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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,

furnish more nutrition for the money expended than most protein foods. Cocoa is a valuable food and drink for children. Fresh fish properly prepared is a useful change from meat for older children as well as for adults. The non-oily fish are typically bass, blackfish, codfish, halibut, and swordfish. The oily fish are typically eels, bluefish, shad and mackerel.

Mutton contains the glyceride of stearic acid, and pork contains the glycerides of palmitic and oleic acids. Raw or imperfectly cooked meat, especially pork, is dangerous on account of the possibility that it may contain parasites.

The spices are called carminatives because they promote peristalsis. In small amounts they are stimulant to the appetite and digestion, but in large amounts they delay digestion, and cause more or less irritation, often constipation, and may irritate the kidneys.

Foods that increase the secretion of the gastric juice are meat broths, hard toasted bread and toasted crackers. Toast and dried bread are easier of digestion than fresh untoasted bread. Sometimes some of the sour fruit juices are stimulant to the stomach.

The foods that inhibit a too great secretion of hydrochloric acid are the fats, as butter, olive oil, and cream. Ice cream and most cold foods are less stimulant to the stomach than are hot foods.

Indigestion. The proper diet in dyspepsia and in intestinal indigestion cannot be outlined without a determination of the cause of the condition, and hence its detailed discussion would go too far astray for a chapter on foods. The diet may or may not be at fault, though rapid eating, and too much sugar, oatmeal, coffee, or ice water may be the cause. The cause of the indigestion may also be eye-strain, chronic disturbance of the appendix, gall-stones, ulcer of the stomach or duodenum, alcohol, tobacco, or general nervous tire. It may be wise to give the patient absolute rest and a starvation diet for a few days, or only catharsis and a modified diet; all depends on the diagnosis. Hence the diet to correct the indigestion must be studied in conjunction with the disease or condition that causes it. Suffice it here to state that no clinical history is complete without a more or less

careful (depending on the illness) survey of the foods and liquids taken by the patient, the approximate amounts, the frequency and the regularity of the meals, and the length of time devoted to the meals.

The diet for patients with diarrhea must also be decided by the diagnosis of the cause. Briefly, an acute diarrhea requires a purge, abstinence from food, plenty of water taken, and bismuth subcarbonate and salol or bismuth subcarbonate and sodium bicarbonate as medication. The first food allowed should be meat broths or milk toast or cereal, tea or cocoa, as deemed advisable. Later the diet should consist of eggs, meat, rice, baked potato, till finally the patient is allowed his regular mixed diet.

In ordinary so-called dyspepsia all soups, fried foods, lobsters crabs, oily fish, and fatty foods should be avoided. All the vegetables that are hard to digest, as sweet potatoes, cauliflower, cabbage, string beans, turnips and beets, should be omitted from the diet. Ice water before and with meals should not be allowed, and many times tea and coffee are inadvisable. It should be noted that some fruits and vegetables are more prone to cause gas than others; also sugar favors fermentation. The individuality of the patient should be studied in considering the fruits and vegetables that should be allowed.

Constipation. It is almost the crime of the age, especially in the United States, that the majority of individuals must rely on laxative drugs to have daily movements of the bowels. While it is not proposed here to discuss the whole subject of the treatment of constipation, it may be stated that its principal causes are lack of regularity in going to stool; insufficient amount of water drunk; too refined or too concentrated foods eaten without enough roughage; and an insufficient amount of walking or other simple exercise.

Obviously the intestines cannot act well if they have no residue to act upon, and peristalsis is not active and efficient without a normal amount of semi-solid substances in the intestines. Stasis in the intestine from any cause tends to allow fermentation, putrefaction and the production of gas, and gas, by its own pressure, may prevent the normal onflow of fecal

matter. Constipation tends to putrefactive changes and to indicanuria, and may cause loss of appetite, headache and other symptoms of toxemia. Constipation may, however, be long tolerated by some individuals with immunity.

The most laxative foods are the fruits, and of these prunes, figs, and melons are generally the most effective. Apples and oranges are laxative to most people, although occasionally oranges fail to cause such an effect. Tangerines are generally more laxative than oranges, while grapefruit is not as likely to be laxative. Grapes, plums, peaches and pears may be laxative. Fats and oils are laxative to some people, and in children simple olive oil often causes satisfactory movements of the bowels. Mineral oil, or an emulsion of mineral oil is now much used for its laxative effects. It is, of course, not a food, and on account of its coating the intestine and interfering with normal intestinal secretions should probably not be used for any long period.

The laxative vegetables are those that contain a good deal of cellulose, or roughage as it is termed, parts which do not digest but pass through the intestine en masse. The most laxative vegetables are corn, cabbage, cauliflower, onions, squash, parsnips, turnips, and pumpkin.

Sugary preparations are often laxative, as syrups, honey, figs, and some jellies.

Graham bread and rye bread are more or less laxative, but a popular laxative food to-day is bran, and bran biscuit, bran bread, and bran crackers are much used. Bran contains 20 per cent. of almost indigestible cellulose, hence after digestion there is left much residue to be acted upon by the muscular coat of the intestine, and constipation is frequently due to a diet of too completely digestible food, which leaves little upon which peristalsis can act. When constipation is caused from too completely digested food with little debris, the fecal substances remain too long in the intestine and become dry and difficult of expulsion. In such cases bran is a useful laxative.

Agar-agar is a laxative of value because it absorbs and retains water, and this causes the feces to be softer and therefore more easy of passage through the intestines. Agar-agar may be

obtained in small pieces or as a powder, which may be eaten with any breakfast food.

Bananas are laxative, and when thoroughly ripe are a good food for children. They also retain water and soften the stools.

One of the most useful laxatives is yeast, and both dried brewers' yeast and ordinary compressed yeast are efficient. Besides the laxative effect of yeast, it has the ability to change the flora in the intestine and to more or less check fermentation. It should be much more frequently given in illness in which there is intestinal disturbance, especially if it is associated with constipation. The dose is enough to cause movement of the bowels, and it may be given in divided doses, three times a day, or in one dose at night. One-third to one-half of a compressed yeast cake dissolved in a glass of water is generally sufficient, and the taste is only that of a sour drink. The dose of dried brewers' yeast is about one-third of a teaspoonful once or twice a day. Yeast is also of value in infections, and at times is an appetizer, because it contains an active vitamine. The dose for this purpose is 1 Gm. (15 grains) three times a day, with the meals.

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Gastric Hyperacidity. The saliva should be about neutral in reaction or faintly alkaline; the normal gastric acidity is about 10 normal hydrochloric acid. It is doubtful if there is always an excess of acid when there are symptoms of hyperacidity; also an excess of acid may be present without any symptom of discomfort. When there are symptoms of hyperacidity the cause should be sought and the condition treated.

An increased amount of oils, butter and cream should be taken, sugar should be reduced to a minimum, and often there should be a diminution of the carbohydrate foods. Sodium bicarbonate should not be given except as a temporary symptomatic treatment. Milk of magnesia or magnesium oxide, calcium in some form, and sodium or potassium citrate are often of value in hyperacidity. Atropine or belladonna preparations, so much lauded for this condition, are not successful in checking the hyperacidity, and may do harm by inhibiting other

secretions.

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