Practical dietetics : with special reference to diet in disease

Front matter

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WVU - Medical Center Library

Introduction

The subject of the dietetic treatment of disease has not received the attention in medical literature which it deserves, and it is to be regretted that in the curriculum of medical colleges it is either wholly neglected or is disposed of in one or two brief lectures at the end of a course in general therapeutics. Upon examining the standard treatises upon the Theory and Practice of Medicine, as well as monographs upon important diseases, such as those of the circulation, nervous system, and skin, one cannot fail to be impressed with the meagre notice given to the necessity of feeding patients properly, and the subject is usually dismissed with such brief and indefinite phrases as "The value of nutritious diet requires mere mention," "A proper but restricted diet is recommended," and favourite, if not convincing, expressions are, " The patient should be carefully fed," and " General dietetic treatment is of primary importance." With such vague directions the dieting must indeed be very " general."

In many excellent works upon food and dietetics the space devoted to the practical application of dietetics to disease is comparatively insignificant, and much less emphasis is given to this matter in hospitals and in the training of nurses than is demanded in the interests of medical science.

A writer of wide experience in practical dietetics, Mrs. E. H. Richards, says: "At present there are comparatively few persons who are called upon to feed the sick to whom a glass of milk or a pound of beef represent any definite amount of food materials. Still fewer who can tell how much food value a glass of lemon jelly or wine whey represents, and yet the adult patient is dependent upon the attendant even more than the week-old infant for the requisite nutrition."

The present volume has been prepared with the view of in some iv INTRODUCTION.

measure making good these deficiencies by furnishing a text-book in which the practitioner of medicine may find detailed the appropriate diet for each disease which is at all influenced by right feeding.

Quite as much depends upon the suitable preparation of food as upon the selection and limitation of the food itself, and it has therefore been thought advisable to include a general account of the composition and uses of foods, and the changes which may be produced in them by cooking and other processes. In this first portion of the work, however, the practical application of such knowledge to the feeding of the sick has been constantly emphasised rather than unnecessary scientific detail.

The reader will also find a discussion of representative hospital dietaries, the official dietaries of Government institutions, and sections upon the proper feeding of infants and children. Numerous cross references and a complete index have been added to avoid undue repetition.

Bennett wrote, as long ago as 1858: " Of all the means of cure at our disposal, attention to the quantity and quality of the ingesta is by far the most powerful." While fully concurring in this view, that appropriate dieting is often more needed than medication, I distinctly disclaim the advocacy of any special dietetic system as a cure-all, as well as the specific influence of any one food in the general treatment of disease. It cannot be expected that the experience of a single individual should cover so extensive a ground as that which embraces the uses or application of all foods, and I have therefore impartially introduced the views of others, especially where, as in such diseases as gout, diabetes, and obesity, opposing dietetic theories are held by clinicians of extensive experience and authority. Due acknowledgment of these references is made in the text, but the admirable researches upon foods of our own Government, found in the published reports of the Bureau of Agriculture and of the Commission to the Paris Universal Exposition of 1889, and at the Columbian Exposition of 1893, are especially to be commended.

\\ . Gilman Thompson.

Introduction

Part I. Foods And F

OOD PREP

Elementary composition of foods .

Food classification ....

Force production. Energy from food Force-producing value of the different cl

I. Water .

II. Salts .

III. Proteids, carbohydrates, and fats Stimulating foods .

Economic value of foods Nutrition

Animal and vegetable foods compared Vegetarianism The classes of foods

I. Water .

Uses of water in the body Purity of water Varieties of drinking warter

Hard and soft water

Rain water .

River water .

Distilled water

Filtered water

Boiled water Special dietetic use Excess of water Deprivation of water. Water starvation Thirst Temperature of drinl

II. Salts .

Varieties of salts Uses of salts in foods Excess of salt .

Deprivation of salt

Sodium salts Potassium salts Calcium salts of water of fo ods

PAGE

Vegetable acids ............ 41

III. Animal foods.

Milk 41

Exclusive milk diet ........... 42

" Milk cure " 44

Chemical composition of milk ......... 44

Fat 45

Casein and albumin ........... 45

Varieties of milk ............ 46

Drugs in human milk .......... 48

Mare's milk 49

Milk analysis 49

Reaction, colour, taste, odour ......... 49

Estimation of solids ........... 49

Estimation of fat . . . . . . . . . . 50

Estimation of lactose . . . ■ . . . . . 50

Estimation of albuminoids ......... 50

Milk adulteration and impurities . . . . . . . . • . 51

Addition of water ........... 52

Addition of colouring matter ......... 52

Addition of preservatives .......... 53

Addition of thickening substances ........ 53

Milk contamination by the cow's food ........ 53

Contamination by the cow's condition ....... 53

Contamination by the cow's disease germs ...... 54

Contamination by extraneous disease germs ...... 55

Souring and decomposition 56

Absorption of bad odours 57

Prophylaxis against milk infection ........ 57

Uses of milk 5S

Adaptation of milk for the sick ......... 62

Methods of altering the taste of milk ....... 63

Methods of improving the digestibility of milk . . . . .64

Dilution with water .......... 65

Dilution with alkaline and aerated waters ...... 65

Dilution with amylaceous foods ........ 66

Addition of alkalies, acid, and other substances . . . . .66

Methods of predigestion of milk 67

Peptonised milk ........... 67

CON TENTS.

Vll

Pancrcatinised milk Koumiss .

" Koumiss cure "

Kafir Matzoon .

Methods of sterilisation an Sterilised milk Pasteurised milk " Humanised mil Modified milk. Milk la Milk derivatives .

Condensed milk Cream Butter Buttermilk Cheese Whey .

Eggs

Raw eggs. Eggnog. Egg The cooking of eggs Preservation of eggs Meats

Consumption of meat Composition of meats Raw meats .

Digestibility of meats Beef .

Beef preparations for the si Solid meat preparations Scraped meat Beef meal Beef jelly Beef extracts Beef blood .

Beef peptonoids Fluid meat preparat Beef juice .

Beef tea Bouillon Beef broth .

Beef extracts Summary Various meats Beef tongue Veal

Mutton .

Lamb Venison .

Pork

Ham and Bacon Fowl .

Game .

PAGE

68 69

73 73

75 77 73 81 81 82 84 85

98 99 99

VI 11

Contents

Animal viscera .

Sweetbread Tripe, liver, kidneys, brains, blood Isinglass, gelatin

Jellies Fish .

Part III

COOKING. FOOD PREPARATION AND PRESERVATION. THE QUANTITY OF FOOD

REQUIRED.

Object of cooking food Varieties of cookin I. Boiling

2. Stewing

3. Roasting .

4. Grilling

5. Frying

6. Braising

7. Baking

8. Steaming .

Soups .

Cooking of fish .

Cooking of vegetables

Food concentration. — Condensed food

Drying, desiccation, extracts Diet of concentrated foods Food preservation

I. Drying .

II. Smoking

III. Salting

IV. Freezing

V. Refrigeration

VI. Sterilisation

VII. Exclusion of air. — Canning

VIII. Antiseptic and preservative substances Substitutes for food Quantity of food required Starvation and inanition

Voluntary fasting Symptoms of starvation Treatment after starvation Famine Improperly balanced ingredients of diet

238 238

239 240 242 243 243 246

247 247

Xll

CONTENTS.

Part IV. Foods Required For Special Conditions

PAGE

Food in adult life 284

Individual size and food ........... 289

Body weight and food ............ 289

Climate and season and food .......... 296

Part V. Food Digestion. — Conditions Which Especially Affect Digestion

Hours for meals and order of taking food Appetite ....

Abnormal cravings Variety in diet

The nervous system and digestion Circulation and digestion Temperature and digestion .

Exercise and digestion .

Rest and sleep and digestion

Sleep in relation to meals .

Mental emotion and digestion Food in the mouth Food in the stomach

Quantity of gastric juice .

Secretion of the gastric juice

Hydrochloric acid

Pepsin, albumoses, peptones Peristalsis Duration of gastric digestion of different foods Digestion of proteids in the stomach Abnormalities of gastric digestion

Hypersecretion .

Hyperacidity

Absence of hydrochloric acid

Pyrosis Food in the intestine

Pancreatic juice.

Bile ....

Digestion of fats

Intestinal gases .

Artificial digestion

I'n digestion of starches

Predigestion of proteids Food absorption .

Elimination of food waste

319 320 321 322 322

329 329 330 331 334 335

CONTENTS. xiii

The urine and food ............ 336

TART. VI.

THE GENERAL RELATION OK FOOD TO SPECIAL DISEASES. — DISEASES WHICH ARE CAUSED BY DIETETIC ERRORS.

The general relations of food to special diseases ....... 339

I. Insufficient food ............ 342

II. Overeating and overdrinking ......... 342

III. Food in itself wholesome, but which is injurious because the ingredients

are not properly balanced ......... 344

IV. Food containing parasites or their embryos ...... 344

Intestinal worms . . . . . . . . . . . -345

V. Food containing ptomaines .......... 350

Poisoning by meat or game .......... 351

Poisoning by milk, cream, ice cream, and cheese ...... 353

Poisoning by shellfish and fish ......... 353

VI. Food containing other poisons than ptomaines ...... 354

Ergotism 355

Pellagra 356

VII. Food adulteration ........... 356

Salicylic acid 358

Tin and lead poisoning ........... 358

VIII. Food containing micro-organisms ........ 360

Tubercular infection through milk and meat. ...... 360

Typhoid and cholera infection ......... 361

Infection through oysters .......... 362

Diphtheria and scarlatina .......... 363

Foot-and-mouth disease .......... 303

Food infection through flies .......... 363

IX. Idiosyncrasies in regard to food. ........ 364

X. Alcohol poisoning. Alcoholism ......... 364

Delirium tremens ............ 367

Part VII. Administration Of Food For The Sick

Regularity in feeding ........... 370

Details of serving food . . . . . . . . . . 370

Feeding helpless patients .......... 372 xiv CONTENTS.

PACE

Sleep and feeding ............ 373

Cleansing the mouth ........... 373

Disinfection of utensils ........... 374

Feeding unconscious patients ......... 374

Nutrient enemata . 375

Conditions necessitating rectal feeding ........ 375

Hunger and thirst during rectal feeding ....... 376

Method of injection ... ....... 377

Aids to retention ............ 378

Temperature of injections .......... 378

Number of injections ........... 378

Care of the rectum ............ 379

Substances available for rectal feeding ........ 380

Prescriptions for food enemata ......... 382

Food suppositories ........... 382

Intravascular feeding . . . . . . . . . . . 383

Hypodermic feeding ............ 383

Medicines and food ....'..... . . 3S3

Diet-kitchen outfit 386

T rained purveyors of food ........... 386