p OWE LU (H.H. J 
Annual. An»/iE5S of THE 
H£T/fl//v£ f>HES>iZ)ENT 
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j < _ [Reprinted from The Cleveland Medical Gazette, May, 1887.J 
ANNUAL ADDRESS 
-OF THE- 
RETIRING PRESIDENT 
CUYAHOGA COUNTY MEDICAL SOCIETY. 
- OF THE- 
BY DR. H. H. POWELL, CLEVELAND, O. 
Gentlemen of the Cuyahoga County Medical Society:-A 
year ago it was was your pleasure to elect me President of this 
Society. To-day, in accordance with our time-honored demo- 
cratic custom, I am called upon to surrender the trust and honor 
to another and take my place in the ranks. When elected, I 
thanked you for the honor, now I desire to express my thanks 
for the uniform kindness you have shown me and for the leniency 
with which you have looked upon my short-comings. 226 
Powftx: Annual Address. 
We have an article in our Constitution which makes it obligatory 
upon the retiring president to address the society upon topics bear- 
ing upon the welfare of the society, or if he prefers, on some sub- 
ject of professional interest. It is my purpose to take advantage 
of the last clause of this article, and discuss a subject upon which 
I have given much thought, and which I know is of great im- 
portance to the profession and of greater importance to all who 
may place themselves under our care. I have chosen for my 
subject, not Pyosalpinx, not Micrococci of ravenous fame and 
classic name, nor pedantic Hystero-Trachelorhaphy. These I 
commit to the tender mercies of a long suffering profession and 
ask you to bear with me kindly while I discuss the homely sub- 
ject, " Dietetics in Disease." This subject is selected, not alone 
because I have given it much thought, but because this society 
embraces in its membership representatives of all specialties, as 
well as general practitioners. I know of no topic of more com- 
mon interest to all medical men. There is no organ or tissue 
of the body that can be properly treated when in a state of 
disease, without a due consideration bestowed upon the food, 
from which alone the blood is to be made for the repair of the 
organ or tissue. It is as important for the oculist, the derma- 
tologist and the gynecologist to bear this fact in mind, as 
it is for the surgeon and general practitioner. Success in 
any of the special departments of medicine often depends upon a 
judicious dietary. Dietetics can never be a specialty, although 
some recent enthusiasts have intimated that such a thing is 
probable in the near future. It is true, a retrospective view 
makes it difficult to tell what the ingenuity of the medical mind 
may do in the way of specialty making, but I am quite confi- 
dent a halt will be cried when an attempt shall be made by any 
set of men to monopolize dietetics. Just here I might be in- 
terrupted by some one present with the question, why is it 
necessary to preach the doctrine of dietetics to us ? 
Is there one of us who fails in his duty in this matter ? Do 
we not all emphasize the importance of proper food in every 
instance ? Is there a doctor in the land worthy of the title who 
underestimates the value of suitable food ? In reply to these 
questions I gladly admit that there are but few physicians who Powell : Annual Address. 
227 
are not prepared to acknowledge the paramount importance of 
" Dietetics in Disease." Since the days of Hippocrates medical 
men everywhere have made suggestions to their patients as to 
what they must eat or drink, but I believe it is equally true 
that as medicine has been largely administered empirically, so 
has it been with food, and very often I doubt not, with results 
fully as disastrous. It is also true that there are men who cor- 
rectly estimate the importance of the subject theoretically, but 
rarely give practical proofs of their belief. They seem to fear 
the dignity of medicine will suffer if not their own dignity by 
elevating the product of the kitchen above that of the phar- 
macy. Many who have not as yet given this subject sufficient 
consideration will be obliged to do so from outside pressure, or 
what we may term fashion, for we do have fashion to contend 
with or acquiesce in, even in the treatment of the ills to which 
flesh is heir. The change in the treatment of disease 
has been radical when we compare present methods with those 
of the olden times. Active and often times injurious applica- 
tions of so-called remedies have given place in latter days to a 
more intelligent appreciation of the salutary methods of nature, 
laboring under difficulties, the guidance of disease rather than 
attempts at garroting it. Heroic efforts have been replaced by 
mild though more certain and agreeable means. We now rec- 
ognize more fully than ever a tendency towards recovery as well 
as a tendency towards death, and that often the principal duty 
of the physician consists in a judicious management of the pa- 
tient, as regards food and air. Science has nothing to fear in 
being made instrumental in solving the food problem. Progress 
in physiological, anatomical and chemical researches can ac- 
complish nothing grander than its solution. 
Laboratory experiments have afforded us a scientific working 
basis, but nothing more. The provings at the bedside are of 
greater importance. The experiments of Beaumont upon 
Alexis St. Martin shed a flood of light upon the physiology of 
digestion and accomplished more in the way of affording prac- 
tical suggestions for the physician than all the laboratory ex- 
periments made up to the time he gave the results of his work 
to the world. Since the main object of this paper is to bring 228 
Powell : Annual Address. 
before you my views of certain articles of diet in disease, I 
will refrain from attempts at "glittering generalities," and con- 
fine my remarks to the few articles many of us rely most upon 
when making out the diet list. I will have nothing to say con- 
cerning the regulation diet long established in diabetes or 
Bright's disease. It may be stated in general terms that the 
articles of food from which we are to select must contain pro- 
teids, fat, and carbo-hydrates in varied proportions, according to 
the indications presented in each case. As a rule, no matter 
what may be the disease, a long continuance on any one class 
will be followed by malnutrition. Nor should the physician 
ever forget the value at times of complete abstinence from food. 
" Let not him that eateth despise him that eateth not," for very 
often he shows his wisdom by such a course. By almost uni- 
versal consent we have come to rely upon the following articles 
as appropriate food for our patients: Milk, eggs, beef tea, gruels, 
broths, and alcohol. We have in this list the necessary pro- 
teids, fat, and carbo-hydrates. We differ considerably among 
ourselves as to the relative value and appropriateness of these 
articles. Let us take up milk first, as it is beyond question of 
first importance. For one, I candidly do not believe I would 
care to practice medicine a day if obliged to give up milk. 
Whilst the majority of physicians are equally as enthusiastic 
over milk as a food for the sick, there are others who too 
quickly look about for substitutes for it, too quickly see contra- 
indications to its use or accept their patients' views as to its dis- 
agreeing with them. A physician often has it in his power to 
do an immense amount of benefit in overcoming prejudice against 
milk on the part of many. Lives have been sacrificed to this 
often baseless prejudice. A plain talk with a patient of average 
comprehension will often induce him to give up his opinions 
and accept yours. I have had a patient on milk say: "I don't 
see how I can get my strength back on such a watery food as 
milk." His mind was set against it. But when it was shown 
him that there was but io per cent, more water in milk than in 
the best beefsteak, the one containing 85 per cent., the other 
75, he became reconciled. We must remove all such unfortu- 
nate prejudices. If we have good evidence in a given case that Powell : Annual Address. 
229 
milk does disagree, it must be respected, but not at once aban- 
don it. Continue for a while to use it after changing it by 
chemical or mechanical means so as to adapt it to the case. I 
•confess my heart sinks within me at times when milk must be 
abandoned. In the order of their use we come to beef tea, 
■either made from fresh beef or from some one of the various 
extracts in the market. What a countless number of graves 
have opened to receive the victims of beef tea; how blindly the 
profession followed for years the teachings of the fathers in the 
administration of beef tea, under the impression they were giv- 
ing concentrated nourishment. How many dogs have fattened 
upon the supposed refuse whilst the human victims have gone 
•over to the majority-starved to death, though otherwise re- 
corded on the mortality list. Beef tea is now known to be a 
stimulant and not a nutrient. It contains the products of 
muscular waste, and certain salts of value, with extractive mat- 
matter, the whole making under certain conditions a suitable 
stimulant, and forming a good menstruum for administering pro- 
teids or carbo-hydrates. Eggs and certain starchy substances 
may be employed. For a few years past, with some other phy- 
sicians, I have used in place of beef tea the expressed juice of 
the beef, and it is with great pleasure that I record the admira- 
ble results obtained by its use. For getting the juice I have 
used the small iron press known as Osborn's, with which many 
of you are familiar. The juice, when properly expressed, is 
highly nutritious, containing by actual test io per cent of albu- 
men. A pound of good round steak will furnish on an average 
six ounces of the juice. If time would allow, I could relate a 
long list of cases successfully treated with meat juice-children 
and old people, young men and maidens. I have come to re- 
gard this meat press as almost an essential in many families. 
What a saving of work to a feeble stomach, what a safeguard 
against distress is afforded by this fresh, nutritious juice. For 
the benefit of any who have not been satisfied with the use 
of the press, let me say a few words. You must get one of 
your own and master the simple technique connected with it. 
Your beef must be free from fat and chopped by the butcher; 
it must be put into the inner compartment of a farina cooking 230 
Powell . Annual Address. 
vessel; the water in the outer vessel may be brought to a slow 
boil. In this manner the meat may be heated thoroughly and 
start the juice. Then put it into the press, which has been 
dipped into boiling water and wiped. The juice is now quickly 
expressed, much to the surprise of one who has neglected the 
method described. The quantity to be given, of course, is regu- 
lated by the requirements of the case. If given in excess of 
demand lithiates will appear heavily in the urine. Alternating 
with milk or eggs, or malt or barley jelly, the condition of the 
patient must be exceptionally bad, which will not exhibit a fa- 
vorable response. 
On account of the satisfactory results observed in the use of 
the expressed beef juice, and because of the difficulty many 
seemed to experience in expressing it properly, I induced, some 
months ago, Mr. Frank Stewart, the well-known druggist of St. 
Clair street, to manufacture it for sale. He soon found it was 
necessary to increase the size of his press, finally arranging a 
small cider press for the work. He also experimented with 
preserving agents, and ascertained that brandy or whisky in 
small amounts acted admirably. This I have prescribed with 
satisfaction ; it forms a first class food for feeble travelers, 
whether by sea or land. A tablespoonful put into half a cup of 
hot water can, as a rule, be taken by any stomach and repeated 
according to requirements. A. Mayell & Company, druggists, 
have also decided to manufacture this juice, and have imported 
an improved hydraulic press designed for such service. When- 
ever it is possible, I advise that the meat should be pressed 
at home. 
It may not be amiss to allude in this connection to the numer- 
ous proprietary preparations now in the market professing to be 
far superior in their concentrated nutriment to any which can be 
prepared at the homes of our people. I allude to them simply 
to condemn them one and all ; they are delusions and snares. 
It is time the profession fully realized these facts and acted ac- 
cordingly. Rival drug houses, not satisfied with numerous 
useless new remedies, have entered the field of dietetics and 
propose finishing with their foods all who have survived their 
medicines. Each house is provided with an organ in the form Powell : Annual Address. 
231 
of a journal of dietetics or reconstructives ; like street corner 
showmen, they shout, every one, the merits of his own exhibit, 
whilst denouncing that of his rival. It is lamentable that men, 
some of them high in the ranks of the profession, give coun- 
tenance to these commercial enterprises, and by the great influ- 
ence of their names increase the sales of these valueless and 
oftentimes hurtful articles. If it were possible to grant that 
some of these potted or bottled preparations equalled the home 
made articles, the extravagant cost of them should deter medi- 
cal men from advising their use. This, I am sure upon reflec- 
tion, will be admitted by most of you ; but, to illustrate the 
full force of this point I will consider for a moment a product of 
beef regarded very generally as the best in the market. As it 
is not my purpose to make invidious distinction, if such a thing 
were possible, I will not mention the manufacturer's name. 
Fourteen years ago I introduced the agent of the manufacturer 
to this society. He distributed specimens. Since then, through 
active advertising, the civilized world has become acquainted 
with it. I hope to be forgiven for the small part I have had in 
giving it sale in this community. It is put up in bottles that 
hold four tablespoonfuls, and is retailed at the modest sum of 
one dollar per bottle-the price of six or seven pounds of the 
best steak or of four gallons of milk. I have at various times 
tested it with heat and nitric acid for albumen without finding 
any. The absence of albumen might perhaps be explained, if 
it were claimed, that it had been converted into peptones, but no 
such claim is made. It can be nothing more than an agreeable 
stimulant, utterly devoid of any nutritious elements. By united 
action we can do much to correct this widespread evil and 
thereby do much toward saving both the lives and money of our 
patients. I contemplated discussing some efficient methods of 
administering eggs, alcohol and malt as food for the sick, but 
am compelled, by the length my paper has attained, to post- 
pone their consideration. 
There is, however, one other article I wish to bring to your 
notice, a food to be sure not so well suited for the very sick, 
as for those who will soon become so if not aided by your sug- 
gestions. I refer to "White Rolled Oats," not oatmeal, the  Powell: Annual Address. 
232 
latter may with propriety form a part of the diet of the ro- 
bust with unimpaired digestive functions, or when the con- 
stipated habit must be corrected. It may suit the sturdy 
Scotchman, but the average American can digest but a small 
amount of it; it acts as a laxative by irritating the bowels and 
passing out undigested-with " White Rolled Oats" it is other- 
wise ; the oats are exposed at the mill to a high degree of heat, 
the bran is thoroughly removed with all the indigestible parts 
of the grain, and then carefully rolled. We have here a farina 
cious food of great value, where the digestive fluids have not 
been suppressed by febrile action or other contra indications do 
not exist. For a year or more I have been prescribing and 
using on my own table the brand known as the "Quaker Mill " 
of Ravenna. It has given me more satisfaction in every respect 
than any other in the market, and, as it is not kept in stock by 
the grocers in the city, I have gotten Mr. Frank Stewart to 
keep it. But I must not longer encroach upon your time; a 
volume of good size would be required to properly elaborate 
the hints expressed in this brief paper. If I read correctly the 
signs of the times, the day is not far distant when the physi- 
cians' first prescription will be the patients' .menu, and perhaps 
in quite a large proportion of cases it will not be deemed nec- 
essary to write a second. The treatment and cure of many dis- 
eases by a carefully selected diet will be regarded as legitimate 
work for the most scientific and skillful of the profession. Poly- 
pharmacy is a curse to this country ; careful observations of the 
influence of various articles of food upon the course of disease 
will put a wholesome check upon it, and at the same time re- 
dound to the credit of the long tried, standard remedies of our 
materia medica. The banners of our advance guard must have 
emblazened upon them "Preventive Medicine," "Natural Ther- 
apeutics."