland- Jx-cHhin la aUoa wiwato* 
product. Anti**eptio pm|w>rtif^ havp t>«wn an^ribpfi to thp bile, 
a property that bas never been demonstrated. When a biliary 
fistula occurs and the bile is diverted fn^m the iDtt^^tin?, the 
ftces are very light in color and ^ivc ofi'a fetid odor, especially 



CffeMtSTRT AJ^D FJfTSiOLOQT OF DIQESTf02f, 



if large qiinnlilira of meat and fjil aro taken. The mitiptitr^ 
factive actioD of thp bile is probably an indirpct nii«f. In thnv^ 
piitiente in wbom ihe supply of bile ia cut off from the int«u 
tine u c<»twi(li:nible amount of umii|^te<l and unabsorl^ food 
puisi;^ ihrongb tlie iuti^^tiDc. It ha* been'provedi bowever, 
tliat in bcttltby animalf tlie <>nt]re supply of bile mar be 
(liverml and the uiiiniak btill continue healtby, whicb ehows 
lb:it tile fiiiirtionf^ of Uicr bile can, to a certain (.'\teiit, be 
replaceil, Tbc bile also helps to arrest peptic digestion ia tbe 

Qlyco^n. — One of the most important functinnx of tli« 
liver is the Bo-calle<I glycogenic function. In 1857 Claude 
Bernard denimiAtratcd the presence of glycogen in the liver. 
Glycogen is soluble in water, and bus tbesime general choniic 
formula aj4 starch. Towanl digestive juices it also behaves 
like starcJ], and the end-prodiictK are the fam^ as in the ca^ 
of starch, namely, maltose and Jeictrin. Glycc^n is coaitnonly 
knovrn as aniLotil ^tiux-b. With i**dln it gives a reddUh in^tejid 
of the blue color of ordinarr i^tarchi Glyot^n ia elaborated 
by the liver and can be detnomtrated in the liver-cell^. It 
occnra in grpateat quaniity after m«il8, and df'creasps with 
fasting. AAer prolonged fasts it miLy disappear alt^tgether. 
The oarboliydrat*'9 aid directly in the formation of glycogen. 
Tbt»e reach the liver in the form of dextrose and levulose, and 
are converted into glycogen by the abstraction of a moliKjnle 
uf water, Ijictoee is not so easily chan)j;c«b ami if given in 
exceseive quantities, can l>e demon blrat^^-d iti the urine, wbieb 
shows that it baa not been utillsuMl. iHiring infaucy, however, 
lactose, or inilk-eu^r« forms an important whiition to the diet, 
and ia used up in the fxvly in coiisi*1erf»blp qnaintittcM, 

Glycogen may be formed directly from proteins, a process 
that occiira pathologically in diabetes. According to some 
antbor»f fat can not be converted into glycogen ; others, how- 
ever, lielieve that, under certain pjithologic conditions, this may 
take place. 

The fnnetion of glyocgi^n has bten a matter of much dis* 
putc. Bernar*!';* view was that it fnruishes a meuns o{ storing 
up the sugam until they are ncedei], the glyoiigen Iving ooa- 
verted into ttignr (ileitrfwe) and takcfn up by the bloiHl. The 
same amount of rtiigar is found in the blood nhelher the indi*- 
vidual is fasting or is living on protein footl. If the amouat 
of «iig»r m llic bl^Mxl eseeeth a c?erlain |)ercentage, it ia ex- 
ortted by the Uidne>>, A*Hn»Txiing to som<^ authors, glycogen 
IS obanged into dextrose by the action of on enzyme. 



DIOESTION AKt) ASSOnPTlOS. 



SI 



Giyco^D m altM) foutxl in the munc*)ft<, MhixmI up, hi all jirotKi* 
liility. Tor inim<tlinte ut^. The (!tffereno<^ ihat cscifrts between 
the mii^cle and Mver Kupptl^e uf gl^o'igt.^zi niuv he OLirti|>ar«(t to 
the dtfTereiice hetxi'een retail a1]<>]>h^ whi^re mtit^rial lit <iupp]Ted 
immeciiatcly to the consuro^U", and the urarehoiUAf^, where it in 
etore<l in lurgo <)uatititic}4« The Elv^ig^'n in the niiasele is 
oxulir^l iuul ix^ cnerp;v iy>iiverted into muscular force- 
Urea and the Liver. — vVnother fuDctioi) of the liver is the 
formaljQn of ureii. After the nitn^^ous elerDentfl have been 
4VfTif>ijinc«l nx a (^ourcw uf tidsae-HUpply anJ ener^, they ar^ 
crlimin^urv! {p^m the body, print-i|)Any by tbi- kidtiey^, id the 
form of UK^. That nrea iR fonned in the liver Las beon 
proved OJcperirDeotaUy. 



PECULIARITIES OF THE DIGESTION IN INFANTS- 

DuriDjj; tLe Ilr^t your of lile the infant takc« his fivxl Uy 
mcking. If ihctx in any dcff^ct of tbti Wyin or of the pjilale, or 
if nasal obi?itniction occurs from any oauac, nnr&irig may be 
diffirult or imposeiblij. It h important^ therefore, to exflmin« 
the infant oarefully to a>4oertAin if il in capable of taking siiffi'* 
oient nourishment by mttiiml mctbodfL. 

The Saliva. — At birth Ibe amount of «aliva aecreled 18 00 
trifling that aa a factor in dieention it may be totally dii«n>* 
garded. It ii^reas*^ gTaiiimUy, however, both in ijuaiitity 
and m digestive <^pHbilitv. f^baw hiLi demonstrated that it wafl 
<|uit« active even tn very young infkiii^. At the fourtb rotmth 
it« amylolytio jKiwt-r it* i-sLMly flvmcmAtraluI. With the eruj^* 
tioD of tt^'th then? Lh a coDHid«-rahl<T iiiLTittnc- in f|uant]ty, tto 
that an iijf;int of from right to It-n montha ur A year of ago in 
able to dtgi'At u Kmall quantity of xtarch. 

The Stomach, — Holt give*^ tlie fallowing tabic regarding 
the capacity of the infant «tomiich ; 

Rinh B ^MmT^ftl^, 

awetka . - 7 LfiO ' 

4 " 4 aoo '* 

6 " II 127 " 

$ " 4 a57 " 

10 *■ S <,» ■■ 

12 ■ , 6 4.W " 

I4-lft v««ka 12 A.O0 " 

b- acnvntlu. . t-t 6l76 " 

7- » ■ 6.68 -' 

10-11 ■' 7 flLH " 

l'2-U '^ 10 aM> " 




52 



CHEAflSTnr AND PffYSrOLOOY OF DlQESTfOir. 



In iufuuto gaidtric digtM^tion ui probubEy of no wry great 
importance. In the v<*ry jouog the gtonio^uh acts chiefly aa a 
resdrvoir from which tiio food is passeil iDto th« inte8titke. 
The length or tim^ th(^ food remains in the infnnt ^tomaoh 
inoieai^e^ with the age of the child. Holt srUiU* tliat in healthy 
bre&st*fed infanta one month old the slomaoh is found empty 
at the end of an hour or an hour and a half after nursing. 
^Vhen fed upoD cows' milk, the food remains, on an average, 
]mlf iin hour long^. In infante from two to eight months M 
the foixl remains somewhat longer — two hours for breast-fed 
and two and onohalf to threv houra fjr bi;lttt?-fed l>abic:«. 
Gnetrie digestion h prolonged in all case^ where there is any 
dertkDgement of digeetion. The millCp however^ 1>e^iDS to 
leave the ftiomaob very soon after feeding, and r»ntinueA to do 
so gradually until it has all passed into tte intestine. 

Pepsin is pre^^nt in the infant stom^ich at birthn The reai> 
tiou of the stomfl4^h-ount4'ntd is acid, depending on tlie presence 
of hydrochloric acid, and in i<arly iniaucv of lactic acid aa 
well. 

Rennin ptayr^ an iiuporUitit purt ui infant digestion. It 
c<iitgnliitc.-« inoth<^r'» niiLk lu lfK>de flnkes, whereas cows' milk is 
coagtdttted \a large ma^se^. This fact must be lx>rue in mind 
in feeding cows* milk to young infants, and the milk should he 
so modilied ae to prevent curdling in lat^ masses. 

Intestinat Digestion. — The starch-digesting ferment of 
the ]funLTCL4ti is out vary active during early life. In amaunt 
and jjower it £Ccms to correspond largely to pytaltD. 

Absorption di9Vrs eomewhut in infants, depending on 
whcibcr they an.* breast- or bottle-fed. In breaat*fe'l infanta 
from 2 to 5 per c^nl. of the proteins and fats pass diivctly 
through i\iQ intoetine. In bottl<^fed hahieef Uffclmann states 
thnt the tvsidue is from 1 to 3 per cent mooe for the fats, 
whereas for the pn^ileins there Is a still greater increase. 

Numerous bacteria are present in the intestines uf infants, 
and while they may play some part in the digestive process, it 
ts one on which neidier life nor health depends. 



METABOLISM. 

Food is required for two purposes : to build up the body and 
repair tissu^waste, ftnd tft supply eni^rgy luid heat. 

For purpoflOB of study food may be chissified into protein*, 
iat, carbohydrates, mineral salt*, and water. These are more 



PI 

METABOLISM. 



33 



or l4i« complex oombinniioDs of tbe vtrious elemeoia^ oxygeo, 
nitrojjrn, hv*lr(jp;rn, etc. During di^^tioiL, as&iniilatioM, rt*jMm- 
tion, ntid rJErrction the food lakco undfrf^xw manv c^bangeA, 
bn-al:mg d^iwn ioto nmpler oompouDda or \mt^ tmnHformed 
int^i otlicrrt. Tli«v change arc tprmef! mfiishofijrm. While not 
a r<Nxl, thir uxyg^n of tbe air play8 ao impotlant part !n nutri- 
tioti. 

In youtl)^ ttntil the body attains its fiill tm, m&terial U 
needed from whtcb to build tho tissues. Tlii^ niflterUJ » d^ 
rlvvd from the? finxh Fmm birth until dcatli the Iifopn>ccM«8 
cauw a CKJii^Liiit ^ha^tU^ of ill*' tissues, und this wbwic must b« 
reploocd or the IkkIt will hemme iimiblc prop^^rlr to mrry on 
it« fonctioDjc. Only pn>1«n suhstancoe, that !« bo Miy, ix>od 
oontalnin^ nitrogen, can l>e ns^l tor tbitt purpose. Fat may be 
used to )<^tore material in tbi.* connective' li^ne for future nm 
as fuel, and also to pr.it^ tbe bcdy fmm t-i^ld. 

Every act consuniu» vdct^'. If a mun litU a |>ouud n foot 
hij^h, be must nrprodiicc in his ktdy tbut amount of <-nergy. 
Tbia toergy i» obtaini.-d from ihc fi>i>d. Tht' foroe Uiat liolb 
tbe food oloments Ui^-tbcr in cf>niiiiimtioii Ih <vlh*d |H>t<-iitiiil 
energy. In brmking up the kn^i inlj> ximplcrr cvm|MjuiidTt tlw 
body Acte this energy free or chun^^ it into kinetic energy. 
The cJuinf^ by which thia is Sroupht about are not very w«ll 
uncfemtood at present, buf they ii>ay be likened to fx^mbuHtion • 
thus we speak of *■ burning " up tbe fowl-matcriiil in the hwiyj 
as if the body were a very supericir kind of furnutv^, for the 
changed that go on are, for the most part, vury pn)bably a wrt 
of complex oxidation. iV>tein4, futtt, and cart»<>liyilrute^ may 
all be Durnt ap to furnish beat imd ener^ ; the liLSt two — fat* 
and airbohydrales — tiw uiswl (-xclui^ivcly for one or tlie other 
parposc, if wc regard the fnt stored in the body merely a* fuel 
(or fiitiire tu^j. 

Tbe fA\ffi Aid in tbe digiwtrve iind other pmoe^^t^, -ind lire 
utilized in the composition of the Ix^nes iind teeth. Water 
is pnjbably not u;wd to ftirnisb eneno', but tt Mr\'is a» a 
menstruum, if the term bo allowabhs for tlie pn>cc«0€«. 

Atwater givvvt the following table to JIluAttrutu the used of tbe 
different tcod elements : 



34 CUKMiSTSr Ayi> PHYSIOLOGY OF DtOESTlOJf. 



conuUiw — 



AWH/m fnffrtt^atta t>/ /bod 



Edlblo portion — f. c-* flrab 

nf moHlK v<^V bnii vLile 

of egg, wliefil flciiir^ *tc. 



NutrS«nlK 



Prftteia. 

FaUk 

Minem] maUoTi . 



HeTiiw — t, jr-f bODm» eacnuls, shcIU, bmn, etc. 



£r«H ^ Natrientt in tht Body, 

. ^^jnUfln— 'fonn* tissues — r. ^., white (albumiiO "f 'H;?*! 
"*twrtl (twBeinJ wf milk, l^n moil, gluten of wlif^i, i-it, 
l^tit— ■» KlorrH 114 (ill—,-, J., fat of ment, lHit(*r, olW* 

oil, oils of corn, tthcdt, rtc 
CavlH'hvdnin*— lire inuiHfonnnl into (ot — *. j-, *ii(p»T», 

MiiivtHl molJi.*ri {wA\) — jhnrr in fortninK bnnn, hahIm in 
(IJK^lMni — r, J,, plnjftj'balcR of Mau^ cl«,, priU>L| wnlw, 

ttc- 



All Bcrv* M Aiol 
to yxts\A cnorgT 
in tho TonnH ^ 

culir powpT. 



After the body has reached \U full development, the body- 
weight remains more or \e&s coDstant, and the Jiiod thai has 
btfen uAed i» ext^rctol by mvao» ol' tbe respimtioa atid the 
urine, and, to a larji^e o?ctcot, by ibe fov^a. 

The well-knort'ii law coneerniDg tbe eon*ervation of energy 
ftpparetitly ajiplit^x U\ nietaboliem in animal bodied^ and lim hnia 
\\4m\ |>mcticaily |»n)V«I, although tbe experimentd have never 
iiuilo roBcliKt the ideal owin^ 1o the almost insurmountable 
(lifBctiltieH tlml attend such experiments. In other worda^ food 
that is uwd in the body furnishea the same amount of energy 
that it woiild fumwh if burnt in a furnace or a calorimeter, 
providing tlie ejul-prinluctb lu liicL uisc are tbe sime. The 
huit-\'ah]ea of foods may dicrctore hv takeu as a standard of 
their food-value, but it must alwayi^ be remembered that in tbo 
praefioail appiieation of tbis fact in working out dietariea the 
digeatibility and adaptability of jl food are of great importance, 
as well as the amount of enorify it coulains- 

The heat-value of various foods may be determined experi- 
mentally by the use of an instruineut known as a bomb calor- 
imeter, the result being cxpresfied in cafories, A calorie ifi ibo 
amount of heat that is nect'snar}' to niL^e the temperature of I 
klhignLin of water 1 decree O. (It h nearly the same as the 
amount required to raise 1 pound of water -I decrees F-) Tbi?, 
expresse^l in nieebanical foroe^ means that a calorie wotild raise 
a ton almut KM feet, or that it la equal to 1,/J4 foot-tons. 

According to Atwater, the fuel-valne of the varioua classes 
of ftxKl as ordinarily supplied is as follows ; 



METABOLISM. 



86 



1 AUI <if noMb fumiidu* 4 cftlorio ; 1 poaod funuoha I8S0 t^ori^iL 

1 " fill " 8,0 '* ; 1 " " 4040 " 

1 " c^rbohydntu; fiimblicii 4 cnloric«; 1 pound fumiibc* 1830 fsloHc*. 

Tbew fi^irtv arv wnnrwlmt lower than tJ>v fi^rm given by 
oUex <wtiD]fttioii!?L, nn<\ nrc Ixv^n] ii|K>n thir mcj^t nn^cnt ex|>cri- 
tiKmta. Thd fiiel-valtic" formcrlv giv*ii w<»ro : priit<-in ami <'ur- 
hohydnt««r 4.1 CAlorim pfr giHm ; fiit, fl.Ji <<u1nri4-M ]M»r p%m. 
Ii will be obfierv<>d thnt fat Ium a v«ry lii^ii for^l- value, which 
doubtless cxpfuins why it u eioTfil a* ii n^wcrvc fiii-L 

Exprriment^ in mcbibotii^ii) lmv<! b«*ii mndc to determine 
many thingM^ but thr rvlution of energy and food to mental 
labor i* a probl^i ihiil hjw ni^er l>oen worked out. The 
H:*>pi.' iir>d imiKHlancH' of hihOi ex|x'riiiii'«l« have l>t?en rfated by 
Atwati-r, the lcnd!o^ Amrriain authi^Hty on ibis ttcieitpo, aa 

"The wi*?nr(» of nittrition muat W Htti died from the etand- 
potDt8 uf (he metabclitiiii of matUr and pnerf^ if its funda- 
menial lawiF arc to be thoroughly leni'm-d. The ideal experiraeut 
(or iJie d^-U-rm inn lion of metabolic balance would include a 
n^pinition eiptTiiDi-Dt, a dietary j^tudy, and a digestion eiperi- 
iDcnt ill which the Llk^nnal valturs of food and exerpta are 
deUmnined. It would also include a measurement, mth a 
c&lorimL-ter, or by otlu-r r-iiiUtble mcmiH, of tbe beat produced 
in the orf^nl^m. If work is also performed^ it must abo bv 
m^ofeiind. Xo experiment has y«t been made whioh reaebes 
thifi idrtil, M*»rif» oft^n gperial problema eonneeted with metab* 
olism have been the au^ect of invest i^^iLtion, such as the fol* 
lowiufi;: The functions of the nutrients of food : the formation 
of £bX Iroin prot<rtn and from earbohydmtcs ; the digestibility 
of fooda of vaiiouA kindv ; tlie iftodynamic valuer of nutrieote ; 
tlir fiK'l-\iduc (|KiT<»iitiaI ^iKTfryl i>r i'ikkI; ihe influence of 
metalxfEiMEi of v»riouf!i diR-iuieK^ fil' .lIimImiI, dnigv^ condimentu, 
and the likr, and nf vnrioupi formn of treatment, mcdiciil or 
othrrwiEte, im, ft^r injitaiico, hot bath*« ; the influence of prolonged 
han^^ or thSmt on ni<>tAlKili«m ; and iho qu»ntiti«« of nutri«iita 
conaumcd and appmnriat** for i)eople of different cla^f^ei^, oceu- 
paticDi<, and (vndition*^, and For aniniali^ of dilTereut kitids or 
aaitnalri ivd for diPcrent <.-<.i>n<tmic )inqxv>»:/' 

In njetAhoIitiriw-xpf^rirntntJs the re»nlt« «r^ iwnally cxproeecd 
in termt^ of the m-<K>mc and the oitt^o. Tbo U*nnM umh) 
de^gnate the amounts of nii.n^gen and of nitrogen and carbon, 
Ttw»e are the i(]o?iL nxidily awerfiiiiied and are <jf the gntiteifl 
inipt^rtano^. The tlLi^rmal value of the food and excreta miut 



36 CHEMISTRY AKD PHYSIOLOGY OF DIGESTtOK. 



be Ascertained, a^ well m the amount of energy used cluriag 
the e3t|>erlment. 

Tiiu iliit»riw c<>utx?ruiiig uieUibolihin held bv die aDcknta and 
by tho older writer* arc botJi curioun uud intcnsetiog. John 
Mayitw, who in 1668 udvtinoed the l>oli^f tliat food \h to tiie 
hwiy what \\\A ia to fir^*, otme n«ir tht> view a-* Iield to-dny, 
Thi» WAA for A time forgotten, hut Ijaa since been revived by 
IftU^r investigatorfl, HalW, in 1762, formulated a mechanical 
theory, which was that lx»th liquid and solid particles were 
rubbed together until they became exhausted, and that the 
dfbrirt from this pnH^ess was then excrt'ted, LavoLsitr, in 1789, 
stated that combu&liou occurs ui the IkmIv in a way aoalo^oua 
to combustion aa we ordinarily kitow it. Liebig contributed 
mueh to tliie eubjoot, and many opinions which ho inlviincod 
have f*in<v b«?n proved to he coiTK-t, In 1X40 hp piil>hftheil 
a dietary Btitdy that was an attempt at a carhoa balance. 
Pettenkofer invented the respiru^otL-ap|>aratui«, and diu-ing 
1865-66 both be and Voit published the resului of their clujwio 
exporimenlA. 

The principal work along these Htk^ i» now Ix-in^doncin 
the United Siak'.s. Especial mention must be nuulc of Al- 
water, who, witti Lan^ortby, collected data and publit^hcd n 
r^uiLi{^ of almost all the kuown mct^bolinni-expcriniente oi 
value in which the balanoo of in-come and ont*j^ has been de- 
termined^ Thifl waH later published by the United States De- 
partmeDt of Agriculture, as have been many of hia experimeDt^, 
With his ooworkers he ha^ conducted nunieroim investigations — 
t«o numerous t/) receive even mere mention here. Of cejXK^ial 
inten?st are his exi>crinicotfi on alcohol, conccnnng which more 
will be said m uootJier phice. The building of a n^j^piratory 
calorimeter and the cs|>erinicntp mailc with il, the effect of 
muscular labor on mctjiboli^m and on the digestibility of foi>d| 
the ri?Iate<l work oq the ohomic ci>nipoHition of AmeHcfln Joods, 
etc-, are among the interesting i^xperiments condncled by this 
ardeot worker. H, W. Wiley, of ttie Division of Chemistry 
of the Department of A^culture, and his associates buve con- 
tributed nimicrous valuable papers on the chemic composition 
of food and on the use of preservatives and aibikcrauTs. The 
rcsullii of mctabolie^ni -studies furnished by Ajuerienrs probably 
far exceed those of any other country. Mtich credit is due tho 
Government for it* efforts along these lines as well na to private 
individnstlB who have lahore^l In this ScH. Of these, mention 
mu«t be made especially of Pmf- Chittenden, of Yale Uni- 



I 




METABOLISM, 



87 



veraity. The KiiAruantt have zl^^ done a lai^e amount of valu- 
able wurk, wbicb, ht>wever, u iinfortanutcly l^eyond the reach 
of mo«t »ludcDtft. Among thcira workerr« Tchit(1n<>v«k], Pa&liu- 
tin, DaDilevekif and Likhacbov may be mentianed. In Ger- 
many the most preimiTwnt workem are liankp, Pfl»pjer. ZHnist, 
and von Noorden. The hu^t named ha^ aconnipli^lieil a grmt 
aiDoutit of work having a direct bearini: on tlie niim&^ment of 
diecase. In Japan, Kelltier, Mori, and Oi ; in Italy, Malfetti, 
AlbertoDj and Nov! ; in EnKlan<l, North and Paton, and in 

Methods of BxperlmenUng In Detenniniag the 
Ftwctlona and Nutritive Value of Pood. — Tlie oldest 
apparatn" of im]>ortxinee !>* thf rr^pit'tthrry rA«m/j<r dcviswl by 
Pc'tu^nkofer and Voii of Mimirh, Many dilfi:»ran1 forrna of 
tltia appftmtiiK havr been mmle and used by varmiiK nUmi-i^rH. 
Amon^the mo^i iiunortant of lii<*Ao are tlie- Mxallod n-Kpira- 
lory caloriQieteni. liiihiu-r aD<t Rosenthal and AtwAt4*r and 
IVisa have devLsed Uitcful forms of these. The earlier oint* 
were metal chambers large enough to pennil a man or an ani- 
mal to live comfortably in them* Air was pumped through tlio 
appumtuf^, and na-aAnml aiad anaJyxed ; ibod and excreta uiidcr- 
wentaimilar iuviT^iigationa. 

Am on cxanipUf of th<? nmrc mvnt and olabonito r(>«ap]mtory 
oalorlnirTifFH nr ^xjn'rirnciit c-hiiinlM^rH tin' oito nl th<- We*sleynn 
Univcreity, mado hy AtwiUor and Hoea may briefly be de- 
^bcriUth U toJci-3« into con^idcralion not ojdy tlie air and the 
food and excreta, but nl:*ii lh<? heat ^*neraM by the lx>dy ; and 
it i^ furaii^hed witli nppliunceji fur niuAr^iihir work an<] for r^ 
cording the annie. The ii{i[»aratn.K (H»Tist-<i8 of a m^'tallic tliam- 
ber so oovercKl ilmt the interior la unat!ecled by the ontf^Ede 
lempcntturt*. In this a man liven, itit^, driukf, works, nad 
Htt^'pM.^ The »ir tlmt vcrittUtc-t thr c^lmmttcr ia wnrnai^l or 
ooolod lilt uttvjfcssiry to have it cdwayx [>f a ctTtaJn (t^mppratarej 
and the amount of moiiitiin* within it. i« n^iilat<*tk Thp mr- 
renlA of air i«Ls*ing into and out of Uic ehambiT ait' mcit^ured, 
and the amount of cstrboEi dioxtd itnd niitor i» AWU:*i-tjiincil hy 
analvKiag sampk*H of it. The ti>od anil drink, the urine and 
the fec^^ are weiglied ttmi analyx^xi, their ]>ol4*ntJal oJier^y ik 
determined, and iJie kinetic ita^TQ' ttt* given otl' from tli«; body 
in the form <tf heat and external mii»(rular work in uImi aHC«r- 
tainfdi The orrangcnttnUi for mciL-iurixig the liiut arc vtry 
oompleto, and conaiflt of dtviccrt for preventing gain or UiKt i>f 
)i«at through the wnlle or by veutikliim. The heat givm off 



3& CHEMISTRY AXD PHYSIOLOGY OF DIGESTION, 

by the man in tlje ehaD^ber U carried ofi' through a %me» of 
pipe* hy mcADi^ -jf a current "»f water. The quartity of the wsIlt 
ntifJ the riec in temperature indicote the amount of heat that 
hrt« Iwen given t>ff. The messuremenl^ of the t«mpomttire of 
thp interior, of the inner wnlls, of the inw^ming Hm! ont^ing 
air. and of water are muiie for the most part by electric means 
which are so delicate thai diffcreuees of u hundreilth of n dep;reo 
AR* e»«ily detrrmined. The apparatus is pnivided with appli- 
a«cM» fiir passing food and drink iuto the dwinlier nnd for re* 
movlug th** evcrelo. It in idsfi t^upplii^l witli a telephopo. 

The mrumcT of this ap|iarjhJ8 was cli^termined hy (musing 
ftn electric current throuph a resisloDce coil and hy htirning 
fldeohol in the (JinndiGr. In the elcotnc \t>&t% the amount of 
h«it defj^cted wfis fonml to l>e almoet Ideutit^d with tho )imi>nnt 
g«fncmli.HL In the alcohol tostn the nverage amounts found by 
a<:-tt]nl i'Kperimeut were: for carbon, i*9.5) [»er cent of llie 
amount j^^nemted ; for b)*drogeu^ 100.f> {ler ctrnt. ; und for 
h*at, 99. y per cent. The moasurenienld of heat given oft" from 
the bodr of a man inside the chanilier are so delicate lliat very 
alight boilily niovemeHtft, suc^h as riaiiig frum a chair ur lurniug 
over in bed, aire noted by the obtterver who id watching the gal- 
vanometer and thermometers. 

The experinienU are usnully conducts! for a period of about 
eight days, the lujit fmir diiys nud tiv^ nightie being spent in the 
obemlxT. I>jrin^ the entire time the diet, i.s tiniferui. The 
preliminary period of four day^ is ocm^ujijixI in bringing the 
body, at lea^t ap|»roximateiy» into nitrogen and carbon oqui* 
lihrinni with the food, and to make the determination of the 
nutrieniii absorbed aa nearly accurate as practicable. The 
ucLuul wid the theoi'«tic retiulta obtaiued wnvv verv clone, 99 
per cent, of the th<^retio 100 ptr cent, being uueounied for, 
Thi«, witlt a phyaiolugt<> exjHfrimeat, is practically a demon- 
Atmtion of the law of eonservation of energy- 
It is imptx^-tible, in the present volnme, to give anything 
like an adequate idea of tlie details of metaboli^m-experimentai 
and for figures and reatili* the student is referred to the reporta 
of the iaveHtigaton* and to the excellent summary of Acwater 
and Langwortby already referred to, A few of the results 
nmy be of interer^t. 

Vegetarian Diet* — CoDeJusioa^ are not quite in accord. 
Voit concluded that while it id perfectly poeeible to suheist on 
a v^^etable dioL a mijied diet is it\ be preferred, Cramer 
foitncf that a vi-getable diet with tnilk and eggs furnished snffi- 




METABOLISM. 



3d 



cieDt Doumhnieni fur Uw body, btit if tb- Diilk and e^gM vrere 
omitl«d, the IjTiciy hul to dn unneccrtnary work to gel the 
rx*quirod omikunt of protein. He found thut tt wtui utno objco* 
liunabU frxKn iin <^coDomii? cUindpoint. Rulgom drt^^nninMl 
ibnt tli4* nuiiiiiLl protein could Ixr entirety n?pIii<<>Hl by vi^-tnble 
prrruin m-itbiut any .nppnvmblt.- clian^r in tl)r hitn^ii baLtncc. 

Hllk Diet. — RuliiKT found ihat the Milid \Hin of tU« 
mtlk vr2£t tiol M> complelL-ly di^-Atixl by adults ^ that of miat or 
<^g!i. He fouiHJ that young ohildren digest milk moro completely 
than adults. The difference* may be due to the amount of aab in 
tbe milk, mucb uf wlich i^ uul uevik-d bv tbe adult but vrbiub 
10 of groat n^e in the- bone- format iou of i\i4* prowJDg budy. 
Marbo found that th« uitroj^eri m^tabali^tu in hmlthy |H!f>toiu 
wa*i fifgtdatwi by iht^amnunt taken ; it waH lowered wheo muoh 
milk wafi lakea and tncrea-st-d when the quantity wa^ Weened. 
Wbera an ej<'lui4iv<- milk diet was ibieii, there were an increase 
in the asnimilalion and a decraue in tlie ur'n: acid. 

The Amoimt of Protein Kequired, — As at^ted before, 
a certain amount of prutein is ab*>hilely e»-emial^ and ihhi 
fleema to beur a relation to ibe auiouut of mueculur work per* 
forcDiKL A uiau tuny do lonsiilcrablo work on plenty of cor- 
bohydntcb and fat and a amalL amount of protein, but be will 
be in D)UAh lM'tt-*r oondition if the ioot\ elemenfA an? eorreclly 
pmpurtic»nod. KijkriianTi hfis Mated that the metabolinm of 
tbod in the trupic^ is itot diminiebeil, and that EnropeaDs who 
live Id tlie tropica ot^usume ^ much food as ihmt: doing the 
same vtork id temperate clinrnt^a. The diffiotdty of getting 
proper m«a£ U usiudly the reason why it is not used< {i^\ 
Woodruff, in the sectionT Diet and TropicH and Army lotions.) 

Pasting. — During the euiitlnuuuL'e of faBtlo^ the daily 
leas of weight in the individual diaiinteihvci. The- Ittw workod 
out for uniiuaU, that the iutennity of metabolism u inversely 
propurtiiinal Ui du? i4i7J> nf thi* organiAin^ weens to hold fpW for 
man. AcounJiii^ t^ von NiHirdeo, the excretion of iiitnigen 
during a fa.'itinj; cX)>erimeDt wa^t an follows: For five days 
before the failing tfie daily average aEnount of nitrogen excreted 
in the urine was 16.2 gram.4. Un the first five days of the &flt 
the avera^ <laily output was \2,i) grams* The amount dimio- 
iftht-dj aad from the iWL-nty-firtit to llie tvienty-lirtU daj the 
avcTops was 4,7 grams and from the tweuty-aixtli lo tlie 
thirtieth day it was JS.3 granid. The cxpenment lasted thirty 
dayn and was made by Luciaui on the profeti^ooal fiuter 
Sueci. 



40 CHEMISTRY AND PHYSIOLOGY OF DlQESTIOy. 




The InflueDce of DmgB on HetaboUsm, ^See alM> 
PekhI AttulUo^tK'u,) — FupiU-r found llmt borlc ACId Jid not 
iitflueDCC the metatwliam oi" prolan. It diuiicieLed the 
abdorptioD of DutrHMiU in the inteBtitio, liowi^vor, aad u not 
rec'^min^n(lf<d aa a forrd^i^roiiervative to he givefi nny ext^n<)od 

Bnmild of Potassium. — Chittenden and Ciithbert state 
that thifl Axw^ inort'a.Hed the metabolism of nitrogen aad 
slightly diminished the excretion of phospliDric acid, Ainmo- 
nium bromid i[icn?uFied the nitrogen metaboliam, while the 
amount of phosphoric acid excreted renained about tbc same. 

ClnchonldLn Sulphate. — Chittendert ond \Vhilebon»^ deter* 
fnin<>L that this dni^ <3uiidod a dimioulioD of the excretion of 
iirpa, and that the effect tasted for some days after the last, dow 
bad been given. The excretion of uric acid was not corre- 
fl[iondin{^ly increa^. 'i'he excretion of ph^wplioric aoid wiw 
dim in itched. 

Aittipyrin. — ^Walttr savfi that the inflnence of nntipyrin was 
to decrease tlie metaboliem of protein in all ftuhjecfj*, iind that 
the aiwimllalion of protein was improved in fever subject* and 
waa uncluuLj£e<l In ln-altby individuals. 

Lithium Cart>onate.— Oor^ky states that tho nietjiholiam of 
nitrogen and the <|uuritity of ur^ and nrio imd w(!n> coneider- 
«bly mrri'jiw'd und^r th*: inrtiic-m'e of litldtmi (NirlMmatp, The 
increast.* of urea w*i8 ntill ^reiit*?r ntV;r ibe j)eriod when lithium 
was taken, wher(.ii& tb<^ <timtittty of uric acid was lea*. 

Cigarette-smoking.— -Oraraat^hikov and O^sendovr^ki draw 
the following ronr!u&i<nis : Smoking dgaretlee lowers the ratio 
of the nitrogen of tiie nriiae to that aaKimilated, — i. f,, lower* 
the metalwlism, — ihi? decrease being especially marked in the 
CttM- of uoa-smokers ou their fir&t atU-'mpta at amukiu^. Cigar- 
ettc-«nioki[ig also lowers the as^iinihition of tin- iiitrogvnous 
ciunvtTttienu of the f^tfwL (Then* were no coaeludiood drftwn 
AM U% tJif' influence on Iwniy-wcighL) 

Muscular Work- — It hjis Ik^o ahowu tliat the enei^" for 
mu?<cnlar work may be deriv^.'d from fiit^ »nd earbobydrat^, 
and for the moRt |>nrE the energy- for work is MipplieiJ by snob 
food. Work muv ^ki dfme or» a iion-nitn'genons diet., but it 
m\\^ not trt? inftrrnl that nitro^n is uime^'es.siry. In experi- 
ments with non-oitmgenoijs dieT8 it was found that the men 
tirc<l vcrv c)t]i<:kly and soon became exhaastevi. It may he 
that wiUi ftueii a diet tijc t]itrt>^n of the hofJy Je nliliKcd. 
Pnwli^iflllY, nitoigiTi must he *?applitff in (he fi^xl in pmiMirtion 
to the nriKujiit of work done. 



4 




ASSORPTIOy OF F0OD& 



4l 



MentiU Work. — Theft have be«i but few exp^rimettfi along 
ttift liDe. Atwiib^r showed iLuL ihtre wum int tuorv □it<tii1h* 
oIi«m of matter with aevcre mental labor ifa&n with the moot 
complete r«st po^ibt«, 

Ma8&A£«.-^MH£Aaji:e incr^ASffi th& appetite and the nitrog^^n 
[neta)x>lifiin. 

Baths* — FrantziuH hzis drawn the follbwinf;cono]ii5ii»nfl from 
hiH experimentfl ; UDckr the hifluence of warm miiMTal liaths 
the metabolism and afitiitnilatjon of nitrogen were JncredflMl. 
I'lidiT the mHueDcc of fre*li-vratcr bulbs there wns no jii>pfm- 
abk- efTccl on tlie uitnij^'ti melabollHtD, but the asHimiluliun of 
nitn^n wne improve! ifi most coAea. The iiicrea«^ of weiphl 
in rJiildrcn v-tm |^fll«r with the use of mineral Ixiths than wilJi 
fiwh-w.il<?r hftthn at the game tn^mpernUire. 

Metabolism in Disease. — For vamufi rcasoDfi tids van not l»e 
dif^cii:^>«d bi-rp. Where eiiwrimunts Imvin^ a pnictif.>al bearing 
on tile ti}hject of diet m djMo^ have been inutle the reifultti will 
be fitatal witi] ilio considcRition of limt diK^atw. 

From chcir ex[>criinent» Kiipprl ami Kio^ll luvo drawn the 
concltuiou thiLt more body protciu i» e^iisiiuiLHl in fe^'iT tbun 
doriag fwtiDg. 

ABSORPTION OF FOODS. 

Food abMirplioii ukte pluci^ rhiofly in thi^ mhaII intestine* ; in 
ihe ftonwcfa ami in the lai^ Jntc^tiIle it tulces place only to a 
limited dagTw. In dctt^rrmiiiing th<^ degn.'e of ubi^'irlmKility of 
fVtod, tbc amount of tlir> rhTnmtflry fixwl pnnripbv* trig«>»it«<l 
ipiist fir^t he awertuined, and the pro|x>rli"n tlwit hiis iiol been 
abm^rbul dctormiuod froui the few?:. Thf dt'^^i* of ith^rbabil- 
ity of ft food ]Ddi<:at4'«, in a mea^uix-^ lii^ nnlritive value. Ac* 
CKirding to Atv.'ater,* frt^m on onliniiry Mtxul meal an avenge 
of 9'Z per ccriL of protein, 95 |>cr ixnU. of fat,*<, ntid ft? ]»or cent, 
of <;an>ohydmteH i» ubwrbed iti thr lH«ly. " The pp>p>ilioii of 
the sevcni) ontneii1« which the UaIv rttatiL* fur \U use nve com- 
moolv called |KTcontapo« or oueffioients of digestibility." Tlits 
following tiihfe, taken from Atwater, givod t}t(?9to oo<d!ici<*ntM of 
cUgeatibilhy : 



Ha, 



< Ptintida ^ yviritiofk and y^tniw Vduf nf Fi<o<t, F. 



tTmcn Bulletin No. 



42 



I 1. VPl il^ 

CUEMISIRY A^J> rUYSWLOGY OF DWKSI'IOK 



ChfffioifnU of IHg^biiity and Fu^t-vaiw pff I'ound cj KutritnU is 
I?iffcr^rU GrGupe of Food-malcriab. 



Kind or rood 



ProtdD. 



"«•■ 



MeaU anU EliJi . 
K^m ........ 

riuiy prodiida .... 

AiumBl too6 (of mixed 

diet) 

Omb 

I.«guiD«B (dii^d) . - 

Sunn 

Sttmbw 

V«ff«ubl« . . H 

PniiU 

V«^iable botb (of 

Diixpd dic't) 
Toijil food (of miwd 

dct» , 



Pier fr^. 
37 
97 

97 

97 

86 

7a 



S3 

S6 

81 
92 



Puel- 
taluB per 

ponnd. 



1940 

lOflO 
1940 

1940 
17M 
1670 



1410 
1620 

1840 

1820 



rai. 






an 

96 
95 

96 
90 
90 



90 
90 

90 

95 



Fu«t. 

v*luQ per 

punrid 



4040 

4')90 
3990 

4060 
3800 
3800 



3800 

3890 

3800 

4oao 



CtibobjrtfniM. 






98 
98 

98 

98 
38 
OT 
98 
98 
95 
90 

',r 

97 



vMuo prr 



1730 

173ii 
1730 

1730 

I8C0 
1840 

1760 
1800 
IdOO 
1690 

1820 

1S20 



Bi'ibn^T* gives the following table, showmg the ubKorbulitllty 
of vurioua fuodtt ; 



Fixxl-stuflli- 


Weight of Miufl 
hi ktaowh 


4TiuFli«il fn ivri><iiiia«« of 


Freah. 


Drlf^H 


9G 
95 

92 
04 
95 
»fi 
06 
93 

n 

96 
91 
1)1 
85 
79 


Albumlo- 

97 
97 

94-'ys 

9fl 
81 

OS 

rta 
86 
93 
80 
83 
08 
82 
61 


Fal. 


ii>o 

100 

99 

89 
99 
97 
90 
99 
96 

92 
66 
82 


Aah. 


Mmt . 

K©pi - . . - 

Milk 

Milk and chooie 
Wlitcbmui. . 
Blnck litind • • 
Mn^iuoni . . . 
Indian com ■ . 
Coin aud cbecaa 
Bice 

PoOitow - ' 
Ckbbi«e . 


9&\ 

9S4 

2170 

£490 

seo 

1360 
595 
760 

338 

SOO 

3073 

3B30 

K06 


d78 
^7 
316 

420 
763 
7615 

646 
780 
562 
521 
eil9 

^52 


95 

95 

95-97 

97 

94 

83 
91 
93 
93 
96 

94 
94 


82 

82 

51 
74 
98 
64 
76 
70 
81 
8^ 

84 
81 

7i; 



The accompanying chart, tolccn from Atwat^r, indicates tli« 
imtriUv*.- ingredient?*, refuse, nud fiiol-v&liie of prinoipul foods.* 
Absorption of Proteins. — Eighty per cent, of proiema 

' r.fii^thr.f, mm. vol. IT,, p. 115- 

* Fantien' BiilliilJTi Niv 142^ IfniEal l4Uto« De|urtmeQt of Agriublturtf, I90& 



JOgOBPTiON OF FOODS. 



«t 



COUPOSmON DP MILK AND OTOEft FOOD-MATKRJ^LS. 






/WJ#in «o(o^uEii1a. t. f , 1«*n of iii«kt. wliito oJ cgf . r«toid («urdk of milk, and 
gtntec flf iib«Ht. miikti iuujcJb. biuod. bouc. etc. 



gaifi^i>^ fin, , » c^**- .— ■ 
rqgVvaiae or nih ^/-.,r. 



.Jgg^goJ /egg ?g<?J ^Jg ffWtf Jwj JfJvt 



WVrl* mlU^.w,-*' 



.^^J:.,,^;^^U-.U.i.^,i.^i^ 



Balum[lk.l9L0L 






LJ_4^-i_ i| _ «> _-J_;ti_ -_J_^ _^ja ^;_ >- _^^ -_ -_- _j __- _ j_ i_i._ J M^M^ a ■ ■ ■ 






CEicoc* vAolc milk 



* 




eniDir-.. 



.1-L.'J^:"-L'J— : 



44 CUKUIHTRY AJfD PHYSJCLOOT OF D10E8TJ0K 

are absurbed to tlie Btuall iDlefitiue; aud 14 pc7 ocuL lu ih% 
lai^ intctttine. The prot*!liie of aDimal food arc mncb more 
completely nbeorbed tlian are those of vepetnble origin. The 
following fahl«, tflken from Hutchison (p. 1^4), gives the relo' 
tive absorption of proteiD in various fcxxl ; 

I'Tolrln not nbaorbcd. 

Meiu iv3pcrwHL 

l^i^tiUrtDr , i . i - 10.5 " 

Urits! pcM 17.0 " 

Bwii» 30^ 

Fluiir 30.^ « 

Pot«U«s . . 32.0 " 

Ou-itXi and iU , P - 3&.0 " 

I-potilw 40,0 " 

Absorption of Fats. — Fal?, like proteins, ar^ al>f^>rbcd 
mEiStdy in the *;amll intestliw. This ubsorpllon of fat ia very 
mmplrti?. Ar^onrtliug tii Hiit<^hison, 150 y^rams run he ^hst>rhe<\ 
in ODV <luy ; whim mure than this umouut is ingested, the rscesa 
18 thrown off iu Uw feces. 

Absorption of Carbohydrates. — CaplKjhvdmtcs are ab- 
HorlKtl moff^omipletely than either the fats or the prol*^iu*i ; c-in- 
8ec|Ueiidy ihitiie f^torls leave but a i^miall reeidiie in the inteslino. 

As imbner, Atwaier^ and oUitoi^ have |>olntt,-d out, foiids 
taken ill com b illation aro abncrbed more iM>tnp[ct«ly thim when 
tftk4;u Jklono. Atwuttrr hiu^ ^ou'n that tho folluwicig pr(i|H>rtions 
of the aliin<mtary pritiolphs nrv aksiirhi^ when the imtividottl 
lak««amixcd diet: 

AalmtJ fuoilti f'A per c«nt. Wper<i^riL lOOiH-rcent. 

Cvrailit dTid niinsni - . Kn ■' W " 98 •' 

Vp^rttahWundfruiw. . HO " 00 " 95 " 

Food tliat ItJivt^b u ^ttiall quaoiily of lumbnorUiti n^iihic In 
tbe iuti^tiue ia »ot uudosirable, in that this rcviiduu :?tltiiulutcd 
jK-ruttatsia and thug regulates the ooaditiori of the- bowels. 

Absorption of Meat-^-Mmt Imves a v<Ty f^mall nsidue 
in the interiimt- — ;ibont "1 i*er cent, of that ingi^Htni is not ab- 
{(orbed. On thiti accx^unt meat ia a moat vaKial>le article of 
food. 

Absorption of Fish, — t^ish is very completely absorbed 
in the intestine. Acx^ording to Langworthy, 95 per cent, of total 
(^olidtt, 87 pereeiit- of protein, and bO [percent, of tat an:- al^Kirbed- 

AbsOTption of Milk. — ^^lien milk h taken aloae^ only 
90 per oent- of the oonstituentj^ are abBorbed ; if two litera of 
milk are taken daily, the We of dry ^mb^tance, aocordiag to 



■ ABSOBPTJOy OF FOODS, ' 4o 

Bubiier, id 5*7 to 7.8 per cent ; if three lit^re, the lo^ is 10.2 
to IL6 percent, Wben taken \tith uthcr food, Iiowitvlt, nilJk 
is miicJi more compUteLy abtforbecl. Wait' foimct that ou a 
milk diet alone f^2.1 per cent, of prQt4nn and $f>.3 p«r oeiit, of 
earbohyd rates were abflorbeJ^ but tlmt upon n hreafi-and-niilk 
diet U7.I per e*nt. of proteio and 98.7 per cent, of carbohv- 
drateji were sbciorhed. 

As stated elw^here, infaDtfl atKl childrpn abaorb mitk much 
more completely than do addlta In childhood, milk leaves 
a residue of only 4 ]^t cent., whN-eas in adults ID per t'enL in 
not absorbed. According to lliitcliLHoti, boiling dwvs not intx^r- 
fere with tiie abciorption of milk. Kuqiim mid kelir are tt» 
completely al>Tf-rh<>l as if^ milk. 

Atworption of ^gge^ — Kffg* ^f* very thorouphly ab- 
ftorhwl in tlie inlei^tine. Itfibner wtateft that li.inUlviilwl eggn 
are aI)frorbed alma*it as completely us moat, only 5 per oent. 
beinf- lost 

Absorption of Vegetable Foods. — Vt^nble^ are 

mor** or less completely absorlKxl in Ihe iiitetiiio. If thv bulk 
of tbo vo^'tAhlc^ i?L not t<M) grmt and ilie anioniit of eeUulose Is 
nut too iikrgv, tley will U? uliuo^i eniirely al)c-orlH^l. ()ii ai> 
count of their bulk mid the large prtiportionfi of oe1hilo?ie whiob 
tb^ contiLin vi^^tubW nrc, liowovc^r, itit<unip]etc1y abKorboJ. 
The prot<»in Ik hrrr? thi* i<lt?meiit lliat is not al^torbed com* 
pletcly, tlif^ airt»oby<lmtGA and bXa uadergoing complete ab- 
»orpti<nK 

Absorption of Cereals. — Sarb eereah as rice are very 
compit Uly aliHorbeil ; the starch is entirely absorlked, and !9 
per iient. of the proteid is lost. 

Absorption of Xcgumes^ — The legumes, such as jieas 
and Ikiiii.-*, if giveu in n finely divided atale, aie very com- 
pletely iibHorbed. RUbaer finds tljat even when ^iven in 
uniountii of 6O0 grams daily the loss is but alight. Ho cal- 

CHtlati^d thiF< id : 

Po»ontu« ion. 

l^rf ff(]t»UAvir - U.l 

Prolnn ,....,. - 1T.9 

CarlHihrdmtc 3.fi 

Minonl cnattdT .,.,.., US.ft 

If, however, thwe fiul»tjuices are not given in a finely divided 

* ytx/fition /nTttrfiTOfHui at iKr l^nii-rrmly of 5Vnf*MH«, United SCfkCot Di^par^ 

»fnl of AicHoiiltuns Balklin No. 6.% lAOH, p, 43. 



4e CHEMISTRY ASD rHYSIOLOQY OF DlQBSTlOif. 



stole, Ujo low iti prot^iiu tg very greai — according lo Rtlbncr^ 
at* hij^b H9 W ptr cent. 

Absorption of Roots and Tabere. — The «beorption of 
rooti4 fln'l tttbcre, 8(]<*h ak ctifTute, poUtora^ ^c.^ depends upoD 
thp quantity ^»f *"ellul<»se they rontiiin. Ina^mtKih as tho potato 
co»tain« bot little ci^lliilc'Sfv it is very ctimpletely abrorbed. 

Absorption of Green Vegetables, — Most jji^n veg- 
otabk'S «ri» very mcHjmpleti.4y al^Mjrbcd iu tln^ intestine. Tbey 
lmv€ II \i\T^ residue^ which act« m a stimulajit to intc^titiul 
pen totals Ls. 

Absorption of Fruits. — Fruits, like gi^een vt^Ialilcs, ure 
ii8UAlly incoirn>lot<'ly ubsorbcd ; iiocordin); to IluttihWti, TO 
per i>eiit, of tbe prutein, ttO per o*int. of tlie fat, nnd 95 per 
ornL of the mrbriliydmh-ft art* nnJinarily absorbed. 

QUANTITY OF FOOD REQUIRED. 

Tiiia varicH in.v<^^yirily uodcr npecial condttiona. Tbe adult 
requires more food tban doee the child ; a man i\t work, more 
than one at re^t : an emni^mted irrdividiml \c^^ tbjin when he 
was in robust con<!ition. The rejection of a proper diet ie de- 
I>endpnt upoDaknowledjjeof theaniount of thethreealimentary 
fliibfltJincefl, proteins, airhobydratei*, and fatA, neetswary U* main- 
tfiin tbe nutritive eiuilibriuni and cooHMjuently the body-weight* 

Dietaries are formulate<i by computing the quantities of tlie 
alimeniarv principles required under special conditions. 

Protein, — Tin.- <|Lmntily of priftt^iu dishite^mlptl driily by a 
iasting hmlthy individufiJ weighitig 70 kilog-rum^i \& 60 gmnis ; 
it in obvious, therefore, that at leai^l tliis amount should always 
bo pr<*aent in every *'omputi?<! diofar.'. Ordinarily from 100 to 
125 grams of prou-in arc a>ii?iumo<l dsiily. As has bocu stated 
elsowlure, 1 gram of fat oan replace 2.4 jrrainh of protein or 
carbohydrate^, and the protein can replaocand be ]>arlly replaced 
by the carl>nhvdi"ates and fats. Kale and car bohy< Irate* are, 
therefore, protein economizers. That purl of the protein, how- 
ever, rttjuJi^'d far or^^ni/jilion of tJic body <.-,iii nul be replaced 
bv the cftrbobvdmtes or fate. 

Chittenden's Experiinents, — Of particular interest m this 
eannection are (h*» rec**nt ex|ierinirnts of Chittenden-' The,'*© 
were made on three groupf^ of individuals : CoUegr? profe^isors 
and instructors, rcpre^nenting raentjd worker*; Uniteil States 

' Phyit\Uo.jifni fifonamj in yutrilion. 



QVASTn'Y OP POOD HEQUIRBD. 



47 



soldien, nprevciitio^ ph^fiicd workers, and coll^ athleUfl, 
repre«eiitiDg n combinaLion of mGDiiil nnd ptysical work. 
Tbc cx[M'rinn!nU on'^-ml long pcrioJa of timt-, duriDg wfiich 
tbc pmtnn fix^J supplictl wu;^ fruiu oni^lialf to one-lhird lh« 
Ktuouiit umially taken. It W]l% fiiand thiiL tiic* nitn^gtui Imfuitcc 
ift-as dunly mftin tubed on thu food allowoiicc, adi) tb<.- unmount 
of nitrog9D <^croCcd daily wAfi from 9 to 6 gmmd ipiitcad of 
abmit \^ gmniK, hm in tlir indiviilimU talking a Ht/rndfird 4)ii>L 
Tile cbuug^ from u full cik't to Lbe reatricUni oiift wajt made 
frndiudly^ and wliiUt ihe prutL^m food waa dtmiDijiheil fhe t^or* 
Ikohydmu^ and fut t^iipply vnx^ uot, but wa» lefl t€ the nppettte 
of thi' iiKlivklual. i)n tbc refitricted diet there V!Vt» at fimt a 
flight lof** of wtiglitj Imt iliis i^oon ptoppcd and the aieutal and 
pliy^iokl vi^ir wa?! timiiitaiiiH al a ijigb hiandanl and w^s even 
grrfitcr, and llic fivling of woll beiDg Mid to be more ujarked 
thuD i>D tiic fall diet, Vok ha& modi^ cIcap that the idoal diet 
finurfiNtK of tlio nmjdlptit ntnoniit of protein fooi.1, lopetLer with 
DOD-DitrogeDOUS food, that Vk-ill keep the body in a Alat« of vigor. 
The eipliLoatloa ipveii of the advautagee of tbU diet is that the 
protein food wlieo metabolized gives a onmber of cmlalline 
uitro|ireiiou« products which are excreted through the KidDeys. 
If taken in excess the kidneys are overworke*i and the pTDdurl^ 
may beio re complete roeiabolifina or aAeniard either surcharge 
tlie blotx] or U- depoftiked in the tibaued, and k> be a fact^tr m the 
caudatioD of di^cufle. let most in6tauc«» tbe nitrogen cquUihrium 
waji ctftabliahcd on a daily intake of 8.5 to 9.fi grnniBof nttrogen, 
or about ^/> gromw of tiilmgenotiFi foo<l together with the fat 
and earUihydratcst, to bring tli^ fueJ vulut* up to 2500 1o 2600 
calorie.^^ and thin \ra8 ample t^i meet the requirententa of men 
under cnuditionx cf Iiodily and mental activity. Chittenden 
mgCfl the phywolf^ic ooonomy in nnirition, wbii^h be «iys means 
"temperanoe and simplicity in diet, coupled with inieUigent 
npilation, which, however, soon becomes a habit, and event- 
mdly Itiadi to a iiitAlemtioii iu diet which fully (^tisflc:^ all the 
cravings of iJie ap|x.^ite a^ completely aa it bufHceet to maintain 
the ho<ly in equilibrium and in a general condition of health 
and vigor." 

Of great intereat in this ooonectJoo are the experiments of 
Folin,' to which tbe reader is referred fora fuller di^cusfiiou of 
tbe underlying priDciples of the subject. 



4& ctfK^rrsTRr asd PHYsroLooY of DioESrionr. 



Carbohydrates and Fats.— C3rt>ohydraieB dmiinifb 
Diln^notiH wai«U* and are almi ^pareni of the faUf, 240 grama 
of carbohydrates being equal to HK) grams of fat if 100 
gramfl of pmU^in are tnkeii :in<J absorbed with 600 grams of 
carbdhyJrute^, tlie animiiit of iUt can U.- u^njjletely ptt>tccud*i 
Fat alim« can not tbt-ck llie waste of the uitrogeDoua tia^ues' 
and ttua not rc|>htcu t^rbobydratee in thejr prolem'S|>arinfj^ |>ower* 
The ingoi^tioTi of largL^ qiiAiititi£<s of fnt iiiorcasen the flociimii- 
latioD of fat ill the Uxly, jtiid thi8 oontiiiue^ until ihe quantity 
admitiLHterLHl reaehe* 300 jfraiiis, when no more can l>e digested- 
Gelatiu is a \'aluable protestor of protein, 100 grams of gelatia 
beiug etjuivalent tn about 3o grams of protein or 200 grams of 
carbf»h yd rates ; It doea not, however, protect agaiont fat loss so 
woll as the oarlx>hydi'ates or fat, 100 grains of gelatin being 
effiiivaleot to about 20 grams of iuL Ordiuarlly about 600 
grains of trarboliydrutea aod 50 grama of fat arc eoDSumod 
daily. 

Proteins, Carbohydrates, and Fats in Combina* 
tion. — If fut is rtiQibined with the prott^iii, less timii half the 
qtmntity of protein is re<]nire*l to maintain the iiitn>^aous 
<H^|uilibrium. If more prot^-in, fut, or mrlwhylmle be i!;uii|)lied 
under ihe^^e w>nditionj^, fnl will bw deposital in the tiMUPS. 
Inurimtidi as f<MKl eontwiii^ a variable pm|W)rlioii of proteins, 
carbohydnLtes^and fats combim-d, the ftH.>d-vaIue must be deter- 
mined from the atandpoint of the combined effect of the threo 
cdlmt'titjiry principle's contained tKer^in, 

To rr|K?at, the pni|»r farm of diet is & mixed one, the exoeM 
of any J*'>'xl principle in one being countemrt<*d by n deficieney 
in another Hntehison cites the cwse of Dr. Stark, who lived 
for forty-fnor \\i\y^ on l>re;ui and water^ for a month on brc^id, 
water, nn<l t^iigar^ and for three weeis on bread, water, and 
olive oil, and who tber^aifter iK^iame feeble in headth and ulti- 
mately died with aymptoms regenibting £«onrvy. Hariinon<l ^ 
atleiuplixl to live on >vzitJ:?r nud i^ |>ound^ of starcb didly ; i>[t 
the tenth day, on tuM^mnt of e-xtrcmt debility, tlie exptrinicnlrt 
luid Ut \n* di>^iK>iiti»n4M|. 

In onler t^o siipjily the rei|nirement8 of the organism a certain 
amonut of potential euerL^y i^ needed to overtmbncc the amouat 
dts^i{>jikHl in waste and in the pn^duction of body-heat. More 
jKiteiiliul eneigy iseonsumetl during work than when the indi- 
vidual is at re?rt. The following table, computed by Rtibut*r, 

1 Jgur. Amtr. Mtd. ^mdc. IHGT.pL Ml. 




©r^yr/rr of food nFQurnEn. 



49 



^own ihe daily liaitKx>nflti[]ipUoti, id units of htat («lorM»)| 
tn on tulult wri|^itig (J5 kilognkroii s 



Daring mt in bed 
In Rpovr . , ^ - 

Inniodcnla work 
In h&rd vorit > > 



. J800 i«lurip« or 28 cflkmi ftr kila 
. SIOO " '^ 3S " " " 
. 2300 " "33 " " " 
. SGOO " " 40 " ■• " 
- 3100 " ** 48 •■ " " 



FcxMU Itiiljnei^if mvvnti^tiuua wv leuru tbat*^ 

1 f^. <A prob-in t= 4.1 <Mlorii« 

1 gtn. of fat = 9.3 *' 

1 gnu of ovrboliydraltf ts 41 " 

Xt faiw sil^n Ivon dt'tf'rmini'c] t1i:i1 1 gmm of nioohol ^uala 7 
oalorim.^ In t\\\wr yruxAs, x\v2 minilKT of gram* *>i' j>r*>feiiiaj fato, 
and carbohydmtoi required daily cud be GODvcrt«d into dieir 
cftlonmetric iH)uivul€nlj^^ nnd iTinHniEicli a^ wo luivc »^n tlifit 
tl»? vuriiJtis aliinentjiry |iriiKti[>k'7« ihii in u <K^tco lie flubeti- 
Uttcd lor oiK^ uii'^tlK'r {Umc of iMitij/nninica^t tin- <Iuily fi>o(I rv- 
quireitK^nte can bv enfiily eatimat^! in f:tt]ork^ of ht«L Tliu» 
tD onlcr U> mlcululi: llic cttli?rtu value uf imy foixl in ptTpKriiij^ 
n diclAry ttic nuinlxT »f grums of proteins oontainr<I inrc miiHi- 
|)1io<l 1>y 1.1 ; ibn iinmbrr o£ gruins of iiit, bv 9.3 ; and the 
DumWr of gmni* nf r«Hw>liyiJnili«, by 4,1 ; tho ti»Uil ia then 
afirertained by adding. Bearing the weight of the IndividnAl 
in mind, a dietary can ca«Lly be coiL^^tmcted according to the 
following method : 



' TU, 



The qukntifv of protein ooiwum«d daily i< TOO gin. X 4.1 = 410 
" ' " ciirtohtdnii« " " SOO " X il - 306O 



The iivcRi^ numl»er hf oiilorifs* renuiriHl thniy bv an imUvMiiaJ, 
oocx^niing in tULn mU'ulatii>Uj i;i tlicrrfon* -'1000. Tbc ftrlloM'ing 
table, Utkvn fmm HuUliHun (|>, 30), ilWtrato.H the ini^Wl of 
coiutructing diaudiird dk-UiHe^: 



) 8«« AtwAtw^K deierniliwtionA, p. 8^ 





^^^^50 CBEAfrmtY A^D PHTSIOLOGr OF DJOPSTTOy^^^^^M 

^^^H STANDAKD I»IETAHim ^^^| 

^^V (= /£5 vnttim) of ytftftnd nwi SSOO f>ttana nj rna-yy «/ eA« txmdard Jar dnil^ ^M 
^^H dittary of a tjvin <a moti^aU rmiAfvUir H'(ff-k.) ^H 


^^B FiH^tl-mMerlili. 


ADOuat, 


Tola! 


1 




^1 

^^1 BmF, found 9lC«k . . . 

^^H huffier - - - - 

^^1 PoCiUX^. .... 


OtinetM. 
13 

:£2 


0.26 
0.1 A 

ai7 

0.89 




0.14 

0,02 
0.12 


0.12 
0.16 

ft. 02 


0^1& 
0.75 


680 ^^H 
320 ^^H 
1700 ^H 


^H 




a 


1.4a 


0.28 1 0.30 


0.90 


S455 ^1 


4 

la 


0,21 

0.1 1 
0.^ 
0.33 


0.23 
0.04 


0.21 
0.11 
0.02 

CO! 


0.59 

0.2S 


BSO H 
460 ^1 
1615 ^^M 
640 ^H 








^H 




30 


1.49 


0.27 ; 0.3S 


0.87 


sbM ^H 


10 

1 
1ft 

le 

4 

16 
S 


oas 

0.06 
0.13 
0.17 
0.23 
0,67 

aio 
1.^ 


O.I0 

o^ot 

0.02 
0.04 
0.00 


0.09 
0.O6 
0.O4 

0.02 
0.13 

ai3 

0.02 

OJI 

aoi 


0.05 
0.15 

0.17 
OM 
0.19 
1.18 


660 ^^H 

225 ^B 
325 ^1 

sao ^1 

460 ^B 
1286 ^ 
345 


KulUT - - 
Mjik, uuu piial 

1 PhtAfOffl 




f OiUOMJ* . . 




Braul - . . 




8u^> . i -f 


t t 1 


L 


d« 


S505 


in 

3 

3 

16 

12 

9 

1 

59 


0^ 
0.19 
0.05 

0.11 
0.13 
0.12 
0,44 

0.06 


0.09 

0.06 
0.03 

0.04 

aoi 

o.oa 


0^06 
0.11 
0.33 
0,06 


Ann 
«50 
136 
460 
326 
240 
»S5 
115 


^H Ect^ iwo 


^^T Milk, ciDC pint . . - > 




i 


1.32 

0.14 

0.07 
0.11 
0.13 
0.26 
0.11 
0.24 
0.;J3 
0.19 


0.29 


(J.44 


0.flO 


^40 


4 

14 

16 
5 
2 

16 
9 
3 

71 


0.0A 
0.07 

0^04 

o.or 

0.01 
0.01 
0.04 


an 
an 

&04 
0.01 

o.oi 


0^05 

0,10 
0.33 
0,26 
0.19 


610 
140 
450 
32S 

205 
420 
040 
345 




Huiicr . ^ r . * . . 


I Milk, one pint. • • - 
1 DranB ... .... 






fii^r 




1.58 


0.2T 


0^ 


1.03 


3540 


L 




J 



iiDANTlTT OF FOOD REQUIRED. 



St 



FDod-niAicrlmli. 



VL 

Beef 

Mackflret, nit ^ 
Tvocggi . . . 
Batter ■ . . . 
Oieeee . _ . 
HiJk, one pint - 
Potttoee, . . - 

Kce 

Bmd 



Anumut 



8 
4 
3 

24 
1 
16 
8 
2 



56 



Toul 
OTguila 
maUer. 



018 
0.08 
D.05 
0.13 
0.04 

ai3 

0.09 
0.11 

0.36 
0.69 



1.88 



Proteld. 



iVwdi. 

0.08 
0.04 
0.03 

0l02 
0.04 
0.01 

0.01 
0.06 



0.2B 



TMa, 



Cubo- 



aio 

0.04 
0.02 
0.13 
0.02 
0.04 



0.01 



0.36 



Pamdi. 



0.06 
0.08 
OJO 
0.32 
0.09 



0.64 



Fnel- 
Ttloe. 



QWoHk 
560 
230 
136 
565 
130 
826 
160 
206 
720 
175 



3206 



AMERICAN AND BURC»>EAN DIETARIES AND liHETARY 
STANDARDS. 

" Many interesting things oome to light on comparing the 
dietaries of persons with different occupations and incomes and 
perfonning difFerent amounts of muscular work. A oompari* 
son of the dietaries of the inhabitants of different countries is 
also tntereeting. Such comparisons are made in the following 
table, which includes as well the commonly accepted dietaiy 
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 appn^>riate 
ftctors."' 

The following table, taken from Atwater,' gives i 

' Atnter 

* Fumcn' BaUetio No. 142, Vmied States Deputmcnt of Agrieoltiue, 190^ 





1 


■ 


^^^i^^afEMrsTsr and ruYsioLoor of moESTroy. 


^^^H 


^^^M f^d-c^ntumptton ^f /lirMM t« Diffcrcttt CireuttataHfva 


cini/ /Vvpojoi 1 


^^H Dietary Atandanir, 






^^^1 (QtjbhIHIm F#r Uin prr tiny.) 








ll 
Is 


AcEualJr OAli^ii 1 ingvstltjlitH 




. 






i 






^ 




=5 






e 






e 


i 


c 


^^^^^^^B 


go 




, 


1 


5 




^ 
1 




* 




w| 


^ 


£ 


} 


£ 


i 


S 


1 








— " 




ftitoN 




^^^1 nvAOTva vtTii aitjvl wmc 




r?m, 


flm. 


an. 


Gm, 


flm. 


/hn. 


^fl. 


1/ 


^^^H Wvycuttft In fifvt Vnrk 


7 


1^^ 


177 


4iO 


14:1 


IIU4 


4L7 


»a» 


K4 


» 


ISl 


!« 


OM 


171 


177 


«I 


rriua 


1 


^^^H rOnLNiH Irnlnpi 111 C'lXlQecUGUL 




















^^^^B Hn^l l.'j;llfr<ni]a , . , 


a 


KA 


HM 


im 


VII 


Mrt 


filfi 


Af><» 


M 


^^^B )*nF*mi] iniu^tilnJMt r . , , . 


1 


la) 


113 


fl77 


i:» 


lir? 


1^7 


trirt 


T 


^^^H PBitfvlliih mri^h&tJ« . . _ _ . 


^ 


1)BI 


110 


Til 


174 


IIH 


fm 


4.MU 


S.S 


^^^1 rtUWriKH 4ITII HBDUrjVV 




















^^^B 




















^^^1 FAnn<')>' riimiiid in wic-rn 




















^^H UiiltL^I MnUi 


10 


97 


110 


m 


B 


124 


Alt 


MU 


M 


^^^1 H«'tiiini(iii rtuuiUn In rnittfd 




















^^m BuioE, ..... 


u 


10:1 


lAU 


«I7 


a^ 


i4:t 


nvo 


Rnna 


7> 


^^H Liborvn^ fumUEin In \atige 




















^^H dtln or I'nlicil ^Mi« . . 


12 


101 


ua 


M4 


^^1 


no 


:« 


ZMO 


«.« 


^^H LaUnrrn' fkULnir* In VnElvd 


















1 


^^^B 8Uiof (mnri.* oomfOfUblc 




















^^^H ctrt'iiiiinuiiiri«A) 


t 


m 


M7 


IU4 


110 


140 


ft» 


u« 


7,i 1 


^^^B RuuEi-a [x'AvAiiia ...... 


. , 


ISO 


:» 


Ml 


IIV 


;ii 


Ml 


JIU 


u 




a 


1B4 


Ttf 


ftlZJL 


17J 


7& 


A07 


asa) 


hA 


^^^H mofkniloHAI. Hitlt. 




















^^^B Lawr^rnH ti'Ajrbvni, «tG., in 






















14 


im 


I2fi 


439 


w 


no 


410 


R33D 


TJ 


^^H Oilti-fn rtiih^ 111 tTcilti-d ftMlf* ; i& 


JOT 


11» 


I'lP 


w 


Ml 


4i» 


SSS 


T4 


^^^H utrmAri ptiyxlrlAtui ,-,-,, 2 


131 


UTj 


a/7 


1^1 


90 


WT 


4.B 1 


^^^B jjiiviiMt? prafMKir 


I 


la 


£t 


41« 


Hi) 


IV 


40S 


aw 


4 1; 


^^^B kEH ynu uttmi on Ko iejc 


















ii 


^^^^B EKl'lME. 




















^^^H Hen |Amrtrlc^\n> In Tf^ptju- 




















^^^B l3oii rjiliiriin^rr . . 


tl 


m 


aa 


W» 


101 


7ft 


■JH 


nm 


u 


^^^B M<»Q lUumikti) In r««|ilratloii 




















^^^H AppftnitiiR , . 


& 


1^ 


«i 


IDS 


UT 


Tfi 


oon 


MSO 


i ' 


^^^H rMtJbONft Ik iTiprriTiiTRoiMmif- 




















^^^H itTl.HrlCi 


















,i 


^^^B Pnnr nktnlUci In New Ti^rk 




















^H 


U 


n 


«& 


«7 


ee 


90 


n5 


2MA 


«.o 1 


^^H ljilKir(<r" DuDilla |ji PltU- 




















^^^B fiurii, TH . .... 


a 


n 


ua 


308 


■?\ 


fO 


a« 


^HOO 


4J 1 


^^H Ofrnnnn Uborpr'i ftimlljr , . . 


I 


w 


.■u 


■>7 


Vt 


RU 


■rs 


IMC 


'.t 


^^^B [UllKu mitctuiiloi , . , . . 


a 


7S 


SH 


aw 


TO 


afi 


»H 


■^2i& 


e-tt 1 


^^^H ■inL^JtE.E.AXRQllB. 




















^^^fl Mfftm IhmllloA In AlabATDA 




















^^H «m1 VEreTnlH . . . , 30 


RA 


1*JS 


44'} 


7S 


1H« 


4?7 


ma 


4j 


^^^B lliLllKn rnmlEli-a [a €bii>Atfv 


1 


1Ui( 


111 


UOI 


W 


lOfi 


3Tfl 


B«& 




^^^B rrriarli f ^nniLfliant In Chlf ako 


& 


114 


]:>H 


auf 


101 


160 


ur> 


ffi^O) 


^^^^H Ih-ihonLtnn ^m 11 lot In ''^1- 




















^^H <'i«^ 

^^^B InhnhltDnU -Uvi v|11ii|f«, 


B 


US 


im 


mt 


106 


OA 


MO 


&m 


ftj 




















^^H rMiinili(Hn Kipotninn, itm 


1 


M 


lU 


^ 


fil 


1ft 


Wi 


14M 


4.7 


^^^B Itiinalnn Jpw« In rhioaff^. 


H) 


13T 


t<» 


ILK 


1^ 


H 


v& 


n«k 


ft 


^^H Mititmn fitnitict in Utm 




















^^^B UfiiTlon .... 

^^B 


4 


W 1 « 


BLU 


m 1 B7 


fat 


M«0 

4 


" 



QUANTITY OF FOOD REQUIRED. 



fiS 





II 


Actd&ll; eAifln. 


XHtmtibl*. 






























j 






f 


C' 


d 

€ 




^5 


d 






A 




J3 


9 

-3 






5 = 


^ 


, 


h 






X 


J 


t; 




^l 


& 


k 


5 


£ 




3 


£ 


MianLLAKBOim {Qmii»ifF4\. 


GffL 


Qm. 


(tvt. 


Owt. 


1.- 


ChlneM dcntlM In rAliromiA 


1 


Ilfi 


113 


as9 


loe 


107 


^8D 


26^ 


4J» 


ChiaeHV laundrymim in (^11- 




















fOTHla 


1 


lAfl 


7* 


Mfl 


IH 


t:^ 


M« 


Mftn 


fi7 


ChlDeBv fmrm libOT^r In *^\- 






















1 


144 


fifi 


A40 


133 


00 


esi 


iflwn 


fl? 


Tlnlt^ !4Ut«fl ■.mif TmClnn, 
























TAI 


161 


4H 


uo 


IM 


440 


ir7»i 


n 


Oennan Army ntloa. peu;e . 




114 


» 


4Hh 


lOfi 


S7 


4afi 


3725 


fiji 


DirrAflY ST AND A Kbit. 




















Kui bC bftTd work {VoJi) 




Itt 


100 


45(K 


1B3 


flfi 


487 


S27n 


4.e 


Hon nl iDiiilerBLu mjrt (Volt) 


, 


lie 


5C 


NBh 


100 


U! 


480 


tWf 


hA 


klBA wHhvt^rybaniiuiuculHr 




















kUiL with haril muscQl&r 


, ^ 


IM 


fO 


(■1 


Wl 


i') 


{■) 


UOI> 


7.1 




















work (AIwAlcr) ....,, 




uo 


fO 


f'^ 


]3« 


(') 


"1 


4U0 


ii,a 


MaQ wUh mo'k'tatcly &ctiro 




















muaonTHr wr^rk (Atwter) - 




12S 


(') 


t*) 


IIA 


(■) 


{'J 


&100 


OJI 


IfAri Willi JL£bL 1o mudtnle 




















immciilar work <.\l«HL'r) . 




117 


{'^ 


t') 


103 


ro 


t'> 


aofio 


fl.1 


UtLb at "serltntory" or 




















woman vilh landemlely 




















flftWe work {At»ntcrl , . . 
WoiuHD at IL^hi to iDoat^rAtv 




tflD 


i'l 


i') 


02 


r-^ 


f^) 


7700 


«.t 




















musculM w^rkt or Tnnii 




















without muBoular cxercUv 




















(Alwaieri 


- ■ 


90 


CJ 


i') 


as 


I') 


{') 


2450 


0.1 



^n /dm/ i?a/fr>n qf Solid Food.^Mn. E. H. Richardt.) 



MAtt^rlftl. 


Amanutfl. 


ProtclJ. 


F4t. 


CarbcH ' Calor- 
by d rates. | lu. 


M«t 

Oyelerfl , . , , . . 
Bruklbtt racoA . . . . , 

Ullk 

|Mth 

Butter 


fin. 
4M0 

2»A 
22^, A 

1114 

4.'iS.G 

14.17 


10 

a 
1 

4 

15 
1 


»H1 Of. 

31.7* 1,12 
34.02' I.JO 
12.52 0.44 
(i.OD 0,23 
a,fi3 0.1» 
18.14 0.04 

0.141 \ 
100,80' . , 


ffn. 

2.26 

il,S4 

2.04 
7.,W 
4.42 

18.14 

57,97 


U.OA 

O.20 
0.10 
0.04 

" 7 


257.28 

^ 0.60 
4.» 
00. TJ 


Off- , 

4.1M 1 l2[n,S2 

. 1 243 72 
70-01 

0.U 1 iflr>.4a 

0,17 7^,56 
S.20 1 01R.31 
aVO 112.17 

imaa 


ToUl 


■ ■ 




. . '2571.U 



It should be nnderstood that standard dietaries, such as have 
just been given, must be modified to meet individual condi- 
tions- Witiiout modification thej are useful in preparing 
dietaries for persons living together in large numbers, as for 
armies or on board ship. 

' FbtB and cnrbohydnitcs m sufficient unounte to fumiflb, together with tlM 
proteiiii the ipdicfttea amount of energy. 



54 CHEMISTRY AND PHYSIOLOGY OF DIGESTION. 
An Ideal Maiion ^ lA^id Fao4.—{Mfi. B, B. SU^ardf.} 



llKtMlaL 


Arnonnt. 


P»Uid_ 


Vjtl 


Cvbo- 


nftiArtM- 






9>i. 


On. 


On, 




B(wf bnth or coiuuimm^f 


1 pint - - 


20,5 


0.5 






To wMch him btca ii*idwi 












one Urvv vug luuiiu 












■hell 


2 OMatet . 


41 


6^ 


^ 


fil,67 


Dried fnih loup . . . - 


X qutrt . - 


, ^ 


, , 


IO0.O 


410.00 


Ijeuurn jtlly ...--' 


J iiinl , > 


6.5 


. , 


la^ 


T7-90 


Whole milk ^ . ^ ^ - , 1 qtuut. - 


34,0 


36.0 


44.0 


661.00 


Rioif or imjflrroot ■ . . 


3 ML (dry) 


6.3 


0.3 


tt7.2 


:JM1I 


Qrapc-tnu^r or ■ome oao 
of ihc pmpAfod fOfNb 












(dry) 


4 01, (drjr) 


2^ 


. . 


100.0 


430.35 


TQtttl 


2.fr-3 qt,^ • 


76.9 


"43.6 


S23.T 


2043.6S 



While diet-lists are easily prepared at^cordiog lo the luetLod 
jast outHiimi, il sumi idwavcs be reiatmb^j'eil ilmi the digesti- 
bility aud iil>fl(>rbabUiLj^ of f<K>d play u most ini|]orlant r^le, and 
are not to be uogleoted iu iViruiulutJng tbt? dietary ; for while a 
oprtain food mny {wntatn a ^r^at miiny more eolf>ries thnn an 
<Hiual weight of another f«"K>d^ yet its relative iiidigpjitibility 
and Tifin-nbBorhability may render it far less ai~ai]?ible its an 
article of diet. For 4-xam)>le, while 4 oimces of ^u^^age pro- 
diioe 510 calories*, 4 ounces of cheese 520, and 4 ounoe« of 
beef only 2^(0, yet the beef is Jar [nore digestible than cither 
the sausage or cheese, and thns more vuhiuble :i^ an article of 
food. As has Ijeen aptly said, " We live not U|Krti what we 
cat, but npoa what we djgest." Therefore, a diet^-list giving 
quantities of food principles or calories is ascful only as it 
suggestfi gpnoral principles that niny he mo'lified to meet indi- 
vidual eouditioDs in health and in disease. 



THE INFLUENCE OF VARIOUS FACTORS UPON 
THE DIGESTION. 

Apart from the selection of a proper diet, important factors 
that especially afTeel the digestion are the following: 1. The 
boiinSf order, and frt?(|uericy of meals. 2. Variety !u diet^ 
3. The appctiti'. 4. The temperature of food. 5, Best and 
exercise before und after meaU. 6. Emotion. 

1. Order and Frequency of Meals. — It i^ ii<iUA]ly 
customary to fix certain bonrs for the taking of meals ; these 

' A«D9i^|jaf ti> bow Uio riM ia ^t«il 



hours ytkry with the occuptttioa of the individual. In large 
citicti, whf^re die uoou lit;ur Ui Likeu ujj Lar^ljr wtUi ttctlvt; 
bubUitiBa pureuita, tveuin^ lA selected aa ike fUDcvt couv^utent 
hour for dinner. Sir Hgutj- Tbocnptoii ^tato^ that tbroe goi* 
ftml flyiUmiM ur»* in uwt*, ii<Hw>niLng tf> whuJi, iwo, tlirtn*. ur four 
mcftU are takeii <3ail}\ The first ^yst(ml, whidi conHtnU of two 
roesLt ft day, i8 followed in Fnuii^e and oilier 4X»iinlrte8 on tJie 
oontineDt of Europe. A aubAtantial rae^I, coneistijie of fiMi or 
meat and other ooiirse'i of solid food^, is eateo aSout noon ; 
no foc^l is taken l)elore the noon meal, e3[cept on arising, 
when a cup of coffee or cUocf^lale aod a small quantity of 
brviid aiid butUr are taken. The *ccoud meal, which is dinner, 
ia eau-a betwoto 6 and 7 o'clock in thtt weninp. This moal 
ii the largest meal of the day, uod cotisiats of soup, fish, m«nt, 
ve^eiables, ^latb, JeiiHorl, nod hhu^k oi>fFee, The eetnind 
eyslem, commonly in votnJe in Enijland, oonsiftts of four meals 
daily. The 6rst meal» or hreakfa.m, is taken at alxtut 8 A. M., 
and oonsiste of cocoa, tea, or coffee, bread, butter, bacoHf 6ah, 
or eggs ; dinner is eaten between I and 2, and ooosifits of 
8oup, meat, fi^b, regetabtes. and pudding; tea is taken at 
$ r, M,, and aupjjer is served at 8, and consists of meal, lisb, 
vc^tables, and suwed fruits. Dinner is taken in the eveoing 
by the wcU-lo-do ebts^e^, and a substantial luueb h usuully taken 
Bt noon. Thi* durd tiy^torn^ pra<:<tisi:^] in thtt IJnittd Stat^a, 
conAifitii ia taking three moaU iiidly. In many towns it i^ cus- 
tomary to dine at noon ; in oUwr^, in the evening. The usual 
breakfast, taken between 7 and 8 a.m., eonsiiitH of fruits, 
brfioklast food or oeroals, eggs^ liacon, or salt tial, t^a, i^oooa or 
coffee, and bread and bun*?r. Luncheon, eaten between 12.30 
aod 2 o*clock, ooo^sU of cold meat or a obop, v^etablefi, 
mlads, and deasert, Dinner, eaten between 6.30 and 8 p. m», 
ia the bcavicat meal of the day, and eooHUts of foup, fish, 
roeats, vegetables, salads. And fritit. 

The conventional order of taking food at ilinn<^r app*ar* U» 
be moit rational, namely, soup, fisb, entr^, meat, vegetables, 
salads, fmiti. Small quantities of soup stimulate the gastric 
secretion^ do not interfere with digestion, and pass rapidly 
from the stomach ; the fisb and entr^ are then partaken of, 
before the acidity of tl»e gastric secretion has reached ita 
bright; next follows the meat, the stomach now secreting 
liberal qnantJtica of gastric juioo wbcrcwith to carry on the 
cBgceHre processes ; finally oome the mrbohyd rates, wbioh do 
not undergo digestion in the stomach, and which enter thia 



&6 CHEMISTRY AUD PHYSIOLOGY OP DIOESTIOJf, 



organ vfhrn the food already taken w about to pa^ irom the 
tftlnmarh into iho mt^i^llne* Tlitr catiag of boiintttbl dinners, 
niJtiU- up of miiny rnnrww. wticn frf>qii4>nllv imlril^red in, ia 
likely to lead U* cligofitive di^^turbaDc^j^, CliildreD aod mvalids 
fdjoiild always c-Jit diiiDcr iit mitlduy, between 12 and 2 o'clock, 
mid should never >h* iilli>we<l to tak^ this meal at nigbU 

The frtt'puncy oj wrn/n nm&t Ije regtjhiled aeeording to indi- 
vidual ooriditions> PjUienlji pofleritjg fn>m di)^*tive disuirb- 
aiK.'CS aad iIllk^c wlio lake v(?iy small i|n:ii]tiltc-s of food at a 
time require nourishment at fjvquent and rep;iilar intervals ; 
wtkcrcaii iboee wliose digestion is feeble, wboidd allow eix or 
sai*Von lioor*! to ellipse between meals; ordmar-ily the int^r\'al 
lK'twiH<n meals flluridd V« nlioiit four nr five honr^, thtt: being 
about die lime necessary for coiiiplel*' dige»lioD of a mixed 
meal it: the sl4>maeb. The bahit of Imbitunlly oniitlin^' the 
noon IniiolieoD, so njnimoiily uractisod by bu«v AnterininSf 
8hoiild Ik' discouraged. 

2. Variety in Blet. — In order ihopoughly to satisfy llie 
uvedtf of the body the diet mimt [jg varied. AlibcugU a did 
reetrtotcd U> but at few artidea tif food may contain a Biiflicicnt 
quantity of the ullmeulary prioeiplt^ to siifetuiu the bo<ly nutri- 
tion, yet the monotony of sn*>h ii diet ho<^tnn^ ^t ohjection- 
ahjo that it oin not be digest^ thoroughly. Aoeonliug lo 
Woods Mod Merrill/ "it is a matter of coinmoa observatiou 
th«t digt.'sfJon experimeots nmiie with one kind of food-mnte- 
rial do not givo on the whole iis reliable r^ults u.h tho^' io 
which Iwo or roon? food-materials are used. In othvr woniSj 
it ap[H4in< tlmt with a mtKed diet the n&aitt ;>erM>n will dtgrnl a 
larger proportion of iiotrienle tlmn wJtb a diet coiniNi^^ti! of a 
pingk' f(Ki(l-(tiotcriflL" Certain mcee restrict the variety of 
foofl frtim religions motives, snoh as tbt' Jewish retJtridion of 
ham, pork, and oysters- (8ee Levitrua, i^bapttr xi.) 

3. Appetite, — Appt^tite is the desire for food, and is 
de[»erident upon various eonditiotis. It is controlled by the 
Rensfltion of Imnger, and is often induced by the eight, smell, 
and laskj of fotid. As Pawlow has ehowTj,' the smell or sight 
of food will exeite the flow of the gastric secretion, nnd this m 
turn will produce an apjittitL'. Simple bitleis or ^onic form 
of alcoholic drink will at times induce this pensntion, Tho 
appMimnce of badly pref>ared t»r improperly wrved food will 
ofti*n diKpel the np|>ptite. In cliildren the appetite is usually 

^ Uoitvd StnivH Depttrlnienl nf AKncullitn: BLjUnltn No. 8C 

> 7^ Work lifOie iHfrntivt tii<ni^ 



I 



ISFLUSSCK OF VARIOUS FACTORS Vi'ON JflCESTIOS. 67 



gvod, wltcrcttft In tlw ngcd it is Icj^sodciI. 801110 persoDs bave 
ronciMu npjvrcito^, ana ubuormjil vTuviTk); (ov food. Tliui ia 
often the ca4c iti diaWlic iin<l olhcr coiidiuoDs, wlicii| at timce^ 
thr ttppotiut mil not be Kfltifjliefl. 

4. Temperature of Food. — Tli*- t^mp^^rahir^ of food 
vrboa taken \b of ix>Dg!derable importance. Tbe icieal letn- 
iwranw ie that of the body, fi\jra <i»° to 100^ F. [V^ei- 
mAnn), ihe limic» of bafety beiu^ between 45^ and 1^0^ F. 
AooopJin^ U> liutchbion, extremes of U'lnpemlurcof food are 
apt (o givi- ri«e to ^tric duturbiinco^, mi<li i\s ^w'k catatrEi. 
Uflislouuiii ^UtU^ that n drink at u tciU|K<nuut\- of VZ'l" t\ 
JDOPOftWU the body-leiupvrutnre 0.1 to 0.^ d<j^rrr 0. It i» 
bdlovod by many thai uLtxr of tbc efomaoh^ k> t^ommon ia 
eooks, M oOen due to the takin|2^ of too bot fixxU. Tlut^^bison 
oom^d^ra that tie proper (eniiwrature of iv-ater intended to 
qucDch c1h> thirst should be between '^0^ and 70^ F. 

b. Rest and Exercise before and after Meals.— 

It » often udvirrable to retit, but not to nleep, after meals. The 
laiver pari of ttie worlc of the stomach ^liotild be €om[>lel»d 
before miring at nighty otherwise the t'lccp is apt to be dis- 
turbc^L About cne or iv*-tj Uuun should be* n1iovri.-d to ebipee 
between a light evening meal and bedtime, iind three or four 
hotira between a bw^'v nK*:kl and Hte<<p. From [veraorial obaer- 
vationA (^ee thf* R(*<'tir>n on U<*it and S!t*en in (itiHfrin l>L4tiirl>- 
inces) the authoiM liav»' o^mehided tliat diaej^tioti U improv<?d 
by rest after meals ^>ut im|iairal by flleep. In many m^UuMUiB 
a period of rest before eating meala is a valuable aid to digen- 
lion. Violent exercise immediately after raeaN inhibit!^ di^er;- 
Uun^ wbGn.^s moderate exercise one or t^io huiir>- afler meals 
mtttcrially aids this process. 

6. Food and ISmotion. — Severe nierttal strain and stronj; 
emotion disturb the dljfedtion, and f^>r this reaeon food aboidd 
not be tflken until a iiorTixl of rwt and oomp<wnre ba^ inter- 
vened. On the other hand, pleasiiralile sen^<ktion<i aid the 
dilution, and pleasant conversation at the table is thereibre 
to be reoommeaded. 



58 ONEMtSmr AUD PHYSIOLOGY OF DIGESTION. 

THE RELATION OF FOOD TO VARIOUS INHERENT 
CONDITIONS, 

iDqiiiried Are oheu msule cuuccmiDg tlie relntion of food to 
varLoits (vm^litioiiSr hucli :is the infltieiu^e nf j«ci. race, iind the 
like. Tlitse r<iiiiJiTJ(jiia will now be brk*fl_v discu^^ed. 

Heredity, — Certain systemic comiitiofi3 &ud diseases, or the 
t^iiJuicii^ to ihern, are inherited, Tlioae of eefM^-iul iiitt^resi, 
from the staadpoiut of diet, Mi-e IcuDuesa, ob^ity, diat>ne«, 
gout, and alL^oliolisnu Frjod idio.syncraates are uUit otten 
lulieiiUrMi. Among the^e are die liability Ur iLe ilevelopnieEit 
of tirtieivria or poi&ining from the eutttig of straw bcrrius, crabci, 
<!tc, Iti tbe ease of obcj^ity, gout^ and the like, tht* dl<it shotdd 
Iw regulated with a view to preventing thfse diseases. 

Bex, — As a rule, women eat and require le^a fcxxl than 
men- Tliin is pri'bidjly *lue in large measure to tlie infhwjr and 
sedentary llfi? le*! by so many women. Uudrr equal uondilions 
fiex has little influence on foo^J requirements. A twatctr staled 
that under similar eunditioiiB women require foiir-lift.lis a^ niucb 
ft.tiid art men. 

Age in ^cime luea^ur^ itiiluence^ the qtiuntity of forjd Uaktm i 
a ehild requires proportionately a larger amount of food thim 
an adult, Atwat^r^ thu^ eoEnfvtrea the amount of food. n>qnired 
in rhildli<K>rl with the quantity neede<l by a maa at moderately 
aetivc musciilBr work : 



Buy 


15-lfi yr. requires 0.^ 


Girl 


Ifi-lrt 


" 0.S 


Boy 


13-M 


0.6 


OEf] 


13-14 


" 0,7 


Boy 


12 


07 


GirJ 


10-12 


" 0.6 


Wd 


10-U 


OS 

0.5 


aiUd 


2-6 


0-* 


Cbild trnHor 3 


" 0.3 



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

Race, — The food i>f different race? varit's widely, but this 
is due, for the mo.^ part, to the vnrying conditioua iiuder wbiel) 
th^ live» and eapecially to the food>&ujjplv that i^ moat avail- 
abW hy reason of cost and the euae with whteh it can he pro* 

' prinfipU* rtf A'ufrifttm and 2fuiTitiK Vaiue of Fo&Ur Fannens' Balleiia Na 
\A% Uhltod ftutu Dopnrtmcnt fit AgncattufB. 



REIATIOS OF FOOD TO VARIOUS COSDITIOIfS. 5& 



cui«d> The EskiinnA iiubaiHt IiLfgfly upon raw or ])anly oocked 
BMat Had uw Uugv uitioiiutn uf L»t. Ill die torritl xuiiv Uie 
DaUved oat Wgvly i^f ccrcaK ^ruibi, and vc^euJiiw. Id the 
tttmpcmto 40DVM dio Uioi in mixud^ nricl ii; m?pen(l4snt lai^^y 
apon aociaI aod llimiiml eviTiflitiiins Hcing af iW iTir»!it vaned 
cli&ract£T in the cnj^' of Uh* wetl-tiwlo, whereJLH uiit<iii^ the jxHrr 
it ia apC to be maije up of thi? ch<«per meaU, l>read>s and v^- 
tabtevi. Soldiers and tnivellerii frtim the tempenite koi>€8, goin^ 
either north cr fu>iith, uaually retjuirc approximately the ^ame 
varieties of food tliey ha<i At home. Soldiera in the tro[HC0 
crave and eat meat, when they can obtain it, in almost IB 
lai^ <|uaiktitlcfl aH tliey would at himw, and even after years 
of life la the tropius do not make any groat change in their 
diet. 

Major Chaile* E, W*»rtdruff, Surg:eon U. S, A,, expreii;^*fi 
the following opinion: *'AI1 Datives of the tropics (^where 
civilization causes over- population) are id a condition of 
nitrogen etarvation atd need much more nitrogen than ihey 
can possibly get The old btandard;! of teucbing that we 
should eat as the natives is most vicious. They do not cat 
meat becaust- ihey can not get it. They crave it, need it, luid 
«at it when they can. On accotmt of the destniclive effects of 
tlic conopntrati'd tp-^piMil m*tiiu<J rays on protoplasm w© &«e() 
UKftr nitnigen tliun at htiiiit'. Pl^a^e don*t L<opy the old falfle- 
hoiMi rh;it we iiodl letw*. It is also true that we iiee<l fat, as it 
funii^bcn cner^V' l>ett<,^r tli&n cArbobydrates, It is eaten in 
prcfrrenoe In starchfti and sugam for this purpose by worken^ 
when tliey can atlord it, but they lake to starrli (rioe) becnujte 
it is cTjc^i^er. It is incorrect to say that it ovcrbcut^. It d<H« 
Dot overheat us, and ii is false to »uy that fut i« iii>t needed io 
die tropics," 

Clltuate. — In cIoac relation to the question of nico m th» 
question of tCTU|>erature and climatp. Then? Are mnny Ht(r*»r- 
ences of opinion, ai* one can gather from Major Woi.idr nil's 
wordfl. In reirard to the subject he says : ''CHmale affect* diet 
tnainly by the supply it affords/' The main difference' liw in 
the amount of beat and energy that must be ifUppIieiL In cold 
climates more food, es^-ecially fat, is neetlod, Ix'cjuwc thr amount 
of heat required to maintain the warmth of the h^Aj \^ grcau-r. 
If the iadtvidual is doing a large amount of work, a proper 
quantity of food muet be supplied whether the elimatf^ in hot or 
cold. When the individual h in a hot clitiiat« and i* doing 
IhXle or no work les4 food is required. 



80 VHEMISTRT AND PBYSIOIOOT OF DIGESTION. 



Season. — WTwU ha^ juj-t been said rcgardiog dininto :tpplies 
mifio tn season. Simewlint more fv-od 1^ rvunirvd in wixit^r tima 
in suniut^r, in order to supply the extra heat. People who arc 
well dud. n 11(1 well sheltenMl n^iod ]e«« food in oolil wenthervnd 
in cold flinuHcs tlinn thu^ip who nr(> jiooriy Had and exp^wwd to 
the elements . (^W the ubj^tmct Irom WoodruS' in the i^ectioa 
on Anny ilations,) 

8ia:e and Weight, — Oth<.*r things being eijiml, the larger 
the iKirly the more loud is n^i^dinh This ie an imporlflnt point 
m fi^eding infimtH, and ie digi-usa.<<] in t\\v Rs.i|ioiT i»n Infant 
Petnliiig. ir the r<K>d*sn[)p]y in childhood i^ ins^iifGeieui, ihe 
child will l>c iJudpr^ixccL As uppli^l U> rucc^, however^ this 
ntle is theoretic, and, sin(!<i evident^ to the contrary exi^t^, the 
pnhjroL reqnirew further *tiidy. 

The wingbt of tlie individtinl im very important in the nuinagc- 
ment of diseases thiit are intlneTiced hy diet, Tliv wet^hini^ of 
palieuta its n praetiee ihiit is runch n'^f^knUnh Weighed with 
the same seah-8 at ditTeri^iJl timt?( during tlie day the w^'ight of 
an adult, will vary, on the avemgi% two ]>i)iind[4, uml in iniiny 
instancies aj> mm^li a? three. With chaiij2T*> iu clothing thi* viiri- 
Aiinn oiny be much moi-e. The diflL-r»?nets iu weight aro 
govemtHi by tJic amount uf foofJ and drink in^;cfie<l, and by 
tile condition of the bowels nod bhulder, whether th'^v havd 
been emptied or :ire full. It is easy U> r<X" how prrorp^ mav 
arij^e nnl*">is all ihese things he con'^iderecl. l*atienfe .ire easily 
buoyed up or dejjreast^d aa a nsult uf wi-ighin^, and care sheuM 
be exerciaed to avoid the lat*er. If the patient h weigbe*! in 
his olotheff, the ^me garments should he worn at eaoh weigh- 
ing. The relation to meakinn? and to ibe voiding of urine and 
fe<x<5 should aJ:w, sti far as possible, lie tlie same at earh weigh- 
ing. The pat4eut bIiouIiI be iiistrui^ted not to drink water for 
the sake of increoBiDg his \v*^ght, 

Re&t and Exercise. — Much le*is foi^l \?t recjuiretT during 
rest than during eJteroIae- In t^xercise ihe niusealar activity 
]ncrejL<e.s ojtidaliun and tis^ue-wa^ite, and thi^ wa^t^ mu?^I bt 
oountcrlialaaoed by an increoieil eonsum|>tion of fixxh A(*conI- 
ing to Atwat*>r: A roan at bard work re<jnirefl 1.2 of the food 
of a man at moderate work ; a man at light muftoular work re* 
^uire^H O.D oi the futHi uf a man at mo<lt?nite work ; a man of 
Bedmturv habits require* 0.8 of the food of a muu at mnderate 
work, Riibner BtaK^e that : (1) At rest a man requires 2500 
enloHcM ; (2) at professional work a man rer|nine.4 2631 eatories ; 
(3) at moderate mur^cular work a man retjuirefi 3121 calories; 



RKLATioy or Fooo TO VAniom coyBinoss. 61 

(4) at M*\'civ miiMctiljir work ji roaa rtwjuirtH 36ri9 <A]<rH(-» ; (5) 
III binl Uilxtr ft niATi r<4[(iirv« 5213 oalanoi, 

Individnal tendencies have ^omo uffec*! on tlio nmiHint 
of food required. There are many jperrfms wliii <At v(*ry 
eparin^ly unii who nevertfaelee become obcfle ; ottient i)artak4i 
of ui Linii!«ii:illy lurg\.< qumitUy of food and never ffitt^sti. 1\m 
ift due [miboildy, ujs Hutchison potuU out, to the faot thul thi; 
*iictivity nf x\w. t^AU in ci^rlnin individuals ii; greater Uian in, 
olbem, aud ]<.-iid,-< icj u luorc nijtld btTuktDg-<lowii of food and a 
greater vnwftc of hv^xU** 

The grvut Irnclcnoy with mofit pcrsoDs is lo overent, Jn e«>n-- 
iequence of which fnU iirr» utorpd Ujk ; &e a nwult, olvettitv or 
giistro-intc!«tmiJ or other diHtiirlxincefi occur^ and thuA ih^exoeiut 
of food i** ellniinau<l, At times the peveiw condition — that of 
eonAuminj^ th* lillle nouri^fbmcnt — oocars. The period durinif 
which an iudividuiil oin ^ahsUt without food i^rie^s and de- 
peodH largely U|Km the umount of excnri^c luken and upon 
aUnospfaericoondiLiori^ fiuch u^ moij^tinr and toDiperature. A 
conditiuu ludrp fnx|iifrn(ly xukI with than uctiml Gtarvatioa ifl a 
ODc-cddicd or impTOjK-rly balanced diet — tltat is^ one in which 
01M or tho other of iho food clement* in tnken m excess, while 
the other elexnent^ are diminished or lacking. Thus if an indi- 
vidoal t^L** exn^Ksivt' iiuantitieti of meat aod no veKetable^i, the? 
diet U too rich in prntoins nnd too poor in carhobydmtes; as^ain, 
if lar^ qunntitie^ of hnlter and rich cakes l>e eaten and no 
mest or vegelablen, the ili<'t will be too rich in fats and carbo- 
hydrates and too poor in prnteins, and may^ thcretore> prove 
hauiofuL As a rule, iu a tkadly balanced diet the number of 
adories is too »ma11 lo nit^t the requirements. The following 
dict-Ii«t, given hy Mr>«. K< H. Richarde, «bowe a common 
iovalid diet too low in proteins : 



J {hmmon tnwilid ftntion Tua Low I'n /VvDvCo. — (JK^ £ Bi Itiffutrth,] 





Frowlu 


m. 




CnloHOL 


1 pint of b««f broih at cvtMomaiA ■ . 
1 pint of tmp^rinl Gnniim i>nnUin- 


(tUL. 

3.06 
6.B0 


fltaL 

0.4 


9m. 

60 
7» 

44 


88.7 
205.0 
521.7 

2M.0 


SquorUof liqaifi ToUl - 


27^ 


214 


m 


11W.4 



62 CHEMISTRY AND PEYSIOLOQY OF DIGESTION. 

Tobacco and Digestion. — Tobaooo frequeDtlj plays an 
important t6\g in mfluencing the digestion of food. It is a well- 
known fact that the ehewtng of tobaooo increasee the salivaiy 
secretion, frequently reduces the appetite, and increases the 
movements of the bowels. As a n^e, it is better to smoke 
aiter meals than before, the irritating effect of tobacco being 
thns lesBened. 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 acta as an excitant to the nervous system, and should 
be prohibited in all nervous dieeaees. 



CLASSES OF FOODS- 
ANIMAL FOODS- 

Aniual foods conUin Diuch digestible matUT, chiefly pro- 
tciiw, n cK^itiiHli-inbk' ijimntlty of fut, in htititr fixid.-i nirbo' 
hydrutcM, nnd, in luMition, water nud mineml siUts. Being 
liutrotighly iligcMU^i, tb«y ]mi%'<t but Httlo r««idm; in (b<T ]ntr!t(tiD<t. 
Thf' vsriniw form>* nt'jinimul AwkIh — milk, rgg^, mivit, fijJi, and 
j^el&tin — will now be dt^scrilwi lUniiT thoi:^* iundingi^. 

MUJC AND MUX PRODUCTS. 
Milk, tbc iiio«4t loiportaQt of unimiil AxkIi^, <7i>Dtiur» all the 
cIcmcntA nix)t^«f^arv for the mnuitcuBticc uf lifv^ tiiid oonstitotcg 

Composition.— Milk mtitainH varying proportions of <iftch 
of the tour cla«^s of fiiod prineiplcv: — pmteina, falUp cmrbo- 
bydrates, and mineml &alt& Uuadulterat^'d, it contains from 
90 to 84 per cent, of wiitcr^ v;irvinjj willi Ui<s quulity of tbc 
milk. It forms the exclusive dit't ioryoiia^f growing mam- 
malia, but o^ng to the fact that the propcrtiotu of proteins 
and fat ar« in exoe^ of the carbohydraUs, it is unsuitable aa 
an exoliiHive diet for adults. 

The principal uitrogenoD? compound of milk Is caaein* It 
difftfre from the other protein couipouode in that it contains 
both phoaphoriis and sulphur. Casein is not ooaguUtod by 
beat, hot this cimnge m£y be effect^ by adding a^id or by 
reitael. The casein clot formed by adding acids may l>e dia- 
solvcd by neutralizicg the add, while that formed by rennet is 
not affected by the addition of alkalis. Milk contains, besides 
Cttein, bictidbumin, which is similar to the Berum-albumin of 
(he blood. The totjd proteins avera^^ about 3Ji per ceuL of 
the bulk of llie milk, or about 125 piT cent, of tlic total iK>]ids. 

The fat& of milk conrvi^t of the glyccrida of poltnitie, 
ctAflnc, iin<] oleic acids. In addition to these, milk contains 
Hcvi^nil other fat** in smalls proportions, to which the flavor of 
butter is duf. The fat is suspcndiMl in the milk in the form 
of minute ^^lobnles, which give th^* milk itn while color and 
opacity. Fat averages about 4 per cent, of th^ milk or about 
31 per cent of the total ml'ti^. 



64 



CLASSiCS OF FOOI>& 



The cbieT cnrbohydmtc of milk !« Inctoer, or milk-^ugar. 
HiUc-Mlg&r j^ not ti^nrly eo t^weet n& ordinary ^ugar, »ud is 
lem solnhl^^ in ^^ntir. It n^rurte tji Fehling's siilution like 
glucose. In the pre»c!iuo of the lactic acid baoillus it is cod- 
verted into Inctic acid, which cati&cs the milk to turn sour. 
Lactuse forms about 38 per cent, of the total solids. 

Milk CKjntfiiiij^ nlxHit 0.7 |>cr t^euL nfmlU. These ailts exL^t 
chiefly iti the form of phoejihiUea, chloride, and t^ulphatof^, 
roUissium &a\Xs occur in lurgur qimiitirief than do !?odiuni ^ts. 
Calcium salts are very c^sonti^l Ut youngs gixpwing auimaU^ 
inasmuch as tlicy ploy a very importnnt |>nrt in tlic formation 
of l>oni?. The relative porf.'entn|^eF« of ssilb^ in the afih of huroac 
milk are ahown by tiie following t«l>lc : 



Cotcium pkoirphfttft 

'* ouootNtte 

milplmlft 



lulpGatc ISA 

23.47 



Miifanium cnrixmatc ---,....... 8^77 

Bodjuiu thlorid 21JT 

Ferric oxid and nlummum O.gT 

ioo.c)0 

Variations In Milk, — Then> are wid<' variations in the com* 
position <»f the milk of diilereut aainiaK \VhiIe huimin milk 
coDtaind more giigar and le^^n protein than (X)W8' milk, the ^tel- 
value is about the 8ame. Dc^s milk seems to be the richTOt^ 
wbtreau* that which lome* fnHn the horse i& exoecdbigly j*oor, 
Bfi joay be seen frum the foUiPwiag table: 





Cbtn/wfi/iw V(mtpo9Uii>n 


^ T''ar(<>M* £<nfi« o/ MUL* 






Witflr 


ToUl 


Tout HDll4a, 




Kind of 


n^Ln^ 


Albu- 
rn iHh 


Toul 


F>t 


hrclnittH 

;mJl|r- 


MInonT 
in4tlbn 

(■•hj. 


viliiQ per 
pound. 




Perrt. 


Perel 


frrtt 


prttt 


JVrrt- 


Prr<t 


r*rr<. 


Ffret 


CUiorin. 


WctlDBU 


BT.* 


12.0 


LO 


l,S 


3.3 


».« 


t:^ 


o.a 


31* 


OOIT . . 


sT.a 


12>ft 


3.0 


(K& 


3,& 


3T 


4.9 


0.7 


BIS 


it0m 


7fr.4 


■MA 


«,] 


M 


11.! 


»,<) 


&i 


O.T 


on 


■wo 


n.fi 


19.2 


,vo 


1-a 


A.fi 


«,« 


ce 


o.» 


AOB 


frublo. 


BL« 


1».0 


JV^ 


0.9 


a. I 


7,r. 


4.1 


o.« 


EWO 


Cit. . . 


SLl 


17-1> 


S.I 


«,0 


ft.1 


3,3 


iji 


o.« 


400 


<tn*l ^ , 


»,1 


1«.8 


RV 


M 


4.1L 


4.B 


4,t 


0,0 


3« 


M.J^ 


1B.b 


10 


0.B 


».V 


3,3 


fF> 


03 


312 


fir«:: 


M.n 


ia,i 


0,9 


1»« 


11, Jl 


in 


ft.O 


0« 


223 


ftU 


8.a 


1,3 


ai 


1.3 


1.2 


ikl 


0.3 


UD 



pp. 267-363. 




ASiMAL FOODS. 



66 



Not ooly m tluMv a vriik variution m the milk of dtflVrent 
miimal:s l>^>t ooww' milk itself !;■ H(ibji?ct to groal cliaii^ns in 
tbc pcrwntn^ oompotciti^^D of m ingrcdicnte. These raay be 
ntuihiittfd to mmny oni]8«i, the br«ied »ru) oon(1itio& of aciiiiutfl, 
arid Th>' f^x^l :iml thf* care they receive hping r^fkonnble in ft 
grtni <l.vri"<' i^r ihi'w: chmncw. Aa u rulo. a younp cow giveji 
bi'li'T milk thuij WD uki one, und a wtrlUfcd animul yieldH richer 
milk thai) onr tliut m puorly fed. The milk flow is grmt^t 
fOiorlly afief calving, btit the milk incruLso^ in riclinttfs as the 
quaDtily l>»'(''itmi's .-rniilhT. 

A«luJleraUon. — Milk i^ oAcii i»ltiltcTUt«l by unHcmpulous 
dftirymtn by thr nd<iition of irntcr* Thi?i 10 the most comiuon 
mirtiiod of lululurrution, nnd, if the water utwd for this pcrpo^ 
i* piin*, prvKlncvK no 111 pflVot other than to dilute the milk and 
thfirby Icwwa the |>eix)en(flge of itB ingretliente, Unforniritttelyt 
however, vi-utcr ti^ for thU purpOT^e i& net ulvvuys pure and is 
fny|iteiitly n eouroc of contiiminaUon. Other methcds of alter- 
ing; iIr^ <piulity of milk consist ia the removal of the fatfi— ihe 
incrto?^ iu tlio wpocilic jfravity which is (irodiicts) tJiereby \b 
voMtitvrM'Ut} by thi- fiirtlier^uldition of wattr ; and in the addi- 
tion of prtser^'iitivi.'??, The latter uicthod, while it dw* [jot 
detract from the outrttive value of tbe milk, may, if the milk 
b<^ iiwd r^^tftilarlvj prodiioo ddet4>noua ro«ulte, 

Dljccstion of Milk. — When milk ent^r^ the MomAch^ it in 
coagulated by tiie hydrochloric acid and the reofiiii of tbe (laetric 
juice. These curds, or cm^la, cooaiHt of precipitated casein 
and a portion of the tat that ha^ become enLingled in the curd. 
They vaiy in sixe and consiiit^nce acc^*rdin^ to the anioucit and 
the dilution of the milk t-ikeii. The ciiticin *ioon nnderj^oes 
change, bein^ ctmvvrUHl intu «on;o form of prptonr^ and the fut 
18 i^^D liHcmt<*d. Tlic jilbuminnujt cnvclo|>c uf the fut-globulcit 
in dtwnlvcd, and tbe fat ocxlIohcc^, forming lai^^r dro|i!<, In 
whi<'li rinidttion it pa?uaw inw* thi' diKMh^mirn. A pnrtiou of 
the watcriind »ume of the i^iUti an< uIi^jHW in tht^ .^tnnmch. 
The nml that ho* in*t bwn acted upon by the frastric jnioe, 
together with the wat<'r, sall^, and carbohydi'ate.H that fitiU 
rentain, »l^ pa<« inu) the iiiU-^tint^, where tijeir diger^tion is 
eom|iii"red. l^iiHn^ in^^n^s*?* the digestibility of milk, tbe 
prei-ipiUik Iviiii; de|Mj>4itt^l iu a more flwcident fi>nn. if ibe 
milk i» previously diluted with lime-water, barley-water, or 
oae of the aeniU?d wut^r^, nuch n& V*ieby, tho curd^ formed are 
cBiallor and «ofl4fr, and the niilk often retidereil more julatable. 
Bread or cracke.rK added to milk make a f>^K>d meehaniflal 



se 



CLASSES Of FOODS. 



dili]«ct by mlngliog with it utd m^ulaiouig a Boti coodiUoa 
of the curdfl. Tbe addition i>r ulkalia amy hv: r&Mirtvd lo wicb 
a view to noutrulizing th<i tusid^. Thi8 hu^ tlit> oHVct of ooftgu- 
Iiitmg the aisdn mori^ slowly, and formiD^ flocouli rathar than 
cb<!esy ma^ae^. 

Cream. — When milk is allowed to ^and for some hours, 
the glohulcs «f ikt rise to the top, and, together with consider- 
able milk, ure removed a^ cream. This product contains about 
18 per Gent of &t, and some protein and carbohydratee from 
ibe milk mixed with it. Accoiding to Letbcby, ru; quoted 
from Yv>. thu fullowtuK table sbuwa the average oomuositioa of 



cnaini 



W«*r . 66.0 

Froiob 2.7 

Pit* « S6>T 

aubohyflT«t<« - iB 

Salu IS 

Skimmed Milk. — The residue ren:iaintng af\«r the iv^moval 
of crraiu from ordinary milk is (\iUeJ ^:Lk1Illmed milk. The 
amount of fat baa been gn^atly rcdnccil by croiming, but the 
peroeDtage of proteiu rc^mains almntt the ^nmm. It is more 
<«Miy di^i^ttf^il timn whole miJk, iori^mnrh nn the fat \\aA been 
remove*]* The composition of fikimmed milk, according to 
Irftheby, as stated by Yeo, is as follow* : 

Wur^r . . - W> 

Pnkltiiii . . , . ...,.,- . . , , 4J) 

F»tt L8 

CbibobydrtiM M 

aau a« 



Devonshire cream is a ft)H<l cream cbtain^d by Hkimmin^ 
Diilk :ift*T it ha* beeo heatc<l slowly to cot over 160* F, It 
is more nutritious, but not so caaily dipeetibic aa ordiiiaiy 
CTflam. 

Bntter. — Butt<»r i* made from the creflm of milk by the 
process of obumiiig, which causes the fat-globuleti suspended 
in the milk to coalesce, thus forming a ^Mt\ ma^. Biiit^'F 
is occa^slonEdly made from milk oth^r than tliat fn>m the 
cow. A varying proportion of common salt is nlwnyp added 
to it til enhance lis pnlatableness and Itn k««ppiDg qiiali- 
tiea. The flavor of butter is due to the growth of micro- 
organisms. Pure cultures of certain ori^niAmH ar? now 




ASiMAL FOODS, 



m 



nxWued to ripen butter and bo impart a coiistant flavor. Ap- 
prozimatel/f butter may be »&i<I to conaiAt of: 

ni sao 

Vlmiv I(k0 

Uilk«a0ur M 

Ctmku , 0.9 

Od a<!count of the eue vith vhloh It b di^;est«d butt^, when 
(ivsbf is oa«r of llic tnoi^t viilimliU< liiu v TikxIn The ntiif^idity 
which <»ccunB wlicn butter i:* Wrpt too Wg swcnifi la be due to 
tbe cafiein, whichp on undt^rg^ng form^tntjLiinD, lib«rac«6 fatty 
n^U, On UiU n<^(H>iint thftt butter kt-i-pK \tf*t v/h\rh containn 
the least c»«eia. Butter is bcj^t pnxwrvul by kccpiug it at low 
tempenturc, find p>ix1 rc«ulti^ art- ixlso obtained by tialtiDg. 

Bnttennilk. — Butt^'ratiJkt which h fumied during the 
mauufiietureof butter^ if* uiiolht-r milk derivalivo of no little 
ini[H>rULiia^ II Is uh-cI exleiiNtviJy to a Wvcrage, ftnd b< highly 
nulfitidiis eiiaI nuilv Uigt^ted. It wuLuus tbe oiisein <>€ tlie 
milk in a HtK-ly i^<jiiigulatcd fona. Aocording tc Pjivy^ oa quoted 
from YeOr the coitipcTt&itioQ of buttermilk is as follows : 

Water ftao 

NiUoffcfintiB nultcr 4.1 

Fkttj mauvr M 

Ijtcxmv .....•«•■. 8l4 

Sdinc trailer -.,.,,-.-. ,----..,. &S 

Card and Whey. — Om! to. iht^ fywipjkted oaeein of milk. 
This coagulation mnv be hrouglit abc<ut by rennin, a ferment 
found in (ho ^strit? jiuce, or by »uch acid Eubstances as lemoD- 
jtiice, white vinc#;iir, etc Whey is the fluiJ portion cf the 
milk r<.*rnni[ii!ip ii|ir»n the con^^dntion imd n^movsl of the eojwin. 
Whrv is III] exn'lU-nt drink nnil food in thow awes in whteb 
milk lA n<i well bonip. 

Cheese- — 01ic?ese tfi mridt; tip of curd and ji rertiin propot^ 
tion of thn ikt of milk. CIkjcsch viiry in e^'mpnaitioti and c<fn- 
siif1etK« stpoordlng t'> their pr<'pnrali<m. Some chet*^s are soft, 
while otli<?r*! nre banlpued int^i vtiUtv hy pressure. The* flavor 
of chevse is dm* to tlie grf>wlh of oertAin mioro-H>rganisnie during 
the ripening proivsg. The hnnler ehee«« keep much longer 
than tlie soft i»uft*. The ftvenige cDmpo^tion of chcesej as 
ahown by Parkw*/ i» aa foUowfi : 

Wiur B6lO 

Fioitia^ ZlM 

VktM . - SR.5 

&ihn 4.5 



* ffyyim^t third «litio&. 



SB 



CLASSES OF FOODS. 



Cbec»e u ■ autntioiuv imi ngixi'nbk* fowl, but !t ij« uflcn ilif* 
Scult of digcstJOD. TLe h&txler cbce^cs ure mucti more iii<li- 
geAtibU than those of eofl ociDtiis-tence. Utke milk, c\ie^e msy 
contain oertain poisoiioiiM F^uliAtanrrA, dur tf> organi&ms th&t 
enter the milk ; of the^, one of tbe mo^ oomnion is tyrotozi- 
€on. PcrifioniDg cnay follow the €sting of such ch4%fic. 

Etunlsd, Eefir^ and HatzooQ. — Kumiss 18 n fer- 
meiiU^i drink prcpurttl by both hiot^ arid am! alcoholic fcr- 
mnitution. For tniiTiy centuritK it lias Ix^n miidc fr<mi mtir«»' 
milk by tlio nutiv^v livuig tieur iht^ shores iif the OiitipuiM Bt^tu 
Tlic milk in obUiinc<l from ii ^peciuT bree<) of mar^^, tbr Miimnln 
being ft-d v<*rj" oarrftdly. Tho milk is mix<x] with n kiimi^K 
ferment, the W-tir jicid fcrnietit (converting ^vme of tbr KUgar 
iulo luetic ucidp while auiother part of the sugar is corivertwl 
into uh^bol utid carbonic acid ; ii fiinull <{i]antity of cusein is 
di^^^^U'dn The milk is constainily ugitalel, iind the fermenta- 
lioH iillowcd to proceed for a period £)f twenty-four hours or 
wore. 

Kuralt^ It* au ndd, <*flerv<;&ctDg ilriuk, and contmns a verj 
MUjill pritjurtifin of nb'i^biil. It is very ea^Jly digestrili bring 
much more digt^tibli^ tlmn milk. The casein is wi findj 
divided thnt himpi* <mn not be formal In the Ftoniacli^ itnd it is 
«i«ily aotcfl upon by tlie gnstrin liecretlon. In tlie ITnitfd 
8tAU« it Ims been prepared from cows' milk to which nn arti* 
ficinl fcrmeut j» added. 

Ku7nm Ottre. — In certain parts of Russia this form of cure 
is not UDCommoD. It congit<ts in drinking !<mull ijUttctitics of 
kuini.vt anO gra<lnji]ly iacre^sing lUem uniil lat^ ^unntiliea 
un^ Ijikcn. Kumiss cnres hiivc bt-eo prescribed in chntnio 
gajitri^intcstinal mtarrhs and C-bronic cntarrhs of tlie respiratory 
tittct. 

Kefir resembles kumT:4s, and is often used as a .vubtditute 
for itn It was ori^nully made in the Caucasus from ci^ws* 
milk fcrra*^iite<l with S^i^fhtiroiniff*''/* mtirodmiui^ la('lic acid 
ft*rmHit<ilioii gcktug on nl lh(^ ^mtm^ time. Alcohol, lactic aeid, 
and albumins an: formed aw a re-siilt of the fermentative pmc- 
«Hc«. The co^iD i& |Mirtly digested. Tablets of the kefir 
femieiit have beeu pr(?t>are^l by Juruck. rhe«e are sold under 
tbe name of kclilac tiiblct^. Thty rondor tbe home mnnufao- 
tnrt' <tf kefir an oaay matter* (See ti^4^ipi'«.) 

Matzoon. — In tlm form of milk lactic ac^d is pnxliieed liy 
fermentation with a ferment ol>tairn»d fnm Syria, It is thicker 
than kumi^ and does not contain alcohol. 

KuiniM^f ketir, and malzoou are agreeable forme of milk 



ASiMAl FOODS. 



Iboda, are <^'iilv dige^tible^ and ar« specially iifefiil in dioee 
OBBce in which ruilk can not be laktu or ii< not w<'ll tHirae. 
The foUovring Uh\e u biken (mm Hutchison (p. 137) and gives 
Uie oompoaiiiuQ of kuuiib^^ kL-fir, etc. : 



KuiukM . . 

Ketir , . . 
UanV tTiilk 
CcFVt/ iniJk 
B«ll«cviilk 



noMd. 




nt 


»atti. 


AlovbcO. 




frtead. 


tWcoL 


Ar«c^ 


/%rML 


ftreon. 




M 


hi 


2.1 


o.« 


1.7 




3.1 


j.a 


£0 


0.8 


2.i 




&6 


u 


2.5 


0.6 






SJ 


4^ 


3.6 


0.7 






8J 


zs 


Lft 


V.< 







■dd. 

Ol& 
OlS 



OlS 



THE MODIFtCATION AND PRESERVATION OF MILK. 

The rhomic cvkin portion , viirktion w, and mliillonninn nf 
milk, as woll BS of some of the milk-inxxJucts, luivt* alirudy 
twcn oon^ridcn^d. It now remaiiui to disousB thff uethodd m" 
modifying and pry'jM^rving milk and milk-food^ luiL^miR'Ii 
fl.^ milk i]4 u«tinl]y takcD in the* i-aw state, it m highly inifKnlunt 
Clifll i! be frtv fnmi alt nyrtf^ at on ta mi nation. 

Contamiaatiou of Milk. — An important sourov of von- 
Uniination of milk ia through dif^ea^e of the udder of (be cow 
or oareloesnced in handling this orgun. Cosvd an* too ofVn 
kept in liltby etabl<*«, from wWb dust aiid L^xrtvvut-Dtilioud 
matter find their way intu the milk^iuiil. Thf*gt*rnn of di^^ojae 
timt do not ^'t into thp milk in ihc stable. frequeniJy tit* so thrttugli 
the iif^'ncv of tlic Wttlcs or wins in which the milk is fihippiHl, 
and which an* niUrn uuck'tin or clt'«iisHl with polluiecl wroler. 

Cov/n flhotild not Ixi alhitved to «at tlic drv h>jiv«7f on which 
they arp mostly tnddwl, la^t their color, ^idor, or evi*n |Kii.^r>notii4 
pruperlicB be imjiarlo) to the milk. Sour niUk mid milk fn>ni 
poor cow» IS unfit for food nnJ tthould n<:»t he i],-hx1. 

At timo-f tulj^n^uhism or infiumniatory comlitioiiiE diw* to 
mier(W>r^nii4m^ may i'xi?!t inthrr in thr luhlr-r of ihr rnw 4»r in 
Home du^tant or^tti, imd may be m slight 08 not to attnict the 
attention of thi* milker, ^^»t^, in a report to the Ilrilii^h 
Medical Asitociation in 189!*,^ d^'Ticribed liis aimlvi^i'T^ of 186 
samplas of milk oht^ineil from various sources; of thcw, 
tubercle bacilli were prew^nt in H ; puft in 47 ; utreptocooci in 
106 ; the pereeatagftj were t%A fuHowii : .5,3 (wr cent, amtained 
tubercle hncilli ; 78,7 f>tT o^nt, contaiupJ pun. At tJiua* micro- 
orgaoiemB urc iutrudutv-d into milk from an uddLT that ho* not 
bp>en properly elainwed liefore milking or iVoro the nnelean 

* Bril MhL /«.r., IBflfl. 



70 



CLASSES or FOODS. 



handd of the milker. Among the piilbogcnic gL-rms that may 
tJiUB gain access to tbe mitk nn- tbe biiciLti af tvphoid fever, 
tubeicaloaiBj diphtheria, and cholera. On cotcriog tlie milk 
tbeoc organiems ooDtinuo to grow and in a uhort time multiply 
finornioiTsly. In nildkion to pattogenii^organiflnis^ othor miero* 
orgnnii^mf^ which produce souring but are otherwise liarmleaa 
may gain access in the milk. 

De Schweioitz, in the SixteeDtli Atmuftl Report of the Bureau 
of ADimal Industry^ 1899, calls iitt«ntiou to the fact that in 
our cities uiilk conLniiia from ^OOU to 8500 bacteria in a cubic 
centimeter; in some instances there are as many as 1,000,000 
to '1 ,000,060 in a cubic c<.-nti meter. Tbe maiimuia limit of 
the number of otgaoiams iu milk that is fit to lie used u 50,000 
tn 31 cubic centimeter. Applying tijis rule to the samplee 
obtaine<l by de Sehwciniti^ frnm '12 defllcrs, but \Z were fit 
for use. Ill 130 8umpl^ examined by de 8chweiii]tz in which 
the f^rtnt^st care was taken to prevent con tarn iuattonf from 200 
to 50,000 bjict^ritt were fotiutl in a cubic centimcler ; in the 
largest proportion, however, but i'lvm 200 to 5000 were found, 
From tbis it will be ^en that the grwirest aire is reqiiirod in 
handling milk fr^ni the time it comes from the cow until it is 
served as food. 

At Burusidc Farm, Gre«n Spring Valley, Md., tbe form of 
Mr. Samuol Sohoemaltor^ from which the Walkor-Gordoii milk 
sold in Baltimore is ohL-imwi^ tbe following precautions to pre- 
vent contamination are taken : The dairy in managed by tniined 
persons, and is being constantly infipected by experts in their 
respective departments* The number of bacteria ia the milk 
is Pecijrtled daily at the labonitory. The cow* are teste*! for 
tuberculoeie at frequent intervals. The stables are kept In 
a thoroughly hygienic c^Midition, the flo<jr and walls beiug 
cementcfl and well scrubbed each day. The milker i" re<|uirfd 
to serub hie bnnda thoroughly before millcing^ an*l to clothe 
hTmself in % whit^ Ktj^Hliaced fiuil. The oowm arp thoroughly 
groomed one hour before milking, and tbe udders of the 
cow are ctcansctl just before milking. The cowe ure milked 
into ?ipccial niilk^paiU mi armnjred aa to prevent dust from 
entering. Tbe first milk drawn, wbitjb usiiallv coutains any 
germs tluit may liave euti^red tbe uiUk-ducL^, ts discarded. 
The pails, bottles, and other apparstu^'i are sterilizci^ at a tem- 
perature of 212° F- Tbe milk is pa^^icd from the jiail into 
cans, ond iff then t^ken to the milk-house, wbero it %f^ fltrain*?d 
through sterile cotton Into a ftlenlized eooling fjink^ af^er wbi^^h 




^^^^^^^^^^^^^^ AMMAL fOOM ?] 1 

^^V kii bottled, corked, and ffealed. A guurauUx? a» ti> Uio |>urity ^H 
^^H of tt)^ milk ^ix-H »it]i L-uoli Ixjttlc. ^^M 
^^M Modified Milk. — Moditiul milk ix prvjvired fmm tho aire- ^H 
^^B fully elected (m>wa »et iL-iide for producing milk that ts to be ^^M 
^^M separated and rocambined aocordin^ to t)iv prc<j«criptioD of the ^^M 
^^H pbysidatu The ^-paralion of tli« iiiillc and creiun ie atx^om- ^^M 
^^H plisbed by meann of the centrifugal niaolune. The separated ^^M 
^^H milk and cream, as well as the whole milk, %v)iidi Ims bcea ^^M 
^^m cooled at a teuiperature of 40^ F. or below^ are tlicu seut to ^H 
^^H (be oity laboratory, wherv tliv definite peiveutiigva <jf cream atid ^^M 
^^H modititxl Euilk arc rec<:i[ubin4.Hl. ^^| 
^^1 ll i& the ^renil belief tLat iDvalids and iufaub; thrive bettor ^^M 
^^^ upon mix»l milk obtained fnini a ntimbi^r of r^iu-*, ihnn upon ^^M 
^^M the milk of a aii^le oow, which h apt to vary with thv oondi- ^^M 
^^1 tioD of the aaim^. Aooonlin^ to Itotch, "ccrl^un brewlt^ of ^^| 
^^H cows are better than otJieni for oopyioe human milks." Tho ^H 
^^M following list of breeds beet adapted UtT modified milk, with V 
^^M analjrcea, is taken from Itotch : 1 




9m. 




Albu- 


MliMtal 


Taud 

UUdL 


W«t«r. 1 


^^H Hobielu-Fiivtuui , > 
^^H Amcricui gmdc* ^ ■ . 
^^B CoaiDBoa a^tiYOi . . 


4.04 
4.09 
3.S9 

S.S0 

4.01 
3.H9 


i*rffnt 
4^ 
4.3) 
4^ 
4-88 
4^ 
4.35 


4.17 
404 
4.01 
3.99 
4.03 
4.09 


SkrvnL 
0,73 
0.73 
0.73 
0.T4 
0.74 
0,73 


FirtmL 
)3.S3 

lasi 

13.04 
11.M 
13,17 
l£.8a 


B«.7:i ^H 
M.7V ^H 
80.96 ^1 

89.oa ^M 

8a.8a ^H 

^1 


^H Stcrillxatloti and PasteoricaUon of Milk.^Hltk is ^M 
^^H AttTnUnnl hv Wiling, mid i.-^ tints rtvtdereJ le^ digestible for ^^| 
^^H dyopcptir pnticni^ ; iUs Uuite U d&o altered ; vi\ tho nther hand, ^^| 
^^H itttriliuition destroys all mi^rro-orE^aii^niai. Ff>r p^rsunri Vp'iiIi ^^| 
^^H Donnal digestion milk i^ neiinlly motv va^Wy dl^ttitible when ^^M 
^^H boiled. The di^ad^-autiiges of HterilixaCion htv in a measure ^^M 
^^H overcome bv P:ii$tetirimion. Bv tbi^ pn><-et» the milk u ^^M 
^H kept fLt a iemjMmture of 7i>^ C/(lo^^ F.) for from twenty ^H 
^^1 to thirty miniitti^ ; thuA rao^t imcn>H>rgaDLimH are killed, the ^^M 
^^H spores, however, Dot being destroyed^ although their growth ^^M 
^^H i& iubiblUHl. The U^te of the mUk la Dot no njarkt^Iy altered ^^M 
^^B ad in ntcriUncd milk, and it h sahl to be more i^u^ily digtwlibl^ '^^t 
^^H for putientd sulTeriiiff rn>in pi±tro-ii]t^t!iial diaturluinoee. It ^^M 
^^H doeA not, however, k^^p ii<t long, snd gour^ in one or two daya. ^^M 
^^B While bacteria arc destroyed by sterilization, their 5por«fl, ^^M 
^^H which are also present, are not killed, and if kept at ordinary ^^M 



72 



CLASSES OF FOODS. 



t^m^K'niUirr, Xhvy continue to [iimiiLsi.' lately in DiinklKT and 
thus render the milk unfit fcFr use. These (organisms frequciidy 
dcstiviy tlje protein oi* the milk ruUu,-r thiiti the lactoisc, mud as 
there mny he an iil>««Di% of the cusUtmary stiuring, the fact thiit 
the irilk is <y>utjiiiiinated tmiy thui^ be ovorkHikod. The dis- 
adviiQtngc*« tlitit uct^rue ihrni sWnVmn^ milk an- DULni felted in 
the cnmsli|«itmg i'f!i*L't flud in iu altered Ijifite. As llie reswlt of 
gteriltKatiou variduti chiitiiio uhan^i:^ lake place : the lucUihniniiR 
is somewhat coagulated, tlie ca^in is so changed that it is Leea 
eaMly atled ujton hy the rennin, and part of tlie laoio^ la 
cliaiigetl iul<> caranicl ; some of the soluble walta are (xjuverted 
into tnmduhle ones. A large pnf|H>rli<:m of the^e chiiutjea are 
DOl yvt thoroughly uodetBtood, Ae-atirdtiig to Uolt, the greatest 
objtH^tion Ut st<*rili!cing tnrlk lift* in the feet that niany infantA 
fed ii|K)n it for long i)eri<xi-s of time are a]>t to fiuffer from 
scurvy ; he reports that at Iwlhi a dozen audi caaoH have come 
under hi* notice. By Pasteurization all tlje**e diffirullies are 
overcome, and from 08 to !iy per eent^ of all micro-orgaiiiami, 
including the bacillus of typhoid and of tuberculosis, are de- 
slx'jyi.'d, altliuugh their ^pureu are iml killed. Sjjccial care euuhI 
he ex'^rcisod ia Puateuri^ing milkf and aa noon aa it id i'a^tenr- 
ijsod it should l>e phiced on ioe. 

Process of Sterilization- — Ry means of the AniolH !^t^ril!»^r 
milk can tlL^ily tie ^terlLzod in small brittfcii in quanlitii':^ jn^t 
suflieient for t-iiHi fiWiny:. Sterilii^tiou niay also K' cfilv.t^d 
Rimtdy by ex|K)King tlie hottles in a ves^ that U tighdy cov- 
erea and open at the bottom, and allo^ving the steam from 
boiling water to enter from below. The milk is then kept at 
a temperature of 212* F, for one hour. 

An eAeellent ap[jjiraLua fui' Pasteurii^in^ luilk is that devined 
by Frouman. '* Thia apparutufi Of>neiste of two |>arts, a }>ail for 
the water and reveptaole for the bottles of milk. The pail ia a 
simple pail with a eover ; there is a groove extending arcund 
the ]mjl to indieate the level to which it is In be filled with 
water^ and aup|K>rts inf*ide fir the reoeplaole for tJie bottles of 
miJk to rest on. The receptacle for the bottles of milk oon- 
mtB of a series of hollow rinc cylinders fastened loj^ther; 
this filfl into the pail, so that the lower inch of the cyliDdeitf 
is imiuemed in chi' vvat«r. TlkiH Tv<xfplacle has two »et£ of 
horizontal ttupport.f, thr upper set continuous aroimd the rcocp- 
tftcle, for uae while the milk is being heated; tlie lower irter- 
mpted set ta us<d for mismg the receptacle during cooling. 
Such receptacles are made for ten fi-otince botdes, seven 8-ounoe 



n 



jyiMAL FOOLS, 



78 



bollkfi, three l-pint, and one ^pint bcttl«e, and two ]H)iuirt 
boUfe«. There is aL^o a lai^ appamtus for the use of liospiuU 
or |niblic iDtitilulii>uf^ wlitoli hoA u ivcepUdi fur futl^-three 
0-oUQoo or 8-otiuco bottlee. 

"The spparBtUB is ubo<) in the followinj:; wny : ThL< jml u 
filled to the levd of the gn>ove with \v'aler, covered nni put no 
the sto\*e, the receptacle for the bottles beiDjr left out. The 
bottler of tuilk :ire then filled, fftoppered with cotton, aiid 
dropped toto their plaoes in the cvlinden;. Sufficient water is 
poiiR^l iato t-AcU c>']inder to surround the bidy of the bottle. 
A> MX>» a£ ihe WJiter in the |nul boil^ ih^^rou^hly It i» taken 
frum the fttovc nnd set on u nmt or utl>U< t>r otIiLT non-ooDduclor 
in A plnoo where there i* not o draft of wind blowing on it The 
lid rf th(» prtil ut removed ami the Pe<vptael© refit* on the upper 
CdtntintioiiK HMpprirtH. The liil \h th^n m|ji()ly put on the pail, 
aud the pail i^ thus allowed to Bt^uid for three-quarters of an 
hour. Daring the firet fifteen minuter ihe temperature of the 
milk rise* to ubout it« maximum, or above U6* C, the point 
de^tr^nl for Pa^itiruriziu)*, and ri-nmiii8 (here the remaining thirty 
minuter. During the iui<t litUt^n minutes lUe cover of the pail 
b removed, the receptacle i» lilted uud given a turn so a» to 
rest on the opper supiwrtfl, thus briiij^ing the top of the eylin- 
dera oontaitiifijjT th4> liottW nbov<> the level of ihe |iail. The pail 
ifl then put imder ii (y)IJ*wnt4<r tuiioet atid tho water Li allowod 
to run into the pail and ovetAow, but it ^liouM not run into the 
cylinders. Thiia (he h<>t walj-r b* n^plaeed by cold water, oimJ 
!q fifteen minutea the milk in the bottles i* of about the leni- 
pei^ture of the cnld water used. The bottles may then be put 
into a refrigerator until required for feeding. This mpid cool- 
ing ifi A mopt important part of a low tempprnture eterilixatiaD^ 
the importanee of which l^ apt to be overloi.kktt).*' 

Since heating does not de«troy the »porr» of bncteria nor th«^ 
toxins in milk, it is eesenlial thut the milk be as fresh nnd skn 
fr^ from disease germs as po^ible before steriliration is under- 
t:ikeD. A» Holt pointfl out, it ia also important to beer in mind 
that "flteriliied milk requires the name modification for infant 
feeding as plain milk. Tliere is no evidence to ?hi>w tluit it8 
<hgestihility is in any way enhant*ed by the process of hoitiiii;, 
but ratlier to the oontmr}"/' A tjucistion frequently n^lctnl of 
ihc physician is whether all nillk should be eteriliswi l>ef»re 
using. The miJk UffualN- sold in hifgc eitic« is, a^ a rule, trann* 
ported fi^m consiflcrablc difltanrcf, and b; often not conMrnnnl 
for from twenty-four to forty-eight hours ; it is thiw apt, Gtpt^ 



74 



CLASSES OF FOODS 



cialLy in bot weather, in he cuntaminau^l with rtJtcro-<tf^nUmd. 
Boiliikg ifl llic only saife iiierbod cf *lcJitTT.>ving eudi wif^uutjui-. 
In tho poet few rears there ha&i becD a growing icskdcncy, c^^m- 
Cially in larg« oitiesj towRrd tbe «stAblifiliineiit of dairies, suoh aa 
the Walkpr-Gonlon liabomtflri^. fn^tn which perfectly pure milk 
may be obtained, tliu^ obviating tlie tiecet^ity for utilization. 

Predigestion of Milk* — Milk niiy be partly or wholly 
prwiigested in onJcr tu render it more eaatly digestible for iodi- 
viduaJs siifteriog from gaj^tro-intotitinal disorders. This proc- 
ess h roiilily noeomph'ahcd by adding an iiclive preparation 
of |x-|>siu tr> uddiduted mJlk and allowing the feniienuition to 
prrK-<?e<i under the influence of heat at the Ixidy -tempera tare by 
imznersion m hot M'atcr, During tliii; fetnientAtion tlie casoin 
Is partly or eompl^tely n>nvertf<l Tntfi alhumoseK. If the 
pnic«ss le allowed to contiDue too long, the milk hecomee 
bitter. For this reawm it is ordioarily removed from the hot 
wnter after a few minutf^, and i» pla4?ed upon ici^^ which pre- 
vents further fermentatiotip In order to prcdigest milk in 
ftlkulinc sohition piincn-utin is subslituteil for fR'psin ; puncrca- 
tiTatioD of milk hoff now largely replaced peptonJEfltinn, In 
onler to riTwt itaiicn^itiAutlon of milk Faircliiid'a jieptiiiiEing 
tubes ore nrditmrlly employed. These tubes contain five grains 
of pancreatic extract ftnd ttf^een grains of sodium bicarbonate. 
ICneh tube contains suffieient powder to digent one pint nf milk. 

Where the taste of pancreatized ndlk proves objectianable, 
the addition of carbonated waters or of email quantities of 
coffee may reader n more palatable. 

ITiG di);^tibility of tnilk may be increased by the addition 
of hot or cold water, carbonated waters, BUch as Vichy or 
Apollinarie, lime-water, oatmeal- or barley-water, or farinaceous 
fooda, euoh as arrow-root or Hour y occnsioually small quantities 
of srUt or fodlum bicarbonate arc helpful. 

Hnmanixed Milk.— By the term *^ humnnize^l milk" 
niHint ojiw^^ milk that hits bi^en so modifled as to approach 
humAn milk as n^^arly n» ]ioHfiible. This ie accomplished by 
de^'rejisinj^ the cnseiii and increasing the fats and sugars. The 
milk is jmrttrtily predigested and Pasteurized. The following 
dir^tionti of Leeds for tbe preparation of humanized milk are 
given b^ Fairuhlld : 

" One-hilf pint of purr cnM wmcr 
One mcnmre of pcplogntiic milk powdOT 
IM^tuilf pint of frvth onUl milk, 
¥toaT tftblMpoonfuIji of iw«t fpfwh crMim. 



ASIMAL POODS. 



n 



"Fimt di»M>Ive the powder in the waWr by rubhiog and 
Atirring with a spoon, ibeo atld the milk und cream ; mix well ; 
litat III ft H»iuj[fun wtiL wufftnul Atimng uiitil blood-warui — 
not too hot tu Uv iii^rt.-i.-ublv borne by tlic Dir>ut)k ; koop iit ab^iui 
diH torn |jerature for ton minutce ; cbf^n briiLj^ rpiickly to boiU 
in^^]>o]nt; pour at oDoe intii a clean bottle, shake thoroug;hly, 
mrk tightly, and plaoe directly on ioe or id a very cold 
place. 

" Vih&x a feeding is required, pour out tW portion and warm 
it to the profier temperature. Iiikewurm ; alwny# sbake the 
bottle tborou^ly before and ut\er pourii)|^ out a fetdiDg.*' 

Condensed Milk. — CoudeiLsod milk is munufactuncd by 
6vaporatukif iMyf&* milk in a vacuum until it bccom«a thickened 
aad jelly-like. Il is ii«ed largely among tli« poorer olaasee for 
inftnt fealing. Although they appear to &t1en :ind thrive on 
it, io&ntB fed on thu form of milk are often poorly developed 
and miotic. The two principal formA of condensed milk are 
those coDtaining comparatively little su^r and those to which 
tsne-engar has been added. The iirift form contains from lo 
to IH ])or cent, of ntilk-^migitr; the htt«r, fnjm lo to 18 per 
ocnU of milk-0ugur and fmm 3S to 40 |K<r ccnL of cane* 
fugar. 

Cond^D^ inilk i« most eaHily digested, but ia apt to contain 
loo little fat; the unsweetened ooad«nsed milka are the mo^t 
aatisfftctory forme for infant feeding. Condenned milk Ui to 
be used only when frer^h milk \a not obtHinable, or temporarily 
when modt^rd or humanized miik \b not well borne. The 
Bvemge <.x>mpo»ttioa of unsweetened and sweetened condensed 
milk is Ma followft: 







rrm«ii]. 


YmX. 


Milk' 

«uiC»r, 


■uffKr. 




/Vfrtail. 


J^rrmi. 


/V^sM- 


JVCMJ, 


Aronf- 


TTiuir««brDV(l (nndennMl milk ' 


, 40 


IS 


n 


Itl 





&wc«t£Dnl mndeoMd mtlk > ^ 


. SO 


12 


12 


16 


40 



For uAtT in infant fce<]itig condensed milk should be diluted 
with water itt k'iiHt etpial in umount to that which has Ti^n 
evaporated ; this is n^iuilly twice it» volume. For a child ten 
months eld Starr adviitc?* that iviTidi^itni^) milk be dihitoi! t4'a 
lunee* (Ser Infmit Kittling,) Thtrr ;ire ruAuy nhjei-tmniiblp 
Jbnoa of oondi^ri'SK] milk tm thc^ nuirket some «f whio.h arc 
mannfeetunxl from iikimine<l milk. Among the best brand* 
of oondenned milk mny W montionwi Borden's Eagle Rnin<1 
Condensed Milk, Anglo-SwisA Brand, and the TdettI, 



^^^^^^^^^^^^^^^^^^^^^R^V^^^^j ^^^^^^^^^H 


^V^ 78 CLASSES OF FO0D& ^^^H 


^^^r EGGS ^M 


^^V Eggs, )ik& milk, form u a>niplete fuod — tbit is, tliey conlaio 


^^1 a proportiiiti uf ^icti of tin* fuiirlnai^Eitul fi.Mjd tk^metits nccer^ 


^^M Burj" lijr the pres^^rviition of life, i^^^ «"'! "li^k art itie only 


^^1 (?()nkple1e fowUpnuiurie furuisbed by the ajurmil kingiJon. 


^^H The e^g& of the lien are nonsumnl in Ear^j^t i]Uiiibcr>, but 


^^H those of the duck, turkey, guiuoa-b<?j), and of Mime wild iowl 


^^H ar<> ii\att piik'H. Th^ ^^K^ *^^* domc-siic fct^-U viry in Htee and 


^^B fippe-ui'utiiiv, but tlieir competition i^ ab<)tU the ^amn* 


^^H Th? tihcl! uf n heu'>t t'fi:^^ <\>ni^tttuto$ 1 1 ]lurt^, the white 57 


^^H ^'^t 1^^ ^'^^ y^^k <^'^ [virt^ of Mh' entire- weight of the eg^. | 
^^M Thu following table, tftken from Langworthy/ i<h<>w» the ctim- 


^^H ]>oMfiou of hi-ns' ^t^P*i cooknl and law ; of whitosJiclliyl uiid , 


^^B of l>rown-shL-lii4) (^^; itnd of tlie yolk and white of thc^g 


^^H of th« duck, gtiuK*, turkev, and guinr^'fowl : 


^^^B Averrifff tStmt/vijiirion of Egyx. 


^^^H Hen 


1 


1 


J_ 


^ 


6% 


i 


lt1 


Per**. 


/V*^. 


JVrt. 


ft»r#. 


Pvft, 


oii^Hn 




n.'^ 


«/f 


1U 


0,10 




0,* 


«I5 


. . 


73.7 


111,4 


ia«> 




IXI 


TM 


^^1 WhIU 


. , 


S0.^ 


12-1 


tim 




Oj* 


«4 


^^H V>lk 


. 


4«.A 


lft,T 


nA.aa 




1.1 


17W 


^^H Whole cjor boiled, edible 


















. , 


73.!f 


Ul» 


lfl.«0 




t.^. 


"KA 
















^^^H . . 


to 7 


ffi.f 


ItpS 


tOM 




M 


ffTS 


^^^1 Bmwn^hollcdejRiuriif- 
















^^^H ottAftod 


10 V 


«4.8 


ii,B 


IIhSO 




W 


MS 


^^H inick: 
















^^^1 Wholccer.rdlMr ponign 1 - - 


0OS 


IShI 


la^ 




l.« 


7U 


70J 


13,9 


HJO 




l^ 


MA 


^^H whii* 




STJ> 


11. 1 


0.00 




■J 


3l6 




, . 


iA.» 


1#J 


SfiJSO 




1.1 


IStf 


^^^B OooiDr 


















M.S 


M7 


12.9 


U.30 




o,« 


7«0 




«.R 


i3.a 


U40 




i,r> 


AB 


^H iviiiu 


, , 


sa,3 


ll.O 


, 0.02 




o.« 


316 


^^H Voth 




U.I 


ira 


aA.m 




u 


IttO 1 


^^^H TuTiry . 

^^^1 Wholly (in upiiicliftMid . 

^^H Wbc*io oKif . 0dfbk ponioo 
















ISA 


flS.S 


1Z2 


970 




a.i 


«tf II 


, , 


rj.7 


13 J 


11.20 




0,0 


TOT '1 


^^1 Whiiii 




M.7 


11,5 


o,os 




OJ 


21fi 


^^H Yntk 




u,s 


17.( 


a3,» 




L2 


ino 


^^^H OuEiii4-rQ>fl : 


















!*.» 


fio.n 


uv 


fl.fO 




d^ 


«40 


. . 


Tifi 


la-i 


i2jn 




Q.D 


TSfi 




, , 


n.« 


ii.a 


o.o« 




u 


31ft 


^^B Yolk 


. . 


49l7 


IA.T 


ai,n 




1.3 


]i0G6 


^1 

^^H Af? may be H«n from the foregoing t^iblc, tbo ^^ oontaTn)<! 


^^H mainly prntein and fat«, in addition to water and mincrni 


^^H matt4?r. The white and the yolU differ ir compor^ition^ the 


^^H ^ FWiDvn' Uulli'iln N<l 128;, United 8uim Department of AgrkulLiu«. 



whiu- or>ntinuing \vM j>nit^*in nnd uiittr iliia i\w yo\k, and 
-tTATvcIv nny f!ti uni) iinh, whereas tlic yiilk condMDs coriHtlvrable 
fut iitxl ii--ih. 'rh<* vrhiu^ if- mM to Ik* purr |>rot«tn ; h is ooin- 
ptnuiX mainly of f^iir ailbuminic Hnd h ttlight amount of carbo- 
i]yilnit«>. Tli*» an>iiiiiinj' me nvalliimiiii, ^vmHlKiitninr ovrtmiimn, 
and itvttimu\titi, the ovultHirtiin Ijciii^ the main oonHtittieiit. 
The yiillt i>f iht* c^ ii* vtTv cvrnph^x in compwu^on^ and con- 
taitL* l-") p<*r cvtit i>f pniU'in (vit^-Uin), 20 per wnt of palmi- 
tin, olein, and sttttrin (tlw fMy rleiiiciil«), and O.o per cent, 
of ofiltiriog-rrmitt^r, l>i^ldH4 iH^iittm, ittidriti, >;fi1tj( of iron, cd" 
cittm, piUu^hium, uiid iiia^t]i.'.^iiiii] ; the t"Lnl phf>f^|Fh(iru» (Mjuira- 
Itnt in the ycilk ie slightly over 1 ptT w'tit., while (hnt of ihc 
white i- hut 0,03 pot <yait. The %hv\\ of tltc hco'w cpg him no 
fbod<*\itluti ; it i^inniHt^ nmiulv nf minrntl inntti'r ooittjiining !I4 
per oeiil. of mbium i*jirhonnt«. 

Theflavorof the t^i; U ilrjK'ii<Ieiil in lar^* mem^iire iipoD the 
firtid (^b*D bv the layiug lu*n. Kr<*s<li i^^gft lmv<; tlio (inn^l fluvor, 
Langworthy ^ giv<>A llto following ni<'thi>ds f^r U^iUif^ the fresh- 
iiEfi6of>ggs: "'Oiiidling/ a.n it i-icalk-d, ih niKfofllif* mt-th'idK 
moHt I'oiiiiiioiily f*)Howrt-(], Th<" "'ggn ari' liel<l h[i in n !4iiiliib]<< 
di-vioL- aguinut a light, Thr fn^h i-gg apjHsir?* Liiulitixlcd and 
iJm^ittt trtmrihiocnt ; if incnhution hiiH l>^in, n djirk r<]M:>t J« visi* 
Wp, which innrAi>u?K in kisu^ firmrtling in thfi length nf tim^ incii- 
bition hii* ofuitintir^h A ri'ttcn rgg nppenni d}krk<H>lorKl. Th^ 
Bg« «f cpgs may he approxinnilHy jo'lfftil hy taking ad\imtape 
of the fact that at« they |^w okl tlieirdt-o^iily decrt-iL7M:-« thruuj^h 
eva|)ontti<>n of moivHtnn^" Acsoorrling to Siebd, n new-laid 
t^ plAod in II vi'Jiwl of bnnc mntU- in thi* prijporlif.in of two 
niinocH of suit to one pfnt of waiter will »i on<v ^ink to tho 
IjiitlQm. Ati ef^ oiM' d)ty ohi Vhill ^idW I>cIow tin- surrAOi\ but 
not lo the bottom, while uoc thrw; dnyn nid will ewim nboiit jtirt 
iinmen(C<1 in ihc lt<jitid- If more thnn three diiys old^ the agg 
will fltiiit on the ittipfnee, the nriLiinnt of shrll pxjwi-itfl ini>TV9»ju 
ing wiih ng^\ If the v^ ii* Iwn wtyK??" old, oidy ii little <»f ihr 
9hell will dip in the li'piid, [Vnn>]dt ' g'wv^ tW folhjwing tul}l<* 
8fiowing llic digeAlihility of e^ : 

2 mff-hoiln] c|ot» Imve ihcf ftninaGh in 1) haun; 
2 mw vfixn ]«ivj< ilie titumich in 2{ hutim. 

2 tinrH'WIoil ccpk Imvc the iruimnch in 3 houn. 
V^g^ omelet iuivw tli« tdQindi^h in ^ hciQr?L 



' Faimen^ li\f\WtU\ No, 12a. 

' Huiehinn, Food ft«rf JfieUHei, p. 161 



78 



CLASSES OF FOODS. 



Tiic &ct ilrnt raw tgg^ remain in tbe srtoniuch longrr thnti 
4pfl-boilccl E-gg^ is ()u« to iIl^! fiujt tliat tlicv urc sn bliiod timt 
they excite neithBr the motor n<>r the secret<jry fouiction ] it 
rhoroiJghly mik^t.icatcd, hitnl-lmlttfl c^gs are as digp^tihlo ua 
Boft-boilwl ones, Witb a*niie |H;rsifn* «^ir^ in any form ftre 
indigivtihle^ and pnxliici* unjileafuiil eriiutation;^, imiisea, and 

liuw i*gg& are best t^kea directly from the bhidl, or they 
may be coiubiaed with milk bmtha or with colfee. Id varioua 
di-s<-iLse5 aCTJorapanled by Iom of fle-iL aud stivii^th raw *^rgs lo 
large oximbsra are prescribed, an inuuy a^ 24 tgga being given 
in twenty-fimr hfiure.' 

Egg;-albtimm in best ab»iorb«l when t^it^n raw und pmp- 
erly diluted, ltd |>AlalnbiIity may be increased by flavoring it 
wldi filuTry wine, oraii^, lemon, or ^pe juicCj or by serving 
ir in <^rwini, wtoua, or ci*t!W. 

Egg-nog is prepared from milk and eggs^ flavored with 
90UI*'- alcoholic drink, ajid sweetened with sugar. 

When allowed to remain in the aifj <ctb decompoee from 
the entrance of germs Lhrou^di their sh^h Di>com posit ion 
may be prevent^ iji various waye^ Bticb a^ by ct^titing tliom 
with oil or varnish, packing them in sawdust, or pladng them 
in cold j^t^rage or in certain aotutjons, siicli as mlicylie acid 
and glyo**rin. 

MEATS AND THE MEAT PREPARATIONS. 

Meat forms the fleshy or mitsciilar parts of the body. It is 
une of thi; most impfirtaut arlid^'^ nf fi mil, and \s tho chief 
souiee of mun'A protein supply. Meat may be eaten raw 
or oooked. Raw meit, when well ground, is verj' i-nHily 
dige&t^L 

Meat is composed of muscle-fibers held together by oonaeo- 
tive-tisMit baudfe; bt^tweeu the rau5cltvfiljers are hit* of ful. 
Ad ordinarily set^aj cneat ooutaine muscle tig^uef connective 
tJti^ues, Llood-vcMeelsj n^r\"ca, and lympbatie^, together i^-ith a 
varying amount of fit. The more fiit. th^re is in meat, the less 
wnifir ard mtn>g«nmis iiiatler dtie^* it fnmtain. nnd w*^ iwM, 
Cooking ha^ the cffi'i^i of rendering the ronnfcfive tiHsues aoln- 
ble^ thereby causing a ^epapation of the miiscidar fibers, allow- 
ing the digestive secretion to mingle more thoroughly with 
theoL Cooking also entiaocos the flavor and appearance of the 

» Elj. "F^ble »f Egg;' Nrv' York MuL J*^r., Notember 14, l«a 



mctttf but, OD tbvr i>tlj(-r haoi], caoMA a lo^ in fat aa<l «^xUw>- 
tiv4^ Ci.M>kuig likowisL* dttitjv^yg the Hiidro-organirtiTui Uiat 
mAy be prvM^ut ip Ui^ meut, and thus rvn^eru il morv u-hutiv 

Mmt may be oxikfy] in vanouB wavn — it may be bniled, 
tftewfd, roii«t«d, or fried. Meat i^ boiled by placiug it iu aM 
wttcr and subjecting it to n cjcxifrat^? beat for wjihg time- Id 
UiiA wav the connective tisflue becomes geliitirised, nod a por- 
tion ikf tbe oi^Qic salt&, albumic, and extrscttvee is diEisolved. 
Tbr? iuugtsr Ibe prrxmo 10 allowed uj cutitiimef ttiu more lante- 
lewt <lo«s tbe meat b«cotiie and tbi* riclier i« tlie brotli. This 
taatdcuft maM <if meat ba^ a bigh nutritive value, and, eom- 
biikfd witb tbe brvjih^ oonstitut^-s a numnon^ food. The 
procffwof fftifwing meal is accompli.shed by placing tliemcat 
in Ixiiline wafer* by means of wbi<^h (he albumLii cm ibo surface 
ift ouiokly coagulated, tlius preventing the juice from escaping 
and i^» reLiiniug ihe tiavnring matter ; the broth that is pro- 
cuired in this way is very poor in quality. Meat is roasted by 
placing it in a very hoi oven, llie superflcml layers thus be- 
coming immediately ooa^ulat4?d, and so |>rev«uitiug escape of 
tbe juice. To broil meaCf rtimll biU tire ofinkt'd ovt-r an open 
6re, tbe albumin of th<T xurfa<v hoinj; t.btis not only <^ki4gu1at«d, 
bnt thl^ tnnrr fili^ri* ht^wg t*o«keil at the same time. Frying 
tfl uci^onipli^ic<l by placing the meat in boiling oil ; the eurfuoe 
albumin is at onw cjapiilnlod, the juice is prevented frODH 
escapin]^, and the meiit in mpi^lly oookcd. 

Digestibility of Meats. — ^The digestibility of mi-nt^ ig 
goverri«l by tnuny conditions: Tbe ng(r uC which th*» uirinialg 
euleji wtre kilhnl, tbo length of tiitjc the mt^it i)* kept IwfoiT 
euting, the care bcAtowcd upon iho nrtimnl:* during life, and the 
mcTtluHl* of preparing the mcsttfi for the tabli^. Moat>^ are moiit 
easily digpfitnl wh<m st^we'l ; frying random ibpm m<»it indi- 
gwtiblf. The flavor of meat vsries with the condition of the 
animal from which it was obtainctl. Tlie meat of mature ani- 
mals Ia more pnmounccd and agreeable in flavor timn thut of 
younger eatth?. 

Tbe following table, tjikeri from Pcnw>ldl, giv*« the relative 
digesubili^ of meat fboda : 

One tct hr« Aoum ,' 7W t6 thrte hatn: 

200 gTu. bc^fjuice. 2fiO gm- cnlf '* tmm hotled. 

3S0 gn. ■wcQtliKii^ hoik^- 



80 



CLASSKS or FOOIHL 



7%irMi9/n^h^urKf Fovr to fan lumrt- 

2.10 gra. fitewod yoiin^ cljickon, '2\0 tcm. rau^l pij^coii. 

230 gm. broilftl puriridgt 3jO gm, rmrJt lilfet. 

240 gLu. tittwud |iL^t>ii, !250 ^m. tiL^vf-ivak grilled. 

195 gm. mmt pitfi'on, 250 em. smciked lonjpje; 

SGOgm. b(«f (mw or boiled J. 34J0 gm, bare. 

250 gui' t%lf 'f for^t, boil«L £40 gfd. rMM piiLtfiiltFCH 

160 Km. hnrn builcd. 250 gin. rotjit fTOooe. 

100 gin- ruprrt ve&l- SfiO gm- toMi ducL 
lOOgiu, bocfoicak. 
100 RHJ. bcpfulcuk pulp. 

Beef. — Th*» irnrnpoHitinn n{ lnvf varies gi^atly, c<§[M?<-Lallv in 
rvgurJ to the Eimutmt of fut ziud wuUt it coDtains* Au ox fn>m 
tlipeo to five VL'ui's old supplier the best Iwef. The meat of a 
very l«iu animal will c^iitiiiu about 75 per ceut- of water and 
about 2 |H.T *xnt ui' fut. The water iti fat m^t is reduced to 
between 50 and S-'j per eeiU., while the fat rraclies 2.5 jjer cent, 
or over. Tlic uniouut of nitrogenous substances ia also con- 
sidcTflbly reducwl in tat meat. Beef-fat is ctmiposed of tliu 
glyoeridfi of the fdtTv aeids, the nitio being three parta of atoario 
fttid palmitit* acid^ tn nne purt of ol^ie acid. 

Meat Preparations. — Nnmerons meat preparatinnfl, both 
solid and litjuid^ are now oti the market, tlie aim being to pro- 
duce a e*jneeutraled food that will be readily di^tiled. The 
diderent beef-juice« have bat slight nutritive vaJue, Dio^t of 
them containing onJy 4 or 5 per cent of protein; iheir chief 
vahie He^ in tbe fact thai ihcy i^imuJatc the appetite. 

Bouillons, — Bouillonff are pn.-pan^ by cutting meat into 
miuill bita^ heuting sh:)w]y ia water tor a time, and then boiliQg 
it quickly. The tluid thus produced bae a v«.ry a|>rceciblo ilavor, 
but its niitru-nt vnhie ie exeetilinKly flmall^ as it contains only 
exlractiveri, sidts, ami a vitv minute quaiklity of gelatin. Bouil- 
lons increaAi^ the flow of the dige.stive secretions, and cyn Iw 
rendered more nutritions by the addition of at egg, certain 
ceKals, or v(^tables» 

Beef- e^c tracts. — Jiecf-extractfi are concentntted bouillons 
tliat are to be diluted at the time they nr^ taken. Their nutri- 
tive value LB about the Aame au that oC bouillon. 

Bccf-julcC. — To produce a nutritious liquid beef prcpatu- 
tioii the meat should be boiled sliphtly and then out into small 

fiee<*i and presseil through a I em on -squeezer or a meat^presw. 
n this way conaiderable quantitiffi of protein, in addition to 
tbe saltfl and extractives, are obtained. The beef-juioefi sold f>ii 
tbe market, such o£ Valentine's^ are prepared by <iubjecting ihe 





meal to strong pressure. Tbcsc prcpanition« contom frocD 5 
to 10 per <x" lit, ol* protein. 

Meftt Povpdere. — The mitritiv^ valnp of thwp pivpamtioiift 
\'^es greatly- Tho^^e mofit fr^uciitly u»cd aix' a number of 
peptoDefi, Sornatos-^ And the Mofi^iieni ** hw{ Mm!/' 

Meat*jeUled. — MetLt-jcllie?} are frccim^ntly pwn to LDvalidA, 
and are an n^;reeabJe mums of ftdniirji?»ti;Hug pmtdn food. 
ALttiottgh they »Io not vtitiMy trplwv the prN>iriii in the ti}«ucT«, 
ihey prtxliice a con^klcroblc qtiuiitUy of rticrgj', Ai-conliiig to 
Bauer, " By ihi? addllton of ^eUtin very Jorgr qiinntitiM of 
nlbtiiQJa can be 8parv>l in tlw? bo(iy or dcvoto*! in hicrcn^K* of 
bulk, jiiftt as by ihe supply of fsta an*! rarlwihydmtj^,*' Meot- 
jelly is, therelVire, a pmtein-rtpttren Among ThoM? mf«t com- 
monly employed are cdf Vfool and ealfVbeud jelly. 

The followiii);; table, taken from ChittondoJi/ gives the per- 
ccntiige cjjmpositiou of heef-productH : 



CMiillta«iUi. 



WmMI (MILO^C) . . . . 
SalMnuiUirntUO^C.)- 
v^JaWe ID wBicir > . . . 
IbKilabtc !□ KxUr 
InortUUc coast 11 LtPiiU 
Ruintaiirlt? Afiil ^v^)kt ' ' - 
rfti,nbof mncUvM ^ . ^ 

SolDbLo Iti n p*F CC-ftlfnhol 

TvnUoltronn 

nirmn af lfi»o1abl« mMtor 

tivnlubl* pntcekd iDAtior ^ . 

SolQbl* ftlbunlo locMkAUUT« 

by bMtf 

SOlublO tfbUBlOM 

reifioao » . » , 

TaUl pr«l*[d nutler tvftlt- 

*1Am feA nutrliucDt 

NatrUIro nluQ u <?Aaipared 
Willi fmii iHD bwntcAa 

hect lOOK . 




*2' es. 

1-^ 



«J0 









M4 



TIM 17.30 111.00 400.CD 



n.og 

IIU 



VM 



An exomuiatiou into the cheiiiic cifmiHuiition of beef prepnrft- 
tions hft« reoently beta made by Dr. E, L, Whitney, Professor 
of Pbyaiol<^o Chemijilry in ihe Raltimon* MnHienl College, 
nnd his airai.>^tant. Dr. C A. CInjjp. A n*|>nrl of thrse valnahte 
jmnly>^«^ in advanee of their publication titu bovu fumiahed the 
nntfaora by Profesfior \STiitoey : 

* PtMeedingmf PkiiadelpMa (hmity MfdiasJ Soetefy, I(*9I,p. 150. 



«2 




CLASSES OF FOODS. 



it- 3 
4 t 



i I 



3 S 

5 S 

— « 












^ ^ 



2 S 



« 

^ 



*:^ =■ g 



1^ « 51 
C< Ct — 



g 



O *4 












4a 5 ^ 



III 

H d o 



II 



II 



*" ^ 5 



Hod 



SS 



o" o' 



' (« oc O 

— fr- o 

K d «f 

- CI 



t£ 



III 

H o d 



o o 



si "^ ^ 



Hod 



d O 






H ci -^^ 



- =■ gi d 



7 
£ 



it: " *"' 



! I 



d et 



J 



i 

1 



i 



•5 






£ J J 



= 2 



■n 



a. 
B 

a. 



"5 r 

nil S.MII 




AS IMA L FOODS. 



63 



Teal. — Veal is tough and indi^tible, especially when oV 
tuned fixriu aiiiitialM timt arc killeil too yuuu)£> It iLiir«n» 
ooouderably in flavor from bt'i'f, and (KjuIuidh more gdatmthan 
tlio ktt«r. Aa in mauy peraoofi voal iiAa a t^-DcleDi-y to produce 
iiidi^fi'^tion, It iH 1o W avairled m all oaiie« of (lifj;<>«livo ([t'lilllty. 

Hatton. — Mutton is <.v>DHdercd more c!i^stt)>t<- thai) l)orf 
by EiiglL^li writ^re^ probably l>eoaiiBe in FZn^land th<* Average 
mutton U more t^nJer than that obtained in the ITnited Si^im ; 
the beef, however^ is bferior U* that miaed in thU country. Its 
fiber is finer, bm it wDtains more fat than does beef Mutton 
&i contains a larger proportion of glyoerids of stearic acid, 
which makcfl it more ftolid and leea digestible iliuii the fat of 
beef. 

If^mb. — Lamb, when of the right agc^ and tendorneia, ift aa 
digestible as beef or mutton, but it oonrain.i entirely too munh 
fat. 

Venison, — Tlnlesft obtained from young animals, when it 
ifi lender, highly flavore*!, and short-fiberedj venieon is apt to 
be difficult of digcfitii.in. On account of its stimulating action 
it fehould be avoided by dyMpepties and others with weak 
atomachfe. 

Fork. — Pork is the most indigestible of all nneats on ac- 
count of the largi? [x-iyN-^olage of fat that it oonlainH, This &t 
condsta chiefly of tJ)<^ glyt^ri^le of fAlniiti<' and olr^ic acidn, and 
may be i»rr-^eiit in thv pwiporlion of 37 |«t (wnt. or more. 

Ham and Bacon. — Ham and bacon are both more di^jitU 
bi? that! pork. In seme part^^ of (aenoany ham plays quite an 
important jnirf in invalid dietaries, but in Knglana and Ameriea 
it is »Hrl*.h?m pit^orilxti. Itacon is used lately a* an army 
ntioa. %Ybt'n oo*>k<'d crUp, thin Blice« of hacon are easily 

Horse Meat. — Hoiftc mcnt is not ueed for food la the 
United Stnt^ or in England, but i* oonsunie*! in lar^- quauti- 
iifin in Francy and Gtrmany, and to a leR.s extent in some otiier 
European countries. 

Rabbit. — When young, rabbit meat is quite digestible, bat 
it iw u-i-unily omiUcd from diet-lifits. 

FowL-^hick<n in one of the most dig^tiblc and agree- 
able varieties of meot^. The meat of yonng pigeons al«o is 
especially digi^tiblt^ ; tliat of ducka and geese contaiu« too 
mncb fiit. 

The Hcj^ of game in c«aily digested^ the meat of the breaet 
being befit a^laptml for invalid ufw. 



^K M CLASSES OF FOODS. H^^^H 


^^M The following tabl^, Ifiken fVom Aiw&ter/ givES the geneial 






Witcr. 


Fti>- 
Mla, 


Fvi. 


<Xrbo* 


Jah. 


Funl 

pound. 




f^ii£ 


JWtf. 


rw-jrf 


.fhvi* 


7hr«« 


t^^ 


Abr. 


^^H Bnt frMh : 


1A1 


eta 




Ifi.O 


*TI^ 




% 


^^H rUnK 


US 


H.D 


17,0 


IV.O 


, . 


0.7 


Utt 




l^B 


f^A 


ld.1 


17.6 


. , 


Oil 


un 


^^B j''>nt*rhi^ijitf iit«UE .... 


VL7 


03,4 


1fi,l 


17.9 


, , 


DA 


itoo 




IIB 


MO 


10^ 


10.1 


, , 


00 


vn 




ib.9 


I4.fi 


n.9 


- ■ 


0,7 

a7 


U4fi 








Ki.V 


IU,A 


lfl.7 


, , 


0.0 


lou 




:,:i 


(iO.t 


I1».U 


12.B 


J , 


to 


wo 


^^^H Rump ..>..,- 


aJ-I 


4.\<t 


m.H 


At^ 


. , 


0,7 


luvo 


3«.ft 


4iW 


i:i.s 


7.3 




0.4 


M& 


^^^H l<buu]ijcr ftiiij clod ^ ^ . > 


JD.4 


M-H 


1^,4 


v.o 


. , 


UJ* 


7lA 




U7 


«,1 


;ts 


1T.A 




0.T 


9S5 




lC-7 


M.4 


U.4 


is,a 




0-7 


lOtf 


^^^B Bctt, conivd. Tnnaedk pkk> 














1 


^^^1 ilrivd! 














' 


^^^H Corucd U'of 


e.4 


4^3 


14. S 


391B 


. . 


4.4 


1N5 


^^^H Dried, baU^. unit pinokcd 


«u> 


OB.B 


ll.W 


19.2 


, . 


4.2 


lOH) 1 


<.? 


M7 


».4 


a.v 


. , 


US \ -no 1 


^^^^H CAiin"ii ^i*iil*^*l iHTiif, . , . 


, , 


Ol.A 


3(».n 


z^a 


, , 


i,a 


UK) 1 


^^^1 Canned C4>nir^d bvor , , , 


' 


fiL8 


' M,S 


t«.T 




4jD 


1270 


11, s 


»l.l> 


1A4 


ILO 




o.« 


74ft 






«1.1 






■ ■ 


0.V 
10 


dao 




^^^H rortquarter. . ■ ■ ■ < < • 


W.ft 


M.ff 


1^,1 


c.n 




0,7 


«n 




30.7 


u.:£ 


16.3 


04 


, , 


OJ 


uo 


^^^H liiti(k.^ii 


















v,« 


».o 


13.B 


3C0 


. , 


OJ 


'3 ' 




111,4 


M.3 


in.l 


l(.7 


^ 


0.0 


^^^H LoIncJiopa ........ 


\U> 


42.Q 


13,:> 


ZB,> 


, , 


0.7 


14U 


^^^H TVr«iu&rt<'r , - . . - 


^a 


«u« 


US 


».A 


. ^ 


0,7 


LE» 


^^H Ulndiiuartor. wltliool tftl- 


















i7.a 


tf.i 


tS.8 


»3 


^ _ 


0.7 


1310 


^^B l^mb. 
















^^H BfouI 


ifl.i 


4».S 


1£,I 


19l1 




OS 


IDA 




17.4 


&7.V 


l&.V 


ia« 




0.9 


8» 


^^^H pork. fPMhi 




10,7 


4S.0 


ia.fi 


35,V 


, . 


O.fl 


im 




Iftl 


41.8 


tl.4 


Ulf 




OB 


134& 




ia.4 


44.0 


1^0 


3.B 


, ^ 


0.7 


I4H> 


^^H Pork. iMtfid* carad, «o<l 
^^H pith led < 

^^^H Horn. Haiitkvd 

^^^B ^houldi^MQOked .... 


, , 


fAA 


Ihfl 


18,0 


_ ^ 


IjO 


Boa 
















1L« 


H» 


14.2 


3Su4 




4,3 


i«» 1 


1&3 


«,s 


ut.o 


U.fl 


^ ^ 


h& 


i«« 1 


^^H Siilt[Mjrk 




7.B 


1.9 


M.:f 




A.9 


AH6 1 




'7-7 


IT^ 


a.L 


K,2 




4.1 


im* 


^^^H B&iJMieo : 


















U 


s&,a 


t«.2 


1B.7 




IB 


UfA 




• 1 


ftj 


la.o 


H.a 


i.i 


Z2 


30f5 


^^^H lotip* 




fi7.3 


1».A 


ia,fi 


)a 


14 


lltt 




BI.4 


il 


2.fl 


&.I} 


LA 3ft 




» « 


919 


4.4 


0.4 


1.1 


1.3 m 






Bt.fi 


4, A 


4,S 


fijs 


u m 




1 f 


W.O 


lA 


l.L 


5.B 


Uh lO 


^^H PogLtrr: 


414 ' 48,7 


12.B 


1.4 




O.T SOS 




IB, 7 


13J 


, . 


O.T 70 




UI.4 


WA 


. . 


U,T 14TO 




UI.1 


IM 


- - 


0.B loao 


^^H ■ JViwfipfai ^ jTnir^iwn, Unitod 6utofl Dopaitfowt ^ A4:Hcru]tun, p. 16, 



ANIMAL FOODS. 



6S 



Animal 'ViBCCra. — Aninial vii^cera are not »o nutritious, 
ftltbuugli aumv lit' tiaeiii ait? quitt- h» tll^^libUT a^ itiiK«t iiK'atK* 
Tripe, IWetf kiduey^ t%tid bruinji ore catcD v^-iy rxtvuMvcly. 
Tbo be«it i« tougb, indijiestibl^, and but Mf*idoiD vnten, TIiq 
blond of th<< |iig tm^ Lwcrt nituli* into n fnrm **{ piLflding and is 
relished by w>fue. Swwtbri.tuij*— ciUicr Lke jmncrea:^ or the 
tbjmu» gkud of tliu wif — lux" cjwiiy dii^^tod. 

Tbc following Uil>l<T, fximpikd by Hiitcbi»oii/ gives the 
general com{Xi(4itiou of animal vUix^ru : 



»S«?(*««P) 

TJi-nr it>x ) 

lA*et (vhivp) ....... 

Uwrt kix) 

Hrsrt (Hhbt^) , . . . . - . 
iMiitlinx] 

8wwihnaijtf . 

Blood 

Trit« 

TongiiA (ox), frnli 

ToDffiMi fuaoicd mnd mlt^d - 



WmUt. 


Vitro- 
mnwtm 

KOMUiT, 


Fftl. 




76.7 


14L0 


IB 


0.4 


7«,7 


15.8 


S.2 




71 .a 


S0.7 


4.5 


li 


01.3 


Ul 


9.0 


5.0 


OS.f) 


t6.0 


20.4 


, , 


O0ii 


17.0 


is.e 




7ft7 


ld.1 


a2 


, , 


7tkd 


».2 


2.6 


^ , 


709 


16.B 


IS.I 




60,8 


l&l 


0.2 




74.6 


1A.4 


18.S 


, . 


tt3.a 


17,1 


ia.1 


, , 


35,7 


24.3 


3J.6 


. , 


80.0 


&8 


9.3 


1 



190 
L80 
1.00 

V70 
1.U0 
(XOO 
LOO 
1.20 
100 
C.8fi 
0.50 
LOO 
a50 
1.10 



FISH- 

Thc fiifTcrent kinds of fish varv widely in tbpir nnttittve and 
dige^iv4* qualities. For example, the tloutulfr aud tJit? ovriter 
an mtiob eeaier of digestutn than thoae that oontjiin a lar^ 
ammtnt of &t, like the saluKni und tb<- liornng. Kul:^ G<jntain 
tbi* greatest proportion of fat, which may rcocb 2ft per cent. 
While-flea lied fieh, as a nde, oontuiiiM littli! fiit. 

AH fii^h arp lie^t in sivi^nn ; out of K^nnnn ih«y lose flavor 
ftD(] have a diminished nutritive value, sod m some eases de- 
velop an offensive odor. These chan^fc*! are due chiefly to the 
change in foot]. Fish are m hest condition just before spawD- 
inj; ; after this process they become thin and unfit for fixxl, 
Tlie flavor of [«orac varieties, aucli as the ray and the turbot, is 
{mproved by keeping. 

On acxwint of the rapid changes they nndcrpo hy way of 
decomposition, fiii^h nlioiiTd always bo aatcrt in as fnxh a cx^ndi- 

' Fwd Olid Prmeipla of Di^tet^ctf p. 79. 




CLASSES OF FOODS. 



ticii VM poraiblc VuriouB methods have beeo reported Ut willi 
u view t*j preventing the.^ ohangi^. There are nmny nitKlcrn 
c'Oatnvflnoeft fov prcsorving fisli, and drying, sruokJng, pioUlingf 
aultiDg, autl cunning are pnictlsed on u large »cale. Thcise 
Euutb'xljj ail ruixlifv the flnvor more or leJi^, 

T}i&re ai^ ^veral varieties of tish that are ]>oijiK)noiis. Tti€se 
are, however^ coiiliiit-d oliiefly to tru[>!cal waters. Tbe panisites 
diat may he preseDi in finh arv destroyed during Uie cooking. 
J'tomaip-poiauning Ia of ralber rare oecurrenoe, 

TLe fuUuwiug Uible, lakvu fruui Lungwjrthy,' giv« the com* 
poaitiou of the taix oiohI ci>uiQioii)y oitea : 





Q/mftoHtion q/ /UA. 














lUnd of rood-mtl^tiAl. 


u 

a 

fWfl*. 


•J 

Oh 


1 


1 

£ 
Ptra. 


i 






1 


I! 


/VtsAjUA. 


rtrt* 


Ar0. 


/*ra 


ftrrt. 


J^ft 


GJor- 


AkvUb^vbolfi 


aM 


- . 


ffJl 


B.7 


9« 




0,1 


IMI 


MB 


ilrrwcil 


-tT 




41 A 


104 


OJt 






0,B 


11.4 


31A 


Bou. larK^'TaoaUt^ bUck, 
























«u 


. . 


Uj% 


%Jt 


04 






OJ 


0,4 


IT» 


B4KA, »ma]l-tu'mlhui1 Mfrck. 
























M4 


- - 


4HA 


US 


lA 


■ 




0.7 


ISJ 


m 


Ba», mutll-iDOuUiod h]Mtk. 




whala ----- L . ^ 


flail 




U.7 


10 J) 


1.1 






00 


117 


SBO 




4t3 




4U 


lOi 


D»3 






0.7 


Li.O 


i» 


Bi.1 




3IJ« 


8.» 


0,2 




00 


«.1 


IflO 


BftM, Kirlpi'll. rlTVMd .... 


KIT 




r.4 

BS.O 


»,7 


X2 




O.f 

O.B 


11,4 
0.0 


3U 

iTfl 


ftuttarnb. Jr*— J - - . - - 


4ftS 




10^ 


0,1 


Ofl 






0,7 


tl.l 


3DS 


MjB 




A»-» 


lU 


7-2 






0.7 


iv,a 


ruo 


BultonlihHWliOlO 


4U 




40,1 


10,3 


C.A 






00 


17,1 


4S0 




St 




4Js.i 


1Z« 


0-7 






O-O 


I4JI 

ll,fl 


370 




4SI 




71* 


14.9 


D.(^ 






l.O 


1^.4 


Ktf 






«»-0 


10,1 


0.] 






DJ 


10.7 


1M 


Kfil wLt-wAtor, (1r«Mf4| - - - 


30.3 




fli-a 


|4,« 


7,3 






D.a 


n.* 


070 


Flounder. coinmoD. drtscd 


070 




W>H 


ALA 


a» 






u,e 


7-V 


IW 


Ploand«r. wIfiMr- drcHod - 


M.2 




sr-o 


6.E 


0^ 






0J( 


fl.M 


iX 




AU 




>UJS 


7.1 


0^ 






0-£ 


S-U 


tn 




01 J» 




40.1) 


Ai 


0.3 






0-A 


H-O 


lU 




r.T 




OUV 


IB.I 


4.4 






o> 


S0.4 


4U 




4AJ) 




ar.3 


to.a 


A.9 






as 


IB,7 


430 


Bfackcrcl, ilrcwcil ■ . . ■ . 


4V.7 




**.T 


ii-i 


aj> 






Dl? 


la.o 


soo 


Mftokor«l, Si>an1»b, dn«i4 - 


24J 1 - - 


M,4 


Ifl.B 


7:3 






]J 


11^ 


AM 


Mftckcrcl. HpnnliA, wbolB. . 


HJt 




44JV 


laj 


B.a 






I.O 


n.9 


»10 


HullPt. i1 rawed 


4PJI 




BB-i 


O.A 


1j« 






0-fl 


[?.ft 


2« 


Mait«i. wht>l« . . . t . . . 


flTJ 




ai-a 


iki 


ua 






0.0 


10^ 


21a 


PvkIi, white. df^«c<S - . . . 


&U 




>M 


«.? 


U 






0.0 


11.0 


330 


Fcrch. vhllr. vholv r .... 


ori 




9»,4 


r.t 


1^ 






0.4 


V.l 


IM 


PDrch.rGlbv.drT$Hd . , . 
Pickerel, ilrttted , 


w.i 




»-7 


1^4 


0.7 






OJO 


M-3 


30« 


UOJ 




AE.l 


ii-t 


OS 






OlJ 


ia.0 


Stt 




47pt 




4U 


»,* 


03 






0-7 


10,T 


1» 




■OJ 




U-t 


IB-ft 


0,4 






0.1 


14.1 


3«D 




«U 




44.T 


lO-T 


0,» 






Q,a 


11-fl 


^0 




3&T 




ALS 


t«J 


O.A 






M 


xn 


Blfl 



< i^A nt food, Fannefi^ BuUctiD Ifo. 86, United QtAita Dcpartmrnt of 
AgriouUur*, l»t»H. p. 12, 



^^^H^^^^^^H FOODS. ^H 


^^H Clad or fbod-maUrlAl 


u 




1 

1 


t^^ 


2 


^1 




111 1 

■ 




iwtf. /WA fwtf' ^'''"'* ^^^B 


fWvAjlih. 


Ardft 


I1V& 


*W IK 


1 


1 ■■ ■■- a^^i" ••'*»- 


^^H 




14.7 

u 


' ■ 


MA 

WS 
HuO 
4IXB 

11.3 

mji 


1«4 


14 

^1 

as 

4.4 




93 

O.T 
0.A 
OVJ 
0,* 

0^ 


ml 
iai 
ai 

lOJ 

>u 


)7a ^^H 

940 ^^1 
KM ^^1 








U.1 
41J 




Mvl 




4J 




a? 
u 
to 


14.7 
lift 


ITS ^^H 

SOS ^^H 


Star8«oa.(inMMd . 
Tomeod, drwinJ < 
TiDinoo()4 «iiul« 
Tnjut, lirvofe.drOMC 
TiQUt. btvtik.. wli'iM 
Trout lAba. dnnod 


. . . . 






4M 

0,0 
A1 


IS 

u 

n.J 

M 

114 


0.3 

u 
J,l 

ai 




u 

04 

07 
OS 
0,A 


8.4 

la; 
laN 

IT.4 


no ^H 
MB ^H 


Taftwi. vhnlii , , , 




«T.T 




n.» 


u 7.n 




OT 1*0 


140 ^^H 


WvAkflnh, whdLo 




4U 
HJ 




3U> 


irtl 
M 


u 
u 


. : 


aa 


lai 


wo ^H 




WblUUali, drcHtfd 




4M 




■L4 


1U 


L4 




a* 


17 jO 


SS ^H 


W?illflft«(iH Whol* 




ttJ 




BLS 


lOJ 


a;Q 


, . 


aT 


14jD 


no ^^H 


Oannml ■*£»■« of ftMlk Btb 


















^^^H 


H *»M - 


4U0 


- - 


ujD 


IU| u 


' ' 


LO 


ICfl 


ODO ^^H 


jy«f-wd^*A, 
















^^1 


K40VfKiJ. " No. U" lAltod 


i&A i rt 


»1 


IIT 1 1A1 




L7 


>1^ 


«io ^H 


Co.1. Ht^tol ftild ilTle4 - ^ . . 


».» 


ir,a 


40.» 


14J) 0.4 


. , 


Ip3 


tT.I 


^H 


Ciwt, " bmoloM eodflib." ult 


















^^^^1 


M^d dried- ....... 


, , 


lU 


6U 


^1 


01 


, . 


17 


M.1 


41A ^^1 


nirlAr* 






M.1 


axo 


lo.: 


7J 


4M 


4Q,» 


loao ^H 


nvrrlnjr, KlUd. ■iiiot«d,«nd 

*Tr|«r - ... 


1 














^^^H 


H4 fl^ 


1^2 ; 9U 


»j 


. . 


4J 


«^ 


^H 


nik/lduck. "Dndon liiiddJo,"' 
wm aaliud, 4m<>l(f]d um drtod 


1 














^^^H 


Sit 


M 


Ift3 


iM ai 


. , 


1.0 


171 


lOfi ^^M 


^^B HftUTiui. aalUd.imolL«d.4nd 
















^^^^M 


^^B driud 


(U 


Ltl 


tiut 


19.1 ' I4,1> 


. . 


l.» 


inn 


MA ^^H 




BJD 




axA 1 Mu rij 


. ^ 


Ul 


414 


VM ^^M 




M 


t.V 


».a ivj lAA 


- ■ 










^^■_ MMli«r«I.»]lHUnii«d ^ ^ 


iftj 


u 


MJ 


lAM ; liJi 


, , 


LI . B7.3 


iiu ^^H 


^^^1 TUikTiT iEi«rv-iiiuk«rttlk 












^^^^1 


^^^1 cftunod .... ... 


. . 717 


S1.B 


u 


, , 


1.7 1 ^2 


fiTA ^^H 


^^^M lUd^DCk, BmoKM. c«tin«d • ' . 


lA M,r 1 11^ 


" 1 ■' 


t^ 1 n-f 1 «oo ^^m 


^^1 Craataceans. — Th<^ mort popular of tho cni^uooww oto ^^M 


^^1 the cmb and th-.^ lobster. Tliey nre highly initritioEi^, bat tt ^H 


^^H the same time highly indi^eHlihK lx\ aom^ permns tho rrat> ^^M 


^^B and the lobster are especially apt to bring on nmiscn, vomiting, ^^M 


^^H ftnd other and moro distn'ssin^ comliliotis. ^^M 


^^H Shellfish. — OvEter^f c'latn^, nmi mii?!iF«<;I« an> the fomiJ< of ^^| 


^^1 Rht^Ufi-sh chieHy eatoii. O^-rstOEV, ^vlicn ^\\v\\ frosli ami ru\^\ ^H 


^^M cone»titute the most digi^libk- animul f^Kxl, but wboii ooi>kod, ^H 


^^H their di^tivpvnUic in nmrl Imvi-rt^. Tbi.! ^ift jna-t ]n pnrjKtr- ^^| 


^^H Lioiiulely larffcr and more niJlriliou?« than the <Njrrmp'>iidmi^ ^^M 


^^H^ portion of ihc clam. The; liard c>r roUMOLjlnr porti^vu U tough ^^M 



88 



CLASSES OF FOODS. 



uni) mthcr intJigc^iblo, su<l is be«t omitUxl from invalid dictn* 
rics. Oystera ehonUl never be fried f'»r tlie »ick. It may l>e 
well here to ciill nttentJori to the pnctioe of '* fatt^jning" 
o^retere for tii<> market; thiit is done by plaoiog them in either 
fresh or salt water for a definite length of time, tthioh gtvee 
them a fresh aiid plump appeamDC4\ If the wat^r ueed (or 
thi!< piirpo^ coDtains ^wnge, c<:}iita mi nation \rr sure to fallow, 
Oy&ters iiave iii inaDv cases been the eitrriers of typhoid fever, 
aod moiiy jjerKms have been iufectetl in this way. 

C1atu8 arc a jMipuljir article of AieX, and ure as agreeable to 
most puldtes n£ oysters. Mas^ls are i^iiDAumeil cUieSy by tlie 
poorer olossey lu the seap^irt towna of England. 

Luugworthy ' giv^s the following table of the average oom- 
poAition of molluelcs, crnataoeanr^, etc. ; 



ChmpotUion of Mt>Uwki, i^^acmn*, etc. 








Kind of fbod mkt«ri^. 


la 


/Vet 


1 


1 


g 


II 


IS 


i 


l! 


MOlhuU 


Pvrd. 


iVrf, 


Jfcret 


Fir A 


Ar£«. 


J^rt, 


ftr*f. 




Oy»tcn.«pIli . ,,,,.,, 


, 


, , 


flaa 


a.] 


1.1 


S.11 


US 


11.7 


3H 


OytttTi, In ■bell ... . , . 


ati 


. , 


1K4 


1.1 


0.2 


O.fl 


0.4 


Uf 


40 




. . 


, , 


i&t 


7.* 


2J 


&t 


1^ 


1 1.7 


soo 


l^oJlorfl . ...,.,.. 


« • 


■ w 


aa,^ 


14.7 


AJ 


a.« 


U 


I>,7 


3tf 


Lonf cURiii, In »h«1l . , * . . 


M.* 


, . 


4(L4 


4Ji 


(r.rt 


Ll 


IJt 


H.O 


M 


Loni rEam*, ojtnnpd - > > . 


. , 


, , 


BU 


«.!} 


l^ 


?.» 


tJ 


lA^ 


270 


Jtouti'l rlKmBn niturrv*} rrom 




















■bpll , . . 


. ^ 


, . 


MA 


lOJ 


1.1 


a.] 


2A 


ij>-a 


MO 


KountleuuniiH lA Bhell , . , , 


«M 


, , 


t7.t 


tl 


0,1 


i.t 


o.» 


1.4 


«3 


Itonnd danut. <<t]in«d , , , , 


. , 


, . 


0&1t 


10.4 


0.8 


a.0 


2J 


i;.o 


9^ 




40.9 




4XT 


44 


QpO 


V.I 


M 


0.0 


I4Q 


OenntU •vvimn of mollaiki 




















00.4 


■ ■ 


UjO 


■Li 


(L4 


1.0 


OJ 


\0 


100 


0^iC4iwnu. 




















LobiUir, Inibi-Il ....... 


«11 


, , 


ai.i 


SJI 


0.1 


. , 


o.o 


o 


Itt 




4 , 


, , 


TJ.« 


]«.] 


1.1 


0,4 


L4 


n.1 


8M 


CmrfliiD, In >hc11 ■-■••. 


VJ.T 


, , 


10.0 


a^ 


0.1 


0.1 


0.1 


zs 


40 




«M 


, . 


MI 


T.> 


9.9 


OJ 


1-4 


HKl 


lU 




. . 


. . 


mo 


ISM 


1.A 


0.8 


I.U 


20.0 


S70 




. . 


, , 


ns 


1»4 


1.0 


o.a 


n.s 


W.9 


no 


Qomrnl hvctruffl ft cntMju^ 




















HUB ichi'luaLve uf cAuiicdl - 


7>,T 




3D.B 


4J 


0.4 


OJ 


0.0 


M 


100 


ThTrt/rfft, lurfit. ftf- 




















Ttmjtln. In Hhvll , . . 


7»J 


. , 


iM 


1.0 


OpT 


. , 


012 


14 


110 


Qrccit innU. In Hhcll . ■ - 


fHO 




10.1 


<A 


D-t 




OS 


<;» 


00 


PravtHfitft , 






MO 


4J 
10.? 


OJ 
0.1 




OlJ 
OlI 


1.1 


10(1 
>10 


OeaoMl ATCTsiK of ti*t, mol- 






















44.« 




41B 


100 


U 


Oil 


OB 


1U 


m 



* F«>ft CM Food, Fftmiere' Bullrlin No. 85, fnitci) 6l*t«o Deponinent of Agri- 
CUllUtv, 16B0, p. 13. 



I 



rSOKTABUt POODS. 
VEGETABLE FOODS. 



W 



Vftgvtalil? (otxb dtflTur from Aiiimiii food» especially lu that 
ihty or>nUm a lai^ pro|>ortj«iii of *it«rch and sugar and oom- 
panUivi'ly a smaJl amount of p'^U*iiL. Y«o ' givpK tJio foIlowiDtt 
tabk to fallow the diflerenoe beCwecu vt^etoljlc aiul aaimal foccS 
in thifi iTgaTxl ; 





CtDTU 


FM. 




MttL 




fiL4 

89.4 

16.ft 
7.7 


0.9 

0.4 


* 
08.0 

ai.9 

01.2 


Ol« 
Dl7 









Vegctablce do, however, contain a certain amount of protejna 
and fate ; sODte are rich in [>njteiaa, othern in fatx. 

Carbohydrates of Vegetabled. — Thc-JH- arv atarchca and 
sugars. Starch is fouud in all pbuite, and \» converted into 
dextrin by moina of dry \u%i (»r l)v cOf.)king. The Htareh- 
ipnnu1i;» in vegi'tablc* art' held together by a ci^IluIo«tc fVnm^ 
work Cdlulosc i« a carbohydrate, but is very iiwoliihtc; (t 
can he iitilia?d afi a food only wjien young ; whejz oltl, it i« 
r^islant and can not be digcste<i, aad binders digi'Jtinn of 
the rtarchtt* enveloped by it Beside* the starch and eellulow, 
another form of carbohydrate, known as pectin, Is present in 
acme vt^^fnhU' RkkIh. WLen fniit i» coolted, this |iectin gel- 
atintKcff, and the jelly when digcflted \^ eonvcrtwl iiit*» a rvrtnin 
form of exif^T. Sugaru arc altK> iQipoitant oarbohydratcfl found 
in v«getab1<««. (The refuler bt referred to p. 1 03 for u dctniJed 
dexTiptinr of sag:vrp.) 

Protein In Vegetables. — Thcw prot**irie belong mainly 
to the globulins, but in n<)ditton vi^^tablcA oontain a Ift^gv 
number of nitn^i^noui^ >'ub»;tan<^'4^ tJiut are not proteins. Among 
the ^-arioufl prot«:*in^ in v<>g<ijibloft are g1ut<-n, n# found ^pix^ially 
in flour, legumen roun<I in the ]<^mc»^ and vegetable proteb 
fimnd in vc^elalflc julcx'*. 

Extractives in Vegetables — TKrre w n considerable 
amminl of fxtnicti%''' mutter in 04^rUiin V4^tabl«e, such a£ 
JuipnmgitK, which \* not lltiliireil in the hntlv- 
' Food in HMiltk and DUrcte, |x M 



IN) 



CLASSES OF FOODS. 



Pats la Vegetables.' — Th^ fkts in v«gi*tjibla< itre chiefly 
iu the if.>rm of oils. In ad^Utiou, vegetables contain u coiieiJer- 
able auioiiiit of 'vrater an<l salt. The amount of water vori^ 
between 70 nncl 90 per cent. Thf nmin mineml oonsthueiiU 
Are lK(> a.i1t>^ tif jx^tus-^iuoi and &ot\\xim unileii with M^rnc udda. 

Digestibility of Vegetables- — Tho dige*tiou of v^e* 
tables takes pUi<?o mainly iu the iot^stine. Curing to the 
greater bulk of vegt-table fotnl and to tlie oellulasc that aur- 
rouoda vegetable cells and tLus (>revents the ready aooe^ of the 
digestive jdcea, vegetable food is nol eo easily digeeled as auiiuat 
food. (For an account of the ahsorb&bilicy of vegetable iiHRla the 
reader is referrt"! lo p- "l^*) For convcnicuoe of destTiptioti 
the following oladsIflcatioB of vegetable fo<xU has been adopted s 

1. Cereala. 5. Fruits. 

2. Lt^umes. 6. Kutd. 

3. Roots aod tubora. 7. Fungi. 

4. Greeu v^^etables. 8- Lichens. 

CEREALS. 

Cereals are the moat important foot! -proti nets derived from 
the vc^table kingdom. Of this ohisB nf food^ tLo^e in com* 
moaest uee ate wheat, corn, rj-e, oatH, Iwrley, rio*, and buck- 
whoit. Tbe cereals are eaten chiefly after huvicg been ground 
into flour or meal. Fluur is uio^ eDmmonly made from wheat 
and rye, wlier«Aa com and oats are the chief ^oiirce^ of meal. 
Com la aleo eaten io lurgt' quantities wlioU, and bnrlty aod rica 
are also eateTi in thi^ wtiy. The following t^ble^ gives the 
cbemic comjx)sitiim of the mo»4t comnion cereals : 



Biriey 

Biickwheiii . . . 
Com (niaiie) . . 
K&fir cL>ni . . , 

Oai« 

Kw 

Winter vnrioli** . 









Cu-bafarilnta. { 


W4tW. 


ProtoLn. 


Fat. 




CmAa 


Pwranl. 


per eeiU. 


/^ff«l*- 


7V ftrnl. 


Af «it 


lO.fl 


13.4 


1.8 


69.8 


2.7 


13.6 


10.0 


2.2 


1U5 


8.7 


fl.3 


9,9 


%» 


74.» 


1.4 


1G.8 


{).ft 


a.a 


mJi 


1.1 


IU 


IU 


5.U 


MT 


9,5 


12.4 


7.4 


0.4 


7%.2 


0.2 


11.6 


1O.0 


1.7 


Tao 


1,7 


10.4 


is.fi 


£.2 


71.2 


L8 


las 


II.S 


2.1 


7£0 


1^ 



Alb. 



%i 

1.5 
04 

1.9 



1,8 



^ UnEtad SUten Department nf Agrictiltarv, Off^oi of Exp«ri^N^^t 8tattoa, 
BvllotiQ No. 11, fp- 16 and 17, am\ fiulictia No. *2H [Hcriocd Kdition], p. 50. 




VEOETABLE FOODS. 



91 



Wheat is tbe most important source of flour, owiug to the 
fact ttiut it can Iw niiwl tn uny tein|)rrvlo cItmuU: am) yield* 
Uw bv3t flour at tbo least r;t[N;ii!«c It i« rich in w>luls utid <K>n- 
taifiv little vrnUr, The wh<nt-gmin la covcrwl by six layers, 
which form the hmn. Of tbng<> hix, tht* thiv<> oiitormcwt ooat4 
fnnn llii* flkiii, iiml th^ rL^muining flirti^ Inyr^m thp 4^vdop »f 
ihc grain. Th<? onU'nu'.i^t hiyt-r U «ilIM tho t<^ta: llic iDni*r- 
iuo»t, 4>r <!i'TVtt1 hi>>T, tuk^7< i(« mimi- fnim the ecroaliu which it 
coutaiii^. Within tlic- <:i(^reatiii hyrr, and aJjaa-nt to the embryo^ 
\im tlic cii(i(wt)fnn, wliidi rfnitaiiiH th<T staHi< The unbryo 
licHftt the lowiT nnl of the gniin^ The livv otiur layer* are 
ouiij|xwi*<l <ihiofly of cwUuIob^ic Thu vcrcul layer im the rioht^t 
ill [utrc>|^n<>iL<^ rtulMbiiKx^. Thi? un<)u«|>iT(ji (^>tkt^iini« a krgc 
amoiitit of Htaroh, a nttrogcnffii? ?nbst<tiio<r ('aUciI ghttcn, Eu>me 
ftugnr, nni) fhi* <*<>lhjl(>M^ nf its cell-walL 

Flour iJi mmlo hy grimiing thor grain of the varioiiB ocnalH. 
Although dour b made chiefly from wheat and rye : barley, oata, 
Daizei etc., aiv alw mauufacture<l into flour. 

Bread is made by adding to flour a detinitc proportion o( 
water, a Utile salt> and theTeavemng agent* The mixture op 
dough ia then kneaded, either with the hands or, better, with a 
apoon. In the largA modem bakeries tlie kneading in done en- 
tin*ly bv m«chinfry. Aftrr tliin ihr d'nigh b* ^ct anUh for a 
number of boun*, during wbkb time fcmn^nUi-tinti taken plao<v 
It 19 th«n molded into loaves and baked. Tbi> It^aveatag in 
dppi^ifdf^nt tipon tlie actum of tiie yeast on thi* starfh, snmp of 
which it convert** into sugar, aiid then intj) abxibol and carbon 
dioxid g;u4. The gits cjuw^'s luibbtc^ t*) app^ir Ihnjuehont tbo 
doi^hf aiul readers it light and ^|Mmgy. Dnnng the baking 
process Uie yeast germs an^ kilWl and the alcohol and carboiiif; 
acid ga* arc driven ofll Hot or rre-*h brca<lf when maHtifyit^Hl, 
(nrm& a teuncii'UH, donjrliv ni\i^, and hemv is not r»t dijj:tt*tibli! 
as stale brcnd, <>r brrsid tiiat bus l>een ]ill<>wrd to dry nHghtly^ 
for the latter will orumhle int*> finer partial™ and no U more 
thoroughly miTe<1 with tbv gastric juice, Tf)iwHng l^rcad miike* 
it more digestible. A dice of bread remains iu the stomach 
about two and ooiybalf hounf. 

Xext to whoat bread, which tbnr^ far ha.s alone Ikh*ii nieu- 
ttoncy], lye br«iid Is the mo*t ini|iorUnt of tbi' hn.tid.4tntrH. 
While it iji not m> digi^tiblc for invaliilA as wbi\it bread, It in 
more laxnlive urn] k-><-|M frt^h longer than whml bread. Wheat 
aod rve Hour aiv (ifitui mixed in brtW-itiakirig. 

Pum|>craicko) la a wh'jlo-r}'c bread uiud^^ by the Gcrmansk 




»i 



CLASSF^ OF FOODS, 



It i>« «1i^ttly laxntivc. Glub^ brFa4l le mode from glut^o flour, 
And ia uscil chiefly by diabetica Tbc beat bn^d coulaiua irum 
40 Ut 60 |Kr cent, of i^lulcDi Br&cuit^, pastries, &Lid puddings 
lire mftde by abiding lo the flour varying <)UAntitiGfi of egg^f 
sugAT, milk, butter, fruit, flavoring extraolK etc^ Thoy \"ary 
widely in riebiiL'^f^ and digestibility^ and are to be uvoid^ by 
[»erf*yi;s wifli weak fll^^stiun. 

Backwlteat floor i^ ofV^n made into batter-oaka^ in the 
Unit^ f^tatefir but >□ some parte of Hu^iii buckwheai porridge 
fitnus iTk< pnuclptl oen^d fuod. Br^d made from buckwheat 
cnimblre and dw** ni>t kwp well. 

Millet ij largE^Iy o^<^l in India, Chiua, and Haaaia. 

Sorghum i& ocx^n^lonnlly madv into brcuil, but in Ammcft 
it i*i ^rowT] utiuaUy for the niolasae^ find syrup that may be 
obtuit}e<l from it. 

Rice constitutes the staple food of many of the peopleti of 
the Orient It is grown diiefly in Asia^ but is also rait^ in 
some parts of Europe. In the United Stales rice culture id 
coiiJined chiefly to South Oarohna X£ice coiitaintf a lar^ prc- 
pfjrtion of starch in verj- digestible form, but it is comparatively 
poor in other coiibtituentfi. 

Barley bread was ated for food by the early Greeks and 
RomoDji, who alto u^ed barley tiu-ul to a largv vjcti-iit in the 
tmining of their iithld^'-s. Siiu'i" lhi> inti-othicrinn of |iarut4ti'Ei aa 
food, and with the dmk|R-nit]^ of wheat Bour. barky bread had 
gnidually fallen iiiti.> dii^u^-. BarW*water id used as a bevera^ 
for invulidj^ and infants. 

Oats eont^LJii JIIktaI proportions of lat, protein, and nalta^ a 
Inr^Tf* am-xint of *tftn*h, and considerable indigestible cellulose. 

OAtmeal is umxI to die bent advantage in making porridge; 
owing to itfi lack of ginten it makes only the poi:>r%et kiud of 
brcfuL What is known tt? St-otch groats h prepared by freeing 
the* gniln {mm its outer husk. Oatmeal porridge is taid to act 
n* A mild kixative in iwme pi^rsont^j and to exotte dy^peptio 
symptoms m others. 

LEGUMES. 

Of the lo^imes, the pea and thr b«in are tho most important 
food -prod ucLs. Id the middle and noriLern |)arta of Europe 
the pea k the mu»t |K>piibir It^itie, while in the Med iter raai^u 
conntricfl the bean predomtuate*, Tu America* i^ecis and Ix^nu 
arc cxtcanivcly raised. Tlnj jK.'unut ie an American fuvontc^ 
but the lentil i^ oaten only to a very small exteiiL 



il 



VEGETABLE l-'OODS, 



09 



• 



'Hie Icf^iimcH (vnuin n lilwnil |ir'>portion of pn>tein (legti- 
nii;ii)f <ar^iytlr»ti.<9r and a link' fai^ b(^i4«4 u Iai^* uniotmt of 
wnUT. Altbtm^li It-^iitiv? ciiiiUiiiL n |)ni|ir»rtiim uf protctii in 
CJLccnei of thut (if mrut-r a \hTgc nmount of fiii, nnil oonntdcTHblc 
«taroh^ thoT urv \*^* <%i)ti]y (]tg<vt<Hl thiiD Jimrtiul fcxxlsv As 

"(1) A» gBneniliy iJtic»[>iittHl aiul n^y.]^ tJic imtrienteof vcgiN 
tablf foodn nre inchw'u in c^elU cotuiwHeil uf <rUiiIo«f or wo<Miy 
fibiT, which ill mon- or \cs<^ hard anrl gn-tiUy iii(i;rfer&* with 
their sti^irption. 

"{Z) VcgeUiblo fi^Ki H pmrK^ to fi-rmentation in lh« jnta»- 
iIih;, tniu iocrcttHbg the pvriat&ltia movemetiCH, and, if large 
liinuiinl^ arv vatcti, luL-ttniing the food ouwanl before there Iul>^ 
licrrn i^tifHojctit timf? for the ub.->orptir>n uf lUt cuiibiiued uutnoulQ. 

"{^) Tb4» C4>]liil(w^ iirvwent lu-u aa a toool irriUut and pro- 
ducfm the «imi* *'iK*<-l." 

Legume un.* n|>t to produce femientciUoii, nud id this way 
ooca»ioTi flaliilvno' and ^i^nHiiit^tiiml diaitn^^. The digesti- 
bility of X\\v k*fri]moM {ir|K-ihU hr^>ly ti]>oii the RUinner Ja whioh 
thn' iiru [>re|virtHi aod the atDoiiiit that i^ eat«n. A )ar^> por- 
tion of the l^^mei onlinarily eatvii ii ira[>erfectly al^^oHjod by 
the inte-^tinv* StrfimiK*!!* hit* Hhi»wit tlmt about 40 per cent, 
of tbo oontaincH) pntt^in in r'xikcd Ixiiiirt U lv(t ili)iiboorbed| the 
btviiH bring pnli?ti with tht* AzlnA ; and that with a Hour mode 
from IpnliU only H.'2 per cpnt, of tht* origina.! amount nf protein 
is left (inabsorixx) : ;«) that when i^ten Einiply cooked, a much 
lui^r |>rojw.*rtioo reitiaina iiD:tb*orlKHl than when ficely divided 
into n [ictwdi^r. 

Beatta form one of the ol<Wt formic of vi^table foodB, hav- 
ing been ciiltivated by the aiicieut Grvcks, Romans, and Egyp- 
tbns. Tlie Dumerouhi s^rieties lasel for fijoti have all been im- 
pr<»ved by cultural m^lioda. Tlie AVindj^^r beuii^ the one which 
was first <?nltivat4Ml, U still grown in Kumpct bwt doc=i not thrive 
well in Aiaerion. The kidney bean, the mo«t important speciofl, 
ift easily cultivutefl, growing mpidfy and seedin;^ early. Th* 
Lima beon \s n great fivorite, especially in America. It is a 
short flat bean, soriewlmt like tlie kidney in ^hApe, This variety 
is a climber^ although btji<h Lim^is have been developed by cul- 
tural inetliodd> 

There are wvenl ^mrieties of peaSt the n»ost iiii)n*rtjmt being 
the lieKI and thi: ^rdun ikh. The fiirmer U ^t-nendly u?«^l for 

' Kumcn* BaUetin Nol VZl, VtiiUd Sldtei I^pnrUiwntoT Agncullurv, 19W), 

p. IR 



^V H CLASSES OF FOODS. ^^^i^^^l 


^^H fodder; but oDe varieiy^ th^ Caua^finn Add pea, i^ growo for ^H 


^^H XaXAtr ixav, Tlit'rt ^re nrnny varittit^ii of ihe g»rilen jwa. Tlw 1 


^^H tfht^lliiig ]K:atit the kiud in most oomroon Ufie in Amerii:^, and tlie 


^^H AU^^ poa are the moet important VHrieties. 


^^H TUv lentil, s» ha^ iWn ^t^r^, ig hut little us&\ Id tb« 


^^H Uiiit€»] States- The chief supply of lenlJls cooips from Egypt, 


^^H ver>' few i.>ein^ growo in Europe. They form u Ligbly Dtitritious 


^^H fooJ, but tlio iiiivoT \A disa^^reeahle tu niuny pers^Dg^ aud thfy 


^^H ure @aid to prixJiioo indigestion in .^ome int^tances. 


^^H Tbv peanut, althoti^h peculiar Id il^ grvivkfh, i^ a Ic^ime 


^^H iw woll a>5 the [tm and bean. It clitters chemically from the 


^^H olht^ tt^LTucH iu that it oontaiiis a 1arg« amount of fat. 


^^H (hmpnuiiion of Preak and Dritd Legitrna fvmpared with that q/ ofkfr 


^H F^d9.—{Abtl}] 


^^^^fe HittrlAl. 


a 




i 


i 


5 


* 




^w-^ 


JVrfil. 


Ptr^ 


PertX. 


JV<i 


CalirrHm. 


wi,a 


«.3 


0,S ' 7.4 


0.8 


I» 




71.9 


4,^ 


D.A U.0 


U 


w 




»j.fi 


^.i 


0.« 13.T 


07 


awi 


58.S 


0.1 


aa 2».1 


a.0 


740 


«&fi 


7.1 


(LT 1 3»0 


1.7 


em 


^^^H tlliinU'd |KU ....... 


74.fl 


7.0 


D.fi U.V 


IM 


w 




0^« 


».i 


CLO 1 3^7 


L4 


VOD 




Ml 


l-i 


Cli , «.s 


1A 


« 


^^^H i^uiji^il LhiiA tK4np 


TU.t 


4.0 


0^ 1 i«.e 


V« 


wo 




Tt7 


7.0 


0.3 ! lAir 


U 


480 


^^^^H <~ALiui.'0 i<vni b . . - 4 4 I I * i 


»^ 


3.a 


0.3 9J& 


1-1 


3to 


tAS 


G.9 


a A i»fl 


u 


«DD 


^^^^H J'ntuui ^iiillur . . 1 r 4 , * , , , 


%A 


2».» 


tf-ft ; 1TJ 


fij» 


mat 


^^^H Drli'jl li'iruuLO*: 














10.4 


lai 


Lft 1 4b.1> 


4,1 


itM 




13.A 


^b 


u 1 M,a 


Z^ 


1006 




7.6 


a.D 


t« ' u.l 


4J» 


IflPft 




fl.< 


:e&.T 


LO ' M.t 


fi.7 


i«sa 


^^^B Drfsd p«>i 


0.A 


M.fl 


1.0 «io 


a.ft 


IttC 


^^^H Auf btftni •••-•!'. .... 


la.n 


!2r4 


lA > flftfl 


3^4 


l&W 


lO.fl 


M,a 


14^ a>.7 


4.7 


18W 


^^H Cbfektrfjua , ^ 


H,e 


i:f.4 


«,T as.s 


3.8 


1690 


^^^H I'vinuUi 


fl,3 


a^B 


K« V«-4 


30 


9U0 


^^^H flL John> brcf^ {cftrob bMn) a . 


1^,0 


A.P 


1.3 76.» 


3.fi 


l&«fi 




raa 


a.! 


01 , 1A4 


LO 


safi 




Bl^ 


I,< 


03 5,« 


ijD 


146 


^^^H TetmatnflB .,»... 


M.A 


(19 


04 , tV 


OA 


IM 


^^^H WtiHtt brc4VftLKt fnoilK 


7,7 


IflT 


7S Oft.3 


2.1 


IMO 


OH 


>a.i 


in ' %.7 


la 


1100 




1Z8 


11.7 


LI 7IA 


(U 


IMO 


iLfl 


IftT 


10 


Tft.n 


a,« 


l«0 




70,n 


au 


r» 


, , 


1.1 


7«0 


^^B pried Iwf-r 


87.0 




an 

44 




8:1 


840 


■ SST:::;::::::::::: 


m 


14^ 


S.5 


S.4 


LjO 


ai£o 

730 


^^^H a Eoroppaij nrjAl^il*, 


^^H ^ Fftrmcn^ Bullnin No. 121, UnitiNl StaLoi De|>aaiiient of Aftricaltoiv^ 19(X\ ^^ 


^H p- M 



ROOTS AND TUBERS. 

Ro<ft1« and tiil>or^ coDstitute another eJa«i of vc^^ftable foodfi 
tbat an" of grt^t imponance. They <XiUlAia txitb starch and 
dogar, sttxd ui tlie« ouuHlitueiiu U inn tJjeir chief value as a 
fiHNJ, Oil aocxiuut of Hic Muiall prt^jiortiou vf pruttin aud the 
Urge amuuui of wutcr ibcv (vintaiu, ihcy oro liilcrior in QUtri- 
twt vfttuo to both U^ni<*tt and oer«alfl. 

Tbo potato i^, for lievi^ml nnuumK, tlio mcMt !m|>orljmC 
member of th^t ^rouj). It ui a tiiher or thickened under- 
ground i*tem of iSofonuTft (nbtrmum. It growt* ojiiiLlly well in 
a variety of AoilA, njvl when properly cooked iti t&^Wy digei^ted. 
IFbeu cooked in water, the faXXB paft'i into tlie water, but 
when cooked in their ^kins this loas ie hirgely prevented. By 
baking or rcmflttug the snIUt vlw btnt retutJied and the potato 
rontiertid moat owiily lUf^'Hlible. 

The 8we«t pot&to fjoDtaina more wat«r and eugar but le^ 
gtarch timn du- \ihiti* jtnfnto. Whi^n l>oiW, it nmidly lR'ry>med 
mealy, hut iii ofii-n wnvertwl into a ^trhagy, »o(ldtn ma** that is 
diffiaull of dig<«tioa. 

The yftm is a tuber Homevhat rvifiembling the potato, Ii i8 
grown and eaten ehiefly to tbe tropics, bnt also m some purb^ 
of Kurojie, 

The JcmBalcm artichoke i» (commonly used in England. 
It t» riwvft am] wutrr}% eoiiLainK Uule »UUY^h, ia only mUghtly 
nutritive, but i^uite eueily digtrjttibl*-. 

TI)cbe€t<H»ntn]nea very lui^ p<*rocntnge of starch and ^ugnr. 
It i* mi»vi1 extensively for tlu' nugsir iTwlustry, nnd i? til?m largely 
wnployol for n^jilcJng i^latin t^ K^iiH vari«*ty to the diet. 

Carrots, wlicn young and tender, f>mi a very nutritious 
food, and are grt^tly rvliiMhi.^1 by imny persons. They contnin 
from ^5 to -+0 per cent, of water. 

Farstiipa when lx>iletl h.iDjreuongh form a good food; like 
carrots, they contain a large proportion of water and a eon- 
eiderable amiiiiut of sugar. 

Turnips have v<*ry slight nutritive voliit, but are, never* 
the!ess, very popular as a v«^tfibl«. They have a tendency to 
miw^ fl^tuifnec 

Sadishes are u^ chiefly to give a relUh to the food* 
Tliey contain little ^rth and a \nr^* |>erecntage of watex. 

The following tnble, taken frtun Alw:iT**r/ givea the average 
composition of tb? common root^ and tnber? ; 

1 Ptinnitfa of NutritUn and UutrUipt Vaive of Fot)ti8, Fannen^ Biilt«Eb, 




M 



CLASSm OF FOODS. 



ywt^-ttMerUXM. 



FbuiUKv . . . 
Bueel poUUtM . 
Beets. . . . , 

PoJHlkifM . > 4 

Tumtpi . . ■ 



i 


S 


i 

3 




a 




^ 


* 


& 






i 


ftrn. 


Peret 


FfTA 


PtrcL 


PfrcL 


t^ti. 


20 


02. a 


L3 


0.1 


14.7 


0.5 


21] 


■Vf.! 


1.4 


o.d 


21.9 


0.9 


20 


70.0 


i.:j 


0.1 


7.7 


0.9 


20 


^^GA 


1.3 


0-4 


10.8 


].l 


30 


62.7 


a9 


0.1 


5.7 


<Ka 



e|l 



29S 

160 
230 
ISO 



GREEN VEGETABLES- 

Thi." gre(?n vegetables are valt]a.ble Dot tmly on account of the 
amouutof uutrimciii pri'^'iit in them, but for tbe variety und 
relish they give tu the diet. Thev cctuUin u large aiuuimt of 
ealt^ RnJ bave VAli:al>le antL@(iv>i'b(iti<f propertiofi. 

Bryant and Milner, ii) a vi?ry oarelnl W'riefl of i''TC|wrinientftj* 
bave arrived at the following coucluMoiLi ciHicerniDg the tlig&iti- 
bilhy of certaiu vegetables: 

" So fiir ite source of protein or fat are concerned, tbe v^e- 
tableH (potatoes, cabbage, nnd beeta) includetl in these HlitdieA 
may be eonsidertxl aa of little value. They do, however, con- 
tain curbohydrate^ which are well digtated and absorbed ; and 
tliey may therefore he coiiaideivtl as of valne a» cfuurcet^ «jf 
energy, a lurgv proporliim of whioh apptars to be availublo to 
tb(j bcniy, Tb(' ehiuf vulue of luuiiy v^getable^, however, le, 
ptrhapM, iiAule from the luitrtnuMit or enei^ tbcy fnniiiih ; they 
add a pleitsiDg variety and |>ahitahtlily to the diet, supply 
oi^ntcaoidd and niiiienil mits and ^ive the fi>od a hLilkin<*4S 
tlutt st.H'nn t.i l>e of iniiKirCance in it") moebanicnl aetion in 
luaintiiinini^ ii heaitJiy activity of the alimentary tract. Pos- 
sibly the Ti^uh uf these conditions i» a favomble inDuencc ui>on 
the di^&limi of other food eaten with the vegetable," 

Cabbages contaiti a eotisiderabU- quantity uf eulphur, and 
on thia u<^oQEit arc apt to otiufto ttotult'iKro ; wliere digestion is 
good, however, they ure ooiisld<?rt'd u wboleeonio form of food. 
Saufrkmul h oubbiige prepared hy placing salt between layera 
of shredded I'^bba^c^* le»ve^ and then mibjectin^ the luaAs to 
prt^ssiire- This pn*ftj***s out the juiee, after which acid fermen- 
tation 8etii in. Owing to the fermentation it produces eauer- 
kiaut if( oon>iidered indigestible. 

CanUflower is llie most digestible member of the cabbage 
fiimily. It iiiaj be eaten either aa a Aulad or boiled and wrved 
with a milk-wtKy^. 

* Anmoan Juumtd of J'AyjriuCo^, 1D03, vol x., No. 2, p- 91. 



VEGETABLE FOODS, 



Vf 



Spinach ih a ]>i>pular fonn <»f vegeUMe and b awd to a 
gi-eiit t-xtfUt, It U valimblr cbicflj" for iw kxuUvc fff«U 

Lettuce in Ui« luont imgHJiiaiit reprvrwnUtiv<* oi" tt (fTOup 
of v^gt^lrl^ uitially «it*>i! mw. It lit math^ into salacl ami 
dKBHd with viiu^^. The vuriiiuA cretAes nI,<o U^lon^ to tlus 

Sorrel iitmti^n <:hierty in Europe. It has a ]*eculiar acid 
ta'^te, due to acid oxalatft'A, ou aooount of the presence cpf wbich 
it ia to be avoided by those flubject to gout or rhi-moatum* 

Celery, which U ujiiiially eaten mw, is acriugy iind biM 
!Kun.'t^];r aiiy imtrilivo value. <Jw>ked lu iuiJk it forms awholc- 
scnie aud Jigcatibl« article of ftMxI. 

Tomatoes uru caUsa botli raw aad cooked, and are refnwh* 
itig, gt'iiorally Hki-d. and i<ft.4i1y digejited. They are used to 
flavor bn>th.H and arc vnhiablc for mnnin^ piirpoBee, tnasmtich 
ftA they retahi their tiavcr l)etter than most v^^table^ 

Thfi eggplant, a close relative of ilie tomato, i» l«w diges- 
tible, aHpecially when fried, than the latU>r, 

Cuctlinbers are eaten raw, and when yoiiup arc ofteo 
plcklt^d III vinegar. They are very indi^t-Btibltr- 

Asparagus \a Ligtily Gat4?eni(^ for \i& delicate flavor. It 
16 oaaily dig^^ded, even by invalids. It has a elightly diuretic 
action^ and iin[iari» n mo*t ofTenftivi* oflor to the urine, which 
persists for frum twelve (o twi^nty-fonr houni. 

Rhtlbarb, whi-n thoroughly cooked, is <)uite digestible and 
act'' jv* a laxative. 

Pumpkins are u^*d largely in the making of pies, etc., but 
tb^y htivo no s|ic-cl[il food-value. 

Squash, when young, b quite ciigeetible. 

Ouioua, garlic, elc», an- n«xl i>olb as vegetabica and as 
ooii<Urncats, While onions aro u^ed largely for flavoriDg meat- 
slews, ^adfi, and the like, thvy are altiu t>aten for their mildly 
laxative j>iv>|jerties. 

The following table, taken from Hutchison (p, 239)^ gives 
the cH>iniKi8itiou of thi'' various v^etables : 
T 



^^^^^^^^^^^^^^^^^^^^^^^^^j^^^7?!^^^^^^^^^1^^^^^^^^^^^^^^^^^^^^^^^^^H 


^H 8S CLASSES or rooDS. ^^^^^H 






m 


t 


41 




Si 


m. I 




PrrcL 


FvtA 


Pvrct, 


l^eL 


J^rL 


Fertt 


oitortv. ^H 




. 6P.a 


t.eo 


0.40 


as 


1.30 


1.10 


165 ^H 


^^H Cnhbige, cooked . . . 


■ 97.4 


0.60 


0.10 


0.4 


0.1S 


L30 


105 ^M 


^ S0.7 


3.W 


0.40 


4.7 


0.80 


1.20 


175 ^T| 


^^m &a-kij« 


. 93,3 


1.40 


0.^0 


3.8 


0-«tO 


CDO 


175 1 


^^H Nefl-kiLle, cooked . . . 


^ 07.9 


0.40 


O.07 


0.3 


0.20 ; i.io 


175 


^^^1 VL^eUble roanxHT - , 


. 90.0 


3.60 


0.60 


as 


IJO 


U.IHJ 


i:a) 


- M.a 


0-06 


0.30 


2,6 


afio 


IJIO 


ISO 


^^^1 V^seuble aurrov, 
















^^^H cookc 


d 90.S 


0.09 


O.04 


a2 


aos 


a87 


120 


^^^B Bniw^ apmtiU > . > 


, fia? 


l.fiO 


0.10 


a4 


U30 


0-37 


95 


^^^B Tomoloee - ^ ... 


. di.ft 


1.30 


O.S0 


G.0 


0,70 


1.10 


105 


^^^P TiiumioKAf cookttd . > 


■ 94,0 


1.00 


0,20 


ai 


0.70 


1.60 


105 




. 82.» 


3.80 


0.90 


8.9 


a50 


1.50 


275 




, 9-Ll 


1.40 


0.40 


2.6 


1.00 


ago 


105 


^^^1 Lettuce, CMfked < . . 


. f»7.3 


0.50 


0.10 


0.5 


0.40 


a9o 


106 




, »1.8 


1.20 


0.60 


C.8 


0.70 


a9o 


150 


^H Gelerj 


. n,\ 


1.40 


0.10 


3.3 


090 


0.90 


35 


^^^H O^lcrr, cookoi ... 


. 07.0 


0.M 


0.00 


0.8 


OM 


uoo 


65 


^^H Tuniiti CAbbs^ , . . 


. 87.1 


2.fi0 


0.50 


7 J 


IGO 


1.30 


145 


^^^B RLuliurb ,--,., 


. f)4,l3 


0.70 


0.70 


2.8 


0,tiO 


I.IO 


105 


^^^B Maoodoiiiv (tiiiBcd) . . 


. flai 


1,10 


0,70 


4.5 


1,00 


1.10 


no 




. fl3.i 


0.70 


0.50 


a7 


1,30 


aio 


110 


^^H Ctuumber 


. 05.9 


0.H0 


0.10 


2.1 


0,40 


0.50 


70 


^^H Ounmbcr, cooked * • 


. 07.4 


afio 


0.02 0.7 


0,20 


0.9O 


70 


^^H AmMnfcm 

^^H fUKifv, cooked , . > 


. ei.T 


2.20 


0,20 1 2.9 


090 


110 


no 


, 87.2 


1.20 


OM 


9.0 


0,30 


£.20 


110 




- 91-0 


1.00 


0.08 


3.0 


0,80 


0.60 


no 




, 87.0 


3.30 


0.70 


6.0 


l.fiO 


1.30 


no 


^^H Red cabbage .... 


. 90,0 


l.*0 


0.19 


G,8 


0.79 


1.29 


no 




. 91.0 


1.40 


0.70 


19 


1.70 


0.90 


no 


^^H Ve^Mriauisin. — It ^Inot be ont of pliice here to point 


^^H out the difA<lvaiitagoe of ao exoIuBive v^^tfiMe A\^i. Veg\^ 


^^H tartans an? thow who FTubeint almotvt entirely iiprm vegetahleSi 


^^1 i?erea)H, fruity and nute ; exoeptioaally milk imd e^s are addeil 


^^1 to their diet-list 


^^H It id quite pos^ble, by the eating of vegetables alone, to 
^^H supply alt the food coiii;tituent6 — cflrbohydml^^, fa($» aTi<l pro- 


^^H teuU — that ore required by the body. Frotdns nrc obtained 


^^B partly from vegetables, milk, ami e^ge; those derived froin 


^^H vegetables, hnwevcr, are dig^ted vich miicb more difficulty 
^^H aoa absorbed to a much eligbti^r -Ic^ref^ tban those derived 


^^H from auimril food. Personn «ub»i^ting on a. purely vegetjible 


^^H diet for any great length of time are apt to lose i^trength, as 


^^H well as physical and mental vigor nod endurance. Laborers 


^^H are nimble to perform the same amotint of work tliej could 

L 1 



FRUITS AJUD SVT&, 



»9 




apUsb on a diet coDtAinitig animal food. While vcgeta- 
blc* oontaiD \ngt proportJoDH of proteiuis ^^ order to sujipl^ 
tLcm in mfEcioDt an)oaat vcr^ large tjiLantitiea miut bo eat«D. 
ThU overiWding U apt m many instanoec to produce d]g«6tiv« 
diMtiirbflDO^ pnrtiVuUrly En thoc=o Huffering frDm ga^tn>int<>(iH- 
lud dLsordcn^ A purely veg^t&ble diet, if peisiBlal iu, is also 
Slid ^ to lo«<«n the powt^r of rtfiistiug disease.* 

FRUrrS AND NUTS 

FRUITS 

FruitA are of littJe value a« nutrimcuta^ and arc uaefal 
laaiolv to gi\(? varttrty U> the dieU Thcv «re iiimnl extensively 
ae iiavonng agvot^. Tbe cbief nutdt^ve ronAtltucnt nf fruits U 
fiugar, fttid Uit^y al^ contuin a Htniill ntnouiir of nilmgcnoiid 
nuittera, o^llulit^^ ^Inn^biis, orgnnic (u*-idK, And a v^gHable jelly 
called peetdD, whtrb c»uBct^ fruit to g^latiniAe wbeu bailed. 
Tbe sui^r pninenl in fruit ii< inmnly fniit-wugur, or Icvulose^ 
bat Bome fniiL^ oontiiiti^ in julditi<tnf cw)[i«idcnib]e enne^ugar. 
In general, iruit8 contain a lar;^ amount of wut^r, but Iwh 
earthv t^alta than other foridfl. The mineral elemonb^ of fruit 
oon^mt of potAi^h, iiniu^I with urtiiric^ eltrio, ami malic acid. 
To Un^e j^IIa iri diir the nritiM.i}rbui!c piT)[>erty of fruit. In 
Ad<iitioti to till? prfipcrty friiitit iJ^n act uti diuretic?, tnxativce^ 
Aikd cathartics. The flavor and odor of fruits are due to tbo 
|«mu)n'V> offwfaentifll nlLa »nd eomjioiind ether*;. 

The digci^ibility of fruite varit*^ wilh the kind of fruit eaten 
and if*( modtr of pripjiration ; stewwl fruite are more <sm\y 
dipcsitible tbnu raw fniiU. Among the nn>ree»i=Jly digestible 
fruit* are oran^, kmi^mSf gmpcs, and peflchps ; ruw apples^ 
pi^r», and bwJrtims are eomewhnt les." di^tible, 

I^emocs, limes, and shaddocks^ jHiseegeing similar 
propertica, are, for descriptive purposes, da&aed together. 
Tlicy are valufthic anti^orbutiM^ and hiivc an ncid, pungent 
flavor that mrtv be impflrted f« otherwise tuafelesj^ foi^ls. A 
WH'lin^r and n.'rre?hint; drink may be made fn>m lemon-juice 
dibt1j.*it ^ilh WiitcT nnii >WL<4'tcned witli a i^mull quantity rif Migar. 

Oranges an.' lu^ed in in\mli<l dii.>tjLri<^^, their Jnif^e allaying 
thirst vvry efttn'tively ; it can l»e IxTiie often by even llie most 
irritable stomaeb. 



W. K*imiAn't Kmaya an DUl^ p. 64, vtc 



100 



CLASSES OF FOODS. 



Apples are wholesome, digestible, and dightly laxative. 
Fresh apples ontain approximat^^ly S ptf-r c^iit, of sugar and 
85 j-er cent, of water, but iu drjiug tw<*-thirds of the wutor is 
lost and the sugnr is inoreflBw) to ahaut 45 ipov cent 

Pears &r&, as a nih^, more eaaUv digcatihlc tLan applet, 
owing ti> the fact that their Gei^b is siM*t and their e;kiiinot80 tough. 

Peaches are ^rboleHome and digestible. They contain lose 
^ug:Lr ttian most fruitd. 

Bananas are the mo^i DUtritioufl of the raw fruitA. The 
many varieties differ in digestibiliiy and in flavor. The ordi- 
p^ry banana, b^ obtained in the UnlU^ 8laU%, in o^uuidered 
indigestible* The flour whiol> b produced from dried banauad 
la very easily digestible. 

Grapes ^^ontain « large amorint of water and iwnsiderahle 
sugar, besides salts of S4>diiim, potaseiiini, niagneeium, caldum, 
and iTftn. Wlien thoroughly ripe ihey are veiy digestible, and 
forni a uwful addition to the invalid diet. The habit of swal- 
lowing the skins and needs of gra|>es is moet pernicious, as 
intestinal irritation is ot^en brought about id this way. 

Raisilis are prepared by drying gm|)eH, the white oues 
bein^ those niot^t u^ecl. They are indigestible udIcm well 
oooked; they are usually added to puddings, sweet breads, etc. 

PInms and green gages are quite digestible wh^^n fully 
ripe. They soon overripeu, however, and then ^re as hnrmftd 
aa when uriri|)e. 

Pmttes are dried plums. They contain much augat and 
are markedly laxative in their effect 

Olives have a bitter taste, and are eaten ehiefly as a relish with 
salads. Tbeir nutritive value is due to the oil they coDtain. 

Stramrbcnics are very wbole^me uiiltwt taken in t-^ieeHA. 
They arc ^uite rich in saltd of sodium, potajisium, and calciuoii 
and have mild diuretic and laxative proj^erties. 

Currants, gooseberries, raspberries, huckleber- 
ries, mulberries, and a tew odu^r l^^rnes 4?nntain eonsidera- 
ble amounts of fiiee acids. They have slightly laxative prop- 
crliefi. 

Melons contain over 95 per cent of water and about 5 per 
cent, of other eoustituents ; they arc cun^^idercd indigef^tlble. 

Figs and dates conbiiu large c|Uantitie4 of sugar. In the 
eastern part of the Unitcvl States they are sc^n only in the dried 
form, altbou^i in Cidifomia, where they are raieetl, they may 
be obtAin^d fre«J]. The value of thf date as a food to tJie 
Arab is well known. 




FRUITS AND SOT& 



Th« following tabU', Uikm from Hutcht80D (p. 244), |^v<» 
tbe composition of the varuAi8 fruiu : 



P«ftlV _ < 

Apakcttt . . . 
Pncbw . • , 
GrftD fftipm . 
Plunu . . . « 
K«ctu-iii«a . ■ 
OwnJO * . 
Oooarbatrld , 
CUfiuin . . . 
atnvbenitt , 
WbortkberriM 

Blmakbtrrii« . 

UiiUvni** . . 
Gittpoi - ^ . . 
Melon*. . . . 

WA|«nMlOM - 

Bhawm . . • 
Onugcs . . 
Lauooi . . . 
LamoDJo^ - 

F1^<lrf<il ' . 
Tlfpi, frmh > , 

Prwn««, clrtfl ^ 
CafTmittH, diT . 



I 



fil50 
»l20 
«fLM 
ASlOO 
88L80 
«X80 
78^ 
8t90 
diOO 
86,00 

MJO 

m30 
8aP0 

86.60 

79.00 
89.00 
92.S0 
7i00 
86.70 
S-Oa 
9.00 

LOB 
100 

7^1 

164 
103 
2.79 



(L40 

h4U 

a40 
i.io 
tr.5o 
a40 

1.00 

CfW 
0.80 
0.4C 
0.40 
1.00 
0,70 
0.(K) 
LOO 
0,50 
0.30 

l.OO 
0.70 
0,80 
1.60 
Q.BO 
LOG 
1:00 
004 
4.40 
AlSO 
1.00 
L4C 
OM 
IM 
150 




NUTS. 
Nut* contain n large quHntity of fat and a soraewtiat larger 
proportion of protein. They liavc but littlt focKl-vailuf', and are 
«fit£n mainly t» a iic8»ert. The average oompo^ition of the 
nuts k: 

WAier 1*- 4 pei-c«ot 

Prrtrin 6-15 " 

FktH 4fH>0 " 

CarXiohjdTMm 8-tO " 

Owing to the lai^ amonm nf wllulfwe, aa well as the !ai^ 
pro^K>rti<»[) of fat llrt^y imhiIuiu, nuU< art- uuL <«Hil_v iUu;tBk-d. 
The deoac ceDalcite fminevrork which makcd Duto oo mdigcrti- 



^^m Ids CLASSES OF ^^^^^^^H 


^^H bif c:Ln be dotrojred by ^indiiig, ard thus the nut mnde more ^^M 


^^H cnMlydigi^vliMe ; 4Ucb |rre|kanitio[iaaA NtJtnwt, Bimtiio^-, and Nut- ^^M 


^^H iucal,ofthcBaiiito» Nut VtjtA CEtiuijmuy, utr j)n.<|i:mil in Uijj^ way. ^^M 


^^H Almonds oontAiD muiblLLt^ljiit no Hturciiundvcty little sugur, ^^M 


^^H knd tli«>y nr*>, tberi>tore. oi\eD utllizod uj> u brc^ud for dlrdiotios. ^^m 


^^H ChCBtnutd contatD a unall amount nf oil nnd a Large T 


^^B Amount of airbohydrftk»8. T1jc>' urc nOt'u tat^n raw, and arv 


^^H quite iiidSgeiitible. Properly cix>lce<] thoy arc' vviy diffuAtible. 
^^H Wainttts contain a farge projx»rtioii of jirt^triii and tat, but 


^^H are quite iudig^tible; in eotue individual tboy produce a 


^^H markedly laxative effect. 


^^H Tbti COCOanat c^jntaLiig a large amuuut uf fat and carbo* 


^^H hydrate, but h exot^iugly indigestible. 


^H The following tabk, tnlren from Bulletin No. 122, United 


^^1 States I>e|iartmLQt of Agriculture, givet^ the oiknipu^ilioit nf 


^^H nuta ftd coiupiired with that of otber food-substauue$ : 








CoxapOAlUoti ftnd Aifrl-rftlu* of the 


^^^^^^^H 


Ar<< 


1 

i 


Hlible pi>rt]uii- 


i 


d 


1 


i 


3 


'1 




ftrrf- 


Peratil^ei. 


/^4t' ftrd. 




64.5 


:i&,soi 4.8 


Sl.O 


51,90 


17,3 


2,0 : 3030» 




1U.6 


50.40 


6.3 


IT.O 


66.80 


7.0 


3,D 


3329 




52.1 


47.W 


S.7 


16.6 


fi5.30; 13.0 


2,4 


3432 




iXS.2 


37.80 


3,7 


15,4 


67.40, 1L4 


2,1 


3495 




58.2 


46.30 


3.0 


11.0 


71,20 


13.3 


1.5 


3633 




58,0 


43.00 


H.8 


16.7 


64.4U 


14.H 


lp» 


3806" 




16.0 


S4.0U 


46.0 


6.2 


^M 


43.1 


1..^ 


n«5" 




W-O 


76,00 


6.9 


io.r 


7M 


74.2 


2.^ 


1876" 




40.S 


fi4,40 
5^.20 


4,1 
4,0 


8.1 3T.4n 


4ao 

1S.2 


2.4 


S71A 




51 -« 


-i7.40 


115 S263 




86.4 


13.60 


4.5 


27.9 


61,20 


a* 


3.0 


3371 




74.1 


2fi.90 


2.5 


27.6 


56.30 


1L7 


1.9 


3105 > 


^^H CiMauiiit 


4S.8 


51.20 


Kl 


5T 


50,60 


27.» 


1.7 


2936 


^^H Oocouiiitf flbnddod ^ ^ , . 


48.8 


100.00 


3.5 


0,a 157,30 


S1.6 


1.3 3125' 


^^^B PSiiuicliii> 1c«nivU .... 


48.8 


100.00 


4.3 


22,ft ,54.50 


15,6 


3.1 3010' 


^^H TijuMinior Pimmpinmedidu 


-t0.G 


6.94 


3.4 


14.6: SJ» 


17.3 


2.8 \3:am 




S4-5 


7.65 


9.S 


25,H 


38.60 


24.4 


2.0 


2560" 




38.5 


67.40 


1.« 


30.5 


A9.S0 


las 


S.5 


3177 




41.6 


58.40 


17,9 


S.9 


0.20 


77.5 


1.5 


1453 




12^ 


S7.20 


QL9 


lao 


18.56 




1.6 


1130^ 




12.8 


100.0A 


U» 


tae 


1.16 


74.8 


0.5 


1640 1 




sao 


B0.00 


7a5 


» 


0.10 


ia4 


1.0 


S85" 




^^K > Thew T&luQi vtn cftlcuUi«d ; unl«aB otlienn»« indicated Ui* rueL-T«luw 


^^^H w«r« dotArtuLDod. 



SUOAB&, 



lOS 



FUNGL ALGAE, AND UCHENS. 

Pnngi.-wThc thn.'c vAricticsof fuugi iij^uitlly eaten ftre th« 
diixhnktm, mjffl^s and morel. 

Mushrooms are \tr\yxA chicAy for their Ojiroeablc t&fte 
Thvy ]H>j^-7^ti Aome nutritive value, being rich tti nitro^ioiu 
mtitu-r, tJitH niftU'dal, however, oociin-ing in sutrb fnrni that it bt 
buiHllghtlv al>si^rbed. They iin^apt l<» pitxiuw gaAtrt>-inteiillnal 
irntatioD, and lUrwgm; wUh ruaiiy [n^n^uun. 

The truffle givtwA uiidcrgruuud, and in Cfi[>ccukll^ mugbt for 
on lUHMJunt fTf itH doJicuto flavor ; tie blaole variety iit ooiiiiidiTvd 
tlii^ finr'Kt. 

Tbo murd is iii^inilly obfaint*^) from Francie. It w sold id 
the iIHchI HUit<*, and t^ luilijced chietly for EHeanonmg purpoA<<A. 
The following tabh% by Kotiig, givei^ the oompoeitioQ gf the 
tau.HliD>oni, trufflt", and monO : 

Vuihrooa, Trufllo, Mor«L 

W«u;r «M1 72^80 M.00 

NitroffvnouB nrntUr &57 B.9L &4I 

Fat Aia a« a» 

GnfiQ-«UK3if und ninmiit(< -.>... 1.05 . > - CpTS 

OtJicr Dcm-nilroKvDuuf tiut»UQC(9i ' . . 3«7l 7,M &96 

Woody aber ft67 7,« fter 

ABb a76 S.S1 aw 

Maiiy fungS jire poiw^nous^ and Ibeae are usimlly dijftinpiwhed 
by a di^a^rvcabU' thlor uiid taete^ and other pixMiliaritieH m 
Btructitrc, etc- (Far an cxc^^JIcnt di»cription of th« various 
AiDgi the reader \s referred to Farmers' Bulletin No- 16^ {Jiiited 
States Di^partmeat of Agrinitttiir?.) 

Algae. — TJje <in!y one of thi» ^mup that iji utilised as food 
is IrUh moss. Ittf mo»t important oonstituent ia lic^brom, a 
mudla^. It 18 mjLdt^ into a Hootliing drink for patients Huffbriog 
fn>iii thn>iil irritation. 

Iflchens. — riie only impoitAnt lichen used aa ft food is 
Ictland moss. It contains two carbohydratefl : (1) liobeniuf 
a gi.*liitim)Ufi enbstance ; (2) iwdkdienia, which resembles etaich. 
loclimd mosA 13 utilized aa a food in ttie Airtlr rcgi^jns. It has 
bvcD mad<j lalo a bread that has botin reo>(jinii]en<)ed by Seaatof 
for diatMlitiiL 

SUGARS. 

8ugam are carbobyflratc* that contain hydmgen and oxy^n 
la a proportion tJ> form wat«rr. Sugar ia one of the mo«t valu* 
abh^ and pnpubir form* of food. Thtu popularity ia <!iip not 
only to it« ntitritive value, but aliio to tta pleasant taste. Ai> 



104 CLASSES OF FOODS. 

cording to Abel,* Sti poands of sugar per capita were consumecl 
in Kii^land in 1895 and 64 pounds in ihc^ United ^tatet^ in the 
saun.' ^L'ur. Froui 7,000,000 to 8,000,000 U^ub are couftuuitni 
animuU^ in tbe difTcreiit couulrlcfi of the world. Tbo principal 
Vftria^ of sugar in use is caiie-su^r ; beiaide>4 tliis, gntpi?-siif>ar, 
frnit-ffligar, and milk-fiUgur alwi enter into the compoHitioo of 
our food^. Sugar U obtained in a fluid Btate, an iu honey, aa 
well a^ in cTTslalline form. 

Sugar is very fattening and at tbe same time i^r also a great 
*onrc<: of mu^eiihr t'nerg}\ Tbe negroes witrkiug in the fiugar 

SlaiitJitiuns in the Wust ludics sbow the effect of eutiog sugar 
uring the burve^t tK^a^^oii ; tJiey chew the eugar^-^^ne con* 
MtaLDtJr, in coreequcnce of which their weight and muscular 
d<iveIopraent increase moet remari:?ibly, Siignrs aud starch are 
0a!d lo he identical in nntritive value, owing to the fact that 
both must be converted into dextrose before they can be ab- 
sorbed. MoHt of the ill effects attributed to the use of sugar 
are due to the fact that more than one-quarter of a pound is 
coD^uuK^ diiily (Hutchison); thifi amount may be taken with 
impunity by ihc lit«Jthy adult, but if more be takeu, it will be 
excreltH.1 rapidly by the kidueys, giving ri&e to a condition 
known as temporary or aliujentary glytjoauria. Hiitcbimiii (p- 
270) pv*"fl thi^ fijllowiiig figiiri-e us tht ninxinium umoLint^ of 
ibe various t^ugar^ neoesnary U> produLxr aliiueutory glvL'osuria : 

For lactose 120 gun. 

" tnn&««»r 150-20ft " 

" Icviil.*!.- 200 " 

" dciliu^ , HOO-250 " 

Bugar can be absorbed only as dextrose and as levulo^c, all 
VAneiioft of sugsir Inking convert*^ into ihrse forms before they 
iTC abflorlxil- In atn^ng ^iitioii ^iigiir irritat<.'g the mucoua 
membrane <tf the stomach, an<l is apt lo undergo fermeitation 
Aiid thus produw gastro-inlp.'slimil difitresj*. Robcrt.=on' gives 
the following table, arninged flcc*jrding lo the mpiJity with 
which sugars are apt to ferment : 

Levuloee I mofl fcr- Ltvuluje tnnwl fer- MaUoe*' (dkbI fcr- 

nienUble). luenlablu), Tii«ritAbl«). 

ijictose. MfllttiK. InT&rt-njgnr. 

Dextrone. iX'Kixiwj C^in&flugur- 

InTfrt-miCTf. IriTGn*iigiir LV'itrr.*w. 

t^n<"*tignr. Oine-ffiignr. Leviilfne. 

M*lt<He. ljict<*iv. Ijtulu^a 

* Farmer^ ttullelin No. 93, Vnixtd SUIes Drptrtrntmi of A^o.ultarc, ISM. 
> EdmhftT^h Mvl. Jovr., March, 18M, 




Cane-sngar is the moBt common and tnoet exteosivelr n&ed 
form of sugar. It is made chiefly from sugar-auie and from 
the sii^r-bcet When j^ure, it ooii»it4t« of a mu^ of whit^ 
ciyataK It is sohibtc in ono-bulf it« weight of euld water and 
in cvcu lci*« of hot wntor. In ordtT to obtain i\\^ &u)(ur from 
the cupc the oano.« hpc crtiiahcd nnd tin- fluid ohtfllucd treated 
with «ii1j>htiroiie noii^, n^iitmlisced with Wma, and ho!)(<d ; it ia 
\Wx\ fillepwl and evaporat^J, when th^ mignr crj'flfalli^H*^ nut. 
The fiu^jar i» still further retinfnl by remelliug and (ilterint; 
tJinju^h charoosih 

CAramel va made by heating refined cano-^ugBr to 400^^ F., 
wh<:a it lA mdted imd browntiL The m^sulting browD aih- 
«tanoe \i eoJtcd caramd. It htiH a bitter tn^Te. and is often 
ur*«l tt> u fluvortDf; tgenl, t^pericilly fi*r invrdid f«Hnl&, 

Candy contains n hii^ amount oi »iigar, hrfiidcs huttf^r aud 
other fill*!, ^t4irrh, nut*> flnvorin^' cxlmcti*, ete. The chief 
vnnptir« of cnndy nro mndi> up lurgply of glucose avid etarch, 
colored with anilin dyes. Thompson rays : " children iiH^imilate 
candy better than adulti^ bccauee they are lc*« liable to dys- 
pepeisi out] because of their relatively nctive muscular ener^ 
and relatively hirije body snrface for lo^in^ heal, lu pn)[K>rtion 
tD their Eize. They do not, ai? a rule, rare for fnt meat, and 

E refer sweets a^i a natural eubstitut*/' Contmrj' to jtoputar 
v\wi\ thtre is no evidence to fchow that caiidy pruducoi any 
injiinoiis effect on the teeth* 

Molasses, Tteacle, and Syrup. — Mola&ses and treAclo 
are by-pnHhit^iH fonnf*:! in the mannfaetnn* of eane-*4n^r. 
MoIaaBea forma a highly nutritious food. On account of the 
impurities it eontaine molasses has a more prooounced aperieni 
effect than nUned syrup. Besides cane-tiugar and certain acids, 
etcv, mola^^sf^s contains about 30 per cent, of invert-sagar and 
the J^alne amount of nut^r, 

HntchtiKin (p. 264) ^ivetf the following table showing the 
oompoe^itioti of moluHCBi treacle, and i^yrnp; 

HoLuKt, Trcin?lc. EfrniK 

dnHiigEir . 47,0 3'IA 39.0 

Froit-niimf S0.4 37.2 33,0 

Extnctif c and coloring-mitttr ... 2.7 S.fi 2.8 

Hilta 2:0 a.-! 2,fi 

Viler 27.3 U.A 22.T 

Glucose, or grapC'Stlgar, is chiefly nade from *tarch by 
inversion or bydrolyj^it. It is not oeerly so i^weet &a can<v 
augar, and cryAtallixca with difficulty. It is prescut an souili 



loe 



CLASSES OF FOODS. 



quantities, in ooTDbiitation with other vnriotic# of sugar, in 
most fruite. When takea in excess, gliici>^ appears in the 
urine tnichnnged, 

Lactosej ur sugar of milk, is tLe nutuml curbohyiJrute 
for the youug, growing irifuul. It la Ic^t.^ alitiDilaiit in cumV 
tnilk than in huniun mitk, und for this roiu^a it should h& 
Added tit the millc of hoUle-f^ infnutd. 

Honey ia ^u^r in u cOTiceutnit<H] solution. It h mocle hy 
boes from the nectar g-^therei] from vnriou?* flowerw. It coutnins 
a cr>"talli«ible augur, reaeoibling glLiC4i»e, and a iion-cryatal- 
tizabk form* Honey was formerly u^ as a sweetening agent, 
but cane-sugar, on account of its cheapnesH and abundance, has 
largely sujiersLnlL^I iL Be^ldea angarj bonej' coQiaina wax, gunj, 
and coloring i^uhj^taiici.^. 

Saccharin is n^ largely as a substitute for ^ugur la oaaes 
of rheiimfltism and dia3>eti3s. After loag-ooatinued u* of lurge 
qiiantitiert of sac^hurio tligi^sitive dij^tiiHnneet^ an- apt to he |>ro* 
duccxl, 

Xfemlose, or frait-sagar, U altw utilized &» a form of 
eugar in ceitatn cases of diabet^. 



SPICES AND CONDIMENTS, 

S^MCeaand cotidimetito |)lay uu important r6lr in increoaing 
dl€ Appetite and aiding the digestive fuuctiooB ; they have pnio- 
Uoiilly no uutritive value. By the action of the^e substanom 
on the organ of lasbi as well m on thp mueouR membrane of 
the stomach the appetit<? i.i i^timubteil and the secretion of 
gaJ»trio juice increased. In certain ga^^tric ilisturbances, as well 
u in dimoseH of the kidneys, they act as irritants and should 
be uvoidwi. 

Tile peppers are among die iavonte spices; there are two 
varieties, the white and the black. 

Mustard. — Muatanl Is used chiefly in salads or with other 
foods, and ha^ u. marked tendency to tnoreji^^ the aj>|>ctitc. 
There are two forms of mufitard : that which is obtained from 
the block mustard plant und that deriveil from the whit^ 
mustard plant In large qiiantitje« and diluted witli water 
mustard nets as an irritant to the Atoiuacb^ producing n&nses 
and vomiting. 

yine^ET is produced from various alcf>holic drinks and from 
fhiita. It eontainii 5 per cent, of acetic acid. By its action 
on the cclluloHc of vi-gi^tabtes vin^ur sot^ens the fiber, wj tliaE 




it not only acta as a cnndimentf but nl^io ilh^UIa in the iligi?t4lic>ii 
of the cellaloBe; for this purpoae it i^ abided to ««iich veg^^tahli^ 
as cabbugf?, lettuce, and cumitDbers* 

Horseradisli in a uondinjeni ttat is mucti tuited with various 
foocU ; u stimulat^fl tho flow of aaliva a« well afl of the gaatno 
excretion. 

fiances^ suoh as totnflto, c&teup, WoroefitenJiire, artd the 
like, incTfBst the ji]>|)etiEe and give a relbJi to certain f>od3. 

Spices art Qjerely I>y adciinjif a Bavor to foodfl, in thifl way 
increasing the ii|>[)et!tc for food that would otherwi^ be insipid. 
Ibwe mmi in iu»e are ^"g^^r, ciDnumuo, ntitDieg, and cloves. 



FATS AND OILS. 

OnL^AfUk of the body<n'ti(;bt ooneiat^ of fat. This id ob- 
tained in part from fatty tbod and in part from the carbo- 
faydrate^ and the proteinn. Most of the hi«t eiiei^y furnished 
the l>ody is supplied by fat ; it oxidizes very rapidly, and iu 
this way spares the protein eiementa tliat would oUifrwise \ie 
required to furnish energy. Fata are digested in the intestine^ 
vbere they are emulsified previous to being absorbed. The 
ma'it usi-ful form* of fiit are cream and butter ; othor forms are 
buom and <^M]-livi*r nil. ^V*hrnl t^aUm tcK> lilK^rally, fntfi an* a|it 
to viiUf<: indigt^tiiHi, and when tbLi cxUtA, ttiey .iliuuld be taken 
cnly in vi^ry restricted quanlitioA. 

FtHhU fned in fat are iudl^*vtibl(.', and hot fabt aiv more 
tndigp^itibb' than ooUL Fn\» nm\ uiU Irnve a ti*n(ien<*y tai ndii^ve 
const tpatii>n^ but are (.v>imteri[idii3i(uii in diiirrlKAp 

The mt>sl imporUmt animal this are butter, ormni, lard, wuet, 
cleomargarinp cotb^Iene, butterine, cod-Iiver oil, and bme-nur- 
row. Of tlw vii^Tt^ble fats, those airwt eonimnnly employed 
are olive oil, eolton-seed oil, linseed oil, cacao-butler, and the 
«ils obUiiued from nut«, such aa oucuauut oil^ peanut oil, and 
«lmr^nd oik 

Indications for the Use of Fatty Poods,— Fatty 
fixMirt nn* indit^twl efl|nviaUy in wasting disortl^rs and in enn- 
valctfceuce from ctTlnin amU* di^'ase*, Tlu-y are needed |ar- 
ticalarly id tubercrjioiiiii, rachitis, chronic bronchitis, and chronic 
di»casc8 acecnijianied by the formation of abscesses. 

There are nuny proprietary fatty foods on the market, some 
of which are worthy of njention. In most of tbe?e the fata, 
usually cod-lEver oil, have been emulsified ; this emuleifioadoQ 
uma to moke tb« oil leva objectionable to the taat« and also to 
tender it more cueily digestible* 



106 



CLASSES OF POODS. 



The Use of OUvc Oil In the Treatment of Certain 
Diaeases. — Tby txtcrml and subcutaneous nso of olive oil 
win W *litcii?*i.d fiirtljLf Oil (p. 290), Cbauff'>nl and Dnpre 
were the fir^t to advocate the use of olivt? oil m ihi? treatmeDt 
of <*holetithiaai/t^ TKcy reoommendcd that two dop<« of 400 
grfltrii^ eirli br givdj at lintf-}itntr iuterv^U, the patient being 
directed to lie for thi^^e hour^ on hm right side. T]i<> use of 
olive oil in tlio treatment of this eonditJon hn.^ ^uhF^e^tucintly 
been udvoeAled by Walker, Vett^teiuer, and others. 

KoM*4ih^-)m has advised the use of olive oil in the treatment 
of tsirkhirt of the ettophatjus due to carcinoma. After allowing 
» wuall qmintity of oil to flow into tbe esopbagns, patients who 
were unable to swallow before have frequently been enabled to 
swallow thijds and seui idol id&. 

HiMjently Cobnheini * has advoeated (ho use of large quanti- 
tk'« of olive oil in the treatment of certaiii fm'ms of gantriG 
dwortfrr. In cflM'S of ga'^t^ic dilatation he tonally adminiateni 
the oil once daily, m the morning before break£i.st, in dofien of 
from 100 to 150 e,o,; in those in^tanee^ in which lavage is 
practised the oil is given immediali^Iy after this procedure. 
After taking the oil the patient is required to lie on his right 
Bide for from fifteen U) twenty-five minutes, ajid la not per- 
mitteil in pjirlnkc of imy fo<>tl for uu hour. The oil is admic- 
i5t<"re<l warm, ut nbout the bo<ly-tenipfmturi.\ If, iiotwitli- 
gtnnding this procedure, the patient still continnea to fiufPer 
pidn. -"ifl e,c- are agnin given at ni.y:l»*, l><*fon* retiring. Ivater 
Cohnlieim orders thai a wim'ii:las&ful be taken one hour before 
hn/JikfiL-si ami two de-^.^ert^poonfuls from one to two hours 
before tliniier and before supper. In simple forma of deer 
be rcooiumend^ (bja the olive oil be used only In the momingt 
and the emulsion of sweet almonds (aee below) at noon and 
ni^bt ; mii^l puliunt^ do nut obji-et to the taste of the oil. 
Aceording to 4.\>linheim, lo tbo^e inManocs to which the lasto 
of the oil Ih objected to, this may be overcome by tjiking a 
pinch of salt, a NWidlow of bmndy, or by allowing a ppper- 
mint drop to d!8J<o1ve iu the mouth. The oil trail-r^eiit must 
be continued over a fieriod of wee-ks or months. Cohnheim'a 
concliij^ion.4 are as follows: 

" L Cftj«--i of dilatation of the stomach due lo spasm caused 
by an uloer or fissure at the pylorus are cured or at least mnrkwily 
ivlieved by tbe uBe of large quantities of oil (100 tn 1 'lO gi*aoij^j. 

" 2- Casea of uttuoaitt uf tbe pylorus due to urguuie diwa^e 

> ZcitKlr,/, kUn, MvL, vol. UL, ptiL 1 And 2, ^. 110. 



FATS ASD OILS. 



vrttb secoadanr dilntacion arc uliM> u^ftnlly robtivdy cured by 
tho une of Urge quaiiliticif »f oil ; lliut U, tlio^e |>atient8 are 
&V01I from dislitrbriuix-:s whik K^hiliiig tiu hl>»E«atiu)Ufi HAf. lu 
Amt CMes the i>il art" mwhnnicall/ hy ndicviog fri(.-tion. 

** 3. CiiAce of ivlutivc rttonofiU nf tlio itylnriiK Ami du<xli^uni 
which nr^ cHnionlly miirk**fi hy n mntintiouH hy|M*r«iHirH.i«n 
and pyloroHpasm several liour« aft^r the pnneipjil idl^U, ait 
much improv4Hl or curt>d liy the oil trnitineut. 

"4. The pyloro?^p:iHm fatmd in cnsc« of carcinonm of th« 
pyloniE is mueh dimini^hod or n^licvivl by the oil treutiueut 

" 5. Oof^CT^ of ulcer of the pylonis a.>f90oiute4] with or without 
hypercblorhy drill &re quicldy <nirv(l hy nuaixui of the oil treat- 
meot or by an rmubiioii of ^wi^t ahiiondM. 

"0. The oil ir^ hest ULkcti thrco timc^ daily, Iirjf to one hour 
b^ori? mrtalfl ; as a nile, it U Uvt tii u<1mini«U>r a wincfv-lnEHfitl 
early in the morning and two f h'>iwrU]M)onfuIx heforrdinnernm) 
Hupper. In mild cases an eiiLiiUiou of sweet almoDds Enay be 
substituted for it* 

"7. The oil fuinis three indioatioDs: it overcomes pylore^ 
ftjMistii; it relicvc.i tnction, ami ti'ud^ to improve the genomi 
nutrition. 

"8, The oil ftcto a« a nnrcotic in case^ of pyloroepaam^ pro- 
ducing, hovrovci'p DO unlavonible effect — neither eructationa bot 
ditttrhen. 

** 9. Xo favorable effect of the oil treatment haj^ been found 
in purely hy^iteriG ii^&strio colics. 

" 10. In that form cf ^etric t^euroBis manifested by pain 
when the fitcraach is empty very f:ivorable s>iDptoniatlc relief 
has been obtained from the use of olive oil. 

^11, A oertain number of oases of Ktenotus of the pylorus 
aOQOnipanl<xI by a consequent gastrecto^b can of\en be so much 
rdieveil by IIr- oil tre-atmcnt that no operative j»riwe<Jun» n«od 
be andcrtakcn. A trial should be made of the oil trcatmoat 
in all oasee of fit«no^ of the pylcruti bcforu udviaiug 0|>eratLVC 
procedure. 

"12, The treatment prevents propbylacticruUy Uie prrwhic- 
tion of gaatrecta^ia and prevents relapfi&i when utilized 111 
fivvruhle ca^es/' 

Olive Oil in the Treatment of Chronic DyBcntcry. — Ruth- 
erford^ gives his results with olive oil in (hetreifctm*^'nl nf dircnic 
dyscuiery. Accoj^Jiii^ to hinij '* Upon the inreniul a<iQiiaiMra- 
tiou of olive oil typical cast« uf thmnic <Jywmeiy pfa<;Ui2iUj 
without exception show chanf^ in their oonditiou aa follows : 



no 



CLASSES OF FOODS. 



"1, Foeitive evidence of iufTrm^cd ijUoDtities oC liHc m tbu 
fcoes, 

" 2. Decrease in tbe number of iliiily bowel movements anJ 
murk^il improvement in the chnrarter of the same, 

** 3. Gnidufti e<?j«»ation of sigiia of fermeDtatton aud pulre- 
factioo along; the intestimtl truct aud consequent subsidence of 
paiu aD<) tenderness. 

'* 4. GenenU ey«temic improvement ; guin in appetite ; repair 
of digestive faculties ; eymptoiuB of improved nervous system ; 
and rapid giiin in weight ttnd strength, 

*'o. ApjuircQt pofiitive cure after an average time of two 
montba antl upsvnrd, M^itb few retiirrencea." 

Tbe metliod of osnying out tlie trKtfiDeut ts as follows ; 

" J^rst Pervxl. — The patient is given one ounce (30 c-c.) of 
olive oil three timee a day for the first three days, when the 
quantity is increased to two ocni^^s (60 c.c.) three times daily, 
and on the sixth day the same quantity is ^ven four times a 
day- During dte iirst three days the patient is to be kept oa 
a milk diet. During the latter half one to threi' ounces (30- 
90 cc.) of scraped beef ur it» equivalent of ej^-albumin vrill 
be ad<led daily. During this treatment a slight loss in weight 
may he tempomrily noticed. 

** Setymd Pfrioii. — During this period the amount of oil is 
given in greater quantities (not less than three ounces — 90 cc, 
— three times a day wiihout discomfort to the patient), and 
must be kept up for a length of lime in severe and chronic 
Qflflee; perhaps for two months or longer, during which peiiod oon- 
valeficence will have b«en esTablishe^l and the weight r^aincd. 

■* TfUrd }'<rio(L — During this |)criod the patient is gradually 
restored to a firll diet^ and the oil decreaf«d in amount until the 
nlcere have permanently heated and a recnrreooe not probable" 

Blum tint advocated the use of olive oil by reotal injection 
for the treatment of g<iU~do7i€ coHr, and claims good ra>4ults from 
its use. Fleiner fin^t recommended the use of copious oil in- 
jections — 400 to 500 cc. — in the truitment of certain forma 
of cAromc coj^paiion. Remarkiible results are produced in 
the spastic forms of chronic coustipUioa when this quantity of 
oil is inject*Kl two or three time?* weekly. The oil should be 
hfttted lo the body*teinpeniturc, aud injected high at bedtime 
an<l rHaineii during tlio tiight ; the same precautions should be 
ol>Jwrved ae in living nutrient enemata, (S^-o p, 285.) 

The TTse of Smnlsion of Sweet-fllmond Oil in tlie 
Tieattcent of Certain Gastric Dlscrdera. — Cbhtibcim* 

> ZcUMchr, / Uin. Med., \qL liL, Nv. 1 and 2. 



SALTS. 



Ill 



r^commeDdii an «mult<idn of ulmoudH id thoee ra»M id which 
olivt oil 10 not well borne. Id effect it Sk identical to olive oil, 
previ^nj^l^ dcm-riU^I^ relieving ^putiin und irriuitioti ^ on the 
other biint], tt ljick« tlic nutritive vohie of olive oil. Od nc- 
coattt of \\fi motv plcoaint flavor it \» prefcrrwl hy some, 
O^hnheim givfia thp fMirtwiitg tlinpcrinnri for pre]iariiig nn emiiU 
HOD of ttlmond dl : A il<?(^^rt&poonf(il of Btie^t almonds are 
blanchecl by scolding with hot wnter and removing tlie Hkine, 
after bong allowctl tu dry they arc grotind idIo s jK^wder and 
piftiH<«i into a Clip of boiling' ^nter : \\m mixture \^ iicxt nibK-d 
by ii](.wi# of a vpoon, und ittniiuiHl throui^b u pif^x.' of pXMU!\ a 
quantity vqual to fVoDi 200 to 'i50 gnims ehuuld W obtniit^d 
from a d<^>«trrUp(Joikfnl i>f atmotidi*. TJie cniiilsToo sliuuld be 
taken wartn«d aiirl c^weetcned onoholf hncir licfor;; mi'ul^, iu 
ordvr to n.-li'?ve «ny irntjition at the pylonix and to prevent 
^{la^iD in thifi ptirtiou of the i^iomaoh. 

The various lal£ still to be mentioned are butterine, oleomar- 
pirin and l>»[ie-m arrow. 

Butterine i§ a i^i prepiifKl from beef and ho^v fat, tnd is 
frequently ug^ in this country instead of butter ; oleottiar- 
gaiin is n similar preparation ma<kr from twf f«t. Bt>tli but^ 
terine and olecraatpirin are wholesome futty fotids, the only 
objection aa;aio#^t them beiog that tbey are of^eo &old fraud- 
ulently for butter. 

Bonc-tnarrovr is a fat obtained fmm llie large bones of th© 
oz. It ia u^ted in the treatment of tuberculosis and id the 
various forms of anemia, especially in pernicious anemia. The 
marrow of yonn^ animals 16 uaually preferred. A prcjwnition 
known aa the glycerin extiact of bone-marrow xs oAen utilized. 

SALTS 

The principal mineral c^onstituents of the body are the chlorids, 
phosphates, sulphates, carbonates, fiuorids^ and silit-Ah^e of 
potai^tuim, sodium, magncf^ium, caelum, and iron. lodin is pre^ 
cnt (.-spix;ially in tKe dtyroid ^laitd, and tbv other huIo|^nB are 
also found iu the body. The amount of h<Ntt and rnergy ttnp- 
pji^ b)' salt Eui>taholi£jn ts «o tunull aa t'> he practically disre- 
garded, but the Aalts play a moi*t im[iortant part in tJie metnboHc 
pTDoaafiea and al^ maint^iiu oKmotic pri^ssnre. They are also 
eesential to nervous and muscular n?ftction. 

The following table &ltow» the salt content of some of the 
tiBsuefi of tfa« body: 



113 



CLASSES OF FOODS. 






s s g s s 

O O O ^ 0> 



2 :2 s 



5 

1 



M 9* 



^ 



^ 



3 3 



»-- ** 3 

Ca d *-i 



^ 5 "? a I li 2 1 ^ ^' ^ 

' « C eS *0 ^ 9' ^H 

c d o o o d 



a 



!5 



^ ^ f^ n M o 

O o ^ ^ o o 

^ ■^ ? V 3 = 

g fe S S S 3 

cf 3 ^ ■-^ ^ ^ 






- § 



|3 3 ! g i i I 2 : • 3: 



II 



r 2 „ S •:! K 

* d ss S ^ d 

o 

.„ ►. » .- 2 g § 

d rf do ^ "^ 

d d 

^ ;;;;;;;,;; ; 

U ::::;:::: : 

s 5 

IM ^ f I & I § 1 1 s 






114 



CLASSES OF FOODS. 



p 



lai^ ijuiuiiEti<.<9 uf the xilkuliuc bu»ea aiid &Jao pho^pborlc acid. 
Tb*.' alK&llne baaca art% bowt'Vt'r, alwaya iu ex<xifis, 

Tbe nietaboiism *y{ ib<? sdt?^ in tiie body pluyf^ a very im- 
poHart jiurt in tbe plij-siulogy of uutritioii, and ilieturbanoeH oi' 
tiiis salt metabolism may bt- ihe cause of disease. This aiihject 
ia as yet but Httlc understood, but tbe tiierapy of the future will 
tiodoubteily depend u|K>n the practical application of tbe prin- 
ciples of nutrition. If tlie oaJis are witlidrawn entirely dtuth 
reeiUts, and Forstcr aud othera have ahown thai dogs fwi upon 
jbodfi from which iIk sidts bad bu^eu eJtlract*:d by water die ia 
from 20 lo 36 days. If aa!t5 ni^ given in excess they nrc ex- 
creted, but if greatly in excess, may be retained lu ihe body 
and C4n]8e untoward symptoms, Undt^r eer(ain exjnditions even 
small amounts may be retained or^ on tbe other band, saltd may 
be esereted m aucb quantity in the urine that tbey oanuot be 
held in stispensioo^ and are couj^equtintly depo^it^ iu the urinary 
tract and cause fitone. 

Animul food c^intains sidpbur and phosphorus comjiound:*, 
which by osidution in the body are clianged into snlphurio end 
phtmphoric fieid::^, whicb t4?udi Ut render tbe bloixl uud tiis^iics 
acid. The destructive mctabolUm oftlie tia^ues of tbe bo<ly 
t«nd« toward the same end. The vegetable foods, the cereals 
excepted, J'nnlain large amounts of alka,line ha^'g, whidi lend 
to nentralii^e tbe actdri and to render t!»e tls^nos alk:ilinf>. A 
umall arui^UDt of tbe acids formed in the rai""tatK>lio pror*?4ses ia 
neutralixed by the aiumonia from ttie protein, and this is ejc- 
creted as ammonium saltif, and takes tite place nf tbe alkaline 
salts fr<>ra v^etable fooils The daily needs nf the body are 
summarized by Gantier as follows for the average adult : 

iMMi. j AeUi. 

Sfi 3.32 PA >-«■ 

StLQ 7.70* SO, 3.0a» 

Ho, • ■ < 



1-17 
.0.04 



so. 

CO, 



.0.36 
.0.06 



(a) The food doe^ not In realliy rentain 3.9 ^ims of P,Oj 
and tbf 2.03 gramn of Bulpliur Iricixid indiraled, but contains 
pho^pborona and eulpbur, which if reduced lo the given com- 
poaiicb would yield these figures. 

(6) This comprises tbe amoimt of sodium chlorid taken in 
twetity-fonr hours. 

Alimentary Alkalis.— The average ration of 110 grams 




116 



CLASSES OF FOODS. 



ofaiof of wliioli arc luiMitude, au mcapucity for work, dy-Hpeiwia, and 
cranipd. These !»yruj)toiii8 itre pro[U[)Lly relieved by i^toring 
the usual all^waDce of salt. On the other hand, a aalt-free 
diet or 11 lowered salt alluwuru^e s^mA to liavo a beiiedcJal vH'^t 
m dotne nervous dUeo^ea, aa in epUepsv^ m wblch diaeaAe it la- 
crcoses the aoUoa of die bromids. It haa been euggeetod that 
a salt^frae diet be tried in hysierm and sorue of the other fuD^ 
tiniml Dervnus troubles, aa an addition of 12 to 15 grams of 
salt to the diet in hysteria a^j^ravates the conditioQ very much, 
and In latent liysterlu miiy ninke it manifest. The effect of a 
salt-free diet iu edema is noted in the section on Nephritis. 
Animals which feed exclusively upon meat do not need salt, a 
fact pointed oat bv Bunge. The acids formed in metabolism in 
these auim^U is neutralised by base^ formed by the breaking 
down of protein. Potasainm ualt^ being preaent in vc^tables 
cauaea an exouss of potassium in the blood, la order to elimi- 
nate this, BA explained above, a large amount of sodium chlorid 
is necessary. All gramuivoroua animals ceed salt> and the same 
Li true of man, who is omnivorous. The average indi^'idual 
takes more than there is any necessity for, however, the taste 
for tliis Havor leading to excesses. An average amount for an 
adult is from 20 to 30 grams a day. 

The Halogens. — The elements cblorin, iodin^ bromin, 
and fliiorin are tiken into the body in fi><>d or drink. The 
most important, tthloria, is taken prinoipally as aodium chlorid. 

todin 19 f'>iind in unolei^protelna snd especially in the thy- 
roid ^tand, wbich contains 0.075 to 0.13 per cent. It is also 
found in the other orgaa,^, Gautier gives the following tables 
(afl«r P. Bouroet), showiag the iodin content of various food: 

lodin ptr Kilotjram o/JVah Matrriah 



Green bean« 0.33 

BAnaond 0.31 

A^pftngiu 0.24 

<inrUc 0.S1 

WhiUcubbaeft 0,21 

Mi«hT*ii>rn» 0.173 

8tmwbcrri«t 0,17 

RiM 0-17 

OirroU 0.134 

S0TT*1 0.12 

0.12 



flmn pQM O.BO 

TomatQw 0.S3 

Grmpes 0,0^-4M) 

Arti^bqkw O.OIT 

pMn 0^017 

^Vhlt« dried bc«na O.014 

L«ltuce 0.012 

FoUtM* O.Ol 

Oatmal 0.009 

Whont dour 0.00T 

BmJ 0.000 




SALTS. 



117 



lodm ptr KQoffnm m So^rt^ AnimtU FoodM. 



CtnjdiriQip Ml 

Cnbi XM 

Lobiter L78 

flnokad barring - - - \.t>7 

Fmh Almoa .......,, \M 

BvAcli 1.38 

p7«Kr« 1^2 



Bnroo J.35 

Frubcnd ]^ 

AnrhoTics 4,^ 

TuDiij, frvfa <k88 

Eci OM 

Whitiag 0^1 

rrout a,06 



Fiah, fmilii, aod itarcby vegetables manifesUy fanuBh moet 
of tli« iodiu. 

BrotQin U found in (he nuclear proteiDs and is excreted 
in ihe Bweat. Foods which <rontutD iodin also have brotoin in 
them, although Dot lu the ewne qiuntitiett. Fluorin is preeent 
in tb<r body aod ia t&k^n in wilh the drinkiug-wflter. 

Salphnr. — Sulphur \& contnincd in both antm&l and vege- 
table pnotf'iTis. Kour-fiAhi; flf tho Biilpbur Uken is oxidtxed 
and excTflt^d in the unne either a8 siilphftteA or phenol fiiilphal^s, 
the remainder enters into conLponnds of more complex eompo- 
sjtioa. About one gram of sulphur is excreted daily by an 
ndulL 

Fhospboroud. — Fhofiphorous i» taken into the body m the 
form of phottpliatca and al^ in the more iximplex organic com- 
poandB, a^ lecithin, nuclein, and others. The yolk of eg^^ fish 
rr/e, nt^rvoua tif<»u«, lob^i^r, and glandular atmcturts aro foods 
partloutarly rich in phosphorous. Phoephoroiie is particularly 
important in the groivth of the body and enters lai^ly into the 
oompoj^ition of bone. The yolk of egg U the raoat available 
form for feeding: cbiWren or invalids where it is thought best to 
incr^wr^ the amount of phosphorous. The Danilewiskys have 
shown tliat lecithin exert a favorable influence upon metabolism 
of groving animaJa. 

£rOD.— Iron 19 supplied to the body in the food in conrider- 
sble quantities, and a suRifient amount jh abst^bed to mjiiutain 
the irt»n equOibriuai. BouiedngauTt tslimatc^ the daily loss of 
iron at 0,06 to 0.08 grams, and moet of this is excreted through 
the inteatinal wall and parses out of the body in the feces, a 
small amount is excreted in the bile and a trace in the urine. 
Animala fed upon ftuxl;* ivior in irfrti Ixoome anemic- Young 
animalFi thrive upon milk which \9< poor in iron, but this is ex- 
plained by Bunge, who ha^ ^howii that the bodie«i of animala 
which live upon milk contain at birth a large amount of irooj 
which is EUfBoient to tide them "kver until they tike food richer 
in iron> Iron la t'ltmtiiattHl fmni the body duiuig ntarvaliou 
and, aooording to Salkownki^ the amount eiiminutcd la tncnawd 



lis 



CLASSES OF FOODS. 



during fever. The amount of iron oontained in food DiaU;riul 
IK tthowti ill iLe following tables : 

MiUigramM of Iron in Ii/0 FarU ttf Frtah Material {BoiMiatgauU). 



Tiffi Uowi ^A 

BuU^iicr's iii«ftl 37.5 

Lvnttln - 6-S 

Fuh 7.& 

WJiitv UsbDB 7^ 



TolALOa . ........... 0.6 

Hen's egfr . (.7 

While bmd 4.8 

Voal 1.7 



MiUigntrtu of Iron in IffO Qranu of Med SutMtance (Bungt). 



Blood BL'Turo . 

WhiiAcif Uon'iicfiK Traoe 

Rice I.lk'J,() 

r™rl tinrlc/ 1.4-1-5 

Whrnlllourl-ifusi) 1-6 

CukV milk 2.3 

Uumikn milk 2.3-^.1 

Do?'* mUk ^3 

Pip* 3.T 

ICaxpbcrriM -..,.,.. 3^0 
Eliuu?t-fml kttnuli . , » ■ ■ . 4*3 
H^Lrlt-jr . . - . ,.,... 4.^ 
Chbbaigv (iiWdo x^llow Ivavm) 4.^ 

Rr« 4.9 

p4H'I«it ftLmomto 4i9 

Wh«it - 5l5 

Bilberri«a fi.T 

F<iEa(o«» C4 

PnB fl.S-O.S 



Wbke bmns , &3 

UrrolB ftfl 

Wliml bran £L« 

l^LniwbciTii0 Ii.&-0^ 

LiupahmI 9'fi 

UuE>?clwi aLmon^ . - - . 0^ 

Rfu cU^rriiA, wif liotiC tfloiLi<>^ 10 

Brown Kkiniit?<l liaeni miU , 13 

Appl«fi ...-'-- - - . 1^} 

Unndelion leu TLft . . , . , 14 

Cftbbttgv {o\itet given JcaT«a) IT 

B*flf 17 

Telkoregg ....'-.. 10-24 

Spinnch ^SV 

^^eblcxxl £26 

Uvmatoffen 290 

Hvmagofiin ....... 34U 



Manganese. — This metal is found in the body in minate 
quitatititis, ^ind ^niii)! aruuuat-s are t'ouiid in some food muTeriaU. 
The a^h of legume^i aapamgus, cauliflower, lett^icc, grupt^a, aud 
of varifjufl gmias contatoa voryintj amounts of moDgan^o. 

Silica. — Thiii element la eliminatpfl in t\v^ )inir ard deupia- 
mat^ eE>ittieltum. It la present in many ve^^etablea, but the 
part played in the animal economy ia unknown. 

Aide niC.—Gau tier hna d^monslral*.-*! the presence of a trace 
of Hnu*nio in the ectodermic tiaanft'*, the ftkin, hair^ brain, niam- 
ni:iry ^tmid, and thyroid. SmalK-r traoes have been detnonptm- 
t<j*l in other organs. The role of arsenic in nuetabolLflni is un- 
kaown. Tmuea of ar^*enic have been fonnd iu certain vege- 
tablea, as cabha^ and turiH[)e, as well a9 in some cereaU* 
CommoD suit tnny oontaiu fioine araeoie, and it ir somettmes 
nnw^nl In foods either aa an adulterant or as a food poison^ 
(See same). 



I 



J 



SALTS 



as 



SALT MBTABOJSM AND DISEASE. 

TbB tiasiitt (liilVrr in llmr ^^^jiU eiMn]>i.>stt[oii, imd chan^ in 
aalt pa«tftbolism an* pnilmMy ihn* vilUvr U^ mnjphy *^r gn>vrtb of 
certain oigiuitt or U^mk?^, ur to Owir tAkicigoii new AmLHiunn, ar 
ti» tbe prf>oCiM» ijf ilinv^ifir. SlUilicrt v£ the bnlani-cs of tlic vnr- 
iouti t^tSf }iAVU been niaiic but sparingly in disease, uiul dotibt- 
l>*v* thU siibjtvt will \w 1aki-n np rnon? iMirrgrlicmUy Jn tlw» AiUirp. 
In hnijg<.^r* WvJIriuiu fuLinJ iluiC then? waj* n gRULtor loss of salt 
tbuQ <xmlj be accounlvd for by Uio tDetub<.»li£iTi of tbo fleshy 
pftrW. The princiiml ejice^ war* jiliortplioric pi.'ntoxu) and cal- 
cium flii<] mitgiLeHJuni oxid in al>ont tha Hxixi^ pr<>|>ortii>n U9 ftn 
found in t>one, and th<^ Akelelonn cf tho nnirnLiU were forinil to 
have actually lo^t G or 7 per cent, of tlii^ir weight. TJu*re i» 
a lowrrvd cttlciiiDi cxcretiou iu many tllsi^.'H^l C4>iiditi(>nt«r arnuug 
wbScli nmy ho montioDcd, [>lonral flVueiiiu, popuuiouIaT ddlnum 
trnnutifl, and varinu* fvi'i^r*. In ptilm^maT^' tuiK-rouloeOi* 8i.'nutor 
found tlmt t!ji*n> wtin nn <*tocss of culcitirn r-xrrj^tiHb In ontixv 
mabu^a tite calcitnii balance ii« Oiisttirhtii, and more le eicnrted 
than ia Uiken into Ur^ body, Phwphoric acid leseena the cal- 
cium excreted, anrl Ihi'* might Ix' used in *-x)Wiriiu*'ateI thera- 
peutics. CD«t^;^l^on^ which 1ju« bi*CD done in a ivvf tiiwrt, «>»- 
tore8 llie OiOj i^qujlibritim, and there i# qIho a U*ndency U> 
rcsbtration of tlie M^lphiir t-qntlibrima. On the otbe-r hand, Iu 
myositiei o8fii^<anD the ammiat of ralctum cxinrt*:^ in the urin« 
la liiwrr than normal- TIktv Ir^ aUn n rcti^ntirm of lime enltd in 
arthritis defonimn'^- In i-mhirti-nliv tin- mb'inm rTcn-tiiiti tft 
inferferred with, and Rumjif claims to havo nhfjunrd gmul nw 
enlls by ^vini; salu which aid tht^ e-xention of r^tlt^ium a^ lae* 
lie acid, mMliiim lactate, sodium citrate, aodiuu earboaate, and 
•odium chlorid. 



BEVERAGES AND STIMULANTS. 



WATER. 

Wateh is the chic£ cnnetilueot of aH beverages, nni ftlso 
«DterE largely iott^ the pompoeitioD of f<o1id f<x>d. The buman 
body itself is cDmposed of about 60 per cent, of water. While 
man can live f'>r weeks vitbout fooilf he cau abstain from w&t«r 
for but a few days. Wat*r is absolutely necessary tis a Bolvent> 
and Ji« it is coust^otEy i>eing eliminat^.'d by tbi^ gkio, luugs^ and 
kidney's, this ioss must l>e replaced by M>me meaofi in onler to 
maintaia the trinctJoiia of the body. Tbia is moat <;uDvenieDtly 
doDe lijix>ugb the ogeucy of the varitjiis beveragee. The best 
inethod^ however, of replcniehing the water-supply ie that of 
drinkiag the water in its pure state, when it retains all lis aol- 
veot properties. Some waters are taken for tbeir laxative or 
putative action, and others for the salts which they contain. 

The amount of water cansuDjeil daily by the average person 
ie from six to eight glasses. This varies, however, with the 
amount and variety of f^iKxl and exercise taken. The oge, eex, 
and sii^ of the individual and the reason of the year also in- 
fluence the lolal daily consurajitlon of water. In very warm 
weather, for example, and under (severe physical strain, much 
water thitt would not be lost in the cold season of the year is 
eliminated In the form of perspiration and must be oompen- 
sated for. 

Water is abeorhed ohiefiy in the iulestiue ; a small amount is 
absorbed in the stoinnch, and but a very trifling amonnt, if 
Anv, in the mouth. The wat«r absorbed in the intestine is 
passed into lymphatics, and I'arried on into the circulation, 
whence it i& eliminated. Thus by removing; the water from 
thebliHxl and ftendiag it through the kidneys into tht bladder, 
spaoe is fiiade in the circulation for the entrance of more fluid 
from the aluni-ntary tract. 

As previoiihly stated, wnt*r is ditninat^d through the skin, 
kidneye^ Uii)^, and feces. The amount of water excreted daily 
varies greatly under special conditions. In cold weather the 
fikia is inactive and the kidneys excrete a greater amount 
of water than in hot weather, when the sweat-glands fiioo- 
120 



I 



WATER. 



121 



HOBftte tncm tcrtivelv'. Wlieu lliere is \ teocleocy toward 
U^uiJ mcivemcnte fr^tn the bowf^l, the rlitninfltioti by the kid* 
Dey6 is lcd±fc[ic<l. It) worm wvutliGr cluninixtion by the luDgs 
18 iitinKilAted. 

Tbr temfwmtiire rf dnDkin^wiLf«T i« ft mntt^r of mme im- 
portjtnt^. IcvhI wnttr will Ktitnuliitr n more rapid and a grealer 
>*cen^li«ri of pifftric jtiic**, hut l«*HtiiN lb<j motility of the ;ftomach. 
Ictd watijr in exoi^» is injurimis^ mid t^hould not be taken wLirn 
one is overh«at«d. Hot water baa a very beneficial eifect ud an 
irrilal4d fitomacb. 

Wat<T \» a aiuid valuable dlunrlii: and diaphoretic. Wljen 
tlie Htomach cau put rctairt it, it bi ofWi givea by the rcc- 
Ctim. A piiit of «alt jiolutiou, if inj(Tct«d by tiiv use of a roctal 
ta\^^., will, if thc^ cubin luut pn-vioiiBly be^ii oniptinl, hc^ retained 
long enough t/i Ix' abw>rl»t*r If n hntf-pint or even a pint of 
Bait tinlutjon lie intrtNhn'iil under the skin, it will b<* ubi^rbed 
rapidly and an rapidly W. eliminated. Thin i^ one of the most 
naeful meaaiirefl ff>r produciiifr rapid elimination through the 
kidneys. 

Aixijnling to tht^ aii»>unt of mineral water ibey cxiiitaiii 
waters are clafe^nl ofi bard aad eoft, Rain-watex 10 euft, and 10 
the purest form cf nntunil yfAicv. The hinJneits of wntcr is 
due to earlby rarbonfiti'K \ by boiling, the cstrbonio aeid gfui ig 
driven off an<l the t^irlHitiate^^ are precipitated, and tin? waltT 
^ws rond^rEV;! more Huilablc as a bevenig4\ Boiling; bos tbe 
additional advantn^ that it destroys most of the tnicroorgia- 
ienis that may be pre«ont ia the wuter. 

Water often coDtainm impuriljes, such gg lime, mi^esin, iron, 
nnd other salt^, or niicitw^rgaaisiufi, and it often becomes iieces- 
«iry to ptiHfy it for drinking purposes. Typhoid fever and 
cholera are commvinicated chUfly through the agency of polltitod 
drinking- water. The beet method of purifieadon is by diFtilta^ 
tion, by wbif*b mpanfl Iwith inrrptnie and orgfmic impuritiea 
can be removed or rendered innocuous. Tide method is now 
Dficd largely on ehijjg. When ilistillc<l and aerated, eea-wutcr 
makes a most plesf^nt bevcmge. Water may alK> be pnrified 
by meane of filtiation, charcoal an<l sao'I Wing used extensively 
for fins purfK#e, l*t»rwhiin rylindii^rfi are also in common use, 
Wbutevcr tlie filtering ugt.-nt empb^yttl, unless it be kept el^u 
it ir^ liable to become a source of oontamiuation rather than c^ 
puritii^tion. Owing to the faot that eoluble impuridee often 
pfuv tbrr>i]gb tbc! filtor, Bhere<l water i« not nearly 90 reliable as 
di^tilleil water. A very economic and convenient method of 




isi 



BEVERAGES AND STIMVLASTS. 



purifriDg water is to dtseotve one gram of alum in a little water 
txii*} puur this foIiitioQ into viiv gallon of tbf \«au^r 1" Ia- ^iiri- 
iicd, Ai'tcr eiaodiag for tweuiy-four bour» the impuritioa will 
bo precipitated. 

MINERAL WATERS 

MinoTHl waters are frequently taken as AuhHtitiiteA for firdi- 
imry water; at times tbey produce a moflt marked i^timulatiDg 
effix^t on various or^Ds. Their efficiency is greatly enhanced 
when a ** driuking cure " is eomhiiied with proper dietetic regu- 
lations. Mineral watera difler Jrom ordinary waters in the 
greater amount of gaseoufi and solid matters they contain. The 
ji^aneoiiB cutlet ituentfi uf uiintrral waters are juaiidy carbon dioxid 
ftud fiulpliurettf^d hydrogen. The sulid conzTitituent^ htv salu of 
»odium, poUiStiiuai^ piflgnoAiuiik^ nluminuui nnd calcium^ iroD^ 
iodin, Sroniin, chlorin^ and stdphtir Taken Itefore meaU, 
waten^ contaimng carbonic acid have ft iioothitig effect on an 
iiTitated stomach. Takeu in excess, all carbonated waters are 
apt to produce indige^iou- 

Some waters have a purgative effect, others a laxative, and 
still fitbers diuretic. Thermal waters issue hot from springs, 
their virtue being due to thdr beat. Snnie mineral waters have 
no meJiciual virtue whatever, and are uttUzeU merely aa drink- 
ing-wat4-*f. 

Classification of Mineral Waters, — The following 
cK'isitieatlon and de-'<cription of minfrul waters are ^kon from 
Cohen's PhtfutDlof/ic Therap€\itics, vol. ii., p. 41(i (Ktsch, Hind- 
dale, and Peale) : 

r ^Impte acirlulooa. 

( Alknlini.* TwUnt* aoidulous. 

Sixbum cht(>ri<L ivilh i'xlin on/i firomttb 
8altiie frntvr or briiiv ^SooW). 
in. Hitter wtt^n. 

iOtrboDaCed Iron v^ten. 
f'lilphuRitwT iron wiiwrfl- 
\tvtn ttnA nifjenii' wnlen. 
Vt pjnb.T luinvnil wnioi-s. 
VII. Acnuiilht-'nTinl w:iCi-nL 

T, Alkaline Mineral Waters, — These waters are divided 
into: (]) Simple acidulous waters; (2) alkaline nczdulons 
waters ; (3) nlkaline muriated acidulous waters ; and f 4) alkaline 



WATER. VHH IS 

aalEEkMUfidiilniN waters. The itini]>)e iK*idTiloii]« ViHtcr^ nre tboev 

increoMvi tbu |>erbiUiltic udiuit of the ?<Urmach ami mtc^tUic- 
Tb»« MFmt«iK am utiliu'd lur^ly in the trvjiUtK^nt of minijr giu»- 
Iric flinlurtidDc^r* mid in (tiUirrliiil cviziditiorift nf tlw* rffxpiniUiry 
tmcL Ainnng the inot^t imiHjrtunt of thojw wnters arc : A|»oI- 
liD&m waU-r; tiur Dori>tlJt*en(iiioUc. iit Oirisbatl ; ibc Gcy»*3r 
SptiDg in CalifomuL; uiid tti4f Mnnitou Soila Spring in 
CoWado. 

^/Aia^'7(£ A^i'MoiLM Waters. — ^Tlicw^ wnU-rH coiitjkin, iii ndtii- 
don to large (luantltie?^ of cartKiii dioxid^ varying ]>n>{i(irtioiipt 
of aodiuiti oirliuDaU!!. lu luutU^ruh' 4}uatitUi(\>4 thi^v Mluiulatc 
the activity of the icuHtro-iiitc^tiual trud ; tbo retipirotoryj nud 
tbe unnar}' o^uum. They dimolvu mucuii und nmiirulizt* Uw 
exocMt (>f acid in tlu- Alf>ni]i<'li. 

The foUowiEig uMv ^ piv<y tlio chomic ooni{>oHitiou (in L liter) 
of the motft iiD|>or1juit idkuline aeiduloiiH waten: 

Onm. 

BiUrij oT wdium biciLrbonai9 3.31 

Fkabinmn, of aiKfriiTn bimrbcinntc. . . . » . « . . , . . S>67 

Nt-uenanr, of Kuliumbiciirlhiiiaie L<tt 

flklibrunzi.of Bodium bk'arbouate ' - . < , . « i . > . ■ SiU 

Sajtnuir HprtiiK nf nlium bdcjirbonMe U.30 

Vols, of udium bBcarbotiBCi: 7.S 

Vichy, uf Fuliuni bicuboiuilc .'. ^ ....... . .4*66 

Bbtftun I Viohy), ar nxliimihioirbonnliv 0.W 

CkliforniD l^ltncr, nf nudiiim liirnrbonatc 0:60 

Idan-ha, of •udiuin And ulo^cbIueii bjoiTboDaLu . . « . . LSO 
Xspn flodn (r:\goilrx),of ndiuni nnd imgrnediiun cuboMtn 

and biairbonflt» .0.70 

SoraloKB { Vkiilij' }h of Aodium blfArbonfilc^ - , , 1,43 

fiontoffn (Vichy), of cah-iiirA And rinKncniiriL bicarbon^lei , 2^ 

Allatiiie Muriatai Aciriulojut Water*. — Th<;He water* iMnluiii, 
in additiuu to pMMiimn carbiiDatc^ and carlnm dloxid, hirgv (^uan- 
titledof dodium cbhiruL Tlu-v cjctrl a murhL'dly nrdvt^nt ifffVct 
OD uric ac'ilj aat\ Vutuofy tlif jtt'CfVtionM from th<' n?jipinitory 
trn^t. Thi'V tin- trM^uiAnWy ii?*d"iil in ratnrrhul **#iiuiitii>ii*i nf th? 
rcHpiratory tnici, surh m rhroiiit^ br«)ncldti«» und in chronio 
csLtarrh of the* Htoniat'h, of th*' hiltary iia»8a^':<, and nf the 
urinary organs. Tbfv are u^c} for gai^ling ami inhaUtion 
pui^MM6Bt and alfto for bathn. To tlim cla^ belong tb€ waters 
of Rc^at^ EnjB, Selters, nod Sarat^^ga Viohy. 

The oheiaio composition (ill I liter)of thvmcnit iniporlantalka- 
line nmruilcd acidulouH ivut<^r» ia nbo^vn by tb*- folluwiiig table ;' 

' Thkvu frum Colivn'fi rfaaioLisic IWqiKUlicH voL Ix^j p, 420. 
> JAv^ ToL U, p. 42S. 




194 



BEVEHAOES A^D STIMULANTS. 



Onmtt, 

.£ot(tA h2S 

A5stnaiinahauseQ . . * . . 1.26 

Azule 1,0 

Ekw . LO 

Qleiohonberg 1.0 

Olen Alnine . l.D 

T>iiluliiCDowi|i ...... 1.0 

IMvin 1.0 

R*jiNlorf - 1.0 

£oyat 1,D 

SaiuiwiA 1,0 

^rslogK Vicbj IhO 

^llvn 1.0 

S£m«»picA l.O 

WeilUcli 1.0 



SoilLuDi 


fiwSlnm 


btcubooAU. 


chlorlda 


C^ramt. 


<fnma. 




0.41 


0.13 


1.57 


0.13 


1,56 


3.03 


1.00 


S,U 


1.85 


CM 


0,36 


6.70 


445 


S.OI 


O.flO 


t.Z4 


1.84 


1.36 


1.73 


0.0S 


1.40 


).4S 


2.20 


1.23 


2.33 


6.44 


4.61 


1.36 


1.2^ 



Alk(dii\€ Saline Acidnlove Waters. — These waters c?ontain huI- 
phate in addition to bicarbonate and clilorid of sodium. Tbey 
occnr as both warm aud cold waters. The cold waters possess 
& markedly <tiiirctLc effect, iind when taken in large quantities 
act a« purgativejf. Tbe wumi waters dituini^^li the iirinury 
fieeretiyn. The cold alkaline Kiliiie waters are tiseful in etroug 
itidivlduak for re^luciog ficsb and for the rdid^ of cousllpiitiuii, 
Tbc warm wnters oie useful iu gastro-intcstioal catarrh, uloer 
of the stomach, gout, catarrhal jaundiee, coDgestioo of the 
liver, cholelithiasis, and in <yindittons associated with urinary 
concretions. Among this class of waters are to be meDtioned 
Carlsbad, Marienbadj Elster, Keyser Spa in California, Castle 
Creek, Hot Springs in Arizona^ Idaho Hot Spriogs, and 
Man i ton Hpricgs, 

The following table* gives the chemic composition of im- 
portant alkaline i^ine water ; 1 liter of water c<»utaina : 

Sodium Sodium ^rHlliini Scxllum 

njlpb&le. culHm4i[i, blcQrtjunmtfl. t^Jufid' 

A| ■ tfmPM, Ontmt. Gromj, f^ma. 

Aniudc VidM (Lover Spring) . . 0.24 0,05 . . 0.(15 

Bcririeh o.ea . . 0.72 0.21 

Oirlibad 2.40 1.29 IM 

ElM«r S.ia - . 1.68 aa2 

Tnm^mnAmd 2.80 0.07 IM 

Qf^v^r&im 0.04 0.06 D.S4 0.14 

Mnnitoti (MikniUiu SpriDi-) . . . 0.20 0X12 . . 0.40 

MnricDlod rp.04 . . 1.S2 2M 

Rtihitflch 3-Oa . - IhOT 0,07 

KoyjilGorKedninDubcSpriog) . 0.1» 1.24 1^ 

fe*ringd*Ip Scluwr l.T^ , . 0.O9 0,0$ 

T&wp 3.10 - - 4.67 S>e7 

^ C<Th«ii'» Pkyn'JtHfit. Tiifntptu^, voL 12^, p. 421. 




J 



WATER. 



13fi 



The chemic compoAitkn of the >alt9 of (.'arUbod 8[>nLdel 
and Marienbad 8priu^ un coRipleie evapiiration is as foliows^ 
(3 to ^ grawa (45 Vj ^0 gmiiia) art disaulvt^ iu a gloas of w»tcr 

flodiQB viilplute 43.36 pi»r cvDt &l.[{8pMutfaL 

Sodiw bicmrixiDftte . - . 34u^ '' S3.31 " 

SodiiUD oKJurid 10.391 *" W.W " 



IK Sodium ClUorld Watcrs-^To thw claw bdoog tU 
ample ftoclitim <-h)orid ^rntorH, sodium cblond vmt^ni oootnining 
icHlin and hmmin, and brine nr valine ^iratera, 

Simpir *'i>fiinm Chlorid Waias. — Tliese wal^rs coDtain, ID 
flddiUoD to fiodlum chlorid and other chloriJs, <airbon diuxid in 
hrge i|ijantitic<. folium chlorid increased tbe fi«;retioii of (Ik^ 
mucom menibmncs, (.*?«(tccial]y of tbe ^lomacb. Tb&ie wafent 
have a nmrki-<tly diuretic utul lixntive cfTcct, and arc useful in 
cbroQic catarrh »»f tin? rejpirnlory tmct, and of the stomacli, 
intestiae, and biliarv piwuigf^. 

The following tnble,^ giv«s the cbemio composition of aunpU 
«odium chlorid wat«ri ; 1 lit^r of water coatains : 

flodlum chEorld. 

Badco-Bftdco 2.0L 

Bath aSO 

BoofbofD* ..<........ MO 

Bjnn fipringt f liTcr and ktdnej) ■ • ■ • . 10.0S 

II7TU1 ih>nng ( If jroQ S^UTpri>« ) ....>...., ,2QA.V 

CinMtAdt . . ■ . . , - , 14& 

TcinerfA Snntoga tipringit >.....•>■■■■>' 4S.49 

Un>itwi<.h , ZlOm 

Glcnwruitt Spring (YftrnpA) IT.AA 

Hiuroiple 12.70 

If'jujVuric fr.80 

KiHinifrn - < i - . . . 5.SS 

Eroothtti ZM 

UU-rtj Iloi StiHnicv 0.3tS 

Monilorf &71 

Ffnaont 7M 

8*ltBr. ■£ 6itniloKm R|irinKB 4.97 

8ocl«n !o (lie Tiiiru« 3.4t 

Fjipi^r Blim IJck 8.ST 

Uub Hit gninff* 17,0iS 

M"iwb^«n 6,83 

lodin and Bromin ffoter*.— These waters contain iodiD and 
bromiD ID addi(joD to sodium cblond. The iodin occura in tbe 

^ Cbhcn^s Phyaotopt TharopaUiei, vot ix-, p. i2&. 



196 



BEVimAGES A^'D STIMULAyTS. 



form of magoesiiim iodid, calcium iodid, and sodium iodkl; the 
broiniD, in tbc fomi of sodium and mague:^um broniid. Tli««ie 
wutero JDcitufif! tiic activity of the lymphatic vcsffels aad hufitea 
absorption ; they are iiidtoitcd id cusoh^ ol' i^erofula, ^yphilidf uad 
in dleco^cH of the ^lande, us m goiter. The priacipul iodin 
waters are Heilhrniin, Kreuznach, SstratogH Xudio^u and 
CongresfL 

The chemic compotiition of the importflnt iodin and bromin 
vutena U as fullowb i * 1 liter of water coniaio^ ; 



Chuniiion Spouting Sprlug - 
KiLxJfkior 5t>rliii{ - , 
Ft^nkUn ArUiHinn V!el. 
HbII 

IIt:]|liriiJ1» . < • . 

IvMfiitvh . . . , . 
KnnkrnlK'tl . . . 
SrcdAmu:^ . , . , 

Ljf)|»ik . , , , . 

Lov«r Buwden (LiUiiA ^ptiag) 113 

R«d t4pring (Tumnngpring) - t>M 

ftUndilirf lO/M 

Sftbbnm 1.90 

GhmtOB (KkungcA Spring) . 5,96 

VfMofg 10.02 

WocNlEall Spa 19^ 

ZkkoiD 0.93 



Sodium 
cblurM, 

. Vl^ 

. n.2S 

.12.17 
. 4.^8 
. «.^ 
. 0.20 
.10.5^ 






0.O42O 

o.oaoo 
O-OIW) 
O.O015 
0,0004 

0,0'JO!t 

o.o:iuw 
0.O05O 

0.01JJO 

0,0160 
0.0300 
0.0076' 
0.0010 



aoiiium 

0.0(f»^ 

O.uTUft 
0.0(H0 
0.004O 
U.0U40 
0.0(MO 
0,0040 
0-00-10 

0,0730 
0.0730 
ftOOOfl 
0,4)006 
0.O0O« 
U.OOOG 



Pcwlium 
0,0010 

o^onio 

0.0010 
0.0010 

0,Ofl!0 

o.omo 

O.OGIO 

o.o(no 

o.iit>io 
o,o(Jio 
conio 
o.oti]o 
coaio 

0.0^08 

0.0308 

0.0200* 

0,0200 



Special importADct had been attached to litbiiitn, which U ofteo 
preeeat in Bodivim olilorid wat^^re. und whieh ia bt^lii'Vod to huvo 
a spmal <!ifeot in dianolving tirit- acid. It ia very donbtftil if 
Biicx! an HctioD o(H^iirft» yet thi^se wnters pofwewi a marki^tlly 
diuretic action. They are uneful in the treatme-nt of ^itt, and 
of renal and urinary coucretions. Among (lie most imporUmt 
fiimple sodium chlorid waters may be mentiotie*! those of Ham- 
btirg, Baden-Baden, Kih^ingeu^ Wicj^badcn, I'ymiont^ Byron 
Springs in California, Con^rest^, Excelsior, Huchoni. ^^igh 
Kock, and ScUer at ^ralc^ga. Among the lithia waters ara 
Eli/ahetlbruDDen at Hombur^, KTster, KissiD^Dr Londonderry 
Ijithia Springs, Geneva Lithia SpHikgH, and BiitTalo Lilhia 
Springs, 

IJL Bitter Waters, — These waters are clmnicterized by the 
lar^'c pn)|Xfrtion of sodium sulphate and mngn>.-!^itim r^iilphate 
wbieb they contain ; tbey also contain varied propi^irtrons of mag- 
nesium cblorid, carbonate, and nitrate, calcium carbonate, und 

* 0»lifn'ii Ph^nnhnif TUrapfvficM^ rtH. ix,, p. 432L 



WATER, ^pp^p 127 

fioditmi diloriOf. Tbe mngncfiium sulphate acts as a put^tive^ 
'Hlc^ wat<*n^ are IndicjittKl iti small dosofi an sUmuUmtfi to die 
iDtc-iitiiial ]HTUitjiUi»; tk-y »rc it'si-fnl in tiabitujil oonstipatiOD. 
Th(^ |miii-i|nil ,><|mi]^ U'luijpii^ Uy this Wji>* arxr tbi' ApcDIfl, 
lluu> mVi Jjimw, Fm-«lmll!^lmll, Kiiwingen^CntbOmbard Springb, 

Tbe rr>l]<»wing tiiblc^' giv^ tb<» chrmio onmpnjfltion of tbo 
mocitt im|K>rlJini bitter wnlcr^ ; 1 liter of wiit^r cont^DA: 

itoJhila llirn«>lom 

•■jtliliAla, luiphalff. 

Onam. Onm$. 

Aljip IKU 2.90 

Bedfinl Springe* 0^ 

Hnnvwtorf 7.00 2.20 

fiuil>-rcn biLlvr Wftlvn; 

Ap^nU IMO ^.40 

Ifnujudi Jino» SSjH t^Zh 

Fmtift J^Mcf _ . . aBS.18 &I,T6 

VutMriu , 83.60 W.19 

Ourtnliin MlncnU flpHiiff* lf-14 - , 

CMb OKhftrd 3tinfiK» (£iiiuu ur FcilcV* 

8pr(nM) 1.01 aiun 

FHodrU^Uull 6.0A Mfi 

EiHungui BtttcnjuaDo 6.SC ^00 

U Bor Sprion lUO hM 

&I«r9BDth«tm e.67 5.43 

nuMBHotSiiringi £67 , . 

PMlbu 9.a0 10.8C 

Udnchiu «.09 10.Wt 

IV. Sulphurous Wstcrs. — Tber^e waters contain hydro^fm 
solpbid or Home other sulpbnr uonipc^ind, r^ticb a^ KHiium. cal- 
cium, maj;ni^'*>uin, or poUi^vuini finljiliiil. Tlic ^ulpburtiiis waters 
are obuiiDed brth botaud cold; rhcy are espc^-ially nseful in 
the treatment cf M'pbilis nml of chronic lead*poi«>iitng, and in 
bemoirhoidal o.iiidtlion^ and con^t'stions of the liver. The 
priudpal sulpbiiroiis wiitei> arc the AiuWrswn Siiljihur 8pnD{^p 
Oilifomia, French Lick Spriogs, Richfield Springs, and Cold 
Sulphur Spring*, 

V. Iron Waters, — ^Thej^ewatem contain lar^ prf^portionBof 
iron ; they an? diviJetl into the carlionateti in>n water<, sidphaU.'d 
iron wutcr#, and irtyn utul Jirwiite W!Jtcr»>, The ciirlxniali-^I iron 
wtilen* oontnin Jarpe qtianlitio* of earUin dtuxtil ; tln^e watvn* 
in<*rca*i? the iiumWr of the red blo-Kl-ceJU and the amocnl of 
hemoglobin. Tlii-y titininlate th(^ api>ectLc, but are apt to pro- 
duct' <^]n[<ii|iatum. Tlicy nn? im]n<itlvd in chluniMin and in 
iincmia. Anh>ag the principid atrboimtcd irfin watcTd arc thooe 

' QolH^re Pliymot^ffic Thrrapmiift, mh ix., p. 4M. 






128 



SEVEBAGES AXD STIMULANTS. 



of FrunzenstFod, Fyraiont, ^hwalbach, Rlcbfield, CreSBOO 
(Pi,), anJ Rawley (Va.). 

liie cbetntc cumpositioti of carbonated iioa water ie as fol- 
lows;^ 1 lifer of water coutaine : 

Iron blcftr- Iron c*f- Troo ffttbon 
boDAttt buiuU. dloild 

Oranu, Otant. C-c. 

BaitTtld 0.087 . . 16S3 

Bochttt 0.087 , . 15D6 

Cr«»on 8pr!iua OM^ . . Ifi05 

Cudown 0.06S . . 1»0 

EUier 0JW4 . . 1»6 

Fraiu«n«h»l 0.070 . - 152S 

ImnuiH 0.062 . . 887 

Iron i:(a fijiflng 0,0fi2 0,0*7 987 

KoenigBWLTt 0.085 0.057 lldS 

KrynicA 0.029 0.OC7 1013 

LivbenHteia 0.100 O.a'^? 90fl 

Morienhnd 0.106 0.0fi7 1173 

OjuCulitiiie O.HW 0.102 1173 

Owo»o Siiring- - 0.273 0.102 1173 

PucJtic CoQgreae SpniUK .... 0.239 0.102 1173 

Pjrmont 0.077 £>.10a 1486 

Ricb6dd Iron Sprlnra 0.085 0.102 1480 

Bock Enon SpHngs 0.243' l-«6 

Sctwalbafh , 0.080 0.343 1571 

8l» 0.070 0.243 304 

SiMru Aitaaui Well 0.010 0.243 304 

atoban OXm 0.24^ 1383 

Siluu« 0.U9 0.243 R94 

eLMoriti. , 0.036 0.243 1SS2 

Vibnye OXHe 0.243 337 

Sidphaifd Jrrm Waters. — These wnt«re oonUiiD priDoipally fer- 
rous aulphiiU?, in sklditian U> eodiuiu, rDugntsuim, and calcium 
sulphate. Many of Iheae waters also contaiD ur^eDtCf alum^ and 
ButpbUTLo acid in amal] aoiouota. They are especially indicated 
ia caa^H of clironio diarrhea, io anetnic children, in obronic gas- 
tric catarrh, m ulcer of the stomacbi and id chronic malarial 
cachoxiu. Thcet* waters should be given cautioijely, as at times 
they produce indigestion and naoeefi. They are best taken in 
fiEOftll individual doses. Among the principal aulphated iron 
waters are those of Sharon Chalybeate Spring, Bedford Aluoi 
S^iHikg, Fauijuier White Sulphur Springs, and Rockbridge 
Alum Spriugs. 

The following table* gives the chemJo oomposition of the 
most importaot milphal^d iron waters ; I liter of water oontaina : 

* Coh«n*0 PK^Kioioffie Tkerapaitiett vol ii-^ p, 444. 

■pKrtoiid. 

' C6h(5Ti'« Phyrioioip^ Thmpfrtliea, roL Li,, p. 445. 



WATER. 

Iron ii3]pb4(a. 

AfclLihul OAm 

Oiiirch mU Alum S^'tap, 1718 

KitUninfT Minora! 8prin( 0.411) 

Uilb;rt>d 0.290 

Mu-k^ O.IW 

OtkOnlurdfipriDfR O.fiCfi 

Parad - . , , ],1U0 

lutK* caca 

JUimwbjr 1490 

flchnjIcT Cbuntir Spring 1.197 

Jro» and ArMmic WaUra. — ^l^liow wuU-nt contain cooiitlon* 
bid qnatititiefl of arM*ni<! In luMitiori O tin* Lnin ; th^y am 
indioated especially in chlorotic aiid aneinic coiiditioriH, in 
chronic malaria, and in neumljfia.^. Among the^e wat^rn may 
be mentioned Ilarbln Hot Sulphur Springs, Crockett An^nic 
Lithia i^prings^ and b>vineford Ariienic Litliia £^prtDg. 

The following table' givert the chemic compoeition of the 
Diofltiiupjrlaut infuttudarseuicvratera; I Ut«r of water cuutaiuit: 

Omwuf. Onm4. iknm. 

QpocktU AntiAc UthU Springs 0.0006 0,0003 

OtwberqoclLe (BrtlMmik) O,370O 0.O061 0.0003 

Hftr^in Hot 8u^ur tenoffi . . O^OISOO 0.OOA1 O.OOW 

iduffisiE 4.1800 0.0D01 o.ooao 

L«*ioo $.0600 0.008U O.OOTjO 

Rc^CAtn .... ... ...... 3^2000 0.0039 0.i)OAO 

KoncMrgno ^ , . . . 3.0000 OJWO 0.0050 

V|. Earthy Mineral Waters. — Thei^ watera are oharaclcr- 
ired by the prericnoi^ of Urge nraonnta of caloium elikI magn&* 
iium »^!ti!. They diminMi the pmHuction of acid in th<* vtom- 
ich, and also tiie secretions from the respiratory, digestive, and 
uriiinry trru^U*. Theynrv indicjittd ewpcciully in chronic <^utjtrrli 
of the nrinnry orgims, in uric ftc.*id diath<^>HiM, gout, serofiihi, 
and mdjLtiit. In drinking the^ wat<r» small i|uniitities »honId 
be lakf-n at first, and gradually increft.*«i until tlio flow of urine 
w markuilly infreas(?ij. Antong tln*f*e waters art- thinwof Con- 
treievillc-, Marli-ulwid, Wildungcn, NfuDitou Spring?, Mount 
Clomena Mineral Si>riiigs, Bedford Springs, Allo^hany Springs, 
Capnn Spring*, and Greenbrier Whiti* Snlpbur Spring*, 

The chemic cnmjioflition iff lb*.- mowt important earthy min- 
Wul waters is as followa ;* 1 liter of water conl^inH : 

* CvTi«irv Pkynioiuyir ThtrotmOiia, lol u., p. 447* 
' Ibid, ral ij(,.v.46l. 
9 




180 



B£V£RAQKS AND STIMULANTS. 



CftLcluiu 


Odciun 


IHcvboDftU. 


carboantf. 


QnmM. 


<*ntifu. 


. . 


0.06 


0.42 


0.47^ 


0,4U 


0J3 


0.42 


0,13 


0.42 


0,1« 


0.42 


OK 


0,45 


0.16 


1.44 


0.16 


1.44 


0,34-0.78 


],44 


0.12 


0.30 


0.12 


0,(rt> 


0,12 


0,41 


0.13 


0,41 


0,40-1,11 


OM 


0,40-1.11 


0.60 


0,&] 


0.10 


0.&1 


0,10 


0.08 


l.!f7 


0.08 


I.£7 


0.08 



lulphtCc 

AltrghanF Spring - , . . 1.80 

Aliotit:! Mineml Spriap . - 1.80 

ArhaiiKia HolSpnnBH . , l.BO 

Hiirb - . . . ISO 

Hprlhipi) i.M 

CJiilun SprinKB Mft 

Cuntn-ievJIlc IJD 

I>HliurK 1,04 

Kalon Rapid Well* .... 0,77-0.94 
CivfvnbHer Wbitc SoJphur 

HprinA 1.3S 

InMlbwT 

Louk^rtttd IjIS 

lipp«prin^ 0,8S 

Mjinirxju t>prit)Bii ..... 0.«3 

MArk-tituktrRudolfHadlo . . 0.82 

Old Swiwc Spring 0.22 

Srideiiu 0.22 

Wanu Sulphur ^pnDg» < . 0.24 

WviBbenbdrg . . . . 0^31 

Wildun^u SLOO 



VIL AcratoUiermal Waters- — These waters, nlso kiioivn 
OA niiD|>]e "r " iudiflV.reut " waters, ure characlerizotJ by the 
fart thnt tLey nrc obtained at n tcmperRtnre of 85^ F, or over. 
Thoy do not, however, cotitam any active mineral iiigr«dit?nU. 
They are rarely used for drinking piir]K>j^e@, but are ueed 
mainly for thermal l>athq. (For a more complete deArriptioa 
of mineral waters and their uses the reader is referred to the 
recent and most excellent volume on "Balneolcgy and Cnino- 
thtrajiy'' by Kiach^ IIinrKliile, iitid Pcale, in Coben'tt Si/iUfin 
of I'hymohfjit' ThrrtipfrtH'^Vj voL ix,) 

Diet at Water Cores. — Wat^r cures should alway* be 
curried out at the walerinjj-pWes, Under exotptionu] cirtiunj- 
»tanre>i a ^*'8t<•^ run" iwiy be nnlennl at the patient^-4 homo, ln:t 
liie r«siilt8 an- nt-vtr as ftatisfaclory sa wheii the patkiit has a 
change of air, of sc*ne, ]>leDty of out-door exerciw, and I'recdoin 
from care and worn'. The methods and the diet van' greatly 
at different springn, and for ihe most part uaoecegsanly so. 
Many of the diets and nieth'wlH are empiric and are not founded 
OD any noimd hania, LVrtain artielea are forbidden at certain 
umoga, of\ea for moat fanciful r«iw>n&. The routine and the 
diet of many apria^ m the sanio for all pationu^, t^uite re^rdle^ 
of the nature of the disease. An important factor in the failure 



WATKB. 



131 



of water cuiv5 Ls tii€ nbuw- of wAt«r drinking. PatienU with 
weak hearts ehninic ntphriiU, or dilated and atonic Homa^he 
i&uj' cuAJl/ iakv uivre tvutvr thau aiu be lJi^pl^M^l vf, imd jKwilive 
tnjtiry may result, 

A« 11 ml*;, the wat«r ^houtd tw talcc^ m the morning ufW 
ming^ juni fn»m 200 to 1*00 c. om. iihoiild Ij** dmnk *I<>wly, jinr- 
ftrably whiUt the patiejit f^trolb abmit. One^tialf hour ^^lutiild 
invuriaUly cUp^ bdVire eating, aod ii' large qiuintitiE^ of wati^ 
are taken one Iwnr .sbodd be the *ihort**t interval between the 
W7il4.'r iukI fiKHi, Brwikfast should be (ollowi'd by waJking or 
other out-dofir mnii-^'menl^ and, it" the patient is uot obese and 
r6(|uirc» it, half nn Ivniv or au hour's rcDt may be t^en before 
and after llic middny mml la &ome easefl watt-r h takeu W 
twcca brcak£k.Ht und tiio midday moal. 

Tlu- nAi^rnnoit Hhmild bo -ipc^ril out of doors if jkosHible, and 
w:it4T may in Honir (<»He> tn- taken in the afternoon, at least half 
an hour berorc afi^'moon U^ or cotfee. Ihe eveaing meal should 
bt light niid fiikf-n not kt^r than ttevea o'clock^ and the patient 
should bt* in l)*Hi by nine o'clock, C'are should be taken not to 
disturb Um ra<lical!y the habiU of the old and infirm, m by so 
doing often more harm than gmwl may result- 

The dieL ottlr^red will, of tHirinte, defiend u|>rm the uiituro of 
the dia^o^c. In gencnilf it may Ik: atut<^ tbiit tht^ dirt nhotdd 
be that which the patimt'it cH>bdition coIIm for, untl nut tho morn 
OT h-** arbitrary dirt of the |iurtimiW spring whirh thp p'ltif^nt 
ymV^, Hrraltby iiidividtifd^ may txike tlic strict cures if thry 
80 d<»ire, and often find tlip clian^ intcreHtini; and fwl b^ter 
for the Diental effect ao prodiiL*L<d. In a gtTienil t^ay the diet 
cnreitAt wateriE^pIaces tr>rbid UK^^it^ difiioult of fi!jri>!4tii>n, n8 
fat or fta.lt pork, amoked meat<, fat susa^fi\ i)At6 d<- fnie grv^ 
sardines, Iol»t«rs, eels, and the like, und certnia i^i.^'eUibli^ are 
usually on the furbidden list, as i^abUi^-^ young p>tato<^, <?ld 
pcod, truffli?."$, mtisbrooms, noripp ami overripe itr stale fruit, 
berrlcit in %ume pbioe^, ntits sls well as all very highly seasoned 
and (V)TiipHe-ited di^thc*, c.hees€^ ^tc. 

In e^'^cnd, nil strong alcoholic bevemp^pare fi>rhiddcn, but, 
ail :l ni\t.\ light wine or beer i# allowable in small quantities if 
th<^ [nfif^nt ran be trustdl not to take to mueh. Ooffee and lea 
are n.^tmlly allowed in mi»derate qiiantitJefl, but ohooolateor eoooa 
may tw itiihjutitntod in most instano^s when they are contraindj- 
eitt-d, or ?iome hot gnK'l or .»iul>^litut*^ fur uuflVe may be taken. 
Smoking ia uaually forbiddcUj but thid rule le vory frec[uenlly 



132 



SBVERAQES AND STmULASTS, 



brokeD> The advice i>f an cDJighteued pU}<Bician at the cure ia 
very viLluable* 

B<«ii]ea wnter, there are ft nttmbor of beve»mg€«i that serve 
ni)t only U) meet llie plivsioil needs of the body, but are aliio 
taken to produce ii stimnlttut effect. They also serve the pur- 
pose of a stimulnDt where micIi i* neotssary from time lo time, 
as in t.be rase of dii^iae, TUv biibit of using beverages, cither 
for the pur[)ose af relieving fatigue oi" fur conviviality, is most 
pernicioLit^, an it 14 apt to induce u hnbit for taking siicb drinks, 
which in time leads to exoesaea, We shall now tike nj? in 
order the other beverages— tea, coftee, coooaj and the varioua 
aleohoHc titimulants. 



TEA. 

Tea is a preparation made from the leaved of an evei^reea 
plant known as 7hea, It is grown in China, Japan, ludia, 
Ceylon, and in North Carolina, There are many varieties of 
the plant, and the flavor of tea variei* with lis source and the 
v^iriety of the plant. There are two great classes of tea:4, the 
green and the blaek, the distinction bolvvoen the two being due 
to the method of preparation. Several times during the year 
thr* plant fiends out youTig Nhajtr^, which are picked as ofUn as 
they appear. Bhiuk tea i.n prr|>ared by (-xi^^sing the fresh 
leaves U* the rays of the sua; afti_'r they have boe<>n)C' withered 
the constituents are hberaled by rollJug and breaking up the 
fibers and cells of the leaf- The broken-up leaves are then 
coltei'ted and allr>we<J to ferment while still moist ; during this 
process the laimiu aL'Jd is p^nOert-tl less Huluhle while the enseu- 
tial oils arti increased. After again exposing them to the aun 
the Icuves are dried iu an oven. In the process of preparing 
green tea the Chines *' wither" (Jie leaves in pans at a tem|>er- 
atnreof 16d'*F. ; the Jji|junes(>steuui them. The fluid priueiplea 
are then lil>erated by bnrakinij up die loiives; finally they are 
again withered, sweats in Ijags, and slowly ri>asted. The 
chief diflerence between black and green lea lies in the fact 
that black tea. is fermented while green ia not. Aa in the 
prcNjets of fermentation the tannie aoid beeomes lei^s Mjhible, 
black tra conlatns tuuoh leas taiuiic acid than greon t«i. Tlie 
following tiible, from Bauuister/ gives the oompoeition of hlaok 
uud of green tea : 

> t:^iUor Lecmrc^ 189Uv 



COFFEE. 138 

8l4ck tCA, QfWIl Wft, 

__^- - - 9JtO 5.06 

I'^flMiia aM 13a 

A&makk IttMM) TO OJO 

AlocMk «mtel 6L79 tOfi 

bmln o..'w 

Tludnftnil jiM^lra^ld S.BO V2S 

T»nnlc«clil , . - 16,10 2T.14 

ChlorophjUaiKl rotn 4M 4.20 

OlInlcM 34.no 2A.0n 

AA 6.27 «.07 

Tot \\nn pmct^onlly nontitricnt^iniiT^icTite. Its pTmci|iail ooo- 
vdta»Dl« aro cnfToin aikI t^itnlr Aci<1, arH it^ Bpeoial nrcimu Is 
dm to A volatile oil. It owc^ it« j^timnlsling eifect to tlie |in^s* 
eoce of catTGiu. Ad tbe action of tannic acid id detrimental to 
tlie |>rocetifl of dii^fitiou, U^ i^bould be so prepared a^ to contain 
tk» liir^r a pru[M>rtion of aifieui as poricible and the fimalle^t 
[iu6«tt>lt' nmotint of tunuic add. 

\Vbt'n tbc leaver iirt^ plihctxl in boiling water, ctifioiu ift ex- 
tnu:tod vt-ry tupidly. T^iiniic iwid, Jujwcvvt, i» inuoli lew 
soluble; it folbws, therefore, that in order l*> bnvc w little 
tannic oo-id m the tcii lie po^lblo, the leuvo« fjliould \*o Hoilod in 
wflt*r for na short n lime ib< prru'tic-rible. To pn*iftre the iDfiiBiOQ 
pour b<»iliDg water uu tbe tctt-leuvi» sindallow the nurture to st^nd 
vliere it will keep liot» thouj^b lUJt boil, for frum three to five inio- 
uUw. Wnter uatni in prx^pnriiijr t<sL isitould out l>e haid or stule. 

When the tannic acict whiuli tea contains occurs in lar)^ 
quantities, tbe pepsin of the gtiatric jtiice is precipitated ; in 
weaker sulutjons tea retardh digi^liou. Fur thene reaaou*i Ua ie 
Dot a suitable bev^ra^o for persona fluffering from gastric: di»- 
tiirbanoee. Among fbe ntore prominent eyoiptooi^ of uxoe&6iv« 
tejL^lrinking ftf* gastric di^ordfTfl, oardiae dintrerw, and a variety 
of nervonfl symptoms, &uch as e:ici lability, deepleAflnej^, and 
muscular incooniinatjon. 



COFFEE. 

Cc»Oee waA introduced into Kurope in tbe aame century as 
tea^ and only a few yeare later. It h prepared from tbe seeda 
of Coff'eit araffica, which was originally grown in Arabia, but 
lias siikoo been eullivated in Javji^ Ceylon, CoHta Rieti, and 
Braxil. The fruit of the plant, which has tbe appearance of a 
<-beaTy, when opened disclosos the coflee-bean. Id order to 
prepare the beans for use tliey are dried at a high temperature 
and then n^asted and ground. In roasting, one-liilli of the 



134 



BSVEBAOES AND STIMULAKTS. 



cufTem nufl one-tentli of tb« fat pr^etit are lost. Tbe aainm 
of coffee ifl di-if to the presence of caffeol, an oil liberated in 
rofisling. According t^; Hutelii^^n (p. ^10), a cup of bliiek 
ooffbe contains uboiit 00 large a qiiuntitr of tannic acid and 
onffcin OS a cup "f i*^. Cnffoe is **fVcn a'hiUernlfHl, chioon", 
aeorna, nnr! other wilhutiinnes being flfMed fir thin piiqjin;^, TI10 
adulteration mny not he injtirioiis in its pWcd, but altera, t^oiue- 
times eveti apreeably, the flavor of ihe wflee. 

Preparation of Coffee. — In order to obtuio wiTee of ilic 

finc:^ flyvur. tbe beans shoubl \.k- nin,sle(l and griniiul wb(»rtly 
belon? thev are W be iiwil, jl^ tlie flavor ia impairLnl by ex|>or4- 
ure to Uic air alter ^udin^\ Tbe waU^r ishould buve reacbtxl 
the boiling-poiut before Jt b jMired over tbe coffee- Tlie jM 
ehnuld then be placed for a few mcments in a hot ploecT but 
boiling tuu^t n^t be allows] t** eoulintie, or tbe ar^jmji will bo 
lost and tbir eoffee eonUiin t'X> largt> a pcrcenlagi> nf tannic acid. 

The eSeet of coflee on the systi^m is tlmt of a sUtnnlant, due 
to the (^flffein present; it aeU direetly on tlio cen'bral wnlere^ 
StJmulut^ tbt.' heiirt, uud deepens ibe nfipiE-ations, It U un 
excitant of the nervous svatem, and ir .some person?' pnxKioes 
nervnimncss^ excttjibiUiy, anil iu^cirmiia ; in otbci^ it aci^ ^ iLn 
agre*.'uble stimulant. In person?* safferiug from dysjie^isra it 
baa a tendency lo dii>(tovb diger^tiotip It lessens tbe strain of 
fntigue, and robbers frci]uently depend upon it^ $timiilittiag 
effect during large mareb™. 

The following table, taken from Bannister's Cantor Lectur^^ 
gives the composition of raw and of roasted cofiee: 



Diffcin 

SftcchjiriTLQ nmRcr .......... 

Ckfleic acldfl , . , . . ■ 

AltJuboIEc cxuact (idtrogeoouf and oolo> 

in^maner) 

fUtandoU 

IjbrudIii •>-<■*■*•««<■> 

DoKtnn 

CcUiiloee utd irwnluble coloring-matter . 

A-Jx 

HoEfltura 



IfDChfl. 



ft*w, BobAdiL 



1.08 
9.5fi 

B.46 

6.90 

12.60 

9.dT 

0.87 
Z7M 

3.74 

B.0a 



0,82 
0.43 

i74 

H.14 
laSQ 
11,33 
1.24 
38,62 

0.63 



EhbI ImdUfi. 



Rair, ftcutvd- 



1.11 

s.eo 

8.68 

ISl 
U.81 
11.23 

0.84 
38.60 

$.08 

9.84 



b06 

Ml 
4.52 

12.67 

1S.41 

18.13 

b36 

47.42 

4,88 

LIS 



COCOA- 

Cocoa waa Tntrod«<*<l iut^j Eiim|>e lon^ before either coffee 
or tea. it 19 prepared from the wt-da of the cacao tree, J^- 




COCOA. 



Ids 



irotnn cac<uK The needn arc coDl^iiied In a ]>ii1py fruit, nome- 
irhnt rcflcmblinp a cuviimbtr, from which iVicv arc extracted. 
The fruit ii* gathered into hcups nnd allow<^I to fcrmrnti wbcn 
th» pnlp boeome^ loosen^. Dating; tbm ptx)C9K« ihe e««dft 
become dart uinl low sonn* nf their bit*f rnw*. They ar<> thom 
roii^4^, by which |kroc<¥w iltey nre broken into hiU, constituting 
the so-called **cocoa oibs," A tlecoclion of cocoa nib« U ma(U 
br boiling the gc-cdi; in wiit<.-r for Mev(?ml hi»tin( and removing 
the rc<i<iiifi by HtraiDiDg. Cocou, 00 ordinnnly prepirc-d, ]» 
piAile by priniiuiE the wcth into a |m>iU', tii which ^n^r or 
Ataruli i?* addtnl ; if Manjh is ujwit, the ciX!(Jii ic* lK>ilwl for a fvw 
mii:ut4^, but if ?<uj^r i?i addc<I, the cocoa only rcijuiTCtf the addi" 
tion of iKfiliu^ water or ntilk. 

ThMibninun, t!u' *4ni*f alkabiid |inMiPTit in lyxvm, rti?*iirM to 
tmountfi of fi'ttni I Ui 2 |K'r C(.rnt. O-^nm iiUi ooiiiains iiittx>- 
geooutf siiWliiicct*, if) ]>«-r a-nt* ; Uinnic m'lA^ 6 jxr ixrnU; 
ttarch, i U> \'r imt cent- ; fet^ known as^ ctuvia-butter, 4J5 to 50 
per cent. ; mineral eon^tiientri, 2 to 3 per eeut. 

Theobromin. while » Ktimalarit, is it^m apt tu tmliice nervous 
^ymyUtm^, huoli a.H HIe(-|lh^HHllt^sn and |>ul[nl4ittim, than eilht^r ttia 
or ftjtTei', Uy reawm of ihtr. hirge prjjH>rti<Hi of ntjgar ui»d fat 
ContiLined in it, how<'ver, wlicn UJfcd in cxccin, oocou i» likely 
to prfxhirtp indigi-Mtion. Whon not t^K> ri(*h, it form* a nntri* 
tioii« drink wpiviaUv iwcftd for ohUiiivn nnd for oonvabsoentri. 

Tilt folli^jwin^: table, taken from Kweli/ givei^ the checnic 
Annlysi^ of various cocoa pri'pamtionii : 



UaaHM^a oocftttaia ^ ^ 
Van HouBtia'H ocktmi . - 
BloAkeKn Dntrh roiyit ^ 
BountiW* 00C0& cxtnct 
Sountrvo'tt pvtnlvml 

cbnralKtc 

Epip's prupanrfi cwim ■ . 
Frj'^ diaujoiiU sweet 

chocolate . . . . . 
London cotna ( unknown 

QukvrJ -.-.... 
Chocob^Ml!n]r^ , . - . 



ht. 



3[.13 
29.81 

S7.S6 
25.94 

11.13 
2L13 



riber. 



3.70 
4,38 

4.42 

1.30 
1.51 

0.81 

3.13 

hlO 



Qiii«- 



MmU. 



51 
» 

5G 



ft,33 
S.64 

1.6fi 
3.16 

1.16 



Addoditai^ 



Nona 



Veprlilde ■rrmr-ront. 
Mai^h amjW'TWJt. 
Mucli whi9t«tHrcli uul 
aoi»v BiTov-rooC. 



2.83 Mud. «mw-rooL 
1,40 1 Nnoe. 



Chocolate is prejiared by adding &taroh, sugar, and such 
flavoring snbsbincctf »« vanilJa to cocoa. It ocntaiDA 1.5 per 
' AlW* Qmmfniai Orffonie Aiuij/tu, voL HU P- ^ 



1S6 



BEVERAGES AND STlMULAyTS. 



cent €f UieobroQiIn^ \^ per cent, of fat, S per oeot of uitro* 
genoiis Bubstanees, aud nlwut 60 per eent. of sugar. 

Id addition U> tlieir stlTtiLilant elfect, eoooa imd chocolate 
possess a u):trkeil Dutxictit vulv<; aiA posi^esaed by eiUier U^i or 

Till? kola nut p^iseessea properties dmilar to those of coooft* 
It (HiTitains UD itlkaloid, caffem, thein, or theohrotnm, 

ALCOHOL. 

Alcohol is prwiuoed hy the fermentation of sugars with 
je&Kt, The prindixil constitueat in all alcoholic beveraj^e? is 
ethyl iiIcohoL The glucose coutaiued in fruits is fermented 
directly into alcohol^ whereat^ the starches in sneh dubstarcci^ aA 
potatoes, grainii, etc., are coiiV4?rled mXo dejctrin aud maltow, 
find then, by ttie aid of diaatatic fermentA, before the alcoholic 
fertu4.-t]LLt]uii can takt^ pluc-e, they are coavertei into giuco^e, 

Tbc fuod-vuluc of alfx>hol has been a subject for diacuei^ioD 
for many yean. Although all admit that aloohol taken in 
exc't'Aa ]i4 a poJFioa and in detrimental to healthy yet opininnfi 
difliT widely a^ lo the fooJ-value of alcohol taken in moderate 
<luaDtttie.^, There are iboae who niaiQtain thai alcohol, even 
in mail] ijuatilitieA, in dftrimenud to health and act8 aj^ a 
poiHon, wberea.H others believe that, on the contrary, when taken 
in ADial] <]nantitie8, it jw^ac^eB a coEigidomble nutrient value and 
la to 1)e rec<minieiide<l as a valuable food. The most recent, aa 
well aa the moat txhausilve, work Ustriijg oo this subjett Uita 
been done by Alwatcr in hid experiments on "The Nutritive 
Value of Aloohol *' iu TTte Phynoloffic Anpfcts of the JJqtior 
Qiu-Mmri, U*03- This writer flums up his re^iiilti* under the 
following headings : 

z. Effect of Alcohol upon the Digestion of Pood. 
— According lo Atwater, the itlWt of alcohol in small tjuan- 
tities ia slightly to increase the di^tibiiity of protein, but not 
to alter the digestibility of other nutrtent« — that is, carbo- 
Lydrates aud ht:-- 

a. Proportions of Alcohol Oxidised and TTnozl- 
diaed. — Alwftter finds that ot len&t 98 per cent* of the alcohol 
ingcst/d is oiidized in the hty\y, vrhePr^n* ordinarily fl8 pep 
c<»nL nf the carlnjhydratejs 95 i>er cent, of thii fuli*, and U3 pei' 
cent, of the protein are oxidiToo ; the ailcohol i& therefore oxidized 
more completely than «re the ntrtnent.^ of ordijuiry fooda 

3- Metabolism of the Energy of Alochol. — Atwater's 
GOncluBiuns regarding the metubt^lisin and energy of alcohol 




ue: "The energy which was Utent or potential in the alcobol 
was wholly tmuBfbrmed tu the body, W!W actually giveo off 
fiom tlie body, an<l wns Rclimlly recovi-rcci ii8 hiiit or html and 
Dniscular work/* " L The' hiw of the aniMTvution of energy 
obtaJnvJ witli tlie alLX>)jo] diet a« with the nnlinjiry dirt, 2. 
The potcutial €ii<tj»>" of the Alcohol oxiOiKcil in the IkmIv wiw 
tnDefonti^ oomplotcly int4> kinetto «>ner^ Ami npiKarMl «tthOT 
ni4 h«it or AH mn^f-iilBr wnrlt, or hoth. Tn thU cxtrnt, nt nny 
rate, it vfaa uso<:l like the energy of the proteiiii fjtts, imJ ctirbo- 
hydmt^fl nf the foo*!," 

'4, Protection of Body^mateiial by Alcohol.— (a) 
Protection of Kody-fat* — The conclusion raicbed by Atwnt^r 
baM;d on din-ci rxiwrinunt*, i^ that tliu fiit pRik*ciii.»n following 
the UM* <if uk'ohiil i^ very uli^iitly tlilTiMT'iit fniui Unit fnlUnvrng 
the txiUing of pnlinary food, iind tluit tilcnhol |irotc<Tt3i the body> 
fat {juttc* am vfloctjvcly an do the fnt*t unci carhohydmtos of the 
fiHifl for tthic^h it ix HnhMHtnttvl. 

(A) Protection of Body Protein. — ** The power oP alcohol to 
protwt tlic pn.nein t.'( tiwxi i.r body tiitsue. or both, from con- 
fttimptiou is cltnrly deruoiiHtruti'th It« action in thiif respect 
npinnrft to be similar to that of the oarbohydmt*.^ imd fat« ; 
that is to sayj in it» oxidation it yielda encrpy tietileci by the 
boily, au<1 thut^ Ktves other f^ubstanccp? frt^tn oxidultoci. I:i tbifi 
way uleohol ft*Tvc» the body ^1* fiTod. ^uni bow modemte 
quantities of alcohol compare with ij^odynnmic amounts of 
sagajTp Ftaroh, nn<] fnt in the power to protect protein ftvm 
kataboliem in not yet settled. Apparently it i^ in fiome cases 
equal, in others inferior, to thcee FuWance^. It hi by no means 
c^iflin that fiit^ and ear botiyd rates are always equal tc each 
other in this power." 

" Alt'ubol uppewrs also to exert at time** a special action as a 
dnig. Iij hirj^c quantities it is iwsitively toxio^ and may retard 
or*rvcti prevent metubolism iti general and protein mctjilxtlism 
in particular. In nmall doses it seems nt timea tA> have an 
opposite influenoo, tendinf^ to iDcreaee the dUintcgmtifin of 
protein. TKi* ftction^ fliotigb uoI «*ni*lnsively demenstmted^ in 
very probable. It offers a Kttisfactory explanation for the 
occafiiooal failure of ulwbol to protect prot^^'in, the usiiuniption 
bein^- that the two tcTideneicT' count*-njct ttich otlu»r. The only 
justification for calling iilc*"h*il a pffjtein |>oiMin in found in this 
disinlej^mtinK tendency. Tlii* phurmacMynaniic action of 
alcohol Appi^rv to be leiaptiinry, and miw^t aiit u» occur with 
people little acctistomed to it» uwj. The cireum.^l/iucea under 
which fluch action occurs cannot be fnllv deSned." 



138 



BEVERAGES AND STtMULANT& 



5. Effect of Alcohol on the Radiation of Heat 
from the Body. — Ahval^r fintls ibat nl<H>liol taken in 
mociemte ijuunliti^s prinlui^es no consi*Wa)>lr incrcaae 111 tUe 
amount of hrat ra<liuti.Hl from tLe hodv ; iit hir^' quantities it 
c£iu&4j» n dilnlat!i>n nf tlie vc^'ctOis cif tht.* Aiti, incrcafiiiig tbe 
circulution ami tbtts incri^a.^ing the Iieat mdintifin. 

6. Sapidity of Combustioii of Alcohol in the 
Body. — By AtrtTilrr's f^xp.^rimrnt'i it is rihr>w» ihat **alrobc>l 
is not sn*l<k'rj!v or nijmJlv oxidizc'l ; \»U if there l»e sudden or 
r^id exidation, tlivte is a correspond lug docrraLse in the oxida- 
tion of the carbohydmleSf fats, or protein ; in othCT* words, 
ttloobol, carbohydrates, and fuls rejibai.' one an*>ther as soams* 
of energy, ^0 tluit &4 one is osidiz-i.'il xhv other is rurr^[KLudiiigly 
bpai'wl/' 

7. Alcohol as a Source of Heat in the Body. — At- 
wftter foiuid that iu nioHt of the oxj>eriment5 ** alcohol wad cer- 
tainly a source of beah for ibe Ixxiy." 

8. Alcohol as a Source of MoscoJar Energy. — 

The conclusions re^icbi-d by XUvniev ivgardinj; this are 
ejttremely important: "The liyiK^thf^sIs that ibe altx^hol coa- 
trfbuu.uj its ahare of energy ior muscular work is natural and 
extrcm<fly pn^bable^ but not ahuolatcly proveih The hyp^'thesis 
that tbe energy uf tbe alcohol was not so iise<l is not called for 
as an expWiutioD uf any fact observed in tlie^^ eAjH^riments* 

" It should not be forgotlen that the desimbility of ulcohol 
ag part of a diet for nmsculur work is not decided by tbe nar- 
n>wer qurstion here disciiftseih Thcrp is a very r.-sential differ- 
ence between t!ie trans ion nation of the pjleutiitl energy of 
aleoliol inU) tbe merljanical cncrgj- of muscular work and the 
mlvant^ige or disadvanta^ of alcohol in the diet of people 
engaged in musculur labor. Kvou with the suiull doeos in these 
eiperimentd there were indications tliat the :4ul>Jeets work^ to 
slightly better advantaj^e with the ordinary ratlc^rns than with 
tbe ftloohol. The results of practical Usiss on a large scale 
elsewhere coiaoide with those ^*f general (»bsorvalioD in imply- 
ing that the use of any considerable quantity of .ilnoholio 
lieverage* as jwirt of the diet for rniL^eidar labor is generally of 
doubtful value and often positively injurious." 

Alwater gives the following propctrtions as to tike availability 
and fuel-vame of aW^hol in nutrition as compared with earbo- 
hydrales and fats; I gm. of alcohol^ I j gro, of carlwhvdrate, 
aud I gm. of fat yield tbe flame amouuc of energy u> the body, 
And hence are isodyuaiuic one with the other. 

Alcohol as a Food. — Inasmuch as alcohol contniDS no 



I 



AICOIIOL, 18ft 

nitrogtiKHU coDstiuieiiu, U <»i not be look^-d u)>on aa n food 
tending to nT|Kiir tii^mje, but mvrvly u» a fuel ibut uu oxidicEii^j 

Alcohol IS lotrily digc^tin] and rc^udily AhMoHicd in tlie diIU 
net\taty tract ; lu n food. h»w4-v<*r, it in «<n«tly, ititd tho liftTk^ 
cf ftddictjon and rxoewi in itn use M ^init. Tlio Imbiltud titw 
of «loo)iol evoii in conAidertbl^ qiijintitic^ d<ie* iii»t lend to pro- 
doco injurious 4^ifectE« in many persons, wlu'reoA in <»tbore 
diangcs, eiipedally of a cirrhotic nature, in the tissues, 
blood- ve7«eJ^r liver, kidiiiTjns, i^*., an* »pt to occur. In 
cvrtuiii dU(itL-«^*A, t:9}Hx-iully tliO!^* iuJConi]viDi^-(i by malnutriiian, 
cstfcoic fccblrncKi, mid cathAiJAtioti, Alcohol acta ns & food and 
tcr^-CK an cxo<;lletit jiuqKHw in Et^t>riug etrcngth to a wouk and 
«>nfpc>b1(Hl }>nly, 

QuiC4.' 1L0 im{x>mmt hs Atwul<.Vft crixrimentfl on "The Ka- 
Intivc Vuliit* of Aliyjhol " ia the vahinbk* rt*%"i<?w of Abel on 
"The Pharnmc*'>logic and l'hy8i<>K<gic Action of Alcohol/' 
|Hibli«hcd ill llii? thytnrtltiipc AwjiCirU *tf ih^< lArpior Probiffni. 
Abel Mmifiiari7A74 the lrHiou of ali^oh^l on the vascuUr fiy^stem 
ill l\w tuUowing vfny : 

*' 8t» fur as (>re^ciit cxpvriiiK'tital widcoco goes, we mny my i 
1. That ftloohol iLt Auch — tiiat Uf when it is introduced into the 
civvLiljttion with tlic avoidance of locnl irritation — ia not a cir- 
culatory ' i!itim(ilniit.^ 

*' 2. A]o<.'hol in modemte quantities, my a pint of wine, haa 
no diTDct action on the beurt itj^f, either in the way of stimu- 
lating or dcprofsing it. This atatement \s based on the resiilta 
of lalwrutory experimenlH, extending over *hort periods of time 
only, aod does not imply that it holds for the steady daily xiae 
of alcohol in this quantity, Laj^c quantities of alcohol weaken 
the heart. 

** It haa aUo no action either on the peripheral or central 
#ndfl of till- nt>TV'ed which control the nxiv and force of the 
heartf except |>iv>hflhly in unusual oircMmhtancew, siic*!i ax pro- 
lonjced and severe intoxication. 

*' :{. Alcohol in moderate qnanttties haa alao ro dirtct action 
on the walls of the blood-vewela, either on their mu^tcnlar po^ 
tion or on the peripheral terminations of their vasomotor 
nerves. Tliis statement aUo refers only to tlie results of single 
adminlstnitioDe, For the pathologic effects of the contiuiied 
UBo of 'moderate' quantities the writtnga of pathologists niuat 
he consulted], 

"4. In mridenite qnantitios it has also no appn^ciiihlr rlTt^ct 
on the arterial blood-pr&isure. When a chaiigi^ in this bveomM 



i 




140 



BEVSRAOHS A^n STIMULANTS. 




apparent, it is always in the direction of a fall iintl not of a 
rise- Afi exception is *ieeii when ttie spinal oorxl is («\"ered in 
Lt« upper [>ortiou. In tliis ai^ a smull and temporary rise of 
pr(!S5»re follows th<^ mpid injectioD of diluted alciibol, except 
in tLo3c instances whpn the hlo«I-pres9ure is very low— any 
30 mm, or below. It is iissunied thnt an anon^nlous oonditioa 
of 8ome pnrt of the circulntory npparatriB aocounte ftir this 
Duueual effect. In the enrly stages uf its action it oBUfllly 
caiisoji some di^ree of flushing of the skin and brain, and later^ 
when very large quantities have been takeu, va?*cular dtlatutiou of 
the abdooiiik.-il vessels ooeure. The fall of blood-presajre due to 
very lax^ qaantitiesiaa toxic pbenomenonand is never met with 
under nrdiiiury circ urns lances. It is due to the deprednant action 
of tlie alcohol oTi tlio nervous centers which tontroi the oiLlibcrs 
of the artenee and also in purt to the weakened heart. 

*' 5. It \a not to be iuferre^l that the nbove statements forbid 
a reasonable aud pnident u^ of iilcohol to tbempeul^cs. The 
day L6 happily past when the therapeutist plied hig [mtient with 
a number of botUes of wine a day in the belief that be could 
Rtjmulate the heart, lower tbe t^'miterature, supply iiutrimeot, 
and e^ect other good endB wilhotit detriment of any kiud^ by 
giving these lar^ qujiutitles. This broad cjue^tton of ihe 
tb^rupcutic use i»f wiu(^ cnc uot Ix* entered on iii detail at this 
point. It may be remarked, however, that the cerebral efiecta 
of aloohol, its numerous indir^t influenceB, its action in caus- 
ing a different bnlance in the parti^ and fiinetiorB of the vascn-* 
lar apparatus, ufteu justify ite moderate use in therapeuUcs. 

'* 6- Alcohol, by virtue of its locjil uction un raucous mem- 
brauef^, and also by virtue of its cerebral action, is capable of 
afiectiDg the several pert^ of the %'aficular apparatus iu a number 
of ways, tbo rosullTng effects often Ix'ing aueh that the term 
* circulator}' stJmMlinl' is ofien applicable. Such indirect 
effect*, which are shown by all of the pharmaoologtc con- 
genera of aleoholi are familiar in the use of alcohol in daily 
lif« and in medical practice- 

'* Of these indirect effects, none ts more often ol>5erved than 
a qiiickening or slowing in the pulse-rate, as is frequeutly seen 
in medical practice. These indirect influcnt^es must not be 
allowed to hide the true character of ala>ho], which is alwaya 
dcpr^^nt in kind, and which easily gets tbc upper band of the 
effectfljUBt noted. In a word,aleohrl, in respect to its inherent 
sctioSf when cnce in the blood and tissueSj must be classL-d widi 
the ueethctics and narcntica." 

The aotioQ of aleohol on the reepiration is thus summarized 



AlCOffOl, 



141 



bjr Abel : " 1. Alcobol ia a n^itntoiy stimulunt of moderate 
poiror for hnmAn boings. Dormg a pwocl of an hour or more 
aiW itM ndminJAtnition it caii'v^ nn mrmnw^ in Um? volume of 
«ir pueitig through the lunf^ und in tbr> a^Morption of oxygen 
(SL6 per reot.)- 

'*2, Highly flavored vrine»y bmndy^ and other alcoholic 
bererages whioh oontiiin lar^r aiuoiint^ of stimulating eAterg, 
haTC » niiire prctnounecxl »etit>n than ethyl alcolioK 

" 3. The stimulating actiou of alarboUc b«vera^» in greater 
m tbc <^arte u£ &tigued pcnvooa tluui iu tboae who orv in tio 
iriM cxbausttiJ. 

'*4. liirroiu^I ]i<?il-(]isAi[iation alwavHiiooompanie^ tht* filHivr^ 
named oft"'rls_ Thi; 4<ijni|)<-iiHat)r}r inon^^e in heat^pnxluffioti 
reqnire«« itu inorcasc in tlie oxidative processes of ihe tise^uea. 
Toe iucrcaikil ^knmnd for oxygen ih the direct cause of the in* 
created activity <(f the n^^piratory center. Small or * purely 
» exciting' d'WCs of aloohikl have alfio the effect of iucreasing the 
tDOvement8 of the digestive tract and of cauimig a *tate of ' nn- 
Rst' or t<nihioii in the f<keleud iiiUM;1t», and thiis further adding 
to the deuanil for oxygt-n. Accordiug to tbte view, alcohol ia 
an iiidir<>4<t ^tiniuliint of tbo rL>Hpinitory L*enter. 

*'-x It wfjouUl \n: iMjrnij in mind that thf^w* phymologii; 
effects sire less pn^nr^uuctKl iu inrm tliiin in [in- nibbit a-utl other 
aDitnab. whieh differ from him in ixw[>eirt to tint <asc with which 
the rer^pinUory nnd lK*Ji(-n.*^duting inis^lianinma are iriHncnccd. 
Hinger'rt rx|jlanution of the* iu;tion of aIoi>lK>I on thi* n*Apimtioa 
and on tht^ heat^rc^ulating tui^tutnirtnitt of the body at onoc mg- 
gCMta txm]|iaris<^n wittt one or {Liiuthi^r of tlie anlipvretioA, Huch uit 
(|uiQtu or aotipyHii, and cdlU to luttid the Ji0icuUil^1 tlint huni" 
I per tht* Mtudy of thtisn dmgM. How far th« iiclioa uf uh^hol on 
' mo ei'Tktnil ii<^r\-oii'i aystitm, and how fur its inflntnu't^ iw a ' pro- 
toplanmio |ioiKf>n' may moilify it^ ofx^ralion oa nxi nntipj'retic; 
how far variation^ in the exti^nial t^niit^ratnn^, id die humidity 
of the air, and in the t«mipcratnre of the IkmIv itself inHnon<.*f ita 
action, mnut all re<?eive further study. In a word, ili-tjiiled 
chemic and physiologic ntudita similar to tlio^e that have 
been made on other antipyretics are demanded. Such HtudiiM 
will uitbvr HtrifiigLlitn or disprove the above theory, and wilt 
tend to bar-uioiii£<: the eoiifliotiiig viuws at present eiilcrtnin<?d 
m regard t'> the utw of aloobol in fever. As the theorj' now 
fitamU, ejipecially when taken in connection with the facU 
brought out in other nection^ of this paper, it atforda a .soientiftc 
explaiiation of tlie more del(>t<'rioiiH rrtt^tj* of alcohol in polar 
and tropical aa eompari^ witti t'^niixtmte r^ionn.'' 



142 



BBVBRAOES ASD STIMULANTS. 



AbiO tliiis RiinmuriKes the wttrk on tlie acdfrii nf Hlc^^ihiil on diti 
nervous eystero, ivith special referrncc to its pi>ycl>ologlo aHior ; 

" The psychologic experiments thus far nuide u^jHAr to 
provf that nvuUrnte quHntifiPs of alcohol (15— 30— 45 gnuiiF*) 
^hort^Q the ^iraple ly^cViou timis ; ihe time requinii in a certain 
type of as^ookticn process and in certain more elementary men- 
tal effecta, such as reading in n whisper and adding columns cf 
simple figures; that is, processes in which central motor inDer- 
vatjon js in importiint factor. This effect, that i*, greater brev- 
ity of c^rabml time, is tacitly ofic^iuu^ by iuvedtigiiturs to iodt- 
cate that the mental <i|>cratLon& in qucttiou nrc perforniL-d with 
greater eoee end with Ices friction ; an sssumption for which 
there is no proot. 

"A greater t«idency to premature and erroneous reactioas is 
seen when the reactor hafi received alcoluil. The reactor oft^n 
believce that he is reacting more quickly than usual even when 
the eerebral time is longer, 

"In no respect is the action of alcohol in moderate quantities 
more striking than in its influence on the a!r«)cialioB of ideas- 
Tbe time cousunied in af^^ociatiom? iuvolving a »uL>F^itmptii.*Q 
judgmeut is, for example, only a little shorter tbun noniinl ; 
but tho lime required to find a rbjme to a ^ven word is con- 
fiiderably sliort^ned ; and tlil* slalo la^U for pnrre time after the 
alciihid hu.s been taken. 

"In jfenifTTii, tliefi, mental proc<*ssrs which involve the work- 
ing np I'f conceptual mat^^rial are not favoretl by moderaEe 
quantities of alcohol. 

" It vi'ill ht* seen tliat alcohol 19 not found by i>sychoh>finsl8 
to intrt-ase tht' nuantity (ir t-igor of nn^nial 0[>emiions ; in fact, 
it clearly tends to lessen the power nf clear and i^onbeinitive 
rawtonin^. In many reaj^cct^ Its action on the higher functiona 
of the mind resembles tlmt cf fatigue of the brain ; thouj^h with 
this action is assncJafe^l a t(»ndency to * gT^ater motor energy and 
ease/ There Imn Wen much diftcnssion as to whether uicf.>hol is 
in any wnye a stimulant for the bniin. We have seen that 
pharmacologists of liigh repute deny that it ho^ this action ; 
lioMing that a!eobi>l is R sedative or narcotic »ubstanc<* which 
Iwloni^ to the simc clas* as ^)anddehyd and cLloroform ; that 
its Btimulaling aeticn is but fictitirius ; Jiml tiiat cvi.*n the earlier 
phenoQJCDa of Us niTtimi nre to be referred to a ]iarTily3^ing action 
on ccrobrid finhibitory) funetion;:/' 

Tile Action of Alcohol on Muscular Activity.^ 
Abel shows: "L That a1o>hol haw a favorable ncti(m on th6 



ALCOHOL. 



143 



perfonoaiiue of inu^ctiliir vviirk, \M>ih wlieii Uic inuM<l«s Are 
vigorotiJ mid wliun ihcv nrc rxLnu^<^l. 

" 2. Tbitf £ivorablc nrcl ^tlmuluting action 10 vtxa almost im- 
medi:it4-ly af^iT iho tLrhuiiuNtnilion of tlie oionhol, but IiwU only 
a very fihort timc 

"II. A paraly^nif anion alvny^ ftiicco^dn the stimulation. Id 
about half an hour aftt?r ihi^ aii minify I ration <A' ihn ntcnhol tbe 
work done reacbet^ a minimum ; ami Ire^jh dmc^ oi alcohol show 
only a ^ligbt stimulating action. 

"4. Tbi8 later |iaru1y£iD^ action ot aWbol overbalance the 
prinmrv stimuljaiti^ i_-l1V;;:t in Micb n wnv ilml llie auiu total of the 
amount ot' work <lonc witli nioohol U les^ tbau tbttt done without it. 

**b. Similar ifeprea^iug cflTeetA are not se«ii to follow tbo use 
of tefl, coffee, or kola.'' 

The effect of alcobol on the digestion aud secretion is thus 
siiniiuarized by Cbittendeu :^ 

** Upon the stx"n'ti<iii of uiliva the preseoice of strong alcobol 
or an alcoboUc bvvcru}^' in the mouth has » direct ^ttmiiluting 
efibct> leuding to a euddcn incrcu^ in the How of »Lliva. Tht^ 
acoirleration of eccrt'ttoOf honever^ iM of bric-f dunitiou. Tho 
stimnladng effect m mtinifc»tcd not only by an inorcinj^ in the 
volume of tbe secretion, but also by an iDcrease in both or^^anio 
and inorganic oonptitnenti*, Tbe effect prodnoed in in no wenae 
peculiar to alcohol^ but is common 10 many **o-called stimulanle, 
such ae dilute acid (vinegar), etJicr vajwir. etc, Indeetl, the 
effect is precisely analogous to that induced by an increaw la 
intensi^ of stimulation when the salivary glands are electrically 
excited tbrf>u^}i their nerves, 

" Hence, no far as our results go, alcohol and alcoholic fluklH 
are without any j<pccilio effect upon the secretion of jmliva, ex- 
cept to produce a transitory stimulation of secretion while ia 
the month cavity. 

'^Ufion gamine F^ecretiod alcohol and aleoboHc fluids have a 
marke*! effect, increasing very preatly botli the flow of gastric 
juice and also its content of acid and toLiI solids. Furlher, 
this actioa U exerted not only bv the presence of nl(xiholio 
fluids in the stomaeh, but ul^ iridiret'tly Uirougb tlie influence 
of alcohol alHorl>cfl f^>m the inotine, 

" Whisky^ bniijily, ?sbcny, claret, li^cr, and fwrtrr all agree 
in producing Mimiflntion of gnstrio secretion. Furtht^, au al- 
ready stated, th* g^isfric juiee F«t*pete<l nnd^T »leolu>!io Mtiuula- 
lion is morie acrd, conTAin* more solid matterami more combined 





I 



144 BEVERAGES AND STIMULANTS. 

hydrochloric acid than the onJioary aecretion. Ii ia likewise 
elrocgly pn^lt-olytieu 

" If these refiuhs are ooneidered in connection vrith onr pre- 
vious observalions upon the mfltieucc of alcohol and alcoholic 
drinks upun the purely ohemic processee of gastric dig^tion^ 
it is seen that side by side vrith the greater or lesser retardatioo 
of dig;eslive p^^teoiysis caused by alcoholic lieven^s tht^re 
occurs an incn?sdc<l How of gustnc Jtiico rich iti acid und of 
unqiiefiCioDttbte digestive p^jwer' Tbo two effects may thus 
oonually coiuitcrbnlance ciich other, though it is evident that 
modifvLDg conditions tuny rciwlily retard or stimulate the proc- 
essee in the stomach a™^inling to firc(imstanct«^ Foremost 
among the latter is the rapid disappeamuce of alcohol from the 
aHmentary canah 

*' Since any influence exerted by alcohol or alcoholic bever* 
apes upon the solvent or di^ativt* jKJWer of the giistric juice in 
the etomnch must depend upon the prej^ncc of alcohol in the 
BtoEoacb content?, it Ibtluwi; that the t€n<]ency toward rapiti 
nONval of the nhiijhol fruDi the uliuieuUiry trucl by ab^rptiou 
TUMst ncc^^arilr diminiah corrwpondingly the c^it^nt of any 
ivtardatioii of gnstric dige&tion whit^h tho proflonoo of nI(M>hol in 
the etomnch nmy occasion. Since, however, the stimnhition of 
gflfitTic secretion induced by alcx»hol i^ brought about uot ouly 
by the direct action of alcohol in the atonmcb, but also by the 
indirect action of alcohol absorbed from the intestine, it follows 
that possible inhibition of ihe digestive action of tlie gaatric 
juic« would probably be of shorter diirutiou than the stioiula- 
tioi) of secretion^ and that consequently in the body alcoholic 
fluids would b^inUy Uwl to any rctaii-Iatiou of ^f^tric digestion. 

** Eflpccinlly worthy of note is the rapid <ii^}>pearauoe of 
Alcohol from the stomach and alini^ntary tract wbeQ alcoholic 
fluids arc taken. 

" In view of thin rapid diflappear&nce of alcohol from the 
alimentary tract tt \s plain that alcoholic fluids can not have 
much, if any, direit influence upon the secretion of either pan- 
cn^tic or intestiuni juit**'." 

ITse of Alcohol as a Remedy In Medicine. — In con- 
ditious of heart wttikm-^s uud arterial relaxation alcohol stimu- 
biles the heart, tones dp the art*^ne*, and tend* to brin^ nWit 
a normal <!ouditiou. In fchnlG condltionn it lowers the temper- 
atnre atui checks tift»:np-4lpstriietton. In protracted dtscnAe it 
stimulates a weakened digestion and* by replacing a certain 
qiiuntilv of rarhobvdnite, often RTves as a fofwl, 

Consnmption of AJcohol. — Aoxinliug to ThompHon, 






ALCOHOL 145 

tbe total oinsumption of alcoholic bever&g^s a r^r in Americt 
is more timu 1,000,000,000 galloofl. The toUowiog trtbk% 
lakfji from TJiuEU|iBuii*ii Dlttd.wit^ y. 23d, ^ivc^ tbc nnniial per 
oapita conaumpttoii of alcoholic beverages id !8l*0: 

bmt^ wido. spirlu- 

Efl«]jmd • 3(X31 0.30 \m 

Kimnn; 5.10 21.84 \M 

licmiiinT X&.60 1.34 \M 

Uiiil«dSuii«i UL)0 0.4i 0.ai 

ALCOHOUC BEVERAGES. 

Alcoholic Wvcm^^ urc tllvidcd luto several oUsaeB, t^g^ 
spiriu, UqucunrUiiJ biLtL<i>. nmlt Htiucn^ wiQe», etc. 

SPIRITS. 

SpinU ore protliioiH) I))* fcrmontin^; Miccharine subfltances 
unci obtiiiiiiug tJic alcohol \\y di^dllaUoo. Of thtTw mibstaDO^, 
corn, r'wx", liwrley, [uoliiA»(^'<, and jmtat'Xw are th<ftc most com- 
naouty titilieefl for thi^ pt]q».-<e. Ta ailditiuu tj the aiWliol, 
by^-pnMlu<rt4 an.' fiiruii?!!, uitU it i^ ti> tbifsv that rtpirit^ owe their 
ciuLnujkrUlic 6av<ir aod 4x]^r. The l>^-pruduct4 ci.niluiii ihe 
higher alcohols, euch na propyl, butyl, and Amyl alcohol, this 
miiture formio^ what in loiowo as fusel oiL 

Whisky- — The ttniteil States PJiarmju>oiwIft d^fiiw* whijjcy 
BH *'a» alcoholic liquid obtaim4 by distillation of the ma^ 
of firmenletl gniin (a^uallv of mixttiiV4 <»f cnhti. uhoiit, and ry«) 
and at Ica^t two y<-arH old." Whitiky jxmkv^t^ an iilcotudio 
«trengtli of fW>rii 50 to 58 per cenL by volume. It 8hoald l>e 
froo from liUi^n^tublo odor. The ether ami aldehydi< <:onliiined 
in whisky bi<iH>mc altered in character an it ageA, and the flavor 
\b tluis rL'iidtml ti\K>W! a^revublr. 

Brandy. — In the United Btntj^n Pharmacopeia brandy \n 
defined us an "al«dioH<.> li(|uid ohtunwl by the diettllitimi tif 
the feniiented iiTiiiuHnftL^I jniiv %\i frr^h grB]M?s, and ?it l«iKt 
four yearji old," Brandy c^ititnin^ from 46 to 55 i>er ccat by 
volume of alcohol. Tlie 4|iiality nf brandy deT>eiid,'* upon the 
TOrirty of |rm|>e}i hm^I miti tipttr the length of time the brandy 
is allowefl to stand : ihi- older the brandy, the bint<*r the ijuality. 
With brandy, jnat a-* with whiskey, on standing ethers and nld«- 
Lyda are produced ti) whiuhtbeapedalflavorof th^braody isdoe. 

Tljt- color of bmndy is due to the liiunic ncid extracted from 
thv oak oaako in whicli the brandy ie oontaine<l. There uv 
many inferior ^nult^x of hrandy ork th*^ market, w*me being 
merely atoobol ooloixtl and flavoretl with various eAHonoea. 

10 



146 



BEVERAGES AND STIMULAKT& 



Rum. — Rum is tlie |inK]ii(<t ttf Xhi* diAtiUittitm of ftrrDioiit^Ki 
molaeMW, iL» flavor twing due to certfiiu bj'-jirod«rt;i. Some of 
the eixnilcd " mm " of the market ii^ mfldo b^' adding various 
PBwnr'OJi to alcohol. On standing;, by the development of 
sp^cifU ijdebyds anj ethers, rum improves lii quality. It con- 
tfiiu^ nbout the HLme percentage of alcohol as do brandy and 

Gin. — Gin is produced by the distaUution of rye and mall 
nuLsh^ tl8 flavor beiug due to juniper berries which are added 
during fermeutiUion. Inferior ^luJes of gin are maauiactured 
bv nilding jiinip<*r berries, turpentiae, otc. t> alcohol. Otn 
t^jQtitint^ from 15 to '20 per ocot- of alcohol ; but the i*tr(?nglb la 
r^imetimGE tncres;^ by the addition of alcohol, 80 that it may 
contain a& much as 35 per cent, of alcohol. 



^ 



LlOUeU&S AND BITTERS. 

Liqueurs or cordials imd hitters contain n large proportion 
of ttlciihol, and tt i\\gh jx-rcentAge of su^r and essentml oils. 
The folKiwiu^' Ijibl<' frivefl the composition of somo of th<; more 
eonimoD liqueurs and biltera : 



liqtuntr. 



liqtunt 



AbnTilhe 

Anite 

Kumnirli 

Pi^pFnuint . . . . 
AnfKWum - , . . 

Ciim^iciii ^ . . . V 

B«i«ltirtlnd ■ - - ■ 
Cliartreuae > . . , 



Alflohol. 



Volume. 



56.0 
40.0 
32.5 

SCO 

4ao 

5S.5 

5S.0 
44.0 



Wel^t. 



44.0 
S2.0 

2fl.O 
28,0 
38.4 
4^0 
42.4 
35.2 



fCxtrooM. 



1.8 
33.3 
2fl.S 
44.0 
12.0 
27.0 
35.0 
36.4 



BufliLr. 



1.1 

30.9 

sa2 

43.2 

7.5 
203 
S3,4 
34.0 



SaU. 



OtmnK 
OJSSO 

asio 
aioo 

0.090 

ai40 

0h07& 

0.110 
0.091 



MALT LIQUORS. 

Under the beading of malt liquori- nre indialed hoer cr nic 
and aloiit or porter. These bevcnipoi* are miule by fermenting 
malt and hops. Malt is pnxiuccil bv iiUowing moji^teiicd Iwirley 
ti» gtniiinHtc at a mocik-mlc tcm|K"mtiire; in tlilj^ procesM the 
diaatatio fiTmoni aols upon thi? wmrt^h, converting it into ^ugiir 
aiid dextrin. Afier drving and grinding, thp malt is inix^ 
with water and thus mn<]e into a xne^^h. which la iigain heated, 
thuw more completely cbanj^in^ the Ktarchw into siignr. 

Beer, — The quoli^ of iht beer <lepcuds hu^y uiwo the 



ALCOUOL. 



147 



temperature at whicb tJie proc«fiB of manufnoture h carried OQ. 
Pftk beer is* prmlnoi^l hy <Irymg th^ mush at low tcniperatiire^ 
whereas (he diirker I)ei*r8 an* tJie rtsuli of (]r\'iiL^ t)ie auilt at a 
btglK^r teiii[>t?ratuTV. llic infumoD i>f ittult U tvrmrd '' nuutli." 
Tbi" iliiutulac aotlon of malt ts iiihil>ltiHl \>y boiling tbo " nuinh " 
witb hf>|»i; in tlii* %v(iy runnio urid and exirLiotiv<?i» tre witii* 
drawn. Tho inaxh in now eixiW and U^rm^nUA witli y^^unt. 
Id order to Hooitre a pure l^ecr, greiit (<aiition intiHi Ixt ^'xtrnxod 
lo ppociinf pure yejwt. TIk' y«t<t thai riflei* to (he ?iuriaoe aftiT 
fennoiTtution in t^kinmitnl off, the remamder H^ttlin^ at the 
bott^tin. Beer \» now placed in eafik,4, the yea^t whioh wa^ 
allowed to remain contiDuing to produce fermeutation. The 
longer ihw protieHs is allowed Ut <xitiiiuue, tie Btrtmp-T is tlie 
percentage <if aJ<-H>h<J iii \mxt. The mild or bitter beers are 
diHtlnguirihod by the rvhitivi: ]>ruporfion of bops contained io 
them ; tin* niihler fomu *?ontain <^n)iidt?mhle quantttJt^ of hoiw, 
vhfTva^ the bitter one^ ooiKatn but riniall amotintfi. 

YoUtile kKlieA are aW pnxluced wbleh, in addition to tlie 
carlxvnie acid giiJ* fonntHi, add to ibe plua^nt flavorof the Im^t, 
In order to add to the keeping rjUAtitii.^ of beer varioui* pre- 
servatives are added^ such zi^ calcium ?4ulptiato, salieyUo neid^ etc 
TIksi* Mibstanees not only aflWc the flavor of the beer, but wIutd 
UiJccii in lur^t- i|uiuititi<^* bavr n liclclTiinis eflVvt on tlic i*v»»tenj» 

Porter and StOOt. — P<»rtrr and rtout. arc- mfulc by fer- 
menting malt, t}i<f latt4>r, bowuvor, baing niiju^t^l, during whicb 
pivwY*.-* a rertain amount uf ir-intmrl in produ<vd. It, i« U> thiK 
i^idv^laiicv tiwxt tilt' dark color ijn" iluc, Bi^r a« well as stunt 
oontaicd from ^ u> 8 jkt <vo(. of Ahv>hol, from 2 to ij per cent 
of dextrin, and from 0J> to 1 jier cent, of sugar 

ITie following table* givei* the composition of some malt 
liquors : 







tt 


1 








as 




1 


i 


Off a 




5 


1 


1 




3 


B^vHrinii winter brer 


9i,ei 


3.21 


4.99 


0.81 


0,44 


2.9S 


ana 


aso 


Ba^-uinn -Kimuii^r tver 


90.71 


3.flS 


A 61 


0.49 


0.87 


4.:{v 


0.128 


0:22 


Muiiidk [bifbrau , - 


. ' 170 


*.87 












Mirnirh t^|qitnibrau > 


. . 123 


0.61 












Pllwrwr 


9]Jfi 


a«i 


4,97 


0^7 


. , 


. . ciao 


0.20 


Munich H'H.'k-b'Mr 


8fL72 


407 


7.23 


0.71 


QM 


. . 


OJTO 


a27 


Enfttii^^ It I'' nn<1 por1«« 


80.10 


4«fl 


6.03 


ass 


0.64 . . 


0.310 


oai 


Bertin vhi(* Wr - * 


■ ' 


&9I 


4.8a 











' 1>7dcii'» ^on^urA <lfr Ema^rtin^T^trtipUf p. 106. 



148 



BEVERAOES ASD STmULAyTS. 



i 
a 



II III 



2l 

= 3. 



mm 



I I 

S 3 



apwqJV3 












§3 || 

D9 90 



111 



E ssf Sal I 






&" Ci tf C» i ■i i d i^ 9 S (0S O 3 9 









O 3 d = 9 A o 



& 3 






■PI" 






' C 9S3 3 a 






^^3a^cc^£t::«a~£9ciaa 



-apvnci 



I TJt5-:! 



4 






^^2«3 






JO ran* 
_anwnpatf 



|=Saai5 






^5^ 



9l?l9S S— S— *-*H CM^'^ -^-^ 



'HfV 






= 390900 O 9 









i»u9xa 



'^SicSSE 






i^ 



pd.tf4««i i£ 






S 3 

* « 



« «(j 3B V lo idn « « qj e oc *A t:^ 4 « 






Bui a t^ iB *a <i 



a c* If <o t- » A 

1= if^C Vo4 4 



fl ■! * 






fq loqoaiv 



Ji 4 4 * 4 d 4~ 












JO MfUPlia 






e?^«?^< 



— MpSTti'c t^ i«aci — i>E 4 >4 « <^*o,ea — 



S^S 



lllfi 




■^ E 3 — ^ « 












i si '-^'^ 



.'--; > ' 



i 



S ■ *>-J --" 









= 25 



was 9 



^5 sS "3 = = =»fl 






I lllll 

■- h^ h >i b ^ 
-_ S^ ¥ II t i 



■3g : ■? :i2 , 






« H -£ 




^ 



ALCOHOL, 



149 



The tmhle on p. 1 41%, tokcni from Cmnpton, Ftrment^ Aioo- 
Wwi RrrvnigrM^ IT, S. D^^partinGiit of A^i<?altiiw, Bulifitin No. 
13, 1887, givee uu atmlvj^k of American malt Uijuoni. 

▼INE. 

Wine m proclucwd by the f^rmenlatiiMi of (rra})e-juioe, the 
juice boin^r litvt j>n>««i*ii IWu the ^rape by cruahing. There 
are ft lUKDtxrr of fiirtorsf sucli iks tbe cbamcter of th€ gr&pe 
utilised, ilA oukivEtion, juid tho milhod of manufacturiog, that 
enter into the pntduction of n gcMKl wine. 

Tbt fullowiii^ t4jbb', Uikrii fixirii OiipK^^ ^ivL'« itic* main con- 
tttitucnto of gm[>v-juict^ n&d the wine tlmt is nuniifjictu/od 
therefrom. Gnipe-juioe or nitiet oontainfl — 



ThTUric aciJ. 
fincctnlc n.c\A- 
AlbmnuLoui lubiUnocc. 

Wine conUuiia^ 
'Water 

K(hyli<' Blrohol 

Biiiyiic: i!c-(ibol 
Anivlir lU^fil 

Milic mdd 
T^mHc new 
Rocvfnio dcid 
Succinic ncid 
Acetic ftciil 
Formic loid 

Pn>[iiomu aoid 
ButTric acid 



JJ to 23 p«r c«dl 



0.du>0;dp«r<fiQt 



VcffHAHr Q 1 1100*. 

Hini^ml ouhtitafiOiL 



ElhfiTfL of f(Tr«p^ng alcohoU and acldsb 
tilftcniL 

Aldaby4. 

(^rbcinii! ftcid ind aiamoiiia- 

Triiiicilkvltimin- 

QIU f>rE>liiiVil hv fi^m^QUlioo. 

Atbaiiiinoiiifl niAller, 

Co mrt i^miitl£r. 

l^nic tcid. 

ExtnwliTea. 

Hiaeral putten, C.15 to 0,6 per rent 



^H Among tbe oinAtttuent^ of the juice of the ^rape are albu- 

^^ minoiiN 8ubgtai)<'^. erap*- and fruit-sugar^ and tartaric and tannic 

I ac^idrf. Tiic ycA-'^l that grows upon tbe albumins fcrm^ntfi tbe 

f sogar, with the produdion of alcohol. The cliara«k;r of the win^ 

L depciidt4 upon tlie quantity of albuminous malerful present : if 

I there is Uttlf albuiuin, tbe y^ast soon cew«e« in it8 work of c!on> 

verting sugar into aJcxiho), id con«oquciioe of which the wine 

^^m * " WLat \a Wine?" Popuiar Sdnt^ Revim, vcA. vil 



IfiO 



BBVERAOES AND STDfULANTS, 



prodaood U itwvwt ; ott tbe oUier band, if tbcrc U nmob ttlbu- 
romoiis nmtertal present, the yeuat cotitinucf to gmw until all 
tbe 8ilgsr ia <x»u\'«^rLe<i iuto a1<»bi>l, in consequcDct? of w^hli^i u 
dry cr acid wine is pntdiit**!- 

Ordinarily, wiot* do<s not <;oDtain more tlian 1*j p<-T c<?nt- of 
alcohol^ inasmuch as tbe action of the yt^ast \s inbibited by tbi^ 
percentage of alcobol. Frequrntly, however, wine Is ** fortifii<d " 
by tbe addition of ulcobol ; this true of port, wbtch h always 
" fortified/' 

Tbe ywut umnI in the fermoatatiOLi of ^rape-Juice is obtained 
in pure cultures and fiddud to tbe juice to produce the reijuired 
fiavor. 

Th© methods of wine-proditotion vary greatly^ and rp^utne 
no description here. SnfBce it to Aay that the femirntation at 
first last^ fmrn three to aix weelo^ ; the albuminous ntutcml is 
removed a uiimber of times, and the wine is then pluood in 
cajiks ; here the perccnlni^ of alcohol increases, and tlic aAor 
of the wine becomes fixed. Fermentatioo still goes on, how- 
ever, and may coTitiuue for many years, thus increasing tho 
]>ertvriing4.' of ulcobo). 

Ethern nnj also produced^ which continue to be formed even 
after the wino has been placed in bottles. Tbe color of red 
wine is dne to a color! ng-matter contained in tbi^ Akin of the 
grapes. 

Of the important ingredients of wiiie^ may l>e mentioned 
water, acids, alcohol, sugar, ethers, glycerin, and extractiveii- 

idoub, — ^The most important acids contain«d in wine are 
tartari<^ malic, and tannic ; otheni of less importance ai^ acetic 
and auectnic. Tartaric acid ot*cum in combination with potas- 
sium ns pota^iiim bitartrate. Tbe total nmouut of acids in 
wioo varies, but rarely eJcceeds 0.5 per coat 

Ahohol, — There are several ^loohols present in wine; 6tbyl 
alcohol occurs in largest r|nantity ; amyl. propyl, and butyl 
alwhol are also present in varying amounts. Aa has been 
stated, natural wine never contains more than 16 per cent, 
of alcohol ; if it contains more than this amount, it has been 
** fortilied." This is often done, es[)ecially when the wine is to 
be shippe<:l from warm couutrics to forci^^n districts, to prevent 
H MNiriog. 

S^iga^.—S'^wr wine* contains about 1 por ccct., and sweet 
Tinw about 4 p*r cent,, of sugar ; it U evident, therefore, that 
flngnr in present in too small a quantity to be of any food- 
value. 



1 



ALCOHOL, 



161 



JSlAer«,— Mhuv vAriiaiv» of I'tbt-ra urt present in wine; ibey 
ure j>rr»)ttct^ l>y tJir luitvon of the Lilc^ltoln an<l aciiU upoik «K;b 
I'tlirr. It U to i\\tf chanictcr iid<I qtmntity of the ethers con- 
Cninnl >n tWm thnt tJi<- ilitVf^r of vnriouH kin^tg of wine« u 

(/Vvcwm.-^ljrrorin w present in wino in nbout one*foiir- 
teetitli ^^\' tlir volume of the rilooliol. 

tlrtrnd'wfA. — A liirgt" pnrt of the solitl iiiAt«nal of the wine 
10 made up of ^-xtraotivcs, mainly tbe carbohydnite^, t» peotiiift 
and gumti. 

Yarictlcs of Wines. — Fnjui a diVttftlo tituudp^liit the 
cbuMififtilion nf (.liitmlKT^ is probably tbc moat pft«iti<-'*J ; uo* 
ttonliag to thifl aul^ior, wioeQ are divide into itcvcn c)a««M i 

\. Slixnig dry wijww. 4- Aoid wiocH. 

2. Strtuig rtwwl Mines- 6. Sftarktirig wine^. 

3. Aroniuli<^ wmt-;*. fi. Perfect wtiiea. 
7. Rough Of afitringeat wiuef^. 

1, Strong Diy Wines. — Thrj*L' art* wino* that contain a 
lar^ pcriM.-Dtage of nlcobol, to wbicbr oa u nik', iiddLticiml 
alcohol baa befin added m their production ; in other worda, 
they lire "foKi^ivfL" Exaioplea of thiii elass of wines ar« 
port, Hhern', mid Mudeim, In r-nfle** of fever these wme** are 
Utilized in plaoe of whifdcy. Port contairn from lo to 20 per 
cent, of nl<x>hol and conAiderai>le tannic acid. Sherry is a 
fortiiied wine ; it wntaina from 15 to 22 per cent, of alcohol. 

2, Strons: Sweet Wines, — These wines contain fruit-sugar 
in (juantiti&i sufficient to act as a preservative and ]jrevent 
fiirther fermentation. Under this head inuy be mentioned 
Tokay, Mulag-a, and sweet ciiauipa^jne. They contain from 
IS to 22 per cent, of olcoliot and from 3 to 5 per cent, of 
iugnr, Owiu^ to tlieir sweetness tbey nre taken in umall 
quaiititie?*. 

3, Aromatic Wines, — Aromatic wines po&se«<4 a superior 
fiarorand eonUin eAiemial oils and coneidenible alcohol ; rx* 
ampl^A of thLi clas^ of ^vino* are Moselle, Capri, and some nf 
the Khine wines. 

4, Add Wines. — ^The distinguiabing feature of thi* class of 
wines is the large quantity of acid they conttUD. 

5, Sparkling: Wines* — Sparkling vrino^ contain ooTisidcnblo 
^uantitie« of oftrlvotiio ocad ga^, to which tht^ir <*xhilumting 

trffeot IB due. The chief yanety of this cla^ of wines ii 



153 



MBySRAOES AND STTXULAST8. 



ohftinpn^e; The iryne^ or sweetnefia of champagne depends 
upoD the proportion of canc-^itgar and oognac addi^ during 
tJio process of manufacture. In tlie manufacture of dr>' cham- 
pagne 8 per cejit- of sugar la added, while the sweet brands 
(K>DUitn OB mncJi uf 16 per cent. 8ince dry champagne does 
not contain large ^jiiantities of sugar, and uinoe the lat^r part 
of the sugar it originally contained has disappeared during fer- 
mentatitjD, it is considered l&^a likely iu produce llmulence, and 
is tliereforc preferred by invalids. Dry champagne is a pure 
wine ooDtmniiig from 9 to 1*2 per G«Dt of aloohol and from 1 
to 4 per r^ut. of sugar, 

6. P^«ct Wines. — Perfect wines sire defined by Chambers 
as those couljiinio^ uk-obol, water, sugar, ethereal flavorn, fruity 
extraetivea, and acids. Under this head wme Burgundy and 
Bordeaui. Burguatly oonlains a rather large peR^enTage of 
aloohol and extractive matter; it is, therefore, said to have 
<H>uciderable " body." Good Bordeaux wines are thoroughly 
fernicntcd, and, together with the BHi^undiee, contain very 
little supir ; thcY are, therefore^ well borne by invalids, and are 
E><;pocinUy useful as tonics during convalesoence from protracted 
illiteH)ie8. 

Roueh Wines. — Rough wines eontinn considerable quantities 
of tannic acid, to which they owe their astringent effect- 
They contain litde alcohol, and are of slight value for medicinal 
purpoaefi. 

The following tabb, taken from Dupr£, givat the chemio 
composition of some wln^s ; 



Wtne. 









Rock [thrtv HOmplM^ ...... 1KT3 

Cni-ii win- iihr^fftampln) . . , ' i%itt 
Plicrry Htu>-cfa"jj>IeJii - . , . , . , 17 JO 

MmlfrUawii «"tmi>le<l - 17^ 

Potl 1th [T*i lampletj . . , , , , .1 ItU 

MAMlft ' it.n 






Pi' SI 



o.Bw o,oe» 

0.900 0.1«T 



0.<S4 
0,S4? 

o.ara 

0.3M 



Q.IKZ 

a?i% 

0.130 



0/46 

ocii 

4S7 
O.fiW 

a»i 



(1.077 

3,015 

] Wfl 

ifioa 



=1 



i.noe 

2-. 



filoo 



017 

tM 

O.IH 
0.8) 
OBI 

Its 

o.» 



OjMS 
OJM 

aoM 

VIS 

aoM 

D.06S 
0.0W 



The foUo'wing tablts * give the overage compoeition of norae 
American winefi: 






inm«nl of Agriciiltute, Balletin No. 59» IftOO. 



^ 



AVCOBOL. 



153 



I II I 



IJ I 

M § 
n i 



II 



m 



» 11 



s 



S5 

li 



If 
5: 

i. 



EB§6 

c:: - 
s: S 



t 



t 

If 



11^ 



2 ^ ■ 



' f ~ f — ? f 



J 



! I. £ 



r 



f 



33 



li 



g 



gi m\ 






1 1 






?-se 



i i t 



_S8 






g«g 






>P*d1l0lATltr^ 






AltNjfaAl. 



OtjMrat- 



if 



OlTMnl-akOhol lUlOx 



Utnoi 



A«lL 



Aili-«x1rui1 nllo. 



ToUuldi, 



VoliUteuldL 



PUvd«ddi. 



Brtr*ct.f«L 



ratio 



FoUrtnllon. 



Rodaclnf angAT- 



0O41UIU Cblorld. 






BulptiDFoni Mid, 



PnCeld*. 



tnc-iDAtttr- 



IH 



SSVBBAOES AND STIMVLANJB. 



•= t 



3> 



3^ S 2 I 



i*B> 



i I .ir 



5 » ? es 



I 






?? 9& 2« 
3S 



<= s 



1 sH. 






»» 



£ S e ^3 s S^ ^5 G8 S2 



ft 


1 


s y : 


gs 


SIS 


£-1 ^? 




fi 




':': 




ii ll 




6 




■ * 




. . 88 



3 S S il'g 



^ ^ gi 



1^ i:f 



ff 

&£ 



t1 S |j& ^ ££ 
















2^S 
C IS 






>i 5 Ski =15 . -4 



i i 



X I s 



II I ll S3 J ;j_ 

11 i i^ ii ii ii 



5 ;: £ ss 



£8 



t 



si 



epccidf gtiTit7- 



volume. 



Aloobot- 



OLjocral- 



Glfcorol-okohu: atio. 



Kstnct. 



Aflb. 



1o 



Ajh-citnKt rmio. 



TOWI Vidf . 



Vo!At|f« ft«|fU. 



nxed *oida. 



BXIEMCI* K*l^ 



Voktlle-Add-toul-ftcid 



PolarlntloQ, 



Reducia^ eugarb 



eodiuni clilorld. 



BUlphltCl!. 



Solphurouj ACld. 



Pncetdi, 



loff-ummr- 



n 



ALCOHOL, 



15S 



ACTION AND THERAraimC USI OF MALT LIQUORS AND WINES- 

Malt li<]UorH, when taki*n in nK)d<*rat<» qiiaiiHfir>j<, tte^m tn buI 
dig^cAtion, inoreaHe the apffetite, anil Htimitlnt^ trtiMrJr j40(?rvt!oii. 
OccariiDnnJIy, especially in tbi>ae who l<«d a sedenlsry lifu, tiiey 
rive rise to indigestion and ffaetric acidity. On act^nint of th* 
uige qunntitiefi of carbohydrateH they contain they have con- 
ddeniblc food-vs!u«. The use of malt liquors ia cftntraiudi- 
catcd i-epcciallv in eucli condiiionsi aa gout, obeaity, dlab«t«flr 
and diftca^i* of ttie unnary tract* 

AVinee appear to exert a depre8«ng efCeci on Llie piatrlo 
fiprretTon. Takon in moderate quanities, however, hy iooreasing 
the appetite and ilie motor fmiction of the titonjacb, this de- 
prvssin^ effect is not only overcome, but the dij^ion is also 
graitly improved. 

A»;Htic' gives the following concluf^ions as to the nm of wine 
in lieidtli : 

'* NVincs fur daily uiw by beallhy adults itliouk) not on the 
AveragD Gontam more tliiui 10 per cent, abnoUitc alcohol (hy 
weight) I fi or 9 per cent, ie better, 

" If wine l>e used a* the daily drink, it i« best, tut fatr iw may 
be, t<> \isc only one kind at a time and no other form of alcoholic 
liquor. 

** Sound natural wines are to l>e obtained at the best economic 
ad\'flnta(;e from the Bordeaux district ; tlie rcJ wSnt^ are to be 
j>rer^rii<d, Khine wines (white) arc equally' excellent, but more 
expensivep 

"Hungarian wines are also in many in6tance» excellent, l>ut 
they arr unequal in quality^ owing to defects of mannihcturc, 

''Greek vnn*^ labor under the wimo defp-^ts- 

"The fortified wines, a.4 a clnwi^ devehip no prriper vinoui 
qnalitie^ tiil they have been for some years in bottle. Sherry, 
however, \b ifTcatly superior to the other vine^ of this class in 
tile m|>idity with which it developts the volatile etlien^, 

*' Fortified wines in ismall rjuantitic^, especially jtherry, for 
the reaj*oii just name<l, arc the approiiriatt- >;limuH of wrmin 
kinds of infantile and yoiitJiftiT dvbilily^ and of the curi<cbW 
uervoue *y»tcm of old persons. 

" ITnlf ft bottle of a nntuml win<i a day for a sedenlaiy and 
a bottle a day for a vigomort and notivMy employed iidult affoMi* 
a reasonable and prudent allowiuiceof Alcf>hol, and tbi^ quantity 
cf wine, either alone or with water, will be enough to satisfy 

■ On tht Vm <3^ H'liM in HmUh ttnd Dumw, 1877. p. aOl 



IM 



BEVEHAOES AUD STIMULASTS. 



«i]«^ 'nan 






It 



o <— n ^ 



^im 



i. 






« «i <«< PI Id *-t 



HT 



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« « CPt ^ 






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o o 






5 - 



4^ - 



O CI 






S0 9^ -^ i« ec 
k^ lO cc r- 05 
ai <n Cb eti o^ uj 









S I? 3 

9 to lO 






CD fZ ^ S & ^ 

d O Ci ■« O «S 















5 3 

^ id 



-^ o to 
6 d e^ C" 



Sec 



5: 









7J — « d 

■A «a kc 91 
o o o o 



04 

IS 






— < « ea 



mJ3B 






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3 

y -it 

I J 1 

t V V 

■^ ^ "^ 



_S 3 ^ 

^ -2 -S -S 



V & w 



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1 "^ ^ I ^ 

£ (2 cS n - 



1 E. 



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I i 

'3 'Z 






'D 






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I I S I I I 






Ear: oc 



11 



n 



ALCOHOL, 157 

the Qeedfl of moderate persona for a beverage at luDoheon and 
dinner, the only two m^ils at which alcohol should, as a rul<^ 
be taken." 

CIDEIL 

Cider is a beverage prepared from the fermented juioe 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, (^der is 
a diuretic driuk and acta as a laxative. On exposure it uuder- 
gnes an acetic acid fermentation, whereby it is rendered uofit 
for drinking purposes. 

The table on p. 156 ^ gives analyses of Amencan ciders. 

^ Crmmpton, Food* and Food Adwiiervmi§j U. & Denuimeut at AgricultiucL 
Bulletin No. 13, 1877. 



VARIOUS FACTORS IN THEIR BEARING 
ON DIET, 

CONCENTRATION OF FOOD, 

Concentrated foods are those from which the lai^r po> 
tion of the water proBent has been ahatracted, and thus the 
weight uud Iho bulk of Lhe food dimuikbecl. There are 
many tmlvoted ixiDcentrated foodh uo the luarkeL, Thev liud 
dieit cJijcf unc in tho trcatTueiU of |>a1Joti1^ who t^e too little 
of lh<^ 08ual forme of food to mtdntdkin tti^ti^h, mid, secooil, 
in cases where it is imjiortatit that a large quantity of nourish- 
ment be taken* 

Food can be conccntTated to various degrees. DeKictnted 
meat ivi the most coDcentnitetl form of protein ■ sugar, the moi^t 
cx>n<.%ntnitH form of curbohydmte ; and olive oi), the most 
coDcecitmt'.^d f^jrin of fat. 

1. Concentrated Proteins, — ^Theae foods are iir^pared 
from milk, meat, v\^t ^^^ vcg^taLlee. Htal ts ooaceiitraled 
by drying:, aud in tbifi form it is gcJienally iTidigc^tihle ; which 
can, however, be overeonje hy predigtslioii or powdering; in 
this class of foods are included somatose, penitnicun, and 
Moscjiiera's " Ikef Mml " (see p. 162)» Ainon^ the con- 
€cntrat<.d fi>otl& derive*! frcm the oof^eiii uf milk are nnlroec, 
eucaSL^in, eJc. [see p. 161). Ej^ff* Jire drieil hi raao; sugar Is 
usually iwldeii, and the eggs are then i^lveriised. Of tlie 
vcffdohfr proteins uiilired in concentrated form ttre aleurouat 
and h^iEHkin. 

2. Concentrated Carbohydrates- — Suj^iir is the most 
important of tlio concentrated csirbi'hydrLitey. In ihifl form, 
however, it is apt to di^^a^ree and cause fermentation. To this 
cla»» of concent nite'l curhfiliydmtts belong the malt extracts, 

3. Conceotrated Vegetables. — Man? v<^elahles, such 
B9 potalooi, carn»ls, eabbaj^ and the like^ are concentrated by 
drying. They are ntilJTed only in those instaDGcs ia vhioh it 
U im|x>si^it>le to secure tVesb vegetables. 

Bre^d is fre»jucntlv dried and t-aten in the form of "hard- 
tack," when it ie impCHaible, a« duriag voyage^ to obtain tnxh 
brtod. 

168 



I 



PRESERVATJOS OF FOOD. 



159 



PRESERVATION OF FOOD. 

^y pn«4Mrvation of ffK>d i« meant the procesfl by which the 
fi>od U Ko chan;^<(l ihat ii can be kept for a lon^r or shorter 
period of time without undergoing putrefactiDii. The proct-M 
cf fermeDtatioQ ia iDduced by micro-orgnni^Dis present in tlie 
almoaphere coming into rontact with the food and contiiminiUing 
it. Since putrefa-i^tive ^nos reijiiir? u certain umount of motflt- 
ure aud heat for Lljeir ^toivlL^ ^uch fi>wU ix* oontiiin littU water 
and that are not kept too >ivarm iLr<* not «o Jikcl^ t*j undei^ 
deoom|>otiitiou ; ou tb« irthor h&Dd^ foode contaiuipg muob water 
tind«*rgtj r<^rnien(^ti("iTi v*-ry rapidly. To prevent thw jmx^^sa 
ftiur nielliodrt of pres^rv^ation are, according t*j Yen*' tivailable ; 

1. Diying. 

2. Exchiaioa of the air. 

3. ExpoBure to cold, 

4. TrGatmect with antis^tJc chemic agentfl. 

1. Drying^. — By tliis jinx^t^u lurgt pn>portiouofth« water 
» abstracted. IVtamicaD ia a form of meat preserved by thia 
nsethod (eiH^p. 161). Vt^gctubleB, a uoh a^ carrots, pectin, potat'^^iet 
eto., are iil^ft pn'«f-rv«l Uy clrying. Milk, in tlio form t^f nutnwe, 
tgg^ us ejrg |H.Mv<l*.r, uui] fruils aro often prewrvctl in thia manner. 

3. Sxclaeion of Ali, — Air may be prevented from com- 
ing into contact witli food in a number of ways : by immersing 
the forx] in oti or fat ; by h<>attiig the food, bo aj^ to evaporate 
the exienial bvers ; by amting with some impermeable aub- 
«lance, as oH, sail, sawdust, vaniisb, or fKiniltin. Fis\} are 
frequeutly prewr^cd by inunirrniQij in oil or by emokiug. Uam 
ind bttooo are prcecrred by amoking, by which process the 
outer surfaoe Itecomes ooagiilatwl unti impt^rtn^able. ^gs^ are 
preserved by eovaring lh(^ fresh pggs with fiome impermeahte 
substance, *nch sis oil, fut, beeswax, or sawdust In order 
properly 1^ pi*es«rve fotid by cxchision of air it is highly im- 
portant that the food be periertly fresh, and tLat any mr that 
may be prewnl be erpelled- 

In eanninff, th»? food to be preserved is healed in tin cana 
until »teamed» wbeii, nil the air having been expelled^ the can 
is soldered and rendered air-tight. Variou.'^ methods have been 
reported to to obviate the neeft^sity of cooking in pre^*r\"ing 
food. MoCaJl advises the |)artinl i>«eliision of nir un<l tlii» dis- 
infection of what remains with sodinia sulphite. A method of 
replacing the air by nitrogen and sulphurous acid has aim lecu 
recommended. 

1 Fvod m IlaUtk pml I>««cat^ p. 17IL 



lANf LIRRARY. STANtO^vJ 'A^SHysSXW 



160 VABiOVS FACTORS /,V THEIR BBARnTQ 02J DIET. 



3. BxpOdOre to Cold- — Food can be preserved indcfi- 
mtely bj ice. Meat and lisb, whjcli urc otWn pn^ervid by thia 
me&na, shoukl be cuokeil at once ailer tlmwiog. Yv^yzen on^^t 
io«es ulK)ut 10 per cent- mure of its nulritive viilutr in citoking 
ihau fl■e^=h meat. Freijueotly food is not kept directly qu ioe, 
but in refrigeratiDg ctuLinber^ \ \\ can tbus be shipped maDy 
diouaands of mtlcs on land or wuter witbout fibowiiig tbo 
slightest tendency t/j (ItK-omjko^Etion. The use of oold storage 
for indf^finik' periods of timt; la ti be ciiudeoiuedj aud sloruge 
wareboiL<ie^ should be <»m]>e]le<t to bmtid all stored fo<xl au audi, 
as well as with the dale of entranc^e, 

4. Treatment with Antiseptic Chemic Agents, — 
Under ordiiiar>' circumhtaiioeA the only cliemii^ agents ulJowable 
in preserving food are ^It, sugar, vinegar, and wood smoke. 

1- 5«]tliiE. — Th« Baiting of fcod ia a melbod that has been 
practised for moDy ceaturi^^. In thir^ way meat and ^sb are 
easily preeerved. The pale color of the taeat produ*.-^ by 
saltiD^ ia overcome by adding a little -saltpeit-x in addition U^ 
oommoD salt. By saltiDg, conaidemble protema are extracted 
ftom the meat — according to Liehig, one-third of the nutritive 
value of the meat is lost ia this way. After tlie salting had 
been accompliahed it lei often followed by ,sm<»kiiig. 

2. Sugar in ^rong solution acta as an aDtiseptic, and fruits 
are thus often preserved iu concentrated sympB, 

3. Vinegar acta as an antiseptic in preserving cucumberp, 
pioklee^ oysters, vie, 

4. Other Antiseptics for Preserving FoodB Among 

these subatances are Bulphur vapor; weak uarbolic acid; strong 
acetic acid ; injections of alum and alumintum ohlorid into the 
blood-vessels; boric acid ; borax; sdic^dic ai^id; formaldeliyd. 

Chittendeu and Gies^ have studied the eflect tf borax and 

of boric acid on the g-cnenl nutrition. They conclude thai, 

tukcti in small do»^ for a long time, horax doea not alter 

metaboliMn or dir^turb nutrition. In larger doses borax retards 

protein and fat a^lmilatioD. la very lur^'c doges it cuubcs 

nau>i«]i, vomiting, and diarrhea^ (See Food Adulteration, p, 

189.) Wiley ^ has made an extcndtnl ^tudy of foixl prcscrvativGft. 

and coocludcj* that boric acid and borax tiML-il even in aniaU 

qnnntitie^ over long )>crtrxlH of time di^tnrh rLppi>tit4% di^tJou 

aud the gtrneral hoilth. The fact that certain individuals ridv 

LLke Amall amounts of certain food preservatives for long periods 

of time without injury is no a^umeut in favor of their use, a^ 

' Amtr. Jour, Fhjftial., IftfiS, ?Jc>> I. 
*Vnilgd Slata I}fpartv%&nl ft/ AgmdUtr^, Bulletin M. l^rt T- 




ARTIFtCIAL FOOD PREPARATI0H8* 



in 



wo bave do m(4li(Ml of (IctormiDmg who will be and who will 
not bt irijuri'd hi tblw wuv. WiW slaU-H |wi*itivL'lv diat lh«r« 
u DO neotHsily lor ii-mti^ citJu't rhraiir prr^MTvulivtw or nrtificiiil 
colon ng-iuatl«r ii) tWUpriKltictK KikxI tuw[« nhoiild Ik* vimctt^ 
and carrkd out )»rohibinii}; tla* u>c- of colonu)c-iuatt«rv, chaotic 
prc^rvativeii, uiid noptiititiuatioii of cv«ry kiud. 



ARTmOAL FOOD PREPARATIONS. 

To tliiH class of f^jinl* liclong thn?^ preparations that nrc i«0 
€ODceDtrat<^d ua to fomi^h u lurge umount t>f TockI tn s^ihaU 
htilk ; K'Jng of smnll Inilk, fh<*v cuo l>c iidde'] to liquUI fiKHl*, 
&n<l thii« {\\^ Qiitritivu viiliit.* \t( l\\v LttUr iacrciiLM^ witlioiit in- 
croii?<iog the total f|iiaiitity of liquiiJ Uken. A iiimLbcr of (Jicm 
pn^tuirjitiorirt liave 1>ceii mefitiomil itridor tlie lic^ud of 1>vef-jiiic«s 
aod meal-powilerc The variim.-* ftiseio pr<?|iamtiorii(^ among 
Vi\\\c\\ may be mentioEieil iiuLmeie, euca.4«jn, sanose, and pJanmoD, 
are artificial food& 

1. NatrOQC Id prupttrcd from the cahviu uf uiilk ix>Dibineil 
urith un &lk&li (siwlmm), which converts th<^ oasctn into n color- 
less, lost^leau powdor oi>mpIet.tJy soluble iu w(il*r. It oontutn-t 
fnii» b*i to 1ft prr f*i-nt. of nitliigiin, und if* usoil as « f»MKl in 
dig4«tive <]isturban(X!ii. It {& a<lmini^t43rc^ in Mups (one-third 
to one-half 4>Tinee of Dutnjse to each cupful). 

% Eticasein ir^ a similar prepamtioD, in which, however, 
imnoitLu I iiCi-r* tDp^Uad of mxlinm. 

3. Sanosc I* a fotxl oonuiinin^r HO per ocut, of pure com^Jd 
D^id 20 yvit i'eiiL. of cg^ttlbumiiK It in n c<.florK<^-4 |Hiwdcr> It 
CTniiUiru*?^ ii) water, forming n whiU- litjuid, and um Iw tukro in 
cocoa, milk, or hn>th. 

4, Plflsmon 1^4 pr^partil from th« prot^inn of mltkj and U a 
most uicpful oMrin product. It i* s whito ta«t«*leM?( powder, 
Boliible in wiina wat«r. It is administered tn walcr. milk, or 
bntfhs. It crintairig about 70 per oeot. of prototns. 

Artificial Proteins made from Meat. — A numWrof 
the.-* pripuriliooa have already b*^ri dixTilKtl- T<> this cJliss 
bebng: I. Pemmk^an. 2. Peptorie^prfxlucis. 3. MoAqueriL 
" Betd" Mtuil." 4. Souialose. 

1, Pcmmican i» prepared by cutting mt^t into thin tdiccit 
and allowing tkp^; U\ <lry ; r^ugar and driod fruits arc added, 
th« nutritive \*aliip ci^ the meat lR'iti;;r tWreby iocrea^ied. Fftrty 
parta of tat are added to -^0 imtiA of meat.' 

"1, Peptone* products. — Pt^pton^prrxhictA are predicted 
^ \'tjil, iitilKhr./. Si*jtogie, ll^H% vol «*v., p. 2^2. 



162 VARIOUS FACTORS />' TBETR BEARIItQ OK DIET, 

firotelu foods, Wbcn given id large cjiiantitira they tend to 
pivxluoo diarrhea, utnl are objectionalile to many patiente on 
account of their disagreenble iaaie. Among the prinripal p^p- 
tone-pmduotd ruaoufactiired may be mentioned Kcmiuench's, 
KocIl^s, Benger's, 8avory & MoorcV, Qtrnrick'fl, Armour's 
Wine of Beef Peptone, and I'anopcpton. 

Tlie following table, taken from Konig, gives th<: cfaemic 
composition of some peptone preparatioor* ; 



PrepantioiL 


1 


n 


fl| li 

1 








i 




3U0 

40. lA 

27.Q1 


177 




14.S6 


tun 

l&BS 
2.74 


lfi.94 


Q.Tf 


T.7S 

a.» 

010 

12.10 



3. Mosquers Beef Meal is pre[>ared by ptxrtklly digesting meat 
by rutains uf a furn^^ut oljtainotl from pJDoripple jnioe. Aooonl- 
iog to Chittenden^ thi^ prodnct contains 90 jier cent, of nutri-> 
tive matter (13 per cent of tat and 77 per cent, of protein). 
The proteins are mainly m the form of albumoflefi and |>eptones. 
This i>repaRition has a very high nntritive value and may be 
added to cocoa, milk, or brotli, 

4. Somatose, — Somatome is a pre(lif>ested meat consif^ting of 
alburao^teg. It ia a yellowisli powder, tasteless, <jdorle5s^ and 
highly nutritious, and ia Uf^ually well l>orae even in g^istric 
distil rbmict^- 

Artificial Proteins prepared &om Vegetables. — 
The two principal forms of this Anss of focKlfl are as follnws : 

1. Roborat. — This is a vcgt^table protein manufactured from 
rit«, wheats and maize. Il i& a fine, odorle^g, and tasteless flour, 
ftligiuly soluble in water. It is Mell borne by the stomach, and 
ia absorbed about a.** well as an animal albumin [up to H5 per 
cent.). It ia fVee from mtdein and doea not jiKTcase the cicre- 
lioii of iirii: acid. It may be added (o nny fiMid, but cinlinunly 
30 or 40 per cent, of it is iniscd with flour aud baked. 

2. Leffumin con^ii^ts of the cn^n of the legnraes, and is a 
highly nntritions protein fond, 

3. Alcuronat is a brownish powder chiefly utilized ae a food 
for diabpti*^. It contiiin-i -^0 percent, of protein. 

Artificial Proteins prepared from both Anitnal 
and Vegetable FoodSn — tjf Ibi?^ das*, one pro*luct esi*e- 
c-iolty must be named — u <*, Tropou. This Is prepareil mainly 



I 



I 



ARTIFICIAL FOOn PREPARATIONS. 



163 



N 



from fish itntt vegetables, mA as floM od Uie market appears aa 
a brcnvDisb tAst^^lces powder. It \m eateii nitxed with brotba or 
gracU. 

ARTmOAL PROPRIETARY FOODS. 

A lar^ numJjer of proprietary fooda, designed as substitutes 
for milk for iiifantfi and invalids, are on the market. iDfonlA 
fed upon such f'xxls alone are aot to becx>oie rachitic. Some 
of theee foods have little food-vulue, especially tbe atuylaeeood 
foods in nlacb die starch lias not bccu |>reil[j,j;t^ht4.nl. Many vf 
tbesc prcpsratiotis contain too Httic fat and llir too gnxki a piM- 
portion of oarbohyd rales. AccordiDg to Holt, " when chilaren 
are fed upon foixLs lackiD;r in fat the teeth come late, the bones 
are soft, the muscles flabby," while *^ children fed upon foods 
containing too much sugar are frequently very fat, but their flesh 
is veiy iHjft ; ihey walk late and they perspire reatiJly about the 
bead and neck<" As Halliburton ha^ recently pointed out,^ 
"mere ttbemic analysis is no critcrioa of food-valiic, for the 
digestibiltty of the food is tbe all-iinporUiat qut^slion, Invesli- 
gatioos into the value of food-ttuil^ must be <x>n(]ucted aud con- 
trolled botb hi tn't^o aud m vitro — both in tbe body sud in tlie 
te«t^tube. The rcAulu of teut-tulie exp^riniontn are of \"nliw, but 
tbe final loit of foo'I-stuBk mn^t be mwle on juiimalfi, and prefer- 
ably on man. The^ cjcpcrimout^ are both t<dious and difficulty 
but there i:^ a growing; appa^^uition of their value and an in- 
creasing resort to their u?k>." 

Hntciiisi>n ' divides proprietary foods into three classes : 
I. Foods prepared from cows* milk with variona 
additions or allenitioiifi, and requiring only the addiliou of 
water to ^it llioui fur itnuicdJate use. To thia elaB>i bcluug 
Malted Milk, Nostk-'e Food, Laotaled Food, Oarurick^ F*>od, 
Cereal Milk, Wj-eth's Prejjarc'd Food, nnd Wampole's Milk 
Food. Tlw'se fooiJs are propand frf>m flour hakwl and mixed 
with milk or cream an<l then lirictb By minus of the malt 
which is aitded tbestnreUe*iareci'iovi'rt/:Ki into dextrin and mal- 
tose. The general e<>[ijp<»,-iition of tlieiw fix)dA is as follows : 



W^Ut , 90.0 

I'lolvm ....,pp,« 1.0 

E^ a5 

Siutr 5.0 

Minonl nuittpr - - .,...,. O.C 



I* " Dl«w]<i V*1d« of Piienwd Fowto." ^«p York M^ Joier., JnmuirT 28, 




IW VABIOVS FACTORS IN THEIR BEARJSO OS DIET. 

The chemic compoMilion of Malted MUk and of Xci^tl^'s 
Food 114 thufi givt*n by Chitteii<]cn : ^ 

UAitoil MlllE. KeiU«'i Food. 

Wulcr i''140 92.76 

Proti>b Lt5 Q,81 

Fnl 0.60 0;8( 

SiiKur a8» S.W 

Miti^Tu! itiKltor aSO 0,18 

% Farinaceous foods prepared from cereals of 
which the starch has been partly or wholly con- 
verted Into dextrin or sugar, and \vliit*li require the addi- 
tion uf milk lo Ik dkem fur (i?*e. Tu tliis cla^ Iwlung Mellia's 
Food, SnvotT & ifodres Infant Food, nad Ben^r's Food. 
Tliew fw^ls ure |)rt?pare<I I>y mixing oquid piirti* <*f wheat flour 
and !>:irlpy malt with hmn nnd potasj^Itim hicarbonale. The 
mixtart i& made into a piist^ %\ith Wiitcr, and kept at a warm 
teni|>ciTttiirc until the starch is converbMl into dextrin aod 
niJLlt*iJSo» Aja lljo&e fxwls jirc ivmr in fat. iirotpin, and mineral 
inatt^TS, they are uddtd lo milk in ordor t> rc'udcr them more 
outritiiJiis. 

3. Farinaceous Foods in which the Starch has not 
been PredigCSted. — To this cla&s helong Ridge's Food, 
Nenvr'f- Ft>ud^ Im|jor]al Gramim, and Robinson's Patent Bar- 
\c)'. These foods are poor iu fat, prntein^ and niinenti mutters. 

Other Proprietary Foods.— Crackers are prepared from 
flour, ^vnter or milk, and are baked into various forms. 
Bnkinc-iwwiler aod eoda, and frc<|UontIy milk, buttefj sugar, 
and rtavrtring extracts, are added. Crackers are, as a rule, 
ea^U' di^tf^h 

Malt Extracts. — Malt extracts arc niaunfacuirctl bv heating 
a si^IuUou of malted harley at a moderate? t^mix.TaIure m iJorrWi 
The avi-rage cotn|K»sitioii of malt extracts, as given bj- Klem- 
pcrvr,* iti ae follows t 

Siignj 50^56 

Soluble filan-b 10-15 

PrateJD 5-6 

A*h 1-2 

Malt extraots are especially useful aa beverages for thofio 
weiil;ene<l by cbnjnic disease, as tuherL'uloBiK or aaeiuta, and in 
tlie couvalesceni* from acute diseases, as after typhoid fever 

» iV™ IV* Mrd. Jmr., Joly Ift, ISSO. 

' l^ydenS HaruHtwh der ErnaJtruitijatkerapU. 



e 



COOh'tSO OP FOODS. 



165 



or pDeumonta. Among the various roalt preparations niay be 
meniJoiied MuJCiDe, Ktpler'a Kxtmct of Malt, and llofl^s Malt 

The follcwiug tabic givea tbo chemio compoMtion of various 
pn^pnc'Uiry footk maQiifactiired by the Uaitte Creok Saoi- 
tarium i^. : 



nrfakOut OkmId *ui3 ucrcdi. 



(hnKHV 

XoMtivd wtwBt flak«i 
Touted com Ukm • 

Gruiuto 

QnHioli ..... . 



I 



QhilCD mto] 4<i ivr crnt 
QlntcD bucu!i 40 poi c«aU 

BnrmrHie 

Miklltd nuUt ...... 

XuL Wi«r . H , . . . . 

Nm Jncnl . . 

Almond Iraltcr ..... 

Almond meal - , . , . 
NuLlotnitf , 

I'rrloM 

MelToH - 

Polato meal 

HuUui«bttiiu 



1 


Albnml. 


Plull 


T..UI 


1 


1 Waut. 


D»Ui tl6' 


carboliy- 


FnofiU' 




mollis 




dnu*. 




100 


11.55 




Ta.fiO 


1.4& 


0.OO 


11.00 




7B.fiO 


\M 


G.80 


0,00 


lacio 


Taao 


1.&0 


8.80 


11.40 


2C-48 


T7.57 


2.23 


11.40 


ll.d7 


' ■ 


72.63 


2.00 


fl.70 


41J0 




47.fl0 


1.10 


8.70 


41.10 


' ■ 


47.90 


I.IO 


13.40 


16.00 


3fi.30 


44.30 


»ioo 


2. GO 


23.70 


4^.'^ 


43.^ 


27.50 


3.00 


^.30 


. , 


17.10 


46.50 


3.00 


29.ao 


, ^ 


17.10 


46.50 


4. SO 


21,00 


. ^ 


MM 


hiM 


4.80 


21.00 


^ ^ 


17.30 


«.90 


60.00 


12.12 


, , 


0.91 


10.46 


M.^ 


2I.A0 


. . 


2.86 


I0.S3 


aLi: 


3LS7 


49. tit 


64.A2 




7-10 


&oO 


, , 


8(LeO 


0,40 


&74 


23.62 


■ ' 


«2.4d 


2.03 



2.60 
2.fi0 
hOO 

o.»o 

1.00 



1.20 
1,20 



1.40 
2.20 

IJO 

4.10 
2.00 
2.00 
1.51 
1.40 
n,44 
B.10 
3.10 



COOKING OF FOODS 

Tlie cooking; of fcKxl U an art pmt^ti'*ed by all races, savage 
as w«ll OS civilized. Food U coukol to inipix>v« its 6iiv<>r, to 
Bof^cn it so that it <?An be maetjoatcd uad mfirt.- 4>a&ily digc.'tittHlf 
anJ finally to destroy nil pamfiiteA and dlseano g^rrtw tbat may 
be preiwnt in the rai<r food. By cookiDg. certain flavors bi« 
developed, wfcich by their savriHneK^ increase tlie appetite and 
the taslt for the food. Cooking, moreover, destroys the tough 
fibrous eDveiopfi that siiiTCUDd many foods, ttius permitting tibe 
food U) be more easily acted upon by the various digestive 
fluids. Various parasitic organiame preseDt in many foods are 
d^stmyed by cooking, and ib^r food lliitn freed frum one of ite 
most daDgcrous el«m«nt^. On cooking, th** protein in food 
coagulates ; imd«r th« iaflnence of dry heat the etarches are 




166 VARIOUS FACTORS IS THEiR BKAntSQ OX DIET. 




gradtuilly coDvcrtcil into flextrm, whereas tinder the influence 
of moist beat tLf ^rsoiiles gradiiallj' swM uutil tljiy rupture 
their envelops. Supers, by boiliDf* ai'c cLang^ gradually inlo 
caramel, which is the source of \}ie odor frequently given off 
in t.h* «H>kiiig o{ fiMKL ftTi^n fats are hnated, th<^y iindergn a 
cliAnge, will] tho production uf freo futty aQiAn, which are of^ 
rcpon^ible for ihv: *)dors tluit exi^t in thi^ kitchen, 

Cookiog: of Meat. — Boiling. — In oroking meats the tem- 
perature of llie water ^bouM not exeee<l the tempeniturt^^ nece^- 
fijiry tor the congiilaiion of the i)roteiiifi, la order thai the meia 
tujiy r^liiin as niuub <}f\i& Javoru^ jxiK^ihlc* it should be iuimei^id 
ill boiling wator for t\ few moiutnt^ ; iu thi:* way the prot<^ia 
on the furfLiec immetliutely collgu]uteE^f thus preveatiDg esoapd 
r>f the cnnstituents mid »o retaining all the nutritive elemeute 
in the meat. After tliis \ti\» been acoomplisheii the temjiemture 
of thr water niay he hiwereil jinJ the process of cooking cua- 
tinacd. The hn>th wbicli is go prwiuced is thin and poor. If 
a rich, nntntious broth h de^i^ired, the meat should l>e tut into 
email pieces rind [rlai.'ed iji eotd water, and the temperature 
gniflu.i!ly inrreaserl to 150** F. In this way the nutritiuua 
elcmeTitft of the meiit jmss out into the bnjtb. 

Rodstitig. — In roasting, the meat ia fir^t exposed to a high 
tVDpvratnre and afterward <!Ooked slowly ; thus th<> oitter layora 
ooagnlate at once, jireveiit.ing e*i*?ajje t\C the juieK-^*. Roasting 
not only prevents* evaporation of the flavors of meat^, but by 
its effect on the extractives develops savory odors and flavors. 

BaKclns:. — Baking much resembles roaeting, except that by 
the latter process the beat is applied all round the meat, in- 
stead of only to one side, 

Stcwingi — For tbia purpose memt is cut into Hmull pieces 
and placed in a fimall quantity of vrater. The water i$ heated 
slowly, but not allowed tt> boil ; a certain omouat of the nutri- 
tions snhstances thus pa^^e* into the wnrer, whteh then IweomM 
rich, and to which flavoring substanpes and vegetables are 
added. Ina^^much as the juice is eaten with the meat» none of 
the nutritious ingredients is lost. 

Brazing. — In this process the meat is placeil id a small 
ve*tfel and covercl witi a stroog li^pKkr of vegetable and 
animal juices; it la then heated, but not bmIe<K The lough 
fibera of the meat an; tbiia loosened and made tender ; the 
meat also beoorne^ impFc^riatc<1 with vcgetaldee and spiocs 
present in the juices, whioh enhauL-es its flavor. 

Bn»iling. — Bmilingand roa*^ingare similar pn^cesses, except 



COOKING OF FOODS. 



187 



that in the former stnsller portiotia are utiliiwd ; tlio prooeic* u 
thiu more rapid, a larpe aurfaoe being exposed to tiw» cnrecL 
udioii of tliL* butt. 

Frylni:. — Id ihi* proccM ibe m<»t is pui into buiUug fat, 
with which it bocomw fAtumt<x! ; fatty aoids arv llnia pro* 
<[um)^ wlitrh hnvi* ii t,en4lency to irritald? (be stomach and ouuse 
indigestion. 

Cooking of Fish. — Fi»ti may h^ boiled. bn^!l«l, bnlced, 
mid fric<l. B(>il«<] fish ik most cunily difre^tt^, IimAmuob b» 
tbe f)nviiTin;r xubfrtiinco nrv mure ciuily distfoLved out into the 
VtttCT mid lo^i, U;«s tiuK' ntbtuld be coti^med in boiling tish 
tlwu iu Wttng niniL Sir Hcory Thompson Iiaa shown tbat 
€Ve[i with can^ful Ixnlifig -> [H*r tx'fit. of thr »s>lid matter of (l^h 
is apt to bu lofit J for tliie roftfioD steaming i« ofkn ]>rcfctablc. 

EFFECT OF COOICINa 

Th<* effect of ooofelng^ on meat U to diminish its wat«ty 
mnsttittirnlv^ thus ™»nc*>nt rating and rendering it morp nutritions; 
by tbiH process aliio the ejctracUvefi, m well «s some of the fat^ 
arc psirtly removed. 

The followiug tatde, taken from K^^ni^, »hows the clicmlc 
composition of certoiu mcat« before and aAer cooking: 

IW^r, mir 10M tUM U£ 080 

BrorbciW 50^ 84.1S 7^ 0.40 

Bee/ ruutvd S5.30 84.93 &:S1 0l72 

Vf«i ciiilcn. ntw . - . 7La6 0.93 6^ O.eS 

Vca! c!][Jt|5 roft*t«! . . 67,J^9 11,^5 11.9* ^XSA 

Effect of Cooking on Vegetables. — The important 
object in ttic 0(.>oking of vc^t^bles ia to rupttire the celltitose 
envelop and so to mil\4^a the i-outained slanrJi -granules. Uudijr 
the inHumc^^ c»f beat and oiuiftture the «tarcb swells and bursts 
\t& envelop, forroiug a pnf«t«; tliis past4>, in iu lurn, expands 
and ruptures the ccIIuIosl* envelop ; oooking, tberefor^ renders 
v^^table foodii mom easily dig«8iible. 

As hn5 \i^i\ pointM out, in the eooking of meats ft otttun 
proportion if the ingretlienls is lo&t, ITnlik? mwits, bowoveTi 
vcgetnblf^ become more watery in cooking. In this condition 
thftv are more easily acted upon by the gastric secretion ; on the* 
other hand, the addition cf water in cooking so inurtii«e* tlicir 
bulk thaL the motor function of the rtomacb \n apt to be over- 
tax^ > 

When food la cooked rapidly there is a tendency to overorxifc 



US 
IM 
1,43 





leS VA&ICVS FACJVISS IS THEIR BIAHI^V ON DIBT. 

the outer layers and to leav^ the inner underdoiie. The better 
|ibiti^ thei^i^luri", ih to oxjk lood slowly for a lon^r perioil of 
tiDie dt a luwi'i- li'iu^^L'aLiii'c. Various appliances Arc on the 
market whloh have for their object the productioD of a coD- 
tiniioiiM ntrdon of a nK^lerate heat, at the etpennE^ of as little 
fuel m pojwible, the *• Aladdin Oveo " of Dn Eilward Atkin- 
i<tii\^ i» mi npfnnttu.s of this kiod. '* It is a smiple iron box, 
c'losf-d in front by a door, and bavin^ an opcniD|r in the top 
that oommimicn(e.s with a tube to let oif any siijM?rtiuou^ eteam, 
ThU 1>ox lA gurroundtnl by another, whot^' lop and &ideH are 
made of DOD-conducting material, for iht purpose of holding 
the !i«tt. A ht^udftrd, oil wliii."h this box is Kit, aiu\ a lamp 
UDdoriiL-tith fMJmpiolv tlie a}>p(initUB," Atkineon claims that 
ordiiiurily two puuods of fuel are p«|nire<l for every poiinil of 
food (nokeil, whert^s wiih hi.-* <t\'oti two and one-half |>oun(lfl 
of fuol will cor»k [*ixty pound:* of food. CanoD More Ede, of 
England, invented a similar apparatus for the cooking oi juniiy 
mealrt.' He describes his apparatiLs as follows ; 

" Jt oonsist& of a box 3 feet higii, '1 feet \^-ide, 1 foot y inchea 
deep, wiih an outer case of sheet iron. The side^ and lid are 
IiumI with 2J inches of fell, and inside this, again, is a further 
lining of tin. Underneath this Imjx, which will hold 30 gallons, 
aro plfleM two Iff Fiek'her'e atmospheric gn^burners. The 
{v\i Iwiofc a nnn-coTidiU'tor, nearly all tlie heat fivjm the gas is 
nlilijail, and a comparatively small expenditure of gas ^ufhcei^ 
to raiae the tenipi*niinre of the couteiitw of the bos to hoihng- 
point, or to the heat reciuire*! for the fooii which is ht'mg cookt^. 

** When once tlie de?iire<l lem|>eratnre is oht^iined^ one of the 
burners can be tnrned off and the other lowercl, when, owing 
to the prevention of radiation by tho felt, it will be found th:it 
a merely nomtuAl expeaditure uf gas will enid>1e the U'm|»era- 
ture to be maintained for houi^, and e\'en when the gns is 
totally eitingui^hed, many hourK will elapee l>efire food oookod 
will l>eeome cool, 

*'Bot, except in the rase of puddings which recpdre rapid 
boiling, the cooking i^^ done in an inner pan, whieh h placed 
inside the box, nnd vrliich c>ntairis mTlier more than twenty 
gallons. The appnratiH rany be tn-st deserilml tta a huirc War- 
ren's pot, with the additional advantage thai the whole of the 
inner pan in nnrruundeil by warm water." 

' EJwnnl Alkinwm, Thf Sr-imf^f of Nutrilifm find the Art of Oooking in iJU 



DSSASBS CAUSED BV yCQD'i>OlSOy& 



169 



DISEASES CAUSED BY ERRORS IN DIET AND 
BY VARIOUS FOOD-POISONS. 

DlM-ftiii' m:iy b*f cfUiiMnl Uy taliJng tito liitk' or tno mucli A>0<!, 
l)y adiet th;a is iint w<*Il linlncKMxl, — timl i^.tltJiM nol ccntuin the 
coiiibi nation of io<Hi-<"leinc'iil« in cornvt pnjp^jrlions, — jirid by 
other tUctc>i9 ojkI iitf]ii<-nc<v tbc jirci'iw nutiiru uf iriaiiv of 
wbicli U obM^ure. It may ul«o be 4uu.<iv] by (.vrKun ]xjiH>ii» 
cr dit*exst'-gi'rniH or pQnLsil<:i4 taken iiiUi ihv IwhIv witb tlic fu<xl 
or Urink. l>i*^a*e may rMK^aiJ^ioirdly U- (»rodiit*i\i by u jJtr*i(jiid 
tboti idif^jrucr^y. It in aW fr4.-i|ucatJy caufu^l by <Krt«iii 

Thv dii^ou^LuA duo to tbe tulcing of mNu^c-ii^tit f»f)d ore Ktarvn- 
tioD, amlnuLritiurif muniHmii^rnml >(i»iiic loriUKofnnt'mia. Cblo* 
roHis ih apt to oecup in undoHl-d girl», 

OverttUing, or tlic titkin^' of iR]|ir(>j)er fooi), ^ive* rj«o to « 
great variety of dif«<'ii$eii, eA[H.*cially in tbo^ wlio Imvo Ijurcdi- 
tar\" tendencitfi Ui certain disoa^i'Ti. The foml, by priHlucing 
irritation in the alinientiry iraci, umy ho the direct oaunv of dis* 
COM-, AH iu ariKc LEuli^^rallun, dtarrhf^, ami Ujt* Uk«^ Dlnea^v 
may also l*c prwliKH-d hy the cxcc*r»ivc amunnU of f<x>d assimi- 
lat<}i t^Ichcr being dcpodtod us fail aind ciiu^infr obesity, or by 
overworking the orf^ttns of excretion, |>roduoing dep;i?nomtioDa 
or W'iorost'jii, The kicineys, liver, and heart are the organs moat 
likely to jiuffer, but the nervoufl system may also be affected. 
In epik'ptioji attacks may he broii^fht on by overfi^eding. Gout, 
lilhcmia, ami the like are among the iliwaseti cau»e<l by a too 
getieroiL* diM- Diseawfl cf the skin, suc^h a>^ acne, eC2<?tQa, ajid 
tirtimria, may also have tlie same oiiiFial factor. 

Ovcraitiiij!: is pnihably an proline a wjui-ce itf diseajw as over- 
drinking, a fact that is not ^uti^lly adniilled. The common- 
est eflWtii of overdrinking aiv tlit- ner^'ou^^ conditions caused by 
^xccsdvi! tea- or ooflW-*!rmking, an<l the all too faniiliar corrli- 
tion, with its well-known symptoraali^lr^, of acute or chronic 
alcohol i^nu 

Acute food-poisoning is due to the action €f ptomiiin^. 
and i**oft<^n known x< ptomain-poisoning- l*tomrtin«, *ir toxinK, 
an* poJtionoiifi ^ul^UiQcei^ caused by tlic action o^ Ijuct'^ria, and 
may be ^nerated in nitrogenous foods or in the idimi-nlary 
tract. ilit.-y i-q«eitihle nlkaloid^ and ^hcn absorbed arc par* 
tially destroyed in the liver. 




170 VARIOUS FACTORS AV THEIR BEARING Oy DIET. 

Parasites In Pood or Drink. — Qtiitc a numbor of dig* 
esihen ;;rv ixjiniuuiiiouted to muu throug]i citLer the |mru!«i(c or 
iu embryo being takeu mU' the slunmch with the iiwxl or in 
drinkiD^tvst^T* For a thurougb knuwieilge <A' theee jiarof kes 
and their effeeU rn the hitman s-y^t^m the student is n^fi^rred to 
the text-bookfl on baetei"iolog>'. 

The Amoeba coll, which causes a Wm of <'hroDic dysentery, 
la probably taken in with the drinking-wiiter. Itw HlV-Iii^tory 
IB not d^ltuitely known. 

CoccJdlum Ovlformc. — The spores, knonn ns pAoro^pemiia^ 
have been found in (lie liver, pleura, and other organs of man. 
They prc:»bnbly ^io entrance into the «yflt«m froni water, green 
vcgetablce, or from hnndHnp animali^ sueli as dogt4 und nibbit& 
The life-hislory of thin orpflni^m is obseure. 

THchomonas^ and cercomoruis are flroall parasites at time* 
found in the «tooK 

Disioma hepaticum, or livor fluke, usually infej^t^ tl)e ^11- 
<bict or the gsdl-blmlder. The enibnos are attached to atjuatic 
pLantj^, mid hcnt-e arc Iwi-lievcd to Ix- taken in with tbem or with 
drinking-wjiter. 8everal other isjiccic* are described as occur- 
ring in China Jiud in Kgvpt. 

Bilhiirzia h«ctiiatobla, or blood fluke, in found in the urine. 
It ie a native of Kgyjit, eouthern Africa, and Arabia. The 
embryos are pro}>ahly taken into the IkmIv with drinking- 
water. 

Tapeworm. — Several speciee of tapeworm have l>een de- 
scrilW, The neck and head of this worm, called the iKiolez, 
mav hccome encysted, and the worm i a then known u£ tha 
cVriticercus, 

Ttntia ^<ofin7Ji. — The pork nipcworni if* ti iwinc%^hjjt rare 
form, iuft-ction naually takinj^ place by moaus of the embryos 
preaent in raw or underdone pork. The embryos are seen ia 
the meat as $tna1l wtiitf^ spotff, and, Irnm tlA mottleil oppearauce, 
the meat containing them is usuaHy called measly jmrk. Gov- 
ernment inspection of meat lio« done much to prevent infection 
by this and otiier forms of [wirasitcj^, 

Timia m&fioctnrlhfn or mtfintda ift the moitt common tjt{)c 
worm in the Unilinl 8taU*«, rnfi^etjon \^ prodneed tlirough 
eating raw or underdone bi.vf. Th^rw art? wv^-nil otJitr rare 
varieties : 

' Tor A ilacripiiijii of tLe IriclionLomiUi ti^ IXxik, Ata^}-. Jmr AW. Sd-^ 
lew, voLaiL.i». I. 



I 



VJSBASKS CAUSED BY FOOD*P01$OyS. 



171 



Tlnua citcummna or diiptieaf a vtry email tapi'worm, m 
found in the dog and oooiAioDallv in nmo. lu embrroA occur 
In the dog Iouph;. 

7tmt<£ yfm<opitn«/tf fa is a form fuuitd in Boston, 

Tatnift nana nnd mada^a^^arinmsis aro forms oooaaionally mot 

Hfiihnft^jihtiluH latiut ia a tapeworm found in the nnrtU of 
EuPrtiH*, but U oocaaionally iiu|M>rted into tlie United Ktateii, 
Th(* larvaj are found in fisb. Two other forma, B. maritivia 
and H. 7n\/ttf*iJ, liave been found in man, H. loryfatuA^ fieen in 
Ureenland, and Ji. cristalua are other rare forms ; the former 
Wi^ found in an immature &1ate in IceLund and the latter 
UBuall^ oociira in cadA ur dogs. 

T<tni<i JS''hinoc(>c<^u«. — TUu a faund in die int«9tini?fl of doga^ 
In man it may f^trm singl^j or multiWalar eysti. Infootion 
occur* fr»»m bundlinp^ ^*^ ^r from eating green vegetiblea. It 
la rare id Ameriai, but not uncommon in Europe. 

Ascarls lumbricoides, or round-Morm, la a common paroaite 
who&e life-lii-ftary i^ unknown. 

OxyiiHs vemtjcularis, or piu-worm, a amrill paraaite often 
found 111 cliildrcn, \s believed to be laki.^n in with fruit and 
other raw food, 

Strongylua duodenolc. alfo called Anchylostornum du9- 
dvnalct ir* i\ [Hivct-iitv attructiug oonsidL'rabte alti-utloii iu Ami^r- 
loa. Kormerly but little known in th^ United Htatttt, numer* 
ona instaneea of int'ection hy ihb paraaite have reeontly been 
reported. It U a small paraaite* from (i to 10 millimetera kng, 
and i* present ir the upper [art of the intestine. It c]EUi<j» 
severe anemia. The embryoa of the parasite are probably takon 
in with drLDkin^wnt«r. it u apt to occur in bnck-makerai 
mineru« and those followirtfT similar occapationa. 

FiJaria Sanguinis Homlnls. — Thin pamaite la liiund In ihe 
Southern Sf:itfs, tin*] h proK'ibly ul^«> taki'rt with impun? water. 
Itoaii&e^'i hematof^hylnria and oerlain fonns of i^lojihaiitiiiMtf. 

Pilaria nr Dmcunculus medinensU, or gninoH-worm, d<^ 
vdopg iu the Cyclops, a amall crufttai.''*ai>. Tlie lar\'je are juxth* 
My lakcn into the stomach with drinkinj^ water. It eauaen 
voudeB and ulc^ra. Cases of infecUon that must have occurred 
ia Am<*rii.*a havo been described. 

Thchocephalus dispar. or whipworm, is found in the cecum, 
ami i4 nbout 4 or 5 ccntimetem lu length. It doe« not, na a 
ruli7, cnuNC any j^ymptoujH, 

Rhftbdonema intestinal U a tmall panu^ite often apoken of 



172 VARIOUS FACTOHS IS TUKtR BEAHiyO OS DIET. 

tL* the Coclkia-Ohina diarrhi^ worm. IL li^ foinul in the intes- 
tinefl, aud oiutM:^ a furm of tr<i|iH:ii] lUiirrhfa. It has betju 
(liflc-tivcrcd ia many parts of the w*>rhl. 

Parasitic Diseases.^ — Trichiniasis. — ThU ib a dU^a^ 
CAUiKv] iiy 4*3ittiig lli(> !iii-r'jillrxJ ** mfiisiy " giork, <>r pork in* 
fected with Tnvhmn i«pindk. Tliia piinif^lt^ miMiBnres 1.5 ruil- 
limeter^ in len^h — the IV-muto, 3 to 3.0 millimeters, nnd the 
cmbrvop from O.o to 1 millimoter. The emhrya^ are generally 
coiled up and eccapsulated, and are seen in tlie vohintary 
mu^lefi, giving v'lf^ to the name mentioned alxjve. The jinrft- 
fiite \b also found in the rat, and I>ock believes that the disease 
b (.-oitirnnnicatetl to the ho^ by eatiof; infect<»l nits. 

Whou latien into the Inltr^tiaal camt), the oavelop aiitrouDding 
the einbryo ia dissolved, and in from three to fliv days the latter 
dewlopfl into a full-grown triehina. The female pi-oduces the 
embryos by thoiiaandt^, anJ these vvoik their way through the 
intestinal wall and enter into the voluntary muscles, where they 
may be found several weeks after itifectioD, If they are to be 
i'oujid at all, Ibey are present in the diaphra^^ which, owing to 
its proximity to the iutefitina] canaE, if, the favorite site In the 
mUH^lee die jMira^ites are surroundeil by a zone of irritatiou, 
and finally become tJicap^ulated, lime sallf being deposited in 
the Gupsule, Thus eiieapeulated, the parasite may Wvc for 
ycftrB. It^ prt'^ency? gives rise to gastro- intestinal irritatjnn, 
fever, nain^ and prostration. Tberr !■* frequently a piolure 
i^imulatinLf typhoid. A murkeil <*trsinriphilia i$ ii^nallv present, 
and thi; disease pmvea fatnl in many c^a^'s. 

Owing to the greater fre<juenoy with which raw pnrk i,s eat^n 
in (iermany, triohiniasis is coramont^r in that, country than in 
the Unite<i States. A temperature rf 140* F, kills the para- 
site, and ihe only sure way of preventing llie disease is to cook 
all porki The prcscna; i>f the parasite is ounily detected, and 
in phie^s wh^re meat is inspeet^d infeoted niL^at ^hoidd be rpjf^ot^ 
by the Government in*^|»fHlMr, Pickling and enring mejit may, 
if the pieees are thin, kill the paniaites, but they may siirvi^'^ 
if the pift'e? of meat are large. 

Diseases from Milk. — Nnmerong di^^easefl are transmitted 
tliiviugh the agency of milk, the cow itaelf being diseased or 
siih?et|nenC contamination <*f the milk taking place. The cow 
may be ^deriag from diw^aaed nddera or from some aGTectioa 
of the mammary gluiid. The organism most commonly present 
m Infc^otcd milk Ib the ^treptoeoocns. Tubercle bacilli may lind 
their Vp^ay into the milk from a diseased gland or ndden Afl ft 



E 



DISEASES CAUSED BY F00J>^POISOyS. 



173 



nUtf it may be vUitccI tliat if tfao disoiwe, whatever it cDuy be, 
u not in the ninnimnry j^land or in tlic M*l.li.r. it w iinlikt^ly lliat 



tba h 



vhirh 



thi 



ill lind tLeir 



irlcrift 

iiiUk l)ir milk. Il aIkhiIi] Iw> borne in mind, hnwever, that milk 
l*rxini u i^kk cow, cvcd if it (loe« not cause dl^^eajiie directly, is 
u|it to 1)0 poor in qoulity, nn<l i^ not dcsimble {or Tood. 

Milk iiit'(.*ct!oiL is mo»l ctminmnly tlit' n?inlt of imnuro milk, 
made -*> Uy impn^iK-r wire smJ cM>ntaini notion with t'>xin- 
prcMtucinj^ iMioteriu, Tbc diaua^e may be the re«ull of toxins 
fi>nm*<l ill iht? iiiilkf or tlic WcUrrlii llirnthclvv^ inav \}tt tlic atUM? 
of the didturtmDOu. {For dctiiiU u.-* to ihr j>rt>[Kr ciirr c;f this 
food, f^^e the ncH^tion od Milk.) Sour milk or milk x^^lii^^b W 
itWtit to turn inn}' ouuiu* guvtric or ii3t4:9itiuiil diKturbane4!4 in iu*- 
voli<ls or childn-D. 

PDison:^ Tnin^mittat in Milk. — PoijirtiirtiH iubslanr-o.'* tokc'n 
in with til'. f'.tiHl oi' (lirunlmul ur adiiiini,<«ivnd in Huftioient 4)uafi- 
tilios ib^ ri'imnlie^ niuy lie truusniilied in llie milk and c^uso 
fiVrnptomEt in the o<)nT*iinirr. Tliis is iiol of very frequent oc- 
curence. Among Ur- nnnifroiisdriii^ which have been re]H>ried 
aa cauftiug |nMsniious symptoms iiro : ur,winr, Wil, cujuier, m*T- 
cury, Uirlur t-iiittic^ iixliii, ntnipln, vcmtrum viridc, atrychiib, 
croton <jil, uiid i^tlier^. 

Tuberculosis. — Milk uh a ojnise of tiilkomiloKiit hjis of Iat« 
vear- Wvn tlh- Nijl>jtH?t uf much discussion. Thif (liscuwion wft8 
mri^ly tin- nvsult of a ptalerncut mudr by Ki>ch, in lOOl, UiAt 
Ixtvine 1alH-rculo^]<4 rouhl not Ix' traii-^tnitiiHl to niun, and ih^it 
the (ILsf^i^e an found in man and in animals was due to two 
difTerenc or^ni.«aifl. This staUmeiit ha* not bet^n h^trne cut 
by facta, aud it may with ttal'eiy Iw MaU-<l ili:it ibi- di^^i^ne in 
both muri uDcl arumalfl in du« to the sumc orgunlt^m, cdUiou^h 
(iome diflVrcneo iti the diaouAC mid bIso iu tite orguptstn bh 
foiintl in man and in animnli^ cjcist. If n cow lias liibereiilortU 
of the mannnury ^hind or of the ndilt-r, altliou^:h the discfi(ti> 
may not l*^ uppimnt to ihr^ unk^ eye, the milk will (contain 
tnberclf^ bacilli. If ihe diaease oceurs elnewhere in the h^nlv, 
tul>ercle bacilli are not apt to find their way into the milk. 
The tubercle barillus, moreover, does not multiply in milk. 
Tiiberculo^La mav he produced in man by the same lNicillu« tli»t 
cjku»('H imviiic- tubirrinhr^ia* WliL-re thta ha» ocourrod, it has 
Udiiolly hcT^n thi' ri^ult of uccidr^nt, the dieea^^ followioj^ f>einp* 
of a local nature* mid of no ^rt-nt intt^nsity. With what dneree 
of frequency the tu1>err4e iMirilhis i^ found in milk, and whether 
it has ever caui>od luljercnWifl fj^om the use of milk containing 
it^ Are Cjueeitiond that can not be detinitely anawvred ut this time. 



* 



* 



174 VARIOUS FACTORS tN THEIR BEABfyO 0-V DIST. 



Diarrheal Diseases. — Tbc question of <liarrli[^] difieases flft 
cati»e<l hj milk i^ i>f iti<^^nmt^t pra^ticnl importunes. Diarrh^ 
diTrcase is oommoneBt in llie warm months, and 97 |ier n-nt, of 
the cuMB that occur in children are in iMittle-fcd hibVsn Wliore 
the milk is pure and where proper aire ba& i>ecM obst'tvW in 
tmnKiniHsion trcMn the cow to consumer^ the disease i^ rare. 
Whwo tbc milk h impure ami \!A «iR*U»*eIy IiHndlod, many cat^es 
iff diurrtieu und deatli an* the rcf*ult. These discast's nmv he pn»- 
duced hy toJtins generated la ite milk by the hnptcriu, or by 
the bacteria thcmeehvs being introdciced into the int^etiiutl 
tnirt. It i& not definitely known j%i»t whst Imct^ria give rise td 
summer diurrliefl* The di^^ea^ is probably due to diSerent 
orgKiiitiiu. K«*eut inve3lipatiuD& pfjint to Iitu:Wu^ tlytta^Uricus 
(Shiga) as the or|T^ui,'<ni most commoidy pR^seut. There is no 
greater le^^son to be litiinetl in the wholu niugeof milk infeolions 
than tfiat impure milk ctiwff/t dhirt-yAu 

Diphtheria. — I>iphlhrriii biuilli iruiylind their way into nilk 
frotu (Ike milker^ whrt mav have thr diM^a^e iu Jt niihl ffrrm, or 
from Hib^cqiient contaminntinn. A auml>er of epidemics have 
owf^l thoir origin to infected milk. 

Scarlet Fever, — Where epi<lemic8 of this diA^ose have 
occurred as tlie result of milk infection, tlicy have iisnully 
been traoeil to a cjise of the dis«ise in a milkor*a family, Kober 
tabiilaiiHl 9J* Bwirlet fever epidemics as folh>ws ; diiwu«e at dairy 
or milk farm, 68 ; |»ersoc-* employe*! at the ditiry cither hnlgcd 
m or had vlyited infected houyea, tt ; fr^im infilled boUkvs or 
milk fans Wtl ia scarlet fever houses, 2 ; einplfiyees workiug 
while $ii0cnng or rtcovcriiig from the dijea.«c, 17 \ employees 
aetin}^ as nurses, 10 ; milk stored in or n«ir the slc^k-room, 3 ; 
infit^tinl eloth uainl \r\ wijiing cim?i, 1. In 10 instances the in- 
fection was attributed to infiarnmntion of the nddcr nr lo puer- 
peral fever in the cow. TInw uulbrmks sboidd i>e retjardeil as 
cases af streptococcus nr r^biphyloiKKHUJs infection ruther thau 
Gcarlet fever. 

Typbold Fever- — IVlany epideraios of typhoid fever may be 
tnK^ to an infected nktlk supply. Too mtich Mtree» iiin not bft 
laid on the im|>ortanoe of iuvestl^tiuK dairy farms aa a source 
of typhoid fever epid«mies, KoL>er tabulatfMl 195 epidemii^ 
cmiHieil by milk. In 67 instt£n<^es fbennlk wur prohahly tnfect> 
ed by iisinj; infected well-water to wash the ut*'nsilb, and In 16 
of these, infected water had been intentionally added to the 
milk fir purposes of dilntion. In 7 instaiLce^ tlie infection wag 
«ttiibutea bo oow» wading in so^n-age-polluted water or paatures ; 



i 



■ 



VlhfA^KS CAUSED BY FOOO-POlSoyS. 



17* 



^i£U^ instoDoes the tlaiiy cniployc«« acUxl tut nunwii ; h\ 10 io- 
Btano«d pnti^nt>i HutlV>riDg with milil nttnrki: oi>nUniu*4] at work ; 
ill 1 lUt^tAiicc the nnlk-^-iiiiFr were washed wiih the ilishrloth used 
amotitr the tevir jkuticnt^ ; w 2 inrfunei'*: ih'iry cmijIoyH^* were 
coiinectol with the ni^ht ^il wrvitv ; uml tu 2 instances the 
mitk htul Ih^u kq>t in u e]oH*t ia the «iok-Tuom. 

Asiatic Cholera. — TbtA disease may be transmittal thronfth 
the agency of milk, but the usual mode of iiifectioD is tbrougli 
dnukiii^'-wfltvr. 

Milk -poison Ins (Qalactotoxlsmus). — Id 1885 tyrotoxiooa 
wfti found iu millc. nod in 1886 Newton and WalW^ rt^portod 
int4^n<ftting sieries t>{ caseg of poisoning due to the pi-eseiioe of 
thU toxin In milL The milk vas obtained from a dairy in 
wliioh the milking was done at midnight and at nam. The 
noon milk wa* the one that was poisonoUB. While etill warm 
it wafl plaeed in eans, and delivored lo the consumers in the 
heat of the dav. The heat permitted the growth of bacteria 
which caused the furoiatton of tuxiu, Thvi'e have been uuaier- 
oua instances where it« presence m milk has caused poisoning. 

Vaughan and Novy havo al^o found it iu iotv-oream ami in 
en^tard. Shearer ha^ denion^.rated it^^ presence in vanilla and 
lemon ices, Besidai t\Totoxicon, other toiin* liave been found 
in milk, Vnngimn and Perkins have isolati^! a toxin, oau^ed 
by a colon-like bacillus, which produce^ marked flymptomK. 

Cheese-poisoning: (Tryrotoxismns). — As early as 
J 827 tht^oriei* b(^n lo l*e di-^aenunati^l as !o the reason why 
BOtne cheese, iLHually ap^uirently unaltered so far na ordinary 
observntion wi^nl, should ciiu»e [Kiisoiiiug, Huiiucfcld and 
othera oAcr him believed it to be due to the fatty acidtt. 
Niim<"r<"in8 ejtws were reported and di§eussed. In 1883 and 
1884 about 3tf0 «4ses of cheese-poisoniag were peporte<i to the 
Mic-higun State Board of Hoalth. All who ate of tlie ehee^ 
were uttncked, and the symptoms varied with the quanta^ 
taken, being more severe where la^' amoimtfl had been in- 
gesteik The s^nipt^nns were vomiting aud purging, with watery 
stools; tlie timgue, at first whit€. then bt*<.:!im*j rixl and very 
dry, and there was pJiin in the rc|;ion of the stomach, Tim 
pnint! won feeble and irrcgidari and in some instances there was 
(.'vjintkiiisi. Vnughan siudie<l these ca>ied, and fouri<) that ihe 
jMiiiiifwing wart due to twelve difTercnt variHic* of eliepsr, nnw-t 
of whitih ciime from one l^ictory. The cliecKr sccmc<l to thSer 
but little from ordinary gtHMl chi'cw, but if oflcre<l to coU or 
dogs t(^tlier with good clteeicc, the uniinaU invuriably chose 
the good. If fe^l to hiingr>' eat«, they wouhl eat it and appar- 
ently with no 111 etTect*. The pEitou was isolatt^^ and con- 



176 VARJOtlS FACTORS /.V TftEFH BKARt^G OX DIRT. 

Bitted of 11 orvKtulHiK', highly poUonrms eiilii^taiiuc, wluoh 
Vniighan rallwj tyrotoxicun- Tyroloxicon, h*»viever, appeiira 
to he a comparatively rare |M>ison, and olher toxic substances 
have been iliscoveretl in clieese< Vaiie^han isolated an albu- 
moBe; Vaughan and Perkins, two bacilli; and VauRhan and 
McClymonda, a bacillus of the colon groups all of which wore 
toxic. 

Typhoid Fever and Oysters- — TyphoiJ fever hiu bom 
tr:an&mitu.-d hy uifectcd oyst^rA, the oyetera having usually bo<!tt 
grown vi*rv ti«ar tliu otitlrt of a eewer or on artificial beds. In 
New Haven, some yoars ago, thirty stndents were infected with 
ij'phoid by ealitki^ raw oy,^ters supplied by a dealer who made a 
I)r:uctice of placing the fresh oysters in the river for a day or two 
aft^r rweiving them. KunDiDg from his house to the river, 
near where he had placeil the oyat^is, was a drain-pipe. His 
daughter had typhoid at the time, and hip wife had died of the 
disease slionly before. Instances have been reportcil in other, 
ouuutnt^r but it In not u very (xiiutnon niixle of infection. 

Poison from Masse Is (MytilotOKi&mus). — AoTord- 
in^ t[> Vaughun and N"vy, there are three kinds of ma*s©l- 
poLHODini; : 

1. Where the principal symptom? are gastro-intestinnl. and 
of varj'ing int*?nj^ity> Tlii?i form may at times be cholerifonn 
(ComW). Death may follow very rapidly — in Combo's case it 
OQOcrred In two days. 

2. The mo«t frequent form is that in which symptoms are 
principally nervous^ coming on shortly alter the mnssela are 
catcnn '1 here i* a /*cnNUion of heat and itching j a mah of on 
urti^MLrlal nature, and Rometimt^ v<?9icnlar, nppcarti. Then^ niav 
he (lyKpnpa, nnd drrjth may result frnm ixmvuhWe trf-tnors or 
coma. Death has followed from this form in three days 

3. In the thini f>rm the symptoms are lluw^e of an intoxlca* 
tion resembling alcoholism followed by paralvaiH and drntlu 
Cornb^ in 1827, reported death as early as three hours a1li*r 
eating the nm^iH'ls, and others six or seven honrs^ and still olhera 
alWr li.mgvr iuitrvul?^ 

Various theories have been ndvauoed to fXpUin the cau^e of 
IdusmI -poisoning. Itri4?^r haj4 isolated a ti^xin from mitsstla 
which be calls mytilotoxin, which caused a fatal case of poison- 
ing- Fnrtlier study is needeil 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, case* of poisoning occurred froni the eating of 
oysters taken from near the outlet of a drain from a public 




DtSKASBS CAUSED BY FOOD-POESOm 



171 



water-cla*et (Fawtiimr). VarioiL* nilca for rccopuiKiiip pouoa- 
OUA HhelUfisli have been j^ven, but they are not, an a rule» reli- 
able, Shell-tiflh that if in-sli, that had Imtcm taken from clean 
vater, and that has Hoen wneh<?4l with oloaa voter, is ^nerully 
enfe. Kept »t n qnmmer t^mpemtun?, whether eooked or not, 
it in unfit for food. 

Folfloaln^ dne to Fish (Ichthyotoxlsmus)-— Fish 

may be poiBooous under viirious oondltions : 

(1) Some are ulvmys poisonous. (2) Some are pobououfl 
during tlic e|)nwning F4-ason. (3) Somt may be infectwl vrith 
bucUTial disotse^ wliich may c»urcc dm'UJW' tn num. (4) Like 
ether niti:ogenoD3 foods^ fi«h may be mfc^otcd with bdcteria 
which produce toxins. 

Koh(*rt, according ta Novy and Vnu^uin, mak^s the follow- 
ing claitfificatjon *S |w»isnnnuM ^vi}\ ■ 

1. Where the fiah are supplied witli pot^D gl;tn<lv» connected 
with barbed Hm, witb which tlicy wound their eneniiea, like th« 
poison of «nake«. The^cau^ pHM^ttatioDT convulsions, and death 
in num. 

2. The gf^nus T^trodifn, a Ja[)anO''M* fi.*h which li;is pni^onouH 
ovaries, wlud) are \vsji pnh^nuas tn winter, when th(? uvancn 
are inactive. Kakkf% a disease of Jufan and other Eastern 
countrief^ is bclicvcil to be one to the eating of certain vanotiM 
of the Srt>nihritI(C family, (See Beriberi.) 

3. Certain ether liah whose 11 oa<h nnd glands are harmleM 
may be dangerous on account of the decomposiug substances 
or corals, etc., ou which they feed. 

4. PoiMwiing due to ptomaiiiM, of which Ann'p lias i.'^ohitt^ 
two. These are due U* tbc fiwh \mii^ infected witb ?4nin>phytic 
bnctem. The syiniitoins mv pnmiliially due to involvement 
of the (^tro-into^tnal tmot nnd nervous system — niiuseOj 
vomitin)*, dbrrben, prostration, raphes, etc. 

Fn Rii^^ia and Germany tb(»rc^ nre orrtaiu Rsh Hmt^ if eat^n 
raw. may produce di^^ea^e, hut tliut, when thoroughly cooked, 
are hamilefis. The cause is probably found in a bacterial din* 
^ase of the ^h. 

Meat^poisoning (Kreotoxismna). — Many forms of 
m (^t- poison in^ have beeu d<??M^ribed, and .M.*rno hiivc bt-en g^ven 
Epecial names. Certain diseases the result of direct tmnsmis- 
aiou will be eon^iflored separately. Tlje meiit of unimairt tliat 
have died of disease of any kind id unfit for food» and the old 
Mosaic law, ** Ye shall uot eat anytbing that di«tl> of itAalf," * 
is a good hygienic rule. The Jewi^nh lawa concerning what 




178 VARIOUS FACTORS IN TUEIR BKARISG ON DIET. 

wem r^^arded as oleaa aud uncleaD iueat« are set forth in ih« 
foiirt«eQili (;lia|>U*r of tbe book of Deuteronomy. 

Poisoning liiifi followed tbe iagcetion of rtki]iats of variooa 
kindjf in which toxio <tiilMtaiioi?A had formed. Some meata 
itadergo changes that can he detect^Kl by ordinary RKianiir \rhile 
in i^till others putrefactive changes are nol apfum'nt. The 
poisons vary in nature, and in some canea toxins ami Isaelcria 
have been Isolated. Among the many foods that have eau^ 
meat-poisoning maybe mentioned canned moat8 — pigs' tnngucs^ 
pottcJ chkkenf and the like; hora, sausage, brawn » veal and 
pork pifd, ribh of btcf, g\)opt--grtaai? — iti fact, aluiiiJ^t every kind 
and form of «ioa»t foods. 

Satis^ice- poisoning, known a.^ iHitulidmutf or allantia^ils, baa 
been known for <iver a himdreil yejirs. It \* lieooming less 
fre£|uent an tlit; cauites that give tmc In ihe disean' are Iwcoming 
l>etter kno\vn to saiisa^^niuki r?*. Id Badeti, Gerinuny, where 
very faulty methods of prei>anng and curing tchU^re were in 
vogue, the disease waa formerly fn^uert. Blowl that had 
become decomi»o*fetl was often used, and in other inatancea the 
saDAge was imperfectly criin.41, iJitf outride Ijtiiig jimokwl and 
rendered barmkaai die ccut^-'r reoiaiomg eort and highly poincju- 
oiifl. For this rcitson those who At<! the outside of the ^uaage 
exhibit«Hl no ill iflVf.-f**, wliile those who jmrtook of tin* JW'utrP 
Were niiule very ill and many dini. The symptoms vivTy with 
the kind of poiBou that ha.4 dc^'elopinl in Uie meat, but there 
are no oharaoteristtc lesion.% in ihone who die, 

"Von Faber, in 1821, observed sixteen i>er9ona who were 
mflde sick by eating fresh unj^moked saueage mnde fmrn the 
fleeb of a pig which had suffered from axi abscess on ils iieek, 
Five of the jMitieulft died. The sjuiploins were aa fi>llow?i ; 
There were eouhtriotiou of the throat aad difficulty iu ^wul- 
lowing, retohing^ vomiting, oolitvlikia pains^ vertigo, hoargt^uess, 
dimneNH of x-ision, and headaohe. T*ater on, ii> severe oa«?s, 
there was complete exhaustion, and, finally, paralysis. The 
eyeballs were retracted, the pupils were sometime* dilated and 
then eontraoted, and they did not resi>ond t-i light ; there was 
pnmlysifi of the upper lidfi. The tonsils were swollen, but not 
aft in tonaillitia. Liquids which were net irritating could be 
uirritsl aj* lar aa tJie ewpbagu*, when they wero rejected Croin 
the luouth and nose with coughing. Solid food could not he 
awollowed. On the back <:if the tongue and in tlif^ pharynx 
tht-^re wuji observed a puriform exudate. Obstinate con^tijmtion 
crxiflted in all, while the sphincter ani was jiaralyzed. Breathing 




DISEASES CAUSED BY FOOD-POtSONSi 



179 



wu CASj'i but all tiad A crcupoufi oougli. The akm woa diy 
ftrul thei« waH inooDliuc^noc? of urine. There wnn do delinum, 
ftml the mind i>*niaiiied oloar ro iU^ lisU"' 

Thcre %vrr<- Io^h of voW', typlioitl^likr slnnU, mEirltPcl drlirmin, 
and m*»ntnl diMtLirbntJ"* that pTssiatwl f<>r wi^cJc* aft<*rwiinl. 
The on«rt o*viirr«l in fmni cig1it«%n to twvnty^ftWT hiHiT% Hft*r 
eatmg the saiiMi^, nnj lii»tod from one to four wcckzf. There 
were no dt^uth^* 

Tript' hat rc|x*rt<'*l over 80 ai*ca whon' tlieri* were frdinent 
stooUf wmk mid nipul hej;rt, »nd delirium. The ]>upiU wa« 
ostmlly (^►ntrucU*d but renctrtl t" light. 

Bellurd ixrjNjrlt^l 4W d<<aUiH duu tc |irti'UiiionIii« uiu&tnl hi 
most of tbc cn-'M'?' by editing infected bacon, Aix^frdJug to iWir* 
ob^rrvcr^ thn*ic who bud ihv dlitciitt.i oould IniikMiitt li t*j othcn* 
wbn httd iKit. <Tjitrn cif tb^ m**nt., u fm-t that Iium bi'iii Jiotrt) m 
many other instniiccf«> After hiivin^ Ui^n k*'pt several mouths 
ibc baiH)t) ]ofi>i it« loxteltv. Tliii^ e]fidecinc wm known asi the 
Middlenbtiroii^b jmuumonin i^piJcmie. 

Another interesting <-pidt'mic of m<>At-poi-inniug cwMJurr^d at 
Mi(hiMmr)j, Hnlland. Mi^it from a cow ftick with puerperal 
fever wjis mtvu by SjMj suldiern anfl 36 rflisM-nj*^ the s^Tuptoma 
oiniflirituiE v€ viimiliii^, pui^nj^, dixxtmw^, i«UvpIr?uneh3, dllulA- 
tioB of the ptipib, (ind in bquic caB<ui au <H^Kemut<^ud eruption. 
There were no fatahtiea. 

Gtirtner fouod Rttrdht^ entmdlih m ftotne in^tnnom of naMU 
]>oiMiiijng, and otben* have also demonstrated it* presenoe;. 
Vnnghun and Perkins i^olat^ two l^aeteria — a liaeiltu^ and a 
BtreptoeocciL^ — from prc^H^d chieken tbiit poisoned a large num- 
ber of pcnronB at Slurjjifl, Michigan, Cmft'ky and I'aak have lao- 
kitcd n bacillus re^inblin^ die colon-lnK-iUnt^. Vuii Ermengem 
di«ooventl a budllut Bimilur to that found in other outbii^kfc ; 
it vifXR present tn meat that, appai-cntly, bad not undergone 
pulrefiujtive t-Jmrgefi ; 34 per«ona were affoct*?d and '^ dwd, 
The eympti)m» r<>nffihte<l of delirinm, frver, pain in the Abdomen 
and beiid, and proi>tration. Ellezelle^, of Belgium* found an 
arf^aDl^m in liam tlmt ap|>cnred, freth^ but that hud prnducc^d 
poifionin^; in ^mc with fatui r<.-saltfi. The patientf^ bud jimrkitl 
netvou* ^*yMT[^tom», eonf^i^ting of diplopia, mydriami*, ptopi*, 
aphnxitt, uphoniu, and uuuriu. Other portions of thu pig were 
(sitcn wiliiunt eutitfit]^ any ill eflVvl*, The bum bml btn-n eiirttl 
in brincj while the ctli^r part of thu pig bad uot. Au anaerobic 



180 VARIOUS FACTORS JX TBESR BEARING 0*V DIET. 

orgnnism wa^ searched for nn<l found, atiii i\m wu numtid 
RidUun boftUismus. It i» aA virulent a^ tlic totuim^ baujllus. 



OTHER FORMS OF FOOD-POISONING- 

Mashroom -poisoning. — PoMonoUi fun^ nre often rais- 
taken for cdillo iimshroonn^, iin<\ lcn*l to toxic symptome. If 
th^re 18 a ling about the etalk ami the mnshrnom p*»el easily 
and has ]«ik gills, it is said to be noD-poisonous, This rule ta 
not a safe one, emce fiome of the most ikn^n^u^ forms of 
fun^i answer lo thin description. The active princi|ile \n these 
poisonous fun^i U inugcariu or s<jm« allied alknluid. The 
Bymploms prodtictti src vomitinff^ diarrhea, cramps, and j^n^t 
prostration. The pupils an.' w)nlnictH, and in children there 
may be conviiUi'ms. The treatment consists in empljing the 
stomnch nnd Wwcls a^ pn^mptly rts podsihlci and in giving 
atropin uml other rHKti^r^iEivee, 

Grain -poisoning:, — Then* are three form* of gmin-poiftoii- 
ing, geccmlly dcserilw^i a^ ergotism, pt^llagra, and lathyrism. 
Tljey are ili^^'aftrs '^een almost e^cehisivdy iimone tlie nqiinlid 
sod destitute, the effects lacing due to itiKufficicnt nourishment 
eombined in eaeb cjise with tlie pjx^citie poison frf>m the grain. 
Most case« and ejiidemits have occnrre<l auiong the poverty- 
stricken Europeni peasaal& Tlic well-lo-ilii and properly 
nourished are iinu-]i K-ss ^uflooptible* 

Ergotism (Sitotoxismus).^Tfi« history of er^ti^in is most 
int^*re>iting. It in yery prolmhio thut many eant^ of "St. 
Aotliony'* fire,*' described ia tie tweUVIi iTeiitury and lat«r, 
were coties of grain -poisoning. It is aUo prolMtble that ay]»hilifl 
and varioiw forms of ulcers and gangrene were confounded with 
it ami with one another, it is not within the prc^vince of this 
book to d<acril>e the horrible epidemics of the middle ages, with 
their wake of mutilaiions and misery. Within roceot jeara 
epidemics liave (je^miTtnl iti ItuaaiJi, 

Tlmillier was the drst to disc<.»ver that the oinee of the di^ 
eafte vxii^lJ^d in spurred rye, H« also point4<d out that the rye 
lA H|>tirred in the dump, cold BeasoiiA, and that t)ie d<;gree of 
vindency de|>emla ujkhi the amount of the poison taken. He 
ppovtHi hii! theories by animal ex j crimen tat ion. Dociart, in 
1676^ ascertained that ergot was most a^itive wheu freflh, and 
that it loses in Tiruieuce as it ages. It is produced by a mi- 
croscopic parasiiCj known as Cfai'ieepx pJirpuiTfi, growiii(( on 
Uie rye. The disease i» caused by eating the grain on wliich 



J 



MSEAaSS CAVSED BY FOOD-FOISOXS. 



181 



tbe paraajte lias grovn. Acoording to Kobcrt, ergot oontaiiw 
two poi^^tiR, >'pW<i4iiiir ixcidf wliioh ctuiM^t giiiiijfn^ix!^ und ntmu* 
fin, whirli ]»rov£>ki« T.hi* unc^^thi-jim fu«l i*i>nvi>lwifint*. The «rj>i- 
ceptiWlity lif ililT-TPul. inilivutunU varioi* y;it«tly. TIk'tv iire 
two fomit^ oi" itn^ iii*(^L"^c *>nv in whif^ii ^ii^rtuKr i:* tlio [^romi'- 
iiunt fcftluw, unci a m.'CoikI in which there jm^ (yitnijUic^n^ nnd 
anoithcviTL An avtiV* and a chronic form '>f tlu- <1iH<.UHo occur. 
In tlic ^ingn'Tioiirt form ttiere aa', at fiist, tinglin^^ aiit^lhc^ia, 
H]w.-4rn(Kli(j intivtiiuent/i, and laU^r bl(MHl*.HtJi8ia, rnJlow<?<l bv pin* 
grcnc of the pxtreiulu<jii In Uic convnL'^ivc form there arc 
prodromal nymptomB^ Utsting for a w«*k or ton clays, ronnUtin^ 
nf lu^uliu^ho, w<nkniMK, anil tingling i<«nMttiiius. FrOIrtwmg- 
thiTM* tl»»nj un* c'rain|>M in tlie mnwW nnd (.H>nviiUin[i«, Tlio 
»lvi8mH may lii><t for houra or diiyjf, and arc apt to recur. Mm- 
till (li}!tlnrbaniri^ and ^ymptom^ of <:<»rd involvom<^it may *uiwiw 
VCMK-. Tlio tlist^M.* viiould not Ix* mi^tAkc^n fort^rvtlinum-lalpa^ 
KaynfludN (1l^'-jis<\ or nrnrilynin, who^o AymptoniA it Minitilak-^ 

Acoordin^' t<i llijiigor, ergot niny l>e dtU'^Jeil in ilnnr hy mix- 
iug a HuuUl i^nnntity with vihvr and adding a few crystals of 
oicalio acid. Tho mixturo is thtrn boiled and alli>wc!d to settle and 
dear. If f?r^t in pre^ent^ a red tin^i^ will be imparletl to the fluid* 

LathyrUm { Luplnost3],^TiLiA is a milder foroi of grain- 
poi«(.iniri^, liio pt)iM»nMn» agi^nt being Uic eet-d of LaSiifrus 
MUitimnmi L, riVurrf, i-c^niniunly known an the chick -|ien. Poi* 
nciniagiH^nnc froni iIlc mcfil ground from th<^- ^«*(hI», \vhic.h hai^ 
U^^ii UM'd to adultcrati^ flour. The dir^eawe wan uoU<d an early 
aH tbe wevenieeiuJi ivniurj", and wan studied bv Jaincj* Irving In 
India, A> the jx-muU of iljt? faiLurr- of tlic whuat <-*a)p at Alla- 
liabud the iidiahitants Ufied lUc chtck-jHsi for iood, tiiid an opi- 
dotnlL' of littlirvUm ffillom-d. Thi* d]wa?e affeet^ the l<^i 
pr«idni'ing a stitlii4»*< of dte joints, and luay eauM:* a tijMiHtic 

Pellagra (AlaldUmua). — ^Th» m at^ a dL4i.>aHe of extreme 
poverty and misen", and ha* been seen principally in Italy, 
i'rance, Spain, and Houmauia. It has never been observeti in 
Araeriai, It h aiuse<l by eating termented maize. The exact 
nature of the ohangea in the grani are not fully uudiTatood« 
The «rarly symptoms are indt^fioite wfakneus, pains, and diges- 
tive diHCurbaiiot^g, Titc t^kiii is usually ^tTeoted. Iienee the name^ 
]ie]Iiigni ( fM'/fin af/fiti — i *■,, nk^cr of the skin). An erj'thema, 
with swelling and pet^xrhiie, apix^rn. Hull^ are fn^iueul, and 
when they break tlicy leave nleer^. The ^kin Kyniptomn difr- 
npfK'ar, but a pigmented] etkin rc^nmtn.'i. After fteveral months 
the ^yInpU)n)H sub-sidej usually to ntvur the Jbllowing i^priag. 



182 VARIOUS FACTORS TX THKIR BEARtSQ OS DIRT. 

Id the flCY<:rfrr caiacs there mav 1>c pronfjunccJ iicrv<ru3 synip' 

nnd niontrtl dUtiirSanoi*. Th«* iiMt do nf>t fjtrnt^mlly romn <m 
until tht^dmLSL' Ims Ix-en pr«*ent for i*<"Vonil ym\n^ Many of 
the oa±*G8 in the inj?ani^ »Ay]iim8 in various |iartA of Itjdy uru 
cases cf pel1a}£7^, uHUallr with either melanchi^Iia or a suicidal 
mania. In this i<U\p' t!u> (Condition is hopelesf*, 

Phodphonis-polsoning- — it has been reconimenHed that, 
after acuEe phi>HphoniH-|MJiHoaii»g, all fal be exrlude^l IVcm die 
diet, on tJit' pritioiplff that fat will djBM>lvG nny pbospborua 
re'Tminitig iu tht? nt^maoh and eo hasti*ii ite ubsorpti^^n. For 
diis n^iirton llw- urticleH eveliiiled shotild be not only (he hiir.ter 
Hnd i\X\wT faL% btit even milk and Mk- yolk** of *^gp. The du^t 
should eonstiftt ehiefly of cereaU, ^riielfl, and the like. After 
sevftrnl dayr* the oi'dinary diet may gmdually be reHum^. 

In chronic phaHphonifrjioiiiionin^ Ma^tiit, of I'ari*, reo>m- 
mendsan exelu>>ive milk diet, combined with the iabahition of 
oxygeu, gentle exerciee, anJ ix^peated smjill doses of turpentine. 
If ><iippuration baa occurred], a snpjHkrtin^ diet of the naoflt 
nutrilii^iift eSiJirnctor. similnr to thrtt ii&«l for other Euppurativo 
oombtionN^ shonld l>e pre^ril>«Hl. 

Beriberi, or Kakk^. — This disi^ase ih occasionally seen in 
the United SUiti's, and is priibubly of inicrt^bie origin. It haw, 
however, been attribtited to diet as well as to other caused. 
Diet probably acts only il< a prwl imposing factor, improper food 
tcmting to lowvr \\\^ gem?ral health of the individnaJ. The 
theory that the di-^i?ase U of dietary cirigiu is the result of 
oba^rvathin^ madi? in Ja]iau. According to Man^^u, up to 
1883 f>vcr one-fourth of the entire muHl<;r of Jupan*i>c sadlora 
Vere affected with beriberi. In 1883 thero were 123G case^ 
ainnng M49 niL^n, In 18^4 more nitro^noiis fond was ;uMnl 
Uy tlie diet, and thit fjlhiwing yiar only 41 cisos were reported. 
In ISftT tbu dtseajrio iuid pnn^tieally disappeared. Other hy- 
gienir reforms brought al^jut at the 8Jimc time prol>nbly had 
a dit'idi'd influence in ext^^'miiuatirit^ the dWa&p. It hn^ been 
attributai to the nae i>f an excess of carbohydrate fo'xl or 
ftpuilei.1 rit'eu In the Java jirisooSf whtrn^ rice iv enteu vlicUed^ 
tjeriberi ja aai*l to be preheat in the proportion of 1 to 30, 
whilst in the ta^Litutions in which the noe is funiEsdn^I tho 
inmate uiinhLdlef], tht^ dii^eiLse is seen in onlv t in 10000. Minra 
and other Japaneae ntithonti<^ believe that the di^Jtac i^ duo to 
eatjig fish of a certain variety or raw and inipro|>erIy cured 
fiab. (See Poiaoning Due to Fish.) 



I 



DiSEASSS CAVSKD BY FOOIhPOISOSS 



183 



Uaiitvoii «taU9 that with pMper b\pciiic meaniirf^ and a 
libem) fttid varic*! ilk-larv thcJiM^aM.' may hv (>rfVL"iiieiJ. If n<w 
15 ud<^, the ninonnt tnkon ^^hoiild bc decreased, and wlieat, bar- 
ley, jtots, or bmuft 9Tibetitat«d. 

AiDerim. Tliere it^ uo evidence to ^low that tt has ever been 
tnuismitted by articles of diet, but ca^ieti are recorded wbtrre the 
infoction bus been trucod to barley -t^bmtli», to ffra'm chewed 
niWf and to etruw being cunii'd in the mouth. 1 he mammary 
f^land, b<.4b in eowH ajul in women, muy be infected, but so far 
DO wiw luuf btvn trtn^ul directly to milk. 

]^oot-and-motith I>i3€ase. — ThiA disease nmy be Inofif 
mittod from infectc<l ca1tl<< l>y means of milk or butter made 
from the milk of cowu enffcrinp from tKe diKeow, a** vrel] as by 
direct contact with the animnl^ The di^eane vi^s studied a^ 
early ^ 18)14» when three Gcrtiinn veterinary surffeons dnuik 
the milk frcmi infected cowrt. All develo]>ed tbe dii^eifie. In- 
fante nnd cliildrtn have ali^o bcf'n inf^tcd by drinking con- 
tuminutcd miik. The conlogioue principle ie d<^s1njye<l by hc^t, 
but the flv^h, milk^ nnd milk-pnulni.'tp; of uiiimtiU witb fx>t- 
and^moutli dirwn«c sbmdd iva be iiswl for fiiod. During epi- 
demics c«pcctal care should be taken to avoid the products of 
Bnch animals, nnd in case of dnnbt the milk ahould be boiled 
before Uflinp. 

Hydatid Disease. — Hydatid cysts, caused by the egga 
of Ttmm rchinococnt^, may ti\so be classed with the diseases 
caused by diet. The para»iite grown in the ^mall intestine of 
dogs, UDd tbc ov& are takcD into the alimentary cannl of man 
by drinking water contnining them, by Imndling dogs and 
oirryiDg till' infi'iitud Imiid* li.i thi? uioulb, luid by eating niw 
green vt-gctnblcfli. Tlic diactisc U rarfi in jVnierica, In the 
medical wardu of tbc V>i>nnu bospitolf^ a nnitintp <jitc>^tion !«, 
"Do yon keep flogi*, and do yon cat grctiu K:i1nd&?" 



IDIOSYNCRASIES 

In *Minf*id**ring ffWwl-poL^kriing, ibe existence of food idi'i^yn- 
cnisic^ mnsl bu bomu in mind, fur, iisiiic from the fatnl tbrm«r 
iJicrc arc many persons in wboni tt-rtjuu articles of diet ^ve 
ri«c to curious cflucl*. Many of tbeM' an^ imaginary or i>art!y 
BO, and it t» not uiiUMud fijr p]it!cnt-'< tn declare that tbin or 
that article of fucHi d<Kv! not agree with them, Thh* h especially 
true of milk, Ai< n matter of fact, tbc idio^iVEicnisy has beeu 
part of tk« mentul ci]ujpmcnt of tlw individuul lor a long time, 



184 VARIOUS FACTORS Ilf THEIR BEARiyO ON DIBT. 

And ID many oa^cd liaji beco fofltcrcd by pbydioiaos who play 
npon tlie imiipioation of their paH^nts ; c*i>ofTaI!y is this w> 
with regard to druiirs. It i^, however, undoiibtwlly tnio that 
food idiosyQcmsiefi do exi^t. and tli^it id certain pc^oplL- purticti- 
lar articles uf diet will prtxluce symptomi^ ot^en of an aluniiiDg 
nature. The mo^ usiiai mnntfcj^jition is the prcHluetion of 
rn«Iie*^, geneniUy of an urtiL^rial ty|)e. Tlie <^ting of straw- 
berrieB, oyst^Te, crHLi»<, and oUkt sbdi-fiish is a frt^jneiit onu?c. 
Id othen^ iLttuck^ of vimiitirigy g;t$lrir jHilUf diarrbivi, faiiituess, 
or GcrmhiimtionB of theisc, may be pmdiioei]. Among other 
artic^leg mentioned as occasionally prodncing thi^ effect are the 
white or tho yolk i*f **a;gv, w>tfee, tia, fnt, honey, ami. indeed, 
almost any article of diet. Amblyopia liafi been attributed to 
tbf urn of chocolute. 

FOOD ADULTERATION. 

The ndulteration of foo(i is a 8ubjo<rt of such wide scope that 
it oaii not b<? entered tnto here in detail.^ The flubject ts one of 
the gr(«t*'wt imporlanoe to the community at lar^e : and where 
\i^\\ ri-f^ctirjufi do not exi^, laws fihouM be enactecl which will 
iuMin- the i>r'>jKT inhpeetioii and regulation of the Mile of ull 
food-fituffs. Tht' Bale of injurious articles should be absolutely 
prohibited^ and aduUenLteil bnt non* injurious commodities should 
be properly bnmdtti so that the piircbiifi<.T may not be compelk-d 
to pay un exurbitant prioe for an iuftrior artide. The iawa 
should apply to both native tiud iniporteil food-stuS$. 

In the Unit^.'d States the law c Quel od July 1, 1^(13, prohibita 
tb<T introducrti^n of — {ft) foods containing auhetainces deleterious 
to health ; (&) those mii^bmudcd ; and U) foods tlie sale of which 
IB prohihik'd in the country frcmi which they are shipped. 

Almost all the States have enacteil fowl laws of more or less 
efficiency, but the laws should be sufficiently nnifurm and 
Btringent to prevent the sale of food-staffs deh^terious to fac^allb, 
and to prevent inishranding. Although under the pivrreut law 
in]|Krrted articles aru pure and properly branded, then- are great 
opportuuitie^, after the articles nave entertjd the oouufry, foi* the 
p^rpcLratlou of &and; the same is true of native food'^luflk. 

'For Ml «xleD<1t^ Btiidy t*i lluB Mnhjerl Ihe re*<lor \^ refrnrd fn Blvth't 

book cjn I'i}Ih!/i. nm[ iiIhd ki \\\v riitUml lniMeliiif uf the DivJT'inn of t'hcrmi«ifT 
of the Unufli Wai« Deivirlmtut of AKriniliurt!. Thf buUeiin rtn FcmkI 
A'lvrlkrnlion. liiKiwii tth >>, 115, i if wlit*'l» stmie (tn pnris hnte ulimdy bcm 

iwnvH], (^11 \a- (\in\K\ ill bM Ltiti liirK^r lilimnt^ l>ul, uiirDrtUDalcl*. iLr rftrllrr 

parts urv out of priiiL It lb lo be Loped thAl Uiifl hiilletin wiU be reipnnted at 



I 



FOOD ALVLTERAT102S, 



Ififi 



Food adullcmtion is of twokiudfi: tliut which w iojurioUM 
mid that which is noii-iujiiriotiH, The lollcr in pnurtij^cd where 
there are no fi\o<! sianrkrdtc, or, whtrt- i*iioh liti I'xUt, in d^bns^- 
meotfi from ibe^e l]x«d htandurclK. i\fhiltrnit!(»i]ii mity he rka- 
6ifi<^ afl follows : 

L (!bRrt?n/i<>na/ — to suit the tn#U; mid dorTinnd^ of the publio. 
Such adulU'rationrf are iiwuiillv i^ffwt*jd hy itR-Hnn of Lvlorinj^- 
mutiei^, many uf which art liarnjftii, aud hy bliuchiiig certain 
prochicts, 

2. AocUI^rUal or iiieu^ntul'—iint^^ Ttoiu inivirgnnii'iit, cnr^ 
le«aD<riis, or inoompetenL-y on the part of the pruiJiicMrrr manu- 
factiirer^ or hie a^^enlp^ Thie uatiully c^riMittn In uti udmixtiirc 
of flonie fomj^ guhRtanoe, RiK^h sk hiiJ^lc^^, Hti'inx, h«v<'K, vie, 

3. JrfeiVrtfj'^— to comply with or take odvaiiuigt* of t^rtain 
fixe<! arbitrary t^ndards, 

■1- intf^xtionnl — tor piirposcR of gain and competitioD, 

Coloring-matters, — The iL-»e of eolano;:-niatter in (bod w 
a moot p<:>mt. We think we can safely aw^ri thai the use of 
auv arlilieia] cvturiug-iuatUjr ia objectionable, aud nuiuy of the 
dyLi» HO iL9<xl arv harmful, Fortuuatelyi the peopk- un< Ix^iog 
edii<:<ated by Wiley and his aT^soeiatev, and a demand fur pure 
and uncolon^l foudn Is being created. 

Alcoholic bCTerages are fnxjucntly adult^nilcd. Wood 
or methyl alcohol i(« somctiincK eubi<titutcd for p;rain or ethyl 
alcohol, Thi^ if* CJfjKvially true of the flavuring extrartSj which 
are iiseil in toiiuII i|tiaiitities. WikhI ah-nhol is an excectltogly 
daDgenjus mhilieraiif^ Blinduci^ and <-vcti death have folh>wtH) 
lis- iiac. TLr liight^r tliey ^itinid in tlie ^'rie.-<, the niori: tuxic 
the alc»>hfil3 l>ecomc. Hu«t hufl T*h"Wii that a larg;cr t^inglc do^c 
ff methyl alc"ohr>I thun of t^thyl nWhol i^ re<|uired to kill, hut 
thai the aleoludh* differ wulely a* ri'pirds ihrir eflertit with <?on- 
tinned use. A qtuintity of ethyl ahw>hol »omewlmf l>elow th« 
kttml dose may be taken day after day widioiit <jfflusing death, 
whereas repeate<i lai^e doscft of methyl alcohol may a|>eedily 
result in d«ithf the ria^on being that the end-product'^ of grain 
alcohol arc acetic acid and tt'siler, whereas the end-|jroduct« of 
wood alcoh(»l are formic acid and water 

Adulterated alcoholic li4)UOT>< e^mtnin fii^ oil, tanniiii log- 
wood, water, coloring- matter, and burnt sng,»r. VarionH gmdes 
of cheap whinlcy and hranily are maniifartnre*! by uiiMe.rnpnloitri 
rectifiers by mixing newly made alcohol with etJoring and 
flavoring matters. An imilation of |^ is frequently made 
from cheap spirite, turpentine, sugar, and water. 




186 7ARI0XJS FACTORS J-V jnEUi BEARTSG ON DIET 

The Adultcrntion of Beer, Wtne, etc. — ll7nr and brrr «re 
HOf^liJAtk-^tocI by the ad<lil!oii of vurloiiK fiubntaocve uHuully 
3(blcyl ftfl jire^ervatives. Cliief itmong the^ ia s«1icylio a'>i(l, 
which is mlddl to arrest the aotion of fernjonts. Itfl uwj is 
forbidden lu France and Germany, altliou^h in ihe latter 
country it may Iw added lo beer» that are lo be exported. 

Gt*rard found that, in a liter^ wine contained L95, I, GO, 1,48, 
1,41, 1.U5, U.81, and in one case as mneli as *,i,b grntna of 
Balicylic acid ; ^ynip coticamc-d in the fiame qitartity, 0. SO— 1.50 
^r&niA ; beer, O/i-5— 1.25 jj^raniA j milk^ 0.'2&— 1.85 grunib. Id 
one case it will be noted thnt a liter of wine contained a full 
twenty-four lioiiiv' dose of wHcylio aeid. 

Crnmpton lonnd wilieylicaeid in about one-third of the flam- 
plea of American bottled beer vrhieh he examined. He did not 
%nd any in drafl beer Sulphurous aeid is one of the oldent of 
preservatives. Its u*^e i-s forbidden in both France and Ger- 
niany. Ifomx ih frLXjiienlly u;^cd. and is also forbidden in the 
countries meutioncil. Sodium bicarbonate \s iiKcd in beer to 
correct the iicidity uiuwd by in^propcT brewing, and a\&f ia 
ennf*c an incrot&e in the carbonic ncid contentj so that the beer 
will have a better "head." 

Wine is adulten;ted by addini; ^^>^r, gummy snbelanceSf 
colon ng- ran tters, and salicylic acid and mineral acids as pre- 
flervalivefl. In France wine is frequently pUisftred by the 
addition of g;ipsi.im, or ealciimi sulphate. As Crampton says: 
*'The sulphuric acid of tfie llntc salts replaces the tartaric acid 
which is combined with potash^ and forms an acid siilpbute of 
poEash, while the larturi** acid ?*?pnnit€9 <Hit U£ a tartrate of 
lime-" This give* tJ:c wiuc a brighter color, clears it, and 
mnlccs it keep better, 

Adidteratc<I beer may contain httrnt angnr, liconce, treacle, 
qnaasia, eorian<lerf caraway seed, CayenTio pcp|wr, soda, aali- 
cylic acid, 8alt, carVmic acid (ortificiidly intr<.iduc€d), ^ralna 
other timu Iwirlcy, glycerin, glnco^e, water (udilwi by retailer), 
toljjuwo, and (.'otvnhis indicn.*, 

CuliT T.s fn^tpicntly sidnltc rated l>y ihi^ nddition of Wttt«r and 
pHrtcrvaTivt-.H, and h al.w manufactun?il ailificially. 

Many of the flffuUl ttuitt t^tiut^tji nnt merely beers, and ino!*t 
of them liavc little itr no diuatJinir uctifi:) ; they have no special 
f4Hid-valu4r, n<ir do >iuoh cxtracti aid dtgr^stion. Some atg a4:lul- 
tonilid and harmfnh 

lAfjittitm nn- fronnenlly adullerattyl and imit^it^l, and may 
contain iiijuriou« coloriny-iuatter. Maraschino and crfniis dc 



I 



FOOD ADVLTERATIOS. 



meDthe vWrrio^ Duiy be cnlorod mi\\ anilin dyoi, uod tboy 
iMjnK'limi.^'* o«riluin i\\\ A>«tonirsUin^ iirittiiut of rJiIoriti^-uuUUT, 

Tea. — UmW the prc."*oi>t law tcon im|Hjrtc<l itiUi th« Uiiitvcl 
StAtoA aro pmoiimlly fn^c frr>ni EtduUoriitit.iU. Afuny iitfoHor 
t«ft« aiv «(^ifl, hctwpvor^ nnil tKoir *:i!c \>- iif>t r<<iitrtf*t4Hl. T<<n 
nuty be aclult^raUnl br mixiog cxlum^l4xl or foroigii k^ivi'?^ wtUi 
it, umlaJJitit; colnring-mattor xm) u^tnitgtiiU. "Faring'' \a 
dOtiKlJTne^ pmcti^tnl, ami ooiiHif^U oj' tix^itini^ ilir loav<?;< with 
pltinibitgo, iri(ligt>, or Prui*ttmri bin*"* \W olijfdr l^in*; tu mukc 
nil inferior Ui\ reMeiiiMo a 1ietU<r protltkl. TIk- MniuJt uinotiiit 
of tilt; hflikUvmnt^ \}^^\ i$ ijot injuriou.s and the iidiitt4.'mtioii U 

Coffee. — Green one] roiL^trtl <v>flrc*e muy be imitjit<^l. An 
infnrLor gmfl4> of C4>frc« im fr(>f}i]oiit1y (uiimlrHl mut Ki>)d lu ai 
U'ttrr jirtirl<\ nnii rnfi«ti*il <!iiff(s^ mny K* adnltoniti^l hv tli<» 
wiilition of loo raiicb glaring, Oroimd (.i>nV't? i« frequently 
lulultcnLtofir nnd may contain little or no cijtKxv Chicory is tbe 
commoTieHt mliilt^mnt 

Cocoa ifi fn^fiic-ntly adiilU^mt4Kl by adding Atim^i, Hiigar, 
clay, brick-diiM, ('<jioring-mairer, imd flavoring material The 
0(H>m-buttt'r aia_v Ijo extntcted aiu! tjillow or otbtT Ikib uiid uLb 
RiibotitiiK^l, 

Ploui' iyi mlii1t<vnit«l by ndding aChc^r gminpi before grind- 
ing «r by mixing <>lhf»r fl«iir» nf nr» infrriiir gruil^f or from ii 
diSV'reiit gruiii. In tbe United 8t;if*-« the i«il<r of "mixod^' 
flonrt is it<guljiUvl by law. Tlic mix^T rniiifl pay a Mpcciid tax, 
and the pri>dii<>t niimt bcitjrmrtly lal.rellwl. V'wrioii* tniiicral 
sub^tanoe,^ bnvr boon (<>iind in P^uroix-un flours^ but Much 
adidt^rant^ an- seldom iwcd \i) tJie Unit*.^ SUili^j*, 

Bread. — Thin Iul^ Jkh"!! iL<lulu>mt<-dby tho ust of inferior flour, 
and by the aildiiiun i>f 'itbtr sobilaiioi^s, Inntniic(-?i biivo Ikwo 
report*.^ of the use of Bu1pbut<- of t*oj>por imd of anmiODtum, and 
iduio ifi flUo umhI. In fumgn i-onntmii t^oup iiiid gypMtiin ha\*e 
bc'f^n useil, and nt;uiniiiis f^ilnrid lius I>oert udib^l ta bivi"! rriad'* 
frum ail infi*rior fiiiur, fop the puriKie** of making it n-wnible 
tbnt m.td^ from a Iw^tltT quality. 

Batter. — TIiia niay 1>e atluIti'mUHl wttb olvoniai^rin, but* 
terin water ("fttret^^hed butler''), bird, (^otton-seod oil, l^i^f suet, 
and <dive oil. Butter and oleomargunn have abotii the same 
cum]H)RJtion, aud jioKtkviH alxnit cHjual di^llbillty, with tlie 
babiijc« sUigbtly in favor of butler. Oleoiuargario i^ nol 
injurioUA, but t« prevent fraud should le «>rreully labclltHh 

I^ard. — Thi-"* mnv In.' wbiltemJi^d with si*'jiriM, tH>tUiit-w»d 
oil, iind wutvr, Tlte adulLcrant^ ari' u.'iually banule»». 



188 VARIOUS FACTORS ly TBEIR BEARiyO OS DIET, 

Olive oil. — Tliij^ is fn^iuonUy utliilu-mtcd witli cott<iu-»c«d 
oil, tU\ Ftirtigii mh urv not ho (HKiimonly 3ulultcrnt4?il lu 
foriD^rly^ btit ioreign lubcU nm irequtoUy plat?eJ on impuro 
oiU, tLi* lulielliug Ix^ing done In tlii* United ^tate^. 

Confectionery in i^imrlimo^ fiophieticubxl with UirUtrio 
ucid, gliKHiM-, standi, »f>ji]w1(MK-, aud other bub3tauo(>». iDJiiri- 
0118 coli>ring-nuitt4?r» may Ik' u^ed. 

Spices. — Xiiew, |iarticiiiurly tLe ^toudJ spices, are fr^ 
qaently ndultvrat^d. Bluck [tcpiicr Ima bixn exteDsively adut'- 
temUtl Willi a laigv vnri<*ty of feulji^imu't^p 

Honey* — Afler being exljactr<l» honvy is ftometitno adul- 
terated ^^'itJl gliic**^ or oun^tiu^r tynip. Tiiie is not practiced 
to us grrat nix esl«»nt as c^minionly f{iip|y^!^1, und purt t-xtnioted 
booey iiitty be boii]|^ht in the open market Otmb honey cATiDot 
bi' mode without the aid of bees. A tliin Kheel of bet'swax, in 
wliich tficn? are bc-xaj^nal impreftsioii& corrt^sponding to the 
bftMw of tbt* oellSj calle<J comb iVmndation, h used very eiten* 
Aively to bring about great<?r uniforniily id the size of the oells, 
aad also to lessea the labor of tlie bee. In EunJ|)e it in said 
thai f'crafiju aad paraffin are u^ed for tblw purpose- Tliey can- 
not be suoceeefully employed in Amtrica, however, aud bee- 
keepers Blate that the use of tiie^ waxc-t> i^ imf>os?ibl(>. Honey 
may contain |K»L«<m, Plugge found that the honey from 
IVto<i'Hitnitro7i pimticum is poiR^fnoii?<, und Xeuopboo, iq his 
Anaba?iij<, det-cnbe-^ nUack.s rif intoxieatioii due to oatin^ boney. 
Although dcflth seemed near, nnneof bif> w»hlier^ were killed hjr 
it- Strabn and Dioscoridea both Apeak of hijney as prodiiciDg 
madness or ukelftucliolia. In AbysMnia honey from the cneso 
tree is need iv^ an autheluiiutia The honey fnjni gelBeinium is 
aUo poieououa, lu Bruti<:hville» S. (_\, twenlv |H'r?ons were 
made ill and three? dii-d from eating honey derivtsl frf>m this 
ftouroe. In New Zealand honey from the " whaiiriki,*' a cress- 
like plant, causes severe eympt^>ms and fiometime-i death. 

Glycerin. — This ia ndultenit<d with (jbioope and water. 

Infant Poods. — Tlic^e are fre£|uently adulterated^ many 
of them being inerfly cereal uiixtures for which an exorbitant 
price is ohnrjjeth 

Baking -powder, — Stjin-li in larj^ ijuantilies Is oft^n 
adde<l to buking-|Knv<ler. Alum may be adile<l in place of 
ertom of tiirlar ; hut if th<^ powder ih oorrcetlv lnl)clled, and 
the addition Li allowed hy the stat^i law, it ]s not to he t^or- 
^idered an adulterant. Mallet reganis alum balcing-iMiwders ab 
iojurioufl. This is an open qneatton< 



t 



FOOn ADULTERATIOS 



189 



Canned Vegetables and Meat. — Thc»,e frequently &:»d- 
taiD fliit>Atan€€fl deleterioU8 to heatlh. (.'op|M^r and xiuc^ ej»jte<A' 
ally the former, luftv be used to oolor p*^-, Ijead, tm^ Ami r.mc 
uuiy bo pivaeut it* the ivsuli of unhiU'tilioiial coutxituiimtioii. 
Lencl luftv gntri eiitr^Doi' from itit^ ttuklvr, nliich iM fn^guctitly 
UAod in largf^ f^unulitica and ullowtyl to <irt>p iDto tW am. 
I^efld -stoppered buttles arc aIao Aoiuetim^!* uk^, end account 
for the j>re&euoe of lead in the food, MornlHe h^wl ii* nhjvtrtion- 
able, and tht pn-senci^ of lead Aalu is highly tnjiiri^nj!«. There 
are two kinds of tin plate n&ed io the manufaotiiir of cans — the 
"bright/' in which pure tin U nse*!, and the *Merne" in which 
a mixture of lead and tin is used. This latter ia employed 
for ixKiflng purposes, altliough it in sometimes wrongly u&ed 
fnr cans. IVcstTvalivc*, !*iic!i n,-* niilphuroiiK ncM^ t«ilit\rhc add, 
hi*ric ftcid, and othetSf iiro fr<Hjin?ntIy ndd*«l In ruined foodir. 

Preservative*, — Vnrionit *!h<*mtiniU nri' niiiMl with fotidjt 
to preserve them. In many cijiintriw the addition of such 
preservatives is forbidden by hv.\ Homotime,H only one pre- 
t^ervative is used, but i^ftci) mixtnr(« of two or more are added 
in combitatioD. B(.)nix anil boric ftei<l are the mcst frequent 
combination, Tb<'»c Kiil)stJin*'«*, together with sulphurous acid, 
sulphites and sulphaU^, «dicyli<.^ »cid, beniwilo acid, and formal- 
dehyde* are must fii^miL-ndy cmploywl. A large munbtfr of 
other cht'mi<.'ala arc used, chicrty t^i evade iawp ttiat forbid 
tile use of the drugs just montiontd. It may aafely bo 
fltuted that the addition of *ny olw^Tnio prc*i4or\'ative to food 
is nndeiirabti'. There are differences of opinirin re(cardiiig the 
actual effectsiif th.- variou.H preservatives upon the human body. 

Borax an<l boric acfd as preservative* are the subject of 
immen}us conHictini: opinions, It ta poAsible that Bome of the 
favorable opinions have been issued by those who draw their 
salaries and their opinions from the Mime source. While il 
is stated by many that the use of thcso cbcmicQla i^^ not in- 
jnrioufl, thero ore inatancet on reoortl where they have caused 
severe symptoms and even death. Borio acirl and borax 
may, however, find their proper use in preserving meats, 
such nfc Imms, for eiporlinp purposes. Meal sprinkird with 
borax or boric acid docs not become slimy, as it d'jcs without 
it. Ik-fore tlic mf?it is ueoiI, the boric acid i^hocild Ik- wsLshcd 
off! The German Govcrnni*-nt lias i'?tpn«sly forbidden iJie use 
of Miidi jKiwdem "ju mmtn iiu|ii>rU-d inio tJiut country. Tbir* 
nwiriutiou nmy, liovrevvr, have bceu inspired by tlie Agruruui 
pnrty, and uot by coitHidemtion for the [mhlla b«altb. 



190 VARIOUS FACTORS IN THEIR BSARfSG OS DIET, 

Wiley ' <x)ncliide» ft8 the result of his eiperiments tbat Iwrio 
acid and burui tiltuuld itoi be u»e<l tfxtwpt wLere pc^fwrvatiuu u» 
a ucccaaity, and wli^rc it ha.* Uxm ehowii thwt oihcr mctliods cf 
pres^vaUou omi not be einployad. Articles ooDtaining bono 
»oui or bonix ^loiild bo prv^pfriy hriiidecl for the prtnt^otion of 
the youog, tlie fiiok, and tbo debiliuted, I^ir^ doses (4 or 6 
graniA a day) cause lose of appetite and of ability to perform 
work ; nuKlerate doaea (3 grams a day) cuusc symptoms, but the 
eubjccU are able to continue work for some time; mniill dosijft 
(J to 2 grains) may be taken for a limited tim« witbiml result, 
bui unfavomble syraptomb were produced in Bt«n<.' «uwfc, *' It 
appear^i therefore, that boric acid and borax, when continuously 
fulministerod id email doeoe for a lon^* period, or whoa given in 
laf^ doses for n short porir>d, create disturharcefl of Jippotite^ 
of digestion, and of heiildi/' 

Harrington ' bos shown that horic aeid may be the direot cau^ 
of subacute and chrouic uepbritiSH Food preserved with [hew 
dnigr^ is therefore especially iDJurious to individuals aiiflfering 
wilh Bright'^ diseitse. 

Sulphite ami bisulphate of sodium are used for preserving 
all sortf* of fi»Hj, :iiiil ^.''^|nx■ially Ujr prcscrviug the L-olur of meatn. 
Their use id regarded as ilangerous, and lias bwn pn^dbit^l in 
G^rnTany. 

Sulphurous ACid is frefpiently UAed, (*«|KV'ial]y for pnvorving 
winec?. In some eoimtries a e<^rtah> anifmrit of Hid|ibur is hIIow 
able ill wine, but the amount it^ ofiea exceeded. It is also 
widely iised in preserving the color iu dried fruits. 

Salicylic add is widely used a« a pre?cr\7itive. It is exceed* 
ingly |K>wtTl"ul. and i« uswl only wIktc the taste of the article 
IE not impiiiad, UH in Invr, midt cxtnicl*. presrnfd fmit and 
tbe like In some in^tADces the nmriUDt of ^alit^vlic aoici ron- 
tainod in food, to be eaten by one individual in tweuty-fonr 
hours bfi>i hi^n found to equal th(> ni^ucimum medicinal drtse 
prescribed for the same length of time. It is undoitbtedly 
highly ohjectionable, and ilii u^ sbmdd be prcihibiti'd. It in- 
hibits digestion and irritates the kidm-ys ; fooii pii^'&erve*] with 
salicylic acid i-* e^^pccially injurious id hl^^s of Brigbt's diseOBft. 

Formnldehyd is frw|ucnlly used for preserving milk. As 
it Imrdciir* niealti, it is ui^t ueuully euiployed iis u niait prps(.T\a- 
iiw9m In genurnl, it may be stated tbat ibe ut^e of formaldebyd 
u a prc*rTvut]ve is undcEirable and daii^-roii?^. Attempts have 

* RrwuJtn ot lioria KrjtrrimfntJi. Qrviil'i'" No. 15^ UureaU of Cbemiairyj 
tJniinl Sliilp* iVpnrlmfnt r\t A»?rK'nhiirK 

1 American Jtjiimat ^ Mt^i^ ScLtyt/xt, September, 1901 




FOOD ADULTERATION. 



191 



ny'cntly bcon miulo to nhow ilmt in milk very f*ma1l amoaRtH^ 
1 : lOi^OOOiind K**t, woiilij Inbihil the growth of boclerb^ and 
at till? Kumt? tiniv riot Itv. jjn-jiKiu'ial in limltU, ever to Uml of 
iDfonttf. According U^ Vaughn^ formuldoliyd ia thi* proportion 
of I : 2r>,00n, or 1 : r>0,OOO, n?tard- the jrrowtli of tbo laiHic 
ucttl ItnriUiiiB, niu] t)ui>: ildnvK th<* Mmring uf niilk, wlitli* it Iiah 
hut littlo eltcut ou the mtilUplicetion of thi' colon und typhoid 
bacilli. It ri'movtv the dnn^^ signal wiiliout r^mtiving the 
danger, Sticl) \iw of fornialdehyd should be prohibited, as it 
m^t lead to the use of milk whiob^ while eweet, might &till be 
laden with discftge-produciDg bacteria, 

flydrogfen pero^ild iti used to a sliglit t*xk'tU, and is prolinbly 
tlu' h^-'t iiijurioii-* uf all prewtfrvalivoj", 

Metallic Poisons and Food. — Snmll amtmnU of mc-taln or 
thoir Kilts iiiiiv imd tlicir wjiy uiro f*rmL Th<' rui^'Udli« »*alu 
are highly injuruius, and may pniduc'e rithor iwniv or (hrouic 
l>0]wning. Many cascH of leati-iwifiuiiiii^j are tni4:<nble to con- 
taminated food. 

Lead lia.4 1>een coDniderccl in <!onnection with auinc<l goodft. 

Copper may be abided iiUentiotially ha a coloring-matter or it 
may gain entrance from llie use of e^ipj^^r or bniiis kettles. 

Nickel is eumctiiaes ukh) 1o oolor green pca^, ami may be 
found LD food cooked in nickel vcfisela. In the latter event the 
amount found i& &o Bmall that it may pmotiixilly bo disregarded. 

Zinc 11^ sometimes fonrd in food, ea|feeia)1y in dried apples. 
It owes itfl prpsence to the ^dvamzed ire^n racks upon wliieh 
apple? arc fre<]Ueiitly dried, Tlie amount present ie, however, 
so *^mall as to be unimportant. Zinc may also enter foo<l from 
eert^tiu kind* of solder^ but these arc uow rarely used- 

Ar^nic may Iw intrfidnceti into footi in various ways, Tlie 
arttcli?^ miiM linbh- t<i ci>ntJLiii itan! Ixjcr, malt extrat^rts, r^'rupcff 
aud ftHidn ci>Dtaiuiii^ gliiLi^M: nr vuicgjir. lu the widi^^^prvad 
occiirrenee of ar^ctiie-poiiioning^ in MaiiclH^stcr, nver 0,0()0 
persons were affe^eted, and n\ov \00 ditnl. The |Kji&oning wa* 
caused by drinking hixrr whtr'h conlainnl araetiie flmvefl from 
impure sulphuric aicifl u*ed in tbftnniiufactarcMjf browing i<ug:ar 
or gluci^'4i\ In other Kri.-nhtit':^ tliear^'nic Ikij* Iwru finind to be 
oontained in the malt which had been drietl in kiluH h«^ted by 
burning arsenical gnK-ooke. 

The following table, an presented by Prof. SharpJess,* givefi 
the food ai'tielra likrly tu be lulubi'mted : 

* t>orn BuUuUd 1^0. 2^ l;iTmou of Chumi^Lr;, Uniud fiiam PeptruoCTt 
of A^cullurcL 



^K^VdiylRWUS FACI'ORS in THBfR BEARUSQ Oy DIET. 


1 


^^H Arti^im. 


JDtfMtft^'rttf 


#V.w(iJfllf 


Annd^wtOl 


■ 


v^uUemtUi. 


oifuCtminti, 


adviltrimU, 




^^^M Arrow 'root. 




OHior rtnrrho* wblch 
wholt rrr tii ^rt for 

I Ml VTllllillV ■ftklL-. 




^ 


H ^?- 


Sxxlj*hMc o( ftttjm. 


WjiLrr, burnt >u^At. 
FloLim ttUitr tJifto 
vrirQi.. InrcrluTflmir. 


AibcB fraai ari>n, 

grl^ frT>ni mill- 




^^^H 9ntl*r. 


COlPpQI. 


cp*i of inlU. il*rph- 


Cunl, 




^^^^H Cunnnil Tr^tb' 


j^liji or copper. 


K(cc**i>r water, 


}Sc*l il4iji«4irc0! Lu 




^^^H blnuid aisM. 


tcjbl. 




Iho proceM of 




^^H CbMM- 


^lltofnitTcurylii 


OlcomariEidD. 






iSfl rlnil, 










l-ulirioniw colon, 


Grmpe-flOffar. 


nonr 




■ rE Jn? Ift 1 «* 










■racttt 








^^1 QVBH- 






















ti^u-tittt*. alTnoml nr 










olhtr nul^hulU. 










I.iiriir 411^ r. lov- 










crule cotn»i. 






^^^V <V«aji «nft «ta i^iy 


0x1 11 of frofi tnd 


Animal tHr. vUnb. 
Aour, uid suK«r. 






^^^1 


otb pr tulorlng> 






^^H CiyBiina pepper. 




GrtiHnrl t!op flouFi 
Mil. ih1p-br»d. In- 
UjAti mciil. 


Olid of Iron* 




H v^. 


Alum. 


Turniv rlc. Cnrrnno 

popwr. muBtnfd. 
ilin-flor rmrn-tk'ft 'It 

Wiupf, mgir. 


GHl ^Dd uiu]^ 












^^H 


Atntn MlU ipLfLL 








of turpealltw. 








^^^B Honey. 




liliicoto. c«ac-iuff»r> 


pollen oFvnrtoui 
pUqU And la- 
HClfl. 




V ssf^ 


(^iiMLLcliniriHlump 


GclatlD. 




V HuiLard 


CJironuito of load. 


Vcllovr Inku, flaur. 






Ulk. 


W*li»c, 


hunu buieiir, uniiaito. 


|?a^'1rdlrt 




■flAL 


Innniffl wttb pAn- 
AnlLlii n^ltint, Mtu- 




Taiutvtl. 






Turtitp 

Ci<jlHtii*. u|ipl«'Jv)1]r> 








tclit\ «tn[iuw. 








Oftnne*!- 






Old and wormj. 




Plekle*. 


8>1U of GOpp«r, 
ttlum- 








PrODTTOi. 


Anlllii cotton. 


AppIcA, pumpklnfl.Dio- 






^^_ Poppo'- 




Klmit. ihli'-lirrAd. Iln- 

need Ini^iil- 


tend. 




^^H Sapi. 




ri]liili>aUrc^, 






^^^ Eua. 




Water, 


Sural 'iigar 




^^H ffttgU- 


BaEu i>f tin «ad 


Rka-aour^ 


tendAnrldJrt, Iri' 
awit» dMirt And 
aliT«. 




W dorm. 




Flnwr, itKirhMr 








AtrtW-TvMJl. 






■ dnnuntin. 




Bfa-Lp-brcua 






■ piiD«nto- 




. 




■ TCL 




IM, plmntiiui], Kum. 
ta<IIicu. I'rvuBiiiii 

I*1u<.1h Clilnn clay. 


Fofruff InOtif 
oiutb- 




^^^ Vineg»r> 


8uLphiirli\ hTilnv 
ntlip(rii">iiH kH^ 








^f 








H^ 








^^- WiOb. 


An N lit ro Irkrii, 
cnxlp brand ;r. 


Wttpr, 






^^^B > It in« OTid«nilf la orcnigtc (o hare omJttod colUnwoi oil uul wKier. 


J 



DIET AS A SIBAt^S OF DIAGSOSrs. 



193 



^ 




DIET AS A MEANS OF DIAGNOSIS- 

Ti'j'UiiieiUM im^ giv'on todrU^niiine llio funetiotinl iJi^turhaDces 
of Hk' ^timtiHif mid to arKi^rtnia wli*^tt«T f^r iw>t pathtilopc trori- 
dirioiiK c.vUt- Ttu-rt' are many forms of te&t-mcalw siiul Ihcy 
fttrvp varifnis ]Ulr|*»l^ef^, 

Test-meals Employed to Stimulate ttie Gastric 
Secretion for the Ptirposc of Determining the Se* 
cretory Function of the Stomach.^l. Th« Test-break- 
fast of EwalJ And lUtan, — Thix i'rin>in(-ii of u ni!l or a ^lin** 
of wheat brt-jut (36 to 70 pm>) and 400 e.c. of wTiU?r or tea 
without sugar or milk, taken in the Ttioniin^ on a failing stomach. 
The e^Dt€Titfi of the stomach ure removeia one hour uflcrwiird. 

2. Tlie test-dinner of Hie^l o"ri&i^ti< of 40(1 €,c. of soup, 
200 gm. of bcffytcuk, 70 ^ny, of Itrmd, and a ^U^ of water 
(300 uc*), token at noon. Thi^ fit4>t[ULcb is trni|itinl uf iIa uhi- 
l^nls ill fioro four to n\x hoiirr^ 

h'}. T«st-Eticttl of OermAjn Sfe. — Tbia ooiwixbt of GO to 
HO p^m. of fit^raptnl Ixn^f nod 100 ti> loOgni- (if whi^jLt bn.>aii. 
The contents are reinovcfl after two hour»< 

4. Test-meal of Klemperer. — Klrrn[XTcr ^vc^ J ltt<Tr of 
milk and 70 ^m. uf wheat bmul aixi vm\it\e» tlie stomach two 
hours afterwanl 

5. The Double Test-meol of Salter. — T\m Kson^tU ot' 
40 em, of beef scrapwl ami btiilcd ; 200 o.r, of milk ; 50 gm. 
of ooilctl rice, and 1 &ofV-boilcd epg. This is followed in 
four hour^ by an Ewuld toM-nnml, and the contents of the 
«tomaeh nre withtlmwn one hour aft*r, 

ti. The Oatmeal Test- break fast of Boas. — Thin breflkfafit 
is contpi^^d of a |)ldtefut of oatmeal broth (>re|ured by boiling 
down to J liter 1 liter of wftter to which a teaK|xx)nful of 
oatmed and a piuch of sail hav*' pR'viou^ly been added. This 
tcBi hn£ for it«4 object tlic dt*lcniii nation of tactic acid, inaffmucb 
SiA laclte scid is present tn all ordinary bnmdt; utilized for test- 

On account of ita Eimplicity^ the KwaM-lJow* test-break fa^t 
ig moKt iiiKiful, althmigh r>c<^L>^innally a Uto^'i?! dimmer is found 
prpfpmblp ; the only objr<'tinn tn thp latter licg in the- fact that 
ui withdrawing tijo stoniucb-coii tents bit« of meat tliat may not 
have Ixtn thoroURlily dipwtcil are apt to olj^truct the paesa^ 
of the c(»nt<.*ntK through the tuW, In examiainii; for lactic acid 
Uw B'>as imtmcal t<wt i>* pR'fcrrtiL {For a cU:*f'ription of tfao 
varioutt meihodK uf examining tiic ctmteni^ of x\w MtOTnacJi for 



194 VARrOVS FACTORS ly THEIR BKARmO OJV DIET. 

aciJ, rcrmcntoj dc, tbo reader b rvfi^rrvd Uj Ibe texl-books oo 
dij^euf^vi nf tlic stomach ilm<1 oii c'Iii»i<.til (3i;iL:ii"rti*.^ 

IMetetic Tests for Betermining the Motor Power 
of the Stomach. — L Hethod oJ Leube. — This t^st condsts 
in IiJiviug ibc patient \aki^ -100 u,*-, of soup, !iOO gm, of bcef- 
statk, 50 gin. of brmd, imd 200 c.a of vrattT. The ^oinnch i« 
wu&hwl injl at th^ cDtl of six liour^ ; if it i& found l^} \w empty 
al thU lime, th^re ojni be no motor itnpairmeMt of the 
»toni)u-h. 

2, Method of Boas. — If the etomuch be wneht-d out ut the 
<jnd of lwt» lniui>: iiflcr an orillniiry Ewuld-Bourt lest^hn^ak- 
fixAtj under iKirmiil eonditionti the slumtteli should Iw f^und 
empty • 

3. Test-supper of Boas. — Thi^ enpiHT con^ii^tfl of ^d mcut 
with bread uiid hotn r uivl :i large cnp of t«i. If, on washing 
out tfi*' stumaoh the following morning, fixx! U titill touiid lo be 
prej^'iit, a dilalution al' the -itimiai-h exists. 

I>letetlc Test for Determining at the Same Time 
Disturbances of botii the Motor and the Secretory 
Functions of the Stomach. — Method of Sahli. — lu tils 
U'^t .litih^UiTit't?!^ Tiol ubsoHtod bv iIh.' btoimub uru addii.! {n u ttibt- 
mml. \iU*v willuiniwaJ of tlio stomach -^^inirnt'^ if. is |MXv^ible 
to dctemiiue how nuicb of the tesl-niml bus pu^sc-d into tJio 
iDtcstiue, h<*w inudi renmiiis in the »<tonmdi. and how mndi 
of the witbdm\^ni mewl t'ODtists of ga^trie seurctiou. Tlic 8ahli 
te^t^meul ennsif^ts of the following: 25 gm. of ordinary flour 
and 15 gm, '>f butter nre pjjiccd in a ^uitJible ve^^wl over a 
flame and sillowwl U) rou*t until brown. To tbtB arc slowly 
added 350 c.c. of water, aud the wbtfle stirred L'onbtimtly j a 
pineh of salt, j>uflioicnt for M^n&oninp, is added, jmr) the inixturo 
is allowed lo boil for one or two mtntitcs. After the stoniaob 
has bwn thoroughly Wft^herl nut the patient i^i given liOCI <^o. 
of this aoup, and the remaitiing 50 c,c, are rfljiiiuHl oa a control. 
Aft^r one hour the Btoam^^h contents are witlnlmwn and the 
qnantitA' is noted. Three hundred cubic centimeter- of water 
are now introduced through the tube, and the atoniach i^ gently 
ma^sjtgal ; within a few minutes Uiis diluted mc^al is witb- 
dniwn jnid it*i f|nantit_v noU'<l/ 

Dietetic Test in the Diagnosis of Atypical Cases 
of Ulcer of the Stomach, — ^In oosoe of aly^ioiil forios of 
idcer of the e(oraa<^h f-eMlip advise.s hia dietetic trentment (see 

' FiJT the melbod of rxjvmtmng the cont«Dta »cc BaliU, Pertin. lUiiK 
WocJunnfMr., 1902, 2%<A 10 iiid IT; ttnd Arofwuu. M<dimi Rccffd, Ihc^ 6. I003L 



n 



DIET FOR SrSOERS ASD SPSAS^EBS. 195 

p, 3SS) as An nid to dtuf^oti^. If n bcm-liciik] r«;«iiU follows 
the trmtmi*Dl, the prcvtiKv of mi ii1<xt is indlcat^Kl. 

Dietetic U^»X» ore odttx of vviiiK as a nK-aiirc of diafirnofliA and 
|iro^caU ID diabetes. Tlie^^^ test^ ore <lc9cnbcd in the soctioa 
en KaWtc^^ (p. 471). 

Schmidt Atid St rassbur^r Test- Diet.— Sfm 1188 1.1 1;^ the fol- 
low-ing modi6mtion of this diet, ss follo\i-H : Milk, 1) litres ; 
Horaped m<ot, SO grains ; m&shixl potatoe*^, 20O tn^niG : eg^. 2 
grams ; butter, 40 ^me ; i:>fltmml gniel. made with 40 gratiu 
natineal ; bouillon, ^ litre jnnd tW.wK4i,'tck of 18 ^^m^ each* 
The b^^nning of tbb diet is murkefl by giving carmin<% In 
bealtit this diet will go through tlic intcvtinc in 15 to 25 hours. 
Ill dmrrhea* whore tht> |inucipid trouMtr is m tbcCQtr>n^ in 10 to 
15 houra; and where ihcr^* in incrpdWMl poristidBiQ of the entire 
bowel, in S to 5 hours. To toel iJip di^sti^n of t^ertnin arli<4e« 
of diettwioe thenriiial amount fthonld hegivi^^amldiarcortl nuiy 
be used to mark the food so given. The amount of muoui;, the 
appearance, the reaeiioii. the amount of f**rnientation, mny all be 
Dot«d. ThiR method of Httidyjni^ tttooU ib ififfljdc} <^^ily carriud 
cuts und of great pracrtical value. 

DIET FOR SINGERS APrt> SPEAKERS, 

The diet exortft considi-ruhlt? iiiilti<:nce on tho voice- A full 
mcfil iiiuy iiii|ffur tlio respiration to Eiich an cxt^-nt a» to inter- 
(V'rt' H-itli i*'"^!"*^ *"■ '-'VCT to makr it enliruly iin|KW!<iblc. Tho 
ctin^stioii of tla- vocal eorcL^ which may follow Ihu liiking of 
fuud ur drink or nuiokiiig otV-ii hjin lui iiijiinituj^ c(Tw.t qu the 
voice. Irritating artickvi ni' (in.td mid drink nmy uIko im|m]r 
the voice, und fEh<iuld ulwuyH be avoid^l by ;iinj;riv niid ^p'.^ik* 
«m. SingT'r« n(ir*u jitiku^tw eurimiK idiiiKynf-rneio, certain nrtjolett 
of ffjod !tn|isdring thr voiw of wmic while improving tliat of 
otlien*, Wp (V KuMJ<i41, in RrjursakUii-wt Actors, givee an inUr- 
«dUng lijit of Hrlii-k's Uikon by pnjminent actor* btforc going 
on tJie stagt-. Ilr litntc^ that P^lmniK) Kran, EinLTv. and 
Keeve drank cokl vviitor ileuJ briiiidy ; John Ken^blc lix>k 
cpium; Lewia, mulK-d wine and oy«t^j>^; Macn^idy wa^* accii»* 
to(ut-d Ui eat ih*i h'un iif a iiuaum elioji jin-vkitm L4> giitng on 
the plago, but Mnbm.(|uc'ntly lived aliii«rtt oxtdttsivtly on a vcgnr- 
lublu diL-t ; Oxbiiry dmuk teu ; Honry Hu!^l41 ale a boJW 
«^; W. Smith drank mfilv; HmluiTn drunk lH>ttW [n^rter; 
MiN? Cntlty tuok Untikt^l U^ and Mad<;ira; G. F, Cook wonid 
drink anything; Hcnd^TRoii u-W ginn arable and T^hcrry ; 
ludodoD drank Madeira i Mrw. .loidan aUt calvtV-foot jelly 



196 VARfOVS FACTOHfi tS THi^lH BHAHim OS MET. 



and ribern' ; C. Kcnn took beef-tea; Mr«, Wood aing od 
draught p<>rter ; Harlej' Uwjk tiothin^i: duriiij; n iNrfiirmance. 
Malibnm, it i^ ?m^, ate u luiicEi in hin dn^-Hing'nrom Ij/ilf aa 
hour bcforo smpn^. Thi» (unlisted of u cutli^t nnci hidf a 
lv>ttK* of whili' vvjno, aft^r whioh \w smokM a dgnrctb* until it 

Ah a rule, iiothhr^ MioEih) he eatt?n befoiv ?»it*"g "^ ^paikiitg, 
The |>r]]ioi|>al meal should b*- taken two or three h<nir>i Wlbro, 
and it Ethould be M>mowh&t lighter than UHaal. Many siagcni 
eat but little on the day of their |iprforniance, hut [mrtako of a 
good njeal ai^rward. A AkkI niiieh a^ by sin^^e.rs h the K}- 
culled "Jcmiy LioJ wjujj." This i*« vtry hhuad ami thn-Ji luit 
alier ihv vi>ioo. It in nmde of lH>uilh>ii uii<l ma^-T to wlii(?li on: 
added, bolbre serving, the yolki* of tivo <^^ beuteo up in n 
half-pint of cpttim. A liair-ti^L-s|Mniiiful of sugar is adHrtlj t(iu? 
it is tlitvored with spi^vs. Oiher* nk^^ mw ej^, tizg uiid 
flherrv, ">r alhurain-wat*?r, while Mill olhers |>ivrer j'^IUo* of the 
grhitiii variety, or eveu honey, Onuge-juice hoa its iidvorat*^ 
ami the chewing of dried pliinig has been recfunmerKliJ. Mandl 
^u^f^c?^!?^ timt ]>efore the performance the singer .nhould lake a 
few hilu* of Ijrcjid or choo<>Iate ixii*! linr*'.- thi- iiiontli \vilh m\A 
water. If tlie song is Icnpthvj cold water or j«ugar water miiy 
bc^ takvn darhig the |>crformnnoe. 

In tin- interval l>etween (*nreerta th? Btngpr '^houM live on a 
eeneral mixed diet, avoiding irritating food^ Moat dingers 
nnvc a tendency to become stout. The general ruled lor dieting 
the ob«>e may be enforced to prevent or to rt^inL^dy thi», 

Aleohol, in the ff>rm of the strongiT bevenig<.*>^, is harmful to 
the voice and nhouM always Iw avoidt*"!. Light vhinea and 
beer, except when taken to excces, nrp a«t generally injurinuu. 
They are bftii avoided, however, as their n^e may lead !,<> the 
fornmtii^n of the timior habit. 

Smoking' is inJLinou^i to the voice, A^^ii^llng to Mnok^nzl^, 
howi'Vc^r, many fanioii?t Aingeni u^ied tobacco freely without ap* 
jwreiit liarniful efifeetH. 



^ 



DIET DURING ATHLETIC TRAINING. 

The course of dic^t und exercise whieh athletes^ both auialecir 
and profcsftional, nrdcrgi.* lo fit them phy?»jcally for gamee, cor>- 
tost^r or feats of ondumnpo, Ifl known n^ athletic training. Tho 
neoo^iity i\yr snch rmiTung U MW rpt^ogniwrl by all athlet***, 
and while opinions differ a^ to methods, there i^ perfect accK>rd 
in the ideal that i^ sought. 



n 



PrUT DVniSQ ATHLETIC TRAJy/SG, 



197 



Profcasiotiik] athletes who are constantly performing feat** of 
Btrcni^h, ^ki^, or fiKluraiice, are, for Xhf mcKt jwrt, xnore or 
luHf <rfiurttiu]llv ia tntiiiiiig, ami it^x^ui^^ tin.* iLii[K>rtani:e of 
keeping in |>ci'fcot trinu While ooeodionnl iixcJulgcruo^ miiy 
Dot be 1iiiri»riil, ^r^nfiTiOLHt (JistdiputioTi i^ »lwuyA (liB^iittrfiuK in 
i(* <*OTiwKjii<'iiiv.H. Thw if* teij^viftlly tnio wWrt* finrr hIciII nrwl 
jiul^niieiil nre rcqiiir^Hl ami flleady nerv<« are a n<*tx*?4*ity. 

Tho iillimatt object of nil training \a Io rediire ibc itoAy* 
wtfipht until it will remain eoofitant under the n^ular rmiliiie 

liift (luring the tntirin^ penoci. There L^ a<<nal)y a los.^ of 
reiglit for tlie lirst Uw weeks^ varying wiih the previous eon- 
ditfoa of the imlivklual. lu aUiut tbrue %veek>i the weight 
beeomes couaUiit. Th* losw of vtn^gbt is actompHflhwI at lh<? 
<>X]M-UKG uf thi.' ful aiifl watvr in the tiwue^ In wel 1-1 mined 
n\t'n ilic TuiirtcU-^ an* \\nrd nttd flmi, ihr' itit U reduced to a mini- 
mum, the skill ift elcar, the eyes are Imght, the expre**sion U 
indioative of perfeet healtb, die body ia active, RVelt^ and full 
of vene, and tbe ^* w ind " is (;rood> In the undertraineil indi- 
viduid the ti^iiefl are not hardened and the '^wtnd*' is tint so 
good. In the tiverlnunwi thtri* ip* n curioij» condition, dne to 
oven'xcrtinn urn luidly <.htw.*u di<'tarv"» or huUt, and the indi- 
vidual low?** weight and energy, and is in every way unfitted 
for ihc content for M-hich he wa** ]>regwiring. 

Tl*e lenpih of lime rprfniire^l tf^ tmin an individual varies 
greatly, but a nollege youth of tlie average athletic type tan 
usually be put in gowl shape in six weeks. The transition 
from onlinary life to tbut of tniiinng t^hoiild be ^niduah This 
!£ tnie Ixiih of diet aud of exercise- 

The did-table& of various trainers differ con^idenibly, A« a 
gentml r«l<r it may be siid tliat the diet sljoitld eout^is^t of 
wholepfjnie f()od, wick iw j^iod Iwio U^ef or mutton, W^t given 
iiiidcrdnnc, twflt nr Atnic l>rcad, aod potatoes and green vcge* 
tablt-j^ of !ill kindfi. Among the prj**<'ril»ed nrtielca arc ull 
entW«?«< puddings, jHi*itrie»*, sautes, piekles spieps, "ap|)etiKeTS," 
and all fancy and complex dtslit«. TwitXM.'tjtiked meait should 
be avoid<*d. All ^pirib* an<l atn>ug alcoholic drinks, m^ well us 
tia, coflee, and nerve ^tiTt]ula^lts of any kind, sboidd U* pro- 
hibiteth Soinc traiiK'rs aU4>w a modertUe amotint of light wioo 
or beer, while others foiiiid their use nilirely. On thcwholci it 
would ftcem bcf^ttoomittbeiD. Tobacco in all formal ia forbidden. 

Water Is iiFiially allowed in ronHderable C|UAutrtv — geoeraUy 
oa muoh u9 J6 dr*iin.Hl early in the training. If tbei"e i* a 
tendency to rihe>iiry, th*» amr>unt ia somewhat limited. The 
quantity is reduced gradually, only sufficient being allowed to 



f^ 



198 VARIOUS FACTORS W THEIR BRARiyO OS DIKT. 



allay tbirst; it should bo sipped slowly. Tbc imporUiice of 
limitJD^ tlie amount i^f water logtstcd Tir a ft^wdavs Wforc any 
contest is recognized by nil professional nthlotee aoil tmiuera. 

Food \A b^ giiren in tbre^ m^flts, at about equal intcrvulfl 
of time T Br^kfrist betwp<*n K and ^ ; dinner IWwpeu 1 and '1 ; 
and supper bcti^'ooii 7 and 8 or 8 nnd 9. 

Tbe PclaUon of siigur to Irainmp is of esi^e^fiiil iTil»»r&«t., and 
opiQioDs conocTDini; its use differ Men in irainln)^ sovm to 
crav*' sugar^ and ure oft«n allowtn] a r«ii*()njit>le nniount of 
cererils, or tn ym atjd onflee whni rhf UUtcr are Tised, but it ia 
getieiTillv dcttuuHl advl>)!tt>k' to forbid its u?*p in pastries and cokoi. 
Further study i» nctid<"d to tloolde this ijuestioM. In thia oonnto* 
tion it is intor^fiadiD^ U* (wneider tbu report cotjoumiiig tb« addi- 
tion of sugar to ihi^ diH of twn club civwk in Holland daring tho 
tmining for n raor. Atwuf^raiid Bryant^ cil^ the AtUowiugcaiie: 

"Two younjr men with only two hniirn a day for practice, at 
the end of two months entemi for the race. No change? had 
b^en made from their u^u^l diet except that tboy ate as much 
stignr ojs tliey wished, traioetime:^ as niuob an a third of a pound, 
at tbu time of tlicir daily exeivisc. One of tbcuk, however, did 
not mnke tbi*: addition to bi^ diet until tJic thini week, when 
he be^n to show all the sign^ of overtraining — lose of weight 
and a heavy, didl feelings with no desTre for study. On tbe 
tbini diiy atVr l)eginuing the uee of eugar thtse symptoina dis- 
appeared. At tbe time of the mee iKiih youthn were viotorioua 
over their aDtfigonistti, who did not believe hi the use of fiugar. 
No bail cUcet^ were ob*iervedp" 

The act^)n)panying interesting table (p. 200) is taken from 
tbo n?|x>rt " menfioiied. 

Tbomppon » g^ves tbe following report of tbo Yale tix-w, on 
the auth*>nty of Dr. Ilartwell, formerly cv captnin of the Uni- 
vernity enew and of the Univeriiity foot-lwilJ team : 

"TIk tnuTking coverci! a period of ten and one-half wects. 
Breakfast, at T.liO a. M,, eonr-iat^ cf fnjiis (oranges, tamarinds, 
fipt, and gnipes) ; cereals with rich milk and sugar, et<^ ; becf- 
ftteak, usually nire ; chops, #tow>i, basb, with once or twice & 
week some snJt meat, as lutcxin or liam* us^nally acoompnnied by 
liver ; stewe^l, browmnl, or baked poUitoea ; eg^ served to dif- 
ferent w»y& ■ iHLlmeal'Wikter nii<l iiulk as l>T'Vet;i^, witlk teu oo 
special occasions for sonii^ purtit^ular indiviilutil, I}xnni*T con- 
sUted cf sotipSf n)eat<, fish^ vegetuble^, with n simple dessert^ 

' t>tfiiiry Shiiiw '^e I'niv^rtilij Rani CV**'*, 

> Bulletin No. Td, Uuilod ^Ukt^ Depurtmotit of Airriculluiv, Experinii^nt 
Station- ' /VucJiAi/ Vitirlic*, y. 720, 



H 




DIET DVRISG ATHLETIC TRAfyiKO. 



199 



SDcli EL-H rice, hreirl, or tapioca pudding, some fniit, and the 
8an»<J iK^v^ragej* ^ al breakfest were alw uet'd. The meats 
iDcUiOixl ruu>L U-d", aiuttuu, i>r dkick«i>, two kiniU bcin^ always 
•oTvod. But little fi:ttLvy was ustxl. Fi^b wn« served twioc a 
W€ok. Tbc vo^-tat>l(^ in<!]ud«d potatoes, mflsb^ or boiled; 
totnatont, fwyii, biwnx, and com. Two vei^table^ beAidefl 
potatoes iv<!re usaally served. Supper (8 to 8.16 r, m.) con- 
sbtcd of cerealei, aei at breakfast ; cbopt;, st«WH, cr cold meat 
from dinner ; mrely beefettak ; potatoes, ittcvrcd or baked ; and 
^gK about three limes a week, usually not on the twmo <hiyii 
that they were ser^-ed for brt^kfiwt. Sometimi"* ale wtw |>er- 
mltletl t^> some individual. AAcr the crcwa* invm In final 
pre[>iimtii>n for iLe race at Xcw l^mdoci ibe diet vtirie<l Mime- 
vrbut. Bn^kf/k&t and diniK^r r(<mai]i4-<3 about th<i wuni?, but a 
light lurirlKHju of eold meat, wt^'wrd fir Imltnl iviL'tt««w, milk 
and toast wiw servi^il at 4.30 in tb^^^aflenit'on, Aflor Ujis Uie 
evening cxtrcii-iC vfw* cngngeti in for aUiut two liount. Forty- 
five niinuto< after lUm wjij* e<>uiplett>d cold oatmeal or oriier 
oen^d with milk and ti^a^t wah t^ervinl. A li^ht f^upper (f^.-10) 
iro« *mtvk1 just before the men retired. This diet was much 
more libtral than thjit wrved teii years before. The men were 
allowctl as much food as they desired." 

Atwiiter find Uryant' ^ve ihc followinf^ aooount of the dkt 
of the lTar\'ard l>oat ore\v at Cambridge, in IROft, in the di- 
ticriptioD of the conditions of their dietarj' t^tudien. The dit^t 
vra* >^lm|kle^ and consisted of roast and bmiletl beef and himb, 
frica*«H^-d ohickeo, roa^t turkey^ and broiled fish. Eg^, mw, 
pom-bwl, or boiknl iii the shell, were uae*l plentiinlly. Lat^ 
amounts of milk and cream were abo coDsume<L t^itnieal, 
hominy, and pbrcildtHl wheat wcrt eateu extensively, and corn 
cnkpiH were iwrved occai»ionally- Bread v.ikA alaioi^t always 
taktm in th<t form of <iry tout* Potatoes were serve<l twice a 
dav, ritbi'r Imkot] or Imilf^d nnd mn^hed with tbe addition of 
a little milk and butter; ooca>iionally they were "creamed." 
Boiled rice, pri^pured with a little cream and sugar, was sensed 
]nritca<I of pottitoctf at vomc tti4-ad«. Beets, parsnip?;, green pea^, 
and tunat'tos were u^^xl to furnij-b » x-aritty of vegetable**, 
Mac^i'onE was occasionally scrvf.*d. For ilc>*serl, apple, tipiocu^ 
ouslanl, or i^her pudding coniaiuing a brgt* i>n>[)ortioii of milk 
and i^ga, wan wcrvcd. The niirinbers of tlie crew were allowed 
bear otitM a day. Milk wu--i c>btained from one of the lai^ 
crcBnimcMHiip|)Iyingthiitvi<:iQity,andwa)tofuMiNuaIlygor>fl qual- 
ity, ivjiituining !>.^ j>er oent. of luitt^T^fuL A very thiek, heavy 

' iiW. cit. 



200 VARIOUS FACTORS /iV TttFJR BKARim 01^ MET, 



■^umTKiry </ fifMittM »f DitUtry Studiiv u/ C^i'ivr^ify Boat Crttea and 

(Nmdcniv in \*^ urtuallj^ raivti per (um fwr iIajO 



MCTARv nTT>m <^r vxivjcBfimr noAT gbewvl 
IlHTvan^ Unberailv crew mtQunbridgefKot 227] 
Hnrrnnl Frefihnuiii crew m QimliridiBfi: (No. 228^ 
Ynit' 1 'nivef^iiTy i-ivw nt NVw Elaven fNo, 'i2&) . 

Uiirvnhl Fri^liiiiALi ctvwnl Onttti Ferrr I No. S31 ) 
YhIs VhStltsUv crew ai Golcs Ferry (No, 232) . 
OtpTAin of lUrvntid Freshman crctr JNa 233) 

Arerngc , 



Strj(MAUtZ>:iittlMT.TSOFOTJIKII mKTAHY ffflTliIEfl. 

ProfewioTwl ttthU^te, Snndow* . , . ^ . , . - 

Plil©-%hlcr. En*;lninl'. 

Av<?rage ol 15 i-olleifL' Hubs* ....,.,.. 
Avtrape of 14 ni«'himicB* fnmilie** . . , . . 

Arritt^ of lU ririiivjV fnniilid' - - 

AfumE^or 2^ mechanics' and farmors' fnmili*^^ 
AT^fnge ot 14 pTof€»ional men's famllleJi - ^ . 

Man with modiMTiiv nni^oiiliir work (Voit) . . - 

Mnf» wjili fKiMlimto muucidnr h[>rk (Pliiyftiirj , - 

Mun with uir-Hc^nilc miiwinlpr work (Atwuier) . . 

Mnn with hunl niiiMuliir work Voitj , < . • . 

Mfti wllh hiiiil imjM-idnr work I I'lnyfAlpJ . . . 

Man with lintd rEiiuculat work Alwnierf - . . 

Mqj] wiU» svveiv mutculnr wuik ^PUyfairJ . . - 

Mwi with Kvere miiKukr work (At^iilcr) . , ^ 






162 
153 

^4^ 

100 

13J5 
171 
l&G 



15S 



J61 
270 
£44 

278 
H»7 

loa 

07 
llX) 
(04 



lift 

14.^ 
]^ 

1S& 

175 



On. 

175 
2311 
170 
170 

171 



177 



232 

4m 

151 

7ft 
14H 
1.50 
130 
141 
125 



5lS 
51 

ioo 

71 






<7m. 

4411 

4U$ 
37-=i 
44^* 

410 

4:U 
487^ 

440 



710 
£02 
S3 
4-5ft 
402 
4tt7 
420 
423 



500 
iao 
MB 



£' 



trt. 

4)30 
4020 

370fi 
4075 
3075 
4070 

4ai5 

40B5 



5740 
7886 
4460 
22"M 

S46S 

$m 

3325 



3055 
&140 
SdOO 
5370 

a6so 

4fi00 
37fi0 
ft700 



cream was aUo nii<^, dihiletl alwiit one-half with milk, Thia 
mixttire, or thin creimi,<*nniiiiriHJ iiUm 1 C )>erc€nt, of l>uit<?r-fat. 
The Iwef used dnriDg the wlinlie-s was t-utirely from t!io loiu. 
The Hfjift^ were pometimes from ibo Jilkr, and at other times tlie 
ordinary loin roaat with the bone vas used. The meat was sliced, 

< Connivltoitt (Stopm) 8tb- Rirt., iRyi.p. ISft 

' UikpublithcO iiuitvrukl. 

» ConnvoUcut (S(om) t^la. Rpt, iei>«, ii. 158. 

• Mfiiefd Tftfi^Aonfl (itt^ftf. \Mrt, vol, i,.p, 45!}. 

' ThiUiI KiAle» lh?|wrtincii1 i-f A|ri-ii-iih"rv Vi-arlw/k, 180&, p. 4J\0, The 
Tcwilt:* .irv ftuniimrioi'd from (Viniiwtlcul {Su-rrsi Sia. KpiA. ]8^J (o Ifi^T.uid 
the hnlktinii tA Iho Tni:^ 8lnLw I>Qpirliiii^i)t of AjrriciitliLrL-. 

• PfoiH ft imiiHiarv In Unlffid Sfnlu» DniKtrlmrni of Aarigoltut^ Qffic« of 
ICxpcrimfnl ^donji, Ifulledn No* 21, pp, 20(i-213. 



DIET ounryo athlmtjc tralvlw. 



303 



frewi fmm i^niciioiUy uU ihe clt^r fai^ancl sent tn thetabkinft 
larp' [iliitUT, fniiii w hit'h the men were 6erv«l iiulividiiaUy. The 
icrf wiirt :<cni"ccl mrcj bui not too uiidertimic ; ttoiat' uf ihi- ulbi-r 
dull UibtvM in tbo ^amc lioii^^ H^rvc^^l mucU niivr ni<Al> Th^ 
U^r-fv-u-stk wftiq frood from bone and from n<*arly flll llie vidibU fat 
bt'lVrt' beiii^ ir^rvftl. 

I^nih chops were wrved with llic Irfiue. lAmb nrM miilton 
ruLfattf, which were iiW taken fnmi the ley, were also clftir tnr-nt, 
trimmdl fw a« to be riracik-ally free from visible fat. The 
turkey iim<^ wuk f^hipped tnim a disiance, and bad been kept in 
<X>1(I «tonigi>< It WHS bakol uilh forco-nie[il,^-e.j "stuffing" 
«jr 'drcj^iup," — altluugh but little of ibis kiUer wa» tcrvwl to 
ibe orcw. ChickcEi wa* nlwayn fricajwced^ and ficrvi.^1 free from 
fltl bonee, with t\iv ex<>epliou of thodo of the leg nnd wiag. 

Rroilr*! fiah, usually bhielish nr Spcmish mackerol, wsis com- 
motily t;ervcd for breukfu«t| as were also eggs« either raw or 
poachvd, No pa«tTy wius allowed, iind the puddings werc^ 
&» pr(.*vioiij(Iy i^tjttedy compotuxl largely of egg^ imd milk. A 
Msnll amount of ootTc-o jelly wu K*rve<l, find at uik- lutvl 
dnrinj^ the study k<^^r«^ul wa.* sdluwL^I. No frc'i*b fniit, with 
liw cxciptiiiii of orungt^ for bn-Jikfiwl, wa** scn-cd. Slcwud 
pnnk(^> rhubarb, or apples were also eaierif pruuc-s tnost nbun* 
dantiy' No bevuragv^ odior than wal«r, milk^ and beer were 
jJlowed. Breakfn^l wa» ^rved at 8, lunch at I^ and dinner at 
6 o'dookr although ano or the other of the nrews was usually 
late at dinuer. Atwjitcr and !li-\':int' give Uie follownQg 
statisticfl of the Harvard crew at Cambridge, 1*^98 ; tlie poei- 
tionr^ shown in the table arc thoi^ occupied by the diRVrcnt men 
St the time of the race : 





Ag^ 


Uftrs, 


HajiL 


UajraA. 


M«T3e. 


P<>fJtFr>n- 




AA«r 
rcwltig 


Befnn 


Aftdf 

rowlng- 


Bafbrs 


Adttr 


llcrnnl Afln 
ri>wliig/mwlii|E 


% 

G ^ . . 

T 

fiiitmrtiiu- 


Hi 

9) 
IS 

3 

- > 


i«a 

IS 

147 


IVko^ 


puufidf, 
itv\ 

141 

174 
]«0 
1471 
ITI 


1TB 


AWMfa. 

til 
iTt 

14S 
171 


Pff¥mU 

mil 
I(a| 


lA^r 
1614 

i7a[ 
lt» 

170 


im 

170 
1A74 

is" 


ArcMffc 


IfiS 




1«31 1 )«» 


i«!4 


l«i4 


loat 


m 


ATvngBlnA , 


^ 


- . 1 , . 1 34 




T 


— 1-1 — 


^ 



Bmt^rH—Oa Mat tn vplcht not [iik«fi after rovlnf. Mhj M. mcijlutu work. 

* Iak. ciL 



202 VARIOlfS FACTOM LV THEIR BEARTNQ OH DIET. 



"The losR f»f weight during the pcTfiod cf exercise Is due 
pritirijmlly \xi >vutt^r uf |H-i>piratiDn and tlie water anil i^ri>i>u 
diusid uxcrtUxl lu the broath.'* 

It i« in tenanting, ui this <v>iitieotiun» to compun> the diAt of 
the English l^oat rrows, hm given hy Ye*'.* MapJuren giv(*H iht- 
following scheiucis of tmiuiug x\a dLrricii out at Dxtonl and 
Cambridge : 

A DATS TRAD>'ISa Foa THE SUMMER RACKS, 



7 A. M.1 Rbo. A short waIIe ar rua- 
8.30 A. M-: Brcfikfajit of underdone} 

meat, onu^t nf birud or dry toaDt, 

t«ia (iw HitlvflA puAfiblt). 
S P' H. : DiiiTicr: fiieAl iil9 itt brenk- 

fa«C), brwul, iv> vcgcuiUes (not 

mCrlctl/ mLlicrvd in), 1 [naX of bccr^ 

h or 5.80 P. V- : Rnvin^ exercbe- 
11,30 or r.u.: >^upjMr: i.-«)rl uwat or 

bnidt •oiiietiniea jelly or imtcr^ 

CTVWi 1 piril of beer. 
10 t-.M.: Kvtiro t4 b«d. 



A run oT^OO vnnlrt ju Tuhi tu pwHbti^ 
t.Tndprdonc itkoat, dry tiHut, tva 2 cupa 

(hlcr (inly IJ), wntot^cn™ tooca- 

uuiiii]ly)r 
Meal (a« jlI bmikfaiti, Irviul, bota- 

U>tf^ niiJ i^cL-ii-ir 1 [iml of Wr. 

Dt>9dcrt : crQTi^t4, blflcuiti or ^1^^ 

glni^t'H of wiiiii. 

Cold lucnt, br«idt lc(tu«o or wau> 

crcas ^ pi>^t <^f l>c^r- 



A DAY S TILVIXINO FOR THE WINTER RACE 



*30a. bc: Rmo. Aftbortwulkornto. 
If A, u. : BtnUifiLit» [u in nurumtr. 
1 1*. If- : Luncbcan ; bmd or u mnd- 
wich iikd } pint of boct. 



7 a. 3L: ExerrbeniforsumrEiornctt- 

8<30 A- V- : BnwkiiL^t ntf in i^uinmor. 

A lllfle <!oJd ni^Atn breadn nnd \ pint 

of beer, or bbcuit nnd i^w of 

Hhcrn' inomptiiucs jolk of egg in 

the t*! lerry ) . 
lowing ejtenritip. 
5 to 1} I'- u. : IMuucr, tta In aunimer. 



2 r. K, : Rowing cxpti:!*?, 

f, H. : Dinntr; invut aa in Hiirnmer, 

bnuul, Knmc^ ntlf lu in fiimmcriLs Lo 

vfircljiblM» rici^ pmlding or jelly, 

Aiid \ |jiitt uf b<n.-r, 
10 V. ii.: Kcli™ Irtbo!. 
Water atricily forbiadcc. .\s liltle 

liijaid to be drunk u ponible. 

In ftiimmiiig up the resiiltfi of tlieir observations AtwaU*r and 
Bryant stat« tbatj in a '* general way, the diilV-renee botweftQ 
the food of the athletes aiid that of other people repreAenti A 
difference in itcttud physical need even if neither is an aecnrate 
mtrotaure of that itoe<l." Oiio ofthti (4iitf di(TeivoceH Ilea lu the 
fact that the food of athletes is productive of a lar^r amount 
of oucrgy than that oc^naamed by ordinary wnrking-peoplt; or 
college luen. The daily exoesr^ over the ordinary diet waa 
about 400 calories, or about 10 per eent. The amount of pro- 

» i'cW III JJntlih ami ;)i-tci*r. 1,. 281. 



DiET DURiSQ ATHLETIC TRAINING, 



203 



lein <xinBnDiecl vm 4''> per oeot larger. " In otlurr wor(Lt/tfae 
diStreiiGe in pn>r<.'iii was four and oue-half limes a* gKal lu tho 
difTer^iioL' in fHcl-viiliir, jind tlic excefla in proteia wmild oooount 
for n oonniJcmlilp part of the oxceiw of c:i«rgy iif tlio dwt of 
the atb1<>t4<»i iw ^>mpnr^ with mon in ordinary cx^mpHiion," 

AtwnU^r iiml nryiuif' clo^ the a^outit (tf thrnr oxiH^nmento 
with tlie following iiit«ro«tin^ ob^rvations: 

"In thiFf connection it l^ i»t«rest.io|E to ohterve that mnny 
phy^iologii^t^ urv coniiug to mt^rrUiiit the view tlml the unoitot 
of mct/iix»UHn» in thi? \yoi\y u rvgnlftttfl not ttimpiy by the rau»- 
culur work, but aWj by tlw nervous elforl mjuired in tfic per- 
fomimoe of Uii» vrork. Th« €«po('iully lurgc proportion of 
protein obvrvixl in th« dietmy »tudic» of the iiniv<Trhi(,y boAt 
crcWi^, of foot'ljall t^rnns, of tltc profc^fHioiuil ntlilote, and of 
the pngiliul, :iit fHitiipiiivii with the dietiiry sttidms of t^illi^gn 
men w\\\ oixlinnry exrrrii^c, nm! with ordimiry farnilie** of 
workingmeu luid profo^ioiml men. &courd well with u view not 
uuconimon of lute uiiiun^ phy?iialo^i8t«. Aco^»rdiug to tJiis 
vW". men wlu) ]>L'rf(>nii <x>nt>nuixl itnificidAr liilwr, even if it is 
flvtive enough to mukc tho totiil amount liirge, do not require 
C74[iiKTlEtlly liir^ Lini4>unt4 of pmtcin in their food fiO long &s 
tbe\' uutierfTo no e^^pecial mental htrain or muscular fadgue^ the 
principal reipjiicEnents tx^iuj; an abundant Hupjily of ea-^ily di- 
gested l'<K>(i- material. On wi coDtniry, when a man or animal 
must perform intense mu^enlar \rork for a fihorl period of time^ 
and U, therefore, under TOon^ or l(?iw oervnu^ as well as milMTU- 
lar strain, a considerably kr^r supply of protein ^eems to be 
required than untler normal cnnditionsof filow, lon^-et >ntinned 
work. In other words, if a large amount of work niuit he done 
in a abort time a coDfiiderable exroaa of protein is required id 
the food, Tliis view, which has been especially ad\-ocated by 
ZuLitz.* Aeem8 to lie JUvuruJ by the re^uftA of dietary studies 
above discuBM?d. 

" Reeent ezperinienta made by Diinlop, Paton, Stoekman, 
and Maeeadam^ hnve to dn with the amount of protein required 
when severe muscnlir work U performed. The results are difl- 
CufHcd with especial referenoe to training;, and are believed to 
"show the importance of two points long known to athlotea 
and others doing excessive muscular work. The one i^^ the im- 
portance of pro]ier training?, for by it an abstniction of pn^teid 

' 1,0c. ft^ 

* tTailcd Slaica DcptLmncot of AffticuIlure, Exporimont S^tion lt«oi)rd, 

v©]> »iL, pp. &38-~&6a ■ Ji>^r, /^y«tof.^ I8»7, vol Ji*iL, p. 59. 



204 VAfiious FArroRs is riiEtn bearing on diet. 

matter from tiN^ueii other tlian mui^^le oar I>p avoid<Ml ; tlie other 
is tbe iai[H>rUiitce ol" Uitiv being a hiifficinicv of [imteui In tlie 
diet to compeuctate fuT the hiss whtoh f>orurs. An ulmiidance 
of protein in the diet of un rUhlete Ims other fuiiotions t'5 falfii 
hesidt-^ this. It \-t rtttynltvd iliirmg (mining fnr btliUlrn^ iiji lli'> 
cnergy-Iilji^Tatin^ T(H*chftnian» — the proti^ptasm of mMM-lis ruiJ 
it ia al>4o reqiiinil afur work to repiiir thiit iiies^Imtii-in. The 
ben&fitg of tmining are well known in other wavs, sudi as pre- 
paring the heart for giiddenly ineren.^ed <1iit7 and limiling the 
aiier fatigue etfects, 

" The |M>wer of the body to perform (he maximum of diuh^u- 
lar work within a coikijianttivcl^ short time and vrith a miuinLum 
nmoUEt of fatigue is scoured by meaiid of Iraioiti^. Of ciourt<e, 
skill ID applio^tion of mu^iilitr &trengtli i^ as ei^seiitial aa is the 
amount of ^mwer cjtiTled. The &kill is sought by exercise aod 
practice. The ohji-ct of regulating (he diet in traiiiing i8 not 
only to funiiitb the material to siipi>ly the }x>wer, but also to 
put the maehire iu the bft4. condition lor developing as well aa 
applying tlie |N*wor. In other words, the man is to be sub- 
jected tor a ^b-rt time to intense muHcnlar strain and consider- 
able uervoii.-i tll'orl. Thi^i he in io Ijear with a Lauxioium of 
result and die minimum of fatigue. For tbia he needs pmcticsl 
truiniii^, on tlji* one hand, uod proper di<»t, on thi> other. If 
ih*' vi(*W!i abfivi; pnrvont<-iI iir<* t^ttmvt, the diet for men from 
whom intense mii»cular effort Jk reipiirwl for short periods 
should aupply lii>eral amouuU of energy and especially large 
amounts of protein.'' 



1 



INFANT FEEDING. 

The *4ibject of inlant frCTlin^, dnr ng !w>th hc-jilth muI dinouie, 
ift one of extreme importaiKx-, ami nuc an whi<^t] Hucccna in 
p^mtric' |>ractJc* larp'ly *ir-[K»n<l«, IWi»ro taking np Uic ntDfly 
nf infnDt fmling the »tuilent ^tojlil rend crurcluliy ihoi^^tion 
on Milk. 

Infancy is that iiertixl of life (lutirij; frr.^iu birth to iil>out (wo 
and one-half yeans. GiiUhood i» the [icrir^il from two and one* 
half yearn to ptjiwrty. I'he thw>ry tliat iufuDcy cndi* at two 
and one-half years is on ftrhitrury (>iie. 

There are four m^hcxU of fwdiiig infaitU; 1, Bn^iiil* or 
saatenml fpediug. 2. Wet-nursing, ^, Mixnl fc**ding — i. *,, 
brau«t-fu.H)in^ eupplcmeaEed by bolt lo- fowl iiig- 4. Bi>itlcv or 
artiflciitl ftf'din;^. 

L Breast-feeding:. — ^The milk frum a healthy mother \a 
by far the be*t nourifJiment for an infant dm-inc iJie first year 
of \XA life, and ean not \k fully replnco*! by any other fann of 
fiH^liiJg. InJimt-s fed on tht* breiu^t-nMlk of a h<-allhy woman 
nw J!itrorger and IxHter able to reiiat dlnea^. Wbile it 18 true 
ihfJt babien may l>e reared on artitieial foods and remain b^thy 
and pviw strung, tiie [»eiice»Uig« i>f ruUuat Uittle-finl IcibiiTi Li 
mtj<:h :<n]jillt-r than that of hcaJthy br(iL-<l'fcc] Infants Thin L« 
purUcuhirly tnte of the poorer olagACK, who ntVin lu-k Ixith tho 
timo an<1 tin- int/lli^nee re4[uiro<l to renr « hmltliy infant by 
bottk^fecilin-r. 

ContraindicAtions to Maternal Nursing. — ^Tho followini; 
niW, adaptiil from Holt, will Ik* fbiind a rtltabk- friiiilo iq 
det^^rmining whether or not n mother i^ t^tteil to nun^c her child : 

i. If the mother has tulK<rcn[osi.4 in any form, latent or 
atrtlve, »he should not nurse ht^r nhild. A inlx'nndmifl mother 
not otily eJt|Mjpert ln^r oliild to iiifmiiiin, Imt h;w*t*'U?t ibi- |iro|;re?.d 
of liic dirtiNiae in hrrMclf. If tho mother \nvf pulmonary tuber* 
culoHin, numing iii almost <*ortnin to prove Cntid i<t hor. 

2. Wlien tho mothrr lia?c hrul any M>riouM <v>mpUoationr Mirh 
!LH nophritii-, t>>nvidi<ioa?*, sevfTi' hmiorriiage, *ir *cptif^ infefrtion, 
during' prcjji"mt\v or purmrilioa, J<hc aluuid not be allowed to 
Dupse ncT infant, 

^. 1 f the mother in oharelc or qnieptie, nursing in ctvntmin- 
di<at<d. 

2nb 



206 



n^'FAyr FEEDim. 



4. If the mother is very feeble or has any »anou& chronk 
didea&e, tlie cbild will derive ItftK', if auv, U^nt-fit fmui breiuit- 
jbcding aoil the mother will \yt greall;^ injurt<l, 

5. Kilning should not be attempt^ wh«rc ex]>t>riuDeo ha* 
shown rin twn jirevioiiA ocroaHioii^^ TiniW tjivorahlc; tontlUioDii, 
that the nurther is unable to uourtr^li her chibi, 

6. When no milk is secreted, feetlinij U, of courw, iiinwsalhle- 
Good artificial feeding is (*> be [ireferred to poor breanl-feed- 

ing. If artiticial fee^iing must be renorted lo, it is well to bc^n 
cerly, for tb& infaut's iligcstive organs are then apt to be in 
com jmra lively gi.>od conditioD. 'Xlic question has two side^^ 
howevor, and muat cai^fiiUy be coDAidered, 

Many mothers with an ftbimdance of matenml love uud 
tnanifold good intentions ai^e of^en lacking in ]iktelIigeD<>e and 
can not be taught the proper care of au tntant. 

If the prospective mother is under observatioa during preg- 
nancy, the breasts should be carefully e^iamined, arid ii' th« 
nipples are found to be i^bort or relracled, nieowres diould be 
toJEcn to correct tJiis wnditicn. This may bo done by exercis- 
ing gentle traclioE npoii tlie nipple dnily. In <txtremi:* oases of 
letmctiou a brcjisl-pump may be needt^h During the entire 
nursing period the brco^t^ ehoidd receive careful attention. 
Cleflnlineas id imperative, and alW each mirsing the breast should 
be carefully waened, proierably with n eolufion of l>oric lu.'id, 

During the fir.^t forty-eight hours the child receives practi- 
cally CO uouridiment from the bi-eaat, the cnly fluid seemed 
duriug this time being colostrum. This has a laxative effect 
upon the infant's bowels, emptying them of the dark brownish 
matcriiil, known as mtx-onium, which hn^ rtccumulated in the 
intestinal canal during uterine life. Tlie child should, however^ 
be put to the breu^t at regular intervalrs, ^o U5 to establish a 
free flow of milk ; tbi^ generally bc^ns on the third day, but is 
eonietimee delayed. 

During the first two days of its exiJ^tenoe the child gets about 
BIX ounoes of colostrum a day, which is all that is needed. It 
may, however, be given a tea^poonful or two of warm boiled 
water or of a 5 per couL solution of sugar of miik. In iin- 
UBually robusi but fretful children, or when there is fever, a 
hmall amount of nounshmcnl may be re(]iiire<l ; this slioahl l>e 
given according to the ruK*s for artilicinl feeiling. If the milk 
IS delayed beyond ftirtv-right hourfl, it l»cconnfl nocesstirr to 
feed the child by the bottle until tlie fluw is r^d>li^b*Hl. The 
cluld tthould bt' put to the broonit rt^^ularly^ or tliL^ hi-uu-tt-pump 
mwv Ix* n?«d lis stimulate the M^cretion of the milk, KeimH^ 



BRKAST'n:Ei>ryG. 



807 



cvinip tea, and Uit? like sbauld Iw exciudtii] froiJi Oie clithrs 
diclaiy. (For a careful consideration oftlic qiicJFlion offending 
during «irly iofiinov, ^nd for otlicr (|ucnd<)iij( t.HjnwrtiiTij; itifiint 
niitrilion, ihe reader in refi^wd to iW <'XfvlU'nt work of Cxemy 
aod Keller, De^ Kmdt»-Em(i}irunrt and J-'rwihrwrvj/M-ThernpifJ) 

Before eaterinif tpon a i^nflidcnitioii tif brMut-fiTcdiii^ il^clf 
one or two poioU in omneotion with tlie Mjbjcol inu^t be ex- 
plained. Muny tDoUiers do not nursf* their infants booiuse 
ibey have not been properly inatnietod un to tJi« importjincc of 
doing it; others, beoau»r lie matter h left to the min^', who, 
after two or three trials, dt.i.idin that the imithcr i?* ii);^i|i:d>]<,' of 
DorBing her baby ; in Uie tutUfr cilmc thi; prohnbilitirvi am that 
notJiingiii niNmjf with them'ttluT. OiYeu, t<M>, Uiouttendin^j^pbv- 
«iciai), especially if he in an obstelrie HpH^iidii;}^ ih npt to f^ivt* hia 
atti^ntionwltollylo theiiiolber,Wvintrthiii-liild t^ktheiiurhe'scare. 

The mi'iital attittide of the mutber hi;« a nmrke^l eficcl oa the 
milk »ecrctiikiir nod if ^be hts be«i pro[K!rly lut^trucTecl and 
encouraged Iwforehand, ^ere is usually no diflicalty. If, on 
the other liand, she has grave doubts a» to her cajmbility, and 
jrurtlcnhLrly if she hcdrs Uith jihyMciim uod minH.- diH;o»^t her 
prohnhk incompetency, thr milk [H:crctJon mny be inhibited. 
The mental condition of the mother is oiteo affecte<l as the 
reenit of weighing the child. It is very de^inihle that the 
child be wei^hetl regularly and the weight recorde<l ; but if the 
inoth'?r is at all nervoufl, cr if the child ib Dot doing: well, thft 
weighing should not be done hy the mother or in her preaence. 
A loss in weight, or even the fict that there is no material gaia, 
may $o affect the mental condition of the mother af- to prove 
deleterious to the secretion of milk. With proper encourage- 
nieot aod by stimulating tho brea»t by placing ibe child at it at 
re^lar int^rval^ the flow of milk is promoted. 

The subject of the litness of mothers for nnrsing their infanta 
i*i receivinj^ m<rre aTtention of late years, and in Germany an 
attempt has been ma<le to sliow that tlie daughters of aleoholio 
parents or ancestry are apt to be incapable fjf ntiming their 
in&ntt!. While this has been proved ^tati^^tically, an alcoholic 
ancestry is of so common occurrDDco that almost any existing 
evil might he attribntcil to it and iti« reltitionship proved, 

Brcaat^niirTiiiii; often proves w fnilurc litTiniJ^tr the mothirr doca 
not tinclcr^tjind how to give tbt? breast to the diihl. With tho 
increase m civili^cntion l}iore t^eems to W u diminution in in- 
fttinet, and rBvn*fijl din-orions slionld Im* given in every nxm* 
The chtltl f^hould lie on the Hjrht or Ml arm, acoonling to 
whether the ckild id to mxtne at tlie right or uc tbo left breast* 



308 



TXFASr FEEDiyO. 



If tbc inr>t!icr Li in a niuiii^' ^K>»lare, her body i^lwuld be in- 
<ilin(.*d ttlightly forwarO. With ber free band sbe i^bouM grasp 
the breast near ibe nipple l>ptwe**ii ihe first two tiDgeri. If^ 
owirij;: to tlie free flow of milk, tlie cliild take^ tLe milk too 
npidly, tbiB may be checked by slight prepare of the liogei^. 
The child should nurse until 8ati?iiied. The contents of one 
breast ai^ generally eufticient for one nursing, and the breast* 
ahoQid be iised alt^^^mately, Whco luitUlied^ the iDtaot wiU 
usualir fall asleep fit the breast. Under ordinary condition* 
the niirsiug ahould last for from abont teu to twenty minuter. 
If the milk i* taken too rapidly, vomiting may ensue immedi- 
ately al\er or during feeilitig. If Too nmcli i>i taken, it in re- 
gurgitated EilmoRt inime<)iately. Tf the infant consumer more 
than half au hour in nurBicig, the breast and the milk p^bould 
be examined* Ah the infant grows older it requires and tokes 
more food, and consetjuently will require a longer time Ui nun*c 
tbun it did during the early days of life. 

The int-uk-ation of good nureing-lmhit^ can not be too strongly 
tnairtted njxjri. Many attncks of indigestion, voile, and diarrhea 
may be Irnced t^ improper nursfng. Wiien good babiti^ are 
onoe wtablisbed, iberc is gonenallv vory little trouble, the auo- 
txu of the training depending largely on the manner in which 
it IS done. Regular liours for feeding should be tixnl and 
adhered tty ; and if the eliild is asleep at ibe fefdirig-honr, it may 
be aroiiswlj for it will almont invariably go to sleep after nurs* 
ing. After the last feetiing, which should usually fake place 
at y or 10 o'clock, the child should be quieted and allowed 
to sleep as long us it chooses. 

During the first month or two the iDfaul will, an a rule, 
nwnkcii b^^twocn I or 2 o'clock and a^iu at alK>ut 4 or r> 
oVltrk. Afler two or throe mouths it will require but one 
night feeing, and nf^er five montba of age the average infant 
will sleep all niirht without nurslnir. 

When tlie change U bein^: juade and the child awakens for 
EU accustomed noraiug^ it fihould be given a little warm water 
from a bottle and be (juieteil, but not taken np. Kegular nursing- 
liabits induce regular bowel movements and sleep, and the three 
combined insui\< bcalth and comfort not ofily for the infuut, but 
for the mother as well- A healthy child, if traioed to do so, 
will sleep without rockinj^ or cwldling* Three things are, 
however, esseniiid to secure siiece«i in rfiifl training: a satisfied 
appetite, dry napkins, and a quiet, darkened room. The infant 
iuu«t not be nun«e<l each time it cries. If it has eotic, the 
wumi milk may soothe tbo child tor a time, but later aggra- 



BREAHT'FEEDISa. 



2D9 



vntet the liy>tilili.% wbieh in awny cases is due to overfoeding or 
to tOf> frt^iiont Ibisling. 

Tli«< TollowiDg tubicf fnKu Holt, muy be used aa a guide la 
biXAAt-frMling ; 



Im ddy ...... 

2d " ■ , , 
3d Eul^Stliday . 
4l1i lo 13th wovk 
3d to 3th month . 
6lU lo I2lh " 



I««myf0ur lioun, 
.. . * 4 

10 
S 
7 

e 



Intcrvftk 




tlurlntf 


a^y. 


%i%-l 1 A, U. 


6 hoim. 


1 


4 


1 


2 " 


ft 


21 .- 


1 


3 ■' 


1 


S " 






In case i>f ^^icknefis and wben tbe lufact is feeble and below 
the avera^, espeoial nika are nnjuirtd, aud Jh'ectbaa should 
be tnoditiLn] to £utt 4tt<Th individual oa^s A good gc-ntTul rulo 
in to Tt^ ilic' cliild Lif^vinting lo tbt- ngi* to which th^r WHj^ht 
correspoiidA. Th<- child*^ weit^ht i^ tlte \ye»i tnJex of i» nutri- 
tion. During tlie Arst four LiontUa it nuty be wci)^)KHl twicr a 
week; aftj^r that lime onoe a wt^'k is ^suffim-ot. The iiv<.»nigc 
mimmiim gain for an infunt i:§ four nuno^f a w^rk. If th« 
W4'i{^ht falls below this for several Me«k8 conMOutivclyf it i» evi-* 
dent tliat itomethtng i,^ v^roug. Daring Illnoss, of ooun^, there 
may be no ^;m\ or Iw:^ a(^or>^d]^g to the sevf^rity of tl»<T <7oii(]itiou. 

When the brcfw*t milk h iosufficient for, or unoiiitol to tb« 
necd^ of, the inftnt^ it hcoonie^ fn^tful, colic occiini, and the babo 
appejirs to hi* **cT<vwJ^ Disturhanw« of i\\r> nlimpntary tract, 
diarrhea wttli ^atit^h stools ooDtaining a large am'>UDt of 
Enucus and undigez^ted oiird?^, take place lit times. At tlmcH the 
stoolfi are brd^inisti. and contain mucus and numcrc^u^ curds the 
%\Te of a gruiti of wheal or lai^r. Id other cai^t^ there mar 
be chTODic coDstipatton with small, hani, dry stoolj^ 

If the infiDt i^ t^'ttlng loo Httle milk^ it is fretful and gains 
slowly or not ot nil, but there h rxrtly nny di^tiirbaocc of the 
stotnncli or bowels, fn thftse cases the nurstng is contmuiKt for 
over thirty mimtteA without pattsfymg the ohilil, or it nmy nurse 
a minulr- or two and then refti.^ to nurse because the flup;>Iy lm 
eo «Mnry, When? tU' hresi^t milk if* nearly nonnal in quantity 
and in quality, cerlaiii metLtun-^, whieh will he ()isi'u.-viiecl further 
on, may l>e taken to augment ihe supply utid enrich ihe quality, 
or it may Iw »up]>Ionieuled hy artificial finding. When tlie 
milk \^ very poor in quality, as, for example, when the specific 

ftvity \t> from LO]<j ti; 1,02j aud wlitrii only 2 or 3 per eeuU 

ortflin ia pree«ut, llie child .-ihould l)e weaned at onoe, for the 
condition !■ not 9Tuenabl<> to tn-utmuat 

Mothe^M milk nmy easily Iw U-M^ by means of Holt's milk 
14 




210 



jyPAIfT FEEDING, 



heif wbJcb consiHto of a lactumeUx aiid a croun guuge.^ Wiih 
this tlio specific gravity nud the nniount of cimtn may cosily l>e 
««--Umat«l. KttimuU^i with this inKtnitu«nt tht^ crenm i^ to tLe 
fut a>i h vi (j> ^- Tlie following tJibU will h^-lp tn ^«timAting 
the quuJity of human railk ; 



IICLltbjr TnrlMloiu ^ . 
Ilc4l(]iy vaHaHuju - , 

VAiiftUohii 

VarlaUonB 

V«rfaUuiui 

VullUODB ...... 

VvlfeUgn* 



Spcdflo 



lla)uvr i-VlB 

n«tuw tir:K 

Above I.OKt 
AteiHlJttt 



bOUlB. 



• per cent, 
9-a iior Mat. 

nigb <4lVTVS 10 |4f oont > 

Low (lidow 5 per ctm.l- 
Hlifh- 



ProtAim, 



l.a por p*nl. 
IJorm*] I rich 
foUk). 

lollkK 

below. 

Very loif jytiy 

Very high (Terj 

rich milk). 
HlptL. 



When t!ic mothor'n milk is fourd to not ogrce with the iafacit, 
it may ofUn he mn<HfiiHl by the following means : 

1, If fh*' millc i* t«o rit»h, the diet should lie limited, espe- 
cially as to th(! nmoLiiit of meat taken- All alcoholic and tDalt4*d 
dnDk« tiliould bv prohibited. With plenty of fresh air and exer- 
cise, 3uch m talking, the daired effect will geoerally be brought 
al)oiil. Tlu> ejcercij^o should be carried to the point of fatigue. 

2. Wh(?n the milk h pood but deficient in <pmniity, tlm 
supply may lie migmnitt'il by niiisjiiapc of the brr«sia thi^ 
timc^ a day for from five to ten minutes* A good malt extract 
may bt; given with (he- mcalR, and fresh air and exercifw prc- 
senlwHl. Sufiidr-nt flnid should ho given^ prefri'ahly loilk. 

'5. When the niilk is deficient in tiuantity and poor in quality^ 
im|iroveiiicnt may Ik- brought about by v'airioiis mean;? : Mas- 
B&ge, malt, and iron art' lo Ixr pre^ribei.1 if there h anemia. 
An aleoholie mult extract combined with fvplonale of iron or 
of iron and mangane"^ i,'^ a good oombinnlion^ und may be bad 
in very jialaLtble fiirtu. The diet shouhl hv amplf, and ooutnia 
:«uJBdciit iiitn^uou9 food. Milk ^huukl he Uilccn with tJie 
mcoli^, during tlie iuturvolf between m«ile, and at bedtime. If 
lh*» milk iaterferes with digej*tiou, ns it nften does in th^^ coses, 
thi' foUowing mixture may l>e nstd witii advantage : 

Fill a gbiss tbrt-e-tiUiirU^rft full of milk, aud add u table- 
)*paonrti! of limt-watcr and two lable^poonfuU of cream ; thea 
ml the gljiSA with wat<T. The ]ime-wat<^r may in many caaes 
1 TliiH uiuy b« liftd frooi Eiiuvr & Amvad, N«w Vofk. 



WET-yVRSlNG. 



211 



be nmutM and the glum merely f\}\<%l with |»luin A'ah^raiW the 
addiiion of ibe cream. AnotI*er t^*^'iitml m frxwii air — driviug 
4ir ualkiiiji^ if the motikcr is sttxHip; enough. It its very im* 
|K>rtaril tlmt the niotlier obtoin ^iiflfic^icat rest. Touring l)ic night 
the ohild ahoulil he reared for by iho tiurH«p And Im giv^n tho 
bottl<^ iiiHUind of tl»^ breofit. 

4. Whm the <^uaiitit>* ts sufSoieDt but the <(UaIity is poor, 
little eau be done, and the child mnst geuemliy be weaned. 
The fViregi^mg nioifiires may be tried, hut not for too long a 
jierirtti, a^ the child may siilfer in coiiHL-qucnw, 

A moot point is whether it is wiw to allow the child one 
bottJe a day as n rouiirte practice. The authors always follow 
this plan afYer the second months and w))erc proper precautious 
re^arJin;;oJeanlLn<«8 and Postcuri nation have l>eeik tiiki>Tk, no ill 
reBultA have 1iFs>n seen to fnllow^ The a<ivan1aQ;e-i of thifl 
method are aa foUowa : 

Hie child leama to take mtlk from n bottle, and if, owing to 
the illneag of the motlier, it becomes ncces«ir)' at any time to 
aibfitilute tlu- bottle, this may be done without niueh tlifficulty. 
On the other ha&df if the cbikl has taken nothing hat the 
breast^ it may often refuse the bottle entirely, with (Ji^^aicrous 
fttolts, severe cases of acute inanitiou havtnf^ i>e«u kiK^wn bj 
fiJlow. TbU method facilitates wuuxiii^. Iftbc mother in weak, 
it alk>wa her to obtain an QndiiiturU.-d night's rest- Among tb« 
iipppT c-lflHses the t^hild is oft(*n wtianwl early ftf* that nursing 
may not interfere with ihe roriiher*!* sooial plrrjuHnnv* and duties 
If the breast-feeding be auppleineuted by the lK>ttk% many of 
thcee women may Ix* indiioed to nurw? their childivji during the 
greater part of the first year, when they would olherwi-*e ^ve 
it up venr' <^1^1y and abandon the chikt to the care of a nume. 

2. Wct-anrsing- — With the advent of a more thorough 
knowledge tjf infant ftvdin>; wet-niireiog ha*, fnrtunatelv, biv 
<»me \^ps IWquent. Neverthelcfis, th^^re are some mfinls that 
will thrive on nothing but breast-feeding When thi* is the case^ 
n W4.'t-Qurse uiUHt hv choMrn according to the following rules : 

The W'>muii sliould 1k' hoaUliy and of good habits. The 
sbscnoe of .wphilH, tiiUtrcntosiK. alccTholigm, and other difleaf^e^ 
ahould be determined by carHiil examinati<^n. The nipples 
flhonld be oareAiUy cxflxnJii(!d for 11.<hiir<^ and nleenktion. Tlie 
breaBt ahonld be exaiaitieil before* and aft<T ntir^ing, aiid the 
milk totted as previouflly dcricnlK'd- The wkc of the br«»al 
alone ie tiot u g^j<id guide om 1« tlic annntint or qunlity of the 
milk it fttereU-H, The fpianttty may \n' jn^lgftl hy the size of 
the brmst before ami alttr aiirj^ing or by weighing the baby 



212 



iSFAyr FEEDJyG, 



before ftud uAer nursiug. This latter method^ AUIiouf^h a good 
oiiCj ii* iKil uHimlly resort!^ to, TLe welruursv sliunW iilvmys 
be one who biL9 nursed her own child nuixvii^funy for nt tciwt a 
TQonUi. If pueaihle, elie shtiuld I>e a priiinpani hetwooti twenty 
HiuJ (hirty-five y<?nrs of agf. Younger <>r olfler wonion should 
not, a« u nde, be ernijliiywi. If Uie iofmit's condition permits, 
the iini>c shouM \k given at leiLst a wwk's Trial, fur oftni the 
chanife in her mode of living may cumsk a scyuity flow of milk 
or render it otherwise iinsatisfaclorv'. When i*he has become 
aeeustom«l to her surroundings, the milk miiy bemmt? perfectly 
normah Owing to idlencT?^ and a too abtinilaiit diet the milk 
may become too rich. In these eases the rules previuunly laid 
down may oorreut the condition. Suitable wot-nnrse^ are not 
caBily obtained, are oX]>ensivo, i»nd are often a 8i>uree of eon- 
Htjint trouble nnd annoyanee. A woman who will give itp iJie 
care of her own child for pay \s usually a very unplenAitnt 
person to have about. For theae rca^otifl, except where there la 
severe acute inanition, ot)ier m«ins should be tried before a wet- 
nurse IS res<jrled to. Wet-nur«in^ is. however, very sticcie8&- 
fully carrktl out in Germany :md some ofJier tvHintripjii. 

3. Allxed Feeding. — By this ritlbiMl. as previously de- 
scribed, the child is fed partly on the breast and |>artly on tJie 
bottl(% This metliod id indicated when the mother^s milk id 
poor or sHioU', owing to some interveniop illness, or whun, 
owiTl^F to delieinnt quantity, the mother i-an not entirely aur«e 
the djild : it is alf*o useful iii weaning. AVi-anin^ is aeeom- 
pli^^hed with less discomfort to mother and child if done gradu- 
allv. If the mother is nursiutT tbe child but once or twiw a 
day, her milk may become very pof>r, smd couHequeutly should 
be examined from time to time. In these cases the child is 
usually «»tiftfit>l :iAer a ln^ttle, but not after the breast-feeding, 

4. Artificial or Bottle-feeding. — When it hecomeo neo- 
cesary to feed the child arTifimiilly, tin? pfiysirinn muj^t under- 
stand the natnre of the milk nii^cuirp that hi? prpttcribefl, wn thai 
be may vary it to Huit the child's di^?^tion and modify it to 
meet the rw|uiremcnt4 uf the growing infiint. 

In the L'nitc*! ^UxU^ the only milk uvuilablc for infant feeding 
is wnvft'milk. To injure suei^^ew by artificial Ji-efliTiir, an acciirute 
kno\t kHlgi.r of the com|>ofiition nf tJic- milk, iind in brpw much It 
dilTcre from mother's milk is c^st^ntiul. A knowledge of llif 
nicthod-t fnr overcoming these diflerences is nlsri neccw«iry. It 
ehonld conr^tautly ht? b<irne in mind that white general di^hiC' 
tii>nrt mny bf* miulc »nd nvenig** figure's giveu^ th<» e!(?meiit **f 
personal equatiou ent^*n^ largely into the problem, iind euch 



ARTtriCUL OK SOrriB^FBBmNG. 



SIS 



infflnt miwC be coneuk'nMl u law (into ir^lf. Cblldrca living iu 
tliecimiilrv ditil in lt](< r-nnilitT Uiwii:«, wlK^rr tlirre i>^ no DVBl^- 
CKiwdiii^ mill whvrv UP abuiiUaDoe uf fn^?ih iiir ciin he Lad, 
ieem to tbrtvo on ooW mlllc Uiut luu Uvn inoclilimJ btU liltlo, 

f(»rimps tm'pt^ly l>j' llu- nfldit.icfcn of U"nt<ir in vurifMiH prf>|>orlionii, 
n ibv liii^r tdUiiH, wliorc ovt-rcitiwding ipt frequent and fresJi 
air anil !<uiill)j:bt are not easily H^vuml, tW qiii-Ktion \^ a irLore 
diCticiilt 4ino. l.'hildren with thesio euviroomcnU n-qiiire a mora 
cx»ct milk mixture and additional care. Aiiotlier {>omt 1o b« 
R'iiieml>en:*il U lUat in the country milk Ia j.^ent^rally oMjiimxl 
more or le«* pur** and fresh, wlierea-* in ihe town It i.-^otii-n rem- 
taminiitrd by dirt and bui=U^ria, utid whrn Mnpinti liir long di^ 
tuncot irt *t<di^ and o^n prcacrvixl by the uddition *>f chomlculn. 

The firvt i-huM|^T* mndt' in milk to ndapt it lo ihe infiiutV di» 
gcwtion w^rv to udd wottr, barl<*y-Malt-r, (»r <«itnK^l-\vat4*r, lu 
m^c^U^l by Jjioobi. Lichi^ itii^.'^eHlfHl tliut a nialt«,Hl, dexirin- 
ixed nu*al W mtxt*d with the* milk. Meigs eniplcyed a milk 
mixture that i.^ Attll ur^oil in the feeding of hIcIc infants. Bie* 
dert, in tj<-rmany, t'head^ in Kaglaod, and many oth<^r^ have 
made iiu^^^tiou!^ hut the tnetho<) in mont common u«* to-day, 
tlmt <»f (wreejitnge feeding, la largely ^( American origin, and ia 
iiMiJilly known a^ th« "Anicrit^uji niMhod.*' Although a nunibcr 
of woU-known |>udiutrimims rtill uto tho oUW lucHhiHlH, the 
Amrri(*un miTtlmd i«, iri llu- mitlior*' rkplnlun, xW* lk«f- At t>nt^ 
time it wa« Ixlievty! Unit tlie milk i^hoidd Ik* made tocfiriv- 
g|K>n<l ill the |>eiTentajfe of itA variotiH 4dement^ with that of 
bnitiim milk, and thin \* the hafiit< of the nietlio<) of percentaf?e 
fi^tfiinj;. There are, however, several cliflietiltieit tliat must be 
overeome, and it wa.^ found m-ceflsiry to be^^in with pereentage* 
below Lho^onlinnrily found in moiher's milk, and tacreoi^ them 
a^ thu child's ilig4<aLii>n became adapted lo the cows' milk. 

For our pn.-f«?rit kziowlu]ge of lliin unbjrtt we urt indebted to 
the e3cper[ini-iiL-i of Lh: T. M, Koti.di, of Hilton, udio Hrwt advc^ 
cated the eMahlinhmettt of a milk lalxiraiory tor fdling phyHieinna' 
milk prc^riptiiin», a plan tlnat wan vorked out by him and 1:^ 
ihe Walker-fiordon Com|)auy. 

In order to adapt cowa' milk to tlie infant's digestion several 
dmng«9 must be made in it» These become apimrent i>y study- 
ing the nature and eomiKJ^ition of the milk. 

The piotcina differ not only in uiiiLitiiit, but ulso in charaeter- 
In Imnxfm milk the pn>teias couslst of lootalbumiu and c^iL^in, 
in the |>ri>ptirt)oi) uf two^lhirds of tbe former to one-third of 
tho hktt<<r. En e4»wv' milk ontv-^ixlh of the protein is hietjitbumin 
and the rtrmuinder iv; c^isein. The total protein of human milk 



214 



rS'FAST FBEDISO. 



precipitate m fine flukes ; timt of fov/ cnilk, in heavy cuHa. 
The \o\a\ nmmmt fif protrin m/itrnnl nlwj varie*, Wiug frora Lft 
to 2 per cent. ii> litimati mtJU, imd^ on Uio avenigo, ^,5 |)Gr ocuU 
in coW milk. The? Tnodifiomi^^n cf>n)ii«ts in diluting ttie milk 
until tlip proioiii i)* from 0,6 por twnt. !«» more, ji<?oording to the 
age of the infant uml it« (Ugt'ttlivt (Lljility. in f*<ita« cades of 
tlifficult fc<?(]iTjf^ iht* lucfitUnjinin und ca<<i-iii njay !>e Hqwirated 
ttiul ailiitni in the ai^niriHi amoutiU, This is not, liowevw', 
usually necefli»ary, 'Y\\e ^t^lem^ may be prevented from forming 
largi^otirds by tlieaiidiliuEi uf lime-waterorof iMirley-oroatineil- 
gru^L With tlie snuiIltT pfi'tviiUi^ra Uiih Ih not ordinarily iviniirtd, 
WhcD iic-ce3i^ry,ii3diiriuj^ illiiOHUf the prottuuBiuuv bo prodi^'&t4>d, 

Sn^flr. — TiiQ milk-«iigar of hiinutn milk im present in ft 
very oon.sfanl proportion — fi'oni 6 tj^ 7 |>er t'ent. In i^wg' 
milk it average* about 4.5 per cent. Diluting the milk, of 
oonrse, dacreasefi the proporHon, and the amonni rrnist bi? rnsd^ 
up by adding cither milk-sugar or cane-:^ngar. Tho fiimier, 
being that normally preaeiit in the milk, seera-'^ the most nnit- 
fthle. Cane-sugar has, however, many advocam^, among them 
bein^ Jjicobi- Oine-siijjirar, uwiu^ to its e.\<x'wjvi' swi-etnft^s, m 
u^cd in Jn»t half the i|naiility of niilk-sn^r. Ad it is inex- 
pensive, it is useful in praolioc among rbe poor. 

Daring ihe first fi>w diiys of life stigur may be giv**n in the 
proportion of »i to h.^ iwr cent. ; frcitu the st*riind wci-k Uy tlin 
thirtl nvinlh, (J percent., and fix*m that lime until llu? Wt^venth 
monlh 7 per cK'ut. may bii u^al. At tlie ekventli niontli it 
may be reducod ic 5 and a few montha Inter to 4,h'> ]>er cent. 
There is no advantage in giving over 7 |>er (h nL, and it may 
give riw to ^ymptumf' of eseei^aive sugar feeding, 

Pat. — Tlic fat of liunuot milk aveiagts 4 ptr cent. ; rJiat of 
oowm' milk is the sumcp When the milk h^s Uh^u dilut<^fl, the 
amount must cither be made ap by adding ei'oaiii cr hv using 
tlm niipi^r onf-tliircl or np|wr half of the nnlk ntU'i' the cream 
has riM*n. Il is preferable to use fresh creaai that has risen by 
the srravily metliod, or the toinrailk method. 

Theit* are objections, ba^ed on tlieoretic groundf^, to the use 
of centrifugal cream ; these have been mentioned in tlie section 
on Milk, and are of les^ practical iutereist in Infani feeding than 
was formejly supjxised. 

The amount of' fat to be given varies vrith the age, weight, 
and digeetive ability of the infant. For an iivorage infant, 'il 
per cent, the lir^t week. "!.'> per cent, the ^iecond, and 3 |>er 
cent, the third week are the amounts usunUy prescribed. At 
four months the amount may be increased to 4 per cent. ; at^r 



MILK MODIFWATIOS. 



aifi 



that time tbis amount must not be ^xoeeded, or the in&ni b api 
to develop iiiiligeaLitfti, >vith tb« iarjL^' wLitiAli aIooIb ^jviug uff 
the <;hanictcr]8tic odar of the fatty aoid?. 

SaJtS- — TLe mioenl coDstittierite of humun milk muktt up 
thout 0,2 por (?fiit. of it?^ 4^ntiT¥ bulk; tho4« of L<nwV millc itn? 
tliroc or four limes gr«it«r. Thcrte inor^nic «ilt« van- in about 
the tiiLQie proportion as tbc prctcLifi. Whcii the milk is modi- 
fied for the purpose of iDcr^afiin^ or jiniinisbiti^ the fjerceotage 
tf proteins, it is, ut the mime time, m'xlilicd for the «tlt& 

ReftCtlOtl« — ^The rraction of linnmi) milk u nlwjiy^ alkfl*- 
Utie. Since oows' milk is usually lurid or iiviitrulr Ihi^ uciility 
ntwt be oonwujd by uddiog oithur -"> per cent* of limr-wnt^^r or 
KxJiiim hicorbonato. The sodium wilt it* iiswl in the proportion 
of ] ptTiin to tho ounce- Ah tlie \\ti\(f procIpitnt« nt thff higher 
temppraliim^, when ih^ milk ih to h** l>oilnl it i* Wlhr Ii> n<li) 
the bioirboiiate. For young infunU, ^vhi-tj there \a a hyjx*ni>?id- 
ity of the stomach or acute iUneM, largfT <]tiantitii» than thow; 
just montionod may he Mt\!. Ooit recommeuds the aw of 
potassium bicarl>onBtc'. 

PoyntoHj followinj^ ilic feuggc^tion of A- E. Wright, recom- 
mend^ the use of t^mliuni cilrril^'. The soda forms a compound 
with the casein and alters the <-Lird produced, rendtriag it very 
much EQori^ digt-'fttibk*. Tbo uitriu acid forms calcium citrate by 
uniting with tho oalcium siilu. The use of sodium eitratt* 
enables on<^ to giv*; a milk containing more protein than would 
otherwise he dig<ee.t4H]. It h useful in weaning infanU, in prac- 
tice amon^ the poor, whore niiik modification is imperfectly 
done, and is of service in some cases where milk is not well 
home without the sodium citrate, From ) to ^ or more grains 
to tlic oum?c are used. A convenieat meiLod is to order a 
solution CfjDlaining 2 grains to the druu. A drup or twu of 
dilftroform should be addi^d to each 12 ounc^^, to prevent the 
growth of ori^niam* wliich i* lukble to take place. From a 
mth<»r limited cjcperience with this method we are inclined to 
tliink timt it is one of considerable value and worth trying. It 
aeems to be especially adapted to dispensary work. 



MILK MODIFICATION. 

METHODS OF PRACTICAL VALUE IN MODIFYTNG MILiC 

There nr^ a nnmber of methorla of mtik m ml ifi ration that 
tnay be osed with ^od rei^cdts in the artifieial fci^ling of infunlfi. 



216 



lypAyr feediitq. 



A pnotiod kaowlfHig^^ of ttic^ nirtliodN in n ilcdidt'mtum in the 
rearing of botcltsfi^l iufauU, llioise mocit iu u^> are: 

1. Lftlwratory feeding. 

2. Tojft^miJk merhi.Nl, 

3. Cclt*s dmniul metlioil 

4. M&tenia gmtliiat*]-* 

5. Aooording to Miiyniird LfitM's tabic (after Rotcb), 

6. Baner'?i method. 

7. Acoi.irtltng t« Loui^ Starr's tables. 

8. Ctuipin'e iiietliod. 

1. I,aboratory Feeding. — In cities ihe best substitute 
for breasi-feetiing is fiir»i»lifd by tnilk labonitoritt-, where coodi- 
ficatioD.'^ are m:tJf according to the physimii's prL-scription. 
Tbe Walker-Gordon laborutorie*!^ now eatublislied iu muny 
cities, eupjily an ideally clean niilk, mietenlized, pjt»teun£ed, 
or sterilized ut auy temperature desired. The milk id supplied 
in nursing-bottle* J each bottle holding enotigb for one feeding 
and being rtaJy for us<^. Rpyimd warming tbe holtle and 
putting ou a nipple do further pre|>aratioi] is nere£^ry. In 
winter tiio milk is delivered in baskets, and in summer in Email 
refrijjrnitMre. Whsn economy must bo piuctiseil, the milk niny 
be obtained in larger jars and divided into the requisite number 
of feedings by the mother or nurse, lllank forms on \vbicb U) 
write prescriptions are furnished phyeiciaUB, The following 
is an example oJ" euch a preM;riplion ; 

^ — 



f*e^0s9iL 



Fat 4 

Milh-augar . ^ . ^ . 7 

Proieins 2 

Lime-water 5 

Other Diluent - - ■ 
Ji fated at 107* F. 



Niiniber of \ * 

feedings ^ • ' ' 
Amount at \ ^ 

each feeding ' 
Infant'it age - - 
Infant's weight- 



tiunC9», 



Oneritcb ran...— 



D*Tff. 



•lONATUnC. 



....tflo 



M, ». 



^ MILK MODIFlCATIOy. W7 ^H 


^^M TUt^ pnr»cri{itmQs are tilled at Ujc k1x>nitnry by mixing ^H 


^^H togcllH*r milk, crtrain, staudaixl HU^r eKiliitbn^, mi<l wutcr in Uie ^^| 


^^1 proper |>ruportion^. In some coaea a l& [>cr o:nt. grnvitf ^H 


^^1 prmm lA uwkI, And in otben a SO por cent. ocntnitigiLl r-ixtttn. ^H 


^^H Other chiD^ being ^nnl^ it is mor^ di^inihlr im tlifviretu? ^H 


^^M gronnJ^ to u«c }i:i^ivity cream. Tht folluvriu^ mMc, frjm tbe ^H 


^^1 W^ilkcr-Oonlon lulKimtory rtronU, ig a ffotKl giijde to Ur quuu* ^^| 


^H iiiy and 4Uality of the luUl rvquired by the average iuf^ut : ^H 


^^H ^AoipfA^ the ttver^i^ pcrftntitfft* trnplft^f^, and tht aa^^ni of modified milk ^^M 


^^H /ft! to <t hr^ numtter f^f it\faiiU. ^^| 




r«rccnUAB. ^^H 










In ouni^M- 


F4t 


«a«tr. 


?roc«liha, ^^H 




!^ 


a,Dii 


4.n 


^^1 




>JU 


aji 


^^1 




I 


IhOQ 


«J) 


^^1 




?! 


M.on 


4.0 


^^1 




3.» 


fi.A 


uoo ^H 




>,Wl 


iM 


^^1 


^^^^^^^^^^^/^B^ifl^B ■■> >»>ii*i>-L' 


s 


&N 


6, A 


\M ^^1 




>M 


OAO 


4^ 


^^1 




» 


»J10 


4. a 


^^1 




11 


JL/W 


flji 


^^1 




u 


a,» 


AA 


1^ ^^1 




b4 


fl.JHr 


4,0 


^H 




M 


3t.M 


hX, 


1^ ^^1 




« 


%M 


OJt 


^^H 




*^( 


a.Tfl 


12 


^H 




*^ 


»7A 


OJ 


IJIB ^^H 


^^^H fovcnlctnib. . , , , . 


*^ 


3,?a 


AS 


^H 


^^^1 riKiiti>piiiii 


1* 


a.M 


00 


^^H 


^^^H Klnc(«ciitb . . . 




&1B 


di 


lA ^^1 


^^^H 


*S 


aWk 


4.1 


^^H 


^^^H Twcnly-flnl 


^1^ 


a^n 


flJ^ 


^H 


^^^H TwrnTy-ff^p^k^nd 


A 


&n 


ej^ 


^^H 




a 


&.:a 


0^ 


^H 


^^^H Twrntr^fhiinh 


n 
f 






A.8 




^^^H Twenty 4lxiri 

^^^H Twriuy-i^vc'iitti 


1 




XTfl 


«Jl 


J 




4.00 


^ 


^^1 


^^^H Twmy-clj;l)Lli 


H 




4.00 


T.O 


^H 


■ 




4.00 


9.0 


^H 









4.00 


7,0 


^H 




a 


4^ 


?.o 


^H 


^^^H T]jinr«o<:oiLd . - ' ' 1 « 1 • . . . . . 


a 


4.00 


7-0 


^H 






4^ 


U, 


^H 


^^H Thmv roEirtti 






4.00 


la 


^H 


^^H Thtnr-nnh . . , , 






4^ 


«,ft 


uD ^H 


^^B ThiriT-iUt^i . 






4.00 


flJi 


2M ^H 


^^^H Tiim>'>«pvviitii 


< 




4.00 


h» 


^^1 


^^H ThJriy-^lvbth .... 


« 




4.00 


4JJ 


KiQO ^^1 


^^^H 7brtL> TiiiiUi .... 


* 




««« 


«a 


U)V ^^1 


^^^H 


ff 




Afifi 


4Ji 


3^ ^^H 


^^^H ron^-nnt <9 


■ 


4110 


SJ» 


^^H 


^^^H forTT-nerond 


4A0 


AA 


^^H 


^^^H FoTl^-thrrtl . . 


J 


400 


lUI 


^^H 


^^^r rortT-f'HEirih 


■ 


4 00 6.0 


7^ ^^H 


^^F rianH^ftli, 


t 


4Hjm) ' A.0 


^^H 


^^H^ Fort3'-«Jklh . . , 




4,00 1,0 


^^H 


^^^B Ponj-vrTtnili , , F ' t r < - ^ ' 


4.M) 


A,0 


1A« ^^H 




*\i 


4M> 


10 


^^H 




TU 


40n 


QA 


^^1 


^^^1 nrtkvih . 1 * k » . 1 1 ■ t ■ 


r 


4.00 


M 


^^1 




t 


4.00 


4.0 


274 ^^H 




rti 


4M 


04 


^^H 





218 



IKFAST PEEDiyO. 



Amount lOd 


FBI. 


Sugar. 


FraUidi. 






ajD3 
4jOD 

<00 






0.1B 



The pcRcnti^ mrt gfvf^n frx the round DDmI>era qcii ne»reii tba actauU poroeni' 

Iteoently other moiliiieatioDg have been made by meana of 
whey. The whev U obtained by adcJiii;^: rennio to the milk, or 
Fuiix^hild e Ksscnce of Peimin tiiuy be uji€\L Ii should be heated 
to 1'50° P. for tive miDUtci^ before bcioj^ .nddeil to the milk 
mixture, iu ord^r to destroy the eDzymo in the milk aud so 
prevent ooagulafiuii of the easein. When whey is ordered, the 
protein eoDstitueot b iadicat^ in the prescriptioQ, for example, 
as fol]o^vH 1 

tkiwhi 0.00 

lActathunun IX7( 

Kf>l<'h givew the following formula?, flhowiiig the proportions 
of whey and <*JL5ciu a^ a guide for feeding healthy infatitfi where 
it i* thought desirable Uj .split tlitj prutetns: 



■{ 



rromatuf© 

A I U'nti 

Frill nf 2rT week . 

En<l of Sd n^k . 

End <i(4iIl wt^ck . 
Sodofflrh week . 
Knd of 8th wwk . 
Ifindof 12tU^cck 
End of 4ih month 



I.Ofl 

\M 

2.00 
2.50 

3.&0 
iM 

too 



4.00 

&60 
rt.O0 

7.00 
7.O0 

7.O0 



i 



0.2S 

0.2G 
0.G0 
O.-'JO 
0.75 
1.00 
1.00 
1.25 
1.60 
l.fiO 



^tfi"' 



3 

& 

0.2S 
0.fi0 
0.60 
0.S0 
0.76 
0,76 
fl.flO 
0.flO 
O.VIO 
0.75 



0.2S 

0.25 

0-M 
n.25 
U.»0 

n.flo 

0.7.S 
1.25 



33 






1 

U 

2 

Si 

3 

H 

4 



is 

£3 

I* 



s 
s 



s 



s 

t 



h 






24-18 

10 
10 



8 

7 

7 

6 

6 



In most leases whey mixtiiivs are iiniieee*tsary. In aoutfi ilU 
nflMor when tliere i^ docidt^J Irwering of iIk- pmtein digestive 
power they may be of great servio*. AtHXjrdiag to Gndee,^ the 
albumin content of whey varies with the kind of reimel used. 

' Archira of P«diatrKt, June, 1!*01 



MiLK MODIFICATION. 



319 



Tlif more perfect thL* ciinlHn^ of thu cuj«cin, the more dcHindite 
w the whvy for ft^itig infants. 

Thir folloMTing tabic, from RotcJi, £^vc4 the po«»!1>ilUic« of 
Buob modi ligation in the milk 1ubor9t)fy t 



fM. 


<::uciiL 




eoiPLr. 


rm. 


C-AvLu, 


bum In. 


BUfU 


1.00 


0.2S 


0.2G 


4-7 


2.50 


0.25 


0.60 


4-7 


1,00 


0.*2S 


U.50 


4-7 


2.50 


0,26 


a76 


4^7 


1.00 


0.24 


0.76 


4-7 


i-so 


O.GO 


0.60 


4-7 


1.00 


0.50 


II.2G 


4-7 


2,50 


0.50 


075 


4-7 


I.0O 


0.50 


O..VJ 


i-7 


2.75 


0.25 


0.26 


4-7 


ix» 


0,60 


0.76 


4-7 


2.T5 


0.26 


0.60 


4-7 


iM 


0.2A 


0.2& 


4-7 


2-75 


0.25 


0,75 


4-7 


150 


0.^ 


0,50 


4-7 


2.75 


0.50 


0.60 


4-7 


1.60 


0.25 


0.76 


4-7 


±75 


D.50 


0.76 


4-7 


1.50 


0.60 


0.26 


4-7 


3.00 


tiM 


0.26 


4-7 


r5o 


o..=ia 


a50 


4-7 


a.oo 


0.26 


0.60 


4-7 


1.50 


0.60 


a75 


4-7 


S.0O 


0.25 


a76 


4-7 


2.00 


0.£» 


0.^ 


4-7 


3.00 


OJM 


0.25 


4-T 


±m 


0.25 


0.5(1 


4-7 


:!.oo 


0.50 


a60 


4-7 


2,00 


0.2-> 


0.75 


4-7 


3.00 


0.50 


a75 


4-7 


2,00 


O^'iO 


0.50 


4-7 


S.50 


0.26 


a5o 


4-7 


100 


0.50 


0.76 


4--7 


S.50 


1X26 


a75 


4-7 


S25 


a25 


0,2-5 


4-7 


3.50 


0.60 


a50 


4-T 


9.«G 


0,25 


0.50 


4-7 


3.60 


0.50 


a76 


4-7 


2,25 


0.25 


0.75 


4-7 


4.IK> 


0.25 


0.25 


4-7 


2.25 


0,50 


a6o 


4-7 


4.0O 


0.2S 


0.60 


4-7 


22Q 


0,50 


0.76 


4-7 


4.1)0 


0.25 


0.75 


4-7 


2.25 


0.75 


0.50 


4-7 


4.»0 


0.50 


0.26 


4-7 


2,55 


0J5 


0,76 


4-7 


4.00 


OJW 


0.60 


4-7 


2^ 


0.35 


0.25 


4-7 


4.00 


aso 


0.75 


4-7 



lb ord«r !o obtain waii^fuolory rofliilts th^ "4(i^j«^ of 1nhr>r»- 
toiy foetiint; miir<t tn- tliorouj^hly studied. The authon; lia%'e 
adikpt^i Hfilt'i* .ndn^mo of laving weekly reports mmic on all 
arlificmlly fml infaDtn and on many others. Thwse T\-[Mjrto in* 
supi^liM in blank form, in pflds^ tc the mollior, who fiUs out 
one each week and sends it to the phy^ciun. By this fn<'thcMl 
part of the reHiwnsibility is placed on the mother, untl thr phy.ni- 
ciau ia kepi iDforuitxl as to ihe ii>]ant*i! condition nud nrr<lleA!i 
viutfi are thua obviated. The following ^ \& o sj>ecimea of rtuch 
form: 

^ Fn>jn Holt, DwvitAV iff hfa/Kfy othj CMIdfuod^ p. 184. 



INFANT FBEDtyO. 






1 



I 



K 



% 4 






(^ ^ ^ ^ a 




MtlK MODIFICATION. 



S21 



The perCTntJig:e of fet» protein, and sugar required by an 
iDiknt of any giv«n nge mu^t be bomc in mitid if one is to use 
any method of {lerccDbige feeding. Tlie fullowing sobodule 
ftill be fitiind useful us &il tiid tt? Uio [uijiuory. The figures for 
intcrnicfliute Agct^ are c^uily etik-uJulcd: 



1 ^ 


PtroaiiUflB. 




Number 

&f 

Uhuun. 


Intorttl 
bjdij. 


1 


riti. 


8u|[u. 


I'rvtclb, 


Ouaea. 


Ciru&a. 


Prainfttim bftott 


1.0 


40 


0.26 


H 


10-M 


lS-30 


1-1| houn 


l*t-2iI(Uf , . . 




&0 


, , 


i-it 


50-15 


<r^ 


M " 


2d-ttlJi dHj - . . 


2.0 


6.0 


0,50 


U 


4& 


10 


» *• 


3d tf wk - . , . 


S.S 


6,0 


0.T6 


£ 


60 


10 


2 " 


3(1 miJtitli , ' - 


3.0 


ao 


1,00 


3 


00 





24 " 


3d mciiitb . < > 


3.0 


as 


IW 


111 


no 


fl 


3 " 


4lh muruh , ^ - 


«A 


7.0 


)^ 


4 


Ito 


7 


3 •' 


6lh month , . . 


S/^ 


7,0 


176 


5 


lao 


7 


S " 


6tfa-)0th ajonlh . 


4.0 


7-0 


2X10 


7 


220 





3 " 


lllh moiieh. ^ ^ 


4.0 


b.0 


£50 


e 


SfiO 


fi 


4 


12th montli . ^ ^ 


4.0 


M 


aoo 


» 


2d0 


5 


4 " 




4h0 


A,h 


ar>o 


9 


300 


5 


4 '■ 



The quantity should be increased half un ounce or an ounce 
at a time. Later, as the child**! appetite grows r^troitger, — that 
b, ivhen lie :?ceni^ diss£itis5ed aft^^r his tmlllt, — the ijuality u 
raiaecl- The fat may usimlty bo lucreai^Ml O.o per cent, at a 
time; the sugiir,0.5 to 1 pi*r ceut. «t ti timr; ibo pr^jteiru, from 
0,1 tj> 0/25 pr»rornt. »t ii time. Stroug, Itf^ilthy, \\\t^^. babies 
R'i|iLire mna' umi rioht^r milk than tlu>se nf frailtr ooustitutioQ. 

Ssnitkin, of St. P<.'t<Msbtjr^, ba*i 0AtimQt4^ the amount to be 
f«<I t<> a child Af^r>r(ling to tSe wei|^ht. He ascertained that a 
biibyV slflmuch heJd ubont one-hundn^^ith of its weight at birth, 
and |]iiit the increiLHi* nmounled to aluint a gram a day. By 
taking (Hie-hundrciUli of tlie iiuliul \vvl|clit at btrth and adding 
a ^ram for carh ilny the avcmgr nincmiit n:<juir«l for each fw^og 
18 as<vrfflin(xb This ia ii fiiir working nile, btit prttctioally the 
amount i« psstly dettTraitutt !iy tlu! uif*tluMis alr(«dy dejwiribed. 

What is known as nursery milk i^ aIho supplied. This is 
from a selected herd of cattle whose milk contains the fat in 
very small giobulft-. This is said to be more easily digesl^dr 
especially by weak infants. 

2. Top-milk Mettiod. — M:iny method? liax-e been devised 
for obtaining ihe desired [percentage fr«ai milk us it is used in 
the home- Ni> phtii h nttdpler or more practical than Flolt's 
top-milk m<^hod. Simitar plans lia%'e been deviwd by Chapin 



lyFA^T FEEDING. 



and other writt'i^. Whenever tlic intcUi^nt coopcmtioD of 
mol-lic^r or oiirse can 1>e secured, lloltV meLliod wi[] be futini] Co 
work ttdmlrdhljh'. The milk ue)eJ mu»t bt pure, Trcvb, and 
more or less uniform id <.4i»racter. It is a good plan to et^ 
and even !« mulfe a rough nnal}'st» of^ the rnillc used. Ooc«- 
&iiiQ:iI failure may l»e due to tL« fcict thut a ver>' iMXir milk i» 
beinf; used. For tlii^ misou llie aulhoiv a<JviBi' tliat tlic milk 
for the inlufit be prcicurx-d from u diLirr timt ts kuown to supply 
good milk. Some dair^'m^^n furDUh milk Uint hns l>eeii ex- 
amined and itA 'juaHly certilied lo by u oomjH^UitDt exnoiiiier; 
Om h ^Id under the name of oercified milk, and ^ afi a rule, 
i]uite reliabk-. 

Tbc! top-milk method cooaists In using tlic mixture of cream 
and milk iu the upper one-HurJ or upper one-liulf of a jur of 
milk l.but li3t?^ Iteeo jtUowf^d Ut ^taud for some time. Liiter, the 
whole milk ujav l>e ufHi-il. Thia meth<^>d work^ ^tislnetorlly 
only when the milk U bottl<*d ecum after milking, before the 
creara hns 8eparaU^d. For thoae who can not obtain eueh milk 
the oece^-^ry mixtui*e of csreani and milk may Ite made as indi- 
cated by the table (p, 22^1), The lop layer of cream may he 
removed from the buttled mOk with a -npotm ; the remaimierj 
by mcan^ of a ttmjdl dip])er ; for i\ih |mr|Ki6e a Clmpin milk- 
dippor, whicK mity ht: obtaiited at any drug-store, will be found 
very Ufieful- Amithor method is to use ti siphon. The plan of 
pouring off (he upfw^r t^ne-lhirtl ie nut nt-^irly so reliable. After 
it has been rcm(.i\xd, iind belbn? the nipiired |iortion ih takeu 
out, the eutiir upjKT one-third or oii**-haIf, as tht* case may be, 
should bo thoroii;;hly mixed. 

The followiti^ lahleH ret^ulre no e3[planatiou. Wien de^red^ 
the fieri^eutof^e of }ime-*wal«r may Ix.' increased, or it may l>e 
repln*x*l liy schIuioi bicarUindti^, 1 gmin or more per omn!f, if 
thr milk ifi to \ic hcilh^. If the ijmintity re(|uirod eKtH^nis '20 
ounr<>i, thr smaller tiiipplemcntar>- fub1<>r4 m^iv be titled^ or the 
qttimtity rajy winily Ite ejih-uhihil Ijv adding nn Ufiilitiomd onft- 
fourtli lo each item for 25 oituce8, or ono-half more for SO 
ounc«», etc. 

The Bii^r may Iw measured by means n( a pill-l>nx holdirg 
«actly an oiuK-e^ or very eonvenieiilly by allowing two and one- 
half level tid)le?t]Ji'Oiifulsof milk-»ugnrto tlje^junpe. When oine- 
tnupirij*uned,<iid_voiie-liairihe4uantity wi^e^uireJ, Pry meafiur? 
of MipirL-<ju^t twice that of weighing. Thu^H, one ounoo of sugar 
by wHght woulit mc^iiiiiro two ouno<.^ in a nii?u8iiriDg-glafis. 

Thn following formulae have been mken from Holt :' 



XILK MODIFICATION. 



223 



FkUT Skrtes op FoRMm.A8- — Fat to PiioxKiDfl, 3 : 1. 

Privuiry Formulu^ — ^Ten per cent* milk — fiit, 10 per cent. ; 
#»par» 4.3 f)tT <vnL ; ;>n>kidH, 3.3 per wnt, Ob(aine<i — (1) 
&« upper oDc-tliini of iKittk-il milk or (2) equal parte of milk 
ami 1^ jicr cant crcurn, 

Deriwd JormuUut^ glviog quaatjtk4!» for 20*ouDCie mizturcx : 

















Kilt 


6iii[iir 


i^Wtb 
















peroeni. 


peroral 


pcrcant. 




Milk-nugv 


, loci 














1. 


LiiiiD^wntcr 


tut. 


vflfaSoa. 


tOp.c 


nulii 


. J-OO 


S,&0 


0.33 




W»t4»r, 


r J,IL uL HO 01. 














2^ 


i; 


'(* 


u 


^* Sot 


f( 


44 


. I.fi0 


6.60 


O.fi0 


a^ 


*f 


li 


u 


" 4i*. 


X 


4< 


. £00 


6.00 


0.66 


4. 


<l 


n 


H 


" 5of. 


u 


ri 


, 2.50 


e.oo 


o.gs 


& 


11 


tt 


U 


" Got. 


tt 


<A 


.aoo 


noo 


1.00 


6. 


«■ 


k| 


u 


'* To*. 


u 


IJ 


. aao 


a&o 


Ija 



71i&£f (iFM*^ fn I? GmAmafti Form ih^ QunntltifA VwiutUtf Rnjuited /^ 
Obtnininf; the Different PtU^par^-nta^^e. 

ABCDBPaUIJKLMNO 
^cn?*''* '^^ ^'j-»io 1.0 ijj so s.i> lii jj a,7a s^ »id &o a^as aa s.t id 

^ouiiwfl*^ ''^O^. f^j^ tO.OM/l 34K0 UhO kVO a»jO aSjOOMiOMLA tt^M.M >T.i> S&O 40.0 

^mUkl'oEn™*"^ )*'^ a.o ao to m oo to s,«o ro io.o 11.0 is.do ia.o i4.fl la^ 

I'T^t^kdji : Tho prjTcnUgc in vitrh cruw will Itv oniMliinl fiiL 

^ii^r: 1 onniN' m JO, fir 1 rAUM|M>rmri]l in K ouiiCf«t ^^^ S<& P^ v«Dt. 
for ibc^ tower &nj ^'y fur tht< bijcht-r fi^nuulan. 

Umo^nl^rT 1 imrt to IX) of lIjl- f^Hxl, Ifiv nvenig« n-oiiirvd. 

Wifrr: Hiiffirii-ni ff> In' H'lcliul \n thi? foiTV"'«>lf iTijfTwlicinf* lo briti^ the totsi 
loibc iiumtK^r (>r ormo«e (ifwdfiod: in |)dr1 of IhtB whli?r the mitk4iifenT lh Jj»- 
fKi]v«). Barlt^T^wnli^r or nwy yilwt ililutviit tiuiji Iw mldciJ in xhc nmr iikiiiiiii^r. 

SEco5n Series of FoRMrtcAs — Fat to Fboteiiw, 2:1< 

Pfimtirit fhnrtfiiii. — Sloven per cent, milk — fat» 7 per cent.; 
i^iij^r, 4.4 por oi*nl. ; prnt«icij*, 3,5 per rent. Obtained — (1) lu 
upper om^lmlf of bnttlivl milk, or (2) by using 3 p(trl» of milk 
Ami 1 jiart of lt> )ter oc*nU vmim. 

/>fr»c«:</ /(/nmi^w, giviiig <}uaDUtioi« for 20-ouncc mixtures: 















mt 


Sugnr 


rrotvlda 














pot cent. 


perctuL 


porocQt. 




'Milk^iiKir 


IM.' 










■ ' 


1, 


Ijmo-waior 


lol. 


with 3 rai^ 7 pH c 


milk 


. IXW 


&&0 


0.50 




, Wilier 


a.Knd.'20ttt. 












9 


<i 


V 


u 


"4(11 " 




. MO 


5.75 


0.70 


J 


■1 


H 


t* 


« .s™. » 




1.7S 


6.00 


O.W 


4. 


II 


li 


h 


" 6ot " 




.2.10 


aoo 


l.OS 


9. 


II 


41 


«■ 


« Tofc " 




2.S0 


afio 


1.35 


e. 


II 


U 


<( 


" «™l " 




.490 


flj»0 


1.40 


7. 


" 


H 


.• 


" fltw, " 


n 


.3.15 


7.00 


IJ>6 


9. 


*t 


PC 


■4 


" 10 OL " 


i< 


^3.50 


7.00 


1.75 




' Milk'«utfnr . 


i<^] 












9. 


IJcn^wjil«r ^ 


1 oa. 


" 12 OE. " 


u 


■too 


7,00 


2.00 




WaWt 


(|^ 31I 


^Oai. 













3M 



iNFAyr FtiEmm, 



7bA£ff Qiwing in a OontUn$td Fitrm the QuarUi^Ua CruaU^ Ht^r^ /or 

■ ui'-iiir p fi El T IffI hi 

' T*aMaliiai.pftrcciii. ... i,o la u i^ 2.0 1^ 2.?d 2jb 31 a,s t^ 40 4ja 
Por toMI find. BQiuTA . too sco ao.o u d ti w.i>i Ti^yi v> '■» vi.u «o.o u^ ua 4C0 
TUoTporociitiiiiJk.ouQM* fljJ CO <.(} fi.o io.<i ix.oa UM iiuio is.o sikc aiJ) SLO a&o 



To obtain tho oiaol ftl.par»nU»ffO Inkc onfr-ihin! t!i« number of ounos of 
top-milk In A SO^iiincv mixture and add 0.16 10 tht nnilL In pnictJcc thu 
mg}\X «mjr mnv b« difiv^rdu). 

I^1cid< ; The |tercentfl;^ in mill c-ahf will ^qiutl on^half of the fjiL. 

fiugiir: I nance in 20^ or I even UiblM[H>onfijl in 8 oiinoe», miUI tlio food 
b«ODinm linlf nillk ; nflcr Uini 1 ounce ill '^» or I tven tublgHpooLfu! Iij tacU 
10 oiin<*™ of tUc foiwi, wUl ffive the prupyr nnu»iint, 

Limc^wnlcr t TgnjiUT in tho nmyioniun iif I pnrt to *J0 of ihe loUil food. 

^Vaicr or ^.riiiui' lUluriit : S4Lmoit?iit Oi Iv ikdiieil U> iLt fui^guing lngrv«lianU 
lo ituikc lbs lintd] nainbcr of ouncf« »p«ck£^ ; in ]iari of [liifl die sogir U duh 

TuiJic SERiEfi OF Formulas — Fat to Photeiiw*, 3 ;7. 

Prmiarif Foi'm\dn, — Plain uiilk — fat, 5 per cant. ; sugar, 4.5 
per cent, ; proteids, 3.6 per cont. 

Derived Jonntdai^^ giving quantities for 20-oiiDce mixluns : 



{Milk-sutfir . lojs.j 
IJtri(?'WdtcT - 1 OB. V with 9 dZ. plain miLk 
Wptcrq.i. ad, 20odJ 



1 
3. 
A. 



Wnicr,q.iittd.2flQt ) 

N il El «' 



" 60s. 

" 8i«. 
« 10 ot. 


H 


" 13 OS. 


rc 




n 
It 



ptroini- 


pgrcPuC- paroent. 


-I.OO 


6.00 


0,37 


1.30 

. l.OO 


6.00 
7.00 


100 
1 40 

17fi 


.2.40 


S,00 


2,10 


.2u8D 
-3.20 


5.W 
5.50 


2,.'>0 
■i.ftO 



7. 



7h£^ Oiving Quanfitm of 16 per cfnt. Miil- R^fptirfti for Obtaining 
FormH/<x4 with /liffh Fai and Lotc I*rofdds. 

ABCDBPQHIJE 

. i.« te 12,0 t.s M s.n M.n «» iu 4^ 4.4 
. 30,0 Bai» sao ai.D 3XA rr,o ix^o h,o 40.9 40J> Ko 

. ^ 1.0 10 >.0 0.0 T.O ftU 4« «.0 lOO IL.O 



forlntal ^mn. lUiTii'itu 

Tako lAjriir nunl, mllk.ounova- 




Prole!d« in ntl mjvs nitl i>p one-fiftb the ftit. 

Siignr: I even inbl»j>nonfiil for ench S ouncoi Till j^iye 5.5 per cont, for 
thv IntTftr fnrrMiitiiM |A« It, C, vie) and G per oenL for llie liigner fnrniullia 

LilDl^4rat«^: 1 ounce 10 ^ nuncea tiT ibc fnod will ^to 6 |wr cwnt. 

3. Coit's Decimal MethodJ — This is based on divim&I 



MILK MODIFICATION. 



225 



aud voliimetrio mctbridrt. The inventor claims that k ia csBily 
memorized, and do©* nol require any but very simpLo calculation 
U> work out what ia needed lo give the re()iiired furmiila. Three 
stauilarL |.iiYpunitLijiih ^i^ all tliat are required : (1) A decimal 
or lf> |x-r cent, cream. (2j A uicoliar&tfid flkiiu-milk for iutrtr- 
duojng pr>teiuj^ not carrivd by tLo oraun. (^) A utundard 
«ngftr i^nlntion for introduHnff lactoie not ofliried by tbe 47r«ttm 
or j^kiTii-milk. Only tbe decimal weaiu and the ^ugiir Kolutioii 
arc rfquinni duniif;; the first few mouthfl. The 10 jier ottnU 
CR^iu i< W^t obtained by allowing a bottle of niiik to Htaikd for 
Sj)ci-n boun^ Tbe upper U ounces of each quart, when muced 
with half it« volume of sterile wnter, give the required Gtrengtb. 
Ttieu- iire diflcrcnces in this gravity crenm^ tof>-niiIkr and cen- 
trifugal cicanij &0 shown by tbt followiog tabic, prepared bv 
Coit; 

J^r^nttaga Compoaition o/ D/rimaf CVram. 

K^ L Gmvlty . . . , , t0.0 S.33 2.m Bfi.Ol 

No. 2- Topimlk . . . 10.0 37(> -UO 81,75 

No. 3. CoDirifiigHl < . . lO.O LW ZOQ 6G.W 

The following tnblc *how» tlio npprnxinmt^^ percontagea of 
protein and lactose carried by three decimal tTi'unij* when they 
are used to introduce definite fat-valucA into milk mixtures : 



formttiaa. 

Ko. I, OtuvilT frrani, 180 c.c (6fl,rEj + urater. ft) cc (3fl,0l.), 
No. 2. T»r>i>i!lk. inulinllnj ftrnvitj cr«m, 300 t\c. ( 10 fl,o», j, 
No. S. CmtHfu^l crv<at]>. 20 per ccDt. hi + nr&ter, equal ToluroeB. 



Protein* l,U LacXoac, LO 



Dtclenal cmm 
No.1 , - 



TWfmal rrrtftm 
No. 2 . . 



Dec-irnal cr«uD 
Nv. 3 . . , 



' For introducing milk-rriT, 4.0 . 
** '* " 3,fi . 

** " ■* 3.0 . . 

" " " 2.6. H 

II II ■' 3 A 

Frir JntrruliirTrntf mitk-fit. 4.0 . , 

** " " 3.C. . 

" " " S.O - . 

" ■■ 2.6 H 

- " " ZQ. . 

For introducinf nulk-lki, 4.0 . . Pnl«In, OhOO LaaUm, CL8 

' " " 3.6. . " 0.60 " 0.7 

« " " 30. . " 0,4fi " M 

' " " 2.6. , " 0,40 *' Ofi 

< " " W> . '' 0,30 " tL4 



Oft 

0.7 

06 

" Ofi 

Prrrtpin, 1/t 

LS 

l.I 

" 0.9 

" 0.7 



0,» 
0.8 

njs 

LoetOM, 1.8 
- 1.0 

lA 
*' 1.2 

0,B 



U 



ass 



INFANT FEEDING. 



The Fitaodard safichanitcd ^kiin-milk is muile by adding 50 
grauiF^ of tnitk-tfUgar to 1 liter of skifn-inilk, which is eqiiivutcnt 
to adding 1 ounce to 20. The skini'inilk lias n fonniilu of 4 
per ctnU j)ratein nnd 5 per cent, sugTir, iir n nxt\o of lo 4. 
Willi tLc addition of tbe jnugar the int rod net ion of the pn^teiD 
U eioiple- A given amouat of food multiplW by 0.25 wotdd 
indioate one-quarter of ttH bulk, whi<^h, if Rkim-milk, vmtdd aidd 
to the mixture 1 per cent, of pmti^id, Thii; saine decimul multi- 
plier would uidioite the peR^cntape of r^ii^rthus iotroduotd by 
a 10 per cent, sohition. The foll^jwing table will »liuw tli€ 
lactone cnrrietl by the lUiQchanU^d ^kim-milk correspoudiiig to 
definite protein values : 

Sjicrhaniod sklDi'inllk. 
Amounl of fttoA b cc -: 0.125 or jl = Prolt^in ti.d Lnclow 1,25 
Araouni of fmxi in c.c. < 0.2-^0 or ) - " 1.0 " 2,fiO 

Anioiini r/ fnod in o.c. - 0375 or j - '* 1.5 " a7fi 

Ampuiil of food in c.c <. 0,600 or j[ = " '2.0 " B.OO 

The fitandard sugar Bolution is ea.'iily prepared by dissolving 
100 gnm^ of laotoae io »tuf1icivtit water to make ni&i^un^ 1 liter 
(or in proportion of 2 oimoes by weight to 20 ouat^ca of wutcr). 
The only difficulty with the sugar i^ found iu f>ocasiu[ial inipu- 
ritiGS, such 118 frec< lactic acid, which should he g;un.rded against 
l>ecaii9e of its teudeucy tu prt-cipital*' the casein of the inilk. 

For the calculation of formubLH three points only are to be 
borne in nuud, nainely : The porceota^ formula desired; tlie 
quantity of food required, and that the standarde, except for 
protein, represent percentage values in ratio of 1 to 10, Given 
the§e constant fxu^i*>Vf, the problem of adjustiag percentage com- 
poeition becoiaea an ea^v ime ; The i|uanti1y of food reoiiirrd is 
reduce*! to cubic centiiu*il«rfi (ount^efl multtplied by 30), and this 
prmlut^t is multiplied by die jierc^ntage tenth of the element t/) b« 
introduced The following table will serve to illustrate : 



Oat fifeAlag. 
9&«s.»30 

DociauU crouD - . . 



60.00 C.C. 

0.2 
12.00 f.c 
60.00 C.C. 

0,55 

300 
300 

eundardsugvrvol. . . 33.00 cc 



Hnk'fm. Fnt«ln. LteUm. 
Itei]ll!nHl perocntJige 

fonuiiU 2,0 0.5 6.0 

Decimal (;reflm intro 

diicing 2.0 a& 0.f> 

8ugAr Aololttrn .... , 5.A 

InUxidiicing ..... . J),5 

Woricinti /<rmiiUi : 
DnNiiiii] rn-niti , . 12c-c- 
8tK(]d«rxl migiT tol. 33c^c. 
Wftl«r. , , . . .J6c& 
Sfl.OL oi , . . . 0Qe.& 



L 



MILK MODIFICATION. 



227 



Oft* dMj'* food. 

0.40 



Ikeclmid creUD . ' 



6laiHiiinJ njjU smI. 



. 42a00&f^ 

106(100 CCL 

0,66 

59SO 

5250 

,"577.50 C.C 






OD«£ec4]P4|H 

SB^ca. x30 S40.00&C 

TWimal cRsm . . , . M,00 c.c 
240.00 c^ 
_ 0.26 
1200 

_wo 
&ccbftrai«d skim-iiiilk iU}.O0c.c. 
WLOOc-c 

UDO 

TO 
SbuvcUrd lUgar nl . , ^.00 &c 



UlU-lkL PreMla. Uirtotfi. 
. . 10 1.0 0.6 
■ 4M LO LO 
U 

Woridhg Jtrrmttat 
DtM^inukl cnttiEi , 430 oc 

•nlutkn . . - (77 AC 
BoUcdivmier(lii- 
dudiniraJladi i_&S fcc. 
TobeditUcdiDto 
T fiwdhigi of 5 

Ullk fki. l^rolelD. L«io«o. 






vkin> 



milk . _ . 

gliuuliud Hi^o/tfol. - 



2.0 
I.O 

t.o 



7.0 
6.0 



_ _ M 

DcciiDAlcrvun r -MJclc 

I S»4:i.'bHn(«d vkiuMoilk 60 && 

UUiidaitl tfu^tr Aviation - . . . . 84 0.0. 
9 fl-Df. or. S40IML 



4. Matema Graduate Method. — The very f^itnple a»d 
usefU! apparatus known as tlie Emmu!^ Mntema Graduate 18 
of gr^t valuta wbere oue can not jwcure int4.-Ili|j;ent coo|wra-- 
tlon iu tb« home, and alao wbere there are no faciHtiea for milk 
prL-puration, Tlii^ luotLod of lofant feeding ba^ been triotl by 
ilw HiilboN for H^voml ymnt in the R^jl^^prt Garrett Free Hofi- 
pitul for Children, Baltiruoi^, and too much can not be naid 
rv)i:nrdiug ita ainDplicity and eflicieDcy. With jU fix formulae, 
howpver, it is not adjifjtahle to all ca^teci, flome infaxitfl being 
totally inoapabli* of taking the step from one formula to another. 

Tho apparatus cf^nsials of a glass jar with a lip and seven pan- 
els, and a <«pacity of 1 6 ounces. One of tiie panels ejcbiljits an 
onliiiary ""nee ^rjduation ; llii^ othorHix [jauflr- present six dif- 
fcn-ikt formula.': for tLt.' mndiri^^tion of c«ws^ nifllc, each formula 
bf^JTig »i> urmugfKl us to ke«p pace with the infantas f^rowlh, vit, : 

Fkl . .3p«r««nt. 24 per cent- SpcTowiL ajprtocui. 4pcrccnL 31paroeaL 
(bipr.e » ^ " 6 " 7 " 7 " aj " 

Protein ftfi " O.ft ■' I " ]} " 2 " 2j « 

For Formulik eee ^pvt^toi InAlruclioni bdov. 







INFAST FEEDING. 



.p»ru 



U ■(Kt 
KlU-rius4r 



55- 



UK 



K 

i^ 






6 



II 
if 



2 



?< 
^ 



5a 



Milk . . . , pftFt* 
(?rwiq - . -^^ 
BarlBy-irnipl " 



^1 






Having dmded whmh fomiiila Ia tn be u*ed, the panel oon* 
tainiDg: Uiat tbmiula is tb^ only one to be followed. 

Tbe quautity desired for twenty-fonr koura is next to be 
coDsidered^ and tbe apparatus tilted — once, if 16 otinoe^ or lefla 
are required for (be twenty-four boura ; twice, if iroDi 1 G to 112 
QUACcd are required for tbe twenty-four hourB ; three times, if 
&om 32 U> 48 ounces are reijuired fur tbe twejjty-four buunu 

I>is£criONa. 

(The lines beneath tbe wonis indicate the pointa to which the 
various iugredieutfi are to be filled in.) 

1. Jfific-gugar. — Iniroduce mUk-sugar to the line so marked. 
M'here good milk-sugur can not be obtained, granulate sugar, 
ui jusL Iiair tbe quaatily, should be used. A small ci-oaa on tbe 
upfinratus irulicates this point* (Set dlreetioos for Fommla 6,1 

2. Water. — AJd UjiW wat^^r (hojj to the wati>r-Qiiirk, and 
atir until the sugar is diK^olvw!. If any particle,'^ are seoi 
floating in the s'Oution, it abould be filtered either through ab- 
sorbent cotton nr through two thicknesses of clean muslin, 

3. lAme-yrrtter. — Ordinary lime-water, such as is obtained at 
drug-*^re9, i^hotild then be filled Vo the L-waler mark. 

4. Crtxtm. — This should be the ordinarj- cream (16-20 per 
cent) B8 obtjuuetl \\\ bottled milk; it should be poiu^ in to 
Uie creum iDark. If the cream is purchased scparat^lv, ordi- 
nary orenm^ and n*\i c^^ntHfiijjal oroanij sboum be used. 

5. Sfftlk. — Ordiuury good eows' milk should be naed and 
the jnr filled to the inilk mark. 

6. The eutire mixture should next be stirred. 

7. The whole Khonid then he poured into separate bottles and 
steriliBwl if desired, or stopper^ whb cotton aud immc^liately 
placed upon ice. 

Diret^ionft for Formula 6, — I. Sugar. — In this formula 
granulate BUjEur sbould bo nscil in place of milk-sugar, and 
tbe sugar iatroduccd into the vcj^scI to the line Ihas mnrkccl. 

2, Jiarletf-ffrtuI, — In this formula harley-gruel should be used 



I 



MtLK MODIFICATION. 



instead of water, and the glass filled to the line tbiis marked. 
Beirk\v*gmvl should be prcLKirctl Uf folluw^ : To I mble^Gpoonrul 
of pctirl bftrlcy, afici' soaking for several boura, odd 1 puiL 
of water, A pinch of ivdtt and boil for fivo or six hours, adding 
TWrtor as neoetiMirv. Strain through mn&lin. Or tht^ follow inj^ 
metiiod may be up^ : 1 rounded tabl^&poonful of Uohiimii/B 
barley flour; rub op with cold water, and add to 1 pint of boil- 
ing water ; cook for fiftwn ininLito^, stir» and Blraia if lumpy. 
3, Cream. 4. Milk, — Add the »amc a^ m other formulas. 
6, '^ii. *i. Sirrilizf:.—ik\mv a» in other formulae, 
6. Maynaid I,add*8 Table.' — Another method of modt- 
fyiDg milk is according to MaynanJ T^add'a table. In this Uiq 
4|aantit]es have been estimated, ThU method is useful in hos- 
pitals where there \a a milk laboratory. In geoeral practice it 
IB of slight vaim*, for it neoe^wilatefi memorizirg a lengthy table, 
or carrytDg it about, both of which methods are open to ol^jeotioD. 



?r«acnptiou C4ti- 

tJufitrii inLituni 
of » ouncca- 



Ftt'f^N mUk III OUDCtt 




51 



• r s 



(') hdicfttea tbnt tb« combioitioiiuliDpowibl«wiib thv percvnUgv ol crmm 



S30 



lyFAUT FEEDING. 



0. Baner's HetlLod.^*ManT sttc^mpb* have t>een madi* 
from liuie tu lime U* ix>uipuuj h tal>1e uf equatiTJOh fri>m wtiii;]j 
the quaDtitics of mUk^ cream, etc, nia^ be iletcrraJned £ot any 
given Euixture ; tlic simplest of these ia tlmt uf Baiier : ' 



^Juandiy dosireil (in ouiicm) 
iJonrcd pciveuugT^ of Gn 

DidPMl percentage of proleia 
To find ixt ouncea— 

Cream (16 per cent.) 
Milk 

I>rymilk-sug»f 



-A 
-V-(C+3f), 



Example. — Siippose it is desir^ to make 40 ounces of a 4 
per cetiU fat, 7 per ftfat- sugw, 2 [>er cent, ptxit^ia mixturv* 
By subatituting the figures In the equations above we have — 



Crauu 

UUk 

Water 

8u«*r 



-40-20-20 otincca. 

&x40 



too 



- 2 oimcei. 



Jjouii Siatr't Table of InyrtdUnU, Ifourt, and hUftvak of Frying, and 
jhfal Quantity o/Fhod/or a Healthy Ar/i/tnnfiy Ffd Infant fro>n Birth 
i9 tht Snd qf ih€ Seventh Month* 



J^. 



During 1«i wis. 



Front M Id 

Fromfttd wt 

M moath 
Froia Ed to 

Alli raantb 
During eiit 

ttMtUJ 



1 




i 


/ajj 


niu 


. . 


fUj 


- - 


tlM 


ftH 




fti 


OV 


' 


'm 


Dm 




(BUM 






ftplQCb 



ftUJ 
atMM 



Honn for 



S A, H. tU 

II r, V. . 

■aiucLliDH 

1 A. H. Hid 

Sa_3i. 
f a A. M. lO 
1 11 P. M. 

ill KM. 
f 7l. H.IO 



Intcrrali 



Tatu 






ft Ik I 



> A«v y»r« jV«/. Jtw. March 12, IS^B. 

* From £>»«»(« oj tht jXgMive Otjfona in CKHdrnt p, !4 



■ 



. MILK MODTFICATIOX. SSI 

7. IfOuls Starr's Tabic (see ]>a^ 200). — Tim in a fre- 
quently UKCtl gtiiclo to niitk-prGS(<ril>lng, II tatky \yc employed 
Oit « liHxift Cor imMiificiition hy tbowt* uhu ubjnut to tho [K*rc«»ntago 
mGClnxl. TIjc latter meUiod, buwev^r, onoo ninM^rrotl, will he 
fotjnd moTi- sutJAf&ctory for ^oeral {lurpo^es. 

Throuflhoiil like «^bth mufl ninth monibt fir« niMlj ft Jty «lll be «ufflcient, 

Milk fM 

tWm i%i 

Milk-auffu- s' 

W.«.r fj 

Thii ftllufrb 40 lluicloubcBi of food i diy. 

d* Cbapia's Method. — Clmpiu suggests tln^ rtinoviil of 
the top-tnilk or crcnin from lH>ttlc<l itiHk by mcAns of n ^mnll 
milk-Klipjtcr lioldlng one ouiii-^^ He remitvef the crnuti an 
mtm n^ tht* milk Im (1f*Uv(!ro«^ if llic cmkm \tas seiiaratj^^L For 
yotiit^ iufiinU Ik- removes i* oiinocs from the l'>p of n (jimrt of 
milk [fcu to pn^k-iii, 3 : 1). For older infinite bo advW^H tbe 
removal of 16 ounces (fat to protdn, 2:1)* He diluU-it tlitft 
with M'limt-, Imrley-j rit^, or oiitmeil-vraWr, using 1 or 2 
tAblee|Mx»nft]]« of flour and a quurt of witter, und boiling for 
fifteen mintilcs. Thi» i« doxtrini/Hcd if de^ired^ stmined, and 
salted, uiid nugar i«adilcd« 



TmontuBBtrn IjHxtaus* or QuurmT Ain> ^rnsvum or Mix-nmiA.' 



boim- 

Sl onnccfl— onc-BGVQtiih u»p-milk. 
Elffhl '1^-ta. ttiViMa^ one evtiry tiro 
hours. 

M oijn«i»— oni>«iilh lop-millc 
Hghi A^yL Uediog^ one every two 

30 oiinc«»^-oi]^flfili CnfHtiilk. 

ScTDti 4-or foicdiriM o"* tverj tiro 

uid «>ne-hft1f to cTiro^ hoiinL 

39 oiinoM — onivfuurt^i Uip-mllk- 

Sit &^w. fcodinp, one cTory tbrott 



S ox. of !^oi. to|>mi]k (after being 
n*r]ior«l rrom Settle and mirfrd). 
14 oz. of dilavnL 

1 14. v( aiiJi^tir. 

3 o«^ of ^^ lopmilk fofter being 
r«inr>vi.Hl from outtle bikI mil«4). 

I>^ tjt. of ilihii<nt, 
I OE. of mijenr. 

4 01 of %'z, top-milk {»,(19t Mng 
rrmoTcd from Wttic oiid mixtJ). 

H nj, diliivnt. 
J 04^ of (itLienr 

5 o«, nf ^^n, (ftp-milk Uft«r b*tnj{ 
T^noff^d front t^otlU mod uiix«d). 

^ m. of dll»«nl, 

1| ui. of Mii^r. 

H OL of iDiMnllk fhHKl «Ad qtlftK 
hattW. 

27 oa, nf d&limnt. 

1} OL of l>II|^- 



■ Oupin, /n/nnl Fteding. 



aas 



lyFAyr FEEDiya. 



42 oiinc»— one- third top^ilk. 

6U 7-ot ftedin^ oae •**ry three 

honr^ 



40 ounOTs— onf-lmlf iDi^-millu 

Six 7-Qi. or five S-dt. fwdiiifcts <>i^ 

every Ihnw lo ihrctr ami on^half ] 30 rd. of (Jilut!nt. 



H oi. of top-^ilk frora omr «jwut 

28 OE, of <}i]ueiit. 
S o*. of miBT 

30 OK. of ifip-mllk from one (|iiAit 
UnHv. 



every ibro! and one-bdlf Itour^ 



I jnm i>f iliJuuil. 



ChapiD givce tte oompo^tion of' tlie mixture in the foUow- 
hg tnble ; 





lj?w4»t vitrcmt^ 


Hkb«t ciirtdic. 




l*Ml"* ll. 


j)-uiilk ftmu ullk 


^M. \i 


]■ lullk fron mllli 


^a, toi^tnllk- 


^ 


H'r ci'ul. 


bt. 


a 


pci e*Et- 


Ckl, 




Fai 


I'fyU'in 


i^B»r 


Fat 


l-Tolcln 


SUnf 




per cvJit 


per r«Dl 


ptirconL 


per deal- per ccut per i^nL 


IKIulcd 8 tim<» . . 


. 1.10 


IVM 


0.-50 


2.00 


0.ftO 


aM) 


• 7 « - , 


. 1.30 


11.13 


0,67 


2.rto 


0.A7 


O.'j? 


" 8 " . . 


. 1.50 


0.W 


0,67 


a.fi7 


y.87 


0,67 


" 5 " , . 


. 1.80 


O.00 


0.80 


3.30 


0.80 


0.80 


" 4 '* 


. S/Jft 


0,75 


1,00 


4.0U 


1.00 


1.00 


** S " - , 


. S,00 


1.00 


1,33 


6.60 


i-sa 


1.33 



It is UDpoBRible to ^v« the exact composition of niixtiirce, 
as thU win ile|M'Tifl on the ri(*hne*4 of the nrlgirial milk ; bnl 
tbe nmg« <if ooru|K)sitio[i will jilways fall witliiu tJie rollonin^ 
limit«}f witliout the solids of the dilueut aii<] the sugar 







Lowut cilrmnc- 


Ulstieit cilnme. 






]«OL 


Ui[>-iiillk fVma mlLi 


IC-Ax. Cop-nillk tnttn mUk 








i per vuut. 


lau 


biKH t^ciit, (hL 






Pni 


Prtitelrlt 


PwiraT 


F*l 


Pro:*3lri* 


SiiiTir 






percirm. ^r i?oni 


por(?enl. 


pvr iNiiil, 


piT oe Dl 


[lerujDi 


DUuKmJ 8 timor . . 


. a? 


0.33 


0,50 


l.l<£ 


0.50 


0.50 


" 7 


II 


. 0.8 


0,43 


0,57 


1,30 


Oft? 


0.57 


8 


u 


. aa 


O.50 


im7 


lltO 


0.67 


0,67 


- 6 


■1 


1.1 


O.flO 


0.80 


rno 


n.80 


0.»0 


- 4 


H 


. 14 


0,75 


1,00 


2.-25 


I.OO 


1.00 


" 8 


■■ 


1.8 


l.flO 


1h.^ 


3.00 


J. 33 


1h3S 


" '1 


II 


2.7 


1-SO 


■2.00 


4.SU 


2.O0 


2.0O 



r 



Malted Gniels. — MaJtwl gruels are advocated by some, 
e^pecinUy in prtpiiring milk lor infuniA with weak digestion. 
They n re prepjireil in the fnllowiiig manner; A tahle^poonfol 
of barley Hour orof aiiv other flour de^fre*! is boikd in :i litUe 
more thnn a pint of ^^uter for fiil*?<Tn mimit^^s. As st>on a* it Iiaa 
<^nole<l ft t4?fl«ponnAil of n po™l malt txtmct or a tcaspoonful of 
ilin^^taw iw wided. Thin mixture is fttinvfl thomn^My^aiifl may 
then be used tn the place of ordinary bnrley-wal^r, Diaata^ 
prepanitioDA are made bv mot^t of tlic lea^ling mauufactarini^ 
chemii«ti«. Diii8t<jidr vaixAt: by iht^ iimi of HorlidCj maltine^ 




Jf/XA' MODIFICATION. 



23a 



oihI diiLKymc are pre|)oratioiis of this claj«. The thit'k malt 
cvtracte anr fiotDctimcfi given 1q iatontfl jiiat kn^fore s ft-uding. 
Of lh(«c, eovcTui dos^ may be giveu daily for indigi^Ucn imd 
€on«Lipaliiiit. 

C^hapin »ii^Q:;rf«t« tliAt a hom^-oifulo d^ouciiou uf mult be 
oi^eH ju making roAllcd gru«L Hic^ directioDB arc un ft>!]<}V9 : 
"A tflbl^poonful of malted barley*graiDa is put in u cup, and 
CDODgh cold water added to cover it— u?iiially two inMifpoon- 
fiilft, flf tlie msiit quickly al>?orlis f^ome of tht? water- This ifi 
prepared iti llie evening and pla^e*! in a refri^-mt^jr over- 
ci^t. In tbe momiug the water, looking likt- ihiri t^'a, i« 
nmoved with a «por>Q or skimmed oG; and is rwuiy fop use. 
Alxnic n tables p(x>nful of this smhition oan be aeeitred and im 
Ycry nclivo in (Huf-t^urv. It \a bullk-it^iLt to dc^Uuim; a pint 
of grud in ten to fii^een miuutee. Thk should he prepared 
frt'*U every d«y/' 

Vegetable Broths. — Edsallaml Miller have experimented 
with a lieiiu ilour, in which the nlarch is predipej^led by means 
of a <)i;i8tnj^ic fonin-jit. Thry have found it useful in digestive 
di&t!irbfln04.'8 anil malnutrition. M6r}' reooramends the use of the 
following vegetable broth an a fiub^titute for milk afUr gai«lro- 
eutoiti^: 

Polaloo* <Ki ^aiN 

C^ttrrou 4C 

Tumip- \h " 

Urjod pca« " 

tTltJ Uvni 

Wulcr 1000" 

Boii iu a w^verwl lartlien pot for four hours, strain and add 
wator to make 1 litre, and o grams of i*ali- 

Battermllk as an Infant Pood. — From time i*} lime 
buttermilk has Ix.'cn mlvncalcil as an infimt fotnl. It i.s used, 
mogt frwjuontly in Hollund, and bus n.*oi!i»tly bad mnny <*x;m>- 
nentft, among the most prominent of whitrh if4 Teixeira de 
Mattos, of Kottcrdnni. 

The btittermilk is pre[>arud by mixing a quart of the milk 
and a table>|x>ouful nf noe, liarley or any other flirur desired. 
It should lx< fieatiKl gnidnally, stirring ixitistimtiy until it ha« 
boiled up eevend tiiins^. Two or three mLled|Nxmfula of sugar 
are then added. About half an hriir i^ rt^uired to pre[>are 
thU mixture. T^bt^n finUbinl, it is of a y^ttovriah color. lb 
dtotdd be poured into l>ottliNt or jnr^, and if it becomes lumpy, 
it should be sbnUen thoroughly. This mixture it; ti>M*d for 



au 



INFAiiT FKEDim, 



infante of a\{ iigu4 nnd in about the tisual quantities. It is 
vrf}' highly extolieJ hy it^ advt>cates as a fcKxl for DoimnL 
bobicA and also fvr tbo&e wJtli digeetivo disttirbuiicwe and 
mamsmiift. 

If buttermilk feeding is commeDoed suddenly, TotnitiDg And 
diarrbea nmy follow. If, however, its use » [jersistol in, ibe 
digestion aoon returns to the normal. It \i^ al^^o pg^id that an 
revereioQ to sweet milk will cause a similar dit^turltaace in ]>iil* 
termilk-fed babies, and that the chang<» -should alwaya be 
made gmditall/f by mixitig bLitternnlk and sweet milk together 
before preparing tbt» food. Tbc aulhoi-n bavt haJ uo expen- 
€OOo with this form of ftHxlJnj^> 

ItftmO£:etl. — This is a filerile, mftdifiL»d milk t*ons«*rvr, manu- 
factured according to the nietbixi and under the 3ui)ervi8ion of 
Professor Biedert. It has l>eeii hitrhly rw^jtiiuieuded in Ger- 
many ami huA been inti'odLieixl into tbeUnite<i State-s. It i^!«old 
in caus, aud (.niiulsious of it are made either vrith milk or 
wat«r, according to the age and condition of the child. After 
summer iliarrheas water emuUiono are used as dilute, as I : 30. 
Ill piviEiatiire or w<?akly infante dilutioni^ of 1 : 20 are recom- 
mctidcd to start with, using later atrungcr emulsiona aa a ohtld'a 
Oondition improves. EmulGions I : 13 and 1 : 9 are fre^jiiently 
used. In i^nstipation 1 : l*-8-7-5 may be trie^l before adding 
mi)k to the mixture. Ramogen may also l>e mixed with barley 
gruel and with veal broth. In older ehildrcn cmiibitjng are 
made with Ramogen, milk and water. The cumposttioQ of 
some of the% emulsions i« said tu be as follows ; 

A.- RAMOGEN VATIR EMULSIONS. 



L I 
U. I 


13 
9 


Frulfiln 
- 0.61 
= 0.95 


7M, 
\A 

iio 


3 
4.50 




B.-RAMO0ENWATEII M11.K 


EMULSIONS. 




L 1 

V, I 

3CL 1 

XV. 1 


Wfttor. 
IS 
13 
13 
13 


12 = 
16 = 


1 
LA 

1-9 
2,5 


IJ 
2,10 

2.80 
2.90 


a3 

S.T 

4.1 



Siegert uses mora coneentruted emubirins, and advises the 
addition of flugar. Ramogen^ as ^d, is said tn (luntain in 100 
parts : protein, 7.1 ; fat, 15.5 ; aii^ir, 35.5 ; s»lt«, 1.4. 

Gartner's Milk, — Thia iaa i>ropri(>tary modified milk first 
prepared by Qartner. It U made by c^ntrifugalinng a mixture 



■ 



miK MODlFlCATtOK S8C 

of ecjiial parta of cows' milk ;ind uf r^terilized vraler. The oilxi^ 
arc ia put luto a gpcoia) nuichinc and rotaUnl ao rapicUj^ thnt 
it is &oi»iraU<d meohaiiicaUj' into a creamy milk aaa ft skim- 
milk. The cream iTmn drawn oW d>nTain« about i\w flxme 
amoQilt of fat and protein as id avcra^ tnother'ii milk, itnil 
fiUiEar iH added to U to bring thrf pea-^Dtage up t4> alK>itt 7 \wt 
cent. Wbcii freyh, it has bwn u^ed with fiuccem in feeding 
boUi sick aDd hi^lthv mfiuitd- 

Backhaus' Mllk,^Thifl u a centrifugalized milk that has 
beoD »ubj(?c!ed to the actiou of a tnlxture of renoetj irypsio, and 
fodiuni carbonate. It i« m<xtifit.s] witti t-TWtu uiid Au^^nr of 
milk, and etcnIizGd, It is made in three different dtrvngthtf, 
haviQgp it u said, the following compositioa ; 

I. II. UL 

Fkt a.1 $.2 aa 

Bugtr 6.0 a4 48 

Pn>twi ....,.....*.. 1.6 &1 U 

Aflh 0^ 0^4 M 

The firat mixture eontaimi 1 |)er cent, of laotalhumin uiid 0.8 
per cent, of caaein. The others conhist chiefly of oomiu with a 
ituall percentage of laotalhumin. 



ARUnOAL FEEDING. 

In the methods of feedmi; just descril>ed the addition of &ri- 
naceous grueU— t. €,, barley, oatmeal, arrow-root, rice, etc. — to 
aome of the foods baa been recommended by oertam observers. 
That such addition to the infitnt's dietary during the fii^t year 
IB advi^ble is a qtiestion that hftf not been fully decided. 
When deemed necesrrary, it i» prubahly be£t U> he^in the 
addition of a ^tarohy gruel to the milk at aboat the eigbtb or 
ninth month in normal tn&ntd. In those infante whr> expe- 
rience difficulty in (ligeHfinpj the proteins, as will l>e explained 
nnder the heading of the Feeilin^ of 8it^k Infants, and for the 
purpose of preveQtii)^ coof^lation of tlic milk into lar^ clot^, 
the addition may be made earlier. It is well to be^ by 
adding a half-ounoe or an onace tor each feeding and, a^ tbe 
infunt';^ ^tarch^igesting power increaAefi^ to increase tbi« amount 
pro[)ortl(iuatoly. 

Bcginoing Bottle-feeding:. — In order to micceed it is 
necessary that this nietliod be be^n properly. The percentage 
ufl«d to begin with should always be well within the infant'a 
digefttive power, and rai^ as rapidly as possible to a milk 



JXFAXT FBBDiyO. 



suited to tlie oge of the infant. It Is u good plan tc start with a 
milk givcu in the $<.heJulc f;>r n baby oi»>tbird the agv of the 
ODC to be fed. JjicU day, or even st longer iDtcrvalb if iit>ccft* 
eaiy, the milk may he mado slightly etroQger. If-tho milk 10 
made too Bfrong nt first or tlie perceDt^g^ raised too rsipidly, 
indigeBtion, «)lic, and offent^ivc stool!^ will \)g the result. On 
the other hand, the opposite miHtake, thut of ft^ing aa infant 
on a milk too weak, t^hould Aim be av^idct). When thJA um- 
take is made, the tnfant becomes pule, eries, and do<» not in- 
croLfie in weight. Severe hunger may result, and 6ymj>toinJt at 
inunitjon imiy fi.»L1ow. 

Tecbtilc of Modi^ing Uilk at Home- — To j«*urc 
sucGCM in bc>me tnodifioitinn a verv oirotal tcchnif! miirit he 
followed by the mother or the nnrse, lu the ub^tioe of a 
nurKc sppciftlly trainf*d for tlie ptjrpo^e it Iw^r^impfi nerewyirj' for 
the phyeician to give caref<.il wrilteu jiod vltUiI iuHtnnrtions, 
and then to see pereonnlly tliat these are curried uut. Knowl- 
edge on the i>art. of tlie mother or nurse shoold aot l>e aTriciimrd, 
for, Hi u rule, she dix^ not ptiswv'id it. There art; uiany nun^e:*, 
both grfldnat« and otherwise, whose (loneeptiouft of infant fe<.*d- 
iug and milk preparation arv pnictieally uei^less. Like many 
mcdiail ^^tudeat^ and recent ^^ra<liiate3, they understand more 
about laparotomtci? thna tliey do about milk. If this is home 
in mind, mnny unpleasant eiperk^noes may be iivoided. 

The vessels and instniment^ u&e^l 4io«Id be kept scnipulously 
clean, and he used solely for the purpose inten*l*xl. After use, 
or, whnl is de<.iiiie<lly better, just previous to being used, they 
should l>e either boiled or scaildi'd with (soiling ^TaUT, preferably 
the former. 

The Dursing-lKHtles .'fliouid have rtumded bottoms, !*o that 
there are un c^irncrs for holding dirt, and uW tliul. ihrv run not 
be stwHi ftlxmt the room. If only one or two hottlc/* nrc ilw^, 
they should l>e s<>nld«l aA^r each fee*bng othI IiIIih] nJth^r 
with horio acid or ^>odinm bu^urboaate solution, made by adding 
a tcaspoonfiil of either drug to a pint of waler. Wfien the 
bottle i» to be useil a^iin, the* s(^lll1ion .-^lumM l>e ponr*^! otit 
and the l»ottle rinf^tni with pliiiii t*tmk' w;itpr. 

The iiippW ?^h<mld l>e of ihe ordinary .short hl»ek-rubber 
variety. Wbit<^ uipple^s which are eaid to contain lead, aa 
well lis all eomplicaied uippleu and tube^, should be avoided. 
These latter c^n not l>e kept clean, and a«- a Bourw of infection 
in diarrliea. In Home eiti« their sale U probibi(«Mi by law, 
AA^r tmch fi^eding the aipple abould be wattbed, fnrning it 



P 



MILS MODIFiCATIOS. 



237 



iDudbont to do thb* tlioi^tighly, mid tiioo placed in i g]Ai«» of 
bono acid solution [^ :0j). It h a ^xxl plan u> ImvT Mrvi^ral 
nipploi on hatul aud \a* 1x>il llu'in l>ef<:>re vuiw^ tficm for the 
fimt time, and then for five mintilOH evm' day. The hole or 
holefl ]Q the nipple should be jur^t large enough U> allow the 
milk, tu dru|> uut K^mt^what mptdlj'. It sltould uoi iluw oul ia 
a fitreacD. If the holez* are too Hauill, tUi-^y itmy be «ularged or 
IMW iloei made- by u^iiiff a rvd hot duruiii^uctHlli?, Some 
nipptoi are iMaiK- wiriu^t lioU'S, ami ifwi"**' may Im> pedriratiHl in 
the ttamc manner. When .sevend healed are so made iii a 
nipple, the nulk may not drop very laf^l, but the fi>od i^ea^hes 
the cliild rapidly enongli, a laoL that may easily be demon- 
strated if the nipple iri graj^ped between the tingers and sucking 
movemeotfi imitated. 

Preparation. — It la best to prepare the entire quantity for 
twenty-fuur bourft at one time. If the wt^ather is warm, the 
milk must be PaDtouri^*d or DterillA^d immi'diutL^y (i^« seotioa 
on Milk). If neither can be done, then, mtless the weather ia 
€oId and a clean milk can be obtained, but one fee<ling ?ihould 
be pmared at a time. 

if me to{>-miIk method ii^ uvod, tbc milk vlioiild be reccIviH] 
in bottler. In all citit'tf tlifrrc aro reli;ib]e ilairif.^ that Mtpply 
milk in bottIej4. Wh(*re thi« i!* not the cntfo. the bottl(.<?« should 
be fiimi^hod thr milkmaD^ &nd arnin^'inent:^ can f^'nemllv be 
mnde by which tho milk *ill bi* poureil iriln Iht-m a* won uj« 
poi4*iblp nft^r milking. After the milk linf> sloixl lor at lou^ 
fivv: hours, the firet mJDco rtf orctam muy lf>c removed with n 
epooD nnd th^ remainder of the upp^ one-tbinl or one-half, aa 
the ca;^c may be, mth a Chapin milk-dipp^. Another method 
i» to \i*e a bent gla&« tube and siphon ofl' the lower part of the 
milk from the bottom of the bottle, or the top^oilk may be 
poured off with reasonable accuracy. 

Tb<* phy^cian ifhouli] always write out th<* qiiuntiti^A to be 
Ufted fftr prermrin^ tlie milk. The milk- or cane-*tigor Ih di»- 
aolvc?d in hot wiiU'n Oirc rtlioidd br tiikt^ii tjj ii>e a i^ugnr ttiAt 
given a clrnr »>lution without Httmn^;. IF tho solution itt not 
clear, however, it ehotild bo (iWrod thmu^^h ft wad i>f ootton 
pluetv) in the bottom of s funnel or throngh a piecH> of drug- 
giMt*T< filter-paper. This suhition, together with tlie !imt*-wiilor 
or wvlium bicjtrlx»nate, fihoiiM he |M>un.Hi into a pitclu-r. Into 
thirt the milk, or milk and cn-nm, should be poured, and the re- 
mainder of the wati^radiM. The water ^ihouldal ways be boiled. 
The mixture ahould then be j«cirred and pi:»ured into the aursui^ 



28S 



IXFAXT FEEDiyO. 



boltl^. The bottles should then Iw stoppcrcJ with moderatety 
tiglit plugs of non-dbftorbent cotton, to keep out IjacU-ria. Tbe 
bottler nrc llien Pttsfeurized or Bt<*riltzw] unil pliunkl in a refrig- 
erator- 

At the feeiliiig hour tbe Iftottle \a takeu out of the refrigera- 
tor, placed in a piti.:her or tall ves**-! of h<it water to wann it, 
tiiv outtott plu^ removed, and a iMpplc ^tib^titutod. TLt* milk 
should bL' Louk^d imtil it is lukewai-m— tiUut 98^-&9'' F. Tb© 
nippk shouUi Ui^wr \w pla«d in the ntontb to 1<?st tbe lieat, 
but the milk may l>e allowed to drop on the wri«t» where it 
should feel warm, but not hot. 



FEEDING DURING THE SECOND YEAR. 

During the seoood year of life as much care h rwjuired in 
fteding ae during tlit first. The f«iir of the secooJ summer 
would hirgely be overcome if the child were not. dlowcc! to eat 
food tiDKuited U* lt» diction. Tht^ fact that eotne children 
thrive on almost any kind of food h no excuBe for permitting 
ft child to have ihe same food as its elders, as if< so otlen done. 
Mo!^t of the ilhirss and many of tbe deaths of cliildbofid are 
trtwrublo to impnt(>er diet. 

During the &eciio<l yt^ir tnllk ^lutuld form diel>aaie of ttie 
diet. In citiee or where the roilk-eujiply is not above suapi- 
oion, it is bcfi to Prtsteuriico the milk until xkic eocoud Bummer 
has been pae*;ed, or even Innger if (■Irfiumfitaof^es warrant. A» 
H nd(^, the ndlk requires hut little medi^mriOD, find af^er die 
eighteenth month, and often before, may gi-nerally l)e taken 
tinmodil^ed. As iIk* child is now ahle to digest aCarcliy food, 
milk'-sugar tDuy he omitted. In ease^ wliere the milk Is not 
thoroughly digested, as is evidenced by curds in the stools, 
lime-water may be used, and may be adde<l in qTjantities of from 
5 to 10 per ceiiLj or even more if ni?een«iiy. If llie milk 
IB very rich, it Bhould Ijp dilutiJ cithor with lime-water or 
usually with plain sterile water — thn-e piirt* of milk to one of 
miler. If ihi^ milk is |>iior, or if milk tlmt is not rich doea 
not a^r(<e with the child, it ma>^ be prepared as follows : Fill a 
trhisj* three-^inart<*rs full nf milk, add one or two tabletipoonfula 
of cream, and fill to the fop with phiin water. If this does 
not answer^ add a tablet {Kxinful of lime-water. Ihiring ill- 
De^ and of^cii under other circumstances the alkaline carbo* 
uated waters will be found useful for diluting the milk. If 



^ 




FEEmSG DVRISQ THK SECOND 7KAR. 239 

the milk b poor, uiother plan ii t6 lue the upper two-thirds of 
the milk^ 

Starchy r<Mid iniiy Iw pv^n in the form of ^ru^l, Htti4^r aian 
or, wbal i« Iti'tJ^-r, rriixKl with the milk, Barley-^niol or, If 
there \^ n tuidi-my to (<oti»t]|>utiuik, 4)aUiieuJ-|^rud m adiltiJ, on^ 
flftb or on^fi^tirtli ])iirt of gruel l>etng iMldei) to <ttoli f<-<Hlii^. 
The ^jcl «hoitU] be fre^l^r prepared and uixod imnusdiotcly 
with ih^ milk. A pinfh of nalt. atn! li v(>rj" »mnll fjnnntity of 
cane-sKignr may l>e w\i]v*\ to rt^iitU'r it more jmlatjilik'. It may 
thea \ic I^'teuriiuxl like vrvlinnry milk. 

l>urini^ tlie ^txoml ymr fivo niwilri at aLx>tit four-hour inter- 
vnU »houM be jjiven. lliu lw»ttle should be diAjK-ncivd vrith, 
ami ihtr food W tjik**ii from a nip nr ?*j>ooa. If the bottle w 
Dot tnki-n from xhv: MUl etirly, li niny Ije ditficult to break it 
of the botlle liiibit^ The followiDj^ itid-lLHtf^ for diflerant ag«4 
win be foand i»t<cfii1 : 

7\eplfth io fyU^mth Mtmih. — Milk ; (mrley, luitiiuwl^ whoat- 
flonr. fiinnn, or nrmw-ront gnu'l ; bjirhy or ortfrnml jHly; 
tightly boilod yolk of egg, given witb stale brcsd-cnimbH. 

Beef, mutton, and ohickec broth^ chicken jelly, bn-cf-juiee. 

Omnge-jciici.' or (he jnice of othcT ri|w fniit^ as of p«Lchc«- 

FitBt meal : On wakiug, the child should receive a citp of 
warm milki modified &h previouj^ly eitggcetcd. If the cbild is 
accustomed to waking very early, more milk may be givea at 
about 7. A. M. ; othenrtsc tbi« Iwt may be regarded a& the flr^ 
meal 

Second meal, 10.30 a. u. : Kight oime^ <if warm mtlk and 
barley-gruel. Third meal, ^ f\ M. : One of foUowiDf^i^ 

fa) Eight ounces (a cupful) of beef brotli. 

lb) " *' " " veal " 

(c\ ** -* « " mutton « 

{ft) " " « ** ehicken « 

(e) Yolk of a lightly boilod c^ willi KtJile bread^cninibH. 

Fourth mealf 6 i\ u* \ Eight ouqcvb of milk and baring- 
gniel. 

Fifth meni, 10 P, *l» (if requiro<l) : Kight nuntreg of milk. 

Onmgp-'jni<^^ one nr two taht««ponnfulii at n timfi may be 
given one hour before the 10.30 a. h, feeding. If there is a 
tendency t/> hw** l>oweIs, this should be omitu^t. 

If the cbihr* np[>etitc in very good, a nmall piece of zwie- 
bB<*k may l)e piven with either the Mvond or th<' fotirtli roeal. 
ThiA should not be iKtiiketl in the milk, but the child should be 
allowed to aibble at it drv. 



S40 



JXFAyr FEEDSNO. 



FyUeix to EigkUtn Months. — Sume as above, together with 
EWJeback, stale bread (oven-dried), whole ^ga very soft boiled ; 
stnLioed oatmealf barley, or wheal porrid^ ; bread and milk, thin 
biscuit (cruckerK)^ junket, scrajjed raw bec^ or mutton in very 
smidl qiiuDtitira. 

A Sample IHct /or o t^Ud of l^fieen to ^^htet-xt MoiUJia, — 
SreaJ/aslj 7 A. M. — ICitber {a) two tAblo^poonful^ of a eercfil 
jelly (oatmeal or nther grain as de^ired)^ wilh Halt and two 
tablef^pooufidfl of cream, and eight oimcefl of milk to drink; or 
(b) a bowl of bff^ad and milk containing; eight ounces of milk 
and a slioe of stale bread, 

i^oTut Mcal^ 10.;iO A, M, — Milk, with a cracker or thin alio© 
of atale bread or u piece of zwiebjick, 

lliiM Mi-iii^ 2 v\ M. — One of ibe f<>lluwji]g : (a) Very soft- 
boiled egg with ftole bi'e^d-et'UDibg, {h) Eight ouoceA of broth 
(beef, veal, mutton, or cbicken) with etiilo broad-^rnmiba or a 
little barley abided to it. (p) A tablesfwonftil of mashed baked 
potato with meat broth or ^mvy (one to two o^lnf^es), or with 
two lableepoonfula of cream. Milk to drink. (*/) Scniped raw 
beef or mutton, two or three table^jxwnfuls on n ** biinqiiet 
wafer," witli a cnp of milk. A table^poonful of jnnket may 
be acided tn any of these, 

SitpjitTt 5.30 or fi p. M- — Eight ounces of milk with a piece 
of Kwieback^ u slice nf stale broad, or a cracker or two. 

Fifth M<ra, 10 p. M. (if ni-e<W).— Cup of milk. 

Fniit-juice may be given, as previoiisiy directed. E^a should 
nol l>e given ofk-tier than twice a weolc, as cbitdren tin* of tbem 



Eifjhirtii MonfJi^ fo Titv} rtTwi Out-Half Yearn. — Milk is to bs 
Vi^rdcd m tlie chief article of diet. Many childreo Iiave no 
desire fiir otber fmni.'^ until after the second or third year. These 
eiiildreii will generally be fnuud U\ thrive on milk alone or with 
slight additions to die diet. As the child's digestive power in* 
crease^ the foUowing urtideA may, however, be :idded one st a 
time. 

Fruit : Juice of ripe fresh fruit, thiit of oninge.^ and jjeiphes 
being best. Rijie fresh grapts skinned and f^eeded. Baked 
apple — piilp only, die skin and secdu to be carefully removed, 
Stcwe<l prunes tlie skins to be removed by pai«?iing through a 
sieve. 

Meats: Scraped raw beef or mutton ; rareron&t-l>eef or mut- 
ton pounded to a pulp. Chicken or turkey, the lean white meat 
miDcei] to a pulp. 



FEEDiSQ DVRisa THE SECOJfD YKAfi. 



341 



V^tablfH : MaAhed hi\k&\ {xriato witti cTtnni or covermi 
vrilii )^nivv fruii) rtiiLil uunU. IT die lattt^r Is vttry Tut, itw fiiL 
ahoulii be reuiovtjd by tikixaminf; ur l>r nicttDnofa piece of blot- 
ting-paper. Very well-<.N>okvd mjhiucIi, mk-r}', and cauliflower 

tO|M. 

CVnuIn ; WvU-boiUHl rice luid other wdl-«*ukwl rx-reuls alrfsdy 
D>eatio«ed. 

DffiM^riA : Rnil^Hl i^u^rc), milk ftnd ritte pudding, junket. 

Four mealH will ^enL-rally suffice aflcr iho eigliU-eiitli monlli. 
Tl»e (<»ll<iwin^' diotary will serve aa a suggt^tioii : 

If ih€ child w:ikc8 early^ a cup of warm mflk (alx ouno4^). 

Brtni^ad, 7 A- M. — («) Four (ulj]frB|H>oiifuln <ff uutaieal iMjr* 
ridge or otlier cereal witli nidt and two tubk^poonruln of crvum ; 
milk lo drink. i^tA Yolk of a lightly boik^l c^ witb icalt and 
bread broken into it ; Riilk to drink. 

Sfcmd Meiil^ 10,30 A. M. — Cup of milk witli two iwda bi«^ 
emits (crackers), »life of bread, or a jneoe of zwieback. 

Dintxer^ 2 p, K. — One of the following: (a) A bowl (eight 
ounces) of meat broth wilb rice, barley, or breQci-<*rumbe added 
to it. Slice of malo bread ; junket or rice and tnilk pudding. 
(6) Tablus|x>oufnl oi" wbiie meat of cliiLkeu or \>i' rare l>et'f or 
mutton, cither Mraped or pounded to a pulp. Slice of Htale 
brmd thinly biitfcrt^!, juiikvt, ri<v or milk pitdding, or a boil(?d 
c^UKtitnl. (i*) Fc-rffH'lly fn>Kb )>iiil(<l Hi^b {\\\v whif^^ m^^l) with 
a tablc«poonful of iiia^tbed bjtkcd potato nioUtened with cream. 
Dcfiscrt aif in preceding:. 

Supprr, />.30-6 P. M. — A bowl of bread add milk or a 
cup of milk and a &lice of bread or a piece of zwieliack. A 
cup of milk nmy be given at about 10 r» m, if n^cs^ry. 

From two and one-half years up to the siJiili year the diet 
of tlic child may gradually be iai.n?ased. Milk should *till, 
however, he tvkcn in lar^ <]uantitic6 — about o «jtiart daily — 
an wi'll nit »»omL' form of ooreal for hrenkfant, with or witlioiit 
an *ygg,tiT fri'fth fruit if there i^ a tendency to constipation. 
Meat prepareil a^ al»ove diouM be given onoe a day^ and 
preferably at th^ midday mfal^ together with potato and Mjme 
grt'cn vi*p'table, as Jipinach, asparagtw, or cauliflower tops. Th4* 
evening meiil should t>e liizhtr und conr^ist of braid nnd milk. 

It \si well lo prepare two lists, wbiclk may he ^ivcn bi the 
uurAe ur mother aci a K^i^e* One list abould cnntnin thr f(N>d 
allowed, ar»d the other VkX th<«« forbidden. It t;i not well to 
depeDd on verbal instructions, as tlioy ar« «a»ily forgotten or 
miAeonsitrued. 
IS 



S42 



INFAyr PBEDIUQ. 



The Dut /ran Two and Oar^aJf to Sia; Yctirn. — MUk may 
be allowed vrith t-vcry m«il (may be omitle<l from dinner if dc- 
Bircd). The average child should t^Jtc a qiinrt a du)', plaio or, 
whoD plain millc h Dot tboroiighly digested, modificx] oft for 
twelve to fift«*en months. 

G'mf^ — Two to eigbt ouiico« n duy mixed witli tbe milk, 
taken ^ a bevemge, with ccreuls, tic. 

Bread and biscuU tnuy be allowtnl with ever}' m«il— fl^tul*? 
bread, dried bread. The so-called " pullwl breud,*' jcwkbuc-k^ 
and the various (oTm» of biscuits or cnickers. 

Orceifo. — Abno^t nay kmd of crreal for brcukfu^t ; outinoul 
and wboihin ^t*» are the best. Bioe and homuiy for dinner, 
B&rlcy ]8 tigcJiil in j^otJp«p 

Vrgff/ihifji may be allowed for dinner — potatoes in some form 
or a wreal w-ith one green vegetable ; spiaach, amliflower tops, 
and the like are the best. 

£^g« are very gooii, but ebildren are apt to tire of them 
efl«!ly. They i^Jionld be given for bn^kfo^t, n^ u rule, but 
never day after day. 

JWeiil. — AlUiwpd on(!e a day for diDDcr und in older ehitdren 
for breakf;t.'«t (Xx:afiiL^iml]y. Boiled or broiled fisb tua^ be given 
for brcaktast or dinner. 

SrofJw and soups of tilmple ooropoeition may he eaten. Meat 
broths with cream and iTrralu are especially niitritina'i. 

Dfjt«ir(9. — Onoe a day, with dinner. Plain cuf^tard, milk 
and rice pudding, broul and cuBtard pudding, and junket are 
the b'wt ; iocKjrettia oik* a week. Fruit should be given once 
iiftily, and otdy ripe fresh fruit, in eea^n, should be used. 
The hojit are oranges, bilked iipples, and stewed prunes. Ripe 
jfeucleHf jjeare, gni|)et4 without ^kins or seeds, may alto bo 
given. Frctih juic€ of berrit« in small quantity, strawberries in 
perfeet oondittua eparinglvp Ripo cantal^tapc imd watermoloTi 
in mfideml*'' fjimntUie^ may al»in be allowed. Great mrv flhoidd 
be u»ed in chmwing and gtvinp fruit to children. It ib a very 
iinportaat artioJy of diet, but if stale, epoilefl or unripe, is capa- 
ble of doing mueh harm* Too much should not be Riven in 
hot weather. I/*monade is useful during very hot weather, 

AocuRUixd TO Mkai^. — Brmkfmt — Every day, milk to 
drink. A wt-lt-t7)okef] eereul, with salt and crvanii but little or 
DO sugar* Bread and batter. 

In addition to th« aljove, one of the following every day : 
Eggi* lighOy boiled, poached, and for older children ecrambk^ 
or made into a plaui omelette. Boile<l or broik^ l^«h. For 



FEEI>INQ DVRIHG THU :iBm^B YEAR. 



243 



older children a vei; litUe fioeJy chopped beef» mutton obop, or 
bee&teuk. For youo^r children meat at breakfast ja Dot, as 
« rale, iifceawiry. Fruit uiuy be given before or after bieak- 
fatft, during tlie latter port of the morouig, or at about tioou, 
Oue vaHety d-iily, and if there i^ a qjx^cial teudeucy to eoDsti* 
pation, stewed pnioes or baked appU's iwiiy 1^ ulloweil with the 
dinner, hut not on the days on which they lia\'e been uwd 
earlier. OraD^fi, baked apples, stewed pruEies, petiches, pcitrs, 
grapes without seeds or skins ; ripe apples (the softer varieties 
may be t^ivun ; tikose kaowa by dealerB as " hard *' apples are 
Dot suitable used raw). 

J9mn<r, — Btvad o^iid butter as desired evvry day — not to be 
eoten to the excliiAion of other foods^ however. 

Onf soup each dny. BoLiilJoii, beef, vt]«I, mutton^ ohioken^ 
or oyster brotb^ which may be ihickenwl with barley or other 
oereals (either grain or flour). Milk and cream may be added 
when demrable. 

One meal daily — roasted or broiled. Beefsteak, beef, Iamb 
or mutton chop, rare rou^t beef or iimtton^ chicken, white meat 
of roast turkey. 

Two I'c^dabfeg dailtf — one greeD vt^^etable and om^ other 
dish, usually potato in some form, should be giveii.^ Potatoes, 
baked or lUoaLodT tauliilovi-t^r t<iiJttj iid[)urugua-tiprf, stewed otWvj 
spiuach, h^jminy, plain nuiUirvrjij tiiWied p*^M^ young ^tring- 
heanA, and almost any grwn vegi-table in aeaAon. 

DfMni. — Junket ia tJie best, mid may be given ni<»Rt fre- 
quently, but rice and milk pudding, plain e^sta^], oiid plain 
tapioca pudding may hIho Ik? u^ in small quaniilies. Ic^ 
oream otoe a week. Fniit in some cases may be used. 

jftijipcr.— Very light simple suppers should be given every 
day. Milh» mUk-t<pa:st, breail aud butter, and, for older cluldreo^ 
a little slewed fruit or baked apple, ivitJiuut too muth nugar. 

Abticles Forbidden (jifW Holt). — The following urtielee 
should not be allowed ohtldrco under four yearK of nge, and 
with few exoeptinns they may be withheld with advautage up 
to the seventh yeir. 

Mfnt^. — Ilam^ sausage, pork in all form^^ Raited fish, corned 
beefj dried beef, goose, game, kidney, livpr, baeou, meat-stews, 
and dreeing from mailed meat< 

V^finblfj'. — Fried vegetables of all varieties, cabbage, pota- 
toes (except when boiled or i-oaA(ed), raw or fried onious. raw 
celery, nidislu^, lettuce, cucuml>ers, tomatoes (raw or cooked)^ 
b«ets, egg-plant, and green com. 



a44 



rs'FANT FEKmya. 



Bread and Oalce, — All hot bread and mlU ; buckwheat and 
all other griddle-cakefi ; all sweet cakeA, particularly tboae oon- 
taining dried fruite and tliose hcsvity tTDHted> 

y>f«M-r/*. — All nul«, candies, pics, tarte^ and pastrj' of every 
de^wriptkoii; al>o ruilads, Ji.-1lic«, bjtij|)», und prt^^rvea. 

I/rinke. — Ten, coffco, wine, beer, and cider. 

fniUt, — All <lni<d, oannE*d, nnd preserved fmitd ; bananas ; 
all fniito out of wtMon and stale Ihiitf)^ pArtioiihrly in fnim* 
mer. 

Tile meals should be given flt fixed liourSf which practice should 
be fitrictly adhered to. Fe<xling bciween meals, even when oon- 
sisting Gi the moi^t Lritling things, should be avoided. If the 
child can not gi> from une in<Al to anothr^r ^t'ithout discotnfort, 
the inl<.Tvnls should be ftbort**iieiL Tn wrt^iin easte it may be 
advisable to give a small cup of milk ^r hrolh and a erncker 
between the meals, at &tntcd intervale, ae m icc^ling youngor 
child mn. 

Candies, cake, and the like should be kept from young ehil- 
div^n. lu well-roguhitcil homed, if he once lenms that he can 
not have them, the child will 8ocin eeo^e to demand fiweeta, 
The frequent indiilgeooc in svtet^ts of various kin<U created a 
desire for them to the exclusion of other food. This craving is 
analogous to that for alcijhol in adults. Overindrtlgence in 
Bvreets eau^es indigeetioo, hendjiclie, aiul the like, ailments that 
may easily be prevcnte<l» 

The child ehmild be taught to eat slowly fln<l t<» <ihew the 
fond we!l. To this prt<\, Rom*" older individual sbniild always 
be present nt meal-times to see timt Rifficient time be taken for 
the meal, and that the food be finely divided, a# young children 
do not, as a rule, chew very well. The quantity given to a 
healthy child should depend on his appetite. In sirk children 
this is not a reliable guide, and, where p.issihie, fixt-d amountB 
may be given (see Fee^ling of 8ick Oiildren), The child should 
Dot he forced to eat, nor should he he given special articles 
to teonpt the appetite. If the fbod offered is not taken, it ie 
w#ll to wait unfit th** next iukA, when it will genendly he 
found that the appetite ho^ returned. IjOSR of npi>etite i?* often 
merely an indication that the digestive organs require a slight 
rest. 

During the hejitnl portions of the y«ir the child will reqnire 
less solid and niori' liquid fooil. Tlie same w ttiie during f^ick- 
ne^. Many of the ga^mvinle^tinal diAturhancea attributed to 
teething arc the? nmult of improjier feeding. 



DtET OF :sCffOOL CEIIDRES. 



*Mb 



Tb« followiDg ubles tftkcD from FnHMDfto' pv« ihts diet after 
one year of age : 





e4.K. 10 A,X. 


1 r.K, 


ftr>& 


• r.M. 


ALia&ca 


■ 

i-na.tttik 


S-Woi^mllk. 


iOflHsm«i, 
V Oft milk. 


IMOOL milt. 


S'lOGt.lIllU. 












Atlfrnoi. 




■ oft milk. 


■ Oft&Uk, 

340ft onuifv-JuJccv 


OL irau. 


■ OLDillL 


AlUmoL 




a«ft.a[U. 


«oftckttr»up» 
Boffrbollad ecK. 
Soft milk, 

■Md ftuOliulltr 


» ut. milk, 
aoftgrocL 


eoLuUk. 






«4Ania. 


4 UL vICb-RUUlf) 

!^1 ox. icmpcd 


Sot. milk. 
A 01. mtl. 
Prt4d «D<1 

butter. 


• oftmlU* 



IM <^f tU nir4 Yw. 



IVhL M. 


W A K. 


1 r.H. 


^^^o p. ■. 


Onnse^uioe, 
10 Oft milk, 
A Oft |cm*1, 
SoftrboitMl vg^. 

Srtftd ftod buiier. 


8 Oft null. 


6 Oft aoup, 
Meal. 

Ve^etablw, 


10 Oft male. 



Dki ^fl4rth€ Tlifnf Ytvr, 



BrvftkiUi 


DlDnvr.U-lMi. 


ftipper. ft r ■. 




Soofh 

finwj ami buitrr. 


Milk. 

BnaJ and buttvr. 



DIET OF SCHOOL CHILDREN, 

The prriod M^nailly wptrken of a?* *' school cJaya" is an px- 
treraely active one phyaically. The vast number of metabolic 
chaugtM ^I>^g "'1 a>i<^ the growili of the body ilentaod a plenti- 
ful nnd u fiuilabl« (Ikt. IWli lu and cut of scbool luid m 
iftRinitiaric9 <urdul att4^uUon nLuuld be ^^vvti to fooci, ft^eh air, 

■ Artkinm <4 P^diatrie*^ Joav, 1004. 



24S 



tNPAUT FKEDISG. 



ftnd exercise. In other words, tlie physical development 
should recmve &8 much attention ba tbt' mental ^^wtK Iq 
In^ardiug-Hchoolfi e^|>eciallv the diet should be the ^rnhject of 
cai-^tful iiiliniy, the aun being t<> avoid monotony and to provide 
a BUtiieient and satisfying diet. In many schools the diotary 
in left to the discretion of ttie eook. In ooiisidering Bcbool 
dietaritifi several points arc worthy of con ^i deration. 

Milk, beings cn^ify digcrstcd in moat cado^, ie of great valtiCi 
tcpeeially for children whow DUtrinon is below norma). It 
ahctuld \h* furnished as a beverage daily for breakfast and 
supper, and is advisable even with dinner. It may also be 
us(^ in the prejuimlioa of puddings und ^oup^. Crenm is vrry 
valuable^ and wbeuever {jostiibte should be suppltc<l tii Mifli- 
Gient quantities. A cup of warm milk with bn^d or onickcr^ 
is helpful during the middle of die moniiug ami as a subeititule 
for tua in the iifterrjijtiu, Deli(;att? tthildre" ami others may with 
advantui^ tttlcc agla^ of wurm tuilk a short time before going 
to l>ed. If tli^ rising hour is some time Wforc that mt for 
breakfast, a cup of milk or of bread nod milk 4muld be givnn 
on rising, , 

E^a may be used alone or In the prepanstion of various 
dishes. They may be used in almost any way t^xcept fried. 
Fried ^:s are apt to be very indigestible. "1 hey are often 
prepared in this way in order to disguise the stale taste of an 
egg that lui^ been in storage for some time. 

Meat is a very im|x^rlant pari of tlie diet, its it t^outatus a 
Ini^r quantity of protein, from which the ttsaned aro built tip, 
and in a more availnble form, than in any ether form of food. 
Milk and eggs are also valuable nourees of prolixin. Meat 
should be provided, therefore, in sufficient quantities, half 
[wund a day being, perhaps, a good averafl:e allowance for a 
growing boy, the larger and more robust taking tliat tjuantity 
or more, the smaller and more delicate children taking some- 
wlmi Ic^, Steak, diopw, itnd roosts of beef, mutton, lamb, 
fovrl, and bncot] are the most Auitiible meut«, althongli poik, 
t">getber with meat pt^-ws, meat pudrlirgs, ^4iusngc, and hashe?*, 
tuny be allowed in ^mnller <{i]antit]es. These last, while gen- 
erally rclifihcd, nn> not sr» digv^tible nnr aiich good sources of 
nutriment ns thos*.* fir^l named. With mre and proj^er prepari- 
tion many of their ill effivLs can be obviated- More mtat is 
ftipiired in winter tliau in tiummer, and more in c^ild climates 
than in warm, Y^ stated that too much meat may give ri^e 
toeccenia. 



DtBT OF SCHOOL CHlLDHBif. 



247 



Mmt maj be givco twice a day, unil egg?* or frub fish may 
lit- ^ub:<litiiUHl f(»r it ubyiil llirw* timvs « wc«k. WlicD the^e do 
iJot Mttirtfjr the appetite, luvut may be adtlcd. For tbu purpose 

Bn^ul uml l>iittiT Mhoi)t<i 1h> j^vitn wiUi ^laicb ni««I. Broad 
mwlL' fn>m Oio wbolo-wbcnl Hour dim/ be iuhiI in the largest 
qiuinttty, but it \» wt^l to »iitii>ly various kinJs r>f brmd, Ui uvoid 
nK>iiotMny, " Btx>wn brww giv<*(i corilmuouAly boconiea verj' 
tin?M>nie. Kye bread may be givun oci^iisioiially, and bread 
DiAde from tinxturx^ ofwbi<atand rvti is very pulutAblo. Hiiak, 
binciiii, and cnickem may alno be :^ii]>plk^. Corn-brew), wIic^d 
properly uutdo, iiuiy be givcui ot«^ a week or ofU'iirr, nad 
griddlo cukiii uf buakwbcnt, com, or whcet iloiir two or tiiroc 
tim4^ a week, Theait* Wt nmy be M>rv«d witb tsynip or fruit- 

Ceival porride^H of all kiniL* maybt; giv«i for bruiLkfii6t> oat* 
meal bein^ proliabty Uie DioHt dc^imblv. 

V<^tabl€A cf dmotit all varit!ti«>it may be ii^. For ditiner 
two varietiea should be giv^ji, one grwn vegetabb? and \to\^' 
toea. Salads made of tb^ gri-ou vegetablesT with the very am- 
pletit drest^iugti, are ujwful addltiuUB to tbe Ulet 

Fruit Tiliould invariably }>e given once a day. 

Sugnr libould l>e providiiHl for in the di«tury. OandlcM und 
many i>f tbe swei^ts given lo childn^i mtv bcirmfu! tind c\xv\tm 
indigivtion und dy&jwpsia. If proptT ewt't-t'^ were provi<kHi, 
lliero would Ix- slighter l<jndttricy to iriduli^ in ibe Ic*< dft*ir- 
iiblc fiirms whenever opportunity afTorded. With flie nie4di<. 
fliid when the appetite d^nimndrt r?dti>dying betw(*eu mt^^l-^, tlKfy 
may be ^iven with or without a gla.-w of milk, liegiilarity 
alioald, however, Iw obflerved, and tbej fihould not be given 
iinni<nliutc1y before or uA«r a mea), Fruit-eyru[}s, auj^ 
fiyrupn, honor, prt'Scrvwi fruite, find jam nuiy be euten with 
brvad. Cnnuntil», obotvjUte, maple-^ugur, ond phiin aiugtir 
taffit'.i are (be U^t of the otfier form8 of »weet8. 

Simple de^sertj^, Kuob am cut^tardd, milk puddings with rice, 
tapioca, and the like, bread pndding, plain oake^f and properly 
prepared paltry may l>e uwhL 

The beverages should he water and milk. Weak cocoa or 

chocolate may be given after the fteveoth year. Tea and coffee 

ahould not be given before tlie tbiileeuth year, and may be 

withheld advantagooualy fitill longer. Alcohol id not to bo 

, need except by a physiciau^a Jirt>otLon. 

Eapeoial care dimild be taken to avoid a monotonous diet, 



4 



S4B 



INFANT FKEDiSQ. 



for there are many inflUiDO€« where the constAiit repetition uf a 
<^rtaiii forui of RkwI haa cnsHwl at dl^lkt^ for il thai \\a^ iwr* 
BiBicd throughout life or l>c*fn ovtircouie only witli Jiffictihy» 

A aecomi point to be remembered ih that the food ahuuld be 
well prepAnxi »nd attniHivolv mtvh}. Tbn lia!4 more (o i)o 
witJi influencing the api>etili.' of clt^licate, nervnim cliildrt'ii tluiii 
ia generally Mipposea, aod cap not be inmsted upou too 
fltitingly. 

0\"ereating should be avoided, and to thih end an old^r 
penH^n shoidd always be pre^eut wlkcn practicable \ in school, 
thiff should be losUted upon. On the other hand, a child 
should Dotp thruu^li caprice or habit, be allowed to cat too littJf, 
By exeroLHiikg a littlu tact, moat of tbo dielikee which arc uot 
deeply rooted, but wbiob may beooine 8o if persistefl in, may 
generally be overcome, Thf^se dislikes are oAen the result <^ 
imitation. 

Sufficient time should be allowed not only for the meal, but 
for the performance of whatever small duties may be requirwl 
of the child, A time should be set for one or two regular 
dully viaiii" lo the water-closet. Hurrying to school should be 
avoided* Itcadin^ and studyiug immediately before and aAer 
meals should be prohibited, as should bathing or any very 
active exercise. Some ligLt form of recreiUioEi nmv» however, 
l)e indulged in. The hours for Toeal-i vliouhl be wi nrningrd 
that the child may have freshly pix-|»anHl nicjds, imd not c^jld 
luncheons or warmed-over dinner*. I.ai<lly» nihbltug nnd <'«!- 
Ing between meals, except under the i^ondilionH provi(ni:*ly 
dcscrilieti, should be strictly prohibilecl. In spite of ntnngent 
rules, bowcvcr, many infriup'meiils will occur. 

It m by neglect of the diet, fresh air, and exercise that many 
cases of tnbcrculoF^is ^in bi^advay j uneaiia may result from 
Bnch neglect, and ji dolicatc, ncrvoiia child be the outcome of 
onp i\vA.\ fihoiild, h\- right, [>» lifjihliw 

Diet List for'a Boys' School,— fi»vnA//w/, 7,30 a. m.— 
Ilatf-hour allowed. Fruit. A cereal with eream. Bread and 
butter, eggs, Ix^iled, poached, or as omelet. Fish occasionally. 
Com bread ouce a week ; griddle cakes once a week. Milk lo 
drink. 

Dinner^ 1 r. M. — Three-quartera hoar allowed, 8oup; 
meat — roant-beef or mutton, bteak, or chicken ; fish once a 
wfck ; [totatocd and a green vegetable. Homiay or Hoc once ft 
w*evk, vV simple de^^^rt ; fniit. 

fhpper, 7 P. M.**Ralf-hoiir allowed. Hash, cold meat, fish, 



OTHER FACTORS />" tSFAyr FEKmSG. 



249 



or omelet in email ()iiaiiliti€». Brtftd ai)<l Uiiur wiUi Byrup or 
preservnl fruit or fruit-juic«. Plain cake* Milk lo <lriDk* 

OTHER FACTORS IN INFANT FEEDINC. 
feeding in Infant Asylnms. — The R^Iin^ of infAnU 
in 0V«Tr^rr>wJi4i iTil'iinl su^vlikms, with lli«ir \iwk of froli air tiuti 
jmicity of uttetiddtitAf is a matUT of gn^t ilifTiuulty. Auv 
attempt at fcU^ntittc fei'diD^ iiDd€r such circiim»tanc<»« will uiti* 
maU'ly lead to failure, tbe method in tht^e^: ciim.% Ih^iii^ 1ic1<I to 
blaix>c- The primary' atu^ of m^ilhutrition and mum]<]UUA in 
iD»titution« is tin* luck of frcfli uir un<l iiiOividual ^iitv, and 
until tlitsv uiT ol>lJii»abl€ it is iiM^k'sg tj uttcmpt to uixiouipliHli 
any tiling by r*p(.Ti»1 fi-itliti^ iikiIkkL?. Id ManlW inntitutloaA 
tliC U«C of tli€ Mnlcrna gnuliinto will Ixr found rati ?« factory. 

In tW l»rg«r siHylumti it ik w<-11 to haw twi» nr tlirtf* giTD(*t»l 
workiug formiihw, *nch Ji> fal ;t jut wnL, j*ugiir *i pi^r oenl., 
prDtciu 1 per <n?iiU ; and fat 4 per cc»t>, Hiigur 7 per cent., 

t»TCleiii 2 perw^nt- These may be varitil W Ti<l<))itg more or 
tm vitkUT hj ttivm to ii(bk]>1 them rnipre 'IomIv Xo fi]nivm\ ite«K 
The yoiin^T infauts nuiy^ wh<m poseiblc, rtTx-ive J<iwcial iiitxt- 
un%. For aubetitutc feislin^, coudeuaeil tiiilk, Ixirby- and i^g- 
wawr will be found raost useful. 

The idlownm^t: of a frw (^e(iU< *i day gfiHTully tiimlt" for mi 
iofitiit'?! <;ri1Jiv (^irc; L-t qiiilc tDailcupiEitv to aotTompUflb miy good. 

The Infant's Stools. — A very fair conoc^tion of llie 
infant'^ dtgi-wtinn mn bi- obuiiK^I from nn (Examination of tlw* 
Mool»> Thi^t 4»*iiM be dour in nil ea?4CH, ami i» a.'^ Lfn|>orl;int 
a TVirt of tlif rontiue a,-* th<' ejcami[iali«m of the h<nrt or Iun^», 

The Mze of tho t^lool should be not^ fir^t, although tbia is 
not of very great importance, as it variea with the number of 
Bt4Xila aud the f^m and peculiarities of the child itaelf. 

Thi* uumbtT of mUniU ih always to be ooueidtreO, but ie uot 
neiLrly w> important a* iW ohiinnt^r of the ai*>ob An infant 
roay havo one or two etoola a duy^ or its many us four, five, or 
nx, but ao long as iht^ cliaraclj^r of lb<^ Mool remain?* ^roodt it 
may be n^arded as perfectly normal. Id <Jiarrhea tlie course 
of tlie disease is better told by the quality of the stools than 
by the number, and this may to a certain ejtletit be said to be 
true of conHtipation. 

The coa^istcnee of the stool of nursiDg infaoti^ should nor* 
mally be about tliat of butter, nlthoii^h piligbt varintiimH either 
way arc not to be rq^rdcd a» dietinctly abnr»rmid, The ^UmI 
should be auiooth, xuid ennlAin no curds or ^lid niuecce. In 



SflO 



ISFAST fESDING. 



constipatioD the stoolu are hard and dry, wbile in diarrhea ihej 
are soil or liquid. 

Lumps are frequently aeen in the fltool Tbefie are usually 
curds or masses of undigested fat. They may, however, be 
clum^M uf niucuA. 

MucUfi is predt'Dt normally in the atool, and ite presence in 
cosily demonstrated ; it should, bowover, be so intimately 
mixed with the stool thnt it can not he seen with the naked 
eye» Any irritatjon of the Int^^stinal wall causes a great 
increase in the amoimt of mucus in the stool. In diarrhea and 
in ]iiti!»tinul iudige^ticn there tnay he large amounts, and in 
coii^tipation cc^nsidemble mucus may cover the hiird ma»«eft of 

The reaction of infuutii' stools is usually a(*id or ncutnil, 
although 0(»mctimc4 it \h alkaline. Either acid or alkaline 
dtooU may l>c altered in oolor. A return to a normul oolor ih 
usually hmiiglit nboiit in these crises by the adminirttmtinn nf 
an alkali wheo the stools are acid, and mv€ rerma. Alkaline 
etooU, green in color, may be produced by giving nikalis in 
large doges for seventl days. The color of the stool ofU^ 
fiiniij^hc'S i>onsidcrable lufonnatton a* to the condition of the 
infant Normally the color is a light butter yellow, hut thi' 
BtooU may vary somewhat in this respect, and be lighter or 
darker. la young breast-fed infants the stool^i may be a dark 
y^-lloiv, like the yolk of an egg, In artificially fed l>obiod the 
etools aro apt to be very li^tit Jn color or even decidedly whitish. 
Rbnbarb imparts a yellow f!olor to the stool. 

White Mt}olji are seen sometimes in artificially fed children 
that seem to be olht?rwise in normal condition. As a rule, 
however, whitv st^ioL^t are either the result of the ingestion of 
ezcfififiive quautitit-^ of fat or indicate an absence of bile. In 
the former ca*^s the stools are largo, whitish, and have tlie 
characteristic odor of fatty acids, which ret^mbles that of 
mncid butter- The stool may be dried and burnt with tJte 
same odor and the fat rony bo dieeolvcd by <ith<'r- When bile 
is absent, the stools are white and hovp wvery foul, almost cadav- 
eric, odor. 

lied stools may owe their color to the presence of fresh blood 
from the rectum or the lower piirt of the intestinal tract. When 
it comes from the uppor partw, the blo<xl is always black. The 
fftri>aks of frt**h bl*x)d freqiieiitly f*cen where hard stools are 
pa^vkHi coniv from slight «-xci>riAti(;as of the anuH. 

Stack i^oqU arc cau:)cd hy the presence of blood. Ill this 



OTHER FACTORS IS ISFAKT FEEDISO. 261 

ease the hCoqIh are black and tarry. The blood may oomo from 
the mtestincB or Btom&ch, or from blood HW-allowoi, c»|>wrially 
that tri>m bcmorrhago from tbc pufitorior iiarc«. 

Jilack or blae/dsh-brotm »tooijs may iilfo be caused by tins 
adloiitiHtniti'jn of bLsoiutb, iroa^ or tannic acidi iirown t^ioU 
are fn<|Uf.-tilly ms^rx oa tho rc^^Lc of boctorUil and cbcmic clmiigCA 
in diG intestine to the course of mtcetinnl itxligertiou and intwt- 
tiTkfll infet'tion* Rnw beef-joioe irny give Hm to foulnnnelliiig 
brownish- or grajUh-ooIored slools. 

GiVCTi ^oo£f are due to a larife number of causes. Tbia may 
result from intestioal iadigeetioa and infection due to improper 
food, tiFually either an exoeHs of migar or of fat, or to the prc^«* 
cure of buct^riii. C^lomd cauj^c^ groon ^UxiU, utid alkalis, if 
coiilinueiL and not n?utmlixo<l in iiwi iiiU-.<<iiiiCj may jinjdixrc iliu 
«aoi€ efto:t- 

Symptoms of Dietetic £rTors.^Too much etrcHs vwa 
not he Inid Tipon the iin|x>rtjk(]ce of inve^tigatinj^ the aourt* of 
distarbancetf due to dietetic erron. There is ample room for 
further clinicul study of this subject 

Too Low Protein, — T)ie ^toola are small and coaatipated, if 
the other food elemonla wre low, a^ they are apt to be. The 
child does not gain weight fn^ rapidly as a normal child, cr it 
may n*raam stationary or even lose weight. It U anetnie, and 
if ih« low jiri>i4.iTi U cui>ti:mftl, tbe diild bt^^mie* marantic. 

Too High Protein. — The child la opt to ha%'e olio, vOEuiting 
any time, but u^iiAlly half an hour or more oA^^r fc-odifig. The 
aIooIa cnitt/iin undigeflied eiircU^ aiirl mutiLUi, and may h<t y«»l* 
lotfish prceu or otherwise dUcolored. 

Too Low Sugar- — The gain in weight in apt lo 1m? tJow, and 
Ihe cJiild may be constipated. The^e infantn Hre ii^nally tliio* 

Too High Sugar. — Vomiting an hour or tv-t) afWr iik^lIs, the 
vomit4.<d matter UhUally lx?ing wy\n. Acid eructatiortH are 
wmmon. Colic is fmjuent. The stools are generally gra^ 
gnrcn anJ very irritAtiiigf the buttockn olWii Unug exi.*uriaU?(l. 

Too l-ow Fat* — ^Tbe <:biid guiu^ wtight rJcwJy, und w apt to 
h<^ fN^nsliprited unlets on exee>M of »ugar iu given, aa in con* 
(leui^-niilk feeding. 

Too HIjfh Fat, — The chiM vomita an hour or two after feed- 
ing. Colic IS common. The stooU may be thiu and green or 
greenish yellow, and contain gmalt masAefl of undigeHt^xl fjit and 
conKidonibk miieii& These small lumps are ot^en mi^tfikeu for 
Gurdj^, Tliey are marc or le:^ translucent, and whco burnt give 
off tbo od^r of dtty icid» ; they nay be dissolved ui ether. 



S62 



lyFANT FEEDIJiO. 



Vurd^ are iiot> however, dissolved in ether. Another type 
more oomnioD is the largv, white, ratlier diy titooU having the 
odor "jf nuicid butter. 

It muni ht rt-iuemb«rod that the iN>Ddit40]i of the MooU m&y 
bo due to oDe or more of the food elumvcte, aud experience in 
the^ caftOA.a-H in nnv.t others, is the b<*>it l^^-lK^r. It ie only by 
practice and careful observation that the lining of infants may 
be conducted properly, Anotlier fact to be remembered ia tlmt 
the food need not be clmiiged to meet every trifling alteration in 
the temper of the child or ia the character of ite rtoolfl. 



THE FEEDING OF SICK INFANTS. 

The Feedingr of Difficult Cases The feeding of ee*-- 

tBm tnfiuitH often becomes & difficult mutter, not sii much ou 
ftooount of actual (vmditioiii^ of dii^^i^-, as owlu^ to per^ouid 
idiosyncrasy. Others again are difficidt in ieed I)eeaii^ €f 
actual disea:^ of the digestive organs or on account of the 
lowering of mitrition due to the exihtence of other dismae^ 
These cases will be considei'etl ht jih^jKr order. 

At tljt; ouit?et it mn^t l>e remembered thiit the fault may not 
be due to the food it^lf^ bnt to its preparation or the mode or 
time of adEiitni8tralior>« and to improper surrouudinge and oaro* 
To r4u<y>vd ill t)ke^' ilHli<:ult casos It is necessary to loolt dili- 
gently into (he minut^t fletailt^ of the infant's life. 

1/088 of Weight. — Loss of weight in an infitnt should 
always be wnsidered a v<iry serious synij>tom. During an acute 
itinera, snclfc as pneimionia or diarrboa, this is to be expected- 
In chronic coiiditiou-i the weight may fluctuate, going up and 
down, or remaining morc^ or less statiotmry. If, however, in a 
period of u month or two then? is no genera] tendency to gaia, 
in spite uf the Hnctuation, tbU indicatiou i» a serious matter. 
WbcTx.' an infunt \r losing uvtght without any Fipc-oial cause, 
this amy be attribut4>d to insuilicient f<HKi. If the infant ifl 
nuniing, the br<ast milk may be ])oor or iDsuSBcient, or both. 
If the habe is bottle-fetl, the milk may not have been incrfAsed 
in stn'.ngth in proportion to the child's growth. 

It frequently happens that difficulty is experienced in obtain- 
ing a food suited to an infantas digeeti<»n» This end, however, 
once attained* the physician miiy iucreasc the cjuantity, but nat 
the (juality, of the fob<l, and the infant fnmlly ceases lo incrcaw 
in iveiKht, remains stationary, nnd then loses. Loss of weight 
may also be due to a food too rich in proteins or to one unsuit«d 



run FEKDHCQ OF SICK tNFASTS. 



263 



U> tlw infant's digc»1ifm. This latter tnuse iifiually, but not 
nlwity^, f^Wiv rise U» othtT symptoms. 

In nil cajKs n careful filuily of thi? food ]#< twunitial. Acuu- 
ntc ehnrtfi of tho quantity of food tnkou^ ibo time, whothcr Uic 
cbi!<l vnmilii And at what timi?, anH tho niimbor and oharaoler 
of til? F^tootfT, cic, Arc of great help. If the food » inoreaMid 
or dcc^muf^d. aa the csi^c may he, to an avf^rng? i^trength for a 
<?hild of the «i/e mid weight of the one under oonBideratiop^ 
and lh<!rc i» ihon iio rhuii^* in the child'^ ccadition, tJie foo^l 
hhiriiUI K* )Hj>toiiiKC4l, titiier jmrttally or eomjdeltly, c^r mixe*l 
with nu »lbiiniint74*4l or maltoti tWI or with baric}' -water. Ther 
addition Ut the; dietnn' nf albLimiD-^watcr or of sm^ll quantities 
of one of thi.' prrdipi^tfil Ixrf prcpamdoDs (Ponopepton, 
gtL V— XXX ; Ltcjtiid lit^C P^rptonnids^ ptt, v— ."^ ; or onf» of the 
other b(H*f prvrfnnLtioTir; in iqmilur doflea mixeil witli water) in 
hidicat4<l- Miiuiti" dor*<^ <*t* dux vomica or str\"chnin, with or 
wtth'iiii fin alkali 114 liiaLrl>on»teof Aodu, or of crai«ot« (Liquid 
Beef IVptonoids with (*rt*a?*otc, ptt, v-xx, of tlie Arlington 
Chemical UoJiipiiny^ la an I'xcrllont form in wliicl ttr give cnii- 
8ote) are often of valtie, (^^ih^t'ifllly wh^Tf tnbcmil'.wi.^ ii* siis- 
P«h;Ic<U Ixjpti t>f wi'igiit niuy he auiM^l by pcr^iQtent vomiting 
(»ec Vomiting)* 

Stationary Weight, — This frequently followe when an 
tt!fant iR wesiTipil or when one is fe<J arlilirinUy from (hp outlet. 
Even if the child m receiving ot>rreet percentage of fixxl if may 
not gain for aev^rnl wccka So long; as the infant is well and 
tlie perccntupe jiikI quantity given correspimd to those direct^ 
for an infitnt of the siime nge nnd wei^lit. no :d[irm need be felt, 
even if a month Hb<in!(i ela|)Ae wilWil i!iliowing iner*"a'*t* in 
wcij^it. HowcvtT, onr<' the regular gain in weight ii* <'i<t4il>- 
liitlu'd, it should not nmmin filntlumLrA-, but nt>outd iuirraae 
gradj*]ly from work to week* The dviTrt^ w«?kly gnin dur- 
ing the fir*t yonrof ]\U^ iu Iw^lwet^n four nnd flight ounoc*. The 
weight may oeejiM^iuuily, without auy apiKirt*ut. a*wigri»ble <^HUwr, 
be the Jtanie at rmc wf^kly weighing n^ it wn^ at ttie preoiHling 
one- If thi8 persists, a careful search for the cau*<e must be 
ninde^ nnd will oOen [>e found to be in?4ufTirient food. 

Colic.'— Thin ir*nn)ix*ai>lt^»o<K^ur in hreasl-fed thJin in bottle- 
fed babie;* on ttie ixinx^uU^is iiaually reeomniendcd. J I is espe- 
cially Ukely to K^nut uu during the fln^l three months, Ln 
brt^»t-fed iufiuitn it id otWii a diflicult matter to owreome. If 
on e^caniiniUtau tho protmna arc found to he too high, an effort 
Ftlionld be made to reduoe tlieni, and tlie intervala of nuraing 




264 



lyPAST FEEDING. 



mny be leD^^fapncd. In boUle-ft'd infutjU (x>lic is ubijoIIj due to 
tbc fact tbftt ttic pcrccntof^ r*r prot<?in m too bigh. Tbr wm*li-» 
tion may hIbo \w causes! by the food being givi^o too €-o\d^ aa 
wdl sji by a hont nf <^ii8eR tbat l>par no relation to the food. 

Vomiting. — Imviediakfy f^fto' Fi^e^vng. — {a) From the food 
bein^ ^iven in too large qiiimtitk^. licilutw qimntity. 

(^j From frxxi Ix^ing pvcD too ililult.', iitk] so ncc^^vwiliitiiij; 
the takJTkg of too large <]uiLi]titii35« Keduce tbc quantity niid 
iucre&sc the strcrigtlu 

(c) From taking foot! too mpidly. Give more alowly — io 
brcnst-fcd children, by r^ulntiiig the flow by grasping the nip- 
ple btlwocn the fingers ; in bottlc-fcd babtee by ueing a nipple 
ivUh » enmiler bole- 

At any TXnie. — Due to ihfi ubdominal binder being too tiglit^ 
or to eluiking or holding tbc infunt wlt)i tlic bcud over the 
nursc^s Ktioulder, patting on the baek, eU", From too high pro- 
teins— this is more apt to be aocompunicd by €tlier ifyjiijjtorn^ 
ws oolic, etird» in stoold^ etc* 

One or Tico Hqutb iificr Feeriint;, — ^Tbc vooilUhJ nrntj^riid Is 
tmiinlly s<.>ur»ud <;iirJW, or it may be watery nod conttiiu unicua. 
ThL? is dne lo the j>erccntiige of fnt or i*ngnr l>ring toi> bigh. 
The fat, or both fat mid eiiK^r, shoub! bo <Iper«iw*I, and the 
foaJ be given slowly and at longer intervals- 
Vomiting al»o occurs in many d!se8f9ed conditioDB. It is a 
frequent accompaniment of gastric and intestinal di^^rder?, infec- 
tioiif and all acut^ diseuf^m ; it occurs in nervoua discoecs, such 
as meningitis, and in brain tumor, in pcritonitifi, and in intes- 
tinal obetnietionT with coughing spells, n» a babit^ or reflexly 
from into^tinnl or pharyngeal irriUitJon, or in toxic conditions, 
Bucb as iircniift- The treatment depend* on removal of the 
caufic where pQSEiblc- When it occurs in ordinary acute dis- 
eAses, however, niiieb can be dene in a general way to overcome 
VOmitlBg. The fotnl ehoidd he ^iven in KufHcienlly Rmall qnan- 
tJtieB at two-hour intcrvala, or iji some cfiAe^ a teasi>oonful of 
food may Ik* given every hour^ or even every half-hi^ur where 
larger qiituitities are not retained. If the caHe is acute, it may 
be iiew*ary lo secure a wet-onrse («t*e Inanition). Washing 
out the fJtoinnch and gavage Jire two very imporUnt means of 
trc-Jitin^ persistent vnmitiEig whicli should iiul be forgotten* 

Tho phyaiologie less that occurs during the firat forty-eight 
hoant of life should not W foT^tten, 



GAVAGE. 



iu 



GAVAGEL 

Ottva^-, or rf>ef)ii]|^ hy mi^uin of a .'<U>ri»u4i-liibr, if h rncUiod 
Qitcd iu vunous discof^f^ unO cunJitioDN of xtifnttvy nn<I obild* 
bood. In i'tu^Gi whem tlie cUld i« not ublo totaki' oo^imhuicnt, 
or on\y m inHnf^civni amoimt. Ami in nxu^ of iiiifHuii.rtilkMcT 
vomtttng, this method may be nvortwl to. It i» tiw^ in ilio 
fifediitg t)f premftture infiinUi, vrlKther iu An incuWtor or not» 
and in casCA of Rmall^ wf^k, marantic! infantj* wlm, owing to 
we&knaw or lack oi" appetite, do ih>1 taki^ sijftirif^-iit nckurinhmenU 
It IS alfw emplovMi att^r surgical 0|>erationA alKitit the- hoid or 
D«ck wbere awalluwing in iiiu-rrertd wiUi, uiid in Acute dii^«ttr*e»| 
eucb &tf pn«nenutiuif lu fevers, aud in dvliriimi <n coma. 

Tim ri^ultd duit follow ttm tuHbod of fMnlin^ uiv Aur]>riFLiiig, 
p^pecLilIj in eBS£n wh^ro fWre i-t tf^hrmtaTit vfiniiting or wlii^n^ 
the stomach has & very small caiiacity. In th<- fornuT case the 
vomitins may oease and the fooa be retained -, in the latter, the 
capacity of a stomach that previously held only an ounce or 
two may rapidly l>e incn?a&eJ until an aveia^siz^d feeding i» 
reiain^d with eo^. 

The tcchnic of the method is) simple, and the pnx:vdiire eon* 
ducted without dilEi^idty in rhildrc-n umlvr iwo yvnm of age; 
above that ago it mny he dif!icnjlt, nnd a iDi>uth'^ag mny he ro 
quirrd ; in »ome txees muid f<H?rlin^ mu^t He eub^tuted. Tho 
np[ianih]M <rmp]<\v(*f1 tw th<- i^ntt* that ik nu'i! fcir wiiKhing out 
the v^machp and siniw it i% frequently <lc«imble to wash out 
ihestomtefa before introducing the meal, the laune tubing mny 
serve for l»oth purpfwes. It eonsiiif^ of i moft-ruhber nilhctj^r 
connected, by meunp of a pietse of gla>* tubing, txi a piw^e oi" 
mbber tubing to the other end of which a funnel is attached. 
The nurw hold^ th« cliild on lipr lap, with the head bdd straight 
and mil mrlinixl in citlir.r dire*'lioii. The tatbeltrr in mt»int4!ued 
widi warm wiilcr and held sevend inches from the ond, so as 
to allrfcw onough of it (o pa^ into the e^opha^s with the first 
attempt at inlro<luction. The mouth i^ ojientsl^ if nefessavy, 
and the catlieter |Ni!<<4ed rapidly int<i the pharynx ; there ift obu- 
ally a ^wallowiitcr mi»v<>mi-nl, and the tuW ih readily passed into 
the ptomach. If the pr«eednre is carried on too slowly, the 
Umguc may interfere, or if the catheter is held too near the end, 
it may cause gagging. Before introducing the food it i« well to 
wafh out the stotuach with normal salt solution- A* wx>n a« 
all the food baa entered the stofnacb^ the catheter ii^ pinched and 
rapidly withdrawn. If it is withdrawn slowly, the food may 



JNFAST FEED12^. 



come up with tlie tube. If tlu^ mthof^r la l«ft opea u it is 
withdruwiif the drip^uDg iuU> Uie plutrvcx mtiy caui^ vointtuif^. 
If the child is young, it id a good plun t<* i«ip the finger Ix- 
tweeD the jftWB for n few momeute to preveiU g-^i^tig. If the 
food comee up, the feeding most Ix* re])eul4?d. 

Nasal Feeding. — For this |uir|>o^e a cuthtier h\ pro|>or- 
tion to tlic she of the child should he uwecL Tin* prtu'edurc i» 
the same a* that for adults. (See Forced Fi^eding.) 



DIFT [N DISEASES OF CHILDREN. 

Cyclic Vomiting. — ^This U a diiHcu1l.o<indition tommhat. 
The alt^kfl oome oci at raorv or 1<^ re^lur intorii-ab, and Jire 
dut to seme deraa^ftmi'iit <if nietaUjlirim ; iht-y Imve Ir-I'ti s»id 
to be aualc^us to attaek:^ of luiumiiie. In thi^ ii4>udiEk>ii the 
ratio of the excretiop of uric acid to wn-a is diwuirlx-d. 

During tbe attack it h well to give the .itomacb absolute rest- 
Food aud driok lend to aggravate the condition. In the early 
Btiige of the difterise nonnjil ioXl solution oiar be given four or 
Gvc timed a day by the n.-etiJm, the qtmniitv v^iryiu^ from 
3 to ^ ouneei^, aeeording t^i ciruunic^taiUM.'^f. If the atta<Tk ia 
pn>hirgi^l, it tK uell Ui feed tbe rhild hy the reetiiiu ; even in 
taisi^ of orOinury r-everily it is desirable to give the food fur a 
day or two by die rtvtnm. When the vomiting dist^onitmies, 
the glonuich Mbouhl have r*'sL for some buun before feeding is 
reniinied. If there is any doubt a» to the advisability of giving 
ftjinl by the stomach, it is well to continue tbe nutrient eaeniata 
for a !*hort liuie. When feediiig by the oioulli is refumed, the 
food sboidd W ^ivrn in ?iinall (jiiantilii'e ut inlervaU of three or 
four hours. Milk to whieh lime-water la* been added, pep- 
tdmi:?ed ntilfc, albnmin-water, barlfy- water, and the like should 
oonatitiite the diet for three or four day&. After that a return 
to the <mliuiir\* diet may l»e made. In the intei%"al the diet 
may be the same as tlmt directetl for migraine. Plenty of freeh 
air and out-of-door exercise are indicateii Holt advices that 
AUgars and sweets be excluded from the dietiiry, and that the 
starches be limtte<l. The diet should fousi>tt of meat, green 
vu^'^tahh-H, milk, and dtalo bi%ad. What haa been p^ld regard- 
ing any speeial article of diet aod its relation to migraine applies 
to the^e earths. 

Stomatitis. — In ntomatiti^ the feediug ofC«n l>cc<rme^ a 
matter of great importance. In the milder forms tliere is not 



DIET IS DISKASES OF CiULDRKS. 



357 



much difliculb/ in getting tb« chiJil to tako liquk) noiimlmicntp 
&*peciaUy if it is ^vea cotd. In the «c^vcrtT fumu^, audi il» 
uJcerallve at-JuiaUtU, the child mny tvfusc all Ibod. In thcr^; 
cfi»G6 it <Jioulc] ho offered food in the form of loe-cold milk, 
nlhuuiiu-ivat^r, and the like. If all fiwu) i« refiiKcx), »r if in- 
Hiinirii'iit i(Liarititift« are taken, rectal IWdiri}^ must ha inscitiitod. 
Ill T^onK' tTjL^iOH naAoI feeding ouiy be ref^>rted to, \ai% lu many 
imthiits wh^re thifl i-i iaJicateJ it can uot be employM bwuuiHc 
of the inflammation extending into the nan^. In all oaae^ tlie 
diet should l>e similar lo that ujw'd in scuny, FrL>h ftuit- 
juic«9 and vegetables an? to bt? ^iveu. In the Tiloerativt' c^fl»t*i> 
cblonit« of [KitaaHiuui or miiierul at^iiki are Ufleful, 

Acute Oa&tfic Indigestion — Acute Gastritis. — As 
tlicwe disvurtoa luu not, a^t a niJe, i>o <JUtinguiflbed from euch 
other at t)i4> imt>ti<t, and xint^e the dietetic iiidicstioii^^ »re ahinf^ 
similar lintw, thoy may^ for convenience, Ije cousi^lered together. 

The main indicatlonii are Cn empty the fitomacb and to give 
it rest. If possible, it should be cleansed by washing witb a 
tube and an abundance of warm water ; where tlii« \& not |w*- 
sible, warm water may be given to drink, and, if noowwary, 
vomiting induced. 

Food ^lould be dLseontiuned entirely for »tx hoLir<, auJ 
duriug this iiitcrvul Hiuall <|uuutit]iui of hot water may br giv^n. 
At the eud of tlii^ tiino, if tb« voruitlug lui4 ceased, Kmull 
amoantti — 1 ti> 3 unnce.s— ->f album iii-wat<*r or of l>arW-waf#»r 
may l>e udmiui-stert-d. Milk in any Ibnn should be wiliiheld 
for twenly-innr hours, whi-n, if \\\n- baby i^ breast-fed, tt may 
Iw nurs^ for a few mineit^'H at thn.i-hour intervals. If this is 
found to ^ree with the chihl, tlie timi- of nun^ing may be 
lengthened and tbe interval betwci^n feedings 7«horti'ned. If 
the baby U tnHtle-fed, il w wtU hi witlihohl cows' milk, and to 
give album iu-wat<?r or rice-water in its st<nd ; wbeu tlip st<jmmdi 
ban beeouie tolerant, other article* may be mlded. At first 
broths^ free from fat, and meut-juiiH- may be tried, followe<l by 
malted milk. Only small qnautitir>s should he gtven at lirHt, 
and at intervals of three or (onx hour*. As imimn-eraent 
oecars the food may In- given i>rtener and in incrt-jsini^ (}rjnn- 
tities. In the severe castas, whore vumitin^r iierHijiits prcfwinnl 
foods, such ss Pam^pvpton or Li<{uid 1^,'f Pq>tonoi<J.s. diluted 
with water, may be retained. For the younger infants and for 
older infuiitb if ihe ntiMimuh Is at nil irrilablr, it In "*dl i*i |""|>* 
touixc the <x>wb' milk when U ifl lirat given. For older infants 
a small amount of milk may be added to a lai^* quantity of a 
J7 



2dd 



INFANT FRED f NO. 



certei vator, such as barlcj-wator. It may be well to boil tbo 
two together for a few minutes. The amoiiDt of milk nui/ 
gmdimlly be increased, an equal volume of lim^wntor IxdiiK 
Added to it al firsU If the stomach U very irritable, Rmall 
doeefi of hot water freqiieotly repeated may be tried, or, what id 
Ufiually of greater ser\*i<«, teugpoonrul dot^es of equal part^ of 
lifoc-wuter atid dunatuoiwwutcr. 

Chronic Gastric Indigestion — Chronic Gastritis. 
— WlliJc difTorc-nt pathol<^ic couditioor^ nre ]>n«c[il in Uie^e 
diBCflSC^ tJic treatment i^ pmctically t-hc sanies and for thia 
rc&BOD they may be <»n8idered together. lu both diseaevi? tbe 
food ifl ajit to be retained in the ntomacb for a long time ; it 
is alfto likely to be imperfectly digested, tbe lar^e amoitnt of 
inacus which i^ usually present in it^If interfering^ with diges- 
tion* The stomuch ^bould be washed out once or M?veml times 
a day with warm water or with a wcAh iHjlution of so<liiim 
binartionate (1 dnim to tbc pint). The food »hoLiId he given at 
interviklti of iJircc, four, or even (\v** hourB, w^cording to the 
age of the child. It ehould be suited to the iufant'e digestion^ 
pjid what ha^ boen said about infant feeding in general and th« 
feeding of diiliu'EiU ctisos appliot here^ Paheneo am! jiidgiiK^nt 
are nocesfnrv to d<*fermin*^ what i» the bcflt fowl for tlic infnnt 
and just how long it should be continued without a chan^. 
In this, as in so many other conditions, experience B tbe nafest 
guide. The milk may lie parlially [)eptonia?d or a milk low in 
proteins may be ^iven. A milk low in fatr^ ih oflen atte[ided 
by good refiult^. Oociwioiially the su^r may be reduced with 
advantage, or wmdenscd milk or one of tbe proprietary foods 
may be triwl, Barlcy-wutcr aud milk in varying projiorlioos, 
but usually with a larp^ anioiial of horlcy-wator, may bo 
digested. Barley-water and a Wk?ak, f*t-free veal broth may be 
mixed together in equal qnaniitieFt and used to advantage. In 
some eases whey mixed with barley- or rice-water may be tried, 
and if it is possible to give fat without causing vomitinj;, cream 
in small amonnte may Ik* adde<l to the mixture. 

General hygienic mcnj^iirw* should carefully be observed. 

IMlatation of the Stomach. — Tbe methods of diagnosis 
and irwitmcnl of tlii^^ ooudition an- s^imilar to tbow when tlie 
disease occurs in fnlult«. The caeeotiala of the treatment are 
stomach* washing, gnifill mealf at sufficiently long intervalEf and 
tonies^ such as ^trvchnin and nnx vomtta. Tbp charMfittr of 
the food should be about tbe same as that advisisi for chronic 
gastritis. 



I 



IPWT ly Dl^'ASES OF CUIlD&Ky. 



2fift 



IHarrhea In Infancy and Childhood.— The acuU 
diarrfaMw of irALDcy and cliildhood may be divided into two 
cliMHs: In ihv Jirst, the i^UxAs <.<«DUiii only tjucb bacteria aa 
are fount) in the normul intcedDol tra4.-t- Thene arv theM>-ca11«d 
eimplit (Imrrfkoflf, niul nrci usually bcni^. Simple diarrhui la 
CHiiRt^l hy the ingPMiHin of nrticlcs of food whieu t\w child is 
incaipubic of digesting, or by coar^, ah^tluit-ly indigE^t^tible 
eubfitancGJ, such as »i^&\£, ekias of fruit, and the like- The 
diiirrbca miiy nliKj bv due to ner\*ous intJuenoes, to dnigH, or to 
cxtn.'mej< of tcinpi'niliire. In the second class arc those diaiv 
rhcte in which imth^igL^iiic boct^Tia are present in the intestJDai 
tmct ; tlicM! are the wMulled intbciious diarrheas. The bacteria 
iucludc tljc dhi^L'Fl(?xner dysentery bacilliu^p recently fuimd id 
muay ciuo°, fltrepioeo<>^i nod cthtr pu&-fonning micro-organ- 
Uroit, InfectiotiA dinrrheii is nlso koown as "summer diar- 
rhea"; when it becomes choleriform, it is termed *' cholera 
infantum/' It ib always a senoits disease. 

At the onr^et of any diarrhea occurring in an infant there is 
DO Enclhot.!, tihort of a bacteriolo^'ic examination, c)f determin- 
ing whether one has to dcnl ^-ith a simple or with on infectious 
diarrhea. It is uell, therefore, to adupt dietetic mcanur^ liuit' 
able to eitht^r condition, and to make such changes Irom day t« 
djiy IL-* the condition of the child directs. Many infants are 
cncrlfici^l cvciy year bcuau&e this &imp1<j rule ia not carried ioto 

In nddition to ihe^ varieties thftfe are also severe mnditir^na 
witli nmrktHl bivv^l lesiona which some writers separate clioi- 
<nlly ; tlie dlet^-Mo indieatioDS are, however, practicallv the same, 
and the entire siihjeot msiy be considered imder one head. 

liifcctiouH diirrhea in rare in babies that are fed exclusively 
on lJ»e breast. Tlieae cjiildren, moreover, when afflicted with 
tiie disease, lire more amenable u> Ireulmenl than are hutile-fed 
babies. Niiiety-sevuti fier ovnt, of tlie deaths due to diarrheal 
diseases 4>ccur in bottle-fed bubles. In 8ome of the more recent 
reports n mni-ii larger per<ii?»tJige of casi<H was found in hreaet- 
feilbahie>. The greater numlier of t-herie children had beeo^ven 
(jiilM>ilwl wnt<*r til drink. From tills it would w^m that the 
dlMuM' may be cau^ hy infeetitd water, and in warm wither, 
therefffre, all water given to intants should be boiled. 

When a hreaet-fed baby i& seized with a <iittrritea in winter, 
the disease is almost sure to be of a simple natare> and a daw 
cl oLHior oil ur uf ealomel, fullowed by a little bismuth and 
(dudk^ ia uauatly all tliat is rt!<[uired for relief. Tho dietetic 




seo 



WFAHIT FEEDINO. 



manogemetit conHifits id fihorteotng the Iciij^th of time tin* child 
nun^ed and Icugtheaiii^ the iulervul Wtwet-u ihi* iV-ediiigs to 
fiix boUTb. lu the mt.'unwlLiJr plum IidiIihI waiter, or ulbumiu- 
water, rioe- or barlcy-WAter, or wbcy, tnny lie given. Plulu 
water is tho bcet^ perhaps, unless the oliiM le verj- hungry. 
After one or tw<} r^!lyJ^ of stirh tr&ntment the ortliijjiry rc-gtme 
may generally be r&tunieJ. 

In summer, however, a diarrhea, specially if severe, should 
arouse suHpicioo, and for twonty-four hours, or until the ehiWa 
oondttioD warranto, milk should be withheld. The hriUHla 
should be pumped out carelally at rt'gular iutervul^, t*> ]»revait 
dbtro^ or a po^^sible cevi^tioii of the seeivtioa Tim tslilld 
should be jj;iVHu pliilii boiled wat^^r, or eome wne "f tlir urtl<!teti 

!)revioiijly mentioDod, at frequent intervals and in email dfi^e^. 
X there iei preat thirst, one or two tea-^pootdutf* should he 
given every fifteen or thirty minutes. If flnid tk well riv 
tabled, several ounces may be given at a time al intervals «f 
two or three hours, If the child is very feeble, it should he 
stimulates) with whisky aud stryclmiD^ or small doses of gome 
of the hquid beef prepur^lions may he tried, such as I'an*]- 
pepton, Liauid Jleef I'eptoaoids, Ionic btc*f, aud similar prep- 
aratioDB, diluted and given cold. Small dose^ should be ^ven, 
and it the food is dilute<l sufficiently, the laxative aotlcm they 
are supposed to exert will not bi> obtained. If by the etxwiid duy 
vomiting has ceased and the ehild seems better, it may bv put 
to the breast for a few miniita^i and the effwrt noted. If thfi 
milk is well borne, the child may lie given the breft.Ht <tvery Mix 
bourg, shortening the interval from time to time until the child 
has returned to its r^ular schedule. It is well to make a 
gradual return, and if the milk aggravate the diarrhea or gives 
rise to other symptoms, it should ojtriun be discontinued. When 
the br«t*t milk is of good quality, there u mrely any difficulty 
with these cases. 

In bottle-fed babies every diarrhea, espeeially during warm 
weather, should be treated as serious, and eertain preonntionn 
betaken. For the first twenty-four hours il b* a j^hhI plan to 
withhold all food and give plain water, as previously *U)5:e(4led. 
Milk is absolutely contraindicated, and must not be given until 
rcco\Try h complete. Under this plan, if the diarrhea is a 
(timple one, reeijvcr}- in mpiil. The child's appetite and condi- 
tion muht govern the hierwi-Ke iti diet. Albumin-water, rioe- or 
barley-water, and wbr>- arr cxrollent foods to begin witb> If 
tb«6C are well l>;>rue, malted milk may bo givcD, followed, if 



DIKT IX DtSBASm OF CHFLDRfCK 



2«l 



ftll gocn vtvUf by cgwh' millc. It i« u gooJ plun^ if 6« cliiki w 
i>l(l i*.iiu(i^li lo iligi.'->;t il, tf> mix eqiml [iurt8 nf borley^WAter 
nfid rnilk to^itlxT iu:il tioil tlicm for a few tiimuUn^, 'lliiA lA 
unimlly wiM borru', and rniw Ire i^he tlnit su-p in the return to 
tJit* 4;unt(>njiirv tlii-t. 

Ill thu i[ir<.H:ti»iM form-i, tiO If^ng ^"^ llic^ dificnMe ii^ in ito ikctJv« 
."itoj^, milk, ninco it furniHlim uu ox<<<rUciit oultun'-|rTvmni] for 
fJuT [«ti^<^-i)icr (iru'U*ria, iiHt^ ntt n polwin. In iht-M* i«*v*'Ft» rsMw 
uc foot) KlKfttld bcf^ivm for twenty-fimr hoLir<. Pl^tiu l)oiliHl 
wuter or very vttt^k alUtimin-HaU-r may l>e prt^cnbcd In tiinall 
il4)»>e« at frequent inlervnU Whisky in very dilute form and 
Htryi^nfn iiuiy lie given nn necjuired, if the wbisky is vom- 
ited and the child in very weak, ten di\*pfi of bmiuly may be 
adminislered in a uah^ixxuful or tw(» of water. SomeiinieB 
teoHgKflruful dunes of i<wd cUauipgiie will M?lt]e the otoniaob 
when uoiUmg vise axn be rt'UiiiuHl, WasbSog out the stomaah 
ttud giviug It ulMalutt* TC"At wiU friL*i]Ui>uLJy (>h(.-f.'k tlie vouiitutg. 
A mmmoK TiiiKtuki^ In tliiit nf piitlln^ ti>o many dnigw mid tVv)d8 
inUi an irritubk% nuiir^LUb^^l ^tLimacli. AWoIutc ri^t for »evenil 
liourtt will frrqtiently jdlny tliii^ irritability* In many cil»«« 
<^t]i]ul piirt« of lime-vrnt^r and einrFLimin* water in leiupoonful 
do6e& is an effective inethod of relieving njiti»<ea. 

if the diarrhea continues while tbe stomnch if? at re^t^ there 
ifi apt to be grpat thirst. ThiH may in a mcaj^ure be allayed 
by biuall bitA of ice chipped off with n needle and placed in the 
(^bild^a modth, or the luoutb laay be epouju^ed out with water to 
whicfi a little leruou-juiee had been added. 

If the amount of fluid alwtraetetl from tlte body rentier* 
collap^ probable, or if the child seejna i^rcally weakened, the 
eubcittatieons infniuon of normal !^k solution is indicated. This 
should^ of course, \te given under aseptic precautionB. One or 
more ounces may be given at a time, eight ouneea being the 
average amount for twenty-four houn;, It ie a>itonishing bow 
n4>idly thi^ miiture m absorbed. 

When the vomi^ng ortwes and the child becomes more oom- 
fortftble, food will u^nally he retain^. Alhumin-^vater^ Pano- 
pepfon nod water, whey, rioe-water, and hnrlpy-water are thi* 
moat Euitable forjds. The cereal waters agree admirably with 
some chilcben. but not with others. If the child doc« not tnke 
them plain, tliey mav be sweetened. 

The return to mlllc should be made very gnidtially. In the 
wevere e^wv eown* mdk T<hould be withheld ftir a week, when, 
if tbe chiid'v amditiou permits, it may be tried iu one small 



4 



262 



WFAUT FEEDING. 



ffvdinf*. If it cQUfieA no trouble, it may gradually b^ added 
uDtil tliG usml diet i^ resuma]* Tke return is best niado by 
allowing first the articles previouply sviggc^tcd. Then malted 
milk, or one of ihe dry foods thnt is to be oiixlhI witli wattr, 
may L>e given, followed by |>urtlit]ly or wholly peptoniziHl milk 
or the burley-wnt^r-ond-milk muiturc previously dcj+cribctl< 
Plain wplKt^kimmed meaubrotlif^ wioh us v^ broth^ may he 
uskI- Oare mnst. be tnki'n t.» remove ell the f«t, or thin i^a 
freqnent swmrt^' of trouble. The milk ^liould not at first con- 
tain too ^mat a pon.vnt»j^- of fut. Tliiri bold irtUir\*ation plan, 
a« it is wjinijtiiue^ adknl, Jsu<-eLx.-d» t>etter than any other. 
Lut^r, hoWfVtTf eare mnst ho taken that tli^ penod« of undt^r- 
feeding be not U.io protnii'UHl, fur while it is desirable to '•stmrve 
out ibe diiirrbrJi," tlie rhild nniM not be stjineil to death 
during the priMM?s3. A dny or two of abfioIiit<^ obstincncc from 
food does no hanof ae- tn tho M^verc cne4^ food is not retAinodj 
or, if retnined, is nnt HW^imilntj^I ; on t)ie other hnnd. n rfvhiemi 
diet^ eoDtinuod for weeks nnd monthi^, aa is not infrequently 
done, is apt to prove diNistroit^. It li^ a ^ood plan U) keep an 
accurate record of all the food taken while the child \b on a 
r^trieted diet The nmonnts tvken dtirinf; each twerty-four 
hours may be ndded to^ber, and fn^ni these it may rea<bly be 
seen whether or not the child h getting suflidcnt notirishment. 

Piarrhca in Older Children. — When diurrhea oceara 
in otdcT children, the early dietetic treatmcDt i« similar to that 
recommende^l for infante. As the child recovers a rctnm to 
the orflinary diet may he made, mpat, egg«, and broths cf 
various kinds being given at fin^t, folloxved hy boiled milk and 
toast or dry bread. Vegetables and fniits should be given 
only after recovery is eomplete^ and their effect should carefully 
be watched. Cereals may aW cause a rt*currence of the 
trouble, and ishould be most thoroughly cooked and given in 
small quantities at ^rst. 

Xlcocolitta. — Tbia term is used to include those bowel 
<>ooditioiie in which there arc eerious lesion* in the inteatine- 
The disease usnally follows a summer diarrhea. The dividing- 
line between the two ia Imrd to draw, and it \s veiy prt>tfable 
that ileooolitia is merely a severe form of lofection with tho 
Riign-FIexner l>acillns or other bacteria. The term dysentery 
Is also frequently applied to tlis affection. Conditions rc»eni- 
bling this di^a»e may eome on in the course of chronio 
diKonlerif. 

The feeding of tlieae codes id a diflicult problem* In gmcnl 




DIRT /iV DISSASES OF CHlLt)RBS\ 



263 



the <liot 14 similar to that ^ivon tn diarrhea. Ah all nourish* 
ment is u«iuilly rclii^nl, bowiivrT, when tho illftettHc i» pro* 
tracted, as it i« upt to Ik\ ii i» exlrvmdy litl^cnU to r^ustniii die 
uhild^ uDil tilt- fikiU ;iu(l UwX uf both uuntc u'ltl pbysiciuii arv 
tcstcfl to the iitmoi*t» 

In the aout« cwds^ wb«n tbetv is vomiting, it ig a good plan 
to wiiJifaold 4II food for the first day or two. Water may Iw 
g^veo ID dmall quantitiog, and atimiilanU \( nec«ssar)\ Wiish- 
ing out the stomach frequently alkys the vomittti^, Tliia 14 
best done mth a ii\\w^ but in older children it i.« a|>l t<j cauae 
excitement and doe» more hunn than ^foo(J, With younger 
childrea the prooewi is eaaily carri^ out. A ^\v^ of wami 
wut4?r will H>nictim<;r^ acoompliab the »Lmo pur[Kiiw- Often a 
cup of hot Wtttor j*ip[K^:l slowly will relieve tin* nuuBea. Kqunl 
part« of limo-watcr and cinnanir>ii-wntGr form a mtxtun; that is 
v«y useful for irritahie stomach. 

When the stomach coiitinuen irritable, it is best to ^ve some 
one of the liquid beef prepamtiona, such a^ Punopepton or 
Liquid Peptotioida. These cornbiDe a certain amount of nour- 
ishment with alcohol md are «timulatinK foodf. The autliora 
luvo fpiJ caifies of acutG membranous colititi for a week on sneh 
preparations when everything else was rejected. The do^ 
nKiat lie regulated atHX>nUng lu the piviMiratiun and the aj^ of 
the child. It id gr^D^raliy b^^i tif give small dijsi^, sufficiently 
diluted with water, ovory two or three hourt* ; but if fluid can 
b^^ given only in t^nn^joonful drMw^ it may b<^ n4.«eHsary to 
give a toaspoonful of the diluted b<«f ev^ry fifteen minutj^ \\t 
balf-hour. Completely peptonized skim-milk may bt* trit'd, 
and albumin-water and Stokes' brandy-and-ege mixture are 
often given with good effect. In other caa« barley- or rice- 
wat4>r is r^taioctl. Malted milk is o1\en of j^reat sem-ioe, and 
the fnalte<l fiKxls, which are ordinarily mixei^ with milk, may 
be given mixed with water instead. KumiAA nmy sometimeB 
be retained when other tood^ arc rejected. Animal broths free 
from &t nm also useful. If vomitia^f is porsifitent, gavage 
should be resorted t^j. If any one of the ftxtds mentioninl 
seems to augment the number of stools, another should be 
substituted. 

As the child tmj>roves, malted milk, one of the malted 
food#, or equAl [wirt* of milk and barley- or riw-gniel boiled 
together^ may U- given. E>dcay> f*x>tl h valuable in the oou- 
vaJoBoeaoe from diurriieid di^rui^sf* Riiw <>r virry mn? ;!)craped 
meat may be givnn, but thia is apt to oau^ very ofTcnvive 



m 



INFAST FEEDSSG. 



stoob^. Eggs C"'K)kwi ill various vtaya und IhUt pliiin boiJwl 
milk mAV ho given. Zwieback, crarkers, nuil to»st may be 
luldet) <AaliuuMy to Lite ilict^iry, iiti<I tbe return t(* the m^rmal 
nllowoncc Ik^ mude grudunlly. Grcnt care t<lioL]]d always be 
exi^rcised during und after eonvaU*sot:ace, a* dietiiry ermrs are 
npl Ui lie fiillowiil by wpr'eily ami jwiverp trlapft(W. Fi-G-di fruit, 
coarse vegvtublc*, uud nil irribtiing ami iu<iig:etfl.ibIo artide* 
j«houM be pnjidbittsL 

Chcxmic neocoHtis. — The dietary of a child with ihie di^eaj« 
ts not WL^ily con^tnicletJ, The ii-ods direrl^nl i\tT uruu.^ cows 
are ail tis^^ful, and a dietary can be formiiJatcti from them, 
TLie eflect of any fiKxl ou tbc t^t^iolg should be watched, but 
iibt«ervations should not he maile in the prer^^nt^i? of the ptitieut, 
a« children of four year& i*r more may bci'ome very morbid 
frf>m wiit^'hing fre€|uerif examiniififini^ of iheir stools, 

Tlu' pn*digpsted foods, fiia^h as the beei' prrjwi ratio ni<, peptnn- 
iztd milk, and the like, are among the mop^t valuable artielGS 
of <lict i[i these rasos, but Imrk-y- or rioi'-j^njel, with or without 
milk, nud ^gs ruay Also be useiL MjiJied Diilk and the mnltt-d 
fwKl?- are of Bervice at times. Alcohol, in the form of whisky, 
bmndy, port or sherry^ and in wlmlever sha|)e it is mopt ]ralut^ 
able, may be given, 

InaDciiciie with cocofinnt o\\ or cocoa-bwtter arc u-wful in 
promoting nutrition. A ohangc of air i^ often followed by 
oxc^ellent refiults. 

Chronic Intestinal Indigestion. — TJD<lpr this head 
may be included the ordinary fotiu of chronic intestinal indi- 
l^eation, an well as such tiipecial forms as starch indi^^tion and 
the so-called mucous disease. 

Where the coiJperatioQ of the mother or Durec ain be secured, 
the reeull* of trefitnient are vory siatisfactory. If the diet can 
not be controllcil ab»K)lutely^ it U diOiuult w im|MWHible to ac- 
complish much in thcAc ca^^ee. 

Chronic intestinnl [ndigcstion oot^urs at nil ag&i. In young 
infants it is frequently due trt improper f€e<IingT nnd di^appcttrs 
wheD the child is put upon a pro|)er diet. It may be seen in 
both breast-fed and hottle-fcd babies. In breast-fed infants it 
is frequently «*uw.ti by au over-rich milk, in which cnse a 
simpler diet for the mother witli exercise out of dwrs will k*e 
all that is rcquiritl. (8ee Mana^ment of Nursing Mother*.) 
Ill othi-r inslJintr?, where the mother hu^ been takiag various 
articles in oriU-r tn inc-reiise the tlow of milk^ a rr^nm to a 
proper regimen brings relief. In stilt otber casee the child is 




I 



DIET Ui DIJSKASSS OF VUIlDRKy. 



nursed loo often or loo long. The dl^iea^ may <*ome on aa the 
resiiit of allowing the child to A^ep all night at itft rooihcr'a 
breutft, witb tbe oojiHcquent fre<|ticni aiid irregular night fecd- 
ingSi Id another trouhksomc cbue of oa^e^ do ctM£c can h« 
made out. In tbei^t if th« (X>DrlitioD perni^ta &w\ tho Ghiltt^B 
genernl health is nfTwledr weaninK wboald be oon^uloriHl ; whtn, 
however, the child cotitiiiuefl to thrive and the condition can not 
be relieve<l, niirviiie may be allowed to ccntmue; frequently 
thcf^ cascH recover in a short time. 

When the dif'eu»« occurs in bolile-fed bibiGf^, the child hnA 
ii^iudly been ^vcUj for a considcrahle period, a ibod 100 high 
in one or more of the tbod ckmcnu. ^Tbie subject has been 
diffctiHcd iiodirr Infant FcciUd^, to which ux-tiiju the reader is 
pcferrod.) Another frcqncot cause in bottle-fed babies ia the 
«8ft of a proprietary fwn] ununited to tlfe age or condition of the 
child, or the use of improper articles of diet, especially starches 
ami eiigara. 

Sugar and starchy food in excessive <juantjtie? is a factor in 
the causation of thi^ diH?a«e that y often overlooked. Careful 
questioning frequently hrings out the fact that sweets of various 
kinds have l»een given to the infant by indulgent parenta or 
friends. Periodic attacks of vomiting and pain or of malaise 
and d 1^:0111 fort, ziiiulogoLia tu the bilious ailacks of oldi/r indi- 
vidiial^i, may uhuuIIv he relieved by rcduoing the cArbuhydmu^ 
to a Tninimum. Th(«e attnek^ are oocaflioDally so severe and 
mi»lm<ling a* to give rise ro the diagnosis of malaria, inhejcu* 
lowi.s typhoid fever, an<i many otiier diseases, even by comp^ 
tent physicians. In alma^ eveiy instance a complete cute can 
be quickly brought about by dietetic means alone. 

Between une year and eighteen months it is common for 
mothers to deaire to increafie the diet of thetr children. Milk 
lihould always f*>Tm the basis of the die^ and if other articlea 
diHUgree. a dii-^t of niilk and broths delusively may bring about 
a dtate of porfect comfort. 

Jn fMilfr Chiffhen, — The management of these CAsea is, as a 
rule, quite satiefactory. They require individual study, how- 
ever, for in one case the fat may be the cause of the trouble, in 
another !t may he the curd in the milk, and In ^ill another the 
carbohydrate>4 may be the disturhing element. The diet t<lioijld 
aim to give the intestine as little work io do as porti^ihlc. To 
thi» endf the cnrUihydraU^ shorjld be diNrikntiDued ftltogt'llier at 
fiiwl ; and when they are Iwgiin i^^ain, it should be caadouftlyj 
and the efiect should bo carefully watched. Tho fflt« should be 



S8fl 



INFANT FEKDTNQ. 



ptady reduc^ or ev^n omitt^.^ ultogf^dior. Protein dIioiiM bo 
givea in as digistible u fjrin us possible, and peptoiLLzed tf it 
eaufle indigustiou. 

In severe cases the child may l>e tei\ upon p^ptouiz^^ skim- 
milk, Thia mat Iw iJonipl*?tel_v nr |>urtiiil)y i»e|»lj<nnz«3, as cir^ 
cunkfitanoca demand. It shoidd bo given h\ moiicnt1« qiintititiea 
every two hours* ICnmiss mity h*i ti(^>d to vary ibe diet, and 
buttermilk, if th^ i*!dld will take it, formw jin :igriW»lc clmngn. 
AlbumiD-wat^r and liqtnd prtdigt^led Ixvf propjirutions muy 
al^ be U6i>d, Chicken or vctil brotb from wbich the fat luLa 
been removed may likewise Ih< giveo. 

Kare or raw meat \% usiiAlly wdl l^irnc. It ^bcuM be 
5cnL|K!d fine and givt'ii imniHimtidy aft^r pn*pariit^ iL If 
dtwircd, it timv be r<:illcd iulo ?>m.ill bulla. Of tbis, two or 
three tablcipoonfiils are a^Q average ihijly allowance. Betf j» 
to bc^ proforred, but mutton may ]>e |iertuitt4^. Di&h gmvy 
from wbi<*b tb^ fnt iia^^ been skimmed may be given, and may 
be t^rved in a green gluse if the cx>lor of the fluid excite 
di^i^uflt. 

AfttT a week or two, if impn^vemeut has li^un, a malted 
food may l>e added to (he millc. Eskay's Food is of purticulnr 
value in these irtestinfil cases, and is occasionally well borne 
when cvtn |ie|iloai7^) milk 10 not. The food should bo given 
at rt^ular-Umed intervals ^ and if nue meal is not well bijrne, 
nothinp tibciiUI be given until the next regular fcvding-time, 
Abflohitely no ft«Hl t^hould ho given brtwwn m«al^ Water 
may hp alkuv^Nl sui tlesire*!^ but fllifrtild \\p ^x^t\ between meab, 
»o as not to interfere with digestion. Four meals a day, or 
even but three, should be nil that is permitted. 

k» improvement setjs in the dieb-liHt may be extended to in- 
clude jniiket and simple dishes prepared with milk or eggs or 
both together, TIh-ji a little zwi^'backT toast, or thin crackers 
may be allowed. Of the meats, nhicken, l>eef, and nintron are 
the most preferable. The white meal of boiletl or roast fiah 
may be nllowed, witljoat any rioh suuou;, however, and oysters 
may be ^ivtrn in tiea»on. The dretsiry must nr>t i>e increased 
too rapidly, and it iiit well to allow a month to go by before 
making any dMiided clmn^es. 

Cereals may be added in the form of a little very thoroughly 
eiH>ked rice or barh'y in the broth. Later, green v*^tables, of 
which the hi^^X are Apinaehr cauliflower topH, asparngits-tt|iep or 
thoroughly stewed celery, may be given. 

If imjiroveiaeat goes ou, well-oooked oensd>, such a^ rice 



c 



DfRT tS DISEASES Of CtW.DRRS. 



S87 



tnd erite, mar be pivcti at hi«akta4t. Ttioy should lic tbor* 
oughly cookoa artel AtrainiHl if n<M^4viaary. (htmcal should not 
be given until tlu^ di^;t>^t!oD \\i\» Ixvcime norrial. Well-oooked 
macaroni makei^ a |>]t'asant (-JiaDgt^ aud tVcHli-truit yiw^. ttvxy 
be giveiif ]jrvf<-nil>ly au hour Ix-'lutv ineal^. Of i\w JatU^r^ 
orangf-juiw U k-at, but Ui ataaon tbe jukx- of fully rlpeoed 
puac'lic'K or gruptu>, vrilhoiit rJcins or eowlflj nui)- be giv^n. 

Ail impmvotnont |>m^n>SF40f4, oreafti and hiiMf^r nuiy Ix^addM. 
A very .%mall |Hirtinii of weJl-hakiJ, on-aly |M>tat*i may In; given, 
with tho addition of oream. Potaloefl should never be given 
early in the trt^lment, and, when this fo<Kl \a added the ^ect 
should carefully he waU^hei 

The dieting iiiuflt be eontiuucd for a year or more, and for 
several yeai^ lat^r tbe diet miiHt be oircfully 8U]>erviD(xl. This 
mi0t be loaisted upon, aud l4 usually Dot a difficult matter afUr 
improper f(«dii)g daj^ brought oii a relapse. AJthou^h every 
ear& Hhould be talcen to avoid rehip^es, when they ooour they 
form the niowt jwwerful incentive for vigilance on the part of 
tlie iHirrie or mother. 

Direetion^ lu* to ijuantttieH and ijrepnmtion of food and the 
hour* of fotnliu;^ i«]i'iuld U* written ont^ and a curvful x^^ixA 
kept of what tJK' ditld tak^, And IIk* quantity, am veil aft the 
number tind ohanR-ttT of tbe eto<ilfi< By this plan it is frc- 
qtioutly cu^ to di^t«x-t jdict^ynern^^ics, aiid to k^ni wluit aj^-ei* 
and what disn^of^ with the particular patient in char^^-. 

A point of no email importcnoe iii the nvoidnnpc of starviw 
tion. Unless a phvHi^rnn thorouf^hlv understsindrt the fe^ih|; 
of infants lie mny starve a chilfl iuid rpnder it weak, anemic, 
and unable to widiBtand the cffeotA of the disraM.*. OeuieH thiit 
have been set down as intmctuble cut^irrh of the intestine are 
often merely the re»ult^ of slarvntiori or due to an nuMiitable 
milk mixUiro. In r^iuh cases, with return to a nitjonal diet 
recovery promptly f illown, 

CotisHpatiou- — Chrouic constijiatiiui 3i« thi? enu^ of niorv 
worry mid di?itrcrts than utmost any <kth*^r <^nditioii. In onW 
tn relieve it, the diet mti^t lie regulated oarr»fully add oorroct 
hiihitff hft ftmunl. The formation of o*»m*i"t habits ix nf n« 
mtich importanei' u« tlio diet in the prevention and oorrecUon 
of thi^ eonditiiin. Infants ilh yoiiEi;r a.H timt? mcinthA f^ ai^e 
may he taught to have a ^tuol rej^ilarly by placing tiiem upon 
a small eliamber at a stated hour. In older children a It^ed 
time ^ould be ^t for the daily vinit to the closet. The best 
time for thia \a ju»t aAer a meal, preferably hreakfaat, aa at 



I 

lyFAKT FEEDING. 



thi* tim^ there is a wave uf perisliilei? of which ndvantag^ may 
be taken. 

ConsTipntion la qiiitc commoo in brenst-lVd infants^ and ift 
DHDally dii^ tn the child'n grrtting a minimum amount of food 
or 11 milk that in low in fet iiml gmenilly high in prnteiD- The 
ijiialilv of the inutlierfi milk theiiUI he uoproveJ if po^ible, 
fnllowin^ the directioris pri'viim^^ly laid down. Between the 
oiirsing(^ tbf infiuit HhdiiM lie givon miter. If this is not stiffi- 
eierit nml the niothtr's milk is found dofident in tat, 1 or 2 
tca)^p(X>Dfiili?( of cream may lie added lii 4^ch ntu>ing, or cod-liver 
or olive oil iiiHv l«^ ^'iven in half to (eii.siiininfiil drjj*cs- An 
efficient eJiufi^ in tbt' diet t-onsirtts in g;iving 1 or 2 tca- 
BpnotifulE of tbonmghly ooukc-d outmfal. This should bo of 
iiltoitt the e(*usisten(*e of crwiiti, well sweetened with sugar, Htid 
stmined if iiectssan'H Tliii^ iimy be given once, twice, or 
oftener a Any^ fi* the c;i.w re*|uires, aad is best pivcn with a 
riurr^ing. Oninge-jtiii-c well eweetene*! nmy be prescribed in 
dcwes of a feasiKxjuful t«i n tAblo^pfioiifiil, given nn hour or so 
before a iiumng. Stewi'it [*nine-Jni<-e may be il.^ in the same 
iminner, niid in si'jiT'nn any fnni-jniee fnun perfeetly fresh ripe 
fruit niiiy be nliliaed, Tht; very aeid fruits should not be 
allowed, A IcMpoonfiil of a mailed f«Hl pajmre*! with barley 
lUAy he ^ven, and email amoLinfi^ of the thiek sweet malt 
extmetri may be npeil with advantage. MellinV VtnA may be 
useii to sweeten the food iu place of tagar. Care thould he taken 
not to disturb the infant's dige^tJun by tlie too frequent use of 
any of the articles just mentioned, or by the fise of too large 
f|imntilLee ; only one artiele shoiil<1 be trie*! at a time- If these 
ineanj- Ikil^ dru^ or sup(K)sitorieR miiKt temjiorarily be resoriwl 
to. It should l>e br>rije in mind that the eoostant use of drugs 
may <lcfcat any eilbrt* along dietetic lines. 

In bottle-fed babie*^, if the milk i& modifie*! properly, eon- 
etipntion will iimnllv be ovptvome. If relief is not obtained 
by thiji me^n^. nK-ayurew similar to those dira'teil for brea5t-f«l 
babes must be taken. A small quantity of barley- or oalmeail- 
water may be mixed with the milk or a malte'l fxtd added to 
it- Loiiii>f ytarr ^ive* the following diet-list \\\t emisli|»atioii 
in a child from eifrhteen months to two and one-half years 
of n^: 

Firtd Mrntj 7 A. M. — A breakfastenpful (fSviij) of new 
milk, with an additional Uihbujwonful (fS^ t>f cn^am j 2 to 4 
tiih)4>hpor>nfulN nf thori>iiphlr ei>ok*^i ootmt'ul or erueked-wheat 
porridge, with cream and salt; 2 ^liccfi of wfaole^wheat or 



DIET IK DISEASES OF cniLDnEX. 



269 



bmn lircfid, Inaurrod ; the jiitc<> of a rijie orange^ or luilf of & 
iDOclerata^i^'ecI npc apple ^'mped with a Tipoora, or a ftmall rijie 
p«ir, ftcmped, or a jwyidi. 

^^fciiwt Mml, II A.M. — A leacupful (fSvj) of milk, with 
oil a^Miitoiuil tahkMiKHjuful (f3M) uf cream; n nlk-v uf bran 
brmd- 

Thirti 3/"«i/, S P, M. — A bmikfa*^t<>upful (fSviij) of mutton 
or i*hirlcrn bmth, »r t or 2 tiibl4!*|Mumfiil-* <>f E]ii<1<'iN!oiif' nsast 
mutC'iii, b(H.*f, or chickon initirxKi tine uiifl |K)ijhil<-(I to a panLe; 
puK-c of 7!^piiiach: miu^hixl ciiuliliowor Io|ia; [iA|inr.i^i]^lii>fi; 
st4;w<^l celery; wbi>!(^wb^t or bran bre^, butUT<:*(l ; jiinKct 
and crfum ; noc*anti<milk pu<ld]ng with slewed prune-juic% ; 
baked applr with t're:im. 

Fourth Mtid, fj..iO P. 3f. — Milk, 1 or 2 break fa&tcupfuirt 
(fSviij— xvj), with aJditJoual cream ; wliolc-wheat or braa 
brcud, butttrtsi ; ^tcwrcd fruit. 

For drink t ptiro waf^^r only. No cuudimtnit but wdt. 

In ohJor <*hihlrt»n, fnl nftNirding lo llii' ndirs Jilnwiy laid 
down, ooii8tii>ation m not m) fni)ticiit, but wlh-ii the diet is tit^^g- 
Jcctcd and tli€ child idlow<d lo do a^ it plcafte^^ it ij4 a veiy 
common complaint. A glaA* of wati?r, either hot or ihiM, should 
be giverj au Imor ln'fore liniikfiLst. Op«im, a* well as watiT, 
shouKl be addtil lo the milk. BaHey- (rr niitrucid-wiLtA^-r may at 
timc-i Ih< udfhH] Xa> tijt- milk Willi benefit. Meiit brotbi^ un^ laxa- 
tive in Uicir e5ect« when u^MchJ to tbirt chcL Under eighteen 
anontha fniit-juit'Cfl, or alVr that (imc prrfcctly rfpc sound fmit, 
fiqiecially wJi<*n tjikt^n an bcmr bofon' n mojil, Ia vr-ry pervte*- 
ablo^ ^>g^ u^'l pruticfl atewi-d u>g(*rli<?r aiv helpfiih a^ are oat- 
men! ami Uread mad^ from iinlx^lted flour- la mach older 
children the mmmgemeDt in rtimilnr to tbat recommended for 
adtilt"*. 

Holt mana^ an average eiwe of chronic eijnf^tipatioii in a 
child of four years of age aa follow8 : " Mm»flftgi* for eight iidn* 
utof, luornlug and ulglit \ tlie jiiiee of half au omngv and n 
gUaa of Vi(?by immt-sJiatcly ujKm rirting ; a lin^jikfo^t of oat- 
meal, with oiic" ountt* of on<:mi, driL-d hn^ad uith buttor, an ogg, 
half ^la."^ ftf milk with i^wjim and wnt<rr nddeil ; a dinnrr of 
soup, one *tarcliy vc'g<?t^d)lc-^»\ ^-, potato with crcitm — and ono 
(rn-en Vf-jri-tabUr, iMvfNloak, briki*<l applo or prunes diied brea<l 
anti burt4^r, am) water 1i> drink ; for sapi)er, *?ream toast, i^^^, 
driwi bread and butter or (xraliam enu*kers, lialf glo-'w of iiiilk 
with cream and w^ter added: a suppoculory containing nnx 
vomica and byo«cyamua at bedtime." 



270 



INFANT FEBDim. 



Inanition. — IpaDition U a term looeety applied to variouB 
C0lI()KlOD^ ; it *Jiould, however, be restricted lo thoae cases cf 
ucuU: eUtrvutioD ixtining lui iu very earl)' lilu. It U t^bamcter* 
iyxA by a losH of wL-ight, aud ueiially ty ft?V4>r as well^ and the 
ooiitlitiou is nM iiifroqucntly mi^takea for »>iue otber diseafe. 
It fiillouii uSglinenoe from food, tsiK<h an iKH^ure in tlkose <b^b 
wliere infanta are abandoned on door-stepfl, or are groR&Jy neg- 
lected and starvefi. Other causes are nursing at a dry or uearly 
dry breast, in which case the child sie2es the nipple eagerly and 
atier seversi vigorous attempti^ at Btjcking drop!^ tbc nipple, crkSf 
and Geems to be uueonifortdible, Gnir^ errors in foedtng, as 
where a cJiild U given a food ab^aliiti^y iintjiiiud to ite nf?cd6, 
vxty al&o bring about tbid condition. It may eccar in infantM 
with enfeebled digestion — either those congenitally debilitated 
t\T those rendered S4> by disease. Sndtlen changes in food mfiy 
al^o oceasionally cause it. 

In the mana^ment of these cases, which i« apt to be diffictdt, 
the same general routine should be follDWed us is suggesteil f<>r 
ukarantic Labies, If possible^ a w^ct-nun^* should be secured. 
Holt advises that the breust-milk lie diluted witJi an equal vol* 
upe of water or of lime-water. He also stiggeftts that If there 
IH diarrbi-Ni, thf milk be pUDi|Hd fruTii tlje brtiusl^ and the cream 
removed. The pntportion of fat inay griMlually be inrrruscfl. 
When n wtt-nuree can not l>e secured, the child shoiihl first bo 
giv*»n vrry dibite mixturcfj^ lu; suggested in the tahlt*« ou pp. '218 
and 221, or u milk ^ nioditi<^1 as to be indictitiHl for a child 
mueb youn(xer than the one in band. These milk mixt-iirea 
should bt* partiiillv or conipleldy iMfptonii'^l. The authora 
have ustd weak milk mixture?* to which Peptf^idc Milk Powder 
has been added, with beiielit. Tlu'se may be given by meaDB 
of a lw>ttle, or if the child will nut suok, by incane of u medi- 
ointf-dn-ppPT or sjkjoUj nr by gavage if uecessary. In all cases 
iu winch a child rtfuees to take food a stumuch-tulxi should l>e 
p(t»^ed in order to asoertuin if tlie esopbngus ia patent or not, 
and the fauces ."jhoubl al>n be examiueii carefully l)oth by «ight 
and by touch. 

If the peptoniiied milk is not well home, iiredigivsted l)eef 
preparations, diluted condensed milk^ malted or farinaceoua 
foods^ albtim in- water, barley-water, in tiici, any form of food 
that can be given, may be tried. Those just mentioned are^ 
liowever, the m^ht apt to prow ueefuh Wuter, if needed^ u>uy 
be gjven by aabcutaueous injection or by th« rectuUj a normal 
Bait solution being best for thia purpose. 




JtAf^ASMUS. 



371 



Children very Bmall at hinb ai^ befit tratf^d in the same 
mtmtier a^ prviuatun.' lubitt^. Iii3iiiiit>i> In uldtr infaiiU^ may 
often be conibatf-Hl bv all'>win^ fooii ibat would Dot be |>ermitted 
under ordiQury oondt^oDs, Solid food euit^ for a Mid twice 
the fi^e of t1w> on^ iiiKlor tn^fment i^m^timeti HiKveeilfl wheji 
everyihinjr else han failed. 

MaraSTDtlS, — MarasiuuH, known aI.so under th*' namen of 
"waiting disease of cbi!dreo," athrepaia, and simple alrojihy, 
is beet described as a condition of peniiciiHb' atrophy. The 
term iiinnition should 1>e iificd only for thnine cai^eK of acute sUr- 
vution, wiih their cbaracteristb eyniptonis and cau^r^^f iKrcurring 
in infiuitfi. 

Atrophy in infants may bo divided into two clo^nea ; The 
piiiiMTy csBes, where the cau^ U unknown, and the ttocondary 
case>4. or th<w*e that follow delinile pathologic conditions. The 
dividing-Hne can not at prewnt dvfinil4>ly l>e drawn. All ca^es 
occurring in the counte of the ear^ily recognised disease.^ may at 
once be placed in the group of secondary caawr — thosL- following 
tubercuIoeiH, for example. Most cases seen clinically occur in 
infants who Iiave not had proper food and care. Some niiihors 
would place the?* in the list of t<!Coiidary uu^e, and consider 
llieni fn)m another i-land|>oint, regarding the prooeas of nutri- 
tion 04 twofold — digestion as the lin^t stop, und ui&Hiiuilution n^ 
the **pnnd. Under the heiwl i4' primary ut^iphy tln-se aiilhi>rH 
would pluce only thoK' cu:<4->( in which thi^ t^ef^nd factitr wa^ at 
fault ; or, in <»llier words thoHo ca^^ recLivin^ profter care and 
a phyAiidc^ifally corretjt diet. Thin divit^ion is, for pracrtieal 
purpo,**efl, usel*tss ; and since we la^'k definite intormalion on the 
subject, the cases should be divided, frtm a pathologic basis, 
into those that exhibit leeiicnA of deJ!nite diseai^es, and thoae in 
which tlit^re are au ftpcdal and oonatant leaiojis Uyond waiting 
of the aiuaclea and Itody-fat and atrophy of tlie thymus gland. 

If care la taken to ^xeludi* tu1>ert>uWU aa well as other di@- 
esAes, the diagnosis of th<* condilioii present no especial diffi- 
culties. 

In some instances the cause of the disease can not be made 
out, whereas in other instances it is traceable t*^ improper 
feeing, lack of care, m^titlicient exercisef and, most important, 
lack of fresh air and suDfihine. 

When cafies are seen ^e?L^^1:lUjLblY early and if the causes can 
be rccopoiBc*! aud remedied, the outlook ie good* In private 
pmctico case» among the well-to-do nsti^lly do well. If wen 
late, the prognosis is nearly bopelet^fl, and in aF^lnme and in&ot 



■ 




2?S 



INFAyT FEEDINO. 



homctf the outlook \» inORt ^oomy. If, wben tbe infADt i« fir^t 
sef'n, digesiivi' disturbances are present and «in be ojrn^lt-J by 
(lirtjiry raeasuren, tin.- outloA ia luore bopclu! tliaii hi tboMS 
cases where Huttii^ieut food is tako» and dig^tixl but tlic child 
nevertheless (Mjnlinues to wiiato. In iho really typical form* 
this \a the cjise, mid the disturbance seenis to be due to ini- 
proptr utilizjLtloD \\i the food. Sufficient food may be tikca 
and enoii(jh di^-^led and absorbed, but id the biirniDg-up of the 
food in ibo bixij" wonie change takes place tkit permit* it to be 
di!-pot*c<l of without properly nourishing the r^yj^lem. 

Tlie treatmoni of these cases ih e«>4?niiully dieUiry and 
by^itjnie, aud either measure aloue muBt iiiiL The ohild m\t%% 
In; kept warm, aud io a well-ain-d room ; if pos-^ible, it should 
be^vcri suu-buthe u.nd he liikL^o Into the fcesb air. In prrt|H'r 
seasons of tbc< year it shtiuld U"- oiiUof-doorH nir>^t nf the ttmej 
preferably in die country. The child*H hody should be mu*- 
sfi^'ed gently once or twice daily, using jrentle friction and ft 
luhrlcauL ^ucli as cocoa-butter or cocoanut oil. The rubbing 
moveuient^ should always h^ directeil t-nward the heart, bo as to 
(acilitate circulation* The child should be carried about and 
coddled aa much a^ possible, for many of these infants are 
Hlarvin^ for want of a niuther'H love as uiucb 3a fur want ^^f 
food. The child aboidd l>e IL-d while lying ox\ the Durae^A lap 
or aroiT and pot as it lit'S iu the crib, Thi* last is, of course, 
impructlcahh* in niany infant bomes nud hospitals. The feed- 
ing should t»e the name as has been gu^^sleil under the headiti^ 
of Loss of Weight, Of dru^, crea.'irite, hesl given in the form 
of Liquid Beef PeptoTioIdn with creosote. raHtnoaie i.if creasote, 
or carbonate of gnaiacol, is the moat useful io the conditioU| dux 
vomica and alcohol also being of Bervice, 

Nur^ng Homes for Marasmus Cases. — If homes could be 
eelablirthed for tht uumng aud luire '»f marantic hable^, the 
Infant mortality from this discia^e would be ^rcutlv dimirnHhcil. 
Thia nur^iikg-bonie plan has been carried into elfW^t m i;oRie 
of tlie cities i)f Gipnuanv- In th&ae institutions women who 
have recently biru ilelivered are r^red lor on condition tbat 
they nourish ooo or mon- infants. The <^nantity of milk 
secreted by tbt^* women und*»r the constant stimulation of 
several J^ucki^g children is remarkable. 

It must be rememljcred thai a lar^e pereeuta^- of the casea 
of mafasmus occur in diildreu who have been abaadoned by 
tb«ir mothers at birtb. If a child eh uursed at die breat^t for 
two or four weeks, it ia more likely to improve nD<] live than if 




RAVHiTIS on Ji!CKt-I'S. 



273 



It ifl taken from the breast immediataly and given unc^rUiin 
milk iJiixLinv^. 

Bialnatritioo* — M&]»utrilion i» a t^rm applied to ctutpn of 
d^ffociivi; uutridou that run a iDor« chronic? eourv^ thun tlioxc 
aufTerin^ from inthnilion or iimmj^muA. It fxiuih* in tnfimtfi nnd 
111 olihr cliildr^it. In the t^>rQivr titu miinagemout Li >iiiiil;Lr to 
that of nmranniiirt ; in the latter, the fmt\o ^'n&Ta\ rukn iLpply. 
Tb<* life of the child mu^t, w> far a?* pxsible, he ojin^fully 
n^ulated, and an ahiindance of freflh air and Aun^hine, together 
with appropriate exerciaea and intcn'als of undisturl>ed rent, 
eDJotDi]d. Tbe diei K however, the nicwt imiwjrtaat eleaieat In 
th« treatment. Tht.* ff>od flhuuld be plain anj wholej^ome, carc?- 
liilly prepared, and given at regular but not too frequent inU:r- 
vala. In &ome eafii.>s it may be found ndvi^nble to give siinalli^r 
meaU at shorter iniervaU, The fiwx] should he siieh as la 
recommended for normal children; a list of these articli^j* ia 
ffiven oa p. 24-3, where the details of the feeding will alw> W 
found 

Feeding aitcr Intabation. — Usually thin i^ aoc:om- 
plif^htil with hut littlt^ cir no ditficulty, but in itome instances 
9vruElr>wing may at fir>t he dilti^julti and tn thest* caj^e^ ^mi- 
solid^r micb sa Junket, Hoft-hoiled ^gs or a very li^ht omelet^ 
wine-jolly, or milk-tonfltj may he Bitb^tttuted for the liquid. If 
th« flemiw^lids fall, it ha^ been engge^ted that the ebild be p)aoed 
with it^ head lower than itff body, anil that nourinhment he given 
while in thift position. As Aoon as the obiUi learns to swallow 
with the tube in plare the u^ual light diet msy be fl^iven, 

Ettnresis, — Ik^ides the training and the medicinitl treats 
nient, a phiin, nutritious diet m of grrat ^ervi^e in these casea. 
In the mujority of cm^ of nocturnal enuresis, on queation- 
IDg it will be found that the children have t>een getting large 
quantities of cofTce or tea, or that larp^ amounts of wafer have 
been taken diirin^j the evening, or that the hlndder has not been 
emptied before fl;oing to b«i. In these exiles the treatment is 
obvious, and eonsista in excluding coffee, tea, and BtimuUttng 
foods (spR*es and the like), and iu limiting the amount of fluid 
taken after four in the afternoon. Muoh can be dune by proper 
training. When <l<?pendi>nt upon other tTaii^e*, the treatment 
must l>e direotiT^i towanl ihew? conditions. 

Racliitis or Rickets, — Riekets m a disease of nntrltion, 
btit one that is not well nndoratood. Meiat of the co-^fs occur 
in tbc temptral'? ?!oni7, in<1 ^touthem raced transported north 
seem espeeuilly pndiHpo^nd to it. It 10 v^ry (lommtin among 
13 




274 



ISFANT FEBDISQ, 



tlie Dcgrom of B&ltimorp, Tbe suthors bave foujid that 
D(ar1y 100 per ociit< of the iDfantd in asylums for colored 
cli'tUlr'eii wepo affect^^d with rickets, wherefts in eimilnr iDfitUu- 
tioim for white ctiildrpn in the «ime dt^^ the diseaM^ waa rare, 
Itjiliani; living in Amenoi sci*m predisposed to it, and children 
with biid hyRicnic mrrcundin^ are more apt to be affected than 
thwM' rwirtd akmld better c^onditione. It ih adi^ea^^e of the city, 
TIk" [uajorit^' of the e&M*5 occur between six months and two 
years of age ; it is not often seen iu breiist-fed children udIcas 
hu^talioii bus he«o continued for loo long u period, HoItHtateti 
thut nmong tUe Itallani^ in New Vnrk City it 10 not unoontmon 
to find it m cbtMreii who ore hreast-ful.. 

KJeU(^t8 may be produeed cxppritn en tally in ammatG, as has 
bceji prjvcd by Blani] Sutton in his fumoue experim^b^; he 
fcil lion whelpi* on an excliiBive diet of raw meat, and in a short 
time tliey dt'vfliii>ed severe rickets. Thoy were given mtik, 
pounded L)oii<^, and cfid-livcr oil^ and in three months, without 
any change in thtiir fiiirmijniiiiigSj thi-y were curt*d. Geurin 
C':ij>eriDiented on a Kttcr of pup^r and found that those wbo 
huckled did well, whereas those fed on raw tueat developed 
rioktli". Numerous txpcriaientt< of tJiis kind have been cou- 
duetotl, and while deductions were not always in aceoni, they 
tended, nevertbtleiw, tn ghow that, the disease may be pmdncwl 
by withholding milk from young animals and substituting for 
it other articlei^ of diet. 

In children fed artificially by improper methods rickets i» 
apt to develop, A food low in iiits is especially liable to pro- 
duce the diseofie, jwrticnlarly if, at che same time, the proteins 
are aluo deficient. In such a diet tliere is ainioat tnirUiin to Ije 
either nn exce^ of the carhohydralea or of eome euhEtanee 
iinmiitcd to the ohildV digestion. Among footU that cau^^fi 
ricketj; may be mentioned some of the proprit^tjiiy foods and 
condenK'd mtlk. 

The lime saU.*i are, under certain conditioDfl, apparently al>- 
laorbed with dil^cidty, and this would seem to be the case 
when the food i^ iJeGcleut in fat. Hence if the child's diet 
locks fiLt or if the lim<- ealta are delicient, the bonefl will be 
improperly nnun&hcd. It has been thought that this was due 
to ttTi excels of Inolit^ ncid, and there are a number of other 
theories thut need not be couaidored here. 

Diet. — Th<i feeding in tickets is vef>' aimple, and when it is 
possible to mmbinif with it outiloor life and proper care and 
narsiug, is very «flii^i«nt. If the child must be fed artilieially, 



JUCUnfS OR RICKET& 



976 



sncl if it exhibits syniptomn that are NUggeative, HUch as sweat- 
isi^t tenderness, or reatlessnefis at night, it should be given 
cr^um or cx>d-]iver oil in nd<lJtion to the proper diet. In this 
wa)' the dia^^a^e may be prevented. When th« diM-aae huA 
devclop<Hl, tb« ohild should bo pbiced on a diet 8uitAbl« to it^ 
rtgv, a» Htig^txit^l ilk thv eertion on the Feeding of Infknte - the 
{ttoA Ahoiitd eonaist in freah milk, eggs, meat, vegetables, and 
fruit The basis of the diet should be milk, whicb should <««- 
tain 4 per cent, of fat if the child can digest that amount aud 
is old euongh to receive it. Fat in some form must be supplied, 
and where creara is not well borne, other forms may be tried or 
ihey may be given in combinatioD. Of these, (xxl-liver oil is 
one q£ Uie most viduable, aud may be jfivt^u plain, in teuspuon- 
fiil doMe or 1»v4, My as u*>t to diHurb the digtifitio»> If the 
phiiu oil is Dot well borne, it may bo givon m tho form of an 
«>muWoti or with malt preparations, Pat baeon browned to a 
cri^ by dropping Amall piecea in boiling grea^ie may be tried» 
and will ofcn ag^ree where other fats do not. Butter may lie 
u-sed, but in larj^ amounU this may »ot l)e no well borne as the 
other forms, C^re should be taken that too much be not given 
and the child's di(£eetioa disturbed by eicess of fat 

The hyp<^iph<wpbiteft may be tised for their tonic action, but 
pniljabJy cxc^rt ihj !i|n;ciiil i-flix:t oa the dtneuMr. Irop or arsenic 
muy in: u»cd if Uiftrv i^-i anemia. 

LouM Starr' give* tlie following diet-lisi for c ehild of eigh- 
Ufm mrmtlia in which the di.^^ea^ i* nncomplieated by diarrhea: 

Fird MmK 7 JO A. M.—A btvakGLtteupful (8 ounces) of 
milk with a t«i>lft*i)oonfid (imt^-half ounc*) of cream ; on alter- 
miUr duyi^ the yolk of a uoft-Wiled e^, witli a little butter, salt, 
and bread -crumb^s nnd two to four taldespoonliUa of well-cooked 
and strained orncked-wheat porridge with cream and salt* 

Sororul Mt^ily 11 A. M. — A break fat t cupful (8 ounces) of 
milk with a tablfj«p<rtiuful (one-half ounoe)of cream and a aliCd 
of whoU*-whcat broad. 

TJiird Mfttl, 2 P. M. — A good tablesf^oonfiil of well-minced 
and p«nnd<.*it rhicken or mutton* with gravy and a littlecrumbled 
*Iak- hread ; u taL>le«poonru) of piirf*'' of spinachi stewed celery, 
or cauliflower tjjpa ; thin bnwd and butter 

Fmirth MmJ^ 6 P, M. — Milk and cream as at first and eccond 
nu^l^ ; fhin breati and butter. 

For drmk^ pure water. 

Avmd exccHo of rannacix>im fiKid. 

■ X>uoiflRi 0j the Digaiivt Or^om of (^iklnm. 



276 



H^FAXT FEEDIKQ. 



Should there be n oomplicatingiliarrhGa with li<iuM flffennive 
Htooltt, a diet «?miUi!riin^ n miuimuni (juaiitiiy of cuf^no ^ould 
be ft<loptcd> For citamptc ; 

Fir^ Mra/t 7 A, M, — Vwil broth (half pound of veal to a 
pint of watpr) ami bnrley-wat^r cfjUJil parts (;! to 4 ouDoe*i). 

.SwoTiff M^tf 10 A. if, — Cream, hjlf oiinne, whey (fiv>ibly 
prepared) 'i ounces. 

Third Meat, 1 P. M. — Siimt* aft first, witli cliickea bmth in 
plaoG of veal brt>th. 

Fcuri/t M^nf^ 5 1\ M. — Sunw? a^ seci^ud. 

FifiJi Mfj/^ JO F. }L—^in\ii us ttrst. 

If feeble, one meal at 4 \* M-, Katne as B»*ond. 

In extrc'ine utsen with dhirrbea Starr limitd the diet to raw 
beef-juice In one t'l tbrw (abl<^p<>f>cful do^cs every two houn^, 
with a modified bntndy-anil-pgg mixture twioe caob day, 
(See rw'ipes for lEifduL Biinidy-aud-egg Mixture, in the seo- 
tioQ on Reeipei?). 



n 





DIET FOR SPECIAL CONDITIONS. 
DIET FOR THE AGED. 

Whkx a mail ha^ imiwlhI lim lif\i('th year liij« did should be 
giiflfdiHl. DirUry iiidiscrttiuD« or u too plrntiful diet will 
nflult either in (be putting on of tlc'^li anil the cooMH|Ui-ul dis- 
oorofon^ of uln-wity *'r In the devdopmcnt of pout or alliwl 
Affcctiouif- In coQt^idering the dirt of the n^rd the old didum 
thftt a. miiD Is IL8 old auj hi^ ftrtr-rir^ nppticfi* ^1^ nan not alttviifB 
hf f'Vfunifd hy iffitrx. In tltc ngrtl thprv is a l«fl»;ening of all 
plij^}(ic9l Aotivitioe. TIjo old mttr taka« \ves exercise, had 
dimiiii?th<.d puwprs of digt*stioD, Aiid is h^»;e ahl« to obt^rk the 
nutriiiK'nt W haj< dij^-^ti^l. Ilir^ eireulation iff f>oor and hiji 
bow^Ti arc rtni^tijuiktl. Di'jrvnt^nitivt* pHXTt^stw have taken place 
in hjjc or^ii«, and hi? i^ more apt t^i ftrl \he cffLTt^ of indis- 
ione in diet. For tbefw hmi^ods the diet i^boidd be lighter 
tbttD in vomif^r vefin^^ und the ainount itf fiiod euleii should 
Vftiy with chc needs of the individci&K The food fihouJd be of 
flo «ftei]y di^tible variety ; it should be ^v«n in BmalW 
qnantitlei; at a time, nn«l the intervale belween me»U nhonld he 
shortened. If there is a tendency to obewty, food that is apt 
to Im.' convertetl into fat f^hould t>e given lu diminished amounts. 
The proteins f^hould be somewluit \vi*^n^i from time to lime;. 
The practice <>f eating heavy ^uppere lute at night nnd of eat- 
inj; U'twrxn mwiln KJioijld be discontinued. The person should 
limrii what iHtrtlrutur arti« k^ of food disn^s* with him, and 
trfniin from catinjf food-i that tend lo cftii»e flatulence. Yco 
i»iiggv«t«i that in the en^ of cook<^) fruits a small qnontity 
(about ft tefltp<H>nfid to the pound of fruit) nf uHliuni hi<^r- 
(K)nat^ be f^tewed with them^ to correot the aeidity that causes 
flatnloiiee. 

In the aged fm>d bear* u close relation to ficcp, A cup of 
h(^t milk, hot toddy, or H>me hot liquid food taken at l>ed-timc 
will oflen ovcrc»me troublesorue plw]ile#ft*D**s. A few »i|« of 
milk ora miM stimnljint lakcn during \h^ c«rly morinng houw, 
Mben the ugcil arc apt to awaken, will frctjueiitly iiiHurc ?*li^ 
afraiD, 



2:*t 



mST FOR SPECIAL Ci}SDITtONS, 



Food Snitable for the Aged (Yen). — Young and tender 
cliicken and gumt^ and other Lender meals. Pott^ chickeo^ 
giime, iind othor potled meaU. Sweetbreads, \>'liit« iiahj aa 
sole, wliiting, emeltfi. flounder, etc,, best when IxjUed. Bacon 
griHrd. Egg* li^bt];r rooked, or I>ea0?o up witli iiiilkj «tc^ 
NiitntiouB fioujH, such afl^slxickcui or fiali puK-ea, Wf-tea, luuttoQ 
and chicken hn:)t1ia. Milk in all furma wben cosily di^^ted. 
When it is not wA\ horne, tJie arlditlon of an eqtiaL ipiantity 
of warm Vichy, or of warm wat^r, will often prove helpfuL 
Beef-tm and milk supply thf? needed mineral aubstauce, and 
the former in au e^ceJIeat stimulant. 

The following foitda arp all suitubk : Bread-and-inilk made 
with the crumbs of stele breaJ and without lumps. Por- 
ridge and oatmeal gruel. FudiHogH of ground rice, tapioca^ 
arrow-rootp s^o, macaroni, with milk i>r ej^, aud flavored 
with spices rr serv<Kl with fruit-jutoe or jelly ; bread and butter, 
the bread to be at leoflt a <iiiy old ; rusk, lo be soakeil in ten or 
milk and water. Pre[Jared fooiU, oonsi.sting of predigej*ted 
starched ; at tixia ajje ihn digestive fermentn are provided .scan- 
tily by the digestive oi^ns, and soluble carlKthydmtes are vnl- 
uable for uminfaining tho body-heat. All Cirinaneous foods 
should be subje^tcil (^o a bij^b 1om|>eratufe for ^oine time dnriiig 
the <*ooktug prooeiss, so a;* to render the starch-grannies more 
digestible. 

Vegetable pur6ea cf all kinds may be taken in moderation — 
e. ff.f potatoes, oarrota, epinoch, nnd other succulent vegetable**. 
Potatoes nnd i'resb vcgetiiblos are a necessity ; if omitte<l, a 
."worbulic atnle may l» engendered. Stowed eeiery and st^wwl 
Spanisli or Portugal onions leud variety to the diet. Stewed 
or bakod fruits, fmit-jellieft, and the pulp of perfectly ripe raw 
fntitA ifi small quantity may be taken. 

Dr. Greoi^ 8. Keith^ in hi?^ Fadit of an Old Fhymtjvan, gives 
the following aecounl of his diet in \m old age: 

" Fnr breakfaat I havt a \iiv^ cup of tea, with milk or 
cream ; brown bn^ad from two t»i throe ouncea ; and usually 
one and a half oun«?es nf fisli^ or iialf that quantity, nnd that 
very randy, of Iwioim. Rometimes fnr a few days I take a cop 
of coffee with half milk, but no fish or bacon. Liineh is a 
oup of oowMi or rlioenlate, if the weather l)e cold ; if it ia warm, 
a small tumbler of milk* about »\x ounces, with the aume quan- 
tity of bread oa at breakfast. At both meals I use batter, not 
a quarter of an ounoe, and quit^; a^ tutiob jelly (»r marmalade. 
ThU lz> my usual lunob, but tHx-asioaally instesid of rocoa I 



have a baked apple, or «oiiic pniai?i with milk, or i^trawborricA 
vfitti crmni m long ax T i»» grt tlieni, or wry rurcly vt^^taljle 
»->ii]>. Wheu I hav« tie milk I uke usually ii morst-l (noi half 
all iiunor) t^rohimv;. At 4 r, M., a ttmnW cup of t«n, uiit) noiue* 
tim<n hinouit or coke. F»r dioitcr, nt 7, which b my chJcf 
mcml, J bavu A>up, from Ji'^bt, luotJU, |><}tAtoef, oclciry, osirrotx, 
fl<^t thp (imt two mnifp vriili nn mrat sttick, and the othi^rA 
with a little fn>m lumb or u l>onc> ; or fi^li iH»up> the ocly animnl 
ffoiip I iuiiul^v in. Fi^li^ mostly vrhxte tlocp-dtak ^Ai ditvct 
fmjn Montrosi' ; of thiH I Ukkt! no more ttian threw ouncv^, with 
a |HiUit«i nii<i nlwuyx another vt^table freah from thegfirden- 
If tjkrtv 18 no fii^h. I may take once or twioe a week an ounoe 
or two, <rrrtrttnly not mort', of huub, gume, rabbit, or iripe; 
but oftflti f huvc nritbrr fLsb uor fleali. Tb*j diuufrcutU witU 
Kt<fwixl fruit witli cmuti, or padding, or fruit tart ; ol' ihtt**; I 
takci *i fuir hc»lpmg. During Uie wint^^r wwuiftn, innteiid of friiit 
or pijddiiijar. I otien Jiavc ocl<>ry, witJi <.ilioe«cj» oiiliaike and butti^. 
On thi* tilH I i*njoy iht* Ust of heallli, and for my agv (--wv- 
^Tity<><-i^ht) mil up to a fair amount of «aercL-i('^ walking tijree 
to fiix mili^ daily in f;ood and Konjct]m(<9 in Wl wratbcr^ and 
u^mully part of thi» is up n ^to^p rood with a rixe of '2oO fe<»t. 
The only ronfejwion I have to make U tliat when at home I 
do a<it rihe till I have had bn-akfjint and rvwl ibe nt^w^^jKtjter. 
Thin ifl a liahit I tiave recoraiuradvd lo luaoy approaufiiiig my 
own a^, and thoAC who have.' tried it adtott that Ui<>y an> 
airoQgcr for the rwt of the day, I enjoy breakfaAt just il« 
miirh a>t my oLhfT m»ils, though I m>ver ftsA what (<an 1h> 
ealhd hunger, and have rmt Hone ao for niAny y«ara. I t^ould 
omit a meik! at any time without diacomfurL This I have 
long looked upon as the l>est proof of perfect digestion. Dur- 
ing very warm months I take rather less bread and butter, and 
I do not Ivy to make this op by taking anything else." 



DIET DURING PREGNANCy AND THE 
PUERPERIUM- 

Diet dtuittg; Pregnancy. — Under onlinar}* oirciinislances 
no oilier diet thati that to which the patient is accii«torai>d i^ 
advisable. The foo<i should l>e plentiful and nourishing. All 
highly seof^otted food and indi^stibie articles are to be avoided^ 
ni- are all articlt^ whioh are kiiowa to disagree with the [latieiit. 
^Vheu there i« a morbid craving for uuauitablt- things die 
patient ^ouM bo carefully guarded against indulging ber uppe- 




S80 



DJET rOR SP£CUL VOSDlTlOm. 



tJt«. Special diets may be ordered for patients with diabet^ 
or heart diwaae, or wbcre the patient ih ^uij-, over-fat, 4tJtiuIi::| 
cr cljloroiic ProcbowDLck' hoa called especial atteotioa to 
tb«ae oonditious. 

"Ditt in Obesity and Pregnancy. — In g^^nfrsl, the diet 
IB the .Haroe a^ adx'iaed id cbesity. This should be eomhintxl 
with exercise, either walking or light gymnastics and nia^sai^, 
which should doi, however, bo given over the abdomen. The 
diet shoald ooDsist of meat^ liEh, green vegetablet^^ fruit, and ft 
small allowance of earbohydnite^. ProchowDick albiws 4 or 5 
oaDee>4 (120-lijO grams) daily. Fruit is permiLled, but should 
not be eat«^i in too largv tjiiautltitA nor to relieve thirst. The 
amount of Siiid should bo refitnctod to a pint or a pint aud a 
quarter (500-600 eem). Proehowtiick allows a moderate 
amount of fat, a^ cn>am and butter, but not fal sauces, Soui>s, 
awoefc*, ftpiritj*, and pro^erva* are to be avoidt'd. The following 
is a Hample dietary as advised by Pnx;bownick : 

7.00 A. M, — Four ounce* (126 ccro.) coffee with milk; IJ 
ouDces (40 grara^,) bread and butter ; 1 or 2 eggs ; u little fruit, 
Before or arter this 40 to 45 minutes walking. 

10,00 A, M. — Massigu or gymuubtic^. 

10,S0 A> if, — Fruit ; 1 egg ; a very amall slice of brea<l and 
butt^^r. 

Miihhiy. — Roast or boilecl meat or fifth ; vt^tnblea, no bei^ 
or (Has; !*flLid; ehe*.'se ; fruit; 4 oiim-es (125 ecm.) water or 
wiae Mid wat4.T. No afternoon nap. 

^.00 P. M. — A. small cup uf <^>ffee or tea, ni.it over 3 onui^-s 
{100 nrm,) ; a very small **lice of bread and biitt«r ; an egg, if 
necessary. Walk for an hour or an hour and a half. 

7^0 R M, — Eggs or cokl meat ; 4 ic 6 oun<«fl (125-200 
ocm.) t«a or milk ; 1 to 2 ouooev (40-00 grams) bread ; butter ; 
fruit or ^lad. 

Thirst iA usually wjmplaintj of i?urly in the treatment, Th* 
diet i^hould be vant*d to suit tlif^ pntieut, aiitl the routine 
should be so arranired as not Id be disagreeable to the patient 
The redult of the lowered amount of 6uid and carbohydrate, 
logetlier with tbeescercise and massage, is to reduce the amount 
of lat, tone up the system, and to produce a nmall child, so that 
labor is made easier The uriue should be examined from time 
to time and the ^latieut should be weighed. 

Prochowiiicb's IHet in FelWc Contraction. — Accord- 
ing tt* I'rochownick, Florscbutz, and others, a diet de£cieot in 



I 




n 



J>iET 2>UR1NQ rR^ayAyCY ASD TUK PUERFERSVM. 281 

GartK>b}-<Jratc« and duidfi nviil result in a i^malJ chiJd without 
otherwiFre inftueDcing ii« development, a view vvbich has been 
cuufiriikL'd b^ I^atton in Kuglaud. TLediet ihadviK^d in woiucm 
wlio liavo previously boroe very large chdxlrcu &□<! id wonif^n 
with eoniTaote<l ]>«lvf«. In tbe latter, Procbowniclc docji tiot 
advir^ rbe diet M'hen the conjugata vera i-4 UOow A r>ni., but 
there are instances where the child was born alive aud well with 
the coujiif^Bla vt-ra ", 5, 7, and even 6.5 c, m. By iollowin^ 
his plan dirticult labor may often be obviated, and even the 
inductioD of premature lubor unneceHRan'. The diet may he 
begun U>u or twdve wteks before the birth ia expected, and 
aAcr the first wtck or two i^hould he rigidly followed. Fraeiikel 
advi«0H beginning fear or tive monlliM beiore delivery. The 
average diet consiste <'f 140 to IfiO grains of protein, 80 to 130 
grams of fat, and 100 gramrt of earlw^hydrafefl, altojfetJier a 
value of ISOO to ^000 calc^ite. The fluid eht>uld be lestrieled 
to about 500 ccm. per day. Prochownick'» original diet ' ia &a 
follows : 

Breakfast. — One pmall cup of eoffee (il oj,-lOO ccm,) ; zwie- 
back or bread (1 ouDce-25 grams) ; a little butter, 

D\n7\rt\ — Any kind of ment, e^p, or fish, with little sauce; 
grct'D vt^g^iablefi prepared with fat (ai* creani) ; salad ; dieeae, 

.S'li/yjcr.— ^me ow diiuierj with 1 to 1 J ounces (40-aO grams) 
bread, and lu miicli bultur us dedred, 

AhitFthttriy farbiihitrh, — WatiT, f4oijps, potatoes, desserts, fciugar, 
and beer. 

Drink per day. — Ret! or moselle wine, 9 to 12 ouucft^ (300- 
400 tvin,). 

Ail i\w mothers bore this diet well after getting used to it* 
Thimt waft complaioed of during the early pan of the treat- 
ment, aod if* e**[H-eially noticeable in fat w^jmeu. Some object 
til thf- lar^ t|ua»tttie4 tif annual food, but thi« id overcome by 
the iJK<.'of grr-eu vi'getabki^ aad salads. All the coutinement^ 
reported have Ihvu 4.^^ier than on previous ocrtwions^ even when 
thff diild W1L4 brge and fat, and all the children were bom alive 
even tliout:h the majority of the mothers had had previous mis- 
oarriageH. The children were lean at birth, with the bimes of 
the head unusuaJly mobile. The children were all ap[>uR*ntly 
mature io every way. In the majority of iDEtances the chdd 
gained normally after birth, and the <lkt apparently had no Imd 
influence on lactation. The urine should be examined rfgHl;»rly 
and the amount of urcix o^tlmatcd. It biLs been suggested that 



883 



HiKt FOR SPECIAL CO^^DITWSS, 



BUtAi tt diet would lavor ecl&uipAia, but thLs hiu »ot liv«u boru« 
out diEiiuilly- 

l>iet during tlie Paerperium. — Formerly great restrfc- 
tloDS were plaocd oa thp did of a reoently Odivered womaOf 
tlins acvMumting, ic jart^ for the loss of weight thut lias been 
ti€t4>d. If tlkc?re \s no nauj^ea aiui the |>ati«ikt dt^irpA U, a oiip 
of tea or li gluss of warm milk may be gi%'eD sood aiW dt-livery. 

Tl)e ap|H<titr i.-* generally poor for a few days afte* delivery, 
but tbod should l)e giv^n at rt^ular intervala not too widely 
fireitarated. The first din", milk, mitk-tosist, or, if desired, dry 
or buttered toast, with coffw, t«i, or cocoa, according to the 
t^<tte of tlu* juitient, tiijty be given. Water itiuy be allowed aa 
dcnmHl. On the see<>nd and third day* fejmply soups or any 
of tbp following may Iw ndde*l to the dietary : Meat broths, 
l>p^f-t«i, soft-hniletl or poatrhrtJ eggs, raw or sfewed oyster*, 
and t^omc simple d'jj^sert. stjcb a« wine-jetly, boiled cuHtan), or 
junket. During the next few days chicken, Bcraped beef or 
mutton in small qiiaotitie^, buked potiito, nco, and cereals may 
l)e given> und by the end of the week a gnulual return to the 
ordinary diet may be mude. 

DIET IN THE SPECIAL DISEASES OF PREGNANCY, 
Lowered TJrea Outpnt-^I>uring prc^imncy tbe urine 
phr^uld W walohLHl c]c>>4^K% ^md an t>xnminuflon for albumin he 
mude weekly, espeeially if there is the sli^ht^t reason to sus- 
pect kidney dtsea-se. If albumin is foond or if any untoward 
8\-mptoms arise, the urva output for twenty-four hours should 
be t^stimali*d. If the r|uaiitity excreted is below normal, the 
patient should be put at onoe on a railk diet, the milk gencmliy 
bei[ig skimmed (see Milk L'ure and Diet in Nephritis). If the 
|>atle[it Itrea of this, letluee salad and bread and butter may 
]tc allowed iti jtdditton, l'»p|!;ether with zwieback or bi«cnits 
(cmek<*rs). Very ^mtill (juanlitiiw of herrioj,' roe may f-e giv^n 
as a relieli- An ubtiEitlanee of water, either plain water or 
what lA known as Butllilo I^ithia Water, should be drunk. 
Cream-of-tartar lemonade (one dram to the pint) is also useful 
aa a l>everage. 

SfLltTBtion. — If this occurs, the patient shonid be pit 
uj»ou i\ rigonius milk dieU 

Gingivitis. — In Ihia condition a generous, well-mixeil diet, 
including fruit and fivsb v<*getahle3, is inrJicateti- lu udditipn 
tonic-) :iod astringent uiouth-waaLcs, ea^HJcialiy thodc containing 
the tiiioture of mjtrh, are to b© prwt:rib«d- 



c 



DIET DVBINQ PBEQSJUfCT ANJ> THE PUERPBRIUM. 283 

Femldoaa Vomiting. — T\m ia oflen asBocjated with 
diaeased conditioDS of the kidney. Whatever the oause^ the 
patient ehoold be kept in bed and placed upon a restricted 
diet, oonsietiog of peptonized milk and ftimilar preparatioiu, 
given in small quantitiea at iotervala of Uiree or four boars, or 
eveo oflenen Beotal 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 
ooDtrol the condition Itself. When the vomitiug has cefl.%d^ 
the return to an ordinary diet should be slowly and carefully 
made. 

Aberrant Mental Conditions dnring: Pregnancy. — 
The patient should be placed in bed, if p^^sible, and excretion 

Sromoted by means of baths and the like. An exclasive milk 
iet (or one that is nearly so) is generally to be preferred. 



SPECIAL METHODS OF FEEDING. 

RECTAL FEEDING. 

Natrient Enematft-— Tho ndminititratioti i>f food by tie 
ny'tiim (k n nu'Ui*^] of fci-tling of ancient origio. .it^lJus and 
olhfP* iiLciiUiid it, and whUt* linrinj^ tije Middle Agts have re- 
fcnwl Ii> ilj though not in vt-ry glowing t^^rniw, tbeir imperfect 
tcchnio |)roliiib]y n^ulliik^ ia pranicjil fuilttrc. Vi»itnnd BomT 
found that a dog's rectian wiruld not ubBoil» cgj^-ullitnuin uud 
witter nnlese MMJimii cblorid were mixeti uith it. Miut-jutoe 
and pe|rt<?De eolations have been recommended, but un actxruut 
of their c<^ are u*^it iu tommoii uac. Von Lcube advist-d the 
use of albuTDin tf> which (?h<.ippod panortra^ has h&^u ndded. 
His formula was as follows : 150-^00 gmiu!^ (5—10 o/.) i*f 
Hcmped and finely choppoil beef; 50—100 ^nims [}iS ox.) of 
finely chopped jiancreaa (of (he i;ow and ho^j), free fritm fat; 
150 c.c. ("J oz,) of Inkewanu wati»r. The mixtnre U to be 
Btirred until a lukewarm niajsa resultfl. If desired, fat may l>e 
added — 2J>-&0 g^ramfl (alioat 1—1 J oi..). It is best to allow 
the mi^cture to stand fttr f*ome time in a warm ^]ace before 
UHiug* The pitpored pancreas extracts, either dry or Ui^uid, 
DOW on tht' iiinrkrt, timy lie **iibstiuited for ibe choppLni paii- 
crea^H Eu'iild ifhuwisl that tbis pro(«dure was tjnuttieetiiiry, 
and that albamin that was imt i>«pIoiiii«Ki or |Min<^rf<Jit]/^l 
eoutd be abaorbeil. t-sptTiaUy if a small cjiiantity of salt wiia 
added. This la^t w-ernr* toojiawe reverse peristalsis, tmdGriitzner 
liafl shown that siibfiiAni-e^ intrmluced with tlie ^It solution may 
be found in the etomach, a tact tJiat has been confinned b; 

All the various da^eefi of fo<x] may he utiliKcd in reetal lad- 
ing. Protein may t>e Bupplied in the form of pi'c<3ijfr'8t<.'d meat 
or «^-a1bumin to which ^t has been added- Nutrose and 
aimilLir prepairations have been arlvited. Pept^ineii may be 
added, from 50 to 60 ^raai^ (li-2 oz,) in 250 grams (about 
4 J oz,) of water being the proper &tren(rtl>- Of the carbohy- 
drates, grape-?^ngar has been recommended. Not more than 300 
c.c, (G oz.) of a 10 to 20 per cent, solution »^houId be uIIowl^I. 
li' too much grape-^ugnr U given, it may f»(ise pniu in the 
3&4 




RECTAL FERDIXQ, 286 

alxlomen ami lo(Mone4H of thr liowd^ Storcii lui^ hopn uned, 
and solutions coDtamin^ il are readily dlgeMCe<t und ubM)rl)«d ; 
It lA aUu haid tf> be k'aa likel/ ibun grapc^-ftUf^ar Uv {^iw Htie tu 
flyni^onm of deatrvAi. Fat niuy Ixr itAnl, not ninre t>uin 10 
gramd (J 02,) beiitg gii'eti iq twonty-t'imr hour^. It ist be^t 
given in tbe form of yoik of rg)^, tmt oth<T ffitMsmlainiag miIh 
BlaDcefi^ mid) a8 crfiam or even oUa, tiiuy l>c iiamI. If tvclal 
feed]D>; id to be carri^xl i»ut for any Icii^h of tim-^, it I* ndvUa- 
ble to combine varioim article, and for this i>iLr|KR^ a immber 
of rprij>efi have been ipven on pflgt* 288- 

Burner believos that but one-fourth of tli^ nutriment neoded 
by die \ioAy tan be ub?Tf>rl>ed by tbf n-ctuni, and Wtb \\vt and 
other lairlk-r wriU'r* pluLx-d Uk' limit of lime during wbicli 
rKrUl foedin^- wai* j»i7wrtwal>b* at from oiu* to two wivk^. The 
avemge time dtintijj^ wbu^b nn iiidivtihml mfiy Im' !«Li?«t;iined by 
this method of fi<<sttng mjiy Ik* miriMTViktiveJy plncr'd iit fn>m 
four to iieven weeki^; von I^-ubr has kept a patient alive for 
aisc montbi, and Kic^l for tea months, by excbisive rectal 

TliG fliiooefis* of the nifth^d depends largely on pro[>er t^K^biiic, 
With poor twbnic lln' reitiim ju^n lH?<«mefi inilable, and for 
tlii? n-aMMi n«Aiil fet.HJin^ Hliould noL be intniHt^^d li> thi- nurse 
or tbr Ininily, Uiit tho phy^ir-inn hiDutclf [thoiild f^l-c tbut 11 U 
propi>rly w>ndiirt«l- Iti li'h-pitiiU <ir in privnU- pnioti^N? wh<jrc 
the nnnir ba*i \wi*u jjjK^^i.'illy tniln^l grnpnil dinvHonH may 
»nHiec, but in nny ca^^e explicit writl^^n din>ction-i arx* a«lvi>*a!>U\ 
(>nrc the rcotura Ix'tHjtuc* irritable ihe prwo*« ij* conducU-d wiUi 
dilliniUy. 

Procedure. — The rt^ctum sbonhl be ck<nri»^ thoroughly by 
adminL#l4>rJng a hijrh injection of nnmnd salt tiolution one hour 
b<*for*' tbr onc-mu is to Iw givon. Thi-* dnmning tilumld be 
pmrtiniil jit knnt <rmT □ duv, nud If niiuli miii.njd i^ prcvteni, it 
Diuy 1«? well Ui prctvdo t^ncli fiTdinp by u cli^iirieing enomtt. If 
(h« n**"ttim is inflaminl, a molutinn (*f lM>ric aoid may bo used 
inst^nd of thr wdt Holntton, or if th(?rp ix miich tnuous, a >ioIu< 
tion of Hodiiini bii'Jirbonut'^ may Iw rmployed — ji l(^>oonful 
of either lo thi- pint of wnl*T l»cin(r ^uflict^nt. For the first 
one or two eli.-an.-(ing ent'roat^i tbe bonel ^lioiild be flushed by 
the ordinar\" nu-tlKxl ; Intor a return-flow eatliefer may l>e uwed ; 
with this -M'v^Tiil ^nartA of solution may be used ; witJjout it 
J to 1 pint >vill 1m' »i]0icii-tit In inoT<l ('am'^-^. 

The t^rm^MTaUirr of tht? c^lt-an.-tlog cncmalu should be l>eCweeD 
95^ and 99^ F, ; that of tbt^ t>u«mata whiab are to be r^tviMd, 



'^M SPECIAL MHTHODS OF FEEDISO. ^^^^^^M 

b«tw«OD 90^ ttnd 95^ F. BolutloDS thai are too hot or too cvtld 
will prf>m|itly bt njedwl. 

Tile fHiticnl ^boui(l lie on hU sidt, with the hipK veil elevated* 
On jiot^njuv of di^i«i£e ttiit* [lOAition n)ay be impracticable. A 
ri-otnl ttibir or a large catheter should be used. Thie sliould 
notj however, be loo large; a tube 1 cm. (about half an ioch 
or lfi38) lM?ing the pro|)er size lor an adulu Forchildnrn tUe 
lube flhould be proportiou&tely muullen It should bi^ liibrioutvd 
thonjugldy, but glycerio tbould not be u«ed for this piirpo&e. 

In miroduoing the lube, it ebould be twisted glightlyr ^'liieh 
letfaeiu the liability of Its becoioirLg impjiefecl in thp ivctdl folds. 
If it is not po^gei] *a^ly, a small quaatity of the Hujd should 
l^e allowed to flow in, wliich wilt i?erve to bidluoD out ttie 
reetuia, after which the tube may usually be p^ed witli eaae 
for eight or ten incheti or more. The tul)e eliould in all cfl^Cd 
be introduced n& high up as poa^ible, a« the enema is thus more 
likely to be relaioed and abgorbcil. Theoretically, too^ it is 
urged ihat the bluod from the lowest part of the rectum is 
relumed through the vena cava, whereas thnt froia the higher 
partd returns by way of the piirtil i*y»tem and parses directly 
through the liver. This is of no praetieal rnomert here, ad 
ftUgar sfJutiouri absorbed from the rectum, even when introduced 
into the lower portion, do not cause glycosuria. This is ex- 
plained by the fact that the lower portion of the rectum baa 
a small capacity and absorbs but little. 

The fluid should be allowed to flow in slowly from a fuonet ! 

or a founiaiD^sTriDge- In some instances, where very small 
injectiuiid are being used^ a small hard-rubber synnge may be 
attaciied to the tube. Caro should be Uikcii to avoid injecting j 

air with the fliiid_ The mKhod of administering nutrient 
enemata by means of the otd-fashioned short liard-rubber noA^zlo I 

of either a piston or a Davidson syringe can not be too strongly ] 

condemned. In the bands of the unskilful it may cau^ injury ' 

to the rectum, and even if u»&l bv a trained nurse, only 6U0- < 

cecds in placing the fluid in the lower part of the rectum, where 
it i« apt to be expelled. I 

AAcr the injeetion the patient shtfuhl lie as <(iiietly as poi^ible ' 

for at least on hour, aiu! l>e instructed to try to retain tlkc contents I 

of the bowels A pad oC gause or a towel ehnuld be pre^^ed 
over the anus for twenty minutes or half nn hour, and the mtml 
•should, if possible, be diverted from the subject. After a few 
days the bowel oflen acquires a tolerance for the iujections, and 
they iDoy be retained without difficulty. 




RECTAL PEEDJyO. 



287 



If the rccUim i» irriublo and tbe fluid r^Jeoi^, it U well to 
pn*c«li: thr niitHrnt curma hy n sniall i^u(i[>o0Kor)r i<outauiiii)C 
ojnum, or, wbit !:« bclU^r^ n »inM rrcud iFijoction of tli« ^ctUT« 
of ojkiuRi may W gkv«Ei. Thi« may b« mix^ with a little 
)it]in!h \i'ftU*r, Iwt thf whole fflw«jlH l>e ag small &8 poMiM^. 
The 'ipuim r^boiitd not lie um.*iJ unlraH neces^ry. and the dose 
Hbould Im- just Mifliri^iit to quiet tlio bowel ; c»r the opmm may 
be uddt^l dirtH^ily hi Uie riiCEuiL 

If there are bemorrhoids, rwtal fw^Un^r will be greatly inter- 
fere with, Befiin* ^wh i(ij<^H'ti(^ii they nmy Itc pAiiiud with a 
2 |Jt.'r cx'iiL oHalii ti<thz(i(ni, atid ItctwcK-ii ibv ft'iiliiig u «(>ucbitig 
oiotmoQt HhcHitd l»c applied. 

Thtt amount to bci givi^ra ut tiich inj<«tirkn ifi an important 
factor. An a mlpf it Mhnitld tioI vy(*(vh1 J of n liirr, (^ pirt). 
If thi« }» not Weil tx^niCt the amount mav be rcducecl to from 
30 to 100 c-c, (1-3 u»0- 

Tlie Dumber of eiieniata t.i be uwsl will depend m>mewhat 
upon the patient'* <y>RMtilution ; a^ a genital rule, five, or 
better MXf houR4 i^liould l>c allowed! to eia[>si* IxiwetMi cturh 
feeding. 

It i» wW Ui rcDienibrr that (mcking in the vagina and tether 
gyoc'cologSo dre«Hiog» may interfere materially with the injection 
of fluid into th« bow«l. 



INDICATIONS FOR THE USE OT NUTRIENT ENEHATA. 

Xutrieut enemala are iudieated : 

1. Id extremely weakened conditions^ its during tiie progress 
of fevers, wten the quantiiy of PxmI taken tbniugh the mouth 
ii4 inHuffident to sustain Hfe or when even prt^iJi^^ttxi ftxxi can 
not be retained. 

2. In dirwaM« of the pbajynx and e*opbagus in whicb ob- 
rtructicnm to the pa^sn^ of food exist, n» fn)m tomors ; also 
ocrtwionally in «pa8mo<lie eonptrietione of tJie wopbagiia ond m 
pftralytie conditions of th^ pharynx whea the patient is nnable 
to flwallow foodn 

3. It] iise^A^ of the filomflchf ss m canoer occasioning 
stricture vf tlie cardiac orifice, with inability to swallow Hifli- 
cicnl noiiri^bment. In dj»ea«e^ of the stomach in which it is 
imporUint to relieve tbe etomach of work — c^g., in carcinoma, 
in iioii-muli^mnt strictures of the {^'lonm with oonaequent 
dibitation, and iil?io in nWr of tbe Moniach^ both when hemor- 
rhage bail oreiirrcd nnd when liquids ore bndly borne. lu that 
ff^mi of n(frvoii« dyspepsia known nc irritable «tomaeh, whicb is 



BKCTAL FEBDUfO. 



2S9 



Singer's Enema. — 

r26 gmtns [4 oL,) milk. 

12^ ^^rQA (4 oz,) viinv. 

1 or ti voIJu of €ggti. 

Salt. 

1 tpaApoonful of Witte*H peptfint^. 
May be ifiv<?o three, or pofiaibly four, Umeri a day aod 
w«ll borne* 



18 



r 



Rlescl's Enema, — 
iir>0 C.C (H ox.) milk. 
1 or 3 «ggH. 

Salt. 

1 or 2 tfflflpoimftilfl of red wiii& 

Ri^l doei nf>t ui^e pcptunL^ ai^ bo feara that tt might irrilate 
the Ttctitm and aiu^ diarrbcu. 

Bwalrl's Nntrient ^nema. — 

2 or 3 eg^. ^ 

1 tablfspoonful of water, 

A small amount of flour ut boiled in lialf a cup of 20 
per cent, ftolutt^'n f»f d<*xtroM> and a wincgla^ of n?d wine 
ttddod. The e^ scluiioii in t^tirred iii^ cure Ix'ing taken iK>t U> 
hav« the tMjlutiou too hot lest the ulbtmiin be coagulated. Kcitire 
nmounlf 2oO c,c. (8 or,.). 

A Preqaent Army and Hospital Pormnla.— 
3—5 ^gi*- 

Io(J-2^ cc. (5-8 oz.) 16 to ^0 per cent, Bobition 
of dextrrise. 

Add II little f^turcU solution or mucilage to muke it more 
vist*id cud a fcvr dnip* of tincture of opium. 

Boas* Fonnala. — 

2MC.C, (8 oz,) milk, 

2 yolk-H of i^gs, 

A miiuU <|imiitity of salt. 
1 tjibh'.'i|>ocinfiil of red wino. 

1 lubUptMinfiil of '^Kraftmehr' (Health Floar), 

JaccDud'9 Recipe. — 

2G0 v.t\. tHmillon- 
120 o-»o. wine. 

2 yolk« of rf^, 

4-20 gmmw (l-i> drnms) drv peptone. 
Id 




2W) 



SPECIAL METHODS OF FEEDtlfQ. 



SoBenheim'B Bnema^ — 

I »r 2 teUfi|HHinf lU nf p^t/)n^or a w^ll-stirr^ r&w egg. 
1'5 grams (4 ilraini<^) of dcxtraise it' carboliydmt4« are 
thouf^ht (iesimblc 

Zantac's Recipe for Adminiatxatloii of Fat. — 

Soda .<^iliiibn. 

200-250 C.C, (6-8 oz.) water. 

OTHER METHODS OF NOURISHING THE BODY. 

Food suppositories havr h^'i-w ?iiig^<'Klt'd, htjf. tlidr mm? ig 
OiX'n (j»niu(iyo^i<t'tiinis, Hn^oLirfime, lh(.\v mwy not W iibsorbctl. 

Nutrient inunctions, <.'S[H.vially with oil?, have bwo !*ug- 
g^Uil, unit m w mil i 111 JUS "jf ^Pcat trmuciiUiou they mnv prove 
iisofuK The body i^^ rubbed with oil, eiich as (.iLive nil, etfd- 
liver III!, t»r (wcoaiiut oil, or wiih <HKxm-huln*r. This keep'^ the 
&km bfthj tVie luossEige idmi provtnj^ belpfii!. It is fii pirti<:iibr 
v&lue in niaraptic intiiiiC^, mid ha^ beeii uf«d us a routine pmctioe 
by the authors in nil ^uc*li (JUJies, with very gratifyiug r^ults. 

IntravasCDlar feeding \\i\9 been tried. According lo 
Thompson, Hoddfr, ns i*arly ae 1850^ used inlravn&'ukr tojoc- 
tioQK of milk fer the eollup^ of Asiatie cholera* Others have 
U[%d milk atid peptone ^lutioos, NormJil salt solution would, 
liowevcr. wem to be a safer and a more pniv-tical method of 

E'tting rtuid into the body, Intravasi-ular feeding will always 
s attended with too many difficulties antl dangers to be of value 
to tJie pnietiti<uKT. 

Sttbcutaneous feeding ib a subject of considerable in- 
tereet, aod was need as early aj^ 1&6S' by Menael and Perko, 
Karpt, Krfig, Witthaker, and others have al«o employed thia 
method. One of the most iiu|x)rtant eontribtitioiifi to the sub- 
ject baa been ma<le by von Iveube. This ob«?r\'er could obtain 
no good re«iilt« from the use of either proteins or of rarbo- 
hydrates. He iff of the opinii^n^ however, that injectiona of oil 
arc of pnicticttl value in iiourisbtiig patients under f^ueb eon- 
ditiuim a» Render it m-oeanaiy, as in the failure of rectal eu^aiutA 
because of the presence of hemnrrbiiid-* <ir irritation of the rec- 
tum. His attention was direot^nl to the fiict thnt lui^ f^uan- 
ttlies of oil were tise*! in giving eamphor injeottons, whieli are 
more widely used in Germany thnn in America. Fnt emlK>li 
residt BO mrely as to l)e practically oo objeelion to the metboA 
Yon Li-ube uses tLe purest olive or seeame oil, and a 10 o.a 



fe 




OTitKR MKrilODS OF KOUniSmSO THE BOOT. 



syrin^, nmde after the onlinary hypodemiatio Byiing^ pattern, 
or a aeoUtr, a iuU:, and a fuuut^l. From ^0 Ur 40 cc (l—tj oz.) 
of oil may bo u^ed daily. TLu coDleolB of the syringe (10 CiC) 
should be iojooted in tbreo diffi^rent pliufcfl and the vruunds 
seaJipd with rollodinn. The oil Rltrtiild W inJMli^J vi*ry aUiVfly, 
and, of course, the strirtesl im^j>8iK nniftt he ol>wi-rv<«i. 

Saline Irrigations and Infaslons. — L Saline Rectal 
IriigaUons. — Ittvul saliiio injt^'tioiis ar<; t'hix'^.nally uwfnt in 
all conditionfl associated with hcniorrhajjre ; alw» in the varioiia 
infoctioua (UaEasctt, u well m in iuloxicatJ*>DH and ju those coo- 
diticMis ID whidi it m noce«fiur>~ t<j allay thiret. 

The fluid iiMxl should be a norniul saJt solution, and ehoiild 
be given high, with the rcotal lube ; if it is Dooeesory to prepare 
8Ui^ a Holiitinn qiiicUly. a T«aspooiiiiil of nalt may be added to 
a pint of water, aiid rapully injectfil by means of an ^^nlinary 
foautaiD f^yritij^e. The fluid -should l>e at about the teiiiT>er.itnre 
of tlic body, snd should be ailmiiiUtered filowly, wliilt the 
patjent is m a rwliniug posiii(jn> As much a» ^ quart to a 
quart of the HuicI can Ix- titili^Hed at one time. 

A usL*ful niHiiud i»f iidmiai-H^tf^riiig r^alt wilutitm U the plan 
followed iu lunuy ^nrgicul ctiuiifi. Whi-o dct^^mt^ advimble, 
either on account of low of bltrud, to avoid thin»t, or ho to fill 
up the aystem that further lymphAtii- iibMorptlon in impo«>^ibte 
(aA al\er operatioua about the thymid). the nthition may be ad- 
ministered eonliDUousIy, To do thiit uj)o lither normal saJt solu- 
tion or a sliji^btly stroai^r solutton in an ordinar}' douche bi^;. 
The bag is placed from 4 to 6 inches above the rectum of the 
patient. The n(*iz]e [^ then [ilaced in the rectum and allowed 
to stuy there. The tliiid llow:^ into the rectum a« it j» absorbed 
but Dot io sulUcient quantity to cuum^* it to be eipvllcd. 

2. Saline Infusions. — Solint; iuiu^ious are giveu siibcu- 
tanooiijJy, jind arc csj>coiany uHi-ful in eaeea in wbioli rectal 
saline irrigation- *^n not hv utilised, as in certain intestinal dis- 
ease«; nr whrn an imnn-iliiit** <'ffect iw required, as in fludden col- 
lapse from hemorrhage or from Hhock, They are alto ut^eful in 
ca^es when large qunniitiofl <*f fluids have been lo^t by the btxly, as 
in the dtarrh«^i4 of dy wiik'rj" and of eholem, in various infcrtiimr^ 
oonditioQs and tntoxityiliona, as in pneumonia, cnp"*i]Klrw, nrid 
^pboi<] fever; and in the uremia of chronic Brigbt's dim^se. 
The mtmt e-onvi-nicnt knation for admin isle ring tlie infusion w 
between the chc*l-wnll and ilie mammary gland, i>r deeply into 
some muficlc, a** in iho lumbar region, abdominal wall^ or but- 
tock. Thff injcetiim tthonld he given under the mtkst aj:<.^ptie 



SPECIAL METBODS OF FEBDim. 

precautigos. No appamtus \b required bcvonil a rountjiin 
ajringie to wbich on a?piratmg ncc*llr ij* nttdclnyi. Tlic m- 
fuaioD ehoitM he wsrm, nn<l alimilil be al1owft<l to nin in vlowly ; 
frpc|nently aH nmrh sui* 1 or 2 qiinrl^ ran be inje^-tW into <>ii« 
plac€> The mixture used is a normal— OjS per cent, — «iiU »olu- 
ttcoi. In certain cases Cugbing^ preform tliu followitif; Hr>ltition: 

8fHtiitm rMorid O.V00 

Cnlciuni chlnnd CkOn 

Potaaiitmif-hloHd 0.010 

Duoillod water »0M 

Toao55 



Ciiml>s ha* re|>ortcd a fotal ease of Kwjliim chlorid |xi)»oti[iig. 
By mistake 1 lure of satumtetl salt aolutioa was iDg««Ud bypo- 
dermically. When seen four hours later she was romaloM*- 
After about ux hoars of coma, a period of excitation followed, 
?ihe waa maniacal, and talket) inoohcrently. Thi^ condition per- 
8i!<tcd for twenty-four hour*, wht-n she diod — 124.4 gm, (1920 
gr.) of sodium ohlorid had l>een usel. 



DIET IN DISEASE. 



General Roles for Feeding tbe Sick. — Tb« nurse and 
family wh(iuld be fully impr<«fed with the iiDp*>rlance of ihe 
pruper feeding of the patient. Definite directions ojs to bow 
much food, its form, itfl preparatiun, uod Iwy/ often it la to be 
givcu, hUuuIiI be wrJlteii out. Id all nciite 8eriouj^ coiiditione, as 
in pucutnoDLa or io typhoid fevvr, a record of thcw dctailji 
ithouhl W be[>t, to^tber with the retard of the rjuantity of 
fluid lJiU*Ti, (h*» niMifiinft* fttven, ele- 

T\wn-. is usually a tendency to err in either extreme— that of 
giviDg either too much or too littk food. Oare sboidd be takvn 
that the imtient^fl wishes are, wherever practicable, cjirried into 
effect. 1 he nun^ and family Fihould be questiontHi curt^fully ixja 
to tlie patient'^ likes and dislike;^, und a1>^ons to h'u idio^yncm- 
Biesi. A tactful, observing nurtte is of inestimable value, but a 
GortleHH or Hlupid one l^ an evtir-present source of danger. 

The." training uf nursea in regard to feeing i^ oAen fiitilty. 
Kv«ry nuRM should Im> instrnoUHl in the 8i]bj«etof pmctioaL 
di<*li-li<-_«, iiniJ nhrmld know Imw much ffwyi U required by the 
diffvrcut ly|H^ of ])Qticut4- The details of feeding patieota 
shoidd alwavft be gone into. 

The food should lie given at regular intervalsp In uncon- 
fldoua or semiconscious jmtientfl this i^ of great importance, but 
it iA jiiHt as important iu the conscious, as the appetite nsually 
comas on at r4-rtaio llmeH, and if the meati is not furthcoming, 
mar di^^]>|Hur, 

Th<-' uiJpoult' of tlw-* eouscioiH |>utient and of the oonvaleeoent 
should be fo^I^red, and notbiug done that may iit any way diR- 
tori) it pAtienta vary much in this particular, but as a nde 
individuals who are not owrfestidioua when they are well, 
beoome bo when weakened by disease. 

The sick-room should be orderly, and no di^hej?^ ulen^ilM, or 
food be allowed to «tand at>out the room either Ix-forc or after 
using. All food and drink sbouhl l>e offeml from MTupuloii?<ly 
clean glofl^eb or dishes. Thc^e should be a* dainty nn ptmniblc, 
and the food mUisI be mwlc attractive in appcamn^x^ ; when the 
dinb permit>^, it ttaty he gamiKbHl with a *^rig nf grtvn. Tlie 

£13 



SM W^r IN DISEASJ^. 

napkins and Itnen fihould he »fH>tle«», The exterior suriace of 
doases and cup^ »liould lj« wiped dn' before they are ofienxl to 
fte patient. 

Pood tluit \i& Htttle or that buJ4 acqiiinxl an uuplcasaut ta$t« 
from staoditig in a n-fngLTUtor tiigethcr wiili other tbijig;^ sliould i 
not be given. A Mrong egg id nii cggiiog may be the mentis of 
tumiQg n [taticnt Forever ugulu^t tiii^ form of nuuriehmeni. 
Tbci food «Iiould be tested by the Tiiir>>c, but ncver^ when }K>atii- 
bk, ill the patiect'a pr^si-nce or with the sume spi»on. If thero 
is anything wrotg with a di^h, this should be du^covered nud 
remedied bt^forc it is brought to the putieot. 

A mirae should always remembtT the eternal titness of things. 
UtenBils and dishes should be uaefl only fur rhe ptir[x)se fiir 
whicli (hey arc iiiteufleil, and not its inuUeshills for olher urticles. 
AiUrr curing for the patient or remciviug evucujitions siiHidenb 
time shniihl be allowed to elapse before fee<Hiig fa l>egiui. The 
patient should bo made to feel tliut the titmngt cleaziUDe!^ and 
ram have been olwprvi?d. The hnndH and fa** nf the pa.tieDt 
should be ^iped with a moist cloth and then dried bclbre food 
is ^ven, and the lips cleansed after the meul is complete. 

The position of the patient should be as comfortable a one as 
poaaible^ and one in which lie will not tire before the meal is 
ended. If the |>atient is weak, the food should be given in 
such form that he may take enough of it without induciD|r 
fatigue ; otherwise he may beL»[iie tired of mastiuitiag and 
HWallowing and take an in-tuflioieut amount, Patienia who cam 
alt up ID bc><l should lie piN>v!de<] with a lied-trjy on whit^h to 
place the fotvl. The leg^ ^ihoiihl bt^ plnet^d high onotigh for the 
patient to (Nit comfortably from it. 

If the jnitiout is helpless, care should be exercised in giving 
food so that it will not b<^ drawn intT> the lung?* during inspira- 
tion or eoiighmg. This may be avoided by giving the food 
diowly, and by seeing that each mouthful is swallowed before 
another is given. These patients may be fed in varioufi ways. 
^Hie fijod may be giveo fn>m a fl|)oon, or. whal ie ufiUAlly pro- 
forred, from a dnnking-fTup with a epout, or by using a Iwnt 
tube and aUowtiig the |>ativiit to take the food from a gla^s. 
When the patiejit h taking bread and similar solids, great car© 
should Ih* excroiaed not to allow the crumbs to fall into the betU 

In most severe illnesses it is necessary to awaken the [uitient 
during the niffht Uy administer food. This is a point that 
requires special judgment Oilen the patient is more in need 
of sleep than of food. If the patient does not drop off to 




FKKnrxo uscosscioi^ Asn nKFRAcroiiY pAvrKHTS-^S 



Abcp Vfrysoon uftff Ukirig food, it may b^ better to wait untQ 
be awakens bofore giving it As a rule, hov-cvi^r, b severer ill- 
ntss U»e :<lwi) 13 ciiitturbt:^! for tmt u few miiiuUs by takini^ food, 
A Clip »r wuriii milk ik vimduT ligUt fjud muy often luduco 

Tb<T patient'^ mouth sbmild olwayv hr. kept clean. If dry 
oikI purc-tiod, it should be runted U^fom nnd afW taking food. 
A Aiiitnbli* mi>utb<-;nuli U ^ivoii riridtT tin* bnA<Jing of Tuberni- 
lostfi (|i. 'V27), but uny of tht^ ailkuUnu moutb-wBflhe?^ may be 
u#kI ; bt>rIo acid and water iiUo mnkc nn cBtcicnt wni^b. If tbo 
fnoutli i.4 dry, it j«houId \k moi^kiicd from tiaic U) time, nnd for 
this puq)use u littl<* giy<x*rin, wiikT, and lemon-juice will be 
fcmtid u.^i^'tlil. If the [latLt-nt \s liclpK^j^, llic ntoutli may be 
nH'ublH^i out wiib ci>Uuii ru?<li.'tJt.*il to Uir «'nd of a stout pnilx^or 
vvuuiid nbout the? finger. Tb» AbvtiM b<! moistcDcd with M>mc 
uatUi-ptic jMolution. 

In nil <4iHi*K wh<*nt th« illnwfi w likely to be protrartj^, 
amintr^Tncnts Mbonid W made to canr for and prejwire the f<H>d 
with ixs little di:My^ifort to tliu bouiwliold as pO(«ai[ile» For this 
purpose u diet kit<jheii may be impravi8«d, preferably ia a room 
adjoining th«^ jtatkntN. If the patient'^ mt^anrt allow, a ^tmall 
eick-rooru rt'fri^rpnitor should be provid^'d^ and a tin rcoepUdc 
for storing foods that do uot iievd to Ih^ kept on uhv A gaas or 
alcohal lanip will serve for beuting ffiwl. A thcjnnomctcr, a 
graduate, a funnol, nnd filtcr-papcru an* n<We<)i and n meat- 
iuin«in^ maohin^ wilt \w found h uurfnt i;ddit]fin. S^iuoejutn^, a 
dinh-pAit, and a supply nf t«i towpN ffbonhl aUo U^ provido*L 
Borit* acid or borax and so<lium bicarbonate will help to keej) 
things fraib and clean. In mise» of iuft^tions and r(»miuuai- 
cable dineaf«eii a covered boiler for disinft^ting all dishes^ and 
uteasils should be added. The dislicw should be Wled in water 
to which 2 or ;i per cent- of «odium binirlKHinte haa l>eeQ added, 
and the bolting should be allowed tj> ei>nlinae for fallv Iwtaity 
nu'nntea after the water bos bq^im to boih Where infrtruetions 
are likely to be carelc^slv follnwod out, it ie l>eat to din>ct that 
the difihi^fl b^ boiled for no hmtr. 

Feeding: Dacocscioiis and Refiractory Patients. — 
Unconscious p&tiente may often easily be fed by means of a 
teaspoon. Each spoonfid should be swallowed before a second 
is given. \V. Gilman Thonn>snii ndvist',"* that, in the case of 
comator^e childn*G, the nouri^liraent In* |>oiire<l into the nostril 
ii]8t«ud of into iIk- niouih. The Itnid tliu8 given is swallowed, 
and any cxcvjw returned by the utber no9tri]< If any difficult 



296 



DIET jy J)ISK.i6K 



is expiTifiJocd in »walIowjng, it i--* lx*?*t U* n-r^ftri to i-iibcr the 
etomoch or the nci^ tube. WtUk a little pmctlcc nmat |)ulJ4riit6 
oon bo fed with iKe tube morp cu^ily than in any oilier way, 
A moiitb-gag fihoulil be IntHKlacf*! nr n rollrr luiinlitge omy be 
placed between tbc tetth and hold in plnw ly nii ;iNi<l'<taul. In 
iufani^i wbo have no teeth ttiij?! prennitivn in iin[i<r(e>'^rv, iia tbe 
finger ajiBwers the pNrp<.i«.' jKrfi.cdy, Tbi^ tuU', |>n-vioui:ly 
tnoifilened, ie nu^f^ed h\U> the pluinux iind mpidly inla Ibe 
fitODiaob. If the tubo is ni>l [mssfcd rapidly tlirougb tht^ pbaiynx, 
contmctjon may follow uud the Lube U: prx-visiiuJ fruui tuler- 
iug die caophogiiA. Id orvlcr to |*a,s.s the tulu- into lb* e^pb- 
agufi it ifi DCccsaary to bold it siiffioicntly wM biu-k from th<? ond. 

If naml fooding is to he waodj a naanX tube, nr in eiL^ of 
infants a catheter, is well oiled and gently passed tlimugh tbe 
nose into tbe esophagus and then into the f^tomacb* Care 
should be tjiken not to pa*s the tube into the larynx. Thijn 
accident can alwayr^ be avoideii by waiting a moment before 
pouring in the food. Either stoinaeh or nasal tube slujnld bo 
provided with a fwnnelj and m soon as the tube bjis been Ratl^ 
iaulurily iiitn>duced^ di^ uourishment — iitilk, uiilk ami v^, or 
whatever liquid food id dcsirol — may Ih' poureil tflowly into iu 

In order to prevent atr from entoring in advance of ihc fi.>od 
a small quantity of the fond may be poured down tbe side of 
thi' funnel until the tube is fulb In many cases it may be 
dei^irable to wash out the stomach before introducing tiie food. 
The tube ahoulJ be withdrawn rapidly, &o as not to excite 
vomiting. Food so intn.>dueed may be retained when it would 
otherwise be vomited. Thift is true l>otb of infants and adultfi. 
{See the sections on Gavage, Forced Feeding in Tuberculosis, 
and Lavage.) 

Id the caee of refractory patient;! — the insanf!^ tlio hyeteriCf 
and others who refuse to eat — forced feeding becctnes rtece^^ 
sar}'. In this case enough attendants should he present to con- 
trol the patieuL He r^hould be held 6rmly and the lUBal or 
tbc fitoniatb-tube be introdueol. In order to prevent regurgi- 
tation of the food, which some patients manage to do quite 
skilfully wbile it is Ix'ing intn>duceii, the ribs may be tiekle<1* 
This prevents flxation of tbr diapbnigrn, wiih<»ut which tbe 
Ctiod trail cot be rj<Krt^i. Tbi:( should lje duut; only when OC<a* 
aion demands, (Soc Diet for tbc Inaaoc.) 





FKBDiSQ ly FEYHB. 



FEEDING IN FEVER- 

B«foro dining Attention to tl)« diet in fEpecinl tormm of 
p_vn>xiii it will Ik* wril Ut rtinKuU^r hrit-tly the gf<n<'nU dii*trtio 
principles* iuvolv^xi uiid tJicir u[>pliiTHU<Ki to tliJ.H cIojM of di»- 

Tlicre fxifitcHl, In fonncr years, maoy difiVreot view* coo- 
oeming the opnt»ct method of feeding fever c^a^es- Prior to 
the lime of Graves (J 848) it was the general pnirtiw to 
"ittarve" fevers. Oraves taught that a fever panent required 
fiKKl niid idunild he fc<l, and iu hits lecturen, publbihcd In IK-lft, 
tJicrc appcarc^l the iiiuch-<^ij<»tcd Hcntciu^ : " If you nhouLd be 
in doaht am to un f>pitAph to be plotf^ecl upon my grttve, tjtkn 
iW\fr—*lIfJnifrtvrfi^*** With tho t'^rhiug of Miirrl)i:«f>ii mi<) 
Others tliLe view giudually replaced the older otic, and ti:Kky the 
pmfe««oi3 aiQ in accord regarding tbe diet indicated in febrile 
dWairCfi. Minor difierenceti in opinion ^xi^t and varioua theo- 
ries have been promulgated^ but the practical application \s the 
same in all cases. 

Id fever tbe metabolic preoc»8C^ are incrcused, while at the 
]>i&mr time the power of SHiimilation in lowers). This rcsiilt^ 
in the bnming-ujj of the body prot^^ine as well n» of the fate* 
Indood, it U 8tatc<] thiit the prcitcins su^er a greater Iom pru- 
portionately than the fat^^. The appetite is diminisheci or 
entirely lost, there is a marked jesftened activity in all the 
glands concerned in digestion* and, as previously noted, absorp- 
tion and tbe assimilation of food are much below the nonnu. 
Thirst also is much augmented. 

Foods appropriate for healthy icdividunls are not, as a 
nile, snitfd for fever patients, and solid foods nsually cause 
vomiliag or severe indiifestion. \i\ ordL-r pi'o|)er1y to nourish 
a fever patitnt it is ueccfiMkry that tlie fixnl be cfu^ to take, 
easy to dijjfe^, and easy to assimilate. Any food that does not 
possess the^e three qualities is not snitahle for a fever paHent, 
When the disease runs ita oourse rapidly, the diet Is of no great 
importance, for even if the patient take but little food, the 
period of comparative fa^aling is a brief one and any low is 
easily made tip while re<y»very U in pn>gres«. In prolraoted 
diseases, nil the other hand, such as typhoid fever, nud in chronic 
fevers, the diet h of primary importance and shc>uld he tbe 
phyaician^s Krst caiv. In ehronie diM.-a^CT* and in tliosc fevers 
vhere refnissions occur, the periods when clige&tion is cooapara- 



258 



DIET IS DISEASE. 




tive.lj' good should be taken advantage of, and the paitenc nour- 
ieiLed mid atreagtheiieJ as mui.<}i as }>o»stb!e. 

Ill fevers thv itioutb ivtjiiiree especial aire (see Typhoid Frvcr 
and TiiWn^uWU) ; the boweJs Likewise should l>6 regalaU'd, aod 
ooriHt]|>atioti avoided. 

Siiitalile U'venige* should l>e given to allay thirst, and if 
the patient \& nut getting sufficient liquid with hia food, be 
fihouJd be offered water or some other driuk «v«r}' lliree or four 
boura. This should be dotit* whether or nut the patient 18 oan« 
hoioas, for a patient sL-eiuingly consciuus \% ofleu in an apathetio 
GonditloD. The wat«r is roffiiired uui onl)' to <]ueneh thint^ 
but to aid ill tlie elijuitiation uf wm^te-prtxlucts^ vrhicL, oiriug 
to tbc increased metalxjliaoij are migmcDtcd. The moat eutt^ 
able of all drinks Is plain wat4?r. Whea tliis do«ti not ogree, 
or to m«'t six*(^i:d indicjUione, miDf ml wat<.*rB are nften of grait 
use. The natuTuI watt^rs, sinct^ they do not conlHin such hifge 
amouutit of earhon dioxid, are Ijest. If the artificial wateis arc 
nsed, — »nfl thiTt is generally the ca^e, — they should be allowed 
partially to eSV-rvo^we before being given lo the |iatieEit, lest the 
gas in the et^jm^ch cause uuplea^ut syrapt^ma. The " Impe- 
rUl Driuk " (see Appendix] is very useiiilj and id generally taken 
with a wlisL To thi* may be added the white of an €^, 
hcatoD lip and strainc*!, \£ the pnticnt is not taking much foijd. 
Both leoionade and oraogende are useful, and fhi? former \& par- 
ticularly vahiable. Since the hydrochlorie acid of tlie r>tomach 
is deficient during fevers, water acidulated with hydi"oehlorio 
or phof^phoric acid i* of serx-ice^ as it increases the powers of 
digestion. Barley-water, oalmeal-Wiiter, toast-water, and albu- 
min-rt'ater are all of servioe, containing, as they do, nourish- 
ment with drink. Albumin -wat^r is made by beating up the 
white of a fR'sli egg, straining it through a cloth, and theu 
adding; six or eight ounces of water. This may he flavored 
w-ith lemon, "range, Klierry, or eogoac. Wine whey is also of 
value^ and under rrrtain ciroumstanctw, as in affcotions of (he 
bladder, Baxseed tea or gum-water may be given, Eorely, beer 
or some other beverage h permissible. Patients previously ac- 
customed to Inking large uiirtnttties of bevr daily may refuse all 
forms cf TiourishmeDt, unless a certain amount of thi,** bever- 
age la allowed. 

The food for fever eases should always be liquid. Milk, as 
it contains various fond elements in a 8u:1ahle ci>mbi motion, 
is the beat of this elo^s of fiHide, and if properly adminiRttired 
agrees with most patients and is easily di^estetf. It should, 
as a ruler be diluted, and a small quantity of lime-water or 




FEEDiyO rX FKVKR. 



299 



sodium bicarlmnale sliouM be acU^ to it Ijime-wat^r may ha 
added in amouRis varying irrtm 5 to 50 per c^ot according to 
circucaMtaii€«a. Vichy or tfeitter water, or even ordinary waler^ 
tnay be used^ and may be flavored if the [ulienl piYfen. Barley^ 
water or oaUucuI-wat^r may be mix(.-d witb it, or, wimt im oocne- 
tinie^ of great acrvit^e, C'<juat purte of a oereal water and tnilL. 
rnay be boiled together. If tbe mixtures mentioned do DOt 
agrt*, the milk should be j>eplonia?tl. Milk pliould not, liowevi^r, 
Iw pepioniz^t! if tie |>atient can take and digest it \v)tljinit i»e|>- 
toni&ttion. Butlennilk, kumtiw, or whey may also be uaed. Rut- 
tcrmilk, however, contains but little Doiiriifhment: kumii^ may 
not be relished at first, btit many paticntH aoon learn to like it. 
Liwtly mfanla^ &nd invalids' food may be givca. Malted milk 
niAy be enjoyed by tbe patient, and ia useful lu tbo»o caaca in 
which there ia diarrhea. 

^ffff* '"^y be given raw or in th* form of album in-water, and 
ao excellent mode of admini^itration, especially if the patient 
requires a stiinulant at the same time, h to give tbe time-honored 
Stokes' brandy-antl-egg miitnrc. Given in this form, the egg 
genenilly agrees. It may be well to make up the mixture with 
ont*-<inHrt4*r or onc-hfllf tlie anonnt of bmndy. 

M«it-juici^ and broths, for whioli recipes will be given further 
on, muv l>e u^iied. Ttie lueal-extr^ctA are best given well diluted. 
The variety of broth should bo changed each day, nalng beef, 
veal, mutton, and chicken in turn, to amd monotony in the 
diet. The vflriong predigeated btxef preparationa and beef-Ju ices 
fiold in the shops may be used at times, and are often of g^tat 
\"aliie, especially when the patient can nol retain other forms of 
food. Stmined vegetable broths are useful occasionally in long- 
continii^d fevers, and gelatin prepomrioiif, Guch m ealves*-foot 
jelly, wine-jelly» or fruit-jelly miidc with gelatin, may al»o be 
employtd. Fruil-jtiicc^T cj*|>cciuMy lemon^ orange, and nusp^jcrry 
juices, arc gcnrmlly rcli/^bcd. These should be diluledi and 
arc l>c«t given cold or ^-itb cracked ice. Solutions of grape- 
augar alone or drink sweetened with grap^-sngar ar« to be ivc- 
ommcnded. Granulated extract of malt dissolved in water or 
milk i»^ roli^lied by some patientf^n 

Alcohol. — The question as to the ^'aliie of alcohol in ft*vor» 
is one that hart Ijeen widely di3<^!a«^wHl. The pafcst view, prob* 
ably, \^ tlijit which fnkc^ the middle ground, fitr wliile aknhol 
may Imve b<N?n, and Hill i?*, jfn-atly nbiBtnl in sickness there 
can !«■ iiu ditubt that it renders j;rwit servicie, espei:iaUy an 
a food and a ntimulant In fevers. Since alcohol i» not needed 



300 



Dmr IN DISKASE. 



in all ca»ce, Ui^ growing t£D<U'nov \* to rcEinct ite u»o to tho*« 
niwfl in which it \a A^fimKi-\y xuaH^xXi-A. Ir abouM nat h» re- 
played a-4 a routine mt'jL'vtm; iu uiiy di.-ii^ase, nor t^IiouIiI it I>l> 
used for apy length of time where there U ci lik^Iihofid of tlie 
patient acquiring the hakit. lu acute feNi^ni in strong |iattentjf, 
wlicre the disease is apt to be of nborl durationj it fthoulil nr>t 
b^ uf€d. ir th« odor is apparent on the breath of tlie paiieiit, 
or if it causes excitement, <Lelinuni, or any menial tiympiom.-*, 
itaboiild be used only in liiuitt^l tjiiautititT). 

AJcohoI, it should be remembered, \a not only a rttiroulant^ 
but H food ns well, each gram of it fufuiMfiing »crveii <ndi)rioii of 
beat or that equivalent of encr^ lo (he body. It should not be 
given too oirly iti the disease lei^t Ma at! inula tin jf cflect be loitt 
as the system becomes accustomed to it. On tlie other haud, 
stiroulatioDf either by alcohol or sny other etimiilaut, should not 
be delayed too long. As soon aa the pulse becomes compre««sible 
and weak tlie stimulant t^bould be auministered, Wbeu one Is 
suffideDlly expert fu aubcultatioD, the need fur ulcohul cad be 
learned fmm the hcxirt-bciit. When the first sound becomes 
weak or lo?e3 its sharpni^e, it is a sign that the heart is begin- 
ning to flag. Sir Dyoe Iluekworth deseribefi thn aft follows : 
" The cardiac indications fnr the u^e of alcohol in fever are a 
notable los* of l^>ne i:i the first sound, especially if this be in- 
appreciable at the bu>ie {Su»kcs' sign), ind Uie lus'iociatwl condi- 
tion of the pulis(> — thnt of lowanerial pt^surt* and the phase 
of it known a.": dicrotism/' 

In hyperpyrexia aleolitil is of great value, for when the tem- 
perature nni^ vioy high digr^tioii ami assimiliition aiv apt to 
o<>mc almost lo a standstill. In tb('-<p onsos alcohol Is cumIv nb- 
Morbid andactg as a stimulant smd iwsi AkhI. In pontinufiU liy[>t!r- 
pyreiin large iimounU can W* ^""iven, and it seeiiis to W* cutiriily 
uu^l up in the boily without prothjctng any mental f^ymjitoms. 

In the i^i-callotl nxthcnic fevern alcohol in smalt amounta and 
at quite frNjuent irt^Tvals i* a^^ful. In the very feeble and in 
the aged it may generally be taken with great l)eneUt. 

In prolonged fevers in children attended with difficulty in 
fee<ling alcohol is also of value. In the^ cases the heart indi* 
rtttiona ure uHualty well marked and are rtiltabk' guides to the 
dcftagc. In giving aloohol to ehi]drt>n it libuuld \h* wl^II diluted, 
and nmsitl frefpiErnt mthrr than large doses lU longer iiitervalfa, 
nhould be administered. I^rge doses are rarely needed. 

In thofie habituated lo the tlaily use of alcohol it must be 
given in seme fvrm whea these persons become ill with fe^"er or, 



i 



loSnd, vrbeQ oonHhoc) to bed from any c&uf«. When alrohol 
b witbdtswQ sii(l<lenly from thohc Uf^'ii^tomel to lur^i* daily 
aniCHUito DUtritiuii npUlly fuih and delirium uuL iutrcqucatly 
«ctH in. 

It xhouM \h^ tvmrmKen^l that mnny condition^ io vrliich 
nl»>hEil wnH thmtght hi Im* imliMporiKnUlf^ n few yeAm ago or^ 
trt^tcd ju^ UA tratijEfadorily now wttboiit it. 

Tlic fona in uhkh atcoliol U to Ik* iriveti fever patients 
dopoiidft on individLial taste. A» a ruk', [mrt whisky or hnndy 
diltired wiih plain nr with a miiicra] water i:* prcfcralle. If 
then* ii* a divided pn'fen^-noc for wiuct> n pure old wine, tiliier 
U^t or red, may hvt pn^Mcribcd. 

The qt]£iuiity to Ik* ^ivcn dcpeiKb upon eircnm^tuncen, and 
lbt< aj^f ooodition, tuil>it'<, nnd tolemooc of the pntloiit ull piny 
on im|Mirtjnil |iArt in dn>»iing thiic qiK^dnn. In infnnlj^ ;ind 
young chiklri'n frrtm { ounce to 2 oiincen of whiwky divi<led 
over twfiity-four houni may be regarcUd ^ a ntiMiiiEiblc limit. 
Id older cliiUIn^a from 1 to 4 ouuocs in twenty-four hoiir>^T ^^^ 
in adiiltit from ^ to 8 ounera in the wime k-n^h of lime, form 
a good awmgc. In the tti^of h;ihiiif.'> mm] nl-'ti when otluT 
circutniitatict'^, too nuni<Tuii# to ujeutioi; ki\, warmul, llie^ 
amoUDtfi may be iDeruased. 

FEEDING IN INFECHOUS DISEASES. 



TYPHOID FEVER. 

Tb^ DWHIgement of the diet '\^ one of the mo6t toiportftnt 
ftotor« in the trratmcnt of typb<nd lever, nnd tho ij^ludent and 
ihf i>mcthjoner c^hoLild^ lliereft)re, ^eek to h-aru nioHt ihor- 
oijgbly how to f<»d n ty(>hoid putieui* Fnrtuaately, the* Icudiag 
uutlioritlrA niv tn accord as (o the principles govoroing ibc diet 
in thi» tWtuiis^f and the muny ijKici.il dinuHsts that u]>p*jar fr<jim 
(inii' to lime in the luedir^d jniirnnls are best 4-ntiwIy disrt*- 
garded. 'Ilio problem before the phy!;iciaD h tbv ftv<iinir of a 
fev(7 patient wLr» is iikcly to be ill for gome weekn, who ha.i 
a diaea^ed eondition of the liowcI», and whcii?Le c^i)vale.4oence i& 
apt to he slow and to require careful attention. It shouW he 
borne in mind that, owing to tlie pn-scnw of the fever, there is 
an actual diukiuulJon in tlie digi'^tlve and ab^rplive powers. 
The digealiv^ juk^n arc lem attivt-, and the aaiouut of bydro- 
ehlorio acid in the fiiomaeh I* dimiuinhed. The liver is more 
or kss disturbed, and the bile 'at leaM aelive than normaliy- 



302 



DiBT IN J>iSEASK 



Pervtulsw w I<c«onod ami alMtorptiun defootivc. In ftdtlttloQ 
nlopTAtionM luvtir in ib^ intr-fiLinct ami itrr- lijih)^ to gti on to pnr> 
roratioti. It tihoutd always be bome m riiiiid tluLt u mild olw 
of CyplKiiil IM au d&D^mu^ u^ a sovi'tr mie, Ixrth lx^^iji<e the 
teDdcncy to severe ulocrution is just us i^n^t iu tht< oiic iw lu 
tlic othvr, aiid also bccMUHS u inihl aif>c \» rDon* npt to be K<«U4 
airefully inaiut^<<lj jKirtiniliirly in regard U) iho diet It mu[*t 
Iw ri'TDi'inbt-ret] ttitit ditrJEi^ li-viT Die metabi^iUc pnxH^at^es an". 
lu'i^htctivijy anil i}v%i^ at tli*; nihi^ limr, uUv^rpLioii ia lessennl. 
A:4 a onn^K^ticncc, tlic bixly protein tH burnt up. Other tbiugs 
b«ing o<]IIhI, tbo I«h4 t(KxI-innt«niil in iii^>-lmilut<!(l, the? more body 
prof*n» will he ih'Kf.rnycNl, It i-^ fvldrnt, then, t.lmt thi.^ iJlor1» 
slioiilcl he directeil towanl r^upplyitig the jKit^'iit witli a Mufficirnt 
amount of cflfiily i)ig«»tod nnd rmdlly :u^imilate<) fiKxl. Minor 
diHtnrbaiict.'s of digtsstion should be V(at<:lio4] for und^ (*u far as 
[wHHibk, orrt-ctofh 

While the " Mnrviiti'iti imitniiiit" of former dfiys has, owing 
to iiiv U1p( jn< Mf (imvH^ niul Miirx^hismij become ubsolek-, care 
miiiit ht iakcTt not t<> err on the other side — the pnticDt must 
Dot be overloaded with iootL 

Foo<l aiid drink >ihould W given at n.*palflr inlcrvaU both by 
iii^ht and by ilay : the* apjictite of tiie patient should not be 
consult^, for these piitients are oft<?o apathotie or have no 
desire fi^r fooih The food should be pven at int<^rvaU of from 
two to four Uxirs, aeeonling to tiie condition of the patient and 
the <ju»intJ1y taken at a tiinc Thi>sc who are f^tron^ and in 
cninpjiratively j,^fhl <umdition may lake their nuurishmnit at 
four^hgiir inturvalt^ during the oi^ht, even if it is ^iveD at more 
fn?4gu<Tnt intcrvids dunog the day. 

Tli*j cpieetion of drink U nlen of ffnertl importance in 
tlwwi- eji>«s for ill some pHtientw severe thimt \s a very dis- 
a^rwiible symploin to combat. Pure water, ^ven with or 
withntit ice, la to \vi def>ended upon, but if there am no contra- 
indications, thi.H utuy Iw varieil tn many ways- The natural 
spring watt^rs, nr, if th*-^' ntri not lie oblaiiieil, the artificial 
ones, are eiten nsi-fnl. The anifieihl waters oomain lur^ qnan- 
tittea of carbon dioxid, and to avoid Inndilo Uicy shoiUd always 
be allowed partially Ut ejrer>'<wtf!e Iwfow* they nre given to die 
|>atient. If f livre Is no luarkcx] lj<>woi diMturlHim*r, fniit-jniee may 
l>€ ntided lo the watfr* Ijcniooiidi*, orangi'snh', nusplipirv jui*^, or 
rasphern" vinegar and water are otU-n welcome changes. Wwik 
tea, eapeoially if a little red wine la adde<l to it> i-^ an adnitmhle 
thiret-quencher. Cold weak coffee in n*li^ed by «ome, Ked 



I 

i 



FE£i>rm i.v ryrncriow i>tsBAS£& 



303 



wine aD<) wnUr, white winca, or cv«ra nhtny or bmiM])- mvl 
waUr nufcT U; given to ^omc potieatv, cfipci-milv If pbiii vmt^jc 
CftUftc« unpl«^nt CTm(>t«ioff- \Vbc«i U»or« oix' irrituWjtit^ of 
the inUwtitie and severe dmrrhcn, ivd wiuct mul w(*iik tm nrc to 
be prefrrrpd. Albiimin-wiiU'r, «inw it <nimhim» f™Hl nnd 
driDk, itf mobt tiscrtiL It may \w flavnriHl with kniuD- or 
oranpsjuiw. or n«iy bo ^buken up witl> u littb* iJurrn- or bramly 
mu) ioc^ (Tlw 0^^, wtn<rh Junihi iilwuys bt j)erft*cUy Liv^n, 
tluiiiltl be lH<ubMi and thta ^UiuntHJ Uirou^i a cloth.) TJie 
V4rh:»n)^ muoiln^rtiuiursdniikH may K' iisik), biic are ni>t ^nerolly 
ivllfJit^K <ruiii-;irahi<"-wiil<'r, iirruw*nM)t-wiit«r, bitud-wat*^, 
bnrlcy-vmU^rf puttnoil-wiLUr, and nimlUir bt:vi;ru^^ htxYis their 
phicc^ in the phygicmn^s hat of poAxibilitiea. 

(^iHliinj^ Hiid ('Ijirlfi' nHaiuimeod the nd ministration of Large 
qiittOtitiiuH of waiir in typhoid. Thoy adiniiii^UT u (:nIloD or 
iiion* til twrtiiy-foiir hoiir^, ^vinjf it in amall iiiid dttiniiequan- 
lititis. C'ltpiiiu^ elimiuAtion of urine follows, corre^tpoDding to 
the amount of wal*^r mgf«t«d. They chiim lliut the |nitient is 
made mort? <?omfortable, b* leiis toxic, and ihal the nervouH ^ymp- 
loms art? ItP^ ttao when iht largt aiiiuuul of wat*T U not j^ivii*. 
The food fmr e:cccllouoc iu thi» di^t-af^t^ la iiiiik< Then; I-** no 
one food that mwte eo many indicatioiiM. It [NjAM^itscri great 
nrnrif.ive valne, is eofiily prof iiri-d, ea a ni^ nnd t* geiiondly 
easily administered. It muni Iw btinu* in mind, hcmrver, that 
there are Aome patients with whom udlk diMgn*<^7^ arid runny 
who d(j not like it. Milk^ bowevxr, diwigrccn hw* commonly 
than i^ generally iinajrin<^^. The lunoiint to be Kiven daily 
vari<« botww^ 1 and 3 f|U]irb<, acoonlin^ I'j the putinit. 
There an< not many pHti<:'nt^ who e-fin fuko ^) quart;* of pfitia 
uiilk, and iL in ^-u^'ratly a i^ikhE plon t^i varv tU lijrm of aiU 
minl-ftmtion, and r>oraAionnl]y U> eubstitutc lor it other articles, 
which will W menticmf'd further on^ i^o tlmt the pnti^nt mav 
iiontintir* U* fjiki- milk chiring tJip entire (yinrw* of ihr diaeaiie- 
If milk i» giv*'n plain, it is only » quc^tiim of time when it 
1 will dLsufTTLv with »iiy patient. Children are more apt to tjike 

I it over long [wirKKl^ vf time thim are itduItK. At the Garrett 

I HoBpitaJ for Childn.*n in HaUlmort* Uio aatliors T^ehlnm n»e any- 

I thing besides milk lor ty|ilimd caH'i*, and do not. fitid it mtvsi- 

I sary to make Hmugv-H in it. For i.ddi?r childrf-n i>r adults it 

I flbould always be modified. Wbi^i milk formn Uie diet, dvt 

i month re^piireK |)arti<ndar cure, ckH tho little milk that rt^muna 

[ in tin? RkOiith often turiiii tht jiutii^^nt again*'! the next fci^lng. 

I Thim* are niony wayn of mfidtfyifig milk ntvl tvudoring it 

^^ more agreeable atid more di^^tible to the imticnt^ The simplcA 



DIET ry DiSKdSS. 



mrt1i<x] b to add from 1 to 3 ounocfi of luno-wat«r to oacrh glius 
of millc, nr |>Iiiin wflt^r or ?« minimi tvAter mny be it^tvl rnHf^iL 
If milk ia wt^ll borne and it is deaired to incpeaso tlie amontit 
of iiiitriMiont, orvum may be a<I<Ied to it. If this causes ud- 
pW-sitiit ?*ymi>li>in?i, it i^Iioiild bo di«M3ntmued at once*- But- 
termilk muv begivm occai«it>iiiLlly, but }» fur inferior id outii- 
tivo value to plain milk. Kumis» or ketir may be usod^ and 
u'bile Cbey tuny not be i^tialied ut fin^t, nio«I imticiitit learn to 
riijoy liidii. A pim^b of salt may rtmdtT uiilk niorx- palntal>le 
to H>tne jwrsons^ and the ad<lit.ji>D of a spoonltil of biundy mny 
be rclisbud by others. The rnilk mny b^ given ool<l, l>o flavored 
witb fniit-juicfW^ vanilla, tip nnlmcg, or it may Ik' givvn in t!ic 
form of ice-crram, Wbcn milk is uot well lK»rnt', it is a gvod 
plan to [H'cpare barley-water and add l« it an equal quantity of 
niilkf boiling tbem together for u few onputeH. Plain boUcd 
milk may aliso l>e nseil wirb bt*nefiL, 

AnKjng tlie disagreeable symptoms lo whirb milk givi^ riw 
may lie inealiuncd u Imd lasLe in tlie nioutb, whieb, however, ia 
apt to be present In any case ; a aenfe of fulness «r prer^ure iu 
tlii^ ubJomen ; enicLition, or evon pyrofiis. When \\\e milk is 
n(il wpU di^'sted, it may rtinne dinrrhea, with eikUeky juiinft, 
and the undigested eurds will be found in the tiio<jL*, To 
obviate these *yniptotns the measures previously suggested may 
be tried (see also Milk Cure^i). Malted milk may be a8e<l, or 
tbe milk may be taixtxl with some of tbe tiivulid fcH^ds^ nr it 
may be partially or completely peptonized. For ibe lai*t pur- 
pose the peptogcnic milk powder will be found useful 

When milk le found lo disagree, other forms of ntilnaitub 
mnfft be given* If care is taken to supplement its uac hy otbcr 
foods from tbe begiDuing, ihe milk will be leas apt to causa 
difttnrbaiKVp 

The carlxibydrates are valuable foods in typhoid, uad may be 
used in many different forms. Of these, tbe v&riouf^ gruels lire 
the most easily dij^flted, and may be giv<?D plain or mtjted with 
milk or bouillon. Oatmeal^ iboronghly o^okfd (three hours' 
boiling at lcit<t) and strained, is best, but may not agrw^ with 
tbe potient. Barley-water (Robinson's barl<'y flotu- ip an excel- 
lent preparation for making tjarlev-watrr), arrow-nx^t, i^ago, 
tnpioeai nnd the prepared fnod^ may all bo nstsl. Id Ovrmniiy 
aletiritnitt flour in itddi'^t lo bouillon nr Monps. 

Of thf pnnteinti and albod substanees there are a number that 
may be us-ed. Meat i^ to be forbidden bo long as iever iK-^-unt, 
Fat must be tkimmetl from soui^, br'.ithN, and l>f>t]illon, wk it is 
apt to disturb iJie jutient'e digt'--*tiou, Bi-or-jinee^ made acw^d- 




FEEDtxa rx ryrecrrous tuseasbs. 



ing in any of the rocipee given in the Apfi^j^Jix, mmy l»e 
Of-«L or bwf-juic*» PX|irmBpH ftnm vptv fllij^lly broilnl bwf or 
«kinii»o<l c!i»sh pravy may be ii*4«l. This may W wrvcni in a 
frrtfn j;]ji*w if ilic tnilor nf ihc juice its L>hjtH.^ionnbIc. Botlle 
bouillon may hv employed^ as may also the vanon* hijimi beef 
pr«[>amiio[iF4 and meat-jiiioea now on the market. Mosijueni 
Meal Jelly and Valentiue'H Jieef-jiiice are iii*ful bm expensive. 
Beef-L'xtracU art m**Te Btiiuulutiii^ tlmn uulriliouA, 

Senator rtxKjmm<>m)a ^^ktinuua fiubd(auoo<^^ aucli o^ gv-Ia(iii| 
c«UW-fi>ot jelly, l>o(tl« bouillon, and the like. The gKbtin 
jdliea may be flavored with fruit-jmce^ or wUIj wine. 

P41& fthowld W urted **parintjly. Kii:ff-waler, however, when 
I>m[K!rly jm^panxl, rarely cuntics diwtn.^-*. Kaw eggs may 
occaiiionally bo giveit, or the yolk of tin egg in bouUlon or 
broth, h^gs and milk tog^her may <<nnrte ii>dJge«tio[i, but if 
th» paueDt Ia id Deed of a fitimulaul itn well us 11 IikmI, Blokea^ 
braady-iUiJ-«3^ niiilunr, alrc-wdy dciM^rilMnl, iiiiiy be used, and 
in ntinli^ruU' (|iiAiilitio^ rurely di^ugri^e^. 

Sotna('4i<, cuoaHkTk, nutro^ and similar |nvj>iirutloiu roay be 
niivoti wirii l>i)iiiUoii or othi^r food^. 

AWliol hold-H an im[iortaDt pUcc as a KkxI ft» well jw a 
stimulant in lon^H^initiiuieil levers. The U'n<li.*ticy U>^\ay in to 
prescrilK? it in i*iniilliT f|ii;ini itied than formerlvT and many have 
alxmdiinefi it?! use aIlf>^thLT. It in, Deverthelctis. a valuable 
ally in lighting typhoid, and should not he dT?»eunkHh It 
ithotild not Im^ given to childn^a as a routine trcatojcntp but 
evon ill young [mtients it it* ufU^u of the ^reatefit strvice, ^\Ticn 
given to udult^, it id well in hcgia with v<ir}' SDinll doec^^ and 
to inonjcuHs those ns the patient growH weaker or as the fever 
<uintitiiin4 U* prc^reas. Too miif'h itliould not, however, be 
g^vcM. and if thedosaee hiu been Uny large at first, it cao not 
be incrtuHvl a^ nt^ivA lat^r on. In habitD^, alcohol will be 
needed from the ontftct- 

The fonn of alcohol to l»r nwii i» largoly dependent on the 
patient's la>^ie. Ah a nih-, p:'HMi nid whisky, pn>i>erly diluted, 
ia bebl* Old hmiidy U f^xnX^ bnt lunch of the bmjidy wld 
lA of very irifL'rl'>r (|uulitr. Thp red wines arc twf*fnl, «*|>e<.'ially 
whon tlicre i^ diurrhm, and the ohl wliite winoci are ox(vllont if 
the iiatlent enres fiir thrm. Thf bmndy-and-^-gg mixture pre* 
viously mentioned l-* very iiMcfnh 

Eurb ea^e of tvphiml Hlmuld be made ao individual study 
and the diet arranged a<M'*>nlin^ly. A physician who prescribes 
a routine treatment in ert<>h ea>ie \n nctt doing hi^ duty. Tlie 
aoiomit of food should l>e iucrea^ed or decreased and the char- 




306 



DIET ly P1SSA8R 



ftcur of It allorpd as ocoasion dematKU. If the patient rccpiv<*g 
insufficient food early in the diseaee, the low of wctgbt will be 
much greater than it shculfl be- 

Care of the Mouth. — This is of primnry importaDoo. ir 
begun I'Jirly and i^rsiMM lOt nmuy xtndmmH^ monUi condl- 
tii^itiH uiiu Im,* uvoided. If thi- niiutth i.n in ^loil cotidittoD, liu; 
patient cod, ik.-< a nilir, tuke his fiKKl cajtily j if it let not, the 
gruuUs^t (iiifiuulty muy be experienced. AJUr ctuh ftn^Jing the 
moatb elLDiiM 1m* r't(<imj«ec) <;mvfu]ly, !i prooeoding tlinl iihoiitd 
never Ix* in*gk«twl. If the patient \s strung emjugb, he may 
rinse the iii<3iUh with u raild antiseptic mjIiiIiuii — tlir pawrip* 
tian given in the ^eetioD on Tuberculosis i» an adniinibk one. 
Brmc acid twlittionrc Vy which a little glycerin and leiron*juicc 
have been addid or one of the prepared mouth-wa^hce diluted 
with watcT may be u^^ed ; diluted hydrogen pero^iid h also 
servicciible. If the patient is tfw weak tu dij thif, the nurse 
should ftwub the mouth. The physician should aesurc Liiui^lf 
that the nuree in carr^'iDg out hij; or*?ers in tbig regard^ foP 
csrelase nursj.^ are nfT4?n apt in npglect this. 

Diet in DlRestlve DistmbaBces. — In vases where the 
food M TvjGvicd or badly borne it is necessary to ^ive the 
stoniaeh iibrR^lute rest fir several hours or more. Then very 
Biaall quantities of egg-wat^y*, barlty-walcr and Imion-jmce, or 
^imiliir preparations, may be given, Pano]ieplon and the liquid 
beef prepflmtions are usdtU iji this condition, and may be served 
with cmcked ice or diluted with water, Wetik tea i»r red wine 
and wntcr in smjill doees are uwful, espwi/illy if thtre is diarrhea. 

Diarrhea is oAeo caused by the a^^v of milk iu tvhich there 
are large numhers of baeieria. When* diarrhea pepsiste, the 
milk used should be examined and stenli/x*<l orpastenriKed milk 
u«cd. The effect of using paateun£*d milk in HUch cases is 
often very strikiiigf as has been shown by Edj*alL 

For the diarrhea an ice-bag lo the abdomen ha* been highly 
reoommended^ but is seldom well home. Instead, cloths 
nioisteiied with vt.Ad water may be used. 

For the painful and troublesome nrcnmulation of gas in the 
infefitine either the iee-hag or the cn\t\ applicatiriQfi may prove 
benefirifll. The nulhors havi* nhtdtinivl ex^-pllpnt ro«ulf*i fixim 
the use of turpentine stupe«4^ but these have failed in the handa 
of many phypicians. When the meteorism \» due to thi* imixrr- 
fect di^stion of starch, the airbohyclmles should be nnlueed 
or withdrawn ; when it is due ti> milk^ the form in whidi this 
10 given i>bould be changed or it should be withdrawn alto^^'ther 
for a time 




hEEDlSQ IS lyPBCTIOUS DISEASiS, 



307 



Hctnoirhagc. — Whvu haDorrLage from ihe buwel oc«uni, 
tW inUj-tiTiol tmcl flhijnlr] he pivrn nbifnliitr r«<t for n nuniK-r 
ft{ hoiiru. An i<Kwlin^, r<*Jil applinitiotii^ or u cold-wuUr i»U 
fihriiiti) t>^ plac^l upon iIjp nMoraon. To rvluve thi» thirxt th« 
pati^t may be allowed to t^uck mnull bit« of ki*, or io(-c<iId 
Viler or cold tea may be ^vcn in spoonfiil do«c«, Aflcr ftonie 
hotin the pcktient may be ^veo a teaiJfKtonfuI of cold milk, 
eihI tliitf mm' bt- repf^uu^d everj' tvfo ur tliruc boura, Beyoud 
tliisj if tlie bln'ding in mvere, the inti^tiiuLl tnct should be 
given GumplHv n.'sL for twenty-four hours or longer. Opium 
or tDorphin m»y alw* b<^ iii»cd. The return to the regular fever 
did should br mntl^- ^p^nihinlly and with cntitiou. 

Perforation, — When pi-rTiiralion woiirss^nJl foo<l should he 
diNxmliDUfd and Hur^'ical treat mt-nt jutilitu1«d, or where this 18 
uut p(»»ihlc, hir^je d.iM.« of nRirphiti or opium may be pr^ 
swribe-dn Foil(>iA'i(jj; ojK^ratiori the diet will be tlmt of any 
buvrel jterfonition Mint huf^ bei^n operated ugxiti. If tlii* patient 
milieu without isiir|;k*jil iiitcr\'entioii^ or whon thi« bus been 
fyiiiid imijruc'licidjk', fcnni may k* piven after an intfl-\-ftl of 
twiriity-finir h(i(ir.% but only in \cvy ^tnoH riuantltlos at «u£fi» 
eicnlly wMc intrrvnU. It la be^ to begin with tcnf^pootifut 
dottCM <:\'e^^' thnxt bour^, ami if the food in rptained, this may 
^idiJnlly be inrreaRed. ITfiualty fond is rejertod, and when 
tJii» i» the auv, the fitomacli should be ^iveo complete rest, for 
fwdiii^ only lends to iippnivale the condition. 

CODvalesccDCe. — TW- diet duHn); Ibe firei weektt of con* 
VflkrKJCne^e n.Hptirc« u)4 much car« mui attention as it received 
ihrou^hout IIk- febrile i>eH()il ; [n fuel, r«in<;e ihvitv gnttieals often 
d(rvelo[) a ntvcimiM Hpjii-liU'p lK>rii of M.'vcnd wi<cki«* milk diet 
and fever, cvca greater care t* nrcrttttary. The piitirntV wifbefi 
i^honld in nowixc govern h\» di(%' and relatives and friends 
Hhoidd be ountionnl iignirist giving the patient anything not 
ordered by tlie plnwiun. Mnny u rehi[U4e and death hae been 
cauj^eil by the mi.'tgtiidi'Ll kjii<lne»s of friends and relntives in 
thi« rcajKH't, 

When there lia.H been tievcre bowel dinturhance, the patient 
in to ha kept un a liquid diet until the ninth or tenth day of 
the afebrile period. After mild ca^*^, where there haw been 
but liltltr biiwt^l diwturbancp, clmtigcfl may Iw made in Uie diet 
after the fifth or mxth ufebrilo day. In these mild case« th« 
greatest eaution tM rc^quii^d, aM diL*y artf oi\ea ^nite as apt to 
do badly as are th*^ fti?v*»re on<**, and Ibe attenaantfi are much 
more likely lo l>e eareJe*i-* in earryinj; oat infltructions. 

The 6r6t addition to the dietary 4iould be made by giving a 



i 



306 



/)/AT is DIS^ASK 



picoc of ;:wiGbaok over winch hot mtlk or cream haa beea 
pourff!. If flCTirr*!, milk-tooM, miHc aixJ crn<kcn», or jiinknt 
may be i^tib^dttitcd for this. If this ia woH l>omp, other nrti- 
fil^r siicK lis sofl-bnili^ ^gS^ ■*' ^he 4*^^ P^^ '^^ oy*itcrq if ihvy 
are in eeason and can be obtained frmh, may b* add'il firun 
day to day. Thickened meait broths containing; w<rll-lwil«i 
rice or vennitvlli may be {jiveu. Finely f4eni|Kil niw beef, 
r«<btcetl to a pii))> in ibe luuiuier ^uggcHU'd fi>r tuberculohld 
|)atieiiU, aL^o lend^ variety. 

Tedder meat*, vegetaljlej^, am! bread-stuffs in iucreaHfng 
1 1 iri It titles niuy lie alloAeU. Uojif<t durki-ii, fii|uab^ or partridge^ 
boiW (white) fish, eucb a.s trout j of tlic vegetablt'S^ spinnoh, 
<ntiliftnwer topfi, si^panigu^-lipfl, pur^ uf iK'tt^j carrotd, op 
ten<i(>r jitriTig-l»cans or artiehok<*s, wejl-flookwl rut\ and luknl 
poUito ma^betl and servi-d witb oream or dish y<*"^'y ; UmMf 
zwiebackp cmckrrs, and tho cmst <tf bn'ad may all Ih* i>er- 
mitttHb If the eonilid*>ii of tb(* Ixiwt^l |*erniith, friiit-juicefl may 
be allovpe<), ua well as a tmked apple, apple-^nauce, or junket 
flftvoretfl with fniit. Other siek -room delioacies may be onlercd 
at the di-^eretion of the phyBiciaLi, Cbi'fw, lender steak, juid ri)artt 
beef niay generally he givcu lu the third afebrile wi-t'k (vciy 
finely divided ni«it may be iillctwitt miieb earlier), and tlic diet 
gradually ehanged nnfil ibe nrdinury diet is n^umed- Por 
some time after an Jittai-k of typhoid thp piilient qhntdd be 
iottructed to exerci&e eare in the selefHion of his diet, and 
eApeoially to avoid all foiwl such im ^reen fruit, green com^ 
cr&)»;, and the like, that in likely t^i cause diarrhea. 

The following menu fur the first vreek iirc*>iivalesocuce may 
serve mix guide Ui tlie iuexperieneofl phy>ieifln, and may b« 
alterutl to tuh the individual ease. It may l>e begnu about the 
fifth or Mxtb afi-'brilo flay in mild (lu^s, and aluxtt the ninth 
nr tenth in severe ca^es. Milk sboiild form th<] bulk of the 
dipt, fit tbi?; periinl. 

Firi^t Day, — Milk-toast ut zwiebaek covere<l with hot milk 
orercam or emekcrs antl milk. Beef-jidee, 

Srcoud Dftif^ — (liiekeo bmlh thickened with riee or vermi- 
celli. (The rice should be bniled thor*>nghly.) Soft jwirtn of 
fievenil ny^ters, or a vor\' Uj,ditly U^iled e^^, 

Tftird Ai^.— 'JuukH, a meat brotli Uucktiied with wcll- 
cooke<I biirlpy (boiled at le;ist three hours), with Imrley flour, or 
wiUi Ktalc brcad-cmmbs- Wino-jdly, ScrajM^d mw beef. 

Fanrth D'ltf. — LightJv lnjile^l or fxmobL^l ejjg. Arrow-root, 
Iwirhy gnu'b '>r milk-U>a,"it. Ohioken-jidly. 

I'\flh DfiJt. — ijiiaket, a little welUlmled rioe with a muuII 



F£Et}mO IN tSfEcrmUR DlSEARt^ 



309 



I 



■moQDt of Gncly ilivided ma^t tOiicken, ^quali, or piirtridgei 
jifx^ferably the white meat Appl^^^Aaiioe if bowels purmit 

Sixth da}/. — Scraped beef, p«ac!ie<i tgg, cdvi»*<foo( jdly- A 
baked cu^Uinl. A piece of uxi^t or xwk'back. 

StPimOi Thy. — A f^trmW piece of finely (Hvidrd broiled cbop 
or vrtcuk^ buk<<d |hituU^ A Itulttd npple, WelUboIl^d ric9 snd 
cimin ior brtuJcfibiL JiinkH for Mip|iQr. 

ATYPICAL TYPHOID.-C0MPLICAT1D TTPHOIl>. 

TIkiv iix* two clax^t^ uf MJW* ill wbidi i"j*fici"bl attention to 
the diet \ii rtspiiitHb TUttvj nrr : {n) iii\\>u-n\ typlidid, cft#ee 
wbetv Um* f(-ver |K-r"*iiU fur wueJm qj* pnu'tknlly llie only »yoj|>- 
iotn ; mid (^) tlKk?*" I'ltTH^a tlint hixw nin tiMrir cx)iir:«c, but where, 
owing to Hnmo <Tam|)Ii«ution, mcwt fnHjm'ntly tlio prxv^ctnco of 
pu^thpfevrr n?imunh bigh. 

Tbe fir»t elu^ urc oJlvn jur^oeiated wiib uxtnnDC emaeiatioDt 
and tha ft'ver niiiy be rc^nle<l iit« u true iniinttion fover. In 
olb^re tbc emaeiiiti"[i tnay not be extreiiK-, but tbe fever niuy 
pefsi»t, am) may notiH-'^Lppear tinttl the |«tii'i)t U allowed 1o «ic 
up. In then' caM%t ufUT ^tifficieiit lime hat- dapH*"l for beiiliiig 
of the inlcvftinn) ubH'Tiitioii.-^ tt) laike pbu.'c, »iid if tbt»ixr an* no 
otber iymptotnA forbidding; it, the diet may be inerrawd in the 
Ninie way as diirini;* an onlinnry (*iMividri?crn<?e, If nn ciaecr- 
bulion of tb«i HvmptomK oc<'i)iv nnd the r<>x*i>r int^reiu^^M, it ifl an 
iiidit^tion that too miicti food is being giveiu 

In the secontl elass of c^&^e^ there miiy bcexLremeemaeiationf 
with tl»e dex'Blo;)mentof nl»)<;ce«M« or furtindcs. Tlu^w p^tienlfi 
may be benefited by an inerefiw in tbe dii-f, fur sonte of tliem 
dri not aeeni to be able to a>s^imilHte MJfTicieiit noiirislimeiit from 
the food-rmpj)ly to make up for the wartte. 

la any caH? wb^re there u* frvrr (be diet should be wat^^h^ 
carefully and no changes br made nn^llv^JH^dly. 

TYPHUS FEVER. 
The diet in Uii^^ diixeafte in the nune nj^ in all aente fevers ; 
typhus requires no c<p?ciftl pret^aatiou^, stK^b tif are needed in 
typhoid. During the acute Htni^ of (he <li*ea«- tlie diet shoubl 
be liquid, milk Wingln^tp When (hirt i-* not well borne, liquid 
mtU-titi]te«. mr-lt ii-' are n.ied in lyjjluwi, may l>e given. The 
food should Ik* adniiriMHyil at n^tilar tiiuX su^eiently IV«<|Uefit 
interval** — i-very iwv, ibnT-, nr fciur biturn, Hoi!or(liii|r in the 
qoantitv the pntient in iMc-. t<i take at on<: tloir. A (juart of 
milk nml a pint i»f animal bnitk may Ixf (HinKiJerrtl m fnir 
amonnt 'jf fiwiil for one day. Wat*^ should W given fW^-ly, 



310 



DIET IS LiSEAUK 



CurwhniajiD calln attentinn to the fact that eggs arc bettor 
borne in typhufitbaD iu t)^hoiiJ, and reo<>mm**ndK tiiatr^veml bo 
giveu cvef^' 4lay» He abttt advbfen tlic ue* oI* mjIiJ fuoU, cvi-it 
cluring tbo period of fever» if tbc^ piuetit in ubli> to iimnttoutc uuti 
«W3illovr. Tie allowd rulL, AvrlotjaolcT i-liiokL^ii, uuJ 4-lioj>ptK] mcflL 

Afi a rule, th** juitlonU rifjuin* n sapp>rTiiig and n MtimttlutiW 
diet frooi the outset. AWhul may bv given wlicii tlio piilrw and 
the getiem] cmDdition demand its iihv. Bhick rolling c^jXHitallv 
when there is a tendency to atajwr, ir* alrw to be recomuiendei- 

Complicntione are treated in the rame way ^ whr-n thoy 
oeour in typhoid. During c».»Lvalc**cence the diet shouhJ \m ill- 
crciLsed a^ rapiijly n^ jux^ibJe^ Lht- u^uaL <^re being obacrved 
(sec ihc set^tion on tW Diet in Fevers). Alcohol in Aoine form 
is geneniUy neoessivry at thia time. The f^^m in whiL^b It U 
to be giv^'n injiy h** gnven»ed by th»* yiatienl'^ laste^ and the 
iLCDouut sliQuld be oirefully regulated by the |>alicnt'd condidoa. 



SMALLPOX. 

Tlie diet in §mall-pox in similar to that recnmntendwl in other 
acute Jeveri. The only point to be noted e£p4.H;iMl]y ih ibaL the 
supporting diet should be begun early, a^ in thei-i-ver& mse^ the 
i>xtenAivomippiitMtii>n iiiakena larj^e drain on the patient's system. 

During the first stage of the disease there is little desire for 
food. The diet should be liquid, iind c^ini*wt (if milk, broth*, 
alb UCJ in- water, and the like- lati'tiae ibirat is frenerally prtti- 
ect, and thia may be n?lievetl by watf^r^ lemonade, or tlie oar- 
bonated wnters. 

When tlie iDidal fever ^uhftities and the [Kitient ftvU improved, 
it ifl wtdl to allow auy Mfiht aiitritious food he niity de^re — milk, 
c^gdj ehojje, eteak, or rare roast meat ; bruad or tfiosl ; and the 
more eofiily di^^ted vegetables, snch an well-cooked jv^aIo, 
(^pinfif'h, oeleiy, afii^aragud-tips, cauliflower topft, and the like 
are all suitable. 

Mlien the wjeond jwrlwl nf fever CDine** nn, a return to the 
]i*jnid diet may again be made. The diet should lie as ample 
as iKiswblCt and the fond l>e given at re^^ilar intervals every two 
or three hriur* during the day and every three or four hours at 
nig^bt. Milk, plain cr |>eptoniKe<l, milk-puridi, mw egga, egg 
and sberrv, and the variuup <*onihinutions and dishea made of 
eg^ aud ruilk iiliould be given. Broths, beef-juioe, and the like 
may also be added {s^oe Ueoijies in Appendix). When there U 
marked dysphagia, as there in apt to be in all severe c^seSf the 




FEEDixa /y rsFRcrrous nrxBAfttcfi 



stu 



food iR heit ^iven oilr], at more frequt^nt intcrvnU, atiil id Jtmaller 
quaDtilies. H«cta! I'eedmg may be rerioit^d to id Honic ca^e^ 

In severe coflea alcohol ia requir^^ and tna^ be given 
from Ijme to time a« the ci>iKlitiou uf tlio puueiit deutandB. 
WhUky, bmndy, uid port wine arc, as a rule, Imroe benl ; the 
vhUky or brandy should be given In diluted form, combiacd 
with a small amount of glyr^n nr Avrup to avoid irntatiog 
th© throai. Stimtdantg may be added lo the milk, nr tln^y nmy 
be given in tiie form of milk -pun cU or eor-no^, accffrdin^ to 
the |iatie[it^5 taste. Alcohol iJiould Dot be given as a routine 
practice in all casee, aa was formerly done. Mild cases and 
even tliofie of moderate severity, in patients under twenty, usu- 
ally require lictle or no stimulation. 

During the convalencence the diet may be increaaod rapidly. 
Ab soon as tho fever doobno^^ meat mny be added to the dietary, 
and when the appetite »nd digestion allow, other artiolefl of diet 
may be giveo. 

SCARLET FEVER. 

Some dtCTerenoe of opinion exists rc^rding the value of 
diet in prcveniin^ nephritis in iH^r let fever, A careful study 
of lliefie cases, however^ has led to the belief that a strict milk 
diet diiriug the height of the disease and a mixed milk und 
fftriii:kcefj(LH dipt during oonvaleHPtJop Tire by far tin? HiiffvL 
Zic^ler, rept^rtitig an eipcrioiice uf twenty-one ycftt» with 231 
QLvM kept on an exclusive milk-diet, did not have a single <xm 
of nephriliM. Previous to that time, on a mixed diet, half hiA 
cases dev*.*In|K^l nq>hriti7<. Our own exi>enenee, whiUt much 
smaller, UiL^ Imh^ii otlierwir*!; like that of Zi^ler. The milk 
should be dl1uti.Hl with Hmivwaler or with a €arlM>nated wal^; 
if it dina^ri.*e», it may lie peptiruixed, eilht^r [>arlially or com- 
pletely, Kumiss or butt4M-milk, purtieularly the former, may 
w ^ivou a^ a change. Ahlioiitch they muy refuaie it at tirnt, 
cbildn^n <if^en Wrn to liki- kumirw. If milk beeomesdifttast^'fu! 
or di-'iiflgrt'cs, it may be miKt^i with I>arley-water or arrow-root 
p'uel, orthoT-e miiy Iw^lven plain. Oyster or clam broth, the oys- 
ters or clam.4 having l»f^n fltraiuf-d out, makes a pleasant change. 

for the tliipft, which i» ^^nerally pn^t, plain or carbonated 
wut*re, barh-y-water, oraii^-atlis or lem<»nniie may be given 
fa-crly. A level leoHpHmful vf criMm of larUir stirred into S' 
glosA of Icmrjmide ia u uticful diuretio drink if albuminuria U 
prosent. 

Phiio vimilla io»M'r*'jiin fir n plain h*m<'»n i*^* mjiy Iw* piven in 
amall quantities. Finely shaved ioe, aUo in very Hmall quan- 




m 




DIET IS DISEASE, 



Utic9, uttd flavurx?d wiUi u Uttlc Imum- «r oruigv-juice, often 

Jac<Yiu(l and Bfjgtn&ky iDMtAt that vr^rlatinnl iKfphriti* mny 
grncnilly 1)^ nvcrttxl if tt miltc <lirt i« lulli^nn] to for M*vr*m] 
wwUi* ill ull widcs. It in a pinnl pluu u>lct thpdiot in nil csh^s 
be iti< Mmple as jHi^ibN' for tiirc« wcek-s mi<) (li^n to okake ftHdi- 
ti<j»s to it from (i»Y to day. If then* i.-* alburniimriaor nfphri- 
tU, A milk und 1arin£ceoii8 liic-t, as rwimimeiultHJ in nephritic, 
ghoiild he adhered to. If there ha^ been a severe alhuEninuria, 
without c3L-vLn, irr if nymptoius of uepLritiB lmv<- up[>(!urrtl, the 
dic^t nhouhl Im* liijUJd for a mimtJi ur ^Ix wc*kf*T the iiriii*- htiag 
nirrfuUv wittohcd in the meautiiiK^- Owing to ourf^liMiEiQt^iM >n 
rrgiinl to tht* <\itX, mild mse^ of ^tcurlatma nuy be folkiwcd by 
ficvcre nephritis. 

In all cn»W9( the diet i^hoiild be pradiiAlty incream^ from day 
to day during oonvaleAtX'noe ; the following may serve a*i a guide 
to Uie ordt^r in which thi-s inerea^e may he made: Milk-tosst, 
junket, oiiatard, fariaa pudding, oraogej, rice-pudding, baked 
apple, hread and milk, f^ago or Upioea pudding, with or wilh- 
out appl^f coru-btsirch puddiug, boiled cu^taid. 

TXin return to cn«iat ii? beu^t made by idlowing a frtaM cjuuntlty of 
boilol <ir bakcfl fish, the ¥fft pnrtjt of oy.^tfrs, very Mjfk'lHiikHl 
eggs first and then the lightest and most easily digested meat**, 
uLicken, raw or very rare beef in minute quantities, and the like. 

During ihi" height of the disease jind (hroiifjhoiit conval^s- 
OeOcH' meat-cxtraeU i^nuld l>e iiV(iidi<<l, a.'^ th<*y eontuin large 
quantities of mmt extractives, which are liable to irritate the 
kklney.-i. 

IWt in IkhI whouhl he insisteil upon until the fcv^r \\m& h*^n 
uhrient ut Icuat u wet-lc. In mild oapos of ^■orlet fev^r stimn- 
Innfv i»n» not r^ipiinnl; hui In th<* •*veTe wises, whcrtr there ifl 
adoniiLH, marked angina, or aepsii', alcohol may be umhI «ls the 
h(?in and i:e»cral eondilion indif^nte the neoil for ir. (See 
Alcohol in Fevers.) Strychnin and illgllalia are al^^o useful. 

MEASLES, 

In measles thp diet i;* Mmilnr t** thai of nny ncute fever. The 
food of infants, if lM>tlIo-frdf should lie morr dilute! tluiu usual ; 
for older childn'n nii <*xeh]iitv«ly liquid diPt Ik indirAled, 

Milk, w>nps !ind linkfhs mny lie alliiwrd, and ihfKP may be 
peptonized if ni<H>«in\ The fixMl tih<:uild be givt^n at regular 
inter\iil», these de^icnding r»n the iimimnt ^vcn at eaeh time — 
gcncmlly two, three, or four hi^urs apart. 

Thint may be allayed by water, phtiu or uarbonikdf onog^ 



FERDtSQ W ISFFXynOVR DISKASRR 



zii 



$dr, lunoiuulc, uiiil tbo liki-. Tti« n-tuni to a solid diet shouM 
be m«d« gndttally, Aloobcl tnvLy be tiH<) ifnc^cwurr. When 
gaAlro*in1«st!nal di.ttiirUmc^^ su[KTv«niv tJicy should be trcut^ 
ill iLe cu:»Luuiiiry way. ^S^ FtH^Jing i» Fvver.) 

HUHPS. 

"White fci'«r or ^w^-llirtg i'j£ii*lo tlR' diet i^houtd be liquid. 
Duriitj^ coiivult-Mvitix^ rvimc vulk) food iiiny be tiikcD. Coiv 
mIiouIi) be ohncrv<*tl to nvnid all ocid.i nnd ii.*((nngt'Dl:<i as thc»i^ 
may cuti.-« extreme diHcomfort nxu] c%vti inu^tiK^ pnicii 

THOOPINGODUGH- 

]& all €Adc« of whoo]>iii^^-<x>ugh the diet and the bowcb 
reqiiin? the c\nnvtii iitt^^iition. 

If the child hftH any t^^dejicy t4i the soiled " miioouci db»* 
e&0C ** or to iot«Htinal dii^urhnDce, tbi& bi almotit Hure to mani- 
iesi itself duritig tht? i^urne of the dineo^ as all the mucoiiA 
membmneg are apjiiinrntly affected. Attacks of iodigi-iition and 
the aMominal distention that uhuallv follows may int-roflse th« 
number of |>aroxy5ni5. There is always a leiidcncy to vomir. 
Th'iH usually occurs witli or alW tlie ]ian>xyMim of t^xjghiitg, 
hut tbr pbiu^'ttx may bocouic w* irntublc ihot vomiting may 
hv cxcilinl by tluT Uiking of fiXKi, driuk, or mwlii^im-. Any 
dnig that, ti^nd^t t^i priMhuv' nnUNm sliould cnn^fully \u- twnidt^]. 

The iliet for cbiblroii under two year* of n^* »hoiil<l l« fluid. 
Milk, dilut4-<l with liire-wntur or a carbonated water, or i»ep- 
tonijct'dr i^bnuM Ix* tht.^ niain.tfay. Broth-i, albumin-water^ and 
bnrley-wiiUT are nlM> u^ful. In children who are weak or in 
whom vomitiDg in etevere, K)me of the predlgG^ted liquid beef 
prcparatloax, well diluted witl water, niay be givoii. Tiitt<e 
aru ntioiulating acid contiiio utnibiderable nutnmeut. 

Ohildrcn «ver two yeortt of ago^ if tin* ea»o ia Btvcrf, should 
he |U]t tin a ]i4[iud diet. If forx) is retaiae<l and vomiting is 
not tniuidcsnme, ficmi^lid food may be giveu; if thU caiiscK 
no diHturhiLnee, ear-Ily ili^f^ted solid fo<td may he allowed- 
Kumiss if* flomctinuvs of value, and custards l''>r!<*y» iiiilinenl, 
or arrr>w-ri>r>t gnieU, hi^olha, junket, and the like are useful in 
vuryiug the diet. 

If nmeh difficulty is esperieoced in feeding the child, the 
food alioutd 1m* i^iveii in Huail quantities every two or three 
hours. If vomiting persists, the mcaaun.'T^ reconintcndc<l in the 
ieotioQ on Vomiting may be tried. If a m9fl] is vomited^ it 



314 



DtliT IS DtSEASS, 



uiAj be re]K»ted after a abort interxul. Children with muooua 
dUea^H! bIiouM receive the diet recommended for tliat condiiioa. 

Ill weak duldren and in pmimcted ca^es ulcohol may be 
iit-nldl, Thia way be givt^u in the ibrm of lit^uid beef pepto- 
nuidii, [)(Liiu[H.'pl<ii], luilk'puDdi, egg-nr^^ or sborry and albuEQUH 
WLtter. In many en-ies it U desirable to give only the stimu- 
lants, and in thw*e ca**e*i whisky and sweelened water or wtne 
may be given. A jfood mature<l wbifiky i^ usually the most 
aaliftfactory, ba tiie dosage Js easier to manage and the effect 
more constant. In very severe cafiHi nutrient eiieinata toay be 
necessary. 

It has been held by aome that diet has a specific influence on 
the couFffe lif tbi^ di^iease. llaiinoii c1aim8 co Lave cured ca^ea 
io two weeks by a "ionic dirt" that ixmsi§led of roaat-be^f 
with toa^t and pure Maderia or p'>rt wine iti the morning ; bi^ 
cnit and wine at noon ; meat broth, roa^t meat, toast^ and wine 
in the afternoon : wine in the evening:, and cold water ai night. 
He allowed no milk, vegetables, soups, or pnddings. 

INFLUENZA. 

The diet in this disease sliould he that recommended in all 
acute febrile condilioas. During the height nf the disai^ the 
food sIkiuIU be lic^iitd, aud Ih_- givi-ii in sjiiall cjuuntidf-n and nt 
regiiUr inlvrvaU. A* the (.vjuditioii juiprovcn q return to a 
eemiAolId diet and then to solid food umy be made. Convm- 
lesioenw is apt to ht* slow and bvliotis, and during: this period 
easily dieted nutrittoui^ fond should he given tn as hr^ 
quaniities as tlie patient can diijf-'-t, Millc and ep:gs, either 
alone or combined in the form of ejig or i^t^-nog, may be given 
between meak Alcohol tA usually indicated throughout the 
disease, and may be giiven in the form of whisky and water, 
wine, or mailed lic|U(>ra, aceurdtug to the ooudition and lante 
of the |jatic-iit. If coDvalc^scetift- ia sluw, a change of air will 
of^o facilitate recovery and reelore ibe ap^xnite and Hin^ugtbi 

MEMNOms AND CEREBROSPINAL FEVER. 

In Uii^!^ diaea^s the diet in that of all ucuFe fevers. Tlie 
food may be liquid or semisr>lid, and should be given at ivf^ular 
fulervttht. If the patient is able to swallow, several ounces 
may be ^ven at a time every two or three honrfl. If awallow- 
iog is difficult, small fpuLntities of predigested food may be given 
at very j^hort iutt-rval^ — evtry half-liour, or if it Is givco only 
a t^aapoonful at a time, as frequently aa every tifWn uiinutefl. 
In thi^su ea^^es the fo»d may be given with a toa^poon or a m^xl- 



F&Ei^iso at jyr&}Trou8 dssbases. 



31& 



knnfrHlropixT. In fome cumk, when it do€« not excite convut- 
sioiMp a Moiuach* or riaxnl tube rimy Ik? u«rd. 

If the patknt lh uhh to hualKiw, 1l<]iii<l,s un<I !wmiftolid« an 
iDclioftted. Wat^T may b^ given freely^ and im the potiCDta are 
oft€D unconticioii^ nr only M^miGnn^ioiiH, wntcr r^iould lie given 
fta a n>uiino. Thm Li a matu^r that U fW^ij<rnLly n<>frlttct<Hi. 

Alo^bul may l>e UM-d yihi^a die jiul^^ ntid g<-nrnil otmdiLmn 
iodlcvLtc th« aw<t fur rtijomlntion. Dunng tic ucutc Atogc it U 
Qdually not r<Mjulred, aud whcp givca too curly rany intensify 
tlmomJiml KymptnniA. A* tint* ivtti^ntV «trrjigth fniln it U 
demftndcd in imTf^ai^in^ ffuanfiltcK 

Th<' c>onvaK?*ceiii<e in t4> Ix* inanai^t as afker auy acute fever^ 
and an aimndaiuN* of fm>d nbould l)e allowed. 

DIPHTHERIA. 

The feeding of diphiln-ria (wticnt^ h* <nrrSf(l out nlonjr the 
aami* Unr^ a.t thortc laid down for arut<- fnvcrn in grnt^ml. 
Owing ia tho huTition of tU*.^ 1o»inii nnd tho fiv*|ucncy with 
whioh iriiuliiUii^n op tnu*brt>1oniy i* pf»rromif*iI, *]Mvial diffinil- 
tio atW, and inu»i 1m^ met prrintptly ami inrclligrntly, or the 
patieDt nmy sncoimili nTnilly* 

The direful inaiuigcRii'ut of the diet in diphtheria i& of the 
greatest importance. If the patient't^ nutntioD ia not mflin- 
tftiiied, the body ^vitl n'H be able to withstand tlio effects of tlie 
polHon^ thai aw* iiitn>duoed irit'i the circnlatiiiTu 

If tbr diMTincT iK'ctin^ iti a titirstng infjiitt, Koplik udviwH that 
the milk \-tc drawn from the lircuat with a bren^-pamp and fed 
to the child fri>m a hoitlc or sftoon. This id done to avoid 
inf4>otion i>f tbr brfywL If the niothGr has ljrt»n Hindered immutK^ 
the dancer of baant infection h very t*light. 

In all aiJicw, if there i« any fever, fho fmnl should be liquid, 
and jihoLild l)e given in «nijdl quantities ;tt n^^ulur int^rv&K 
The niait uwfal of tbo li*pii<l food* art* milk^ pbin, with limo 
water or a carlK^nated water, or {lefXonij^t^Hl iiUmmin-A'ater; 
Aoine form of predigcrtttd beet" aa Liquid Bt-ef IVpiom^ids or 
Panopeptou ; soupt^ and grueU uud the \-ariotiB prepnrod fcx>da of 
which malted milk, Kekay*^, or MellinV foods are oxampIeA, 

Oeiflsionally semisolids an» flwallowwl with prpat^r eai^p than 
liquids ; in thit< en^* any of the foodu just mentioned may be 
thickened ^vith woli-<>ooke'l cereals or ^>latin, or custirds or 
junket may be given. IeeH?rmm, if plain, may b\} allowed in 
Ftmall ({uaDtitieK, t*'gK-»^ ^^^*^ milk-jtuueb are wmetimeA u^e- 
fulp althougli, a^ a rule, stimulants are beet given alooe, and not 
couibiued with tlit; Ibud. 



31fi 



DIET W PISBASK. 



If tlie pflti«Dt can not ^wallow^ nutrient eiicniuta mny Iw 
reAortecI to ; or^ an reoamnK'iided by (vilnitiu TJiom[Mion, a ii«ml1 
or a etonwch-tube may be eraployed. If ibe Jailer mode of 
fi^eding IB aUopt<:H], care should be tivkvo Iti avuid atrug^lc^ witli 
pulk'll1^. \sliOrH.- iii^rt^ are wiaik. 

Intubation. — AtWr iulubution htts been dono tbert* mny or 
nmy not lie some difficulty in fj^wullowing. As^ a rule, w\hh t\w 
cbild Hwaliowh for tbe firht time, there muy l)C a ^li^lit (K>itgb or 
w>me hesitation ; iu th<t roajurily of ea.^\'*j however, thU diji«j>- 
|>curi an the api>i'ehenHi(»n of the cliihi iri aila^etl. Tht^n- may 
be a little difticdty for ihe first day, but this passes ot!" gradu- 
ally HA Ihe muprcles become aocuetomed to work under the new 
€>ondili<fnK 

Some children find it difiit'uH to close the epiglottic vrlth the 
tube in position, and heuce during dt^hidtiou Bom^of thefoodig 
likely to 1m' drawn luUt tlie larynx or e^'eu into the limgA. Thi& 
Tuay <Tatitfe dynpiiea and violent cou^hinjf, or when ilrawo into 
ihe Innjr i»ay ijive rise to pneumonia. This acroident is not 
very likely to occur if perfectly made lules are uw^l, and if the 
]irecautiou is taken to press ^e tiil>e well into pkice l>efore the 
mouih-^n^ is removed. 

CXDwyer believetl that food thai enters the tube b always 
cwnghc^ i[p iiud utrvfr caii-^ta pueuitionia. lie rc-com mended 
that, if the ohild is yld i^nuu^h, ho Im.' ioHlructiil to take the food 
av nipidly aa {losi^ilile aud tJien to oouj^li afterward, instead of 
after «inh nci of dt^Iutilion, as he is opt to do. In some chil- 
dren there may he a slight n'^unptation through the none. 
Taken all in all, the difficulty e,T|»erienced in feedinp; thew casea 
is iiniall ouiiL|>ared to the enormous benefit the child derives 
from the ojieration. 

If iht-re ifi difficulty in fiwallowinp: liquids, aolid or fiemisolid 
footl may Iw given inslmd. Caw id ben y^ of Chica^-u, Hj^g«&ti4 
dist the child lie placed wirJi Iiin htsbd lower than hie body, in 
tKi» |Hitiit]c>ii KWtdlowhi^ becom^g easy. The child laay also li« 
across the iiurKe*s lap with his head thrown well back and down. 
Il i^hould always l>e remembered that food may be refused 
bi'^tii^e ot iiau?^ea, or becaii&e the child hnjj ro desire to take 
anythinf;, as well as owing to any nctnal difficulty in AWallowing* 

The diet should be the same as in non-opcnitive cu5e«, and 
if semisolids or solids arc reqriiret), sot\-boiled or poauhixl aggf^ 
jailk-toUMt, eustanls, junkei, bread and milk, oatmeal ]M*n"idg<', 
tiud isJiuilAr IikhIa luay be ^iveii. 

If tiwalluwjjig hecomo^ impos8ib]c, an event tluit oocurw very 




FEEDISO /y ryFECTIOVS DISEASES. 



Sk7 



nircly^ the cbild may l>c A^l willi l1i« ^Uimuc'li or Dasul tube or 
hy in««nd of auinent eniMnjit&. 

No Mpeciat dictt^tk* rul<^ are necessarr for foetJing trachi^ 
atomy eaaif*. 

Postdiphtheritic Paralysis, — In paraly&is of ihemu*- 
di^ of ili^fliLliiion wliicli may ocair after dipbthcrin, mo?^t of 
the food may n^turn throiij^h the in-»w ; or if tin? nnwdw of tlir; 
tongue a.H vieW as tlie soft palule are involved, d(.xlii1tt^>ii 
beoonu^a iiDpossible. When thw occui*, the child mu^l be frd 
with the su^mach- or mwal tulx.- or by the rh^Uiui. (8(?c 
(Juvage). 

ERYSIFELA& 

The iiet in erysipela-H is tbo same as iti other acnte ftvera. 
During the hc>ight of the diffca*^ a lujtiiJ diet, given in »uiull 
quautUIoji awl rojivatod at «hort aud regular iui^rvaLt, u rccooi- 
metiitc-d, Ai tlu; frntioat iinproviB a gradual return may be 
made tj> the onlLrmr-y ili«1. 

At<^ihol if* u^-fiil, nnd |irtru<riU w'tiU t^rynx\whs, like thiwi* witti 
septicemia, may Lalo; tur^ quantUiuH ^tilhout jinxludiig aa 
intoxicating effect. In the aevere fomiH whisky or brandy may 
be given at r^uUir intervals in da^e^ ^ufliotetit lo iiiaint;th] the 
heart aviioiT. The efted of the Mtiiuiilutioii j^houkl W' wuteh<Hi 
carefully and the atnouni nitjulate*! aec-orduig t« nilvs f»n*viou-Hly 
laid down. i''Vom Mxtfeu lu tweiity-lhur ouutv^ a day umy he 
r«<]uired, 

RHEUMATBM- 

Acate Rhcamatism. — The e\ui.'t n<briori that diet t>ean4 
to rheuiiiatUm ha?« not ivrn pntvei), ami [lif Hiateitieiit dmt any 
sftecial divt may act a.-* a p]>.Hli?L|»ofii[i<^ fiic:trir ir* ct>nje<:tiinil, 
Imppojvr and ia^ullicient f<M>d oro reMj>uUAibie only in «o taran 
they lower tlie re^hitanee of the body, 

During the arnli- ntLiek the nuuui^-inent of the diet \< simi- 
lar to that of oth^^-r aeute fevers, Smic* diversity of oiiinioo 
exists as to what enustiluteri tlie bewt diet in tijese (^s^. 
Cheadle allow^s amnial broths, and says that hp has never seen 
any advantage result from etitting them off entirely. Senator 
pn.\scri1>es a fiomenhat more liberal diet than is given lu other 
aciit-?! f*rverfl. 

Ounn^ the ouute atoce the aafcet plaoc U to put the |>atieut 
on a milk or on a roilk and ferfniifV'jmfl diet. If the patient 
can not take niilk, oyi^tcr or chioi broti), preferably without the 
oyat«rs or clams, niw oystery, milk-toiwl, barley or ai'row-mot 
gruelf bult4;niiilk, knniijM<, .ttul, if these uiv i>ot mrfficient^ ^onpvi 




I 



niET IN DIBBASB. 

anti broths, mftv \w giveiK ll is well, so far as po^iblc^ to 
avoid unimul broths, aiic] mcat-esctractji are contraindicaLed. 

TbitHt ir« nt^nilly ^ firomipetit symptom^ and for thU bland or 
ic'ifl drinks iimv l*e given freely. Lemonndi? U generally wr- 
vi<tmhle, especially since lemoDfi have bwD aflvocut4?d iu tbc 
tnaoneot of the di^ea^^ Carbonated water or Vichy may be 
UM-d, and milk and i^urbouated water, bcitlermilk, or kumiM 
may bu irkd, 

UuUl omvaloBcoaoe u fully eetablLsbed, — that i=, for a week 
or U'V\ thxyii aftj^r the ftver baj* ^ulisided, — the pHtitDt should b© 
fed only milk and fariuaeeoua footh The return to solid food fl 
fihtmld be ^rradual. Fisb> oyaterfi, and eggs should be added ™ 
6rftt, fidlftwwl by chicken and later by oth<!r meats. Vegetable!* 
may be adde<l at the fcame lime, the more wisiiy digested, Midi 
as well-baked potato and well-cookctj ^ptnucb, canlitlower lops» 
stewed celery^ and the like, being dioeeu first. Sweets are t<> lie 
nvQidpd, hut fresh fruit may b<^ liikcn. The patit^nt's strength 
^hoLdi) In? fostered, and if there is uiiemia, tht r&turu to the more 
«w^]]y digepte(] nnimul f(M«ls ?^houlil not \h^ delaytfl Xivty long. 

Tbr> nieaLs t^bnjld not be of sufficient sife 1o tax the patiect^H 
digestion, and mav be aupplement^d by two or three extta 
gls8Hes of millc a day, served with a pieee of loaiit or a biscuit, 
or by an egg-nog or a cup of vegetable broth, 

Alfohol ifl contraindicat^i'd in the aeure stage of the dismac^ 
but may be preAcrilnxl for vtry weak patients and where cardiac 
coinplicationa indicate itt^ use. During cmvalesoenoe, if there 
18 "^ontinuwl wcikntsn, it mav be pni^Ioye*!, 

Chronic Rheumatism. — Wiiere the disease t*i rhronio, 
the diet should l>e us nniirisLin^ u^ |>f>saible. Ae a rule, sweets 
and meat are best avoided. Fieh, e^^, oysters, and the lighter 
meat«, all farinaceons foode, and the mon* diger^tible vegetjibles, 
particularly the green onen, may be alkiw<^l. When the patient 
ifl very weak and anemic, aleohol may be given if desin'd ; in 
other ca^ej?, where the Ionic or stimulant effect ia not especially 
indicated, it ia to tx.' avoided. Qjrv ahouhl l>e taken not to 
miHtako thin oonditiou for guut or for arthritlfi deformansi aa ia 
BO fre^juently done, 

ASIATIC CHOLERA. 

Infection with the diolera spirillum takes place through the 
mouth, and Is usually ^^aaiK^l by drinking contauiiuuled water. 
Infection TtM).y also W conv<^yed by niiik and by rnvi vcg^^tablertj 
by tnuehing a contaminnted object, aad by similar methods. 



I 



I 
I 




PERDING /y JSPBUriOVS DISEASES. 



319 



Tbc disease ma/ be carried hf flicsi^ uid tbufi milk awl other 
fooJa limy btoouic iuAi^UiL 

During a cbolt^ni epidemic the following propbylactic ni^iia* 
urw are to be carried uuu Ooly tbo more importaut iiuca will 
be TD^ntiOTMNl here ; for m. d(iiiilf'«l uiudy nf tlii?* initljji^ the 
reader u referred lo workii on Hy^ini4' and cm Public Hi^filtli : 

Fati^'ue, meEtal wurry, and anytliinj^ ttiai lowerx the mental 
or pbvbical ume should be avoided. 

All ^xhauHtiiig exercises should be ejEcladed, and alcolol 
taken bol eparin^yT if al ail. I>ifttcirimr<'<*4 of ilie t^tJ^inacb or 
bowels »liould n^ceive prompt ireoijuent, and active purgation 
eb>uld be avoided. 

All food should 1m cooked and all l>oven!tgra boiled, with the 
exoeption of tho«e 1>otlle«l and known to be nbftt^lutely free from 
any po^nihle (^oiii^iminarion with the Wnilera Hpiriiluni. Ci»ffee 
and other similar beverages *diould l>e made fnjm iwiltd water. 
Ice should be made from dtatilled water, or when this is not 
praoticahlG should not be need in any article of food or drink. 
Only bf'iled water ^lould t>e used for cleansing the teeth. 

All mw vegetables and all food, euch as fieh or shelUfidi, 
that may be prtly dct.<oiaputiedt' should be avoided. Cun: 
abould be taken to mh-ufq pure milk. 

Any aHielv of food liabli! t^ produce lodigeation or dlarrliea 
iibnuld not h^ 4<filjm. 

Sin«? tlif micn>-orjTaDij<m oaasin^ aholera will not tlirive in 
au acid medium, acid drinks are a useful preventive measure 
agaiDBt infection. lemonade made with aromatic sulphuric 
acid or dihite sulphuric acid haa been widely recommended. 
Ten or fifteen <lrops of the acid should be added to a i^lafis of 
water. Phosphoric acid and lime-juice, as welt as vinegar aod 
pickles, are aW ti»ed. Care .^Jtould be taken not to diftturb the 
oSj^cetion by biking too much acid, and it ahonid be taken 
through a tuVrt?. f-i pn"flecl the teeth- 

The di^ea^ie 1^4 usually dividefl into four Fita^-4 ; this divieion 
is, however, arbitrary. These stages are : a premonitory dinr- 
rbea, a 8e\"ere diarrbea, a stage of collapse, and a reactionary 
atagc Tbc mildest cases pasH through only the fir!<t ami tho 
second stage. The diet for euch stage wiil be indicated further 
on. In uddiUoQ to ihc diet, ccrijiin general itidieations for 
treatment may be mentioned. Kcuucth MaclAxxl lui» »um* 
mariRod tlic^ somewhat as follows : 

The patient should be put to bed and kept absolutely i|uiet. 
The preliminary diarrhea should be checkecl aa soon as possible. 
Ad die circtilation &ils stimulatits should be given. If the 





320 



DiBT LK DISEASE. 



I 



t«ru|icni1ure is exax«i\^, it Klxaild U- reduoed ; If tbc t>odil^ 
b«lt U Ic^wenxl^ it slioiiH be niUwl, 

Any persistent duinbe^ ahuuM Wolicckecl; auy tcnd<iJov to 
vomiting ^ho^ld be n>1ic-VGil if \xiri^\\>\c^ TJiii^t sUould t>o oJ- 
layctl, mid p^un and (]ii;1r@>^ nlk^viutcd no fur as pos>aM<\ 

During tie ?^Utge of diarrbea littk- or no finKl shc.»nld Ix* giv<»ii. 
Acid drinks, and T^iilpliuric ucid c^pivially, may l>e ^JmiiiT?<U;red. 
If ftjod U tiikcii, it sliould he giveu in v(*ry Amall fjuiiiility, iind 
in tlic form of nlbumiu-water, bcef*juic« or prt^iigi^t^l beef 
i«ohitionri, barley- or <fltm«i]-wati^r, or ^bey- Milk w Ijftrt 
avoided, for if it i# nut <ligesie<l or iibsiirU'd, it fonuH a mosrt 
exct^lknt cultiirc-nieiliiim for Uie dt-vx-iifpineiit of Uic cbuli-ra 
0pirilliim. ff it i:f j^v«n, it ,-flioiild first he pept^niaun]. Tea 
in smflll r|iinntit]^ nmy W Ltllowed tf defined, or a little red 
wine (Han?!) may I>p adminiiiU-rfNl, 

In tbe >fCCoiid eUigo c'^intinaou^ purging and vomiting gen* 
crally occur. Morphin by|>oilenptf^dIy is probably tbe bost 
meuns of checking ihft^e eyniirtumsH A niust^rd-plii«tcr over 
tUe abdomen inuy give ^ime rtdief, or tttr[ientine stupes may be 
applied. During liifs jilajje lU} ftn^l yboiild be given, tor it will 
be rtjecled, Tbirst sb*nild \k idlaytii as far as possible by any 
of llie following articlw, given in very wnall qiiantitiee and at 
ten- or fiflt^n*iainntc intorvaU: Craokod ioe, cold water, oold 
ntsid wat*>r (dilute pbospKoHc or eiilpkuric aci<t dilated with 
wnfi^r), earlx>nal^ wat*r, ic^l lemonade, or lime-juice. Weak 
tea or ntron^ black coffee may also afford relief. If vomiting 
oontinuea, thirst may be aafluaii<!d by allowing the patient to 
hold a little ioed lemonade or iced wal«r in the moutii without 
tiwallowiiig it» 

If morphin does not check tbe vomitings it miiy Bometimes 
be relieved by washing out ibc ^tomack with uonaat t^t solu- 
tion or with wt^k boric acid solution. If the fluid in the 
ptitit*ut'fi body iri muc^b reduced and the patient paweee into tb© 
third, or algid, stage, injecliooft (if normal tinlt Hnlntion may 
be given anlxnitaueou^ly or intravenously. By this meanA a 
patient is often revived, but, unfortunately, the permanent 
relief hoped for by this methiK) of treatment has not l>cen 
attained. 

When the vomiting censes and the tieven^ symptoms l>egin to 
^ub^iide, small qnautiiii^s itf foo<l may 1h! given. At Jir&t ii tea* 
»]M)uiiful every fifteen minuter may Im tru-d ; and if thid ia 
relaiucd^tbc i^uanlity may be imfreaBe<l ond thi^ interval luugth- 
etied. Albtimin-wat-Tj [H^ptonixcHl milk, imd l>«'f*jni(v or pn^ 





I 



FKEDiya ly iNFEcrious diseases. 321 

<!u;rdt«d bc(f solutiood hboukl be given at 6nU Tbe fttomiirli 
often riiJiitiitr^ irriuUv for duyx and wcck« aflvr an ixtUick, and 
rn«c cnrv T^imoM Ix cxcroi^nl tiot t<> cxciu- diiirrheu ur vomit- 
ing. 8tiinuLunU, in xIk iWm erf smnll tloora* f>f iocd cbampafj^nG 
or JUtit'Hi lir.unlv <>T whUlcv, limy bo ndminiftUTrod. 

YELLOT FEVER. 

Tbtt diMOiw U ui!tiull}' dc7><Tibod em prMCDtiii|j; three atag«H 7 
the period of ins-aftion and fever, followc<l by a period of calia 
or npmiji*ion. Matjy mild mitiw ivoQVi?r without passing iiitu 
the third stage, which iff merely sd exaoerl»ktion of the ^^ei-oiid 
staf^> and is acootnpaiiied by hlaok vomit and freque!iit]y by 
ur«mui and <v>llapse. 

Almofil all writ4?n* agree afl to die ij<>i?esAity of withhnldinf^ 
Jill food for the first seveoty-twn hourrt of tlie db4i-af^ye. At the 
out^t it is well I0 give an enema and tvo or three grainci of 
cnlomelt followed by abtH)lute rest of the Atoniach f»o far ajji the 
ffivlujf of food is oorn-T-Tiif-*!. A-* iiH>flt of tJu- subjectfl of yrllow 
fever are in robust Iit^ltb wlnju -ilrickt-u, the nt^u-vation ia vrtU 
home. If food jm giveit, it in olrtioHt cMinin t^j Ix? r<*j<-(!tiHt and 
to Hggruvato tho symptom*. During tlii» porimi iSt^rnlxTg 
TCComniendK the following mixtuiv 1 

Sodium bicarlmnJito ' . >^ - > - 60 i^iiu 

HcTourr bicdJorid J gnin 

Wiiet. 40 ounoea. 

Of this, three tablflipooiifiiU an* to Ik* given ittvcold evory 
hour ; ft trmtiueDt that lia^ bt^ii highly pniiM'd. Touatrc is a 
firm l)eliever in tlie <?*Bcac}" of Vichy [OJlertins)^ and admin" 
istera one or two Ix^ttles a day, AlwHUutu rcvi and un iihun- 
daiicr of fn^h iixr nre e^sT^^nlijil ndjuittrta l-^ the tmitinent. If 
Vit*hy «iii nut In* ohtaitR^I, soda-water, otic dntia to a qttart of 
cold water^ may he ii»ed intend. 

If vomiting i^ severe^ the ritoitiacli ftlioiild hr* given al>imh]t9 
Pft&l tmd *alt j^Iution be adiniuistcred by the rt^otum ; or if tlw 
recium becomes irritable and the jjaticDt ^bcuM become algid, 
ihe injectioas may be given iDtravcuously^ ue recomiiicn<kH( in 
cholera. 

During the third day, if tlje ieiii|H'miiJiv liill!* below 102** 
F., a small <^imntity of milk und Iimc-Wttt<,-r niuy \k given evert' 
four hours. This la nuirc likely to W rctuinod if bikcii oold. 
21 





322 



t>IET ly J>fSlSA8R 



Qftult, papes ^^^^ ^^*^* li^*^ ribould be uvoidct], and Dothin^ but 
milk ami linie^wster or ulbiimiQ-wutrr mny Ih^ ullownl. Trti 
and othur beverages roaj" «:!XoUf- vutDiting. AiulcfEwn, Lowcvcr^ 
BUggttfU oD« Binall cup of frar^hly prtrpoiyxl tea, dmwn but a 
itiiiiut^' or two, Ut Ur lakoTi in tlie nu>rmnp Ir i^frt-ih t>ie pntient, 
AW Wid food should \to forl^idilon until c'jnvalf#c«nce ik well 
esuibliabt'd, us very gtight indiilgeiKv^ have rcf^iiltfxl fatally. 

If the miicnt ^U >%'or8e inist^^vd of U-tt«r^ and if vnmitiDg 
bf^as agaiD and the. dmrrhm Is jtovi^re^ all fixrd will be rejected, 
leed rbanjpagre, Rhine wirie, or bmrdy and wau^r may be 
gdminirilereil in nmall <)uanlitief^ at fre(|uenl mtervaln, Blaok 
0(>fl'(f timy ultfo tw tmplovi^. Cracked ice, .*odu-waler, Iiaie- 
watcr, Vit^hy, «r the carlM>njiU:d waters nmy he given a trial* 
Thirst muy he somewhat ixJieved by Eillowing leriKinade or 
dllijt<* a('\<\ Hfdiitiiius 1<> be held in Lhe nitfUtb rather than 8wal- 
low<Mh Subi*iitaueons injectinti:^ oj' normjd .sitlt !*<:»Iiition, or iu 
very 8e\*ere casi^s intravi^noits injectinnB, may 1^ tried. Mustard 
pai«te may be applied over the epigftstriam or tiirpentiKe Atiip«fl 
may be ordere<l Morphin hj'piwlerraically i^ more eHicient in 
relieving tbevomiling than any other drug. 

If llie severe Jiiymplomfi abaU.*, nourishment may again be 
att<'nipu<l. A tt^»{MrotLfut of albumin- wal«T, with or without 
a Htth' dilute bruiidy or champagne, or tUti fiaaie (jnantity of 
peptrini7r>f] milk or (if preiligf^U-d lieef-sulution, may he given, 
ir tilts » relainedf it may be repeaieil iu from twenty minutes 
to bftif on hour, the '[uantity being gradually inoreaaed and the 
ioterval lengthened to two lumn*. The stomach is hpt w be 
irritable for days, and the frnxl must be liquid and often predi- 
gested. Peptonizfid milk, album in- water, i^hicken-brcth with- 
out fatj and similar fluids may be given. The convalescence is 
to be conducted as after typhoid fever. 



I 



I 



DENGUE. 

The diet in this disease is that of an acute fever. For the 
thirrt, freebly prepared and iced carbonate*! water may be given. 
Aloobol is not usually rwjuired, eicept in habitufe, and is best 
avoided ir the early stagf*). Severe ctises should be treated like 
yellow lever. 

MALARIA. 

During the attack of an intermittent fever the stomach is 
generally irritable, and if food i^ given it is^ likely to be vomited. 




pREnisG fH ryFEcrrom diskases. 



S23 



N 



If the pAtieot has any ileeire for food, milk, brothjs, or gnieU 
nuj be allowed. Wuen the appetite retunuij the oUHtoinaiy 
diet may U* rv*f<i]m{^J. The diet i^bould be vaiied, and fruit 
aud given vt^'tal>1f?« mtiniuiHtcret] tu (x>iuiteru;tthec«mHtipauoa 
tbui i« ujsiudly prnMUiL. Tht^ aa<-jt)i£L ibut fuUuwH repeated 
Attacks of mnlAria ndcn rctjuinr-t nn eap^-ciaUj' uulritioufi unj 
imrigonting di<»t, *n<<h uh ih pnMonbrd in the oouvaleo^noe 
from fpvpVA in g^'m-rnl. 

In tbr [>n>l<>n^il ntid mor? or le« contiouou;- malurial fc^cn» 
the dit^'t U NiiniUr U» tliat of any aciiti* fever, Al<x>1]ul nmy bo 
givcD in the coiivalesMX-nct' followinji; the bcvitit furm& Wliiid(y 
it« a ]H>p(d»r adjunct to trcnUncnt, And cure dioiih) be exerui^ 
th&t loo iimcb be not tak^n miil injunoud habits formed. 



ii 



TETANUS. 



In all cnHM of tht« <lia«afW the eSorts should be direot^ 
towanl F^iipplyin^ the patient willi the larj^t po»>ible amount 
of DOuii^btneDt, Many cases die from e^tbaUBtioD, due, in fxirt, 
to lack of food. The difficulties of feeding a look-jaw patient 
can be apjireeiatinl ^.^nly liv one whu h^H maimged a severe oaw. 
Extreme enmcijitiou and marted anemia, the renult of iniiufli- 
tieut nurriment, are ^uerally pre?enL 

Wbcn tlie di^^a^- ih UT>t seveie, litfuid nuurishment can 
asimJty bo given without difficulty by allovrinj^ the food to 
pass between th^ ti>ot.h. This is rendered oo^ier wlien a UaAh 
ift mir^ing. If the tertli are so regnlnr and fit bo clisely 
together a^^ to keep all fowl out, nusa\ or recUil fetidinf^ may be 
tried. In tiici^ cu^^e^ food should be^iven every une or two 
houri^ and from one to wveml onnei*^ iKhoiild bt.* taken At a time. 
Milk^ which should be fmrtially peptonifiedf Diilk-pnnch^ c^- 
iH)g, albLmiin-water, piin^ijK-pton and water or any teliable liquid 
predigi-dled l^'ef, ini^nt brothn, and stiinidaiiU nhuuld Im tidiiiiii* 
i&terefh Milk, if it Agrees with thi^ patit^ut and can be j^ivvn 
in suHiclent <|uantitii>^, tt^ very uM^fuL 

In severe efljM« anj" attempt to handle the patient or to feed 
hiai ii* like.ly to bring on a eoDVulsion- Thi& ts an true of rectal 
fe(Kliiig as of montli-fi^n^. In some eiues rectal fecxlinc may 
be suceeft^rnh In thei^ difficult caeux une^ithesia may oc in- 
duced hy chloroform, and ii' the jaw* rtlax «ifliutcnlly, a 
eloraach-iiibe may be piiJ^s*'d anil ii pint of pntUgi-atc<,l fiKwl 
mul ^llmulant jHrnrHl inln the -itoiniich. In many ca-'itw a numi 
tnbc caa be used to guod udvantnge. 





S9i 



DIET IS DISKASE. 



RABIES. 



The mana^nieDt of the dk-t m nbif^ is sulvitunlmlly tlio 
AOioe ii» 111 U'ljiniJ*. In moel aiw:-> t-ven tlie sli^bt<v*l niovi*- 
ment^ about tbe patWt may excite violent gpiidiu& When this 
is the cuf^e, all uttempt^ ut rix^Iiu^^ whether by tnuuth, na^dil 
tube, or irctiiniT muj*t bt.* (lijHM>ntiiiiH<<), OaIvv has t<i]ggKHt«d 
tlmt the thrtNit be otHMtiiizitl m ni< to le*flca the ^pasfOJ^ and 
[leruiil the piticut to swivlhfw, WbuiK-vt-r piWibli;, tJji.s sbutild 
be doDe, but it c&a not generally be accoiuplishcd* If the 
jmticmt U fiufftarlug from huiigor, ehloroform may be sdmiDia- 
U*nK\ bv iiibnlatiiin i^ the- [toint of rr^'bixntion, nnd foDd bf> givi^n 
hv tin* stomueh- or nasal rain* or by tha rectum. Sinoe nil 
cu^sof mbi(>4 nrc fatal, the patient's euflerings should not be 
nngmetiUHl by ineffW'timl efforts to nditutii:*tor food. One who 
Lfts never stnm a cam' of nibiefi run not reiiiize tlie extent of tlie 
suffering that attempts at fettling may Indnee. 



TUBERCULOSIS, 

The im]>ortarce of proper diet in tubereidosiR hnj* been 
dwell ii[>on since the time «>r HijipwJniteK. Arrtjeiis mentions 
tho use of milk in ihp tn-atmrnt of phtbisirnl |)iitientf;, Qm*- 
lationri pregnant with futt-s ivlating to the vahic of proper food 
mifi^ht be adrleil from nlmojit every mcniiail writer of pronii- 
nenee. Osier sums tip the matter «« folhiwe : " As a healbig 
of » tuberouJous process i* larp^ly dependent n^wn the etate 
of nutrition, the <iuestimi of diet tx'comea of the very firBt 
iniiKprumee." 

In a di.-^eaae with such pniti^jin manifestutiime there are many 
poiulH that tnuet be consiilercnl. An the; mnlady tis^ually attockii 
the hingft, this seetion will deal prinpipally with piihnonury 
tuU-ri'uliiKl'^, fiir if the dietetic manA^^mcnt of a awe of pul- 
monary phtliisis is understood tberoLighly> thore will be no aiffi* 
culty in mtxhfying it to meet the reqtiiriLjnLnt* of other forms 
of the diweaee. 

From the outlet the patient tuu^t be impresned with tlie fnct 
that diet h* of primary importance in the trejitnu'Oi of the 
diaeaae, and whenever he dtr^playd a lendenL-y Ui ln^t-ijiae alle- 
les in thi« regard^ ihe tnjunetiouA coimcming diet mu.^t lie 
repented. Directions should not be }^iv<<u in n gtmerid way, 
but should be sjieinfie, covering both tla^ arfieh** to lie ealen 
and those to be avoided. The time for talking footl and tlie 




PERmsa IS iJ^FEcrrovs diseases. 



826 



iDt to be takeu stb^ruld \v mn^fiilly outlined, Thisu? potnt« 
vary w»tL <JiflVT«il patientis but «icU <^at* iminl Iw rtudint in- 
dividiinllv if ^iLoce«e la to be attaiiiCHJ. It in gviKvally bettor to 
give written inAtnictioii.4 i>nii<y>i'niii)f th<* fli^^, an tlio |mti<?nt it 
apt to be forgetful, c^peciall^ if be bait ci^rtaiii Ktnmg likw auA 

Cave should be taken to give only siioh diivfitjons a** ihft 
ooBditioD of the patient will warrant carrying out, A good 
diet ind freah air at home are to tie preferred to starvation id 
a more etiitable climate Tbe patient idiould not lie permiiCed 
b> ppeiid l*x> iiiuch iif lit» uiontj' uu raUniiid faix- and Iijij Utlk 

Thtt nutrition of tbe patient is a rtliabU- giiidu att to tbe 
proj^n** rtf lb« disease. If b*- i« taking Mjffi('i(*nt niitritiouH 
food, iH di^.sliiig it, and la ^uninir in wd^bt, the prognrMiK im 
good. If the n^erse ia the eaw, tbe pro^a*tis is bad. A p<*r- 
Hgtent inabilily t^ digest food ia al^'avH an unfavorable symp- 
tom- Can? should be tateti to avoid disturbing tbe Fftoiuach 
by tbe wte of nauHcating drugs I'atientd are too frequently 
doM.-d exiM^Mively with ureaHul*-, cud-livtrr uil» <Ton^b mixluret, 
and bypjpboflpliile?*, while milk aud ^^;ge arc cot given often 
enough or tmly in inHiiilieicnt qiuuitittea. 

Irntiilnllty of llic idomjK'b wbtitdd rc^'oive early and fb'* moat 
dLrrfnS oim^idinLlinri. It in tiHunlly ilix* to ft^vi^r, uiifmifi, the 
HWnllowiag of sputum, or improper f<x)d or drup*- If due lo 
ttvtTy eiirc in jM-Ut'ting tin? diet, lu* will U* d*writ>od fierwift^r, 
ebould l>c cxereised. Whttn there in marked anemia, fre^b air, 
Kunnbinc, gotxl fofxf, massage, ami iron in ani^'tily aAflimiljible 
form are helpful. In all nasi*** fhe |vittont >djouId be inatnicted 
uoi to nwaU"W llip ti}it]tuuB, ii^ Irriuibilily of tbe Htutuacli with 
vomiting is alinoHt ccrtiiin to follow Hvioner f>r later. He .-ibould 
be question<d obwely n^irding tho finnl and dru|rs lie is taking. 
On*- Tihoidd bf'iVTtuiii that hi' rwmit t'lktag n ^laleTit medinne in 
addition to what ha?t Ikt-n preseniM^l for bira. " Quiek eiinw" 
are always uttmctivf, nnd atL- ofU^o imbilged in secrrtly, to the 
great dctriineiit of the patient, A ^u^pin»ion of all dnigs from 
time to tinw will do nmcb to ri'lieve the ovenloMxl ^toniaeb. 
In i^mm individuals irrital>iltty nut] mui!rc(<a may Ir' broii^it on 
by tlic to<> onitinuouH admin mtnitii^i nf uiiy t.»w dnig. 

Tb^ appGtit< , iiincc it is gi^nt^ruUy poor nn<l rjipriclnus, is not 
a good guiil^' UM t<i tb<r iiru<junt of foritl to be* tak^m. Ia mo^t 
<ianm morr fiHKl ejm he digi^idfsl timn fhr npiH^litc* demands. 
WTiile this is BOfc thf ckviri-j* of thf pnticnt Kboiihl, iievcrtlK-b-'Sas 



sas 



DfET IN mSEASE. 



be coD»ii1ti?d fio fiir ah pn^iblc, and more good can Keoerally be 
iicix*mpHslu^d hy huuiorlug ibe |>ftlicDtN rcawm^blr flrm^in^Ifi 
xhna bv combjiliHg them. Tbc character of each pntit^nt .nhiuild 
be studied, and in th'tn ooDditioii partiotikrly tJict play* nn 
bniwrtant KVle. A niirw or a phyflician with natiiml tnt^t iiiid 
8yru|)atliy will cfUii manage to ^i suffinGnt food itit^i an iii* 
tnietflble or capricious patient where skill and want of tact 
would fail completely. 

Other factors to be considered are the nationality und the 
iifltial mode of life of the patieuL Many of the diot-list* in- 
tended ibr tubercuWus |iutieut« are taken frotn ih^r works of 
UcrmaQ writera. A German or i\ Gemmu-Aroerlcan niight 
thrive upou thew, whereon an Englishnmn, a Frenchinnnj or 
an American would find it Hifficnit to takp some of the nrtio-lp« 
a^IvtHed. 

In the choice and pre])anttion of food the utmost earc should 
be exercised, Detweiler^s wiyinp, ** My kitchen \» my phar- 
macy," holds in these «i«». The food »hoiild be pre])arod 
Himply^ and yet MhouUl be vuncd and nmde a» tcrnptini^ a« 
possible. 

Tile ftonuich and lut&stine should l>e watched, uud oonnti* 
pation promptly relieved. Patients who are taking lar^ qaan- 
titiee of food and rioting mach of the time are apt to be 
oofitive. Sngnrs and ^itarchefl are rarely well borne, Tliia 
may be due to the presence of catarrlial conditions of the bowel, 
but niay <dso be tnie cveu when cutflrrli is not present. Young, 
growing girla ofk*n tmve sweets, and when this craving is 
indnlgtyl in to exeej^^ the stomach and digi'-Htiou become dis- 
onJered. 

While suflicient finxl ^hotdd be giveo, nn exresa is injurious, 
and eaoli patient should Ijo watchod airdullv. Not more should 
lie given at one time tbuu tlie patieot t^ii diget^t with eaae, 
BardgweJl and C'lmpnian, in their filtidieft on mefjibolism in 
tuhereulrjsin, tbund that some }>atient?* who were tiiking very 
large quantities of fornl and were gaining in weight were 
excreting excessive anioinit^ i>f urt^a^ner 900 graini^ daily. 
Tlie^ patient'* generally mjiintaiiie<t their iionnal weight, and 
the dismse np|H?ar<?<l to be ijuiesceut. For economic reauioua 
they were (tbhf^) t*i rL-dacc the diet of the jiuticntn, and found 
that, in^ti^ad of producing dis%3trf)ua redultj^, a gain in weight 
and general impravement followed. The^ patleJit€, of couroe^ 
were being s^imewkit overfed. 

IU*9t 18 in]j)ortuat, and tho patient should be instructed to 



1 




fEBDixa ly iSFScrious diseases, 327 

n»t before aa<l aAer EucftU ; if he is not rfociving Uic oombmcd 
reHt uod diet oitre, to Iip ^polc^i) i>f Int^r, b«t shouU lie down at 
lefl^t h»lf an hour l>ofi>n» nnd nf^pv nt*>ii]i*. 

Coughing \a sotnctimcfl cxciU-d by the taking t>f food. If 
tbifl iH due to laryiigea] iDVolvcmeut, it i<liotild be- uianoj^ 
accgrding to dinxTtionfi given utititr Di»Ltts\^is of the I^arynx. 
When it 18 due U^ tbi- pr(M»ura uf an ovcHiIIl^ stouiucb, tlio 
mcnla may be smulkT and clowr to^'ther. G^vii^* or firuliiig 
by meaiut of a !4oft-nibber tubv iiiay bt; craploycHl m ibiwu Ciii^-4 
that vomit cvcrydiing tljry cat because swallovriDg brioga on * 
fipai^modio cough, 

Tbe care of tht^ mouth ia of great impnrtflnoe. It ia well to 
rin>»o the mouth Ikofore and after mating. The teeth also should 
be kept HompuloUAly clean. Kiiopf advices the ose of the fol- 
lowing mijiture after meaU r 

11 K*«»r»ot* <.f fifp|H'TTiiini - - . . . . - - ll\^ 

Th^naol jr>*. 

Baaicdo ftoU jijj. 

iliiolitrr of ntnlTpCapi iy- 

Alcohol , - . , - Jr*. 

M, Half a U'««|KAirifiil Id ■ ^htm »( wvtor CO bt luwd u s in»L]tb'W««h. 

Foods to be Tsed by Tubercaloas Patients. — 
Milk, — This is one of the most important articlea of diet for 
the tubeivulous patient. Unlefls f^ome special reofion exists, 
milk ^hoiilil always (oiin a part of tlie diet. It may lie bdfen 
with the WpaU or be given betwtien the intervals vf feeding. It 
t§ of the utmost importanoo that tlte milk be sipped slowly^ and 
not KwiJIowed tjuiekly id lurge quaulilie*. The milk muy be 
taken plain, or may (>c moditiod in varions waya. Lime-water 
may be added, with or without the addition of ereatn ; ear- 
bonnlefl water may be mixed with it, or the milk may be pep^ 
tonized. Buttermilk or kumiss may be taken if desired. 

Eggs, v'hra tliey ain be taken in sufficient quantitie^^ are 
alM) of the Bn"iit**flt vahu\ In certain oase#, however, tbey may 
not he w<JI bonie. If th<' enlin- vgg aui not be taken, tbe 
whites alone may he given. E^albtimln ofVn renders most 
vtlioleat !«ervioe in Imlpiug Ut nourish these patienU. Tho 
vrhitca of from six U* twenty-four eggs bcAtcn up lightly and 
strained through u oloth may l>c taken daily. A v<^iy ^miiU 
pineli of salt ami a little lenion-juiee or other favoring Hnl>- 
gtfiDce may itv uJdt-d. Given in tliU way, u large number of 
eggs can easily be taken, and are almost invariably well bunic. 



DIET IN V lb' EASE, 



If the patient con di^:oBl the oggs «t)tin?, th^y mity be vciy 
]ightly boiled, or, as n cbat^, they may be made into a Hp;bl 
omel^ or poached. Hard-boiled and fried eggs thnuld not be 
eaten. 

Meat. — Meat of all kinds, if properly prepared, may b© 
eaten; bat ^'high'' gQ^^» highly seasoned aishee, and twire- 
cookcd meut^ should be avoided. Beef and mutton aro the 
tnoiit suitable varieties. Itaw meats, especially mw iKif^ hitve 
been highly extolled by FreucL writers. Tbe exp<.-rim(^ntJi] 
wiirk of Richct and Hfricoiirt <*n dogs, tcoding lo show the 
vuluc of raw laeat, bati hoen much criticised, Cornil and 
< 'hanteniesne recently oontribnted to this subject by tlteir rx- 
[u<niTii-iitA on doj^fi. Plaee<l under similar couditions, tonic of 
tb^ aniinnlA were fed on raw meat and others on cooked, und 
botJi 4erieA were inoculated wilh vinileat tubercle bndllL The 
doga fed on cooked meat all died in a short time of tubcrc^iiloi<i», 
while those fe<l on ratv meat lived. 8onu' of Ibr nninwilf*. at 
the time in apparent gowl Lciilth, wrv kilh'<l uihI Hhdwcil 
tuberculous deposits. Others lived in appjircnt good health, and 
on beiDg killed a year later showed tuberculoua dopostts in a 
condition of heal in j;. 

Galbmith hiis recently shown that t!ic exhihirioii of niw mait 
is followed by a marked mcRiftHtr of nitnigen retention, provided 
the beat value and Dilro(fen of the diet exceefleil tbe aclnal rc- 
quirementf4 of the individual per kilo, of bofly w»-ighL Ke 
also found that there was an improvement in the inte-Htuml mo- 
tabotii!!m, and this improvenienC la^t^ some time after the return 
to thv uj*c of cookL-d meal. In Galbralfb'^ paLieai9 thert \ViW a 
rapid increase in ihe hemoglohlu, and tbe digestive Icruki^cyltia 
WHS n'niarknbly inereawed, 

firancher fliiggesls thnt fcr hibemjJons patients the raw meat 
l}e given in the form of a findy divided pulp. This is prepared 
by flcraping the meat with a knife, which will r^ult in a mass 
of shredded mcat^fiber. This is placfnl in a mor(ar and pounded 
and nibiW with a peatio until quite smooth. It is then prosfiod 
gently through a sieve lo remove any larger panicles, Thi» 
niw meat-pulp is very tmnWy dig«^Ied and highly nulritiuna. It 
may be given in various ways, as spread on Nindwicbt^ or given 
in milk or in warm tiotiillon. It mny be mixed with puK-cs of 
v-irioin; kind" or u'Jth vt^fjihles, or, In tbe ca^o of children, 
with smull <jimutitie» of pre^rs'es. It may be rolled into balU 
And w> fiisily swallowed, or It nmy be RTved with an egg, with 
nnchovie;^, or with i»io5cl<>d herring. 



FSKDiyO IN IXFECTIOVS DISEASES. 



SS9 



Mmji'j\tif€ U aliio of grmt vulue. TliU nuy Vm* prepared 
aoconltD^ to any cf the rwipen given in iJic Appendix, or 
the juice nmy be eJEpre***ecl frtjm beef by nieon^ of a roeat- 
prcfls. Good ruund ele^tk ?JiouKl be very »%ktly broiled, cut 
into enudl cubes^ and th« jtiioc prosf<.-<l out, \Vltb u ^^ood 
pr«M «boot <H^t oimoea of jiuoe cun Ik< extjnL<.'t4>d from a jjotmd 
of nriMit. Thm ^oiild be ^e^AonM and beuUHJ by [ilaoin^c the 
v«fiHel oonbiininjf it in warm water. CWie ^liould be taken not 
to heat it too thoroui^hly, or the albumin will coagulate and the 
jolco be spoiled. Fnsnly prepaivd be«f-jiiiai is always prefer- 
able, but when this can not be obtaine^t^ liquid l>eef poptunoids^ 
prcdigefited beef, or MoB<|Uera lleef Meal niay be employed 

J. C\ Itoux and Josias have used tLe mw-meat oure in 
cbildren with good rebidta. No cooked moot wau allowed the^ 
paliectfi. 

For patientjt who can not op will not take raw berf, very T9M 
steak, roaAl^beef, ^r beef wup iilionUl be prei^ril^ed. 

Pish- — Frc^sb fish, boiled, bniiled, or baked, may W allowed. 
Both oyslew and claris from whie.li the liard j>ortiou ha.-* been 
removed may be eaten, preferably raw, but they niay alno be 
given Etewed, rocifited, or broiled. 

Cereais< — Wher« thoiw mn be digestetl, they are of x'aIuo. 
I» the oirly I'Uigi-s of tht' dj-tiitir th<^ wcrvc Dot mdy us nutri* 
merit, but al8r> jiid m regulalitig the hi>wc]fl, and are ii^unlly 
COiuly digested. If tliere t^ cousti|iatjonf thc^y nro nf vvfuvial 
value, (^itmcul, whimten griti4, cummt^l miixh, nod rit*^ ^\\i\ 
milb are the mu^t i^uitable forms. 

Vei:etables. — Any <»f tb^ easily ilifri>?<tcd vegetable** may l>e 
alloweil. Thoy t^hould be slcametl or cooked with a* little 
water a« poHt^iblep to HvcMd diHsoKing out tlie salu, wliich* 
together witii much of the nutnment, are tlirown awuy with 
the water. 

Bread. — Wheat or rye !>rea<l, or mixtum of l>ofTi, may Iw 
Udcd. Zwitjbuok le of great vu]u<t. All hot bruadtc^ pujttry, and 
oakoi ehmdd be uvoided. 

Fruit. — All frpsh and preferably ripe fniil may be allowed 
in moderation. It nhotdd be taken the first ihin^ in the morr- 
ing or as a dc^^sert. Baked applcH and orangf:^ an^ well l>orno 
and useful, and grape^ p<fiohe6, p«ar4, and other fruit in mxkiii 
may be allowed. 

Fats. — In tuhprculoftw, when falfl and oiln ain l>e taken and 
absorbed, tbe piitgooaia in ulwav-H mmrb In-lti^r tiiau when tlie?ie 
can not be tolerated. While they ore of the greuteat value id 



830 



DIKT IS Di^iEASS, 



treMmeni^ care i^hould be taken not to disturb the patieat's 
dlgestloD by forcing mare fatty foods into the dietary than the 
Bluomi^b rtili tvlcmt^?. Mont fiutieut^ however, wx>u acijiiirc a 
dUliki' for ikts of till kinds* Tbey ut^ beat jpven m the form 
of trrmm aod butter; thu yolks ^jf eggs, eriap fat bacon^ and 
olive oil are alfio us<'ful. C^-liver oil is really as much a fo*Kl 
aa a medicine-. Either the plain oil or an emulsion may be 
u^^I, and the dtmm sliould be ninall to be^ii witli and gradually 
be increased. A comnioii mistake is to adminieter lie oil in 
excessive quantitie.^. Only [perfectly sweet fi"esh oil is to be 
ujsed^ as rancid or ?^tale oil may disturb the digestion, It^i use 
should be discontinued froiu Uuie to time. Children bear oil 
better than do adulta. If there ia a t*?adeiM?y to diarrh««, ftita 
and oils must Ix? uslmI with caution. 

Alcohol There is miioh diversity of o|iinii>n e^jnt'ernlng tha 

intluenee of aloohol on tuberculosis. Three vi^wa have been 
expressed, and each has its supporters: 

L That alcoholism is antagonistic to tuheivutosts. 

2. That alcoholism exerts no a[M?cial influence ou the iudi- 
vidiial as r^rards tubei^ulosl^ 

-t. That aleoholisoi definitely predi9]>06eit to tul»ercu1osis. 

The last view has the lar^^est niinilwr of suppt^rtersj tts alo*>- 
hoIi«ni probably renders the body more susceptible to all in* 
foctione. Osier has etditcd hie opinion ns foUowd : " It was 
formerly (bought that alrohol was in some wny antagoni«tic ts> 
tuberculous disease, but the obser\*atioi]S of kt« years indicate 
clearly tliat the reverse is the case, auJ that clircnic drinkerH 
arc mtjch more liable (o both acute and pulmonary tuberculosis. 
It ie |)robat)Iy allogether a question of alteretl tissue-soil, tlic 
aloobol lowmugttie vitality and enabling the bacilli mororoadily 
to develop and prow." 

Coiiceruiiig the use of alcohol lu the treatment of tuberou- 
losia, it may be said thnt, except in the last stages of the disease, 
it is best avoided. Nationality aii<l habita. however, must not 
be disrf^nled. Tn those habittuit«d to the ns^ of a glass of 
wine or beer with their dinner, thitt may be allowed. The 
quantity' taken must be limited to Ihe smallest reasonable allow- 
anoe. This will vary with each individual 

PatienU who are guining in weight or who are in Kood con- 
dition are better ofl' without aloohoK Thaw who are going 
down-hill may often take li^ht wine, beer, or wcll-dduwxl spirits 
with ;w)vantagt:. Of the last, well-matured, pure whisky is 
tfao host. 



FKKDtlfQ m ISFKCTiOVH DISEASES. 



331 



ratientA with high fevi?r who are in an exhnuht^ oouditlon 
may Iw ^ivt^ii alcohol lrw.'I\, fdUuwin^ tlw ntuiit^ nil<"tt a-i wt-re 
laid iJowit in the gi^ncru) Uf>Daii]t^nLtioa of fevers. In llioc 
QiMB alcohol ia givon aa « foixl, and b, aa & rul<>, v<!ry w^ll 
bom& 111 theiw a'l^'nnood c^^teH pure whirtky wpII LlIhitiH] in 
pertiApa tbf best form of aWhnlit^ ^tifuulant, l)Ut (he pati<'titV 
lasle niay be inmisuIIwI in thU r<?flp«*L 

Other Beverages, — The usual beverage--^ may he given in 
moderation. In chronic mborculofli* cocoa may l>e tak«n night 
and cnomiiig w-itb piHxl «0«cL Tea or G^fl'eo may be allowed 
in ^mall c^uanlitioH iiii]i?s8 they pnxluce unfavorable ^ymptooift. 
Milk and milk-punuh, buUcrmiik, leiiioimde^ or omii^*«ad<! luay 
be iii^Jodr and malt i^xlnirtn arv uHeu of beucfit. 

Number of Hcflls. — Food may l>e given front three to nix 
tjiuea daily. On ri^intr, milk may l>e taken, or, if desiired, a 
cup of bouillon in^t4?nd. Thij^ may be followed by breakfiui, 
and aliout the middle of the morning a glai^a of milk, e^- 
aibumin, beef-juioe, or broth may be given with a cracker ^r a 
piece of toa^C 

A midday dinner should be the rule, and during the middle 
of tht' al\ernou[i a light lunch of scruped betff^ milk, or aoihg 
aimilar food may be giveo. 

Sapper may be tidccu at p eonvenient cvetiiug hour, aud 
before g*^^ng tji bed a ghua nf milk may he dnink. If dtHircil 
or if deemed neocsMary, a anmll amount of lirjtiid noumhinent 
mny be taken during the night if the imtient awakeEia. Ah a 
mle, howe^'e^, it is well to give the stomach a fiiU night's reat- 
In severe rases, where only small f|Uantitiefl of liquid or seroi- 
holid food are taken, the intervals should be shortened to every 
twc» or three hours. 

Feeding: Advanced Caacs. — In advanced at^es patients 
may g(.'Eicrhllv Ixr jN^ruiitted to seliHit their diet. The4i« palienta 
can i>l>e[i vut hearty mcuU ivitli u relir^b and apprirently digest 
them witJ»nit diffienlty. As a rule, their diet must be li^ht, 
liquid, or semiWid. The same principleF may lie applied here 
%n in. feeding fevor cases, witJi the exception thiit the patieot^A 
dftitrcs should, as far as |x>s^ible, he grjtified. 

Phthisis Cures* — Various diet curea have been advo- 
cated for tlie relief of phthisis, and these an? referral to tindi-r 
the liead of Diet Cun». The benefit which follows tJ>cir ii»6 
is due lar^y to the fresh ur and abundance of food they 
privwrlbe. 



MET Hf 2>JSEASS. 

Darcmbcrg*3 Dietary. — lu 1883 Dart-mUi-g r«cODi-> 
incn<ltil the folluwing di^rt I'ur tiib<ir<nJofin patit^iibi ; 

H«al . ^ - 600 grtiinK. 

Biwi 300 " 

UVo oKg^ haitor m UX ft) " 

PoUKoW 100 " 

Ricf, (imcarrmi. rmiir> pcak,orleiitUi 3(X> " 

B«vr - . . . 1 li(« 

Milk t '* 

Detweiler'8 Dietary. — Tbe foUowing 10 the schedule m 
use in Dvlweiltr'* Sanitarium : 

7—8 A, M, ; Oofle^, t«i, or rhooolat<^, biscuit and butter or 
breflid and butter. A ^tai« of milk lAken in sniull sipH, 

10 A. H. : Ono or two glasses of milk taken in small bip^, 
or bouillrin with an c^Kj bread and butter, or cold meat with 
bread, butter, and wine ; if jmi^ible, a glass of milk. 

1 R M. : Dinner — roast, vegetaLles> deiwert, wiue and seller. 

4 P. Id, : Milk, kumiss, or bread and buttex with wiiic or 
oogaoc 

7— 7p30 r, M. ; ll^jt mt&i with potatoes, rice^ noodles, cold 
meat, 5no ^UKk^'f pr>iiltry with ^lad, preeorvcB, nnd wine. 

Latf in tifeitinff: A glass cf milk witli two or three spooofub 
of (^o^n*!. 

Aroopdin^r m Miink and Ewidd, thn Ciregoing dii-t represent) 
about 3000 (Tjilorios a day. S\ich a diet is much better suited 
to a Gerrrmn than to an Ameriean stomach. 

Weber'fl Dietary, — The following is t^koD from the 
CrooniiLD Lectures for 1885 : 

At 7 li'dock, or earlier, while Htiil In bed, a cup of milk, 
with & dessertsjKK^nful or a tabh'H|HH;)i'Lful of ct^ac^ or with 
]ime-water, or with a suatl quanti^ of tea or ooooa^ ami a noall 
pidc^ of bread and butter. 

At half past 8 or 1*, after dreflfiin(f, breakfast of milk, with 
some slightly stimulating addition, as tea, coffee, or cocoa, bn^ 
and butter, or bacon, ham, or fish. 

At 11, n tumbtcrful of milk or ktimiss, or sometimes ;i cup 
of broth or beef-tea, or a f^nchvich and a gla^ of wine* 

At 1 ur 1.30,11 substantial meal of meat, poultry, flsb, or 
f^mCf with fresh vo^^etablcM) some ]i|^ht puddling or cooked 
frittt, and a ginsa of win<>. 

At 4 o'clock fl glans of mtik or kiimiHs, or a cup of tea or 
coffee containing an abundance of milk, nnd some bread and 
butter or plain biscuit* 



FKEDJNQ IN SSFICCTIOVS DlStCASfUS, 



SZZ 



At 7 r, U-, ADotlier sutMlunlial men], t^imilar to that iii tlie 
mUdle of iJieday. 

At 9^10 or 10 p, H., on ^ing to bed, a cup of niilkr bread 
jmil milk, ur milk ^vtth r^>iue farumcx.'^riu fixNi^ ua HuriN, Wte- 
big's, Ne*»tI6\ ur MtUiij'p. At this time, if tbcrc art ulgbt- 
swuatA, tho uUnlitiuu of u tttbI«*6[>o<iiifii] of bruady U wrv Uficfut. 

GfiBtric Irritability^ — ^ustric irritubiUty in a troubIoM>m« 
^npt^foi iu niitiiy atMin nf liilM-rt<ulri?«it<. i 'ure m avnidiitg nan* 
•eOQji dm^ ftnil firi'iiHrationti will hiivo mtitrli (o ilti in prc-vent* 
ing iL The [wti^-m munt aUo l:^ Hijoined ?((rii-tly ur>t to ."iwaih** 
the tiputunK If t\\G attack in ^everv, the patient flhoulcl t>e 
pla<*ed on a li<|ui(l diet, conHinting diietiv of milk iu wme form, 
diluted or |M']>toaijE«l, liuttermilk aod kuniiAA aiv valuable in 
thin <.»uililii>ti uud urt' ofXt'ii wtrll burnt.-. Kivbli totaLl-Juioe atid 
broths muy Iw »llowt*<l, uud the viirioua p<:ptf>Jii»Kl dished mea- 
tioDiN) in the Appi^ndix may be given to lend variety to the diet* 
BcmjMx) nimt mixed with milk or prepannl in the form of small 
balU is cift»m of r«^rvice. The predip:"j*t*Hl liquid l)eef j>pepara- 
tiona are usefulj an<i may Im? j^ivi-ri diluted witb water, Pano* 
pepton poured over criulied ioi> is fi<»metiiue^ retained when 
everything else is rejected, t^-ulbumin l"* aUo uanally t^ 
tflined. 

Alivjluil may lie iiJ*e<l in tin.* l«t*T Hfaj^t* nf the dtwiiw or whrn 
the {xiticiit U Vf^ry w<^ik. OI<] hmiuly m>x<*d witli n ittitiAX 
c|unntity of a onhl mrhi>natcd water or te<L^p(v>tiiul iloocn of iced 
cham|>ngnc &tv uJvt^od in Hw vnrv smniifi cAses. Lorgv^r do««0 
nuiy Im* giwii in fUv hss S4'wn' ensf'^ 

Food nn<I <Irii)U Khutihl Ite givcu tn finiall qimntitiGS nt rfhort 
interviil? — one to fonr nuncx'Tr every two or three hours, or twioe 
an much at Um^r intervals. The quuntitv t^ikeii ^shimM be 
mm.4t]red carefully and reeordinl, as olherwi^* (he luilicnt imiy 
rewive an in-tuftici<!nl diet or he given a su|>eiubtin(knir. In 
weveiT? iinaes wa?^hing oui the nUiiiiueh givt?» iiion* relii!f thau 
any other pron-fhire. Iu Icaa wvtTe «t*cs u ghmn of hut water 
with or without Hodiiim himrbonate may l»e tnkcti ou rwtug, 
and at Im^d half an hour l)efon* eating, or prrfemhly an honr 
Iiefore. 

If no food is retained, forced feeding by means of a fttomach- 
tiibe may be tried, ThU is kno^^'n aa D^bore's method, 
l^ar^ quaiititie?^ — H to UJ ouqopk — may Botnctime^ be retained 
when given hy tljo lube that, it'.>:wuJIowe<l. would N.* n^ieoled ;iC 
ouwj. If ilie Bevcn- fgnn of irricabiliq' fcnkus, rcclul fwdicg 
may be resortml to. 



384 



DIET IN DISEASE, 



Fever. — If there n fever^ the qu«Htiou of fiMNJiDg the ]mtleilt 
sliimld be carefully tKHi^*idcn.j, If tlirre ib much irritability cf 
Ui€ stwnuich, tiie general nilcs for fovding ievcr |iatieut» may be 
fnllowc<I. If (ligoetion is not di^tiirbod nad the a]>}>etit(; is good, 
tb« |mti«Dt muy he a]]o\x^\ A light dirt, of which millc should 
furni ji hugi* iwrt ; a** a nile, it is Ixtit given vt)\d. The ii»iial 
liqiiid IocmI muy ali^i* W allowed. tSon[)S. white nu^t ef chieken, 
mw fir mre nwi^l-hiff, or limlenloiie iihUUjh are indicAtixl. 
BolUhI, broiled^ or Imki-il fiisli uiul ovMtvr>« mid \.\iv more eii^iily 
dig«6t(*cl vegetabU-w iin-ixTiiii^Hibli. TliejnitieuL's siin^undiiiga 
have considerable InHueiiee on hi,H n{}{M'iitt', nud when jxis^ible, 
be fdiinilil take liin tm-iiln ^vbilt; rrclining on a |hirc4i ur in a 
b(tui-parh>r, uiui<l |H-rfect c[iii4^. Thtx excitement And fatigue of 
u UM^fil in tbe dtiiing*rt>oiii nre liest uvoiJtd. 

If notul f(HitI darg not. m/rer, tin- jiftfinU idmuUi hf phti'i^ mi a 
Utftui tiift. Generally, however, h tnlicnnjbius imtient wilb 
fever will do reiu:trkably well on ageiKtral diet. Milk, lemonade, 
and Mmibtr preparations are nseful, recips for which will be 
found iu tlic Appendix. 

The diet lor llie more ativanowl eaw?!^ bais been iiidiciite<). 

Forced Feeding (Stualimentation). — D^bove diticov- 
erfd accidentally that foud introdncetl l>y means of a stomacb- 
tulw wiu H'tained when, if taken by tbv tnuiilb, il would be 
rejfWt^. He tbeit*fore turned hi^ attentiork 1o ihi- treatment 
uf tubcreiiloiiR |HLtientiL by m^ims of tJii^ method, and met with 
a ineusuruble wuefflw*. This form of tn^tment is especially 
applimble in tho^e lases where there are au irritable stomach 
and no ap)>etite. 

Food \h introdneed into the gtotnacb by the tube at reguUr 
Interval Milk, }>eptoDi/e<l or diluted, |;raimd-meat niij^turca', 
eggti and milk, ulbuaiia-wattr, beef-juioe, predige^tcd beef 
]>ri^|mrHlionF4, and similar liquid foode m^y be utilizc<l for tbis 

W hen, during fever, the patient's appetite and will-|X)wer are 
^nal to it, feeding may be conducted id the usual way, without 
ttiG tul>e. Moderate quantities of easily diger^ted food may be 
given at frecpient interval*-. Two or three ruther sul^tunlinl 
meals tbrin the Ihij^ik of the diet^ while no rij^ing, at bedtime, 
and during the lutervaU between meiils liquid fowl is lo be 
ordered. Under this metbwl of tmLtment eertain tuse.s gain 
very rapidly and reonvcr thdr tii^inl weight in a ebort ttnit!. 
Ae 900D as tbp <?iJ8toronry wpighi of i\\f puticnt ie reacbtrcl^ it ii> 
well to diminish the qiuintity rif friod gi^'en, mj aM to avoid llie 



^ 



DSKT Ijr I>JSRASKS OF THE STOMACH. 



335 



ttttjcV^ of overfeedinfr, which show themselvat in a coated toafi^9, 
a li€fivy braith, torpidity, adcI th^ trtin of symptoms popularly 
known iM liilU»iiM)c-»«* Should tbrec «ym|jtcitn» niw, a valine 
or ^mall <Jom'*< of culomvl, ti)gi<t}M.T with a nnluctioii in the 
ammiiit of fiwMl givi'n, will give prumfit relief. Gii«triii aitarrli 
ftjul fever arc ix>ntnLindicntii>D:4 to euralijueiilation* 



DIET IN DISEASES OF THE STOMACH. 

Id d lso a w a of the stomach the sclectioD of a proper diet ia 
oftn of more importance than the choice of druf^i^. No ubec^ 
lut« (lidctie rcgtilations van be- formulated iii thjJ» claiKt of di^ 
m-**!*, but it is impf>rtAt]t to rt^ulafc thi; ffmd in eifliforinity with 
the panicidnr difRiuw with which the patient \» niftMed, tuid 
alno to consider the individuul tnstea nnd [>cculiuntL<^ iif tlie 
|iatient ; even in the r<^]ncipn of m diet in any specitil discus 
uf iii4> Htomuolk Hian^'g fire nAtftn rendf^nd necpgdarj ; tlie»u 
mtiid W msiiU- gnidunjiy nml ii(.<c<inling tn th^ piinent^s j>ower to 
diml the fo(M). 

rood 18 HRJd tf> be eUGiIy digestible when it produce^i no ga»* 
do-intestinal disoomfort^ iji pn^NNi from the i«tomaeh into the 
intMiue ut A DortTiul rate L>f «peed, and U easily ab?wrbcd. 
Under normal ondition^ tbo digestibility v( foud^ i*^ easily 
aeoerlaiiwd, far the motor and si.<cn:tory functiuLL» of the Htorn* 
soh being nonnnl, tiu-- dTect of the food upon one or hotii t>f 
ihci*c fnni"lion."» ran rpiulily be determined ; in the vnriou* gHK- 
Xnv. iViHturhmytt^, h<>w*»ver, this prohl^ro Is more diftirnlf, iVir 
hire tliere rmiy W a mot<ir fir a *4perrtory di^^nrtHinee, or lioih 
functirmi^ may V»e iriipairv<l- In ileter mining the ditt for a 
special ^^itrit,^ dif*ii!HH»iK*e two points muel be borne in mind : 
first, the power to inen>at^ the nutrition of the jJiiti«*nt, mid, 
>^«ooikdly, the neeejwity of giving tinwl in a ibg^ij-tible form, fio 
as to leasen the work of the aiomaeh. I^nhe haa devised a 
scale of liie varioun artideH of finnl, givi'ii in ihe order of 
their digeatibiliry. Thw wcale formnihc- brisiaof iJie wt^Il-knowo 
Lenbo " idt*r diet/' 

Leube'B Diet Scale.' — DiH L — If the dif:eMion is very 
much reduced, the fnltowin^ artieles of food are most easily di- 
gestible : l>ouillon, meat solution, milk, raw or soft-boiled e^g^. 

Diet IT. — Somewhat less digesiible llian Diet L are the follow- 
ing articles of tbod : boiled calve^'-bBVLin, boiled thymur^, boiled 
ehicken and pigeon. The dtfif-rent forma uf miitt arc untuncr* 
> JSeiUihr./. J/in. JVr/., vol. vL, [l 191. 



336 



PIET IN VlSKd^iK. 



at«l in the order of their digvfitibility. Gniela,aiid in tlieeven- 
mg milk miuhes ouide with mpiooi und wbit« of e^^ may al^a 
be placed in tbia liat The Tnajority uf jratienU cnn digvTil 
boiled calv^' feet m »<lditioD to the various meat foods Alxtndjr 
enumerated. 

Wrf ///, — If Diet ir. la well Ijome, Diet III- may be 
given, ThU MmsisiH :n adding oooked or raw beef to Diet I> 
Leube gives the following method of preparing beefsteak and 
beHeVGfl that beef cooked iu thU way is very rasily dige8ted : 
The nieiit should Le kept for soQie time, and is then craped 
witli a dull flpooo ; in this way a palp is obtuineJ, coosn^ttog 
only of the delicate parts of the muHclei and not conisintng any 
of thi' tuugb^ haixlf and »ini!wy portion. Tbis pulp is ruitdted 
in fn^li biitUr, liaw hiim h also to be recommended* lo 
addition to meat a ^mall quantity of maiihed potatoes may be 
given, some stale wheat bread, and Hmall amounts of cofiee or 
l«a with milk (cautiouBly). 

Did JV. — This list is so arranged that if the patient can 
di^-^t the articles uf food mentioitc-d iiniler (his head for sr^me 
time, he i.'iiu then begin with his usually accustomed diet : Itoast 
chicken^ roast pigeon, vpuison^ partridge, roaKt-beef — me<lium 
to raw (panictilarly oold), veal (from the leg), pickerel, boiled 
ahadf macaroni, bouillon with rico. Small qunadtie^ of win<; may 
bo takoD one to two hours before ctxting ; gmmca are c^ntraindl- 
Cftted. Young and finely obopjie*! ^^pinaoh ifi allowable* ; <rfher 
v^c^blcvf, KiK'h as aspani^s, may be trteil cantiuitsly, althcii|^h 
Ij|.*id>c considers tine a rather risky procedure. After thi« fourth 
diet the natienli^ »re iillowi^l to take a mon^ lil»eml diet, hut the 
increHse should he gniduaL They should n^fmia from eating 
vi^'table^, r^lads, pre^rve^, atid fruits for itome time ; and when 
tliey are re&uuied, a buktHl apple lb the flr^t of tlj&se urticle^ to 
be eaten. 

Beaumont^s Table. — ThU shows tlu* meuu timt- of di^s- 
tion uf tin.' ditleivnt articles of diet — nuturally, in thf stomach, 
and artiticially, in viaU, on a water-bath. The pn>pQrtlon of 
jpLHtric Juice to aliment in artificial di^retilion was genemlly *^cu- 
lated at one ounce of the fonniT U* ont- dmra of the latter, the 
bath beinjj kept as close Ut ih*- tialnral temperature — 100° F, — 
as practicable, with frequent agitatiou. 



DIET ly I>ISKASES OF THE STOMACH. 



337 



JfoA 7\rju 0/ ChymiJiai4iOTt, 



Anlcim* of dial. 



Rio 

6«Vo 

TWdUk* 

IkrlflT 

Milk 

MUk 

(Hhtlxt 

Trip*, aouwd 

Brnlii\ unlmiU . , . . 
VftiiNin, pti««k .... 
Siiliwl marrow, ftuiiul 

Turiur. domoAkftUd ■ 
Turk«7, idU . . t . . 

Oflon^wiu 

Vii^t moklinj: . . , . . 
Ijvvr. Un'f, fiWi - . . 
Ejuiilt) (n*)i ...... 

CliickLMi, full-KTUirn ^ ^ 

SBft'«^' 

,tndi 

,fMi 

,tnth 

_,imh . ... 

Egg^ vliiiipMl . . - . 

Cuntnnl ■ ,,.'.< 
Codluh. oTirvl drv . - . 
Trout, mlmoti, fiiwh . . 
TitMit. caimoii. Tmb - . 
Bflitik iiHjHvl, fn^b . . 
Fbundtr, fm*b , . . . 

CUtHali, fmli 

^moil. Bitted .... 
Opten, f nvili ..... 
OjBlem, fiwli » , , - . 
Oyrtets, frwh .... 
Beef, fitr-h. I^'.iHh rt» - 
fkcf, rrenh, Wn, dry . 

Bc«fslL-iik 

BwfirtL<ak 

BNlvi«k ---,.. 
Btcf, Willi rail only . . 
\WvU willi ruiuvUni. «lc> 
Bwf. frWip Willi - ' 

B»f 

B«er 

fWf. nUl^ linrri, Mlrttd - 

Pork "toiik 

Porki Fill >nd Imih . - > 
Pork. r(>iwiily *iilt«d 
23 



IdMObhL- 



Uovpf«pu«d. Time. 



Boilvd 



BoUed 



BroUod 
Bailed 

BoUed 
iCouC«d 



Brx>StetI 



t>icaw«tfd 
lluni Iniltvl 
hofi builfd 
Fried 

llOMt«d 

Raw . 
u 

BBk«d! 

Boilad 
« 

Fried . 
BraU«d 
FrW . 



Bf>iL«d 

B4W . 
Rovtod 
8tow«d 
Ro««t«<I 
*t 

Btollcd 

Miuw . 

BolM 



Fried . 



IM 
IM 
»0 
2:W 
2rCJ0 
2:15 
2:30 
IK» 
1:00 
IM 
1:3ft 
2^ 
2;a0 
2:35 
SilB 

ibao 

2:30 
2K» 
2:30 
2:4A 

:njo 

2:15 

2:00 
1:30 

2-00 
1:20 

3:00 
3:30 

3:W 
4:f)0 

3.30 
3i0n 
3:30 
3:00 



2^ 

3:30 



4:00 

0:15 
4:30 



Id Tt&U, 



Uow prepBrcd ! Tim*. 



Boiled 



Boiloi 
Haw . 
BolM 



Bulled 

Bon«d 



Cut fine . . 



UudboUttd 



lUw - 



BoileJ . . 
Raw, «otit« 

u 

M3«Uc»ted 
a 



MuHicflUd . 
En drv |HAoe 



HMtioftMd . ftrSO 



3:16 
S:20 

4-U 

4;« 



4:30 
^20 



e-.30 



d;SO 



fl6 
4;W) 
(J;30 
SrOft 
3:30 



7^45 
'130 

g:U 

9:30 



9:00 





338 



PIET /Jf DISEJSB, 



Mtnm Time of C^j/m^icntvrn (Continuwl), 



ATtkln or <3Jet. 



TVir-k, recenti/ sited 
Purk, rerenily nltftl 
r^trk, JTC'^'tirly *ttJl«d 
Vitrk, n^vnUy wlU!il 
MjIIoH) frvdb - < > 
Mu(U»n.fV«ib . . . 
MiJll4^j,frDih . . • 
Mutlon,f»eh . . . 
Vi^ljwh. . . . 
V«l, rt»h . . . , 
Fowls, domestic > > 
Fowk, domMtlo ' - 

Dui'kH, wiW . . . 
Sirt'i^ beer, fn«Li , . 
Sijol, muLton . ^ ^ 

Buitvr 

Cnttm 

Chfeftf, oM, Htrong 

cm. dlv 



braul 

Kftvip, mnirrow hani* 
Hriupi bvQLH - . . . 

ScHLp. luutlon ' - 
(rn^U torn nnA tx^iu 
C^ii;kii|J Hilljf ■ ' 
(.KMt'f HUUp - . 

KThifuipfV, froih ■ ■ 
'IVniliin - - . , . 

TlMu1<kTI - ^ - . 4 

fVinilag« 

rjirtilik^f* 

]f<tne, hog** folid . 
Bmns^ pod . . . . 
Brau), nhiter Fitflli 
Itn^oij, cora . . . 
Caki*^ vam .... 
Cokv, iiponi^ . ^ . 
Dumpirnjt, ajiple . 
ApplM, lour, ufd 
Af^lai, MOT, iDtllow 
A|lpl«^•«•et, mcllaw 
Parsnip* 



In HLcmuch. 



Bitv prepAred. Tlm«. 



Broiled 
Ban . 
Btcwcd 

Broiled 

II 

Boiled 
Broiled 
TrM . 
Bulled 
Bouted 



Boi1«d 
M«ll«d 



Riiw 



BoUad 



Warmed 
Broiled 
Fried . 
B(^l«d 



BoUtKl 






BolUd 



BoU«d 



JL n. 
4:15 

a:oo 

2:00 
3^15 
3:00 

i.m 

-1:00 

4:30 
4im 
Aim 

Atm 

At^ 
5:30 
4:S0 
3;30 



:i.ao 



4:00 
4:1^ 
3:00 
1;50 
&S0 
3:45 
3:00 
3:80 
2:30 
3;S0 
4:00 
b-M 

^T6 

3:00 



2:^0 
3:a0 
3=15 
A-00 
2:30 

2:50 
2:00 

1:30 

2:30 



Id viHiB, 



Bow propu«d TlmV' 



Giw 






MB0lJt»l«d . 



Enlitv i>ieoe. 
Divid^ . ' 

Maeliciit«d - 
liividixl . 



Entire piece 
Mu^lk'titni ^ 
Entire piece 
Mndlunlod 
DivHipd . . 

Ell lire piece 
En tin- piew* 

Mafilicatcd > 



Broken . . 

Entire pln*e. 
Mutlr&ud - 

Muhvd , , 



K m. 

3:30 

b4A 
3:30 

0:30 



13:00 
10H)0 



13:30 
ia:4J'j 

21:00 

10:00 
li-W 
fl[30 

yo-oo 

*lOrW 
4;3C 



6:1G 



MET tN DJ&EASES OF THE STOMACH, 



^9 



Memm l\mt oj Qa/m^ftOirm (ContioDcd), 



Artlcki of diet. 



Fftmip* 

I^mnj|is ---... 
Oinot, orang» . . . 
Cjumil, urnEiit*' - - - 

I'armt omnjev - . . 
B<Mb 

Tuni&p*, lUt . . . - 
PoUil(irJi^ Iruh . • 
Pouiow, Irwli > . . 
P(rt*tw-N Iriuli - . . 
Folatuwik Irifili - - - 
ULbbaif^, hmd, - . 
Ckbbw "^J^^ viririfRr 

Ckblaipt 

Pv«4'h, invlluw . . . 



IdiuomcIl 


Bow pnpvH]- 


TUae. 




A> m^ 


Bdl(!^ . . 


, , 


Row - . . 


, 


BdW . . 


Srld 


Bdlcd. . 


Z'M 


- 


S:30 


H 


9:30 


Rcwlcd . . 


t30 


Ekiced. . . 


aso 


Ba« . . . 


3:30 


BMW . . . 


2:00 


BdUd. . . 


4^20 



InvUU 



Uov prrFB^nd- 



Enlirv piwc 
Eiilirv pivctL 



MDvhnl 

Muticmted H 

Boikd. . . 
Cutn&tJl . 



TiBft, 



A, M. 

)T:15 



8-30 



\2im 

30:D0 

10:00 

0^ 



"The foregoing table w^aAeoiQpiiU*d from all the experiment 
made upon St. Martin &im^ 1 8*iii, taking the avemgtt mm wch 
as were gencmlly |>erfonned undt^r the natuniUy htiiltiiy coiiili* 
tion of the stomach unci with oniiiiary cxrrri^'." 

Thr iiK^ui tiniw uf urtiiidnl rliy mi ficn tiiKi lmv<? Iwcii tiJw-n 
from ?iich rxpcrimcm^ ai» were gcncrnlly oiodt? witli tJic pure 
gagtric jitioo, or with ^iic'h Jlic^ nfi was too pilightly vitiiited to 
itnpfiir itji uUvmt f^fft^t in any rta^pntial <l<*gT«v, Thry rxhihit 
the average, a« near as pnictieahle. for the (iigrstion of one dnim 
of alimeotanr" mittler in mie oiuice of gaatrie j»iie*\ or in aWit 
that proportion, taking the lengtti of tinu' the food uiu] ^tric 
juice were ht-aUx). Kx<^'pti('!iH, however, miwl be made for Uie 
bone, oil, rream, ami imf' or twn nllittr arlieh'?*, which i^livmify 
mnch slower and with mf>re iHfficitltv than the less miitcfiiLniUd 
aliraents. Seveml experiments where the methods were tin? 
same and the rosalt^ were similitr have heax i>nutted. 

PensEoldt ha^ devisG*] the following table ^vlng tl>e digntLi- 
hility nf fo<xl. He experimeutod on normjJ cu&es, iiohiovhi^ hn 
results hy nieaim of the htomach-tuW, by cl<-ternjiuiiig tlii=^ 
pr<^rr^s of ditrestioQ and Ujo exact time at whidi the stomach 
was entirely empty after i^ting a rerlHin ipmntity of a special 
food. The tab lo* sliowa the [period of time it takes a givea 
quantity of fo<>il u> leave (he !*tomaeh : 

' X>(Kliic4. Ar<h. /. kU%. Mod., IWA, p. WJ^ No. 57. 



^ DIET ly 


DISEASE, ^^^H 


^^^^^^ Om tt tw> hatn: 


IVfp lo/oiir hwn .- ^^1 


^^^^^ lOO-SOO gm. purr vrdicr. 


^0 ;^iit. yniin^ chicltt-n, Ixnlvil. ^^H 


^^^L^^ 230 iTD. ttrboTiDt<Ml wat«r. 


230 ^TiK tuirtti<l^. Iioilwl, ^^H 


^^^^^H W gDL tm, alotiLV 


220-250 gm. pigixini huib^l. ^^H 


^^^^^^1 ^ jUXI gm- coff«Cr aIoti^ 


]0o ^lU- ingeun, fritut- ^^H 
250 Kill' Wr, niw, IkiIW. \nn. ^^M 


^^^^^^1 200 gm. i^ocoo^ plooft. 


^^^^^^1 200 gm. bcor^ 


2p^0 fpn. :»lv»i' feel. Uiilnl. ^^H 


^^^^l^^r 2f)0 ^u- li^ht vinoo, 


^^V 1O0-2UO gm. boiloc] n^ilk. 


160 ^1- hum, mw, ^^H 


^^^^^^ :H}U goL in«At broth, ftlom* 


100 ^1. vm\, varm luirl ctdd, leJiru ^^H 


^^^^^^L 100 gm> t^ipv ^^ 


100 gm. IrvvlHliAk, bnitud, cold or ^^^| 


^^^^^^^^H 


^^^1 


^^^^^^H 3Vf b> fArvir /kruri 


100 gm. b««rMt«»k. nVj m^tnp^rf. ^^H 


^^^^^^^H SOO |f7D. cof]» vrith crouo. 


100 gm- tffTidvrl»in. ^^H 


^^^^^H 200 KID. HHxu with milk. 


200 gm. Hlimt? ivhIuioh, boiled. ^^M 


^^^^^^P 21)0 ijTU- Maliign winv. 


Id gm. oavifirv, Mltv^l, ^^H 


^^^^■^ 200 f^n. ^^Ofner*' wbt 


SOO gm- uLLhlinert in vintigar, kip- ^^^1 


^^V SOO-500 irtu. wat«r. 


|wre<l livrriDg, 1 


^^H :H)0-d(K) gin. k^r. 


150 gm. blat'.khrrad- ' 


^^H aOO-AOO gm. bc'iJfd milk. 


IfiO gm- liftHey liiWid- 


^^^^^^ )C0 gm. c§:gK, raw Jtnd tcmmbled, 
^^^^^^L hiLitl-boUecl or as omelel. 


ISO gm- whw-i brwid. 


100-150 giu. Alburi bixTulti. 


^^^^^^^1 100 gm. be4^f-f4tYU±«^, raw. 
^^^^^^H 250 gm. onlvoj' bniLiu^* iH^tli'd. 


150 ffn. i>pinu\ art vi>u0laU«, 


!r>0 );iii- Lulibnbi, tx-iliiJ. ^^H 


^^^^^H SW gm, caUW thyniu^ bailed. 


^^^^^^H T'2 gm, nj'NUtn, rtk^. 


150 gm. i-Am>ti^ hoiU'il- ^^| 




15i) gnt- iipmncli, b>iU^, ^^H 


150 ^1. ciicuuibvr nkd. ^^H 


^^^V 20O grn, Hlii-lllikli, thiMcd. 


150 gm. r:>di»ih«M, nw. 1 


^^^H 200 gm. cod, bi^ili'd. 
^^^H ISO gm. oiuUMutti-r. ImiIIivL 


IM) gm- A]ipW " 




FburtofiiV hovni 


^^^1 I£0 gm- uiparajn^- ^H^iK^l. 


210 ieiii. pjgeon* brolJed. ^^H 


^^^^B loO gill. pcilnltHvt, UpUcU in ajiIi 


L Z'?0 p^i- ailet of bevf, bn>;l4KL ^H 


^^^H 


2^> ^m. U'cfBWttk, broiled ^^ 


^^^H IfiO gm- munbod i^ttutoeM. 


2d0 gilt- beef tonffu^ RUok«d. y 
100 1,111. fiinokvd beef lU ijlccik 


^^^H 1^ gm, rilt?<4L<d iljrrj icn. 


^^^1 I£0 gni- raw cbvrritH. 


2W gm, bHJv, broilod. 


^^^1 TOgrn. wbilv brvud, i>\i\ or frei^h, 


210 gm. pjirtridge, bmilod. ^^^ 


^^^^B dry 9T witli 


2^ gjii. g'K'ec, uivtikMi^ ^^^H 


^^^1 70 gm. prulzek 


2A0 ^i). diii;k, broil&il- ^H 


^^H TO gLiL iwi<?bA<'k, frv^h ur aUle, 


200 ^. hcrrinp, «ftll*d, ^^M 


^^^^1 drv (kr wjlh lea. 


150 f;m. lontibt, iiiiiblii<(L 1 


^^H 60 gm- Albert bi»cuil& 


200 gm. |iWH a* purine, 


^^M 


laO gni- ftlrin^bcftns. 


^^H PenaoMt hns aW *>oiistnict*^ n wtifs of fmir flict-]iM» bn^ 


^^H ou tfae tpDglh of time at which ' 


h'arious foodf; le4tvo th<^ stoicncK, ^^h 


^^H depending u|>on their mi>Ic of 


prepurulion and on other qituli-* ^^M 


^^H tie^ of the foo*\. Thi-y n^frvr ^^^ 


in the muin with Leube*« diet* ^^| 


^^H lists, but arc more complete and vxugU ^^M 



J>1ET ly DISEASBS OF TUB UTOMACS. 



341 



PENZOLDT'S DIET-U6TS. 
DU J. (about ftn Ihg*]. 






Com^ milk . 



{Lfubis Koeii- 
UacntU) , . 






I9t2 



Ifr^MIB. 



^i»*f- 



Uethod of 



Prom beef. 



IMOliL 



How to b» eamL 



without Dii. ot^Lovlj. 
not vhTtpiV ' 
Well bolliN] orEnilr* milk 
I «ivTlll»d, I liinvwiLttr 

hvfll«d or mw. 



S'i 



lor tr dddTvl. vlUi s 



Ifi&kvn r«T, «hDul4 
be atirred Into th« 
warm, iu>L boUli^i 
mcAtcroih. 

In (dAoannjI 4vmm, 
Almdin BMMl 
btotb. 



DMti brviD 

odor. 



Or4lii«ry wALcr >Jot too «*Ad. 

or iLftiunl cAr- 

boDAltd wai*r 
Vilta > iDUll 

GrMnUfo or 



PiBMn ..... 

Cbl«k«b - - . - 
lUfTbMf. - . - 

IUwtWVf'«AOlUflV 

TaplocA ' - 



i04ncd7 

100 flD- 



"BSIfil — 



7tn i^y«). 



Bolltd. 

IWtlad, 



BoIloiL 

C^op(iAi1 flu* Dt 

«f r«i>oil, wUh h 

tltlld kmH, 
Wltbciiil *ny ftO- 

<1iyona. 
Bollnl wlOi uUh 

tn mftkff Tart. 



pYtcd fruai nil 
iiipii)liruiu'>- 

Pfi.-O fti.rii iiJl 
tlii'lnSrflni^ 

Mlth^tll tlkln, 

tondon* anil 

IliU llk(i- 
AitJibnirB (ho f«i- 

Uiii>d i-lilrknn i 
l^rom the undi^r- 

RinokMnllUlS, 



Duiiftkn ill m^M 

\u MtUiki-n In mntt 
Hail lKkp» In mHbt 



Kfltt tak«ii In mojit 

broth. 
To b» eAtra with 

MkC*. 

To b» o«ton wltb 





Diet lit. iabfnU Mght l>n^»\ 




ngcon . . 
CbUktB . . . ^ 
eevikvtk , , , 


\ 

1 

100 cm. 

100 ID. 


BfOlIod Willi 

rroih bitti^r^ 

Bruiled wllh 
rmh biJlUir 

WltbrTtvht>ui(ci 

flue. 


Duly yJiiiitf MfO, 

»k|ii, pic. 
Onl> r"iiiU Flint. 

■kin, ■■U', 
fnim ifttf thnder- 
loJi»< wHI 

ftmoki'fl u 11 11] ft, 
wlUiuut Llitr 

Bull- ri<MAncii 

r>It», >ilr-f- 

TllO iHpUlltHt 
ft^iuuld Lid 

erumbU on 

oruflhiaii 

t**e avdy ibo 


WkhoUEifrftTf. 

WUboiil|Eniirj 
WUhwblMhrefld, 


Milk bri^l.fHlo' 
tiiir-k. or Frti^ 
lpT:ne4--r pfttKln 

rouilooi . , . . 


SOfm. 


Crl*|KK], b&knL 

b^lk-1 Iei tail 
WttlOT ATld 

lUAahvil^ 


Tu bu i-mvfulljr mii^ 
lUfcUtiUod- 


Cttutiaowor , . 


fiOcu. 


A« ■ VHCUUO 

boIlHTin lull 





MS 



I^mT IN DISEASE, 





/K^f /K (d^ou/ £iy&/ to /buff««n i^^). 


Food or drink, 


L«r|H«t 
qDanilir to 

cjae lime. 


xithod fir 

prcptntLoo. 


0p«olal nqulrt- 
mrnU. 


How to be caton^ 


V«qUoc .... 


100 gn. 


Bauit«4- 






rttnrldf«. . - . 


1 


AoulvJl wlthoul 


«ttliOUl,lblTU. 








bacon. 










HodonPt Lv0«» 










«I0.. >hiiul<l 










luinflftirit 










IJruv. 




Bowl bMf - ^ ^ 


IWgn. 


UedJan lo r^r* 


blincfr-Htllki; 
bpACtn 


Warmor eoliL 


Fllieturboer. . 


100 gra. 


tf edlum M nre^ 


Prom food* 
fill rod rjitik: 
btwluii. 


Warn or cold. 










VuL . . . 


. , , . , , 


RfdaLnl. 


Biiirk or tfl^. 


Wjtrni nr old. 


I'lk* r 

Trnut . . I 




DOlJcdlDMU 


All Alb boaei 




100 lOL 


anj abdltlon* 


■hauld tiv o&rp- 


■InlbBflahgnvj, 


UaYl«n? , . . 


AOpn, 


Raw. 


mtffbthrMll, 

KUBSian 
Qarlir«. 




Blcc 


M^m. 


Viubed. pushed 
ilirvmitEi • 
•ice. 






AtfpirKffUH > ■ , 


Wun- 


^ftiUtthotif Hny 


Wtih n intio malted 








cr the bunt 
paru. 


butter, 


BcrAmbJcd cRXi 


i 


With A link 








trviii biiiicr 










&nd tflU 






ooiffici jnoanic} 


3 


KUi [if lUnar 


Miiti hAVt rLum 


To be oaton ac oace. 


Fruit Hugo. - . 


Mtfrn. 


boi]cd fruit lo 


Fri'p rrom bLI 








tw Eirnlrii.'il , pvcl 








thruugli D 










fllv'fl, 






Bed vrLdc - , . - 


Iffigm. 


Uebl. purv Bor- 
OgiBU x> 


Or Bomc corrv- 


tiUfflitly warm. 






•KPOiJtatf klud 
rf red wine. 





Tliese tJibles of Penxoldt arc vulujiblc as u bu^id for the selec- 
Wori of fw>d ill gu=«inc distiirUinpes, In tliese cnaes It U ini- 
portiint that the footl lie quickly flissolve*! in tKe gwetric secre- 
tion, that it lie readily ahworhrMi, that it W neitlicr formontwl 
nor t!pr^Tii|M>sed u'hilp lM?iiig iligpjitp-i nr absorbed, nnd that lli© 
entire process be attended with do discomrort. It miist be 
borne ill miiul tliot the dig^tibility of food varies widely with 
the iDdividiial Inste, fjr no mutter how iligr^tible a fwd may 
bCf if it is unpalatiibU', it will not be df^lwl pniperly, lu 
geneml it mny be saul : First — that in acuce i-onditions the 
food should be of such ii cbamrler thut the 'Stomach shtKild l;e 
Bpured rt* m»oh work as poe^ibJe -, seoond — tn rhnmie disturlv- 
ano&5 it U imftorUint to i^iipply suflidcnt x^tinatitles of noitnsh- 
EDCnt in an eanily dtgestibU form, «o as to maintain \hv bfuly- 



DIET IN IilSBA.<{F^ OF THE STOMACH, 



949 



wcJglit fto fur ai* pof^ihlc. Id i)i<t«rmmiiig tW quantity of fiHxl 
that » necefttary during tweniy-four hour^ the amount is i^ti* 
roaled in calorics of h«at. Aa ia wotl knovn, a hmuan being 
at rtftt reijuireM ^*5 caluritrs |)er kilo of weight, whe^nsis while 
he U performing Hglit wwrk In.- r«jiiirT» 40 culuHe^. lu order, 
therefore, to dt'lormiDO t\ic cnwi amount of uourimlLmcnt it 1* 
only nowftaory to know the weight of the individual. Ina»- 
much na the proteinA can Ix.^ n-|iIa<?<Hl In n im^axum hy th<r car- 
bohydrates and fatu, an int^rcbivti^ of anv of th<ve thii^e food 
elements can be made aooording to tlie patient's condition. 
The following tabW, taken from Konig,^ give the comj>ositioD 
of diflerent tbods and the number of heat uuitii they produce. 
Wben the weight of the person Ik knonii, it h an eftKV matter 
to detemiiiie whether the amount of nounBlimoiit givco i^ aufii- 
4;iODt to mainUiin the body-weight. 

It is well too to weigh every patient &(i1Tonng with a ^tomaoJi 
disorder when trvatment in fivt^t inaugurated, and to repeat this 
fivjm time to time in order to deferniiDe whether the patient la 
gaining or lo^inj; Qe&K 

The diet must be considered from the standpoint of the ga^ 
trie ftecrotion ; there maiy exist, on the one hand^ the eondition 
of hyperchlorhydria ami hypersecretion ; on the other, Lypo- 
ottorbydria and aiiaciJit/. 

In caAeA of hy|>erchlDrliydria an abundant protein diet it> 
indtoatod, inasmuch as the exoces of hydrochlorio acid is neu- 
tralized by this olajM of foods. On the other hand, a» Rieg^l 
poinU out, oertaio caaes of hy|>erchlorhydria at times do better 
upon milk, bread, and amylaceous foixls than on protein foods. 
Ordinarily the proteins that are best adapted for patictts 
suffering from hyperchlorhydria are the red meats anil eggi^L, 
whereas the carbohydrates must be given in tlie moet cosily 
digei^tible form. 

In eaace of hyjKM^hlorhydria there h a diminution nf the 
gastric scerction ; coiJscqnci»tly the protein foods arc dtgc»t»] 
with diffioidly, wbereaH the o«pb*>hydrttl^ nre more easily 
di^ste<i. Ill this condition, therefore, only very tender mearis, 
preferably scraped, are to be given, whereas such wwily dig<.'St-- 
ible vegetables as spinaehf aHpura|i;uF>, mu»bLHl potatooj?^, and 
furinaeeouA foods may be eaten tn qtiitv lar^- (|uantiti<^. In 
b<'th h^'porchlorhydriji and hypocblorhydria a ren^unable 
amount of fat muet be estcn, prvferuhly lu the form of good 
butt4T. 

» Die inataeMhdum litifirvnyf u»d GmvMMmiUfl, BcrUa, I98S, p. M, 



' 



I 




344 



DIET TK DISEASE. 



coMpoemoN of the mobt common food tmBSTAMCm 

Z Dairy FnydwU. 



Con^ raHk 
Cr«*m . ' 
Butler - . 
Wbe7 . 
Buttumnk 



Kumin (of c«w&' 

CbeoM (crmm) 

Chwe , . . , . 
E« . 



Pn>i«JD. 




B«if (fit) .... 
BwfnainJ . . 
Vt-Hl (rut). . . 

V<:>il (Inn) . - - 

HuiCon (TO7 Uk) 
Halton (lewnr) . 

Pork (fat) . . . 
i'ork ieftH) . . . 

Hum {Wcatphatiftn) 

PalveHvcd fo*nl 
poultry . . 
Spfins ohickon 

Duck (wUd) ■ 
fiqiub _ , . 

G>IM. ■ - . 

Hm 

Vculwin. . . . 



Pllu 



fibeU 
SaJmon - ■ . 

OyvEm . . . 



Sua . . 

Kyt? Hour . . . 
whvaUn hnmd 



Z.d^ 



^.00 
13.60 



Fftt, 



ArflikA 
3.0(^3.80 

KP.00 
0.30 
1,30 



MT 



30.00 
12.00 



17.19 
S0J8 
18.88 
10.64 
l-kSO 
17.11 
14.M 
20.25 
2S,97 
2100 
6450 
2100 
18,49 
2166 
2114 
23,00 
23.54 
1S.7T 



IH.&0 
S0.61 
17.09 

moi 

lf».50 

'2K.01 



20.38 
I.AO 
7.41 
0.83 

36.39 
5.77 

37.34 
6.81 

36.43 

0,10 

1.00 

3,11 

1.00 
LOO 

MS 

i.n 
m. Fith. 

QM 

1.0& 
0.34 
6.42 
121 
0.57 
IT.OO 
Ifi-i'fl 



Qulinljydniln, 



3.70 
3,ft3 

o.rifl 
3.60 
3.00 
0.70 
kdicidd 
1.90 
doobol 

aso 

3.00 

5.0U 
0.50 



77. JVfqU and OtoM^ 



IV. (JermU an^ Vfi^tahU^ 



0^ 

3.G0 

10.DO 



Trace 

2.O0 
0-7S 



0.7fi 



2.B6 
0.4C 

aw" 
7.fta 



8a.5€ 
73.00 
69.00 
5100 



6400 
276,01 
837 OO 

3.C7 



S199 



394.00 
!i40,00 
]0o,00 



> > ■ 


310.81 


_ , 


09.U 


ao7 


146.61 


, ^ . 


fttt.97 


0.05 


399.31 


1 . - 


120.81 


' ■ 


40<V<e8 


^ , 


146.30 


IM 


4^.6y 


. . .. 


il3.»2 


2.^ 


322.S3 


. . . 


10(UK» 


1.20 


lfl7.W 


laa 


131.30 


0.7* 


](K),(»7 




103.flO 


0.1fl 


107.08 


1.42 


106.44 



83.67 
94.04 
1541.93 
I3l'.9;i 
113.B3 
34.1J0 



356.70 

345.78 
342.50 
345.00 



DIB7 ly DI&RASES OF THE STOMACH. 



346 



9 


OrmJf nmf Vt^tsAAf (Ovt 


inued). 






rnrtda. 


7M. 


CUt>gb)rafUM. 


QUfirlCL 


Boll ' 

tiuliiloWBT , - . - 

P<M 

SpinBdi 

l^^tW 


4.60 

oaa 

SXKM.O0 

1,04 

2L0O 

&,50 
10.60 
10.M 

1^ 
llfiO 

aai 
a.4v 

1-02 


1,00 

an 

1.00 
0.40 
0.21 
0,»0 
],50 
2.00 
2.00 

bsk 

0.81 

0.58 
0,00 


4&00 
4a.T3 

7aoo 

4.0O 

0.74 

2.50 

76.00 

«$.0O 

M.OO 

20,00 

66,77 

75.19 

4.44 

0.96 


210.00 
21S.37 

39.00 

3^.80 

21X0 

34110 

311.75 

319.00 

83.00 

$31dO 

32,1.00 

38.00 



K &nip« flnrf Baiangt^ 



iritb 



Mitk Boup. 
wheat llour 
Mfflt brotb 

OftTTi . . . 

Mwt-juioe (prened 
BecflcB 



(ordi- 



tloii 

Mftlititmct. ^ - 

Biirlcj *mip . . 
Rloe jukp, irith milk 
Cbflbe. ..,.., 

T« 

Bw 

PofteT 



&.00 

0.40 
6.00-7.00 

0.^ 

0.00-11.00 

protdn 

4 lJO-4.60 

peplDfie 

&OD-iaoo 

\.m 

8.80 

3.U 
\2M 
0.50 

0,70 



3ji6 

0.60 
0.50 
0.50 



1.00 

aeo 

0.13 

6.35 
6,00 



15.00 



J^OO 
11.00 

28.60 



0.30 
<L30 



UlOO 



258,30 

60.06 

182.61 



lOO 



VL FrvitA 





FMft4CSd. 


FrolcizL. 


IIU. 


OlftiO- 




ItreenL 


Perftnt. 


JWrml. 


FtTfmi. 




0.62 


0.36 


. n . 


i:n 


Pouv. . . 








0.30 


0.36 


- . - 


3.54 


Planii . . 








1.fiO 


0.40 


. , - 


4.68 


PflLO-hrH. . 








a93 


0.00 




7.17 


OmjMs , , 








ars 


0.59 




1-Ofl 


Simwbcrncft 








0.93 


0.64 


0.43 


1.01 


Cb»(nuia . 








I * • 


3.48 


1.37 


nM 


Su^rouw 








. . . 




. . • 


3.40 




' - - 


LSO 


- 


&28 




Me 



PIET tS DISEASE. 



The following diet-IUu, de^ieted by von Noordon/ iiidusttc 

how an easily digestible diet, contaiaiog a Miffick^ot mimbtr 

of colurioA df beat to niamtatn tbe body-weight, c^aii l>e pre- 
pared: 



/ A PtinripQliy MUk Diet wi/h Adiiiti&ru t^f Cari/ohifdraU^ in 
lAquid I'hrm, 



MUk,!7{X)o,o, 

Soup of lapincn floui 30 gco. and 10 

8ouT>of 41) ^m. whetttdoitr. viUuvmut^ 
of the nuitk, 10 gai. mg^r, juid 1 
*«« 

Toi*l 



PraUla. 



10. 



7,0 



H7S 



if%t. 



aA.3 



BA 



71.8 



hi^^u^J ^^"-i- 



flfl-T 
30-0 



40.0 



139.7 



1»5 
244 



1703 



it Ptindpaily Afiik Did ipith thf JcUMon ^ Otrbohtjdraia end Fat 
in ftip /bm md ifibi^. 





PioMOa. 


At. 


Cubo- 
hrdntei. 


Caloric*. 


Millc IfiOOtLc 


17 
7 


sa.6 

6.5 


90 


lOAfl 


Soupoi 15 ictu. n^i 10 ^. butter, 
INipoTHO gni. cftni floiir, 1 egg, 10 


257 
396 




86 


77,5 


166 


1711 



in, iTiVi DiH vrith AddUi&n of LifffU P^hy and Broth*. 



Mil)c, 1250 OA 

Mrvi tiivlb wilL 1 egtci ^^ {("■' '^' 
tiult«r: GO xa%. of fineloiuira whrat 
broil - 

CBk»,70KnL-, biitti^fT 16 m. , - . 

Soup of 3D jcm. Upifxn nuuTt L C0E, 
10 ^m. butter 

Tolal - 



Pn»db. 



51 



10 
5 



7» 



Y^. 



49 



H 
IS 



«9 






53 



30 
60 



30 



163 



C^Ioflea. 



873 



337 
20£ 



1791 



' 10^1. AlbimH>Hi?:imconUun^ jn 9D c(M>f Dennjtr'* pvptoiie prejiantitxi, 
in 22 gin. uf KMiimaifricli'is ur in ^0 gta. of KocbV 



DIET IN DISEASES OF THE STOMACH. 



347 



iV, MUk wUh TVticfar Jfel, FUrur, B^ter, and Soup*. 



Spring chldMfl, 100 gn- h . 

Tv*t r/ac* ■ ' 

Tij^Mtil wUvt^x hread, 100 gm. 

BulU^r, :W Ilia 

l>out, too Km. 

M)lk,12Mcc 

r«ui 



FnMtn> 



19.9 
2-0 

\4A 
7J) 

19^3 
5tJ> 



113J) 



TVU 



4.0 
U-0 
0.6 

2.1 
49.0 



S2.4 



h^E&H""-- 



Prrocnf, 
30 
65 

A2 



27 



106.4 
127.4 

\mi 

213,9 

ioa.4 

ST8,0 



isaLo 



r, RicA, AJrf IrtiUUtHg l>ui 



Tender moiii^ ^fiO gm. - 

Civ«, 20gm. 

Thfvceffgs 

100 gm, «wi«b«ck - . 
100 gm, whdHt hrnul . , 

5d gm.. cak« . . , . > 
60 g»n- biittftr . , . . - 
40 ^m. Upjm^ flnur . . 
4') gm- c(>rTk Hour • . . 
20 gUL. *iini' . , , > , 
12M)<ic.injLli 



Ibttl 144 12S.8 3S( 



hotcln. 



49 
4 

Xl 
8 

7 
4 



51 



a,o 

15.0 

1.0 

ojs 

2.3 
44^ 



49,0 



' a 

75 

35 

40 

40 

20 
62 



ralarlAJi. 



9M 
100 

1ST 
407 

134 

3Z 

878 



S747 



The diet in motor (li:^tiirbuao(» of tlic titoruach, a^i in atuny 
or in dilafattotif ilt^^pouds j^rvitTly t)j>oit whetber an exciws or t% 
deficieDcy of gastric juice la *ocrct*^l ; if tliere ia an iTi<*n*aptep 
an ex<.*cw* in protein OmmJ ^ives tbe best n^iitte ; if, qu the oIIipt 
hand, there is ft diininiiliftu of tliir* secretion, pn>tein food miwt 
be giveti tilt* [laticul. in tie must easily digratible fomi^-^,^^., 
as t^e albiimosca and peptones. The cjirbohrdrntitt &.ud the 
lighU^r vcgctnblce may b<» given in eooiowhat lar^^r propor- 
tion. Til both ronditineift th^ ingestion of fluids should be 
reduoe<l nf^ fiir aa jHwfiibl^p 

Normally the appetite is a feir indication of the number of 
calories of heat tluit may be required ; Id <^vndition^ of ^strio 
disorder, however, this is not the ca^; these patients lose their 
appolitc, a[]d eonst^uenUy ofloii take ioHutlideut DUtrition. Id 

■ Mmt of variouR kindi, finclj chnppod, twm or f>i«l in biJtL«ir; cold or 
vmnn, taken ai mcnln. 



34S 



DIET IN DISEASE. 



tliUMC In^tanci^ ill whmfa iU^ ^atttrie dimjnier w ftii\nr.v/\mt jiro* 
tTBcU«l ftDil a«x>mprtnied by great lose of weiglit, am! in nbich 
the patu>nt tako? tpciu£[iciciit Douriebiucnt, it iioc<] culy be 
borac in mird thut bikIx u pntlent, resting qui<'tly in Uh], 
TMliiireg only about one-sixth of tlm number of calorioii nwft*- 
$BTy for a [lutieut wbo is uot n.'j^ting. Thi.4 plan may, there- 
jbre, be ust^I with ;tdvuiiUi|;t> in the tn^tnient of many patients 
fiuffering from dLnordcrs of tbcatomacb. 

Uqu>id Foods in (Stuttric IHtiorderx. — In those cases in which 
it is nececHary to q»re ibe stonmcb as much work as possible 
milk ih the food that i*» usually miwl tmsiJy borne, lu (trdcr 
to aupply a siiffic^ient Dumber of oaloriu? it iiiList be taken iu 
Ijlt^ ([uautities, frequently diluted v-ilb limt^-watvr or barley- 
water in order To add to its digestibility, or flavored with 
oofFee, tea, or <*oooa to lend viiriety and a<ld to its jialatabitity. 
In those cases in which milk is not well borne buttermilk, 
whey, kumiss^ and kelir may serve afl subfltitutes. Among the 
other forma of fluids that may be given are broths (chicken, 
beef, mutton), bouillon, lieef-tea, and meal-juice Of tbew, 
meat-juiw ih most nutiiUouH. 

(irl<di/ioiui F^rttvi vf Food. — QelatinoQH articles of food, aa 
j^latin, ciitve»' fcct^ cto., are easily digested and readily ab- 
woHw). 

Mrtii^. — The digestibility of nieflt ean be intircased by ciio})* 
pin(?, bcatintr, grindinj;, Bcrapiri|j:. etc, 

Er^tjti. — Tbe digestihilily of eggs depends ii|m*ei tbeir mode of 
prepiiration ; raw and son-boiled eggs are usually the moat 
easily digestible formK 

Fii<h. — In rep:3ird to fish, those eontaining but little fat are to 
be reaiDjmeudetl fitr jMLtieoti^ siifTering from gTt^trie disturbanoes, 
Buoh \is ^cllfish, pike, tn»ut, c^rp, nnd halibut. 

Ocirhofti/draiat. — Tho numlicr of vegetahlee from which eeJeO' 
tioa may be made is lurge. The secretions from the month and 
intestines play an injportnnt role in tbe digestion of these ftuh- 
FlaT»c*s. Tliey should l>e miislicatetl thoroughly. In those 
CftSfs itj which then* i* danger of fermejilation tbey should be 
given with caution. The bo^it form in which to give amylaceous 
food is in the form of nviebaek, t<iast» stale wheat bread, tapioca 
fiour, (Jataieal, etc Kb^teiii ban highly rwumnieudL^I aleuronat 
flour, which conlnin!^ about 80 per c«it of protein. 

Lftptjnintnts fooda (xtnlain a oonBidorable amount of protein, 
mueb of wlnL^h, however^ is not el>sorbed. They are apt to (five 
rise to considerable fermentation. Potatoes are best given mashed 



DIET IS DISEASRS OF TIIR STOMACH, 



M^ 



Oibbugi; OKI tain» much cvlluloM^vid should beomilt«d 
fn>m the <\\ct tit aII |mlicntA nuffrrini^ frnm st<>miicli <ii4ord«.-f>>. 

yruiff nrr of rtlight nutritK'c voluc^ but give a rclLsli lo other 
CmiIh anH inonvjto inU»tinul ppruttaJiiiH. 

the wri^lil of iho patient, am) alao bocuti'w? uf ite high calorie 
Taluc. Borne ohwrv^^r* olaini, liowcver^ tlut it act-s as au 
irritant u> the i^t'>ruuuh. it i» true tli»t niiuiy |MUcat4 find that 
&t m<al, K'^^J" j^raviea^ et^j., givo riw to iiidi^tiou &Dd often 
10 nausea and vntiiiting. MiutIl il(*|ioru]Hf howt-vtr, on tlir mode 
af prepamluiii. A ix»nHJdt-nLl)lr uinoutit of Git may- lx< given m 
ifae mm of frcsth butter ^pr^u) on wbcnt bnrjid or tncMt. Cer- 
tain fiMTOA of chocoluto fWRtaiti quit4-n Uir^ [K*r(^ritup> of ikt, 
and on tJiU nncviiiiit uri' v<*ry rntnlum*, <>f diiwi^, Mf^hnng'n 
Vigor CiwN*olate ij* lo lie cviK'c^ially p«?ommcnd<HL Olive oil 
baa recently been nx^wiimended in the treatment of tvrtaiu 
gastric diw*Klers (wt |». 108)< 

Concerning thi^ relative digpHtlbility and ntitrilive \'aluo o{ 
vaiiouA lujuid and iiolid foodn, the n:«der ift referrefl t'^) llie boo 
lunj ili-yliii^ with thi?* T'lilijjH't,. 

Special Factors bcariug on the Diet in Patients 
Suffering: &oni Gastric Disturbances. — I- Von Noonlcn' 

demorLHtmt'vl thf* fnot lb:*t tlip in(*'34lini> will vir^-rinu-ily |wrfonn 
the work of tl](? HtoniHnh in rnnilllioiiK in wliit^h tbo *^vrpU*ry 
fiiDcttoD of i\w lutler \i^ I*wl. TIniB. a;* hm lx*eii gbown by Ewald, 
Leabe, ttud otfitTB, in hlkt^ of atrophy lif the j^i^trio mucouA 
membniDc in which Ow^re is no Inng<T any gastric secretion tha 

Silicnt may nmlMtniii h'lH weight, for thi> intestine ossiiiuw i\m 
gfti«tive fiiiK'iion normally caniixl on by tbe J»t4>miioh. Hlin* 
born" h(U!t likcwlM- dciuoiiMruK'*) thin fact in ivLtm uf iLchylia 
gn^tnca. The |Hiint to he borne In niiad la that <:vca in <»m3i 
in whit?h the secretory miction of the ntomach w Wt ontircly, tho 
intestine mny ns^nme this funrrtion rtf tlir Atomnch, 

2. In those cfliH^fl in wliieh it i* nfiee^tHary lo sjwre the fttoni- 
peh, nA when i^x*d van not Ix' difjCKtin! or is vomiKnl, eitlier pre- 
diget^ed ff>ods may be ntitij^ or foodn may be administered 
through channel A other tJinn the Atomach. Among tbe artificial 
predige^l^d preparations are fbc^ albiimom?s and peptones^ Den- 
aytjf^M Albuuiose-peptoiK-^ t^nial<tF«trp Nutix)H.\ and Mo^queni 
Beef Meal. For tbe various methods of feediDg, tbe reader 19 
roftrrod to tbe aeotknu on Reotal Feeding, Subeutaneona Feed- 
ing, etc. 




3£0 



LtET IN DISBASS, 



3. The foUow'iiig rules for eating should be carried out : 
((t) FockI •dioulil beihoroiighty Duir^tiuited ; tJiU is especially im- 
porlaiit lu thu»<e oom^h iu wLich tbcre are mtirkL-d ^Atrlc tlihlurb- 
Buccd, Biermtoki' and the authors^ has'e nbowa the impor- 
tance of the efTeot of the salivarv digestion i)|x>]i tbi> j^btrio 
(leffretinn in i«» far that an alienee of i^alivarv necretiou not 
only rasiillii iu an absence of amylolyflis, but that the prole- 
©lyfiifl ifl inuob retarded, 

(6) The meals should be taken at regular intervale and in 
m<Hlerate qiutntitief^, according; to the nature of the gastric di&- 
4^8e ; this rule must be varied uuder certain conditions ; t. </., 
timall freijuenl Dieals ^Ikould be taken iu utony, whereas uudcr 
other uoiiditioDs, such a8 bypercblorhydiin, somewhat larf^r 
meolfl ahculd be given but threw time8 daily. 

(0) The tempenitnre of rhc* frwKl is aW» an iin|t»rtant factor 
in the treatment of gastric disturbances; as TJffelmanr has pointed 
€Ut, the food ahould be taken at a temperature between !*8** and 
100^ F, The ingerrtion of very hot food is l)elievetl k) be a 
frequent cause uf ulcer of the stoniacb. On the other hand, 
\V*>gclc attributes the dyj^pcp^ia of many AiucricjiTis to tlie 
taking of tco-cold wut4-r and other drinks. 

{(!) The question of rest or exercise aHer eating is one ibat 
)F( of eonaidorable importanoe to those j^ufft^ring from guatric dis- 
turbanc-eK It is generally admitted that violent exer(.<ise should 
not be indulged in after eating- According Ut Sehule,* [latlentK 
suffering from superacidity should not sleep after eating. From 
experiments not aa yet published the authors have determined : 

(1) Under normal condilion^ the secretory as ivell as the 
motor functions of the st"m;tch an.' not iuterfered with during 
re*l ; during sleep at\era niral, however, the secretory function 
remain?^ normid, but (he moU>r fuuction is slightly diJ^turbed* 

(2) In casea of hy perch lorhydrijv with uornLal motor function 
th^ au'idity \s reduced and the motor function remains normal 
while noting, wbereviv^ (luring kileep the acidity remains about 
the Hume and the motor function ia impaired. 

(3) In conditiom^ of hy perch lorhydr la witli motor insuffi- 
cicrey the ucidity U lei*»enc<l and the molor function impaired 
during TV»tj w\\t:TVHJ* during pUrp the acidity is still further de- 
creased and the motor function Mill further impaired. 

(4) In oondiii(ui>; of liy|M>chhirhydria with normal motor 

' Jntemational Atedieal Magtaiw^ AilgUSU 1896. 



D/ET /iV DISEASE:/ OF TUB STOMACH. 



3«1 



activity the ucidiEy t^pcnis to bo tDcrea^^ and the motor function 
reuuunjt nitrnuLl iltirinfr n^st, whcrcu^ during »\^p the aeklity i;* 
iucnmwd imd the mut^>r rtjnctiun i» dt^^turbeO, 

(o) In condition:* of liypichlorhydria vritli dimiubJied aiuUn* 
ftcftivity tho noicLity ^scftnn i** Ix? incrtTww<i and the iuot<*i" funo- 
ti^ni im|irtiviHl during r^Wnl, whpr«w diirin}^ sloep the uddity re- 
nuuD« ttbout the «Ltne and the moU>r fuoction is int^^rferM) with. 

Vnm\ ihcrfc obstTVAtJuus it uppeartr that in oonditicnit of ga**- 
trio di^liirljuiKLv ut.'f.'ompdiLied by hy perch lor by dria and Iiypo- 
chlorhydrin iind in nUflor diKiurluim-i'^ of tie ntomaoh tlie 
guhtrii^ <iigi'.-<tii^n }» improved duriug reet, bat impaired by fletp, 
aAer uimlH. 

SPECIAL CURES IN THE TREATMENT OF THE DISEASES OF 
THE STOMACH. 

Among the special foniib of trL^lntcait n^i>inmi>iulctl in gn^ 
trie dbttirliances may l>c mentioned die rt*»t oiiiv, tlicinilk curc^ 
the grape cure, and forced feediii); or jjHvagi* 

The rest ctire, fir.st deviM^ by Weir MitJ^lu-ll luid »ulw*^- 
quently e^[)ceial[y deveJo[MKl by Knrkliart, in (ierinnny^ for the 
trfatment of gaj'iric conditions^ ]ilA>n nn im]w»n4iiit rAb in the 
tnnMticikt <hf jitomuch diwnlcn*. Thii* tniitmont !» <vpixially 
u:«cfnl in ciutc^ of natmj^thonia with severe miorc-xui fltid emaci- 
iitinn. Ii lA aIm) iiiwfiil in tho tn^ntment of iil<x^r^ gnetritis, 
Htony, fltid gii*t.nip(<>«in, 

Tlic n^t tn'UtincDt in gnstric diH^rdeo^ should be carried out 
for from six to eti^ht wwks. Tho n%iill8 that follow this plan of 
trcafnicrt ;m' ciften iniirvflbjue. Fnr a further c^onwi tie ration of 
the lEclbLKi and plan i.if i^nductiiig the rest treatment tfyttemat- 
ically th? reader is referred to the Hcction ilealinfr with thit^ subject. 

The Milk Cure, — The nmlerlying prineiple of tlie milk 
cure oonnijiU in the ingestion (»f Jrirge (|imiiti[i(^ of milk, either 
alone or together with otlirr fiMMlrt- TTrnler normnl oc^iKtin'ond, 
wkf-n Ijikeo alono in larg^ qLuuititie>i, — eay, three liters a day, — 
milk doeA not wiffioe a^ a food; in certain digrstivo di^^tnrh- 
anoes, however, milk given uJone for a time forms a iisi.-ft]l food 
and allows the stomach to n^in tU normal rune and Inactions. 
Milk is especially ti«iTnl in the ttiMilment of iibvruf the Mom- 
ucb and in oertfiin formi<of chroni<< ^Htritis ; it i> {Kbrtienlarly 
u^jM.^ful in ihe secondary form?* of gsuHtritiSj aa OjfH* depending 
iijion tnl>cn'uh>Mi?", anvmia^ viv, la mhiw i'um^ nf m-rv^niJ^ dys- 
pepsia milk <mrert .HfmH-tlniesi effect rejxiarkjiblt? rvvultH, wh*r«a 
in others milk dit^roe^ nad^ a» « eonsequent^, the milk euro 




DIET JN DtSh'ASK 



ain not be und^rUken. When there is a diminution or an ab- 
sence of ncul in the ^tomac^h, millc ia usually not well borne. 
It lA ulso GoutruinJiGitul iu severe cas&i of atoo)' and of dilata- 
tion, ID iDtcstJnol cooditioDA ae€oaipaDi«<d hy extreme; flatulence 
and chronic diarrlicon* 

Wlipn milk 18 i^iv^n in lar^ qnantiHoa in addition to other 
foods, it is more frequently better borne and in h'iw apt in dis- 
sgree. One of tte disudvantages of tJie milk cure in the obfiti- 
nute GODSli|Mition the milk is apt to induce. Milk oan often be 
renderwl inort diger*tihle by the addition of barloy-wat«r, 
linie-wat^r, uiilk of laaguesia^ aud the like, or email quantities 
of coffee, tcdp or whi<^ky may t>e added to it, When milk dJa* 
agrct-ti, ci^^aiu, buttcruulk, kelir, kumisH, or matsoon niuy be given 
m a substitute for it* (Sec Milk Cure-) 

Forced Feeding or Garage. — This method wa* first 
intTodiK^^l by Debove, and cnn«is(A in introducing milk, eggSj 
and mc^ut-extracts into the stomach by means of the stomach- 
tube. It is especially u^^ful in nervous anoreAia, in wliicb cases 
there is great danger of starvation from lack of nourishment. 

The Grape Core- — In this Ibrm of trcjitment the patient 
live* exclusively upon pnipt*»; it is cupceiully u^dnl in jttethoHc 
individuals, iu whom it l* important to diminish the weight; 
111 chlorotic girlh sutferiug with dyspepsia, aud in certain cax^ 
of Dcrvoua dyspop»izi. 

DIET IN DYSPHAGIA. 
Dysphn^a may be due to any obstruction in the mouth, 
pharynx^ or cm>phjij:urt. The difficulty and pain induced by 
ewallowing must Ih^ obviated by lessening the efforts at deglu- 
tition as much aH poHflible ; tor this rea^n food must be given 
in a conoentratw] fonn, and only in a liquid or semisolid i^tJitc ; 
milk, efz^^lbumiii, and the t^uceiitmtwl liquid Ixt^f pn-|iurw- 
ti«ii3 are es|H.^ia]ly uneful in thid condition. In those cn^cn in 
which food van not he swallowed in eufHoient quantities the 
putienl inUMt Int M through the stomach-tube. In this way 
broths, gmdj milk, and the like ran l>e jmssed into the stomach. 
In very a^ravated cases g^astrolomy must be performed to 
prevent starvation. 

DIET IN ACUTE GASTRITIS- 
Oaer haa ^id thai "evtry ca^c of acute catarrh of the 
atomach Ims a uotunil teudeuoy to heal of its own aocord unless 
a chronic form is produced by a mistaken dietor wrong medica- 



DIET ry DISEASES OF THE STO^ACJT. 



353 



tion." It i« a gviicmlly adiuitW &vi iliut in Liu- truuttiK^ot of 
thvf ron<lition thr^ dU-l pla^'rt tW I<»dii]g rAli-. TLc iir&t ^TOp m 
tbo trmttment <hiiiiiuU in iwctiriog iiliKolult^ n>M for tlie st^nL»ch 
nnil H totn] ab«tlneDOO from foml Otr nt K*fut twtrTity-foiir hours. 
Thi« procedure 18 itometimev very <)iflicijlt to mrry out, for 
mauy puticnUi Ik'Hcvc thiit food m iiixx^Mtry fur thpin, and that 
their' cuu wcurt- it'licf more qtiiokly by Ijikiiig iiouri^hfnciit. 
Tho nuuMU and voiniung tvhich arv pn^^ciit Jn mon* or Je?w 
duf^v in thi» ooiidicfon^ uhI whioli are agj^vatcd by the biking 
of ffMwI, will won ciiiiviiiuc (he piaiuiil "f the ntioemity of ab- 
:«l4tining from foi>d. The thimt is, hnwcA'cr, jw jwvcrc in th<?:9c 
coscK thnt puticntft RUiy W allf>wnc1 to rxniti^ tlio moiilh with wntor 
frequently, t« ivLiin tiny bit* of tr<' in tho moutK, or nvpn (o 
driuk very »mull <iiia[ilitim of curl)onttt4d wut4.TS. With thiA 
plan of trc-aitnu-Mt n^wviiy iJ^encTully follows in two or ibrwi 
diiy:«. AIVt the fir^ twenty -four houn* fwnlinj^ may Ix* bc^u 
by giving uautiuiinly samll quuntitiest of milk dihittxl with limcv 
wiiter, brolbji^ mid L^^-aibiimin ; llww am gnidujiUy U- in- 
cri>fl^Hl U\ quantity, and diiHug the next day or two bollod 
4;li)<:kt;n, nwc^Tilinad.'t, r»eni|KHl bnuf, in tuhlilii^n U> towt^ may be 
adJ<sl. 

Tlio anihofs tm* ■ccu*tom«i to preJK'.nbo tho followinj^ diet 
about thtf K(>cond or tJiird day afbr s,n attack of nciitc gastritin:^ 

Ta-X.: liM ^inii- milk with iJini^-wMlpr 101 

9 A. K. r loo gm. eifj^lhijnkin flavored vith omige- or lemon-jiike . - 53 

11 A. v.; L^^fiu. bruiL ^iiU cKj< &4 

Ir.X.: 150 ffm. milk wiih lmK<-W]\f9r 101 

Si-. M-: G gm. Armoui'moluble beef in TnrtPr 10 

6 r. H. . 100 ipu^ c^^«lb(jftiiu davoivd vltii oraaffr- ur lenitw-juluc - - 53 
Ti*. M.: IfiO KJT>. milk with lime-walor 10] 

After tills tliini day Um flirt 10 incTeuMod lu follows : 

0«10H«tt. 

Ta,x,: ms^. >ul[k(1An wiUiTOicm. loa«i <1»2} £83 

9A-H-: 1 vcrv nofl-hinlftl ("ffip" 160 

]1a-m,i 2oo«tii.' Hu.aaoii wki. I cm da 

If. X.: lOOgra. rlt^ c^h^d in niitV 177 

70 gm. t«<wt . - . 182 

%P.K.'. lOOffm, mrHilbiimEri (^2) wkli SOgm. i-rai?k0n(l8T) . . . S40 

Sp. X.: t50^L fliilkffitli fOffin. Iviot - - S83 

7 F- X, : lUU gm. fKS^bumin lUTorMl with onng^ or lemorv-jttioe . . 53 

■ In conifurins tbcM iUel'li«t« Hl^ht iliw^rieptncieH in flie calorie valacs of 
the fooHji wiU be nol«1- The«* diftr^no^ nnve flrtApn fmm mmft authntv 
wing the pulorie mluw of mw foods, while r>iher* have comjuiterl the Tdlual 
of cookvd fcKidfL III ihtf dirl'lieU ^ren by ihe lotboft adorie ntuca ^rf food* 
aa pivp«r«l far tho table are ffivttn. 

£3 



* 



3M 



DIET jy DISEASE, 



The fdlowiog table, taken fmni Boa^' Magmkrankli^ittn^ 
^ves a diet-li^t lo be followed aflcf the i^econd or third day 
Icillowing an uttack of acut*: gastritis ; 



Ba^v.: 200 gtn^ tnWk imth Ua) 136.0 

bu^i. £wiubuck 17&» 

10 A. It.- SOOgni. boiiilUfn with (^ B&ft 

12 X.: 20O|^t, milk Mup £27.3 

AG i^n. uwukJ braid 129.4 

ar.M.T 130|:in.niiik lOl.S 

fiOgm. onki» . , 187.0 

Tr.u.H SOO i^L milk fxiup with rioe i :^-l 

60 gro. twicbw^k \7M 

14W.0 

DIET IN CHRONIC GASTBmS. 

The dictdki tmitriK-iit uf ehrom<! ga-Htrilis in of fur ijrcatcr 
iii][)orUinf.<u rWi lUf Lix^liueut of this di!H>a:4e by thf.> iii4e of 
dnigi«. Thi' diet must l>e varied a<-<:ordiug tt the Htnge of tlie 
di^eaee. luu>^mudi ax tUt moU)r function of i\u^ utoiiuicli h 
vauMy uiiiii»|imreii and onlj- the secretory fuuction utTectud, the 
raoet costly bomtr foriuet of fo<>d iirv liquids^ such as brotJiii; 
nnfortufifttely, these foods do not fnraUh sufficient mitrimont to 
i4ii^;tain the jwitJent Thp'iT iiiitrittv** vahir niny ho inrr^itnH] hy 
the addition of be^f-extnicts, egg*, barley and ritv, peptones, 
flomatOBe, etc. The diet shoidd vary according to the character 
of tlie gnstritis; in timsc uir'k in which the ga&tric wwrelion 
has entirely f*r nlmnst entirely disappnkriHb (>rotfin t*hHi \$ 
di^9le<i with great difliciilty; it must, therefore, be pivon in 
the loost digestible form ; of tbc5w (ImkIi*, Rrni|ied Uxf, [*t<'W(*il 
beef, strwcd rbicl<en, broiled Mcak, and boile^l ftwcctbreads arc 
<!:apo(nftlly to be rooommendeil- V<^»;ctnblee should also t>e given 
in the most, digpvf.ihh" fnrm, best n* n miinh. Milk is t]j44?ful in 
most cases ; oeciisionrdly, however, it U not well l>onn> ; when 
this is the caso, it eau be made more ajn^'cable by adding small 
quantities of rk*e, potutucM^ or cucixi to it, or kefir, kiimi^, or 
matjQoon mny be subslimtcd for it. In lboi*ft eouditionn in 
which cr>U)<idenible Jicid »till rf'mn]Q.s in the stomach meatus In 
various ferrna tire very aect'plahir ; to tliir* list mny Ix- addwl 
fish and cj^ ; ve^rctctbles, sitch as maitbrd poUitoe«, Hpinaeh, 
maAhe<l carroty especially in the form of purees, arc to bo 
reoomm<»nded. In uU inetaiK^e^ fat >ibould W ^ivuQ !n an easily 
digestible form — as gwid butter, efwonniit-butt^r, or Mehring's 



^ 





DIET JN DISEASES OF THE STOMACH. Mft 

Vigtir tliwvilftle. It U imfxwtiblf to forrmlnto <^xact rok* &« 
to the number uf menlii that should h<* eaU-n and tJie qmiility 
that fihotild \xt Uiken at eai^h meaJ ; in a ffeneiul wav, 8niaU fH^ 
«jueilt m«ibi urp Iw'Bt Uirut^. Mineral waltPH arc uftiii iiE*i;fn] in 
the truvtirit'iit uf cliroiiic ga.itritJa, tmd tlic diiUnp watcru and 
nikidim* nidiin? wnt*'r* art? oM|Mviul)y to Im? rocvinimt^nd^'d ; «f 
thtf«e, thi* wator* nf KHKingi^n, H<>niltnrg, 8amt<ign {C^ftng;r(vi»), 
Carlnbod, Marionbat), and SamU^ (Hnthoni) an.* osjK.'i^ially 
noted for their uwfulneap* in tlio treatmont c>i" <-}iroiiio ^islritiH. 
Wat^riihonlJ he taken in small i|iuiittitii^ lx"(we<-ii meal?<. Al- 
coholic <4timulaats *jr any strong <4tirrkitlantA nhould, as a nile, 
be omittnl ; when ulilUed, they should be given in Hniall quao- 
titiea and bent dibitLHl with niint^ral watcn*. KaU and 6pit*« 
toay be iiDowed txranioDally io -imnll i^uaxititieA, 

£wald n>ooQimou(lri tlic fullowiDg diet in oLronic gaAtritis; 

Ba.»-: 150-200 em, ten with TG-IOO gm. of »ia1e bmd, luwi, or 

10 A- If. : 50fiD. bmui, LO ^-m^ butter, hO sTm^ i>o1il mtai, or ocaktflotitllj 

Oiweiu of li^il vJnt' uroiK-thini of a Uier of mUk, 
2 r Ji.i 160-S(XlpTD. wnivt, milfc, ur Umlllon fmm whllf* mcBti- ; lOO-l^A 

I or 5 r. X. ; f^e-founh Lo onr^thlrd of w littr of rnimi millt (wvanicakallj 

mixed vlih cocn or coffpv). 
7 to8r. H. : SOOffm. mip i>r|inp: ftO gm. viiilcbrrfld; 10 ™- lull*r. 
Ocoudonallf bi 10 rfclock r, H.: 60 pn. wlimt hr«i! (biHOUit or vwlebnok): 

ono flip of toa. 

Theaulht'n* Imvo found the following diet-lirtufleful in cases 
of cbronii? giwtrititt : 

%A.m.i ^QOgm. milk flnvpird with tva I3ft 

60fnn.MiLlGLirru<l (IM) with40irni, lutl«T-(326) 480 

I Dofl-boilisl tua H . - , - , ,.,..,.... IW 
IOa. H.t 100 Km. •enpcdbiwr (llfl) vhh 60 urn. -tati^ ln™J i^i l«i»rt 

(IM) 273 

(or thicken nrdwinh (200) or £Ogiu. Miorry (OOf with egg (SV)) 

11a.m.: IViililInn wilh rjTR ^ M 

)DO^.(<Juckvn 104 

(or 100 pti. iNTEb dKF|i4 (330), 
or lOOirni.br^W ifmk (509)) 

100 pn. K|>ifinth - 166 

100 iBni. Eiinibrd |h<Ia|(h.« - * . >.. 197 

100 CTM. KloiTiH] a|ip]<!d .>>.••.> ,<.. 63 

60 imi, t*«rt IM 

4r. H.i l^»:ni. milk ttjtbm SI 

SOcti. cmek*™ 102 

7P.IC.t lK)giii.tital«bTmdl1A4) with 40 gm .butler (326) 4S0 

2Q0«m.mUk J35 

2466 



^m 



DIET IS DISEASE. 



Tbc following (W«^le) is the diet in chmQic guatritin: 



Morning: 

Tbranooo: 

NcKin; 

AA«rtii>uni 

During llie 



lin* 



160 ^1. COCOA . . . . 
25 ^pn. bultvt' an u^ttmU^ 

t Aoft-b)iLoil CM ^ . 

150 irm- chioktn , , . 

200 ifni, i^rrolA . . . . 

150 ^1- C0C04 • ■ - < 

35 KTH. I'lill^i- - . - . 

SOOgui. barley bi^h . ■ 

1 "^^iK ■ 

]<>•) }^i. scmiwd htffl 

ItN) ^m. ntJi<T:irmK - - ■ 

W> i^\u wino . ^ ^ , . 

T'^ gilt. KVtehnok . ' . 

Totnlft 



S.O0 6.0 



0,1& 
6.00 
)2v60 
28.00 
2.14 
S.00 
0.1S 
3.20 
6.00 
2^.00 
9-O0 



_9M 

117,20 



20.8 
(.0 
0^ 

in.6 

0.4 
6.0 

20.S 

e.o 

S.0 

1/) 

94.6 

8&0 



7.50 
0.15 

16.00 
1.80 

16.30 
7.M 
0.16 

17.09 



T6.70 

6.00 

rt3.tiO 

S3ti.01 

9T0 



16.0 

100 
2130 



Boaa' <3iet for dironlv iraMrilift : , _. 

8</c]ock: 20fl ^. milk and Untir mup (lOUgm. milk) I'Jl.a 

SOgFii. Itrajul - . . ." 129.4 

30Riri. bumr 213.9 

lOtrdockr 2i.-sp* lftO.0 

50ei!ii. whiitibrtflii -J 30. IJ71I. biilter ...... . . 313.3 

or 50 gill, wkitt* bn^ii ■* 30 §m. bullcr -<■ 60 gm. m^nipod beef 

l3<^clock: aOOgui. farimniiLb*oup , 2S7.3 

200 r»i- milk ami iw 36a4 

100 gWL pmuos 44.0 

So'filock: 200 gm. milk nnd l<<v or milk a»il oafle^ (lM»giro. milk) . 101.2 

50 jpu. while br«jii 138.4 

7o^dock: 200ffin. riocnixl niilkfmijp . 335.4 

50 gu;. »wioU.,:k , 178.9 

Diet for chronic gastritis (Boas) : 

So^olock: 2O0gn]. milk vlLh 40 gm. COMA + ^O^iL HLijTir . . . . 4n2.U 

50giii. «kivorJSO(nn.Kvb>hiu?lE (178.0) .... 1S7.0 

lOo'Dlock: SOgin. bread wicli 30 ^m, biiltor - 343.0 

100 gUL. CBir-bm(ii or t(Mi ^Tu. fnveotbread (90) or 100 gm. 

broil«i FTK'kfl-li (71.75) , . . , 140.0 

12</olock: BoupofSOgm., U|>iooa, lOgm.bmiertnd 1 pgg 2A2.0 

lOgni, noudln ...... 3A2.6 

or lOi) inn- vpinnHL (Jfi5.fi5)) 100 gUL imn^4> nf li^nH 

(U'3)» 100 gm- C5rn>:fi (10), 50 gm. nijwbed TiotAloea 

(fl3,7). 

100 fin], brenjiL of young cbicken .,.,-----.. 106u4 

100 gui^ rail cbopH {2^), or 100 gm- AteweH venl^ pigvon, 

TcTiiHon, finli, loo gni, farinUr ojnelvl of eggt ^puIh 

trith ham 2ft3.0 

S o'clock: 100 gm. milk and Ice nUh^giti. srigur 147^ 

SSsrn. ooko9 ... - 03.6 

To^dock: ^gm. wlifnt brmi] with 30 gm. butter 343.0 

60 gm. acrapftl mcftl fi9,5 

Tot4l ^8012 




J>iET IN niSBASBS OF THE STOUAClt. 



357 



DIET IN ATROPMC CATARRH OF THE STOMACH, 

In conditioDfi of atrophy of the gastric miicouii iiicmbRine 
there iM a c^mplctv i^x^ciice of the* ^r^trio iwcrctioii. The con- 
(lition buii iils^o been tenni^l (tcJtyliu ptMtrku \yy Etiihorii. Id 
ttiie liWiiw the iiilci^tinu ncU" viuiirii>iii*ly «J"I (lii^-^ls tliu fowl 
for the i6t4imn<'h. ll !?< importufit to urrungc the tiicl s*» thnt it 
can wuily bv Act«<l upon by tJw ]nt<*itiiial juicw. The fcoJ 
muel lie bnikpn ii|i h\U\ a^ rtm- jKirtirh^A fi» poKnlhlr, nn<l uhould 
to a larg^' extent be given in Hqiii<l uiiiJ scmiliqitul form. Of 
Ihc liquiiif, brvthr«, Midi »j* txirk^, n<M.-, or chickcu brotli, »re 
to bt' RtNJiiinwiidtd. 

Vi'gtyliil)!*'^ im- iimmlly well Ixirno; ci^rmU mIioliM Im- enl^^ii 
ftfter Lk* <dl(i]<iftt* ha^ been removed. Pcaj4 and In'mir^ Atralned 
aod entrti as b pur^, lut iii brcflli, urt- «M|H-emliy umdu), 
« t]icy omtuiii quite a lur^ jtcrectitugc of protein. Pobitoea 
ftnd ricv! ure to be cnton oooked with bntUi ur milk^ or uh a muiih. 
^V^ H.rp tn bfi taken 6o1^^bnili'<r Mi^kU nniKt Iw ^^ivrn in tJn^ 
most digestible fcmis, a^ bmiiiH, seni|>etl beef, b'lihnl Mvcttr 
breads, and only ia fimall amount ; mw oy^tera un^l h\\\\i.-i\ 1i.^h 
are also ppmiifwible. In \ery severe forniw jwrnal'mc mid Mt»fr- 
qiicni Beef Mad are to be fldde<I to the milk or brrrth. Milk 
i^ oocasioniiliy imperfectly dige^te<l in this eiimdition, «ik1 emmi, 
kelir, kumisSf or mat^mou may be 9iLbF^[itiile<l fir it. Bitiier 
may be euteii ou cracker*, stale breadj or toast.^ Such bevcm(^es 
60 ten, coffee, eoooo, and ^mall quaJitit]<»of ^ne may Wallowed, 

Stnall ricnlft f h<*idd be taken at intorvalg of two f>T three hoiirp. 

The following diet-li*it, advit^ by W^ele, givew the diet iti 
atrophic catarrh : 

Morning: ISOpn. ooooi &00 ^1,00 13.50 

Forcnouu: J&Ogm. wine I-Oll 12,0 

aO gm. buiivf ton uwbImJ brood) . . 015 1C.60 0.1:^ 

tOOj^. nmlloloinimlnriArionp . . . S.60 O.IO A.2A 

Noon: lOOpm. «-mj>e<l boej 2000 fi-lH) 

lOOgtii. niafth^l poiuUHv. . . , . , a.10 0.00 21.30 

10^1, iiiahciinkcl D.50 . - ^50 

1 oiip leu (with jmif^Uick) . , * - 

AAemcwn: 20(rn>- biitmr • . . 0,15 Ifi.BO 0.12 

30frm. honer 0,40 ■ ' 22.00 

Evfriln^'- ^r-Opii. ric* ' . 3Z00 fi.3fl 71.00 

DuriTiL' > T5ffm. iwir-Uck {or U^vlfd Irwid) ftOO 1.50 63.90 

Uii-d»y:» J''>Ogn^. milk »,;0 9^ 13.00 

^St"} '««-■««««= ^ ^ ^- ^ 

TottJ 72.70 0Z85 219.64 19.0 

Olaritfl 300 64^0 9*20 t30 

Eaiirenum W of <«Jciri«* . > , . 1030 




3S8 UIET jy DlSJiAS£. 

Einhorn' advises the following diet in cubcs of itcbyJia guj»- 
trica : 

8a. M,: Oainiu«1 idLlt crmm 150 H&C 

{jtKm viih milk 200 13fi 

Tonnltfil bnaii 60 IM 

Butlor - 30 Ifl3 

UK.! Fcftsmjp , . . , . . - - 200 \W) 

ScniiWmmit ^bruildd) vr ti«li 100 *JI3 

Bakud or nia»JLod potatoes. - - . . 50 63 

ftpinnob or tiimipi . - ^ tU 

WhMjrvn lnva^l BO 136 

Baiter . 20 163 

6r, K.: Two pggn Unn-bolledr orM^nuiiblud . li>0 

B'nrina wilii milk tKKI 43S 

Wheatcn br«ail (iO 1S0 

Buiccr 2K> 103 

Tnilmilk jtndMitnr) 2-10 iMJ 

9.30 P. M. : Kuini* . , , . 2TM3 

Cinokoni . ^ . •,>■■-.. 80 

Butter 10 

or m Bundwlcb vrith cmm or cnvinro 9tfl 

"2947 
DIET IN HYPERSECRFnoN. 

By bjftTBecn'tiDn is luomt a cuntinuouG eiceasive aecretion 
of gndtriu juice ; the coDdition msty be iDtermitteat or clirouic. 

Iq Intermittent hypersecretion llio vxciesaive 8ecrctit>o 
occurs periiniii^ally an<l U wocMmpuMtxi bv t*xti"eni<? diBtrvftj*. 
Thih distresfi may ohen be le^48<>ued if a small ijiiuiitit)' ctf milk 
or a hiird-boiled egg is taken at llie very be^innine of au 
attack. Inasmuch as fiiiids in lar^c qtiantities ti^ud to increase 
the vomiting, tbdr use ^bould be prohibited. If thirst i^ 
pevere, *^mall bits of ice may be given or recUii injections 
itdministered. The diet during the interval between attacks U 
similar to ibut fn\>cribtd in hyj:ieri_b Why dria f*/. v.). 

Chronic Hypersecretion. — In this conjirlou an exG«a»- 
ive C|uantity of gastric juioe 'ia ff^rcrote^d continnouBly, Jn the 
treatment of this diaorder all foods that tend to increase the 
aeeretion of acid in the atoroach, audi nn T^pioes, eoudiment^r 
and stimnlnntfl, are to be ^TOftcrilxd. The diet should be made 
up largely of tlie proteins, since tbese fi)ods are generally well 
Ixinie ; the earhobydrates are ]>oorly digested, and hence must 
be given only in small quantities and in the most readily 
n^^imilublL' forms. {'"Irnds should be admiuistered sparingly. 
Food should be given at intei^al* of two or dittc hoitrci All 
forme of mcalB are alloviablc — chicken, roost Ixjct^ Iamb ohopn, 
* Dvtatt4 oj Sltmt^, p, 370. 



1 




MET ly DISKASKS Of THE STOMACH. 



3fi9 



SroUed steak ; of carbohydraU^, the beM are oatm^l, Kwrie* 
liack» aini Ne?4il^'** food ; pur^ of |)ocacoeA, ^phach, eln., luay 
aJvo Im? taU^u. MiUi U au t-xuelleiit fuixl iu lliL» (HMturr aud 
ma/ he taken villicr iJoQe or mixod with tou, cutfuc, coooa, or 



100 gnk. tmvitli milk U 

2 «ft-hoUod fifnc* 110 

lAOgm. alfft-fonticUr 36.0 

lAO guL *«rtAlbriia>i in boitlllon . . 8^0 

250 gm, tapinpa miuh ..,.., HO 

60 gm- GTfBm 2.0 

300 gu, hLilk «J 

200 ffm. ham 48.0 

3 Hnunblcd cggi ilO 

100 j^ni. flUiifonkt lout SIL3 

lOOgni. milk t g.. 

10O[cm. milk/ °^ 

Toiiil S18.0 

C-itoriiM OOO 

Entile nimibcT of otlori^* ....,,, 



Mominsj 

Korvnoub ; 

TCoon J 



Aftamooa : 
Eroiing: 

At mat] tim» 
10 f. M. : 
During Qiglii: 



p«t 


Qtrhohr' 


3.0 


A.% 


lao 




17.0 


LO 


H.fl 


ILO 


13.A 


L7 


M 


S.S 


ro.o 




12.11 




Uf, 


60.7 


&0 


10.0 


147.0 


lOiS 


IIMO 


4S0 


- 27CW 



The authors have pre^tcnhed the following diet Jn hypet^oor^ 
lion of gastric jiiioe: 

Sa.II.1 200inii, milk davorod vlth («a 135 

:eB'jfL'builv<tvg;gK . . i . 100 

eOfCni, to4ut - UM 

40^. btiLkT 320 

10 A- M. : M) Kiih ravtr Pttntptfd beer -. 60 

fiOfftn lf*Hl , ISO 

ISm.: lUO^i, bmiW »lMik 210 

or liHl KHi. dikken or Limli chop 

TOO 1^1 uHikHnLf^iJn 18 
or ICK) jpjL of carrots (41) uiosUed atid Hinunnd* 
or 100 ^01, uf (HSU (318) manhnl ami Bimtnnl, 
liT 100 pm. Hpinioh (165) 

1O0}n".HULett)i«&tbrttul 25d 

4r.ll>; 200 gm. milk ISA 

1 H>fl'l»]lod tfOi 80 

OOgni, XiM*\ 154 

40 gill, hiitlvr *«.. 320 

7 P. v.: 100 ipn. bakfd treat - 106 

lOOgm- milk - 67 

£319 



DIET tN DtLATATTON OF THE STOMACR 

Tn the (!ietctj<^ treatment of dilatatioD of tbe stomach it muflt 
be reroember^l lliat fliiidK are badly b^rne, and muh^ ihorofore, 
Im" givpn only iti v^ry Hmall qtiatititi^^A — not ov-er on<!to oiie and 



i» 



DIET IV DISEASE. 



on&*half liters n dny. The fluid* that are pcrmie?il>lo urc milk, 
cream, <hj1!o4% xm, und N>iiiHoD, all in ?imu]] qiiuntittes* The 
iMrvt tliul acc'(>(ti[iaiiii9 this (]iaea.ie mny be relievLxI bynllowiDg 
the pnlicnt to duck hits of ioc or by giving rectal injectioDd of 
wut**r «r u»rmal salt guhiUon. Since nutrition ib ueually very 
funky in this (lisenfle, mitricnt enctnnUi must frequently \te em- 
ployed* \Vhi'[i milk is udmioL^teTrd, «ucL substanof^ us tii|»ii.»cit 
ntul ri<<(T slKHild l>t uilded. E^ or cuncpntmted nie<Lt-i*^tmct» 
^otiUl hv aiklcni tii Ixjutllon t(» ttionau^^ it^ uutrilive viilue> 
MeAt8 i^bould be given only in the nio^t digestible forms ; of 
the^, 8t<Tweil chickeiij boiled svreethreade, cflW^^s'-biitina, and 
&crap4-d beef are ttj be preferred. V<^lablett, sueh as carroto, 
spinach, pea*, potatoesj j^houM be administered ia the furm of 
pnr6oe. Brwid t^hould be isitt'ii stale ; wheat bread or luupit is 
best, Stewe<l fViiit.s, uneh as s-t<>wpd pntne^ and bziki^il upplen, 
are olsn perniL'^ible. Since fat^ are apt to cflu^ fomentation, 
butter Bhould l>v allowed only in quite small <)iiantitioe. Aloohol 
is wit to he rei!i>mmeuded in this coDditiou ; if if. must be used, 
it h^ beiit given in the form of 8onie It^hi wino. Strong t^pic^fl 
sliould always he avoided. 

The special fmtiire of the traitment eousists in giving fVw|Uedt 
cwncentrnted meals. Patienti3 with dilnlalioo of the stoniiiel: 
shonld br rantioncd ag«iust vi-sifin^ wah'ring-plnc^a for the 
pnrpoee of drinking the walcrt^. 

The following k t\\G dieUliKt nnrd liy the nnthors in dilntiif ion 
of the Htomach : 

CftlorfM. 

9A.IIi: 100 irni, milk with lea i 67 

&0 giti- »ah wKovi bread •. >* ISO 

10 fun. b\ttU}r 80 

1 t'KK . ' 00 

10a.1L^ too pm. rnv«r-rap«d brrT , 118 

hO tcai. loast ISO 

10 «ni. tmiivr fiO 

&0 cc. tihciTY win? ...•'..'-. 60 

12H'] 160^, broilwl Blt!0h dl( 

iirl54JKni. liuiibi'hujiB ur chickun 

lOOgrn. Utke<) puUUwi . . , , 127 

lUO gm^ Miiiia^rti - - 166 

□r MK) ipv. iiiipittniriiH ( 1 BS ) 
or liX* piiH pus^ (]in?ihcMt and «tniri«<J (3181 
or 100 ^1. ct^ro(J^ mnNhd and ntminM) (41) 
iWH. ; 100^1. cmm 1114 

hOgm. »ia1» br«jd ISO 

10 gm. biJltor -,---....,. • 00 

Tp.M.! iDOKm. tH»Iv<) Twk flah 80 

&0 gm- *tn\e wh<*ftt brmd .taa. «■ UQ 

lOgm. buiLer - * 80 

9067 





DIET IX DISEASES OF THK STOMACH. 



361 



JSteu' IM'UH in Dii4Uciion ^ the SUnt>a<k. (WciIn. 

8 A.».: ]W Arm- Uit ttiid milk ^wtvhAnn, not sm*') vitJi 50 gm. 

\^M^ve\ brMil - 11>£k60 

10a.1L: I00r"-rt"ur 4S7J)0 

:5<j|pti.ua«t«f]br«ui (77.70) -r 10 lpn.l>iilter(7L«l} . . - 149.00 

JSv.: l.V»|f«i. hftilW niMt saaTO 

24 Ifiij. tniMliod poUUMt 6S.7I) 

or AO tPi. irplnicb (VU], 40 fD). Wtou (SIXft), or 

iMCi AOjcfD. cr«ajii - 107.80 

4 r- K>± 100 lEin. icA with iiiUk (fttfchftrln, nui Mgarf iMlth />0 citit 

UM<it«dbr^«d IW^fiO 

7 P-M.: 100 gm. brodlid nrch 71.7ft 

^giiL «litt(bi«d(lS0.Ol>)-MOgiu. buuci ITIJKI) . . . 300.30 

ItXiiriii. cvMu 314,00 

9r,M.: 'Xluni^cmun IttLtt 



Toul 



, iOltf ,6b 



ff^^^/iFj JUrt'lUt /ifr JHitaaliQn t>f tkt JSt&numh, 



2^.0 

1.8 

110 



T«ii vrirb >M) irm, cmm . . 
Foxvivun: - eg^ . - 

20 icin, Huimr ,....,.. . . 

20 irtn. 4>JK"A<- 

100 nin, mmt-nl t-wf S0.7 

l^JO irin. lujufitvl iH»talon ^ . - 3^8 

Tp« with 'VI K^^ rwifn - K** 

lOOjLCm. Huiir ipuH pwic} - - - 4/Z 

^'"^'Jf^^lsOKm.xwicback 8.6 

■ ' ' 200 gni. mi]k «,4 

ToUl 104.-2 

IWurii* 427.0 

Eiiiiiv numtwr uf PAlcrlcB - r 



Put. 

M 
13.3 

lao 



AftfTDOon: 



V\^i: 



1.5 
0.6 

13.3 
LS 
4.3 

1.3 

7.3 

I50.S 

M0.0 



IftO 

21,3 

SS.0 

9,6 
127,5 
723,0 



AloohQl. 



i8.a 



T53 

100 

I6O0 



BMerft JM*iut fir JMiafotion qf the Stomach. 

l*rotcia^ Fat. 

61.M.: 500^. milb, 40j(ni. i«n , 20.3 18.4 

8 A*H>i (^Umcol Kiup with lA ^la.. uf nunt uluUctri &ft I4O 

lOJh-M.: Ocnm mjiiun? llSfi cc of orcnm ami & 

C.of Iflctow), 40gm. lonM 7-8 J29 
«oi]p wifJi ;-oU of 1 t^g . , . - 4.0 ftS 

140 gm. tff R*irt Wf, TcniKJTi, poultry, 

builnt choppud bMf, or fi»b 42.8 10,4 

40 fcm. bA«t ,3.3 04 

£5i&fni. cinnamon vtk^ noda titke^ cofTtt 

i-nk^i biocuit, Bma]l cup bliick coSw . . 2.0 1*5 

4 p. «, ! 2JtOc.o, of milk, wnlor. or oow*. 3 ivii^ 

biicfc<30gni.) 9.2 113 

7 P. M. : Lvgumiiicw tu^up 4ith 15 ^. uf mvat lolu* 
tion nr niip made /rorrt } diii|v «oup 

tosvogv . . , 7.8 Ifl 

Bin flour muaL ia3 14, 1 

130.8 «as 
Total vkluc, tth>ut 2f334 calorifa. 



£6.8 
14.3 

41.6 
7.7 



30.S 
14^ 
38.3 

13.8 

98.1 

313.0 




MS DIET IN DtSKASS, 

Bkdtrtt Ihtt'Xisi far JhUUatmti <ff the Siojnach. 
(More ffouruliing tliHD th« Preceding UaL) 





Pntftd, 


r«. 




&A,W.- 


S50 re. mnir, S5 gm. lout , . U.O 


9.S 


S5.« 


6 A. v.: 




10,2 


15.4 


1QA.U,: 


i:£d (^^c^creim, 2 KiricbAck . . . , . fiuH 


14.0 


18.8 


ISX.: 


140 rm- Ttypifft heat, vi^ixon, |fOuUnr. 

cHopped \teet, i^' tihli . . . . . 41.8 








10.4 






40 sta^ tita^i J.3 


0.4 


S0<8 




2ft t^m. aoda caku, clntwnvii «akc« 








oof!ec (Ake^ bbcuit ..--.., t>0 


IJ 


11.0 


4 F. Hh , 


: 1^ i-.u. milk-t-^ucmi, 3inir1jiitJi wiUi 








fruit jollj - . , 13.5 


15.g 


^4.6 


7 p. *!.: 


Eicemuib.2 Bwioback, uakiw . - - 14.8 


10.8 


78,7 


10 r.H.. 


10.6 


20.3 




1H.0 


~m9 


2e4,3 



T»rHt Tnliju, Hhniit *i:i4l cnloriM. 



DIET [N ATONY OF THE STOMACH, 

Since atony \b frequently canned by iDJudicioUfi and too rapid 
eaciog, persons with feeble di^tive powers should exerci8e 
especial cauttou tu oat slowly, niii^ticate tborougblv, uiid avuid 
iDtligcstjble food. Persons suffering from atony of llie Mtoniacb 
fihnuld «it attmti (|uanlitiee of food nl fni't^uent mtervuls. Siitoe 
w:it<-r is not nlipiortvd in llie Hlf>n>uoh fo nny extent, it i^ advls- 
abli* that iht ([tiaiitity of Huidd taki.*Ti should not i xoe<^^ 1 i liters 
a day ; tim amount should include all tiutd;^ — rolfec, tea, soups, 
etc. If tli^ tJiii'st is very great, enemata of wat<:'r or nutrient 
enenwin may be ndministtred. 

The ti*e of milk in large quantjlies, as has been recom- 
meudfd, Is not generally to Iw advi&ed when the patient is 
olilr t4> gi> alK>nt, flince the weiy;ht of l:irge i|UaDtitie^ of milk 
may ovcrdisteud the stoinndi ; whcu, however^ d rest oure is iu*iti- 
tiitcvl, niiik is oomnionly woll borne^ evt^ii in verj" lar^ro (|uaD- 
liiiw. TJje diet in atony of the afomseh varies neeinding to 
the nMnre of Ihe gastri^^ t^ecretion, la <fisi-@ of !^u|>eracidity 
ft liberal in<flt diet, consisting i^sTX'eiaUy of chicken, beef, mut- 
ton, or Iwm, is to be r<»eominend<:d ; fish, egjp-, hard and soft 
boilcii, arc ftlso permissible j the vegetables sliould l>e selected 
with can*; mrrots, peas, Ixains, and cauliflower may be given, 
but must be inashtnl and sfmiued 80 as to rid theui of cellu- 
lose ; p<>tot<Kt-i, rice, and gritfl inuy also be allowed. Butter 
irt ibc form of fat be«t suiUKl to thin condition. AWbolio 
srirnulants are, tut a rule, not well home, and their us** nbonM 




DiET IN DISEASES OF THE STOHACIL 36S 

be prolilblttfti ; ill a limlt«<i iiuiiLt>er of cuaet alcohol in the 
ft>n» of a light wine atjtri ua tk atomachic, and mu^ \>c pre- 
«critH\]. 

In tbiu^ Dst)U*A in wliirh tlierv U aa hIhc^di^ or a iliiuinutitm of 
Arid in llir ^istrln soorctioii the lighter forniH of iiic^t, Hur-h aa 
t)R' wliik' muut of olti<'k(-n 4ir tlfth, swet^thrt^acU, stewed chicken, 
&r raw M*ni;H'<l iHVt", nliould U' iillowed ; vegi^talilej*, on the other, 
bmKl, iuu.< bi* given in somewhat latter C|uautitias. The tieat- 
Dient of the chrvnii? eoQ.sti])ation acciim])anyiDg gaAtnc atony, 
since it Is one of the imwt oo«j*tarit syin]>toms, requires speciiLt 
ii)«-jitiiiii. Ill tli^ Ut-ittiutttit of tbin (xfudJtiuu the mulii reliuuL-e 
muHt be plutx'd on th<" tViH. Such furnin of looda ahould bo 
given u* vill, iu tW tsiurwr of ^ligrrttioii, pr^xluce gubatauo«a 
tliat <»Xfnfj> inU-iilinjil jx^ristnlpik ; among t\ut»* foods may he 
menti'iii^) (Tmhutu bn^wl. cc^rtain vogftnhl(M, t*Licli as carroU, 
beans, t«nuU>e*s |hiu*» and t»nii|>9, rniKnironi, sU'v^-d and ra^v 
frolta, buttermilk, ltoia*y, eukI rider* T\m fonu of dii^t will 
often overerime the oon^^tipation of utuny without the aid of 
di^gs. (For a more ext^DMw coTLsidt-rutii^n of tho dietetio 
treatiueut of dii'ouiir oJiL-iliiialiou Ok* ivjuIgf is refenx^d to die 
atC'^llou deolluj^' vfitb thin Milijt'Ct.) 

The fullcnft*ing ]i.-it lu^ been ws&l by the authors in thv trcut^ 
nuHit nf ntouy of t)\e tU*tngich i 

7a^^.: JOifni. nrsMgC'jiricN' - - . Rft 

B i_ M. : ^HX) pn. milk ]39 

1 t»ft'b(>iliMl c^ fiO 

60 txm. UHUtt 1fi4 

■lOfini^ buturr . . > . 215 

to A. M. : 100;i;ui. raw ttmiiod beef 138 

60jtm, italc vhvac bread IM 

1S».: lOO^m. bralW -tciUt . , S09 

oT 100 jE^. bmb (^hnpi (230) 
or 100 fim- «fwiNi chlckwi (106) 

SOOgm. awimiugii* . . ..... ^ 37 

or 100 1^. Tva>^3ie) 
Of 100 gm. tpiiucli ( 100) 

¥JOgttL mpiihc-d poutoa 1S7 

50 gm, brrad (nuiloj ISO 

Sr.«.: ^oomu.miik Itf 

itOifni. whwt liKnd .1*4 

40 2111, huUet , S25 

7 r, MpE 100 ITEM- biiiTed rwk Oib SO 

lOOKmmjLk . , 07 

00 tnu. brad . IH 

40|rui, butMf SSA 

^fiO 



lANE UBRARY. STANFORD UNIVERSITY 



r 



864 I>I£T IN DISEASE. 

JfUt-iUi in Att/ny of ^otjkkA icM If^ochiorftt/tiriii.^[AJtvr Wt^fU.) 

Pncdn. Fti- ,,y^n,j^ b»l. 

Ucirtitng: ]M^. IcgiiminoflC cooot 0,0 4X1 IH.5 

M^-m. crnm 1.8 13,3 1.8 

Kaifinnon i 1 aofl'SoLlixJ I'cfg . . . It.O A,0 

20 gm. awii^Ucli . . . , 2.5 ai 15.0 

Kwn: lUO^. wm|>r^] bwr . . 17.1 0.0 

200 ^i. ina*\ivt\ |x>faUH« 4.2 2.7 42.6 
20f{m. mdi L-xtnwi . . 1.0 . . 11.0 

AiWmooD; l£0|i:nk, IrKiuikinw tu4.xj« O^O -iO 13.6 

oOKm, crmni ... 1.8 13.3 l^ 

t^^oitig: 2aOgiu. ttpiM-B imliJ . . 12.0 8,0 Il.O 
IJSgm. dlA^toPC innll ex- 

iTBPt 0.8 9.0 

Durinif Ihflilflr: 50gm. iwiebnck . ... 10 1.0 35.0 

lOo'cfockM lUf^bl: <f00ent, milk 6.4 7>S O 

lOffia, oognae , . . _^_^ M 

TuUl 71.6 64.9 163.6 6.0 

Calorim 290 000 670 50 

Kjitirv number of ctloricA 1600 

Di^'iiH fe Aiifny of the .Stttmttck ioUft Jfypfrehhrhydria and Mrutai 

Mitming T ]5fl itm- p«p1on« ccwoft - - B.0 6.0 7.5 

no in"- mm 1.8 13,3 1.8 

Forenoon ; 30 (itd- milk-Uituit .... 3.0 0.2 20lO 

50 gm. hnm 12^ 4,0 

1 egg 6.0 JShO 

Noon: I20|i7n. wumi ni«t .... SI.O &0 

SOOffm^ irnmhccipotiilop* . 4.2 2.7 42.8 

Afternoon: IfiO pn. peptone cwon . . 8,0 6,0 7.6 

W^LtTMim , , . . . l.e ia3 1.8 

Eveninirt 120 i^. ool<] niu4 Tn«ftt . . 21.0 AO 

200 gm. rice O.O 6.6 28.6 

lOydock: I00girj> wine 3.3 7J 

Ihirinjr the ^j r fiO Km- t^ichndt . , , , 6Ji Ji^ ^,0 

Toiol 102.8 747 151>.l 7,8 

aioiie* 420 700 fi40 55 

&itiriMiiiniberof f«lriH«9 ISOO 

Dirt'iitt/or Atony *>/ the Stomach, ru atlvitfd by Boos, 

Onloriw. 

H A. V. ; 100 (pn. milk ttnt] wa» .^fl gra. whwt bw«d, 30 gm. botter 401.2 
( m cfiimlifditirin, ^0 i^m. iiiillt ). 

10a.m.: >M)fprj, wliKii hn>ncl, 50 ^ii hutCt-r . , 343.7 

00 |G^i. )horn|XHt iiii^L raw .,,,.. 71.5 

nrbniiU! (TlM.:i), or 5l> ^m, Ilhtii (2fi2.2) 

12 m: lAO^iL vofikitl buef, and 50 j^t- rrACAronJ 43Ql8 

(or HK) ^rt- tit'i!, rnrinu, inuhIikI |n«Uituc«) 

Sril: 100 gni. miUcHUfl t««. 50 iciii- ^li^t breiul, SOfiin. butl«r 401.2 

7p-M.! 100 gm. wild bwf 213.8 

60 gm. while btcttij, 30 gm. butler 343-7 

22144 



L 



DIET IX DISEASES OF THE STOilACff. 



<1S5 



DIET IN ULCER OF THE STOHACK 

ProphyUM'tlijally much mn he done h v a (Arofulty selected 
diot u? prt'Vt'iit the oiint^t uf aii uWr of iIut nU>tua(^h. A» iwuu 
■n thr wry firnt wvinpUmin iHniuiuc muiiilifnt, the {mtiL-iit rthmiUI 
be plupcfl U]>c*n un nWulutv milk dit^-t. TtK< (vioporuturo of tti^? 
fiiod KhmiM bv r<>guluu*d^ ao tliat it be not |pvcn bx) hot or too 
rLili\. Aneniia, wliidi r«j frt^jiK^Dtty unromfiaiiirA itii> diiwiwe, 
niuAt Iw oombated ; hypereMorhydria, vvhioti i.-^ eo imiK>rtaDt an 
etiolijgin factor in tliU condition, rauflt also be i.kV<*r(H>in€. 

Iloari^ dividea the treatmeat of uloer of the 8U»nia«h iutu 
aeveral stages : 

tita^€ of licmoiThofjc, — In this stage Boaa advines abwUite 
reet iu Inj ; liie pulienl iiol beiug (^veu allowe<] l*> ttjise fur jiur- 
|wBCH of dofceatioii or uriimiion. No uouricbnicDt whiUevcr 
xhotild l>c f;iven bv the mouth. Id robniit indis'idnnU uvi-n uutri- 
r!iit cnx'nmta may \w omitted. If thi- |mti(uit is M'rak nr in fw*bb* 
oonditiiin, feiilinn by tb<- rwtiim muy Ife in.sti[nl4*d. (See the 
Heetiim on Nutrient Knematii for rbc method of previa mtbn 
and utilization of tliia Diode of feeding,) Only two or three 
nutrient eDematu are to be given daily, lioas i-arries out this 
phin for KhtH". or four davft. After thin he gradnally begins 
niin]ih-r<.<eilin^, ihv. nourl^bmeut wnhi>ttiii)E: t'xdiihivt'Iy i>f tittidtt 
given lit a t^:mjR-ratun- of !)8^ to 100^ R lie ptcftrs milk 
(iHnlcd with limc-watcr, with tea, or with cufToe. Iw addition 
hn |>rrniits Iw^f-tca, froihly i'xpn*«*ed r>r urtiRciul btt'f-juiw, 
and og^-iiEbiimin. Tlie iniirlionatec] waterp, sm^h fl,H Vio-by, are 
al^ iiM^l\iL 

AHoT the lirjit week lloas begins the regidar Let]l)e aii<l 
ZlcniHM'n nicer txeatnicnt, which be conducts an follows : The 
[tntimt is given \ iiter of Carlsbad water, which he drinki* in 
l>od niomiog and eveDing. Kot-wjtter applications are placed 
on tht- nb<]onietip Tlte diet during tbiM stage couAi^tm mainly of 
milk ill addition to other Anids. If the juticnt is veiy wenk| 
DQlrii^nt i-nemata may ooca^ionally he ^ivian. 

In i\\t' tri'atment bepiniiinfr with the tliinl anil oontiiiuin^ 
during the f^Jurth week B^jils j>erniit^ the patient to lY'cliue uo 
a couch, and continues the use of the Carbbad water, which 
i^hould be given for four weeks from the time it ii§ first 
biken ; he advices that the diet »1i]] coDsi^t moinly of milk, 
alth(^U(fh he now pcrmil* ttic addition of p^cuLkecl ;:wff^'l>!K'k, 
HC&ldixl cnickcr»> and »*>ft nyiU, Mititt< («woirtbread», bnuQa^ 



*. 



i 



ia» 



DIET IN DISKASE. 



m<^t bulb), fitth (perch, oy^ttcis m Nmall <|imntili^), in addi- 
tion ut tbc ligbt red wine and carbcmaEed wuterat are also 

lLlluWl:*d. 

A*W the fourth week, if the p&tieut i^ doing wt-lt, Boas adds 
frf>rTi itO iv 200 gm. of DiWied [>otatooa, st^w^xl fruits, and 
vi-f,'chdili?s, ftiich ns gpinftt^h^ fiarrote, |)i^a, aitd lurnipH, in the 
form of pur^, to ihu diet previously given. Tbe meats — 
broiled steak, ebopA, and roa^t beef — if well cooked, can finally 
be given more liberally. According lo Boas, tbc patient sbould 
avoid raw fniit, acid and highly p?ea8oiR-d food^, aikI al«o very 
hot and very cold <1rinkK, for mjitiy ye^irs. Even in those 
cosL's In wbicli there has been no benjorrliiige Biais nevertheless 
advises the rc*t treatment. It i.* generally admitted that tbe 
ivst oiire is tbe only satisfaclory |Jnn for trcsiting cases of uWr 
of the fttnmach. Typiihe and IVniroblt have dpvitiod i][ptari<^» 
for these cases ; Iht'se have been given elsewhere? [see p, 341)" 
The fir^ dieUry shoitid be followed for ten dayi^ ; tbe t^econcl, 
for Ujc Muccoeding ten daj'B ; th<? thini^ f(»r about eight day*. 
Tbe severity of tbi* c<^n4lii]on in vach ea^e must, of ojiirse, 
delerniine tlie length of time duriu|^ whieh each dietary raujrt 
be continued. In all ins~laDeas milk seemn tolietlje most iiwful 
form of food during the first weeks of this rest treatmeat, 
Thia phin was csirri(>d out many years ago bv Cniveilhier in 
hts treatment of nicer of the stomach. Op-cai^ionally milk does 
Dot of^rtT, and substitutes mu;^t be given in itr^ stead. Of tbe^, 
buttennilk, kefir, Riat/.oon, and kumiss are specially to be 
ruounnu-TKletb -imong other prejuirations tlmt have been found 
U9cf\il as f'HMlfl are the well-known Lenlje-Rosetithiil hecf solu- 
tion, as reeommended by Leiilxr nn<l K<tseulbal, mid chicken 
and calves'-fiwt jelly, as advisixl by Fleiuer. 

In those <'a><es Id which milk ie n<*t well iMirne Deliove sog- 
gcfitfi that the milk 1m? pa&'MMi InU^ the stomacb through the 
fttomficb-tube. Iii> found tbut when given in this way tbi^ milk 
WBX not vomited. Honvercl nlno ret^»niniends this modt of 
feeding in intractable cases nf ulcer. 

There are a number of eases of ulcer of the stomach ibat do 
not yield to Ibe ordinary re^ treatmeat as ontlinetl hy Boait, 
Lcube, and I'cnzoldt. l.>onkiD* tirsjl directed atlentbn to the 
fact that excellent respite could be obtained in this claAfi of 
ciUKS by exclusive t%.v.U\\ nlimeatation. His treatment extended 
over twcnty-thrrc days ; since then McCall Anderson ' and 
BoftK* have obtained excellent rer^nlts by this plan of Iroal- 



DIET ly PiSEASBS OF THE STOMACH, 



367 



metit in obstinate and recurrent case* of uWr of the sloinacli ; 
Rie^l, too, uppTDvra of this plan. Boas earries out i^xclufiive 
Kdai sltDietimtioii for ut Itofit ten (luy^ ; he then allowri duidftf 
8Uoh «fl milk, icn^ boutlloD, red wine, for ftome davd, uiid tiually 
permit/1 the pntimt to pceunje hie uetinl diet- 

Tlicrft nre n c'c-rtiiin number of light foims i.>f u]oor of the 
eUfUiAch in which it u impossible to carry out the rent trcat- 
mi^nt. In such €a»« B(»u fldvjses aD ambulatory treatmeot 
toj^lhrr with the ubc of silver nitrate. The silver ifl admia- 
iirterc^l in noIiUioii on nn nnpty »touiuch in from j to h g:niin 
<lo0e»; at the wime lime a carx'fully rvfruktctl diet i* ^ven. 
The fooil consists diiefly of milk miil otlier fluids ; in addition 
he; atlowH teiidc'r moats ami fitth, uuiaIioiI |K;tjiLfN^, iiitd v<:'g^'tiib1es 
in tho form of pur6(!4 (<<aiiitiou£ly]r all in miidrmtc quiiiittticji. 

MimTid wiiteftt are <>ften utili/xy) in thi» tr«4tm<'nt "f uWr 
of tli^ !«toi[mrh ; of tti(!»<*, Curlslwid wiil^rrH liJivr hoen especially 
recommended, but Sunitoff;ii (Uutborn) can uW be u»od vitfa 
beoel^t. The mineral water treatment nhotdd be undcrtakeo 
only at tJie i^jirhig, after the uk-er hiw hciiled| and after the 
pat^eot ha.H under^»n<^' thi^ rest cure. The trc^atmeat at Carlsbad 
or 8amt<^ wilt often prevent tlje |MXsibi1ity of r«1apw#^. After 
the uloiT lias hmled, it is iniportjiut Uf overtime the anemia 
which Is i>.^ti;dly present in most eases of gastrie nicer. Thin 
may he flccomplisheil hy mcan^ of the diet (see Diet in Ant^min) 
tts well is by sending the [ksitient to some invigorating wnti^ring^ 
place or to the mounlnins. Iron and arsenic should al^ be 
given to nverpome this e<*DditJon, They should not^ however, 
be presicribed until the ulcer is healed. 

riEr-LIST>* OF WEGELE FOB CICER OF THE STOMACH. 

iKet L—7\t b* JoHfrvtd aX teoMt Urn doft. 

Ncming: 350gtn, millc 8^ C».00 ISO 

Scnieflf.SgTti.nch) MO 0.50 7.Z 

10<irdock: 'J^Km. iniLh &50 fl.OO 1^0 

1 rtifce . . . OflO a5fi JL7 

J2o'olock: I50ffm. bomlloii 076 0.46 a9 

50 griL nifiAi wliition (or «gir) . &.A0 ApOO 3.5 

4rfelock: 2-50 gTM. milk 8^0 ft.OO 12,0 

2<Tik«, 1,10 0.50 73 

lOe gitk IriiiiilUm ....... aT5 0.-|J> 0.9 

aOgiii. iiHtttaolutioaor lege. - S^ 3.00 3.5 

2 cAkM JJO OM 73 

Toul .47.90 as.55 70:4 

(kloriM 200 330 330 




»8 



mET IK ntSEASS, 



DUi JI, — To he /mUowvI at fnul krti c£^iil 

Moming ; dSO Km. milk , . . - , 8.6 9.00 

3<ttkcii I^ 075 

10 o'clock; 300 Kui. b<HiiUon 3,S 4.40 

1 cgtf . - 6.0 MO 

Noon: 1 boil«ct plg«oa , 22.0 1.00 

about tfOU em. n<4 1q boidlloa . . tV.0 :j.00 

4 o'clock: '260|fnu imlb tLC V,U0 

2<«k«9 1.1 0,60 

Stydock; 150^1. houilioD 6.4 D.TO 

lOUgm. 9w»t1*f«Ai!a jg^U 0.40 

Toul 90.6 88.75 

aiorJM 370 860 

iCntiiv nuEuber of oilorlos ...... 



Cubo- 

hjdntM. 

12.0 

JM 
S.2 

0.7 
40.0 
12,0 

7.3 

8.0 

300 
. 1100 



>"-^^- ^" hVdSm 
Momins: ^ cups of tnurculTwwiib lliOffiN. 

of milk - 3,4 Sm 4.H 

20 n». Hijnr - - 0.5 IB.S 

3«k«i LS 0.75 n.l 

I0«^c1ook:200|rm. boiiElbio .S.2 4.40 3.3 

Ugg 6.0 5.00 

Nood: 200gui. Kfuii 3.2 d.00 17.0 

150 SDi. }i^rri««lc 31.0 2.^ 

100 giu. Qiobtied potiito«« ..... 3.! 0.S5 £1.3 

4o'ulockt 2<ijp»te;i wilFi I00giii.iiiilk . . 3.4 SM 4.9 

24>ifm. auKur 0,>^ 1^.2 

a^ik** 1.8 0.75 n.l 

^TTniutf: 100 giu. HcrapiNl ham 16.0 0.10 

200 pa. p.)ui> a_a MP 1T.*> 

Toul fi0.1 41.S5 13fl.7 

Oiloiia . . j&O 360 020 

Enure Dumtker of calories 1250 

iNtf iVi—Tu be fifttomed at ittut cn)« v>r«t. 

Uomie^: $cup«icA ctrcofl«a, 100 goi. milk 3^4 3^0 43 

20 gm. fiiiifiir 0,5 . . 13.2 

milk-iooflt i-Ugm.) 4.6 0.5 39.0 

10 o'clock: 200 gra. bouaian %,% 4.4 %S 

1 €^ 6.0 &0 

Noon: aX)gm. soup 8,a 60 17.0 

irOgic. r«ul fowl 97.6 140 1.7 

100 ^. oirrolsor *Tiiiioch . , . . I.O 0.2 S.l 

2i}0gni, li^Lt rloiirlofid 9.0 6.4 46.0 

46'olock^ ampxor Ua widi ]0OtfD.lDitk 3 4 S6 49 

20 17111. FLUgar 0.5 . . 18.2 

iuiJk-ioti< > . . 4.5 0.5 29.0 

Evwiinv: 100 gm. cviUI rnait dimI 38.2 2.8 

150 jmu Upioca 7.0 &0 8.0 

10 o'clock utiilffli: SOOgtiJ. luilk ^_a5 _ 9.0 12. 

TiiUl ISQ-S 63.0 1P0.O 

L^Wit* 405 585 AI5 

Kniirv mtmber of calorlMi I»00 



LIST IN DISEASES OF THE STOSfACB. 



3€9 



The followiug Hwl, Uiken from Boas' JfagerikrankitHUrM, givea 
bjs Jiet in utoer of Uw >«toiiuicb ; 

$JL, M.: 300 irm. milk ADci flour 40UM Hl.Q 

10 A, M.: :£00)crii- Ixtulllon wUh l egg ... , M.D 

farina mil k iou|) f327.4), mup of 30 rm. topioci, I tost, 
IOki". I'uUrrfiSat .\ ........ .\ , . , 0W,4 

If.ll.; aOOtftiL iuiUt{i:H), jOyni- N«iU(S'«»r«H! (149,6) • . . , . SSI.6 

7r. M.: SoupofSOifTTiH KpifHA >Qd 10irm.«IUiaiOM IHO 

During Lhctkf: 1 liler milk (At 8^6,9 o'doi;k, aw KOI.) Wt,b 

TotAl 14M.1» 

The ■jne difti Tiih tho tddiiiuD of 100 gm, iwiobtck. 

^ Tottl laWki 

8a, »(-: tVOxio. u>Uk 1S6.0 

6U ^11. KwiuUidi - . . . . . . , IT8.(> 

IDa^K.? fiOgm. •craiKrJ mwl ^%^,5), logs fa)) 139.5 






wUt] ^LKiRTu, milk I3b.1) 

12c:^clofrk: Snii|iar 30 ffiQ. upjix-n, t «Kir, lOgm. biittvf lE8fl.O 

I<>0 gio. i^Itw' hrnirij tm^ivtbn^, fc*] chop, rblckon, wild 

t'igwin M0,0 

200^*11]. inUk ikuil iM willi SOgm- flu^ir I-V;,0 

SOj^.i- r.wirWk ITM,*I 

mt^iu. Itiin bnm 2^2.ir 

50t'iii' tvioUick ITH.ll 

3QU tEiii- luitk ^2^ 

Tdui saoi.o 

LenWrtJt^ TToentIv <*iiiitioDH against tlie ^nct Ql)«tin^Dee diet 
in the treatment of ulii^r of the stomachy I'vcn in those inritjiiiMW 
in which then* is hi'm»rrh:i^. He hn»cs his coodtisioD.^ on 
the fact thut since uIu-t of tiw t4onutch is most frec|ueiitl; 
acxximpuniod by supcmculity and aljui hy on enfeebled coocU- 
tion, it i& be*t to give pfvktrin foti*! mrly to overcome the ocidity 
HB well »A to hiiiid np tlir* svKtrm. Tli« accompanying table 
illufllmt^ hiA methcMl of fiN-ding, 



tMty ftRcF 1tt>l faV' 




























ni«UMikaBi« - . - 


1 


2 i 


4 


r- 


A 


; 


ti 


9 


lU 


11 


13 


IS 


u 


U^ ■ ' ' . 


7 


S 4 


A 


A 


T 


n 


■ 


■ 


« 


ft 


» 


ft 


ft 


ST.:- : 




9 


Tt 


*o 


ID 


40 


4[f 


nn 


M 


Ml 


Ml 


M 


VI 


»ft ;0D ¥nwf«n 


TOO 


ffO 


ffv» 


lixn 


nw 


iJXn 


1000 


l'f> 


locm 


BAWfcriHdbecr 
VDk o&^»4 with 










»ty:3sax»tx>sr^:Bin>»3x» a>c»:x» 


rln . , . . 












inft 


Iflil 


mrt 


■jnn 


IVNI 


ajn 


XM) 


nn 


7wl0t>B^lr 














X 


40 


40 


An 


ni 


nn 


inn 


iTAin lt«w> . . . 


















ra 


»> 


60 


.VI 


hO 


11iitl«r . 


















?o 


40 


<o 


40 


40 


LUodM , . . 


380 49) <9T 7n gu tm 


UM 


ITfl 


:£1M 


'J471 


•Ml 


IOH: 


vm 


)[)n 



Thft ^jrgj* nn<] milk nn? gtvrn i«* ooM and in tMHpoonfuI 
doetefl. By cn^nfi of thift nu^thfxl lie Iiaa ti^eated tiO caHeH with 
■ i)MiteA. iW. R^acA/TucAr.. 1904. Xo. 11. 



370 



DIKT rS DISEASE. 



gtmUfjring reeulta* In those inetancc? in wbich tWrc tiA.H b«n 
Scmorrhugo tbo [latieDt ii? kept in bed for fourE^n days, ttiicl 
nn ice-bu^j is [jlaood on the ab^Iomen fiir ten clay^. Tbis same 
obscrvt^r also advocates the us€ of lurge (Iwiea vf bisiutitb. 



GASTKIC HEMORRHAGE. 

As fioon as h(rinorrl]ag<e from the rtomnch occuni, the patient 
sboulil be put U.t bttl TUid Dot allownl to ii»e, eveu for pur- 
pOMfl of tldccttting or urinating. A light Joo-bog shouM hti 
placed ov^r the r^on of the b^tomuchT and no fo(x:l uv drtnk 
whatfv^r i^hoiibl be hIIowh) ; in rtnler lo qufioch the thirst 
small qiiantitiof^ of ice may be g\\VD the imtitnt Ui suek> 
Nwurishment must be entirely by the rectum ; but even this is 
usually nnnecessary for the first few tlay&. In ortler to combat 
the weakness following great lostt of blo^xi ^ll solutiooH may 
be injectwl iLto the rtctutu, c»r if the jsitknt h very weak, 
mffeej mefltjuict', or v^hi^ky may be udiled U> tlie eueum. lu 
very grave ctt&es salL infusions must be reported to. 



F 



DIET IN CARCINOMA OF THE STOMACH, 

Bojis divides the IrejitJueut of caurerof tb*' stuinneh into the 
trt'alnicnt of wmc^r of the oardijtc [>*)rlinn of the gtomacb and 
that of tbit bo-ly of the slomach. 

Ill ttie treatment of Cancer of the cardiac portion of 
the stomach the diet eJiould be aiicb aa will prevent, s(> fur 
HH |H)tfiib!e, any irritrttiou of the diseast-d aud Nleiiose*! e^ipbagus 
and atomach. Solids bbouIJ, therefore, be avoide<l. Milk is 
the food tkit IP ngitully Ix'tit borne tn lbU disejise. It ean l>e 
rendenxJ more nnfritir«j!^ by the itddition "f somat^isc, Nestl^'s 
food, egg^, and the like. E(«ide@ ihi^, broths of all kindj^^ 
cocoa, milk with tea or eoffee, or Kuttermilk may f>e ^ven, 
Mchring'a Vigor Chocolate is useful for supplying lat. 

As soon a8 difficulty arisea iu swallowing liquids, gastroU 
omy should be performed, in order to supply the nourit^hment 
which It i» imposeiblc to patw id tlm>ngh tl&e esophagus. If 
thi« procedure is deemed inadvi*able, nutneul euemuta may be 
reeort«d to. 

In the dietetic treatment of cancer of the body of the 
fttotnach milk likewise forms the most important article of 
diet. Tlie more easily di^stibTe forms of meat> each as »^weet- 
hreads, scraped beef, brains, aad stewed chickeD^ are permia- 





DIET /.V DISEASES OF TffE STOMACH. 371 

Biblr. In thiH ilisfiLso there U tmuJly a <]i>»Uj^u> for mmt, mid 
tiAh may be bubritituted for it; of ttk««e, boiM iiiwrkerul, rucJc, 
buddook, or trout are to \k reooruni<'ti<l<'d. iX tlie vc^'UbU«, 
ujaHlu^ |K>UiUit», hpiiiacli, <urn)t.H, \ntvi, iMMiici, uiuliHi>w[.-r^ 
tt' moHht^l and Atnimt<l hu ha to rid ihvja ^f dtrlluUiM^ nru 
uduiiEvtiblt- ; ric', Juriuu, uud utrrn-Hturvli wjUi itnlk arc iiW 
valuable tbrmft of food. Milk wiUi t4<i, oolfcw, or cocoa, or 
wiiw or wliUky, nuiy l>o f^ivmi Jor ibr tbirxt. Fluids hIh»uIiI, 
however, bt" lakeii in siimll <|iumtiti(-ri ut » time In i»rtlcr fA> 
ffupfily the neci'jwary iiiuintilviif fat, bultcr or Mrbriii|fB Vipir 
Chocolate U to be n^tx^Ritneadcd. lu tht^ caac.^ it iftoftt^n 
important to promote the general nutrition by ineanK of rectal 
allniGDiatioii, In caAt'fi »f canoer of (he- stoniaoh too abundant 
a dit^t rJu'Lild uiit hv iunltiU-d ti|iiiiiT an at bi;&t but little cau \ms 
gaiued by thia method of tn^tmcnt, 

Di^'fui/af Oineft t^ the Stomach, tu given bu Boiu. 

8 a.m.; llWgm. milk DJid i» feT,J>), AO gm. twlelw-k (iT4.S), 10 

KTiubiuter(7r3) :^3(!.G0 

10a.1I.: 100|^). broiled porch 7J,S0 

50tE'iL imtiMed tiidd 139.90 

tir too inn. oilvf^ bn^n (140), iWMlbraid (90J, t 

19</dDvk^ IWgni, milk «ncl rW &MJOO 

100 emi. vial 14^-1'. 

&Opu- nufoirom - ... 12^30 

Sp.kf.: lOOprm, t«iiiiKl milk (CIS), 60^,cakf«n»7> .... S&4M 

7 P.M.: lOOinn. craiin _ . 2144M> 

AOirTii''vieWh,lOj(TiL butter(7].S),3<) ^nt hun (131) 37^30 

ftp. W.: 60giia.4rc*m 107^ 

TWl 2W0Ja 

Pict'lUt of Wtgfit/or Qinttr q/ /Ar Slf<minrA, 

Albumin. ?M. ^^^^^S;,, *^ 

Morniair: l^icm. laultnlcininiinoM! ooom - 6,0 4.00 VA.h 

Poirn.>oa: 200 kjh- k<?fir. 6.6 4.60 S.S I.O 

Noon. I'V) Km, mnllpU'inimmcwdoup - 4.0 O.IGO 0-3 

JOUtrn- Ji^mpi^d tHrvf . . - 20hO 6,00 

An«rnooD: 1-M) grii. niaholfifuimncoeccKKW - 4.0 4.00 IX^ 

Evmins: lOO f^, m^mpocf htttn S6.0 aOO 

l^irn.lApiociL ..•«•.. 7.0 6.00 RO 

lOf/dock: W(f]ri>-ki'tir 6.« 4.«0 3J4 

With \hv rcK'on^ SntfTD. honey ,0,4 22 

witli ihi^ kelir ^ ^1. cognAc I4.C 

Daring tbe dny : *W jpu. fwieliswk JWI _L_00 3ft.O 

TiiUit 87.6 87.15 10^.0 25,0 

Oildri.* S60 ^m 450 100 

Enijr« namb«r of caloriw 1260 



I 

4 



ft72 DIET ly DISEASE. 

The QUtbont Iihw round tlie faliovriug dret-liet useful in mmiy 
caM^ of CHNwr «f tJw.' ^toniacb : 

Sa-m.: IfiO^i.milk with tM 100.0 

^ pik. toust ]AO,0 

10 A. X.^ lUO icni. knkFcl trout . KkGnO 

lOORin^ milk Of 3OinTKPbno|i0pUjti {4T.&K . - ^ flT-0 

10 Kin. buricr ... 81.0 

W ^i. uuuit 130hO 

W jiiiL plictry 60,0 

Uu.; boirilJoii wi(U Ti ^n, K>miitn«; 16,0 

100 put. clii<!kon , . , , 106.0 

or 10L» gm- rnlv«' iKorlbrrad 190) 
or 100 (piv i^alvH^ bmiiui ^140) 
nr ino^pn. t.iuBb<100) 

60;^. niocurnDi 212,0 

lot) i^rrt. muflbtHi potaCocn . ^ - -..,.»..- > lZ7iO 

»r Ion fpa. rpinach (IW) 

or UiO cm. jiHpumffiui 4 IS) 
^'i >£ii]. Kt^lc! whmt brvdd . ,,.,., . . , . 650 

4p, M.: /iOjnn. tcBiX .130.0 

'ill pn. buttor ... 162,0 

^0 ({in. riivtiiiv . .,.,... . 52,0 

TF.U.: KiOinn. mi]k(IOO) witbSpi.NirnjtlciiM (]fi). . . IIGO 

100 nnn. rlci.^ ccMikvd iiL miU; , . . 177,0 

'jO>e:h, i*b™i brwwl 130,0 

Sp. U. : 30jrrn, Prtur3pi!i>toD • - £7,6 

DIET IN GASTROPTOSB AND ENTEROPTOSIS, 
A^Tiilo th<- trftiitnitrat of gflBlroplot^is iiiiJ enten>ptofil^ i* mninly 
inprh;ininid, — reqoinTig tijp ll^ of weiUfittiny; Jibdomhinl lmn<U 
ages, majwiigc. iiml elw^tricily, — much can he i\c*:t*m\}\\^]mi by 
pn^lKT wire in t.lio dJoL Jtemarlcnbio rtaull.'* iii-e fr(.'qni.'ntly 
obtniiitvi fiT»ui r(i?^t fure:*, the jialk'nt Iwiug cjompelleil Ui Tx^nimn 
in llio TK'nmliont jHisition tor a long period uf lime luid U* t:ike 
large (|unnliticd of food. FaticnUi aflliclecl with tho^ coiiditiotiH 
.shrtuld lie down after (ttting. Tie du-t ^lumld U? wry nourish- 
ing;, jnid rlu"ild i-'tnitain soniewbut lurgi; pro|«>rtion6 of fatly 
f^xHl:^, Milk in nil C'KodlcnL f-Hw! in many (jntwf, und, whiro 
it is well b<jra*?j tuny 1h» tnlteo in Inrgt- (|UiintilIt^s. Wlit*n milk 
is not well Ix^rnc, ^ilid f^toila muHt he adinintst^^rHh Of the^, 
nil fcTTns of dij^KHtible mealA can iisti;dly hi' ul1ou'<>d, c^ikiIi aa 
oSiVkrn, roaat-ln^cf, broiled steak, and larab chr>}KS ; fxah of 
varioii?< kinds and digestiblp vepelablej* are alflo permiK^ible ; of 
tin> vegetahle^ especially to \k' recommended are spinach, car- 
rots, aspragns, antl caiiliflo\i-pr; of the fat8, butter, cream, and 
Mi?bnng's Vi^or Cb<»colfttc are pMrtriL-uJarlv iiwrfid. 

In order U) ovcroome lh<i ^vt^rc cun^thvation Aocwmpanying 
th«i4o conditionB, foods that excite intoetinal perifitalsi^ are espe- 



DIET IN DISEASES OF TlfK STOMACIT. 



S73 



cially to be nToonimfnili^il ; mn<.iiig Ui^aw nmy b€ mcDtiuucd 
older, buitermtlk, grape-juice, fruits, nnd ho»ey. 



DIET IN NERVOUS GASTRJC DISORDERS 

Nerrons A^norexla. — In thi:^ oondition it i^ iinportant to 
ifM>1at^ tile pationt from his family. Mitk, in gnulimlly incir^ut- 
ing quantifke, aii<), if (Ni&fiLUo, oUicr {(xm\s, f^Wtld bo givcu. 
If Uio patient iJw^ not tflko sufiicicnt [lourUlimcnt, nutnnit 
encmatu sliould l>c ntiinmif^teir**!, or ilw [lulicnt miiy Ix- fcni liy 
meanff of the i^tomaWi-tithu. The f«KHl should Ik< ^Iveii hi a^ 
couoentmtiH] luul nucritiou^s a fi»rni a^ |>aAHl1)](^; for this fitirposc 
egg? uro MiituUle. SoinuUine i^Loald l>e :i[]d(H) In tUr. ctiilk, 
FWiUcntly cases iif anorc-xiii ure coinplctt'lj cutvil by a wt-U- 
rcgulatetl resit <aire of from dx Ut ten ^«^'okM* dtmition. 

Nervous Vomiting. — This h ofti^i (jv<"n*<irTn* mcnOy by 
iHolation !ind clmn^ of tt^ne. In severe t*n*i'j* i>utientj<t t^huiild 
Ik* placed in be<l ; Ujcv urt* l>e-«t f<*<l on H'Tiii^olid or liqtiid 
fiMjd, since tlu' ktt^r is more (u'sily n'tnhK*<l thmi kuIkI food. 
It ehouhl be ^iveii in very itmtiU i|imntiti<y ; HcnifRiL hwff oggit, 
riw, :iud to(ist are e^jwcially uhoJuL (.>afki»<l itx* will ortca 
nITon) relicC The moat iii<iigeafible furnw nf fiwils are fr^ 
(jnently well btinir when th(? nicisl dij^-Mibh* urc *|K?edi}y 
votnitetL In severe castas the [Hitiertt ^IxpnUt b*" !cil f^T some 
days excJusivdy by rcotal alimt'n tuition. 

Wervous Subacidity and Anacidity, — Tho foot] nhonld 
be givt^n in mm]] qiinntitics and frcvjnently. The diet iiwd not 
be limited to airlKih_v*lnilc fmid, but Mumid be a inixetloiie, 
Bince the inlwtine liike* up the work of the stomach in dig^Bt* 
iDg the protein food A more extensive (ieaTiption of llio diet 
to Ife used will be found in the seelJon on the Diet in Aebylia 
Onstricji. 

Diet In Nervous Dyspepsia. — In thl^ oomiilino the diet 
ehould not btr too rratrictj?d. St ri^nt:th tuning foiwl, without uuy 
attempt nt a too ri(^roo« di^t, ^honld be prcflicnWl. In tliose 
cases in which milk is well UjJerateil it should Ik' i;i^t*ti in Iflrge 
quintitii<i< ; when it ij* not well l>*irne, hnitirmilk, ki*fir, or 
kii[ni.4-< may l>e snbstitute*! for It, Tht* pritii'nrV ftp[>eut<^ i^lioiild 
Ite humorc^fi, and he ^^liould be uJlowtil 10 cat anv fooi! he can 
tli^Ht. Alcoliolie (^timllfants »Lould l>e pmhibited, or given 
i»n]y in very small rpiniiHtlf^' In severe canes a well-con- 
dui<u*d rt»t cure will protluoc the bent re^iilta. 



^ DIET IN DISEASE. 


% 


■ 


^^^^^f Diet at RffvnvnrtuUd try HurkaTt/or ^rrvous Dytpeptia^ 


V 


^ [For the linit aix dajra i>r LnwluwiLl.) 




^M 


^^H 7.30 i- N. : \ liter nailb and 2 iwi«tjiu-.k. 
^^^H 10 jL. M ; [ liter tutlk Jitid 1 ihivtwck. 




^^ 




1 


^^^1 1S.30 p. M. ; A |ilat« of wit[> witJi 1 ^g, 50 ^- bruUud meal, and iiuBh«d ^J 


^^^1 pOLAU«& 




^^H 


^^^H ^,30 1^, M, T 1 lilAT aiiVk amt t iwietock. 




^^^1 


^^^1 5.30 F. BC, : I lit4>r luiLb nnil 2 Ewititnt^k 




^^H 


^^^L^^ 9 r^ K^ ^ t Liter niilk, 50 giu. bn)iie<l iiieAt, with hrviicj mij htiiur 


■ 


^^^^^^ 2>»f/ fu Rfcttr/untnd^d by Burkurtfor ^ervfnt* Dytpfptift, 


■ 


^ (For ninth to fiftwnth dnj of tTvatinaDC.) 




■ 


^^H 7.30 A-M, : } liter milk and 2 zyi\vintc\i. 
^^^B 8,30 A. H. : CViRi^e nnii civmii, hrwul miii butter. 




■ 






^^^^^^^ 10 A. M. ; liter cnlllc and 2 zwitrboclL 




^^H 


^^^^^k M. 




^^H 


^^^^^B ] r. M. : Soup Willi vgg, 100 gni. mwi, tnastied |K)Uloai, 


7dgm.pnmaL ^^| 


^ 8.30 P, M, : 1 Lilv<r milk 




^^^H 


^^^1 6-30 p. M, J i liler milk. 2 swioback- 




^^H 


^^^1 8 p, M, : i \i^ftv loilk, cr> gm, meKt, brvul luul liLitier 




^^H 


^^^1 9.30 P^ M. . 1 litpr milk, 2zwieback. 




■ 


^^^1 Diet w Re-commendcfi htf Buriart for Nervous DytpepHa, 


■ 


^^H (After Ihe tifteenth Daf.) 




■ 


^^^1 PrgteEu^ 


r... J 




^^^1 ^roall cup of coftix ortM (SO jEn. rrfTn) 0.7 


18,2 


34.0 ^M 


5,0 


H 


^^H 80 ^1. cold mwi . - . , S0.8 


2.0 






OJ^ 


^1 




ld.6 


H 




10,0 


mo ^H 




10,9 


H.4 ^ 




10,& 


14.4 i 




40 


11.4 




6,4 






1,7 


42.6 


^^^H 12&gm. prunn . , , . ,0.4 


. . 


8.8 


^^^1 SOO ictn. of rarJIUcOOUl food of lOJ huid 12^S 


S1.2 


45.0 




18,2 


'24.0 




10,0 
20 


J4.4 






0.5 
16,0 


S9.0 
0.1 






2.0 






5,2 


S3.2 


^H ' rXK) ^m. mtlk 17.0 


18.2 


24.0 




18,2 


S4.0 




2,0 


}0.e 


^^^ 


100,8 


380,2 


" IttBT IN HYPERCHLORHYDRIA OR HYPERAOUTTy. 


By the torm hyporcih1t>rhy<lria is meant an iDoreflde 


in tK« 


secretion of mnrmtio acid in tlio fltomach^ Id the treatment of 

■_ J 



DIET IN DLSKASms OF TEE STOMACH. 



375 



thifl coDdUioL tbc main obj(?ct \» to prcvi'nt this incre&^c in 
acid ; tliia i» I>c3t ac-ci>in])lislieil by regulution of tbc diet. All 
irritAtinjf futxls, lurb ns .tpia-s or (Hindi im-ntjf ([>opi>t-rr nuiaUird, 
vici^^r], sHuuld be uvnidk«l, uud tbc uh* ^^f ull ;(ti»nj; nicobolic 
l»*voni^s uwl of bftixl subsUinoen, which aiv upt to in"iuit* Dio 
utomopRb, surt as ttutn, should Ik* mterdictcnL Food mii^t be 
Ui^>rougIi1y mjiFticuk'd, luid should be taken noithcr too cold nor 
Un hot. The cluss of {ivnU th»t >uv>m tn W Ikrat fluitw) nn? tho 
protetu^, 8iti<» thej' oombinc with and tlicrrlore iieutnil[£<^' the 
€xoi*8« of lioid ; for thU riiaou foods conUimini^ ud abiindaiioe 
of prottiit, 8uch ui! ("gg^r nii^t, and fi8b, nmy Ik* j(ivvn quit« 
fn^ly ; lUirbobydniU^v should Ixr adimuUUTcd in eujull qimutitioa 
mnd in the mo^tdigr^tiblt^ fornm. 

CUt«- bnin^ boiled OU ^m &MX> 

Uvi-r rouKiKi* ft.M MO 0.40 

Ulvi^ Uiymai, bQilad 0.W ^60 T.SO 

UMtmiiH0« IM 4.0a 8^ 

Ow-relu nmufi 1.10 4.4D 0.80 

Blood iDUttOD ].90 (.90 10.40 

I'ork, boiled I.a0 6.40 12.80 

IliLDi, boilod L» 7.» 14.10 

iUm. mw 1.W 7.00 15.30 

MuitoQboUcd 1.90 7.00 ]&.» 

B«rwi(xi 3.00 a^ 16.00 

\W, boiled 1» 8.80 17.60 

LvubclCowailuU mcftt foluUun . . - . 2.W HJU 17.60 

B^t aiO 0^ 0.S0 

Milk (riiulvjicAardiffcrvnIkindtfl. . . 0,36 1.44 2,80 

Whii* brm'd 0.30 1^ 2,40 

Gtuhuki brud 0^ IJO ^48 

BUck hntkd (gny bnad) 0.50 8.00 4.00 

rumpcrmdtel 0.70 2.80 fi.fi0 

■'HM)d"ch*M , . 1.0O 4.00 9M 

FmnuKdeBm UO GJ!0 tO.40 

EdAiiicbr«w L40 QM U.W 

"n>ckjitem^'cli«io L70 6.80 iS.60 

P<« Munge LTO 6.80 16J0 

Rwu^ri^n fi.16 8.40 18^ 

Hwl« diecM :i.eO 10.40 20.80 

Cixott 4.10 10.41) 3280 



FleJ5(7her hae iovefitigatod the subject of the tximbLninz 
efToct of muriatjc sdtl witb vurk>ii« foods ; ke difioovered 
that boef, veal, bom. and mutton bind twice as much mu- 
nfttio aoid as do calviu' brninfl and sweetbreads ; the first- 

* KroJikheiiot d, Spfuffrvhr.,d. Hagfru,i^4. Damef, l$9^, p. 932. 



S7A lHf:T IX DtfiEASR 

named claflB of meats are ttcrefore mofit jqjjtiible ia conditions 
of hyperchlorhydria. In addition, Fleiecber m4;ntjor>s tJie fol- 
lowing articles of foods capuble of Ijinding Ijli^ <jUJin1itteA 
of muriatic acid : pork, chei*e<!, gau^ig^, Lam, Grtiham bn-ad, 
milk, un'l ojcoa. Farimweou^ fof^nls ure not wtll toleraleil la 
tbis conditioD, and niui3t be given eitlicr in n very dige^ible form 
or, beet, combined witb protein fond. Only the more <ligr?-stible 
vogplaMpH ape to he allowpd, Mich itw mawhtd potato^, spiiuu^h^ 
SHpamgUfi, peau^, and carrots, stminc<i and cation In the form of 
pur^efin Fabj tend to leeseti the acidity of the gastric secretion, 
and are therefore to be recommendLHl ; they arc best ^vcn in l)io 
fbrmof butter, cream, olive oil, ^nd the like. Of the fluids uJkn* 
line mineral wulers, HUeh as Apolliuaris, Vicby, and Seltzer, arc 
tajM-iiilly useful ; the «irbon dioxid contuiued in the«e wulen* 
producer a sedutive e0eet ^nd lessen« the secretion of acids. 
Th«w wiitcri? may bo Lifie<l to dilute milh or wine. The tabU 
on p. 375, hikm fmm Fleischer, show^ the ability of varlows 
foods to combine wilb muriatic acid : 

Id arranging the diet for patients with hyperchlorhydria it has 
bei^n fi)iind bcT-t, in theauthon^' experience, in dealing with pa- 
tients Ukin^ but little nourishment, to allow tliem to eat ut 
frecjueat intervals; if, however, larj^e meals are consumed, it is 
advisable to permit only three meats aday, altewiag the gtomach 
to rent during the luLcrvaK 

The following diet hae been nwd with advantage by the 
authoK in caaee. of hy perch lorbyd Ha : 

Calorlpa, 

6a.v.: 200|^, milk llnvored with tea ]:!& 

S PofE-lxului] vgiCH lOO 

aOgau (fiai^ 164 

40^"^, hiKKT , , . 32fl 

10*, v.^ 50gm, -lierry {(jn)*ith I .*KR (SO) ,110 

12 U-. lOO^i), rlik'keii (c»rliroJ«<l[nt«lof wmtkind) . . 109 

1(K) ^, niikflhtfJ poiftio«»i -...,, 1S7 

tOO|rTTI. Mplnm'll 10S 

or I0i>ui'" iiM]>itni(i"i» (185). 

10<lgm. f^itivitl upi'IiTi 53 

or I0Oi*Tn ■^I'.'nf! pnintt .*.......,. 44 

d0|^, £1UIl- hi'hi-.tt IrrvHil . , . 154 

4fMl.: IbO y,m. milk , . 100 

fiOt-m.rPu'ltere , , . 188 

5i,'ni. biiiicT 407 

7r. M.: 100 ^m. milk fliivorcd with l«A 07 

lxi(VU:>ilvdegg 80 

50 gm, \oaet ^ . ^ . 190 

2S gta, htAUiT S08 

«70 



I 



I>IET ly jytSEASBS OF THE STOMACB. 


1 


377 ^1 


J)id-iiMt/or Ihtiattt m'M Oft$tne J/sjrr^iciditij.^^Bifdfrt) 


H 




Gr«ni» 


Gr«nu 


firmnm 


Ol\- 1 




r™i*in, 




<»nMi ^^J 


In lh« moniinff 


bctwvvn T and @ o'ckwk : AOO c-C. 








^^H 


of milk, 40 i-m- tmiKt . - ^ 


20^ 


LS.4 


55.S 


4sa ^H 


Ill Ihv momirttr 


jii JOo'dook: 70 am. of tToilol 
irm- of nlow**l yvuX without iho 








^^H 


vwl (or m> 








^^H 


■kin, prTpuf«l an whitv mtftiul) nr IvirTKtuik 
or fuwJ.^O jn"- uf UfiM, 1 v^. - Cttit-back 








^^H 








^^1 


(30 EiD,) 1 r>f a liter i>r vine ... 


%^% 


ISLO 


sao 


306 ^H 


Twelve <i clock 


nwjii: Freiioh ■oup, willi yolk 








^^H 


of cnr ' . 




4.0 


t>.2 


7J 


^^1 


140 nn. of broiled or hoilod fowl, mA mcnl, 
piiTiia or huolitf, 200 Km- of r»w niiMt w 
















^^H 


bwfuJeflk, or 


100 gm- of finel;^ <!hop}i«l boiled 








^^1 


^rcf or ti»h , 




4a3 


10.4 


- ■ 


2TS ^H 


Aopam^uH wilh rmrn gravy (a few boidii of 
jLK|>[im^uti oud half a kpcxmrul of gnrjr) SOgn> 








1 








J 


of Ucut . . H 




i2 


1.2 


ifi.t 


S7 ^H 


Onwlcl iitmffi* . 




12i 


1^ 


v.fl 


^H 


Oiip nrniill Clip of block cofl^ 










In ihc afti^moon n( A (^dock : 2&0 gm. of milk- 








^^H 


cfK'oa. 3 ewivbnck -..,.,. . . , , 


13J 


15^ 


44.0 


385 ^H 


In lh« CTi-nin^ 


: m T o'clock: TO jnn. of ooM 








^^H 


lucRl wicb 100 sen*' of tncttl'jeUj, SOfitu. of 








^^H 


tOttBt ^ - - H 




24<2 


5.4 


IM 


21S ^H 




M 


iki 


Ol5 


^H 


Toed. 


1 


IfiM 


96.S 


13&0 


23118 ^H 




I>ie(-liti /or JJitpfTttddity. — { H'^jt^/i^), 




H 






rroitln. 


-^, CATbO- 




HorniD^: 


100 f^m, tm vrith mUk • . . , 


3.4 


3,C 


48 


^^H 






12.0 


10.0 




^^H 


Forenoon: 


lOOi^iii, mw linin 


26.0 


8.0 




^^H 






3.0 


ISsfi 


17 


^^^^^1 




200 jfiu. Atvurunat mnl broth 


^^1 


, 


(lO^m, AleurunuiUil^lXrbrulh) 








^^H 




tfiT 2j0 gm. oalmvfl] brolb 








^^H 




(COgnLoaLnitnho'JtiObruUi) . 


10.2 


1.7 


ao 


^^H 


^oon; 




as.0 


1,7 


ao 


^^H 




^0 gm. mjuthfv] pnlnroM ■ . - 


8J£ 


ao 




^^H 




100;^, whiU- wmv ffjth titni>> 








^^H 




lci>>n, V ioh V or BUinvr w«ior 






aft 


^H 


Aflrninon: 


I00pn-l« 


54 


S,6 


4.A 


^^H 






2.0 


13.6 


l: 


^^H 


Evif iiiD|{ ; 




eo^ 


4.0 




^^H 




^ scnimbledrons IDOgm. vino 




3.5 




^H 


Aliueal tlitien: 


100 ^ni' Al«urtiiiat toaid - - . - 


28.3 


1.6 


66,7 


^^H 


10 crdork nt 


25(1^10. milk 


8.S 


9,0 


120 


^1 






-^^^_ 


- 








To(4l 


229.S 


Ao.I 


UM 


^1 




QiIoHm 


rno.o 


700.0 


600,0 


^H 




&ilu« Eiiuab«r of OblprifB • 






2412 ^H 



37S 



L!ET IN DISEASE, 



DIET IN nvrTESTINAL DISEASES. 

Tbo (tiH playv cjuit^ &< iDipurt^nt a r^h i» the tn^atniont of 
discuM^ of the iiitt^titu- m it d^n.^ in the trt^tment of f^lrio 
dworders. In tnanj' jnteAtbal dUturhanocfi, auch a» acute in- 
le^tinal catarrh, diarrhea, etc., curea can often be ejected bjr 
dJet alone, when without this mode of treatment the dirteafle 
might become iutrstctable. The diet in iiitoitiDal diseases, a-* 
in gastric ilioordfr*, muBt i>c auch as will pnxliU'e no annoving 
6yitip&>m$> The proc<ieH of digcstiou in tb^- int^Btiuu m ex- 
ceedingly «jtupUeated, and therefore the digeatibiUty of foods 
in ihi:^ f>iirt nf tlie alloieutary truct h most difficult to deter- 
mine. Thi?L gLibJcct was i^tudint by Ilfibuer,' who ctc^tenuiaed 
the d<^roe of absorption of various foods in the intestine. 
The following table gived his results: 



FOOd-fltuffii^ 



Hwt 



Milk ftitd chene 
White brad . . 
Bbck brawl . . 
M ji Cfl Ufltii . . . 
IdiUod corn . . 
Corn and chffew 

mn 

Pcu - * ■ ■ ■ 
PotttMl. . . . 

UbbagQ .... 



WoUhtofaame 
lugnjo*. 



I 



{tii-i 

2470 
3490 

mo 

1301) 
685 
750 



G38 

000 

8078 

S8S0 



^ 

'C 

o 



376 
247 
S15 

420 
7GS 
76fi 
626 
041 
780 
55S 
621 

810 

40ti 
35U 



Abiorbod In pcrceiiujivs of— 






96 
94 

05 
83 
96 

96 
96 
DI 

91 
7(1 



d 

A. 



67 

»T 

94-09 

9« 

81 
CM 
83 
Ufi 
93 
80 
8a 
6H 
82 
61 



II 



95 

96-97 
97 



94 
83 
91 

63 

w 

94 
91 



100 
100 
99 
89 
99 
07 
96 
99 
08 
92 

b6 

82 



a 
5 



82 
51 
74 

va 

78 
70 
SI 
85 
68 
84 
81 
78 




It is thus ahowD tlmt certain forms of foods oontam very large 
proportions of protein mutter, hut ihat their ahnorbabilit^ is ^o 
flight thnt their nutritive vahie is far lower than that of foods 
fHjntainin^ l&i-^ pn^t'^iii. Thtis, while pea« contain ci^nsklera- 
bly more protein (7 [»er ceut.) tban dovs milk (3.7 jmt oeut.), a 
amcb aomller pro]>ortiou of ]in»teiu is ubsM^rlied in the case of 
the former than in that of the latter; on the other hand, die 
abHorlrubiltlv de|)e[iiU greatly ua the mode of preparation of 
the food; when vt-gctaMcd ore niaahed and then stmiiied so aa 

^ ZritnrJir./. TtUliiyyr, vol. xr., p. llfi> 



DIET ly iNJESTlKAh DISEASES. 



870 



to rid them of thi'ir cvlluli»io t^^nvolopv^^ tlicy urv much more 
readily ab«orlK<<l ttmu wht'n (^iU<ti with tlir ix-lltilosc. Tbc 
dlgcfit'ibilitr <jf (.rt^ruio fixxls in the (iiU'Htiiic \x\t\k*h gnirtly wiUi 
diCca^U iiulividriRK For iULi r<Tunon v,xm'-\ rules* ainutjt Iw 
formLiIntc<] iTi »Dy (m>r, htit thi^ dirt mu^t W vnrlo^l acoortltng 
to iudividiiat jtw^itlmntiiK, B<>U4 ^ butt €X|)t«s^ his opinion 
on this finhjfv^t ns fnllnwH : 

^1. Id a namber of iiitwtiDal di^cflAM a change of diet !a 
mm e e owi ry or may i^von be hjirrnfiih 

"2, In Bomr tu^w wpcciid diddic rtvxt riot ions arc dirvctly 
indicated, hut thu»o i^hoiild Ik- as lew ix» ixjssiblu. 

"3. In another soric* nf (m.w» uu ubundimt, heuvy^ uot 
en»ily dig^'^tihU* nr abwrbiihlc Jiti i* iridirjiUiL 

"4. Thf gcncml aim of our trwilnicnt .nhmild olwavA be to 
M> mihtiiL^ tho r^nj^ boforn iik tbut iIigi-iiitioiL <jf u iitjnnul dl^tt 
will alwiiy* *M*nir in thp niimpntiiry i^miid wittmut iiny ■iiKjfv*- 
^ve or objective dib-tiirbiLiKxi^. Under tht»G [<ii'cuiii&tancot only 
can the tiii«y be con'iidertHl ruryxi." 

AocordtEi^ U\ tliNrolToct <>u ioU^tiual |K>ri4tal»;M, fiinds may 
bo divided into three chi«*e»: those inducin^^ onstipation ; 
thotfc pr.*d«cin|* a laxative elTtn't, und tho*- exerting no irHpccial 
elf^t in either direction. In the fit^t cIjihs arc tho^e foodii 
coutaining un untriiigent, j^uch a« tuiiniii ; among tfio^^ may be 
mentionod certain rod wines, cocon, and ton. Kiee, tapioctt, 
bftrley, eago, maoftroni, 6nd potatoes have a t«ndeiioy to pt^i- 
difc^ conetipAtion in many indi^HHnnU. 

Among the laxative foods may l>e meationed fruitti and c^r^ 
tain vegetables, a» cucumbers, tomatoes, and eahljutre ; cider, 
buttermilk, beer, and the carbonated waters aW exert a laxa- 
tive effect. 

In tbc third cln-ss, foo^ls that have do especial eiTect on the 
int^tJiml movements, may l>e place^l meats, fiah, e^s, toasted 
brmd, and xwieback. It must l>e remembered, however, that 
t.'crtjun foods that pmve lajcative in ooe individual may be t^oii- 
fttipnting in nnother, so tlint no precise rules oan be formulated ; 
in encb c<(S(^ individual tendenrie^ miist l>e emi^iiltf^d. 

In severe forms of Intestinal disturbances reeliil alimeutation 
must ofWn l>e resorted tc. For a further eonsidenttion of the 
technie and forms of fixwi to Ijc utilize*! in this methoil of feeding 
the reader ia n*ferr<*d to the si.'ction on Rj.'ctal Fwding. lu those 
cases in wliioh fluid canuot l»e(jiven either by tiic month or by 
tiie recta m subcu tail eous ftwliiig bcconn^ nw'cssury ; for tfau 



3«0 



vmt ty DJSh'ASh:. 



pnrpoBe olive oil may he uwd ; one ounce may be injcctcti 
Iwkv ilaUy uikKt ilie skin, l>fBt Ju i\iv it-gkm i>f the lliigli ; io 
BCmu tiflbcs uorniut £)ull iuiusione ure iudiafctvtL 

DIET TN INTESTINAL DYSPEPSIA. 

In i[itc«tiim] <]ys|K-p?iu toixl filtoiiM l)o ^iveii lre<|ueQtly an<l 
ID verv frTnall <iimntitie^- At Jii^t only the lk{iii<l form-« ^liuiiUl 
be n?^, *i<kr|i ai7 w*?ttl( kn, ]>fplo[ii/c<t rkilk^ DialcoJ milk, 
Itouillon^ fluH ej>g-iilbnrnin : siftf-r a few liays the |>(kliout uiny 
gradually beplaci?d ou the tbllowitig diet : 4^v«ft' hrainN, itweet- 
breads, broiled eteak or luiub i.-hcip!?, HjA-boiled e^s:s botIi*<l 
lish, sntAi IV- mnckerel or n>c^k> bukiHl potatoes, spiuaoh, JL^jiam* 
guB, and »!itewcd frtiit*!. 

The IbUowing ]i>ft give* the gciicml plan ui a diet used by 
the nuthorg in thi» <H.>nditluti : 

dJorlw. 
tA.ll>: 15(»jffn, rnilk >vith M 101 

I noft-boiWl c^g - 8n 

eOgm. tfxiHtcJ wWbi >>nti<l(lA&) wlllL^fifcn^. batl4'r(m3) SlK 

100 pn. brrdk^ .'hirkon 106 

or 300 ffm. hi'oiW MehIc (SW). 
<sr ]0U irm, lamb diop (^0). 

hO ffm. mufib*^! jifitncoc* cir 100 gm- spinaoh (166) , . , . 04 

100 gm. an[Tlc*iO'?(* ... 88 

^0 j^TO. wWi bK*iid, itfilu <*r*Jilowrt . ISO 

3r. K.: aWpn, milk I3fi 

7r. H. : 20Uffm. milk ^rithrlTO 2iia 

I vifi'hoiFivl «^ ..>..... ...... SO 

lOOflm. nh«it brtvd nndSO imi'butir-r ilttfi 

2227 
DIET IN ACUTE INTESTINAL CATARRH. 

A« in uaute ^sfrio c^itarrh t^f* ftl^t in neuter intcMinal catArrh 
the n^^uhiMfiii of the diet i^ pmhfibly tho mnst impnrtaTit faelor 
in the treatnipnl of the disease. The pHtietit should be kept in 
bod ; after the bowel has been thoriHi^jlily emptied by a eathar- 
tic, liquid foods, siieh a** olear biv^ths, — fit tin^t witbtmt, and 
then with eg^, — thin pnicls, Hi^ht t^^a.roi^wi <H)oke<l in vater^ 
and egjr-albnniiti, ^honkl 1k' jjiven rxcln^^ively '"ir fievi.-ml ihiy^i. 
1q this cojKiitiuii milk xh^inld iiot^ ii?* a rule, l>e given. When 
there is eJttrcni€ tliii^t, the c»rl*imnt**d waters may W Hllowcd, 
but only In Amiill r|iinn1itieA. Thr thirst ts l>est relirvrd hy 
plaeing hit>i of onishfd io<* iti th*t pntimtV tnnath. After thp pain 
and Jirt(v>nifort have di«ipp<*jired, tcHist. ersickcf*, stpwrti f^hit^kfn, 



■ 



J 



DIET ly XXTESTIXAl DiSKASJ^. 



881 



fiofVbdil^ ^ggs, mtis-hed |M>tati>f!J<, mid l)uilod Hoe may l>t added 
to ihc diet ; iBdigestible foods, siioh ^ mw fnt\bi, hvxwy vcgc- 
Uibk-A, itDil fatty and acid foods ^loiild \w n\'(ti<M for a ooiiftid- 
cmble period of liiue nfU^r (ht? cviUirrh Utu* dinnpjKain.'d. 



DIET IN CHRONIC INTESTINAL CATARRH. 

The dk't<itu' tni-ii till out io olironJc mtefitinal calarrli de]H-itdit 
upon ihv cH>iiditioii *>( tlic f**aii niovtmcnt* ; these are, in a 
measure, an nvh-x uh i*> the p<»rtion of the lx>wel invoUvd. 
Ai^'^>nling 1^1 Nothiiii^l/ aisfsof chirmic iiiteatinal cacurrh may 
Iw- div]d<-d iiili* fiHir ^mtipn : 

'* 1, C(k-4vi cbamrtrri/ccl by protioiioocd con»ti|>alioD, Au 
evBCuatioD iippcur^ only on<?<( in two, three, or loMr days ; som^ 
times ofdy wJtb the nv] n\' rathsirti*??*. The feral mstter is 
usually hard. Af^ a vtmm of the coufftipation, Notbuag^I as- 
Biimiifi a d(M^r(ti^ Hotivity cf the automatic nervous apparatus 
of th<» irt^siiui.*^, thii* hein^ the R^ult of the catarrhal process, 

"2, iSwieA in whidj *'onMipati<ir iind di;irrhoa constantly 
alt4*mfttJ>. Fcr two or ihreo duvH there inav bcii daily evacua- 
tion <jf very JianI ticjvcrta. On the fwlUmiup ilay ihcro may Iw 
four to j"ix vrry thin or muffhy movcnicnts mixed with mucus, 
awmmpnuiiNl by viotont paim, and then a;>Ain con8ti|>atiou for a 
day Of tw(i, ctp. Or there may bo <)uil<>a normal evaeuatiou 
(once daily) fcr a few days in sucxvssio]] and then again four tn 
seven diarrheal movement* in one day^ and atler thisoonsliiia- 
tioD, The principal feature of these ca»e« ts the oonstipation, 
but the excitability ff the ucrvou** apparatus being qinte j;ood> 
the decomposed ^ta^nant contents oltcn c^iuse inci-cased peris- 
taUis and diarrhea. SomcUmt^ thc^c allcmating peri^8 of 
coi IS ti (nation and diarrhea continue for a long time. Thus the 
ftaticnt may be coii^ti|>aiod for four or tivc week*, or even for a 
few uiontli^, and then af-ain the dinrrhca may set ia> lasting 
several weeks or months. 

"3. In a very limited number of cases there is a daily evac- 
uation, which is uftuatly not formed cr inii?ihy> 

"4. Cases in which there are for months i*cvcral dinrrheul 
evacuations daily. Tlie dejtvta. nw a rule, show the hiUary n> 
action, or they may cotit:tirL yclljw fnij^nunts of inucUH, yclh^w- 
tinged epitbeliura, and romidHM.'lK In tluwi? cjim^ the wttarrlud 
propcfw nflccli* not only the large bnwel* but oI-"*n the tiiuall in* 
te.Htine. The absorption HufFerrt, and them am more abnormal 

■ SjMctcile l\ttJuIoyU urui Thfrap.^ Vol. JLttL, p. IW, 



3S2 



DiET IS DISEASE. 



|tru<lu<:b« in the coolent^ (ucide), wbicli give iw to increased 
|tcrK'«tRl-'<i-« in tW ^rnall a« well oa large bciwcl." ' 

The ttxwtmcnt t»f chronic inlostinal catarrh thoreiorc reeolvea 
itself into ihe trvatmcmt nf the nc«om|wn}*iog chronic cuDaCipa- 
tion^ chrrinic dmrrhea, <kr n condition of constipBtion alternatiDg 
with diarrhea. 

Diet in Chronic Constipation,— In this condition s 

mixed diet, containing, &o far a^ ixitfiihle, those siibt^tances 
that stimulate the into^tinal pfri^tuIrdK, should be prescrihed> 
Aatringente and anything that UmiU bt produce c^nattpation^ 
HuA 08 OKXHi, chocolate, Uu, rcxl wilier, rice, farina, ele., ^hoiilti 
be avcided. 

The following foods should be preecribod hi oojw« of cbronic 
consti|>ation : Graham and rye bread with bntter^ fruit, bntler- 
milk, kefir, cider, beer, fret^h vegetables, as cabbage, p>aner-kraut, 
and salads. Fats are especially to l>e recommended, and honey 
is also useful, Salts stimulate the intestinnl movements, there- 
fore foods containing salts are indicuted in this condition ; among 
this class may be mcutif.>nc<l herring and caviare- Sugar, espe- 
cially milk*i-ugar, has n marketl tendency to increase intestinal 
peristalsis. Water taktn c*.»ld or on an empty stcmuch will ulso 
stimulate intestinal niovementSi 

Diet in Clironie Biarrhefl. — When eevere symptoniH, 
such AiH intense disrrhea and {tnin, present themso1vc» iho 
paljenl must Ik? put to bed and kept on a very rigorous diet ; 
the |>eriod of rest may he tengthene<i or shortened aocording to 
the severity of the disease^ In moderately severe cases several 
weeks will usually snftice. Nourishment should be taken in 
amall quantities every Jew hours, sufficient must, however, be 
^iven to muintnin the biHly weight. All cold drinks or carbon- 
ated waters, fmitJi, cabbttge, and Hilads are to be nvoidcd. The 
most suitable foods tn this disorder are broths t^ontaining barley, 
tice, and fnrinii, *oft-br»il«l eggs, HWi*ethrends, stewerl chicWenj 
broiled steak^ boile<.l fish, toast, cracker^ baked potatoes, tea, 
milk (boikxl), and ec»ooa : in many ca^es port wine is quite nse- 
fnl, as it centains tannin, which acte ns an ntitringent to the 
bowcK In this cotrdition milk even when boded is ofUn not 
well home, and mu^t then be avoidf*d. 

The followinfji diet-list, taken from BoiiSj*illnstrates the method 
of prescribing nonrl-^hmctit in chmnic nitorrh of the iiiUntint 
ncccmpanic<l by dinrrhcn i 

' EinburiiT /Kv^i'j of inUatintt, ^ ICNX 
* Duams of Ihe InJjMintA, p. £S4. 



■ 



DIET ly lyTESTJyAL DISEASES. 



$A,M.t Rieh«l coccaHn wuler), ont ncchftrkn labJet (oroTUallotc), lout 

uH bu»«r (20 to 30 gm.). 
10 JL H.: One oup (200 |^.) Hoe rmel btickwliei^ 4>r oaCtiii griti in vnl 
bouiUcm (nvojd mil). In nddillon ; /K) leni. rD«»l«l ttal orbecf 

(■CT»p«f!)j fHuil (Wi lit CM'trJ mwl (nVnuriatll or »ln>iLKljr picktol 

1 r M.: 6oup oTpcKut nr iHtiiiMor piritic orotUMal, frifiiiA, ororimnliircli, cUr. 

(kildltirw of iiiirtiiM i>r I'linudn aIIawkI ; winmliw f»rNdd«n). In 

■Dmnwr hncklcWiTV nonp iw\th «ncchAHii if ilMii«<i)> 
too nn. of rloc boulUan (ivold rloe witb uillk ) or fUliu twnillon, veU 

tJJirk»n*tl hv ciy)kiiig, 
Grvcn vi^A^^mfili^ nr iniUten in pur^ form (AO U> lOU^.), meft 

Aud flvJi (ftu ujii,x-^ri«i|) (£^ u> 100 Km.) fbutlvr muop Hliun-iid; 

emmwDOM or lui^hty iteuoncd macm farbldd«4i). 
^tewcd fruitu, witli ihecxivptinA of liiicUeb«irT^M fttidi-niubem<^ 

EorUddcn. 
Coittitdi (cDrn-«tArch» with ii Uitle yolk of c«K uul icm-turin) 

nlloirid. (Avoid fntii-Jobri^l 
Ad bcvctuACii: Jlucklchcrr? ^^c, Buwiiidj, Ccutuntv, Binmruba 
wine, nlcf noHmiL ^fiwoct winc», whlivt winv*^ niid elT«rvacvnt 
bcvonuo* forbidden.} 
4 r. M. ; Tern (wiiikont milk) vith aiuvliarin or ciHiOo, caliM, io«ti, ittit^hni^k 

(vithbntlcr). 
7 r. H.: t^imiDod irruci (<3Btnjc«i, vU^}, cold or wanu meal [AOicni.), Ioimi, 

halUtr (aigm-)- 
9r, M. : One gliiw of hucklcbtjiry k<nion&do, «nnQ«d or hot tiiulied viae 
(nocluirin ), or tei Hlthoni rod wino. 

In rcinf?itinna of chronic intestinfll catarrh In which 
diarrhea alternates with constipation tl^e ^me plan of 

treatiEent mav be followed as has Ijecn deMcriljeil for th'we caws 
iCComfKUitod bv constipation or diarrheal ; it is especially impor- 
lant lo lr«it by diet the more prominent ^yirptom*^, whether it 
be di&nii^ or c^nslipation. Mineral wnlrru uiv frequently 
utilised in aiKOS uf ehmnic* intestinni »ilnrrlu Fnr eases 
Accompiinied by eoD*lijMttion (be wiitcr* nf Mnrienlwd av\i\ of 
fttratop;!! (Conpre^s an<i Knthom ^prinp*) niv most hcncfiriuU 
Wher^ fliflrrbea h the prominent symptom, CWUbfwl and Vieby 
%Te to be recommended. 



DIET IN DYSENTERY. 

Tbo diet in acntc dysentery is similar to that prescribed 
in aente mte>*tinal ^^t^rrh. The patieiil in put ta W! snd only 
liqind footis are ndminif^tered, <^K tlieee the mofrt suitable arc 
bouiUon, broth, egg-albumin, and tea ; jfmdually, as tbc con- 
dition improves, Fremisclids, such ^ mjlk-to£i»<t, ncc co(>kc<l in 
milk or broth, gruels of tapioca, etc, may be firt^wrrilnsd. Solid 
food should be nb&tnined from until « few dnyw aiWr tbo diwjrdcr 
has abated. 

In clironic dysentery the food ii^kmild be given in small 



384 



JilET IN DISEASE. 



ijujitititint at froqucnt inUTvnl:), All c<mt>o, iniligtvttblc food 
tilioulij be avoiilci). In nttxr rrsprcls tJic dkt la ^lEniW to tbat 
idnsady given uuJer (Jhr^miQ InX&it'inul Cutarrb, 

DIET IN ULCERS OF THE INTESTINE- 

1. Diet In Ulcer af the Duodennm. — Tbediet id ulcer 
of tbriliKKlcnuni i^ tht' sjimt'UJ* fliat<»rt^L*inu ulcer, au J tht raider 
is rcttrrcd fi>r tbc dctnilrt lo dn? /^ec^tiou doftlint; ivith tbw *abjcct. 
Id ca^ee acooni|i4iiiied by heiQ<>rTba^ alk8oluto iv^t in bed muRt 
be inKistpH iipon^ nnd rr-olul !Jimi>Tit:ition ndniinifiltired if n«<c^«- 
Bary. After the lir«t w«?k tbc Irfube reet eure ^bould lie insti- 
tuted, uc'cordin^ lo the tntlbiJh dc8crii>eel el^ivhere. The lir«t 
form of food to be allowed is milk ; after the first week Carls- 
bad wntcr should be given each tnorDJng. In very fltvorccase» 
BoQA advises exclusive rectal feeding for oae or two weeks. 

2, Diet in Other Forms of Intestinal TTlcers. — In 
addition to ulcer* occurring iu the dn*:KJinunt, Tiilren'tdiMis ulcera, 
sypliilitio ulocrs, tosic ulcere, amvloid ulcers, and dyaenlcm 
ulcet^ mav occur in the iuto^inc. In auv form of ulcer th? 
diet Fihniild be non-irritnttng ami pnhWy <lip:™tible. Among 
those fooils that may be jjiven are milk, ejrp** riec, farina, m^), 
all forms of broth, Gs|)eeially chicken and mutton bnjtbs, sweet- 
breads, stawed chicken, bake<l potatoes^ mashed potatoes, tea, 
cocoa, crackers, and toast 

DIET IN MAUGNANT GROWTHS OF THE lP4TESmNE. 

The. medical 1niLtnii*ni iu muHgiuiut f^rowtht^ of the iat^^tine 
is only an adjuuc^C to the surgical treatment atwayt^ indieatod, 
and consists ^Irly in Irtuitiuj^ the symptoms as they arinsie. The 
diet should Im> hi|^hly nutritious and at the same time easily 
digestible ; t^niall i|mmtities of food should be given at fre(|Uerit 
Intervals. Milk, brotlis, solVlwiiled eggs, raw scraped beef, 
6wpetbreadrt, baked tiiid uK»lied |>ulat<H*, vejrttableh, hncli aa 
iarrots and [jois, tliat have Inrn fiin?ly divided and strained, 
stowed fruiU, toai^t, and crackers are porrais^ible, 

DO^T EN ACUTE INTESTINAL OBSTRUCnON. 

The tre«tmt?nt of ai^ule ml^tinal oWruotiou, except whm 
due to the impaotion of a forvign body, when it may possibly 
be passed through the l^owel, iy purj^ly fiurgieal ; a^ Treves baa 
mil "There iaone measure for aeute intestinal obstruotion, 



I 



I>tKT IS l^TFJiTISAL DtSEASKS, 

and Lliat in b^ mcanA of Ui]xirof »iuy/' Previous to (operation 
tfacfuUowJng dieloiic regiilaUoiiH should be carried out: The 
patient .nbuuid br kt-pt lu bed, uud iu llie ui:ute attaolu ult food 
fihould l>c witlibelJ. Tbirst luuy be qmucbed by amatl bite of 
ico k<Tpt in llio uioiitU or a fW drops of hot water may be giVen 
al frpqn4»nt inlrrvuU. If the du*«i«* <*it£tidfl nv(T ft period of 
several djiys, reetal uli mentation or du^ admmintratioQ of salt 
eolutioiu must be rewrt«d to. 



DIET IN CHRONIC INTESTINAL OBSTRUCTION. 

In tliU coodition the <3ieL kWiUI cbiefly lie liquid or 8emi- 
fioliJfi, All iiidi^'^tibly fiX)*l «lumld Iw nvolded, e**peeially tlione 
fonna tbat an.^ apt to leuv<' n Inrj^- anmntit of residue ia the 
bovrel. Tlic fitixl^ to bi* nvoideil ure aaiadi^ hea\*y vt^tableti, 
and fruit»(. Milk broths, ^^f hniiled fueat^ chicken aud 
Ewcvtbn-ndi, btnU'd ^A\ rii<C| fannii, tount, cruekvrti, uud butter 
arc p<'rnji;4i«iblc. In udviinoe<i ou^rd n!4>tul fcediug mudt bo 
Gurri^Kl out. 

DIET IN APPENDICITIS- 

Tli« diet«tio tivaUiicut in this ibsease mtirt be govenwd by 
tfa« vymptomit^ for eur^cnl trmtmeDt is ii^iinUy indicated, Tbe 
pntiont should l>o put to bod, find tmdor no condiuon be allowod 
to t\s^ until reo^ven' ij; cwniplet^*, Dunikf^ tlie lirat djtVK Hahlj 
and PeDXoMt recommcDd that all food bp mthb^ld ; liqiiidfi, 
such UR eg:g-albitniit], w«ik tea, thin broth, barley- or rice-water, 
or milk diltitvd wiih lime-watcfp may be ^iven in small qtianti- 
liea when doeinod ncouesuiy. When the acute symptoms have 
fEub$ide<J, Ww diet cau be iucrejvi^d somewhat: tbe milk may 
be taken iiudiliited, mid eg^ miiy be uddtxl to tbe bmth, Wlicfi 
the puiu and fev*-r luiv*? disuppcared entirely, ^rpueU nxade of 
rico trt" liarley, i!K*fi.-l>oil<^i c^|;(E», scraped U^f> stewed chicken, 
toaflt, and cmc^ker^ may W added tx> the list ; r^till latT mnnhed 
potatoes and V(*gcta.hl*yi— finely diviH<?tl jind ctrjiinpd — may K? 
al]ow<dt and liiially, when the patient is well, tbe usual Jiet 
may I* resHnicd- 

OehsTier ^ tid\'i8es the following; plan of Ircfltment in all ca^efl 
of apfjetidicitiH in which operation is to be pert"rme<l, tielioving 
that it nduce» tbe mortality and t^hangi^^ the olasH of oii84» in 
wbieh tbe mortality is ^rmtest u\\o anotliLT class in which tlie 
inurtality is very small after operation ; 

*( In evcrv cu^ of mMito Appendicitis oil food by moudi and 
1 "TIm Uortolitx in AppomlicitV M^ixtd SfmM, M^r S, 1W8. 



S8S 



DIET IN DISEASE. 



ftll cnUmrticif are prohibited. In cobc the piitu-itt Mjffurv from 
nii»M>a or vomitingf gn^trir Invuge is at ouce cmployix). Id 
th« milder gr^^v ihv put^eot is permitted to nneo the mouth 
with cold water and to drink email sips of very hot wiiUr at 
short intervals. In tbi* severer cases the pittieDt ik permitted to 
rinse the mouth witlt <xdd wuter, but \s not permittt^d Ut drink 
cither liot or rold waU-r for the fii^t few days UDtil tJie ucule 
uttiK'k ht\s tfuhtiidedf whe-c tbc use of f^inall nipa of hot wiiter is 
begun. If the oauBea [tem^tfi, gasLri<^ hivago is repeat^ once 
or twioe at intervals uf two to four hours, In order to remove 
any aiibr^tancc wbtcli had regiirgit-Lted into the stomach from 
tlic smulJ inlGetine." 

^* The putient is supported by nutrient encmata oonfiieling of 
an ouucc of one of the concentrated predigcsted liquid foodtf in 
tljc mnrket, dis^^jlvp*! in three ounces of warm nonn:il Kilt solu- 
tion iutrjdiiced through a catheter which is inserteil a dij^tanoe 
of two nnd one-hulf to tliree inched. In case this gives rise to 
puiu or irritjition or nausea, it is inlemiptetl for twelve to 
twenty-four Lours at a l^me. In cases in which no water la 
givijn by mouth an eneuiu of eight otmwj^ of normal «dt wdu- 
tion w given four to ^ix timed a dny in addition to the nutrient 
cnomuta. In cases openited during the acute attack this treat- 
ment is continued for several days after the operation." 

"After the patient has been free from pain and otherwiae 
practically normal for four days he is first driven from one to 
four ounce of weak beef-tea, preferably prepared from oom- 
mercial beef extract, every two nonns. In a few days one of 
the commercial predigf.-e1cd foods, dissolved in WRter^ is eiibati- 
tu ted ; still Ister, equal parta of milk and Hme- water ; then 
general liqiiidv, then light diet ; and finally, aAer tbc patient ha^ 
fully rc<^ovcrcd, full diet is given," 

DIET IN MUCOMEHBRANOUS CATARRH OF THE DTTESTINB. 
Various diets have been recommended in ihifl disorder by 
different writers. Fleiner udviaei; a simple non -irritating diet ; 
others, as voa Noordcii, recommend a very coarse diet — one 
that will leave a large amotmt of re&iduc in the intestine. The 
authors believe, with Einhorn» that a middle t*onrse i* best, and 
thpri?fonr prewrihe a uutritiiius mixed diet that is not loo course ; 
on mich a diet tbc movement? of the bowels become more nearly 
normnl and the seeretion of mu<'us la lessen^]- Von N~oord«n 
renommpncb a diet (TOURiKting " largely of Gmham bread — 250 
gnuns a day in addition to a great variety of le^minous vc^e- 



DIET IN JXTESTINAL DISEASES, 



sa 



toblcfl, iDcludiD^ the liufkfi; vegetablt« c^jntainme much ccllu- 
Icmmt; fruit with small ^omIs and tliick «^kin»^ Itko curmntji, 
gDOM<bcrriiw, ^rA[K-«r ImkkIl't^ Urgv; quatiTiticj^ of fat, in iHirticii- 
inr of butli.T tuid Ukhih. Tlic iMTniaiieiil <'flVct of tUc ilirt is 
(<hi<:f1y dmr tn llir nnioiliit of (:elluIo[H^ wliit^h it i:^ntjiiii». TJ]i« 
c)cllul(«(c UQ^lcrgTH^ <lr<^m|K>stdon in the intctitintro ami thii^ 
M>ft«flij« tlio movvmvntit.'' Of fifleen pstticDtA mIio vtvni irvnU'd 
bv v<m N<Kinlrn in thin wuv seven wrrc cim^I and spvi^n ini- 
proved, iu GODjiiiK-tion with tliis diet miDenil waters an: usee! ; 
of thiscf uiiti-rs eontniiiing &o<liiim eJiluriil arc e»?pc(;ifilly lo be 
ivcotunicndoil, in piirticuiur those uf Kifi»iiigeD und of M^ie»- 
biidcn. (Fur a ili^^uw<ioii of the InruUncnt of Enuoomemhranoiis 
(iibirrh (ithcp thnti by tho iUrt~c, ^.j by oil <:^K*tnnti^ itxi^ilbD* 
«f ib(^ kiwi'lfi, vto. — the Mud<;nt is rvfernii to Uio U'Jit-lnK>k» 
CD intc?^insl dirscnse^.) 

Kwulfi ' u<h']»^ the following diet in ocrtAin <m)^Cfi of ixi(*m- 
bruntiiiA mlitU : 

" It iH only mtional tli^t in thc*£C chbcs a mild, Doiiri»bin^ diet 
i^ionld be instituted* which through Jt^ nuurisbin^ fiuuliticff 
procluc^es » laxative effect. This diet may be followeil wh<*D* 
ever constipation duc^ not ej[ist — u socallcd Inetovi^etAble or 
tviin conritipatm^ diet, llie fbllowiug diet scheme nKX>nimends 
il^telf for thiii purport : RrcakfoHt : Hweet Diilk, eijoou, uiiUned 
with coooa, while or dark bread, with honey, jam, or fre»L 
fmit I>iDn<;r (prcftrably at midday) : A*c#jct*bIcB or fruit, as 
npplcfi, plimift, bluebt-rriee, ni8pberrie«, eherries, n broth cf 
vi>g4>tjdil& soup, ftptimch, tomnto, or beet> =onp^ a milk KiWpf or 
ennhicl milk, butl<^r, and a liberal amonnt of frosh vc^'elflbles 
flix* <lej<irnhle, or pwi, riee, or lentil t*oup, stcw^ vegetables 
with dumpling, maearoni, puddings, bluiioTnan^e with fniJi- 
jui<x«, fU\; Aahids and eggs variourily prq«irt'<l, brtwl with 
butter, and a ligbt cheese, tiupper : A tbic3c M.iU]), Tniule with 
barley, rioe, tapioca, eic,, baked potatotVj v^^j hnwl, butttr, 
cheette, iui)k» etc- 

"Aouording to the needs of the patient the fore^ing dltri 
will be more or lest* earefully followed, and on ftfrrtjiin day* a 
small amount of meat may he allowed by way of \'ariely- 

** While thifl diet ia directed especially nf^ibst the local 
intestinal <v»ndition, still it serves well to support and improve 
the general nutrition, because of the high ptrcenUijje of carbo- 
hydratcG and lats, which is veiy im])Ortaiit," 

■ Amtrifim ^tdieine, IW4, vol vil., p. '2AL 



38ft 



Si!KT fS DfSRAfiF.. 



DIETETIC TREATMENT OF NERVOUS AFFECTIONS OF THE 

INTESTINt 

!. Atony of the Large Intestine. — Tlw <iifti>ri<r trmt- 
mciLt of this di!^or<k-r is il^ntlraJ lo i\vAl iiidlnil<^l tor habitlttl 
cori8tipatton, to be de^criE>ed further oi>. 

2. Flatulence or Heteorism. — Tlii>^ condition is char* 
mjtfnscd \%\ Jia exceiisivt- accuruululioti of gu^ m tbe iuU'ntluv. 
Ill till' cJieftlic trcatiTienl, liiorL-foro, iiKHLs tliut Itud to prudtiot? 
lurge qunjiiitiee of gas, sueli aa beer, oidet, eurSxiiiuU'd wuten*, 
fruit, rabbngi?, rvf? nod Gmluim hmadit, iind potatot^s, Jthonld l)e 
iivoidfii. Th<e oiaorder h oft^ji of purf^Iv iiervoiii* origin, liud 
when this is the caee, unrestricted diet is Ixi be roooinmeHdi-d^ 
ODti timt will tone up ibe pationt^s syAt^^m and thus cause tbe 
flatulenoe if* di^p[>ear. 

3, Diet in Intestinal Neurasthenia. — Thin disRafle 
re«enil>lt!s utrvuiB dyflpeji^nia. At tiuiiti tlit! luuT^t iudigtatible 
food is well hoi-pe, wh^r^irt the digcatiljit formB crcat*? didC»Di- 
fort; in cucb c«Hc il is i[U]x)rtunc that the diet Ijo n-gulat^Ml 
fio(v>rding 1o ihe [>]il](^t'F^ dijjri^iitive [towers. Generally ii lib* 
ej*id diot \A indioit^^l in tliese trapes; in many instances a ays- 
temati<r r^l cure id needed to bring about relief. 



DIETETIC TREATMENT TOR HEMORRHOEDS. 

Since c*oii4tipation in of\en & frequent oauae and aeoompaol* 
ment of henaorrhoidfl it is important tlmt this t^frndition he nor- 
rect. As has been poiote<i out elsewhere, proper diet play» 
ftti important rile in ih^ prevention of chronic oonrtlipatiotu 
Padenta aiBicted with hemorrhoids should eat in moderation, 
hut should avoid all exoeascfl of food and drink. An abund- 
ance of outdoor exercise, coD^iMting of walking and simple 
gyaiua^tii^, j<ihould be indulged in, violent ^-yuinuAlIcs and 
horseback -riding should be avoided. A daily evacuiitioii of 
tho boneU should be secured. FatiL^nts with hemorrhoids 
fthould avoid alcoholic hcvem^;^, spitynl foods, fttmng ooHee 
and tea, cheese, cabl)a£e, and U'jins. Th^ foofirt mofti sniU»d to 
this eoudition are |>otatoeSr <'urn>trf, spinacli, nsjmraj^ns, and 
even naiads, sinc4> they stimulate intestinal peristidnin and thun 
help to keep the stooU ftoft, 8tewed and raw fruits, includ- 
ing grapes^ oranges, pears, and apples, are also beneficial. 
Water Is tlie West l>everaffe in this condition. The water* of 
Gu^lshad, KiHHUtgen, and Saratoga are most hexufticial; tbey 
ftd boat when tukeu at the springs. 




DJBT /A" ISrrKST/SAL DISEASES. 3B9 

IHet/or m/iarif I^imU vfiih I/cjnorrh(Hdi,—{Jfttr Wtytit.) 

Honuog: Milk or *vak lot, (jralidm brmdand butter vilb boncj. 
Kormwii : Kt'ittvmiilk, 

Num : S:hUp, vw-ubla, ecjmpatr Ihnlodj, BDiI Iran fncBL 

AfUmuoa : BiiUi^nutJk vt fruit and Onfaim binuL 

tiincnl wAinn adiJ |^pc<juicc may bv lukfU. 

i>urf ^ Ntrvotu and Thtn /Wtm/i wi^A J/fmorrAoitU,^{A/i^ ^'^i^.] 

Forvnoon : Bmu^niiilk or kf^t' a ihy okl. 

Xoon : Soiai. nHit inmL U^bt i-t^mbln, cunpoUi. 

AlVriKion - KflUr «r ti» and nrftui 

Kfcainf ; iCieo Jind niilk, rorn|K)(^, nnd lii^bL whit* wine, 

DIET IN CHRONIC DIARRHEA. 
The AuthQff Diti-lUt for Moderatt tiwr* u/ (ArvnAv iMorrAvo, 

$ luM-t 200«in. of cocM (cooM Id «*!») . 46J) 

2RoMK>iledcgSx I«a0 

fiOfffp umm ISOO 

10 A-».: S.'iOgin. broihvlih 1 c«r KM) 

30 gm. I^nopepion . , ,.^ ., ^,6 

12 !«.: 20Dpn, bmlUldiifk-ti SttO 

WfriD.t<iHt isao 

£00 ^. iniiiih(^ pococow SI&O 

4r. v.; AO|EO!k I'n.MniK^pton .« ftM 

1 aoft-boJlfd cgs tlM 

200 cm. G(MX« (oDuked In wilrr) < - . 40,0 

W icm. U««t 1S0.O 

7kji.; tOOgm, ritWGwiktsd inbuuHloQ ZLO 

300icm. v«tfv(1>n«l ]80.0 

;)0Rra. whuaibPEAd ISaO 

9p. M,: lOO^rm. nir nnp«dU!«f II&O 

AO ffiu- ranopvfHon 67.fi 

&D|rm. kHUtt ^aOjQ 

90U.a 

The dictttic trmlmtut of Jiurrliea must vary lu^^mxling to 
tbc type of iho diaordor. la tlae norvoun vuru'ty tlir putiimt 
BhcMild he iD>itrucl4>d to ro^tmia hU bo\v<?1 moveiDt^utii ox'Hjpt at 
a orrtain hoiir in the. morning- Under all otrKlirimi^ it w im- 
portant ta cjcclude from the diet all iocxl^ ihnt \mvv a lendeEK^^ 
to etitniilate the inte^ineA, Coar^, in<lieefltible foods, espt^rialty 
those cotitiiniD^a lai^pereenta);eof ceUulose, must l>e avoided; 
in this clu^ are e^peciaJly to be niE^ntioned cabba^, pickten, 
mbIihU, tiirnipti, carrotfij al) eold drinks, carbonated waters, and 
bevefBgi%(inclndiDg champagne and beer). Among the foods to 
be rccorrmendcd arc broths, t«a, rod wmc«, farina, rice, and 
barley ^riielif- Raw milk aHuolly hes a laxative effect, but 
Vihen boiled or dilnted wifh lime-water or brandy it U oonHtl- 



^H 390 DIET ts nmKASR. 


1 


1 


■ 


^^B patiug, although in a eertjiii) numlx^r of ciu><.*!it 


it miut Iw entirely ^H 


^^1 excluded as it increa^e^ the numl)or of movements. 


In a num* ^H 


^^H ber of casee of cJiroiuc diarrhea milk airoabiivolxx'ii given vrith ^^| 


^^H good nrsultM, The ^uthitrn bav^ suco^edec 


ill rdieviii^ 


oa±te» ^H 


^^H of chronic diarrht^ by i^jratenmtJc real cures. 






^1 


^^^H Dkt-tUt M Chrmtie Diarrhea. (&twf Oucj).— (4^ Wtgfk.) 


^1 


^^^^^^ rroUln 


ITit, 


Cirbo- 


Aim- ^^1 


^^^H Mnmln^T 200 gni, iimrn ccicoii (hrtilwl in 






^^^1 


^H HMT) . 2Ji 


3.150 


12,0 


^^^1 


^^H I ftoft-bolled egtf .4,0 


3.00 




^^H 


^^^B Fi>nnonD: 250 gm. iltfi^trtirmorvrhiirtlpWrrieH 






^^H 


^^H {fiww 80 gii^ driei) bemw . 0.1) 


\.m 


4.7 


^^1 


^^^H Nood; £M giu^miUL) ' ......... 5<A 


4hOO 


7,0 


^^H 


5.00 




^^H 


^^H 100 fiu. t^crupt^J mmi (Letin) - - 20h7 


1,50 




^^H 




0.50 


a@.o 


^^H 


^^H AftoroooQ^ 250 t:in. wliorili-lo-rrydecLK^liun ^ 0,^ 


1.30 


47 


^^H 


^^^1 Evening: £50 gni, TrLnUnlLi^iiin^nofw houi> . . 6.o 


0-i5 


15.5 


^^1 


^^B with 1 tgL; , . ti.O 


5,i>0 




^^^1 




fl.OO 


120 


^^H 


^1 ^J^;***^} r.!.Kn,,r»K.Wl. B.U 


l.>0 


4S^ 


^1 


. . 


7.0 


^1 


^H '^^^'^J^ MOgiu, harIey»«iiP*h(20;!W))- . fi.O 


4.00 


25.0 


H 




42.00 


10.89 


^1 




3^ 


690 


^1 


^^H £niirviiiimb«r«f Oftloria 


. . . 


■ ■ - ■ 


1660 ^^ 


^^B iNtf^Ktff ^ Chntnit Diarth^ {LwScwrt Oww).— {-^ffrr n^T^fcJ ^J 


^^^1 l^l«ln. 


ri. 


rurbo- 


Alr<cv ^H 




3.fl 


12,00 


^^1 


^^H 1 ojOf , . . , 6.00 


CO 




^^1 


^^B KorcDoon: 240 f^.kdlr (four lUyis old) . , 8.*20 


5.7 


S.00 


^H 




4.0 


7,50 


^^^ 




5.0 




^ 


^^H 150 iciQ. rrxutod chicken . , . - SS.O0 


lO.O 


I. SO 


^J 


^^H S^ inn. mjiAlio) |>ij(atD» - . ■ 6.00 


1.7 


4'i.70 


^^1 


^^H 2 o'dock : SfiO inn. Aoorn cocco ..... 2.30 


3.a 


12.00 


,^^1 




5.7 


2.00 


^1 




41.0 


17.00 


^^H 




5.0 




^^^1 


^^H lOOgni.Mr(Wlbiv&<l - . . , 28,0U 


o.a 




^^H 


^^H lOoVWki SSOzm-kofir B.20 


fi.7 


2.00 


^H 


^^B During Uic 7£i ^. Kwidbtck or toostcd 1 n »#; 

^H di^: imi^i r ^^ 


1.5 


42.50 


^1 


IBS 


0.12 


^^1 


^^^1 ^^ Ifm. whurtlelwrrr wine > ^ 


TlTfi 


8.75 
150.25 




^H T^ital 127.00 


^H Cklorin .520 


740 


015 


210 J 


^^^B ' fiitico number of «nIoricA > . > 






fioes ^m 



j)iET i^ lyresTryAi piseasks. 



391 



DIET TREATMENT IN HABTTUAL CONSTIPATTON, 

la Uie dietetic treatmcDi of habitual cocHtipation it U ewcu- 
tial Uiul tbe food ihat is iiigestvd aIiuuM bv Aui:h a» will iucruLrw 
the iattttiDal movemoDtd, Tfao«c foodti tLut \ci%\a a Uirgt^ bulk 
of fixMl xnatLer are u^iefid for ttik i>ur|>0!ie. Tho9(i< ttmt Ijuvq ft 
flosall nwidtie are rnoat apt ta proouce <^hroriic ciiii«t]|>udi)ii. A 
diet coDALitiiifi: pnnci])aHy of etn^H and milk witli only a ^auiU 
C|uautity of vegetables ood water is oae that ii eoD.^tiputing. 

A glasfi of cold water taken liefore breakfast will olWn rx^i- 
late tbe boweU ; oocaaionallyr according to i'eazoldt, a pinch 
of i^lt added to tbe water will increase Its efficacy ; raw or 
cooked fruit, l^ken on au etepty HLonia<!b murikiu^ or evealci^, 
ocoaaioiially gjv^d guod rL^iilf^. It in u Hell-kuuvkii iaot tti^l 
tbe smoking of a dgar la iho uioniiog will ^Hvn Hlimulate peri^- 
talftk. Tbe patient sbnuld reottgni/e tbi? im|x>rtan»> of liaving 
an evaoiiation of tbe bowek at the t^ame time encli day. 

Chronic constiftation U a frequent acoompauinKut of dys- 
peptic diaorders, and niay be relieved by appropriate treatment 
of tbe ^^tric disorder. It should not be fot^tteo that liabltuaJ 
CQiifltipnti^n ifi frequently induced by the peiwient um^ uf 
catbartica, and the nae of drugs should be avoided a^ much 
Its poAaible in the ti-eatujeut of ihia diaorder, Sedeiiliiry hnbit* 
ore ■>ft«o the cuuae of oon«UiMitiou, und for (his roasnu proper 
exercise should always be preseribed alon^ with thit cliotfttio 
treatment. The vegetnbtes that are eAfwH'ially inu^fiil in the 
treatment of cbn>nic coustipatioa aix' spinaib, pt^tui^ cjiuUflower, 
cabba^, a>iparaicus salads, onions, celery, and toiiLiitoi'i^. The 
ccreaU that .stimulate the intestinal movements are outmcul mid 
cornmeai. tiniham, ryo, com^ whole wheat, and bran hrGiid« 
aro also u.seful. Otlier foods claHSed as laxativan an; lioney, 
cider, niokv4^ed, ami acid fruits, »ucb as apples, peBn<, j>eacbe&r 
chciric:*, nud onmgcij. On account of tbo aicidn and fwedi thev 
contain, berries »re effective laxatives. Pruntia, dutcui, uad figs 
are also t^i be recommended, 

Hnbitiial coti^ti|mtion is often due to the fact that water itf 
taken in insiillicient quantities ; therefore, in the treatment of 
Uie Jisi>Txler, an abundance of water must l>e prescribed. The 
fijcxjfl u> Ik? nvoided are tea, claret, cocoa, cbocolalo, rice, barlev, 
and farina gruel i^, imd huckleberries. In some cases milk actn 
as a laxative, whcreiw in others it lias the oppor^ite effect. For 
this reason it« effect ahonld be te^tcil m every ca^. Boil«!>d 
milk uKually ounstipatcs. Buttermilk is preferable to awcct 




DIET IS VISEASh\ 



tnllk a« a Uxfitive. Mont oij^ca of ImbiLiiul ooni^i^uLtion ouii be 
relitvtHj or ciiml li}' ihe ilicLetio ti^eiittiirtiL lirnr Inul tlown ; it 
la :iot within tlic provuioe uf tlib bo^jk tu diftciin^ ibe value iff 
nuuutu^ niid diMtrioity ; auiHoe it to Buy that tbo;^ urc reliiLblo 
wljuvunU lA the tttatment of f»iiftt]|ml:bTi. 

J)iet4Ut/or Chronic OantHjiatiitri. — (^ct* WsgeU.] 

Honuoff : SOO gm. milkjuid caOcc 3.20 140 3,20 

30 gvL butlflt ■ ■ < . 0^1 24.60 O.U 

30«m.hcinvT. . . . 0.3& 0.09 17,00 

Fdiviiixid: SOOgm. buiic^miilk . . 1^.15 2.S0 11.20 

Hood: WMRm. bouilimi . . , I.OO O.IM) 1-20 

900gm. inutioTi . . S3.20 &0.fiO 070 

800 gm. turlv rabbii^ 4.20 U-JO 21,60 

SOOgm. filuiLi^. - 0.bO . . 11,W 

300 fcn. viiUe wino or 

cWrr 9.00 S47 

Afternoon: 3O0 gm. buirflrmilk . . H.15 3.^0 11.20 

£vcntii|c: l-Vl fT" inciK , 2S.90 11.00 0.10 

30jcc. butter . . , . C.21 StfiO 0,15 

SOOgni, sIl'WlhI applis. 1.00 . . 39,U0 

550^m. i;ra]iBiiihmul 22.50 2..50 12^00 

After t¥emng i«»l : 750 gm, bcw ^00 6.6 4.70 38.8 

ToIaL > . . 14fi.77 104.50 245,S0 £3.5 

aioriM. . 600 1800 1000 375 
Entire number of caloriea ..... 3775 

The outliorFi fre<)iicntlr prescribe the following diet in casca 
of ohronic constipntion : 

6 A. v.: 40gnL onuigDJiiice 68 

e A. u. : 300 gro. milk villi cofToe . 102 

2 Brtft-bdlrd eftRs . . . • 100 

150^1. UmhEUii bmd . ST6 

40giu. buiiL-r S96 

IOjuh.: 400 gm. cidor . . . 280 

ISM.: 200gTD. brolh. wilb 1 <^ M 

100 gni. ■Toiik 214 

100 gm. c-onnti 41 

lOOffni. hntiv 19S 

1'>0 gni. (imbjirth brrsd .-•-•.,. 975 

SftTgrn. BlPWdii nppl« .10ft 

4r.X.: 40Ugm. buttomtilk , , 100 

7r.X.: 100 gni. urmp^ hoof 118 

150 gm- flrnbnin br«ul <....>■..«« 376 

200 gill. ttLw<-J jrriiDis ,« 170 

aOOgm. riflcr SlO 

ftp.K.: 40£ta.%H<(ir400^. bultcrmUk) - - < . _46 

3025 



DI£T tS UVKR DUiEASES. 



SfiS 



1 X.M.I A cbu cf roid watvr. 

6 A, M. ^ A Tibml IriffikfiHl, nidi twwUtwd coflcv, plenty «J butler^ Imtuc^, 

■nd UnhAiii bnrad or piitnpvmicLvl* slUr vhich tlie imiUnt 
xfiuuld leu to Blvol. 
1 t. H.: Matidii^ nmi nf mwi, » Urf^ tjuaniiu of Tc^ublci, aalad, »t«wel 
fnii1> Ciirijiiceouji fuoJ, batf a luiuc of wbilr wiDu <M<wUe) «r 

7 KM.i Ufiti villi • Uiy* «aiouiit of lnui«f^ Ur«buu brvttd, aicvod froit, 

Aiid bctir. 
JO r-K.; B«fiiro r«tlrin|C, frtvh or elew«il fruit. 



DIET IN PERirONTnS. 

Acute Peritonitis. — The diet m acut« perilonitis ifl purely 
of H^>n(]iiry importance, and r^tiin« considcmtion only iinlil 
oprnitlvc priKrciluri' <yin U.- iiiKlvrtitkcii. No food whiiuvcr 
flioiikl 1>c ^vcn by the moutb ; if l»x^ce>M^y, rcctid alimcntAtion 
4inulct hty m^ortod to. If opcrvtioD ia not iiDdcrtaU^ and 
vomiting \\i\A oi^flfvKfltTid^ hirv be |^V4*n in a few days. Fonda 
tlmt may be pre'icrH>ed are tuilk and lime-water, diluted hrolhi, 
und c^g-tLlbnmin witli or without brandy or ihcrr}- ; only very 
«mdl] quuntitie^ should be taken at a time but at frequt'Dt in- 
ter\al« ; gradually pliin inilk, brotb, ond f^ntol^ muy be udded 
to tbe list ; ftolid food &itoidd not be ulbmEnl for seveml weeks. 
Wlieii tftimnbLnte urc required, they sbouJd be giveu in tbe form 
of wbiaky, bnutdy, i>r ubjnTk(ai>(E>c. 

Pict in Chronic PeritonitiB. — The diet in chronic pcri- 
tODJtiB should oon^ii-t of boiled nieat«, e^^, milk^ stxile brwu)^ 
toAAt, or emckprs, And vegefjiblea. only, howevpr. in the Pirm 
«f pur^."^ ; oLrholiydratefi should be eaten sparingly, on aeceunt 
«f their tendency to ferment'. Food ehuuld be euten in small 
quaDtiliee at regular but frDquent intervals. 

XMET IN UVER DISEASES- 

To prevent ne«!l™« repetition, oertain goiii^nil di<'tet-io rales 
will here be given for the munagement of livt-r discaiie:^ in gen- 
enl. The theoretic diwuwuons bearing; on thii« (subject have 
become «o numcrotm ae to ren<ier even brief eonsideration of 
them impoH^ible* For tlii?: rea-^on the subject will be dealt with 
here only from a practical] htuiidpoint. 

The l^roup uf syiupumis gtutenilly darufed as "bUiou^neaa" 
are ur^mdly thu result of overeating, and the M-called '* bilious 
attack " ift noLhing more than a <^ry of the liver for n^lieC 



394 



VIET IN niSKASS. 



Many individuals when ihejr became constipated suffer from 
the^ attacks, The^e two facte rumish the mdic&tioDfi for tttAt- 
ment : ret^t aad open bowcU. In tli? acute attacks id] thut ih 
D^^&.-vtiLr/ IS a rastricted diet for several da^s, together with the 
aduiiui-itmtioD o^ calomel, followed by & eoUne. The ohjoot of 
truitmo[it in nil dL^ease^ of the liver j^lionld be U^ give ih" orgnn 
ajt littJo work to do as possible. It should not, however, be 
put at absolute re^t, and it is probably not possible to accom- 

fliflh tlkiH end on account of its mflueuce on j^nend nieUibolism, 
II genemlf a simple, well-ni;xed diet contuiniD^ protein, fkt, 
and carbohydrates is iDtliaited. in ccrt^iin dif^euset; in which 
the funotion of the liver is manifestly impaired, fat and carbo<- 
bydraten muat be realricted ur evsii ouiiticil eotirt-ly for u few 
days, Botli, if not pi\»iuptly disposed of, arc apt t<:i undergo 
chuogu^ in tht* iolesliaal canal. 

Ct^rlftin articlB§ of diet are known, while others are believed, 
to l>e injurious in diaea^ conditions of the liver. Overeating 
ia injarioua, first, on account of the overwork it necessitates; 
and, secondly, because the superfluous food is apt to undergo 
putrefaction, Tbe resulting l»LOterml protlucts are believed to 
act OD tbe liver iu much tbe dame manner as does alcohoL 
The excessive use of alcohol pn>duoes inarked changes in the 
liver iu certain indivtduab, TLLs has been provi-^l hy expen- 
meatA on nmmul^. In a series of experimeuts ^H^rft>rinc<1 by 
tho authorat in the Pathologic Laboratory of ti\e Joints Hop- 
kins HanpitnK Baltimoiie, actuaJ cliThotic elmngf^ in the liver 
were induced by the administration of alcohol,' ftouie |>ersou3 
may take alochol ct^ntinuously with impunity. If taken in 
excessive t^uantities, however, over sufficiently prolong^ penoda, 
it probably invariably prodtices chronic ti'tsue changes. Whea 
a oertain amount h taken, it seems to be burnt up in the body 
as food ; when this limit is |ius9edf it beix>njes a [H>iHOii, In 
certain fcvcw onormoun <|iiaiititie^ may olVa l>c (xtuj^uni<.'d with 
great beoeHc. Just what amoutit muy he taken with safi^ty by 
any one individual is not known, and is dependent in large de-> 
Ijree on idiosyncrasy. It has been estimated that two ounces 
of alcohol on llie average tuav be consumed a? a fond in twentv- 
four hours. The form and tbe amount of concentration of the 
alcohol are im|H>rtant factors in considcrinf; the effect of alcobcl 
on rhc liver. AVIii^ky, bnindy^ aud similar spirituous liquors, 
bik>ni in a a>ncenlrated form, undoubtedly pnnluce mon? marked 
tiAsue ohangea In the liver than light witic* or beer. 



DIET IS UVKR DJSEASKS. 



3» 



In all lirtT (JMeoM* alcolu/l should be amidat iiiile^ sivwially 
imlicaitcd aa a tonic or sHmulaot. In any caae it ahould be 
givrn well diluUxi. A wcU-miitur^ pure whisky well diluUnl 
witli u'utcr if^ to bi* prefcrroci, und tliis odI/ in the niiiatle^t 

Ccrlnin fc'od* have been rc^rdod as '* Btimiilatiii^ " or '* irri- 
tating^' to th^ ltv«r Amorif^ these are ]>eppors of various 
kindts ufAcef^f miiMsinU, conoontmteil mpat extraeln aivl lUi^iLt 
broths, and the ftubstunces formed iii roasted and baki*d tiu^lii. 
To Ix' pn.wcribeil an? [»cp))ers, iudi&he*r horaeradisb, nijtoiis, 
watercix^r uikI ulery. Kult in too lar^- qiuiDtitlGA is aUt> 1o 
be condemn n 111. StroEt^ coiTcu and t^a are harmtij)^ but weak 
tea Mx^mii !« l>^ woll lx>nif; in many cases- 

III ju'wrc diseusc^ of the Jiv^^r the diet must usually be 
TCiftrictod to milk, dihitecl or pcptoni^cd^ gruels, albamla-water, 
kumiiv, btittcrmilk, nnil bhind bnothe, each ae oyster brotbn 
Oranj^-juirp a*i well a^ bmionailt* may gpnernHy be allowed. 

In the milder disease and during con\'aleH^ni?e the diet need 
Dot be m ri^dr and lean meat, eurd, junket, bread, toa-st, zwie- 
back, frosb fruit, or fhiit i^tewed with little or no BUgar^ may be 
allowed. In the chronic caaes and lighter forma the following 
articles may help tJ make up the dietary. Milk, variously diiiJt«d 
and prepare<lr buttermilk, curd, kumian, cu^tardf junket, e^r^, 
lean meal, if beef or mutton, preferably nre, ^wcutbreau)^, 
obiok^Ui ftqiiab, liver, the 9oh purt of oy^iters, niul the more <ii* 
gefitibU foTDU of fishp Vtv^h giy»cu vo^fidil<*s and green nuladu 
without ml are permiR^sibK Small quautifit's nf «vll-bukptl or 
boiled mealy |Hitdto may br allnwr^l once li day, fjr many 
person^^i do not relish a mc^I ihat doc^ not ooiitain fiotuto in 
Bome form. The starchy food* sbouhl lie partaken of Momu* 
what sparinj^ly ; bread, toast, zwieback, pulle<l hrf'^d, and hitf- 
cuits (crackers) may l>e permitted. Small quantities of oeraal 
foods may be taken — rice, mgq, and tapioca, when sufficiently 
wol1*«ookixl, ni<iy be allowed. Fresh fniit \» a vahiablr; adjtmut 
to the iliet, Orango8, grape-fruit, ripe peaebes or poar^^ grap«*H, 
fitrawhwriefl, nfti^ plllm^ of the moHt tender varieiitn may iill he 
tak^n. Stewed fruits ooly slightly sweetened and haked appli^H 
may be allowed with advantage. If there ia coastipatioD, stewed 
prime? are nwfuL Lemonade may be taken as a beveraj;^. 

Mineral watei^ may be drunk frwiy if dropsy is not present, 
and are U>st tsiken on rising and between mcii]s. Hot water is 
a valuable siibstitiite for the mineral watenf. It is tMpecially 
UOcfiil in allaying tbimt when tliere la drop«y. 




3se 



DIET IN I>ISEASE. 




TJie ftxxl i^lifnjld be UtkcD slowly^ wi^l) masticated, and never 
in loi> lurgr f|i]iiDtitir-j(. If neccasury, moa- milk may W giveo, 
KO Ufi to nuilc(* iflrgt* uniounts of otber fooil imneooc&aary. The 
pnti(*Dt Mhoubl Itt* dciwn dirccUy b^ore nnd iifWr mcflla. In no 
cum xlimiM tiu> patient eit imm^iat^ly afl^r taking &ctiv6 
cxeirirH'. 

lu <MTiaiii i^hrviiikr coTKlitioii^, euch as Lypcromia, fatty degen- 
eration^ auJ clirouic licpulitiSi exercise is to be tiikcD at proper 

Ill Hunimer and In warm diniiit^^ more v<^etal>Ies un* m be 
alluwod uud IvMf fcteuL. If piitrefuctlvi? chjinge^ take pl^cc la 
ihu iiitvHtliK-^ u iilvt oontiidtiiig t>f white of egg and water should 
bo iimiutaiiiod iiutil thi^ c^mditioD i& ovoroi>me. VVbpn the 
piitrt'iWruMi is cniL^ by torpidity of the liver, it may Mom^ 
tlmcii be )ircvPEitt.-d by iru^reu^ing the amount of v^^[iibl€» und 
by tlie uheof Lixativt^. 

CATARRHAL JAUNDICE. 

During tbo acuie stag^^ so long sks there is any tendency to 
vuniit or uhilc dyiipejviia i^ uiaiked, the jratient aliould be kept 
quiet in bed. The diet should ix^ \-'7vy bghi and Auid. Fat is 
QBpodally to be avoided, ar^ are, of ooiirae^ all food^ tbat are 
aitber cheniieally or trnvhanically irrilatfnff. 

Milk, whi<rli niuy licber be Akimm^l iir dihited with lime^ 
water or minenil wat*!rs or peptonized, is prolxibly tlie n:iost 
useful article of diet. On acoouiit of tbe fat whieh whcle milk 
contains it is, however, open to certain tlieoretic (>bjeetione. In 
practie*N nevertbelofts, it w generally well borne. Buttermilk 
or kumiA-'i may aUo be used, as may bcef-juiee, o}'stcr-bnHh, 
(-liiLii iHJLilUuti, ^dbmniii-waler, and velUc<>uk^l and atrfiined 
luirlcy f^utJ. If llic ^tomuob is irritable, foo<1 should ho given 
in Hroull quantitiett and at regular intervals As the stomach 
1)t<f*omi*^ t*>lerani nnd the ap)»etJt^ rctnrna, bread, zwiebaok, 
lO!u<t, Uan meat, such 3» the brea^^t of chicken, sweeibreadtf, 
unci tender titeak or chops may lie administercxl. Soups Lhiok- 
eni>d ^vilk barley or ilour may be givcn^ and the lighter forms 
of fi.^h may b\iso l>e allowed. Fruit, m-cII cooke<) and witbotit 
too much eug»r, may be added av c^Jn^'alcsc'cnce ()^o^r4::^0C«. 
All coarse tomie of vegeljibleti niuhl he avoided, but ppiunoh, 
a^paroguj^ ''psj 'w*^ cauliflower top^ may br given* Well- 
cooked mau^hod pntaitoe^ may ba« hIIowcmI in modpmle qtianUti^v. 
The mral.w should l>r emnll nnd, if upriKKary, may Iv* given 
frcqncndy. During coavalL'^eucc, wbm the appetite* rettiniH in 



mET IS LtVER DmEASKS, 



397 



full JbrcOy the |intk*nt s^limild be oaution^Nl aniiuvt overeutbg. 
For Msvcml nioiiUis tho diet shoald be gimi\l<*a and all irritating 
aiid <viarK* articles of Ityxl avoldt?d, 

ColTiie and tea should be iorhiJdeii during tlie acute etage, 
but during cxmvulenLi-iictf tbey uiuy Lw allow^l^ but ^buuld bu 
gtvai nc-itlier t<>u xlroii^ nor tu tou great quuiitily. Alc^^bol 'ma 
hc«t ikvcM<lctI. Futtf, such as butter aud ervam, should be wUh- 
lipld longi<Ht in tlit* rettini to a full diet. IP an oxoohr r>f Btnroh 
ur of sugar i« tuken, dJAtiirbanccA are certain to follow ; if faU 
arc ^ivrii tn |jk> ^rrcat abundaiice or too earlyj |>utreGictiire 
rti;i[i^N «n> a]it to ooc:nr, 

M im-ntl xval^r may Ikt drunk freely during the tvjurse of tbe 
diA(^44^, and tlie bowels should Ix? kept of^en. CarUbad and 
Viohv are especially to l)e recommeudwl, but otluT wator* may 
be Used, l*!ain carlxjuuleJ ^vator is usffiil as a bovci'agc- 

Catarrlial Jaandicc in Children. — Tho diHc<y^ is mrv 
ill c^hiMroEi uu<lL*r ti^o yoais of uge. The same genemi pnnri- 
pl**--* of diet, may he atlhered 6:1 a^ when tbe di^a^^ oocurs iu 
adults Fat, Alarcha^, and augar should be reduced in quan- 
tity, and rare meat, fruit, aud milk more plentifully supplied. 
It vomiting occurs, milk diluted with limc-w'ater or a carbo- 
nat^l Wifctt*r, or j>eploni/ed milk may be ined. If the gastric 
AyruptomH are severe, the diet flhctukl be the same a^ that for 
aoule gafitric uidigesijoD, CaluuK-lr the saliue^ iiud nuueral 
vat«ni should be preacribed to kerp the ho\vela open, 

CONGESnON OF THE UVER. 

Acute CongCBtion. — The trentiuent depcadM largi^ly on 
the funise. When the i*onge*tiori oeciir* in the course of acute 
di!4<u4eei, the diet ia practically the taint* an tlmt of the a^^AcKMUti^Ki 
dL-*ea-*e. Whoa there is pain, rent i.* ottsential. Iffhe paiient's 
condition wari-ant^*, the <liet should be largely rtvitriuti*d. 
Diluted milk, thin aoups, albumin-water, and tbt^ like may be 
SJveu ill smalt quautities. In weaker jtttientft the diet shouhl 
be regulated ncoorclhig to iht' gtuieral *?(jnditKiu ; if trirmcialion 
lit extrvm^, a larger dli't .diouM hv anlt^tvA^ «Ln? bolng tiiken 
nit to disturb flie titouiaeb. Milk, i«oupv, ii*un monl, fruit, 
cooked fruit, and bread op toaat xhoidd form tlie bulk of t.b(' 
dietan,'» All irritating fiiod^, iv>f!ee, fttr^mt lea, and alcohol 
jirc to be avoided. Salines are indicated in most eose^. 

PaaaiTe Congestion of the Liver. — The rliet should 
Ije restricted anil tlic same general principlee observed aa 
directed in liver diseose in general. 



I 



398 



DIET IS LISEASB. 



ACUTE YELLOT ATROPHY. 

Hw diet elioiilil ba n*»<trici€<l; nsimlly odI^ liquidjq ain be 
given, eucli n» milk, ilihUeil ii# in eufairhiil jaundice, ulbumin* 
wuter, €^<% lu gi^iit^nil tlie mumtgenieDt reaeniblcs Umt uf itn 
tttiiiti- fever. 

ABSCESS OF THE LIVER. 

In ibe mrly i^bLgvtf the |»itierit ^hmiUl be put at r«»t iind 
rccoivf a voiy light dkt of milk^ gruclsj albiim in -water, nnd 
tlii; lik<^. Af\i>T operation die dint muy bo sf tiiitrLtioils as poci- 
sll>1«r, bnunng in mind tho general jkrinciplos of diet in liv^r 
(Ii«eii0eJ«. 

FATTY LIVER. 

The diet will depend tipon the exciting eaiiAe. When the 
fatty liver is ihe result of general (ibesity, the treiitmpnt should 
be along the Iine» indimteil for that conditiuit. Wliea it is due 
to tuberculosis or to otiier obronic infcotions, the diet should be 
arrangt-d aw^ortbugly. In the f>evi'ro cachexias timt mjirk incur- 
able diseaws little ciin be done >n the way of diet. 

In gericnit the foot) nhould l>e e^i^^ily digi-fetiblc ; milk, lean 
meatj and egg.'^ are irainly to be relicl on. Predigonted milk 
and meets may he of value, but foXn and ods should be avoided. 

AMYLOID LIVER. 

This it^ URUftlly cau!<t^ by iMog-sslanding suppunition. The 
food rtbould Iteas f^nBiiy di^tible Jis it is |Hi!4sibln to make it. 
At the tmme time the largist umoimt. itf protein malarial eon* 
sifitent with the patje-nt'fl digestive [>owere, should be given. 

, SVPHUIS OF THE LIVER» 

Tile diet rihould Ik? arrangi^i awonling to tlie general prin* 
€Jple0 laid down for liver difeeaeea in genend, 

DIET IN GALLSTONE DISEASE. 

Cholelithia^iiH is & sobjeet of ever-inoreaHing inlerest. It is 
ef^timate^l that about 10 per cent, of ihe populutioti of Ger- 
many have gall-intones, Kehr state** that only abouf o per 
cent, of theae ever give rise to serious disturbances. Numerous 
theories have been advanced regnnling the cau^ of the forma- 
tion of ffidl-stones. Errors in diet nnd tJie various food cl^ 
ineDt« have beeu L-ongidcrwl causitive, and have letl Ut t!ii? 
establishment of vjirloun dieUiHes. Most obpcrvef^ arc^ hovr- 
evoT, indined to outisidcr the prophylnctio measures about to 



DIET ly LrVER DISEASES. 909 

he described of value- (For so «cbauBtive diflciiwiioD of tbis 
Bubj*x;t the fiuidenc w rofiTrt'd to the iirticle bv tiuincke and 
Hnppf-Seyler i« Xotbiia^V Knryfitfprdia uf Mniicint^ which 
hiw bocn ably ^Jited by tie lute Dr. Frederick A. Puckflrd.) 

Th^ two hcXor^ that id nil probubility «xort th<^ miwt influ- 
eocG on the {omiation cf jtAll^AtoDeft (lit* Uif' Kbuw nf l»tU atnl 
the iDfliunmalion of the bile-pansa^j^ tiiid jniH^bladdcr. 1V» 
t)ii« crd anything that will inoreaee ibc How of bilo should Iw 
encouraged, and anything that retanis it, nvoidc^L To obviate 
the Utter nil fiKHl thttt is liable to cautte imiigf'jition^ with the 
Mtcndnot ihiugerv of putrefactive changes «ettiiig uj» inHmnms- 
tor}- prxKx«8fa, «faould be careftilly avoided. 

The patient should l*ad au aitive* if jHMWihIe an out-of-door, 
life and physical ex^irci^ *bcrtild be a part of the daily n>ntino. 
Hnrwbnrk-ridin;!^ for thow vbo are in (<ondiU<>t] ami who mn 
afford it is excellent. Walking, fencing, ^If, tetiniit, and 
BwimmlDg are belpful^and when thefle are not enjoyed, n»- 
tematie gymnastic exefci*efl should be prescribed. ExereiaeT 
if the niottonfi are violent enough, acts directly by foiving the 
bile from the; liver and gall- bind d<?r^ and indirectly by increafi- 
ingthc movements of the intestine?^. 

The clothing should at all timea be comft*rtabIy loose. 
Women t'^peoially slionid l>t* (stutloTied In rogurd to thi:^ fK>Tnt. 
Tb« c><:>rset« Bb<:4dd fit li>otii'ly and bo ifUBpetidc«d from the sboul- 
ders, so aa tn take the pi^ssiire from the wai^t. A*Vr intidK 
the clothing ahould Ike looaened^ so aa to rdieve the al>domina1 
organa from piewmre. 

Constipation should studiously fee avoided. The diet obould 
be arranged with this object in n^ind, and the use of laxative 
salines is to be recommended where their uw hh necessarr. 
Epbom aalt£ and sulphate of soda are of especial value in this 
connet^tiun. If tie^ired, the aallne mineral waters aiay be sub- 
etitutcd, or, for thof^i^ who can afford it, ocoasioual vigils may 
be made to various mineral springs. 

The meals shocld be taken at rrg:idar intervals not loo widely 
fie|Minil«i. Pn^longed fiiMtiug should never be permitted, for 
<atin^ imjrcji&es the flow of l>ile wliih' fasting causes the bile to 
he stored up in the gall-bladder. Home yearft ago Frerichs con- 
tended tliat in cholelithiadia the meals tdiould comcclose together. 
Care rousL, however, be exercised to see that the food is bting 
thnr<Fi]g;hlv dige^iil and uiovnl along the lnlc^tinBl tract nor* 
mally, KL-hradviHej4 a supper to W t^keu latcatnight. Other 
authora hav« advocated wakiag the pBlient in the middle of the 




400 



Vim' llf DIS^AS& 



niglit to admmister DourislmieDt. This laj^t would ^eem to be 
entirely iinnecefitiary, Nauiiyn insists on the ijupurtauce of a 
ifuttidc^utly lar^^ bieaki'uAt aiiJ, iiidi^vd, a lai"^*^ luoul atW aw/ 
ftut. Tlie avcra^ Aniertcun bruikfa^t ts, howvvcr, suffioteotl/ 
lui^ In jiLmoU &\\ liJB(auoo8. Care ehould be fallen not to err 
in tin* iippo^iite dipe(*tioii Iiy giving more food tlmn can 1)b di- 

In tlie dioice of fowl tliorc ai* oertaiii thin^ to be avoided. 
Id the firvit plaw, all food that is not entirely above siis|ricioa 
op that is liable to set up putrefactive cliiiDKes must be intrr- 
dinted. In thi^ cat^^ry are to be plucx'd ^T;ile fruits, ^talc li»h 
and »beU-iltih, overripe clieeHe, and the like. 

Flatbhould, a-Hanile, b« reduced toaroinimum, for there- uoon- 
rtidornbL- <*lioica] evidenoe to «how tlmt ^n abundaiioe of (at 19 
injurioa-t in jpdl-itoiie di^iease, as well a« in otli'T disorders of 
tlje liver. Whether the fat acta iu any other way than in pr»- 
duciDg Uiwel disturbances ifl a question that has not yet been 
decided. Herler haft reoently pointed out that dogs fed for 
months on a diet rich in fat and low in proteins showed coneny 
tions in their ^ll-bliiddcrs. Fiit, $lv>uld, however^ not be elimi- 
nated from the dietar}' iiltopicther- 

Exceartes hi c^rbohyd rales, either in starches or in sugar, 
should lie carefully avoided. Anythhi}^ that will irriUit^* the 
liver should he prohibited, as should all ric^h and cumpliouti-d 
d]iihr<!<. Any food that ia apt to eause iadigealinn i* tn be re- 
garded aa unsuitable forthe patient with gall-at/>nes. 

Protein, carbohydrates, and fat should pi to make u|i the 
dietary^ which should consist of simple food, plainly prep.irefJ, 
with caje, however, to avoid a monotonous diet. Mejit should 
not be eaten too freely, and only the leaner varieties should be 
used. Milk and eggs an? allowable, but if tJn^ nulk im extremely 
rich, a purEioD of the oreatn abrjnid W removed. Some autbora 
forbid the yolk of o^^ us coiitaiuiug too mut<h fat. 

The ^reen vegetables and fresh fniita are ^uitnbU artic-lw of 
food and may be |)ArtAken of freely- Cereals aud pofjitflet* may 
be u*ed in moderation, but not where there ia ''jitaroh indi^re^ 
tion." Tiimi|is, lieel**, and (he like may be partaken of ftpariagly- 
While various authors forbid the use of some of these, it is 
probably not the choice, but the <|nantity, that should be con- 
sidered in thi» connection, 

Breud, rolU, and the like may be eaten aa desired, bearing in 
mind that in ^'starch indip;edtioD '* the amount should he limited. 
Pastry and ftoy but the pUineet cakes should be omitted Frooi 



DIET IS LIVER DISEASES. 



401 



the clieL H&rlpy made tbi? slatcment that he believed that 
fttitrcb piifJdin^!^ anfl fat b&coD cauM^d more gall*«loDw in Eug^ 
land than aI) other fowh put together. Alcohol should ho 
avc^d«(l, but coflw nnd t«n may W altow^ in moderation. Th« 
drinlcing of hot wntpr on rising aiid at bedtime ha^ been ad- 
vised, a« well as the vnrioufl luiuerul watet^ toeotiooed in ooo- 
iicction with coustlpatioD. 

Coo:iij<tiiig die^nuwTf ure believed to excvi some inflaeiicc on 
the fonnatioii of gull-stones, and wIivd gout, chronic rheumatism, 
d[abet<*H, olx^ity, or d)-i4pe[Mii exisl^, U)e diot ^Tundd be ix^u- 
htlctl £ii^c<}rdin)fly, lu iew diseoiieji ure there &* timuy rontm- 
dietory opiiiiotiis <x>iiccri)jng diet »s in gatl-^^t^jti^f and for tbit» 
reuHOD thuir dicMuedion bud hoen omitted untireJy. 

ORRHOSIS OF THE LIVER- 

Hypertrophic Cirrhosis (Hanot's Disease). — Hanot^ 
ifi h)j? mouograph on the dieen^- that lK«r« bi^ tiatnc, clii^miMHCM 
Ujc Hulijert of the diet uhnoH iu u word. Ho reoommeadN a 
milk diet fur wt^kji at a lime wliere it is wdl borne. Where a 
more exten.sive dit-t is indicatfxl (he same lines way be followed 
a» wcnr laid down for eirrbosb in geiiend. 

Cirrhosis. — So far as diet is concerned, all fornifl of <Ar- 
rliosia luay be treated iti much the mine g^ierul way. Sinoe no 
two oiM^i iivii ^xiiolly ulike^ it muHt never l>« for^^tU'ii timt vacli 
ca.-«e ref^uirc^ individual consideration. The h«aj% the kidneys* 
or tlie alimctitary <Tnnal maybe involved, and lu^cit^-'f luay be 
pre^nt. The exi^t^-nce of taese complicationn materially affeotfi 
the management of the cast^. 

Certain ca^tes of cirrhosii* are due to the long-continued uw 
of alcohol, highly seeM>no<i food in esceastve quantitieit, and, 
pnilmbly, t^j chrooic iiiteatioal fermentations. Certain uir?Uillio 
poihmiM may aleo cnuse it. 

All ludtvidunU who are prc<dt4]>osod to eirrhodL^, — tlukte u-ho 
fHimi* fn>m fMmilie^ where liver di**^**.' or iitl»>r forniK of eir- 
rhotic disiitse are frequent, — ^hotihl bi> cantioned in regard to 
the diet and the ti!<e of alcnhoh Those lar^ eaters and drinkers 
OT fhofle who "iiiiflVr from indigestion, discomfort, or even pain 
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 ; alcohol aheuld he withheld 
nltogetlier or reduced to the smulK-t^t poF^ibL^ amount. All rich 
fitodd Mid those mentioned as irritzLtlujc die liver slioidd ho 
avoided. If alcohol is given up and (he patient lives correctly, 




402 



DSET W DISEASE. 



BQoh <mu of^ii W done iu Uiu wHy i>Ugcs to av^rrt, or At )<aet 
to pOfttpoue^ lilt (lisiitroij^ cotieenucnty^. 

Caees ^thottt A&cites. — When ibc di&caw bofi been 
<tiiignf>«^T iinf) If ascites is not pre!3.ent, tlie ptitiecit mny bo put 
on a milk diet or a diet i'/)m|icr^^1 lirgcly ui milk and mitk 
fooda. Kumln^ iiiiil bitttfTniilk »re verv tieeful. E^-fllbi)Enin 
and cerea] gruels may idso Ur iij-ed- Unciera simple di<?t "f 
tbthkiod thegaatricsympUiiusniuy Atuiteori'vendisap[xiir. Tlie 
ealine tniDeral waters and [lotn^iunn indid Are \filLi»bl€ adjuncts 
iu ihe treaUnent- The co»wid<^mlinn of other i\nt^ jimi^wX in 
llki6 i;<>uditiun dut'M not rt^nie williin ihc six^pe "f thin nork. 
Whtn ro(?t>vcrv luia ^et in a simple diM, c«>mp*»scil of milk, tlio 
Wn, tiHiiily di^cstiMi^ meute, prefenibly broileii stutk nnd ohopK, 
chickc^n, and int- lik<\ '^s, hp(«d, gr«^n vi^fHftblp*;, ntid fnilU, 
pfttat^-S nnd t'omiU, if denim!, ai^ iilliiwuidi?. The mctd* 
should be flitiall and takeu at r*?j;iilnr intirvuN, Hot wator or 
the NiliTie watcTS tnay Ixt tak«ii ou rlAing mid nn hour or m> 
before eating. 'I'he geueral prinoipkA far di^^nnl condition* 
of the liver already de*crihod mnat bo followed. 

Cases with Ascites. — The bek-irtion uf a diet for xU^hg 
ra^-es ih fretju*-ntly a matter of c^on&iJeruble diffirnlty. K(v«l, 
radinee^ urd u rp*4trict4jd, !^>mcwhal dry diet <rfU-n gives gr{:al 
relief, Whpn the kidnevfi ure in reoBonably good condition, a 
dry diet., v\\v\\ »■ ifi n'<rornmend('<l for senile heart, may bo trip<i. 
Hot water may Iw? sipjMxl on rising (ind nt various int^rvak 
during the day, and help to fiiwh out ihe waste-protluctj* of 
mf^bolicm, Slunild ki<liiey T*ymptomw arise anti the quantity 
of urtne Ik.' greiilly lessened, it ie l>etter to inenftse the nllow- 
tnce of finuh 

If kidney diaenfie^ nrv present, it ia not wise to attempt to 
relieve IIk ascites by withholding Huidfl. Wlicn kidney compli- 
oationn an^cs, French writers and others recommend a <iiet oom- 
poiwd Ui^ly of milk, no the ground that it is a gocwl diuretic, 
excreting not only tlie fluid itBelT, but a portion of the flaid 
held in the body.u» well 

DET IN DISEASES OF THE PANCREAS- 

little las been writt«i *m this fiubj^oL A ttem]itfi at feeding 
pancrtws hv the mouth and hy recta! encmata have not been 
productive of good re«;ulte. It hae been sagyesU^J that when 
the diftgnoeif) of panereatio disease has been aiaile, ^>otJi fat^ and 
carbohydTatea he withdrawn from the diet, a^ they are apt to 



I 





DJET ly DISEASES OF TBB RKSPIRATOEY ORGANS. 403 

tickd^Tgo fermentation in the alisence of the pancreatic juice. 
The bile may, howe\'er, aasisl in the emuli-ification of fal, and 
pancreatic extracts or taku-diniiUtse may Iw giwii by the mouth, 
witli tt view to aiding starch ilifj^tioD. Pancreatic extract ia 
btwt frivon in Mi1o1>coated ptlls. 

The dit'l iihuuli:! eonHist largely of milk, which may be J>ep- 
Umi»Hl, pnedi^Ud meat solutions, egg-albumin, and the iike. 
Ah'tkhnI may be given aa required, both aa a food and as a 
i<tiniiilant. 

A(^cordhig to Dolm^ki^ the pancreatic secretion is increased 
by the ingestion of acids and ucid drinkt-, Alkjiiine drinka 
dJEninigh the EecreUoD of the piiticrai£p Au abundant diet 
cau^» an iucrcui!»e in the amoiuit of the secretion. 

DIET IN DISEASES OF THE RESPIRATORY 
ORGANS. 



DIET IN PLEURISY. 

The diet suitable in the trwUni(.-nt iif i»lonrigy with «ffnf;ion 
has been th<T subject of nimiy (rx(H'riinrnt-"*p Th« two principul 
methods advocat^ are: (1) To ^\\c tlic patient um drys dic?i a^; 
i« posaiblc, in the hope that, by rcrtricting the amonnt of fluid 
((applied to the blix)d, the aheorption of th<> iloM cfliiHion will 
be hastened. It hju* alwi Ite^n recommenrlpd that onlinar}- lAble 
salt be taken in larj^ qaantitiea, on the principle that, owing to 
the increased dt^iwiity of the blood, a more rapid abHorptiou will 
take place. 8chrc*tb'pi * dry cnn.*" has al«> Wvn recommended, 
(2) The second plan, adv*iait*'d captxrtally by certain French 
vritcns Is U> place the jiutit^it on an cxclneive milk diet, in 
mndi the same manner a&dt»cribtxl in the Milk Cure, Thja 
is said to ini.-r«£^ tlie excnlion of nrinc, and alw> to cauae 
the abeorpti'>n of the ofTu^ion. The return to a ^nernl diet 
should be gradnaL Praptically either plan may be followedj 
aocmrding to the €on<litii>n of tlie patient. If there la fever or 
r^.^m pi i eating kidney or heurt dift^isc, the milk diet \^ to be pre- 
ferri^. ]f there are no oomplicatin^ d]^a«ei5 and no fever, 
ordiaury diet with a lessened amount of fluids should be pre- 
i^cribtHl No eou])^ but little c^jffce, tea» or other twveraKea^ «iid 
Ui< .small an amount of water ^ Ibe pottent ean c^mfortiibly get 
altin^ vt\ should bi^ iillowtnL I^i^ elusions art- better n-uiovi?d 
tiy n^pimtiou thou by diet. 




4M 



DIET IS DISEASE. 



DIET IN EMPYEMA. 

Tlic dietetic mAiuigi'mi.<iit nf iMtijiyoma l^ tlie sitmc ua that of 
any Hr{nic (Condition. If tli«iv i^ tevcr, tlu' diet ^Itntilcl he tliat 
mlvJMx] \i\ the tt^alment of fever* ui gi'turaL If there is liule 
or no fever^ llit; ilit,^ nliould l>e nliniliir to Uml rei^oniiueadecl Ja- 
thc! <:fir)j^ atageo of Luberculmift. Cdnmu ThompAOD odviaed a 
dit^t ooutuiniDg o^ inuoh futt^v food ilh the |>utioiit mo take Jid 
l>t-*t inrf-^'tiiig the d<'iimT«l< mufii^ nn ihr (ivntj^m hy tho rropption 
of 8uch krge qiwntiti<>fl of \m^. Fo*xIh that cjiuse Uie (genera- 
tion of gBs ]Q thtr iuk^ltnc rihituld Ihj Avoid<Hj. ThJA usually 
arit^e^ from ud cxtvs,"* nf onrboliydniU^ food, hut may aUo be 
cautial l>y tho iuge.'^tioii of large c|uantitie-i of fat. If there id 
inarkod tym[ianit«», the embarraasni^-nt of the I'espiratioti id 
inorea^. 

LARYNGISMUS STRIDULUS. 

Attacks may be brought on by overfeeding, hy the inge^ion 
of iDdlg€«ttbIe nrticli» of food, and by c^n^^tipstion. The diet 
8bould be carefully aupervi&ed, and the saine general indica- 
tious met lu in mclut<». 



LARYNGITIS, 

Id cKroniG tnflanimfttion^ especiEilly tuberculous 1aryngili0f 
MPtain diototlo mowniroe may be employw! tliat wilt giveoon- 
sidemble T»?]ief Ui th^ patipnt. Hnrd and dry toasts and the 
like should Dot be eateD, as they give rime to pain nn bejng 
AWallowed. For the Hame nsiflan highly ^eofioQed fiKxJs are to 
bc' avoided. Only ^miw^lid or liquid food i^fiould he eaten. 
Milk, ri]»tard», jtniket, %o\i\y^ and griicls, raw oystei^, raw eggSj 
Mniped hec'f, mid the tike are tJie most auitahle articles of diet* 
To nllay the irritation in the larynx Ijoomia advises that a raw 
epg I>e nucke*! frum tbe .ihelK If there is much pain on sAiral- 
lowing eo^leia or eocain Nation? should l>c applle<l locally 
before feeding, A tablet eont^iiuiDg ^^ of a grain <jf oocoin 
may be plaeed nn thr hack i>f the tongiip and allowed to dis- 
solve. This is getiemlly efl'ective, and ha« the advantage that 
the patient can Ul^e it himself 

Difficulty in swjiUowin^ may w>metime* he overcome by tlio 
following twu niethocb : Hy allowing the patient to he flat on a 
lounge with hU face o^'e^ the tnlge. Fowl is to f>e »tick^ 
thn»tigli a tuljc fnun a vi??w?I p]atx*<1 imrnediatrly Wlow, T^ic 
ffceond meduid conflirttrt ia dinrtiug thr pitient to lean forwaird 
wbil« eating. SajrjuH (quoted from Th^mpAoa) Bay» tlmt thU 




J}iKT IN DISEASES OF TISE RKSPIRATORY OROAI^S. 405 

latter posture caases the food to [hi>w down nlong tlie pyrifann 
sinuses, thus avoiding the upper portion of tlw loiynx, contact 
with which causes tbe ^vere pain expericticcd during degluti- 
tion in advauced cstaen of lar^ngitlH, 

DTET IN ASTHMA. 

Aflthma usually ooouta iu inurkt-dly neurotic individuals, who 
•f^ apt lo exhibit otln-r nf-urosMsi, mioh a* giudrir ami intestinal 
diaordere. Various forms aC Utotl — <, ff„ the sturd>es and 
sugar»^havc been said either lo uauM^ or to predi«pofi& tlie 
tn^vidiial to astlinia. 

As A nmU«r of fact, many nttachn of n^thmi un> brought on 
by indigestinn, this usually being directly tmcoabie to *K>fne 
error in diet- H<> jmtenl is this fact that certam am^s arc 
classed as " peptic " or '* ga^iUic " asthma. 

Any food ihat eaosej^ indigcsUon should he avoidod. Pat^cnta 
usually le^rn by experience what they c.<an atid what thc-y oun not 
digest. S>m(* purioufl idicwyncra>4irj* oei*ur: Kor exnrnplr, iu 
one patient riee may cau@e indige^lion — even when the mo«t 
minute t^oantities Bie introduced into hti food without hut 
knowledge an attack of indigeslion and Bubfle*|UootIy of asthma 
may supervene. The!*e idi^'r-yueraMes cxist^ of iiourrfl*, iu othent 
besides asihmaltes, and many remarkable stories, some well- 
uutheuiicated, are (ulU in Uiia rounectlon. 

The asthmatic ^lould live a quiet, wd I -regu lilted Ufe. If 
tLoro is auygufirio or intt^^tlnal deruTigt'mcnt, it phoiild oaro- 
fiitly be treuled. Tho diH should iw light and nutritinOH^ aud 
should b<' taken at regiilnr ink'n'nU. Th*- mmis nhould l>e of 
a si/e to be easily digt^tetl. V^iolen: exercif*e of all kind* .should 
be prohibited. 

The foo<iR most suitable for the asthmaMc are the lighter 
kJncLj of fish and meat — llie \rhile meat of chicken^ niast-beefj 
beef-steak, cb<L>|is, and mutloDp Tlie most ^sily digested vege- 
tables, such Afi Apinach, aa]ramgiis-tips, cauliilowcr tojis^ baked 
potatoes, 4ind (he like, may be taken. Cereals and whole-vvlitrat 
brend msiy be iiaed in nirMlemtion. To most oases, plain des- 
sert>i may be allowed, Pork» clieeie^ heavy cakes, pastry, and 
all similar indigestible articles of diet» sltould be avoided, Futs, 
su^ir?!, nnd i^tarchcs should be taken in niodc^ratiori, if at all, 
ETpcHf^nw vn\] generally prove the best guide as to what is 
iiiriijible. Foods that are apt to cause flatulence are best 
avuide<h 

Dinner iihould lie taken in the middle gf Che cbiy, and the 



408 



DIET IS DISEASE. 



flupper aboald be lighL Eating at night should be dUooua- 
Lenanced. Tea mid coffeej if they do not cAuse gastric di»* 
turbauce, may be tukcD id moderation. Strong ooQee has been 
credited with warding oil' aitaclu ; for this purpose two or three 
cupa of atroBg oofiTeo aro to be talccD juet before a Uiroalonod 
attait^lc. 

In the weaker patients alcohol may be allowed, be^t given 
ia the form of good tDaiiined whisky. Beer and alee should be 
avoided by miist patients. Every caae of aathma should be 
Btudied carefully in order to learn what foml is and what is not 
harmful. AU asthmatics probably give up many articles of 
diet that are in reality indicated in their condition. 

DIET IN EZWPKYSEMA, 

Fatients with emphy^ma should seek to prevent ftfttuleoce 
and constipation. AJI imligc^thle foods should Ijc avoided, 
and the diet should fx< along tlif? same linos u£ tiidicutcd in 
aslbma. 8tarebes unci sugar .shoukl ha tukvn only In motlemtc 
quuiiLiiii»^ as otherwise thry nmy ferment uiid give ri*c to 
6atiilenee ; the dyspncn that it is apt to bring on may be a 
fiource of grcdit discomfort. In the later stages milk is found 
to agree better than any other food. CV>d-liver oil^ wlieu it 
agrees with the imtient, is to be recommeoded. The mealn 
should be small euough to be easily digested, and the heaviest 
meal should be taken In the middle of t£e day. 



r 




DlffT IN CHRONIC BRONCHmS. 

The liietetro mamigr>njent of chronic bronchitis is similar to 
that a<lvistnl in the eurly stages of tuliereulosis. In tin* dryer 
jorms demuloi.<ut drinks are useful, and hot flax-seed te^, sweet- 
ener) with hugur and flavored with Icmon-juico, should lie taken 
in sufficiently large quantities and is particularly effective. Hot 
drink?^ of various kinds may Ije used, and are especially useful 
in I<!m(H>i'arily relieving trnubleaome cough, ilol milk or hot 
iemoD^tde, or, if stimulants are indicutcd^ whieky and glycerin, 
may he given. 

MET IN HEMORRHAGE FROM THE UJNGS- 

When a jwticnt has had a hemorrhage fn>ui the hmgs he 
fiboulJ immedTJitely be put (o rc^t an<l kept absohitely quieL 
If the hemorrhage hits h«en severe and the patient is in daugur 



DIET IN DdEASES OF THK RESPIRAroHr OROAy& 407 

of collapde, iu addition Lo the Ufiiial moq>l]ifi InjiH^tJotw, norma] 
Bait 8o]utiou ni&y 1>g ^ven hy the rectum in dul>o(itttut9ou.-sly< 

Tbtf fiKHl ftbuulii l>e Uuuid in torat, Fr|>Uiiii»vil ur plAiti 
Dulk^ liquid b«ef poptoooiaA <ii- fliniilnr pn-purutiunct, frc^h bccf- 
juice, liOiiilW, fiud tilt like may \te u**eJ, und idiould W givon 
in Ainall qtiantitiiiK At rt^itur inUtrviils — twn nv ihiN-r mmnvi 
Diay he given every two or thret' liour^. If tln'rc- i» a UMidcncy 
to voruit, food may be ^ivcn liy th** t^'Ctitiu. 

To allay tbimt only ituisM ijuautitiai ni' fluid ttliould Ik^ ^iv^n 
at a time. Later, when the atonmoh In tolerunt^ larg<T (|iiuiitiliG^ 
may l>e preficribedn 

If there i& uo recurreDce of the beninrrbuge mid tltt- imjihII- 
tion of the irtomAch permite, a nipid rwliim ahould be tnoflc to 
an ordiDftiy dieU Mittt should l>o given in abuiiduiicc; to chjuu^ 
terart the fuiemia. 

Alcohol L^ as a rule, best avoided. If it u ueodeda^ a »timu- 
ItiDli tt should be fciven in atnall quantities. Id very ftevere 
CAt^^ birger quantities may be required to support the heart. 



DTET IN PNEUMONIA. 

In pneumonia, feediu^ 10 of thi* ^itfatuit hnpirlanve. The 
pat]lMlt^s strength must be fofiltTcd, for thr l>cttcr tb<* nutrition 
ifi uiuiiiULiiit^, Uie un»iv likely will the putieitt bo tj witliHtand 
tlie <*ffl*ctst of ibu diwsi^ie. Formerly, nwing f« eiiergetif^ htit 
oi\an micdiivct^, tt^nttneiit, ttuldv ]>jitieiitf« died in tlic tuirly 
ataRefl of ^iinval^^cent^. The Fiviu'ti wrilen* described tbeu- 
patienU a* having '* died cured '' — Mort tptfiri 

The same general principle* of feeding should be followed as 
are indicated in all acute feveni. During the eounnc of the 
di^ea^e the jtatient hhould reoeive an aliumlhnce of w^Ut in 
addition to die liquid twd sup|jlied. riaiti wuUrr or any cpr- 
bonatod wat/>r tbut tbo [lutii^iit may dteiru sbotild be given. 
Milk and seltKer may bt allowed fret^ly, Ijemoiiade, or omogiv 
ade, or water flavored uitb lauinriuds may serv^e Co lend vnri<>ty. 
The ''imperial drink" (the reci|>e for which ai>pmrs at the end 
of ttiis lM)ok) may also be given. 

During the height of the diseflse milk should fomi rhe baHia 
of the diet. This may be peptonized or diluted with lime' 
water. Albumtn-^aier, wine whey, malted milk, beef-juKM!, 
KffkayN food, aod similar prepamtiuiis may Iw employed when 
milk is not well bomo. Precii|feftte<l liquid beef prejrarationA 
may be u^ed both for their Atimulatiog etfeota and aa a food. 




408 



DIET LS DISEASE. 



'Jli<^j' fibould always be diluted freely with wat^r, ueiIo^a, beoaiise 
of vomiting, a cono^ntraUKi ibod ifl iu<)i<^t4Hl. 

Foixl bboulit be f^iwii at ft^uliir inttj'valtt tfT from two to 
four hourflf iicoordiDg lo tin.' |>adent'B oouditUiii uiid ibt amount 
he IP able to take at one time. 

Cciiifltipatioii, tlatulon<^, and vomiting are to be avoidnj whMt** 
ever possible. If they do (*eciir, efforts should at once be made 
to relieve tlie condition. 

In most cases starches and sugarn are best omitted from the 
diet. Fruit may be allowed at any time during the disease, 
uml is of special benefit duriug convales^ceDce. Meet gmtefill 
during the scv<:rc utage are onin^^e-Juice, leiaonade, grape-fruit, 
and grapes. During conviiTe^ceDci- ripe peaches or pears ia 
eeoBon m«y be added to the diet. The return to a geiivral diet 
should be made gradimlly, and no snlid fm>d jihotild he allowed 
until the fever has aubsided. Then the general dietetic rules 
for coDval<»centfi may be followed. 

I'ncumoniu patients show a wonderfid tolerance for alcohol, 
and it IK apjwircntly utilinx! by the htMJy hs a IckkI us well us a 
8timulftiiU Large qimntitie-s may tjlteii be taiken without prrv 
duoing nttj eymptoma of intoxication. SbouUl ihcy oceur. it 
18 an evidence that the <lose has been too lar^. Alcohol 
should not be prescribed as a routine raenenre, but should be 
ordered as soon as the heart begina to fln^. The indication for 
its use may generally be determined by aUHcultation before 
either the ejinptoms or the pulse poiut to the need for it. It 
fibould be given at once when the first sound of the lieart 
becomes pmlnnged and weaker. In w«ik individnal»-, whatever 
their agi>, espL>cially in patient* o\"er fifty, alcohol may l>e begun 
early. The dose fnr adults is onc-bnlf nn onnw? of pure whieky, 
»ui!icicntly diluted, every four hours; this niuy Ix? iucr«ise(l 
when necessity nris*^ Strychnin nnd other heart stimulants 
have obviate*! the need for the i-nomioitF^ dopes of alcohol ftir* 
merly prc*n^nb<»d. In nlri^holir- Mibjrct* it F^hould he given regu- 
larly. If it is withdrawn, delirium or cclla;>sc may ensue* 
The Ufiuul Hire should bo ob«>r\'fd in determining whether tlic 
KtJmuIunt is doing ^ro^"' <*r harm. It is be^ given in the furm 
nf pure mrvtunfl whi^ity, but champagne, brandy, i>r ram 
may owaii^ionally bi- MibMiimted when these ntv better bonie- 
In nil ea»^CTi they islionld be well diltitecl with plain nr caHKjnated 
water. 

Pneatnonia In Children. — Tho mme g^nend plan i a to 
he ffhllowed n« whni the di«e»«e i>ccnrK in ndidts, and l>otii 



I>IET ly DISEASES OF THE Rf-JSP/RATORY ORGANS. 409 



lobar pneumonia And bronchopDeiimonia require the s^me 
dietetic management 

TLe food bbitiild be jjiveii at r^uUr iutvi'vala, or if the cbild 
b at the broa^ it sbtmid be oiirMsl at ro^lar itit^^^rvuls. If a 
child ut the bretLst is too weak to niirac^ tbe milk niuy be 
nnmpei] mit and piven by nnaans of a slomach-tulw or a tifHwrn, 
The fllomach-tuhe should not, however, be used iu pneumonia 
except a.s a In^t r««v>r1. 

When infants are fed on modiBed cows' milk, the milk 
Ahould he further diluted with linie-waten Food should not 
be given oftencr than eveiy two liourn, aod if a sufficjent 
ouautity is lalieii, the interval may be ItiDgibcnt-d lo three or 
lour houra. Milk la ilie most imponant food^ and may be 
diluted with linu^water or with oarboojkted water. It may be 
peptonized partially or completely, or bt' prepared with the 
Pepto^nie Milk Powder, with Eskay's, Mellin's, cr similar 
iboda» or malted milk may be n»ei. Buttermilk, pUun or pre- 
pared after the method directed in the section on Infant Feed- 
ing, may be trie<h Knmisd is often retained where plaiu milk 
is rejected. If milk i& not well borne, Ijarley or oatmeal gnieU 
may be used by way of variety, if these can^n flatulence, 
they should be avoided. Albiiniin-waier and fresh U^ef-juiei* 
are tiHcfuI fintdaj aiid such preparalions w* PuiH»i>cpl<m, ]i<|uid 
bi?of [itypfopuid-'', and pr^i^^t^^l Ik**' art' of greut »;orviee wlicn 
othi»r fcMHls are not well n-laiucd or ft*iiinij;it*^. B«»f hmih or 
otli(*r niejit hrrithn may ocH^anionally bcfEiven. 

The problem of tl-eding ehildrcn suflTGrine; from pncumoniA is 
fretiwntly a very difficult om', for while they njiiy t;ike a fowl 
reaaily, they may refuse it the nest time it i.n oilm*<l or vomit it 
if taken, ^hen milk is well borne, It should coimtitute the dict^ 
but where it is not, the phymcian must liwve a* immy ntnourt-^s* 
art poftsible. From one to alx ouiioew, ju-vurdfng to thr iigt* ntid 
eondition of the ptttient, may UKUully \tQ givm nt a time» but it 
may at tini^^ he neoesaary to givt the ibod iii tciupooufui or 
UibleHpoonful quantities. 

If there is much vomiting:, 0<|Un1 part^ of lime-wBtJ^r aitd 
cinnamon -water may be given to j^eait wlva^taj^ A ten- 
epoonful of this mixture fiftei?n minuff-s before feeding may allow 
the food to lje retained where it wonfd otherwise be rejectee!. 

Water &honld in all caw^s be offered the child t>om time to 
tlKDe, and the itn^tjike of forcing U»- child to take foixl wbtii it 
wants only a drJnk of wut<?r ^^hotild bt Avoided, If there ia 
no flatulence, the carbonate<l waters are often very well borne. 




410 



DIET ty DlSEASie, 



Alcotiolic .stlmulantA are generally needed and are well borne. 
Wliirtky or brandy diluted with at least eight parU* of water may- 
be given, a little ^Utfur or glyocrin being added to o%'ercoaie llie 
Aharj> i^htv aud n.'uaer it more ptiUtable. In |>neuniouia, aa ia 
otW-T dlfwae^a, alvoliol io \M\rui- l^etter wLen it i^ given in email 
quuiititi(<i« aud fWjuently, thzin when Jar^'r do^^ at greater 
inter\Til« are |ire*icrihed. The average interval in two hours, 
but it may l>e j^iven hourly or even more fnxjueDtly whoa 
occasion demands. 



DIET IN DISEASES OF THE ORCUIATORY 
SYSTEM. 




DIET IN DISEASES OF THE HEART. 

General Directions for Diet, — The diet for [witienw 
witli hvari di--*i']i?**; u^imlly rt-ijuiivft niorv or leaa careful regula- 
tion, lln* Hubji'i-t may hr. dividi?d inl^i a cociHideration of tlie 
diet s^iiitable bcforej ood that indicated after, com]kensation is 

lOBt. 

While compensation hi (food, the diet reqttir<» ot>mpunitivcly 
little couAjderatiou beyond the obscr\'ancc of certain geacml 
ruled. When oompcnsntlon m bordering on rupturoy bowcvor, 
tliu diet munt be snpervi?^ed t^arefnlly, &» in this way miir?h die* 
r-omfort may l*e Hjtnred the patient and even the time of ruptured 
compeitHatioD be postponed, 

Tlie meals should be small — more should never be ^veo 
than the patient can easily digest. If the stomach is over- 
loaded, the diaphragm is pushed up and displaces tlie heartland 
this may occasion palpitation and dyspnea. If the mealn are 
too large, the rcttidut^ of any digested food in lln.- intratiiic may 
undergo fermentation and cau»c llatuIcncCf with its attendant 
disaeri^eable symptoms. 

The meals should be sin^ple and well cooked. Improperly 

Iirepared fiiod is a cause of indigestion, and may produce flatu- 
ence or duioomfort. The food chosen should be of a kind that 
is easy of digestion, A sufficiently long interval should be 
allowed to elaj)fie between meals, uud eating between meaU 
should be strictly prohibited, as e\'eD small portions of food 
taken while di^^estion is in progress umy give- viae to flututcn<» 
in theni-' ]>jitieiit><. 

The meals should all be of about ofjual siseci whilo tho cvon- 



DIET IN DtSKASES OF THE ancUlATORY SYSTKX. 411 



Ing m«al iDAy l^ n littlv wialler nml lighter ttiari Uk* otlicrftj 
and tbf^ ^jriiit-uiJcil lUful nlii>ul<) ]tv tukt-ii ul luJclJuy, tlu-ri; !«hijijIiJ, 
a« bui> b«t-u sojiif l>c but cumjjjrrutivc^ly littlr difTcrrnc*^ in thvir 
aue«r tuid tiic» putiovjl should be iuittru£-t<!<] cun^ully tu UiU 

Tlio lUDount iif fluid tiikm nhould not bi* tou liirgr^ oor, on 
die other hand, flliotild it l>e I^h) ^mail. When ci.>inpciiBaitioD 
has been loBt, the i)u<iili'>D an t<> tlie aiuoant of fluid to be tmketk 
becomea of much ioiporlance. At no time ^iHiuld it Ik* forgotton 
that rluids diHtend the vesnels, raise arterinl ti^nHJitii, tind incrcAflC 
tiie work of the heart. If the qtmiLtity of fluids given in* too 
fiDiall, eliiiimation ia delayed and thc^ trritdtjvrr elfi-ct i>f \he 
retained mkjjiiritiofl in tlio HoimI pruvcw bunuful. Fluidn should 
bo taken betwoeu nieaU, aud aro bcttt nippod «lowly. Weak 
tea uiiiJ eotfoe may la- Mowvd In snmll qiiiintititn Ih^wivii 
meaU ; if thty do not eau^ Satult-Jit^e., howvvor, iliey nmy be 
allowed at meal time^, t>nt always in ^rrat moderation. 

Alcohol ifi befit avoided- If, owing to the general weaknc^fl 
of the patient, ilfl use U indieated, it &lioiild I* given in Jinmll 
quautid»^, and in the form of |mre whUky or brandy well 
diluted. Wine and heei' are coulmudi^ated. 

Id general it nmy 1>e fAid tliat a diL't of pbitily pn^fiared 
food, unenouodkorvd by ton muay restrict iou^, t» h&st in theiiG 

All highly mwiioncd f^xxl and tk- i^^ndiinents in gi-neral 
should be omitted from the diet, m tlie\- tvnil u^ Htirniilut^ llw 
appetite of the jiatieiit, and may ranse him to tak« more food 
thftii it ifl ni^K^^^ry or (hwimbh* for him to have- 

f^tewrt and tkney dishi-.s f^ihiniM i%\»o be omitted, aA should tJie 
foodfii Ufinally cla^^ied &>< difficult of digestion, such oh fried foodH 
and the likr- 

8lareb(H, j^ugars, aud fata abould, ua a ruli\ ho interdicted j 
thiii re*tri(»lion, however^ nhould l>e i*nforoed strictly only when 
niade neeesiSBry by eonipli*'jiting i^toriiHrh dif«ftrderH eoming on 
a^ oom|x<n8aliou niptureii» when ttiey are apt to cauw fermenta- 
tion aud Hatiileno-. 

Droadbent dwelU on the nece*wity for giviug a diet oontaio*- 
ing about the unnal prr^portion of food oonritituent^. Htaruties 
and vegetables are Uiwful additions to th« diet, tbey help to 
keep il fVoin being too largely nilnjgeuoutji. If too much pro- 
tein material lu taken, it is imperfectly oxidir^cd an<l the wnflt<.- 
aooumulatiiig in tlie Uood iiHirefiaee the work of the heart, just 
as when too muoh food is taken. 




41S 



DJBT m DISEASE, 



Tb« d]«t AxcfuM «o«k«ijfi larp>lj of ibIUe sod of diflb«i Enado 
from titiit food, lygn, mn* mmtK 4b«p<vUlly mutton bdiJ be^, 
poaltry, fbh, and oy^u^rs. W'cilUbaked bmd, mils <vc bifr- 
cujljt, wtiicb are iior^T M W eaUn wano, and otrval^ in mod- 
ignite r|uanliti«i may be allowed. WeH-oooked potatoes^ spiii- 
>rh, aMparapiii tipcs caaliflon^er tone, and similar vegetables may 
be tal:en, all stalks being avoided* 

Tlie diet-lifit iboitid be Bimple, and sach ^ will not re4juir« 
burdeiiiug dve pul!ei>t with complicated dire<.-tioDfl. 

Afi com )h; ligation b4>eoDion ini|>aired numerous dieorderfi of 
di^ifttlion otNTur and reuuin? eare and attention. The patient 
with heart fiLsease may aevelop a di^iia^^le for food^ and thiA will 
oA«n tax the infcenuity of the f>hyAician. 

As bI<M>d ^taf^U seta in, constipation is apt to ooeun H>'po- 
Rtatic congestion of tlie liver oonies on, cnufling lefisened met' 
abolbm atirl consetjuently interfering ^^reatly Vi-ith the ^uerat 
nuirition. TIk* ^toiuiich and intestine iire afTect^^, and a 
cbronic catairliul c^^nditinn of bolli is gL'nei'ally prvw^nl* 

Th(? rfiiantity of flwid ^ivcn should now be rc|pj1atcd care- 
fully, neither too mnoli uor too liltle being given. A glass of 
ViiJiy half an hour before eating will help to pn^pare the 
fitomach for a meal, and tvill, as a rule, be excreted promptly. 
Fluid is ahiwlutely necessarj* for metabolic chan^resr aiid may 
be taken in the form of the " imperial drink/' ebewhere 
described^ betwei^n m^lH. A glass of hot water flushes out 
the bo<Iy, mid, nr, it in rapidly excreted, does not add materially 
to the amount of fluid pn.T^i:tit< 

In the Ortcl trc«tment of hcnrtdijwiao the fluids are allowed 
only in a veiy limited de^pve. If the patient is on a milk diet, 
othpr fluids li4>)iidt*H milk nhnitld be given in oomparatK'oly 
small (iimnlitic^. 

If aJfvui itt iscvore, the fowl may he ^ven in as concentrated 
B form 18 giosi^iblc. 

l£ fiihilmrf 19 troublesome, fatA, b-tarchcs, and sugars, aa 
well M bt-er, ]m.H\vy\ and sl».*w.»j are to l»c avoided. ISo ^Itd 
food «bouhl Ih- iJikiTi Ix^t^rcm ncJtlft. Cofftt* or tea taken with 
tlie meals mny giv<r risr to Hatiilenre, They may, however, in 
0omc caf>e^ Ix' tnbcn during tho dfiy, at a time when the stom- 
ach i« empty ; thpy t^hmild U* IW^hly prppirpd and should 
TiMver He atn^np-. Only mirli *|Uai»titiiw iif fitnt] a.* the patient 
can diKett shotil'l Ix? alhiw(*d, and, if nc^x-sstry. dlgi'stjon may 
be aided by giviag i*Sf*n<>o of pepf^in or otlicr diget^tivea. In 
m^me <tuw« a milk diet may h<H?ome iKHN>!tsiiry, 




XP/KT JS DISEASES OF THE CIRCULATORY SYSTEM, 4i:i 

tSW^fm ditatation of the hcsrt {VKnimng iluring or followiDf^ 
any acute discaiw rpquirc« rcHt ami a milk ilit-t. 

I\ilpiUit\on and rfywp/wi aiv nfVrn cuiuwt] by tht in^^Iiuu uf 
too abuDdant mcnU; if pcr^i^^rtcnt, the focxl Khotild be given in 
fftnollor qiiantitii?f4 anil nt kliortor int^rviLlH. Fmir or fivp v^nm^l, 
ill«t«aiH of thtvie Inr^, mrfiU mny l>p tiikf^n nt rr^^iUr iiili-i-vuli^ 
or u milk diet may be onior^ for a timo. The gi'tienil m»ii»gi>* 
ment may bo such at. has be-on niif^-sk'fl for fliitiiloiiot^'* Tw, 
€u9Wf acii tobttw^j should Ixr avui(k*d. uml fffervt^'iii^' drinks 
may alm> be omittnl. If Ibun.' l-* i^)imti]xitiim, aU^hc*!) i'ru'm, 
c«pociiilly prun«> or fig»t^ tn- iiM.rrtil. 

Otuftric tlu^irbaJiftsii nru Iwett iiK*t by mil and a milk di«t foT 
a tiiuo, Atlli u gmdiml niuni li) tJu? ctrdiiiary dic-t ur a diet etuoh 
iLs is iL(lvi?'«d fur <3iisert of gnntrit* cuUarrU. Mul'Ii rvUef fre- 
quently fiiUiiwH tbo ilnnkiTi^ nf n gljtHi uf hot water or of 
Vichy half n» bmir Won* a inwiL 

Ae niplurt^i a>m|)oriJ!intioii U iKxromimniod by cff^iniou, t^tm^o- 
tbing mtj&t W iHiid >vit!i >i{H<<ial referenoo to tlio removal of 
fluid/i from the botiy. H<?ri*, indeed, feeding is a difficult task, 
for Iho patient iiwiully has a disgust for food. As BnmdlK^Hl 
eay?^, tho ol>j<"ut w to l<co]> down ih<» volume* of the bUxKl while 
maintaining its quality. If the patient is very lU, nourishment 
may be a<ioiinL»tercd ovcry tbreij hours. If he ia able fo be 
aboutf it will often be well to allow him to tjiho hie nieale iivith 
the family at the regular m€«d-time. He may he ^ven chiekeDp 
tender meatA, fiflh, ny^ter^. junket^ and other forms of light 
food. When but little is taken at the rt'^iilar meal-time, food 
may be piven Kuveen the meala^ ;it rei^u'si' [>eri<Hls, time being 
allowed for c^>mple(e dige^lion to takf; plucc. Milk, albumin- 
water, egg and milk, Houp, or bi-ef-tca iu Hm&ll quantities are 
useful for this purpoee. Broadbcnt reciomniendft mait or 
chicken jelly or meat estmrt'*, for thi^Sr Htinitjlating efR-ct on 
the hciirt. PoH«l'mrat anndwii^ir-* or meat pulp, prefuirwl ns 
directed ii>r tub«r<Milau>4 pcitii'ntM, may he f^vvn. In Germany 
raw ham i* Homfttimrfl prcwrilw'*!, Oonntiiwtion mny ofU'Ti !» 
avoided by addiiif: et^wed fruit, prunes, or Hgs, or v^*tjibl« 
pnr^, all in Amall qimntit!(>K, to tlw did. If ni*(*<*HHnrT, pre- 
di;i^^leti fo-Ml? nmy lie u>*ed. 

Fhiids nthrr than milk and 4onpH should he taken in 08 
Knmll <pianttlies aj* ]K)Hfiible. " Im[>erial drink " or hot water, 
u."* pn'virninly HUg^'-Httii, niiiy hv ^Jven to ijueoi^ti the thirnL 

HtiroubintH txtv usually nei-dc-d, hut ahould b«T ji^jvcn only 
under the gupervisIoD of the phygieiaD, aa there is a tendonoy 



L 



414 



I>IET W PiSEASR 



to tAke too miMb to relieve fkintiicn^ or oUier iiviU|itoinii, In 
Son-al<^oh4iH(Wf from oDt'-lmlf W> tw^ ouncvn fif whisky a day 
mfly be allowwl at tin? tH^jfliibUig} th-e luDuimt Imiig ittcmi^^ 
ftS OOOfltfon demands. StimiiUting dnigv Imvt* lar^-ly xiipnw 
Beiled the one of alcohol in the^^ m^eA. 

HEART LESIONS EN CH1U>B£N. 

Thp cliot i» (st^ntially the liamp jik thnt ('.^r nfhilte. CJiiMreil 
wIk' arc Jihlc to h*y tilwjTit rc^jinre careful mjM-rvision, the Ireat- 
mcut luring along the same geiicnti linefl afi were laid down for 
mliiltH, ljeti» iijoii \rt retjiiiretl than in healthy and the m^ls 
dioiild hv enudler. Can; vhuiihl \k cxerrii^] to see that the 
fiKwl \^ tMlt-ri shiwly and well m»j?ticat*HL The diet should con- 
sist liirguij" vf luilk, v^^f mid meat, with or without a ctrcal, 
And vcgulables, the last being nC the more easily dig^t*."d vuric- 
ties, such 03 wcll-no<iked apitmch^ asparagtisH^tiiw, &in\ cnuli- 
flower to|t.', as thete are Icttft apt Ui csiHc fhitul^.noc. Fresh 
young [x^T^, loflfihwl anil stniinpd, and fr^^^h, t^nrTer Ktring- 
bcane may alwo U^ allowed, Putatoe^i, either well tmhet] or 
well boikil urnl intt!(lK'(l, may be cutcn in wmall quantities. All 
eoarw ami islalky v^^^'Uhles are to U* avoided. If thorc is 
flatulence, tiie t^rholiydnit*-?, 4is well a^- the fat*^, may he very 
much le*!aeiie<I or omilktl temporarily. 

In the moro ^vere eaees oiilk agree?* bettiT ilian any other 
form of food, tnid should be given in eonall rjOuntitics f^t regular 
inten'al*. A^ a rule, it ptioiild n^^t be inkcn too cold. The 
variouH m<:idifoation9 nf milk and nthfT l!f|iiid fojid^ that hav8 
been mentioned in connection with pneumonia mtty he em- 
ployed. In some cases, eepecially when dropsy Is severe, there 
is no deFiire for food, nml the problem of feciling (hen becomes 
a difficult one. In the»e nises pntli^esled i'RHJs of v'arioiw 
kinds, riiw ramt-]'ulpj t^ advi^-d in tiibiTculo^t^ and becf-tcaf 
beef-cxtraot, uiul the like, may Ik* tried, 

SENILE HEART. 

Balfour'ft little Ixiok on Tht SenUt Jfeart will prove a valu- 
nhk- f^nide to the oare and management of the nged. In hm 
el»apter rtTlatlug to diet be says : "Oardi«<" iruublt-h are ulivaya 
alnrmnig, purtlctilnrly in old uge, but much may be doii« to 
n^licvc th<j patit^it wnl to prolong hiw liie. Attenticn is to 
hf paid to the littlfJ thiiigs of diiily life — the Ittde tliingu of 
eating, drinking, and doing — that intluenee the. p;iti€nt'a eomf<:irt 




VSET t}l DLHEASES OF THE CIRCULAWHY HYSTBM. A\b 



and graduallv turn the scule of health itt his &vor. The phrsi- 
oian*# rt^ljitioucf jlfv oftoi pitted a^in^t the habits f>f a life- 
tioaef am) ftjfficuhjr' nuiy be had in K.-<^nriii^ uccgiiicw^noc. All 
bfttrt a^octiona of tho oM &ro not ncooeiwrily 8en]l<> m choractor 
or 'iri^iTt, Many fs^i^t^ may W of veiy long stAodiDg. Senile 
cnnlino laiJtire iri «86i?ntially ba^^ecl upon impcHeot nietal>t>liHm- 
Tho diet must be reifiilat^d to suit the patieDf, and certain 
thin^ miiF^t be ooneiderHl. Morit of the fmtient^ are belc»w or 
at iheir usuflJ weight, Tbe«c recjuire direful regulation of a 
normal dietary, to be given prcfreiUly. A rimalkr numl>er are 
over their nurDiEil weights, and bufler more from breutblessneee 
than tlie preceding cta«» of caae^p Tbea.' require to be specially 
dietcul and cared for, »o as to remove the oboiity without diiuin- 
nhing (he eaHiac energj' or th^? etren^i^h of tho myooatdium. 
I^a^tly, there ane thoRe in whom there is more evident fiiilm^ 
of tiie Qiyocardium- There are more evidence* of dilatation of 
tlw heart and of the ti»9aea. Such cases require a apedslly 
dry diet." 

Ponr Important Rales. — 1. An iaten*a] of Jive boiuB 
should U* al!i>w+.*il t-> elapw ImIwcch ihcaI^ 

2. No ]Kili<J food r^lioidd be tukcD between meals. 

3. All persons with weak hearts should take their principal 
meal in the middle of the day. 

4. PerM>n3 with weak hearts should take their mmls in aa 
dry A form as poft&ible. 

All indig^iible food should be avoide<L E^ixH^ially to lie 
mentioned in this class are dried, salted, or otherwise preserved 
meats, cheese, |tti*try, all other fxxU in which fatty mfttt^r ha« 
undergone prolunge<l exposure to heat, luid Jill sweets aud nuts ; 
owing to thdr truit>ility to cause Hattilenf^p vegetable fo<xl must 
be cho»«n with care. V«g^kiblcs of the cabbaj;« family, and 
carrots^ tumipe, and paraoip^ are regarded with dUf^iv-ir by 
Balfour, Even potatoes should be eaten Hpuringly. Fruits 
should not be cmwded into a meal as a de^^ert, but may be 
allowed to form part of the meal, <^pedal]y at breakfast or at 
a midday dinner. 

No ^>od is t^ be gainctl by attemptinff to enforce dietetic rules 
founded on the ntmibcr of miofi of carbon or nitrogen ro^juired 
lo cany on the proct-w^.'s of life. 

Tb« foods to be aIlowe<l persons with wcaik hearts are the 
tender varieties of white f1«h, chii^keu, rabbit, j^iimer muttou, 
or wdl-gmwn lamb, all of which BalfoLir |^vcj» in prcforcnoe 
to tough UW. One well-boiled, ripe, mwily potato may be 



4ie 



DIET !N DISEASE. 



ftllowcd at diiiuer, Hpiiiuch, miw tt dum uot cuune flAUileticc, 
i» llie Bofesft vr^cUil>lei osponigus-ttrpd, onions, antl tomatoes 
inuy bo tukcu in tamlcnxUciu. I\^u^, beun^, cLnd other U^uiut- 
aoua fi^Hids, wlifrn frcuh, voung, HnJ gre^n, niny be pnrtnketi of 
ill mode rati 1)11. 

Not mure than ftvf' ouii(!ei4 of fluid, and if ix*asible lea*», 
diould be taken with h mmK If wut^^r 14 desire<l witli Uie 
meals, it should be tukr^ii hot and r{i]i|K*J ?Uowly. It' U% it 
used, it should b« weak — a tea.H[)Of>nrul of tiiij toa to five ounces 
of water, Ht«e]>ed for nut nioi^ thait Lhrei: minuU^. ColTet^ inay 
be sweeti^uf^J lo laste, uod bikeii b1a<:k or widi rntiui. Ch'x^u* 
lute and coooa un; tuu I'lc-b for those with w<:ak h<;virtftp but if 
tAkgn alone taay oucaj^iunully be tiAefuI. 

Alix>ho1 ^lould h^ |)rt*f4crib(Hl only am it is nfied^. 80 mnny 
patients have heeQ u<x;iLdlonie<l to it« use all tlKur lives tliat it 
cannot be cut off altogether. For tliofv to whom alc<jlnjl ij* 
permitted half un ounce of whisky, brandy, or gin nia_v bo 
given in three or four ounces of wal^T twice a day, ti>gi'tlRT 
with their fcxnl ; or a single ghis,s of :<herry ur port or two 
glasses of nny H^'htcr wine, such aa hock or claret, eiieh glaj«» 
to bold two lliudL>uaccs, may Iw nnlercd. The stmogtT wiuo* 
are best omitted, as they an) liable, if taken in lai^r quanti- 
ties, to giv<^ Hrio to dyspepsia. Champagne is, as a rii]<>, for- 
bidden. Idiaiynernsie*! oooir in regard lo the effeel of win^*, 
so that the iudividual case rnurft he considered iH'foro it is 
ordered. Ala>hol is l>etft ^iven in the form of pun* whisky 
and water, always ia extreme moderation. As a stimulant for 
a weak he^rt, small quantities of alcohol are frequently pre- 
scribed, to be taken at various times (luring the day. This is 
most injurious treatment, for although the primary effect of 
alciihol ii fltlmulatiog, ntcoudarily It ia depresaaiit. A letter 
plun is to dlwwt such a putieut lo take two or thnn; jitpn of 
water^ as hot as f>au be svvuilon'ed, oeeu>4ioiiul1y tbivjiighout tlio 
day. A|>art from that taki*n in the (fnid iitWn onnt^its of 
water a day are all that should 1>e allowed, but if severe tliinit 
is complained of, a half pinl of hot water may be flipped about 
four hours after each meal or only after the principal meal. 
This cWnaes the stomach and prepares it for rest. Hot water 
Quenchet^ the thirst betier than does cold. The thiret is usually 
aU6 to a t^tarrhal dyapepMiu, and soou di^ppeurs after the 
dicit has been regulated. The foHowiag is Balfour's diotaryi 
whioh is easily modified : 

** BreaJ^OJit &.'Mi One small sliee of dry toast, weighing 



UnST IN DISEASES OF THE CIHCVLATOBY SYStKM. -117 



about an ounce and a half, with butter; one soil-boiled or 
pciclit-d e|^', or ii:iir w aiiih.)! liaiKluck, ur ite equivalent iu ijiy 
oihtr trtbh white iiab, witli JVoiu i\\n.^ \o ^\t ouuoti of tea or 
ooffee, with oreum and buoar. If there be any difEculty about 
the teOr it may he re|)laoed by a f4imi1ar tjui^nfity of infiiAion of 
ooooa-nibi4^ or milk and hot water, or cream und ttelt^^r waU'r. 
Some prefer oaimoal iKuridge, with milk or cream, and in ordi- 
nary circuni stances tliie need not be objected to, provided not 
more than lour or live ounce* of milk be taken, and the por- 
ncl^i^ be not more in c[uantily than three or four ounces of oat- 
meul| well boiled : providtxl, u1m>, that [)orrid^ uloue be takeo^ 
and aot porridcv tirat, followed hy teaj toa*t, etc-, which n 
deettnKitive of all comiort, both for atjoioeh and heart. 

"The priwyjpoJ mpat of the day, whatever it is called, lunch 
or dinner^ Hhoiild be taken about \.'M or 2 o'clock, smJ may 
comirit of two court's, not more — ISsh and meat> or ti*^[i and 
pudding, or meat and pudding. Sonpfl, i)astry, pickles, and 
cheese arc abfK>]utoly lorbiddea. Y'hite fi&h and meat with 
gbort Sbers are i>rei'erred. Half a haddock^ or itfi c<{uivalent 
iu any other while tifh, boiled ia milk, mcjmed, ur broiled, 
nevur frtixl ; wiug and ijart of the hreuM *A a chickt'u, or itA 
equivalent iu aweetbreadfl, tripe^ rabbit, game, or muttou ; one 
^iigle pottttu or a littlo t^piiiaoL, For pudding, any form of 
t^imple milk pndding imiy be (aki-n^ or abfjut half a pound of 
Ktjcli frniU a» [»«ir?*, appk*--*, gra]>es, etc, either cooked or un- 
cooked. During: i\m nu<jil fourorfive onnoe^ofhot water may 
be Mpiwd if desired. 

" From .'i to 15 three or four ounces of tea may be taken if 
<lesjre<l, iufuM-d, an in the morning, not longer than four min- 
ule^**, and with cream and nugar if wislicd ; but no solid food 
I^^J^t be takej) with \i — lujt <veu a morsel of cake or himuit 
If thc-rc- l>e uuv dlftit^ulty about the tea^ four or five ounces of 
Lot WHler may l>e substiiuted for it, and if there se*rn ntiy uetnl 
fora Ht.imuknt at tlii:* time, a tefl>ipi;Mjnful of Lichip:'*j extract 
of l)e<*f may Ik- stirred into it, 

''Supper, or the tai*t meal of the day, moFt always be a li^ht 
meal. It should be taken alwnt 7, and may consist of white 
liAh and a potato), or toast, with butter, or some milk pn^Min^T 
or bread and milk, or Itevalentaj made with milk or witli Lle- 
big'a extract of bwf At bedtime^ four or five oimccs 'jf hot 
water will sootlie the aton^ach, promote alecp^ and pave the way 
for a comiortable hreakta^t next momiDg." 

87 



418 



mRT /iV DISEASE. 



Whon there U unit^rnH, the followiog "dry diet" U reooiD- 
meiided by Balfour 

" Jiretikjnsi, — One Giogle elioe of dry toaat, w«fi|^hing &boiit 
ftn ounce and a hiilf, with nn biitf«r, but with & HJD^le mip of 
tf^ infuK^ nr>t longer liian fntir mintitcA, with cn^om and sugar, 
amountiug in fl!l to not iiLore tl»ui fbiir oiidc<«, and DoihiDg 

■' Difmer. — Not moT% than the lean of two ohope, or tts 
i^qiitviileiit in chicken or fish; no vegetables; aa much dry 
toapt jw may be dpsircii; half an ounce of brandy, whisky, or 
Hi>lljua] gin, iti three ouncw of wal<?r, uiid uutiiiujh; iW. 

** M*/jpcr. — Ah much <iry toitst moy Iw taken ae is desin^di 
along with half ap oiiik« of brandy, wbiaky, or ^ in thi«« 
outifN^ of wat^r; iind nothing more." 

It is not <k>9iinib]c that a patient in thix condition drink muoht 
even betwct*o iiL(>alj<, but if thirsty, he imy bi^ ]M>rniitt«l to sip 
slowly thn^ or four ounces of hot wat^ about an hour before 
each in«£tl. 

ARTERIOSCLEROSIS. 

In mo8t cases of nrterio^^oIeroAie symptomg of i^enile heart 
occur at the Miuie time, uud the same ^ncrul prinoiple^ muy be 
followed a* were iliredeii for that conditiiju. The French par- 
ticuhu-ly adviicale a milk diet iu the trctttmeut of arterioecleroeis, 
and where there are headaches, insomnia, and other untoward 
symptoms, an absolute milk diet may be msvA with advuntu^. 
As, soon a£ the Gymptom? tfisiippear a mlxei] diet muy be sub- 
fftjtnte4b (See Milk Cure for methodfi of giving milk.) Min- 
erjil waUrr may be preserilied, (»r trips may l)e made annually to 
miueml springs. Whenever possible alcohol should be pro- 
hibited. 

ANEURy^4- 

Tn moflt ftasp« of anenrviSTn thnt nre pmvTnp trf^nbleflome the 
treatment consiats of rest, a restricted <iiet with n limited antount 
of Riiid, together with potassium iodid. Prom ten to twenty 
gnvins <\i the lodid three times a day are suflicient. 

t'ertain cases ol' aneurysm may be relieved by rigorous diet- 
ing. The saccular fonnst and especinlly ca-'^e* of aortic anenrvj^m 
with Hmall ojMwngs, are most apt H» improve under tbif* treat- 
ment, I>ietitig is also helpful, it i» s«id, in traumatic aneurysm, 
Tuffnell, cf Dublin, adviee<l the following diet t 

Urtakffnd, — Two ounces of bread witli a Little butter &n<! 2 
oancea of milk. 





MET IS DISEASES OF THB CIRCULATORY SYSTEM. 41ft 

Dinner, — Frcm 2 to 3 oiinc4?« of meftt viUiout f>alt, and 4 
OCDCCH of milk or claret, 

dipper. — The same aa breakfast. 

AbM)]ui« [ih^Kii^ aiiJ meoui] n«t muht be secured for iJie 
peti«nt, and a compcU-ut ikurm- wLu will ^ee that tbv diet ia 
strictly adhered to U t«8vuiml* Thirst may bo relieved by 
aifiall quantities of acidulated dnnka or by atpa of hot water. 
Potassium iodid may l>e prefloribej, as inay alp*o morphiti. Few 
patieDtt-f howev<;r, are willing to uudeiyo the wifflrrin^ tliat suoh 
treiilQient eiitiukf and not many will i>ersist in it for more than 
eev'(^ml weeks. TiifTnell advised thiit it is to be folio ned for 
aevcml months, nod hv and otJien) rep<*rt cures in certuia cases. 
Tbe anemia that fallows may bo extreme, and niav Imve the 
petietit in a serious conditjon, 

Broadb<?nt advises rest and small, oqnal'si^od meals, token 
at rep^ilar intorvaU. The meaU must be ooDcentrateci> and 
billh^ fiiibi^tAncea, bUch as riee, potatoes, and bread, are to be 
excluded from the dietar}\ Tbe iimouot of water taken in 
twenty-four hours should not exceed forly oiiDces, avid an much 
leBs as possible is to be taken. Twenty-four ounce* he places 
as the minimum. 

The objw^t of tin- Irotitmcnt i8 to produce the slow circula- 
tiou (ffii ry>tul<niH(H] IiIcrhI in thrhojx? tbnt fibria rnny be formed 
ill tbe Bac> Burrtuy Yt'w thxr" not favrir aiicli wvcrc difting. 

Whoo ibo case is unt a siiitAblc one and t* not ^vinj^ cspcdal 
trouble^ it ie probably best it ivHH>nim<»tid a i^ii'wt lifn und a 
9impl1^ dicif avoiding inrligtv^tilib' nrlictpx offocMl ;md tbn»^ iliat 
caiuw flatulence. As O^I<-r bos mk\, the mcKlical pn.>fe»iton haA 
fmniRbed numerous exmnpliw of men with aorlic imcurv^m liv- 
ing for oonAidi.*mblo periods nnd doini; j^hxI work. Of tfac«C 
tbe late Hilton Fa^e was a notjihlc example. 




ANGINA PECTORIS. 

In thjFi di^coee diet i^ of the greatest impr^rtfinee. Tbe 
majority of vh^j^ ^t^i'iir in " Iur|fe outers," and, as Oi-ler says, 
tlienMS " di^lb in iht^ [Wt," Ah n rule these patients miHsrc 
that oven>iilin^ Ik liannful to them. 

Tbe iiir^ilti nbould )>f> HnifiU and f^asily di^sltlde^ and a1) ricb^ 
hifc^liiy 'jisoin^ fitci], aw well sui ^uythm^ that cati&e* fernieiita- 
liun, should be carefully avoided. Flatultuce is a aymptom 
that must, BO far as possible, be avoided, for as aoon a» the 
stomach beciimes distended distress follows that may produce an 



420 



DIKT AY LISEASE. 



attack. T!he evoning meal ^^houltl Ik' isnuill> and filing bt« at 
nEght ^lioiild be iirohihttul. 

If tlie fiutjeot b^ m mlilUi^ii, llu? Mjhji^t i>f gQUt or glycD* 
tiurinT Uia diet muat tic n^guLitcd aoourdlngly. The dtctsiiitttble 
for varirjue uawee diflers wi<Uj% uud ptrrsoual idioeyncmit^ must 
nlwjivs hi? bikeii iiitu uc*c»iitiL 

Id hU IfctuiVA on iiugjrm Olcrcnlls to mind that Dr. 8mol* 
let, in Humjtfti-ftf (Xinkcr^ iiuiki--H tMu* of his oliamct^r^, MuU 
Bramble, ^}' : '^ For my \^\ii\ part^ I liavr liu<l a hospital th<»c 
iourttien v-^arn within my-icH" and studied my uit'u ctwc with 
most painful atmition, conRtypiently niiiy l>e suppoHixi l^i know 
dometjibu of tbv matter/' An Int^.'lli^'ent j\itiL-iit sh^tuld knew 
what food doi»B ;i,ud v-'hat dtnw in>t cvitiHe Matultjin.'e. Ftutiiloiioe 
irt most apt to oociir in fat flahhy pationtr. anc] id du»c with 
woak hKirt>i and arionowleroj*!*. Hot wat4^r tukiii half nn 
hour bt^fore nteiiU may 1m; useful. 

In Uioew with whom tlie drinking of MimnhmU isi a life-Ion^ 
habit alcohol may be nllowed, Uft in thi' fi>rm of hot toddy aC 
bedtiniL'. To quote O.^ler again thi& may prevent tht' llatulenoe 
that is apt to come on during the early morning lioura. 



ANEMIA, 

Acate Posthemorrhagic Anemia.— Thp rendrr h re- 
ferred to tiir sectioa co Did after 0|n?tntions for ttnggCrttJons aa 
to thg diet in thin disorder. In the cnso of tho saiallc^r Iwmor- 
rhngwi, whirh are rapidly rei-rtvered from, the nsunl dii^t may 
he fi^llijwcd- In the more sovere forinj*, sjHHjifll eaix' may be 
nxjniriH). If the anemia that follows a wvere liemorrhap* l>e- 
<xim*'» ehronic, the jMitient is to be inanuged the same \^ in 
chronie )«econdan' iincmiu* If much blood ba» b^en lost, fluid 
should l>e j<Tipplied tn the body in the form of normal aalt Aolittion^ 
by transfusion ialu a vein, subrutaneoiihly, by ihe it'ctmn, or by 
the month, according to tLc condition of thr jmtic-tit. Ill iikihI 
cases the fluid part of the bloo^l b rapidly rL*pliW!4*d, If tho 
hemorrhage has been ftv.m the stomach nr howcrl, iipt^eial niiin- 
agc^>tnent» as detailed un<ier their re&[wctive heiidingn, lis iieee**- 
san', 

\( the patient h very w^ik, rold milk is usually the moat 
acceptable form of foo<i. Hoi milk is pi*el'erred by some, and 
18 bft^t for many eaaes, I'resh beef-juice and weak beef-t«i are 
valuably?, as i^ also album in- water. As ^^oon a*^ the patient is 
able U> i^ty a diet Ltnitaialng eouniderable pivtein aud the Ire-^h 
green vegetables should be adminisiert'd^ aa vrell ati mdk^ ^p^> 



niKT IN DISEASES OF TUE CIRCULATORY SYSTEHf, 421 

rare or mw mrat, witli i«[»iDaeli, ahpctragUf^lipH^ apples^ straw*- 
berri«», aud otiu^r l're»h fruitn and vegetables. 

Indigefttibte article nhonlil tie avoided, and strong te^ecffeSf 
uimI tJii? uiLR-li ctmututiutt^ bvtjl-tuu »liimld uot be taki-u, espv- 
cbtlty in tbv acute aUigen. 

Aooordii^g to tbti ruc«^r t-xpmm^nU oud obdcrvatiooa Uut 
iiAV4> Iwun mode on thu rabjeci, the tn^tabolio prooea«e» of the 
Ixvly aiv ritii4T cibctut nonnal or liiniibir tf> tlio^e goin^ on in a 
oonditioii i^' Inin^-r. Inm in ^<kme form xa advisable id the 
sevt-rer oai^tw. 

Chronic Secondary Anemia. — EITorU should be made 
to locate and remove the cause. The diet should be about tbe 
aatoe as that rGcommeoiled tor chlorosis. Kr^sb food, milk, 
vgj^ to^tfl^ ^nvn vegi;tablt^, uiid frvftb fruilA are the luosC 
tmportuiit tLniohs of diet. Frv^i air and sufficietit rest are 
also esHeiitiiLL 

Pcmicions Anemia. ^In npiteof tlw» grave ant-mia tlie 
body fat and rmisch^ orten rentaln for a con.hiderable tiroe but 
little diinini&b*"<l in size. The blood deslrmrtion, however, is 
progressive, and tends to a falal ending. Rest, removal to a 
difi'erent climate, freah air, and attention to the diet may in some 
cases prolong lilV. NevfTihele^s the tendency of tlie disease ia 
to be<.i)Uie |in>gn*«ively wor*. 

(>wiu|^ tv tJie unorexia, voruiliuj^, tuvi dijirrbeu tlnit arc uj>t 
to he pTctH^itf the dUd ha a inutt4*r <tf importuneck Cuupliuid 
and HtinitT ohum that a uurbohydrat4j diL't i« bctti?p bunm tlinQ 
onfi crtmpor4**d lftrj?:i'ly of proti'diK v\s the n*Mi\i of rx|»*Tiiii<.*ntj 
Hunti-r bL-4 U-en Iccl to believe that intestinal putrcfflctiun oc>our» 
l^A oiUai on A milk and carbohydrate diet. 

I^redigefllc<l foodi, prepaid infanta' or uivalidi' fiKMLs, mw 
meat-juice, and similar articJes of food may be allowed- Small 
quantities nf alcohol may alK> be presertlied. 

Duriuff recent years the boiie-ja;trrow of long lx>nisi of ani- 
mals has been recommended highly in eaw3 of pemicioud 
anemia. The marrow is euten niw^ in doses of &om one 1o 
thrpe tah1eflpoonfu|(^ twice daily. The authorn have obtained 
good results in seve-ral cases tVom this form of treatment. 

CHLOROSIS. 

Tli« diet for ehlorotac patients i^ not generally undervtood, 
and thervfon.' reqidn.^ «»]h?ci«I **tudy. 

In cblorijf<i-<« iiu ij^iangtvi ucxrur iti either fflt or uui^r.leas. 3uu)c 
putieotA are fnC wbilr otht?!^ ure (hip, thin dcpcndijig for tbe 




4SS 



DtET ry DISEASE. 




moHt part on nraidental oircittnAtniioof* and bearing onl/ an 
indirect rehtion to the nueniia. The thin [HitJODts ai^ usually 
those uicliviiliiul^ %vIki arc of ihut habit; tha'w who have och 
exisliug <l[^<jL-?e r>r the .-itoouich ; tlio^e w1i» Extkr Uk> Utile fooj 
and who lire, in c<>ti**qiich(w-, suderiiig (Vf>m maluutrltiou ; or 
liutly, tbote whr* must iirjd<?r|j;o ouutidemble Ivodiiy exvrtion, 
uatiAlly in g(?tting their livelihood. 

TIlC' fut [iiuieiit/!^ ami tluKic who are rifhtn edematous looking 
arc Jiidividimls vvlnt are dthcr tat hv rmlun^ or who are receiving 
too mitol) milk or other Ktiid ^vith theiv tiict, 

Uod*-r a pmi^-r diet no change in the we^hl may occur ; or 
in the ca»e of the fat, edematous-looking patients, there may be 
a losH iu weight while tlit anemia in iiupiifving, or if ihv patient 
\iaA bc^D fakiug too Utile nourlBhtiietU or ia dohi^ too much 
work tiiid l-i tliiti 11] ooudix|ueiioe, there amy be a gain iu weight, 
riu* mt*tal>i>]tir pr4jei'.4fiK4f 8o far a^ \ri known, are the qame ha in 
health. Owing to the lowered henjoglobiii value of the blood, 
thiT jiatii^nt ij* not ahle to exert herself much without producing 
great fatigiie. 

In the ti^Jitment of the chlorotio patient three things are 
im[)ortant : iron, wufficient food at pro]>er iiitervaU, and rest. 

Regarding the diet, the i^uality and the quantity of the food 
may be ibu fiumc ii^ in huidthy iudivtduaU. The mcalH ^hnuld 
be given at n^uW inU^rvnla, not too wiJcly sc|iHriit<Hi — uHually 
not more than throe hours apart. In euuHeqaenoe of the shorter 
interval and hettmae the |iutient'g dw^ire for food is apt lo \ye 
loM'ereil, the mt^^ibs HhoukI he smalK Thenp[ielile id uai»riciouB, 
tnd while the rt^^^br uiejits tuny be left uutoudutd, such unde- 
eirable arliclcs ai' pieklo^ ami sweets may 1>e greedily devoured 
in tlie intervalj?. This tendency ghould be controlled and 
nothing allowed between the meals. Von Noorden rei^ommenda 
five mealh ilaily— at 8, 10.30, 1, 4.30, and 7 ur 7.30, Tbia 
Mime oUwrv<-r alao lunintH on the value of taking an abuiidanee 
of protein foiid at hreaklSu^l, giving aa bifl rcaeon tlial protehi ia 
tlitf only food (aloohol not being eonsidered) that U ready for 
use in the ho*!y shortly after ingestion. Cari>ohyd raters tor the 
mo»t ]iart a^ firnt to the liver, and lit** are too [jIowIv ahsorbeth 
The patient who take^^ the cualociary Continental breakfast of 
coSee and rolls has a long wait before the ceila receive adequate 
nourUhment. The kind of protein food ie of little importamv, 
aad ouiy bd either meut s>r cgg^ ; meat ib, however, oKpvciutly 
reoomoi6nded| and &hould be taken regularly for hrcak^t in m 
definite quantity* 



DIET ty VDih'ASES OF THJi CIBCULATOHV ^YSTEIi. 423 




In geaicral tho diet fihouid aliio contain aufticient proteiD, and 
von Noord<ro advUes the use of »ucb preparationa ob i4omatoaier 
putrwv, proto^ei), or euca^iu, when Deceheory lo increa^ ibe 
quoAtitf of protcuL. 

Milk in gcnfTiilly pn.«cnbixl id too large* qiiuiititiv&. TUU 
Pih»iil<1 l>e AVoidei] where tbe appetite i^ arriall, an a glaae uf milk 
ID iiiese rasefi gtoerally obeck^i any furtlii^r desire far fttoA. It ia 
also lo be avoided in thnee cases in vhich the apjietit* ifl fair 
but the patipiit fibgws a decided teodenCT lo take ou fat or to 
buco[ni.-:4 uEiacwlmt edemjitouH tookin^. In tbe>€ individuala the 
<N:ll9 retuiu tuo much water. Uben there is atony of the 
aUiniucbp waUar ij^ to \>c taken in sniall c|tiaiititie&. Milk U to 
be UM^ hy jxttionto who are thlu and whei^ then.* Las been 
a pnvxiflting mAlniitritioD. Milk luid cream nitxod is of ^roat 
vaIijo- 

Fresh fniit and vegetables, particukrly the green vegetables, 
aro of cspecinl value and may be partaken of freely. AJl kinds 
of fn^h fruit in season are to be recoiti mended , avoiding flmall- 
Medc<l bcrriw* wbcn- tliere i^ irriUbil