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PHILADELPHIA: W. B. SAUNDERS, 925 Walnut Street 




Author's Preface 

Chap. I. Food and Food Values ... 

II. Food and Food Values {continued) 

III. Stimulants — Alcohol 

IV. Stimulants — Coca of Peru, Coca Wine 
V. Restoratives — Tea 

VI. Restoratives — Coffee, Cocoa, Chocolate 

VII. Water-Salts 

VIII. Under-feeding and Over-eating 

IX. Under-feedmg and Over-eating -In youth and middle 


X. Under-feeding and Over-eating — The aged 
XI. Under-feeding and Over-eating— Dishes for the 
XII. On Thinning and Fattening 

XIII. On Thinning and Fattening (continued) 

XIV. Digestion ' 

XV. Digestion (continued) 

XVI. Digestion (continued) 

XVII. Indigestion 

XVIII. Invalid Foods 

XIX. Acute Gastritis 

XX. Ulcer of the Stomach 

XXI. Diabetes 

XXII. Diabetes (continued) 

XXIII. Diabetes (continued) 

XXIV. Diabetes (continued) 

XXV. D'mhetes (continued) 

XXVI. Gout 

XXVII. Dishes for the Gouty 
XXVIII. Uric Acid as a Cause of Disease, and its Pre 

by Diet 

XXIX. Consumption 

XXX. Rickets 

XXXI. Scrofula and Scurvy 
XXXII. Fever 

XXXIII. Typhoid Fever 

XXXIV. Chronic Bright's Disease 
XXXV. Chronic Bright's Disease (continued) 
















1. The Gastric Glands of Man 

2. The Duodenum from in Front 

3. The Duodenum from Behind 

4. Tubular Glands of the Small Intestine opening on the 

vSurface of the Mucous Membrane between the \' 
magnified 40 diameters 

5. Tubular Glands of the Large Intestine, magnified 40 


6. Arteries and Veins of the Villi, injected and magnified 100 


7. Glomeruli of the Kidney; Origin of the Uriniferous 


8. Course of the Uriniferous Ducts, Diagrammatic Plan 
g. The Gastric Glands of Man 

10. Gastric Glands of Man in a Morbid Condition 

11. The Tubercle Bacillus, magnified 1000 times 

12. Diagrammatic Representation of Peyer's Patches in Typhoid 

Fever ... 

13. A Peyer's Patch seen from its Free or Superficial Side .. 

14. Glomeruli of the Kidney; Origin of the Uriniferou 


15. Course of the Uriniferous Ducts, Diagrammatic Plan 

16. Section of Diseased Kidney in Bright's Disease 

17. Transverse Section of the Medullary Substance of the 

Healthy Kidney, magnified 350 diameters ... ... 205 











In presenting this book to the public I am actuated 
by the hope that it will prove useful to those who 
are sick, and to those who have to nurse, feed, and 
prescribe for the sick, and that it will aid the healthy 
to preserve health. Believing that lay readers will 
act with greater intelligence if they understand the 
rationale of a diet, I have briefly described in each 
case the accepted causation of the disease, and the 
reasons for the special diet prescribed. Medical 
men will also, I trust, find the dietaries and recipes 
practically useful, and likely to save them trouble in 
directing the dietetic treatment of patients. I have 
to acknowledge my indebtedness to the works of 
Dr. Pavy, Sir W. Roberts, Dr. Burney Yeo, Sir 
Henry Thompson, Dr. Cheadle, Dr. Haig, and 
those of other writers on dietetics ; also to thank 
Dr. Donald Macalister for his great kindness in 
reading the proofs. I feel pride and pleasure in 
the endorsement of the value of the book by so 
eminent an authority as Sir Henry Thompson. 


38 WiMPOLE Street, W. 


In few departments of medical knowledge are 
precision and resource more desirable than in that 
of medical dietetics. The selection and prescription 
of foods for the delicate, the sick and the aged 
require not only a knowledge of the leading features 
of the varied nutritional derangements presented, 
but also the faculty of perceiving what modifications 
may be necessary for each individual case, since 
almost every patient has his personal peculiarity to 
be ascertained and provided for. The first thing 
necessary for "food and feeding- in health and 
disease " is to be well instructed in the elements of 
physiology, the nature of foods, and the normal 
laws of feeding, as well as in the deviations by 
which the action of these laws is modified. To this 
must be added some practical acquaintance with 
kitchen usage and processes. A certain familiarity 
with the resources of the cook is essential to furnish 
a suitable daily menu, which shall be agreeable to 
the invalid, and as much as possible varied within 
the narrow limits which are dictated by the circum- 
stances of each case. No man is a really accomplished 
physician or surgeon who has not made dietetic 
principles and practice an important part of his 


professional education. I do not hesitate to express 
my opinion that the present volume forms a hand- 
book to the subject, thus briefly set forth in these 
few lines, which will not only interest the dietetic 
student, but offer him, within its modest compass, a 
more complete epitome thereof than any work which 
has yet come under my notice. It is so because its 
accomplished authoress has the advantage of pos- 
sessing not only a remarkable acquaintance with the 
various branches of medical knowledge, after many 
years devoted to their study, but also in no less degree 
that which has been conferred by long culinary and 
housewifery experience. I can strongly commend 
this book, therefore, as supplying an important want 
in our educational literature. 




The Albuminates. 

Before entering on the consideration of questions of 
Diet and Dietetics, it is of the first importance that the 
processes of digestion and assimilation of food in the body 
should be thoroughly understood, as well as the composi- 
tion and the exact values of those foods which serve to 
build up the body after wear and waste, and to maintain 
it in a condition of health. I will, therefore, commence by 
giving a brief description of the constitution and dietetic 
values of the various kinds of food which form the mixed 
diet of an ordinary European, and also some account of 
the processes of digestion, absorption, and excretion. 

The human body is composed of the following ele- 
ments: — Carbon, hydrogen, oxygen, nitrogen, sulphur, 
phosphorus, chlorine, iodine, potassium, calcium, magnesium, 
and iron. The first four are present in far larger proportion 
than the rest. In order that the body may be reconstituted 
and nourished, all these elements must be represented in 
the food of man. 

Food is composed of organic and inorganic materials. 
The organic materials are furnished both by the animal 
and the vegetable kingdom, and are composed of the 
following elements : — Carbon, hydrogen, oxygen, nitrogen, 
sulphur, and phosphorus. Of these, oxygen is necessary 


for the oxidation of the tissues, that is to say, for their 
combination with oxygen in the processes of life and 
function ; carbon is necessary for the production of heat, 
which is caused by the combination of carbon with oxygen 
to form carbonic acid gas ; hydrogen is necessary in order 
to combine with oxygen and form water ; and nitrogen is 
all-important, as it is the essential element in the composi- 
tion of the living tissues of the nerves, muscles, brain, and 
blood, as well as of the secretions and juices of the body. 
Its presence is also necessary in all the vital processes, for 
without it no energy can be produced, nor can any of the 
changes take place which are characteristic of the living 
state in the body. 

Foods are divided into nitrogenous and non-nitrogenous, 
according as they contain the element of nitrogen or not. 
In the following table the various principles of food are 
classified and arranged : — 









f2. Fats, or Hydro-Carbons Oil 

Margarine, etc. 

3. Carbo-Hydrates 



Grape-Sugar or Glucose 
Milk-Sugar or Lactose 




Vegetable acids : Acetic, Tartaric, Citric, and 
Malic Acids. 

Salts : Chloride of Sodium (common salt), Chloride 
of Potassium, Carbonate of Calcium (lime). Phos- 
phates of Calcium and Magnesium, etc. 


The albuminates contain about 15 per cent, of nitrogen. 
The following analysis by Malder clearly explains their 
composition : — 

Nitrogen 15*5 

Carbon ....... 53"5 

Hydrogen ....... yo 

Oxygen 22"0 

Sulphur i*6 

Phosphorus 0*4 

Albumen is composed of carbon, oxygen, hydrogen, 
nitrogen, with some sulphur and phosphorus. It exists 
in its purest form in the white of an egg, and is character- 
ised by being coagulable by heat. Albumen is an im- 
portant constituent of all flesh foods, and of eggs and milk. 
It is also present in a great number of vegetable products, 
and is found in wheat, oats, Indian corn — hence in bread, 
oatmeal, and Indian meal — in barley, rye, rice, buck-wheat, 
beans, peas, lentils, bananas, potatoes, almonds, and nuts, 
and in small quantities in carrots, parsnips, turnips, and 
artichokes. It is present in its most digestible form in the 
flesh of animals. Some vegetables contain albumen in 
large quantities ; and, as constantly insisted upon by 
vegetarians in support of their views, there is a larger 
amount of albumen in a pound of peas than in a pound of 

Fibrin is almost identical with albumen, but it contains 
more oxygen and sulphur. It is a constituent of the blood, 
and undergoes spontaneous coagulation out of the body. 

Casein is a component of milk, from which it is thrown 
down by the action of an organic acid, such as rennet. It 
is casein which constitutes the curd of milk, the curdling 
being effected by the production of free lactic acid during 
the process of the souring of the milk. Casein is also the 
basis of cheese, and in this form it is a highly nitrogenous 
food. Besides the four elements, carbon, oxygen, hydrogen, 


and nitrogen, casein also contains sulphur, but no phos- 
phorus ; and it is remarkable for the large quantity of phos- 
phate of lime which it is capable of holding bound up with 
it, and for the tenacity with which it retains it. (Pavy.) 

Gluten is the tenacious, sticky material which is left 
when flour is kneaded with water and afterwards washed to 
remove the starch. According to the report of the Paris 
Gelatine Commission, which sat for ten years making con- 
tinual researches on the value of the albuminates and 
gelatine as articles of food, it is stated that gluten is alone 
necessary to support life. This assertion has since been 
disputed. To gluten, howe\'er, bread, the staff of life, owes 
its high nutritive qualities. • 

The Meaning of Metabolism. 

The albuminates, or nitrogenous foods, were formerly 
designated by the older writers on dietetics as flesJi- 
fonners, the hydro-carbons, or non -nitrogenous foods, being 
classified d.'s, force-producers. Recent researches have, how- 
ever, shown that this sharp division of foods into nitrogenous, 
or flesh-formers, and non-nitrogenous, or force-producers, 
cannot any longer be maintained. It has been proved by 
experiment that the muscles do not undergo waste during 
exercise, which waste has to be restored by nitrogenous 
food, in anything like the degree which was formerly thought 
and taught by Liebig. In fact, the amount of tissue waste 
in muscular exercise is small, and hence the amount of 
nitrogenous food necessary for repair is also small. The 
life and health, however, of all the organic nitrogenous 
tissues, fluids, and secretions can only be maintained by 
constant change. As the blood circulates through the 
body, carrying the elements of nutrition to the furthermost 
limits of the tissues, it modifies all with which it comes in 
contact ; here parting with some element in order to pro- 
mote cell secretion or nutrition, there taking up products 
destined either for excretion or for further elaboration. In 


order that these constant cell changes, this production of 
secretion and excretion, these processes of elaboration and 
assimilation, which constitute the actual art and method of 
life, should go on, the presence of nitrogen is necessary. 
Hence one of the great uses of albuminates in the food is 
to provide the nitrogen necessary to promote the changes 
of nutrition in the body. This process is called metabolism. 
Thus we see that albumen is a necessary food, not only in 
that it repairs tissue waste, but also because it plays a large 
part in the production of functional activity and energy. 
Without albumen, the rapid tissue changes necessitated by 
great activity of body could not take place ; hence races 
and persons who live on a non-albuminous diet are inert, 
wanting in vigour and initiative. Change their diet and you 
are often able to change their character. Thus the potato- 
fed Irishman, on his damp soil, is said by those who employ 
him in manual labour to have " no heart in him " ; but 
transport him to a stimulating climate, and make of him a 
beef-fed ^American, and his energy becomes sustained and 
even sometimes excessive. Albumen is, moreover, capable, 
it seems, of being split up by the agency of the cells in the 
body into nitrogenous and non-nitrogenous principles ; for 
we find that when an animal has been fed exclusively on 
albumen, both fat and sugar have been produced from this 
food within the body, and hence it is possible that albumen 
may under certain conditions also play the part of a force- 
producer, force being produced, as I will show later, by the 
combustion of fat and sugar in the body. 

To sum up : The uses of albuminates in the body 
are threefold, viz. : (i) To repair the waste of those tissues 
which contain nitrogen, zn's., the muscles, nerves, brain, etc., 
and to reconstitute the secretions and fluids of the body, 
and the digestive juices ; (2) to control, stimulate and support 
the vital processes of functional activity and nutrition, and 
to promote oxidation in the body ; (3) to contribute to the 
development of muscular and nervous energy, by splitting 
up into nitrogenous and non-nitrogenous elements, by the 


production of heat, and under certain conditions by the 
formation of fat. 

Do THE English Eat too much Meat ? 

The amount of albuminous food necessary.— A certain 
amount of albuminous food is necessary for the repair of 
the body, which is wasted, even in those who hve sedentary 
lives, by the constant activity and change taking place in 
the organs ; but there is but little doubt that the quantity 
of flesh foods generally consumed by the well-to-do English- 
man, is far in excess of the amount of nitrogenous material 
required to repair tissue waste and to promote secretion. 
The exact amount of nitrogenous food necessary to barely 
support life, or to maintain the body in health with a 
moderate amount of labour, or on which to do hard labour, 
such as that performed by a navvy or engineer, has been 
accurately determined by experiments carried out on a 
large scale in armies and prisons. Thus a prisoner sentenced 
to less than seven days' imprisonment without hard labour 
is fed on i lb. of bread, with two pints of oatmeal gruel 
made of 2 oz. of oatmeal to the pint. For twenty-one 
days' imprisonment the bread is increased to i-^ lbs. a day. 
The amount of nitrogenous material in this diet is only 2^ 
oz. It is the lowest diet on which life can be maintained 
compatible with health, but without hard labour. An 
English soldier on home service receives i lb. of bread and 
f lb. of meat, which represents nearly 4 oz. of nitrogenous 
material. For hard labour the nitrogenous material should 
be increased to nearly 6 oz., which would be represented 
by about i k lb. of bread and i lb. of meat. From these 
facts the conclusion will, I think, be easily drawn that the 
ordinary Englishman and Englishwoman of the middle 
classes, who perform no hard labour, and who live, as a 
rule, sedentary lives, consume far too much nitrogenous 
food in the meat, bread, eggs, milk, and fish taken in three 
square meals a day. In the accounts of centenarians 


recently collected by Sir George Humphr)-, it was shown 
that those who reached advanced old age in good health 
were those who lived sparingl)-. 

What becomes of the albumen. — The albumen which 
is taken with the food undergoes, after digestion, and the 
assimilation of the elements necessary for tissue construction, 
retrogressive changes, and it is finally thrown into the blood 
in the form of urea. This urea must be excreted by the 
kidneys, and therefore if an excess of albuminous food is 
taken, a great burden is thrown upon the kidneys, which 
may result in producing disease in these organs. In youth, 
when growth is rapid, a much larger amount of nitrogenous 
food is required than in old age, when tissue change is slow. 
Also, those engaged in hard labour require and can dispose 
of without detriment to their health, a larger amount of 
nitrogenous food than those who live sedentary lives. 

Gelatine is derived from bone and fibrous tissues by 
boiling. It has the property of solidifying into a jelly on 
cooling. It approaches an albuminate in chemical com- 
position, and is rich in nitrogen. It cannot, however, replace 
albumen in the repair of tissue waste, as it rapidly under- 
goes change in the body and is eliminated as urea. But 
just because it undergoes changes so rapidly and easily in 
the body it may be taken as a substitute for albuminates 
when stronger foods containing albumen cannot be toler- 
ated. This is the rationale of the use of beef-tea — which 
is simply gelatine — in cases of acute sickness, when meat 
cannot be digested. It also contributes to force pro- 


FOOD AND FOOD YAhUES— {continued). 

Hydro-Carbons and Carbo-Hydrates. 

Fats — S24gar — Starch. 

In the group of hydro-carbons or fats are included all 
vegetable and animal fatty foods, such as oils, suet, butter, 

The value and necessity of fat as an article of food is 
obvious from the fact that the outer covering of the body 
beneath the skin is composed of fat. It is fat or adipose 
tissue which gives the rounded form and curved lines that 
constitute, according to our ideas, one of the essentials of 
beauty, and it is moreover this outer covering of fat which 
protects the body and organs from sudden changes of 

Fat is in constitution a much simpler food principle 
than the albuminates, and it is shown by analysis to be 
composed as follows : — 

Carbon .....••■ 79 
Hydrogen . . . . • • • ^i 
Oxygen ^ 


The uses of fat.— We all know that combustion is 
caused by the combination of the oxygen of the air with 
the freed carbon of the substance which is being consumed. 
It was taught by Liebig that fat split up in the body, and 
that the freed carbon combined with the oxygen which is 


taken into the lungs in respiration, the result being the 
production of carbonic acid (CO^), and that it is b}' this act 
of respiratory combustion in the lungs that the body heat is 
maintained. Fatty foods were hence considered necessary 
as heat-producers. Recent investigations have, however, 
proved that the matter is not so simple, and that though 
fat is split up and combined with oxygen in the production 
of heat, especially during muscular exercise, the process is 
effected in the tissues by the action of the cells, and not in 
the lungs, as formerly taught. The use of fat seems to be 
threefold, (i) To maintain the body heat. In cold lati- 
tudes, where the body is subject to rapid cooling, fatty 
foods become a necessity, so that the carbon ma}- be easily 
supplied for combination with oxygen in combustion. 
Hence the Greenlander consumes large quantities of blubber 
and oil. (2) To produce force. As muscular force is only 
produced at the cost of oxidation in the tissues, fat is 
rapidly burned off during exercise. If fatty food is absent, 
the tissues themselves would be wasted. This fact, well 
known to every athlete and mountaineer, brings us to the 
third use of fat, viz. (3) To prevent the waste of albumen. 
If albuminous food alone be given, a very large amount must 
be consumed for the body to obtain the elements necessary 
for the production of heat and mechanical energy ; but if fat 
be added a much smaller amount of albumen is required. 
Hence we see that there is no diet so wasteful as a purely 
albuminous diet. It has been moreover conclusively proved 
experimentally that a small amount of meat food taken in 
combination with bread and fat, suffices to maintain the 
albuminous structures of the body better than an exclusively 
lean meat diet. 

Fat stored in the body as adipose tissue is a bank on 
which the body may draw for supplies of energy and heat 
when required. During great muscular exercise fat is 
rapidly broken up into its component elements and oxidised, 
and in the case of enforced starvation the bod)' finds in 
adipose tissue the materials for its own support. It is 


stated that in the Franco-German War of 1870, the German 
Emperor, acting on the strong!}' expressed opinion of 
Ebstein that muscular fatigue could best be supported on 
fat, gave orders that each soldier should have served out to 
him 250 grammes of fat bacon. It is a well-known fact 
that fat animals bear privation of food better than thin 
ones. H\'bernating animals during their winter sleep live 
on the fat stored in their tissues, and awake in spring with 
their bodies almost devoid of fat. 

The carbo-hydrates include starch, sugar, and dextrine. 
Hydro-carbons and carbo-hydrates resemble each other in 
being entirel}' free of nitrogen, and in being composed only 
of the three elements of carbon, hydrogen, and oxygen ; but 
they differ in that in the carbo-hydrates, hydrogen and 
oxygen always exist in combination with the carbon in 
such proportions as to form water. The chemical formula 
of water is HoO ; the chemical formula of starch is CgH^pOg ; 
from which it will be seen that starch is composed of 
six atoms of carbon and five molecules of water. The 
various substances in the group of carbo-hydrates, such as 
starch, dextrine, and sugar, are easily convertible one into 
the other by the action of ferments, as will be shown sub- 
sequently in describing how in the process of digestion 
insoluble starch is converted into soluble sugar by the 
action of ferments in the saliva and pancreatic juice. The 
principal carbo-hydrates used in the food of man are starch, 
and the various kinds of sugar. Starch is contained in all 
farinaceous foods, and in many vegetables, such as peas, 
beans, and potatoes. Sugar is found in the form of cane- 
sugar in the sugar-cane and beetroot, as milk-sugar or 
lactose in milk, and as grape-sugar or glucose in fruits. 
Considering, therefore, how largely our ordinary food 
consists of bread, potatoes, milk, and sugar, it will be 
seen that the carbo-hydrates form very important elements 
in diet. 

How carbo-hydrates produce power.— It is taught 
generally that the action of carbo-hydrates is that o{ power- 


producers in the body ; that is to say, that during muscular 
contraction, or in fact, in order that it may take place, a 
carbo-hydrate must be split up in the body, and its element 
of carbon combined with oxygen to produce carbonic acid 
(COo). A muscle may be compared to a steam engine. 
The muscle fibres, composed of an albuminous material, 
correspond to the brass and steel of the engine. In order 
that the steam-engine may work, coal has to be burnt to 
produce power ; and in the same wa\-, in order for a muscle 
to work, carbo-hydrates have to be burnt to produce 
energy. Owing to constant use, some of the metal parts 
of the machine wear away, so do some of the constituent 
parts of the muscle, and the refuse is thrown into the blood 
in the form of urea. In the engine, the rapid firing 
necessary for working at high pressure does not wear away 
the machine, but the consumption of coal must be increased, 
and the production of carbonic acid much augmented, in 
the production of increased power. This is exactly what 
takes place during severe muscular exercise. The albumi- 
nous constituents of the muscles are not worn away, but 
the muscle requires the fuel of carbo-hydrates or of hydro- 
carbons in order that the required carbon may be oxidised 
in the production of mechanical energy. This rapid oxida- 
tion is the cause of the increased heat of the body during 
muscular exertion. The carbonic acid produced is excreted 
b}- the lungs. In the experiments made by Dr. Edward 
Smith on himself, it was shown that five times as much 
carbonic acid is exhaled when walking at the rate of three 
miles an hour, as during sleep, and twice this amount 
while working the treadmill, in which enforced exercise 
all the muscles of the body are continuously at work. 
From experiments made by various scientific observers in 
the ascent of mountains on a strictly non-nitrogenous diet, 
it has been ascertained that severe muscular exercise and 
fatigue can be well borne on a diet of carbo-hydrates 
only ; in fact, it is now well established that the energy or 
power developed by muscular work in the body is pro- 


duced by the oxidation or burning off of carbonaceous 
matter. Hence it results that fatty and starchy foods 
form an excellent dietary on which to do hard physical 

In order that carbo-hydrates may be digested and 
assimilated, it is necessary that they should be converted 
into glucose. This is brought about by the action of the 
saliva and of the pancreatic juice, and will be described 
when digestion is treated. The carbo-h}'drates do not 
act only as energy-producers in the body ; the}^ also con- 
tribute to the formation of adipose tissue. 

The production of fat from starchy and sweet foods has 
been very much discussed, and a great number of ex- 
periments have been undertaken on living animals to 
determine whether this transformation does or does not 
take place. The experiments by Huber, Grundlach, 
Dumas, and Milne-Edwards have proved that bees can 
manufacture the wax of the comb out of a diet of pure 
sugar or honey. From the observations of Persoz, a 
Professor of the Faculty of Science of Strasburg, on the 
production of foie gras, or fatty liver, in the Strasburg 
geese dedicated to the production of this pathological 
dainty, he found that far more fat was manufactured in 
the bodies of the geese than could be accounted for by the 
oily matter of the maize on which they were fed. The 
following record of an experiment by Tscherwinsky on 
pigs is also very conclusive. He took two pigs ; No. i 
weighed 7300 grammes, No. 2, 7290 grammes. No. i 
was killed, and the fat and the albuminous constituents 
of its body were carefully weighed. No. 2 \\'as kept four 
months and fed on an exclusive diet of grain. The 
animal was then killed. The amount of grain it had taken 
and the amount of albumen contained in the grain were 
carefully estimated. Its excreta were also analysed. 
After the pig was killed the amount of fat and albuminous 
substances contained in the body were estimated. The 
amount of fat that had been produced by the diet of 


grain could be ascertained on comparing pig No. i with 
pig No. 2. The following table gives the result : — 

Pig No. 2 contained 2*50 kilos of albumen and 9"25 kilos of fat. 
Pig No. I „ 0-96 ,, „ 0-69 „ „ 

Assimilated 1-56 ,, „ 8-56 „ „ 

Taken up in food 7^49 „ „ 0"66 „ „ 

Difference yg^ „ „ J'go „ „ 

It will thus be seen that only a small part of the albumen 
of the food was assimilated, or incorporated in the structure 
of the animal, but yet there was an increase of nearly 8 
kilos of fat. Whence was this fat derived ? The albumen 
which was not assimilated could, by splitting up, only 
furnish a ver}- small part of it ; and therefore the con- 
clusion is inevitable that it was produced from the starch 
of the grain. How fat is produced from starch and sugar 
in the body is at present entirely unknown. The body is 
a laboratory of far greater complexity than the most per- 
fectly fitted laboratory of the man of science. The cells 
of the liver, the pancreas, and the muscles exercise wonder- 
ful powers in splitting up complex bodies into their com- 
ponent elements, and in re-combining these elements into 
new substances. After the most careful experiments have 
been made on the living body, the actual processes of life 
escape our detection and investigation ; hence we do not 
actually know, we can only guess at the truth, and argue 
from the results of broad and coarse experiments. 

Though it is now ascertained beyond dispute that fat 
is produced from carbo-hydrates, it has been proved by ex- 
periment that the production of fat is much more rapidly 
and easily effected if the carbo-hydrates are not given alone, 
but in conjunction with a small amount of fat. Thus 
Boussingault found that if pigs were fed exclusively on 
potatoes they would not fatten beyond a certain point ; but 
if fed on potatoes mixed with wash, which contained a 
quantity of nitrogenous and fatty refuse thrown out of the 


kitchen, they fattened freely, and the fat which was produced 
in their bodies was ascertained to be greatly in excess of 
that given with the food, whence it was concluded that the 
small amount of fat and albumen ingested enabled the 
body to turn the starch of the potatoes into fat with greater 

Cellulose, which is the basis of construction of all plants, 
is a carbo-hydrate which the human system is incapable of 
digesting. It is the indigestible cellulose of vegetables 
and fruits which gives rise to indigestion in persons of weak 
stomachs after they have eaten uncooked salads, etc. By 
cooking, cellulose is rendered soft and less injurious. 
Persons with weak digestions should therefore always eat 
fruit, vegetables and salads cooked. Cellulose forms, how- 
ever, the bulk of the food of the herbivorous animals, in whose 
digestive system special arrangements are made for its 
digestion and assimilation. It is a matter of current 
observation that cows and horses will fatten on grass and 
hay, and their bodies must therefore have the power of 
converting the carbo-hydrate cellulose into fat. If, how- 
ever, it is intended to produce an excessive deposit of fat, 
cattle are fed upon maize or oil-cake, in which the presence 
of oily substances contributes to the increased production of 
fat from the other constituents of the food. 





There is no subject respecting which such opposite 
opinions have been expressed as on the value of alcohol 
as an article of diet ; and there is also no subject on which 
it is more difficult to express an unbiassed opinion, based 
on the clear and unmistakable evidence of science. 

Is alcohol a food ? — This has been seriously denied 
by some scientists, who have sought to prove, in support 
of their assertions, that all the alcohol taken could be 
recovered again in the breath, the perspiration, and the 
excretions ; and hence that it played no part in tissue 
change. This, however, is not the fact. Only a small 
amount of the alcohol taken can be recovered, and the 
question remains — What becomes of it in the body ? 
Dujardin-Beaumetz, the French physician and pharma- 
cologist, gives the following answer to this question, basing 
his opinions on practical experiments. He states that 
if alcohol is taken in small quantities it passes into the 
blood, where it acts upon the red blood corpuscles, which 
are, as is well known, the oxygen-carriers of the body, and 
it obliges them to part with their oxygen. By this action, 
alcohol diminishes the oxidation of the tissues, and is there- 
fore, though not a true food itself, a substance which lessens 
the necessity for food, thus being what he calls un aliment 
d'epargne, or, as we may translate it, an economiser of food, 
or a tissue waste-preventer. If taken in large quantities, 
too much oxygen is extracted from the blood corpuscles 


and the temperature of the body falls, owing in part to 
deficient oxidation. If taken in still larger quantities, the 
whole of the alcohol does not undergo combustion, but, 
circulating freely in the blood, acts directly on the cerebro- 
spinal system, producing excitement, narcotism, and the 
symptoms of intoxication. 

The effects of alcohol. — Alcohol has the effect of stimu- 
lating the cardiac centres and of increasing the number and 
volume of the heart-beats, and also of dilating the arterioles, 
thus temporarily producing a sensation of warmth and 
comfort frequently succeeded by chilliness, which is caused 
in some measure by the greater surface of blood exposed 
to the influence of skin radiation. The lowering of the 
temperature of the body by large doses of alcohol is a well- 
known fact, and alcohol consequently was at one time 
advocated and used by certain physicians to reduce the 
temperature in acute fevers. This method of treatment 
has now been discontinued, as it was found that the remedy 
was as bad as the disease ; and that in reducing tempera- 
ture by alcohol, which is less certain in its effects than 
other available antipyretics, various morbid conditions and 
complications were produced. The depression of tempera- 
ture in the coma of intoxication is, moreover, so well 
known to the persons who have to deal with these unfor- 
tunate cases, that in the Glasgow lock-ups, large fires are 
kept alight on Saturday nights, before which dead-drunk 
persons brought in may be laid, in order that they may 
not perish of cold. Alcohol is one of those strange sub- 
stances which have the power of producing apparently 
opposite results. In small quantities it stimulates the 
action of the heart, in large it depresses it ; in small 
quantities it increases the secretion of gastric juice, in 
large it destroys the pepsin and arrests digestion ; in 
small quantities it has an exhilarating effect on the nervous 
system, in large it is narcotic. If, therefore, the produc- 
tion of the stimulating action of alcohol be required, the 
question which it is important to answer is, — What is the 


amount which can be taken without exceeding the narrow 
limit beyond which alcohol is harmful ? 

The amount of alcohol which can be taken with 
impunity.— There is a general consensus of opinion on the 
part of physicians that from i to i| oz. of pure alcohol is 
the maximum amount which a healthy man should take in 
twenty-four hours. Translated into common parlance, this 
means from 2 to 3 oz. of brandy or whisky, from 4 to 6 oz. 
of port or sherry, from 10 to 15 oz. of champagne or bur- 
gundy, or from i to i| pints of beer or porter. More than 
this is harmful. Persons under forty years of age, in whom 
the digestive functions are normally performed, and who 
show no signs of nervous disturbance or degeneration, do 
not generally require alcohol at all, and are healthier and 
better, and are likely to live longer without it. For persons 
over forty, in whom digestion has become impaired by 
anxiety, confinement in close rooms and offices, or by 
sedentary or unhealthy occupations, or in whom nervous 
energy is exhausted or deficient, a small amount of alcohol 
in the form of wine or beer, taken with the food, is a useful 
stimulant. By its influence the secretion of gastric juice is 
increased, and digestion thereb\- promoted. 

The almost universal use of fermented alcoholic drinks 
with meals, in all times, nations and ages, and the facility 
with which the fruits of the earth ferment and produce 
alcohol, seem to point not only to a human need, but to the 
supply of such a need by Nature. Alcohol is, however, 
like many of the other gifts of Nature : its use is beneficial, 
its abuse baneful. It is, in fact, a matter of common ex- 
perience that, when taken in moderate quantities, " the 
appetite is augmented, digestion is promoted, the nervous 
system stimulated, and the mental faculties exhilarated by 
alcohol " rPavy). Dr. King Chambers picturesquely puts 
it : " That everybody recognises in alcohol a power of 
blunting sorrow and pain, of checking the sensation of 
weariness, mental and bodily, of taking the points off the 
stings and buffets, discomforts and nastiness of daily life ; 


but also of corrupting the delicate appreciation of its higher 
delights ; in short, of diminishing the sensibility to im- 
pressions in mind and body, and of lowering the receptive 
functions of the nervous system ; " and he urges that for 
healthy persons alcohol should never be taken as a stimulant 
or preparation for work, but only as a defence against the 
injury done by work, whether of mind or body, and that 
it is therefore best taken with the evening meal or after toil. 

The pernicious habit of taking nips. — Whatever may 
be the opinion or judgment, based on experience or science, 
as to the value or uselessness of taking some form of alcohol 
with the meals, there is no doubt in anybody's mind that 
the custom of taking wine or spirits or beer between meals 
and on an empty stomach — in one word, the pernicious 
habit of " nipping " — is highly injurious. The morning nip, 
between breakfast and the midday meal, which is so 
frequently taken by domestic servants, nurses, workpeople, 
and " City men," renders the taker less fit for his daily work 
than he would otherwise be ; and it is often in women the 
first fatal step towards dram-drinking, and the shameful 
life of the woman-drunkard, of whom we hear and see so 
much at the present time. The flushing of the face, caused 
by the dilatation of the small blood vessels, and usually in- 
duced by alcohol when taken alone, is symptomatic of what 
takes place in the stomach. The direct action of alcohol on 
the mucous membrane is to produce temporary congestion 
or blushing of the internal surface of the stomach. This 
congestion ultimately becomes chronic if "nips" or "drams" 
of spirits are frequently indulged in, with the result that the 
mucous membrane becomes thickened and indurated, a 
quantity of tenacious mucus is secreted, the digestive fer- 
ment is paralysed or destroyed, and alcoholic dyspepsia is 

Does alcohol give strength? — In contradiction of the 
popular fallacy that spirits and beer give strength and 
enable a man to do his work better, there ma}^ be quoted 
the experience of soldiers on the march in the tropics, of 


explorers toiling day after day across the frozen oceans of 
the North Pole, of Alpine climbers undergoing great fatigue. 
In all these instances the conclusive and invariable experi- 
ence is that alcohol taken in any form during the period 
of exertion, causes increased fatigue and depresses the 
spirits. On the other hand, in the opinion of many, a small 
amount of alcohol, taken after the work of the day is done, 
proves sedative and harmless. 

The use of alcohol in disease. — Much as opinions 
may differ, however, respecting the value of alcohol as an 
article of diet in health, or in a condition of slightly im- 
paired health and vigour, there can be no doubt that in the 
hands of the physician alcohol is one of the most valuable 
drugs he possesses. In the period of depression and " reso- 
lution " of acute pneumonia, in syncope, in the sudden 
enfeeblement of the heart from fright, accidents, or loss of 
blood, in ischaemia of the blood vessels of the brain, in 
acute fevers when the heart must be supported, in collapse, 
and in certain degenerative nervous and cutaneous diseases, 
alcohol is invaluable, and there is no drug in the pharma- 
copceia which can take its place. But even in these cases 
it must be used with caution and under medical advice, and 
it may be accepted as an axiom that small doses frequently 
repeated are always more efficacious and less dangerous 
than large doses at long intervals. The pulse is to the 
physician and to the intelligent nurse watching beside a 
patient in a state of profound depression, the indication of 
the amount and the frequency of the dose of alcohol to be 
administered. I have within my own experience seen, 
more than once, a patient pulled through the imminently 
fatal exhaustion of acute pneumonia during the period of 
the rapid fall of temperature, by minute and oft-repeated 
doses of brandy, given immediately the pulse was felt to 
flag ; and I have seen similar cases die for the want of the 
use of alcohol at this critical time. In the debility of con- 
valescence, "a little wine," recommended by St. Paul to 
Timothy " for the stomach's sake," may promote digestion 




if taken just before meals : but this is again a matter for 
the physician to decide. 

The evil effects of alcohol when taken in excess are 
notorious, and I need not enlarge upon them here. It 
is the abuse of alcohol which fills our hospitals, our 
prisons, our lunatic asylums, and our workhouses ; it is the 
fertile parent of vice and crime, the foster-mother of 
pauperism, and the constant generator of chronic poverty. 
But besides the evils which can be traced directly to dram- 
drinking, tippling and excess, who can gauge the number 
of cases in which the bread-winner dies from acute disease, 
from which the alcoholic habit deprives him of the power 
to rally ; the children are born with degenerate con- 
stitutions ; the will power for good is weakened, and 
character and happiness destroyed ? It is not to be 
wondered at that, seeing the evils wrought by abuse, the 
use of alcohol is condemned, and the cry is raised : " Come 
out of the unclean thing, touch not, taste not, handle not "'. 
But the conventual and monastic view is not that of human 
life. The wise man is he who can enjoy all the good gifts 
of this world while keeping his body in subjection, his mind 
pure, and his life undefiled. To acquire property is not to 
be a thief, to be a husband is not to be a profligate, and to 
drink wine is not to be a drunkard. " Be ye temperate in 
all things," is the dictum both of the philosopher and of the 


STIMULA^^TS— (continued). 
The Coca of Peru— Coca Wine. 

That all men and women feel the weariness of life is 
testified by the fact that the people of all nations and all 
climes have the universal habit of daily seeking a restora- 
tive and stimulant in one of the vegetable products which 
contain a substance or alkaloid capable of exercising a 
definite effect on the nervous and cardiac systems. Thus, 
the Chinese and Japanese sip their tea, and the English, 
following their example, brew the five o'clock cup of 
the fragrant herb to sustain them in the day's work, the 
Arab and Turk seek, like the French and Germans, restora- 
tive powers in the aromatic coffee berry, the Cingalese 
chew the betel nut, and the natives of Peru on the slopes 
of the Andes find in coca leaves a principle which sustains 
the body in fatigue and comforts the mind in hopelessness. 
Von Bibra says of coca: "It satisfies the hungry, lends 
new strength to the weary and fatigued, and makes the 
unhappy forget his grief". What, then, is this strange 
substance which seems to conceal a fairy's wand ? We 
shall find, however, that, resembling other fairy wands 
for the cure of the plagues of life, it may turn, like the 
magician's rod, into a viper. 

Coca is obtained from the leaves of a shrub-like plant 
called the erythroxylon coca ; it is a native of Peru and 
Bolivia, where it has been cultivated with the greatest care 
from the remotest antiquit}'. When Peru was concjucred 
by the Spaniards in the sixteenth century, and the ancient 


and interesting people of this country were discovered, it 
was found that their Incas or kings looked upon the cultiva- 
tion of the coca plantations as a public and national duty, 
and also that the strange custom prevailed among the 
Peruvians of chewing the leaves of the coca plant during 
frequent and short periods of repose, specially set aside for 
this purpose. This custom prevails to this day among the 
half-bred Indians of Peru and Bolivia. Three or four times 
a day the Indian, labouring in the mines or on the plan- 
tations, retires from work, and, lying down in a comfortable 
position, draws from a leather pouch a few leaves of 
coca ; these he rolls into a ball, which he puts into his 
mouth and slowly chews, adding from time to time a small 
amount of unslaked lime, which is said to bring out the 
true flavour of the leaf. The chewing causes a copious 
flow of saliva, which is swallowed, but the masticated leaves 
are rejected when all they contain has been thoroughly 
extracted. The Indian of the Andes is by nature gloomy, 
taciturn, and melancholy ; but when chewing the coca leaf 
in repose he seems to be in a condition of passive happiness, 
and to be removed for a short time from the depressing 
effects of the toil, the poverty, and the hardship of his lot. 
The indulgence in coca may be pushed to the extent of 
intoxication, or the habit of chewing may enslave a man ; 
but these cases are not common among the Indians. 

The physical effects of coca are, however, more salu- 
tary and in many respects more remarkable than the 
mental. It is universally acknowledged that coca stills 
hunger, overcomes drowsiness, and increases bodily activity. 
All travellers in the Andes bear testimony to the wonderful 
power shown by the Indians to endure fatigue, cold, wet, 
and exposure, with only the scantiest allowance of poor 
food, if they are supplied with coca. The life of the Indian 
of the Andes is one of extraordinary toil and hardship. 
His diet consists mainly of a small quantity of maize and 
frost-dried potatoes ; he is constantly exposed to the in- 
tense heat of the plains or to the terrible cold of the high 


plateaus of the Cordilleras ; the toil exacted of him in the 
mines and the plantations is excessixe ; but he is yet able 
to perform, not exceptionally, but constantly and as a 
matter of daily life, the most astonishing feats of endurance 
on a diet which would be absolute starvation to a European, 
or to exist even for a time without food at all, by the aid 
of the power which coca gives. Von Tschudi, the naturalist 
and traveller, gives a remarkable account of an Indian, 
sixty-two years of age, who was employed by him in dig- 
ging for five days and nights, with only an interval of sleep 
of two hours each night. During this time it is asserted 
that he never tasted food, though at intervals of from two 
to three hours he chewed half an ounce of coca leaves. The 
work done, he accompanied Von Tschudi on foot through a 
two days' journey of seventy miles across the level heights, 
halting only to chew his coca. The most striking stories 
are told of the men engaged in the postal service, who, 
half-naked, traverse the icy slopes of the Andes carrying 
the heavy mail bags. These men walk from 200 to 300 
miles, crossing the mountain by paths rising 13,000 and 
14,000 feet above the sea level ; their scanty clothing being a 
poor protection against the fierce snowstorms, the intense 
cold and the rarefied air of the Andes. Their food for the 
journey consists of from one to two pounds of dried maize 
and potatoes ; but if supplied with sufficient coca to chew 
they endure cold, hunger, fatigue, and sleeplessness not only 
without complaint, but without even seeming to be aware of 
them. In like manner the Indian labourers in the mines of 
the Cordilleras, whose toil is spoken of as incessant and 
excessive, and performed in damp, cold, and darkness ; the 
shepherds tending their flocks of alpacas on the bleak 
Pampas, and the farmers irrigating their fields at night in 
mid-winter on the high plateaus, standing often knee-deep 
in icy water and exposed to cuLting blasts, are all said to 
be equally inured to a life of surprising hardship and priva- 
tion, by the daily use of coca. It is stated, however, that 
though no hermit or monk ever lived so ascetic a life as 


these poor Indians, yet the appetite for food is only stayed, 
not destroyed by coca, and that if any one is kind and 
CTenerous enough to feed them, they eat with voracity and 
evident enjoyment. It is also said that if they change their 
food and give up coca they lose their power of endurance ; 
and, moreover, that the Spaniards who go to work in the 
mines cannot stand the great hardships of the life and the 
inclemency of the Cordilleras till they take to the regular 
use of coca. Von Tschudi tells us that this life of silent 
endurance and bitter abnegation may be much prolonged, 
even in one instance to 130 years. 

The other remarkable effect of coca is the influence 
it exercises on the respiratory centres, so that the rarefied 
air of the higher altitudes of the Andes can be breathed 
without the distress usually experienced at the height of 
thirteen or fourteen thousand feet above the sea. All 
travellers speak of the extraordinary way in which the 
Indian porters will keep up with the quick pace of the 
mule along the roughest mountain paths without showing 
any signs of breathlessness. 

Though wonderful but little credited stories were told for 
two centuries of the sta}-ing power of coca leaves, no attempt 
was made to introduce them into Europe, and scientifically 
to test their value either as dietetic or therapeutic agents till 
about forty years ago. The first experiments were nugatory, 
as the substances which give the leaves their subtle power 
escaped or were volatilised during the voyage. Care has, 
however, since been taken to enclose the leaves in air-tight 
boxes, with the result that a great variety of fluid extracts 
and wines of coca are now made, and are widely recom- 
mended for their tonic properties. 

The staying powers of coca. — I have had some small 
experience of the value of one of these under exceptional 
circumstances. When reading some years ago in Paris, 
under pressure of time, for public vwd 7ioce medical exami- 
nations I found that I could work for from fourteen to 
sixteen hours a day, for three or four weeks together (work 


ending in successful examinations), without mental or 
physical fatigue, or bad after-results if I took a small 
daily dose of coca wine. My modicum was a bottle a 
week, discontinued immediately my task was done. Re- 
cently, when making a long convalescence from influenza, 
in which depressing cardiac symptoms were marked, I 
found again in coca a good and reliable restorative. I have 
no reluctance in saying that, if I ha i to accomplish some 
severe work which drew exhaustingly on my full mental 
and physical powers — such as preparing in a short time 
for a public scientific examination in a foreign language, 
doing literary work under pressure, or nursing one dear to 
me through a serious illness — I would unhesitatingly, and 
with good conscience, seek the support and power of en- 
durance coca can give. 

Mr. Eber Caudwell published an interesting account in 
the British Medical Journal (vol. i., p. 17, 1888) of the 
effect coca had on himself in enabling him to go through 
long hours of toil without sleep, and while preserving his 
full mental activity and vigour. When the pedestrian 
Weston was performing his feats of walking, it was noticed 
that he was always chewing a greenish substance, and after 
repeated inquiries he at length admitted that this was coca, 
to which he trusted to maintain his muscular activity with- 
out fatigue. Singers find that coca enables them to inspire 
more deeply, and to hold their breath longer than they 
could otherwise do. 

But coca is not without danger ; and what to the poor 
Indian may suffice for food ; what may enable the student 
to give the hours of sleep for study widiout increasing 
fatigue ; what may yield to the traveller and labourer the 
power of accomplishment without inducing weariness, may 
become to the fashionable lady another source of self-in- 
dulgence. As a rule, all well-to-do persons are over- 
nourished, and the debility of which the)- frequently 
complain is not due to the want of food and stimulants, but 
to having fatigued and broken down the bodily machine 


in its efforts to digest and get rid of the amount of food, 
wine, and "strengthening substances" taken. The only 
justification for adding coca to one's daily diet would be 
an undue amount of labour to be undertaken, or the lessen- 
ing of the usual amount of food ingested. Coca gives to the 
Indian the power to endure a life of penurious toil and 
privation ; in like manner a rigid asceticism should with us 
accompany the use of coca. The knowledge of its powers 
cannot fail, however, to be of value to the pedestrian and 
traveller, and to those who work hard and live low. 

Cocaine. — The most valuable substance extracted from 
coca is cocaine, which from its power of producing local 
and superficial anaesthesia has been much used of recent 
years in operations on the eyes, teeth, etc. Cocaine rapidly 
became a fashionable nerve stimulant and sedative ; but its 
use has been accompanied with many fatal accidents, and 
with the introduction of a new disease, namely, a morbid 
longing for cocaine, or cocainism. Thus the fairy's wand, 
that stayed the hunger of the poor and enduring Indian 
in the Andes, has become a viper in the bosom of a self- 
indulgent society. The sale of cocaine to the public, other 
than as a drug, has been forbidden in France, and will 
probably also be rendered illegal in America. 

The scientific study of cocaine has led to a better 
comprehension of the mysterious qualities of the coca leaf. 
The first effect is sedative, rapidly followed by stimulation, 
in which the heart beats are quickened, the nervous system 
becomes more active, the intelligence more acute, and the 
muscles pass more easily into a state of contraction. Dr. 
Mantegazza says that when he was under the influence of 
coca he had an irresistible inclination to gymnastic exercise. 
The absence of the sense of hunger seems to be due not only 
to the anaesthetic effect of the cocaine on the nerve ends of 
the stomach, but also to the fact that coca is an actual 
economiser of food, and so modifies the vital processes in 
muscle as to affect its chemical activity, and to render it 
capable of performing an equal and greater amount of work 


with a lesser consumption of carbo-h}-drates Stockman). 
The absence of emaciation, subsequent debility or other 
bad results after the most exalted powers of the organism 
have been called forth, point to coca being more than a 
nerve stimulant, and also an actual economiser of the bodily 
expenditure. If it diminishes the consumption of carbo- 
hydrates during muscular activity, that is to say, if it 
enables the machine to work with less fuel, less oxygen 
will be required, and hence is explained the effect of coca 
in preventing breathlessness during the ascent of high 
mountains. Excessive quantities of coca cause headache, 
giddiness, mental aberration, and ultimately nervous 





The restorative properties of tea are well known and 
universally admitted. To partake of " the cup that cheers 
but not inebriates " has become a national habit, and is 
indulged in equally by the richest and the poorest. 

How tea is prepared. — Tea consists of the prepared 
leaves of a small shrub-like plant resembling a camella. 
It is cultivated in China, Japan, India, and Ceylon. The 
leaves are gathered by hand three times in the year, the 
young and tender shoots making the finest teas. The 
peculiar astringent quality and aromatic flavour of tea, as 
we know it, are developed in the processes of drying and 
roasting. Green tea is prepared from the young leaves, 
which almost immediately after being gathered are cast 
into shallow pans and roasted over a brisk wood fire. After 
being thus treated for about five minutes, they are re- 
moved, thrown upon a table, and rolled with the hands. 
They a.te again thrown into the pan, and are well shaken 
about over the fire for an hour and a half, till they are 
thoroughly dried, when the pale green colour characteristic 
of green tea is fixed. These slightly roasted and delicate 
green teas are highly appreciated by the Chinese, the 
Japanese, and the Russians ; but are scarcely used in Eng- 
land except by tea connoisseurs. Many of the teas known 
in England as " green teas " are not of this fine variety, 
but are the coarser teas faced or coloured with Prussian 
blue or indie^o. These are, however, little used now. In 


the preparation of black tea, the leaves after being plucked 
and brought in from the plantation are allowed to lie in 
heaps for about twelve hours. They are then tossed into 
the air, and patted with the hand by the workmen until 
they are soft and flaccid ; again thrown into heaps, and 
allowed to remain for some time. They are then rolled 
into balls, and the sap is squeezed out by the hands of the 
workmen, the leaves receiving at the same time a twist. 
They are then roasted and rolled, in the same way as green 
tea. After this they are laid on sieves, and exposed out of 
doors for three hours to a sunny air. The leaves are again 
roasted and rolled a second time, and this process is re- 
peated, with slight alterations, three, four, and even five 
times. The tea leaves are now perfectly dry, of a fine black 
colour, crisply rolled, and assume the appearance we know 
so well. There is no doubt that fermentative changes take 
place in the preparation of black tea, which considerably 
alter the chemical character of the leaf 

The constituents of tea. — Tea contains three active 
principles to which it owes its peculiar properties and 
characteristics. These are theme, a crystallisable alkaloid, 
to which is due its stimulating and restorative properties : 
tannin, whence it derives its astringency and a good deal 
of what is popularly known as " strength " ; and a volatile 
oil, to which it owes its aroma. There is probably also a 
bitter principle, which has not }-et been separated ; it is 
less soluble than tannin, and is extracted from the leaves 
and passes into the water after a long infusion or stewing. 
Both theine and tannin are soluble in boiling water. The 
theine is in combination with tannic acid, and the theine 
and tannin are together dissolved out of the leaves into the 
water. There is a popular impression that by a very short 
infusion of only two or three minutes, theine can be ob- 
tained from tea, without the tannin. This is a mistake. 
Tannin, which is very soluble, is always dissolved out 
with the theine. Some teas, however, continue to give q'^ 
tannin after the chief part of the theine has been dissolved 


out. These are chiefly the Indian teas, which have been 
highly fired and much fermented in the process of pre- 

The following table, taken from a number of analyses 
recently made by the late Professor Dittmar, shows clearly 
the effect of allowing the water to stand on the tea leaves 
five minutes and ten minutes respectively, and the varying 
amount of theine and tannin given off by China, Ceylon, 
and Indian teas : — 

Five Minutes' Infusion. Ten Minutes' Infusion. 

Theine. Tannin. , Theine. Tannin. 

China . . z'^S . . 3'o6 i China . . 279 . . 378 

Ceylon • 3"i5 • • S'S? Ceylon . 3-29 . . 730 

Indian . 3-63 . . 6-77 Indian . 373 . . 8-09 

From this it will be seen that though Indian tea con- 
tains 25 per cent, more theine than China tea, it also 
contains 100 per cent, more tannin. Indian teas are much 
more widely used in England than China teas, and the 
" strong syrupy teas," advertised as of good value, and so 
largely consumed by the working classes, are, as a rule, 
blends of various Indian teas rich in tannin and astringent 
matters. It thus obviously becomes a matter of great, 
and even of national importance, considering how exten- 
sively and continuously tea is drunk, to ascertain the 
physiological effects of its principal constituents — theine 
and tannin. 

The physiological effects of tea. — Universal experience 
teaches us that tea exhilarates without intoxicating, stimu- 
lates the circulation, excites the brain to increased activity, 
promotes wakefulness, and banishes the sense of weariness. 
It also deadens the sensation of hunger, and increases the 
power of fasting. It will cool the body when hot, and warm 
it when cold. In tropical countries it has been found to be 
a most valuable restorative when taken by soldiers on long 
and fatiguing marches. Lord WoLseley, who is a great 
advocate for tea as a bcverasje on which to do hard work 


gave orders that the water-bottles of the soldiers whom he 
led on the two famous and exhausting expeditions of the 
Red River, and up the Nile to Khartouin, should be filled 
with cold tea ; and he is convinced that, whereas alcohol 
induces fatigue, tea will give the power to endure and over- 
come it. 

The exhilarating and the staying powers of tea are due 
respectively to the theine and tannin it contains : the theine 
exhilarates the nervous system, the tannin stays hunger. 
This latter point has been made clear by the interesting 
and valuable experiments of Sir William Roberts, who has 
shown that tannin, taken even in very small quantities, has 
an inhibitory or slowing influence on the digestion of food 
in the stomach. He found that this took place with tea 
made at the ordinar\- strength, and taken in the usual 
amount, with food ; the digestion being still longer delayed 
if a large amount of fluid tea was drunk. He could not, 
however, detect any appreciable difference between the 
inhibitory effect of tea infused for two or three minutes and 
tea infused for fifteen or thirty minutes. In fact, the tannin, 
always and inevitably present in tea, is sufficient to retard 
digestion ; and the amount of tannin taken, and the in- 
creased retarding effect produced, depend not upon the 
length of time the tea is infused, but upon the total 
quantity of fluid tea drunk. This inhibitory or retarding 
influence of tea on digestion Sir William Roberts considers 
to be useful and salutary. Slow digestion does not mean 
imperfect digestion ; and it would appear that the tannin 
by slowing digestion, and the theine by exhilarating the 
nervous system, give to tea the extraordinary power of 
inducing the endurance of fatigue and fasting, of which we 
all have daily experience, and which makes tea so favourite 
a beverage with the poor. The afternoon cup of tea, taken 
with a small amount of bread and butter, will enable a 
great many hard workers to dispense with luncheon, and 
to remain without food till a late dinner-hour, without 
experiencing any discomfort. The inhibitory or slowing 


influence of tannin is more marked on starch than on 
albuminates ; hence the satisfying character of a good meal 
of tea and bread, and the probable cause of indigestion and 
nightmares consequent on a " high tea " with cold pie and 
cakes. A pinch of bicarbonate of soda put into the teapot 
will destroy the deterrent effect of tea on stomach digestion 

Tea has its dangers, and these are well known to doctors. 
If taken in excess, it may produce cardiac disturbances, 
palpitations, flutterings, a nervous impression of distress 
and anxiety, and even intermittence of the pulse and sleep- 
lessness, while sometimes it provokes an obstinate form of 
gastric catarrh. It is said that these effects are due to the 
tannin contained in the tea, but this assertion is by no 
means proved. Tannin has but a slight effect on peptic 
action, and the slowing effect of tea upon stomach digestion 
is not fully explained by the presence of tannin in tea 
(Roberts). The assertion one hears made that the tannin 
of tea tans the coats of the stomach into leather is one of 
those statements which are based more upon a lively 
imagination than on the data of science. The coats of the 
stomach do not in any way resemble a hide. They are, 
moreover, not dead membrane, but living tissue, and the 
effect of tea on meat fibre is not to harden it, but to cause 
it to swell. If tea is found to disagree with a person 
either by over-stimulating the nervous system, or by de- 
laying digestion, the remedy is to take it in smaller 
quantities or extremely weak, and also not with but after 
food. In some forms of dyspepsia, particularly in the 
hysterical flatulent form, tea should, at all events for a 
time, be entirely abstained from. 

How to make good tea. — The evil effects of tea have 
been attributed to the methods in vogue of making it. We 
have seen that the soluble theine is at once dissolved in 
the hot water, but that the tannin contained in the coarser 
teas generally used in England continues to be given off 
if the tea is left standing on the leaves. Now, this is what 


almost invariably happens ; and the last cup of tea drawn 
from a pot long standing, and which is said to be " very 
strong," is strong, not so much in the restorative principle 
of the theine, but in the astringent tannin which inhibits or 
slows digestion, and also in the bitter principle which is 
finally extracted from the leaves. To the habit, customary 
among the poor, of slowly stewing the tea on the hob, and 
also to the practice at restaurants and railway stations of 
continuously boiling it in urns, much of the dyspepsia 
attributed to tea-drinking is probably due. The reason is, 
however, not clear. The professional tea-taster allows the 
boiling water to stand on the tea leaves five minutes and 
no more ; the infusion is then poured off and drunk. If 
this custom were universally followed we should probably 
hear fewer complaints about the evil effects of tea-drinking. 
In order to prevent the tea standing on the tea leaves, 
various teapots have been invented, by means of which 
infusion for a certain definite time can be obtained, and the 
tea leaves are then withdrawn. The best and simplest 
method is, in my opinion, to have a fine wire basket, in 
which the measured amount of tea leaves is placed ; it is 
then closed and dropped into the hot water in the teapot 
for five minutes, after which it is withdrawn. Another 
method is to have a china strainer under the lid of the tea- 
pot, in which the tea leaves are deposited, and the boiling 
water is poured through the strainer. These teapots are 
made in Japan, and are imported in large quantities into 
this country. I have also seen used in Germany a concave 
perforated metal measure, which is placed at the top of the 
cup ; this is then filled with hot water. When the leaves 
are sufficiently infused the measure is withdrawn, and the 
tea leaves are thrown away. 

National customs in tea drinking. — In England tea is 
drunk with sugar and milk. Some contend that this custom 
has been introduced owing to the fact that we drink coarse 
tea, so strong in tannin that it is necessary to add sugar 
and milk to mitigate the astringent flavour. This may be 


SO ; but the addition of sugar and milk makes the cup of 
tea a nourishing food, whereas alone it would only be a 
stimulant. In Russia, tea is drunk without sugar and milk, 
but with a slice of lemon added ; but there, the finest and 
most costly teas are chiefly used. In China and Japan — 
the home of the tea plant — the drinking of a cup of tea is 
the invariable accompaniment of all ceremonies. No visit 
can be paid, no bargain can be struck, no contract can be 
made, no meal can be taken without a cup of tea. If one 
is engaged, as is the lot of every traveller, in paying 
numerous visits both of business and pleasure during the 
day, it is surprising the number of cups of tea one can con- 
sume ; and yet tea-dyspepsia and tea-nervousness are 
unknown in Japan. The cause may be due to the fact that 
Japanese teas are only slightly roasted and fermented, and 
that the method of making tea adopted leads to less tannin 
being dissolved out than by the English method. Every 
Japanese household, however poor, possesses a large metal 
tea kettle and a small porcelain or pottery teapot. Into 
the tiny teapot is placed a small amount of fine green tea. 
On this is poured water not quite boiling. Without allow- 
ing the water to stand on the leaves more than a moment 
or two, the tea is poured into small porcelain cups, and 
drunk pure, without any admixture. Tea taken in this 
way is extraordinarily refreshing. When in Japan, I have 
sometimes, after being engaged in the fatiguing, incessant, 
but fascinating occupation of shopping, turned to the sales- 
woman serving me, and said, O clia dozo Oka san, which 
means, " Please give me a cup of your honourable tea, good 
lady," at which request the tiny teapot has been im- 
mediately produced with many smiles and bows, and has 
yielded an astonishing number of small cups, water being 
continually added from the pretty chased iron kettle. 
After this " restoration" shopping again became fascinating. 
The tea ceremony in Japan. — There is another kind of 
tea which is also drunk in Japan on the occasion of the 
unique and solemn Tea Ceremony. This ceremony, which 


has become a national and tenaciously-held custom, was 
invented by a great chieftain called Hideyoshi, in the early 
part of the sixteenth century, with the object of teaching 
his turbulent barons to be courteous, self-controlled, and 
silent. At the Tea Ceremony, the details of which are 
long, elaborate, and definitely arranged, a fine green tea, 
which has been ground into powder, is brewed in a regu- 
lated and ceremonious manner by an official of the house- 
hold, called the cha-nou. The tea powder is stirred with 
a whisk in hot water in an antique bowl. This bowl of tea 
is handed round to the guests seated on their heels on the 
matting, and is drunk, tea-dust and all, in solemn silence, 
the bowl being returned to the cha-nou with forehead 
bowed to the ground. Thus in this, as in many other 
things, Japan takes the opposite view to England ; but we 
may, I think, learn from Japan to our advantage, and the 
cup of tea, which in England is notoriously the signal for 
scandal, is in Japan the opportunity for a meeting of friends 
in silence. 



RESTORATIVES— {continued). 

Coffee — Cocoa — Chocolate. 

Coffee is a valuable restorative. — Though coffee closely 
resembles tea in constitution, it has its own special charac- 
teristics and properties. From time immemorial it has 
been known and valued in Arabia, the native home of the 
coffee plant ; and the finest coffee still comes from Mocha. 
The Moors and Arabs of the Orient, who are forbidden by 
their religion to take alcohol, find in coffee a stimulating 
beverage. The first coffee-house was opened in London 
in 1652, and since that date the use of coffee has con- 
stantly increased, though owing, in a great measure, to the 
imperfect way in which it is made in England, it is not 
nearly so favourite a beverage here as in France. 

The coffee plant and coffee berry. — Coffee is the seed 
of the fruit of the coffee tree, a shrub-like plant which is 
cultivated with the greatest success in /\rabia, Turkey, the 
West Indies, and Java. The only preparation the berries 
undergo is that of roasting, during which their peculiar 
aroma, taste, and flavour are brought out. 

The constituents of coffee. — Coffee, like tea, contains 
three active principles. These are the alkaloid caffeine, 
which is identical with, and has the same properties as 
theine ; secondly, an astringent substance resembling tannin 
is present in much smaller quantities than in tea ; and 
thirdly, a volatile oil developed in roasting, which gives 
the coffee its aromatic odour. Coffee, like tea, also con- 
tains a considerable amount of gluten, which is only slightly 
soluble in water. 


The following approximate analysis will show the dif- 
ferences between tea and coffee : — 















Water . 

Tannic acid . 

Theine or caffeine . 

Gluten . 

Fat and volatile oil 

Woody fibre, gum, etc. 

From this table it will be seen how closely tea and coffee 
resemble one another. Tea is, however, the more astrin- 
gent drink, and coffee the more stimulating and aromatic. 
In Europe, the ground coffee berry is generally simply in- 
fused, when its theine, tannic acid, and volatile oil are 
dissolved into the water. Among some of the Eastern 
nations the custom prevails of pounding the coffee in a 
mortar till a fine powder is produced. The coffee grounds 
are left in the cup, and are swallowed with the coffee. In 
this way the gluten and nutritive properties of the coffee 
berry are consumed, and thus a cup of coffee becomes a 
nutritious food. 

The physiological effects of coffee. — Coffee has been 
called in France " an intellectual drink," owing to the fact 
that it has a decided stimulating influence on the nervous 
centres, lessening the need for sleep, and increasing the 
capacity for mental work. It also seems to have, like coca 
erythroxylon, the power of augmenting the functional 
activity of the muscles, even while it diminishes tissue 
waste. Like tea, coffee lessens the sense of hunger, and 
will banish fatigue. To the soldier on the march it has 
proved the most valuable restorative, and for the explorer 
in the Arctic regions a cup of warm coffee has been 
declared to be a far better nightcap than rum and water. 

As to the power of coffee to sustain under fatigue, 
cold, and exposure, I may, perhaps, be allowed to give a 


personal illustration. Some years ago a party of travellers, 
including myself, started from Leukabad with the intention 
of climbing the Gemmi and crossing a pass involving a 
toilsome mountain walk of not less than thirty miles. The 
Gemmi is a solid wall of granite, which rises steeply to the 
height of 5000 feet. So precipitous is this immense cliff 
that travellers are only allowed to mount it on foot by 
means of the narrow paths which are cut in zig-zags along 
its bare surface. We had not proceeded far on our journey 
when we were overtaken by a severe snowstorm. Unwilling 
to turn back, and enjoying the beauty of the storm, we 
steadily climbed to the summit of the Gemmi. Here, how- 
ever, we met the full force of the storm, which was sweeping 
unchecked over the glacier- worn surface of the snow-covered 
plain. In the teeth of the wind and the blinding snow we 
pressed forward mile after mile, while the icicles hung from 
the beards of the gentlemen and the hats of the ladies. 
Presently we came in sight of the lonely hospice which 
stands beside the black waters of a tarn. Glad of shelter 
we turned into the little inn and shook the snow and icicles 
from our clothes, and changed wet stockings and boots for 
dry ones, always carried with us as a precaution. " What 
shall we take ? " v/as then the question, and various stimu- 
lants and hot drinks were suggested ; but my husband, 
knowing that we did not wish to stay the afternoon and 
evening at the dreary inn, advised us not to touch alcohol, 
but to take only hot coffee if we wished to continue our 
journey. To the disappointment of the innkeeper, we 
therefore ordered nothing more than a large pot of smoking 
hot coffee, with which we refreshed ourselves. After a 
short rest, stimulated and warmed by the coffee, we again 
started gaily on our journey, and walked another sixteen 
miles through the snow-covered forests to the nearest green 
valley, which we reached late. We were all convinced that 
it was owing to the coffee that we accomplished this toil- 
some journey in the snowstorm on foot, and that if we had 
taken alcohol as a restorative we should have spent the 


afternoon tired and chilly by the inn fire. This view is 
strongly expressed by Germain See, the French physician. 
In comparing alcohol and coffee, he says : " The muscular 
system and muscular energy are marvellously roused by 
coffee, and a man fatigued or overworked can find no more 
wholesome support ; whereas alcohol produces in the muscles 
a dubious passing excitement, and in the end a degenera- 
tion of all the organs of human activity." Sir William 
Roberts sa\'s that coffee inhibits or slows stomach digestion, 
which action is very marked in strong black coffee, hence 
it is unadvisable for those who ha\-e weak digestions to take 
strong coffee after dinner. 

How to make good coffee. — Coffee is not sufficiently 
appreciated in this country. This is due in a great measure 
to the imperfect way in which it is made. Coffee should be 
purchased in small quantities fresh roasted, should be ground 
just before it is used, and should be taken perfectly pure 
without any admixture of chicory. Coffee can be made 
either in a percolator, in which an infusion is made by 
slowly pouring boiling water through the ground coffee, or 
it may be boiled in an enamelled saucepan and then 
strained ; or it may be prepared in any of the patent 
machines which boil the coffee for a limited time only. 
In m}- opinion the full flavour of the coffee is only extracted 
by boiling, but the time of boiling must be very short, not 
exceeding a minute. Dr. Burne}' Yeo suggests that the 
coffee grounds left in the bag of the percolator should be 
boiled in water, and that this water should be used to per- 
colate the next day's coffee with. In the French army 
coffee is made in a machine in which the water is passed 
in small jets several times through the ground coffee. 
Good coffee cannot, however, be made without a sufficient 
quantity of ground coffee ; not less than 2 oz. to a pint of 
water should be used. 

The small popularity coffee has in England is due to 
the fact that it is largely adulterated with chicory, and also 
that it is made so weak that its stimulative, refreshing, and 


aromatic qualities are not enjoyed. Cofifee can be drunk 
much more continuously than tea without inducing bad 
consequences, though in some people strong coffee produces 
palpitation of the heart. 

Chicory is the roasted and ground root of the wild 
endive. It contains a volatile oil and a bitter principle, 
but no caffeine. It is added to coffee to increase the 
flavour, and to give the appearance of strength. It readily 
stains water, so that its presence can at once be detected 
by putting a pinch of what has been purchased as ground 
coffee in a cup of cold water ; if pure the water remains 
clear, if chicory is present the water will be stained. 

Cocoa. — Cocoa is derived from the seed of a plant called 
the tJieobronia cacao. The name was given by the botanist 
Linnaeus, who expressed his high opinion of cocoa by the 
name " theobroma," which means "food for the gods". 
The seeds are embedded in a pulpy fruit ; when ripe they 
are separated, sun-dried, and roasted. Cocoa nibs consist 
of the crushed kernels of these seeds ; but cocoa such as 
we generally use has undergone a long and elaborate process 
of preparation. The following analysis (Payen) of cocoa 
will show in what way it differs from tea and coffee : — 

Cacao butter 50 

Albumen, fibrin, etc. 20 

Theobroma ........ 2 

Starch . ........ 10 

Cellulose ........ 2 

Mineral matter . 4 

Water ......... 12 

It is thus seen that cocoa is rich in fat, that tannin is 
absent, and that it contains an alkaloid, theobromine. This 
alkaloid is almost identical with theine and caffeine, and 
has probably the same stimulating and inhibitory action ; 
but as it is present in diluted cocoa in very small amount, 
cocoa is a less stimulating drink than tea and coffee. Its 


constitution shows, however, that it is highly nourishing. 
In the various prepared cocoas, the excess of fat has been 
extracted, and sugar, and sometimes starch, added. There 
are three ways of making cocoa according to the mode in 
which the cocoa has been prepared. Stewing : The cocoa 
nibs are slowly boiled or stewed for several hours, and the 
subnatant fluid is poured off. A more stimulating, but less 
nourishing, drink is thus obtained than from prepared 
cocoas. Infusing: In cocoas prepared without the ad- 
mixture of starch, such as Van Houten's and Schweitze's, 
it is necessary only to mix a certain amount with hot water 
to make a soluble infusion. These cocoas are particularly 
suitable to those persons who must avoid starch in their 
diet. Boiling : Most of the prepared cocoas contain a 
large amount of added starch ; it is therefore necessary to 
boil them before drinking. They form a highly nutritious 
and fattening food, especially when taken, as is usual, with 

Chocolate is prepared from cacao seeds by grinding, 
and by the addition of a large amount of sugar and various 
flavouring matters. It forms a luxurious and highly nutri- 
tious food, and is very rich in all the necessary constituents 
of diet, vis., hydro-carbons, carbo-hydrates, and albumi- 
nates. A small amount of solid chocolate will be found a 
valuable preventive against hunger when circumstances 
oblige one to go long without food. I have frequently 
found that a penny slot of chocolate at a railway station 
will enable me, after being eight or nine hours without 
food, to continue my avocations without being tormented 
with the sense of hunsrer. 




Water. — When it is remembered that water forms from 
60 to 70 per cent, of the body, and that it enters into the 
composition of every Hving tissue, it can be readily under- 
stood how important an article of diet it is. In all the pro- 
cesses of metaboHsm or constant change, b}^ which alone 
Hfe and function are maintained, water plays a part. Thus, 
in digestion, the food principle must be dissolved before 
assimilation can take place ; in respiration the expired air 
is charged with moisture ; in circulation the blood must be 
fluid ; in the secretions, by means of which the body machine 
is maintained in working order, and in the excretions by 
means of which the refuse is cast out, the presence of water 
is an absolute necessity. 

To drink pure water is the custom of the natural man ; 
to drink impure water is the almost invariable habit of the 
civilised man. In the days of the Greeks, the Romans, the 
Egyptians, and the powerful and interesting races of India 
and Asia Minor, the provision of pure water for the people 
was looked upon as a national obligation ; and the ruins 
of the great aqueducts, by means of which the water of 
mountain and sky and lake was carried immense distances 
to the cities, to-day cumber the ground whence the people 
now draw their water supply from polluted wells. It is 
only of recent years, and not till the ravages of cholera and 
typhoid had at last taught the people and municipal 
authorities the lessons which the sanitarians had never 
ceased to preach in season and out of season, that the 


OF ] 


absolute necessity of a perfectly pure water supply for 
drinking purposes has been recognised. 

In London the water supply is derived from the Thames, 
the Lea, and the New River, rivers which receive sewage 
and filth of every description along almost the whole length 
of their course. Elaborate and costly precautions are, 
however, taken by the water companies to get rid of all 
the unwholesome and dirty particles with which the water 
is more or less charged. This is done by means of filtra- 
tion and by the formation of large filter beds. Nature's 
way of cleansing polluted water is twofold — either to pass 
it through immense filter beds of gravel, beneath which it 
collects in underground reserv^oirs, which may be naturally 
tapped by "faults" in the strata, leading to the forma- 
tion of springs of pure water, or by shafts purposely sunk ; 
or foul water is purified by means of the flow of a river, 
during which the solid particles sink to the bottom, and 
the organic pollutions, such as germs, etc., are oxidised and 
destroyed. Spring or well water often contains inorganic 
materials, dissolved out of the soil through which it has 
passed, such as lime, iron, etc. River or stream water is 
the pleasantest to drink, as it contains much air, and a 
small proportion of organic salts, which give it an agree- 
able flavour. So long, however, as it is not considered a 
crime against humanity and the State to pollute a river or 
stream, unfiltered river water is dangerous to drink. 

Water is purified in three ways : by filtration, b}- dis- 
tillation, and by boiling. 

Filtration. — A great variety of filters have been in- 
vented. The principle is the same in most of them ; namely, 
to pass the water through some finely granular material, 
such as gravel, manganic iron, or charcoal, with the 
intention of arresting the passage of suspended particles. 
None of these filters which are in ordinary use give com- 
plete security ; and in order that they should give even 
comparative and temporarily good results, it is necessary 
that the filtering material be frequently renewed. It is 


now known that to confer safety, water should be bacterio- 
logically pure, and free from the bacilli of disease. The 
only type of filter known that fulfils these conditions is 
the Pasteur-Chamberland model, and partially some of 
its imitations. In this filter the water is made to pass 
through a solid cylinder of porcelain base, specially tested 
to produce complete sterilisation of the water. This filter 
is now used extensively in laboratories and wherever it is 
important that water should be entirely free from dangerous 

Boiling. — Water is rendered quite harmless by boiling. 
In cases where it is not possible to have a pure water supply, 
where the water can only be obtained from a polluted river 
or well, cases which are common enough in the country 
districts in England, and almost invariable abroad, it is 
more than advisable, it is necessary, for the preservation of 
health, to boil all the water used for drinking purposes. 
A most useful, and, in fact, an indispensable addition to 
the traveller's luggage when going abroad is a little Etna 
and a spirit lamp. The purchase of a few lemons will 
then enable the traveller to make a refreshing and inex- 
pensive beverage with water taken from the bedroom 
carafe and thoroughly boiled. If he follows this simple 
plan of drinking fresh lemonade made with well boiled 
water, he will escape the risk of imbibing the germs of 
typhoid fever or cholera. Boil your water is the sum and 
end of all the teachings of the bacteriologists and sani- 
tarians as a protection against typhoid and cholera and 
infectious diseases carried by water. 

The amount of water daily required to be taken varies 
considerably with the individual, some persons losing more 
by perspiration and the kidneys than others. From 2i to 
4 pints a day is the usual quantity required, and with most 
persons much of this is taken in the form of tea, coffee, or 
beer. A draught of fluid is useful after dinner to wash any 
undigested particles out of the stomach. 

The organic salts. — The universal custom of eating 


common salt with food testifies to a need of the body for 
this particular material. Such, indeed, is the fact. Chloride 
of sodium, or common salt, is found in all the tissues and 
fluids of the body. Without it the blood could not main- 
tain its fluidity, nor could fluids pass through animal mem- 
branes. When it is remembered that it is only by the 
passage of fluids through the membranes of the blood 
vessels and the lacteals that the products of digestion can 
be absorbed, it will be seen how important it is to take 
salt with our food ; in fact, if we were entirely deprived of 
common salt, we should soon die. In parts of Central 
Africa, w^here no salt is imported, and the local suppl}- 
is small, salt is so highly prized that it is a valuable 
article for barter, taking the place of money. The salts of 
sodium potassium and magnesium are contained in small 
quantities in the animal and vegetable foods we take, and 
are important for the maintenance of the body in health. 
The salt which is, however, present in the largest amount 
in the body is lime, in the form of phosphate of calcium, 
which constitutes one-half of our bones. As the bones when 
once completely formed, at the age of about twenty-five, 
do not change in form, the presence of lime in the food is 
not of so much importance in adult life as in youth ; in 
fact, it becomes often rather important to exclude it, for 
drinking water highly charged with lime salts may give 
rise to concretions and deposits in the kidneys and bladder. 
In such water the lime can be precipitated by boiling. 

Fruit salts. — There are a whole class of salts called 
lactates, tartrates, citrates, malates, and acetates, which are 
present chiefly in fruits and vegetables. These are con- 
verted into carbonates in the body, and they contribute to 
keep the fluids of the body alkaline, which is necessary so 
that the functional activity of the body may be carried on. 
If these salts are not provided in the food, the body is ill 
nourished, and finally that condition of mal-nutrition known 
as scurvy is produced. Though green vegetables have 
small nutritive value, they always form part of the diet. 


owing to the fact that they furnish the body with the 
necessary fruit salts. The experience of sailors and Arctic 
explorers has taught us, often by the severe lesson of 
terrible suffering, that it is far better to do without the 
rum ration than without the preserved vegetables, which 
contain the fruit salts required. 

Condiments, such as pepper, spices, and vinegar, give a 
flavour to food, and perhaps aid digestion by stimulating 




Thanks to the careful and lengthened studies and the 
recorded observations of physicians and sanitarians, more 
especially of prison and army doctors, there is no subject 
in physiology on which we possess such accurate informa- 
tion as the amount and kind of food to be taken in 
proportion to the amount of work to be done. If the 
body be closely watched it will be found that it responds 
in its capacity for work to its food supply, as accurately 
and delicately as does the steam engine to its fuel supply. 
Without fuel, and the proper supply of fuel, force cannot 
be got from the engine, and without food and its proper 
supply in amount and quality, work cannot be got from 
the human creature. A person may indeed subsist on 
very low diet, or even exist in a quiescent state for some 
time without food at all, if supplied with water ; but a life 
of health and vigour can only be maintained on the con- 
dition that the body is properly fed and nourished. To 
ascertain what is the proper amount of nourishment is my 

Subsistence diet. — We learn from studying prison 
dietaries, the feeding of famine-stricken populations, and 
the diet of our own poor in London, what is the smallest 
amount of food on which the body can live, but not do hard 
work. This is three pounds of meat, with a pound of fat 
on it, or the same quantity of butter or lard, two quartern 
loaves, and about an ounce of salt per week. For meat, if 
unattainable, can be substituted two extra quartern loaves, 
or about a stone and a half of potatoes, or between 5 lbs. and 


6 lbs. of oatmeal. Thus, we see that a person can actually 
exist on four quartern loaves and a pound of butter or lard 
a week without being gradually starved. This is, however, 
the diet of bare existence ; on it a person can do no work 
bodily or mental, or he will certainly break down. Children, 
it must be remembered, in whom tissue change is rapid and 
growth is taking place, require more than a subsistence diet. 

A working diet. — Work may be divided into three 
degrees: i. Moderate, which may be represented by a 
daily walk of from five to seven miles. Such is the 
amount of work done by soldiers on home service, by 
clerks, or ordinary persons in easy circumstances. For 
this, judging from army dietaries, 5 lbs. of meat and 7 
lbs. of bread weekly, with the addition of vegetables 
and milk, are sufficient. 2. Active work, such as is 
accomplished by soldiers on campaign, letter-carriers, and 
artisans, and which may be represented by a walk of twenty 
miles. This requires a fifth more nitrogenous food and 
added starchy and fatty foods. 3. Hard work means the 
work got through by navvies, miners, etc. As a rule these 
men eat increased quantities of meat if they can afford to 
do so. Science teaches, however, that in this they err ; and 
that the force for hard work can be got at much less ex- 
pense to the purse, and more easily by the body, from 
certain vegetables and from starchy and fatty foods than 
from large quantities of meat. An exclusively meat diet 
is wasteful as well as costly. 

How the poor liYe. — Now let us consider these dietaries 
and bald statements of fact in the light of experience, and 
learn something of how the poor live. In a thoughtful 
article by Mrs. S. A. Barnett (which was published first in 
the National Review for July, 1886, and republished in 
a book entitled Practicable Socialism, a series of papers 
by herself and her husband), the application of correct 
scientific principles of diet to the needs and possibilities 
of the poor is considered. The article should be carefully 
studied by all who feel themselves called upon to decide social 



questions, either theoretically or practically. Very much 
has been written about dietaries, and the amount of food 
necessary to raise so many foot-tons ; in other words, to 
enable a navvy or docker to do his daily tasks ; but no 
one, except Mrs. Barnett, has, so far as I know, taken 
the trouble to turn the percentages and quantities of 
carbonaceous and nitrogenous food required to maintain 
health, into economical dishes of potatoes and meat for 
a family of a working man and his wife and eight children, 
and to show us the cost of living to a farthing. 

Assuming that, on the lowest estimates, a working man 
requires i6 oz. of carbonaceous and 4 oz. of nitrogenous 
food a day ; his wife, 12 oz. of carbonaceous and 3 oz. of 
nitrogenous food ; and his eight children an average of 
8 oz. of carbonaceous and 2 oz. of nitrogenous food a day 
each ; the total indicates that 92 oz. of carbonaceous and 
23 oz. of nitrogenous food have to be daih' provided. To 
show how this can be done with all the advantages of 
scientific culinary knowledge, Mrs. Barnett gives the 
following daily menus, which I make no excuse for quot- 
ing at length : — 

Quantity of Food. Cost. 

Breakfast — Oatmeal Porridge : 


i:^ lb. of oatmeal ...02^ 

\\ pint tinned milk . . o \\ 

\ lb. treacle o li 

Dinner — Irish Stew: 

i:^ lb. meat 08 

4 lb. potatoes .... o 24 

i:^ lb. onions 01 

A few carrots ....01 

\ lb. rice 01 

\\ lb. bread o 2\ 

Tea — Bread and Coffee : 

25 lb. bread 03! 

2-J- oz. coffee 02^ 

li pint tinned milk . . o \\ 


2 5 





1 8* 



Here there is a short allowance of nitrogenous food, 
which would be corrected by a rather larger allowance 
of bread. I will give another of these thoughtful daily 
menus : — 

Quantity of Food. Cosi. 

Breakfast — Bread and Cocoa : 

s. d. 

2\ lb. of bread . . . . o 3f . . 

I5 oz. cocoa o I5 . . 

1 pint tinned milk ...01 . . 

2 oz. sugar o i . . 

Dinner — Lentil Soup, Toasted Cheese : 

i| lb. lentils 03 . . 

1 lb. cheese 08 . . 

i^ lb. bread 2:^.. 

Tea — Rice Pudding and Bread : 

f lb. rice o ih ■ • 

i| pint tinned milk . . o li . . 

2 oz. sugar o \ . . 

I5 lb. bread o 2J . . 

Total 2 li . . 

Carbonaceous. Nitrogenous. 





It will be noted that the family is strictly teetotal, and 
that no extras of an\' kind can be allowed. 

Wages and starvation. — Now, it is apparent that on the 
lowest estimate and with all possible care and knowledge 
the daily necessary food of a working man, his wife, and 
eight children, cannot cost less than on an average 2s. 4d. 
a day, or i6s. 8d. a week. If he is in receipt of a regular 
wage oi £\ a week, this leaves 3s. 4d. for rent, firing, 
clothing, and school fees. " It is not to be done ! " ex- 
claims the impatient student. But it is done, and done by 
hundreds of thousands, and happy is the family who can 
depend upon a regular wage of ^i a week. How is it 
done, however? By starving. In Mrs. Barnett's pathetic 
words, " The children have to put up with less than they 
need ; the mother goes without rather than let the children 
suffer, and thus the new baby is born weakly and half 


nourished ; the children develop greediness in their never- 
satisfied and but partly-fed frames ; and the father, too 
often insufficiently sustained, seeks alcohol, which, anyhow, 
seems to pick him up and hold him together ; though his 
teetotal mates assure him it is only a delusion." Mrs. 
Barnett sums up the whole matter in these words, " While 
wages are at the present rate, the large mass of our people 
cannot get enough food to maintain them in robust health." 
The results are scrofula, consumption, skin diseases, the 
exhausting diseases of the bones from which the children 
of the poor suffer, and the want of power to recover from 
acute diseases ; it is the poor and ill-fed that the epidemics 
of cholera and influenza sweep to their graves — a stunted 
and physically degenerate population. 

The moral and mental results are that ill-nourished 
brains are incapable of sustained intellectual effort, or even 
of correct and consecutive thinking ; and hence that de- 
generate morality and low cunning take the place of a 
robust conscience and trained intelligence ; and it is partly 
thus that the " criminal classes " of our latter-day civilisa- 
tion are produced. Mrs. Barnett, with her intimate know- 
ledge of the lives of the poor of London, among whom she 
has lived for the past twenty-three years, also shows how, in 
the desperate struggle to obtain even an insufficient supply 
of food, no funds are left the working man with which to 
provide books, the means of culture, and the opportunities 
of social intercourse, all of which are as necessary for his 
mental health and development as food and drink are for 
his bodily welfare. Nothing is left, moreover, wherewith 
to purchase rest and peace by the seaside or in the country, 
and nothing to meet the severe tax of sickness or conva- 

How this state of things is to be cured taxes the mind 
of the philanthropist, the economist, and the socialist ; that 
it is intolerable there is no doubt. We have long been 
accustomed to boast of our wealth, and to be proud of our 
national resources ; but the squandering of the rich, which 


is apparent to all, blinds our eyes to the wants of the poor, 
which are hidden. We forget, moreover, in calculating the 
national wealth, that the prosperity of a nation must not 
be estimated by the spending power of the rich, but by the 
purchasing power of the poor, and that as long as half our 
population cannot by any possible means obtain enough 
food with which to maintain health, disease, suffering, crime, 
and unrest will be the result. 



Food in Youth and Middle Age. 

The story is told of a great lady, who had been the wife 
in succession to three husbands, all of whom had been 
devoted to her — for she was a woman of unusual intelli- 
gence, beauty, and character — that she was once asked how 
it was that men so different in disposition as her three 
distinguished husbands had been so greatly attached to 
her, and by what secret charm she had chained their minds 
and their hearts. The great lady replied simply, " I fed them 
well." But it is said that the lady outlived all but her 
third husband, and the question which this story suggests 
is: "Are the well-fed the long-lived?" This involves 
another question : " What is the proper amount of food to 
take at different periods of life ? " 

In youth food should be abundant. — At this time the 
body is not only growing, but tissue change or metabolism 
is active, leading to vigorous life. The youthful body is, 
if healthy, intensely and restlessly active, and energy is 
redundant. Watch a family of children out walking with 
their governess or nurse ; notice how they run, skip, and 
trundle their hoops, how they shout and laugh ; how they 
are filled to overflowing with the vigour and energy of life. 
This energy and the necessary growth of the body cannot 
be maintained without an abundant food supply. The 
food must also contain all the essential elements — albumi- 
nates to build up the muscular and other tissues, fats and 
starches to develop heat and energy, and mineral salts to 
aid in the healthy formation of bones and teeth. 


The diet may be as simple and wholesome as possible, 

the simpler the more wholesome ; but there should be 
enough to eat to satisfy hunger. The greedy child is, as a 
rule, the ill-fed child ; ill-fed in not having enough to eat, 
or in having food inappropriate to its age ; for the modern 
custom of allowing children to partake of highly-flavoured 
dishes with their elders is as much to be deprecated as the 
starvation system which was in vogue at Dotheboys Hall. 
Meat, soups, milk, bread, butter, porridge, eggs, fruit, 
potatoes, green vegetables, farinaceous and sweet puddings, 
should be the staple articles of diet of growing boys and 
girls. Alcohol in any form is unnecessary and undesirable 
for young persons ; even to the weak and delicate a cup of 
beef tea will be found to be more sustaining and stimulat- 
ing than the " strengthening glass of port wine " which 
anaemic little girls are often persuaded to take. 

The anaemia of school girls at the age of puberty is 
frequently caused by an insufficient meat dietary at school. 
Between the ages of twelve and sixteen, girls develop with 
great rapidity, both mentally and physically. The calls 
on their physical constitution are great, and can only be 
responded to by the body being well supplied with the 
materials out of which to manufacture energy and the 
elements of repair^ — in other words, by having girls well fed. 
It may be interesting and instructive to recall one's own 
experience of youth, and to record a dietary based on 
rigid principles, adopted and enforced to maintain health 
and to banish daintiness. One of a large family of children, 
1 remember well the nursery and schoolroom dietary and 
regimen, to which all were submitted up to the age of fifteen. 
It was as follows : For breakfast, oatmeal porridge with 
milk and sugar, or bread and milk, on alternate days of the 
week, except on Sundays, when one boiled egg and bread 
and butter were allowed. For midday dinner the fare was 
roast or boiled joint, with potatoes and vegetables, and a 
sweet pudding or pie ; for tea, bread, butter and jam. 
There was no restriction as to quantity, but what we took 


on our plates we were obliged to eat, it being looked upon 
as a disgraceful sign of greediness to take more than one 
could consume, or to ask for a second helping when appetite 
was satisfied. If we did so we were made to feel the dis- 
comfort of surfeit, a sure way of checking greedy demands 
for " more ". As we lived in the country, ripe fruit and 
fresh milk were supplied ad libitum. Every day we were 
obliged to walk six miles along the roads and lanes, to go 
through half an hour's calisthenic exercises, and to have six 
hours' lessons Riding on horseback, gardening, and play- 
ing filled up the rest of the time of a happy, healthy, and 
vigorous childhood. These personal reminiscences may be 
pardoned, as they illustrate my point that the dietary of 
children should be plain and abundant. 

In adult life. — When the processes of digestion and 
assimilation are active, when all the organs are healthy and 
the body has the power of eliminating and discharging 
effete products, the intake of food may be in excess of the 
actual needs of the body, without harm. This is true, how- 
ever, only so long as active muscular exercise is taken, or 
great demands are made on the energy of the whole system. 
Englishmen are said to be the greatest meat eaters in the 
world, and they carry their carnivorous habits to whatever 
part of the world they inhabit, whether it be the tropics of 
India or the wintry plains of Canada ; but they are at the 
same time the greatest athletes in the world, and the people 
of the most devouring and restless energy. The youth of 
England expend much of their strength and energy in 
walking, boating, cricket, tennis, and football, and if they 
did not do so they would soon become — if they con- 
tinued the same diet — a dull, phlegmatic, and stupid 

The bilious attack a warning. — The generous diet of 
adolescence, e\-en of those who undertake active muscular 
exercise, must, however, be watched with care. The re- 
current bilious attack, the frequent headache or migraine, 
or an increasing deposit of fat. show that the supply of 


food is greater than the demands of the body require, and 
must be decreased if health is to be maintained. 

" I can accustom my body to ring alarums for food 
whenever I choose," said the wise Locke ; and the regular 
recurrence of appetite at certain intervals and hours is no 
certain sign, in such an automatic organ as the stomach, 
that food is absolutely required by the body. In a very 
few days a healthy person can easily accustom himself to 
get hungry at any hour of the day he chooses, or which is 
convenient for meals. 

The diet of the sedentary. — If, however, an abundant 
dietary is dangerous, unless carefully watched by those who 
take daily active muscular exercise, it is more than danger- 
ous, it is disastrous, to those who lead sedentar}^ lives, or 
who are brain-workers. The great majorit}' of our adult 
middle-class population in cities lead sedentary lives ; and 
it may be said unhesitatingly that they, as a rule, consume 
far too much albuminous food, butcher's meat in particular. 
The albuminoids of the food, being not fully oxidised in 
the body by muscular exercise, remain as effete products, 
and ultimately give rise to dyspepsia, liver complaints, gout, 
and Bright's disease. 

Ill-temper a symptom of excessive meat-eating. — One 
deplorable result of excessive meat-eating in England is 
the ill-temper which is a chronic moral complaint among 
us. In no country, I believe, is home rendered so unhappy 
and life made so miserable by the ill-temper of those who 
are obliged to live together as in England. To everybody 
who reads these lines, examples will occur of homes which 
are rendered quite unnecessarily unhappy, when they might 
be happy, by the moroseness and rudeness of the head of 
the family, by the peevishness of the wife, or by the quarrel- 
ling of the younger members. If we compare domestic life 
and manners in England with those of other countries 
where meat does not form such an integral article of diet, 
a notable improvement will be remarked. In less meat- 
eating France, urbanity is the rule of the home ; in fish- 


and rice-eating Japan, harsh words are unknown, and an 
exquisite politeness to one another prevails even among 
the children who play together in the streets. In Japan I 
never heard rude angry words spoken by any but English- 
men. I am strongly of the opinion that the ill-temper of 
the English is caused in a great measure by a too abundant 
meat dietary combined with a sedentary life. The half 
oxidised products of albumen form urates and uric acid, 
which, circulating in the blood, produce both mental and 
moral disturbances. 

The diet of the athlete. — On the other hand it may be 
justly urged that though the too liberal use of meat by 
those who live sedentary lives and who are past middle 
age is strongly to be deprecated, and though it is a fact 
that beans and grains can furnish a large supply of albu- 
minous food, yet there is an abundance of evidence in 
support of the opinion that no diet is so favourable to the 
production of that condition of the muscles which enables 
a man to undergo prolonged and excessive muscular 
exertion, as lean meat, particularly beef Under this diet 
the muscles seem to attain a firmness and contractile power 
not otherwise produced. During the training of athletes 
the diet consists of underdone meat and a small amount of 
bread and vegetables, fluids are restricted, and only a small 
quantity of tea and beer is allowed, all sweets, pastry, 
puddings, entrees, sauces, pickles, and condiments are 
strictly forbidden. This diet, accompanied with exercise, 
will in about the space of six weeks reduce all superfluous 
fat, and give the muscles firmness, bulk and great contrac- 
tile power. 

Meat necessary for continuous exertion. — In countries 
where continuous physical exertion is the necessity of life, 
man has generally discovered for himself, wathout the 
teaching of science, the great value of a tneat diet. Thus, 
in the limitless plains of the Pampas, which can only be 
traversed on horseback, the Indians have learnt by experi- 
ence that meat alone will give them the muscular force to 


gallop all day long. Sir P'rancis Head, in his account 
of his "Journeys Across the Pampas," tells how he 
could not stand the fatigue of constant galloping, but 
was obliged, after five or six hours' riding, to rest in a 
carriage, till he had adopted the diet of the Indians, and 
lived on beef and water. " But after," he says, " I had been 
riding for three or four months, and had Hved on beef and 
water, I found myself in a condition which I can only 
describe by saying that 1 felt no exertion could kill me." 
Vegetable feeders may be and are capable of great feats 
of strength ; but the capacity to endure prolonged physical 
exertion belongs to the meat-eater. The gentleman may 
dispense with butcher's meat without harm ; the navvy and 
miner require beef and mutton. In fact, in this topsy-turvy 
world the under-fed are the poor working men, who need 
food whereby to work, and the over-fed are the well-to-do 
middle-aged, who should be abstemious in order to enjoy 
the good things with which their lives abound. A com- 
munity of goods might be to the benefit of both. 

Brain-workers should live sparingly if they would work 
well and live long. Their force is required for mental 
exertion, and should not be expended on the task of 
digestion, for "they should remember that the digestion of 
heavy meals involves a great expenditure of nerve force". 
Besides fish, eggs, milk, and light porous well-made bread, 
fresh vegetables and fruit should form their chief sustenance. 
They should take onl^ a small amount of butcher's meat, 
and that especially at those times when they are able to 
take more physical exercise. Some animal fat is, however, 
useful, such as fresh butter or cream, or a rasher or two of 
fat bacon at breakfast (Burney Yeo). 

Women, whose bodies are smaller and whose energy is 
less, require, as a rule, less food than men ; but the same strict 
dietetic rules cannot be adopted by them as by the other sex, 
for during menstruation, pregnancy, and lactation, demands 
are made on their physical and nervous systems which can 
only be met by a more abundant food supply specially rich 


in albuminoids. Their diet must, therefore, be regulated 
more or less by the varying circumstances of their physical 
condition. Women, however, who lead sedentary lives — 
and they are the great majority — must remember that a 
dietary of which meat, eggs, and milk form a large part, is 
not conducive to health ; while, on the other hand, if obesity 
is to be avoided, farinaceous and saccharine foods must be 
taken with precaution. The healthful thing to do is to 
lead an active and unselfish life, on a moderate diet, 
sufficient to maintain streneth and not to increase weight. 



The Food and Feeding of the Aged. 

It may seem hard that the man who in youth has known 
the pinch of poverty, who remembers how the cut of 
mutton, with a supply of potatoes and greens, scarcely 
sufficed for a vigorous appetite, should find that in the 
prosperity of later life an eight-course dinner of delicacies 
fails to tempt him ; but that, nevertheless, his physician 
warns him that the attack of gout from which he is suffer- 
ing means that he is eating too much, and that his diet 
must be lowered. Is life, then, never to give satisfaction ? 
Must youth always know desire and old age satiety? 
Must the poor muscle-worker never have enough food to 
give energy to his frame, and must the rich idler have so 
much to eat that disease is the consequence ? To find the 
happy mean, to live according to sweet reasonableness and 
knowledge, is the aim of the teachings of science, and if to 
these are added the principles of Christian communism, 
the wealth of later life will not lead to self-indulgence, but 
to the mitigation of the sufferings of those who want the 
means of life. Of this result, all know many splendid 
examples. I recall one of a gentleman, now in possession 
of a very large income, who told me that in his youth he 
lived on a salary of los. a week. He early made up his mind 
that to eat little and drink less would be his rule in life. To 
this resolution he has adhered, though fortune has come to 
him. Nearly an octogenarian, he is still a man of untiring 
vigour of body and mind. Simple in life, he dispenses his 


great fortune as a custodian for his Master, while Hving 
amid the refinement and cultured surroundings proper to 
an EngHsh gentleman. 

In advanced life tissue change is slow, digestion is less 
active, and the ability to assimilate food is greatly diminished. 
As middle age is passed and old age approaches, the in- 
take of food, particularly of nitrogenous and fatty foods, 
must be steadily diminished. Sir Henry Thompson, who 
has written forcibly on this subject, says : " As we increase 
in age, less energy and activity remain, and less expenditure 
can be made, less power to eliminate at fifty than at thirty, 
still less at sixty and upwards. Less nutriment must, 
therefore, be taken in proportion as age advances, or rather 
as activity diminishes, or the individual will suffer. If 
he continues to consume the same abundant breakfasts, 
substantial lunches, and heavy dinners, which at the sum- 
mit of his power he could dispose of almost with impunity, 
he will in time either accumulate fat, or become acquainted 
with gout and rheumatism, or show signs of unhealthy 
deposit of some kind in some part of the bod)', processes 
which must inevitably empoison, undermine, or shorten his 
remaining term of life. He must reduce his intake because 
a smaller expenditure is an enforced condition of existence. 
At seventy the man's power is still further diminished, 
and the nutriment must correspond thereto if he desires 
still another term of comfortable life. And why should he 
not ? Then at eighty, with less activity, there must be 
still less ' support '. And on this principle he may yet 
long continue to live." ^ 

The kinds of food which the elderly should particularly 
diminish are the nitrogenous and fatty varieties. Growth 
has ended, tissue change is slow, the energy which induced 
activity is gone, and nitrogen is no longer required to 
build up, after the ceaseless wear and destruction of the 
body. To persist in taking nitrogenous or meaty foods 
after middle age is passed, is to throw a burden on the 
^ Diet in Relation to Age and Activity. B}- Sir Henry Thompson. 


kidneys which they are not able to bear, and the diseases of 
gout, rheumatism, renal cirrhosis, and apoplexy are the result. 

In old age, the power of fasting is not so great as in 
earlier life ; and the meals, while being smaller, should 
therefore be more frequent, the intervals between them 
being short. A small amount of alcohol with food is also 
often beneficial to the aged. The long fast of the night, 
during which sleep is not sound, is ill borne, and a glass 
of milk, or a cup of beef tea, may often be taken in the 
night with advantage. It is difficult to lay down any 
fixed rules for the dieting of the old, for age is not accord- 
ing to length of years, but to the number of infirmities. We 
all know men of seventy-five who are as active, physically 
and mentally, as others of sixty. Sir Henry Thompson's 
rule is the best, namely, to diminish the intake of food as 
activity diminishes. As age increases, let the quantity 
taken be less, and let fish and poultry take the place of 
butcher's meat, and farinaceous foods of highly-flavoured 
dishes. Saccharine will be found a useful substitute for 
sugar, and cream for oily fatty foods. A nourishing 
stimulant to be highly recommended, and which may be 
taken between meals, is an ounce of dry cherry brandy 
mixed with a wineglassful of cream. 

Centenarians. — Sir George Humphry has investigated 
the life-histories of centenarians in England, with the view 
of ascertaining the causes and circumstances of longevity. 
The report w^as published by the Collective Investigation 
Committee of the British Medical Association in 1887. 
As one reads of the habits and lives of these men and 
women who attained to the age of one hundred years and 
more, one is struck b}- the fact, that the}- were almost in- 
variably lean people, of spare habit, and of great modera- 
tion in eating and drinking. Of thirt\'-seven, three took 
no animal food, four took very little, twenty a little, ten a 
moderate amount, and only one acknowledged taking 
much meat. With regard to alcohol, the returns are 
much the same, and abstemiousness is found to be the 


rule of life of these centenarians. Fifteen had been total 
abstainers, either during the whole or part of their lives ; 
two took very little alcohol, twenty-two a little, and ten a 
moderate amount. Sir George Humphry's interesting and 
valuable collection of facts regarding centenarians con- 
firms opinions which have been held from time to time by 
various persons, in opposition to the generally accepted 
view that as age increases and strength diminishes, food 
should be more stimulating and strengthening. 

Cornaro's precepts and practice.— The most remark- 
able of these persons was Cornaro, an Italian nobleman, 
who lived in the fifteenth and sixteenth centuries, and 
who attained the age of upwards of a hundred years. He 
seems in middle life to have suffered from dyspepsia, 
brought on by over-indulgence ; for he says that he had 
"fallen into different kinds of disorders, such as pains in 
my stomach, and often stitches, and spices of the gout, at- 
tended by, what was ahnost still worse, an almost continual 
slow fever, a stomach generally out of order, and a per- 
petual thirst." At the age of forty, he decided that 
abstemiousness and regularity should be the order of his 
life, instead of the previous course of indulgence in eating 
and drinking, which was surely driving him to his grave. 
He kept his resolution for a year, at the end of which time 
he declared himself free of all his complaints. He states 
that his rule was to take as much food and wine as would 
check appetite without completely satisfying it. " I ac- 
customed myself," he says, " to contrive matters so as 
never to cloy my stomach with eating and drinking ; but 
constantly to rise from the table with a disposition to eat 
and drink still more. . . . What with bread, meat, the 
yolk of an egg, and soup, I ate as much as weighed in all 
12 oz., neither more nor less. I drank in all 14 oz. of 
wine." Cornaro lived on this meagre diet to a vigorous 
old age. He wrote several treatises on the subject of diet, 
urging others to follow his example ; one of these was 
written when he had attained the age of ninety-five, and 
shows that he was in full possession of his faculties. 



Dishes for the Aged. 

After having insisted, as I have done, upon the necessity 
of diminishing the intake of food, particularly of albuminous 
foods, in old age, it will not, I think, be out of place if I give 
a few recipes to show how the aged may be well fed on 
a light diet. Fish and poultry should take the place of 
butcher's meat. Besides the ordinary methods of boiling, 
frying and baking fish, soups and delicate dishes may be 
made of fish, which will be found to be not only appetising 
but satisfying to those on whose muscular powers but slight 
demands are made. Fish contains a third less of albumi- 
noids than ordinary meat, and is hence very suitable as an 
article of diet for the old. Sir Henry Thompson, to whose 
scientific and practical studies on food we owe so much, 
points out that, besides the well-known sole, turbot, salmon, 
whiting, haddock, mackerel, cod, trout, smelt, herring, skate, 
and mullet, there are other kinds of fish admirable for food, 
which yet are almost totally neglected by the British 
housewife. These are the wolf-fish or cat-fish, the halibut, 
sea bream, bass, gurnet, ling, hake, thornback, pollock, and 
coal-fish, to which may be added the conger, excellent for 
making soups and stews, and the sturgeon (of which the 
flesh approaches that of meat in quality). The following 
are Sir Henry Thompson's recipes for fish soup : — 

I. Put three ounces of butter into a stewpan, add two carrots 
sliced, one onion, and a shalot in thin shces, then cloves, a little 
thyme, and some parsley. Frj' them gently until of a reddish tint, 
then add three pints of cold water. Let it boil, skimming occasion- 


ally. Then add a small fresh haddock, bones and all, cut up into 
pieces, and the head and bones of two whitings, setting aside the 
fillets; a cod's head or that of a turbot, or the fresh bones, head, and 
fins of two large soles, the fillets of which are required for another 
dish, may take the place of the foregoing. Add some salt and a little 
pepper. Let all simmer together for two hours gently at the corner 
of the fire ; take out the bones, and pass all the rest through a coarse 
strainer. Divide the fillets of whiting into two or three small portions 
each ; boil for a few minutes in some of the stock, add a little fresh 
green chervil and parsley chopped not too finely, and serve all 
together in a tureen. This soup may be thickened if desired by add- 
ing a tablespoonful of white " roux," that is a little flour well mixed 
with butter in a stewpan over the fire, cooked but not allowed to 
brown. This is unquestionably an improvement. Fillets of other 
fish may be substituted for those of the whiting, or a few shell fish or 
oysters if they are well digested. 

The following is the receipt for an economical fish 
stew : — 

2. Take three or four pounds of hake, ling, skate, or haddock, and 
one pound of " cuttings or trimmings," which are the best part of the 
fish for stock making. Remove all the fish from the bones, break up 
or pound the latter, and set aside with any portion of head there may 
be and the cuttings. Put into a saucepan over the fire two ounces of 
lard and two or three onions sliced, and let them fry until brown ; 
then add two quarts of water and all the pounded bones and trimmings, 
some parsley or other green herbs, pepper and salt. Let the whole 
simmer for three hours, adding the amount of water lost by evapora- 
tion. vStrain out the bones, bits of skin, etc., add the fish in pieces, 
and boil gently ten or fifteen minutes. Thicken with sufficient flour 
mixed smoothly with a small portion of stock, and added before 
finishing. In order to make the dish complete and substantial a few 
small suet dumplings should be well boiled and put into the tureen. 

Stewed Cod. 

Have ready some boiling water in a saucepan and put a little salt 
in it. Take a slice of cod about an inch thick and half a pound in 
weight. Clean it and put it into the boiling water and let it boil 
gently for five minutes ; then lift it out and let it drain. Have ready 
heated in a stewpan one gill of veal gravy or good broth. Put the cod 
in this and stew it for five minutes ; then add a tablespoonful of very 
fine bread crumbs, and let it simmer for three minutes. Mix a tea- 


spoonful of arrowroot and half a teaspoonful of anchovy sauce, with a 
dessertspoonful of sherry, and a teaspoonful of lemon juice, and stir 
it well into the gravy. Boil all together for two minutes, then lift 
the fish out carefully with a fish slice. Pour the sauce over it and 
serve it quickly. Half a dozen oysters, bearded and added with their 
strained liquor two or three minutes before the cod is taken out of 
the stewpan, improve this dish. 

Haddock Pudding. 
Boil a haddock weighing about one pound for about ten to fifteen 
minutes in boiling water with a little salt and a tablespoonful of 
vinegar. Remove all the skin and bones, and cut the fish in small 
pieces. Boil half a pound of potatoes in salt and water until they 
are soft, then rub them through a sieve and mix them with the fish. 
Add one raw egg, an ounce of butter, and a little pepper and salt. 
When thoroughly mixed make the compound into any shape preferred ; 
put it into a buttered tin and bake it until it is of a golden colour. 
Serve the pudding with egg sauce made as follows : Mix one ounce 
of butter with one ounce of flour in a saucepan over the fire. Add 
gradually one gill of the water in which the haddock was boiled, and 
one gill of milk. Stir over the fire for ten minutes ; then add two 
hard-boiled eggs which have been cut into very small dice, and a 
few drops of lemon juice. Pour this sauce round the fish pudding. 

Macaroni and Fish. 
Cut a quarter of a pound of well-boiled macaroni into small 
pieces. Take away the skin and bones of a quarter of a pound of 
cold boiled fish. Mix the macaroni and fish well together, with a 
little pepper and salt, half a pint of good fish or chicken broth, and 
one ounce of butter. Put the mixture into the oven, and when it is 
quite hot and brown it will be ready to serve. 

Warm in a saucepan, stirring all the time, a quarter of a pound 
of cooked fish, a quarter of a pound of rice after it has been boiled, 
and one ounce of butter. Beat up one egg, with a little pepper and 
salt. Add it to the fish and rice, and cook altogether for two 
minutes. If it be too stiff, add a little milk. 

The Pot-au-Feu. 
The pot-au-feu as prepared in France is savoury and 
nutritious. The following recipe is adapted from Le 
Livre de la Cuisine, by T. Gouffe : — 


In a tin-lined iron or copper pot, place about two pounds of the 
leg or shoulder of beef, and half a pound of bones broken into frag- 
ments, in four quarts of cold water. The bones should be put in 
first, then the meat tied up to preserve its shape, add one ounce 
of salt, place the pot over a steady clear fire which will give a con- 
stant gentle heat, bring the water to the boil and skim carefully. 
As soon as the scum rises pour in a little cold water ; let the water 
boil three separate times, skimming each time. Then add the 
vegetables, which should consist of a pound of cut carrots, onions, 
and turnips, half a pound of leeks, an ounce of parsnips, half an 
ounce of celery, and three cloves stuck in an onion. The throwing 
in of the vegetables will temporarily check the boiling. As soon as 
the water is brought to the boil again, draw the pot aside and place 
it on a spot on the fire or the hot plate where it will simmer gentl}' 
and steadily for three hours. The vegetables should be left only 
just long enough in the broth to cook them. When done the meat 
is withdrawn, and while still on the fire the broth is freed perfectly 
from grease. In France this thoroughly-boiled beef is eaten as a 
separate dish, either hot with the vegetables, or cold served with 
oil and vinegar. The broth is frequenth' served with croutons of 
toast, or with the leaves of boiled spring cabbage floating in the 

Sweetbread Soup. 

Boil a pair of sweetbreads for five minutes with a little water ; 
skin, trim, and boil them gently in one and a half pints of white 
stock, with a bouquet of herbs, a piece of celery, or as much celery 
seed as will lie on a threepenny piece, and a shred of mace, until 
they are quite tender. When they are quite soft either pass them 
through a hair sieve or chop them finely. Remove the herbs, add 
a little pepper and salt, a few drops of lemon juice, and a gill of 

Brunoise Soup. 

Take one young carrot, half a young turnip, two leaves of celery, 
a little of the flower of a boiled cauliflower, one onion, one ounce of 
butter, one pint of water in which the cauliflower was boiled, one 
pint of milk, one teaspoonful of salt, pepper, and two ounces of 
stale bread toasted. Stew the ingredients, except the toast, to- 
gether for one hour ; then break the toast in pieces, add it to the 
rest and stew all together for another hour. Pass all through a 
sieve and return it to the stewpan to get hot. 

Maigre Soup. 
Shred one pound of potatoes, and put them with one leek, one 
onion, and one ounce of butter into a pint of boiling water in a stew- 


pan. Boil until the vegetables are soft, then pass them through a 
sieve, adding a pint of hot milk to help them through. Put all into 
the stewpan, and stir until it boils, then sprinkle in one tablespoon- 
ful of Groult's tapioca. Boil until the tapioca is clear; flavour with 
a little ground mace, pepper and salt, add a little lemon juice, and 
a tablespoonful of chopped parsley. 

Steamed Asparagus. 

Trim the asparagus, then steam it by putting it in a jam-pot 
nearly filled with boiling water, placed in a large saucepan half full 
of boiling water and tightly covered. The asparagus will take 
nearly an hour to cook in this manner. Serve with it a sauce made 
of one ounce of butter melted over the fire, one tablespoonful of 
cream, the yolk of an egg, and five drops of lemon juice. Stir the 
mixture in an enamelled saucepan over the fire for three minutes. 

Apple Snowballs. 

Boil half a pound of the best rice in boiling water for fifteen or 
twenty minutes. Strain it and spread it on floured cloths. Peel 
and core one or two apples and put them on the rice. Sprinkle over 
them sugar and a little lemon juice, then cover each one entirely 
with rice, tie the cloths, and boil them for an hour. 

For many of these practicable recipes I am indebted 
to that excellent and valuable manual, The Art of Feed- 
ing the Invalid} They might be multiplied indefinitely. 
The principle to be remembered is that the food of the 
aged should be light, farinaceous, and easily digested. 
Among things to be recommended, I might mention also 
all kinds offish, rice, tapioca, arrowroot, sago, custard, and 
bread and butter puddings, poultry, game, fresh vegetables, 
ripe fruit, omelette, junket, and milk. The food of extreme 
old age compares with that of extreme youth, and for 
toothless age pap is as useful as to the teething babe, nor 
must it be thought that the dentist's art gives the stomach 
the power to digest the strong meats suitable to youth. 

1 Scientific Press, 428 Strand, ]V.C. 



Thinning the Fat. 

The accumulation of fat in the body is a frequent condition 
after the age of forty. Those who have read the previous 
chapters will not be surprised to learn that this accumulation 
of fat is generally due to the intake of food being larger 
than is necessary for the requirements of the body. " Why, 
I am a very small eater, and yet I grow fat," is the indignant 
exclamation ; for there is nothing people resent so much as 
being told that they eat too much. The inexorable fact, 
however, remains that if you grow fat, you either take too 
much food in bulk, or too much food of a certain kind, that 
is of a fattening kind. This excess may be every day ex- 
ceedingly small, and yet in the course of a year, or a series 
of years, it results in transforming a once graceful figure 
into an unwieldy shape, and an active energetic person into 
one to whom movement and exercise are repugnant. Dr. 
Burney Yeo has shown in a very practical way how a large 
accumulation of fat may take place in a few years from a 
very small cause. He instances the case of a person who 
daily takes in excess of his wants half an ounce (about two 
lumps) of sugar. This sugar not being required and burnt 
off is converted into fat, and stored up in his body as such. 
This daily consumption of sugar, and this daily storage of 
fat, will result in one year in increasing the weight of a 
person eleven pounds, and in five years in raising it no less 
than four stones. From this example it is seen how in 
middle age, when metabolism is slow, a small excess of 
fattening foods will lead to obesity by imperceptible 


degrees. It rarely has the same effect in youth, when the 
body is able to consume and get rid of much larger 
quantities of food. There are, it is true, certain cases of 
obesity which are pathological instead of physiological ; 
these are generally associated with anaemia, or with fatty 
degeneration of the heart, leading to imperfect oxidation in 
the tissues, or with hysteria. Such cases are not within the 
range of this work, and should be treated by the physician. 
Treatment.— In the treatment of ordinary obesity there 
are certain definite principles to be followed. 

1. To oblige the body to feed for a while on itself, and 
to consume its own fat ; 

2. To prevent the re-accumulation of fat. 

Both these conditions can be accomplished by diet. 

Before commencing the dietetic treatment of obesity the 
patient should undergo a careful physical examination by a 
physician to ascertain if the organs, particularly the heart 
and kidneys, are sound. Some of the systems in vogue 
for reducing fat tax these organs severely, and if there 
are any signs of incompetency or disease of the heart or 
kidneys, the system adopted should be modified accord- 
ingly. It will be remembered, that when explaining the 
action of hydro-carbons and carbo-hydrates in the body^ 
it was stated that carbo-hydrates — i.e., starchy and sugar 
foods — are the substances out of which adipose tissue is 
manufactured ; but that, as in the case of fattening pigs, the 
production of fat in the body is much more rapid if fatty 
foods are taken in combination with starchy foods. Thus 
it was shown that pigs fatten much more rapidly on meal 
and greasy pig-wash than on meal alone. From these facts 
we infer that the ordinary mixed diet of adults, consisting 
of meat, fat, and farinaceous foods, is, after the period of 
youth and activity is passed, liable to cause an excessive 
deposit of fat. The indication is, therefore, to cut off the 
farinaceous foods, and, according to some authorities, to cut 
off the fatty foods as well. It is not, however, sufficient to 
reduce the consumption of fatt}- and farinaceous foods ; the 


intake of food, and more especially of fluid food, must be 
reduced generally. It is useless for the fat person to sa\' : 
" I will not diet myself, I will take more exercise". If he 
increases exercise he will probably increase appetite, and 
consequently the intake of food. He must increase exercise 
and decrease the intake of food, being willing to suffer even 
for a time the pangs of hunger until the body learns to feed 
upon itself and habit has modified appetite. 

There are three typical and well-known methods of 
treating obesity. — One has a wide popularity, and is 
known by the name of its inventor, Banting. This system 
consists in increasing the amount of albuminous or meat 
foods, and of greatly decreasing both the fat and starchy 
foods. The second is that advocated by Ebstein, the 
German physician, in which the albuminous foods are 
greatly diminished, and the starchy foods still more so, 
but the amount of fat taken is normal. The third is that 
practised by Oertel, in which the albuminous foods are 
increased, and the fats and carbo-h}^drates reduced to 
about a fourth of the normal. ^^.11 the methods agree in 
one particular, that is, in reducing the total bulk of the food 
taken. Thus, while the normal amount of food consumed 
by a healthy man will amount in grammes to 6i8, Banting 
would reduce this to 260, Ebstein to 235, and Oertel to 
280. The following table (taken from Dr. Burney Yeo's 
booky clearly states the kind and quantities of food al- 
lowed : — 

Albumiiiates. Fats. hydrates. 

Normal average of grammes 130 ... 84 . . 404 

Banting 170 ... 10 . . 80 

Ebstein 100 ... 85 . . 50 

Oertel 155 179 . . . 25"40 . . 70-10 

The Banting regime was as follows : — 

Breakfast, at 9 a.m., to consist of 5 to 6 oz. of animal food — 
meat (except pork and veal) or boiled fish ; a little biscuit, or i oz. 
of dry toast — 6 or 7 oz. of solids in all. A large cup of tea or coffee 
(without milk or sugar) — 9 oz. of liquids. 


Dinner, at 2 p.m. — Fish or meat (avoiding salmon, eels, herrings, 
pork, and veal), 5 to 6 oz., or any kind of poultry or game. Any 
vegetables, except potato, parsnips, beetroot, turnips, or carrot. 
Dry toast, i oz. Cooked fruit, unsweetened. Good claret, sherry. 
or Madeira, 10 oz. Total of solids, 10 to 12 oz. 

Tea, 6 p.m. — Cooked fruit, 2 to 3 oz., a rusk or two ; 2 to 4 oz. 
of solids ; 9 oz. of tea without sugar or milk. 

Supper, 9 p.m. — Meat or fish, as at dinner, 3 to 4 oz. Claret 
or sherry and water, 7 oz. 

On this diet Mr. Banting reduced himself in one year 
from 14 St. 6 lb. to 11 st. 2 lb. There is, it will be noted, 
the greatest possible limitation of carbo-hydrates and fats, 
they being reduced from the normal of about 500 to less 
than 100. The large amount of meat taken in the Ban- 
ting regime is extremely distasteful to some people, and in 
the cases where the kidneys are not healthy, or where 
there is a tendency to rheumatism, this severe dietary 
may be actually injurious. 

The Ebstein regime is based on the theory that it 
is the starchy and saccharine foods, not the fats, which form 
fat, and that it is not necessary to reduce the latter. In fact, 
Ebstein contends that the ingestion of fat is useful in curing 
obesity, if combined with a greatly reduced food supply in 
albuminates and carbo-hydrates, as fat abates appetite and 
diminishes thirst. About half the usual amount of meat is 
allowed. As seen from the following dietary the Ebstein 
diet is very meagre, although it does contain butter and 

Breakfast (6 a.m. in summer, 7*30 in winter). — White bread, 
well toasted (rather less than 2 oz.) and well covered with butter. 
Tea, without milk or sugar, S or g oz. 

Dinner, 2 p.m. — Soup made with beef marrow. Fat meat with 
fat gravy, 4 to 5 oz. A moderate quantity of one of the vegetables 
allowed, namely, asparagus, spinach, cabbage, peas, and beans. 
Two or three glasses of light white wine. After this meal a large 
cup of tea, without milk or sugar. 

Supper, 7-30 p.m. — An egg, a little roast meat with fat, about an 
ounce of bread well covered with butter, a large cup of tea, without 
milk or sugar. 


In the Oertel system the maintenance of the general 
health is carefully considered while the fat of the body is 
being reduced. Steady walking exercise to strengthen the 
muscles of the heart is insisted upon, and walking slowly 
uphill and going upstairs are especially advocated. The 
quantity of fluid drunk is diminished, while perspiration is 
promoted by baths ; the normal condition of the blood is 
maintained, and wasting of the muscles prevented by an 
albuminous diet. The diet may be as follows : — 

Morning. — One cup of coffee or tea, with a little milk, altogether 
about 6 oz. Bread, about 3 oz. 

Noon. — 3 to 4 oz. of soup ; 7 to 8 oz. of roast or boiled beef, 
veal, game, or not too fat poultry, salad or a light vegetable, a little 
fish (cooked without fat) if desired, i oz. of bread or farinaceous 
pudding (never more than 3 oz.), 3 to 5 oz. of fruit, fresh preferred, 
for dessert. It is desirable at this meal to avoid taking fluids ; but 
in hot weather, or in the absence of fruit, 6 to 8 oz. of light wine may 
be taken. 

Afternoon. — The same amount of coffee or tea as in the morning, 
with at most 6 oz. of water ; i oz. of bread occasionally. 

Evening. — One or two soft-boiled eggs, i oz. of bread. Salad 
and fruit; 6 to 8 oz. of wine, with 4 or 5 oz. of water. 

It will be noticed that fluid is either forbidden at meals 
or taken in very small quantities. There is no doubt that 
taking soup and large quantities of fluid with food increases 

Dietetic rules. — None of the rigid dietaries given above 
could be followed by all persons alike ; the amount of food 
necessary for a large active person would be excessive for 
one of small stature and indolent habits. Each case must 
be treated more or less on its merits, remembering always 
that there are certain broad principles to be followed. De- 
crease the total amount of food taken, and strictly limit 
the amount of drink ; cut off all sugar, beer, and spirits ; 
eat no potatoes, bread, puddings or pastries ; skim all 
milk, take no soups or fancy dishes ; take a fair amount of 
roast or boiled meat, with fish, game, poultry, and eggs. 


as well as vegetables and fruit. Take steady exercise, and 
promote the action of the skin. 

The Carlsbad regime. — A little personal experience 
may be useful after so much theory, and it may be inter- 
esting to my readers who suffer from too great an abund- 
ance of fat to learn how I put theory into practice and 
reduced my weight 15 lbs. in three weeks. This result 
was obtained at Carlsbad, and the regime was as follows : 
Rose at six, took three tumblers of hot Sprudel water, 
walking for about twenty minutes between each glass. 
Breakfast at eight, consisting of one or two small crescents 
of bread and a boiled egg. On alternate mornings a vapour 
bath with cold douche, or general massage of the body. 
Dinner at one o'clock, consisting of a small amount of fish 
and meat, or poultry, with green vegetables ; no potatoes 
or sweets. In the afternoon a walk of from six to eight 
miles up the hills in a flannel dress. Supper at seven, con- 
sisting of a poached q%^, or a small cut of cold meat. There 
is no doubt that I suffered from constant hunger on this 
limited diet ; but under it my weight steadily diminished, 
and a feeling of lightness and well-being took the place of 
previous heaviness. Continuing the diet after I left Carls- 
bad, I lost another six pounds, and it was some years 
before the tendency to increase in weight showed itself 
a^ain. I am quite certain that no one need fear becoming 
a ponderous size, a source of discomfort to themselves and 
of disagreeable impressions to others, if they checked the 
beginning of obesity by suffering the small inconvenience 
of submitting to a restricted diet for a time. 




Fattening the Thin. 

There is no doubt that in spite of the controlHng influence 
of diet, some persons have a tendency to grow fat, and that 
others either become or remain thin. It is more difficult to 
make a person thin by nature grow fat, than to reduce a fat 
person. The articles of food — the butter, cream, puddings, 
and sweets — which are eliminated from the dietary of the 
fat, may be greatly increased in the dietar}' of the thin, often 
without making any marked difference in their condition 
and weight. By a strange perversity of nature also the 
thin person frequently dislikes the food that would make 
him grow fat. It is probable, moreover, that the greater 
activity of the spare body keeps it thin. 

When, however, thinness becomes progressive, and 
approaches emaciation, and is moreover associated with 
anaemia, weakness, and that group of nervous symptoms 
known under the name of hysteria, it may be very success- 
fully treated as a symptom of a disease of nutrition. 

The Weir-Mitchell treatment. — This system of treatment 
consists in rest, isolation, over-feeding, passive exercise or 
massage and electricity, and is known by the name of its 
founder. Dr. Weir-Mitchell. The patient is taken from 
home and strictly isolated from friends and family ; she is 
put to bed, and in extreme cases is not even allowed to sit 
up in bed, but is fed by a nurse. The patient should be 
weighed before being put to bed, and should be weighed at 
frequent intervals during the treatment. She is first placed 
on a milk diet, and for the first day or two from three to 


four ounces of milk are given every two hours. The milk 
may be slightly warmed, and if it is particularly distasteful 
to the patient it may be flavoured with a little tea or coffee. 
The quantity of milk taken is gradually increased, and the 
intervals lengthened to three hours, till at last two quarts 
are taken in the twenty-four hours. This rest in bed and 
the simple milk diet " nearly always dismisses," says Dr. 
Weir-Mitchell, "as if by magic, all the dyspeptic conditions" 
from which the patient had previously suffered. The circu- 
lation is at the same time stimulated, and the muscles 
undergo passive exercise by being kneaded by massage and 
moved by electric currents. The bowels are carefully 
regulated. After from four to seven days a little solid food 
is taken, namely, bread and butter for breakfast, and a milk 
pudding for dinner. A day or two later, fish and chicken 
or a mutton chop are added, first either at the mid-day or 
evening meal, and then at both. In about ten days the 
patient is put on three full meals daily, and the diet is as 
follows : — 

Milk, sixty to eighty ounces. 

Breakfast, porridge and cream. 

Second Breakfast, cocoa and egg, bread and butter. 

Luncheon, fish, bread, pudding, and milk, or chicken, vege- 
tables, and pudding. 

Dinner, mutton or beef, two or three kinds of vegetables, milk 
pudding, or stewed fruit with cream. 

Extract of malt may be given with one or more of the 
supplies of milk, and in some cases cod-liver oil is also 

Dr. Weir- Mitchell says of this treatment: " No trouble- 
some symptoms usually result from this full feeding, and 
the patient may be made to eat more largely by being fed 
by her attendant ; " and as to the beneficial effect, he says : 
" I have watched again and again, with growing surprise, 
some listless, feeble, white-blooded creature learning by 
degrees to consume these large rations, and gathering 
under their use flesh, colour, and wholesomeness of mind ". 


Tonics are also given in rather full doses, iron, arsenic, and 
sulphate of strychnine. Where there is no alcoholic habit 
to break, a small daily dose of whisky or wine is found to 
assist in the decrease of fat. As the diet is increased and 
maintained at its highest point, it is necessary to carefully 
watch the urine, and if an excess of urates is found, it is 
an indication that the amount of food must be reduced. 

At the end of five or six weeks the patient will be 
found to have gained considerably in weight and strength, 
and the muscles to have become firmer and fuller. The 
massage can then be decreased, and normal exercise on 
foot allowed. The excessive diet is also slowly reduced ; 
the quantity of the milk is first lessened, then the inter- 
mediate meals are dropped, and gradually the patient 
returns to a normal, active, open-air life. The cure may 
be completed by a sea voyage or a foreign tour ; and the 
patient, once restored to health and family, and to a life 
of interest and usefulness, rarely relapses. The following 
cases will illustrate the treatment and its results : — 

Under Dr. Weir-Mitchell. 

Mrs. C. Kept in bed and fed by an attendant. 

First day. — One quart of milk in divided doses every two hours. 

Second day. — Cup of coffee on waking. Two quarts of milk in 
divided portions every two hours. 

Third to sixth day. — Same diet. 

Seventh, eighth, and ninth days. — Same diet, with a pint of 
raw soup in three portions. 

Tenth day. — 7 a.m., coffee ; 7*30, half-pint of milk ; 10 a.m., ditto ; 
noon, 2, 4, 6, 8, and 10 p.m., ditto; soup at 11 a.m. and 5 and g p.m. 

Fourteenth day. — Egg and bread and butter added. 

Sixteenth day. — Dinner added and iron. 

Nineteenth day. — The entire diet was as follows : 7 a.m., coffee ; 
8 a.m., iron and malt extract ; breakfast, consisting of a chop, bread 
and butter, a tumbler and a half of milk; 11 a.m., soup; 2 p.m., 
iron and malt ; dinner of anything she liked, with 6 oz. of Burgundy 
or dry champagne, and at the end one or two tumblers of milk; 4 
p.m., soup ; 7 p.m., malt, iron, bread and butter, usually some fruit, 
commonly two glasses of milk; 9 p.m., soup. 


(At 12 noon massage for an hour; at 4-30 p.m. electricit}^ applied 
for an hour.) 

At sixth week soup and wine were dropped, iron lessened one 
half, massage and electricity onlj- on alternate days. 

At ninth week milk reduced to a quart. All mechanical treat- 
ment ceased. 

Result. — Gain in flesh about face in second week. Weight rose 
in two months from 96 to 136 lbs. ; gain in colour equally marked. 
At ninth week drove out. Cure complete and permanent. 

Under Dr. Playfair. 

A. B., aged ^z. Rest in bed, isolation. 

First day. — 22 oz. of milk in divided doses. 

Second day. — 50 oz. of milk in divided doses. 

Third day. — 50 oz. of milk in divided doses. Massage half 
an hour. 

Fourth day. — 50 oz. of milk in divided doses ; egg and bread 
and butter; 40 minims of dialysed iron in two doses. Massage i^ 

Eighth day. — 50 oz. of milk in divided doses, mutton chop, 
porridge, and a gill of cream ; maltine twice daily. Massage three 
hours, electricity half an hour ; continued to end of treatment. 

Fifteenth day. — Three full meals daily of fish, meat, vegetables, 
cream, and fruit ; two quarts of milk, and two glasses of Burgundy. 

Twenty-second day. — Amount of food lessened. 

Result. — On twenty-second day sat in a chair for an hour ; after 
a month walked downstairs, and went for a drive. Enormous in- 
crease in size. Cure complete and permanent. 

The blood should be examined.— The success of this 
treatment is now estabhshed. Dr. Weir-Mitchell is anxious 
to insist on the fact that increase of weight should corre- 
spond with increased richness of blood. The number and 
colour of the red corpuscles of the blood should be ex- 
amined and estimated during treatment. This is easily 
accomplished by means of the delicate instruments de- 
signed by both Malassezand Gowers for counting the number 
of red corpuscles in a minute drop of blood, and estimating 
the amount of haemoglobin they contain. Dr. Weir- 
Mitchell insists that there is an intimate association 
between the gain and loss of fat, and the gain and loss of 


red blood corpuscles. He therefore finds those cases in 
which these usual conditions are reversed, when there is 
an excessive deposit of fat with a decreased number of red 
blood corpuscles, very intractable and difficult to treat. 
He recommends that in such cases the patient should be 
put to bed, massage should be freely used, and the diet 
restricted to skimmed milk, or to milk and broth free from 
fat. When the weight is lowered, iron should be freely 
given, and by degrees a general diet. The red blood 
corpuscles will be found under this treatment to have 
increased in number, and as the weight diminishes strength 
increases, and health is re-established. 

Dr. Weir-Mitchell gives a case of a lady, aged forty- 
five, 5 ft, 4| in. high, who weighed 190 lbs. (13 st. 4 lbs.). 
She was ansemic, feeble, and breathless. " She was kept 
in bed for five weeks. Massage was used at first once daily, 
and after a fortnight twice a day, while milk was given, 
and in a week made the exclusive diet. Her average 
loss for thirty days was a pound a day, and the diet was 
varied by the addition of broth after the third week, so as 
to keep the reduction within safe limits. . . . After two 
weeks I gave her the lactate of iron every three hours in 
full doses. On the fourth week additions were made to 
her diet list, and Swedish movements were added to 
massage, which was applied but once a day ; and during 
the fifth week she began to sit up and move about. Her 
weight at the seventh week had fallen to 145 lbs., and her 
appearance has decidedly improved. . . . Now, after two 
years, she is a well and vigorous woman." 

The reasonableness of dietetic treatment. — This case 
illustrates the fact that each case should be treated scien- 
tifically, intelligently, and on its merits. It is as futile as 
it is dangerous for the unlearned to prescribe dietetic rules 
for the ailing, the weak, and the obese. " She wants 
support," a sympathetic friend will say of a poor invalid 
suffering from the nausea and weakness of advanced 
Bright's disease, and will proceed to recommend steak and 


port wine, ignorant of the fact that she is thereby increas- 
ing the effete products in the blood of the patient, which 
are the causes of the symptoms remarked. Or another 
will tell of a great reduction in size brought about in him- 
self by a meat diet and mountaineering, and will unhesitat- 
ingly prescribe the same for a fat friend whose pallor and 
lethargy bespeak a fatty heart and perhaps damaged 
kidneys. Dietetic treatment is but reasonable medical 
treatment based on principles or knowledge more scientific 
and accurate as a rule than therapeutic treatment, and it 
should be undertaken or prescribed only after a careful 
study of the causes of the condition complained of 



In the Stomach. 

Having now considered the nature and constitution of the 
various foods which sustain and build up the body, I will 
proceed to describe the methods and processes by which 
they are digested and assimilated. 

Digestion of food in the mouth. — When solid food is 
placed in the mouth, it is masticated or ground by the 
molar teeth. It is at the same time thoroughly mixed 
with the saliva, which is poured out in abundance at the 
moment required, by the salivary glands, the ducts of which 
open into the mouth on the inner side of the cheeks and 
under the tongue. The period of time that the food 
remains in the mouth, subject to mastication and to the 
influence of the saliva, varies with different individuals ; but 
it is well that this period should be as long as possible, in 
order that the food may be completely broken up, and the 
tougher and harder portions rendered fit for digestion in the 
stomach. Besides mastication, the first step in the digestion 
of starch takes place in the mouth. 

Starch is contained in a great number of the vegetable 
foods which are common articles of diet — namely, potatoes, 
flour, peas, beans, etc. In its uncooked condition, it is 
incapable of digestion by man. It exists in the form of 
small granules, composed of concentric layers of material. 
These granules are insoluble in cold water, but on being 
boiled or placed in hot water their outer envelope bursts, 
and the contents swell up, the whole forming an opalescent 


gelatinous mass. In order that starch may be made 
perfectly soluble, so as to pass through the coats of the 
minute blood vessels of the intestines, it is necessary for it 
to be converted into sugar, and, therefore, one of the most 
important acts of digestion is the conversion of starch into 
sugar. This is brought about by the action of a ferment 
or diastase. Such a ferment or diastase is present in the 
saliva, and is called ptyalin. It acts on the starch contained 
in the food, and partially converts it into sugar while 
mastication is going on. 

The mouthful of food, having been thoroughly ground 
by the action of the molar teeth or grinders, and well 
mixed with the saliva, is rolled into a ball or bolus by the 
tongue, and passed, by the act of swallowing, to the back 
of the mouth. It is here seized by the self-acting or in- 
voluntary muscles which form the pillars of the throat, and 
it is passed by their action, and by the rolling upwards and 
backwards of the root of the tongue over the epiglottis, or 
trap-door which closes the opening into the windpipe, into 
the gullet or oesophagus, a long tube which conducts it to 
the stomach. 

Digestion in the stomach. — The stomach is a large, 
hollow, bag-like organ, larger at one end than the other, 
and furnished with strong muscular walls which can con- 
tract in every direction. It is lined inside with a highly 
organised mucous membrane. This mucous membrane 
consists of follicles or glove-like depressions, some of which 
are simple, others divided or branched. The glands of the 
stomach are of two kinds, — mucous glands, which are lined 
with large, clear, rounded cells, that almost entirely fill 
up the central opening of the tube, ^w^ peptic glands, which 
contain large spheroidal and finely granular cells. i^See 
Fig. I.) It is these cells which are supposed to be prin- 
cipally concerned in the secretion of pepsine. The result 
of the action of the two kinds of glands in the stomach 
is that a mucous fluid containing pepsine, and called the 
gastric juice, is abundantly poured out at the moment 



of digestion. By means of the slow, continuous, and 
churning action of the stomach, the food is constantly 

Fig. g.— The Gastric Glands of Man. 

A. Peptic gland of the middle part of the stomach, i. Its excretory duct. 
2, 2, 2. Its three principal branches. 3, 3, 3. Its secondary divisions, in the course 
of which are numerous culs-de-sac all of which are filled with spherical cells. 

B. Peptic gland of the splenic end of the stomach, i. Its extremely short 
duct. 2, 2. Its two principal branches. 3, 3. Numerous culs-de-sac in which 
they terminate. 

C. Mucous gland of the pyloric end of the stomach, i. Its duct. 2, 2. Its 
two main divisions. 3,3,3. Its secondary divisions. 4,4. Small racemose glands 
at their termination. 

rolled from one end to the other and becomes thoroughly 
mixed into a fluid pulp or juice. Unlike all the other 


digestive fluids the gastric juice is acid. It must be re- 
membered, and it will be found to be very important to 
bear in mind, when considering later the question of dys- 
pepsia and its treatment by diet, that there are three chief 
ingredients of the gastric juice, namely, pepsine, free acid, 
and mucus, all of which are necessary in the process of 
gastric digestion. 

The peculiar quality of the pepsine is that it has the 
power of digesting and dissolving substances of an albu- 
minous nature ; the mucus seems to dilute the pepsine, 
and to prevent it from acting too violently, even on the 
coats of the stomach itself, and the free acid — which is 
hydrochloric acid — is necessary in order to enable the 
pepsine to act, for it is only in the presence of a free acid 
that pepsine is operative. Hydrochloric acid has also an 
antiseptic action, and it stops abnormal fermentation by 
destroying the numerous bacilli and minute organisms 
which are swallowed with the food, which if not destroyed 
would flourish in the stomach and give rise to active 

The digestion of albuminous substances. — A large 
part of the food is necessarily composed of albuminous 
substances. They form, as I have shown, the chief con- 
stituents of meat, cheese, milk, and eggs, and are found in 
many vegetable foods, such as peas, beans, lentils, and 
also in wheat and oats. In the condition in which al- 
bumen is introduced into the stomach it is incapable of 
being absorbed by the blood vessels. It must, therefore, 
first be brought into such a condition that it will pass easily 
through the coats of the veins and be introduced into the 
circulation. That albumen in its usual condition will not 
pass through an animal membrane may be proved by 
placing the white of an egg on a bladder tightly stretched 
over a vase quite full of water. The white of Qgg, which 
is pure albumen, will not pass through the bladder into 
the water. If, however, some pepsine and a free acid be 
added, and the whole allowed to stand at a temperature 


of about 100 deg., the albumen will undergo such changes 
that it will pass easily through the bladder, and will be 
found diffused in the water on the other side. The action 
of pepsine and the acids of the stomach is such that in- 
soluble albumen is converted into soluble and diffusible 
albumose ; and in this state it passes through the delicate 
walls of the blood vessels of the stomach, and is conveyed 
by the portal vein to the liver. Owing to the presence 
of hydrochloric acid in the stomach the digestion of starch 
is interrupted as long as the food remains in this organ, 
for the diastase which converts starch into sugar can only 
act in an alkaline medium. The digestion of cane sugar 
is, however, continued in the stomach, where it is converted 
by the action of the hydrochloric acid into glucose or 
grape sugar, in which state it is readily absorbed by the 
blood vessels. 

The time occupied by gastric digestion varies from 
three to four hours. Some articles of food take much 
longer to digest than others. In arranging the diet of a 
dyspeptic, it is important to know which foods are most 
quickly and easily digested in the stomach. 

The process of digestion in the stomach being com- 
pleted, the albumen being turned into soluble albumose, 
the cane sugar into glucose, and a large part of these 
substances having been absorbed direct by the blood 
vessels which ramify on the surface of the stomach, the 
semi-fluid mass passes gradually, and in small quantities 
at a time, out of the stomach through the narrow opening 
of the " pylorus "'. The pylorus is a small circular 
passage or opening, which is closed by strong encircling 
muscular fibres during the process of gastric digestion. If 
the chyme, or partially digested mass, is thoroughly well 
mixed, and there are not any large undigested or irritat- 
ing portions present, the food passes through the pylorus, 
without any feeling of discomfort. If, however, portions 
of food are undigested, the pylorus may refuse to let the 
chyme pass, and the muscles of the stomach, being then 


thrown sympathetically into a state of irritation, may con- 
tract spasmodically, and the food be ejected forcibly from 
the mouth by the act of vomiting. If, on the other hand, 
the stomach has performed its part well, the food passes 
into the duodenum. 



DIGESTION— (coH/nn/(:^f). 

Digestion in the duodenum. — The duodenum is a strong 
muscular tube, about twelve inches in length (whence the 
name), which curves round the head of the pancreas or 
sweetbread. At about the centre of the duodenum will be 
found the orifices of the tube or duct by which the pan- 
creatic juice is poured into the duodenum ; it here becomes 
mixed with the chyme or half-digested food contained in 
the duodenum. 

The pancreas is a glandular organ resembling the sali- 
vary glands in structure. It is concerned in secreting a 
fluid, which has the very important parts to play in the 
digestive process of changing starch into sugar and of 
emulsifying the fats. It has been already stated that it is 
necessary for insoluble starch to be converted into soluble 
sugar before it can pass through the walls of the blood 
vessels. The first step of this process commences in the 
mouth by the action of the saliva, but it is here incomplete, 
and it is stopped altogether as long as the food remains in 
the stomach owing to the acidity of the gastric juice. The 
substance called pancreatine, which forms ten per cent, of 
the pancreatic juice, has the power of almost instanta- 
neously changing starch into sugar. There are various 
forms of sugar, and the kind of sugar into which starch 
is changed by the action of the pancreatic juice in the 
duodenum, is that known as glucose. 

Digestion of fat. — We have now seen how albumen, 
starch and sugar are digested ; but there remains the 
digestion of one other large and important element of the 


Fig. 2. — The Duodenum from in front. 

Fig. 3. — Thf, Duodenum from behind. 

Fig. 2. — I. Superior layer of transverse meso-colon. 2. Second part of duo- 
denum. 3. Inferior layer of transverse meso-colon. 4. Third part of duodenum. 
5. Superior mesenteric vessels. 6. Fourth part of duodenum. 

Fig. 3. — I. The portal vein. 2. Fourth part of duodenum. 3. Head of 
pancreas. 4. Common bile duct. 


food to be described, namely, fat. Fat is not acted upon 
either by the saliva or by the gastric juices, but the instant 
it comes into contact with the pancreatic juice in the 
duodenum it undergoes what is called emulsification. 
Milk is the type of emulsified fat. If a drop of milk be 
examined under the microscope it will be found to consist 
of an immense number of very minute oil globules held in 
suspension in an albuminous fluid. In "setting the milk" 
these oil globules, being lighter than the rest of the fluid, 
rise and form the layer of cream. By the process of churn- 
ing they are still further separated from the albuminous 
and other constituents of milk, and form a pure oily 
substance called butter. In order that the fat foods may 
be brought into a condition similar to that of milk, in which 
they can only be absorbed by the lacteals of the intestine, 
they must be emulsified or broken up into minute oil 
globules. This is effected by the action of the pancreatic 
juice, and fat once so emulsified remains in this condition. 
The digested food in the duodenum is called "chj'le," and 
its reaction is alkaline. 

The liver and the bile. — About the level of the orifice 
of the pancreatic duct in the duodenum is found another 
small opening, which is that of the bile duct. Through this 
the bile is poured into the intestine. The bile is produced 
in the liver. The liver is the largest, the most complex, 
and one of the most important organs of the body. It is 
lodged in the right side, and fills up a large cavity which is 
hollowed for it in the base of the right lung, and bounded 
by the lower edge of the ribs. The liver is composed of 
large, irregularly shaped, flattened cells, which are closely 
covered by an exceedingly fine network of blood vessels. 
One set of these blood vessels is derived from the portal 
vein, and the blood passing through them contains, as 
we shall see when considering the question of absorption, 
a large amount of the products of digestion. The 
minute final radicles of these blood vessels communi- 
cate with another set of radicles, which after ramifying on 


the surface of the Hv^er cells, collect into larger branches, 
and finally form the hepatic vein. The hepatic vein pours 
its contents into the vena cava or large blood vessel 
which conducts the blood to the right side of the heart. 
From this short description it will be seen that the 
products of digestion are brought into close relation with 
the liver cells. The bile arises originally in the interstices 
between the liver cells, and in what are at first wall-less 
canals ; these minute ducts contain an acrid greenish-brown 
substance, known as the bile. The ducts gradually grow in 
size as they run together, and they finally pour their con- 
tents into a strong muscular tube by which they are con- 
veyed to a hollow sack-like body called the gall bladder. 
In the gall bladder the bile is stored for future use. 
At the moment that the food passes into the duodenum 
the bile is slowly poured out from the bile duct into the 
duodenum. This discharge of bile continues during the 
whole process of digestion. 

The uses of the bile. — It is allowed on all sides that the 
bile is a fluid of great importance in the digestive process, 
but what part it actually plays in this process has not yet 
been fully ascertained. Of its uses we are more convinced 
when by some accident, such as the plugging of the bile 
duct by a stone, or when the flow of the bile is diverted 
outside the body by an operation, it ceases to be ex- 
creted into the duodenum. In these cases when no bile 
passes into the duodenum the patient or animal emaciates 
rapidly, and may even die of inanition. As far as we know 
at present the action of the bile is to emulsify the fats in 
the food, and to precipitate or throw down from the chyle 
all the partially digested and undigested particles ; it also 
exercises an antiseptic action on the food-mass in its long 
passage through the intestines. If the bile is deficient or 
is withdrawn entirely, the food undergoes putrefactive 
changes in the intestine, with the production of flatus and 
putrescent odours. 

Digestion in the intestine. — From the duodenum the 


food passes into the small intestine. The small intestine 
measures in the adult male seven and a half \-ards long. 
Throughout the whole of this length its internal surface 
or mucous membrane is closel}- set \\ith small tubular 
glands, called the crypts of Lieberkiihn. These glands, 
which are present in countless millions, secrete and pour 
out into the intestine a watery alkaline fluid. The intestinal 
juice has, though in a much smaller degree, the same 
properties as the more active juices of the stomach and 

~\m ^^f^ ^^.^^^ •, 


Fig. 4.— Tubul.\r Gl.-\nds of the Small Intestine opening on the 


Magnified 40 Diameters. 

I, I. A vertical section of the mucous membrane of the small intestine. 2, 2. 
Tubular glands, their bases resting on the muscular coat, and their mouths 
opening on the free surface of the mucous membrane. 3, 3. Mouths of these 
glands. 4, 4, 4, 4. Villi covering the free surface of the mucous membrane : they 
are here mostly conical, are very large and placed close together. 

pancreas. Thus the processes of digestion are continued in 
a lesser degree throughout the whole tract of the intestinal 
canal. The albumen which has escaped change into 
albumose in the stomach, and the starch which has not 
been converted into glucose by the action of the pancreatic 
juice in the duodenum, slowly undergo those necessary 
changes in the intestines. 

The presence of food in the intestine acts as a stimulant 
to its muscular walls, and slow contraction of the involun- 


tary muscular fibres of these walls takes place, by means 
of which a vermiform movement of the intestine is set 
up, which slowly passes the chyle on towards the large 

The large intestine and its contents.— The opening of 
the small intestine into the large is by a narrow slit called 
the ileo-c£ecal valve. By the time that the chyle enters 
the large intestine, its fluid particles and the large amount 
of intestinal juice thrown out by the crypts of Lieberklihn 
have been absorbed, and it has assumed a pasty consistence 
and has acquired an offensive faical odour. The faeces con- 
tained in the large intestine consist of the indigestible 

Fig. 5.— Tubular Glands of the Large Intestine, Magnified 40 

A. Tubular glands seen sideways and from above, showing their substance and 
their mouths. 

B. The same seen sideways and from below, showing their substance and their 
terminal culs-de-sac. 

remnants of the food, and various excretory materials 
thrown into the alimentary canal during the process of 
digestion. The undigested substances are the woody and 
fibrous parts of vegetable food, the elastic fibres and tissues or 
gristle and the insufficiently cooked parts of animal food. 
This collection of excrementitious materials, being of no 
use whatever to the economy, is gradually passed along the 
large intestine, and is thrown out of the body by the rectum. 



DIGESTION— (continued). 

Absorption — Excretion. 

Absorption by the veins of the stomach. — The absorption 
of fluids by the minute radicles of the veins of the stomach 
is so rapid that in cases of poisoning by hydrocyanic acid, 
death occurs in a few seconds. There is no doubt that 
the gastric juice which is poured out in such large quantities 
during the process of digestion in the stomach is absorbed 
together with the albumose, the dissolved salts, and the 
sugar derived from the food. In this way the system is 
relieved from the excessive drain which would be thrown 
upon it, if the whole of the gastric juice required for the 
digestion of a meal had to be manufactured and thrown 
out anew each time. The absorption of the gastric juice 
secreted in the process of absorption, in conjunction with 
the soluble albumoses or peptones, is one of the most im- 
portant things to remember in the dietetic treatment of 
dyspepsia ; for, if we could succeed, by means of the rapid 
absorption of fluids by the veins of the stomach, in pro- 
viding the peptic glands with the material out of which to 
manufacture pepsine, the digestive process could be im- 
mediately aided in cases of atonic dyspepsia. 

Absorption from the intestines.— The villi and lacteals. 
— If a portion of the small intestine of any vertebrate 
animal be opened, washed, and floated in water, its internal 
surface will be seen to resemble that of velvet, and to be 
covered with a countless number of minute projections, or 
vz7h' (Fig. 6). I have already stated that the mucous mem- 
brane of the small intestine consists of a vast number of 


tubular depressions or glands. It is between these glands 
and on their edges or surfaces that the villi of the intestine 
project. It will thus be seen that the area of the internal 
wall of the intestine is enormously increased by the alter- 
nate dippings and elevations of its surface. The part 
which folds in or dips, forming the tubular glands, is con- 
cerned in secretion, and the part which is elevated, forming 
the villi, is concerned in absorption. The construction 
of a villus is as follows (Fig. 6) : In the centre is found 
an inverted tube or canal, closed at one end, the walls of 
which are formed of thin transparent epithelial cells ; this 
is the blind end of a lacteal. Closely covering it is a fine 
network of extremely small blood vessels. The external 
surface of the villus is lined with a single layer of columnar 
epithelial cells closely set together. 

Absorption of fat by the lacteals takes place in the 
following manner : The minute globules of fat which have 
been emulsified by the action of the pancreatic juice, the 
bile, and the intestinal juice, pass through and between 
the epithelial cells which form the outer lining of the villus, 
and also through the transparent thin wall of the lacteals. 
The lacteals communicate with a fine network of lym- 
phatic vessels which ramify on the surface of the 
mesentery, or membrane to which the intestines are 
attached. Along these vessels, which are abundantly 
provided with valves to prevent a backward current, the 
oil globules, absorbed from the digested food, slowly pass, 
till gathered into a larger vessel called the thoracic duct. 
This duct passes upwards beside the vertebral column, and 
pours its contents into the left jugular vein in the neck. 

Absorption by the capillary blood vessels of the intes- 
tine is, however, much more important than by the lacteals. 
It is seen from the structure of the villi that there is only 
a single layer of epithelial cells intervening between the 
digested fluid food in the intestinal canal and the extensive 
surface of the capillary vessels. Absorption, therefore, of 
all solvent and fluid matters from the intestine into the 



veins of the villi takes place easily and rapidly. The 
intestinal juice which is poured out in such abundance 
during digestion is also re-absorbed by the blood vessels of 
the villi. 

'r/^ ''^^^^^^^ 






Fig. 6.— Arteries and Veins of the Villi, Injected and Magnified ico 

T, I, I, I, I. Cylindrical villi receiving one single voluminous vein which 
occupies the centre of it, and several very small arteries all of the same calibre, 
arranged around the venous trunk with the divisions of which they anastomose at 
their ends. 2, 2, 2, 2. Flattened villi receiving two venous trunks which com- 
municate with each other by numerous branches, and several arteries which ter- 
minate in the extremely rich network formed by these branches. 3. A larger and 
more flattened villus receiving three venous trunks which by their branches and 
anastomoses form at its summit a very close network. Around these trunks and 
in their interspaces very small and pale arterioles are seen which are connected 
with this network. 

The portal circulation. — The blood, now laden with the 
products of digestion, passes from the venous capillaries of 
the stomach and intestines to the blood vessels of the 


mesentery. These pour their contents into a large vessel 
called the portal vein, which conducts the blood direct to 
the liver. It will thus be seen that by this arrangement 
the albumose derived from albuminous foods, the glucose 
derived from the starch and sugar, together with the 
various salts held in solution, are carried direct to the liver 
by the portal vein, there to be elaborated into the sub- 
stances necessary for nutrition. The glucose is converted 
by the action of the liver cells into glycogen, and is, it is 
asserted, ultimately restored to the circulation in the form 
of glucose, to be probably burnt up in the tissues in the 
processes of metabolism or tissue change. The albumose 
is, after passing through the liver, returned to the circulation 
in the form of blood albumen. 

Most of the fatty particles of the food are absorbed by 
the lacteals, and enter the general current of the circulation 
by the thoracic duct, which pours its contents into the left 
jugular vein. The jugular vein leads into the superior vena 
cava, which conducts the blood to the right side of the 
heart, from which it is pumped by the pulsation of the heart 
into the lungs. In the lungs the fatty particles with which 
the blood is charged after a meal entirely disappear, and are 
probably burnt up in the process of the maintenance of the 
body heat. 

The blood is charged with the elements of tissue 
change. — Thus in passing through the two great separative 
and constructive organs of the body, the lungs and the 
liver, the venous blood, charged both with the products of 
decomposition (carbonic acid gas), and with the materials 
for repair, undergoes such changes by casting out the 
products of tissue destruction, and by modifying the 
materials of reconstruction, that it issues both from the 
lungs and the liver in a renovated condition, and charged 
with those materials which are necessary for the growth 
and repair of the tissues. 

The blood, as it issues from the lungs, is carried by the 
pulmonary artery, and as it issues from the liver by the 



hepatic artery, into the aorta, and 
circulation into the further- 
most parts of the body, 
where it nourishes the 
tissues. But the lungs and 
the liver have not done all 
that is necessary for the 
scavenging and renovation 
of the blood. After leaving 
the liver it passes all through 
the tissues, is again col- 
lected by the veins, and 
passed on to the right side 
of the heart. It is thence 
pumped into the lungs, 
where it parts with its car- 
bonic acid gas, and receives 
a new and revivifying 
supply of oxygen . Passing 
again into the heart, it is 
pumped from the left ven- 
tricle into the aorta, thence 
to be distributed to the 
bod}'. But though appar- 
ently cleansed by its passage 
through the lungs, it is still 
laden with the products of 
decomposition, of incom- 
plete oxidation, or retro- 

then conveyed by the 


Fig. 13. — Glomeruli of the Kidney; Origin op' the Uriniferous Tubule*. 

I, I. Glomeruli surrounded by their capsules, or the funnel-shaped terminations 
of the uriniferous tubules. 2, 2, 2. Uriniferous tubules springing from the capsules 
and much contorted in their course. 3, 3, 3. The interlobular branch of the renal 
artery. 4, 4. Its branches or the afferent vessels of the glomeruli. 5, 5. Two 
glomeruli in which are convoluted the afferent vessels. 6, 6. Glomerulus with 
the capsule partly removed. 7, 7. Efferent vessels of the glomeruli. 8. Efferent 
vessel the branches of which, 9, break up into the capillary network of the kidney. 



gressive changes which have taken place in the tissues 

in the course of tissue 
change or growth, and 
in the production of 
energy. These effete 
products are more par- 
ticularly those which 
result from the incom- 
plete oxidation of 
albumen, and they are 
found in the blood in 
the form of urea and 
uric acid. As these 
substances are most 
deleterious in their 
efifectSjand even poison- 
ous in their action if 
allowed to circulate in 
the blood, it becomes a 
matter of the greatest 
importance to get rid 
of them. This is accom- 
plished by the action of 
the kidneys. 

The kidneys are two 
bean-shaped bodies, 
which lie at the back of 
the abdominal cavity, 
on either side of the 
Fig. 14. — Course of the Uriniferous ducts, Diagramm.vtic Plan. 
I, I. Rectilinear uriniferous tubule ; a collecting duct passing from the peri- 
phery of the lobes towards the papilli of the kidney towards which it opens. 2. 
Lower end of the tubule, which has been cut off a little above its mouth for the 
convenience of the drawing. 3, 3, 3. Other collecting tubules opening into the 
cavity of the preceding. 4, 4, 4, 4, 4. Malpighian bodies or glomeruli. 5, 5, 5, 5, 5. 
Contorted tubules springing from the glomeruli and forming the greater part of the 
cortical substance of the kidney. 6, 6, 6, 6, 6. Straight tubes succeeding the con- 
torted tubes and descending from the cortical into the medullary substance. 
7j 7) 7i 7. 7- Larger branches forming loops. 8, 8, 8, 8, 8. Other ascending 


vertebral column in the lumbar region. The arteries which 
conduct the blood to them come off at right angles to the 
aorta, from which arrangement it is obvious that the blood 
passes with considerable force into the kidneys from the 
main channel of the circulation. Within the kidneys the 
artery at once divides into a number of vessels which end 
in what is called a glomerulus. In the glomerulus the 
vessel breaks up into a great number of finer vessels folded 
one upon another in a tangled ball. The arteriole com- 
municates with a vein similarly constructed and arranged, 
but of smaller calibre. It is apparent from the arrange- 
ment that the return of the blood from the glomerulus 
must be somewhat hindered. This convoluted ball of 
blood vessels is pushed into the globe-like distension of a 
fine tube. (Fig. 7.) The delicate transparent double walls 
of the sack-like end of the tube envelop the glomerulus 
on every side. Here we have all that is necessary for the 
process of filtration : namely, blood carried at high tension 
from the full current of the circulation suddenly brought 
almost to a condition of stasis in the tangle of the glomer- 
ulus, and a bag or filter furnished with a conducting tube 
in immediate contact with the distended blood vessels. 
What happens is that the watery constituents of the blood, 
together with the urea and other extractive and colouring 
matters, are filtered from the capillary vessels into the 
sack-like termination of the uriniferous tubule. In a state 
of health the albumen and fibrine of the blood do not pass 
this filter. The urine thus excreted from the blood in the 
glomerulus passes by a series of looped vessels into a single 
tube which opens into a basin-like cavity called the pelvis 
of the kidney. The fluid which is being constantly forced 
out from the uriniferous tubules is finally conveyed from 
both kidneys by long, narrow, muscular tubes called the 
ureters to the bladder, which is emptied at will. 

To recapitulate. — I. — i. Starchy foods are converted 
into glucose in the mouth by the action of the saliva, 
and in the duodenum by the action of the pancreatic juice. 


2, Albuminous foods are converted into soluble albu- 
moses or peptones by the action of the pepsine of the 
gastric juice acting in an acid medium, and by the trypsine 
of the pancreatic juice acting in an alkaline or neutral 

3. Fats are emulsified in the intestines by the action of 
the pancreatic juice, the bile, and the intestinal juice. 

II. — I. Albumose is absorbed by the venous radicles of 
the stomach and intestines, and carried by the portal \'ein 
to the liver. 

2. Glucose is absorbed by the capillaries of the villi, and 
carried by the mesenteric veins to the portal vein, and 
thence direct to the liver. 

3. Emulsified fats are absorbed by the lacteals, and 
are carried by the thoracic duct to the left jugular vein. 

III. — I. Albumose is converted by the liver into albu- 
men, and is present in the blood in the form of blood serum 
and fibrine. 

2. Glucose is converted by the action of the liver into 
glycogen, and is stored there for use in the economy. 

3. Fats are burnt off in the lungs and in the tissues in 
the production of body heat. Fat is also stored up in the 
tissues for future use. 

The various digestive juices are re-absorbed during and 
after the process of digestion. 

The excretory products of digestion are the bile, ex- 
creted by the liver ; the urine, containing urea, excreted 
by the kidneys ; and the faeces, containing the indigestible 
and undigested remnants of food, broken-down cells, masses 
of bacilli which flourish in the intestine, and the colouring 
matters of the bile. 

Any abnormal divergence from the long and complicated 
process of digestion will give rise to many conditions of 
ill-health and disease, to dyspepsia, gout, diabetes, etc. 



Having described the various foods used by civilised man, 
and the processes in the human economy by which these 
foods are digested, I propose now to consider the deflections 
from the normal in the long and elaborate process of diges- 
tion, and the treatment or rectification of these abnormal 
conditions by diet. In treating, however, of the question 
of dietetics I do not intend to simply state the foods which 
must be avoided or which may be allowed, but also to 
arrange daily Jiienus for the patient and to give practical 
instructions how the dishes are to be prepared. Dyspepsia, 
diabetes, gout, Bright's disease, etc., their physiological 
causes, and their dietetic treatment, will be taken in order ; 
and I trust to be able to make it plain that a suitable dietary 
and an intelligent .cook are more valuable to patients 
suffering from these complaints than all the drugs of the 

Indigestion is the most universal of complaints. It 
afflicts alike the rich and the poor, those who eat too much, 
and those others who eat too little ; the idle and the busy ; 
the young and the old. When, however, the length and 
the complication of the process of digestion are considered, 
and when it is remembered that the slightest deflection 
from the normal will cause pain and discomfort, it is not 
surprising that indigestion is such a common complaint ; 
still less so when it is borne in mind that in order to please 
the palate by agreeable flavours and sensations, the average 
civilised man in well-to-do circumstances taxes the long- 
enduring powers of digestion to the very utmost. The 


organs concerned in the process of digestion are the mouth, 
the stomach, the Hver, and the pancreas ; disturbance or 
impaired action of one or any of these may be the cause of 

Causes of indigestion : in the mouth. — The food may 
be insufificienth' masticated, owing to the teeth being de- 
cayed or deficient. If the food remains too short a time in 
the mouth it is not properly ground into a pulp by the 
grinders, and is not sufficiently mixed with the saliva. If 
introduced into the stomach in an unmasticated condition, 
the food takes a much longer time to be broken up by the 
action of the muscular movements of the stomach and 
submitted to the action of the gastric juice. The saliva, 
being alkaline, stimulates the secretion of the acid gastric 
juice, and thereby exercises a considerable influence in 
quickening and aiding digestion ; it is therefore important 
that the food should be well mixed with saliva before 
being swallowed, and that those who have a tendency 
to indigestion should masticate their food slowly and 

In the stomach. — The most important part of digestion 
takes place in the stomach. Here the food is thoroughly 
triturated by the movements of the muscular walls of the 
stomach, and mixed with the mucus and gastric juice 
poured out from the glands of the stomach ; the albuminoids 
are acted upon by the pepsine, and absorbed by the veins 
of the stomach in the form of albumose. The most frequent 
cause of stomachal indigestion is chronic gastritis. In this 
malady the mucous mem.brane of the stomach is subject to 
frequent attacks of subacute inflammation, with the result 
that the peptic glands become atrophied, their cells are 
degenerated, while the mucous glands become hyper- 
trophied. The consequence is that the gastric juice is 
deficient in quantity and poor in quality, while mucus is 
secreted in excess. When this malady is once firmly 
established, it is very difficult, if not impossible, to cure. 
The mucous membrane of the stomach may be, however. 



in a condition anatomically healthy ; in this case the in- 
digestion ma}- be caused by irregular nervous action, or by 

Fig. 9.— Thk Gastric Glands of Man. 

A. Peptic gland of the middle part of the stomach, i. Its excretory duct. 
2, 2, 2. Its three principal branches. 3, 3, 3. Its secondary divisions, in the course 
of which are numerous culs-de-sac all of which are filled with spherical cells. 

B. Peptic gland of the splenic end of the stomach, i. Its extremely short 
duct. 2, 2. Its two principal branches. 3, 3. Numerous culs-de-sac in which 
they terminate. 

C. Mucous gland of the pyloric end of the stomach, i. Its duct. 2, 2. Its 
two main divisions. 3, 3, 3. Its secondary divisions. 4, 4. Small racemose glands 
at their termination. 

an unhealthy condition of the blood. The gastric juice 
may then be secreted in excess, giving rise to " acidity," or 



it may on the other hand be secreted insufficiently, causing 
slow and difficult digestion of the albuminoids. The gastric 
juice may also contain either too little or too much acid. 
In the first case, the pepsine is slow and uncertain in action ; 
in the second, digestion may be too rapid. These irregu- 

FiG. lo.— Gastric Glands of Man in a Morbid Condition. 

A. Atrophied peptic gland containing no longer spherical cells, but only a 
small quantity of fluid, i. Its duct. 2, 2. Its branches, the calibre of which is 
reduced, and the outline very irregular, the culs-de-sac hollowed along its course 
have almost entirely disappeared, and are only represented by very small swellings 
of uncertain form. 

B. Another peptic gland from the splenic region, of which the duct, branches 
and culs-de-sac are on the contrary dilated, i. Free end of the duct which is not 
dilated. 2. Lower end of the same dilated like a bottle. 3, 3. Its branches 
slightly dilated. 4, 4. Terminal culs-de-sac filled with fluid and inclined to be cystic. 

C. Peptic glands the divisions of which are atrophied ; three of these divisions 
terminate in actual cysts, i. Duct of the gland. 2, 2, 2. Its different branches. 
3, 3. Dependent cysts. 

D. Cysts of various diameters which float here and there in the fluid of pre- 
paration, and which were wrongly considered by anatomists to be closed follicles. 
I. Cyst detached from the gland to which it belongs, carrying with it a part of its 
pedicle. 2, 3, 4. Other smaller cysts, the pedicles of which have been broken off 
at the point of insertion. 

larities, in the .secretion and condition of the gastric juice, 
may be due to the want of proper nervous control of the 
minute blood vessels which feed the peptic glands, or to 
abnormal conditions of the blood, as in fevers, anaemia, 
diabetes, etc. Stomachal indigestion may be also caused 


by slow, sluggish movements of the muscular walls of the 
stomach, or by too rapid and energetic movements which 
cause the food to be ejected into the duodenum before it is 
thoroughly broken up and submitted to the action of the 
gastric juice. 

It will be seen from the foregoing that the causes of 
indigestion in the stomach are many and various, hence 
the extreme difficulty of treating; this complaint on any well- 
defined rule. The symptoms may be the same, but the 
causes are different, and the disease must consequently be 
differently treated. In one case alkalies are indicated ; in 
another, hydrochloric acid gives relief: in one, food must 
be taken at frequent intervals ; in another, long periods of 
rest must be given : in one, fluid food can alone be borne ; 
in another, the meals must be taken without drinking. 
The stomach has, m.oreover, many idiosyncrasies and anti- 
pathies which are either constitutional and permanent, or 
functional and temporary. Thus one person cannot digest 
strawberries, another cannot take onions ; one person 
cannot eat shellfish, and to another mushrooms will give 
an attack of indigestion. The dietetic treatment of 
stomachal dyspepsia can therefore be only correctly arrived 
at by experiment based on certain well-known principles ; 
in fact, each dyspeptic must discover for himself what he 
can cat, how much, and how often. 

The principle of treatment by dietetic rest. — I am 
convinced that indigestion need not be such an universal 
complaint if people would treat their bodies in the same 
way as they treat their emplcnees, and make them work 
hard on the lowest possible wage, with proper periods for 
rest. xAbstemiousness and physiological rest are, in my 
opinion, the initial principles involved in the successful 
treatment of gastric dyspepsia. If the indigestion is caused 
by want of nervous tone, give the stomach only as much 
food to digest as will maintain strength ; if it is caused by 
alcoholic excess, cut off all wines and spirits ; if caused by 
irregularities in the production and quality of the gastric 


juice, rest the stomach as much as possible till nature effects 
her own cure. The doctrine of rest is not sufficiently con- 
sidered in treating derangements of the stomach. If we 
have a sore and excoriated skin wound, we take care to 
rest the part so as to let healthy granulation go on un- 
disturbed. The mucous membrane of the stomach may 
be considered in acute forms of dyspepsia to be in much 
the same condition, and its cure would be better accom- 
plished by rest than by anything else. Such rest could be 
partially obtained by taking predigested and fluid foods. 
Unfortunately, however, the practice of the dyspeptic is 
generally the opposite. Finding the appetite fail, and 
thinking it the most important of physical duties to eat, 
he tempts appetite and stimulates a fatigued and jaded 
stomach by highly spiced foods and b)- dainty dishes, thus 
often rendering chronic a condition which might have been 
only temporary. " Why do you come to Carlsbad ? " I 
once asked a visitor who was a well-known diner-out in 
London society, and who by his air of general well-being 
did not seem to need a " cure ". " Because," was the reply 
" it enables me to eat what I like for the rest of the year.' 
This is an example of what I mean by curing dyspepsia by 
means of resting the stomach. The plentiful ablutions of 
the mucous membrane, and the rigid abstemiousness of life 
and diet insisted upon at Carlsbad and other spas, give the 
stomach the chance and opportunity of curing its d)-spepsia 
by rest. 

Duodenal indigestion.— After the food has been acted 
upon by the gastric juice in the stomach, and the albu- 
minoids have been in a great measure rendered soluble and 
absorbed, the acid chyme passes into the duodenum, where 
it is acted upon by the bile and the pancreatic juice, both 
of which are alkaline. The role of the bile is to emulsify 
the fats, and of the pancreatic juice to turn the starch into 
glucose. The bile is secreted by the liver, and it is rightly 
thought that the liver plays a large part in causing indi- 
gestion. If the bile is deficient there is constipation and 


often distressing flatulence ; if it is secreted in excess the 
bile salts are not re-absorbed, but circulate in the blood, 
producing great depression of spirits. The bile may also 
regurgitate into the stomach, causing \'omiting of a very 
acrid substance. If the pancreas fails to fulfil its part, 
the starchy foods are not converted into glucose, the pro- 
cess of digestion is not completed, and undigested food 
passing down the alimentary canal causes irritation and 
diarrhoea, and the patient emaciates. 

The symptoms of indigestion.— In those in whom the 
process of digestion is normal, eating gives only a sensation 
of satisfaction. The food passes from the stomach into the 
duodenum without exciting any uncomfortable feelings, 
and the person goes about his occupations untroubled by 
the cares of the body till hunger tells him it is time to eat 
again. Not so with the dyspeptic. Eating gives at first 
the sense of satisfaction ; but this is soon followed by a 
feeling of distress at the pit of the stomach. The waist 
seems and is unnaturally distended, eructations of flatulence 
take place, the stomach feels sore inside, pain spreads to 
the region under the shoulder blades, the intelligence be- 
comes dulled, the temper irritable, the spirits depressed, 
and there is a tendency to drowsiness, the indulgence in 
which is at once the temptation and the refuge of the 
dyspeptic. That a person is suffering "only from indi- 
gestion " is often thought to be a reason for expressing no 
sympathy with his malady ; but, in my opinion, there is 
no condition which is more worthy of our pity ; in fact, a 
severe illness is, I think, much more endurable than the 
daily constant miseries of the dyspeptic. The healthy can 
scarcely realise what he suffers : the discomfort which does 
not amount to pain, the depression which does not reach 
melancholia, and the nervous irritabilit}', the manifesta- 
tion of which makes him shunned by his friends. While 
he wants to dine he dreads to eat ; when he longs to be 
cheerful he feels in the depths of low spirits ; when he 
wishes to be kind he cannot help being cross. He is an un- 


fortunate— to be pitied, to be borne with patiently, and to 
be helped ; but first of all he must help himself He must 
make his own condition, his tiresome, contradictory, ill- 
regulated stomach, his study, and must discover what to eat 
and what to avoid, and having discovered the rules by 
which to govern himself he must abide by them. 

Doctors, to whom dyspeptics go for treatment and 
advice, are fond of giving their patients written or printed 
lists of the things they may eat and not eat, the time for 
meals, etc. This rule of thumb may answer fairly well with 
a mass of people, but it is scarcely intelligent or scientific. 
These lists, and even the prescriptions, are handed on from 
one dyspeptic to another in the hope that the talisman may 
act without the payment of the standard fee. The results 
of this haphazard method of treating a most complicated 
malady would afford comic reading if they could be col- 
lected, and might doubtless form the bases for many 
miraculous cures. Asking once for something requiring 
immediate attention to be made up for me at a well-known 
chemist's, I was informed that it could not possibly be done 

that day, as the Countess of was going away into the 

country, and had sent all her prescriptions to be made up 
— they being always carefully preserved by her for country 
dispensation to her poor neighbours and dependants. 

I cannot resist the temptation to tell the following story, 
illustrating the way in which dietetic rules for the treatment 
of indigestion are handed on and looked upon as infallible 
specifics. Four men, unknown to each other, once met at 
the common table of a country inn. They all paid evi- 
dent attention to what they ate. One refused the soup, 
and remarked, " Sir A. B. forbids soup at dinner ; " another 
objected to drink anything, saying, " Sir A. R. advises that 
the meals should be taken dry." A third rejected the 
entrees and sweets, and sighed pathetically, " xA.ll kickshaws 
are tabooed by Sir A. B.". The fourth man, however, was 
observed to eat steadily through the dinner, and to partake 
of all the good things with evident relish. " Sir," at last 


said one of his companions, "you do not seem to follow 
the dicta of Sir A. B." " No," was the genial reply of 
the man who had enjoyed his dinner, " for I am Sir A. B." 
I once had the audacity to tell this story to the great 
physician indicated, and no one's amusement could have 
been greater or his laughter more hearty. 

To treat dyspepsia dietetically there are certain broad 
principles to be followed. First, the bowels should be regu- 
lated with care, watchfulness and intelligence. Both con- 
stipation and diarrhcea should be avoided. It is of the 
utmost importance that, on the one hand, the digested food 
should not lodge or stagnate in the intestines, there under- 
going fermentative changes and causing flatulence and 
distress ; nor, on the other, should it be hurried through 
the intestines without the opportunity for proper assimila- 
tion. Constipation is sometimes caused by the patient 
taking food which is too easily digested, so that the peri- 
staltic action of the intestines is not excited by the presence 
of undigested morsels. In these cases vegetables will often 
effect a cure. A glass of water taken on rising will have 
in many cases, both a tonic and an aperient effect. Chronic 
diarrhcEa can be often checked b}' taking the most easih-- 
digested food and raw meat juice, the preparation of which 
is described in the chapter on invalid foods. It is incorrect 
to think that constipation and diarrhoea can only be cured 
by pills and draughts ; a careful dietary can do more to 
establish a healthy condition of the intestinal mucous mem- 
brane than the use of drugs. 

In cases of atonic dyspepsia, caused by want of nervous 
tone, the meals should be small and frequent, if they can be 
well borne. The period of time between meals necessar}- 
to digest each meal properly can only be ascertained by 
experiment in the case of each patient individually. It is 
the greatest possible mistake for a dyspeptic to force him- 
self to eat. If he is not hungr}-, it is probably because 
gastric juice has not been secreted in sufficient quantity to 
enable him to digest a meal. An attack of indigestion 


will therefore probably follow if food be taken. The rea- 
sonable thing to do is not to oblige the patient to eat when 
he has no appetite, but to give him the material out of 
which the stomach can manufacture the pepsine required 
to perform digestion. This can be done by giving a small 
cupful of beef-tea half an hour before the meal. The beef- 
tea is rapidly absorbed, a stimulus is given to secretion, and 
the gastric juice is produced and poured out in time to 
digest the subsequent meal. This rational treatment of 
indigestion was discovered by the physiologist Schiff. It 
is too little known and practised. 

In all cases of indigestion the meals should be simple ; 
that is, composed of few dishes ; and one or two things only 
should be eaten at the same time. Thus, a dyspeptic may, 
perhaps, eat a cut of roast beef with comfort ; but if he 
heaps his plate with potatoes, green vegetables, and York- 
shire pudding, and eats them altogether, he will infallibly 
suffer from flatulence and indigestion. It would be better 
for him to eat his vegetables at one meal and his beef at 
another. It is better also to drink between meals, and not 
at meals. To make this a habit is, in some cases, alone 
sufficient to cure obstinate dyspepsia. Pastry, mysterious 
concoctions of preserves and flour, rich, greasy, and highly 
spiced and flavoured foods should, as a rule, be avoided by 
the dyspeptic. It is most important, however, that the 
food should be well cooked and daintily served, and that 
variety should be studied. " By variety," says Dr. King 
Chambers, " is meant not a great number of dishes at 
once, which is confusing and oppressive, and destructive of 
the object aimed at ; but a frequent (why not daily ?) dif- 
ference in the principal dish, to which the few other dishes 
are harmonised. Some of the most appetising dinners one 
has ever eaten have really consisted of one article, novel 
and unexpected. The famous Mrs. Poyser sagely remarked 
that a man's stomach likes to be surprised, and no surprise 
is possible if the same monotonous superfluity is repeated 
day by day." 


In the intelligent combination of simplicity with variety, 
and of good cooking with both, lies the secret of the power 
to relieve much of the discomfort of the dyspeptic. 

Whether alcohol should be taken or not is a subject 
again for experience. In many persons whose dyspepsia 
is the result of sedentary life and too constant an applica- 
tion to anxious work in close rooms, a small amount of 
alcohol with meals undoubtedly promotes digestion ; if, 
however, it causes flushing of the face and throbbing of the 
arteries it should not be taken. Good whisky or brandy 
well diluted is often better borne than fermented wines. 
Tea acts on some dyspeptics like poison, producing a sense 
of weight in the chest, palpitation of the heart, and nervous 
excitement. If taken weak, and if the tea leaves be re- 
moved three minutes after the tea is made, it can be 
digested and has a refreshing and invigorating effect. 
Sugar should be taken sparingly by persons over forty ; 
vegetables should be cooked well and in a variety of 

Probably the best of all cures for dyspepsia is fresh 
air. I am acquainted with chronic and constantly suffer- 
ing dyspeptics who lose their dyspepsia as if by magic on 
going on board ship and sailing across the ocean. High, 
dry, bracing, sunny climates are the best, in which outdoor 
exercises, such as riding and golfing, can be enjoyed. 
Cheerful society should be sought, and even " frivolous 
conversation " is recommended by Dr. King Chambers at 
meals. Perhaps our forefathers had better judgment than 
ourselves when they enjoyed the jokes of the jester after a 
banquet, instead of listening to the solemn perorations of 
the speech-makers. 

To consider his dyspepsia scientifically and philosophi- 
cally, to study it, to lay down rules for his own guidance, to 
follow them, and then, as far as possible, to forget his 
malady, should be the aim and practice of the dyspeptic. 



The preparation of food for those who are seriously ill is 
a matter of vital importance, for the life of the patient often 
depends either on the maintenance of strength during the 
acute period of the disease or on the recovery of power 
during convalescence. In acute illness and in high fever 
the stomach is unable to digest solid food. It becomes, 
therefore, of great importance to administer food which is 
not only highly nutritious, but which contains the food 
principles necessary for the maintenance of strength and 
the repair of the tissues wasted in the fever process. 

Patent foods often of little value though of high price.— 
It is only of recent years, however, that the feeding of the 
patient has been based on scientific principles, and that 
doctors have turned their minds to such subjects as the 
correct making of beef-tea and gruel. Even now, un- 
fortunately, the provision of food for the well-to-do is en- 
trusted too much to the vendors of patented and secret 
preparations ; and we are left in ignorance of the actual 
constitution of the foods for which we are paying a high 
price, in the hope that they contain the necessary elements. 
In this we may be, however, entirely deceived, and many 
of the patented beef-teas and meat-juices which are pur- 
chased at great cost, in the belief that they are " strength- 
ening," contain only a trace of albumen. The expensive 
preparations of malt also advertised as " foods " cannot be 
properly included in this categor>\ 

Invalid foods can be well prepared at home.— My 
object will be to show how the most nutritious invalid foods 


can be prepared at home, in the sick-room, and at the least 
cost. I have, when attending on the sick, been frequently 
struck by one of two things — either the immense cost at 
which the patient was being nourished on patent foods, or 
the small amount of nourishment which was extracted b}' 
means of ignorant methods from good materials. If the 
nature of the food principles necessary for the maintenance 
of the body be remembered, and also the broad facts of 
digestion, beef-tea, jellies, etc., would be made with much 
more intelligence, and the invalid would be better fed. 
Having, in the previous chapters of this book, given some 
account of food values and of the processes of digestion, I 
will proceed to describe how the invalid may be intelligently 
fed, without resorting to costly patented foods of unknown 
composition, and I will give recipes which may be safely 

Beef-Teas and Beef-Juices. 

Beef-tea— methods of making. — i. Remove all the fat 
and skin from one pound of fresh gravy beef ; cut it up in 
small pieces, and put it in a stone jar with a pint of cold 
water and a little salt. Replace the lid of the jar, and let 
it stand all night. The next morning place the jar in a 
saucepan of boiling water, and let it simmer gently, but 
never boil, for five hours. Strain the fluid from the beef 
through a colander. 

It must be borne in mind that beef-tea made in this 
way is, as well as the patent beef-teas and beef-juices, not 
a food in the true sense of the word, but rather a stimulant. 
Such beef-teas contain little or no albumen, and only a 
very slight amount of gelatine, but they hold in solution 
the sapid extractives and salines of the meat. The universal 
experience, however, is that beef-tea is to the sick and weak 
a valuable restorative, though it must never be forgotten 
that it is not nourishing. 

2. Whole beef-tea.^Make the beef-tea as in the pre- 
vious case, but instead of throwing away the residue of the 


meat, pound it in a mortar into a pulp, pass it through a 
wire sieve and add it to the beef-tea. The beef-tea made 
by this method is thoroughly nutritious, as all the fibre 
and albumen of the meat are contained in it. 

3. Peptonised beef-tea (Sir William Roberts' recipe). — 
Mix half a pound of finely minced lean beef with half a 
pint of water and 20 grains of bicarbonate of sodium. Let 
it simmer for an hour. Remove from the fire, and when it 
has cooled down to a lukewarm temperature add a table- 
spoonful of liquor pancreaticus} Then set the mixture 
aside for three hours, wrapped in a tea cosy or flannel to 
maintain the temperature, and occasionally shake it. At 
the end of this time decant the liquid portion and boil it 
for a few seconds. Boiling stops the process of digesting, 
which should not be allowed to go beyond a certain point, 
or otherwise the beef-tea becomes bitter and unpalatable. 

Beef-tea prepared in this way is as rich in albuminates 
as milk. When seasoned with salt it is scarcely distinguish- 
able in taste from ordinary beef-tea. By being partly pre- 
digested it is eminently suitable for invalids whose digestive 
organs are in a much weakened condition. Care should, 
however, be taken not to continue the use of predigested 
foods too long after the stomach has begun to recover tone, 
else that organ becomes demoralised, and ma}' lose the 
power of normal digestion. 

4. Raw meat-juice (Dr. Cheadle's recipe). — To one 
part of best rump steak finely minced add one fourth the 
amount of cold water. Stir well together, and allow the 
beef to soak for half an hour, then place the whole in a 
piece of muslin or cambric, and forcibly express all the 
juice by firm twisting. 

By this method a highly nutritious and nitrogenous food 

1 Liquor pancreaticus is made from beef pancreas. Pancreatine 
has, like pepsine, the power of digesting albumen and turning it 
into soluble albumose. The preparations of pancreatine are much 
more reliable than those of pepsine. Zymine is also a most useful 
preparation, and food is rapidly peptonised by it. 


is obtained, containing no less than five per cent, of albu- 
men. In Dr. Cheadle's opinion raw meat-juice is the most 
easily digested and restorative of all animal foods, and the 
most valuable of all nitrogenous preparations for children. 

5. Beef balls raw. — Scrape with a knife all the juice 
out of a fresh rump steak, leaving nothing but the fibrous 
tissue behind. Mix with cream and roll into balls. Heat 
a baking tin very hot, and roll the balls rapidly over the 
hot surface. Sometimes a drop of cherry brandy is added 
to each ball to mask the flavour ; but I have found that 
rolling the balls over a hot tin and the addition of cream 
will take away both their objectional appearance and raw 
flavour, while the condition of rawness remains really un- 
altered. This is a very valuable food in acute gastritis ; 
also in gastric catarrh, when solid food is ill tolerated. 

Malted Foods. 

We have seen that in the digestion of starch, it is acted 
upon by a diastase which is contained both in the saliva and 
in the pancreatic juice, which diastase converts starch into 
glucose or grape sugar. Malt has at a certain heat the 
same effect on the starch contained in wheaten and other 
meals. Before being converted into glucose, the starch is 
first changed into dextrine, then into maltose, and finally 
into grape sugar. In malted foods, the malt flour is 
mixed with the finest wheaten flour, and the process of 
conversion into sugar is started and then stopped. On 
mixing the malted food with water the process recom- 
mences, and is carried on rapidly, either while being cooked 
or in the stomach, and in a short time the whole of the 
starch is turned into grape sugar and is ready for absorp- 
tion. In most of the patented malt extracts sold, the 
change of starch into sugar has been carried too far, and 
the maltine has, as a food, not much more value than treacle 
or syrup. Both Sir William Roberts and Dr. Cheadle are 
agreed that these " malted foods " are quite unsatisfactory 


as foods if taken only mixed with water ; but that, provided 
they still contain a considerable amount of active diastase, 
they make, if mixed with milk or gruel, valuable and highly 
digestible foods for invalids and delicate children. 

How to make malt infusion (Sir William Roberts' 
method). — Mix three ounces of crushed malt thoroughly 
well with half a pint of cold water in a jug. Let the mixture 
stand over night. The supernatant liquid is then carefully 
decanted off from the sediment and strained through two 
or three folds of muslin, until it comes through fairly clear 
and bright. Malt infusion thus prepared has a light brown 
colour like sherry, a faint maltish taste, and the odour of 
beer-wort. It is prone to fermentation, and should be pre- 
pared fresh every day. 

This method of preparing malt infusion is so simple, 
and the product is so efficacious in aiding the digestion of 
gruel and farinaceous foods, that it should be regarded as a 
household remedy. It costs three farthings a pint. 

Malted gruel. — The gruel should be well boiled and 
strained to separate the lumps. When cool enough to 
swallow, the malt infusion is added. One tablespoonful 
will digest half a pint of gruel. The action is very rapid ; 
in a few minutes the gruel becomes thin from the con- 
version of the starch into maltose (Roberts). Other 
farinaceous foods, such as arrowroot, can be malted in 
the same way. 

Pepionised Foods. 

In cases of extreme debility of the digestive organs or 
arrest of the digestive function in the stomach, the oppor- 
tunity which science gives the invalid of having digestion 
accomplished for him outside of the body, is one which the 
tormented dyspeptic may be expected to avail himself of 
with eagerness. But the object of using peptonised foods 
should be always to tide over a difficult time, not to en- 
courage a habit ; to give the digestive organs physiological 
rest, so that they may recover power, not to enervate them 


by continued disuse. Peptonised foods should therefore be 
used with caution and under medical advice. 

Peptonised milk. — Dilute a pint of milk with a quarter 
of a pint of water, and heat to a temperature of 140 degrees. 
Then mix with the hot milk two teaspoonfuls of liquor 
pancreaticus and twenty grains of bicarbonate of sodium. 
The mixture is then poured into a covered jar, and placed 
in a warm place to keep up the heat. At the end of an 
hour and a half the milk is raised to the boiling point for a 
few seconds, after which it can be used as ordinary milk. 

The cold method of preparing peptonised milk.— Add 
half a pint of water and twent}- grains of bicarbonate of 
sodium to a pint of milk, and three teaspoonfuls of liquor 
pancreaticus. The mixture is then set aside in a room at 
about sixty or sixty-five degrees of temperature for three 
or four hours, at the end of which time it is ready for use. 
If used at once it need not be boiled ; but, if the milk has 
to be kept any time, it is better to bring it to the boiling 
point for a few seconds so as to arrest fermentation, and to 
prevent the production of a bitter flavour. 

Peptonised soups, jellies, and blancmanges. — These 
can be prepared with a little ingenuity, it being always 
borne in mind that the peptonised fluid added to the stock, 
cream, isinglass, etc., used must have been boiled, and the 
action of the ferment arrested : otherwise a disagreeable 
bitter flavour will be communicated to the food, and the 
result will not be successful. In soups, peptonised gruel 
can be used instead of water ; in jellies it can be added to 
the isinglass or gelatine and flavouring matters ; in blanc- 
manges peptonised milk is added to cream. 

Peptonised milk gruel. — Make a good thick gruel. 
While still hot add an equal quantity of cold milk. To 
a pint of this mixture add two teaspoonfuls of liquor pan- 
creaticus and twenty grains of bicarbonate of sodium. Set 
aside in a warm place for two or three hours, then raise to 
the boiling point and strain. The mixture should be 
watched and tasted from time to time, and boiled as soon 


as a slight flavour of bitterness is perceived. If the pep- 
tonised process is allowed to go too far, the bitterness 
produced makes the gruel unpalatable. 

Peptonised beef- tea has been already described. 

If the above recipes be carefully and intelligently fol- 
lowed, invalid foods of the highest nutritive value to the 
patient can be made at very moderate cost ; and if the 
previous chapters regarding digestion and assimilation have 
been well studied, the need for these foods and the rationale 
of their preparation will be easily understood- The subject 
will again be dealt with when treating of diet in acute 
fevers and convalescence from them. 



Indigestion may sometimes pass, owing to some tem- 
porary cause, from the chronic condition to the acute form 
of gastritis. 

The causes of acute gastritis are various. Some par- 
ticular article of food, such as, for example, mushrooms, 
mussels, or the skin of a fowl, has proved intractable to 
the digestive juices, and has remained undigested in the 
stomach. Here it becomes decomposed, and sets up in- 
flammation of the gastric mucous membrane. Over-eating, 
or eating food in a state of decomposition, may also induce 
acute gastritis. The cause is, however, often difficult to 
discover ; for, quite suddenly, a dyspeptic, who is digesting 
fairly well, may suddenly develop acute gastritis, and the 
digestive functions become completely suspended. 

The symptoms are pain at the pit of the stomach, 
nausea, vomiting, loss of appetite, and general malaise. 

The indications of rational dietetic treatment are 
two : First, to try and get rid of the substance which is 
setting up irritation in the stomach ; and, secondly, to give 
the stomach physiological rest, so that it may recover its 
normal condition. 

Emptying the stomach. — When acute gastritis is first 
set up, and it is suspected that the pain is caused by some 
undigested article of food in the stomach, it is well to 
wash out this organ without delay. This can be done 
without the use of the alarming stomach pump. If about 
a pint of hot water be drunk, and the back of the throat 
tickled with the finger or the handle of a tooth-brush, 


vomiting is provoked, and the contents of the stomach are 
forcibly ejected. Among the chyme and half-digested 
food vomited will generally be found some one thing 
which has been eaten at a meal, perhaps the previous day 
or several hours before, and which is still quite undigested. 
Let the patient continue to drink hot water and to provoke 
vomiting, until the stomach is coinpletely washed out. A 
serious attack of acute gastritis may often be prevented by 
this simple and common-sense expedient. 

Resting the stomach. — If, however, the gastritis is 
established, the stomach must be rested. For one or two 
days no food of any kind should be taken. A little ice in 
small lumps can be sucked to prevent nausea and to allay 
thirst. After this enforced abstinence the stomach will 
possibly be able to absorb a little predigested food. Pre- 
digested beef-tea, the making of which is described on page 
114, is the most easily assimilable. If this is found not to 
disagree, predigested milk in small quantities at a time may 
be given. As the patient recovers appetite raw meat juice 
and raw meat balls {vide page 115) should be carefully added 
to the dietary. At this stage Leube's meat solution would 
be a valuable food. This requires an intelligent cook to 
prepare ; but if the directions are carefully followed there 
is no difficulty about it. 

Recipe for Leube's Meat Solution. — One pound of lean beef 
is minced very fine and mixed in a fire-proof porcelain jar with a 
pint of water and three teaspoonfuls of pure hydrochloric acid. The 
mixture is then placed in a Papin's digester, and the lid screwed 
firmly down. It is boiled from ten to fifteen hours. In a Papin's 
digester the steam cannot escape, and the water is thus kept boiling 
at a much higher temperature than in an exposed vessel. After 
being boiled this length of time, the mass is taken out and pestled 
in a mortar till of a smooth paste. It is then returned to the digester 
and boiled again for nearly twenty hours. It is removed and spread 
out on a flat dish and the acid is carefully neutralised with pure 
carbonate of soda. Returned to an open enamelled saucepan it is 
slowly evaporated to a syrupy consistence. In order to make this 
food palatable a little spice and celery seed should be added to the 
meat, and before serving care should be taken to make it both look 


and taste nice. In this meat solution the meat has been partly pre- 
digested, but all the albumen has not been turned into peptone. It 
is, therefore, a useful intermediate food. 

Care must be exercised not to take predigested foods 
too long, else the stomach becomes demoralised, and the 
very condition aimed at, the return to normal digestive 
power, is delayed. Predigested foods are crutches, which 
must be discarded as soon as there are indications of the 
return of healthy appetite, and that the stomach can 
digest its foods, instead of having them digested for it 
outside the bod}'. 

The return to solid food should be ver}- gradual, and 
only the most easily digested foods should be attempted, 
such as the ball of a well-grilled mutton chop warrenised, and 
not boiled, mutton or chicken, x^ll uncooked vegetables 
or salads, and any hard chippy articles, such as fried bread 
crumbs, should be avoided, also any foods or dishes which 
are found by experience to produce the uncomfortable 
sensations of indigestion. 

Nutrient enemata. — In cases where the gastritis is both 
acute and persistent, in which nausea and vomiting are 
incessant, and the weakness of the patient progressive, it 
may be necessary in order to give the stomach rest, and at 
the same time to maintain the strength, to resort to nutrient 
enemata. In using these two important things must be 
borne in mind, namely that the absorbent powers of the 
mucous membrane of the rectum are slight and slow, and 
also that irritation may easily be set up. The foods selected 
for nutrient enemata should be, therefore, easily absorbed 
and bland. It has been found by experiment that albumen, 
peptones, starch, and fat in the form of an emulsion, are 
all absorbable in the rectum. It is well, however, to ad- 
minister the albumens and starch predigested, and hence 
peptonised beef-tea and peptonised milk gruel, or maltine 
with peptonised milk, are the most useful foods for rectal 
alimentation. Not more than from one to three ounces 
should be injected at the time, warmed to the temperature 


of the body. A long tube carefully oiled should be used, 
and to obtain the best results the rectum should be 
washed out with lukewarm water an hour before the enema 
is administered (Yeo). In cases where more solid food 
can be retained and absorbed in the rectum, Leube's 
meat and pancreatic paste may be injected. This is 
made by mincing two to four ounces of meat with a half 
to one ounce of fresh pancreas free from fat. Pestle in a 
mortar with a small amount of lukewarm water till the 
whole is reduced to a smooth paste, of a consistence suf- 
ficiently fluid to pass up the tube of the enema. It should 
be injected warm. Life cannot be maintained for long on 
nutrient enemata, and their continued use may provoke 
obstinate diarrhcea ; but they may prove of great value in 
cases of acute gastritis or of ulcer of the stomach, when it 
is of the utmost importance to give the stomach absolute 
rest while still maintaining the strength of the patient. 




When dyspepsia is of long duration and severe in 
character, and is accompanied with persistent vomiting 
and acute pain after food, ulcer of the stomach may be 
suspected ; if to these symptoms is added the vomiting 
of blood, then there is Httle room for doubt. Ulcer of the 
stomach is a most intractable disease, and its situation in 
a hollow organ which is subject to incessant movement 
during the process of gastric digestion, renders it very 
difficult to treat. 

Ulcer of the stomach is of different kinds ; it may be 
small, circular, or oval in shape, with sharp, perpendicular 
edges, and looking as if a portion of the mucous mem- 
brane of the stomach had been punched out ; or it may be 
large and spreading, with thickened sloping edges. The 
floor of the ulcer may be formed of the outer coats of the 
stomach ; or it may be constituted by one of the adjoining 
organs, the liver or pancreas, which has become adherent to 
the stomach by the process of inflammation and ulceration 
having extended to its surface. Sometimes gastric ulcers 
cicatrise and heal, sometimes they remain quiescent for 
a time, giving the false impression that cure has taken 
place ; but the ulcerative process often begins again, and 
in many cases ends in perforation. Perforation may take 
place into the peritoneum, into the colon or intestine, or 
into an artery, in which case profuse haemorrhage occurs. 
Sometimes, however, ulceration and infiltration of the 
tissues may extend to the adjoining organs, and a com- 


munication may even thus be established between the 
stomach and the external air through the abdominal 

The symptoms of gastric ulcer are pain, vomiting, and 
haimatemesis or bleeding from the stomach. The pain is 
characteristic. It occurs almost immediately after taking 
food, and it is either felt at the epigastrium, which becomes 
tender on pressure, or it is referred to the region of the 
spine corresponding to the last two or three dorsal or first 
two or three lumbar vertebrae, or to the region between the 
shoulders, the muscles on either side often being tender ; or 
again it may occupy the umbilicus or some area or point 
near, and when severe it radiates from its chief point of in- 
tensity towards the oesophagus, backwards to the loins, or 
downwards and laterally over the whole of the abdomen. 
The pain, when severe, is of a burning, boring, and shooting 
character, attended with a sense of soreness. Vomiting is 
a later symptom, but it is generally very persistent. The 
pain and vomiting occur soon after the ingestion of food. 
Haemorrhage takes place from time to time, the bleeding 
being from the excoriated surface of the ulcer, or when very 
profuse from the erosion of an artery. 

The tendency of gastric ulcer is towards recovery; 
and when death occurs it is from perforation of an artery 
causing profuse haemorrhage, or from perforation into the 
peritoneum, when collapse and death take place in a few 
hours, or from perforation into the viscera. Death may be 
caused by exhaustion in consequence of the patient sinking 
under the long-continued pain and vomiting, and becoming 
worn out by the want of food (Bristowe). 

Treatment by diet— It is obvious that in this distressing 
and painful malady diet is of the greatest importance, the 
necessity and aim being to maintain the strength of the 
patient by such food as can be digested without provoking 
movements of the stomach, and without causing the 
dreaded pain and vomiting. The object must be to give 
the stomach as much rest as possible, so that cicatrisation 


of the ulcer can go on uninterruptedly. Food must there- 
fore be given in very small quantities at a time, and at 
short intervals. In cases where there has been severe 
haemorrhage, and where it is likely to recur, the stomach 
must be kept absolutely at rest, and the patient fed by 
nutrient enemata for a few days at least. 

An exclusive milk diet is the diet indicated, and this is, 
as a rule, well borne in ulcer of the stomach. The casein 
of milk is, however, thrown down as curds on coming in 
contact with the gastric juice of the stomach, and these 
curds are often difficult of digestion, especially the curds of 
cow's milk, which are large and flocculent. To prevent 
their formation the milk should be mixed with an equal 
quantity of lime water or an alkaline water. Dr. Burney 
Yeo recommends that to every four ounces of milk be 
added ten grains of bicarbonate of sodium, five grains of 
hght magnesia, and ten grains of common salt dissolved in 
a tablespoonful or two of water. This may be taken every 
two or three hours. The yolk of an egg beaten up with 
two tablespoonfuls of hot water may, if required, be added 
to the cup of milk, and given twice a day, or an ounce of 
the crumb of a stale roll, well soaked previously in hot 
water, may be mixed with the milk two or three times a 
day (Yeo). Buttermilk is sometimes recommended, as 
curdling of the milk in the stomach is thus avoided, but 
the sour taste of the buttermilk is disliked greatly by 
some patients. Malt extract is recommended by some 
physicians, and a puree of potatoes in cases where a 
vegetable food is well borne. 

In some cases a milk diet cannot be endured. — There 
may be a distinct intolerance of milk — and recourse must be 
had to bouillons and purees of meat. The meat or chicken 
must be reduced to a fine pulp and mixed with a little 
broth or beef-tea. Leube's soluble meat (see page 120) is 
much used in Germany in these cases ; it is so prepared 
that it is ready for immediate absorption without the action 
of the gastric juice, and hence it must be a valuable pre- 


paration for ulcer of the stomach, where it is necessary 
to obtain healing by rest. 

Hot tea and coffee, gruel, porridge, and alcoholic drinks 
are strictly forbidden.— If the symptoms of pain and 
vomiting have disappeared, after two or three weeks of 
this restricted diet, there may be a gradual return to more 
solid food, but the greatest caution must be exercised not 
to take more food than is absolutely required for the 
support of the body. 

Useful Recipes for Convalescents. 

Puree of Chicken. — Remove all the skin and bones from part 
of a roast chicken. Chop the meat, pound it in a mortar and rub 
it through a sieve. Take the bones of the chicken and boil them for 
several hours with a shalot, a small piece of carrot, two leaves of 
celery, a bouquet of herbs, and enough water to cover them. Strain 
through a hair sieve and remove all the fat. Add the pounded meat, 
and simmer until it is sufficiently thick ; add half a gill of cream, a 
few drops of lemon juice, and a small lump of sugar. 

Creme de Volaille.— Melt half an ounce of butter and half an 
ounce of flour together in a saucepan, and add half a gill of white 
stock. Take the flesh of half a chicken, chop, pound it, and rub it 
through a sieve. When the sauce is cool, add one egg and half a 
pint of whipped cream, and mix all together. Put it into a buttered 
mould and steam for a quarter of an hour. 

Steamed Sole.— Skin and fillet a sole ; wash and dry the fillets, 
and put them in a jam-pot just large enough to hold them; sprinkle 
a little salt and lemon juice over them, and cover them with a 
buttered paper. Put the jam-pot into a saucepan half full of boihng 
water. Cover it tightly, and let it boil for ten minutes. Mix an 
ounce of butter with one ounce of flour in a saucepan over the fire, 
add one gill of milk and liquor from the fish, and cook for ten minutes, 
stirring well. Pour this sauce over the fillets, and garnish with 
slices of lemon and a sprig of parsley on the top of each fiWet.^Art 
of Feeding the Invalid.) 




Diabetes was considered not so long ago to be an in- 
curable and inevitably fatal disease. Thanks, however, 
to the labours of Claude Bernard, Germain See, and Pavy, 
the cause of this mysterious wasting disease has been dis- 
covered to be an inability on the part of the economy to 
assimilate starch and sugar, and, in the severer cases, in 
the morbid production of sugar from the tissues them- 
selves. Hence diet and the rigid exclusion of starch and 
sugar from the food become the most important factors in 
the treatment of diabetes. The value of starch as a food, 
and its behaviour in the body, are as follows. 

The action of starch in the body, and what becomes of it. 
— Starch is quite indigestible in the uncooked state ; when 
cooked it is insoluble, and incapable of passing through 
the membranes of the blood vessels of the stomach and 
intestine. To be rendered soluble and capable of assimila- 
tion it must be converted into glucose or grape sugar. 
This conversion of starch into glucose takes place partly 
in the mouth, by the action of the diastase of the ptyaline 
of the saliva, but much more rapidly in the duodenum by 
the action of the pancreatine of the pancreas. Cane sugar 
is dissolved by the fluids of the stomach, or is swallowed 
in a soluble condition. The soluble glucose and sugar 
are absorbed by the veinules of the stomach and intestine, 
and carried at once by the portal vein to the liver. In 
the liver the sugar is lost sight of ; though after the in- 
gestion of food the portal vein may contain an abundance 
of saccharine matter in solution, there is not a trace of 
sugar in the blood of the hepatic vein of a healthy person. 


What, then, becomes of the sugar in the liYer ?— This 
is a question which has been partially solved for us by 
the researches of Claude Bernard. He discovered the 
presence of an amyloid or starchy substance, which he 
called glycogen, stored in the liver cells; and the result of 
his researches tends to show that the soluble glucose 
which is brought to the liver by the portal vein is con- 
verted by means of a strange and not well-understood 
action of the liver cells into this insoluble substance or 
glycogen, which is then stored up in the cells. It is there 
available, as Claude Bernard insisted, for conversion again 
into sugar to be carried off by the capillaries and burnt up 
in the tissues in the course of tissue change and the pro- 
duction of energy. Claude Bernard contended that the 
liver was a magazine for the storage of sugar in the form of 
glycogen, and the regulation of its supply to the economy. 
Without the interposition of the liver, sugar would ob- 
viously be introduced into the circulation in irregular 
quantities at the moment of digestion, which would have 
a very disturbing influence on the system. It has since, 
however, been strenuously denied by Pavy that glycogen 
is ever reconverted into sugar, or that sugar is burnt up 
in the tissues. Recent researches tend to show that the 
formation of glycogen in the liver is the first step in the 
metamorphosis of starch and sugar into fat, and that it is 
fat and not sugar which is the hydro-carbon burnt up in 
the tissues. 

The cause of diabetes. — Now it is obvious that, if by 
some morbid change in the liver cells they have lost 
the power of arresting the sugar and converting it into 
glycogen, the sugar will pass into the general circulation, 
and that it will appear in the urine. This is what takes 
place in diabetes. The indication is therefore to check 
the ingestion of starch and sugar. There is also another 
dietetic indication given by understanding the normal 
physiological process. If, as is believed, fat is manu- 
factured from glycogen, the emaciation and weakness so 


characteristic of diabetes are due to the want of fat in 
the tissues, which fat is not only deposited in a smaller 
degree than usual, but is consumed in the production of 
force. It is therefore obviously necessary that as we 
deprive the diabetic of the carbo-hydrates of starch and 
sugar in his food, we should supply their place with the 
hydro-carbon of fat. 

Diabetes may be divided into ( i ) glycosuric dyspepsia, 
(2) diabetes minor, (3) diabetes major. 

1. In simple cases of glycosuric dyspepsia the disorder 
seems to be functional. It generally rapidly yields to 
dietetic treatment, and the sugar which may be present in 
the urine in the first instance in considerable quantities 
disappears almost completely, if not entirely, by the rigid 
exclusion of starch and sugar from the diet. In these cases 
it seems as if the liver had lost its power of converting 
sugar into glycogen, and that therefore the sugar ingested 
with the food, escapes unchanged into the blood. The 
excessive thirst, the malaise, and the dyspepsia character- 
istic of the malady disappear on the enforcement of a rigid 
diet, but they make their appearance again on any relaxa- 
tion of the regimen. 

2. In diabetes minor there is probably some permanent 
impairment of the powers of the liver ; and though by the 
maintenance of a diet devoid of starch and sugar the 
amount of sugar in the urine may be considerably reduced, 
it is scarcely ever banished altogether. It is these cases 
which derive so much benefit from the treatment by 
alkaline waters, carried out at Carlsbad and Vichy. This 
form of diabetes is frequently associated with gout, or what 
is called the uric acid diathesis. The continual mainten- 
ance of an exclusive diet has a quite remarkable influence 
in cases of diabetes minor ; and whereas patients here- 
tofore, before the cause and nature of diabetes were dis- 
covered, would drag out a miserable existence, tormented 
with thirst, growing weaker from increased muscular feeble- 
ness and doomed to an earl>- death, they can now be 



kept in fair!}- good health by a rational dietary, which it 
is neither painful nor disagreeable to maintain. 

3. Diabetes major generally occurs in young and thin 
persons, and is a very grave malady. It is little influenced 
by diet ; for though starch and sugar may be excluded, 
and the patient may be kept exclusively on flesh diet, the 
liver in this case exercises its power to break up the nitro- 
genous elements and to extract glycogen from albumin- 
ous foods, and even from the tissues of the patient 
himself; so that he is, as it were, devoured by the 
abnormal activit)' of his own liver. 

Two opposite causes for diabetes. — It is seen from the 
foregoing that similar symptoms are produced by totally 
opposite conditions. In diabetes minor the glycogenic 
function of the liver is depressed, and it fails to convert the 
sugar brought by the portal vein into glycogen. In diabetes 
major the glycogenic function of the liver is abnormally 
excited, and the liver cells convert into glycogen even the 
nitrogenous elements of the muscles of the patient. It is 
a question whether we have not here to do with two totally 
different diseases, and that, owing to the presence of an 
identical symptom, viz., the presence of sugar in the urine, 
we do not err in submitting both classes of patients to the 
same regimen. In the first, the exclusion of starch and 
sugar is well borne ; in the latter, the economy seems to 
cry out for sugar, in order to feed the rapacious voracity of 
the liver. The most, however, that can be done in cases of 
diabetes major is to relieve the sufferings of the patient, 
and to make the end as easy as possible. 



DIABETES— (continued). 

The dietetic treatment of diabetes is one of intelligent 
watchfulness. Cases differ so much from one another that 
no hard and fast rule applicable to all can be laid down. 
What is harmful to one patient is well borne by another ; 
and whereas a rigid regimen can be followed by one person, 
its maintenance leads to adverse complications in another. 
The successful treatment of the diabetic patient lies in fact 
between his cook and his doctor ; in the careful and intelli- 
gent preparation of his food on the one hand by the cook, 
and on the other in the checking and control of his diet by 
the physician, according to the physical signs given by ex- 
amination of the patient and his urine. On these depend 
the maintenance of a fair standard of health and comfort. 

The following table, showing the percentage composition 
of various articles of food, will be found to be most valuable 
to refer to in preparing the diet not only of diabetics, but 
of other invalids : — 

Water. Albumen, Starch, Sugar. Fat. Salts. 






Biscuit . 

Wheat flour . 

Barley meal . 


Rye meal 

Indian corn meal 




























Carrots . 









Cabbage . 






Treacle . 



New milk 






Skim milk 



Butter milk . 



Cheese . 


8 33-5 

Cheddar cheese 



Skim cheese . 



Lean beef 



Fat beef . 



Lean mutton . 



Fat mutton 






Fat pork 



Green bacon . 



Dried bacon . 



Ox liver . 






Cooked meat, roast 

no dripping being 

lost. Boiled, as 



sumed to be the 

same . 

Poultry . 



White fish . 






Salmon . 



Entire egg 



White of egg . 



Yolk of egg 



Butter and fats 



Beer and porter 



Albumen, Starch, 




























i5'45 2-95 









I '4 











There is one broad rule to be followed in the prepara- 
tion of the diet of a diabetic, that is to avoid all articles 



containing starch and sugar. The following list of articles 
of diet which may be allowed or must be forbidden to a 
diabetic, is based both on the published opinions of 
observers and on practical experience, and is given as a 
dietary table which may be faithfully followed. This 
table should be written out plainly on a piece of cardboard, 
and hung up in the kitchen of a diabetic patient for the 
guidance of his cook and housekeeper. 

A llowed. 

Butcher's meat of all kinds. 

Ham, bacon, and tongue when 
not sugar-cured. 

Poultry and game. 

Fish of all kinds. 

Oysters and shellfish. 

Crabs, lobsters. 

Beef-tea, broth, not thickened. 

Soups, made of meat stock with- 
out any starchy thickening. 

Jellies made without sugar. 



German sausage. 

Eggs, cheese, cream cheese, and 

Butter, fat, oil, and lard. 


Almond cakes, bran cakes and 
gluten bread, as substitutes for 
wheaten bread. 

*' Torrefied" or charred bread. 

Saccharin to replace sugar. 

Cabbage, endive, spinach. 

Broccoli, Brussels sprouts. 

Lettuce, spring onions. 

Cucumber, green asparagus. 

Watercress, sorrel. 

Salad, celery, tomatoes. 

Artichokes, mushrooms. 

Cauliflowers, sea-kale. 

Turnips, French beans. 


Sugar in any form. 

Wheaten bread, oatmeal cakes, 

Ordinary biscuits. 

Rice, arrowroot. 

Potatoes, carrots. 

Parsnips, beans, and peas. 

Sago, tapioca. 

Macaroni, vermicelli, 

vSpanish onions. 

All sweet fruits, such as grapes, 
cherries, peaches, strawberries, 
apricots, plums, gooseberries, 
currants, oranges, and all pre- 
served fruits. 


Puddings of every kind which con- 
tain sugar or farinaceous foods. 



English sausages. 



A llowcd. Forbidden. 

Vegetable marrow, dandelion. 

Cardoons, mustard and cress. 

Radishes, turnip-tops and nettles. 

Unripe fruits, such as green goose- 
berries, green currants, and un- 
ripe apples cooked with sac- 

Nuts of all kinds except chestnuts. 

Sardines in oil. 

Foie gras. 

Norwegian herrings in oil. 

Pilchards in oil. 


Savoury jelly. 



Tea and coffee. Champagne, and all sweet and 

Cocoa made from nibs and mixed sparkling wines. 

with cream. vSweet ales, mild and old porter 

Water, soda-water. and stout. 

Vichy and Apollinaris waters. Cider and perr)'. 

Claret and Burgundy. Sweetened lemonade. 

Dry sauterne and chablis. Port wine and Madeira. 

Champagne, sugar free. Liqueurs. 

Brandy and whisky, in small Rum and sweetened gin. 

quantities, unsweetened. Patent cocoas and chocolates. 

Milk, sparingly. Sorbets. 

Lemonade, made of fresh lemons. Fruit juices and syrups. 
and sweetened with saccharin. Ginger beer. 

Bitter ale, in moderate quantity. 

From this list it will be seen that the number of articles 

permitted a diabetic is large. The exclusion, however, of 

certain articles which we have come in modern times to look 

upon as of absolute daily necessity, is often felt severely, 

particularly at first, till the ingenuity of the cook has been 

exercised to discover an agreeable and varied dietary within 

the limits imposed. The strict exclusion of bread, the 

staff of life, is that which is felt most, and the patient ill 

reconciles himself to the gluten and bran breads and almond 

cakes which have been introduced as substitutes for wheaten 

bread, although these are useful in making an agreeable 


variation in the diet. It is well and wise so cleverly to de- 
sign and arrange the food of a diabetic patient that he can 
take his meals with his family, at a common table and 
from the same dishes, unaware, and without being con- 
stantly reminded, that he must not take this and must not 
touch that. To show how easily this can be done will be 
the object of subsequent chapters. 

The examination of the urine. — In order satisfactorily 
to carry out the dietetic treatment of a diabetic patient it is 
necessary to examine the urine daily. The initial physical 
sign of diabetes is the excretion of sugar ; stop this, and 
the symptoms of thirst, dryness of the mouth, lassitude and 
weakness are arrested. The effect of excluding starch and 
sugar from the diet can only be accurately ascertained 
by discovering if the excretion of sugar by the urine is 
arrested or diminished. There are various ways of testing 
the presence of sugar in the urine. The following is the 
easiest, and is one which can be well practised by a nurse. 
To a small quantity of urine in a test tube add half the 
amount of liquor potassae or liquor sodse, and boil. If 
sugar is present, a yellowish brown colour soon makes 
its appearance. This brown discoloration of the urine 
becomes more intense as the boiling is continued, and will 
be the deeper in tint the larger the proportion of sugar 
contained, becoming finally almost black if the quantity is 
very large. The coloration is produced by the colourless 
sugar being turned into brown molasses by heat, much in 
the same way as a deep brown sticky fluid is produced 
when a piece of lump sugar is burnt in a candle. If now 
to the coloured fluid in the test tube be added a few drops 
of nitric acid, the brown coloration disappears, and there is 
an odour of burnt molasses. To ascertain the amount of 
sugar present is a more difficult laboratory process ; but any 
nurse who has charge of a diabetic patient, or anybody who 
is closely watching the effect of diet on a diabetic person, 
should once a week, or at least once a month, collect the 
total quantity of urine passed in the twenty-four hours, and 



send a specimen to a doctor or a chemist for analysis and 
report. This analysis will be her chart, showing her how to 
direct her course of dietetic treatment. For her compass 
she needs to take daily the specific gravity of the urine, 
and to ascertain roughly, though with fair correctness, the 
amount of urine daily passed. As it would be troublesome 
and unadvisable for the patient to collect the whole of the 
urine passed in the twenty-four hours, a sufficiently accurate 
estimate can be obtained by collecting the amount of urine 
passed at night in the bedroom. This should be measured 
every morning, and the specific gravity taken. The record 
should be entered in a book, and kept for comparison with 
the record of the dietary of the patient, so that the effect of 
the food taken can be judged by watching its influence on 
the amount and the specific gravity of urine excreted. The 
normal specific gravity of the urine is about 1*025. This 
varies greatly, even in healthy persons, and may rise to 
I '030 or fall to roi5 without any deviation from health, 
but if the specific gravity is found to be constantly at or 
above rojo, sugar ma>' be suspected. The normal amount 
of urine excreted by a health)- man is about three pints ; 
in the diabetic this may be very much increased. 

A diabetic record. — The foUcnving extracts from the 
record of a diabetic patient, which was kept for several 
years, will show exactly what I mean, and how a nurse or 
a non-scientific person may easily check and ascertain the 
effects of diet on the patient under observation. 



at Night. 

30 OZ. 
30 „ 

21 ,) 
24 ,. 

34 -. 

26 „ 

28 „ 

16 „ 

I -025 
I '034 

I '020 

Dinner party, took sweets. 

Nervous, low spirits. 
Dined out. 
Tongue raw. 

•015 Much better, tongue better. 




Feb. 17th 
,, 23rd 
„ 24th 
„ 26th 

Apr. 5th 
„ 6th 
„ 8th 
„ gth 
„ loth 
„ nth 


at Night. 

S. G. 


I -025 
I '020 

1-035 I'^^'o helpings of treacle pudding 




1-040 Left off taking bread. 


I -033 



In this patient, who for ten years was carefully and 
successfully dieted, any indiscretion, such as was com- 
mitted when dining out, or in taking treacle pudding, was 
immediately detected by the specific gravity bulb, which, 
it will be found, gives sure and faithful directions as to the 
course of dieting to be pursued. 

Weighing the patient.— Emaciation is frequently a 
marked symptom of diabetes, and one which it is most 
important to check. A weighing machine should form 
part of the furniture of the bedroom of a diabetic, and he 
should be weighed at regular intervals, and the record kept. 
By depriving the patient of all starch and sugar in his diet, 
which, as we have shown in the earlier chapters, are the foods 
out of which much of the fat of the body is manufactured, 
and by his wasteful excretion of sugar, the body naturally 
emaciates. It becomes, therefore, of the greatest possible 
importance when framing his dietary not only to exclude 
starch and sugar, but to compensate for this exclusion by 
giving an excess of fatty foods. The influence of these 
must be noted by means of the weighing machine. 

We thus see that it is not only necessary to diet a 
diabetic patient, but closely and carefully to watch the 
effect of this diet on him, by ascertaining and recording its 
influence on the specific gravity and the amount of urine 
daily secreted, and on his loss or gain of flesh. 



DIABETES— (continued). 

Menus and Recipes. 

The principles of a diabetic dietary. — In order to 
facilitate the duties of the cook and housekeeper in 
providing for a diabetic patient an agreeable dietary, from 
which starch and sugar have been excluded, I have arranged 
a series of menus for the day's meals, and will give, in many 
instances, the recipes for the dishes. It will be noticed 
in studying these viemts that four principles have been 
followed — -firstly^ to exclude starch and sugar ; secondly, to 
supply their place by the hydro-carbon fat, so that there 
may not be a lack of energy-producing and fat-forming 
food ; thirdly, to make the meals digestible, a weakened 
digestion being a frequent accompaniment of diabetes ; 
and fourthly, to make the food as appetising as possible. 
Thus, with these objects in view, it will be seen that cream 
is used in the place of milk, cream being practically free 
from lactose, or sugar of milk ; unripe fruits sweetened with 
saccharin take the place of ripe fruits ; Bonthron's almond 
biscuits grated are used in thickening soups and sauces 
instead of arrowroot, and almond flour is employed instead 
of wheaten flour. Fish and vegetables are cooked with a 
liberal allowance of butter, and every opportunity is taken 
of adding the necessary amount of fat by means of such 
dainties as foie gras, cream cheese, olives, etc. In order to 
make the food digestible, directions are given to warrenise 
instead of to boil, and to braise instead of to bake. It will, 
I trust, be seen from these menus that it is quite unnecessary 


to add to the miseries already endured by a diabetic that of 
a repulsive and unpalatable diet. A common-sense com- 
bination of science and the culinary art will produce for him 
as dainty dishes as any epicure may desire. 


{Time — Suniinev.) 

First Day. 


Buttered eggs. 

Sole, fried in butter, with lemon juice added when served. 

Cocoa made from nibs, with cream. 

and " torrefied bread '". (i) 


Hot sardines on toasted gluten bread. (3) 

Warrenised breast of lamb, with spring cabbage. (2) 

Camembert cheese with Callard's cheese biscuits. 


Spinach soup. (4) 

Cutlets of salmon fried in slippers. 

Poulet a I'estragon. (5) 

Green-gooseberry fool (6), sweetened with saccharin. 

(i) Torrefied Bread is made by toasting thin slices of 
ordinary bread before the fire until they are deeply and thoroughly 
browned, almost blackened, so that the starch and gluten are in 
great part destroyed by the heat (Yeo). 

(2) Warrenised Breast of Lamb, with Spring Cabbage. — A 
Warren cooking pot is a very necessary article de cuisine. It is a pot 
consisting of three stages connected by a steam chimney. A small 
amount of water is put in the bottom of the pot ; in the second stage 
the meat is placed with its flavourings, and in the top the vegetables. 
The food is, it will be seen, thus cooked by steam ; all the juices of 
the meat are therefore retained, and not lost in the water as in boil- 
ing. Meat is rendered much more succulent, tender, and digestible 
by warrenising than by boiling. 

(3) Gluten Bread cut into slices, soaked in butter and toasted 
or fried, is very palatable, and will be found a useful article in the 
preparation of food for diabetics. 


(4) Spinach Soup is made from a weak meat or bone stock, to 
which a fine puree of spinach is added. Some cream is added when 
the soup is poured into the tureen. Puree soups made of the vege- 
tables permitted are very useful additions to the dietary. Among 
them may be mentioned turnip, tomato, sorrel, lettuce, and asparagus 
soups, to all of which cream may be added with advantage if it is 
well tolerated by the patient. 

(5) PouLET A l'Estragon. — It will be found useful to study the 
various ways of preparing fowls from French and English cookery 
books, the forbidden ingredients being replaced by those permitted. 
The amended receipt can then be written out by the housekeeper 
and given to the cook for her guidance. Poulet a I'estragon is a 
very palatable dish. Before cooking, the liver is removed and a 
bunch of fresh tarragon is placed inside the fowl. The fowl is then 
roasted or braised. When finished it is cut into joints which are 
placed upon croutons of gluten bread, the whole being sprinkled 
with chopped leaves of fresh tarragon. Fresh roasted tomatoes are 
placed round the dish. The liver and giblets are stewed with 
tarragon leaves. When sufficiently cooked the liver is rubbed 
through a fine hair sieve to thicken and flavour the gravj', which is 
served in a sauce boat. 

(6) Green-gooseberry Fool. — The deprivation of ripe fruits is 
often severely felt by the diabetic patient. It is, however, perfectly 
safe for him to take unripe fruits before the sugar is developed in 
them, and these can be made into palatable and digestible dishes 
by stewing them with saccharin, passing them through a sieve, as 
in " fools," or mixing cream into them. 

Secoxd Day. 

Fresh haddock fried in butter. 
Cold tongue. 
Coffee and cream. 


Vegetable marrow farcie. (7) 

Devilled ham and French beans. (8) 

Cheddar cheese with diabetic biscuits and butter. 



Clear soup. 

Roast lamb. 

Green asparagus with clear melted butter. 

Almond pudding. (9) 



(7) Vegetable marrow or cucumber makes an excellent dish 
boiled and stuffed with veal forcemeat, in which, instead of bread 
crumbs or flour, Bonthron's grated almond biscuits must be used, 
but the forcemeat must be bound together with a beaten egg. 

(8) "Devils" are easily made, and render a dish of cold meat 
palatable and savoury. A paste is made of almond flour, curry 
powder, mustard, salt, and oil, with sauces to vary the flavour. 
This is spread on the cold meat to be devilled, before grilling. 
Served hot. 

(9) Almond Pudding and Cakes. — The correct making of 
almond pudding and almond cakes by the cook of a diabetic is an 
art to be practised and mastered. When sweetened with saccharin 
they make tasty sweet dishes, which prevent the patient from 
missing and longing for the forbidden puddings of former days. 
The following recipes will be found most valuable : — 

Almond Pudding. — Take two eggs, a quarter of a pound of 
almond flour, a quarter of a pound of butter, and three tabloids of 
saccharin dissolved in a tablespoonful of brandy. Warm the butter, 
beat in the almond flour and the yolks of the eggs, adding the 
dissolved saccharin. Whisk the whites into a stiff froth, beat 
all together. Put into dariole moulds and bake in a quick oven, and 
serve with a little hot sauce made with dry sherry and saccharin. 

Almond Biscuits. — To every ounce of almond flour add two 
whites of eggs and a little salt to taste. Beat the whites to a 
stiff froth, add the almond flour, and beat well together. Put in 
buttered patty-pans, and bake in a moderately quick oven from 
fifteen to twenty minutes. The whole has to be done quickly, and 
baked directly the ingredients are mixed. This biscuit will be found 
very useful as a substitute for bread. 

Third Day. 


Fresh herrings with mustard sauce. 

Savoury omelette. 

Tea with cream. 


Cold mutton with French bean salad mixed with oil and a dash of 


Stewed lettuce. (10) 

Roquefort cheese with diabetic rusks. 



Tomato soup. 

Sweetbreads aux fonds d'artichauts. (ii) 

Fillet of beef garnished with cauliflowers. 

Custard pudding sweetened with saccharin. 


(lo) Stewed Lettuce.— A well-grown lettuce is selected. It 
is first boiled in plenty of water, care being taken not to let it drop 
to pieces. When nearlj' done take out, drain, and place in a stew- 
pan with a little rich brown gravy, and allow it to simmer for twenty 

(ii) The Sweetbreads are first stewed in milk, then removed 
and rolled in slices of fat bacon and placed in the oven for a quarter 
of an hour. The bacon is then removed, and the sweetbreads are 
cut in slices, and grated Parmesan cheese is shaken over them. 
They are again placed in the oven and braised in a rich brown 
glaze. Served on a crouton of gluten bread, in the centre of which 
is placed the fonds iVaytichauts boiled and cut in quarters. 

Fourth Day. 


Curried eggs (without rice). (12) 


Cocoa made from nibs, with cream. 


Braised knuckle of veal with mixed vegetables. (13) 

Foie gras with diabetic biscuits. 


Cock-a-leekie soup. 

Turbot with tartar sauce. 

Duck with olives. 

Cucumber au sauce Fairlawn. (14) 


(12) In making Curries, cocoanut or green apples can be used 
as the basis of the curry. 

(13) The braising of meats makes them much more digestible 
and also more savoury than roasting. Put in the braising pot a 
little fat or butter and finely-chopped onion, and brown the knuckle 
of veal in it. Then add more fat — bacon fat being preferable — a few 
vegetables, spices, a bunch of herbs, salt, and pepper. Close the 
pot securely so as not to let the steam escape, and place hot coals 


on the lid from time to time to obtain equal heat top and bottom. 
Time taken, half as long again as for roasting. 

(14) Cooked Cucumber is a very useful article. It is boiled in 
the same way as vegetable marrow. "Sauce Fairlawn " is made 
from butter, milk, and yolks of eggs, adding three tablespoonfuls 
of grated Parmesan before serving. This sauce is poured over the 
cucumber in the dish when served. 

Fifth Day. 


Eggs, with black butter. 

Grilled kidneys and bacon. 

Cream and aerated water. 


Fish pudding. (15) 

Cold meat and tomato salad. 

Neufchatel cream cheese and almond biscuits. 


Bisque soup. (16) 

Boiled fowl, with bechamel sauce (17) and baked mushrooms, 

vegetable marrow. 

Green currant fool. 

Hot caviare on gluten croutons. 


(15) Fish Pudding. — Make a thick white sauce of butter, milk, and 
yolks of eggs, to which either anchovy, Worcester, or Harvey sauce, 
ketchup, a little chopped anchovy, shredded onion, and a small amount 
of pickled mango are added according to taste. Pour the sauce over 
the fish after it has been broken up, and bake in a dish in the oven. 

(16) Bisque Soup. — This is made in the usual way, except that 
it is thickened with almond biscuits grated instead of rice. 

(17) In the Bechamel Sauce the beaten yolks of two or more 
eggs are added to thicken. 

Sixth Day. 


Poached eggs and spinach. 

Smoked salmon. 

Van Houten's cocoa, made with cream. 


Crab omelette. (18) 

Cold or hot mutton. 




Sorrel soup. 

Cream of veal. 

Turkey poult, with French beans. 

Cauliflower au gratin. 


(i8) Crab Omelette. — Break the eggs required into a basin, 
season with salt, pepper, chopped parsley, and a small piece of 
chopped shalot ; beat well together with a whisk, shred the crab, 
and mix it with the eggs. Fry in butter in the usual way. Another 
way is to make the omelette and put the shredded crab inside instead 
of folding it over. 

All kinds of omelettes, excepting sweet omelettes — viz., omelettes 
with fine herbs, with kidneys, with oysters, with ham, etc., are suit- 
able for diabetic patients. 

Seventh Day. 


Kippered herrings. 

Grilled bones, with buttered broccoli. 

Egg flip- (19) 


Mayonnaise of lobster. 

Stewed pigeons with mushrooms. 


Gruyere cheese. 


Julienne soup. 

Broiled sole with white wine sauce. 

Grilled mutton cutlets with savoury sauce. (20) 

French beans. 

Lemon sponge. 


(ig) Egg Flip. — This will be found most useful, especially in 
those cases of diabetes where there is much dyspepsia, from which 
the patient suffers particularly in the morning, and is consequently 
unable to eat a good breakfast. Heat half a pint of milk not quite 
to boiling point ; pour it on to the well-beaten yolk of an egg, stirring 


all the time. Add two tablespoonfuls of unsweetened whisky or 

(20) Grilled Cutlets are much improved by a good sauce. 
The following recipe is excellent : Melt a piece of butter on a plate, 
and add a piece of glaze about the same size as the butter, also a 
little Harvey, Worcester, anchovy, or ketchup sauce, varying to 
taste. Well mix with a knife, and spread over the cutlets before 
broiling. When done, serve with the gravy from the chops. 




A Week's Menus for a Diabetic. 

{Time— Winter.) 

First Day. 


Smoked salmon. 

Kidneys and bacon, on a bed of Brussels sprouts. 

Nib cocoa and cream. 


Roast grouse. 

Baked custard pudding, with bottled green fruit 

stewed with saccharin, (i) 

Brie cheese. 


Celery soup. 

Red mullet en papillotte. 

Spanish steaks. (2) 

Tomatoes, with frozen savoury cream. (3) 

Russian caviare on gluten croutons. 


(i) Bottled Green Fruit.— The fruit— greengages, plums, 
gooseberries, cherries, currants, etc.— should be gathered when green 
and unripe, bottled in the usual way, and sweetened with saccharin. 

(2) Spanish Steaks.— Take one pound of rump steak, two onions, 
two ounces of butter, one and a half gills of brown stock hot, half a 
tablespoonful of tarragon vinegar, and one tablespoonful of cream. 
Cut the steak into rounds, score them with a knife, sprinkle parsley 
on the top of each, then put a little butter and vinegar over them ; 
let them stand while the sliced onion is frying in the butter. Strain 
the steaks, see that no fat is left in stewpan, cover the bottom of it 
with the hot stock, let the steaks simmer gently in the stock for one 


hour, then dish them. Reduce the gravy by stewing to half the 
quantity, pour it round the steaks, adding the onion before serving. 

(3) Cut fresh tomatoes in half, place them on ice till slightly 
frozen, whip a proportionate amount of cream, mix with it pepper, 
salt, a little tarragon vinegar, ice and place a dessertspoonful on 
the cut surface of each tomato. 

Second Day. 


Herrings and mustard sauce. 

Cold tongue. 

Callard's almond biscuits. 

Coffee and cream. 


Oyster omelette. 

Koast loin of mutton with mashed turnips. 

Gorgonzola cheese. 


Clear soup and grated Parmesan cheese. 

Steamed turbot with Dutch sauce. 

Braised pheasant with puree of savoy cabbage. 

Sea-kale with French butter. 

Third Day. 


Cod roes, stewed brown. (4) 

Swiss eggs. (5) 

Potash water and cream. 


Roast rabbit with stewed leeks. 

Rhubarb and cream. 

Stilton cheese and Callard's cheese biscuits. 



Soup, croute au pot. (6) 

Roast goose and broccoli. 

Stewed celery. 

Cocoanut cream. (7) 


(4) Fresh Cod Roes are rather neglected; they can be purchased 
for a few pence, and are excellent for breakfast stewed brown. Par- 


boil them first ; let them get cold ; cut in slices, and stew in a rich 
brown gravy. They make also a light pleasant dish, fried in cutlets. 

(5) Swiss Eggs. — Spread two ounces of butter on the bottom of 
a fire-proof porcelain dish, and lay on it six thin slices of Gruyere 
cheese ; break six eggs on this, keeping the yolks whole. Sprinkle 
over some mignonette pepper and salt. Mix together a tablespoonful 
of chopped parsley and two ounces of grated Gruyere cheese. Strew 
over the eggs. Bake in a quick oven from ten to twelve minutes. 
Serve in the dish they are baked in. 

(6) Croute au Pot. — The croutons must be made of gluten bread. 

(7) CocoANUT Cream. — Whip cream and mix fresh grated cocoa- 
nut with it ; sweeten with saccharin if required. 

Fourth Day. 


Fried bacon, served on a puree of Brussels sprouts. 

Cold pheasant. 

Van Houten's cocoa and cream. 


Braised leg of Welsh mutton, with tomatoes and mushrooms. (8) 

Cheese cake (g) and cream cheese. 


Hare soup, without wine. 

Water souchet of sole. 

Duck with turnips. (10) 

Russian salad (leaving out the potatoes, carrots, and peas). 


(8) The mutton is braised as already described. The tomatoes 
and mushrooms are cooked in the oven with a little butter, and placed 
round the dish. 

(g) Cheese Cakes. — One pint of milk, half a tablespoonful of 
rennet, one ounce of butter, two eggs, one tablespoonful of brandy, 
quarter of an ounce of almonds, and saccharin. Turn the milk to a 
curd ; let it stand in a warm place till thoroughly set, tie a piece of 
muslin over a bowl, break up the curd and pour it on to the muslin ; 
leave it till all the whey has run off. Beat the curd smooth and add 
the butter and eggs well beaten with the brandy, almonds, and sac- 
charin. When well mixed pour some of the mixture into each of the 
patty pans and bake for about fifteen to twenty minutes. 

(10) Duck with Turnips. — Slightly brown the duck in a flat 
stewpan with a little butter and onion; then add a pint of good stock 


well flavoured with vegetables, herbs, spices, etc. Keep the stewpan 

well closed, so that the steam does not escape. Simmer gently for 

one and a half to two hours. Remove the fat from the gravy and 

serve it with the duck. The turnips are cut in thin slices, fried gently 

in butter, and served in the dish with the duck. 

Fifth Day. 


Ham or tongue omelette. 

Spiced beef. 

Tea and cream. 


Larded sweetbread. 

Cold mutton with endive salad. 

Camembert cheese. 


Lettuce soup. (11) 

Fried cutlets of cod. 

Sirloin of beef with gherkins (12) and stewed Scotch kale. 

Devonshire junket. (13) 


(11) Lettuce Soup. — This is made the same way as spinach 
soup, only winter lettuce is used. 

(12) Sirloin of Beef with Gherkins. — Roast the beef; when 
half cooked add the vinegar from a bottle of gherkins to the drip- 
ping, and baste constantly. Chop the gherkins quite small, and 
place them round the dish in the gravy when served. 

(13) Make the junket in the usual way; add a solution of sac- 
charin to the whipped cream. The succharin must not be added to 
the milk, else the rennet will not make curds. 

^ Sixth Day. 


Stewed mushrooms. 

Cold fowl. 

Boiled eggs. 


Oxtail haricot. 

Coffee cream. 


Oyster stew. 

Marinaded venison cutlets. 

Boiled guinea-fowl, with celery sauce. 

Little tarragon creams. (14) 


(14) Put into a basin one white and two yolks of eggs, a quarter 
of a pint of cream, a little white pepper and salt. Beat up well with 
a fork till smooth, and add a little chopped tarragon. Butter some 
little dariole moulds and sprinkle them with chopped tarragon and 
truffles mixed. Pour in the cream mixture, and stand the darioles 
in a stewpan of boiling water reaching to three-quarters of the height 
of the moulds. When the water boils draw the pan to the side of 
the stove and poach for about twenty to thirty minutes till the creams 
are set. Turn out on to a warm dish, and serve with cream sauce 
round them. The cream sauce is prepared by putting into a stew- 
pan one oz. of butter, two raw yolks of eggs, four tablespoonfuls of 
thin cream, a pinch of salt, and three or four drops of lemon juice. 
Stir in a bain-marie till the sauce thickens, add a saltspoonful of 
tarragon vinegar, and strain it. Mix in a light sprinkling of fresh 
tarragon and serve. This cream sauce will be found nice to serve 
with fillets of soles, whiting, etc. 

Seventh Day. 


Finnan haddock. 

Cold brawn. 

Cocoatina and cream. 


Boiled calf's head. 

Turnip tops. 


Clear soup with poached eggs. 

Fried cutlets of plaice. 

Roast turkey. Broccoli sprouts. 

Fish-roe souffles. (15) 


(15) FisH-ROE Souffles. — Take six soft roes of fresh herrings; 
blanch, pound, and tammy them ; then flavour with salt, pepper, 
powdered mace and nutmeg; add half an ounce of butter and the 
yolks of two eggs ; beat well together ; whisk the whites of six eggs 
into a stiff froth, mix same with the roes, and bake in rammakin cups 
for about five minutes. Serve immediately the souffles are removed 
from oven. 

From the above menus and recipes it will be seen that 


the diet of a diabetic need not be monotonous and re- 
pulsive. All that is necessary is to study cookery books, 
to eliminate all starch and sugar from the recipes, and to 
make experiments to see if good dishes can be made by 
substituting saccharin for sugar, and almond flour for 
starch, or by omitting it altogether. 



DIABETES— (continued). 

Carlsbad. Marienbad, Vichy. 

Carlsbad has been called " the hospital for diabetics "• 
It is a hospital, however, of which the walls are the pine- 
clad hills, the roof the sunny sky, and the medicine the 
hot bubbling streams. At Carlsbad, the dietetic treatment 
of diabetics is carried out under the most agreeable and 
revivifying conditions. 

The town of Carlsbad lies in a narrow winding valley, 
through wdiich flows the stream of the Tepel. The houses 
climb the hills on either side ; and it seems to have been 
hard to find level spaces for the Curhaus, and the concert 
and promenade rooms. At certain spots in the shallow 
river, hot saline water is seen bubbling up through the 
crust of the earth and mixing with the stream. One of 
these hot springs, called the Sprudel, shoots high into the 
air, while others bubble up slowly into wells and reservoirs. 

All the Carlsbad waters contain the same alkaline 
ingredients in almost identical proportions ; they vary 
only from one another in the amount of carbonic acid 
they contain, and in the temperature at which they come 
to the surface. This temperature varies from lOO deg. to 
1 66 deg. The principal salts they contain are sulphate of 
sodium, chloride of sodium, carbonate of sodium, and car- 
bonate of calcium. The springs are believed to be derived 
from a common source seven to eight thousand feet 
below the surface of the earth. In fact, Carlsbad may be 
considered to be set down over an immense cauldron of 
boiling water, which is forced up under the pressure of the 


steam through cracks and holes in the earth's surface. 
The water is very agreeable to drink, and has been com- 
pared to rather salt chicken broth. 

Life at Carlsbad is framed to be free of care, and as 
diabetes is frequently caused by over-anxiet\- of mind and 
the worry of life, it may be conceived that to be relieved 
altogether from the causes of the malady may alone effect 
the cure. On arriving at Carlsbad one is immediately 
visited by the tax collector, who demands a tax of from 
four to fifteen florins from every visitor according to his 
means. With the money obtained from this universal 
cure-tax, the immense forests which stretch for miles round 
about Carlsbad are maintained as public gardens; twc^ 
bands of the best reputation, and composed of highly- 
trained performers, are engaged to give music all day long 
to the visitors ; the theatre is subsidised, and the Curhaus 
and promenade rooms are kept up. Lodgings can be ob- 
tained at Carlsbad at every price. The usual course of 
life is as follows. 

At the wells. — Called early, the visitor is out in the 
fresh morning air by six o'clock at the latest, and with a 
glass cup suspended by a leather strap across his shoulder, 
he takes his way to the great Curhaus which covers the 
spouting waters of the Sprudel, or to the wells of the 
Schlossbrunn, Muhlbrunn, Elizabethquelle, or Neubrunn, 
as he may be directed by his physician. He joins the 
queue at the well, and in turn hands his cup to be filled 
by one of the neat little maidens whose duty it is to 
charge the glasses. Waiting until the water is cool 
enough to drink, it is slowly sipped, while the delightful 
strains of Labitzky's band are enjo}'ed. A short walk of 
about twenty minutes is then taken either up and down the 
covered promenades of the Curhaus, or among the flower- 
beds of the Stadtpark. In the course of two hours three 
or four half-pints of hot water have been drunk, and three 
or four miles have been walked. 

Breakfast. — By this time one feels not disinclined for 


breakfast ; but rigid abstemiousness is the rule of life at 
Carlsbad, and though one might feel capable almost of 
eating a mutton chop or some ham and eggs or fish for 
breakfast, it is not allowed. Cheerfully submitting to the 
doctor's orders, the many visitors are seen trooping into the 
various bakers' shops, and purchasing their frugal breakfast 
in the form of a couple of " crescents," or some of the 
admirably made diabetic cakes. With these in a paper 
bag the patient betakes himself to one of the many little 
tables set out under the trees of the restaurant gardens ; where 
breakfast is made, from coffee, the bread purchased at the 
baker's, with perhaps a single boiled egg, or a few slices of 
German sausage. 

Bathing. — After breakfast the papers of the day are 
leisurely read, and at about eleven o'clock the operation of 
bathing is gone through. The baths are of different kinds, 
hot saline baths and vapour baths ; but the characteristic 
bath of Carlsbad is the peat bath. This consists of black 
peat pulverised, then screened and freed from accidental im- 
purities and mixed with hot Sprudel water. After lying in 
this mixture for some time the patient takes a dip in a 
bath of clean water. The effect of the peat bath is said to 
be stimulating to the skin and sedative to the nervous 

The midday meal. — The patient will then go home 
and rest for a while, till at about one o'clock the pangs 
of hunger become irresistible. He betakes himself to 
one of the many large air}- restaurants furnished with 
balconies or shady gardens, where he can take his midday 
meal in the open air. Dinner is frugal and strictly 
kiirgcii/dss. It may consist of a course of fish, meat, or 
fowl, the orthodox green vegetables and cheese, with a 
single glass of lager beer or claret; no bread or sweets are 

The afternoon is spent in strolling along the beautiful 
paths of the forest, or in walking through the valley to one 
of the gardens, where a delightful classical concert given by 


Labitzky's band ma}' be enjoyed, while sipping coffee 
under the shade of the trees. 

The evening meal is taken about seven, and consists of 
a bowl of bouillon or a couple of poached eggs, or some 
dish making an equally light repast. For those who are 
well enough, and who can enjoy social pleasures, there is 
an excellent theatre and frequent dances at the Curhaus 
from eight to twelve, at which visitors are expressl}- 
requested to attend en toilette de ville. Most patients, how- 
ever, seek their beds at about nine o'clock, having been 
sufficiently tired out by this idle da}- of drinking water, 
bathing, and taking pic-nic meals to the strains of an 
excellent band. 

The influence of this peaceful life and the strict diet 
enforced on the diabetic patient is quite remarkable. It is 
ascribed by many to the waters ; but it is, I believe, a fact 
that these waters may be taken at home, where the patient 
is subjected to the usual worries, anxieties, and work of 
daily life, and they will not produce the same result as 
when taken whilst he is living a quiet, open-air life, free of 
care, in Carlsbad. The cure is, in fact, not only a water 
cure, a bath cure, and a diet cure; but a music cure, a fresh- 
air cure, and a laissez-aller life cure. In a ver}^ short time 
these beneficial influences are felt. The diabetic loses his 
dyspepsia, his depression of spirits, and his extreme thirst, 
and he gains strength and begins to feel again that life 
can be enjo}'ed. 

Careful daily examinations of the urine show at the 
same time that the percentage of sugar steadily diminishes; 
in fact, in most cases of diabetes minor it will entirely dis- 
appear in the course of three or four weeks' treatment. The 
cure is, however, not a permanent one ; it is generally 
necessary for the patient to return to Carlsbad every year. 
In fact, the remembrance of freedom from his troubles be- 
comes, as soon as they return the following year, persuasion 
enough to induce him to think of another visit to the springs. 
Men occupying responsible and important public posts have 


been known to be visitors at Carlsbad for twenty, thirty, 
and even forty years in succession, thus preserving their 
health and their possibilities of public usefulness and of 
personal enjoyment of life, by an annual stay of three or 
four weeks at Carlsbad. 

Marienbad is nineteen miles south of Carlsbad, and 
its waters closely resemble those of Carlsbad, excepting 
that they are of a much lower temperature, ranging from 
43' to 50° Fahrenheit. The springs were first brought into 
notice in 1870 by the abbot of the convent of Tepel, and 
since then Marienbad has become a very fashionable resort, 
and is crowded in the summer with visitors. It is preferred 
by some to Carlsbad, owing to the fact that it is situated 
on a hill 2000 feet above the sea level, instead of in the de- 
files of a narrow valley like Carlsbad. The air is fresh, in 
fact at times even chilly ; but the beauty of the environs, 
the extent and variety of the walks through the forests, and 
the general gaiety of the place, make Marienbad one of the 
favourite spas of Bohemia. 

Vichy is another spa greatly resorted to by diabetics. 
It is eight hours by rail south of Paris, and is situated in a 
pleasant valley 800 feet above the sea level on the bank of 
the river AUier. The waters are alkaline, and contain a 
large amount of bicarbonate of sodium. They vary in 
temperature. Some are hot, others nearly cold. The waters 
come from immense underground reservoirs, which may be 
visited by passing along dark subterranean passages. The 
effect of drinking these alkaline waters daily, seems to be to 
maintain the fluids of the body in an alkaline condition, to 
promote oxidation and quicken tissue change, and to im- 
prove assimilation. Thus they have the opposite effects 
of fattening the thin and thinning the fat; the former by 
improving digestion, increasing assimilation, and aiding the 
formation of flesh ; the latter by rapidly oxidising inert and 
unnecessary fat tissue. 

The influence of Vichy waters on diabetes is often very 
marked. In 100 cases treated by Barthey, fifty lost all 


traces of sugar ; in sixteen it was greatly diminished ; while 
in thirty-four it remained stationary, although digestion was 
improved. Slight cases of diabetes improve greatly at 
Vichy, but more severe cases require protracted treatment 
and frequent return to the spa. The dietetic treatment is 
strictly enforced at Vichy, but there is much to amuse and 
distract the patient, and to make his period of "cure" pass 




Gout seems to be the most ancient, the most persistent, and 
still the most incomprehensible of diseases. Its origin, its 
cause, and its cure are almost as little understood now as 
in the time of the Romans. Any number of views have 
been promulgated ; but after reading them the poor student 
in search of knowledge is more confused than he was 
before, when he held the simple and popular opinion that 
chalk stones meant gout, and that colchicum relieved the 
attacks. Among many opinions, that of Dr. Todd seems 
to be the most practical, when he says : " There is no dis- 
ease in which the patient can do so much for himself, or in 
which the prescriptions of the physician are of so little 
avail without the full and complete co-operation of the 
patient, as in gout." 

Causes of gout. — So far as we understand gout it seems 
to be caused by a want of balance between the intake of 
food and the power of the body to oxidise and utilise it, 
and it can be controlled by the patient checking the con- 
sumption of food, and taking means to promote oxidation. 
Let me explain. It will be remembered that when I de- 
scribed the part played by albumen in metabolism, I 
showed how albumen and the foods containing that sub- 
stance are oxidised in the body [vide chapter i., page 5). 
After yielding the nitrogen necessary for the reconstruction 
of the vital fluids of the body, the final product of albumen 
is urea, which is separated from the blood by the action of 
the kidneys, and being very soluble, it is dissolved in the 
urine, and cast out of the body as a waste product. 

Uric acid formation in gout.— Now, it can easily be 

GOUT. 159 

understood that if by some fault in the organism the oxida- 
tion of albumen is not completed and carried on to the 
final production of urea, but stops short at the production 
of a less highly oxidised substance, namely, uric acid, 
there will be a disturbance of the ordinary course of action 
in the body {vide chapter xxviii., page 166). This uric acid is 
not, moreover, soluble like urea, and cannot be carried off 
by the kidneys with the same facility, being an insoluble 
and intractable substance. It exists in the form of small 
pointed crystals, which cause irritation of the urinary pas- 
sages. Circulating in the blood, uric acid enters into 
combination with the sodium of the serum, and forms 
acicular crystals of urate of sodium, which are deposited in 
the membranes of the joints, giving rise to the well-known 
symptom of gout, namely, chalk stones. The attacks of 
gout are caused by an effort of nature to get rid of these 
deposits of a foreign substance in the joints ; the joint be- 
comes acutely inflamed, there is an increased flow of blood 
to the part, and urate of sodium is discharged into the 
blood current. 

The want of physiological balance in gout.— Now, it 
will be understood that, if by some inherited or acquired 
vice of the constitution the gouty person has not the power 
of oxidising the amount of food ordinarily taken, there will 
consequently be a want of balance between the consumption 
of food and the elimination of waste products, with the 
inevitable result that a quantity of effete and injurious 
material remains circulating in the blood. The person 
threatened with gout must, if he would be healthy and 
wise, ascertain by careful observation and experiment the 
exact amount of food which his body has the power of 
oxidising, or he should by increased exercise and fresh air 
so stimulate oxidation in the body that the balance can be 
restored and maintained. There is no doubt that this can 
be done; but the gouty person- must, if he would be free 
from the attacks of his malady, become an ascetic in the 
matter of eating and drinking. 


The intake of food should be strictly limited. — The 

gouty person should never eat to satiety, but only enough 
to maintain strength and to restore the waste of the body. 
It is difficult to lay down any hard and fast rule on the 
question of the amount of food to be taken, as it would 
depend in a great measure on the amount of exercise taken 
daily. This is, therefore, a matter which the patient must 
decide for himself after careful observation. T am ac- 
quainted with a vigorous old gentleman of eighty-eight, 
who successfully keeps the attacks of gout to which he is 
liable, at bay, by a frugal and scientific dietary. He break- 
fasts on fruit ; at mid-day he takes a small meat meal con- 
sisting of four ounces of meat if he has walked twelve miles 
in the previous twenty-four hours, and of two ounces of meat 
if he has only walked six miles. His evening meal consists 
of baked apples, custard pudding, or some similar light 
dish. On this simple dietary, combined with active exer- 
cise, this octogenarian is able to live a busy public life, 
to be alert in mind and vigorous in body, and to ward off 
the gout which would have killed a more self-indulgent 

The Kinds of Food to be Taken and Avoided. 

Foods containing starch and sugar should be avoided 

or taken in moderation. As already explained, starch is 
turned into glucose or sugar by the process of digestion, so 
that starch and sugar may be considered to have the same 
effect. Why sugar should have so deleterious an effect on 
the gouty is ill understood ; but it is the common experience 
of gouty persons that sugar is poison to them. It is sup- 
posed that as starch and sugar are more easily and rapidly 
oxidised in the body than albumen, and as in the gouty the 
power of oxidation of foods is impaired, if the usual mixed 
diet of foods containing albumen, starch, and sugar be 
taken, the bod)- will seize on the more easily oxidisable 
starch and sugar, while the albumen will remain partl}- 
oxidised, thus causing the production of urate of sodium in 

GOUT. l6l 

the blood, which, as I have shown, is the cause of gout. 
For the same reason fatty foods should be taken in mode- 
ration. They rapidly undergo acid fermentation in the 
stomach, and become, in some measure, the cause of the 
" acidity " so much complained of by gouty subjects. 

The diet should be limited to beef, mutton, chicken, 
game, fish, eggs, green vegetables, a few ounces of stale 
bread, and a small quantity of butter (Roose), Fruit may 
be allowed, if not too sweet, and if found by experience 
not to disagree. Tea and coffee should be used in mode- 
ration. Cocoa made from nibs is recommended. Milk is 
ill-tolerated by some ; but in other cases from one to two 
pints a day can be taken with advantage. Pastry of all 
kinds is forbidden. Bread, rice, potatoes, beans, and peas, 
all of which contain a large amount of starch, should be 
taken only in small quantities. The gouty person should 
not therefore be a vegetarian ; for the vegetarian, in order 
to obtain the amount of albumen necessary for tissue 
change in the body, is obliged to take with it a large 
amount of starch, as vegetable albumen is contained in 
beans and peas, which are full of starch. The gouty person 
should, however, be a total abstainer, for it is indis- 
putable that alcohol in any form is injurious. Excessive 
beer drinking is often the cause of gout among the poor, 
while a long course for many generations of " high living " 
is the fruitful source of gout among the well-to-to. If the 
enfeebled digestive powers need the stimulus of alcohol, old 
brandy or whisky well diluted, or good claret or hock, are 
the most suitable and least injurious drinks. Water is the 
only article of diet the gouty may take in excess. It is well 
for him to drink an abundance of water, either hot or cold 
as he may prefer. Water washes out the tissues, augments 
secretion, and, by removing waste products, may prevent 
deposits of uric acid and urate of sodium. The various 
effervescing alkaline waters may often be substituted with 
advantage for plain water, and, as lime juice is recom- 
mended to those who are unable to take vegetables, a 


lemonade made of an efferx-escing alkaline water with lime 
juice and saccharin will be found a most refreshing and 
agreeable drink. 

Exercise and fresh air. — It is important not only to 
limit the amount of food to be oxidised and disposed of in 
the body, but to increase the power of oxidation. This is 
best done by exercise and fresh air. Exercise stimulates 
the circulation, promotes tissue change and increases oxi- 
dation in the body ; hence it is obvious that the mainten- 
ance of that delicate balance between the food taken and 
the oxidation of that food, which is so necessary for the 
gouty, can be greatly aided by exercise. The exercise 
must not, however, be too violent and fatiguing, for any- 
thing that tends to depress the nervous powers may cause 
an attack of gout. Undue excitement, sleeplessness, over- 
study, . anxiety, should, therefore, all be avoided by the 
gouty. If, owing to stiffness of the joints, active walking 
or horse exercise cannot be taken, passive exercise should 
be resorted to, such as can be obtained by means of 
massage. Fresh air is of great importance, though damp 
and cold should be avoided. Great benefit may be obtained 
by a sojourn in a warm dry climate, such as that of Las 
Palmas in Grand Canary or Orotava in Teneriffe. Fine 
hotels and the best medical attendance can now be found 
at these health resorts ; and it will, I think, not be long 
before the martyrs to arthritic gout will learn that the 
"Fortunate Islands"' may be to them a discovery worth 



A Week's M6nus. 

First Day. 


A boiled egg and dry toast. 

Cocoa from nibs with added milk and sweetened with 

saccharin, (i) 


Baked apples and custard pudding. 

Lime-juice lemonade. (2) 


Tomato soup. 

Roast chicken and asparagus. 

(i) The discovery of saccharin has been as valuable to the gouty 

as to the diabetic. It should be used in the place of sugar. 

(2) This is an excellent drink. It is made with ApoUinaris or 
soda water, to which is added one teaspoonful of lime juice and a 
tabloid of saccharin to the pint. 

Second Day. 

Grilled sole with lemon juice and butter. 
Tea and toast. 
, Lundi. 

Stewed cabbage. (3) 

Stilton cheese and rusks. 


Bisque soup. 

Mutton cutlets and French beans. 


(3) Take a good-sized savoy, or spring cabbage ; cut, wash, and 
use only the heart ; boil it for a quarter of an hour. Meanwhile take 


two ounces of fat bacon chopped fine, a little onion and parsley, and 
a few herbs. Brown together in a stewpan. Put into the mixture 
the boiled cabbage and stew all together for about three-quarters of an 

Third Day. 


Eggs with black butter. 

Fresh fruit. 

Coffee and toast. 


Artichoke soup. (4) 

Sardines on toast. 



Fillet of beef au printaniere and potatoes. 

Stewed rhubarb and cream. 

(4) The various soups made of vegetable purees are excellent for 
gouty patients. They are sufficiently sustaining to prevent a feeling 
of hunger, and if well digested give a fair amount of nourishment. 

Fourth Day. 


Fried cutlets of cod. 

Milk and soda water (5), toast. 


Banana fritters. 

"Cart-wheel" (6) and pulled bread and butter. 


Spinach soup. 

Roast pheasant and broccoli. 

Almond pudding. (7) 

(5) Milk is often found to be more digestible if diluted with an 
alkaline effervescing water. So treated, it makes also a more agree- 
able drink than when taken pure. Should the physician proscribe 
milk, cream and aerated water will be found to make a most nutritious 
and agreeable drink, particularly for breakfast, if tea and coffee 
cannot be taken. 

(5) This is a cheese which owes its name to its immense circular 
size. It is made of skim milk, and is thus free from fat. In cases 
when the richer cheeses cannot be well digested, "cart-wheel" may 
form a useful food for the gouty. 

(7) The recipe for this has already been given. 



Fifth Day. 


Poached eggs on toast. 



Boiled sole. 

Tomato salad. 


Victoria soup. 

Roast grouse. 


Sixth Day. 


Cold ham. 



Stewed plums and rice. 


Boiled chicken with potatoes 


Cauliflower au gratin. 

Seventh Day. 


Finnan haddock. 

Nib cocoa and milk, toast. 


Cock-a-leekie soup. 

Cheddar cheese and Callard's biscuits. (8) 


Cutlets of salmon. 

Roast mutton with potatoes and cauliflower. 

Gooseberry fool. 

(8) Callard's biscuits and cakes are as useful to the gouty as to 
the diabetic. They are carefully and intelligently made, are free 
from starch and sugar, but yet very pleasant to eat. 

1 66 



When explaining the part played by albumen in the food 
supply of the body, it will be remembered that I described 
how the albuminoids, composed of oxygen, hydrogen, 
carbon, and nitrogen, yielded up their nitrogen in the pro- 
cess of oxidation in the tissues, which nitrogen is absolutely 
required for the formation and reconstruction of the tissues 
and juices of the body without exception : hence the neces 
sity for a certain amount of albuminous food. 

How urea and uric acid are formed.— Now, the final 
product of oxidation of albumen is urea, which is sepa- 
rated from the blood by the action of the kidneys, and, 
being a very soluble substance, it is dissolved and cast out 
of the body in the urine. Not all the albumen, however, is 
oxidised into urea ; a small proportion never reaches that 
state, and remains only partly oxidised in the blood and 
tissues in the form of uric acid. Uric acid is soluble in 
an alkaline fluid, and much less soluble in an acid fluid. 
If, therefore, by any cause the alkalinity of the blood is 
decreased, the uric acid present may be driven out of the 
blood current and deposited in the joints, liver, spleen, etc. 
When subsequently the normal alkalinity of the blood is 
re-established, the uric acid which has been driven out is 
washed again into the current, and is therefore present in 
excess. An excess of uric acid in the blood produces the 
symptoms of depression of spirits, irritability of temper, 
headache, and malaise. 

Uric acid the cause of headache.— This whole subject 
has been very carefully studied by Dr. Alexander Haig, 


and the results of his inquiry are embodied in a book called 
Uric Acid as a Factor in tlie Causation of Disease. Dr. 
Haig was led to study this subject by an extremely severe 
and periodic headache from which he suffered almost 
every week, and which, from its painful violence and in- 
capacitating character, threatened to cripple or cut short 
his career. Seeking its cause in order to accomplish its cure, 
he began to carefully examine the excretions of the body, 
and he arrived at the following interesting results. A 
headache occurred when there was an excess of excretion 
of uric acid following on a period when there had been a 
diminished excretion. Uric acid was excreted in excess 
when the urine was increasingly acid, and presumably, 
therefore, when the alkalinity of the blood was high. The 
excretion of uric acid corresponded with the severe head- 
ache, and, consequently, with the increased alkalinity of the 
blood and the increased acidity of the urine. Now what 
are the conditions which alter the alkalinity of the blood 
and the solubility of uric acid and the consequent excretion 
of the latter by the kidney ? Cold decreases the alkalinity 
of the blood, and drives the uric acid into the joints and 
tissues ; warmth and acid perspiration increase alkalinity, 
and the uric acid is then washed out of the joints and 
tissues into the blood ; good dinners and generous wines 
decrease alkalinity, which is followed by a reaction and 
falling acidity. Dr. Haig found that by administering an 
acid to himself he could drive away his headache, by, in 
fact, driving the uric acid circulating in the blood into the 
joints and producing pain and pricking in these ; or he 
could bring on the headache at will by giving himself a 
dose of alkali, when the uric acid deposited in the joints 
and tissues was washed out of them into the blood. It was 
the presence of an excess of uric acid or urates in the 
blood, he therefore argued, which caused the headache. 
He contends that what our forefathers called " phlegm and 
humours," what the unscientific call " bile," and what the 
doctors label gout or rheumatism, are all manifestations of 


the same condition, namely, an excess of uric acid in the 

Decreased excretion of uric acid causes symptoms of 
gout, "bile," and headache.^ He beHeves, however, that 
this excess is not due to excessive formation of uric acid, 
but to decreased excretion. The formation of uric acid is, 
Dr. Haig states, always as compared to urea as i to 33. If, 
therefore, a person excretes on an average 500 grains of 
urea a day, he should also excrete about 16 grains of uric 
acid. If this amount is not excreted it is because it is re- 
tained in the body, and will either be found subsequently 
in the deposits of urate of soda or chalk stones in the joints 
in gout, or it will be excreted when from some cause the 
alkalinity of the blood has been raised with the accom- 
panying symptoms of headache, depression, and rheumatic 
pains. Dr. Haig does not deny absolutely that an excess 
of uric acid may be formed by deficient oxidation ; but 
his investigations lead him to believe that urea and uric 
acid are produced always in the same proportions, and if 
we want to diminish the one we must diminish the other. 
They rise and fall together. 

Treatment by vegetable diet. — Having arrived at the 
cause of his periodic headaches, and having formed the 
opinion that in order to prevent them the formation of 
uric acid must be diminished, and the high alkalinity of the 
blood maintained, what was the process of cure adopted? 
A change of diet. And it is for this reason that Dr. Haig's 
researches on a rather abstruse subject are particularly in- 
teresting to us. His object was to decrease the formation 
of urea and uric acid, and to keep up the alkalinity o[ the 
blood, so that the uric acid formed should be held in solu- 
tion and steadily excreted daily by the kidneys, instead 
of being driven into the joints and tissues. An animal 
diet increases acidity, a vegetable diet diminishes it. Dr. 
Haig succeeded in curing his headaches by reducing the 
intake of nitrogenous food and by putting himself on a 
vegetable diet. In this way the excretion of urea was de- 


creased from an average of 500 grains to 300 grains a day, 
and of uric acid from 16 grains to 9 grains. The alkalinity 
of the blood was maintained, the old stores of urates were 
washed out of the tissues, and when the exact balance was 
arrived at, and the uric acid daily produced was daily ex- 
creted, the headaches ceased. 

" Bilious headache."— Dr. Haig argues that not only the 
so-called " bilious headache," but also gout, rheumatism, 
and epilepsy are caused by excess of uric acid in the 
blood, and may be controlled by limiting the consumption 
of animal food and putting the patient on a farinaceous 
diet. With respect to epilepsy, he considers that the fits 
are caused by the same condition which produces periodic 
bilious headache in others. Dr. Haig conclusively shows 
that an excess of uric acid in the blood profoundly alters 
the circulation, and interferes with tissue change and nutri- 
tion, which finally result in serious organic disease. 

Mental depression. — We are all acquainted with those 
unfortunate persons who, though they are possessed of all 
the good things of this world, though they have within 
their reach the pleasures which wealth can give, and 
the comforts and enjoyments of home and family, yet 
persist in thinking that life is not worth living, that ruin 
haunts their steps, and that the affection of friends is not 
for them. These are the victims of uric acid in the blood, 
or what is called uric-acida;mia. The condition is graphic- 
ally described by Dr. Haig : " Self-reliance is absolutely 
gone, extreme modesty is common, or even habitual, a 
feather weight will crush one to the dust, and even the 
greatest good fortune will fail to cheer. If roused from 
such a condition a considerable amount of irritability and 
bad temper is sure to be manifested, quite out of proportion 
to the requirements of the case. . . . Clear the blood 
of uric acid . . . and the mental condition alters as if 
by magic ; ideas flash through the brain, everything is re- 
membered, nothing is forgotten, exercise of mind and body 
is a pleasure, the struggle for existence a glory, nothing is 


too good to happen, the impossible is within reach, and 
misfortunes sHde hke water ofif a duck's back." 

The daily dietary to ensure cure. — In order that this 
blessed result ma}- be obtained by these sufferers, Dr. 
Haig- lays down the following regime to be adhered to : — 

Animal Food. — Milk, i to \\ pints, previously boiled. Eggs, 
fish, fowl, or game, i to 4 oz.. varied a little from day to day. 

Vegetable Food. — Vegetable prepared products, vegetables 
twice a day, fruit three times a day, to any desired extent, according 
to appetite. 

Tea, coffee, cocoa in moderation, and as flavourings rather than 
as strong decoctions. 

The daily dietary may be as follows : — 

Breakfast. — A large soup plate half full of porridge eaten with 
milk ; a few mouthfuls of fish or egg prepared in various ways ; one 
or two rounds of bread, or its equivalent in toast, with plenty of 
butter; a cup of milk, flavoured with tea, coffee, or cocoa, previously 
boiled. Finish with a small quantity of any fruit that is in season. 

Lunch. — Potato and one other vegetable cooked in various ways 
and eaten with butter, fat, or various sauces ; pudding, tart, or 
stewed fruit ; biscuit and butter ; a little fruit as at breakfast. For 
drink, a little milk, which in winter is often warmed, or water, often 
taken in summer, with a little fruit syrup, such as Stowers' lime 
juice cordial. 

Afternoon Tea. — Bread and butter and cake of various kinds. 
A little milk and water flavoured with tea. 

Dinner.— Soup made without meat stock; fish, of which only a 
very small piece is taken ; two vegetables with sauces, butter or fat ; 
any ordinary pudding, tart, or stewed fruit, though not as a rule very 
rich dishes containing many eggs; biscuit and butter; a good supply 
of various fruits for dessert. For drink, water with syrup, aerated 
waters, or a little milk, often taken warm in winter ; a tumbler of 
water, aerated water, or in winter hot water at bed time. 

Dr. Haig's opinions on vegetarian diet. — As Dr. Haig 

states, there is no starvation about this diet ; but it has its 
inconveniences, owing to its running counter to the accepted 
habits and customs of the country. A mutton chop is 
always obtainable, while well-cooked vegetables can rarely 
be got anywhere. But health is worth purchasing at the 


price of inconvenience and trouble. With an earnestness 
born of conviction, Dr. Haig asks : " Do we not here in 
England die younger and in greater number than there is 
any necessity for ? Are we not afflicted with an infinite 
number of diseases which cause far more pain and misery 
than is at all necessary ? Are we not given to all kinds of 
debauchery and excess, and have we not huge asylums full 
of lunatics, and prisons full of criminals?" And he re- 
plies to his own queries : " I look upon all these things as 
serious and widespread diseases of the human race ; and as 
I am not one of those who believe that Nature herself, if 
she had a free hand, would tend to destroy us, but rather 
to preserve what is good and eliminate what is evil ; and, 
further, cannot believe that the tendency to these evils is 
part of the ground plan of Nature's work, or that the un- 
alterable bias is to have headache, epilepsy, mental depres- 
sion, mania, and their results — murder or suicide, alco- 
holism, morphinism, cocainism, etc., — and is originally im- 
planted in our nerve centres, I am driven to the conclusion 
that not a few of these evils are the result of unnatural 
conditions, and that prominent among these is the un- 
natural diet, the evil action of which we are now in a 
position to follow out completely through our knowledge 
of the powerful effects of urates on the functions and nutri- 
tion of the whole body." This is a strong denunciation of 
the meat-eating habits of our race and country. 




Consumption was once thought to be both an incurable 
and an unpreventable disease. It came mysteriously ; it 
often attacked the youngest and the fairest ; it destroyed 
promising careers ; and unless it could be checked by the 
exile of the patient to a warmer climate than England, its 
cure was thought to be hopeless, and death sooner or later 
inevitable. Of late years some considerable progress has 
been made in respect both to its prevention and to its 
successful treatment. The disease has by the researches 
of Koch been shown to be due to the ravages of a minute 
bacillus in the tissues. The effort of medicine in the treat- 
ment of consumption is first to make the tissues resistant, 
and next to cut short the life of the bacilli or to limit their 
power for evil. This end is mainly accomplished by the 
following means — giving the patient sunlight and fresh air, 
regulating the diet, next by the application of antisepsis. 
The tubercle bacillus. — Before proceeding to point out 
how these objects can be attempted, I will describe the 
appearance and life history of the tubercle bacillus. If a 
beam of sunlight fall through a chink of a shutter into a 
darkened room, a number of motes will be seen to be float- 
ing about in it. These motes, made visible by the strong 
light, are present everywhere in the atmosphere in countless 
numbers. If they be allowed to settle and are examined 
under a microscope, it will be seen that they are composed 
of particles of dust and of minute rod-like bodies or bacilli. 
These bacilli, though simple in structure and closely 
resembling one another in shape, are yet so dissimilar in 


their action and life that they require certain soils and 
certain conditions in order to grow and multiply. It is 
probable that the tubercle bacillus, pictured in Fig. 11 is 
very largely distributed in the atmo- 
sphere ; and if taken in with the 
breath it may settle on and grow in 

the lungs, and produce phthisis or ^ _ 

'=' ^ / Fig. II.— The Tubercle 

consumption. If taken with the food bacillus, Magnified 
it may settle and grow in the intestines ^°°° Times. 

and produce consumption of the bowels ; if introduced into 
the brain it may cause tubercular meningitis, and if it finds 
its way into the marrow of the bones it may cause abscesses 
of them. In order, however, to grow in the human body the 
tubercle bacillus must find the right soil, exactly in the same 
way as a seed will not sprout unless it falls on the right soil. 
The conditions which produce in the tissues of the lungs or 
elsewhere, the nidus or soil proper for the growth and 
development of the tubercle bacillus, are probably in some 
measure hereditary, and also largely due to environment. 
The rebreathing of expired air, damp conditions of soil 
and defective nutrition may be set down as predisposing 
causes. Why one person should contract consumption 
and another should not is not fully known. Once, how- 
ever, the tubercle bacillus is established in the tissues of 
the air vessels of the lungs, it undergoes rapid multipli- 
cation. By its irritating presence inflammation is set up, 
the tissue breaks down into pus, and cavities are ultimately 
formed in the lung. The patient becomes emaciated, loses 
strength, and finally dies from exhaustion or from insuf- 
ficient aeration of the blood, owing to the fact that a large 
part of the lung has broken down and has been spit up in 

The aims of treatment in pulmonary consumption are 
to improve the health and render "the soil" for the bacillus 
more resistant, to combat and conquer the bacillus, to deprive 
it of its proper nutriment, and, if unable to kill it outright, 
to render it weak and powerless to work mischief. It is, 


unfortunately, not yet known positively what substances 
are destructive of the life of the tubercle bacillus, but there 
is some reason to believe that oil and soda salts are 
antagonistic to its life. Hence probably the well-known 
benefits which result from the use of cod-liver oil. How 
the oil acts is by no means clear. The opinion of Hughes 
Bennett, by whom its use was introduced, was that it 
prolonged life by improving the nutrition of the tissues. 
It is now suggested by others that the oil, by being burnt 
up in the body, absorbs the oxygen required for the active 
multiplication of the micro-organisms. What we do know, 
however, is, that if wasting can be checked, and the weight 
of the patient increased, the tubercle bacillus is often 
successfully combated. 

Treatment by super-alimentation. — A consumptive 
patient should be carefully weighed at frequent and re- 
gular intervals ; if he gains weight it is well, but if he loses, 
a serious effort must be made to induce him to take more 
food. Sometimes, if the fever is high and continuous, 
appetite is destroyed, and there is even a distaste for food. 
In such cases many French physicians, following Dr. 
Debove of Paris, recommend forced feeding, and the 
introduction of food into the stomach b}- means of the 
oesophageal tube. They report that under this treatment 
the patient recovers appetite, rapidly gains in weight, his 
strength increases, and the cough, expectoration, and night 
sweats disappear. Without resorting, however, to these 
heroic methods, a patient can with advantage be " over- 
fed " in the normal way. Care should be taken to give 
him as much fatty foods as he can possibly digest, and 
far more than enter into the usual dietary. Bread and 
butter, cream, cocoa, chocolate, and milk are all excellent 
foods for a consumptive, as well as the usual articles of a 
healthy dietary. When cream is not well borne, it may be 
rendered more digestible by adding to each wine-glassful 
a teaspoonful of brandy, kirsch, or rum, with or without 
hot water. Milk may be rendered more digestible by 


adding to each tumblerful, about six grains of bicarbonate 
of soda, and five grains of common salt dissolved in two 
tablespoonfuls of hot water. Malt extract is also very 
useful in facilitating the digestion of farinaceous foods. 

The treatment by Koumiss.— Koumiss is fermented 
mare's milk, and has long been a favourite beverage with 
the Tartars and other Asiatic tribes. In Russia con- 
sumptives go to certain stations on the Caspian Sea to 
undergo the koumiss cure. The secret of the whole thing 
is that koumiss is milk slightly fermented, and conse- 
quently highly digestible, large quantities of which can 
therefore be taken without producing dyspepsia. The 
Russian mode of cure is to rise early and to take a glass 
of koumiss every half-hour, with the exception of the two 
hours preceding dinner and supper. Meat and fats form 
the chief part of the meals ; sweets, fruits, and salads are 
forbidden, as well as ices, coffee, and spirits. Koumiss is 
made in Europe from cow's milk. It is particularly ap- 
propriate in cases where the temperature is high and the 
appetite impaired. 

The treatment by powdered raw meat. — An excess of 
food can be given to a consumptive more easily by ad- 
ministering powdered raw meat than by any other method. 
Dujardin Beaumetz, who was an advocate of this method of 
treatment, recommended that the powder should be pre- 
pared from the lean of beef, which is cut into small pieces 
and dried in a water bath. When thoroughly dried it is 
reduced to powder in a coffee mill. The powder may be 
taken either with lentil flour in the form of soup, or with 
milk or rum punch. In this way an amount of powdered 
raw meat representing several pounds of meat can be 
taken daily. Abundant food would be, however, of little 
use if not combined with an abundance of fresh air. The 
aseptic stimulating air of the mountains, as at Davos, the 
ozone and revivifying breezes of the ocean, the sunlight 
and warmth of the South, Torquay, the Riviera, and 
Orotava, are all invaluable in the treatment of consump- 


tion. In fact, in some cases, warmth, sunlight, fresh air and 
the aseptic atmosphere of high altitudes, are sufficient to 
arrest the tubercular inflammation and to effect a cure. This 
result is probably due to the fact that the increased vitality 
of the patient, induced by placing him under healthful con- 
ditions, enables him to resist the destructive action of the 

Tubercle bacillus conveyed by milk. — There is no 
doubt that the tubercle bacillus can be conveyed to the 
human subject by milk from tuberculous cows, and that 
children have been infected in this way and have lost their 
lives. It is therefore a wise precaution to boil the milk 
taken by children ; indeed, when the source from which 
it is obtained is not known it is absolutely necessary to do 

That consumption can be caught by the healthy from 
a consumptive patient is now a well-authenticated fact. 
The tubercle bacilli abound in the expectorations of the 
consumptive, which should not, therefore, be spit on to 
the floor or ground and left to dry, for in this way the 
bacilli are disseminated in the atmosphere, and if then 
inspired into the lungs may induce consumption in the 
nurse or attendant. Hence it is of the utmost import- 
ance that the expectorations of consumptives should be 
spit into covered vessels, that they should be carefully 
collected and burnt, and that similar precautions should be 
taken in the home and in the sleeping apartment. A 
healthy person should never sleep in the same bed with 
a consumptive. 




Rickets was at one time thought to be a disease of the 
bones ; it is now known to be a general disease caused by 
mahiutrition, and which is almost always preventable. 
The well-known changes which take place in the bones are 
but the signs and symptoms of a constitutional condition. 
Rickets in the child is the incontrovertible sign of ignorance, 
neglect, or incompetence in the mother or nurse. A mother 
should be as ashamed of her child having rickets as of its 
having vermin. Both mean neglect of maternal duties. 
The neglect may be, it is true, due to ignorance ; but in 
these days of enlightenment and education, ignorance on 
matters of vital importance is inexcusable. But in these 
days also of patent foods for infants, ignorance shelters itself 
behind assumed knowledge, and patent foods plus ignor- 
ance are the fruitful source of much rickets. 

A story will illustrate my meaning. Some time ago I 
was interested in a "bonnie baby," the only and posthu- 
mous child of a young widowed mother. The child was 
the joy of her heart, and its evident health and ceaseless 
activity and gaiety were sources of pride and pleasure to 
her. She suckled the bab\' herself When it was about 
six months old I lost sight of it for eight months. When 
I saw the child again I was immediately struck by its 
altered appearance. It was pale and peaky, had lost its 
gaiety and activity, and had a look of premature age and 
weariness. " Your baby is starved," I said with brutal 
frankness to the mother ; " what are you feeding it on ? " 
" I suckled it until it was eleven months old," she replied, 
" and since then I have fed it on ," mentioning a patent 


food. "What is it made of?" I asked. "I don't know," 
was the answer. "Don't know!" I exclaimed, "don't 
know on what you are feeding your baby ! You have only 
one thing to do — to bring up that baby — and you are 
steadily starving it into rickets by not taking the trouble to 
learn how to feed it properly." I presented the alarmed 
mother with various text-books, giving the required infor- 
mation how to feed infants, and I hope she has profited 
by them ; otherwise her child will have rickets. This is 
an example of how the disease is produced by carelessness 
and ignorance on the part of well-meaning mothers. 

Rickets is caused by the necessary elements of albumen 
and fat being absent from the food, and by feeding children 
on starchy foods and skimmed milk. It hardly ever occurs 
in suckled infants ; but it is developed in babies brought 
up by hand, or during or after weaning. Insanitary con- 
ditions, such as bad air and unwholesome dwellings, may 
aid in the development of rickets, but they are not sufficient 
to produce it ; while food deficient in albumen and fat will 
cau^e it, even when the hygienic conditions are of the very 

Infants' natural food. — I must stop for a moment to 
consider the proper and natural food for infants. This is, 
of course, mother's milk ; but if not obtainable either from 
the child's own parent or a foster mother, then cow's or 
goat's milk, treated so as to resemble human milk, should 
be substituted. Milk is a typical food, inasmuch as it 
contains all the elements necessary for nutrition, namely, 
albumen or nitrogenous matter, fat, a carbo-hydrate in the 
form of sugar of milk, salts, and water. The albumen is 
chiefly in the form of casein, which can be precipitated or 
thrown down from the milk by an acid or rennet. It is 
thus that cheese is made from milk. The fat is suspended 
in the milk as minute globules, which can be clearly seen 
under the microscope. These globules of fat, being light, 
rise in the form of cream when milk is left standing for 
some time. Thus skimmed milk is milk deprived of its 


fat, though as its albumen remains it is still a highly nutri- 
tious food for adults, but is inadmissible for infants. The 
sugar in milk is called lactose. Unlike ordinary sugar it 
cannot cause alcoholic fermentation. The mineral salts, 
though small in amount, are of great value from a dietetic 
point of view. 

To know how to feed an infant properly when human 
milk is not available, it is necessary to know the nutritive 
value of other kinds of food, and to ascertain if they contain, 
in the proper proportions, the four necessary elements, 
namely, albumen, fats, carbo-hydrates, and mineral salts. 

The following table gives the comparative analysis of 
the various kinds of milk : — 








Nitrogenous or albuminous 

elements, - 






Hydrocarbon fat, - 






Carbo-hydrate or sugar 


milk, - . - . 






Mineral salts, 






Water, .... 













From this we see that cow's milk is richer in nitrogenous 
elements and fat than human milk, so that to make it suit- 
able for infants it must be properly diluted ; goat's milk is 
also richer, but ass's milk is much poorer than human 
milk. Now compare these perfect foods with the materials 
frequently given to hand-fed infants, and which are produc- 
tive of rickets. To do so the following table should be 
studied :— 

Arrowroot, - 







Bread, - 
Wheat flour. 


- IO-8 

- 12-6 

- - 15-6 



















It will be apparent on comparing this table with the 
previous one giving the various milk analyses, that the 
farinaceous foods which are given to children and frequently 
to hand-fed infants, are deficient in fat and contain a super- 
abundance of starch. This deficiency may be made good 
by the addition of milk, or still better, of cream to the bread, 
flour, or biscuit used. Obvious as may appear the teachings 
of nature, it is a fact that some mothers, finding cow's milk 
disagree with their infants, and not knowing how it should 
be diluted and treated to make it digestible, will proceed to 
feed them on biscuits soaked in water, arrowroot, bread and 
skimmed milk, or on patent foods mixed with water, with 
the inevitable result of producing rickets. The fat and the 
albumen necessary for nutrition are withheld, and the child 
is fed, or rather starved, on starch. Now starch, it will be 
observed, has no place in milk, and it forms, moreover, no 
element in the proper dietary of an infant, inasmuch as 
infants in the early stage of existence have no power of 
digesting or assimilating starch. Dr. Cheadle, in his admir- 
able book on the Artificial Feeding of Infants, gives an 
instructive case of the production of rickets by deficient 
food, in children of ignorant, though well-to-do parents. 
The parents were prosperous tradespeople, but the mother 
was too much occupied with business to suckle or attend to 
her children. Of five born healthy three had died in infancy. 
The child Dr. Cheadle was called to see was eleven months 
old, and had all the signs of well-marked rickets. The 
symptom which had, however, alarmed the parents was 
spasm of the glottis, so severe as to threaten suffocation. 
On inquiry it was found that all the children had been 
hand-fed on a patent farinaceous food, cornflour, and arrow- 
root made without milk, cow's milk having disagreed with 
them. Thus these little ones were starved to death, though 
abundantly fed. A proper dietary effected a cure in the 
case of the infant yet alive. 

Symptoms of rickets. — The earliest and least distinctive 
symptoms of rickets are restlessness and slight feverishness 


at night ; the child sweats profusely, and continually throws 
off its bed-clothes. Next is noticed an unwillingness on 
the part of the child to be touched or moved ; it seems 
sore all over, and has no longer any pleasure in being 
tossed about and caressed. The first positive evidence of 
rickets is given, however, by enlargement of the bones of 
the wrist and subsequently of the ankle, knee, and elbow 
joints. Then the long bones become bent and bowed, the 
ribs fall in laterally, their ends form knob-like projections, 
and the sternum projects in front, causing the well-known 
pigeon breast ; the bones of the head are thickened, and 
the fontanelles remain open long after the time they are 
closed in healthy children ; the head becomes large, flat on 
the top, with projecting forehead ; the teeth are late in 
appearing. While these deformities in the bony skeleton 
are taking place, the general condition grows worse, fever 
increases, perspirations are more profuse, and the tenderness 
of the body becomes so great that the child dreads being 
touched. Appetite fails, weakness increases, the child 
emaciates, and has a wan, anxious, pallid look. The abdo- 
men protrudes, and the liver and spleen are often found to 
be hypertrophied. When rickets prove fatal, death is 
caused either by lung trouble induced by the falling in of 
the thoracic walls, or by impaired digestion and consequent 
weakness, or by croup or convulsions. 

Rickets may exist in a much less marked degree ; the 
ends of the long bones may be thickened, but the consti- 
tutional symptoms may not be so marked. Recovery is 
the rule ; and persons who have suffered from rickets in 
their youth may become very strong, but they are usually 
short, and the deformities of the bones, the bow legs, the 
curved spine, and the narrow chest generally remain, and 
often cause much misery and discomfort in after life. 

If the bones be examined in rickets, it is found that in 
the cartilaginous extremities, where growth is most active, 
there is considerable enlargement, softening, and rarefac- 
tion, and that the earthy matter present is much less than 


in the bones of healthy children. It was hence formerly 
argued from this fact that rickets was caused b}- the want 
of lime salts, and that to give a child lime water and phos- 
phate of lime would cure the rickets. This is, however, 
quite insufficient ; moreover, many of the farinaceous foods 
on which rickety children are fed are rich in lime and 
phosphoric acid. Inasmuch as the disease of rickets is 
caused by food deficient in fat and albumen, so the cure of 
rickets lies in restoring these elements to the diet of the 

Dietetic treatment. — Dr. Cheadle considers that too 
much reliance is placed on cod-liver oil, chemical food, 
lime, and iron. Drugs are not so useful as proper diet. 
Cream can take the place of cod-liver oil, milk of chemical 
food, and albuminous foods of iron. The diet of a rickety 
child should be most carefully examined ; and when it is 
found, as it usually is, that the child is being fed too ex- 
clusively on a farinaceous food, the missing elements of 
fat and albumen must be restored. This is best done by 
means of cream and cod-liver oil. If cream cannot be 
taken, boiled cow's milk, milk puddings of entire wheat, 
and raw meat pulp (the making of which was described 
in the chapter on invalid foods) may be given. Syrup of 
lacto-phosphate of lime is useful ; but the best of all 
medicines are fresh air, sunlight, and outdoor life. Parents 
should be on their guard with respect to many of the con- 
densed milks advertised as good and reliable foods for 
infants. As has been recently pointed out in the British 
Medical Journal, some of the advertised condensed milks 
are made of separated milk, deprived of 90 per cent, of 
their fats, and are even worse foods for infants than 
skimmed milk. To bring up an infant on condensed 
separated milk is to ensure its having rickets. Those who 
have the care of children will be glad to know that the 
Milkmaid Brand of Anglo-Swiss condensed milk is reliable, 
and is made of whole milk. Mothers must be not only wise 
but wary if they would have healthy and happy children. 





This is a disease which is supposed to be hereditary 
and is stated by some to be alhed to consumption. A 
scrofulous child does not, however, often become con- 
sumptive. The signs of the disease are well known. The 
child is thin, pale, and unwholesome-looking, it has not 
the gaiety of childhood, and the glands, especially those 
of the neck, become hardened and swollen, and often slowly 
suppurate and discharge a purulent cheesy substance. 
The edges of these abscesses are ragged, and, when heal- 
ing takes place, depressed puckered cicatrices are formed. 
These are unsightly, and are characteristic of a scrofulous 
diathesis. Malodorous discharges from the ears or nose are 
not infrequent in scrofula. 

The treatment is simply nourishing food and fresh air. 
Care should first be taken to ascertain what the child can 
digest well, and all indigestible food should be avoided. 
" An abundant supply of good milk should be the basis of 
its diet ; also wholemeal bread and plenty of butter " (Yeo). 
Fatty foods are what seem to be needed in scrofula ; and 
as puddings are, as a rule, better liked by children than 
meat, there is little difficulty in getting them to eat food 
so agreeable to them. A plentiful supply of butter and 
cream with breakfast and tea, bread and dripping, suet 
pudding with jam and treacle, apple and suet pudding are 
all good foods for the scrofulous. Cod-liver oil is the 
doctor's sheet-anchor ; but where this is not well borne, or 
there is a dislike to it, cream may take its place. To 


make this digestible it is only necessary to add a teaspoon- 
tul of cherry brandy to a wineglassful of cream. Cream 
and soda water will be found an excellent drink for the 
scrofulous. The clothing should be of wool, and every 
opportunity taken to give the child a healthy active lite 
in the sunshine or by the seaside. The dreaded disease 
may thus be warded off or ameliorated, and the weak and 
scrofulous child grow into a healthy adult. 


Allied to rickets and resembling it in many of its charac- 
teristics is the once dreaded disease of scurvy. Scurvy is 
still occasionally seen in hospitals, especially among 
children. It was once the scourge of the navy, when 
sailors were fed for long periods exclusively on salt meat 
and biscuits. It was, however, discovered that this painful 
disease was cured by the return of its victims to an ordinary 
mixed diet, and more particularly to the use of fresh 
vegetables and potatoes. Hence it was argued that scurvy 
was caused by the lack of the salts and acids contained in 
vegetables, fruits and potatoes. Strange to say it is not, 
however, sufficient in order to prevent scurvy to give the 
salts and acids contained in vegetables, though in cases 
when it is impossible, owing to their bulk, to carry even 
compressed vegetables, lime or lemon juice served daily as 
a ration to sailors will commonly prevent the disease. It 
has, in fact, by this means been banished from our navy. 

There are some persons who are unwilling to accept 
the dicta of science and experience, and who put their own 
uninformed belief before knowledge. The breakdown of 
the Nares expedition to the North Pole is an example in 
point, and gave another pitiable illustration, if any were 
needed, of the cause of scurvy. Commander Nares would 
not follow the advice of the doctor, who urged that it was 
necessary for the sleighing parties, bound on long journeys 
across the ice, to take lime juice with them. He considered 
that dependence on lime juice was a doctor's fad, and held 


the view that scurvy was caused by darkness, depression, 
etc., and beheved that alcohol would be more useful to the 
men than lime juice. The party consequently completely 
broke down with scurvy. The pitiful story is thus told 
in the pages of the British Medical Journal, December, 

" The suffering of the men on these expeditions across 
the ice was frightful ; without exaggeration, says one of the 
authors of the log-journals, ' they may have been said to 
have suffered agonies '. Before they were out a week or 
a fortnight, they were ravaged by scurvy ; their limbs 
swelled ; their teeth fell loose ; the blood was effused in 
patches ; one half of them became prostrate, fetid, miserable 
beings, whose existence was intolerable to themselves and 
those around them. Every sledge party without an ex- 
ception broke down prematurely from scurvy : not only so 
but the disease seems to have taken all the commanders 
of the sledge parties by surprise ; each in turn expresses 
his astonishment, horror and terror of this affliction, when, 
its full force being felt, he can no longer shut his eyes to 
its nature, and each bewails pathetically his want of lime 
juice. ' Oh, that I had a ton of it ! ' writes Lieutenant 
Rawson, and Commander Markham groans over his 
pitiful modicum of two small bottles for each sledge ; 
does not venture to begin to use it, until, defeated by the 
prostration of his party, from the fearful ravages of scurvy 
he has resolved to turn back ; and then finds it necessary 
to issue only a small quantity to the sick alone, every other 
day, and even this expedient exhausts his store in about 
ten days. 

" Some of the parties utterly, rapidly and completely 
broke down with scurvy. All were baffled and beaten by 
it, and all suffered fearfully from its horrible infliction. 
Since the days of our earlier navigators no such sad story 
has come home as that of the disablement and breakdown 
from sickness of this splendidly manned and lavishly found 


They left the spirit casks behind them on the ice-fields, 
having learnt by bitter experience another well-known 
dietetic lesson, — that in cold and fatigue alcohol is worse 
than useless; but that under these conditions hot tea or 
coffee is the best restorative. 

Symptoms of scurvy. — The disease begins gradually. 
The person who is stricken with scurvy first suffers from 
a feeling of increasing weakness and constant fatigue, and 
a sense of soreness in all the limbs. He becomes deeply 
despondent, and is subject to fits of faintness. Presently 
the characteristic signs of the disease make their appear- 
ance ; the gums become swollen, turgid, dark and spongy, 
swelling up often over the teeth, and sometimes dropping 
off in gangrenous masses. The teeth are very tender, and 
often drop out. The breath is particularly foul. Purple 
patches and bruises appear on the legs ; the feet swell, and 
there is great pain and stiffness in movement. There is 
often want of appetite ; but even if the patient feels in- 
clined for food, his teeth are too tender to chew with. A 
more miserable wretch cannot be conceived than the 
victim of scurvy ; but his cure is certain and rapid if he 
can only obtain the food for which his blood is calling, 
namely, vegetables. 

Dietetic treatment. — It is highly satisfactory when one 
has to treat such a painful and pitiful disease as scurvy, 
to know that recovery is usually assured by the simple act 
of changing the diet, and putting the patient on plenty of 
fresh, soft, succulent vegetables, and from four to eight 
ounces of lime or lemon juice daily. Potatoes and cab- 
bages are the best vegetables. Yams, onions, carrots, 
turnips, oranges, pears, and apples are also valuable. In 
extreme weakness, beef-tea and milk must be given in con- 
siderable quantities until the patient is able to take solid 
food. When he is able to chew, meat should be given. 
Under this dietary the symptoms rapidly improve ; the 
swelling and bleeding of the gums disappear, the teeth 
become firmer and less tender, the purple patches grow 


paler and less painful, the tendency to faintness decreases, 
and the patient gains strength. 

Scurvy can be prevented on long sea journeys, by each 
person eating daily at least eight ounces of preserved 
potatoes, three ounces of other preserved vegetables — 
carrots, onions, turnips, celery, mint and pickles, and drink- 
ing three ounces of lime juice. Among recommendations 
issued by the Board of Trade to shipowners is the follow- 
ing. Each man should have at least two ounces of lime 
or lemon juice twice a week, to be increased to an ounce 
daily, if any symptoms of scurvy manifest themselves. By 
following these simple dietetic instructions scurvy has been 
banished from our ships ; and when it occurs, as in the 
Nares Polar e.xpedition, it is due to direct neglect of obvious 
and well-known precautions. 

Scurvy in Children. — Helpless babes need not have 
scurvy if their mothers knew how to feed them properly ; 
but owing to the absence of anti-scorbutic elements in their 
foods, children sometimes .suffer from this disease in a 
severe and well-marked form. The cachexia, mental apathy, 
and depression, the muscular weakness, the purple spots and 
patches with deep extravasations of blood, the tenderness 
of the limbs and the swollen ankles are present, with the 
most characteristic symptom of all, the soft, livid, purple 
and spongy condition of the gums, which are sometimes 
so swollen as to hide the teeth altogether and to protrude 
from the lips in lobulated, bleeding and ulcerated masses. 
Unless these .symptoms be relieved death occurs from 
syncope, or from increasing weakness. Dr. Cheadle gives 
among others a case typical of the cause and treatment of 
scurvy in an infant. A healthy child, whose parents were 
in good circumstances, was suckled till it was six months 
old ; it was then weaned, and fed entirely on oatmeal and 
rusks mixed with water only ; no milk was given to the child, 
condensed milk, which had been previously tried, being 
thought to disagree. At ten months mutton broth was 
added. This diet was continued without change till the 


sixteenth month. It will be remarked that it was deficient 
in animal fat, and contained little nitrogenous material. 
It was a diet likely to develop both rickets and scurvy. 
Most children of a year old are given milk and potatoes. 
In spite of the administration of potatoes and cod-liver oil, 
well-marked scurvy developed in this case. The treatment 
consisted in giving pure milk, fine potato gruel, and raw 
meat. In a few months the child was running about strong 
and well. Numerous other cases may be quoted, but there 
is a wearisome similitude in all of them. The little 
patients are nearly always bottle-fed children under two 
years old. " In no instance," says Dr. Cheadle, " have I 
seen the disease arise in an infant at the breast, or when 
fed on an ample supply of good cow's milk. Oatmeal and 
water, bread and water, various patent farinaceous and 
desiccated foods, peptonised condensed milk, sterilised 
milk, pancreatised food and milk, German sausages, bread 
and butter and tea, beef-tea, gravy and bread, in some 
cases with no fresh milk at all, in a few with a very small 
amount only, are the dietaries on which I have seen scurvy 
develop. And in these cases, with children as with adults, 
the improvement which immediately follows the adminis- 
tration of anti-scorbutics is one of the most remarkable 
facts in the whole range of medicine, and a convincing 
proof of the condition being true scurvy." 

1 89 



The rise of the body temperature is the pathognomonic 
sign of fever. It is not, however, the only symptom which 
constitutes it. The well-known pathological condition 
known as fever is manifested by a group of symptoms, one 
or more of which may be more or less marked or may be 
even entirely absent. The rise of temperature is generally 
preceded by chill or rigor. The person has the sensation 
of general chilliness ; he shivers, and feels as if cold water 
were running down his back ; the skin has the appearance 
of goose skin, and is often bluish in colour ; the face looks 
pinched, the eyeballs are sunken, respiration is more fre- 
quent and the pulse quickened. The patient feels nause- 
ated, depressed, miserable in mind and body, and attempts 
to obtain warmth by curling himself up into warm bedding 
or clothes. Rise of temperature follows, and is accompanied 
in typical cases with restlessness of the body and limbs, 
headache, dulness and mental apathy, extreme sensibility 
to light and noise, a feeling of great fatigue, rapidly in- 
creasing muscular weakness, drowsiness or sleeplessness, 
with illusions, hallucinations and delirium, wasting both of 
the muscles and of the fat of the body, an arrest of the 
digestive functions, and an inability to digest solid food, 
great thirst, dry mouth, dirty tongue, a dry burning skin, 
scanty excretion of urine, and often constipation. 

This collection of symptoms shows a profound disturb- 
ance of all the organs of the body. Whether the increased 
heat is the cause of these symptoms and organic disturb- 
ances, or whether the increased temperature is one of the 


effects of a specific poison acting on the sympathetic ner- 
vous system, are points which are still undecided by patho- 
logists. The question of importance to us, in considering 
the treatment of fever from the dietetic point of view, is not 
theoretical, but how, practically, to prevent by proper diet 
the extravagant tissue waste which is going on during the 
fever process, and so to maintain and build up the strength 
of the patient, that when the fever has passed, convalescence 
may proceed uninterruptedly towards recovery. 

The waste of albumen. — To this end there are certain 
well-ascertained facts to guide us. In normal health the 
intake of albumen in the food is balanced by the re-con- 
stitution of the albuminous tissues and fluids in the body, and 
by the excretion of urea. In fever this balance is disturbed, 
owing probably to the high temperature. The combustion of 
albumen is far greater than in health, and the excretion of 
urea about double. x\t the same time appetite is abolished, 
and stomachal digestion is suspended. Not only is there a 
great distaste for solid food, but it is rejected by the stomach 
if taken ; hence the ordinary supply of albumen is cut off. 
How, then, is the quantity of albumen obtained for the high 
rate of combustion which takes place in the body during 
fever? First, by the combustion of the organ-albumen, 
that is, of the albumen contained in the muscles and the 
blood corpuscles, and secondly, by the combustion of the 
store-albumen, which is contained in the tissues as a reserve. 
From the abnormal destruction of albumen which takes 
place in fever, it is easily understood why muscular weak- 
ness is so rapid and extreme after even a short attack of 
fever, and how, owing to the destruction of the muscles and 
blood corpuscles, the patient grows pale, anaemic, and 

Excretion of urea. — The excretion of urea in fever is 
out of all proportion to the amount of albuminous food 
taken, and is due to the large decomposition of the organ- 
albumen and store-albumen in the body during the fever 

FEVER. 191 

The waste of potash salts. — During fever the excretion 
of potash by the urine is excessive. This is probably due 
to the destruction of the muscles and blood corpuscles, 
both of which contain potassium. 

Diet indications. — If attention has been given to the 
foregoing explanation, which has been rendered as clear and 
simple as the difficulties of the subject allow, it is evident 
that the aim of dietetic treatment in fever must be to pre- 
vent the excessive waste of the albumen of the tissues, and 
to supply the body with albumen and salts, which are 
being rapidly burnt up in the system, so that when the fever 
passes, emaciation and weakness may not be so extreme 
as to greatly retard convalescence. 

Beef-teas. — The almost universal custom is to feed the 
patient on beef-tea. This treatment is from time to time at- 
tacked on the ground that beef-tea is neither a strengthening 
nor an albuminous food, but is mainly stimulating, and con- 
tains only gelatine and not albumen. This is true, but 
beef-tea still remains a very valuable food in fever. It is a 
preservative food ; it preserves the tissues from destruction, 
and thus indirectly maintains strength. The muscles and 
blood corpuscles are being destroyed in the fever process. If 
therefore a nitrogenous food can be presented for combustion 
in their place, they are saved. Such a food is beef-tea, 
containing, as it does, a large amount of soluble gelatine. 
Beef-tea also contains salts and extractives of the greatest 
use to the patient ; and if, as I have elsewhere advised, a 
little muslin bag full of chopped vegetables be stew^ed in 
the beef-tea and the juices be squeezed into the liquid before 
serving, vegetable salts, which are necessary to the depleted 
system, will be added. 

Peptonised beef-teas can be used with advantage, and 
in prolonged cases meat pulp may be given mixed with 
broth or beef-tea. Of the prepared extracts Armour's 
nutrient wine of beef peptone is one which should be of the 
greatest value in fever. Each pint contains one pound of 
predigested beef. Here, therefore, peptones, not gelatine, 


are the nitrogenous food administered. This excellent pre- 
paration can be obtained, I believe, in a non-alcoholic form. 
Dr. Burney Yeo says, " The unpleasant taste and smell 
of peptonised foods are opposed to their general adoption". 
There is no reason, however, why these foods should have 
an unpleasant taste and smell if carefully made. Celery 
seed should be boiled with the beef-tea ; or a roiix, made 
with a very small quantity of fried onions or baked flour, 
be added to the cup of beef-tea, or a flavouring may be 
given by vegetables or herbs. These flavours may be varied 
from day to day, and peptonised foods be thus made 
palatable and pleasant. 

Test for peptones. — It may be interesting and useful to 
the scientific nurse to know how to test a beef-tea or beef- 
extract for peptones. Dilute the beef-tea with five or six 
times its volume of water, render the mixture alkaline with 
caustic potash, and add a small quantity of sulphate of 
copper. If peptones are present a brilliant rose-red colour 
is produced, if the proteids are unchanged a violet tint 

Farinaceous foods. — Duodenal digestion is not so pro- 
foundly altered in fever as stomachal digestion, and hence 
farinaceous foods are more easily digested. Gruel and 
arrowroot are most useful articles of diet in the sick-room, 
and as they are generally the vehicle for milk they are ex- 
cellent foods. The use of milk must, however, be carefully 
watched, not only to see if it agrees with the patient, but 
to ascertain if it passes through the digestive track as hard 
and irritating curds. In this case its use must be discon- 
tinued. Junket is an excellent dish not sufficiently used 
for fever patients. 

In cases where there are periods of remittance of the 
high temperature, as in intermittent fever, it is advisable 
to give the patient solid food during the periods of inter- 
mission, if it does not provoke vomiting and diarrhoea. 

During conYalescence the return to solid food must be 
p-radual ; to overfeed a convalescent is as unwise as to starve 

FEVER. 193 

a fever patient. The food must be selected especially 
with the object of repairing tissue waste. It should there- 
fore be albuminous, and of a kind and variety not to over- 
tax the weakened digestive power. The ball of a grilled 
mutton-chop, braised fillet of beef, roast and boiled chicken 
are among the best and most digestible foods for the 
convalescent from acute fever. 




Typhoid fever is caused by the presence in the intestines 

of a minute bacillus, which is most commonly introduced 

into the body by the means of polluted water or milk, or, 

as some suppose, by aerial transport in sewer gas, etc. 

It finds its proper soil or nidus for vigorous life and 

multiplication in the solitary glands and in Peyer's patches 

of the small intestine, as well as in 

the mesenteric glands. The solitary 

glands of the small intestine are 

about the size of a millet seed, 

and are found scattered over every 

part of the mucous membrane of 

the ileum. They are simple in 

structure, being composed merely 

of dense net-like tissue, the meshes 

of which are closely packed with 

Fig. 12.— Diagrammatic Re- lymph corpuscles. They are per- 

PRESENTATioN OF Peyer's ^^^^^ ^ ^^^^ capillaHes and 

Patches IN Typhoid Fever. , , , • , i r 

surrounded by a rich plexus ot 

a. Early stage with swelling of , , . , „, , , 

the patch ; 6. Later stage with lymphatic Vessels. The UodulcS 

sloughing; c. Ulcer with infii- bulge towards the interior of the 

trated walls (from Thierfelden). ^^^^ ^^^ ^j^^j^ ^^^^^ ^^^ situated in 

the submucous tissue. Their upper surfaces are free from 
villi. Peyer's patches are simply collections of soHtary 
glands. They are oblong in shape, and are about an inch 
in width and from half an inch to two or even four inches 
in length ; they are found placed lengthways opposite the 
side of the intestine which is attached to the mesentery. 


The morbid changes in the intestine. — When a person 
is infected with typhoid by swallowing the bacilli typhi 
in the water or food, the microbes make their way to 
the Peyer's patches and solitary glands, where they find 
their proper soil. They here multiply, and by their irritat- 
ing presence, as well as by the poisonous substance which 
they excrete in the process of 
living, inflammation of the closed 
follicles is set up. The glands 
swell and become solid, ulceration 
follows, and a slough is finall\- 
separated and thrown off The 
walls of the glands are succulent -^ \,> 

and vascular, and considerable "^ ■'•,*^ 

haemorrhage may be caused by ^-"ll^* 

sloughing. The ulceration may, ^^ 
moreover, extend downwards : ; 
through the muscular coat, even "^ ^ 
into the serous coat, and result 
in perforation of the intestine. 
If the process is gradual, the i : ■ ij .v 11,: .. > Iaich seen 

inflammation generally extends ^"^"'^ '"^^ ^^^'='= °« superficial 

*=" -^ Side. 

to the peritoneum ; fibrinous 

1,1,1. A folded Peyer's Patch. 2,2. 

exudations are then thrown out. The folds which form the superficial 
and adhesions take place between or mucous layer of this patch. 3, 3. 

,1 •, J i.u i-U- J The grooves which separate the folds. 

the peritoneum and the thinned ^■, ^ /f ^ . 

^ 4, 4. Pits observed from place to 

walls of the intestine. These place in these folds. 5,5,5. Vaivuiae 

inflammatory adhesions form a conniventes. 6, 6. Solitary dosed 
^ , , , , . . , follicles situated in the space between 

false wall to the intestme and thevaUute. 7- 7. 7- Other follicles 

prevent the escape of its contents similar to the preceding but smaller. 

into the abdominal cavity. The ^' ^- ^^^'^^^ ^°"'"^"' ^'^^^'"^ °'' '^^ 

summit of the valvulag conniventes. 

ulceration may be so severe and 

rapid as to cut off the blood supply of the serous coat, 
in which case the latter undergoes necrosis, perforation 
takes place, the contents of the intestine pass into the 
peritoneal cavity, and fatal peritonitis ensues. 

Periods of the illness corresponding to morbid processes. 


— Inflammation of the follicles is contemporaneous with 
the' first symptoms of illness. It reaches its culminating 
point about the tenth day. If the case is slight, resolution 
or absorption of the products of inflammation then takes 
place slowly ; in severe cases the follicles ulcerate. The 
sloughs separate during the third week of the illness, but 
the process may not be completed until the fourth week. 
Cicatrisation of the raw surfaces of Peyer's patches begins 
about the end of the third week, and takes about two 
weeks to complete. Indiscretions of diet may, however, 
again set up inflammation, and Dr. Bristowe declares that 
the liability to perforation continues for from two to three 
months after the commencement of the illness. 

Physiological rest the rational treatment.— Knowledge 
of the processes of inflammation going on in the intestines 
of a typhoid patient gives the indication for treatment. 
This is in a word physiological rest. Let the bowel remain 
as immobile as possible, so that cicatrisation of the raw, 
ulcerated, and bleeding patches inside it may take place, 
and let no impetus be given towards perforation by un- 
digested particles of food setting up violent peristaltic 
action. The rest must be also muscular as well as physio- 
logical. A sudden movement of the patient may rupture 
the friable adhesions between the ulcerated intestine and 
the peritoneum, and the dreaded perforation into the peri- 
toneal cavity may consequently take place. When the 
inflammatory process, accompanied by fever, is over, and 
the appetite returns after the third week, the condition of 
physiological rest of the intestine must still be maintained 
as a leading principle of the diet. The slough is probably 
thrown off, but the raw surface is not yet cicatrised, and 
until cicatrisation is complete the patient is not safe from 
the fatal accident of perforation. In feeding him this is 
the first consideration. 

Typhoid patients sometimes killed by their friends' 
kindness. — Every hospital student can recall cases in which 
a promising typhoid case, recovering from an acute attack, 


has suffered a sudden relapse, with, perhaps, perforation 
and death. On inquiry it is often found that the bad 
symptoms set in after " visiting day," and that kind friends 
(sympathising with the patient's desire for solid food and 
his distaste for the rigid regime so long enforced) have 
surreptitiously brought him plum-cake, fruit, or bread and 
jam, etc. ; these have been secretly eaten at the cost of a 
relapse, and perhaps even of life. It is only necessary to 
study the pathological conditions depicted in Fig. 12, and to 
appreciate the fact that the intestine is in typhoid ulcerated 
and raw, and its walls dangerously thinned at certain points, 
in order to recognise the importance of not giving the 
patient solid food or articles likely to set up irritation or 
to cause violent peristaltic action of the intestine. 

The cardinal principles of dietetic treatment are as 
follows : (i) to maintain the strength of the patient ; (2) to 
give the intestine the physiological rest necessary, in order 
to avoid the accident of perforation, and to favour repair 
and cicatrisation. In all acute fevers metabolism of the 
tissues is abnormally active, and the waste great. The 
products of combustion are consequently present in abund- 
ance in the blood. Appetite is abolished, and stomachal 
digestion is suspended. Our object must, therefore, be to 
give the patient foods (i) that are easily digested, or rather, 
quickly absorbed ; (2) that will not increase the amount 
of urates in the blood ; (3) that will diminish the abnormal 
waste of the tissues. Hence the reason for the use in acute 
fevers, of beef-teas, jellies, arrowroot, gruel, and milk. In 
typhoid it must, moreover, always be borne in mind that 
the food given should be in the form of bland fluids very 
easily digested. 

Milk.— This is the aliment that suggests itself as the 
most appropriate for typhoid patients. It is a complete 
food, and on it alone a patient can subsist for an indefinite 
time. As a rule it is well borne. In such cases it should 
be taken in small quantities at frequent intervals. It must, 
however, be borne in mind that though milk is a fluid out 


of the body, it is curdled at once in the stomach by 
the action of the gastric acid. It may therefore, if not 
digested, pass as a firm solid through the whole length 
of the intestine, and set up irritation, leading to injury. 
It is of the utmost importance that in typhoid the evacua- 
tions of the patient should be carefully watched. If the 
milk is excreted in the form of curds, this is an indication 
that the patient cannot digest pure milk. It must then 
be given diluted. Equal parts of milk and Vichy or Vals 
water, or one part of milk to two of Apollinaris or soda 
water, may be administered, or ten grains of bicarbonate 
of soda and the same quantity of common salt should be 
added to every pint of milk and water in equal parts. 
Milk thus diluted and mixed with alkali can often be 
absorbed when pure undiluted milk would be undigested 

Ass's milk, which is precipitated in the stomach in an 
extremely fine curd, and which is consequently the more 
easily digested, may be substituted for cow's milk. 

Whey may be usefully given where milk is ill digested. 
It is made by boiling a pint of milk with a teaspoonful or 
two of lemon juice or rennet, straining through muslin, and 
squeezing all the fluid from the curd. Care should be 
taken to break up the curd with the fingers while pressing, 
for then much of the fat and some of the finely divided 
casein of the milk will pass into the whey and make it 
more nutritious. 

Eggs. — These should not be cooked, but the yolks 
beaten up raw^ with boiling water or hot broth. 

Beef-tea. — The usefulness of beef-tea is universally 
acknowledged in acute fevers. It is valuable in many 
different ways, inasmuch as it contains gelatine, which, as 
already described, prevents waste of the albuminous 
tissues ; soluble salts, which compensate for the extrava- 
gant loss of these in fever ; and certain stimulating sub- 
stances dissolved out from the beef. Mutton and chicken 
broths and clear soups are useful, as well as beef-tea 


essence, which should not, however, be given in too 
concentrated a form. In preparing clear soups and broths, 
vegetable juices should be added in order to supply the 
body with the salts and acids contained in vegetables, 
which are particularly needed in fever. It is important, 
however, to exclude the indigestible vegetable fibres from 
the soup. The vegetables used should, together with the 
aromatic herbs, be cut up fine and placed in a muslin bag 
and boiled. The juices should then be pressed into the 
soup or broth. 

Raw meat pulp may be given in prolonged cases of 
typhoid. Thin oatmeal or barley gruel, carefully strained 
from all gritty and irritating particles, and flavoured with 
sugar and lemon peel, is one of the best of the farinaceous 
foods. It can also be mixed with milk, beef-tea, or meat 
essences, and thus a useful composite food is produced. 

Water is an absolute necessity of the fever patient to 
allay his consuming thirst. Barley water, toast water, pure 
iced water, soda and effervescing waters can be given, 
changing one for another as the patient tires of each. 

Alcohol in any form is as a rule forbidden, and should 
only be given under medical advice. 

Diet during convalescence. — This is often extremely 
difficult to arrange. As soon as the temperature falls to 
normal, the appetite of the patient often becomes voracious. 
His piteous demands for food are almost irresistible ; but 
they must, notwithstanding, be firmly resisted, for it must 
be remembered that the intestine is still undergoing the 
process of ulceration and repair, and that solid food might 
set up fresh inflammation and cause fatal peritonitis. It 
is not safe to give any solid food till the temperature has 
been normal for at least eight days, and in severe cases for 
a longer period. The return to solid food should be very 
gradual. The beef-tea or soup can first be taken with fine 
bread crumb ; custards and jellies may then be added ; 
eggs are admissible lightly poached or beaten up in broth, 
also oysters and boiled fish ; sandwiches made of pounded 


chicken between thin squares of bread may next be 
attempted, and if no bad consequences result a slice from 
the breast of a boiled chicken may be eaten ; but not until 
all danger is completely past may the patient enjoy again 
his mutton chop and rump steak. 

Dietetic precautions in preventing typhoid. — It must 
never be forgotten that typhoid fever is a filth disease, and 
that its most frequent cause is the pollution of drinking 
water by infiltration from drains or cesspools containing 
the specific poison of typhoid. To ensure protection 
against typhoid it is first of all necessary to make sure 
of a perfectly pure drinking water ; but as this is difficult, 
if not impossible, under all circumstances, the drinking 
water should be always boiled, where there is reason to 
believe that the source is or may be polluted. This is a 
precaution which should be invariably taken in all those 
countries where the laws of sanitation are not observed, as 
in Italy, Spain, and the East. A necessary part of the 
traveller's luggage is a small Etna, by which he can boil in 
his bedroom all the water he intends to drink. Milk, of 
the source of which we are not sure, should always be 
boiled before being given to children to drink. If these 
simple precautions were observed the cases of typhoid 
fever which not infrequently occur after a visit to the 
Continent would often be prevented. 



The pathology of Bright's disease. — If my readers will turn 
to the chapter in which the structure of the kidney is de- 
scribed, it will be found that that organ is represented as 
performing the part of a scavenger and a filter in the body. 
It will be remembered that the arterial blood is brought by 
the short arteries of the kidney straight from the main cur- 
rent into a close tangle of loops of blood vessels called a 
glomerulus. This glomerulus is pushed into the blind and 
expanded head of a long uriniferous tubule. The cells 
lining this bag-like end of the tubule are small and flat, and 
they act merely as a filter. The blood, carried with con- 
siderable force straight from the renal artery, is brought to 
a sudden condition of stasis in the loops of the glomerulus, 
and it can be easily understood how that, under these cir- 
cumstances, the blood parts with a good deal of its fluid. 
What, however, passes from the blood is not its nutritive 
constituent parts, but its excess of water and the excretory 
products with which it is laden. These products are 
specially urea and urates, which are, as has been already 
fully explained, the final products of the digestion of albu- 
minous foods. 

Now, if instead of the blood parting only with urea 
and water in the kidney, it allow^ed the albumen, which 
forms its most important nutritive constituent, to pass across 
the filter into the uriniferous tubules, and if at the same 
time the excretory products of urea and urates were retained 
in the blood, an abnormal condition, highly prejudicial to 
health, would be present ; for there would be an extravagant 


waste of albumen, out of which the blood reconstructs the 

tissues and fluids of the 
body, and the blood instead 
of being cleansed in the 
kidney would remain 
charged with the poisonous 
products of combustion. 
This is what occurs in 
chronic Bright's disease. 
The kidney is damaged ; 
it fails to separate the urea 
from the blood, and it 
allows the albumen to 
escape into the tubules. 

The symptoms of 
Bright's disease. — The 
consequences are increas- 
ing weakness and fre- 
quently emaciation, en- 
feeblement of the mental 
powers owing to the pres- 
ence of effete products in 
the blood, thickening of the 
arteriesdue to the irritative 
action of these products on 
the walls of the arteries, 
consequent embarrassment 
of the action of the heart, 
venous congestion, and the 

Fig. 14.— Glomeruli of the Kidney; Origin of the Uriniferous Tubules. 

1,1. Glomeruli surrounded by their capsules, or the funnel-shaped terminations 
of the uriniferous tubules. 2, 2, 2. Uriniferous tubules springing from the capsules 
and much contorted in their course. 3, 3, 3. The interlobular branch of the renal 
artery. 4, 4. Its branches or the afferent vessels of the glomeruli. 5, 5. Two 
glomeruli in which are convoluted the afferent vessels. 6, 6. Glomerulus with 
the capsule partly removed. 7, 7. Efferent vessels of the glomeruli. 8. Efferent 
vessel the branches of which, 9, break up into the capillary network of the kidney. 



escape of the fluid of the blood into the tissues, with the 
consequent symptoms 
of dropsy. 

The aim in treat- 
ment. — There are ob- 
viously, therefore, three 
important considera- 
tions to be taken into 
account in treating 
chronic Kright's disease 
— namely, how to pre- 
vent the waste of albu- 
men, how to make good 
this waste, and how to 
prevent poisoning by 
the retention of urea 
and effete products in 
the blood. Before, 
however, considering 
treatment it would be 
as well to inquire into 

Causes of Bright's 
disease. — These are 
acute fevers, cold, alco- 
hol, and excessive eat- 
ing of meat. 

Acute albuminuria 
is an almost constant 

Fig. 15.— Course of the Uriniferous Ducts, Diagrammatic Plan. 
I, I. Rectilinear uriniferous tubule; a collecting duct passing from the peri- 
phery of the lobes towards the papilli of the kidney towards which it opens. 2. 
Lower end of the tubule, which has been cut off a little above its mouth for the 
convenience of the drawing. 3, 3, 3. Other collecting tubules opening into the 
cavity of the preceding. 4, 4, 4, 4, 4. Malpighian bodies or glomeruli. 5, 5, 5, 5, 5. 
Contorted tubules springing from the glomeruli and forming the greater part of the 
cortical substance of the kidney. 6, 6, 6, 6, 6. Straight tubes succeeding the con- 
torted tubes and descending from the cortical into the medullary substance. 
7) 7) 7> 7. 7- I-arger branches forming loops. 8, 8, 8, 8, 8. Other ascending 



symptom in scarlet fever, and frequently also of the other 
eruptive fevers. In these cases recoveryfrom the albuminuria 
is the rule with appropriate treatment ; but sometimes the 
attacks leave behind a certain enfeeblement of the action of 
the kidney, which may finally result in the establishment of 
chronic Bright's disease. The progress of the disease may 
be so slow and insidious that it is not noticed till certain un- 

FiG. i6. — Section of Diseaskd Kidney in Bright's Disease. 

a. Normal epithelium, t. Epithelial cells cloudy and swollen, c. Cells in 
extreme degeneration, d. Loose degenerate epithelial cells. 

explained symptoms lead to the examination of the urine, 
when albumen is found to be present. Cold is a frequent 
cause of Bright's disease, in cabmen and others whose work 
requires them to be exposed to all weathers. The abuse of 
alcohol also frequently results in chronic albuminuria. The 
presence of albumen in the blood seems to exercise a peculi- 
arly irritating influence on the tissues of the kidney. To 



excessive consumption of meat, and the consequent labour 
thrown upon the kidneys, some of the cases of Bright's dis- 
ease, from which the well-to-do and well-fed suffer, are 
attributed. Worry and anxiety are also, there is little doubt, 
frequently the cause of chronic albuminuria. It may be 
objected to the assertion regarding meat eating as a cause, 
that a great variety of experiments have demonstrated that 
temporary albuminuria cannot be produced experimentally 


V^ rS MON ! 


Fig. 17.— Transverse Section of the Medullary Substance of the 
Healthy Kidney, Magnified 350 Diameters. 
I, I, I. Section of the collecting tubes, showing their diameter, their cavity, 
and their lining epithelium. 2, 2. Ditto of the ascending portion of the urinife- 
rous tubules. 3, 3, 3. Section of the descending branch of the same, showing 
their much smaller calibre, slightly larger cavity, and very flat epithelium. 4, 4, 4. 
Section of the blood vessels. 

by an excessive albuminous diet. This may be the case, 
and yet the continuous use of an extravagantly albuminous 
diet, combined with an abuse of alcohol, may and does 
throw on the kidneys so great a work of elimination, that 
subacute congestion and consequent albuminuria may be 
the result. Certain it is that in meat-eating countries 
Bright's disease is much more prevalent than in those where 
the staple articles of diet are rice and fish. 

Treatment by diet. — Two objects must here be aimed 


at : to diminish the loss of albumen, and the production 
of effete excretory products. It has been erroneously 
thought that, because albumen is lost by the kidne}^ there 
must be an excess of albumen in the diet to compensate 
for this loss ; but it is forgotten that while the albumen is 
• lost by the blood the urea is retained, and that as in the 
digestion of albumen, urea is the final product, an excess 
of albumen in the food will, when the kidneys do not 
excrete all the urea, lead to a dangerous accumulation of 
poisonous products in the blood, with probably uraemic 
poisoning, coma, and death as the result. The indica- 
tions therefore are to give such nutritious food as will 
maintain the strength without increasing nitrogenous refuse 
in the blood. 

Milk diet. — It has been found that the best food in 
severe cases of Bright's disease is milk, and if it is well 
borne the happiest results have been obtained from an 
exclusive milk diet. It is quite remarkable how beneficial 
the result often is when a rigid milk diet has been main- 
tained. The amount of urine has increased, the albumen 
passed has diminished, the amount of urea excreted has 
been augmented, the dropsy has disappeared, and the 
improvement in strength and the general well-being have 
been most marked. The milk should be taken as fresh 
as possible, and in small quantities at short intervals, 
namely, about six ounces every hour during the day, one 
glass on getting up and another on going to bed — about 
from three to four quarts a day in all. If the milk is dis- 
liked and produces a disagreeable taste in the mouth, it 
can be mixed with a little lime water or aerated waters, 
or a small amount of alkaline water can be taken after the 
glass of milk. If the milk treatment is tolerated by the 
patient, it should be continued either till there is a com- 
plete disappearance of albumen from the urine, or the 
amount of it is very much reduced. This period varies in 
different cases, but usually after six to eight weeks of milk 
diet, there is such a marked improvement in the condition 


of the patient, and such a striking ameHoration of symptoms, 
that he may be allowed to gradually return to a mixed diet. 
If there should afterwards be a return of the dropsy and 
albuminuria the milk diet should be again enforced. 

Some patients have been known to live on milk for 
years, and have certainly suffered less discomfort, and have 
lived longer, than if they had attempted to live on an 
ordinary diet. On leaving off the milk diet the return to 
an ordinary regimen should be by cautious and slow degrees. 
A little arrowroot should first be mixed with the milk, 
then rice and tapioca, milk puddings should be added, and 
finally a little fish, chicken, and cooked vegetable may be 
ventured on. Daily examinations of the urine should be 
made to see what influence the change of diet has on the 
excretion of the albumen, and if any particular articles of 
diet exercise a malign influence. If the albumen does not 
reappear, a light nutritious dietary can then be established. 

What an albuminuric may and may not take. — There 
are certain things which the albuminuric must avoid, and 
they are briefly butcher's meat and alcohol. 

There is one thing, however, which an albuminuric may 
take in abundance, but which is often ignorantly withheld 
from him in the fear that it causes dropsy, — and that is 
water. Water is an excellent diuretic in these cases. It 
dissolves out from the blood effete products which are 
soluble, and it washes out the tubules of the kidneys which 
are clogged with the dibris of broken-down cells. Water 
should not be taken in excessive quantities at a time, but 
in small quantities at frequent intervals, and between meals 
rather than at them. It will be found that water will 
diminish dropsy rather than provoke it, especially if it is 
alkaline and slightly purgative in action. Professor 
Semmola, of Naples, recommends the following drink for 
the daily and habitual use of patients with Bright's disease: 

Sodium iodide, - - - - 15 grains. 

Sodium phosphate, - - - - 30 grains. 

Sodium chloride, - - - - go grains. 

Drinking water, - - - - 36 ounces. 




Dishes for the Albuminuric. 

Recipes for vegetable soups. — The study of the prepara- 
tion of various dishes and soups which shall be at the 
same time nutritious and appetising and yet not too 
stimulating and nitrogenous, becomes the duty of the 
housekeeper who has to cater for the victim of Bright's 
disease. These patients, particularly those suffering from 
the contracted-kidney form of disease, have feeble and 
capricious appetites, weak digestions, and often suffer 
from constant nausea. To prepare their food so that it 
shall be attractive, nutritious, and yet deficient in strong 
meats, will tax the art of the cook. Vegetable soups, 
which may be varied from day to day, according to the 
vegetables in season, will be found to be most useful 
articles of diet in cases of chronic Bright's disease. I 
quote the following method of the preparation of these 
soups from Sir Henry Thompson's valuable and suggestive 
treatise on Fooc^ and Feeding. 

The following is a good recipe for a clear, purely vege- 
table stock : " Slice two carrots, two turnips, a head of 
celery, and two onions ; put into a frying-pan with a few 
sweet herbs and half a pound of butter. Fry until well 
browned, then put them with three or four cloves, some 
salt and black pepper, into six pints of cold water in a 
saucepan ; bring to the boil, and gently simmer for two or 
three hours, reducing to four pints, not less ; strain off into 
a vessel, letting it stand for use. When required, pour off 


the clear liquor, leaving the deposit, and you will have a 
good vegetable stock. If it is to be used as a clear vege- 
table soup, heat, adding at the close two tablespoonfuls of 
cornflour previously mixed smooth in some of the liquor, 
and let the whole boil ; if any scum arise, remove it. The 
cornflour gives to the decoction an agreeable body. 

" To convert this into a meat consomme, add after boiling, 
and just before serving, two full teaspoonfuls of the Liebig 
Company's Extract of Meat. 

" Another mode of giving body when a soup maigre is 
not required is to make a decoction of beef bones without 
meat, which have been thoroughly broken and allowed to 
simmer gently at least six hours, then cooled and the fat 
removed. The result, which is a strong jelly, can be 
warmed, strained clear through flannel, and used instead 
of water with which to make the vegetable soup as above 
directed ; it adds substance and quality, and the animal 
matter takes the place of the cornflour employed for the 
preceding soupe maigre. 

"Thickened vegetable soups maybe made with these 
stocks, or with a weak meat stock, by rubbing in smooth, 
well-made //^re^j- of almost any vegetable matter. Those 
most commonly used are made from green peas, potato, 
carrot, turnip, artichoke, tomato, salsify, etc., or from dried 
vegetable products, as split peas, lentils, haricots, rice, 
arrowroot, semolina, etc." 

Methods of cooking macaroni. — Macaroni is also, as 
the same careful observer points out, an article of diet 
greatly neglected by the English, and would be valuable 
in the cases we are considering. The methods of cooking 
macaroni, as recommended by Sir Henry Thompson, are, 
as I have found from personal experience, so excellent 
that I find it impossible to abridge them, and quote them 
in full. 

" Put four ounces of good macaroni (Genoa or Naples), 
as little broken as possible, into a saucepan with three or 
four pints of boiling water. Boil ten minutes, not longer. 


Then pour off all the water, and place the macaroni in a 
stewpan with a pint of good and well-flavoured stock made 
from beef or veal, or both (or from a well-furnished stock 
pot), adding a saltspoon of salt and half that quantity of 
pepper, and let it simmer at the corner of the fire until the 
macaroni is tender ; it is never to be soft and flabby. The 
time necessarily varies, according to the kind and size of 
the macaroni, e.g., fifty or sixty minutes for the best 
Genoese, from twenty-five to thirty minutes for Neapolitan. 
Its condition, however, should be tested by trying a small 
piece. Most of the stock is absorbed by the macaroni by 
this time; but that which remains, probably a fourth part of 
the original quantity, may be strengthened, if necessary, 
by the third or the half of a teaspoonful of the genuine 
Liebig's Extract of Meat, and thickened by adding a little 
baked flour (baked quite brown), which is preferable for 
this purpose to the brown t'onx often used, which contains 
butter in a somewhat indigestible form. The above con- 
stitutes macaroni au jus in the simplest form. 

" For those who can digest cheese and butter, an ounce 
of grated Parmesan, and, perhaps, half an ounce of good 
English cheese may be added, gradually stirring well 
during the latter half of the process, towards the end of 
which a little pat of butter may be added, with a sprinkle 
of Parmesan over the dish when filled, before serving. 
The macaroni ought now to ' spin ' well, that is delicate 
threads should extend from one portion to another when 
moved. Lastly, hot tomato sauce may be poured over it, 
or be supplied separately, since some prefer the macaroni 
without this addition. Serve on a hot dish provided with 
a cover. It is now a dish of macaroni a V Italienne. 

"If there is only a weak stock, chiefly made from 
bones, etc., in the stock pot, use it, but add rather a larger 
portion of the Liebig's Extract. In such a case a little 
flour of lentils, well boiled to thicken the stock with, would 
be a suitable addition. The Liebig's Extract should never 
be added until the end of the process, and merely be well 


stirred in immediately after removing from the fire to 

" If, instead of stock, milk is used, an agreeable change 
may be made ; and this form constitutes macaroni au 
maigre, the foregoing recipes being au gras. To prepare 
this, boil four ounces as before, ten minutes ; drain and 
place in a stewpan with a pint of milk, simmering as above 
directed until sufficiently tender. Serve hot. Any milk 
remaining unabsorbed by the macaroni may be thickened 
with baked flour (white). Flavour with a little cinnamon 
or vanilla, or otherwise to taste, and sweeten with sugar or 
saccharin, if desired. For those who prefer a savoury dish, 
and can take cheese and butter, a tablespoonful of grated 
Parmesan and a small pat of butter should be gradually 
added, stirring it in during the latter part of the simmering 
process, according to the directions just given for macaroni 
a V Italienne.'' 

Foods allowed. — These recipes are illustrative of the 
kind of diet which should be prepared for an albuminuric. 
Many of the recipes which have already been given for 
gout and rheumatism would be also applicable. I must 
state, in conclusion, that the following list of dishes and 
articles is permissible. All kinds of farinaceous food, rice, 
tapioca, arrowroot, hominy, oatmeal, cornflour, gruel, etc., 
cooked with milk or made into puddings. All kinds of 
well-cooked vegetables, avoiding in serious cases, peas, 
beans, and lentils. Soups made of fish ; purees of vege- 
tables and thin bone stock ; cocoa, coffee, and chocolate ; 
cooked fruit, koumiss and junket, and fish and white meats 
in small quantity. 



Abstemiousness, 58-62. 
Adipose Tissue, 9. 
Adult Life, Diet for, 54. 
Aged, Dishes for the, 64-68. 
Albumen, 3, 7. 

— Composition of, 3. 

— Waste of, 190. 
Albuminates, 4. 

— Composition of, 3. 

— Uses of, 4, 5. 
Albuminous Food, 6. 

— Dangers of, 61. 

— Digestion of, 84, 100. 
Albuminurias, Diet for, 207-211. 
Albumose, 96, 97, 100. 
Alcohol, 15. 

— Amount to take, 17. 

— Dyspepsia and Alcohol, 11 

— Effects of, 16, 20. 

— Food, Alcohol as, 15, 16. 

— Nips, Habit of, 18. 

— Strength-Giver, 18, 19. 

— Time to take it, 17, 18. 

— Typhoid Fever, Alcohol 


— Uses of, 19. 

— Value as a Drug, 19. 
Alcoholic Drinks, Fermented, 17. 
Alcoholic Dyspepsia, 105. 
Almond — 

Biscuits, 141. 

Cakes, 141. 

Pudding, 141. 
Anaemia of School Girls, 54. 
Animals, Hybernating, 10. 
Aorta, The, 97. 
Appetite, Peculiarities of, 75. 
Apple Snowballs, 68. 
Artichoke Soup, 165. 
Asparagus, Steamed, 68. 
Ass's Milk, 198. 
Athlete's Diet, 57. 
Atonic Dyspepsia, 117. 


Bacillus, Tubercle, 172, 176. 
Banting Diet, 71. 
Bechamel Sauce, 143. 
Beef Balls, Raw, 115. 
Beef, Sirloin of, 149. 
Beef-Tea, 191, 198. 

— Making, 113. 

— Peptonising, 114, 118, 191. 

— Use of, 113. 

— Varieties of, 113. 

— Whole, 113. 
Beverages, Diabetic, 135. 
Bile, 100. 

— Uses of, 89, 90. 
Bilious Attacks, 55. 
Bilious Headache, 55, 169. 
Biscuits — 

Almond, 141. 
Callard's, 165. 

Bisque Soup, 143. 

Blancmanges, Peptonised, 117. 

Circulation, 96, 97. 
Examining, 78. 
Venous, 96. 
Vessels of the Intestines, 94. 

Body, Composition of, i. 

Bones, 45, 181. 

Brain-Workers, Diet for, 58. 
i Brains, Ill-nourished, 51. 

Gluten, 139. 
Torrefied, 139. 

Bright's Disease, 201-207, 208-211. 

— Causes of, 201, 203. 

— Chronic, 201. 

— Foods allowed, 211. 

— Milk Diet, 206. 

— Pathology of, 202. 

— Recipes of Food in Bright's 

Disease, 208-211. 

— Treatment of, 203, 205. 
Brunoise Soup, 67. 



Cabbage, Stewed, 164. 

Almond, 141. 
Cheese, 148. 

Calcium, i. 

Callard's Biscuits, 165. 

Capillary Blood Vessels of the Intes 
tines, 94. 

Carbo-Hydrates, 10. 

— Importance of, 11, 12. 
Carbon, i, 2. 

Carlsbad — 

Diet, 74. 

Life, 153. 

Town, 152. 

Treatment at, 153-156. 

Waters, 152. 

Wells, 153. 
Cart- Wheel Cheese, 164. 
Casein, 3. 
Cellulose, 14. 
Centenarians, 62. 
Cheese — 

Cakes, 148. 

Cart-Wheel, 164. 
Chicken, Puree of, 126. 
Chicory, 40. 
Chlorine, i. 
Chocolate, 41. 

— Value of, 41. 
Chyle, 89. 
Chyme, 85, 120. 
Circulation, Portal, 95, 96. 
Coca, 21-25. 

— Effect of Excess, 25. 

— Effect on Respiratory Centres, 


— Leaf, Mysterious Qualities of, 


— Leaves, 21, 22. 

— Physical Effects of, 22. 

— Staying Powers of, 24, 25. 

— Wine, 25. 
Cocaine, 26. 

— Effects of, 26, 27. 
Cocoa, 40. 

— Constituents of, 40. 

— Preparations of, 41. 

— Theobromine in, 40. 
Cocoa Nibs, 40. 

— Stewing, 41. 

Cocoa-nut Cream, 149. 

Boiling, 41. 
Infusing, 41. 

Cod, Stewed, 65. 
Cod Roes, Fresh, 147. 


Berries, 36. 

Characteristics, 36. 

Constituents, 36, 37. 

Making, 39. 

Physiological Effects of, 37. 

Plant, 36. 

Sustaining Powers, 37, 38. 
Condiments, 46. 
Consumption, 172, 173. 

— Various Treatments, 173-176. 
Convalescence in Fever, 192. 
Convalescents, Food for, 126, 193, 

Cornaro, Precepts and Practice of, 63. 
Crab Omelette, 144. 
Cream, 62. 

Cream, Cocoa-nut, 148. 
Creams, Tarragon, 150. 
Creme de Volaille, 126. 
Croute-au-Pot, 148. 
Cucumber — 

Cooked, 143. 

Stuffed, 141. 
Curries, 142. 
Curried Eggs, 142. 
Cutlets, Grilled, 145. 


Depression, Mental, 169, 170. 
" Devils," 141. 
Dextrine, 10. 

Diabetes, 127-130, 131-137, 138-145, 
146-151, 152-156. 

— Causes of, 128, 130. 

— • Glycosuric Dyspepsia, 129. 
^ Major, 130. 

— Minor, 129. 

— Treatment of, 131-137. 
Diabetic — 

Beverages, 135. 
Diet, 131-134. 
Recipes, 138-145, 146-151. 
Aged People's, 60-63. 
Athlete's, 57. 
Banting, 71. 
Brain-Workers, 58. 
Bright's Disease, 206, 208-211. 
Carlsbad, 74. 
Children's, 54. 

Convalescents, 126, 193, 199. 
Diabetic, 131-134, 138-145, 146- 

Ebstein's, 71, 72. 
Fever, 191-193. 
Gastric Ulcer, 124-126. 
Gout, 161, 162, 164-166. 



Indians of the Andes, 22. 57. 

Meat, 56, 57. 

Milk, 125, 197, 198, 208. 

Oertel, 73. 

Poor, 49. 

Purees of Meat, 125. 

Rickets, 182. 

Sedentary, 56. 

Subsistence, 47. 

Typhoid Fever, 197-199. 

Vegetarian, 58, 170. 

Women's, 58, 59. 

Working, 48, 49. 

{Sci" also under Food.) 
Dietetic — 

Rest, 113. 

Rules, 73. 

Treatment, 79. 
Digestion, 81-86, 87-92, 93-100. 

— Duodenum, 87-89. 

— Excretory, Products of, 100. 

— Fat, 87, 100. 

— Gastric, 85. 

— Intestinal, 90-91. 
Disease, Use of Alcohol in, ig. 
Dishes for the Aged, 64-68. 
Duck with Turnips, 149. 
Duodenal Indigestion, 114. 
Duodenum, Digestion in, 87-89. 
Dyspepsia, loi-iii. 

— Alcoholic, 105. 

— Atonic, 109. 

— Duodenal, 106. 

— Fresh Air for, in. 

— Glycosuric, 130. 

— Stomachal, 102-105. 

— Symptoms of, 107. 

— Treatment of, 107-109. 
(Sec also under Indigestion.) 

Dyspeptics, 108. 

Eating, Too Much, 69. 
Ebstein's Diet, 71-72. 
Eggs, 198. 

— Curried, 142. 

— Flip, 144. 

— Swiss, 148. 

— Whites of, 84. 
Emaciation, 137. 
Enemata, Nutrient, 121. 
Epiglottis, 82. 
Exercise, Muscular, 9. 

Faeces, The, 108. 
Farinaceous Foods 


Fat, 8. 

— Composition of, 8. 

— Digestion of, 87-89. 

— Emulsifying, 89, 94, 100. 

— Production of, 12. 

— Reducing, 69. 

— Storage of, 9. 

— Uses of, 8, 9. 
Fats, 8, 108. 
Fever — 

Albumen, Waste of, 190. 

Beef-Teas for, 191. 

Convalescence, 192. 

Diet, 191. 

Potash Salts, Waste of, 191. 

Symptoms, 189. 

Temperature, i8g. 

Typhoid (see under Typhoid). 

Urea, Excretion of, 190. 
Fibrin, 3. 
1 Filter, Pasteur-Chamberland, 44. 
Filters, Variety of, 43. 
Filtration, 43. 
Importance as Food, 64. 
) Macaroni and Fish, 66. 
I Pudding, 66, 143. 
I Roe Souffles, 150. 

Soup, 64, 65. 

Stew, 65. 

Stewed Cod, 65, 66. 
I Food — 

Aged People, Food for, 60-63, 64-68. 

Alcohol, 15-20. 

Amount to take, 47. 

Composition of, i. 

Condiments, 46. 

Dietetic Values, 1-7, 8-13. 

Digestion of, 81-86, 87-92, 93-100. 

Farinaceous, 68, 192. 

Fatty, 161. 

Flesh-forming, 4. 

Force-producing, 4. 

Inorganic, 2. 

Invalid, 112-118. 

Malted, 115. 

Middle Age, 55. 

Nitrogenous, 2, 4. 

Non-Nitrogenous, 2. 

Organic, 2. 

Over-Eating, 55-59. 

Patent. 112. 

Peptonised, 116-118. 

Physical Work, 49. 

Starchy, 12. 

Subsistence, 49. 

Sweet, 12. 

Under-Feeding, 47-52. 

Values of, 2, 8-14. 



Youth, Food for, 53. 
(Si-e also under Diet.) 

Fool, Green-gooseberry, 140. 

Fowl a I'Estragon, 141. 

Bottled, 146. 
Salts, 45. 

Gall Bladder, 90. 
Gastric — 

Digestion, 85. 

Glands, 83, 103, 104. 

Juice, 84. 

Ulcer, 124. 

— Diet in, 124-126. 

— Symptoms of, 124. 
Gastritis — 

Acute, iig-122. 

Chronic, no. 
Gelatine, 7. 
Gherkins, 149. 
Anaemic, 54. 

Physical Constitution, 54. 
Glands — 

Mucous, 82. 

Peptic, 82. 
Glomeruli of the Kidney, 27. 
Glomerulus, 99. 
Glucose, 12, 96, 100. 
Gluten, 4. 
Glycogen, 96. 
Gooseberry Fool, 140. 
Alcohol in, 161. 

Causes of, 158. 

Diet in, 161, 163, 

Exercise in, 162. 

Fresh Air for, 162. 

Menus for, 163-165. 

Physiological Balance in. Want of, 

Uric Acid in, 158. 
Gouty, Dishes for the, 163-165. 
Gruel — 

Malted, 85. 

Milk, Peptonised, 86. 
Gullet, 82. 


Haddock Pudding, 66. 
Haig"s Dietary, 169. 170. 
Headache — 

Bilious, 169. 

Periodic, 168. 
Hepatic Artery, 97. 

Hybernating Animals, 10. 
Hydro-Carbons, 8. 
Hydrochloric Acid, 84. 
Hydrogen, i, 2. 


Ill-Nourishment, Effects of, 54. 
Ill-Temper, Causes of, 56. 
Indians of the Andes, 22, 57. 
Indigestion, loi-iii. 

— Alcohol in, in. 

— Causes of, 102. 

— Duodenal, 106. 

— Stomachal, 102-105. 

— Symptoms, 107. 

— Treatment, 105, 109. 
{See also wider Dyspepsia.) 

Infants — 
j Feeding of, 177, 179. 
I Natural Food of, 178. 

Rickets in, 177-182. 
Inorganic Food, 2. 
Intestines — 

Absorption from, 93. 

Capillary Blood Vessels of, 94. 

Digestion in, 90, 91. 

Large, 92. 

Morbid Changes in, 195. 
Invalid — 

Feeding, 112. 

Foods, n2-n8. 
Iodine, i. 
Iron, I. 


Japan, Tea Ceremony in, 34, 35. 
Jellies, Peptonised, 117. 
Jugular Vein, 96. 
Junket, 149. 


Kedgeree, 66. 
Kidneys, The, 97-99. 
Koumiss, 175. 

Lacteals, 94, 95. 

Lamb, Warrenised Breast of, 139. 

Lettuce — 

Soup, 149. 

Stewed, 142. 
Leube's Meat Solution, 120. 
Life, Advanced, 61, 6g. 
Lime-juice Lemonade, 163. 
Liver, The, 89. 

— Cells, 89. 

— Sugar in, 129. 




Macaroni — 

Cooking, 2og-2ii. 
Fish with, 66. 

Magnesium, i. 

Maigre Soup, 67. 

Extracts, Patented, 115, 116. 
Infusion, Making, 116. 

Malted Foods, 115. 

Malted Gruel, 116. 

Marienbad, 156. 

Meals for Aged People, 62, 68. 

Meat, Braising, 142. 

— Dangers of Excess of, 56. 

— Diet, 56, 57. 

— Eating. 6. 

— Juice, Raw, 114. 

— Physical Exertion, Meat for, 57 

— Powdered, Raw, 175. 

— Quantity Required, 57. 

— Solution, Leube's, 120. 
Mental Depression, i6g. 

— Cure for, 170. 
Menus — 

Aged, The, 65-68. 

Diabetic, 138-145, 146-151. 

Gouty, 163-165. 

Poor, Menus for the Poor, 49, 50. 
Metabolism, Meaning of, 4, 5. 
Migraine, 55. 
Milk, 89. 

— Ass's, 198. 

— Diet in Bright's Disease, 208. 

— Diet in Gastric Ulcer, 125. 

— Gruel, Peptonised, 117. 

— Infection in, 176. 

— Peptonised, Preparing, 117. 

— Soda Water and Milk, 165. 

— Typhoid Fever, Milk in, 197, 

Mouth, Digestion of Food in, 81. 
Mucous Glands, 89. 
Mucus, 84. 
Muscle, 4, II. 
Muscles, 57. 
Muscular Exercise, 9. 
Mutton, Braised, 142. 


Nips, Pernicious Habit of taking, 18. 
Nitrogen, i. 

— Necessity for, 6. 
Nitrogenous Food, 2, 4, 6. 
Non-Nitrogenous Food, 2. 


Obesity, Treatment of, 70-74. 

Oertel's Diet, 73. 
CEsophagus, 82. 
Omelettes, 145. 

— Crab, 144. 
Organic Food, 2. 

— Salts, 45. 
Over-Eating, 47. 
Oxygen, i, 2. 

Pancreas, The, 87. 
Patent Foods, 112. 
Patient, Weighing the, 137. 
Pepsine, 84. 
Peptic Glands, 82, 83. 
Peptones, Test for, 192. 
Peptonised — 

Beef- Tea, 114, 191. 

Blancmange, 117. 

Foods, 116-118. 

Jellies, 117. 

Milk, 117. 

Milk Gruel, 116, 117. 

Soups, 117. 
Peru, Coca Plantations of, 22. 
Phosphorus, i. 
How they Live, 48. 

Menus for the, 49, 50. 
Potash Salts, Waste of, in Fever, 191. 
Potassium, i. 
Pot-au-Feu, 66-67. 
Poulet a TEstragon, 140. 
Ptyalin, 82. 
Puddings — 

Almond, 141. 

Fish, 143. 

Haddock, 66. 
Pylorus, 85. 


Raw Meat — 

Powdered, 175. 

Pulp, 199. 
Respiratory Centres, Effect of Coca 

on, 24. 
Restoratives, 28-35, 36-41. 
Rickets, 177-182. 

— Symptoms, 180-182. 

— Treatment, 182. 
Rules, Dietetic, 73. 

Saccharin, 62, 163. 

Salt, Common, 45. 

Fruit, 45. 
Organic, 45. 

Sauce, Bechamel, 144. 



Scurvy, 184, 185. 

— Children, Scurvy in, 184, 187. 

— Prevention of, 187. 

— Symptoms of, 186. 

— Treatment of, 186. 
Scrofula, 183, 184. 
Sole, Steamed, 126. 
Souffles, Fish-Roe, 150. 
Soup — 

Artichoke, 164. 

Bisque, 143. 

Brunoise, 67. 

Fish, 64. 

Lettuce, 150. 

Maigre, 67. 

Peptonised, 117. 

Pot-au-Feu, 67. 

Spinach, 140. 

Sweetbread, 67. 

Vegetable, 165, 208. 
Spinach Soup, 140. 
Starch, 10, 81. 

— Action in the Body of, 82, 127. 

— Composition of, 10. 
Starchy Foods, gg. 

Starvation Wages, Results of, 50, 51. 
Steaks, Spanish, 146. 
Stew, Fish, 65. 
Stimulant, Nourishing, 62. 
Stimulants, 15-20, 20-27. 
Stomach — 

Absorption by Veins of, g3. 

Coats of, 82. 

Digestion in, 82. 

Emptying, 85, iig. 

Resting, 105, 120. 

Ulcer of, 123-126. 
Subsistence Diet, 47. 
Sugar, 10, 128, 135. 
Sulphur, I. 

Super-Alimentation, 174. 
Sweetbread Soup, 67. 
Sweetbreads, r42. 
Swiss Eggs, 148. 


Tannin, 2g. 

— Effect on Digestion, 31. 
Tarragon Creams, 150. 

Tea, 28. 

— Black, 2g. 

— Ceremony in Japan, 34. 

— China, 30. 

— Constituents, 2g. 

— Cultivation, 2g. 

— Dangers of, 32. 

— Drinking, National Customs 

in, 33- 

Tea, Dyspepsia from, 32, in. 

— Exhilarating Powers of, 31. 

— Green, 28. 

— Indian, 30. 

— Leaves, Effect of Water on, 


— Making, 32, 33. 

— Physiological Effects of, 30. 

— Preparation of, 28. 

— Staying Powers of, 31. 
Teeth, Decayed, 102. 
Temperature of Body, Lowering, 16. 
Theine, 2g, 31. 

Theobromine in Cocoa, 40. 
Thin, Fattening the, 75. 
Tissue — 

Adipose, g. 

Change, 61, g6, 103. 

Waste, 5. 
Tomatoes, 147. 
Tubercle Bacillus, 174, 176. 
Turnips and Duck, i4g. 
Typhoid Fever — 

Alcohol in, igg. 

Cause of, ig4. 

Convalescence from, igg. 

Diet in, ig7-igg. 

Periods of the Illness, ig5. 

Preventing, 200. 

Treatment of, ig6. 


Ulcer, Gastric, 124. 

Ulcer of the Stomach, 123-126. 

Under-Feeding, 47. 

Urea, 7, 105, 107. 

— Excretion of, in Fever, igo. 

— Formation of, 166. 
Uric Acid, 166-171. 

— Dietary for Excess of, 168-170. 

— Excretion — 

Decreased, 168. 
Increased, 167. 

— Formation of, 105, 166. 

— Headaches, caused by, i66, 

167, 168. 
Urine, 108. 

— Examination of, 135, 136. 


Veal, Braised Knuckle of, 142. 
Vegetarian Diet, 170, 171. 
Vegetable — 

Albumen in, 3. 

Marrow, 14 1. 

Soups, 165, 208. 
Vein, Jugular, g6. 



Vein, Portal, 96. 

Veins of the Stomach, 93. 

Venous Blood, 96. 

Vichy, 156, 157. 

Villi, 95. 

Vomiting, 124. 


Wages, Low, Results of, 50, 51. 
Water, 161. 

— Amount in Human Body, 42, 


— Boiling, 44. 

— London, 43. 

— Pure, 42. 

— Purifying, 43, 200. 

Water, River, 43. 

— Spring, 43. 

— Well, 43. 

Waste, Tissue, 5, 190, 193. 

Weir-Mitchell Treatment, 75-79. 

Whey, 198. 

Women, Diet for, 58, 59. 

Active, 48. 
Hard, 48. 
Moderate, 48. 

Working Diet, 49. 

Yeo, Dr. Burney, 69. 
Youth, Food for, 53. 


















Messrs. Callard are supplying these Foods to Guy's, The London, St. 
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Are imported in Bottles and used in treatment of CHRONIC GASTRIC 



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gestible and U^^^ each Jar o the 

nourishing. V """'"" 




Liebig's Extract of leatCompanf, Li 


225 15 






No. 202, 
From £1 lis. 6d. 


No. 213, 
From £1 Is. 

Tap Filter, No. 215, £1 1s. 
Reservoir as shown, £2 2S. 


Is the only FiSter shown to reliably prevent 
water-borne disease, such as typhoid fever, 
cholera, dysentery, diarrhoea, malaria, etc. 

No other Filter has been shown to do this, 
and the majority have been proved to in- 
crease and prolong: the infection. 

These statements are not based on any experiments made on 
behalf of persons interested in the Pasteur Filter, but on the 
entirely independent Reports of Researches made in the Conjoint 
Laboratory of the Royal Colleges of Physicians (Lond.) and 
Surgeons (Eng.), the Public Health Laboratories of Edinburgh 
and Paris, the Municipal Observatory of Montsouris, etc., on the 
opinions expressed by the leading British and Foreign Medical 
and Scientific Text-books and Journals, and on the Ministerial 
Reports of the French War Office, etc., recording the results of 
the use of these Filters in the French Army, where it is fitted to 
the 245,000 quarters having the worst water supplies in France, 
Tunis, and Algeria. 

Made in all forms, with any desired out- 
put, for use in families, institutions, etc. 


J. DEFRIES & SONS Limited, 









The following important facts, which have been conclusively 
proved, show 


(a) It does not cause the slightest disturbance of any bodily 

(fi) It does not pass into the saliva. 

(f) It does not pass into the milk. 

(d) It passes exclusively into the urine. 

(&) It is entirely eliminated from the system within twenty-four 

(/■) It has no influence on the assimilative functions. 

(g) It passes through the system absolutely unchanged. 

(A) It exercises an aiitiseptic influence upon and prevents decom- 
position in, the contents of the intestines. 
(/) It has no effect upon the sensory organs, nor upon the nervous 

Where sugar (the ordinary carbohydrate) in any form is pro- 
hibited as an article of food, or as spice, on account of its effect 
in diseased or abnormal conditions, such as dyspepsia, diabetes, 
glycosuria, et hoc genus omne, it may be asserted without fear of 
contradiction, upon the evidence we have already referred to, that 
the administration of Saccharin, while satisfying the palate of the 
patient, cannot possibly aggravate the existent conditions ; on 
the contrary, its antiseptic influence may be for good. 

This sweetening agent is supplied in three forms, viz., Saccharin, 
Soluble Saccharin, and Saccharin "Tabloids". 

The " Tabloids" are portable, and of the greatest convenience 
to those travelling or away from home during the day, as a 
"Tabloid" or two will sweeten a cup of tea, coffee, etc., as well 
as sugar. A little spoon accompanies each bottle of the Soluble 
Saccharin ; this spoon once or twice full is also sufficient to 
sweeten a cup of tea or other beverage. 

Supplied by all First-class Pharmacists and by the Wholesale Drug Trade. 

WILSON, SALAMON, & Co., Ltd., 



Scientific Press List. 

'Demy Sro, ciot/i ;/in, pp. 200, price .?s. fkl. 

Art of Feeding the Invalid. 

By a Medical Practitioner and a Lady Professor of Cookery. 

A popular treatise on the most frequent disorders : with detailed lists of 
suitable diet and original recipes for daily use. 

" Mrs. Ernest Hart, in the foregoing pages, says:—" For many of these practicable recipes 
I am indebted to that excellent and valuable manual, ' The Art of Feeding the Invalid ! ' " 

" Its design is excellent, and we think it has been successfully carried out, containing, as the 
work does, information not hitherto published in such a form. It is scarcely necessary to 
remark on the usefulness of information of this kind to matrons of institutions, sisters, and nurses, 
and heads of households, and to all concerned with the care of sick and delicate people."— 

" This is a useful book. ... To the housekeeper who has a dyspeptic, gouty or diabetic 
member in her family, this book cannot fail to be of great value, and save her much anxious 
thought, and prevent her making serious mistakes."— BriVts/i Medical Journal. 

Cronn Sfo, illustifiierl, 4_00pp., cloi/t f/i/f, price :)S. 

Helps in Sickness and to Health. 

Where to Go and What to Do. Being a Guide to Home Nursing and a 
Handbook to Health in the Habitation, the Nursery, the School- 
room, and the Person, with a chapter on Pleasure and Health 

By Henry C. Burdett, 

Author of Hospitals and Asylums of the World, Pay Hospitals of the World, 

Cottage Hospitals, &c., &c. 

" It would be difficult to find one which should be more welcome in a household than this 
unpretending but most useful book."— r/if Times. 

" We can heartily recommend this little epitome of useful information to all who desire to 
have at hand, in the most accessible form, a ready guide to tell them where to go and what to 
do, without a moment's doubt or loss of time, where time is so valuable that a few minutes or 
an hour lost may be irreparable in the mischief resulting." — Spectator. 

" We have often desired to obtain, either for ourselves or friends, the very information this 
book supplies. We therefore can, with justice, commend this synopsis to the profession and to 
the public ; indeed, we feel that no medical or general library can be complete without such a 
book of ready reference." — Lancet. 

" This book iills a gap in popular sanitary literature by providing within the compass of 
one volume of very moderate size a useful collection of facts not easily found elsewhere, unless 
a sanitary library be at hand." — British Medical Journal. 

London: THE SCIENTIFIC PRESS, Ltd., 428 Strand, W.C. 

Scientific Press List. 

Second Edition, non' ready, nith » new Chapter, aceoinpanied by rotoitre^l 
and other -plates, on the Artijicial Feeding of Infants by the cincients. 
Crown 8vo, cloth ffilt, profusely illustrated, price 5s. 

With Facsiiviile Autograph Letters froivi the late Sir Andrew 
Clark, IVI. Pasteur, Etc, Etc- 

Infant Feeding: by Artificial Means: 

A Scientific and Practical Treatise on tiie Dietetics 
of Infancy. 

By S. H. Sadler, 
Author of Suggestions to Mothers, Management of Children, Education. 

" Mrs. Sadler's book deals with the question of the artificial feeding of infants, and contains 
a very useful collection of the views of the best known English authorities on the subject. The 
truly terrible ignorance displayed by mothers, especially amongst the poor, upon the subject of 
infant feeding is answerable for an infant mortality so great as to be appalling." — Daily 

Crown Sro, cloth r/ilt, price 3s. h'd. 

The Mother's Help 


Guide to the Domestic Management of Children. 

By P. Murray Braidwood, M.D., 

Formerly Senior Medical Officer to the Wirral Hospital for Sick 


" To many young mothers it should prove invaluable." — Provincial Medical Journal. 
" We do not doubt the need of it in the ignorance of many mothers, and we can recommend 
it as likely to enlighten that ignorance." — Glasgow Medical Journal. 

Crown Svo, cloth .'/ill. with ma?ty Plates and Illustrations, price ifs. fid. 

Spinal Curvature 

And Awkward Deportment: their Causes and Preven- 
tion in Children. 

By Dr. George Muller, Professor of Medicine and Orthopcedics, 

English Edition, edited and adapted by Richard Greene, F.R.C.P. 

" Dr. Miiller's little book is an able essay upon the effect produced by exercise, attitude, and 
movement upon the growth and development of the body. He further gives directions which 
any intelligent parent or teacher could carry out with the help of very simple apparatus, showing 
how to avoid or, in early cases, to cure certain malformations which, in the majority of cases, 
arise either from the neglect of very simple hygienic rules or from carelessness."— Daj/j Chronicle. 

London : THE SCIENTIFIC PRESS, Ltd., 428 Strand, W.C. 

Scientific Press List, 

Ihird ttiid Rerised E(h'tio>i, (/t'»)y Svo. 30!) pp., profuse fv i/histi-ated nii/i 
f'lipYrif/ht J'orti-aitx tiiir/ '/Jraiii/ir/s, price ?,v. fid. ipogf free). 

How to Become a Nurse: 

And how to Succeed. 

A complete guide to the nursing profession for those who wish to 
become Nurses, and a useful book of Reference for Nurses who 
have completed their training and seek employment. Compiled 
by HoNNOR Morten (Author of Sketches of Hospital Life, The Nurse's 
Dictionary, etc.). 

" To those who are frequently appealed to bv young girls or young women, as to the steps 
they should take to become nurses, this book of Miss Morten's must prove a perfect godsend."— 
British Medical Journal. 

Third and Revised Edition, demy /flmo, {suitable for the apron pocket), hand- 
somely hound in terra cotta cloth boards, /4.0pp. , price 'is., in /tandsome 
leather, r/ilt . price 2s. 6d. 

The Nurse's Dictionary of iVIedical 
Terms and Nursing^ Treatment. 

Compiled for the use of Nurses. 

By HoNNOR Morten. 

Containing descriptions of the Principal Medical and Nursing Terms 
and Abbreviations, Instruments, Drugs, Diseases, Accidents, 
Treatments, Physiological Names, Operations, Foods, Appliances, 
etc., etc., encountered in the Ward or Sick-room. 

" This is a very useful little book for reference purposes, and some such should be at the 
disposal of every nurse, more especially in the early days of training. It comprises not only 
what its name implies, but a description of the common abbreviations used, of many instru- 
ments, drugs, etc." — The Birminf^hatn Medical Review. 

Eif/kth Edition, Enlarf/edand Rerised , profusely illustratetl nith orer /OOcuts; 
Croiiti Sro. cloth !/ilt, l.'>Opp.. price .'is. Od. ipostfreei. 

The Theory and Practice of Nursing:. 

A Text-book for Nurses. 

By Percy G. Lewis, M.D., M.R.C.S., L.S.A. 

Always a standard work on Nursing ; it now occupies the position of 
a classic, being used throughout the world in Training Schools and 
by Private Students. In order to bring this standard work 
thoroughl}' in line with the times, the author has most care- 
fully further revised it throughout, and, to meet all demands, 
has added chapters on Monthly Nursing and Confinements, con- 
sisting in all of some fifty additional pages. This standard manual 
may now, therefore, be taken as the most complete work of its 
kind now in the market. 

" Full of interest and instruction . . . cannot fail to assist nurses in their work." — British 
Medical Journal. 

We can warmly recommend it as a nursing manual . . . Full of useful hints and infor- 
mation." — Birmingham Medical Revici,.\ 

London: THE SCIENTIFIC PRESS, Ltd., 428 Str.\nd, W.C 

Scientific Press List. 

Crowti 8ro, '-iOO pp., pro/usety iilustrated nith on'r/inaJ r/rftn/i/f/g, fisf of 
InstritiiK'nts re'/ifin^'l , loirl a Glossary of '/'iriiis , price ■?s. W. 

Ophthalmic Nursing. 

By Sydney Stephenson, M.B., F.R.C.S.E., Surgeon to the Ophthalmic 
School, Hanwell, W., etc., etc. 

A valuable contribution to Nursing literature on a subject hitherto 
never handled with special reference to Nursing. On account of 
its compact and clear arrangement, and its numerous illustrations, 
it is specially recommended to the use of the Nursing Profession. 

" May very advantageously be studied by nurses and clinical clerks, or dressers who are 
about to enter the Ophthalmic service of a hospital." — Thf Liincd. 

Important Text-book for Asylum Attendants, 

St'rour/ J-Jditiou , ':iOOpj)., flot/i , prire 'Js . del. 

iVIentai Nursing:. 

A Text-book specially designed for the instruction of Attendants on the 
Insane. By William Harding, M.D. The want of a complete 
book for the instruction of Asylum Attendants has been long felt, 
and it is with confidence that the publishers recommend this work 
to the managers of all Institutions for the Insane. 

" Nothing could be better devised to serve as a text-book. The lectures are so simple and 
so instructive that they cannot fail to impress and interest readers ... Of great value to 
all nurses ... No institution should fail to supply their officials with copies of the work." 
Local Government Journal. 

" The book is written in a clear, easily understood style." — Glasgow Medical Journal. 

T)einy 8vo, ?iear/y 200pp. . rfof/i .<////, profiisefy il/usfrftter? with over 70 speriftl 
r/ifs. jtrire 6V. {post free) . 

Art of iViassag:e. 

By A. Creighton Hale. 

A complete Text-book of this valuable art. The most practical, simple, 
and generally useful work published on the subject. With fully 
illustrated chapters on the Anatomy of the Human Body. 

" A volume on the ' Art of Massags,' from the pen of one of its foremost advocates in this 
country. . . . Admirably illustrated." — Westminster Revie-u'. 

" The latest and most complete book we know on Massage."— ()!(£■£■(;. 

" A clear exposition of the science. A book to be read by all interested." — Publishers' 

London: THE SCIENTIFIC PRESS, Ltd., 428 Strand, W.C 

Van Houten's 



Bi] W WW^ special proGBSs of manufacture : 

1. The excess of fat is removed and the 
other valuable constituents are in- 
creased, including the Albuminoids, the 
Theobromine and the Phosphates ; 

2. The natural Flavour and Aroma are 
fully developed ; 

3. The Solubility is greatly increased ; 

4. The tissues of the bean are softened, 
and, with the fat or cocoa butter, 
rendered more Digestible and Assi- 

" VAN HOUTEN'S COCOA has formed the 
''subject of special analysis by some of the 
" greatest European Chemists, and all concur 
" [^ regarding it as a perfect beverage, 
''combining STRENGTH, PURITY, and 

— Medical Annual. 







APR 20 t916 

MAR 2 2 1950 

Hart. I i.7l577 

Diet in siC kTiess and in 


Jan. 19*1 4. 


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