UC-NRLF
B 3 IDA AST
^iii/l\ I'^iDa
y«RS.ERN?^ST MART
DIET IN SICKNESS AND IN HEALTH
DIET
SICKNESS AND IN HEALTH
BY
Mrs. ERNEST HART
KOKMERLY STUDENT OK THE FACULTY OF MEDItlNl. uf FAKlr., AND OF THH
LONDON SCHOOL .1F MEDICINE FOR WOMEN
THOR OF " THE MICROMETKIC MEASUREMENTS OF THE BLOOD CORFUSCLKS AND I'
STIMATION OF THEIR H.-F;M0GL0BIN," " THE THIRD OR INVISIBLE NORRIS CORPUSCLK
"on the FORMATION OF FIIiRINE," AND TRANSLATOR OF "CORNIL
AND RANVIEr's I'ATHOLOGICAL HISTOLOGY," ETC., ETC.
WITH AN INTRODUCTION BY
SiK HENRY THOMPSON, F.R.C.S., M.B., London
LONDON: THE SCIENTIFIC PRESS, Ltd., 428 Strand
PHILADELPHIA: W. B. SAUNDERS, 925 Walnut Street
i%°'-o<^
60t^^
CONTENTS.
Author's Preface
Introduction
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
age
X. Under-feeding and Over-eating — The aged
XI. Under-feeding and Over-eating— Dishes for the
aged
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)
Index
Appendix
8
15
21
28
36
42
47
53
60
64
69
75
81
87
93
101
112
iig
123
127
131
138
146
152
158
163
166
172
177
183
189
194
201
208
213
221
171577
GWEfiAL
■■71
cC
LIST OF ILLUSTRATIONS.
PAGE
83
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
diameters
6. Arteries and Veins of the Villi, injected and magnified 100
diameters
7. Glomeruli of the Kidney; Origin of the Uriniferous
Tubules
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
Tubules
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
92
95
97
98
103
104
173
194
195
202
203
204
AUTHOR'S PREFACE.
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.
ALICE M. HART.
38 WiMPOLE Street, W.
INTRODUCTION.
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
Xll INTRODUCTION.
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.
HENRY THOMPSON, F.R.C.S., M.B., Lond.
DIET IN SICKNESS AND IN HEALTH.
CHAPTER I.
FOOD AND FOOD VALUES.
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
2 DIET IN SICKNESS AND IN HEALTH.
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 : —
Nitrogenous
Albuminates
Albumen
Fibrin
Casein
Gluten
Gelatine
Non-nitrogenous
f2. Fats, or Hydro-Carbons Oil
Butter
Margarine, etc.
3. Carbo-Hydrates
Stimulants
Starch
Dextrine
Cane-Sugar
Grape-Sugar or Glucose
Milk-Sugar or Lactose
Alcohol
Tea
Coffee
Cocoa
Inorganic
Water.
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.
FOOD AND FOOD VALUES. 3
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
beef
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,
4 DIET IN SICKNESS AND IN HEALTH.
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
FOOD AND FOOD VALUES. 5
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
6 DIET IN SICKNESS AND IN HEALTH.
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
FOOD AND FOOD VALUES. /
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-
duction.
CHAPTER II.
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,
etc.
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
temperature.
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 ^
lOO
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
FOOD AND FOOD VALUES. 9
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
lO DIET IN SICKNESS AND IN HEALTH.
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-
FOOD AND FOOD VALUES. II
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-
12 DIET IN SICKNESS AND IN HEALTPI.
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
work.
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
FOOD AND FOOD VALUES. 1 3
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
14 DIET IN SICKNESS AND IN HEALTH.
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
ease.
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.
15
CHAPTER III.
STIMULANTS.
Alcohol.
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
l6 DIET IN SICKNESS AND IN HEALTH.
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
STIMULANTS. \J
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 ;
2
1 8 DIET IN SICKNESS AND IN HEALTH.
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
established.
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
STIMULANTS. I9
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
OF THE \
UNIVERSITY 1;
20 DIET IN SICKNESS AND IN HEALTH.
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
prophet.
CHAPTER IV.
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
22 DIET IN SICKNESS AND IN HEALTH.
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
STIMULANTS. 23
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
24 DIET IN SICKNESS AND IN HEALTH.
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
STIMULANTS. 25
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
26 DIET IN SICKNESS AND IN HEALTH.
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
STIMULANTS. 2/
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
breakdown.
28
CHAPTER V.
RESTORATIVES.
Tea.
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
RESTORATIVES. 29
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
30 DIET IN SICKNESS AND IN HEALTH.
out. These are chiefly the Indian teas, which have been
highly fired and much fermented in the process of pre-
paration.
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
RESTORATIVES. 3 1
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
32 DIET IN SICKNESS AND IN HEALTH.
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
(Roberts).
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
RESTORATIVES. 33
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
3
34 DIET IN SICKNESS AND IN HEALTH.
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
RESTORATIVES. 35
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.
36
CHAPTER VI.
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.
RESTORATIVES. IJ
The following approximate analysis will show the dif-
ferences between tea and coffee : —
Tea.
Coffee.
5
12
15
5
0-50
075
25
13
4
13
50-50
56-25
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
38 DIET IN SICKNESS AND IN HEALTH.
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
RESTORATIVES. 39
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
40 DIET IN SICKNESS AND IN HEALTH.
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
RESTORATIVES, 4I
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
milk.
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.
42
CHAPTER YII.
WATER— SALTS.
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
UNIVERSITY !.
OF ]
WATER— SALTS. 43
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
44 DIET IN SICKNESS AND IN HEALTH.
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
organisms.
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
WATER — SALTS. 45
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.
46 DIET IN SICKNESS AND IN HEALTH.
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
appetite.
47
CHAPTER VIII.
UNDER-FEEDING AND OVER-EATING.
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
object.
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
48 DIET IN SICKNESS AND IN HEALTH.
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
UNDER-FEEDING AND OVER-EATING.
49
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 :
Nitrogenous
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 \\
Total
2 5
4
14
3*
14
7
22^
92
1 8*
50
DIET IN SICKNESS AND IN HEALTH.
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 0 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.
22-5-
15
loi
22J
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
UNDER-FEEDING AND OVER-EATING. 5 I
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-
lescence.
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
52 DIET IN SICKNESS AND IN HEALTH.
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.
53
CHAPTER IX.
UNDER-FEEDING AND OYER-EATmG— (continued).
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.
54 DIET IN SICKNESS AND IN HEALTH.
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
UNDER-FEEDINC; AND OVER-EATING. 55
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
race.
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
56 DIET IN SICKNESS AND IN HEALTH.
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-
UNDER-FEEDING AND OVER-EATING. 57
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
58 DIET IN SICKNESS AND IN HEALTH.
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
UNDER-FEEDING AND OVER-EATING. 59
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.
6o
CHAPTER X.
UNDER-FEEDING AND OVER-EATmG—{cuntinued).
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
UNDER-FEEDING AND OVER-EATING. 6l
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.
62 DIET IN SICKNESS AND IN HEALTH.
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
UNDER-FEEDING AND OVER-EATING. 6^
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.
64
CHAPTER XI.
UNDER-FEEDING AND OVER-EATING— {continued).
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-
UNDER-FEEDING AND OVER-EATING. 65
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-
5
66 DIET IN SICKNESS AND IN HEALTH.
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.
Kedgeree.
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 : —
UNDER-FEEDING AND OVER-EATING. 6/
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
tureen.
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
cream.
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-
68 DIET IN SICKNESS AND IN HEALTH.
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.
69
CHAPTER XII.
ON THINNING AND FATTENING.
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
-JO DIET IN SICKNESS AND IN HEALTH.
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
ON THINNINC; AND FATTENING. 7 1
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 : —
Carbo-
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.
72 DIET IN SICKNESS AND IN HEALTH.
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
fat:—
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.
ON THINNING AND FATTENING. 73
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
obesity.
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.
74 DIET IN SICKNESS AND IN HEALTH.
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.
75
CHAPTER XIII.
ON THINNING AND FATTENING— {coutinued).
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
y^ DIET IN SICKNESS AND IN HEALTH.
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
prescribed.
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 ".
ON THINNING AND FATTENING. //
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.
78 DIET IN SICKNESS AND IN HEALTH.
(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^
hours.
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
ON THINNING AND FATTENING. 79
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
8o DIET IN SICKNESS AND IN HEALTH.
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
CHAPTER XIV.
DIGESTION.
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
82 DIET IN SICKNESS AND IN HEALTH.
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
DIGESTION.
83
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
84 DIET IN SICKNESS AND IN HEALTH.
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
fermentation.
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
DIGESTION. 85
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
86 DIET IN SICKNESS AND IN HEALTH.
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.
87
CHAPTER XV.
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
88 DIET IN SICKNESS AND IN HEALTH.
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.
DIGESTION. 89
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
90 DIET IN SICKNESS AND IN HEALTH.
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
DIGESTION. 91
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^ ^^.^^^ •,
.".LACKERffAnEB D-. E SAtUE S.
Fig. 4.— Tubul.\r Gl.-\nds of the Small Intestine opening on the
SURFACE OF THE MUCOUS MeMBKANE BETWEEN THE ViLLT,
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-
92 DIET IN SICKNESS AND IN HEALTH.
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
intestine.
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
Diameters.
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.
93
CHAPTER XVI.
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
94 I^IET IN SICKNESS AND IN HEALTH.
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
DIGESTION.
95
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/^ ''^^^^^^^
Ji.l
-^^^m"
M
P.UCKtRBAUER DtL.
m
Fig. 6.— Arteries and Veins of the Villi, Injected and Magnified ico
Diameters.
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
96 DIET IN SICKNESS AND IN HEALTH.
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
DIGESTION,
97
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
''"Sk,
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.
98
DIET IN SICKNESS AND IN HEALTH.
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
branches.
DIGESTION. 99
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.
lOO DIET IN SICKNESS AND IN HEALTH,
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
medium.
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.
CHAPTER XVII,
INDIGESTION.
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
pharmacopoeia.
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
I02 DIET IN SICKNESS AND IN HEALTH.
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
indigestion.
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
thoroughly.
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.
INDIGESTION,
103
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
104
DIET IN SICKNESS AND IN HEALTH.
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
INDIGESTION. IO5
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
I06 DIET IN SICKNESS AND IN HEALTH.
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
INDIGESTION. TO/
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-
108 DIET IN SICKNESS AND IN HEALTH.
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
INDIGESTION. IO9
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
no DIET IN SICKNESS AND IN HEALTH.
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."
INDIGESTION. Ill
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
ways.
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.
CHAPTER XVIII.
INVALID FOODS.
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
INVALID FOODS. II 3
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
followed.
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
114 I^IET IN SICKNESS AND IN HEALTH.
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.
INVALID FOODS. II 5
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
Il6 DIET IN SICKNESS AND IN HEALTH.
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
INVALID FOODS. II/
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
Il8 DIET IN SICKNESS AND IN HEALTH.
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.
119
CHAPTER XIX.
ACUTE GASTRITIS.
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,
I20 DIET IN SICKNESS AND IN HEALTH.
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
ACUTE GASTRITIS. 12 1
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
122 DIET IN SICKNESS AND IN HEALTH.
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.
123
CHAPTER XX.
ULCER OF THE STOMACH.
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-
124 I'lI^T IN SICKNESS AND IN HEALTH.
munication may even thus be established between the
stomach and the external air through the abdominal
walls.
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
ULCER OF THE STOMACH. 125
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-
126 DIET IN SICKNESS AND IN HEALTH.
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.)
127
CHAPTER XXI.
DIABETES.
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.
128 DIET IN SICKNESS AND IN HEALTH.
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
DIABETES. 129
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
9
130 DIET IN SICKNESS AND IN HEALTH.
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.
131
CHAPTER XXII.
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.
Bread
37'
47*4
3-6
2-3
Biscuit .
Wheat flour .
Barley meal .
Oatmeal
Rye meal
Indian corn meal
Rice
Peas
Arrowroot
i8-
IS-
15"
15*
14'
13"
15"
i8-
15-6
IO-8
6-3
12-6
8-0
ii'i
6-3
23-0
73-4
66-3
69-4
58-4
69-5
647
79-1
55'4
82-0
4-2
4'9
5"4
37
0-4
0-4
2"0
i'3
2*0
2-4
5-6
2*0
8-1
07
2"I
17
17
2-0
3-0
1-8
17
0-5
3-5
132
DIET IN SICKNESS AND IN HEALTH.
Potatoes.
75
2-1
Carrots .
83
1-3
Parsnips
82
i-i
Turnips.
91
I"2
Cabbage .
91
2-0
Sugar
5
—
Treacle .
23
—
New milk
86
4'i
Cream
66
27
Skim milk
88
4-0
Butter milk .
88
4"i
Cheese .
36
8 33-5
Cheddar cheese
36
28-4
Skim cheese .
44
44-8
Lean beef
72
19-3
Fat beef .
51
14-8
Lean mutton .
72
i8-3
Fat mutton
53
12-4
Veal
63
i6-5
Fat pork
39
9-8
Green bacon .
24
7'i
Dried bacon .
15
8-8
Ox liver .
74
i8-9
Tripe
68
13-2
Cooked meat, roast
no dripping being
lost. Boiled, as
-54
27-6
sumed to be the
same .
Poultry .
74
8-8
White fish .
78
i8-i
Eels
75
9-9
Salmon .
77
i6-i
Entire egg
74
14-0
White of egg .
78
20-4
Yolk of egg
52
i6-o
Butter and fats
15
o-i
Beer and porter
91
Q-I
Albumen, Starch,
i8-8
8-4
9-6
5-1
Sugar.
3-2
6-1
5-8
95'o
77-0
5-2
2-8
5'4
6-4
0'2
0*2
0-5
3'9
267
1-8
07
24*3
3I-I
6-3
3-6
29-8
4'9
31-1
15-8
48-9
66-8
73-3
4"i
i6-4
07
I-Q
I"0
0-6
07
0-8
1-8
0-8
0-8
5-4
4-5
4'9
5'i
4"4
4-8
3'5
47
2-3
2*1
2-9
3-0
2-4
i5'45 2-95
87
3-8
1-2
2-g
I-Q
13-8
1-3
5'5
I '4
10-5
1-5
—
1-6
307
1-3
83-0
2-0
—
0-2
There is one broad rule to be followed in the prepara-
tion of the diet of a diabetic, that is to avoid all articles
DIABETES.
133
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.
Aspic.
Tripe.
German sausage.
Eggs, cheese, cream cheese, and
cream.
Butter, fat, oil, and lard.
Caviare.
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.
Forbidden.
Sugar in any form.
Wheaten bread, oatmeal cakes,
porridge.
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.
Pastry.
Puddings of every kind which con-
tain sugar or farinaceous foods.
Beetroot.
Liver.
English sausages.
Treacle.
134 DIET IN SICKNESS AND IN HEALTH.
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-
charin.
Nuts of all kinds except chestnuts.
Sardines in oil.
Foie gras.
Norwegian herrings in oil.
Pilchards in oil.
Pickles.
Savoury jelly.
Custard.
Beverages.
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
DIABETES. 135
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
136
DIET IN SICKNESS AND IN HEALTH.
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.
Jan.
gth
loth
nth
12th
13th
14th
15th
i6th
17th
i8th
passed
at Night.
30 OZ.
30 „
21 ,)
24 ,.
34 -.
26 „
28 „
16 „
I -025
I '034
1023
1-031
I '020
1-013
1-030
1-039
1-030
Dinner party, took sweets.
Nervous, low spirits.
Dined out.
Tongue raw.
•015 Much better, tongue better.
UIABETES.
137
Date.
Feb. 17th
,, 23rd
„ 24th
„ 26th
Apr. 5th
„ 6th
7th
„ 8th
„ gth
„ loth
„ nth
Quantity
passed
at Night.
S. G.
Remarks.
I -025
I '020
1-035 I'^^'o helpings of treacle pudding
1-028
1-030
1-040
1-040 Left off taking bread.
1-038
I -033
1-012
1-026
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.
1^.8
CHAPTER XXIII.
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
DIABETES. 139
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.
A WEEK'S MENUS FOR A DIABETIC.
{Time — Suniinev.)
First Day.
Breakfast.
Buttered eggs.
Sole, fried in butter, with lemon juice added when served.
Cocoa made from nibs, with cream.
and " torrefied bread '". (i)
LiDicli.
Hot sardines on toasted gluten bread. (3)
Warrenised breast of lamb, with spring cabbage. (2)
Camembert cheese with Callard's cheese biscuits.
Dinner.
Spinach soup. (4)
Cutlets of salmon fried in slippers.
Poulet a I'estragon. (5)
Green-gooseberry fool (6), sweetened with saccharin.
Recipes.
(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.
I40 DIET IN SICKNESS AND IN HEALTH.
(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.
Breakfast.
Fresh haddock fried in butter.
Cold tongue.
Coffee and cream.
Liiiicli.
Vegetable marrow farcie. (7)
Devilled ham and French beans. (8)
Cheddar cheese with diabetic biscuits and butter.
Dinner.
Oysters.
Clear soup.
Roast lamb.
Green asparagus with clear melted butter.
Almond pudding. (9)
DIABETES. 141
Recipes.
(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.
Bveukfast.
Fresh herrings with mustard sauce.
Savoury omelette.
Tea with cream.
LuncJi.
Cold mutton with French bean salad mixed with oil and a dash of
\inegar.
Stewed lettuce. (10)
Roquefort cheese with diabetic rusks.
142 DIET IN SICKNESS AND IN HEALTH.
Dijuwr.
Tomato soup.
Sweetbreads aux fonds d'artichauts. (ii)
Fillet of beef garnished with cauliflowers.
Custard pudding sweetened with saccharin.
Recipes.
(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
minutes.
(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.
Breakfast.
Curried eggs (without rice). (12)
Ham.
Cocoa made from nibs, with cream.
Liincli.
Braised knuckle of veal with mixed vegetables. (13)
Foie gras with diabetic biscuits.
Dinner.
Cock-a-leekie soup.
Turbot with tartar sauce.
Duck with olives.
Cucumber au sauce Fairlawn. (14)
Recipes.
(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
DIABETES. 143
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.
Byeakfast.
Eggs, with black butter.
Grilled kidneys and bacon.
Cream and aerated water.
LuncJi.
Fish pudding. (15)
Cold meat and tomato salad.
Neufchatel cream cheese and almond biscuits.
Dinner.
Bisque soup. (16)
Boiled fowl, with bechamel sauce (17) and baked mushrooms,
vegetable marrow.
Green currant fool.
Hot caviare on gluten croutons.
Recipes.
(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.
Breakfast.
Poached eggs and spinach.
Smoked salmon.
Van Houten's cocoa, made with cream.
Lunch.
Crab omelette. (18)
Cold or hot mutton.
Asparagus.
144 DIET IN SICKNESS AND IN HEALTH.
Dinner.
Sorrel soup.
Cream of veal.
Turkey poult, with French beans.
Cauliflower au gratin.
Recipes.
(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.
Breakfast.
Kippered herrings.
Grilled bones, with buttered broccoli.
Egg flip- (19)
Lunch.
Mayonnaise of lobster.
Stewed pigeons with mushrooms.
Cauliflowers.
Gruyere cheese.
Dinner.
Julienne soup.
Broiled sole with white wine sauce.
Grilled mutton cutlets with savoury sauce. (20)
French beans.
Lemon sponge.
Recipes.
(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
DIABETES. 145
all the time. Add two tablespoonfuls of unsweetened whisky or
brandy.
(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.
146
CHAPTER XXIV.
DlABETES^icontinued).
A Week's Menus for a Diabetic.
{Time— Winter.)
First Day.
Breakfast.
Smoked salmon.
Kidneys and bacon, on a bed of Brussels sprouts.
Nib cocoa and cream.
Lunch.
Roast grouse.
Baked custard pudding, with bottled green fruit
stewed with saccharin, (i)
Brie cheese.
Dinner.
Celery soup.
Red mullet en papillotte.
Spanish steaks. (2)
Tomatoes, with frozen savoury cream. (3)
Russian caviare on gluten croutons.
Recipes.
(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
DIABETES. 147
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.
Breakfast.
Herrings and mustard sauce.
Cold tongue.
Callard's almond biscuits.
Coffee and cream.
Lunch.
Oyster omelette.
Koast loin of mutton with mashed turnips.
Gorgonzola cheese.
Dinner.
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.
Breakfast.
Cod roes, stewed brown. (4)
Swiss eggs. (5)
Potash water and cream.
Lunch.
Roast rabbit with stewed leeks.
Rhubarb and cream.
Stilton cheese and Callard's cheese biscuits.
Dinner.
Oysters.
Soup, croute au pot. (6)
Roast goose and broccoli.
Stewed celery.
Cocoanut cream. (7)
Recipes.
(4) Fresh Cod Roes are rather neglected; they can be purchased
for a few pence, and are excellent for breakfast stewed brown. Par-
148 DIET IN SICKNESS AND IN HEALTH.
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.
Breakfast.
Fried bacon, served on a puree of Brussels sprouts.
Cold pheasant.
Van Houten's cocoa and cream.
Lunch.
Braised leg of Welsh mutton, with tomatoes and mushrooms. (8)
Cheese cake (g) and cream cheese.
Dinner.
Hare soup, without wine.
Water souchet of sole.
Duck with turnips. (10)
Russian salad (leaving out the potatoes, carrots, and peas).
Recipes.
(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
DIABETES. 149
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.
Breakfast.
Ham or tongue omelette.
Spiced beef.
Tea and cream.
Lunch.
Larded sweetbread.
Cold mutton with endive salad.
Camembert cheese.
Dinner.
Lettuce soup. (11)
Fried cutlets of cod.
Sirloin of beef with gherkins (12) and stewed Scotch kale.
Devonshire junket. (13)
Recipc>;.
(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.
Breakfast.
Stewed mushrooms.
Cold fowl.
Boiled eggs.
Lunch.
Oxtail haricot.
Coffee cream.
Dinner.
Oyster stew.
Marinaded venison cutlets.
Boiled guinea-fowl, with celery sauce.
Little tarragon creams. (14)
150 DIET IN SICKNESS AND IN HEALTH.
(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.
Breakfast.
Finnan haddock.
Cold brawn.
Cocoatina and cream.
Lunch.
Boiled calf's head.
Turnip tops.
Dinner.
Clear soup with poached eggs.
Fried cutlets of plaice.
Roast turkey. Broccoli sprouts.
Fish-roe souffles. (15)
Recipe.
(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
DIABETES. 151
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.
152
CHAPTER XXV.
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
DIABETES. 153
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
154 IJIET IN SICKNESS AND IN HEALTH.
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
system.
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
allowed.
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
DIABETES. 155
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
156 DIET IN SICKNESS AND IN HEALTH.
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
DIABETES. 157
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
pleasantly.
158
CHAPTER XXVI.
GOUT.
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.
l6o DIET IN SICKNESS AND IN HEALTH.
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
person.
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
II
1 62 DIET IN SICKNESS AND IN HEALTH.
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
making.
i63
CHAPTER XXVII.
DISHES FOR THE GOUTY.
A Week's M6nus.
First Day.
Breakfast.
A boiled egg and dry toast.
Cocoa from nibs with added milk and sweetened with
saccharin, (i)
Lunch.
Baked apples and custard pudding.
Lime-juice lemonade. (2)
Dinner.
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.
Breakfast.
Grilled sole with lemon juice and butter.
Tea and toast.
, Lundi.
Stewed cabbage. (3)
Stilton cheese and rusks.
Dinner.
Bisque soup.
Mutton cutlets and French beans.
Junket.
(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
l64 DIET IN SICKNESS AND IN HEALTH.
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
hour.
Third Day.
Breakfast.
Eggs with black butter.
Fresh fruit.
Coffee and toast.
Lunch.
Artichoke soup. (4)
Sardines on toast.
Dinner.
Oysters.
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.
Breakfast.
Fried cutlets of cod.
Milk and soda water (5), toast.
Lunch.
Banana fritters.
"Cart-wheel" (6) and pulled bread and butter.
Dinner.
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.
DISHES FOR THE GOUTY,
165
Fifth Day.
Breakfast.
Poached eggs on toast.
Tea.
Lunch.
Boiled sole.
Tomato salad.
Dinner.
Victoria soup.
Roast grouse.
Asparagus.
Sixth Day.
Breakfast.
Cold ham.
Melon.
Lunch.
Stewed plums and rice.
Dinner.
Boiled chicken with potatoes
saute.
Cauliflower au gratin.
Seventh Day.
Breakfast.
Finnan haddock.
Nib cocoa and milk, toast.
Luncli.
Cock-a-leekie soup.
Cheddar cheese and Callard's biscuits. (8)
Dinner.
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
CHAPTER XXVIII.
URIC ACID AS A CAUSE OF DISEASE, AND ITS
PREVENTION BY DIET.
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,
URIC ACID AS A CAUSE OF DISEASE, ETC. 1 6/
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
l68 DIET IN SICKNESS AND IN HEALTH.
the same condition, namely, an excess of uric acid in the
system.
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-
URIC ACID AS A CAUSE OF DISEASE, ETC. 1 69
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
I/O DIET IN SICKNESS AND IN HEALTH.
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
URIC ACID AS A CAUSE OF DISEASE, ETC. 171
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.
172
CHAPTER XXIX.
CONSUMPTION.
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
CONSUMPTION. 173
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
coughing.
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,
1/4 DIET IN SICKNESS AND IN HEALTH.
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
CONSUMPTION. 175
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-
176 DIET IN SICKNESS AND IN HEALTH.
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
microbes.
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
so.
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.
177
CHAPTER XXX.
RICKETS.
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
1/8 DIET IN SICKNESS AND IN HEALTH.
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
best.
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
RICKETS. 179
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 : —
Elements.
Human
Milk.
Cow's
Milk.
Ass's
Milk.
Goat's
Milk.
Artificial
Human
Milk.
Nitrogenous or albuminous
elements, -
^■35
4'374
1-7
4-5
2-57
Hydrocarbon fat, -
2-41
3'499
1-4
4-1
4-46
Carbo-hydrate or sugar
of
milk, - . - .
6-39
4-403
6-4
5-8
3-02
Mineral salts,
•34
702
—
—
-57
Water, ....
-
88-51
87-132
90-5
85-6
87-38
Total,
lOO-Q
lOQ-Q
lOQ-Q
IGQ-O
loo-o
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 :—
Food.
Arrowroot, -
Albumen.
Fat.
Starch.
82-0
Sugar.
Salts.
Wate,
18
Bread, -
Wheat flour.
Oatmeal,
8-1
- IO-8
- 12-6
- - 15-6
ii'i
1-6
2-0
5-6
1-3
■8-1
47*4
6-3
58-4
3-6
4-2
5-4
2-3
1-7
3-0
1-7
1-7
37
15
Biscuit,
Cornflour,
73-4
65-1
8
14
l8o DIET IN SICKNESS AND IN HEALTH.
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
RICKETS. l8l
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
1 82 DIET IN SICKNESS AND IN HEALTH.
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
child.
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.
i83
CHAPTER XXXI.
SCROFULA AND SCURVY.
Scrofula.
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
1 84 DIET IN SICKNESS AND IN HEALTH.
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.
Scurvy.
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
SCROFULA AND SCURVY. 1 85
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,
1876:—
" 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
expedition."
1 86 DIET IN SICKNESS AND IN HEALTH.
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
SCROFULA AND SCURVY. 1 8/
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
1 88 DIET IN SICKNESS AND IN HEALTH.
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
CHAPTER XXXII.
FEVER.
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
190 DIET IN SICKNESS AND IN HEALTH.
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
weak.
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
process.
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,
192 DIET IN SICKNESS AND IN HEALTH.
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
appears.
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.
13
194
CHAPTER XXXIII.
TYPHOID 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.
TYPHOID FEVER. I95
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.
196 DIET IN SICKNESS AND IN HEALTH.
— 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,
TYPHOID FEVER. 197
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
198 DIET IN SICKNESS AND IN HEALTH.
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
(Yeo).
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
TYPHOID FEVER. 199
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
20O DIET IN SICKNESS AND IN HEALTH.
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.
CHAPTER XXXIV.
CHRONIC BRIGHT'S DISEASE.
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
DIET IN SICKNESS AND IN HEALTH.
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.
CHRONIC IJRIGHT S DISEASE.
203
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
the
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
branches.
204
DIET IN SICKNESS AND IN HEALTH.
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
CHRONIC BRIGHT S DISEASE.
205
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
LKftRMANSKLD.
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
206 DIET IN SICKNESS AND IN HEALTH.
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
CHRONIC BRIGHT'S DISEASE. 20/
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.
208
CHAPTER XXXV.
CHRONIC BRIGHT'S DISEASE— {continued).
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
CHRONIC BRIGHT'S DISEASE. 209
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.
14
2IO DIET IN SICKNESS AND IN HEALTH.
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
CHRONIC BRIGHT'S DISEASE. 211
stirred in immediately after removing from the fire to
serve.
" 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.
213
INDEX.
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
igg.
— 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.
B.
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.
Blood-
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.
Bread-
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.
214
INDEX.
Cabbage, Stewed, 164.
Cakes-
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,
24.
— Leaf, Mysterious Qualities of,
22.
— 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.
Cocoas-
Boiling, 41.
Infusing, 41.
Cod, Stewed, 65.
Cod Roes, Fresh, 147.
Coffee—
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,
199.
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.
D.
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.
Diet-
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-
151-
Ebstein's, 71, 72.
Fever, 191-193.
Gastric Ulcer, 124-126.
Gout, 161, 162, 164-166.
INDEX.
215
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
192.
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.
Fish-
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.
2l6
INDEX.
Youth, Food for, 53.
(Si-e also under Diet.)
Fool, Green-gooseberry, 140.
Fowl a I'Estragon, 141.
Fruit-
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.
Girls-
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.
Gout-
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,
159.
Uric Acid in, 158.
Gouty, Dishes for the, 163-165.
Gruel —
Malted, 85.
Milk, Peptonised, 86.
Gullet, 82.
H.
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.
I.
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.
J.
Japan, Tea Ceremony in, 34, 35.
Jellies, Peptonised, 117.
Jugular Vein, 96.
Junket, 149.
K.
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.
INDEX.
217
M.
Macaroni —
Cooking, 2og-2ii.
Fish with, 66.
Magnesium, i.
Maigre Soup, 67.
Malt-
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,
19S.
Mouth, Digestion of Food in, 81.
Mucous Glands, 89.
Mucus, 84.
Muscle, 4, II.
Muscles, 57.
Muscular Exercise, 9.
Mutton, Braised, 142.
N.
Nips, Pernicious Habit of taking, 18.
Nitrogen, i.
— Necessity for, 6.
Nitrogenous Food, 2, 4, 6.
Non-Nitrogenous Food, 2.
O.
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.
Poor-
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.
R.
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.
Salts-
Fruit, 45.
Organic, 45.
Sauce, Bechamel, 144.
21
INDEX.
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.
T.
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,
33-
— 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.
U.
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.
V.
Veal, Braised Knuckle of, 142.
Vegetarian Diet, 170, 171.
Vegetable —
Albumen in, 3.
Marrow, 14 1.
Soups, 165, 208.
Vein, Jugular, g6.
INDEX.
219
Vein, Portal, 96.
Veins of the Stomach, 93.
Venous Blood, 96.
Vichy, 156, 157.
Villi, 95.
Vomiting, 124.
w.
Wages, Low, Results of, 50, 51.
Water, 161.
— Amount in Human Body, 42,
44.
— 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.
Work-
Active, 48.
Hard, 48.
Moderate, 48.
Working Diet, 49.
Yeo, Dr. Burney, 69.
Youth, Food for, 53.
ABERDEEN UNIVERSITY PRESS.
APPENDIX.
CALLARD & CO
BY ROYAL
WARRANT
TO HER MAJESTY THE QUEEN.
MANUFACTURERS of
CHLESS Al
THOSI
DIABETES,
STARCHLESS AND SUGARLESS FOODS FOR
THOSE SUFFERING WITH
GLYCOSURIA
OBESITY.
GOUT,
EOZEMA,
RHEUMATISM, etc.
Messrs. Callard are supplying these Foods to Guy's, The London, St.
Bartholomew's, and the principal London and Provincial Hospitals.
BROWN AND WHITE BREAD WITHOUT STARCH.
ALL KINDS OF GLUTEN, ALMOND, BRAN, SOY BREAD
AND BISCUITS.
AFTERNOON TEA BISCUITS, IVORY JELLY, CHOCOLATES, etc.
SPECIAL WINES, etc.
Please write for Descriptive Catalogue, Reports, etc.
65 REGENT STREET, PICCADILLY CIRCUS.
223
CARLSBAD
HATURAL MIHERAL WATERS & SALTS
Are imported in Bottles and used in treatment of CHRONIC GASTRIC
CATARRH, HYPEREMIA of the LIVER, GALL STONES, CHRONIC
CONSTIPATION, DIABETES, RENAL CALCULI, GOUT, and Diseases
of the Spleen, arising from residence in the Tropics or malarious districts.
THE NATURAL lYIINERAL WATERS OF
VICHY
(STATE SPRINGS).
CELESTINS. — For the Kidneys, Gravel, Gout, Rheumatism, Diabetes, etc.
GRANDE-GRILLE.— For Diseases of the Liver, Biliary Organs, etc.
HOPITAL. -For Stomach Complaints. VICHY SALTS &. PASTI LLES.
HUNGARIAN NATURAL
"The Tasieless UpBrient." |
The Salts of ^sculap contain
90 per cent, of Purgatives.
Extract from LANCET.
" It is an admirable Aperient
Water. One of the most powerful,
indeed, that we have examined, and may
be used with perfect confidence."
MINERAL WATER.
USES.
1. Against Obstinate Constipation.
2. As a corrective of Indigestion.
3. As a certain relief and cure in all
Bilious Attacks.
4. As a preventative of Gravel and
Stone in the Bladder, Gall-
stones, etc.
5. In all Disorders of the Stomach
and Liver.
6. As a remedy and specific for Hae-
morrhoids' (Piles), Rheumatism,
Lumbago, etc.
7. For the relief and prevention of
Obesity, Attacks of Gout, and
Internal Congestions.
8. In mnnv Female Disorders, during
Pregnancy, and for Nursery Use.
SOLE IMPORTERS:
INGRAM & ROYLE, 52 Farringdon St., London, E.G.
The New Pamphlet, " Foreign Natural Mineral Waters," on application.
224
JIEBIG
COMPANY'S"
"THE ORIGINAL BRAND.
MAKES THE KX T R ACT
PUREST AND
BEST BEEF TEA. Ur 13 Ej JCjr .
HIGHEST AWARDS AT ALL THE PRINCIPAL EXHIBITIONS SINCE 1867,
AND DECLARED
Above Competition since 1885.
A Medical Com- /) • M c c-
fort of the highest UZn See Signature
Efficiency, ren- if NO^ t^ annexed) in
dering all other /-) f '// ^) fj"^ l^^^ f °^^
Food more di- i]^/^ '^'k^^^'V^
gestible and U^^^ each Jar o the
nourishing. V """'""
BEWARE OF IMITATIONS.
THE COMPANY'S COOKERY BOOK SENT FREE
ON APPLICATION TO
Liebig's Extract of leatCompanf, Li
9 FENCHURCH AVENUE, E.C.
225 15
THE
^ PASTEUR
(CHAMBERLAND)
FILTER
TABLE FILTER,
No. 202,
From £1 lis. 6d.
TRAVELLING FILTER,
No. 213,
From £1 Is.
Tap Filter, No. 215, £1 1s.
Reservoir as shown, £2 2S.
With
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.
SOLE LICENSEES AND MAKERS:
J. DEFRIES & SONS Limited,
SANITARY DEPARTMENT,
147 HOUNDSDITCH, LONDON, E.C.
226
THE VALUE OF SACCHARIN
IN
DIABETES IVIELLITUS, GLYCOSURIA, GOUT,
OBESITY, AND ALL DISEASES IN WHICH
SUGAR IS FORBIDDEN.
The following important facts, which have been conclusively
proved, show
THE ABSOLUTE HARMLESSNESS OF SACCHARIN.
(a) It does not cause the slightest disturbance of any bodily
function.
(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
hours.
(/■) 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
system.
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.,
165 QUEEN VICTORIA STREET, E.C.
227
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."—
I^ancei.
" 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
Resorts.
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.
228
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
Chronicle.
Crown Sro, cloth r/ilt, price 3s. h'd.
The Mother's Help
AND
Guide to the Domestic Management of Children.
By P. Murray Braidwood, M.D.,
Formerly Senior Medical Officer to the Wirral Hospital for Sick
Children.
" 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,
Berlin.
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.
229
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'
Circular.
London: THE SCIENTIFIC PRESS, Ltd., 428 Strand, W.C
231
Van Houten's
Cocoa.
PURE SOLUBLE
BEST & GOES FARTHEST
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-
milable.
" 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
" SOLUBILITY."
— Medical Annual.
232
/^
u^
^r^
u
UNIVERSITY OP CALIFORNIA LIBRARY
THIS BOOK IS DUE ON THE LAST DATE
STAMPED BELOW
APR 20 t916
MAR 2 2 1950
Hart. I i.7l577
Diet in siCkTiess and in
health.
Jan. 19*14.
M&L
l^i^X^MLfapR -jO. K.]g-
ti2Q t.^i
fSi
A-o. A^
n/577
H33
BIOLOG i
UBEARY
THE UNIVERSITY OF CALIFORNIA LIBRARY
Live Music Archive
Librivox Free Audio
Metropolitan Museum
Cleveland Museum of Art
Internet Arcade
Console Living Room
Books to Borrow
Open Library
TV News
Understanding 9/11