WBD G2584 i&eo PSSJ ■St'PJf-" mffim NATIONAL LIBRARY OF MEDICINE NLfl QDlEEbEl 1 T ;-*»'.-/-.4'| L* **»s' W*/- SURGEON GENERAL'S OFFICE LIBRARY. ? 4 f :> 1 •' a—6i3 NLM001226211 t " Doctor, What Shall I Eat? " A HANDBOOK OF DIET IN DISEASE. for the PROFESSION AND THE PEOPLE. BY CH. GATCHELL, M. D., FORMERLY Professor of the Theory and Practice of Medicine, University of Michigan. WBD mo Entered, according to Act of Congress, in the year 1880, by CH. GATCHELL, In the office of the Librarian of Congress, at Washington, D. C. Cramer, Aikens & Cramer, Printers. Milwaukee, Wis. t DEDICATION: to MY FATHER. PREFACE. When entering upon the practice of my profession, I well remember that one of the first questions which greeted me was, ''Doctor, what shall I eat?" I also rec- ollect that in the college lecture-room I received no special instruction which would aid me in making a reply, and therefore, from necessity, I early began searching for such information as would enable me to answer intelligently this question, which was almost daily repeated. While it is expected that the profession may find this book of value when called upon to answer the constantly recurring question which composes its title, yet, as the introduction indicates, the object has been to adapt it more particularly to the wants of the people, and to pro- vide for them a practical work on the subject of diet in disease—one which they can take into the sick-room and into the kitchen. Great care has been taken to select only such recipes as have been obtained from reliable sources, and many of them have stood the test of trial in my own practice. Free use has been made of all works on kindred sub- jects, and Chamber's " Manual of Diet" has been con- sulted, while Niemeyer's, Aitken's and Ruddock's works on Practice, and Ziemssen's Cyclopaedia, have contributed valuable hints. Acknowledgment is also due Florence Nightingale's " Notes on Nursing," and the chapter on " The Sick-room," by Marion Harland. My father, Prof. H. P. Gatchell, M. D., has kindly given me the benefit of his experience. With this introduction the book is sent on its mission in the hope that it may answer the important question for others, as it has for me. CH. GATCHELL. TABLE OP CONTENTS. Pag£. Introduction.............................................................................. ix CHAPTER I. How to Feed Fever-Patients..................................................... 21 CHAPTER II. Diet in Dyspepsia.—Aids to Digestion......................................... 31 CHAPTER III. Diet in Constipation.—Rectal Alimentation............................. 43 CHAPTER IV. Diet in Consumption.................................................................... 53 CHAPTER V. Diet in Diabetes.—Bright's Disease.—((ravel........................... 62 CHAPTER VI. How to Nurse the Baby.—How to Choose a Wet-Nurse.—How to Wean the Baby................................................................. 73 CHAPTER VII. How to Feed the Baby.—Diet in Cholera-Infantum................ 79 CHAPTER VIII. Diet for Travelers.—Diet in Seasickness.—Diet for the Cor- pulent.................................................................................... 91 CHAPTER IX. Diet in Scrofula.—Rickets.—Scurvy.—Chlorosis.—Collapse... 99 CHAPTER X. Diet in Rheumatism.— Asthma.—Heart Disease.—Alcoholism... 104 CHAPTER XI. Diet in Diarrjicea. — Dysentery. —Cholera. — Diphtheria.— Gastritis.—Biliousness.......................................................... Ill CHAPTER XII. Diet for Convalescents............................................................ 119 CHAPTER XIII. Recipes :—Beverages.—Meats.—Oysters.—Broths and Soups.— Breads.—Gruels.—Blanc Manges and Custards.................. I2.r> INTRODUCTION, The human body is composed of a great variety of substances, and yet they are capable of classifi- cation into a few simple groups. These substances, which we know under the general name of foods, become component parts of our bodies and enter into the composition of living tissues. It is im- portant to the health of our bodies that we receive a due supply of each of these different classes of foods. If we should be entirely deprived of any one class our health would seriously suffer, and sooner or later the body would succumb to the disease which would inevitably result. These elements are so generally distributed throughout the animal and vegetable kingdoms, among those substances upon which man relies for his sustenance, that it requires little calcula- tion on his part to supply his body with the need- ed variety. The penalty of a violation of this is seen in scurvy, a disease which follows a diet de- ficient in potash combined with vegetable acids, and all that is necessary to its cure is to supply the system with food containing those elements of which it has been deprived. But in disease, on the other hand, the system X INTRODUCTION. loses an undue amount of certain elements, and these must be supplied in increased quantity in order to make up for the rapid loss. Thus in fevers we supply those elements which make mus- cular and other tissue, which waste very rapidly ; in consumption we supply the same, together with fats ; in rickets we supply salts of lime, in which the body is deficient. Accordingly, the regulation of the diet in dis- ease consists in supplying those foods containing the elements which are lacking in the system, * and offering them also in a form to be readily digested and assimilated. Hence, if we can learn the wants of the system, and if we know in what state to introduce the re- quired aliment, we are prepared to intelligently feed the sick. To teach this is the design of this work. As already indicated, foods may be convenient- ly divided into three different classes, which are named as follows : Organic I Nitrogenized, 6 ' } Non-Nitrogenized. Inorganic. * This, of course, docs not apply to diabetes and diseases treated up- on a similar plan, as the result of experiment; but as a general rule it will hold good. I once had a diabetic patient to whom no instruc- tions regarding diet were given, as I wished for a short time to try the effect of medicine uninfluenced by the former. To my surprise the amount of sugar in the urine began to increase rapidly. Inquiry elic- ited the fact that of his own accord he had begun taking large quan- tities of sugar in order to siipjih/ the loss which he learned was taking place. He was immediately dieted. INTRODUCTION. XI I. Nitrogenized Foods. As the name denotes these all contain nitrogen. They have for their bases certain principles called fibrin,* albumen and casein. The chief foods of this class are of animal origin, and eggs, milk, cheese, and all meats contain them in abundance. In small proportion, similar principles exist in some vegetables, as gluten and legumine in wheat and peas respectively. Foods of this class contain a large proportion of nutrient matter, and of a kind which has to go through but few changes before being converted into living tissue. Their chief function is to act as tissue-builders. They enter largely into the com- position of muscular and other tissue, and hence we give them in fevers, in which there is great and rapid loss of flesh and waste of tissue, in consump- tion and wasting-diseases generally. These foods are all digested in the stomach, and hence should not be given in conditions in which this organ requires rest. Beef is the chief food of this class, and is inval- uable in the dietetic treatment of the sick. " One of the most important articles of diet for the sick is beef, and it should be of good quality ; the bone should not exceed 20 per cent., the fat should be firm, not yellow, and free from blood, and should * This term is meant to include muscle-fibrin, called by Flint muscu- line. xii INTRODUCTION. not be in too great proportion relatively ; the muscle should be firm without being tough, not too pale nor dark-colored, and should not present any marbling or lividity on cross-section."—(Bar- tholow.') Mutton is more easily digested than beef and in this respect to be preferred to the latter. It is, however, of less nutritive value. The broth of mutton has a delicate and peculiar flavor which renders it especially agreeable to the sick. It. should be well freed from fat. Veal is less nutritious than beef, abounding in gelatine. It is also more difficult of digestion than the latter, and has a very limited use in the invalid's dietary. Venison is more easily and quickly digested than beef, but does not possess the same nutritive value. Chicken is an important article of diet for the sick and convalescent. It is agreeable to the taste and easy of mastication and digestion. It is not, however, so nourishing as beef, but probably enough so for all ordinary purposes. Pork, containing as it does much fat, is difficult of digestion and finds no place, either fresh or cured, in the invalid's dietary. Salted meats are not very easy of digestion. They are deficient in nutritive value and should not be taken by the sick. INTRODUCTION. Xlll Fish is a nutritious food, but not adapted to the wants of the invalid. Salted fish is difficult of digestion and should never be used by the sick. Cheese is a rich food and cannot be taken by those with dyspepsia or weak stomachs. In nutri- tive value one pound of cheese is equal to three and a half pounds of lean beef. Oysters are highly nutritious, easy of digestion, and usually well borne by a delicate stomach. Simply prepared they form a valuable addition to the invalid's dietary. Eggs are rich in albumen. They are highly nu- tritious, generally easy of digestion, and form a very important part of the invalid's food. They should never be cooked more than three minutes. The yolk is more digestible than the white, if hard-boiled. Raw or whipped eggs are among the most digestible of alimentary substances. Milk is one of the most important articles of food for the sick, and life may be sustained for weeks on this alone. It is highly nutritious, con- tains all the elements which enter into the com- position of the tissues, and can be served up in many different forms and be introduced into a great variety of other foods. Some diseases can be cured by simply adopting a diet consisting ex- clusively of milk. There are some with whom milk disagrees either in health or sickness. This cannot be accounted XIV INTRODUCTION. for, being due to some idiosyncrasy. When this is the case it can sometimes be remedied by add- ing a little salt to each glass of milk—not enough to make it taste salty. The addition of lime-water to the milk will correct it for others. Clabbered milk, sour milk and butter milk are equally as nutritious as fresh milk and will be borne by many stomachs which cannot tolerate the former. These are valuable articles of diet which are too much neglected. Gelatine belongs to this class. It possesses scarcely any nutritive value, and must not be relied upon as food. On it alone any animal will starve. It may be used as a vehicle for the introduction of other substances, or for its sooth- ing properties alone. II. NoN-NlTROGENIZED FOODS. The foods belonging to this class are sugars, starches and fats, the first two being exclusively of vegetableorigin (liver-sugar being left out of ac- count), while the last-named is produced by both animals and vegetables. While the nitrogenized foods in the main go to build up tissue, these find their chief use in keep- ing up the heat of the body.* Hence when the athlete wishes to develop his muscles, he eats * Although the doctrine on this subject has been modified, yet since each class finds its chief use in the direction indicated, the statement as made, will stand. INTRODUCTION. XV beef; when the Esquimaux wishes to fortify him- self against cold, he eats blubber. All the principles of this class are fat-formers. Mr. Banting found sugar to be the most active agent of this kind that he used. Sugar has a very limited range in the invalid's dietary, being used chiefly for seasoning. It is especially harmful in diabetes. It should never be taken by the corpulent if they desire to de- crease their weight. Sugar-of-Milk is to be preferred to cane-sugar in the preparation of dishes for infants. Fats—including oils—cannot be taken by those with weak digestive powers. They are unfit foods for fever-patients and those who suffer from indi- gestion. In consumption fats are very useful, not only in supplying the element which is deficient in the system, but also in aiding the nutritive process through the influence which they exert over cell-growth. Inunctions of oils serve a valuable purpose when it is impossible to take them by the stomach and yet it is desired to keep up nutrition. Cream is too rich for most invalids. It should never be used in febrile conditions, but is of value in consumption and wasting diseases. Butter may be placed in the same category with cream. Consumptives should use it liberally. Cod-liver oil has a deservedly high reputation in xvi INTRODUCTION. the treatment of a certain class of diseases, espe- cially in consumption. While the oil undoubtedly is the important agent, some ascribe to the iodine which all cod-liver oil contains, its peculiar virtue in this disease. It holds an important place also in the treatment of scrofula and marasmus. Olive oil may be substituted for the cod-liver oil if the latter disagree. It is equally as good as an inunction. Starches form a large and important part of our food. As food for the sick they occupy a prominent place. After the salivary glands be- come active, starch forms an important part of the infant's diet. Corn-starch has but a limited use in the invalid's dietary. It can be made into blanc-manges for the convalescent. It is too heavy for most stom- achs. Sago is an excellent form of starch of which to make dishes for the sick, as well as for infants. It is to be preferred to tapioca, a similar product, because the grains are finer and it can be rendered smoother, and hence is easier of digestion. Arrowroot is another starchy food much used in the preparation of dishes for the sick and for infants. It is excellent of the kind, but it must be remembered that a child will starve if fed on starch alone. Do not depend too much upon the arrow-root gruel, to the exclusion of other foods. INTRODUCTION. xvii Wheat. Preparations of this grain form many of the most useful foods known to man. It con- tains all the elements which enter into the compo- sition of the body. Wheat flour, however, as ordinarily prepared, has been deprived of the most valuable constituents of the grain, the salts and nitrogenous portions. The flour which is made by the so-called "patent process" is not open to this objection. Brown flour, or Graham flour, also retains these elements. This is a very valuable food and can be gotten up in a great variety of forms. Potatoes. These form a valuable food, but are not well adapted to a diet for the sick. They are rich in the starchy elements. The best potatoes are mealy and powdery when boiled. Young pota- toes, and old waxy potatoes are indigestible and should never be taken by those with weak stom- achs. Rice is said to be the chief food of nearly one- third of the human race. It contains a greater proportion of starch than any other vegetable. It is easy of digestion, leaves very little residue, and is a useful food in sickness, finding its chief place in bowel diseases. Care must be taken to have it thoroughly cooked, or it will defeat the very object for which it is given. Gums, such as gum-Arabic and that which ad- heres to flax-seed, have the same composition as xviii INTRODUCTION. starch. They possess no nutritive value what- ever, but pass through the alimentary canal un- changed, and flax-seed tea and similar prepara- tions are useless as foods. III. Inorganic Foods. While the principles belonging to this class can- not of themselves support life, yet since they are as necessary to the proper constitution of the body as any other, they occupy the position of a food and must be considered as belonging to the class of alimentary substances. While some oi these go to the formation of solid tissue, as lime in the bones, their general purpose would seem to be to exert some sort of control over the processes of nutrition. Water is the most important of the inorganic principles. It enters into the composition of all the tissues of the body. Some diseases are much benefited simply by drinking large quantities of "soft" water. The important point to be observed in the use of this principle is to obtain it in as pure a state as possible. Salt enters into the composition of almost all our food, but in insufficient quantities to satisfy the demands of the system. It exerts a favorable influence over the processes of nutrition, and if entirely deprived of it disease will surely follow. Iron exists in our food, both animal and vege- INTRODUCTION. XIX table, in sufficient quantity to satisfy the wants of the system in health. In those diseased condi- tions in which it is deficient it must be supplied in increased quantities. Phosphate-of-Lime is supplied in combination with animal and vegetable foods. When it is de- ficient in the system, as in rickets, it should be artificially introduced. CHAPTER I HOW TO FEED FEVER-PATIENTS. The old notion that we should "stuff a cold and starve a fever," has long since given way to the modified doctrine that both the cold and the fever should be well fed. It was the great Dr. Graves, of Dublin, who said that he desired no greater epitaph on his tombstone than simply the three words, "He fed fevers." To the reform which he thus initiated we owe many lives, for no doubt under the old and erroneous method of keeping the patient on a low diet for fear of add- ing "fuel to the flames," many poor victims were actually starved to death when recovery would have followed had they been properly nourished. But care and judgment in the management of the dietetics is as important as the medicinal treatment itself, and a certain plan must be ob- served. The instructions which follow will apply to almost all the acute fevers. It is well to keep in mind a few general RULES. 1. Give no solid food to a fever-patient. 2. Let the food be simple but nutritious. 21 22 DIET IN DISEASE. 3. Give food at frequent intervals and in small quantities. 4. Let a fever-patient have all the cold water that he wants to drink. 5. Solid food given during convalescence will often cause a relapse. 6. If the patient be properly nourished from the outset there will be little need of alcoholic stimulants. Remember also that those fever-patients who have been judiciously nourished will make the best recoveries. If the patient's mouth be foul, the lips, teeth and tongue covered with " sordes," before giving food cleanse the mouth with cold water contain- ing a little lemon-juice, using a swab or the corner of a napkin. A little of the liquor-permanganate- of-potash may also be used for this purpose. When a patient is weak and lying on his back, it is exceedingly tiresome for him to take food or drink a spoonful at a time ; even this slight effort wearies him. At such a time none but liquid food should be given, and this through a bent glass tube. Food for fever-patients should be fluid in form, easy of digestion and highly nutritious. MILK. No better form of food than this can be chosen if it agree with the patient. HOW TO FEED FEVER-PATIENTS. 23 Give to the patient regularly every two hours a teacupful of milk. This may be fresh from the cow, or scalded, or ice-cold, to suit the fancy of the sick one. When but little food can be taken it is a good plan to have a pitcher of iced-milk, and when the patient complains of thrist give this in- stead of water. Typhoid-fever patients who are fed on nothing but milk throughout the course of the disease make excellent recoveries. The best way of administering it is to let the patient draw it through a bent tube. If the milk disagree or be thrown up curdled, a tablespoonful of lime-water to a cup of milk may prevent this. BUTTERMILK may be given instead of sweet milk. It is both refreshing and nutritious. It should be fresh, and, like the milk, given in small quantities fre- quently repeated. Its tendency is to allay fever. To some patients milk is repugnant. To others its continued use will render it so. Its use may then be varied by giving gruel. The perfection of gruels should be, according to Miss Austen, " thin, but not too thin ; thick, but not too thick." For the first three days of the fever, if the pa- tient receive oatmeal gruel the waste of tissue which occurs during that time will be fully met. The oatmeal, however, should be thoroughly well 24 DIET IN DISEASE. /• boiled. If it be underdone more harm than good will follow. RECIPE 1. OATMEAL GRUEL. To two tablespoonfuls of oatmeal add two table- spoonfuls of water, and make a smooth paste. Stir this into a pint of boiling water, and boil for half an hour, stirring well. Add a little salt, and strain through muslin. If too thick, thin with a little milk. Later in the course of the fever the patient requires food which is stimulating as well as nour- ishing. But unless the patient is in an asthenic, i. e., a weak and low condition, preparations con- taining alcohol should not be given. If, however, there is great prostration with weak and feeble circulation, alcohol is indicated. BEEF-TEA. This much-abused article Avill find its chief use in those weak conditions in which the patient needs stimulating. There is very little nourish- ment in it, but it seems to have a remarkable power of sustaining life out of all proportion to the amount of solid matter which it contains. If a patient has a continued fever and it is known that beef-tea will be wanted from day to day, too much pains cannot be taken in its prepa- ration. It is well to observe the following rules: 1. Never let beef tea boil. HOW TO FEED FEVER-PATIENTS. 25 2. Always begin with cold water. 3. The finer the beef is cut the better. 4. There should be no fat, gristle or bones ad- hering to the meat. 5. The proper proportion of beef and water is a pound to a pint. 6. Beef-tea that "jellies " when cold has not been properly made. 7. After, being made, carefully remove from the surface all traces of fat. 8. To " warm up " beef-tea, put it in a cup and set the cup in a vessel of boiling water. To get all the virtue of the meat the following recipe is the best: RECIPE 2. BEEF-TEA. Take one pound of fresh meat, cut very fine, soak in one-third of a quart of cold water over night. In the morning remove the meat, saving the water in which it has soaked. Put the meat into two-thirds of a quart of water and let it sim- mer for two hours, keeping the water up to its original level by replacing what is lost by evapo- ration. Now pour the beef-broth into the cold liquor in which the meat was soaked, squeezing the meat as dry as possible. The meat which remains should be spread on a tin plate and slowly dried in an open oven. When perfectly dry it can be easily reduced to a 26 DIET IN DISEASE. powder in a mortar. Mix this meat-powder in the liquor and you have all the elements of the meat in a fluid form. Salt to taste and add twenty drops of muriatic acid and three grains of pepsin. A simpler method, and one which will answer for all ordinary purposes, is the following : RECIPE 3. BEEF-TEA. Prepare a pound of beef in the usual manner and soak it in a pint of cold water for two hours. Now place the vessel containing the meat into a sauce-pan of water, and let the water in the latter boil for three hours (putting the meat and water into a stone bottle and this into a kettle of boiling water answers the same purpose). Replace water that is lost by evaporation. When done strain and salt to taste. The last vestige of fat may be removed by skimming the surface with a piece of white blotting-paper. RECIPE 4. WINE WHEY. Put a quart of fresh milk into a saucepan and let it come to a boil; as soon as it reaches this point add slowly a wineglassful of sherry wine, skimming off the curd which rises for about fif- teen minutes. Add a tablespoonf ul more of wine, skim what curd remains and it is ready for use. Sweeten to taste, and season with nutmeg if allowable. HOW TO FEED FEVER-PATIENTS. 27 Whey is not very nourishing, but prepared in this way it is refreshing and stimulating. RECIPE 5. EGG-NOGG. One egg; One tumbler of milk ; One dessertspoonful brandy; One dessertspoonful sugar. Carefully scald the milk and let it afterwards become cold. Beat the sugar and egg up together to a froth, put into a tumbler, add the brandy and fill up with the milk. If wanted in a hurry the milk may be used without scalding. This is stimulating and. nutritious. After the stage of depression has passed the stimulating food may be dropped and a return made to simple, nourishing, easily-digested articles. Food should be given yet with great care, espe- cially in typhoid, and nothing solid should be swal- lowed by the patient. Give again meat broths, milk and the like. RECIPE 6. MUTTON BROTH. Take a pound of fresh mutton, free from fat; cut into thin slices with a sharp knife ; put into a suitable dish, salt, pour over it a quart of cold water and let it simmer over a slow fire for an hour, then let it boil for an hour longer. Strain off the broth through a sieve refusing the meat fibre. Season to taste. 28 DIET IN DISEASE. RECIPE 7. BEEF BROTH may be made according to this same recipe, taking a pound of beef free from fat. A piece of the neck or shoulder is best. These broths may be thick- ened with sago if desired. RECIPE 8. CHICKEN BROTH. Take a tender chicken ; remove the skin and all fat. Cut it in two longitudinally and remove the lungs, which will be found attached to the back. Now cut these halves into small pieces, cutting through bones and flesh. Put these pieces into a suitable dish, salt, pour on a quart of cold water and let it simmer for an hour and a half, then set it on the hearth or back of the stove and keep up the heat for half an hour longer. Strain through a sieve or coarse towel to separate the broth from the bones and fibre. Season to taste. Thicken with a little flour or sago if desired. The yolk of an egg beaten up in any of these broths adds greatly to their nutritive value. This dietary is intended to apply to any of the essential as well as to the symptomatic fevers. But some of them require special mention. TYPHOID FEVER. This fever is generally protracted and exhaust- ing, and the diet needs careful attention, especially HOW TO FEED FEVER-PATIENTS. 29 when convalescence approaches and the appetite returns. Relapses are often brought on by some error in diet or over-indulgence. No solid food should be taken until health is fully restored. It must be remembered that the lining-membrane of the intestines has been ulcerated, and for some time after the patient is up it is in a very sensi- tive state, and extreme care must be observed lest the inflammation be again aroused. So simple a thing as eating too much boiled rice has brought on a fatal relapse. A diet consisting exclusively of milk may be depended upon in this fever. Let the milk be scalded. Give this throughout the entire course of the disease, and until convalescence is far advanced. There is no better diet in typhoid fever. TYPHUS FEVER. In this fever there is great and rapid destruction of tissue, and it is highly important that this loss should be met, from the first, by very nutritious food given regularly and persistently. If the pros- tration be great, give beef-tea and egg-nogg. If swallowing becomes impossible, life may still be supported by nutrient enemata. SCARLET FEVER. While the general dietary already given will apply to this fever, yet, since there is usually some inflammation of the stomach attending it, the food must be especially bland and unirritating. so DIET IN DISEASE. Only a small quantity should be given at a time, and it will be better borne if it be cold. Iced milk, iced barley-water, and the like, will agree better than warm food. A milk diet fulfils all indications in this fever, and is especially useful in that its tendency is to act as a diuretic, and thus keep the kidneys freely acting. CHAPTER n. DIET IN DYSPEPSIA. Since this disease is generally produced by errors in diet, no plan of treatment which does not in- volve a careful regulation of this important mat- ter can ever be successful in effecting a cure. While it is true that " what is one man's meat is another man's poison," yet a strict observance of the dietary here given cannot fail to benefit every case, and it will cure in many. It is important to the success of the treatment that, once begun, it be faithfully carried out, and the instructions given be rigidly observed. If this be done, it is not too much to say that every sufferer from this very common complaint may be restored to a state of health. Dyspeptics should adhere to the following rules: 1. Eat slowly. 2. Masticate thoroughly. 3. Never eat when tired. 4. Avoid exercise immediately after a meal. 5. Do not eat " between meals," or be con- stantly "nibbling." 6. Never overload the stomach, or eat until you feel oppressed. 31 32 DIET IN DISEASE. 7. Do not drink large quantities during or after a meal; a moderate quantity will do no harm. WHAT DYSPEPTICS SHOULD NOT EAT. Peas, Herring, Beans, Sausage, Hash, Sardines, Ham, Mackerel, Fish, Salt-meats, Cakes, Fresh bread, Cheese, Griddle cakes, Cabbage, Raw vegetables, Cucumbers, Young potatoes, Confections, Old, waxy potatoes. Pastries. Drink no tea or coffee. Never eat meat that has been twice-cooked. Fats and pastries are especially to be avoided. Eat no sweet puddings, sauces, or the like, at the end of a meal. Flatulence is more apt to follow the use of veg- etable than of animal food. Some can eat with impunity what disagrees with others; avoid everything which disagrees with you. The use of alcoholic beverages will produce dyspepsia, and aggravate one already existing. Eat no fresh bread. All bread should be stale or toasted, and the crust is to be preferred to the crumb. DIET IN DYSPEPSIA. 33 The dyspeptic should never eat raw fruit at the end of a meal. Between-meals a little ripe fruit will do no harm. Take nothing into the stomach at a meal that will lower its temperature, for this interferes with digestion and produces dyspepsia. Therefore take no ice-water, ices, or ice-cream. If the dyspeptic be troubled with eructations of gas from the stomach, this may be corrected by eating only vegetable food at one meal and animal food at another. Taking both kinds at one meal will aggravate this trouble. An interval of five hours should elapse between any two meals. It requires this length of time for the stomach to dispose of its contents after one meal, and to overtax it by forcing more food into it before it has had an interval of repose is a fruit- ful cause of indigestion. Rest after a meal aids digestion. Those who are in good health should do no kind of mental or bodily labor immediately following a meal, and still less should a dyspeptic. It will aid recovery if the sufferer from dyspepsia will rest for one or two hours after a meal. Many dyspeptics can entirely recover if they will observe the instructions already given, and confine themselves to a diet of dyspepsia-crackers, cod-fish and clabbered-milk, prepared according to the recipes which follow. 34 DIET IN DISEASE. RECIPE 9. DYSPEPSIA-CRACKERS. Take of wheat-meal one quart; butter, one table- spoonful ; water, enough to make a very stiff dough. Beat this dough with a potato-masher or rolling-pin for half an hour, laying it on a bread- board for the purpose ; roll it into a ball and beat it out over and over again. Now roll it out very thin, cut into round shapes, prick with a fork and bake in a quick oven. The ivheat-meal should be especially prepared for these crackers. If no other is to be had use good brown flour. But too often this is made up of poor flour, middlings and bran. To secure a good article, buy some good wheat, take it to the mill and have it ground. Let the bran be sifted out, but leave the middlings and flour together, and you have a good wheat-meal. recipe 10. COD-FISH. With a sharp knife cut thin pieces of the cod-fish cross-ways of the grain of the fibres ; soak this over night to extract the salt; the next morning pour off the water in which it has soaked, put the fish into some fresh water and cook it for half an hour, then add a teacupful of milk and a table- spoonful of flour ; just before dishing for the table beat up an egg and stir this in. This is a very nutritious dish, and it is also very DIET IN DYSPEPSIA. 35 easy of digestion. Eaten with some of the dys- pepsia-crackers, it makes as nice a meal as anyone need desire. If milk should disagree, then it must be omitted and the cooking done with water only. If the fish be soaked in sour milk instead of water the salt will be better extracted and the fish made fresher. RECIPE 11. CLABBERED-MILK. This is simply thick sour milk. It is also called loppered milk and bonny-clabber. Set a quantity of skimmed-milk away in a cov- ered glass or china dish. When it turns, i. e., becomes smooth, firm and jelly-like, it is ready to serve. Do not let it stand until the whey separates from the curd, or it will become acid and tough. Set it on the ice for an hour before it is wanted for use. Serve from the dish in which it has turned. Cut out carefully with a large spoon, put in saucers and eat with cream and nutmeg. This is one of the most wholesome of dishes, and those to whom it is new soon acquire a taste for, and grow fond of it. Marion Harland, in her excellent book, " Com- mon Sense in the Household," says of bonny- clabber : " Few people know how delicious this healthful and cheap dessert can be made if eaten before it becomes tart and tough, with a liberal allowance 36 DIET IN DISEASE. of cream and sugar. There are not many jellies and creams superior to it." To be relished the clabber must be new and fresh. If allowed to become stale and tough it will pall on the taste. In health it may be eaten sweetened, but it should not be eaten with sugar by dyspeptics. Nutmeg must then be relied upon to give it flavor. In case the clabbered-milk is not agreeable at first, begin with a small quantity—a tablespoonful at a time—and gradually a taste for this very useful food can be acquired. Some prefer taking it as a drink, beating it up until it becomes creamy. RECIPE 12. SCHMIER-KASE. This is made by tying clabbered-milk in a cloth to let the whey drain out. Hang it in a cool place over night. It may be eaten like the bonny- clabber. It is an excellent food for the dyspeptic, and may be taken in almost any quantity. It is light, nutritious, and easy of digestion. It is called by some cottage-cheese. By observing the rules already laid down and adopting this dietary, many cases of dyspepsia may be cured. The greatest obstacle to a com- plete recovery seems to be that as improvement takes place and the appetite returns the patient is tempted to over-eat, and this being yielded to DIET IN DYSPEPSIA. 37 almost invariably causes a relapse. The " word to the wise " is not always sufficient, and each one must learn by sad experience. It is better to eat moderately until the stomach fully recovers its powers, than to transgress these rules and suffer a relapse. The dietary already given should be adopted and strictly followed by all who suffer from dys- pepsia in its worst forms. Those who suffer from the milder forms of this disease should live on simple food. Dishes prepared according to the following recipes will be found to be well adapted to the wants of the dyspeptic, and also to afford ample variety. White bread disagrees with many dyspeptics, and its use should be avoided. The following recipe makes an excellent article of brown bread. RECIPE 13. BROWN BREAD. Prepare a good sponge, as for white bread. Put into the bread-pan two parts brown-flour (do not sift brown-flour), one third white flour, and to every quart of this mixture allow a hand- ful of Indian meal, with a teaspoonful of salt. Wet this with the sponge, and when it is mixed, add, for a loaf of fair size, half a teacupful of molasses. The dough should be very soft. If there be not enough sponge to reduce it to the desired consistency, add a little lukewarm water. 38 DIET IN DISEASE. Knead this long and thoroughly, and set it to rise, which will require a longer time than for white bread. Give it plenty of time. Knead again, make into loaves and set for a second rising. When light bake steadily, giving it a longer time than white bread requires. Be careful that it does not burn. Do not cut while hot. RECIPE 14. UNLEAVENED WAFERS. Mix good, dry flour, with a little salt in it, to a stiff dough with milk. Roll out thin. Cut into round cakes, and roll these again almost as thin as letter paper. Bake very quickly. They may also be mixed with water. These wafers are easily digested, very delicate, and fill an important place in the dyspeptic's dietary. They can be used as crackers, eaten with soups and broths, and in a great variety of other ways. J RECIPE 15. UNFERMENTED BREAD. Take one ounce of bicarbonate of soda (baking- soda) and one-quarter ounce of salt; mix with four pounds of flour. Mix this with a quart of cold water containing half a fluidounce of muriatic acid, and make a thin dough with as little knead- ing as possible ; put it in the oven without delay. It requires a longer time for baking than it takes for fermented bread. DIET IN DYSPEPSIA. 39 This is better for the dyspeptic than the ordin- ary fermented bread. Some of the preparations of gluten, for which recipes are given in Chapter V., will be found to be good food for dyspeptics. Besides the articles here mentioned, there are of course others which the dyspeptic can eat, but there is such a difference in their stomachs that no general list can be given which will apply to all cases, unless it be the simple dietary recom- mended at the opening of this Chapter, which will agree with all. If complete recovery be aimed at, it must be adopted and rigidly adhered to until a cure is effected. As the stomach becomes more tolerant the return to a mixed diet must be carefully made. Even after health is fully re- stored care in the selection of the food must be observed, for it must be borne in mind that that which will once produce a dyspepsia will also be the most efficient agent in bringing about a return of the same trouble, and. probably the most im- portant general rule yet laid down is :—Avoid everything which disagrees with you. AIDS TO DIQESTION. RECIPE 18. PEPSIN. To prepare : Take a perfectly fresh pig's-stomach. Carefully dissect the mucous membrane from the muscular coat, and place the membrane on a flat 40 DIET IN DISEASE. board. Clean off all remains of food and mucus with a sponge and a little water. With the back of a knife, or with an ivory paper-knife, scrape the surface very hard and squeeze out the contents of the glands. Spread the viscid mucus thus obtained on a piece of glass, so as to form a very thin layer, and dry it at a temperature of 100° over hot water, (or in vacuo over sulphuric acid). When dry scrape it from the glass, powder it, and keep in a well-stoppered bottle.—(Beale.~) This powder may be kept in a glass-stoppered bottle for years without losing any of its virtue. It is a valuable aid to digestion in dyspepsia. When it is desired to use it to aid digestion, two or three grains may be taken just before a meal, or it may be taken with the food, sprinkling it on as you would salt, as it is tasteless and inodorous. Or, it may be prepared in a fluid form, and a tablespoonful of this fluid mixed with any of the dishes of animal food recommended in this work. RECIPE 17. DIGESTIVE FLUID. Prepare according to the following formula : Pepsin powder, 5 grains ; Muriatic acid, 18 drops ; Water, 6 ounces. Mix these in a bottle, and keep it well corked. This fluid may also be used in preparing nutrient enemata. DIET IX DYSPEPSIA. 41 Good preparations of pepsin can always be had at the druggists'. It is a good plan to keep some on hand at all times, for in sickness it is a great aid to digestion. It should be used in the prep- aration of animal foods alone, as it is useless in the digestion of the starches. RECIPE 18. MALT-INFUSION. Crushed malt, 3 ounces; Cold water, | pint. Mix these in a vessel and allow it to remain for from twelve to fifteen hours. Then run it through filtering-paper until it comes perfectly clear. This is rich in diastase, and contains maltose in considerable quantities. It is liable to fermenta- tion, and hence must be prepared fresh daily. It may be preserved, however, by adding a few drops of chloroform to the infusion and keeping it in a bottle, well corked. The malt-infusion is to be used to aid in the digestion of farinaceous (starchy) foods. It may be used by the dyspeptic, or may be added to the infant's food. It is best taken mixed with the food. Add a tablespoonful to half a pint of gruel. It promotes the digestion of bread, oat- meal, sago, tapioca, rice, and articles of this class. The preparations of extract of malt to be had of any druggist, may take the place of the above 42 DIET IN DISEASE. domestic preparation. These extracts contain in an easily digestible form many elements which go to make bone and muscle. They are especially valuable in those cases of indigestion in which the starchy foods are hard to dispose of, when the patient is troubled with eructations of gas and flatulent colic. It also aids in the digestion of fats, and may be taken when these disagree. This makes it especially useful, combined with cod- liver oil, in those diseases in which the latter is indicated. CHAPTER m. DIET IN CONSTIPATION. The condition of the bowels is so directly de- pendent on the nature of one's food, that either an unnatural looseness, or a condition of costive- ness, may be made to follow a radical change in the diet. So true is this that those who travel over the western prairies, living on crackers, beans, rice, coffee, and large quantities of buffalo-meat, will sometimes go for as great a period as two weeks without a passage of the bowels, while, on the other hand, we all know how frequently a diarrhoea follows the use of green corn, squash, or other summer vegetables. Putting, then, what we learn from these facts into practice, and the dietetic treatment of cos- tiveness becomes a simple matter. The indica- tions for treatment are to avoid eating much meat and dry food, but to drink freely of water and let the diet consist largely of coarse meals, succulent vegetables and juicy fruits. Accordingly we may lay out the following dietary : WHAT TO AVOID. Tea, Beans, Coffee, Cake, 43 44 DIET IN DISEASE. Wine, Pastry, Beer, Pickles, Pork, Biscuit, Veal, Muffins, Salt meats, Fresh bread, Cheese. Griddle cakes. WHAT TO EAT. Mush, Figs, Hominy, Pears, Oat-meal, Prunes, Wheaten-grits, Peaches, Corn-bread, Apples, Brown-bread, Oranges, Greens, Melons, Cresses, Grapes, Squash, Cherries, Turnips, Raspberries, Spinach, Blackberries, Cabbage, Strawberries. Tomatoes, Asparagus, Cauliflower. A menu somewhat after the following order may be adopted :— Breakfast: Begin the meal by eating an orange; take a dish of oat-meal porridge, some brown bread, tomatoes, a goblet of milk with a pinch of salt in it. DIET IN CONSTIPATION. 45 The meal may be varied by adding occasionally some fried-mush, farina or hominy, wheaten-grits, a mealy, baked potato, and in season substitute musk-melon, raspberries or strawberries for the orange. A little salt in milk is said to overcome the constipating effect which it is supposed to possess. Dinner: Vegetable soup ; a moderate quantity of beef or mutton ; brown bread ; such vegetables as squash, corn, tomatoes, asparagus, and the like; for dessert, Indian pudding, and peaches, melons, apples, grapes, or other fruits. Supper : Cold meat; corn-meal mush with milk, brown bread; milk; baked apples or stewed prunes. Wheaten-grits may be substituted for the mush. Graham crackers will make an excellent addition to this diet. Other fruits may be taken ad libitum. Do not overload the stomach. Drink as much soft water as you can dispose of. It is an excellent plan to drink a goblet of water every morning while dressing. It is an error to suppose that a person is consti- pated unless there is a daily passage of the bowels, for one who has an evacuation regularly every forty-eight hours may consider himself in a con- dition of perfect health as regards this function. 46 DIET IN DISEASE. DISHES. RECIPE 19. PORRIDGE. Two tablespoonfuls oat-meal; One pint boiling water. Mix the coarsely ground oatmeal with a small teacupful of cold water till it is of uniform consis- tence. Then pour onto this, in a sauce-pan, the boiling water, and keep boiling and stirring for forty minutes. It is now fit to serve, but may be kept simmering till wanted, if a little more water be added as the other steams away. Serve hot in a soup plate, and add cold milk to reduce it to a proper temperature. RECIPE 20. BOILED MUSH. One cupful Indian meal; Two quarts cold water. Stir the Indian meal into the cold water, bring it to a boil, and boil for two hours, stirring often with a wooden spoon. Eat hot with milk. RECIPE 21. OATMEAL GRUEL. Boil two ounces of oatmeal for an hour in two quarts of water. Salt to taste. RECIPE 22. OATMEAL PORRIDGE. Put into a farina-kettle—i. e., one kettle set within another—two quarts of boiling water, some DIET IN CONSTIPATION. 47 salt, and six ounces of oatmeal. Keep the water in the outer kettle boiling for one hour. Keep the inner kettle covered, and do not stir the por- ridge until it is ready to serve. Eat hot, with milk or cream. RECIPE 23. OATMEAL PUDDING. Take some of the porridge made by the last recipe, add the yolks of some eggs, some sugar, salt and lemon, and the whites of the eggs, well beaten. Bake for one hour. Serve with cream and sugar. RECIPE 24. WHEATEN GRITS. One cupful cracked wheat; One quart boiling water. Soak the cracked wheat in a little cold water for one hour, stir this into the boiling water and boil for one hour, stirring often. Add a little salt. This may be eaten with cream or milk, with either salt or sugar, some preferring one, some the other. RECIPE 25. GRAHAM MUSH. One cup Graham flour; One quart boiling water. Wet the flour with a little cold water and stir this into the boiling water, previously salted. Boil half an hour, stirring constantly. 48 DIET IN DISEASE. RECIPE 26. HOMINY. One cupful hominy; Three pints cold water. Put the hominy into the water, salt, bring it to a boil, and boil for one hour, stirring often. Eat with milk. RECIPE 27. BREAD SAUCE. Crumb up several slices of brown bread, cover with water ; boil till smooth, pepper and salt to taste, stir in one-half the quantity of stewed tomatoes. This makes an excellent sauce to be eaten with meat. RECIPE 28. BAKED APPLES. Cut out the blossom end of the apples with a sharp pen-knife, and pull out the stems ; wash, and pack them in a pudding-dish, putting a little sugar on top of each apple. Pour a cupful of water in the bottom of the dish, and cover the dish containing the apples closely with another dish or pan ; set in a moderate oven and let them steam until tender all through. When done pour the liquor over while hot, and repeat this as they cool. Set on the ice several hours before tea. Transfer to a glass dish, pour- ing the juice over them again. This is the only proper way to bake apples. They are more tender and better flavored than when baked in an open dish. DIET IN CONSTIPATION. 49 Besides these articles the dyspepsia-crackers (R. 9.), brown bread (R. 13.) and unleavened-wafers (R. 14.), recommended in the chapter on Dyspepsia, will make valuable additions to this dietary. Stewed prunes, baked apples and other fruits should be freely indulged in, and may form part of each meal. RECTAL ALIMENTATION. In some diseases, when food cannot be taken by the mouth, it becomes necessary to resort to rectal alimentation. Life in this way may be supported for many weeks, no food whatever being taken in- to the stomach. The most common conditions in which this becomes necessary are— Ulcer of the stomach ; Stricture of the oesophagus ; Inflammation of the stomach ; Diphtheria, when the patient is no longer able to swallow; Debility or exhaustion, the patient being too weak to take food; Finally, any condition in which the stomach rejects all that is taken into it. The following are the RULES TO BE OBSERVED : Preparatory to administering an enema, empty and wash the rectum by giving an injection of clean, warm water. 50 DIET IN DISEASE. 1. Force the enema in slowly. 2. Throw it as high up as possible. 3. Inject at intervals of two hours. 4. Inject no more than half a teacupful at a time. 5. Let the enema have a temperature of about that of the body—say 98° or 100° Fah. RECIPE 29. MILK ENEMA. Warm milk, with a little salt added, makes a simple and readily-absorbed enema. Heat the milk to the proper temperature, inject half a tea- cupful every two hours, and the patient is getting considerable nourishment. RECIPE 30. BEEF-TEA ENEMA. One pint beef-tea; Three ounces raw beef; Twenty drops muriatic acid ; Two grains pepsin. Take of beef-tea (R. 2.-3.) one pint. Take three ounces of raw beef, free from fat, scrape it with a spoon, and chop it until reduced to a pulp ; stir this into the beef-tea, heated to the proper tem- perature, add the acid and pepsin, and it is ready to inject, according to the rules given. Also, a simple enema of beef-tea is sometimes given, without the addition of scraped beef, but it DIET IN CONSTIPATION. 51 is not so valuable an aliment as that prepared as in this recipe. RECIPE 31. DEFIBRINATED BLOOD ENEMA. Fresh blood is the most valuable of tissue-foods, and, when from disease the system is no longer able to keep up its usual supply, we are but imi- tating nature when we introduce this pabulum in- to the shrunken veins. Blood may be looked upon as meat in solution, and in a far better state to be appropriated by the system than any that the arts of man can provide. The blood must necessarily be deprived of its fibrin, but so small a quantity of nitrogenous elements is lost by defibrinization, that its value as a nutrient is not materially lessened. Defibrinated blood, then, is the most valuable nutrient enema that can be used to sustain pa- tients demanding this kind of nourishment. Go to the slaughter-house and take from the large pan the blood of a recently-killed beef. It must be taken fresh, as soon as it has flowed from the neck of the animal, and before it has had time to coagulate or form a clot. At this time, or even while it is flowing, it must be whipped with a bunch of straw or a handful of twigs, to remove the fibrin. Secure the blood-serum, which remains, in a wide-mouthed jar. When wanted for use this may be brought to the proper temperature by setting the jar in a vessel of warm water. Inject as you would milk or other enemata. 52 DIET IN DISEASE. RECIPE 32. COD-LIVER OIL ENEMA. Chop fine a half-pound of fresh beef-pancreas, cover this with water and allow it to stand for an hour in a warm place. Strain through a cloth. Mix an ounce of this pancreas-solution with a half ounce of cod-liver oil and use as an injection in those cases in which it is desired to supply ths system with fat. CHAPTER IV. DIET IN CONSUMPTION. The object to be aimed at in the dietetics of this disease is to give a liberal allowance of the most nutritious food that the patient is able to digest. If you can keep up nutrition you are doing much towards arresting the course of the disease. The diet should consist chiefly of animal food, such as beef, mutton, chicken, and other fresh meats, milk, eggs, oysters and animal fats and oils, the object being to provide such food as will be most easily assimilated. By this it is not meant, of course, that no vege- table food should be taken. Good, mealy pota- toes, bread-pudding, plain preparations of rice, sago and tapioca, and all sound and fresh vege- tables which are easily digested, may form part of the dietary. Use plenty of milk in the prepara- tion of all dishes into which it can be made to enter. The consumptive should avoid the use of salt- meats, fish, pork, rich gravies, pastry, and every- thing which will disturb digestion. Above all must everything be avoided which will loosen the bowels. 53 54 DIET IN DISEASE. Use no alcoholic stimulants whatever I Alcohol is not only useless in this disease, but may do positive harm. On this subject Dr. Cham- bers says : "As to the use of alcohol in threatened cases, and in the early stages of tubercle, I have no hes- itation in pronouncing an opinion adverse to it." When the disease is far-advanced and it is desired to stimulate the waning strength, there is less objection to its use. MEATS. Beef. The consumptive should take an abun- dance of fresh meat. Every morning for breakfast, if the appetite be strong enough, a tender beef- steak, rare-done, should be eaten. It should be broiled quickly on a gridiron, over a clear, hot fire, or on the coals. Do not prick it with a fork, as it will let the juices escape. Dress with butter and season with salt and pepper. Serve hot. At dinner take a liberal slice of rare roast-beef, together with some of the juice of the meat. Take also, if it does not disagree, a little of the suet cut from the hot roast. Mutton is very digestible, and may be used to give variety to the meat diet. For breakfast a mutton-chop may occasionally be substituted for the beef-steak. The only proper way to cook the chop is to broil it. Select a nice chop, sprinkle with salt and pep- DIET IN CONSUMPTION. 55 per, and place it on a grid-iron over a clear, hot fire for six or seven minutes, turning it occasion- ally to cook both sides equally. Do not prick it with the fork. Chicken may be added for variety, but as a steady article of diet it is not so well borne as beef. Soups and meat-broths form a valuable addition to the consumptive's dietary. Veal is, compared with the other meats, indiges- tible, and should not be taken. Raw meat is sometimes recommended for the consumptive, but really it possesses no virtue which does not belong to the rare-done beef in an equal degree. If taken, it should be minced very fine, seasoned with salt and pepper, and spread on a thin slice of bread. EGGS. Let eggs form a prominent part of the diet. An egg should never be cooked more than three min- utes. They are best soft-boiled or soft-poached. If the eggs be hard-boiled the white, which is less digestible than the yolk, should be removed, and the yolk alone mashed up with a little butter and salt, and eaten with toast, or an unleavened wafer (R. 14.). This is very palatable and nutritious. MILK. Milk may be used by the consumptive in un- limited quantities, if there be no idiosyncrasy which prevents. It fulfils all the indications of a 56 DIET IN DISEASE. nutritious and easily assimilable food, so impor- tant in this disease. It should be used in the preparation of as many dishes as it can properly enter into. Let the patient take occasionally a tumbler of milk with an egg beaten up in it. Some like it warm from the cow, and if the patient does the milking, so much the better. Clabbered-milk (R. 11.), already prescribed for the dyspeptic, is also an excellent food for the consumptive, and it cannot be too highly com- mended. It contains all the elements of fresh milk in a form requiring less effort on the part of the system to assimilate them, thus making it both very nutritious and digestible. The patient should learn to use this, and let it form a promi- nent part of the dietary. It makes a nice dessert, and may be used in this way, or it may form the principal part of the meal at breakfast or tea. With cream and sugar and fresh, unleavened wafers a nice meal can be made. Cottage-cheese (R. 12.) is another agreeable food of this same class, and for variety may sometimes be used. Buttermilk, also, should be freely in- dulged in. KUMYS. Another form of milk, the use of which has been attended by great benefit in many cases of consumption, is Kumys, or Arabian milk wine. It is said to have been thus used by the Arabs for many centuries, and is now very extensively used DIET IN CONSUMPTION. 57 by the tribes living on the steppes of Russia, and it is only comparatively recently that it has been known to the civilized world, having been intro- duced by Dr. Jarotzki, a Russian physician. The Arabs make it of mare's milk, but an excellent article can be made from the milk of the cow. It contains some alcohol, and is contraindicated in those cases in which the latter should not be used. There are many different methods of making Kumys, almost as many as there are people who make it. No better article, however, can be made than that supplied by the following RECIPE 33. Take, Three quarts fresh, rich milk ; Three q uarts hot water ; Half-a-pound white sugar; One teacupful good yeast. Dissolve the sugar in the hot water, add this to the milk, and let them cool down until luke-warm. Now slowly and carefully stir in the yeast. Set the crock containing this in a warm place, as you would bread to rise ;—stir it occasionally, and in five or six hours it will be slightly sparkling, and small bubbles will rise to the surface when stirred. When it reaches this stage put it into stout bottles, tie down the corks, and set the bottles in a cool place—in the refrigerator or on the floor of a cool cellar. A thick mass will form on the surface (the 58 DIET IN DISEASE. casein) when it begins to separate, and once or twice a day, for several days, the bottle should be well shaken, and this will fall in a powder to the bottom. When two days old it is ready for use, although it will keep for a much longer time, and may be used when a week or more old. It is best, how- ever, when from' two to four days old. Care should be taken in opening, as it is highly effervescent. Use a champagne-tap, if possible. In starting a new lot, instead of yeast use a bot- tle of old Kumys, stirring it into the milk and water carefully, as directed for the former. If a larger quantity be wanted than this recipe provides for— six or seven quarts—the quantity of the differ- ent ingredients used may be correspondingly increased. If there be too much alcohol generated, put in less sugar. Very stout bottles must be used—ordinary ones are apt to burst. If you do not succeed in making a good article the first time, try again, and yet again. Like bread-making, this is an art in which practice makes perfect. As already said, the use of Kumys has been followed by great benefit in many cases of con- sumption. A bottleful a day may be taken, in addition to the ordinary diet. Drink a glassful before each meal. DIET IN CONSUMPTION. 59 COD-LIVER OIL. Of all articles used in the treatment of consump- tion, cod-liver oil remains the most important. The giving of the oil is not merely to supply fat, but its action is to improve nutrition, since fat is the basis of all molecular, or cell-growth. Dr. Chambers says : " Cod-liver oil is a typical aliment, representing what is the fittest of all known substances to supply the deficiency that constitutes the disease. . . . Oleaginous substance is what is furnished by nature for the primary growth and nutrition of all the higher tissues of animal bodies ; so that in administering it we are wisely imitating the wisest teacher of medicine, mother Nature." Instructions regarding the choice and mode of administration of the oil will be useful here. The oil should be as fresh as possible. It should have no color, but be pale and clear. The brown-colored oils are impure, and made from livers that have partially decomposed. The oil should be kept well corked, and in a cool place. If exposed to the air the oil becomes strong and rancid —keep well corked and do not open oftener than neces- sary. There are many preparations of cod-liver oil in emulsion—combined with malt, with pancreatine, hypophosphites, and other articles. These are all useful, and are to be recommended in different cases. 60 DIET IN DISEASE. A dose of a teaspoonful is sufficient to begin with. Increase this quantity gradually until a tablespoonful is taken three times a day. Do not take it on an empty stomach—it will cause disagreeable eructations. The best time to take the oil is about half an hour after a meal. If taken at this time the oil has but a short time to remain in the stomach, as the already partially-digested meal is fast passing into the intestines. While taking the oil avoid the use of all pastry, pork, fat meat, rich dressings, and the like. There seems to be less danger of disturbing digestion if all other, fats and oils be avoided while taking this one. To some the taste of the oil is very disagreeable and they find it difficult to take, while others meet with no difficulty whatever. But even in the latter class its long-continued use will cause it to pall on the taste, so it is best to disguise it as much as possible. There are various ways of accomplish- ing this ; what will suit one may not suit another. Before taking the oil chew something of a sharp nature, to engage the nerves of taste. For this purpose chew a clove, a peppermint lozenge, or take a pinch of salt. The spoon should be introduced well into the mouth, the oil deposited well back on the tongue, and taken down at one swallow. DIET IN CONSUMPTION. 61 After swallowing the oil the taste which remains in the mouth may be removed by drinking some well-sweetened coffee, or by immediately eating a fresh cracker. The use of the oil should be persisted in for months and years. MALT EXTRACT. This offers a useful food for the consumptive, as it assists in the digestion of the starches and fats, and hence, combined with cod-liver oil, the latter can often be taken and disposed of by the system when in its pure state it would disagree. The same can be said for cod-liver oil in emulsion with maltine and pancreatine. HYPOPHOSPHITES. The hypophosphites of lime and soda, as intro- duced by Dr. Churchill, of Paris, are beneficial in many cases. It will not do to substitute the hypophosphites for the oil, but some patients who have been taking the latter for a long time cease to make further improvement; in such cases the hypophosphites may be given together with the oil, and improvement will go on. The hypophosphites in solution are kept by all druggists. T CHAPTER V. DIET IN DIABETES. Diabetes is marked by the appearance of sugar in the urine. The dietetic treatment is based on the fact that sugar and starch (which latter in the system is converted into sugar), when taken into the system, cause an increase in the amount of sugar passed off in the urine, and aggravate the disease. The indication then is to supply a diet containing neither sugar nor starch. The following tables will aid in the selection of a dietary for the diabetic : VEGETABLE FOOD PROHIBITED: Arrow-root, Pastry, Asparagus, Potatoes, Bread, Peas, Biscuit, Rice, Beans, Sago, Beets, Sugar, Crackers, Turnips, Carrots, Tapioca, Maccaroni, Vermicella. Oat-meal. fruits prohibited: Apples, Plums, Grapes, Pineapples, DIET IN DIABETES. 63 Banannas, Raspberries, Pears, Blackberries, and Peaches. Other sweet fruits BEVERAGES PROHIBITED : All alcoholic drinks, as wines, beer, brandy, ale, cider, etc. All sweet drinks—i. e., those containing any form of sugar. Honey may be mentioned in this connection. VEGETABLE FOOD ALLOWABLE I Artichokes, Olives, Cabbage, Greens, Celery, Lettuce, Cresses, Pickles, Cucumbers, Spinach, French-beans. Mushrooms. FRUITS ALLOWABLE I Lemons, Gooseberries, Cherries, Strawberries and Currants. Acid fruits generally. ANIMAL FOOD ALLOWABLE : All meats, poultry, game, fish, oysters, cheese, milk, and eggs may be freely indulged in. Liver alone, on theoretical grounds, is prohibited. DISHES THAT MAY BE TAKEN : All preparations of gluten ; Oysters, stewed, or fried with gluten or bran- flour; 64 DIET IN DISEASE. Jellies, if there be no sugar in them ; Lettuce,with hard-boiled eggs and salad-dressing; Soups of various kinds, if they contain no flour. Tea and coffee should not be sweetened with sugar; glycerine may be substituted, if agreeable. It is better to put cream into tea and coffee in- stead of milk. Custards and puddings should be sweetened with glycerine. If the diabetic be compelled to take ordinary bread, it should be cut thin and well toasted. In changing the diet, observe the following rules: 1. Do not adopt a rigid diet too suddenly. 2. First reduce the supply of bread and in- crease at the same time the supply of meat. 3. Next substitute brown-bread for wheaten- bread. 4. Then some bran-bread or gluten-bread may be substituted for the wheaten-bread. 5. Now gradually come to a diet regulated according to the tables already given. The diabetic patient should Chew slowly and eat moderately; Drink as much water as the thirst demands ; Wear warm flannels next the skin ; Take a great deal of open-air exercise. Of all articles of food of which the diabetic is deprived it seems to be harder for him to deny DIET IN DIABETES. 65 himself bread than any other one. For this rea- son physicians have taxed their ingenuity to pro- vide a substitute which shall be free from starch. One of the earliest substitutes devised was bran- bread. But few will care to go the trouble of preparing this when gluten-flour can be obtained, and besides it is deficient in nutritive value. GLUTEN FLOUR. Fortunately we have in gluten flour a substitute for ordinary wheat flour which makes an excellent article of bread that can be freely eaten by the diabetic. It is agreeable to the palate, very nutri- tious, and almost entirely free from the starchy elements, so injurious in this disease. The amount of starch which it contains is so small that it need not be taken into account. Gluten flour is made from that part of the grain of wheat which under- lies the bran-scales and surrounds the starch-area. It is now manufactured in various parts of the country. It can be made up into a great variety of agreeable dishes, and the following recipes will enable the diabetic to provide himself with a diet as liberal as those enjoy who are under no restric- tions in this respect. RECIPE 34. GLUTEN BREAD. One pint milk; One pint warm water ; One heaping teaspoonful butter ; 66 DIET IN DISEASE. One-half cake yeast; Two eggs. Mix the milk and water ; soak the yeast-cake in a little warm water, beat the eggs well, and add these to the milk and water ; stir in gluten flour until a soft dough is made, work in the butter, kneading as you would ordinary bread-dough. Mould, put in pans to rise, and when light bake in a hot oven. Gluten bread requires less yeast than ordinary bread, and less time in rising. The dough should be made softer than for white-flour bread. RECIPE 35. GLUTEN GEMS. One egg; One pint water ; One tablespoonful butter; One tablespoonful baking-powder ; Gluten flour to make a thin dough. Beat the egg up, add it to the water, put in a little salt; mix the baking-powder with the dry flour, and then stir this into the water to make a thin dough, and stir in the butter. Bake in hot, well-buttered gem-pans, in a quick oven. These take a longer time to bake than other gems require. RECIPE 36. GLUTEN MUSH. Stir the gluten into boiling water to make a thick mush. Cover the vessel containing the mush, set DIET IN DIABETES. 67 it in another vessel of boiling water, and keep the water in the outer vessel at a boil for half an hour or longer. If there are any lumps, stir in a little boiling water and they will break down. Eat with cream. RECIPE 37. FRIED MUSH. Stir one pound of gluten flour into a quart of boiling water, add a little salt and boil for ten minutes ; pour into a shallow dish and allow it to cool. The next morning cut into slices and fry. Eat with butter. This is a very nice dish for breakfast. RECIPE 38. GLUTEN CAKES. One cupful gluten ; Two tablespoonfuls butter ; Three tablespoonfuls grated cheese; Two tablespoonfuls cream ; Yolks of two eggs ; One-half teaspoonful salt; A little nutmeg. Mix all of these ingredients thoroughly together in a dish ; roll out thin the dough thus made ; bake in a quick oven. This is a very agreeable cake and helps greatly to give variety to the diabetic's diet. 68 DIET IN DISEASE. RECIPE 39. GLUTEN PUDDING. Soak two thick slices of gluten bread, broken up, in half a pint of milk ; add one beaten egg ; sweeten with glycerine and bake in a small basin. This makes a tolerably good pudding for the diabetic—enough for one person. RECIPE 40. GLUTEN WAFERS. Stir some gluten flour, with a little salt, into cream to make a dough which can be rolled out very thin. Cut into forms and bake in a quick oven. Gluten flour can also be used for making gruels, for thickening soups and gravies, and in frying oysters. MILK CURE. Cures of diabetes have been effected by an ex- clusive milk diet, as recommended by Dr. Donkin. This is well worth a trial, especially in recent cases. In order to obtain the full benefit of this treat- ment, the patient must adopt and rigidly adhere to the following rules: Use fresh milk. Carefully remove all cream. The milk may be taken cold or warm, but should not be boiled in the warming. DIET IN DIABETES. 69 The first day take from four to six pints. (This would be from two to three glassfuls of milk taken every two hours during the day.) It is better to divide the day into equal periods and take frequent draughts—even though a glass- ful be taken every hour—than it is to take a large quantity on the stomach at once. Now the quantity of milk taken may be in- creased from day to day, until five or six quarts are taken daily. This quantity, six quarts, need not be exceeded. Nothing else must be taken while the milk diet is used. If at the end of a week there is no improve- ment, the treatment may be abandoned. If the treatment be of benefit, it will be denoted by a diminished amount of urine, less sugar, and improvement in the general health. This treatment should be continued from three to six weeks after all sugar has disappeared from the urine. The return to a diet of solid food must be grad- ual, and upon the care taken in this, much of the success of the treatment will depend. Milk should still be taken, but other articles gradually added, and meats, beef-tea, broths, and the class of vegetables recommended as allowable, may now form part of the dietary. The success of this treatment consists in rigidly carrying out the strict rules which have been laid down, and above all care in returning to a mixed diet. 70 DIET IN DISEASE. For variety, clabbered milk may be taken along with the sweet-milk diet. By following the instructions given in this Chap- ter, any person suffering from diabetes may live to enjoy a fair degree of health for many years, and permanent cures have sometimes followed the die- tetic treatment, especially the milk diet. BRIGHT'S DISEASE. In this disease " the object aimed at by the die- tician should be to supply the nutrient organs with aliment which is the most readily and rapidly convertible into blood and tissue, namely, digestible animal food in frequent, moderate quan- tities ."—( Chambers.) According to this, then, the diet should consist largely of dishes composed of milk, of soft eggs, oysters, mutton, rare-beef, chicken, game, and the like. Some physicians advise the observance of a diet composed chiefly of vegetables, on the supposition that a meat diet throws extra work upon the kid- neys in compelling them to remove from the blood an excess of urea, from the waste of azotized material. Hence the diet should be chiefly com- posed of vegetables, and bread in all forms ; pota- toes, rice, hominy, maccaroni, peas, beans, and other vegetable food, should make up the princi- pal part of the diet, while comparatively little meat should be taken. If the patient does not do ' DIET IN BRIGHT'S DISEASE. 71 well under the meat diet first recommended, then this may be tried, but the greatest benefit will probably follow the use of the MILK DIET. " In a series of cases which have been described by Dr. Schmidt, in his inaugural thesis, I have obtained most brilliant results where all other treatment had failed, by putting the patients on an almost exclusive diet of milk."—(Niemeyer.) Having tested this plan of treatment in my own practice, I am prepared to recommend it to others. The patient should gradually leave off all his ordinary mixed diet, until he reaches an exclu- sively milk diet. Begin by drinking a quart of milk a day, and increase the quantity from day to day until finally five or six quarts of milk daily are taken. The day may be divided into equal periods and half a pint or a pint taken at a time. This treatment should be kept up for at least a month. By that time considerable improvement will have been made, and the after-treatment may be regulated by the varying conditions of the case. The instructions given for the milk-diet in dia- betes, on pages 68, 69 and 70, may be applied here. The subject of Bright's disease should make it a point to drink large quantities of soft water. This helps to " wash out from the blood," so to speak, the impurities with which it becomes loaded. In disease of the kidneys alcohol essentially acts 72 DIET IN DISEASE. the part of a poison, and must not be taken in any form or quantity whatever. Therefore drink no spirituous or malt liquors. GRAVEL. Those who are subject to stone in the bladder, and gravel, may do much towards a cure by adopting a systematic dietary. The object should be to take a large proportion of vegetable food, and but little meat. Eat meat no more than once a day. Avoid especially rich sauces, cheese, rich soups, sugar, fats, cream, and everything that will disturb digestion. Take no spirituous or malt liquors of any kind. If the attacks of gravel are frequent, come to a strictly vegetable diet, eating no meat whatever. Drink no " hard " water, or water impregnated with lime. Drinking freely of " soft" water, rain- water, or that which has been freed from mineral substances, is very beneficial, and the more " soft" water the patient drinks, the better. A strict observance of these rules will do much towards promoting a cure. CHAPTER VI. HOW TO NURSE THE BABY. If both mother and child are in good health, no directions on this subject are necessary more than the dictates of nature afford. Young mothers, however, commit a few errors which, with a little instruction, they may be spared. And first, do not ruin a child's health by put- ting it to the breast every time it cries. This is the only means it has of expressing its emotions. " If it is hungry, it cries; if it is overfed, it cries ; if it suffer from the prick of a pin, it cries ; if it lies too long in one position, so as to receive undue pressure on any one part, it cries ; if it is exposed rto cold, or any part of its dress is too tight, or it is held in an awkward position, or is exposed to too bright a light or too loud a sound, it can indicate its discomfort only by its cries. And yet the one remedy of ignorant nurses for so many different evils is, not to find out and remove the true cause of offense, but to offer the child the breast." If you have regular intervals for nursing, the child will be less apt to fret for the breast than it will if it is given whenever it cries or becomes uneasy. 73 74 DIET IN DISEASE. As a rule, during the first month of life the child should receive the breast about every two hours during the day, and about three times during the night. After the first month the intervals may be lengthened, and it may then be fed about every three hours during the day, and only twice during the night. The infant should be fed in this way until after the appearance of the first teeth, or until it is eight or nine months old. Prolonged nursing is injurious to both mother and child. A mother who is consumptive or scrofulous should not nurse her children. A mother who is very excitable, or subject to fits of violent passion, should not nurse her babe. Do not put the child to the breast after hearing any depressing news, or suffering from fright. Convulsions and death of the child have been" known to follow a violation of this rule. RECIPE 41. SORE NIPPLES. Wash the nipples with a little warm water and milk before and after each nursing, dry thorough- ly and gently, apply a little olive oil to the surface and cover with a nicely-fitting India-rubber shield while sucking. HOW TO CHOOSE A WET-NURSE. 75 HOW TO CHOOSE A WET-NURSE. Almost all that can be said on this important subject is poetically expressed in the following lines from Saint Marthe in Peedotrophia : " Choose one of middle age, nor old nor young, Nor plump nor slim her make, but firm and strong ; Upon her cheek let health refulgent glow In vivid colors, that good humor show. Long be her arms, and broad her ample chest, Her neck be finely turned, and full her breast; Let the twin hills be white as mountain snow, Their swelling veins with circling juices flow ; Each in a well-projecting nipple end, And milk in copious streams from these descend. Remember, too, the whitest milk you meet, Of grateful flavor, pleasing taste, and sweet, Is always best." The nurse should, of course, be in perfect health. Reject those who are cachectic, or who have any taint of scrofula, consumption, tubercular affec- tion, specific disease, or other communicable malady. There should be no return of her cata- menia. As these points would in all cases be referred to the family physician, it is not necessary to give specific instructions in a work of this character. Her age should be but little, if any, greater than that of the mother. Her breasts should be full, plump and well formed, and she should be able to suckle with both breasts. There is danger of the child becoming deformed, or squinting, if it nurse on but one side. 76 DIET IN DISEASE. The nipples should be prominent, so as to be easily grasped by the child, and be free from cracks or sores. The milk should flow freely, and when dropped in water produce a cloudy appearance, and not sink to the bottom in thick drops. The nurse's milk should not be older than the child which is to be nursed. There is less objection to giving " young milk " to an older child. Milk that is over twelve months old should not be depended upon to nourish a young babe. If for any reason a mother is unable to nurse her babe, then it is wise to provide a good wet- nurse. But let me caution physicians and moth- ers against getting a wet-nurse for a sick baby. Artificial feeding has been brought to a state of such perfection that it is now possible to adminis- ter to the child any desired variety of food, and the physician has the matter of nutrition entirely within his own control, but if a wet-nurse enter into the problem, you have all the annoyances of sore nipples, mental emotions and caked breasts to contend against, and you have no more control of the child's diet than you have of the clouds in the heavens. HOW TO WEAN THE BABY. If there be nothing of special importance to demand the weaning of the child at an earlier period, this should be begun when it is about nine HOW TO WEAN THE BABY. 77 months old, by which time it will generally have cut several teeth. In fact, the weaning should not be begun until two or more teeth have made their appearance. Begin the weaning when the child is strong and well. If it has become reduced by disease, or is suffering from an acute attack, postpone the ordeal until it is again in good health. Do not Avean during the summer season. Select a season of the year when the weather is mode- rate. March, April or May are favorable months, as are also October and November. Prepare the child for the weaning process by getting it gradually accustomed to other food besides its mother's milk. Give milk from a bot- tle, or feed it soft spoon-victuals, such as arrow- root, sago, cracker soaked in milk, or any of the numerous articles recommended in the next sec- tion. At the same time give the breast at longer inter- vals, so as to accustom the child not to expect it. When you once begin the weaning process, be firm and unrelenting ; take no back-steps. The process should occupy about twelve or fourteen days, so that at the end of two weeks, at the most, the breast can be entirely dispensed with. It is better to excite an aversion to the breast 78 DIET IN DISEASE. than to have the child fretting for it. This can be done by touching the nipples with some bitter substance, such as a little salt or soap. After weaning, it is important that the child's stomach should not be overtaxed. Often at this time the foundation of a weak stomach is laid. CHAPTER VIL HOW TO PEED THE BABY. Since the health of the child is directly depen- dent on the nature of the food which it receives, this becomes a subject of vital importance, to which too much attention cannot be paid. There are two periods in the infant's life when especial care is called for in the management of its diet—at the time of weaning, whether this be pre- mature, or at the usual age—and in its "second summer," when it is so liable to disturbances of the stomach and bowels. Until the child is old enough to live on a mixed diet, milk is its natural aliment, and the important object to be kept in view is to give it a preparation of milk resembling the mother's milk, and to give this before any change has taken place in it—i e., before it has in the least degree " turned." All the instructions which follow are directed to this end, and if strictly observed the little ones will be spared many days of ill-health, since more than half the sickness from which infants suffer is pro- duced by improper food and improper feeding. Sir C. Clark, an eminent London physician, 79 80 DIET IN DISEASE. once said : " The ignorance of mothers in feeding children is worth a thousand pounds a year to me." goat's milk. If the child be deprived of its mother's milk the best substitute is goafs-milk, if this can be ob- tained pure and fresh. But it is so scarce an article in this country that we must seek for some- thing which it is not so difficult to procure. CONDENSED MILK. This must often be relied upon in feeding the baby, and it is to be preferred to ordinary milk unless you are certain that the latter is fresh and pure. The American brands are better than the Swiss, as that which you get is more apt to be freshly-prepared. But, after all, the main dependence must be placed upon that milk which all can obtain in such abundance—cow's-milk. But in its natural state it cannot with safety be fed to a young child, and it requires some modification in order to fit it for the infant organism. "The important difference between woman's and cow's milk is that the casein of woman's milk curdles in the stomach into small, light flakes, forming a very loose jelly, while that of cow's milk coagulates into large, compact lumps. "The loose flakes of the woman's milk are easily digested and assimilated : the firm lumps of casein of the cow's milk, the infantile gastric juices HOW TO FEED THE BABY. 81 are incapable of dissolving. They are thrown up again, or wander through the whole intestinal tract as large, sour, undigested masses."—(Vogel.) Of all domestic preparations the following is the very best : RECIPE 42. SUBSTITUTE FOR MOTHER'S MILK. Fresh cow's-milk, one-half pint; Pure, soft water, one-half pint; Powdered sugar-of-milk, one tablespoonful; Phosphate-of-lime, one grain. Dissolve the sugar and lime in the water, and add this to the milk. This is the nearest approach to human-milk that can be prepared. If the child be under one month, increase the proportion of water. Any druggist can furnish the sugar-of-milk and phos- phate-of-lime. The following directions, though they may seem unnecessarily minute in detail, are of the utmost importance, and Florence Nightingale, than whom there is no higher authority on the subject, would consider that the half had not been told. Although it involves some trouble (if it be so considered), yet it is much less trouble than it is to care for a sick baby, and too much attention cannot be paid to the CARE OF THE CHILD'S MILK. Have the milk brought to the house twice a day, and let the morning's supply be brought as early 82 DIET IN DISEASE. as possible. Be sure that this is not the milk of the previous night. If possible, let it be the milk of but one cow. If the milk of but a single cow cannot be obtained, that from a number of cows, mixed,—as ordinarily contained in a dairyman's milkcan—will be more uniform in quality than if frequent changes be made. Do not let the milk-man bring you skim-milk. Keep the baby's milk separate from that in- tended for general use. Have ready a pan which has been well scalded and scoured, then rinsed with clean, cold water, and dried. Receive the milk into this. In this pan the milk for the day should be scalded. Do not let it boil. If by accident the milk should boil, use it for some other purpose, and get a new lot for the baby. Now this scalded milk should be put into a crock kept for the purpose, previously well scalded, scoured, rinsed and dried. Keep two such crocks, and let one be drying while the other is in use. Cover the crock with a clean, folded napkin, or folded towel (this excludes the air more effectually than can be done by a dish or hard cover) and set it in the coolest place to be found. If the air of the refrigerator is not laden with the odor of cooked meat and vegetables, this will be the best place for it. Otherwise set the crock in a pan, surround it with ice, and set it in the cellar. If ice is not to be had, the milk may be put into a jug and lowered, down the well; but a crock is to be preferred to a jug, since the former is more easily cleansed. TO PREPARE THE MILK FOR THE BABY. Take from the crock enough for one feeding; add HOW TO FEED THE BABY. 83 to this one-half part (one-third, if the child be under one month) pure, warm water, in which has been dissolved an even teaspoonful of sugar-of-milk and a pinch of phosphate-of-lime. If the milkman has already anticipated you, do not add the water. If the sugar-of-milk is not to be had, use a small lump of loaf-sugar. Put the milk into the nursing-bottle, and use immediately. After the child has had sufficient, throw the rest away—it is the best economy in the world ! If allowed to stand in a warm place, it very soon be- comes unfit for use. Prepare it fresh according to the above directions, every time the child needs feeding. Do not use the same bottle of milk throughout the night— prepare it fresh at each feeding, as you would during the day. Never put a second supply of milk into a bottle con- taining the remains of a former—use a fresh and clean bottle, even though no more than an hour has elapsed since the last one was used. Keep on hand some litmus-paper — to be had of any druggist—and dip a small slip of it into the milk occasionally. If, then, this blue paper turns red, the milk is acid, and unfit for use. THE CARE OF THE BOTTLE. At least three (five is not too great a number) bottles should be kept for the baby, that some may be going through the cleansing process while one is in use. Select a stout bottle, having no lettering on. it, and with no sharp angles. 84 DIET IN DISEASE. Use a simple, thimble-shaped, black rubber nipple. Black rubber is purer than the white— the latter contains injurious ingredients. As soon as the child has taken enough for one feeding, empty from the bottle what remains and without delay scald and wash the bottle with hot water and soap. After scalding, put the bottle in- to a basin of clean, cold water, in which a little soda has been dissolved. Let it remain in the soda-bath for half an hour, then take it out, rinse it in clean water, and let it dry by hanging it inverted on a peg. It is important that this process should be gone through with after every feeding. A nursing- bottle which contains but a mere trace of old milk— so small a quantity that it can scarcely be seen—is sufficient to spoil all that is afterwards put into it, and thus derange the child's stomach and bowels. FEEDING THE BABY. The quantity to be given at each feeding will vary with the constitution and temperament of the child. A little experience will teach how much the child cares for, and afterwards the amount prepared can be regulated accordingly. Do not give the bottle too often. According to the age of the child, the interval may be from two to four hours. Be careful not to over-feed. As soon as the child shows the least sign that it has had enough, take HOW TO FEED THE BABY. 85 the bottle away. The habit of taking a little food every few minutes interferes with digestion. Do not feed the child while on its back, or lying down. Do not bounce the baby about after feed- ing, lest it throw up what it has taken. Let it lie quietly for at least half an hour. Milk should form the child's food for the first six months. No starchy food is needed, nor can it be digested, until the teeth appear, and the " dribbling " shows that the glands are secreting an abundance of saliva. Before this the child can starve on arrowroot and other starches. Even after this period the diet should still consist prin- cipally of milk. To this may be gradually added grated cracker, well-baked, stale bread, rice-flour, arrow-root, sago, and the like. At this time the best thing with which to thicken the child's milk, in order to add to its nutritive value, is the flour ball. RECIPE 43. FLOUR BALL. Take of Flour, one pound; Salt, one teaspoonful; Sugar-of-milk, one teaspoonful. Mix these well together ; tie the mass up tightly in a stout muslin cloth, or a pudding-bag, so as to form a firm ball. Boil this in a kettle of water from early morning until bedtime. Take it out and hang it up to drain and dry. The next day open 86 DIET IN DISEASE. it and peel off from the surface the layer of dough which will be found. There will remain a hard, solid ball. Dry this hi the sun or in the open oven. Keep it in a dry, cool place, and, as it is needed, shave off from one side two or three teaspoonfuls, make this into a paste, free from lumps, with a little water, stir this into a pint of milk and scald it, being careful not to let it boil. In the flour-ball the starch of the flour is changed into gluten, which makes a highly digest- ible and nutritious food for infants. You need not seek further, or ask for greater variety—the child will thrive well on the milk and gluten. If the sugar-of-milk be not at hand, it may be made with this omitted. RECIPE 44. LIME-WATER. Get a piece of unslacked lime the size of an egg, break it up, put it into a clean quart bottle, and fill up the bottle with rain-water. Let this stand over night; the next morning it is ready for use. There will still be a heavy sediment of lime in the bottom of the bottle, but the water will have taken up all that it can dissolve. When you have used all the water in the bottle, fill up again with water on the lime which remains, and repeat this again and again as long as the lime lasts. As the child becomes older and greater variety is called for, a selection may be made from among the following preparations : HOW TO FEED THE BABY. 87 RECIPE 45. THICKENED MILK. One pint milk; One tablespoonful rice-flour. Salt the milk slightty and set the vessel contain- ing it into another vessel of boiling water. Wet the rice-flour up with a little milk, stir this into the boiling milk and let it thicken, keeping the water in the outer vessel at a hard boil for an hour, stirring often. Salt to taste. RECIPE 46. SAGO-MILK. Take a heaping tablespoonful of sago ; soak for two hours in a pint of cold water ; let this simmer for a quarter of an hour, stirring it well to prevent burning. Strain it, and add a cup of milk. Sweeten to taste. RECIPE 47- ARROW-ROOT GRUEL. Mix a dessertspoonful of arrow-root with suffi- cient cold water to form a soft paste; rub it till quite smooth ; add a little boiling water and a tumblerful of milk, stirring briskly. Boil for a few minutes, stirring all the time. RECIPE 48. BREAD JELLY. A quantity of the soft part of a loaf is broken up, and boiling water being poured upon it, it is 88 DIET IN DISEASE. covered and allowed to steep for some time; the water is then drained off completely, and fresh water added, and the whole placed on the fire and allowed to boil slowly for some time, until it be- comes smooth ; the water is then pressed out and the bread, on cooling, forms a thick jelly, a por- tion of which is to be mixed with milk or water, as wanted. This bread jelly, recommended by Dr. Churchill, is very nourishing, and can often be taken when other things disagree. DIET IN CHOLERA-INFANTUM. Many of the directions already given will also apply to the feeding of the baby in cholera-infan- tum, or "summer complaint." The same strict attention should be given to the care of the child's milk and bottle. Keeping this in mind, the proper care of the infant during the summer months may be summed up in these three rules: Keep the baby cool; Let it have plenty of fresh air; Let it have no food in which the process of fermenta- tion has begun. If these instructions be rigidly observed, the child need not see a sick day. The first and most important thing to learn in the dietetic treatment of cholera-infantum, is to Give no starchy foods whatever \ DIET IN CHOLERA-INFANTUM. 89 Flour, arrow-root, sago, and the like, will do absolute harm, for they will ferment and aggravate the disease. All food given at this time, then, should be of animal origin. SCALDED MILK may be freely given, if the child retain it on the stomach. If it be thrown up, add a little lime- water. Condensed milk (any good American brand) should be used, if perfectly pure and fresh milk cannot be obtained. BEEF-TEA. When the child is in a weak and low condition, beef-tea is to be preferred to all other foods. Give a good article of beef-tea, as much as the child can take and retain, repeated at frequent intervals. Remember that in that low and prostrate condi- tion into which children with this disease so rap- idly run, beef-tea is the most important dietetic article that can be given. It is stimulating, and rouses the waning strength. After getting up a reaction from the use of this, give again condensed milk, fresh milk, or infant's food. RAW MEAT. Scraped beef has been successfully used in the dietetic treatment of cholera-infantum. Take a piece of fresh beef with one surface cut across the grain; scrape this surface with a spoon until as much of the pulp is scraped off as possible. Now, 90 DIET IN DISEASE. with a sharp knife, take off a thin slice and make a fresh surface and scrape as before, repeating this until it has all been reduced to a soft puree. By this method the indigestible fibrous part of the meat is rejected. Feed this puree to the baby, after adding a little fine salt to it. A little pepsin will aid its digestion. M'any sick children have been brought up from very low conditions on this diet alone. EGGS AND MILK. The white of an egg stirred into milk and lime- water makes a nutritious food which is generally retained. Try this if other foods disagree. It is very nourishing. There are many preparations of " Infant's Food " now in the market, which fill an important place in the child's dietary. Any good brand may be relied upon, and they are always to be preferred to milk of questionable quality. They contain no starch, it having all been converted into gluten, which is more digestible than the starch, and does not undergo fermentation as does the latter. In cholera-infantum a change from the ordinary diet to one of these, will often hasteh recovery. This forms an exception to the rule that animal foods alone should be given in this disease. CHAPTER VIE. DIET FOR TRAVELERS. Many of the disorders of digestion with which those who are " on the road " a great deal are troubled, may be avoided by giving due attention to the nature of the food which they take, and by observing a few simple rules in the regulation of their diet. As a rule, much of the trouble arises from tak- ing too much meat and not enough vegetables. Dishes of meats and eggs are more quickly pre- pared than are vegetables, and there is great temp- tation to rely upon the former almost to the exclusion of the more succulent food. Again, there is a disposition on the part of some to eat too heartily, more than the appetite demands, and more than they would if at home. It will be found that if a light diet only be indulged in it will not be followed by the headaches, constipation and digestive disorders that attend immoderate eating. The hasty swallowing of meals at railroad eating- houses is another prolific source of indigestion on the part of travelers, and the dining-cars now to be found on all first-class roads are an inestimable blessing to the traveling public. If you are com- 91 92 DIET IN DISEASE. petted to eat at a station, take but a light meal and eat slowly and deliberately. The traveler who suffers from constipation should refrain from eating great quantities of meat and white bread and rolls, and should partake largely of succulent vegetables Tand fruits. Cabbage, pota- toes, turnips, cauliflower, tomatoes, squash, beets, onions, corn and peas should be freely indulged in, and brown-bread and corn-bread in preference to white-bread. All kinds of ripe fruits, apples, peaches, pears, grapes, banannas, strawberries, raspberries, black- berries, oranges, and the many others to be found in our markets, should be freely eaten. Veal and chicken will be found to be less bind- ing to the bowels than pork, beef and cured meats. Nuts, confections, cakes and pastries should be avoided. The drinking of so much tea and coffee at hotels and railroad eating-houses is another cause of indigestion. Drinking much tea, especially, pro- duces indigestion and constipation. When possible, drink milk instead of tea or coffee. A pinch of salt in each glass of milk is said to overcome its constipating effects. Butter-milk, when it is to be had, makes an excellent and wholesome drink. Some of the ailments from which travelers suffer are due to the water which they are compelled to drink. These may be avoided in a great measure DIET FOR TRAVELERS. 93 by drinking no water which has not been boiled and then filtered. A pocket-filter may be carried for the latter purpose. In some parts of the country the dishes will all contain too much grease, causing acidity, a nauseous taste in the mouth, flatulence or diarrhoea. The best way to correct this is to take some vinegar or lemon-juice on the plate, and eat these with as many dishes as possible. In hot weather the appetite for breakfast of those who travel is often impaired by passing a restless, sleepless night. This may be remedied by wring- ing a sheet or some towels out of cold water and spreading them on the floor, or hanging them where the breeze from an open window will blow over them. This will cool and moisten the atmos- phere. If, while traveling, you are taken with diarrhoea keep perfectly at rest on the back, and suck a lemon, and you will soon be over it. A careful study of Chapter II., Diet in Dyspepsia, and Chapter III., Diet in Constipation, and an observance of the instructions there given will be of great aid to those who suffer from the disturb- ances to which traveling men are especially liable. DIET IN SEASICKNESS. Really the only certain way to avoid this bete noire of ocean travel, is to take the old Captain's advice and " never go to sea." But if once you 94 DIET IN DISEASE. are called upon to pay tribute to Neptune, there is nothing for it but to endure with the best possible grace. There is usually almost complete loss of appetite, and really but little food of any kind is required. It is a good plan to have the steward bring a bowl of gruel or porridge to your berth every morning. After taking this, lie quietly for several hours and you are pretty well fortified for the trials of the da}\ Lemons possess no especial virtue in relieving the sickness, but they are very grateful to the sufferer in removing from the mouth that foul taste which is an inevitable accompaniment, and for this purpose all who are about to start on a voyage are advised to provide themselves with a supply, if they are not to be had on board. Lemon-drops, to be had at the confectioner's, make an excellent substitute, and I would advise all who are about to make a sea-voyage to pro- vide themselves with a pound of lemon-candy, or "acid-drops." They are really better than the lemons for the purpose indicated. While the sickness continues little else than the porridge or gruel, with perhaps some tea and toast, can be taken. As the appetite returns something more is called for, and yet the stomach will not permit its owner to go to the saloon, much less to indulge in the rich fare with which the table is generally laden. At such times I found it a good DIET IN SEASICKNESS. 95 plan to remain in my stateroom, or on deck, and before meal-time get the steward to give me a sight of the bill-o'-fare. From this I could gen- erally select some plain-cooked vegetables, oysters (when in season), sago, or rice-pudding, or other dish which my feelings would at once tell me would be relished. Besides these attentions to diet the sufferer should remain in the fresh air as much as possible, and also avoid the upright position. If the weather permits, spread your steamer-rug on the deck and lie upon that; if compelled to be below, maintain the recumbent posture. It is found that those whose stomach and bowels are in best condition when they go aboard, seem to suffer least. Hence, before setting out, avoid all irregularities. Seasickness is usually a harmless complaint, from which there is complete recovery in a few days. But in rare instances it is so long-continued that the victim suffers in his general health from want of nourishment, since no food whatever can be taken into the stomach, and sometimes even life is endangered. In such cases nutrition should be kept up by nutrient enemata. DIET FOR THE CORPULENT. Those who are unusually corpulent may reduce their weight many pounds by observing a strict regimen in diet, and by taking proper exercise. 96 DIET IN DISEASE. The rule should be to take with the food no fat or sugar, and as little of the starchy foods as it is possible to get along with. Accordingly, the following dietary may be pre- sented. WHAT SHOULD BE AVOIDED : Fats, Pies, Milk, Puddings, Cream, Rice, Butter, Gruels, Pork, Soups, Sugar, Sago, Cake, Tapioca, Candies, Beets, Bread, Potatoes, Biscuit, Arrowroot, Crackers, Corn-starch, Pastries. Sweet potatoes. No sweet fruits should be taken. Put no cream or sugar into tea or coffee. It is best to avoid the use of milk altogether; let water be the only drink. Alcohol, in spirituous or malt liquors, must not be taken. WHAT MAY BE EATEN : Fish, Beef, Veal, Mutton, Tongue, Pigs-feet, Turkey, Chicken, Game, Oysters, DIET FOR THE CORPULENT. 97 Celery, Spinach, Onions, Lettuce, Cresses, Radish, Cabbage, Greens, Tomatoes, Squash, Other vegetables, containing little or no starch ; Sour fruits, as cranberries, lemons, sour apples, and the like. Besides adopting this dietary, the object may be promoted by observing certain other rules, the most important of which are the following : Do not spend too much time in sleep. Eight hours should be the utmost limit—seven hours are better. Take a cool sponge-bath every morning, and, if possible, take one or two Turkish baths a week. Take a run in the open air, two or three times daily, until perspiration is induced. According to these rules, the following daily regimen may be observed : Rise at seven o'clock, take a cool sponge-bath and rub the body with a coarse towel or flesh- brush. If possible, take a short, brisk run in the open air. Breakfast at eight on lean meat, being careful to avoid all fat. Eat also dry toast, any vegetables in the list, and tea or coffee without cream or sugar. 98 DIET IN DISEASE. Dinner at twelve : Eat plain meat (avoiding fat), fresh vegetables, as tomatoes, cabbage, cresses, celery, onions, and others in the list. Take no potatoes or sweet dishes. Dessert may consist of a tart jelly, baked apple, lemon-ice, or the like. Do not take soups or pastry. Tea should consist of lean meat, apple sauce, a little toast and tea. Eat moderately, and if this regimen be carried out, keeping up the exercise, it cannot fail of having the desired effect. After continuing this for two or three weeks the measures need not be so strictly carried out, but still no sugar or fat should be taken in the food. Sugar is the most active of all as a fat-forming food. Take the weight of the body every few days, and do not let the reduction in weight go on at a greater rate than half-a-pound a day. CHAPTER IX. SCROFULA. While scrofula is often of hereditary origin, yet it may be acquired. Prominent among its causes are, an absence of sunlight, breathing a vitiated atmosphere, and living on insufficient, unwhole- some food. Hence, while the matter of general hygiene should not be neglected, the regulation of the diet must receive due attention. Give to scro- fulous subjects an ample supply of the most nutri- tious foods. Let the child have a greater amount of animal food than those children receive who suffer from no taint of this kind. Of all foods of this character, cod-liver oil is probably the most important. If a mother be scrofulous she should not nurse her babe, but put it immediately to a healthy wet-nurse. If, on the other hand, the child inherit scrofula from the father, and the mother be free from any such taint, she may nurse her babe. During lactation, however, she should take three times a day a teaspoonful of the hypophosphites of lime and soda. If the child be put to a wet- nurse the latter should likewise take the hypo- phosphites. 99 100 DIET IN DISEASE. Too early weaning should be carefully guarded against. After weaning, the child should receive an un- usually large proportion of animal food. It should have a bountiful supply of milk, adding to each glassful a tablespoonful of lime-water. Give to the child a piece of meat about the size of your finger, cut lengthwise of the fibre, from the rare part of the beef-roast or beef-steak. Let it have this to chew. Take a small piece of beef, broil it very quickly on hot coals. Do not cook it too much, but let the inside be red and juicy. Mince this very fine with a chopping-knife, spread it on a thin slice of bread which has been lightly buttered, sprinkle with fine salt, and give to the child to eat. This is more palatable than the raw meat usually recommended in these cases, and there is not so much danger of the child's becoming afflicted with worms as there is when the meat is taken without cooking. If the scrofula be already established when the child comes under treatment, cod-liver oil should form a prominent part of its diet. Give a tea- spoonful three times a day. This is a most impor- tant remedy in these cases. Give the oil by inunction if there should be difficulty in getting the child to take it by the mouth. A scrofulous child should enjoy an abundance of fresh air and sunshine. DIET IN RICKETS. 101 RICKETS. The condition known as rickets is caused by faulty nutrition, and a proper regulation of the diet, supplying those elements in which the sys- tem is deficient, will correct the tendency, and restore the child to a state of health, in almost every case. Too early weaning often causes rickets in other- wise healthy children. Bottle-fed children also sometimes fall victims to the disease when those who have care of them are ignorant of the proper nature of the food which they should receive. A rickety child should receive a generous meat diet, as in scrofula. Give it raw-beef, finely minced and spread on bread. Let it have plenty of milk, with lime-water added. Extract of malt, contain- ing, as it does, phosphates of lime and other salts, is among the most important foods which the child can receive, and its use should not be neg- lected in any case. Preparations of malt, containing, as they do, phosphate of lime, are very valuable in the treat- ment of rickets. If not given in this form, some pure phosphate of lime should be put into the milk which the child drinks. Cod-liver oil may be given in small quantities, beginning with doses of ten drops, and gradually increasing the amount until the child takes a tea- spoonful two or three times a day. This is a 102 DIET IN DISEASE. highly important part of the treatment. If this course be pursued, giving the child meats, milk, lime-water, extract of malt, and cod-liver oil, in addition to its other diet, and the matter of gen- eral hygiene receive due attention, recovery will follow in almost every case. SCURVY. Of all diseases in the catalogue this is pre-emi- nently the one which is most amenable to dietetic treatment. Since it is produced by a lack of vege- table food, the treatment suggests itself:—Supply the system with that of which it has been de- prived. Hence all that is necessary to cure a scorbutic patient is to supply him with a vegetable diet. Half a pound of potatoes a day will prevent scurvy. Give to the patient tomatoes, saur-kraut, onions, greens, cabbage, spinach, and other vege- tables, and especially limes or lemons. The citrates, tartrates, malates and lactates of potash should be used as drinks. " Land scurvy," or purpura, may be treated in a similar manner as regards dietetics. CHLOROSIS—GKREEN-SICKNESS. In this disease the food should be of such a character that it can be readily converted into blood, in which the system is deficient. Hence juicy beef should form an important part of the DIET IN COLLAPSE. 103 diet, and the patient should take as much as she can with comfort; more, even, than the immediate wants of the system demand. Fresh milk should be taken in abundance. Besides these, other nutritious animal foods should form a prominent part of the dietary, and oysters in all forms, codfish, soups and broths, should be freely taken. COLLAPSE. In the collapse following wounds, and the col- lapse of "shock," extract of meat and wine, equal parts, is the best stimulant that can be given, and its use has saved many lives. It was used with great success in the Austrian army in 1859, and in the American armies during the late war. RECIPE 49. EXTRACT OF MEAT. Cut the lean of fresh-killed meat very small, put it into eight times its weight of cold water, and heat it gradually to the boiling point. When it has boiled for a few minutes, strain it through a cloth, and evaporate the liquor gently by water- bath to a soft mass. Two pounds of meat yield one ounce of extract. Fat must be carefully ex- cluded or it will not keep.—(Liebig.) Equal parts of this extract and good sherry wine should be freely administered.—(Ruddock.) CHAPTER X. DIET IM" RHEUMATISM. Give no meat whatever to a patient with rheumatic fever; it will invariably aggravate the disease. If meat in any form be taken in rheumatism it seems to turn to acid, and as this is already in ex- cess in the system, the meat will only aggravate the disease. The patient must live on vegetable food until health is fully restored, however hard it may be for him to be deprived of his abcustomed diet. Even after apparent recovery the return to a meat diet must be made very cautiously and grad- ually, for if adopted too early it will sometimes bring on a relapse. The patient suffering from rheumatism must, therefore, have a purely vegetable diet, consisting of such articles as gruels, boiled rice, preparations of sago, tapioca, farina, corn starch, panada and other preparations of bread, mashed potatoes and the like. The patient should receive no beer, ale or other malt liquors, or alcohol in any shape, as these will invariably aggravate, and must in all cases be strictly prohibited. No acid drinks should be taken, and sweets should be avoided. 1W DIET IN RHEUMATISM. 105 RECIPE 50. ALKALINE DRINK. Peel of one lemon ; Tablespoonful of sugar; Half a pint of pure water; Half a pint of Vichy water. Slice the lemon-peel very thin and put it into a pitcher with the sugar; pour on enough hot water to dissolve the sugar; add the other water. This makes a pleasant alkaline drink for use in rheu- matism. CHRONIC RHEUMATISM. " The rheumatics seldom need lay a patient up if he will adopt the simple dietetic expedient of eat- ing a certain quantity of fresh mustard with every meal, much if he is worse than usual, a little if he is pretty comfortable."—(Chambers.') RECIPE 51. CELERY-TOAST. Cut up some sticks of celery and boil in a little water until tender; add some milk, stew for a while, salt and pepper to taste, thicken slightly with flour, pour this over some soft toast, and eat as you would asparagus. It is claimed by many that cooked celery is of benefit in chronic rheumatism, and there is suffi- cient testimony to this effect to make it worth a trial. I offer it on the authority of a writer in the Medical Record^ having had no experience with it myself. 106 DIET IN DISEASE. ASTHMA. Asthmatics are generally dyspeptics, and for such cases more is to be done on the side of the stomach than in any other direction. The following plan of dietary has proved to be of great benefit in the treatment of this disease. It was first employed by a prominent English physician. First by proper treatment get the bowels to act- ing regularly. "After having attended to the general secre- tions for about ten days, the strict dietetic treat- ment is to be begun. " The diet is to be regularly weighed out, and adhered to with the greatest strictness, the hours of meals being most rigidly fixed as follows: "Breakfast at eight a. m., to consist of half a pint of tea or coffee, with a little cream, and two ounces of dry stale bread. "Dinner at one p. m., to consist of two ounces of fresh beef or mutton, without fat or skin, and two ounces of dry stale bread or well-boiled rice; three hours after dinner (not sooner), satisfy the thirst with as much milk, toast-water, kumys, or other beverage, as is desired. "Supper at seven p. m., to consist of two ounces of meat as before, with two ounces of dry, stale bread. " The patient is not allowed to drink any fluid whatever within one hour before his dinner or sup- DIET IN ASTHMA. 107 per, and not within three hours after either of these meals. At other times he is not limited as to drinks, except that the use of all malt liquors is to be prohibited. Soda or seltzer-water may be indulged in at other times when thirsty." Dr. Pridham says of his method: "Under this treatment in a few days the dis- tressing symptoms may be expected to subside, and after the regimen has been strictly persevered in for at least a month, two ounces more of meat may be permitted if digestion is found to be suf- ficient. The stomach must not have more to do than it can accomplish. The powers of digestion are known to be recovering when the stomach craves for food as the hour of nourishment arrives. If flesh is gained, strength improves; and while the tongue cleans, the appetite improves, the dis- tention of the stomach lessens, and there is suffi- cient evidence that the powers of digestion are re- covering. Great encouragement is then given to follow up the line of treatment which is here in- dicated. The patient ought also to be able to sleep six or seven hours at a time, and to lie in bed all the night. If these results follow, the ulti- mate cure of the case may be looked for." This makes a very spare diet—more so than many patients are willing to submit to. For such it may be modified and rendered more tolerable by Dr. Salter's dietary in Asthma, which is as fol- lows :— 108 DIET IN DISEASE. "Breakfast:—A cup of bread and milk, an egg, or a mutton-chop, or some cold chicken or game. Tea is better than coffee, and milk and water bet- ter than either. Dinner:—Mutton ought to be the staple diet; beef or lamb rarely, pork or veal never. Succulent vegetables or potato may be eaten, and a little farinaceous pudding or stewed fruit, or fruit out of a tart, should conclude the dinner. Water is the best fluid to drink, and there should be no cheese and no dessert." A light tea should be taken. The quantity of food eaten should be small, and therefore highly nutritious, extremely digestible, and of the simplest and plainest kind. HEART DISEASE. In organic disease of the heart the kind of food taken is not of so great importance as the quantity that is taken at one time, and the relative amount of liquids and solids. The indications in this disease are to— Take but a small quantity of food at a time; Let the food contain but a small proportion of liquids to the amount of solids; Drink but a small quantity of liquid at any one time; Drink no cold water or cold liquids of any kind. In heart disease the circulation of the blood is • so obstructed that absorption takes place very slowly, and hence if a large quantity of liquid be DIET IN HEART DISEASE. 109 ingested it remains a long time in the stomach, thus not only interfering with digestion, but, by its proximity to the heart, embarrassing the latter organ in its action. Hence, a patient with heart disease should take a dry diet. Do not begin a meal by taking a dish of soup. Take liquids by the teaspoonful, or only a sip at a time, during meals. At other times, also, drink should be sipped only, and not swal- lowed down, a gobletful at a time, as is the habit with many. Take all the water that the thirst de- mands, only take it in the manner directed. Whatever solid food is taken should be highly nutritious, and largely composed of meats. Let beef, mutton, chicken, oysters and game form a prominent part of the diet, with a fair proportion of vegetables. In a word the patient should have a rich, nourishing diet. No alcohol in any shape should be taken by a person with heart disease. In enforcing this I cannot do better than give the words of Dr. Chambers: "Alcohol is really the most ungenerous diet possible. Addiction to it impoverishes the blood, and is the surest road to that degeneration of mus- cular fibres which is so much to be feared. And in diseases of the heart it is especially hurtful, by quickening the beat, causing capillary congestion and irregular circulation, and mechanically dilat- ing the cavities." 110 DIET IN DISEASE. ALCOHOLISM. In trying to overcome the appetite for alcoholic beverages much aid may be derived from a judicious regulation of the diet. The supply of alcohol should be cut off at once. The diet should then be made to consist entirely of farina- ceous food and fruits. The victim should eat no meats, cheese, eggs, nuts or other foods of this character, but the diet should be limited to the starchy foods alone, bread, oat meal, potatoes, and other vegetables. He should also eat freely of fruits. Let him take some fruits at every meal, and eat all of them that he can between-meals. He should indulge freely in apples, oranges, banannas, grapes, peaches, pears and all kinds of berries. In a word, he should become a strict vegetarian, for vegetarians do not become hard drinkers. CHAPTER XI. DIET IN DIARRHOEA AND DYSENTERY. A person suffering from diarrhoea should take as little food as it is possible to get along with— the less the better. That which is taken should be light and easy of digestion, and such as will not irritate the mucous lining of the bowels. But in acute attacks it is best to take no food whatever. The patient will not suffer from this fasting, and in many cases recovery will quickly follow if he simply maintain the recumbent post- ure, and take nothing but cool water or lemonade. But if the attack be protracted it is necessary to judiciously nourish the patient. If the food be cool the diarrhoea will be sooner arrested than if warm food be taken. RECIPE 52. MILK AND LIME-WATER. Let the patient drink iced-milk containing a tablespoonful of lime-water to the gobletful of milk. Take small quantities at frequent intervals. In many cases this is sufficient, and nothing more need be taken. It is refreshing, nourishing, and at the same time astringent. 111 112 DIET IN DISEASE. RECIPE 53. RICE GRUEL. One pint boiling milk; One tablespoonful ground rice. Wet the rice with cold milk, making a smooth paste, and stir this into the boiling milk. Boil for ten or fifteen minutes, stirring well, for it will easily burn. Salt to taste. RECIPE 54. BOILED RICE. Boil some rice for one hour in sufficient water to cover it. Season with salt or butter and serve plain or with milk. If properly cooked this is an excellent dish in bowel diseases. It should be cooked long enough to completely soften the grain. If the grain of the rice can be felt when pressed between the thumb and finger it is not done. If the grain be hard it will irritate the bowels, but if well softened it is easily digested, entirely assimilated, and is one of the best foods that can be used in bowel diseases. RECIPE 55. THICKENED MILK. Milk, thickened with flour and seasoned with salt, makes an excellent dish in diarrhoea. CHRONIC DIARRHCEA requires a greater variety, and more nutritious food. Give the most digestible kinds of meat, DIET IN DYSENTERY. 113 mutton and chicken, and soft eggs. Meat broths, thickened with sago or flour, are good. Rice with milk may be added. Avoid the use of vegetables —except mealy potatoes—and all food that is re- laxing to the bowels. DYSENTERY. Much that has been said on diarrhoea will also apply to this disease. But in dysentery fasting is not of so great importance, although a light diet only should be indulged in. Cold drinks often aggravate the colic which ac- companies many cases of dysentery. A diet consisting exclusively of milk is of as great value in this disease as in diarrhoea. Take it as recommended on page 22. It may be taken cold if it does not aggravate the colic. RECIPE 56. EGGS. Eggs may be given either raw or soft-boiled. If cooked, no other form than boiled eggs should be used. Raw eggs, beaten up in milk and seasoned with sugar, make a palatable and nutritious dish, especially useful in dysentery. RECIPE 57. RAW MEAT. Raw meat, finely scraped with a spoon so as to form a pulp, is an excellent dish. It may be spread on a piece of toast or stale bread, and salted. 114 DIET IN DISEASE. Chew the bread well so that no hard pieces find their way into the stomach. This is very nourish- ing and does not aggravate the disease by irritating the bowels. It may be used in either acute or chronic cases. Avoid the use of fruits and succulent vegetables. CHOLERA. During the prevalence of a cholera epidemic all persons should be very guarded in what they eat. Avoid all food which has a tendency to derange the stomach or to relax the bowels. Eat sparingly of vegetables; eat no pickles, cucumbers, squash, green-corn, unripe fruit, or other food that is re- laxing to the bowels. Drink no ice-water, and avoid the use of alco- holic stimulants. DURING THE ATTACK no food whatever is required. The incessant thirst from which the patient suffers it is hard to gratify, for water taken into the stomach aggravates the vomiting. And yet the patient should receive all the water that he craves if he can retain it. * If this is impossible, much benefit may be derived from holding small pieces of ice in the mouth un- til they melt away. Injections of warm milk may be used with advantage if nothing can be taken by the stomach. DIET IN DIPHTHERIA. 115 AFTER THE ATTACK no solid food should be taken until the stools are con- sistent and fgecal. Great care must be observed during conval- escence. An attack of indigestion at this time is often followed by a fatal relapse. At first only farinaceous food should be given, and this in small quantities, frequently repeated. Rice, thoroughly cooked, corn-starch, thickened milk, arrow-root and the like, may be first taken. Milk, however, is to be preferred even to this, and if the patient can take it, nothing else need be sought for. Meats. When greater variety is called for, soups and broths containing no vegetables, may be given, and after this meats which are simply prepared and easily digested. Vegetables. This should be the last form of food resumed, and during convalescence the use of all vegetables must be strictly prohibited. DIPHTHERIA. To keep the patient well nourished is an import- ant part of the treatment of diphtheria, for while it is a very exhausting disease, at the same time the throat is often in such a condition that it is almost impossible to get the patient to swallow any food whatever. The pain on swallowing is so great that even adults will sometimes suffer the pangs of hunger and endure thirst rather than take food or water. 116 DIET IN DISEASE. It is therefore important to begin to give a diphtheritic patient an abundance of nourishing food as soon as the disease has announced itself. Begin with soft eggs and milk. Let the' patient drink all the milk that he can be induced to take. A glass of milk with an egg beaten up in it should be given at as frequent intervals as "it can be taken by the patient. In the stage of depression, milk, eggs, and wine or brandy are called for, as the patient then needs stimulating, as well as nourishing. Milk-punch, and similar preparations, will fulfil the indications. RECIPE 58. MILK PUNCH. One tumblerful of milk; Two dessertspoonfuls brandy. Sweeten the milk well and stir in the brandy thoroughly. Give very cold, with ice. RECIPE 59. EGG NOGG. Yolks of two eggs; One gobletful rich milk; Tablespoonful sugar; Tablespoonful brandy. Beat the egg-yolks up well with the sugar; stir this well into the milk and then add the brandy. RECIPE 60. EGG COFFEE. Make a cup of strong coffee—add boiling milk one-half; sweeten a little more than usual; beat DIET IN GASTRITIS. 117 the white and yolk of an egg together thoroughly. Boil the coffee, milk and sugar together and pour this over the beaten egg, in a cup, as you are about to serve it. This is nutritious and stimulating, and of as great value as the preparations containing alcohol. If the patient can no longer swallow, he should be nourished by nutrient enemata. In this way many lives may be saved, for otherwise the patient will perish of exhaustion from want of food. Inunctions of oil will also help to keep up nu- trition. Rub the legs and the abdomen well with olive oil, repeating the process several times a day. GASTRITIS. In inflammation of the stomach very little food of any kind can be taken, and during the height of the attack, when the stomach is much inflamed, there must be an abstinence from all food. Whatever food is taken must be cold. Let the patient take small pieces of ice in the mouth, and some bits of ice may be swallowed. Often ice-cream can be taken when all other food is rejected. This is soothing, cooling, and at the same time nutritious. Iced-milk may in some cases take the place of the ice-cream. Lemonade may be drunk if the patient craves and retains it. As improvement progresses, and the patient is able to take a greater variety, give starchy foods 118 DIET IN DISEASE. only, such as barley-water, rice, arrowroot and the like, but no meats. The meats are digested in the stomach, while the starchy foods are digested in the canal beyond the stomach. If the attack be protracted, and nothing can be retained on the stomach, as is sometimes the case, then the patient must be nourished by nutrient enemata. (Chap. III.) Exceedingly great care must be observed in re- turning to a solid diet after the attack, as any in- discretion is liable to be followed by a relapse. Take no meats or solid food. If milk agree, noth- ing more is required. When a change is made, broths and gruels may be added. The first solid food taken may be oysters, raw or stewed. These will often agree when the stomach will tolerate solid food of no other kind. BILIOUSNESS. In that disturbance of the liver commonly known as " biliousness," regulation of the diet will promote recovery. Avoid the use of highly seasoned and stimula- ting food. Take no spirituous or malt liquors. Take no heavy meats, sweet or oily articles of food. Let the diet be light and easy of digestion, consisting mainly of vegetable food. Eat mode- rately, and avoid overloading the stomach. In jaundice the patient should eat an abundance of green vegetables at every meal, and drink freely of cold water. CHAPTER XH DIET FOR CONVALESCENTS. After a long spell of sickness, with the derange- ment which the digestive organs generally under- go, it is often difficult to tempt the returning ap- petite. Nor is it necessary to urge the matter if the patient is doing well, and not suffering from want of food. There is little desire for food so long as the tongue retains its coating, and it will be found that the returning appetite will keep pace with the cleaning of the tongue. After recovery is so far advanced as to admit of a more generous diet, the following recipes will help to settle the much-vexed question—"What shall I eat?" RECIPE 61. MUTTON CHOPS. When the patient is prepared to indulge in a meat diet, mutton chops will be found to be very acceptable. They should be broiled over a clear fire for six or seven minutes; turn frequently, and do not prick with a fork. Serve hot; season with salt and pepper after they come from the fire. 119 120 DIET IN DISEASE. RECIPE 62. GAME. Pigeon, quail and snipe, are especially acceptable to the convalescent, and will tempt the returning appetite. Broiling is the best mode of cooking. RECIPE 63. CHICKEN. Tender spring chicken may take the place of the game when the latter is not to be had. It is very nice broiled, or may be stewed or fricasseed. RECIPE 64. OMELETTE. Two eggs; One cupful buttermilk; One-third teaspoonful soda; Three tablespoonfuls flour. Beat up the eggs, stir them into the buttermilk with the flour, add the soda, some salt, and stir all to a creamy consistence. Put three table- spoonfuls of this batter onto a hot, buttered grid- dle. When one side is brown, fold it on itself, turning one half on the other. Serve hot and eat with butter or syrup. It can also be made with sweet milk and bak- ing-powder. (A. M. G.) RECIPE 65. MILK TOAST. Pare off the crust from stale, light bread; slice half an inch thick and toast quickly. Dip each DIET FOR CONVALESCENTS. 121 slice, as it comes from the toaster, in boiling water. Butter thinly, sprinkle a little salt over, and lay in a deep, covered dish. Have ready in a saucepan enough boiling milk to cover the toast well. Thicken this a very little with flour, being careful that it is not lumpy. Salt this milk, melt in it a bit of butter, and pour over the toast. Cover closely and let it stand five minutes before serving. RECIPE 66. POTATO SURPRISE. Scoop out the inside of a sound potato, leaving the skin attached on one side of the hole, as a lid. Mince up finely the lean of a juicy mutton-chop, with a little salt and pepper, put it in the potato, pin down the lid, and bake or roast. Before serv- ing—in the skin—add a little hot gravy if the mince seems to be too dry. RECIPE 67. TOMATO SOUP. Peel six good-sized tomatoes and cut them into small pieces; put them into a sauce-pan, with a quart of water, and boil until tender; season with salt and pepper. Now stir into the water half a teaspoonful of baking-soda. Lift the kettle from the stove when stirring in the soda, or the soup will run over as it foams. Boil again, and add a pint of sweet milk. Put broken crackers into a 122 DIET IN DISEASE. dish, pour the soup over them and serve imme- diately. (A. M. G.) This is an excellent dish for convalescents, being often taken with relish when nothing else tempts the appetite. It may be used in all cases except where there is a tendency to looseness of the bowels. RECIPE 68. SAGO CUSTARD. Two eggs; One pint milk; One tablespoonful sago. Boil the sago in a little water till clear; add the milk and let it come to a boil, then add the eggs, well beaten, and sugar to taste. Put the vessel containing the custard into another vessel of boil- ing water; stir till it thickens a little. When partly cold flavor with lemon or vanilla. RECIPE 69. SPANISH CREAM. One quart milk; Yolks of three eggs; One-half box gelatine; Two tablespoonfuls sugar. Soak the gelatine for an hour in the milk, put on the fire and stir well as it warms. Beat the yolks very light with the sugar, add to the scalding milk, and heat to boiling point, stirring all the while. Flavor with vanilla or lemon. When almost cold, put into a mould wet with cold water. DIET FOR CONVALESCENTS. 123 RECIPE 70. BAKED CUSTARD. Two eggs; One pint milk; Two tablespoonfuls sugar. Scald the milk; beat the yolks up with the sugar, add this to the milk, and when well mixed stir in the whites, previously beaten light. Flavor to taste. Pour into cups and bake until firm. Eat cold from the cups. recipe 71. arrowroot jelly. One cup boiling water; Two teaspoonfuls arrowroot; Two teaspoonfuls white sugar. Dissolve the sugar in the cup of water; put this on the fire and bring it to a boil. Wet the arrow- root in a little cold water, and rub it smooth. Stir this into the hot water while it is boiling. Add one teaspoonful of lemon-juice and keep it boiling until it is clear. Wet a cup in cold water, and pour in the jelly to form. Eat when cold, with cream and sugar. This is a delicate dish and will tempt many a dainty appe- tite. RECIPE 72. SAGO BLANC-MANGE. One pint milk; One-half pound sago. 124 DIET IN DISEASE. Soak the sago in cold water for four hours. Heat the milk and stir in the soaked sago. When it has dissolved, sweeten to taste. Boil slowly fifteen minutes, stirring all the time; take from the fire, flavor, beat until nearly cold, pour into moulds dipped in cold water. Turn out and eat with sweetened cream. Besides these domestic dishes, preparations of malt, extract of malt or maltine, will help build up the atrophied tissues and hasten the return of strength. Recipes for other dishes which can be used in convalescence will be found in the next chapter. CHAPTER XLH. RECIPES. BEVERAGES. To allay the thirst from which the sick so often suffer, especially in fevers, is not the least im- portant part of the treatment. A proper supply of liquid not only helps to moderate the fever, keep the kidneys active, make the tissues soft and the membranes moist, but it also adds to the patient's comfort, and prevents to a great extent that restlessness with which it is so frequently ac- companied. Fever-patients, especially when there is delirium or stupor, in which conditions they are unable to make their wants known, often suffer from want of water. In all such cases water should be offered at frequent intervals. But pure water, if taken too freely, is apt to dis- order the stomach and bowels. It is found that the addition of certain substances to water greatly increases its power to quench thirst. Acids, in particular, seem to possess this power. A weak infusion of cascarilla or orange peel, acidulated slightly with hydrochloric acid, was, with Dr. Graves, a favorite thirst-allaying drink for fever- patients. 125 126 DIET IN DISEASE. The following recipes will afford an ample varie- ty for all cases: RECIPE 73. RASPBERRY SYRUP. Put 6 pounds of raspberries into a china or glass bowl, with a quart of water in which has been dissolved 2J ounces of citric (or tartaric) acid, and let it remain 24 hours; then strain it, taking care not to bruise the fruit. To each pint of clear liquor add 1\ pounds of loaf sugar, and stir it till dissolved. Leave it for a few days, and then bot- tle securely. A little of this syrup in water forms a refreshing drink for fever-patients. RECIPE 74. STRAWBERRY SYRUP may be made according to the same rule, using 2 ounces of citric acid. RECIPE 75. RASPBERRY VINEGAR. Put a pint and a half of best wine-vinegar to three pounds of raspberries, in a glass or porcelain vessel; let this stand for two weeks, then strain without pressure. Put into bottles, well corked. RECIPE 76. RASPBERRY VINEGAR. Mash the raspberries in a crock, cover well with pure cider vinegar. Let this stand for twenty-four hours, giving it an occasional stirring. RECIPES. 127 The next day strain off the vinegar and juice into another crock, containing the same quantity of mashed berries as first used. Let this stand until the following day, when the juice should be again strained off. Now add one-half the quantity of water that you have vinegar, and to this mixture add three pounds of white sugar for each quart. Now stir over a gentle fire until the sugar is dis- solved. Bring slowly to the boiling point, skim- ming meanwhile, and as soon as it boils, strain again. Bottle immediately and seal the corks well. A tablespoonful or more to a glass of ice-water makes a very refreshing drink in sickness. RECIPE 77. JELLY WATER. One teaspoonful jelly; One goblet ice-water. Any jelly may be used, currant-jelly, cranberry- jelly, or other kind. Very tart jellies are the best. Stir up the jelly in the ice-water until the two are well mixed. RECIPE 78. APPLE-WATER. One large, juicy apple; Three cups cold water. Let the apple be a juicy, finely flavored one. Pare and quarter it. Put on the fire in a closely- 128 DIET IN DISEASE. covered sauce-pan, with the water, and boil until the apple stews to pieces. Strain the liquor as soon as it is taken from the fire, pressing the apple hard in the cloth. Set away to cool. Sweeten to taste with white sugar. Drink ice-cold. This is a very refreshing and palatable drink, and forms an agreeable change from the more common ones. RECIPE 79. LEMON WHEY. Put a quart of new milk into a saucepan and stir it over the fire until it is nearly boiling; then add the juice of one lemon and let it simmer for fifteen minutes, skimming off the curd as it rises. Add the juice of another lemon, skim for a few minutes, and it is ready for use. RECIPE 80. WHEY POWDER. Sugar-of-milk, 2 ounces; Pow'd white sugar, 8 ounces; Gum Arabic, pow'd, 1 ounce. Mix. Dissolve half an ounce of this in a pint of water. This makes a demulcent drink for use in bronchitis, pleurisy or pueumonia. TO WHITEN WHEY. Beat up the white of an egg with a portion of the whey, mix with the rest, boil for a moment and run it through a jelly-bag. RECIPES. 129 RECIPE 81. LEMONADE. Take two lemons, wipe clean and peel very thin* being careful to cut off none of the pith, or white. Now cut off all the pith, and throw it away. Cut the lemons into thin slices, take out all the seeds, put the slices and the rind of one lemon into a pitcher, add a tablespoonful of sugar, pour onto these a pint and a half of boiling water; cover and stand on the ice to cool. When cold, strain into another pitcher and it is ready for use. Although this involves more time and attention than is usually given to the making of lemonade, yet the superior quality obtained well repays the extra trouble. RECIPE 82. ICELAND MOSS LEMONADE. One handful Iceland Moss; Two quarts boiling water; Two lemons. Wash the moss in two waters. Peel and slice the lemons, throwing away the peel. Mash the sliced lemon up with four tablespoonfuls of sugar; mix this with the moss, and pour over it the boil- ing water. Let it stand until cold. Sweeten to taste, and take it ice-cold. If too thick, add cold water. RECIPE 83. FLAX-SEED LEMONADE. Four tablespoonfuls whole flaxseed; One quart boiling water; *In preparing lemon-peel for flavoring, pare very thin shavings from the surface, getting in none of the white, as this will render it bitter. 130 DIET IN DISEASE. Juice of two lemons; Sugar to sweeten. Put the flax-seed in a pitcher, pour on the boil- ing water, cover it and let it steep for three hours. When cold add the lemon-juice and sweeten to taste. If too thick, thin with cold water. Let the patient have it ice-cold. The last two recipes make soothing drinks in throat and lung troubles. RECIPE 84. EGG LEMONADE. Beat up one egg to a froth; make one goblet of lemonade, using the juice of an entire lemon; sweeten to taste, stir in the egg and add pounded ice. This is a delicious and refreshing drink for the sick, and has, moreover, some nutritive value. RECIPE 85. LEMON-ICE. Six lemons; One large sweet orange; One pint of water; One pint of sugar. Grate the peel of three of the lemons, and re- move the rind of the orange. Squeeze out every drop of juice from the orange and all the lemons, and steep it in the rind of orange and lemons one hour. Strain, squeezing the bag dry; mix in the sugar, and then the water. Stir until dissolved, and freeze in a freezer, opening three times to mix all together. RECIPES. 131 RECIPE 86. BARLEY-WATER. One pint boiling water; Two ounces pearl barley; Lemon-peel and sugar. Wash the barley well in two or three waters. Put this into a pitcher, together with a tablespoon- ful of sugar and the peel from a quarter of a lem- on, cut very thin. Pour onto these one pint of boiling water. Cover the pitcher and let it stand on ice until cold. When cold strain into another pitcher and it is ready for use, RECIPE 87. THICK BARLEY-WATER. Wash the barley as in R. 85. Put it in a sauce- pan, pour over it two quarts of cold water, bring to a boil, and let it boil for two hours. Pour into a pitcher with the thin peel of half a lemon; set it on ice to become perfectly cold. When cold, take out the lemon-peel and sweeten to taste. RECIPE 88. BARLEY-WATER. Two cups boiling water; Two tablespoonfuls barley. Wash the barley and soak it half an hour in a little luke-warm water, and stir, without draining, into the boiling water, salted very slightly. Sim- mer one hour, stirring often. Sweeten to taste 132 DIET IN DISEASE. and strain before using. This may be used tem- porarily as a substitute for milk when the latter disagrees. RECIPE 89. RICE-FLOUR MILK. Two cups boiling milk; Two tablespoonfuls rice-flour. Wet the rice-flour up with cold milk, and stir it into the boiling milk. Let it boil for ten minutes, stirring all the time. Sweeten to taste and eat warm with cream. This makes a simple, yet nourishing, dish for the sick. RECIPE 90. TOAST-WATER. Cut thin slices of bread, and toast till nicely brown, with no suspicion of burning. Put several such slices into a bowl and pour over enough boiling water to cover. Cover the bowl closely, and let it steep until cold. When cold, strain, sweeten to taste and put a piece of ice into each glass. It may be flavored with lemon-juice. This may be freely indulged in. It is of very slight nutritive value, and must not be depended upon as a food. RECIPE 91. ELM TEA. Take nice slippery-elm bark, break it into bits, pour boiling water over it, cover and let it stand until cold. Take with ice, and sweeten if desired. RECIPES. 133 This is used as a demulcent drink in throat troubles and coughs. RECIPE 92. CAFE- AU LAIT. Fresh, strong coffee, and boiling milk, equal parts. Strain the hot coffee through some muslin into the pot from which it is to be served. Add the hot milk immediately, set the pot on the hot stove for five minutes, and it is ready to serve. RECIPE 93. COFFEE AND EGG. Make a cup of strong coffee, adding boiling milk as usual, only sweetening rather more; take an egg, beat yolk and white together thoroughly; boil the coffee, milk and sugar together, and pour it over the beaten egg in the cup in which you are going to serve it. This simple recipe is used frequently in hospital practice. A sick person, needing nourishment and having lost appetite, can often be sustained by this when nothing else can be taken. MEATS. RECIPE 94. TO STEW OYSTERS. Take one quart of liquid oysters, put the liquor (a teacupful for three persons), in a stew-pan, and add half as much more water; salt; a good bit of 134 DIET IN DISEASE. pepper; a teaspoonful of rolled cracker for each person. Put on the stove and let it boil; have your oysters ready in a bowl. The moment the liquor begins to boil pour in all your oysters, say ten for each person. Now watch carefully, and as soon as it begins to boil take out your watch, count just thirty seconds, and take your oysters from the stove. You will have your big dish ready with one and a half tablespoonfuls of cold milk for each person. Pour your stew on this milk and serve immediate- ly. Never boil an oyster in milk.—(Delmonico.) RECIPE 95. CHICKEN JELLY. Half a spring chicken; One quart cold water. Break all the bones by pounding the chicken with a mallet, bones and meat together. Put this in a saucepan, pour on the cold water, cover the vessel, and let it simmer slowly until the meat is reduced to shreds and the liquid boiled down one- half. Now remove it from the fire, strain it, and press it first through a cullender, then through a coarse cloth. You will have now a thick liquid which you can salt to taste (pepper if allowable). Re- turn it to the fire and let it simmer five minutes longer. Pour into a dish and skim when cool. This will, when cold, set into a jelly. It is best to keep it on the ice. RECIPES. 135 Slice it up and give to the patient cold, just off the ice. It may be eaten alone, or with toast, Albert biscuit, or unleavened wafers. It is very nice made into sandwiches by putting the jelly between thin slices of bread spread lightly with butter. This chicken jelly is one of the most delicate meat dishes for the sick. It can be given in a great variety of cases, it is easily made and very tempting to a dainty appetite. Some patients can take this cold when nothing else of a solid nature can be eaten. BROTHS AND SOUPS. RECIPE 96. RAW-BEEF SOUP. Chop fine one pound of raw beef, put it in a bottle with one pint of water and five drops of muriatic acid. Let this stand on the ice all night. In the morning set the bottle in a pan of water at 110° F. for about two hours. Strain through a cloth until the mass is nearly dry. If the raw taste be objectionable, the beef to be used should be roasted quickly on one side; then make as above. This beef soup may be substituted for milk in those cases in which the latter is called for but cannot be taken. 136 DIET IN DISEASE. RECIPE 97. VEAL SOUP. Take one pound of veal—almost any cut will do—put it into one quart of cold water, salt, boil slowly for two hours. Before taking from the fire stir in a little flour, previously made into a thin paste with cold water, and free from lumps. RECIPE 98. MUTTON BROTH. Take a pound and a half of mutton, free from fat; put it into a quart of water, salt, and boil slowly for two hours. Slightly thicken with flour. RECIPE 99. CHICKEN SOUP. Cut up a tender young chicken; put it into two quarts of cold water, add a little salt, and boil slowly for two hours. Add a little rice half an hour before it is removed from the fire. BREADS. RECIPE 100. RICE BREAD. Make a sponge of One quart of warm water; One teacupful yeast; One tablespoonful white sugar; Two tablespoonfuls lard; One quart white flour. RECIPES. 137 Beat well together, and in about five hours, when it has risen, add three pints warm milk, and three teacupfuls rice-flour wet to a thin paste with cold milk, and boiled four minutes, as you would starch. This should be a little more than luke-warm when it is stirred into the batter. If not thick enough to make into a dough, add a lit- tle wheat-flour. Knead thoroughly, and treat as you would wheat bread in the matter of two risings and baking. This is a nice and delicate bread for invalids, and keeps well. RECEPE 101. UNFERMENTED BROWN BREAD. Mix three pounds of brown-flour with ten drachms of bicarbonate of soda; make this into a dough with twenty-five ounces of cold water containing twelve and a half fluid-drachms of muriatic acid. Bake immediately it is prepared. RECIPE 102. BREAD PANADA. Place in a sauce-pan some very thin slices of bread-crumb, and rather more water than will cover it. Boil until the bread becomes pulpy, strain off the superfluous water, and beat up the remainder to the consistence of gruel. Season to taste. Some prefer it sweetened, while others eat it with salt and pepper. 138 DIET IN DISEASE. RECIPE 103. CRACKER PANADA. Six Boston crackers; Two tablespoonfuls white sugar. Split the crackers and pile in a bowl in layers, the sugar and a little salt scattered among them. Pour enough boiling water on them to cover them, and set on the hearth, closely covered, for more than an hour. Eat from the bowl, with more sugar, if desired. The crackers should be clear, soft and jelly-like, but not broken. RECIPE 104. BREAD SAUCE. Crumb up two slices of stale bread, or two dry biscuit; pour on this half a pint of hot water; season with salt and pepper; boil until it is smooth and add a piece of butter. A little onion will lend it zest for some. RECIPE 105. BREAD JELLY. Cut the crust from some slices of stale bread, and toast nicely without burning. Pile in a bowl, sprinkling sugar and a little salt between; cover well with boiling water, and set, with a tight lid on top, in a pan of boiling water. Simmer well until the contents of the bowl are like jelly. Eat warm with powdered sugar and nutmeg. RECIPES. 139 RECIPE 106. BOUILLIE. The bouillie commonly used in France as the first food for infants, is made by gently roasting the best wheat flour in an oven, then boiling it for a considerable time either in water, or in milk and water, and adding sugar. GRUELS. RECIPE 107. OATMEAL GRUEL. Take three ounces of oatmeal and boil slowly in four pints of water, till reduced to two pints. Strain through a sieve. Add milk if it is wanted thin. RECIPE 108. CORNMEAL GRUEL. One cup cornmeal; One quart boiling water. Make a thin paste of the meal, mashing out all lumps. Stir this into the boiling water, letting it boil for three-quarters of an hour, being careful that it does not burn. Salt to taste. RECIPE 109. SAGO GRUEL. Two cups water; Two tablespoonfuls sago; Three teaspoonfuls sugar. 140 DIET IN DISEASE. Put the sago into water and warm it by setting in a saucepan of boiling water. Keep it hot for one hour, stirring often. Now boil it for ten minutes, stirring well; season with lemon or vanil- la, and pour into a bowl to cool. Eat it either warm or cold. recipe no. ARROWROOT GRUEL. Take three teaspoonfuls of arrow-root flour; mix this into a soft paste with a little cold water; pour upon this half a pint of boiling water, stir- ring well until it is thoroughly mixed; boil for five minutes, add some milk and a little salt, and sweeten to taste. BLANC-MANGES AND CUSTARDS. RECIPE 111. ARROWROOT BLANC-MANGE. One cup milk; Four teaspoonfuls arrowroot; Two teaspoonfuls sugar. Make a smooth paste of the arrowroot, with cold water. Stir this into the milk while the latter is boiling. Add the sugar, flavor with vanilla, stir all the time and boil until it thickens. Turn out, and when cold eat with cream. RECIPE 112. ARROWROOT CUSTARD. Two cups of boiling milk; Three teaspoonfuls arrowroot; RECIPES. 141 One egg and two tablespoonfuls white sugar well beaten together. Wet the arrowroot up with a little cold milk, mix this paste with the boiling milk, and stir for three minutes. Take it from the fire and whip in the egg and sugar. Boil two minutes longer, fla- vor with vanilla or other extract, and pour into moulds. RECIPE 113. TAPIOCA JELLY. One cup tapioca; Three cups cold water; Juice of one lemon. Put the tapioca in a two-quart basin, and pour over it sufficient water to cover it. Let it soak four hours. Now set the basin in a sauce-pan of boiling water; pour more warm water over it, if it is too thick. Keep the water in the sauce-pan boiling, and stir the tapioca frequently. Cook un- til it becomes clear. If too thick at this time, put in a very little boiling water. When quite clear, put in the lemon-juice and sweeten to taste. Pour into moulds. Eat cold, with cream, flavored to suit. This will be found to be an excellent dish, easily digested, simple, and very tempting to the sick. RECIPE 114. FARINA BLANC-MANGE. One pint milk; Two tablespoonfuls farina. 142 DIET IN DISEASE. Heat the milk to boiling; stir in the farina, and a little salt. Boil for twenty minutes in a farina- kettle. Flavor and sweeten to taste and pour into moulds. Set in a cool place. Eat with cream and sugar. RECIPE 115. TAPIOCA BLANC-MANGE. One cup tapioca; Three cups boiling milk; Three tablespoonfuls white sugar. Soak the tapioca four hours in two cups cold water, and stir the whole into the boiling milk. Sweeten and boil slowly for fifteen minutes, stir- ring all the while. Take off, flavor to suit, and pour into moulds. Eat cold with cream. Wash the tapioca well before soaking. RECIPE 116. TAPIOCA PUDDING. Take an ounce of tapioca, soak it in an ounce of cold water for two hours; pour off this water, add a pint and a half of milk and boil slowly un- til it is well incorporated; stir into this one-half ounce of sugar beaten up with two eggs. Season with lemon. RECIPE 117. GELATINE JELLY. Place one ounce of gelatine in half a pint of cold water—soak for ten minutes; add half a pint RECIPES. 143 of boiling water and stir until the gelatine is dis- solved. Add the juice of two lemons, sugar, and the white of an egg, well beaten; stir these in, boil for two or three minutes, strain through a jelly-bag, and let it set. RECIPE 118. GELATINE CHARLOTTE RUSSE. One pint cream; One-half ounce gelatine, dissolved in cup hot milk; Whites of two eggs; Two tablespoonfuls white sugar. Whip the cream light, beat the eggs to a stiff froth, and mix these and the sugar all three to- gether. Flavor with lemon or vanilla, and last beat in the gelatine, which should be quite cold before it is added. Pour into a dish and set on the ice. This is a nice dish for those who can take anything so rich. RECIPE 119. JELLY OF ICELAND MOSS. One handful Iceland moss; One quart boiling water; Juice of two lemons. Wash the moss in five waters, and let it soak for an hour in a little cold water. Now stir it in- to the boiling water and simmer until it is dis- solved. Put in the lemon-juice, sweeten to taste and strain into moulds. 144 DIET IN DISEASE. RECIPE 120. FLOATING ISLAND. One pint milk; Two eggs; Two tablespoonfuls white sugar; Teaspoonful vanilla extract. Beat the yolks well, stir in the sugar, and add the hot, not boiling, milk, a little at a time. Boil until it begins to thicken. When cool add the flavoring, pour into a glass dish, first stirring well. Heap upon it a meringue of the whites, beaten to a froth. This well known dish makes a very agreeable one for the sick or convalescent. RECIPE 121. COTTAGE CHEESE. Heat sour milk until the whey rises to the top. Pour off the whey, put the curd in a bag and let it drip for six hours, without squeezing it. Put it in a wooden bowl, chop fine with a wooden spoon, salt to taste, and work to the consistence of soft butter, adding a little cream and butter as you proceed. Mould into balls and keep in a cool place. It must be eaten when fresh. There are few nicer dishes than this for the sick or convalescent. IND EX. Page. Alcoholism........................... 110 Alcohol in fevers.................. 24 " in heart disease....... 109 Alimentation, rectal.............. 49 Alkaline drink..................... 105 Apples, baked....................... 48 Apple water.......................... 127 Arrowroot............................. 16 jelly.....................123 Asthma, diet in..................... 106 Austen, Miss......................... 23 Baby, to nurse...................... 73 " to wean...................... 76 " to feed........................ 79 Banting................................ 15 Barley water........................ 131 Bartholow, Dr...................... 12 Beale, Dr.............................. 40 Beef.................................11, 54 " broth............................ 28 " tea.................24, 25, 26, 89 Beverages.............................125 Biliousness, diet in............... 118 Bonny-clabber...................... 35 Bouillie................................ 139 Butter................................... 15 Blanc-manges..........140, 141, 142 Breads.................................. 136 Bread, brown........................ 37 " jelly.......................87, 138 " , rice........................... 136 " sauce.....................48, 138 " , unfermented.........38, 137 Bright's Disease..................... 70 Broths.................................. 135 Cafe-au-lait........................... 133 Chambers, Dr...................70, 105 Charlotte russe..................... 143 Page. Cheese.................................. 13 Chicken......................12, 55, 119 " broth...................... 28 " jelly........................ 134 Chlorosis.............................. 102 Cholera, diet in..................... 114 " infantum................. 88 Churchill, Dr....................61, 88 Clabbered milk.................35, 56 Clark, SirC........................... 79 Cod-liver oil.......................... 15 " " " in consumption. 56 " " " in scrofula......... 100 Cod fish................................ 34 Coffee and egg...................... 133 Collapse................................ 103 Constipation, diet in............. 43 Consumption, diet in............ 53 Convalescents, diet for.......... 119 Corpulent, diet for the.......... 95 Corn starch........................... 16 Cottage cheese..................56, 144 Cream................................... 15 Custard...........................123, 140 Diabetes, diet in.................... 62 Diarrhoea, diet in.................. Ill " .chronic............... 112 Digestion, aids to.................. 39 Digestive fluid...................... 40 Diphtheria........................... 115 Dysentery, diet in................. 113 Dyspepsia, diet in................. 31 Dyspepsia-crackers............... 34 Eggs...........................13, 55, 113 Egg and coffee..................... 116 Egg-nogg..........................27, 116 Eggs and milk...................... 90 Elm tea................................ 132 146 INDEX. Page. Page. ...... 50 143 " blood................ ...... 51 16 ...... 52 15 ...... 50 18 ...... 15 118 ..... 21 127 Fish................................ ...... 13 ...... 9 56 ...... 10 1M ...... 18 130 " , nitrogenized....... ...... 11 " egg................ " , non-nitrogenized. ...... 14 129 ...... 11 " iceland moss.. 129 ...... 81 130 ...... 85 86, 100 ...... 117 41 ...... 13 61 " jelly................... ...... 142 35 ...... 65 115, 133 ...... 67 12 ..... 65 103 ...... 66 113 ...... 66 Milk...........................13 55, 115 ...... 68 ' Brighfs disease, in. 71 ...... 68 ..14 23 ...... 17 14 ...... 72 80 ...... 21 ' diabetes, in............ 68 ..... 102 ..... 22 99 80 Gruel, arrowroot............. .87, 140 ' and lime-water....... 111 " corn meal............ ..... 139 116 " oatmeal...........24, 46, 139 87 112 ..... 112 119 ..... 139 11 .. , 17 54 ..... 108 91 136 119 ..... 61 M 47 INDEX. 147 Page. Niemeyer.............................. 71 Nipples, sore........................ 74 Oatmeal...........................46, 47 Oesophagus, stricture of........ 49 Oils....................................... 15 Oil, olive.............................. 16 Omelette............................... 120 Oysters..............................13, 133 Panada, bread..................... 137 " cracker................... 138 Pepsin.................................. 39 Phosphate-of-lime................. 19 Pork..................................... 12 Potatoes................................ 17 Potato surprise...................... 121 Pridham, Dr......................... 107 Purpura................................ 102 Raspberry syrup................... 126 " vinegar................ 126 Rheumatism, diet in............ 104 Rice..................................17, 112 Rickets, diet in..................... 101 Ruddock, Dr........................ 103 Sago..................................... 16 " blanc-mange.................. 123 " custard.......................... 122 " milk............................... 87 Salt....................................... 18 Salter, Dr.............................. 107 Scarlet fever.......................... 29 Schmier-kiise........................ 36 Scrofula, diet in.................... 99 Scurvy................................. 102 Seasickness, diet in............... 93 Page. Soups................................55, 135 Soup, chicken....................... 136 " raw-beef..................... 135 " veal............................. 136 Spanish cream....................... 122 Starches................................ 16 Stomach, ulcer of................. 49 " inflammation of..... 117 Strawberry syrup.................. 126 Sugar.................................... 15 Sugar-of-milk........................ 15 Tapioca................................ 16 " jelly.......................... 141 " pudding................... 142 Tissue-builders..................... 11 Toast-water........................... 132 Tomato-soup........................ 121 Travelers, diet for................. 91 Typhoid fever....................... 28 Typhus fever........................ 29 Veal..................................12, 55 Vegetables........................... 115 Vogel.................................... 81 Venison................................ 12 Wafers, unleavened.............. 38 Water................................... 18 Wet-nurse, to choose............ 75 Wheat................................... 17 Wheaten grits....................... 47 Whey, wine.......................... 26 " lemon......................... 128 " powder..................... 128 " to whiten................... 128 A BRAIN & NERVE FOOD. VITALIZED PHOSPHATES. THIS DIFFERS FROM ALL OTHER TONICS BECAUSE IT IS COMPOSED OF THE VITAL ELEMENTS, THE NERVE- GIVING PRINCIPLES OF THE OX-BRAIN AND WHEAT-GERM, IN THE SAME COMBINA- TION AS IT EXISTS IN THE HU- MAN BRAIN AND NERVES. It is the best promoter of Digestion. It restores to the active, busy brain of man or woman the energy and ability that has been lost by disease, worry or overwork. It restores vitality where there is debility or nervousness, prevents loss of memory and brain fatigue. In impaired vitality it restores to the system that which has been wasted in excitement, in excessive bodily or mental emotions. It prevents consumption and diseases of debility. It aids wonderfully in the mental and bodily growth of infants and children. It gives a happier, more restful and better childhood. For Sale by Druggists, or by mail, $1.00. F. CROSBY, 666 Sixth Avenue, NEW YORK. FACTS OF IMPORTANCE CONCERNING CARL L. JENSEN'S PURE PEPSIN. Transparent and Glittering as Minute Crystals. Recent investigations demonstrate that five grains dissolve the boiled whites of four eggs, equal to 2,000 grains of hard boiled albumen, in four hours in a bottle; it is there- fore conclusive that its digestive property in the stomach is more than double. Hence, it is very decisive that this Pepsin is eminently of the greatest value in all cases of Indigestion. The following Test easily demonstrates its Digestive Strength: Digestive Test.—Boil the eggs, as usual, three or five min- utes ; then mash up the albumen uniform like a pulp, so as to imitate a proper mastication ; to every egg use four ounces of water, each ounce acidulated with five drops muriatic acid ; finally add the Pepsin and maintain a temperature of from 100 to 110 degrees. Agitate the mixture frequently. PROCESS OF MANUFACTURE. Pepsin is the digestive ferment suspended in its vehicle, presented as very concentrated Peptone, which inseparably is obtained from the broken-up tissue of the stomach preferable from the hog. The strength and activity of the Pepsin depend solely upon the careful avoidance of too much a solution of the texture of the stomach in the process of isolation, and the carefulness of the further manipula- tions as to purification and concentration. My further process consists in : as soon as this concentrated ferment is rendered clear and trans- parent as strained honey, it is poured on glass plates for desiccation ; thereafter it is scraped off and sifted, so the scales are of a uniform size, about a line in diameter ; then one per cent, of a solution of gum benzoin is added, thus covering every scale with a minute film of this preservent agent, rendering the hardened scales still more imperme- able to destructive influences, which drugs of organic origin are liable to, especially from animal source. This Pepsin, therefore, challenges all other similar preparations. 1, Because of its enormous digestive strength. 2, Because its action is always uniform and permanently secured, therefore the most reliable. 3, No other Pepsin so inducing in appearance, and put up in a form so easily for inspection—each scale is clear and transparent as glass. 4, No Pepsin so pleasing in taste, readily soluble on the tongue, leaving a faint agreeable taste from the balsamic flavor of the benzoin, and 5th, its great sale, not in- duced through fraudulent misrepresentations from interested medical men, and to fraudulent test by leaders of some medical societies, but demonstrates its superior qualities to any interested in a therapeutic agent so invaluable as this preparation. The following houses are ordering frequently. FRENCH, RICHARDS & CO., Tenth and Market Sts., Phila. LEHN & FINK, 160 William St., New York. MEYfcR BROS. & CO., St. Louts. Mo., Fort Wayne, Ind., and Kansas City, Mo. 1.L. LYONS, New Orleans. FULLER & FULLER, Chicago. W. H. TORBERT, Dubuque, Iowa. GEO. WRIGHT & BRO., Milwaukee, Wis. JAMES G. STEELE & CO., San Francisco, Cal. NOYES BROS. & CUTTER, St. Paul, Minn. MORRISON, PLUMMER & CO., Chicago. NIL L JENSEN, M. 3 3748 THE BEST ARTICLE OF DIET FOR INFANTS, DYSPEPTICS and INVALIDS. HORLICK'S FOOD. Nutrition in its best form. Requires no Cooking. Supports life alone. Not a Medicine, but a delicious beverage when dissolved in milk or water. The best substitute for Tea, Coffee, etc., etc. Invaluable to those suffering from Constipation or gen- eral debility. No home should be without it. Suitable for those in health or sickness. Sent free. A pamphlet giving full information. Also, testimonials from the most eminent physicians through- out the country, showing it to be the best substitute for mothers' milk. J. & W. HORLICK & CO., Racine, "Wisconsin. (liquid.) For Dyspepsia, Mental and Physical Exhaustion, Hervousness, Diminished Vitality, Urinary Difficulties, etc* Prepared according to the directions of Prof. E. N. Hors- ford, Cambridge, Mass. There seems to be no difference of opinion in high medical author- ity of the value of phosphoric acid, and no preparation has ever been offered to the public which seems to so happily meet the general want as this. It is not nauseous, but agreeable to the taste. No danger can attend its use. Its action will harmonize with such stimulants as are necessary to take. It makes a delicious drink with water and sugar only. Prices reasonable. Pamphlet giving further particulars mailed free on application to manufacturers. Manufactured by the RUMFORD CHEMICAL WORKS, Peovidence, R. I. P o CD CO © o CD ,P +3 GG CD S3 $1,000 GIVEN If any ALUM or any injurious substances can be found in this Powder. PURE CREAM TARTAR. Largest Cans in the WORLD! MOST FOR THE MONEY. TRY IT. Also o-u.r PURE SPICES, FRENCH MUSTARD and COFFEES. C.E. ANDREWS & CO- Milwaukee, Wis. go »-S O B. CSJ CD CD GO C-r- CD P a p o e4- CD CO a*! NLM QOlZEbZl 1 WHinrinifmwr mfttmmmiftmyni nmwiimwi i ^fW^S^S^^^^i^ NLM001226211