WHAT SHALL I EAT? Dr. F. X. GOURAUD AUTHORIZED TRANSLATION BY FRANCIS J. REBMAN RE B MAN ALBERT R. MANN LIBRARY AT CORNELL UNIVERSITY THE GIFT OF MS. THAK MIGLOEE Wheaton, 111. "CORNELL UNIVERSITY LIBRARY 924 051 840 548 The original of tliis book is in tine Cornell University Library. There are no known copyright restrictions in the United States on the use of the text. http://www.archive.org/details/cu31924051840548 WHAT SHALL I EAT? WHAT SHALL I EAT? A MANUAL OF RATIONAL FEEDING BY Dr. F. X. GOURAUD Formerly Chief of the Laboratory of the Medical Faculty of Paris With a Preface by PROF. ARMAND GAUTIER, of Paris ONLY AUTHORIZED TRANSLATION INTO THE ENGLISH LANGUAGE BY FRANCIS J. REBMAN WITH A GLOSSARY CONTAINING DEFINITIONS OP THE PRINCrPAL TECHNICAL TERMS, AND AN INDEX OF DISEASES REFERRED TO IN THE TEXT NEW YORK REBMAN COMPANY 1123 BROADWAY Copyright, 1911, by REBMAN COMPANY New York Entered at Stationers' Hall, London, 1911 All Rights reserved TRANSLATOR'S PREFACE In reading this book in the vernacular, I was struck by the practical manner in which the au- thor deals with the subject before him, and I considered it advisable to present his views to the Elnglish-speaking public. The style is facile, succinct, and very readable. He gives an im- partial survey of the burning questions of the day and, by advancing the arguments of oppos- ing authorities, leaves it to the reader to arrive at his own conclusions. Read the book and you will understand what I mean to convey. His opinions on the questions of alcohol, white bread, and vegetarianism are interesting and worth studying, as they strike a keynote on the discussion of these important factors of modern diet. The striking feature of the book lies in its arrangement. The author gives for each article of food mentioned in the book the actions on the digestive functions, on assimilation, secre- tion, and elimination. This is important. He vi TRANSLATOR'S PREFACE likewise gives the reasons why a food should be employed or rejected, according to the normal or pathological conditions of each individual case. Indications and contraindications are given in every instance, which makes the choice of food adapted to each case easy. The book deserves a place on the five-foot shelf of every medical man — in fact of every thinking, intelligent person in the land, who takes an interest in the hygiene of the kitchen, the proper choice of food for the table, and a rational care of the body. The business man will derive benefit from its perusal; the educated housewife will find in it many hints that enhance the management of the kitchen; and the afflicted as well as the con- valescent will be encouraged to turn to its pages with profit and satisfaction. For the better understanding of the technical terms employed, I have added, at the end of the book, a glossary containing definitions of the most important medical and scientific expres- sions used in the text. This glossary does not appear in the original edition. F. J. Rebman. 1123 Broadway, New York. PREFACE People generally — alas, too often — follow old- fashioned and stereotyped rules in their daily diet, such as: "When hungry, eat." "What is eaten with relish, does no harm." "When the stomach calls, everything tastes good. ' ' Many believe that every one should follow his own tastes and inclinations and should loyally ad- here to personal predilections and to the habits formed in early life. But are not these habits due rather to circumstances, i.e., influences — good or evil — that surround us? Likewise to prevailing fashions, local customs, to current ideas and to individual caprices and prejudices, etc., i.e., conditions which are calculated to create artificial wants that often enough entail threatening and dangerous symptoms? Not unlike to the opium-smoker, does the heavy meat-eater, for instance, experience that feeling of ungratified appetite, as though something were still wanting, when he cannot get his fa- vorite food to excess. viii PREFACE This peculiar illusion is strangely and strong- ly marked in cases of morphinism, of alcoholism, and of nicotinism. It is an error into which the happy man is apt to fall who thinks that he is doing the right thing when, with a copious and succulent meal, he appeases a merely imaginary craving. The same mistake is made by the work- ing man who drinks for the avowed purpose of bracing himself up for his task, or to make up for underfeeding, but who does not drink sim- ply for the sake of the pleasure and bodily grat- ification derived from the beverage. Yet there must of necessity be certain laws, rules, or regulations by which our diet is to be governed. The food question is paramount in man's life; his very existence depends on it. It has engaged the serious attention of physiolo- gists, eminent physicians, chemists, sociologists, and even moralists. In recent years the follow- ers of Atwater have taken up this study, and have demonstrated the social and hygienic ad- vantages that accrue from feeding the masses properly. They also point out the necessity for teaching those who depend for their living on the work of their hands, how to feed and how to procure, at the smallest possible outlay, the PREFACE ix food best adapted to their physical needs. The medical profession is nowadays well equipped, by personal study and observation as well as by the aid of researches made by able and clever chemists, to understand and regulate the ques- tion of alimentation, in the sick-room particu- larly, with judgment and precision. Many ex- cellent books have been written on the subject, and much good has been achieved by the dis- semination of this wholesome literature. Touching on this point leads me to refer here particularly to Dr. Gouraud's new book. Dr. Gouraud was formerly the chief of the labora- tory of the Medical Faculty of Paris, and also the intern of several hospitals. In both capac- ities he earned well-deserved distinction. His book is clear, succinct, and practical. He tells everything that is of importance and all that is essential for a medical man to know. The author quotes for each article of food — meat, milk, eggs, bread, pulse, wine, etc. — the reac- tions produced on the digestive functions, on assimilation, on the secretions, and on the ap- paratus of elimination. He also enumerates the reasons for the employment or rejection of each food according to the constitution and the state X PREFACE of health of the individual. This is an ingeni- ous form of presenting the subject, for it allows of determining at once what alimentary sub- stances may be permitted to enter into any given diet or regimen, and clearly points out the indications and contraindications for their employment. It gives me pleasure to recommend, in strong terms of approval, this book to the medical read- er, for it is preeminently practical and cleverly conceived. I know of no better guide. Armand Gautier. Paris, France. TABLE OF CONTENTS PAGE Prefaces v and vli Introduction 3 MEAT BUTCHER'S MEAT 19 Beef 20 Composition — ^Alimentary Value 20 Methods of Preparation 23 Reactions 27 Indications and Contraindications 33 Preserved Meats 44 Veal 46 Horse-Toeat 47 Mutton 48 Park 48 Gelatirums Substances 50 Organs Rich in Nuclein 52 Liver 52 Kidney 53 Sweetbread 54 Brain 55 Marrow 56 Delicatessen 57 Some Particulars 59 POULTRY AND BARNYARD MEATS 61 Composition — Alimentary Value 61 Methods of Preparation 61 Reactions — Indications 62 zi xii TABLE OF CONTENTS page: GAME 64 Composition— Alimentary Value 64 Methods of Preparation 64 Reactions — Indications 66 EXTRACTS MADE FROM MEAT 68 Soup — Bouillon 68 Juice of Meat 73 Extract of Beef 74 Meat Powder 75 Peptones 76 FISH LESS FATTY FISH 80 Composition — Alimentary Value 80 Methods of Preparation 81 Reactions 82 Indications and Contraindications 84 FATTY FISH 85 CRUSTACEANS AND SHELL-FISH Composition — Reactions — Indications 88 MILK Composition— Alimentary Value 94 Cmv's Milk 95 Mother's Milk 100 Ass's Milk 101 Mare's Milk 102 Goat's Milk 102 Methods of Preparation 102 Adulterations 107 Reactions 109 TABLE OF CONTENTS xiii PAGE Milk Diet (Absolute) 113 Indications and Contraindications 117 Derivatives of Milk 126 Butter-milk 126 Whey 127 Kephir 128 Eoumys 131 Yoghourt (Curdled Milk) 132 Fresh Unsalted 135 Cooked 136 With Unbaked Crust (Salted and Unsalted) 138 FATS— GBEASE— BTTTTEE^OrL Composition and Properties 141 Reactions 144 Indications and Contraindications 146 EGGS Composition — ^Alimentary Value 151 Methods of Preparation 154 Changes 158 Reactions 159 Indications and Contraindications 162 CEB.EAI.S General Characteristics 167 Special Characteristics 175 Barley 175 Oats 176 Rice 177 Maize 180 Rye 181 Buckwheat 182 Wheat 182 xiv TABLE OF CONTENTS BBEAD PAGE Composition — Alimentary Value 185 Reactions 188 Indications and Contraindications 191 Value of White Bread 194 Biscuits — Crackers 200 Pastry 201 Pastes (Nutritious) 204 Chestnuts 206 LEGUMES— PULSE Composition and Food Value 207 Methods of Preparation 210 Reactions 212 Particulars 215 POTATOES Composition and Food Value 219 Methods of Preparation 221 Reactions 222 Indications and Contraindications 223 Changes 226 Farinaeeotis Foods and Legumes in Early Infancy. 226 GREEN' VEGETABLES Composition and Food Value 234 Methods of Preparation 237 Reactions 239 Indications and Contraindications 241 Particulars 245 Sprouts and Bulbs 245 Roots and Beets 249 Herbaceous Vegetables 251 Vegetable Fruits 253 Mushrooms 254 TABLE OF CONTENTS xv FBX7ITS PAGE Aqueous, Acidulated 257 Composition — Alimentary Value 257 Methods of Preparation 260 Reactions 262 Indications and Contraindications 264 Particulars and Characteristics 269 Saccharine and Neutral Fruits 278 OUy Fruits 279 CONDI]I£ENTS— SPICES Salt 283 Sugar 288 Other Condiments 292 XEKVE FOODS Coffee 295 Tea 301 Cocoa 304 BEVERAGES Water 308 Alcoholic Beverages 316 Alcohol 317 Liqueurs 323 Wines 327 Beer 337 Cider 342 VEGETABIAXISM— FKTJITASIANISM Adherents and Tenets of Vegetarianism 344 xvi TABLE OF CONTENTS PAGE COMPAKATIVE TABLE OP ALIMENTARY PROPORTIONS 360 Glossary— Definitions of Technical Terms Employed in the Text 363 Analytical Table op Diseases Referred to in the Text 369 Weights and Measures 371 Index 373 WHAT SHALL I EAT? INTRODUCTION Life, by its chemicophysical actions, produces throughout the whole organism an incessant flow of cellular changes. The living cell uses itself up, as it were, and incessantly casts off certain elements which are not in consonance with its proper functions, deriving its heat and energy from the combustion of organic matter that reaches it in the ordinary way and through the proper channels. Wear and tear and com- bustion is the never-ending process of decompo- sition, or catabolism, which must of necessity be compensated by a parallel process, or, in other words, by corresponding acts of assimilation, i.e., metabolism. Thus life is determined by a dou- ble action, i.e., absorption and decomposition. The organic equilibrium or balance is estab- lished by the proportion that exists between the two. Alimentation renders assimilation possible by adducing the requisite material in an appropri- ate form. Every substance which the organism 4 WHAT SHALL I EAT? is able to assimilate is food, no matter whether it is used for the purpose of reconstituting the wasted tissues, or to recover the losses in cal- ories. If we adopt this general definition, then oxygen is food — in fact, the most important food of all. But in general practice the term "food" is applied only to those substances which pass by ingestion through the alimentary canal. Food is, therefore, the condition of life of the organism, but becomes a harmful element when it departs from its physiological functions. In former days the opinion prevailed that food might either act as an aid or as a foe in ev- ery disease. Modern science, however, claims that food has an enormous influence on the well- being of the human race in general as well as on the individual; that the origin of many morbid conditions can be traced to a faulty regimen, and that rational feeding is the fundamental condition of our physical health. In primitive times the physiological instinct inherent in man served as a guide in the choice of quality as well as quantity of food. This has changed but little in our days. Individual greediness, encouraged by a culinary art at once complicated and ill-advised, and the exigencies INTRODUCTION 5 of modem life which force upon man the im- moderate use of alcoholic and other stimulating substances, undoubtedly lead to an anti-hygienic, irritating, and too copious employment of food. At the same time the unrestricted influx of pop- ulation into large cities and the difficulties en- countered in provisioning the same, largely af- fect the food question, often enough indeed to the extent of downright wickedness and knavery. Against these evil tendencies — becoming more pronounced every day — a certain current of re- action has set in with the avowed purpose of providing a pure food supply based upon the ra- tional principles of physiology. This movement might be summed up in the following axiom: "Rational feeding must, while pleasing to the palate, maintain the physical balance, equip the organs with comfort, and reduce to a minimum the fatigue engendered by its ingestion." In order to establish a proper basis in this connection, it is primarily necessary to fully un- derstand the two conditions by which the physi- cal balance is maintained, i.e., fixed principles or the material for up-building, and calories or material for combustion. It is easy to deter- mine the former, because the renal, intestinal. 6 WHAT SHALL I EAT? pulmonary, and cutaneous eliminations establish their limits. We mention, first of all, water, of which we excrete more than 2,400 cubic centi- meters per day. Then there is nitrogen, which, either under the form of urea, or of purins, or amino acids, amounts to about 15 grams (an equivalent of about 100 grams of albumin). Finally, we must consider the inorganic sub- stances, viz. : salt (sodium chlorid), 11 to 12 grams; phosphates, 4 to 5 grams, allied either with alkaline or earthy basic substances; sul- phates, 3 to 4 grams; carbonates or bodies, such as lime, 0.50 gram; magnesium, 0.20 centigram; soda, 1.50 grams; potash, 0.40 centigram; iron, 0.02 to 0.04 centigram; and a whole series of other substances present perhaps in negligible quantities only, yet, nevertheless of appreci- able physiological importance; we quote iodid, arsenic, manganese, fluorin, bromin, etc. The daily percentage of water and nitrogen is nearly always sufficiently large. Nitrogen, in- deed, is believed to sin by excess rather than by default. The mineral bodies are never present to the same extent. We shall, therefore, exer- cise particular care in giving the mineral value of each food mentioned. As for the rarer bod- INTRODUCTION 7 ies, such as iodid, arsenic, and manganese, they are found only in a small number of foodstuffs, chiefly in vegetables. In order to obtain them it is necessary to change the diet constantly. It is much more difficult to calculate the re- quirements of energy, of the calories. It entails untold labor, though at the present hour the question seems to have been pretty Jdefinitely settled. Pettenkofer and Voit made a series of very successful experiments with men in prime condition; A. Gautier calculated the amount of food consumed in Paris from 1890 to 1899; At- water figured out, in his calorimetric labora- tories, the number of calories emitted in twenty- four hours by a man in a state of perfect health. The results obtained in all these instances were approximately the same and allow of the follow- ing conclusion: T%e mean ratio in the adult in a moderate cli- mate is thirty-eight calories per kilogram per day. For several years Drs. Pascault, Fauvel, and Labbe have demonstrated that even a notably smaller ratio is quite compatible with even a very active life. It seems to us, however, that these statements, although they are interesting 8 WHAT SHALL I EAT? from the standpoint of pathology and- in cases in which a restriction of diet is indicated, for instance in arthritis, are not applicable in the domain of physiology or to normal health. We feel rather inclined to modify the axiom quoted above and put it in this way: We can, if needs be and the interests of health so require it, decrease the mean ratio to thirty calories — and even below this — per kilogram.per day, so long as this is done under the careful surveillance of a physician. Of course this law of ratio is modified by many circumstances. It is too low for heavy weights and men of big stature, and vice versa. That it is too high for children under fifteen years of age goes without saying. In sick peo- ple twenty-five to thirty calories are rather indicated, except in special cases, such as con- sumption. For the more important exemptions we refer the reader to special treatises on the subject, preferably to that excellent work by A. Gautier ^ from which we shall have frequent op- portunity to quote. The calories are produced by the combustion •A. Gautier: "L'alimentation et les regimes," Paris, Masson. INTRODUCTION 9 of the food. Two principles must be here main- tained: 1. Food develops in the human body exactly the same amount of heat as it does in the incubator of the chemist.^ 2. In the sus- tenance of life no energy is consumed which properly belongs to it. — {Berthelot.) All energy utilized by the living organism is derived from the food and from the tissue itself. It is simple enough to calculate the heat pro- duced by the combustion of each foodstuff. We will classify the substances which serve as nutri- ents for our body into four divisions, viz. : the albuminoids, which include all nitrogenous sub- stances; fats; carbohydrates; and inorganic mat- ter (ash) — the latter is completely oxidized and of no calorific value. The others are each its own special coefficient. 1 gram of albumin gives when burned 4 calories 4 1 gram of fat gives when burned 9 calories 4 1 gram of carbohydrate gives when burned 4 calories. 1 Now, if we know the composition of a certain article of food it will be easy to compute the number of calories obtained from it. "We must not forget, however, that a part of 'Always on the condition that the final state of the residue be the same in both cases. 10 WHAT SHALL I EAT? all that we consume is lost within us and passes through the alimentary canal without being absorbed. We shall keep an account of this factor, i.e., intestinal non-absorption. The fig- ures which we shall give for each food will cor- respond not with that which enters through the mouth, but with what passes the intestinal bar- rier — in other words they refer not to the sub- stances ingested, but to the substances digested and utilized by the organism.^ We have thus briefly described the laws gov- erning the general fixed principles as well as en- ergy itself. To this the labors of the hygienist would be confined if the problem of nutrition were not strangely complicated by a new factor of the utmost importance, which controls the whole system of the physiopathology of nutri- tion, viz. : alimentary reactions. The human body is a machine so delicate, so sensitive, that it reacts immediately, and in a manner of its own, to every substance which enters it through the tube. Each food acts in its own fashion on all the cells and on all the organs composed of these cells. Reaction exists by necessity, no 'This has been rendered easy by the excellent tables so carefully prepared by d'Alquier. INTRODUCTION 11 matter how insignificant it may be in itself, no matter whether it has as yet escaped the investi- gations of the physiologist. If we take into consideration that ingestion takes place two or three times a day, we can easily understand what a weighty influence it exerts on the func- tions of the organs. The reaction of food may be considered from three different standpoints: a, every food must be prepared and digested before it can be util- ized by the cellular system, and then only does it possess the power of digestive reaction; h, every food is a source of energy, which gives a special impetus to the life of all the cells, and as such it exerts a general reaction; c, every food leaves a waste, of which the system must needs rid itself, and as such its reaction is elim- inatory. The digestive reaction is the strongest in evi- dence, but the least understood; again, the sub- stances which require the smallest amount of digestion, such as water, salt, glucose, etc., modify, by their very presence, the physical and chemical equilibrium of the gastrointestinal canal. According to natural laws the greater part of the food is digested, and then it possesses 12 WHAT SHALL I EAT? a twofold coefficient of excitation, i.e., glandu- lar on the one hand and muscular on the other. The equilibrium which establishes itself auto- matically between these stimulations, be they strong or feeble, results in the harmonious and normal functions of the digestive apparatus, i.e., in secretions and peristalsis. The ultimate general effects are sensibly more complex and present much of the unknown. The principles of alimentation produce a com- bined action upon the nutritive movements of the entire organism. Pascault very tritely says: "Life springs from an exciting cause and continues to subsist on it. The living cell passes from the dormant state into that of activity, having been called into existence by a demand coming from within. " ^ The excitations which we draw from the am- bient center, emanate largely from the food which we ingest. Some foods have a much higher stimulating power than others. They accelerate nutrition, cost more, but give a dou- ble measure of life. Others possess only a very indifferent amount of stimulation and rather re- tard the cellular action, but make the living less 'Pascault: "L'arthritism par suralimentation. " INTRODUCTION 13 expensive. Both are useful, on the supposition that they compensate each other, and that es- tablishes a balance for maintaining the nutritive function on a physiological level. Apart from this general reaction which addresses itself pri- marily to each individual cell, food effects also a specialized reaction on each organ, nay, on each function thereof. Some of these are well under- stood; for instance, the action of beef -tea on the heart, of coffee on the brain, of sugar on the liver. Much, however, is still shrouded in mys- tery, and in this regard the task in front of physiological research is still very exacting. Finally, the combustion of any food leaves behind certain residues, such as water, carbonic acid, inorganic salts, urea, uric acid, etc., which must be cast off in proper proportions and through the proper channels. Carbonic acid finds its escape through the lungs; other ele- ments are eliminated through the kidneys, still others through the bowels, and some through the skin. Even a hasty review of the albuminoids, of the fats, and the carbohydrates, throws much light upon this subject. Nitrogen intensely stimulates the digestive organs, glandular as 14 WHAT SHALL I EAT? well as muscular; but its action is of short dura- tion and of no lasting value. Fat, on the con- trary, owing to its retarding action, tempers the excitations aroused by preceding influences; while the carbohydrates slightly fatigue the stomach; but they impart tone to digestion and prolong its action, thus facilitating the absorp- tion of albumin and fats. The general reaction differs not from this. Nitrogen here also acts as a stimulant by aug- menting the activity of the organism. Fat, however, exercises an inhibiting influence which diminishes disassimilation, chiefly that of nitro- gen. This selfsame retarding action is also very markedly observed in the carbohydrates which rather direct albumin and fats to the liver. Resistance is very pronounced in the kidneys, because the ternary bodies, by reason of perfect combustion, leave but water and carbonic acid behind, while the nitrogenous residues engage exclusively the renal glands, often enough to the latter's discomfort and detriment. A judicious proportion in their relative func- tions, in accordance to the physiological laws, may be observed in these three fundamental bodies. The calculations made in this direction INTRODUCTION 15 are based entirely upon experiments made with due care and diligence. IN THE ADULT. Albumin present 18.1 per cent. Fat present 10.4 per cent. Carbohydrates present. . . 71.5 per cent. Grand total 100.0 Now taking into account the isodjaiamic co- efficient and the total amount of calories re- quired, we derive the following formula for the daily ratio in a man weighing about one hun- dred and thirty-five pounds: Albumin 96 grams Fats 55 grams Carbohydrates 379 grams These alimentary reactions represent the sa- lient feature of the problem before us. They must ultimately determine our knowledge as to whether our method of feeding is built upon hygienic and rational principles or not, or, in other words, whether by filling our daily wants, we also afford such comfort to our organs as is compatible with the minimum amount of fa- tigue in the performance of their functions. 16 WHAT SHALL I EAT? The exhaustive researches which are nowadays being made in this branch of medical science have for their object the establishment of pre- cise laws and regulations afFecting the hygiene and methods of nutrition. These will, natu- rally, occupy a prominent part in this book, the aim of which is to present, in a concise manner and so far as can be done, the good and evil efPect on our system of everything that is placed before us on the table in the shape of food or drink. We know well enough that, as a rule, the man who is in good health troubles himself but little about what he eats. While we appre- ciate that, from the general standpoint, he can and should be able to eat anything and every- thing that is eatable, yet we think that his diet should be so arranged that, so far as the limits and proportions which we intend to define are concerned, it should offer a variety sufficiently large for all purposes without giving undue preference to one or any. We shall take occa- sion, in its proper place, to point out certain useful details in the choice of foods adapted to the needs and requirements of individual cases. INTRODUCTION 17 The medical man should never lose sight of the paramount importance of dietetics in every illness, especially of the alimentary reactions. The functional troubles which father a patho- logical condition, more so than any anatomical lesion will do, demand of necessity the utmost circumspection and prudence in the selection of food, as to its nature as well as to its quality. Forbidden should be everything that, by its action, is calculated to give aid to the further development of the germs of the disease, but recommended all such as will neutralize, mod- ify, or destroy them. Always bear in mind that there are diseases which are entirely, or at least in part, due to and arise from a faulty diet. These should be combated by diet only. However, this specific field of therapeutics has a vast and complex compass. To facilitate its study, we shall present a review, as it were, of all the foods in common use, somewhat in the fashion of a dictionary, quoting for each indica- tions and contraindications. The chemical composition will be followed by a discussion of the food value, and then the re- actions which explain and justify the same will be dealt with. 18 WHAT SHALL I EAT? We apologize in advance for any repetitions which will unavoidably occur in a book like this. They appear to be useful, for they make the book handy and easy to consult. MEAT BUTCHER'S MEAT Meat, composed of the muscular flesh of the vertebrates, has constituted in nearly all ages a principal part of the food of mankind. During our time, under the influence of improved con- ditions and the accommodations of the market, its consumption has increased in astonishing pro- portions. If it has entered into the diet of the workman and peasant as an ordinary matter, it has assumed an exaggerated importance on the table of the wealthy. From 1852 to 1900 the yearly consumption per head has progressed (in France) from 42 to 79 pounds. This increase, which witnesses to a growth of wealth, is in all probability not equally favorable from an hy- gienic point of view. The meat diet encounters daily an ever-growing number of adversaries, and there is no food that gives rise to more varied and more interesting problems. We shall study these problems more exhaus- J9 20 WHAT SHALL I EAT? tively with regard to beef, which may be taken as a typical element of animal food. As for the other kinds of meat, we will go only into such details as distinguish them from the former. BEEF Albumin 18.00 Fats 14.00 Carbohydrates 0.00 Ash 0.72 Chlorids 0.06 Purins' 0.19 Available calories = 220 COMPOSITION AND ALIMENTARY VALUE The essential characteristic of beef is its rich- ness in nitrogen, only exceeded in cheese. The proportion of nitrogen, however, varies consid- erably according to the individual animal as well as to the cut. The fatter the animal, the smaller the percentage of nitrogen. The shoul- der is the poorest cut, while the ribs of beef, sir- loin, and rump belong to the richest and most savory pieces. The figures given at the head of this chapter represent only the mean average. * The purins (puric bodies) always have reference to uric acid. MEAT 21 The nitrogen is composed of albuminoids, i. e. , myosin, myostroin, myoalbumin, and partly of extractive substances belonging to the family of xanthic bodies. These xanthic, or puric bodies, though small in quantity, are yet of such importance as regards quality, that, for certain diseases, foods may be divided into two categories, viz. : those con- taining xanthic bases, and those that are free from them. A few words on this subject, no doubt, will be considered opportune by the reader. Xanthic bodies or bases, or puric bodies or bases, comprise a number of substances which are commonly derived from nuclein and possess the nuclein of purin. — {Fischer.) These sub- stances are principally guanin, adenin, hypo- xanthin, xanthin, and uric acid. .By oxidation guanin becomes xanthin, and the latter is turned into uric acid. In a similar fashion by oxidation adenin gives hypoxanthin, and this again gives xanthin, and this in its turn again uric acid. Uric acid, therefore, is chiefly derived by oxidation from the xanthic bases which are contained in the urine in small quan- tities. The derivation of the xanthic bases 22 WHAT SHALL I EAT? from nuclein is schematized in the following sketch. luolelB^ Albumin P H ■ CarboliydraliSS^ lanthio Bases. Ihyiniii' icleio Aold. Recent research has proved that urinary pu- rins spring from two sources. Endogenetic purin is produced by the rejection of nuclein by the organism; its percentage, though variable in each individual, is a fixed quantity in each indi- vidual. Exogenetic purin, of alimentary origin, varies considerably according to diet, and may be reduced to zero by a regimen entirely free of all xanthic bodies. The nitrogen of beef contains also collage- nous, membranous substances, that boiling transforms into gelatin. Fat varies in inverse ratio to albumin, but in much stronger propor- tion, changing sometimes from 1 to 3. It lends to meat much of its taste and savory flavor. The carbohydrates are either totally absent or represented only by traces of glycogen. The mineral principles are relatively insig- MEAT 23 nificant, for beef is not a mineral food. We em- phasize the scarcity of chlorid of sodium (salt), which fact puts meat in the class of dechlorated nutriments. On the other hand the supera- bundance of phosphates explains the frequent occurrence of phosphaturia, due to the excessive use of animal foodstufFs. Beef is a powerful factor in humoral hyperacidity. Its alimentary value, which depends almost wholly on the percentage of fats present in it, is rather slight. It takes only second place to but- ter, sugar, bread, rice, and pulse. Moreover, nearly half of its calories are derived from al- bumin which itself is very inferior in producing energy. If to that the high cost of meat is added, it is hard to understand why beef should be held in such high repute as a table food. Its sole merit, from the alimentary standpoint, can only be, that it supplies within a small compass a comparatively large amount of assimilable ni- trogen. METHODS OF PREPARATION Mankind very early formed the habit of cook- ing meat. Raw meat is nowadays used only as a sort of remedy, more or less acceptable accord- ing to the taste and liking of sick or ailing peo- M WHAT SHALL I EAT? pie. Richet's research on its efficacy in tuber- culosis has given it, nevertheless, a fresh claim on importance. He quotes the following recipe: An absolutely fresh piece of a prime cut is se- lected, it should be as far as possible without tendons. It is scraped with a knife, which de- taches the pulp, and this is rolled up into balls that the patient swallows without masticating. It may also be served in warm bouillon or cov- ered with powdered sugar. [Why not coated with the white of a fresh raw egg? — Trans- lator. ] Aside from this exception muscular flesh is subjected nearly always to the action of fire, which develops its flavor. It is in this way, perhaps, a little less digestible, but it excites more thoroughly the gastric excretions and has stronger powers for reconstruction. — (Bichet ) The different methods of preparation affect its physicochemical qualities more or less favor- ably. Boiled, the beef imparts to the water in which it is cooked a certain quantity of albumin, on the average 7 per cent, a great deal of fat, i.e., 20 per cent, of which a goodly portion is unfor- tunately lost in skimming, and much of the MEAT S5 iTxineral salts. The nutritive value of the beef would thus be much diminished, if it were not sustaining at the same time a concentration of nearly 40 per cent, which maintains the ratio of nutrition very effectively. Boiled beef, it is true, is more nitrogenous, but, on the other hand, it is impoverished in fats, demineralized, more insipid, and withal heavier on the stomach. We point out, however, that if kitchen salt is added while the soup is boiling, a large part of the chlorids will pass into the meat. In roast beef a crust is formed on the surface, which greatly diminishes waste. A moderate roasting occasions a loss of only 10 to 12 per cent of water, 2 to 3 per cent of nitrogen, and 10 to 12 per cent of mineral matter. The loss in fat, however, is much greater, the average being 35 per cent. Of course this entails an impairment of nutritive value; but by compen- sation, as it were, the development of the flavors attains its highest degree, and makes roast beef the more savory and the more stimulating for the stomach. Stewed meat, cooked in the pan in fat, becomes more concentrated through evaporation, but the loss in nitrogen is small, likewise that of mineral matters, 2 to 3 per 26 WHAT SHALL I EAT? cent, but is almost surfeited with fat to the detriment of the ambient center. It is more nourishing, but also heavier and less digestible. Excluding these methods of preparation the dif- ferent sauces and gravies tend again to change and modify the nutritive value as well as the digestibility of the meat. In a general way all sauces containing butter or warm fats, all brown butter sauces and ragouts, etc., are bad. The white and piquant sauces also belong to this same category. On the other hand, meat cooked in its own juice, according to the custom of olden times (baked beef and beef a la mode), are foods good for the stomach and hygienic in a general way — it is meat which has not lost any of its nutritive principles, but remains suffi- ciently salty without overstimulating the appe- tite or causing the inconveniences that follow in the wake of surfeit. A practice that can be recommended is to garnish the meat either with green vegetables, or, better still, with potatoes in any form or with dumplings or other farinaceous prepara- tions. In this manner its deficiency in carbo- hydrates may also be compensated. Moreover, it adds variety and change to the diet and MEAT 27 excludes all excuses for overindulgence in bread, so common with many persons. REACTIONS A. Digestive. — Meat is essentially a stimu- lant of gastric secretion, in fact the most stimu- lating of all foods. It possesses a psychic action by means of its odors and aroma, and a chemi- cal action through its extractive substances. — {Pauhff. ) We shall endeavor to show how the methods of preparation affect the stimulating qualities. The degree to which the meat is cooked gov- erns the length of time required for its passage through the stomach. The closer the fiber, the longer it remains. A slice of roast beef is di- gested only at the end of three to four hours. The stimulation extends also to the bowels, to the pancreas, and to the liver, and thus affects the general tone of the whole system. But this period of excitation does not last long and is soon followed by a passus of depression, the in- tensity of which is in direct proportion to the degree of excitation. However, it is complete, for meat leaves no residue. Meat justly deserves the title of "gastric ali- 28 WHAT SHALL I EAT? ment," in contradistinction to pulse and fruit, which are foods for intestinal digestion. This accounts for the fact that heavy meat-eaters at first experience a sensation of comfort, but soon begin to feel uneasy and sluggish, with a craving for more, i.e., renewed stimulation. Meat has no staying power, and leads to overeating and gluttony. We have already stated that meat leaves no residue. That is the reason why an animal diet often is the cause for constipation and stasis, particularly in the large intestine. Although this is generally known, we yet consider it of such importance as to warrant us in giving it special mention here. Meat also encourages the formation of micro- organisms in the canal and furthers putrefac- tion. Combe was among the first to show that the amount of sulphoether in the urine, the evidence of this putrefaction, is increased or di- minished in proportion to the amount of meat consumed. His contention is sustained by many authorities. The excessive use of meat, it is claimed, gradually afiPects the intestinal flora by intensifying its virulence, changing its composi- tion, and breeding enterocolitis and appendi- MEAT 29 citis. It is now generally recognized that ni- trogen forms a splendid breeding-ground for intestinal bacteria, and that constipation helps to develop them. Resume. — Meat imposes upon the gastric muscles a slow process of activity, but vividly stimulates the glands of the stomach for useful purposes, whilst its action on the intestines is less favorable, because its excitation is of too transient a nature; the absence of residue inhib- its peristalsis, and the extravagant content of nitrogen forms the germination of microbes. B. General. — The reaction of the meat diet on the process of nutrition in general can be described in three words: it excites, it acidifies, and it intoxicates. The acceleration of organic activity following the ingestion of meat is due to the predomi- nance of nitrogen which diminishes the power of assimilation, to the absence of carbohydrates, and to the presence of extractive substances. Under moderate circumstances this influence helps to maintain the general tone of vitality: it becomes harmful, however, when carried to excess. Meat acidifies because its ash is acid, because 80 WHAT SHALL I EAT? the phosphoric acid contained in it outweighs the basic substances, and also because its com- bustion is never complete, thus giving rise to acids, the most important of which is uric acid. In the carnivorous animals these acids are neu- tralized by an equivalent production of am- monia; but in man the formation of ammonia is very limited, and with an increased consump- tion of animal food the ratio of humoral and urinary acidity rises in proportion. Meat intoxicates by reason of its basic purins and by ptomains, which easily become most nox- ious poisons to the heart, the vessels, and to the whole organism, though they are of indifferent value when present in a small volume. More- over, the bacterial fermentations due to meat are of a toxic nature. MetschnikofF points out that to them chiefly is due premature senility. To know the action of meat on nutrition only in a general way, does not suffice. It is of the utmost interest to understand the influ- ence it exerts on each organ in particular. The first question which confronts us here is: In how far is meat necessary or useful to the man who performs physical labor, and to him who follows mental occupation? MEAT 31 Albumin, and in consequence all foods of which it forms the basic value, cannot furnish the amount of calories required for mamuil labor. Bouchard says: "Meat does not produce force." This fvinction belongs to the ternary bodies. Yet, on the other hand, it seems to be proved that meat is a very useful article for the workman, the soldier, and the athlete, as it in- creases ability for work in the production of calories. — (Gautier.) Take, for example, the Anglo-Saxon race. They are heavy meat-eaters and excel in athletic sports. In sum total, meat does not supply power for physical tasks, but it assists in accomplishing them. It is quite different in respect to mental work. If alcohol and tobacco have proved themselves powerful aids to the author in rendering his task easy, meat has never offered the same ad- vantage. How often do not writers after a heavy meal, especially if it consists largely of animal food, complain of that sluggish, drowsy feeling which renders them incapable of accom- plishing anything. At the Congress for Food and Hygiene, De Fleury insisted that meat is not an aliment fit for the mind, and that its use does more harm than good. 32 WHAT SHALL I EAT? The cardiovascular system is likewise affected by a meat diet, chiefly by reason of its excess in extractive substances. The pulse grows more rapid and harder, the tension is raised, whilst the vasoperipheral con- striction increases the heart's action and predis- poses the smaller vessels to sclerosis. An exaggerated meat diet is one of the prin- cipal factors in hypertension and sclerosis. Hepatic excitation is not less marked, since uropoiesis, the neutralization of toxic matter, imposes upon the cellular tissues extra labor. This excitation, which at first is limited to uro- poietic tapping, soon invades the biliary and glucogenic functions also. It would be interesting to know the influence of meat on the development and functioning of the intestinal secretory glands — the thyreoid^ and genital glands, and the suprarenal capsules. As the functions of all these organs are anti- toxic, it is likely that the use of muscular meat entails additional activity, but precise informa- tion on this subject is still lacking. C. Eliminatory. — The ingestion of muscular • According to Leopold Levi meat is poison to the thyreoid glands. MEAT S3 meat reacts strongly on the kidneys. If urea, the issue of albumin, may be considered in the normal state as a diuretic, its elimination through a diseased kidney must be much more laborious. Uric acid and the xanthic bodies are substances which act as irritants to the renal capsules and are very hard to eliminate, and toxic issues from the intestines add still more to the task of urinary depuration. Experiments made by Hanssen prove that so far as calorific value is concerned, a nitrogenous diet produces the highest molecular elimination. Achard and Paisseau claim that the same regimen favors the retention of chlorids. All this leads us to the conclusion that meat has no favorable effect on the functions of the kidneys. Nevertheless, the question is rather complex, for it is a well- known fact that meat is often better tolerated in cases of nephritis, than one would be led to believe by this theory. INDICATIONS AND CONTRAINDICATIONS Since meat is easy to digest, is highly nitro- genous and stimulating, it should form a part of normal alimentation, especially in our epoch of strenuous life with all its exacting exigencies 34 WHAT SHALL I EAT? and unforeseen fatigues. We all stand in need of it — the tiller of the soil as well as the toiler in the town. But if the rational use is beneficial, the abuse is equally obnoxious, and the daily ration must be carefully allotted. For the adult of an average weight of one hundred and forty-five pounds, 150 to 200 grams should be an ample allowance.* Of course age must be taken into consideration. From the fiftieth year onward it is better to fall below this aver- age, while very old people might dispense with it altogether. During the period of pubescence the allowance should be rather increased. "Up to the tenth or twelfth year meat should be given sparingly. From this time on the ration should be steadily increased. The average ra- tions which I am disposed to grant are as fol- lows; Meat, well trimmed, boned, and cooked, 100 to 120 grams from the seventh to the elev- enth year; 120 to 160 grams from the eleventh to the sixteenth; 200 grams and over from the sixteenth year upward."^ More abundant al- lowance may be made with benefit to frail and lymphatic children, and to such as are predis- posed to tuberculosis. ' Legendre : CongrSs de Paris, 1906. MEAT 85 In pathological conditions the use of meat is primarily indicated for all weak persons, conva- lescents, those suffering from nervotis depression, and all who have to repair previous losses of any kind. Tuberculosis is one of the most important in- dications. Grancher admits that in England the reduction of tuberculosis coincided with the increase of meat consumption. All authorities agree as to the necessity of heavy rations in nitrogenous food for this dire disease. Gastric stimulation, uplift of tension, increase in humoral acidity, are all of the utmost bene- fit in cases of weak tension and of hypoacidity of delicate stomachs. Richet has demonstrated that raw meat possesses merits of especial effi- cacy, though he does not give satisfactory rea- sons why. We have already described his method of preparation. But 150 to 200 grams per day should be sufficient for all purposes, and according to A. Robin and Binet this amount should not be exceeded. Labbe and Vitry have pointed out the dan- gers of superalimentation in tuberculosis, espe- cially in its advanced stages, as intestinal ab- sorption of nitrogen decreases in the same ratio 36 WHAT SHALL I EAT? as ingestion increases. Mousseaux calls atten- tion to cases of renal litJiiasis due to the same cause. It is useful to know these facts, for, while they prove that nitrogenous superalimen- tation in tuberculosis may be reasonable and proper, still its utility is by no means as yet established beyond a doubt. Meat is also an appropriate food for diabetics, on account of its small content of carbohy- drates, but we say this with caution, as it may have evil effects as well. Renal, cardiovascular, and cerebral complications — the latter occur fre- quently enough — are pregnant reasons for re- stricting, if not entirely suppressing, the use of meat. Coma, tendency to coma, exaggerated acetonuria constitute absolute contraindications; recourse should be had at once to an alkalizing and antitoxic regimen, vegetarian by prefer- ence. Even in ordinary cases of diabetes without complications a nitrogenous diet should be care- fully considered, as some patients make sugar with albumin. Linossier and Lemoine have shown that it is necessary to distinguish be- tween glycosuria from alimentation (the urine voided fasting does not show traces of sugar), in MEAT 37 which case meat is excellent, from glycosuria of nutrition (the maximum of sugar is in the urine of the fast), when the albumin must be reduced to its minimum. In nearly every diet advised for obesity, meat plays a prominent role, because it possesses the advantage of being deprived almost entirely of fatty substances, thus increasing the activity of the organism; but it must not be eaten with greasy gravies. Moreover, particular account must be taken of the state in which the liver, heart, and blood-vessels are found. Its use in gastrointestinal affections is still very much under discussion, and opinions differ widely. In one point, however, they all seem to agree, viz. : that the meat should be roasted or boiled, and eaten without gravy or sauce, cut into small morsels, or minced, or passed through a coarse strainer. It is generally advocated in hyposthenia and in dyspepsia by insufficiency, in all of which cases it serves to stimulate the secretions. Like- wise in gastric putrefaction, as the albumin does not ferment in the stomach. In hyperchhrhydria Dujardin-Beaumetz re- jects it as too exciting, A. Robin admits it as 38 WHAT SHALL I EAT? useful for saturating the hydrochloric acid. We are inclined to believe with him that it should be allowed in small doses, roasted rather than boiled. In certain cases aggravated by stubborn vomiting and emaciation, a broth made of meat powder, according to Debove's method, will give very good results. In cancer, in cases of inveterate chronic gastri- tis, meat is neither tolerated nor is it desirable. Besides, all general symptoms should be care- fully watched in the patient, because the rules laid down for these instances are subject to nu- merous exceptions. Minced or raw powdered meat is very service- able in ohsUnate chronic diarrhea, so prevalent in hot countries. Both improve the general condition, especially that of the bowels. The same beneficial results will be observed in per- sistent cases of enteritis in children and infants. Nobecourt and Rivet have arrived at very inter- esting conclusions regarding this subject, viz. : if salts are very abundant and liquid (aerobic flora), raw meat is indicated. If, on the con- trary, they are less abundant and very fetid, nitrogen is injurious and a lacto-farinaceous regimen is required (anaerobic flora). MEAT 39 A meat diet is also useful in enteroptosis in adolescents, and in the adult with weak and de- bilitated digestive apparatus who, indeed, stand in need of gastric rather than intestinal alimen- tation. But it does in nowise agree with entero- colitis, constipation, or any kind of disease that inclines to cecal stasis. At any rate only the most moderate use is advisable under these circumstances, and then only if the meat is unquestionably fresh. Game and delicatessen, which precipitate putrefaction, must be totally avoided. There are cases in which meat is unreservedly good and useful; but those in which it is harm- ful and absolutely injurious are much more nu- merous. The latter comprise chiefly all affec- tions of the heart and of the vascular system, of the kidneys, liver, and nervotis system, and last, but not least, diathetic arthritis. In arterial cardiopathy ^ hypertension, vascu- lar sclerosis, aortitis, and angina pectoris it is always injurious. Huchard has proved its ne- farious effects in the genesis of a whole series of symptoms, beginning with toxic alimentary dys- pnea. The physician should direct all efPorts at his command toward the most rigid exclusion 40 WHAT SHALL I EAT? of all meat foods. He may relent somewhat in cases of valvular insufficiency; the animal diet should be regulated by the degree of compensa- tion observed. The use of meat in^diseases of the kidneys is a rather involved problem. In all acute attacks of uremia it must be absolutely prohibited, while in orthostatic albuminuria it will do more good than harm. Between their two extremes we range all forms of chronic nephritis — more or less compensated — for which absolute rules can- not be given. Although muscular meat does not agree with all such cases, yet it cannot be made the object of a sweeping prohibition. The excellent articles by Widal on dechlorated diet, of which meat forms a part, have contributed much to generalizing its employment. A care- ful watch on the diuresis and albuminuria of the patient will be a great help in testing indi- vidual tolerance. It will be found that by some it is borne badly, while in others, especially in younger subjects, it has a tendency to diminish the albuminuria and to improve the general condition. But frequent changes in the diet are always beneficial. The more acute the conges- tion of the kidneys, the stronger the misgivings MEAT 4.1 as to the effects of meat, is a good axiom. In cases of inflammation it is less frequently toler- ated than in fatty degeneration. Wisdom in the choice of meats is another commendable factor in the diet; fowl and ham should always have the preference, whilst game, liver, etc. , should be kept from the menu. In liver complaints Robin establishes the fol- lowing rules: Meat stimulates the cellular func- tions, it must therefore be forbidden in all cases in which these are already exaggerated, such as hypertrophic biliary cirrhosis in the initial stages, atrophic cirrhosis, congested enlargement of the liver in arthritis and all Tualarial affec- tions and colonial diseases, and in lithiasis, in order to prevent the formation of calculi. As it wears out the parenchyma, it can only do harm in acute Jaundice, acute yellow atrophy of the liver, and in the advanced stages of atrophic cir- rhosis. But if given in small doses, its stimu- lating action may be well utilized in the milder insufficiencies, such as in the initial stage of the second period of Laennec's cirrhosis, and in jaundice as soon as the skin begins to get clear again. In nervous diseases the rules are not so severe, 42 WHAT SHALL I EAT? although sensible restriction is always counseled, and this applies with similar force to all cases of hypertension and neurasthenia, and all afFec- tions involving lesions. Some authorities are be- ginning to trace the origin of certain diseases, the etiology of which is vague and unknown, to intestinal troubles of very old standing. Londe insists that the source of the symptoms, and in fact the whole genesis of nervous dis- eases, may be found in the diet of the patient, and he does not hesitate to consider meat as one of the most untrustworthy factors in this con- nection. We have reserved the consideration of arthri- tis to the very last, because in this class of dis- eases an animal diet plays such an important role and is so difficult to control. Arthritic pa- tients are apt to eat too much, they do not di- gest their food, are troubled in consequence with hyperacidity and autointoxication. Meat tickles the palate and stimulates the appetite to surfeit. In this manner oxidation is lessened, acidity and autointoxication are increased, and nutrition is seriously hampered. If arthritis is due to overfeeding, it should be charged princi- pally to the abuse of meat. It is simply sur- MEAT 43 prising to see morbid symptoms, such as neural- gia, articular pains, migraine and skin diseases vanish as soon as the patient gives up meat in every shape and form, after therapeutic agents have failed to respond. We shall refer to this again later on in the chapter on vegetarianism. WTiile speaking of arthritis, we take occasion to particularly mention renal lithiasis and uri- cemia in general, skin diseases (eczema particu- larly), and hepatic manifestations. So far as gout is concerned, the authorities are of differ- ent opinions. Pascault and de Grandmaison^ are in favor of unrestricted abstinence. Garrod, Ebstein, Cantani, and von Noorden advocate a moderate use. Von Noorden claims that meat has the power to dissolve uric acid by its content of thymic acid, and advises to test the suscep- tibility of every patient. His method of pro- cedure is as follows: The patient is to be put on a strictly antipuric diet. The uric excretions are to be carefully examined each day. The allowance of meat must not exceed 100 grams. If 50 per cent of the purins ingested (the rest is always oxidized) are found in the urine, the elimination by means of the urine is normal, and 'De Grandmaison : Traite de I'arthritisme. 44. WHAT SHALL I EAT? the allowance of meat may be continued. If otherwise, it must be discontinued. The same test may be made with 150 to 200 grams. Nevertheless, we are inclined to the belief that gouty subjects might do well with a smaller amount of nitrogen, as they have the tendency to make uric acid even with albumin. PRESERVED MEATS Those preserved in tin cans lose some of their nutritive power and should never be given to patients of any kind. As a rule they are put up under a temperature of 225° to 230°, and are hermetically sealed. Generally speaking the muscular portion of the meat retains its nutri- tive quality, and also the flavor of cooked meat, while the high temperature destroys the mi- crobes and toxic elements, always supposing that the meat employed is absolutely fresh and un- tainted. But the utmost care should be exer- cised in the soldering of the tins. It must be done on the outside of the cans and never come in contact with the jelly that forms a cover to the meat. Unless these precautions are ob- served, ptomain-poisoning is sure to result. Salting does not modify the composition of MEAT 4.5 muscular meat to any appreciable extent. Pickling slightly disintegrates the albumin- oids, and, perhaps, the extractive substances to a higher degree even. Meats prepared in this fashion, however, are certainly less toxic and should appeal to persons who are afraid of auto- intoxication. Unfortunately they are slightly hyperacid, as a part of the alkaline phosphate of potash is lost in the pickle. Still this is in a certain measure compensated for by the pres- ence of salt, although it is a feature objection- able in cases of nephritis. Smoked meats are a trifle too rich in albumin, but their digestibility is often enhanced by the process, and delicate stomachs that reject cooked meats will in many cases tolerate them very well indeed. Refrigerated meat, according to Gautier, loses none of its essential qualities, and shows but slight modifications of its original composition. 46 WHAT SHALL I EAT? VEAL Albumin 18.00 Fat 0.08— Chlorid. . . 0.06 Carbohydrates. . 0.00 Ash 0.79 Available calories = 155 The value of veal, which has for a long time, under the name of white meat, been held in high repute, though quite unjustifiably so, is in many ways inferior to that of beef. Being poorer in fat, it is less nutritive, deficient in myosin, but stronger in resisting the action of the acid juices, and it is less digestible, as has been demonstrated by the experiments made by Penzoldt. Moreover, as is the case with all fresh meats, it is surcharged with nuclein and xanthic substances, and therefore more toxic. Many persons, although not dyspeptics, cannot eat veal without discomfort, an idiosyncrasy which cannot be accounted for. Cases of ptomain-poisoning by veal are of fre- quent occurrence, and are generally accom- panied by grave symptoms, such as severe diar- rhea and general intestinal intoxication. Veal is unfortunately consumed to a great extent in MEAT 47 country districts. It should be prohibited in all cases of dyspepsia, eczema, uremia, nephritis, cystitis, and catarrh of the urinary tract. HORSE-MEAT As the consumption of horse-meat is con- stantly on the increase, especially in large cities, it is necessary to give it some attention here. Its composition stands no comparison with beef, on account of the small amount of glycogen it contains (0.5 to 4.5 per cent). The food value is the same. The absence of cystin in the mus- cles recommends it rather as suitable for raw- meat cures. It is wise, however, to take here into consideration that a great many worn out, emaciated, and exhausted horses find their way into the slaughter-houses, and that for this rea- son alone horse-meat in general not only pos- sesses a lesser grade of value as a food, but is in many instances absolutely injurious to the con- sumer. 48 WHAT SHALL I EAT? MUTTON Albumin 15.30 Fat 16.00'— Chlorid. . . 0.06 Carbohydrates. . 0.00 — Purin 0.11 Ash 1.00 Available calories =170 Mutton is not quite as rich in albumin as beef, but it contains more fat and mineral sub- stances. Its nutritive power is, therefore, lower, but it is not as readily digested. Uncooked it has great renown as a cure for consumption. Lamb may practically be accepted as the equal of mutton, though it is rather insipid in taste. PORK Albumin 16.20 Fat 32.10'— Chlorid . . 0.06 Carbohydrates . . 0. 00 —Purin 0. 10 Ash 0.50 Available calories = 370 Excess of fat and close fiber of the meat are the characteristics of pork, which make it less digestible. Many stomachs cannot bear it. 'This includes the fat underlying the skin, which is always present in abundant quantities. MEAT 49 But its nutritive value is higher, while the price is lower than that of beef. Thus it is one of our staple foods. Pork is at times tainted with trichinae (trichi- nosis), parasites which live in the muscular tis- sue and afPect man seriously when introduced into his system. On the Continent of Europe this danger is greatly forestalled by a rigorous, governmental inspection of the slaughter-houses. Ham deserves special mention here. Because the meat of the ham is finer and shorter in fiber, it is easier to digest, and forms a valuable food in cases of gastric or intestinal dyspepsia. In nephritis it may be recommended for the reasons that it is easily assimilated and puts no strain on the kidneys; likewise in cases of albuminuria or hepatic congestion, as it allows but the mini- mum amount of albumin to pass through the kidneys. * * * We now come to a category of f oodstufPs which hardly contain any muscular fiber, and, there- fore, do not deserve, properly speaking, the name of meat-food. But since they are of ani- mal origin, this certainly is the place for men- tioning their qualities and properties. 50 WHAT SHALL I EAT? We mean the entrails (tripe, etc.), glands, heart, and the tissues and organs less differ- entiated, such as the skin, bones, and tendons which we shall divide, according to the nutritive qualities so intimately connected with their his- tological structure, into three classes, viz. : gela- tinous substances, glands, and those organs which are rich in nuclein. GELATINOUS SUBSTANCES These comprise the head and feet of the swine, caK, lamb, and mutton. They contain some muscular tissue, assimilable albuminoids, and a small percentage of fat. The chief constituents, however, are elastic and connective tissues, the periosteum and cartilage, which, when boiled, are transformed into gelatin, rich in nuclein. To obtain good results and proper assimila- tion, prolonged cooking is required. Gelatin is a most useful agent for the human economy, and, we think, ordinarily too much neglected. Gelatin possesses very valuable properties. Being totally absorbed by the intestines, it exer- cises a marked influence on the economy of metabolism. Its action is primarily directed MEAT 51 toward the albumins, but affects also in a lesser degree the fats. In the first instance it exceeds that of the carbohydrates by two. Numerous experiments have demonstrated that the addition of gelatin to food notably reduces the ratio of nitrogenous repair. Gelatinous foods are particularly recom- mended to those who get easily overheated, or who must build up their system: emaciated, convalescent, or jaded persons. A. Robin claims that they are of great service to consump- tives, in whom disassimilation always takes place in an exaggerated measure. On the other hand, they are pernicious in cases of gout, uremia, and arthritis; and, on account of the excess of nu- clein contained in them, also in nephritis and dyspepsia. But there is no reason why these patients should not partake of such jellies that are nutrient as well as agreeable to the digestive organs. Senator recommends for treatment of ulcers a diet composed of gelatin, sugar, and fat.i ' The formula is as follows : Dissolve 15 to 20 grams of gela- tin in 200 grams of water, add 50 grams oleosaccharin of lemon. To be taken within twenty-four hours together with i of a liter (J pint) of cream and 30 grams of butter. The total = 900 to 1,000 calories. — {Berlin Medical Society, January 8, 1906.) 52 WHAT SHALL I EAT? ORGANS RICH IN NUCLEIN LIVER, KIDNEYS, SWEETBREAD (tHYMUS GLANd) All these organs, which come from cattle, calves, or pigs, are rich in nuclein. Sweetbread easily takes the first place in accordance with the histological formula of its composition. Liver contains only one-fourth the amount of nuclein found in sweetbread, and kidneys even less than that. On general principles none of them is fit for use in cases of uremia, gout, stone, or arthritis. LIVER Albumin 19.9 Fat S.6— Chlorid. . . 0.08 Carbohydrates. . . 0.5— Purin 0.33 Ash 1.6 Available calories = 145 Gelatinous substances are present in abun- dance. Glycogen varies from 1 to 16 per cent. Lecithin and phosphorous fats are plentiful (see Eggs, page 152) in goose liver, even up to 30 per cent. These, combined with nuclein, make liver a food rich in organic phosphorus. As it is readily and quickly digested, it may be strongly MEAT 53 recommended to convalescents, in the period of adolescent growth, to phthisical individuals, and in cases of slight neurasthenia. Liver is frequently employed as an organo- therapeutic medium in icterus, atrophic cirrhosis, and hepatic sluggishness. It should be taken raw, or but slightly cooked. A temperature exceeding 140° Fahrenheit coagulates the albu- min and destroys its useful ferments. Pig's liver is preferable, but it must be quite fresh. The dose is 100 to 200 grams. It may be administered raw as an enema after it has been crushed and emulsified with the serum, or by the mouth after being slightly cooked, in order to remove its disagreeable, insipid taste. KIDNEY Albumin 18.4 Fat 4.5 Carbohydrates... 0.0— -Chlorid. .. 0.26 Ash 1.2 Available calories =124 The absence of glycogen, and the negligible quantity of lecithin it contains, diminish the nutritive value of kidney. Nevertheless it is a food easy to digest; but, to be good, it must be 54 WHAT SHALL I EAT? taken from young, herbivorous animals. The kidneys of old and carnivorous animals should be eschewed. — (Gautier. ) The renal glands have also been employed in organotherapy in albuminuria and sluggishness of the kidneys. The results obtained are, it is true, of a contradictory nature; but cases are on record in which marked improvement has been observed. It may be administered like the liver, either by the mouth, raw or slightly cooked, or as an enema emulsified with the serum. SWEETBREAD Albumin 22.0 Fat 0.4 Carbohydrates... 0.0 — Purin 1.20 Ash 1.6 Available calories = 1 23 Besides its exceptional abundance of nuclein, which alone gives it a predominant place among phosphoric nutrients, it abounds in collagenous substances. It is easy to digest and may well be recommended — even more so than liver — to convalescents, and to debilitated and nervous persons. MEAT 55 BRAIN Albumin 12.78 Fat 15.59 Carbohydrates 0.00 Ash 0.89 Available calories = 202 Although it is poor in nuclein, it contains a surplus of lecithin approa,ching that of the yolk of the egg. At all times brain has been consid- ered a typical phosphoric nutriment. In this regard it is only second to the yolk of the egg and to sweetbread in the animal kingdom, and to spinach, cabbage, the legumes, and barley in the vegetable kingdom. It is nevertheless a food for rephosphatization. It is easy of diges- tion, if one is careful in removing the mem- branes. It agrees marvelously well with conval- escents who have a weak stomach, and benefits those who suffer from depletion of phosphorus. 56 WHAT SHALL I EAT? MARROW Albumin 1.87 Fat 88.04 Carbohydrates 0.00 Ash 1.53 Available calories = 862 Mark the heavy proportion of ash and of fats which, moreover, are phosphoric fats. Marrow is, indeed, a nutrient, phosphoric, mineralized food element. The figures which we have given soar up to those given for beef in the adult ani- mal. In young animals fat is not yet abundant, but nuclein is fast accumulating, whilst the marrow is still active in the process of blood- making. That is the reason why the marrow of young animals is employed in organotherapy for cer- tain cases of anemia due to inability of making blood-corpuscles. Very encouraging results have been obtained in aplastic anemia. The method of administration is the same as indicated for liver and kidney. MEAT 57 DELICATESSEN Under this name we comprise a considerable number of foods, in the preparation of which nearly all parts of the animal, predominantly those of the pig, are utilized. Every country has its own individual style and recipes, and its own particular names and labels. We must, therefore, here confine ourselves on general principles to a few words as regards these prod- ucts of universal consumption. A mixture or medley of cooked or raw meat materials, the ofFal which cannot be used in its natural state, such as the heart, the lungs, the spleen, the blood, fats, with spices varying in number and quantity, all are used in this enter- prise, and they possess a fairly high food value. Perhaps they are also enriched by the addi- tion of vegetable substances as, for instance, the famous pea sausage of the German army. But that is, perhaps, the only good quality they possess, for from the hygienic standpoint they present many defects. 1. They are a food hard to digest, placing a heavy embargo on the stomach as well as on the bowels. The materials used for making them 58 WHAT SHALL I EAT? are heavy, especially so if they cannot be cooked. Besides, foreign products may be introduced unbeknown to the consumer. 2. They are apt to produce intestinal putre- faction. Waste material and decayed matter may slip in unperceived in the manufacture. Even if well made, they yet offer an excellent culture medium for intestinal microbes. 3. They constitute also an ever-present dan- ger of infection to the whole system. 4. Moreover, they are a food relatively expen- sive. One gram of nitrogen contained in this foodstuff costs more than that contained in fresh meat. With rare exceptions they offer but a mediocre means of sustenance to the person in good health, and it is always wise to distrust them, for they certainly are crude materials. It is a matter of regret that these preparations have obtained such a prominent place on the tables of the poor. It is needless to say that they are forbidden the sick, all who have delicate stomachs, who are afflicted with intestinal fermentations and intoxications, or who suffer from heart trouble or Bright' s disease, eczema, gout, liver complaint, or arthritis. MEAT 59 SOME PARTICULARS Sausage is made of meat offals and the fat of either beef or pig, highly seasoned, finely chopped, and pressed into cleaned entrails of some animal. The food value of sausage de- pends upon the characteristics of its constituents. The following table, compiled by d'Alquier, shows the composition of three of the best known varieties: Carbo- Albumin. Fats. hydrates. Ash. Calories. Cervelat 23.21 43.62 4.48 512 Ham Sausage 37.06 34.10 3.66 483 Sausages, small, for frying 16.62 37.71 2.85 427 The sinall sausages which are sold in links, chiefly for the breakfast - table, are rich in grease, and must be well cooked or fried. Head Cheese is a mixture of different kinds of meat, gelatin, and bouillon, and contains: albumin, 19.89; fat, 32.16; carbohydrates, 0; ash, 2.36; calories, 389. Galantin is a mixture of pork, ham, and fowl, contains less fat, and, therefore, less nourish- ment, but is easier to digest and more harm- less. Albumin, 41.30; fat, 6.10; carbohydrates, 0; ash, 1.88; calories, 239. 60 WHAT SHALL I EAT? Meat-pie is harder to digest, on account of the paste and crust (see Pastry, p, 201). It is made of all kinds of meat — veal, pork, duck, game, etc., which naturally impart to it all their own good or bad qualities; but hot it is always heavier than cold. Pate de fois gra^ shows albumin, 16.30; fat, 88.84; carbohydrates, 0; ash, 1.67; calories, 482. It is a very nourishing food, rich in lecithin, and often enough easily tolerated even by deli- cate stomachs. This is particularly the case if the liver is taken from geese or ducks especially fattened for the purpose. As it is highly sea- soned and contains truffles, those who suffer from Bright' s disease, arthritis, or eczema, must eschew it. For making adipose tissue it is of great value, likewise to consumptives. Black pudding, or blood pudding, made of the blood of pigs and lard and spices, is heavy and indigestible. It is generally eaten with mus- tard. Blood is a good culture medium for mi- crobes, for which reason the pudding should always be absolutely fresh and thoroughly cooked. It is not a dish to be recommended, despite the fact that it is rich in iron. MEAT 61 POULTRY BARNYARD MEATS COMPOSITION AND FOOD-VALUE Carbo- Albumin. Fat. hydrates. Ash. Chlorids. , Purin. Calories. Chicken... 18.87 12.89 0.77 0.06 0.15 204 Pigeon.... 21.97 3.71 0.85 0.06 131 Duck 22.58 4.94 0.91 0.06 145 Turkey . . . 20.95 21.76 0.75 0.06 0.15 299 Goose 15.21 31.86 0.41 0.06 S66 We add here Rabbit.. 22.59 4.06 0.85 0.06 0.11 137 Generally speaking, the percentage of nitro- gen is higher than in beef. Uric acid is also more abundant, as is the case in all birds. The nutritive power depends on the proportion of fat which abounds in goose and turkey, but is scarce in pigeon, duck, and rabbit. USE AND METHODS OF PREPARATION Fowl is principally served roasted, and all that we have said about butcher's meat is here applicable. When fried, fowl is serviceable to dyspeptics, as the congealed fat is easy to elimi- nate, while it appeals also, perhaps, more to the taste and is less stimulating. Fowl should be bled and not choked. 62 WHAT SHALL I EAT? REACTIONS — INDICATIONS For a long time a distinction was made be- tween white and red meat, attributing to each quite different qualities, strongly in favor of the white meat. It was claimed that the red meat produced excitement, congestion, and toxins, while the white meat was easier to digest, less irritating, and devoid of troublesome after- effects. Opposite effects in the temper, mood, and character of man were attributed to the red meat. So it was said that when Garrick, the famous English actor, had to appear in the r51e of a hero, he fed on roast beef; but on mutton when he had to play the simpleton. Science does not admit such ridiculous claims nowadays. In fact a complete reaction has taken place in this regard, and the tendency now is to give preference to the red over the white meats. This new doctrine is quite absolute. The color of the meat is a matter of secondary con- sideration only, and can in nowise prejudice its physical or chemical properties. It cannot serve as the basis for a correct physiological classifica- tion. We will, however, make certain general observations on the comparative value of red and MEAT 63 white meat as foodstuffs, and separately con- sider the digestive and general reaction of each. 1st. So far as digestion is concerned it will be generally admitted that chicken and pigeon are better tolerated by weak stomachs than butcher's meat, because they contain less fat. This must be emphasized with regard to chicken in which the grain of the fiber or its membrane is ever so much finer. A convalescent or a neurasthenic with an enfeebled stomach can eat with more comfort and less risk the wing of a chicken than a piece of beefsteak. On the contrary, duck, turkey, and goose are harder to digest than red meat, and should be rigidly excluded from the table of the dyspeptic and the typhoid-fever patient. We have already spoken of veal and pork. So it would be useless to revert to them here again. 2d. From a general point of view everything speaks in favor of red meat. It is more nourish- ing, contains more iron, and is an important article of food for the adult. It contains a sen- sibly smaller amount of extractive matter, and, in consequence, is less irritant and toxic. In summing up we repeat that, if chicken and pigeon are of service to the feeble and dyspeptic, 64 WHAT SHALL I EAT? the red meats are better for him who is recover- ing from an attack of arthritis. GAME COMPOSITION AND FOOD VALUE Carbo- Albumin. Fat, hydrates. Ash. Calories. Quail 22.80 7.60 1.20 171.60 Thrush 22.87 1.68 1.14 116.42 Partridge 24.46 1.36 1.04 120-42 Venison 20.55 1.82 0.85 107.53 The meat of game possesses three principal qualities: 1. A high percentage of albumin; 2, a small amount of fat; and 3, a strong propor- tion of extractive bodies, particularly creatin. These are present in a higher degree in animals that are killed in the hunt, which should be prohibited by law. The violent muscular over- exertion, which precedes death, gathers in the muscular tissues, in fact in the whole organism, a mass of xanthic toxins which there is no time to eliminate. Game undergoes frequently complicated culi- nary preparations, which unfortunately increase all its objectionable features. Jugged hare, partridge in cabbage, and others are risky dishes, because the toxins of the blood become mingled MEAT 65 with those of the muscular tissues. The same may be said about the salines (ragouts) of wood- cock, in which case the entrails that are left in the T)ird invite infection and intoxication. The habit of hanging game until it "gets high" is objectionable and antihygienic. The meat of game, like that of all wild animals, is rather harsh and tough. The cadaveric rigid- ity of the dead beast serves to increase these qualities. Moreover, the meat is generally sev- eral days old before it reaches the kitchen. Hunters are, as a rule, endowed with a veritable perversion of taste, and imagine that game appeals to the palate only when it is "high," i.e., when it smells strong and when putrefac- tion is already well advanced. The process of decay is not only accomplished by the formation of toxins, but is a genuine hotbed for micro- organisms, whence frequently spring gastric troubles and enteric disorders. We had a case of a strong, healthy man who contracted typhoid fever of the gravest nature from eating a part- ridge that was too far advanced. We cannot too strongly condemn such habits, which are bound to endanger the health of even the most robust. 66 WHAT SHALL I EAT? Venison may be prepared in a perfectly safe and sound way by pickling in the following manner: Place the best cut into a basin or large pot, add salt, pepper, bay-leaves, spices, etc. , accord- ing to taste; pour vinegar over the meat, adding a few drops of olive-oil. Turn the meat over once or twice every twenty-four hours. This method will prevent the meat from spoiling, but will make it tender and give it a most agreeable flavor. REACTIONS — INDICATIONS Game is hard to digest, and favors a rapid development of micro-organisms in the intes- tines. It should be banished from the menu of dyspeptics, and those who suffer from enteric or enterocolic ejections. Small birds, such as quail, thrush, partridge, lark, may here be ex- cepted, on the condition, however, that they are absolutely fresh when eaten and have not been "hung." Game, on account of the toxic substances it contains, is ever dangerous to the circulatory system; it contracts the small vessels and in- creases the action of the heart. For this reason MEAT 67 it is bad in cases of cardiac auctions and hypertension. In Bright' s disease its use should be prohibited, as it affects the renal capsules. It excites the nervous system, for which reason it is not suitable for neurasthenics. And for all these reasons it is not a fit dish in arthritis, eczema, or liver complaints. Consumptives, who are so much interested in watching their diet carefully, should make only small use of it. 68 WHAT SHALL I EAT? EXTRACTS MADE FROM MEAT BOUILLON, SOUP, BEEF-TEA Albumin 1.21 Fat 0.32— Chlorid 1 Carbohydrates.... 0.44 Ash 0.31 COMPOSITION AND FOOD VALUE Soup contains a few of the divers constituents of meat, but in variable proportions. Fat is present only in small quantities, as it is gener- ally skimmed off in the cooking. For delicate stomachs this is all right, but it takes a great deal of the nutritive quality away from the soup. Albuminoids are more abundant, unless they are largely removed in the skimming. The remainder is principally composed of albu- min, which in the boiling is partially trans- formed into albumose and peptones; and also of gelatin derived from the meat fiber and from the bones. Xanthic matter is plentiful. Crea- tin, xanthin, hypoxanthin pass into the soup and constitute a large portion of its physiologi- cal properties. Salt evaporates almost com- pletely. About fout-fif ths of the essential salts MEAT 69 in meat are lost, and have to be replaced by the addition of ordinary table salt. Unless salt is added artificially, phosphates, chiefly phosphate of lime, will predominate. The ash is acid. Thus it will be seen that soup contains but a minimum of nutritive power. Pure water should only be added in the proportion of 1 liter to 40 grams of meat, which will preserve an abundant proportion of the mineral constituents. How to Make Soup. — This is simple and easy enough. The best proportions, according to Chevreul, are: 2 pounds of lean beef, 2 J liters (5 pints) of water, 18 grams of table salt, and 110 grams of vegetables (carrots, turnips, leek, celery, etc.). But if you want to make a really good soup, then plunge the meat into cold water and at once bring to a boil. This insures a more thor- ough dissolution of the meat substances. Of course, the soup must be skimmed before serving. If the meat is put into water that is already boiling, the albumin is apt to coagulate on the surface and, by forming a crust or scum, to im- pede the proper issue of the alimentary compo- 70 WHAT SHALL I EAT? nents; the meat may taste better and more savory, but the soup loses much of its value. What is known as "bottle soup" is, however, the most nutritive of all, especially if it be taken only by the spoonful. The method of prepar- ing it is as follows: Cut the meat, after remov- ing the fat, into square pieces about three- eighths of an inch in thickness, and put them into a large-mouthed bottle which can be firmly closed. Without any additions, the bottle is placed in a steamer and allowed to boil for twenty minutes. Three hundred grams of meat will give about 100 cubic centimeters of a deep brown liquid, of good strong flavor and taste, which can be used ad libitum. Soup made from the knuckle of veal has the advantage of being more gelatinous. Chicken soup is easy to digest, and also rich in gelatin. Reactions. — The action of soup on the stomach is very marked. It strongly stimulates secre- tion. Pauloff has definitely proved that this stimulation is due to the extractive substances contained in soup to a very large extent. When the psychical fluid fails, soup steps in by start- ing the flow of the gastric juices which then continue to flow by its own force. Its use at MEAT 71 the beginning of the repast is, therefore, fully justified, especially in eases of anorexia. The intestinal reaction is, however, quite in- significant. Soup is a typical gastric food. Consisting of peptones, xanthic matter, and salts, it is wholly absorbed by the system with- out further efforts on the part of the digestive organs. The heart, the blood-vessels, the nervous sys- tem are all strongly affected and stimulated by it. Soup is really a nerve food, almost akin to alcohol and coffee. "The physiological effects produced by the creatin and xanthic leucomains, components both tonic and bitter, which are largely ingested in small doses and not injected under the skin, may well be com- pared to those of caffein and thein, which we derive from tea, coflFee, and cocoa." — (Gautier.) The action of soup on the renal functions is more difficult to calculate, because here certain elements have opposite effects. This much may, however, be claimed that, if taken in small doses and, granted, that the renal epithelium is intact, soup exercises a benign influence on the process of elimination, whether this be indirect by relieving the tension of or by giving tone to 72 WHAT SHALL I EAT? the heart's action, or direct by means of the salts of potash present in it. This is the opinion of Gautier, who contends that soup accelerates the action of the kidneys. But the same dose that stimulates the epithelium when intact, may have the very opposite effect on the diseased tis- sue. It is certain that if the kidneys are disor- dered, soup carries into them those objectionable toxins quoted by its adversaries, the more so as it adds a large amount of salt to the injurious effects of the leucomains. Indications and Contraindications. — Inasmuch as soup is, practically speaking, an extract of meat, it shares with the latter all its advantages and disadvantages, and we do not repeat our- selves when we here take occasion to emphasize its features. It is an excellent food for the feeble, for con- valescents, dyspeptics, atonies, and those with low tension. It is a food for remineralization, highly to be recommended to all who suffer from loss of the important mineral ingredients. On this head and as an aid to digestion, consumptives are well advised in making a moderate use of it. The more important contraindications are kidney troubles, whether acute or chronic, on the MEAT 73 one hand, and cardiovascular affections of any kind, on the other. It is to be shunned by all who suffer from hypertension, angina, or from atheromatous or aortic affections. We have in view a case of a patient in full convalescence from an attack of asystole, who brought about a relapse of the gravest nature by eating a plate of soup surreptitiously. In cases of uremia, stone, gout, or arthritis the prohibition of its use should be tempered with discretion. In acute diseases soup may be given in small doses in types of general asthenia, but it should be forbidden at once if symptoms of plethora and congestion be observed. JUICE OF MEAT This approaches the composition of meat much more than soup. Although less nourish- ing, it possesses all its qualities, and is a regular muscle-builder. For consumptives it is a valu- able food, because, according to Richet, all the antitoxic components of the meat enter into the juice if the pressure is sufficiently strong. Two hundred grams of raw mutton should be forced through a meat-press. The juice thus extracted 74 WHAT SHALL I EAT? may be consumed either at the begimiing or in the middle of the meal, or it may be mixed with the food. It may be taken by itself fresh or lukewarm, but it must be heated or boiled for fear of losing its therapeutic properties. In convalescent hypopeptic or nervous persons, and in cases of chronic gastritis, meat-juice will of- ten stimulate the gastric functions — in fact, the whole system. There is a large number of commercial arti- cles which are prepared in ever so many different ways, the principal advantage of which is sim- ply one of commodity. EXTRACT OF BEEF The best known of these is Liebig's Extract, so called after the famous German chemist. It is made by evaporization under pressure. The fat is removed by filtration, and the liquid is condensed in a vacuum pan, also under pressure, until it attains the consistence of a thick syrup. This method extracts all vestiges of fat and a goodly portion of gelatin. With the exception of this difference, meat extracts possess all the good as well as the bad properties, indications, and contraindications of soup; they are equally MEAT 75 rich in xanthic matter. It may be of interest to give here the formula of v. Liebig, the fa- mous German chemist, for making a beef-juice from fresh beef: Hydrochloric acid (dilute) 30 minims (drops) Water J to S pint Table salt 1 saltspoonful Rump-steak, cut into small cubes. . . f pound Soak for one hour. Strain through muslin cloth. Serve cold. Use a porcelain, glass, or horn spoon. It will stain silver or any other kind of metal. — (Translator.) MEAT POWDER Albumin 69.50 Fat 5.85 Carbohydrates 0.00 Ash 13.25 Available calories = 313 Meat powder is very nitrogenous, but is a food of high value. It is manufactured in large quantities from dried meat reduced to a powder. It may be made at home by scraping the meat with a knife into a pulp, which is then allowed to dry in a steamer placed on a hot metal plate. This should be slightly inclined, so as to al- low the fat to separate. Finally, it should be 76 WHAT SHALL I EAT? pounded in a mortar. But it is well to bear in mind that it spoils quickly and grows rancid. Meat powder is put to many therapeutic uses. It is a food easy to digest, and will quickly restore losses in nitrogen. It may be added with advantage to other foodstuffs, such as soup or milk. Emulsified with a small quantity of mineral water it may be administered with the stomach-pump. As a sedative in gastric troubles it is highly recommended. Excellent results have been obtained with it in hyper- chlorhydria, in cases of denutrition, phthisis, gastric hyperesthenia, and obstinate vomiting. PEPTONES The peptones are produced by the digestion of muscular meat, either by the aid of papain in the hydrochloric fluid, or by pancreatin in a solution of carbonate of soda. There has been much controversy about its alimentary value; but the question seems to have been finally set- tled in the affirmative. Among the subjects discussed was the balance of nitrogen. It was shown that up to 69 per cent of the usual albu- minoids could be replaced by their weight with MEAT 77 peptones without disturbing the balance of nitrogen. — (Gautier. ) The true peptones are but seldom ingested by way of the mouth. They are chiefly adminis- tered by means of rectal injections for nutritive purposes. WTien carefully emulsified with bouil- lon, milk, or even wine, with the addition of 4 to 5 drops of laudanum, they are well tolerated, absorbed, and assimilated by the system. In all cases where feeding by the mouth is impossible or objectionable (in esophagoiis ste- nosis, gastric ulcers, incorrigible vomiting) these injections should be given. They will often sustain the patient for weeks. K by the mouth they are generally taken in the shape of peptonic preparations, commercial articles which are principally composed of albu- min and albumose, and contain but a small fraction of peptones. Among these we mention plasmon, which is composed of: Albmninoids. Fat. Carbohydrates. Ash. 74.5 1.7 0.3 The available calories are about 350, but as intestinal absorption is frequently imperfect, this number is correspondingly diminished. Some of the preparations, for instance, pepton 78 WHAT SHALL I EAT? Kemmerich and somatose, are produced from muscular meat; others from the albumin of milk (plasmon and sanatogen), while tropon is a mixture of animal and vegetable albumin. All these substances have so far fallen short in actual practice of the results claimed for them. Re- quiring no mastication, leaving no residue and easily causing putrefaction, they often enough become irritants to the stomach and the bowels. Besides they have the disadvantage of being almost purely nitrogenous. Pepton Kemmer- ich and plasmon are perhaps the best among them. They should never be made the basis for nutrition, should never be taken in large doses, but only for the purpose of raising the level of the alimentary ratio. They prove useful in cases of insiifficiency of nutrition, in cancer, re- peated attacks of vomiting, anemia, and for feed- ing up phthisical persons. With prudence and discretion they may be employed to advantage in dyspepsia, cardiac affections, and Bright' s dis- ease. But in cases of enteritis or enterocolitis their use must be strictly forbidden. FISH In respect to hygiene of food, fish proves a rather heterogeneous group. The great differ- ence in the composition of the various species of fish entails a corresponding variety of properties and organic reactions. We have, therefore, decided to divide them into two classes by set- ting aside the usual division into salt-water and fresh-water fish, i.e., less fatty fish and Jhtly fish, a better physiological classification, we think, than the former, which also renders it easier to point out the indications and contraindications. We shall study the first class according to our usual plan. For the second class we shall con- tent ourselves with simply pointing out the differences. The crustaceans, mollusks, and shell-fish will be considered in a separate chapter. These de- serve special mention, for in certain districts they form an important part of the diet of the inhabitants. (See pages 88-92. ) 79 80 WHAT SHALL I EAT? LESS FATTY FISH BASS, PIKE, CARP, COAL-FISH, GOLDFISH, SMELT, GUDGEON, BULLHEADS, CODFISH (frESh), WHITING, PERCH, PLAICE, SKATE, CATFISH, SARDINES (fRESh), TROUT COMPOSITION — ALIMENTARY VALUE Albumin 18.00— Purin. . 0.057 Fat 1.35— Chlorid 0.07 (fresh- water fish) Carbohydrates. 0.00— " 0.50 (salt-water fish) Ash 1.07 Available calories = 82 We have put together in this group all those in whom the percentage of fat varies from 0. 50 to 3 per cent. The figures given represent the average composition of the sixteen kinds of fish enumerated. So far as the nitrogenous element is concerned fish strongly approaches beef. The xanthic valids are in favor of fish, excepting which the flesh of fish has the same nutritive value as meat. Rosenfeld, after numerous experiments, came to the conclusion that fish gives the same satisfaction as meat, allows of the same utiliza- tion of forces by the navvy, the sportsman, the soldier as well as by those who lead a sedentary life. Many people, for instance the Japanese, FISH 81 live almost exclusively on fish, and but rarely eat meat. Nothing can explain the prejudice which so many people have against this article of food. If fish is a little deficient in stimula- ting quality, naught but good can come from its use to the system. In the variety under observation, fat is pres- ent in small quantities only, which, of course, reduces the caloric value. It is a fluid fat, how- ever, rich in olein and organic phosphorus. Mineral substances are present in smaller quantities than in meat. Phosphorus predomi- nates, and fish may be styled a rephosphorating food. Lime and magnesia are found in rather large proportion; of iron there is scarcely a trace. Salt is very scant in fresh-water fish, but very abundant in salt-water fish. METHODS OF PREPARATION Fish is served either fried or baked or boiled, with or without sauce. The frjdng process, the white sauces, and the mayonnaise add the fat which is wanting, but add also to the troubles of digestion. Dyspeptics should give fish the preference over soup and white meat; but if they eat fish fried, they should only partake 82 WHAT SHALL I EAT? of the meat of the fish and leave the fat on the plate. The custom to eat potatoes with fish has a practical value, as it supplies the want of carbohydrates. REACTIONS a. Digestive. — The meat of the less fatty fish is tender and delicate, easy to digest, does not excite, and passes quickly through the stomach. It seems to favor fermentation less than muscular meat, but it must always be absolutely fresh. This question of absolute freshness in fish is of great importance. It is an essential quality, on which depend to a large extent its dietetic properties. Absolutely fresh fish will never cause any in- convenience, but if it is spoiled even in the slightest degree, it becomes risky. Unfortu- nately putrefaction sets in with incredible rapid- ity, quite unknown in other articles of food, excepting shell fish; in the summer-time it requires but a few hours. The packing in ice is only a palliative, which frequently serves merely to mask the odor. In fact, a sort of maceration is produced in the water of the melting ice, FISH 83 which accelerates decomposition when access of air is permitted. In the summer months it is, practically speaking, well-nigh impossible to obtain fresh salt-water fish anywhere, except at the seaside itself. The danger is the greater, because the odor betrays putrefaction only in its advanced, and not in its incipient stage. b. General. — This differs but little from that of meat, since the action is the same as that of any other nitrogenous foodstuff. But the scarcity of purin reduces the exciting influences on the heart and blood-vessels, and consequently on the whole system. Attention is called here to the fact that cer- tain lake fish, especially of the Lake of Geneva and of Annecy may cause infection of bothrio- cephalus latus (broad tapeworm). c. Eliminating. — Reaction on the intestines depends entirely on the state of preservation of the fish. When quite fresh it has but a slight toxic effect on the renal glands; but, when spoiled, it fatigues the kidneys and may be- come a source of danger. 84. WHAT SHALL I EAT? INDICATIONS AND CONTRAINDICATIONS Fish constitutes the world over an excellent diet, possessing the same advantages as meat, without its objectionable features. As a popu- lar food the less fatty fish, however, must give way to the fatty fish, which are certainly more nourishing; but the former are ever preferable in pathological conditions. That is the reason why they agree so well with dyspeptics and in hypo- or hyperchlorhydria. It is advisable to eat the fish before the meat, as it assists the transitional process from the lacteal to the ordinary regimen. It must not be pre- pared with hot butter or fat, and must be abso- lutely fresh. There are dyspeptics who cannot digest fish bought in the city, but who tolerate a fish diet perfectly when at the seaside. In cases of intestinal trouble and under similar conditions it affords more comfort than meat. It pleases the weak stomach of the convales- cent, inasmuch as its richness in phosphorus and mineral substances renders it useful. In arthritis and for obesity it may be well recommended as a change and a means to react on the abuses of the meat diet. FISH 85 In albuminuria it is generally held to be injurious. Teissier considers it a food criterion of recovery, if fish can be eaten without showing an increase or reappearance of albumin. Dar- emberg claims that a fish diet (absolutely fresh) is not only inoffensive, but very useful in the treatment of albuminuria, in fact apt to bring about a genuine cure. We believe also that eczematous persons have nothing to fear from feasting on less fatty fish fresh from the water. FATTY FISH SHAD, EEL (fresh WATEr), HERRING, MACKEREL, SALMON, TUNNY (SPANISH MACKEREl), TURBOT, MULLET Albumin 18.50 Fat 11.50— Purin . . 0.13 (salmon) Carbohydrates . 0. 00— Chlorid . 0. 07 (fresh-water fish) Salts 0.87— " 0.50 (salt-water fish) Available calories =169 The percentage of fat is below that of meat, fluctuating between 5 and 13 per cent, except in the eel where it reaches 26 per cent. It varies, however, not only according to species, but also with the season of the year in the same species. 86 WHAT SHALL I EAT? The fatty fish are more nourishing than the less fatty, also more nitrogenous, though poorer in mineral substances, but much richer in puric bases. They are heavier on the stomach, as their flesh is firmer and more compact. Even when quite fresh they are apt to cause gastric and intestinal fermentation, and this objectionable feature is frequently intensified by the greasy and rich sauces which are served with them. The action on nutrition, on the circulation and on the renal system, depends on the richness in purins which make them almost the equiva- lent of meat. We draw attention to the fact that the fresh serum of the eel has a toxic effect on the kidneys. For these important reasons the use of fatty fish is contraindicated in all cases in which the less fatty fish may be recommended. In dyspep- sia, gastric as well as intestinal, in arthritis, obesity, cardiac ailments, Bright's disease, and eczema their use will always prove harmful. To this list may be added liver complaints, uremia, gout, and slxme. There are circumstances, how- ever, under which they prove superior, for they are a valuable food for the normal, healthy FISH 87 human beings, and especially so for the poorer classes. In a piece of beef cut from the neck — one of the cheaper cuts — one gram of nitrogen costs about 12 cents, and 100 calories about 17 cents. A fresh herring costs about 3^ cents. Fatty fish, moreover, may constitute a complete diet; that is to say, they may represent the only supply of food available for an entire race (Esquimaux). In diabetes they are of great service on account of their high nutritive power and the absence of carbohydrates, although their use may even here be contraindicated by reason of other com- plications. They should figure frequently on the table of consumptives. Boiled fish with mayonnaise, sardines in oil crushed into a paste with butter and hard-boiled eggs, are most nourishing foods, rich in fat, and easily tolerated by the stomach, especially dur- ing the heated term of the year. 88 WHAT SHALL I EAT? CRUSTACEANS AND SHELL-FISH The crustaceans, mollusks, and shell-fish, oc- cupy by no means a secondary place in the list of our foodstuffs, and perhaps justly so. We shall be brief in our remarks about this variety, which are considered to be often more harmful than beneficial. Carbo- Available Albumin. Fat. hydrates. Salt. Calories. Prawns, shrimps.. 25.83 1.57 3.32 128 Crabs 15.30 0.46 1.01 71 Lobsters 18.85 1.01 1.85 92 Oysters 9.71 1.14 1.62 53 Mussels 13.60 1.09 1.20 70 It is apparent that this category of food is rich in nitrogen, especially prawns {shrimps). Xan- thic substances also abound, particularly in the crab and in snails. Fat is most prominent by its absence (lobster). But, as if by way of com- pensation, they are foods strongly mineralized. This, however, is again minimized by the fact that salt is present to such a large degree. Snails deserve special mention here, as in some countries they are consumed in large quan- tities. They are a hard, tough, indigestible substance, which must be made piquant by the addition of spicy condiments to excite the FISH 89 stomach. They are unfit for the sick-room, and present no advantage whatever to the hale and hardy. Lobster, grayfish, and crab also have a hard, compact meat, and are difficult to digest. They are powerful excitants and full of toxins, not infrequently causing eruptions on the skin, nettlerash (urticaria), vomiting, and diarrhea. Dyspeptics should never touch them, and they should be barred from the menu in cardiac or in Bright' s disease, in arthritis, and in eczema. Shrimps and prawns are less dangerous; the meat is more delicate and rather rich in mineral matter, mainly phosphorus; the taste is refined and piquant, which justifies their use, especially during the summer months, for the purpose of whetting a sluggish appetite. Moreover, they have the advantage of being eatable without sauce or other bothersome additions. They must not be consumed in heart or in Bright' s disease, nor in eczema. Dyspeptics and those afilicted with arthritis should not eat them, ex- cept once in a great while. But to anemic, con- valescent, and consumptive persons they may be recommended. Oysters and mussels resemble each other a 90 WHAT SHALL I EAT? good deal; in fact, the mussel might be styled the oyster of the poor. Being less nitrogenous, they are easy to digest. They carry no undue excitement to the gastric regions, and do not fatigue them. Gautier considers them genuine condiments. The reaction on the general sys- tem, and particularly on the kidneys, is fa- vorable. Still, there are objectionable features connected with them, as they frequently harbor intoxication and infection. Ptomain-poisoning, which manifests itseK in the same manner as in spoiled meat, i.e., by gastrointestinal intolerance and by dermic erup- tions and headaches, is by no means of infre- quent occurrence with mussels as well as with oysters. Their pathogenic properties have been the subject of much research during recent years. They are undoubtedly due to certain changes which take place in the liquor of the oyster, a truly living organic liquid. As in fish, these changes take place very rapidly, par- ticularly with a rising temperature, and the toxicity increases in the same proportion. Twenty hours after the oyster has been taken from its bed it requires 44 c.c. of its liquor to every two pounds of body weight of the victim FISH 91 to kill a rabbit; after two days at 65° Fahren- heit it takes only 14 cc, and after three days, at 75° Fahrenheit, only 6 cc. — {Baylac.) It is easy to understand the wisdom of the old saw: "Abstain from oysters during the months which have no 'r' in them," i.e., May to August, on account of the high temperature prevailing during that period. The infection which seems to be more pre- dominant in the oyster than in the mussel, is ascribed to the presence of pathogenic micro- organisms. Typhoid, cholera, and Eberth's bacillus have been found in it. The cause of the disease in the patient can be traced beyond doubt to the consumption of these mollusks. The trouble is evidently due to the bad location of the oyster-beds, which not infrequently are too near the outfall of sewage. The attention of the proper authorities has, however, been called to these defects, and in many countries the oyster-beds have been placed under the surveillance of government inspectors, by which means much of the danger has been removed. Nevertheless, it is wise never to lose sight of the facts quoted above. Mussels and oysters should not be eaten by 92 WHAT SHALL I EAT? those whose intestines, kidneys, or skin do not function properly. Their peptogenic value, their richness in mineral substances and rare metalloids, such as iodin and bromin, make them serviceable for building up enfeebled con- stitutions. Convalescents, and those run down by disease, will be benefited by their use. The same holds good for cancer, tuberculosis, and dyspepsia, in hyperchhrhydria and glycosuria. For the latter disease particularly they possess, according to Bouchardat, a definite therapeutic value. MILK In milk we find a new alimentary constituent, and perhaps the most important of them all at any rate so far as quantity is concerned. We refer to the carbohydrates which are missing almost entirely in all of the foods described so far. The presence of this element makes milk form a natural transition from the rich regimen, composed chiefly of albumin and fats, to the vegetarian regimen, in which the fats almost entirely disappear and the nitrogenous content is diminished, thus leaving the carbohydrates in a predominant position. And it cannot be otherwise, for milk is in itself a complete nutri- ment, at any rate so far as the earlier months of life are concerned; later on the bad proportion of its constituent compounds, especially the in- sufficient quantity of certain mineral bodies, prevent it from being adequate to the wants of our organism. This is at once apparent when an adult is by necessity restricted to a rigid milk diet. Milk, besides fruits, has always 93 94 WHAT SHALL I EAT? been one of the principal foods of the human species. From the medical standpoint its importance consists chiefly in its dietetic and therapeutic value, inherent in its own essence or present in its derivatives, for cases of illness in which it may be employed either as a vehicle or as a means. An enormous number of problems come here into consideration which interest not only the physician, but the hygienist and the sociologist alike. COMPOSITION AND FOOD VALUE The composition of milk differs in every spe- cies of mammals. And again it varies in each species with the age of the individual animal, and according to the period of lactation. It also depends on the physical condition, i. e. , the state of health of the individual animal, on stabling, grooming, surroundings, nature and method of feeding. The best that we can do is to give the average or mean composition of milk of each species, basing our calculations upon scientific experiments and analyses given by recognized authorities for different kinds of milk used for domestic purposes. MILK 95 COW'S MILK Albumin 3.28 Fat 3.48— Chlorid . . . 0.15 Carbohydrates.. 4.82— Purin 0.056 Ash 0.53 Available calories =182 The density is about 1032. The figures given above do not, however, represent a standard by which adulterations may be detected. They are also somewhat below those usually quoted, but we wish to point out that we are dealing here with substances already in the process of di- gestion. Milk is essentially composed of an opalescent plasm, in which myriads of butyric globules of ^ to £^ m. m. in diameter are held in suspen- sion. This plasm holds albuminoid substances in a more or less complete state of solution; also a special kind of sugar and different kinds of salt. For the better understanding of the sub- ject we quote Gautier: "There are two kinds of bodies held in suspension in the plasm of milk, viz. : 1. Globules of butter which seem to con- tain an infinitesimally small amount of fatty substance encapsuled in a very thin, elastic 96 WHAT SHALL I EAT? envelope composed of proteid matter. There are about 1,500,000 of these little balloons to the cubic millimeter, 2. Fine granulations of phosphates which are united in a special albu- minoid nuclein substance." The albumins of the plasm, which may form from 1.5 to 5.5 per cent, are casein and lacto- albumin. The first is found in a state of demi- dissolution. The lab-ferment, together with the pressure of the stomach, precipitates the acids into a clot (cheese), which becomes the more compact the stronger the acids are. This coagulation, like that of blood, is facilitated by the addition of salts of lime. The casein is peptonized by the aid of pepsin, and leaves an indissoluble residue, composed of nuclein and phosphorized paranuclein. The lactoalbumin is suspended in the serum after caseation, and does not coagulate under heat. Butter is the principal constituent of milk, and controls the food value. Large institutions, especially hospitals in Europe, pay for the milk they use, according to the proportion of butter contained in it, which varies from 30 to 82 grams per liter. It is formed by the coalescence MILK 97 of the fatty substances contained in the butyric globules. To obtain it, the milk is allowed to stand, when a layer of cream, composed of these globules, forms on the top. The cream is taken ofp and churned, by which process the thin cov- erings of the albumin are broken, thus allowing the masses of butter to unite and assume a solid appearance. The skimmed milk, although de- prived of the fats, is used for many purposes and quite fit for consumption. At any rate, in large cities it is diflficult to obtain any other but partly skimmed milk. Although it is not as nourish- ing as whole milk, it is preferable in many dis- eases in which the patient can digest it with more ease. What is left behind in the churning is called huttermilk, an article of food which pos- sesses excellent therapeutical properties, to which we shall revert later on. The third nutritive element of milk is the carbohydrates, i.e., lactose or milk sugar. This is a bihexose, well known for its diuretic prop- erties, which makes the sugar in diabetics. The oscillations are a little less accentuated, varying between 3.50 grams and 5 grams per liter. The mineral substances are relatively abun- 98 WHAT SHALL I EAT? dant, furnishing about the twentieth part of the dry extract. They are not readily absorbed by the bowels. While it shows 98. 8 of albumin, 94. 5 of but- ter, and 100 of lactose, 33. 8 of the salts in chil- dren and 49.6 in the adult are not utilized. For this reason milk cannot be counted among the best mineralizing foods. Two elements are predominant, viz. : lime and phosphorus; the former to the extent of 1.60 grams per liter. Because this is not readily absorbed, being pres- ent chiefly in the shape of phosphate of lime (but slightly soluble), and because in infants three-fourths of it is rejected, milk cannot lay claim to being a first-class vehicle for alimentary chalk. Phosphorus is also abundant, and is present chiefly in the shape of physiological values well differentiated; one portion envelops the casein under the form of nuclein; a second portion is present in the shape of lecithin analogous to that contained in eggs to the extent, in the mean, of 1 gram per liter. The rest is represented by phosphocarnic acid, or nuclein. Gautier insists that the principal role of this phosphocarnic acid is to act as an agent in the MILK 99 assimilation of phosphorus, lime, and iron by the economy. Cows' milk is unfortunately not well supplied with this agent, phosphorus, in the shape of nuclein, representing only 6 per cent of the total amount of phosphoric content. It IS well to bear in mind that, if the absorp- tion of phosphorus is defective when milk is taken raw, it is still more so when it has been boiled or heated for some time, as this process separates a part of the lecithin while producing phosphates. As a phosphorating food milk is only of medium value. Of other elements there are only a few: mag- nesium is rare, sodium chlorid about 1.50 per liter, iron about 0.004 gram. Milk is essentially a living food. It contains a number of diastasic ferments, viz. : oxydase, yeasts giving solubility to the casein, and hydrolyzing amidin. Our knowledge of these is at present very limited, but their usefulness in the process of nutrition is unquestionable. 100 WHAT SHALL I EAT? MOTHER'S MILK Albumin 1.84. (— ) Fat 3.52 ( + ) Chlorid . . . 0.05 Carbohydrates. . 6.11 ( + ) Ash 0.23 (-) Available calories = 66 Its composition changes somewhat toward the thirtieth year; a little later on it is less mineral- ized. Abundant feeding increases the amount of butter and sugar; underfeeding diminishes the amount of casein and of butter. Nitrogen declines during the period of lactation; butter and lactose vary but little. Aside from the changes that take place in the distribution of nitrogen and the ternary bodies which we have indicated by + and - , mother's milk possesses certain qualities which make it differ from and superior to cow's milk. 1st. Casein is precipitated in finer and more granular floccules. Its digestion leaves no resi- due of nuclein. 2d. The absorption of the mineral substances is more perfect — 80 per cent for the whole of the salts, 60 per cent for the lime, and 92 per cent for phosphorus. — {Michel and Perret. ) 3d. Phosphorus is present in its organic state. MILK 101 The following table, in which the amount of phosphorus per liter is given, will show the difference. Or^ranic Phosphorus. Phosphate of Casein. Mother's milk 0.320 0. 132 Cow's milk 0.180 0.580 4th. Although up to the present time no definite proof of their existence has been ad- vanced, yet clinical facts force us to admit the presence in mother's milk of certain specific ferments which not only facilitate its digestion and absorption, but also the assimilation and fixation of the substances in the organism. It is also possible that their specificity is better adjusted, and that, thanks to them, the moth- er's milk agrees so much better with the infant. ASS'S MILK Albumin 1.79 Fat 1.30 Carbohydrates 6.07 Ash 0.35 Available calories = 44 This approaches more than any other in qual- ity the mother's milk. It is very easy to digest. Casein is precipitated in fine floccules and leaves no residue of nuclein. 102 WHAT SHALL I EAT? It is a valuable food, especially for irritable and shattered stomachs. It causes no inconve- nience. As it is subject to rapid changes, it must be consumed soon after it has been drawn. It will keep fresh for a few hours only, but before being consumed should be warmed up to 100° Fahrenheit. Mare's milk possesses pretty well the same qualities and composition, but is difficult to ob- tain in almost any country. It comes on the market, however, under the name of koumys (see page 131). GOAT'S MILK It is superior to cow's milk, as it is richer in casein, butter, and mineral matter. METHODS OF PREPARATION AND HOW TO USE MILK The most natural and cheapest method of using milk has always been to drink it raw. The "benefactions" of our present-day civiliza- tion, the crowding into large cities with its sordid consequences, has forced us to look upon the use of milk in its raw state as a source of danger, and to eschew its use almost entirely. MILK 103 The danger is twofold, as both the alimentary canal and consequently the entire system are at once menaced. This is principally the case with small infants whose digestive organs, especially in the summer, are so easily upset by raw milk, which is never sterile. The udder of the cow is always more or less soiled with foreign matter, and this constitutes a first cause of contamina- tion, aggravated, indeed, by all the manipula- tions which the milk undergoes between the farm and the table of the consumer. It is bad enough in cold weather, but the summer heat hastens the development of bacteria; fermenta- tions arise at the expense of the casein and pro- duce ptomains. Thus charged with toxins and microbes, milk becomes the most dangerous source of enteric trouble, the greatest slayer of infants known. Luckily much has been achieved by dissemi- nating this knowledge among the people at large, and the use of boiled milk becoming more universal every day, infant mortality in the larger cities has been appreciably reduced. The infection which at first attacks only the digestive tube, is prone to spread and involve the whole organism. Milk may become the 104. WHAT SHALL I EAT? carrier not only of ordinary microbes, but of diphtheria, typhoid, scarlatina, smallpox, and even tuberculosis. It has been proved to satis- faction that the bovine bacillus may become pathogenic for mankind. It has often enough been discovered in milk, and despite the sani- tary measures of modern times, inspection of stables, testing of cows with tuberculin, con- tamination cannot be efPectually prevented. The intestines, no matter how sound, may at any time serve as the gate of entrance to the tubercle bacillus. Moreover, medical science has not as yet discovered a means by which the presence of this dreaded bacillus can be discovered in the system, until it has actually attacked an organ. All these facts should as- sist in discouraging the use of raw milk every- where. Sterilization of milk becomes therefore im- perative. But how to do it? There are so many methods, and the results are so unequal. Pasteurization, or heating the milk at a tem- perature of 160° Fahrenheit for twenty or thirty minutes, is a good method for killing the princi- pal microbes and changes the milk but little. But it requires a special outfit, which is not easy MILK 105 to master and handle. Besides, the sterilization is not complete, and milk cannot be protected for any length of time by this process. Scalding the milk at a temperature of 210° Fahrenheit for a few minutes simply suffices to prevent the milk from turning, but it will not destroy all the germs. It would not be advisa- ble to feed it to a tender infant. The best method we can advocate is to heat the milk to 210° Fahrenheit in a steamer for at least fifteen or twenty minutes. This will insure the destruction of all pathogenic germs. A few yeast spores of casein remain behind, but that is not a matter of any consequence. But in all these methods it is to be emphasized that the milk must be absolutely fresh. With the heating of milk up to 230° and 240° Fahrenheit for several minutes, we come to industrial undertakings. As all the spores are destroyed, the milk may be kept for weeks and months. A great many varieties of such milk are in the market. Some are sold as in their natural state, others are modified so as to ap- proach the composition of mother's milk. Recently some one has been singing the praises of homogenized milk. The object of 106 WHAT SHALL I EAT? this preparation is to break up the globules of fat into infinitesimally small particles, with a view to prevent the formation of lumps of but- ter which are so frequently found on the surface of sterilized milk. We must, however, add to this list, which is already overlong, milk powder, a preparation of a very delicate character, but which seems to have the advantage that it keeps better and longer than any other variety. If its value for infant feeding is debatable, it yet serves a great purpose, especially for explorers and the colonial trade. For nursing purposes none of the industrial preparations are to be recommended, and we can honestly say that the farther milk is carried from its source of origin, the less it will agree with the infant, not because of the modifications of the casein, or the elimination of the lecithin due to the journey, but by force of the destruc- tion of the ferments. This, perhaps, will supply an explanation why the continued use of steril- ized milk has in its train scurvy and Barlow's disease. Restime. — Cow's milk should not be taken raw. Steaming the milk at hom£ for fifteen or twenty minutes is still the best method of sterilization. MILK 107 The commercial preparations, harmless to adults, should have added to them, if at all used for infant feeding, a dash of orange-juice or that of the lemon. It would be futile to refer to the endless uses to which milk is put in the culinary art. Most of them are beyond criticism, some are perhaps a little hard to digest. If you suffer from ar- thritis, do not forget that the addition of a bit of milk singularly increases the nutritive power of certain dishes. ADULTERATIONS For the comfort of readers residing in New York City the translator subjoins here, without guaranty, however, for its correctness, an article which appeared in the New York Times on July 25, 1910, under the heading of "Topics of the Times:" MILK IS HIGH, BUT CLEAN However badly 9 and 10 cent milk may choke New York at thought of the price, there ought to be some consolation in the assurance that at least it is the purest and cleanest milk in the world. That it is clean and pure may, indeed, explain in part, though by no means 108 WHAT SHALL I EAT? altogether, its high price. And, while the milk purvey- ors as a rule have cooperated cheerfully with the health authorities in maintaining a high standard of milk-sup- ply, the untiring work of the Health Department is at the bottom of the inestimable result. Dr. Darlington, when Health Commissioner, labored diligently to keep the milk sold here uncontaminated, a task not easy in a territory covering half a dozen States, extending north into Massachusetts and west into Ohio. Commissioner Lederle, as shown by a recent statement of his methods of dairy inspection, has not permitted the work to lag a moment. Not only are samples of practi- cally all the milk brought into the city analyzed daily in the Health Department laboratories, but a keen lookout is kept over the entire city for sectional outbreaks of disease which may be traceable to the milk-supply. Dr. Lederle 's statement shows also that the closest practicable reckoning is kept of the thousands of dairies which sup- ply the city. This inspection is maintained by a corps of trained men who visit the dairies at regular and often at irregular intervals. For each dairy a score card is kept by the inspector for the Health Department, and each dairy has its rating. It is 80, 90, or 95 per cent good, as the condition found by the inspector warrant. If it falls below the high standard required its milk can- not come into New York until all objectionable conditions are removed. The fact is, the requirements on the dairies are more exacting in cleanliness of cows and milkers than are usually maintained for private consumption anywhere in this country. The Attorney-General, who has inves- tigated this question, says that the charges for milk are exorbitant. But it's clean and rich, and it is far better MILK 109 for the people that it is such than if it were not clean, not pure, mixed with water, and possibly dirty water at that, and yet cheap. A few words here about cryoscopic analysis, which seems to render an excellent means for controlling and testing the purity of milk. Pure milk freezes at 31 ° Fahrenheit. This is a fixed figure, no matter what the proportion of the difFerent constituents may be or the age of the cow or the fodder given. Every deviation shown by the cryoscopic thermometer points to some adulteration. This process of inspection, which requires a little time, and a small outlay for instruments, deserves the careful attention of every large community, inasmuch as it is of the utmost importance. REACTIONS a. Digestive. — Of all the foodstuffs, milk is the one which makes the least demand on the digestive glands, and causes them the smallest amount of excitation. Clinical facts and lab- oratory research agree on this point. Pauloff, above all others, has made a special study of the reaction of milk on the digestive secretions. In the stomach, with an equal amount of albu- 110 WHAT SHALL I EAT? min, milk produces a chlorhydropeptic secre- tion, inferior to that of meat and much inferior to that of bread. In the duodenum, with the same quantity of fat, the secretion of steapsin is scantier than with meat; with the same quan- tity of carbohydrates the amylolytic secretion is slightly lower than with bread. The study of the nitrogenous changes gave this same author the chance to observe at what little expense the digestive process of milk is carried on. A meal of bread produced in a dog, during the subsequent hours, an enormous rise in urinary nitrogen; with a feed of milk, containing the same amount of nitrogen, the rise observed was nearly three times less. The ingestion of nitrogen being the same in both in- stances, the difference in the rise can only be ascribed to the difference of the digestive labor, considerable in the first instance, a minimum in the second. Moreover, the milk was retained, and in a fashion had an equally beneficial effect on the intestinal flora and on the ferments which it provoked, thus proving its antiseptic and an- titoxic qualities. But we must make here a necessary restriction in order to explain the complexity of the clinical facts. This beneficial MILK 111 influence cannot be exercised unless the diges- tive functions are normal and the milk is well digested. Under such conditions a milk diet should make the intestinal flora fall from 67,000 to 2,500 cmm. — {Gilbert and ZHminici.) The change from a meat diet to a milk diet is ac- companied by an important diminution of uri- nary sulphoether. Rapid digestion of casein, antiseptic action of lactic and succinic acids, which are derived from the lactose, such is the double explanation of this phenomenon. If, e contra, the milk is badly digested, if the intestines are already infected, the casein be- comes the prey of proteolytic bacilli, and ad- vances their growth and ferments by giving way to powerful toxins. This explains the fact that in numerous cases of enteric trouble, the ingestion of milk is accompanied by aggravated symptoms, which, however, disappear with the removal of the cause. b. General. — The influence of a milk diet on the general system is of the same nature. The absence of stimulation is the principal character- istic Hence the feeling of faintness so often experienced by those who by sickness are re- duced to a milk diet. They do not suffer from 112 WHAT SHALL I EAT? the want of calories, but from the want of an excitant. All the organs are benefited by the quieting action of milk: the nervous system, the liver, and probably also all the glands of the blood-vessels. In a like manner it affects the heart and the vascular system. Milk is a sedative of the first order. Its poverty in salt, the absence of xanthic substances, the characteristics of its own albumin (one of the least toxic), all aid in this action. It suppresses the toxins in the circulation, neutralizes vascular construction and defective tension (the natural consequence of the former), and relieves the action of the heart. The ease with which it is digested is favorable to the cardiac functions; every act of digestion must fatigue the heart. With milk this fatigue is reduced to a minimum. 3d. Eliminating. — Neither is the influence on the kidneys less profound or favorable. Anti- toxic, rich in lactose, poor in salt, milk is an ad- mirable diuretic. It is, indeed, a common case of Bright' s oliguria, in which a milk diet is able to increase the daily output of urine to 3 or 4 liters. Sedative and antiseptic for the alimentary MILK 113 canal, antitoxic and calming for the general system, diuretic for the renal glands, milk lays claim to the title of a therapeutic agent of the first order. But these properties will not be re- alized unless milk is used when and where it is needed. The absolute milk diet requires certain precautions to which we shall give forthwith proper attention. ABSOLUTE MILK DIET The physician should not content himseK with simply prescribing a milk diet to his pa- tient, but he must complement his orders with a series of instructions without which good and satisfactory results cannot be obtained. Their object must be to correct the faulty distribution of the alimentary principles in the milk and to insure proper digestion. 1st. In the adult the ideal proportions would be: Albumin 18.1 Fat 10.4 Carbohydrates 71.5 But the actual proportions in the milk are: Albumin 28.0 Fat 30.0 Carbohydrates 42.0 114 WHAT SHALL I EAT? Fat, therefore, is too predominant and carbo- hydrates are wanting. The former may be remedied by boiling or skimming the milk, especially in liver troubles. The latter may be improved by the addition of either ordinary sugar or of lactose, according to the amount of diuresis which it is intended to produce. It is also advisable to take with the milk a few dry biscuits (crackers) in almost all cases of illness. This is of practical value, as it gives strength to the patient and reduces the quantity of liquid to be taken. It requires 3 liters of pure milk to make a proper ration. 670 X S = 2,010 calories K 50 grams of sugar (ten lumps) per liter and 80 grams of dry biscuit (crackers) are added, 2 liters of milk will be sufficient. 670 X 2 + 400 X 0.80 + 397 = 2,067 calories These proportions are more ideal and the ra- tion is superior. The addition of thick barley- water or of gruel, in quantities to be regulated by the nature of the disease, will often prove beneficial. MILK 115 2d. It will happen often enough that the milk is not well tolerated by the patient, pro- ducing gastric fermentations, or diarrhea or constipation. This may be the fault of the doc- tor, who has not taken all the circumstances of the case into proper consideration. The tem- perature of the milk is an important factor. When once boiled, the milk may be taken either hot, lukewarm, or cold, just as the patient pre- fers it. We should never forget that the fashion in which milk is preferred by the patient has a strong influence on its digestibility. To aid digestion, milk should be taken slowly and in small quantities. Without this precau- tion it is apt to form large floccules and to fer- ment. There should be an interval between each dose. Two liters of milk should make six to seven doses. If to be taken in six doses, then 350 grams should be administered every three hours; if in seven doses, then 300 grams should be given every two hours, thus leaving seven hours for a night's rest. Each dose should be fed slowly, with a spoon, for a quarter of an hour. The milk should be eaten, not drunk. It should be masticated, chewed, in order to mix it with the salivary secretions so necessary for 116 WHAT SHALL I EAT? the digestion of lactose. This is facilitated by soaking crackers, or bits of bread in the milk. 3d. The disgust or nausea, so easily gener- ated by this insipid and monotonous mess, is another impediment to good digestion, and pre- vents proper assimilation. The doctor would do wrong if he were to be relentless, or relied too much on the energy of the patient or the insist- ence of the attendants. He will gain more by allowing a few cups to be seasoned with a few drops of tea, or coffee, or even brandy, if the condition of the patient permits, or to flavor the milk with a trifle of vanilla, or caramel, or orange-blossom, etc. 4th. The greatest obstacle, however, to a suc- cessful milk diet is gastric hyperacidity, which quickly coagulates the casein into compact dots and large masses, leaving little, if anything, for digestion. The addition of Vichy or soda water (potash water is preferable) will act as a correc- tive. Bicarbonate of soda (baking-powder) and lime-water also will modify this acid propensity. Rennet, the virtues of which have in recent years been so much extolled, should, we think, not be used. 5th. As a last precaution we recommend, es- MILK 117 pecially in cases of infection and cachexia, that the mouth and the gums be carefully rinsed with a draught of Vichy or soda water. This is the only effective way in which the remaining particles of milk that provoke lactic [fermenta- tion and so readily cause the appearance of thrush, can be effectively removed. For severe, acute attacks of cold in the head, or of grippe or influenza in the incipient stages, the following recipe will prove of decided advan- tage and comfort: Half a pint of boiling milk, One or two lumps of sugar, One tablespoonful of dry gin (London gin). Stir thoroughly and pump into it two or three gen- erous dashes of soda or potash water from a syphon. Drink hot after going to bed. Cover up well. A co- pious perspiration will ensue, with a subsequent feeling of relief and extreme comfort. — {Translator.) INDICATIONS AND CONTBAINDICATIONS Milk as a Food for Infants. — We can only succinctly repeat here the principal rules which govern the nursing of babies; referring the reader for details to the larger text-books. Nothing, so far as infant feeding is concerned, can excel mother's milk or replace the breast. 118 WHAT SHALL I EAT? We have already on a previous page given the reasons for this statement. The average length of time for suckling is from twelve to fourteen months. Marfan fixes ten to eighteen months as the minimum and maximum period for weaning. Mixed nursing, in which the breast is alter- nated with the bottle, is not an equivalent to suckling, although it has certain advantages. The small quantity of mother's milk absorbed by the baby provides the necessary ferments. Should the bottle disagree with the child, it is easy to give it the breast alone for a few days. If the mother has not milk enough, or if suck- ling fatigues her too much, mixed nursing must of necessity be resorted to. In some places the babies are put to the nipple of the goat; although the method is superior to bottle-feeding, it cannot often be obtained. To raise a baby on cow's milk alone is a diffi- cult task, especially in large cities, and requires many precautions. The milk must always be boiled, and at first must be diluted with water and sweetened with sugar, or a spoonful of milk- sugar. The quantity of water must be grad- MILK 119 ually lessened, and about the eighth month pure milk may be given. About this time one may begin to give pap, of which we shall speak a little later on. But for a long time milk, which is such excellent nutriment for growth, must take the foremost place in the feeding of the child. Pyreaoia. — Nourishing, easy to digest, allevi- ating the heart and kidneys, milk presents a good article of food for all acute diseases, and forms the most convenient base for a fever diet. Skimmed milk is very useful in such cases, as it does not burden the stomach for any length of time, being digested rapidly. When sweetened with milk-sugar it proves beneficial in oliguria, mixed with brandy in adynamia, and with bar- ley-water and gruel in cases of intense denu- trition. Gastrointestinal Affections. — The time is not far off when milk will be the foremost remedy for dyspepsia; although it does not suit every case, because its sedative reaction and propensity to cause fermentation proves at times objection- able. In all gastric defects of a serious nature, espe- cially in cancer, in all forms of severe excitation. 120 WHAT SHALL I EAT? such as ulcers and hyperchlorhydria, milk is of great utility. In the latter case particularly, the absolute milk diet should always be advised, as it produces marvelous cures. Milk must be prohibited in gastrointestinal atonia, in severe dilatation of the stomach, in gastritis and in gastroenteritis, in cancer with processus inflammatorius, and in certain nervous affections (nervoTis vomiting, rumination). For the rest of the cases a moderate use is not injurious; but it should only be taken with soup or mixed with other eatables. Under no consideration, however, should milk be used as a beverage during the repast, because in this form it retards the process of digestion and favors fermentation. Taken by itself, milk is an antiseptic; but when used as a drink with other foods, it becomes an autotoxin. — {Pascault. ) In intestinal therapeutics much reserve must be employed in the use of milk, for whatsoever answers no good purpose easily entails injury. Its quick binding and absorbing qualities make it react, as a rule, favorably in attacks of diar- rhea, markedly so in cases of chronic diarrhea in hot climates. Nevertheless, meat-juice, and even MILK 121 raw meat, may here prove more beneficial. In enteric fever in adults, its action is imreliable, being well tolerated by some individuals, but producing fermentation and flatulence in others. Combe, ^ of Lausanne, strenuously opposes the use of milk in any kind of intestinal inflamma- tion. In infants of tender age, enteritis consti- tutes an absolute contraindication. It is often quite sufficient to promptly stop the use of milk in order to bring about immedi- ate improvement. Extreme caution must be exercised in resuming the milk diet. It should be accomplished in easy stages and with small doses. To the constipated, those great eaters with chronic cecal obstruction, the use of milk will not readily appeal. In enterocolitis, it should constitute a part of the regimen, but in small allowances only. Affections of the Liver. — At the last Congress of Food and Hygiene the indications were elo- quently described by A. Robin. He empha- sized the fact that while milk in many cases is most useful, by force of its sedative and quiet- •Combe: "Intestinal Autointoxication," English translation by G. W. States, Rebman Company, New York. 122 WHAT SHALL I EAT? ing effects on the liver, yet the lack of stimu- lating power may also render it harmful. The milk diet gives relief in cancer, in the first stages of cirrhosis, biliary hypertrophic cir- rhosis, Laennec's cirrhosis in its first stage, hepa- titis indigenous in hot climates, and in arthritic enlargement of the liver. In the second stage of cirrhosis a milk diet is too excitant. In icte- rus the use of milk must be stopped as soon as the primary crisis has come to an end. In lithiasis Gilbert recommends skimmed milk in small doses in order to stop migration of the calculi; but after that crisis has passed, milk must be stopped. Affections of the Heart and the Blood- Vessels. — Every asystolic condition invites an absolute milk diet. Huchard has shown its beneficent action in cardiopathic conditions of the arteries, in supertension, in arteriosclerosis, whether it consists of functional disorders or fixed lesions. Although these diseases do not radically jdeld to a milk diet, yet these cures, undertaken for a few days in each month, wash out the tissues and bring about a toxic correction which can only benefit the general conditions of health. Nephritis. — As for the heart so for the kid- MILK 123 neys, milk is an heroic food, being at the same time antitoxic, hypotensive, and diuretic. The researches made recently by Widal and Javal have brought much light into this question. According to these authors, milk acts like an agent charged with hypochlorite, easing the kid- ney that has become impermeable to chlorids. And as it is not difficult to find other foods even less chlorated than milk (farinaceous foods, pastes, unsalted bread, and even meat) these may advantageously be employed to replace the former in the diet list for Bright' s disease. These conclusions are of more than passing in- terest, as it often becomes necessary to change the diet of the patient. Nevertheless, they should not let us lose sight of the special quali- ties of the lactose and albumin contained in the milk. In acute nephritis and in slight and severe attacks of uremia the milk diet should be rigidly enforced, special precautions being adopted that it is well tolerated. In all cases of dropsy, milk is an important factor in the diet list. Nervous Affections. — Calming, antitoxic, rich in phosphorus, milk is in all these affections an excellent nutrient, the more strongly indicated 124 WHAT SHALL I EAT? the higher the nervous tension. According to Weir Mitchell it is the only food permissible in the treatment of neurasthenia. Cancer. Tuberculosis. — Milk is by far the finest food for building and feeding up the con- stitution. Its use is preeminently indicated in all stages of denutrition, of which these two dis- eases are prototypes. Many consumptives are able to consume several cups of milk between meals. Of course, this form of superalimenta- tion is not required in patients who are blessed with a strong digestive apparatus. Arthritis.— The employment of milk in ar- thritis is one of those delicate questions which cannot be answered with absolute'certainty. In some cases it is to be shunned, primarily as a means of excessive nourishment which adds too much force to a diet already too abundant, and the danger always exists that on account of the good reputation it enjoys, the patient is apt to use it too generously. Besides, many persons sufPering from arthritis are troubled with an atonic and sluggish alimentary apparatus which is incapable of digesting milk, thus inviting stasis, fermentation, and intestinal congestion. Yet there are patients who respond well to a MILK 125 generous milk diet enforced during several days. But it must be preceded by a thorough purging. It is always wise to keep an account of the various clinical facts, viz., beware of cecal sta- sis and of intestinal fermentation; bear in mind that milk, wrongfully employed or badly digest- ed, may become the source of serious untoward events. In gout and lithemia everything can be gained by a diet absolutely free from all puric substances, but it is proverbially true that the arthritics form a family that disregards all re- strictions as to diet with the utmost audacity. In oxaluria milk must be neglected on ac- count of its richness in lime and its poverty in magnesium. — {Klemperer. ) Diabetes. — The natural tendency, of course, is to interdict the use of milk because it is too rich in lactose, yet sugar of milk is better tolerated on an average than other forms of carbohy- drates, and there are cases on record in which a milk diet lowered the percentage of sugar appreciably. Although we should consider it wrong to particularly recommend a milk diet to diabetic persons, still it is sometimes advisable to fall back upon it. The susceptibility of the 126 WHAT SHALL I EAT? patient should first be tested, and in the face of the many complications that usually accompany this disease, it is, perhaps, just as well not to re- linquish at once this ever-valuable aid. DERIVATIVES OF MILK Casein and butter are the nutritive constitu- ents of milk, while lactose, lactic acid, and the salts may be looked upon as valuable remedies. The therapeutic value of all the derivatives of which we intend to speak here depend upon the latter qualities. I. BU'lTER-MILK Albumin. Fat. Carbohydrates. Ash. Available Calories. 2.6 0.6 3.2 0.74 29 It consists of what is left of the milk after the butter has been churned out of it. This residue has been robbed of its fat and a small portion of casein; but lactose remains, with the excep- tion of a minor amount which has undergone lactic fermentation. This modification renders it an excellent rem- edy for gastrointestinal troubles in infants; the absence of fat makes it easier to digest, and ex- MILK 127 ercises a direct disinfectant action on intestinal putrefaction. In acute gastroenteritis it may be found more or less superior to soups made of legumes. Ac- cording to Rivet, buttermilk affects the feces in the same manner as nursing at the breast does. It is also highly spoken of in cases of infantile eczema. — {Lesne. ) If 80 or 90 grams of sugar per liter, or a tablespoonful of flour be added and the whole cooked just to the boiling-point over a slow fire, it will make a food almost as nourishing as pure milk. II. WHEY TVtte whey is the liquid left after the milk has been coagulated by the aid of rennet, and is nothing but the clear opalescent serum of cur- dled milk. This is the sweet whey as against the acid or cheesy whey obtained by the addition of tartaric acid. It contains less albumin, hardly any fats, but the whole of the lactose, a portion of which is transformed into lactic acid, and all the salts of milk, with the exception of phos- phate of lime, which is eliminated with the casein. 128 WHAT SHALL I EAT? This liquid contains but little nourishment, but possesses highly diuretic and mineralizing qualities. It is also slightly laxative. Whey-cures are frequently taken in Germany for the purpose of flushing toxic bodies out of the organism in gout, stone, liver complaints, and gastrointestinal troubles. The proper amount to be taken should not exceed 500 to 750 cc, in doses of 150 c.c. at regular intervals in the morning and afternoon. III. KEPHIR Lactic Available Albumin.^ Fats. Lactose. Acid. Alcohol. Ash. Calories. 2.9 3.1 2.9 0.6 0.6 0.65 65 It is obtained by a process of alcoholic and lactic fermentation of cow's milk, or sheep's milk, by the aid of two fermenting agents, i.e., the saccharomyces mycoderma and the dipsora caticasia. Kephir comes from the Caucasian mountains. Kephir tablets are a commercial article, and can be used in any household, al- though it is rather difficult to obtain satisfactory results with them at home. Here is the recipe. Boil the milk, take off the cream; fill the bottle three-quarters, add the kephir tablet, cork the ' These figures refer to fatty kephir two days old. MILK 129 bottle tight, and put it in a warm place. It should be shaken every two hours. The amount of alcohol and of lactic acid is increased by pro- tracted fermentation. As a rule, kephir No. 2 is employed, which has fermented for two days. Kephir of one day's standing is rather laxative, and that of three days' very constipating. Its characteristic properties are: 1, peptoniza- tion of a small amount of casein; 2, presence of lactic acid, which acts as an intestinal antisep- tic; 3, presence of alcohol and carbonic acid formed from the lactose and acting as stimulants to the process of digestion; 4, an abundance of diastase partly derived from the yeasts. Reactions of Kephir. — a. On the stomach. It is a food easily digested, as it does not remain in the stomach very long, especially so if it is made of skimmed milk. Experiments made by Gil- bert and Chassevant show the following results: One liter of raw milk remains in the stomach for seven hours. One liter of skimmed and boiled milk remains in the stomach for five hours. One liter of fatty kephir No. 2 remains in the stomach for four and one-half hours. One liter of kephir, made from skimmed milk, No. 2, remains in the stomach for three and one-half hours. 130 WHAT SHALL I EAT? b. It accelerates nutrition, by raising the rate of urea and diminishing the acidity and the amount of uric acid. It is also likely that it aids assimilation, as a number of authorities have observed that kephir makes flesh more rapidly than any other food. We specially recommend it: For a number of gastric and intestinal trou- bles; for hypopepsia, chronic gastritis, and apep- sia (here it will greatly aid digestion); it will often stop vomiting in pregnancy; in eases of cawcer it often affords great relief. — {Martinet.) In chronic enteritis and in dysentery it is a strong factor in intestinal assimilation. (On account of its richness in acids and alcohol it is harmful in cases of hyperchlorhydria and ulcers. ) For consumptives, emaciated, anemic, and ner- vous persons, in whom the daily losses are not compensated by proper assimilation. A special point in favor of kephir as a food for phthisical patients is its action on the stom- ach, on the canal, and on nutrition in general, which is clearly antagonistic to the actions of the tubercle poisons. It renders also great services in stimulating a failing appetite and arresting a stubborn loss of flesh. Certain invalids never MILK 131 begin to pick up till they are put on a diet of kephir. It is not to be recommended in affections of the heart, or the Mdneys, or the blood-vessels; not to patients who have a leaning to plethora or congestion. The usual dose is from half a liter to a liter at noon for luncheon, or about four o'clock for a repast. Patients who are on a strict kephir diet should follow the same regimen as those on a strict milk diet, although the doses may be slightly increased because the nutritive coeffi- cient is smaller. IV. KOUMYS Albumin. Fats. Lactose. Lactic Acid. Alcohol. Ash. Available Calories. 2.20 2.12 1.53 0.90 1.72 0.29 44 Koumys, formerly prepared only by the Tar- tars, has gradually found its way westward. It is made of mare's milk with a process of lacto- alcoholic fermentation, similar to that of kephir, though stronger. The technique is pretty well the same, but the germ used differs. The milk is put into bottles five hours after fermentation has set in, which is then allowed to continue 132 WHAT SHALL I EAT? for five to six days. The product is an "emul- sified liquid, effervescent, with a sweetish, acid- ulated taste, reminding the palate of the taste of milk of almonds. It stimulates the appetite, aids digestion, and is slightly intoxicating." — {Gautier. ) It differs from kephir by a stronger percent- age of alcohol and peptones, and a smaller percentage of salts. Indications and contrain- dications are for both the same, except that koumys should be taken in smaller doses. V. YOGHOURT Curdled milk has been employed during all ages and the whole world over, although it is known under different names in different re- gions. The curdled milk of Bulgaria or Yog- hourt contains only two lactic ferments, i.e., a streptococcus bacillus and a streptobacillus called Maya. However, what we are about to say of the curdled milk of Bulgaria refers just as well to any other ordinary curdled milk. To make yoghourt the milk should be boiled down to three-fourths of its quantity; it should then be cooled off to 112°; the Maya ferment is then added, and the vessel containing the milk MILK 133 is kept in a temperature of 112° for six to eight hours, when the milk is curdled. The characteristic qualities of yoghourt are the presence of lactic acid, varying from 10 to 20 grains per liter, and the solubility of a por- tion of the casein. It acts as an intestinal anti- septic, affects in time the flora of the digestive canal, combats cecal stasis, and lessens fermen- tation. MetschnikofF, who attributes to these fermentations a preponderating role in the econ- omy of the organism, does not hesitate to call curdled milk the elixir of long life. It is useful in arthritis and to heavy eaters with big abdo- mens and cecal obstructions, but only on the condition that it is not added to the ordinary diet, but takes the place of other foods, as other- wise it might have very troublesome effects. Ordinary curdled milk offers the same advan- tages as yoghourt, only, perhaps, in a some- what slighter degree. CHEESE Cheese, although a product of milk, possesses quite different characteristics. Its dietetic prop- erty is almost nil, but its food value is great, and plainly justifies the renown in which it has been held at all times. There are almost as many different kinds of cheese as there are countries where cheese is made; but they may all be classed into three or four groups, according to the different methods of manufacture, and according to the composi- tion and the properties which are, however, almost identical in all. The manufacture of cheese is pretty well the same everywhere, whether this is accomplished by lactic fermentation or by the aid of vegetable or calf rennet. Coagulation involves the casein, nearly all of the butter, a little of the lactose, and a goodly portion of the phosphate of lime. The acid salts stay almost entirely in the cheese, while the basic salts remain in the form or mold in which the cheese is made, whence is 134 CHEESE 135 derived that slight taste of acidity in the rind or crust. Coagulation, produced by spontaneous lactic fermentation, constitutes the first variety, i.e., fresh unsalted cheese (pie-shaped cheese, cream cheese, Gervais, petit Suisse). The mean composition is: Carbo- Available Albamin. Fata. hydrates. Ash. Calories. 10.80 20.70 3.78 2.00 265 They possess nearly the same properties as curdled milk, of which we have already spoken. We will only mention that Gervais is particu- larly rich in butter, and that the petit Suisse contains a considerable amount of kitchen salt, for which reason it is not suitable for patients suffering from Bright' s disease. With these restrictions, unfermented raw cheese however, always on the condition of absolute freshness, may be recommended for moderate use in the sick-room. It should form a part of the milk diet. In most cheeses coagulation is brought about by the aid of rennet. Some of them pass also through a more or less prolonged process of cooking. 136 WHAT SHALL I EAT? Second variety: Cooked cheeses (Emmenthal or Gruyere — ordinarily known in this country as Swiss cheese, — Parmesan). Both are excellent foods. Albumin. Fats. Carbo- hydrates. Ash. Calories. Emmenthal. . . 28.37 28.49 1.43 3.69 400 Parmesan . . . . 39.34. 18.97 1.95 4.72 357 The percentage of albumin, it will be no- ticed, is exceptionally high, which renders these two varieties the most nitrogenous foods known. Meat and vegetables are outdistanced. Fats are very abundant, for which reason the food value of the Emmenthal variety, being made of the whole milk, exceeds that of Parmesan in the preparation of which the milk is partly skimmed. The large amount of salts, chiefly chlorid of sodium, however, detracts a good deal from its value. These cooked cheeses have a mild, stimulating effect on the stomach and the bowels. They are easily digested, wholly absorbed, and possess the same quality of being readily assimilated as the fats and carbohydrates. On the other hand, on account of the large percentage of ash con- tained in them, they are prone to produce, when taken in large quantities, acidity in the organ- CHEESE 137 ism. Minkowski attributes to this cause the striking prevalence of stone observed in Saxony, where cheese figures so largely in the diet of the inhabitants. Very nourishing, rich in nitrogen, free from toxic qualities, cheap in price, this variety of cheese is a food of great value, particularly so to the peasant, to tourists, and to troops engaged in field exercises. In the sick-room it renders good services. It has its proper place in all conditions which re- quire strong nourishment, such as tuberculosis, neurasthenia, convalescence. By its savory, piquant flavor it lends itself charmingly as a means for modifying, in an acceptable and effective manner, the milk diet, except in Bright' s disease and in cardiac affections. In dyspepsia, especially in the hyposthenic form, in enteritis and in enterocolitis the easy assimila- tion of these cheeses and their peptogenic and antiputrefactive elements render a valuable aid. The grated cheese sprinkled on pastry and farinaceous foods forming the basis of Combe's regimen,^ offers the double advantage of cor- ' Combe: "Intestinal Autointoxication," Rebman Company, New York. 138 WHAT SHALL I EAT? reeling the insipid taste of these preparations chiefly composed of salt and water, and of sup- plying the proper proportion of nitrogen and fat. For diabetics they are useful on account of their high alimentary value and the absence of carbohydrates. They are also highly recom- mended in acetonuria. In arthritis they must be used with caution; their acidity and high alimentary power are here a source of danger. The habit of finishing every meal with a bit of cheese, often enough proves fatal to men of the world. Its use should be confined to a specified amount in the aggre- gate for each day, and must not be looked upon as a negligible quantity. Third variety: Cheeses with an unbaked cmst, whether they be salted, such as Cantal, Chesh- ire, Canadian, American, Roquefort, Dutch, or unsalted, such as Brie, Bondon, Camembert, Coulommiers, Gorgonzola, Livarot, Mont d'Or, Liederkranz, etc., are subject to the action of certain yeasts, molds, and fungous growths, the nature and intensity of behavior of which vary in each particular brand. Their mean com- position is: CHEESE 139 Carbo- Albumin. Fats. hydrates. Ash. Calories. Salted cheeses\ . . 25.00 25.50 4.4 3.87 366 Unsalted cheeses^ 19.90 23.00 4.3 3.40 They range about half-way between the cooked and the fresh (white) cheeses. During the period of maturing they undergo numerous transformations, the more pronounced the more matured the cheese, by which their properties are entirely changed. Their casein content is partly peptonized and partly transformed with a series of products more or less noxious, such as leucin, tyrosin, amino acids, and ammonia, whence they derive their odors and savory qualities that give each cheese its peculiar taste. Their fats are soluble in alcohol, glycerin, and in fatty volatile acids reenforced with ammonia, and their lactose fer- ments in lactic acid, alcohol, and carbonic acid. Thus modified, the cheese preserves the quali- ties of its peptogenic and assimilable substances, since the diastase secreted by the yeasts seems to continue within the intestines the digestion of casein; but it thereby loses completely its char- ' Average of four cheeses quoted. 'Average of seven cheeses quoted. 140 WHAT SHALL I EAT? acter of an antifermentative and slightly toxic food. A moderate slice of these cheeses is beneficial to a normal constitution, and if taken at the end of the principal meal aids digestion. Tubercu- lous and diabetic patients can fall back on them with advantage, so long as there are no intes- tinal, hepatic, or renal complications present. In dyspepsia, enterocolitis, arthritis, heart, and liver troubles, and in Bright' s disease^ they must be avoided; likewise in eczema and, in fact, in all diseases of the skin. FATS (GREASES)-BUTTER-OIL Although of diiferent origin, yet these arti- cles should be classed under one heading, be- cause they are all composed of fatty substances. Of albumin, carbohydrates, and mineral bodies there are but minute traces, likewise of the fatty volatile acids. We speak here of the neutral fats which are formed by a mixture in variable proportions of butyrin, margarin, stearin, and olein. These bodies are formed by a union of one molecule of glycerin with three molecules of corresponding acids, i.e., butyric, margaric, etc. COMPOSITION AND PROPERTIES Fercentase Available Point of of Fat. Calories. Melting. Mutton fat 83.40 790 108 Beef fat 81.07 773 105 Pork fat 81.85 782 91 Butter 79.50 752 88 Olive-oil 90.00 846 35 a. Animal Fats. — These fats, however small in proportion, form an integral part of all the organs. We have seen that, no matter how lean 141 Ua WHAT SHALL I EAT? the meat may be, it contains a certain amount of fat; but it accumulates more richly in the connective tissue around the intestines. It is formed chiefly in the membranous layers which control rather its digestibility than the point of melting, for which reason the fat of pork and lard is harder to digest than beef and mutton fat. As a rule, fat is consumed while hot, mixed with the juice of the meat or prepared with various ingredients and condiments which only add to its objectionable features. b. Butter. — This is formed by the union of the fatty globules of the milk. Besides a small percentage of casein, lactose, and certain lactic salts, it contains also a considerable amount of ferments — bacteria which cause it to degener- ate quickly and grow rancid, unless kitchen salt is added in sufficient quantities. In hot weather particularly, butter should be eaten only when quite fresh. Hot melted butter is very hard to digest, be- cause the water which separates the fat globules has been evaporated, thus rendering the attack on it by the digestive juices much more diffi- cult. — (Pascault ) FATS (GREASES)— BUTTER— OIL 143 Brown butter, however, is an exception, be- cause the high temperature under which it is prepared produces a partial separation of the fats from the acids. Although not equally as well digested as the fresh butter, it is pref- erable to hot butter. Oleomargarin is an artificial substitute for butter. If carefully manufactured it is not injurious, and if mixed with genuine butter, although impairing the taste somewhat, it does not detract from the digestibility or food value of the butter itself. The laws, especially in the United States, relating to the sale of oleomar- garin are stringent and strictly enforced. c. Vegetable Butter. — Under this name many imitations of butter are comprised. They are principally made from the refined oils of the cocoanut. The taste is rather insipid. Among the better classes these preparations are but little known, but the poor people find them economical as well as acceptable, for they are cheap and keep well. Among vegetarians they have found great favor, and in many armies of Europe they are in use on account of the wide- spread adulteration of lard. d. Olive- CHI. — This is the finest oil for table 144 WHAT SHALL I EAT? use. It is principally composed of olein and margarin with slight traces of stearin. In the southern countries of Europe it takes the place of butter for cooking purposes. Many authori- ties contend that hot olive-oil does not carry the same disadvantages which are attributable to hot butter, and that dry and crisp fries made in thoroughly heated olive-oil are very easy of digestion. REACTIONS a. Digestive. — Although the fats escape al- most completely the action of the gastric juices, they yet exert an important influence on the digestive powers of the stomach in general, for they diminish the peptic, especially the hydro- chloric secretions, and retard the opening of the pylorus and the evacuations of the digested food. But they ferment easily and create irri- tating acids. Their action on the intestines is less marked. They provoke there rather pancreatic and biliary secretions, and gently slacken peristalsis. But as in the stomach, here, too, they are subject to fermentation. b. General. — When the fats have once en- FATS (GREASES)— BUTTER— OIL 145 tered the general circulation, they are accumu- lated in the liver, infiltrating it in a normal physiological manner. Thence they are gradually distributed through- out the tissues. It is easy, therefore, to under- stand how an excessive use of fat is able to choke the hepatic parenchyma. The fats play an important role in the process of nutrition, chiefly by their caloriferous power, for one gram of fat gives on an average double the number of calories than one gram of albu- min and carbohydrates will produce. If the latter are superior in their action on the muscu- lar system by force of the isoglucoric coefficient, the fats excel them in the struggle against the loss of heat. That is the reason why the in- habitants of cold climates consume such vast amounts of fatty substances. The fats do not only afFord much fuel, but they restrict also the waste of energy, and influence the economical principles within the system almost as much as do the ternary bodies. They also furnish, well nigh exclusively, the material for our reserve forces. Excessive alimentation modifies but little the surplus of nitrogen and sugar in the organism, because everything that is not burned 146 WHAT SHALL I EAT? up and consumed is converted into fat or adipose tissue. Hence it is that overfeeding becomes a danger. A surcharge of fat jams the organs, obstructs their movements, makes the circula- tion sluggish, and prepares the way to physical degeneracy. These dangers are frequently in- creased by cardiac localization. c. Excretory. — Fat is not discharged from the system in the same manner as water or car- bonic acid. When it does not ferment it does not molest the kidneys. But the fatty acids which it produces are more troublesome, as they irritate the skin through which they are eliminated. INDICATIONS AND CONTRAINDICATIONS In the normal individual the absorption of fat is the strongest protection against the loss of caloric force. In cold climates a larger amount of it is required, while in the warm countries the need for it is much restricted. In the temperate zones fatty foods should be used with moderation, especially during the heated term, if gastric troubles are to be fore- stalled. This precaution is indispensable in patients who require a calorific diet, such as consumptives and diabetics. FATS (GREASES)— BUTTER— OIL 147 It would appear that fat constitutes an emi- nent nourishment in acute diseases in which the caloric losses are so enormous; but, unfortu- nately, in these .very conditions it is badly tol- erated and is therefore not absorbed, for which reason it has to be eschewed altogether. In prolonged chronic fever cases, however, its use is fully justified. In tuberculosis a diet of fats becomes a neces- sity, and it is for the physician to find the form most suitable to the individual case: cream, fresh butter, mayonnaise of fat liver, etc. The benefit derived can easily be measured by the increase in the weight of the patient, and by a decrease in the losses of nitrogen and phos- phorus. But, while the portions allowed should be generous, excess must be avoided. Much depends on the size of the stomach of the pa- tient. From 100 to 150 grams per day should be sufficient. — {Laufer.) If this figure is ex- ceeded, a momentary but too rapid improve- ment will be obtained, and the gastric troubles and diarrhea that are apt to follow will do more harm than good in the end. In diabetes fats are equally useful, for the pa- tient will draw from them rather than from the 148 WHAT SHALL I EAT? albuminoids his daily ration of nutriment; and in the majority of cases they are well tolerated. Von Noorden fixes the daily ration from 150 to 200 grams. Not only fresh butter and fresh cream, but also meats and fatty fish, with sea- sonings rich in fat may be requisitioned. Later on we shall see that one of the advantages of vegetables consists in the fact that large quanti- ties are easily tolerated. In arthritis nothing is to be gained by a ca- lorific diet which retards the process of digestion and produces so easily putrefaction in the atonic, sluggish tube. Animal fats must be strictly interdicted, making some allowance of a moder- ate use of butter and oil. The same holds good for gout, and above all in obesity, although in the latter case fats should not be feared any more than carbohydrates. In diseases of the liver the use of fat should be limited for fear of overcharging the paren- chyma. The limitation is absolute in all dis- eases of insufficiency, in JLaennec's cirrhosis, and in hyperhepatic afflictions. In lithiasis certain fats, by force of their cholagogic action, are great favorites ; for instance, olive-oil, especially when taken in FATS (GREASES)— BUTTER— OIL 149 the morning, a spoonful in coffee, or by it- self. Whenever there is a suspension or a decrease of pancreatic fluid an analysis of the feces will show that the fats are badly dissolved and but little absorbed. In all such cases they must be rigidly excluded from the diet. In eczema, acne, and all skin eruptions, which are due to bad intestinal functions, all greasy cooking, all fries, all sauces and gravies should be avoided. Fresh butter may be allowed. Whether dyspeptics may partake of fatty sub- stances depends on the conditions presenting themselves in each individual case. In dilation with atony and fermentations they are to be shunned. In nervous and intestinal dyspepsia they are often badly tolerated; oil, fresh butter and fresh cream in small quantities may be per- mitted, but hot butter and hot grease should be scratched off the menu. All foods should be merely cooked in water with salt, and seasoned Avith a little butter and cheese on the plate when on the table. These precautions refer also to hyperchlor- hydria. Fresh butter and oil have a sedative effect; the latter, especially, is well tolerated. 160 WHAT SHALL I EAT? and, when taken in quite large quantities, Avill soothe pain and sufPering. A very good recipe for this ailment is a mayonnaise sauce made of olive-oil and the yolk of an egg. EGGS Albuminoids 7.37' Fats 6.20— Chlorid . 0.046 Carbohydrates... 0.00 — Purin... 0.0 Ash O.SS'' Available calories = 90 Eggs have at all times been a staple article of food. Because they are easy to digest they occupy a predominant place on the menus of the sick chamber. The egg is composed of Shell 7.2 White of egg 35.4 Yolk 17.4 The average weight is about 60 grams. The shell consists of lime salts. Certain authorities have advocated that after eating the egg, the best thing to do with the shell is to pound it into a powder and swallow it. This ' These figures do not refer to 100 grams or 100 per cent, but only to the composition of eggs, i.e., the average of 60 grams. 2 That is without the shell. 151 152 WHAT SHALL I EAT? certainly would be an economical way of sup- plying the system with lime; but, apart from the fact that intestinal absorption would be rather incomplete, we have grave doubts whether such an ingestion would not be injurious to the canal itself and seriously involve the appendix. The white of egg is almost wholly composed of albumins, viz. : ovoglobulin and another al- most analogous to fibrinogen. Of mineral sub- stances there are only traces, apart from silica, of which there is abundance. The ash is al- kaline. In the yolk fats are predominant: 31.40 per cent as against 16.12 percent in albuminoids. These are formed of vitalin and nucleo-proteids. The vitalin is soluble in albumin and in lecithin. The nucleo-proteids consist of one part of albu- min and another part of strongly phosphorated nuclein, or, more properly speaking, of para- nuclein. This difference is not without im- portance, for the paranucleins do not contain any xanthic bases. Eggs have no action on uric excretions. — {Fauvel. ) The fats consist of olein, margarin, cholesterin, and lecithin. The latter is present to a large extent, for which reason natural medication with the yolk of egg (of EGGS 153 which one alone may contain as much as two grams of lecithin) is preferable to the use of the artificial lecithins sold by chemists and drug- gists. This exceptional abundance of phos- phorated paranuclein explains the fact that the yolk of egg is one of the bodies richest in organic phosphorus. Iron is also present to a large extent. It is found in the form of Bunge's hematogen. The ash is acid, owing to the presence of phosphoric acid; but this acidity is more than compensated for by the alkalinity of the white of the egg. Reswrm. — The whole of the egg, white and yolk together, is a food equally rich in fats and in nitrogen, alkalizing, abounding in phos- phorus, iron, and silica. The yolk contains more fats than nitrogen, much iron, and a large percentage of phosphorus; only Parmesan cheese and a few rare green Vegetables contain more phosphorus. The food value is consid- erable, reaching as high as 90 calories. An egg is equal to 40 grams of meat and nearly 150 grams of milk. The yolk of an egg represents 61 calories. 154 WHAT SHALL I EAT? METHODS OF USING AND PREPARING EGGS Eggs are eaten in a hundred different ways; every country has its own formulas and recipes. In the kitchen, the white as well as the yolk is utilized in the preparation of all kinds of dishes. It is beyond our scope to refer to every one of these, but they are all pretty equally commend- able from an hygienic standpoint. 1. The simplest method is to eat the egg without any preparations at all. So long as the egg is quite fresh it is pleasant to consume. In this condition it is easily absorbed by the econ- omy. A raw egg swallowed whole before din- ner does not spoil the appetite and slips almost unnoticed into our daily allowance. Not everybody, however, can eat raw eggs. So the common method of serving eggs is boiled soft in the shell. This is wholesome food, espe- cially when coupled with a few slices of bread and butter or buttered toast. Arthritic patients should never forget that two soft-boiled eggs with 60 grams of bread and 5 grams of butter represent 379 calories, i.e., about one-sixth of an average daily allowance of food. Hard-boiled eggs, the principal components EGGS 155 of cold luncheons, snacks, and picnics, are rather hard to digest, are very filling, and cause thirst; but when sliced and mixed with a salad they very happily enhance the nutritive quotient. The addition of hot butter in making fried eggs, scrambled eggs, buttered eggs, and ome- lets, detracts somewhat from their hygienic quality, and they are not too easily tolerated by delicate stomachs. 2. The carbohydrates make the most judicious combinations with eggs, because the two to- gether form an ideal nutriment. An omelet with potatoes, although somewhat hard to di- gest, makes an excellent dish for the robust stomachs of laboring men. Most appetizing and easy to digest are omelets with preserves. But "omelettes au rhum" and "omelettes souf- fl6es' ' are too heavy for a delicate digestion. Meat, ham, and bacon omelets make heavy dishes and require strong digestive organs. 3. Invalids and sick persons tolerate eggs best when mixed with some liquid. They may be beaten up with milk, soup, bouillon, and choco- late, or cofFee and milk. Sometimes the yolk only is used. K the white of the egg is also 156 WHAT SHALL I EAT? used the liquid must be allowed to cool off to at least 140°, or the white of the egg will coagulate, which is equally offensive to the eye as it is unpleasant to the palate of the patient. For some time a mixture of the yolk of the egg, white sugar and water was thought to act as a substitute for mother's milk. Martini has proposed for nurslings the follow- ing formula: The yolk of one egg 15 grams Sugar of milk 5 " Water 100 " But aside from the fact that the mineral sub- stances are not present in their proper propor- tions, this mixture, if administered for any length of time, will cause flatulency and other gastrointestinal complications. To be brief, we recommend here two prepara- tions which are worthy of mention. Mulled eggs or egg-flip. Beat up the yolks of two eggs with one ounce of powdered su- gar until the mixture whitens; add a glass of hot water, stir lively, and then add one or two teaspoonfuls of brandy. Drink as hot as possible. EGGS 157 The second is more difficult to make. Mar- tinet gives this formula: ^ First: Mix in an earthen vessel (it is important that no metallic utensil be used) the yolks of five eggs with 60 grams of powdered sugar. Beat this mixture, adding, gradually, a generous wineglassful of muscatel or old sherry. 2. Add a small stick of vanilla, a bit of cinna- mon bark, and a small piece of lemon-peel. Put the whole over a slow fire, all the time beating, until it comes almost to a boiling point and quite frothy. 3. Now strain off the vanilla, cinnamon, and lemon-peel. Put the earthen vessel into a stewing-pan, surrounding it with hot water, and, still beating the contents, add slowly and carefully a teaspoonful or two of maraschino until the mixture stiffens. Drink hot with some light cake, biscuits, or crackers. This concoction is called in France and Italy zabaglione, in France also sabayon. If pre- pared according to the directions given above, it consists approximately of 20 grams of albumin, 30 grams of fat, 70 grams of carbohydrates, 22 'A. Martinet: "Les aliments usuels," 1909. 158 WHAT SHALL I EAT? grams of alcohol, and gives about 800 calories (l liter of milk giving about 670 calories). 4. The digestibility of cakes and of side dishes, and their nutritive qualities, depend largely on the quantity of eggs used in their composition. The white of egg, beaten or whipped into froth or "snow," is largely used in pastry cook- ing. Later on we will discuss the possible dan- gers that lurk in this preparation. CHANGES Eggs, like meat, fish, and all other nitroge- nous foodstuffs, spoil quickly. This defection, of course, strongly affects their quality. Candling is not a sure means for determining their fresh- ness. The best way to find out whether an egg is new-laid or not is by plunging it into cold water. If fresh it will lie flat on its side (or horizontally) in the water; if eight days old it will rise at an angle of 45°; if three weeks old at an angle of 75°; if a month old it will stand upright; if older it rises to the surface. Rotten eggs are easily detected by their in- ternal appearance and their odor, which is due to the presence of sulphurous hydrogen. Mi- crobes easily pass through the porous shell and EGGS 159 impregnate the albumin with dangerous poisons, which successfully defy the sense of vision and smell. It is well to bear in mind the many cases of ptomain-poisoning caused by eating 6clairs, cream-puffs, and similar articles purchased of confectioners. By far the larger part of con- fectionery bought in the ordinary pastry-shops contains the white of eggs the age of which is very doubtful, and cream cannot be improved by cooking, because the ptomains are not destroyed by heat. Heat, indeed, develops ptomains, a fact which is clearly demonstrated by the frequency of ptomain-poisoning in the summer months. The only effective Way to prevent and escape these dangers is really to abstain altogether from confectionery purchased from the makers, at any rate during the heated term. REACTIONS a. ZHgestive. — Eggs are easily digested. They put but little strain on the action of the stomach, as they remain only a short time in it, if soft- boiled at the utmost from one to two hours, the minimum length of time in the case of any solid 160 WHAT SHALL I EAT? food; but from two to three hours, if hard boiled or in the shape of omelets. The absorption by the bowels is also complete, i.e., 97 per cent of the albumin and 95 per cent of the fats. But little residue is left behind. Eggs give off a great deal of heat, and ferment easily, but not as readily as meat. Certain infants, arthritic by heredity, present veritable idiosjoicrasies as regards the yolk of eggs. This condition, however, generally disap- pears with age. We had a child of five years of age under observation which could not support more than 7 or 8 drops. If a larger dose was given, diarrhea and violent vomiting would set in. b. General. — The action of eggs on the liver has given rise to endless discussion, and seems to be governed by the amount consumed. If in small quantities, the action on the biliary tract seems to be favorable. Experiments made by Brun with the yolk on animals have proved the maximum of biliary excretions. The so-called danger of cholesterin precipitating calculi does not exist in reality, because alimentary choles- terin is not eliminated through the bile. Du- fourt injected as much as 4 grams of cholesterin EGGS 161 in the stomach of a dog, but could find no difference in the quantity of biliary choles- terin. If large quantities are eaten, eggs may be- come injurious, as the liver becomes surcharged not only with nitrogenous bodies, but also with fat and lecithin. Chemical analysis of foies gras shows how quickly lecithin is accumulated in the liver. The nervous system derives from the lecithin of eggs, which is rich in phosphorus, a marked stimulus, perhaps even rather exaggerated. Nutrition, of course, is strongly influenced by lecithin. Many experimenters have studied its action on the organism, and all have obtained the same results. Lecithin moderates absorp- tion and diminishes oxidation. It is also an aid to assimilation, it regulates the reserve of nitrogen and phosphorus, and distributes throughout the economy an albumin which is rich in phosphorus and possesses pow- erful resisting qualities. All this again depends on the amount consumed, as has been shown by Robin and Binet. With six eggs per day one can observe how the metabolism in consump- tives is diminished, i.e., the output of carbonic 162 WHAT SHALL I EAT? acid as well as that of oxygen. But with a dozen eggs per day it is raised, carbonic acid and oxygen both being increased. c. Renal. — In former days eggs were forbid- den in albuminuria. The blame was laid on the white of the egg. Experiments, however, made under more favorable conditions have corrected this error. Certain patients suffering from Bright' s disease can eat as many as ten eggs a day without the slightest modification of the albuminuria, whilst in others there is a diminu- tion. Nevertheless, the influence on the renal functions is not altogether favorable. If the albumin is light and a little toxic, it is apt to provoke fermentation. On the other hand, lecithin contains, in its molecular composition, a given amount of neurin which possesses toxic qualities. INDICATIONS AND CONTRAINDICATIONS The egg is preeminently a food for growth and physical development. Under this title it constitutes for the infant one of the most valu- able resources, and should take an important place in the list of infant feeding immediately the baby has been weaned. Note, however. EGGS 163 that in hereditary arthritis the bowels must be carefully watched. Eggs are appropriate food in rickets, anemia, diminished mineral metabolism, where phosphorus, potash, iron, and silica are wanted. Milk supplies the necessary amount of lime which is wanting in the egg. In dyspepsia and hyperchlorhydria it does good service. Its presence affords but feeble secretion and fixes a large amount of free acid. Patients who are troubled with crises of linger- ing pains will derive much soothing effect from swallowing a fresh raw egg. In dyspepsia from insufficiency, in atony and dilatation, eggs should be touched with the utmost caution, if at all. They should be taken in very small quantities only, and never with hot butter. The sulphur in the yolk quickly undergoes pu- trefaction when the gastric juices are deficient. In intestinal troubles and laxness of the bowels eggs are well tolerated. In all cases of com- mon or specific diarrhea, summer complaint, and dysentery, soft-boiled eggs are wholesome food, likewise in enterocolitis. Constipated persons will find them troublesome, as they ferment too easily. In Bright' s disease or cardiac affections they 164 WHAT SHALL I EAT? may be taken either in the shell or in the shape of side dishes; but the stomach, often so very sluggish in these cases, may claim the same pre- cautions as in dyspepsia from insufficiency. Finally, the egg is a food for reconstituting the system. It limits the losses in the economy and adds the fixation of nitrogen and phos- phorus, wherein consist its great merits. It ought to be a dish of predilection to all who get easily overheated and who have weak powers of assimilation. In cancer, neurasthenia, and phos- phaturia the large content of phosphorus shows its proper place. Likewise in diabetes, in all forms of emaciation and consvmiption, and in anemia; in the latter case on account of the heavy percentage of iron present. To convales- cents who need remineralization eggs should be recommended. Thiberculous patients should eat eggs, especi- ally the yolk, in large quantities, for unto them they are not only a food but a medicament, in- deed.^ To facilitate tolerance one has to have recourse frequently to all sorts of artifices: A 'Recent experiments made by Calmette into the lecithino- philic properties of the tubercle bacillus establish a new argu- ment in favor of the employment of the yoke of the egg in tuberculosis. EGGS 165 new-laid egg sucked before dinner; the yolk beaten up in cacao, or in beef-tea, milk, or claret, also in beer, sabayon, etc. But care must be had not to sin by excess. If certain patients have attempted to cure them- selves by eating eighteen eggs a day, we con- sider such an undertaking fraught with many dangers. Six per day is considered the best average by Robin and Binet. Moreover, there should be intervals of rest from time to time. Arthritic patients should make moderate use of eggs, one at a time only. Monteuuis very tritely says: "The egg holds the first place among the aliments for overfeeding. " In gout, eggs are useful because they contain no uric acid — in fact they assist in the elimina- tion of paranucleins by the aid of thymic acid. In liver complaints no special directions, either one way or the other, are required. We have already mentioned that the cholesterin of the egg does not affect gall-stones. CEREALS With the cereals we pass from the animal into the vegetable kingdom, which alone can truly furnish us with energy, because it alone can utilize the solar ^heat for the purposes of re- building the organic structures with mineral substances, the combustion of which develops the calories necessary for our existence. The energy which we draw from the animal king- dom is, after all, only borrowed from the vege- table kingdom and simply reaches us in an indirect way. No wonder then that the vege- tables occupy such an important if not unique position in our food list. If we consider the calorific, the nitrogenous, and the mineral values of our foodstuffs, we shall find that at least two- thirds of each of them are derived from the plants, and if the proportion of fats is smaller, this is outweighed by 90 per cent when carbohy- drates come into consideration. Among the vegetable foods, the cereals easily are in the front rank, and it is quite useless to 166 CEREALS 167 expatiate on the importance of a class of nutri- ents which comprises bread and rice, staple articles that have served humanity as the pillars of nourishment from time immemorial. GENERAL CHARACTERISTICS The composition in all of them is of a similar character, the differences being very insignifi- cant, for which reason they can be all classified under certain properties which are common to them all. Carbo- Albumin. Fats. hydrates. Ash. Calories. Barley 10.77 0.67 68.66 1.54 335.0 Oats 12.37' 6.03 65.77 1.36' 380.0 Rice (unground) 7.19' 1.76 72.59 0.89' 349.5 Maize 7.17 3.04 70.41 1.03 348.0 Rye 7.71 1.23 73.47 0.83 346.0 Buckwheat 5.90 1.30 74.34 0.80 342.0 Wheat 10.12 1.00 72.73 0.43 352.0 The carbohydrates come to the front and, as is the case with vegetables generally, outstrip the element of fat or nitrogen. Neither is any other part so largely represented elsewhere as in the cereals and their derivatives. The car- bohydrates are principally present in the form 'Purins = 0.06. ^purins = 0. 168 WHAT SHALL I EAT? of starch, which is contained in the grain and varies in form and coarseness according to the quality of the flour. The albumin, though smaller in percentage, differs materially in its composition from the animal albumin. It imposes a much heavier task on the digestive ferments and is much harder to absorb. If the coefficient of nitrogenous intes- tinal utilization is about 96 for the meat, it is only about 80 for the cereals. The nuclein exists only in the skin of the grain, that is, in the bran. Flour well bolted contains merely traces of it, if we except oat- meal. Cereals do not belong to that class of foods which generate uric acid. The percentage of fats is very small, but the contents of lecithin claims attention. The mineral bases are well represented, the cereals furnishing more than one-fifth of our daily ration of mineral matter. Potash and phosphorus are predominant; magnesium is, as a rule, quite abundant, often exceeding the per- centage of lime; iron exceeds in rye and barley, but the amount of sodium chlorid is very small. Like all vegetable matters, the cereals con- tain cellulose, which serves as a wrapper for the CEREALS 169 nutritive bodies. It is very much reduced, however, in the process of grounding and bolt- ing. The little of it that remains in the flour resists almost completely the attacks of the di- gestive juices. On account of the small amount of water pre- sent the nutritive value is high; neither does the insufficiency of intestinal absorption afPect this to any extent. But the method of prep- aration modifies it largely. It will be easily understood that, while bread is one of our most substantial foods, a soup or broth made of oats, for instance, is such in a much lesser degree. The methods of preparation vary a great deal. Sometimes the grain is only decorticated, like rice, or oatmeal, or pearl-barley, in which shape they are used for making soups, puddings, and all kinds of side dishes; or they are crushed into a coarse flour from which soft foods are made, such as cream of rice, gruel, and groats; or they are turned by an elaborate process into a fine meal for making bread and pastry. All these difPerent preparations are well tolerated by the stomach, as well as by the intestinal canal. Bread will receive particular attention later on. 170 WHAT SHALL I EAT? The reactions of the cereals are almost exclu- sively due to amylaceous bodies and to lecithin. They pass through the stomach almost without calling into service the secretory process; the starch succumbs simply to the action of the saliva. The albumin, it is true, is harder to digest; but on account of the ternary bodies there is but a small proportion present. More- over, farinaceous foods seem to have a whole- some influence on the glandular and muscular activity of the stomach. Beauvy found from the examination of the vomitings of nurslings that the addition of farinaceous foods makes a finer and more granular coagulum in the milk. In the bowels, however, the action is more pronounced, and requires a surfeit of pancreatic secretion. Slowly absorbed and assimilated throughout the length of the intestinal tube, the cereals are really a food for intestinal diges- tion, as meats are a food for gastric digestion. They act as antiseptics. Combe has thrown much light on this subject in his farinaceous regimens, and his contentions are upheld by a number of authorities. Physical rather than chemical laws are very likely the underlying CEREALS 171 principles. Carbohydrates prevent putrefaction ; hence it happens that in the lacto-farinaceous regimen of Combe their presence retards the ab- sorption of lactose and facilitates the production of lactic acid all along the intestinal canal. Nutrition is influenced in a parallel sense by the carbohydrates on the one hand, and by the lecithins on the other, both being elements of economy, since they restrain notably the disas- similation of nitrogen. The stimulating power of the cereals is very limited, as they give off their calories gradually, quite in proportion to our needs. On account of the sugar which makes them digestible, they are suitable for manual labor and physical exercise. The action on the kidneys is very light, be- cause there is so little of albumin, and xanthic bases are absent; and also because the ternary bodies are burned up in the water and carbonic acid. Achard and Paisseau have demonstrated that a regimen rich in carbohydrates facilitates the elimination of chlorids and diminishes re- tention. There are certain indications and contraindi- cations which are common to all the cereals in general, to which we will refer now. The par- 172 WHAT SHALL I EAT? ticular qualities belonging to each will be given in separate paragraphs. There is no need for going into details on the question of food value for the normal individ- ual, as this is seK-evident. The health and physical endurance of the peoples who live al- most exclusively, or at any rate to a great ex- tent, on rice, as they do in Asia, or on maize, as in Italy, or on oatmeal, as in Ireland and Scot- land, bear eloquent testimony to their quality of being an ideal food for all who are engaged in muscular occupations. Their market price is reasonable, and the demand which they make on the action of the stomach is slight. In digestive troubles they are well tolerated. Dyspeptics can well support them so long as they are decorticated and served in an appro- priate form. Not less useful, as Combe has proved to satisfaction, are they found in intes- tinal troubles, but relaxing or constipating cereals should be chosen according to individ- ual propensities. These same digestive qualities and the ab- sence of toxic matter point to them also in cardiac and in Bright's disease. The relative abundance of lecithin and phosphorus render CEREALS 173 them worthy of consideration as a food for building up weakened constitutions, and for the period of growth and physical development. Hence they are suitable for convalescents and consumptives — especially the varieties that are highly mineralized. For young people who are slow in developing (Springer), nursing women, and in fevers with demineralization, cereals that are rich in lecithin and nuclein should be freely prescribed. Dishes made of the whole grain are preferable. Martinet gives the following directions: One table-spoonful each of wheat, rye, oats, barley, and bran. Roast slowly in the oven or in an iron dish; grind in a coffee-mill and form into a pulp in a mortar; add one liter of water, boil down to about one-half (at least two hours required); squeeze through a bolting cloth and add enough water to make one liter of fluid. Keep in a bottle previously rinsed with boiling water. It should be kept in a cool place, or in the ice-box. In the summer months it should be made afresh every day; in the winter every other day. For children the use of cereals is common 174 WHAT SHALL I EAT? property. We will refer to this matter again later on (page 226). Only in diabetes, however, are serious contra- indications observed. Yet there are no abso- lute rules. Von Noorden even goes so far as to recommend oatmeal. The tolerance of carbo- hydrates in diabetics is a complex question. Recent research has established the fact that sugar may be used to more or less advantage, likewise starch and the plants from which it is derived. Labb6 has proposed a classification of starches according to their tolerance by diabetics. The downward scale recommended is figured out thus: potatoes, rice, barley, oats, wheat, vegeta- bles. But there is nothing definite in all this. It after all depends on personal idiosyncrasies. Moreover, the tolerance even changes almost every moment in the same individual. The question can only be decided by frequent analy- sis of the urine, which gives the proper indi- cations for the use of foods applicable to the occasion. CEREALS 175 SPECIAL CHARACTERISTICS BARLEY Barley is rich in rainerals and easy of diges- tion. The percentage of phosphorus is only ex- ceeded in the not fatty fishes, the yolk of the egg, cheese, cabbage, spinach, and beans; that of magnesium only in the carrot. Lime is very scant, for which reason it agrees with patients suffering from oxaluria. It is rather laxative, on account of the large content of cellulose. Barley flour is used for infants, by convales- cents, and tuberculous and demineralized per- sons. It is also claimed to be of exceptional value in the diet of prize-fighters. Pearl-barley is less nourishing than the article hulled by machinery, and again the latter less than barley decorticated by hand. Barley-water has ever been highly prized as a beverage for fever patients. A decoction of un- strained barley — or a full tisane — formed the meager diet (diaeta tenuis) of Hippocrates. When strained, however, it makes the rigidly meager diet (diaeta exacte tenuis). In all fevers and in all cases in which the stomach is very irritable — for instance, in peri- 176 WHAT SHALL I EAT? tonitis, dysentery, typhoid-fever, etc. — barley- water is the drink which is the best tolerated and offers the most advantages. Meunier recommends to dyspeptics, who must take their beverages hot, an infusion of sprouted barley as very nutritious and easy of digestion, by reason of the diastase which it establishes. OATS This cereal is rich in fats and lecithins. It is rather laxative, but at the same time stimu- lating. Porridge is a common dish in Ireland, Scotland, England, and in the States. It is an excellent food for the tuberculous and for all persons who have to fight against emaciation. In the Orient it is used for fattening up the young girls during the period of pubescence. Von Noorden makes his diabetic patients eat large portions of oatmeal well mixed with but- ter and vegetable albumin. The tolerance of carbohydrates is often enhanced thereby, but the results are by no means always the same. Oat-water is made in the same manner as bar- ley-water, but is not in common use as much as the latter. CEREALS 177 RICE No other foodstuff is of the same superb ser- vice to the human race as rice. It forms not only the predominant, but almost the exclusive nourishment among the peoples of the East. K we may be permitted to draw a lesson of die- tetic feeding from war, we may at once claim that the Russo-Japanese War was the triumph of rice over rye However, it is not wise to be too enthusiastic, as there are also drawbacks. Rice is by no means a complete food; it is too rich in carbo- hydrates, and too poor in nitrogen and fats. If we were to meet our needs for nitrogen by the use of rice alone, the quantity required would be quite excessive and far beyond the physio- logical ration; and if we sought to find the necessary number of calories, the ration would be notoriously deficient in nitrogen. But there are no people who content themselves with the use of rice alone; meat and fish are also con- sumed. The Japanese soldier received during the war each day 500 grams of meat or about 300 grams of salted fish. Rice is the poorest in albumin of all the cere- 178 WHAT SHALL I EAT? als. Riibner, in his experiments with adults, could not prevent a loss of a minimum of 90 grams per diem, which was the equivalent of the rice absorbed. This poverty in albumin is one of the reasons why rice is inferior to wheat. Rice — we speak here of the shelled article — con- tains only about half the amount of phosphorus and lime than white bread; the percentage of magnesium is slightly lower, while that of iron is a little higher. The percentage of potassium is six times higher than in the other cereals. That is the reason why the races that live on rice con- sume less salt, in spite of the fact that rice con- tains only small traces of sodium chlorid. Rice, on the other hand, is superior to bread in its content of cellulose, which struggles with constipation and maintains the intestinal tone so closely allied to the tone of vitality. But then this is one advantage which would not afPect the European races, were they inclined to adopt rice as their only staple food. Our intes- tines, civilized, badly worn and badly trained as they are, would not know how to master such a mass of residue. Nevertheless, no matter what the relative values of bread and rice are, rice is an excellent CEREALS 179 food; and we cannot too strongly advise its use by the sick as well as the healthy. It is easy to digest and — a very valuable quality — well toler- ated in hyperchlorhydria. In attacks of diar- rhea it renders excellent service, whether it be taken whole or in the shape of rice-water — very likely because it acts rather as an antiseptic than a binding agent. If consumed in large quantities it may fatigue the digestive apparatus and cause constipation. Klemperer recommends it in cases of oxa- luria, on account of its low percentage of lime and its abundance of magnesium. The form in which it is easiest digested is when boiled to a point, not too much and not too little. In the process of cooking the starch is puffed out and partly converted into dextrin. The alimentary value is, of course, diminished proportionately. One hundred grams of raw gives about 300 grams of cooked rice. When boiled in water with some kitchen salt alone, it is insipid and can only be eaten in small quantities. With fat, or in soup, it appeals more to the palate. But cooked with milk, it makes one of the best of culinary products, because the deficiency in albumin 180 WHAT SHALL I EAT? and fats is thus thoroughly compensated. Rice pudding offers the same advantages; it is appetizing, nutritious, easy to digest, and for that reason useful to persons with a capri- cious stomach. The Orientals eat rice without the addition of other foodstuffs, but they know how to season the taste with a variety of spices. MAIZE — CORN This is the wheat of the people living in the southeastern section of France, in the northern parts of Italy, in the Tyrol, in Roumania, and in certain sections of Hungary. [It is used largely in the United States as sweet or sugar corn, and, especially in the Southern States, for making corn-bread and corn-cakes. Under the name of hominy it is well known as a breakfast-food. In Italy "polenta" is eaten with grated cheese. — Translator.'^ Maize is rich in fats and cellulose, but poor in albumin. It is a very nutritious food; but, unless eaten fresh from the cob, demands a robust stomach. Mineral substances, with the exception of magnesium, are absent. CEREALS 181 [Pellagra, a disease endemic among the maize-eating races, running parallel, it seems, with beri-beri among the rice-eating nations, has recently been made the subject of research by many medical authorities. As in beri-beri, its causes and origin are as yet but imperfectly understood, for which reason remedial and pre- ventive measures are still lacking. The gov- ernments of several countries are now, however, taking an active interest in this important question, and satisfactory results may soon be expected. — Translator.^ The bran of maize appears to be strongly impregnated with toxic matter, which accounts for the fact that corn- meal is less dangerous. Balf recommends that corn-flour, used for consumptives, should be quite fresh, as the toxins develop rapidly with the age of the flour. RYE The black bread made from it is eaten chiefly by the inhabitants of poorer districts. Lime, iron, and cellulose are its characteristic ele- ments, all of which should prove valuable in the treatment of constipation. The bolted flour makes the ordinary rye-bread. WTien 182 WHAT SHALL I EAT? unbolted, the product is called "pumpernickel" by the Germans. Both kinds are hard to di- gest, and from this point of view inferior to the white bread which is made from wheat. Rye is often tainted by a parasite, the clavi- ceps purpurea, or ergot, of rye. This is a poisonous substance and often gives rise to epidemics, the symptoms of which strongly resemble those of ergotin-poisoning, and are strongly marked by gangrene of the extrem- ities. BUCKWHEAT This is also called "black wheat" in Nor- mandy and the Bretagne, where it is exten- sively cultivated and baked into cakes known as "galettes," which keep for a long time. It is a heavy food and hard to digest. [Buck- wheat cakes are a favorite breakfast dish in the United States. — Translator.'^ WHEAT We have reserved this to the last on account of its special dietetic importance. Its food value is only second to that of oats. Unfortu- nately it is not so rich in mineral substances. CEREALS 183 The flour made from wheat is hardly ever used by itself as a food. But the products into which it enters, such as bread, biscuits, pastry, pastes, etc., are of vital interest to every- body. BREAD To the white races bread is the staff of life, the staple food indispensable for their daily- rations. It represents at least two-thirds of the alimentation of the poorer classes. When a foodstuff like bread has once assumed such an important position in the diet of nations, the slightest modification which it undergoes will have a very intimate effect, either good or evil, on the public health and welfare of the community. The manufacture of flour, as well as that of bread, has, during the past century, undergone many improvements; but whether they offer ground for approval or regret remains to be seen. In days gone by, the flour used for making bread was ground between millstones, but in modern times metal cylinders are employed which crush the very heart out of the grain. The sifting and bolting of the flour consist in the removal of the husk or skin of the grain, which is called bran, and gives the flour a dark 184 BREAD 185 or blackish appearance. A 10 per cent bolting still leaves a goodly amount of this impurity in the flour. The best white varieties are subject to 30 per cent of bolting. To make home-made bread, flour is mixed with water and a small amount of kitchen salt, to which is added a proportionate amount of yeast or leaven. This mixture is allowed to stand, generally overnight, and to rise. In the morning the dough is kneaded, formed into loaves, and then baked in the oven, where it assumes its characteristic golden yellow appear- ance. The product represents about 100 per cent, i.e., 100 pounds of flour will make about 100 pounds of bread. COMPOSITION AND ALIMENTARY VALUE Albumin 6.94 Fats 0.95— Chlorid. . . 0.65 Carbohydrates . 52.69— Purins 0.00 ' Ash 0.79 Available calories = 255 These figures refer to bread of medium white- ness. Nitrogen is formed of the gluten or 'Whole-meal bread contains about 0.04 per cent. 186 WHAT SHALL I EAT? gluten casein, a true vegetable casein which swells in water. It is accompanied by cerealin, a vegetable pepsin, which possesses the property of peptonizing the nitrogenous matter. The fats consist chiefly of phosphorated lecithin. Nearly the whole of the phosphoric content exists in this form, if not in the form of diphos- phoric methylic acid. Starch is the essential and truly nutritive element of bread. The percentage varies con- siderably, but oscillates between 40 and 60, and is dependent on the manner of making the bread. In the beginning it undergoes, partially at least, carbonic fermentation. The gas permeates the dough and makes it light. During the baking the starch of the crumb is transformed into starchy paste, and fixed or united with the gluten. In the skin of the crust the heat of the oven produces an ample amount of dextrin with partial cara- melization. Among the mineral constituents phosphorus prevails, chiefly in the organic form. Potas- sium and magnesium are well represented. The ash is acid, by reason of the predominance of phosphoric acid. BREAD 187 Since bread is nearly wholly absorbed by the economy, its nutritive value is high; it ranks after the legumes (peas, lentils) and cheese, but precedes meat and potatoes. The alimentary value of the crust is sensibly higher than that of the crumb, because it contains less water (25 per cent as against 45 per cent in the latter). That is the reason why it is better to make loaves oblong, for they represent a larger amount of crust. A round loaf of bread, weighing one pound, contains 39 per cent of water; but a long loaf, weighing a pound and a haK, only 33 per cent. Stale bread is also a little less hydrated, although its peculiar quali- ties do not depend on this condition, because, when warmed up, it resumes almost entirely the characteristics of newly made, fresh bread, in spite of the fact that the reheating process still further assists in the evaporation of water. When bread is eaten together with other ar- ticles of food its alimentary powers are consid- erably increased. We wish to emphasize here, however, that among the numerous devices em- ployed in the household, there are only two which appeal to us as particularly judicious, the first is the spreading of butter on the 188 WHAT SHALL I EAT? bread, because in this wise the necessary amount of fat is added; and secondly, the use of cheese with bread, which raises the standard of both the fats and nitrogen very appreciably. REACTIONS a. Digestive. — The action of bread on the stomach is rather complex. To be properly un- derstood, it must be considered by itself. Glu- ten, like all vegetable albumins, is hard to digest, and provokes a very strong peptic secre- tion, four times as strong as that of milk or meat. — {Chigin. ) But it is small in quantity, while the starch, which is the predominant fac- tor, escapes the action of the gastric juices and comes under the influence of ptyalin; that is to say, on the condition that the rate of hydro- chloric acid present is low. The constituents of bread are changed but little in the stomach, if the physical conditions in which it enters do not paralyze the action of the salivary ferments and peptonic juices. When taken in overlarge quantities, or when it is insufficiently chewed and masticated, it forms a compact spongy mass, difficult to break up, and which quickly ferments. This explains BREAD 189 the fact that dyspeptic persons often cannot tolerate it, and that it is prone to aggravate di- gestive troubles. To prevent both these patho- logical conditions, it is quite sufficient to turn the bread into pulled bread or into dry toast. In the intestines the process of digestion is accelerated, and it reaches there its final stage. Fortunately, the percentage of nitrogen is low. Among the albumins, gluten requires the largest amount of tryptic ferment. It is different with the hydrocarbonic element. The starch of the bread yields to the amylolytic secretion in its weakest form. The absorption of albumin by the bowels reaches only 79 per cent, while that of the starch goes up to as high as 99 per cent. On the whole, bread leaves but little residue, and that is the reason why it is claimed by many to favor constipation. In a previous chapter (page llO) we have seen that the percentage of nitrogen being equal, the effort required to digest bread by far ex- ceeds that of milk; but this can have reference only to the nitrogenous content. When we take the amylolytic ferments into consideration, we find that the starch, which is, after all, the 190 WHAT SHALL I EAT? real nutrient element of bread, is digested at very small expense of physical force. This brings us to the conclusion that bread, al- though a good purveyor of carbohydrates, is a poor provider of nitrogen. b. General. — Short of nuclein as well as nitrogen, bread exerts only a small, albeit be- nign, stimulating power over nutrition in gen- eral and the organism in particular; powerful as an element, it gives off its calories only in proportion to our needs, without provoking an artificial stimulation, which would in any case be followed by a wave of depression. For all that, it is acidiferous, Gautier has made this clear by proving the predominance of phosphoric acid in the ash. c. Eliminatory. — Unless it ferments within the tube, bread leaves but small traces of ex- cretion behind, consisting chiefly of water and carbonic acid. If properly digested, it imposes only a very light task upon the kidneys. BREAD 191 INDICATIONS AND CONTRAINDICATIONS Bread is for all, hale or ailing, the funda- mental element of alimentation. From the physiological standpoint the man who performs manual labor requires a large quantity of it. So far as pathological conditions are concerned, we know of no disease in which the use of bread is especially indicated; but there are such in which, by retaliation, as it were, it is badly tol- erated and may even prove harmful. Of course, the first place is claimed here by the gastric affections. Nowadays a number of stomachs have forgotten how to digest bread. Surcharging the canal with bread produces putrefaction, and lays the foundation for the numerous cases of dyspepsia in heavy eaters and in individuals who force the food down in a hurry, swallowing it without proper mastica- tion. Frequently it is quite sufficient to cut down the daily ration of bread and allow it only in the shape of toast, to see most of the symptoms vanish as if by magic. In hyperchlorhydria it is borne with small success; for the salivary ferments are clogged in the superacidity of the gastric juices, and the 192 WHAT SHALL I EAT? starch, remaining undigested, quickly under- goes putrefaction. All starchy foods — and bread belongs to them — should be permitted in small quantities only. The same must be observed in dilatation and in stenosis. In other forms the idiosyncrasy of each patient should be the guiding line. As a general rule fresh bread is harder to digest than the stale and seasoned article, as it offers a more stubborn resistance to the attacks of the gastric juices. This refers to hot bread even with stronger force. In like manner the crust is easier to digest than the crumb, as we have already pointed out. The physician will know when to recommend toast, or crackers, or "zwieback." For intestinal affections a great deal of cau- tion is needed, and it is often advisable to lay down strict rules, especially in cases of constipa- tion. Diabetics should scratch bread almost entirely from their menu. But to overcome this hard- ship, which may seriously impair the appetite, bread deprived of its carbohydrates and en- riched with albumin may be easily obtained in the market. Among the most serviceable we BREAD 193 may mention "gluten bread," which contains only from 10 to 30 per cent of carbohydrates, and also "almond bread." In arthritis the daily ration must be strictly limited, so much the more as the patients fre- quently have a great liking for bread. For cverfeeding, bread is an important factor, but all the same it is a source of stasis, intestinal putrefaction, and humoral acidity. An average allowance of 250 grams (half a pound) per day should be ample; the rest of the diet might be supplemented with potatoes boiled in water, which have the advantage of being [less nutri- tious, slightly laxative, and alkalin withal. In gout a similar diet is counseled. 194 WHAT SHALL I EAT? VALUE OF WHITE BREAD So far we have spoken of the ordinary white bread made of the best and finest wheat flour, such as may be found everywhere nowadays in cities as well as in the country. We will now consider in how far and under what conditions it is a superior food to the coarse bread made in former days. The difference in its manufacture is twofold: 1. The flour is ground between steel cylin- ders instead of stone; 2, a more careful sifting makes it whiter. The result of these two ma- nipulations is a more thorough expulsion of the bran, and therefore a finer quality of flour. If we are to speak of the effect this has on the calories alone, we shall find it very favorable. If the content of nitrogen is somewhat reduced by this method, starch in the bread is increased and intestinal absorption is facilitated. In the white bread the power of absorption rises to 95 per cent; while in the cruder forms made of the whole grain, it is only 90 per cent. So far as appearance is concerned, this is a matter of secondary consideration. But it is necessary BREAD 195: to increase the average of the daily ration by 5 per cent, in order to compensate for the losses. Yet from another rather problemati- cal standpoint, the white bread has two decided disadvantages. 1. It is not sufficiently stimulating, primarily, to the digestive tube. The residue, however, that is the cellulose contained in the bran which has been dreaded so much and by so many, nevertheless possesses most useful qual- ities, if present in small quantities only, for it sustains the tone of the digestive tube, raises the power of functioning, and strives against atony and constipation. In our days it is the digestive tube of all organs which shows the most marked degree of degeneration. Consti- pation, cecal stasis, and all the evil conse- quences, enterocolitis, appendicitis, and prema- ture senility, are they not all partially, at least, due to this regrettable use of flour so quickly assimilated, and leaving no ash ? Many au- thorities have answered this question latterly in the affirmative. The white bread is not sufficiently stimula- ting to the general organism. This contention will be clear to him who understands the inti- 196 WHAT SHALL I EAT? mate relationship that exists between the di- gestive and the general tone. If, on the other hand, the general organism has to fear evil results from the atrocious and coarse overstim- ulation caused by certain foods, then it can- not either, on the other hand, be satisfied with the normal tonic furnished by alimentation in general. Cellular life is a function due to ex- citation; a diminution in the latter is bound to lessen the intensity of the former. This in- sufficiency of stimulating power is particularly serious in a food which represents two-thirds of our daily needs and constitutes the source of an energy so minutely graduated and so well regulated. We need not be amazed if, with the introduction of white bread in the country districts, the peasant, finding no longer the re- quired quotum of stimulation in the bread, goes to seek it elsewhere, — (Monteuuis.y And here it is where the bread question touches the ques- tion of alcohol. The second defect in the white bread is, that it is not sufficiently mineralized and is insuffi- ciently phosphorated. This fault, of grave 'Monteuuis: "L'alimentation et la cuisine naturelle dans le monde." BREAD 197 import for this as well as for all other ali- ments, represents a deficiency of about 20 per cent of mineral matter in our ration, as has been amply demonstrated by chemical analysis. We quote from Muntz the following table showing the comparative composition of flour ground on metal and flour ground on stone. Ground on Metal. Ground on Stone. Crust. Crumb. Crust. Crumb. Nitrogenous matter... 8.06 5.87 8.50 6.62 Ash 1.81 1.57 2.52 2.06 Phosphoric acid 0.19 0.13 0.28 0.20 The sifting and bolting accentuate still more the damage already done. Of 21 parts of min- eral salts contained in 1,000 parts of grain, only 5.5 are in the flour, while 15.5 are in the bran; and of 8. 93 parts of phosphorus, 2. 33 are in the flour, and 6.60 in the bran. The bran, there- fore, which we so ingeniously separate from the flour to the highest potentiality, carries ofP with it three-fourths of the mineral constituents of the grain, i.e., phosphorus, magnesium, etc. But it can serve no good purpose to dwell any longer on the importance of these facts. An organism impoverished in mineral sub- stances, a nervous system robbed of its per- 198 WHAT SHALL I EAT? centage of phosphorus and magnesium, must of necessity be vitiated and impaired. We cannot help but admit that this deterioration of bread logically crops from the customs of our times and from the intensity of our present-day life. In the same measure our nervous and cerebral underfeeding intensifies the phosphoric disas- similation; and demineralization is on the daily increase. Many efforts have already been made to remedy these evils, which are the natural con- sequences of our industrial progress. We have already discussed the drawback to be found in white bread, so far as the bowels are concerned. To counteract constipation cer- tain kinds of bread have been recommended which leave a sufficient percentage of residue; among them rye-bread, also called brown bread or black bread, likewise Graham bread, which is made with all the elements of the whole grain coarsely ground. All these are serviceable, but, after all, only to heavy eaters with a robust di- gestion. Most of the modern stomachs, how- ever, are too delicate to digest them. The more and the better this question is studied and ventilated, the clearer becomes the BREAD 199 object to be attained, and the greater will be the efforts to produce an ideal, rational bread which will possess all the required good quali- ties. Two formulas have been suggested: one faction recommends the true whole-bread con- taining the whole of the grain; another faction wants the brown bread, called also "modern" brown bread (Monteuuis), which ranks half way between the white bread and the whole- meal bread. We freely give our approval to the latter form. The only strong objection to the whole-meal bread is the difficulty of di- gesting and tolerating it. Our economy no longer seems strong enough to support a food relatively coarse. With the brown bread the inconvenience is minimized. Moreover, it is advisable to proceed slowly in this reform by taking, for instance, in the beginning, 50, then 100, then 200 grams, and so on, until the full amount can be consumed with impunity. The advantages of mineralization seem to equalize themselves after a short time. FauveP substi- tutes for white bread one equal part of whole- meal bread and one equal part of modern 'Fauvel : Congr&s international d'hygi^ne alimentaire. Paris, 1906, 200 WHAT SHALL I EAT? brown bread, and claims that in two cases under observation the increase in phosphoric excretion was about 0.25 gram. A daily gain of 0. 25 gram would mean for the year a total of 91.25 grams of phosphoric acid. We need scarcely come back again to the special varieties of bread which are sold at more or less advanced prices to the public. After all, it is, perhaps, easy enough to obtain at the baker-shop bread made from any grade of flour. The question is not without difficulty, how- ever, and possesses interest enough to justify continued efforts in the right direction. BISCUITS— CRACKERS They owe their name and properties to the manner of their manufacture, i.e., a paste con- sisting of wheatmeal and water twice baked. They are easy to digest and very nutritious. Many contain also milk, butter, and eggs in variable proportions. The average composition of dry biscuits is: Albumin. Fat. Carbohydrates. Ash. Available Calories. 8.99 7.92 69.74 1.34 399 A glance will reveal their value as an article BREAD 201 of food and the high percentage of mineral content. As they are very easy to digest, and not sub- ject to putrefaction, they are suitable for diges- tive troubles. In intestinal dyspepsia, in all gastric, cardiac, and liver complaints, in Bright' s disease, and in anoreocia, they should replace bread to advantage, and allow of happy changes in a diet otherwise insufficient. In the milk diet they are indispensable for correcting insipidity and desirable proportions. We take exception, however, to all kinds of biscuits or crackers that are lined, coated, or stuffed with creamy or jammy substances, for they are hard to digest and belong rather to the category of pastry. PASTRY An enormous variety of articles, all dissimilar in composition, quality, and food value, belong to this denomination. Nevertheless, since paste is the principal ingredient — and all its injurious qualities are common to most of them — we have thought it reasonable to speak of it here under the head of wheat flour. Butter and eggs are employed in varying 202 WHAT SHALL I EAT? proportions, and the whole is carefully mixed, rolled, and cooked in a slow oven. The product is of a solid consistence, very nutritious, but difficult to digest, especially when not suffi- ciently baked. The puffs are perhaps a little lighter, but frequently bear the disadvantage of being made of stale cake. Paste is only the foundation of this unhealthy and antihygienic food. The multitude of re- cipes and formulas is the sum total of all the mischief wrought by their use, no matter under what name they are advertised and sold; petits fours, fondants, dragees, pralines, fritters, pan- cakes, they all belong to the long list of dan- gerous, mischievous preparations called pastry. Their bad qualities belong to the digestive or- der. They surcharge and fatigue the stomach and invite intestinal putrefaction. The whole catalogue of cakes, sweetmeats, cookies, and pastry, without exception, must be forbidden in dyspepsia, enterocolitis, diarrhea, and constipation; in cardiac and in Bright' s disease, in eczema, and in all skin diseases; likewise in diabetes, liver troubles, obesity, and arthritis. The hale and hardy are cautioned to use dis- cretion. The gentle sex particularly is prone BREAD 203 to commit indiscretions in this direction, a fact which accounts for the many crises in dyspepsia, anemia, and diabetes among women. But there is a kind of home-made pastry which may grace any table and even prove of benefit to the sick, as it is light and easy to digest, pleases the palate, and possesses none of the offensive qualities mentioned above — dia- betes, however, always excluded. It embraces, according to Pascault — setting aside the biscuits already mentioned — the fol- lowing: Cakes made of sweetened paste (flour, sugar, eggs, and butter), known as madeleines, Genoa and Savoy cakes. Gingerbread and ginger-snaps. Tarts made with fruit or rice, but always presupposing that the crust of the paste be baked crisp. Meringues made with whipped cream, but not with cream bought of the pastry cook. We may add brioche, especially flannel brioche, which, if thoroughly done and eaten with butter, is, as a rule, tolerated even by dyspeptics. 204 WHAT SHALL I EAT? NUTRITIOUS PASTES These are obtained by mixing wheat flour with variable, but always small, quantities of milk, butter, and eggs; macaroni, vermicelli, noodles, tapioca, Italian paste. All these are as near as possible identical in composition. We give only the analysis of macaroni. Albumin 10.46 Fats 0.70— Chlorid . . 0.08 Carbohydrates . 72.34— Purin ... 0.00 Ash 0.83 Available calories = 349 Although the proportion of the constituents approaches that of the cereals, especially that of bread, the food value is lower, for the ash is alkaline, and the percentage of phosphate of soda is too high. However, they are light, especially for intes- tinal digestion. Combe recommends them strongly in his regimen for gastric and intestinal dyspepsia. They serve as a substitute for bread in gastric dilatation with fermentation, and in enterocolitis. To be truly efficacious they should be pre- BREAD 205 pared without butter and cheese; simply boiled ia slightly salted water. When placed on the table, a small dab of butter and some grated cheese may be added to make them more palatable. According to Combe they are more digestible if no eggs are used. Contraindications are diabetes and obesity. They agree with all whose bowels function badly, i.e., in liver complaints, cardiac affec- tions, Bright's disease, and often in arthritis, but their use must be properly gaged. In dyspeptic tuberculosis, rapid and lasting fattening is often achieved with a generous diet of these preparations. 206 WHAT SHALL I EAT? CHESTNUTS In many parts of the world the large and the small varieties of chestnuts play an important role in the diet of the inhabitants. In Corsica, they are called "the bread of the tree." Al- though they do not belong to the same family, they approach the cereals very closely in com- position. Albumin 6.35 Fats 2.40 Carbohydrates 67.00 Ash 1.60 Available calories = 321 The percentage of nitrogen and carbohy- drates is lower than in the flour of wheat, but that of the fats exceeds it. Mineral bodies are plentiful. The pulp, however, made from cooked or boiled chestnuts, and chestnut flour are not so light, and should not be eaten by dyspeptics. As a nourishment to the normal constitution they possess real value. LEGUMES-PULSE These form a group remarkably homoge- neous, so far as good and bad qualities as well as composition are concerned. The composition is almost identical in all of them. COMPOSITION AND FOOD VALUE Carbo- Albuinin. Fats, hydrates. Ash, ^urins. Chlorid. Calories. Lentils 20.40 L31 57.40 2.35 0.07 0.07 337.40 White beans 17.45 1.39 59.69 2.63 0.07 0.02 334.50 Split peas 19.35 L54 57.71 2.10 0.04 0.05 336.00 Dried broad beans 21.01 L45 55.25 2.22 0.00 0.04 332.00 The content of nitrogen in legumes equals that of meat, but in carbohydrates they are superior. The nitrogen in pulse is called legumin, i.e., a vegetable casein, which forms with water a paste that is analogous to gluten, but is easier to digest. The legumes are rich in nuclein — the richer, the younger the growth. They must be classed among the foods that produce uric acid, for instance, meat, 207 208 WHAT SHALL I EAT? Oxalic acid is found in notable quantities in white and broad beans; lentils and peas are free from it. If fats are absent, the carbohydrates abound in the form of starch in about the same measure as in the flour of cereals, but the per- centage of cellulose is sensibly higher, though principally localized in the skin, or husk, of the seed. This, of course, enhances the food value of decorticated pulse. The ash contrib- utes a large part of this high dietetic value, as its percentage is twice that of meat or bread. The young, green legumes are mineralized in a higher degree with a corresponding elevation of calories. Potash is preponderant, and when combined with soda — present in a lesser de- gree — it adds a certain amount of alkalinity, but far below the proportion contained in other vegetables. Phosphoric acid also obtains a higher rate, exceeded only in cheese, the yolk of egg, and oatmeal; and, being almost wholly in an or- ganic form, it is very easily assimilated. Nu- clein, lecithin, diphosphates of oxymethylene, place the legumes at the head of rephospha- ting aliments. Lime and magnesium are well LEGUMES— PULSE 209 represented, the latter a bit more than the former. Iron abounds only in lentils. The alimentary value of legumes is consider- able. They constitute almost a complete food, for albuminoids and carbohydrates are present in high proportions. Riibner was able to main- tain the balance of nitrogen and carbonic acid in the men on whom he experimented by giv- ing 520 grams of dry peas per day. But, mind you, results like these are of no other than a purely experimental value. The moderate cost also adds much to their worth. The cheapest calorific unit to be found is that of the legumes. One hundred calories of split peas cost less than one hundred calories of white bread. It requires only one kilogram (a little more than two pounds) of split peas to make an equivalent of 1,400 grams (about three pounds) of bread, and the expense is smaller. To this must be added the ease with which the legumes can be kept and their inalterability, factors that establish them as a food of the first order, well adapted for provisioning large masses of people. For practical purposes, however, it is well to bear in mind that this high nutritive poten- 210 WHAT SHALL I EAT? tiality, especially from the standpoint of super- alimentation, needs strong correctives. All legumes absorb, in the cooking, large amounts of water; for instance, 300 grams of dried peas make 1,200 grams of pur6e; for beans and lentils the proportion is well nigh the same. And again, intestinal absorption is far from being perfect, scarcely ever exceeding 91 per cent; while rice, bread, milk, meat, and pastes attain as much as 95 to 96 per cent. Lastly, they produce, especially in the sick, a feeling of fulness, which limits the ratio of in- gestion. PREPARATIONS AND METHODS OF USE To render legumes digestible and assimilable they must be hydrated and cooked. Hydration is accomplished, preparatory to cooking, by soaking the pulse in water — each variety according to its own requirements, until the husk is softened off. This is important, for the water transforms a part of the starch into amylodextrin, thus facilitating the process of digestion and absorp- tion in the canal. It equally modifies the cellulose and makes it more absorbable. Legu- LEGUMES— PULSE 211 min has a tendency to form, during cooking, insoluble combinations with the carbonate of lime contained in the water which indurates or toughens the mess. For this reason soft water should be employed. Hard water may be softened by adding from 3 to 5 grams of bicarbonate of soda per liter. The rule, almost universally observed, to cook legumes just for one hour, we consider ill ad- vised. It offers several disadvantages which we may as well point out at once. It is a mistake to cook pulse in a large volume of water which is afterward poured away, for in this manner a certain amount of sugar is drained ofp, thus lowering the nutritive quality of the food and diminishing its digestibility. It wastes the aro- matic essences, which flatter both taste and smell and stimulate the physiological secretions of the stomach produced by psychic reflex action. It also entails a heavy loss of important min- eral salts which are dissolved by the water in cooking. Legumes should be cooked over a slow fire in the smallest amount of water compatible, and in a vessel hermetically sealed. It is easy enough nowadays to find utensils specially de- 212 WHAT SHALL I EAT? signed for that purpose. We shall revert to this subject later on. The seasoning of legumes can easily be ac- complished. Butter or oil will add the re- quired amount of fats which are lacking. Sick persons should eat them in the shape of a thick soup (puree), or use only the husked article, for the peel is hard to digest, overloads the stomach, and irritates the bowels. Neverthe- less, this has its disadvantages also. The puree is swallowed too rapidly, without proper mastica- tion, which is bad for the stomach and deprives intestinal peristalsis of that residue of cellulose which serves as a physiological stimulus. This form of diet should be restricted to cases of necessity only. REACTIONS a. Digestive. — IS. we consider the constituents only, we have seen that they are almost the same as in cereals, excepting the large per- centage of albumin which slightly embarrasses the gastric action. But then it is chiefly the cellulose, shell which retards the attack by the ferments and impairs digestibility. The necessity of prolonged mastication to com- LEGUMES— PULSE 213 plete the work of cooking will thus be ap- parent. In the intestines the dry legumes react at once, through their albumin and starch, on the glandular system, principally the pancreas, and tbrough the cellulose on the muscular system. If ingested in overlarge quantities or crowded into the canal otherwise overtaxed, they quickly provoke acid or gaseous fermentation. b. General and Excretory. — From this double standpoint they occupy a place exactly midway between the cereals, on account of the large vol- ume of nitrogen and nuclein. Nevertheless, they should be rather counted among the stim- ulating and toxic aliments, being, as it were, a vegetable meat. After what we have said about the nutritive qualities of the legumes, it will be easy to find the place which they should occupy in the diet of the artisan and laborer largely as a substitute for meat, of the soldier, of the masses in general, and of anybody in sound health and endowed with a good digestion, especially in the winter months. In the summer-time, when our calor- ific needs are less acute, preference should be given to the fresh article. 214 WHAT SHALL I EAT? Legumes are a particular requisite for the diet in childhood and during the period of adoles- cence, when the construction of tissue demands the aid of phosphorous elements, of lime and magnesium, all of which are furnished lavishly by the legumes. In cases for remineralization and rephosphatization in convalescence, and, above all, in tuberculosis, they will answer the call. In all these cases the dried legumes should be taken entire. To advance gastric tolerance all that is required is thorough mastication. How- ever, there are conditions in which they will not be supported, except in the shape of thick soups, or when decorticated. Among these we give mention to dyspepsia, either hypo- or apeptic; in the average cases of dilatation, and in gastritis of long standing; also in secondary dyspepsia of tuberculosis, in anemia, and neurasthenia. Like- wise in enterocolitis, enteritis, and enteroptosis. Here preference should be given to peas, lentils, and kidney-beans. For children afflicted with hereditary arthritis, whose intestines are so often delicate and irrita- ble, they form an important part of the diet. Finally, there are cases in which their use LEGUMES— PULSE 215 is absolutely interdicted in any shape or form. First of all, in diabetes, not only because of their high percentage of carbohydrates, but also be- cause they belong to the foods hardest to digest, following immediately after the saccharose and starch of bread. Then, in obesity and hepatic affections, as they possess a strong tendency to be transformed in the liver into fatty substances; likewise in hy- perchlorhydria and in the major gastric dila- tations, where their hyperacidity arrests the digestion of starch and provokes putrefaction. Lastly, in arthritis, not so much because they are too nutritive, but on account of their tend- ency to produce uric acid. Gout, gravel, rheu- matism, migraine, neuralgia are danger-signals for removing them altogether from the diet list. Scleroma, cardiac affections, and ^W^g-Ai'* disease belong to the same catalogue. PARTICULABS 1st. Lentils. — These are particularly valua- ble from every point of view, because the per- centage of cellulose is low and they are easy to digest. On this claim they are of special bene- fit to dyspeptics and in enteritis. Their large 216 WHAT SHALL I EAT? content of iron gives them the preference over all the other legumes. Being ferruginous they rank in line with, or immediately after, pud- ding, the yolk of egg, certain green vegetables, and certain fruits, and therefore are wholesome food for anemics. 2d. Beans. — There is a large variety, nota- bly white and brown beans, whose composition varies but little. Rich in cellulose, and con- taining a slightly higher percentage of fats than the other legumes, they are less digestible. They ferment easily and give rise to formations of gas, for which reason they are especially con- traindicated in flatulent dyspepsia. But they are rich in phosphorus and magnesium, hence beneficial to adults and growing youths in good health. Kidney-beans are much tiner and much more easy to digest than the other kinds, but they are also richer in xanthic bodies. String-beans are almost on a par with fresh vegetables, of which we shall speak presently. The pulp represents less than 9 per cent of their weight, the rest of 92 per cent is water. They contain not more than 4 per cent of carbohy- drates at the utmost, principally in the form of LEGUMES— PULSE 217 nuclein, inosite, or amylaceous bodies which do not produce glucose. In diabetes they are per- missible. But they are contraindicated in arthritis, uricemia, oxaluria, and in diseases of the liver, by reason of their heavy content of uric and oxalic acids. 3d. Peas. — On account of their composition, their percentage of nitrogen, fats, and starch, they are midway between lentils and beans. The marked presence of cellulose makes them equally as hard to digest as beans. Split peas, which are deprived of the husk, are more nutri- tious and better tolerated than dried peas. Both are eaten in the shape of thick soups (puree). To prevent putrefaction it is wise to add small pieces of toasted or fried bread (sippet or crouton), which insures slower eating and better mastication. Fresh green peas contain relatively little sugar, though a trifle more than string-beans. But they contain quite an appreciable amount of xanthic bodies, entailing the corresponding contraindications. Well mashed they are easily digested, and the cellulose is assimilated to a large extent. 218 WHAT SHALL I EAT? 4th. Broad Beans. — They excel in cellulose (we have classified the legumes in accordance with the increasing percentage of cellulose: lentils, kidney-beans, peas, broad beans). It follows that the latter are a dish relatively heavy and indigestible. In spite of the abun- dance of phosphorus, and, above all, of mag- nesium (no other food contains more), they can- not be recommended, except to robust stomachs. Decorticated, they are a little bit easier to di- gest; but for farm laborers they are an excel- lent food. POTATOES Potatoes are the most widely spread type of tubers. Their properties place them between the cereals and legumes on the one hand, and the green vegetables on the other. The pre- ponderance of water depresses their food value. The percentage of carbohydrates is low, and that of albumin still more so. The mineral value of phosphoric acid, lime, and magnesium is superceded by potash and soda, and confers upon them a higher alkalinity than that found in fresh vegetables. COMPOSITION AND ALIMENTARY POWER Albumin 1.73 Fats 0.11— Chlorid . . 0.01 Carbohydrates . . 20.00 — Purin . . . 0.003 Ash 0.77 Available calories = 90 These figures, which represent the mean composition, vary, however, not only in the different varieties, but also with the age of the 219 220 WHAT SHALL I EAT? potato. In the spring of the year, for instance, their content of carbohydrates is higher than in the autumn and winter months. The carbohydrates, which are about the only nutritive quality possessed by the potato, are present in the shape of starch or yeast. Heat transforms the starch into sugar; but, when the potato is exposed to cold for some time, this phenomenon is reversed. If kept too long in a warm place, the potato begins to sprout, and the change of starch into sugar becomes abso- lute. The content of nitrogen is small, and nearly half of it manifests itself not in the shape of albumin, but as glutaric acid, i.e., asparagin, leucin, and tyrosin. The ash contains only a small amount of phosphoric acid, a little magnesium, and a still smaller quantity of lime, but up to 60 per cent of potassium. For this reason potatoes should never be eaten without salt. Bunge demon- strated that potassium, ingested in this man- ner, splits the sodium chlorid in the blood and forms a chlorid of potassium which, if present to excess, is eliminated through the urine. This loss of chlorin must therefore be restored by POTATOES 221 other means, because the potato contains scarce- ly any trace of it. The potassium in the po- tato is partly combined with organic acids and partly with phosphoric acid, and makes the ash strongly alkaline. Iron is represented in fair quantities. The alimentary value, contrary to popular belief, is small, because intestinal absorption is imperfect. The figure 90 given above refers only to the eatable portions. In potatoes bought at the grocery the loss is heavy, for they do not, as a rule, yield more than 69 calories to every 100 grams. METHODS OF PREPARATION For the purpose of modifying the starch and rendering it more assimilable, cooking is indis- pensable. The method of cooking, therefore, as well as the manner of seasoning, greatly enhances the nutritive quality of the potato, while weight is not appreciably afPected by boil- ing. One kilogram (about two pounds) of raw potatoes makes just 1,000 grams when boiled. We must not lose sight of the fact that a part of the essential salts is lost in the water. This loss may be compensated for by the addition of 222 WHAT SHALL I EAT? kitchen salt. However, it may be circumvented by baking, puffing, or steaming the potatoes. Baked potatoes lose one-fourth their weight by evaporation, and therefore are commendable. When puffed or steamed, scarcely any change in the weight takes place. Mashed potatoes are good food, especially for dyspeptics. They absorb nearly their own weight of water. The addition of milk largely increases the rate of albumin and fats, therefore that of nutrition. Potatoes, fried, possess almost double the alimentary force on account of the large elimi- nation of water and the addition of fat; but they are harder to digest. When they are prepared with butter or drip- ping, or made into a potato salad, the same rule applies. REACTIONS a. Digestive. — Of all vegetable foods potatoes are the easiest on the stomach. Nitrogen is reduced to a minimum; starch is present in the shape of finest division; the cellulose is tender, and small in proportion. But seasoning may, as we have seen, affect the digestibility very smartly. POTATOES 223 The influence on the intestinal digestion is equally propitious, inasmuch as the carbohy- drates stimulate pancreatic secretion, and peri- stalsis receives a moderate and beneficent reflex action from the cellulose residue. Putrefaction is rarely observed. b. General. — Potatoes have a rather liberal effect on the nutritive process and on the cellu- lar system in general. Being poor in nitrogen, but rich in ternary bodies, they undoubtedly restrain the energy of the economy. By their wholesome action on the digestive organs they improve the general tone of the whole system. Their alkalinity advances oxidation and the combustion of cellular waste. c. Renal. — The abundance of potassium salts makes them slightly diuretic. INDICATIONS AND CONTRAINDICATIONS We have no hesitancy in declaring potatoes a good food article, although the nutritive value is below that of bread and pulse, and the pur- chase price is higher. One thousand calories of potatoes cost 45.82 per cent more than one thousand calories of white bread, and 42.40 per cent more than one thousand calories of split 2M WHAT SHALL I EAT? peas. They are by no means merely the poor man's food, for they grace the rich man's table perhaps even more. In pathological conditions the indications cen- ter partly in their digestibility and partly in the high rate of alkalinity. The first quality addresses itself to weak and disordered stom- achs, i.e., to dyspeptics by instifficiency, to ane- mics, debilitated persons, and convalescents, by all of whom they are well supported, provided they reach the table either baked or steamed, or mashed with milk or a small allowance of fresh butter. In intestinal troubles the potato proves like- wise of benefit, especially in cases of constipa- tion, so common among women, when they should be consumed at the midday meal. In Bright' s disease or cardiac affections baked and mashed potatoes should figure in the menu, because the absence of chlorin and the high percentage of potassium makes them a diuretic food. If we admit the theory of Bunge, they should be of decided use in cases of oedema. Their high alkalinity points to them in hyper- acidity and arthritis. Besides, although "fill- ing," they are less nutritive and certainly do POTATOES 225 not favor superalimentation. Arthritics may safely risk eating meat and fish garnished with potatoes so long as the latter are not fried, "sautees," or buttered. If potatoes in large portions have been spe- cially recommended in cases of diabetes, it cer- tainly was on the score of their high alkalinity. It is true, Labbe has shown that the starch in the potato is the largest portion of its utilizable components, but this quality does not seem of sufficient importance to permit of an explana- tion of the many cases in which improvement has been observed. On the contrary, as we have said about arthritis, the diabetic who stands in need of fats should season his pota- toes with butter, dripping, or oil. In gout or liver complaints they are also a welcome nutrient, readily taking the place of bread, which is acid and harder to digest. In obesity they are harmful. Stoutness is fre- quently due to the abuse of farinaceous foods in general, and of potatoes in particular. WHAT SHALL I EAT? CHANGES When the potato sprouts, it often happens that solanin, which is formed at the expense of albumin, increases in very disquieting propor- tions. From 0. 04 it may rise to 0. 60 gram per kilogram and cause poisoning, diarrhea, vomit- ing, or dilation of the pupils. Sprouting pota- toes should never be consumed. If, however, their use cannot be avoided, it is well to re- member that solanin is centered chiefly around the sprouts, and that by peeling thickly and cutting out deep the shoots the danger of pois- oning is minimized. THE USE OF FARINACEOUS FOODS AND OF LEGUMES IN INFANCY AND CHILDHOOD Toward the end of the first year milk be- comes insufficient as a nourishment for the child and farinaceous substances must be called into service which afford new elements in new pro- portions, favoring the development of the diges- tive organs and of the body in general. They are particularly useful when inflammation of the bowels makes milk toxic and dangerous. Recent experiments have shown what excellent POTATOES 227 results may be obtained in such cases by the ad- ministration of light farinaceous foods, and with soups made from legumes. We will add here a few words about their twofold usefulness in the healthy as well as in the ailing infant. The flour we refer to is either obtained from cereals — barley, oats (gruel), maize, rice; or from legumes — lentils, peas; or from tubers — the fecula of potatoes, tapioca, arrowroot. With the exception of the last three men- tioned, we know already their relative composi- tion.^ The fecula of potatoes represents starch al- most in its pure state. Tapioca is a fecula de- rived from a plant called manioc, which grows in. Brazil. When treated by heat it becomes translucent. Arrowroot is a fecula made from a plant growing in the Antilles; it is called maranta indica. Albumin. Fats. Fecula of potato. 0.74 0.05 Tapioca 0.17 0.37 Arrowroot 0.88 0.18 ' The flour made from peas and lentils is practically of the same composition as that of dried le^mes, of which we have already given the analysis. Carbo- hydrates. Ash. Calories. 78.32 0.43 324 84.50 0.09 349 82.50 0.20 344 ^28 WHAT SHALL 1 EAT? Nitrogen and fats are wanting, but the salts are abundant. Starch really represents the true nutritious value which is considerable. These different products have a special claim each as baby foods by a series of qualities which is common to them all, but is more or less pro- nounced in each individual variety. 1st. They are nutrients very easy to digest; they require but the slightest exertion on the part of the stomach as well as of the intestines. Yet, from this point of view, their value is un- equal and their composition permits of making a scale of digestibility of which we shall speak anon. 2d. They exert an antiseptic action upon the intestinal flora. We have dwelt on this ques- tion to some length (page 170), so need not re- cur to it here; but this quality is of particular value in the infant forever exposed to the dan- gers of intestinal infection. 3d. With the exception of the feculae, the percentage of mineral bodies is very high, a quality to be much appreciated at an age when the organism is building its frame and laying the mineral foundation for its cellular sys- tem. Organic phosphorus, which is so plentiful POTATOES 229 among them, is a powerful aid in the proper ad- justment of the chalks and phosphorus in the osseous tissues. 4th. Their nutritive power is high, as the table given above shows. Yet danger lurks in this advantage, and the child must be con- stantly guarded against overfeeding. 5th. They keep for a long time without un- dergoing a change. While traveling during the hot weather season, when the milk goes wrong so easily, they are most convenient arti- cles. For the normal child, whose digestive tube is in good shape, these flours may be mixed with the milk, boiled for fully five minutes in order to facilitate the digestion of starch, and given in drafts gradually more concentrated and in- creased in amount. A systematic progression should be followed not only as to quantity, but also as to the quality of the flours used, espe- cially during artificial and mixed nursing. Previous to the sixth month the digestive fer- ments are but little developed in the baby, and milk alone should be given. After the sixth month, when the salivary and pancreatic juices begin to exert their influence. WHAT SHALL I EAT? only starchy flours should be added: fecula of potato, cream of rice, arrowroot, and tapioca. We put tapioca at the end of the list, because it is a trifle harder to digest than the rest. After the twelfth month flour, slightly al- buminized, may be introduced, wheat-meal, barley, rye, maize, oats (all given here in the order of their digestibility). During the third year, or sooner or later ac- cording to the digestive aptitude of the child, flours rich in albumin may be employed; len- tils, peas, beans. Each of these should be given alternately. A regular system of rotation should be estab- lished and the child should not be limited to one variety only. However, the flour made from legumes, being highly nitrogenized and rich in xanthic bodies, must be rather eschewed in children with deli- cate stomachs, especially when subject to ar- thritis or eczema. When nursed at the breast, these broths can- not be given until the child has been weaned, when the method of procedure will be quite sim- ple, but the child should, nevertheless, be sub- jected to methodical regulations. POTATOES 231 As for quantity, careful watching is no less re- quired. Between six and nine months it is suffi- cient to add one teaspoonful of the broth to the milk once a day. By and by the amount may be increased, keeping a strict account of the daily rations, always remembering that one generous teaspoonful of flour weighs about 10 grams, and consequently represents an average of 350 calories. In cases of enteritis and gastroenteritis, so com- mon and of such serious consequence in the first tender years of life, and when milk is calculated to aggravate the trouble, the cereals and le- gumes will render signal services, but then the method of employment differs. The lack of di- gestive juices and the fear of putrefaction de- mand their application in very liquid and the least nutritive form. Cereal decoctions, and broths made from legumes, are among the prep- arations most in use. We give two reliable recipes. 232 WHAT SHALL I EAT? CEREAL DECOCTION ACCORDING TO COMBY Wheat Pearl barley Crushed maize Dried beans, shelled and unshelled Lentils, shelled and unshelled .... Dried peas, shelled and unshelled 30 grams of each, or 1 good soupspoonful Put into 3 liters of water, boil thoroughly for three hours. Add 1 liter of water and 5 grams of salt. Then strain. It should yield 1 liter of broth. BROTH MADE FROM LEGUMES AFTER MERY Potatoes 60 grams Carrots 45 " Turnips 15 " Dried peas 6 " Dried beans 6 " Water 1 liter Soak the dried legumes first in cold water. Bring the water to a boil and add the other vegetables. Boil for a quarter of an hour in an earthen casserole or a porce- lain dish provided with a cover. Add 5 grams of salt. Strain. These two preparations, which may be varied ad libitum, have a strong compound of mineral substances, and for that reason make excellent broths. As they ferment or turn sour very eas- POTATOES 233 ily, it is wise to keep them in a covered dish and in a warm (not hot) place, but not longer than twenty-four hours. The nutritive coefficient is rather of a moderate degree. They represent, so to speak, a sort of water diet; but have, espe- cially the broth made from legumes, the advan- tage of maintaining the mineral reserves in the organism. The predominance of inorganic ele- ments, chiefly that of sodium chlorid, is held by many authorities to constitute the basis of their therapeutic efficiency. They certainly form an excellent substitute for the rigid water diet, especially in acute dis- eases in which salts (liquid or crystallized) pre- vail. The treatment should not be protracted beyond a period of ten days; neither should the broths be given during the first six months after birth. — (Mery.) At the end of ten days more solid feeding should be resumed, beginning with buttermilk, light soups made from fecula of rice, gruel, or such preparations as we have referred to already under the head of substitutes for milk. Great caution is advisable in the resumption of a heav- ier diet. It should not be started until all the morbid symptoms have completely disappeared. GREEN VEGETABLES This class comprises all those vegetables which are, as a rule, consumed immediately after they have been gathered. They are also known un- der the name of fresh or aqueous vegetables, because water is their chief constituent. We prefer, however, the denomination of "green vegetables.'^ The varieties are very numerous and differ considerably in accordance with climatic condi- tions and surroundings. We shall first discuss the properties common to them all, and then particularize the qualities of each individual kind, reverting afterward to the indications and contraindications. COMPOSITION AND FOOD VALUE Green vegetables are individualized by three distinct characteristics common to them all in the same degree. 1st. Water is the principal factor in their composition, varying from 85 to 95 per cent. 234 GREEN VEGETABLES 235 The juice of fruits and even milk are less watery. 2d. The mineral principles are very weak. The ash represents only 1 to 2 in 100 parts of fresh extract, and 10 to 20 in 100 parts of the dried compound. Sodium, and again potassium, preponderate and confer upon the vegetables a strong percentage of alkalinity, which acts as a powerful aid in combating the evil effects of hyperacidity, against which man has forever to guard himseK. Silica is relatively abundant. Phosphorus, lime, magnesium, and iron are found in variable quantities. Chlorin does not reach even 0. 01 per cent. Besides these mineral components, which are nothing uncommon in all our foodstuffs, a few of the green vegetables show also traces of iodid, manganese, arsenic, and fluor. It is more than probable that these metalloids play an impor- tant role in physiology. Of course, when pres- ent, they enhance the mineralizing value. 3d. The abundance of cellulose, although characteristic, is perhaps also of smaller signifi- cance, because dry legumes when not decorti- cated, as well as certain fruits, are much richer in cellulose. Nevertheless, green vegeta- 236 WHAT SHALL I EAT? bles derive a great deal of their alimentary power from this presence of cellulose, at least one-half of which is digested and absorbed, but only when the vegetable is just from the garden. In large cities this condition is hard to obtain, as the supply comes from a distance and reaches the consumer in all possible grades of freshness. This defect in the absorption of cellulose is one of the many inconveniences caused by the diffi- culties accompanying the problem of provision- ing large centers of population. The real caloriferous principles, such as albu- min, fats, and carbohydrates, are small in pro- portion. Nitrogenous substances scarcely reach 1 to 3 per cent. Among them we must mention a small amount of casein, vegetable legumin, and phosphorated nucleo-proteids, all present in the form of albumin. The rest are under the form of amid, amidoacids, leucin, tyrosin, glutamic and aspartic acids, all of very doubtful value. The percentage of fats is small. They are partly composed of phosphorated lecithin. We must not neglect to mention the aromatic substances, nor the essences, acid and piquant to the taste, which confer upon many vegetables the merit of genuine condiments. GREEN VEGETABLES S37 The carbohydrates are the most mteresting part to study in the garden vegetables which take such a prominent place in the diet of diabet- ics. The percentage balances between 3 and 5. Contrary to the cereals, starch and its deriv- atives (cane-sugar and glucose) do not represent even one per cent. In their stead we find, how- ever, sugars much easier supported in diabetes, such as levulose, galactose, mannite, inosite, dulcite, a small portion of inulin and dextrin, and certain mucilages and gums, unfortunately hard to assimilate. The nutritive power derived from all these compounds is exceedingly small, as by far the largest amount is due to the ternary bodies. However, this defect is outweighed by the abun- dance and variety of inorganic bodies. Accord- ing to Gautier, man draws from this source about one-fifth of his daily mineral ration. This is the reason why alkaline and minerali- zing foods must figure in our diet. METHODS OF PREPARATION Fresh vegetables must first of all be most carefully examined and thoroughly washed in several changes of water, to which should be 238 WHAT SHALL I EAT? added some kitchen salt. They become soiled by the ground in which they grow, the dust from the roads, and the water used for irrigation (especially dangerous in the vicinity of large cities). If cleanliness is required in every food, it is trebly needed with vegetables. Radishes, long and round, or black or white, beet-root, tomatoes, onions, artichokes, may be eaten raw, either with salt or vinegar and oil to make them softer and more digestible, or with- out. They are all heavy, and must be prohib- ited in dyspepsia and in all cases of intestinal disturbance; but in the normal stomach they act like stimulants and aperients, and have, espe- cially in the summer-time, a tendency to whet the appetite. To counteract the irritating ef- fects of the aromatic essences contained in them, they must be thoroughly masticated. Often a prolonged cooking of the vegetables is required in order to effect the softening of cellulose and the bursting of the vegetable cel- lules; it assists at the same time in dissolving the starchy matters, the gums and mucilages, and to render them more assimilable. We have already given hints how to preserve in the cooking the nutritive principles, the aro- GREEN VEGETABLES 239 matic substances, and the essential salts. We confine ourselves, therefore, to a few remarks here about the importance of preventing the waste of the salts. In spinach, for instance, nearly 7 per cent of the mineral content may be lost by pouring away the water. Yet there are certain vegetables, such as artichokes and asparagus, which must be cooked in plenty of water; but the water so used should not be thrown away, but utilized for making sauces or vegetable soups. It is quite a different thing, however, when vegetables are prepared for diabetics. In this case plenty of water should be used, in order to reduce the proportion of the carbohydrates. Von Noorden recommends even to cook them twice in an excess of water, and each time to pour off the liquid. REACTIONS a. Digestive. — The action of the aqueous veg- etables on the stomach is complex, and must be properly analyzed. The nutritive principles, i.e., the ternary and nitrogenous bodies are, so to speak, a negligible quantity. But this defect is offset, to a certain extent, by the higher per- WHAT SHALL I EAT? centage of the savory and odorous substances — those aromatic essences which slightly stimulate the gastric secretions and act as substitutes for condiments. On the other hand, against this benign influence, operates the inverse action of cellulose, which ferments easily, overburdens the stomach, retards evacuation, and even secre- tion, whence arises that feeling of surfeit so fre- quently experienced when partaking of vege- tables. On the whole, many varieties are hard to digest unless they are absolutely fresh and mashed, or, still better, strained. In the intestinal canal cellulose produces more essential effects by provoking intestinal peristal- sis. With some it acts simply by mechanical contact; with others the reaction is indirect. It undergoes a process of fermentation and is trans- formed into carbonic, lactic, sulphurous, and fat- ty acids, which continue their course through the muscular system. But it is easy to under- stand how readily this fermentation may be- come exaggerated, thus turning the advantage into an inconvenience, and the vegetable into a carrier of putrefaction and flatulency. b. General. — These foodstuffs have a very low stimulating power. Their action is vested GREEN VEGETABLES 241 principally in their alkalinity, which advances oxidation and the nutritive process in general. c. Renal. — The large percentage of water and potassium renders them diuretic. Yet, some varieties contain elements such as purin, alka- loids, ether, benzoic acid, which act as irritants on the kidneys. INDICATIONS AND CONTRAINDICATIONS One of the useful qualities of fresh vegetables undoubtedly is that they prevent man from eat- ing too much. This may sound paradoxical, yet will appear justified, if we remember that bulky, yet less nourishing as they are, they soon provoke a feeling of satiety. It seems that by a special dispensation of Providence they appear on our tables during the summer months, when the excessive heat reduces our daily needs al- most automatically and without giving cause for alarm. Green vegetables are essentially a summer food, the same as the dry legumes are intended for the winter; and both, though en- dowed with different calorific values, furnish an abundance in mineral compounds. They are more appropriate for the diet of the well-to-do, of heavy. eaters, and persons of sedentary habits. 242 WHAT SHALL I EAT? than for the man who performs manual labor, as he cannot find in them an equivalent for the expenditure of muscular exertion. Their low nutritive power puts them also to the fore in the pathological domain. In obesity, they greatly assist in reducing the pain and in- convenience occasioned by the starving process. All regimens prescribed for stoutness contain green vegetables in plenty. In arthritis the same profitable results may be obtained. Green vegetables are precious by reason of their alkalinity which counteracts the excessive acidity of the stomach, and of cellu- lose which relieves constipation. For which reasons they should undergo a process of most thorough and minute mastication to forestall excessive fermentation in all cases when they are employed for cathartic purposes. Moreover, a careful choice should be made among the many varieties, rejecting all those which possess toxic or irritating qualities. The self-same observations are applicable to gout, uricemia, and liver complaints, for which, as a general rule, the "grasses" are suitable. In diabetes the primary indication is "green GREEN VEGETABLES 243 « vegetables, " for in every form they are service- able. They fill the stomach and assuage the pangs of hunger so exacting in this disease. Not only is the percentage of carbohydrates low and still more reducible by proper cooking, but a portion of it is present in a form which may be readily utilized by the economy: levu- lose, mannite, inulin, inosite. According to Gautier, artichoke, oyster-plant, salsify, chicory, lettuce, onion, leek, and Jerusalem artichoke are the most favored varieties in this respect. They exercise a benign influence on the course of the disease, by reason of their alkaline and vegetable albumin contents. — (Von Noorden.) For the same reasons they are indicated in re- nal complications or in menacing coma. Finally, they assist in digesting the fats with more ease, which is so important a point in diabetes, thus correcting somewhat their own nutritive insuffi- ciency. While in dyspepsia from fermentation fresh green vegetables cooked in water or milk are well supported, in cases of hyperchlorhydria, chronic gastritis, atony, and dilatation, small quantities only, if well cooked, well mashed, or strained, are tolerated. The species, too, is of 244 WHAT SHALL I EAT? importance and, such varieties as are eaten raw must be strictly prohibited. In intestinal affections, with a tendency to in- Jlammation or diarrhea, green vegetables are ever harmful; but for constipation they are ex- cellent. In enterocolitis they should be used with prudence, and only when strained or well mashed. Still greater discretion is ordered in ptosis and with women afflicted with lax and irritable bowels. Convalescents, demineralized and anemic per- sons will derive benefit from the mineral re- serves accumulated therein, which assist in the reconstruction of the tissues. In tuberculosis, on the contrary, a food so alkaline can be of no practical value. In diseases of the skin, the heart, and the kid- neys no absolute rule can be laid down, as every- thing depends on the special properties of each individual variety. GREEN VEGETABLES 245 PARTICULAES Ash. Calories. 0.66 75 0.43 23 0.83 28 0.46 49 0.85 42 Sprouts and Bulbs Carbo- Albumin. Fats. hydrates. Artichokes 2.64 0.25 15.04 Asparagus 1.61 0.14 8.67 Cabbage (green) . 3.71 0.47 6.69 Onion (spring) . . 1.35 0.24 10.00 Leek 2.00 0.39 7.20 Artichokes. — The lower fleshy part of the leaves is quite nutritious, but very rich in ex- tractives. Manganese is present in large quan- tities. When reduced to a pulp (puree) they are well tolerated even by a weak stomach, but prove slightly irritating to the kidneys. In gout and arthritic they do more harm than good. Asparagus. — The eatable part is the sprout of the plant before it has exfoliated. Its distin- guishing feature is the high percentage of ex- tractive matter (purin = 0. 025 per cent) and of iron (9.92). It contains also aspargin and a substance that gives a peculiar odor to the urine. But little is known of this. Asparagus is apt to irritate and congest the kidneys, and, while increasing the production of uric acid, it WHAT SHALL I EAT? impedes its elimination. Traces of manganese are found in the ash. Dyspeptics should par- take solely of the tips when quite green, and in small quantities only. In arthritic gout, dis- eases of the kidneys, of the heart, and the liver, likewise in hlennorrhagia, it is better to abstain. Cabbage. — This is a favorite food among all the nations of the world. Gautier claims that it represents one-fifth of all the green vegetables consumed. The ancients highly extolled its therapeutic value, and it is still employed by quacks and charlatans. Its chief quality consists in the high grade of mineralization. There certainly is no other food that can outrank it in this respect; phos- phorus, lime, magnesium, iron, reach a height scarcely ever surpassed in any other food. Be- sides, silica is plentiful, especially in cauliflower, with traces of manganese and arsenic. Purin is absent. It is rather heavy and perhaps the hardest to digest among the green vegetables, and makes a flatulent dish. The different varieties vary, however, in this respect. Cauliflower is the easi- est in the lot, then come savoy, green boiled cabbage, and Brussels sprouts. GREEN VEGETABLES 247 The culinary art, that adds fats, grease, lard, cream, bacon, and pork, still further increases the indigestibility. Only robust stomachs can stand large helpings. Sauer-kraut, however, is an exception. The leaves of the cabbage-head are cut into shreds or strips and macerated for not less than ten or twelve days in salt and a little water spiced with bayleaves, peppercorns, and juniper berries. Lactic fermentation makes of this a food easy to digest, but perhaps a little toxic. For the man in prime condition it is an excellent nutriment; but diabetic persons should beware of it. As an antiscorbutic food it would prove a failure. Dyspeptics may partake of cauliflower with discretion. All varieties of cabbage must be scratched from the diet list of cases of intestinal auctions, liver complaints, heart disease, albumi- nuria, arthritis, and kindred diseases. Onions. — The nutritive power, especially of raw onions, is very superior, attaining as much as 300 calories per 100 grams. Whilst car- bohydrates are abundant, ordinary starch is scarcely represented. The acrid essence, so pungent to the eye, strongly resembles that of mustard. 248 WHAT SHALL I EAT? Onions are used a good deal for seasoning almost anything — soups, sauces, stuffings, etc. ; and, as they have a stimulating effect on the stomach, they prove useful in anorexia, hypo- chlorhydria, in chronic gastritis of old standing; hut in the other forms of dyspepsia they should be avoided. In kidney or vascular or skin diseases, in cys- titis and blennorrhagia they are prohibited. Leeks are similar to onions — richer in es- sences, but less nutritive. Garlic is a condiment. Its active principle is sulphid of allyl. It is a gastric stimulant and an intestinal antiseptic. Slightly diuretic, it is yet an irritant for the kidneys and vessels. It should be avoided in nephritis, cystitis, and in blennorrhagia. Dyspeptics should treat it with mistrust. By reason of its sulphurated essence its action in pulmonary affections is anti- catarrhal. GREEN VEGETABLES 249 Roots and, Beets Carbo- Alboinin, Fats. hydrates. Ash. Calories. Carrots 0.95 0.25 10.03 0.73 47 Turnips 1.10 0.16 7.30 0.65 56 Salsify 3.44 1.06 12.15 0.53 74 Beet-root (red, cooked) 1.36 0.08 9.22 0.80 44 Celery (knob) 1.64 0.14 8.15 0.62 41 Carrots. — The percentage of carbohydrates is relatively high — 7 out of 9 per cent is repre- sented by cane-sugar. The rate of mineral matter is medium, excepting, perhaps, lime, which is six times stronger than in the potato. The nutritive power is small, unless they are prepared with butter and cream. Intestinal absorption is defective, even more so than in the potato. Carrots, ingested in large quantities, make soft and pasty salts. They prove useful in constipation and to persons of sedentary habits. Hepatics may, as a rule, make extensive and more or less justifiable use of them. The presence of sugar puts them be- yond the lawful reach of diabetics. If thor- oughly cooked and mashed, dyspeptics need not fear them. In turnips the carbohydrates are not so pro- nounced as in carrots, though the taste is more 260 WHAT SHALL I EAT? sweetish. They are slightly stimulating, but flatuous, and do not agree with dyspeptics or diabetics. Salsify is a rather fibrous food and not adapted to dyspepsia; but its compound of inu- lin makes it agreeable to diabetics. The oyster- plant resembles salsify in every respect. Beet-root should be cooked and mixed with salads. It is too hard to digest to suit dys- peptics, and too rich in sugar to appeal to dia- betics. Its content of oxalic acid prohibits its use in arthritis, oooaluria, and atheromatous af- fections. Radishes and horseradish are condiments rather than foods. Sulphocyanate of allyl, the active principle of mustard, imparts to them the double quality of acting as a stimulant to the stomach and as an antiseptic to the intesti- nal canal. If they are properly chewed and masticated, their use is quite rational, especially in the summer-time, and not only by persons in good health, but also in a number of diseases, such as diabetes and anemia. But when the functioning of the stomach, liver, heart, and kidneys is defective, they become harmful to the economy. In blennorrhagia they must be GREEN VEGETABLES 251 avoided — horseradish particularly. They con- tain arsenic. Herhaceoiis Vegetdbks These are the real green vegetables and pos- sess in the highest degree all the properties, ad- vantages, as well as inconveniences of which we have already said so much. Albmnin. Celery 1.35 Chicory (curly) . . 1.47 Cress 2.12 Spinach 2.65 Lettuce 1.10 Sorrel 2.20 Rhubaxb 0.44 Celery, too little appreciated, is a stomach and heart stimulant, but rich in cellulose, to be avoided in cystitis and hlenvxyrrhagia. In Eng- land it is reputed to possess antigouty proper- ties. Chicory has a certain bitter by-taste which enhances its aperient and stimulating virtues. This amaritude is still more pronounced in the endive. Mineralization is weak, except in wild chicory. Fats. Carbo- hydrates. Ash. Calories. 0.21 5.80 0.92 31 0.11 3.10 0.58 20 0.26 3.76 0.98 27 0.36 4.29 1.43 32 0.27 2.91 0.66 19 0.49 4.89 0.81 32 0.54 3.60 0.50 21 252 WHAT SHALL I EAT? I Cress is an excellent appetizer by reason of its allyl content. It is also rich in iodid, and on this account it may be recommended in lym- phatic and parathyreoid troubles. It is diuretic and antiscorbutic. Spinach is particularly rich in mineral bodies. It supercedes all others in calorific value, and also in the percentage of mineral content of phosphorus, lime, magnesium, and iron. It is, therefore, an excellent food for derhineralized and anemic patients. But as oxalates prevail, it is harmful in hepatic troubles, in atheroTna, ec- zema, albuminuria, oxaluria, arthritis, and gout. Fresh and carefully cooked, it agrees with dys- peptics. Lettuce is sometimes cooked and served like spinach, but is chiefly eaten as a salad, like dan- delion, corn salad, and chicory. Irritable stomachs do not tolerate salads well, and in hyperchlorhydria they should be avoided. For persons of sedentary habits, and for heavy arthritic eaters, as well as in constipation, their application will prove very useful, as they often serve to prevent overeating, act gently on con- stipation, and mineralize and alkalize the sys- tem. GREEN VEGETABLES 253 Sorrel and rhubarb might just as well be counted among the fruits. The high percent- age of oxalic acid is their particular quality. All contraindications enumerated under the head of spinach apply here with double force. Stomachs that are overworked or in an irritable condition cannot stand their acidity. VEGETABLE FRUITS Carbo- Albumin. Fats, hydrates. Ash. Calories. Eggplant (Aubergine) . 1.07 0.22 5.30 0.39 28 Melons 0.68 0.12 6.38 0.36 30 Tomatoes 0.76 0.32 3.90 0.38 22 Eggplant has not yet become a very popular food; melons are bad for diabetics^ and, as they are apt to relax the bowels, they should not be recommended to persons with a sensitive and irritable digestive apparatus; but if they are thoroughly matured, dyspeptics may partake of them in small quantities without experiencing any subsequent inconvenience. The tomato has an acid taste, on which ac- count its use in arthritis has for a long time been considered obnoxious. But Gautier has, by very careful experiments, demonstrated that the tomato contains but slight traces of oxa- 254 WHAT. SHALL I EAT ? lates, and that the ash is decidedly alkaline. Therefore no reason exists why arthritic, gouty, and anemic individuals should not eat tomatoes without unpleasant consequences. In dyspepsia and hyperacidity, however, they should be re- moved from the menu, unless they form a mere admixture to sauces. Gherkins and capers we look upon more in the light of condiments than vegetables. In hyperchlorhydria and enterocolitis they are pro- hibited. But they may render good service in dyspepsia from insufficiency, chronic gastritis, and in anorexia, in tuberculosis, and anemia. Esculent lioletus . . . . Mushrooms Albumin. Pats. . . 4.00 0.32 Carbo- hydrates. Ash. Calories. 0.50 0.60 22 Champignon, raised mushroom beds. . . in .. 3.57 0.20 1.00 0.70 21 In spite of their nitrogenous compounds, they possess but little alimentary value and serve generally as seasoning only. While their sa- vory qualities provoke gastric secretion, they do not agree with delicate digestive organs. Xan- thic bodies are plentiful, and toxic elements are present. Hence they cannot be allowed in ar- GREEN VEGETABLES 255 thritis and similar conditions, neither in albumi- nuria, nor in aif ections of the heart. Fatal accidents, superinduced by the inges- tion of poisonous mushrooms, are so frequent that it is needless to dwell on them here. It is often very difficult to distinguish between edible and poisonous mushrooms, and even the good ones may have a toxic effect on predis- posed and enfeebled persons. If truffles do not in every instance cause poi- soning, they nevertheless fall under the same restrictions which we have mentioned before, especially for ^uty patients. FRUITS Fruit was no doubt one of the original foods of primitive man, and even now, among the ancient races, still claims the place of honor. After vegetarianism, in which extensive use is made of it, we have heard a good deal lately about fruitarianism, the believers in which pre- tend to content themselves with fruit alone as a diet. We will not enter here into a discussion about the specific merits of these two doctrines, but will confine ourselves to the remark that we cheerfully admit the excellent value of these products of nature as a proper aliment; also, that with the qualities possessed by them, it is quite possible to correct or neutralize the evil effects emanating from the many bad habits that taint our diet. It would be a matter of great satisfaction, in- deed, if the companies and trusts that are inter- ested in the supply of fruits were to arrange the 256 FRUITS 257 prices so as to enable the denizens of towns and large cities to use them more freely. For the purposes of our study we divide the fruits into three classes, according to their com- position and different characteristics, viz. : 1, watery, acidulated fruits; 2, those that contain sugar, properly speaking; and 3, amylaceous, or oily fruits. WATERY, ACIDULATED FRUITS COMPOSITION AND FOOD VALUE Carbo- Albumin. Fats. hydrates. Ash. Calories. Apricots 0.81 0.11 13.74) 0.44 61.00 Cherries 0.95 0.67 16.31 0.41 77.00 Lemons 0.33 0.33 9.62 0.26 44.00 Quinces 0.94 0.62 25.00 0.35 113.00 Strawberries 0.81 0.50 8.72 0.48 44.00 Raspberries 0.67 0.93 13.39 0.38 62.50 Gooseberries 0.68 0.48 13.14 0.55 61.50 Oranges 0.51 0.22 11.38 0.34 51.00 Peaches 0.77 0.43 14.18 0.43 65.50 Apples 0.25 0.26 14.17 0.29 62.00 Pears 0.43 0.26 14.50 0.32 62.00 Plums 0.62 0.31 17.10 0.44 76.00 Grapes 0.96 1.25 18.34 0.32 91.00 It is obvious from these data that water rep- resents about four-fifths of the weight of this 258 WHAT SHALL I EAT? class of fruits, to which is due their refreshing nature and their strong power to quench the thirst, thus acting as substitutes for tonic bever- ages or hard and soft drinks. According to Pascault the water contained in fruit possesses particular properties and enjoys a special vitality, an electric reaction analogous to that of mineral waters when taken at the springs. This much is certain, that the special proper- ties of fruits rest in their watery contents. Albumin and fats are small in proportion. Fruits are the least nitrogenous of our ali- ments. Carbohydrates form the only caloriferous principles. A little more abundant than in the green vegetables, and in composition less varied, they consist almost uniformly of glucose and levulose in equal parts, and a small percentage of saccharose. The latter is diminished in pro- portion to the ripeness of the fruit. We may add a small compound of gum and of pectic matter, which in the boiling forms the jelly; and of ether, to which the fruits owe their pleasant and distinctive aroma. Cellulose is very lavishly present, averaging FRUITS 259 often one-twentieth of the total weight, or one- fourth of the dry extract. Free acids and acid salts (malate, citrate, tar- trate, fumarate) are plenteous, whence their real acidity, so easily discovered by the taste, is derived. After absorption these organic acids are burned up and transformed by the econo- my into carbonates, which alkalize the juices. Hence fruits, when being ingested, are acid, but in the process of assimilation and elimination become alkaline. On account of the small per- centage of ash their mineralizing power is also very small, ranging after green vegetables, leg- umes, milk, eggs, and certain cereals; but pre- ceding meat, fish, bread, pastry, and rice. Potassium and sodium constitute about 50 to 60 per cent of the ash. Phosphorus is wanting; lime and iron are a little stronger. Sodium chlo- rid oscillates between 0.01 and 0.02 per cent. The alimentary value is naturally low, except in grapes, 100 grams of which will give 100 ca- lories. The merit of watery acidulated fruits is to be found in the high percentage of water and cellulose, and of alkalinity. 260 WHAT SHALL I EAT? METHODS OF PREPARATION AND EMPLOYMENT Fresh, natural fruit holds its laxative, anti- scorbutic properties, for which reason it is best to eat it in that condition. But it should be always carefully washed and peeled, thereby removing a very liberal and noxious flora of microorganisms. Its digestibility depends largely on the state of ripeness. Immature pears and plums, for instance, will frequently cause diarrhea and dysentery. The state of preservation, however, is, on the contrary, a matter of secondary consideration. It is by no means an established fact, that mellow pears, for instance — that is to say, fruit advanced in age — is worse for the stomach than when quite fresh. Cooked fruit is very easy to digest, and can be eaten to advantage by a large number of dys- peptics. Peaches, unpared, just steeped for two or three minutes in boiling water, form an ideal food for irritable stomachs. In intermittent fever a fruit-broth made of apples, cherries, grapes, bayberries, and prunes is most effective and beneficent. Ewald gives the following recipe: FRUITS 261 "Pass hot gruel through a strainer, add sliced plums (or any other fruit), sugar, and a pinch of salt. Boil anew until the fruit becomes ten- der." Fruit, fresh or cooked, does not keep well. Although hundreds of methods and means for preventing its rapid decay have been advanced and recommended, none has so far given the same satisfaction as sterilization. Put the fruit, either with or without sugar, into a preserving- jar, screw the lid well down upon the rubber ring, place the jar for one quarter of an hour in boiling water, being careful not to let the water reach the cover of the jar. The heat will ster- ilize the fruit completely. As the air in the jar cools ofp it forms a vacuum, and hermetically seals the lid. The prevailing methods of preserving fruits are to boil them, with an addition of sugar, into a jam or syrup, which is kept in air-tight jars or bottles. These preparations are easy enough to digest, and the large content of sugar in- creases the nutritive power; but they incline to provoke gastric- or intestinal fermentation and putrefaction. Children, particularly, are apt to overeat themselves on them by reason of the 262 WHAT SHALL I EAT? sweet taste. Proper vigilance in their diet, as well as in that of arthritics, is therefore required. In anorexia, and in conditions of general debility, they serve an excellent purpose. Fruit jellies, due, as we have already said, to the cooking of the pectic contents so abundantly present in certain fruits, are especially easy for even deli- cate stomachs. Some fruits (apricots and pears) are treated by a process called desiccation, which strongly enhances their nutritive power, as the percentage of water falls from 85 to 33, and even to 30. The juices, lemonades, and syrups made from fruit are all to be recommended to the healthy, as well as for generous use in the sick-room. REACTIONS a. Digestive. — There is a strong resemblance here to the green vegetables, as has already been forecast by the analysis. The action, how- ever, is twofold, and at the same time opposite. By essence, taste, odor, and acidity it is both physical and chemical, which gives them the quality of condiments as well as of aperients; while the large percentage of cellulose, on the other hand, retards the process of digestion, and FRUITS 263 even may irritate the stomach. In both in- stances the effect is more pronounced than in the legumes. The same similarity may be observed in the intestinal reaction. Cellulose here again acts, and stimulates peristalsis. When it is present to excess, or when the fruit is ripe, it irritates and ferments and engenders diarrhea, the more so if the canal is enfeebled and in an irritable condition. b. General. — Since they contain nothing of a toxic or stimulating nature, being composed of salts and ternary elements only, fruits exercise the beneficent effects of a cleansing, elimina- ting, and disinfecting character on the whole organism, this being entirely due to the high percentage of water and alkalines, for which reason they are, as it were, an antidote to meat. Besides, they possess a special antiuric value. Not only do they dissolve uric acid, but they also inhibit its formation. — (loteiko.) This reaction pervades the whole system, but particularly afFects the circulation and the liver, the functions of which are largely moderated by it. c. Renal. — The kidneys are relieved in the 264 WHAT SHALL I EAT? same proportion. Elimination through them requires no exertion, oxidation is accelerated, and the cellular tissue is protected from deterio- ration. INDICATIONS AND CONTRAINDICATIONS Fruits alkalize the fluids of the body, increase combustion, disinfect and favor elimination. All these properties render them a choice food in arthritis which, after all, is only a state of hy- peracidity, with small powers of combustion and elimination, but strongly inclined to autointox- ication. Their limited nutritive power guards against superalimentation, and the cathartic efficacy enhances their utility in every division of arthritis. Gouty persons had better beware of them, unless intestinal tolerance has been well estab- lished. In uricemia and urinary lithiasts, likewise in liver complaints, they are prohibited. In chronic rheumatism their use should be re- stricted to lemons only. Diabetes requires special consideration. If fruits are alkaline, and if their carbohydrates consist chiefly of levulose, they, nevertheless. FRUITS 265 contain a large quantity of glucose and saccha- rose, which cannot, as is the case in green vege- tables, be eliminated to any degree by cooking without loss of taste and flavor. The best ad- vice is to vise them in moderate quantities, with due regard to the percentage of sugar and the degree of tolerance which can be thus tabulated: BUberries, whortleberries, lemons, gooseber- ries, oranges, raspberries, strawberries, plums, peaches, pears, apples, grapes, quinces. It is well to remember that all stone fruits contain the smallest amount of sugar just before they are entirely ripe. In acetonuria, menace of coma, fruits contain- ing citric and acetic acids may be recommended without hesitation, as they contain antiacetonic properties. Among the illnesses in which a fruit dietwill prove especially beneficial we may mention ne- phritis, diseases of the skin (with a few excep- tions), and fevers. In all these cases soups, broths, and juices of fruits have their proper place, above all, if there is a tendency to consti- pation, as in meningitis. Diseases of the heart and of the blood-vessels may just as well be added to this list. But, if 266 WHAT SHALL I EAT? the cardiac muscles are enfeebled, peeled fruit cooked or in the form of jelly, is preferable, be- cause it puts less strain upon the action of the heart and of the intestines. In atheroma, fruits rich in citric acid must be prohibited, because they increase the chalky deposit in the tissues and the calcification of the arteries. — (Loeper.) For the same reason Ferrier is against the use of oranges and lemons in pulmonary tuberculosis. In gastrointestinal afPections it is difficult to establish a fixed rule, and extreme caution is required. The same may be said about dyspep- sia, with atony of old standing; likewise about dilatations with putrefaction. Some cases will tolerate jams, others cooked fruit with sugar, still others fresh fruit, eliminating, however, such as are too acid or too rich in cellulose. In hyperchlorhydria non-acid and thoroughly ripe fruit may be tolerated. Similar effects will be observed in anemia and dyspepsia, on account of the aperient virtue contained in fruit. In intestinal affections fruit must be forbidden whenever there is exaggeration of peristalsis, irritation or inflammation of the bowels. It is a matter of common knowledge that in enteritis, and in all cases of diarrhea, the use of fruit will FRUITS 267 cause a reappearance of the symptoms; but this refers only to raw fruit; when cooked, or in the shape of preserves, the juice of fresh fruit does not fall under this ban; in fact, jelly of quince is a well-known remedy for these mal- adies. In recent years some exceptions have been made in this direction; for instance, cures have been effected with fruit (banana-paste or straw- berries) in cases of simple serous diarrhea, so prevalent at times in hot climates. The ban- ana-paste acts through the antiputrefactive quality of its carbohydrates. The action of the strawberries is as yet difficult to define. It would appear reasonable to assume that, inversely, fruit would constitute an exceptionally strong remedy for constipation. But the prob- lem is rather complex, for we must not lose sight of the fact that, if cellulose affects in- testinal peristalsis, it may also cause fermen- tation and aggravate the very trouble it was intended to combat. In simple idiopathic constipation of heavy eat- ers, in arthritis and persons of sedentary habits, marvelous results will often follow the use of fruits. It often happens, too, that with the cos- 268 WHAT SHALL I EAT? tiveness the hemorrhoids, so common among this class of patients, disappear also; for they regulate peristalsis and circulation alike. In enterocolitis they are not so well borne, and may give rise to irritation, and even spasms. K at all, they should only be administered either cooked or as preserves, fresh fruits being re- served for light attacks, or convalescence. If constipation is due to atony or enteroptosis, much prudence is required; the dilated and fa- tigued intestines have need for a food which leaves less residue — in fact, for a gastric rather than an intestinal diet; and all fruits belong decidedly to the latter. But, if used at all, then only when absolutely ripe and after the peel or skin and all the seeds or stones have been care- fully removed. Fruit possesses, moreover, another distinct advantage of great social import. The water which it carries into the system diminishes the desire for drinking-water and alcoholic bever- ages. Foster has proved that the consumption of alcohol decreases in direct ratio to the in- creased consumption of fruits. In the war against alcohol, which is so conspicuously be- ing waged nowadays, this factor should play FRUITS 269 a prominent role, and proper means should be adopted for a plentiful and cheap supply of fresh fruits among the masses. The manufacture of non-alcoholic wines from grapes is a step in the right direction. Every efPort should be made to make these products more and more popular. PARTICULAES Apricots are remarkable for their high acid- ity, which restrains their use, however. But this inconvenience disappears when given as preserves or compote. Whortleberries, bilberries, and cranberries are highly prized for their astringent and antiseptic properties. Combe makes large use of them in enterocolitis. As preserves they render excellent service in cases of gastrointestinal embarrass- ments, chiefly in diarrhea. Pineapple is very easy to digest. It is very rich in cane-sugar. Cherries possess a large amount of cellulose, especially in the skin, which cannot be removed. The sick should only eat them cooked. Min- eral substances, preferably iron, are promi- nent. A diet-drink made of cherry-stems has a 270 WHAT SHALL I EAT? diuretic effect exactly within an hour after con- sumption. Many cases of gout will yield to a cherry cure, since the uric acid is changed into hippuric acid; but a constant watch must be kept for the appearance of sjrmptoms of in- testinal trouble. Quinces are so rich in cellulose (they contain three times as much as cherries) and tannin, that they cannot be eaten raw, but only in the form of marmalade, jelly, or jam, with plenty of sugar. In diarrhea, especially in the serous form, they act as an astringent and a tonic. In the normal person a too free use of them will bring on constipation. The lemon occupies, among the fruits, a place of its own, and is of great therapeutic value. Citric acid is refreshing and stomachic. Lem- onade is a most wholesome drink, and withal most popular. Sucking the juice of a lemon refreshes the system in a marked degree, espe- cially on hot and exhausting days. For dyspeptics who are debarred from the use of spices, vinegar, and aromatic substances, the lemon furnishes an agreeable and hygienic sea- soning, which can be employed in a hundred different ways. As it is almost entirely devoid FRUITS 271 of carbohydrates, diabetics should turn to it with predilection. As an antirheumatic it deserves special atten- tion. In acute articular rheumatism it is of doubtful value; but in chronic rheumatism it is an unmixed blessing. The diet should consist of six to eight lemons a day. Stronger doses are apt to tire the stomach and to favor the de- velopment of arterial atheroma by depriving the tissues of their chalky constituents. If the latter be the case, the lemon must be eschewed, likewise in tuberculosis. — {Ferrier.) We must here call attention to the so-called antihydropic virtues, which are of doubtful merit, and to the antiscorbutic value, which is imquestionable. In Barlow's disease it often suffices to add a few drops of baby food in order to prevent an accident. Strawberries contain very little cellulose, but masses of seeds which make them rather hard to digest in dyspepsia, except when cooked or pre- served. As the sugar content is relatively low, diabetics may eat them in fairly, large doses. Of all the acidulated, aqueous fruits they are the most highly mineralized. There is an abun- dance of sodium, of lime, and of iron (as much as 272 WHAT SHALL I EAT? in lentils). Hence, they are a splendid food for anemics and demineralized persons. The straw- berry cure, which, according to Gruebler, equals the grape cure, is of particular value in "pleth- ora, biliotisness, gravel, and gout." — (Martinet) From 300 to 500 grams is the standard dose. In certain cases of chronic diarrhea, in hot cli- mates, two to three pounds of fresh strawberries per day should be prescribed. In eczema, urticaria, and in all skin diseases they are forbidden, because they contain a sali- cylic element which is very irritating. Raspberries are inferior to strawberries, inas- much as they contain three times the amount of cellulose and less ash. Gruebler claims for them antihemorrhagic properties. Gooseberries are extremely aqueous (93 per cent of water to the pound). The taste is strongly acid (citric). The abundance of skin and seeds makes them heavy and irritating to the stomach and the intestines. But in the shape of jam or jelly they are excellent. They contain only 4 per cent of sugar, hence should be the favorite fruit of diabetics. Mandarins are almost identical in composi- tion with the orange, but approach the lemon FRUITS 273 more than the latter, being richer in citric acid and poorer in sugar. They share also the same good and bad qualities, although in a smaller degree. The juice of the orange possesses a strongly marked flavor, and is often used for masking the taste of castor-oU. The Peach is one of the choicest, most deli- cately flavored fruits; but, being rather rich in cellvdose, dyspeptics should not partake of them except as compote, or when cooked in the skin. Pears are a heavy food, rich in cellulose and hard for delicate stomachs, unless they are cooked. Dried pears have a high nutritive value, 257 calories in 100 grams. Apples show the same disadvantage. The per- centage of magnesium is double that of lime, for which reason they suit patients suffering from oxaluria. Certain authorities claim anti- uric properties for them which should prove use- ful in gout. Weiss maintains that the apple only reacts when eaten with the skin, on ac- count of the picric acid present therein. Plums and prunes are of slow digestion and often the cause of diarrhea. Dried prunes are 274. WHAT SHALL I EAT? a good remedy for constipation. Prunes with senna are a mild purgative, and worthy of rec- ommendation. Peaches, pears, apples, plums, and prunes con- tain malic acid. Sugar is bounteous enough to exclude them from the table of the diabetic. Grapes reach the highest zone of all the prop- erties recognized in fruit, generally speaking, for which reason they are preferred in medicine for the purposes of cure. The percentage of acidity is moderate, but varies somewhat in the different species. It decreases with the age of the grape in the same ratio in which sugar in- creases. The latter is nearly all glucose, and exceeds in quantity that of any other fruit. Saccharose, dulcite, and mannite are but slight- ly represented. If ingested in small portions only, grapes agree with almost every kind of illness, but it is necessary to warn the patients, especially those sufFering from indigestion or enterocolitis, to care- fully spit out the skin and pips. We make two exceptions here: diabetes, on account of the prevalence of glucose, and diarrhea, on account of their laxative action. The indications for a true grape cure, which FRUITS 275 consists in the consumption of from two to four pounds of grapes a day with a corresponding re- duction of other foodstuffs, are naturally very limited- It is largely practised around the Lake of Geneva, but can be undertaken anywhere with well-matured and mellow grapes. The following rules are generally observed: One-half the quantity prescribed is taken about noon, an hour or so before luncheon, one- fourth an hour after luncheon, and the last one- fourth an hour after the evening meal. Cer- tain precautions must be observed, if this large volume of food is to be well tolerated. 1. The grapes must not be eaten too cold; 2, they must be previously washed to remove the sulphate of copper coating; 3, they must be eaten very slowly and thoroughly masticated, skin and pips being carefully rejected; 4, after each dose physical exercise must be taken; 5, moreover, it is wise to begin with a smaller dose, say one poimd per day, which can be easily increased until the maximum of four pounds has been reached. Since four pounds of grapes represent about 1,800 calories, the necessity of reducing very materially the rest of the diet will be ap- parent. Haussmann suggests total abstention S76 WHAT SHALL I EAT? from beer, meat, fatty fish, salads, and coarse bread during the cure. The following symptoms should be carefully watched: Stomatitis caused by the hyperacid- ity of the grapes, attacks of dyspepsia and of diarrhea. If any of these should manifest them- selves, the daily ration should be reduced. It very rarely becomes necessary, however, to in- terrupt the cure altogether on account of any of these events. This diet at once involves the intestines, the liver, the kidneys, and nutrition in general. Hence, the indications can be given with pre- cision. As the action on the bowels is loosening, the cure is effective in constipation. Especially in people of sedentary habits, in superalimenta- tion and abdominal plethora. Hemorrhoids rap- idly improve under it, but only when stomach and intestines are robust and vigorous. The liver experiences an excitation like to the cut of a whip, which stimulates all its functions, espe- cially the bile secretion. In lithiasis and hepatic congestion, unless complicated with alimentary glycosuria, it proves of much benefit. The urine becomes more abundant, more al- kaline, but poorer in uric acid under this treat- FRUITS 277 ment, which produces also very happy results in uricemia, gall-stones, in chronic catarrhs of the bladder, especially of old standing. But the digestive avenues must be clear and in good condition. The intraorganic combustion is markedly ac- celerated by reason of the steadily increasing alkalinity of the somatic humors; in fact, a grape cure constitutes a veritable irrigation, a lixiviation, so to speak, of the whole organism, especially in slow and toxic arthritis. Whether it has an economic reaction on the nitrogenous bodies, on the fats and carbohydrates, is rather doubtful. We do not think that a cure of this kind can have the least beneficial effect on tuberculosis. Raisins (dried grapes) show a heavy loss of water and free acids which, of course, increases the percentage of sugar. They are hard to di- gest, and unfit for delicate stomachs and intes- tines. Fats. Carbo- hydrates. Ash. Calories. 0.50 21.87 0.65 100 0.80 71.61 1.23 308 0.24 18.09 0.43 81 1.22 61.52 2.09 276 278 WHAT SHALL I EAT.? SACCHARINE AND NEUTRAL FRUITS Albumin. Bananas 1.21 Dates 1.60 Figs (fresh) ... 1.12 Figs (dried) ... 2.89 These varieties of fruit form an homogeneous class, possessing the following characteristics, viz. : absence of acids, which gives them a pecul- iarly sweetish taste, a very high percentage of sugar, especially when dried or half dry; and a fairly high nutritive value, which is due almost entirely to their carbohydrates; but a feeble mineralization, with potassium and sodium pre- dominating. They form staple foods for certain tribes in Asia and Africa and the West Indies, and are an important food factor also in the United States and certain parts of Europe. Their anti- costive qualities (especially of figs) render them particularly valuable. Of course, in diabetes and dyspepsia of the stomach or of the bowels, they have no place, being much too hard to digest. Bananas may be excepted if made into a compote with plenty FRUITS 279 of sugar and passed through a fine strainer, in which form they make a very nourishing dish, equally easy for the stomach and the canal of the confirmed dyspeptic. — {H. Lahhe.) Figs and dates are emollient fruits. OILY FRUITS Albumin. Carbo- Fats. hydrates. Ash. Calories. Almonds (dry) .... 17.60 49.00 17.00 1.60 605 Hazlenuts (Filberts) 13.50 56.00 12.17 1.91 636 Walnuts (dry) .... 14.06 52.06 15.48 1.24 619 Olives (green) .... 0.83 18.40 8.80 1.10 213 We might as well eliminate olives as a food- stuff, for they are used chiefly as a condiment, or savory only, and are very hard to digest. Their best quality is to be found in the oil which is gained from them, and of which we have al- ready spoken. The other fruits, however, belonging to this category are an exceptionally valuable nutritive coefficient by reason of their very high nitroge- nous components. With the exception of butter, oil, and animal fats, they leave the other foods far behind, surpassing in nutritive power even cheese and beans by one-third. The great drawback is their indigestibility, especially when 280 WHAT SHALL I EAT? eaten in large quantities. They represent sim- ply a lump of cellulose, abundant and compact, which makes them, despite the most careful mastication, a rather tough proposition even for robust stomachs, and quickly provokes that feel- ing of fulness and satiety characteristic of nuts. Even inveterate vegetarians are beginning to recognize this fact and to use them only when finely grated. Upon arriving in the bowels their action is doubly laxative, owing to a sur- charge of cellulose and oleaginous principles. We take leave to point out the larger percentage of nitrogen and the complete absence of xanthic bodies. Also, that, like cheese, they furnish a considerable reserve of albumin quite free from purins. Generally speaking, they are fit enough for robust and healthy constitutions, quite suitable for navvies and persons engaged in manual labor or dwelling in frigid zones. In patJwlogical conditions their use is very lim- ited, and almost exclusively restricted to diabet- ics, for whom they form — being both nutritive and almost free of sugar — an ideal substitute for bread. The "almond breads," however, sold in the market, are too heavy and too solid, apart FRUITS 281 from having a disagreeable taste and being very indigestible. We prefer the almond cakes pre- pared after de GofF's formula, viz. : 250 grams of shelled sweet almonds are pulverized in a mortar, 2 eggs are added, together with 2 grams of bicarbonate of soda and 1 gram of tartaric acid. Triturate and mix carefully. Pour the paste into a mold and cook for twenty-five min- utes. This will make a cake weighing 300 grams, sufficient for one meal and containing only 5 to 7 per cent of carbohydrates. Dyspeptics should shun all these fruits the same as any other indigestible food. In ar- thritis and obesity they had better be forgotten, for they are too replete with nutriment. CONDIMENTS Under this name we comprise a number of substances of spicy taste which are added to our foods for the purpose of either changing or im- proving their flavor. They form the most important basis of what we call "the kitchen," and to them are due, in a large measure, all the advantages, as well as the inconveniences, of our cooked foods. For, if dispensed without reason and judgment, with a free hand as it were, they do harm; but, if employed in moderate quanti- ties, ihey serve a useful purpose, and in some instances become even a matter of necessity. The advantages of condiments are in favor of digestion. Most of them appear to stimulate the action of the stomach and of the intestines by direct chemical action; although this is doubted by some and absolutely decried by other authorities. At any rate they seem apt to provoke a certain amount of irritation. Nevertheless, we must admit that they sharpen the appetite by adding zest to the dish and thus 282 CONDIMENTS 283 exciting the psychic secretions, the importance of which has been demonstrated by Pauloff's researches. In this, no doubt, consists the sum total of their utility, which is chiefly of an anti- septic nature, indirectly stimulating the normal secretions, and directly acting by their essential oUs (salt, garlic, mustard, etc.). They may be looked upon as agents of as- similation and economy, though, with the ex- ception of salt, this is a matter of secondary consideration. Most of the condiments are not foods in the strict sense of the word, inasmuch as they do not cover our needs of energy or of mineral principles. We except salt and sugar, the for- mer being indispensable for maintaining our mineral equilibrium, and the latter being the most useful factor in the production of mus- cular force. SALT Sodium chlorid forms the chief constituent, and is accompanied by certain very valuable im- purities, such as bromid, iodid, arsenic, and fluor. The composition of the salt gained from saline waters differs but little from that of the 284, WHAT SHALL I EAT? rock salt taken from mines. Both undergo con- siderable changes in the process of refining. The fine table salt contains less iron and arsenic than the coarser kitchen salt, and for that rea- son is perhaps less hygienic. Sea salt particu- larly excites the gastric secretions. Sodium chlorid is the one mineral principle in which nearly all our foodstuffs are deficient, and has to be added at the rate of from 6 to 8 grams to our daily rations. Recent research seems to have proved to satis- faction that the hydrochloric acid of the gastric juices is principally derived from the sodium chlorid ingested with our food, and not from the salt contained in our blood. Salt is, there- fore, an essential condition for this secretion. For the bowels it is of smaller importance, but it maintains equality of tension of the blood (isotonia). If taken in overlarge quantities it provokes hypersecretion and diarrhea. The effect of salt on the nutrition is consider- able. It contributes much to the stability of vascular pressure and the general tone of the organism, and facilitates the changes in the tunica intima. The small molecules of sodium chlorid are, so to speak, the small change which CONDIMENTS 285 serves as a medium between the double cur- rency passing from the cellular tissue to the plasma, and vice versa from the plasma to the cells. It exercises over the process of nutrition an influence of economy and moderates the movement of nitrogenous disassimilation, bring- ing about at the same time the oxidation of the unassimilated substances (coefficient of oxida- tion). Some authorities invest it also with the power of forming hemoglobin and red blood corpuscles. For all these reasons, sodium chlorid, the pro- tector of the isotonia of our body fluids, should be kept on a steady level within our economy. Bunge goes so far as to claim that this cannot be accomplished except by the absorption of a stated daily ration. In effect, our daily food, especially the vegetables, carries into our system a notable amount of the salt of potassium, which splits the sodium chlorid into potassium chlorid and sodium phosphate, both of which are elim- inated like foreign bodies, thus establishing a serious loss in sodium chlorid which it should- be the task of alimentation to supply. Salt is also an important factor in the renal secretions. Not only does it augment the aque- 286 WHAT SHALL I EAT? ous diuresis, but also the solid residue. Sodium chlorid is the active means "by which the kid- neys eliminate the greater portion of unassim- ilated substances, such as urea, the complex amins, the leucomains, etc., and the glucose in diabetes, no matter whether these bodies form a direct union with the salt or whether the prod- ucts of decomposition of the tissues are disin- tegrated and carried ofp by the sodium, such as the biliary acids and the original sodium of the salt itself ." 1 This discussion would be incomplete if we were to neglect to make proper mention of the injuries done by the accumulation of salt in our tissues. Archaud and Loeper, and Widal and Javal, have dealt exhaustively with the fre- quency of its occurrence, which often favors the formation of oedemata that infiltrate the whole cellular tissue and the serous cavities, and final- ly involve the canal and the process of nutri- tion itself. In rare cases the retention of chlorid is dry, causing hypertension and cardiac fatigue, as well as sluggishness of the pulse. — {Enriguez and Ambard. ) In both conditions the renal functions are af- 'A. Gautier, loc. cit., p. 386. CONDIMENTS 287 fected, and it is quite true that, if the normal kidney requires salt for normal action, salt is poison to the pathological kidney, involving proportionate serious damage. For the healthy person salt is a necessary adjunct, the more so if vegetables form a large item of the diet. The only tribes (Tounguses and Ostiacs) known to eschew it, live almost exclusively on meat. Too much salt is injurious. Diseases such as nephritis follow in its wake. In some diseases it is permissible to force the daily allowance a lit- tle; for instance, in tuberculosis, scrofula, and lymphangitis, in dyspepsia from insufficiency, and in hyperchlorhydria. According to von Noor- den salt will serve a good purpose in gouty affections by speeding the solution of uric acid. A dechlorhydrated regimen is indicated in a number of cases. In nephritis, especially in cedematou^ nephritis, it has been adopted by Widal with gratifying results. It often brings about a rapid resorption of cedematous growths, and permits of constant changes in the diet of the patient by varying slightly salted with unsalted dishes. In dry nephritis with hyperten- sion, improvement is less marked, as the reten- tion of chlorin is smaller. 288 WHAT SHALL I EAT? Nevertheless, it is always advisable to give it a trial. To judge from these facts, a dechlorhy- drated regimen ought to prove efficacious in scar- Idtina, as the advantage of a varied diet ought to forestall renal complications. The question, we think, deserves further study. These reflections should encourage us in adopting the same regimen in dropsy, in cardiac diseases, in hepatic affections with ascitis, and also in infections phlebitis. — (Chantemesse.) In the first two cases it has proved useful, although not curative. In the latter case the results are uncertain. The same observation has been made in arterial hypertension, hyperchlorhydria, and in obesity (Labbe), in all of which the effect has been of unequal value, causing anemia, ano- rexia, emaciation, and inadeqvute nutrition. SUGAR We shall deal here only with saccharose, or cane-sugar, such as is ordinarily employed in every household. This is a disaccharid, which splits into glucose and levulose. The consump- tion of sugar has attained enormous proportions in all civilized countries; and, from the hygienic standpoint, is an important factor in our bill CONDIMENTS 289 of fare. As a condiment sugar stimulates the appetite, for which reason it seems to appeal strongly to frail constitutions. To children it should be given in moderate quantities only, as they rather require a given proportion of salty foods. Only a little of it is retained by the stom- ach, although its sweetness flatters the palate. In the bowels it is dissected by the acids of the intestinal juices and absorbed in toto, without leaving a residue, thus favoring constipation. In concentrated solutions it is prone to irritate the gastric mucous membrane, and, if eaten in overlarge quantities, it may give rise to an acid fermentation along the whole of the gastrointes- tinal tract. When once it has entered the gen- eral circulation, it infiltrates the hepatic cellular tissue, and is warehoused there in the form of glycogen. Combustibility bestows upon it a calorific value, almost equal to that of albumin; but, as the organism utilizes only the glucose, no chem- ical changes take place, for which reason it may be considered superior to starch, which requires a much more thorough digestion. Its isodynamic coefficient is 397 calories per 100 grams. An attempt has been made to attribute to 290 WHAT SHALL I EAT? sugar a diuretic action; but, whatever there is of it, is rather feeble and indirect and provoked by means of hepatic excitation. Beet sugar is an excellent food for healthy persons, especially those engaged in manual labor. The working- man will derive from it as much or even more power than from meat; besides, it is less expen- sive and less noxious. Ebtperiments made on horses and men have proved sugar to be of great value when strenuous and prolonged physical efforts were demanded. Troops also, engaged in fatiguing field exer- cises, are said to have been much benefited by a generous sugar diet. As a fattening medium it possesses undoubted merit and should be recommended to all who are under the necessity of keeping their physical reserves in special repair, especially when the appetite requires a stimulating agent. But we warn against excessive use, for fear of consequent fermentations. Patients suffering from gastric or intestinal putrefaction in atony, stasis, or gastrecstasis, or from sMn diseases, especially acne and furuncu- losis, should heed this advice. In arthritis sugar often becomes a factor of superalimentation. In CONDIMENTS 291 obesity and liver complaints extreme caution is indicated. In gout it only proves dangerous when eaten together with meat, in which case the acid fermentations impede the elimination of the uric acid, whilst a vegetable diet has the opposite effect. — (loteiko. ) It goes without saying that in diabetes it is interdicted. To meet the hardships coupled with this absolute prohibition, certain substi- tutes are manufactured nowadays which, though they possess the taste of sweetness, yet are de- void of all the inconveniences attributable to sugar. Foremost among them are saccharine (benzoic sulphinide acid) which is quite harmless and two hundred and forty times as sweet as cane-sugar; and dulcine (paraphenol-carbamid), two hundred times as sweet as cane-sugar, but of which not more than 50 centigrams per day may be consumed with safety. — {Kon Noorden. ) In former days honey was more in common use, in the pharmacy as well as in the kitchen, when the price of sugar was so much higher than it is to-day. It consists of almost equal parts of glucose and levulose, with a small percentage of saccharose and some aromatic substances and coloring matter. The available calories are 230 292 WHAT SHALL I EAT? in 100 grains. On account of a slight prepon- derance of levulose it proves to be harder on diabetics than cane-sugar. But its laxative and antifermenting properties render it excellent in food value. As a purgative for children of ten- der age it is admirable. OTHER CONDIMENTS In the kitchen a whole series of substances are employed which have been styled by Gautier as, 1, aromatic condiments, i.e., vanilla, cinnamon, cloves, chevril, parsley, bay-leaf, etc. ; 2, acrid or peppery: common peppercorn, ginger, all- spice; 3, alliaceous or ally lie: onion, mustard, horseradish; 4, acid: vinegar, capers, gherkins, citron; 5, condiments of animal origin: ancho- vies, caviar. Their food value is either nil or exceedingly small, yet they possess properties of which we have already spoken. They stimulate the appe- tite, and consequently the digestive functions; their action is antiseptic, especially the aromatic species, such as garlic and mustard. In the summer-time and in hot climates these condi- ments serve the purpose of rousing the torpid and sluggish digestive organs into useful activ- CONDIMENTS 293 ity, whilst among the poorer classes they aid in disguising dishes of doubtful freshness, and pre- vent accidents. In certain diseases they may be employed with advantage. In diabetes they help to digest the fats; in chronic gastritis and in major atonies their stim- ulating and antiseptic virtues need not be feared. The same is true in chronic feuers and in tuberculosis. For this reason, especially in the summer months, the "hors d'cEuvres," or savories, are iiseful in anorexic tuberculosis. Special mention may be made here of caviar by reason of its strongly marked lecithin phos- phorous content. It is well to bear in mind, however, that these condiments, when taken in small doses, are wholesome, but soon become noxious when in- gested in large portions, because they force superalimentation, because their violent stimu- lation is superseded by a phase of corresponding depression, and because they irritate too much the whole digestive system — the stomach, the bowels, the liver, and the organs of elimination. As too irritating and therefore ever to be avoided, we quote: red pepper, ginger, allspice. 294 WHAT SHALL I EAT? red cabbage, and all varieties of sauces and pickles, whether of English or American ori- gin. Among the less irritating, which may be taken with impunity but in moderate amounts, we enumerate: garlic, onions, capers, gherkins, mustard, ordinary black and white pepper, cloves, and vinegar. The others are harmless. Certain morbid conditions are contraindica- tions: hyperchlorhydria, inflammaticm of the stomach or of the intestines, hemorrhoids, athe- roma, kidney disease, cystitis, blennorrhagia, skin diseases, liver complaints, cirrhosis, lithiasis, jaundice — in all of which pepper and allspice are specially harmful, as has been proved to satis- faction by long experience. NERVE FOODS The term "nerve foods" is justifiable only in part; for, although the substances to which it refers primarily exert a stimulating influence on the nervous system, their value as a food is, with the exception of cocoa, almost nil. We are tempted to include them rather in the name of medicaments than of foods. But, since they form a part of the daily nutriment of the nor- mal individual, we will give them due consider- ation here under the title of nerve foods. COFFEE It is used in all civilized countries to a large extent; and, we are afraid, often too freely. The berries of the coffee-tree are dried in the sim and come on the market in the shape of green beans. Roasting frees the essential oils, devel- ops the aroma, and produces a partial carameli- zation. The roasted beans, when ground in a coffee-mill, are ready for infusion. 295 296 WHAT SHALL I EAT? It is needless to give a quantitative analysis, as coffee possesses no alimentary value. Besides some nitrogenous matter, cellulose, sugar and dextrin, aromatic oils and fatty substances, and a few mineral bodies, among which potassium phosphate predominates, its essential principle is caffein, partially combined with a certain tannic a,cid (caffeotannic acid), which gives the coffee a slightly antiseptic property. Caffein is a tri- methyl xanthin, and is closely related to xan- thin, uric acid, and the purin bodies. The absorption of coffee increases, therefore, the pro- duction of urinary uric acid. A cup of coffee, consisting of about 100 c.c. and made with 15 grams of coffee, contains, ac- cording to Gautier, 0.26 centigram of caffein. It is important to know this proportion. So far as nutriment is concerned, such a draught represents only 15 calories which may be raised to about 55 calories by adding two lumps of sugar (10 grams). Of course, coffee with milk is another proposition. The nutritive power is increased here in proportion to the amount of milk added. While the milk tem- pers the stimulating properties of the coffee, the latter adds to the digestibility of the milk. NERVE FOODS 297 It is worth while to understand the reactions of coffee on the system for the purpose of know- ing how to use this article, because coffee is a nerve food, and possesses properties almost iden- tical with those found in tea, cocoa, etc. The action on the stomach is very slight and favors digestion. Cold coffee, with plenty of water, is a wholesome beverage and does not fatigue the stomach. In many cases of dyspep- sia even fairly strong coffee is by no means dele- terious. Its action on the general system of circulation is, perhaps, the most prominent, cer- tainly above all vascular and nervous. Coffee heightens the tension, reinforces and modifies the heart-beats, raises the central temperature, and produces a feeling of warmth and comfort. It impresses the nervous system, both the cere- bral and the muscular; it stimulates the power of activity and relieves the feeling of fatigue, compensating the loss of energy by increased circular activity. The writer can work with a clearer mind even into the small hours of the morning after sipping his cup of coffee; the la- borer, the traveler, the merchant, all alike will feel renewed vigor and forget all about fatigue and lassitude. 298 WHAT SHALL I EAT? The action of coffee may thus be defined: it augments the power to work, but in no wise modifies the consumption of calories or the or- ganic wear and tear in a given task; it does not add to the productive power of the organism, nor in the least changes the relation existing between the calories utilized in the work accom- plished and the calories lost by radiation. Cof- fee is by no means a food of economy. If some authorities admit that it diminishes, in a slight measure, the consumption of albumin, a large majority flatly deny it. In this respect coffee, being neither a nutri- tive element nor a food of economy, is inferior to alcohol (taken in small doses), which possesses both qualities. Res^ime. — If coffee increases the power of pro- duction, it does so because it allows of a tempo- rary abuse of the physical forces, but at the cost of a resulting bodily fatigue and increased or- ganic expense, which must be compensated by a corresponding amount of rest and sleep. Coffee is a diuretic and acts in a similar fash- ion to soup. As it produces uric acid, it is a strain on the renal capsules. In its action on the organism, coffee obeys NERVE FOODS 299 the general law which governs all stimulants. Taken in small doses it assists the system in its fmictions, but in large doses it becomes toxic and provokes morbid symptoms. The symp- toms of caffeinism are, briefly, the follo-wdng: in the vascular system palpitation, sudden flushing of the face, anxiety, oppression in the region of the heart, general depression in the nervous sys- tem, insomnia, muscular weakness with trem- bling, and a general state of neurasthenia with inability to work. Small doses of cofFee will assist the workman engaged in manual labor, in fact, anybody who has to undergo fatiguing work or exercise. Al- cohol has the advantage of being a food, in fact, a food of economy; but has the drawback of be- ing more intoxicating. As an habitual tonic cofFee falls behind beer, wine, and chocolate, which are nutrients and aliments of economy. It is ever risky to expect from cofFee, for any length of time, the stimulation necessary for the performance of a given task which is beyond its powers. Unfortunately, a mistaken belief leads only too often to the abuse of this beverage, of which principally brain-workers render them- selves guilty. But it is an error committed 300 WHAT SHALL I EAT? by the working man as well as by the female worker. In pathology cofFee finds but few applications; chiefly as an antidote for morphin and opium, or in cases of acute alcoholism. It also renders good services in the struggle against chronic alcoholism, as it corrects the asthenia of absti- nence. In surgery it is employed sometimes in spinal anesthesia with cocain or stovain, in order to prevent cardiovascular symptoms. In medicine, cafFein in its pure state is preferred, as a rule. Coffee is noxious in cardiac disease, in angina, hypertension, scleroma, in all diseases of nervous origin or those involving the heart; and, above all, to neurasthenics — those excitable creatures who forever fall back upon the abuse of this highly prized "Pick me up. ' ' Dyspeptics, and all those subject to congestion of the visual organs or to varicosity of the face, acne rosacea, or psoriasis, are advised to use cofFee in moderation. Its close relationship to uric acid precludes its use in all cases of uricemia, gout, Z^t;er complaints, and arthritis. Kneip's Malt Coffee, Postum Coffee, and sim- ilar preparations may act as substitutes for cof- NERVE FOODS 301 fee with people who can accustom themselves to their rather disagreeable taste, which, however, may be somewhat corrected by the addition of a third or a fourth of real coffee. TEA The use of tea is on the steady increase throughout the world, we think, for the general welfare of the people; for it is a most wholesome and hygienic beverage. The dried and more or less toasted leaves con- tain nitrogenous extracts, cellulose, gum, dex- trin, a fairly large proportion of oxalates, ash in which phosphate of potassium predominates, and, above all, its active principle, "thein" [tri- methyl xanthin], similar to caffein but contain- ing a larger percentage of tannin. Ceylon tea is somewhat stronger than China tea; it has a thicker and browner juice. The black teas which midergo a slight fermentation before be- ing dried, contain a smaller amount of thein and tannin than the green varieties. Although the composition is analogous, the dose of the active principle differs greatly. A cup of tea of 120 c.c. can be made with about 1 gram (a pinch) of tea, and contains 0.4 gram 302 WHAT SHALL I EAT? of soluble substances, and only 0.025 gram of thein, or ten times less than a similar cup of cofPee. Its nutritive power is nil, if we except the sugar and milk which are generally added. The action of tea on the organism is almost the same as that of coffee, perhaps a little lighter. Tea assists digestion; with rum it is used with efPect in heart disease. The large percentage of tannin makes it slightly binding. The action on the kidneys and on the neu- rovascular system diifers somewhat. Elxcessive tea-drinking is apt to provoke palpitation, ver- tigo, neuralgia, trembling, irritability, and emotional nervousness; yea, even symptoms bordering on epileptic conditions which only cease with the absolute suppression of this alkaloid. Weak concoctions of tea make, nevertheless, a harmless, indeed, a useful beverage, especially in hot climates, as the water used for the pur- pose must of necessity be boiled, thus destroy- ing impurities or any possible bacilli that may be contained in it. Dyspeptics who prefer tepid or lukewarm NERVE FOODS 303 drinks derive much benefit from a cup of weak tea sipped warm during the repast, or cold after eating; but we must advise moderation, and un- der circumstances recommend, rather, infusions made from camomile orthe blossoms of the lin- den-tree. Five o'clock tea, or afternoon tea, so much in vogue in certain coimtries, is by no means wrong in principle. For people in good health it constitutes a useful repast, as it ofFers a wel- come stimulant in the fatigues of the daily rou- tine. K a small pat of butter or the yolk of an egg be added, it even becomes a nutriment. But one or two small cups must be the limit. The habit of gorging one's self with a mass of rich cake or pastry — in itself heavy and indiges- tible — washed down with three or four or more cups of tea, is bound to entail serious conse- quences and endless trouble. So far as contraindications are concerned we can only repeat what we have already said un- der the head of coffee, laying particular stress on cases of oxaluria. 804 WHAT SHALL I EAT? COCOA ^ Chocolate and cocoa deserve special mention, as they are the only nerve foods which possess a real nutritive value. The cacao bean contains notable proportions of albumin, carbohydrates, and fats. In the manufacture of the powdered article a large amount of the fat (butter of ca- cao) is removed, until the following proportions are obtained: Albumin. Fats. Carbohydrates. Ash, Calories. Powdered cocoa.. 17 25 13 3.00 350 Chocolate 57 22 62 1.70 487 The carbohydrates consist principally of cane- sugar. The oxalates are very abundant, 4 grams per 50 kilograms. The ash consists of phosphate and sulphate of potassium and of magnesium. The active principle, theobromin (dimethyl xanthin), which reacts very much like cafFein, is less prominent in cocoa than in chocolate. As for the rest, chocolate does not differ from cocoa, except that the percentage of sugar is ' We have adopted here the spelling in general use, "cocoa," well knowing that it would have been proper to follow the scientific spelling "cacao." — (Translator.) NERVE FOODS 305 higher (about 50 per cent). In chocolates of in- ferior quality, sugar is frequently supplanted by fecula. A cup of sweetened cocoa made with 10 grams of the powder represents about 74 calories, and contains in the neighborhood of 0. 13 centigram of theobromin and 0.045 of oxalates. A cup of chocolate made with 15 grams of the powder represents the same number of calories; it con- tains 0.19 centigram of theobromin, but only 0.012 of oxalates. The physiological action of cocoa approaches that of coffee and tea very closely, but is mod- erated by the presence of fats and sugar, which make theobromin less stimulating than caffein. That is the reason why cocoa is borne better by dyspeptics than chocolate; but it ferments eas- ily, and is binding, which is a drawback. Vascular, cerebral, and muscular stimulation and diuretic action are less pronounced, but the general tonic action is stronger and more rapid. A cup of cocoa or chocolate promptly produces a feeling of comfort which, as Gautier so tritely says, can only be explained as "a nervous effect provoked by the flavor of cocoa, sustained by the tonic influence of theobromin, and completed 306 WHAT SHALL I EAT? by the nutritive element of the food in direct ratio to the amount absorbed." People who are engaged in outdoor exercise or sport should bear that in mind; likewise those who are depressed in spirit, convalescents, or hy- popeptics. For forced alimentation a cup of choc- olate with 150 C.C. of milk and the yolk of two eggs will do much. It represents at least 300 calories. But chocolate should never be made the base of a diet. Excessive use is bad for the stomach and the bowels, in fact, for the whole system. Martinet quotes the case of a man sixty years of age who brought on a serious attack of gener- alized rheumatism by having lived on chocolate exclusively for several years. Children are more sensitive in this regard than adults, and a special danger lurks in the circumstance that many farinaceous baby foods are flavored with cocoa. Variot claims that children who are surfeited with cocoa are constipated, puffed up, flabby, frail, nervous, and peevish. Cocoa is a food simply for sustenance, but not for development. — {Guinon. ) We warn here also against the too frequent NERVE FOODS 807 use of chocolate candies, which overload and ob- struct the stomach and the intestinal canal, spoil the appetite, and cause carious teeth. In gout, gravel, uricemia, rheumatism, cardiac and Bright's disease, arthritis, arthritic constipa- tion, they are dangerous titbits. In liver com- plaints, diabetes, and oxaluria, chocolate must be rigidly avoided. Persons suffering from diabetes or heart disease may partake of cocoa in small doses, but never when sweetened with sugars So far as the other categories of disease enu- merated above are concerned, cocoa ranks even with chocolate.* ^ Not so much on account of the chocolate, but of the impu- rities, such as paraffin, which they contain (so-called milk choco- late), and especially on account of saccharine and sugar. — (Translator.) BEVERAGES NATURAL WATER Water is the most necessary substance, with- out which man cannot endure for any length of time. Even when fasting for a period of days, we cannot exist without a given quantity of water. Of course, this is quite natural, for water is the principal constituent of our cellu- lar system; and, being constantly eliminated through the kidneys, the intestines, the lungs, and the skin, it must be incessantly replenished by daily rations. The normal human being excretes every twenty-four hours 1,500 c.c. of water through the urine, 60 c.c. of water through the feces, 900 c.c. of water through the lungs and skin. Total.... 2,460 c.c. Of this quantity about 1,400 c.c, are carried into the system by the food we eat, of which nearly 400 c.c. are derived from the oxidation 308 BEVERAGES 309 of the hydrogen contained in the foodstuffs in- gested. So that we have to supply just a little more than a liter of fluid in order to satisfy the demand. Moreover, physical exertion strongly changes and affects the elimination of water, i.e., on an average of 1,000 c.c. through the urine, 60 c.c. through the feces, 1,900 c.c. through the lungs and the skin. Total 2,960 C.C. The percentage of water contained in the food is subject to very little change, while the ratio required for work, oscillating between a liter and a half and two liters a day, must be main- tained for the proper functioning of the tissues. It is true that the renal secretions act as a regu- lating force in this process of supplying mois- ture, being scant when the supply is small, but profuse when the proper measure is exceeded; also that cutaneous and pulmonary excretions play only a subordinate role in this game of compensation. But it becomes a matter of urgent necessity that the natural laws should not be transgressed, 310 WHAT SHALL I EAT? one way or the other. Drinking too little water is just as injurious as drinking too much. The former dries up the tissues and allows of an undue accumulation of toxic deposits, especially of uric acid, which may cause a lot of trouble. On the other hand, the latter soon degenerates into an evil habit, with all its baneful efPects on the heart and circulation, by supplying a pleth- ora of watery elements; and on nutrition, by re- tarding its progress and leading to'obesity. A thorough understanding of these laws will materially aid in finding the just proportion for the healthy individual, while it will also indi- cate the proper adjustment of the quantity of liquid required for different regimens. There is, first of all, the dry diet — prized so highly in the major dilatations of the stomach — the aim of which is to avoid alimentary surfeit and the dilution of gastric juices, which precipi- tate putrefaction. The idea itseK is all right enough, but it must not be pushed to the ex- treme; for, after all, in cases of dilatation or gas- tric fermentation, or even hj^opeptic affections, it quite suffices to restrict the patient to a diet of thick soups and the smallest allowance of bev- erage during the meal, to effect a marked im- BEVERAGES 811 provement. One small glass of water should be the limit, but that is always required for prop- erly stimulating the appetite and forming the chyme needed for the process of digestion. Moreover, it is wise to drink a glass of water be- tween meals when the stomach is comparatively empty, to support its action. Restriction in the use of water forms a part of the treatment in obesity; it is the fundamen- tal principle in Oertel's cure. Stout people shotild drink but little water, and never during meals. Less than a liter per day is the norm. But this again depends upon the fact whether the formation of adipose tissue is occasioned by arthritic or toxic matter. Oertel's cure does not agree with every individual case, and re- quires careful supervision and never-ceasing vigUance. A judicious restriction in the use of chlorinated substances will often prove to be of better advantage. — (M. Labbe. ) Patients suffering from cardiac troubles, or from Bright' s disease, are likely to derive benefit from this selfsame treatment. If there is a ten- dency to drink often and much, it is prudent to restrict the daily ration to 1,500 c.c. without fear of restraining the proper flushing of the 312 WHAT SHALL I EAT? kidneys. On the contrary, much comfort will be experienced in the heart's action and that of the renal capsules. — (Widal.) But, be it remembered, in order to obtain satisfactory results, protracted treatment is a conditio sine qua non. ^ However, there are many morbid conditions which demand an excess of the normal quotum; for instance, gout and uricemia, which require large quantities of water for ridding the system of a surcharge of uric acid. But even here moderation is a hard and fast rule. Diuresis is always the criterion. One liter and a half to two liters is the average. Anything beyond that is a strain on the heart. The term "natural water" applies to the nat- ural product containing no mineral or chemical substances foreign to its essential organic or in- organic composition. Genuine potable "table" water must be "fresh, limpid, free of odor, slightly alkaline, agreeable to the taste, easy on the stomach. ' It is well to bear in mind that in pathological conditions the system absorbs only very minute quantities of water from the solid foods, so that 1,500 c.c. represents in reality only an inferior percentage of the daily allowance. BEVERAGES 813 aerated, free from putrefaction, and fit for com- mon domestic consumption." — {Gautier.) We may, with advantage, dwell upon a few of these qualities. Aeration is conducive to diges- tibility; badly aerated waters press upon the stomach, not so much on account of the absence of oxygen, but because they are too much im- pregnated with organic matter, which easily putrefies and becomes injurious by absorbing oxygen from, instead of conveying it to the sys- tem. Chalk is another important factor. Good, healthy drinking-water should contain about 0.500 to 9.300 grams of mineral matter, and 0.300 to 9.100 grams of carbonate of lime per liter. This hydric chalk forms a mineral co- efficient in our daily ration not to be neglected; and, if wanting, will seriously affect the consti- tution, especially in the young. If present to excess it will do harm, because it makes the water hard and unfit for cooking vegetables. The most important quality of good drinking- water is sterility; in other words, water must be free from pathogenic microbes, above all — in the heated season. In the summer months infec- tion is chiefly due to Eberth's bacillus, and spe- cial precautions are required to secure sterility. 314 WHAT SHALL I EAT? Boiling has its advantages, but, unfortunately, it precipitates the essential salts. The filter is, perhaps, preferable, but it requires everlasting cleaning. Filters should be boiled at least once a week. Natural mineral waters, if selected with cau- tion, are all right enough for a certain period; but, if excessively used, they have their draw- backs also. They are really intended for mor- bid conditions of the body. On the whole, the water provided by the mu- nicipal authorities of large cities is healthy and fit to drink, especially if the supply is carefully guarded against noxious infiltrations from sur- rounding sources. Rain water, gathered in cisterns, lacks the necessary percentage of salts and mineral mat- ters, and is apt to contain microbic substances. River water is, as a rule, contaminated, and therefore risky. Water should be consumed during meals. To drink water only before or after eating we con- sider a bad habit, especially in persons of seden- tary habits. But we recommend taking a glass or two of water before bedtime, to persons who are troubled with indigestion or plethora. BEVERAGES 315 The man who toils requires more water be- tween meals; but, if he can accustom himself to the habit of drinking only with his repast, he will be benefited by it. To sum up, our drinking-water should be always fresh and cool, although tepid water will agree better with dyspeptics. Ice-water, or very cold spring water, is ever harmful. 316 WHAT SHALL I EAT? ALCOHOLIC BEVERAGES Water, pure and simple, barring exceptional cases, has never constituted the only and exclu- sive beverage among the nations inhabiting this mundane sphere. In all ages throughout the world liquid refreshments containing alcohol have enjoyed a special privilege and have been held in high repute. The methods of preparing them, the taste, the strength are ever changing with the habits, the customs, and opinions of individual peoples; but they all present, in the principle, the same beneficial and deleterious characteristic qualities. Here we are at once face to face with one of the burning questions of the age — the social problem of the period, viz., alcoholism. It is quite impossible to deal, in a short chapter, with this important subject, on behalf of which oceans of ink have already flowed from a thousand pens of able writers — a question which enlists the in- terest of the pathologist, hygienist, sociologist, and moralist, as well as that of the political econ- omist. The lines which we intend to follow are of a threefold nature. 1. We shall rehearse the BEVERAGES 317 principles which seem to be more or less es- tablished, at the present moment, as to profit and loss in the use of alcohol. 2. We shall con- sider the percentage of alcohol contained in va- rious beverages. 3. We shall enumerate and give the advantages and disadvantages of such substances as may act as equivalents of, or sub- stitutes for, alcohol. ALCXDHOL 1. Is alcohol a food; or, in other words, is our organism capable of burning up alcohol intro- duced into our system to advantage, and of util- izing its heat for the purpose of meeting our calorific needs? This question has been fully discussed from every possible point of view, and has been the subject of innumerable experi- ments, seemingly in favor of the affirmative. The claims advanced by Atwater appear to be most conclusive. He put a man into a calori- metric chamber for a period of three days, ascer- taining all the time the number of calories obtained by a given non-alcoholic regimen. During the next three days he substituted an isodynamic quantity of alcohol for an equivalent amount of carbohydrates, resuming the original 318 WHAT SHALL I EAT ? non-alcoholic regimen for the subsequent three days. The resultant in calories, in both in- stances, was the same within one thousandth part of 1 per cent. The conclusion, therefore, is that alcohol is utilized by the organism, and, as a nutrient can replace an equivalent amount of sugar or starch. But this holds good only when alcohol is absorbed in small quantities. If consumed in large quantities it is, in part, eliminated through the lungs, through the kid- neys, and by perspiration, without being utilized by the economy. Thus we are aided in making an exact calculation as to the quantity and pro- portion of the alimentary value contained in alcohol. The isodynamic equivalent of alcohol is 7 per cent; that is to say, one gram of alcohol will give 7 calories; or, to be quite accurate, 7.184. It is evident that this percentage exceeds that of carbohydrates and of albumin, and almost equals that of the fats. 2. Reactions. — The action of alcohol on the stomach is well defined, and subject to two fac- tors, i.e., quantity and concentration. In small doses, and when of low proof (50 per cent), al- cohol facilitates the task of the stomach, espe- BEVERAGES 319 cially its secretory functions— a fact which is well known and often brought into practical use with advantage. Strong and oft-repeated doses of high-proof spirits irritate the gastric mucous membranes, give rise to functional troubles and to anatomical lesions on parallel lines, to hyper- chlorhydria, to mucous hypersecretion, to apep- sia with corresponding glandular proliferation, accumulation of mucous elements and mucous atrophy. Often these lesions do not last a long time, but break out as ulcers, nearly always followed by hematomesis. There is scarcely any direct action on the in- testines, as alcohol is nearly fully absorbed by the stomach; but the secondary reflex action dis- turbs the gastric functions throughout the whole length of the tube. The first point of attack is the liver. Small doses congest the parenchyma, and excite the cellular stricture; strong and fre- quent doses provoke a reaction in the connective tissues. Clinical experience has shown that al- cohol, in its very diluted form — for instance, wine — constitutes one of the principal factors in cirrhosis; but, in massive doses, it clogs the hepatic cellular structure, and may bring on grave attacks of jaundice. WHAT SHALL I EAT? The circulatory system is likewise affected, for it accelerates the heart's • action, hastens the circulation, causes congestion of the face by vasodilatation, and produces an appreciable sensation of heat. Prolonged abuse frequently leads to cardiovascular sclerosis. Its tonic and exciting action extends, in equal measure, to the nerve-centers; hence it may be considered a nerve food, like coffee and tea. It is universally acknowledged that alcohol pro- duces a feeling of euphoria, diminishes fatigue, and augments, for the moment at least, mus- cular power and cerebral activity. Poets with- out number, and writers in every branch of literature, often enough seek inspiration in the cup that cheers. Alcohol certainly influences the general pro- cess of digestion, and here again the question of quantity is of the utmost importance. It un- doubtedly accounts for the many contradictory results obtained in experimental research. A small dose of alcohol, i.e., less than one gram per kilogram, diminishes the percentage of ni- trogen in the urine, and restrains, in clearly de- fined proportion, the disassimilation of fats and albumin. In this regard it is inferior to fat, and BEVERAGES 321 still more so to carbohydrates; on the contrary, in strong doses it augments this disassimilation of nitrogen and the excretion of urea. If, in the former case, its action is simply that of a tonic, in the latter it comports itself as a violent stim- ulant. Normally, alcohol acts through the kidneys. It is burned up there and eliminated in the form of water and carbonic acid. By its"sclero- sing action on the vessels it may seriously handi- cap the renal functions. Alcohol is endowed with a twofold character: it is a food as well as a nervine. As a food it possesses a nutritive value which is far from be- ing negligible; as a nervine it sways, by way of the nervous system, a notable stimulating power over all the functions of the body. But, as is the case with all substances belonging to this category, it cannot be ingested in quantities even in the slightest degree excessive, without detriment to the organism. It is really a dan- gerous food, as it is strongly intoxicating, and its use has to be forever most carefully watched and controlled. Just so soon as the normal dose is exceeded, alcohol no longer nourishes; it in- toxicates. It gives off its heat rapidly, so to WHAT SHALL I EAT? speak in a brutal manner, and the best part of it is lost without profit to the system. Instead of deriving a benign stimulation from its inges- tion, the organs find themselves quickly in the turmoil of excessive excitation, which is fatally followed by a pronounced depression demanding fresh libations of the stimulating fluid and in ever-increasing quantities. This succession of alternatives is very baneful, and lays the foun- dation for gastritis, cirrhosis of the liver, cardio- vascular sclerosis; the faculty for physical work is diminished (Chauveau), cerebral productivity becomes more and more impaired, nutrition is inhibited, followed by pathological conditions such as arthritis, and even tuberculosis. These general remarks will assist us greatly in forming a correct judgment of the respective value of the various alcoholic beverages under consideration. The first rule to be observed is, to avoid altogether all that have a strong con- centration; that is, a high percentage of alcohol. The second is, beverages in which alcohol is strongly diluted, are permissible. Nevertheless, the problem is not without vexa- tious complications on account of the presence of secondary substances — alcohols of superior BEVERAGES 323 grades, essences, and diflFerent compounds, which add their useful or noxious effects to the basic action of alcohol. ABSINTH — APERIENTS — LIQUEURS All these products, although of widely differ- ing composition, deserve to be gathered under the common title of reprobation. The parti- sans in the antialcoholic war are all in accord in demanding their absolute and unconditional suppression. Their intoxicating power is chiefly due to the high percentage of alcohol, as will be apparent from the following table: xT^ r.« i o« X f Vermouth From 20 to 30 per cent j^ ^^^^^ ^p.^^^^ {Sweetened liqueurs Kiimmel Black currant catafia, etc, ' Anisette From 40 to 50 per cent - Chartreuse Apple- Jack Cognac Kirsch (Bitters Curagao Rum From 60 to 80 per cent Absinth Their deleterious qualities are further in creased by the addition of superior alcohols- WHAT SHALL I EAT? much more intoxicating than ethyl alcohol — and certain essences particularly noxious to the ner- vous system. Absinth easily tops the scale of toxicity. It is a violent poison for the nervous cells. Ab- sinthism has in its wake, neurosis, epilepsy, in- sanity; and, for the offspring, nervous defects without end and number. The aperients follow in second line. They contain so-called aperient substances macerated with the alcohol. In reality, they are most harmful to the functions of the stomach; in fact, as a rule, they ruin the stomach first, be- fore they strike the liver and the arterial system. Liqueurs enjoy a slightly better reputation. Nevertheless, they contain a very large percent- age of ethyl alcohol, with the admixture of other high grade alcohols such as propylic, bu- tylic, amylic, etc. , and of ether in varying quan- tities, by no means negligible. And yet we speak here only of the highest grades of spirit- uous preparations. If the unfortunate working- man only knew the nature of these admixtures that are put into what is given him to drink, he might be more cautious and reserved in his po- tations. BEVERAGES 325 It is the abusive use of liquor and wine that builds up the long list of cases of chronic alco holism, with its formidable retinue of gastric, hepatic, and vascular complications. The worst feature of this sad state of affairs is the fact that it is by no means due to excessive periodical drinking. It is the regular daily consumption of even moderate doses that plays the havoc. The man who drinks, say one glass (20 grams) of cognac or whisky, or any other drink after each meal, consumes 20 c.c. of alcohol every twenty-four hours, or an equivalent of at least one-third of the maximum dose permissible. Add to this the usual quota of malt liquors and wine taken during the meal, and it will be at once apparent that the grand total of alcoholic liquid consumed borders on or exceeds the limit of what may be considered innocuous. The steady, daily consumption of alcohol by persons otherwise in good health, claims, there- fore, serious attention, and should be combated as profitless and outright injurious. It is different when we have to deal with pathological conditions, however, in which alco- hol may render truly beneficial services. Ther- mic and neurovascular stimulation and cardiac 326 WHAT SHALL I EAT? tonicity engendered by its application prove extremely useful in the treatment of grave infections with nervous asthenia, slow pulsation, syncope, hypothermia, and general collapse; like- wise in typhoid pneumonia, irifectious grippe, typhoid adynamic fevers, and, generally speaking, in all infectious diseases which are accompanied by cardiofvascular asthenia. Even heroic doses of, say, 100 grams of rum or cognac per day, are not fraught with danger. Alcohol acts in these cases like a medicament, a food, since 100 grams mixed with sugar will give as much as 470 calories, and will limit, like an aliment of economy, disassimilation. Its value in this respect is of the same import in the fever patient and the healthy person alike. — (0«.) Alcohol has, in recent years, been strongly rec- ommended to diabetics, because it furthers the tolerance of fats by the stomach, acts not only as a nutriment, but also exerts a happy influ- ence over the utilization of sugar, and mini- mizes the chances of interference by acetonuria. But, particular care must be taken not to exceed the proper measure, or to neglect the special contraindications given for individual cases. WINES Alcohol by Weight. Carbohydrates. Ash. Purin. Chlorid. CalorieB. 1 5.7to8.6 1.7to2.8 O.lltoO.26 47to74 It is evident that wine is entirely free from fatty and nitrogenous substances, and from pu- rin bodies. Ethyl alcohol is the principal compound, the percentage of which varies with the different growths. We affix here a table, giving the names of the best known brands of wine and their respective percentage of alcoholic content. From 9 to 10 Per Cent. Bourgogne, red ordinary. " white ordinary. Bordeaux, ordinary. " red — special growth. " white — special growth. Gers. Alsatian, white. 'These figures do not refer to the heavy "liqueur" wines such as Madeira and Port, etc. , nor to Champagne, 327 328 WHAT SHALL I EAT? From 11 to 1% Per Cent. Bourgogne, special growth. Medoc. Narbonne. Algerian wines. Rhine wines. Tokay. Frmn 13 to 15 Per Cent. D'Asti. Spanish wines. Champagne. From 15 to 17 Per Cent. Port. Madeira. Marsala. It is important to be familiar with these fig- ures, for often it may be opportune to remind a patient inclined to a liberal use of wine that a bottle of Bordeaux represents about 66 c.e. of absolute alcohol, or a glass of Champagne 17 c.c, or a glass of Madeira 7 c.c. A calculation on the total amount of alcohol absorbed during twenty-four hours will sometimes not a little surprise the patient. The ethyl alcohol is accompanied by su- perior alcohols, such as propylic, butilic, and WINES 329 amylic, which are intoxicating in a much higher degree; but, luckily, present only in small quan- tities, though the proportion is higher in those growths the aromatic flavor (bouquet) of which is more prominent. Among the carbohydrates special mention must be made of glycerin — it varies from 4 to 13 grams per liter — mannite, levulose, and glu- cose. The two last-named substances are espe- cially abundant in certain liqueur wines such as Malaga, which may contain as much as 150 grams per liter. Wine contains organic acids, principally tar- taric acid, found almost entirely in the potassium, and is particularly abundant in the Medocs and the wines from the Bourgogne; also cenotannic acid, up to 2 grams in the red wines — the white wines show only traces in the summer-time; of mineral acids, sulphuric and phosphoric acids are present. Among the basic substances po- tassium, lime, magnesium, and iron may be mentioned; they vary from 0.008 gram to 0.05 gram per liter. The percentage of acidity is weakest in the Alsatian and Bordeaux wines; it increases in the order named here in the Rhine wines and Alge- 330 WHAT SHALL I EAT? rian, in Madeira, Marsala, and Champagne, and in the red; and still more so in the white wines from the Bourgogne, reaching the highest vol- ume in the Muscat d'Asti. As a portion of this acidity is organic, and consumed by combustion, wine is, so far as nutrition is concerned, in reality but slightly acid. There is no need for discussing here the reac- tion of wine on our organism, as it coincides with what we have already said about alcohol in a strongly diluted state. We will, however, make mention of the evil effects of tartaric acid which is apt to fatigue the stomach, and those of tan- nin which make the red wines rather binding. The white wines are diuretic. Very young wines often enough irritate the intestinal canal and produce diarrhea. Adulterations. — Not so very long ago this en- terprise had assumed formidable dimensions and contributed not a little to that vigorous cam- paign against the use of wine in general, which was then being waged, but overproduction of the genuine article has largely contributed to relegate it to the past. The most inoffensive methods are watering, sugaring, and the blend- ing of different vintages. The addition of WINES 331 coloring matter, especially of fuchsin, often con- taining arsenic, is harmful. While the admixture of sulphate of potassium for the purpose of pre- cipitating the albuminoids and microbic sub- stances, called "platrage" by the French, is absolutely injurious to the stomach. [The so- called artificial wines manufactured from sub- stances foreign to grape-juice deserve no spe- cial mention here, as they contain none of the qualities attributable to the genuine article. — Translator. ] Indications and Contraindications. — We do not hesitate to range wine among what is rightly called "hygienic beverages." We have already pointed out the tonic and nutritive effects of al- cohol when consumed in small doses; and with wine it is comparatively easy to restrict the use to minor quantities. A bottle of wine of 600 C.C. contains about 60 c.c. of absolute alcohol, or less than the maximum allowance for an adult of middle weight. K this quotum is not exceeded in twenty-four hours, the wine will act as a rational stimulus to the different organs of the body and fiurther their functioning powers in a useful manner. This benign influence is strongly felt by those who lead a strenuous life, WHAT SHALL I EAT? or who are exposed to frequent changes in the weather, and to the inclemencies of an intolerant climate. Still, if there is an inclination to ex- cessive consumption, it is better to enforce total abstinence, not only from grape wine, but also from all other beverages containing the noxious and dangerous elements of alcohol. Fortunate- ly, it seems an established fact that wine-growing countries are comparatively free from the rav- ages of alcoholism. Apart from the stimulating, nutritive, and tonic qualities which wine possesses, other very valuable antiseptic properties belong to it, of especial merit to the inhabitants of countries where the drinking-water is often bad and viti- ated. Sabrazis has found that Eberth's bacillus lives only two hours, i.e., in the human body, after partaking of red wine of 10 per cent; thirty minutes after ingesting Bourgogne, twenty minutes after old white wine, and ten minutes after Champagne. The acidity seems to have a stronger reaction than the alcoholic content. Moreover, by acid- ulating the drinking-water with wine, about twelve hours before using it, a suspected water may be purified and sterilized. It is an old cus- WINES 333 torn, practised so much in the monasteries and colleges of former days, and undeservedly de- cried by modern authorities. Wine should not be given to children under twelve to fourteen years of age; but, during the period of pubescence, it will often prove a useful aid in overcoming the trials and troubles as well as the dangerous complications of this passage. From fifty to fifty-five years and upward the daily ration must be restricted, as should be the case with all stimulating aliments. Woman, also, has every reason to be more abstemious than man. In a number of pathological conditions wine accomplishes much good, but wisdom in the proper choice is required, especially in the elim- ination of fraudulent and adulterated prepara- tions. A good old Bordeaux generally agrees with convalescents. In anemia and chlorosis a Bordeaux, at least two years old, will prove of benefit, as it is rich in iron and tannin; likewise in tuberculosis, unless it is contraindicated by dyspepsia, diarrhea, a tendency to hemoptysis, and congestion. Diabetics may make fair usage of dry wines, but must avoid the sweet brands. We have already pointed out the happy influ- WHAT SHALL I EAT? ence exercised by alcohol upon glycosuria and the digestion of fats, so important in diabetes. Gautier emphasizes also with good reason the antiscorbutic properties of the red wines. Another factor in their favor is, also, that they keep better than the white wines. The contra- indications are numerous and important. First of all we mention cirrhosis, especially in the as- citic form with portal hypertension, which is, in efFect, one of the more frequent complications of vinism. The patient afflicted with this malady betrays a most astounding susceptibility in this respect. The ingestion of even the most minute quantity of wine often suffices to reawaken symptoms which lay dormant for months. On the whole, wine is injurious in all liver complaints, especially in the congestive forms of arthritis and malaria. In all hot climates, ab- stemiousness in the use of alcoholic drinks is an essential condition for physical welfare. Dyspeptics rarely tolerate wine in any shape or form. Sweet wines, red wines, especially the heavier sorts, and the indiscriminate use of sev- eral kinds of wine during the same meal fre- quently account for the trouble. In the lighter forms of hyper- or hypo-chlorhydria a small dose WINES 335 of white Bordeaux, mixed with water, may be allowed. An exception may be made with Champagne, which possesses a special virtue on account of its large content of carbonic acid. It is indicated in all cases of gastric intolerance, in acute diseases, affections produced by chloro- form, and in pregnancy. It has a tonic effect on the organism worthy of our attention. Thor- oughly iced, it is more active than when served at the ordinary rooin temperature. In intestinal affections the use of wine is lim- ited. In constipation and enterocolitis the red wines, especially those of high flavor, should be avoided. In nervoiis diseases, neurasthenia, and hypo- chondria, and mental affections, it is always in- jurious. It is astonishing how total abstinence will often cause the symptoms to vanish rapidly, only to recur again as suddenly after the slight- est indiscretion. All these patients are super- sensitive to every excess in the diet, especially in the use of alcoholic stimulants. Wine is absolutely to be excluded from the menu in all cardiovascular affections, especially in hypertension, in aortitis, and in angina pec- toris. In albuminuria white wine is, perhaps. WHAT SHALL I EAT? less injurious than the red. Old red Bordeaux agrees with orthostatic conditions. It is also preferable in renal lithiasis, as it is less alcohol- ized and less acid. Moselle and Bourgogne wines should be treated with distrust. Strict sobriety is also to be prescribed for all workers exposed to saturnism, for alcohol is prone to favor the frequency and gravity of accidents. In gout, von Noorden grants a small allowance of white wine, thinned out with water. Cham- pagne is preeminently forbidden. In chronic rheuTnatism, neuralgia, rebellious migraine and asthma, abstention from wine should always be counseled. The symptoms will very often quickly disappear. Skin dis- eases, eczema, psoriasis, furunculosis, ojcne ro- sacea, all demand total abstinence. The evil efPects of wine on the complexion are so well known that women of fashion, solicitous about their beauty, are wont to confine themselves to the exclusive use of water as a beverage. BEER The manufacture of beer is more complicated than that of wine. Barley, which forms the or- dinary basis, is turned into malt by allowing it slowly to germinate in vaults at 50° F. Diastase is thus developed, which transforms the starch into dextrin and maltose. The whole is then dried in a temperature of 165° F., when more maltose and less dextrin is produced. Under these conditions the light, amber-colored beer is obtained. At 225° F. the dark beer is the result, which contains less maltose but more dextrin, which is not subject to fermentation. In the process of brewing the grain is filtered ofp with water at a temperature of 160° F., which process carries with it the diastase, invertin, dextrin, maltose, and albuminoid matters. These in their turn become partially peptonized, while a large proportion of the maltose is changed into glucose. When desiccated, this maltose furnishes what is known as "Malt Ex- tract." 337 338 WHAT SHALL I EAT? Hops, in certain quantities, are added to clar- ify and preserve it while giving the beer that bitter taste. Fermentation is produced by the addition of fresh yeast, which transforms a part of the glu- cose into alcohol and carbonic acid. High fermentation at a temperature of 50° F. ensues quickly, and produces a light beer or small beer; low fermentation at 40° F. or 42° F. is much slower, and produces a heavier beer, called "lager." The mean composition of beer is: Alcohol Carbo-< Albumin. by Weight, hydrates. Ash. Chlorid. Furins. Calories. 0.50 3.90 5.9 0.19 0.01' 50 Beer differs from wine by the presence of purins, an appreciable amount of sugar, and a small percentage of alcohol, which latter cir- cumstance makes it a trifle less nourishing, the alimentary value being only 55 to 60 per cent. Besides these constituents beer contains a no- table proportion of carbonic acid, which makes it sparkling; also some bitter, resinous, tonic sub- stance, certain acids and salts, but chiefly earthy, alkaline phosphates. 'Porter contains 0.17 purins. BEER 339 The dark brown beers are more nutritious, richer in extracts and dextrin, but poorer in alcohol. Malt Extract possesses highly nutritive quali- ties. Liebe's preparation has the following composition: Albumin. 5 Maltose. 76 Dextrin. 16 Calories. 390 The diastasic ferments which it contains, ad- vance digestion and assimilation, and are splen- did agents for superalimentation. The heavy English beers — pale ale and porter — exceed in the percentage of alcohol and purins. As beer contains more water and less alcohol than wine, its action on our organs is slightly more beneficial. The gastric reaction is com- pensated for by the presence of carbonic acid and the hops, also by the deficit in alcohol, which renders it very easy on the stomach. Considerable quantities may be absorbed with- out engendering any appreciable degree of gas- tric fatigue. When consumed with the food, it has wrongly been accused of impeding diges- tion. This is not true, except in very rare cases. But it is well to know that beer and milk are incompatibles. The dark brown beer 340 WHAT SHALL I EAT? is always better tolerated than the light-colored beer. Beer is slightly intoxicating, and may be justly called a non-calorific beverage. Yet, it is benignly tonic, diuretic, and even diaphoretic. If drunk to excess it fatigues the heart and the arteries, the liver and the kidneys, by producing a surcharge of aqueous infiltration of the organ- ism which may deteriorate into atheroma, slug- gishness of metabolism, and obesity. Indications and Contraindications. — Beer de- serves the title of hygienic beverage even more so than wine. It nourishes more and alcohol- izes less. Two liters of light-colored beer con- tain less alcohol than 600 c.c. of wine, and yet have double the nourishing power, or more. Again, it is much cheaper in price, and there- fore is within the reach of the poorer classes. It is to be feared, however, that men who per- form very fatiguing tasks, not finding in beer the desired stimulus, will fall back on stronger concoctions. In pathological conditions preference is given to dark malted beers. They certainly furnish an excellent drink to dyspeptics, particularly in cases of gastritis of long standing, in atony, tuberculosis, emaciation, and cachexia, when wine BEER 341 cannot be tolerated, and in nervous affections. Beer may be of service in certain cases of he- patic insufficiency and intestinal susceptibility. It is of unquestionable value to the pregnant and nursing woman, as it stimulates lacteal se- cretion, apart from being a food. It does not suit diabetics. Leo claims that the products of yeast fermentation are injurious to the patients. Neither does it agree with gout, congestion of the Ever, obesity, Bright's disease, albuminuria, atheroma, and cardiac trou- bles. The light-colored beers must be avoided by dyspeptics, and in all cases of enteritis, dysen- tery, catarrh of the bladder, and in blennor- rhagia. CIDER COMPOSITION AND REACTION Alcohol by Weisrht Carbohydrates. Ash. Calories. 2.08 3.40 0.20 84 Cider is generally made from a certain kind of apples called "cider apples," which are crushed, together with a given amount of water, through a press. The juice, which is drained off, is again diluted by the addition of one-third of its quantity of water, and is then allowed to ferment. The acids^ in proportion slightly less than in wine, are altogether of an organic na- ture, and by combustion alkalize the cider. In this respect, and also because its alcoholic content is low,* cider makes a good, pleasant, and refreshing drink; but it contains very little toxicity, and is still less calorific than beer. This accounts for the sad fact that cider-pro- ' This defect in alcohol is still further increased by the fact that the peasants, as a rule, add yet more water to the cider set apart for their own use, serving it under the name of "cider water." 342 CIDER 343 ducing districts pay such a high tribute to alco- holism. Indications and Contraindications. — Cider re- tards gastric digestion, and is not fit for dyspep- tics. Its purging propensities make it risky for those who are inclined to diarrhea, but useful in constipation. Garros attributes to cider anti- gouty and antiuric properties, which accelerate the elimination of uric acid by alkalizing the humor, for which reason he recommends it in cases of urinary lithiasis and in gout. To make sweet cider the apple-juice is drawn in bottles before it has had time to ferment, and left there until it is clarified. This makes a sparkling liquid, full of alcohol, which easily goes to the head. It should be consumed in small quantities only. VEGETARIANISM It would be partial to wind up a book of this kind without devoting at least a few words to the important problem of vegetarianism. Since Pythagoras was one of the first adepts in its practice, it has always been able to boast of a goodly retinue of partisans. Nowadays the number of adherents and enthusiasts is on a steady increase, especially in England and Bel- gium, countries in which of yore the abusive use of meat has been most rampant. The move- ment is strong, and many attempts have been made to put it on a scientific basis by advancing its rational and physical advantages. In fact, we have already a formidable array of books, pamphlets, and treatises on the subject, which are by no means devoid of interest; but, on the contrary, worthy of our attention and closer study. It is scarcely necessary to give here a defini- tion of the meaning of the word which implies its purpose, viz., the restriction of our daily 344 VEGETARIANISM 345 diet to foodstuffs gathered from the vegetable kingdom, to the rigid exclusion of animal foods. Such, at least, is vegetarianism in the strict sense of the word; although there is a milder form in which the use of meat only is eliminated, while milk and eggs still find admittance into the sacred precincts of the dining-room. The term "fruitarianism" is self-explanatory. Vegetarianism is, primarily, a reaction ema- nating from the abusive use of meat in contra- distinction to the wide-spread belief that a good piece of savory, underdone (rare) beef consti- tutes the best possible nutriment. So far as that is concerned, we are free to admit that an excessive meat diet entails greater disadvantages than real alimentary benefits. The tenets of vegetarianism may be thus briefly summed up; 1st. It is a regimen poor in nitrogemms sub- stances, but rich in ternary bodies, and of un- doubted advantage. It is beneficial to the digestive organs, which, instead of being sub- jected to the abrupt and violent stimulation of carnal albumins, are exposed only to milk and the sustaining action of vegetable substances. The middle intestinal regions are also agreeably 346 WHAT SHALL I EAT? affected by it, as they are kept free from ni- trogenous elements, which form so excellent a culture medium for the intestinal flora. The kidneys, too, are relieved, for a smaller amount of residue is left behind to be eliminated. Therefore, the benefit accruing extends through- out the whole process of digestion. The physical exertions required for the proper digestion of meat foods are minimized in the vegetable diet. The ternary bodies are, after all, agents of economy in the same manner in which nitrogen accumulates conditions of dis- assimilation. Desgrez claims that the de- struction of albumin reaches its apex in the meat diet, touches its lowest level in the vegeta- ble diet, and holds the golden mean in the milk diet. As a producer of energy, nitrogen is the equal of the ternary bodies. But nitrogen acts in a blunt, abrupt fashion, and may even cause a waste of energy; while the fats and carbohy- drates free their energy in a slow, progressive manner, and in proportion to our bodily needs. It seems also to be established that vegeta- rianism, when tolerated, confers an increased superior power of endurance when moral and VEGETARIANISM 347 physical efforts are required. In sporting exer- cises, and, generally speaking, in endurance tests, vegetarians have certainly proved them- selves superior to meat-eaters. Fauvel claims, from personal experience, to have become much more inured against fatigue since he became converted to vegetarianism. Lefevre insists upon increased resisting power against cold, observed in himself and in a number of other vegetarians. Moral advantages are by no means less conspicuous; intellectual occupation becomes easier, and braia work more intense; the mind is more cheerful, and the temper more evenly balanced. Such are the virtues claimed by the vegetarian school. 2d. It is a regimen poor in purins and, there- fore, less toxic. The purins contribute in a large measure to the toxicity of meat. Their num- berless misdeeds have been thoroughly studied by the vegetarians, especially by Haig, whose work we deem it profitable here to review in brevity. In meat-eaters he finds an overproduction of uric acid, and also a retention by reason of hu- moral acidity, which inhibits elimination. This excess of uric acid retards the circulation by its 348 WHAT SHALL I EAT? vaso-astringent action, and may also increase the viscosity of the blood; it engenders, likewise, the sluggishness and the physical and moral torpidity so often observed ,in heavy meat-eaters. A fresh repast of nitrogenous food may well, by raising the amount of acidity and precipitating the uric acid into the tissues, produce a momen- tary sensation of comfort; but this does not en- dure and soon makes room for a corresponding feeling of depression. The need for nitrogenous ingestion increases in a similar manner as the craving for alcoholic stimulants becomes ever more exacting in those addicted to drink. Such is the beginning and the course of this phase of diet. The accumulation of uric acid is incessantly heaped up; and, ere long, morbid symptoms manifest themselves. These charac- terize the second phase, marking a still higher degree of intoxication, the modality of which depends on individual reaction. Migraine may serve here as a typical example for demonstra- ting how Haig explains the affiliation of un- toward events. According to him, migraine is due to a sharp crisis of alkalinity of the blood arising from toxic substances; uric acid now en- ters the circulation in large quantities, "the VEGETARIANISM 349 small blood-vessels are contracted, the skin is chilled, vascular tension increased, secretion of urine diminished, the nerve-cells are shocked, moral force is weakened, and intellectual power becomes clouded. " — {loteiko. ) By analogous deductions he attributes a whole mass of diseases to this accumulation of uric acid in the system, viz. : epilepsy, asthma, hysteria, dyspepsia, hemoglobinuria, anemia, albuminuria, diabetes, cardiac defects, etc. Gout and lithiasis are the last phases of this condition, the last degree of accumulation of uric acid, the surest symptom in an unmista- kable diagnosis of uricemia. This is Haig's the- ory. In certain regards it is, perhaps, somewhat exaggerated; but, by therapeutic experiments, he proceeds to prove its truth. These he based upon a diet capable of reducing the production of uric acid. Now, as there is a number of veg- etable aliments which contain xanthic bodies, such as legumes, asparagus, mushrooms, beer, tea, cocoa, coffee, Haig advocates a special vege- table regimen which might be called antiuric, in which all these substances are prohibited, but the use of milk and eggs is permissible. 3d. It is a regimen more mineralizing than 350 WHAT SHALL I EAT? any other. The proportion of ash is undoubt- edly higher in vegetables, and green vegeta- bles, especially, are ten times as much miner- alized as meat. 4th. It is a regimen very rich in cellulose, and, by reason of a superabundance of residue, better adapted to prevent consUpaHon and intestinal stasis. 5th. It is more hygienic, because certain vege- tables (dried legumes) and fruits are easier to keep, and not so readily subject to change. Moreover, disease is rarely transmitted from the vegetable kingdom. 6th. It is the least expensive diet. This side of the social question is of great importance, and has been dealt with ia a very able manner by Professor Landouzy, by Marcel, and Henri Labbe. Meat is expensive, and contains but lit- tle nourishment. Legumes and cereals are com- paratively cheap, and full of nutriment. * * * These are the principal claims advanced by the disciples of vegetarianism. It remains now for us to expose the possible fallacies contained in this doctrine, and to point out the objection- able features. This we shall do by showing un- VEGETARIANISM 851 der what conditions a vegetable diet may prove profitable, or, on the contrary injurious, to the health of man. The first objection is that it jades the diges- tive organs and causes discomfort and tension. It lacks nearly all the stimulating qualities con- tained in meat. To give an equivalent value of calories, a much larger volume of food is re- quired, which produces a feeling of fulness and overloads the digestive apparatus, while absorp- tion is imperfect. The vegetable albumins are tougher, and re- sist the attack of the gastric juices much longer. Pauloff has demonstrated that, for instance, the nitrogen contained in milk imposes a much heavier task on the stomach, as well as on the intestines, than the animal nitrogen; and bread does still more so. These observations possess a great deal of force, and command our careful consideration. It is a matter of common knowledge that per- sons who follow a rigid vegetable diet sufPer greatly from dyspepsia, distention of the stom- ach, abdominal pressure, and intestinal flatu- lency. The partisans of this reform do not take the trouble of denying the existence of these 352 WHAT SHALL I EAT? evils, but they make strenuous efforts to prevent the mischief. In the first place, they seek to diminish the percentage of albumin; then their advice is to protract the meals and eat the vege- tables in slow and easy stages; to masticate with better care, thus reducing the surcharge of liquid content and the volume of the food; and, finally, to make successive attempts with inter- ruptions, when passing from the meat diet to the vegetable regimen, thus giving the stomach and the canal proper time for adapting them- selves to the new habit. Judicious though these precautions may be, we do not believe that they are adequate to make everybody — the fragile and strong — accustomed to a strictly vegetable diet. On the contrary, we are of the opinion that many persons with a weak and delicate stomach, with "civilized" intestines, or a "busi- nessman's" digestion, will readily agree with our objections. A purely vegetable regimen fails to supply the organism with the necessary vascular and nervous tonicity. A decrease in alimentary stimulation must needs impair the vital fimc- tions of the digestive glands. If this is true in certain morbid conditions, it applies to the VEGETARIANISM 353 healthy being, just as well. The resisting power against disease is also weakened. According to Ewald, the percentage of sickness and mortality among the prisoners who are kept on a rigid vegetable regimen is much higher. Excessive deprivation of tone and excitation is prejudicial to our modem surroimdings, and does not agree with the exigencies of a strenuous life. We all have to undergo hardships and perform fatigu- ing tasks for which a certain amount of stimu- lation is required, which, however, cannot be foimd in a vegetable diet. Moreover, as vegetables have to be ingested in large quantities, they carry with them into the system also an undue amoimt of lime, which surcharge may become the hatching ground for chronic rheumaUsm and atheroma. So far as rheumatism is concerned this danger is, perhaps, only imaginary, despite the fact that it is strongly in evidence among herbivor- ous individuals, because it is rather due to the action of hyperacidity, which impedes the excre- tion of phosphate of lime; and that defect seems to be rather corrected by a vegetable regimen. As regards atheroma, however, the objection as- sumes a serious aspect. — (Loeper and Boveri.) 354 WHAT SHALL I EAT? Of course, a wise choice among the vegetable foods is always possible when this dangerous condition is threatened; for instance, legumes, cabbage, spinach, carrots, rye, and oats might be eliminated from the diet, while the other cereals, also potatoes, rice, pastry, a number of green vegetables, fresh fruits, and nuts — all poor in lime, yet rich enough in food value— still remain available. Nevertheless, the last two objections are by no means definite or conclusive. But those mentioned at first should always be taken into serious consideration when an opinion must be given on the opportuneness of a vegetable regi- men. That vegetarianism possesses great virtues in certain pathological conditions is now generally admitted even by those who do not approve of it for the normal human being, particularly in cases of arthritis, unless it disagrees with the patient, which is often enough the case in hereditary arthritis, especially in the second and third generation, when the digestive tube is too delicate and weakened to get used to it. But the heavy eater, the "bon vivant, " who has poisoned his constitution by excesses, is well ad- VEGETARIANISM 355 vised if he adopts a vegetable diet, which, unless it is already too late, will improve his health and prolong his life. Other morbid conditions akin to arthritis will also be benefited by it, always on the condition that the organism is strong enough to support it. To this class belong those who suffer from fatty degeneration of the liver, neurasthenic hy- pertension, migraine, rheumatic affections, neti- ralgia, and rebellious sciatica. Urinary lithiasis is also an indication; but the biliary form is an exception. — {Martinet. ) As for gout, opinions differ. Maurel and De Grandmaison recommend a vegetable diet. Garrod, Ebstein, Cantani, von Noorden, allow meat in small quantities. Von Noorden's con- tention is that meat assists in eliminating uric acid by reason of the thymic acid which it al- ways contains. In many sMn diseases a vegetable diet is also a great boon. Eczema, acne rosacea, and psori- asis often yield to it when external remedies have failed. In Bright' s disease and albuminuria of certain standing, a vegetable diet, with milk, eggs, and cheese, often gives satisfactory results. 356 WHAT SHALL I EAT? The same may be said of hyposystoU, myocar- ditis, and all ailments attended by insiifficiency of the orifice. All these require foods of easy digestion; and a strict vegetarianism imposes upon the heart and intestines an extra amount of activity, both useless and dangerous. In scleroma, hypertension, aortitis, and angina, a vegetable regimen may be recommended with advantage; but milk must be allowed under all circumstances, as it agrees with the patient bet- ter than any other food. In digestive affections it is rarely indicated. Exceptions are: chronic constipation, hemorrhoids, and hyperchhrhydria, in which it may assist in inhibiting gastric secretion. But the opuiions are divided on this subject. A. Robin is strong- ly in favor of meat in hyperchlorhydria. We add also enterocolitis, but only in its graver forms. The famous regimen of Combe is said to be of a vegetarian character. "Vegetarianism presupposes an absolute in- tegrity of functional energy. It does not suit constitutions weakened by hereditary taint, by disease or old age; neither does it agree with weak stomachs." This phrase of Professor A. Gautier comprises VEGETARIANISM 357 all the coniraindicaiions of vegetarianism. It points out in unequivocal terms all the condi- tions in which it is not only unserviceable, but really dangerous, viz. : tuberculosis, which re- quires the largest possible food value in the smallest possible volume; dyspepsia by insuffi- ciency, intestinal atony, and ptosis, all of which require a stimulating diet combined with the least possible encumbrance — women worn out by pregnancy and nursing, all those who have to build up lost tissue and require feeding up, or who lack digestive or general tonicity. If we pass from the pathological domain into that of physiology, the question at once arises: Is vegetarianism, under all circumstances, ap- plicable and beneficial to every human being in perfect health? We do not believe it. Man has ever been omnivorous. The oldest customs — the very structure of his digestive apparatus — prove that the mixed diet is the most suitable. This is preeminently true in respect to the growing youth. In the period of formation and develop- ment, animal food is a matter of necessity. For the full-grown adult we must make a dis- tinction. Sigaud divides the human race into two classes — the strong and the weak. The 358 WHAT SHALL I EAT? latter cannot afford to eschew the tonic stimula- tion of meat. The former thrive sometimes on a vegetable diet. In summing up we will admit that vegeta- rianism is an excellent regimen for many, but it does not suit all. A modified vegetable diet, that which includes eggs and milk, appeals to us as more rational and suitable for many indi- vidual cases. In conclusion, we do not hesitate to borrow another notable phrase culled from Professor A. Gautier's book: "A system of modified vegetarianism should gradually eliminate the fierce and rugged ele- ments from man's character, and fill the earth with gentle manners. It is both feasible and rational, and should appeal to and be practised and advocated by all who seek the ideal life and aim at producing a sweet-tempered, intellectual, and artistic, yet vigorous, active, and prolific race." COMPARATIVE TABLE OF ALIMENTARY PROPORTIONS Carbo- Albumin Fats hydrates Ash Water Beef Veal Mutton Pork Liver Kidney Sweetbreads .... Brain Marrow Cervelat sausage Sausages (small) Goose-liver Chicken Pigeon Rabbit Duck Turkey Goose Quail Partridge Venison Coalfish Codfish Trout Sardines (in oil) Herring. Salmon Egg Yolk of egg Milk Swiss cheese.... Butter 360 Carbo- Albumin Fats hydrates Ash Water ] Beef Barley Oats Rice Maize Rye Buckwheat . , Wheat , Bread , Macaroni ... Lentils White beans Dried peas.. Potatoes Cabbages . . . Onions Carrots Turnips Cress Spinach Tomatoes . . . Mushrooms Apricots Cherries Lemons Quinces Strawberries. . . . Oranges Peaches Apples Pears Plums Grapes Bananas Dates Figs (dry) Almonds (dry).. Hazlenuts Walnuts (dry).. GLOSSARY DEFINITIONS OF TECHNICAL TERMS Acetonuria — The presence of acetones in the urine. Acne — Inflammation of the sebaceous glands. Adynamia — Deficiency or loss of vital or muscular power. Albumin — A proteid substance, the chief constituent of the body. Albimiinoids — Substances resembling true proteids in their ori- gin and composition. Albuminuria — The presence of albumin in the urine. Albumose — ^A substance formed from albuminoids during diges- tion. Alkaloid — Resembling an alkali. Amid — A chemical compound produced by the substitution of an acid radical for one of the hydrogen atones of ammonia. Attiiti — From ammonia. Amydin — Soluble starch. Amylolitic — Pertaining to or effecting the digestion of starch. Anabolism — The process of changing food into constructive tissue. Anorexia — ^Absence or diminution of appetite. Antitoxic — (Counteracting poison. Aortitis — Inflammation of the aorta. Aplastic — Structureless ; not able to form tissue. Arthritis — Inflammation of a joint. Assimilation — The process of transforming and absorbing food in the organism. Asthenia — General loss or absence of strength. Asystole — Imperfection of the heart's action. Atheroma — Tumor. Atonia — ^Want of tone ; debility. Atrophy — ^A deterioration of parts originally normal. Azoturia — Increase of urea and urates in the urine. 363 364. GLOSSARY Blennorrhagio— An excessive catarrhal discharge from the urethra or vagina. Cachexia — Depraved condition of nutrition. Calory— A heat unit. Carbohydrate — An organic substance containing oxygen and hydrogen in the proportion in which they form water. Cardiopathy— Any disease of the heart. Casein — ^A derived albumin. Catabolism — Destructive action of the organism. (See Disas- similation. ) Cecal — Relating to the cecum. Cecum — ^The large blind pouch in which the large intestine begins. Cellulose — ^The primary substance of organic cell-walls. Chlorin — A non-metallic element. Chlorosis — The "Green Sickness." Cirrhosis — Increase and thickening of the connective tissue of an organ, especially of the liver. Coefficient — An agent that unites its action with that of an- other agent for the procuring of a certain result. Colitis — Inflammation of the colon. Collagen — A substance existing in various tissues of the body. Coma — ^Abnormally deep and prolonged sleep, with the func- tions of the brain in abeyance. Combustion — The burning up of food by bodily heat in the organism. Creatin — ^A neutral organic substance that occurs in the animal organism, especially in the juice of the muscles. Cystin — A substance found in the urine in small amount. Cystitis — Inflammation of the bladder. Depuration — Cleaning. Dextrin — The soluble or gummy matter into which starch is converted by diastase or by certain acids. Diabetes — The sugar disease. Diaphoretic — Sudorific ; producing sweat. Diastase — A nitrogenous vegetable ferment. Diathetic — Liable to certain diseases. Dietetics — The science of systematic regulation of the diet for hygienic and therapeutic purposes. GLOSSARY 365 Disassimilation — Decomposition and rejection of undigested food substances. Non-absorption. Diuresis — Abnormal increase in the secretion of urine. Dulcite — An hexahydric alcohol. Dyspnea^Difficult or labored breathing due to disease. Endogenetic — Due to internal causes. Enteritis — Inflammation of the small intestine. Enterocolitis — Inflammation of the small intestine and of the colon. Enteroptosis — Relaxation of the abdominal viscera. Epithelium — The cuticle of a mucous surface and of the skin. Etiology — Causes of diseases. Euphoria — The feeling of well-being or health. Ezogenetic — Due to external causes. Extractives — Substances extracted from various animal tis- sues. Fecula— The starchy part of a seed. Ferruginous — Containing iron. Flora— Plant life. Galactose — Lactose. Gasterectasis — Dilatation of the stomach. Gastritis — Inflammation of the coating of the stomach. Glucose — Grape-sugar, starch-sugar. Gluten — ^A substance resembling albumin. Glycogen — Animal starch. Glycosuria — The presence of grape-sugar in the urine. Hemoptysis— The spitting of blood. Humoral — Pertaining to the natural fluids of the body. Hydration — The impregnation of a substance with water. Hyperchlorhydria — Excess of hydrochloric acid in the gastric secretion. Hypertension — Abnormally high tension. Same as superten- sion. Hypertrophic — Marked by excessive size. Hypopepsia— Disorder of digestion. Hypostenia — Weakness. Hyposystole— Deficiency of cardiac systole. Hypotension — Abnormally low tension. Lowered or diminished tension. GLOSSARY Icterus— Jaundice. Ingestion — The partaking of food. Inosite — A saccharine substance in the human body. Inulin— A vegetable principle. Invertin — A ferment found in the intestinal juice. Isodynamic — Having equal force. Lactose — Milk-sugar. Iiecithin — A complex nitrogenous fatty substance present throughout the animal body, licucin — A product of pancreatic digestion. Leukomain — Nitrogenous bases or alkaloids developed by our vital functions. Iievulose — The natural sugar of fruits. Xiithiasis — The formation of calculi (stone). Malate — A salt of malic acid (found in unripe apples, grapes, etc.). Kaltose — A variety of sugar found in beer. Ilannite — The exudation of the flowering ash. metabolism — The natural changes constantly taking place in the cells of the human body. Myocarditis — Inflammation of the muscular tissue of the heart. Myosin — ^The chief proteid of the muscle. .Nephritis — Inflammation of the kidneys. Neurasthenia — Nervous affections. Nuclein — ^A substance that occurs in the nuclei of the cells. Olein — A natural fat. Olig^uria — Diminution of urine. Oxaluria — Presence of calcium in the urine in undue propor- tions. Fancreatin — The active elements of the juice of the pancreas. Parenchjrma — Soft cellular tissue. Pathogenic — Producing disease. Pathological— Abnormal, diseased conditions of the body. Peptone— A proteid body produced by the action of digestion. Periosteum — A fibrous membrane that invests the surfaces of the bones. GLOSSARY 367 Peristalsis — The peculiar movements of the intestines which propel the contents onward. Physiological — Pertaining to the natural or normal processes of the healthy body. Proteids — ^A general term for the albumin and albuminoid con- stituents of the organism. Psoriasis — ^An inHammatory disease of the skin. Psychic — Pertaining to the mind or sential principles. Ptomains — Inanimate poisonous substances resulting from putrefaction of albuminous substances. Ptosis — Drooping. Puric — Belonging to purins. Purins — Unclean or poisonous substances, foreign to our ali- mentary organism. Pylorus— The opening of the stomach into the duodenum. Pyrexia — Fever Saccharose — Cane-sugar. Sclerosis — Overgrowth of the connective-tissue of an organ. Silica — The oxid of silicon. Solanin — ^A glucosid. Stasis — A condition of standstill. Steapsin — A diastasic ferment. Stenosis — Constriction or narrowing of any part. Stomatitis — Inflammation of the mouth. Supertension — See hypertension. Ternary bodies— The fats, albumins, and carbohydrates of any food. Therapeutics — The application of remedies as a means of cure. Toxic — Poisonous. Tyrosin— A decomposition product of proteids. Urea — The chief solid constituent of the urine. Uremia — Retention in the blood of excrementitious substances normally excreted by the urine. Uropoieses — The neutralization of toxic matter. Xanthic — Pertaining to xanthin — yellowish. Xanthin — A leukomain found in nearly all the tissues and liquids of our economy — yellow coloring matter. ANALYTICAL TABLE OF DISEASES Note. — This table contains only a list of the principal diseases referred to in the book, indicating^ the number of pagre on which the diet affecting the disease is mentioned. Acne, 149, 290, 300, 336, 355 Albuminuxia — see Nephritis Anemia, 56, 78, 89, 130, 163, 164, 203, 214, 216, 224, 244, 250, 252, 254, 266, 288, 333 Angina, 39, 73, 300, 335, 356 Aortitis, 39, 73, 335, 356 Arteriosclerosis, 122 Arthritis, 39, 41, 42, 43, 51, 52, 58, 60, 67, 73, 84, 89, 107, 122, 124, 133, 138, 140, 148, 154, 162, 165, 193, 202, 205, 215, 217, 224, 225, 242, 245, 247, 250, 252, 253, 254, 262, 264, 267, 277, 281, 290, 300, 307, 334, 354 Atheroma, 73, 250, 252, 266, 294, 341, 353 Atony, 72. 120, 149, 163, 243, 266, 290, 293, 340, 357 Blennorrhagia, 246, 248, 250, 251, 294, 341 Bright's Disease, 58, 60, 67, 78, 86, 89, 112, 123, 135, 137, 140. 163, 172, 201, 202, 205, 215, 224, 307, 311, 355 Cancer, 78, 92, 119, 124, 164 Cardiovascular — see Heart Cirrhosis, 41, 53, 122, 148, 319, 334 Coma, 36, 243, 265 Congestion — see Plethora Constipation, 163, 202. 252, 267, 268, 276, 307, 335, 343, 356 Consumption — see Tuberculosis Convalescence. 35, 51, 53, 55, 63, 72, 89, 172, 224, 244, 306, 333 Cystitis, 47, 248, 251, 294 Demineralization, 55, 163, 244, 252 Diabetes, 36, 87, 125, 138, 140, 146, 147, 164, 174, 192, 202, 203, 205, 215, 217, 225, 239, 242, 247, 249, 250, 253, 264, 271, 272, 274, 278, 280, 291, 292, 293, 307, 326, 334, 341 369 370 ANALYTICAL TABLE OF DISEASES Diarrhea, 38, 120, 163, 202, 244, 266, 267, 269. 270. 274. 334. 343 Dilatation, 120, 163. 204. 214. 215. 243. 266 Dysentery, 130, 163, 176, 341 Dyspepsia, 37, 47, 51, 61. 63. 66. 72, 78, 84, 86, 89, 92, 140. 149. 163. 172. 176. 191. 201, 202, 203, 206, 214, 215, 216, 222, 224, 238, 243, 246, 247. 249, 250. 252, 253, 254, 260, 266, 270, 271. 273. 274, 278, 281, 287, 300, 302. 334, 341, 356, 357 Eczema, 47, 58, 60, 67, 86, 89, 140. 149. 202. 252, 272. 336, 355 Emaciation. 51, 130, 164, 224, 288, 340 Enteritis. 38. 66, 78, 127, 130, 137, 214, 215, 231, 266, 341 Enterocolitis, 39, 66, 78, 121, 137. 140. 163, 202, 204, 214, 244, 254, 268, 269. 274. 335, 356 Enteroptosis, 39, 124 Fevers, 63, 147, 175, 265, 293, 320 Gastritis, 37, 38, 74. 76. 119. 120. 130. 201, 214. 231, 243, 248. 254, 293. 335, 340 Glycosuria, 92, 276, 334 Gout, 43, 51, 52, 58. 73, 86, 125, 128, 148, 165. 215, 225, 242, 245, 246, 252, 254, 255, 264, 272, 273. 287, 291, 300, 307, 341, 343 Gravel, 215, 272, 307 Heart, 39, 58, 67, 73, 78, 86, 89. 122. 131. 137. 140, 163, 172, 201, 205, 215, 224, 244. 246. 247. 255. 265. 288, 300, 307, 311. 335. 341, 356 Hyperchlorhydria, 37, 76, 84, 92, 120, 130, 149, 163, 179, 215, 243, 252, 254, 266, 287, 288, 294, 334, 356 Hypertension, 39, 42, 67, 73, 122, 288, 300, 334, 335, 356 Icterus — see Jaundice Intestinal Affections, 58, 86, 125, 128, 130, 149. 163. 192. 193, 201. 224, 238, 244. 247. 266, 269, 294, 335, 341 Jaundice, 53, 294 Kidneys, 54, 72, 131, 243, 244, 246, 294 Littiasis, 36, 41, 43, 122, 125, 148, 264, 276. 294, 336, 343, 355 Liver, 39, 41, 43, 49, 53. 58. 67, 86, 121, 128, 140, 148, 165, 202, 215, 217, 225, 242, 246, 247, 248, 249, 252. 272, 276. 288, 291, 294, 300. 341 METRIC WEIGHTS AND MEASURES 371 Malaria, 41, 334 Migraine, 215, 336, 355 Nephritis, 40. 47, 49, 51, 54. 85. 122, 247, 248. 252, 255. 265. 287, 335, 341. 355 Nervous affections, 39. 41. 74. 123. 130, 149, 300. 335. 341 Neuralgia, 215, 336, 355 Neurasthenia, 42. 53, 63, 67. 164. 214, 300, 335, 355 Obesity, 37, 84. 86. 148. 175. 202, 205, 215, 225, 281, 291, 341 Oxaluria, 125, 179, 217, 250, 252, 273, 303, 307 Phthisis — see Tuberculosis Plethora, 73, 131, 272, 276 Rheumatism, 215, 264, 271, 317, 336, 353, 355 Skin, 140, 149, 202, 244, 248, 265, 272, 290, 336, 355 Stone, 52. 73. 86, 128, 277 Tuberculosis, 35, 51, 53 67. 72. 76, 78, 87, 89, 92, 130, 140, 146, 147, 164, 172, 205, 214, 244, 254, 266, 277, 287, 293, 340, 357 Xncers, 51, 77. 120, 130 ■Uremia, 40, 47, 51, 52, 73, 86 Uricemia, 43, 217, 242, 264, 277, 300, 307 Vomiting, 76, 77, 78, 120 APPROXIMATE EQUIVALENTS OF METRIC WEIGHTS AND MEASURES One gram is equal to about fifteen grains. One kilogram is a little more than two pounds. One C.C., or one cubic centimeter, is equal to 16.9 minims or drops. 3.54 cubic centimeters = one fluid drachm 28.35 cubic centimeters = one fluid ounce. 567 cubic centimeters = one pint. 4536 c.c. = 4.536 liters = one gallon. INDEX INDEX Absinth, 323 Adenin, 21 Alcohol, 317 a food, 321 a nervine, 321 Alcoholic beverages, 316 Aliment, definition of, 4 Alimentary proportions, 360 Alimentation, ration of, 5 Allspice, 292, 293 Almonds, 279 Alsatian wines, 327, 328 Amylodextrin, 210 Analysis, cryoscoplc, of milk, 109 Anchovies, 292 Anisette, 323 Aperiente, 323 Apple-jack, 323 Apples, 257, 273 Apricots, 257, 269 Arrowroot, 227 Artichokes, 245 Asparagnis, 245 Aubergine, 253 Baby foods, 228 Bananas, 278 Barley, 175 Barnyard meats, 61 Bass, 80 Bayberries, 260 Bayleaf, 292 Beans, 207, 216 broad, 218 kidney, 216 string, 216 Beef, 20 extract of, 74 fat, 141 tea, 68 Beer, 337 Beet-root, 249, 250 Beri-beri, 181 Beverages, 308 alcoholic, 816 Bilberries, 269 Biscuits, 200 Bitters, 323 Black wheat, 182 Boletus, esculent, 224 Bordeaux, 327 Bouillon, 68 Bourgogne, 327, 328 Brains, 55 Bread, 184 alimentary value of, 185 composition of, 185 rye, 181 stale, 187 white, 194 Brioche, 203 Brussels sprouts, 246 Buckwheat, 182 Bullheads, 80 Butcher's meat, 19 Butter, 96, 141, 142 brown, 143 hot, 142 melted, 142 milk, 126 vegetable, 143 Butyrin, 141 Cabbage, 245 red, 294 Cacao bean, 304 butter, 304 Caffein, 296 Caflfeinism, 299 Caffeotannic acid, 296 Cakes, 202 Caloric coefiicients, 9 Calories, ratio of, 7 375 376 INDEX Capers, 254, 292 Carbohydrates, 20, 22 Carp, 80 Carrots. 249 Catafia, 323 Catfish, 80 Caviar, 292, 293 Celery, 249, 251 Cellulose, 168, 218 Cereal decoctions, 232 Cerealin, 186 Cereals, 166 general characteristics, 167 special characteristics, 175 Champagne, 327, 328 Champignon, 254 Chartreuse, 323 Cheese, 134-138 Cherries, 257, 269 Chestnuts, 206 Chevril, 292 Chicken, 61 Chicory, 251 Chocolate, 304 Cider, 342 Cinnamon, 292 Citron, 292 Cloves, 292 Coal-fish, 80 Cocoa, 304 Codfish, 80 Coefficients, caloric, 9 Coffee, 295 Cognac, 323 Condiments, 282 assorted, 292 Cookies, 202 Com, 180 bread, 180 salad, 252 Crabs, 88 Crackers, 200 Cranberries, 269 Cress, 251 Crustaceans, 88 Curasao, 323 Dandelion, 252 D'Asti, 328 Dates, 278 Decoctiotis, cereal, 232 Delicatessen, 57 Diet, dry, 310 milk, 113 Dragges, 202 Dry diet, 310 Duck, 61 Dulcine, 291 Eel, 85 Egg, 151 flip, 156 mulled, 156 plant, 253 test of, 158 Esculent boletus, 254 Extract of beef, 74 of meat, 68 Extractive substances, 21 Farinaceous foods, 227 Fats, 141 animal, 141 reactions, 144 Feeding, rational, 5 Figs, 278 Fish, 79 fatty, 85 less fatty, 85 Fondants, 202 Fowl, 61 Fritters, 202 Fruits, 256 acidulated, 257 cooked, 260 fresh, 260 neutral, 278 oily, 279 percentage of sugar, 265 preserved, 261 saccharine, 278 sterilized, 261 watery, 257 Galantine, 248 Galettes, 182 Game, 64 hanging of, 65 Garlic, 248 Gelatin, BO Genoa cake, 203 Gers, 327 Gherkins, 254, 292 INDEX 377 Ginger, 292, 293 bread. 203 snaps, 203 Glands, 50 Glossary, 363 Gluten, 185 Goldfish, 80 Goose, 61 Gooseberries, 257, 272 Grape cure, 275 Grapes, 257. 274 Grayfish, 89 Grease, 141 Guanin, 21 Gudgeon, 80 Ham, 49 Hare, jugged, 64 Hazlenuts, 279 Head cheese, 59 Heart, 50 Herring, 85 Honey, 291 Horse meat, 47 Horseradish. 292 Huckleberries — see Whortle- berries Hydration, 210 Hygienic beverages. 331 Hypoxanthin, 21 Juice of meat. 73 Kemmerich, pepton. 78 Kephir, 128 Kidneys, 52, 53 Kirsch, 323 Koumys, 131 Kiimmel, 323 Lecithin, 186 Leek, 245, 248 Legumes, 207 in childhood, 214 Lemons, 257, 270 Lentils. 215 Lettuce, 222 Liebig's beef-juice. 75 Liqueurs, 323 sweetened, 323 Liver, 52 Lobster, 88 Macaroni, 204 Mackerel, 85 Spanish, 85 Madeira, 328 Madeleines, 203 Maize. 180 Malt Extract. 339 Maltose, 337 Mandarins, 272. Manioc, 227 Maranta indica, 227 Margarin, 141 Marrow, 56 Marsala, 328 Martinet's recipe, 173 Measures, 367 Meat, 19 extract of, 68 juice of, 73 pie. 60 powder, 75 preserved, 44 raw, 24 red, 62 refrigerated, 44 smoked, 45 white, 62 Medoc, 328 Melons, 252 Meringues, 203 Milk, 93 adulterations of, 107 ass's, 101 cow's, 95 cryoscopic analysis of, 109 curdled, 132 derivatives of. 126 diet. 113 food for infants, 117 food value of. 94 goat's. 102 homogenized. 105 how to use, 102 in influenza, 117 in New York, 107 mother's, 100 pasteurization of, 104 powder, 106 sterilization of, 104 Mineral principles, 22 Mullet, 85 Mushrooms, 254 378 INDEX Mussels, 292 Mutton, 48 fat, 141 Myoalbumin, 21 Myosin, 21 Myostroin, 21 Narbonne, 328 Needs of the organism, 5 Nerve foods, 295 Nitrogen, 22 balance of, 76 Noodles, 204 Nuclein, 21, 207 Nursing, 117 mixed, 118 Nutritious pastes, 204 Nuts, 279 Oatmeal, 176 Oats, 175 Oil, 141 Olein, 141 Oleomargarin, 143 Olive-oil, 141 Olives, 279 Onions, 245, 247, 292 Oranges, 257 Oxalic acid, 208 Oyster-beds, 91 Oysters. 88 Pancakes, 202 Pancreatin, 76 Papain, 76 Parsley, 292 Partridge, 64 Paste, 202 Italian, 204 Pastes, nutritious, 204 Pastry, 201 home made, 203 Pat^ de fois gras, 60 Peaches, 257, 278 Pears, 257. 273 Pea sausage, 57 Peas, 207, 217 Pellagra, 181 Pepper, 292 red, 293 Peptones, 76 Perch, 80 Petits fours, 202 Pickles, 294 Pickling venison, 64 Picon, 323 Pigeon, 61 Pike, 80 Pineapple, 269 Plaice, 80 Plasmon, 77 Platrage, 331 Plums, 257, 273 Polenta, 180 Pork, 48 fat, 141 Porridge, 176 Port, 327, 328 Potato. 219 fecula of. 227 sprouts, 226 Poultry, 61 Powder, meat, 75 milk, 106 Pralines, 202 Prawns, 88 Prunes, 264, 273 Ptomains, 44, 90 Pudding, black, 60 blood, 60 Pulse, 207 Pumpernickel, 182 Puric bodies, 21 Purins, 21, 22 Quail, 64 Quince, 257, 270 Rabbit, 61 Radishes, 238 Raisins, 277 Raspberries. 257, 271 Ration, composition of. 15 theoretical. 7 Reactions, alimentary, 10 dechlorated, 287 Regimen, dry, 310 Residues, 15 Rhine wines, 328 Rhubarb, 251 Rice, 177 Richet's recipe, 24 Rum, 323 Rye, 181 INDEX 379 Kye bread, 181 ergotin, 182 Sabayon. 157 Saccharine, 291 Salads, 251 Salmon, 85 Salsify, 249 Salt, 283 Sanatogen, 78 Sardines, 80 Saoer-kraut, 247 Sausages, 59 Savoy cake, 203 Shad, 85 Shell-fish, 88 Shrimps, 88 Skate, 80 Smelt, 80 Snails, 88 Solanin, 226 Somatose, 78 Sorrel, 251 Soup, 68 bottle, 70 vegetable, 212 Spanish wines, 328 Spinach, 251 Starches, Labbe's classifica- tion of, 174 Stearin, 141 Strawberries, 257, 271 Sugar, 288 Sweetbread, 52, 54 Sweetmeats, 202 Tapioca, 204, 227 Tarts, 203 Tea, 301 Ternary bodies, 14 Thein, 301 Theobromin, 304 Thrush, 64 Tokay, 328 Tomato, 252 Tripe, 50 Tropouj 78 Trout, 80 Truffles, 255 Tunny, 85 Turbot, 85 Turkey, 61 Turnips, 249 Uric acid, 21 Vanilla, 292 Veal, 46 Vegetable butter, 143 soup, 232 Vegetables, green, 234 particulars, 245 Vegetarianism, 344 Venison, 64 Vermicelli, 204 Vermouth, 323 Vinegar, 292 Walnuts, 279 Water, 312 boiled, 314 drinking, 312 natural, 308 rain, 314 river, 314 use of, during meals, 314 Weights, 371 Wheat, 182 flour, 183 Whey, 127 cures, 128 Whiting, 80 Whortleberries, 269 Wine, 327 adulterations of, 330 artificial, 331 Woodcock, 65 Xanthic bodies, 21 Xanthin, 21 Yoghourt, 132 Zabaglione, 157 Spring, 1911 Ctetjman*£( analytical Catalogue 1123 BROADWAY, NEW YORK Cable Address : Phone : SQUAMA, NEW YORK 5135 MADISON SQUARE Sub-Office : 40 E. 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