How to feed the sick, or, Diet in disease : for the profession and the people

Front matter

NATIONAL LIBRARY OF MEDICINE

SURGEON GENERAL'S OFFICE

LIBRARY.

Preface

When entering upon the practice of my profession, I -well remember that one of the first questions which greeted me was, " Doctor, what shall I eat ? " I also recollect that in the college lecture-room I received no special instruction which would aid me in making a reply, and therefore, from necessity, I early began searching for such information as would enable me to answer intelligently this question, which was almost daily repeated.

While it is expected that the profession may find this book of value when called upon to answer the frequently recurring question which suggested its writing, yet, as the introduction indicates, the object has been to adapt it more particularly to the wants of the people, and to provide for them a practical work on the suject of diet in disease— one which they may take into the sick-room and into the kitchen.

Great care has been taken to select only such recipes as have been obtained from reliable sources, and many of them have stood the test of trial in my own practice.

Free use has been made of all works on kindred subjects, and Chamber's " Manual of Diet " has been

PREFACE.

consulted, while Niemeyer's, Aitken's and Euddock's •works on Practice, and Ziemssen's Cyclopaedia, have contributed valuable hints. Acknowledgment is also due Florence Nightingale's " Notes on Nursing," and the chapter on "The Sick-Eoom," by Marion Harland.

With this introduction the book is sent on its mission in the hope that it may answer the important question for others, as it has for me.

CH. GATCHELL.

Preface To Second Edition

The early exhaustion of the first edition of this work has led me to hope that another may be received with like favor.

In preparing this edition the entire work has been revised, and many important changes made. The number of chapters has been increased, and many additional recipes have been inserted. The chapter on the Dietetics of Infancy, in particular, has received especial attention, and been much enlarged.

Hoping that it may be the means of aiding in the restoration to health of many sick ones, it is again consigned to the profession and the people.

CH. GATCHELL.

Chicago, September, 1882. / i

Table Of Contents

Introduction 11.

Chapter I. — How to Feed the Baby.— The Use of Goat's Milk — Condensed Milk — Cow's Milk — Fat — Caseine — Sugar — Salts — Gelatine— Lime-water - Substitute for Mother's Milk — Food for Infants Under Four Months and Over Four Months— Oatmeal-water — Barley-water 21.

Chapter 11. — The Care of the Milk. — Testing with Litmus Paper — Milk of One Cow— Preparing Milk for the Baby — Care of the Bottle — Kind of Nipple to Use — Method of Feeding — How to Nurse the Baby — How to Choose a Wet Nurse 31.

Contents

Chapter VII. — Diet in Consumption. — Stimulants Harmful- Meats— Eggs— Milk— Koumiss— Cod-liver Oil — Whea Indicated — How to Select — Malt Extract — Hypophosphites. 75.

Chapter VIII.— Diet in Diabetes. — Vegetables Prohibited— Fruits Prohibited — Vegetables and Fruits Allowable— Animal Food Allowable — Rules to Observe— Gluten Bread. — Milli Cure.- Rules- Quantity.— Diet in Bright's Disease. — Milk Diet.— Diet in Gravel. — Must be Strictly Vegetable. 83.

Chapter IX.— Diet for Travelers.— Light Eating— Vegetables. Diet in Seasickness 93.

Introduction

The human body is composed of a great variety of substances, and yet they are capable of classification into a few simple groups. These substances, which we know under the general name of foods, become component parts of our bodies and enter into the composition of living tissues. It is important to the health of our bodies that we receive a due supply of each of these different classes of foods. If we should be entirely deprived of any one class our health would seriously suffer, and sooner or later the body would succumb to the disease which would inevitably result.

These elements are so generally distributed throughout the animal and vegetable kingdoms, among those substances upon which man relies for his sustenance, that it requires little calculation on his part to supply his body with the needed variety. The penalty of a violation of this is seen in scurvy, a disease which follows a diet deficient in potash combined with vegetable acids, and all that is necessary to its cure is to supply the system with food containing those elements of which it has been deprived.

But in disease, on the other hand, the system loses an undue amount of certain elements, and these must

INTRODUCTION.

be supplied in increased quantity in order to make up for the rapid loss. Thus in fevers we supply those elements which make muscular and other tissue, which waste very rapidly,* in consumption we supply the same, together with fats ; in rickets we supply salts of lime, in which the body is deficient.

Accordingly, the regulation of the diet in disease consists in supplying those foods containing the elements which are lacking in the system,* and offering them also in a form to be readily digested and assimilated.

Hence, if we can learn the wants of the system, and if we know in what state to introduce the required aliment, we are prepared to intelligently feed the sick.

To teach this is the design of this work.

As already indicated, foods may be conveniently divided into three different classes, which are named as follows:

As the name denotes these all contain nitrogen. They have for their bases certain principles called

* This, of course, does not apply to diabetes and diseases treated on a similar plan, as the result of experiment ; but, as a general rule, it will hold good. I once had a diabetic patient to whom no instructions regarding diet were given, as I wished for a short time to try the effect of medicine uninfluenced by the former. To my surprise the amount of sugar in the urine began to increase rapidly. Inquiry elicited the fact that of his own accord he had begun taking large quantities of sugar in order to supply the loss, which he learned was taking place. He was immediately dieted.

Inorganic.

I. NiTROGENIZED FoODS.

INTKODUCTION.

fibrin,* albumen and caseine. The chief foods of this class are of animal origin, and eggs, milk, cheese, and all meats contain them in abundance. In small proportion, similar principles exist in some vegetables, as gluten and legumine in wheat and peas respectively.

Foods of this class contain a large proportion of nutrient matter, and of a kind which has to go through but few changes before being converted into living tissue. Their chief function is to act as tissue-builders. They enter largely into the composition of muscular and other tissue, and hence we give them in fevers, in which there is great and rapid loss of flesh and waste of tissue, in consumption and wasting-diseases generally.

These foods are all digested in the stomach, and hence should not be given in conditions in which this organ requires rest.

Beef is the chief food of this class, and is invaluable in the dietetic treatment of the sick. " One of the most important articles of diet for the sick is beef, and it should be of good quality ; the bone should not exceed 20 per cent., the fat should be firm, not yellow, and free fom blood, and should not be in too great proportion relatively ; the muscle should be firm without being tough, not too pale nor dark-colored, and and should not present any marbling or lividity on cross-section." — (BartJiolow.)

Mutton is more easily digested than beef and in this respect to be preferred to the latter. It is, however,of less nutritive value. The broth of mutton has a delicate and peculiar flavor which renders it especially agreeable to the sick. It should be well freed from fat.

* This term is meant to include muscle-fibrin, called by Flint musculine.

INTRODUCTION.

Veal is less nutritious than beef, abounding in gelatine. It is also more difficult of digestion than the latter, and has a very limited use in the invalid's dietary.

Venison is more easily and quickly digested than beef, but does not possess the same nutritive value.

Chicken is an important article of diet for the sick and convalescent. It is agreeable to the taste and easy of mastication and digestion. It is not, however, so nourishing as beef, but probably enough so for all ordinary purposes.

Pork, containing as it does much fat, is difficult of digestion and finds no place, either fresh or cured, in the invalid's dietary.

Salted meats are not very easy of digestion. They are deficient in nutritive value and should not be taken by the sick.

Fish is a nutritious food, but not adapted to the wants of the invalid.

Salted fish is difficult of digestion and should never be used by the sick.

Cheese is a rich food and cannot be taken by those with dyspepsia or weak stomachs. In nutritive value one pound of cheese is equal to three and a half pounds of lean beef.

Oysters are highly nutritious, easy of digestion, and usually well borne by a delicate stomach. Simply prepared they form a valuable addition to the invalid's dietary.

Eggs are rich in albumen. They are highly nutritious, generally easy of digestion, and form a very important part of the invalid's food. They should never be cooked more than three minutes. The yolk is more digestible than the white, if hard-boiled. Eaw

INTRODUCTION.

or whipped eggs are among the most digestible of alimentary substances.

Milk is one of the most important articles of food for the sick, and life may be sustained for weeks on this alone. It is highly nutritious, contains all the elements which enter into the composition of the tissues, and can be served up in many different forms and be introduced into a great variety of other foods. Some diseases can be cured by simply adopting a diet consisting exclusively of milk.

There are some with whom milk disagrees either in health or sickness. This cannot be accounted for, being due to some idiosyncrasy. When this is the case it can sometimes be remedied by adding a little salt to each glass of milk — not enough to make it taste salty. The addition of lime-water to the milk will correct it for others.

Clabbered milk, sour milk and butter milk are equally as nutritious as fresh milk and will be borne by many stomachs which cannot tolerate the former. These are valuable articles of diet which are too much neglected.

Gelatine belongs to this class. It possesses scarcely any nutritive value, and must not be relied upon as food. On it alone any animal will starve. It may be used as a vehicle for the introduction of other substances, or for its soothing properties alone.

II. NoN-NlTROGENIZED FoODS.

The foods belonging to this class are sugars, starches and fats, the first two being exclusively of vegetable origin (liver-sugar being left out of account), while the last-named is produced by both animals and vegetables.

INTKODUCTION.

While the nitrogenized foods in the main go to build up tissue, these find their chief use in keeping up the heat of the body.* Hence when the athlete wishes to develop his muscles, he eats beef: when the Esquimaux wishes to fortify himself against cold, he eats blubber.

All the principles of this class are fat-formers. Mr. Banting found sugar to be the most active agent of this kind that he used.

SuGAK has a very limited range in the invalid's dietary, being used chiefly for seasoning. It is especially harmful in diabetes. It should never be taken by the corpulent if they desire to decrease their weight.

Sugar-of-Milk is to be preferred to cane-sugar in the preparation of dishes for infants.

Starches form a large and important part of our food. As food for the sick they occupy a prominent place. After the salivary glands become active, starch forms an important part of the infant's diet.

Corn-starch has but a limited use in the invalid's dietary. It can be made into blanc-manges for the convalescent. It is too heavy for most stomachs.

Sago is an excellent form of starch of which to make dishes for the sick, as well as for infants. It is to be preferred to tapioca, a similar product, because the grains are finer and it can be rendered smoother, and hence is easier of digestion.

Arroivroot is another starchy food much used in the preparation of dishes for the sick and for infants. It is excellent of the kind, but it must be remembered that a child will starve if fed on starch alone. Do not

* Although the doctrine on this subject has been modified, yet since each class finds its chief use in the direction indicated, the statement, as made, will stand.

INTRODUCTION.

depend too much upon the arrow-root gruel, to the exclusion of other foods.

Wheat. Preparations of this grain form many of the most useful foods known to man. It contains all the elements which enter into the composition of the body. Wheat flour, however, as ordinarily prepared, has been deprived of the most valuable consituents of the grain, the salts and nitrogenous portions. The flour which is made by the so-callecl " patent process" is not open to this objection. Brown flour, or Graham flour, also retains these elements.

This is a very valuable food and can be prepared in a great variety of forms.

Corn, in the form of meal, hominy and samp, forms an important food, but it finds no place in the invalid's dietary. It contains more oil than the other grains, and it is hard to digest.

Oatmeal, has come to be a favorite article of diet with many, but it must be remembered that it is a very hearty food — almost as much so as meat, and it requires a strong stomach to digest it. It is not a proper food for invalids or dyspeptics. It will not hurt horses.

Potatoes. These form a valuable food, but are not well adapted to a diet for the sick. They are rich in the starchy elements. The best potatoes are mealy and powdery when boiled. Young potatoes, and old ivaxy potatoes are indigestible and should never be taken by those with weak stomachs.

Rice is said to be the chief food of nearly one-third of the human race. It contains a greater proportion of starch than any other vegetable. It is easy of digestion, leaves very little residue, and is a useful food in sickness, finding its chief place in bowel diseases.

INTRODUCTION.

Care must be taken to have it well cooked, or it will defeat the very object for which it is given.

Gums, such as gum-Arabic and that which adheres to flax-seed, have the same composition as starch. They possess no nutritive value whatever, but pass through the alimentary canal unchanged, and flaxseed tea and similar preparations are useless as foods.

Fats — including oils — cannot be taken by those with weak digestive powers. They are unfit foods for fever-patients and those who suffer from indigestion. In consumption fats are very useful, not only in supplying the element which is deficient in the system, but also in aiding the nutritive process through the influence which they exert over cell-growth.

Inunctions of oils serve a valuable purpose when it is impossible to take them by the stomach and yet it is desired to keep up nutrition.

Cream is too rich for most invalids. It should never be used in febrile conditions, but is of value in consumption and wasting diseases.

Butter may be placed in the same category with cream. Consumptives should use it liberally.

Cod-liver oil has a deservedly high reputation in the treatment of a certain class of diseases, especially in consumption. While the oil undoubtedly is the important agent, some ascribe to the iodine which all cod-liver oil contains, its peculiar virtue in this disease. It holds an important place also in the treatment of scrofula and marasmus.

Olive oil may be substituted for the cod-liver oil if the latter disagree. It is equally as good as an inunction.

INTRODUCTION.

III. Inorganic Foods.

While the principles belonging to this class cannot of themselves support life, yet, since they are as necessary to the proper constitution of the body as any other, they occupy the position of a food and must be considered as belonging to the class of alimentary substances. While some of these go to the formation of solid tissue, as lime in the bones, their general purpose would seem to be to exert some sort of control over the processes of nutrition.

Wate?- is the most important of the inorganic principles. It enters into the composition of all the tissues of the body. Some diseases are much benefited simply by drinking large quantities of "soft" water. The important point to be observed in the use of this principle is to obtain it in as j)ure a state as possible.

Salt enters into the composition of almost all our food, but in insufficient quantities to satisfy the demands of the system. It exerts a favorable influence over the processes of nutrition, and if entirely deprived of it disease will surely follow.

Iron exists in our food, both animal and vegetable, in sufficient quantity to satisfy the wants of the system in health. In those diseased conditions in which it is deficient it must be supplied in increased quantities.

Phosphate-of-Lime is supplied in combination with animal and vegetable foods. When it is deficient in the system, as in rickets, it should be artificially introduced.

CHAPTER I. How to Feed the Baby

It is a fact, well known to medical men, that one-third of the children brought into the world die before they complete their fifth year of existence. While there are various causes which combine to produce this fearful rate of mortality, probably there is none which is so directly responsible as improper food and improper feeding. It was his knowledge of this which led Sir C. Clark, an eminent London physician, to say — "The ignorance of mothers in feeding children is worth a thousand pounds a year to me." And this significant statement has been made in various terms by many physicians.

Since the health of the child is directly dependent on the nature of the food which it receives, this becomes a question of vital importance, to which too much attention cannot be paid, and it is designed, in this chapter, to convey to mothers and nurses such information as will enable them to avoid those errors of feeding which are responsible for much of the illhealth of infancy and childhood.

And first, it cannot be insisted upon with sufiicient emphasis, that there is no reliable substitute for the mother's milk, and, until the proper period for weaning has arrived, in sickness or in health, the child will

DIET IN DISEASE.

thrive best on that food which was designed for it by nature. Mother's milk is made for babies — cow's milk is made for calves. Human milk has another immeasurable advantage over cow's milk, in that it is always fresh.

But the time arrives when a change becomes necessary, and then it is that we must seek for something to replace that food which is now no longer the child's natural aliment, or of which circumstances deprive it.

There are two periods in the infant's life when especial care is called for in the management of its diet — at the time of weaning, whether this be premature or at the usual age, and in its "second summer," when it is so liable to disturbances of the stomach and bowels.

Until the child is old enough to live on a mixed diet, milk is its natural aliment; and the important object to be kept in view is to give it a preparation as nearly as possible resembling the mother's milk, and to give this before any change has taken place in it — that is, before it has in the least degree "turned." While it is true, as already stated, that mother's milk is the child's natural aliment during its nursing life, yet, when the period of weaning has arrived, we are compelled to resort to the milk of the lower animals for its newlyadopted food.

Goat's Milk.

If the child be deprived of its mother's milk, the best substitute is goat's milk, if this can be obtained fresh and jpure. As compared to cow's milk, it contains more sugar-of-milk than the former, and it is less liable to become acid. As a substitute for mother's milk I would recommend this above anything else that it is possible to obtain.

HOW TO FEED THE BABY.

But it is so scarce an article in this country that we must seek for something which it is not so difficult to procure.

Condensed Milk.

This must sometimes be relied upon for feeding the baby, and it is to be preferred to ordinary milk, unless you are certain that the latter is fresh and pure. Often, when traveling, we are compelled to rely upon its use, and then it is the best substitute that can be obtained. If it be used at all, the American brands will be found to be better than the Swiss, as the former are more apt to be freshly prepared. Be careful not to prepare it too strong.

Cow's Milk.

After all, our main dependence must be placed upon that milk which all can obtain in such abundance — cow's milk. But in its natural state it cannot be fed to a young child, and it requires some modification in order to fit it for the infant organism. Both cow's milk and human milk contain, in addition to a large per centage of water, which is greater in the latter than in the former, the following elements :

Fat. — This, in the form of minute globules, is distributed throughout the mass of fresh milk. After the milk has stood for several hours it rises to the top as cream, and, when churned, becomes butter. It is an important element of nutrition, but when given in too great quantity is a source of harm, becoming converted into fatty acids and setting up indigestion. The proportion of butter in cow's milk is greater than in human milk.

Caseine. — This is the cheesy part ot the milk, which coagulates and forms the curd. It contains very im-

DIET IN DISEASE.

portant elements of nutrition, but requires strong and healthy powers of digestion to render it capable of assimilation. Cow's milk contains a greater proportion of caseine than does human milk.

Sugar. — There is a peculiar form of sugar, known as sugar-of-milk, in all milks. This is much easier of digestion than the common cane sugar, which we use on our table. There is a less* proportion of sugar-of-milk in cow's milk than in human milk.

Salts. — There are numerous salts in milk, among the more prominent of which are the phosphates of lime, soda, and potassa, all of which perform very important parts in the processes of nutrition. These exist in cow's milk in greater proportion than in human. There is also common salt, or chloride of sodium, which is of equal importance to those already named. There is, relatively, less common salt in cow's milk than in human milk. There is, relatively, a smaller amount of free alkali in cow's milk than in human milk, and hence the former is more apt to become acid than is the latter.

A review of what has been given concerning the relative amounts of the different constituents of these two kinds of milk, teaches that in order to so modify cow's milk as to make it more suitable for the baby's use, it is necessary to

Decrease the proportion of Caseine arjd Butter,

and at the same time increase the proportion of Water, Sugar,

Common Salt, and Free Alkali.

HOW TO FEED THE BABY.

Now, if cow's milk be diluted by simply adding water to it, the first of these is accomplished, and the proportion of the solids is correspondingly decreased. But this is not enough. There is still another object to accomplish.

" The important difference between woman's and cow's milk is that the caseine of woman's milk curdles in the stomacfh into small, light flakes, forming a very loose jelly, while that of cow's milk coagulates into large compact lumps. The loose flakes of the woman's milk are easily digested and assimilated : the firm lumps of caseine of the cow's milk, the infantile gastric juices are incapable of dissolving. They are thrown up again, or wander through the whole intestinal tract as large, sour, undigested masses." — (Vogel).

Therefore, in order to render the cow's milk digestible for the infant's stomach, we must prepare it in such a way as to obviate this tendency on the part of the caseine to coagulate into large, compact masses. This we can in a great measure accomplish by diluting the milk with some mucilaginous liquid, which shall hold the caseine in suspension, so that it shall be slowly and gradually attacked by the gastric juice, thus producing a looser clot, on which the digestive fluids and the peristaltic motions of the stomach have a better opportunity to act.

There are several articles which may be used for this purpose. For very young infants the most appropriate are preparations of gelatine, isinglass, or gum Arabic.

DIET IN DISEASE.

Gelatine.

Cox's gelatine, one half ounce ;

The white of one egg ;

Pure soft water, boiling hot, one pint.

Soak the gelatine for about ten minutes in a teacupful of cold water ; then pour on to it the boiling water, and stir until the gelatine dissolves. Beat well the white of one egg, and stir it briskly into the gelatine solution ; put it on a slow fire, and stir gently till it boils ; take off as soon as it boils ; let it stand a minute, then strain well through a jelly-bag. When cool it will form into a stiff jelly. Keep this well covered and in a cool place.

One-third of a one-shilling package of Cox's gelatine is one-half ounce. Eussian isinglass or Cooper's gelatine may be substituted by those who are accustomed to their use.

Gum Akabic Watee.

Dissolve enough pure gum Arabic in two ounces of water to make a thick syrup-like mucilage. Keep this in a wide-mouthed bottle, well corked.

After diluting the cow's milk with water— which process accomplishes the first step indicated as being necessary, viz., decreasing the proportion of caseine and butter, as well as that part of the second which requires the proportion of water to be increased— it only remains to add those elements which exist in too small a quantity.

HOW TO FEED THE BABY.

And before going further let me give a word o advice concerning the purity of the different articles to be added to the milk.

Water. — Let this be a j:>?/re, soft water. Above all things is this caution necessary here in Chicago, where, at some seasons of the year, our lake water is so contaminated by the city sewage as to be the cause of much sickness among both children and adults. Use for the baby Waukesha, or some other pure spring-water. That from the Douglas Park artesian well is excellent. If spring-water cannot be obtained, do not use the lake water until it has been first boiled and filtered.

A very good filter can be made out of a common earthen flower-pot. Get a neiv flower pot, with a hole in the bottom ; line it with a piece of netv canton-flannel ; put into the bottom of this, to the depth of two inches, some clean sand ; over this put a layer of pounded charcoal, and fill up with fine gravel. This domestic filter will answer the purpose of the most elaborate, and is very easily made. After several weeks' use it should be renewed.

Sugar-of-milk. — Do not use the ordinary cane sugar, but get of some reliable druggist a half pound or a pound of sugar-of-milk. This is the kind of sugar which naturally exists in milk, and it is much more easily digested than the former.

Lime-ivater must also be added, in order to supply the free alkali which, it has been said, is deficient in cow's milk, the absence of which renders it so much more liable to become acid. This you can get of a druggist, or prepare according to the following :

DIET IN DISEASE.

Recipe 3.

Lime -Water.

Get a piece of unslacked lime the size of an egg, break it up, put into a clean quart bottle, and fill up the bottle with rain-water. Let this stand over night ; the next morning it is ready for use. There will still be a heavy sediment of lime in the bottom of the bottle, but the water will have taken up all that it can dissolve. When you have used all the water in the bottle, fill up again with water on the lime which remains, and repeat this again and again as long as the lime lasts. Do not shake the bottle, but use the clear lime-water off the top.

Common salt must also be added, for it performs an important part in assisting in the digestion and assimilation of other food elements, and, as compared to the other mineral ingredients, it is contained in cow's milk in insufficient quantity.

Food for Infants Under Four Months of Age.

With the knowledge which we have gained, we are now prepared to compound a food which is recommended as being an excellent substitute for mother's milk.