MANUAL OP DIET. BY THE SAME AUTHOR. THE INDIGESTIONS, OR DISEASES OF THE DIGESTIVE ORGANS FUNCTIONALLY TREATED. By THOMAS KING CHAMBERS, M.D. OXON., F.R.C.P., LOND. Third American Edition revised. In one handsome octavo volume of 287 pages, cloth, $3.00. RESTORATIVE MEDICINE. AN HARVEIAN ANNUAL ORATION, delivered at the Royal College of Physicians, London, on June 24th, 1871. In one handsome volume, small 12mo. ; cloth, $1.00. In this little book, the reader will recognize the same independence and vigor of thought and clearness of diction which characterize the works of the distinguished author. This small book comprises within its pages a collection of subjects, medical and social, which will occupy men's thoughts, and awaken discussion for many years to come. Brit, and For. Medico- Chimrg. Review, January, 1872. r A MANUAL OF DIET IN HEALTH AND DISEASE, BY THOMAS KING CHAMBERS, M.D. OXON., F.R.C.P., LOND., HONORARY PHYSICIAN TO H.R.H. THE PRINCE OP WALES, CONSULTING PHYSICIAN TO ST. MARY'S AND THE LOCK HOSPITALS, LECTURER ON MEDICINE AT ST. MARY'S SCHOOL, CORRESPONDING FELLOW OP THE ACADEMY OF MEDICINE, NEW YORK, ETC. PHILADELPHIA: HENRY C. LEA. 1875. SHERMAN A CO., PRINTERS, PHILADELPHIA. PREFACE. THE aims of this Handbook are purely practical, and there- fore it has not been thought right to increase its size by the addition of the chemical, botanical, and industrial learning which rapidly collects round the nucleus of every article interesting as an eatable. Space has been thus gained for a full discussion of many matters connecting food and drink with the daily current of social life, which the position of the Author as a practicing physician has led him to believe highly important to the present and future of our race. THOS. K. CHAMBERS. 24 MOUNT STREET, GROSVENOR SQUARE, January 1, 1876. y CONTENTS. PART I. CHAPTER PAGE I. THEORIES OF DIETETICS, ........ 17 II. ON THE CHOICE OF FOOD, ....... 29 III. ON THE PREPARATION or FOOD, 87 IV. ON DIGESTION, . . . 101 Y. NUTRITION, .......... 122 PART II. SPECIAL DIETETICS OF HEALTH. I. EEQIMEN OF INFANCY AND MOTHERHOOD, .... 125 II. KEGIMEN OF CHILDHOOD AND YOUTH, 134 III. COMMERCIAL LIFE, 140 IV. LITERARY AND PROFESSIONAL LIFE, 144 V. Noxious TRADES, 152 VI. ATHLETIC TRAINING, 155 VII. HINTS FOR HEALTHY TRAVELLERS, 169 VIII. EFFECTS OF CLIMATE, 175 IX. STARVATION, POVERTY, AND FASTING, 184 X. THE DECLINE OF LIFE, . 197 XI. ALCOHOL, 200 Vlll CONTENTS. PAKT III. DIETETICS IN SICKNESS. CHAPTER PACK I. DIETETICS AND REGIMEN OF ACUTE FEVERS, . . . 231 II. THE DIET AND EEGIMEN OF CERTAIN OTHER INFLAMMATORY STATES, 245 III. THE DIET AND REGIMEN OF WEAK DIGESTION, . . . 252 IV. GOUT AND RHEUMATISM, 261 V. GRAVEL, STONE, ALBUMINURIA, AND DIABETES, . . . 270 VI. DEFICIENT EVACUATION 278 VII. NERVE DISORDERS, 282 VIII. SCROFULA, RICKETS, AND CONSUMPTION 294 IX. DISEASE OF HEART AND ARTERIES, 301 ALPHABETICAL INDEX, 307 DIET AND REGIMEN. I. GENERAL DIETETICS. CHAPTER I. THEORIES OF DIETETICS. WHAT is the natural food of man ? Each animal in a state of nature finds substances suited for its nutrition ready to hand, and within the grasp of the instruments he possesses for their acquisition. And these substances seem, generally, the most proper to sustain the health and strength. So that it has been not irrationally argued, that it would be a useful act of scientific reasoning to infer from the structure of the human organs what kind of food they are most fitted to appropriate, for this would probably prove most conducive to physical well-being. When, in pursuit of this reasoning, we come to compare man's form with that of other mammalia, his prehensile organs his teeth, his jaws, and his feet and his nails do not seem to fit him for grappling with any of the difficulties which the adoption of special kinds of food prepared by nature entails. He can neither tear his prey conveniently, nor crack many nuts, nor grub roots, nor graze. His digestive viscera, in middle life, are too bulky and heavy to qualify him for the rapid movements of the car- nivora; and they are not long enough to extract nourishment from raw vegetables. To judge by form and structure, alone, the natu- ral food of an adult man must be pronounced to be nothing. On the other hand, if we read the laws of man's nature by the 2 18 GENERAL DIETETICS. light of the general consent of the individuals of his race, which is the wisest course, 1 we shall arrive at the opposite conclusion, that his food is everything which any other warm-blooded animal can use as nourishment. If we try to construct a universal diet- ary from the records which each new traveller brings home of what he has beheld habitually eaten, we shall find very few forms of organic matter, capable of supporting mammalian life, which are not appropriated by man also to his own use. By selection and preparation he contrives to remove such parts and such quali- ties of the substances presented by nature as are noxious to him, and to improve such as suit his purpose ; so that as finally swal- lowed, they are more wholesome to him than to the beasts who eat nothing else. These lists of possible eatables are most interesting to the student of human nature; they lead to inferences as to the action of laws, religions, customs, and associations, in making that abominable to one race which is most highly appreciated by another, and they are an important part of the arguments of those who trace political events and national character to physical causes; but they are not suited to the present volume, which will concern itself with the action on individual health of food generally acces- sible in the British market. Reference may be occasionally made to a more extended materia alimentarla, but it can contribute little to the main arguments proposed. The power by virtue of which man becomes so truly omnivor- ous is habit. He can gradually, in time, accustom himself to live on anything containing nourishment, provided he be not limited in quantity, nor restricted in facilities for preparation. The in- ferior animals could do the sante if they only knew how to set about it ; for when we bring our reason to bear on their lives, we can effect what at first sight seem most radical changes in their nature, in respect of food ; and we can even induce and perpetu- ate hereditary forms of body suited to the altered circumstances we have brought about. Spallanzani found that pigeons may be fed on flesh, and eagles on bread, by accustoming them to it ; the domestic dog grows strong on biscuit, and often suffers in health on being brought back to his native food ; our poultry is more 1 " Consensus omnium nationum lex naturae putancla est." Cicero de Legi- biea, i, 8. THEORIES OF DIETETICS. 19 robust, more fertile, and apparently happier, for being supplied with meat, fat, or soup, and our cats have accommodated them- selves to a mixed diet, assimilating their form to that of herbivora, by a considerable increase in the length of their bowels over those owned by their cousins of the mountains. The speechless creatures have not the wits to acquire unaided these new powers; compulsory education is necessary ; even for such a simple process as learning to eat turnips, the lamb requires a shepherd to stand over him and forcibly make him chew. Man's chief bodily strength de- pends on his willingness to submit to the pain of acquiring habits, and on his forcing his domestic stock to submit to it, for the sake of a future advantage. The solvent actions of the juices of the intestinal canal on food seem to be the same in quality in all classes of animals, and to admit of modification in the proportions of their ingredients ac- cording to the diet adopted. Under vegetable food the saliva becomes more copious, under meat there is more gastric juice. The bile of a grazing ox is more watery than that of a man ; the bile of a growing boy (who can digest any amount of meat) was found by Gorup-Besanez 1 to contain nearly double the amount of solid contained in that of an old woman (whose age would dispose her to be very little carnivorous). This shows the importance of what may be called the prepara- tory or mechanical parts of digestion. The digestive solvents can evidently grow equal to all emergencies of the chemical acts re- quired of them, and the differences in the results of those acts must mainly hang on the mechanical condition of the substances pre- sented to them. Fortunate indeed is it that such is the case, for the mechanical condition of the food is certainly more fully in our power, and more easily influenced by our reason, than the chemi- cal solvency of the secretions. We can choose, according to its hardness, softness, and other external qualities, the sort of victual we put in our mouths ; we can prepare it with art, can regulate its bulk and the period of taking it; while the muscles which chew it and swallow it are almost entirely under our direction. But it is only very indirectly that we can influence the saliva, the gastric and pancreatic juices, and the bile. 1 Untersuchungen iiber d. Galle, Erlangen, 1846. The relative proportions of solid matter were 17.19 per cent, as against 9.13 per cent. 20 GENERAL DIETETICS. Assuming, then, that man can easily accommodate himself to a varied and mixed diet that he has, as a matter of fact, accom- modated himself to it and that, therefore, it will in future, as in the past, best suit his requirements the next point of interest is the proportion which its several ingredients should bear to one another. Physiologists have pointed out that in the preparation made for the infant at its entrance into life, and which is a striking in- stance to the faithful mind of a controlling design in creation, we have a typical instance of what the All-wise considered a suitable dietary. Looking to its qualitative composition, we find milk contains alimentary principles capable of separating themselves, and, in fact, habitually separated for economical purposes, some- what in the following proportions : Water, 88 per cent. Oleaginous matter (cream, butter), 3 " Nitrogenous matter (cheese and albumen), . 4 " Hydrocarbon (sugar), . . . . 4J " Saline matter (phosphate of lime, chloride of sodium, iron, etc.), " This rough average is the best way of stating the facts for phys- iological purposes; since, as every mother, physician, and far- mer knows, the proportions vary considerably in different speci- mens of even the same species of animal, and are influenced by differences in the mode of living. The argument is, that there or thereabouts, may be found the ratio which there should be in our dietary, in the amounts of the alimentary substances of which the above may be taken as representatives. That is to say, that, supposing a man to consume 200 ounces of victual daily, the con- tents should be about 6 quarts of water, J a Ib. of animal matter, such as cheese, or lean meat, or eggs, 6 ozs. of fat, oil, or butter, 9 ozs. of sugar or starch, 1 oz. of salt, and some small quantity of bone or iron. A serious flaw in this argument is that while the dietary is pre- pared for, and truly suits very well, the newly born, we have no evidence that either it is intended for, or would suit better than THEORIES OF DIETETICS. 21 another, the adult. The milk of our domestic animals so closely resembles that which supported us in infancy, that if we carried the reasoning out to its logical consequences, we should all be feeding together now at the same manger. If the milk represents what the adult ought to make his diet, our bull would require only a little more butter, and our horse only a little less than we do; our goat would want one-third more meaty or nitrogenous matter to be contained in the food than ourselves; and the dog would require five times the proportion of flesh that is laid on his master's table to be afforded him. 1 In point of fact, the life led by the young of all animals is much the same, whereas in adult age they differ widely in their occupations, and in the demand for the sort of viands best adapted to those occupations. There is greater promise of profit to the dietician in a calcula- tion of the outgoings of matters resulting from the wear and tear of the body, reducing these to ultimate elementary substances, and thus ascertaining in what proportion to one another new supplies of ultimate elementary substances are required, merely to replace those consumed. It is obvious that the food which supplies the demand most accurately will be the most economical in the highest sense. "We can measure, for example, the carbon and the nitro- gen daily thrown off in the excretions, and then lay down a rule for the minimum quantity of those elements which the daily food must contain to keep up the standard weight. If the diet is such as to make it necessary to eat too much carbon in order to secure a due amount of nitrogen, there is an obvious waste, and the di- 1 The computation of the ingredients of milk is a deduction from the fol- lowing table of M. Boussingault's analysis: Milk of Water, per cent. Casein and Albumen. Butter. Sugar of Milk. Salts. Woman, . . . Cow, 88.9 86.6 3.9 4.0 2.6 4.0 4.3 4.8 0.1 6 Ass, .... 90.3 1.9 1.0 6.4 4 Mare, .... Goat, 90.9 84 9 3.3 6.0 1.2 4.2 4.3 4.4 0.5 5 Sheep, .... Dos, . 86.5 77.9 4.5 15.8 4.2 5.1 6.0 4.1 0.7 1.0 22 GENERAL DIETETICS. gestive viscera are burdened with a useless load. The same reck- oning can be applied to the lime, sulphur, phosphorus, oxygen, and hydrogen, which go towards building up and renewing the tissues of the body. The dietary must contain these, or the body must waste away by the unstayed drain of destructive assimila- tion; and if it contains any notable excess, not only is it uneco- nomical, but may be pernicious to the health. Suppose, for instance, a gang of a hundred average prisoners to excrete in the shape of breathed air, urine, and fseces, daily 71 J Ibs. of carbon and 4J Ibs. of nitrogen, which is pretty nearly the actual amount of those elements contained in the dried solids of the secretions, as estimated in current physiological works. Ni- trogen and carbon to that extent, at least, must be both supplied. Now, if you fed them on bread and water alone, it would require at least 380 Ibs. of bread daily to keep them alive for long; for it takes that weight to yield the 4J Ibs. of nitrogen daily excreted. But in 380 J Ibs. of bread there are 128| Ibs. of carbon, which is 57 Ibs. above the needful quantity of that substance. 1 If, on the other hand, you replaced the bread by a purely ani- mal diet, you would have to find 354 Ibs. of lean meat in order to give them the needful 71 J Ibs. of carbon ; and thus there would be wasted 105 Ibs. of nitrogen which is contained in the meat, over and above the 4^ Ibs. really required to prevent loss of weight. 2 In the former case, each man would be eating about 4 Ibs. of bread, in the latter, 3J Ibs. of meat per diem. If he ate less, he would lose his strength. In the former case, there would be a quantity of starch, and in the latter, a quantity of albuminous matter, which would not be wanted for nutrition, and would burden the system with a useless mass very liable to decompose and become noxious. 1 Dr. Letheby's Analysis gives 8.1 per cent, of nitrogenous matter to bread (Lectures on Food, p. 6). Of this } is nitrogen; Boussingault's analysis of gluten giving 14.60 per cent. (Ann. de Chim. et Phys., Ixiii, 2*29). M. Payen makes the proportion of carbon to nitrogen in bread as 30 to 1. 2 The proportion of nitrogen to carbon in albumen is as 1 to 3 (15.5 to 53.5 by Mulder's analysis, quoted in Lehrnann's Phys. Chemie, i, 343). In red meat there is 74 per cent, of water (ditto, iii, 96). THEORIES OF DIETETICS. 23 Now, if a mixed dietary be adopted, 200 Ibs. of bread with 56 Ibs. of meat would supply all that is required. Besides water, 200 Ibs. of bread contains . . 60 of carbon . . 2 of nitrogen. 60 " meat (including 12J Ibs. of fat upon it), .... 12 " . . 2 " 72 4\ Judged by the above standard, it will be clearly seen that milk does not represent a typical diet for an adult population, the ni- trogenous matter being in considerable excess in proportion to the carbonaceous. This is suitable to the young animal, whose main duty consists in growing, that is in appropriating an excess of nitrogenous matter to form an addition to the body daily, but not to the full-grown, who has to develop force, or its equiva- lent, heat, by the combustion of carbon, and had rather not go on growing. Calculations such as these, applied to the other numerous, though less bulky constituents of the body, are invaluable. They afford a basis for the administration of food-supply to armies, na- vies, prisons, and other bodies of men dependent upon us ; they enable us to detect the causes of wasteful expenditure, and to distribute limited means in an economical fashion. They tell us why nations which, voluntarily or involuntarily, become depen- dent on one kind of food for subsistence can never be wealthy, for they devour and waste their substance ; and they teach states- men how to avoid those ruinous revolutions, which, as has been well observed, arise more often from want of food than from want of liberty. But the calculations must always be open to the correction of continuous observation and experiment. Chemical analysis is much too young an art to be infallible, and hitherto undetected substances and conditions are, year by year, turning up, which modify our conclusions. And a very wide margin must be left for unforeseen contingencies, and a discretionary power be placed in the hands of individuals, or there is a risk lest the adminis- trator should have to regret making too precise a reckoning. He whose income is only just equal to his expenditure, is always on the brink of insolvency. The most important modification required to be made arises 24 GENERAL DIETETICS. out of the differences of work demanded. Men may languish in solitary prisons, invalids may lie bedridden, paupers may wait for better times, nations may idle away existence, on a scale of food- supply which is followed by death from starvation when work is demanded. How shall the effect of physical exertion be reckoned ? Here the engineers have helped us with their precise and irrefrag- able science. Joule of Manchester analyzed, about thirty years ago, the relation which the heat used in machinery, as a source of power, bore to the force of motion thus made active. He found means of proving, that raising the temperature of a pound of \vater one degree Fahrenheit was exactly equivalent to raising 772 Ibs. to the height of a foot. And, conversely, that the fall of 772 Ibs. might be so applied as to heat a pound of Avater one de- gree Fahrenheit. Thus, the mechanical work represented in the lifting 772 Ibs. a foot high, or one pound 772 feet high, forms the " dyna'mic equivalent," the measure of the possible strength, of one degree of temperature as marked by the thermometer. Phys- iologists seized eagerly on the opportunity which Joule's demon- stration seemed to afford them of estimating, in actual numerals, the relation of living bodies to the work they have to do. So much earth, raised on an embankment, represents so much heat developed in the machinery, living or dead, muscle or steel, gang of laborers or steam-engine, which raised it. Both muscle and steel come equally under the great physical laws of the universe which the far-sighted mechanician has expounded. Now, in the animal frame, the supply of heat, and therefore the supply of ca- pacity ibr work, is that which is developed from latency into energy by the chemical actions, the ceaseless round of unending change,, which is an inseparable part of life. The amount of fully digested food, converted through several stages into gaseous, liquid, and solid excretory matters, produces by its chemical changes a definite amount of heat, of which a definite amount es- capes, and a definite amount is employed in working the involun- tary machinery of the body, and the rest is available for conver- sion at will into voluntary muscular action. As the mechanician allows for the effect of friction, etc., in making his calculations, so the physiologist allows for the action of diffusion, conduction, im- perfect secretion, and so on, in reckoning the quantity of heat available, and allows also for the waste of mechanical power in- THEORIES OF DIETETICS. 25 volved in the form and structure of the limbs. To make all these allowances necessitates courses of experiments and calcula- tions which have taken more than a generation, and will probably take more than another generation to complete. But the road seems clear, and already we have gained fruitful information as to the sort of food by which we can expect to get most work out of men and beasts; we have found the cause of many of our failures in distributing victuals ; and we have learned how to avoid much cruelty and injustice that our fathers unknowingly perpe- trated. It may be reckoned from experimental calculations, too long to be inserted here, that the expenditure of force in working the machinery of the body in raising the diaphragm about fifteen times, and contracting the heart about sixty times a minute ; in continuously rolling the wave of the intestinal canal ; and in various other involuntary and voluntary movements which can- not be avoided even by a mere cumberer of the ground, without doing anything that can be called work it may be reckoned that the expenditure of force in doing this is equal to that which would raise a man of ten stone 10,000 feet. But a man cannot even pick oakum without expending more force and requiring more to support it. A prisoner on penal diet has half as much again. There are several reasons for believing that in assigning their physiological functions to the several sorts of food, we should as- cribe nearly all the business of giving birth to force to the solid hydrocarbons, starch and fat, by their conversion into carbonic acid, just as we have good grounds for thinking that it is the con- version of the solid hydrocarbon, coal, into carbonic acid, which drives our locomotives. It is not necessary to be acquainted with every step of the process, which, in the body, we confessedly are not, to appreciate the argument. To the nitrogenous aliments seems allotted the task of continuously replacing the wear and tear of the nitrogenous tissues. Flesh food, or that which comes near it in nitrogenous contents, after a few changes replaces the lost flesh which has passed away in excretions ; and thus the en- gineer takes iron ore, makes it into wrought plates or steel, and renews the corroded boiler-plate or worn piston-rod. One of the most cogent of these reasons is that the chief nitrogen-holding 26 GENERAL DIETETICS. excretion, the urea, is little, if at all, increased in quantity by an increase in the work done : whereas the excretion of carbonic acid, in a decided manner, follows the amount of muscular exer- tion. Now it is very clear that if the supply of power to do work depended on the renewal by food of the nitrogenous tissues, and on their decomposition, the urea would have no escape from being largely augmented in quantity by muscular efforts, and di- minished by rest. This is not the case. At first, exercise dimin- ishes the amount of urea (Parkes), and, even when continued, very little increases it (E. Smith, Haughton and several others quoted in Parkes's " Hygiene," p. 383). The very small increase which takes place during the following rest may be attributed fairly to the extra wear of the muscles from extra motion, just as a steam-engine is expected to require more repair than usual when in hard use. But that amount of repair demanded is as nothing, compared with the increase in the tonnage of coal consumed. To give an example of the mode of working out a problem by this theory : Dr. Frankland ascertains with the calorimeter, which calculates the amount of heat evolved as a thermometer does its degree, the quantity of energy or force, under the form of heat, evolved during the complete oxidation in the laboratory of a given weight of alimentary substance. It was explained before, that heat and mechanical work, being convertible into one another, bear an eternally sure proportion to one another : now, and forever, a definite production of so much heat represents the potentiality of so much motion, used or wasted, according to circumstances. So that from the reading of the calorimeter may be reckoned how many extra pounds ought to be raised a foot high by a man who has eaten an extra pound of the food in question ; how many steps a foot high he ought to raise himself (say a weight of ten stone) before he has worked out the value of his victuals. Dr. Frank- land has thus estimated the comparative value of foods as bases of muscular exertion, and he has made out a table of the weight and cost of various articles that would require to be consumed in the system to enable a man of ten stone to raise himself 10,000 feet. This is equal to going up a ladder two miles and one-third high a stiff" day's work. Three pounds and a half of lean beef at a cost of at least 3s. Qd. would be wanted; but if little more than half a pound of suet, worth about 5|e thoroughly prime by being kept alive till their constitution has grown up to their size. To illustrate the matter by our own race, a school- boy of six foot one never becomes hearty till he is at least one or two and twenty. But after that, the weedy youth may harden and be a fine man. So indeed with these overgrown lambs, if they are kept till four years old, the meat is very choice ; but of course the temptation is to bring them to the butcher directly they are as tall and broad as a real sheep ; and the farmer looks upon himself as a benefactor to his species, as having made two animals in the time formerly required to make one. But I hear with sorrow of attempts being made to " improve," as it is called, the Welsh breed, and trust they may be unsuccessful. A more promis- ing statement is that Welsh mutton, in the London market, is imitated by a cross between the Southdown and the Scotch. 1 We may pardon the deception, if the meat is as good as its model. A striking proof of how opposed .are the interests of the farmer and of the consumer in the breeding of sheep is, that in the minute experiments and calculations of the advantage of different breeds and various modes of feeding, no attempt is made to reckon the goodness of the dead meat. We are told the weight, but never the quantity of osrnazome it contains, though the readiest possible test in the tint of the gravy is very familiar to the eater. To get good mutton in country places is now a serious problem, and I would suggest to my professional brethren, who are of course permanent residents, that they cannot confer a greater boon on families in the same position of life as most of us are, that is to say, not rich enough to have parks and farms, and yet willing to pay a good price for a good article I say they cannot confer a 1 Macdonald, Cattle, Sheep, and Deer, p. 483. 34 GENEKAL DIETETICS. greater benefit on these their neighbors, than by inducing them to join in a " mutton club," buying the lambs of a full-sized breed, and keeping them to at least three and a half years old before killing. The price per pound will not be less than charged by the butcher, but it will supply an article twice as good as his. There has been felt a good deal of alarm, more I think than is justifiable, during the last few years on the subject of the class of parasites which are not uncommon in the flesh of all animals, namely, the cysticwcus and the trichina ; and which, when suffi- ciently numerous to be conspicuous, constitute what is called " measly meat." The cysticercus of the pig is the sort most frequently seen, form- ing a cyst as large as a hemp-seed. Its commonest habitat is the tongue, on the under surface of which it may be discovered even without cutting into the interior. You may also find the oval holes left by it when dried up in otherwise very perfect hams, and opaque white specks, like seeds, intimately adherent to the muscular fibres, which are its remains dried into calcareous mat- ter. This measle-worm of the pig has been found by the indus- trious German naturalist Kiichenmeister to be the undeveloped embryo of the Tcenia sotium, the tape-worm of most usual occur- rence in Great Britain. By keeping them alive in warm milk he was able to watch the development of the animals. The cysticer- cus of the ox is smaller, and is either rarer or seldoraer discovered in this country. It becomes the Tcenia mediocanellata, the species which infests the intestines of Germans, Swiss, and others, pro- ducing exactly the same inconveniences as that with which we are familiar. As the measle-worm of the mouse produces the peculiar tape-worm of the cat (Tcenia crassicollis), as the brain hydatid of the sheep (Qxnurus cerebralis) produces the Tcenia ccenurus in the dog, so the minute larva which infests the flesh of our prey re- venges itself on its natural enemy. An old boa-constrictor is always a complete museum of tape-worms, derived from the various living game which it has devoured. Now, there is no doubt that the boiling temperature entirely destroys the vitality of these creatures. When cooked they can do us no more harm than a baked lion. So that it can very rarely, if ever, happen in civilized countries for them to be transmitted directly to human intestines. Another mode of communication ON THE CHOICE OP FOOD. 35 must be thought of, and I think it is not far to seek. Though we do not eat our food raw, dogs very often do, and they distribute far and wide by their excreta all that escapes the solution of the gastric juice. Thus the embryos get spread abroad on the earth, into streams and wells, and especially in our kitchen gardens among the materials of our solids. I had once brought to me a child three years old, with tape-worm, a very rare thing at that age, and thus affording peculiar facilities for detecting its origin. It was the son of a sculptor in the suburbs of London, and all the cooking arrangements of the family seemed perfect, as also their water supply. But in the stone-yard, which had once been a gar- den, grew a quantity of nasturtiums, and among these the baby used to play, and sometimes ate the flowers and fruit. As the yard was open to the road, it was much frequented by the dogs of the neighborhood, and showed unmistakable signs of their pres- ence. One could not question that here lay the carrier of the little patient's troublesome inmate. The observant and enthusiastic physician of Iceland, Dr. Hjalteliu, also informs me that intestinal parasites are exceedingly common in that country, and that the cause appears to be the distribution of their ova by stray dogs who are always in and out of the kail gardens. Another possible source of tcenia may be shell-fish, eaten raw, and often containing in their stomachs minute organisms derived from decayed garbage thrown away or used as bait. Only the other day I found in the prehensile organs of a prawn a shred of animal fibre, and saw a man fishing for crabs and prawns at the mouth of the Arun with a piece of paunch. With all these possible sources of infection there is no need to suspect butcher's meat, which is never eaten raw except by some eccentric amateur savage. The real evil of measly meat consists in its proueness to rapid decomposition in spite of cookery, and to that may fairly be credited cases of illness which are reputed to have followed itH consumption. So that it is fair enough that all that is largely infected should be destroyed. In France there used to be ap- pointed to the markets officers called " langueyeurs" from their inspecting the tongues of carcasses offered for sale; but their legal authorization, and possible tyranny, seems to have given dissatis- faction, for M. Delpech says they have no lawful authority, but are employed simply as a warrant between buyer and seller. 36 GENERAL DIETETICS. They have to report to the inspector of markets, usually a skilled veterinarian, who judges if the quantity of measle-worm is suffi- cient to render the meat unwholesome. The shoulder and the breast are the parts usually examined as tests. 1 The Trichina spiralis is another parasitic inhabitant of live flesh, of a more active character and of a higher grade in creation than that last discussed ; for instead of being a solid worm like the ta^nia, it is possessed of an intestine. 2 It is sometimes found in human flesh and in pork, appearing as a minute white speck, just visible to the naked eye, which constitutes its nest, in which one or two curled-up specimens are seen, by a microscope, in active movement, but prevented from doing harm by the cyst in which they are imprisoned. The danger consists in its escape and won- derfully rapid multiplication, under special circumstances not very clearly defined ; for it exists at most times in considerable numbers without giving rise to any symptoms whatever. But there seems sufficient evidence that in a few instances an epidemic has occurred of its invasion, in overpowering quantities at once, of human bodies, through the food eaten. The symptoms are in- flammatory fever and local lesions from the interstitial presence of a mass of quickly increasing foreign bodies. But these instances have been extremely rare. A few years ago a physiologist in this metropolis, having become the fortunate possessor of some speci- mens of live trichina, instantly invited a crowded conversazione of medical men and others interested in the natural history of our species, and introduced to them by means of the hydro-oxygen microscope his acquisition. Very few of the party, if any, had seen one before ; and very few, if any, have seen one since. The trichina is said to cause degeneration of the muscular fibres in its vicinity, so that the joints infested would not present the healthy appearance described at the beginning of this section. It is killed by the temperature of boiling water, PO that if a dish is fairly cooked, it must be quite safe. The cases which have oc- curred of its proving deleterious have been where the meat has been eaten raw, or imperfectly warmed through and served cold, 1 Delpech, Diet, encycl. des sciences med., art. " Ladrerie : " an excellent monograph on the subject, date 18C8. 2 Professor Owen has identified the trichina as one of the Coelelminlha, and the College of Physicians has adopted his classification. ON THE CHOICE OF FOOD. 37 with its defects concealed by some enveloping sauce. No decently delicate feeders need be afraid of it. If the leaden dull color of the meat before us has been destroyed, so that it does not look raw when the gravy is run off, and if the peculiar texture of fibre which distinguishes uncooked meat, is removed, we may be sure that the temperature has mounted up to that sufficient to coagu- late albumen (150 Fahr.), and that any stray trichina would be killed on the spot or permanently imprisoned in a solid nest. It may be proper to mention that no form of drying, salting, or even smoking at a low hea't, is sufficient to destroy the trichina. So that when travelling in Germany it is wise altogether to avoid the sausages and uncooked ham often served up in thin slices, and which in point of fact, have been proved the sources of trichinous poisoning in the few instances on record. The whole influence of fevers and inflammations upon the flesh of animals thereby affected during life, and whether they should be considered as a reason for its being pronounced absolutely unfit for food, is a moot-point. There is a good deal of hearsay evi- dence on both sides, but I cannot find any crucial cases recorded as observed by competent witnesses. 1 An enormous quantity of meat is destroyed on this ground, for, according to Mr. Youatt's estimate, one-fifteenth of the whole horned stock of the country die annually of inflammatory fever, milk fever, red-water, hoove, and diarrhoea, and one-tenth of the sheep and lambs are carried off by corresponding ailments. 2 When we add those which perish by accident and accidental sickness, it is obvious that several mil- lion tons of meat are thus taken out of human mouths by the law which insists on the destruction of all which bears the marks of disease. Opponents say that if it possess only a fraction of the nutritive power of good meat, it ought not to be wasted, but sold at a lower price, provided always proof can be obtained, that it does not, when eaten, communicate disease. This, as said before, 1 "In no well-ascertained case has it been found that any ill eftects have been produced by eating the flesh of diseased animals, although there is abundant evidence that at the outbreak of the distemper in Massachusetts, and before public attention had been directed to its true character, a considerable num- ber of animals, in which the usual premonitory symptoms had appeared, were slaughtered and their flesh sold." Second Annual Report of the State Board of Health, Massachusetts, 1871. 2 Youatt, Cattle, Preface. 38 GENERAL DIETETICS. is a moot-point, but yet what is certain is to my mind quite suf- ficient to justify the exclusiveness of the existing regulations. It is certain that there are some diseases, originating in beasts, which may be communicated to men handling the carcass before it has been submitted to the action of heat, as for example pustula ma- ligna and glanders. And some fevers, such as typhus, are com- mon to man and beast, and are indubitably contagious during life, and probably after death, till the flesh has passed through the purification of fire. Now most of those who would buy diseased meat on account of its cheapness, cook their own victuals, and are exposed to all the evils which may accrue from handling a dan- gerous article. Again, this "braxy" meat, as it is technically called, runs rapidly into decomposition, and becomes a serious nuisance on that ground alone. It is also frequently saturated with the soluble drugs which have been given as medicines by the veterinarian. Ergot of rye, digitalis, opium, tartar emetic, are often administered in enormous quantities. Mr. Youatt advises upwards of half an ounce daily of solid opium for an ox with lock-jaw, which is 240 times the full human dose, and as this is equally distributed to the soft parts by the circulation, in a beast (say) of twenty stone, each pound would contain at least half a grain of the poison. A case is recorded, in which tartar emetic taken by an ox before slaughtering produced serious effects on 107 persons who partook of the meat. 1 One' person who died had eaten only half a pound. Tartar emetic was found in the con- tents of his abdomen. Acute fevers cause an acute degeneration or interstitial death- in-life of both blood and tissues. Virgil notices that in victims slaughtered during the cattle plague the peristaltic vermicular j notions of the intestines, by which the priests told fortunes, are stayed, and that the blood is as the blood of a corpse, scarcely staining the knife Nee responsa potest consultus reddere vates, Ac vix suppositi tinguntur sanguine cultri. Georg. iii, 491. And it may be remarked that the poet, who is a practical far- mer as well as the most picturesque of sweet singers, expressly 1 Quoted by Dr. Pavy from the Central Zeitung fur Veterinarmedizin fur 1854. Treatise on Food, etc., p. 149. ON THE CHOICE OF FOOD. 39 says that he is here speaking of the early stage of murrain, the fatal later symptoms of which he describes afterwards. The Re- ports of the Cattle-plague Committee of Privy Council show, that his lines will apply to England as well as to Italy. Now, it can hardly be maintained that it is honest to sell in the market meat thus saturated with natural death, though the animal has been slaughtered before the full declaration of the fever. The best possible meat may be rendered unwholesome by nor- mal decomposition. The stomach can, indeed, through habit, be- come used to food in this state ; and thus may be accounted for the instances we read in books of travels, of savages, like the Es- quimaux, who bury their flesh till it is putrid, or like the Zulus with whom (according to Dr. Colenso) the synonym for heaven is " maggoty meat." Of course, rather than die of starvation, or be reduced to the straits suffered by Hezekiah's army, one would acquire such a habit, and invent a sauce to make it tolerable ; but it is scarcely worth while to do so in civilized society. Under ordinary circumstances many cases are recorded in works upon poisons, such as Dr. Christison's, where decayed animal food has produced severe and even fatal diarrhoea, in spite of cookery hav- ing concealed some of its repulsiveness. High game has fortu- nately gone out of fashion, and the most frequent form in which we now meet with decomposing albuminoid matter is that of a fusty egg. Some housekeepers seem to consider this quite good enough for made dishes, and thus spoil material worth ten times what they save by their nasty economy. No egg should be al- lowed to enter the kitchen, that has the slightest smell of rotten straw. But this seems rather beyond the subject of butcher's meat, and it is time to proceed to another department of the lar- der. The suitability of different sorts of meat to different consti- tutions will be considered in a future chapter. 2. POULTRY AND GAME. Tenderness is the chief virtue in poultry, and is most difficult to find in the winter season. Spring chickens come in with May, but during the five previous months much care is requisite in purchasing this article of the table. A young, and therefore tender bird, may be known before plucking by the comparative 40 GENERAL DIETETICS. \ largeness of the feet and the leg joints. And when a fowl ap- pears at table with a thin neck and violet-tinted thighs, it is wise to avoid being helped to the leg. These are invariable signs of age and toughness. The same violet tinge may be noticed in the thighs of old tur- keys, which are also distinguished by their hairiness. The age of ducks and geese may be tested by their beaks, the lower part of which breaks away easily in youth. Besides being tough and indigestible, an old fowl has a rank flavor, like a close hen-house, which arises from the absorption into its flesh of the oil furnished by nature to lubricate the feath- ers. This is still more perceptible in old ducks and geese. It may often be tasted some time after a meal, and must therefore, like most rank oils, arrest digestion. Game may roughly be selected by the same rules as poultry. Those who have interested themselves in ornithology may also get some help from observing the undeveloped spurs in young gallinaceous birds, and the pointed long wing-feathers of the young partridge, which become rounded at the tip when he is old. Poultry should not be too fat. In cooking, the oily adipose tissue becomes rank, and is less digestible than the fat of mam- malia. 3. FISH. The sanitarian has not much advice to give concerning the marketing of raw fish, except that it should be fresh. The guides by which to judge of this are the fulness of the eyeballs, and the bright pink hue of the gills. The sense of smell cannot be trusted to, as it may be deceived by the use of ice. When cooked, the flesh of fresh fish is firm but friable ; that which is stale is flabby and stringy, even if preserved by cold from actual putre- faction. The less salt, and the colder the water is whence our fish comes, the better adapted is it for the table. At Gibraltar it is not hard to distinguish the mullet caught on the Atlantic side of the rock from that which lives in the Mediterranean, a warmer and more concentrated sea ; so much is the advantage on the side of the former. An Icelander dining at my house passed by with ON THE CHOICE OF FOOD. 41 polite scorn a piece of prime Scarborough cod. Seeing my sur- prise, he explained that no one who has tasted it at Reikiavik could bear to eat cod in England, and that it was best in the polar circle, braced up by the melting icebergs. The nearly fresh waters of Loch Fyne supply the choicest herrings, and the pure light mountain streams a better trout than our lowland streams, where the atmospheric pressure is greater. Every sort is best when it is cheapest, for then it is most plen- tiful and in fullest season. It is a wise plan to contract with your fishmonger to send you so many dishes a week at a fixed sum, and then it becomes his interest to supply that with which the market most abounds. For healthy persons, every kind or- dinarily exposed for sale in England is wholesome, provided it be good of its kind, and not spoilt in the cooking. The selection of fish for invalids will be discussed later. Complete cookery, however, should be insisted upon. The conger-eel, for example, is a very foul feeder, and has been known, if carelessly grilled, to cause diarrhoea, probably from the fetid contents of the stomach saturating the flesh. And at the Patho- logical Society on May 5, there was shown a specimen of the bunch-headed tapeworm (Bothriocephalus latus) which had grown in a person used to eat half-cooked fresh-water fish. The only sort of reptile of dietetic importance is the turtle. It is sometimes viewed as a mere luxury, but is in reality a most digestible and nutritious food, and if more demanded w r ould quickly become more plentiful in the market. The creature grows too slowly for it ever to remunerate artificial culture, but nature supplies it in immense quantities, and its tenacity of life enables it to be brought over alive from the tropics. Fresh turtle is much more costly than it ought to be, but the rival importation of dried turtle fins is reducing the price. This last-named article is of great value, and of moderate price ; from it, first-rate real turtle-soup may be made at no more than the expense of mock- turtle, if we deduct the price of the wine used, which to some palates is no improvement. The fins should be soaked for at least twenty -four hours before cooking. Caviare, the roe of the sturgeon, is best obtained from a fish- monger. The dealer in preserved provisions seems to think it all the better for being preserved, whereas it should be as fresh as 42 GENERAL DIETETICS. can be got, exhibiting its freshness by its softness and light color. That black, hard sort of fish-jam which is sometimes served up, is really unfit for human consumption. All that has been said above, applies equally to Crustacea and shells; but an additional remark maybe made about crabs. They should be cleansed scrupulously before cooking, and if that which is removed from their prehensile organs is fetid, they are hardly to be considered safe. The frequency- with which crabs disagree unexpectedly with a healthy stomach, may be attributed with reason to the garbage on which the creature lives. And of oysters it should be remembered that they are to be eaten raw, or, at most, barely warmed through ; for complete boiling makes the flesh tough, so that it is prudent, if they come from near river- mouths, to keep them alive in a shallow dish of clean brine for a day or two, feeding them with meal, and changing the water so as to leave them bare twice a day, in imitation of the tide. They become peculiarly plump and wholesome under this management. 4. GARDEN PRODUCE. The commonest fault committed by housekeepers in respect of vegetables, is that they do not supply a sufficient variety, seeming to consider that the meat is the only part of the meal that re- quires care, and that all the rest is mere garnish, beneath the no- tice of a Briton, and unfit to sustain his vigorous life. Yet that is not the experience of the observers of mankind. The attention of Herodotus was called to the fact that the Persians, the man- liest and most sporting nation in the old world, had at meals not only several dishes, but several courses of vegetable food, preced- ing a very moderate allowance of solid meat. 1 And Sir Henry Kawlinson describes the diet of this tough race as practically the same now, so that the assumptions of some anthropologists that hunting races are necessarily riotous eaters of flesh, and that car- nivoracity strengthens a nation, are not accurate. The Persian gentleman is the spiritual father of the British squire f yet, at 1 Herodotus, Clio, cxxxiii. 2 He taught his sons "to shoot, to ride, to speak the truth," and then left them to educate themselves ; he was devoted to his sovereign to a degree that astonished Herodotus ; and he loved a good glass of wine in good company. ON THE CHOICE OF FOOD. 43 many a hospitable board, if a guest does not fancy meat that day, or lias eaten enough of it at a previous meal, he will have to fall back upon potatoes, or to solace himself by picking a few bits out of the sauces of made dishes, where the vegetable flavor has been saturated with that of meat and spoilt. Usually, he goes on eat- ing too much nitrogenous food out of sheer idleness. Another fault is that the vegetables are not sufficiently fresh. Unhappily dead plants do not stink early enough to disgust the nose; but yet, every minute they are kept after their actual death, that is to say, after they have ceased to be capable of growth, renders them in some degree less digestible. Sometimes they are kept too long out of mere carelessness, sometimes from lack of sale, but sometimes also intentionally, to make them look better at table. For a long time, I could not make out why London asparagus so often disagreed with people, till at last I caught a gardener cutting it twenty-four hours before it was wanted, and putting it in a damp warm frame, "to swell," as he said. Cu- cumbers and broccoli are often spoilt in the same way. The vast wagons of cabbage that one sees coming into London at midnight are often the bearers of two or three days' cutting in small gar- dens, kept till a full load is accumulated for a single journey; as early travellers by rail may see for themselves. Sprinkled with water they look well, but never regain their fresh character. They ferment in the stomach, and produce flatulence. Potatoes. The virtues of a potato are to be mealy and pow- dery when boiled, and to mash readily into a smooth puree. This shows that the starch-granules are in a healthy condition, and that they absorb water and burst the envelopes of glutinous matter which the heat has coagulated. Young potatoes, from not so easily breaking up, require long mastication to render them solu- ble, and are not then very digestible. But old waxy potatoes are worse, for they seem to unite again into a sticky mass, after being swallowed, and remain for hours undissolved; the worst of all are potatoes affected by the peculiar epidemic called after their name. The diseased part, looking as if it were stained with a drop of ink, remains quite hard in spite of any amount of boiling and digest- ing: eating it is equivalent to eating so much rotten wood. Pota- toes which have begun to sprout, are also indigestible, and frosted 44 GENERAL DIETETICS. potatoes begin to decay immediately a thaw sets in. The best potatoes are "Regents." Jerusalem Artichokes are largely used in England by people who have gardens, partly because the plant is handsome, and partly because the root is not injured by frost, and so can be al- lowed to remain in the earth during winter. The dried stem is also convenient for firing. It is a watery vegetable, and though it had the start of the potato in European horticulture, it has never been brought to the same perfection. The fact is it contains no starch, and the " inulin " which replaces that valuable aliment, is only 2 per cent, of its weight, whereas in its successful rival there is a proportion of 16 per cent. It should be eaten only as an oc- casional change, for the sake of its flavor. Turnips may have nearly the same things said of them. Yams and sweet potatoes come now into the London market. They are as mealy and wholesome as the commoner tuber, and are sometimes useful to tempt our patients into the use of vegeta- ble diet. Carrots contain a quantity of pectin, which can be extracted from them in the form of a jelly, and is often used by confectioners to mix with fruit jelly as a diluent. It resides principally in the outer rind, whose thickness therefore in proportion to the pale core is a test of the goodness of the specimen. When soft and friable they are much more nutritious than turnips. Parsnips may take to themselves the same praise, and ought to be more used, especially with boiled fish. From their sweetness they make excellent fritters, and are liked by children, to whom they are well adapted. However, when old and stringy, they should be avoided. Salsify is in England considered more a dish for the gourmet, than as a food for middle-class tables. This is unjust, for it is nutritious and digestible, and grows easily. It is best eaten alone, fried in a thin coat of batter. It should break readily, and be free from strings. Leeks make a capital soup and a most digestible side dish. The more white there is in them, and the less green, the softer and better they are. They should have but little smell. Sea-kale should be perfectly blanched. When colored it is in- ON THE CHOICE OF FOOD. 45 digestible, as is shown by its being tasted in the mouth after dinner. Asparagus should be eaten as soon as possible after cutting, and then it is most wholesome. The greenest asparagus is that which contains the greatest amount of the active principles, bitter and resinous, and is therefore to be chosen in preference. I have known timid patients to fear that it must be injurious to the kid- neys, because of the peculiar odor communicated by it to the urine. It certainly does no harm, and I doubt almost if it is a diuretic. In early spring, the fresh young fronds of the male fern make a good imitation of early asparagus, and are decidedly better than the wild asparagus brought to table in the south of Europe. With other substitutes for it I have no acquaintance. The number of them shows how well worth having the real thing is. Cabbage is the most valuable antiscorbutic we possess. In the slight degree of scorbutus characterized by bleeding of the gums or by purpura, it is eminently successful, and prevents the same thing happening to other members of the household who are wise enough to prefer prevention to cure. It should be soft but crisp before cooking, and show no signs of having been wetted. If it has begun to heat from incipient fermentation, it is most noxious, and generates in the intestinal canal an enormous amount of flatus, consisting not only of the usual carbonic acid, but of sulphuretted hydrogen as well. Fermentation destroys the antiscorbutic quali- ties of the cabbage, for sour-crout is not nearly so efficacious as the fresh plant. Sour-crout is prepared by taking advantage of the fermentation as a means of afteivpreservation. The leaves of the kail are al- lowed to heat, and then subjected to severe pressure, which arrests the chemical action, and hardens them into a dry mass, which will keep a long time. It requires much soaking, and should not be cooked till free from all sour taste. It should not want chewing, or it is shown to be underdone. The best sorts are the old white garden cabbage and the summer cauliflower. Winter greens are of so many sorts that it would be necc,-~;iry to be a complete gardener to give rules for the selection of each. Their greenness and freshness at a time when all around is brown 46 GENERAL DIETETICS. and decaying is the attraction to them ; and it may be said gener- ally, that therefore they ought to be as fresh and green as possible. Under this heading I include savoys and Brussels sprouts, but not broccoli, which should of course be as white as can be got. I take the opportunity of having to allude to kohl-rabi (a new kind of cabbage of which the leaf-stalks are eaten), to say that it is not prudent to recommend to our patients novel varieties of garden produce, unless we are well acquainted w r ith them our- selves. We do not know how to decide if they are good of their sort or not; and much more depends upon that than upon the kind of vegetable. Cardoons. Those who grow this delicious thistle, which is sel- dom brought to market, should take care that the leaf-stalks are at least an inch and a half thick before they are considered fit for cutting. The artichoke is another thistle, like the last-named, of an orna- mental character, and more cultivated in this country. Eaten raw, or only just warmed, as is common in France, it is as indi- gestible as nuts, which it much resembles ; but well boiled till it is quite soft, it may be eaten with impunity even by invalids. After an early dinner it makes a good dish for supper. Chestnuts are a very good substitute for potatoes with white meat or fowl. They should be thoroughly well boiled, skinned, and served up in a hot dry napkin. Home-grown chestnuts are the best, being more mealy and powdery than those imported. A sweet soup also may be made of ch' stnuts rubbed through a sieve ; but I cannot recommend the polenta cake and bread made of this nut, which are so popular in Italy. It requires a long education to accustom the digestion to them. Vegetable marrow, squash, elector's cap, and a few other sorts of pumpkin are wholesome diluents, but do not form a substantive diet. The same may be said of the tomato. Care should be taken that they are ripe, or they cause colic. Peas and broad beans should be young, and their skins tender enough to crack in boiling. If they are past the time of life for this to happen, they should be chopped, mashed, or otherwise broken up; for the unbroken skins are very leathery. The longer they are boiled, the harder they get. Dried peas, split peas, are deprived of their skins already ; so ON THE CHOICE OF FOOD. 47 that if well boiled, as in soup or pudding, they are very good for food for robust people. It appears wasteful to throw away the outer shell of the pea. It contains a great deal of nutritious matter, but it is not nice in the commoner sorts. There has been lately introduced a new pea, the shell of which is edible, and seems wholesome. French beans, from the kidney bean and scarlet runner, are still more required to be young and tender. White beans are the ripe seeds of the same plants. They are not popular in England, apparently because they do not blend well as an adjunct to meat. But eaten alone with a piquant sauce, they are a most palatable variety of dish, and certainly nutritious. Lentils, again, are too much neglected. They make a capital soup, resembling pea soup. The peculiar flavor of lentil flour, which is distatefnl to some persons (reminding them of garden seeds, they say), may be masked by adding to it some sugar and Indian corn flour or fine barley meal. Or if it is wanted for soup, a few bits of celery or asparagus cover the objectionable taste completely. It is sold under the name of revalenta arabica at a higher price considerably than is charged for it as lentil flour at a corn-dealer's. Mushrooms are best when grown in an open meadow. When forced they are tough and indigestible, and when preserved they are tasteless as well. A meadow mushroom should peel easily, and it should be of a clean pink color inside, like a baby's hand, and have a frill or "curtain" (as botanists call it) attached to the stalk. When the gills are brown they are growing old and dry, and losing their nutritive qualities. The above-described agaricus campcstris is the queen of its class for cooking purposes in Eng- land. It is true there are several other similar fungi eatable, and eaten by experimentalists ; but my experience of them is that their flavor is inferior, and that we lose nothing by the safe rule of ad- hering to the one we know well by sight. The Gigantic Puff ball makes excellent ketchup, and can be eaten in the shape of fritters. It must be large and very white, like a great bleached skull. When discolored it is beginning to ripen its spores, and is then poisonous. The morellc, the fan-shaped chanterelle, and the black truffle 48 GENERAL DIETETICS. should be sweet and fresh. The odor of the last-named when de- composed is so horrible that one can hardly fancy its being toler- ated ; yet I have known a cook use truffles in this state, and say she thought it was the right smell. Materials for Salad. Here again, as in the case of winter greens, the plants used are so many and various that to enumerate them would be as tedious as useless, and to describe their several tests of salubrity would require more horticultural knowledge than I possess. Repelled by the barbarous and barren aspect of a list of their technical names, I was comforted by the recollection of a scene of long ago. A party of young gentlemen and ladies were earnestly disputing about the nomenclature and specific differ- ences of certain plants, and appealed to grandpapa, an elderly Parisian ; he settled the matter in a moment " JEh, mes chers, ce sont des salades" I shall imitate him in condensing them into a class. Vegetables intended to be used for salad should all be fresh and crisp, and sweet and clean. Their colors should be positive and even, the reds very red, the w r hites very white, and the greens pure as those in an autumn sunset sky, except in the full-grown leaves, such as watercress. The salad ought to be dressed by one of the daughters of the house, after she has herself dressed for dinner, singing, if not with voice, with her clean cool fingers, sharp silver knife, and wooden spoon, " Weaving spiders, come not here; Hence, you long-legged spinners, hence : Beetles black, approach not near ; Worm nor snail, do no offence." The purity of the bowl is more important than that of Titania's bower. So will the guests eat it with light hearts, free from all fears of noxious ingredients. With a little trouble, not however necessarily attended by ex- pense, a succession may be provided of materials for salad all the year round, so as to have one at table every day. And a great preservative of health I believe it to be for hearty persons. The most difficult season to provide for is the latter end of the winter, and it may be of use to mention that the dandelion is then a friend in need. If a pot be placed over the plant as it grows, or the ON THE CHOICE OF FOOD. 49 leaves tied up like lettuce, or it be transplanted into a frame, it can be bleached, and thus loses its bitterness. Daisy leaves are also eatable ; and thus with a sprig of tarragon, a few cold pota- toes, and some ever-constant mustard and cress, giant cress, Aus- tralian or curled cress, an olive or two pared thin, or some beet- root and a slice of Madeira onion, a great variety of combinations may be made. Indeed, an inventive lady, with a well-furnished cruet stand, a bottle of Worcester sauce, and some moutarde de Ma Hie, might provide a different salad every day of the year. These "scratch" salads are very much improved by a table- spoonful of light white wine. Watercresses rather spoil salad, and are best eaten alone, so as to make a variety when nothing else can be obtained. And the same may be said of radishes, and of endive, which are too strong in flavor to combine well. Some persons are very fond of tomatoes sliced raw, and eaten as a salad with oil and vinegar. They appear to be quite digesti- ble in this state, if ripe. Celery and cucumber raw are not suitable for eating after a heavy meal. The quantity of woody fibre in them adds an ad- ditional load to the stomach, at a time when all its powers are required. With bread and cheese, as a light lunch, they give an agreeable zest, and seem to stimulate the secretion of gastric juice. That is the time for their admirers, and they are many, to enjoy them. The selection of mere flavoring herbs, such as onions, garlic, mint, tarragon, etc., is not a matter for the dietician to discuss. He may, however, say one word in favor of temperance in their employment. An excess makes us unpleasant to our neighbors ; and disguising the true flavor of the meat, it leads to our putting up with an inferior article. The object to be aimed at in their use is to promote the secretion of digestive solvents ; and the degree in which they attain this object may be judged by the watering of the mouth ; a whiff of them excites the flow of saliva, a copious dose runs it dry. The produce of the kitchen garden, classed according to the main objects which its use serves, may be divided as follows, the order adopted in each class being a rough estimate of the plant's average value as an esculent. 4 50 GENERAL DIETETICS. 1. Starchy and sugary plants. Potatoes, white and sweet, yams, chestnuts, beans, lentils, peas, Jerusalem artichokes, carrots, parsnips, beet-root, salsify, turnips. 2. Stimulants. Asparagus, wild onions, artichokes, strong onions, garlic, and other substitutes, aromatic herbs and other flavors, mustard, cress, and a few other pungent salad materials. 3. Antiscorbutics. Cabbages, tomatoes, and salad materials iu general. 4. Diluents. Cabbages, spinach, turnip-tops, winter greens, broccoli, cauliflower, Brussels sprouts, sorrel, nettle-tops, and in short any leaves sufficiently palatable to eat and soft to swallow, which are green when boiled. The use of the first class is obvious from the powers assigned to starch and sugar by the investigations quoted in the last chapter. Each of these vegetables is a direct food contributing to the force of the body in health. How under certain circumstances some, or all, become unsuitable, will be spoken of in a future part of the volume. The effect of stimulating vegetables is to cause an increased se- cretion of saliva and gastric juice, thus enabling a greater quan- tity of food to be dissolved. Antiscorbutics seem to act by contributing some of the mate- rials of the blood of lesser amount, though of importance to the general vigor of the constitution. Herodotus implicitly attrib- utes the activity and healthiness of the Persian race to the va- riety of fruit and vegetables consumed by them. And I feel sure that the puniness, infertility, pallor, fetid breath, and bad teeth, which distinguish some of our town populations, is to a great extent due to their inability to get these articles of the table fresh. The watercress seller is one of the saviours of her country. The consumption of lettuce with his tea is an increasing habit worthy of all encouragement in the working man, but he must be warned of the importance of washing the material of his meal. The last hint is given in view of the frequency of the occur- rence of the large " round worm " ( Ascaris lumbricoides] in the laboring population of some agricultural counties, such as Ox- fordshire, for example, where unwashed lettuce is often eaten at this meal. Naturalists will not allow us to think that the crea- ture is a lob-worm, altered by its birth in an abnormal habitat. ON THE CHOICE OF FOOD. 51 But at all events its ova will live for years in moist earth, 1 and may easily be brought in from the garden, which has been manured from all sources. Diluents contain a large proportion of woody fibre and chloro- phyll, which are little, if at all, soluble in the secretions of the stomach, and are not converted into sugar by the saliva, as starch is. And they are not liable to be removed by absorption like Avatcr, the most universal diluent. Their use would appear to be to get mixed up witli the nitrogenous articles of food, so that the mass may be permeated by the gastric juice and presented gradu- ally to the absorbents. Like gelatin, though apparently not nu- tritious themselves, they make other things nutritious. Their benefit is made manifest by the improved action of the bowels after their employment. 5. FRUIT. Fruit is hardly ever eaten except because it is nice. A very good reason no doubt, but one that rather removes the considera- tion of the subject from the scope of the dietician. The safest time for taking fruit is in the morning or afternoon with stale bread and a draught of water. Thus may be made a very wholesome and digestible lunch. The worst time is after a heavy dinner. Adults often complain that they cannot enjoy fruit as their girls and boys do ; the fact is they eat it at a wrong hour of the day. Grapes, figs, peaches, cherries, oranges, and strawberries, may be considered to be the most digestible; plums, apples, pears, and apricots are less so ; while melons, and other cold watery things, are not only indigestible themselves, but prevent digestion. In selecting oranges, especially for our patients, it is best to take those with the greenish calyx still adhering to them ; they are the juciest and ripest. The fewer pips, the better the orange, or lemon, or grape. Nuts and almonds have not justice done them by nature. They contain an enormous proportion of a valuable nitrogenous aliment, which in the latter exceeds half its weight, and is called " emul- 1 Davaine, quoted in Keynolds's System of Medicine, vol. iii, p. 194. 52 GENERAL DIETETICS. sin " from its diffusibility without solution in water ; yet this is so cut off by its natural concentration and hardness from the ac- tion of the gastric juice, that it is scarcely digested at all, unless chewed and cooked much more than usual. When chosen for food, they should be used in extreme moderation, and at a time when the stomach is at leisure, and can devote all its powers to their solution. When pounded and employed as a flavoring, they are innocent enough. Frying them with butter, salt, and pepper, makes a tasty and wholesome hot dish for dessert. Cookery, breaking up the texture of all fruit, makes it much more easy of digestion. The Jews, who eat much fruit, assign that habit as a reason why their people suffered less than others from cholera, during recent invasions of the epidemic. But it may be remarked that they sell a good deal of fruit, as well as eat it, and may possibly be prejudiced in favor of the trade. It can hardly be wise to consume more fruit than usual, at a time when a chance looseness of bowels is often the exciting cause of a fatal affection of the system, excited by the special poison then prevalent. 6. GROCERIES AND CHANDLERY. Recent legislation about adulteration has been directed more against the grocer than against any other of our purveyors. The stores he sells have all gone through a process of manufacture which alters their natural aspect, and therefore gives great facility to fraud. The fraud consists in mixing a cheaper substance with a more expensive, and disguising the mixture. The disguise may be deleterious to health, or it may not, or it may even make the compound more wholesome, but the fraud is the same. In these pages, however, we have to do only with those adulterations which render the goods less fit for consumption as food. The line will be taken of shortly pointing out the characteris- tics of the best articles, without attempting to enumerate the sophistications to which they might possibly be subjected, but against which the possession of good characteristics practically warrants them. To detect the special method by w*hich bad gro- ceries are made bad, requires the detector to be as acute as the rogue he is trying to expose ; and unless he makes that his sole ON THE CHOICE OF FOOD. 53 ambition in life, he is not likely to succeed. Money-making is a much stronger stimulus to invention than the love of truth. If a customer suspects adulteration, he will act wisely to place the matter in the hands of the legally established analyst of his dis- trict, the expense of the proceeding being now made very mod- erate. 1 Tea. 2 The uses of tea are 1st. To give an agreeable flavor to warm water required as a drink. 2d. To soothe the nervous system when it is in an uncomforta- ble state from hunger, fatigue, or mental excitement. The best tea, therefore, is that which is pleasantest to the taste of the educated customer, and which contains most of the charac- teristic sedative principles. The sedative principles in the leaf consist of an essential oil which may be smelt strongest in the finest teas, weakest in the inferior sorts, entirely absent in ficti- tious teas and of the alkaloid them, which may be demonstrated by heating some tea dry in a silver pot, when the salt will appear as a white bloom on the metal. If there is any bouquet at all, or any thein at all, in the specimen examined, it is worth something. The shortest way to test the comparative value of different spec- imens is to put a teaspoonful of each in one of the little china tea- pots or cups with covers, here used as ornaments, but originally intended for this very purpose, which has been previously made quite hot. Shake the tea about in the hot pot a few seconds, and then pour on, quite boiling, a small half-cup of water on each. Cover them up quickly, and let them stand by the fire about a 1 Not less than 2s. 6^., and not more than 10s. Qd. 2 I take the opportunity of the first mention of a purely foreign product, to say that the most interesting way of enlarging our ideas on the suhject of food production, is to spend an afternoon now and then at a classified collec- tion of living economic plants, such, for instance, as that at the Botanical Gardens, Regent's Park. It is much pleasanter to think of tea as connected with the pretty little camelia it comes from, than with blue paper packets ; and the despised "grounds" will forever after acquire an interest in our minds. Who would have expected pepper, and ginger, and rice, and sugar to look as they do when growing? No consumption of midnight oil over botanical books, gives so much real knowledge as this short hour of healthy observation. 54 GENERAL DIETETICS. minute. Taste them immediately without milk or sugar, and choose that which has most aroma. On examination of the contents of the pot after use, there will be found in good specimens very little of the dust or broken leaves. The said dust, in fact, consists of the sweepings of the warehouses, which the Chinese manufacturers make up with rice- starch into pellets, and use to adulterate the real article, under the name of " Lie tea," -which expresses its character very well. The hot water dissolves it again into genuine dirt. As tea is made from more than one variety of plant and from leaves at different periods of maturity, the shape and other char- acteristics of the foliage are not very distinctive ; but I think, as a general rule, that, after infusion, the best leaves are the thickest and pulpiest in texture. Green tea, normally, contains much more of the essential oil than black ; but then its higher price offers a great temptation to frauds, and if it is used, more care is needed in its selection. Cheap black tea sometimes owes its cheapness to the admixture of leaves damaged by damp, or which have been actually used and redried. This is easily detected by the scent, but as there still remains a quantity of tannin and coloring matter, people will use it, and think they have got an article worth the price it is sold at. However, good hay, or a bunch of wild thyme or mint, would really afford a pleasanter and wholesomer drink. The dried coloring matter is quite insoluble, and the tannin makes the aliment with which it comes in contact insoluble, and indigesti- ble also. The chemicals used to put a " face," or agreeable aspect, on bad tea are not poisonous, being simply so much inert dirt. They consist of indigo, Prussian blue, whitewash, plaster of Paris, heavy spar, and the like ; new things being substituted as the old ones get found out. Their presence, however, shows that the tea is more or less bad, or it would not have been faced. The finest teas color the water the least. The finest of all, in Europe, the yellow tea which comes overland through Russia, obtainable at Frankfort, and well worth obtaining, communicates only a slight tinge to the infusion. These luxuries are best en- joyed with a slice of lemon in lieu of milk and very little sugar. In using tea, it must be remembered that the small-leaved and ON THE CHOICE OF FOOD. 55 fine-grained tea packs much closer than the coarse, that conse- quently nearly double the quantity may be contained in a spoon- ful, and therefore fewer spoonfuls are required. Coffee contains more of its special exhilarating alkaloid (Caffein) than tea, but somewhat less essential oil. It should not be kept at the boiling-point, or it loses this virtue. The Purest way to have genuine coffee is to purchase it in the bean, with the aromatic scent (which shows that it has been re- cently roasted) still in it, and grind it yourself. It is easy to add chicory if you think it improves the flavor, but as that root con- tains no alkaloid, the beverage is weaker in quality. This is de- sirable under certain circumstances, to be discussed in the second and third part of the volume. A further security is to buy the beans raw, and roast them at home over charcoal ; the trouble is repaid by the delicious incense, which alone, among the opera- tions of cookery, it diffuses through the house. If you have an opportunity of getting it direct from the im- porter, you will find the best coffee is that from Guatemala. It is probably re-christened " Mocha " in the shops. The smallest and roundest beans are the best. The long oval bean from the West Indies ought to be a good deal cheaper. Cocoa and Chocolate, " Cocoa nibs " is the most eligible form in which the plant can be used as a mere beverage, like tea or coffee. They are the seeds merely broken up by rough grinding. But much of the nutriment is wasted in the thick grounds ; so that if what is wanted is a supporting food, either these must be well stirred up in the draught, or the extract of the seeds, "choc- olate," must be used. This contains a large quantity of fatty matter and may be made a meal of. Chocolate is an article so disguised in the manufacture that it is impossible to tell its purity or value. Indeed, the makers say it is improved by adulteration, and cannot be sold without. The only safeguard is to buy that which bears the name of a reputable maker. Sugar. The baser sort, "moist brown," always contains dirt, sand, and mites. If it is dissolved in warm water, the heavy dirt falls to the bottom, and the mites float on the surface, afford- ing an interesting object for the microscope. Grocers get from handling it psoriasis palmarum or " grocer's itch," so it can hardly 56 GENERAL DIETETICS. be a desirable condiment to eat raw. Besides this, a clerical friend of mine was informed by a large and religious grocer in a manufacturing town, that he found it impossible to compete in price with his rivals, without adulterating intentionally the whole of his brown sugar. And he stated (not under the seal of confes- sion) that one of the materials used for coloring, was a mineral of a deleterious nature, but he declined to name it, as, seemingly, in this instance, cunning has advanced ahead of detection. The obvious moral is always to use loaf sugar or sugar candy, the sophistication of which does not answer. Treacle. Common treacle is the waste which drains off from the moulds in which refined sugar is made. It contains a con- siderable quantity of dirt, acids, extractive matter of doubtful quality, and salts, so that it sometimes acts as a purgative. " Golden drop " is prepared by filtering this stuff through char- coal ; it should be clear and light in color, and is then a whole- some article. Grape sugar is used in England only to adulterate that from the cane; its sale might with propriety be prohibited. But, in Portugal, grape-juice is boiled down with quinces into a sort of jam, the etymological ancestors of all the marmalades whose name is derived from " marmelo" the Portuguese for a quince. Let not the reader be beguiled by a poetical regard for grapes or quinces into eating it. My specimen was a present direct from a country estate in the south, and tasted like gritty molasses and onions. . The giver informed me it was very wholesome, but used only by servants and farm-laborers. Raisins, Sultanas, Currants, Figs, and Dates, are the dried fruits preserved by their own uncrystallizable sugar. The muscatel raisins are the best, and are prepared by allowing the grape to dry on the vine ; the inference from which is that expedients used to hasten the process are inexpedient. The best evidence of the goodness of these articles is their plumpness and softness, com- bined with the absence of mites, as tested by infusion in water, in the mode recommended for brown sugar. Mites are not known to be poisonous, but they destroy the saccharine constituents, leav- ing only feculent remains and exuviae, and converting the remain- der into carbonic acid. Now, it is for their saccharine constituents that we employ these dried fruits, both cooked and uncooked. It ON THE CHOICE OF FOOD. 57 may be remarked, also, that the skins are very insoluble, those of all sorts of the grape containing a large quantity of white wax, which in fact waterproofs the texture, and prevents its penetra- tion by aqueous fluid. So they should always be split before using in the kitchen. Cakes made of unsplit currants are espe- cially to be avoided, as they are apt to produce pain and purga- tive effects in the most healthy. Rice should be as whole and unbroken, and as free from dust and dirt as possible. The presence of weevils in it, constitutes a decidedly damaged article, which ought to be returned. In the future pages, when rice is spoken of in connection with puddings, the Carolina is intended ; for curries, or as a vegetable with meat, the Patna is used, since it best retains its form when steamed. Patna rice is also the most eligible thing to eat with jam, or rhu- barb, or roast apples, etc., for it has the least laxative action of all cereals, and thus counteracts the inconvenient tendency in that direction of the sweet parts of the dish. The preparations of wheat ordinarily sold by grocers, such as Semolina, made from hard wheat rich in gluten, Macaroni, Italian paste, Vermicelli, made of flour from which the starch has been partially removed, are more nutritious than the flours of the corn- dealers ; but, at the same time, are less digestible from their being dried up so hard. They are not suitable to be used as vegetable dishes, for they are too nitrogenous for the purpose. But, if they are long boiled till quite soft, they form a substantial meal. The worst sort of macaroni is that stamped in the form of letters, for if it be sufficiently boiled, the shape of the letters is lost, and cooks do not like that. These preparations are apt to get "weevilly," a state of things usually to be detected by the smell. Vinegar. The best vinegar is that made from the acidified white wines of the Loire and Charente. British malt vinegar is deficient in the oenanthic ether which gives a bouquet to the more elegant article, is more apt to become mouldy and to breed worms, and is more often adulterated. As to distilled wood vinegar, al- though its fundamental composition is identical with that of wine vinegar, yet it has not such a pleasant taste or smell as the latter, for the destructive distillation of the wood gives rise to some em- 58 GENERAL DIETETICS. pyreumatic products of doubtful wholesomeness, of which traces always are to be found in the product. There seems nothing gained by scenting and flavoring vinegars. It prevents their being analyzed, and thus excites, perhaps, un- merited suspicion. They smell like lotion, which is unpleasant at dinner. Vinegar owes its acidity to the acetic acid, which constitutes about a twentieth of its weight in French vinegar of good quality, and in British " proof" vinegar 4.6 per cent, of anhydrous acid. As to other substances contained in the solution, tartrate and sul- phate of potash, tannin, and cenanthic ether appear to improve the flavor without in any way affecting the health of the consumer. But it is not so with sulphuric acid, with -which bad vinegar is adulterated. Sulphuric acid especially if cheap, impure oil of vitriol be employed cannot be considered harmless if used in the daily food, in the preparation of cabbage, or pickles, or salad, or made-dishes. The more it is cooked, the more concentrated it becomes, for the acetic acid is driven off by the heat, while the mineral remains. The least injury it can do is to corrode the teeth, when present in excess. To avoid sulphuric acid entirely is, however, not possible, un- less you make your own vinegar; and this is really worth the trouble if your consumption is large. For the law allows the manufacturer to introduce sulphuric acid to the extent of one part in a thousand (in France one gramme to one litre), and the article cannot be called adulterated if this amount is not exceeded. The test recommended by the College of Physicians for insuring the goodness of British vinegar used in the preparation of medicine is a solution of 1 part of chloride of barium in 8 parts of water: of this 10 minims will precipitate all the sulphuric acid in an ounce of lawful vinegar. If, after this has settled down, the test solu- tion still continues to form a cloud, the article should not be em- ployed in the preparation of food. Besides sulphuric acid, cheap dirty vinegar sometimes contains lead and other metals. There was an epidemic of lead poisoning some years ago among the apprentices of a silk-mill at St. Albans, induced by pickled pork. This contamination is provided against in the Pharmacopoeia, by ordering the test of sulphuretted hydro- gen to be used. ON THE CHOICE OF FOOD. 59 Is it worth while to test or get tested such a mere condiment as vinegar? I think so, for it is really a most useful adjunct to the dietary. It possesses the property of softening and finally dissolv- ing muscular fibre, as you may see by watching its action on a fragment under the microscope ; and, in virtue of this solvent ac- tion, it is wisely taken with those meats whose fibres are hard, and from their hardness insipid, such for example as boiled beef, fresh pork, brawn, salmon, tunny, sturgeon, eels, lobsters, etc. The resolution also of the albumen in hard-boiled eggs is assisted by vinegar. Acids favor the conversion of cellulose into sugar, which is the first stage of the digestion of the materials for salad of cabbages, and other green leaves and their employment in this class of dishes is strictly physiological. On the other hand, to put vinegar on beans is, in the strong language of Monsieur Cyr, "detestable;" 1 for it renders insoluble the legumin, which is the most nutritious part of them, constituting, in fact, from a quarter to a third of their substance. 2 Cold boiled beans are sometimes made into a salad, and it is quite true, as M. Cyr says, that the addition of vinegar destroys the flavor, and, probably enough, makes it indigestible. Oil, pepper, mustard and a little white wine, make the best dressing. Beans are a favorite food for persons practicing disciplinary abstinence, and the hint may be of use to them, though not appreciated by the unrestricted world. OIL M. Cyr places olive oil as the highest in order of digesti- bility of all fatty foods, 3 even above fresh butter. But to merit that praise it must be thoroughly good, quite clear and transparent and free from rancid smell. The paler it is, the better. The white deposit sometimes seen is vegetable albumen, which ought to have been refined out, as it prevents the oil from keeping sweet. Lucca oil, which is the best, has a peculiar, agreeable odor, tech- nically called " nutty." Olives gathered young and small are called " French olives," and in this condition are the sort most adapted, by their pleasant piquancy, for eating as a relish. But to use in cookery they are indigestible and tasteless, and inferior to the fruit gathered at a later period of growth, when soft and 1 Cyr, Trait6 de 1'Alimentation, p. 143. 2 In horse-beans 30.8 per cent., in Windsor beans 29.05 per cent., in hari- cots blancs 25.5 per cent. Payen. 3 Traite de 1'Alimentation, p. 122. 60 GENERAL DIETETICS. pulpy with incipient oiliness, and called "Spanish olives." These last, also, are best for salads. In Portugal, they refuse to gather them till they are just beginning to turn purple, and then they are bitter and not so digestible ; but I am informed by a Portu- guese country gentlemen that they might be just as good as the highest priced French fruit, if the farmers would be persuaded to advance upon the traditions of their grandfathers. 1 Caviare should be soft, pale in color, and exhibiting the ova of the roe quite distinct. When old and black, and homogeneous in texture, it is out of season and rancid, and arrests digestion. It is wise never to eat it when you see it served carelessly with cold, withy toast. It should be sent up in a toasted-cheese dish. Pickles. Grocers appear to consider that the final use of pickles is to ornament shops : so they choose them for the brilliancy of their colors and the elegance of the arrangement of their contrasted forms in the bottle. The consequence is that all sorts of expedi- ents, some of them highly deleterious, are used by manufacturers to enhance "the fatal gift of beauty." In twelve samples of pickles taken indiscriminately and examined in behalf of the State Board of Health of Massachusetts by Mr. Hill, last year, ten were found to contain copper, by the simple process of dipping in them a steel knitting-needle, which in a few hours became coated with the metal. Nine of the samples were also examined for alumina and found to contain it, showing that alum had been used, probably to intensify the lake tints. (Fourth Annual Re- port, Boston, 1873.) Black pepper in powder is another article which the conscien- 1 I take this opportunity of alluding to the trade custom of designating peculiar qualities or kinds of food by local names. No fraud is intended, and any legislation which would make the transaction a fraud, would be unjust. The words "Spanish " and " French " do not mean that the olives come from Spain or France, but that they are of the sort made in those countries. A large quantity of " Ostend rabbits" used to come to the London market from near Marseilles, but an importer told me they were bred, fed, killed and skinned like "Ostend rabbits," and therefore to all intents and purposes " Ostend rabbits." So a wine merchant that sells his prime claret as "Cha- teau Margaux," is committing no fraud, if his wine is as good as Chateau Margaux, though it might be proved to have never seen that famous property. Furriers are in the habit of calling tabby-cats' skins "Japanese lynx," and the best "plover's eggs" are usually laid by gulls on the East coast: in neither case is there any intention to deceive. ON THE CHOICE OF FOOD. 61 tious grocer, lately mentioned, declared he could not sell at a profit without increasing its bulk by artificial means. It does not, how- ever, appear that any of the dirt introduced is, to the knowledge of the adulterators, deleterious to health. The simple safeguard is to buy the pepper in corn. Red pepper when pure is entirely suspended when rubbed in warm water. If a red deposit falls, it is generally red lead, a nox- ious metal. Mustard is usually adulterated by the grinders with flour and turmeric, which are not injurious to health, so that the verifica- tion of the drug becomes a question for the economist, not for the dietician. Spices, in general, should not be purchased ground. And it is a prudent proceeding for members of our profession to take the opportunity offered them by the liberality of the Society of Apoth- ecaries, and lay in, at the wholesale market price, a stock of the purest and best spices. They have, thus, test articles which they can compare with those furnished in " our village." It will some- times be found that the latter, even with the grocer's profit on them, are the cheapest; and then of course they must be adulter- ated or damaged goods. Bacon and Ham, when properly prepared and not rusty, give us a fat much more digestible and therefore more nutritious than that of fresh pork. The process of salting, and still more that of slowly drying or smoking, removes a great quantity of the water, and coagulates the serum, which tend to make the adipose matter readily run into rancidity. What we have to do in selection is to see that the removal of water is carried as far as possible, and this is accomplished by observing the loss of weight in cooking. Primest bacon, according to Dr. Letheby, should not lose much above a tenth in boiling; and ham wastes much less. Sausages. After the sensational descriptions of their manufac- ture, sent to journals by special correspondents, it may be pre- sumed no one eats sausages, without some acquaintance with the person who has prepared them. There is, or was, in Oxford a large open window through which one could see a stalwart maiden, with her arms glowing from frequent immersion iiivy in Med Chir. Transactions, xxviii, 82. 64 GENERAL DIETETICS. had not Dr. Murchison taken up the investigation with extraordi- nary energy and perseverance. This danger is unhappily not capable of being warded off by science. The fatal substance which brings typhoid fever into our bodies cannot be distinguished from other organic matters, nor can its existence be made evident by any chemical or microscopic observation. By its works alone, and too late, do we know it. The only possible protection lies in the scrupulous observation of dairy farms by sanitary inspectors, to report on any communication between the drains and wells, and instantly to warn the customers, if the farmers refuse, to stop the sale of dangerous milk as human food. It would be a good plan for the customers of any one establishment to appoint their own inspector. The evidence of the transmission of scarlatina by milk, is not so conclusive as in the case of typhoid. There are no other impurities injurious to health known to exist in the milk of our shops : caramel, brown sugar, salt, and carbonate of soda have been detected, 1 but not the chalk, starch, brains, or other substances sometimes asserted to be employed as adulterants. Milk is sometimes rendered unwholesome in the customer's own house, by the vessels in which it is received not having been properly scoured out with soda. On stale milk, even in minute quantities, there very quickly germinates a blue mould, such as is seen often on cream cheese, and called Didium lactis. The mix- ture of this, adhering to the corners of the can, with the fresh milk, causes it to turn sour, and to give rise to colic and diarrhoea, and, it is not unlikely, also to " thrush " in children, for the crust which forms in the mouth is not a dissimilar form of mould. The purity of the milk supply is a matter of extreme import- ance, and fitly forms the subject of legislative interference, pro- vided always that the legislative interference be judicious and does not impede improvement by competition. 2 It is a subject of 1 Fourth Annual Keport of the State Board of Health, Massachusetts, 1873, p. 295.' 2 Of such injudicious sort would be, for example, the fixing an absolute standard of crea.m contents. The standard must be low, or much genuine milk would be condemned ; and then when any dealer got milk richer than the standard, he would water it down to the mark, and thus the pump would be more active than ever. ON THE CHOICE OF FOOD. 65 pre-eminent importance to the healthy, above all others. I al- ways feel indignant when I see advertised special milk, in sealed cans or otherwise, for the nursery or for invalids. As if the health of the sick and weakly were more important than that of the strong man, on whose arm those sick and weakly depend for existence. Let us keep our strong men well, and we shall have fewer invalids to attend to. In choosing between two shops, I should always prefer the one that did not advertise a special article. Cream, when good, is thick, clouty and yellow. BuiteriiiUk -is one of the most wholesome summer drinks possi- ble. It is equally refreshing and nutritious, and to see it given to pigs instead of being distributed to the neighbors makes the philanthropist's heart bleed. Whey from which the curd has been removed for the purpose of making cheese, is apt to be somewhat sour, from the rennet by which coagulation has been effected. But even then it is a pleas- ant summer drink, and is certainly very digestible, and rapidly absorbed, for it is in composition more like serum sanguinis than anything else. A grate of nutmeg makes it very palatable. In Switzerland it is often drunk as a diet drink, and the inhabitants have such a high opinion of its wholesomeness, that they have founded establishments for the special purpose of receiving pa- tients for the cure of all sorts of diseases by its means. This " Molken-Kur," as it is called, does not however seem to suit English constitutions, unless starvation is required to be the prin- ciple of treatment, as is rarely the case. Junkets and Curds are nutritious nitrogenous foods, but they require the stomach to be educated by use for them to be well borne in any valid quantity. Milton's mention of" the junkets" seems to imply that they were formerly more of an ordinary diet in farm-houses than now. Condensed or " Siviss" milk is a device for avoiding the risk of deterioration by shaking. Six-tenths of the water is dried out of it, and sugar is added as a preservative. It certainly is digestible, as is shown by the fact of infants brought up by hand upon it growing fat, and apparently strong, a fact of which most of us have ocular proof. Great care should be taken that only the 5 66 GENERAL DIETETICS. softest water is used for its solution, and precautions taken against its adulteration. As it is a recent invention it is pure enough at present, but extensive use will probably teach ingenious methods of sophistication. Clotted cream is simply cream skimmed from heated milk. Great accuracy is necessary to secure the right temperature, yet the union of the offices of cook and dairymaid which it entails does not insure accuracy. If the mistress of the household will make it a few times with her own hands, she will find no difficulty in producing a digestible article by observing the following pre- cautions, and for very shame her example will be imitated. Clotted cream is simply cream raised by heat, so that a little albumen is partially coagulated along with it. Take a well- scoured stout saucepan (a broad copper one is best) and put a tea- cupful of quite cold water in it, then pour in the whole milk and heat it over a very slow fire (charcoal is best) till the cream rises ; when it does so, take care not to increase the heat, but keep it up. It should never exceed that which the finger can easily bear (about 150). As the clot rises, divide it down the middle with the finger, and turn it back on itself. Keep doing this till there is no more formed. A bain-marie and a thermometer are a re- finement upon tins method. Bought clotted cream is apt to make the delicacy unpopular. It is often sour, and adulterated with sugar and flour. Butter, like milk, is adulterated with an excess of water, which may be detected by boiling ; the oily matter floats, and the water underlies it. But neither in that, nor in any other detected falsi- fication is there any source of danger to health. Even when rancid and damaged butter is got up again in order for the market, the processes are such as to make it fit for food, though not so nice as when naturally sweet. The palate is a good guide ; but sometimes in autumn and winter, when the grass is scanty, the butter will be flavored with the dead leaves or turnips Avhich stingy farmers will let their cattle eat, and we must not condemn the article as unwholesome because it is nasty at these times. ON THE CHOICE OF FOOD. 67 Cheese. Classification of Cheeses usually in the Market. Cream cheeses, . f Gruelthorpe. \ Neucbatel. f Stilton. Double Gloucester. Cheeses made of whole milk rich in cream, \ , Gorgonzola. Cheshire. Cheddar, f Single Gloucester. Cheeses made of poor or partially skimmed j Shropshire, milk, . . . . . . . I American. [ North Wiltshire, /- Suffolk. Cheeses made of skimmed milk, . . . -I Parmesan. (. Dutch. Cheese is required for two purposes ; one is for eating in small quantities as a fillip to the palate, and the other is in order that it may serve as a substantial food. For the first purpose it may be produced in a rancid, decayed state, and is best when of a rich buttery sort. But to be taken as a meal, to satisfy hunger, newer cheese is better. Poor cheeses, such as the Dutch, are wholesome and digestible if cut in very thin slices and buttered. Toasted cheese is also digestible if it is new and lightly cooked with cream and butter. Tough toasted cheese is about as soluble as leather. Eggs. To choose eggs, dissolve one ounce of common salt in half a pint of water, that is, ten fluid ounces measured with a medicine measure glass. In brine of this strength a good egg will sink, a bad egg will float. If held up to a candle a fresh egg will be found to be more transparent than a stale one, or than one with a chicken in it. Fresh eggs are most transparent in the centre, stales ones at the end. If absolutely necessary, eggs may be preserved some time by rubbing them well with fresh grease when taken warm from the hen-house. But if they acquire a smell of old straw they are unfit for food. Lime gives them a peculiar taste, and prevents the albumen setting. Rennet. Rennet is not always to be obtained good in the coun- try. It may be thus prepared for domestic use in making whey, junkets, etc. Take a calf's " bag " with the curd in it (that is the 68 GENERAL DIETETICS. fourth stomach, or abomasus, 1 filled with acid chyle), pick out all the hairs, and wash bag and curd clean. Then, replace the curd in the bag with six or seven ounces of salt, and set them by for a week in a cool dairy. Then, take a strong brine, made of a quart of water to a pound of salt, and pour it cold on the rennet. When it has stood again for a w r eek, the liquor is fit for use. 8. BREAD STUFFS. There is no bread so digestible as that made by an honest, ex- perienced baker. In baking at home you secure the honesty, but you lack the experience. The chance has to be taken of a bad batch through some accident ; and then the best must be ma^le of it till it is finished. If one had to live on bread alone, brown bread would perhaps be preferable, for (as Professor Liebig taught us) it contains in the bran and pollards, which are returned to it after grinding to make it brown, a considerable quantity of phosphate of lime, valuable as nutriment to the bones and other tissues. But the fact is, most of us take in other ways plenty of phosphates in a more digestible form than bran, and the irritating eifect which it has on the bowels shows that it is not, in this form, made much use of by them as a nutriment. White bread is generally chosen in preference by shrewd working men who wish to make the money spent on food go as far as it can. It is also far less likely to be withy and tough, and is less often adulterated. Not but that some admixture of the bran is pleasant, both to the eye and to the palate, as in the flour which is called " seconds," which makes a very good bread, probably in consequence of this flour not being over-ground. Too much friction ruptures the starch-granules, and the dough does not rise well. Bread should be evenly porous without any large holes, like a fine sponge. The texture should be firm, of which virtue the best test is the being able to cut it up into thin bread and butter. Tough, clammy new bread becomes wadded together into an in- soluble mass by chewing, is not penetrated by the saliva or gastric j uice, ferments anew, and even in strong persons is apt to produce 1 It is figured in a volume previously referred to, Dalton's Human Physi- ology, p. 105. ON THE CHOICE OF FOOD. 69 a disagreeable form of heartburn. If from necessity it must be eaten, heating and copious buttering, as we heat rolls or crumpets, is the best expedient to make it as digestible as circumstances admit. A considerable portion of water quickly evaporates from hot bread, causing of course a loss of weight, so that bakers will some- times try to prevent it by covering up the loaves from the air. The crust is thereby rendered withy, and the crumb is wet and tough, besides which you are buying water at the price of bread. There is another and more objectionable way in which the loaf is forced to hold water in excess, that is, the addition of boiled rice-flour. It is a sticky gummy paste, which renders the dough more adhesive, and prevents evaporation. So that 21 quartern loaves are made with what ought to make only 20. They may be found out by their sodden bottoms, the water gravitating by standing. To shirk this test, bakers will turn them upside down on the shelves, which always looks suspicious. I am told by a retailer of glue that bakers buy a good deal of that substance, and the inference is that it is used in the same way to make the dough adhesive. It is said, also, that alum is added for the same fraudulent pur- pose, even to good flour. But its object, generally, is to make a damaged article bear a good white color, and stop the excess of fermentation to which it is liable. Alum is easily detected in the laboratory by incinerating the bread suspected to contain it, and our analysts are active in this direction. However, they must guard against being too pedantic, and a distinct line must be drawn between a baker who habitually uses a great quantity of adulterant to dispose of flour which he has wilfully bought in a bad state, and one who now and then rectifies an accidental loss of goodness by the employment of the drug. But certainly, the less aluni he uses, the more he is to be trusted. The best bread grows stale the slowest. "Aerated bread," where the dough is raised according to Dauglish's patent, by forcing pure carbonic acid into it, keeps better than any. It is free from the objectionable presence of the remains of the yeast, not to be avoided otherwise, and is more certain to be wholesome than ordinary bread. It is popular, too, at that test of palatable simplicity, the nursery tea-table. 70 GENERAL DIETETICS. Yeast is a great difficulty with those who bake at home. Brewer's barm is the best, but it is apt to go dead between one baking and another, and is not easy to be got. Country trades- men object to sell it, but many retail bakers in London will en- gage to send regularly by post an ounce or two of "German yeast," which thus arrives quite fresh and active. An orderly cook can keep a ferment in constant action by starting it with some " Ger- man yeast " from the regular manufacturers of that article, and feeding the mixture, placed in a cool situation, with some fresh malt and mashed potato or dough, daily. An acquaintance with the theory of fermentation as explained in all books of physiology, and recently made doubly instructive by the researches of M. Pesteur, will enable an educated person to point out the remedy for all difficulties encountered in the kitchen. There is no more favorable subject for interesting un- lettered minds in nature's wonders. I have seen a country con- gregation quite breathlessly attentive to an account from the pulpit of the recent addition to our knowledge on this head ; and I am sure that when their dough has risen well, they have remembered the moral impressed upon them. Biscuits are too hard for ordinary consumption as a bread-stuff, if made from flour and water only, as " captains " and " ship bis- cuits" are. They are very useful, however, to travellers, in rea- diness for those frequent occasions on which the bread is tough, sour, bitter, or otherwise uneatable. They bear well exposure and rough treatment, and if soaked for a few hours in water or O / milk, they take up several times their own weight of fluid, soften and swell, and with a little cream and sugar make a dainty dish of eminent digestibility. Biscuit powder for infants should be made from this kind. Fancy biscuits are too numerous to describe, and of various merits. The addition of milk, sugar, eggs, flavors, etc., makes them less digestible than the plainer sort. Those made on a large scale by special manufacturers are the best, because in them the partial raising of the dough is effected by piain carbonic acid, in- stead of carbonate of ammonia. When biscuits become damaged, they are often damped and heated anew in the oven. They quickly lose the artificial new- ness thus acquired, and grow stale and musty. So they are safest ON THE CHOICE OF FOOD. 71 purchased in tins, where they are not so likely to be tampered with, Oatmeal. The coarsely-ground Scotch oatmeal is the most suitable both for porridge and cakes. If imperfectly boiled, as when prepared in a hurry, or intentionally unboiled as in ,brose, it is extremely indigestible, and produces the most obstinate cases of pyrosis in the parts of the country where it is habitually used. But when well boiled, and eaten slowly so as to become well mixed with saliva, it is a most wholesome as well as most nutri- tious food. An oaten diet has bred the Scotch farmer and the English horse, and where will their equals be found ? Emden grits are the best adapted form of oats for gruel. Barley and rye do not appear to possess any distinctive virtues which can give them an interest in the eyes of a medical man. Though useful when other cereals are not to be got, they are in- ferior to them in solubility and nutritive power, and, at the, same time, have not the attractive taste which would cause them to be a temptation against which a warning is necessary. Maize .in various forms is often recommended as a valuable food. It contains a good deal of fattening matter, and on that ac- count is used for fattening geese at Strasbourg, and other domestic animals elsewhere. But its oleaginous constituents incline it readily to grow rancid, when it has a fusty disagreeable smell. When stale, therefore, it is apt to disagree, and in horses often causes a sort of eczema of the skin. To our race, damaged maize, persisted in as a food, is still more deleterious, producing, for ex- ample, in Lombardy and the Valtelina, a special endemic cuta- neous disease Pellagra which is year by year slowly widening its fatal shadow over the finest lands tilled by man. 1 Maize flour may be refined and made safer by washing out the nutritive portion with alkalies, and in this state professes to con- stitute " oswego," "maizena," "corn-flour," etc. But the eater should understand that he has before him starch only, and must 1 The IVllagra is the punishment of sin. The farmers, cultivating their lands on the metayer system, the landlord and tenant dividing the crop, are tempted to hide some of the grain in holes and corners, where it gets mouldy. They find it makes their fowls ill, so they eat it themselves. See Lombroso. Sulla Pellagra, where figures are given of the peculiar mould to which the author attributes this very serious plague. 72 GENERAL DIETETICS. not reckon on it for nitrogenous nutriment. The economist will probably think he can buy starch cheaper in the form of rice flour, which, indeed, is often sold under these fancy names, according to the evidence of Dr. Bartlet before the Adulteration Committee this summer. Other forms of Starch commonly sold. Arrowroot (West Indian best). Cassava meal. Potato starch (uncolored). Sago (unbleached best). Sago meal. Salep. Tacca starch, or " Otaheite Arrowroot." Tapioca. Tapioca meal, or " Brazilian Arrowroot." Tous-les-mois (West Indian). The only preference that can be given to one of these over the other depends upon its flavor. All are equally wholesome, and equally suitable for the occasions when a physician wishes to ad- minister starch without admixture. 9. ALCOHOLIC DRINKS. Wine. This is a subject terribly overladen with literature, his- torical, poetical, industrial, scientific, and occasionally nonsensical. So that a simple purchaser who wants to know how to get a good wholesome glass of wine, has no small difficulty in winnowing out the required information from so much chaff. The first thing a householder should think of befbre he stocks his cellar, is what he wants the wine for. Is it to take as a regular beverage, or on festive occasions only? Does he intend to employ it for himself or others as a medicine, or to drink it only because it is nice ? Here are the four chief uses of wine, and different wines are suitable for each. As a regular beverage for a healthy person there is no wine in the English market equal to claret. The intelligence and perse- verance of the Bordelais vintager, improving yearly on the tradi- tional experience of centuries, does the best that can be done for a very good grape. Nothing can be more perfectly made than the ON THE CHOICE OF FOOD. 73 greater part of the low-priced Bordeaux wine, now brought over direct from the Gironde. Everybody distinguishes in the grape three parts, viz., the pulp, the stones, the skin. It is on the forms and degrees of pressure exerted to extract the juice, that the presence of these several parts in different proportions in the wine depends. In the pulp is the syrup, which ferments into alcohol, the amount of* wltich constitutes the value of the wine. So as much of that as possible is got out. In the stones are essential oils, which in deli- cately graduated moderation are wanted to contribute to the for- mation of vinous ethers as a " bouquet." In the skin and stalks is tannin, necessary to give astringency and preserve the liquid from mouldiness ; and there are also coloring matter and extrac- tive, which contribute a distinctive hue, a thickness or " body," and fruitiness. There are, too, in the juice, tartaric acid and its salts in considerable quantity, and citrates and malates in smaller amount ; these are rather necessary evils than desirable ingredients, and the owner is glad to see his must deposit the greater part of them in the "tartar" a product of the vintage for which he ex- pressed his dislike by the bad name he gave it in the old days of strong language. 1 There is also some nitrogenous matter, which in undergoing chemical changes acts as a ferment, and having done its work, ought to disappear, lest it should re-establish fermentation when not required. Now, the perfection of claret, above all other wines, consists in the manufacture being so conducted that each of these elementary constituents of the grape is expressed in exactly the proportion most conducive to the wholesomeness of an alco- holic beverage. If any of the above-named ingredients, or their products, ex- hibit themselves conspicuously in the perfected liquor, a peculiar character is given to it, which causes it to be sought out for real or supposed advantages, or avoided for real or supposed evils. We can, thus, classify wines as they appear in the market, in the following groups : 1. Strong dry wines. In these the syrup of the must has been 1 Sal Tartari = "hell-salt;" Cremor Tariarl = "hell-scum," cream of tartar. The history of the word is not known, but Paracelsus found it in use in his day. 74 GENERAL DIETETICS. in large proportion, and has fermented thoroughly into a large proportion of alcohol. 2. Strong sweet wines, Here the sugar has either existed natur- ally in such excess, or, more commonly, has been added in such excess, as to stop fermentation and remain sweet. 3. Aromatic wines, whose chief feature is a delicate diffusible odor comparable to that of flowers, and thence termed "bouquet." This depends on the union of sundry essential oils with the alto- hoi in a nascent state, by which renanthic and other volatile ethers are produced. 4. Acid wines, whence the natural acid cannot be eliminated without destroying the flavor. The acid in them is mostly tar- taric, and not acetic, as in wines that have turned sour.^ 5. Sparkling wines. Here the ferment is not allowed entirely to exhaust itself before bottling, so that it goes on slowly under severe pressure, and saturates the wine with carbonic acid, at the same time giving birth to flavors which would not otherwise be produced, and to very exhilarating ethers, without much alcohol. 6. Perfect wines, where as many of the above qualities as pos- sible are combined without interfering with one another. 7. Rough wines, in which the astringent tannin is predominant. 1. Strong dry wines are well represented by sherry, which is the strongest and driest of all ; and it is ably supported by Port, Madeira, Marsala, Johannisberg, and a few (very few) others of the products of Northern grapes. These all contain too much alcohol to drink dietetically ; much diluent must be taken at the same time to make them wholesome. But for festive use, to take a glass thereof to promote conversation and good fellowship, they are excellent. And, except Marsala, they are well qualified for that post by agreeable flavor. Constant use of strong wines induces a congested and insensi- tive state of the gastric mucous membrane, which prevents its glands from secreting freely, and, by reflex action, affects also the salivary glands ; these liquors are absorbed slowly, and what sugar remains in them, and much of the alcohol also, becomes converted into acetic acid, which fermentation further causes the oleaginous ingredients in the food to become rancid. Thus is generated " acidity " of stomach, or the presence of an undue amount of nascent acids. A gouty constitution is often thus in- ON THE CHOICE OF FOOD. 75 augnrated in a previously healthy person, and, what is worse, is capable of being transmitted as an heirloom, just as acquired pecu- liarities are handed down to their descendants by domestic ani- mals. 2. Strong sweet wines are represented in England by Malaga, Alicante, Constantia, Tent, Tokay, Paxarete, Malmsey, the ex- ported Lacryma Christi, 1 Frontignan, Lunel. They are fit to drink only in small quantities, and are best appreciated, with a plain biscuit, when the stomach is not full. Thus taken they are a wholesome substitute for tea. In order to enhance their flavor and bouquet, the naturally dry vintages are often, either during the manufacture or afterwards, made sweet. The most usual and least objectionable process is checking the fermentation by the addition of boiled grape-juice, and the result of this is an indubitably less wholesome article. By long cellaring the sweetness slowly disappears, and the fine flavor remains ; but there is much risk of decomposition, which has to be guarded against by adding an excess of alcohol. Almost all the port now to be had is an artificial wine of this sort. The port drunk by our grandfathers, and up to 1820, was a dry, well- balanced wine, capable of being kept without brandy and without damage for several generations. I have, in Portugal, tasted some perfectly sound, which had been in a private cellar upwards of seventy years. But the summer of 1820 was an extraordinary one, and produced, in the Peninsula, a vintage such as had never been seen before, and the wine, by a preternatural richness of flavor secured a fatal popularity. Since then, the sole ambition of the Oporto merchant is to imitate 1820. He has more or less succeeded, but at the expense of British digestions. 3. Aromatic ivines. Several of the before-mentioned have a fine bouquet, but what are intended here are such as are chosen for their aroma almost entirely. Moselle, the choicer Rhine wines, first quality Chablis, Chateau Yqucm, several Italian wines (such as Orvieto, Monte Pulciano, Capri, d'Asti), Champagne, are of this description. They bear carriage badly, and have to be prepared for the voyage by artifi- 1 Tlnit used for home consumption is a badly made wine which will not keep till it is ripe. The choicest Lacryma goes to Augsburg. 76 GENERAL DIETETICS. cial additions. So that, while wholesome in their native land, they are apt to be much the contrary as found here, and besides have often lost their aroma unless they are brandied. 4. Acid wines must be in justice carefully distinguished from wines which have turned sour. The acid of the latter is nascent vinegar, whose presence indicates the probability of other more noxious acompaniments of decomposition being also in the dam- aged liquid, such as poisonous moulds and fungi, for example ; but some wines are really made with an excess of acid, consisting mainly of the tartaric and its supersalts. This happens mostly to the growths of cold countries, such as the Rhine districts, and the environs of Paris. White Burgundy wines (of which Chablis is the best known) and white Bordeaux wines (Sauterne), unless in exceptional years, are more noted for their acid than for their aroma. They are best adapted for taking with rich, greasy dishes, and suit well the dietary of the luxurious districts where they are grown. They are an agreeable adjunct to the usual in- gredients of salad dressing. 5. Sparkling wines. Champagne, St. Peray (from the Rhone), Seyssel (or "Swiss Champagne"), Sparkling Moselle, Vino d'Asti, are the best known. Good champagne is by far the wholesomest, and with a minimum of alcohol, possesses remarkable exhilarating power, from the rapid absorption of its vinous ether diffused by the liberated carbonic acid. Sillcry mousseux contains, according to M. Cyr's table, only from 9 to 1 1 per cent, of absolute alcohol, but to a sinking fever patient, a glass will give twice the energy that can be obtained from a glass of brandy. The other efferves- cing wines will be drunk only by those who are reckless or igno- rant of consequences. The test of a sparkling wine is to leave it uncorked. If it be vapid after twenty-four hours, it is bad, and it is good in direct ratio to the length of time it retains its sparkle and aroma. That which roughens the teeth should never be again tasted ; it is made of cider and rhubarb stalks; the roughness is from the malic acid it contains. All these five classes of wine prudence will reserve for festive purposes and occasions; the wise man who wishes to enjoy life, will make them always exceptional, for as idlers have no holidays, so perpetual feasters miss all the pleasures of variety ; but I am ON THE CHOICE OF FOOD. 77 quite sure that the not infrequent manufacture of occasions for domestic rejoicing, a birthday, a wedding anniversary, a harvest home, a horse sold, the planting of a tree, the calving of a cow, a daughter presented at court, or cutting her first tooth, or any other good stroke -of business, is a great promoter, not only of love and happiness, but of personal health. Let the beverages which celebrate the occasion be chosen for their peculiar and exceptional flavors. If they are good of their class, the moderate use will not shorten, but both cheer and lengthen life. 6. Perfect wines. By this term are intended such as possess the virtues derived from the presence of alcohol, of water, of sugar, of ethereal flavors, of fruity extractive, and of acids, without any of them being so predominant as to mask the others, or to require artificial additions for the preservation of soundness and flavor. An enormous acreage is devoted to the production of red wines of this character in the department of the Gironde and other places in France of similar climate. We give the nanle of " claret " to the whole of them, which is better than pedantically endeavoring to affix geographical distinctions. One of the merchant-princes of Bordeaux, a statesman of the highest integrity, gave me some years ago a hint which I have found of the greatest service in the diagnosis of wine-dealers. " When," said he, " a tradesman offers you, at anything but the very highest price, our wines with the name of an estate attached to them, he is giving currency to a deception. If he uses the terms of First, Second, and Third Quality clarets, it is so-far-forth an evidence of honesty." The wholesale houses and brokers buy up from farmers, many of whom do not make half-a-dozen hogsheads a year, all but the small quantity which is kept to store as "vintage" wines, vins de luxe, and indeed much that is quite equal in quality to these speculative articles. The produce is mixed under the superin- tendence of cellarers, who at Bordeaux form a sort of hereditary caste, handing down their secrets from father to son, and adding fresh knowledge "Till old experience doth attain *To something of prophetic strain." The mixed wine is classed as premiere, secondc, and troisieme qualite, not from any comparative superiority in wholesomeness, 78 GENERAL DIETETICS. but according to the price it will fetch in the market. Thus, a much better general result is secured than if it were kept separate, as is to a considerable extent done on the Rhine. If an exporter wishes to pass off some of this blended liquid as the production of some special vineyard, he accomplishes his ob- ject very often by adding an artificial scent. If he wants to sell (say) Chateau-Latour, he uses nuts or almonds, or something which smells like them ; if his ambition leads him to aim at Clmteau-Lafitte, he adds a whiff of violets also; if Leoville be his object, violet alone is probably enough. Others seem flavored with cherries. When the wine is originally good, it is not likely that its wholesomeness can be seriously interfered with by this fraud. But the same cannot be said when imperfect wines, not tempered by admixture, or damaged wines, are cured and fortified for ex- port with flavors, and body, and alcohol. The fault of the two former is not so much that they are actively deleterious, which is not known to be the case, 1 as that they hide the nauseousness of an unwholesome article ; and the same might be asserted of the alcohol, if it were inserted in the form of ripe French brandy, but the price of that would diminish the profits too much, and new corn or potato spirit, full of the poisonous oil of grain (amylic ether), is used. Against the adulteration of claret which does not pretend to be anything else than " first," " second," or " third " quality, we have 1 The substances sold by adulterators and druggists for flavoring alcoholic liquors are, according to Dr. Hassall, cocculus indicus, grains of paradise, capsicum, ginger, quassia, wormwood, orris root, carraway and coriander seeds, orange powder, liquorice, honey, sulphuric acid, cream of tartar, alum, carbonate of potash, hartshorn shavings, nux vomica, gentian, chamomilo, tobacco, opium, juniper berries, angelica root, and bitter almonds. The quan- tities used of the active drugs are infinitesimally small, and would be nauseous if employed in noxious doses. In a trade circular headed " Important Infor- mation for Practical Men," Eichler's Keceipts for Liquors teaches how to use also " tincture of green tea," "raisins," "figs," "St. John's bread," " rhat- any," "catechu," "elderberry, cherry and huckleberry juice," "brown sugar," "yeast " and so far we know what we are about. But as much can- not be asserted when we take in hand a mysterious " wine coloring," and still less when the ill-omened name of " body preparation " is given to one of the drugs recommended. (See Keport of State Board of Health of Massachusetts, 1873, p. 167). ON THE CHOICE OF FOOD. 79 the valuable safeguard of the enormous quantity that is made, and the small profits which could be got out of the labor and risk of adulterating it. The commoner Burgundies and the red Rhone wines run our claret very hard in the race for perfection ; they err in containing too much fruity extractive, which, except the wine happens to be very strong in alcohol, causes decomposition. They do not keep well, and must be drunk off directly they are ripe, or they become unwholesome; but it is only just to say that they are much im- proved lately, and there seems little doubt that the scientific ad- vice of M. Pasteur and others is calculated to improve them still further. The cause of un \vholesomeness in Burgundy is usually the re-establishment of fermentation, through the formation of mouldiness in the bottle. To detect the presence of this de- structive action, cork lightly down about two-thirds of a bottle of the wine, shake it well for half a minute or so, and let it stand : if there is any carbonic acid set free, so as to expel the cork too readily, the Burgundy is unwholesome, and it will, if drunk daily, produce feverishness, tension of the eyeballs, throbbing of the arteries, dry furred tongue, and indigestion. The grand, old-fashioned vintage Burgundies, such as Cham- bertin, Clos Vougeot, etc., do not produce these effects, as they are sufficiently alcoholized not to decompose ; but their price and their strength fit them only for holidays. They should be treated like port, and taken in a single glass with some exceptionally prime dish, such as venison or a saddle of four-year-old mutton. The primest Burgundies are those which have a peculiar odor of wall-flowers. Beaujolais was introduced a few years ago from the Macon market by means of some choice specimens, but it has not sus- tained its first reputation. It is apt to turn sour, and at the best has very little bouquet. The Hungarian wines have been lately widely advertised as superior to claret. Some of them have certainly pleasant fruity flavors, but they do not ripen well in the cellar, and are liable to decomposition. They are inferior to the produce of French vineyards at the same price. 7. Rough wines owe their character to the relatively large pro- portion of tannin which they contain. They have usually a bril- 80 GENERAL DIETETICS. liant tint, but are deficient in alcohol ; and their principal use in the trade is to mix with others to impart color and keeping qual- ities. The Vin de Cahors and Roussillon come under this cate- gory ; the latter, being stronger in alcohol than the majority of rough wines, appears in the markets in its own name ; at the mer- chants', and in public houses, as "Burgundy Port." In M. Cyr's table it is stated to contain 16.68 per cent, of absolute alcohol, as against 17.63 per cent, assigned to sherry, and 20 per cent, to port. The ordinary drink of the population in wine countries usually consists of these rough beverages; but, however beneficial they might be, which is questionable, it would be useless to recom- mend them to those who can procure something more palatable. Beer. The only thing to be guarded against in malt liquors is sourness, which needs no comment. Spirits. This is, in every respect, the worst form in which al- cohol can be habitually consumed. To continue to produce the desired effect it is necessary to continuously increase the strength or the frequency of the dose. Almost all the cases in which in- jury to physical health has been traced to alcohol, are in reality due to spirit-drinking. Distilled liquors are by no means to be considered as merely dilutions of their chief ingredient. The products of recent distil- lation are always deeply saturated with the poisonous amylic ether, which the manufacturers call "oil of grain" or "fusel oil." It is not an adulteration, for gladly would the distillers get rid of it, and would pay largely anybody able to teach them how to do so quickly and cheaply. But it is much more injurious to health than any possible adulteration. I had once an idea that this waste product might be made of economical use, as a medicine or otherwise, and gave it to a considerable number of persons in doses of from one to ten drops. The consequences were invaria- bly feverishness and furred-tongue, and often headache and throb- bing of the temples. After cellaring for a year or so, a great part of this poisonous ingredient disappears by decomposition, leaving only peculiar flavors. And a quicker mode of producing the same effect is to let the spirit drip slowly through the air, at the cost, of course, of much loss by evaporation. But new, unmellowed spirit must be ON THE CHOICE OF FOOD. 81 absolutely prohibited even from occasional or medicinal use in the dietary. If "fusel oil" cannot be detected by its peculiar, but not easily described, odor, it may usually be made evident by pouring some boiling water on the spirits or wine, and letting the mixture stand in a small room, or close cupboard, for the night. It is then dif- fused through the air. It may also be discerned in the breath of the consumer. Chemists have not helped us to any quantitative analysis of this obnoxious substance. 10. WATERS. It is only exceptionally fortunate people that have a chance of choosing what water they are supplied with. Still, it is of prac- tical use to know what are the good and the bad features of each sort; especially the bad, in order that, if they are exhibited, the source may be avoided altogether, or the dangers provided against. Distilled water, as it is condensed from steam, is the ideal of per- fect purity. It has not even air in it, and therefore tastes flat and metallic. But it makes capital tea, beer, or any other infusion or decoction. The principal bad feature it can exhibit is derived from its very purity. From the absence of salt, it dissolves and takes up in so- lution any lead it may come across. So that in ships, or any other places supplied by condensing engines, frequent analysis of the water with sulphuretted hydrogen should be made, lest it should be poisoned by the pipes or cisterns. Rain water may be, and often is, equally pure. It is, in fact, as it falls, steam condensed in the great condensing apparatus of the sky. But it is better aerated than distilled water. For cu- linary purposes, for washing, and the like, it is well adapted. But it is apt to pick up dirt on the surfaces where it is collected, and being, like the last, free from salts, also is readily infected by lead. River water is principally rain-water which has been filtered by passing through the surface soil. A new risk, here, has to be guarded against, namely, that of contamination by refuse organic matter in a state of decay, but not yet sufficiently oxidized into harmlessness. The latter object is naturally secured by the mo- 6 82 GENERAL DIETETICS. tion and aeration of a flowing stream, and the greater part of the resultant dirt falls to the bottom, while the chloride of sodium and other salts make the water actually more agreeable and diges- tible. A purified river is the best drinking-water one can have, but unhappily it is not yet quite evident what length of exposure is necessary to secure its purification, and there is the uncomforta- ble feeling that any organic matter may possibly be of a highly poisonous sort. Water from this source should not be drunk un- less it be quite free from taste and smell, either naturally or after filtration ; or unless we can trace to an obviously harmless source any taste or smell we find in it. By "harmless" I mean such an impurity as peat, derived from superficial layers of that substance. This is not only harmless, but positively a security, showing that the water has passed through one of the best natural filters in the world ; and a slight tinge of it is by no means unpleasant. AVater containing sewage to any appreciable extent gives off a fetid smell just before the boiling temperature, and may be easily detected in this way. The boiling temperature renders it safe from germs capable of communicating infectious disease, but it does not make it clean or wholesome. The readiest test of the presence of unoxidized organic matter, is to put a drop of " Condy's patent ozonized water for toilet pur- poses " in a tumbler of water. If the purple-lake hue thus com- municated remains for a quarter of an hour, the liquid is safe ; if it vanishes, there is more organic matter than there should be. The organic matter may indeed be soap-suds, or some equally in- nocent portion of our fated peck of dirt ; but, on the other hand, it may be the germ of typhoid fever or cholera derived from a source painful to contemplate. As wise persons who have to do with strange dogs always caustic a bite, however free from hydro- phobia the animal may appear to be, so it is prudent always to filter river water unless we have tested its absolute purity. Iron is sometimes spoken of as an impurity which is a recom- mendation, rather than otherwise, of a water, because iron is given by us as a tonic. But I cannot agree with that opinion. We do not give iron to healthy persons; for if we did, we should often find what I have observed in some who habitually use iron-stained water, viz., deficient nutrition, dyspepsia, and obstinate anaemia. And when we give iron to the sick, we give it as a drug, and not ON THE CHOICE OF FOOD. 83 as a drink, and only in short courses, and moreover we do not order it to be used in cookery. I should strongly advise iron springs and streams to be avoided. Lakes are perfected rivers. The organic matter has first been oxidized by motion and exposure, and then is deposited by rest. When Londoners see the happiness and saving due to the bring- ing a few feet of Loch Katrine through Glasgow, no wonder that their mouths water for Bala, or some other available lake. Mean- while, the existing companies do their best to imitate lakes, by letting their property rest in raservoirs before distribution. Marshes are, however, in a very different position from lakes. They are not deep enough to allow the organic and mineral mat- ters to be dropped out of the way, and moreover they are filled with decaying weeds and insects. It is an observation due to Hippocrates, that the drinking of marsh water causes enlargement of the spleen, and many observations have decidedly confirmed this evidence of the conveyance of ague poison by drinking-water. Hippocrates remarks also on the unhealthiness of marsh water, arising out of its frequent change of temperature ; it is hot in summer, and icy in winter, thus tending to produce catarrhs. 1 Springs are underground streams. Before the surface drainage which supplies them has got down to their level, it has been most thoroughly filtered of organic matter, so they are clear and bright. Moreover, being kept at a considerable barometric pressure, they hold a good deal of carbonic acid in solution, which renders them sparkling and exhilarating. But the presence of that carbonic acid makes them take up also a good deal of lime, iron, and other mineral constituents of the deep soil. They are " hard," that is to say their lime forms an insoluble compound with soap, curdles it and prevents it cleaning your hands. This is a very good test of the presence of an excess of lime; and another is a deposit tak- ing place in the teakettle after the carbonic acid, which suspends it, is driven off by heat. Hard waters dry up the mucous mem- branes just as they do the skin, arrest digestion, and thus cause gout, gravel, and stone to be prevalent in the districts watered by them. Ordinary hard waters owe their objectionable quality to carbo- 1 Hippocrates, vol. i, p. 532-3, edit. Ktitin. 84 GENERAL DIETETICS. nate of lime made soluble by the presence of carbonic acid, and derived from the chalk in the strata through which they have passed. This is in a great measure cured by the means by which it is detected, as above-mentioned, viz., by boiling. But in cer- tain districts, as for example in the Vale of Belvoir, the hard waters contain sulphate of lime, which is not thrown down by heat. So no boiling will rectify them, and in such districts rain or surface water should be employed for drinking and cooking. Shallow wells have the same virtues and faults as rivers. They are peculiarly liable to be poisoned by the neighborhood of house drains. Deep wells have rather tne characters of springs. The tests of goodness are applicable accordingly. And here, it may be remarked, that the tests mentioned above are merely hints to excite suspicion, selected as readily applicable without the appa- ratus of a laboratory. If a doubt arise, no analysis should be trusted but that of a special analyst, for which full instructions are given by Dr. Parkes 1 and others. The perfections of water are to be 1. Soft. 2. Clean. 3. With air and carbonic acid in it, to make it refreshing. 4. With salt in it, sufficient to make it tasteless, 2 and to prevent its too ready contamination by lead. Mineral waters for dietetic, as distinguished from medicinal, use, should have the same virtues. Manufacturers s"ay that " soda water " is always most popular, if it contains a minimum of soda, that is to say if it is simply good drinking-water aerated. And a very delicate beverage is the fashionable "Apollinaris water," the salts in which are in proportions to render it most soft and velvety to the palate, and not in such quantity as to give it any medicinal action. It is as good for health as the water of Loch Katrine. 1 Practical Hygiene, b. i, chap, i, sect. 5. 2 Tastelessness is sometimes looked upon as an evidence of the purity of water ; but this is not strictly true. Distilled water, of absolute purity, has a decided metallic flavor, which is removed by the addition of salt and air. The probability is that by these additions it is more assimilated to the fluids of the body, and therefore is more digestible, more quickly absorbed. For the same reason unboiled albumen is proverbially tasteless. ON THE CHOICE OF FOOD. 85 Potash and Lithia waters should be used by invalids only. I have heard some parents object to their grown-up sons drink- ing soda water, under the idea that it diminishes their chance of seeing grandchildren around their hearth. I have not been able to trace any such baleful influence. Toast and water (made by pouring boiling water on a burnt biscuit and two or three cloves) is a wholesome drink, for it se- cures the neutralization of all organic matter. Barley water, if well boiled for about a quarter of an hour, is also a good formula for making hard water more digestible. The " pearl barley " of which it is made, should be washed with two waters before using, and about two ounces to the quart is gener- ally found enough to make a drink to quench thirst. Some very thinly shaved lemon rind is the wholesomest flavoring. Those who drink for pleasure lemonade, orangeade, ginger beer, and the like, should always prepare them at home. The small dealers, who brew what is sold, are prone to use the cheaper tar- taric, malic (as found in rhubarb), oxalic, and even mineral acids instead of oranges and lemons. And they employ, as flavors, the amylic ethers, or " fruit essences," most deleterious drugs. Cups of various kinds are wholesome drinks, if not too much fortified with spirituous liquors. Cura9oa should never be al- lowed to enter into their composition ; the peel of a Tangerine orange ground over with a lump of sugar, will give all the flavor without the poison. Borage and cucumber rind are not injurious. Ice, In Dr. Bidder's experiments on the gastric juice, he found that low temperature does not exercise any deleterious in- fluence upon it. When absolutely frozen, it dissolved albumen as well as ever, though it was quite spoiled by heat. 1 Again, the secretion of glands is arrested by feverishness of system, or by local elevation of animal warmth above the normal degree, and, in hot weather or hot rooms, it cannot but be beneficial to the stomach to reduce the unusual temperature to which the over- heated blood has brought it. Ice, therefore, is one of the most generally useful additions to the dietary of both sick and healthy which the energy of modern trade has made; and the ice-box puts 1 Die Verdauungssiifte, Bidder and Schmidt, Experiments ix, 1, 2, x, 1, xi, 1, xvi, xvii. 86 GENERAL DIETETICS. a daily supply within reach of us all. The only time when ice is found injurious is, during the exhaustion and real cooling conse- quent on violent exercise and perspiration. Pond ice, glacier ice, and snow are much inferior to the lake ice with which the Eng- lish market is supplied. They contain foreign and, sonietimas, organic matters, and melt sooner. Ice machines are to be recom- mended as a means of obtaining cold, when the best ice is out of reach. They are so frequently improved, that it is unadvisable to say which is the best at present. ON THE PREPARATION OF FOOD. 87 CHAPTER III. ON THE PREPARATION OF FOOD. THE most important element in cooking is, indubitably, the cook. And the most important of a cook's virtues is shown in the selection of food. A good cook is, to a certain extent, born, not made ; and if born deficient in necessary faculties, the novice should be made to understand that she has mistaken her mission. The necessary faculties are those of accurate taste and smell with which, joined to enthusiasm and punctuality, she may become a useful and honored member of society without which, she is simply an incumbrance. The tests to try her by are plainly cooked eggs, joints, and vegetables. If she regularly sends these up in a state to give a zest to her master's appetite, let him think no trouble or expense wasted in teaching her whatever she desires to learn ; if they excite disgust, harm rather than good is done by her technical knowledge of those disguises of inferiority known as " made dishes." Cleanliness may be taught, a variety of re- ceipts may be bought, but a delicate nose is beyond price. Choose a cook young, choose her carefully, and treat her liberally. It is an old remark that a good cook shows generally a bad temper. There is more truth in it than in most proverbs; for the fact is that in half-educated persons, just indignation is apt to bear the appearance of wrath ; and the needful rebukes to over- reaching tradesmen, and the disappointments which one who loves her work must feel, if her enthusiasm is not appreciated, beget a sharpness of tongue and manner difficult to endure. Nevertheless, it is wise to bear and forbear, and to keep an effi- cient servant when you have got one. This is not a cookery-book, and therefore, of course, the details of the kitchen could not be entered into, even were I equal to the task. It is not the business of these pages to teach how to make food nice, except so far as that quality indirectly bears upon its wholesomeness. All that can be attempted is, to po*int out a few 88 GENERAL DIETETICS. particulars in which the preparation of food bears upon what is known of the physiology of digestion and the economics of nu- trition. And in a future chapter will be discussed the extent to which a physician should interfere with the cook in the adminis- tration of food to his patients, in sickness. No kitchen is complete without an open range. It is impossi- ble to have a properly roasted joint by any other means, as I learned by visiting the private premises of a " Patent Kitchener" manufacturer, and finding there an old-fashioned fire-place in full operation. He cared too much for his diet to employ his own works. Experience has led me to question even the economy of the closed fire in practical working. Roasting is the most perfect mode possible of preparing meat for the table. The heat radiated from the open range coagulates the outer layer, of albumen, and thus the exit of that which is still fluid is prevented, and it becomes solidified very slowly, if at all. The areolar tissue which unites the muscular fibres is con- verted by gradual heat into gelatin, 1 and is retained in the centre of the mass in a form ready for solution. At the same time the fibrin and albumen take on, according to Dr. Mulder, 2 a form more highly oxidized and, .especially in the case of the former, more capable of solution in water. The fat also is melted out of the fat-cells, and is partially combined with the alkali from the serum of the blood. Thus, the external layer of albumen be- comes a sort of box, which keeps together the valuable parts till they shall have undergone the desired changes by slow heat a box, however, permeable by the oxygen of the free surrounding air, so that most of the empyreumatic oils generated by the char- ring of the surface are carried oif. As these are neither agreeable nor wholesome, the loss is a gain. There is also an acrid volatile product, acrolein, produced by the burning of the fat, which is better removed. The first part of roasting should therefore be got through rapidly, by close exposure to a bright hot fire, in an open, well- ventilated kitchen. By this, the gravy is retained in the meat, 1 Not, however, the sarcolemma, which an experiment of Professor Kolli- ker's seems to remove from the class of substances yielding gelatin. See Kolliker's Mikj-os. Anat. , vol. ii, p. 250. 2 Quoted in Moleschott's Diatetik, p. 450. ON THE PREPARATION OF FOOD. 89 till, at the first incision, it flows out of a reddish color. After the complete coagulation of the albumen on the surface, the joint should be removed a little further off from the fire, so as to roast gradually through. The whole time of roasting depends partly on the weight of the joint, partly on the sort of meat. Brown meats, such as beef, and mutton, and goose, require a quarter of an hour for each pound. Veal and pork, the same, with five or six minutes added at the end to make sure of absence of red. White-fleshed birds take somewhat less ; for example, a turkey of 8| Ibs. (according to M. Gouffe) only an hour and three quarters, a capon of 4 Ibs. fifty minutes, a fowl of 3 Ibs. half an hour, a pheasant thirty-five minutes, a partridge fifteen minutes. The fire should be thoroughly lighted before commencing, and kept up evenly ; two gills of broth put in the pan, and the larger roasts basted with it five or six times, the smaller three times, during roasting. Before removal from the spit, some thick fleshy part should be pressed with the finger, to ascertain that it is soft. Uncooked parts retain their elasticity. All these times have been calculated on the understanding that there is no draught to lower the temperature between the fire and screen, for, however airy and well-ventilated the kitchen should be, such an irregular distribu- tion of heat is most noxious, and overthrows all calculations for the clue roasting of meat. M. Brillat-Savarin pronounced on est ne rdtisseur ; in this he does not show his usual wisdom, for an eye on the clock will sup- ply the lack of an instinctive knowledge of time. Roasting properly conducted is the most scientific and whole- some, and on that score the most economical mode of dressing meat. Baking naked meat at a high temperature is a feeble imitation ; and the way cooks have of baking first, and then browning the outside, so completely reverses the needful order of the required processes that it may be designated a fraud. Baked meat is ill- flavored and indigestible from the saturation of the substance with empyreuma ; but it is not so when the temperature is mode- rate, and when the materials are further defended from it by a layer of some bad conductor of heat, such as a thick pie-dish, or 90 GENERAL DIETETICS. a crust, or a coat of clay (as practiced by the gipsies). No empy- reuma, or product of charring, is then formed ; and the fat and gravy which ooze out, assist in the cooking. The process goes on even after the dish is taken out of the oven, if it is kept hot by being enveloped in a thick flannel, or placed in one of Silver's Norwegian cooking boxes. The " Cornish pasty " is the most perfect dinner that a laborer, or sportsman, or artist, can have brought to his midday rendezvous. Meat or fish, and potatoes, or anything in short that the taste or purse dictates, are enveloped in a thick solid crust, baked slowly, and then packed in several layers of woollen. The basketful will keep warm for hours, and is the ne plus ultra of outdoor refreshment. Vegetables and fruit demand the same slow treatment. For a large party, apple or gooseberry pie should be baked all night in an old-fashioned red dairy pan. Eggs should not be used, or at any rate very sparingly, in bakes ; for submitted to heat for a long period, their albumen be- comes more and more tough and insoluble. Rapid boiling has, in a minor degree, the same case-hardening effect on the meat as roasting ; but the interior albumen seems, by this process, more hardened and less digestible. In boiling a joint, the heat should be kept up for five or six minutes. Then, it should be cooled down by the addition of three pints of cold water for each gallon of boiling water, and retained at that heat. 1 In boiling fish, the addition of salt to the water, or the use of sea-water, makes the flesh firmer, and retains the flavor in the interior ; but in making stock for souchees, the softer the water the better. Mutton is best boiled in hard water, for the same reason as fish. Slow boiling makes, it is true, a nourishing soup, but converts the muscular fibre into a mass of hard strings, which, eaten or not eaten, are in nine cases out of ten equally wasted. They are to 1 That is to say, reduced with water at 50 from 212 Fahrenheit to 170, or to the extent of 42. The formula in the text is given as a specimen of the best, perhaps the only, mode of directing cooks how to reduce temperature. The female mind abhors meters of all kinds, and degrees Fahrenheit men- tioned in our orders would infallibly entail their rejection, as only fit for hos- pital nurses. Medical men cannot be too cautious to avoid introducing any- thing reputed " chemical " into the kitchen. ON THE PREPARATION OF FOOD. 91 be found in the faeces, exhibiting all the beautiful transverse striae of their original state, quite unaffected by their intestinal journey. The utility of Soups and Broths depends on several circum- stances which modify the advantages accruing from their liquid state. In the first, place, heat seems to have an effect in some degree proportioned to the period of application to albumen, ren- dering it more or less insoluble, at the same time that, to a deli- cate palate, there is a decided loss of flavor. Thus soups and stews which are kept too hot, are wholesome enough during the first few hours, may be digested at a railway refreshment room for some hours after, but on the second or third day give the rash stranger, beguiled into a cheap French dinner, an almost certain diarrhoea. Though finely divided, the minute fragments of mus- cular fibre seem to be, individually, rendered insoluble by con- tinued heat. Then, again, a high temperature, too long continued, extracts from the meat all its gelatin an innutritious material, which en- velops the fragments of fibrin in the stomach, and prevents their being acted upon. And this is all the more likely, when an over- anxious cook tries to make the soup what she calls "good" (that is, strong, stiff, and gluey) for invalids. Again, if the soup is, by straining, made clear and ornamental, a great deal of the most valuable part of it is removed : the bouilli, if not over-boiled, contains the chief constituents wanted as nour- ishment. This subject will be reverted to when discussing cookery for the sick. Soup is rendered more wholesome and nutritious for healthy persons by the addition of vegetables. Thus, the "Administra- tion de 1' Assistance publique" in France, adopted, by the advice of a commission of physiologists and physicians, a formula for the preparation of bouillon embracing this addition. Reduced to ap- proximate English measures the recipe is as follows : "Water, 4 pints. Meat (with bono), ....... 2 Ibs. Carrots, turnips, and other vegetables, ... 6 ozs. Salt, foz. Roast onions, ........ i oz. 1 1 Cyr, De I'Alimcntation, p. 49. 92 GENERAL DIETETICS. It may be safely commended for adoption in " soup-kitchens." Boiling is a form of cookery peculiarly adapted to vegetables. Dr. Paris 1 remarks that it deprives them of a considerable portion of contained air, which is injurious to digestion when in excess. Potatoes should be steamed or boiled in their skins, and not so long as for them to fall to pieces from the breaking of the starch- granules ; when skinned, they ought to retain their shape. On the other hand, the cabbage tribe and carrots can hardly be boiled too long. It is essential that soft water should be employed, and it is the securing this, that makes steaming such an advisable form of boiling, for steam is of course, soft water. Particular care should be taken that vegetables are thoroughly boiled soft all the way through, and dried on a cullender. A certain quantity of oleaginous matter renders vegetables, in which there is much combined water, less massive in the stomach. Thus, roast potatoes are better for the addition of some fresh but- ter, and mashed potatoes for a little cream beaten up with the puree after it has been passed through a sieve; and, again, milky rice pudding does not collect into a lump as plain rice is apt to do. In making the latter dish up for baking, eggs should never be used. Baked white of egg is the most insoluble form of albumen possible. Plain boiled rice should always have a little fresh cold butter mixed up with it. In that way it will serve as an accompaniment of meat at dinner. Stewing has the advantage over dry baking, that there is no charring or formation of empyreumatic gases ; and the heat is not too great. The principal objection to it is that the meat often gets saturated Avith the fat gravy, and is, thus, too rich for some persons. It is, however, not nearly so liable to this objection as Frying. Unless conducted with great skill, this process coats each particle of the food with a medium difficult of penetration by the gastric juice, for it is oily, whereas the secretion of the stomach is watery. Butyric acid and other rancid and empyreumatic educts are formed, and disturb digestion, producing, not rarely, flatulence and heart- burn. The art consists in frying " lightly," as cooks phrase it, 1 Cyclopaedia of Practical Medicine, i, 576. ON THE PREPARATION OF FOOD. 93 that is to say, quickly and evenly, and with constant motion, so that the high heat required does not char any part. For those who do not dislike the flavor of oil, it is a more manageable me- dium than butter, and generally turns out a lighter dish. Good Lucca or Provence oil is also less likely to be sophisticated than bought butter. Hashiny is not to be encouraged. From the two processes that are gone through, the animal fibre is too much hardened to be readily digested. Cold meat is wholesomer, and may be made as palatable with mayonnaise or some such sauce. If it must be done, at least let a water-bath (bain marie) be used. Marinating, that is, baking in vinegar and water with layers of bay-leaves and pepper-corn, is suitable for the more oily kinds of fish. 1 Sroiling imparts a peculiar tenderness to the meat, by the rapid hardening or browning of the surface, preventing the evaporation of the juice. It is, in fact, roasting applied to small portions of meat. Tradition commends it as a suitable cookery for the meat of persons in training; but, perhaps, in no sort of dish does it shine so much as in fish. In the preparation of mixed dishes and in seasoning it should be a general and almost universal rule that the different ingre- dients should be as far as possible cooked separately. The reason is obvious, each article, from its texture, requires, for its perfec- tion, to be submitted to heat for a different period. Too long ex- posure destroys its flavor and solubility. To take familiar exam- ples, an egg if made into a custard, or just coagulated, is tasty and wholesome ; but if baked for half an hour in a pudding it becomes useless as an article of food. Spices lose nearly all their flavor, whije retaining all their irritating qualities, if mixed in a dish before boiling; yet if heated up separately and for a shorter time, they retain it, and will suffice in much smaller quantity. Soup, on the other hand, requires less boiling than the vegetables which are usually put in it. If boiled together, the latter are therefore sure to be underdone. If baked in a tartlet, jam loses 1 Another mode of wholesomely cooking oily fish, such as sprats, pilchards, or herrings, is to stew or bake them in a deep dish in layers, with a layer of breadcrumbs between each. 94 GENERAL DIETETICS. all fruity odor and taste, and sinks into the paste. It should be only barely heated after the paste is done. Just warm an oyster, it is sapid and digestible ; bake it in a beef-steak pie, it is leathery and insoluble. It ought to be put in cold, just before the dish comes to table. Onions require long cooking; but the other seasoning herbs usually used in broths should not be sprinkled in till a late stage of the boiling. The effects of salting are often misunderstood. It is well known that living exclusively on salted meat produces scurvy ; and it is imagined that the injury to the system arises from the saline mat- ter thus introduced into it. Such, however, is not the case. Chlo- ride of sodium is such a large constituent of our blood that it can- not possibly be noxious. The unwholesomeness of salt meat, as an article of diet, depends on its deficiencies, not on its excesses : it has lost, according to Baron Liebig's calculation, half its nutri- tive value by the removal of its fluids and salts by the brine ; and the dried-up remnant is difficult of solution. Soaking in water may soften and remove the salt, but it does not restore its nutritive value. Smoking and Drying are not quite so injurious to the texture of the flesh as salting. It would seem that in the latter the hard- ening process goes on continuously ; in fact, the salt remains and continuously extracts the aqueous constituents. But the drying takes place once for all, and the article gets no worse when it is once prepared, until decomposition occurs. These modes of prep- aration seem peculiarly adapted for fish, which naturally perish so readily, and which are more injured than even meat by salting. Tinned meat cannot make any claim to a recommendation ex- cept on economical grounds. When heated up for the table it is too much cooked to be digestible or pleasant. It is best eaten cold, with some of its own jelly, and salad or mayonnaise sauce. The process of "tinning" meat is well known to consist in the expulsion of air from the material by means of heat ; and it is to be feared that so long as this procedure alone is employed, the injury from the excess of temperature is unavoidable. The aim of the inventor should be, to effect the same object by the aid of air-pumps in the cold. Ice seems to promise more favorable results than the last-named device, for preserving meat during its conveyance over long dis- ON THE PREPARATION OF FOOD. 95 tances from the overstocked producer to the hungry consumer. The attempt lias hitherto failed from several avoidable causes ; but the Committee of the Society of Arts, who have taken up the matter, are sanguine of final success in putting the Australian fresh meat butcher in direct communication with the English laborer. It should be remembered that meat which has been thus preserved requires immediate cooking, as it quickly goes bad from the change into a higher temperature of air. It should, if possi- ble, be brought home in an ice-box, and kept there till wanted. Vegetables preserved by drying undergo an interstitial harden- ing of the tissues which renders them insoluble in the saliva, as may be observed by their want of flavor. They are inferior to fresh vegetables for use in preventing scurvy indeed they seem inferior to lime-juice for that purpose so that they cannot be wholesome for the healthy. It is a fact, not explained as yet, that long transport, especially by sea, however rapid, has a some- what similar deleterious effect on vegetables ; so that we do not get the advantage which might have been anticipated from the increased rapidity of communication with distant supplies. A notable instance is that of Algerian peas. The preservation of food by excluding the air by means of oil is a subject which requires further experimenting upon. Delicate fish, such as sardines for example, can be kept in this way for a long time; and from time immemorial the method has been adopted for wine in Italy. A thin layer of fresh oil in the neck of the flask obviates the necessity of a cork in wine not intended to travel, and is much more efficient, preventing even the lightest and most perishable liquors from turning sour. Potted meats and sausages are often judiciously preserved by a layer of lard, which seems effectual in retaining moisture and preventing decomposi- tion. Why do we not apply the same principle to the storing of jams, gooseberries, plums, etc., for winter use? Preservation with sugar has the disadvantage of introducing- an ingredient which is cloying to the appetite, a mask to the natural flavor of the vegetable, and, moreover, apt to generate an excess of acid in the stomach. As a rule, forced vegetables, and fruit out of season, are not to be recommended. The natural period of its perfection is long enough for us to enjoy each ; and, then, a change is as wholesome 96 GENERAL DIETETICS. as it is pleasant. To bring them to table sooner gratifies merely a vulgar ostentation or impatient gluttony, and receives its just punishment in a premature weariness. Certain articles of diet yield their savors best when their valu- able ingredients are got out in the form of an Extract. An illus- tration of this may be found in the Guatemala mode of preparing Coffee and Chocolate* which is as follows : " Coffee berries are used that have been stored dry one year. Taking enough for one or two days' consumption, they rub them in a linen cloth, and lay them in the sun before roasting. This operation is always performed by the lady of the house, over a quick charcoal fire, in an iron cylinder, which she keeps turning for ten or fifteen minutes, till the berries are roasted on all sides. The most esteemed bean is the ' peaberry ' (which bears the round mono- cotyledonous form, instead of the dicotyledonous), in consequence of its browning more evenly. It is not a different species of coffee, but an accidental variety, more common on some trees than others. At the critical moment of perfection, the berries are emptied into a basket and stirred round to prevent their further concoction. They are then ground, and a very strong liquid extract is made from them by infusion in hot water. A common percolating coffee-pot will serve this purpose, and save straining. A dessert- spoonful of this essence, with either boiling water or boiling milk poured on it, forms a cup which is the invariable bonne bouche of every meal. "Cacao trees grow wild, and are also cultivated round some Indian villages ; the berries are dried in the sun ; and an Indian woman generally comes to your hacienda to make them into choc- olate. Kneeling before her mill, consisting of a smooth curved surface with a heavy stone roller, she grinds the kernels up with an equal weight of sugar, and flavors with cinnamon or vanilla, the latter a wild product of the forest. It is ground three times over, and, when in a smooth paste, is cut into oblong square pieces, each enough for one cup. It is then dried on a plate over a char- coal fire. When required for use, it is dissolved in boiling water or milk, and a thick froth worked on the top of each cup with a 1 Dictated by Mrs. Osbert Salvin. ON THE PREPARATION OF FOOD. 97 swizzle-stick or whisk. The cup is often filled up with milk- cheese, cut into small dies." A principle of rational cookery, much overlooked by professors of the culinary art, is that each article of diet should be so pre- pared that its own natural flavors and other characteristics should be enhanced, instead of being masked or destroyed. Condiments and sauces should be so moderately used, as never to be a promi- nent feature ; and then, should be so blended and balanced, as to make it difficult to identify them. There seems to me nothing Utopian in the idea of a universal sauce, adapted to all sorts of animal food, making them all more savory and more wholesome at the same time. 1 There is ample scope for individual taste in the selection of the variety suited to the user's palate. One is almost ashamed to mention cleanliness as an essential in cookery, the idea of the contrary condition in eatables is so re- pulsive ; but cooks do not seem aware how often their dishes are unpalatable, and, therefore, unwholesome, solely from being pre- pared in a vessel which has a disagreeable flavor remaining in it. Soap is sometimes employed in washing pots, instead of soda ; and the taste of the rank train-oil seems to adhere to the metal, and to infect a succession of otherwise excellent material ; and so adheres the odor of onions, and of several other condiments, to a steel knife. The use of printed paper to stand glass and crock- ery upon, in cupboards, is also objectionable, as the oily effluvium from fresh printing-ink is very rank, and acrid, and penetrating, as our patients who suffer from hemorrhoids well know to their cost. Fish is an article very often spoilt by injudicious endeavors to make it palatable. "Melted butter," in reality, requires the hand of a first-rate artist, whereas every kitchen maid thinks she can concoct it. Unless M. Gouffe's instructions have been followed to the letter, it is best avoided altogether. A few drops of Chili vinegar, or black pepper vinegar, or elder vinegar, or Worcester 1 This is an old ambition, see Pepys's Diary, February, 10, 1661-9. Tbe Duke of York " did mightily magnify bis sauce, which he did then eat with everything, and said it was the best universal sauce in the world, it being taught him by the Spanish ambassador; made of some parsley and a dry toast, beat in a mortar together with vinegar, salt, and a little pepper; he eats it with flesh, or fowl, or fish. . . . By and by did taste it, and liked it mightily." 7 98 GENERAL DIETETICS. sauce, or a slice of lemon, or a sauce made by boiling pepper and salt in plain water with a few favorite herbs, assist the digestion of the fish, whereas greasy sauces impede the process, chemically and mechanically. Grilling does for fish that which roasting or boiling does for meat, and is a commendable mode of preparation, especially as it obviates the temptation to take sauce. Those professional lectures are usually the most instructive which take up some universally known and simple matter relat- ing to a subject, and use it in illustration of the principles in- volved in the art to be taught. To exemplify the elements of sanatory cookery, perhaps nothing could be more fitly chosen by a lecturer than the cooking of an egg. First, for the name our great-grandmothers (if proverb register language truly) talked of " roasting " an egg : we call the same process " boiling," marking the fact that there is no essential difference between the two, the end of both being the same, namely, the bringing albumen into a mechanical condition more suitable for the digestive viscera than when raw. Then, an egg, more clearly than any other meat, ex- hibits the virtues of freshness, and the vices of defects in that quality. Boil an egg warm from the nest, and you recognize it by its creamy, lightly coagulated, eminently digestible form of albumen. Even by next day it is less perfect, and steadily de- generates in value, till it becomes the most hateful of poisons. Here, may be pointed out, the importance of selection according to external obvious qualities. Next, should come a scientific picture of the coagulation of al- bumen by heat. Albumen begins to coagulate at 140 01 very slowly, but does not form a solid mass with rapidity under the temperature of nearly 212. Till it has formed a solid mass it is easily permeable by heat, and the central parts are solidified, therefore, equally with the exterior; whereas, coagulated albumen is a bad conductor of high temperature; and if the outside sets quickly and firmly, the inside remains light and semi-solid. Boil an egg at a slow heat, and it is not cooked till hard all through ; put it into quite boiling water, and the white sets soon, and leaves the albumen of the yolk soft. This illustrates the rules given a 1 Simon's Chemistry (Day's translation), vol. i, p. 16. ON THE PREPARATION OF FOOD. 99 few pages back, about applying at first a high heat in roasting and boiling, and afterwards moderating it, when the hardened surface lias inclosed the deeper parts as in a box. The shell of the egg may be a text to demonstrate, how in baking and frying, the ex- ternal media, the crust and the oil, retain the whole of the sub- stance, so that there is no loss during these economical culinary operations, though the meat is less wholesome. Then, that this loss of wholesomeness is due to the saturation of the article of diet with the products of dry distillation, and, also, that enhancement of natural savor, solubility, and whole- someness run in parallel lines, may be illustrated from the obser- vations of Beaumont on the different times occupied in the gastric digestion of eggs in several conditions. He found, for example, Hours. Minutes. Eggs, whipped and diluted, occupied in digestion, . 1 30 fresh raw fresh roasted soft boiled (or poached) hard boiled fried 2 2 15 3 3 30 3 30 It may be observed that this is just the order in which they are tasty ; that is to say, the degree in which they come with facility into contact with the sensory nerves distributed through the mu- cous membrane ; so that pleasure and duty here, as usually in natural operations, become one. General rules for the preservation of food are somewhat decep- tive. They lead to their being too much practiced for the display of the pride of ingenuity. The fact is that food is always the worse for storing in respect of its wholesomeness, even if its taste is not injuriously affected. But economical reasons exist for the restricted exercise of this art. The principle consists in excluding the evil oxidizing influ- ences of air and moisture. In dry goods this is done by keeping them dry and warm and closely covered up. Starch, rice, tapioca, sago, macaroni, vermicelli, sugar, sweetmeats, jams, salt, and dried and salted meats, tea, coffee, etc., require this treatment. And they should be kept in a different cupboard from odorous goods, such as candles and soap, or they will catch the objectionable flavor. But with most fresh organic substances a different treat- 100 GENERAL DIETETICS. ment is necessary to the attainment of the same end. They con- tain in their texture itself sufficient moisture and air to oxidize them into decomposition, and the more stagnant these are the more surely do the chemical actions result. It is necessary, therefore, to let them have free ventilation ; their external surface should be frequently wiped, or at least blown over by a current of air, so as to let the old moisture escape and fresh be absorbed. Thus, meat should hang exposed in an open larder, and be often dried. Lemons should be purchased in the summer and sus- pended in nets for use at the time when they are dear. Onions and garlic should be strung up in an outhouse (not the larder). Parsley, thyme, mint, and other herbs should be dried in the wind, out of the sun, put each into a separate paper bag, and hung up in the kitchen. Where apples and pears and chestnuts are stored, the window should be left open, and the fruit fre- quently turned. Too much draught makes vegetables withy; so they should be laid on a stone floor behind the door. Potatoes are best stacked in dry sand. The date when each article is stored should be written down. Eggs are an exception to the usual rule respecting organic sub- stances. They cannot be treated in the same way by reason of their structure, yet it is impossible to avoid keeping them for culi- nary purposes. They are best preserved by being washed over with a solution of gum and packed in a square box of bran, which is to be turned over a quarter of a turn every day. ON DIGESTION. 101 CHAPTER IV. ON DIGESTION. THE most recent systematic teacher of physiology defines diges- tion as " the process by which food is reduced to a form in which it can be absorbed by the intestines and taken up by the blood- vi-sels." 1 The process consists in the aliments being passed along a canal, thence called the " alimentary canal," running through the body, where it comes in contact with fluids oozing out from various glands, which mixing with it dissolve it, and reduce it to a homogeneous juice or "chyme." The more perfectly and quickly this end is attained, the more healthy is the digestion. These fluids resemble one another in being watery, saline, and albuminous, like the serum of the blood, so that they are well adapted for passing readily through the mucous membranes by endosmose. They pass in, as they passed out, freely, and carry in with them the nutriment prepared in the alimentary canal. But there the resemblance ceases; and the differences of the fluids poured from the different glands are very marked, and their ac- tions on the various constituents of the diet are strikingly special- ized . 1. The saliva, secreted from the glands of the mouth, is alka- line, glairy, and adhesive, and possesses the power of converting very rapidly the unabsorbable starch into soluble and absorbable sugar. 2. The gastric juice, secreted in the thin layer of gland which lines the cavity of the stomach, is acid, and can dissolve, so long as it is acid, the solid albumen and fibrin of flesh food. 1 Dalton's Human Phyisology, fifth edit. chap, vi., whore will be found a complete rSxumi of the scattered contributions of others up to the present time, often illustrated and criticized by the light of the author's original in- vestigations on this subject. An old rfsumt of mine, entitled Digestion and its Derangements (London, 1856), is out of date, as well as out of print. 102 GENERAL DIETETICS. 3. The pancreatic juice is again alkaline, 1 very full of albumi- nous organic matter, and capable of exerting a peculiar influence on fatty matters. It disintegrates them, and reduces them to a state of emulsion, so that the mixture of fat in the watery fluid it floats in, is white and opaque. In this creamy state, it is capable of soaking through the mucous membrane and passing into the blood, by the same way as the starch and fibrin. 4. The bile is very different from any of the above fluids in chemical reaction and contents, and it does not appear to possess the power of dissolving starch by turning it into sugar, or of dis- solving fibrin, or of emulsioning fat in any degree equal to pan- creatic juice, though it is itself of a soapy nature, as is shown by the commercial use of ox-bile by carpet cleaners to remove grease- spots. It is neither acid nor alkaline,. but it possesses considera- ble bleaching powers, and, also, arrests decomposition in animal substances. In this latter capacity, it is highly conducive to our comfort by obviating that intolerable odor which distinguishes the excretions of patients in whom the bile is deficient. But, with all this, it does not clearly appear how any of its known physical properties can aid in the constructive assimilation of nutriment. Yet aid it does, most decidedly. If, in consequence of accident or disease, the flow of bile into the alimentary canal is wholly cut off, the animal rapidly emaciates, and dies starved. Even when the supply of bile is only partially diminished, as in the instance of some of our patients, there is a marked deficiency of nutrition, shown in loss of weight and anaemia. Now, this would not hap- pen if bile were a mere excrementitious fluid containing ingredi- ents resulting from the disintegration of the tissues, and designed merely for their removal from the body. It has assimilative functions to perform beyond the simple drainage of the blood, though what those functions are can be expressed only in the vaguest terms at present, and the most prudent and most recent physiologists decline to give a definite opinion on the uses of the bile. 5. The intestinal juice is secreted alkaline, and possesses the power, like the saliva, of converting starch into sugar; but, unlike 1 Dr. Dobell questions its alkalinity. Perhaps it varies with the state of the body. ON DIGESTION. 103 that fluid, does not lose its power in presence of an acid. It, also, has a certain solvent power over albumen, inferior, indeed, to that of the stomach, but stronger in this respect, that it is not checked by the bile or pancreatic juice. Thus, we see that a meal, as it passes downwards, is irrigated first by a watery fluid which, as it dilutes and adds to its bulk, dissolves or fits for absorption a great portion of its starchy con- stituents. Then, it is further irrigated by a still more dilute fluid, which dissolves its meaty part. Then, the fat is washed out of it by the stream of pancreatic juice. And, simultaneously, the bile is poured on it in a continuous stream, which makes it, in some unexplained way, more easy to be taken up as nutriment. After- wards, the intestinal juice, oozing out in small quantities through- out a long canal, seems fitted to make up the deficiencies of any of the previous solvent acts. The daily quantities of these fluids, as estimated, mainly, from the results of Drs. Bidder and Schmidt's experiments, may be reckoned, at least, to equal the following : Of saliva, ......... 3| pints, Of gastric juice, 12 pint-, Ot bile, 3} pints, Of pancreatic juice, ....... 1 pints, Of intestinal juice, ....... pint, making in all nearly three gallons. Of this, ninety-six per cent, is water, of which only so much passes away in the stools as pre- vents them from being inconveniently solid. The rest, therefore, that is to say two gallons and a half, is restored to the blood by absorption. " The clearest notion we can gain of the business performed by all this two dozen pints of water which exude on the nuii-ons membrane of the intestinal canal, and are by the same membrane taken up again, is by viewing them as a circulation. It is con- stantly going its rounds like an endless chain, finding and taking up inside the solid structure of the body substances which ought to corne out and be got rid of, finding outside nutriment which the body wants, and conveying it in. "Truly, when a man contemplates with the eye of the reason this unceasing journey, this great current so entirely 'removed from the cognizance of our senses, he is at first confounded with the 104 GENERAL DIETETICS. novelty of the ideas it excites (ingenti motu stupefactus aquarum) and almost refuses to receive them. It is highly important, there- fore, to bring it frequently before the mind till it becomes habitual, for there is no view of living phenomena so practically weighty for the medical man." 1 In addition to this, there is a quantity of fluid introduced as beverage. Water passes straight through the mucous membranes unchanged, and alcohol, with a change of no weighty importance; and dissolved in them are numerous minor substances not strictly dietetic, though valuable by acting pleasurably or medicinally on the nervous system. Rightly, then, has digestion been likened by an old chemist to a process of " rinsing ;" 2 all that is required is washed out of the alimentary substances, and the remains passed on to be got rid of along with the waste products of chemical life. Of the reason why these various secretions are able to digest the various constituents of our food, we know absolutely nothing. We find an albuminous matter in saliva, and we call it " ptyalin ;" we find an albuminous matter in gastric juice, and we call it "pepsin;" we find an albuminous matter in the pancreatic juice and we call it " panereatin ;" but the only distinguishing point about each is that it acts upon starch, or acts upon flesh-meat, or acts upon fat, just as the fluid from whence it was concentrated acts. Ultimate chemical analysis merely shows their resemblances, and not their differences. The nearest approach to a similar proceeding in nature is the operation of malting, where, aided by heat and mois- ture, starch is turned into sugar by the presence of "diastase;" and it is remarkable enough that when albumen is artificially dis- solved by gastric juice in the laboratory, a peculiar odor some- what like that of malting is given off. But here our information ceases; there are no more points in diastase, to distinguish it chemically from ordinary albumen, than there are in pepsin or panereatin. In bringing to bear upon dietetics the observations of physiolo- gists, the main things the physician has to consider are the mechan- ical condition in which the food should be brought, the influence 1 Digestion and its Derangements, p. 31. 2 Letheby On Food, p. 48. ON DIGESTION. 105 of its several solvents, and the times when they are ready to re- ceive it. Chewing is the first provision made for securing a due mechan- ical condition. The perfection consists in so breaking up the mouthful that it should be as completely as possible permeated by the saliva. The object of this is, in the case of meat, to soften it in preparation for swallowing and for future solution in the stom- ach ; in the case of starchy matter, to convert it into "glucose" or sugar. "With regard to the amount of chewing required by flesh food, there is a good deal of popular misconception. Persons with bad, false, or tender teeth are often found to fancy that a vegetable diet is more suited to their imperfect power of mastication than an ani- mal one ; and we not unfrequently see mothers instructing their children carefully to chew meat, and neglecting the same precau- tion in respect of vegetables. Physiology teaches an opposite caution. It is desirable, indeed, that the jaws should break up muscular fibre, lest it should perchance stick in the gullet, and be certainly difficult of penetration by the gastric juice in the stom- ach ; but to a vegetable aliment the performance is owing of more important functions. It is still more indispensable that it should be broken up, for it has to be immediately acted upon ; and it is indispensable also that it should be detained in the mouth till enough saliva to convert its starch into glucose has been secreted. Complete mastication, therefore, important for both, is still more important for vegetable than for animal food ; and the leisurely performance of the operation cannot be prudently omitted by a mixed eater. It may serve to remind us of this, to reflect that while lions and tigers and wild dogs bolt their food, cows not only spend the greater part of the day over their nibbled meals, but give it a second chewing when in repose. Doubts have been thrown (Dalton's Human Physiology, page 116) upon the importance of the action in the mouth to the con- version of starch into sugar; but the following easy experiment seems sufficiently convincing. Take some boiled starch, say in the shape of arrowroot, and heat it with potassio-tartrate of copper. There is no change in the blue color of the salt. Now, put some in the mouth, and hold it a few moments only. When it is again 106 GENERAL DIETETICS. heated with potassio-tartrate of copper, the metal is precipitated, and shows by its brilliant yellow color an abundant quantity of sugar. The saliva r then, begins to convert starch into sugar immedi- ately ; and it is not slow to extend its operation to the whole mass submitted to it. A protraction of the foregoing experiment will show this. A mouthful of boiled arrowroot held in a healthy mouth for five minutes, will show r afterwards scarce a trace of starch remaining. But it is true that the morsel is hardly ever allowed to remain in the mouth long enough for its complete conversion ; hardly ever is it sufficiently boiled and chewed for the saliva to affect the whole of it. Much free starch and free saliva must be carried down the resophagus. During its passage the action goes on, and, doubtless, as much saccharine transformation takes place in the latter as in the former locality. But in a minute or two it must arrive at the stomach, and there the acidity of the viscus is said to put a stop to the saccharization. On this arrest of the salivary action by the presence of acid,. Dr. Dalton's opinion of its slight Influence in digestive solution is grounded. Nevertheless, once that the mass has passed through the pylorus, its acidity is neu- tralized, the action of the remaining saliva recommences on the starch yet unconverted, and this action is reinforced by the intes- tinal juice. By the unconverted starch, I mean not only that which was unchanged on arriving at the stomach, but also a good deal set free since that stage of digestion. For, besides the saliva, there practically comes into play in the solution of starch that which I have described as temporarily arresting it, to wit, the gastric juice. Cookery, even when most efficient, rarely ruptures the whole of the granules. Many escape in the best, and in bad cookery the majority escape. They cannot, therefore, be affected by the saliva, till their albuminous envelope has been dissolved by the gastric juice. Then, the amylaceous matter may be converted into sugar, either, rapidly, by the saliva present, or, more slowly, by the pancreatic and other intestinal secretions. For the reduction of starch, therefore, so as to bring vegetable food into a condition capable of easy digestion, the first point is that the salivary glands should secrete a sufficiency of fluid; and ON DIGESTION. 107 this not merely at the time of mastication, but that they should go on supplying it as long as any starch remains unconverted. Then, it appears extremely probable that the gastric glands aid the future carrying on of the process, though the acidity of the stomach pre- vent its continuance at the time of its prevalence. Now, the salivary glands in the healthiest persons are liable to derangement from purely external circumstances acting on the nervous system. Temporary emotion affects them temporarily, and chronic emotions affects them chronically. We all are famil- iar with the dry lips of the coward, the lover, the pitiful, and how the tongue cleaves to thereof of the mouth when pain is endured, or when bad news is brought. "Bread eaten in sorrow" can hardly be swallowed, so long it takes to moisten the morsel. Again, bodily exertion parches the throat. It cannot be expected that meals of mixed food, swallowed when the body is under the influence of the circumstances quoted in illustration, should be dissolved, or nourish the tissues as they ought, And there is nothing surprising in the fermentation of the undigested vegeta- bles, and the formation of flatulence by the carbonic acid which results. Under the same circumstances, a portion of the solid meat re- mains undissolved, and is often thrown away unaltered by vom- iting or diarrhoea; for the stomach is influenced contemporane- ously with the mouth, as is clearly shown by the proverbial loss of appetite from mental causes. It is in this arrest of secretion that the sedative action of alcohol comes in useful. It is an anaesthetic, and prevents the effect of the nervous system upon the alimentary canal from being so deleteri- ous as it has been shown naturally to be. A few teaspoonfuls of good strong wine or dilute spirit will often restore the lost power of taking food, and is an instinctive indulgence, as a protective against the sundry blows inflicted on digestion by the exciting nature of social life in the present regimen of the world. It is possible to imagine a state of society, as among the Pitcairn islanders, for ex- ample, where everybody was apparently the better for taking no alcohol in any form, but even in that instance, the abstinence does not seem to have lengthened life, and it is certain that in Europe, it would shorten it for many of our most active and useful citizens. Equally important is the absorption of the sugar thus formed 108 GENERAL DIETETICS. from the starch. In health, a very great part is absorbed in the mouth and gullet, sometimes all, for chemists have great difficulty in finding it in the stomach, unless it is swallowed in excess. Some of it is probably converted into the lactic acid, which aids the solution of flesh food, and the rest taken up as sugar by the intestines. Still, even in health, a good deal of both starch and sugar escape, and appear in the faeces. But, in the catarrhal state, the mucus which lines the membrane is an almost impermeable impediment to osmosis, from its insolubility in water, and arrests absorption in proportion to its quantity. All mucus is a degree of disease and every Briton knows how easily it is formed by very slight external influences. It is clear, then, that for the easy digestion of starch the w r hole of the alimentary canal must be in a normal condition, and the nervous system not exhausted by recent excessive use. The Mechanics of Digestion refer to the provision which is made for the food being duly brought into the sphere of action of the solvents described above. First comes Chewing, the importance of which, as a means of saturating the mass with saliva, has been already insisted upon. Here may be mentioned, further, the im- portance of its completeness, for the sake of reducing muscular fibre to a fine pulp, so that it may be quickly infiltrated by the gastric juice on its arrival in the stomach. "In the human subject, the teeth combine the characters of the carnivora and the herbivora. The incisors, four in number in each jaw, have, as in other instances, a cutting edge running from side to side. The canines, which are situated immediately behind the former, are much less prominent and pointed than in the car- nivora, and differ less in form from the incisors on the one hand, and the first molars on the other. The molars again are thick and strong, and have comparatively flat surfaces, like those of the herbivora; but, instead of presenting curvilinear ridges, are covered with more or less conical eminences, like those of the car- nivora. In the human subject, therefore, the teeth are evidently adapted for a mixed diet, consisting of both animal and vegetable food. Mastication is here as perfect as it is in the herbivora, though less prolonged and laborious ; for the vegetable substances used by man, as already remarked, are previously separated, to a great extent, from their impurities, and softened by cooking, so ON DIGESTION. 109 that they do not require for their mastication so extensive and powerful a triturating apparatus. Finally, animal substances are more completely masticated in the human subject than they are in the carnivora, and their digestion is accordingly completed with greater rapidity." ! However much natural selection may have rendered stronger the surviving species of other animals, it has, in the case of the human teeth, proved injurious to the perfection of our race. Artists have, unhappily, taught us to see loveliness in button mouths, bud-like lips, round dimpled chins, tiny pearly teeth, and to recognize aristocracy in hatchet faces. You take up a skull in one of the bone-houses near old fields of battle (say at Hythe, where Pict and Briton, and others besides, grin so grimly at us), and you cannot enough admire the evenness, the firmness, the completeness of the set of half-worn, yet quite sound teeth ; but you are fain to confess that to have a wife, or a son, or a daughter with a prominent square jowl like that, would be a severe trial to your aesthetic feelings. You are incurably perverted by the me- diaeval association of moral purity and intellectual refinement with pitifully weak jawbones ; and a big-mouthed broad-nosed Helen would never have been the mother of your children yet would she have saved you many a dentist's fee. Narrow jaws can hold but few teeth ; if the natural numbers come, some must be ex- tracted, or else they crowd^ together, and decay from pressure; and there is no feature which is so markedly hereditary as narrow jaws ; as the mother is, so is the offspring. When, by the grinding machinery above described, the food has been reduced to a pulp, it is easily embraced by the tubular mus- cles of the pharynx and oesophagus, and passed by their steady, wavelike motion downwards to the stomach ; the passage is opened before it, and its return is prevented by the closing of the tube behind as it goes onwards. The sensibility of the cesophagus is so very slight, that we do not, in ordinary circumstances, feel the morsel going down; but if it is peculiar in shape and nature, we become aware how slowly and steadily it proceeds, and ought to proceed. For during this passage, much of the sugar and solu- ble salts, and the watery part, is taken up by absorption, and if 1 Dalton's Physiology, chap, vi, p. 109. 110 GENERAL DIETETICS. it is hurried by bolting mouthful after mouthful in rapid succession, scant justice is done to the victuals, and a risk of indigestion is incurred. The healthy circulation of saliva in this round is very great ; we have seen lately how many pints are poured out daily in the mouth, and of this but little finds its way to the intestines, the rest being taken up in the resophagus and stomach, principally in the former. So, the importance of not interfering with its due action can be easily understood. Once in the stomach, the mass of food acquires a rotation from the wavelike movement kept up by the peristaltic muscles of the stomach. Their alternate contractions and relaxations press on the mass, much as the undulations of a serpent carry it over the ground only in the latter case the undulating body is free, in the former it is fixed. The surface, being the part subjected to the moving power, moves quicker than the centre, and thus the whole contents of the stomach are rotated as a uniform mass, from left to right, and continually irrigated by the gastric juice along the depending, lower, and larger part of the sac. As it passes the opening of the pylorus at the other end, the narrowing of the sac squeezes out, with a somewhat quicker motion, such portion as is dissolved into creamy chyme, and it oozes on into the duodenum, leaving the still undissolved substances to flow along the shorter and upper curve of the stomach back to the starting-point. Thus, a slow, rotatory movement of the whole mass is sustained till all is dissolved, or, at least, so far reduced in size as to get through the pylorus. The rotation seems to be continued in the intestines, if one may judge fairly of the action of their peristaltic fibres by the move- ments seen, immediately after death, in the intestines of a vigor- ous animal slaughtered for food. And the biliary ducts appear, also, to have a peristaltic action, rolling out gradually and regu- lating the flow of bile into the duodenum. Now, over all these involuntary and unfelt but constant wavelike movements, the nervous system presides ; and they are, without doubt, seriously affected by all that affects the nervous system, notably by mental emotion and bodily exhaustion. The oesophagus is sometimes so paralyzed by a sudden shock during a meal, that it does not close behind the victuals swallowed, and they are thrown up by a sort of regurgitation. Even some hours after a meal, the arrest of the ON DIGESTION. Ill stomach's action by emotion may cause vomiting. And many instances arc on record of a mental emotion so arresting the biliary ducts as to produce jaundice. The late Dr. Macleod, of St. George's Hospital, used to relate a scene which he saw in his own practice : a young lady with distended abdomen was charged with being privately married, and her eyes and skin had got bright yellow before he left the room. And, in the wild times, when people really did get into a passion sometimes, they are stated by bystanders to have often become jaundiced. Few of ns have ever seen an adult in a rage of the old sort, so that we must not ques- tion the accuracy of the statement. Yriicther absorption of the dissolved alimentary substances is affected by similar causes is not clear. I see no reason to suppose that it is, as endosmosis is such a purely physical act, that the nervous system can control it only very indirectly. But, as the supply is cut off, it cannot, of course, be active during the preva- lence of such interferences. The subject of the impediments to digestion arising out of dis- ease of various kinds, is of too great weight to be cited merely as an illustration, and will be considered more fitly in a future part of the volume. Here is the place for a few reflections on the suitability of different articles of food. Aliments may be called digestible when they yield readily all their nutritious particles to the fluids destined for their reduction to chyme. It is clear from what has gone before, that a compara- tive estimate of their digestibility cannot be made merely by reckoning, as Dr. Beaumont did, the duration of their sojourn in the stomach. That well-known physician is familiar to all, from having made a series of observations on a Canadian voyageur who had a permanent opening into his stomach, a healed gunshot wound. This was easily looked into, and the time consumed be- fore the victuals passed out noted. But the results, which are often taken as an infallible guide by the dietician, are not truly in accordance with what general experience teaches us on this matter. For example, salt tripe or pig's trotters, by this theory, take only one third of the time demanded by roast beef, the former dish being dissolved in the stomach in one hour, and the latter requir- ing three, while veal took four hours and a half. Sour-cnmt seemed to be twice as digestible as soup made of beef and vegeta- 112 GENERAL DIETETICS. bles. Mutton was three quarters of an hour longer in digesting than beef, and so on. Green vegetables, again, are hardly at all touched by the gastric juice are we therefore to conclude that they are useless ? surely, the general observation that they are very digestible by a healthy man is more in accordance with fact. I do not lay much stress on the objection to these experiments arising out of individual peculiarity of constitution ; for in fact the subject of observation was a remarkably robust man, little affected by external circumstances, and able to carry on, in spite of the hole in his side, the laborious duty of conducting timber- rafts down the American rapids. In order to give observations like Dr. Beaumont's their full value, they should be corrected by a set of similar tests conducted upon the duodenum and ilia, for which a good opportunity has not yet occurred. Experiments on animals have been made, it is true; and they establish the fact that the intestinal juice is of great importance, and that the pancreas, if not the liver, aids in the solution of food j 1 but the alimentary canal, and the habitual diet, of the lower creatures are so different from ours, that a com- parison of the behavior of different articles of food in their case, affords no practical experience for human dietetics. Something in the way of a comparative estimate might be made by laboratory experiments on the juices removed from the body, separately and mixed. Pending advances in this direction, the following general conclusions are, perhaps, all the rules our knowledge enables us to lay down : The degree of Cohesion has an important influence upon digesti- bility. Tough articles, incapable of being ground up by the teeth, remain unused by the alimentary organs, while fluids and semi- fluids lead the van of digestibles. The tissues of young vegeta- bles and young animals are, for this reason, more digestible than those of old specimens of the same class. And emasculated beasts, having 'softer muscles, are better suited for the table than perfect males. It is desirable also that the post-mortem rigidity, which lasts several days in some animals, should have merged in softness before the meat is cooked. But this object, usually at- 1 See the plates illustrative of Dr. Dalton's experiments, Human Phys., p. 146. ON DIGESTION. 113 tained by hanging in the larder, may be arrived at equally well by immediate cooking, before the rigidity has set in. In warm climates and exceptionally warm weather, the latter course is the preferable of the two. That culinary preparation is the most efficacious, which most breaks up the natural cohesion of the viands. And it may be observed that the force of cohesion acts in all directions ; and it is of no use for a viand to be laterally friable, if it remains in lon- gitudinal strings. Fat interposed between the component parts of food diminishes its digestibility. It is the interstitial layer of fat between the bundles of fibres of beef that makes it less digestible than mutton, and that causes larded meats often to disagree. Dilation favors digestibility. Yet it may be carried too far. Even water will sometimes run through the alimentary canal, carrying on too rapidly the matters dissolved in it. And inert substances, such as w r oody fibre, if mixed up in too great quan- tity with food, dilute it so much that the central parts of the mass do not come at the digestive mucous membrane. Gelatin, proba- bly in the same way, retards the digestion of food if too concen- trated. Too high a temperature retards digestion. It is not merely that the gastric, and presumably the other digestive solvents, are de- composed by heat above that of the body, but the amount of se- cretion and the muscular acts necessary to forward solution are arrested by its local action. This applies principally to starchy foods, which are often taken hotter than at all suits the salivary glands. Meat has time to cool before it gets down to the labora- tory prepared for it in the stomach. The application of these rules to practice is not difficult; but it is obviously impossible to compare articles of diet unless they are of a definite quality; and, therefore, it will be understood that all those spoken of are supposed to be of the very best sort, and dressed in the way best adapted for securing their virtues. Some years ago, I printed what I called a " Ladder of meat- diet for invalids," 1 which I will repeat in a future part of this volume, when we come to consider the regimen of the sick. I 1 The Indigestions, p. 101, 3d edit., Philadelphia, 1870. 8 114 GENERAL DIETETICS. there conclude with roast joint of mutton, which is the "promised land " of the convalescent ; so, that dish may fairly here begin the list, which may form a sort of skeleton framework from its actual or possible position in which may be judged roughly the comparative time which each article is likely to require for its di- gestion. When time and strength have to be economized, or where a full quantity is required for purposes of nutrition, it is wise to adhere to the leading names on the list. Where modera- tion can be calculated upon, and full leisure secured, a healthy man cannot be called imprudent for indulging his appetite for va- riety by descending to the very bottom. Indeed, to do so, within reasonable bounds, contributes to high health ; for it is certain that an important element in making the most of food is variety. It is not enough to supply in proper amount the proximate diet- etic substance; both in our own race and in domestic animals there is risk of a falling off in condition unless different substances of the same class are employed in rotation. The very strongest, perhaps, can bear uniformity without injury, but to the average man or beast it is as finally noxious as it is distasteful. Dr. Parkes suggests that the good effect of variety is probably on primary digestion, improving the appetite and so causing more food to be taken by counteracting the cloying result of sameness. 1 But I think it goes further than that, for few can fail to have no- ticed in their own personal experience, if once the attention be called to it, how often a most indigestible dish, when partaken of as an occasional luxury, has seemed to sit easy on the stomach, and to nourish well though its quantity has been spare. The great art is to give it time and space, and to be moderate. Dr. Parkes makes the further very practical suggestion, that where variety of sort of food is unattainable, variety of cookery, to a certain extent, fulfils the same object. Table of Precedence in Digestibility of some Articles of Animal Food. Sweet-bread, and lamb's trotters. Boiled chicken. Venison. Lightly boiled eggs, new toasted cheese. Roast fowl, turkey, partridge, and pheasant. 1 Parkes, Practical Hygiene, p. 186, 4th edit. ON DIGESTION. 115 Lamb, wild duck. Oysters, periwinkles. Omelette (?), tripe (?). Boiled sole, haddock, skate, trout, perch. Tripe and chitterlings. 1 Koast beef. Boiled beef. Kump steak. Roast veal. Boiled veal, rabbit. Salmon, mackerel, herring, pilchard, sprat. Hard-boiled and fried eggs. Wood pigeon, hare. Tame pigeon, tame duck, goose. Fried fish. Roast and boiled pork. Heart, liver, lights, milt, and kidneys of ox, swine, and sheep. Lobsters, shrimps, prawns. Smoked, dried, salt, and pickled fish. Crab. Ripe old cheese. Caviare. The comparative digestibility of various vegetable dishes is easier to estimate than that of animal food ; it is in a direct ratio to the facility with which they are reducible into a homogeneous mass, by mechanical means, from their natural form. And they are more readily digested if this reduction takes place through chewing in the mouth, rather than by mashing in the kitchen, as they in the first way become permeated more thoroughly by the saliva. If, on the score of defective teeth or other reasons, a pref- erence is given to artificially broken-up vegetables, they should be retained in the mouth longer than is required by the mere prepa- ration for swallowing. The influence of the mind over digestion must not be forgotten. " Bread eaten in sorrow " remains unabsorbed, and it is not with- out reason that, even in the earliest times and among the most barbarous tribes, companionship during meals has always been sought. It is not only painful reflections which disturb the di- gestion ; any concentrated thought is equally injurious, and inju- rious in a close proportion to the intellectual powers of the indi- 1 The " tripe ' as made in America would seem from Dr. Beaumont's ac- count to be more digestible than the rich dish we prepare from it here. 116 GENERAL DIETETICS. vidual. The only people fit to feed alone are those fluttering butterflies whose intellects do not dispose them to concentrate their thoughts, and whose good luck exempts them from the need of trying. And even these instinctively seek society. To the brain-worker and the body-worker, cheerful distraction at meal- times is a rule of imperious necessity, the habitual neglect of which entails chronic disease and the early failure of vital powers as a certain punishment. The adjuncts of family meals should be studiously made as agreeable as possible. A change of clothes, clean hands, and courteous manners, should not be reserved for company, but en- forced as a daily habit. If allowed to be omitted, it becomes a labor instead of a matter of course. Table decking is an elegant art, capable of exhibiting the good sense, as well as the good taste, of the artist, and highly promotive of ease of mind in the company, however small, or however familiar. If flowers are lacking, there are always leaves to be had, and I have seen toad- stools with mosses and lichens so arranged as to form a centre- piece that Cellini must have praised. I do not see why we should not have music and singing at domestic meals, as well as at city feasts. All are not eating at once, and a change of performers might be kept as long as required. The cook, also, should be encouraged to make the dishes which are exposed to the eye as pleasant to look at as possible, not so much by adornment, which is apt to be vulgar, as by concealing all that is untidy and sugges- tive of painful idea. The forms of animals, in fact anything which makes us remember that the food has been a living animal at all, should never be conspicuously displayed, but rather covered with such vegetable garnish as is capable of harmonizing with the character of the dish. Ease of body, as well as of mind, is requisite for complete di- gestion. Muscular exertion should be avoided immediately before and immediately after all substantial meals. The repose previous need not be long ; a nap of forty winks, dressing, and washing, are usually enough to prepare even an exhausted pedestrian or hard rider for a good dinner. The best test of due preparation is a healthy appetite without any feeling of faintness or squeam. The rest after meals requires rather more judgment and self-con- trol. Instinct induces us to take it, but does not tell us to avoid ON DIGESTION. 117 excess. Now, it is certain that to a healthy person excess is very possible. Sleep, for example, after dinner retards digestion, and allows the distended stomach to act injuriously on the circulation of the brain. It is proper only for very aged persons or invalids. I have heard it argued by persons more ready at observing the facts of natural history than at reasoning upon them, or perhaps still readier at finding an excuse for laziness, that dogs and other carnivorous animals naturally betake themselves to sleep after a repast. That is true, but, then, it must be remembered, that in the wild state their chance of a meal comes but seldom; they must take the food when they can get it, and to guard against starvation overload their stomachs. The lethargy which follows is a neces- sity, and there is no evidence that it prolongs their lives. Those breeds of dogs which live most in the company of man, and feed on the mixed and cooked diet of their masters, usually give up the practice of sleeping after meals along with their gluttony, and to all appearance seem to suffer less frequently from indigestion than their cousins at the kennels, who require very careful treat- ment to preserve their health. The best employment after a hearty meal is frivolous conversa- tion, accompanied by such gentle sauntering movements as are encouraged by a well-ventilated drawing-room or garden. Then is the time, also, for those true games where luck and skill are so combined as to have the character of game and not of business. I have ventured so far to go beyond what might seem the limit of a dietician's tether, because it is upon these social considerations that depends the determination of the best times of meals for healthy persons. For the heaviest repasts, those hours should be selected when we can secure to the fullest extent leisure of mind and body, and the opportunity of applying the aids mentioned above as tending to promote them. It is useless to prescribe the times for meals, or even their number, unless with a regard to the disposal of the remainder of the day, whether that is regulated by choice or necessity. The intervals between meals, also, depend on the occupations which fill them up. Sleep retards digestion, and therefore a con- siderably longer period may be allowed to elapse between the last food at night and the first in the morning than is suitable during the day. Violent exercise of mind or body also retards digestion, 118 GENERAL DIETETICS. and therefore, when this is practiced, food is not called for so soon as on a day of rest. I have often observed that, in spite of a late breakfast, a keen appetite often comes on Sundays before one o'clock to lawyers and merchants, who on working days do not care to eat till two or three, nor even then. Whereas, busy medical men whose work is more continuous, though less severe, adopt the early Sunday dinner hour only with reluctance. There can hardly be any exceptions to the rule, that after the night's sleep, and the long fast which has emptied the digestive organs, food should be taken before any of the material business of the day is taken in hand. Work done before breakfast is more tiring, and, with due deference to certain well-meaning enthusiasts for early rising, is not done so well as after the stomach has been fortified with what it must require, if in a healthy state. The hour of rising must, therefore, regulate the hour of breakfast. It is no proof of health or vigor to forego it without inconvenience, nay rather the contrary ; but it is proof of health and vigor to be able to lay in then a solid foundation for the day's labor. The natural appetite for food should be fully and completely appeased ; and if there is a desire for meat, there is no reason for declining it ; indeed, where mental work has to be done, it had better not be omitted. For mere bodily toil, a breakfast merely farinaceous, such as porridge, bread, milk, and butter, is most adapted, to which the usual additions de luxe may be made according to choice. Not more than five hours should elapse before food is again taken. To some persons, from habitual neglect, the appetite does not arrive so soon ; and then if they sit down to an unaccustomed luncheon, they feel stupefied by it, and quote this experience as an evidence that a midday meal is unwholesome for them. The stomach requires a gradual education after it has got into bad habits ; so, beginning with a biscuit and a little milk, the patient should advance in quantity, till he arrives at the amount which is shown to be the proper amount by his sitting down to his sub- sequent dinner hungry and unexhausted. The proper amount varies much in different persons and different circumstances, and the only general description that can be applied to it is " moder- ate." Instead of a light intercalary meal, some families prefer to take ON DIGESTION. 119 a substantial high dinner in the middle of the day. This seems to suit idle people and children, but if hard work has to be re- sumed immediately afterwards, very frequently indigestion is the result. It is the cause of that form of congestive dyspepsia to which the middle classes in Germany are extremely subject, and which drives them instinctively to eliminative mineral waters, like swallows to the South. The best time for an adult's largest meal is when the business of the day is done, say, somewhere between five and eight. If it is taken earlier, there is time to get hungry again before bed-time; and if later, sleep comes too soon on the top of it. For light eaters the later hours, for heavy eaters earlier hours are most suita- ble. It may be observed that the court dinners of the city compa- nies and the merry-makings of Greenwich ichthyophagists, where the guests meet to eat largely, are usually early. It is superfluous for a healthy person, not influenced by any of the peculiar circumstances which will be hereafter considered, to devote special attention to considerations concerning the whole- someness or digestibility of his dinner. He is apt to leave off this and leave off that, under the impression that they have once disagreed with him, till his bill of fare becomes most injuriously restricted. Variety in diet is of essential importance to health, and a succession of several imperfect or even unwholesome kinds of food is better than a monotonous repetition of a perfect aliment. Occasional feasts and occasional fasts constitute the natural mode of life for an intellectual and social animal. This paragraph ap- plies to all meals, but I have inserted it apropos of dinner as being the principal. By variety is implied, not a great number of dishes at once, which is confusing and oppressive, and destructive of the object aimed at, but a frequent (why not daily ?)-difference in the princi- pal dish, to which the few other accessory dishes are harmonized. Some of the most appetizing dinners one has ever eaten have really consisted of one article, novel and unexpected. The famous Mrs. Poyser sagely remarked that a man's stomach likes to be surprised, and no surprise is possible if the same monotonous superfluity is repeated day after day. In the course of the evening a cup of tea seems to give a fresh fillip to digestion, and supplies liquid which is required for solu- 120 GENERAL DIETETICS. tion of the viands. Some persons are afraid of its keeping them awake, and will find a good substitute in extempore lemonade a cup of hot water poured on a slice of lemon, some chips of the rind, and a lump of sugar. But tea of an afternoon is by no means to be recommended. The habit of taking it began as a sort of fashionable whim about a dozen years ago, but spread so far downwards through the middle classes that medical men ought to exert themselves to stop it. If the dinner hour is so late that too long a time interposes between it and luncheon, let the latter be moved onwards, and, if necessary, breakfast also. For the dilution and washing away of the gastric secretion weakens its power of digesting the subsequent dinner, improperly blunts the appetite, and not unfrequently generates flatulence and dyspepsia. A biscuit, and an orange or an ice is a much less injurious indul- gence at the same hour. A man in health ought to be satisfied with three meals a day, and should educate his stomach to take enough at them to supply his requirements. The practice of constantly nibbling at odd times induces a flow of saliva almost continuous, like that of her- bivorous animals, and neutralizes the gastric juice, so that meat is not fully digested. The last meal should be sufficiently late for the whole not to be absorbed before retiring to rest. Going to bed hungry is liable to induce a habit of restlessness at night. If business or pleasure keep you up much longer than usual, it is better to take a light farinaceous supper, which, in this case, induces sleep. This, how- ever, is a very different thing from sleep in a state of repletion, which (as was before observed) disturbs the circulation in the brain, producing painful dreams, unrefreshing rest, and feverish- ness. An average adult may consider that he is taking enough to supply the ordinary requirements of healthy activity, if he eats in twenty-four hours the equivalents of a pound of meat and two pounds of bread. The English soldier, on home service, receives from government f Ib. of meat and 1 Ib. of bread, and he buys about Ib. additional bread and 1 Ib., or so, of other vegetable food. 1 Dr. Parkes calculates that this quantity of nitrogenous ali- 1 Parkes, Practical Hygiene for Medical Officers of the Army, p. 523. ON DIGESTION. 12i merit is somewhat deficient for the maintenance of high vigor, so that I have ventured to add J Ib. of animal food, reducing by a few ounces the supply of vegetables. The nearer a man approximates to this allowance the better, if he has no individual peculiarities of size, temperament, occupa- tion, climate, or state of health to allow for. To all but excep- tional cases, anything beyond this is excess not hurtful necessa- rily, perhaps even beneficial as an occasional change, but still an excess. To continue such excess as a daily habit, puts a person in a position more prone to ill health than he would be natu- rally. To err by defect is equally injurious if persisted in; but it has this advantage, that it oftener obtains a compensation which to a considerable extent rectifies the balance. Thus, the soldier at home, above quoted in illustration, gets frequent little treats, partly out of his own and partly out of others' pockets, which fill up the corners left by the government ration. And, perhaps, the most perfect diet is one just within the limit pro- posed, with an occasional transgression as a change. It is possible, certainly, for a high liver to make an equivalent change by abstinence ; and if he is lucky enough to be ill and go to a doctor, he is perhaps advised to do so ; but I have never yet known one to fast voluntarily as a preservative to health, though he must have often felt the beneficial effects of its being forced upon him. It is forced upon him, sometimes, as a direct conse- quence of the habit of overeating; a surfeit of accumulation comes on, or he brings it on by going a little further than usual, and then nausea and loss of appetite perform the good office of mak- ing a change by cutting off the supplies. Unless relieved in this way, the high liver gets torpid and stupid by day, restless by night, there is a sluggish circulation in the veins from the over- loading of the blood with useless material, there are congestions and engorgements of the internal organs, and dark dirty discolora- ( tions of the skin, thick urine, flying unaccountable pains, neural- gia, rheumatism, gout, obesity. The evils of too great restriction of food will be considered in a future chapter, when we come to the subject of poverty as a modi- fying circumstance in dietetics. 122 GENERAL DIETETICS. CHAPTER V. i NUTRITION. WITH the passage of the liquefied alimentary substances through the mucous membrane lining the tube, digestion, strictly so-called, ends. Anything which afterwards occurs to the incoming matter may more properly be classed w r ith nutrition. Prominent among the needful changes in the material for build- ing up the tissues, stands that which takes place in the liver. The biliary secretion from this organ has been spoken of in the previous chapter as taking a part, though not a leading part, in the solution of fat in water, as staying the too rapid decomposition of albuminous food and excretory matter, and as supplying some of the liquid vehicle in which the aliment is conveyed through the walls of the digestive tube. In all these the liver is subordi- nate, and its place may be readily supplied. But the anaemic de- generation of the blood, the gradual pining emaciation, and ulcer- ation of the tissues, and finally death, which follow its suppression all of w r hich point to some deficiency of assimilative capacity and not merely to the stoppage of an excretion show that it per- forms in the circle of life some special duty which cannot be spared or replaced by another gland. The blood going into the liver is altered before it comes out of the liver much further than is in- volved in the mere formation of bile. During the last thirty years, the changes, necessary to life, wrought on the blood by the liver have engaged a large share of the attention of physiologists. I have been comparing the account which I printed in 1856 1 of what had been done up to that time with those of the present day, and I find a progressive advance tow r ards the light, which seems to promise our sons not only in- teresting, but practical knowledge. It was then established that " a copious amount of sugar is formed in the cells, and is forwarded into the hepatic vein, but not into the bile-ducts," and " that the sugar is formed in consequence of taking food." 2 It has been 1 Digestion and its Derangements, chapter vii. 2 Ib., p. 160. NUTRITION. 123 now ascertained that it is not only an immediate consequence, that the sugar does not pass from the food into the liver, but that the sugar-making in the cells of the gland continues for a long time after the alimentary canal is emptied. It appears, moreover, that the sugar, though more copious even than had been supposed, is a very transitory stage in the circle of chemical changes. It is so momentary that it can be made evident only by an artificial arrest, just as electrical action in the earth, though so vast in its results, touches our senses only through the partial derangement which shows itself in the lightning's flash. But let it not be reckoned as of small moment because of its latency. It is an observation as old as Thucydides, that the in- fluential forces in the world are the most active when most un- noticed ; for, indeed, perturbed crises are usually the results of their disturbance. We may see in diabetes the serious evil of the further conversion of the sugar being interfered with, and of its remaining in the blood only to run off by the urine, and we can hardly doubt that the breach of a previous link in the chain, the formation of sugar, may cause equal discomfort and explain at a future time some obscure morbid states. Those who take delight in the glimmering through the mist of future light, will find much to interest them in Dr. Dalton's sketch of this subject, and the details of the experiments repeated by him- self, with ingenious precautions to avoid error, in the ninth chap- ter of his " Human Physiology." That the spleen and lymphatic glands take also a part in nutri- tion, or blood-making, is pretty clear, but which part is entirely unknown. The defectiveness of our information about the stages and machinery of nutrition does not, however, prevent us from having a clue to a good deal of practical knowledge of the comparative NUTRITIOUSNESS, for different purposes, of different kinds of diet. By nutrition, two ends have to be accomplished, the growth or repair of the body, and the production of motion or force. The first indication is more or less fulfilled in proportion to the quan- tity of digestible nitrogenous material, the latter in proportion to the quantity of digestible carbohydrates which the aliments con- tain. It is very clear that the digestibility must be insisted upon, otherwise we should make serious mistakes in our valuations of 124 GENERAL DIETETICS. food. For instance, according to the well-known table of M. Payen, a pound of chestnuts and a pound of milk contain very nearly the same quantity of nitrogen ; yet, to expect that a baby would grow as well upon one as the other would be criminal folly. When, then, circumstances require us to foster growth, to increase the vigor of the muscles and nerves for short temporary exertions, to replace preternatural wear and tear, meat is valuable in the direct ratio of its solubility in the stomach. When the regular performance of a daily round of moderate exertion alone has to be provided for, carbohydrates in the form of farinaceous and oleag- inous food may with advantage constitute the chief of the diet. So that before giving any general rules for the selection of a diet- ary which will best perform its duties, it will be needful to review the special circumstances for which it is required, which I propose to do in respect of normal conditions in the second part, and in respect of morbid conditions in the third part of this volume. SPECIAL DIETETICS OF HEALTH. CHAPTER I. REGIMEN OF INFANCY AND MOTHERHOOD. IT may be presumed no Englishman doubts that the best food for a new-born infant is a mother's milk. 1 Even deviations from the normal condition of the general system, or of the breast, should not be allowed too readily to deter a mother from suckling, till there is evidence that the secretion is disagreeing with the child. Unless diarrhaaa or thrush occur, it may be taken for granted that proper nutriment is afforded, and if proper nutriment is afforded, we may be sure a woman's health is not affected by the inconve- niences which she may be enduring. I have known a woman, unable to feed herself from severe rheumatic fever, have her child held to her breast and be nour- ished only from thence, without any harm following. And in several instances slight inflammation of the breast has seemed to be benefited by the flow of milk induced by suckling. Indeed, I have once seen a breast with an abscess in it supply healthy nutri- 1 Strange to say the opinion is not universal. Dr. Brouzet (Sur I'^duca- tion Me'dicinale des Enfants, i, p. 165) expresses a wish that the state should interfere and prevent mothers from suckling their children, lest they should communicate disease and vice ! A still more determined pessimist was the famous chemist Van Helmont, who thought life is reduced to its present shortness by our instinctive infantile propensity, and proposed to substitute bread boiled in beer and honey for milk, which he calls " brute's food " (in the chapter " Infantis nutritio ad vitam longam)." 126 SPECIAL DIETETICS OF HEALTH. ment to a child, the mother feeling sure that the abscess did not communicate with the lacteal tubes. I fancy no medical man would sanction a persistence in the latter risk, but still it were to be wished that our accoucheurs would be somewhat less hasty than they generally are in debarring mothers from suckling on slight grounds. A certain injustice is inflicted on the child, and prob- lematical benefit conferred on the parent. During the months of suckling it should be the object of the mother first to provide herself with an appetite, and secondly, to provide herself with proper food. The appetite often fails simply from want of fresh air, especially in those who are used to enjoy it, the remedy for which state of things is sufficiently obvious. Sometimes the disrelish for food is a symptom of the exhaustion induced by the labor, and then small doses of sal volatile or a light bitter, such as gentian, will remove it. Sometimes it is a direct gastric anaemia, arising from going too long without food. The patient should eat directly she begins to feel hungry, and not wait to feel very hungry. But at the same time she should be careful not to overload the stomach ; in fact, though she eats often, she should not eat more than when in ordinary healthy exercise. A great mistake is often made by endeavoring to supply the wants of strength and appetite by an extra supply of wine or malt liquor. The nurse should never take more than she is accustomed to ; if she does, it makes her eat less and digest less, though she does not feel the debility which is the consequence of the innutrition. Beer increases the quantity of the milk, just as it increases the quantity of the urine, but it also renders it thin and watery in the one case as in the other. Indeed less than she is accustomed to is the more rational rule of diet, for the happy peaceful circumstances of her situation usually exempt her from the mental wear and tear, and the exhaustions of the nervous system incidental to social life, which it is the special purpose of alcohol to compensate. The most proper food is cow's milk, fresh and unskimmed. It can be taken at all times, in a great variety of forms, and nobody has ever been known to take too much. If it turns sour, lime- water mixed with it not only corrects its acescence, but also supplies a valuable aid to the growing bones of the infant. In the solid dietary again, milk may fairly be taken as the type of the due INFANCY AND MOTHERHOOD. 127 admixture of alimentary principles, because not individual growth, not the production of force, but the secretion of that very sub- stance is the object of the selection of diet. So that we cannot do better than take the proportions of nitrogenous, carbonaceous, and aqueous constituents of the lacteal secretion as a guide to the pro- portions of these principles in the diet of nursing mothers. Anal- yses of milk are to be found in all physiological works, and if it be reckoned roughly that in food as presented for our consump- tion, there is 50 per cent, of combined water, I think it will be found that the following scale of diet corresponds pretty closely to the proportion of the several constituents there enumerated. Supposing the full diet to consist of three pounds of solid food, that will require six pints extra of uncombined aqueous fluid to make it as fluid as milk. And the three pounds of solid food should consist of 14J oz. of meat, 13 oz. of fat, butter, sugar, 20 oz. of farinaceous food and vegetables, ^ an oz. of salt, lime, etc. Small women and small eaters, especially if they have small children to bring up, will require less; but let the reduction be proportionate in each of the several classes of alimentary sub- stances. And at first from the exhaustion of parturition, from the want of exercise and of fresh air, the appetite turns against meat. Let then milk, especially boiled milk with arrowroot or the like, chicken broth, egg-custards, fill up the deficiency. Only insist that enough is taken. The observations by Dr. Barker, of New York, on this subject are so much to the point that I cannot forbear quoting them. He says, "Give the puerperal woman as good nutritious food as she has an appetite for, and can easily digest and assimilate. You will at first find many nurses who will not accept these views, and they may fail to carry out your directions in this particular; but my experience has been that after a time the intelligent ones become enthusiastic converts to this course. . . . Your patients rest and sleep better, and their functions are established with less dis- turbance than they would be with a spare or insufficient diet. 128 SPECIAL DIETETICS OF HEALTH. Since I have adopted this measure with my puerperal women, am very sure I have much less frequently met with those annoj ing and troublesome nervous phenomena that so commonly folio 1 parturition, as the nervous system is then apt to be in a conditio of exalted susceptibility. The function of lactation is thus ger erally established without that disturbance of the system calle milk fever, formerly so common." 1 It may be noticed that the Professor says nothing about wir and malt liquors. They are conspicuous by their absence in h dietary. And in truth the less a nursing mother takes of thei the better, so that her temper and digestion do not obviously suffi from the restriction. The child should be put to the mother's breast as soon as si wakes from her first sound sleep after its birth. The waiting fc three or four days is an old-fashioned relic of the days of dru ging, when it was considered wrong that the young bowels shoul be relaxed by the colostrum of the first milk, but right that the should be griped with castor-oil. Not to use the first milk wasteful and injurious. The best substitute for it is cow's mil diluted and sweetened as hereinafter described. The education of the infant must begin immediately after birtl In the first place it has to be taught to suck, for which ever monthly nurse has her own device, and will only laugh at an male who should presume to interfere. Next it has to be taugl not to be always sucking, whenever the whim takes it or th mother comes in sight. Regular definite times, the intervals b< tween which are gradually lengthened as the child's strength an growth allow, give a rest both to the stomach of the receiver an the breast of the giver, which conduces to the due digestion of th nourishment. As a general rule the daily allowance of milk r< quired by a healthy infant is on the first day very small indeed on the second day it takes about a quarter of a pint ; on the thir day two-thirds of a pint ; on the fourth or fifth day it will cOr sume a full pint. And this quantity augments gradually till b the sixth month you must not calculate on less than two pinl 1 "The Puerperal Diseases," Clinical Lectures delivered at Bellevue Ho: pital, by Fordyce Barker, M.D., p. 27. INFANCY AND MOTHERHOOD. 129 being wanted. The distribution should be in an inverse ratio to the quantity. During the first two months the child should have the breast eight or nine times daily, if the quantity yielded is small, and six or seven times if it is large. After that a gradual reduction may be begun, which before weaning should have ar- rived at the number of four meals daily, which is the most proper for the digestion of mixed diet. If a mother, with or without reasonable cause, deputes her duties to a wet nurse, she ought thoroughly to understand that the expedient is not without drawbacks. All the best accoucheurs agree that in choosing a woman for the office, observation of the figure, the complexion, the color, the teeth, or even the shape and development of the breasts, and the analysis of their secretion, are all unimportant compared with a knowledge of the regularity of the catamcnia. In this respect, it stands to reason we must take the applicant's own character of herself, a serious temptation to dishonesty. An unmarried woman may not improbably have a concealed constitutional taint which is communicable through the milk, and at the best is an unpleasant inmate in the family. A poor married woman, however respectable, is removed from a starv- ing home to sudden abundance, and invariably overeats herself, and it is fortunate if she does not overdrink herself too. She pines and grows anxious about her own child if it is alive, and insists upon having her troublesome husband to see her openly or secretly, on the pretence (a fallacious one) that his visit increases the flow of milk. Moreover, a rich mother cannot but feel some compunction in purchasing for her own offspring what is stolen from another, who is sometimes seriously affected by the fraud, and retires disgusted from this false world. At all events, a trial ought to be first made, under the snperin^ tendence of a medical man, of fresh cow's milk or goat's milk, and of Swiss condensed milk. Cow's milk should at first be mixed with half its bulk of soft, pure, tepid water, in each pint of which has been suspended a drachm of " sugar of milk " (which is procurable at any chemist's, being used for grinding up powders), and two grains of phosphate of lime finely powdered. If the milk has been partially skimmed, as is often the case in cities, then a good tablespoonful of cream. 9 130 SPECIAL DIETETICS OF HEALTH. should be added to each pint, to make the mixture equal to human. If it has not been skimmed, a couple of teaspoonfuls of cream is sufficient. 1 The advantage of using goat's milk, is that the animal can be brought up to the very nursery, even in cities, and will supply nourishment directly to its little master's lips if called upon. Children do not seem to dislike the peculiar taste. Swiss milk has been already alluded to in the second chapter of the first part (p. 65). No inconvenience has as yet been proved to arise from its use, but, at the same time, no superiority to fresh cow's milk has been confirmed. As it is already sweetened in the preparation, no additional sugar is required, but care must be taken to dilute it sufficiently to make it resemble not ordinary milk, but milk and water. Laputa never devised anything more preposterous than " Lie- big's food for infants." It is composed of malt flour, wheaten flour, bicarbonate of potass, water, and cow's milk, and the fol- lowing is recommended as the simplest mode of cooking it : Take of wheaten flour, oz. Malt flour, oz. Bicarbonate of potass, 1\ grs. "Water, oz. Mix well, and add of cow's milk, 5 oz. Warm the mixture, constantly stirred, over a very slow fire till it gets thick. Then remove the vessel from the fire, stir again for five minutes, put it back on the fire, take it off as soon as it gets thick, and finally let it boil well. Be- fore use, strain through a muslin sieve. The object of all this is to convert the starch of the flour into dextrin and sugar, and to elaborate a product which after all is 1 In the above recipe household measurements are used as the nearest pos- sible approximation to the following formula : Whole cow's milk, 600 parts. Cream, 13 " Sugar of milk, 15 " Phosphate of lime, ....... 1 " Water, 339 " 1000 :(Dict. Encycl. des Sciences Med., art. " Lait," 1868.) INFANCY AND MOTHERHOOD. 131 not nearly so like the natural sustenance as may be made with cow's milk, water, and a little additional sugar of milk. It is needless to say what a number of unnecessary risks are incurred of some one of the numerous articles employed being adulterated, of inaccurate measurement, of dirt, and of careless preparation by tired servants, who, it will be observed, have to keep the fire low for the first part of the process, and then to coal it up, making no small smoke, for the final boil. Sensible parents will be content to leave the recipe for some coming race who may prefer art to nature. It is advisable to nourish the infant directly from the breast; and where this cannot be done, as soon as possible after the milk is drawn. Our senses tell us of a peculiar aroma given off by fresh milk which quickly exhales, and appearances seem to war- rant the conclusion that this contributes to soothe the sensitive nervous system of the suckling, and so assists digestion. The best diet for an infant during the first six months, is milk alone. It is true, man is a tough animal, and can stand with im- punity much rough usage, and therefore a vigorous baby often seems none the worse for a certain quantity of farinaceous food ; but the first appearance of flatulence, gripes, screaming, ill temper, or other ways infants have of complaining of dyspepsia, should make the nurse desist from these attempts to hurry on natural de- velopment. It is only when the coming teeth are on their road to the front J that the parotid glands secrete sufficient saliva to digest farinace- Lous food. When dribbling begins, then is the time to begin with the various preparations of these substances bountifully supplied by nature and art. Till then, anything but milk given to a healthy baby must be tentative, and considered in the light of a means of education to its future dietary, and must not take the place of milk. Among the various means of education, I would select as most generally applicable broth or beef tea, at first pure and then thick- ened with a little tapioca or arrowroot. Chicken soup, made with a little cream and sugar, serves as a change. Baked flour, biscuit powder, and tops and bottoms should all have their turn ; in fact, change is necessary, or the child is apt to get too fond of 132 SPECIAL DIETETICS OF HEALTH. its soup, and to neglect the really essential nutriment of milk, and to wean itself prematurely. The consequences of premature weaning are most disastrous, but insidious. The child continues to present the external aspect of health, its muscles are strong and elastic, but the bones do not grow in equal proportion. It is active and anxious to walk, but the limbs give way and become distorted. If it is ill enough to be taken to a medical man, he calls the condition "rickets," but there are crowds of poor creatures affected in this way whose pa- rents refuse to see that anything is wrong till the malady has gone too far for cure. The suspicion that rickets was due to this cause has long been prevalent in the profession, but it is to M. Jules Guerin that we owe the proof derived from direct experiment. This pathologist found not only that rickety children had almost invariably been prematurely weaned, but that the disease was capa- ble of artificial and intentional induction. He took young puppies and young pigs, specimens respectively of carnivorous and herbiv- orous animals, and he produced a rickety softening of the bones of each by removing them early from the mother, and giving the one set meat and the other set vegetables before the natural period. Professor Trousseau has backed the deductions of M. Guerin with his valuable imprimatur. The time for weaning should be fixed, partly by the almanac, partly by the growth of the teeth. The troubles to which chil- dren are liable at this crisis are usually gastric, such as are induced by hot weather ; so that in summer it should be postponed, and in winter hurried forward. The first group of teeth nine times out often consist of the lower central front teeth, which excite no wonder in any but very young parents by appearing any time during the sixth and seventh month. The mother may then begin to diminish the number of suckling times ; and by a month she can have reduced them to twice a day, so as to be ready when the second group makes its way through the upper front gums to cut off the supply altogether. The third group, the lateral incis- ives and first grinders, usually after the first anniversary of birth, give notice that solid food can be chewed. But I think it is pru- dent to let milk, though not mother's milk, form a considerable portion of the diet till the eye-teeth are cut, which seldom occurs INFANCY AND MOTHERHOOD. . 133 till the eighteenth or twentieth mouth. At this period even very strong children are liable to diarrhoea, convulsions, irritation of the brain, rashes, and febrile catarrhs. In these cases the resump- tion of complete milk diet is advisable, and sometimes a child's life has been saved by its reapplication to the breast. Now these means are the most readily feasible when the patient is accustomed to milk ; indeed, if he be not so, the latter expedient is hardly possible. 134 SPECIAL DIETETICS OF HEALTH. CHAPTER IT. REGIMEN OF CHILDHOOD AND YOUTH. THE diet of childhood requires from its rational guardians as much attention as that of infancy. The passions at this age over- power the instinct, and reason has not yet asserted its throne. Children should have four meals a day, but meat only at one, or at most two ; the latter when only a small portion at once is al- lowed. When in health they should have no wine or beer except as a festive treat, no coffee, strong tea, or other exciting drink. Once-cooked succulent meat without sauces or condiments, eggs, plenty of farinaceous pudding, mealy potatoes, carrots, spinach, French beans, rice, bread, fresh butter, porridge, roast apples, oranges, should form the staple of the nursery commissariat. As to quantity, we may take the full diets of hospitals as fairly representing what should be the minimum proper for those who are not restricted by fortune in the matter of food, and the mean amount upon which a growing child can continue to flourish. For it may be observed that while all extravagance is herein avoided, the food is intended mainly for those who are convalescent from acute disease, and have not only to remain well, but to recover flesh. The following estimates are taken from the published tables of diet. The quantities named are those which may be fairly put before each child of each article, and by selecting the larger quan- tities we may give a very full allowance. If the smaller amounts of one are eaten, then care should be taken that the fuller weights of others are chosen. And let it always be understood that food is not to be dispensed with pedantic accuracy as if it were a pharmaceutical prescription. Even in hospitals considerable latitude is allowed, and still more in private nurseries should we avoid making life a toil by too much interference. It is only in cases of prominent and persist- CHILDHOOD AND YOUTH. 135 ent excess in one direction or the other, that we should bring our adult reason to bear on infantile instinct. Full Dietaries for Children at various Hospitals. Age. Bread. Butter. Milk. Meat. Vegetables. Pudding. Hospital. Under 7 Unlimited. 1 oz. % pint. 2oz. 4 oz. Unlimited. St. George's. Under 7 12 oz. 7 }/ 2 pint. 2oz. 8 oz. (Twice a \ week. London. Under 8 5%oz. f about 1 %oz. y> pint. 2 oz. 4 oz. ^ pint. Children's Hospi- tal, Great Orm- ond Street, and Evelina Hospi- tal. Under 8 8 oz. {about 1 oz. ? 2oz. 4 oz. Leeds Infirmary. Above 8 8 oz. /about t loz. %pint.' (3oz. \ broth l^pnt 6 oz. S Gruel, y 3 I pint. 1 Children's; Great Ormond Street, and Evelina Hospital. Under 9 6 oz. ? 1 pint. 2oz. 6 oz. f 14 pint -< gruel or (. broth. f Birmingham Gen- \ eral Hospital. Under 9 7 oz. KOZ. 1 pint. 4oz. 4 oz. To order. St. Bartholomew's. Under 10 12 oz. %oz. 1 pint. 2oz. 4 oz. 6 oz. St. Thomas's. Under 10 6 oz. f 114 pint. 2 eggs. ? 8 oz. King's College. Extreme monotony should be avoided. It is a great inconve- nience to young persons in after-life to have been brought up in such a narrow round of indubitably wholesome victuals that they cannot eat this or that. They should especially be guarded against family whims; and if the parents are conscious of prejudices against any of the ordinary foods of mankind, they should edu- cate their descendants to take these as a matter of course. For it is astonishing how ingrained some of these acquired idiosyncrasies become, and indeed after full manhood they may be concealed but are never quite overcome. Yet few of the minor thorns in the rose-bed are so vexatious to oneself and others. I shall not soon forget the annoyance of taking a young man to a Greenwich din- ner, and finding that he never ate anything which swam in the waters. Thus occasional abstinence, in the shape of no meat or the substitution of fish, and occasional festivities, consisting of food given deliberately because it is nice, are not out of place in the 1 Including what is put in mashed potatoes. 136 SPECIAL DIETETICS OP HEALTH. nursery. Most kind fathers and mothers act on this principle, but they sometimes needlessly let the indulgence trouble their conscience. The articles of diet should be as good and as clean as can be obtained, but no criticism should be permitted to those who sit at table. A boy or girl should be ready to eat anything which is set before them, and not refuse even badly cooked or strange meats ; for in roughing it through the world, whatever position they are in, the choice often lies between that and going without. The plan adopted at many schools of working before breakfast is not conducive to health. If it is inconvenient for the house- hold to prepare the meal immediately the pupils are dressed, the most that should be exacted is the repetition of some light task prepared overnight ; but better than that is to let them have half an hour's run in the play -ground. Violent exertion also of mind or body before and after other meals should be discouraged by a suitable arrangement of the hours of work and play. ^Esthetic pursuits, drawing, dancing, singing, may be made so to combine relaxation and amusement as to leave the powers of digestion un- exhausted, and may be practiced up to the time of meals. To the full development of the digestive organs, muscular ex- ertion in the open air is essential, and it is doubly valuable when it is of a pleasurable character. Proper exercise always involves a rational style of dress ; for ill fitted and uncomfortable clothing is soon rejected by those who rejoice in the natural movement of the limbs. It is even more necessary for girls than for boys that a sufficient playground should be attached to places of education, for they cannot be allowed to wander about the country like their brothers, and the funeral processions falsely called exercise are almost use- less. In town, gymnastics or riding on horseback may be. made substitutes for games ; but the money required for these would be much more profitable if expended in the rent of a field or lawn. For families who are so fortunate as to be near a river or lake there is no exercise for girls so good as rowing a light oar or scull- ing. It opens the chest, throws back the shoulders, straightens the back, and insures the shoulder straps of the dress not imped- ing movement, so that the liver and stomach gain space to act. Many a sculpturesque figure will acknowledge her debt to her CHILDHOOD AND YOUTH. 137 boat for her beauty ; and a few weeks' instruction in swimming at Dieppe or Trouville takes away all sense of clanger from the amusement. Up to the period of puberty the daily use of wine should be allowed only during illness and by the express advice of a medi- cal man. Its habitual, consumption by healthy children hastens forward that crisis in their lives, checks growth, and so habituates them to the artificial sensation induced by alcohol that they can scarcely ever leave it off when they wish. This restriction does not exclude occasional festivities, and boys in active exercise seem to digest well a glass of well-brewed beer at dinner. Between puberty and full growth the principal thing we have to guard young people against is overloading the stomach. Their meals should be sufficiently frequent to avoid this, otherwise the stomach from habitual distension becomes larger than is appro- priate for the size of the trunk, and there is in after-life a tendency to gastric flatulence. Lads sent to learn a business in the city are often much neglected in the matter of a midday meal, and have to make up for it by gorging themselves in the evening. This spoils their breakfast next morning, and they really get starved from over-repletion. The best luncheon a growing young man can have is a dish of roast potatoes, well buttered and peppered, and a draught of milk. Or the same vegetable with a little bacon or fish may be made into a Cornish pastry, which if wrapped up in flannel will keep hot for several hours. In the summer boiled beans and bacon, or bread and cheese and lettuce, with a glass of claret or a draught of bitter beer, may take its place. But let the repast be confined to one dish, and then they will not eat too much. Red meat in the middle of the day is too heating during active life, so that if the conventional form of a sandwich is the only convenient lunch found practicable, let it be made of eggs, or fowl, or cold fish, flavored with a little salad dressing, or the like. Youth is the time when gluttonous habits are acquired. The commencement of them is easily detected, and they should un- sparingly be made as disgraceful as they really are. Ridicule is not always a wise engine to employ in education it is too power- ful but against gluttony it may fairly be used. Let it not, however, be supposed that excess in gratifying the palate is at all 138 SPECIAL DIETETICS OF HEALTH. a laughing matter. It is a vice just as truly as sexual excess is a vice ; and there is the less excuse for its becoming an habitual vice, in the fact that the temptation to acquire it is strongest in youth, and becomes weaker as full growth is attained. That it is regarded as a serious vice by the highest authority is shown to all time by that Avonderful history of the civilization of a specially favored race preserved in the commonest of books. Kibroth- Hataavah " The Graves of the Greedy " remained for future generations as a standing memorial of Heaven's wrath, and of the natural punishment of sins against natural law. The worldly Lord Chesterfield is equally explicit in denouncing the vice, when writing to his son at school, and though his outspoken sentences are couched in language too old-fashioned for quotation, they are well worthy of the attention of both parents and children. The gorging themselves with pastry and sweetstuff at the con- fectioner's, as practiced habitually by school-boys, and often by girls when they get a chance, lays the foundation not only for in- digestion in after years, which is its least evil, but also for a habit of indulgence which is a curse through life. A schoolmaster who should effectually check this without needless restriction of liberty, and make greediness unfashionable among his pupils, I would rank far above the most finished scholar in Europe. An impor- tant step towards it is to give the boys enough to eat at regular mealtimes. Yet are asceticism and hypocrisy to be equally eschewed with gluttony. The hearty enjoyment of what is pleasant to the taste at proper times is quite consistent with, indeed usually goes along with, habitual temperance ; and one of the most practical lessons knowledge of the world can teach is that all pleasure is enhanced by self-restraint. Young people should not be brought up to the habit of taking physic. As a rule, the British mother is very fond of dabbling in doctoring, and apt to try her first experiments on her own family. If there is any definite disease discoverable, a professional man is called iu, but if a child is only weakly, or troubled now and then with unimportant ailments, she tries this and that which has been recommended by her friends, without suspecting the probable truth that the cause of the imperfect condition lies in some irra- tional regimen pursued. She cannot make out what is the matter; CHILDHOOD AND YOUTH. 139 surely it would be wiser to consult some one who can, or at all events, who knows that he cannot, and will not act till he does. The consequence of frequent drugging is sometimes real illness, generally a debilitated state of the digestion, and almost always a disposition to fly to drugs for the immediate relief of petty incon- veniences, which in reality impedes their cure by more far-sighted means. Boys get laughed out of this at school, but girls are seldom so fortunate, and grow up with the idea that something which calls itself physic is a necessity of human life. Now, in all the pharmacopoeias there is not a single active article which, joined to its virtues, has not the vice of deranging more or less gastric digestion. It is that which makes it a medicine and not a food. Assuredly, its secondary or final effect in suitable cases, is to restore digestion, but when taken needlessly, it cannot but be injurious even to such a tough animal as a boy. The proper place for the family medicine chest is, not the bed-room or the boudoir, but the store-room, where there is some little trouble in getting at it, and where it should be locked up along with a stomach-pump, and other provisions for emergencies to be applied by skilful hands. 140 SPECIAL DIETETICS OF HEALTH. CHAPTER III. COMMERCIAL LIFE. THE continually increasing numbers who devote themselves to commercial pursuits, and the still larger numbers whom they in- fluence as dependants as they grow in importance, make the habits of the class a matter of serious social consideration. The commercial man measures his usefulness in the world "by his success in rapidly accumulating honest wealth. Honesty, therefore, being presupposed, the most conscientious is always lia- ble to the temptation of wishing to compress two days' work into one, so as to be rich in half the time taken by his neighbors. To speak of this as a "struggle for life," is silly; of those who labor hardest in our cities, there are very few who would not acknowl- edge that one-tenth of their anxious toil would supply the daily needs of themselves and families. They are in reality egged on by ambitious rivalry, which uses for its purposes that insatiable hunger for hard work innate in the British breast. The haste to be rich is most unwise, and not only often defeats its own purpose by prematurely incapacitating the haster from further struggles, but if it is successful, it surely deprives middle life, or at least old age, of its occupation. A man whose unusual exertions have made him rich rapidly, is sure to have been too much engrossed by his business to take an interest in other things. He may have kept himself, as a duty, acquainted with the pursuits and sympathies of his fellows, but he is incapable of making them the occupation of his thoughts. He is driven to look to the past only for the genuine interest of life. Much more often the health suddenly breaks down before the desired object is attained, and the power is wanting to engage in other pursuits, to take the place of business which is perforce given up. The expenditure of strength, in the hurry to grasp wealth, has resulted only in weakness and poverty. COMMERCIAL LIFE. 141 It was a piece of shrewd advice administered by an old mer- chant to a young one " If you want to die rich, live as long as you can." The most important rule for one engaged in any business which involves headwork or responsibility to lay down for himself is to strictly confine his business to its own times and places. Retail shopkeeping of all employments allows the greatest number of hours to be occupied in attention to its interests ; for, if fairly pros- perous, it does not exhaust the brain, and yet offers the gentle stimulus of movement and conversation. However, the principals of many large concerns of this kind are more heavily weighted, and if they want to enjoy health must draw a strict line between the hours devoted to money-making and those devoted to living, just as much as if they were merchants or manufacturers. The result of a neglect of this rule, of bringing the counting- house into the dining-room and bed-room, is indigestion and sleeplessness. The principal meals should be breakfast and dinner, breakfast before and dinner after the work of the day. But a break in the middle for luncheon is very important, indeed is imperative for all but exceptional cases. At breakfast and dinner, animal food is necessary to a hard worker; but it is not required at luncheon, and often causes heaviness and feverishness during the afternoon. Any large quantity of fat or butter also seems heating, especially if it is cooked, as in pastry. Farinaceous food, vegetables, fruit, should be the staple of the midday meal, with only so much of anything else as is wanted for a relish, the less the better. Many commercial men give up vegetables because they find that taken at a mixed meal, along with meat, they cause flatulence. If they will separate the two classes of food, which require the digestive powers of different and somewhat opposite solvents, the saliva and the gastric juice, if they will take vegetables at one meal and meat at another, they will often find the difficulty over- come, and full quantities of both digested without fermentation. The habitual use of stimulants in the middle of the day is to be deprecated ; nevertheless where an unusual amount of cerebral exertion has been gone through, a cheerful glass of wine or beer will often prevent over-fatigue let not, however, the demand or the supply grow a daily habit. 142 SPECIAL DIETETICS OF HEALTH. The daily use at dinner of a moderate amount of alcohol in some form contributes, I am sure, to the health of brain-workers. Light perfect wine is the best form, next beer, next strong wine and water, last spirituous liquors. Commercial work can be done only in the town, and it must be confessed that town air and influences are not the most favorable to health. On this score many nowadays spend their nights at long distances from their place of business, so that no more time than is absolutely essential should be spent at a disadvantage. The success attendant upon this plan of residence in the country is closely proportioned to the earliness of the time at which busi- ness can be left. Unless an hour or two can be given to relaxa- tion in the purer air before dinner, I do not think the labor of rdshing backwards and forwards is compensated for. It is pleas- ant, doubtless, to see the junior branches of the family flourishing among green fields, but not when the bloom is gained by the ex- haustion of the bread-winner's strength. Those who can afford it, will do better to fix their permanent residence near their work, and live temporarily in the country for a few months during the long days. Besides the reason mentioned above another may be given for the long hours borne by retailers, namely, that their shops are better ventilated and lighted than most of even the wealthiest merchants' counting-houses. To pass from the magnificent dwell- ing of his wife and daughters to the dull stuffy den of many a prince of commerce, recalls the image of Samson grinding in the dark through the treason of his money-loving spouse. Things were not so bad when the family lived over the offices, and a softening female influence civilized the whole house. But now work and life seem to be seeking a divorce from one another, and the place of business is growing more and more gruesome, and, like another ill-omened locality, is not to be alluded to in polite society. A ladies' mission for the improvement of these dwellings is urgently called for. Unlike other missions, it could dispense with promoters, secretaries, speeches, committees, subscriptions, and collectors. Or rather, all these agencies united could embark in the family conveyance, or even in a one-horse fly, and begin operations at once with a builder and decorator as assessor. The scale of expenditure should be proportioned to that of the other COMMERCIAL LIFE. 143 home ; it will probably add very little to the yearly bills, nothing in comparison to silk gowns and spring bonnets. The healthiest exercise for a commercial man is riding when it is possible. It diverts the thoughts, especially if the nag be skittish, prevents the stagnation of the abdominal bloodvessels, and promotes a due flow of bile. But the outside of an omnibus is better than nothing at all, and is within the means of every one. Much walking is usually found too fatiguing, and if adopted as a duty, is apt to be monotonous. Boating and cricket are suitable for the younger members of the commercial world, but they oc- cupy more time than can often be spared, and have to be kept for holidays. The more violent athletic sports are open to still more objection, and if it is attempted to pursue them at the same time that the thoughts are occupied in business, they exhaust the vital powers, and weakness is the result. 144 SPECIAL DIETETICS OF HEALTH. CHAPTER IV. LJTERAKY AND PROFESSIONAL LIFE. THAT dogmatic expression of Biichner's, " No thinking with- out phosphorus," 1 has gained an unhappy notoriety. Strictly taken it is a groundless assumption, for it is impossible for us to have any evidence that intellectual being may not exist joined to any form of matter, or quite independent of matter at all. We certainly do not know enough of the subject to lay down a nega- tive statement. And if it be held to mean that the amount of phosphorus passing through the nervous system bears a proportion to the intensity of thought, it is simply a misstatement. A cap- tive lion, tiger, or leopard, or hare, who can have wonderfully little to think about, assimilates and parts with a greater quantity of phosphorus than a professor of chemistry working hard in his laboratory ; while a beaver, who always seems to be contriving something, excretes so little phosphorus, at least in his urine, that chemical analysis cannot detect it. 2 All that the physiologist is justified in stating is that for the mind to energize in a living body, that body must be kept living up to a certain standard, and that for .this continuous renewal of life a supply of phosphatic salts is required. The same may be said with equal justice of water, fat, nitrogen, chloride of sodium, oxygen, etc. The phosphates are wanted indeed, but wanted by pinches, whilst water must be pouring in by pailfuls. One might go on thinking for weeks without phosphates, but without water a few days, and without oxygen a few minutes, would terminate the train of self-conscious- ness. The practical points taught us by physiology are that for the integrity of thought the integrity of the nervous system is requisite ; and for the integrity of the nervous system a due quantity of such food as contains digestible phosphatic salts. 1 Ohne Phosphor kein Gedanke, Kraft und Stoff, sec. 122. 2 See the analyses of the several kinds of urine in Simon's Chemistry, vol. ii, pp. 144, 342, and 350. LITERARY LIFE. 145 For the intellectual direction of the nervous system it is at the same time essential that it should not be oppressed by physical and mechanical difficulties. The presence in the stomach or blood of imperfectly assimilated nutriment impedes its functions in close proportion to their amount ; so that not only the chemical constit- uents but the mode of administering food must come into the cal- culation. The most perfect regimen for the healthy exercise of thought is such as would be advised for a growing boy, frequent small sup- plies of easily soluble mixed food, so as to supply the greatest quantity of nutriment without overloading the stomach or running the risk of generating morbid half-assimilated products. The physiology of the action of alcohol has a very practical bearing on the physical regimen of the mental functions. Alcohol has the power of curbing, arresting, and suspending all the phenomena connected with the nervous system. We feel its in- fluence on our thoughts as soon as on any other part of the man. Sometimes it brings them more completely under our command, controls and steadies them ; sometimes it confuses or disconnects them ; then breaks off our power and the action of the senses alto- gether. The first effect is desirable, the others to be avoided. When a man has tired himself with intellectual exertion, a moder- ate quantity of alcohol taken with food acts as an anaesthetic, stays the wear of the system which is going on, and allows the nervous force to be diverted to the due digestion of the meal. But it must be followed by rest from mental labor, and is in fact a part of the same regimen which enforces rest it is an artificial rest. To con- tinue to labor and at the same time to take the anaesthetic is an inconsistency. It merely blunts the painful feeing of weariness, and prevents it from acting as a warning. I very much doubt the quickening or brightening of the wits which bacchanalian poets have conventionally attributed to alcohol. An abstainer in a party of even moderate topers finds their jokes dull and their anecdotes pointless, and his principal amusement consists in his observation of their curious bluntness to the absurdity of their merriment. There is no more fatal habit to a literary man than that of using alcohol as a stimulant between meals. The vital powers go on getting worn out more and more without their cry for help- 10 146 SPECIAL DIETETICS OF HEALTH. being perceived, and in the end break down suddenly and ofte irrevocably. The temptation is greater perhaps to a literary ma than to any other in the same social position, especially if he ha been induced by avarice or ambition to work wastefully agains time; and if he cannot resist it he had better abjure the use c alcohol altogether. As to quantity, the appetite for solid food is the best guide. I a better dinner or supper is eaten for a certain amount of fermentei liquor accompanying it, that is the amount most suitable. If worse, then it may be concluded that an excess is committed, how ever small the cup may be. Although nothing can take the place of alcohol in this article o diet, yet fermented drinks are not suited to the nervous system a all in proportion to their alcoholic contents. The fruity ether and aromas evolved in the process of fermentation, and which d not seem capable of existing in a digestible form without alcohol are even more powerful in repairing the waste of the nerve power Burgundy has acquired a special fame as food for the brain, an< claret runs it hard, while good, sound, unadulterated beer is i homely creature little inferior to them. All of these are superio to sherry and port, and to spirits, for reasons given in a forme chapter of this volume on the choice of food. Mental activity certainly renders the brain less capable o bearing an amount of alcohol which in seasons of rest and relaxa tion does not injuriously affect it. When any extraordinary toi is temporarily imposed, extreme temperance or even total absti nence should be the rule. Much to the point is the experience o Byron's Sardanapalus : " The goblet I reserve for hours of ease, I war on water." The posture of the body usually adopted by literary and man} professional persons engaged in writing is a matter worth consider- ation. Chamber counsel are notoriously subject to piles am venous congestion of the rectum ; women who sit much with theii work in front of them get also congestion and irregularity of th< uterine organs ; cold feet from sluggish arterial circulation an frequently complained of by otherwise hearty sedentary workers The ill health which these symptoms indicate may often be pre- LITERARY LIFE. 147 vented by the use of a high desk at which the work may be done standing for a time now and then ; and a further change of pos- ture may be obtained by an easy chair which will allow of think- ing with the body thrown back and by occasional walks about the room. Athletic sports are scarcely consistent with steady, hard brain- work. Probably only the most muscular try to persist in them, and they acknowledge that their intellects are readiest and strongest when they are taking quite moderate exercise, and not when their muscles are corky and their limbs light. There is a peculiar state of health into which those are apt to fall who, having for a long period kept themselves in training for boat- racing or other muscular exertion, afterwards adopt a life which involves mental labor and responsibility, even though they get a fair amount of bodily relaxation. The leading symptoms are emaciation, weariness, depression of spirits, and an unnaturally high specific gravity in the urine, which is, however, abundant and full-colored, thus showing an excess of destructive assimila- tion which cannot but be very injurious. Fresh air and relaxation of mind are of more importance than exercise, which last is indeed mainly valuable as securing them. The limits of weariness should not be transgressed. The attempt to compensate for excessive literary toil by excessive bodily toil is based on a false conception of the relations of matter and spirit, worthier of an ancient Gnostic than of a modern philosopher, which has more than once led to fatal results. I had for some years as a patient a literary lady who wrote much and well in magazines. She would go straight from her study to her garden and glebe, dig furiously and mow with a scythe, despising -or rather luxuriating in fatigue. Gradually paralysis came on, show- ing itself first as "writer's cramp," and then creeping over the whole body. The mind and senses were as perfect as ever, and so long as she was able to move the tongue she dictated lively monthly articles, and at last died apparently of sorrow at being unable to communicate her thoughts. Tobacco should not be indulged in during working hours. Whatever physiological effect it has is sedative, and so obstructs mental operations. But as a relaxation afterwards it is in modera- tion beneficial. As a calmative before retiring to rest it has the 148 SPECIAL DIETETICS OF HEALTH. sanction of a vigorous brain laborer, John Milton, whose supper, we are told, consisted of bread, water, olives, and a pipe of tobacco. There is a flavor about the fare of the happy days he had passed with an elegant literary circle in Italy. The daily habits of Robert Southey, a man who more than any other made literature a healthy profession and 'a successful profes- sion, are thus described by his son in his "Life," vol. iii, 2, and vi, 6 : " Breakfast was at nine, after a little reading, dinner at four, tea at six, supper at half-past nine, and the intervals filled up with reading or writing ; except that he regularly walked between two and four, and took a short sleep before tea, the outline of his day when he was in full work will have been given. After supper, when the business of the day seemed to be over, though he gener- ally took a book, he remained with his family, and was open to enter into conversation, to amuse and to be amused." " My actions," he writes about this time to a friend, " are as regular as those of St. Dunstan's quarter-boys. Three pages of history after breakfast (equivalent to five in small quarto print- ing) ; then to transcribe and copy for the press, or to make my se- lections and biographies, or what else suits my humor, till dinner- time ; from dinner till tea I read, write letters, see the newspaper, and very often indulge in a siesta ; for sleep agrees with me, and I have a good substantial theory to prove that it must ; for if a man who walks much requires to sit down and rest himself, so does the brain, if it be the part most worked, require its repose. Well, after tea I go to poetry, and correct and re-write and copy till I am tired, and then turn to anything else till supper; and this is my life which, if it be not a merry one, is yet as happy as heart could wish." And a very rational mode of living it was, deserving of its re- ward. The country air and quiet among the lakes and moun- tains, the association with kindred and loving spirits, the old- fashioned dinner-hour excluding uncongenial society, the regular exercise, and the sound night's rest, with temperance, soberness, and chastity, preserved his mental powers fresh and vigorous in old age, to leave to future generations undying memorials of sym- pathy with all that is best in humanity. Milton describes himself as " with useful and generous labors preserving the body's health and hardiness, to render lightsome, LITERARY LIFE. 149 clear, and not lumpish obedience to the mind, to the cause of re- ligion and our country's liberty, when it shall require firm hearts in sound bodies to stand and cover their stations." His blindness probably interfered with the activity of his mus- cular discipline in later years, for he was a martyr to gout towards the end of his life. Samuel Johnson is another type of the literary man pure and simple. Scrofulous, awkward, hypochondriacal, and corpulent, he was averse naturally to bodily exertion, yet he walked a good deal, and worked steadily and patiently without bursts of industry or idleness. Passionately fond of company and of eating and drink- ing, he restrained himself, and indulged only when the labor of the day was over. His knowledge of physiology and medicine kept him from quackery, and his medical advisers were the most rational physicians of the day. After middle life, his own obser- vation of his health led him to abstain entirely from wine; I have heard my grandmother describe the air of dignified patience with whieh he passed the bottle which she often pressed upon him at her father's. table. He sat up late at night indeed, yet that \vas not for work, but to rest the mind with sportive and varied con- versation. He had his reward in the retention of his mind, even when its material organ had broken down. Shelley was a vegetarian, and, perhaps, his peculiar way of living, combined with the fact of not writing for a livelihood or to please others, estranged his sympathies from human kind. But at all events, his temperance did not weaken his exuberance of thought and diction. What would have happened had he con- sumed more phosphorus, it is impossible to say ; but he could hardly have been a more rapid composer or stronger wielder of words. Walter Scott passed a genial sociable existence, took much ex- ercise, dissuaded his younger friends from substituting gig-driving for riding, and always insisted on having seven or eight hours of utter unconsciousness in bed. Had he passed his whole life in his study, he would have written probably worse and certainly less, for he would have had a shorter life to write in. It is true that Byron assumes in his poetry the character of a debanche, and says he wrote " Don Juan " under the inspiration of gin and water. But much of that sort of talk is merely for 150 SPECIAL DIETETICS OP HEALTH. stage effect, and \ve see how industrious he was, and read of his training vigorously to reduce corpulence, and of his being such an exceptionally experienced swimmer as to rival Leander in crossing the Hellespont. It is especially when the mind of genius is overshadowed by the dark cloud of threatened insanity, of hypochondriasis, or of hysteria, that a rational regimen preserves it to the glory of God and the advantage of man. Nothing but daily exercise, temper- ate meals, and a punctual observance of regular hours of study and rest, could have kept burning the flickering candle of reason in poor suicidal Cowper. Most rarely and faintly do his writings exhibit a trace of the gloom which made life to him, as he de- scribed it in his last words, "unutterable misery." On the other hand, the keen poison of his own genius slew in youth Kirke White, when he surrendered himself to its exclusive cultivation : That eagle's fate and his were one, Who on the shaft that made him die Beheld a feather of his own, Wherewith he wont to soar so high. The elegant appreciater of nature, the author of " The Seasons," faded away from lazy and self-indulgent habits. The great all- loving soul of Burns produced so little because it was drenched in drink and idleness, not excessive indeed, but sufficient to ruin his usefulness. Apropos of this last matter, we may give to some people the same caution which Swift administers in a letter to Pope : " The least transgression of yours, if it be only two bits and a sup more than your stint, is a great debauch, for which you will certainly pay more than those sots who are carried dead drunk to bed." The machinery of sensitive souls is as delicate as it is valuable, and cannot bear the rough usage which coarse customs inflict upon it. It is broken to pieces by blows which common natures laugh at. The literary man, with his highly cultivated, tightly strung sensations, is often more susceptible of the noxious and less sus- ceptible of the beneficial results of alcohol and other indulgences than others. His mind is easier to cloud, and there is a deeper responsibility in clouding it. LITERARY LIFE. 151 Equally when we descend into the lower regions of Parnassus, the abodes of talent and cleverness and the supply of periodical literary requirements, we find the due care of the body absolutely essential to the continued usefulness of the intellect. The first things to which one entering the profession of literature must make up his mind, are to be respectable and healthy. What noble fragments one finds in Savage and in Poe ! and how sad to know that they are fragments instead of stately struc- tures, solely because the builders had not the wisdom to live regular lives ! SPECIAL DIETETICS OF HEALTH. CHAPTER V. NOXIOUS TRADES. THE digestive organs are liable to suffer from the position as- sumed at work by certain handicraftsmen, and the discomfort hence arising leads to the adoption of an unwholesome dietary, which in the end intensifies the evil. Shoemakers contract a peculiar sort of gastralgia, partly from the pressure of the last against the epigastrium, and partly from the constriction of the abdominal viscera, especially the stomach, by leaning so far forward to work. The use of the upright bench, in which the last is held firm by a stirrup, and an erect posture always preserved, is the best remedy for the evil, and the thanks of the country are due to Mr. Sparkes Hall for his advocacy of this method of getting over a difficulty as old as the Pharaohs at least. Against the constipation and haemorrhoids which the same pos- ture induces the best preservative is the free use of fresh butter, a cold tub every morning, and an occasional dandelion pill. The discomfort which they cause in a sensitive condition of the stomach causes vegetables to be avoided by many shoemakers. They can hardly bear to take sufficient to sustain health. So long as this is the case, they should eat as many oranges and lemons as they can, or in default of them, fresh rhubarb, and try the plan proposed before of eating vegetables only at one meal and meat alone at another. A small quantity of watercresses is also a great resource. The same observations apply with nearly equal force to tailors, but unfortunately they have not the refuge of the upright bench to fly to, and to a certain extent also to sewing-machine workers, in whose case I would suggest that a simple contrivance by which the legs of the instrument could be shortened or lengthened would enable the changes of posture necessary to health to be made. However, it is indubitable that a great deal of the ill-health of all classes of artisans arises from the closeness of their work- rooms, and a more philanthropic deed cannot be done for a de- NOXIOUS TRADES. 153 serving class than the bringing under the notice of the district health-officers instances of the violation of the law by masters. Gardeners often are afflicted with water-brash, arising in a measure from the stooping posture deranging the viscera which receive the food, especially the lower end of the gullet. But I think that an additional cause is frequently the bad cooking of the vegetables they eat. Half-boiled potatoes and cabbage are as injurious as ill-prepared oatmeal is found among populations which are nourished on that diet. The poisoning to which those who work in lead are exposed by their occupation may be almost always prevented by scrupulous cleanliness in taking food. There is abundant proof that the metal enters the system through the stomach, and there is but doubtful evidence of its entering by any other path. From dirty hands it gets into the bread, from dusty clothes it besprinkles the meat and drink, and thus acts as quickly arid surely as if it had been brought in by the more usual way of the drinking-water. It is the most certain and noxious if by any peculiarity in the manufacture it is converted into a chloride salt, but the form which we generally meet with is the white carbonate, insoluble indeed in water, but unfortunately soluble in the fluids of the di- gestive canal, saturated as they are with carbonic acid. In the case of painters who employ white lead, it is quickly deprived of some of its noxiousness by mixture with oil, for in that condition it can only get into the food from the hands. But where the finely powdered or precipitated Kremnitz lead is employed, as for example in the manufacture of polished cards, the clothes be- come saturated with the dust and convey it to the victuals. Not only should the hands be washed, the hair brushed, and the outer garment shifted, before meals, but the men should not be allowed to bring their food within the poison-laden atmosphere of the workshops. Plumbers are said to inhale lead in the fumes which arise in the process of casting, and " brass-founders' ague " also appears from the researches of Dr. Greenhow to be caused by the fumes of solder, consisting mainly of oxide of zinc, being drawn into the lungs. But it must be remembered that in both these handi- crafts a great deal of dirt adheres to the skin and clothes and may thus pass into the food. I have never seen clean men affected. 154 SPECIAL DIETETICS OF HEALTH. Some handicrafts are noxious from the high temperature at which they are obliged to be carried on. In these cases, the fre- quent and free use of cold drinking-water is sanctioned by expe- rience as the best preservative of health ; the copious evaporation from the skin keeping down the heat of the blood. And the most cruel enemy to health is alcohol, which induces degeneration of the liver, heart, or kidneys, or all these at once, and prevents at any rate the due exercise of the lungs' functions, even if it does not directly disorganize that tissue. My own impression is that the emphysema and black deposit so often found in the lungs of artisans exposed to great heat is in no small measure due to alcohol and to the neglect of its antagonist water. For example, the consolidation and subsequent breaking down of the lung peculiar to dry grinders is seldom if ever found in temperate men ; a healthy mucous membrane has the power of rejecting the foreign particles of metal which adhere to it when congested and degenerated. Colliers, who labor in the dark in a confined hot atmosphere deficient in oxygen, suffer from bloodlessness and indigestion. The bonesetters, the popular practitioners among this class, describe it as ~" a little bone broke" in the stomach, pummel the abdomen and make the patient give up work and drink for a season with successful result. Philanthropic coal-owners should arrange the shifts, so that a man may be put in turn on to night work and have his share of sunlight. And it is better for the men not to eat in the pits, but to make their principal meals when off work. The diet of colliers is generally too nitrogenous for a life of daily muscular labor. Tea-tasters sometimes suffer from a special kind of nervous af- fection. The hand gets tremulous, there is sleeplessness, head- ache, anaemia, indigestion, with a flabby tongue covered with a smooth yellow coat. To avoid this, they should live well, and always take some food before exercising their office. Smelling the tea seems to be more injurious, and really less decisive, than sipping the infusion. Evils consequent on other trades are not mentioned here, either because they are unconnected with diet, and not to be avoided by any special arrangement of diet, or else resolve themselves simply into temptations to intemperance. ATHLETIC TRAINING. 155 CHAPTER VI. ATHLETIC TRAINING. ARE the dramatist and the novelist drawing from nature when they present us a picture of a well-born and well-bred athlete, stupid, immoral, selfish, case-hardened by his brute strength against the finer emotions of pity and honor, and blind to intel- lectual pleasures? If the original exists, he is happily very rare. He is certainly not conspicuous in the list of 294 rowers in Uni- versity races collected by Dr. Morgan, which on the other hand is adorned with bishops, poets, public school-masters, leading bar- risters, devoted clergymen, elegant orators, scientific chemists, philanthropists, and other ornaments of the human race. 1 Emi- nent muscular ability evidently is not inconsistent with a superi- ority to the average in other respects, and the improvement of the body does not prevent the improvement of the mind. A charge more serious, because more troublesome to answer against athletics, is that they lay a foundation for disease in after years, and thus shorten life. Likely enough the spectators know that the dropping down dead on the stage of an athlete, appar- ently in the height of healthy vigor, is a gross misrepresentation of nature. But yet the scene rankles in their memories, and they can with difficulty divest themselves of the feeling that the exuber- ant energy of a man in training wears out the vital forces, and is repaid by weakness which will cut short the days. We may know that the impression exists by the frequency with which the friends of patients assign athletics as the cause of all sorts of diseases, without any other reason than that the failure in health was first made manifest during some bodily exertion. Of course it is during bodily exertion that the discovery is made : no one finds out that his legs are weak till he tries to walk, or that his lungs or heart are injured till his wind fails him at a pinch. But that a man 1 University Oars, by John E. Morgan, H.D. 156 SPECIAL DIETETICS OF HEALTH. previously in good health injures his constitution by training, so as to be more liable than ordinary persons to any peculiar class of disease or degeneration, is negatived by the laborious investiga- tions of Dr. Morgan. He has followed up with personal inquiries the 294 " university oars " mentioned above, and he finds, as was to be expected, that since 1829, when his list begins, some have died, some have been killed, some have fallen into ill health, but 238 survive to describe themselves as hearty and strong. Of the deaths (39 in all) 11 were from fevers, 7 from consumption, 6 from accidents, 3 from heart disease, and lesser numbers from other special causes. Now it is heart disease which especially is attributed to athletic sports, and it is a surprise to find statistics showing that their patrons have suffered from it rather less than the rest of the population, and much less than the sailors whom we are so solicitous to keep in good health. 1 Deaths from fevers certainly cannot be considered as evidence of an injured constitu- tion ; indeed Dr. Graves of Dublin (a high authority in this mat- ter) remarks, and the experience of most of us will bear him out, that when zymotic diseases attack strong men the risk is greater than is run by weaker frames. The end of 2 by drowning, and 3 by gunshot wounds, show the possession of energy and unsel- fish courage, seldom the characteristics of a broken invalid. The cases of the 17 who do not furnish a good account of their health are mostly somewhat vague. Among so many, several must have hereditary tendencies to disease; others say their medical attend- ants trace no connection between their complaints and previous muscular exertion, and in such a long period as forty years in- numerable evil influences must have been in action ; while in some families it seems traditional always to speak of their health as only moderate, and in others to look back upon the exuberances of their youth as follies. So that 17 is in fact a small number to be occasionally falling into the hands of the physician. The best test of the value of anything is to reduce it to Arabic numerals, and pounds, shillings, and pence, as insurance offices act by our constitutions. Dr. Morgan has applied this test to the 1 Mortality from heart disease in Kegistrar-Gen. Reports for 10 years 8 per cent. ; in navy (1868), 13 per cent. ; among university oars, 6 per cent. University Oars, p. 28. ATHLETIC TRAINING. 157 294 cases under consideration. According to Dr. Farr's Life Tables the expectation of life at 20, the average age of university oarsmen, is 40 years. But the survivors have still an expectation of life of 14 years before them, and this must be added on, while a calculated allowance must be made for those who have died, and an estimate also deducted for the 17 lives who reckon themselves damaged. The whole calculation is too long to be gone into here, but the result is deckledly favorable ; for, taking the experience as it stands, the expectation of life of each individual comes out, not 40, but 42 years. So that any insurance office which had taken them all at ordinary rates would be making a handsome profit and exhibit a good prospective balance sheet. The conclusion is inevitable that for young men in good health very severe athletic training strengthens the constitution and lengthens life. It will of course strike every one that our example here is taken from a specially select class of humanity. True, the fame of the University would not be intrusted to one likely to break down and disappoint his colleagues. And herein lies a great advantage possessed by boat-racing above other athletic sports, namely, that it is to the interest of all concerned to exclude from the practice those who are likely to be injured by it. For that some are likely to be injured is never denied ; and it probably would be wise if the crews, instead of acting solely on their own responsibility, were to insist on all who joined them having their fitness to un- dergo training tested by a medical man. Mr. Maclaren says he would not allow any one to pull in a college boat whose chest measured less than 36 inches, but it is evident that such an abso- lute rule must be fallacious, for the circumference of the chest must bear in a well-built man a proportion to the height. The better test is the vital capacity or aerial contents of the lungs, which Dr. Hutchinson's spirometer and tables enable us to measure so accurately. Other forms of athletics have not the same safeguard. But still the good sense and good feeling of Englishmen is such, that a man very quickly finds out, or is told by his comrades, if any- thing renders the ambition of distinction in bodily exercise unsuit- able for him. Where there is any suspicion of this being the 158 SPECIAL DIETETICS OF HEALTH. case, parental authority may fairly be interposed, and the matter settled in a single medical examination. It is not necessary that every one who trains should aim at being, or even wish to be, a distinguished athlete. There are modified forms or rather degrees of the same process, which can- not be trusted indeed to produce the extraordinary development of nerve-force needful for successful boat-racing and the like, but which nevertheless bring the body into a state of high health very conducive to comfort and usefulness. The reading or other intellectual pursuits during training should be very moderate and (so to speak) mechanical. Hard head-work should not be carried on at the same time as hard training. It should be gradually given up at theTjeginning, and resumed gradu- ally after the training has been gone through. But there is no reason why the systematic cultivation of the mind and body should not alternate to their joint advantage, and indeed it evi- dently has done so in the case of many of Dr. Morgan's heroes, whose names make a conspicuous appearance in the class lists of classical and mathematical honors. 1 The usual time allotted to training is six weeks. The objects to be attained in this period may be described as : 1 . The removal of superfluous fat and water. 2. The increase of contractile power in the muscles. 3. Increased endurance. 4. " Wind," that is, a power of breathing and circulating the blood steadily in spite of exertion. The first object is aimed at by considerably adding to the daily amount of nitrogenous, and diminishing farinaceous and liquid food, and providing that it should be so consumed as to be fully digested. The second and third are secured by gradually increas- ing the demands made upon the muscles till they have learnt to exert at will all the powers of which they are capable, and for as long a period as the natural structure of the individual permits. Wind is improved by choosing as part of the training an exercise, such as running, which can be sustained only when the respiratory and circulating organs do their duty fairly. 1 The 294 include, at Oxford 6 firsts and 11 seconds in classics, 1 first and 2 seconds in mathematics; at Cambridge 10 firsts and 5 seconds in classics, 8 wranglers, and 21 senior optimes in mathematics. ATHLETIC TRAINING. 159 The muscles of the limbs become under a regimen of this kind more "corky" or elastic, and more prominent when "put up" in a state of contraction. They improve in quality and efficiency, but that they become larger is extremely problematical. Hyper- trophied organs are well known to lose their shape and power; an enlarged heart, instead of circulating blood better, is an incum- brance ; the muscles of the hollow viscera, when augmented in thickness, do not expel their contents freely ; an hypertrophied finger, instead of being stronger than the rest, is weaker ; and all these are extremely liable to degenerate prematurely and lose their vitality. So that if the muscles did by training grow bigger, as reckoned in a state of repose, it were a result not at all to be desired. The skin becomes soft and smooth, and apparently more trans- lucent, so that the red bloom of youth shines through it more brilliantly. The insensible perspiration is regular and even ; while at the same time sweating is not so readily induced by bodily ex- ertion, and it is never cold and sudden, even with mental excite- ment. Superfluous fat is removed from all parts of the person, as is evinced by loss of weight. This requires to be carefully tested by the scales from time to time ; for if the reduction be carried be- yond a certain point, which varies in different men, a loss of power and of endurance is felt, and probably future evil results may arise. This point is technically called the " fighting weight," but the observation of it need not be confined to the pugilistic trade. Training increases wonderfully the vital capacity of the chest, so that a much greater quantity of air can be blown in and out of the lungs and with greater force than previously. And this vital capacity endures longer than any other of the improvements, for I have found in examination for insurance several clients, formerly in training, but who had laid aside violent exercise for some years, still retaining that mark of vigor to a considerable extent above the average. It is evidence of the permanent elasticity of the pulmo- nary tissue, an efficient protection against asthma, emphysema, and other degenerations of the organ of breathing. Indigestion, acidity of stomach, sleeplessness, weariness of life, nervous indecision, dyspeptic palpitations, and irregularity of the 160 SPECIAL DIETETICS OF HEALTH. bowels disappear under training. But if they exist, the regimen should be entered upon with more than usual caution and under medical advice. The following were the systems pursued at the Universities in 1866 as given by Mr. Maclaren in the Appendix to his " Training, in Theory and Practice," and I believe still carried on for boating- men : THE OXFORD SYSTEM. Summer Races. A DAY'S TRAINING. Kise about 7 A.M. Exercise Breakfast, 8.30.. Exercise (forenoon). Dinner, 2 P.M Exercise.. Supper, 8.30 or 9. Bed about 10. A short walk or run... Meat, beef, or mutton. Bread, or toast dry Tea None. Meat, much the same as for breakfast. Bread Vegetables (none allowed) Beer, one pint. About five o'clock, start for the river, and row twice over the course, 1 " the speed increas- ing with the strength of the crew." Meat, cold. Bread; perhaps a jelly or watercresses. Beer, one pint. So as to be in chapel, but early rising not compulsory. Not compulsory. Underdone. The crust only recommended. As little as possible recom- mended. Crust only recommended. A rule, however, not always adhered to. Summary. Sleep About nine hours. Exercise Walking and rowing about one hour. Diet Very limited. 1 The length of the course is nearly a mile and one-eighth. ATHLETIC TRAINING. 161 Winter Races. A DAY'S TRAINING. Kiso about 7.30 A.M Hrt-akl'iist, '.I Kxrrrist! (forenoon) Uiurhron about 1 P.M.. Exercise.. Dinner at five, in Hall.. Bed, 10.30. As for summer races. None. Bread or a sandwich. Beer, half a pint. About two o'clock start for the river, and row twice over the course Meat as for summer races. Bread. Vegetables as for summer races. Pudding (rice), a jelly. Beer, half a pint. Early rising not compulsory. Not compulsory. Crews are taken over the long course to Nuneham, perhaps twice during their practice. N.B. It is particularly impressed on men in training that as little liquid as possible is to be drunk, water being strictly forbidden. Summary. Exercise'.!." \ As for summer races - Diet Nearly the same as for summer races; luncheon being about equivalent to supper. THE CAMBRIDGE SYSTEM. Summer Races. A DAY'S TRAINING. Rise at 7 A.M. Exercise Breakfast, 8.30.. Exercise (forenoon). Dinner about 2 P.M.. Exercise Supper about 8.30 or 9. Bed at 10. Run 100 or 200 yards "as fast as possible" Meat, beef, or mutton. Toast dry. Tea, two cups, or towards the end of training a cup and a half only. Watercresses oc- casionally. None. Meat, beef or mutton. Bread. Vegetables, potatoes, greens.... Beer, one pint. Dessert. Oranges or biscuits, or figs; wine, two glasses. About 5.30 start for the river, and row to the starting-post and back. Meat, cold. Bread. Vegetables lettuce or water- cresses. Beer, one pint. The old system of running a mile or so before breakfast is fast going out, except in the case of men who want to get a good deal of flesh off. Underdone. Some colleges have baked ap- ples, or jellies, or rice pud- dings. Summary. Sleep Nine hours. Exercise About an hour and a quarter. 1 Diet Limited. N.B. On Sundays men generally take a long walk of five or six miles. 1 The course is a trifle longer than at Oxford, and there is a pull of l l / mile to get to it. 11 162 SPECIAL DIETETICS OF HEALTH. Winter Races. A DAY'S TRAINING. Kife about 7 A.M. Exercise, .... As for summer races. Breakfast, 8.30, " " Exercise (forenoon), . . None. Luncheon about 1 P.M., . A little cold meat. Bread. Beer, half a pint, or biscuit with a glass of sherry ; perhaps the yolk of an egg in the sherry. Exercise, .... About 2 o'clock start for the river and row over the course and back. Dinner about 5 or 6, . . As for summer races. Bed about 10. Summary. "'. ' 'I Same as for summer races. Exercise, . . J Diet, . . Nearly the same as for summer races, luncheon being about equal to supper. There is nothing very terrible in the discipline here enforced, while some latitude is permitted to peculiarities and a wish for variety, and plenty of time is left for business and social inter- course. Other plans are objectionable from involving, without any resulting advantage that I can see, a complete bouleversement of the usual times and seasons adopted by the upper and middle classes in this country. For example, in Clasper's method dinner is to be at 12 o'clock, with nothing more than a very light tea afterwards and no supper. Then a country walk of four or five miles is to be taken before breakfast, and a couple of hours' row after, and another hard row between dinner and tea. 1 " Stone- henge" again requires the time between breakfast and dinner to be spent entirely in billiards, skittles, quoits, rowing, and running, in spite of another hour's row being prescribed at 6 P.M. He also requires the aspirant to athletic honors to sleep between ten and eleven hours. 2 Only professionals are likely to carry out such rules. The most doubtful point which a physiological critic 1 Quoted by Mr. Maclaren from Eowing Almanac for 1863. 2 Article " Boat-racing" in British Eural Sports, 1861. ATHLETIC TRAINING. 163 would lay his finger upon is the exaggerated abstinence from fluids recommended in the Oxford scale. The use of water to the extent of the thirst felt by the individual promotes the vital renewal of the skin, kidneys, and digestive viscera, and cannot be injurious. But it should not be very cold, or swallowed in great quantities at once on a full stomach, or after extraordinary exertion, lest it should lower too much the bodily temperature. If the mouth be first rinsed out, and the draught imbibed calmly and deliberately, it quenches thirst much better than when rudely gulped, and is not likely to be taken in excess. It is probably not necessary in the present day to enforce suffi- cient tubbing to keep the skin clean and fresh. It is in fact more necessary to deprecate excess in the use of cold water. If a bath is taken between exercise and a meal, the chill should at least be taken off, for there has been a considerable loss of temperature by perspiration, and more cannot be afforded. The use of a cold bath is to contract the cutaneous arteries, and by throwing the blood back suddenly on the heart and lungs to stimulate them to increased reaction, so that the living stream should flow vigorously to the extremities. If the skin is already pale and cool, as after exertion, it shows that they are already contracted and rather de- mand relaxation. The time for a cold bath is when the skin is full-colored, dry, and warm. Nothing is said here of the training of jockeys and others whose object is to reduce their weight to its extreme minimum irrespec- tively of augmenting the strength, as that cannot be recommended on the score of attaining high health, nor is it likely to be volun- tarily undertaken by healthy persons. The university scheme may fairly be accepted as a typical regi- men for fully developing a young man's corporeal powers to fulfil the demands of an extraordinary exertion. It is a standard which we may modify according to the circumstances for which the train- ing is required. Thus, for instance, in training for the moors or for the thor- ough enjoyment of partridge shooting, the reduction of fat should not be carried so far, as steady endurance for many days together is required, and a treasure of adipose tissue as a basis of molecu- lar growth must be retained. Butler may be allowed, milk in the tea, and eggs as a change for the lean meat at breakfast. For 164 SPECIAL DIETETICS OF HEALTH. men who have got into middle life running is needlessly trouble- some, and quick walking may be substituted both for that and for the rapid rowing. Nevertheless the times should be observed strictly, and the amount of the walking may be raised gradually up to that wanted for the day's sport. It will be necessary, how- ever, to allot to exercise a considerable longer time than is al- lotted in the college training scheme. For it must be remembered that quick rowing for an hour is a violent exertion and takes more out of a man, and practices the wind better than four hours' walking. The chest may be expanded by the employment of light dumb-bells or clubs (if heavy they strain the muscles). And the healthy action of the skin should be promoted by fric- tion with rough towels and horse-hair gloves. The time of the training should not be so long as six weeks, for in point of fact it is carried on by the exercise of the sport, and if such an extended period as used for boat-racing is adopted, there is a risk of over- doing the discipline. A fortnight is quite enough for the pur- pose. To those of our countrymen and women who have not the op- portunity or inclination for spending their holiday in what is commonly called "sport," the fashion of mountaineering is a great boon. And even sportsmen, during the dead season when there is nothing to be killed, experience a compensation in finding some- thing to go up. But a great deal of the advantage of the relaxa- tion is often lost by not being already in training. At least the first week is wasted in getting into condition, and is a period of as much pain as pleasure. This may be obviated by a gradual adop- tion of the diet and discipline, modified as above, for a week or ten days before starting. The pain in the back and sides which hunting men often ex- perience at the commencement of the season, arises usually from imperfect expansion of the lungs in ordinary breathing. The muscles of the trunk are strained by the effort of expiration during exercise. The inconvenience may be prevented by a partial train- ing. The diet should be drier than usual, and all sweets and pastry left off, the chest expanded by dumb-bells and running, and the habit acquired of keeping the lungs as full of air as possi- ble. Women, being weaker-muscled than men, often feel this to the extent of giving up altogether the healthy amusement of rid- ATHLETIC TRAINING. 165 ing. The simple adoption of modified training gets over the diffi- culty. The dumb-bells should be used in private before putting on the stays, and particular attention paid to the injunction of thoroughly inflating the lungs. It used to be the custom before the commencement of a course of training to be bled, purged, and sweated. I do not think it of any service, and it induces constipation of the bowels, besides being weakening. Some take Turkish baths during athletic train- ing, but they appear to derange the daily discipline, unless they are taken every day, which would be a decided excess. Ladies who are going to try training for athletic purposes, will find some attention to costume expedient. If stays are worn (and there is no objection to them if well-fitted and not too tight) they should have no shoulder-straps. The drawers should not be tied below the knee. The best defences to the lower extremities in rough ground are stout Alpine shoes, and light leathern gaiters half-way up to the knee supporting the long socks without garters. A light woollen jersey should be worn next the skin. The skirt of the dress should be short and narrow, and the best materials are serge and homespun. Besides these the less drapery is worn the better. Training is sometimes carried too far the men describe them- selves as " fallen to pieces." The most peculiar symptom is an occasional attack of sudden loss of power, after exertion. It is sometimes called " fainting," but there is no loss ef sense, as in that state, and is quickly relieved by liquid food. It is patho- logically an acute and temporary form of that consequence of overstrained muscle which constitutes " writer's," " turner's," and "blacksmith's" palsy. The obvious remedy is to leave off train- ing. The exercise and excitement combined of practicing for boat- racing will sometimes induce recurrent palpitations of the heart. A physician should immediately be consulted as to whether this arises from an organic cause ; if it does not, rest and a dose or two of purgative medicine should be taken before a resumption of training ; and it will be well to add a moderate quantity of port wine to the dietary. If the palpitations still return, there is no help for it but to give in, and acknowledge that nature has not cut out every one to the pattern of an athlete. 166 SPECIAL DIETETICS OF HEALTH. The unusual strain on the skin sometimes induces boils. The best preventive is to anoint the skin with a little sweet oil after the morning bath. If a spot gets tender and red, threatening a boil, touch it lightly every day with nitrate of silver, and give bark and chlorate of potash twice a day in the usual doses. (De- coct. Cinch., fl. 5 j ; Pot. Chlor., gr. xv.) A modification of training of considerable importance to notice is that which contemplates the reduction of superfluous plumpness, either for the sake of the appearance or the general comfort of the sufferer. There may be a question whether the health is benefited by it, unless the previous diet or habits had been irrational and improper. Corpulence usually prevents exercise being taken to a sufficient extent for confidence to be placed in it as an efficient part of the treatment, and therefore the diet becomes a more essential feature. If an exhausting amount of bodily exertion be persisted in, the digestion of meat is interfered with, while at the same time the absorption of such fat as unavoidably exists in the food still goes on, so that the muscles and nerves lose strength while the adipose tissue grows. Besides this, if by violent means the weight is worked down, those violent means must be continuously sustained to keep it down ; and if they are neglected in consequence of more absorbing occupations, the inconvenience rapidly increases to a greater degree than ever. Many uncomfortably stout persons are very active irt mind and body, and really could not add to their muscular discipline without risk of injury. The following may be taken as a modification of the training regimen suitable for the reduction of corpulence. Day's regimen for a three weeks' course. Rise at 7. Rub the body well with horse-hair gloves, have a cold bath, take a short turn in the open air. Breakfast (alone) at 8 or 8.30, on the lean of beef or mutton, cutting off the fat and skin, dry toast, or biscuit, or oat-cake, a tumbler of claret and water or tea without milk or sugar, or made in the Russian way with a slice of lemon. Luncheon at 1 on bread or biscuit, Dutch cheese, salad, watercresses, or roasted apples (without sugar or cream), hung beef, or anchovies, or red herring or olives, and ATHLETIC TRAINING. 167 such-likc relishes. Drink, after eating, claret and water, or un- sweetened lemonade, or plain water, in moderation. Dinner at any convenient hour. Take no soup, fish, or pastry, but plain meat, of any kind except pork, rejecting the fat and skin. Spin- ach, French beans, or any other green vegetable may be taken, but no potatoes, made dishes, or pastry. A jelly or a lemon-water ice or a roast apple must suffice for sweets and dessert. Claret and water at dinner, and one glass of sherry or Madeira after- wards. Between each meal exercise, as a rule, in the open air, to the extent of inducing perspiration, must be taken. Running, when practicable, is the best form in which to take it. The number of hours alotted to bed in the University schemes is too much for the purpose now proposed. Seven is quite enough, and if the person under training wants to retire before 12 o'clock, he ought to be astir before the time mentioned above. There are few things more weakening than remaining in bed, or even in a bedroom which has been closed during the night, when thoroughly woke up. During sleep little air is required ; we all know the slow shallow breathing of a sleeper, by which the respiratory muscles are rested. Beasts get enough oxygen in their narrow dens, and man in his fusty garret. But once awake, both expand their lungs fully, instinctively demand fresh air, and suffer from the want of it more at that hour than at any other time during the day. If a Sybarite must indulge in the horizontal position, let him at all events open his window and take his tub before he does so. If good Turkish baths are accessible, four or five may be used in place of exercise between meals at intervals during the reduc- tive training. And thorough shampooing by an experienced hand should not be omitted. The weight is to be accurately recorded at the commencement and every four days, so that its loss may not be too rapid or ex- cessive. Six or seven pounds is usually as much as it is prudent to lose during the fortnight. A more important sign of improvement is increased vital ca- pacity of the lungs as measured by the spirometer. After the fortnight's course the severe parts of the discipline 168 SPECIAL DIETETICS OF HEALTH. may be gradually omitted, but it is strongly recommended to modify the general habits in accordance with the principle of taking as small a quantity as possible of fat and sugar and of the substances which form fat and sugar, and sustaining the respira- tory function. Fat meat, rich milk, butter, malt liquors, pastry, starchy foods (such as potatoes, puddings), sweet vegetables (such as parsnips and beet-root), sweet wines (such as champagne) should be taken only most sparingly. An appetite should be acquired for lean meat, especially for beef, mutton, and venison, for game and poultry, for plain boiled fish, for poor new cheese, for green vege- tables and salads, summer fruits, oranges, lemons and pomegran- ates, almonds (fried and sprinkled with salt and cayenne), roast apples, olives, lemonade, buttermilk, claret, and hock. Aerated bread, captain's biscuits, and dried toast, all in moderation, are the most appropriate form of flour. Excessive stoutness amounts to a disease ; it is a true hypertro- phy of the adipose tissue, and it is not capable of removal by the means mentioned above, though in cases where it has been aug- mented by a previously inconsiderate diet, it may be considerably reduced. The subject will be resumed when the dietetics of dis- ease are under consideration. HINTS FOR TRAVEL. 169 CHAPTER VII. HINTS FOR HEALTHY TRAVELLERS. A MODERATE course of training is a good preparation previous to travelling for business or pleasure, or for active military ser- vice ; but it is well in these cases not to let the dietary become habitually too limited or careful. It is convenient to be able to eat without repugnance any food capable of supplying nutriment, even though dirty, ill-cooked, or of strange nature. There is often a choice only between that and going without. When actually on a carriage or railway journey it is unwise to make large meals. They are sure to be swallowed in a hurried manner, and in a state of heat and excitement very unfavorable to digestion. The best way is to make no meal at all till the journey is over, but to carry a supply of cold provisions, bread, eggs, chickens, game, sandwiches, Cornish pasties, almonds, oranges, captain's biscuits, water, and sound red wine, or cold tea, sufficient to stay the appetites of the party, and let a small quantity be taken every two or three hours. If this plan be adopted, not only is activity of mind and body preserved, but that heat and swelling of the legs which so often concludes a long day's journey is avoided. Attention to the matter is particularly necessary when the journey continues all night, and for several days in succession, since varicose veins and per- manent thickening of the ankles have sometimes resulted from this exertion being combined with too long fasts and hurried re- pletion at protracted intervals. The less stimulant a traveller consumes before he arrives at his sleeping-place the better. Then the habitual allowance is of ad- vantage. If a good wine is made in the country he is passing through, he will probably prefer to fare the same as his hosts; if not, Bordeaux and Burgundy are the best vintages when procura- ble, and Marsala in Italy. In France and Germany very good local beer is to be obtained, 170 SPECIAL DIETETICS OF HEALTH. but landlords seem to object to its being publicly used as a bev- erage. We ought to insist on our rights as tourists on this point. In apple districts, cider is usually placed on the table gratis, and makes a good substitute for doubtful water. The water is very apt to disagree with tourists, especially in volcanic, basaltic, mountainous, and marshy districts. A pocket filter is a great protection, and boiling the water makes all organic matters harmless, and gets rid of the greater part of the lime. But neither of these expedients removes the neutral and alkaline salts, which will sometimes act as a purgative. In almost all country places out of England it is impossible to avoid the greasy dishes which are apparently preferred by all ex- cept our own countrymen. And a frequent consequence is rancid indigestion, with nauseous taste in the mouth, and flatulence or diarrhcea. A few drops of vinegar or lemon-juice, and a little cayenne pepper in the plate are the readiest correctives. Another article of cuisine that offends the bowels, if not the palate, of Britons, is garlic. Not uncommonly in southern climes an egg with the shell on is the only procurable animal food with- out garlic in it. Flatulence and looseness are the frequent results. Bouilli, with its accompaniments of mustard sauce and water- melon, is the safest resource, and not an unpleasant one, after a little education. By special favor potatoes can usually be obtained boiled with their jackets on (en chemise), but unless asked for are seldom pro- duced. Raw ham, which some persons seem to find a luxury, will be avoided by all sane travellers who have heard of the frequency with which it is infested with live measle-worm and trichina spiralis. It is a great convenience to be able to eat olive oil, which is much wholesomer than doubtful butter in warm climates ; and those who care for the future comfort of their sons and daughters will accustom them to the taste in youth, instead of encouraging a daintiness in this particular, as I have seen done. Repugnance to the flavor of goat's milk ought to be got over by those who ever intend to frequent lands where the pasture will not support cows. A preference also for boiled milk, or milk that has been boiled, is a safe fancy to indulge, where you are not acquainted HINTS FOR TRAVEL. 171 with the yielder of the liquid, especially when typhoid fever is rife. Irish peasants scarcely ever drink it raw. On the Continent the household bread is usually unwholesome and nasty, and captain's biscuits are never to be obtained. It is prudent to carry a store of them for use whenever the staff of life is especially abominable. This does not apply to Spain, where delicious white, firm, fine-grained bread can be procured in places where it is the only thing eatable by a dainty person. A small tin of the usual tea employed at home is well worth the space it occupies. " Liebig" is procurable in almost every civilized town, and a small store may be laid in when rough cookery is expected. A knowledge of simple methods of preparing food is often a great comfort to a traveller. A friend of mine was once consid- erably nonplussed in Norway, after he had bargained for some lamb, by having the animal handed over to him bleating, with a request that he would return the skin in the evening. The task was accomplished under difficulties, but the details are unpleasant. This is an extreme contingency, which need not be provided against by all vacation barristers acquiring the art of butchering ; but still it is worth while to learn in your own kitchen how to prepare an omelet, fry fish, eggs and ham, cut and grill a steak off a joint, boil and fry potatoes, scrabble eggs, mull wine (if it happens to be sour), boil coffee, make " Liebig " into good soup, etc. These accomplishments may be brought into play without wandering very far from home ; and it is astonishing how popular they render those sometimes troublesome fellow-travellers, the ladies of the party. Travellers, otherwise strong, are apt to get diarrhoea occasion- ally, partly from the unaccustomed diet, partly from the water, but very frequently also from the pestiferous state of the provi- sions for daily retirement in Continental inns. It is worth know- ing that in many places, especially in France, the landlady has a small private establishment of her own, quite unobjectionable, of which she will lend the key to favored guests, especially Britons. In country places gentlemen will do well to worship Cloacina sub Jove. For this sort of mild dysentery will keep recurring again and again, easier induced by having occurred before ; and not un- 172 SPECIAL DIETETICS OF HEALTH. frequently it will leave traces of imperfect digestion in the bowels for weeks after returning home. As a provision against accidental diarrhrea it is wise to be pre- pared with some chalk and opium powders (Pulvis Oretce aromati- cus cum Opio, Pharm. Brit.} made up in 20-grain packets, in thin gutta percha or oil silk, to keep them dry. In northerly lat- itudes half a packet, containing J grain of opium, can be taken after each relaxation. But in warm countries a more efficient, at least a more permanently efficient remedy is to be found in lemon- juice. The patient should lie down flat, and keep sipping a mix- ture of half and half lemon-juice and water, or simply sucking lemons, till the symptoms have ceased, which will soon be the case. The nausea and narcotism induced by opium are thus avoided, and there is no danger in taking an excess of the fruit. It is a good thing to get accustomed to the acidity of the flavor, for there is nothing so wholesome and convenient as a drink. Travellers in countries where the atmosphere is very dry, as in the vicinity of the Mediterranean, sometimes lose their appetite for breakfast from want of sleep. This inconvenience may be overcome by soaking a sheet or some towels in water and spread- ing them out on the floor of the bed-room, so as to diffuse moist- ure through the air breathed during sleep. Long days' rides, especially in the heat, are liable to bring on an inert or semi-paralyzed condition of the stomach, so that if a full meal be taken immediately it remains undigested, and is frequently thrown up again. This may be prevented by a rest and a hot bath between getting out of the saddle and sitting down to table. If these cannot be had, it will be best to eat something very light, such as soup, eggs, bread, and in small quantities, and to make up the deficiency next day at breakfast and luncheon, which should be always the solidest meals in journeys of this sort. Boils are sometimes very troublesome to equestrians. A small piece of nitrate of silver ought to be carried in the baggage, and on the first tenderness, redness, and hardness of the skin, the part should be damped and the caustic crossed twice over it. The ob- ject is not to make the cuticle rise in a blister, but to contract and render insensitive the cutis. This will usually cause the boil to die away. Pedestrians will do well to make a good breakfast before start- HINTS FOR TRAVEL. 173 ing, however early the hour may be. If tea or coffee are not relished on account of the time being so unusual, beef tea or soup will be found an excellent substitute. If prepared over night, they are easily warmed up in the morning. Advantage should be seized of every day of rest to feed well, and fatten up as much as possible. This does not put the body out of training, but in fact keeps it in a condition fit for continu- ous exertion. Beer, wine, and spirits should be avoided altogether during the day's work, but water, cold tea, or lemonade may be drunk ac- cording to thirst. An occasional pipe of tobacco seems to palliate better than anything else that dryness of mouth which constitutes false thirst. This false thirst naturally arises during exercise in a rarefied air, but in mountainous places it is often aggravated very much by eating snow or ice. Spring-water, though scarcely over the freezing-point, does not seem to have the same unpleasant effect. Sea-voyages have a powerful curative effect on some invalids, but they do not generally bring healthy persons into very good condition. If it is calm, landsmen overeat themselves, take too little exercise, sleep badly, and get their bowels constipated. If it is rough, they suffer from sea-sickness and the increased badness of ventilation below. The remedies for these things, so far as they are remediable, are obvious. Short sea-voyages do nobody any good, and a few people a great deal of harm. They are an inevitable evil for all islanders who wish to enlarge their ideas. Sea-sickness may, however, be considerably palliated by rational preparation for it. In the first place care should be taken to finish all preliminary arrangements as long before starting as you can, so that a day or two may be given to rest and a temperance somewhat more than usual. If the eyes or skin are dingy and yellow, take a purge of aloes or taraxacum. Go on board in good time, so as to secure a comforta- ble post. If it is evidently going to be rough, go below and lie down immediately. If you remain on deck, be very warmly clothed, and especially let no chill affect the abdomen or back. If the stomach feels empty, and still more, if any dry retching occurs, take bottled porter and biscuit spread with a little butter and cayenne pepper which last article, by the way, amply repays 174 SPECIAL DIETETICS OF HEALTH. the space it will occupy in a traveller's pocket throughout a jour- ney, so useful is it on all occasions. Nutritious food should be taken when practicable, but loading the stomach with trash brings on sickness; though truly enough it facilitates the process of vomiting, and prevents the regurgitation of bile, which is always peculiarly painful after dry retching. If the voyage is by night, and sufficiently long to make a night's rest of, say seven or eight hours at least, it is worth while to swallow a full dose of chloral on embarking, and to sleep through one's troubles. But if you have to wake up in two or three hours to disembark, you feel ill all the next day, if not longer. Ice-bags, and all other charms for sea-sickness, have turned out mere trade puffs. CLIMATE. 175 CHAPTER VIII. EFFECTS OF CLIMATE. THE race of man exhibits great powers of resistance to external influences, and is able to occupy a length and breadth of the earth's surface such as is attained by no other animal or even plant. This arises not from any innate bodily strength, but from his being able to accommodate himself by the aid of reason to circum- stances. Thus experience has led to the adoption of very differ- ent dietaries in different regions. An Esquimaux would find much difficulty in growing rice near his home, so he wisely dines on such meat as he can get or on whale-bubbler. A Bengalee could not obtain a supply of flesh food without immense labor, and finds rice grown easily, so he lives almost entirely on the latter. The curiosities of food afford examples of the boldness of man in not being deterred by their repulsiveness to his senses from converting assimilable substances to his use, enough to make the simple reader shudder ; but I do not know that the philosopher gains much knowledge from such recitals. Man learns to swal- low, bon gre, mal gre, whatever contains aliment, and the art of living lies in the learning so to eat it as that it shall serve his turn. Climate influences diet mainly by the supply it affords. In most warm countries there is an abundance of starchy and sugary food, and but little animal. How shall this existent pro- vision be made most available for the prolongation of life ? Let us refer back to the principle on which were reckoned in the first part of this volume the requirements of the body for its daily work (p. 21), and draw the obvious inferences therefrom. The diet is, in hot countries, perforce one that entails the loading the digestive organs with a great excess of carbon in order that enough nitrogen may be obtained. In the first place, therefore, the car- bon should not be in too rapidly digestible a form. Starch and vegetable fibre, as supplied by grain and green food, are better than oleaginous matter in warm climates ; for while the former 176 SPECIAL DIETETICS OF HEALTH. only overloads the intestinal canal, the latter overloads the blood and tissues with useless and deleterious products. Then, it is essential that no frequent calls should be made for unusual exer- tion : the muscles and nerves must not be worn out, for the mate- rials of their repair are few. Moreover, the supply of food must be continuously copious and accessible ; for starvation is badly borne by him who is hanging on to life " by the skin of his teeth." No sudden changes must be made in the dietary, even in the form of the vegetable food ; for a new article is with difficulty digested by an unhabituated stomach, though it should be perhaps more ordinarily digestible than the usual nutriment. This is not the case with meat-eaters, who can bear change much easier from one kind of flesh-food to another. The English reader's interest in his fellow-subjects will natu- rally suggest to him the important bearing which these consider- ations have on the duties of both government and individuals towards the inhabitants of our Indian possessions. Our first busi- ness is to keep them alive at whatever cost to ourselves; and the next to render them as little dependent as possible on the accidents of drought, flood, and other unfavorable contingencies of season, partly by storing grain, and (what is infinitely more important) water, the means of producing grain, from one season to another. Tanks, artificial lakes, irrigation works, and roads, stamped with the latest improvements of modern science, will preserve the memory of our rule when the bronze statues of our leaders are as unintelligible as the Memnon. Who cares for, or knows of, the martial exploits of the Pharaohs ? Yet their successful efforts for regulating the food supply of Egypt preserve fresh, forever, our grateful remembrance of them. The heaven of nations is in the hearts of men. Again, we must not expect to get work ouc of vegetable-feeders in return for our bounty. If required to exert themselves in any unusual way, when food is deficient, they simply die. The reason is evident : they have been living on their own tissues, and the small quantity of albuminous matter in grain is a long time in building them, up again ; so that for weeks or even months their muscles are in a state of atrophy. A broken watch must be re- paired before you call upon it to go. CLIMATE. 177 Also, any variations made in the nature of their food must be very gradual and well considered. Still, there is no impossibility in the gradual introduction of changes, at least in the preparation of food. Some method might be popularized of augmenting the proportion of nitrogenous matter in the dietary by mechanically reducing the carbon, such as pro- duces in Italy the highly nutritious macaroni. Starch is readily washed out of the grain, and is itself a valuable article of com- merce for industrial purposes, as well as being capable of conver- sion into more digestible substances for use as food. Also the separation of starch and the storing it in a form less liable to de- composition and the ravages of insects than ordinary grain, would be a great source of safety to a graminivorous people. I had a striking illustration of the different values of vegetable and animal food a few years ago in the case of a robust Hindoo gentleman, who habitually lived on rice and vetches, which he imported himself from Bombay, and had cooked by a servant of the same faith as himself, so that his meal should not be defiled by the touch or even the look of a Christian. The said servant went holiday-making to Greenwich, got drunk and into the lockup, so that his master had an involuntary fast of nearly two days. And- then he was so weakened that the labor of opening his letters brought on hiccough, vomiting, and extreme depression, so that he could not take food when, at last, he obtained it. The mention of beef tea was an abomination to him; he said,, his an- cestors had not put in their mouths animal food for 6000 years, and he was not going to begin. But when the abominable sub- stance was craftily introduced to the other extremity of the diges- tive canal, it seemed to flow directly into his veins, which filled with blood, and he was well. The absorbents had clearly not lost their natural habits by disuse for so many generations. Where the circumstances of a country are such that plants suit- able for food cannot be grown, while there is a sufficient supply of animals to nourish the population, the inhabitants are hardy, enduring extreme cold and heat, and capable of violent physical exertion. But steady daily labor wears them out, and is abhor- rent to their feelings. We may instance, as under several varie- ties of temperature, the Esquimaux, "the Indians and half-breds of the Pampas, the Tartar hordes, and the Arabs of the Nubian 12 178 SPECIAL DIETETICS OF HEALTH. Desert. These nations of meat-eating hunters and herdsmen are mightily strong and prolific, and have fulfilled to them the prom- ise made to the sons of the wild Sheik Jonadab, of never lacking " a man to stand before the Lord forever." But that is only so long as they follow their ancestral traditions, and retain habits suited to none but sparsely inhabited lands. When the inevitable tide of civilization overtakes them, and they become cultivators and craftsmen, they fall under the natural laws of population and take their chances with the rest of mankind. Often, indeed, the day goes against them in the fight of innovation, especially if it has been sudden ; they fade away childless under our very eyes, like that vast American tribe of which, it is said, the only rem- nants are a chief, a tomahawk, and six gallons of whisky. The only possible remedy for this terrible state of things is beef. Our progress is progressively poisoning off our weaker brethren ; we are no more to blame for it than we are for crushing the harmless beetles and daisies that lie in our path. Still, we are bound in mercy to tide them over the struggle, to let them assimilate gradu- ally with the more civilized world. Hunters should have facili- ties afforded them of becoming herdsmen, and, in course of gener- ations, from herdsmen, farmers, and gardeners; for the immediate transition from a purely animal to a principally vegetable diet, though borne by the individual, is fatal to the race. The action of climate on diet seems to be affected by the food produce which it enables the soil to bring forth. The fixed in- habitants grow accustomed to it, and, according to the law of the survival of the fittest for the peculiar circumstances, are prosper- ous and prolific as a race, and healthy as individuals, while fol- lowing their ancestral habits. But that historic fact does not at all show either that the diet is the best abstractedly, still less that it is the best suited to foreigners. It seems absurd to argue that the inhabitant of the Polar Circle lives on fat animal food because it is so cold, and, at the same time, that the burning plains of the Pampas are a reason for thriving on flesh and water only; or that the climatic circumstances of North Norway and Southern Spain are the cause of the inhabitants living almost entirely on bread. The best diet in the abstract is a mixed diet, and mixed in the proportions selected by the experience of the most civilized nations. And it is also the best for the individual who is accustomed to it CLIMATE. 179 to adhere to, under whatever sky he may be wandering. The higher the health he enjoys, the more nearly he approaches to the true aim of being in training, the better he is able to resist the adverse circumstances he may be subjected to. Experience does not justify an agreement with those dieticians who desire us to alter our commissariat in accordance with the example of those among whom we dwell for a season, or in obedience to the ther- mometer, and M. Cyr is indubitably wrong when he blames Britons for "retaining their customary substantial regimen under other skies and in hot countries." 1 In India and in Africa our soldiers suffer from fevers, ague, dysentery, and are liable to contract cholera and other epidemics. But the camps of our foes are usually still more severely ravaged at the same time; and it is observed that those suffer least who continue the habits of sensible men at home. Inflammations and degenerations of the liver also afflict our countrymen in the East, and a certain proportion of this evil is due to intemperance, as it is in England ; but the great majority of the cases are traceable to the consequences of malarious fever. It does not appear that those who make a rational use of alcohol, as they would have done at home, suffer more than the abstinent. The principal thing to be remembered is that as the outgoings of water by skin and lungs are very great, the ingoings must be great also, and therefore that the fermented drinks must be taken in a dilute form, otherwise, thirst will cause an excess of stimulant to be consumed. This ap- plies equally to the warm summers in dry temperate climates, such as Italy, as well as to tropical regions. The object of attention to diet in unaccustomed climates should be to accommodate to the demands of the system the food which can be obtained, and to which we are obliged by necessity to re- strict ourselves. If starchy food is to be got, solely or mainly, a great deal of it must be eaten, and the digestion of this unusual mass is facilitated by being taken alone -and not mixed with meat; and the meat, when it comes to hand, should form a separate meal. Thus the full force of salivary digestion is brought into play. In- voluntary vegetarians are apt to starve themselves from want of inclination towards the flavorless viands. They should be warned 1 Traite dc 1'Alimentation, p. 221. 180 SPECIAL DIETETICS OF HEALTH. of the danger of this. If nothing but animal food is within reach, again, still more is it imperative to eat largely, if the body is to be preserved in its integrity, as has been argued in a previous chapter (p. 21). Sir John Koss found the Esquimaux devour- ing about twenty pounds a day of meat and blubber. And his experience among his own men leads him to urge the desirability of acquiring, previously to a contemplated winter residence in Polar regions, a taste for Greenland food, the large consumption of it being the true secret of life in those frozen countries. " The quantity of food," he says, " should be increased, be that as incon- venient as it may." 1 Again, Sir Francis Head, in his famous journey across the burning plains of the Pampas, where beef and water were the only victuals to be had, got himself into magnifi- cent condition, not by dint of the limited slices of civilized society, but by eating flesh, morning, noon, and night, liberally. 2 Under both circumstances the addition of a small quantity of vegetable food would have rendered needless the excess of nitrogenous ali- ment. When the Englishman is in foreign countries it is more neces- sary than at home to pay that attention to diet which will insure the highest attainable health and condition. For to his constitu- tion, at any rate, if not absolutely, every place is less healthy than England. Plagues of all sorts, terrestrial and celestial, beset his path, and he must walk warily if he would return sound. Per- haps, at home he may have lived carelessly, and been lucky enough not to suffer, but he cannot hope for the same good fortune under less favorable auspices. This caution is not required by the sensible readers of these pages, but it may be useful in its ap- plication to their less wise dependents and clients, who, in coun- tries where one is always thirsty and there is abundance of drink, are as apt to yield to temptation as in England. The punishment of stupidity is surer and heavier than they are led to anticipate by former experience. Exercise and clothing should be accommodated to the food. We should not in these particulars copy the manners of natives any more than we do their dietary. Active muscularity and field 1 Boss, Second Voyage for the Discovery of the Northwest Passage, p. 413. 2 Head's Journey across the Pampas (1828), CLIMATE. 181 sports render the body less likely to suffer from the solar and ma- larious influences to which they, to a certain extent, expose those who pursue them; and the simple precautions of keeping the skin dry and warm after exertion, and of taking small preventive doses of quinine, will make these healthy pleasures nearly as safe in the tropics as in Europe, times and places of extraordinary risk being avoided. In the selection of fit persons to undergo, with safety to them- selves and others, exposure to extremes of either cold or heat, the surest guide is their power of gaining weight and condition under a course of training. These are not always persons of the biggest muscles and bones; indeed, a moderately sized frame is the tough- est as a rule. Sheer pluck will sometimes enable a most unfit subject to pass undetected through tests of endurance; and doubt- less such a temper is valuable in a colleague; but it will not sup- ply the place of hardihood. The surest proof of hardihood is im- provement under training. As the women desiring to undergo bodily hardship are more exceptional than men, so is it all the more necessary to test them thoroughly. Their desire is almost always the self-sacrifice of love ; but they do not wish to burden others with bitter memories or to injure the object they profess to aid, as happens if they break down. The world has less direct claim on their assistance, and therefore they should not offer it without being sure that it is really worth having. This specially applies to the wives of mis- sionaries, travellers in new countries, emissaries to barbarous na- tions, and the like. They are of incalculable service while sound, but a serious impediment when sick. Their enduring courage may be taken for granted, as it is proved by their volunteering. But unless they grow in strength and weight, or at least preserve their weight, under a course of training, their place is home. The standard chapter in dietetic treatises on the due influence of the seasons on the selection of food in temperate climates does not exhibit any practical contributions of science. We hardly re- quire to be told to indulge more in weak potations in July than in December, or to eat a better dinner when our appetite is braced up by a frost. Some of their refinements remind one of the dan- dies in Imperial Rome who wore heavy finger-rings in winter and light in summer, and are beneath the notice of a healthy man. 182 SPECIAL DIETETICS OF HEALTH. Some are positively repugnant to experience, as, for example, the recommendation to keep out the cold by eating sugary and starchy dishes, on the ground that they are producers of heat by combus- tion. The loss of heat by evaporation makes it quite as necessary to sustain the temperature of the body in summer as in winter, and the same amount of force has to be elicited; so that, as a mat- ter of fact, meals of bread and pastry and sweet fruits are more seasonable in warm weather than in cold, for they cause less fever- ishuess and excitement than meat does. The succession in their due season of .marketable articles affords a sufficient guide to their selection. As an almost universal rule they are wholesomest when cheapest, if the simple directions given already for securing their soundness and freedom from adulteration be adhered to. Sir James Clark 1 remarks that " change of air is not more val- uable as a remedy in the cure of disease and its consequences, than as a preventive of disease, more especially in childhood and youth." It is upon the appetite that its effect is first marked, and no doubt this is most prominent when the change is from an impure to a purer air. Yet I have known the mere change alone to have a beneficial influence, as, for instance, a removal for a time from the seaside or the fresh breezes of the Worcestershire hills to London. Observation does not incline me to have faith in the doctrine of acclimatization. It seems to me that a long residence in a climate, instead of rendering it more salubrious to the resider, makes it less suitable in close proportion to its length. I cannot at all join Claudian in his praise of the old man of Verona, who attained the age of ninety without ever going out of the suburbs. 2 He used his natural toughness to set a very bad example to his neighbors ; and if many followed it, I am sure some must have suffered in mind and body. In choosing a place of education for children, it is desirable that the climate should be decidedly different from that enjoyed at home during the holidays. Denizens of the stagnating, oft- breathed atmosphere of a metropolis will do well to select a coun- try school ; dwellers on the high ground of central England will find what suits them best on the coast ; while both the seasiders 1 Cyclopaedia of Practical Medicine, i,49. 2 De sene Veronensi epigramma. CLIMATE. 183 and country folks may venture, without risk of deterioration, to .-(cure for their growing families the many advantages of instruc- tion in a town. Clergymen whose health is below par and even verging on dis- . will often gain wonderfully by a mutual exchange of duty, provided the climates of their several spheres are different. Satirists say that parsons' livings always disagree with them ; and there is a strong spice of fact in the statement ; it is not fancy*, but a real stagnation, from monotony in their aerial and other surroundings. The remedy is easy and cheap, but the physiological.conditions of it should be clearly understood. It would be a profitable subject for bishops and archdeacons to dilate upon in their charges, as it is quite as important to the public that clergymen should be kept in repair as that churches should be so attended to. 184 SPECIAL DIETETICS OF HEALTH. CHAPTER IX. STARVATION, POVERTY, AND FASTING. / Starvation. THERE has always been a certain amount of importance attached to the diet and regimen of the sick, but not till the present gene- ration do we find any notice taken by men of science of the conse- quences to the healthy, of its insufficiency or imperfection. The remarkable researches of Chossat on Inanition 1 form the first im- portant work published on this point. The results deduced by this physiologist from his experiments have only been confirmed and expanded by later observers. The first and most important principle established by Chossat is that absolute deprivation of food and deficiency of food are phys- iologically identical in their action on the animal life. One acts quicker than the other, but the diiference is merely one of dura- tion and degree. Both are equally fatal in the end, if not inter- fered with ; and the end in both is regulated by the same law. Death arrives when the body has lost T 6 of its weight, whether that happens after days, or months, or years. The loss of temperature is a feature common to and identical in both. Starvation or abstinence proved almost always fatal, in Chossat's observations, whenever the animal warmth fell to about 76 (Fahr.) in a red-blooded creature. The importance of the loss of temperature was shown by the fact that a renewal of con- sciousness and nerve-power could be effected, even from the torpor preceding death, by the application of external warmth. This fact affords a most valuable hint for the management not only of absolutely starved but of poorly fed individuals. The sensations of hunger need not be described. After a time these are appeased, and are succeeded by a working and a grum- bling and a dull aching in the small intestine. Then the secre- 1 Chossat, sur 1'Inanition, Paris, 1843. STARVATION POVERTY FASTING. 185 tions of the abdominal canal diminish and finally nearly cease. Digestion becomes more and more difficult, the longer the absti- nence. In fact, an insufficient diet is not only hurtful imme- diately, but it brings on an additional danger which acts in the same direction, namely an impediment to absorption. The ap- petite falls off, and it is only from habit that the sufferer is induced to seek the food for want of which he is perishing. There is absolute constipation, as may be daily noticed in hys- terical subjects and others who do not take nutriment. And the forcible relief of this constipation by drugs makes matters worse, as we may also observe in the same hysterical subjects under foolish maternal discipline. The breathing goes on gradually getting slower and less deep. In a case of starvation for twenty-four hours, Dr. Smith found the exhalation of carbonic acid fall from 34 ounces per diem to 22 (Philos. Trans., 1859). Fasting ecstatics hardly seem to breathe at all ; and if you watch at rest a London needlewoman, or pau- per before she goes into " the house," the motion of the ribs can- not be seen, so little air does she draw in. Contrasted with this is the gasping rapidity with which the respiratory muscles act when forced exertion sets them in motion. The alterations in the blood consequent on insufficient food de- pend on whether there has been a deprivation of water or not at the same time with solids. If there has, strange to say, the pro- portions of the ingredients of the circulating fluid are not affected, but the whole quantity is diminished. In animals starved to death, three-quarters of the blood was gone. But where water is abundant, and the starvation gradual and not immediately fatal, it is easy to see by the coloring of the lips that the change consists in the dilution of the nutrient stream with aqueous fluid. In a ghastly picture exhibited at the last season of the Royal Academy (1874), " The Door of a Casual Ward," it was singular to notice how the secret of the weird and true effect of color lay in the omis- sion of vermilion from the flesh tints. This abstraction was natu- ral, for the reason that it was an imitation of the inner work of nature, not of the mere outside. The nervous system shows how it suffers from inanition by gid- diness, fainting, hallucination, and delirium. During sleep the dreams are most characteristic, presenting wondrous scenes of fes- 186 SPECIAL DIETETICS OF HEALTH. tivity and sensual enjoyment. Lately Mr. Parrot 1 has believed he has traced to inanition certain tissue changes in the nervous system, as well as in the other viscera, which would appear to be the material expression of the functional derangements first named. In an account by Mr. Brett in the " Medico-Chirurgical Re- view " (1841) of the denizens of the Indian prisons at Moor- shedabad, Cawnpore, and Shahjehanpore, one of the most notable results of insufficient food was a peculiar glassy appearance in the eye followed by inflammation and ulcer of the cornea, a copious secretion of tears and from the Meibomian glands, and finally blindness from destruction of the eyeballs, and death by emacia- tion. Strange to say, these dreadful symptoms in such a sensitive part were accompanied by no pain. The same phenomena were observed long ago by Magendie in dogs starved to death by dep- rivation of all nutriment, and they occur also when gelatin only is supplied. Among the poor, especially among children badly fed, very similar affections of the eyes are frequent. They rarely, however, go on to the lengths mentioned above, for the sufferers come under medical care, are sent into hospitals or parish infirmaries, and are reinstated with nourishing diet. A recognition of the true origin of many ophthalmic epidemics in reformatories, pauper nurseries, and such-like collections of infantile weakness is very necessary to be impressed upon the managers of those institutions. Not being medical men, they are prone to apply, universally, princi- ples of regimen suited only to their own over-fed nurseries, and to cure all inflammations by restriction, till they discover their mistake by sad experience. If the lack of nitrogenous food is too prolonged, since it is the blood which is subjected to the greatest drain, and since in fat persons the blood errs by defect rather than by excess, inanition can exist while the body still retains its fat. In the case of the Welsh fasting-girl 2 the body was found after death plump and 1 Compt. rend., Acad. des Sciences, 1868, t. ii, p. 412. Dr. Brown-Sequard calls this Steatose interstitielle diffuse de 1'encephale. By long-lasting in- sufficiency of food the brain is more or less converted into a suety substance. 2 This was a case of notorious imposition, which the daily papers in 1869 detailed very fully. The parents made a show of her, decking her out like STARVATION POVERTY FASTING. 187 with a considerable quantity of adipose tissue upon it, though the jury was quite right in finding that she was indubitably starved to death. This is a fact of great importance in practice : one must be very circumspect in starving or bleeding a stout patient ; doubtless the store of adipose tissue may serve partly to nourish him, but it will not keep him alive. In our treatment of the poor we must apply the same reasoning, and not suppose that be- cause a client, especially in old age, is fat, that he is therefore in good case and capable of bearing restricted diet. Jailers have sometimes attempted, really more from mistaken kindness than harshness, to "tone down" an obese prisoner with- hard fare; and the consequence usually is that the country is put to the expense of sending him to the infirmary. "When entirely deprived of nutriment we are capable of sup- porting life for little more than a week. The Welsh fasting-girl lived for eight days from the commencement of the time she was carefully watched. But so many circumstances influence the amount of resistance which the body can exhibit, and make it vary so much, that no practical importance attaches to the theo- retical limit of possible existence. One thing which remarkably prolongs the duration of life is a supply of water. Dogs furnished with as much as they wanted to drink were found by M. Chossat to live three times as long as those who were deprived of liquids and solids at the same time. Miners who have got shut up in damp headings have experienced much relief by getting moisture from the walls of their prison. Even wetting the skin with sea-water has been found useful by shipwrecked sailors. The fact is water is a food, necessary to the building up of the body, and I think a great mistake is made when we caution the underfed against a free use of it. And, a bride on a bed, and asserting that she had eaten no food for two years. Some reckless enthusiasts for strict truth set four trustworthy nurses to watch her ; the Celtic obstinacy of the parents was roused, and in defence of their imposture they allowed death to take place in the usual time which it does after total deprivation of food. They were found guilty of manslaughter with perfect justice, for the law rightly supposes everybody to know that a human being without food must necessarily die. There was no need to prove the fact by a cruel experiment, and to visit a poor crazy swindler with the pun- ishment of death. Thus to take the moral government of the universe into private hands is quite unjustifiable. 188 SPECIAL DIETETICS OF HEALTH. moreover, water prevents that concentration of the circulating fluid which impedes absorption, and which is a serious hastener of fatal results in those who have not enough to eat. Though, as was before noticed, a certain amount of fat on the body does not prevent the blood from being impoverished, and by its impoverishment leading to injurious results, yet fat is a con- siderable protection against starvation. The old tale of the pig which was buried by the fall of a cliff at Dover, and was dug out alive after 160 days, as recorded by Mr. Mantell, the naturalist, sixty years since, in the " Transactions of the Linnean Society " (vol. xi), is a standing case to cite. The loss of substance, amounting to three-quarters of the entire animal, is probably an exaggeration, as the weight previous to the imprisonment is esti- mated by guess ; but still the duration of the starvation, palliated only by the moisture which oozed through the sides of the sty, is very remarkable, and may certainly be taken as evidence of the protection afforded by the adipose tissue. Life can be supported by a very minute quantity of food as long as complete inactivity of body is maintained. But under such circumstances the slightest exertion will bring on a fatal result. I attended for a long time a surgeon whose power of swallowing was completely lost by cancer of the esophagus. He was cheerful and happy as long as he lay in bed, but at last dur- ing my absence from London, he thought a trip to Greenwich in a steamer would be an agreeable change, and died immediately after the exertion. An even elevated temperature and the exclusion of the sun's rays, as in the "dim religious light" of a closed bed-room, will enable life to go on slowly for a marvellous period ; as in the case of ecstatics, fasters, hysterical and insane persons. But if these are suddenly routed out, mentally excited, and forced to live like other people without due preparation, they die in spite of the soundness of all their organs. It is the same with convalescents from acute fevers, if they are injudiciously roused to mental or bodily activity. Sex seems to have no appreciable influence on resistance to de- ficient diet. But it is not so with age. It is an observation of the rough old times when famine was oftener seen (and therefore STARVATION POVERTY FASTING. 189 \ve may trust Hippocrates) 1 that the younger a human being is, the easier is it starved, till we come to extreme old age, when the powers of life are considered by some physiologists, Celsus among the number, to give way quicker under famine than those of mid- dle-aged men. However, there is no difference of opinion as to its effect upon children. Very large is the number of victims to this law of nature, and Malthusian optimists may admire its equity in balancing population and food. Nevertheless, so long as wide tracts of the earth lie uncultivated, we may not impru- dently suspend its operation as much as we can. Dispensary and parochial practitioners are sadly familiar with a mass of infantile sickness and death which they classify on paper to a certain ex- tent, under heads prescribed by the Nomenclature of Disease, but which appeals to their hearts by its real terrible name " Starva- tion." Europe is deeply indebted to M. Parrot for the bold out- lines with which (in the "Archives de Physiologic" for 1868) he sketches the condition in which an innumerable army of speechless martyrs are found in the great centres of civilization. " In these little creatures," he says, " we see the functions growing weaker and weaker with extreme rapidity, though in a gradual manner. The temperature, often lower in the interior of the body than in the axillae, falls below 92 (Fahr.) and is never above 95. (We all know what 'blood-heat' is.) Usually not more than 90 beats in a minute can be counted in the pulse ; once the number was over 100, in another case it was below 64. The respiratory movements were less frequent than in the normal state and often very weak. The cries, which in some were at first in- tense and prolonged, ceased little by little. The secretions, always scanty, ended by disappearing ; more than once the napkins put on in the morning were taken off in the evening unsoiled and dry. The skin, rigid, dry and cold, often oozed out a serous fluid, es- pecially in the dependent parts of the body. Motionless in their cradles, icy cold, with the face livid and drawn, as if they were mummied, these still living babies looked like corpses. The beating of the heart could not be heard, and were it not for an occasional 1 Aphorism xiii. Hippocrates does not define who are the yipsvrt:, who he says bear starvation bestj but as an Ionian he would probably include all over 45. 190 SPECIAL DIETETICS OF HEALTH. movement of the breath at long intervals, it would have been thought that a body some time dead lay under the eyes. In very truth, death had already taken possession, slowly indeed, and as it were molecule by molecule, but with a sure and fatal grasp. . . The death of these children is due to starvation ; and the diseased appearances revealed by a post-mortem examination, should be looked at not as the cause of the malady, but as its inevitable con- sequences." A common symptom, in children, of a diet deficient in nutri- ment is diarrhoaa. It assumes, when severe, the dysenteric type, streaks of blood appearing in the light green, mucous evacuations. And so it gets entered in the register as "dysentery" or "inflam- mation of the bowels " or " enteritis." But it does not appear to be contagious or epidemic, like the dysentery of camps ; and in hard times may be observed confined to the children of a district, to the children in arms, even, according to the mode in which the pressure of scarcity falls on the population. Yet the suiferers are probably neither deliberately, nor com- pletely, perhaps not even knowingly, deprived of nutriment. Evil is wrought By want of thought, As much as by want of heart. Ask what they are fed upon, and compare it with what rational experience prescribes, controlled by the universally spread teach- ings of physiology, and you will see immediately that the dietary errs in not containing the essentials of existence. The food is not, strictly speaking, unwholesome, but it errs by defect. It is not food at all. Reference to Chapters I, and II, 1 makes this clear. It is there pointed out what children should eat, and everything else is what they should not. Not only youth, but health and vigor render the body less tol- erant of abstinence. Invalids bear it better than strong people, with a few special exceptions. Such of us as have passed middle life cannot but remember, during the old reign of depletion and restriction, when for fear of victualling the disease they famished the patient, instances of the extreme toughness of the human race. 1 Pp. 125 and 134. STARVATION POVERTY FASTING. 191 Among the sick, not the sound, these instances are recollected. It is an act of mercy, when, in sieges, in shipwrecks, and such- like disasters, meat and drink are scarce, to supply those on the invalid list first and most bountifully no doubt it is an act of mercy, and to the honor of mankind will probably always be done but the physiologist must pronounce it highly imprudent and far from being conducive to final success ; for the vigorous and active, whose blood is circulated rapidly, and whose muscles are in constant movement, -really suffer most, not only in feeling, but in their future health and strength. In order to preserve life as long as possible where sufficient food for subsistence cannot be obtained, our aims, then, should be to secure water, warmth, and complete inaction of the muscles. The direst famine does not necessarily exclude these preservatives, and in the more insidious scarcities whose effects are noticed chiefly in children, we can very often readily get as much of them as we want. In the apportionment of a spare supply, the youngest should have the nearest approach to a full ration, the active men and women the next, and the invalids and aged the scantiest allow- ance. So is distributive justice best satisfied. It is a strange thing, and one which at first sounds paradoxical, that the supply of the stomach even from the substance of the in- dividual body itself should tend to prolong life. A case of star- vation for twenty-two days in an open boat was recorded in the periodical prints last spring (April 30 and May 1, 1874) in which the poor victims fought in their delirium, and one was severely wounded. 1 As the blood gushed out, he lapped it up; and in- stead of suffering the fatal weakness which might have been ex- pected from the hemorrhage, he seems to have done well. I would not build much on the rough memories preserved during such awful sufferings, were it not for the support afforded by some ex- periments by a French physiologist, M. Anselmier, to whom the idea occurred of trying to preserve the lives of some dogs by what he calls " artificial autophagy." He fed them on the blood taken from their own veins daily, and he found that the fatal cooling 1 Three rnen and two boys were out for 32 days with only 10 days' provis- ions, exclusive of old boots and jelly-fish. 192 SPECIAL DIETETICS OF HEALTH. incident to starvation was thus postponed and the existence con- sequently prolonged. Life lasted till the emaciation had proceeded to T 6 of the weight, instead of T 4 , as in Chossat's experiments, and was extended to the fourteenth instead of the tenth day, which was its limit in those dogs who were not bled. 1 It is not likely that anybody will feel himself called upon to repeat M. Anselmier's dreadful experience, but no one of us who run to and fro in the earth is secure from the possibility of ship- wreck, or being buried alive, say in a mine or railway cutting, and thus involuntarily contributing a self-sacrifice to that knowl- edge which may save the lives of others. For one famished crew that is picked up, there are found dozens of empty wrecks, of which it is never known how the once living freight fared ; and for each empty wreck there are dozens which have left no trace. The prolongation of life without provisions is by no means a mere speculative discussion. Were I in such a strait as above referred to, my reason would counsel me, and I hope I should have the courage to wound my veins and suck the blood. After starvation, either complete or partial, a sudden return to full diet is not to be attempted. Small quantities at a time of the most digestible food must be given. And the temperature should be artificially sustained till such time as the system is able to gen- erate its own heat, especially in the interior of the body. Table- spoonfuls of hot beef tea and of milk constantly administered ("tea-cup diet"), form the most appropriate nutriment. And it will be much assisted by admixture with a small quantity of pep- sin ; but not too much, or there is risk of diarrhrea. Poverty. The valuable calculations of Dr. Playfair, " On the food of man in relation to his useful work," 2 enable us to arrive at a very prac- tical estimate of what amount of solid victual is required by an 1 Archives Gen. de Medecine, I860, vol. i, p. 109. M. Anselmier conjec- tures that the formation of heat was due to the keeping up of a certain degree of activity in the gastro-intestinal absorption, and the consequent chemical action in the interior of the body, where it would not be lost by radiation. 2 Lecture delivered at the Royal Institution, London, April 28th, 1865, pub- lished by Edmonston and Douglas, Edinburgh. STARVATION POVERTY FASTING. adult living by bodily labor, to preserve his health under various circumstances. The circumstances which chiefly influence the required amount can be classified as follows : 1. Bare existence; 2. Moderate exercise; 3. Active work; 4. Hard work ; 1. The diet of bare existence "subsistence diet" is calcu- lated from the mean of sundry prison diets, of the convalescent's diet at hospitals, that of London needlewomen, and of that sup- plied during the Lancashire cotton-famine, as reported by Mr. Simon. The result is that in a condition of low health without activity, 2| ounces of nitrogenous matter (calculated dry), 1 ounce of fat, 12 ounces of starch, and ^ of an ounce of mineral matters per diem are necessary. The contents in carbon are 7.44 ounces. This, being interpreted, means that a man will die gradually of starvation, unless his provision for a week contains three pounds of meat with a pound of fat on it, or the same quantity of butter or lard, two quartern loaves of bread, and about an ounce of salt and other condiments. If he cannot get the meat, he must sup- ply its place with, at least, two extra quartern loaves, or about a stone and a half of potatoes, or between 5 and 6 pounds of oat- meal unless, indeed, he is so fortunately situated as to be able to get skimmed milk, of which five pints a week will fairly replace the meat. Let it be understood that all these articles must be good of their sort, and contain no indigestible matter or adulter- ant. And there is no economy in substituting for real nutriment things which merely stay the hunger by occupying the stomach for a longer period. The completeness of the digestion is thus in- terfered with, and a morbid derangement of the function induced, which causes part of the food to be wasted. A person brought to bare existence diet can undergo no toil, mental or bodily, under the penalty of breaking down. 2. By moderate exercise is meant the equivalent of some say from 5 to 7 miles walking daily. Dr. Playfair takes as fairly representing the appropriate food of this class the dietaries of Eng- lish, French, Prussian, and Austrian soldiers in a time of peace. 13 194 SPECIAL DIETETICS OF HEALTH. The English soldier on home service, according to Dr. Parkes, re- ceives from government five pounds and a quarter of meat and seven pounds of bread weekly, and buys additional bread, vege- tables, milk, and groceries. Now, such a diet as this is amply sufficient for anybody under ordinary circumstances of regular light occupation. But should extra demands be made upon mind or body, weight is lost, and, doubtless, if the demands continue to be made, the health would seriously suffer. Mr. Buckland, of the Guards, remarks (Soc. of Arts Journal, 1863, quoted by Dr. Playfair), that though the sergeants fatten upon the rations, the quantity is not sufficient for recruits during their drills. 3. Active laborers are reckoned those who get through such an amount of work daily, exclusive of Sundays, as may be repre- sented by a walk of twenty miles. Of this class are soldiers dur- ing a campaign, letter-carriers, engineers employed in field work or as artisans. These habitually consume on the average about a fifth more nitrogenous food and twice as much fat as the last class, while the quantity of hydrocarbons is not augmented, except in the Royal Engineers. 4. Hard work means that which is got through by English navvies, hard-worked weavers, full-fed tailors and blacksmiths. It is difficult to get exact information, but it would appear from Dr. Playfair's estimates that the addition to the diet is entirely in nitrogenous constituents. The higher their wages the more meat the men eat. This neglect of vegetables by the two last classes is in a physio- logical point of view imprudent, and possibly may be a contribut- ing cause of that inordinate desire for alcohol which impoverishes and degrades them. The discovery of the production of force from the assimilations of starch leads to a knowledge, opposed in- deed to old prejudices but supported by experience, that the rais- ing of the energies to their full height of usefulness may be effected by vegetable food proportioned to the increase of requirement, quite as well as by the more stimulating and more expensive animal nutriment. Deficient diet, like all morbid conditions both corporeal and mental, is a vitiating and degenerating influence. Famine is naturally the mother of crimes and vices, not only of such sort as STARVATION POVERTY FASTING. 195 will satiate the gnawing desire for food, but of general violence and lawlessness, ill-temper, avarice, lust, and cruelty. The love of purposeless destruction exhibited by the Parisian communists in our own day may be fairly credited to deficient food. No well-fed people could have wrecked the Vendome column or burnt the town-hall and Tuileries, of which they were so proud. They were like hungry children smashing their dolls. And Thucydides, Boccaccio, and Defoe are all agreed as to the hideous wickedness exhibited at Athens, Florence, and London, during their famine-fevers. The exceptional instances are those where individuals or nations have conquered by courage and self- restraint their natural selfishness, and have made the interests of others paramount to their own. Am I blinded by love of my country, or may I justly quote the history of the Lancashire cot- ton-famine as a case in point? In all physiology there is no more convincing proof of the be- nevolent government of the universe and of its perfecting influ- ence upon our race, than the fact that directly a man begins to care for others in preference to himself alone, his care ceases to wear and exhaust him. It rather seems to be a sustaining force. Observe a lunatic, induced to work hard for some worthy object, he grows fat ; let him sit still and brood over his wrongs, and he dies emaciated. Let a hypochondriac's wife or child fall ill, he is cheerful and well directly; but he relapses as they become con- valescent, and grows as thin and miserable as ever when he turns his attention to his own health. This is the reason why in sieges and famine medical men have often remained sleek and plump, while their neighbors pined, and perhaps also why military offi- cers bear short rations better than the men. Like all divine truths, " to love your neighbor as yourself" is found to be taught by material nature as well as by revelation. 1 Fasting. Fasting is the voluntary restriction of the diet for the express purpose of developing the higher features of the mind. It is " a 1 Professor Maurice well remarks in the preface to his Moral Philosophy that the difference between revelation and discovery is shown by the words themselves to be very slight; one is removing a veil, the other is removing a cover. 196 SPECIAL DIETETICS OP HEALTH. means of grace," and approved as such by religious men of most opposite creeds and diverse nationalities. I am not going to ques- tion their experience, and I should bow to it even if it differed from my own, which is not the case. Like all the material ma- chinery by which the bodily man influences the spiritual man, this " means to an end " not only admits of, but requires frequently to be brought into harmony with, the progress of knowledge con- cerning physical life. And therefore I think that in a manual of this sort mention of it should not be omitted. In the first place, to be useful, fasting must be wholly voluntary. If forcibly imposed even by imperious custom or enjoined as an end in itself, its principal effect is to sour the temper and narrow the intellectual apprehension for the time being. In fact its physiological action is a minor degree of starvation. To secure its being wholly voluntary, it should be private, as advised by the highest authority of all. At the same time that the act is voluntary, the manner of it is best prescribed by another. If the peculiar form and degree of abstinence are self-imposed, they are apt to be excessive, and to do harm without any corresponding advantage. One of the highest mental developments to be expected from fasting is the power of self-control by voluntary effort. If a man finds himself during a fast weakened in his ability to concentrate his thoughts and to keep up his attention, it is doing him no good. If the instinctive appetites, implanted by nature, fail after it, in- jury to the health and individual degeneration follow. For these reasons it is best that the matter on which abstinence is exercised should be rather a luxury than a necessary. It is quite safe for a healthy man to leave off tobacco, wine, or beer, spices and sauces, hot meat, or even meat altogether, or vegetables altogether (if vegetables are a luxury to him), or pastry, or sugar, or butter for a day or two at a time ; especially if he withdraws himself from the bustle of the daily occupations. But it is not wise to do this too frequently, or to let the low diet become habitual. Like all acts of free will, it is most powerful in its effects on the mind when rare, and when it presents the strongest contrast to the usual life. If once they become habits, the spiritual influence of acts ceases. Those who never feast will find a difficulty in advantageously fasting. DECLINE OF LIFE. 197 CHAPTER X. THE DECLINE OP LIFE. EVERYBODY who has passed the age of fifty (or thereabouts) with a fairly unimpaired constitution will act wisely in diminish- ing his daily allowance of solid food. At the " grand climacteric " (as this turn of life is pompously called) the movements of nutri- tion are retarded, and the constructive and evacuating actions of the system being diminished, there is less call for materials of re- pair. It becomes a moral duty to avoid all articles of diet which personal experience has shown to be difficult of solution, to make smaller meals, and, if need be, more frequent meals, so that the stomach may be never overloaded or too long idle. The saving up an appetite for the enjoyment of an abundant repast may be conceded as a harmless folly in our juniors, but it is a shame to a gray head. If custom has made a man a large eater, he should endeavor to " spoil his dinner" by a late luncheon, and to prevent, his appetite being too keen at midday by breakfasting not over early. Very aged people, however, and those who have lost their teeth run some risk of not being sufficiently nourished, from swallow- ing their food rapidly. They are hurried over their meals through the thoughtlessness of those around them, and since they chew slowly and secrete saliva slowly, the food remains undigested. Their juniors should remember this, and govern themselves ac- cordingly. A kindly British matron, who spent more hours at table than was good for her, told me that if she did not do so, she " should be a widow in a week," and that she habitually ate too much to keep her aged husband in countenance. Not a word could be said against such pious gluttony. The dishes of meat should be as soft and tender as possible, and the firmer kinds should be finely cut with a mincing knife. But vegetables should not be over-softened in cooking : there should be sufficient resistance in them to make chewing imperative, so as to excite the secretion of the fluids of the mouth, which are re- 198 SPECIAL DIETETICS OF HEALTH. quired for their solution. Soups and broths are nutritious, but should not contain solid vegetables, except just enough to flavor them. Puddings and pastry are not of much use, and overload the tired stomach. I do not know the authority for the old proverb vinum lac senum, but it seems a very dangerous one, as it may lead our ancient friends to think they may treat it like mother's milk, and measure its benefits by the quantity imbibed. The saying, how- ever does partially embody a truth, namely that in the decline of life the advantages derived from fermented liquors are more advantageous, and the injuries it inflicts less injurious than in youth. The eifect of alcohol is to check the activity of destructive assimilation, the rapidity of that moulting of the body's substance by normal secretion which in healthy youth cannot be excessive, but which in old age exhausts the frame. Alcohol calmly arrests the energies of the nervous system which would fret the tissues to decay, and would seriously weaken them, were not the wear and tear to be continuously replaced by new material. Now, with years, the replacement by nutrition is much diminished, and we, nevertheless, are apt to persist in using our brains as before. We shrink, rightly enough, from being shelved just when the rewards of our exertions are becoming due ; and we do not care to rival the centuries of the olive or the yew, unless we can, like them, "renew our age" and bear fruit unto the end. Here, then, alco- hol steps in as a help in need, and it is strictly in accordance with the teachings of physiology to increase, as years increase upon us, the moderate quantity we had been taking previously. I do not write for habitual revellers and muzzy dram-drinkers (the sooner they become teetotallers the longer they will live), but for the temperate users of natural good things, and I am sure that they may reasonably obey the instinctive desire to take more and stronger wine as they grow in years. The physiologist Moleschott, moreover, states that " a glass or two of good old wine augments the amount of gastric juice, the liquid which performs mainly the digestion of albuminous ali- ments." 1 So that here we find another reason for indulging the instinct. 1 Kreislauf des Lebens, letter 6. DECLINE OF LIFE. 199 Elderly people are able to do with less sleep than younkers, and need not be alarmed at a certain shortening of their night's rest, which is natural. But sometimes the shortening goes too far, even in health ; they cannot get to sleep for a long time after going to bed, and are worn out with restlessness and rolling about ; not to mention that they disturb others also in many instances. This inconvenience may often be obviated by having an egg, a sandwich, a few biscuits or other light repast the last thing, ac- companied by a glass of bitter ale, or sound wine and water. Sweet, strong wines are those usually recommended for this pur- pose : Hufeland recommends Malaga ; and Burgundy or Port, warmed, spiced, diluted, and sweetened, is not a bad drink ; but probably the best for each individual is that which association or whim makes most agreeable to the palate. Some prefer gruel or arrowroot to be the vehicle of the alcohol, and it certainly dilates and distributes the virtues of the draught efficaciously, and also warms up the stomach comfortably ; but it has a coddling invalid- ish look which should be avoided. Dr. \Velsted considers that it contributes to length of days to associate as much as possible with young people, and to adopt such habits and manners as may attract rather than repel them, to which last there is a temptation in old age. And, of the young people, he holds, that the best companions are those whose spirits are high and joyous, and whom we can induce to rally round and infect us with their life. " For," as he says, " that solitude which is associated with fear and sorrow breaks up the strength of both mind and body." It is almost needless to say that ease of mind, contentment with the present, and calm confidence in a future happy renewal of the worn-out body and soul, are specifics suitable for all cases. . It is not hard work that kills the active, nor idleness that kills the man of leisure, be he old or young, but worry. " Be careful for nothing, the Lord is at hand," is a motto which will prolong the lives of all. 200 SPECIAL DIETETICS OF HEALTH. CHAPTER XI. ALCOHOL. 1. PHYSICAL EFFECTS. MANY a man has asked himself, like Horace, " Quo me, Bacche, rapis Tui plenum ?" To what does the natural thirst for alcohol lead ? He sees around him disease, death, and misery directly traceable to the abuse; but he sees also disease, death, and misery, arising from the abuse of other instinctive desires which it were profane to call evil. Is there a use? What happens to a tem- perate consumer, likely to shorten or prolong his days ? Or does he merely gain a pleasure without any consequent good or evil ? It was with a view of getting a basis for the satisfaction of my mind on these points that about fifteen years ago I engaged a laboratory assistant, and carried on the following experiments : Experiment I. A. M. aged 38, weight 254 Ibs. taken at noon every day Habits of life extremely regular. He walks half an hour be- fore breakfast daily, breakfasts at eight on two cups of coffee, bread and butter, and a slice of cold meat : dines at one on beef and mutton in regular quantity, potatoes and pudding ; has tea at five, two cups with bread and butter ; sups at nine on bread and butter, or cheese, with half a pint of ale. He sleeps six and a half to seven hours. His bowels are open once daily. An idea of the normal amount of metamorphosis in his body is afforded by the following table : a , _o a . '3 O 'S 5^5 = 3 ~" Specific gravity. Urea in grammes. Chloride of sodium in grammes. Sulphuri acid in gramme Phosphor acid in gramme Uric acid gramme Amount of urine and its several parts made in 23 days, in perfect health and on usual diet, .... 24.970 1.022 728.437 174.625 51.307 44.719 2.813 Mean daily amount, . 1.085 1022 31.671 7.592 2.230 1.944 .187 On eig'ht days the uric acid was not weighed. ALCOHOL. 201 The effect of the addition of a certain quantity of alcohol to the daily meal is shown by the next table : Date. 5 ' "* s >. r ~~ ~ ."- ? <5 U ~ Specific gravity. Urea in grammes. Chloride of sodium in grammes. Sulphuric acid in grammes. Phosphoric acid in granini''.-. Uric acid in grammes. Daily quantity of best French brandy, added to mt;;ils in ozs. by measure. Sep. 13, 1,020 1.024 30 708 7.140 2017 1.469 4* " 14, 1.570 1.022 39.746 10.990 2.579 .848 3 " 19, 1,050 1.026 38.795 8.400 2.456 1.890 . . . f 6, viz., \\ at 20, " 21, 1,200 1,110 1.025 1.023 42.695 37.974 9.600 6.937 2.622 2.212 1.944 1.798 breakfast, 1 dinner, tea, " 22, 770 1.020 30.030 6.160 2.065 1.386 [ and supper. On September 23, the appetite for food was observed to be some- what less than usual, and the experiment accordingly ceased ; for any change of usual weight, health, feeling, or habits, of course would vitiate the result of an investigation conducted in this form. Here are shown the effects of mixing with the daily meals such an extra quantity of alcoholic liquid as is very usual with mod- erate consumers. Such a quantity seems to put them at ease with themselves and with the world around, without causing any im- mediate injury to the general health, any untoward exhilaration, or any subsequent depression. We may observe : 1. The aqueous part of the urine daily excreted is not increased beyond, the extent of the extra fluid injected. 2. TJie quantity of urea is increased after the first twenty-four hours. 3. The chloride of sodium and the sulphates are slightly increased. 4. The phosphates are diminished. 5. The augmentation is temporary, and after a time is succeeded by a reduction to the normal measure, which reduction is coincident with a loss of appetite. Alcohol, then, is not a diuretic in the commonly received ac- ceptation of the term, and the repute which it has got of belong- ing to that class of medicines, must be due to some other ingredient of the compound forms in which it is usually swallowed, or to its 202 SPECIAL DIETETICS OF HEALTH. relieving (in certain cases of diminished excretion) impediments to the due action of the kidneys. At the same time there is represented by the increased forma- tion of urea, a more active destructive assimilation, and (inas- much as the weight of the whole body is not lost) a more active reconstruction of the nitrogenous elements of the tissues. Old flesh is removed, and meat food is appropriated as new flesh, somewhat quicker than when no alcohol is taken. It is a matter of common observation that the appetite of an average healthy man has a keener edge put to it by a moderate quantity of beer or wine with meals. So that the abovementioned enhancement of the interstitial growth may be fairly credited to a temporary rise of the digestive powers of the stomach. The decrease in the excretion of phosphorus is small indeed but indubitable. The chief source of that ingredient of the urine may be reasonably supposed to be the substance of the brain and nerves, and it can hardly be thought a mere coincidence when a reagent whose effects are most peculiarly manifest on the func- tions of those organs, diminishes what we believe to be the result of their chemical changes. Every one recognizes in alcohol a power of blunting sorrow and pain, of checking the sensation of weariness, mental or bodily, of rendering carnal love coarser, less keen, and less discriminating, taking the points off the stings and buffets, discomforts and nastiness of daily life, but also of cor- rupting the delicate appreciation of its higher delights, in short, of diminishing the sensibility to impressions in mind and body, of lowering the receptive functions of the nervous system. In a series of experiments conducted for another object, Dr. Edward Smith has recorded minutely the sensations experienced by a healthy man on taking moderate quantities of brandy. 1 They consist essentially of lessened consciousness, lessened sensi- bility to light, to sound, to touch. The higher the sensibility of the part under ordinary circumstances, the more obvious its anaes- thesia under the influence of brandy. For instance, there was in the upper lip and cheeks a feeling of stiffness and puffishness, which is one of the first symptoms of lowered sensation, and is familiar to all in cases of partial paralysis. The dartos also and 1 Transactions of Royal Society, 1859, p. 732. ALCOHOL. 203 other muscles connected with the reproductive system were re- laxed ; as was also the sphincter of the bladder, accounting for the increased micturition during indulgence. The pulse also was quickened, a phenomenon which always attends temporary de- bility of the heart's action. Indeed, in all motion of a purely involuntary character, quickness always indicates diminished muscular force. (The same result follows tobacco smoking.) The sensation of swelling in the upper lip is the premonitory stage of the muddy flush by which the artist and the actor mark the face of the " fuddled " man (ebriolus). When he is completely intoxi- cated (cbrius), it is oftener pale or livid. The venous congestion and arrested circulation is then transferred to the capillaries of the cerebellum (Flourens), 1 and stomach (Brodie), 2 and a secondary series of phenomena follow, dependent upon the local affection of these organs. There is a staggering gait, a want of co-ordination in the movements, and often vomiting. Life and warmth are so closely connected together in scientific as well as in popular notions, that perhaps the most striking evi- dence of diminished vitality is the lessened capability to generate heat. And we have this evidence in the case of alcohol. MM. Dumeril and Demarquay published in 1848 their observation, that intoxicated dogs exhibited a great loss of temperature ; and Dr. Boecker 3 and Dr. Hammond find in their own persons the same result from even moderate doses of spirits. This accords with and explains the experience of Dr. Rae, that alcoholic drinks give no satisfaction to Arctic voyagers, and of Dr. Hayes (Surgeon and Commander in U. S. second Grinnell Expedition), that they actually lessen the power of resisting cold. 4 The " warming of the stomach " which dram-drinkers speak of with such gusto is, in fact, a fallacious sensation arising out of insensibility to exter- nal influences. When the poisoning is still more profound, the congestion of the nervous centres produces complete apoplexy, and that of the stom- ach, gastritis. The traces of these morbid conditions are found 1 Recherchcs sur les fonctions du systeme nerveux, Paris, 1824. 2 Philosophical Transactions, 1811. 3 Beitrage zur Heilktinde, i, 250. 4 American Journal of the Medical Sciences, 1859, p. 117. 204 SPECIAL DIETETICS OF HEALTH. after death, but the loss of life seems due to the paralysis of the respiratory muscles and the lowered temperature of the body. I am unwilling to enlarge further upon dead drunkenness and fatal alcoholic poisoning, as I have no personal observations on the subject to record, and their commonly reported characteristics are repeated here principally to show their essential agreement in physiological nature with the healthful and beneficial, or, at all events, not pernicious action of the substance. The effects in a healthy man would seem to be the diminution of the energizing wear of the nervous system, especially that employed in emotion and sensation. Thence there ensues a raising of the digestive powers and appetite, should they have been anywise unconsciously blunted by the psychical movements abovementioned. Just as often, then, as the zest for food is so far lowered, that it is found to be raised to the normal standard by a little wine or beer with a meal, the moderate drinker is as much really better, as he feels the better, for his liquor. In cases, however, where the food is as keenly enjoyed without the aid of any of the products of fermen- tation, their consumption is certainly useless, and possibly inju- rious. So long as alcohol, in the indirect mode mentioned, aug- ments vital metamorphosis, it ministers to the force of the body. But it is not a. sojirce_of__force, and its direct action is an arrest of vitality. This should be clearly understood by all those who try to have rational rules to guide them in proffering advice as to the dietetic use of a " stimulant." That word means a "spur," and inasmuch as a spur is employed either before or during the exer- tion it is supposed to bear upon, liquor is often resorted to as a means of invigorating a temporary effort. If it has any effect at all on a healthy man, it can but weaken nerve power, while at the same time it lowers the bodily temperature which contributes much to the capacity for muscular exertion. Instinct or experi- ence has taught this to men whom we are pleased to call barbar- ous. The Indian porters in South America (it is stated by Mr. Salvin, the ornithologist), when they prepare for a stiff journey under one of their heavy loads, carefully eschew all strong drink, and swallow large quantities of water as hot as the stomach will bear. And Aristotle states that the Carthaginians (the only African race ever fit to fight with Europeans) used when out on ALCOHOL. 205 military service to abstain from wine. 1 The unhappy adoption of the word "stimulant" has demoralized the notions of civilized communities on this head, and led them to reckon on priming themselves up to unwonted strength with anesthetics. Let them rather say with Byron's Sardanapalus, " The goblet I reserve for hours of love, But war on water/' and victory will be much surer. There is, however, another aspect to the question. Man must be viewed not only as a possible victor, but as liable to the reverse fortune, on the battle-field or in the struggles of life. Both side's cannot win. During the Crimean war the Russian surgeons were reviled for serving out spirits to their troops under fire ; but were they not wise to calculate the after consequences of an engagement, and to prepare the bodies of their clients for suc- cessfully bearing blows and wounds? "They have stricken me and I knew it not," says Solomon's drunkard ; and our accident ward at Christmas time will seldom fail to show proof of the power to resist severe injuries conferred by unwonted indulgence in the joys of Bacchus. A healthy man who gets the worst of it in any way, whose intellectual or muscular energy goes down under the pressure of the work demanded, gets the worst of it in a less degree by the aid of strong drink. Give it him when ready to perish from the drain on his nerve tissues, and his life is saved. The laborer whose limbs are stiff with his day's toil, and the brain-worker who still more acutely feels the wear and tear of bread winning, are not wasting the money they earn, which they spend on a fair ration of beer or wine at their evening meal. But if they take spirits of a morning (it is usually spirits which are then taken), never let them hope for the success in the under- takings for which they seemed designed. Both body and mind will be incapacitated, the life shortened, and all the keenest joys taken out of what remains. One of the most telling questions that can be asked of a life proposed for insurance is, " Do you ever take spirituous liquors in the forenoon ?" If the answer is in 1 Aristoth', (Eeonom., i, 5. I have not seen this statement alluded to by historians, though it seems to account for the enormous quantity of vinegar which Livy found no difficulty in believing Hannibal had in his commissariat and used for decomposing Alpine rocks (Liv. xxi, 37). It was made tasty with pears (Pallad. in Februar., xxv, 11), and employed to flavor the soldiers' drinking-water. 206 SPECIAL DIETETICS OF HEALTH. the affirmative, an immediate rejection is the only safe course for the office. As to small quantities of beer or wine that are con- sumed between breakfast and the midday meal, the evidence against it is not quite so decisive, but, at all events, it renders a man less fit for his daily work than he would otherwise be, and is a dangerous downward movement towards the abyss of dram- drinking. It will generally be found to have been the first fatal step in the" cases of women of the upper classes who have adopted the practice. And, to the shame of our profession, it must be confessed that many of us have erred most unhappily by recom- mending or sanctioning the habit in weakly or self-indulgent women. The weaker they are in body or mind, the more helpless they are, and the more hysterical, the more reason there is for withholding the temptation. We must be proof against tears and sighs, blandishments, entreaties, and reproaches, or we are not fit to bear the rod of ^Esculapius. See what happens if, instead of being drunk with the meals, alcohol is taken in small divided doses : \ Experiment II. The same man described in Experiment I, at another time consumed daily, between 9 A.M. and 9 P.M., six ounces of brandy in doses of half an ounce every hour. No effect was pro- duced on the general health and feelings, and the usual employments were followed except on the last day of the experiment, when M was bustling about in a great state of excitement, packing up to leave for a country holiday. The analysis of the urine was as follows : Date. Quantity in cubic cen- timetres. Specific gravity. Urea in grammes. Chlorideof sodium in grammes. l-el .H-e ~ Ills :: I* 02 SO I'liosphoric acid in grammes. Uric acid in grummes. August 18, ... 1,520 1.013 30.465 5.320 2.210 1.299 .008 " 20, ... 910 1.025 33.077 6.370 2.375 1.474 .259 21, ... 1,070 1.022 32945 6.687 2.246 1.637 .193 " 22, ... 1,000 1.021 23.735 6.750 1.897 1.440 .135 " 23, ... 1,310 1.015 25.097 7.205 1.649 1.061 .196 " 24, ... 1,530 1.021 41.867 9.945 3.064 2.203 .390 One day was an interval in the experiment, and only the usual amount of daily diet, without extra alcohol, was taken, when the numbers stand as follows : ALCOHOL. 207 a , a Date. '% 2"^ = 3 = Specific gravity. Urea in grammes. Chloride of sodium in grammes. S52 iii = = ^ "E. 5 K 'C S = 5 L- !j < 5 " CO M * & * August 19, ... 920 1.026 35.88 5.750 2.374 1.904 .281 It is very clear from these observations that alcohol taken in the dram-drinking fashion namely, in small divided doses by no means increases metamorphosis. It rather tends to diminish it, so that during the first five days quoted the mean quantity of urea excreted is 29.063 instead of 31.671 grammes. And this diminution is not sudden or immediate, but is more and more for a certain period, till the retention reaches a point at which a crit- ical evacuation takes place in healthy persons. This evacuation may take place in consequence of the alcohol being left off, as may be observed on the day of interval. Or again if may result from increased exertions and unwonted expen- diture of nervous energy, as may be noticed in the last day of the experiment. In neither case does the amount, even of the urea, replace the amount arrested during the days of arrest ; and the phosphates are still less unable to make up their lost figures in the ledger. It cannot be concealed then, that even without at all infringing on high health, alcohol in small divided doses and between meals, dram-drinker's fashion, deranges the metamorphosis of the tissues, and in the direction of arrest. And persistence in the habit must lead in the end to permanently diminished organization, degener- ation, atrophy. Just as a disused limb wastes away, so must the unrenewed tissues die off gradually, till they become unequal to the support of a healthy man's existence. The first action of alcohol, then, is on the stomach, enabling more food to be digested, and enhancing the origination of force. But if advantage be not taken of this first action, its secondary effect is a diminution of the vital functions in general and of digestion among their number. It might be suggested that the subject of the experiments was so little used to stimulants that an abnormal effect might be pro- duced upon him by them, but that is rendered unlikely by the 208 SPECIAL DIETETICS OF HEALTH. succeeding observation on a person whose habits may be described as closely verging on "full living:" Experiment III. C , aged 43, healthy, though not muscularly robust, of regular life and habits, took daily during the days named in the table a quantity of food proportioned to appetite, viz., about a pound and a half of meat, half a pound of bread, a pint and a half of tea, with milk, sugar, butter, sauces, etc., q. s., half a pint of water, and from five to seven glasses of port or sherry, 1 care being always taken not to annoy the temper, and so nullify the experiments, by overstrictness. Quantity in cubic cen- timetres. Specific gravity. Urea in grammes. Chlorideof sodium in grammes. Sulphuric acid in grammes. Phosphoric acid in grammes. Uric acid in grammes. Amount of urine and of its several parts, made in fifteen days, in perfect health and on usual diet, . 18,800 1.022 493.852 137.655 Do in fourteen days, 2 26.487 27.683 3.839 Mean daily amount, . 1,253 1.022 32.923 9.177 1.891 1.977 .274 The effect of taking in addition, between meals, a moderate quan- tity of alcohol in divided doses, is shown in the following table : Date. Quantity in cubic cen- timetres. Specific gravity. Urea in grammes. Chloride of sodium in grammes. u ' S3 QJ 2'-5a m '- quence of having swallowed a large quantity of gin, and regrets that brandy had not also been poured in by the rectum. He relates also specimens of de- lirium tremens similarly managed, but their result cannot be said to justify the use of brandy except to a most bigoted adherent. He himself does not propose to act in the same way in respect of other articles of the materia medica. 19 290 DIETETICS IN SICKNESS. gether and at once. I am not prepared to deny that delirium tremens may have been the result, in some cases, of such precipi- tation, but it has not happened in my experience ; and I should be ready, if it did happen, to treat it in the usual way, confident that the patient, in spite of the accident, was still gaining a posi- tive advantage by abstinence. 3. AGUE AND INTERMITTENTS. In ague, alcohol should not be spared as an article of diet; and taken more freely than usual it contributes to lengthening the in- terval and shortening the paroxysms, converting quotidian into tertian, and curing tertian altogether. And, in brow-ague, neu- ralgia, inconstant sciatica, and other intermittent disease of simi- lar nature, it is sometimes equally efficacious. But, given during the paroxysms, I have not found so much benefit perhaps it is not absorbed. In ague the combination in which alcohol is offered is of con- siderable importance. The most generous red wines should be used, and the distance at which their bouquet may be smelt may be taken as a rough test of their utility. I remember learning a lesson on this point from a most unscientific source. I was chat- ting in the market-place at Dijon with a farmer's wife, when she incidentally mentioned that her husband was a great sufferer from ague, and was quite tired of swallowing quinine. I advised her to take home a good supply of Burgundy in her market-basket, and begged to contribute the few francs I had in my pocket. She tripped straight off to a grand wine-merchant's office; but instead of coming out fully laden, she bore only two bottles, to the price of which she had contributed out of her own purse. It was of a vintage such as is allowed to trickle slowly over the tongue at the table of a prince, and I promptly called her a prodigal. " No, no," said she, " I am not ; a mouthful of this is worth to a sick man a bucket of commoner wine" and yet the common wine of Dijon is not to be sneered at. She was quite right; there is no wine like Burgundy for ague, and the price (provided the merchant be honest) is a direct measure of its medicinal value. SUNSTROK^!. 291 4. OTHER DISEASES OF THE NERVOUS SYSTEM. Alcohol has been used with great advantage in Sunstroke. Dr. Maclean (in his article on the subject in Reynolds's "System of Medicine") strongly commends the employment of Warburg's Tincture, the only known ingredient in which is alcohol, and in addition a judicious quantity of dietetic stimulants. The treat- ment advocated by this gentleman does not seem to have yet taken hold of the Anglo-Indian medical mind, for the author speaks of venesection still being employed on a large and fatal scale quite recently; so that numerical evidence of success cannot be furnished. I should expect it when collected to be decisive; for there are reported in sunstroke several most important symp- toms which connect its pathology with that of other morbid states benefited by alcohol, viz., a copious excretion of solids in the urine, a high temperature of blood, delirium, weakness of the sphincters, trembling of the muscles, and death by syncope or coma. I have never had a case of genuine sunstroke under my care, the best imitation of one which this cloud-kerchiefed climate has afforded me having been caused by long sitting at a desk with a bald head close to an Argand gas burner. But if ever I were to practice in a hot climate, I should unhesitatingly adopt Dr. Mac- lean's treatment, both as to the use of ice and of alcohol. In concussion of the brain from accident, stimulants are usually administered before the arrival of a surgeon, and no injurious con- sequences appear to follow. And blows on the head which hap- pen to revellers produce, as a rule, much less cerebral lesion after- wards than is expected from their violence. The hint should not be lost, especially since some of the symptoms of severe jar to the brain-tissue much resemble those recorded as produced by sun- stroke ; indeed, so closely as to have suggested the insertion of this paragraph in its present place. Neuralgia is often decidedly benefited by alcohol, as has been already said. Taken dietetically at meals, it involves no risk of tempting the patient to intemperate indulgence; and if good gen- erous wine be the vehicle, a very moderate quantity often suffices. 292 DIETETICS IN SICKNESS. Spirits are not nearly so effectual, and require to be employed in larger doses. But this is not all that the sufferer asks ; he wants to know if he may not have recourse to the remedy when his agonies are upon him ; for neuralgia is not like ague, and is relieved in an unmistakable manner by alcohol during the paroxysm. It is hard to refuse, and, unless the patient surpasses the average in folly, I do not refuse. But at the same time I give this -caution that the intended dose should be fixed upon, and not exceeded even if the pain remain as severe as ever. The chief benefit is by no means immediate, but consists principally in shortening the par- oxysm. An intimate friend of mine with an "irritable stump," often brought on (like Nelson's) by cold or mental annoyance, on the invasion of the spasmodic movements takes a tumbler of very hot spiced port (bishop) or of stiff Avhisky toddy, and then waits patiently till the trouble ceases. This it usually does in two or three, instead of lasting twenty-four, hours. But whatever hap- pens, he strongly advises that the stimulant should not be re- peated. Hypoohondriasis is too generally a constitutional and hereditary complaint to be a good test of the virtue of any remedy. The few hypochondriacs in whom I have witnessed any improvement have been persons who had been living a dull abstemious life, and have been persuaded on sanatory grounds to indulge the palate and the fancy from time to time with unwonted liberality. It is very possible that Sanctorius's monthly excess might be a sanatory measure here, though one is loath to give advice which is capable of misinterpretation. But the daily and habitual use of alcohol in hypochondriasis is worse than useless in fact, deleterious. I have known several cases receive much benefit from entirely leav- ing it off. There is a peculiar form of hypochondriasis which arises from eating too little vegetables and too much meat. It is distinguished by the high specific gravity of the urine (1.025 to 1.035) depen- dent on the presence of urea alone without sugar. There is in these cases often a remarkable lassitude and apparent paralysis of the limbs suddenly occurring after exertion. Sometimes there is emaciation. Both these symptoms usually lead the patient and his friends to attribute the morbid state to insufficient nutrition, INSANITY. 293 and to increase more and more the proportion of meat in spite of the aggravation of the ailment. A rapid cure attends the dimi- nution of the meat meals to one daily, and the supplying their place with plenty of porridge and green vegetables. In mania, melancholia, and dementia, the most recent experience seems unanimous in recommending alcohol. Dr. Maudsley makes no distinction between them in speaking of the therapeutics of in- sanity, and indeed seems to proportion the strength of the liquor to the violence of the disease. He speaks of " wine " as a pro- phylactic against madness in general, and " brandy " as a remedy in maniacal excitement. I cannot find, as I should have liked, any warning bearing on cases which can be traced to drunkenness in the individual affected, though it can hardly be doubted that such do exist, and require special management. Even if the se- quence of causation have been reversed, and the intemperance be the consequence of the madness, the association of the two must surely modify the treatment. It may be that Dr. Maudsley ap- proves of the homoaopathic therapeusis of alcoholism, and his evi- dence to its prudence would be very valuable ; but it should be distinctly and boldly expressed. Leaving this branch of the question open, it may be freely granted that his sketch of the current practice in curable dis- orders of the intellect is correct, and his confidence in its success is not misplaced. But here, as in health, I would limit the quantity, as a rule, to that which suits the stomach best and in- creases the appetite. The advantage of an ample and nutritious diet in insanity is daily more and more forcing itself upon the proprietors of lunatic asylums, though their interest of course would tempt them to an opposite creed. It is good economy in the end to feed highly even pauper lunatics, unused as they may have been to such treat- ment ; for by such means cures are effected, and the country re- lieved of the charge. 294 DIETETICS IN SICKNESS. CHAPTER VIII. SCROFULA, RICKETS, AND CONSUMPTION. SECTION I. SCROFULA is indubitably an hereditary disease; and some ob- servations incline me to the suspicion that the development of the ancestral stain is more common when it is on the maternal side than when it is derived from the father. A faulty early nutrition would seem to have as much influence in drawing it out, as the source of the vital spark. For this reason a mother who is con- scious of the existence of scrofula in her family, even should she never have been herself afflicted, should deny herself the privi- lege of suckling her infants ; and a healthy irreproachable wet- nurse should be got to supply her place. On the other hand, when it is from the father's side that danger is feared, it is pecu- liarly incumbent on her to play her important part with assiduity, and to protract the time of lactation to its full period, observing accurately the suggestion made in the first chapter of the second part of this volume. I cannot too strongly urge the duty of im- pressing this upon patients. The nursing mother will act wisely also if she takes after her meals small doses of the Syrup of the Phosphates, or Parrish's Chemical Food. Lactation ended, the child's diet should be arranged so as to contain a rather larger proportion of animal food than recom- mended for ordinary nurseries and the instinct for a carnivorous nutriment should be encouraged, or at least not thwarted. Warm clothing, much sunlight, frequent exercise in the open air, and an annual breath of sea air will powerfully aid in keeping off the dreaded disease. The "weariness to the flesh" induced by overmuch study must be sedulously prevented. It spoils the appetite and digestion, so essential to the object of our care. RICKETS. 295 The cold plunge-bath, well-ventilated rooms, moderation in the pursuits of pleasure and ambition, and a virtuous life, will usually carry our patients safely up to manhood and womanhood, and after that they may be considered safe. Supposing the tendency is so strong that in spite of these pre- cautions the disease appears, I do then think drugs are useful, but chiefly those which have the nearest relation to aliments, such as iron, the phosphates, cod-liver oil. Their effect on the appetite must be carefully watched ; and the end must not be sacrificed to the means if they spoil the appetite they must be left off imme- diately. In this case also, I think alcohol is of service, employed with the same watchfulness as articles of the pharmacopoeia. SECTION II. Rickets (Rachitis) is distinguished from scrofula by being very rarely, if ever, hereditary. It consists in a softening of the bones, especially of the back bones, in children who do not absorb enough bone-building materials in their food. I think I cannot do better here than quote the words of Dr. Trousseau, who, with his usual happiness of expression, has put before the world the striking re- sults of M. Jules Guerin's researches : " Of all causes, that most sure to produce rickets is improper food. " In his first works M. Jules Guerin had adopted the idea gen- erally admitted that rickets and scrofula are occasioned through deficient feeding ; and by that term, according to vulgar prejudice, was meant suckling carried on too long. But his observation taught him soon that the direct converse of this proposition was true, and that the babies who became rickety were not those who had been kept too long at the breast, but those on the contrary who had been prematurely weaned. In fact, it appeared to be true enough that under the influence of an insufficient supply of proper food, the malady developed itself; but by proper food was to be understood something different from what was commonly meant. Experiments tried upon animals made the question quite clear. In these experiments M. Jules Guerin set himself to find out if it were feasible to produce rachitis at will. He took a 296 DIETETICS IN SICKNESS. number of puppies in equal condition ; and having let them suckle for a time, he weaned suddenly half the lot and fed them on raw meat, a diet which at first sight would seem the most suitable for carnivorous animals. Nevertheless, after a short time, those who continued to take the mother's milk had grown strong and hearty, while those who had been weaned on an apparently more substantial diet pined, and were taken with vomiting ; then their limbs bent, and at the end of four or five months the poor little beasts showed all the symptoms of confirmed rickets. From these experiments we must conclude with M. Jules Gue"rin that the rachitis depended in great measure on the derangements of nutrition which claimed improper diet as their cause. A diet which is taken to at a wrong season may fairly be called improper. For carnivora, it is flesh before the age of suckling has passed ; for herbivora (and an experiment bearing on the point has been made on pigs) it is vegetable feeding, given them too soon, when they ought to be still at the teat. In the human race the same thing happens. Rickets is never so common as it is in babies weaned ere the teething is forward enough, and brought up on pap, vegetables, or even meat." 1 It would be waste of time to point the moral of these valuable sentences. The daily addition to the dietary of a small quantity of the phosphatic salts is still more indicated here than in scrofula. But still nothing can take the place of milk, an article of diet in which our laboring population, both in town and country, is sadly deficient. I have no fault to find with coal clubs and cloth- ing clubs, but I am sure that as a preserver of infantile health a "cow club" is worth them all. Even the small weekly contri- bution, so difficult to extract from our reckless race, can be dis- pensed with, by arranging the price paid on delivery, so as to cover keep, insurance, contract for medical attendance, and re- placement of superannuated animals. Charitable help is most valuable when it takes upon itself the duty of advice and super- intendence. But still, O Lady Bountiful, do not give your spare and skim milk to the store pig, when there are half a dozen chil- dren growing up bow-legged and crooked within half a mile of 1 Trousseau, Clinique Medicale, vol. iii, p. 484, 3me edition. CONSUMPTION. 297 your lodge gate for lack of it. Do not give it at all, but bestow the much greater boon of selling it as low as you like, but still sell it. SECTION III. Consumption. Since the introduction into our materia medica of Cod-liver oil by Dr. Bardsley of Manchester, the profession has been growing gradually, but surely, convinced of the all-impor- tance of the dietetic treatment of pulmonary consumption. Cod- liver oil is a typical aliment, representing what is the fittest of all known substances to supply the deficiency that constitutes the disease. To use the language of microscopic physiology, "the basis of molecular growth " is poisoned, so that instead of actively secreting gland, or elastic tissue, or bloodvessel, or epithelium, etc., 'fit for their various duties, being formed, only a useless cheesy substance is the product of nutrition. The due powers of life are lacking in it. We call it " tubercle," and look upon it, if we are thougtful people, as an infant tissue strangled in its cradle. To save then the parts threatened with tubercle, we must antici- pate the formation of the imperfect matter by supplying a ground- work for perfect tissue. This groundwork is laid by freshly as- similated oleaginous substance; oleaginous substance is what is furnished by nature for the primary growth and nutrition of all the higher tissue of animal bodies ; and indeed many physiologists assert that without it there is no growth ; so that in administering it, we are closely imitating the wisest teacher of medicine, mother Nature. The reason, then, for giving cod-liver oil is to counteract the tendency to form morbid solids by supplying the most suitable material for healthy solids in short, by overcoming evil w r ith good. This is a much higher aim than the mere replacement of the plumpness of flesh whose waste gives the name to the disorder. The object is not so much to cure emaciation, as to cure the cause of the emaciation. Very necessary it is to understand this ; for not a few tuberculous and many tuberculously inclined patients are well furnished with fat, and some are even corpulent ; and they will demur to the prescription of our remedy, if they are al- lowed to retain the dominant idea that all it can do is to fatten. 298 DIETETICS IN SICKNESS. Young women, especially, of consumptive families will often ob- ject to the risk of losing the elegant slimness of youth, and insist that they are as plump and round as they ought to be. What they say may very likely be true ; but yet their store of fat can only keep up the temperature of the body, and cannot be used again for nutrition. For the purpose of nutrition, recently as- similated fat is requisite ; and thus tuberculosis may go on un- checked for lack of it, even in a corpulent person, since his store of fat is not available for digestive purposes. At present cod-liver oil is the most readily assimilated fat we know of: and so to it all other means of treating this class of diseases have a reference. Some substances ground their claims for notice on being substitutes for it, and drugs of various kinds act beneficially by preparing the stomach to digest it; but any- thing which does not look to it for a character is of only acci- dental utility. I heartily wish that some of the efficient substitutes for fish-oil were more agreeable to the palate ; for it must be confessed that the taste and smell are a serious impediment to its employment. Suet is apparently the best : in milk it is to some persons not re- pugnant, and its digestibility is increased by its being made into an emulsion with one of the gastric solvents, to be obtained in the shops under the name of "Pancreatic emulsion." 1 Milk, by itself, comes next in value, and a milk diet has from the earliest times been recommended in advanced phthisis. But the large quantity required to be swallowed, often deranges the stomach and produces repugnance ; so that in recommending it to a pa- tient it is necessary to warn him of this difficulty, and take exam- ple by our master Hippocrates, who, in advising a consumptive to drink a large quart jug (rpt-/.6ruXm mhxd?) of mare's milk the first thing every morning, adds significantly " if he can." Devonshire cream has been used as a substitute, but I cannot say it has proved in my hands an efficient one. If taken in sufficiently large quantities to be of service, it is apt to exercise a purgative action. For my part, I think it is wisest to try and get habituated to 1 The credit of introducing this to the profession is due to Dr. Dobell. 2 Equal to two pints and a quarter. CONSUMPTION. 299 the fish-oil, adopting some of the various little devices which are used to diminish its nauseousness. In the first place it is essen- tial that the article should be the best of its sort, that is, as free from smell, taste, and color as possible, showing its careful and recent preparation. Though they do not always tell their custom- ers, the importance of this freshness is well-known to manufactu- rers. I learnt so when prescribing it for a stranger a few years ago : her husband, who was present, stopped me when I was de- scribing what cod-liver oil should be, saying he knew all about that, for he made it, and engaged that she should have it fresh prepared daily. Some patients will take the oil easiest in milk. Some find the taste annulled by eating a piece of red herring, or anchovy, or sardine, before and after the dose. Some like the bitter aromatic of coffee to counteract the rankness ; and this fancy I am glad always to hear of; for it gives an opportunity for recommending a bitter drug which assists powerfully in the assimilation of the oil. If coffee is approved of, I then advise the oil to be taken as a parenthesis in a mixture of quinine, or of strychnine, or of both together. A sip of the medicine is to be taken, then the oil swallowed, and washed down with the remainder of the draught. If there is persistent nausea afterwards, a few drops of hydro- cyanic acid may be added each time. Nausea may also be avoided by taking the oil on going to bed. Where there is cough, the sheets should be previously warmed. But the taking of cod-liver oil is not an exemption from all other care. The student of the literature of the subject will find his faith claimed by two extreme parties, one of which is all for beefsteaks, porter, and in short for as carnivorous a diet as possible, the other in favor of pulse and herbs, seeds and potatoes. Both are as far right and as far wrong as it is probably possible to be. They are quite right in what they include, and quite wrong in what they exclude. The food should be as near that of health as the digestion of the patient will allow, that is to say, mixed and varied, liberal in frequency, and moderate in quantity. The whims of appetite should not be thwarted, nor the prejudices of theory indulged : the demands of muscular exertion should be provided for by the starchy ingredients of the dietary, and the increased wear and tear of the machinery by the nitrogenous. 300 DIETETICS IN SICKNESS. The full powers of digestion should be brought into activity by plenty of open air and exercise within the bounds of weariness. And this is the reason why English patients are advised to live during the winter months in more genial climes than their own. They get thus more sunlight and oxygen without damp. But also the change is good ; for it has been found that to those living in parts of Britain where the atmosphere is soft and mild, as in the West, a colder and more bracing air, provided it be dry, is sometimes beneficial. From Cornwall the small trading vessels will sometimes carry a consumptive miner to pass the winter in Greenland ; and patients have been sent with advantage from such localities as Leghorn to the exhilarating sharpness of a snow- clad Alpine upland. But this plan requires great caution. Much more confidently can the recommendation be given that the advantages of a sea-life should be favorably put before the youths of families, where there is an ancestral tendency to pul- monary tubercle. I do not mean that they should be driven into it against their will, but that it should be made as attractive as possible. The healthy state of a young sailor's digestive organs is the best guarantee that can be obtained against consumption. As to the use of alcohol in threatened cases, and in the early stages of tubercle, I have no hesitation in pronouncing an opinion adverse to it. But if the morbid matter has broken down, and there is either nocturnal perspiration, copious purulent expectora- tion, diarrhoaa, extreme emaciation, or depression of spirits, wine, especially port wine, in quantity equal to the occasion, is often of decided use. When the demand for it has passed away, it may be left off. DISEASE OF THE HEART. 301 CHAPTER IX. DISEASE OF THE HEART AND ARTERIES. SECTION I. IN disease of the heart the most remarkable change in respect of digestion is the slowness with which liquids are absorbed by the stomach. If much is drunk at once, it will remain a long time gurgling about, and, instead of assisting digestion, will offer an impediment and cause inconvenience. The reason of this is the slackening of the circulation of the blood, which is directly or indirectly effected by all the various cardiac lesions in common. Whether the heart is too thick or too thin, too large or too small, whether the openings of valves are obstructed by warty growth, or whether their stretched curtains fail to control the flux and reflux of the current, the practical result is one, namely, that the vital stream is unnaturally sluggish. Now it is a well known law governing the passage of liquids through membranes that it is promoted by the rapid movement, and retarded by the sluggish movement, of the fluid towards which the endosmosis is tending. It is clear, therefore, that the absorption of potables from the digestive canal into the blood must be deficient in close propor- tion to the obstruction presented by the defective machinery of the circulation. The observation of a dry diet contributes greatly to the com- fort of the patients now being considered. The dinner should never be prefaced by soup, and the drink should be taken only in sips during the meal. And what is taken should not be cold, but at least have the chill taken off. When thirst occurs between meals, the same rule of sipping should be observed. In this way quite a sufficiency to supply the requirements of the kidneys may be introduced indeed, more is probably got into the blood than when larger quantities arc gulped down at once, chilling and par- alyzing the absorbent powers of the mucous membranes. 302 DIETETICS IN SICKNESS. Independent of the inconvenience which the indigestion of fluids causes, it may be feared also that the distension of the stomach accompanying it interferes with the already laborious action of the heart, and aggravates the organic source of the malady. This is especially the case in Dilatation with Thinning of the heart's walls, and is least noticeable in Valvular Disease. Where Heart-disease is complicated with obesity, especially if the fat is accumulated in the chest, the enforcement of a dry diet is still further to be viewed as imperative; inasmuch as it con- tributes powerfully to the reduction of the hypertrophied adipose tissue. The only symptom which may perhaps render it a doubtful policy is the occurrence of dropsy. Should this be very decided, it is of importance to keep the kidneys active to a degree that can be accomplished only by the ingestion of a considerable supply of watery drink. I think, however, this should be always followed up by purgative medicines, often even by mercurials. And when the necessity has ceased, the dry regimen should be resumed. The dietary of persons with imperfect hearts should be at least as nitrogenous as if they were completely sound. What we have to dread is the atrophic degeneration of the cardiac muscle, for till this degeneration occurs the original lesion is not aggravated ; and the constitution often gets so used to the state of mechanism of the- heart that no inconvenience of any kind is felt. And atrophic degeneration is warded off by keeping up the redness and fluidity of the arterial blood. The importance of the existence or non-existence of valvular disease lies not in the injury it directly inflicts, as in the likeli- hood of the induction of other lesions of the heart. If the mus- cular structure remains healthy, injured valves do not appear capable of causing death. But very surely are they fatal when they are followed by dilatation or thickening or degeneration of the cardiac walls, with the sad train of dropsies, apoplexy, pul- monary hemorrhage, etc. In 2161 post-mortem examinations at St. George's Hospital in ten years, the cardiac valves were diseased without the walls of the heart being affected 113 times; but in every case there were other lesions amply sufficient to account for death quite indepen- dent of the valves, such as accidents, surgical complaints, cancer, DISEASE OP THE HEART. 303 low fever, etc. In one alone, where anasarca from granular kid- neys was the immediate cause of death, could any symptom be debited to diseased valves with healthy heart, and that symptom was pulmonary hemorrhage. 1 In the classes of people represented by hospital patients, the probability that valvular disease will be followed by its unhappy consequences is very great. When a patient thus affected leaves our hospital wards, we expect to see him again shortly, and on each fresh admission with a more severe complaint. But the same expectation must not be applied to the more comfortable classes of society. Persons in easy circumstances have valvular lesions for years and years, perhaps through the greater part of a long life, and not only continue to live, but even fail to experi- ence symptoms bad enough to consult a medical practitioner. In my volume of Clinical Lectures 2 I gave some two dozen ex- amples of persons found, when examined for insurance, to have valvular lesions, but who, during periods varying from 50 years doAvn wards, had not in anywise suffered in consequence. This I attribute to their not being dependent for daily bread on daily labor in fact, to ease of mind and body. The renewal of the destroyed tissue being impossible, and equally so any mechanical compensation for the arrested function, it is obvious that in the treatment of the disorganized valves them- selves, restorative medicine, in the strictest sense, must be quite at fault. But indirectly it is almost as effective in prolonging life, as if it could put in a new -valve, or make another muscle do duty for the resting ventricle. It may repair those reparable conditions which are injurious, and which by bringing on enlarge- ment constitute the real danger in cardiac cases. Let us try and cure what is curable, and trouble ourselves as little as possible about bygone injuries. While we bid our patients live generously, we must disabuse them of the notion that the advice includes a free allowance of al- cohol. Alcohol is really the most ungenerous diet possible. Ad- diction to it impoverishes the blood, and is the surest road to that 1 Dcccnnium Pathologicum, MS. in library of Medico-Chirurgieal So- ciety, chap. x,sect. i. 2 Lcet. xxv. 304 DIETETICS IN SICKNESS. degeneration of the muscular fibres which is so much to be feared. And in diseases of the heart it is especially hurtful, by quicken- ing the beat, causing capillary congestion and irregular circula- tion, and mechanically dilating the cavities. Let the fermented drink be limited to that quantity which increases the appetite. In a great many instances this may be very shortly described as none at all, but often also, whether from the force of habit, or the nature of the constitution, a sip of wine enables a sufficient din- ner to be eaten, and more fully digested than when not thus as- sisted. Burgundy and Champagne are the best adapted for the purpose, as a small quantity of these wines is inspiriting, with a minimum of alcoholic contents. SECTION II. In the treatment of Aneurism the science of diet plays a part different from that which it plays in any other diseases which we have been reviewing. In them it aims at restoring health by re- placing what is deficient, and bringing the body directly into a state as near the full natural state as possible. Here its intention more resembles that of a drug ; it would bring the blood tempo- rarily into a morbid condition, to accomplish a certain definite ob- ject; it makes a sacrifice to realize a future advantage. By Aneurism I mean the formation of a pouch in an artery through the yielding of the sides of the tube. The danger is lest they should go on yielding, burst, and let out the lifeblood. Therefore, if the artery be a small one, and capable of being spared till it is replaced by a collateral circulation, mechanical surgery can save life by tying, compressing, obliterating it, or by removing the limb where it is situated. In the largest arteries such trenchant treatment is obviously impossible ; yet there are found from time to time instances of aneurism in even the largest arteries being rendered innocuous by a natural process. In pa- tients who have died of other diseases, the pouch has been found plugged up, and leakage prevented by a firm caulk of fibrin, clotted out gradually from the blood. It is usually adherent to the roughened or torn sides of the artery. Why is not this happy cure always found ? In a great many cases because the mouth of the pouch is so wide and open that the ANEURISM. 305 blood cannot stagnate long enough to form a clot. But in others also, because the fluid is so rioh in non-coagulating material (to wit, blood-disks) that it coagulates with difficulty, and under some circumstances not at all. In such a case that is to say in a person whose fresh color, muscular development, and good digestion show him to be healthy-blooded if an aneurism forms, the best chances of restor- ation to safety are to be sought in making the circulating liquid first, unnaturally stagnant, and secondly, unnaturally coagulable. These objects can be attained by keeping the patient in bed and starving him. Thus is produced an artificial anaemia, a state of blood in which the red disks are deficient, and the fibrin is in ex- cess, a state in which coagulation is at its maximum, and the force of the heart at its minimum. The method is commonly known as Valsalva's, and it has met with a sufficient measure of success to warrant a trial of it being made in every case where no impedi- ments lie in the way. About fifteen years ago, I published a clinical lecture on several patients treated thus, and I concluded that u not merely is it the best mode, but the only honest mode, of treating aneurisms of the trunk vessels; because it is the only one we at present know consonant to reason and experience." 1 The most successful cases are those where the sac is in the de- scending and abdominal aorta, as that of the' stone-mason I men- tioned in the lectures just quoted. Yet others are not to be des- paired of. In the "British Medical Journal " (December 16th, 1865) is published a case by Dr. Waters of Liverpool, of thoracic aneurism successfully treated by rest and low diet, and Mr. Tuf- nell of Dublin has advocated its use in those cases of aneurism which would come under the care of a surgeon. Bread and water, or pudding and water, as advised by Yalsalva, and used as punishment diet at prisons, is the most effective. Valsalva gave as little as half a pound of pudding in the morn- ing, and half a pound in the evening, till the pulsation of the tumor was arrested, and then he gradually increased the quantity till ordinary diet was resumed, carefully watching against a re- lapse, however, during this latter process. And I agree that it is better at once to try the experiment with extreme rigor, and give 1 Lectures Chiefly Clinical, lect. xxiv. 20 306 DIETETICS IN SICKNESS. it up if necessity will have it so, than to shiver and vacillate on the brink of the serious struggle for life, perhaps too late to be of use. The confinement to bed must be absolute. To the future conduct of those who have suffered from aneu- rism, and in whom a recurrence of the disease is, of course, to be feared, it is obvious that the principles above advocated do not apply. The formation of an aneurismal sac is a degenerative pro- cess ; and starvation, bleeding, and confinement to bed would be most deleterious, as tending to induce further debility and degen- eration. The ansemic dietary is for the sole purpose of bringing about the formation of a clot, and the prevention of further degen- eration of the arteries must follow an opposite path. Iron, nu- tritious food, good dry air, moderate exercise, and suitable cloth- ing should be perseveringly adhered to for the rest of the patient's life. I would strongly advocate, also, in the interests of the digestive organs, a change from the climate of England, where degenera- tive disease is the rule, and acute disease the exception, to Italy, where degenerative disease is the exception and acute disease the rule a change, if not for life, at all events for long enough to alter the constitution. It may be remarked that it is in the ab- sence of aneurism that this peculiarity of the Italian climate is shown. In the statistics of Milan Hospital (Rendiconto della Benificenza dell' Ospetale Maggiore, etc., 1862), I find but 4 in- stances of thoracic aneurism in 61,761 patients, or 1 in 15,440 ; whereas at St. Mary's Hospital, London, I find 29 in 7319 pa- tients, or 1 in 252. Again, at Genoa I find the last published bills of mortality (for 1860, printed by Dr. Giovanni du Jardin) without any deaths by aneurism. The corresponding report for London contains 103. The differences are so great, that the lim- ited range of the observation is unimportant, and I cannot but conclude that there is something in the climatic influences of Lon- don favorable to, and something in Milan and Genoa antagonistic to, the formation of aneurism. INDEX. Acids in atonic dyspepsia, 254 Adulteration, definition of, 218 Ague, 290 Air, as a defence against intoxication, 221 Albuminuria, 272 Alcohol, abstinence from, in gout, 263 action (physiological) of, 107, 200, 273 beneficial effects of, 216 different forms of, 73, 217, 235, 290 influence of nationality in con- sumption of, 221 injurious to children, 137, 226 hysterics, 282 nurses, 126 moral effects of, 221 use of in atonic dyspepsia, 256 consumption, 300 fevers, 235 Alkaline drink, 248 Almonds, 51,238, 276 Aneurism, 304 Arrowroot, 72, 238 Artichoke, 46 Artichokes, Jerusalem, 44 Asparagus, 43, 45 Athletic training, 155, 181 Athleticism, evils of, 263 Atonic dyspepsia, 217, 252 Bacon, 61, 280 Bael drink, 238 Barley, 71 water, 85, 237 Bathing, 163, 258, 295 Batter pudding, 243 Bed, lvinor-in, 167 Beef tea, 131, 239, 275 Biscuits, 70 and milk, 243 Boils, 166, 172 Brain, concussion of, 291 Bread, 68, 254 brown, 280 pudding, 243, 249 sauce, 242 soup, 248 Bright's disease of kidneys, 213, 272 Butter, 66 Buttermilk, 65 Cabbage, 43, 45 Cardoons, 46 Carnivora, flesh of, 275 Carrots, 44 Caviare, 41, 60 Celery, 49 Cellulose, conversion into sugar, 59 Change of air, 182, 265, 300 Chantarelles, 47 Cheerfulness, 116, 199, 229,286 Cheese, 67, 254, 275 Chestnuts, 46 Chewing, 105, 108 Chicken and " Hen " broth, 240 Children, diet of, 134 Chocolate, 55, 96 Cirrhosis from alcohol, 213 Claret cup, 85. 238 Cleanliness, 48, 50, 87, 97, 163 Climate, effects of, 175, 221 in atonic dyspepsia, 259 in consumption, 300 in gout, 264 of Italy, 265, 306 Clotted cream, 66 Cocoa, 55, 96 Cod-oil, 297 Coffee, 55, 96 Commercial life, diet of, 140 Condy's wash, 239 Constipation, 252, 257, 278 Consumption, pulmonarv, 297 Cookery, 52, 87, 106 Corpulence, reduction of, 166 Crabs, 42 Cream, 298 808 INDEX. Cucumber, 43, 49 Cups, 85 Curayoa, 85 Curds, 65 Degeneration, arterial, from alcohol, 215 in meat, 32, 37, 38 Delirium trcmens, 212, '284 Diabetes, 274 Diarrhcen, 171 Diet, dry, 301 Digestibility, degrees of, 114 Digestible, meaning of, 111 Digestion, 101 time of, 99 Diluents, 50, 51, 85, 113, 250, 277 Disease, transmission of, in meat, 37 in milk, 63 Dress, 136, 165, 180 Ducks, 39 Dynamic equivalents, 24 Eel broth, 242 Egg nogg, 239 soup, 239 Eggs, 39, 59, 67, 98, 100 Emotion., action of, 110 Endosmosis, 111 Enemata, nutritive, 235, 242. 288 Fagot, for flavoring, 281 Famine, 176, 194 Fasting, 121, 195 Fevers, diet and regimen of, 231 Fish, 40 Flatulence, 252, 259 Flavorings, 49, 93, 97, 281 poisonous, 218 Flounders, 260 Food and work, 23, 28 natural, of man, 17 quantity of, 22, 27, 28, 120 Fraud, 60 (note), 62, 69, 71, 78, 218 French beans, 47, 275 Fruit, 51,246, 275 Fusel-oil, 81, 218 Game, 39, 40 Geese, 40 Gelatin, 249 Gluttony, 137 Gout, 247, 261 in the stomach, 268 Grape sugar, 56, 73 Gravel, 270 Grits, 71, 238 Groceries, 52 Habit, force of, 18 Ham, 61, 170 Hartshorn drink, 248 jelly, 249 Heart, disease of, 301 Heat, 113 Hvpochondriasis, 292 Hysteria, 282 in the male, 284 Ice, 85 Infants, diet of, 125 Inflammation, diet for, 245 Insanity, 293 Intemperance, dangers of, 213, 220 Iron in medicine, 82, 258, 259, 295 Junkets, 65 Kidneys, activity of, defence against alcohol, 221 diseases of, 270 Leeks, 44 Lemonade. 85 r 237 Lentils, 47 Lettuces, 50, 281 Liehig's food for infants, 130 Linseed tea r 237 Literary life, diet of, 144 Liver, sluggish, 252 use of, 122 Luncheon, 49, 137, 166, 253 Macaroni, 57, 176 Maize, 71 Malt liquors, 80, 277 tea, 243 Mayonnaise, 260 Meals, times of. 117 Meat, choice of, 29 storing of, 100 Milk, 20, 62, 126 boiled, 170 diet, 274, 297, 299 gouts', 170 Mineral waters, 84 Mixed diet, 20 Morels, 47 Mothers, diet of, 126 Mould, blue, 64 Mushrooms, 47 INDEX. 309 Mustard, 61, 269 Mutton broth, 241, 250 club, 34 Neuralgia, 291 Noxious trades, 152 Nurse, choice of, 236 Nutrition, 122 Nutritiousness, comparative, 123 Nuts, 51 Oatmeal, 71 flummery, 281 tea, 251' Obesity, 302 Oil, 59, 170 Old age, 189, 197 Olives, 59, 275 Oxalate of lime, 270 Oysters, 42 Panado, 239 Parsnips, 44 Partridge, 40, 89. 242 Peas and beans, 46. 47, 59, 274 Pepper, 60, 255, 259 Pepsin, 235, 256, 258 Phosphates in medicine, 294 urine, 271 Physicking, 138 Pickles, 60 Pigeon, 212 Porridge, 280 Potato surprise, 260 / Potatoes, 43 for invalids. 244 Poultry, 39 Poverty, 91, 192 Preserved food, 94, 99 Professional life, diet of, 144 Puff-bull, 47 Purgatives, 278, 288 Kaisins, 56 Kennet, 67, 237 Rheumatic fever, diet in, 246 Rheumatism, chronic, 269 Rice, 57 gruel, 238 in broth, 241 milk, 260 pudding, 243 Rickets, 132, 295 Riding, 268 Rose tea, 250 Rosin, use of, in wine, 219 Rot in sheep, 32 Rowing, 136, 157, 165 Rye, 71 Sage tea, 253 Salad, 48, 254 Salsify, 44 Salt, use of, in wine, 219 Raiting, 94 Sauce, universal, 97 (note), 255, 259 Sausages, 61 Scrofula, 294 Seakale, 44 Sea-sickness, 173 Semolina, 57 Shell-fish, 42 Sleep, want of, 172, 198, 217 Soup for poor, 91 meagre, 248 Sour crout, 45, 111 Spices, 61 Spinach soup, 281 Spirituous liquors, 80 Starch, conversion of, 106 Starvation, 184, 245, 305 Stomach cough, 257 Suet, 298 Sugar, 55 action of, in digestion, 256 formation in body, 106, 123, 274 Sunstroke, 291 Swiss condensed milk, 65, 130 Tea, 53, 119 for invalids, 244 Teeth, 17, 108 Teething, 132 Temperance societies, 228 Temperature, influence of, in diges- tion, 247 Toast and water, 85 Tomatoes, 46, 49 Travelling:, hints about, 169 Treacle, 56 Trichina, 36 Truffles, 47 Tubercle, softening of, arrested by al- cohol, 217 Turkeys, 40, 89 Turtle, 41 Uric acid, 270 Variety, 114, 119, 135, 254 Vegetable food, uses of, 42, 49, 194, 254, 263, 279, 292 marrow, 46 310 INDEX. Vegetables, cookery of, 92 storing of, 100 Vermicelli, 57 Vichy water, 248, 258 Vinegar, 57, 170 Voisin, on idiocy produced by alco- hol, 216 "Water, choice of, 81 as a remedy, 219, 279 gruel, 71, 237 Whey, 65, 236, 238 Wine, 72 light, beneficial influence of, 2J7, 266 in old age, 198 red, 280 Winter greens, 45 Worms, round, 50 tape, 34 Yams, 44 Yeast, 70 PAVY ON FOOD. Just Issued. A TREATISE ON FOOD AND DIETETICS, PHYSIOLOGICALLY AND THEBAPEUTICALLY CONSIDERED. BY F. W. PAVY, M.D., F.R.S., Physician to and Lecturer on Physiology in Guy's Hospital. In one very neat octavo volume of nearly six hundred pages ; cloth, $4.75. No modern treatise on this subject having existed in the English language, Dr. Pavy's work supplies a want which has been very seriously felt, and in a manner which shows that the author is an extensive reader and has judicious-ly arranged the numerous facts and theories, together with the most striking experiments and the deductions drawn therefrom. It seems to us that he has truly conferred a great benefit upon all interested in the subject-matter of his work, and that nobody will study its pages without having derived valuable instruction therefrom, and without considering it not only useful, but next to indispensable. Amer. Jour, of Pharmacy, Aug., 1874. The present book is a result of his work in this direction, and is well calculated to do credit to his perseverance in collecting facts, and his judgment in arranging them in an entertain- ing, as well as a practical form. It is but rarely that we have had offered us so much practi- cal information in so agreeable a manner as is done by I)r. Pavy in the present instance. New Remedies, July, 1874. Not pretending to contain much original research, it presents an admirably clear, full, well digested account of all important facts and theories on the supply of force and material in the human organism. The size of the work, the concise ness of its style, the extent of its in- formation, the' completeness of its scope, and the general accuracy of its statements reflect not less credit on the industry than on the ability of its author. London Lancet, Oct. 10, 1874. AVe can very cordially commend the book to our readers. Brit, and For. Med.-Chlr. Rev., Oct., 1874. The work will amply repay the reader, whether professional or general, and should find a place in the libraiy of every physician, in the dispensary of every hospital, and would consti- tute a valuable addition to the household library. Chicago Med. Journ., Nov., 1874. In one word, Dr. Pavy has favored his brethren with an admirable book on a most interest- ing and important subject. When the practice was to reduce the diet of the sick to the mini- mum compatible with existence, physicians might dei-pise dietetics; but since one of the great points in practice has come to be the support of our patients by suitable aliment, the study of food has become one of the most important iu medicine. Am. "Practitioner, Oct., 1874. It is seldom, indeed, that we have the good fortune to read so admirable a book as this treat- ise of Dr. I'avy. A feeling of satisfaction is always IV-lt in the reader's mind when the author writes eUarly, instructively, and as master of his subject .; and thrse three characteristics are found combined in the work before us a work which is sure to become a standard authority on the subject of which it treats, and which we have great pleasure in recommending to the at- tentive study of our readers Dublin Joum. of Med. Sci., Oct , 1874. BY THE SAME AUTHOR Lately Issued. A TREATISE ON THE FUNCTION OF DIGESTION: Its Disorders, and their Treatment. By F. W. Pavy, M.D., F.R.S., Senior Assistant Physician to, and Lecturer on Physiology at, Guy's Hospital, etc. From the Second London Edition. In one very handsome octavo volume of about 250 pages; extra cloth, $2.00. It is a model of its kind. The author has a happy faculty of entertaining as well as instruct- ing his reader, combining, so to speak, pleasure willi profit. Accustomed as a teacher to present salient points, he succeeds admirably in outlining his subject. N. Y. Med. Record, Sept. 1, 1869. This work is well worthy careful perusal, and should be in the library of every practitioner. St. Louis Mcd. Archives, Sept., 1869. In the field thus defined Dr. Pavy has given us the most satisfactory essay yet published. N. Y. Med. Gazette, Aug. 28, 1869. HENRY C. LEA, Philadelphia. FOX ON THE STOMACH. Now Ready. THE DISEASES OF THE STOMACH. Being the Third Edition of the "Diagnosis and Treatment of the Varieties of Dyspepsia." BY WILSON FOX, M.D., Holme Professor of Clinical Medicine, University College, London. Revised and enlarged with illustrations, in one handsome octavo volume, cloth, $2.00. A complete "Treatise on Diseases of the Stomach," which bears testimony not only to a vast amount of work, but also to a surprising research in the literature of the subject. As a work of reft- rence, we consider the volume before us most complete, and one which every man engaged in thoroughly studying diseases of the stomach should consult. Dublin Journal of Mud. Science, Oct., 1873. This work, by Dr. AVilson Fox, is a highly valuable one, representing very fully the most recent views relative to the pathology and symptomatology of diseases of the stomach', and oilers an excellent digest of the principles and details of treatment advocated by the most eminent practitioners of the day. British and Foreign Med.-Chirurg. Renew, July, 1873. For want of space we are compelled to omit any notice of the other subjects treated of in this admirable work ; and in what we have written we have not been able, for tin 1 same rea- son, to give the author's remarks on the etiology, symptoms, and diagnosis of the various forms of dyspepsia, which to the student will prove the most interesting and useful part of his treatise. American Practitioner, March, 1873. We have more than usual pleasure in calling attention to this work by Dr. Fox, as well adapted to meet the troubles of practitioners. Cincinnati Lancet and Observer, March, 1873. BRINTON ON THE STOMACH. Lately Published. LECTURES ON THE DISEASES OF THE STOMACH, with an Introduction on its Anatomy and Physiology. By WILLIAM BRINTON, M.D., F.R.S., Physician to St. Thomas's Hos- pital. From the second and enlarged London Edition. AVith illustrations on wood. In one handsome octavo volume of about 300 pages; extra cloth, $3.25. This is no mere compilation, no crude record of cases, but the carefully elaborated produc- tion of an accomplished physician, who, for many years, has devoted special attention to the symptomatology, pathology, and treatment of gastric diseases. Edinburgh Medical Journal. FLINT'S MEDICAL ESSAYS. Now Ready. ESSAYS ON CONSERVATIVE MEDICINE, AND KINDRED TOPICS. By AUSTIN FLINT, M.D., Professor of the Principles and Practice of Medicine in Bellevue Med. College, N. Y. In one very handsome volume, royal 12mo. ; cloth, $1.38. This little volume consists of a c( llectiou of thoughtful essays on important topics, which have appeared from time to time in various periodicals. The subjects treated of are as follows : I. Conservative Medicine. II. Conservative Medicine as applied to Therapeutics. III. Con- servative Medicine as applied to Hygiene. IV. Medicine in the Past, the Present, and the Future. V. Alimentation in Disease. VI. Tolerance of Disease. VII. On the Agency of the Mind in Etiology, Prophylaxis, and Therapeutics. VIII. Divine Design as Manifested in the Natural History of Diseases. A more suggestive collection of topics it would be difficult to conceive. The essays on con- servative medicine are peculiarly valuable. Peninsular Journal of Medicine, Oct., 1874. TUKE ON MENTAL INFLUENCE. Lately Issued. ILLUSTRATIONS OF THE INFLUENCE OF THE MIND UPON THE BODY IN HEALTH AND DISEASE. Designed to illustrate the action of the imagination. By DANIKL HACK TUKE, M.D., Joint author of "The Manual of Psychological Medicine," etc". In one hand- some octavo volume of 416 pages ; extra cloth, $3.25. Dr. Tuke's idea in writing this book is to begin work in this uninvestigated field. It is the first work on the subject extant, and practicing physicians will be am pry paid fur reading it carefully through, and studying the chapter on psycho-therapeutics. Almost every physician rejects the systematic, scientific employment of psychical aids in curing disease, and'in so doing one means is thrown away more powerful than all the agents in niateria medica. Chicago Med. Journal, Jan., 1873. The influence of the mind upon the body is without doubt one of the strongest therapeutical agencies which can be wielded by the physician, and he who passes by it as unworthy of bis attention, or who uses it carelessly and in ignorance of its true scope and value, is neglecting or misusing a valuable assistant in his battle with disease and death. In writing this book the author has placed the profession under many obligations to him, and as the subject is more fully investigated as time passes along, the reader of the future will feel with increased force his debt of gratitude to Dr. Tuke for placing in his hands a work filled with fresh and enter- taining truths, stated in terms easily understood. We advise our readers to obtain it and study it with care. Buffalo Med. and Surgical. Journal, April, 1873. This book of Dr. Tuke is one of intense interest, not only to the scientific man but also to the student of the rational school of metaphysics. Obstetrical Journal, June, 1S73. HENRY C. LEA, Philadelphia. C. LEA/S (LATE LEA A BLANCHARD'S) OF MEDICAL AND SUEGICAL PUBLICATIONS, In asking the attention of the profession to the works advertised in the following pages, the publisher would state that no pains are spared to secure a continuance of the confidence earned for the publications of the house by their careful selection and accuracy and finish of execution. The printed prices are those at which books can generally be supplied by booksellers throughout the United States, who can readily procure for their customers any works not kept in stock. 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The pub- lisher, therefore, has much gratification in stating that the very great favor with which these periodicals are regarded by the profession promises to render the enterprise a permanent one, and it is with especial pleasure that he acknowledges the valuable assistance spontaneously rendered by so many of the old subscribers to the ' JOUR- NAL," who have kindly made known among their friends the advantages thus offered, and have induced them to subscribe. Relying upon a continuance of these friendly exertions, he hopes to be able to maintain the unexampled rates at which these works (For "THE OBSTETRICAL JOURNAL," seep. 22.) 2 HENRY C. LEA'S PUBLICATIONS (Am. Journ. Med. Sciences). are now offered, and to succeed in his endeavor te place upon the table of every reading practitioner in the United States the equivalent of three large octavo volumes, at the comparatively trifling cost of Six DOLLARS per annum. These periodicals are universally known for their high professional standing in their several spheres. I. THE AMERICAN JOURNAL OF THE MEDICAL SCIENCES, EDITED BY ISAAC HAYS, M.D., is published Quarterly, on the first of January, April, July, and October. Each num- ber contains nearly three hundred large octavo pages, appropriately illustrated wher- ever necessary. It has now been issued regularly for over FIFTY years, during nearly the whole of which time it has been under the control of the present editor. Through- out this long period, it has maintained its position in the highest rank of medical periodicals both at home and abroad, and has received the cordial support of the en- tire profession in this country. Among its Collaborators will be found a large number of the most distinguished names of the profession in every section of the Dinted States, rendering the department devoted to ORIOINAL COMMUNICATIONS full of varied and important matter, of great interest to all practitioners. Thus, during 1874, articles have appeared in its pages from nearly one hundred gentlemen of the highest standing in the profession throughout the United States.* Following this is the "REVIEW DEPARTMENT," containing extended and impartial reviews of all important new works, together with numerous elaborate " ANALYTICAL AND BIBLIOGRAPHICAL NOTICES" of nearly all the medical publications of the day. This is followed by the " QUARTERLY SUMMARY OF IMPROVEMENTS AND DISCOVERIES IN THE MEDICAL SCIENCES," classified and arranged under different heads, presenting a very complete digest of all that is new and interesting to the physician, abroad as well as at home. Thus, during the year 1874, the "JOURNAL" furnished to its subscribers 85 Orig- inal Communications, 113 Reviews and Bibliographical Notices, and 305 articles in the Quarterly Summaries, making a total of about FIVE HUNDRED articles emanating from the best professional minds in America and Europe. That the efforts thus made to maintain the high reputation of the " JOURNAL" are successful, is shown by the position accorded to it in both America and Europe as a national exponent of medical progress: America continues to take a great place in this | rowed matter it contains, and has established for class of journals (quarterlies), at the head of which ' itself a reputation in every country where medicine the great work of Dr. Hays, the American Journal \ is cultivated as a science. Brit, and For. Med.-Chi- ofthe Mecical Sciences, still holds its ground, as our quotations have often proved. Dublin Med. Press and Circular, Jan. 31, 1872. Of English periodicals the Lancet, and of American the Am. Journal of the Medical Sciences, are to be regarded as necessities to the reading practitioner. y Y. Medical Gazette, Jan. 7, 1871. The American Journal of the Medical Sciences rurg. Review, April, 1871. This, if not the best, is one of the best-conducted medical quarterlies in the English language, and the present number is not by any means inferior to its predecessors. London Lancet, Aug. 23, 1873. Almost the only one that circulates everywhere, all over the Union and in Europe. London Medical Times, Sept. 5, 1868. yields to none in the amount of original and bor- And that it was specifically included in the award of a medal of merit to the Pub- lisher in the Vienna Exhibition in 1873. The subscription price of the "AMERICAN JOURNAL OF THE MEDICAL SCIENCES" has never been raised during its long career. It is still FIVE DOLLARS per annum ; and when paid for in advance, the subscriber receives in addition the "MEDICAL NEWS AND LIBRARY," making in all about 1500 large octavo pages per annum, free of postage. II. THE MEDICAL NEWS AND LIBRARY is a monthly periodical of Thirty-two large octavo pages, making 384 pages per annum. Its "NEWS DEPARTMENT" presents the current information of the day, with Clinical Lectures and Hospital Gleanings; while the ''LIBRARY DEPARTMENT" is de- voted to publishing standard works on the various branches of medical science, paged * CommunicatiOQS are invited from gentlemen in all parts of the country. Elaborate articles inserted by the Editor are paid for by the Publisher. HENRY C. LEA'S PUBLICATIONS (Am. Journ. Med. Sciences). 3 separately, so that they can be removed and bound on completion. In this manner subscribers have received, without expense, such works as " WATSON'S PRACTICE," " TODD AND BOWMAN'S PHYSIOLOGY," " WEST ON CHILDREN," " MALOAIGNE'S SUR- GERY," &c. &c. With Jan. 1875, was commenced the publication of Dr. WILLIAM STOKES'S new work on FEVER (see p. 14), rendering this a very desirable time for new subscriptions. As stated above, the subscription price of the " MEDICAL NEWS AND LIBRARY" is ONE DOLLAR per annum in advance; and it is furnished without charge to all advance paying subscribers to the "AMERICAN JOURNAL OF THE MEDICAL SCIENCES." III. THE MONTHLY ABSTRACT OF MEDICAL SCIENCE. The publication in England of Banking's " HALF-YEARLY ABSTRACT OF THE MEDI- CAL SCIENCES" having ceased with the volume for January, 1874, its place has been supplied in this country by a monthly "ABSTRACT" containing forty-eight large octavo pages each month, thus furnishing in the course of the year about six hundred pages, the same amount of matter as heretofore embraced in the Half-Yearly Abstract. As the discontinuance of the "Ranking" arose from the multiplication of journals appearing more frequently and presenting the same character of material, it has been thought that this plan of monthly issues will better meet the wants of subscribers, who will thus receive earlier intelligence of the improvements and discoveries in the medical sciences. The aim of the MONTHLY ABSTRACT will be to present a careful condensation of all that is new and important in the medical journalism of the world, and all the prominent professional periodicals of both hemispheres will be at the dis- posal of the Editors. Subscribers desiring to bind the ABSTRACT will receive, on application at the end of each year, a cloth cover, gilt lettered, for the purpose, or it will be sent free by mail on receipt of the postage, which, under existing laws, will be six cents. The subscription to the " MONTHLY ABSTRACT," free of postage, is Two DOLLARS AND A HALF a year, in advance. As stated above, however, it will be supplied in conjunction with the "AMERICAN JOURNAL OF THE MEDICAN SCIENCES" and the "MEDICAL NEWS AND LIBRARY," making in all about TWENTY-ONE HUNDRED pages per annum, the whole free of postage, for Six DOLLARS a year, in advance. The first volume of the " MONTHLY ABSTRACT," from July to December, 1874, can be had by those who desire to have complete sets, if early application be made, for $1 50, forming a handsome octavo volume of 300 pages, cloth. In this effort to bring so large an amount of practical information within the reach of every member of the profession, the publisher confidently anticipates the friendly aid of ail who are interested in the dissemination of sound medical literature. He trusts, especially, that the subscribers to the "AMERICAN MEDICAL JOURNAL" will call the attention of their acquaintances to the advantages thus offered, and that he will be sustained in the endeavor to permanently establish medical periodical literature on a footing of cheapness never heretofore attempted. PREMIUM POK NEW SUBSCKIBEES 'TO THE "JOUKNAL." Any gentleman who will remit the amount for two subscriptions for 1875, one of which must be for a neiv subscriber, will receive as a PRF.MIUM, free by mail, a copy of "FLINT'S ESSAYS ON CONSERVATIVE MEDICINE" (for advertisement of which see p. 15), or of "STURGES'S CLINICAL MEDICINE" (see p. 14), or of the new eduion of "SWAYNE'S OBSTETRIC APHORISMS" (see p. 24), or of "TANNER'S CLINICAL MANUAL" (see p. 5), or of " CHAMBERS'S RESTORATIVE MEDICINE" (see p. 16), or of "WEST ON NERVOUS DISORDERS OF CHILDREN" (see page 21). %* Gentlemen desiring to avail themselves of the advantages thus offered will do well to forward their subscriptions at an early day, in order to insure the receipt of complete sets for the year 1875, as the constant increase in the subscription list almost always exhausts the quantity printed shortly after publication. $g The safest mode of remittance is by bank check or postal money order, drawn to the order of the undersigned. Where these are not accessible, remittances for the "JOURNAL" may be made at the risk of the publisher, by forwarding in REGISTERED letters. Address, HENRY C. -LEA, Nos. 706 and 708 SANSOM ST., PHILADELPHIA, PA. HENRY C. LEA'S PUBLICATIONS (Dictionaries). flUNGLISON (ROBLEY], M.D., Late Professor of Institutes of Medicine in Jefferson Medical College, Philadelphia. MEDICAL LEXICON; A DICTIONARY OF MEDICAL SCIENCE: Con- taining a concise explanation of the various Subjects and Terms of Anatomy, Physiology, Pathology, Hygiene, Therapeutics, Pharmacology, Pharmacy, Surgery, Obstetrics, Medical Jurisprudence, and Dentistry. Notices of Climate and of Mineral Waters ; Formulae for Officinal, Empirical, and Dietetic Preparations; with the Accentuation and Etymology of the Terms, and the French and other Synonymes j so as to constitute a French as well as English Medical Lexicon. A New Edition. Thoroughly Revised, and very greatly Mod- ified and Augmented. By RICHARD J. DUNGLISON, M.D. In one very large and hand- some royal octavo volume of over 1100 pages. ' Cloth, $6 50 ; leather, raised bands, $7 50. (Just Issued.} The object of the author from the outset has not been to make the work a mere lexicon or dictionary of terms, but to afford, under each, a condensed view of its various medical relations, and thus to render the work an epitome of the existing condition of medical science. Starting with this view, the immense demand which has existed for the work has enabled him, in repeated revisions, to augment its completeness and usefulness, until at length it has attained the position of a recognized and standard authority wherever the language is spoken. Special pains have been taken in the preparation of the present edition to maintain this en- viable reputation. During the tt n years which have elapsed since the last revision, the additiot 8 to the nomenclature of the medical sciences have been greater than perhaps in any similar period of the past, and up to the time of his death the author labored assiduously to incorporate every- thing requiring the attention of the student or practitioner. Since then, the editor has been equally industrious, so that the additions to the vocabulary are more numerous than in any pre- vious revision. Especial attention has been bestowed on the accentuation, which will be found marked on every word. The typographical arrangement has been much improved, rendering reference much more easy, and every care has been taken with the mechanical execution. The work has been printed on new type, small but exceedingly clear, with an enlarged page, so that the additions have been incorporated with an increase of but little over a hundred pages, and the volume now contains the matter of at least four ordinary octavos. A book well known to our readers, and of which every American ought to be proud. When the learned author of the work passed away, probably all of us feared lest the book should not maintain its place in the advancing science whose terms it defines. For- tunately, Dr. Kichard J. Dunglison, having assisted his father in the revision of several editions of the work, and having been, therefore, trained in the methods and imbued with the spirit of the book, has been able to edit it, not in the patchwork manner so dear to the lieart of book editors, so repulsive to the taste of intel- ligent book readers, but to edit it as a work of the kind should be edited to carry it on steadily, without jar or interruption, along the grooves of thought it has travelled during its lifetime. To show the magnitude of the task which Dr. Dunplison has assumed and car- ried through, it is only necessary to stale that more than six thousand new subjects have been added in the present edition. Without occupy ing more space with the theme, we congratulate the editor on the successful eoiupleluin of his labors, and hope he may reap the well- earned reward of profit and honor. Phila. Med. Times, Jan. 3, 1874. About the first book purchased by the medical stu- dent is the Medical Dictionary. The lexicon explana- tory of technical terms is simply a sine qua ndn. In a science so extensive, and with such collaterals as medi- cine, it is as much a necessity also to the jiracfising physician. To meet the wants of students and most physicians, the dictionary must be condensed while comprehensive, and practical while perspicacious. It was because Dunglison's met these indications that it became at once the dictionary of general use wherever medicine was studied in the English language. In no former revision have the alterations and additions been so great. More than six thousand new subjects and terms have been added. The chief terms have been set in black We are glad to see a new edition of this invaluable work, and to find that it has been so thoroughly revised, and so greatly improved. The dictionary, in its pre- sent form, is a medical library in itself, and one of which every physician should be possessed. ST. Y. Med. Journal, Feb. 1874. With a history of forty years of unexampled success and universal indorsement by the medical profession of the western continent, it would be presumption in any living medical American to essay its review. No re- viewer, however able, can add to its fame; no captious critic, however caustic, can remove a single stone from its firm and enduring foundation. It is destined, as a colossal monument, to perpetuate the solid and richly deserved fame of Kobley Dunglison to coming genera- tions. The large additions made to the vocabulary, we think, will be welcomed by the profession as supplying the want of a lexicon fully up with the march of sci- ence, which has been increasingly felt for some years past. The accentuation of terms is very complete, and, ai- lar as we have been able to examine it, very excel- lent. We hope it may be the means of securing greater uniformity of pronunciation among medical men. At- lanta Med. and 8urg. Journ., Feb. 1874. It would be mere waste of words in us to express jur admiration of a work which is so universally and deservedly appreciated. The most admirable work of its kind in the English language. Gflasgow Medical Journal, January, 1866. A work to which there is no equal in the English language. Edinburgh Medical Journal. Few works of the class exhibit a grander monument jf patient research and of scientific lore. The extent jf the sale of this lexicon is sufficient to testify to its asefniness, and to the great service conferred by Dr. letter, while ihe derivatives follow in small caps; an ! Robley Dunglison on the profession, and -indeed on arrangement which greatly facilitates reference. We may safely confirm the hope ventured by the editor ' that the work, which possesses for him a filial as well as an individual interest, will be found worthy a con- jthers, by its issue. London Lancet, May 13, 1866. It has the rare merit that it certainly has no rival in the English language for accuracy and extent of as an niv n, - V . tinuance of "the position so long accorded to it as a | references. London Medical Gazette. standard authority." Cincinnati Clinic, Jan. 10, 1874. | LJOBLYN (RICHARD D.), M.D. A DICTIONARY OF THE TERMS USED IN MEDICINE AND THE COLLATERAL SCIENCES. Revised, with numerous additions, by ISAAC HATS, M.D., Editor of the "American Journal of the Medical Sciences." In one large royal 12mo. volume of over 500 double-columned pages; cloth, $1 50 ; leather, $2 00. It is the best book of definitions we have, and ought always to be apon the tndent' table. Southern lied, and Sury. Journal. HENRY C. LEA'S PUBLICATIONS (Manuals). KTEILL (JOHN), M.D., and &MITH (FRANCIS O.), M.D., Prof.of the Institutes of Medicine in the Univ. of Penna. AN ANALYTICAL COMPENDIUM OP THE VARIOUS BRANCHES OP MEDICAL SCIENCE ; for the Use and Examination of Students. A new edition, revised and improved. In one very large and handsomely printed royal 12mo. volume, of about one thousand pages, with 374 wood cuts, cloth, $4; strongly bound in leather, with raised bands, $4 75. The Compend of Drs. Neilland Smith is incompara- : clous factstreasnred np In this little volume. Acorn- biy the most valuable work of its class ever published i plete portable library so condensed that the student In this country. Attempts have been made in various ( may make it his constant pocket companion. West- quarters to squeeze Anatomy, Physiology, Surgery, wn. Lancet. the Practice of Medicine, Obstetrics Materia Medica, | In the rapld course of lectures, where work for the admirably drawn and illustrated, and the authors . of the kind that we knowof . O f course it is useless are eminently entitled to the grateful consideration for U8 to recommend it toalllastcoursestndents bnt of the student of every class. N. 0. Med. and Surg. there ls ft cla(Ig to wnom we very 8incerely comm end Journal,. tnis cheap book as worth Us weight in silver tht There are but few students or practitioners of me- class is the graduates in medicine of more than tea dicine unacquainted with the former editions of this ; years' standing, who have not studied medicine unassuming though highly instructive work. The since. They will perhaps find out from it that the whole science of medicine appears to have been sifted, i science is not exactly now what It was when they as the gold-bearing sands of El Dorado, and the pre- 1 left it off. The Stethoscope. TJARTSHORNE [HENRY], M. D., Professor of Hygiene in the University of Pennsylvania. A CONSPECTUS OF THE MEDICAL SCIENCES; containing Handbooks on Anatomy, Physiology, Chemistry, Materia Medica, Practical Medicine^ Surgery, and Obstetrics. Second Edition, thoroughly revised and improved. In one large royal 12mo. volume of more than 1000 closely printed pages, with 477 illustrations on wood. Cloth, $4 25 ; leather, $5 00. (Lately Issued.) The favor with which this work has been received has stimulated the author in its revision to render it in every way fitted to meet the wants of the student, or of the practitioner desirous to refresh his acquaintance with the various departments of medical science. The various sections have been brought up to a level with the existing knowledge of the day, while preserving the condensa- tion of form by which so vast an accumulation of facts have been brought within so narrow a compass. The series of illustrations has been much improved, while by the use of a smaller type the additions have been incorporated without increasing unduly the size of the volume. The work before us has already successfully assert- i and the clear and instructive illustrations in some ed its claim to the confidence and favor of the profes- parts of the work. American Journ. of Pharmacy, sion ; it but remains for us to say that in the present ! Philadelphia, July, 1S74. edition the whole work has been fully overhauled The vo , ume win be found nsefnl not only to 8tn . and brought up to the present status of the science. j dea(8i b(U to manyot hers who may desire to refresh Atlanta Med. and Surg. Journal, Sept. 1874. their memor ies with the smallest possible expendi- The work is intended as an aid to the me.dical stu- dout, aud an such appears to admirably fulfil its ob- ture of time. A". Y. Jfed. Journal, Sept. 1874. The student will find this the most convenient and he can lay his ra., Aug. 1S74. ject by its excellent arrangement, the full compilation useful book of the kind on which of facts, the perspicuity aud terseness of language, i hand. Pacific Med. and Surg. Jou f ODLOW (J.L.), M.D. A MANUAL OP EXAMINATIONS upon Anatomy, Physiology, Surgery, Practice of Medicine, Obstetrics, Materia Medica, Chemistry, Pharmacy, and Therapeutics. To which is added a Medical Formulary. Third edition, thoroughly revised and greatly extended and enlarged. With 370 illustrations. In one handsome royal 12mo. volume of 816 large pages, cloth, $3 25 ; leather, $3 75. The arrangement of this volume in the form of question and answer renders it especially suit- able for the office examination of students, and for those preparing for graduation. WANNER (THOMAS HAWKES), M.D., &c. A MANUAL OF CLINICAL MEDICINE AND PHYSICAL DIAG- NOSIS. Third American from the Second London Edition. Revised and Enlarged by TILBURY Fox, M. D., Physician to the Skin Department in University College Hospital, Ac. In one neat volume small 12mo., of about 375 pages, cloth, $150. *** By reference to the " Prospectus of Journal" on page 3, it will be seen that this work is offered as a premium for procuring new subscribers to the "AMERICAN JOURNAL OP THE MEDICAL SCIENCES." Taken as a whole, it is the most compact vade me- j The objections commonly, and Jnstly, urged against cum for the use of the advanced student and junior ( the general run of "compends," "conspectuses," and practitioner with which we are acquainted. Boston other aids to indolence, are not applicable to this little Iftd. and Surg. Journal, Sept. 22, 1870. > volume, which contains in concise phrase just those practical details that are of most use in daily diag- It contains so much that is valuable, presented in : nosis, but which the young practitioner finds it diffl- so attractive a form, that it can hardly be spared cult to carry always in his memory without some even in the presence of more full and complete works. , quickly accessible means of reference. Altogether, Its convenient size makes it a valuable companion the book is one which we can heartily commend to to the country practitioner, and if constantly car- those who have not opportunity for extensive read- ried by him, would often render him good service, and relieve many a doubt and perplexity. Leaven- ing, or who, having read much, still wish an occa- sional practical reminder. K. T. Ned. Gazette, NOT. 10 1S70. HENRY C. LEA'S PUBLICATIONS (Anatomy}. QRAY (HENRY), F.R.S., Lecturer on Anatomy at St. George's Hospital, London. ANATOMY, DESCRIPTIVE AND SURGICAL. The Drawings by H. V. CARTER, M. D., late Demonstrator on Anatomy at St. George's Hospital; the Dissec- tions jointly by the AUTHOR and DR. CARTER. A new American, from the fifth enlarged and improved London edition. In one magnificent imperial octavo volume, of nearly 908 pages, with 465 large and elaborate engravings on wood. Price in cloth, $6 00 ; lea- ther, raised bands, $7 00. (Just Issued!) The author has endeavored in this work to cover a more extended range of subjects than is cus- tomary in the ordinary text-books, by giving not only the details necessary for the student, but also the application of those details in the practice of medicine and surgery, thus rendering it boti a guide for the learner, and an admirable work of reference for the active practitioner. The en gravings form a special feature in the work, many of them being the size of nature, nearly all original, and having the names of the various parts printed on the body of the cut, in place of figures of reference, with descriptions at the foot. They thus form a complete and splendid series, which will greatly assist the student in obtaining a clear idea of Anatomy, and will also serve to refresh the memory of those who may find in the exigencies of practice the necessity of recalling the details of the dissecting room; while combining, as it does, a complete Atlas of Anatomy, with a thorough treatise on systematic, descriptive, and applied Anatomy, the work will be found of essential use to all physicians who receive students in their offices, relieving both preceptor and pupil of much labor in laying the groundwork of a thorough medical education. Notwithstanding the enlargement of this edition, it has been kept at its former very moderate price, rendering it one of the cheapest works now before the profession. The illustrations are beautifully executed, and ren- 1 From time to time, as successive editions have ap- der this work an indispensable adjunct to the library I peared, we have had much pleasure in expressing of the surgeon. This remark applies with great force j the general judgment of the wonderful excellence of to those surgeons practising at a distance from onr Gray's Anatomy. Cincinnati Lancet, Jaly, 1870. large cities, as the opportunity of refreshing their Altogether, it is unquestionably the most complete memjory by actual dissection is not always attain- able. Canada Mtd. Journal, Ang. 1870. The work is too well known and appreciated by the profession to need any comment. No medical man can afford to be without it, if its only merit were to serve as a reminder of that which so soon becomes forgotten, when not called into frequent use, viz., the relations and names of the complex organism of the human body. The present edition is much improved. California Ned. Gazette, July, 1870. Gray's Anatomy has been so long the standard of perfection with every student of anatomy, that we and serviceable text-book in anatomy that has ever been presented to the student, and forms a atrikiug contrast to the dry and perplexing volumes on the same subject through which their predecessors strug- gled in days gone by. N. T. Med. Record, June 15, 1870. To commend Gray's Anatomy to the medical pro- fession is almost as much a work of supererogation as it would be to give a favorable notice of the Bibl* in the religious press. To say that it is the most complete and conveniently arranged text-book of it* kind, is to repeat what each generation of students need do no more than call attention to the improve- I has learned as a tradition of thf> elders, and verified ment in the present edition. Detroit Review of Med. by personal experience. N Y. Med. Gazette, Dec. and Pharm., Aug. 1870. 17, 1870. <3MITH (HENRY H.), M.D., and TJORNER ( WILLIAM E.), M.D., Prof, of Surgery in the Univ. o/Penna.,Ac. Late Prof . of Anatomy in the Univ.ofPenna.,&c. AN ANATOMICAL ATLAS, illustrative of the Structure of the Human Body. In one volume, large imperial octavo, cloth, with about six hundred and fifty beautiful figures. $4 50. VHARPEY ( WILLIAM), M.D., and Q UAIN (JONES fr RICHARD). HUMAN ANATOMY. Revised, with Notes and Additions, by JOSEPH LEIDY, M.D., Professor of Anatomy in the University of Pennsylvania. Complete in two large octavo volumes, of about 1300 pages, with 511 illustrations; cloth, $6 00. The very low price of this standard work, and its completeness in all departments of the subject, should command for it a place in the library of all anatomical students. fTODGES (RICHARD M.), M.D., Late Demonstrator of Anatomy in the Medical Department of Harvard University. PRACTICAL DISSECTIONS. Second Edition, thoroughly revised. In one neat royal 12mo. volume, half-bound, $2 00. The object of this work is to present to the anatomical student a clear and concise description of that which he is expected to observe in an ordinary couise of dissections. The author has endeavored to omit unnecessary details, and 10 present the subjest in the form which many years' experience has shown him to be the most convenient and intelligible to the student. In the rsvision of the present edition, he has sedulously labored to render the volume more worthy of the favor with which it has heretofore been received. HORNER'S SPECIAL ANATOMY AND HISTOLOGY. I In 2 vols. 8vo., of over 1000 pages, with more than Eighth edition, extensively revised and modified. I 300 wood-cuts; cloth, *6 00 HENRY C. LEA'S PUBLICATIONS (Anatomy). WILSON (ERASMUS), F.E.S. A SYSTEM OF HUMAN ANATOMY, General and Special. Edited by W. H. QOBKECHT, M. D., Professor of Qeneraland Surgical Anatomy in the Medical Col- lege of Ohio. Illustrated with three hundred and ninety-seven engravings on wood. In one large and handsome octavo volume, of over 600 large pages ; cloth, $4 00 ; leather, $5 00. The publisher trusts that the well-earned reputation of this long-established favorite will be more than maintained by the present edition. Besides a very thorough revision by the author, it has been most carefully examined by the editor, and the efforts of both have been directed to in- troducing everything which increased experience in its use has suggested as desirable to render it a complete text-book for those seeking to obtain or to renew an acquaintance with Human Ana- tomy. The amount of additions which it has thus received may be estimated from the fact that the present edition contains over one-fourth more matter than the last, rendering a smaller type and an enlarged page requisite to keep the volume within a convenient size. The author has not only thus added largely to the work, but he has also made alterations throughout, wherever there appeared the opportunity of improving the arrangement or style, so as to present every fact in ita most appropriate manner, and to render the whole as clear and intelligible ad possible. The editor has exercised the utmost caution to obtain entire accuracy in the text, and has largely increased the number of illustrations, of which there are about one hundred and fifty more in this edition than in the last, thus bringing distinctly before the eye of the student everything of interest or importance. fJEATH (CHRISTOPHER), F.R. C. S., *-* Teacher of Operative Surgery in University College, London. PRACTICAL ANATOMY: A Manual of Dissections. From the Second revised and improved London edition. Edited, with additions, by W. W. KEEN, M. D., Lecturer on Pathological Anatomy in the Jefferson Medical College, Philadelphia. In one handsome royal 12mo. volume of 578 pages, with 247 illustrations. Cloth, $3 50 ; leather, $4 00. (Lately Publislied.) Dr. Keen, the American editor of this work, in his preface, says : " In presenting this American edition of 'Heath's Practical Anatomy,' I feel that I have been instrumental in supplying a want long felt for a real dissector's manual," and this assertion of its editor we deem is fully justified, after an examina- tion of its contents, for it is really an excellent work. Indeed, we do not hesitate to say, the best of its class with which we are acquainted ; resembling Wilson In terse and clear description, excelling most of the so-called practical anatomical dissectors in the scope of the subject and practical selected matter. . . . In reading this work, one is forcibly impressed with the great pains the author takes to impress the sub- ject upon the mind of the student. He is full of rare and pleasing little devices to aid memory in main- taining its hold upon the slippery slopes of anatomy. St. Louis Med. and Surg. Journal, Mar. 10, 1871. It appears to us certain that, as a guide in dissec- tion, and as a work containing facts of anatomy in brief and easily understood form, this manual is complete. This work contains, also, very perfect illustrations of parts which can thus be more easily anderstood and studied; in this respect it compares 'avorably with works of much greater pretension. Such manuals of anatomy are always favorite works with medical students. We would earnestly recom- mend this one to their attention ; it has excellences which make it valuable as a guide in dissecting, as well as in studying anatomy. Buffalo Medical and SurfficalJournal, Jan. 1871. BELLAMY (E.), F.R.C.S. THE STUDENT'S GUIDE TO SURGICAL ANATOMY: A Text- Book for Students preparing for their Pass Examination. With engravings on wood. In one handsome royal 12mo. volume. Cloth, $2 25. (Just Issued.) We cannot too highly recommend it. Student's Journal. Mr. Bellamy has spared no pains to produce a real- ly reliable student's guide to surgical anatomy one which all candidates for surgical degrees may con- ult with advantage, and which posseses much ori- We welcome Mr. Bellamy's work, as a contribu- tion to the study of regional anatomy, of equal value to the student and the surgeon. It is written in a clear and concise style, and its practical suggestions add largely to the interest attaching to its technical details (Jhicago Med. Examiner, March 1, 1874. We cordially congratulate Mr. Bellamy upon hav- ing produced it. Med. Times and Gaz. ginal matter. Med. Press and Circular. 1MACLISE (JOSEPH). SURGICAL ANATOMY. By JOSEPH MACLISE, Surgeon. In one volume, very large imperial quarto ; with 68 large and splendid plates, drawn in the best style and beautifully colored, containing 190 figures, many of them the size of life; together with copious- explanatory letter-press. Strongly and handsomely bound in cloth. Price $14 00. We know of no work on surgical anatomy which an compete with it. Lancet. The work of Maclise on surgical anatomy is of the highest value. In some respects it is the best publi- cation of its kind we have seen, and is worthy of a place in the libiary of any medical man, while the student could scarcely make a better investment than this. The Western Journal of Medicine and Surgery. No such lithographic illustrations of surgical re- have hitherto, we think, been given. While , , . hown every vessel and nerve where o enusasm. e ng que exhausted the words of praise, in recommending this admirable treatise. Boston Med. and Surg. Journ. fJA R TSHORNE (HENR Y), M.D., *--*- Professor of Hygiene, etc , in the Univ. ofPenna. HANDBOOK OF ANATOMY AND PHYSIOLOGY. Second Edi- tion, revised. In one royal 12ino. volume, with 220 wood-cuts ; cloth, $1 75. ( Just Issued.) HENRY C. LEA'S PUBLICATIONS (Physiology). MARSHALL (JOHN), F. E. S., J.U. Professor of Surgery in University College, London, Ac. OUTLINES OF PHYSIOLOGY, HITMAN AND COMPARATIVE. With Additions by FRANCIS GURNET SMITH, M. D., Professor of the Institutes of Medi- cine in the University of Pennsylvania, Ac. With numerous illustrations. In one large and handsome octavo volume, of 1026 pages, cloth, $6 50 ; leather, raised bands, $7 50. In fact, in every respect, Mr. Marshall has present- Ad us with a most complete, reliable, and scientific Work, and we feel that it is worthy our warmest commendation. St. Louis Ned. Reporter, Jan. 1869. We doubt if there is in the English language any compend of physiology more useful to the student than this work. St. Louis Med. and Surg. Journal, Jan. 1869. It quite fulfils, in, our opinion, the author's design of making it truly educational in its character which Is, perhaps, the highest commendation that can be asked. Am. Journ. Med. Sciences, Jaii. 1869. We may now congratulate him on having com- pleted the latest as well as the best summary of mod- ern physiological science, both human and compara- tive, with which we are acquainted. To speak o< this work in the terms ordinarily used on such occa- sions would not be agreeable to ourselves, and would ! fail to do justice to its author. To write such a book ( requires a varied and wide range of knowledge, con- siderable power of analysis, correct judgment, skill in arrangement, and conscientious spirit. London j Lancet, Feb. 22, 1868. l There arefew, ifany, more accomplished anatomists ' and physiologists than the distinguished professor of ; surgery at University College ; and he has long en- j joyed the highest reputation as a teacher of physiol- * ogy, possessing remarkable powers of clearexposition and graphic illustration. We have rarely the plea- sure of being able to recommend a text-book so unre- servedlyasthis. British Med. Journal, Jar. 25,1868. rtARPENTER (WILLIAM B.), M.D., F.R.S., v Examiner in Physiology and Comparative Anatomy in the University of London. PRINCIPLES OF HUMAN PHYSIOLOGY; with their chief appli- cations to Psychology, Pathology, Therapeutics, Hygiene and Forensic Medicine. A new American from the last and revised London edition. With nearly three hundred illustrations. Edited, with additions, by FRANCIS GURNET SMITH, M. D., Professor of the Institutes of Medicine in the University of Pennsylvania, Ac. In one very large and beautiful octavo volume, of about 900 large pages, handsomely printed; cloth, $5 50 ; leather, raised bands, $6 50. We doubt not it is destined to retain a strong hold With Dr. Smith, we confidently believe "that the present will more than sustain the enviable reputa- tion already attained by former editions, of being one of the fullest and most complete treatises on the subject in the English language." We know of none from the pages of which a satisfactory knowledge of the physiology of the human organism can be as well obtained, none better adapted for the use of such as take up the study of physiology in its reference to the institutes and practice of medicine. Am. Jour. Sled. Sciences. on public favor, and remain the favorite text-book in our colleges. Virginia Medical Journal. ' The above is the title of what ig emphatically the great work on physiology ; and we are conscious that it would be a useless effort to attempt to add any- thing to the reputation of this invaluable work, and can only say to all with whom our opinion has any influence, that it is our authority. Atlanta Med. Journal. DF THE SAME AUTHOR. PRINCIPLES OF COMPARATIVE PHYSIOLOGY. New Ameri- can, from the Fourth and Revised London Edition. In one large and handsome octavo volume, with over three hundred beautiful illustrations . Pp. 752. Cloth, $5 00. As a complete and condensed treatise on its extended and important subject, this work becomes a necessity to students of natural science, while the very low price at which it is offered places it within the reach of all. JTIRKES ( WILLIAM SENHOUSE), M.D. A MANUAL OF PHYSIOLOGY. Edited by W. MOEEANT BAKER, M.D., F.R.C.S. A new American from the eighth and improved London edition. With about two hundred and fifty illustrations. In one large and handsome royal 12mo. vol- ume. Cloth, $3 25; leather, $3 75. (Lately Issued.) Kirkes' Physiology has long been known as a concise and exceedingly convenient text-book, presenting within a narrow compass all that is important for the student. The rapidity with which successive editions have followed each other in England has enabled the editor to keep it thoroughly on a level with the changes and new discoveries made in the science, and the eighth edition, of which the present is a reprint, has appeared so recently that it may be regarded as the latest accessible exposition of the subject. is^ui On the whole, there is very little in the book which either the student or practitioner will not find of practical value and consistent with our present knowledge of this rapidly changing science ; and we have no hesitation in expressing our opinion that this eighth edition is one of the best handbooks on .physiology which we have in our language. N. Y. Med. Record, April 15, 1873. This volume might well be used to replace many of the physiological text-books in use in this coun- try. It represents more accurately than the works of Dalton or Flint, the present state of our knowl- edge of most physiological questions, while it is much less bulky and far more readable than the lar- ger text-books of Carpenter or Marshall. The book is admirably adapted to be placed in the hands of students. Boston Med. and Surg. Journ., April 10, 1873. In its enlarged form it is, in our opinion, still the best book on physiology, most useful to the student. Phil a. Med. Times, Aug. 30, 1873. This is undoubtedly the best work for students of physiology extant. Cincinnati Med. News, Sept. '73. It more nearly represents the present condition of physiology than any other text-book on the subject. Detroit Rev. of Med. Pharm., Nov. 1873. HENRY C. LEA'S PUBLICATIONS (Physiology). f) ALTON (J. C.), M.D., *-' Professor of Physiology in the College of Physicians and Surgeons, Few York, Ac. A TREATISE ON HUMAN PHYSIOLOGY. Designed for the use of Students and Practitioners of Medicine. Fifth edition, revised, with nearly three hun- dred illustrations on wood. In one very beautiful octavo volume, of over 700 pages, cloth, $5 25 ; leather, $6 25. Preface to the Fifth Edition. In preparing the present edition of this work, the general plan and arrangement of the previous editions have been retained, so far as they have been found useful and adapted to the purposes uf & text-book for students of medicine. The incessant advance of all the natural and physical sciences, never more active than within the last five years, has furnished many valuable aids to the special investigations of the physiologist ; and the progress of physiological research, during the same period, has required a careful revision of the entire work, and the modification or re- arrangement of many of its parts. At this 'day, nothing is regarded as of any value in natural science which is not based upon direct and intelligible observation or experiment; and, accord- ingly, the discussion of doubtful or theoretical questions has been avoided, as a general rule, in the present volume, while new facts, from whatever source, if fully established, have been added and incorporated with the results of previous investigation. A number of new illustrations have been introduced, and a few of the older ones, which seemed to be no longer useful, have been omitted. In all the changes and additions thus made, it has been the aim of the writer to make the book, in its present form, a faithful exponent of the actual conditions of physiological science. WEW YORK, October, 1871. In this, the standard text-book on Physiology, all that is needed to maintain the favor with which it is regarded by the profession, is the author's assurance that it has been thoroughly revised and brought up to a level with the advanced science of the day. To accomplish this has required some enlargement of the work, but no advance has been made in the price. The fifth edition of this truly valuable work on Human Physiology comes to us with many valuable Improvements and additions. As a text-book of physiology the work of Prof. Dalton has long been well known as one of the best which could be placed tu the hands of student or practitioner. Prof. Dalton h.s, in the several editions of his work heretofore published, labored to keep step with the ad vancement la science, and the last edition shows by its improve- ments on former ones that he is determined to main- tain the high standard of his work. We predict for the present edition increased favor, though this work kas long been the favorite standard. Buffalo Med. and Surg. Journal, April, 1872. An extended notice of a work so generally and fa- vorably known as this is unnecessary. It is justly regarded as one of the most valuable text-books on the subject in the English language. St. Louis Med. Archives, May, 1872. We know no treatise in physiology so clear, com- plete, well assimilated, and perfectly digested, as Dalton's. He never writes cloudily or dubiously, or in mere quotation. He assimilates all his material, and from it constructs a homogeneous transparent argument, which is always honest and well informed, and hides neither truth, ignorance, nor doubt, so far as either belongs to the subject in hand Brit. Med. Journal, March 23, 1872. Dr. Dalton's treatise is well known, and by many highly esteemed in this country. It is, indeed, a good elementary treatise on the subject it professes to teach, and may safely be put into the hands of Eng- lish students. It has one great merit it is clear, and, on the whole, admirably illustrated. The part we have always esteemed most highly is that relating to Embryology. The diagrams given of the various stages of development give a clearer view of the sub- ject than do those in general use in this country ; and the text may be said to be, upon the whole, equally clear. London Med. Times and Gazette, March 23, 1872. Dalton's Physiology is already, and deservedly, the favorite text-book of the majority of American medical students. Treating a most interesting de- partment of science in his own peculiarly lively and fascinating style, Dr. Dalton carries his reader along without effort, and at the same time impresses upon his mind the truths taught much more successfully than if they were buried beneath a multitude of words. Kansas Gity Med. Journal, April, 1872. Professor Dalton is regarded justly as .the authority in this country on physiological subjects, and the fifth edition of his valuable work fully justifies the exalted opinion the medical world has of his labors. This last edition is greatly enlarged. Virginia Clin- ical Record, April, 1872. T)UNGLISON (ROBLEY), M.D., JLS Professor of Institutes of Medicine in Jefferson Medical College, Philadelphia. HUMAN PHYSIOLOGY. Eighth edition. Thoroughly revised and extensively modified and enlarged, with five hundred and thirty-two illustrations. In two large and handsomely printed octavo volumes of about 1500 pages, cloth, $7 00. TEHMANN(C. O.}. PHYSIOLOGICAL CHEMISTRY. Translated from the second edi- tion by GEORGE E. DAY, M. D., F. R. S., Ac., edited by R. E. ROGERS, M. D., Professor of Chemistry in the Medical Department of the University of Pennsylvania, with illustration* selected from Funke's Atlas of Physiological Chemistry, and an Appendix of plates. Com- plete in two large and handsome octavo volumes, containing 1200 pages, with nearly two hundred illustrations, cloth, $6 00. DY THE SAME AUTHOR. MANUAL OF CHEMICAL PHYSIOLOGY. Translated from the German, with Notes and Additions, by J. CHESTON MORRIS, M. D., with an Introductory Essay on Vital Force, by Professor SAMUBL JACKSON, M. D., of the University of Pennsyl- vania. With illustrations on wood. In one very handsome octavo volume of 336 pages, cloth, $2 26. 10 HENRY C. LEA'S PUBLICATIONS (Chemistry). A TTFIELD (JOHN), Ph. D., "^^ Professor of Practical Chemistry to the Pharmaceutical Society of Great Britain, *c. CHEMISTRY, GENERAL, MEDICAL, AND PHARMACEUTICAL; including the Chemistry of the U. S. Pharmacopoeia. A Manual of the General Principle! of the Science, and their Application to Medicine and Pharmacy. Fifth Edition, revised by the author. In one handsome royal 12mo. volume ; cloth, $2 75 ; leather, $3 25. (Lately Issued.) No other American publication with which we are acquainted covers the same ground, or does it so well. In addition to an admirable expose 1 of the facts and principles of general elementary chemistry, the au- thor has presented us with a condensed massof prac- tical matter, just such as the medical student and practitioner needs. Cincinnati Lancet, Mar. 1874. We commend the work heartily as one of the best text-books extant for the medical student. Detroit Rev. of Med. and Pharm., Feb. 1872. The best work of the kind In the English language. }?. Y. PsycholofficalJournal, Jan. 1872. the wants of medical and pharmaceutical students; and, although an English work, the points of differ- ence between the British and United States Pharma- copoeias are indicated, making it as useful here as in England. Altogether, the book Is one we can heart- ily recommend to practitioners as well as students. y. 7. Med. Journal, Dec. 1871. It differs from other text-books in the following particulars : first, in the exclusion of matter relating to compounds which, at present, are only of interest to the scientific chemist ; secondly, in containing the chemistry of every substance recognized officially or in general, as a remedial agent. It will be found a most valuable book for pupils, assistants, and others engaged in medicine and pharmacy, and we heartily commend it to our readers. Canada Lancet, Oct. 1871. When the original English edition of thiswork was published, we had occasion to express our high ap- preciation of its worth, and also to review, in con- siderable detail, the main features of the book. As the arrangement of subjects, and the main part of the text of the present edition are similar to the for- mer publication, it will be needless for us to go over the ground a second time ; we may, however, call at- tention to a marked ad vantage possessed by the Ame- rican work we allude to the introduction of tha chemistry of the preparations of the United State* Pharmacopoeia, as well aa that relating to the British authority. Canadian Pharmaceutical Journal, Nov. 1871. Chemistry has borne the name of being a hard sub- ject to master by the student of medicine, and chiefly because so much of it consists of compounds only of interest to the scientific chemist ; in this work such portions are modified or altogether left out, and in the arrangement of the subject- matter of the work, practical utility is sought after, and we think fully attained. We commend it for its clearness and order to both teacher and pupil. Oregon Med. and Surg. Reporter, Oct. 1871. -pOWNES (GEORGE], Ph.D. A MANUAL OF ELEMENTARY CHEMISTRY; Theoretical and Practical. With one hundred and ninety-seven illustrations. A new American, from the tenth and revised London edition. Edited by ROBERT BRIDGES, M. D. In one large royal 12mo. volume, of about 850 pp., cloth, $2 75 ; leather, $3 25. (Lately Issued.) This work is so well known that it seems almost superfluous for us to speak about it. It has been a favorite text-book with medical students for years, and Its popularity has in no respect diminished. Whenever we have been consulted by medical stu- dents, as has frequently occurred, what treatise on chemistry they should procure, we have always re- commended Fownes', for we regarded it as the best. There is no work that combines so many excellen- ces. It is of convenient size, not prolix, of plain perspicuous diction, contains all the most recent discoveries, and is of moderate price. Cincinnati Med. Repertory, Aug. 1869. Large additions have been made, especially in the department of organic chemistry, and we know of no other work that has greater claims on the physician, pharmaceutist, or student, than this. We cheerfully recommend it as the beat text-book on elementary chemistry, and bespeak for it the careful attention of students of pharmacy. Chicago Pharmacist, Ang. 1869. Here is a new edition which has been long watched for by eager teachers of chemistry. In its new garb, and under the editorship of Mr. Watts, it has resumed its-old place as the most successful of text-books Indian Medical Gazette, Jan. 1, 1869 It will continue, as heretofore, to hold the first ranli is a text-book for students of medicine. Chicago Wed. Examiner, Ang. 1869. DLING ( WILLIAM), Lecturer on Chemistry at St. Bartholomew's Hospital, Ac. A COURSE OF PRACTICAL CHEMISTRY, arranged for the Use of Medical Students. With Illustrations. From the Fourth and Revised London Edition. In one neat royal 12mo. volume, cloth, $2. S1ALLOWAY (ROBERT), F.C.S., ^-^ Prof, of Applied Chemistry in the Royal College of Science for Ireland, Ac. A MANUAL OF QUALITATIVE ANALYSIS. From the Fifth Lon- don Edition. In one neat royal 12mo. volume, with illustrations; cloth, $2 50. (Just Issued.) The success which has carried this work through repeated editions in England, and its adoption as a text-book in several of the leading institutions in this country, show that the author has suc- ceeded in the endeavor to produce a sound practical manual and book of reference for the che- mical student. Prof. Galloway's books are deservedly in high j We regard this volume as a valuable addition to esteem, and this American reprint of the fifth edition the chemical text-books, and as particularly calcu- (1869) of his Manual of Qualitative Analysis, will be j lated to instruct the student in analytical researches acceptable to many American students to whom the : of the inorganic compounds, the important vegetable English edition is not accessible. Am. Jour, of Sci- acids, and of compounds and various secretions avi tnce and Arts, Sept. 1872. excretions of animal origin. Am. Jovrn. o I Sept. 1672. HENRY C. LEA'S PUBLICATIONS (Chemistry). 11 T>LOXAM (C.L.), *-* Profetnor of ChemMry in King's College, London. CHEMISTRY, INORGANIC AND ORGANIC. From the Second Lon- don Edition. In one very handsome ootavo volume, of 700 pages, with about 300 illustra- tions. Cloth, $4 00 ; leather, $5 00. (Lately Issued.) It has been the author's endeavor to produce a Treatise on Chemistry sufficiently oomprehen- give for those studying the science as a branch of ^ neral education, and one which a student lay use with advantage in pursuing his chemical stud s atone of the colleges or medical schools. The special attention devoted to Metallurgy and some other branches of Applied Chemistry renders the work especially useful to those who are being educated for employment in manufacture. We have in this work a complete and most excel- experiment have been worked np with especial care, lent text-book for the use of schools, and can heart- ily recommend it as such. Boston Med. and Surg. Journ., May 28, 1874. Of all the numerous works upon elementary chem- istry that have been published within the last few years, we can point to none that, in fulness, accuracy, and simplicity, can surpass this; while, in the num- ber and detailed descriptions of experiments, as also in the profuseness of its illustrations, we believe it stands above any similar work published in this coun- try. The statements made are clear and con- cise, and every step proved by an abundance of ex- periments, which excite our admiration as much by their simplicity an by their direct conclusiveness. Chicago Med. Examiner, Nov. 15, 1873. It is seldom that in the same compass so complete and interesting a compendium of the leading facts of ehemistry is offered. Druggists' Circular, Nov. '73. The above is the title of a work which we can most conscientiously recommend to students of chemistry. It is as easy as a work on chemistry could be made, at the same time that it presents a full account of that science as it now stands. We have spoken of the workasadmirably adapted to the wants of students ; it is quite as well suited to the requirements of prac- titioners who wish to review their chemistry, or have occasion to refresh their memories on any point re- lating to it. In a word, it is a book to be read by all sent day. American Practitioner, Nov. 1873. Among the various works upon general chemistry issued, we know of none that will supply the average wants of the student or teacher better than this. Indiana Journ. of Med., Nov. 1873. We cordially welcome this American reprint of a work which has already won for itself so substantial a reputation in England. Professor Bloxam has con- densed into a ^onderfully small com >ass all the im- portant principles and facts of chemical science. Thoroughly imbued with an enthusiastic love for the science he expounds, he has stripped it of all need- less technicalities,.and rounded out its hard outlines by a fulness of illustration that cannot fail to attract tnd delight the student. The details of illustrative and many of the experiments described are both new and striking. Detroit Rev. of Med. and Pharm., Nov. 1873. One of the best text-books of chemistry yet pub- lished. Chicago Med. Journ., Nov. 1873. This is an excellent work, well adapted for the be- ginner and the advanced student of chemistry. Am. Journ. of Pharm., Nov. 1873. Probably the most valuable, and at the same time practical, text-book on general chemistry extant in our language. Kansas Oity Med. Journ., Dec. 1873. Prof. Bloxam possesses pre-eminently the inestima- ble gift of perspicuity. It ia a pleasure to read his books, for he in capable of making very plain what other authors frequently have left very obscure. Va. Clinical Record, Nov. 1873. It would be difficult for a practical chemist and teacher to find any material fault with this most ad- mirable treatise. The author has given us almost a cyclopedia within the limits of a convenient volume, and has done so without penning the useless para- raphs too commonly making np a great part of the lk of many cumbrous works. The progressive sci- entist is not disappointed when he looks for the record of new and valuable processes and discoveries, while the cautious conservative does not find its pages mo- nopolized by uncertain theories and speculations. A peculiar point of excellence is the crystallized form of expression in which great truths are expressed in very short paragraphs. One is surprised at the brief space allotted to an important topic, and yet, after reading it, he feels that little, if any more, should have been said. Altogether, it is seldom you see a text-book so nearly faultless. Cincinnati Lancet, Nov. 1873. Professor Bloxam has given us a most excellent and useful practical treatise. His 666 pages are crowded with facts and experiments, nearly all well chosen, and .many quite new, even to scientific men. . . . It is astonishing how much information he often conveys in a few paragraphs. We might quote fifty instances of this. Chemical Kewa. gr bu 1\7& HLER AN V FITTIG. OUTLINES OF ORGANIC CHEMISTRY. Translated with Ad- ditions from the Eighth German Edition. By IRA REMSEN, M.D., Ph.D., Professor of Chemistry and Physics in Williams College, Mass. In one handsome volume, royal 12mo. of 550 pp., cloth, $3. As the numerous editions of the original attest, this work is the leading text-book and standard Authority throughout Germany on its important and intricate subject a position won for it by the clearness and conciseness which are its distinguishing characteristics. The translation has been executed with the approbation of Profs. Wbhler and Fittig, and numerous additions and alterations have been introduced, so as to render it in every respect on a level with the most advanced condition of the science. _ WHAN (JOHN E.) , M. D. PRACTICAL HANDBOOK OF MEDICAL CHEMISTRY. Edited by C. L. BLOXAM, Professor of Practical Chemistry in King's College, London. Sixth American, from the fourth and revised English Edition. In one neat volume, royal 12mo., pp. 351, with numerous illustrations, cloth, $2 25. F THE SAME AUTHOR. (Lately Issued.) - INTRODUCTION TO PRACTICAL CHEMISTRY, INCLUDING ANALYSIS. Sixth American, from the sixth and revised London edition. With numer- ous illustrations. In one neat vol., royal 12mo., cloth, $2 25. & IHAPP'S TECHNOLOGY ; or Chemistry Applied to the Arts, and to Manufactures. With American itddiiioas, by Prof. WALTER B. JoHiraov. In two very handsome octavo volumes, engravings, cloth, $6 00. rith 600 wood 12 HENRY 0. LEA'S PUBLICATIONS (Mat. Med. and Therapeutics). PARRISH (ED WARD), Late Professor of Materiel Medica in the Philadelphia College of Pharmacy. A TREATISE ON PHARMACY. Designed as a Text-Book for the Student, and as a Guide for the Physician and Pharmaceutist. With many Formulae and Prescriptions. Fourth Edition, thoroughly revised, by THOMAS S. WIEGAND. In one handsome octavo volume of 977 pages, with 280 illustrations; cloth. $5 50; leather, $6 50. (Just Issued.) The delay in the appearance of the new TJ. S. Pharmacopoeia, and the sudden death of the au- thor, have postponed the preparation of this new edition beyond the period expected. The notes and memoranda left by Mr. Parrish have been plnced in the hands of the editor, Mr. Wiegand, who has labored assiduously to embody in the work all the improvements of pharmaceutical sci- ence which have been introduced during the last ten years. It is therefore hoped that the new edition will fully maintain the reputation which the volume has heretofore enjoyed as a standard text-book and work of reference for all engaged in the preparation and dispensing of medicines. Of Dr. Parrish's great work on pharmacy it only \ an honored place on our own bookshelves. Dublin remains to be said that the editor has accomplished Med. Press and Circular, Aug. 12, 1874. his work so well as to maintain in this fourth edi- We expressed our opinion of a former edition in tion, the high standard of excellence which it bad terms of nnqualified praise and we are in no mood attained in previous editions under the editorship of | to detract from that opinloQ in reference to the pre- its accomplished author This has not been acconv j gent edition the preparation of which has fallen into plished without much labor, and many additions and competent hands. It is a book with which no pharma- improvements, involving changes in the arrangement d8t can di8pense and fron , which no physician can of the several parts of the work, and the addition of faU to derive much in f orlnaUon of valne to him in much new matter. With the modifications thus ef- , practice. Paci/c Med. andSurg. Journ., June, '74. fected it constitutes, as now presented, a compendium j r of the science and art indispensable to the pharma- With these few remarks we heartily commend the cist, and of the utmost value to every practitioner j work, and have no doubt that it will maintain its of medicine desirous of familiarizing himself with i old reputation as a text-book for the student, and a the pharmaceutical preparation of the articles which I work of reference for the more experienced physi- he prescribes for his patients. Chicago Med.Jou.rn., July, 1874. The work is eminently practical, and has the rare merit of being readable and interesting, while it pre- serves a stricdy scientific character. The whole work reflects the greatest credit on author, editor, and pub- lisher It will convey some idea of the liberality which has been bestowed upon its production when we men- tion thatthereare no less than 2SOcarefully executed illustrations. In conclusion, we heanily recommend the work, not only to pharmacists, but also to the multitude of medical practitioners who are obliged to compound their own medicines. It will ever hold cian and pharmacist. Chicago Med. Examiner, June 15, 1874. Perhaps one, if not the most important book upon pharmacy which has appeared in the English lan- guage has emanated from the transatlantic press. "Parrish's Pharmacy" is a well-known work on this side of the water, and the fact shows us that a really useful work never becomes merely local in its fame. Thanks to the judicious editing of Mr. Wiegand, the posthumous edition of "Parrish" has been saved 10 the public with all the mature experience of its au- thor, and perhaps none the worse for a dash of new blood. Land. Pharm. Journal, Oct. 17, 1&74. GTILLE (ALFRED), M.D., Aj Professor of Theory and Practice of Medicine in the University of Penna. THERAPEUTICS AND MATERIA MEDICA; a Systematic Treatise on the Action and Uses of Medicinal Agents, including their Description and History. Fourth edit., revised and enlarged. In two large and handsome 8vo. vols. of about 2008 pages. Cloth, $10; leather, $12. (Now Ready.) The care bestowed by the author on the revision of this edition has kept the work ont of th 8 market for nearly two years, and has increased its size about two hundred and fifty pages. Not- withstanding this enlargement, the price has been kept at the former very moderate rate. A few notices of former editions are subjoined. Or. Stille's splendid work on therapeutics and ma- 1 abroad its reputation asa standard treatise on Materia teria medica. London Med. Times, April 8, 1865. Medica is securely established. It is second to no Dr. Stille stands to-day one of the best and most honored representatives at home and abroad, of Ame- rican medicine ; and these volumes, a library in them- selves, a treasure-house for every studious physician, assure his fame even had he done nothing more. The Western Journal of Medicine, Dec. 1868. We regard this work as the best one on Materia Medica in the English language, and as such it de- serves the favor it has received. Am. Journ. Medi- cal Sciences, July 1868 We need not dwell on the merits of the third edition of this magnificently conceived work. It is the work on Materia Medica, in which Therapeutics are prima- rily considered the mere natural history of drugs work on the subject in the English tongue, and, ia- deed, is decidedly superior, in some respects, to any other. Pacific Med. and Surg. Journal, July, 1S6S. Still6's Therapeutics is incomparably the best work on the subject. .y. Y. Med. Gazette, Sept. 26, 1868. Dr. Still6's work is becoming the best known of any of our treatises on Materia Medica. One of th most valuable works in the language on the subject* of which it treats. .tf. T. Med. Journal, Oct. 1868 The rapid exhaustion of two editions of Prof. Still6'i scholarly work, and the consequent necessity for a third edition, is sufficient evidence of the high esti- mate placed upon it by the profession. It is no exag- geration to say that there is no superior work upoj being briefly disposed of. To medical practitioners I the subject in the English language. The present this is a very valuable conception. It is wonderful I edition is fully up to the most recent advance in tb how much of the riches of the literature of Materia Medica has been condensed into this book. The refer- ences alone would make it worth possessing. But it Is not a mere compilation. The writer exercises a science and art of therapeutics. Leavemoorth Medi- cal Herald, Aug. 1868. The work of Prof. Still6 has rapidly taken a higb place in professional esteem, and to say that a third good Judgment of his own on the great doctrines and j edition is demanded and now appears before ns, suffl- points of Therapeutics. For purposes of practice, j ciently attests the firm position this treatise has mad 8till6's book is almost unique as a repertory of in- formation, empirical and scientific, on the actions and for itself. As a work of great research, and scholar- ship, it is safe to say we have nothing superior. It ii uses of medicines. London Lancet, Oct. 31, 1868. | exceedingly full, and the busy practitioner will flad Through the former editions, the professional world j ample suggestions upon almost every important poist Is well acquainted with this work. At home and | of therapeutics. Cincinnati Lancet, Aug. 1868. HENRY C. LEA'S PUBLICATIONS (Mat. Med. and Therapeutics). 13 QRIFFITH (ROBERT E.), M.D. A UNIVERSAL FORMULARY, Containing the Methods of Prepar- ing and Administering Officinal and other Medicines. The whole adapted to Physician- and Pharmaceutists. Third edition, thoroughly revised, with numerous additions, bj JOHN M. MAISCH, Professor of Materia Medica in the Philadelphia College of Pharmacy. In one large andhandsome octavo volume of aboutSOfl pages, cloth, $4 50 ; leather, $5 50. (Just Issued ) This work has long been known for the vast amount of information which it present? in a con- densed form, arranged for easy reference. The new edition has received the most careful revi- sion at the competent hands of Professor Maiscb, who has brought the whole up to the standard of the most recent authorities. More than eighty new headings of remedies have been introduced, the entire work has been thoroughly remodelled, and whatever has seemed to be obsolete has been omitted. As a comparative view of the United States, the British, the German, and the French Pharmacopoeias, together with an immense amount of unofficial formulas, it affords to the prac- titioner and pharmaceutist an aid in their daily avocations not to be found elsewhere, while three indexes, one of "Diseases and their Remedies," one of Pharmaceutical Names, and a General Index, afford an easy key to the alphabetical arrangement adopted in the text. The young practitioner will find the work invalu- able in suggesting eligible modes of administering many remedies. Am. Journ. of Pharm., Feb. 1874. Our copy of Griffith's Formulary, after long use, first in the dispensing shop, and afterwards in our medical practice, had gradually fallen behind in the onward march of materia medica, pharmacy, and therapeutics, until we had ceased to consult it as a daily book of reference. So completely has Prof. Maisch reformed, remodelled, and rejuvenated it in the new edition, we shall gladly welcome it back to ourtable again beside Dunglison, Webster, and Wood & Bache. The publisher could not have been more fortunate in the selection of an editor. Prof. Maisch is emineutly the, man for the work, and he has done it thoroughly and ably* To enumerate the altera- tions, amendments, and additions would be an end- less task ; everywhere we are greeted with the evi- dences of his labor. Following the Formulary, is an addendum of useful Recipes, Dietetic Preparations, List of Incompatibles, Posological table, table of Pharmaceutical Names, Officinal Preparations and Directions, Poisons. Anlidotes and Treatment, and To the druggist a good formulary is simply indis- pensable, and perhaps no formulary has been more extensively used than the well-known work before us. Many physicians have to officiate, also, as drug- gists. This is true especially of the country physi- cian, and a work which shall teach him the means by which to administer or combine his remedies in the most efficacious and pleasant manner, will al- ways hold its place upon his shelf. A formulary of this kind is of benefit also to the city physician in largest practice. Cincinnati dlinic, Feb. 21, 1874. The Formulary has already proved itself accepta- ble to the medical profession, and we do not hesitate to say that the third edition is much improved, and of greater practical value, in consequence of the care- ful revision of Prof. Maisch. Chicago Med. Exam- iner, March 15, 1874. A more complete formulary than it is in its pres- ent form the pharmacist or physician could hardly desire. To the first some such work is indispensa- ble, and it is hardly less essential to the practitioner who compounds his own raediciaes. Much of what is contained in the introduction ought to be com- . . LW*VOWI1) O.UU 13 UVJI1 CttlUtm IU LUO LHIrTlfUUUUVU UUgUL LU UB ' 'U!l copious indices, which afford ready access to all parts milled lo memory by every student of medicine, of the work. We unhesilatingly commend the book \ As a help to physicians it will be found invaluable, as bemg -he best of its kind, within our knowledge and doubtless will make its way into libraries not Atlanta Med. and Surg. Journ., Feb. 1874. already supplied with a standard work of the kind. I The American Practitioner, Louisville, July, '74. E 'LLIS [BENJAMIN], M.D. THE MEDICAL FORMULARY: being a Collection of Prescriptions derived from the writings and practice of many of the most eminent physicians of America and Europe. Together with the usual Dietetic Preparations and Antidotes for Poisons. The whole accompanied with a few brief Pharmaceutic and Medical Observations. Twelfth edi- tion, carefully revised and much improved by ALBERT H. SMITH, M. D. In one volumeSva. of 376 pages, cloth, $3 00. IEREIRA (JONATHAN], M.D., F.R.S. and L.S. MATERIA MEDICA AND THERAPEUTICS; being an Abridg- ment of the late Dr. Pereira's Elements of Materia Medica, arranged, in conformity with the British Pharmacopoeia, and adapted to the use of Medical Practitioners, Chemists ar.d Druggists, Medical and Pharmaceutical Students, Ac. By F. J. FARRE, M.D. , Senior Physician to St. Bartholomew's Hospital, and London Editor of the British Pharmacopoeia ; assisted by ROBEKT BENTLEY, M.R.C.S., Professor of Materia Medica and Botany to the Pharmaceutical Society of Great Britain; and by ROBERT WARINGTON, F.R.S., Chemical Operator to the Society of Apothecaries. With numerous additions and references to the United States Pharmacopeia, by HORATIO C. WOOD, M.D., Professor of Botany in the University of Pennsylvania. In one large andhandsome octavo volume of 1040 closely printed pages, with 236 illustrations, cloth, $7 00; leather, raised bands, $8 00. DUNGLISON'S NEW REMEDIES. WITH FORMULA FOR THEIR PREPARATION AND ADMINISTRA- TION. Seventh edition, with extensive additions. One vol. 8vo., pp. 770; cloth. $4 00. BOYLE'S MATERIA MEDICA AND THERAPEU- TICS. Edited by JOSEPH CARSON, M. D. With ninety-eight illustrations. 1 vol. 8vo., pp. 700, cloth. $3 00. CARSON'S SYNOPSIS OF THE LECTURES ON MA- TERIA MEDICA AND PHARMACY, delivered in the University of Pennsylvania. Fourth and re- vised edition. Cloth, $.3. 'HRISTISON'S DISPENSATORY. With copious ad 'itlong. .nd 213 large wood-nneravingg Bv R. EOLESFELD GRIFFITH, M.D. One vol. 8vo.,pp. 1000; cloth. $4 00. CARPENTER'S PRIZE ESSAY ON THE USE OF ALCOHOLIC LIQUORS IN HEALTH AND DISRASE. New edition, with a Preface by D. F. CONDIE, M.D., and explanations of scientific words. In one neat 12mo. volume, pp. 178, cloth. 60 cents. DE JONGH ON THE THREE KINDS OF COD-LITER OIL, with their Chemical and Therapeutic Pro- perties. 1 vol. 12mo., cloth. 75 cents. 14 HENRY C. LEA'S PUBLICATIONS (Pathology, < Nov - 1874. ous editions of this work. It is excellent of its kind, i Asa handbook, which clearly sets forth the ESSEN- The author has given a very careful revision, in view | TIAI,S of the PRINCIPLES AND PRACTICE OF MEDICINE, we of the rapid progress of medical science. N. Y. Med. Journ., Nov. 1874. The present edition of Dr. Hartshorne's work is a do not know of its equal. Va. Med. Monthly. As a brief, condensed, but comprehensive hand- book, it cannot be in- proved upon. Chicago Med. very decided improvement upon the former ones in I Examiner, Nov. 15, 1874. f>AVY(F.W.),M.D.,F.R.S., tT Senior Asst. Physician to and Lecturer on Physiology, at Guy's Hospital, &c. A TREATISE ON THE FUNCTION OF DIGESTION ; its Disor- ders and their Treatment. From the second London edition. In one handsome volume, small octavo, cloth, $2 00. J)Y THE SAME AUTHOR. (Just Ready. A TREATISE ON FOOD AND DIETETICS, PHYSIOLOGI- CALLY AND THBKAPEUTICALLY CONSIDERED. In one handsome octavo volume of nearly 600 pages, cloth, $4 75. SUMMARY OP CONTENTS. Introductory Remarks on the Dynamic Relations of Food On the Origination of Food The Constituent Relations of Food Alimentary Principles, their Classification, Chemical Relations, Digestion, Assimilation, and Physiological Uses Nitrogenous Alimentary Principles Non-Ni- trogenous Alimentary Principles The Carbo-Hydrates The Inorganic Alimentary Principles Alimentary Substances Animal Alimentary Substances Vegetable Alimentary Substances Beverages Condiments The Preservation of Food Principles of Dietetics Practical Dietetics Diet of Infants Diet for Training Therapeutic Dietetics Dietetic Preparations for the Inva- lid Hospital Dietaries. {CHAMBERS ( T. K.), M. D. (Lately Published.} O Consulting Physician to St. Mary's Hospital, London, Ac. THE INDIGESTIONS ; or, Diseases of the Digestive Organs Functionally Treated. Third andrevised Edition. In one handsome 8vo. vol. of 333 pages, cloth, $3 00. TOY THE SAME AUTHOR. (Lately Published.) RESTORATIVE MEDICINE. An Harveian Annual Oration. With Two Sequels. In one very handsome volume, small 12mo., cloth, $1 00. J)Y THE SAME AUTHOR. (Now Ready.) A MANUAL OF DIET AND REGIMEN IN HEALTH AND SICK- NESS. In one handsome octavo volume. Cloth, $2 75. The aims of this handbook are purely practical, and therefore it has not been thought right to" increase its size by the addition of the chemical, botanical, and industrial learning which rapidly collects round the nucleus of every article interesting as an eatable. Space has been thus gained for a full discussion of many matters connecting food and drink with the daily cur- rent of social life, which the position of the author as a practising physician has led him to believe highly important to the present and future of our race. Preface. SUMMAKY OF CONTENTS. PART!. General Dietetics. CHAP. I. Theories of Dietetics. II. On the Choice of Food. III. On the Preparation of Food. IV. On Digestion and Nutrition. PART II. Special Dietetics of Health. CHAP. I. Regimen of Infancy and Motherhood. II. Regimen of Childhood and Youth. III. Commercial Life. IV. Literary and Professional Life. V. Noxious Trades. VI. Athletic Training. VII. Hints for Healthy Travellers. VIII. Effects of Climate. IX. Starvation, Poverty, and Fasting. X. The Decline of Life. XI. Alcohol. PART III. Dietetics in Sickness. CHAP. I. Dietetics and Regimen in Acute Fevers. II. The Diet and Regimen of certain other Inflammatory States. III. The Diet and Regimen of Weak Digestion. IV. Gout and Rheumatism. V. Gravel, Stone, Albuminuria, and Diabetes. VI. Deficient Evacuation. VII. Nerve Disorders. VIII. Scrofula, Rickets, and Consumption. IX. Diseases of Heart and Arteries. HENRY C. LEA'S PUBLICATIONS. IT J?LINT (AUSTIN), M.D., ~- Professor of the Principles and Practice of Medicine in Bellevue Hospital Med. College, N. Y. A PRACTICAL TREATISE ON THE DIAGNOSIS, PATHOLOGY, AND TREATMENT OF DISEASES OF THE HEART. Second revised and enlarged edition. In one octavo volume of 550 pages, with a plate, cloth, $4. Dr. Flint chose a difficult subject for his researches, i able for purposes of illustration, in connection with and has shown remarkable powers of observation I cases which have been reported by other trustworthy and reflection, as well as great industry, in his treat- observers. Brit, and For. Med.-Ghirurg. Review. ment of it. His book must be considered the fullest and clearest practical treatise on those subjects, and should be in the hands of all practitioners and stu- dents. It is a credit to American medical literature. Amer. Journ. of the Med. Sciences, July, 1860. We question the fact of any recent American author in our profession being more extensively known, or more deservedly esteemed in this country than Dr. In regard to the merits of the work, we have no hesitation in pronouncing it full, accurate, and judi- cious. Considering the present state of science, such a work was much needed. It should be in the hands of every practitioner. Chicago Med. Journ. With more than pleasure do we hail the advent of this work, for it fills a wide gap on the list of text- Flint. We willingly acknowledge his success, more books for our schools, and is, for the practitioner, the particularly in the volume on diseases of the heart, In making an extended personal clinical study avail- most valuable practical work of its kind. N. 0. Med. News. TjY THE SAME AUTHOR. A PRACTICAL TREATISE ON THE PHYSICAL EXPLORA- TION OF THE CHEST AND THE DIAGNOSIS OF DISEASES AFFECTING THB RESPIRATORY ORGANS. Second and revised edition. In one handsome octavo volume of 595 pages, cloth, $4 50. Dr. Flint's treatise Is one of the most trustworthy guides which we can consult. The style is clear and distinct, and is also concise, being free from that tend- ency to over-refinement and unnecessary minuteness which characterizes many works on the same sub- ject. Dublin Medical Press, Feb. 6, 1867. The chapter on Phthisis is replete with Interest; and his remarks on the diagnosis, especially in the early stages, are remarkable for their acumen and great practical value. Dr. Flint's style is clear and elegant, and the tone of freshness and originality which pervades his whole work lend an additional force to its thoroughly practical character, which cannot fail to obtain for it a place as a standard work on diseases of the respiratory system. London Lancet, Jan. IP, 1867. This is an admirable book. Excellent in detail and execution, nothing better could be desired by the practitioner. Dr. Flint enriches his subject with much solid and not a little original observation. Ranking 's Abstract, Jan. 1867. (HENRY WILLIAM), M. D., . Physician to St. George's Hospital, London. ON DISEASES OF THE LUNGS AND AIR-PASSAGES. Their Pathology, Physical Diagnosis, Symptoms, and Treatment. From the second and revised English edition. In one handsome octavo volume of about 500 pages, cloth, $3 50. 7LLIAMS (G. J. B.), M.D., Senior Consulting Physician to the Hospital for Consumption, Brompton, and S (CHARLES T.), M.D., Physician to the Hospital for Consumption. PULMONARY CONSUMPTION; Its Nature, Varieties, and Treat- ment. With an Analysis of One Thousand Cases to exemplify its duration. In one neat octavo volume of about 350 pages, cloth, $2 50. (Lately Published.) He can still speak from a more enormous experi- ence, and a closer study of the morbid processes in- volved in tuberculosis, than most living men. He owed it to himself, and to the importance of the sub- ject, to embody his views in a separate work, and we are glad that he has accomplished this duty. After all, the grand teaching which Dr Williams has for the profession is to be found in his therapeutical chapters, and in the history of individual cases ex- tended, by dint of care, over ten, twenty, thirty, and sven forty years. London Lancet, Oct. 21, 1871. LA ROCHE ON PNEUMONIA. of 600 pages . Price $3 00. SMITH ON CONSUMPTION ; ITS EARLY AND RE MEDIABLE STAGES. 1 vol. 8vo., pp. 254. $2 26 1 vol. 8vo., cloth, i WALSHE ON THE DISEASES OF THE HEART AND GREAT VESSELS. Third American edition. IB 1 vol. 8vo.. 420 pp., cloth. $3 00. WX ( WILSON], M.D., Holme Prof, of Clinical Med., University Coll., London. THE DISEASES OF THE STOMACH: Being the Third Edition of the "Diagnosis and Treatment of the Varieties of Dyspepsia." Revised and Enlarged. With illustrations. In one handsome octavo volume, cloth, $2 00. (Now Ready.) Dr. Fox has put forth a volume of uncommon ex- cellence, which we feel very sure will take a high rauk among works that treat of the stomach. Am. Practitioner, March, 1873. TyRINTON (WILLIAM), M.D., F.R.S. ^LECTURES ON THE DISEASES OF THE STOMACH; with an Introduction on its Anatomy and Physiology. From the second and enlarged London edi- tion. With illustrations on wood In one handsome octavo volume of about 300 pages, cloth, $3 25. 18 HENRY C. LEA'S PUBLICATIONS (Practice of Medicine). DOBERTS ( WILLIAM], M. D., *' Lecturer on Medicine in the Manchester School of Medicine, Ac. A PRACTICAL TREATISE ON URINARY AND RENAL DIS- EASES, including Urinary Deposits. Illustrated by numerous cases and engravings. Sec- ond American, from the Second Revised and Enlarged London Edition. In one large and handsome octavo volume of 616 pages, with a colored plate ; cloth, $4 50. (Lately Published.) The author has subjected this work to a very thorough revision, and has sought to embody in it the results of the latest experience and investigations. Although every effort has been made to keep it within the limits of its former size, it has been enlarged by a hundred pages, many new wood-cuts have been introduced, and also a colored plate representing the appearance of the different varieties of urine, while the price has been retained at the former very moderate rate. The plan, it will thus be seen, is very complete, diseases we have examined It Is peculiarly adapted to the wants of the majority of American practltion- and the manner in which it has been carried out is in the highest degree satisfactory. The characters of the different deposits are very well described, and the microscopic appearances they present are illus- trated by numerous well executed engravings. It only remains to us to strongly recommend to our readers Dr. Roberts's work, as containing an admira- ble rfsume of the present state of knowledge of uri- nary diseases, and as a safe and reliable guide to the clinical observer. Edin. Med. Jour. ers from its clearness and simple announcement of the facts in relation to diagnosis and treatment of urinary disorders, and contains in condensed form the investi- gations of Bence Jones, Bird, Beale, Hassall, Prout, and a host of other well-known writers upon thin sub- ject. The characters of urine, physiological and pa- thological, as indicated to the naked eye as well as by microscopical and chemical investigations, are con- cisely represented both by description and by well executed engravings. Cincinnati Journ. of Med. -DASHAM (W.R.), M.D., *-* Senior Physician to the Westminster Hospital, &c. RENAL DISEASES : a Clinical Guide to their Diagnosis and Treatment. With illustrations. In one neat royal 12mo. volume of 304 pages, cloth, $2 00. The chapters on diagnosis and treatment are very food, and the student and young practitioner will nd them full of valuable practical hints. The third part, on the urine, is excellent, and we cordially recommend its perusal. The author has arranged his matter in a somewhat novel, and, we think, use- ful form. Here everything can be easily found, and, what is more important, easily read, for all the dry details of larger books here acquire a new interest from the author's arrangement. This part of the book is full of good work. Brit, and For. Medico- Ghirurgical Review, July, 1870. The easy descriptions and compact modes of state- ment render the book pleasing and convenient. Am. Journ. Med. Sciences, July, 1870. INCOLN (D. P.). M.D., ' Physician to the Department of Nervous Diseases, Boston Dispensary. ELECTRO THERAPEUTICS; A. Concise Manual of Medical Electri- city. Inone very neat royal 12mo. volume, cloth, with illustrations, $1 50. (Just Ready.) The work is convenient in size, its descriptions of methods and appliances are sufficiently complete for the general practitioner, and the chapters on Electro- physiology and diagnosis are well written and read- able. For those who wish a handy-book of directions for the employment of galvanism in medicine, this will serve as a very good and reliable guide. New Remedies, Oct. 1874. It is a well written work, and calculated to meet the demands of the busy practitioner. It contains the latest researches in this important branch of med- icine. Peninsular Journ. of Med., Oct. 1874. Eminently practical in character. It will amply repay any one for a careful perusal. Leavenworth Med. Herald, Oct. 1874. This little book is, considering its size, one of the very best of the English treatises on its subject that has come to our notice, possessing, among others, the rare merit of dealing avowedly and actually with principles, mainly, rather than with practical details, thereby supplying a real want, instead of helping merely to flood the literary market. Dr. Lincoln's style is usually remarkably clear, and the whole book is readable and interesting. Boston Med. and Sura. Journ., July 23, 1874. We have here in a small compass a great deal of valuable information upon the subject of Medical Electricity. Canada Med. and Surg. Journ., Nov. 1874. (HENRY), Prof, of Surgery at the Royal College of Surgeons of England, etc. LECTURES ON SYPHILIS AND ON SOME FORMS OF LOCAL DISEASE AFFECTING PRINCIPALLY THE ORGANS OF GENERATION. In one handsome octavo volume. GOKfTEIsTTS. LECTURES. I., II., III. General. IV. Treatment of Syphilis V. Treatment of Particular and Modified Syphilitic Affections VI. Second Stage of Lues Venerea; Treatment VII. Lo- cal Suppurating Venereal Sore ; Syphilization ; Lymphatic Absorption ; Physiological Absorp- tion ; Twofold Inoculation VIII. Urethral Discharges : different kinds; Treatment; Conclu- sions of Hunter and Ricord IX. Prostatic Discharges X. Lymphatic Absorption continued ; Local Affections ; Warts and Excrescences. DIPHTHERIA ; its Nature and Treat -nent, with an account of the History of its Prevalence in vari- ous Countries. By D. D. SLADE, M.D. Second and revised edition. In one neat royal 12mo. volume, cloth, $1 25. ] LECTURES ON THE STUDY OF FEVER. By A. ! HUDSOJT, M.D. , M.K.I. A., Physician to the Meath Hospital. la one vol. 8vo., cloth, $2 50. A TREATISE ON FEVER. By ROBERT D LYONS, K C C. In one octavo volume of 362 pages, cloth, $2 23. CLINICAL OBSERVATIONS ON FUNCTIONAL NERVOUS DISOKDERS BvC. HANDPIELD JONKS, M.D., Physician to St. Mary's Hospital, &c. Sec- ond American Edition. In one handsome octavo volume of 348 pages, cloth, $3 25. J HENRY C. LEA'S PUBLICATIONS ( Venereal Diseases, etc.). 19 f>UMSTEAD (FREEMAN J.}, M.D., *-* Professor of Venereal Diseases at the Col. of Phys. and Surg., New York, Ac. THE PATHOLOGY AND TREATMENT OF VENEREAL DIS- EASES. Including the results of recent investigations upon the subject. Third edition, reTised and enlarged, with illustrations. In one large and handsome octavo volume of over 700 pages, cloth, $5 00 ; leather, $fi 00. In preparing this standard work again for the press, the author has subjected it to a very thorough revision. Many portions have been rewritten, nnd much new matter added, in order to bring it completely on a level with the most advanced condition of syphilography, but by careful compression of the text of previous editions, the work has been increased by only sixty -four pages. The labor thus bestowed upon it, it is hoped, will insure for it a continuance of its position as a complete and trustworthy guide for the practitioner. It ia the most complete book with which we are ac- | much special commendation as if its predecessors had qaainted in the language. The latest views of the not been published. As a thoroughly practical book best authorities are pat forward, and the information j on a class of diseases which form a large share of Is well arranged a great point for the student, and : nearly every physician's practice, the volume before still more for the practitioner. The subjects of vis- us is by far the best of which we have knowledge. eeral syphilis, syphilitic affections of the eyes, and j N. 7. Medical Gazette, Jan. 28, 1871. the treatment of syph.Jis by repeated inoculations are i u jg rare in the history of medicine to And anyone very fully discussed. London Lancet, Jan. 7, 1871. ; book which contains all that a practitioner needs to Dr. Bumstead's work is already so universally know; while the possessor of "Bumstead on Vene- known as the best treatise in the English language on j real" has no occasion to look outside of its covers for venereal diseases, that It may seem almost superflu- anything practical connected with the diagnosis, his- oas to say more of it than that a new edition has been tory, or treatment of these affections. If. T. Medical Issued. But the author's industry has rendered this ' Journal, March, 1871. aew edition virtually a new work, and so merits as riULLERIER (A.), and v Surgeon to the Hdpital du Jfidi. ~D UMSTEA D (FREE MA N J. ), -*-' Professor of Venerea I Diseases in the. College of Physicians and Surgeons, If. T. AN ATLAS OF VENEREAL DISEASES. Translated and Edited by FREEMAN J. BUMSTEAD. In one large imperial 4to. volume of 328 pages, double-columns, with 26 plates, containing about 150 figures, beautifully colored, many of them the size of life; strongly bound in cloth, $17 00 ; also, in five parts, stout wrappers for mailing, at $3 per part. Anticipating a very large sale for this work, it is offered at the very low price of THREE DOL- LARS a Part, thus placing it within the reach of all who are interested in this department of prac- tice. Q-entlemen desiring early impressions of the plates would do veM to order it without delay. A specimen of the plates and text sent free by mail, on receipt of 25 cents. We wish for once that our province was not rextrict- d to methods of treatment, that we might say some- thing of the exquisite colored plates in this volume. London Practitioner, May, 1869. As a whole, it teaches all that can be taught by means of plates and print. London Lancet, March 13, 188. on this continent. Canada Med. Journal, March, '69. The practitioner who desires to understand this branch of medicine thoroughly should obtain this, the most complete and best work ever published. Dominion Med. Journal, May, 1869. This is a work of master hands on both sides. M. Cnllerier is scarcely second to, we think we may truly ay is & peer of the illustrious and venerable Ricord, while in this country we do not hesitate to say that Dr. Bnmstead, as an authority, is without a rival Assuring our readers that these illustrations tell the whole history of venereal disease, from its inception to its end, we do not know a single medical work, which for its kind is more necessary for them to have. Calif )rnia Med. Gazette, March, 1869. The most splendidly illustrated work in the lan- guage, and in our opinion far more usefnl than the French original. Am. Journ. Jfed. Sciences, Jan. '69. The fifth and concluding number of this magnificent work has reached us, and we have no hesitation in Superior to anything of the kind ever before issued , -saying that its illustrations surpass those of previous numbers. Boston Med. and Surg. Journal, Jan. 14, 1869. Other writers besides M. Cullerier have given us a good account of the diseases of which he treats, but no one has furnished us with such a complete series of illustrations of the venereal diseases. There is, however, an additional interest and value possessed by the volume before us ; for it is an American reprint and translation of M. Cullerier's work, with inci- dental remarks by one of the most eminent American syphilographers, Mr. Bnmstead. Brit, and For. Medico-Chir. Review, July, 1869. (BERKELEY), Surgeon to the Lock Hospital, London. ON SYPHILIS AND LOCAL one handsome octavo volume ; cloth, $3 Bringing, as it does, the entire literature of the dis- ease down to the present day, and giving with great ability the results of modern research, it is in every respect a most desirable work, and one which should find a place in the library of every surgeon. Cali- fornia Jfed. Gazette, Jane, 1869. Considering the scope of the book and the careful attention to the manifold aspects and details of its subject, it is wonderfully concise All these qualities render it an especially valuable book to the beginner, CONTAGIOUS DISORDERS. In 25. to whom we would most earnestly recommend It* study ; while it is no less usefnl to the practitioner. St. Louis Med. and Surg. Journal, May, 1869. The most convenient and ready book of reference we have met with. If. Y. Med. Record, May 1,1869. Most admirably arranged for both student and prac- titioner, no other work on the subject equal* it ; it i more simple, more easily studied. Buffalo Med. and Surg. Journal, March, 1869. VEISSL (H.), M.D. A COMPLETE TREATISE ON VENEREAL DISEASES. Trans- lated from the Second Enlarged German Edition, by FREDERIC R. STURGIS, M.D In one octavo volume, with illustrations. (Preparing.) 20 HENRY C. LEA'S PUBLICATIONS (Diseases of the Skin). WILSON (ERASMUS), F.R.S. ON DISEASES OP THE SKIN. With Illustrations on wood. Sev- enth American, from the sixth and enlarged English edition. In one large octavo volume of over 800 pages, $5. A SERIES OF PLATES ILLUSTRATING "WILSON ON DIS- EASES OF THE SKIN;" consisting of twenty beautifully executed plates, of which thir- teen are exquisitely colored, presenting the Normal Anatomy and Pathology of the Skin, and embracing accurate representations of about one hundred varieties of disease, most of them the size of nature. Price, in extra cloth, $5 50. Also, the Text and Plates, bound in one handsome volume. Cloth, $10. No one treating skin diseases should be without a copy of this standard work. Canada Lancet. We can safely recommend it to the profession at the best work on the subject now in existence ID the English language. Medical Times and Gazette Mr. Wilson's volume is an excellent digest of th actual amount of knowledge of cutaneous diseases : it includes almost every fact or opinion of importance connected with the anatomy and pathology of th skin. British and Foreign Medical Review. Such a work as the one before us is a most capital *nd acceptable help. Mr. Wilson has long been held *s high authority in this department of medicine, and his book on diseases of the skin has long been re- garded as one of the best text-books extant on the subject. The present edition is carefully prepared, and brought up in its revision to the present time. In this edition we have also included the beautiful series of plates illustrative of the text, and in the last edi- ;ion published separately. There are twenty of these plates, nearly all of them colored to nature, and ex- hibiting with great fidelity the various groups ot diseases. Cineinnati Lancet. >T THE SAME AUTHOR. THE STUDENT'S BOOK OF CUTANEOUS MEDICINE and Dis- BASES OF THE SKIN. In one very handsome royal 12mo. volume. $350. J^ELIGAN (J. MOORE], M.D., M.R.I. A. A PRACTICAL TREATISE ON DISEASES OF THE SKIN. Fifth American, from the second and enlarged Dublin edition by T. W. Belcher, M. D. In one neat royal 12mo. volume of 462 pages, cloth, $2 25. Fully equal to all the requirements of students and young practitioners. Dublin Med. Press. Of the remainder of the work we have nothing be- yond unqualified commendatioijfto offer. It is so far the most complete one of its size that has appeared, and for the student there can be none which can com- their value justly estimated; in a word, the work i* fully up to the times, and is thoroughly stocked with most valuable information. New York Med. Record, Jan. 15, 1867. The most convenient manual of diseases of the skin that can be procured by the student. Chicago Med. Journal, Dec. 1866. pare with it in practical value. All the late disco- veries in Dermatology have been duly noticed, and JjY THE SAME AUTHOR. ATLAS OF CUTANEOUS DISEASES. In one beautiful quarto voljume, with exquisitely colored plates, Ac., presenting about one hundred varieties of disease. Cloth, $5 50. The diagnosis of eruptive disease, however, under I inclined to consider it a very superior work, corn- all circumstances, is very difficult. Nevertheless, | bining accurate verbal description with sound view* Dr. Neligan has certainly, "as far as possible," given a faithful and accurate representation of this class of diseases, and there can be no doubt that these plates will be of great use to the student and practitioner in drawing a diagnosis as to the class, order, and species to which the particular case may belong. While looking over the "Atlas" we have been induced to examine also the "Practical Treatise," and we are of the pathology and treatment of eruptive diseases. Glasgow Med. Journal. A compend which will very much aid the practi- tioner in this difficult branch of diagnosis. Taken with the beautiful plates of the Atlas, which are re- markable for their accuracy and beauty of coloring, it constitutes a very valuable addition to the library of a practical man. Bvfalo Med. Journal. TJILLIER (THOMAS), M.D., *"*- Physician to the Skin Department of University College Hospital, Ac. HAND-BOOK OF SKIN DISEASES, for Students and Practitioners. Second American Edition. In one royal 12mo. volume of 358 pp. With Illustrations. Cloth, $2 25. We can conscientiously recommend it to the stu- dent; the style is clear and pleasant to read, the matter is good, and the descriptions of disease, with the modes of treatment recommended, are frequently Illustrated with well-recorded cases. London Med. Times and Gazette, April 1, 1865. It is a concise, plain, practical treatise on the vari- ous diseases of the skin ; just such a work, iudeoii, as was much needed, both by medical students and practitioners. Chicago Medical Examiner, May, 1865. A NDERSON (McCALL), M.D., -^-*- Physician to the Dispensary for Skin Diseases, Glasgow, &c. ON THE TREATMENT OF DISEASES OF THE SKIN. With an. Analysisof Eleven Thousand Consecutive Cases. In one vol. 8vo. $1. (Lately Published.) GTJERSANT'S SURGICAL DISEASES OF INFANTS AND CHILDREN. Translated by R. J. DU.VQLI- BON, M.D. 1 vol. 8vo. Cloth, $2 50. D15WEES ON THE PHYSICAL AND MET>Tf!AL TREATMENT oy CHILDREN Klaventh editioa. 1 voi. Bvo. of 548 pages. Cloth, $2 80. HENRY C. LEA'S PUBLICATIONS (Diseases 6f Children). &MITH (J. LE WIS), M. D., *-J Professor of Morbid Anatomy in the Be.llevue Hospital Med. College, If. T. A COMPLETE PRACTICAL TREATISE ON THE DISEASES OP CHILDREN. Second Edition, revised and greatly enlarged. In one handsome octavo volume of 742 pages, cloth, $5; leather, $6. (Lately Published.) FROM THE PREFACE TO THE SECOND EDITION. In presenting to the profession the second edition of his work, the author gratefully acknow- ledges the favorable reception accorded to the first. He has endeavored to merit a continuance of this approbation by rendering the volume much more complete than before. Nearly twenty additional diseases have been treated of, among which may be named Diseases Incidental to Birth, Rachitis, Tuberculosis, Scrofula, Intermittent, Remittent, and Typhoid Fevers, Chorea, and the various forms of Paralysis. Many new formulae, which experience has shown to be useful, have been introduced, portions of the text of a less practical nature have been con- densed, and other portions, especially those relating to pathological histology, have been rewritten to correspond with recent discoveries. Every effort has been made, however, to avoid an undue enlargement of the volume, but, notwithstanding this! and an increase in the size of the page, the number of pages has been enlarged by more than one hundred. 227 WEST 49iH STREET, NEW YORK, April, 1872. The work will be found to contain nearly one-third more matter than the previous edition, and it is confidently presented as in every respect worthy to be received as the standard American text-book on the subject. Eminently practical as well as judicious in its teachings. Cincinnati Lancet and Obs., July, 1872. A standard work that leaves little to be desired. Indiana Journal of Medicine, July, 1872. We know of no book on this subject that we can more cordially recommend to the medical student and the practitioner. Cincinnati Clinic, June 29, '72. We regard it as superior to any other single work on the diseases of infancy and childhood. Detroit Rev. of Med. and Pharmacy, Aug. 1872. We confess to increased enthusiasm in recommend- ing this second edition. St. Louis Med. and Surg. Journal, Aug. 1872. riONDIE (D. FRANCIS), M.D. A PRACTICAL TREATISE ON THE DISEASES OF CHILDREN. Sixth edition, revised and augmented. In one large octavo volume of nearly 800 closely- printed pages, cloth, $5 25 ; leather, $6 25. The present edition, which is the sixth, is fully up to the times in the discussion of all those points in the pathology and treatment of infantile diseases which have been brought forward by the German and French teachers. As a whole, however, the work is the best American one that we have, and in its special adapta- tion to American practitioners it certainly has no equal. New York Med. Record, March 2, 1868. WEST (CHARLES), M.D., Physician to the Hospital for Sick Children, ice. LECTURES ON THE DISEASES OP INFANCY AND CHILD- HOOD. Fifth American from the sixth revised and enlarged English edition. In one large and handsome octavo volume of 678 pages. Cloth, $4 50 ; leather, $5 50. (Just Issued.) The continued demand for this work on both sides of the Atlantic, and its translation int* Ger- man, French, Italian, Danish, Dutch, and Russian, show that it fills satisfactorily a want exten- sively felt by the profession. There is probably no man living who can speak with the authority derived from a more extended experience than Dr. West, and his work now presents the results of nearly 2000 recorded cases, and 600 post-mortem examinations selected from among nearly 40,000 cafes which have passed under his care. In the preparation of the present edition he has omitted much that appeared of minor importance, in order to find room for the introduction of additional matter, and the volume, while thoroughly revised, is therefore not increased materially in size. Of all the English writers on the diseases of chil- I living authorities in the difficult department of medi- dren, there is no one so entirely satisfactory to us as J cal science in which he is most widely known. Dr. West. For years we have held his opinion as I Boston Med. and Surg. Journal. Judicial, and have regarded him as one of the highest | BY THE SAME AUTHOR. (Lately Issued.) ON SOME DISORDERS OF THE NERVOUS SYSTEM IN CHILD- HOOD; being the Lumleian Lectures delivered at the Royal College of Physicians of Lon- don, in March, 1871. In one volume, small 12mo., cloth, $1 00. SMITH (EUSTACE), M. D., Physician to the Northwest London Free Dispensary for Sick Children. A PRACTICAL TREATISE ON THE WASTING DISEASES OF INFANCY AND CHILDHOOD. Second American, from the second revised and enlarged English edition. In one handsome octavo volume, cloth, $2 50. (Lately Itsiied.) This is in every way an admirable book. The scribed as a practical handbook of the common dis- eases of children, so numerous are the affections con- sidered either collaterally or directly. We are acquainted with no safer guide to the treatment of modest title which the author has chosen for i t scarce- ly conveys an adequate idea of the many subjects npoa which it treats. Wasting is so constant an at- teudant upon the maladies of childhood, that a trea- children's diseases, and few works give the insight Use upon the wasting diseases of children must neces- i into the physiological and other peculiarities of chil- arily embrace the consideration of many affections j dren that Dr. Smith's book does. Brit. Med. Jour*., of which it is a symptom ; and this is excellently well April 8, 1871. done by Dr. Smith. The book might fairly be de- 1 HENRY C. LEA'S PUBLICATIONS (Diseases of Women). (Free of postage for 1875.) rTHE OBSTETRICAL JOURNAL. THE OBSTETRICAL JOURNAL of Great Britain and Ireland; Including MIDWIFERY, and the DISEASES OF WOMEN AND INFANTS. With an American Supplement, edited by WILLIAM F. JENKS, M.D. A monthly of about 80 octavo pages, very handsomely printed. Subscription, Five Dollars per annum. Single Numbers, 50 cents each. Commencing with April, 1873, the Obstetrical Journal consists of Original Papers by Brit- ish and Foreign Contributors ; Transactions of the Obstetrical Societies in England and abroad ; Reports of Hospital Practice; Reviews and Bibliographical Notices; Articles and Notes, Edito- rial, Historical, Forensic, and Miscellaneous; Selections from Journals; Correspondence, Ac. Collecting together the vast amount of material daily accumulating in this important and ra- pidly improving department of medical science, the value of the information which it pre- sents to the subscriber may be estimated from the character of the gentlemen who have already promised their support, including such names as those of Drs. ATTHILL, ROBERT BARNES, HENRY BENNET, THOMAS CHAMBERS, FLEETWOOD CHURCHILL, MATTHEWS DUNCAN, GRAILY HEWITT, BRAXTON HICKS, ALFRED MEADOWS, W. LEISHMAN, ALEX. SIMPSON, TYLER SMITH, EDWARD J. TILT, SPENCER WELLS, Ac. &c. ; in short, the representative men of British Obstetrics and Gynae- cology. In order to render the OBSTETRICAL JOURNAL fully adequate to the wants of the American profession, each number contains a Supplement devoted to the advances made in Obstetrics and Gynaecology on this side of the Atlantic. This portion of the Journal is under the editorial charge of Dr. WILLIAM F. JENKS, to whom editorial communications, exchanges, books for re- view, &c., may be addressed, to the care of the publisher. *** Complete sets from the beginning can no longer be furnished, but subscriptions can com- mence with January, 1875, or with Vol. II., April, 1874. IJ^HOMAS (T.GAILLARD),M.D., Professor of Obstetrics, &c., in the College of Physicians and Surgeons, N. Y., Sec. A PRACTICAL TREATISE ON THE DISEASES OF WOMEN. Fourth edition, enlarged and thoroughly revised. In one large and handsome octavo volume of 800 pages, with 191 illustrations. Cloth, $5 00; leather, $6 00. (Now Ready.) The author has taken advantage of the opportunity afforded by the call for another edition of this work to render it worthy a continuance of the very remarkable favor with which it has been received. Every portion has been subjected to a conscientious revision, and no labor has been spared to make it a complete treatise on the most advanced condition of its important subject. A few notices of the previous editions are subjoined : No general practitioner can afford to be without it. St. Loriis Med. and Sury. Journal, May, 1872. United States by storm when his book first made its appe^i-aoce early in 1S68. Its reception was simply enthusiastic, notwithstanding a few adverse criti- cisms from our transatlantic brethren, the first large Jt and any similar work in the English language ; editio was rapidly exhausted, and in six months a na F more, as a text-boek for students aud as a guide Its able author need not fear comparisdto between second one was issued, and in two years a third one was announced and published, and we are now pro- mised the fourth. The popularity of this work was not ephemeral, and its success was unprecedented in the annals of American medical literature. Six years is a long period in medical scientific research, but Thomas's work on "Diseases of Women" is still the leading native production of the United States. The order, the matter, the absence of theoretical disputa- tiveness, the fairness of statement, and the elegance of diction, preserved throughout the entire range of the book, indicate that Professor Thomas did not overestimate his powers when he conceived the idea and executed the work of producing a new treatise upon diseases of women. PROP. FALLEN, in Louis- ville Sfed. Journal, Sept. 1874. Briefly, we may say that we know of no book which so completely and concisely represents the present state of gynaecology; none so full of well- digested and reliable teaching ; none which bespeaks an author more apt in research and abnniant in re- sources. N. T. Med. Record, May 1, 1872. We should not be doing our duty to the profession did we not tell those who are unacquainted with th , . book, how much it is valued by gynecologists, and 8econd edlt } on makes its appearance shows that the how it is in many respects one of the best text-books ' general judgment of the Profession has largely con- on the subject we possess in our language. We have ; firmed the opinion we gave at that time.-Ctwetnai< no hesitation in recommending Dr. Thomas's work as i Lancet, Aug. lsb. one of the most complete of its kind ever published. I It ig go short a time Bince we gave a fu n rev i e ir of It should be in the possession of every practitioner | the flrst edition of this boo ^ t that we deem it only for reference and for study. London Lancet, April | aecesgary now to call attention to the second appear- 27. 1872. i ance o f t ne WO rk. its success has been remarkable, We are free to say that we regard Dr. Thomas the ! and we can only congratulate the author on the best American authority on diseases of women. J brilliant reception his book has received. N. Y. Mtd. Cincinnati Lancet and Observer, May, 1872. Journal, April, 1869. for practitioners, we believe it is unequalled. If either student or practitioner can get but one book on diseases of women, that book should be "Thomas." Amer. Jour. Med. Sciences, April, '872. To students we unhesitatingly recommend it as the best text-book on diseases of females extant. St Louis Med. Reporter, June, 1869. Of all the army of books that nave appeared of late years, on the diseases of the uterus and its appendages, we know of none that is so clear, comprehensive, and practical as this of Dr. Thomas', or one that we should more emphatically recommend to the young practi- tioner, as his guide. California Med. Gazette, June, 1869. It would be superfluous to give an extended review of what is now firmly established as the American text-book of Gynsecology. JV. Jf. Med. Gazette, July 17, 1869. This is a new and revised edition of a work which we recently noticed at some length, and earnestly commended to the favorable attention of our readers. The fact that, in the short space of one year, this HENRY C. LEA'S PUBLICATIONS (Diseases of Women). 23 TTODGE (HUGH L.), M.D., ** Emeritus Professor of Obstetrics, Ac., in the University of Pennsylvania. ON DISEASES PECULIAR TO WOMEN; including Displacements of the Uterus. With original illustrations. Second edition, revised and enlarged. In one beautifully printed octavo volume of 531 pages, cloth, $4 50. that which speaks of the mechanical treatment of dis- placements of that organ. He is disposed, as a non- believer In the frequency of inflammations of the uterus, to take strong ground against many of the from PROF. W. H. BTFORD, of the Rush Medical College, Chicago. The book bears the ynpress of a master hand, and must, as its predecessor, prove acceptable to the pro- fession. In diseases of women Dr. Hodge has estab- lished a school of treatment that has become world- wide in fame. Professor Hodge's work Is truly an original one from beginning to end, consequently no one can pe- ruse its pages without learning something new. The book, which is by no means a large one, is divided into two grand sections, so to speak : first, that treating of the nervous sympathies of the uterus, and, secondly, highest authorities in this branch of medicine, and the arguments which he offers in support of his posi- tion are, to say the least, well put. Numerous wood- cuts adorn this portion of the work, and add incalcu- lably to the proper appreciation of the variously shaped instruments referred to by our author. As a contribution to the study of women's diseases, it is of great value, and is abundantly able to stand on its own merits. N. Y. Medical Record, Sept. 15, 1868. WEST (CHARLES), M.D. LECTURES ON THE DISEASES OF WOMEN. Third American, from the Third London edition. In one neat octavo volume of about 550 pages, cloth, $3 75 ; leather, $4 75. As a writer, Dr. West stands, in our opinion, se- 1 seeking truth, and one that will convfcce the student cond only to Watson, the "Macaulay of Medicine;' that he has committed himself to a candid, safe, and he possesses that happy faculty of clothing instrnc- valuable guide. N. A. Ifed.-Chirurg Review. tion in easy garments ; combining pleasure with profit, he leads his pupils, in spite of the ancient pro- : We ha to 8a T of u bnefl y and *M7i that II verb, along a royal road to learning. His work is one ls the best work on tbe subject in any language, and which will not satisfy the extreme on either side, but that u stamps Dr. West as the facile prmceps of It is one that will please the great majority who are British obstetric authors. Edinburgh Med. Journal. 1DARNES (ROBERT), M. D., F. R. C. P., *-* Obstetric Physician to St. Thomas's Hospital, Ac. A CLINICAL EXPOSITION OP THE MEDICAL AND SURGI- CAL DISEASES OF WOMEN. In one handsome octavo volume of about 800 pages, with 169 illustrations. Cloth, $5 00 ; leather, $6 00. (Just Issued.) The very complete scope of this volume and the manner in which it has been filled out, may be seen by the subjoined Summary of Contents. INTRODUCTION. CHAPTER I. Ovaries ; Corpus Luteura. II. Fallopian Tubes. III. Shape of Uterine Cavity. IV. Structure of Uterus. V. The Vngina. VI. Examinations and Diagnosis. VII. Significance of Leucorrhoea. VIII. Discharges of Air. IX. Watery Discharges. X. Puru- lent Discharges. XI. Hemorrhagic Discharges. XII. Significance of Pain. XIII. Significance of Dyspareunia. XIV. Significance of Sterility. XV. Instrumental Diagnosis and Treatment. XVI. Diagnosis by the Touch, the Sound, the Speculum. XVII. Menstruation and its Disor- ders. XVIII. Amenorrhoea. XIX. Amenorrhoea (continued). XX. Dysmenorrhoea. XXI. Ovarian Dysmenorrhoea, &c. XXII. Inflammatory Dysmenorrhoea. XXIII. Irregulnrities of Change of Life. XXIV. Relations between Menstruation and Diseases. XXV. Disorders of Old Age. XXVI. Ovary, Absence and Hernia of. XXVII. Ovary, Hemorrhage, Ac., of. XXVIII. Ovary, Tubercle, Cancer, &c., of. XXIX. Ovarian Cystic Tumors. XXX. Dermoid Cysts of Ovary. XXXI. Ovarian Tumors, Prognosis of. XXXII. Dingnosis of Ovarian Tumors. XXXIII. Ovarian Cysts, Treatment of. XXXIV. Fallopian Tubes, Diseases of. XXXV. Broad Liga- ments, Diseases of. XXXVI. Extra-uterine Gestation. XXXVII. Special Pathology of Ute rus. XXXVIII General Uterine Pathology. XXXIX. Alterations of Blood Supply. XL. Metritis, Endometritis, Ac, XLI. Pelvic Cellulitis and Peritonitis, Ac. XLII. Haematocele, n ,_ a , nu ^ eU _/i also to point out to him in extraordinary cases whe ,, ... , Aphorisms. The illustrations are well selected and serve as excellent reminders of the conduct of labor regular and difficult. Cincinnati Lancet, April, '70. This is a mostadmirable little work, and completely and how he may act upon his own responsibility, and when he ought to send for assistance. Jf. Y. Medical Journal, May, 1870. TUINCKEL (F.), Professor and Director of the Gynaecological Clinic in the University of Rostock. A COMPLETE TREATISE ON THE PATHOLOGY AND TREAT- MENT OF CHILDBED, for Students and Practitioners. Translated, with the consent of the author, from the Second German Edition, by JAMES READ CHADWICK, M.D. In one octavo volume. (Preparing.) HENRY C. LEA'S PUBLICATIONS (Midwifery). 25 ' ' EISHMAN ( WILLIAM), M.D., Regius Professor of Midwifery in the University of Glasgow, Ac. A SYSTEM OF MIDWIFERY, INCLUDING THE DISEASES OF PREGNANCY AND THE PUERPERAL STATE. In one large and very handsome oc- tavo volume of over 700 pages, with one hundred and eighty-two illustrations. Cloth, $5 00 ; leather, $6 00. (Lately Published.) This is one of a most complete aud exhaustive cha- racter. We have gone carefully through it, and there is no subject in Obstetrics which has not been con- sidered well and fully. The result is a work, not only admirable as a text-book, but valuable as a work of reference to the practitioner in the various emer- gencies of obstetric practice. Take it all in all, we have no hesitation in say ing that it is incur judgment the best Euglish work ou the subject. London Lan- cet, Aug. 23, 1873. The work of Leishman gives an excellent view of modern midwifery, and evinces its author's extensive acquaintance with British and foreign literature ; and not only acquaintance with it, but wholesome diges- tion and sound judgment of it. He has, withal, a manly, free style, and can state a difficult and compli- ' cated matter with remarkable clearness and brevity. Edin. Med. Journ., Sept. 1873. The author has succeeded in presenting to the pro- fession an admirable treatise, especially in its practi- cal aspects ; one which is, in general, clearly written, and sound in doctrine, and one which cannot fail to add to his already high reputation. In concluding our examination of this work, we cannot avoid again saying that Dr. Leishman has fully accomplished that difficult task of presenting a good text-book upon obstetrics. We know none better for the use of the stu- dent or junior practitioner. Am. Practitioner, Mar. 1874. It proposes to offer to practitioners and students "A Complete System of the Midwifery of the Present Day," and well redeems the promise. In all that relates to the subject of labor, the teaching is admi- rably clear, concise, and practical, representing not alone British practice, but the contributions of Con- tinental and Ajnerican schools. JV. Y. 3fed. Record, March 2, 1874. The work of Dr. Leishman is, in many respects, not only the best treatise on midwifery that we have seen, but one of the best treatises on any medical sub- ject that has been published of late years. Lund. Practitioner, Feb. 1874. It was written to supply a desideratum, and we will be much surprised if it does not fulfil the purpose of its author. Taking it as a whole, we know of no work on obstetrics by an English author in which th student and the practitioner will find the information so clear and so completely abreast of the present state of our knowledge on the subject. Glasgow Med. Journ., Aug. 1873. Dr. Leishman's System of Midwifery, which has only just been published, will go far to supply the want which has so long been felt, of a really good modern English text-book. Although large, as is in- evitable in a work on so extensive a subject, it is so well and clearly written, that it is never wearisome to read. Dr. Leishman's work may be confidently recommended as an admirable text-book, and is sure to be largely used. Land. Med. Record, Sept. 1S73. ftAMSBOTHAM (FRANCIS H.), M.D. THE PRINCIPLES AND PRACTICE OF OBSTETRIC MEDI- CINE AND SURGERY, in reference to the Process of Parturition. A new and enlarged edition, thoroughly revised by the author. With additions by W. V. KEATING, M. D., Professor of Obstetrics, &c., in the Jefferson Medical College, Philadelphia. In one large and handsome imperial octavo volume of 650 pages, strongly bound in leather, with raised bands ; with sixty-four beautiful plates, and numerous wood-cuts in the text, containing in all nearly 200 large and beautiful figures. $7 00. We will only add that the student will learn from it all he need to know, and the practitioner will find it, as a book of reference, surpassed by none other. Stethoscope. The character and merits of Dr. Ramsbotham's work are so well known and thoroughly established, that comment is unnecessary and praise superfluous. The illustrations, which are numerous and accurate, are executed in the highest style of art. We cannot too highly recommend the work to our readers. Si. Louis Med. and Surg. Journal. To the physician's library ills Indispensable, while to the student, as a text-book, from which to extract the material for laying the foundation of an education on obstetrical science, it has no superior. Ohio Med. and Surg. Journal. When we call to mind the toil we underwent in acquiring a knowledge of this subject, we cannot but i envy the student of the present day the aid which j this work will afford him. Am. Jour, of the Med. Sciences. fJHURCHILL (FLEETWOOD), M.D., M.R.I. A. ON THE THEORY AND PRACTICE OF MIDWIFERY. A new American from the fourth revised and enlarged London edition. With notes and additions by D. FRANCIS CONDIE, M. D., author of a "Practical Treatise on the Diseases of Chil- dren,'' EOSS (SAMUEL />.), M.D., ^* Professor of Surgery in the Jefferson Medical College of Philadelphia. A SYSTEM OF SURGERY: Pathological, Diagnostic, Therapeutic, and Operative. Illustrated by upwards of Fourteen Hundred Engravings. Fifth edition, carefully revised, and improved. In two large and beautifully printed imperial octavo vol- umes of about 2300 pages, strongly bound in leather, with raised bands, $15. (Just Issued.) The continued favor, shown by the exhaustion of successive large editions of this great work, proves that it has successfully supplied a want felt by American practitioners and students. In the present revision no pains have been spared by the author to bring it in every respect fully up to the day. To effect this a large part of the work has been rewritten, and the whole enlarged by nearly one-fourth, notwithstanding which the price has been kept at its former very moderate rate. By the use of a close, though very legible type, an unusually large amount of matter is condensed in its pages, the two volumes containing as much as four or five ordinary octavos. This, combined with the most careful mechanical execution, and its very durable binding, renders it one of the cheapest works accessible to the profession. Every subject properly belonging to the domain of surgery is treated in detail, so that the student who possesses this work may be said to have in it a surgical library. A few notices of the previous edition are subjoined : It must long remain the most comprehensive work on this important part of medicine. Boston Medical and Surgical Journal, March 23, 1865. We have compared it with most of onr standard works, such as those of Erichsen, Miller, Fergusson, Byrne, and others, and we mast, in justice to oar author, award it the pre-eminence. As a work, com- plete in almost every detail, no matter how minute or trifling, and embracing every subject known in the principles and practice of surgery, we believe it stands without a rival. Dr. Gross, in his preface, re- marks "my aim has been to embrace the whole do- main of surgery, and to allot to every subject its legitimate claim to notice;" and, we assure our readers, he has kept his word. It is a work which we can most confidently recommend to our brethren, for its utility is'becoming the more evident the longer It is upon the shelves of our library. Canada Med. Journal, September, 1865. The first two editions of Professor Gross' System of Sargery are so wall known to the profession, and so highly prized, that it would be idle for us to speak in praise of this work. Chicago Medical Journal, September, 1865. We gladly indorse the favorable recommendation of the work, both as regards matter and style, which we made when noticing its first appearance. British and Foreign Medico-Chirurgical Review, Oct. 1865. The most complete work that has yet issued from the press on the science and practice of surgery. London Lancet. This system of surgery Is, we predict, destined to take a commanding position in our surgical litera- ture, and be the crowning glory of the author's well earned fame. As an authority on general surgical subjects, this work is long to occupy a pre-eminent place, not only at home, but abroad. We have no B hesitation in pronouncing it without a rival in our language, and equal to the best systems of surgery in any language. A r . . Med. Journal. Not only by far the best text-book on the subject, ' as a whole, within the reach of American students, bat one which will be much more than ever likely to be resorted to and regarded as a high authority abroad. Am. Journal Med. Sciences, Jan. 1665. The work contains everything, minor and major, operative and diagnostic, including mensuration and examination, venereal diseases, and uterine manipu- lations and operations. It is a complete Thesaurus of modern surgery, where the student and practi- tioner shall not seek in vain for what they desire. San Francisco Med. Press, Jan. 1865. Open it where we may, we find sound practical in- formation conveyed in plain language. This book ii no mere provincial or even national system of sur- gery, but a work which, while very largely indebted to the past, has a strong claim on the gratitude of the future of surgical science. Edinburgh Med. journal, Jan. 1865. A glance at the work is sufficient to show that the author and publisher have spared no labor in making it the most complete "System of Sargery" ever pub- lished in any country. St. Louis Med. and Surg. Journal, April, 1865. A system of surgery which we think unrivalled in our language, and which will indelibly associate his name with surgical science. And what, in onr opin- ion, enhances the value of the work is that, while the practising surgeon will find all that he requires in it, it is at the same time one of the most valuable trea- tises which can be put into the hands of the student seeking to know the principles and practice of thi* branch of the profession which he designs subse- quently to follow. The Brit. Am.Journ., Montreal. T THE SAME AUTHOR. A PRACTICAL TREATISE ON FOREIGN BODIES IN THE AIR-PASSAGES. In 1 vol. 8vo., with illustrations, pp. 468, cloth, $2 75. BKEY'S OPERATIVE SURGERY. In 1 vol. Svo. GIBSON'S INSTITUTES AND PRACTICE OF SUR- cloth, of over 660 pages ; with about 100 wood-cuts. $325. COOPER'S LECTURES ON THE PRINCIPLES AND PKACTICB OF SURGERY. In 1 vol. Svo. cloth, 750 p. $2. UERY. Eighth edition, improved and altered. With thirty-four plates. In two handsome octavo vol- umes, about 1000 pp., leather, raised bandt. $6 50. M 1LLER (JAMES), Late Professor of Surgery in the University of Edinburgh, Ac. PRINCIPLES OF SURGERY. Fourth American, from the third and revised Edinburgh edition. In one large and very beautiful volume of 700 pages, with two hundred and forty illustrations on wood, cloth, $3 75. B Y THE SAME AUTHOR. THE PRACTICE OF SURGERY. Fourth American, from the last Edinburgh edition. Revised by the American editor. Illustrated by three hundred and sixty-four engravings on wood. In one large octavo volume of nearly 700 pages, cloth, $3 75. ARGENT (F. W.), M.D. OJN BANDAGING AND OTHER OPERATIONS OF MINOR SURGERY, New edition, with an additional chapter on Military Surgery. One handsome royal 12mo. volume, of nearly 400 pages, with 184 wood-cuts. Cloth, $1 76. HENRY C. LEA'S PUBLICATIONS (Surgery). ASHHURST (JOHN, Jr.), M.D., Surgeon to the Episcopal Hospital, Philadelphia. THE PRINCIPLES AND PRACTICE OF SURGERY. In one very large and handsome octavo volume of about 1000 pages, with nearly 550 illustrations, cloth, $6 50; leather, raised bands, $7 50. (Lately Published.) The object of the author has been to present, within as condensed a compass as possible, a complete treatise on Surgery in all its branches, suitable both as a text-book for the student and a work of reference for the practitioner. So much has of late years been done for the advance- ment of Surgical Art and Science, that there seemed to be a want of a work which should present the latest aspects of every subject, and which, by its American character, should render accessible to the profession at large the experience of the practitioners of both hemispheres. This has been the aim of the author, and it is hoped that the volume will be found to fulfil its purpose satisfac- torily. The plan and general outline of the work will be seen by the annexed CONDENSED SUMMARY OF CONTENTS. CHAPTER I. Inflammation. II. Treatment of Inflammation. III. Operations in general : Anaesthetics. IV. Minor Surgery. V. Amputations. VI. Special Amputations. VII. Effects of Injuries in General : Wounds. VIII. Gunshot Wounds. IX. Injuries of Bloodvessels. X. Injuries of Nerves, Muscles and Tendons, Lymphatics, Bursse, Bones, and Joints. XI. Fractures. XII. Special Fractures. XIII. Dislocations. XIV. Effects of Heat and Cold. XV. Injuries of the Head. XVI. Injuries of the Back. XVII. Injuries of the Face and Neck. XVIII. Injuries of the Chest. XIX. Injuries of the Abdomen and Pelvis. XX. Diseases resulting from Inflammation. XXI. Erysipelas. XXII. Pyaemia. XXIII. Diathetic Diseases : Struma (in- cluding Tubercle and Scrofula); Rickets. XXIV. Venereal Diseases ; Gonorrhoea and Chancroid. XXV. Venereal Diseases continued : Syphilis. XXVI. Tumors. XXVII. Surgical Diseases of Skin, Areolar Tissue, Lymphatics, Muscles, Tendons, and Bursae. XXVIII. Surgical Disease of Nervous System (including Tetanus). XXIX. Surgical Diseases of Vascular System (includ- ing Aneurism). XXX. Diseases of Bone. XXXI. Diseases of Joints. XXXII. Excisions. XXXIII. Orthopaedic Surgery. XXXIV. Diseases of Head and Spine. XXXV. Diseases of the Eye. XXXVI. Diseases of the Ear. XXXVII. Diseases of the Face and Neck. XXXVIII. Diseases of the Mouth, Jaws, and Throat. XXXIX. Diseases of the Breast. XL. Hernia. XLI. Special Herniaa. XLII. Diseases of Intestinal Canal. XLIII. Diseates of Abdominal Organs, and various operations on the Abdomen. XLIV. Urinary Calculus. XLV. Diseases of Bladder and Prostate. XLVI. Diseases of Urethra. XLVII. Diseases of Generative Organs. INDEX. Its author has evidently tested the writings and experiences of the past aud present in the crucible of a careful, analytic, and honorable mind, and faith- fully endeavored to bring his work up to the level of the highest standard of practical surgery. He is frank and definite, and gives us opinions, and gene- rally sound ones, instead of a mere resume of the opinions of others. He is conservative, but not hide- bound by authority. His style is clear, elegant, and scholarly. The work is anadmirable tex-tbook, and a useful book of reference It is a credit to American professional literature, and one of the first ripe fruits of the soil fertilized by the blood of our late unhappy war. N. Y. Med. Record, Feb. 1, 1S72. Indeed, the work as a whole must be regarded aa an excellent and concise exponent of modern sur- gery, and as such it will be fouud a valuable text- book for the student, and a useful book of reference for the general practitioner. N. Y. Med. Journal, Feb. 1872. It gives us great pleasure to call the attention of the profession to this excellent work. Our knowledge of its talented and accomplished author led us to expect from him a very valuable treatise upon subjects to which he has repeatedly given evidence of having pro- fitably devoted much time and labor, and we are in no way disappointed. Phila. Med. Times, Feb. 1, 1872. pIRRIE ( WILLIAM], F. R. S. E., J- Professor of Surgery in the University of Aberdeen. THE PRINCIPLES AND PRACTICE OF SURGERY. Edited by JOHN NEILL, M. D., Professor of Surgery in the Penna. Medical College, Surgeon to the Pennsylvania Hospital, RYANT (THOMAS), F.R.C.S., *' Surgeon to Guy's Hospital. THE PRACTICE OF SURGERY. With over Five Hundred En- gravings on Wood. In one large and very handsome octavo volume of nearly 1000 pages, cloth, $6 25 ; leather, raised bands, $7 25. (Lately Publislted.) Again, the author gives us his own practice, his own beliefs, and illustrates by his own cases, or those treated in Guy's Hospital. This feature adds joint emphasis, and a solidity to his statements that inspire confidence. One feels himself almost by the side of the surgeon, seeing his work and hearing his living words. The views, etc., of other surgeons are con- sidered calmly and fairly, but Mr. Bryant's are adopted. Thus the work is not a compilation of other writings; it is not an encyclopaedia, but the plain statements, on practical points, of a man who has lived and breathed and had his being in the richest surgical experience. The whole profession owe a debt of gratitude to Mr. Bryant, for his work in their behalf. We are confident that the American profe.-sion will give substantial testimonial of their feelings towards both author and publisher, by speedily exhausting this edition. We cordially and heartily commend it to our friends, and think that no live surgeon can atford to be without it Detroit Review of , Med. and Pharmacy, August, 1873. As a manual of the practice of surgery for the use of the student, we do not hesitate to pronounce Mr. Bryant's book a first-rate work. Mr. Bryant has a good deal of the dogmatic energy which goes with the clear, pronounced opinions of a man whose re- flections and experience have moulded a character not wanting in firmness and decision. At the same time he teaches with the enthusiasm of one who has faith in liis teaching; he speaks as one having au- thority, and herein lies the charm and excellence of his work. He states the opinions of others freely and fairly, yet it is no mere compilation. The book combines much of the merit of the manual with the merit of the monograph. One may recognize in almost every chapter of the ninety-four of which the work is made up the acuteness of a surgeon who has seen much, and observed closely, and who gives forth the results of actual experience. In conclusion we repeat what we stated at first, that Mr. Bryant's book is one which we can conscientiously recommend both to practitioners and students as an admirable work. Dublin Journ. of Med. Science, August, 1873. Mr. Bryant has long been known to the reading portion of the profession as an able, clear, and graphic writer upon surgical subjects. The volume before us is one eminently upon the practice of surgery and not one which treats at length on surgical pathology, though the views that are entertained upon tnis sub- ject are sufficiently interspersed through the work for all practical purposes. As a text-book we cheer- fully recommend it, feeling convinced that, from the subject-matter, and the concise and true way Mr. Bryant deals with his subject, it will prove a for- midable rival among the numerous surgical text- books which are offered to the student. If. Y. Med. Record, June, 1873. This is, as the preface states, an entirely new book, and contains in a moderately condensed form all the surgical information necessary to a general practl-' tioner. It is written in a spirit consistent with the present improved standard of medical and surgical science. American Journal of Obstetrics, August, 1S73. WELLS ( J. SOELBERG), ' ' Professor of Ophthalmology in King's College Hospital, Ac. A TREATISE ON DISEASES OF THE EYE. Second American, from the Third and Revised London Edition, with additions; illustrated with numerous engravings on wood, and six colored plates. Together with selections from the Test-types of Jaeger and Snellen. In one large and very handsome octavo volume of nearly 800 pages ; cloth, $5 00 ; leather, $6 00. (Lately Published.) The continued demand for this work, both in England and this country, is sufficient evidence that the author has succeeded in his effort to supply within a reasonable compass n full practical digest of ophthalmology in its most modern aspects, while the call for repeated editions has en- abled him in his revisions to maintain its position abreast of the most recent investigations and improvements. In again reprinting it, every effort has been made to adapt it thoroughly to the wants of the American practitioner. Such additions as seemed desirable have been introduced by the editor, Dr. I. Minis Hays, and the number of illustrations has been largely increased. The importance of test-types as an aid to diagnosis is so universally acknowledged at the present day that it seemed essential to the completeness of the work that they should be added, and as the author recommends the use of those both of Jaeger and of Snellen for different purposes, selec- tions have been made from each, so that the practitioner may have at command all the assist- ance necessary. Although enlarged by one hundred pages, it has been retained at the former very moderate price, rendering.it one of the cheapest volumes before the profession. A few notices of the previous edition are subjoined. On examining it carefully, one is not at all sur- lucid and flowing, therein differing materially from prised that it should meet with universal favor. It j souieof the translations of Continental writers on this is, in fact, a comprehensive and thoroughly practical treatise on diseases of the eye, setting forth the prac- tice of the leading oculists of Europe and America, ami giving the author's own opinions and preferences, which are quite decided and worthy of high consid- eration. The third English edition, from which this is taken, having been revised by the author, com- prises a, notice of all the more recent advances made in ophthalmic science. The style of the writer is ubject that are in the market. Special pains are taken to explain, at length, those subjects which are particularly difficult of comprehension to the begin- uer, as the use of the ophthalmoscope, the interpre- tation of its images, etc. The book is profusely and ably illustrated, and at the end are to be found 16 excellent colored ophthalmoscopic figures, which are copies of some of the plates of Liebreich's admirable atlas. Kansas City Med. Journ., June, 1874. / A URENCE (JOHN Z.), F. R. C. S., "^ Editor of the Ophthalmic Review, &c. A HANDY-BOOK OF OPHTHALMIC SURGERY, for the use of Practitioners. Second Edition, revised and enlarged. With numerous illustrations. In one very handsome octavo volume, cloth, $3 00. For those, however, who must assume the care of edition those novelties which have secured the confl- diseases and injuries of the eye, and who are too much pressed for time to study the classic works on the subject, or those recently published by Stellwag, Wells, Bader, and others, Mr. Laurence will prove a safe and trustworthy guide. He has described in thlt dence of the profession since the appearance of hi last. The volume has been considerably enlarged and improved by the revision and additions of its author, expressly for the American edition. Am. Journ. Med. Sciences, Jan. 1870. 1 30 HENRY C. LEA'S PUBLICATIONS (Surgery, &c.). THOMPSON (SIR HENRY), * Surgeon and Professor of Clinical Surgery to University College Hospital. LECTURES ON DISEASES OF THE URINARY ORGANS. With illustrations on wood. Second American from the Third English Edition. In one neat octavo volume. Cloth, $225. (Now Ready.) My aim has been to produce in the smallest possible compass an epitome of practical knowl- edge concerning the nature and treatment of the diseases which form the subject of the work ; and I venture to believe that my intention has been more fully realized in this volume than in either of its predecessors. Autlwr^s Preface. TOY THE SAME AUTHOR. ON THE PATHOLOGY AND TREATMENT OF STRICTURE OF THE URETHRA AND URINARY FISTULA. With plates and wood-cuts. From the third and revised English edition. In one very handsome octavo volume, cloth, $3 50. (Lately Published.) TOY THE SAME AUTHOR. (Just Issued.) THE DISEASES OF THE PROSTATE, THEIR PATHOLOGY AND TREATMENT. Fourth Edition, Revised. In one very handsome octavo volume of 355 pages, with thirteen piates, plain and colored, and illustrations on wood. Cloth, $3 75. rFAYLOR (ALFRED S.), M.D., * Lecturer on Med. Jurisp. and Chemistry in Quy's Hospital MEDICAL JURISPRUDENCE. Seventh American Edition. Edited by JOHN J. REESE, M.D., Prcf. of Med. Jurisp. in the Univ. of Penn. In one large octavo volume of nearly 900 pages. Cloth, $5 00; leather, $6 00. (Just Issued.) In preparing for the press this seventh American edition of the " Manual of Medical Jurispru- dence" the editor has, through the courtesy of Dr. Taylor, enjoyed the very great advantage of consulting the sheets of the new edition of the author's larger work, " The Principles and Prac- tice of Medical Jurisprudence," which is now ready for publication in London. This has enabled him to introduce the author's latest views upon the topics discussed, which are believed to bring the work fully up to the present time. The notes of the former editor, Dr. Hartshorne, as also the numerous valuable references to American practice and decisions by his successor, Mr. Penrose, have been retained, with but few slight exceptions ; they will be found inclosed in brackets, distinguished by the letters (H.) and (P.). The additions made by the present editor, from the material at his command, amount to about one hundred pages; and his own notes are designated by the letter (R.). Several subjects, not treated of in the former edition, have been noticed in the present one, and the work, it is hoped, will be found to merit a continuance of the confidence which it has so long enjoyed as a standard authority. TOY THE SAME AUTHOR. (Now Ready.) THE PRINCIPLES AND PRACTICE OF MEDICAL JURISPRU- DENCE. Second Edition, Revised, with numerous Illustrations. In two large octavo volumes, cloth, $10 00; leather, $12 00, This great work is now recognized in England as the fullest and most authoritative treatise on every department of its important subject. In laying it, in ita improved form, before the Ameri- can profession, the publisher trusts that it will assume the same position in this country. J^Y THE SAME AUTHOR. New Edition Nearly Ready. POISONS IN RELATION TO MEDICAL JURISPRUDENCE AND MEDICINE. Third American, from the Third and Revised English Edition. In one large octavo volume of 860 pages. This work, which has been so long recognized as a leading authority on its important subject, has received a very thorough revision at the hands of the author, and may be regarded as * new book rather than as a mere revision. He has sought to bring it on all points to a level with the advanced science of the day; many portions have been rewritten, much that was of minor importance has been omitted, and every effort made to condense a complete view of the subject within the limits of a single volume. Dr. Taylor's position as an expert has brought him into connection with nearly all important cases in England for many years. He thus speaks with an authority that few other living men possess, while his intimate acquaintance with the literature of toxicology on both sides of the Atlantic, renders his work equally adapted as a text-book in this country as in Great Britain. tn.uu iuBiainu irriiauuB v egeiaoie irritants Animal Irritant*. Neurotic Poisons. Cerebral or Narcotic Poisons Spinal Poisons Cerebro-Spinal Poisons Cerebro-Cardiac Poisons. HENRY C. LEA'S PUBLICATIONS (Psychological Medicine, &c.). 31 (DANIEL HACK), M.D., J- Joint author of " The Manual of Psychological Mtdicine," Ac. ILLUSTRATIONS OF THE INFLUENCE OF THE MIND UPON THE BODY IN HEALTH AND DISEASE. Designed to illustrate the Action of the Imagination. In .one handsome octavo volume of 416 pages, cloth, $3 25. (Just Issued.) The object of the author in this work has been to show not only the effect of the mind in caus- ing and intensifying disease, but also its curative influence, and the use which may be made of the imagination and the emotions as therapeutic agents. Scattered facts hearing upon this sub- ject have long been familiar to the profession, but no attempt has hitherto been made to collect and systematize them so as to render them available to the practitioner, by establishing the seve- ral phenomena upon a scientific basis. In the endeavor thus to convert to the use of legitimate medicine the means which have been employed so successfully in many systems of quackery, the author has produced a work of the highest freshness and interest as well as of permanent value. JZLANDFORD (G. FIELDING], M. D., F. R.C P., J-* Lecturer on Psychological Medicine at the School of St. George's Hospital, Ac. INSANITY AND ITS TREATMENT: Lectures on the Treatment, Medical and Legal, of Insane Patients. With a Summary of the Laws in force in the United States on the Confinement of the Insane. By ISAAC RAY, M. D. In one very handsome octavo volume of 471 pages; cloth, $3 25. This volume is presented to meet the want, so frequently expressed, of a comprehensive trea- tise, in moderate compass, on the pathology, diagnosis, and treatment of insanity. To render it of more value to the practitioner in this country, Dr. Ray has added an appendix which affords in- formation, not elsewhere to be found in so accessible a form, to physicians who may at any moment be called upon to take action in relation to patient*. It satisfies a want which mast have been sorely actually seen in practice and the appropriate treat- felt by the busy general practitioners of this country, i ment for them, we find in Dr. Blandford's work a It takes the form of a manual of clinical description { considerable advance over previous writings on the of the various forms of insanity, with a description of the mode of examining persons suspected of in- sanity. We call particular attention to this feature of the book, as giving it a unique value to the gene- ral practitioner. If we pass from theoretical conside- rations to descriptions of the varieties of insanity as subject. His pictures of the various forms of mental disease are so clear and good that no reader can fail to be struck with their superiority to those given in ordinary manuals in the English language or (so far as our own reading extends) in any other. London Practitioner, Feb. 1871. W: 'INSLOW (FORBES), M.D., D.C.L., c. ON OBSCURE DISEASES OF THE BRAIN AND DISORDERS OF THE MIND; their incipient Symptoms, Pathology, Diagnosis, Treatment, and Pro- phylaxis. Second American, from the third and revised English edition. In one handsome octavo volume of nearly 600 pages, cloth, $4 25. TEA (HENRY C.). SUPERSTITION AND FORCE: ESSAYS ON THE WAGER OF LAW, THE WAGER OF BATTLE, THE ORDEAL, AND TORTURE. Second Edition, Enlarged. In one handsome volume royal 12mo. of nearly 500 pages; cloth, $2 75. (Lately Published.) We know of no single work which contains, in so r interesting phases of human society and progress. . . mall a compass, so much illustrative of the strangest j The fulness and breadth with which he has carried operations of the human mind. Foot-notes give the i out his comparative survey of this repulsive field of authority for each statement, showing vast research ! history [Torture], are such as to preclude our doing and wonderful industry. We advise our con/reret justice to the work within our present limits. But to read this book and ponder its teachings. Chicago \ here, as throughout the volume, there will be found Mt.d. Journal, Aug. 1S70. I a wealth of illustration and a critical grasp of the As a work of curious inquiry on certain outlying | Philosophical import of facts which will render Mi. pints of obsolete law, "Superstition and Force" is i Lea 8 labors of erlig value to the historical tn- points of obsolete law, "Superstiti one of the most remarkable books we have met with. London JLthenceum, Nov. 3, 1866. He has thrown a great deal of light upon what must be regarded as one of the most instructive as well as dent. London Saturday Review, Oct. S, 1870. As a book of ready reference on the subject, it is of the highest value. Westminster Review, Oct. 1867. l 7 THE SAME AUTHOR. (Lately Published.) STUDIES IN CHURCH HISTORY THE RISE OF THE TEM- PORAL POWER BENEFIT OF CLERGY^EXCOMMUNICATION. In one large royal 12mo. volume of 516 pp. cloth, $2 75. The story was never told more calmly or with greater learning or wiser thought. We doubt, indeed, If any other study of this field can be compared with this for clearness, accuracy, and power. Chicago Examiner, Dec. 1870. Mr. Lea' s latest work, "Studies in Church History," fully sustains the promise of the first. It deals with three subjects the Temporal Power, Benefit of Clergy, and Excommunication, the record of which has a peculiar importance for the English student, and is a chapter on Ancient Law likely to be regarded as final. We can hardly pass from our mention of such literary phenomenon that the head of one of the first American bouses in also the writer of some of its most original books. London Atkt>nJ W Gross on Foreign Bodies in Air-Passages . . 26 Gross's Principles and Practice of Surgery . . 26 Guersant on Surgical Diseases of Children . .' Hamilton on Dislocations and Fractures . _ _j? Hartshorne's Essentials of Medicine . . i?-W- Hartshorne's Conspectus of the Medical Sciences 5 Hartshorne's Anatomy and Physiology . . 7 Heath's Practical Anatomy 7 Hoblyn's Medical Dictionary . "* ''."'"."""*." %V Hodge on Women 23 Hodge's Obstetrics 24 Hodges' Practical Dissections .... 6 Holland's Medical Notes and Reflections . . 14 Homer's Anatomy and Histology ... 6 Hudson on Fevers 18 Hill on Venereal Diseases 19 Hillier's Handbook of Skin Diseases . . 20 Jones and Sieveking's Pathological Anatomy . 14 Jones (C. Handfleld) on Nervous Disorders . 18 Kirkes' Physiology .... Knapp's Chemical Technology ... Lea's Superstition and Force Lea's Studies in Church History . Lee on Syphilis Lincoln on Electro-Therapeutics . Leishman's Midwifery . . . . . La Roche on Yellow Fever . La Roche on Pneumonia, &c. . I Laurence and Moon's Ophthalmic Surgery . | Lawson on the Eye . . . i Laycock on Medical Observation . | Lehmann's Physiological Chemistry, 2 vols. i Lehmann's Chemical Physiology . 1 Ludlow's Manual of Examinations . . Lyons on Fever Maclise's Surgical Anatomy Marshall's Physiology Medical News and Library . Meigs's Lectures on Diseases of Women Meigs on Puerperal Fever Miller's Practice of Surgery Miller's Principles of Surgery . Montgomery on Pregnancy . Neil! and Smith's Compendium of Med. Science . Neligan's Atlas of Diseases of the Skin Neligan on Diseases of the Skin . Obstetrical Journal Odling's Practical Chemistry . Pavy on Digestion Pavy on Food Parrish's Practical Pharmacy . . . . Pirrie's System of Surgery Pereira's Mat. Medica and Therapeutics, abridged Quain and Sharpey's Anatomy, by Leidy . Roberts on Urinary Diseases Ramsbotham on Parturition Rigby's Midwifery Royle's Materia Medica.and Therapeutics . Swayne's Obstetric Aphorisms . Sargent's Minor Surgery Sharpey and Quain's Anatomy, by Leidy . Skey's Operative Surgery Slade on Diphtheria Smith (J. L.) on Children Smith (H. H.) and Horner's Anatomical Atlas . Smith (Edward) on Consumption . Smith on Wasting Diseases . Children Still6's Therapeutics Sturges on Clinical Medicine .... Stokes on Fever Tanner's Manual of Clinical Medicine . Tanner on Pregnancy . ... Taylor's Medical Jurisprudence .... Taylor's Principles and Practice of Med Jurisp Taylor on Poisons Tuke on the Influence of the Mind Thomas on Diseases of Females .... Thompson on Urinary Organs .... Thompson on Stricture Thompson on the Prostate Todd on Acute Diseases ...... Walshe on the Heart Watson's Practice of Physic Wells on the Eye West on Diseases of Females .... West on Diseases of Children . . . . West on Nervous Disorders of Children What to Observe in Medical Cases . . Williams on Consumption . ^-^v^.QBW - t Wilson s Human Anatomy Wilson on Diseases of the Skin .... Wilson's Plates on Diseases of the Skin . , Wilson's Handbook of Cutaneous Medicine . Winslow on Brain and Mind i .tp'J ,-s.ivin Wohler's Organic Chemistry . ,,,*.',.,. i ,i Winckel on Childbed Zeissl on Venereal PAOB . S . 11 . 31 . 31 . 18 . 18 . 25 . 14 . 17 . 29 . 28 . 14 . 9 . & 6 . 18 , 7 8 . 2 23 , 23 26 26 25 , 6 20 20 22 10 16 16 12 27 '13 6 18 26 13 24 26 IS h 6 17 21 12 14 14 5 24 M M tt 3! 22 30 30 30 14 17 n 29 23 n 21 14 17 *f 20 20 20 M 11 ^ A M For "THE OBSTETRICAL JOURNAL," FIVE DOLLARS a year, see p. 22. Date Due IAR tftR-8- 1978 -RECU PRINTED IN U.S.*. CAT. NO. 24 161 UC SOUTHERN REGIONAL LIBRARY FAC A 000416962 9 WBUOO 1875 Chambers, Thomas King. A manual of diet in health and disease WBUOO 1875 Chambers, Thomas King. A manual of diet in health and iisease MEDICAL SCIENCES LIBRARY UNIVERSITY OF CALIFORNIA, IRVINE IRVINE, CALIFORNIA 92664 mni m .