Teething.—Teething is a subject which has at all times interested both doctor and layman, and in its supposed relation to all kinds of disorders of infancy has undoubtedly exercised an influence over the popular imagination out of all proportion to its real importance. Too often it has happened that this perfectly normal, and usually by no means serious, process, has been held responsible for grave diseases in children—diseases which in reality were the consequence of neglect and mismanagement in the far more serious matters of food, sleep, out-of-door exercises, and general hygiene. It cannot, however, be denied—particularly in respect to nervous children—that teething appears occasionally to induce unpleasant disturbances, such as fretfulness, broken sleep, digestive disorders, and occasionally fever; as a rule such symptoms persist only for a few days, if the infant be properly looked after. The treatment should consist in lancing the gums should they become much swollen, and the withholding of the usual amount of food, particularly where intestinal disturbances occur. The ages at which the teeth usually come are as follows:

2 Middle Lower Teeth 5 to 9 months. 4 Upper Front Teeth 8 to 12 months. Remaining Lower Front Teeth 12 to 18 months. 4 Front Jaw Teeth 12 to 18 months. Stomach Teeth (Canine) 18 to 24 months. Eye Teeth (Canine) 18 to 24 months. 4 Back Jaw Teeth 24 to 30 months.

Bowel Diseases.—Digestive disturbances, accompanied by diarrhoea, are the bane of infancy, and are responsible for a very large part of the frightful mortality among babies. The subject, therefore, is one of tremendous importance, but is so complicated that the limits of this little volume will only permit its being touched upon.

As already mentioned, indigestion accompanied by looseness of the bowels may be and often is the result of milk being used from diseased cows, or it may be the consequence of such carelessness in handling it that disease-producing bacteria are later allowed to contaminate it. It should also never be forgotten that where children are eating artificially prepared food improper mixing of the different components may result in serious disturbances, and we should, therefore, exercise the utmost care always in seeing to it that the food is prepared strictly according to the table which has already been given—not forgetting that in a certain number of instances we can go by no rule, and will have to experiment until we ascertain the proper proportion of the ingredients.

After a diarrhoea begins we should at once reduce the quantity of fat in the milk that is being given to the infant, and if the trouble be at all severe it is best to take it off of all food for twenty-four hours, and substitute boiled water or barley-water. As soon as the trouble is checked we may then begin to feed cautiously with largely diluted milk, and, gradually increasing its strength, in the course of a few days return to the food that was being given before the disturbance occurred. A dose of calomel or castor oil in the beginning of diarrhoeal troubles often has a very salutary effect; the parent should not hesitate to administer this if a doctor is not at hand.

In warm climates during the time of teething children very commonly develop chronic diarrhoeal conditions which often end fatally; wherever possible the parent should under such circumstances at once remove the little sufferer to a colder climate where recovery is generally rapid and complete. Even the most careful nursing under the most competent physician is often fruitless in combating disorders of this character as long as the infant remains in a warm climate.

Colic.—Colic is always due to indigestion, and is the result of the food undergoing fermentative changes, with the production of gases. This goes on even under normal conditions to a certain extent, but when it is excessive the intestines become greatly distended, and pain of a severe or even agonizing character is produced.

In the treatment of this condition warm applications should be made to the abdomen, and as quickly as possible an enema (injection), consisting of a few ounces of warm solution of salt water should be given; the salt should be in the proportion of a level teaspoonful to the quart of water. Parents will find the little ear syringe, which may be purchased at any drug store, a most satisfactory instrument for giving enemas to infants, as they do not hold too much, and being soft, are incapable of tearing the delicate tissues of the child. It is of the utmost importance to remember that the salt solution should be tepid, yet not sufficiently hot to scald the infant. As the water when given in this way is expelled very quickly the enemas may be repeated any number of times desired.

Where these measures fail, a physician should be sent for at once, but in the meantime if it be evident that the infant is suffering very much, a small dose of paregoric may be given; it should not however be forgotten that opiates are exceedingly hurtful to nervous children, and that soothing syrups and other mixtures containing drugs of this class should be avoided.

Constipation.—Constipation among very young children generally passes off as the food becomes richer, but should it occur at a later time, the trouble may be more difficult to remedy. Of first importance is having the bowels of the infant move at a certain time each day, which may be quickly accomplished in many little children by placing them upon a small chamber daily at a given hour; usually the baby very quickly learns what this procedure means, and in this way a regular habit is established which is of the utmost value to the child throughout its infancy, and every effort, therefore, should be made to bring it about as quickly as possible.

The addition of malted milk or Mellin's Food may also have the effect of diminishing constipation;—the result being brought about by the maltose contained in these preparations. The same thing may be accomplished by substituting for a part of the milk sugar in the baby's food a similar quantity of maltose. Milk of magnesia may be used in preparing the baby's food in the place of lime-water, with the result oftentimes of relieving a tendency to constipation.

Croup.—By croup is meant a spasmodic condition which usually affects children at night, and is in no way to be confounded with that really dangerous disease, membranous croup, or diphtheria, to which so many children fall victims.

Spasmodic croup is a condition which has as its basis digestive disturbances, and is almost always relieved as soon as the stomach is emptied. Vomiting may be brought about by making the child swallow a small quantity of mustard stirred up in water, or by the use of ipecac. Such severe and extremely unpleasant remedies are rarely necessary, however, since the disease may be in almost all instances at once relieved by placing around the victim's throat a cloth wrung out of cold water, which may itself be covered by a dry bandage to prevent the bed from getting wet. Children will usually go to sleep in a few minutes after the cold cloth is applied, and suffer no ill consequences as a result of its remaining around their throats throughout the night. Where the croup is very severe the little sufferer's feet may be placed in hot water, in addition to the cold cloth around the neck—the combination practically always resulting in the rapid relief of the unpleasant symptoms.

Great care should be exercised in the diet of children who are subject to croup, as by intelligent supervision the tendency to this very annoying trouble may be in a short time entirely overcome.

Nervousness.—Children of neurotic parents, particularly where they are reared in cities, are exceedingly prone to nervousness in one form or another. The condition is undoubtedly often due to heredity, but may be induced in otherwise healthy children by unhygienic surroundings and improper food. Infants exhibiting symptoms that indicate trouble of this kind should not be played with, and every care should be exercised to so direct their lives that the trouble may be gradually overcome. In all cases where nervousness persists an intelligent physician should be consulted.

Vaccination.—The only safe method that we possess of preventing small-pox is by means of vaccination. Its great value has been so thoroughly tested that the writer does not deem it necessary to go into a discussion as to its merits. A child should be vaccinated in at least three places during its early infancy,—there being no danger in doing the operation immediately after birth. Persons ignorant of aseptic surgery should not do this operation, but should always call in the services of some person prepared to do the work in a cleanly manner. Either the leg or the arm may be selected; and children should be revaccinated whenever small-pox breaks out in the community.

Kissing Babies to be Avoided.—Kissing infants in the mouth is a very bad practice, as in this way disease may be quite innocently conveyed to them. The public should be taught to understand that it is not infrequently the case that bacteria may be present in the mouths of individuals who are quite immune to their ill effects, and who are, therefore, perfectly well, but who may, by conveying them to others, particularly children, induce in them serious disease. When caressed in this way at all children should be kissed upon their necks or feet, and never in their mouths or on their hands.

Juvenile Contagious Diseases.—Children are peculiarly prone to a class of highly contagious diseases, the exact nature of which is not yet understood, and we possess therefore little knowledge as to the proper means of preventing their spread. Practically all that is known about them is that they are conveyed by contact, or even by the air, particularly where a child suffering from one of them is placed in a confined place with another who is susceptible; these diseases likewise may be carried by means of clothing and other articles that have been in close contact with a child suffering with any of them. The lesson of importance to be learned, therefore, is that if we wish our children to escape maladies of this class we should not permit their indiscriminate association with others. As these diseases cease to be a serious menace after children have passed through their earlier years it does not at a later time matter so much as to whether they are exposed to them or not. As a general thing children develop these affections in from ten to fifteen days after having been exposed, though one of the most severe of them, scarlet fever, may make its appearance as early as twenty-four hours after it is contracted. These diseases are usually ushered in by a severe headache, pains in the head, back, and limbs, high fever, and oftentimes a chill. As soon as a child develops such symptoms the advice of a competent medical man should be at once sought, and the little sufferer should be at once completely isolated.

In concluding, the writer would particularly exhort parents to obey to the letter the instructions of their physicians, and never under any circumstances to dose their helpless off-spring with patent or proprietary medicines, which contain no man knows what, and which unquestionably are often highly injurious, especially to children.



CHAPTER V

PROPER EATING—THE SECRET OF GOOD HEALTH

Very slowly the world is awakening to the fact that no agencies play such an important part in the preservation of health as the consumption of reasonable quantities of well-cooked and properly selected food, and the habitual taking of wholesome drinks. On all sides the observant medical man sees constant and reckless disregard of the simplest and most fundamental laws governing this subject. Nothing is more common than to hear of men in the prime of life being seized with what is called a "nervous breakdown,"—which generally means a digestive breakdown—to be followed by an era of misery for the unfortunate subject and his scarcely happier family. Nervous and irritable, the slightest inconveniences are magnified into terrible calamities, he constantly fears death, and his sleepless nights become a saturnalia of gloomy thoughts and abject fears.

Of course, not everyone guilty of dietetic sins goes through such sad experiences, for the naturally strong frequently escape the consequences of their rashness, particularly where they live in the rural districts and take plenty of out-door exercise. Let not such, however, flatter themselves that their disregard of hygienic laws will go unpunished. After indiscretions in eating they will all, at one time or another, have acute indigestion with diarrhoea; and how often does the previously well and hearty man after indiscretion in eating wake up with a dull headache, furred tongue, foul breath, and a general feeling of sluggishness and mental depression?

Is it his liver? Our unscientific medical ancestors—at a loss to account for the state of affairs in any other way—answered in the affirmative, and, believing it was produced by a collection of bile in the liver, called the condition "biliousness." How absurd modern science has shown this assumption to be! We now know that the liver is rarely diseased, and that it furnishes its secretion, called bile, for the purpose of aiding digestion rather than hindering it, and that this substance is rarely, if ever, produced in excess. It is undigested, putrefying food in the intestinal tract that produces the trouble. Under such circumstances one usually takes a dose of calomel, which, being perhaps the most satisfactory and perfect purgative that we possess, relieves the condition promptly by getting rid of the offending material; but the drug does not act on the liver.

Unfortunately ill results of quite a different and a much more serious character often follow in the wake of dietetic errors; in those who have a tendency to consumption, particularly where they overwork, this dread disease frequently makes its appearance as a consequence of bad eating and drinking. Many, if not all, of the degenerative diseases that appear in the latter half of life are produced in this way, and nothing is more certain than that the peace, happiness and longevity of mankind could be incalculably increased by the simple observance of what is known concerning proper eating and drinking.

We will now consider the very important subject of the quantity and character of foods which should be taken in health, with suggestions as to those most suitable for dyspeptics.

Over-eating too Prevalent.—The majority of us take much more food than is necessary, with the result that we suffer from indigestion.

When we consume more than a reasonable amount of food habitually serious digestive disturbances are sure to result,—to be often followed at a later time by tuberculosis, morbid alterations in the blood-vessels, Bright's disease, and other serious maladies of a chronic nature. Professor Chittenden, who is America's greatest physiological chemist, has demonstrated that in all probability previous workers along these lines have been excessive in their estimates as to the amount of food required. He showed that a man could live for a period of nine months on a daily ration which contained about one-third of the usual amount of proteids generally thought to be necessary, and at the same time the fats and carbohydrates were reduced to such a degree that the total number of heat units, or calories, liberated from the food scarcely exceeded in number one-half of the standard requirements. He also experimented on thirteen volunteers from the hospital corps of the United States Army, to whom he daily fed rations of only 2,000 calories, and, notwithstanding that they engaged in physical work, all were found to be in better condition at the end of six months than they were at the beginning.

These results strongly point to the conclusion that previous estimates as to the quantity of food required are erroneous, and that man can not only live, but may continue in strength and health on much smaller amounts. It is highly probable that this discrepancy may be accounted for, at least to a considerable extent, by the assumption that much of the food ordinarily taken is rejected by the system, and passes out as waste, while, when small quantities are eaten, it is for the most part absorbed.

Mastication.—Thorough chewing of the food is absolutely essential for proper digestion. While it is true that this, like all other good things in life, may be, and often is, carried to an unnecessary extreme, it is certainly true that we would be infinitely better off if we were to go to the extent in this direction of so called "Fletcherism" rather than perform this most important function in an indifferent manner.

This rule applies with especial force to food of a starchy nature,—bread, potatoes, oatmeal, rice, etc. In order to digest food of this character it must be very thoroughly cooked and when finally placed upon the table it should be of such consistence that it requires chewing before it can be swallowed. Not only is this necessary from the standpoint of breaking up the larger particles into smaller ones, thus permitting the food to pass freely through the stomach and intestine, but it is of the greatest importance for it to be thoroughly soaked with the saliva during the process. It is thus of no advantage for starches to be served in a finely divided form—in fact it is directly the contrary, since under such circumstances it is almost always the case that such foods are swallowed without having been insalivated.

What has been said concerning the mastication of starches applies with almost equal force to other foods. Without exception their digestibility is much increased by thorough chewing. As the result of recent experiments carried out by means of the X-ray, it has been shown that particles of food of any considerable size will not pass from the stomach into the intestine; as often as an object of this kind attempts to force its way from the former into the latter the opening between the two closes, and as a consequence the food is retained in the stomach longer than it is in health—resulting in the course of time in catarrhal conditions of the organ just named, and an unnatural relaxation of its muscular walls. Under such circumstances the patient quickly develops symptoms of indigestion, and if his habits be not corrected the trouble gradually grows worse until the sufferer becomes a chronic dyspeptic.

Classes of Nutritive Substances.—All substances that are of any appreciable value in nutrition may be divided into those that are nitrogenous in character (albumins, legumins), the carbohydrates (starches and sugars) and compound ethers (fats). Of all these the nitrogenous foods are the most important, since they contain the material from which the great bulk of the body is largely composed, and at the same time there is every evidence that in case of need they may be broken up into chemical substances that may take the place of any of the other kinds of foods; upon nitrogenous food, then, a man may live alone, while this cannot be done on other articles of diet. The fats, starches and sugars are very closely related to each other, and it is generally believed that they subserve much the same end in the economy; by undergoing chemical change they furnish energy (heat and muscular force) and are undoubtedly largely responsible for the formation of the fats of the body. While there is some evidence that under certain conditions alcohol may be a food, its value is certainly very small, and it is not of sufficient importance to be considered in this connection. The ideal diet then for a healthy man is a proper proportion of nitrogenous (albuminous) food, along with a reasonable portion of fats, starches and sugars. Professors Voight and Atwater have calculated the following table, which fairly represents the amount of proteids, fats and carbohydrates that should compose the rations for twenty-four hours for the ordinary adult male.

ADULT MALE OF AVERAGE WEIGHT.

At Rest. Moderate Labor. Severe Labor. Proteids 110 grammes 118 grammes 145 grammes. Fats 50 " 50 " 100 " Carbohydrates 450 " 500 " 500 "

The tables that follow, which were arranged by Hutchinson, give a very good idea of the generally accepted views as to the relative quantities of the different foods that are thought necessary for the average adult engaged in ordinary muscular work:—

Fuel Food Materials. Amount. Albumins. Fats. Starches. Value. 1. Ozs. Lbs. Lbs. Lbs. Calories. Beef, round st'k 13 0.14 0.12 .... 695 Butter 3 .... 0.16 .... 680 Potatoes 6 0.02 .... 0.15 320 Bread 22 0.12 0.02 0.75 1760 — —— —— —— —— Totals 44 0.28 0.30 0.90 3455

2. Pork, salt 4 .... 0.21 .... 880 Butter 2 .... 0.11 .... 450 Beans 16 0.23 0.02 0.59 1615 Bread 8 0.04 0.01 0.28 640 — —— —— —— —— Totals 30 0.27 0.35 0.87 3585

3. Beef, neck 10 0.10 0.09 .... 550 Butter 1 .... 0.05 .... 225 Milk, one pint 16 0.04 0.04 0.05 325 Potatoes 16 0.02 .... 0.15 320 Oatmeal 4 0.04 0.02 0.17 460 Bread 16 0.09 0.02 0.56 1280 Sugar 3 .... .... 0.19 345 — —— —— —— —— Totals 66 0.29 0.22 1.12 3505

4. Beef, up. sh'lder 10 0.09 0.13 .... 800 Ham 6 0.06 0.13 .... 650 Eggs, two 3 0.03 0.02 .... 135 Butter 2 .... 0.11 .... 450 Milk, one pint 16 0.04 0.04 0.05 325 Potatoes 12 0.01 .... 0.11 240 Flour 9 0.05 0.01 0.38 825 Sugar 1 .... .... 0.06 115 — —— —— —— —— Totals 59 0.28 0.44 0.60 3540

5. Sausage 4 0.03 0.11 .... 510 Codfish 14 0.07 .... .... 140 Butter 2 .... 0.11 .... 450 Milk, one pint 16 0.04 0.04 0.05 325 Beans 5 0.01 .... 0.18 505 Rice 2 0.01 .... 0.10 205 Potatoes 16 0.01 .... 0.23 420 Bread 9 0.04 0.01 0.28 640 Sugar 3 .... .... 0.19 345 — —— —— —— —— Totals 71 0.27 0.28 1.03 3540

6. Beef 8 0.08 0.10 .... 560 Mackerel, salt 4 0.04 0.04 .... 230 Eggs, two 3 0.03 0.02 .... 135 Butter 2-1/2 .... 0.13 .... 565 Cheese 1 0.02 0.02 .... 130 Milk, one pint 16 0.04 0.04 0.05 325 Potatoes 8 0.01 .... 0.08 160 Rice 2 0.01 .... 0.10 205 Bread 9 0.05 0.01 0.32 720 Sugar 1-1/2 .... .... 0.09 175 — —— —— —— —— Totals 55 0.28 0.36 0.64 3205

Calories Defined.—It should be explained that the term "calorie" is one which has been adopted as a scientific expression for the fuel-value of substances undergoing oxidation, and in this connection refers to the heat-producing capacity of foods. The "calorie" is the amount of heat required to raise the temperature of one gramme of water 1 deg.C. It has been estimated that starches, sugars and albumins liberate during combustion 4.1 calories per gramme, while fats produce 9.3 calories. It will be noted that in the tables just given the total number of calories is in each instance somewhere in the neighborhood of 3,500, which is considered to be about the number of heat units required by the average man at moderate muscular work. The weight of the average woman being less than that of the adult male, a reduction of about 20 per cent. from the foregoing figures would approximate the amount of food required by the former.



CHAPTER VI

BREAD AND ITS RELATIONS

At all times, and among all peoples, bread has been recognized as one of the great staple articles of diet. Although its commonly quoted designation, "the staff of life," would more appropriately belong to the albumins, there can be no question that breads of one kind or another are among the most wholesome and necessary of all food-substances. Not alone is this true on account of the starch of which they are largely composed, but they contain more or less vegetable albumin; it is thus seen that bread is a mixture of the two most important food-stuffs, starch and albumin, but the quantity of the latter is so small that an individual would have to eat an enormous amount of the mixture to secure enough of this ingredient to meet the needs of the body. For practical purposes, then, we may regard bread as being starch.

Within recent years quacks have disseminated very widely throughout this country the error that foods are more digestible when raw. It was long ago demonstrated that pure albumins, of which eggs and milk are the nearest natural examples among foods, are assimilated somewhat better when eaten raw, but this applies to no other foods except sugars. Any success that has followed the teachings just referred to undoubtedly rests purely on the fact that their followers are instructed to live largely on raw eggs and milk, and as the patient usually discovers in a short time that these two foods agree with him while other uncooked ones do not, he naturally eats them to the exclusion of the rest and where he takes a sufficient quantity increases in weight and strength.

The idea that starches are more digestible when eaten raw could be easily refuted by any intelligent farm-boy who recalls one or more sad experiences from over-indulgence in raw sweet potatoes.

What shall we look upon as bread? Of course all such food-stuffs as are commonly included within this designation are to be accepted; such as wheat-bread, graham-bread, whole-wheat bread, biscuits, rolls, light bread, bakers' bread, waffles and batter-cakes, rye bread, corn bread, preparations of corn-starch, with which we should place those articles of diet so commonly used in the south, usually called grits, hominy, egg-bread, muffins, corn-meal cakes, potatoes, both sweet and Irish, arrowroot and the so-called cereals or breakfast-foods, including oatmeal.

Now which of these is the most wholesome? This inquiry cannot be answered conclusively for the reason that the digestibility of this, as of other foods, depends largely on the individual. For the sake of clearness the various breads will now be considered in detail.

Wheat-bread the Best.—It may be confidently asserted that well-cooked and perfectly dry wheat-breads are to be regarded as being generally the most digestible of all bread-stuffs. This is not dependent on any inherent property in wheaten starch as a result of which it is acted upon more readily by the juices whose office it is to render it fit for absorption in the body, but is wholly due to the fact that breads of wheat-flour may be made very dry and light.

As has been already explained, it is particularly necessary that starches should be thoroughly soaked in saliva, and this can only be accomplished when the bread is of such consistence that it must be chewed for a time, and so dry that it will readily absorb the salivary secretion. The writer, then, would advocate well cooked light-bread or bakers' bread, or toast made from either, as being the best of all food-stuffs of this character. The crusts of biscuit a day or so old are quite digestible, as are also waffles, if made with little grease and cooked thoroughly. The soft inner portion of biscuit and that of hot rolls, as well as batter-cakes, is decidedly unwholesome.

Graham-bread should not be constantly indulged in for the reason that it contains multitudes of sharp particles of the husk of the grain that cut the delicate mucous membrane of the stomach and intestines as it passes along, and if its use be long and continued, severe ill effects necessarily follow.

In this connection attention should also be called to the common error that particles of husk are of advantage to breads of all sorts; the former consist chemically of exactly the same thing as sand, and are quite as indigestible, and this, in connection with what has just been said of their action on the delicate mucous membranes of the intestinal tract, should be quite enough to convince anyone that they are not only useless, but injurious. It is true that the irritation produced by the husk will oftentimes cause the bowels to act, but results of the same character may be induced by many other agencies, within themselves less harmful.

Rye-bread.—There is no reason why rye-bread should not be prepared in quite as wholesome a way as is wheaten-bread, and this grain should undoubtedly rank as one of the best of the cereals. Its use, however, is so limited in this country that it is scarcely necessary to go into a lengthy discussion as to its merits. It may be remarked that the ergot fungus frequently grows on this grain, and when ground up with it occasionally poisons the consumer where the quantity of the substance is large and the bread is eaten in considerable quantities. Instances of this kind are not uncommon among the peasantry of Europe, where a black bread made from rye is the staple article of diet. Of course, when making food-preparations of rye, we should be careful to have the flour thoroughly winnowed, and to cook the bread until sufficiently dry to acquire a proper consistency for chewing.

Corn-bread and Corn Food-products.—When made from perfectly sound grain, and if not allowed to undergo fermentative changes afterward, there can be no question that food-products of corn are entirely wholesome, and, from the standpoint of chemical composition, quite as nourishing as similar articles of diet prepared from other grains. It is, however, unfortunately true that we cannot, in the majority of instances, definitely assure ourselves that our corn-bread is made from grain that comes up to the above specification, nor can we be sure that the meal is fresh, or preserved at such a temperature as would forbid the growth of various germs. It has long been known that bad corn would kill horses, but notwithstanding this, we have accepted the view that no amount of deterioration in the grain could result harmfully to man. That this latter assumption is incorrect seems now in the highest degree probable.

Pellagra.—It is known that a very curious and fatal disease called pellagra is prevalent to a considerable degree at the present time in the United States, and it is not going too far to say that all of those best capable of judging are of the opinion that the malady is the result of eating just such corn as we know kills horses.

It is likewise true that the nutritive power of this grain could in no way be increased by allowing it to decay before consumption; indeed, the contrary must be the case, and, if it were in no manner actually harmful, our sense of the aesthetic and of what is proper to eat, should make us reject in this case, as with other foods, that which is unsightly to the eye and unpleasant to the taste. We should no more eat bad grain than a rotten apple, or putrefying meat. The increased prevalence of pellagra is exciting attention all over the United States, and is very generally assumed to be the result of lack of care in the harvesting and preservation of our corn. Instead of being cut before it is ripe, and shocked in the field during the latter part of the summer, it should be allowed to ripen on the stalk, and after cold weather sets in gathered while dry, and preserved in well-covered and well-ventilated barns. Every care should be taken to keep it dry while being shipped from one part of the country to another, and similar precaution should be observed with the various food-products made from it. If kept in a cold place, meal or grits made of good corn may be preserved in excellent condition for eating throughout the winter; but as soon as the warm weather begins they should be stored in the refrigerator, and should there remain during the summer; similar precaution should be taken with meal or other corn-products during the hot months.

Over a large area of the United States corn-bread is an article of daily diet with a great majority of the inhabitants, and its wholesomeness as compared with other breads becomes, therefore, an important question. Unfortunately, corn-meal does not lend itself to the preparation of a dry bread having sufficient consistency to require chewing. It is true that the crusts of the bread made from this grain answer these requirements fairly well, and there is therefore no reason why this part of it should not be used to any extent, provided it be prepared from good meal. We should endeavor to cook thin pones of the bread rather than the thicker ones so common in the south. The objection that corn-bread can only be masticated with difficulty applies to the other preparations of this cereal, such as egg-bread, muffins, etc., and they are not, therefore, with the exception of the crusts, to be looked upon as being the best form of bread. Corn-cakes, like all batter-bread, are to be mentioned only to be condemned. Grits and hominy are soft and moist and cannot be properly chewed, and are, therefore, not to be recommended as good breads. Corn-starch preparations are likewise entirely lacking in the elements required to make good bread, and should only be used occasionally and in small amounts.

Disadvantages of Potatoes.—Irish potatoes are eaten almost as commonly in some portions of the United States as are corn-products in others, and therefore deserve the careful consideration of the hygienist. While it is not believed that, like the latter, potatoes give rise to any definite disease, it is unfortunately true that they are theoretically worse breads than those made from the grain just referred to. In whatever way cooked, they are moist and require no chewing, and as a consequence many persons with delicate digestions do not assimilate them properly.

Arrowroot.—The preparations of arrowroot are considered digestible, though here again we find that such articles of diet are generally moist and of not proper consistence to be chewed, and they are, therefore, not as valuable as are breads made from wheaten flour.

Rice.—Rice is used by a large portion of the world's inhabitants. When cooked thoroughly and very dry, it is perhaps almost as good bread as is that made from wheat. The starch granules of the former, like those of arrowroot, are somewhat smaller than those of wheat.

If it were possible to keep rice-flour in good condition, and if it could be made into light-bread, it is likely that it would be superior to wheaten flour, but this does not appear feasible.

A peculiar and very fatal disease prevails in the East, known as "kak-ke" or "beri-beri," which is now generally regarded as being the result of eating decomposed rice. The writer has seen one or two examples of what he considers American beri-beri, but as our rice-eating population is small, it is not likely that this disease will ever become a serious problem in the United States.

Cereals or Breakfast-foods.—Lastly we will consider the so-called breakfast-foods, which are neither more nor less than various preparations of the different varieties of starch. They are generally made from oats or corn-starch. They are nothing more than bread, and as some of them have been put through a sort of fermentation it is difficult to understand how they could be regarded as being quite as wholesome as the original products from which they were made. This, however, is not the principal objection to them. The real trouble lies in the fact that they are, in the majority of instances, served with cream and sugar. When we remember what has already been said about starches that are soft and cannot be chewed, and of the ill effects of sweets on persons who have any inclination towards dyspepsia, it will be seen that these foods are not to be regarded as being wholesome. The real reason that would appear to explain the coming into existence of these preparations is that they are mixed with cream and sugar, which appeals strongly to the "sweet-tooth" of the average person. They are nothing but bread, and very bad bread at that. The remarks made concerning breakfast-foods apply with equal force to oatmeal, which, as generally used, has the additional disadvantage of containing particles of husk.

In concluding this discussion on starchy foods the writer desires particularly to call attention to a very common error in the way they are eaten. Mention has already been made of the fact that fats after being melted are by no means so wholesome as in their natural state, and produce, when heated with starches, a very indigestible mixture. Thus, theoretically, it is bad to use any great amount of lard, butter or other fat in the preparation of breads, and it is likewise undesirable to spread butter on heated breads, as is so often done just before eating biscuits, waffles and batter-cakes. The combination is certainly a seductive one, and pleasing to the taste of most persons, but this in no way invalidates the fact that the mixture is exceedingly indigestible.

Pastries and Cakes.—Peculiarly unwholesome are pastries containing any considerable proportion of fat, and also most varieties of cake. With the exception possibly of hot batter-cakes served with an abundance of butter and syrup, cooks have so far produced no compound so heinous and totally depraved as pound-cake. Fruit-cake also stands high up in the list of undesirable sweets. It certainly passes all understanding why cooks should continue to persecute the stomachs of a dependent world with such highly obnoxious concoctions; the only excuse that can be given for them is that the mixtures are palatable. Where a housekeeper feels it necessary to prepare cake, she should select some receipt free from butter or other fat, such as angel-cake or sponge-cake, both of which when properly made are exceedingly good to the taste, and lack the undesirable quality of containing fats. Explanation for the peculiarly unwholesome character of food containing melted grease lies probably in the fact that the grains of starch under such circumstances must be to a greater or less extent covered by a thin layer of the fatty substances, and as a consequence it is impossible for the saliva to penetrate to the starch and perform its normal digestive function.



CHAPTER VII

MEATS, SUGARS AND MILK

First in the list of foods the writer would place those nitrogenous substances commonly eaten that belong to the class of albumins. That these substances are in reality the most important of all food-stuffs there can be no sort of question, since they, of all things eaten by the human being, are alone absolutely essential for his well being and even his existence. They are the substances that almost exclusively go to make up the muscle and tendons. Along with the lime-salts they enter largely into the composition of the bones and cartilages, brain, spinal cord and nerves. Other foods are incapable of taking the place of the albumins, so that they are absolutely essential for normal life in the human being.

The amount of albumin necessary for the normal adult has been variously estimated, the tendency at the present time being to place the quantity needed somewhat lower than was at one time done. It is probable that about two ounces of pure albumins is somewhere near the amount required in twenty-four hours by a normal adult.

It is well, since we are so dependent on foods of this class, that we have two quite distinct sources from which they may be taken. The great bulk comes to us in the form of meats, including poultry, game, oysters and fish of various kinds, in addition to beef, mutton, and hog-meat in its several forms. Of animal origin also we have eggs, which are among the most valuable of all foods of this class on account of their high digestibility.

From the vegetable world we get albumins known as legumins, which differ somewhat from those obtained from animal sources, though taking their place in the economy in all essential particulars. Unfortunately the legumins are usually so mixed with starches and other vegetable substances less digestible, that it is necessary to take a large bulk of foods of this latter class in order to secure anything like the requisite amount of the former.

Before taking up individually the various albuminous foods, the writer would again direct attention to the chapter on cooking, and would strongly urge upon the reader the proper methods of preparing nitrogenous foods therein stated. Where the albumins are in a nearly pure state, as in milk and eggs, they are slightly more digestible when raw, but all meats should be cooked until only the faintest tinge of red remains if we wish to have them prepared in the most wholesome way for those with delicate digestions. Meats are, as a rule, most wholesome when cooked "very done."

It has long been the cry of sentimentalists that no living being should die in order that man might exist. Unfortunately for such theories, the stern and unbending edict of nature has negatived views of this kind ages before the altruistic philosopher came on the scene, and we are daily constrained to bow to this mandate of one of the primal laws of existence. However much we might desire it otherwise, it has been written that "only in death is there life;" nor may any animal being disobey and continue to exist. As has been already explained, the human being cannot thrive on vegetable substances alone; from them he may get a certain amount of nitrogen in the form of legumin, but there is not enough to make up for the waste of this substance that constantly goes on in the body.

Theoretically it is of very little importance which of the meats are selected to supply our nitrogenous food, but it is unfortunately true that such foods vary much in digestibility, and it will therefore be necessary to consider them separately.

Beef.—When tender and cooked to a proper degree, beef is considered one of our most wholesome of meats. Like other foods of this kind, it should not be fried, but should be broiled or roasted, and a certain amount of fat may be eaten along with the lean portions without injury, and in many persons unquestionably with benefit.

Mutton.—Of all the coarser meats, mutton is unquestionably the most digestible, and when cooked in the same way as directed for beef is eminently wholesome.

Hog-meats.—On account of the large portion of fat between the muscle-fibers, hog-meat, particularly when fresh, is not usually regarded as being digestible. Some persons eat it with impunity, but for the vast majority it should be taken only in small quantities. It should not be fried. In the form of ham, hog meat is more wholesome than when fresh, but even in this condition many dyspeptics find much difficulty in digesting it. The best method of cooking it is to boil thoroughly. After being cooked in this way and then broiled, it is most appetizing, and is much more wholesome than when broiled without being previously cooked. As bacon, hog-meat enters largely into the dietary of a great portion of the laborers of this country, and there can be no doubt that on the whole it answers the purpose of a staple food admirably. It contains even more fat than nitrogenous substances, and may therefore be looked upon as a mixture of butter and meat. Dyspeptics cannot eat it with impunity in many instances, though it agrees far better with them than does ham or the fresh meat. If it were generally eaten boiled it would provoke less trouble than when fried. At this point the writer would repeat his warning concerning the indigestible character of melted grease, of which the gravy from bacon is a striking example.

When "cured" in a somewhat different way hog-meat as "breakfast-bacon" is very generally used throughout the civilized world, and is one of its most wholesome forms. This when broiled is both appetizing and wholesome, and should form a part of the daily dietary of everyone able to afford it.

Poultry and Game.—Among the more delicate and most wholesome forms in which albumins are taken we find poultry and game well up toward the head of the list. Meats of this character should be very thoroughly cooked by being either baked, smothered or broiled.

Fish.—Fish of almost all kinds are wholesome provided they be fresh and properly cooked. The culinary artist prepares of them most appetizing and nutritious dishes, and they are therefore properly to be recommended as among the best of the albuminous foods.

Oysters and Clams.—Oysters and clams are usually considered somewhat apart from the generality of the foods of this character. When fresh they are wholesome and delicious when eaten raw, and may be cooked in a great variety of ways. The reader should be especially warned that fried oysters are not so wholesome as when they are prepared by other methods, for the reason that they are surrounded by a batter containing quantities of melted grease.

Eggs.—Among the most delicate, digestible, and nutritious of all foods we may place eggs. Though somewhat more digestible when raw, they agree, as a rule, even with the most fastidious stomach, however cooked, even when hard-boiled. Eggs lend themselves readily to the formation of many delicious dishes, such as omelets, souffles, etc.; but unfortunately they do not contain nutriment in a very concentrated form, and where an adult is living on them alone it requires from one and a half to two dozen daily to furnish the necessary amount of food.

Fats.—Under the term "fats" are included all oily substances, such as butter, lard, olive and cotton-seed oils, and to a great extent the fat contained in meats. These substances are closely related to starches and sugars, and undoubtedly play a more or less similar role when taken into the body as food. From the standpoint of heat-producing capacity they more than double, weight for weight, meats and starches, and are, therefore, instinctively highly prized by dwellers in cold countries where much heat is necessary. In warmer countries the necessity for excessive heat-production in the body does not exist.

While oily substances are certainly capable of adding to the cushion of fat commonly found beneath the skin in normal individuals, they are not looked upon as being to any extent tissue-builders, resembling in this particular the starches and sugars.

When fats are to be eaten, care should be taken that they be as fresh as possible, or, if this is not feasible, they should be preserved in such a way as to prevent their becoming rancid—a condition which is the result of the formation of fatty acids, lending a peculiarly unpleasant odor and taste, and producing a decided decrease in food-value. This alteration may be largely prevented by keeping fats in a refrigerator at a low temperature, and may also be greatly retarded by the addition of salt. In this country butter is usually treated with a very considerable amount of salt, but in Europe it is universally served fresh. Within recent years facts have been established that show that Americans use an excessive amount of this substance—possibly causing disease in some cases; and doubtless we would be better off if we were to follow the European practice.

Oily substances when in good condition are certainly of high value as foods, but should be taken more or less with an eye to the climate, and to the season of the year. When placed on cold bread and eaten along with it they are extremely palatable, and may be taken in reasonable amounts with decided benefit to the whole body. In temperate climates it is generally estimated that about three ounces is a desirable amount for the average adult. In this connection it may not be out of place to mention that the various preparations of cod-liver oil, advertised so freely in the lay press, in some instances actually do not contain a single particle of the substance that they are supposed to be principally composed of; and it may be further stated that there is no good reason to believe that bulk for bulk oils of this kind are in any way superior to those fats commonly eaten. The writer often recalls the saying of a very wise old physician of his acquaintance that "cod-liver oil is nearly as good as butter."

Sugars.—This term includes the large number of different substances of a more or less sweetish taste that belong to the group of carbohydrates. They are closely related to the starches, and it is generally assumed that they play much the same part after being taken into the body. Some of these are of animal and some of vegetable origin—but except the sugar found in milk, the only ones commonly consumed are those derived from cane, beets, and fruits; the sugar from the first two is known as cane sugar or dextrose, and that from the latter as grape sugar or glucose. Like albumins they may be eaten without having been previously cooked, and are unique in that they undergo no chemical change whatever as a result of ordinary degrees of heat.

While the consumption of sugars in all civilized nations is rapidly increasing, there can be no question that, irrespective of fruits, they are, of all foods, the most frequent causes of digestive disturbances. It is only within comparatively recent times that mankind has possessed means of separating sugars in any great bulk from the plants containing them, and as a consequence they have only entered prominently into our every-day diet for a relatively short period of time. Before this, it is true, they were consumed to a greater or less extent in various fruits, but the quantity was insignificant as compared with the amount now universally eaten. As a result of this we are now confronted with a new dietetic problem. For ages the human stomach has been accustomed to deal with only small quantities of these substances, and developed accordingly a capacity to digest them proportionate to the amounts then eaten. Now, however, we constantly call upon our digestive organs to deal with large quantities of such foods, and it is not strange that there has been more or less rebellion on their part.

Experiments have shown that a small amount of sugar assists in the normal chemical changes that go on in the body, and it is, therefore, obvious that nature intends us to take a certain quantity of it. Moreover it is true that sugars while being burned in the body give off much energy—mainly manifested in muscular power; where then we are taking active physical exercise foods of this kind are peculiarly appropriate. It would, therefore, not be wise for us to leave this food entirely out of the dietetic list, but to use it only in small amounts—particularly where we lead sedentary lives. Sugar and alcohol play a more or less similar role in the animal economy. It is well known that those who do not use alcohol are peculiarly prone to consume considerable quantities of sugar; and it is equally a matter of common observation that those who habitually take alcohol rarely eat sweets to any extent.

When sugar is properly assimilated, as seems to be done most easily by children, it is an excellent food, but where sweets are over-eaten, and not properly digested, they give rise to a great accumulation of gas in the intestine, and produce in many persons a marked acidity of the stomach, frequently accompanied by severe insomnia. Nothing so quickly relieves such sleeplessness, caused by a "sour stomach," as allowing ten or fifteen grains of ordinary cooking-soda to slowly dissolve in the mouth and swallowing the saliva rendered alkaline in this way.

Milk.—Milk may be looked upon as an ideal food, it being composed of water carrying in solution the three great natural foods—albumins in the form of casein, carbohydrates as milk-sugar or lactose, and fat. Mixed in the proportion in which they here occur, they are most admirably adapted to the delicate digestive apparatus of the infant—the relative proportion of the different substances even gradually changing as the assimilative powers of the youthful organism increase; it is thus seen that milk itself is not of constant composition, even in the same animal, and that it alters in such a manner as to meet best the needs of the delicate being depending upon it for proper sustenance. It is also the case that the composition of milk varies in different animals—showing again how admirably nature exerts its powers in meeting desired ends.

The lesson of practicable importance that we learn from this is that the milk of one of the lower animals is not in its natural state quite suited to the delicate stomach of the growing infant, and that if it be substituted for the mother's milk it must be more or less altered, depending upon the age of the child. It is particularly important that sweet milk be taken slowly, as otherwise large curds, difficult of digestion, form as soon as it gets into the stomach.



CHAPTER VIII

FOOD-VALUE OF VEGETABLES

In recent times we hear much of vegetarianism, which has its advocates among many highly intelligent people, and which, as a consequence, has achieved a certain vogue throughout the civilized world. It is rarely the case, however, that those who affect to practice this cult in reality live exclusively on a vegetable diet. As a rule it will be found that they are milk-drinkers, and not infrequently add eggs to their dietary. It is, of course, absurd to regard as vegetarians those who simply avoid meat, since it is true that the nitrogenous substances contained in milk and eggs differ in no essential particular from similar substances found in flesh of all kinds.

Experiments on a somewhat extended scale have shown within recent years that young and vigorous individuals at least may live and thrive on a diet composed largely of vegetables; no one has yet shown that a strict vegetable diet is that best adapted to the average individual, and no competent authority on this subject at the present time advocates a diet purely of this kind. It is true that the vegetables ordinarily eaten contain all of the elements that are essential to the animal system, such as starch, sugar, fat and albumins. Unfortunately, however, the amount of the last-named substance is usually so small in food-plants that the quantity that would have to be eaten by a normal individual taking active exercise would cost considerably more than if a reasonable proportion of animal food were included, and—which is of even greater importance—the digestive powers of the individual who attempted to live only on food of this character would be severely taxed, and, in the long run, probably seriously impaired. Furthermore, vegetables and fruits contain substances, usually in great quantity, that are scarcely acted upon at all by the digestive juices. Chief among the latter is cellulose, which, while forming the great bulk of the food of herbivorous animals, is scarcely suited to the weaker digestive capacity of the human being; practically none of it is converted to the uses of the body. It is thus seen that in the average man or woman a dietary consisting largely of vegetables would result in the presence in the intestines of a greater or less bulk of indigestible materials, which could subserve no good purpose other than that they would by their mechanical presence have a tendency to cause the bowels to act; as is the case with fruits, however, it is unfortunately true that this large residue of undigested food, in one way or another, often gives rise to considerable irritation of the mucous membrane of the intestine, and frequently produces dyspeptic disturbances, among which looseness of the bowels is common.

This brings us to a consideration of the digestibility of vegetables in general, which is always the paramount consideration when dealing with the value of any substance to be used as a food. It has been before remarked that young and vigorous persons seem to thrive on a dietary largely of vegetable character, but the case is certainly quite different with older people, particularly where their digestive powers are impaired. In the latter we often find that severe intestinal disturbances follow even after moderate indulgence in vegetable foods—particularly where they are served with vinegar, or some other fruit acid. Another peculiarity of foods of this kind that makes decidedly against their digestibility lies in the fact that, being soft and containing a large proportion of water, they are scarcely ever properly chewed, and as a consequence they are swallowed in comparatively large masses without having been adequately insalivated.

Vegetables may be roughly classified as legumes, roots and tubers, and green vegetables, and will now be considered briefly in the order named.

Legumes,—Beans, Peas, Lentils, and Peanuts.—With the exception of the cereals, the legumes are the most valuable of all vegetable foods. Their nutritious properties are mainly due to their relatively high percentage of nitrogenous material, though they also contain starch and fat. Hence these vegetables contain the ingredients necessary to supply all the needs of the human economy; unfortunately, however, when eaten alone in sufficient bulk to furnish the nourishment required, they often—even in healthy individuals—give rise after a little time to dyspeptic disturbances.

Of beans, a large number of different varieties are in common use including string-beans (or snap-beans), lima-beans, kidney-beans, red beans, the frijole, and the Soya bean. String-beans are exceedingly palatable, and are very much prized as an article of diet by the peoples of all countries. When gathered young and thoroughly cooked while still fresh they are exceedingly wholesome, and are very well assimilated, when properly chewed, by even those whose digestions are considerably impaired. The other beans named are generally eaten dry after having been removed from the pod in which they grow. When they are soaked in water until they become soft and then thoroughly cooked they make an excellent food, and, when not taken in too great quantities, are fairly digestible. When cooked with onions, parsley, and red pepper in proper proportions they make a very delicious dish. In Japan the Soya bean forms the basis for a kind of vegetable cheese which is eaten with rice, and furnishes the nitrogenous materials in which the latter is deficient. Peas are wholesome when young and fresh and when properly cooked, and as they come on in the early spring when other fresh vegetables cannot be obtained, they furnish a most acceptable addition to the dietary. When old, after their skins become tough, they cease to be digestible, and should not be eaten except in the form of purees, during the preparation of which the hull is removed.

Lentils are scarcely eaten at all in America, but are much prized in some portions of the Old World, as the basis of soups.

Peanuts belong to the group of legumes, though, unlike the others that serve as food, they grow beneath the surface of the ground. They are highly nutritious, but are, unfortunately, indigestible, owing largely to the high percentage of oil that they contain. The latter is extracted, and is sometimes sold as olive-oil; in a somewhat different form it is made into a sort of butter which is quite palatable.

Roots, Tubers, and Yams.—Sweet and Irish potatoes, which constitute the most important members of this group, have already been discussed under the head of breads. Of those that remain, some few, as beets and artichokes, may be regarded as related to those just referred to, while others, such as carrots, turnips, radishes, parsnips, etc., are generally reckoned among the succulent tubers on account of the large proportion of juice that they contain. Irrespective of the beet, which furnishes a considerable portion of the sugar of commerce, none of them may be looked upon as foods of a very important character, as they contain only relatively small proportions of sugars, starches, and nitrogenous materials. Beets, however, do contain a very high percentage of that which makes potatoes so popular,—about eighty-five per cent. of starches and sugars, with only a trifle of nitrogenous material. When young and tender they are often eaten as a salad, either alone or mixed with other vegetables, and are generally regarded as being wholesome and highly nutritious. They should not be eaten by dyspeptics when pickled, on account of the vinegar.

Artichokes are occasionally eaten, but are not nutritious, although they agree well with many persons.

Carrots, when young and fresh, are fairly digestible, but like other vegetables are exceedingly apt, particularly if old, to produce intestinal disturbances in dyspeptics. They are not very commonly eaten in the United States, but where selected with care we would profit by their more frequent use. They contain a small percentage of starches, with an insignificant proportion of vegetable albumin.

Turnips are exceedingly unwholesome, contain very little nourishment, and may be eaten with impunity only by persons in vigorous health. The same remarks apply to radishes, and to parsnips.

Green Vegetables.—Vegetables of this class are of much more value from the standpoint of their agreeable taste, and the consequent stimulating effect upon the appetite, than from the nutritive materials that they contain. Some of them are eaten cooked, while others are usually consumed in a raw state. They are all much less indigestible if eaten when quite young and fresh—drying seemingly having the effect of producing alterations in them that predispose to dyspeptic disturbances in those so inclined.

Spinach is one of the most digestible of the entire group, and is much eaten in all parts of the world.

Turnip-tops differ in no essential particular from spinach. They have a somewhat bitter taste, but when young and fresh are highly palatable, and if thoroughly cooked cause comparatively little intestinal trouble, but like spinach they contain practically no nourishment. The same may be said of the leaves of various other plants commonly served as greens, among them beet-tops, and dandelion-tops.

Cabbages, many different kinds of which are habitually eaten as food in civilized countries, have comparatively little nutritive value, and are, generally speaking, decidedly indigestible, although young and vigorous persons, particularly where they take abundant out-door exercise, find no difficulty in assimilating the inner portions of the fresh cabbage "head." As in the case with other vegetables, the soil and locality in which the cabbage is grown largely influences its taste, and to some extent its digestibility. It should never be given to infants. Sauerkraut is a preparation of cabbage leaves produced by adding salt, and later crushing them with considerable pressure; after a time alterations occur of a fermentative character, and the product is generally regarded as more wholesome than fresh cabbage.

Cauliflower consists of masses of the somewhat modified flowers of a plant closely related to the cabbage, and is, when properly prepared, palatable, and perhaps somewhat more digestible than cabbage. Cole, and Brussels sprouts, are plants of the cabbage family, and are perhaps even more indigestible.

Salad Plants.—The leaves of the lettuce are usually eaten raw, most commonly being served as a salad in combination with oil and vinegar, or lemon juice. That the leaves possess, when treated in this way, a very palatable taste all will perhaps agree, but they cannot be said to be of any nutritive value, nor are the acids just referred to conducive to their digestibility.

On account of their somewhat pungent taste, watercresses are used in many parts of the world as ingredients of salads, but they are, of all vegetables, the ones that are most liable to transmit disease to man, for in addition to the possibility of contracting in this way typhoid fever, dysentery, cholera, and the ordinary intestinal worms, the human being is apt to receive with them the eggs of the flukes, and the spores of the amoebae that produce chronic tropical dysentery. As they are probably never grown under such conditions as to preclude the possibility of this danger, it would be the part of wisdom to absolutely refrain from their use.

Onions, Leeks, Shallots, and Garlic.—Vegetables of this group are eaten either raw or cooked, and of all those consumed in the former state are least liable to transmit disease, owing to the fact that they are nearly always thoroughly peeled before being eaten. They have the advantage, furthermore, that they may be preserved for long periods of time in such a way as to be fit for food, and when properly cooked have a delicate flavor, and are quite wholesome although furnishing little food for the body. Garlic is never eaten as a vegetable, but serves as the basis for many of the delicate sauces for which the French cooks are so justly celebrated.

The tomato has been used as a food only within comparatively recent times, it having been formerly thought to be poisonous. Like the onion it may be eaten either raw or cooked, and if taken in moderation does not, as a rule, produce any serious harm. When eaten in greater quantities, both on account of the acid that it contains and its relatively small proportion of assimilable nutriment, the tomato is exceedingly prone to cause intestinal disturbances, and should rather be regarded as a fruit than a vegetable. Growing at some distance from the ground, it is rather less apt to convey diseases than the majority of vegetables eaten in a raw state.

While celery is generally eaten raw, it furnishes a palatable dish when cooked in milk. It should not be eaten by dyspeptics or children, particularly if raw. Similarly the cucumber has a well-merited reputation for producing dyspeptic disturbances. It is only eaten raw, is frequently served as a salad, and should be used only when very young and fresh, and eaten only by persons of sound digestion.

Okra is much prized in the Southern States as the principal ingredient of a very palatable soup, but is not as a rule looked upon with favor by the uninitiated. It is also much eaten boiled and served with a little butter and pepper. When fresh and young it is fairly digestible, and furnishes a very agreeable addition to the dinner.

In addition to those already referred to, there are a number of vegetables that are very popular either alone, or in combination as salads—particularly in the South; among them are green peppers, parsley, mint, capers, endive, and chicory. The remarks already made concerning green vegetables apply equally to these just mentioned, and it should here again be particularly insisted upon that salads containing acids are unwholesome for infants and children, and should be used sparingly even by those in health. None contains much nourishment.

Among easily digestible vegetables asparagus probably takes front rank, and in addition to this has the merit of being exceedingly agreeable to the taste. It possesses little nutritive value, but when young, fresh, and well cooked, it may be taken even by infants without harm.

Rhubarb, or "pie plant," is eaten stewed, and made into pie. It is said to be somewhat laxative, and is decidedly more wholesome than many others. The squash, when properly cooked is comparatively wholesome, but contains little nourishment, and is of no particular value as a food, and the pumpkin is not much better, although useful during the winter for making pies after the ordinary vegetables and fruits are gone.

Cranberries, when thoroughly cooked and separated from the hulls, form the basis of a delicious jelly that is widely eaten in the winter over all portions of the United States. Like all sweets it is not entirely wholesome for dyspeptics or infants, but as it is usually eaten with meats and not in great quantities, it may be looked upon as being one of the most wholesome of all foods of this class. It does not seem to have such a tendency to produce sour stomach in many dyspeptics as is so frequently done by other foods containing vegetable acids.



CHAPTER IX

DANGER IN FRUITS AND PICKLES

It is an error shared almost universally by both medical men and the laity that fruits and raw foods are wholesome. Everyone is familiar with the fact that fruits produce intestinal disturbances in children,—not only when they are very young, but after their digestive apparatus is fully developed. Rather curiously, however, instead of ascribing the disturbances that follow to the real cause, we generally dismiss the matter with the assertion that "early fruits are unhealthy," or trace the resulting ill effects to some other equally imaginary factor. In reality the reason why diarrhoea and other intestinal troubles so often occur after eating fruits in the early spring is that the boy or girl after a winter's fast greedily devours enormous quantities of them when they first ripen, and disturbances follow in proportion to the amount and character of these substances taken.

There can be no question that fruits, while extremely palatable, usually produce trouble in dyspeptics, and even in those who still possess unimpaired digestive organs ill effects quite constantly follow on the heels of the taking of food of this character. Unfortunately, however, the great majority of dyspeptics have symptoms that in no way outwardly point toward digestive errors; as common examples, we might refer to the blackheads, pimples and small boils, so frequently observed on the faces of young boys and girls, or the rheumatic pains, and, at a later time, the "Bright's disease," that occur in older people. When you tell such patients that their trouble is indigestion, they are often mildly indignant, and loudly protest that they can eat anything with impunity; that they never have heart-burn, feelings of heaviness after eating, pains in the abdomen, or other symptoms referable to the stomach and intestines. We are rather disposed to be proud of our digestive powers, just as we are of our bodily strength, and nothing is more common than for chronic dyspeptics to maintain that they have never had indigestion in their lives, and to resent any insinuation to the contrary.

Another popular error, almost universally accepted, is that fruits are highly nutritious; as a matter of fact they consist almost wholly of water, and of materials that are utterly indigestible. The latter substances pass through the alimentary tract, therefore, in much the same condition that they enter and serve no better purpose than to promote, somewhat, activity in the bowels. Nevertheless the writer does not wish to be misunderstood as advocating total abstinence from such a palatable class of foods; no harm results in most people if they only take perfectly ripe and fresh fruits in moderation now and then; and these should be always eaten after meals rather than before.

The fruits that contain comparatively little acid are, as a rule, more wholesome than those that are rich in substance of this kind. For example, perfectly fresh and ripe figs or peaches may be taken by most persons with impunity if they be eaten after meals, and at intervals of at least two or three days. Acid fruits, particularly lemons, seem to be peculiarly unwholesome; apples are prone to cause trouble and can rarely be eaten without ill effects, however mellow and palatable they may be. It sometimes happens that persons take grape-fruit with less harm than others.

Closely akin to fruits in their deleterious action on the digestive apparatus are sours in any form whatever. Women, especially, indulge freely and at irregular hours in foods containing much vinegar, lemon-juice, etc.,—usually in the form of pickles or salads. In healthy persons, in moderation, foods of this character perhaps produce no appreciable trouble, but nothing is more thoroughly established than that they act harmfully on the general run of dyspeptics, such as most of us are to a greater or less degree after thirty years of age. This leads to the remark that here, as in everything else, we must regard individual peculiarities—it being true that one person can eat without ill effects what may produce decided disturbances in others, or suffer from excess when moderation would entail no ill-effects.



CHAPTER X

DRINKS—PROPER AND HARMFUL

An immense amount of rubbish has been written during the last few decades concerning the supposed good effect of excessive water-drinking on the human economy. Something like a quarter of a century ago a London physician by the name of Haig brought forward and strenuously advocated the view that a large number of minor ailments were the result of the presence in the body of excessive quantities of uric acid; applying the well known fact that the substance just mentioned requires a large amount of water to dissolve it he conceived the idea that the proper remedy was to flood the body with enormous quantities of liquids, and thus, as it were, wash the offending substance out of the system. So plausible did he make this theory appear that it was accepted very largely by medical men, who in turn taught it to the general public. Within recent times it has been fortunately shown that Haig's theory was wholly chimerical, and that quantities of uric acid greatly in excess of the normal amount could collect in the body, or might be injected into the blood-vessels, without the least harm resulting; thus, at one blow, this widely accepted theory was annihilated, and there now remains no sort of reason for attempting to remove uric acid by excessive water-drinking, or by other means.

It is fortunate that the uric-acid theory has been disproved, for the excessive use of water is not only unnecessary, but highly injurious to the digestive organs, particularly when the fluids are taken at or about meals. Experience has shown that excessive stomach-acidity, which is the most common form of indigestion, is in a large degree dependent on the taking of liquids while eating, and that even in those who are healthy any more than small quantities cannot be looked upon as being wholesome. In dyspeptics liquids seem to act in a hurtful way in several different directions. For example, where persons constantly take liquids while eating the necessity of properly chewing the food is largely done away with; in addition to this the mere presence of water in the stomach seems to tend to the production of increased acidity, for it has often been observed by the writer that even where food was eaten dry indigestion would follow in many dyspeptics if they took water just before or immediately after eating.

The only sensible advice that can be given in this connection is that persons should take no more liquids that they feel a desire for, and they should avoid taking them in any quantity about meal time. What has just been said concerning water applies equally well to milk. When taken alone it very frequently agrees with patients much better than does solid food, but when mixed with the latter is prone to produce indigestion, just as does water. Fermented milk in the form of buttermilk is a very popular beverage in some parts of the world, but it may be well doubted as to whether it deserves the reputation for wholesomeness generally accorded it; being a liquid, and at the same time acid, it is peculiarly prone to increase acidity, and is not tolerated by persons who suffer with sour stomach. It should, however, be said that it, on the other hand, seems to agree particularly well with some people, and has been known when taken alone, at least temporarily, to relieve obstinate forms of indigestion.

Coffee.—The most universal beverage taken at meal time in America is undoubtedly coffee. Each morning countless thousands are cheered and stimulated by its invigorating properties to undertake their daily tasks, but, as is always the case after taking drugs that have such action the system has to pay the penalty in a reaction following later, during which the capacity for work is diminished. It is, however, true that the effect last referred to is not of such importance as to constitute in itself a serious objection to the use of coffee, but other ill results are rather prone to ensue that in many instances change the aspect of the question entirely. In a great many people, particularly after the first vigor of youth has passed, coffee produces anything but pleasant effects, and on some it seems to act as a downright poison. Like all liquids taken at meal time, it predisposes to acid indigestion, particularly when it is sweetened. It is likewise true that when it contains any considerable quantity of cream the liability to dyspeptic disturbances following its use are particularly great—doubtless as a result of the considerable quantity of melted fats that it contains under such circumstances.

From the foregoing it appears then that coffee without either cream or sugar is less unwholesome than when these substances are added to it, but even when it is taken in this way it causes decided symptoms of indigestion in many persons. The writer is not of the opinion that the habitual taking of coffee is to be commended, and would, therefore, not advise its constant use; it, however, must be admitted—as is the case with all other substances that cause indigestion—that in many people, and particularly in those who live out-of-doors and are actively engaged in physical occupations, the use of coffee seems to result in no harm. Like other substances that cause indigestion in a concentrated form, coffee when largely diluted is less apt to produce disturbances of this kind; for example, a beverage consisting of two-thirds of hot skimmed milk and one-third coffee may be taken by many dyspeptics in reasonable amounts without any particular harm. Parents should be warned against allowing growing children to drink coffee; it seriously interferes with the normal chemical changes going on in their bodies, and is almost certain to be followed in later life by nervous dyspepsia.

Tea.—The stimulating principle of tea is chemically so nearly like that of coffee that they are generally considered as being one and the same. That they differ decidedly in their action on the stomach and the body generally there can, however, be no doubt. The stimulating action of tea comes on more slowly than that of coffee, and is correspondingly prolonged. In most persons it is not so apt to produce nervousness, nor is its action in preventing sleep so pronounced. On the stomach it also produces effects that are diametrically opposed to those induced by coffee, since, instead of stimulating, it seems actually to retard the secretion of acids. It is, therefore, probably true that we should look upon tea as a beverage with much less disfavor than we do coffee—though, of course, it should always be remembered that there may be, and unquestionably are, many exceptions to this judgment.

Probably no other daily article of food or drink is so commonly prepared in an improper manner as tea—which is all the more curious when we consider that perhaps none other that requires heat for its preparation is so easily made. It should be brewed by simply pouring boiling water upon the leaves, but the vessel containing the decoction should not be placed over the fire while the tea is being prepared. Of even greater importance is the necessity of allowing the water to remain in contact with the leaves only a few moments—never more than a minute if we wish the tea to be good. The reason for the latter precaution lies in the fact that tea-leaves contain a considerable amount of tannic acid, and, as the longer the water and leaves remain together the more of this substance is extracted from the latter, it is not difficult to see that we should be careful to allow only a brief contact between the two; the presence of this acid is undesirable, not only on account of the fact that it gives to the decoction a bitter and unpleasant taste, but because it has a tendency to cause digestive disturbances. It is seemingly not generally known that there are many varieties of tea, and that some of them are so superior in flavor and bouquet to others that they might well be entirely different substances. The best of all (in the writer's opinion) are those that are composed largely of leaves grown in Ceylon, usually mixed with India tea. If we will demand of our grocer a first-class Ceylon tea we will find that a beverage may be made from it that will appeal quite as much to the palate as a good coffee.

Before dismissing this subject finally, some reference should be made to ice-tea. This beverage is exceedingly palatable when properly prepared, and under such circumstances by no means deserves the disfavor with which it is regarded by many. The latter circumstance is entirely due to two things; first, we find too frequently that it is the habit of house-keepers to pour boiling water on the leaves when the midday meal is cooked and to allow them to soak together until night, and second, the fact that lemon-juice is very commonly added to the tea before being drunk. The ice that the tea contains has little or nothing to do with the dyspeptic disturbances that frequently follow the drinking of cold tea. If we will leave out the lemon and pour off the water after it has been in contact with the tea leaves for something like a minute, it will be discovered that practically all of the ill effects usually ascribed to this palatable beverage have been done away with.

Alcohol.—A discussion of beverages would not be complete without some mention of those containing alcohol. This at once brings us face to face with the bitter controversy on this subject that has been waged so long throughout the United States, and which can only be considered here from the standpoint of the effects of alcohol on the human economy, and to draw corresponding conclusions.

That alcohol, even in very small quantities, reduces the general strength and capacity for work there can be no question, and in addition we find from experiments carefully conducted on the lower animals that the liability to infection by various disease-producing germs is greatly increased by the administration of even minute amounts of the drug. A man then who is a habitual user of alcoholic drinks not only thereby diminishes his capacity to labor effectually, but at the same time renders himself more liable to disease. No more striking example of this could be brought forward than the well established fact that persons who use alcohol are exceedingly prone to consumption—so true is this, indeed, that we might almost look upon the drug as being practically the cause of this disease in most instances. Of course the bacillus of tuberculosis must be present in order for the malady to develop, but we find that the alcohol has prepared a soil for the growth of the germ which would not otherwise exist. This holds with equal force as regards other infectious diseases.