« ForrigeFortsæt »
"Better is a dinner of herbs where love is
Than a stalled ox, and hatred therewith." Proverbs XV., 17. "With a Christian appreciation of the Giver of all good to begin our meals, we shall find them doubly blest.
The "All things come of Thee O Lord eyes of all wait upon Thee O Lord, and Thou givest them their meat in due season. Thou openest Thy hand and fillest all things with plenteousness." It was my privilege to dine once at "Nashotah," that quiet country school of divinity. The students sang antiphonally, these beautiful words of the Psalmist concluding with the churchly Gloria. It has also been my privilege to dine in palace, castle, and many a beautiful home, but when I can no longer remember details of those handsome dinners, the grace sung so quietly and sweetly at 'Nashotah' will yet linger in my pleasant memories. In the saddle, on the frontier march I have eaten with thankful heart my bacon and "hardtack," or in an enemy's country I have carefully heated over a little fire, before the dawn of day, my tin cup full of fragrant coffee-and on sword point toasted a scrap of bread. As we mounted and road away we saw our foes, the cruel Sioux, walking about the firesides we had so recently left. But whether we dine in public hall, or at the railroad lunch counter, or in the luxurious dining car nothing will taste really good, without the "quiet mind" and this we should find only in perfection at our fireside; here in the fear of God and with greatful hearts, we can eat our simple meals in gratitude. Well then, assuming that we have contentment, peace, and family affection, how shall we eat best to secure health?
Slowly is the first requisite and carefully is the next thing, we must remember.
With cheerful conversation we find a valuable digestive aid, but we must not forget the warning of good George Herbert, who reminds us that
The civil guest, Will no more talk all, Than eat all, The feast."
The first step necessary in the digestion of food, is thorough mechanical subdivision or what is known as mastication-chewing. The admixture of the saliva is absolutely essential for normal feeding. The saliva contains a ferment ptyalin which has the property of converting starch into sugar, but probably the chief object of the saliva is to give a slight alkaline reaction to the mass which is necessary in the process of assimilation-Bartholow. When the nutrition of the body goes on in a normal manner, there exists a certain ratio between the income and the outcome. In a perfectly healthy condition of the body, after it
has attained its full growth, there should be an exact ratio between the income and outcome; the income should suffice to furnish the force necessary for the performance of the various functions and to repair the worst of the outcome. In an ideal dietary, the amount of the force should be sufficient to maintain this ratio at the normal standard.-Bartholow's Materia Medica, p. 21.
"The food of man is derived from the three great kingdoms of nature: mineral, vegetable, animal. The classification of foods originally formulated by Prof. Liebig of the University of Munich, indicate the general purposes of these substances on the economy-viz carbonaceous or force producers; nitrogenous or flesh formers. Under the first division are comprehended, fat, starch, sugar, etc.; under the second, substances containing nitrogen, as albumen, casein, etc. There is not, however, a rigid line of separation between these two classes, for both are more or less concerned in the functions attributed to each The ultimate uses of food are two, to construct tissues or repair them when destroyed by wear; to supply force-muscular, nervous, secretory, etc.-Bar
tholow's Materia Medica.
Hon. Erastus Brooks, in a paper read before the American Public Health Association, says: "The good digestion which waits on appetite depends largely upon the food we eat. Carbon with a little hydrogen and oxygen-the chief constituents of our food— compose the alimentary support found in butter, and in all those fatty elements which become part of every healthy life. The flesh, blood and bone need the phosphates derived from animal and vegetable food. The iron in our blood is obtained chiefly from the meat we eat, and traces of iron are found in milk, eggs, and in almost all kinds of vegetables. These elements are parts of our great whole; and in the food we eat their mixture is necessary to prevent waste and decay. Using any one of them alone (unless we except milk or r, P.), the human system would lose about all its forces. Mental happiness and domestic comfort are largely conditional upon well cooked food."
Dr. Richardson, in his treatise on "Diseases of Modern Life," thus sums up his conclusions concerning food: "The food on which the man who would. be healthy should live, should be selected so as to insure variety without excess. Animal food should not be taken oftener than twice daily. The amount of vegetable and animal food combined should not exceed thirty ounces in the twenty-four hours, and for the majority of persons an average of twenty-four ounces of mixed solid food, a third only of which is animal, is sufficient. All animal foods should be taken while they are fresh, and after they are well cooked. The habit of eating underdone flesh is an almost certain cause of parasitic disease. The amount of fluid
taken in any form should not exceed the average of twenty-four ounces daily." He claims that water is the only natural beverage.
Dr. Richardson is also particularly severe in his denouncement of tea drinking, and designates as the symptoms following the excessive use of this beverage, which is so generally used to excess: "Intensely "Intensely severe headaches, constipation of the bowels, with what is usually considered to be deficiency of bilious secretion, flatulency, an unsteadiness and feebleness of muscular power (this, more likely, on account of a dependence on tea as nutriment, to the exclusion of the food really needed), and, not unfrequently, a lowness of spirits, amounting to hypochondriacal despond ency." In the homes of the poor we find, espepecially amongst the under-fed women who take tea at every meal, "this extremely nervous semi-hysterical condition, which very commonly results from this pernicious practice." Tea-drinking three times a day is more or less common in American homes, especially those of the poorer and the middle classes. Dr. Richardson also calls attention to the flatulency induced by tea taken late in the evening, which has the effect of interfering with the process of sleep, and very frequently induces more or less severe forms of nightmare. Dr. R. H. Chittenden contributes in the second volume of the "Reference Handbook of the Medical Sciences," a very valuable article on the adulteration of food, and its perusal demonstrates only too forcibly the source of much of suffering and disease through food adulteration-the danger is, of course, mostly with the cheap little grocery stores which supply the poor. In our fast-growing, busy Republic such matters excite little attention, and offenders seldom receive punishment for these merciless wrongs. We all know how milkman cheat and rob the poor. We have too often witnessed the half-famished, feeble infants of tenement houses, whose only hope for life consisted in some reasonable supply of pure milk, sacrificed to the greed and heartlessness of the milkman. Pity it is that laws are not more faithfully carried out, but, from my own experience, in my efforts to enforce reasonable health laws, I find how bitter is the anger and hatred and malice awakened in this class of vendors by any interference with their piratical traffic. I once knew a physician who overzealously defended these vultures by writing for the daily papers, and I wondered at his conduct until I discovered that his father and relatives were "milkmen." There is nothing which appeals to my sympathy more than this robbery of the feeble infants of the poor, who are so heartlessly robbed every day by these modern Shylocks.
One of our national misfortunes, and one of our characteristics, has been, and is now more or less, that troublesome complaint-dyspepsia. So often does this disorder baffle the best medical skill that,
with some, dyspeptic patients are far from welcome patients for whom diet, hot-water bathing of the stomach, electricity, and the most perfect system of modern digestive preparations fail to derive benefit. Perhaps, in some such case, some friend will suggest an exclusive food of hot milk for a fortnight, and to the amazement of patient and physician, a cure results. In our climate, where stomach catarrh is more or less common, the hot water washing of the stomach is followed by the most satisfactory results. This treatment, with milk for a digestion, will be found valuable in many cases. A simple bill of fare, changing from day to day, and avoid taking a little of many things, is the best plan for all, sick or well. We find so many actually starving themselves with just a bite, acting under the erroneous idea that such a plan is indicated in dyspepsia. A good plateful of mush and milk, or milk toast, or of wholesome bread and milk, will sometimes relieve dyspepsia of long standing. Dropped eggs on soft milk-toast, oyster or clam stew, with toasted cracker, and wholesome beef extract, hot and palatable, is often a curative agent of no mean value. The following table is recommended for consideration:
Soups: Thin soups, beef tea, broths.
Fish, raw oysters.
Meats: Beef, mutton, lamb, chicken. Game: Venison, chopped meat, meat pulp.
Eggs: Poached, soft boiled, raw or whipped. Bread: Eat sparingly corn bread, rice cakes, stale bread and butter, dry toast, macaroni, sago, tapioca. Vegetables and fruit: Green vegetables, such as spinach, turnips, cresses, celery, lettuce, string beans, dandelions, chicory, asparagus, oranges, ripe peaches and pears.
Drinks: Water abundantly, hot water an hour before meals, koumiss, buttermilk, milk and lime
Avoid: Rich soups, all fried foods, veal, pork, hashes, stews, turkey; all starches and sweets; all gravies, sauces, deserts, pies, pastry, puddings, ice creams, sweet wines, malt liquors, cordials, uncooked vegetables, white potatoes, cooked oysters.
If we will give this matter fair examination and faithful experiment, we can save ourselves from a very great deal of suffering and sickness and of expense. Sir Henry Thompson has well said: "I have come to the conclusion that more than half the disease which embitters the middle and latter part of life is due to avoidable errors in diet . . . and that more mischief in the form of actual disease, of impaired vigor, and of shortened life, accrues to civiliized man ... in England and throughout central Europe from erroneous habits of eating than from the habitual use of alcoholic drink, considerable as I know that to be."
MANCHESTER-BY-THE-SEA, February 5th, 1892.
Medical Society Notes.
ALBANY COUNTY MEDICAL SOCIETY. NOVEMBER 18, 1891.
Dr. Henry Hun read a paper on the "Dietetic Treatment of Typhoid Fever," in which he recommended that, in selecting a diet in typhoid fever, patients should be guided by the same factors which lead us to select our diet in a condition of healththat is by our appetite and taste. He thought that if it were true that pathological processes were merely physiological ones so modified as better to preserve the integrity of the body, and were in their nature curative, it might be that our appetite and taste became changed in disease in such a way as to aid in the progress of recovery. As a rule in typhoid fever the appetite and taste were modified from a condition of health in three ways: first, there was great thirst; second, there was a loss of appetite for meats and vegetables (so-called hearty food), and for food containing sugar (sweets), and third, there was a persistence, in a greater or less degree, of appetite for liquid food, of which milk might be taken as the representative. The author believed that we had no better indications for the dietetic treatment of typhoid fever than these three which were furnished us in the perversion of the normal appetite and taste in this disease.
First: In typhoid fever patients suffered from extreme thirst, and to refuse them water would not only be cruel but harmful. On account of the high fever a very large amount of the water passed through the skin and the diarrhoe still further took water from the system; the tissues and organs in consequence became very dry, and the secretion of the salivary, pancreatic and intestinal glands was greatly diminished. The parenchymatous degeneration of the internal organs, especially of the liver, kidneys and heart, present in typhoid fever, to which had been attributed the dangerous cardiac weakness so frequently observed in this disease, was, in Dr. Hun's opinion, due to solidification of the protoplasm of the cells, because there was not sufficient water in the cells to keep the albuminous matter in solution. Hence, on theoretical grounds, the administration of water in typhoid fever was called for, and in practice he was convinced that, in cases of typhoid fever where large quantitirs of water were administered, all the symptoms were rendered less severe, and even the diarrhoea was not increased. He believed that the great effects of cold baths were in many cases due, in part at least, to the absorption of water by the skin during the bath. No difficulty was usually experienced in getting the patient to take large quantities of water in the earlier stages of the disease, and even when he became dull and comatose he should still be urged to drink at regular intervals.
Second: In typhoid fever there was a great aversion to hearty food, such as meats and vegetables, and when such food was taken nausea and vomiting were apt to result. Zuelzer noted a rise of temperature immediately following the digestion of such food. This aversion to hearty food was probably due to the diminished quantity of water in the system, and the consequent scanty secretion of the glands connected with the alimentary tract which was entirely insufficient for the digestion of such food. It should be remembered that in typhoid fever, in consequence of the imperfect digestion, the more rapid peristalsis which manifested itself in the diarrhoea, solid food might not be perfectly liquified when it reached the lower bowel, and hence was apt to irritate the inflamed Peyer's patches. For the same reason food containing indigestible seeds, or irritating insoluble substances, such as pepper, was to be avoided. The aversion to sweets, which typhoid fever patients betrayed, was often so strong that they would often refuse to take ice-cream or custard, which they might otherwise enjoy very much, simply because they were too sweet as ordinarily made. This aversion to sugar was, perhaps, due in part to the amount of water which such substances required for their solution, and in part to the fact that they were apt to produce a flatulent dyspepsia with distressing tympanites. We should, therefore, consult the patient's taste in this matter, and exclude from his diet meats, vegetables, and foods containing much sugars.
Third: Although typhoid fever patients lost all appetite for hearty food and sweets, they often showed a decided appetite for liquid foods, especially milk, and for some form of soup or extract made of meat. Many patients who in health had a distaste for milk relished it greatly in the early stages of the disease, and many took no other food during the whole course of the fever. If the milk was vomited in curds it might become necessary to add lime-water to it or to peptonize it. When even peptonized milk was rejected by the stomach some preparation of infant's food made with milk was often well borne; or kumyss or matzoon might be tried, although the large amount of carbonic acid gas contained in these preparations of milk made them of doubtful value in typhoid fever, on account of the tympanites. Even when milk was well borne it was often desirable for the sake of variety, and to preserve the appetite of the patient, to add other articles to it. The addition of an egg beaten up in the milk was very nutritious and, when the stomach was strong enough to bear it, a very desirable thing. Custard of various kinds, especially rennet custard, ice cream, made with a simple fruit flavor, and ordinary tea, with much milk, were often very grateful to these patients, and very nourishing.
Although many cases could thus be nourished
throughout the entire fever with milk, and some modification of milk, the addition of soups or meat extracts was often very desirable. The beef extracts might not contain much nourishment, but they acted as stimulants, and were frequently so eagerly desired by patients with fever that their use seemed essential. These extracts of beef should be made only with a small amount of water and at a low temperature, so as not to coagulate the albumen, and thus impair what little nutritive value the preparation possessed. Scraped beef, or the juice pressed from scraped beef, was often more serviceable than these extracts, and the scraped beef spread on thin slices of stale bread was relished by many patients. Well boiled, either alone or added to the beef extract, was also of great value. The liquid part of oyster or clam soups made with milk, and even the soft part of raw oysters, without pepper, and soft-boiled eggs might form part of a dietary of typhoid fever in many cases. In regard to the part that alcohol should play in the diet of typhoid, the author thought that we should be guided by the taste of the patient. If he had been for a long time accustomed to the use of alcoholic stimulants, and if such drinks were pleasant
to him, it would be wise to continue the administration of a moderate amount of wine or other alcoholic drinks during the fever. If, on the other hand, he was unaccustomed to their use and had no taste for them, then his diet should not include them. This only referred to the non-medicinal use of alcoholics.
Dr. Townsend desired information from Dr. Hun as to the proper diet in a case of typhoid fever during the first period of convalesence. He thought that the administration of solid food at the beginning of this stage might bring about or, at least, favor the occurrence of a relapse. It was still a matter of question whether these relapses were due to the change in diet, or to a renewal of infection in certain agminated glands in the vicinity of those affected. Dr. A.
Jacobi had expressed the opinion that relapses during the convalescence period of typhoid fever were frequently occasioned by the too early administration of hearty food.
Dr. Hun, in reply, stated that during convalesence the diet should be increased by the gradual addition of more solid food. He did not think that there was very much danger in pushing the solid food when the patient had an appetite for it, and seemed able to digest it, although it should be given cautiously and in small quantities at first. By the fifth or sixth day after the fever had ceased the patient could begin to take solid food. He felt inclined to think that relapses were never caused by errors of diet, but were due to the retention of the typhoid fever germ in the system. He had observed relapses in many cases where the diet had been absolutely fluid.
Dr. Vanderveer, during his service in the army, had
observed more recoveries from typhoid fever than in private practice, although the patients were fed almost entirely on condensed milk and beef-tea, often prepared by incompetent nurses. He would give these patients all the water they desired, and regarded frozen milk as a great comfort to them.
The Hydriatic Treatment of Typhoid Fever, according to Brand, Tripier and Bouveret and Vogl. By Chr. Sihler, M. D., Professor of Histology, etc. Published by Chr. Sihler, 832 Scranton Avenue, Cleveland, O., pp. 340.
In this small volume the reader will find condensed all that is known of this method of treatment. The author is, like all who have carefully studied and practiced the bath, firmly convinced of the righteousness of his cause, and he offers irrefragable proof of this conviction. If the testimony of practical clinical observers shall avail aught, he has made a clear case.
The résumé for bathing on pages 231 to 241 may be termed "golden rules," whose frequent scanning will refresh the memory if referred to whenever a case of typhoid comes under observation. We are tempted to reproduce these, and much else, but want space forbids.
A serious error in this otherwise invaluable book is the frequent omission of translations of the Centigrade temperatures into Fahrenheit. The American reader is prone not to read the useful illustrative cases for this reason, and thus will miss important lessons. The reader will be grateful, however, for this help in the text of the book.
The mechanical execution of the work is creditable, and the author is entitled to our gratitude and appreciation for having published the work at his own expense, because publishers were loth to do so.
No physician who desires to give his typhoid cases the best chance for life can afford to be without this valuable book, for ever those who are accustomed to bathe their patients will discover many practical hints that will tide them over doubts and difficulties.
J. B. Flint & Co. announce the early publication of the following works:
1. A complete system of Gynecology and Obstetrics, with 869 new illustrations, revised by Charles Jewett, M. D.
2. Condensed Encyclopædia of Medicine and Surgery. Arranged upon a new system, etc., by a large corps of writers.
3. Electro Therapeutics of Gynecology, by A. H. Goelet.
"The hunted deer will outrun the leopard in a fair and open chase, because the force supplied to its muscles by the vegetable food is capable of being given out continuously for a long period of time, but in a sudden rush at a near distance the leopard will infallibly overtake the deer, because its flesh-food stores up in the blood a reserve force capable of being given off instantaneously, in the form of exceedingly rapid muscular action.'"
"I think a great part of the weakness and languor' of some persons who suffer what is popularly called nervous debility, and who are oftentimes
Entered at the post-office, New York City, as second-class hypochondriacal, is explainable on the supposition
DIETETICS OF EPILEPSY.
This disease, which has so long and so stubbornly resisted the best directed therapeutic efforts, furnishes much food for reflection whenever we are brought face to face with a well-marked case which emphasizes our helplessness. Seeing that the various. medicaments which have from time to time been brought forward with more or less confidence have failed, we may well pause to ascertain if there be not some radical defect in our hygienic management of the disease.
A review of clinical results under our observation brings into prominence the fact that these cases, being ambulant and otherwise in fair health, do not receive the attention which they demand and which would inure to the best interests of the patients.
that their nervous tissue is over-nourished in quantity, and yet so imperfectly nourished in quality that it is explosive; or (let us use in this simple and not uncommon condition of ill-health, the expression) of more irritable nervous matter. They often keep up this irritability by frequent eating and drinking. My colleague, Dr. Andrew Clark, insists that the most successful treatment of such persons is putting them on very simple unstimulating diet, alcohol in particular being forbidden. My speculation is that the good results are owing to the formation of less explosive or less irritable nervous substance--one of a more normally stable composition. The excitability of these patients reminds one of the fact that the nerves of a weak animal are found experimentally to conduct with greater velocity than those of a healthy one."
Mr. John Mersen, M.A., M.D., who was the assistant medical officer at the West Riding Lunatic Asylum, writes an essay upon the influence of diet in epilepsy which is printed in the fifth volume of these reports. He records "the results of a series of observations of a number of patients suffering from
The matter of diet, exercise, bathing and diversion epilepsy, undertaken with a view of determining the is usually looked into but superficially.
With regard to the first, it would seem from a recent article in the Manchester Herald of Health (Dec., 1891,) that much is yet to be learned and observed. Although an extremist on the subject of vegetarianism the writer makes an excellent plea for the value of a non-meat diet in the disease which it would be wise to heed. He cites the opinion of Dr. Mary Putnam Jacobi, that "there are two agents for curing
value of a vegetarian (or animal) diet and a farinaceous diet in the treatment of that disease, and of testing their value as suggested by Dr. Hughling Jackson's speculations. Twenty-four chronic epileptics were selected.
"Previous to commencing the above dietary, each patient was accurately weighed, and his physical and mental condition noted. Twelve of the patients under observation were then put on nitrogenous diet, the