Rectal feeding is advisable in pernicious or persistent vomiting; sometimes in ulcer of the stomach; in cancer of the stomach; when poisons have been taken that have caused serious inflammation or erosion of the stomach; in esophageal stricture; sometimes in coma from diabetes or other cause; and when there has been hemorrhage from the stomach or esophagus.

Nutriments injected into the rectum cause, unfortunately, at times, an outpouring of acid gastric juice into the stomach. Therefore, unless contraindicated, it may be well for the patient to drink warm water soon after the nutrient enema, although at times even water may cause an outpouring of gastric juice. Whether water should be given will depend upon the sensations of the patient. With flatulence, heart-burn, and pain, water with or without some sedative, as milk of magnesia, should at times be given.

GENERAL DIET CONSIDERATIONS

The frequency with which food should be taken is generally a matter of habit, different countries being accustomed to different methods of taking their twenty-four hours' nutriment. The majority of Americans are accustomed to three meals a day, although the omission of breakfast, or the omission of luncheon was, a short time ago, a fad much in vogue. It is not rational to go without food from the six or seven o'clock dinner of the evening until the noon of the following day. The morning work, which is often the most intense, is then done at a disadvantage. No furnace would be so treated as to coaling, and the house or plant would not warm up in the morning, if the furnace were not coaled early and the drafts opened. The same is true with the individual. The temperature and vitality are the lowest from four to six o'clock in the morning, and to start the day's work with that handicap and to begin labor without nutriment is absurd. Generally, also, the omission of the noon meal is a mistake. This meal may be small, depending somewhat upon the amount of breakfast that is eaten.

The majority of people, to-day, eat light breakfasts as far as bulk is concerned, but the breakfast should represent sufficient nutriment. Unless the individual must do hard physical labor,

he should not eat meat for breakfast. Meat twice a day is sufficient, and for most individuals, once a day is better. The ordinary breakfast should consist of fruit, a cereal, toast, one or two eggs, a little bacon if desired, and a cup of good coffee with cream and sugar, unless there is some reason to omit these substances. If coffee is not taken and cocoa is taken in its place, the rest of the breakfast should be diminished in caloric value. If the breakfast cereal is omitted, the individual may have more toast, or bread in any form he prefers. If eggs are omitted, he should eat more carbohydrate. Sugar and cream on cereals should be recognized as so much more food. If there is stomach or intestinal indigestion, especially where there is flatulence, the gummy cereals should be avoided, but the dry cereals may be taken, if properly chewed. Starchy foods should not be eaten too rapidly; they should be thoroughly comminuted and mixed with saliva. Rapidly eaten, gummy cereals, especially masses of solidified oatmeal, is one of the most potent causes of intestinal indigestion in America. Many individuals think if they have eaten their oatmeal in the morning, they will remain in fine health all day. In other words, oatmeal has become a fetich. It is one of the best of nutriments when strained, or properly broken up into small fragments, and then not eaten too rapidly.

The luncheon must vary in the amount of nutritive value depending on the individual's work, and, of course, on the age of the individual. The growing child must have plenty of nutriment three times a day, and often better four times a day. The noon luncheon may represent a small amount of each kind of food, as a sandwich and a glass of milk, and a little fruit perhaps; or cold boiled eggs; or a salad and a cup of tea or cocoa; or bread and milk; or crackers and milk; or any combination that does not represent too much food. It is generally understood that the individual cannot spend too much time at his luncheon, and must immediately hasten to his duties. This means, then, that theoretically the largest meal had better be taken at night after the work is done, when a person has more time to enjoy his food, need not rush his eating, and may quietly rest a while afterwards. However,

most working men, when they can obtain it, have their heartiest meal in the middle of the day. It is all a matter of habit, and the body soon acquires the habit of the individual and expects its food and nutriment daily in about the same way. Irregularity of hours of eating and irregularity in the amounts of food taken are not best for the physiologic processes of the system. The relation of the organs of digestion and their secretions to the organs of elimination and their excretions is like any other machinery that needs to be supplied with fuel, lubricator, and activators, as drafts, to quickly start the machinery and to get up steam, and some means to keep the apparatus cool and to free it of ashes and gas. Any interference with the regularity of furnishing these necessities, if frequently repeated, will upset the machinery and be of disadvantage to the individual.

The temperature at which the food should be taken is about that of the body, namely, about 100° F. Too hot or too cold foods or drinks, taken on an empty stomach, may not only cause a serious reflex effect, through the pneumogastric nerves, on the heart, but may cause chronic gastric catarrh, and even an acute injury to the mucous membrane which may lead to ulcer of the stomach. Hot drinks will slightly increase the temperature of the body; cold drinks and iced foods will slightly lower the body temperature.

Violent exercise after meals is inadvisable, although it may not be well to lie down and sleep after a meal. Nevertheless, young animals and infants sleep after full meals; and many patients sleep better at night by taking some simple nutriment into the stomach, such as hot malted milk, or crackers and cheese (if the patients digests cheese well), or even some fruit which acts well as a laxative. If a patient has indigestion, this may be made worse by taking food before going to bed; it may cause him to be sleepless and dream. However, many a wakeful patient, by taking simple, warm food into his stomach, causes sufficient dilatation of the blood-vessels of the abdomen to produce the normal anemic condition of the brain for sleep.

A person who is too tired from work or exercise should not eat until he is rested. Mental fatigue, worry, and sorrow will slow

digestion by inhibiting the production of gastric juice and perhaps also by preventing normal peristalsis and thus causing stasis of food in the stomach and intestines. Severe pain, whether in the abdomen or in other parts of the body, will also inhibit digestion. This is typically true of headache. The heat of the body is increased by taking food and by exercise, by exercise especially. At the same time the elimination of heat is also increased, so that the temperature of the body remains the same. In cold weather more food is needed, however, than in warm weather, to keep up the temperature equilibrium. In spite of our thermometers being generally marked as normal for a Fahrenheit temperature 98.6, as a matter of fact, when the temperature is taken in the mouths of normal, well individuals, it is rarely as high as 98.6, and ranges normally from 97.8 to 98.2°.

It is now generally recognized that starvation in feverish processes, except for the first day or two perhaps, is a mistake, as increased temperature not only uses up the food, but also begins to burn the patient's tissues, first his fat and then his muscles. Therefore to preserve his tissues from degeneration he should receive nutriment sufficient to prevent much loss, especially muscle loss. Of course the food must be that which is most easily digested, and the higher the fever the more liquid the food should be.

It has already been noted that natives of cold climates require more fat, oils and protein foods, while those of warm climates require mostly carbohydrate and fruit foods; but it is a mistake for an individual going from one climate to another to adopt absolutely the diet of the natives of that region. When we travel from the temperate climate to the arctic climate we need more starches than the natives, and when we travel to the tropical climates we need more protein than the natives.

After middle age the food requirement diminishes, and in old age it is considerably less than the average requirement for an adult. This lessened requirement is probably largely owing to the diminished amount of exercise, and to a more sluggish metabolism.

The vegetarian fad, which is in evidence among some sets of

people in our own country, among those who believe in Fletcherism and among those who have experimented scientifically on the ability of the individual to work on a vegetable diet as compared with a mixed diet, should not be adopted generally by the inhabitants of this climate. In a large part of the United States for instance, the rapid changes of temperature require a wonderful mechanism to keep the individual well and his inside temperature always the same. Also the strenuosity of the age and the multiplicity of pathogenic germs that are ever present in all of our crowded communities, require an enormous amount of resistance, and there would seem to be but little question that a mixed diet containing a sufficient amount of proteins, especially meat proteins, produces the best average immunity.

To exactly determine the excretion of salts from the body and what may or may not be retained in disease, the amount and character of the food must be known for at least seventy-two hours, and the total twenty-four hour urine and feces of the third day must be examined. Many times a disturbance of metabolism is thus discovered which could be determined in no

other way.

If the urine is too alkaline, or its alkalinity is too long continued, irritation of the bladder occurs, as well as deposits of phosphates. Therefore, although alkaline drugs may be needed for the body, they should not be too long continued. If the intake of salts is increased, the output of urine is increased to eliminate them. The body then desires water, and there is thirst, and more water must be drunk.

DIETS

Before suggesting specific diets it should be noted that potatoes, oatmeal, rice, corn-meal and hominy furnish perhaps the most carbohydrate nutrition for the money expended; that the animal fats are better for the body than the vegetable fats; and that pure oleomargerine, if made with animal fats, is a valuable food. Hot bread and cakes, hot rolls, griddle-cakes and doughnuts are not very good foods for children. Milk is a most valuable food for children, and eggs, even if the cost is great,