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Title: Food and cookery for the sick and convalescent.
Author: Farmer, Fannie Merritt
Publisher: Boston: Little, Brown, and company

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> FOOD AND COOKERY
FOR THE
SICK AND CONVALESCENT.

> CHAPTER I.

> FOOD AND ITS RELATION TO THE BODY.

FOOD is that which builds and repairs the body, and furnishes heat and energy for its activities. Metabolism includes the processes by which food is assimilated and becomes part of the tissues, and the excretion of broken-down tissues as waste products. The body, by the analysis of its different organs and tissues, is found to contain from fifteen to twenty chemical elements, of which the principals are: carbon (C), 21 1/2%; hydrogen, (H), 10%; oxygen (O), 62 1/2%; and nitrogen (N), 8%. Phosphorus (P), sulphur (S), iron (Fe), chlorine (CI), fluorine (FI), calcium (Ca), potassium (K), sodium (Na), magnesium (Mg), and silicon (Si) are some of the others present. The elements found in the body must be supplied by the oxidation and utilization of the food stuffs, and the health of the individual will suffer if these are not properly maintained.

Food adjuncts are such substances as stimulate the appetite without fulfilling the requirements of food. Examples: tea, coffee, spices, flavoring extracts, condiments, etc., etc.

While air is not classified as a food, it is essential to life. Combustion cannot take place without it, and all food must be oxidized (which is a process of slow combustion) before it can be utilized by the body.

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> CLASSIFICATION OF FOODS.

			{Albuminoids	{Albumen, white of egg. {Myosin, lean of meat. {Casein, of milk. {Gluten, of wheat. {Legumen, of peas.
		{Proteids	{
	{Protein	{	Gelatinoids	Collagen of skin and tendous. {Ossein of bones
ORGANIC	{	{Extractives of meat. {Extractives of vegetables(amides).
	{Fats
	{	Starches
	{Carboydrates.	{cellulose.
		{Sugars.
INORGANIC	{Mineral matter. {Water.

PROF. W. O. ATWATER.

The chief office of proteids is to build and repair tissues, and they only can do this work. They also furnish heat and energy, and in cases of emergency are capable of supplying fat. The chemical elements found in proteid foods are carbon, hydrogen, oxygen, nitrogen, sulphur, and generally phosphorus and iron. They differ from the other food principles inasmuch as they contain nitrogen, and nitrogen is essential to life.

The principal animal proteids are meat, fish, eggs, and cheese; the principal vegetable proteids are cereals, peas, beans, and lentils. The proteids obtained from animal foods are more easily digested and more completely absorbed than those obtained from vegetable foods. This is due in part to the presence of the large quantity of cellulose in vegetables. During the oxidation of proteids ammonia is set free, which neutralizes the acids constantly being formed.

The waste products of proteids are excreted by the urine in the form of urea. While a well-balanced dietary


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contains all the food principles, it is possible to sustain life on proteids, mineral matter, and water.

Proteids are the most expensive foods, and there is often found to be an insufficient quantity in dietaries, especially among the poorer classes. it is conceded to be true, that in the United States with those of large incomes there is a tendency to an excess of proteids, but this does not apply to the average American family. Our people eat more than any other people, and do correspondingly more work. The growing child suffers more from the lack of proteid than the adult, as much material is required for building as well as repair. Until recently it was supposed that metabolism went on much faster in young cells, but now the greater activity of the child is held responsible for these rapid changes.

The chief office of carbohydrates is to furnish heat and energy and store fat. They contain carbon, hydrogen, and oxygen, the hydrogen and oxygen always being in the proportion to form water (H2O).

Starch, the chief source of carbohydrates, abounds throughout the vegetable kingdom, being obtained from seeds, roots, tubers, stems, and pith of many plants. Examples: cereals, potatoes, sago, tapioca, etc.

Sugars, the other source from which carbohydrates are obtained, are classified as follows:--

Sucroses (Disaccharids) C12H22O11	{Cane sugar (Sucrose). {Beet sugar. {Maple sugar. {Malt sugar (Maltose). {Milk sugar (Lactose).
Glucoses (Monoanccharids) C6H12O6	Grape sugar (Dextrose). Fruit sugar (Lævulose). Invert sugar (Honey best example).

HUTCHINSON.

Carbohydrates include the cheapest kinds of foods and are apt to be taken in excess. In institutions where large numbers are fed there is a tendency in this direction.

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Carbohydrates in the form of starch furnish a bulky food; and while a certain amount of bulk is necessary, an excess causes gastric disorders. Sugar is oxidized and abosorbed more readily than starch. The monosaccharids are ready for absorption, dextrose being the sugar found in the blood. Some sugar is absorbed through the walls of the stomach, and this holds true of no other foods except alcohol and a very small per cent of peptones (proteids). No water is absorbed through the walls of the stomach.

Sugar (sucrose), on account of its cheapness and complete absorption when taken in combination and moderation, makes a desirable quick-fuel food. Milk sugar (lactose) is equal in nutritive value to cane sugar. Being less sweet to the taste and more slowly absorbed it is often used to advantage for infant feeding and sick-room cookery, where expense is not considered. The usual retail price of milk sugar is about thirty cents per pound. Milk sugar, under ordinary conditions, does not ferment and give rise to an excess of acids.

Sugars are more rapidly oxidized than starches. The former may be compared to the quick flash of heat from pine wood, the latter to the longer-continued heat from hard wood.

The starches furnish the necessary bulk to our foods and are also proteid sparers. Proteids give such an intense heat that but for the starches much of their energy would be wasted.

The waste products of carbohydrates are carbon dioxid (CO2) and water (H20), which leave the body through the lungs, skin, and urine.

The fats and oils also furnish heat and energy, and constitute the adipose tissue of the body. Examples: Fats of meat, butter, cream, olive oil, etc. They are an expensive concentrated fuel food, yielding two and one-fourth times as much energy as an equal weight of carbohydrates. To those who do not consider expense in feeding, there is a strong tendency to increase the use of fats and oils and decrease the carbohydrates, while


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in many respects they are interchangable. "In the diet of children, at least, a deficiency of fat cannot be replaced by an excess of carbohydrate; and that fat seems to play some part in the formation of young tissues which cannot be undertaken by any other nutritive constituent of food," is a prevailing belief among competent observers.

[Illustration: An illustration showing how proteids, fats, and carbohydrates are split up in the body.]

Water constitutes about two-thirds of the weight of the body, and enters into the composition of all the tissues and fluids. To keep the necessary proportion, a large quantity needs to be ingested. One of the great dietetic errors is the neglect to take a sufficient quantity. The amount found in foods is insufficient, and about five cupfuls should be taken daily in beverages. A vegetable diet diminishes the need of water, while one composed largely of animal food increases this need.

Mineral matter is necessary for the building of tissues, being found, principally, in the bones and teeth. It aids in the digestion of foods, and also assists in the diffusion of the fluids of the body. Phosphate of lime, or calcium phosphate, is the mineral basis of bones. Potassium, magnesium, sodium, and iron are minerals, all of which are essential to life. They usually enter the body in


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organic compounds. Sodium chloride (NaCl), common salt, is found in all tissues and secretions of the body except the enamel of the teeth. A sufficient quantity is obtained from our foods for the body's need; the average person, however, takes an additional quantity as a condiment, thus stimulating the appetite and increasing the flow of gastric juice.

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> CHAPTER II.

> ESTIMATES OF FOOD VALUES.

THE familiar comparison between the body and the locomotive engine serves as a most forcible Illustration for studying the fuel value of foods.

Food furnishes fuel to supply heat and energy for the body as wood and coal do for the locomotive. The food not only does this work, but it must also build and repair the human structure, while the locomotive is not capable of making its own repairs.

Latent beat is just as surely found in meat or bread as in wood or coal. They are both waiting to be oxidized, that they may be converted into heat and energy. As different kinds of wood and coal are capable of giving off different degrees of heat, and also giving off that heat in longer or shorter periods of time, so different food stuffs work in comparatively the same way.

The subject of the fuel value of food is of such great importance that within the last few years much time has been devoted to experiments along this line, and the results have furnished much valuable knowledge to aid us in correct feeding.

The latent energy in different foods has been determined by their oxidation, outside the body, in the apparatus known as the bomb calorimeter. Still further experiments have been made with the respiration calorimeter. By this apparatus not only is the fuel value of all the food taken into the body determined, but the excreta, products of respiration, and heat given off by the body are measured. From this statement it can be seen that man himself is used in making the experiments.


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Results have shown that the oxidation of foods is the same in the body as outside the body.

"The amount of heat given off in the oxidation of a given quantity of any material is called its 'heat of combustion,' and is taken as a measure of its latent or potential energy" The calorie is the unit measure of heat used to denote the energy-giving power of food, and is equivalent to the amount of heat necessary to raise one kilogram of water 1° C. or about one pound of water 4° F.

1 gramme1 proteid furnishes.....	4	calories
1 " carbohydrates furnishes.............	4	"
1 " fat furnishes.......................	8.9	"
Bulletin No. 142 U.S. Department of Agriculture.
1 gramme alcohol furnishes..................	7	calories

While proteids are capable of furnishing heat and energy as well as building and repairing tissues, it must always be remembered that their chief office is for the latter work. It is impossible for metabolism to go on without the production of some heat. The proteids are the only foods that contain nitrogen.

To determine the amount of nitrogen in a given food stuff, divide its grammes of proteid by 6.25. One gramme nitrogen equals 6.25 grammes proteid. The excretion of nitrogen for a man of average weight is about twenty grammes daily, the same amount being consumed. When the quantity of nitrogen is increased, there is a corresponding increase of its excretion, thus establishing nitrogenous equilibrium.

128.3 grammes equal 1 oz.

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> Table showing Calorie Value of some Important Foods.

	Household Measure.	Avoir- dupois.	Metric.	Calories.
Egg..................	1	1 1/2 oz.	45 gms.	70
White of an egg......		1 oz.	30 gms	14
Yolk of one egg......		1/2 oz.	15 gms.	56
Milk.................	1 cup	1/2 pt.	250 c.c.	170
Cream, thin, 12%.....	4 tablespoons	2 oz.	60 c.c	80
Cream, thick, 18-20%.	4 tablespoons	2 oz.	60 c.c.	120
Butter...............	1 tablespoon	1/2 oz.	15 gms.	110
Cheese...............	1 tablespoon	1/2 oz.	15 gms.	60
Olive oil............	1 tablespoon	1/2 oz.	15 gms.	135
Sugar................	1 tablespoon	1/2 oz.	15 gms.	60
White bread1.........	1 whole slice	2 oz.	60 gms.	150
Flour................	1 tablespoon	1/4 oz.	8 gms.	26
Rice.................	1 tablespoon	1/2 oz.	15 gms.	50
Rolled Oats..........	1/3 cup	1 oz.	30 gms.	116
Boston crackers......	1	1/2 oz.	15 gms.	60
Graham crackers......	1	1/2 oz.	10 gms.	40
Beefsteak............	1 portion	4 oz.	120 gms.	160 to 300
Lamb Chop............	1	1 1/2 oz.	45 gms.	50 to 150
Chicken..............	1 portion	3 1/2 oz.	100 gms.	100 to 125
Bacon................		1/2 oz.	15 gms.	90
Halibut..............		2 oz.	60 gms.	70
Oysters..............	1/2 cup	5 oz.	150 gms.	75
Beef juice...........	2 tablespoons	1 oz.	30 gms.	7
Potato...............	medium size	3 1/2 oz.	100 gms.	100
Banana...............	medium size	3 1/2 oz.	100 gms.	100
Peach................	medium size	4 oz.	120 gms.	30
Orange...............	medium size	5 oz.	150 gms.	50
Orange juice.........	2 tablespoons	1 oz.	30 gms.	15
Apple................	medium size	5 oz.	150 gms.	60
Strawberries.........	1 portion	4 oz.	120 gms.	40
Canned Tomatoes......	2 tablespoons	1 oz.	30 gms.	7
Prunes, dry..........		2 oz.	60 gms.	175
Breakfast Cocoa......	1 tablespoon	1/2 oz.	8 gms.	36
Brandy...............	1 tablespoon	1/2 oz.	15 gms.	45
Whiskey..............	1 tablespoon	1/2 oz.	15 gms.	45
Sherry...............	1 tablespoon	1/2 oz.	15 gms.	15
Liebig's Beef Extract	1 teaspoon			Insignificant.

[Editorial note: This footnote continues on page 10 in the original text.]

1 In ordinary computations entire wheat bread can be reckoned as having the same nutritive value as white bread.

1 lb. white bread furnishes 1215 calories; 1 lb. entire wheat bread, 1140 calories. The same statement applies to many of the flours, thus:--

1 lb. flour furnishes 1665 calories.

1 lb. entire wheat flour furnishes 1675 calories.

1 lb. corn meal furnishes 1655 calories.

1 lb. corn starch furnishes 1675 calories.

1 lb. wheatlet furnishes 1685 calories.

1 lb. hominy furnishes 1650 calories.

1 lb. granulated corn meal furnishes 1665 calories.

1 lb. wheat germ furnishes 1695 calories.

1 lb. tapioca furnishes 1650 calories.

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A man of average weight (one hundred and fifty-four pounds, or seventy kilos), at moderate work, requires about three thousand calories daily. The standard dietaries include one hundred and twenty-five grammes proteid, fifty grammes fat, and five hundred grammes carbohydrates.

Proteid...........	125	grammes	* 4	==	500	calories
Carbohydrates.....	500	"	* 4	==	2000	"
Fat...............	50	"	* 3.9	==	445	"
					----
Total calorie value					2945	"

> Table showing Number of Calories required under Different Conditions.

A man at light work.............	2450 to 2800	calories
" " " medium work............	2800 to 3150	"
" " " hard muscular work.....	3150 to 4200	"
" " " rest...................	2100 to 2450	"

A woman needs eight-tenths as much food as a man.

The quantity of food required in a temperate and warm climate is about the same; the kinds, however, vary. Mother Nature, always wise and unerring, produces different crops to meet different needs. In our own country oats is grown in the northern part, rice in the southern.

In a cold climate more food is needed,--a fact not due to the temperature, but to the greater activity of the inhabitants,--and fat forms a larger proportion of the diet, as it is oxidized slowly in the body.

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A tall, thin person consumes more food than a short, stout person, for the reason that the larger surface exposed is the cause of a greater loss of heat.

Age has a marked effect upon the rations needed. A child from three to five years old requires four-tenths as much food as a man at moderate work; from six to nine years, one-half as much; while a boy of fifteen years requires as large a quantity as a man of sedentary habits.

The abuses of diet in youth are responsible for much suffering which develops later in life. The laws of retributive justice may be slow, but are, nevertheless, sure. Again, many of the diseases which occur after middle life are due to the habit of eating and drinking such foods as were indulged in during the early years of vigorous manhood.

In advancing years, when growth has ceased and activity has lessened, food is oxidized more slowly; therefore, a smaller quantity is required, and that in a form to be easily digested.

In arranging menus for individuals or families, personal idiosyncrasies must be considered. It is a homely saying, but true, that, " One man's meat is another man's poison."

The "Dietary Computer," by Mrs. Ellen H. Richards, is of great value to one whose desire it is to make out bills of fare according to food values. By its use money spent for foods could be used to better advantage, families would be better nourished, and disease would be less frequent.

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> CHAPTER III.

> DIGESTION.

FOOD, before it can be utilized by the body, must undergo many mechanical and chemical changes to render it capable of digestion, absorption, and assimilation.

Digestion is the conversion of insoluble and indiffusible substances into soluble and diffusible substances capable of being absorbed. Absorption is the taking up of the digested food by the blood-vessels and lymphatics and conveying it to the blood, by which it is carried to every part of the body. Assimilation is the taking up by the different tissues from the blood such material as they need for growth and repair.

Digestion is carried on principally by ferments, and these act by contact. Food is taken into the mouth, masticated by the teeth, moistened by the saliva, and coated by the mucin in the saliva, which makes it easy to swallow. The saliva is an alkaline fluid secreted by three pairs of glands,--the parotid, submaxillary and sublingual. Ptyalin, which acts in an alkaline medium, is the ferment found in the saliva. It has the power of changing starch to maltose and dextrose, but has no effect on proteids or fats. The flow of saliva is continuous, but greatest during eating, about three pints being secreted every twenty-four hours.

Thorough mastication is very important, that the food may be finely divided before passing on into the alimentary canal. If not well masticated it is retained in the stomach for too long a time, thus favoring the development of bacteria, which give rise to acid fermentation.

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Food is forced by peristaltic action through the œsophagus into the cardiac portion of the stomach, where it comes in contact with the gastric juice. The gastric juice is a fluid which contains hydrochloric acid (HCl) and two ferments, pepsin and rennin. The flow of gastric juice is intermittent, but about the same quantity is secreted, daily, as of saliva.

Pepsin acts upon proteid foods, changing some to albumoses and peptones, while by far the largest part is simply swollen in gastric digestion. Pepsin is the principal ferment which acts upon gelatin. Rennin is a milk-curdling ferment.

[Illustration: An illustration of the stomach with the words, PYLORIC STOMACH and CARDIAC STOMACH written on it.]

Cut showing the division of the stomach into two portions.

The digestion of starch continues for about one-half hour after entering the stomach; by that time the food material is sufficiently mixed with the gastric juice to render the whole acid, thus destroying the alkaline reaction. Fats are set free, and to some extent melted in the stomach. About six per cent of proteids, twenty per cent of sugar, and some salts are absorbed through the walls of the stomach. Water passes on with the partially digested food. If the food is liquid, the water leaves the stomach very quickly, and in drinking water some leaves the stomach before the last swallow is taken.

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The stomach has two muscular motions. The first is a turning movement, which takes place in the larger or cardiac portion, mixing the food with the gastric juice, thus bringing the whole to a semi-fluid consistency.

The second is a wave-like movement which takes place in the pyloric end, by means of which the food is allowed to pass by intervals into the duodenum, which is the entrance to the small intestine.

The juice poured out in the pyloric portion contains no hydrochloric acid, but is neutral or slightly alkaline; pepsin is present.

The quantity of gastric juice varies not only in different individuals, but in the same individual according to the diet. Extremes in temperature exert an influence on gastric digestion. Pawlow has made many very interesting experiments along this line, and has discovered that a diet composed chiefly of meat produces a large flow of gastric juice poor in ferments; bread produces a small flow of gastric juice rich in ferments; while milk produces a moderate flow of gastric juice and a moderate amount of ferments. To keep in good normal condition without gain or loss of body weight, a plain, wholesome, mixed diet is the most satisfactory.

There is great danger, especially in the young, of becoming addicted to digestive habits. Each food calls forth a special gastric juice, and if the diet is limited to a few foods the power to assimilate others becomes lessened; therefore if the diet is increased, gastric disturbances are apt to occur. When a patient has been kept for some time on a milk diet, other foods must be introduced gradually, and in small quantities, for the comfort of the individual.

The stomach being capable of great distension, often gives rise to the taking of too much food at a single time. Three meals daily meet the needs of the average person. Dinner should be the heartiest meal, and should be served after the work of the day is over, when sufficient time may be allowed for eating, which may be followed by rest.

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In cases of impaired digestion, fifteen or twenty minutes is recommended for rest after each meal. Where a light breakfast is taken, a lunch should be indulged in in the middle of the forenoon. There are frequently found people of small stomach capacity who seem to require food at frequent intervals in small quantities; whereas if a meal is taken which would serve the needs of the average person, gastric disturbances follow.

Appetite has a marked effect on gastric digestion, and it is often necessary to stimulate the appetite. Attractive surroundings (plants, flowers, music, singing birds, etc.) are provided in institutions where money is not the first consideration. The sanitariums and hospitals in Germany are far in advance of ours in this respect. Good cooking plays a far more important part than surroundings, and it is the duty of the cook to stimulate the appetite by appealing to the sense of hearing, smell, sight, and taste.

While the stomach plays but a small part in digestion, the digestibility of foods in calculated by the length of time they remain in this organ. The average meal leaves the stomach in about four or five hours. The following table will be found of value in considering the ease or difficulty with which certain foods are digested.

> Table showing Time required for the Digestion of some Important Foods.

KIND.		TIME.
Eggs, soft cooked (2)................	1 3/4		hours
Oysters, raw (3).....................	1 3/4		"
Milk, one glass......................	2		"
Graham Crackers (square).............	2		"
Rusks................................	2		"
Beef, raw (3 1/2 oz.)................	2		"
Eggs, raw (2)........................	2 1/4		"
Cauliflower..........................	2 1/4		"
Bread, stale (2 1/2 oz.).............	2 1/3		"
Potatoes, baked (2)..................	2 to 2 1/2		"
Sweetbread...........................	2 to 8		"
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KIND		TIME
White Fish(Cod excepted)............	2 1/2 to 2 3/4		hours
Tapioca, Arrowroot, and Sago Gruel..	2 2/3		"
Beef, roast, rare...................	3		"
Lamb Chops (3 1/2 oz.)..............	3		"
Chicken.............................	3		"
Game................................	3		"
Apple, large (raw)..................	3 1/4		"
Peas................................	4		"
Beans...............................	4		"

Digestion principally takes place in the small intestine. The stomach acts as a reservoir for food, playing but a small part in digestion. Many instances are recorded where people have been well nourished after the removal of the stomach. There was, however, a radical change in the diet, the food being taken in a liquid or semi-solid state.

Food in the small intestine comes in contact with two fluids,--the pancreatic juice and the bile (which is poured out from the liver), both of which are alkaline fluids. The flow of pancreatic juice is suspended except during digestion, while the flow of bile is constant but greatest during digestion.

The pancreatic juice contains four ferments,--amylopsin, trypsin, steapsin, and invertin.

Amylopsin acts upon starches and completes their digestion. Trypsin completes the digestion of proteids. Its action is similar to the action of pepsin in the gastric juice, but it is able to act in an alkaline medium. The proteids which were simply swollen in the stomach are now penetrated by this juice and their digestion is completed. Steapsin splits the fats into glycerine and fatty acids. The fatty acids combine with an alkaline solution and form soap. The bile salts also play an important part in the digestion of fats, but affect neither proteids nor carbohydrates. They, too, combine with fatty acids to form soap, and soap forms an emulsion. Fats thus emulsified are rady for absorption. Invertin acts upon cane sugar, changing it to levulose and dextrose.

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[Illustration: An illistration of an infant's nursing and water bottles and nipple.]

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[Illustration: An illistration of a breakfast tray with various fancy dishes and teapots on it.]

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The liver acts as a storehouse for the body, to be called upon as needed. Some of the carbohydrates which during digestion have been converted into sugar, on reaching the liver are changed into glycogen, and glycogen is reconverted into sugar before entering the general circulation.

The digested food is now ready for absorption, although, as has been stated, the digestion of all foods need not be completed before the absorption of some foods take place. For example, alcohol, sugar, and some proteids and salts are absorbed in the stomach.

Food is moved along from the small to the large intestine by peristaltic muscular contraction. Absorption takes place to a small extent in the small intestine, but to a much larger extent in the large intestine.

Bile salts, on account of their great value, are nearly absorbed before reaching the rectum, and are used over and over again. Salts, bile pigments, connective tissue, and cellulose are not digested (although some authorities affirm that the cellulose in young vegetables is partially digested); these, with the waste products of metabolism, are excreted through the rectum as fæces.

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> CHAPTER IV.

> FOOD AND HEALTH VERSUS DRUGS AND DISEASE.

DR. OLIVER WENDELL HOLMES is reported to have said, "I can count on the fingers of one hand the drugs commonly used by the general practitioner." Drugs are used at the present time to a less extent, and administered in smaller doses, than ever before. The physician of to-day knows that the recovery to health from disease is a natural process, and administers drugs to assist nature rather than to effect a cure. The study of foods and their effect on the individual is of equal importance to the study of drugs.

All infectious diseases are due to bacterial action. Germs enter the system in different ways.

1. Through the blood,--by inheritance.

2. Through the skin,--by bruising or bites.

3. Through air passages.

4. Through the lungs.

Drugs do not kill bacteria; exception must be made, however, to the valuable discovery of anti-toxins, which have done so much for the advancement of medical science.

The healthy person is constantly coming in contact with disease germs, but he is immune from the disease of which they are the cause, as anti-toxins are constantly being formed within the body which neutralize the poisonous effects of the germs.

Health may be defined as a sound mind in a sound body. The necessary conditions for health are:--

1. A correct supply of food.

2. The proper cooking of same.

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3. Air and sunlight supply.

4. Good environment.

5. Exercise.

6. Rest.

7. Sleep.

8. Bathing.

It is safe to state that two-thirds of all disease is brought about by errors in diet,--either the food principles have not been properly maintained or the food has been improperly cooked. To one accustomed to visiting children's hospitals, or children's wards in general hospitals, this statement cannot seem an exaggeration, as the results of mal-nutrition are everywhere in evidence. Correct feeding should begin at birth, and continue through childhood, youth, manhood, and old age. Children more readily succumb to disease than older people; herein lies the necessity