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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

CHAPTER V

PROPER EATING—THE SECRET OF
GOOD HEALTH

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

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

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

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

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

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

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

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

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

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

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

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

ADULT MALE OF AVERAGE WEIGHT.

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

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

CHAPTER VI

BREAD AND ITS RELATIONS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

CHAPTER VII