SOMETHING ABOUT DIET.
IT has been truthfully said that “many persons dig their graves with
their teeth,” but, that improper feeding causes many a grave to be dug
is also true.
So never feel sorry or disappointed when the family physician makes a
professional visit, and fails to write a prescription, but instead,
gives you instruction in the art of feeding and nursing the patient.
Food and stimulants support the strength of the system until the
struggle between health and disease or between life and death is
overcome, and thus cure the patient by not allowing him to starve.
There is a large group of diseases for which there are no acknowledged
remedies, and in which a properly selected and regulated diet forms the
mainstay of successful treatment. This should be combined with healthy,
clean rooms, proper ventilation, and other hygienic means which may
suggest themselves to the intelligent practitioner.
The patient’s fancy for this or that article of diet is no index, as a
rule, of what is best suited for him; invalid appetites and cravings
are abnormal; they are like that of the chlorotic girl who eats chalk
and slate pencils, instead of wholesome food and some preparation of
iron.
An aversion to food is also no criterion of the patient’s need for
nourishment, for the sense of taste is generally blunted or perverted.
The desire for food is lost in all diseases of a catarrhal nature of
the mouth or stomach, and in those that are characterized by high
temperature. In typhoid fever and diseases of a typhoid nature this is
always the case.
With children this aversion to food is greater and more general than
with adults; and it must be made a rule that their refusal to take
nourishment must not be extended beyond several days, otherwise they
fail so rapidly in conjunction with the disease as to perish from
exhaustion.
The repugnance to food arises from abnormal conditions that are
generally localized in the mouth and especially in the parts of the
tongue which are supplied by the nerves of taste; these nerves are
the lingual branch of the trifacial and the glasso-pharyngeal. But
notwithstanding that the food is almost tasteless, when it gets into
the stomach it is retained and properly digested and the patient feels
better for having taken it. An appetite can be thus cultivated, and
after a few days of coaxing or perhaps of forcible feeding, which in
children who are failing rapidly becomes necessary in order to save
them, the taste and desire for nourishment become natural or restored.
Quite often patients beg and plead not to be given food; but in wasting
diseases it should be insisted that some at least should be taken
(always liquid of course), and when they are sufficiently rational they
will always afterward admit that the nourishment did them good.
Liquid food or nourishment and no other is suitable for a sick
person; an invalid can drink food when it would be impossible for him
to swallow solid material. I have often seen the whim of patients
who craved meat indulged; they got a juicy porterhouse steak with
the understanding that it was to be thoroughly masticated before
swallowing. As a rule, the patient is disappointed with his own bill
of fare, and after trying one or two mouthfuls orders the meat taken
away with the remark that it is as dry as a chip. But this same person
will drink a milk punch, a thin gruel with the yellow or all of an
egg beaten into it, with some degree of relish; salt should always be
added and indeed, as much as the taste will permit, but sugar should
be used as sparingly as possible. Salt is what is needed above all
other seasoning; the system requires the chlorides for they are wasted
in fevers, but even in health, the chlorides are very essential and
salt is the best one we have; salt is the source of the hydrochloric
acid in the stomach and one of the most important factors in albuminous
digestion.
The saliva is not secreted in sufficient quantity in fever to allow
insalivation of food, or to moisten the solid morsel sufficiently to
permit its being swallowed without a choking sensation as it glides
into the stomach. A person prostrated by disease has not the strength
to masticate solid food and that is another reason why liquid food is
to be given.
The famous physiologist, Dr. E. Brown-Séquard, is the author of a
method for feeding the sick peculiarly his own, namely, that of
administering small quantities of food at short intervals. He would
give a glassful of milk punch in tablespoonful doses, repeating every
ten or fifteen minutes; this method is advised for the treatment and
cure of dyspepsia, anæmia, chlorosis, nervous diseases and even organic
diseases of the stomach. No particular kind of food was selected for
this treatment; butter, milk, cheese, and meats, bread and potatoes
were alike to be given in small quantities and at short intervals. One
or two mouthfuls even to be eaten at a time, and then repeated in ten
or fifteen minutes, until thirty to forty ounces are consumed daily.
This system never became a recognized expedient, it is wrong in theory,
and certainly in practice; while it may be applicable in isolated
cases, they would be so very few that this method of feeding forms the
exception and not the rule.
Cases are frequently met with, especially in infants and older children
whose digestion has been completely ruined by being fed too often.
These cases are not really overfed, because the entire amount in
the twenty-four hours, does not exceed the requisite quantity; but
giving the food in driblets and at short intervals, causes lactic
fermentation, or in plain English, the food sours on the stomach and
does not digest, as it would do if a proper time were interposed
between each feeding. As soon as the patients are fed at regular and
longer intervals, say, from two to four hours, the indigestion corrects
itself. During the interval, between the time set for feeding, the
children will naturally cry; this is interpreted by the mother or nurse
as a sign of hunger, but nothing is oftener further from the truth. The
child cries generally for one of three reasons: one of these may be
that it wants to be taken up, and dandled or rocked, to which previous
indulgences have accustomed it; or it may have pain in the stomach and
bowels as a natural result of indigestion or flatulence; or the child
may cry from thirst or a sensation of dryness in the mouth and throat;
in any event, additional food would only prove injurious. There is no
objection against giving nurslings cold water between their meals when
they are thirsty or feverish, but warm aromatic tea is so very much
superior that I consider it one of the essentials of the nursery. I
mean fennel seed tea, of which a sufficient quantity should be prepared
every morning to last twenty-four hours; this should be strained and
sweetened, then set aside for further use. When the child is restless,
between meals, some of the tea should be warmed, and given from the
nursing bottle until it is satisfied, for the tea soothes the pain,
quenches the thirst and dispels the flatus.
There are also physiological reasons for these longer intervals
between nursing; they allow the stomach sufficient time to dispose of
its contents before another mess is given to disturb the digestion
of former food, which is as yet incomplete. There is another immense
advantage in having the length of time between two meals from two
to four hours; it allows time for medication and other necessary
management of the sick, for sponging off with cold water in fevers, and
many other things which are necessary for the patient’s comfort and
convalescence, and which can only be carried out between the times the
nourishment is given. A memorandum should be kept in the sick room and
the time and hour noted when everything becomes due in proper order;
this avoids confusion and lessens labor.
Digestion is the solution of the food in the stomach for purposes
of nutrition. Nitrogenous materials, egg, meat, muscle are digested
principally in the stomach, but not entirely so, because the particles
of albuminous food which pass from the stomach into the upper portion
of the small intestine come into contact with the pancreatic fluid,
which is the digestive agent for fats and starches, but which possesses
also powerful digestive properties for nitrogenous or albuminous
substances and even in a greater degree than the gastric juice of the
stomach, which has a strong acid reaction, while the pancreatic juice
has an alkali reaction; here is a very interesting illustration how
similar digestive processes are accomplished under opposite chemical
conditions. The intelligent reader must not fail to observe, from
what has been said, that there are two distinctly different digestive
processes, namely one going on in the stomach and another equally as
important taking place in the small intestines.
Pepsin is the active principle of the gastric juice, held in solution
in a clear colorless liquid, principally water; it has a sour taste
and a peculiar characteristic sour smell. The length of time required
by the gastric fluid to dissolve the food depends greatly upon the
minuteness of the division of the solid substances to be acted upon, as
well as upon the quantity and quality of the peptic fluid.
The pepsin changes the physical properties of nitrogenous substances
so as to make them soluble in water in any proportion and when the
albuminoids have acquired this property they are termed peptones;
peptones are simply nitrogenous food which has been modified to fit it
for absorption and nutrition of the body.
In the tissues of the body there are continual changes going on, termed
in technical language tissue metamorphosis; the waste products that are
thus formed constitute a group of highly nitrogenized substances, which
in a healthy condition of the system are eliminated by the kidneys.
These nitrogenized products are urea, urate of soda and uric acid;
the accumulation of any of these substances in the blood gives rise
to disease; the former is the cause of uræmia and uræmic convulsions,
and the latter have been detected in the blood and exudations in cases
of gouty and rheumatic disease. The characteristic gouty deposit is
urate of soda, due to an excess of nitrogenous elements of the blood.
An excess of uric acid constitutes a disease which is first recognized
by a reddish crystalline sediment in the urine; the term _lithiasis_
has been employed to denote this peculiarity. These lithates are always
to be found in the urine of high livers and are due to an excessive
consumption of nitrogenous food. The great English authority, Dr.
Murchison, looks upon the excessive production of uric acid, or lithic
acid, as it is sometimes called, as due to one of two causes and
sometimes to both, namely to the excessive consumption of nitrogenous
food, or to an inability of the liver to perform its duty, which among
other things is to dispose of the nitrogenous waste products. From
this point of view lithates or brick dust deposits in the urine are
no sign that the kidneys are deranged, but quite the reverse may be
true when the kidneys are overburdened in eliminating this excessive
waste, for they are performing extra duty, which excess in living or a
sluggish liver imposes upon them, and this may excite inflammation in
the tissues of the kidneys and develop into what is known as Bright’s
disease.
This very interesting exposition of the deposit of lithates or gravel
in the urine will naturally suggest that when the urine is overloaded
with these nitrogenous products nitrogenous food like eggs, cheese,
beef, etc., should not be eaten for awhile, and that a vegetable diet
should be principally relied upon, thus giving the liver a vacation;
the diet should be supplemented with plenty of clean fresh water, and
no liquors of any sort should be taken by those whose liver is affected.
Starch, sugar and fat are composed of carbon, hydrogen and oxygen;
starches and sugars are termed carbo-hydrates; because the hydrogen
and oxygen is always present in them in equal atomic weights so as to
represent water; while in the fats the oxygen is considerably less.
This is exemplified by comparing the chemical equivalents of starch and
cane sugar with those of fats:
Starch C_{12}H_{10}O_{10} Oleine C_{94}H_{87}O_{15}
Cane sugar C_{12}H_{11}O_{11} Margarine C_{76}H_{75}O_{12}
When starch is boiled with diluted nitric, sulphuric or muriatic acid
for thirty-six to forty hours, it becomes colorless and thin like
water, and is converted into a species of sugar. A similar process
takes place when starch is taken as food, the diastase of the saliva,
and the pancreatic and intestinal juices change starch into _glucose_,
in which form it is ready for nutrition.
Cane and other sugars introduced into the system as ingredients of
fruits and vegetables are not absorbed as such, but undergo a process
of digestion which converts them into grape sugar or glucose; after
that they are suitable for nutrition and absorption into the blood, but
not before.
The digestion of starches and sugars has been incidentally referred
to as not taking place in the stomach but in the upper portion of the
small intestine, through the agency of the pancreatic juice which has
the peculiar property of converting farinaceous and saccharine matters
into grape sugar. But this transformation into grape sugar is not
the final product of digestion. In the normal process of intestinal
absorption the grape sugar is taken up by the portal capillary vessels
and carried to the liver, where under the influence of this organ it
is changed into liver sugar or glycogen, and it is as glycogen that it
again enters the circulation, to disappear in the lungs. But if the
liver from disease or other causes fails to perform this task, the
glucose passes through the organ unaltered, and as such again enters
the circulation where it acts as an irritant and finally is eliminated
by the kidneys in the urine giving rise to the affection known as
diabetes.
We have learned that there is a stomachic digestion and an intestinal
digestion, the former principally for meats, or that class which are
now called nitrogenous foods, while the latter is confined generally
to starches and fats. This physiological fact suggested the idea of
feeding dyspeptics only on such food as is not acted upon in the
stomach, but passes beyond that cavity to become digested in the
small intestines, giving the stomach a rest as it were so that it
may recuperate and gain strength while the system is being fed by
farinaceous aliments. While a superficial glance justified such a
procedure, a moment’s reflection proves it to be a delusion, and
for this reason, that there will be an unavoidable irritation of
the stomach which the journey of the farinaceous material occasions
in its passage through the stomach, and the insufficient nutritive
value of a simple non-nitrogenous diet causes a rapid loss of tissue
and bodily strength; hence this course proved itself impracticable
and was abandoned. Then again the experiment was tried of putting a
certain class of dyspeptics on a purely meat diet; this had one fault
common with the former plan; it was also too one-sided, and the system
suffered for want of fat and starch, and secondly peptones were not
always formed in the stomach from a deficiency of the gastric juice or
an impairment of its quality, so that this method was also abandoned.
Fats belong to the starches and sugars as heat producers; they are
insoluble in water, and by boiling them in caustic alkali they are
decomposed into soap and glycerine. In the cavity of the stomach fats
remain unaltered; the heat of the stomach may melt or liquefy them,
but in no other way are they changed. They are also digested, like the
starches, in the small intestine by the action of the pancreatic juice
which possesses the remarkable property when brought in contact with
fatty or oily matter at the temperature of the body of emulsifying
it, and of converting the fats into a milky, white, opaque looking
fluid, by a minute subdivision of the oily particles. This emulsion of
the fatty and other substances of the food is termed chyle, and as
such, the fatty substances are ready for absorption by the absorbents
of the intestinal tract. Experience teaches that a deficiency of fat
causes scrofulous diseases, and this class of patients have generally a
repugnance for fat; this is another illustration of the unreliability
of patients to choose their own food. Professor John H. Bennet first
pointed out the usefulness of cod liver oil in consumption and other
scrofulous diseases, and directed attention to the value of fat in the
nutrition of the body.
Dr. Ferguson made extensive observations on the little children of the
factory operatives of Lancashire, Eng. The children were principally
fed on tea or water and bread, little or no fat, bacon, butter or
cream, and they grew up into puny and stunted men and women, while
those who had a bread and milk diet grew into hardier and finer human
specimens.
Fat is also an essential food for the brain and general nervous system;
the lean are the nervous patients and not the fat and sleek, hence
fatty food is considered an important diet for this class of diseases.
The brain and nerve fat is called “lecithin” and a little phosphorus
enters into its composition. Chronic obstinate neuralgia has often been
cured by the administration of cod liver oil.
Milk is the only single article of diet which possesses in itself
all the properties to supply the wants of the system, and it may be
profitable to give this subject more than passing notice. It is the
natural and most wholesome food for the infant when it can suck it from
its mother’s breast; instinctively the newborn rolls its little head
hither and thither in search for this fountain of infantile life and
however great the skill of the chemist in approaching the composition
of mother’s milk, he can never produce an equally good substitute. Milk
contains all the principles which are necessary for human food, the
nitrogenous, the oleaginous and the saccharine, and these are blended
in such proportion that milk is adapted for the complete nourishment
of the young and old. In no other single substance supplied by
nature does a similar combination exist; it contains the material
for the consolidation of bone and for the formation of the red blood
corpuscles, by carrying in solution the phosphates of lime, magnesia
and iron; in this respect an analysis of milk shows a remarkable
similarity to blood. The proportions of the different constituents of
milk are liable to great variations and are greatly influenced by the
nature of the food.
Dr. Playfair of London, who has made some interesting researches
regarding the milk of the cow, has demonstrated that the amount of
butter depends in part upon the quantity of oily matter in the food
and in part on the amount of exercise which the animal takes; and upon
the warmth of the atmosphere in which it is kept. Exercise and cold
weather eliminate the oily matter or butter, in the form of carbonic
acid and water, while rest and warmth diminish this drain by favoring
its passage into milk. On the other hand, the proportion of the cheesy
matter is increased by exercise.
In Switzerland, where the cattle pasture in very exposed situations and
where, from the rolling of the country, they are obliged to use a great
deal of muscular exertion the quantity of butter yielded by the cows
is very small, while the cheese is in unusually large proportions; but
the same cattle when stall fed give a large quantity of butter and very
little cheese.
The character of the food will decide the nature and healthfulness of
the milk. The best food for milch cows is bran or middlings mixed with
well-seasoned and sweet-cut hay, and this mixture thoroughly scalded
and saturated with boiling water; a little flaxseed oil cake, should be
added occasionally, for it enriches the milk and keeps the cattle in
good condition; during the day the cows should be in the open air; they
should not be irritated by dogs, or made to run or trot; these things
will affect the milk injuriously. To feed cows on kitchen garbage or
swill of any sort will taint the milk so that the offensive odors of
the swill can be readily detected, especially after the milk has stood
awhile; such milk is particularly dangerous to infants and should at
once be discontinued. Distillery slops are often fed to cattle in
large cities; these are not only productive of poisonous milk but
also injure the cattle so that they become salivated and lose their
teeth after a few years of this diet. Brewers’ grains are not open to
the same objection as whisky slops; a certain proportion of brewers’
grains added to the cut food increases the flow of milk. In all large
towns there are families who keep one or two cows and who sell the milk
as a means of making a livelihood: as a rule these cattle are fed on
swill, and not upon the best quality of food, and although this milk is
recommended as being pure and one cow’s milk, it is as a rule not good,
for the stalls and the food do not come up to the requirements for
wholesome milk.
I have always found a healthier and purer milk from the dairies run on
a large scale, and outside of the centers of population. The cattle
look healthier, have better food, good pasturage and pure country air,
and if the milk is properly chilled or cooled off before it is poured
into the wagon cans, country dairy milk is to be greatly preferred
over city milk. The animal heat should have left the milk before it is
put into cans for transportation, for it is the animal heat in tightly
closed vessels which causes the chemical changes that encourage the
development of organic milk poisons or so-called _ptomaines_.
Milk promiscuously mixed from a group of apparently healthy cows is
preferable to that of one cow, and for several reasons; the honesty
of dairymen is doubtful, for they will not take the extra trouble to
keep the milk of one cow apart when the cows are being milked; again
tuberculosis or consumption in all its stages is a common disease among
cattle, and quite often a milch cow has tuberculosis when she seems
healthy. If a child should subsist on the milk from a tuberculous cow,
serious consequences would undoubtedly ensue, but if this milk had
been mixed with that of thirty or forty healthy cows, the danger of
infection would be correspondingly lessened.
Cow’s milk should average 12 per cent. of cream; if it contain less
than 8 per cent., it is probable that the milk is watered or that it
was skimmed. A cream gauge is a cylindrical glass vessel about one
and a half inches in diameter and eight inches high, with a capacity
of 12 fluid ounces. This tubular measure is graduated so as to make
it possible to read off from the top downwards 1, 2, 3, etc., parts
or drams of cream which gradually rises to the surface. This glass is
filled with the suspected specimen of milk up to the highest mark and
set aside for 24 hours, at an ordinary temperature; at the expiration
of that time the quantity of cream which rose to the surface of the
milk is read off, and in this manner it is easy to see the proportion
of cream to the entire bulk of milk tested. Above it was stated that 12
per cent. is an average for good milk, and 14 per cent. is extra good,
while 8 per cent. is the lowest that is permissible. If the percentage
falls below 8 per cent. it is a sign that the milk has been skimmed,
and if the density or specific gravity is below 27 degrees, then it is
to be presumed that the milk has also been watered, for sometimes the
milk is both skimmed and watered.
The density or specific gravity of milk gives an approximate idea of
the quantity of solid matter a given specimen submitted for examination
contains, as compared with pure water. The lactometer or galactometer
is a kind of hydrometer, but specially graduated to readily read off
the density which pure milk should have. Pure milk at a temperature
of 55 to 60 degrees should have a specific gravity varying between 27
and 33 degrees and if the sample falls below 27 degrees, it is to be
presumed that water has been added. The density of diluted milk is
sometimes maintained by boiled starch water; this can be detected by
adding a few drops of tincture of iodine, which changes the starch into
a beautiful violet blue, also giving the adulterated milk a similar
tint.
It must always be remembered that while milk presents itself in a
liquid form it becomes a semi-solid in the stomach in the ordinary
process of digestion; this change is accomplished by the action of
the gastric ferment, curdling the milk. Milk is not a diluent for
solid foods and it should never be drank as a substitute for water
when other solid food has been eaten. The practice of eating a
regular meal of meat and vegetables and drinking milk at the same
time invariably overloads the stomach, and if it does not injure the
digestion immediately it is sure to do so in time; it also furnishes
an oversupply of nitrogenous food, developing an excess of lithates or
uric acid, and this burdens the liver and kidneys. If a person is fond
of milk it is most excellent as a principal article of diet at a meal,
and indeed nothing is better than a bowl of well-prepared mush or a
few slices of bread with a pint of fresh milk for either breakfast or
supper.
Boiled milk has considerable healing and binding virtues; it may be
thickened with a teaspoonful of wheat flour to the pint, and taken
quite warm; as a household remedy, it is one of the most valuable in
ordinary cases of diarrhœa, but no other food should be taken until the
cure is effected.
The milk cure is a well-established and recognized expedient for
the relief and cure of a certain class of patients, and as the
success of the regimen depends upon an intelligent employment of the
fluid, it becomes necessary to enter somewhat into the detail of its
administration.
The milk-shake, that is milk shaken in a tumbler or beaten with an
eggbeater for several minutes is frequently borne by persons who cannot
digest milk which has not been so treated; then again, a teaspoonful
of mush or gruel added to a tumblerful of milk and thoroughly beaten,
divides the curd mechanically when it forms in the stomach, and so
makes the milk much more soluble by the gastric juice.
Milk should never be drank cold, but at a temperature of about 100°
F., which is about as warm as it comes from the cow, for cold delays
the curdling and hence the digestion of the milk, and gives it time
to develop acid or lactic fermentation in the stomach, and this may
cause indigestion; a pinch of salt should be added to milk, it assists
in its digestion. There must be certain periods at which to take milk,
allowing a definite interval for the milk to digest; taking milk in
mouthfuls, for instance as a drink instead of water is wrong, for this
will ferment and occasion indigestion. The proper length to intervene
between each meal of milk is four hours; breakfast 8 o’clock, dinner
at 12 o’clock, lunch at 4 and supper at 8 o’clock; if the patient is
considerably exhausted, the time between 8 o’clock in the evening and
the same hour in the morning may be too long, and if the patient is
awake, a meal should be given at midnight.
The quantity of milk which may be taken for one meal is of great
importance, for there is the same danger of taking too much of this
food as of any other. The average quantity to begin with must not
exceed half a pint, and when the appetite is capricious one-fourth of a
pint is sufficient. It is now fully established that a grown person can
be fairly well nourished for quite a while on one quart of milk in the
twenty-four hours.
It is also of considerable importance to the patient that he does not
gulp the milk as this would cause it to curd into a large cohesive mass
of casein, which would be slowly dissolved or acted upon by the gastric
juice, and might give rise to distress from indigestion. If, on the
other hand, the patient sips the milk slowly, or eats it with a spoon,
the curds will be small and flaky particles which even a weak stomach
may digest. There are quite a number of persons who like milk, yet
whose stomachs do not take to it, and for these a milk cure might be
just the thing. It requires often a great deal of ingenuity to devise
a plan whereby the obstacle may be overcome. The first step should
be to shorten the interval between each meal and lessen the quantity
correspondingly; thus to give the patient the milk every hour would
imply that he was to take only one-fourth as much at a time as if he
took it every four hours. Perhaps the milk would digest more easily if
it were first beaten and slightly seasoned with a pinch of salt, or if
a little strained gruel were added to mechanically divide the curd. A
soda cracker, toasted bread, or the rind of thoroughly baked wheaten
bread is an excellent substitute for dividing the cheesy substance of
the milk when it gets into the stomach. They should not be soaked or
dipped into the milk and eaten together, but eaten dry and thoroughly
masticated until the saliva has reduced the bread to a soft pulp, after
which a spoonful of milk should be taken and the bread stuff washed
down. The saliva serves another useful purpose besides moistening the
bread as it changes the starchy substance into sugar.
In other cases the milk sours on the stomach, and then some antacid
or alkali, like lime water or bicarbonate of soda should be added
for several days or until the disposition to lactic fermentation has
subsided. If notwithstanding every precaution, waterbrash, heartburn,
or a heavy oppressed pain in the stomach occurs, or if sourish, slimy
secretions are vomited, the milk cure must be abandoned for something
else.
Diarrhœal diseases of infants who are fed on cow’s milk are caused,
in many instances, by germs or spores that get into the milk from
lack of proper cleanliness and from the unavoidable exposure of the
fluid to the atmosphere of stables and dairy rooms where the milk is
handled before transportation to consumers. To obviate the danger of
feeding nurslings with infected milk, and to destroy the vitality of
germs which find access to the milk, methods have been devised for
_sterilizing_ the milk. This process was first proposed in 1886 by
Professor Soxhlet, and has ever since gained favor with the profession;
it consists of exposing the milk to a temperature of live steam or
boiling water for about forty-five minutes. In New York City there are
two reliable firms which sterilize milk at the dairy in the country and
ship it to the city.
In all the methods of sterilization the milk is placed in six or
eight-ounce bottles and set on a tray or shelf, which stands above the
water at the bottom of a vessel, the cover then applied and the water
made to boil forty-five minutes; a perforated stopper is inserted into
each flask, admitting of the escape of air and gases at the beginning
of the heating process. The stopper may consist of cork with a glass
tube in the center, or cotton, or of rubber with a channel a part of
the distance on one side. If necessary the family can improvise their
own apparatus; an inverted tin pan will serve the purpose of a tray
to support the nursing bottles, and this placed in the bottom of an
ordinary tin vessel with a cover completes the contrivance. The milk
is to be prepared as it is to be administered, that is, the proper
quantity of water, a little sugar, and the point of a penknifeful of
bicarbonate of soda added, and distributed among as many eight-ounce
flasks or nursing bottles as the child is fed during the twenty-four
hours; thus if fed every four hours the milk should be distributed
among six flasks, and if fed every three hours, it would require eight
flasks. When the milk has been sterilized, it keeps sweet for an
indefinite period at ordinary temperature; the bottle is to be well
shaken to mix the cream before the cork is removed and the nipple
applied.
When an apparatus or a sufficient number of flasks cannot be readily
obtained I have the milk boiled in a fruit jar after the manner of
making beef tea, as follows: A quart preserve jar is filled with milk,
obtained not later than four to six hours after milking, the cover is
lightly put on, to allow the escape of air and gases, and then the
jar is put into a vessel, on the bottom of which an inverted pan has
been placed so that the preserve jar does not rest on the bottom of
the vessel where the heat would crack it; the vessel is then to be
filled a third with water, and this boiled for an hour, after which
the jar is carefully closed, as in preserving fruit, until wanted for
use. The milk should be kept in a cool and clean place, and only as
much measured out each time as is required for one mess, after which
immediately close the jar. The water that is to be used for diluting
the milk must have been thoroughly boiled; it is always better to
prepare and dilute the milk before sterilizing it for very young
infants, but when they are a year or more old, the boiling water may be
added at each meal.
The casein, which is the curd or coagulable part of milk, differs
greatly in its physical property in the milk of the cow from that in
human milk. Mother’s milk curds in _soft flaky coagula_ which are
readily dissolved in the infant’s stomach, while cow’s milk curds in
a semi-solid conglomerate coagulum which the cavity of the child’s
stomach is often unable to tolerate nor the gastric juice to penetrate
and dissolve. It is this heavy curd which forms the main objectionable
feature of cow’s milk as a substitute for that of the mother. This can
be greatly modified by first thoroughly beating or churning the cow’s
milk with an egg beater, and afterwards scalding it as above described;
the milk treated in this manner curds light and flaky. But it must not
be presumed that the physical characteristic of casein is the only
peculiarity of cow’s milk in comparison with mother’s milk, for this is
not so; it also differs in quantity, that is, mother’s milk has less of
casein, a fact which may be better understood by the following chemical
analysis of both:
Human milk. Cow’s milk.
Water 87.09 87.00
Casein and albumen 2.48 3.72
Fat 3.90 3.66
Sugar of milk 6.04 4.92
Phosphatic salts 0.49 0.70
—————— ——————
100.00 100.00
There are some children who are unable to digest cow’s milk in any
form, either from a peculiarity of constitution, or from a derangement
of the digestive apparatus; the milk, no matter how prepared, passes
through them curdled, in lumps and undigested; to continue feeding
infants on milk, notwithstanding this symptom would in all probability
sacrifice the life of the child. If curds persist in the stools milk
is to be withheld for a time, and crushed wheat, barley gruel or other
diluents should be given alone or in combination with the thoroughly
beaten white of egg. This treatment must be continued for several days
and in some cases for several weeks.
Whey prepared from sweet and pure milk has often been borne by delicate
and suffering infants, when nothing else could be retained. An
examination into the chemical composition of whey reveals astonishing
nutritive virtue, which it holds in solution; the following table shows
the proportional constituents in one hundred parts:
Water 93.31
Nitrogenous matter 0.82
Fat or butter 0.24
Sugar of milk 4.98
Fixed salt 0.65
When the whey is the product of soured milk, 0.33 or more of lactic
acid is to be added to this analysis, and the same amount deducted
from the sugar of milk. Essence of pepsin will curd lukewarm milk, not
warmer than can be agreeably borne by the mouth; a temperature higher
than one hundred and fifteen degrees Fahrenheit destroys the curdling
principle of the pepsin. The quantity of essence of pepsin to be used
to the pint of milk depends on the strength of the preparation; usually
a teaspoonful or two is added and stirred just enough to mix; let it
stand till firmly curded, then beat up with a fork until the curd is
finely divided; now strain and the whey is ready for use; it should
be sweetened a little; sugar of milk, if pure, would be the best,
otherwise white cane sugar may be used. A newborn babe will require a
tablespoonful to begin with, every two hours, always slightly warmed.
It is particularly essential to keep everything clean, especially the
tube and nipple; these are to be brushed and cleaned after each meal,
and then laid on a clean dry plate for future use; the nursing bottle
too must be rinsed and drained. The prevalent custom of keeping the
tube, nipple and bottle in water after they are washed is a bad one,
for to have them sweet and pure they should be allowed to dry out
between times.
Condensed milk is often a valuable substitute for fresh cow’s milk; its
utility, is probably due to the employment of heat in its manufacture,
which destroys the germs or spores that find their way into all milk,
and to the scalding of the casein which modifies its physical character
so that it no longer curds into large lumps when in the stomach, but
into smaller flakes. There are different brands in the market, and even
the best of them may be too old and shop worn; they then become thick
and dark in which condition they are no longer fit for infants’ food.
The Eagle and Anglo-Swiss are among the best varieties; others contain
too much sugar, while some are adulterated with starch or flour. A
heaping teaspoonful of condensed milk to a teacupful of warm water,
previously boiled, is the average strength, although better results
are obtained when a thin gruel of corn starch or arrowroot is employed
instead of plain water; when the child grows older cracked or rolled
oats or graham flour may be substituted for the arrowroot. The gruel
is prepared in the following manner: take half a teacupful of oatmeal
or graham flour, saturate first with cold water, then stir slowly into
three pints of boiling water; add a pinch of salt and boil over a slow
fire for three-quarters of an hour, stirring constantly so that it will
not scorch on the bottom; then strain, and if it has boiled down to
less than a quart of gruel, add a sufficient quantity of boiling water
through the strainer to make it measure a quart.
The gruel is to be prepared fresh every morning, and the above quantity
will last about twenty-four hours. It should be kept in a porcelain
or glass pitcher covered with a napkin, and set aside in a clean cool
place. At regular mealtimes take out the required quantity, warm in a
little agate saucepan, kept only for this purpose, and when warmed add
the condensed milk, stirring until it is dissolved. This makes a fine
cream-like food, agreeable to take and very nourishing if well borne by
the stomach. The stools may become too loose at times from the oat or
wheaten gruel, then this gruel should at once be changed for that of
corn starch or arrowroot until the bowels are regulated again, and when
that is done it may be advisable to return to the oatmeal or cracked
wheat. The exercise of a little judgment and close observation in
feeding a child will contribute greatly to its well-being; any diarrhœa
or disturbance of the digestion must at once receive prompt attention
and this can often be accomplished by change of food; to allow
these disorders to run for any length of time is to invite serious
consequences.
Adults or grown persons have also their share of stomach troubles; as
a rule they eat too much, too fast and do not masticate their food
sufficiently. It is not so much what a person eats, but how he eats,
not so much quality as quantity.
After an exclusive dietary of milk dyspeptics should gradually return
to a mixed diet, that is a regular dinner once a day; but eat slowly
and masticate thoroughly; thus one eats rarely if ever too much. When
the food is bolted, it makes little or no impression on the nerves of
taste, nor does it appease the sense of hunger, and the only indication
of satiety is a feeling of fullness.
As to the time of taking one’s dinner that depends altogether on the
occupation and habits of the individual. In dyspeptics in whom the
digestion is slow and the circulation sluggish the principal meal or
dinner should be eaten at noon; this gives opportunity to move about,
stimulating the circulation, hence increasing the absorption to its
highest point. If a man eats his dinner in the evening and afterwards
goes out into society or attends amusements the late dinner is not
objectionable. But if a person is worn and tired out at supper and
then eats a hearty meal, and lounges around the room the remainder
of the evening, reading the newspaper or otherwise inactive, he is
quite likely to feel distress from what he ate, and sure to experience
occasional bilious spells; nightmare disturbs his sleep and he awakes
in the morning unrefreshed, languid and dull. It is better for such
persons to eat their dinner at noon, and retire early on a very light
supper.
Beef tea became very popular at one time as a nourishment for the
sick, and there can be no doubt that many patients who were stricken
down with different acute diseases slipped into their graves, because
beef tea was relied upon with a belief that it was a sufficient
nourishment. Observation and careful researches on the subject have
proved conclusively that the nutritive value of beef tea as ordinarily
prepared, that is chopped beef put into a bottle and boiled in a
water bath for three or four hours, has been greatly exaggerated. The
process of boiling the beef has no other effect than that of drawing
out the watery substance of the meat. The phosphatic salts that are
contained in the meat are also extracted with the serum which holds
them in solution. The natural albuminoids (musculine) which constitute
the real nutritive element of beef are congealed and surrounded by the
fibrous tissue—that part which snarls up and renders the beef gristly
and tough. Yet as a nutritive stimulant, beef tea possesses at times
considerable value; it is an excellent vehicle sometimes, for instance
an egg thoroughly beaten and added to a cupful of warm beef tea is a
desirable form of liquid food for invalids.
Eggs constitute a highly nitrogenized food and their nutritive value
is even greater than that of stall-fed beef. The subjoined tables of
chemical analysis give the definite quantity of each constituent that
is contained in one hundred parts of egg and beef:
STALL-FED BEEF. EGG. LEAN BEEF.
Phosphatic salt 0.5 1.0 1.5
Albuminoids 10.5 15.0 17.5
Fat 45.0 12.0 6.0
Water 44.0 72.0 75.0
————— ————— —————
100.0 100.0 100.0
If we compare the analysis of egg with that of milk, a remarkable
similarity will be observed, save one exception, namely the
carbo-hydrate sugar of milk is lacking in egg, and in order that eggs
have the same property of nourishing the body as milk, this element
may be readily supplied by eating a little bread. The writer is
familiar with the history of a case in which a patient was kept on an
exclusively egg diet for five months, and during this time he increased
his weight thirty-eight pounds; he consumed eight eggs and twelve
ounces of bread a day.
We hear considerable unfavorable comment in regard to hard-boiled eggs,
and indeed for good and sufficient reason, but the indigestibility
of the hard-boiled egg is not due to any change in the nature of the
albumen because it is boiled; the cause is entirely mechanical. The
reason is that a hard-boiled egg is not sufficiently divided by the
ordinary process of mastication to allow the gastric juice to attack
it from all sides; if it were finely pulverized either by the teeth or
otherwise it would be as readily digested as a soft-boiled or raw egg.
A raw fresh egg that is thoroughly beaten with an egg beater is
the most readily digested food that there is. The author has known
dyspeptics who could not digest any other kind, and by adding a pinch
of salt and half to one tablespoonful of whisky after it is thoroughly
beaten, it is certainly one of the most valuable foods for a certain
class of stomach troubles that can be recommended. Patients whose
digestion is very weak should begin with one egg every four hours
until four eggs are taken during the day; when the strength increases,
two may be taken for breakfast, and one for each meal the rest of the
day; after the lapse of a few days another may be added to the second
meal, and so the number gradually increased until eight are consumed;
prudence would not go beyond this number lest an excess of nitrogenous
matter overtax the liver and kidneys to eliminate it from the system
and this result in other complications.
Dyspeptics, more than others, must avoid overtaxing the digestive
organs, and while the stomach is sensitive and for a long time
afterwards, they must avoid solid food.
The quantity of bread must also be jealously guarded; while the stomach
is very sensitive and weak it had better be entirely suspended and when
resumed no more than three ounces should be eaten at each meal to begin
with. For those dyspeptics whose stomachs possess average digestive
power, and who require a nourishing and readily digestible meal, the
writer would recommend for breakfast a milk gruel to which a raw egg
has been added: he directs that four tablespoonfuls of oatmeal mush
be mixed with three-quarters of a pint of warm milk and this worked
through a tin strainer by means of a potato masher; to the milk gruel
so obtained and again moderately warmed, a raw fresh egg is added,
which has been previously beaten to a foam, and then the whole mess is
again beaten together, seasoned with salt and served in a bowl.
Medicines should play a very minor part in the treatment of dyspepsia;
the artificial pepsin preparations are all overrated and their supposed
efficacy is due to a careful and regulated diet rather than to the
virtue of the pepsin. If the bowels are costive and if the stomach is
sour and feels oppressed, prescription No. II will materially relieve
these symptoms.
A person who is suffering from indigestion must above all things
learn to discipline himself; when that has been once accomplished the
task of carrying out an appropriate diet will become an easy one, and
restoration to health and strength will be the reward.
INDEX.
ABORTION. The practice on the increase, and not due to a single cause,
113, 114, 115, 116.
is it ever justifiable? 111.
meaning of the term, 110.
criminal, 101.
Catholic Church is decisive on, 112.
Abrupt termination of pregnancy constitutes a disease, 117.
Abscess in peritonitis, 278.
in perimetritis, 278.
of the breast, 340.
Abuses of surgery, 19.
“A bad getting up,” 204.
A husband should not cease to be a gentleman, 94.
A little reflection, 250.
Academicians’ view of fetal life, 102.
Acton, Dr. “A warning against sexual dangers,” 92.
After the delivery, 334.
Amenorrhœa, 132, 133.
Anatomy of the female organs, 119.
Anteflection of the womb, 242.
Anteversion of the womb, 240.
Antidotes to poisons, 389, 390, 391.
Antiseptic precautions, 75.
Apostoli, Georges, Dr., 298, 301.
Arnold, Prof., on cancer, 218.
BABY, barbarous practice of bathing, 337.
care of the, 337.
first toilet of the, 338.
Bacteria, 286.
“Bad getting up,” 144.
Bandaging after delivery, 250.
Bartholow, Prof., 296.
Battery, 294, 295.
Beef tea, 412.
Bennet, John H., 400.
Bennett, Dr., 196, 197.
Berkeley, Bishop, 47.
Bladder, catarrh of, 163.
catarrh, and other diseases, 157.
chronic catarrh of, 164.
hemorrhage of, 168.
inflammation of, 158, 159.
in pregnancy, 308.
irritability of, 252.
nervous irritability of, 166.
paralysis of, 167.
ulceration of, 163.
Braid, Dr. (discoverer of hypnotism), 54.
Brain, fat an essential food for the, 400.
Braine, Dr. Woodhouse, 51.
Breast, or mammæ, of the pregnant woman, 318.
abscess of, 340.
Bright’s disease, 397.
Broken bones, 378.
Bronchitis, 350.
Brown-Séquard, 394.
Burns and scalds, 382.
classification of, 383.
useful application for, 385.
CAMPBELL, DR. HENRY F., 254.
Cancer, Prof. Arnold on diagnosis of, 218.
Carbolic acid, poisoning from, 389.
Carbonic-acid poisoning in chlorosis, 135.
Carpenter, Prof. W. B., 48.
Castration, 274.
Catarrh of the womb, 219.
cause of, 213.
symptoms of, 215.
vaginal and uterine, 177.
Catarrhal inflammation of the womb, 209.
of the mouth, 342.
Cellulitis, pelvic, 285.
in childbed, 288.
Cervical endometritis, 211.
Charcot, Dr. Experiments in hypnotism, 54.
on “Impersonal Sleep,” 54.
Chickenpox, 375.
Childbed fever, my first case, 74.
Children are common objects of love, 96.
will of, 53.
diseases of, 356.
Chlorosis, iron in, 137.
Chronic inflammation of the womb, 104.
causes of, 105.
Clothing to avoid taking cold, 190.
Coated tongue, 341.
Cohnheim, Prof., his theory of inflammation, 147.
Coition and conception widely different processes, 106.
Coitus, injury of interruption or incomplete, 96.
Cold, injurious effects of taking, 184, 185.
Colic of infants, 360.
Conception, independent of the sexual act, 107.
Conjugal onanism, Dr. Devay, 96.
Constipation, 366.
causes of, 366.
in pregnancy, 319, 320.
treatment of, 367.
Continence, 95.
Convulsions in children, 361.
Corset waist, 191.
Cow, exercise of, 401.
Cows’ milk, 403.
cream of, 403.
density of, 403.
Croup, 348.
false, 349.
membranous, 349.
Cutler, Dr. Ephraim, 298.
Cystitis, acute, 161.
chronic, 162.
DALTON, PROF., on menstruation, 130.
Dame Nature, 41.
Danger of overheating, 189.
Darwinian theory applicable to the overcrowded professions, 17.
Days of doctrines and rules, 17.
Delusions as to the curative value of drugs, 36.
Depraved associates pave the way to feticide, 114.
Descartes, 48.
Diarrhœa, 357.
prescription for, 357.
in pregnancy, 320.
Diet, 392.
morbid fancy for, 392.
for pregnant women, 324.
Digestion, 396.
of fats and starches, 399.
Diphtheria, 346.
Disease is as much a vital process as health, 37.
Diseases of children, 341.
that are conjured up in the minds of susceptible persons, 25.
Disinfection of the lying-in woman in Germany, 289.
Dispersing electrode, 299.
Divided skirts, 194.
Dobell, Dr. Horace, 189.
Drowning, 387.
treatment for, 388.
Drug diseases of Hahnemann, 43.
Drugs are physical agents, 44.
Düvelius, Dr., 212.
Dysmenorrhœa, 138.
prescription for, 142.
inflexion, 244.
Dyspepsia, or indigestion, 137, 138.
Dyspeptics, 411, 414.
EGGS, 412, 413.
Elastic garters, 193.
Electricity in diseases of women,297.
as a remedy, 294.
in catarrhal inflammation, 302.
in subinvolution, 303.
medical, 296.
without puncture, 200.
Electrodes and poles, 295.
Electro-puncture, 298.
Emergency treatment in sudden accidents, 377.
Endometritis, 209.
acute and chronic, 210.
Engelman, Dr., 299.
English law on “quickening,” 104.
Epileptic fits cured by a “Christian Scientist,” 57.
Equestrian tights, 195.
Erosions often mistaken for cancer, 218.
Eruptive fevers, 370.
Evans, Dr., 47.
Exclusiveness that has characterized the professions, 16.
Exercise, must be interesting, 63.
in the open air, 62.
Expectation or attention influences the bodily functions, 50.
FAITH cures disease, 55.
Falling of the womb, or prolapsus, 231.
Fallopian tubes, 124.
Fats, digestion of, 399.
Feeding, intervals between, 395.
Ferguson, Dr., 400.
Feticide, 101.
Fire, clothing on, 384.
Flexion of the uterus, 139.
Flexions and versions due to abortions, 117.
Floor of the pelvis, 228.
Flux, 358.
Fly-blister, causing inflammation of the urethra, 152.
Food, repugnance to, 393.
liquid for invalids, 393.
Fractures, 378.
Fright causes and cures disease, 58.
Frostbite, 385.
treatment for, 387.
Functional diseases, 56.
GALVANOMETER, 300.
General causes of uterine and pelvic diseases, 61.
Germ theory of disease, 77.
German measles, 372.
Germans, river-bathing of, 77.
Germicidal properties of drugs, 176.
Girls should be independent to choose their choice, 66.
Gonorrhœal infection, statistics of, 276.
Goodells, Prof., on “abuses of uterine treatment,” 22.
on uterine symptoms, 140.
Graafian follicles, 263.
Green sickness, 133, 134.
Growth of the uterus from the moment of conception, 72.
HEMORRHAGE of the womb, 143, 144.
of wounds, 381.
arrest of, 382.
Hemorrhoids, causing inflammation of urethra, 152, 322.
in irritability of bladder, 166.
Heroic treatment, 42.
Hippocrates’s view of fetal life, 102.
Histology of inflammation, 145.
How a woman should lie after confinement, 335.
Human ovum, size of, 264.
Hygiene of gynecology, 78, 79.
Hygienic measures, 182, 183.
Hypnotism, 52.
Hysteria, amenable to mind cure, 56.
ICE-BAGS, 291.
Imagination is the realm of the soul, 49.
Impersonal sleep of Dr. Charcot, 54.
Improprieties of dress, 68, 69, 70.
Imprudence during menstruation, 71.
In the realm of thought there is no monopoly, 15.
Indigestion, 356.
Infants fed on cows’ milk, 406.
overfeeding of, 394.
Infection, 287.
gonorrhœal, 81.
innocent, 81.
Inflammation, 145.
of the womb, 196.
chronic, 203.
Interpolar regions, 297.
Intra-abdominal pressure, 233.
Involution, 73.
Iron pills in chlorosis, 137.
KNEE-CHEST posture, 254.
in relaxed vagina, 180.
in falling of the womb, 236.
LAITY, object of educating the, 18.
Landois, Prof., on the curative force in the lower animals, 39.
Laws on abortion, 104, 105.
Leucorrhœa, 80, 176.
Little girls, muco-purulent secretion of the vagina, 152.
Lochial discharge, 84.
Lung fever, 352.
Lying on the back after confinement, 73.
MALTHUS, law of, 99.
Man, instinctive desire of, 89.
Mania for cutting operations, 21.
Marital excesses, and prevention of conception, 87.
Marital excesses the mainspring of disease, 91.
Married women exposed to infectious contamination, 80.
Martin, Dr., of Chicago, 300.
Massey, Dr. G. Batton, 297.
Measles, 370, 371.
Measurements of the healthy uterus, 71.
Mechanical age, 19.
Menopause and puberty, 129.
Menorrhagia and metrorrhagia, 143, 144.
Menstrual disorders, 131.
Menstruation and menstrual disorders, 126.
Menstruation, average period of, 128.
precocious, 132.
source from which the blood comes, 128.
Menstruation suspended during pregnancy, 129.
Menstruation, climate and temperament, 127.
Menstruation, diversity in ages, 126.
Mental photography in the hypnotic state, 54.
Mesmerism, 52.
Metritis, 196.
acute, 198.
causes of, 199.
chronic, 203.
cold applications in, 201.
treatment for, 200, 207, 208.
Metrorrhagia, 143.
Milk, 400.
analysis of, 408.
arrowroot with, 410.
boiled, 404.
condensed, 410.
gruel for, 410.
diarrhœal diseases from, 406.
from the country, 402.
promiscuously mixed, 402.
quantity to be taken, 405.
sterilizing the, 406.
shake, 404.
Milk-leg, 290.
Mill, John Stuart, 99.
Milliampère, 300.
Moral restraint, 90.
More thought required to make good mothers than to file briefs or
write prescriptions, 68.
Morning-sickness, 300.
Morphine habit _vice_ asthma, 60.
Mouth, catarrh of the, 342.
putrid sore, 342.
Mucous membrane, 182.
Mumps, 344.
Murchison, Dr., 397.
Mystic union of the soul with the body, 102.
NAVEL, care of the, 338, 339.
Nerve strain, 140, 141, 152.
Nervous and congestive dysmenorrhœa, 140.
Nervous system in chlorosis, 135.
Nervousness, due to excessive mental application, 63.
Negative pole, 301.
Nine years of my professional life, 15.
Noeggerath, Dr., on gonorrhœal infection, 276.
OBJECT of educating the laity, 18.
Ovaries, 124.
acute inflammation, 266, 267.
chronic inflammation, 270.
cysts or tumors of, 264.
diseases of, 263.
displacement of, 266.
incomplete or rudimentary, 266.
supernumerary, 265.
Ova, number discharged at the menstrual period, 131.
Ovaritis, 266, 267.
treatment of, 269, 272.
PAIN in the abdominal walls, 321.
Painful sensations from imaginary causes, 48.
Painless childbirth, 325.
Palpitation of the heart, 321.
Parametritis, 285.
Parotitis, 344.
Pelvis, true, 120.
false, 119.
floor of the, 228.
Perimetritis and peritonitis, 275.
Perineum, 121.
Period of fruitfulness, 264.
Peritonitis and perimetritis, 275.
Peritonitis, treatment of, 282, 283.
criminal abortion the cause, 281.
Piles, 322.
Playfair, Dr., 401.
Pneumonia, 352.
treatment for, 354.
Poisons, 388, 389, 390, 391.
Precocious talents should not be forced, 64.
Pregnancy, breasts become enlarged in, 308.
bladder trouble in, 321.
constipation in, 319, 320.
capricious appetite in, 307.
deposit of coloring matter, 308.
duration of, 305.
diet in, 324.
extrauterine, 305.
false, 306.
menstruation during, 306.
nausea and vomiting, 319.
salivation of the mouth, 307, 319.
simulating, 314.
symptoms of, 305, 306.
unnatural, 305.
Pregnant woman, precautions to, 316.
clean linen for the, 318.
proper clothing for, 315.
Preliminary signs of labor, 330.
Preparation of homœpathic dilutions, 44.
Prolapsus, or falling of the womb, 231.
Protophytes, 286.
Psychical exaggeration, 140.
Ptomaines are developed from uncleanliness, 83.
Puberty and menopause, 129.
Puerperal or childbed fever, 77, 78, 290.
Pulsation of the fetal heart, 311.
Putrefactive germs, 286.
Putrid or septic poison, 287.
Pyosalpinx, 285.
QUICKENING, 103, 104, 310.
Quinsy, 344.
REPARATIVE energy of nature, 38.
Reparative process after confinement, 233.
Retroflexion in pregnancy, 256.
treatment of, 252.
Retroflexion of the womb, 247.
Retroflexion, replacement of, 254, 255.
Retroversion of the womb, 246.
Round ligaments of the womb, 248.
Rose-rash, 372.
Rumbold, Dr. Thos. F., 184.
SALPINGITIS, 259.
treatment for, 260, 261.
Sawyer, Dr. Herbert C., 58.
Scalds, 382.
Scarlet fever, 373, 374, 375.
Schelling, William Joseph, 47.
Scrofulous diseases, 400.
Serous membrane, 277, 278.
Sexual desire, Prof. Carpenter on, 89, 90.
Sexual instinct not unholy and depraved, 109.
Signs and symptoms of pregnancy, 305.
Signs of chronic inflammation of the womb, 207.
Skin, or integument, 182.
Somnambulism, 52.
Soor, 343.
Sore nipples, 339.
Soxhlet, Prof., 406.
Spasms in children, 361.
Spermatozoa, 89, 100.
measurements of, 105.
Spruce, 343.
Stages of labor, 332.
Sterility in flexion, 244.
in ovaritis, 272.
due to abortion, 118.
Sterilization of milk, 407.
Stoics’ view of fetal life, 102.
Stricture of the neck of the womb, 139.
Stupidity of the masses, 23.
Subinvolution of the womb, 73.
Sugar, digestion of, 398.
Superfluous garments, 70.
Sympathy will cause disease, 58.
Syringe, proper selection of a, 181.
TEMPERATURE for living-rooms, 189.
Terror causes or cures disease, 58.
The bed for confinement, 329, 330.
The choice of a physician, 328.
The care of the baby, 337.
The nurse, 328.
The righting of the organ, 331.
Thermæ, 76.
Thrush, 341.
Tonsilitis, 344.
Too much mischievous doctoring, 24.
Tubal dropsy, 259.
Tuke, Dr. Daniel H., 50.
Tying the cord, 336.
UNCLEANLINESS a cause of disease, 76.
Union suits, 194.
Urethra, 121.
gonorrhœal infection of, 152.
in pregnancy, 155.
in the newly married, 156.
inflammation of, 150.
irritation of, 150.
neuralgia of, 155.
Urethritis and neuralgia of the urethra, 150.
caused by eruptive fevers, 152.
Urethritis in pregnancy, 153.
papillated growths and mucous polypoids, 153.
Urinary fistula, 170, 171.
Uterus, 123.
anteflexion, 242.
anteversion, 240.
changes after confinement, 72.
measurements after confinement, 72.
natural position and support, 226, 227.
prolapsus, or falling of the, 236.
retroflexion, 247.
retroversion, 246.
treatment for prolapsus, 236.
versions and flexions, 240.
VAGINA, 122.
catarrh of, 175.
catarrh in children, 177, 178.
acute and chronic inflammation of the, 172.
gonorrhœal infection of, 174.
knee-chest posture in catarrh of the, 180.
relaxed, mistaken for falling of the womb, 179, 180.
Vaginal douches after confinement, 335.
Vaginal injections, directions for their use, 85, 86.
Versions and flexions due to abortions, 117.
Virchow, Prof., theory of inflammation, 146.
WARMING a dwelling, 186.
Weapon ointment, 41.
What is mind-cure? 46.
What is termed mind-cure is not mind-cure, 40.
When the soul becomes associated with the body, 107.
When to begin to train mothers, 65.
Whey, 409.
While in childbed, 328.
Whites, 176.
Whom to teach, 15.
Whooping-cough, 367, 368, 369.
Why crowd our girls into the profession? 67.
Winter cough, 189.
Wives who become delicate and nervous, 93.
Womb, 123.
tear or laceration of, 84.
Women’s rights vice women’s wrongs, 68.
Women, after getting up from confinement, 74.
Worms, 363, 364, 365.
Wounds, 378.
contused, 379.
incised, 379.
lacerated, 379.
poisoned, 380, 381.
punctured, 379.
ZIEGLER, Prof., on infection, 286.