SOMETHING ABOUT DIET.

It has been truthfully said that “many persons dig their graves with their teeth,” but, that improper feeding causes many a grave to be dug is also true.

So never feel sorry or disappointed when the family physician makes a professional visit, and fails to write a prescription, but instead, gives you instruction in the art of feeding and nursing the patient.

Food and stimulants support the strength of the system until the struggle between health and disease or between life and death is overcome, and thus cure the patient by not allowing him to starve. There is a large group of diseases for which there are no acknowledged remedies, and in which a properly selected and regulated diet forms the mainstay of successful treatment. This should be combined with healthy, clean rooms, proper ventilation, and other hygienic means which may suggest themselves to the intelligent practitioner.

The patient’s fancy for this or that article of diet is no index, as a rule, of what is best suited for him; invalid appetites and cravings are abnormal; they are like that of the chlorotic girl who eats chalk and slate pencils, instead of wholesome food and some preparation of iron.

An aversion to food is also no criterion of the patient’s need for nourishment, for the sense of taste is generally blunted or perverted. The desire for food is lost in all diseases of a catarrhal nature of the mouth or stomach, and in those that are characterized by high temperature. In typhoid fever and diseases of a typhoid nature this is always the case.

With children this aversion to food is greater and more general than with adults; and it must be made a rule that their refusal to take nourishment must not be extended beyond several days, otherwise they fail so rapidly in conjunction with the disease as to perish from exhaustion.

The repugnance to food arises from abnormal conditions that are generally localized in the mouth and especially in the parts of the tongue which are supplied by the nerves of taste; these nerves are the lingual branch of the trifacial and the glasso-pharyngeal. But notwithstanding that the food is almost tasteless, when it gets into the stomach it is retained and properly digested and the patient feels better for having taken it. An appetite can be thus cultivated, and after a few days of coaxing or perhaps of forcible feeding, which in children who are failing rapidly becomes necessary in order to save them, the taste and desire for nourishment become natural or restored. Quite often patients beg and plead not to be given food; but in wasting diseases it should be insisted that some at least should be taken (always liquid of course), and when they are sufficiently rational they will always afterward admit that the nourishment did them good.

Liquid food or nourishment and no other is suitable for a sick person; an invalid can drink food when it would be impossible for him to swallow solid material. I have often seen the whim of patients who craved meat indulged; they got a juicy porterhouse steak with the understanding that it was to be thoroughly masticated before swallowing. As a rule, the patient is disappointed with his own bill of fare, and after trying one or two mouthfuls orders the meat taken away with the remark that it is as dry as a chip. But this same person will drink a milk punch, a thin gruel with the yellow or all of an egg beaten into it, with some degree of relish; salt should always be added and indeed, as much as the taste will permit, but sugar should be used as sparingly as possible. Salt is what is needed above all other seasoning; the system requires the chlorides for they are wasted in fevers, but even in health, the chlorides are very essential and salt is the best one we have; salt is the source of the hydrochloric acid in the stomach and one of the most important factors in albuminous digestion.

The saliva is not secreted in sufficient quantity in fever to allow insalivation of food, or to moisten the solid morsel sufficiently to permit its being swallowed without a choking sensation as it glides into the stomach. A person prostrated by disease has not the strength to masticate solid food and that is another reason why liquid food is to be given.

The famous physiologist, Dr. E. Brown-SÉquard, is the author of a method for feeding the sick peculiarly his own, namely, that of administering small quantities of food at short intervals. He would give a glassful of milk punch in tablespoonful doses, repeating every ten or fifteen minutes; this method is advised for the treatment and cure of dyspepsia, anÆmia, chlorosis, nervous diseases and even organic diseases of the stomach. No particular kind of food was selected for this treatment; butter, milk, cheese, and meats, bread and potatoes were alike to be given in small quantities and at short intervals. One or two mouthfuls even to be eaten at a time, and then repeated in ten or fifteen minutes, until thirty to forty ounces are consumed daily. This system never became a recognized expedient, it is wrong in theory, and certainly in practice; while it may be applicable in isolated cases, they would be so very few that this method of feeding forms the exception and not the rule.

Cases are frequently met with, especially in infants and older children whose digestion has been completely ruined by being fed too often. These cases are not really overfed, because the entire amount in the twenty-four hours, does not exceed the requisite quantity; but giving the food in driblets and at short intervals, causes lactic fermentation, or in plain English, the food sours on the stomach and does not digest, as it would do if a proper time were interposed between each feeding. As soon as the patients are fed at regular and longer intervals, say, from two to four hours, the indigestion corrects itself. During the interval, between the time set for feeding, the children will naturally cry; this is interpreted by the mother or nurse as a sign of hunger, but nothing is oftener further from the truth. The child cries generally for one of three reasons: one of these may be that it wants to be taken up, and dandled or rocked, to which previous indulgences have accustomed it; or it may have pain in the stomach and bowels as a natural result of indigestion or flatulence; or the child may cry from thirst or a sensation of dryness in the mouth and throat; in any event, additional food would only prove injurious. There is no objection against giving nurslings cold water between their meals when they are thirsty or feverish, but warm aromatic tea is so very much superior that I consider it one of the essentials of the nursery. I mean fennel seed tea, of which a sufficient quantity should be prepared every morning to last twenty-four hours; this should be strained and sweetened, then set aside for further use. When the child is restless, between meals, some of the tea should be warmed, and given from the nursing bottle until it is satisfied, for the tea soothes the pain, quenches the thirst and dispels the flatus.

There are also physiological reasons for these longer intervals between nursing; they allow the stomach sufficient time to dispose of its contents before another mess is given to disturb the digestion of former food, which is as yet incomplete. There is another immense advantage in having the length of time between two meals from two to four hours; it allows time for medication and other necessary management of the sick, for sponging off with cold water in fevers, and many other things which are necessary for the patient’s comfort and convalescence, and which can only be carried out between the times the nourishment is given. A memorandum should be kept in the sick room and the time and hour noted when everything becomes due in proper order; this avoids confusion and lessens labor.

Digestion is the solution of the food in the stomach for purposes of nutrition. Nitrogenous materials, egg, meat, muscle are digested principally in the stomach, but not entirely so, because the particles of albuminous food which pass from the stomach into the upper portion of the small intestine come into contact with the pancreatic fluid, which is the digestive agent for fats and starches, but which possesses also powerful digestive properties for nitrogenous or albuminous substances and even in a greater degree than the gastric juice of the stomach, which has a strong acid reaction, while the pancreatic juice has an alkali reaction; here is a very interesting illustration how similar digestive processes are accomplished under opposite chemical conditions. The intelligent reader must not fail to observe, from what has been said, that there are two distinctly different digestive processes, namely one going on in the stomach and another equally as important taking place in the small intestines.

Pepsin is the active principle of the gastric juice, held in solution in a clear colorless liquid, principally water; it has a sour taste and a peculiar characteristic sour smell. The length of time required by the gastric fluid to dissolve the food depends greatly upon the minuteness of the division of the solid substances to be acted upon, as well as upon the quantity and quality of the peptic fluid.

The pepsin changes the physical properties of nitrogenous substances so as to make them soluble in water in any proportion and when the albuminoids have acquired this property they are termed peptones; peptones are simply nitrogenous food which has been modified to fit it for absorption and nutrition of the body.

In the tissues of the body there are continual changes going on, termed in technical language tissue metamorphosis; the waste products that are thus formed constitute a group of highly nitrogenized substances, which in a healthy condition of the system are eliminated by the kidneys. These nitrogenized products are urea, urate of soda and uric acid; the accumulation of any of these substances in the blood gives rise to disease; the former is the cause of urÆmia and urÆmic convulsions, and the latter have been detected in the blood and exudations in cases of gouty and rheumatic disease. The characteristic gouty deposit is urate of soda, due to an excess of nitrogenous elements of the blood. An excess of uric acid constitutes a disease which is first recognized by a reddish crystalline sediment in the urine; the term lithiasis has been employed to denote this peculiarity. These lithates are always to be found in the urine of high livers and are due to an excessive consumption of nitrogenous food. The great English authority, Dr. Murchison, looks upon the excessive production of uric acid, or lithic acid, as it is sometimes called, as due to one of two causes and sometimes to both, namely to the excessive consumption of nitrogenous food, or to an inability of the liver to perform its duty, which among other things is to dispose of the nitrogenous waste products. From this point of view lithates or brick dust deposits in the urine are no sign that the kidneys are deranged, but quite the reverse may be true when the kidneys are overburdened in eliminating this excessive waste, for they are performing extra duty, which excess in living or a sluggish liver imposes upon them, and this may excite inflammation in the tissues of the kidneys and develop into what is known as Bright’s disease.

This very interesting exposition of the deposit of lithates or gravel in the urine will naturally suggest that when the urine is overloaded with these nitrogenous products nitrogenous food like eggs, cheese, beef, etc., should not be eaten for awhile, and that a vegetable diet should be principally relied upon, thus giving the liver a vacation; the diet should be supplemented with plenty of clean fresh water, and no liquors of any sort should be taken by those whose liver is affected.

Starch, sugar and fat are composed of carbon, hydrogen and oxygen; starches and sugars are termed carbo-hydrates; because the hydrogen and oxygen is always present in them in equal atomic weights so as to represent water; while in the fats the oxygen is considerably less. This is exemplified by comparing the chemical equivalents of starch and cane sugar with those of fats:

When starch is boiled with diluted nitric, sulphuric or muriatic acid for thirty-six to forty hours, it becomes colorless and thin like water, and is converted into a species of sugar. A similar process takes place when starch is taken as food, the diastase of the saliva, and the pancreatic and intestinal juices change starch into glucose, in which form it is ready for nutrition.

Cane and other sugars introduced into the system as ingredients of fruits and vegetables are not absorbed as such, but undergo a process of digestion which converts them into grape sugar or glucose; after that they are suitable for nutrition and absorption into the blood, but not before.

The digestion of starches and sugars has been incidentally referred to as not taking place in the stomach but in the upper portion of the small intestine, through the agency of the pancreatic juice which has the peculiar property of converting farinaceous and saccharine matters into grape sugar. But this transformation into grape sugar is not the final product of digestion. In the normal process of intestinal absorption the grape sugar is taken up by the portal capillary vessels and carried to the liver, where under the influence of this organ it is changed into liver sugar or glycogen, and it is as glycogen that it again enters the circulation, to disappear in the lungs. But if the liver from disease or other causes fails to perform this task, the glucose passes through the organ unaltered, and as such again enters the circulation where it acts as an irritant and finally is eliminated by the kidneys in the urine giving rise to the affection known as diabetes.

We have learned that there is a stomachic digestion and an intestinal digestion, the former principally for meats, or that class which are now called nitrogenous foods, while the latter is confined generally to starches and fats. This physiological fact suggested the idea of feeding dyspeptics only on such food as is not acted upon in the stomach, but passes beyond that cavity to become digested in the small intestines, giving the stomach a rest as it were so that it may recuperate and gain strength while the system is being fed by farinaceous aliments. While a superficial glance justified such a procedure, a moment’s reflection proves it to be a delusion, and for this reason, that there will be an unavoidable irritation of the stomach which the journey of the farinaceous material occasions in its passage through the stomach, and the insufficient nutritive value of a simple non-nitrogenous diet causes a rapid loss of tissue and bodily strength; hence this course proved itself impracticable and was abandoned. Then again the experiment was tried of putting a certain class of dyspeptics on a purely meat diet; this had one fault common with the former plan; it was also too one-sided, and the system suffered for want of fat and starch, and secondly peptones were not always formed in the stomach from a deficiency of the gastric juice or an impairment of its quality, so that this method was also abandoned.

Fats belong to the starches and sugars as heat producers; they are insoluble in water, and by boiling them in caustic alkali they are decomposed into soap and glycerine. In the cavity of the stomach fats remain unaltered; the heat of the stomach may melt or liquefy them, but in no other way are they changed. They are also digested, like the starches, in the small intestine by the action of the pancreatic juice which possesses the remarkable property when brought in contact with fatty or oily matter at the temperature of the body of emulsifying it, and of converting the fats into a milky, white, opaque looking fluid, by a minute subdivision of the oily particles. This emulsion of the fatty and other substances of the food is termed chyle, and as such, the fatty substances are ready for absorption by the absorbents of the intestinal tract. Experience teaches that a deficiency of fat causes scrofulous diseases, and this class of patients have generally a repugnance for fat; this is another illustration of the unreliability of patients to choose their own food. Professor John H. Bennet first pointed out the usefulness of cod liver oil in consumption and other scrofulous diseases, and directed attention to the value of fat in the nutrition of the body.

Dr. Ferguson made extensive observations on the little children of the factory operatives of Lancashire, Eng. The children were principally fed on tea or water and bread, little or no fat, bacon, butter or cream, and they grew up into puny and stunted men and women, while those who had a bread and milk diet grew into hardier and finer human specimens.

Fat is also an essential food for the brain and general nervous system; the lean are the nervous patients and not the fat and sleek, hence fatty food is considered an important diet for this class of diseases. The brain and nerve fat is called “lecithin” and a little phosphorus enters into its composition. Chronic obstinate neuralgia has often been cured by the administration of cod liver oil.

Milk is the only single article of diet which possesses in itself all the properties to supply the wants of the system, and it may be profitable to give this subject more than passing notice. It is the natural and most wholesome food for the infant when it can suck it from its mother’s breast; instinctively the newborn rolls its little head hither and thither in search for this fountain of infantile life and however great the skill of the chemist in approaching the composition of mother’s milk, he can never produce an equally good substitute. Milk contains all the principles which are necessary for human food, the nitrogenous, the oleaginous and the saccharine, and these are blended in such proportion that milk is adapted for the complete nourishment of the young and old. In no other single substance supplied by nature does a similar combination exist; it contains the material for the consolidation of bone and for the formation of the red blood corpuscles, by carrying in solution the phosphates of lime, magnesia and iron; in this respect an analysis of milk shows a remarkable similarity to blood. The proportions of the different constituents of milk are liable to great variations and are greatly influenced by the nature of the food.

Dr. Playfair of London, who has made some interesting researches regarding the milk of the cow, has demonstrated that the amount of butter depends in part upon the quantity of oily matter in the food and in part on the amount of exercise which the animal takes; and upon the warmth of the atmosphere in which it is kept. Exercise and cold weather eliminate the oily matter or butter, in the form of carbonic acid and water, while rest and warmth diminish this drain by favoring its passage into milk. On the other hand, the proportion of the cheesy matter is increased by exercise.

In Switzerland, where the cattle pasture in very exposed situations and where, from the rolling of the country, they are obliged to use a great deal of muscular exertion the quantity of butter yielded by the cows is very small, while the cheese is in unusually large proportions; but the same cattle when stall fed give a large quantity of butter and very little cheese.

The character of the food will decide the nature and healthfulness of the milk. The best food for milch cows is bran or middlings mixed with well-seasoned and sweet-cut hay, and this mixture thoroughly scalded and saturated with boiling water; a little flaxseed oil cake, should be added occasionally, for it enriches the milk and keeps the cattle in good condition; during the day the cows should be in the open air; they should not be irritated by dogs, or made to run or trot; these things will affect the milk injuriously. To feed cows on kitchen garbage or swill of any sort will taint the milk so that the offensive odors of the swill can be readily detected, especially after the milk has stood awhile; such milk is particularly dangerous to infants and should at once be discontinued. Distillery slops are often fed to cattle in large cities; these are not only productive of poisonous milk but also injure the cattle so that they become salivated and lose their teeth after a few years of this diet. Brewers’ grains are not open to the same objection as whisky slops; a certain proportion of brewers’ grains added to the cut food increases the flow of milk. In all large towns there are families who keep one or two cows and who sell the milk as a means of making a livelihood: as a rule these cattle are fed on swill, and not upon the best quality of food, and although this milk is recommended as being pure and one cow’s milk, it is as a rule not good, for the stalls and the food do not come up to the requirements for wholesome milk.

I have always found a healthier and purer milk from the dairies run on a large scale, and outside of the centers of population. The cattle look healthier, have better food, good pasturage and pure country air, and if the milk is properly chilled or cooled off before it is poured into the wagon cans, country dairy milk is to be greatly preferred over city milk. The animal heat should have left the milk before it is put into cans for transportation, for it is the animal heat in tightly closed vessels which causes the chemical changes that encourage the development of organic milk poisons or so-called ptomaines.

Milk promiscuously mixed from a group of apparently healthy cows is preferable to that of one cow, and for several reasons; the honesty of dairymen is doubtful, for they will not take the extra trouble to keep the milk of one cow apart when the cows are being milked; again tuberculosis or consumption in all its stages is a common disease among cattle, and quite often a milch cow has tuberculosis when she seems healthy. If a child should subsist on the milk from a tuberculous cow, serious consequences would undoubtedly ensue, but if this milk had been mixed with that of thirty or forty healthy cows, the danger of infection would be correspondingly lessened.

Cow’s milk should average 12 per cent. of cream; if it contain less than 8 per cent., it is probable that the milk is watered or that it was skimmed. A cream gauge is a cylindrical glass vessel about one and a half inches in diameter and eight inches high, with a capacity of 12 fluid ounces. This tubular measure is graduated so as to make it possible to read off from the top downwards 1, 2, 3, etc., parts or drams of cream which gradually rises to the surface. This glass is filled with the suspected specimen of milk up to the highest mark and set aside for 24 hours, at an ordinary temperature; at the expiration of that time the quantity of cream which rose to the surface of the milk is read off, and in this manner it is easy to see the proportion of cream to the entire bulk of milk tested. Above it was stated that 12 per cent. is an average for good milk, and 14 per cent. is extra good, while 8 per cent. is the lowest that is permissible. If the percentage falls below 8 per cent. it is a sign that the milk has been skimmed, and if the density or specific gravity is below 27 degrees, then it is to be presumed that the milk has also been watered, for sometimes the milk is both skimmed and watered.

The density or specific gravity of milk gives an approximate idea of the quantity of solid matter a given specimen submitted for examination contains, as compared with pure water. The lactometer or galactometer is a kind of hydrometer, but specially graduated to readily read off the density which pure milk should have. Pure milk at a temperature of 55 to 60 degrees should have a specific gravity varying between 27 and 33 degrees and if the sample falls below 27 degrees, it is to be presumed that water has been added. The density of diluted milk is sometimes maintained by boiled starch water; this can be detected by adding a few drops of tincture of iodine, which changes the starch into a beautiful violet blue, also giving the adulterated milk a similar tint.

It must always be remembered that while milk presents itself in a liquid form it becomes a semi-solid in the stomach in the ordinary process of digestion; this change is accomplished by the action of the gastric ferment, curdling the milk. Milk is not a diluent for solid foods and it should never be drank as a substitute for water when other solid food has been eaten. The practice of eating a regular meal of meat and vegetables and drinking milk at the same time invariably overloads the stomach, and if it does not injure the digestion immediately it is sure to do so in time; it also furnishes an oversupply of nitrogenous food, developing an excess of lithates or uric acid, and this burdens the liver and kidneys. If a person is fond of milk it is most excellent as a principal article of diet at a meal, and indeed nothing is better than a bowl of well-prepared mush or a few slices of bread with a pint of fresh milk for either breakfast or supper.

Boiled milk has considerable healing and binding virtues; it may be thickened with a teaspoonful of wheat flour to the pint, and taken quite warm; as a household remedy, it is one of the most valuable in ordinary cases of diarrhoea, but no other food should be taken until the cure is effected.

The milk cure is a well-established and recognized expedient for the relief and cure of a certain class of patients, and as the success of the regimen depends upon an intelligent employment of the fluid, it becomes necessary to enter somewhat into the detail of its administration.

The milk-shake, that is milk shaken in a tumbler or beaten with an eggbeater for several minutes is frequently borne by persons who cannot digest milk which has not been so treated; then again, a teaspoonful of mush or gruel added to a tumblerful of milk and thoroughly beaten, divides the curd mechanically when it forms in the stomach, and so makes the milk much more soluble by the gastric juice.

Milk should never be drank cold, but at a temperature of about 100° F., which is about as warm as it comes from the cow, for cold delays the curdling and hence the digestion of the milk, and gives it time to develop acid or lactic fermentation in the stomach, and this may cause indigestion; a pinch of salt should be added to milk, it assists in its digestion. There must be certain periods at which to take milk, allowing a definite interval for the milk to digest; taking milk in mouthfuls, for instance as a drink instead of water is wrong, for this will ferment and occasion indigestion. The proper length to intervene between each meal of milk is four hours; breakfast 8 o’clock, dinner at 12 o’clock, lunch at 4 and supper at 8 o’clock; if the patient is considerably exhausted, the time between 8 o’clock in the evening and the same hour in the morning may be too long, and if the patient is awake, a meal should be given at midnight.

The quantity of milk which may be taken for one meal is of great importance, for there is the same danger of taking too much of this food as of any other. The average quantity to begin with must not exceed half a pint, and when the appetite is capricious one-fourth of a pint is sufficient. It is now fully established that a grown person can be fairly well nourished for quite a while on one quart of milk in the twenty-four hours.

It is also of considerable importance to the patient that he does not gulp the milk as this would cause it to curd into a large cohesive mass of casein, which would be slowly dissolved or acted upon by the gastric juice, and might give rise to distress from indigestion. If, on the other hand, the patient sips the milk slowly, or eats it with a spoon, the curds will be small and flaky particles which even a weak stomach may digest. There are quite a number of persons who like milk, yet whose stomachs do not take to it, and for these a milk cure might be just the thing. It requires often a great deal of ingenuity to devise a plan whereby the obstacle may be overcome. The first step should be to shorten the interval between each meal and lessen the quantity correspondingly; thus to give the patient the milk every hour would imply that he was to take only one-fourth as much at a time as if he took it every four hours. Perhaps the milk would digest more easily if it were first beaten and slightly seasoned with a pinch of salt, or if a little strained gruel were added to mechanically divide the curd. A soda cracker, toasted bread, or the rind of thoroughly baked wheaten bread is an excellent substitute for dividing the cheesy substance of the milk when it gets into the stomach. They should not be soaked or dipped into the milk and eaten together, but eaten dry and thoroughly masticated until the saliva has reduced the bread to a soft pulp, after which a spoonful of milk should be taken and the bread stuff washed down. The saliva serves another useful purpose besides moistening the bread as it changes the starchy substance into sugar.

In other cases the milk sours on the stomach, and then some antacid or alkali, like lime water or bicarbonate of soda should be added for several days or until the disposition to lactic fermentation has subsided. If notwithstanding every precaution, waterbrash, heartburn, or a heavy oppressed pain in the stomach occurs, or if sourish, slimy secretions are vomited, the milk cure must be abandoned for something else.

Diarrhoeal diseases of infants who are fed on cow’s milk are caused, in many instances, by germs or spores that get into the milk from lack of proper cleanliness and from the unavoidable exposure of the fluid to the atmosphere of stables and dairy rooms where the milk is handled before transportation to consumers. To obviate the danger of feeding nurslings with infected milk, and to destroy the vitality of germs which find access to the milk, methods have been devised for sterilizing the milk. This process was first proposed in 1886 by Professor Soxhlet, and has ever since gained favor with the profession; it consists of exposing the milk to a temperature of live steam or boiling water for about forty-five minutes. In New York City there are two reliable firms which sterilize milk at the dairy in the country and ship it to the city.

In all the methods of sterilization the milk is placed in six or eight-ounce bottles and set on a tray or shelf, which stands above the water at the bottom of a vessel, the cover then applied and the water made to boil forty-five minutes; a perforated stopper is inserted into each flask, admitting of the escape of air and gases at the beginning of the heating process. The stopper may consist of cork with a glass tube in the center, or cotton, or of rubber with a channel a part of the distance on one side. If necessary the family can improvise their own apparatus; an inverted tin pan will serve the purpose of a tray to support the nursing bottles, and this placed in the bottom of an ordinary tin vessel with a cover completes the contrivance. The milk is to be prepared as it is to be administered, that is, the proper quantity of water, a little sugar, and the point of a penknifeful of bicarbonate of soda added, and distributed among as many eight-ounce flasks or nursing bottles as the child is fed during the twenty-four hours; thus if fed every four hours the milk should be distributed among six flasks, and if fed every three hours, it would require eight flasks. When the milk has been sterilized, it keeps sweet for an indefinite period at ordinary temperature; the bottle is to be well shaken to mix the cream before the cork is removed and the nipple applied.

When an apparatus or a sufficient number of flasks cannot be readily obtained I have the milk boiled in a fruit jar after the manner of making beef tea, as follows: A quart preserve jar is filled with milk, obtained not later than four to six hours after milking, the cover is lightly put on, to allow the escape of air and gases, and then the jar is put into a vessel, on the bottom of which an inverted pan has been placed so that the preserve jar does not rest on the bottom of the vessel where the heat would crack it; the vessel is then to be filled a third with water, and this boiled for an hour, after which the jar is carefully closed, as in preserving fruit, until wanted for use. The milk should be kept in a cool and clean place, and only as much measured out each time as is required for one mess, after which immediately close the jar. The water that is to be used for diluting the milk must have been thoroughly boiled; it is always better to prepare and dilute the milk before sterilizing it for very young infants, but when they are a year or more old, the boiling water may be added at each meal.

The casein, which is the curd or coagulable part of milk, differs greatly in its physical property in the milk of the cow from that in human milk. Mother’s milk curds in soft flaky coagula which are readily dissolved in the infant’s stomach, while cow’s milk curds in a semi-solid conglomerate coagulum which the cavity of the child’s stomach is often unable to tolerate nor the gastric juice to penetrate and dissolve. It is this heavy curd which forms the main objectionable feature of cow’s milk as a substitute for that of the mother. This can be greatly modified by first thoroughly beating or churning the cow’s milk with an egg beater, and afterwards scalding it as above described; the milk treated in this manner curds light and flaky. But it must not be presumed that the physical characteristic of casein is the only peculiarity of cow’s milk in comparison with mother’s milk, for this is not so; it also differs in quantity, that is, mother’s milk has less of casein, a fact which may be better understood by the following chemical analysis of both:

There are some children who are unable to digest cow’s milk in any form, either from a peculiarity of constitution, or from a derangement of the digestive apparatus; the milk, no matter how prepared, passes through them curdled, in lumps and undigested; to continue feeding infants on milk, notwithstanding this symptom would in all probability sacrifice the life of the child. If curds persist in the stools milk is to be withheld for a time, and crushed wheat, barley gruel or other diluents should be given alone or in combination with the thoroughly beaten white of egg. This treatment must be continued for several days and in some cases for several weeks.

Whey prepared from sweet and pure milk has often been borne by delicate and suffering infants, when nothing else could be retained. An examination into the chemical composition of whey reveals astonishing nutritive virtue, which it holds in solution; the following table shows the proportional constituents in one hundred parts:

When the whey is the product of soured milk, 0.33 or more of lactic acid is to be added to this analysis, and the same amount deducted from the sugar of milk. Essence of pepsin will curd lukewarm milk, not warmer than can be agreeably borne by the mouth; a temperature higher than one hundred and fifteen degrees Fahrenheit destroys the curdling principle of the pepsin. The quantity of essence of pepsin to be used to the pint of milk depends on the strength of the preparation; usually a teaspoonful or two is added and stirred just enough to mix; let it stand till firmly curded, then beat up with a fork until the curd is finely divided; now strain and the whey is ready for use; it should be sweetened a little; sugar of milk, if pure, would be the best, otherwise white cane sugar may be used. A newborn babe will require a tablespoonful to begin with, every two hours, always slightly warmed. It is particularly essential to keep everything clean, especially the tube and nipple; these are to be brushed and cleaned after each meal, and then laid on a clean dry plate for future use; the nursing bottle too must be rinsed and drained. The prevalent custom of keeping the tube, nipple and bottle in water after they are washed is a bad one, for to have them sweet and pure they should be allowed to dry out between times.

Condensed milk is often a valuable substitute for fresh cow’s milk; its utility, is probably due to the employment of heat in its manufacture, which destroys the germs or spores that find their way into all milk, and to the scalding of the casein which modifies its physical character so that it no longer curds into large lumps when in the stomach, but into smaller flakes. There are different brands in the market, and even the best of them may be too old and shop worn; they then become thick and dark in which condition they are no longer fit for infants’ food. The Eagle and Anglo-Swiss are among the best varieties; others contain too much sugar, while some are adulterated with starch or flour. A heaping teaspoonful of condensed milk to a teacupful of warm water, previously boiled, is the average strength, although better results are obtained when a thin gruel of corn starch or arrowroot is employed instead of plain water; when the child grows older cracked or rolled oats or graham flour may be substituted for the arrowroot. The gruel is prepared in the following manner: take half a teacupful of oatmeal or graham flour, saturate first with cold water, then stir slowly into three pints of boiling water; add a pinch of salt and boil over a slow fire for three-quarters of an hour, stirring constantly so that it will not scorch on the bottom; then strain, and if it has boiled down to less than a quart of gruel, add a sufficient quantity of boiling water through the strainer to make it measure a quart.

The gruel is to be prepared fresh every morning, and the above quantity will last about twenty-four hours. It should be kept in a porcelain or glass pitcher covered with a napkin, and set aside in a clean cool place. At regular mealtimes take out the required quantity, warm in a little agate saucepan, kept only for this purpose, and when warmed add the condensed milk, stirring until it is dissolved. This makes a fine cream-like food, agreeable to take and very nourishing if well borne by the stomach. The stools may become too loose at times from the oat or wheaten gruel, then this gruel should at once be changed for that of corn starch or arrowroot until the bowels are regulated again, and when that is done it may be advisable to return to the oatmeal or cracked wheat. The exercise of a little judgment and close observation in feeding a child will contribute greatly to its well-being; any diarrhoea or disturbance of the digestion must at once receive prompt attention and this can often be accomplished by change of food; to allow these disorders to run for any length of time is to invite serious consequences.

Adults or grown persons have also their share of stomach troubles; as a rule they eat too much, too fast and do not masticate their food sufficiently. It is not so much what a person eats, but how he eats, not so much quality as quantity.

After an exclusive dietary of milk dyspeptics should gradually return to a mixed diet, that is a regular dinner once a day; but eat slowly and masticate thoroughly; thus one eats rarely if ever too much. When the food is bolted, it makes little or no impression on the nerves of taste, nor does it appease the sense of hunger, and the only indication of satiety is a feeling of fullness.

As to the time of taking one’s dinner that depends altogether on the occupation and habits of the individual. In dyspeptics in whom the digestion is slow and the circulation sluggish the principal meal or dinner should be eaten at noon; this gives opportunity to move about, stimulating the circulation, hence increasing the absorption to its highest point. If a man eats his dinner in the evening and afterwards goes out into society or attends amusements the late dinner is not objectionable. But if a person is worn and tired out at supper and then eats a hearty meal, and lounges around the room the remainder of the evening, reading the newspaper or otherwise inactive, he is quite likely to feel distress from what he ate, and sure to experience occasional bilious spells; nightmare disturbs his sleep and he awakes in the morning unrefreshed, languid and dull. It is better for such persons to eat their dinner at noon, and retire early on a very light supper.

Beef tea became very popular at one time as a nourishment for the sick, and there can be no doubt that many patients who were stricken down with different acute diseases slipped into their graves, because beef tea was relied upon with a belief that it was a sufficient nourishment. Observation and careful researches on the subject have proved conclusively that the nutritive value of beef tea as ordinarily prepared, that is chopped beef put into a bottle and boiled in a water bath for three or four hours, has been greatly exaggerated. The process of boiling the beef has no other effect than that of drawing out the watery substance of the meat. The phosphatic salts that are contained in the meat are also extracted with the serum which holds them in solution. The natural albuminoids (musculine) which constitute the real nutritive element of beef are congealed and surrounded by the fibrous tissue—that part which snarls up and renders the beef gristly and tough. Yet as a nutritive stimulant, beef tea possesses at times considerable value; it is an excellent vehicle sometimes, for instance an egg thoroughly beaten and added to a cupful of warm beef tea is a desirable form of liquid food for invalids.

Eggs constitute a highly nitrogenized food and their nutritive value is even greater than that of stall-fed beef. The subjoined tables of chemical analysis give the definite quantity of each constituent that is contained in one hundred parts of egg and beef:

If we compare the analysis of egg with that of milk, a remarkable similarity will be observed, save one exception, namely the carbo-hydrate sugar of milk is lacking in egg, and in order that eggs have the same property of nourishing the body as milk, this element may be readily supplied by eating a little bread. The writer is familiar with the history of a case in which a patient was kept on an exclusively egg diet for five months, and during this time he increased his weight thirty-eight pounds; he consumed eight eggs and twelve ounces of bread a day.

We hear considerable unfavorable comment in regard to hard-boiled eggs, and indeed for good and sufficient reason, but the indigestibility of the hard-boiled egg is not due to any change in the nature of the albumen because it is boiled; the cause is entirely mechanical. The reason is that a hard-boiled egg is not sufficiently divided by the ordinary process of mastication to allow the gastric juice to attack it from all sides; if it were finely pulverized either by the teeth or otherwise it would be as readily digested as a soft-boiled or raw egg.

A raw fresh egg that is thoroughly beaten with an egg beater is the most readily digested food that there is. The author has known dyspeptics who could not digest any other kind, and by adding a pinch of salt and half to one tablespoonful of whisky after it is thoroughly beaten, it is certainly one of the most valuable foods for a certain class of stomach troubles that can be recommended. Patients whose digestion is very weak should begin with one egg every four hours until four eggs are taken during the day; when the strength increases, two may be taken for breakfast, and one for each meal the rest of the day; after the lapse of a few days another may be added to the second meal, and so the number gradually increased until eight are consumed; prudence would not go beyond this number lest an excess of nitrogenous matter overtax the liver and kidneys to eliminate it from the system and this result in other complications.

Dyspeptics, more than others, must avoid overtaxing the digestive organs, and while the stomach is sensitive and for a long time afterwards, they must avoid solid food.

The quantity of bread must also be jealously guarded; while the stomach is very sensitive and weak it had better be entirely suspended and when resumed no more than three ounces should be eaten at each meal to begin with. For those dyspeptics whose stomachs possess average digestive power, and who require a nourishing and readily digestible meal, the writer would recommend for breakfast a milk gruel to which a raw egg has been added: he directs that four tablespoonfuls of oatmeal mush be mixed with three-quarters of a pint of warm milk and this worked through a tin strainer by means of a potato masher; to the milk gruel so obtained and again moderately warmed, a raw fresh egg is added, which has been previously beaten to a foam, and then the whole mess is again beaten together, seasoned with salt and served in a bowl.

Medicines should play a very minor part in the treatment of dyspepsia; the artificial pepsin preparations are all overrated and their supposed efficacy is due to a careful and regulated diet rather than to the virtue of the pepsin. If the bowels are costive and if the stomach is sour and feels oppressed, prescription No. II will materially relieve these symptoms.

A person who is suffering from indigestion must above all things learn to discipline himself; when that has been once accomplished the task of carrying out an appropriate diet will become an easy one, and restoration to health and strength will be the reward.