FOOTNOTES:
[11] These are from Food and Dietetics (Norton), published by the American School of Home Economics, Chicago. They are used in a number of schools of Domestic Science and in the Dietetic kitchens in hospitals.
[12] Chemical Composition of American Food Materials, Atwater and Bryant, U. S. Department of Agriculture, Bull. 28.
[13] Experiments on Losses in Cooking Meats (1900-03), Grindley, U. S. Department of Agriculture, Bull. 141.
[14] Laboratory number of specimen, as per Experiments on Losses in Cooking Meats.
CHAPTER X
DIET IN ABNORMAL CONDITIONS
In the dietetic treatment of any disordered organ, the object must be to give that organ as much rest from its regular work as is consistent with keeping up the general nutrition of the system. The stomach and intestines and liver are so closely allied that, when one is affected, the others are liable to affection also, and the dietetic treatment is regulated accordingly.
In abnormal conditions it is necessary to say that the food must be regulated according to the case. Yet, broadly speaking, a diet largely of protein, which is digested in the stomach, rests the intestines and stimulates the liver, and a diet largely of carbohydrates rests the stomach, because the gastric juice is not active in starch digestion.
When the body is not in normal condition, because certain elements are lacking in the blood, these elements must be supplied in larger proportions in the food, and the case is one for a food chemist, or for one who has made food conditions a study.
The better medical colleges, recognizing the importance of proper food in health and disease, have in the last few years broadened their curriculum to include the subject of dietetics. Educated physical culturists and food specialists, for the correction of deranged conditions of the system, due to poor circulation and abnormal nerve and blood conditions, are doing much of the corrective work, due to the fact that instruction has not been given in the medical colleges.
Diets for the reduction of an abnormal amount of fat must also be governed according to the individual condition.
In the early stages of various diseases, when toxins are being produced, as a rule the system is not properly eliminating the waste, and it is often advisable to abstain from food for from one to three days, according to conditions. Brisk exercise, deep breathing, and a free use of water are desirable. A laxative is often recommended.
The diets given here for abnormal conditions are to enable those in charge of an invalid to gain an intelligent understanding of the needs of the system and to supply those needs through the proper foods. In serious cases, however, special diets will be ordered by the medical attendant to suit the needs of the individual.
A chemical analysis of the blood and the excretions is often the only method of determining just the diet in the individual case.
Government chemical laboratories in charge of efficient chemists should be so located as to be accessible to every physician.
The system readily excretes an excess of vegetable products, and, as a rule, no acute difficulties result from such an excess. Such chronic difficulties as constipation, torpid liver, and indigestion, however, frequently result when an excess of starch is taken above that consumed in energy.
On account of the readiness with which putrefaction occurs in protein products, care should be taken not to consume these in too great proportion.
A study of the physical ailments of thousands of women has shown, by the constituents in the blood and the condition of the different organs of the digestive system, the habitual taste for foods. One can usually determine which food the individual has formed a habit of eating, because the system will show a lack of the elements which that patient has denied herself on account of her likes and dislikes.
It is necessary to change the mental attitude toward certain foods before the system will readily assimilate them; thus, as stated, a taste for foods which the body requires should be cultivated.
Every mother, with growing children, should be a thorough student of the chemistry of food. If the child’s bones do not increase sufficiently in size and strength after the second year, care in the selection of foods rich in protein and phosphates of lime and magnesium may correct it. Such a child should have scraped meat and whole wheat bread with milk and eggs.
If the child stores up too much fat, increase the amount of exercise and of oxygen consumed, and either cut down the proportion of sweets and starches or decrease the quantity of food and require more thorough mastication.
If one is thin and undernourished, chemical analysis of the contents of the stomach, intestines, and urine is sometimes desirable. The nerves should be relaxed, and proper food, exercise, and breathing should accompany medical treatment, if medicine is needed. Often an entire change in thought and diet are helpful.
Sometimes a torpid condition of the liver and sluggish activity of the intestines are indicated. Special exercises to stimulate this activity and to encourage correct poise and deep breathing are most essential. The mind must often be stimulated and an interest be awakened, directing the thoughts in new channels.
Worry and tensity of thought are among the chief causes in the majority of cases of lack of flesh and of a very large number of blood and digestive disorders.
Anemia
In anemia there is either a decrease in the number of red blood corpuscles or an insufficient amount of blood. When there are too few red blood corpuscles, “oxygen carriers,” the necessary quantity of oxygen is not furnished the tissues and the system becomes clogged with waste. The patient easily tires and is disinclined to exercise, thus the decreased number of red corpuscles are not kept in forceful circulation and the carbon dioxid is not freely thrown off by the lungs; this further aggravates the condition.
Since the blood is made from the foods assimilated, the point is to supply food which builds blood tissue. Exercise and deep breathing will encourage the elimination of waste and promote a forceful circulation which insures nourishment to the tissues. As stated, it is the food assimilated, not always the amount eaten, that counts.
In this condition it is of vital importance that one keep up a good circulation; the stomach, intestines, liver, and spleen must be strengthened through exercise and deep breathing of pure air, for the red blood corpuscles are oxygen carriers, and the insufficient supply must do double duty or the waste of the system will not be oxidized and eliminated, and the blood-forming organs will further fail in their task.
Exercise must be graded to the case, being gentle at first so as not to overtire the easily fatigued muscular system. It should be intelligently directed to the joints and to the vital organs, particularly to the liver and intestines, that they may be kept in normal activity. The exercises must be followed with plenty of rest, and accompanied by deep breathing. The habit of full breathing is one of the most effective agencies in correction of anemia, because the red blood corpuscles must carry their full quota of oxygen or the system is clogged with waste. Oxygen also rejuvenates these corpuscles.
Unless the blood furnished to the tissues is of good quality and contains sufficient oxygen, the nutrition of the body suffers, the activity of the various organs is hindered, and the health becomes impaired. Functional derangements, particularly in the digestive tract follow, and faulty digestion and difficult absorption further impoverish the blood.
The work, therefore, in the correction of anemia, lies in foods which build blood and in daily exercise and deep breathing of fresh air, accompanied by rest.
The windows at night should admit a good circulation of air through the sleeping room, and as much time as possible should be spent in the open air.
Anemia occurs many times in growing girls, due to an improperly balanced diet, caused by a capricious appetite and by the habit of satisfying this appetite with sweets, pickles, etc.
The body, during growth, needs increased nutritive material, not only to replace the waste, but also to meet the demands for new building material for the various organs, particularly the brain and the nervous system. Overwork either in school or in industrial occupations, the hasty eating of meals, or insufficient amounts of food, also aid in reducing both the quantity and quality of the blood.
Worry is one chief cause of anemia.
Insufficient sleep, due to late hours, further increases the tension of the nerves and lowers the vitality, causing depression which interferes with digestion.
When the red blood corpuscles are decreased the oxidation of the fats is interfered with, because oxygen is necessary to burn the fat. The non-use of the fatty material causes it to be stored in the tissues so that the body often appears well nourished and plump. The muscles, however, are flabby and weak and usually the pallor of the skin shows the lack of coloring matter in the blood.
The digestive organs are often weak. They must not be overloaded or the very object of the extra feeding will be defeated. In such cases the food must be taken in less quantity and more frequently. Also a diet rich in albumin and iron must be supplied.
It will often be found that one whose blood is lacking in hemoglobin and in the proper proportion of red blood corpuscles has had a dislike for the foods rich in iron, or perhaps through poverty, or some other cause, has not been able to get the right kind of food.
The yolks of eggs, the red meats (such as steak, mutton, or the breast of wild game) and the deeply colored greens (such as spinach, chard, dandelions, etc.) contain a goodly proportion of iron. The dark leaves of lettuce, celery, and cabbage contain iron; these vegetables are apt to be bleached before being marketed.
It is better, in anemia, to take the yolks of two eggs than one whole egg, as the iron is in the yolk. A good way to take the yolks of eggs is in egg lemonade or in eggnog, with a little flavoring.
Anemia sufferers have usually formed the habit of eating starches and sweets. It will usually be found that they have no desire for vegetables containing iron, or for meats rich in albuminoids, and this habit is shown in the blood composition. They often eat the white of the egg and discard the yolk, rich in iron. Tact and persuasion will often be necessary to induce them to take the proper foods.
If constipation is present, whole wheat bread, oatmeal, stewed prunes, grapes, stewed or baked apples, and oranges, should be taken freely.
When the anemic individual is thin, he should take as much fat food as the system will assimilate. Bacon is well digested and palatable. Fat may be taken in milk, cream, and butter.
The food must be made attractive to tempt the appetite, which is usually poor, and within reason one should be allowed any wholesome food which he desires. Condiments often stimulate the stomach and intestines to better action.
Vinegars, because of their action on the blood, should not be allowed nor rich pastries and sauces.
Beef may be scraped and made into sandwiches or used in purées and meat broth, which may also have a beaten egg in it.
The following is a suggestive diet in anemic conditions:
DIET VII
One pint of milk, to be sipped slowly before arising.
Breakfast
Fruit
Broiled steak or two eggs, soft-boiled, poached, or baked, with bacon
Cereal coffee, chocolate, or cocoa
Toast, or graham, or whole wheat bread, or graham or corn muffins; butter
Middle of the Forenoon
Lemonade with a tablespoonful of beef juice (not beef extract) or with a beaten egg, or a
Glass of egg malted milk, or an
Eggnog
Lunch
Split pea or bean soup with toast and butter, or scraped beef sandwich with lettuce
Fruit or vegetable and nut salad (no vinegar)
Fruit, fresh or stewed
Bread with plenty of butter
Cake
A glass of milk, cocoa, or chocolate—preferably milk
Middle of Afternoon
Egg lemonade or eggnog of two eggs beaten in boiling milk with sugar and spices
Dinner
Bouillon
Tenderloin steak, roast beef, or lamb chops
Baked potato
Spinach, beet, or dandelion greens
Custard, fruit gelatin, or cornstarch pudding, or rice with lemon cream or butter sauce
Bread and plenty of butter
Glass of milk or weak tea
When appetite is persistently absent, attention should be paid to the eliminative organs in order to remove all clogging of the system by retained waste.
If the stomach and intestines are prolapsed as a result of improper nourishment and resultant weak tissues, rest in bed, with special exercises which will replace the organs and strengthen the supporting tissues, is required.
STOMACH DISORDERS
Most chronic cases are due to worry; to improper hygiene, such as irregular meals; fat and greasy foods; hasty eating; too much sweets; insufficient mastication, with resulting lack of saliva; wrong choice of foods; too frequent eating, giving the stomach no rest; too large an amount of food; too highly spiced foods; coffee or tea; a general run-down condition, with a weakness of muscles of the stomach, due to insufficient blood supply; to a weakened or over-strained condition of nerves controlling the stomach; and usually to insufficient exercise and fresh air.
Indigestion or Dyspepsia
Indigestion or dyspepsia is the broad term commonly applied to most chronic stomach and intestinal difficulties, due, not alone to structural disease or to displacements, but also to their inability to perform their normal functions. The term includes troubles arising from so many different causes that in each case the cause must be determined and remedied before definite results can be attained through diet.
The most usual is that the gastric glands are pouring out an insufficient amount of secretion; almost always there is a deficiency of hydrochloric acid. In some cases in which the food has irritated and inflamed the stomach there may be a sufficient secretion of this acid, but an inflamed stomach throws off more mucus and the extra quantity of mucus neutralizes the hydrochloric acid.
When the acid is deficient or absent, the proteins are not well digested and the food may ferment; bacteria may produce putrefactive changes and the formation of gas. The gas interferes with the movement of the diaphragm, pressing it against the heart, causing pain and even palpitation.
Indigestion is usually accompanied by constipation, or by irregular action of the intestines.
Plenty of fresh air, and exercise, directed definitely to muscles and nerves of the stomach, that it may be strengthened by a better blood supply, as well as exercises and deep breathing to build up the general health, should be systematically followed.
Easily digested food, well masticated, and regular meals served daintily, will gradually regulate digestion.
Food should not be of too great a variety at one meal. It must be simple and well prepared; when nerves and muscles are weak it should be served less in quantity but more frequently. Sometimes light food every hour or every two hours is best.
Cheerful constructive thoughts are the very best of medicine for digestive derangements.
A glass of cold water from one-half to an hour before the meal will cleanse the stomach by washing out the mucus and will promote the secretion of saliva and the gastric juices.
The intelligent medical treatment of stomach difficulties is aided by a chemical analysis of the stomach contents. If the stomach is not secreting normal proportions of pepsin or hydrochloric acid, the deficiency of either can be determined. Such chemical analysis will alone determine what elements are lacking.
Permanent relief must lie in gaining a good circulation of blood through the entire body and through the stomach, that it may be strengthened and thus enabled to secrete these elements in proper proportions.
Nervous Indigestion
This is due to the general depleted condition of the nerves. In such cases the entire nervous system should be regulated through exercise, breathing, rest, and a change of thought. Physicians usually recommend change of scene to cause a change of thought.
The diet should be light and laxative, and low in protein. Cream soup, bread and milk, malted milk, buttermilk, cream, fruits, crackers and milk, custards, egg lemonade, and gruels, furnish easily digested food.
Tea, coffee, much meat, fried food, highly spiced food, pastry, candies, pickles, alcohol, and tobacco should be avoided.
When the walls of the stomach are weak and distended or prolapsed, light food served in small quantities at regular but more frequent periods is preferable to a hearty meal, which further distends the stomach walls. The stomach does not secrete sufficient gastric juices to digest a meal large enough to supply the needs of the system, if food is taken only three times a day.
When a loss of weight occurs, it usually indicates a failure to assimilate rather than the failure to eat a sufficient amount of food. A good circulation, particularly through the vital organs, must be established; deep full breathing of fresh air, and regular and complete rest periods, should be observed.
Usually, in chronic cases, a dietitian, or a physician, is not called until the condition has prevailed for so long that other complications have set in and the patient has lost much flesh. It takes months to pull the system down and it takes months of following of proper hygiene to build it up.
Gastritis or Catarrh of the Stomach
This involves an inflammation of the mucous lining of the stomach and is a most common phase of indigestion. In acute cases the physician is called at once. He can then treat the case in its initial stage and cause a much more rapid recovery.
Acute Gastritis is accompanied by nausea and vomiting and the patient should refrain from taking food for at least two days. To allay thirst a tablespoonful of water may be held in the mouth for a few moments without swallowing it. A slice of lemon may be sucked if water excites vomiting, or cold carbonated or acidulated waters may be sipped, a teaspoonful at a time, every ten or fifteen minutes. Rest of both body and mind must be obtained.
After two days begin the nourishment with water and a small portion of liquid food (not over two ounces) every two hours. Toast tea, made by pouring hot water over toast, oatmeal, or barley gruel (thoroughly strained so that no coarse matter may irritate the stomach), limewater and milk, and egg lemonade are easily digested. Increase the quantity on the fourth day and lengthen the time between feedings to three hours. Gradually increase the diet, adding semiliquid food, noted on pages [237-238], soft-boiled eggs, moistened toast, raw oysters, etc., slowly returning to the regular bill of fare.
Avoid any food difficult of digestion and any vegetable containing coarse fiber. Care in the diet must be observed for several weeks or a relapse may occur.
Chronic Gastritis is accompanied by a thickening of the mucous lining of the stomach. It is usually caused by prolonged use of irritating foods and the regulation of the diet is of utmost importance. Alcohol is a common cause. The difficulty begins gradually and the relief will be gradual.
There is an excessive secretion of thick, tenacious mucus which prevents the gastric juices from mixing with the food. The resulting fermentation of food causes heartburn and produces much gas. Thirst may be excessive.
The stomach needs washing. The washing may be accomplished by drinking two glasses of hot water at least an hour before breakfast, followed by stomach exercises, to cause a surging of the water through the stomach. This may be followed by a glass of cold water.
This may be uncomfortable at first, causing a full feeling, and one may begin by drinking one glass, followed by stomach exercises, gradually taking another glass within a half-hour of the first. This, by means of the exercises, will wash out the mucus.
A glass of cold water half an hour before each meal is recommended here, as well as for relief of indigestion.
In many cases as much as a pint of slimy mucus collects in the stomach during the night. When the stomach cleansing by means of water drinking is impossible, the physician often uses a stomach tube.
Chronic gastritis, in any of its phases, is frequently accompanied by constipation, which reacts on the stomach, and the diet should be as laxative as possible, without irritating the lining of the stomach.
In case an acute attack occurs, which is likely in chronic cases, the diet under “Acute Gastritis” should be followed.
Pancreatinized milk is an excellent food in both chronic and acute cases especially when they are severe. This is prepared by putting “pancreatin” a pancreatic ferment (trypsin) into fresh milk. Preparations of “pancreatin” are sold in the drug stores. Pepsin may be used in the same way for making peptonized milk.
The pancreatinized milk does not form hard curds and readily passes through the stomach for digestion in the intestine. The taste is rather bitter; it may be disguised by flavoring. This may be given for a few days, followed by milk and limewater, barley and toast water, kumyss, oatmeal gruel, meat juices, scraped meat (raw, boiled, or roasted), broths thickened with thoroughly cooked cereals, ice cream, egg lemonade, gelatins and whipped cream, custards and raw oysters.
Fruit in the morning and just before retiring aid the intestines. Two prunes chopped up with one fig, or a bunch of grapes, or an apple, just before retiring may be eaten to assist the action of the intestines and the kidneys.
Almost all fruits contain acids which increase the peristalsis, and the resultant flow of gastric juice. Cooked pears, stewed or baked apples, prunes, and dates are mild fruits which may be used if they agree. The juice of an orange on arising may be used if relished.
All cereals should be thoroughly cooked.
The white meat of chicken, well masticated, is readily digested.
After an acute attack, as the solid food is resumed, it should be given regularly and in small amounts.
Thorough mastication is important. The food should be chewed until it is reduced to a pulp.
Fats and food cooked in fat must be avoided. Dried beef, lean boiled ham, and salt fish agree better with some than fresh meats. All sweets must be forbidden. Starchy foods are apt to produce “sour stomach.”
Avoid meat with tough fiber, too fat meat (pork), sausage, lobster, salmon, chicken salads, mayonnaise, cucumbers, pickles, cabbage, tea, coffee, alcohol, pastry, too much sweets, and cheese if it disagrees.
Five to six light meals a day are preferable to three heavy meals.
The flow of gastric juices is constitutional, thus the regulation of digestion depends on the general vitality as well as on foods. The circulation must be forceful, the habit of deep breathing and of regular periods of complete rest of body and mind must be established.
Since one with chronic gastritis is liable to have many idiosyncrasies, he should not be urged to eat foods for which he has a dislike. The easily digested foods should be prepared in various ways and served in an appetizing, dainty manner.
There are four special phases of chronic gastritis: Mucous Gastritis, Hyperchlorhydria, Hypochlorhydria, and Achlorhydria.
In Mucous Gastritis there is a profuse secretion of mucus in the stomach. In this case it is always well to wash out the stomach before introducing food, as suggested above.
The same general diet suggested for acute gastritis should be followed.
Hyperchlorhydria
The condition known as hyperchlorhydria shows a liberal excess of hydrochloric acid. The condition is common, and is brought on by worry, nervous excitement, eating when overtired, irregularity of meals, imperfect mastication, and excessive use of alcohol.
The diet should be a mixed one, in about normal proportions. If anything, it should incline more to proteins than to starches.
The hydrochloric acid is necessary for the digestion of proteins and some physicians give a diet consisting almost entirely of proteins such as eggs, lean meat, etc., because hydrochloric acid reduces the protein to acid albumin, which is less irritating to the stomach than the free hydrochloric acid. However, the proteins are stimulating to the stomach and the protein proportion should not be carried to excess.
The best method is to follow a diet in which the foods have practically their normal balance—avoiding all irritating foods.
The juice of one-fourth of a lemon taken one-half hour before the meal will decrease the secretion of hydrochloric acid.
Limewater and milk may be used exclusively for two days; alkaline, effervescing mineral water may be used and then the diet should follow the general diet in chronic gastritis.
Hypochlorhydria is a diminution in the amount of hydrochloric acid. Since this acid is essential in gastric digestion of proteins, a decrease in its supply diminishes the power of the stomach to digest meat, eggs, etc. Physicians often administer hydrochloric acid about one hour after a meal. It should not immediately follow the meal consisting of part solid food, because it retards salivary digestion. Acid fruits, such as lemonade or egg lemonade, should be given half an hour after the meal instead of at the beginning.
Many advocate a diet omitting protein, but since protein foods stimulate the flow of gastric juices, they should not be omitted, but taken less freely. The meals should be at least six hours apart so as to allow time for digestion and to give the stomach rest.
Achlorhydria
When there is an entire absence of hydrochloric acid, as in achlorhydria, the stomach, of course, cannot digest proteins and this digestion must be accomplished entirely by the trypsin of the pancreatic juice. The presence of liquefied protein, as beef juice in the stomach, however acts as a stimulus to the gastric juice and is an agency in again starting its flow.
The foods should be liquid, so as to pass through the stomach without irritating it. Clear milk must be excluded, because of the action of the rennin in coagulating the casein. This would irritate the stomach.
Pancreatinized milk (see page [99]) may be used as an article of diet, also milk with limewater, junket, gelatin, cream, butter, bacon, olive oil, gruels, and any foods which will pass through the stomach without change and are digested by the pancreatic juice in the intestines.
Bran must be excluded from any cereals. Cereals or any carbohydrates cooked or masticated to a liquid state will pass through the stomach without difficulty and be digested and absorbed in the small intestine.
Dilatation or Prolapsus of the Stomach
Dilatation results from continued overeating (especially when the nerves are weak), or eating when overtired. The muscular walls become so weak that they fail to contract. Peristalsis is likewise weak, and the food, failing to digest promptly, ferments and forms gas. A dilated stomach is enlarged and its weight and weakness cause it to prolapse.
In the prolapsed condition the pyloric, or lower orifice of the stomach, is often nearly closed, partly by reason of its position and partly by the weakened folds of the stomach walls. Because of this obstruction to the free emptying of the contents into the duodenum, it is imperative that the food be of the simplest form, thoroughly masticated, and perhaps predigested and concentrated so as to be in as small an amount as possible. A chunk of food could not easily pass through the pylorus.
All liquid or semiliquid food should be subject to the chewing movements until it, also, is mixed with saliva. The stomach should not be overloaded with either food or water and for this reason six or more light meals a day, at regular intervals, is best.
A dilated stomach does not necessarily indicate that the digestive juices are not secreted in normal proportions, and easily digested proteins need not be avoided. It is desirable to furnish the proteins in concentrated form, as in meats, so as to get the most nutrition with the least bulk. They should be thoroughly masticated.
Milk may be used, with limewater, if sipped slowly and mixed with saliva.
Sugar should be used very sparingly, because it ferments readily and aggravates the distention. If it is evident that fermented products are in the stomach, it should be washed out with a stomach pump.
A tumor near the pylorus, or constriction of the pyloric orifice by prolapsus, will also cause dilatation of the stomach.
Beef juice, any of the better grades of meats, well masticated and containing no gristle, limewater and milk, soft-cooked eggs, and well-cooked cereals and vegetables should constitute the diet.
Avoid vegetables containing coarse fiber, fried foods, and freshly baked bread.
Liquid with the meal should be avoided, on account of the tendency to overload the stomach.
Cold water, taken a swallow at a time at intervals during the day, has a tonic effect on the relaxed muscles. It also incites the flow of gastric juice.
The best and quickest means of correcting a prolapsed and dilated stomach is by rest in bed for several weeks, with special exercises to raise the viscera and to strengthen all abdominal muscles, as well as the muscular coat of the stomach itself. The food must be given in small quantities every hour.
Ulcer of the Stomach
When this condition is severe, accompanied with severe pains and vomiting of blood, the nourishment is given through the rectum for from five to ten days. Then, for ten days, a milk diet with bouillon, barley water, a beaten egg, and once a day, after the third day, strained oatmeal gruel is taken.
Limewater is added to the milk to avoid the formation of large curds and to neutralize the acids of the stomach. The patient is given half a cup of milk every hour for three days, from 7 A.M. to 9 P.M. From the third to the tenth day the quantity may be increased to one cupful, then to a cup and a half, and the periods between feedings lengthened to two hours. If the milk is thoroughly heated, but not boiled, before the limewater is added, it digests more readily.
After ten days, for the succeeding ten days the nourishment should be given every two hours and the diet varied by semiliquid foods, such as gruels, toast water, soft-boiled egg (once a day), beef juice, two softened crackers (once a day), gelatin, buttermilk, and strained soups. (See page [313], Semisolid Foods.)
After twenty days the patient, if all is well, may very gradually resume a normal diet, beginning with baked potatoes, softened toast, lamb chops, a small piece of steak or white meat of chicken. It is imperative that all food, liquid or solid, be thoroughly mixed with saliva and that solids be chewed to a pulp.
Liquids must not be swallowed either hot or cold, but about body temperature. Cold water may be taken into the mouth when more palatable than warm and held there until about body temperature before it is swallowed. All liquids should be sipped, not swallowed in gulps.
When the condition of ulcer has existed for some time complete rest in bed for from six to ten weeks is advisable. Either the diet suggested above or, if it is desired to gain in weight, a diet of milk, cream, and eggs may be followed. All solid food should be avoided.
INTESTINAL DISORDERS
Most cases of intestinal difficulties may be traced to a clogged condition, either due to a weakness of the nerves and of the intestinal muscles, with resultant weak peristalsis, or to insufficient lubrication.
If the waste is not promptly moved through the intestines, irritation may result and the poisons from bacterial fermentation will be absorbed by the system.
Deranged digestion in the stomach also interferes with digestion in the intestines. Likewise delayed intestinal digestion affects digestion in the stomach.
Constipation
A large number of cases of constipation become chronic because of the failure to respond to Nature’s call at a regular time each day. Many others are due to weakness of the muscular walls of the intestines or to the nerves controlling them. In this event the intestinal peristalsis is weak.
Constipation may be mechanical, due to obstruction of the intestine in some part of its course, e. g., prolapsus, tumor, or a kink in the bowel itself.
Still another cause is a failure of the liver to discharge sufficient bile into the intestines to lubricate the feces.
Many chronic cases are due to the pill and drug habit. When one continues to take pills, the condition brings a result similar to the feeding of “predigested” food—if the work is done for the organs they become lazy and rely on artificial aid. Every part of the body requires activity for strength.
If the intestines are cramped by the clothing it may cause constipation by restraining their normal exercise during movements of the body in walking, etc. Exercises for the intestines should be taken morning and night.
Constipation may exist even when there apparently is a daily movement of the bowels. Material may accumulate in the large intestine because only a part of the contents is discharged and may cause the unpleasant symptoms which accompany constipation.
It may arise from irregularity in meals, or from overeating, thus causing derangements of digestion from disturbance of the normal process.
Insufficient food may cause it, because the mass is not large enough to be acted on by the muscular movements of the intestines.
Too much strong tea, by its astringent action, lessens the secretions of mucus and causes the mass to become too dry.
Too little water may be taken and the food not sufficiently moistened; food may be concentrated and leave little residue.
Overeating, especially when the intestinal muscles are weak, furnishes a greater bulk than the intestines have the power to propel, hence a semi-paralysis and inactivity result.
Anxiety and grief or worry may inhibit the action of the nerves and thus cause a stagnation of movement on the part of the bowels.
The cause of the difficulty must be ascertained before relief can be gained.
The most natural relief for constipation, therefore, comes through exercise, particularly when directed to the muscles of the stomach and of the intestines and to the nerve centers controlling them.
The free use of water and such foods as figs and raisins, prunes, dates, grapes, apples, and rhubarb, which are laxative in effect, are helpful. These have best effect when eaten just before retiring or when the stomach is empty.
The use of vegetables which furnish a large bulk of fiber is often beneficial. Cabbage, celery, lettuce, spinach, mustard greens, oyster plant, and asparagus consist largely of residue. Onions are also laxative, especially when boiled. Tomatoes possess a special laxative effect for many individuals.
When derangements of digestion make raw fruits undesirable, they may be cooked and thus used for their laxative effect. They are not so laxative when cooked with much sugar, because much sugar may cause fermentation and gas. A little bicarbonate of soda added to acid fruits after cooking will correct the acidity and not so much sugar will be needed.
Two or three glasses of water should be taken on rising and before retiring. This cleanses the stomach as well as aids in relieving the dryness of the bowel contents.
Oatmeal, or any cereal containing the bran, is laxative. Such are bran or corn-meal bread, Boston brown bread made with molasses, and Graham bread.
Children should be trained to attend to Nature’s call regularly every day. The best time is shortly after breakfast.
Enteritis
Inflammation or Catarrh of the Intestines is similar in its nature to Gastritis or Catarrh of the Stomach.
Acute Enteritis, or cholera morbus, is usually caused by a strong irritant—either by some food which disagrees, by unripe fruits, or by a mass of undigested food.
A fast of two or three days is the usual initial dietetic treatment.
A free drinking of water not only soothes the irritated intestines, but it cleanses the intestinal tract and assists in eliminating elements of fermentation; if these are not eliminated, they will be absorbed into the blood.
Absolute quiet in bed is necessary.
After the fast, a liquid and semiliquid diet is followed until inflammation is relieved and diarrhea and vomiting have ceased. Milk, strained gruels, broths, strained soups, buttermilk, eggs (soft cooked or raw), beef juice, barley water, custards, junket gelatins, soft puddings, etc., are most nourishing and cause little irritation. (See page [313], Semisolid Foods.)
Milk should be mixed with limewater to prevent the formation of large curds and should be sipped. Water should not be taken, as it tends to increase the diarrhea. Ice may be held in the mouth to relieve thirst.
All irritating foods, such as coarse vegetables, pickles, acid fruits and fruits with coarse seeds, candies, beer, wines, and salads must be omitted.
Chronic Enteritis has the same general cause as acute enteritis, though its onset is slow and it takes a correspondingly longer time to correct.
A milk diet for two or three weeks may be necessary to rest the bowels.
When food is taken, if undigested particles appear in the stool, it may be necessary to use predigested foods for a while.
Dysentery
If acute, dysentery demands complete rest in bed. The diet, in both acute and chronic cases, must be confined to easily digested foods such as peptonized or pancreatinized milk (see pages [99] and [308]), boiled milk, meat juice, and the white of egg, beaten and served with milk.
Blackberry brandy and tea made from wild cherry bark tend to check the inflammation.
During convalescence, care must be taken not to overfeed. Fruits and vegetables should be avoided. Begin a more liberal diet with an increased amount of beef juice, gradually adding tender beefsteak, roast beef, fish, white meat of chicken, eggs, custards, jelly, dry toast, blancmange, well-boiled rice, and other easily digested food. The beef and egg are particularly valuable, because of the anemia occasioned by the loss of blood.
DERANGEMENTS OF THE LIVER
The liver is not, in a strict sense, a digestive organ, but the digested food must pass through it and undergo certain chemical changes.
For a fuller understanding of the reasons for the following suggestions regarding diet in liver derangements, the chapter on the “Work of the Liver,” pages [151-152] should be reread.
It will be recalled that the liver acts not only on the foods, but it also stands on guard to neutralize poisonous ferments, due to putrefactions absorbed from the intestines, and to render them harmless. To a limited extent it also oxidizes alcohol.
After the gorging of a heavy meal, the overloaded blood and liver express themselves in a sluggishness of the brain and one feels mentally as well as physically inert.
Since both carbohydrates and protein undergo chemical changes in the liver, it is evident that a diet consisting of an excess of either, must overwork the liver, not only through the nutritive food elements absorbed, but through the toxic substances which may be produced.
The regulation of diet, when the liver is in an abnormal condition, must be more in the quantity than in the quality of food.
The condition of the liver depends also on the activity of the intestines, since the poisonous products from imperfectly digested and fermenting food, not being eliminated, will be absorbed and carried to the liver. If the food remains in the intestines too long, it is attacked by the bacteria always present there, fermentation results and poisons are absorbed and carried to the liver, which usually can render them harmless to the system. If for any reason the liver is diseased, overloaded, or its action is sluggish, these toxins are absorbed in larger quantities than the liver is able to handle, hence they reënter the blood and poison the system.
The most important corrective agencies, when the liver is inactive, is a fast for a day or two, a free drinking of water, deep breathing, and exercise so directed as to bring a free supply of blood to this organ.
It is apparent that the blood must carry its full quota of oxygen to assist in eliminating both the nitrogenous waste and the poisons. It must also be remembered that the liver must oxidize the waste from its own tissues, as well as from other parts of the system.
Biliousness
This condition is due to the overproduction of bile which may be absorbed into the blood to inactivity of the body and a resultant sluggish circulation of blood; to overwork of the liver due to overeating; and to insufficient breathing of pure air. It may also result from constipation and the resultant absorption of toxic matter, as previously described.
It may be occasioned also by obstruction of the opening of the bile duct into the intestines from an excess of mucus in the duodenum. In such cases exercises for the intestines are clearly indicated.
In the bending, twisting, and squirming movements which the infant in the cradle makes, the liver is regularly squeezed and relaxed. The same is true of the free movements of an active child at play. If during adult life these same free movements of bending and twisting the trunk were continued daily and correct habits of free breathing of pure air were established, there would be little call for “liver tonics.”
The transformation of carbohydrates in the liver is an important part of its work and in case of inactive liver the sugars and starches should be limited in the diet. Protein stimulates the activity of the liver, yet it is a mistake to allow a diet too rich in protein. The best method is to cut down the quantity of food.
Two glasses of water an hour before breakfast, followed by brisk exercise for the vital organs and deep breathing, are the best remedies.
The daily action of the bowels is imperative.
In extreme cases a fast of two or three days, with a copious use of water, is recommended. Following this fast the diet should consist of easily digested foods, eliminating those containing starch and sugar in too great proportions, as bread, cereals, and potatoes. The amount should be as limited as is consistent with the actual necessity for rebuilding and for energy.
The taking of fats should be restricted in biliousness. The presence of fat in the duodenum stimulates the flow of pancreatic juice, which in turn stimulates the secretion of bile, thus overworking the liver.
Lemon stimulates the action of the gastric glands and thus tends to increase the liver activity.
It has been thought that eggs and milk cause sluggish liver action. There is no physiological reason for this if too much food is not eaten. The fact is often lost sight of that milk is a food as well as a beverage and that when milk constitutes an appreciable part of the diet other foods should be limited accordingly.
The DIET may be selected from the following:
Soups.—Light broths and vegetable soup with a little bread toasted in the oven.
Fish.—Raw oysters, fresh white fish.
Meats.—Mutton, lamb, chicken, or game.
Farinaceous.—Whole wheat or Graham bread and butter, toast buttered or dry, toasted crackers, cereals in small portions.
Vegetables.—Fresh vegetables, plain salads of watercress, lettuce, and celery, without oil or mayonnaise dressing. Lemon juice and salt may be used.
Desserts.—Gelatins, fruits, cornstarch, ice cream, junket, simple puddings,—all with very little sugar.
Liquids.—Hot water, lemonade, orangeade, toast water, buttermilk, loppered milk, and unfermented grape juice—not too sweet.
AVOID.—All rich, highly seasoned foods, candies, cheese, pies, pastry, pancakes, or any fried foods, salmon, herring, mackerel, bluefish, eels, dried fruits, nuts, and liquors of all kinds.
Gallstones
Gallstones occur most often in persons after middle life, especially in those of sedentary habits.
A substance called cholesterin is normally present in solution in bile and in the tissues. When, through inactivity of the liver, or when because of sedentary habits the bile remains too long in the system, the cholesterin is precipitated, and, mixed with mucus, it forms gall-stones.
A diet composed mostly of starch and fat favors their formation.
All dietetic measures should be combined with exercise to promote the flow of bile into the intestines.
Two glasses of hot water should be taken in the morning and before retiring. Several glasses of cold water should be drunk through the day.
Sweets and starches should be largely eliminated from the diet; sweet fruits and root vegetables must be avoided.
Fresh green vegetables and acid fruits may be taken. Potatoes contain calcium, but because they contain much more potassium, which lessens the liberation of calcium, they may also be used.
For foods rich in calcium which should be avoided see page [219].
Foods causing calcium oxalate deposits should be avoided as they may cause the formation of gall-stones. For a list of these see p. [219].
Meat, if taken, must be lean and eaten only once a day. Beef and chicken are the preferable meats. Fresh fish may be used.
Alcohol must not be taken and coffee and tea must be limited in strength and quantity.
Active exercise must be practiced daily and full elimination secured from the bowels.
The person afflicted with gall-stones must not sit too long or in a cramped position.
The presence of fat in the duodenum increases the flow of pancreatic juice which, in turn, stimulates the flow of bile, so olive oil is often recommended in case of gall-stones. It is questionable whether it is of benefit, because, as stated, much fat upsets the liver.
Watch the water supply. Hard water which contains lime should be boiled to precipitate the calcium.
DERANGEMENTS OF THE KIDNEYS
The office of the kidneys is to eliminate from the system certain nitrogenous elements in solution; the work of the kidneys, in most conditions, is aided by copious drinking of water.
The influence exerted on the function of the excretory organs by the components of the food has not been given the attention it merits.
If the fluids are not taken in sufficient amount and much animal food is eaten, the urine becomes more concentrated and may irritate the kidneys or the bladder and give rise to calculi (kidney stones) or to the deposit of uric acid. Watery vegetables, juicy fruits, milk, water, and most beverages, by increasing the output of urine, lessen its acidity and density.
A diet limited to certain articles of food by the likes or dislikes of the individual, as the starches and sugars, too large consumption of acid fruits or too fatty foods may cause the appearance in the urine of abnormal amounts of various substances, as sugar, phosphates, calcium oxalate, or fatty acids.
Acid fruits in moderation aid digestion and favor suitable elimination, but when eaten to excess, as lemons, taken two or three or more a day by those striving to reduce flesh, the urine is increased in acidity, and irritation of the bladder may ensue.
Too great an amount of food tends to overwork the kidneys as well as the liver and various derangements result; these must be treated dietetically as well as by medicine.
Acute Nephritis
In inflammation of the kidneys (nephritis), the secretion of urine is lessened or may cease. The kidneys and digestive system must not be overworked and all food must be eliminated save milk until the kidney function is restored. It may be diluted with lime or Vichy, or skimmed milk or buttermilk may be used.
Water flushes the kidneys and if the urine increases in amount when water is given its use may be continued. When the amount of urine is diminished or the kidneys are not functioning at all, water, or any fluid or food that gives the kidneys work, must be given only on the advice of a physician, as serious harm may be done unless the inflamed kidneys are given as near perfect rest as possible. Sometimes even milk must be reduced to one pint a day.
In the event that the kidneys do not excrete, the pores of the skin must be kept freely open by sweat baths to assist in the elimination of urea.
Dr. Hall recommends a milk and cream diet of from three to seven pints a day, for a few days, according to the case—two parts of milk to one of cream. If the urine is scanty, he reduces it to one and one-half pints a day, taken in four or five installments. After the three to seven days of milk diet he gradually introduces starches and fats into the diet.
Bright’s Disease
This is an inflammatory condition of the kidneys in which albumin appears in the urine. It results from irritation and may be acute or chronic.
The appearance of albumin in the urine does not always indicate disease. It may be temporary, merely indicating that the diet, for the time being, is too heavy or contains an excess of protein, especially meat. Several tests from one to two weeks apart are often necessary to determine whether the condition is merely temporary or is due to inefficient action of the kidneys.
When for any reason the kidneys have difficulty in eliminating the nitrogenous waste of the system, the dietitian must eliminate protein food as closely as may be consistent with the body necessities. Besides restricting the amount of nitrogenous foods, the kidneys must be assisted in eliminating the nitrogenous waste and the products of inflammation by a copious drinking of water, unless the kidneys are so inflamed that complete rest is indicated.
Hot water and hot drinks are best in the morning, such as toast water, barley water, cream of tartar, lemon and acid drinks. Unless a dropsical condition is present one may drink freely of cool water.
In acute cases the patient is put on a diet of from two to three pints of milk a day, given one-half pint every three or four hours, diluted with one-third as much hot water. Complete rest is imperative.
In chronic cases, exercise, judiciously directed to the extremities, particularly to the legs and the back, will do more than anything to aid the elimination of an excessive accumulation of fluid as in dropsy. This condition is usually accompanied by constipation and poor circulation, and exercises directed to the liver and bowels aid in carrying off the excess of fluid by way of the intestines; this will rest the kidneys. A cure requires patience and perseverance.
In chronic cases it is also well to follow a milk diet for a number of weeks. The quantity of milk for an exclusive milk diet must depend on the age and size of the patient as well as on his ability to exercise. If he is confined to his room, from ten to sixteen glasses of milk a day are sufficient. If he is taking a great deal of exercise, he may take from eighteen to twenty glasses of milk a day. If he loses weight on the milk diet, bread and rice may be added, or potato soup, cereals, tapioca, and various gruels.
If the milk is not well borne, malted milk or predigested milk with butter and cream may be substituted. If the casein in the milk is not well digested, cheese must not be used. An egg once or twice a week and fruit and fresh vegetables may be given, but meat should be omitted.
A. F. Pattee gives the following diet in Bright’s disease.
DIET
Soup.—Vegetable or fish soup, broths with rice or barley.
Fish.—Raw oysters or clams, fresh fish broiled or boiled.
Meats.—Eat sparingly, chicken, game, fat bacon, fat ham.
Farinaceous.—Stale bread, whole wheat bread, toast, milk toast, biscuits, macaroni, rice, cereals of all kinds.
Vegetables.—Onion, cauliflower, mashed potatoes, mushrooms, lettuce, watercress, spinach, celery, cabbage.
Desserts.—Ripe raw fruits, stewed fruits, rice, tapioca, bread and milk puddings, junkets, cocoa.
Liquids.—Toast water, weak tea, pure water, peptonized milk, malted milk, fresh buttermilk, milk and hot water in equal parts, whey, unfermented grape juice.
AVOID.—Fried fish, corned beef, hashes, stews, pork, veal, heavy bread, batter cakes, lamb, mutton, beef, gravies, beans, peas, malt or spirituous liquors, tobacco, coffee, ice cream, cake, pastry.
This diet is tentative only and may be modified to suit the individual. If improvement is manifest after a month or two of the restricted diet, steak, roast beef, and eggs may be gradually added. If, when the urine is examined, the use of meat causes a return of albumin, it must be dropped.
In these cases, active outdoor exercise, full, deep breathing systematically practiced at intervals, a calm quiet attitude of mind and care not to overeat and to keep the bowels active will materially aid recovery.
Uremia or Uremic Poisoning
Interference with the action of the kidneys is apt to result in a retention within the system of the elements which they, in normal condition, eliminate from the system—such as urea, uric acid, urates, sulphates, phosphates, etc. They are the result of the oxidation and the breaking down of the proteins of the body. If the kidneys do not eliminate these the result is a systemic poisoning, and the dietetic treatment must be such as will aid them to act freely.
Fruits should be used freely. The citrus fruits (lemons, oranges, limes, etc.) are the best; they neutralize acids and promote the alkalinity of the blood.
When the system shows an excess of uric acid, the chances are that the individual has not been living on a diet containing too large a proportion of protein, but that he has been eating more than he requires of all kinds of foodstuffs. His system thus becomes weakened and he does not breathe deeply nor exercise sufficiently to oxidize and throw off the waste.
Meats, eggs, and legumes should be eliminated from the diet. A free drinking of water, milk with limewater, cereals, buttermilk, kumyss, barley water, toast water, lemonade, orangeade, vegetables, and fruit should form the diet.
Exercise and free breathing of fresh air are imperative. All food should be thoroughly masticated.
Excess of Uric Acid
When this condition appears it is due to too great an amount of animal or nitrogenous food. It causes dizziness, ringing in the ears, general nervousness, and insomnia.
Uric acid does not render the urine acid but when the acidity of the urine is increased, due to too much animal food, the tendency of the uric acid to form a crystalline deposit is increased. This deposit, as “gravel,” may occasion attacks of renal colic or become the basis, when mixed with mucus, for kidney stones or stones in the bladder.
Headaches if due to uric acid will often cease when animal food is lessened.
Too much candy or sweet foods, or too much fat, eaten in connection with much protein, by deranging the liver function, change the character of the urine and favor the production of uric acid, causing such chronic ailments as bronchitis, asthma, severe nerve depression, gout, and neuralgia.
The natural relief is obtained by control of the diet, supplying less protein. One may either eliminate the proteins from the diet, or may cut down the entire quantity of food. Free elimination through a free action of the kidneys, the pores of the skin, and the lungs, is necessary.
Systematic exercise, deep breathing, copious drinking of water, and fresh air day and night, are the best aids. Exercise and deep breathing promote a free elimination of waste through the pores of the skin, and the free drinking of water creates a greater elimination through the kidneys, thus throwing off the excess of acid.
The skins of fruits contain various acids which favor the alkalinity of the blood. Therefore it is better, when there is an excess of uric acid, to eat unpeeled fruits. Apples, eaten raw and unpeeled, because of the acids, are of benefit. Citrus fruits, such as lemons, oranges, and grapefruit, are advised. Pears, and other sweet or bland fruits, because of the lack of acid, are less valuable.
Pea pods when young may be cooked with the peas. String beans, spinach, celery, and asparagus are of value.
All rich sauces and gravies must be avoided.
Gout
Osler remarks that “gout is evidence of an overfed, overworked, and consequently clogged machine.”
It is usually the result of high living. It most often attacks people past middle age, who have indulged in large quantities of food, especially the nitrogenous foods which are not thoroughly oxidized due to sluggish circulation and shallow breathing. The process, imperfectly carried on, allows the accumulation of the waste material which cannot be excreted by the kidneys unless completely transformed by oxidation. These insoluble materials are deposited in the joints, act as irritants, and occasion the attacks of pain, swelling, and tenderness which usually mark the acute condition.
It is most common in those who habitually overeat, take little exercise, or who have frequently indulged in alcohol.
Sugar and fat in quantities are injurious as the oxidation of the protein is not carried on as completely when these are in excess. In fact, the entire system is more sluggish. Fat also interferes with gastric digestion as it passes through the stomach unchanged, and if the particles of food have a coat of the fat liquefied by the heat of the stomach, it is difficult for the gastric juice to exert its power.
The use of meat and sugars tends to make the urine acid and the use of vegetables favors its alkalinity, rendering it less acid. Therefore it becomes necessary to eliminate meat from the diet, to cut down the fats and carbohydrates, and to eat freely of fruits and vegetables.
Alcohol is absolutely prohibited.
In acute cases a diet of bread and milk, or toast and milk, with light vegetable broths, should be followed for from one to three days.
In chronic cases the diet may consist of the following:
Soups.—Vegetable broths.
Fish.—Fresh fish, shell fish, raw oysters.
Meats.—It is better to omit all meats. If meat is eaten at all, it should be confined to game, chicken, and fat bacon.
Farinaceous.—Cereals, crackers, dry toast, milk toast, macaroni, graham or whole wheat bread, rye bread, oatmeal, and any of the breakfast foods.
Vegetables.—Celery, lettuce, watercress, all greens, without vinegar, string beans, green peas, potatoes, carrots, and beets.
Fruits.—All fruits, stewed or fresh. Unpeeled apples are especially recommended. (Greens, without vinegar and unpeeled apples, increase the action of the kidneys.)
Desserts.—Plain puddings, junket, rice, stewed or fresh fruits.
Liquids.—Pure water, toast water, barley water, buttermilk, malted milk, milk.
Eat eggs sparingly, and in severe cases, not at all.
AVOID.—Alcohol, coffee, tobacco, dried fruits, nuts, cheese, candies, pastries, pies, spices, rich puddings, fried foods, vinegar, pickles, lemons, rhubarb, mushrooms, asparagus, sweet potatoes, tomatoes, gravies, patties, rich soups, lobster, salmon, crabs, mackerel, eel, veal, pork, goose, duck, turkey, salted, dried, potted, or preserved fish or meat (except bacon).
It is not sufficient to eliminate the foods to be avoided. To reduce the quantity of food is also necessary; yet this must be watched as the diet should not be so rigid as to cause a lowering of vitality. Eating between meals should not be allowed.
In an acute attack the diet should be confined to milk, vegetables, and fruits.
Diabetes
This is the result of a serious disturbance of nutrition. Since its presence is made manifest by the appearance of sugar in the urine, it is considered among the derangements of the kidneys. However, one should not be apprehensive of diabetes if the urine test for a day shows sugar. This may be due to an excess of carbohydrates, particularly of sugar, in the diet a day or two previous and all trace of it may disappear in a day or two. If continued tests show an excess, nutritional disturbances are indicated. The treatment is almost entirely dietetic.
The most usual form of diabetes is diabetes mellitus. It is supposed to be due to a disturbance in the metabolism of sugar. It may be aided by defective pancreatic ferments, the lack throwing more work on the liver in the metabolism of sugar.
The difficulty which confronts the dietitian is to prescribe a diet restricting the carbohydrates which will keep up the body weight and not disturb the nutritive equilibrium. The patient has a craving for sugars and starches, but the system cannot make use of them, and the heat and energy must be supplied by fats.
The diet must consist largely of protein and fat. One danger lies in the tendency of acetic and other acids to accumulate in the blood, which affects the nervous system.
While, as a rule, the craving for certain foods is an indication that the system needs the elements contained in them, the desire of the diabetic patient for sugars and starches must not be indulged more than absolutely necessary, because of the inability of the system to utilize them.
There is often a distaste for fat, but its use is imperative when it is well borne, because the weight and general vitality must be maintained. If all carbohydrates are eliminated from the diet, the system will often suffer severely. Therefore the dietitian must determine the diet suited to the individual case, since complicated conditions may exist and the diet for one patient will work harm to another. The fleshy patient can stand a rigid diet, eliminating sugars and starches, much better than one who is thin and emaciated. A thin, weak patient often cannot endure too rigid a diet.
The following list of foods contain least carbohydrates: clear soup of meat without vegetables, all acid fruits, eggs, clams, and lobsters, fresh fish of all kinds, fresh meat of all kinds, and most smoked meat, olive oil, butter, peas, beans, all fresh vegetables (except carrots, parsnips, squash), onions, artichokes, cauliflower, cabbage, and asparagus.
Fats may be supplied in the yolks of eggs, cream, butter, cheese, bacon, and oily nuts, as butternuts, Brazil nuts, almonds, hazel nuts, walnuts, pecans; all should be well chewed.
In beginning a diet, the change must not be too sudden. Potatoes, when they agree, may be used in small quantities as a substitute for bread. At least a week’s time should be allowed for the elimination of all sugar and starch. Begin by eliminating sugars and next bread, cereals, anything made with flour, and potatoes.
Sometimes it is necessary to begin with an all milk diet for a day or two.
Van Noorden gives the following diet, free from carbohydrates, which has been in general use in Europe and America.
Breakfast
Tea or coffee, 6 ounces.
Lean meat (beefsteak, mutton chop, or ham), 4 ounces.
Eggs, one or two.
Lunch
Cold roast beef, 6 ounces.
Celery, or cucumbers, or tomatoes with salad dressing.
Coffee, without milk or sugar, 2 ounces.
Dinner
Bouillon, 6 ounces.
Roast beef, 71/2 ounces.
Green salad, 2 ounces.
Vinegar, 21/2 drams.
Butter, 21/2 drams.
Olive oil, 5 drams, or spinach with mayonnaise, large portion.
Supper, 9 P. M.
Two eggs, raw or cooked.
Van Noorden includes alcohol, in whisky, in his diet and most physicians follow the theory that alcohol aids in the digestion and absorption of fats; the need is recognized since fats must be supplied, yet the sweet wines and beers contain sugar while the sour wines contains acids, which may disturb digestion.
DERANGEMENTS OF LUNGS AND BRONCHI
Asthma
In this affection the free entrance of air into the lungs as well as its free exit is hampered by a condition of the bronchial muscles, the mucous membrane of the bronchi, and the muscles of the diaphragm. The muscles contract spasmodically without due or proper relaxation. This causes a congestion and swelling of the mucous membrane of the bronchi which still further hamper the ingress and egress of air.
Any digestive derangement which causes the formation of gas distends the stomach and intestines, interferes with the free action of the diaphragm, and prevents the free movement of the abdominal muscles.
The chemical action of the undigested and fermenting substances in the digestive tract irritates the nerves and may cause the spasm of the muscles. Digestive derangements will often cause the onset of an attack of asthma in those afflicted with this disorder.
The correction of the conditions in the stomach and intestinal tract will often ameliorate the attacks. Care must be taken not to overload the stomach and intestines, to eat easily digested foods which agree in the particular case. All food found to cause any digestive disturbance should be avoided.
Constipation must be remedied by gentle exercises and massage of the abdomen as free elimination removes material which might aid in inciting an attack.
Many asthmatics are comparatively comfortable during the day, the attacks coming on toward evening or during the night. In this case, the evening meal should be light and easily digested, the heavy meal being taken at noon.
Hot stuffy rooms increase the disorder and plenty of fresh air should be secured both by night and by day.
Many of these individuals make no exertion, fearing to bring on an attack.
Exercise, particularly of the lungs in breathing, should be gradual at first and be increased as improvement is shown. Exercises directed to expansion of the deeper cells of the lungs and to equalize the circulation throughout the entire system will call the excess of blood from the bronchial tubes and in many cases will cause the difficulty to disappear. A forceful, equalized circulation, with regulation of digestion, will do more for asthma than any known agency.
Tuberculosis
Derangements in digestion, common in this affection, are due to several conditions.
The increased temperature is caused by the efforts of the system to counteract the poisons produced by the action of the bacillus. The increase in temperature in the stomach lessens the secretions and the peristaltic action, causing the food to ferment and to be vomited or to pass practically undigested into the intestine, thus throwing an excess of work on the intestinal secretions.
The bacilli-laden sputum, if swallowed, is apt to produce disorders of the stomach. This still further complicates the question of digestion.
Malnutrition, because of these derangements, increases the unfavorable outlook for the patient in this disease. Hence the diet, especially in chronic cases, is of great importance.
When means are ample, the question is much simplified, because by travel, change of scene, and pleasant surroundings the appetite is stimulated and greater variety in the diet can be gained. For those in moderate circumstances, save when free sanatoriums exist for the care of the tuberculous, it is most difficult to keep the diet from becoming monotonous and wearisome.
The appetite, especially in young people, is apt to be capricious, and it is important that the food be served daintily to tempt the patient to eat.
Growing children crave sweets and as these furnish energy they may be allowed to tuberculous children, in moderation, if they seem to be well assimilated. Any interference with digestion, however, must be guarded against.
It is better to give food in smaller quantities and oftener in order to guard against disturbed digestion from overloading the stomach. For this reason also it is better to give the heartiest food during the forenoon when the temperature is lowest.
Milk, butter, cream, olive oil, bacon, and cod-liver oil furnish the fat needed by the system in the most easily digested form and should be taken freely, if there is no irritation in the stomach which will prevent their assimilation. Variation in their use will often secure greater tolerance.
In chronic cases in which there is little or no fever, the fats are generally well assimilated and are beneficial.
The disease causes great wasting, and fats are especially important in counteracting this tendency. They may be given in alternation or be omitted from the diet for a day or two to avoid turning the patient against them.
If diarrhea exists fats must be given guardedly and if fats produce diarrhea they must be lessened or omitted until the diarrhea is controlled.
If one gains in flesh the chances are very strong that the case has been wrongly diagnosed, or that the disease, if present, is being overcome.
Milk, when it agrees, should form a large part of the diet. A glass may be taken with meals and two glasses between meals. The milk should be sipped slowly; lime water or carbonated water may be added to aid milk digestion.
Buttermilk, made by means of buttermilk tablets, from milk from which the cream has not been removed, or buttermilk mixed with one-fourth cream, kumyss, or cream and water, if relished, may take the place of milk.
Eggs are also important aids in the diet, especially the yolk, because of the fat and iron it contains. If they disagree they may be taken with a few drops of lemon juice, orange juice, or grape juice, as these partially digest the egg.
The beaten and strained whites are very easily digested, and in that form may be taken in quantity of from six to twelve a day.
Tender, juicy meats, especially beef and mutton, may be taken, also meat juices and beef soups.
Highly seasoned foods should be avoided.
Fresh fish, clams, and oysters are permissible. Cereals, especially the coarse ones, that stimulate the bowel movements, if constipation exists, are valuable; oatmeal, rice, and corn-meal mush are especially good; also Graham or bran bread, and zwieback made with bran. If there is diarrhea bran should not be used.
Easily digested vegetables are of value, especially if cooked in little water so that most of the salts and other nutrients, which are so frequently boiled out of the vegetable, are retained. Baked apples or raw fruits, especially oranges, may be taken the first thing in the morning, or used as a dessert. Grapes, peaches, and other fruits in season may be taken in moderation.
Tea and coffee are best omitted.
The following constitutes a typical menu in ordinary cases. It must be varied to suit the individual case.
| Breakfast: | Fruit, cereal, two eggs (poached or boiled) with or without a few slices of bacon; two slices of toast or bread, one-half ounce of butter, and a glass of milk. |
| 10 a.m.: | Two or three eggs beaten in a glass of milk. |
| Luncheon: | Fish, chop, or steak, or some tender meat, one-half ounce of butter, one or two slices of bread, baked potato, or a dish of rice or hominy, green vegetables, or a salad of lettuce or tomato with olive oil, a dessert of custard or junket or some other nutritious dish, and a glass of milk. |
| 3 p.m.: | Milk and eggs, meat broth and egg, milk and egg custard, or Graham crackers and milk. |
| Dinner: | Soup if desired, a glass of milk, a liberal helping of some special meat, roast beef, lamb, or mutton, chicken or turkey, potatoes, or a farinaceous vegetable, and a green vegetable, dessert, and a small piece of cheese. |
This menu approximates the number of calories desirable in cases of tuberculosis that have not advanced to a stage in which complete rest is necessary. In that case a liquid or semiliquid diet is given.
When it is necessary that the diet be less expensive, beans, lentils, and eggs may take the place of meat at some meals, and oleomargarine may be substituted for butter. Milk and eggs, however, in the quantity advised, should be taken if possible.
If signs of overfeeding appear, due to the lessened activity of the digestive organs, shown by biliousness, coated tongue, etc., the food may be lessened in quantity until the condition is corrected.
If the tongue becomes coated the mouth should receive the care directed on page [95].
In all cases of weak lungs and chronic lung trouble, the diet should consist of easily digested foods. Those that cause flatulence should be avoided, as the distended stomach presses on the diaphragm and interferes with proper breathing and with the heart action.
DERANGEMENTS OF THE NERVES
No disturbance in any part of the body requires less medicine than a disturbance in the nerves. The correction must come through general hygienic treatment and directing the mind to optimistic thoughts.
Regular exercise, alternated with regular rest periods, the formation of the habit of complete nerve relaxation, the general regulation of an easily digested, nutritious diet, with deep breathing exercises, are the best remedies. The patient should be out of doors as much as possible and, unless too weak, should be employed at light work for mental diversion.
Neurasthenia
In cases of Neurasthenia, or “tired nerves,” all vital organs are more or less affected, because the nerves do not properly direct digestion, absorption, assimilation, or elimination.
The excessive use of stimulants, tea, coffee, or alcohol, is often an exciting cause, because of overstimulation of an already exhausted nervous system.
Complete rest of body and mind must be secured.
The diet should be light and of easily digested foods, but must be nutritious and taken regularly and systematically. Each case needs individual treatment, and the diet must be that most easily assimilated by the individual.
A free, correct breathing of fresh air, day and night, is imperative.
It is important also to thoroughly masticate all food and drink freely of water.
A change of thought, induced by a change of scene or companions, is helpful.
One of the most essential treatments of neurasthenia is to surround the patient with love and tenderness, but the patient should be led to avoid self-pity. This sets up a disagreeable trend of thought which relaxes nerve and vital forces and disturbs nutrition. Sympathy, good cheer, and an attitude of courageous optimism are the best nerve tonics.
Due to the weakened condition of the nerves, troubles which at other times seem trifles are as mountains and very real. Patience and intelligent sympathy, not apparent pity, are the best of medicines.
The tone of the nervous system is quickly altered by the state of mind of the individual. The reaction is a double one, constituting a “vicious circle.” The nerves, disordered from worry, excessive fatigue, or other drains on the vitality, as a persistent pessimistic outlook on life, do not stimulate the natural digestive processes. The faulty digestion may fail to prepare a sufficient amount of food for use by the system. The nerves are thus underfed, which still further increases their inability to send motor and secretory impulses to the digestive and eliminative organs. Emaciation, general debility, and anemia may result.
Hence the importance, in the relief of any nervous condition, to see first that the attitude of mind be calm and quiet with the substitution of thoughts of hope and cheer for those of gloom and depression. The afflicted one must make a brave struggle because the tired body affects his thoughts as well as his thoughts his body.
There is no one food or set of foods which directly affect any nervous trouble unless this trouble be localized by disturbance in some particular organ. Then the effort must be to correct the difficulty in that organ.
Rest is imperative.
If thin, a fat-building diet should be followed to store energy-building reserve in the nerve centers.
In many cases of nerve debility the nerves seem to be stronger in the latter part of the day. When this is the case the hearty meal should be eaten at this time.
Neuralgia
The condition of the blood is affected by the lack of its necessary ingredients, which may occur through faulty digestion as well as through improper diet. The resultant anemia of the nerves may produce neuralgic pains in any one or several of the tissues and organs, as the stomach, the intestines, the muscles, or the liver, etc. Neuralgia of the liver is sometimes mistaken for gallstone colic.
When underlying conditions of disease have been excluded by means of careful tests of the urine and blood, the diet becomes of importance and may result in the disappearance of the pain.
These pains occur chiefly in those who take little exercise and use improper food, which does not give the correct proportion of the needed elements to the system.
Exercise, as the body is usually weak, should be begun moderately but as soon as possible be made brisk and active to stimulate the vital organs to a more perfect performance of their function.
Plenty of oxygen must be secured by day and night and thorough elimination be maintained.
The diet must be nutritious and richer than is ordinarily taken. Milk, butter, cream, bacon, olive oil, and all fatty food should be freely used if assimilated. Beefsteak, roast beef, fresh vegetables, and eggs are valuable. Cocoa or chocolate, a glass of milk with a beaten egg, or a cup of broth into which an egg has been beaten may be regularly taken between meals.
If the digestion is feeble, light foods should first be taken and increased as the system becomes able to assimilate more hearty food.
Coffee, tea, highly spiced foods, alcohol, fried food, rich pastry, and much candy or sweet stuffs should be avoided.
Pain referred to the liver, if not caused by gall-stones, usually indicates overwork of that organ, and fats, sweets, and starches should be avoided to give the liver rest.
Pain referred to the stomach is often caused by tobacco smoking or improper food, as too much candy or preserves, or too strong tea or coffee. Attention to the diet will usually relieve this variety of pain. If the pain comes on when the stomach is empty, due to a disorder of the nerves, the food should be lessened in quantity, be light, easily digested, and taken at shorter intervals.
Many conditions of the system due to dietetic errors which result in impoverished blood are accompanied by pains in the stomach. These are often neuralgic.
Poor assimilation of foods or indigestion produces pain because the tone of the nervous system is affected from the poor blood.
Neuralgia of the stomach often occurs in anemic conditions associated with constipation. In these cases a good, nutritious, but easily digested diet and better elimination will often cure, but as the changes in the blood and nerves are slow, one must be patient and persistent.
There is no better nerve tonic than pure air, exercise, cheerful thoughts, and rest.
Sweets, fried food, rich sauces, pastry, and highly seasoned food should be avoided.
When neuralgia of the stomach, due to an underlying condition such as rheumatism, gout, or diabetes occurs, the diet appropriate to the condition will often affect the cure of the neuralgia.
Chorea
The diet is of the greatest importance in this difficulty, as it is usually accompanied by anemia. Rest and a very nourishing and easily digested diet are essential. Sometimes a complete rest in bed and a milk diet, or a diet composed largely of milk, is the best means of treatment.
If possible the patient should be isolated and in the care of a trained nurse who is naturally cheerful and bright.
Children are especially liable to this malady. They are usually anemic and care should be exercised that they be not overworked in school and that they retire early and get from ten to twelve hours’ sleep.
Their eyes must be kept from strain and the nervous system not allowed to become tense from too much excitement, as teasing by playmates or the family, etc.
They should be given the diet for Anemia on page 249.
DIET IN SKIN DISEASES
An improper diet or a lowered nerve tone are often shown by the condition of the skin.
When the waste of the system is not being properly eliminated through the other excretory organs the skin is required to throw off more than its normal amount.
The muddy complexion in biliousness or the congestion of the facial capillaries in the alcoholic are familiar examples.
Overeating, especially of food too rich or too concentrated, causes fermentation from non-digestion, or imperfect oxidation, due to too large an amount of nutriment for the amount of oxygen furnished to the tissues.
An inactive skin results in an accumulation of fat in the sebaceous glands with clogging of the ducts; germ infection in these clogged glands often results in pimples and boils. An excess of acid in the secretion of the sweat glands irritates the skin and causes eruptions.[15]
Chronic skin troubles are always increased and made more troublesome when there are errors in the diet, and they are often benefited and in some cases cured when the dietetic errors are corrected.
Skin troubles often occur when for any reason the nervous system is run down, because the weakened nerves cause the tissues or organs they supply to become inactive. The skin thus becomes affected with the rest of the body and derangements of its function appear. Increasing nerve tone will result in a disappearance of the skin disorders. This takes time.
All rich food and highly seasoned preparations, veal, pork, tea, coffee, pastry, too much sweets and fats, and any fruits and vegetables that cause flatulence should be avoided.
A diet of fruit, water, and Graham bread for three or four days, every week or two, daily exercise and deep breathing of pure air will usually clear the skin.
The skin of the face is materially cleared by the use of facial exercises which promote its activity and the elimination of waste. Exercises for increasing the tone of the skin and the muscles are as essential for the face as for the body.
In all skin troubles alcohol must be prohibited.
Urticaria (Hives)
This is characterized by distressing itching and may be caused by any article of food which disagrees. A more or less irritant food or one difficult of digestion, such as strawberries, shellfish, pork, cheese, and sausage, are the foods which most usually produce it, if taken into an inactive stomach. When the intestines are in a sluggish condition the stomach does not act well, and any food which does not digest promptly is liable to excite an attack.
It is remedied, by eating very lightly, by fasting for a day or two, by drinking much water, exercising, breathing deeply, and securing activity of the bowels. Care must be taken to avoid foods known to disagree.
Eczema
The cause of this disorder is often difficult to ascertain, but it is aggravated or relapses occur when too much or too rich food is eaten. The skin is not able to dispose of all the material sent to it.
It often occurs in those who are excessive eaters of meat.
The diet may have to be confined to fruit, bread and milk, or crackers and milk for a few weeks.
Meat, if allowed, should be taken sparingly and not oftener than once a day—better only every other day. Beef and chicken are the preferable meats. If no improvement occurs, or if it be slight, meat should be omitted altogether. Eggs may be substituted for meat. A little fresh fruit, if thoroughly ripe, may be taken, but all made desserts must be avoided and very little sweets used. Cracked wheat, or other wheat cereal, with a little cream, may be eaten.
Oatmeal may provoke an attack because of the amount of fat in it. Foods may cause an attack in one case that have no detrimental action in another.
Skin eruptions, eczema-like, often occur if for any reason the diet has been too limited, as in the semi-starvation seen in poor children. In these cases a more nutritious diet will often cure.
Bananas, apples, cabbage, or fried foods, often cause a temporary attack or aggravate an existing condition.
The food must be thoroughly masticated, must be taken at regular times, and not in excess. As this condition sometimes accompanies other diseases, any underlying condition must be sought, but all diet should be as simple as the needs of the system will bear. The foods which are found to increase the irritation of the skin are the ones to be avoided in each case.
Pruritus (Itching)
The all-prevalent American habit of eating fried food often produces an intense itching of the skin in various parts of the body. It occurs often in those who eat food highly seasoned with pepper or other condiments. The articles of food causing the overstimulation must be avoided, and all fried food, pastries, or food containing much fat, must be greatly lessened or omitted altogether.
Itching is sometimes caused during the change of seasons due to the effect of the changing temperature on the nerves of the skin. To rub the skin with oil for two or three days to soften the dead cells and to aid their removal from the surface will secure a better circulation in the skin and help to eliminate the cause of the itching. A free drinking of water, fresh air, and exercise will help the condition.
Acne
The rapidly changing system of the growing boy and girl is especially liable to disorders, due to improper eating, irregular habits, worry, lack of rest, or improper food. Eruptions, especially on the face, appear as a result. The sebaceous glands are especially active, and any alteration in the structure of the blood, due to deranged digestive processes and defective elimination by the skin, causes too great an amount of deposit in the fat glands. Their contents become hardened and infected by germs, with consequent irritation and reddening, and the condition known as acne is the result.
Once well established it is difficult to cure, but it often rapidly improves under a simple diet, rested nerves, cheerful, kind thoughts, and better digestion and elimination.
The food should be thoroughly masticated. Young people are prone to eat too hastily, and thus not thoroughly mix the food with saliva. If careful attention is paid to mastication of the food, water at meals is an aid to digestion. Water should be taken freely between meals, on rising and before retiring, for its diuretic and laxative effect.
All candy, and sweets, hot breads, corn bread, pastry, soups with much fat, rich hashes and sauces, fried food, pork, and veal should be eliminated from the diet.
A badly blotched face is an embarrassment, and no restriction in the diet should be deemed a hardship as a means to an improved digestion, increased mental vigor, and improved health.
A pimple on the face should be treated as antiseptically as a boil. The pus from a pimple which has “come to a head” should not be allowed to infect the surrounding skin. Infection may take place from towels or wash cloths used by one afflicted with acne. Care should be exercised to sterilize the surrounding skin by peroxide of hydrogen or alcohol before a pimple is opened and its contents should be taken up with absorbent cotton. A pimple should never be severely squeezed as the skin will be irritated and other pimples may result.
Often the infection from one pimple is spread by the hands or by the wash cloth. Care should be taken to avoid this.
Exercise directed to the facial muscles and to the liver and digestive organs, deep breathing, plenty of oxygen by night and day, wholesome thoughts, plenty of sleep, and simple food, will eliminate or improve most skin difficulties. Care should be taken, by frequent bathing and friction baths, to aid the eliminative work of the skin.
Rheumatism
Since the medical profession is unable to determine just what rheumatism is, it is difficult to prescribe a diet. The theory so long believed that it is caused by an excess of uric acid in the system is no longer held by most of the advanced physicians. Uric acid, however, sometimes accompanies the disease.
Some authorities hold that it is a nerve difficulty; others that it is caused by an excess of lactic acid; others hold that it is caused by infection from the tonsils and the gums.
Assuming that it is due to the failure of the system to promptly eliminate its waste, whether this failure to eliminate be through a weakened condition of the nerves, and the consequent failure to properly direct the body activities, the correction of the difficulty must lie in building up the general vitality and in aiding the system in its elimination.
Hot sweat baths, a free use of water, and a free use of fruits and fruit juices, particularly the citrus fruits, such as lemons, oranges, limes, etc., are desirable in moderation, because they increase the alkalinity of the blood, and because of their diuretic effect. Lemonade, orangeade, and all fresh fruits and vegetables are diuretic.
The diet should be cut down in quantity. If an excess of uric acid exists, meat may be eliminated and the suggestions given in the diet for Gout may be followed.
The food must be plain and well cooked, not highly seasoned, and the amount must be confined to the needs of the system as shown by the general condition.
Regular exercise, until the body is thoroughly heated, deep breathing of pure air day and night, and a copious drinking of water are necessary.
Leanness
No definite diet can be given here for flesh building, because a lack of sufficient fat to round out the figure is due to faulty digestion or assimilation.
It may be that the strength of the muscles and nerves of the stomach, liver, and intestines should be built up by exercises and deep breathing, and it may be that the habit of nerve relaxation must be established. When the nerves are tense much nourishment is consumed in nervous energy and the nerves to the digestive organs and muscles being disordered, they interfere with digestion and assimilation.
It is apparent that the cause of the lack of flesh must first be corrected. Merely to give a fat-building diet may overload deranged digestive organs with sugars, starches, and fats, further weakening them.
Often leanness is due to inability to digest the starches or sugars, and when this is the case the condition must be remedied by strengthening the digestive organs through exercises for the muscles of the stomach and intestines, exercises to create a free activity of the liver and to strengthen the nerves controlling digestion. Deep breathing habits to insure sufficient oxygen to put the waste in condition for elimination are necessary. Most often sufficient food is eaten, but due to nerve tension or to sluggish circulation, particularly through the vital organs, it is not assimilated.
Usually, however, bodily flesh may be increased by increasing the liquids and the carbohydrate consumption and also the fat if these are assimilated.
If habits of life, overwork, improper food, unhealthy thoughts, nerve exhaustion, excessive nerve tension, or disease are responsible, they must first be corrected. Often the nerve tension must be relaxed by change of habit of both body and mind before the flesh will accumulate.
There must be no mental strain, and plenty of sleep must be secured.
If they can be assimilated, the diet should contain soups, butter, milk, cream, cocoa, chocolate, well-cooked cereals, as oatmeal, bread, tapioca, or rice puddings with cream and sugar, bread, potatoes, leguminous foods, as peas and beans, cake, honey, especially sweet fruits, carrots, parsnips, and other vegetables; meat not oftener than once a day.
Vinegar and too much spice, pastry, coffee, and tea should be avoided.
The free drinking of liquid is most important.
Obesity
Obesity is caused by a disturbed balance of nutrition occasioned, often, by more food being taken than the body requires. The resultant fat is deposited in and among the tissues.
It is most often seen in those in middle life of sedentary habit who continue to eat as heartily as ever without using a little thought to determine the actual body needs for food.
An excess of fat is often seen in light eaters, however. This is usually due to a weakness of nerve tissue, which does not direct the regular activities of the body—digestion assimilation, elimination, etc.—with sufficient force to burn up the normal amount of fat in automatic activities.
In all cases breathing is usually faulty, oxidation is incomplete, and little exercise for the vital organs is taken. Anemia may exist in such individuals.
The body fat is formed from various elements in foods, and a food which may cause obesity in one individual may not produce it in another. Fat meats, alcoholic drinks, or the excessive use of starches and sugars may cause it. The food at fault in each case must be determined and largely reduced or eliminated from the diet.
Many obesity cures are in existence, and have had considerable vogue from time to time. Anti-fat remedies are dangerous, as they lower the vitality of the system and render it liable to be attacked by disease. All such remedies act by decreasing the appetite and causing impairment of the digestion.
The rational method is to limit both the amount of food and the liquid to be taken, to increase oxidation by deep breathing and exercise. By restricting the carbohydrates and fats consumed the body calls on that stored in the tissues. In obesity, unless there is an underlying condition of disease, the amount of water should be limited while reducing and none should be drunk with the meals. Soup, milk, and all juicy fruits and all foods made from cereals should be taken sparingly; sugar must usually be forbidden and fat in the food limited to a little butter. One need not starve under this treatment for the diet may be varied enough to prevent monotony even though restricted.
Fresh green vegetables, fruit, and lean meat should form the main ingredients of the diet, but if gastric disturbances arise the diet must be varied to correct them. Meat should be eaten but once a day.
Extremes in diet should be strictly avoided; a sudden restriction of diet produces changes in the blood which may do harm. For this reason the amount of food taken should be gradually but steadily reduced and one article after another eliminated until the system becomes accustomed to the reduction.
Thorough elimination must be secured through exercise and deep breathing.
All alcoholic liquors must be omitted.
All diets for obesity must be prescribed for the individual condition. A diet suited to one person may be entirely unsuited to another. For this reason, and because of the danger of one following a diet which may be unsuited to the condition, diets for obesity are not given here.
Exercise and deep breathing must constitute an appreciable part of reduction methods to cause a combustion of the fat liberated. These are the natural, scientific means of reduction.
If one reduces by diet alone the excess of fat may not come from the part desired. One is likely to show the results first in the face and neck. One should exercise the parts desired to be reduced so as to oxidize the fat stored about these particular tissues.
A large number of the obese are afflicted with rheumatism, sluggish livers, sluggish action of the intestines, and weak nerves, and the diet must be governed accordingly.
The regulation of food for reduction of flesh must also be governed by age, sex, by the manner of breathing, and by the amount of daily exercise. The food must be regulated in accordance with the quantity of carbohydrates and fats daily consumed in heat and energy.
A rational study of the needs of the system and a persistent following of the indicated regimen will result in a steady reduction, renewed vitality, and a sense of “being fit.” The better elimination secured by exercise and increased oxygen will aid the muscles to release the fat which may have caused them to become flabby.
Reduction must not be accomplished too suddenly, but it can be gained by a little self-denial and determination.
One who carries too much fat is much more liable to gout, rheumatism, apoplexy, high blood pressure, asthma, and bronchial affections.
Feeding the Convalescent
When an individual is recovering from an illness the appetite often becomes excessively active, and his demands for food, if yielded to by the family or attendant, may produce digestive derangements from which recovery is slow.
On the other hand, too much food is often urged on the convalescent from a mistaken idea that large quantities of food are necessary in order to rebuild the enfeebled system.
Care must be taken not to return too rapidly to a solid diet when a liquid diet has been followed for some time. The digestive system shares in the general weakness and must not be overloaded.
The more easily digested foods, as ice cream, milk, tapioca, crackers and cream or cream toast, cream soups and meat broths thickened with bread crumbs rolled from toasted bread, custards, stewed fruits, corn meal, mush, in some conditions, cornstarch blancmange, boiled rice, and poached eggs may be given.
Later, when meat is added to the diet it should be scraped or finely minced so as to give the stomach as little work as possible until it regains its tone.
Potatoes, if allowed, should be baked or mashed.
Sweetbreads in cream, sponge cake or lady fingers with light cream may also be allowed.
At least a week should be taken in returning to a solid diet and the orders of the physician must be strictly followed. Pickles, nuts, or solid meats should not be allowed. They will often occasion a return of fever and possibly a relapse.
After typhoid fever or other lingering illness, the appetite is usually much increased, but great care must be exercised not to allow solid food before the condition of the stomach and intestines shows that danger is past. It is usual not to allow solid food in typhoid fever for two weeks after the fever has disappeared.
It is possible to make great variety in the diet even if it be light and easily digested and common sense must govern in the kind as well as the quantity of food allowed the convalescent.
Scraped beef or scraped chicken may be seasoned, lightly pan broiled, and made into a sandwich. The first solid meat may be creamed sweetbread, a bit of broiled tenderloin steak, or breast of chicken.
It is better to give small amounts both because of the lessened work of digestion and because large amounts of food often destroy rather than aid the appetite.
If the appetite is capricious, or lacking, it needs to be stimulated by food appetizingly prepared and daintily served. A sloppy tray with half-cold tea or coffee will often cause complete loss of appetite.
The face and hands of an invalid should always be bathed before a meal; the fresh feeling induced is often an aid to the appetite. The mouth should be carefully cleansed after eating in order that no fermenting food particles may be carried into the stomach to cause disturbance there. Swabbing the mouth with cotton dipped in an alkaline wash or rinsing the mouth with listerine and water or peroxide of hydrogen and water will add greatly to the comfort of the sick, especially when the tongue is coated and the mouth bitter.
Great care should be taken not to allow bread crumbs to fall into or under the bedclothes, as a small bread crumb is often a source of great discomfort. The skin is especially sensitive and a small bread crumb may so disturb the mind as to cause a patient, otherwise doing well, to become restless and disturbed.
The invalid frequently forgets to ask for water and the attendant should see that a sufficient amount of water is taken. A glass of water should be placed where it is within easy reach and it should not be allowed to become warm. Cool water is one of the prime requisites in the invalid’s dietary.