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Title: Health on the Farm: A Manual of Rural Sanitation and Hygiene

Author: H. F. Harris

Release date: September 28, 2008 [eBook #26718]

Language: English

Credits: Produced by Tom Roch, Marcia Brooks and the Online
        Distributed Proofreading Team at http://www.pgdp.net (This
        file was produced from images produced by Core Historical
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Produced by Tom Roch, Marcia Brooks and the Online
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file was produced from images produced by Core Historical
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[Transcriber's Notes:

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THE YOUNG FARMER'S PRACTICAL LIBRARY

EDITED BY ERNEST INGERSOLL




HEALTH ON THE FARM

BY

H. F. HARRIS




The Young Farmer's Practical Library

EDITED BY ERNEST INGERSOLL


Cloth 16mo Illustrated 75 cents _net_ each.

=From Kitchen to Garret.= By VIRGINIA TERHUNE VAN DE WATER.

=Neighborhood Entertainments.= By RENÉE B. STERN, of the Congressional
Library.

=Home Water-works.= By CARLETON J. LYNDE, Professor of Physics in
Macdonald College, Quebec.

=Animal Competitors.= By ERNEST INGERSOLL.

=Health on the Farm.= By DR. H. F. HARRIS, Secretary, Georgia State Board
of Health.

=Co-operation Among Farmers.= By JOHN LEE COULTER.

=Roads, Paths and Bridges.= By L. W. PAGE, Chief of the Office of Public
Roads, U. S. Department of Agriculture.

=Farm Management.= By C. W. PUGSLEY, Professor of Agronomy and Farm
Management in the University of Nebraska.

=Electricity on the Farm.= By FREDERICK M. CONLEE.

=The Farm Mechanic.= By L. W. CHASE, Professor of Farm Mechanics in the
University of Nebraska.

=The Satisfactions of Country Life.= By DR. JAMES W. ROBERTSON, Principal
of Macdonald College, Quebec.




             HEALTH ON THE FARM

   A MANUAL OF RURAL SANITATION AND HYGIENE


                     BY
                H. F. HARRIS
 SECRETARY OF THE GEORGIA STATE BOARD OF HEALTH

                 =New York=
          STURGIS & WALTON COMPANY
                    1911
            _All rights reserved_


               Copyright 1911
        By STURGIS & WALTON COMPANY

  Set up and electrotyped. Published July, 1911




INTRODUCTION

BY THE GENERAL EDITOR


This is the day of the small book. There is much to be done. Time is
short. Information is earnestly desired, but it is wanted in compact
form, confined directly to the subject in view, authenticated by real
knowledge, and, withal, gracefully delivered. It is to fulfill these
conditions that the present series has been projected--to lend real
assistance to those who are looking about for new tools and fresh ideas.

It is addressed especially to the man and woman at a distance from the
libraries, exhibitions, and daily notes of progress, which are the main
advantage, to a studious mind, of living in or near a large city. The
editor has had in view, especially, the farmer and villager who is
striving to make the life of himself and his family broader and brighter,
as well as to increase his bank account; and it is therefore in the
humane, rather than in a commercial direction, that the Library has been
planned.

The average American little needs advice on the conduct of his farm or
business; or, if he thinks he does, a large supply of such help in
farming and trading as books and periodicals can give, is available to
him. But many a man who is well to do and knows how to continue to make
money, is ignorant how to spend it in a way to bring to himself, and
confer upon his wife and children, those conveniences, comforts and
niceties which alone make money worth acquiring and life worth living. He
hardly realizes that they are within his reach.

For suggestion and guidance in this direction there is a real call, to
which this series is an answer. It proposes to tell its readers how they
can make work easier, health more secure, and the home more enjoyable and
tenacious of the whole family. No evil in American rural life is so great
as the tendency of the young people to leave the farm and the village.
The only way to overcome this evil is to make rural life less hard and
sordid; more comfortable and attractive. It is to the solving of that
problem that these books are addressed. Their central idea is to show how
country life may be made richer in interest, broader in its activities
and its outlook, and sweeter to the taste.

To this end men and women who have given each a lifetime of study and
thought to his or her specialty, will contribute to the Library, and it
is safe to promise that each volume will join with its eminently
practical information a still more valuable stimulation of thought.

ERNEST INGERSOLL.




                  TABLE OF CONTENTS


  CHAPTER                                          PAGE

     I IMPORTANCE OF OUR SUBJECT                      3
    II CARE OF THE PERSON                            12
   III SANITATION IN AND ABOUT THE HOUSE             35
    IV HYGIENE OF INFANCY AND CHILDHOOD              63
     V PROPER EATING--THE SECRET OF GOOD HEALTH      92
    VI BREAD AND ITS RELATIONS                      104
   VII MEATS, SUGARS AND MILK                       117
  VIII FOOD-VALUE OF VEGETABLES                     130
    IX DANGER IN FRUITS AND PICKLES                 144
     X DRINKS--PROPER AND HARMFUL                   148
    XI IMPORTANCE OF GOOD COOKING                   164
   XII SEVEN AVOIDABLE DISEASES                     171
  XIII HYGIENE OF THE SICK ROOM                     217
   XIV EMERGENCIES AND ACCIDENTS                    223
    XV WHAT TO DO WHEN POISONED                     251
       APPENDIX                                     273




HEALTH ON THE FARM

CHAPTER I

IMPORTANCE OF OUR SUBJECT


Notwithstanding the extraordinary advances in a material way that have
been accomplished in this country within the last few decades, it is a
significant and most alarming fact that progress in hygienic matters has
lagged far behind. Why this is, it would be very difficult to say,--for
the reason that the causes are perhaps many. Chief among these, probably,
is the fact that our progress along industrial lines has occupied the
entire time of the majority of our best intellects, and it is also in no
small degree the consequence of a fatalism that regards disease as a
direct visitation of providence and therefore a thing which man may not
avoid. Another cause in some instances is the pride of our people in
their homes and respective localities, which causes them to repel with
indignation the suggestion that any special measures are necessary in
order to conserve the public health where they reside. Ignorant as the
average man is of the causes that produce sickness and the means by which
this result is accomplished, he is naturally not in a position to form a
correct judgment concerning such matters, and as a consequence, sees no
reasons for taking the precautions that are necessary in order to ward
off disease. This ignorance, it must be confessed with sorrow, is in a
measure the fault of the medical profession, which has not in the vast
majority of instances lived up to its ideals in this connection. Petty
and unworthy rivalry has played an extremely important part in this
failure of medical men to do their duty in this particular--none of the
physicians of a community being, as a rule, willing that others should
instruct the public, however vital this might be for the general good. As
a consequence, that class of vultures known as medical quacks has
furnished to the laity by far the greater proportion of their
instruction on hygienic subjects, with the result that the average man
has a greater misconception and less real knowledge of such matters than
of anything else in which he is vitally interested.

Another, and very curious explanation for our general disregard of the
laws of health is that our strong belief in ourselves impels us to think
that however much others may suffer from things generally regarded as
unhygienic, we, ourselves, will be immune. This belief is fostered by the
fact that in early life there often seems no end to our capacity to
endure, and we find ourselves constantly defying without apparent harm,
what we are told by others is directly contrary to all rules of proper
living. But it is unfortunately true also that the reserve force and
great power of resistance that enables us to do these things begins to
wane towards the end of the third decade of life, and we, therefore, find
ourselves sooner or later breaking down after we have become thoroughly
convinced that we were made of iron, and that while other people might
not be able to do as we were, it could not possibly result in evil in our
own cases.

What a pity it is that the young will not learn from the experience of
those who have gone before them! Could they only do so, how much
suffering and woe could be avoided in this world. Unfortunately, however,
there are few men so constituted that they are willing to be guided by
the experience of those who have preceded them, and there is but a faint
possibility, therefore, that any good can be accomplished by warning the
coming generation of the troubles in store for them should they not heed
the advice of those who have suffered before them. Notwithstanding this,
the writer feels that these words of warning should be spoken to the
young, since they, alas, are the only ones to be benefited by such
advice.

_As you value your happiness materially, and as you desire a healthy old
age and a long life, inform yourselves as to the few simple laws that
govern human existence, and attempt so far as lies in your power to
follow them. If you do not do this, disaster will follow as surely as the
night follows the day._

_Apathy of the Public as to Hygiene._--As a partial consequence,
probably, of all the reasons mentioned, along with others, there exists
in the popular mind a curious apathy concerning hygienic matters--an
apathy so great that it is scarcely possible to get the average man to
discuss, much less to put in practice the all-important laws that govern
health. As a result of the work of the various State boards of health and
of the Public Health and Marine Hospital Service, this condition of
affairs happily shows some signs of abatement, and we certainly have
reasons to believe that the future promises great things along these
lines. No sign of this change is more significant than the awakening of
the press of the country to the vast importance of instructing the public
in health matters, and their changed attitude toward the charlatans and
quacks who live by promising the impossible. Largely subsidized by the
infamous vendors of patent medicine, our newspapers and magazines still
lend their columns to these human vampires who prey pre-eminently on the
ignorance and credulity of the hopelessly-diseased poor; but within
recent years some of our foremost journals show signs of an awakening of
conscience, and a very few have even gone so far as to exclude
advertisements of this character altogether.

It has been said, certainly with more or less truth, that we are
creatures of our surroundings, but whether we accept this in its broadest
sense or not, there can be no question that our well being is most
intimately connected with those things with which we come into every day
contact. _Nothing is more important for us to recognize than that our
diseases are contracted from neighboring subjects just in proportion as
we are closely associated with them._ From our fellowmen we contract, as
everyone knows, a large number of diseases, either by direct contact or
by means of the air that surrounds us. From the earth we get hook-worms
and other animal parasites, either by coming directly in contact with it
or through eating uncooked fruits and vegetables. From water we get
typhoid fever, dysentery, cholera, and many other parasitic diseases.
From our food we likewise contract dangerous maladies such as tapeworms
from uncooked meats and fish and the deadly trichina from raw hog meat.
With decomposed breads we take the poisons that produce pellagra,
kak-ke, ergotism and acrodinia. From uncooked fruits and vegetables we
get dysentery, typhoid fever, cholera, and parasitic diseases. Spoiled
beans give us the deadly lathyrismus. From decomposed meat and fish we
get ptomaine poisoning. Mosquitoes convey to us malaria, yellow fever and
a parasite known as the filaria. The dreaded sleeping-sickness of Africa
comes through the bites of a small fly; the bedbug is believed to be the
means of conveying a frightful disease known as kala-azar, and the
house-fly often brings to us the germs that produce typhoid fever,
dysentery, and probably other diseases as well.

The bubonic plague, which is one of the most frightful diseases known, is
conveyed to man by the rat and mouse.[1] Hydrophobia is usually
contracted from the bite of the dog, and it is a well-known fact that
this animal often harbors a minute tapeworm, a single egg of which, when
swallowed by the human being, is often followed by death. Both dogs and
cats probably convey diphtheria, and both unquestionably often have
within their intestinal tracts tapeworms that occasionally infect
children. With the exception of the rare disease known as glanders, the
horse is not believed to be directly responsible for any of the maladies
from which the human being suffers, but it is well established that fully
95 per cent. of house-flies hatch in the manure of these animals, and
they, therefore, become indirectly responsible for some of the most
serious diseases affecting the human being. It is thus seen that almost
every object with which man comes in intimate contact is capable of
conveying to him the poison of one or more diseases. If it were possible
for us to separate ourselves completely from everything with which we are
ordinarily associated there can be no question that the span of human
life would be greatly increased, and that death from bacterial and
parasitic diseases generally would no longer occur. All this is said not
with the object of startling the reader, but to warn him of the dangers
that surround him on every hand, and to urge a recognition of that which
can so materially prolong his life. Fortunately these sources of
infection may be almost entirely done away with by a few simple rules of
life, and the health and longevity of mankind must necessarily be
directly proportionate to the care with which we observe them.

It is now in order to discuss in detail the subject of personal hygiene.


FOOTNOTE:

[1] See the volume in this Library, _Animal Competitors_, by ERNEST
INGERSOLL, for the agency of rats and mice in the introduction and
dissemination of plague and other diseases; and the means of destroying
these pests of the farm.




CHAPTER II

CARE OF THE PERSON


It is happily the case that in America the importance of personal
cleanliness is more thoroughly understood, and is more generally
practiced than any of the other important hygienic procedures. While it
is true that there are many--particularly those of foreign extraction,
and who live for the most part in the larger cities--to whom an
occasional bath appeals only as a painful necessity, a very large
percentage of those born in this country bathe regularly. It should be
thoroughly understood that a daily bath is essential, not only from the
standpoint of cleanliness, but from the fact that this practice is in the
highest degree conducive to health. It should never be forgotten that by
cleanliness infectious materials are removed from the surface of the
body, and at the same time the skin is put into a condition to eliminate
from the system those waste products which it is its special function to
remove. The close relationship of the proper activity of the skin to
health is perhaps not generally sufficiently appreciated--for it is true
that the body cannot remain normal when the secretory power of its glands
is impaired, and that even death quickly follows when they cease to
functionate altogether.

_Advice as to Bathing._--Much difference of opinion exists as to the
proper temperature of the water for bathing, some holding that it should
be quite cold, while others are equally positive that it should be warm.
Unfortunately it is impossible to give fixed rules concerning this
somewhat important matter, for there is every reason to believe that it
should be determined in each individual case according to circumstances,
and that, therefore, both may be right. Some persons unquestionably do
better with one, and some with the other. It has been established clearly
that the cold bath is highly stimulating, and where not too prolonged,
and when followed by vigorous rubbing, is undoubtedly healthful for a
large number of people. The cold bath is often used by physicians in the
treatment of diseases of low vitality. Many persons however, are
unpleasantly affected by bathing in water of a temperature much below
that of the body; particularly is this true of women, and the like may be
said of thin and nervous persons of the other sex. It is claimed by the
advocates of the cold bath that those who practice this procedure daily
are practically immune from colds, but this, certainly, is not always
true; on the contrary the writer has seen instances where the cold bath
has unquestionably led to chronic nasal catarrh, with increased tendency
to inflammatory conditions of the air passages. It is also the case that
baths of this description tend in some persons to prevent a normal
accumulation of fat beneath the skin, and keep individuals of this kind
unnaturally lean.

The warm bath is perhaps, on the whole, more popular than the cold, since
it is preferred usually by children and women, and is practiced by a
considerable proportion of adult males. It is unquestionably somewhat
enervating, and at best fails entirely to give the agreeable stimulation
experienced by those who take a cold plunge. It is, however, to be
preferred in those instances where cold water produces disagreeable
effects, and if the bath be not too long continued it is followed by no
ill results. Persons who become lean under cold baths not uncommonly take
on flesh when they begin to use warm ones. It is unquestionably true that
the latter is to be preferred in hot climates.

The sea bath is invigorating not only from the water being cool, but as a
consequence of the pleasurable excitement with which it is attended. Its
greatest disadvantage lies in the fact that there is a tendency to overdo
it, many persons remaining in the water for hours. Ten or fifteen minutes
is as long as the average person should indulge in sea-bathing, and it is
a question if even those who are young and vigorous should remain in the
water longer than half an hour.

Bathing of any kind should be indulged in before meals, the best time
being before breakfast in the morning.

_Care of the Teeth._--Nothing in connection with the subject of personal
hygiene is of more importance than keeping the teeth properly cleansed.
The fact is not generally appreciated that sound teeth stand in a most
intimate relationship with good health, and that disastrous consequences
are sure to follow sooner or later where these most important structures
are neglected.

While it is true that in a person of vigorous health one or two decayed
teeth do not, as a rule, occasion obvious trouble at once, ill effects
are sure sooner or later to be felt. For one thing, a person without good
teeth cannot chew his food well. Those who begin by neglecting what at
first are slight defects in the teeth seem to acquire in the course of
time a sort of habit of doing this, and ultimately disregard and fail to
have corrected the more serious diseases of the dental structures.
Nothing is more common than for the practicing physician to find patients
with one or more teeth partially gone, or, even worse, with only the
exposed roots remaining.

Where cavities exist, food is constantly forced into them, and undergoing
decomposition, the breath of their owner becomes foul, and portions of
decayed food mixed with multitudes of bacteria are constantly swallowed;
sooner or later there inevitably follows under such circumstances
catarrhal conditions of the stomach, which reaches a point in some
individuals where the health is seriously threatened. Not only do bad
teeth produce trouble in the way just mentioned, but there is every
reason to believe that germs that produce disease--particularly those
that cause consumption--not uncommonly find their way to the interior of
the body through the resulting cavities.

It is the duty of everyone to properly cleanse the teeth at least once
daily--to do so after each meal would be even still better. This should
be done with a moderately soft brush, with which it is unnecessary to use
tooth-powders or lotions--though many prefer to do so. Where something of
the kind is desired, ordinary lime-water is perhaps as satisfactory as
anything else; peroxide of hydrogen, diluted eight or ten times with
water, to which a pinch or two of ordinary cooking soda has been added,
undoubtedly aids the cleansing process, and has the advantage that it
leaves a pleasant after-taste in the mouth. In brushing the teeth care
should be taken that every part of the tooth receives attention, it being
not sufficient, as is so often done, merely to brush the front. It should
be the practice of everyone to have the teeth looked over at least once a
year by a good dentist, as even where cleansing is diligently performed
decay frequently sets in on their inner sides.

The utmost care should be taken of the permanent teeth especially, and as
long as it is possible to prevent it no one should be allowed to pull
them. There can be no doubt that life is shortened by the early loss of
the permanent teeth in most, if not in all, cases--not to count loss in
health and happiness that follows their absence.

_Clothing,--Material and Color._--Clothing will be considered in this
article only as regards its function of properly protecting the body,
which it does by preventing the escape of heat, thus keeping the body
warm, or, under other circumstances, by keeping out excessive heat or
cold.

Materials of which clothing is made differ very greatly in their ability
to accomplish the object just mentioned, some being comparatively poor
conductors of heat and hence fulfill the desired function admirably,
while others, for opposite reasons, are of comparatively little value for
this purpose. In general it may be said that structures of animal origin,
such as wool and silk, are much poorer heat conductors than those
obtained from the vegetable world, and as a consequence the former are
justly held in much higher esteem as material for clothing than the
latter. It should not be forgotten, however, that the protective value of
a fabric also depends upon the manner in which it is woven, since those
that are loosely constructed are much warmer, other things being equal,
than those that are put together more closely; this depends upon the fact
that in the former there are innumerable small cavities between the
fibers in which air is contained, and as this substance is a very poor
conductor of heat, it follows that a garment made loosely and containing
many such chambers is warmer than where the number is less. It may well
be the case that a fabric constructed of a material which is a poor
conductor of heat and closely woven may be actually cooler than another
composed of a substance which is a much better conductor of heat but of a
loose texture.

The efficiency of different materials of which clothing is made also
depends upon their capacity to absorb water. This may be done in two
ways: the water may simply collect between the fibers, in which case it
may be in a large measure removed by wringing, or it may be actually
absorbed into the substance composing the fabric, and, as a consequence,
the latter, even though containing much moisture, do not appear damp.
Fabrics made from vegetable materials, as cotton or linen, have little
power of actually absorbing water, and hence they become wet on the
slightest addition of moisture, while on the other hand those of animal
origin have the capacity of absorbing water, and appear dry even after
the addition of this substance in considerable amounts. A person,
therefore, dressed in cotton fabrics will find after active perspiration
has begun that his clothing quickly becomes moist, while if he have on
woolen garments this will not occur. It is particularly noteworthy that
water is gradually removed by evaporation from animal fabrics, which
causes a general cooling without producing a chill; it is therefore
readily understood that woolen clothing is much to be preferred where
active exercise is being taken.

Color is also of some importance in determining the value of a fabric for
protecting the body from the sun's heat. Within recent times we have
learned a great deal respecting the wonderful penetrating power of the
invisible light rays, and we have every reason to believe that these
modify to a very considerable degree every process going on within the
body. The violet and ultra-violet rays are those that unquestionably
exert most influence, and it has been suggested that they may be broken
up and rendered innocuous by covering the body with materials having a
reddish-yellow color. It is not necessary to put these materials on the
outside where they would be conspicuous, but they may be used as lining
for hats and clothing; and there are good reasons to believe that if
their use were generally adopted suffering and actual loss of life from
overheating would be greatly reduced, particularly in warm countries.

_Work and Rest._--Very slowly the people of our country are beginning to
realize that it is quite as necessary to rest as to work, though
unfortunately in some quarters a strenuous life is urged as being only
secondary in importance to possessing a big family; that there is an
intimate association between the two there can be no doubt, since the
latter beyond peradventure would entail the former. It has ever been the
habit and misfortune of sages now and then to desert the field of their
own peculiar activities and to make incursions into unknown
regions--generally giving advice with a dogmatism and finality
proportionate to their ignorance of the subject under discussion.

As a matter of fact the average American works entirely too much, and
while he sometimes accumulates an immense fortune with astounding
rapidity, to his sorrow he often learns later that he has likewise
acquired a damaged heart, premature thickening of his blood-vessels or
nervous dyspepsia with all of its attendant evils. Descended as we are in
a large measure from the most vigorous and adventurous Europeans of the
last few centuries, and coming into possession of a new world where
everything was to be done, this tendency to overwork is most
natural,--and for this reason is all the more to be combated. That we
have been able so successfully to carry the burden for several
generations is indeed remarkable, but there are not wanting numerous
indications that the strain is beginning to tell. If we do not call a
halt, and devote more time to rest and agreeable pastimes, disastrous
consequences are sure to follow, and we will become in the course of time
a race of neurasthenics and degenerates. Attention should likewise be
directed to the fact that men do not develop to the highest point of
mentality who devote their entire time to work, as leisure is absolutely
essential for thought and the development of all that is best in man.

Let us then cast aside the shallow and ignorant preachments of those who
do not understand the subject, and devote a reasonable time to the
reading of good books, to thought, to the cultivation of the arts and
sciences, and to pleasurable pastimes. In these particulars we are far
behind Europe, and we shall never take our place as an intellectual
people until we radically change our method of life. A nation must dream
before becoming great. Let it not be understood from the foregoing that
the writer would in the slightest degree minimize the necessity for a
reasonable amount of work, for he thoroughly appreciates that without
labor neither the individual nor the nation itself could remain sound--it
is only urged that excessive work is quite as much to be feared as none
at all.

_Health and Labor._--As to the number of hours that should be devoted to
labor no rule can be laid down. It all depends on the age, physical and
mental vigor of the individual, and likewise, to a considerable degree,
on the character of the work. Occupations requiring intense mental or
physical strain can only be kept up for short periods of continuous
application, while, on the other hand, quite naturally, those of a less
strenuous nature would permit longer hours. The young man, in pride of
perfect bodily and mental vigor, too often assumes, because he has been
able in the past to do pretty much anything that pleased him without
ill-effect, that he can continue to do the same through life. No greater
mistake could be made.

Anything that has a tendency to undermine the health, repeated
sufficiently often, will ultimately cause a complete breakdown. How often
do we see the strength and beauty of early manhood blighted and turned to
premature old age and death as a consequence of disregarding the warnings
that have just been given! How frequently do we observe young men
rejoicing in the emancipation from home and school and spurred on by the
fatal delusion that while others might suffer they will not, becoming in
the end the victim of that arch enemy of early manhood, consumption!
Every practicing doctor has seen this, not once, but hundreds of times,
and in the vast majority of instances he can say with truth that the
frightful result is a consequence of overwork--too often associated with
nocturnal dissipation. The man who works during the day, and devotes his
nights to alcohol and gay company when he should be sleeping, will
assuredly, sooner or later--and usually sooner--suffer the inevitable
consequences.

To those who live sedentary lives, active out-door exercise is very
essential, but inasmuch as this little volume is being written for those
who live a saner and more healthful existence, it is not deemed necessary
to discuss here this phase of the subject.

_Value of Sleep._--Closely connected with the subject just discussed is
sleep. Here also we have no rules, or laws, from which we can clearly
determine the amount required in individual cases. Overwise philosophers
have asserted that seven hours for a man, eight hours for a woman, and
nine hours for a fool, was the allotted time for sleep. As a matter of
fact, the necessity for repose varies greatly in different individuals,
some of them requiring less while others demand more. It is a safe rule
to follow that every man should sleep as long as he naturally desires,
for nature is a much better mentor than any man could be--however
learned. The majority of men require at least eight hours of sleep for
the day and night, and this should be secured if possible at such a time
as will permit it to be undisturbed; hence it is that man usually prefers
to sleep at night, and, all things considered, it is probably the time
best suited for his repose. We read many marvelous stories of certain
great men who required little or no sleep. Within recent years the press
has frequently contained articles recounting the extraordinary fact that
a certain prominent inventor of this country lived daily on a mere
spoonful or so of food, and only slept a few hours now and then when
there was nothing else particularly to do. Such stories should be
accepted only on absolute proof, as, irrespective of their utter
improbability, one may observe that they are generally insisted upon in
and out of season with a pertinacity that would indicate that they were
conceived and are scattered abroad with the sole idea of impressing the
general public with what a marvelous and unusual person the individual in
question is. There can be no reasonable doubt that they are merely
evidences of childish vanity and puerile mendacity, and are only referred
to here for the reason that young persons, ignorant of the laws of
health, might attempt to emulate them, with results that could be but
disastrous. _Nothing so preserves youth, health, and good looks as a
sufficient amount of sleep, and it is pre-eminently the secret of long
life._

Reference will be made in the chapter on the Hygiene of Infancy to the
necessity of children sleeping as much as is possible. It will do no harm
to say again here that nothing is so essential for the proper development
of the body as sleep, _and that it is absolutely a crime to awaken a
child except under circumstances of absolute necessity._

_Precautions in Respect to Eating._--A sufficient amount of sleep, and a
proper quantity of digestible and nutritious food, thoroughly cooked and
carefully masticated, are the things which above all others are most
important for the maintenance of health. In the chapter on Foods, the
nutritive values and digestibility of the various articles eaten by man
will be discussed with sufficient thoroughness to instruct the reader as
to a wholesome dietary; it is, therefore, not necessary here to go into
the matter fully, but the subject is so important that a few general
remarks will not be out of place.

Eating should never, so far as is possible, be hurried. Nothing is more
important for the proper digestion of food than its thorough
mastication, and this can only be accomplished when sufficient time is
allowed for eating. It is not necessary that this be done to the extreme
advocated by some, but it is certainly of the highest importance that the
food be so thoroughly chewed that it is reduced to fine particles, and
that it should be so soaked in saliva that it may be swallowed without
the aid of liquids of any kind.

It is also desirable that food should not be taken while the individual
is tired, so that it is a good plan where this condition exists for one
to lie down for a short time before eating.

Regularity in eating is likewise of importance, it being best to take the
meals at stated periods; the consumption of food at irregular hours often
leads to indigestion and is a practice which should not be indulged in.

It is highly desirable to have food served under agreeable circumstances,
digestion being accomplished in a much more satisfactory manner if
pleasant conversation be indulged in during the meal, and if the food be
of an appetizing character. Nothing is of more importance in connection
with this subject than to have the food properly prepared. Not only is
thorough cooking important from the standpoint of making foods
digestible, but as is shown in another part of this volume, grave and
sometimes fatal diseases are contracted by a neglect of this important
procedure.

Fruits, contrary to what is generally thought, contain but little
nourishment, and severely tax the digestive powers of those who have a
tendency to dyspepsia. When eaten at all, they should be perfectly ripe
and fresh, and should always be taken after meals rather than before.

_Drinks,--Coffee, Tea, Milk, etc._--Much misconception exists, among
people generally, and even among the medical profession, concerning the
proper amount of water that should be drunk. While this substance is
unquestionably the most wholesome of all drinks, there exists no
necessity for taking it in great quantities at times when the system does
not call for it. It would perhaps be a good rule for all to form the
habit of drinking little while eating, the reason for which will be
explained hereafter.

Coffee is exceedingly popular both on account of its delicious odor and
taste when properly made, and for the reason that it is highly
stimulating. While it is borne by young and vigorous persons of either
sex with apparent impunity, there frequently comes a time in life when it
can no longer be drunk without ill effects. As a general rule, dyspeptics
do not bear it well.

Tea, if properly prepared, is a most palatable beverage, and one that is
generally better borne than coffee. It is more wholesome when taken
without lemon juice, and like coffee it is less disposed to produce
trouble if largely diluted with milk, or if taken without cream or sugar.

Cocoa and chocolate are often used as substitutes for tea or coffee, and
where they agree with the individual are perhaps as wholesome as either.
Both, however, contain considerable quantities of fat, and as they are
frequently prepared with cream, or very rich milk, they are not as a rule
well borne.

While milk might be considered as being almost as much a food as a drink
still the fact that it is fluid, and that it contains a very large
percentage of water, causes it to be regarded as a beverage. When taken
slowly--and this precaution is particularly necessary where it is fresh
and sweet--milk is a drink that should be regarded as being on a par with
water. It contains no injurious substances, but sour milk should, as a
rule, be avoided by dyspeptics.

The cardinal principle in taking beverages of any kind at mealtime is
that they should be drunk alone after the food has been swallowed, as
when they are taken with the purpose of softening the latter, mastication
is seriously interfered with and the proper soaking of the food in the
saliva prevented.

_Alcoholic Beverages._--Alcoholic drinks are so fully discussed in a
latter part of this book that here it may merely be stated that they
cannot be regarded as having food-value to any degree, and so far as the
matter is at present understood, appear to be entirely superfluous, and
even positively injurious. If taken at all, they should be consumed in
extreme moderation, after meals rather than before. The young especially
should be particularly warned against the use of all beverages of this
class.

_A Word on "Soft Drinks."_--Mention should also be made of those drinks
commonly sold at soda-fountains. The vast majority of them may be taken
occasionally without any appreciable ill effects, but the habitual use of
beverages containing considerable quantities of syrup is not entirely
wholesome. Particularly is this true where the drink contains stimulating
drugs, such as do some of those most advertised. Some of them are, if no
worse, the equivalent of a strong cup of coffee, and should, therefore,
no more be taken every hour or two during the day than a cup of the
substance just mentioned. If their use is persisted in, it is sure to be
followed by indigestion, and in many instances nervous disorders of even
a serious character. The reader should also be warned against the use of
drinks containing medicine for the relief of pain--particularly those
that are advertised as remedies for headache. Practically without
exception, all such drinks contain coal-tar preparations that greatly
depress the heart, and have in a number of instances been followed by
death. Drugs of this character should be taken with the utmost
circumspection, and only on the prescription of a competent physician.

_Tobacco._--Tobacco, of all nerve sedatives, is the most universally
used. In moderation it could not be said that it is followed by any
apparent ill effects in the majority of people, but if used in excess
oftentimes sets up serious disturbances. It is peculiarly injurious to
boys, and should never be indulged in until manhood is reached. Some
persons seem to possess a natural immunity to the ill effects of
nicotine, and appear to be able throughout their lives to chew or smoke
tobacco in any amount without harmful results; such instances are,
however, rare--its excessive use being usually followed by symptoms that
may be of a serious nature. Of the two methods of use perhaps smoking is
less open to objection, though it is unquestionably true that chewing is
not so apt to cause disturbances of the heart. Smoking affects the
stomach, but not to the extent that chewing does.




CHAPTER III

SANITATION IN AND ABOUT THE HOUSE


The bearing of intelligently located houses of proper construction on
health is not so generally understood, even by physicians, as the facts
warrant, and, of course, is even less well recognized by the non-medical
public. It is true that some attention has been given to the matter of
_location_, but even in this connection there prevails a woful ignorance
among all classes as to just how the diseases are transmitted that are
most influenced in this way. As a result of recent advances in medicine
it has been clearly shown that at least some of the diseases that are
most influenced by locality may be easily avoided, and as a consequence
we find that the views of the modern sanitarians have necessarily
undergone a certain amount of change in this direction. On the other hand
recognition of the necessity of hygienic _construction_ has not been
sufficiently accentuated,--since it is possible by proper attention to
the details of building to do away entirely with at least two of the
diseases that have heretofore been the principal drawbacks to life in all
tropical and sub-tropical countries. Much importance likewise attaches to
houses being thoroughly ventilated, and to their being sufficiently roomy
to properly accommodate their inmates. The following table shows the
striking relationship that mortality bears to over-crowding:--

  RELATION OF DEATH-RATE TO DENSITY OF POPULATION.

  City.              Mean number      Average death-rate
                   of inhabitants   per 1,000 inhabitants.
                   to each house.
  London                  8                24
  Berlin                 32                25
  Paris                  35                28
  St. Petersburg         52                41
  Vienna                 55                47

Many other statistics could be quoted, but all follow the general trend
of those just given.

_Choice of Site._--In our rural districts the inhabitants have a wide
latitude in the matter of the selection of the location for their
houses, and it is usually the case that our people are sufficiently
intelligent to make the best use of their opportunities in this
direction. It may, however, be mentioned that it is generally considered
that building-sites in the neighborhood of cemeteries are not favorable
locations, nor should houses be erected in the vicinity of a
manufacturing plant that gives off injurious gases, or obnoxious
materials of other kinds. Inasmuch as we now know that malaria is
transmitted by a certain mosquito, and that by properly screening the
house their attacks may be avoided, the necessity no longer exists for
avoiding the vicinity of lakes and rivers as building-sites; such
localities being as a rule pleasant and often picturesque, they would
naturally under ordinary circumstances be selected, and there now remains
no reason why this may not be done,--provided that the house is so
constructed that mosquitoes can be effectually prevented from gaining
entrance.

Of much importance is the selection of a locality where good and pure
water can be easily procured, as otherwise disastrous consequences are
sure to follow.

The soil should be of a light and porous character, easily permeable by
water, and free from the decomposing remains of excretions of man or
animals. There is much reason for the belief also that the level of the
ground-water plays a somewhat important part in the salubrity of any
given locality, and it is generally considered that this should be at
least ten feet below the surface. It is generally thought, and probably
with truth, that those sites are most healthful which have their location
on a basis of granite, or other rock-foundation; in such localities there
is usually a considerable slope of the general surface of the ground,
with the result that water rapidly runs off after rains, and consequently
stagnant pools, which might serve as a breeding place for mosquitoes and
bacteria, do not form. Soils through which water easily permeates are
likewise, as a rule, healthy, though this depends in a measure upon
whether or not they contain a very considerable proportion of vegetable
matter. Clay foundations are healthful where there is a considerable
slope to the surface of the ground, but where this does not exist the
soil is damp, owing to its impermeability, and often has stagnant pools
upon its surface. Marls and alluvial soils are not regarded as being
wholesome, but it is not unlikely that their bad reputation is largely
due to the fact that they generally exist in the neighborhood of rivers
and other considerable bodies of water where mosquitoes are numerous.
There are no reasons going to show that cultivated lands are
unhealthy--even where they receive yearly abundant additions of manure.
Where it is necessary to build in damp localities the site should be
thoroughly drained, and the space upon which the house is constructed
should be carefully covered with some impermeable cement.

_Building Materials._--Of all building materials, the one most commonly
employed in America is wood. This arises from the fact that in the past
we have had unlimited quantities of timber from which lumber could be
procured at a price so reasonable that no other material could ordinarily
be considered. That the wooden house has some advantages cannot be
denied; its walls rapidly cool following the torrid days that so commonly
occur during the summer in almost all portions of the United States, and
it is usually well ventilated as a result of the numerous fissures
naturally existing in its structure.

Next to wood, bricks are most commonly used for building purposes, and
have many advantages, among which are their handsome effect, their
stability, and their being poor conductors of heat; the last mentioned is
of considerable importance, since it keeps both heat and frost from
rapidly permeating the interior, and as a consequence houses constructed
of this material are cooler in summer and warmer in winter.

Other materials occasionally used are concrete, granite, marble, and
sandstone, any of which, on account of their durable character and the
beauty that they lend to structures made from them, may be selected for
building purposes, but inasmuch as they are rarely used in rural
districts, a detailed consideration of their peculiar advantages for
building purposes is not deemed here necessary.

The internal wall-coating of houses deserves more consideration than is
commonly accorded it, since the dyes used for coloring wall-paper and
curtains in some instances contain noxious materials. Chief among those
that are dangerous are the bright green pigments which commonly contain
arsenic as their principal constituent; where these or other poisonous
substances are employed in interior decorations the air, wherever the
room is kept closed, may become more or less impregnated with poisonous
gases, and serious consequences to the inmates may ensue.

_Screening Indispensable to Health._--Nothing is more important in
connection with house construction than having every opening thoroughly
screened. We have learned that both malaria and yellow fever are
transmitted always by certain kinds of mosquitoes, and it therefore,
becomes a matter of the greatest importance to effectually prevent the
entrance of these insects. It cannot be too strongly insisted upon that
we absolutely know that the statement just made is correct, and that
avoiding the diseases referred to becomes as a consequence entirely a
matter of preventing the entrance of mosquitoes into houses.

[Illustration: Fig. 1. ANOPHELES. (Malarial Mosquito.)]

[Illustration: Fig. 2. CULEX. (Common Mosquito.)]

The _Anopheles_ mosquito, which is the one that transmits malaria, often
exists in localities where the more common varieties do not occur, and on
account of the habits of this insect their presence is liable to be
overlooked. They seldom attempt to bite during the day, and it is only
rarely the case that they try to do so at night in a well lighted
room;--particularly where movement of any kind is going on. During the
day this mosquito remains perfectly quiet in the dark corners of the
house, and is very fond of resting on cobwebs, presenting, when doing so,
an appearance strikingly similar to that of fragments of leaves, soot or
of other natural objects that are frequently found suspended on such
structures. On account of these peculiarities and for the further reason
that the insect bites mainly just following daybreak, when the victim is
profoundly unconscious in sleep, its presence often remains undetected,
and as a consequence we occasionally hear from those who do not take the
trouble to inform themselves that malaria exists in this or that locality
where mosquitoes do not occur.

The yellow-fever mosquito bites for the most part during the day, but
will do so at any time when there is light. In districts where this
disease occurs it is quite as important to prevent its entrance as that
of the malarial mosquito. Not only does screening prevent malaria and
yellow fever, but it keeps out flies and other insects that
unquestionably bring with them the germs of other diseases.

There now remains no doubt that several affections, notably typhoid fever
and dysentery, are frequently communicated by means of the common
house-fly, which spends its time alternately on the fecal material around
privies or in other filth, and in our kitchens and dining-rooms; it is
one of the most astounding evidences of the power of habit, in the face
of common sense and ordinary decency, that we have not long ago taken
active steps to rid ourselves of its disgusting presence. Fortunately in
screens we have a perfect barrier to the entrance of flies, and no house
can be considered complete without being thoroughly equipped with these
all-necessary appliances.

It is scarcely possible to overestimate the economy that results from the
use of screens; among the various means employed for conserving the
public health they take first rank, and undoubtedly insure those who live
in houses to which they have been added an immunity against the costly
effects of disease that could scarcely be computed. A house would be more
habitable without chairs, beds, or tables than screens, since in the
absence of the former we may be healthy, though somewhat uncomfortable,
but without the latter serious disorders are pretty certain, sooner or
later, to make their appearance.

It is of considerable importance to use a screen the mesh of which is
sufficiently fine. Where mosquitoes exist, the screen should be of such
fineness that at least sixteen, or better eighteen meshes be in each inch
of the gauze. Where it is absolutely certain that mosquitoes are not to
be feared, the spaces may be somewhat larger--but always of such size as
will prevent the entrance of the smallest fly.

_Air-space Required._--It is of much importance from a hygienic
standpoint that the rooms of dwellings should be sufficiently large. The
height should never be less than eight feet, and the living-room should
be made as large as circumstances will permit. Bed-chambers should
contain at least 1,000 cubic feet of air space for each adult, with
somewhat less for children, though it should never be forgotten that the
more the better; this means that each person should have the equivalent
of a room which is at least 10 x 12 x 9 feet.

_Heating._--Americans are extravagant in the matter of heating to a
degree that astonishes the average foreigner, and it is by no means sure
that we do not go to unhygienic extremes in this direction. It is not,
perhaps, true that the excessive heat itself could be considered as
especially hurtful, but it is too often the case that the conditions
required to secure the degree of heat preferred by us are incompatible
with proper ventilation, and hence are to be condemned. It is generally
considered that the temperature of living-rooms should be somewhere about
70°F.; for many persons this is lower than would be entirely comfortable,
and as a consequence our houses in the winter are frequently kept nearer
80°F. than the figure just given. The reader should be urged to see to it
that, at whatever temperature his habitation is kept, a sufficient amount
of ventilation be secured.

There are many different methods of heating, the most satisfactory of
which are by means of hot water or steam; a modified form of the latter
is the so-called vapor method, which in recent years has proven extremely
satisfactory. Hot air, supplied by a furnace is also extensively used,
and for the reason that by this method fresh air from the outside is
constantly brought into the house, it is theoretically to be commended;
practically, however, a considerable difficulty is experienced in
securing an equable distribution of this heat throughout the various
parts of the house, and as a consequence it has not achieved the
popularity that it would otherwise have done.

Inasmuch as the installation of plants for heating by the methods just
referred to entails quite an expense, and for the further reason that
they require coal for satisfactory operating, they have not been employed
in the rural districts of America to any considerable extent. The farmer,
for the most part, depends on the old open fireplace where wood is
plentiful and the weather does not become excessively cold, while in
those portions of the country where the temperatures in winter go very
low, the stove is generally employed. Of the two methods, the former is
much the more hygienic where it can be used successfully, but over a
greater portion of the United States this cannot be done owing to the
cold winter climate.

The principal objection to the stove lies in the fact that the heat that
comes from it is very dry, and that where its walls have to be heated
excessively, unpleasant odors are apt to be generated; the former is
usually and ought always to be obviated by keeping upon the stove a
vessel of water, the vapors from which moisten the atmosphere, and the
latter by having the stove of such size that it will not require
excessive heating in order to warm the room in which it is placed.
Wherever possible the open fireplace is to be preferred to the stove for
the reason that it very thoroughly ventilates the room.

_Ventilation._--In order that the health of the inmates may be conserved
proper ventilation of all habitations is essential. However cold the
weather may be, an abundance of fresh air should be allowed to enter all
parts of the house. In the average wooden dwelling there are so many
cracks that good ventilation is generally secured without opening doors
or windows, but where the construction does not permit this, openings for
the entrance of air should be left in the most convenient and suitable
places. Windows may be slightly raised and draughts prevented by proper
screening, or what is even better, rooms should be so constructed that
they have openings at the top and at the bottom to allow free
ventilation. Openings towards the upper portion of rooms are especially
important in hot weather, as the warm air rises to the ceiling and
escapes only very slowly where such exits do not exist. Lowering windows
from the top aids materially in allowing the hot air to escape, but this
is not altogether so satisfactory as having openings higher up on the
walls, or in the ceiling.

_Disposal of Sewage._--No problem that confronts the dweller in the rural
district is of greater importance than the proper disposal of sewage. It
is unfortunately impossible in most instances for the farmer to have in
his house a system of water-works, and, therefore, all dish-waters and
slops are thrown into the yard, and a privy is used instead of a modern
water-closet. Where the lay of the land is such that water readily runs
off, or the soil is of a character that permits rapid absorption,
throwing slops on the ground around the house may not constitute a danger
to the inmates, but nothing is more certain than that the old fashioned
privy is a dire menace to the health of all those in its vicinity.

Not only are infectious materials brought into houses by flies, from
fecal matter and other excretions, but they are carried away by the
rains and sometimes contaminate sources of water-supply. It is
furthermore extremely probable that bacteria in particles of dust from
dried fecal material may be carried by the winds from privies into wells
and houses, and as a consequence diseases may be spread; of perhaps still
more importance--and certainly of far greater moment all over the
southern portions of the country--is the fact that hook-worm disease and
other infections caused by animal parasites are transmitted from man to
man as the result of our adherence to the old fashioned privy.

As will be explained in the chapter devoted to the common communicable
diseases, the eggs of the hook-worm pass from the intestine along with
the feces of those who are victims of this parasite and reaching the
ground, hatch out in the course of a few days minute hook-worm embryos,
which crawl away and permeate the soil in the vicinity; later collecting
in little pools that form after rains, or in dew-drops during the night,
they attach themselves to the skin of barefooted children who come in
contact with such collections of water, and boring into the body
ultimately, through a circuitous route, reach the intestines. Here they
undergo further development, and in a short time become mature
hook-worms, which in their turn lay eggs, and the life cycle begins over
again. It is thus seen that a child having hook-worm disease becomes a
menace, on account of the privy, to its brothers and sisters, and of
course quite commonly receives back into its own body, worms that had
previously escaped as eggs.

In the same way eggs of the two common tapeworms pass out with the feces,
and the offal containing them being eaten by hogs in the one case, or
being scattered in the vicinity and taken in with grass by cows in the
other, have their shells dissolved off as soon as they reach the stomachs
of these animals, and there are liberated small embryos that bore through
the walls of the stomach and later find their way into the muscular
tissues of these beasts, and there lie dormant until eaten by man with
imperfectly cooked meat; after being swallowed, the embryo parasite
passes to the intestine and soon becomes a fully developed tapeworm.

Particular reference at this point should be directed to the evil
effects, which are even still greater than those that come from the
privy, of permitting children and hired helpers to scatter their feces
indiscriminately in corners of the yard, the apple-orchard, or in the
horse-lot; under such circumstances, where hook-worm disease is once
introduced, the soil in the course of a short time becomes thoroughly
permeated with the embryos of this worm, and, as a consequence, all of
the children who play in the infected area barefooted, as is customary in
the country, are sooner or later infected with these parasites. It is
thus seen that soil-pollution from fecal material is a most dangerous
thing, and, particularly in the southern portion of the United States,
deserves the most earnest consideration of everyone. We should see to it
that our children only evacuate their bowels in properly constructed
closets; and it is the duty of the head of every family to provide such a
place for the accommodation of those who are dependent on him.

_Proper Construction of Out-door Privies._--The most practical and
generally satisfactory device heretofore invented for the disposal of
the sewage of communities unprovided with water-works is what is known as
the Rochdale, or dry-closet, system. By this system a privy, at a
distance from the dwelling, is constructed in the ordinary manner, with
the exception that instead of being open at the back it is tightly
closed. In the space beneath the seat receptacles are placed for
receiving the urine and feces. These may consist of pails of wood or
better of galvanized iron; or a single box occupying the whole space. If
wooden receptacles are used, they should be thoroughly coated on the
inside with tar, to prevent both leakage and the soaking of the liquids
into the wood. One such structure, which the writer knows has been wholly
satisfactory has a brick foundation with walls two feet high around the
front and sides, within which rests a shallow tarred box. It ensures
perfect cleanliness.

In any case this space under the seat is tightly closed, being guarded by
doors that open outward, through which the pails or box may be introduced
and removed for emptying.

Each privy contains a box in which is placed either wood ashes or dry
powdered earth, with a small shovel by which a sufficient quantity of the
dust to cover the deposit is thrown into the pail after each evacuation.
It is remarkable how completely this shovelful of earth or ashes destroys
all disagreeable smell. The privy should be provided with at least two
opposite windows, both of which should be thoroughly screened. The
entrance should have a door that is closed with a spring, so that it
cannot be carelessly or accidentally left open when vacant. At intervals
the pails containing the feces are removed, and the contents are carried
to a distance and buried.

Another plan that is quite satisfactory where iron pails are used, is to
place a quantity of water in the vessels for receiving the feces, and
then to pour in a small quantity of kerosene; the latter substance forms
a layer over the water that keeps out flies, and does away largely with
the disagreeable odors that are likely to emanate.

If any contagious disease exists among those who use such a closet, the
fecal material should be carefully sterilized before being removed, as
by means of corrosive sublimate, carbolic acid, chlorinated lime, or any
one of the many commercial disinfectants containing crysylic acid, all of
which may be obtained at any drug store. If carbolic acid or other liquid
antiseptics be used the amount by volume should be equal to about five
per cent. of the material to be treated; the proportion of corrosive
sublimate should be at least 1 to 1,000 where this disinfectant is used.
Along with whatever antiseptic is chosen, water should be added in
sufficient quantity to permit the whole to be rendered semi-fluid, and
the mixture should then be thoroughly stirred, and the chemical left to
act for some hours before emptying the receptacle. By far the most
satisfactory method of sterilizing infected material, however, is by
boiling, since disease-germs are killed by such a temperature in a few
moments. Where iron receptacles are used, therefore, the simplest method
is to set them upon an open fire in the yard for a little while.

A privy constructed after the manner just described possesses some
advantages even over the regulation water-closets that are used in
cities, since they are cheaper in original cost, require less repairs,
and are uninjured by a freezing temperature. The amount of care required
to keep them in proper condition is not excessive, and they are so
infinitely superior from a hygienic standpoint to the old-time privy that
no sort of comparison is possible.

It should always be remembered that the principal advantages of this
closet are that where it is used we are able to collect all of the
evacuations, which may then be properly deodorized with soil or ashes,
and that it may then be finally disposed of in such a way that it cannot
be reached by hogs or other animals; of very great importance also is the
screening of the closet, since only in this way is it possible to prevent
flies from gaining entrance to the fecal material in the receiving pails.

_Water supply._[2]--In the location of houses and schools an eye should
always be had to selecting a site where it is possible to obtain good,
pure water. To those fortunate dwellers in the mountainous regions of our
country this is usually a matter of little difficulty, since it is always
possible to find a location in the neighborhood of which the purest
spring water may be obtained. In less favored regions the well becomes
the main reliance, while cisterns are used in some portions of our
country, in which water is collected during the rainy seasons of the
year. Of the two, the former is undoubtedly to be preferred, provided a
pump be used instead of the old fashioned bucket. The writer is strongly
of the opinion that a very large proportion of the contamination to which
sources of water-supply are subject comes from the bucket being drunk
from or handled by persons with contagious diseases, or from germs being
blown into the well with dust, or carried in by means of insects and
small animals. It is inconceivable that any appreciable amount of
contamination from the surface can reach the underground streams that
supply wells in localities that are thinly populated, though it is
unquestionably true that a well might be infected as a result of the
entrance of surface-water where its top is not properly protected. On the
other hand we have in an open well or cistern every facility afforded for
the entrance of bacteria.

It is unquestionably of the utmost importance that wells be carefully
covered over, and every precaution should be taken to prevent
surface-water leaking into them around their edges. In order to comply
with these conditions a pump is essential, since it is the only means by
which water can be brought to the surface without exposing the contents
of the well to contamination. It is likewise of the first importance to
have the walls of the well curbed to a sufficient depth to prevent the
possibility of seepage from the surface. It is, of course, also quite
necessary that the well be of sufficient depth--the lower we go the more
likely are we to secure a perfectly pure water. In regions where the
water rises to within eight or ten feet, or less, of the surface, the
possibility of the well being contaminated during the rainy season by
seepage is considerably increased, and the waters of such wells should be
used only after analyses have shown that they are pure; where this cannot
be done, the water should be boiled before being drunk. Of course, the
possibilities of contamination are greatly increased if the locality be
thickly inhabited.

As has been before remarked, cisterns are more liable to contamination
from the air than are wells, chiefly owing to the fact that they are
supplied by water that is conducted into them by gutters from the tops of
houses. There is no question that during the dry seasons dust containing
many kinds of bacteria is deposited all over the tops of houses and
remains there until washed away by the rains. While it is true that the
sunlight quickly kills most germs that produce disease a certain number
of them would inevitably escape, and having gained entrance to a
cistern, would be likely to multiply and later cause trouble. It is thus
seen that however pure the rain-water may originally have been--and it is
among the purest of all waters--it is likely to become contaminated in
the process of collection, and may ultimately in this way become the
source of disease. Where any doubt exists as to the purity of such water
it should be boiled before use.

Surface-streams also occasionally supply drinking-water in rural
districts, and while the use of such waters may not always be attended by
danger, their contamination by disease-producing germs is much more to be
feared than when they are derived from wells or springs; where streams
arise from and keep their course through uninhabited districts the
probabilities are strong that their waters are pure and fit for use, but
where they run through cultivated fields, and particularly where they
pass in the neighborhood of houses, their waters should never be looked
upon as being drinkable,--except after being boiled or properly filtered.
Inasmuch as adequate filtration is exceedingly difficult to carry out,
and requires a somewhat extensive and costly plant, this is, as a rule,
not feasible for the dweller in country districts, and boiling,
therefore, remains the only satisfactory method of rendering the water
fit for use where doubt exists as to its purity.

_Location of Pens and Stables for Animals._--Animals should always be
housed at some little distance from the dwelling. While it is true that
man does not often contract directly diseases from hogs, sheep, horses
and cattle, there are some maladies of a most serious character that come
to us in this way, and we should, therefore, always guard against their
occurrence by removing ourselves as far as is possible from sources of
possible infection. The matter also has an æsthetic side, as odors of a
disagreeable character may prove very annoying where animals are kept too
close to the house. It is likewise of importance that stables should be,
if possible, on lower ground than the dwelling, since during rains
materials from their dung may be washed around and under the house, and
may possibly gain access to the well.

Every care should be taken to keep hog-pens and stables clean, since
otherwise very foul smells are engendered that oftentimes find their way
to neighboring houses. There is also a suspicion that some of the germs
that produce disease find the conditions suitable for their stables
and pig-sties.

In this connection it might be well to warn those unacquainted with the
subject against the _all too common practice_ of close association with
dogs, since it is well established that in addition to hydrophobia they
may transmit, while apparently in perfect health, maladies of a deadly
character to the human being. It cannot be too often emphasized that the
less intimate our association with the lower animals is, the greater the
likelihood of our escaping many serious diseases.


FOOTNOTE:

[2] This subject is fully treated in another volume of this Library,
entitled _Home Water-works_, written by PROF. CARLETON J. LYNDE. It
shows where water should be sought, and how it may be supplied under
perfectly safe conditions to the household, with descriptions of
machinery, estimates of expense, etc. This thoroughly practical book
meets a widely recognized need for information, and is written by a
specialist. Thousands of men living in rural parts of the United States
and Canada, out of reach of a public water-system, have equipped their
homes with water-supply conveniences equal to any found in the cities.
Thousands more who could well afford to do so and who could do so
advantageously, have not done so for various reasons--because the idea
has not occurred to them, or because they did not know how to go about
it, or because they mistakenly thought the expense too great. To all
such this book should prove of the greatest practical help.




CHAPTER IV

HYGIENE OF INFANCY AND CHILDHOOD


No characteristic of the Caucasian mind is more marked, and none more
universally affects his actions than a constant, gnawing suspicion that
the things going on around him are not being done in the proper way, and
consequently an irrepressible desire to experiment, and if possible, to
change everything. Such a spirit is unquestionably the basis of what we
call progress, and, in so far as it conduces to the health and happiness
of mankind, is entitled to our most hearty commendation. On the other
hand, it cannot be denied that too often we endeavor to bring about
changes with but an imperfect understanding of the basic principles at
issue, and naturally, under such circumstances, our efforts are crowned
with anything but success. In other words, an enlightened investigation
of the whys and wherefores of any existing state of affairs may and
often does, lead to improvement, while, on the other hand, ignorant
meddling is likely to be followed by disastrous consequences.

Nowhere do we see the bad results of false conceptions more marked than
in our treatment of infants and children.

     Particularly do young infants suffer in this way, as they are
     pounced upon as soon as they enter the world by every old "granny"
     and negro "mammy" in the neighborhood, and plied with abominable
     concoctions that would be productive of homicide if we were to
     attempt forcibly to administer them to grown men, and whose only
     effect on the defenseless little sufferer is to cause colic and
     indigestion. Many times has the writer seen a wee, tiny little
     mortal, who was too young and weak to even protest, bundled up with
     a mountain of flannels in the hottest weather of July and August.
     True to the superstition that the warmer we kept an infant the
     better, too frequently we see them confined to hot stuffy rooms
     when they should be out in the sunshine, or under the trees.
     Instead of being allowed to gain health and strength in the
     forests, which are the schoolhouses of nature, the miserable little
     wretch is later sent to a public school as soon as he or she can be
     trusted to go alone on the streets, and the tiny victim too
     frequently contracts diphtheria, scarlet fever, whooping-cough,
     measles, or some other disease as a reward of merit. Truly we see
     to it that the helpless innocents early realize the truth of the
     melancholy and hopeless biblical lament that "man's days here are
     few and full of trouble."

We should rear our children with as little interference as possible,
allowing them the utmost freedom compatible with their safety, and
permitting them to do those things that nature and instinct demand. Above
all let them sleep as much and as long as they will, insist that they
live in the open air, and encourage them in every possible way to perfect
their physical education by those active amusements that they
instinctively prefer. After they have established a sound and rugged
constitution ample time will be left for them to develop mentally.

_Feeding of Nursing Infants._--The most important thing in connection
with the feeding of infants is to always remember that nature has
provided in their mother's milk, when sufficiently abundant and normal in
quality, everything in the way of food and drink that they require.
During the three days that usually intervene between birth and the coming
of the milk in the mother's breast, infants may be given from time to
time small quantities of pure water, but under no circumstances should
anything else be allowed. During this period the child may be put to the
breast four or five times in the twenty-four hours, for, while it gets
but little in the way of nourishment, there is even at this time a watery
fluid secreted in the breast that goes far towards supplying everything
that the infant needs for the time being.

A child should never nurse longer than twenty minutes at one time. It is
likewise of importance that the time of nursing be strictly regulated.

Particularly during the first year it is of the utmost importance to
watch with an intelligent eye the growth and development of the child.
Where the milk agrees with it it has a good color and gains regularly in
weight; it cries but little, and is good natured, and thoroughly
contented. Should it, on the other hand, lose weight, appear fretful and
listless, and sleep badly, there is something wrong, and the mother
should at once have her milk examined by a competent physician.

In case the mother does not give sufficient nourishment there is no
objection to partially feeding the infant on modified cow's milk--the
method of the preparation of which will be considered later on.

Where colic occurs it generally means that the infant is getting a diet
too rich in albuminous foods, which should be corrected by advising the
mother to take an abundance of out-door exercise, and to avoid all causes
of worry so far as is possible.

Vomiting freely is a very common occurrence in small children, and is
usually the result of too much food being taken at a time. It also
occurs, particularly some time after feeding, as a result of indigestion,
which is frequently the consequence of the milk being too rich in fats.
Wherever an infant shows signs of trouble it is well to advise the mother
to use a diet less rich in meats, and to caution her against over-eating.

Children should be weaned at the end of their first year. This had best
be brought about gradually, by, in the beginning, feeding the child once
daily, and then gradually increasing the frequency, at the same time
proportionately leaving off the nursing. Where children are not thriving,
it is often a good practice to wean earlier, in which case modified cow's
milk, taken from a bottle, must be substituted.

_Artificial Feeding._--While it is true that children often thrive for a
time on the various baby-foods with which the market is so abundantly
supplied, it is, nevertheless, the case that where fed in this way they
are very apt to develop rickets or scurvy, and not uncommonly show
evidences of bad nutrition in loss of weight and strength, becoming
peevish and fretful, and sleeping badly.

Much better than any of the artificial foods is properly modified cow's
milk, which, with care, may be prepared in such a manner as to take the
place of mother's milk in the vast majority of instances. In order,
however, that this be successfully carried out, much care and attention
is necessary.

     At this point it is well to stress the fact that the mother's milk
     differs from that of the cow in some quite important particulars,
     and it is only by intelligently taking these differences into
     consideration that it is possible for us to prepare an artificial
     food that will be satisfactory. Principal among these differences
     are that cow's milk contains three times as much albuminous
     material as that of the human being, and that it is less rich by
     about half in milk-sugar; furthermore, the former is acid in
     reaction, while the latter is neutral, or faintly alkaline. It will
     be seen, then, that in order to prepare a modified cow's milk that
     will approximate that of the human being it is necessary to dilute
     it with water sufficiently to cause the albumin to approach in
     proportion that of mother's milk, and at the same time some alkali
     must be added to neutralize the excessive acidity. Modified milk
     prepared, however, from the whole cow's milk, would contain much
     less fat than is desirable, so that we must use in making it the
     upper third of the whole milk after it has been allowed to remain
     undisturbed for a number of hours; in other words, in making
     modified cow's milk we use a large proportion of the cream, with a
     less amount of the other constituents.

     The following table for calculating the proper proportion of milk
     to be used at the various periods of the infant's life may be
     recommended, as it gives quite as satisfactory results as those
     that are more elaborate; it also gives the frequency of feeding and
     the proper amounts that should be used. The table was devised by
     Dr. C. E. Boynton, of Atlanta, Georgia.

                   Fat      Quantity         No. of
                percentage  ounces at     feedings in    Intervals
                 desired.   feeding.       24 hours.      by day.

     Premature     1.00      1/4 to 3/4      12-18      1 to 1-1/2 hrs.
     1-4  day      1.00    1     to 1-1/2      6-10     2 to 4   "
     5-7    "      1.50    1     to 2         10        2        "
     2-   week     2.00    2     to 2-1/2     10        2        "
     3-     "      2.50    2     to 2-1/2     10        2        "
     4-8    "      3.00    2-1/2 to 4          9        2-1/2    "
     2-   month    3.00    3     to 5          8        2-1/2    "
     4-     "      3.50    3     to 5-1/2      7        3        "
     5-     "      3.50    4     to 6          7        3        "
     6-10 month    4.00    5     to 8          6        3        "
     11-  month    4.00    6     to 9          5        4        "
     12-    "      4.00    7     to 9          5        4        "
     13-    "      4.00    7     to 10         5        4        "

     In making calculations from this table it is assumed that the milk
     from the upper third of the bottle, after it has been allowed to
     sit for at least four hours, contains 10% of fat, and this is
     therefore called 10% milk. The calculation is made as follows:--10%
     milk is to the fat percentage desired, as the amount which we wish
     to make up is to X. For example, if we wish to prepare twenty
     ounces of milk for an infant two months old, we will note by
     referring to the table that 3% is the amount of fat that is
     desirable for a milk for a child of this age, and the formula will
     be constructed as follows:--

       10:3::20:X.   X = 60/10.   X = 6.

     Six ounces is then the amount of 10% milk that must be used for
     making twenty ounces of modified milk,--this being mixed with one
     ounce of lime-water and thirteen ounces of boiled water. It should
     never be forgotten that while milk modified by the foregoing
     formula is suitable for most children, it is by no means always
     satisfactory, and we may, therefore, be compelled to do a
     considerable amount of experimenting in some cases before arriving
     at the correct formula.

     Suppose the infant is twelve months old, we would get according to
     the rules just stated the following equation:--

       10:4::20:X.   X = 80/10.   X = 8.

     Eight ounces would then be the amount of milk required for
     preparing twenty ounces of modified milk for an infant of this age.

     In preparing modified milk according to the formulas just given, it
     must be remembered that in all instances only that portion is to be
     used which collects in the upper third of a bottle of milk that has
     been allowed to sit undisturbed in a refrigerator for at least four
     hours. The lime-water is for the purpose of correcting the acidity
     of the milk.

     It is of much importance to select the milk from a healthy cow in
     all instances where it is to be fed to infants, and where possible,
     it should be examined by a competent laboratory man in order to
     determine if it answers the proper requirements. The writer has
     often seen milk from apparently healthy cows, which seemed in every
     way good, that showed on microscopic examination pus cells and a
     harmful germ (streptococcus).

     It is not desirable to have a milk for this purpose that is too
     rich in fats, and for this reason a cow of the ordinary mixed breed
     is more satisfactory than the blooded Jerseys or Alderneys.

     Not only is it essential to get the proper kind of milk, but the
     utmost care is necessary in handling it. It should, of course, be
     as free as possible from every source of contamination, and should
     be strained thoroughly as soon as milked. It should then be
     bottled, and chilled at once by being placed in cold water, and
     after being properly sealed, should be placed in a refrigerator at
     a temperature of about 50°F., where it should remain undisturbed
     for four hours before the top portion is skimmed off for making the
     modified milk.

     After the modified milk has been prepared it should be returned to
     the refrigerator, where it should be kept until required for
     feeding. It is best not to use milk that has been in the
     refrigerator longer than twenty-four hours, or at most forty-eight
     hours, and then only if kept at a proper temperature. The modified
     milk should be poured directly from the receptacle in which it is
     kept into the feeding-bottle, and the latter should then be placed
     in warm water until its content is milk-warm, at which time it is
     ready to be given to the child.

It is highly necessary in feeding infants by the bottle to remember that
cleanliness in everything connected with the process only makes success
possible, and in no particular does this apply with greater force than in
connection with the proper care of the bottle and nipple. In every case
immediately after use they should both be put in water, which should then
be brought to a boiling temperature, and both should then be kept in a
saturated solution of boric acid. The nipple, after being placed on the
bottle, should not come in contact with anything but the infant's mouth.
Bottles that have no neck are much to be preferred to others, as they can
be readily cleansed. There is on the market at the present time a bottle
called the "Hygeia," which possesses the necessary qualifications in a
perfectly satisfactory way.

When children who have nursed at the mother's breast reach the age of
weaning it is of importance to remember that they cannot eat without
digestive disturbances the modified cow's milk of a strength that would
otherwise correspond to their age; they should invariably under such
circumstances begin with a milk prepared by the formula used for a child
several months younger, after which the proportion of milk may be
gradually increased until it is used in a pure state.

During very warm weather it is well to reduce the amount of fat by using
the whole milk instead of the top portions, as heretofore described. The
same precaution should be followed where children have acute diseases,
and the total quantity taken should be less than under ordinary
circumstances. Where infants have acute indigestion, accompanied by
vomiting and diarrhoea, all milk should be for the time withheld,--boiled
water being substituted; some hours later barley water may be given, but
no milk for at least twenty-four hours. Where children have loss of
appetite, it is well to give less cream, and the intervals between food
should be increased.

_Sterilized (Pasteurized) Milk._--During epidemics of dysentery,
diarrhoea, typhoid fever, scarlet fever, and diphtheria, as well as in
those instances where it is suspected that the cow is not healthy, or
where the milk has to be kept for considerable periods of time, it is
well to sterilize it by heating. The most effective method of
accomplishing this is by boiling the milk for an hour or so, but
inasmuch as it is believed to be then not quite so wholesome as when less
heat is employed, a process known as _pasteurization_ is frequently used;
this consists in heating the milk for thirty minutes to from 155° to
160°F.,--such temperatures killing all of the ordinary germs, but not
altering the milk so completely as when it is boiled.

_Peptonized Milk._--It now and then happens that children fail to thrive
where all of the precautions heretofore referred to have been strictly
adhered to, and under such circumstances good results are frequently
secured by subjecting the milk to a process known as _peptonization_.
This consists in the addition of a digestive ferment, obtained from the
pancreas of lower animals, together with ordinary cooking-soda. In
carrying out the process the milk, whether whole or modified, is placed
in a clean bottle, and the peptonizing powder added after having been
rubbed up with a teaspoonful of milk. The container is then placed in a
pitcher of water at a temperature of 110°F., which is about as warm as
the hand can bear comfortably, and is here left for from ten to twenty
minutes if only partial peptonization is desired, or for a couple of
hours should it be wished to complete the process. The peptonized milk
may be prepared at each feeding, or the whole amount for the day may be
made at one time in the morning; in the latter case, where it is desired
to have the milk only partially peptonized, the ferment should be
destroyed by boiling after it has been allowed to act for from ten to
twenty minutes.

_Feeding after the First Year._--As the infant is weaned other food
should be gradually added; this should still consist largely of milk, to
which some time later may be added gruels prepared from well-cooked oats
or barley, beef-juice, or the white of an egg slightly cooked. The
various broths may also be allowed. Children relish very much all
fruit-juices, and they may be given in moderation without harm, and even
with benefit in many cases. As the child grows older, the various cereals
should form a greater and greater proportion of its diet, but due care
should be exercised in always seeing to it that they are thoroughly
cooked; in order to be digestible for children such substances should be
cooked at least three or four hours before eaten.

_General Hygiene of Infant Life._--In order for children to be healthy,
the greatest regularity is necessary in their habits. They should arise
at a certain hour in the morning and go to bed at a fixed time at night.
Their clothing should be loose, and not too tight fitting, and should at
all times correspond to the state of the weather. Nothing is more common,
and nothing produces irritability, loss of sleep, and even serious
general disturbances in infants, more frequently than too much clothing.
It is generally customary to use from the time of birth and during the
period of infancy a flannel band around the child's abdomen. Just how
this acts is not clear, but there seems good reason for the belief that
in some unexplained way the practice has the effect of warding off
intestinal disturbances, and is, therefore, to be recommended.

Napkins should be changed when soiled, and then should be immediately
placed in water, in which they should remain until washed out; under no
circumstances should they be left lying around the nursery.

When the weather permits, the child should be kept as much out-of-doors
as is possible. For the first few days of the infant's life, particularly
if the weather be cool, it should, of course, be kept indoors, but even
then free access of air should be allowed. There is no objection whatever
to the infant sleeping out-of-doors--in fact, where this is feasible, it
generally shows improvement as soon as the practice is commenced. When
out-of-doors, it is of course necessary to see that the sun does not
shine directly into the infant's face, and wetting should, of course, be
avoided; also the hood of the carriage should be arranged to prevent
strong winds from blowing on the child.

The nursery should be well aired, a window being left up at night except
during severe weather.

_Sleep._--Nothing is more important for the proper development of a child
than for it to have an abundance of sleep. During the first few months of
its life it sleeps practically all of the time--the period becoming
gradually lessened as it grows older. Infants should be suffered to sleep
just as much as is possible, it being not only unjustifiable but
absolutely criminal to interfere with them in this particular in the
slightest degree. Not only is it necessary that infants have all the
sleep that they desire, but it is true throughout childhood, a fact to
which many foolish parents seem utterly oblivious. How often do we see a
child scarcely more than an infant aroused in the morning and sent off to
school, and how frequently do we hear misguided parents boast of their
inflexible rules in enforcing such evil practices. Truly man comes hard
by the knowledge that nature is much wiser than he, and the vast majority
never learn the fact at all.

As soon as the child is able to crawl, it should be placed on a clean
quilt or blanket on the floor, and allowed to move about to its heart's
content. When it is able to walk, allow it to run about and play to its
full capacity--as in such exercises consists the great school of its
physical being, the school upon which will depend its strength and
health in after life. Allow the child to keep up his play as long as he
has any inclination to do so, and never be so foolish as to confine him
in the house when he wishes to be out under the blue heavens, for here
only will it be possible for him or her to develop into a real man or
woman. Allow this to go on until the child of its own accord comes and
asks to be taught other things, for not until then is its outside
education nearing completion, and not until then is it possible for him
to take interest in and learn things connected with books. No boy should
ever be sent to school before he is twelve or fourteen years of age;
girls, on account of their maturing earlier, may begin a couple of years
sooner.

The whole science and art of properly raising children consists in
feeding them good clean food in proper amounts, in never allowing them to
be awakened, and in permitting them to play in the open air to their
hearts' content.

_Teething._--Teething is a subject which has at all times interested both
doctor and layman, and in its supposed relation to all kinds of
disorders of infancy has undoubtedly exercised an influence over the
popular imagination out of all proportion to its real importance. Too
often it has happened that this perfectly normal, and usually by no means
serious, process, has been held responsible for grave diseases in
children--diseases which in reality were the consequence of neglect
and mismanagement in the far more serious matters of food, sleep,
out-of-door exercises, and general hygiene. It cannot, however, be
denied--particularly in respect to nervous children--that teething
appears occasionally to induce unpleasant disturbances, such as
fretfulness, broken sleep, digestive disorders, and occasionally fever;
as a rule such symptoms persist only for a few days, if the infant be
properly looked after. The treatment should consist in lancing the gums
should they become much swollen, and the withholding of the usual amount
of food, particularly where intestinal disturbances occur. The ages at
which the teeth usually come are as follows:

  2  Middle Lower Teeth                5 to  9 months.
  4  Upper Front Teeth                 8 to 12 months.
     Remaining Lower Front Teeth      12 to 18 months.
  4  Front Jaw Teeth                  12 to 18 months.
     Stomach Teeth (Canine)           18 to 24 months.
     Eye Teeth (Canine)               18 to 24 months.
  4  Back Jaw Teeth                   24 to 30 months.

_Bowel Diseases._--Digestive disturbances, accompanied by diarrhoea, are
the bane of infancy, and are responsible for a very large part of the
frightful mortality among babies. The subject, therefore, is one of
tremendous importance, but is so complicated that the limits of this
little volume will only permit its being touched upon.

As already mentioned, indigestion accompanied by looseness of the bowels
may be and often is the result of milk being used from diseased cows, or
it may be the consequence of such carelessness in handling it that
disease-producing bacteria are later allowed to contaminate it. It should
also never be forgotten that where children are eating artificially
prepared food improper mixing of the different components may result in
serious disturbances, and we should, therefore, exercise the utmost care
always in seeing to it that the food is prepared strictly according to
the table which has already been given--not forgetting that in a certain
number of instances we can go by no rule, and will have to experiment
until we ascertain the proper proportion of the ingredients.

After a diarrhoea begins we should at once reduce the quantity of fat in
the milk that is being given to the infant, and if the trouble be at all
severe it is best to take it off of all food for twenty-four hours, and
substitute boiled water or barley-water. As soon as the trouble is
checked we may then begin to feed cautiously with largely diluted milk,
and, gradually increasing its strength, in the course of a few days
return to the food that was being given before the disturbance occurred.
A dose of calomel or castor oil in the beginning of diarrhoeal troubles
often has a very salutary effect; the parent should not hesitate to
administer this if a doctor is not at hand.

In warm climates during the time of teething children very commonly
develop chronic diarrhoeal conditions which often end fatally; wherever
possible the parent should under such circumstances at once remove the
little sufferer to a colder climate where recovery is generally rapid and
complete. Even the most careful nursing under the most competent
physician is often fruitless in combating disorders of this character as
long as the infant remains in a warm climate.

_Colic._--Colic is always due to indigestion, and is the result of the
food undergoing fermentative changes, with the production of gases. This
goes on even under normal conditions to a certain extent, but when it is
excessive the intestines become greatly distended, and pain of a severe
or even agonizing character is produced.

In the treatment of this condition warm applications should be made to
the abdomen, and as quickly as possible an enema (injection), consisting
of a few ounces of warm solution of salt water should be given; the salt
should be in the proportion of a level teaspoonful to the quart of water.
Parents will find the little ear syringe, which may be purchased at any
drug store, a most satisfactory instrument for giving enemas to infants,
as they do not hold too much, and being soft, are incapable of tearing
the delicate tissues of the child. It is of the utmost importance to
remember that the salt solution should be tepid, yet not sufficiently hot
to scald the infant. As the water when given in this way is expelled very
quickly the enemas may be repeated any number of times desired.

Where these measures fail, a physician should be sent for at once, but in
the meantime if it be evident that the infant is suffering very much, a
small dose of paregoric may be given; it should not however be forgotten
that opiates are exceedingly hurtful to nervous children, and that
soothing syrups and other mixtures containing drugs of this class should
be avoided.

_Constipation._--Constipation among very young children generally passes
off as the food becomes richer, but should it occur at a later time, the
trouble may be more difficult to remedy. Of first importance is having
the bowels of the infant move at a certain time each day, which may be
quickly accomplished in many little children by placing them upon a small
chamber daily at a given hour; usually the baby very quickly learns what
this procedure means, and in this way a regular habit is established
which is of the utmost value to the child throughout its infancy, and
every effort, therefore, should be made to bring it about as quickly as
possible.

The addition of malted milk or Mellin's Food may also have the effect of
diminishing constipation;--the result being brought about by the maltose
contained in these preparations. The same thing may be accomplished by
substituting for a part of the milk sugar in the baby's food a similar
quantity of maltose. Milk of magnesia may be used in preparing the baby's
food in the place of lime-water, with the result oftentimes of relieving
a tendency to constipation.

_Croup._--By croup is meant a spasmodic condition which usually affects
children at night, and is in no way to be confounded with that really
dangerous disease, membranous croup, or diphtheria, to which so many
children fall victims.

Spasmodic croup is a condition which has as its basis digestive
disturbances, and is almost always relieved as soon as the stomach is
emptied. Vomiting may be brought about by making the child swallow a
small quantity of mustard stirred up in water, or by the use of ipecac.
Such severe and extremely unpleasant remedies are rarely necessary,
however, since the disease may be in almost all instances at once
relieved by placing around the victim's throat a cloth wrung out of cold
water, which may itself be covered by a dry bandage to prevent the bed
from getting wet. Children will usually go to sleep in a few minutes
after the cold cloth is applied, and suffer no ill consequences as a
result of its remaining around their throats throughout the night. Where
the croup is very severe the little sufferer's feet may be placed in hot
water, in addition to the cold cloth around the neck--the combination
practically always resulting in the rapid relief of the unpleasant
symptoms.

Great care should be exercised in the diet of children who are subject to
croup, as by intelligent supervision the tendency to this very annoying
trouble may be in a short time entirely overcome.

_Nervousness._--Children of neurotic parents, particularly where they are
reared in cities, are exceedingly prone to nervousness in one form or
another. The condition is undoubtedly often due to heredity, but may be
induced in otherwise healthy children by unhygienic surroundings and
improper food. Infants exhibiting symptoms that indicate trouble of this
kind should not be played with, and every care should be exercised to so
direct their lives that the trouble may be gradually overcome. In all
cases where nervousness persists an intelligent physician should be
consulted.

_Vaccination._--The only safe method that we possess of preventing
small-pox is by means of vaccination. Its great value has been so
thoroughly tested that the writer does not deem it necessary to go into a
discussion as to its merits. A child should be vaccinated in at least
three places during its early infancy,--there being no danger in doing
the operation immediately after birth. Persons ignorant of aseptic
surgery should not do this operation, but should always call in the
services of some person prepared to do the work in a cleanly manner.
Either the leg or the arm may be selected; and children should be
revaccinated whenever small-pox breaks out in the community.

_Kissing Babies to be Avoided._--Kissing infants in the mouth is a very
bad practice, as in this way disease may be quite innocently conveyed to
them. The public should be taught to understand that it is not
infrequently the case that bacteria may be present in the mouths of
individuals who are quite immune to their ill effects, and who are,
therefore, perfectly well, but who may, by conveying them to others,
particularly children, induce in them serious disease. When caressed in
this way at all children should be kissed upon their necks or feet, and
never in their mouths or on their hands.

_Juvenile Contagious Diseases._--Children are peculiarly prone to a class
of highly contagious diseases, the exact nature of which is not yet
understood, and we possess therefore little knowledge as to the proper
means of preventing their spread. Practically all that is known about
them is that they are conveyed by contact, or even by the air,
particularly where a child suffering from one of them is placed in a
confined place with another who is susceptible; these diseases likewise
may be carried by means of clothing and other articles that have been in
close contact with a child suffering with any of them. The lesson of
importance to be learned, therefore, is that if we wish our children to
escape maladies of this class we should not permit their indiscriminate
association with others. As these diseases cease to be a serious menace
after children have passed through their earlier years it does not at a
later time matter so much as to whether they are exposed to them or not.
As a general thing children develop these affections in from ten to
fifteen days after having been exposed, though one of the most severe of
them, scarlet fever, may make its appearance as early as twenty-four
hours after it is contracted. These diseases are usually ushered in by a
severe headache, pains in the head, back, and limbs, high fever, and
oftentimes a chill. As soon as a child develops such symptoms the advice
of a competent medical man should be at once sought, and the little
sufferer should be at once completely isolated.

In concluding, the writer would particularly exhort parents to obey to
the letter the instructions of their physicians, and never under any
circumstances to dose their helpless off-spring with patent or
proprietary medicines, which contain no man knows what, and which
unquestionably are often highly injurious, especially to children.




CHAPTER V

PROPER EATING--THE SECRET OF GOOD HEALTH


Very slowly the world is awakening to the fact that no agencies play such
an important part in the preservation of health as the consumption of
reasonable quantities of well-cooked and properly selected food, and the
habitual taking of wholesome drinks. On all sides the observant medical
man sees constant and reckless disregard of the simplest and most
fundamental laws governing this subject. Nothing is more common than to
hear of men in the prime of life being seized with what is called a
"nervous breakdown,"--which generally means a digestive breakdown--to be
followed by an era of misery for the unfortunate subject and his scarcely
happier family. Nervous and irritable, the slightest inconveniences are
magnified into terrible calamities, he constantly fears death, and his
sleepless nights become a saturnalia of gloomy thoughts and abject
fears.

Of course, not everyone guilty of dietetic sins goes through such sad
experiences, for the naturally strong frequently escape the consequences
of their rashness, particularly where they live in the rural districts
and take plenty of out-door exercise. Let not such, however, flatter
themselves that their disregard of hygienic laws will go unpunished.
After indiscretions in eating they will all, at one time or another, have
acute indigestion with diarrhoea; and how often does the previously well
and hearty man after indiscretion in eating wake up with a dull headache,
furred tongue, foul breath, and a general feeling of sluggishness and
mental depression?

Is it his liver? Our unscientific medical ancestors--at a loss to account
for the state of affairs in any other way--answered in the affirmative,
and, believing it was produced by a collection of bile in the liver,
called the condition "biliousness." How absurd modern science has shown
this assumption to be! We now know that the liver is rarely diseased,
and that it furnishes its secretion, called bile, for the purpose of
aiding digestion rather than hindering it, and that this substance is
rarely, if ever, produced in excess. It is undigested, putrefying food in
the intestinal tract that produces the trouble. Under such circumstances
one usually takes a dose of calomel, which, being perhaps the most
satisfactory and perfect purgative that we possess, relieves the
condition promptly by getting rid of the offending material; but the drug
does not act on the liver.

Unfortunately ill results of quite a different and a much more serious
character often follow in the wake of dietetic errors; in those who have
a tendency to consumption, particularly where they overwork, this dread
disease frequently makes its appearance as a consequence of bad eating
and drinking. Many, if not all, of the degenerative diseases that appear
in the latter half of life are produced in this way, and nothing is more
certain than that the peace, happiness and longevity of mankind could be
incalculably increased by the simple observance of what is known
concerning proper eating and drinking.

We will now consider the very important subject of the quantity and
character of foods which should be taken in health, with suggestions as
to those most suitable for dyspeptics.

_Over-eating too Prevalent._--The majority of us take much more food than
is necessary, with the result that we suffer from indigestion.

When we consume more than a reasonable amount of food habitually serious
digestive disturbances are sure to result,--to be often followed at a
later time by tuberculosis, morbid alterations in the blood-vessels,
Bright's disease, and other serious maladies of a chronic nature.
Professor Chittenden, who is America's greatest physiological chemist,
has demonstrated that in all probability previous workers along these
lines have been excessive in their estimates as to the amount of food
required. He showed that a man could live for a period of nine months on
a daily ration which contained about one-third of the usual amount of
proteids generally thought to be necessary, and at the same time the fats
and carbohydrates were reduced to such a degree that the total number of
heat units, or calories, liberated from the food scarcely exceeded in
number one-half of the standard requirements. He also experimented on
thirteen volunteers from the hospital corps of the United States Army, to
whom he daily fed rations of only 2,000 calories, and, notwithstanding
that they engaged in physical work, all were found to be in better
condition at the end of six months than they were at the beginning.

These results strongly point to the conclusion that previous estimates as
to the quantity of food required are erroneous, and that man can not only
live, but may continue in strength and health on much smaller amounts. It
is highly probable that this discrepancy may be accounted for, at least
to a considerable extent, by the assumption that much of the food
ordinarily taken is rejected by the system, and passes out as waste,
while, when small quantities are eaten, it is for the most part absorbed.

_Mastication._--Thorough chewing of the food is absolutely essential for
proper digestion. While it is true that this, like all other good things
in life, may be, and often is, carried to an unnecessary extreme, it is
certainly true that we would be infinitely better off if we were to go
to the extent in this direction of so called "Fletcherism" rather than
perform this most important function in an indifferent manner.

This rule applies with especial force to food of a starchy
nature,--bread, potatoes, oatmeal, rice, etc. In order to digest food of
this character it must be very thoroughly cooked and when finally placed
upon the table it should be of such consistence that it requires chewing
before it can be swallowed. Not only is this necessary from the
standpoint of breaking up the larger particles into smaller ones, thus
permitting the food to pass freely through the stomach and intestine, but
it is of the greatest importance for it to be thoroughly soaked with the
saliva during the process. It is thus of no advantage for starches to be
served in a finely divided form--in fact it is directly the contrary,
since under such circumstances it is almost always the case that such
foods are swallowed without having been insalivated.

What has been said concerning the mastication of starches applies with
almost equal force to other foods. Without exception their digestibility
is much increased by thorough chewing. As the result of recent
experiments carried out by means of the X-ray, it has been shown that
particles of food of any considerable size will not pass from the stomach
into the intestine; as often as an object of this kind attempts to force
its way from the former into the latter the opening between the two
closes, and as a consequence the food is retained in the stomach longer
than it is in health--resulting in the course of time in catarrhal
conditions of the organ just named, and an unnatural relaxation of its
muscular walls. Under such circumstances the patient quickly develops
symptoms of indigestion, and if his habits be not corrected the trouble
gradually grows worse until the sufferer becomes a chronic dyspeptic.

_Classes of Nutritive Substances._--All substances that are of any
appreciable value in nutrition may be divided into those that are
nitrogenous in character (albumins, legumins), the carbohydrates
(starches and sugars) and compound ethers (fats). Of all these the
nitrogenous foods are the most important, since they contain the material
from which the great bulk of the body is largely composed, and at the
same time there is every evidence that in case of need they may be broken
up into chemical substances that may take the place of any of the other
kinds of foods; upon nitrogenous food, then, a man may live alone, while
this cannot be done on other articles of diet. The fats, starches and
sugars are very closely related to each other, and it is generally
believed that they subserve much the same end in the economy; by
undergoing chemical change they furnish energy (heat and muscular force)
and are undoubtedly largely responsible for the formation of the fats of
the body. While there is some evidence that under certain conditions
alcohol may be a food, its value is certainly very small, and it is not
of sufficient importance to be considered in this connection. The ideal
diet then for a healthy man is a proper proportion of nitrogenous
(albuminous) food, along with a reasonable portion of fats, starches and
sugars. Professors Voight and Atwater have calculated the following
table, which fairly represents the amount of proteids, fats and
carbohydrates that should compose the rations for twenty-four hours for
the ordinary adult male.

  ADULT MALE OF AVERAGE WEIGHT.

                   At Rest.    Moderate Labor.   Severe Labor.
  Proteids        110 grammes    118 grammes     145 grammes.
  Fats             50    "        50    "        100    "
  Carbohydrates   450    "       500    "        500    "

The tables that follow, which were arranged by Hutchinson, give a very
good idea of the generally accepted views as to the relative quantities
of the different foods that are thought necessary for the average adult
engaged in ordinary muscular work:--

                                                                Fuel
  Food Materials.   Amount.   Albumins.   Fats.   Starches.    Value.
  1.                 Ozs.       Lbs.      Lbs.      Lbs.      Calories.
  Beef, round st'k    13        0.14      0.12      ....         695
  Butter               3        ....      0.16      ....         680
  Potatoes             6        0.02      ....      0.15         320
  Bread               22        0.12      0.02      0.75        1760
                      --        ----      ----      ----        ----
    Totals            44        0.28      0.30      0.90        3455

  2.
  Pork, salt           4        ....      0.21      ....         880
  Butter               2        ....      0.11      ....         450
  Beans               16        0.23      0.02      0.59        1615
  Bread                8        0.04      0.01      0.28         640
                      --        ----      ----      ----        ----
    Totals            30        0.27      0.35      0.87        3585

  3.
  Beef, neck          10        0.10      0.09      ....         550
  Butter               1        ....      0.05      ....         225
  Milk, one pint      16        0.04      0.04      0.05         325
  Potatoes            16        0.02      ....      0.15         320
  Oatmeal              4        0.04      0.02      0.17         460
  Bread               16        0.09      0.02      0.56        1280
  Sugar                3        ....      ....      0.19         345
                      --        ----      ----      ----        ----
  Totals              66        0.29      0.22      1.12        3505

  4.
  Beef, up. sh'lder   10        0.09      0.13      ....         800
  Ham                  6        0.06      0.13      ....         650
  Eggs, two            3        0.03      0.02      ....         135
  Butter               2        ....      0.11      ....         450
  Milk, one pint      16        0.04      0.04      0.05         325
  Potatoes            12        0.01      ....      0.11         240
  Flour                9        0.05      0.01      0.38         825
  Sugar                1        ....      ....      0.06         115
                      --        ----      ----      ----        ----
  Totals              59        0.28      0.44      0.60        3540

  5.
  Sausage              4        0.03      0.11      ....         510
  Codfish             14        0.07      ....      ....         140
  Butter               2        ....      0.11      ....         450
  Milk, one pint      16        0.04      0.04      0.05         325
  Beans                5        0.01      ....      0.18         505
  Rice                 2        0.01      ....      0.10         205
  Potatoes            16        0.01      ....      0.23         420
  Bread                9        0.04      0.01      0.28         640
  Sugar                3        ....      ....      0.19         345
                      --        ----      ----      ----        ----
  Totals              71        0.27      0.28      1.03        3540

  6. Beef              8        0.08      0.10      ....         560
  Mackerel, salt       4        0.04      0.04      ....         230
  Eggs, two            3        0.03      0.02      ....         135
  Butter               2-1/2    ....      0.13      ....         565
  Cheese               1        0.02      0.02      ....         130
  Milk, one pint      16        0.04      0.04      0.05         325
  Potatoes             8        0.01      ....      0.08         160
  Rice                 2        0.01      ....      0.10         205
  Bread                9        0.05      0.01      0.32         720
  Sugar                1-1/2    ....      ....      0.09         175
                      --        ----      ----      ----        ----
  Totals              55        0.28      0.36      0.64        3205

_Calories Defined._--It should be explained that the term "calorie" is
one which has been adopted as a scientific expression for the fuel-value
of substances undergoing oxidation, and in this connection refers to the
heat-producing capacity of foods. The "calorie" is the amount of heat
required to raise the temperature of one gramme of water 1°C. It has been
estimated that starches, sugars and albumins liberate during combustion
4.1 calories per gramme, while fats produce 9.3 calories. It will be
noted that in the tables just given the total number of calories is in
each instance somewhere in the neighborhood of 3,500, which is
considered to be about the number of heat units required by the average
man at moderate muscular work. The weight of the average woman being less
than that of the adult male, a reduction of about 20 per cent. from the
foregoing figures would approximate the amount of food required by the
former.




CHAPTER VI

BREAD AND ITS RELATIONS


At all times, and among all peoples, bread has been recognized as one of
the great staple articles of diet. Although its commonly quoted
designation, "the staff of life," would more appropriately belong to the
albumins, there can be no question that breads of one kind or another are
among the most wholesome and necessary of all food-substances. Not alone
is this true on account of the starch of which they are largely composed,
but they contain more or less vegetable albumin; it is thus seen that
bread is a mixture of the two most important food-stuffs, starch and
albumin, but the quantity of the latter is so small that an individual
would have to eat an enormous amount of the mixture to secure enough of
this ingredient to meet the needs of the body. For practical purposes,
then, we may regard bread as being starch.

     Within recent years quacks have disseminated very widely throughout
     this country the error that foods are more digestible when raw. It
     was long ago demonstrated that pure albumins, of which eggs and
     milk are the nearest natural examples among foods, are assimilated
     somewhat better when eaten raw, but this applies to no other foods
     except sugars. Any success that has followed the teachings just
     referred to undoubtedly rests purely on the fact that their
     followers are instructed to live largely on raw eggs and milk, and
     as the patient usually discovers in a short time that these two
     foods agree with him while other uncooked ones do not, he naturally
     eats them to the exclusion of the rest and where he takes a
     sufficient quantity increases in weight and strength.

     The idea that starches are more digestible when eaten raw could be
     easily refuted by any intelligent farm-boy who recalls one or more
     sad experiences from over-indulgence in raw sweet potatoes.

What shall we look upon as bread? Of course all such food-stuffs as are
commonly included within this designation are to be accepted; such as
wheat-bread, graham-bread, whole-wheat bread, biscuits, rolls, light
bread, bakers' bread, waffles and batter-cakes, rye bread, corn bread,
preparations of corn-starch, with which we should place those articles of
diet so commonly used in the south, usually called grits, hominy,
egg-bread, muffins, corn-meal cakes, potatoes, both sweet and Irish,
arrowroot and the so-called cereals or breakfast-foods, including
oatmeal.

Now which of these is the most wholesome? This inquiry cannot be answered
conclusively for the reason that the digestibility of this, as of other
foods, depends largely on the individual. For the sake of clearness the
various breads will now be considered in detail.

_Wheat-bread the Best._--It may be confidently asserted that well-cooked
and perfectly dry wheat-breads are to be regarded as being generally the
most digestible of all bread-stuffs. This is not dependent on any
inherent property in wheaten starch as a result of which it is acted upon
more readily by the juices whose office it is to render it fit for
absorption in the body, but is wholly due to the fact that breads of
wheat-flour may be made very dry and light.

As has been already explained, it is particularly necessary that starches
should be thoroughly soaked in saliva, and this can only be accomplished
when the bread is of such consistence that it must be chewed for a time,
and so dry that it will readily absorb the salivary secretion. The
writer, then, would advocate well cooked light-bread or bakers' bread, or
toast made from either, as being the best of all food-stuffs of this
character. The crusts of biscuit a day or so old are quite digestible, as
are also waffles, if made with little grease and cooked thoroughly. The
soft inner portion of biscuit and that of hot rolls, as well as
batter-cakes, is decidedly unwholesome.

Graham-bread should not be constantly indulged in for the reason that it
contains multitudes of sharp particles of the husk of the grain that cut
the delicate mucous membrane of the stomach and intestines as it passes
along, and if its use be long and continued, severe ill effects
necessarily follow.

     In this connection attention should also be called to the common
     error that particles of husk are of advantage to breads of all
     sorts; the former consist chemically of exactly the same thing as
     sand, and are quite as indigestible, and this, in connection with
     what has just been said of their action on the delicate mucous
     membranes of the intestinal tract, should be quite enough to
     convince anyone that they are not only useless, but injurious. It
     is true that the irritation produced by the husk will oftentimes
     cause the bowels to act, but results of the same character may be
     induced by many other agencies, within themselves less harmful.

_Rye-bread._--There is no reason why rye-bread should not be prepared in
quite as wholesome a way as is wheaten-bread, and this grain should
undoubtedly rank as one of the best of the cereals. Its use, however, is
so limited in this country that it is scarcely necessary to go into a
lengthy discussion as to its merits. It may be remarked that the ergot
fungus frequently grows on this grain, and when ground up with it
occasionally poisons the consumer where the quantity of the substance is
large and the bread is eaten in considerable quantities. Instances of
this kind are not uncommon among the peasantry of Europe, where a black
bread made from rye is the staple article of diet. Of course, when making
food-preparations of rye, we should be careful to have the flour
thoroughly winnowed, and to cook the bread until sufficiently dry to
acquire a proper consistency for chewing.

_Corn-bread and Corn Food-products._--When made from perfectly sound
grain, and if not allowed to undergo fermentative changes afterward,
there can be no question that food-products of corn are entirely
wholesome, and, from the standpoint of chemical composition, quite as
nourishing as similar articles of diet prepared from other grains. It is,
however, unfortunately true that we cannot, in the majority of instances,
definitely assure ourselves that our corn-bread is made from grain that
comes up to the above specification, nor can we be sure that the meal is
fresh, or preserved at such a temperature as would forbid the growth of
various germs. It has long been known that bad corn would kill horses,
but notwithstanding this, we have accepted the view that no amount of
deterioration in the grain could result harmfully to man. That this
latter assumption is incorrect seems now in the highest degree probable.

     _Pellagra._--It is known that a very curious and fatal disease
     called pellagra is prevalent to a considerable degree at the
     present time in the United States, and it is not going too far to
     say that all of those best capable of judging are of the opinion
     that the malady is the result of eating just such corn as we know
     kills horses.

     It is likewise true that the nutritive power of this grain could in
     no way be increased by allowing it to decay before consumption;
     indeed, the contrary must be the case, and, if it were in no manner
     actually harmful, our sense of the æsthetic and of what is proper
     to eat, should make us reject in this case, as with other foods,
     that which is unsightly to the eye and unpleasant to the taste. We
     should no more eat bad grain than a rotten apple, or putrefying
     meat. The increased prevalence of pellagra is exciting attention
     all over the United States, and is very generally assumed to be the
     result of lack of care in the harvesting and preservation of our
     corn. Instead of being cut before it is ripe, and shocked in the
     field during the latter part of the summer, it should be allowed to
     ripen on the stalk, and after cold weather sets in gathered while
     dry, and preserved in well-covered and well-ventilated barns. Every
     care should be taken to keep it dry while being shipped from one
     part of the country to another, and similar precaution should be
     observed with the various food-products made from it. If kept in a
     cold place, meal or grits made of good corn may be preserved in
     excellent condition for eating throughout the winter; but as soon
     as the warm weather begins they should be stored in the
     refrigerator, and should there remain during the summer; similar
     precaution should be taken with meal or other corn-products during
     the hot months.

Over a large area of the United States corn-bread is an article of daily
diet with a great majority of the inhabitants, and its wholesomeness as
compared with other breads becomes, therefore, an important question.
Unfortunately, corn-meal does not lend itself to the preparation of a dry
bread having sufficient consistency to require chewing. It is true that
the crusts of the bread made from this grain answer these requirements
fairly well, and there is therefore no reason why this part of it should
not be used to any extent, provided it be prepared from good meal. We
should endeavor to cook thin pones of the bread rather than the thicker
ones so common in the south. The objection that corn-bread can only be
masticated with difficulty applies to the other preparations of this
cereal, such as egg-bread, muffins, etc., and they are not, therefore,
with the exception of the crusts, to be looked upon as being the best
form of bread. Corn-cakes, like all batter-bread, are to be mentioned
only to be condemned. Grits and hominy are soft and moist and cannot be
properly chewed, and are, therefore, not to be recommended as good
breads. Corn-starch preparations are likewise entirely lacking in the
elements required to make good bread, and should only be used
occasionally and in small amounts.

_Disadvantages of Potatoes._--Irish potatoes are eaten almost as commonly
in some portions of the United States as are corn-products in others, and
therefore deserve the careful consideration of the hygienist. While it is
not believed that, like the latter, potatoes give rise to any definite
disease, it is unfortunately true that they are theoretically worse
breads than those made from the grain just referred to. In whatever way
cooked, they are moist and require no chewing, and as a consequence many
persons with delicate digestions do not assimilate them properly.

_Arrowroot._--The preparations of arrowroot are considered digestible,
though here again we find that such articles of diet are generally moist
and of not proper consistence to be chewed, and they are, therefore, not
as valuable as are breads made from wheaten flour.

_Rice._--Rice is used by a large portion of the world's inhabitants. When
cooked thoroughly and very dry, it is perhaps almost as good bread as is
that made from wheat. The starch granules of the former, like those of
arrowroot, are somewhat smaller than those of wheat.

If it were possible to keep rice-flour in good condition, and if it could
be made into light-bread, it is likely that it would be superior to
wheaten flour, but this does not appear feasible.

A peculiar and very fatal disease prevails in the East, known as "kak-ke"
or "beri-beri," which is now generally regarded as being the result of
eating decomposed rice. The writer has seen one or two examples of what
he considers American beri-beri, but as our rice-eating population is
small, it is not likely that this disease will ever become a serious
problem in the United States.

_Cereals or Breakfast-foods._--Lastly we will consider the so-called
breakfast-foods, which are neither more nor less than various
preparations of the different varieties of starch. They are generally
made from oats or corn-starch. They are nothing more than bread, and as
some of them have been put through a sort of fermentation it is difficult
to understand how they could be regarded as being quite as wholesome as
the original products from which they were made. This, however, is not
the principal objection to them. The real trouble lies in the fact that
they are, in the majority of instances, served with cream and sugar. When
we remember what has already been said about starches that are soft and
cannot be chewed, and of the ill effects of sweets on persons who have
any inclination towards dyspepsia, it will be seen that these foods are
not to be regarded as being wholesome. The real reason that would appear
to explain the coming into existence of these preparations is that they
are mixed with cream and sugar, which appeals strongly to the
"sweet-tooth" of the average person. They are nothing but bread, and very
bad bread at that. The remarks made concerning breakfast-foods apply with
equal force to oatmeal, which, as generally used, has the additional
disadvantage of containing particles of husk.

In concluding this discussion on starchy foods the writer desires
particularly to call attention to a very common error in the way they are
eaten. Mention has already been made of the fact that fats after being
melted are by no means so wholesome as in their natural state, and
produce, when heated with starches, a very indigestible mixture. Thus,
theoretically, it is bad to use any great amount of lard, butter or other
fat in the preparation of breads, and it is likewise undesirable to
spread butter on heated breads, as is so often done just before eating
biscuits, waffles and batter-cakes. The combination is certainly a
seductive one, and pleasing to the taste of most persons, but this in no
way invalidates the fact that the mixture is exceedingly indigestible.

_Pastries and Cakes._--Peculiarly unwholesome are pastries containing any
considerable proportion of fat, and also most varieties of cake. With the
exception possibly of hot batter-cakes served with an abundance of butter
and syrup, cooks have so far produced no compound so heinous and totally
depraved as pound-cake. Fruit-cake also stands high up in the list of
undesirable sweets. It certainly passes all understanding why cooks
should continue to persecute the stomachs of a dependent world with such
highly obnoxious concoctions; the only excuse that can be given for them
is that the mixtures are palatable. Where a housekeeper feels it
necessary to prepare cake, she should select some receipt free from
butter or other fat, such as angel-cake or sponge-cake, both of which
when properly made are exceedingly good to the taste, and lack the
undesirable quality of containing fats. Explanation for the peculiarly
unwholesome character of food containing melted grease lies probably in
the fact that the grains of starch under such circumstances must be to a
greater or less extent covered by a thin layer of the fatty substances,
and as a consequence it is impossible for the saliva to penetrate to the
starch and perform its normal digestive function.




CHAPTER VII

MEATS, SUGARS AND MILK


First in the list of foods the writer would place those nitrogenous
substances commonly eaten that belong to the class of albumins. That
these substances are in reality the most important of all food-stuffs
there can be no sort of question, since they, of all things eaten by the
human being, are alone absolutely essential for his well being and even
his existence. They are the substances that almost exclusively go to make
up the muscle and tendons. Along with the lime-salts they enter largely
into the composition of the bones and cartilages, brain, spinal cord and
nerves. Other foods are incapable of taking the place of the albumins, so
that they are absolutely essential for normal life in the human being.

The amount of albumin necessary for the normal adult has been variously
estimated, the tendency at the present time being to place the quantity
needed somewhat lower than was at one time done. It is probable that
about two ounces of pure albumins is somewhere near the amount required
in twenty-four hours by a normal adult.

It is well, since we are so dependent on foods of this class, that we
have two quite distinct sources from which they may be taken. The great
bulk comes to us in the form of meats, including poultry, game, oysters
and fish of various kinds, in addition to beef, mutton, and hog-meat in
its several forms. Of animal origin also we have eggs, which are among
the most valuable of all foods of this class on account of their high
digestibility.

From the vegetable world we get albumins known as legumins, which differ
somewhat from those obtained from animal sources, though taking their
place in the economy in all essential particulars. Unfortunately the
legumins are usually so mixed with starches and other vegetable
substances less digestible, that it is necessary to take a large bulk of
foods of this latter class in order to secure anything like the requisite
amount of the former.

Before taking up individually the various albuminous foods, the writer
would again direct attention to the chapter on cooking, and would
strongly urge upon the reader the proper methods of preparing nitrogenous
foods therein stated. Where the albumins are in a nearly pure state, as
in milk and eggs, they are slightly more digestible when raw, but all
meats should be cooked until only the faintest tinge of red remains if we
wish to have them prepared in the most wholesome way for those with
delicate digestions. Meats are, as a rule, most wholesome when cooked
"very done."

     It has long been the cry of sentimentalists that no living being
     should die in order that man might exist. Unfortunately for such
     theories, the stern and unbending edict of nature has negatived
     views of this kind ages before the altruistic philosopher came on
     the scene, and we are daily constrained to bow to this mandate of
     one of the primal laws of existence. However much we might desire
     it otherwise, it has been written that "only in death is there
     life;" nor may any animal being disobey and continue to exist. As
     has been already explained, the human being cannot thrive on
     vegetable substances alone; from them he may get a certain amount
     of nitrogen in the form of legumin, but there is not enough to
     make up for the waste of this substance that constantly goes on in
     the body.

Theoretically it is of very little importance which of the meats are
selected to supply our nitrogenous food, but it is unfortunately true
that such foods vary much in digestibility, and it will therefore be
necessary to consider them separately.

_Beef._--When tender and cooked to a proper degree, beef is considered
one of our most wholesome of meats. Like other foods of this kind, it
should not be fried, but should be broiled or roasted, and a certain
amount of fat may be eaten along with the lean portions without injury,
and in many persons unquestionably with benefit.

_Mutton._--Of all the coarser meats, mutton is unquestionably the most
digestible, and when cooked in the same way as directed for beef is
eminently wholesome.

_Hog-meats._--On account of the large portion of fat between the
muscle-fibers, hog-meat, particularly when fresh, is not usually regarded
as being digestible. Some persons eat it with impunity, but for the vast
majority it should be taken only in small quantities. It should not be
fried. In the form of ham, hog meat is more wholesome than when fresh,
but even in this condition many dyspeptics find much difficulty in
digesting it. The best method of cooking it is to boil thoroughly. After
being cooked in this way and then broiled, it is most appetizing, and is
much more wholesome than when broiled without being previously cooked. As
bacon, hog-meat enters largely into the dietary of a great portion of the
laborers of this country, and there can be no doubt that on the whole it
answers the purpose of a staple food admirably. It contains even more fat
than nitrogenous substances, and may therefore be looked upon as a
mixture of butter and meat. Dyspeptics cannot eat it with impunity in
many instances, though it agrees far better with them than does ham or
the fresh meat. If it were generally eaten boiled it would provoke less
trouble than when fried. At this point the writer would repeat his
warning concerning the indigestible character of melted grease, of which
the gravy from bacon is a striking example.

When "cured" in a somewhat different way hog-meat as "breakfast-bacon"
is very generally used throughout the civilized world, and is one of its
most wholesome forms. This when broiled is both appetizing and wholesome,
and should form a part of the daily dietary of everyone able to afford
it.

_Poultry and Game._--Among the more delicate and most wholesome forms in
which albumins are taken we find poultry and game well up toward the head
of the list. Meats of this character should be very thoroughly cooked by
being either baked, smothered or broiled.

_Fish._--Fish of almost all kinds are wholesome provided they be fresh
and properly cooked. The culinary artist prepares of them most appetizing
and nutritious dishes, and they are therefore properly to be recommended
as among the best of the albuminous foods.

_Oysters and Clams._--Oysters and clams are usually considered somewhat
apart from the generality of the foods of this character. When fresh they
are wholesome and delicious when eaten raw, and may be cooked in a great
variety of ways. The reader should be especially warned that fried
oysters are not so wholesome as when they are prepared by other methods,
for the reason that they are surrounded by a batter containing quantities
of melted grease.

_Eggs._--Among the most delicate, digestible, and nutritious of all foods
we may place eggs. Though somewhat more digestible when raw, they agree,
as a rule, even with the most fastidious stomach, however cooked, even
when hard-boiled. Eggs lend themselves readily to the formation of many
delicious dishes, such as omelets, soufflés, etc.; but unfortunately they
do not contain nutriment in a very concentrated form, and where an adult
is living on them alone it requires from one and a half to two dozen
daily to furnish the necessary amount of food.

_Fats._--Under the term "fats" are included all oily substances, such as
butter, lard, olive and cotton-seed oils, and to a great extent the fat
contained in meats. These substances are closely related to starches and
sugars, and undoubtedly play a more or less similar rôle when taken into
the body as food. From the standpoint of heat-producing capacity they
more than double, weight for weight, meats and starches, and are,
therefore, instinctively highly prized by dwellers in cold countries
where much heat is necessary. In warmer countries the necessity for
excessive heat-production in the body does not exist.

     While oily substances are certainly capable of adding to the
     cushion of fat commonly found beneath the skin in normal
     individuals, they are not looked upon as being to any extent
     tissue-builders, resembling in this particular the starches and
     sugars.

     When fats are to be eaten, care should be taken that they be as
     fresh as possible, or, if this is not feasible, they should be
     preserved in such a way as to prevent their becoming rancid--a
     condition which is the result of the formation of fatty acids,
     lending a peculiarly unpleasant odor and taste, and producing a
     decided decrease in food-value. This alteration may be largely
     prevented by keeping fats in a refrigerator at a low temperature,
     and may also be greatly retarded by the addition of salt. In this
     country butter is usually treated with a very considerable amount
     of salt, but in Europe it is universally served fresh. Within
     recent years facts have been established that show that Americans
     use an excessive amount of this substance--possibly causing disease
     in some cases; and doubtless we would be better off if we were to
     follow the European practice.

     Oily substances when in good condition are certainly of high value
     as foods, but should be taken more or less with an eye to the
     climate, and to the season of the year. When placed on cold bread
     and eaten along with it they are extremely palatable, and may be
     taken in reasonable amounts with decided benefit to the whole body.
     In temperate climates it is generally estimated that about three
     ounces is a desirable amount for the average adult. In this
     connection it may not be out of place to mention that the various
     preparations of cod-liver oil, advertised so freely in the lay
     press, in some instances actually do not contain a single particle
     of the substance that they are supposed to be principally composed
     of; and it may be further stated that there is no good reason to
     believe that bulk for bulk oils of this kind are in any way
     superior to those fats commonly eaten. The writer often recalls the
     saying of a very wise old physician of his acquaintance that
     "cod-liver oil is nearly as good as butter."

_Sugars._--This term includes the large number of different substances of
a more or less sweetish taste that belong to the group of carbohydrates.
They are closely related to the starches, and it is generally assumed
that they play much the same part after being taken into the body. Some
of these are of animal and some of vegetable origin--but except the sugar
found in milk, the only ones commonly consumed are those derived from
cane, beets, and fruits; the sugar from the first two is known as cane
sugar or dextrose, and that from the latter as grape sugar or glucose.
Like albumins they may be eaten without having been previously cooked,
and are unique in that they undergo no chemical change whatever as a
result of ordinary degrees of heat.

While the consumption of sugars in all civilized nations is rapidly
increasing, there can be no question that, irrespective of fruits, they
are, of all foods, the most frequent causes of digestive disturbances. It
is only within comparatively recent times that mankind has possessed
means of separating sugars in any great bulk from the plants containing
them, and as a consequence they have only entered prominently into our
every-day diet for a relatively short period of time. Before this, it is
true, they were consumed to a greater or less extent in various fruits,
but the quantity was insignificant as compared with the amount now
universally eaten. As a result of this we are now confronted with a new
dietetic problem. For ages the human stomach has been accustomed to deal
with only small quantities of these substances, and developed
accordingly a capacity to digest them proportionate to the amounts then
eaten. Now, however, we constantly call upon our digestive organs to deal
with large quantities of such foods, and it is not strange that there has
been more or less rebellion on their part.

     Experiments have shown that a small amount of sugar assists in the
     normal chemical changes that go on in the body, and it is,
     therefore, obvious that nature intends us to take a certain
     quantity of it. Moreover it is true that sugars while being burned
     in the body give off much energy--mainly manifested in muscular
     power; where then we are taking active physical exercise foods of
     this kind are peculiarly appropriate. It would, therefore, not be
     wise for us to leave this food entirely out of the dietetic list,
     but to use it only in small amounts--particularly where we lead
     sedentary lives. Sugar and alcohol play a more or less similar rôle
     in the animal economy. It is well known that those who do not use
     alcohol are peculiarly prone to consume considerable quantities of
     sugar; and it is equally a matter of common observation that those
     who habitually take alcohol rarely eat sweets to any extent.

     When sugar is properly assimilated, as seems to be done most easily
     by children, it is an excellent food, but where sweets are
     over-eaten, and not properly digested, they give rise to a great
     accumulation of gas in the intestine, and produce in many persons
     a marked acidity of the stomach, frequently accompanied by severe
     insomnia. Nothing so quickly relieves such sleeplessness, caused by
     a "sour stomach," as allowing ten or fifteen grains of ordinary
     cooking-soda to slowly dissolve in the mouth and swallowing the
     saliva rendered alkaline in this way.

_Milk._--Milk may be looked upon as an ideal food, it being composed of
water carrying in solution the three great natural foods--albumins in the
form of casein, carbohydrates as milk-sugar or lactose, and fat. Mixed in
the proportion in which they here occur, they are most admirably adapted
to the delicate digestive apparatus of the infant--the relative
proportion of the different substances even gradually changing as the
assimilative powers of the youthful organism increase; it is thus seen
that milk itself is not of constant composition, even in the same animal,
and that it alters in such a manner as to meet best the needs of the
delicate being depending upon it for proper sustenance. It is also the
case that the composition of milk varies in different animals--showing
again how admirably nature exerts its powers in meeting desired ends.

The lesson of practicable importance that we learn from this is that the
milk of one of the lower animals is not in its natural state quite suited
to the delicate stomach of the growing infant, and that if it be
substituted for the mother's milk it must be more or less altered,
depending upon the age of the child. It is particularly important that
sweet milk be taken slowly, as otherwise large curds, difficult of
digestion, form as soon as it gets into the stomach.




CHAPTER VIII

FOOD-VALUE OF VEGETABLES


In recent times we hear much of vegetarianism, which has its advocates
among many highly intelligent people, and which, as a consequence, has
achieved a certain vogue throughout the civilized world. It is rarely the
case, however, that those who affect to practice this cult in reality
live exclusively on a vegetable diet. As a rule it will be found that
they are milk-drinkers, and not infrequently add eggs to their dietary.
It is, of course, absurd to regard as vegetarians those who simply avoid
meat, since it is true that the nitrogenous substances contained in milk
and eggs differ in no essential particular from similar substances found
in flesh of all kinds.

Experiments on a somewhat extended scale have shown within recent years
that young and vigorous individuals at least may live and thrive on a
diet composed largely of vegetables; no one has yet shown that a strict
vegetable diet is that best adapted to the average individual, and no
competent authority on this subject at the present time advocates a diet
purely of this kind. It is true that the vegetables ordinarily eaten
contain all of the elements that are essential to the animal system, such
as starch, sugar, fat and albumins. Unfortunately, however, the amount of
the last-named substance is usually so small in food-plants that the
quantity that would have to be eaten by a normal individual taking active
exercise would cost considerably more than if a reasonable proportion of
animal food were included, and--which is of even greater importance--the
digestive powers of the individual who attempted to live only on food of
this character would be severely taxed, and, in the long run, probably
seriously impaired. Furthermore, vegetables and fruits contain
substances, usually in great quantity, that are scarcely acted upon at
all by the digestive juices. Chief among the latter is cellulose, which,
while forming the great bulk of the food of herbivorous animals, is
scarcely suited to the weaker digestive capacity of the human being;
practically none of it is converted to the uses of the body. It is thus
seen that in the average man or woman a dietary consisting largely of
vegetables would result in the presence in the intestines of a greater or
less bulk of indigestible materials, which could subserve no good purpose
other than that they would by their mechanical presence have a tendency
to cause the bowels to act; as is the case with fruits, however, it is
unfortunately true that this large residue of undigested food, in one way
or another, often gives rise to considerable irritation of the mucous
membrane of the intestine, and frequently produces dyspeptic
disturbances, among which looseness of the bowels is common.

This brings us to a consideration of the digestibility of vegetables in
general, which is always the paramount consideration when dealing with
the value of any substance to be used as a food. It has been before
remarked that young and vigorous persons seem to thrive on a dietary
largely of vegetable character, but the case is certainly quite different
with older people, particularly where their digestive powers are
impaired. In the latter we often find that severe intestinal disturbances
follow even after moderate indulgence in vegetable foods--particularly
where they are served with vinegar, or some other fruit acid. Another
peculiarity of foods of this kind that makes decidedly against their
digestibility lies in the fact that, being soft and containing a large
proportion of water, they are scarcely ever properly chewed, and as a
consequence they are swallowed in comparatively large masses without
having been adequately insalivated.

Vegetables may be roughly classified as legumes, roots and tubers, and
green vegetables, and will now be considered briefly in the order named.

_Legumes,--Beans, Peas, Lentils, and Peanuts._--With the exception of the
cereals, the legumes are the most valuable of all vegetable foods. Their
nutritious properties are mainly due to their relatively high percentage
of nitrogenous material, though they also contain starch and fat. Hence
these vegetables contain the ingredients necessary to supply all the
needs of the human economy; unfortunately, however, when eaten alone in
sufficient bulk to furnish the nourishment required, they often--even in
healthy individuals--give rise after a little time to dyspeptic
disturbances.

Of beans, a large number of different varieties are in common use
including string-beans (or snap-beans), lima-beans, kidney-beans, red
beans, the frijole, and the Soya bean. String-beans are exceedingly
palatable, and are very much prized as an article of diet by the peoples
of all countries. When gathered young and thoroughly cooked while still
fresh they are exceedingly wholesome, and are very well assimilated, when
properly chewed, by even those whose digestions are considerably
impaired. The other beans named are generally eaten dry after having been
removed from the pod in which they grow. When they are soaked in water
until they become soft and then thoroughly cooked they make an excellent
food, and, when not taken in too great quantities, are fairly digestible.
When cooked with onions, parsley, and red pepper in proper proportions
they make a very delicious dish. In Japan the Soya bean forms the basis
for a kind of vegetable cheese which is eaten with rice, and furnishes
the nitrogenous materials in which the latter is deficient. Peas are
wholesome when young and fresh and when properly cooked, and as they come
on in the early spring when other fresh vegetables cannot be obtained,
they furnish a most acceptable addition to the dietary. When old, after
their skins become tough, they cease to be digestible, and should not be
eaten except in the form of purees, during the preparation of which the
hull is removed.

Lentils are scarcely eaten at all in America, but are much prized in some
portions of the Old World, as the basis of soups.

Peanuts belong to the group of legumes, though, unlike the others that
serve as food, they grow beneath the surface of the ground. They are
highly nutritious, but are, unfortunately, indigestible, owing largely to
the high percentage of oil that they contain. The latter is extracted,
and is sometimes sold as olive-oil; in a somewhat different form it is
made into a sort of butter which is quite palatable.

_Roots, Tubers, and Yams._--Sweet and Irish potatoes, which constitute
the most important members of this group, have already been discussed
under the head of breads. Of those that remain, some few, as beets and
artichokes, may be regarded as related to those just referred to, while
others, such as carrots, turnips, radishes, parsnips, etc., are generally
reckoned among the succulent tubers on account of the large proportion of
juice that they contain. Irrespective of the beet, which furnishes a
considerable portion of the sugar of commerce, none of them may be looked
upon as foods of a very important character, as they contain only
relatively small proportions of sugars, starches, and nitrogenous
materials. Beets, however, do contain a very high percentage of that
which makes potatoes so popular,--about eighty-five per cent. of starches
and sugars, with only a trifle of nitrogenous material. When young and
tender they are often eaten as a salad, either alone or mixed with other
vegetables, and are generally regarded as being wholesome and highly
nutritious. They should not be eaten by dyspeptics when pickled, on
account of the vinegar.

Artichokes are occasionally eaten, but are not nutritious, although they
agree well with many persons.

Carrots, when young and fresh, are fairly digestible, but like other
vegetables are exceedingly apt, particularly if old, to produce
intestinal disturbances in dyspeptics. They are not very commonly eaten
in the United States, but where selected with care we would profit by
their more frequent use. They contain a small percentage of starches,
with an insignificant proportion of vegetable albumin.

Turnips are exceedingly unwholesome, contain very little nourishment, and
may be eaten with impunity only by persons in vigorous health. The same
remarks apply to radishes, and to parsnips.

_Green Vegetables._--Vegetables of this class are of much more value from
the standpoint of their agreeable taste, and the consequent stimulating
effect upon the appetite, than from the nutritive materials that they
contain. Some of them are eaten cooked, while others are usually consumed
in a raw state. They are all much less indigestible if eaten when quite
young and fresh--drying seemingly having the effect of producing
alterations in them that predispose to dyspeptic disturbances in those so
inclined.

Spinach is one of the most digestible of the entire group, and is much
eaten in all parts of the world.

Turnip-tops differ in no essential particular from spinach. They have a
somewhat bitter taste, but when young and fresh are highly palatable, and
if thoroughly cooked cause comparatively little intestinal trouble, but
like spinach they contain practically no nourishment. The same may be
said of the leaves of various other plants commonly served as greens,
among them beet-tops, and dandelion-tops.

Cabbages, many different kinds of which are habitually eaten as food in
civilized countries, have comparatively little nutritive value, and are,
generally speaking, decidedly indigestible, although young and vigorous
persons, particularly where they take abundant out-door exercise, find no
difficulty in assimilating the inner portions of the fresh cabbage
"head." As in the case with other vegetables, the soil and locality in
which the cabbage is grown largely influences its taste, and to some
extent its digestibility. It should never be given to infants. Sauerkraut
is a preparation of cabbage leaves produced by adding salt, and later
crushing them with considerable pressure; after a time alterations occur
of a fermentative character, and the product is generally regarded as
more wholesome than fresh cabbage.

Cauliflower consists of masses of the somewhat modified flowers of a
plant closely related to the cabbage, and is, when properly prepared,
palatable, and perhaps somewhat more digestible than cabbage. Cole, and
Brussels sprouts, are plants of the cabbage family, and are perhaps even
more indigestible.

_Salad Plants._--The leaves of the lettuce are usually eaten raw, most
commonly being served as a salad in combination with oil and vinegar, or
lemon juice. That the leaves possess, when treated in this way, a very
palatable taste all will perhaps agree, but they cannot be said to be of
any nutritive value, nor are the acids just referred to conducive to
their digestibility.

On account of their somewhat pungent taste, watercresses are used in many
parts of the world as ingredients of salads, but they are, of all
vegetables, the ones that are most liable to transmit disease to man, for
in addition to the possibility of contracting in this way typhoid fever,
dysentery, cholera, and the ordinary intestinal worms, the human being is
apt to receive with them the eggs of the flukes, and the spores of the
amoebæ that produce chronic tropical dysentery. As they are probably
never grown under such conditions as to preclude the possibility of this
danger, it would be the part of wisdom to absolutely refrain from their
use.

_Onions, Leeks, Shallots, and Garlic._--Vegetables of this group are
eaten either raw or cooked, and of all those consumed in the former state
are least liable to transmit disease, owing to the fact that they are
nearly always thoroughly peeled before being eaten. They have the
advantage, furthermore, that they may be preserved for long periods of
time in such a way as to be fit for food, and when properly cooked have a
delicate flavor, and are quite wholesome although furnishing little food
for the body. Garlic is never eaten as a vegetable, but serves as the
basis for many of the delicate sauces for which the French cooks are so
justly celebrated.

The tomato has been used as a food only within comparatively recent
times, it having been formerly thought to be poisonous. Like the onion it
may be eaten either raw or cooked, and if taken in moderation does not,
as a rule, produce any serious harm. When eaten in greater quantities,
both on account of the acid that it contains and its relatively small
proportion of assimilable nutriment, the tomato is exceedingly prone to
cause intestinal disturbances, and should rather be regarded as a fruit
than a vegetable. Growing at some distance from the ground, it is rather
less apt to convey diseases than the majority of vegetables eaten in a
raw state.

While celery is generally eaten raw, it furnishes a palatable dish when
cooked in milk. It should not be eaten by dyspeptics or children,
particularly if raw. Similarly the cucumber has a well-merited reputation
for producing dyspeptic disturbances. It is only eaten raw, is frequently
served as a salad, and should be used only when very young and fresh,
and eaten only by persons of sound digestion.

Okra is much prized in the Southern States as the principal ingredient of
a very palatable soup, but is not as a rule looked upon with favor by the
uninitiated. It is also much eaten boiled and served with a little butter
and pepper. When fresh and young it is fairly digestible, and furnishes a
very agreeable addition to the dinner.

     In addition to those already referred to, there are a number of
     vegetables that are very popular either alone, or in combination as
     salads--particularly in the South; among them are green peppers,
     parsley, mint, capers, endive, and chicory. The remarks already
     made concerning green vegetables apply equally to these just
     mentioned, and it should here again be particularly insisted upon
     that salads containing acids are unwholesome for infants and
     children, and should be used sparingly even by those in health.
     None contains much nourishment.

     Among easily digestible vegetables asparagus probably takes front
     rank, and in addition to this has the merit of being exceedingly
     agreeable to the taste. It possesses little nutritive value, but
     when young, fresh, and well cooked, it may be taken even by infants
     without harm.

     Rhubarb, or "pie plant," is eaten stewed, and made into pie. It is
     said to be somewhat laxative, and is decidedly more wholesome than
     many others. The squash, when properly cooked is comparatively
     wholesome, but contains little nourishment, and is of no particular
     value as a food, and the pumpkin is not much better, although
     useful during the winter for making pies after the ordinary
     vegetables and fruits are gone.

     Cranberries, when thoroughly cooked and separated from the hulls,
     form the basis of a delicious jelly that is widely eaten in the
     winter over all portions of the United States. Like all sweets it
     is not entirely wholesome for dyspeptics or infants, but as it is
     usually eaten with meats and not in great quantities, it may be
     looked upon as being one of the most wholesome of all foods of this
     class. It does not seem to have such a tendency to produce sour
     stomach in many dyspeptics as is so frequently done by other foods
     containing vegetable acids.




CHAPTER IX

DANGER IN FRUITS AND PICKLES


It is an error shared almost universally by both medical men and the
laity that fruits and raw foods are wholesome. Everyone is familiar with
the fact that fruits produce intestinal disturbances in children,--not
only when they are very young, but after their digestive apparatus is
fully developed. Rather curiously, however, instead of ascribing the
disturbances that follow to the real cause, we generally dismiss the
matter with the assertion that "early fruits are unhealthy," or trace the
resulting ill effects to some other equally imaginary factor. In reality
the reason why diarrhoea and other intestinal troubles so often occur
after eating fruits in the early spring is that the boy or girl after a
winter's fast greedily devours enormous quantities of them when they
first ripen, and disturbances follow in proportion to the amount and
character of these substances taken.

There can be no question that fruits, while extremely palatable, usually
produce trouble in dyspeptics, and even in those who still possess
unimpaired digestive organs ill effects quite constantly follow on the
heels of the taking of food of this character. Unfortunately, however,
the great majority of dyspeptics have symptoms that in no way outwardly
point toward digestive errors; as common examples, we might refer to the
blackheads, pimples and small boils, so frequently observed on the faces
of young boys and girls, or the rheumatic pains, and, at a later time,
the "Bright's disease," that occur in older people. When you tell such
patients that their trouble is indigestion, they are often mildly
indignant, and loudly protest that they can eat anything with impunity;
that they never have heart-burn, feelings of heaviness after eating,
pains in the abdomen, or other symptoms referable to the stomach and
intestines. We are rather disposed to be proud of our digestive powers,
just as we are of our bodily strength, and nothing is more common than
for chronic dyspeptics to maintain that they have never had indigestion
in their lives, and to resent any insinuation to the contrary.

Another popular error, almost universally accepted, is that fruits are
highly nutritious; as a matter of fact they consist almost wholly of
water, and of materials that are utterly indigestible. The latter
substances pass through the alimentary tract, therefore, in much the same
condition that they enter and serve no better purpose than to promote,
somewhat, activity in the bowels. Nevertheless the writer does not wish
to be misunderstood as advocating total abstinence from such a palatable
class of foods; no harm results in most people if they only take
perfectly ripe and fresh fruits in moderation now and then; and these
should be always eaten after meals rather than before.

The fruits that contain comparatively little acid are, as a rule, more
wholesome than those that are rich in substance of this kind. For
example, perfectly fresh and ripe figs or peaches may be taken by most
persons with impunity if they be eaten after meals, and at intervals of
at least two or three days. Acid fruits, particularly lemons, seem to be
peculiarly unwholesome; apples are prone to cause trouble and can rarely
be eaten without ill effects, however mellow and palatable they may be.
It sometimes happens that persons take grape-fruit with less harm than
others.

Closely akin to fruits in their deleterious action on the digestive
apparatus are sours in any form whatever. Women, especially, indulge
freely and at irregular hours in foods containing much vinegar,
lemon-juice, etc.,--usually in the form of pickles or salads. In healthy
persons, in moderation, foods of this character perhaps produce no
appreciable trouble, but nothing is more thoroughly established than that
they act harmfully on the general run of dyspeptics, such as most of us
are to a greater or less degree after thirty years of age. This leads to
the remark that here, as in everything else, we must regard individual
peculiarities--it being true that one person can eat without ill effects
what may produce decided disturbances in others, or suffer from excess
when moderation would entail no ill-effects.




CHAPTER X

DRINKS--PROPER AND HARMFUL


An immense amount of rubbish has been written during the last few decades
concerning the supposed good effect of excessive water-drinking on the
human economy. Something like a quarter of a century ago a London
physician by the name of Haig brought forward and strenuously advocated
the view that a large number of minor ailments were the result of the
presence in the body of excessive quantities of uric acid; applying the
well known fact that the substance just mentioned requires a large amount
of water to dissolve it he conceived the idea that the proper remedy was
to flood the body with enormous quantities of liquids, and thus, as it
were, wash the offending substance out of the system. So plausible did he
make this theory appear that it was accepted very largely by medical men,
who in turn taught it to the general public. Within recent times it has
been fortunately shown that Haig's theory was wholly chimerical, and
that quantities of uric acid greatly in excess of the normal amount could
collect in the body, or might be injected into the blood-vessels, without
the least harm resulting; thus, at one blow, this widely accepted theory
was annihilated, and there now remains no sort of reason for attempting
to remove uric acid by excessive water-drinking, or by other means.

     It is fortunate that the uric-acid theory has been disproved, for
     the excessive use of water is not only unnecessary, but highly
     injurious to the digestive organs, particularly when the fluids are
     taken at or about meals. Experience has shown that excessive
     stomach-acidity, which is the most common form of indigestion, is
     in a large degree dependent on the taking of liquids while eating,
     and that even in those who are healthy any more than small
     quantities cannot be looked upon as being wholesome. In dyspeptics
     liquids seem to act in a hurtful way in several different
     directions. For example, where persons constantly take liquids
     while eating the necessity of properly chewing the food is largely
     done away with; in addition to this the mere presence of water in
     the stomach seems to tend to the production of increased acidity,
     for it has often been observed by the writer that even where food
     was eaten dry indigestion would follow in many dyspeptics if they
     took water just before or immediately after eating.

The only sensible advice that can be given in this connection is that
persons should take no more liquids that they feel a desire for, and they
should avoid taking them in any quantity about meal time. What has just
been said concerning water applies equally well to milk. When taken alone
it very frequently agrees with patients much better than does solid food,
but when mixed with the latter is prone to produce indigestion, just as
does water. Fermented milk in the form of buttermilk is a very popular
beverage in some parts of the world, but it may be well doubted as to
whether it deserves the reputation for wholesomeness generally accorded
it; being a liquid, and at the same time acid, it is peculiarly prone to
increase acidity, and is not tolerated by persons who suffer with sour
stomach. It should, however, be said that it, on the other hand, seems to
agree particularly well with some people, and has been known when taken
alone, at least temporarily, to relieve obstinate forms of indigestion.

_Coffee._--The most universal beverage taken at meal time in America is
undoubtedly coffee. Each morning countless thousands are cheered and
stimulated by its invigorating properties to undertake their daily tasks,
but, as is always the case after taking drugs that have such action the
system has to pay the penalty in a reaction following later, during which
the capacity for work is diminished. It is, however, true that the effect
last referred to is not of such importance as to constitute in itself a
serious objection to the use of coffee, but other ill results are rather
prone to ensue that in many instances change the aspect of the question
entirely. In a great many people, particularly after the first vigor of
youth has passed, coffee produces anything but pleasant effects, and on
some it seems to act as a downright poison. Like all liquids taken at
meal time, it predisposes to acid indigestion, particularly when it is
sweetened. It is likewise true that when it contains any considerable
quantity of cream the liability to dyspeptic disturbances following its
use are particularly great--doubtless as a result of the considerable
quantity of melted fats that it contains under such circumstances.

     From the foregoing it appears then that coffee without either cream
     or sugar is less unwholesome than when these substances are added
     to it, but even when it is taken in this way it causes decided
     symptoms of indigestion in many persons. The writer is not of the
     opinion that the habitual taking of coffee is to be commended, and
     would, therefore, not advise its constant use; it, however, must be
     admitted--as is the case with all other substances that cause
     indigestion--that in many people, and particularly in those who
     live out-of-doors and are actively engaged in physical occupations,
     the use of coffee seems to result in no harm. Like other substances
     that cause indigestion in a concentrated form, coffee when largely
     diluted is less apt to produce disturbances of this kind; for
     example, a beverage consisting of two-thirds of hot skimmed milk
     and one-third coffee may be taken by many dyspeptics in reasonable
     amounts without any particular harm. Parents should be warned
     against allowing growing children to drink coffee; it seriously
     interferes with the normal chemical changes going on in their
     bodies, and is almost certain to be followed in later life by
     nervous dyspepsia.

_Tea._--The stimulating principle of tea is chemically so nearly like
that of coffee that they are generally considered as being one and the
same. That they differ decidedly in their action on the stomach and the
body generally there can, however, be no doubt. The stimulating action of
tea comes on more slowly than that of coffee, and is correspondingly
prolonged. In most persons it is not so apt to produce nervousness, nor
is its action in preventing sleep so pronounced. On the stomach it also
produces effects that are diametrically opposed to those induced by
coffee, since, instead of stimulating, it seems actually to retard the
secretion of acids. It is, therefore, probably true that we should look
upon tea as a beverage with much less disfavor than we do coffee--though,
of course, it should always be remembered that there may be, and
unquestionably are, many exceptions to this judgment.

     Probably no other daily article of food or drink is so commonly
     prepared in an improper manner as tea--which is all the more
     curious when we consider that perhaps none other that requires heat
     for its preparation is so easily made. It should be brewed by
     simply pouring boiling water upon the leaves, but the vessel
     containing the decoction should not be placed over the fire while
     the tea is being prepared. Of even greater importance is the
     necessity of allowing the water to remain in contact with the
     leaves only a few moments--_never more than a minute if we wish
     the tea to be good._ The reason for the latter precaution lies in
     the fact that tea-leaves contain a considerable amount of tannic
     acid, and, as the longer the water and leaves remain together the
     more of this substance is extracted from the latter, it is not
     difficult to see that we should be careful to allow only a brief
     contact between the two; the presence of this acid is undesirable,
     not only on account of the fact that it gives to the decoction a
     bitter and unpleasant taste, but because it has a tendency to cause
     digestive disturbances. It is seemingly not generally known that
     there are many varieties of tea, and that some of them are so
     superior in flavor and bouquet to others that they might well be
     entirely different substances. The best of all (in the writer's
     opinion) are those that are composed largely of leaves grown in
     Ceylon, usually mixed with India tea. If we will demand of our
     grocer a first-class Ceylon tea we will find that a beverage may be
     made from it that will appeal quite as much to the palate as a good
     coffee.

     Before dismissing this subject finally, some reference should be
     made to ice-tea. This beverage is exceedingly palatable when
     properly prepared, and under such circumstances by no means
     deserves the disfavor with which it is regarded by many. The latter
     circumstance is entirely due to two things; first, we find too
     frequently that it is the habit of house-keepers to pour boiling
     water on the leaves when the midday meal is cooked and to allow
     them to soak together until night, and second, the fact that
     lemon-juice is very commonly added to the tea before being drunk.
     The ice that the tea contains has little or nothing to do with the
     dyspeptic disturbances that frequently follow the drinking of cold
     tea. If we will leave out the lemon and pour off the water after it
     has been in contact with the tea leaves for something like a
     minute, it will be discovered that practically all of the ill
     effects usually ascribed to this palatable beverage have been done
     away with.

_Alcohol._--A discussion of beverages would not be complete without some
mention of those containing alcohol. This at once brings us face to face
with the bitter controversy on this subject that has been waged so long
throughout the United States, and which can only be considered here from
the standpoint of the effects of alcohol on the human economy, and to
draw corresponding conclusions.

That alcohol, even in very small quantities, reduces the general strength
and capacity for work there can be no question, and in addition we find
from experiments carefully conducted on the lower animals that the
liability to infection by various disease-producing germs is greatly
increased by the administration of even minute amounts of the drug. A
man then who is a habitual user of alcoholic drinks not only thereby
diminishes his capacity to labor effectually, but at the same time
renders himself more liable to disease. No more striking example of this
could be brought forward than the well established fact that persons who
use alcohol are exceedingly prone to consumption--so true is this,
indeed, that we might almost look upon the drug as being practically the
cause of this disease in most instances. Of course the bacillus of
tuberculosis must be present in order for the malady to develop, but we
find that the alcohol has prepared a soil for the growth of the germ
which would not otherwise exist. This holds with equal force as regards
other infectious diseases.

Again, it is true that maladies that result from bad digestion and
improper assimilation are frequently produced by the habitual use of
alcoholic liquors. Gout and Bright's disease are in the vast majority of
cases the indirect off-spring of habitual drinking. It should be
noted--and the distinction is of importance--that the affections of a
grave character most frequently produced by the alcoholic habit do not
ensue as a consequence of what could be rightly called intemperate taking
of the drug,--its moderate use more commonly resulting in serious disease
than when it is taken in great excess.

     The explanation of this probably lies, at least in part, in the
     fact that the majority of drunkards only take alcohol at greater or
     less intervals, and as a consequence the system has time to
     recuperate between sprees. The typical dipsomaniac goes weeks,
     months, and even years without drinking at all, but when he is
     seized by the desire for drink he throws everything else aside and
     spends days and weeks in a prolonged debauch; during this period he
     eats very little, and as a consequence largely avoids the grave
     dyspeptic disturbances that would otherwise inevitably result.
     Alcoholics of this class acquire catarrhal conditions of their
     stomachs, and if seized with some acute disease, like pneumonia,
     during or just after a spree, quickly die in a large proportion of
     cases, but they do not develop gout or Bright's disease as a rule,
     nor do they very commonly become consumptive, as is the case with
     those who take the drug in small quantities day by day.
     Furthermore, it would appear that the grave disorders that so
     frequently follow the long-continued use of alcohol cannot be said
     to be the direct result of the use of the drug, but ensue as a
     consequence of the stimulating action of the alcohol on the
     appetite, leading to over-eating. Under such circumstances
     indigestion follows from excessive over-feeding, and this is added
     to by the naturally irritating effect of the alcohol on the
     stomach. When this is continued through a series of years, the
     assimilating power of the organism gradually deteriorates, and we
     begin to meet with chronic dyspepsia, acute Bright's disease, and
     cirrhosis of the liver. Let no one then consider that he is not
     misusing alcohol for the reason that he only takes a drink before
     meals--it would be far better if he were to go on a moderate spree
     occasionally.

In this connection mention should be made of the great evil of patent
medicines containing, and in reality essentially consisting, of alcohol.
A vast number of them are widely sold under the misleading statement
that they relieve catarrh, cure diseases of the kidneys, and that
they act as tonics and general invigorants of the entire system.
Masquerading under one guise or another they are sold to the unsuspecting
public--prohibitionists for the most part--who fondly imagine that their
glass of "bitters," "liver-regulator," or "safe cure for the kidneys," is
entirely harmless. Let all such be warned that with scarcely an exception
patent medicines of this class are nothing more nor less than poor
whisky containing some bitter to disguise the taste, and that they are in
fact taking a drink when they use nostrums of this kind. The ultimate
effect of this kind of drinking is to produce serious and grave diseases.

This discussion of the effect of alcohol on the human body would not be
complete without calling attention to the extraordinary fact that those
peoples to whom we owe our modern civilization have from time immemorial,
most of all others, consumed the greatest amount of alcohol. Explain it
as we may, the fact remains that the greatest achievements of the world
were brought about by a society in which a very large proportion of its
members were in the habit of more or less constantly taking alcoholic
beverages. Naturally, the query is forced upon us whether this drug may
not have played some important part in the great results achieved.
Unfortunately, no one can answer one way or another, but our very
ignorance should emphasize the importance of looking at the question from
every side, and not jumping at conclusions before they are warranted by
facts. It is true that most of our positive knowledge on this subject
would condemn alcohol as being the greatest curse of the ages, but it
may be that it has played a beneficent part in the affairs of mankind
through devious paths impossible to trace. Unquestionably a drug, the
taking of which assists us in momentarily throwing our troubles aside,
must be of a certain positive value to mankind. If only it possessed
these good qualities with none of its bad ones!

Having considered very briefly the general effects of alcohol on the
system a few remarks may be appropriately made concerning the several
beverages commonly consumed in the United States for which it serves as a
basis.

_Whisky._--Under the term whisky will here be included all of those
stronger alcoholic beverages that are the product of distillation. In
addition to those commonly designated as such we may reckon brandy, gin,
and rum, and at the same time those subtle combinations called
mixed-drinks, for which they serve as a basis. It will, perhaps, startle
the average reader when the statement is made that whisky and its near
relatives just referred to, particularly when diluted by water, are by
far the least harmful of all alcoholic drinks. Their bad reputation lies
in the fact that on account of their large percentage of alcohol they are
usually preferred by drunkards, and that when consumed in excessive
amounts by those unaccustomed to their use there often follow those
frightful crimes with which these particular forms of alcohol are so
odiously associated. The facts are, however, that when taken in
moderation they are much less prone to produce indigestion than wines or
malt liquors, and where one is determined to drink, they should
unquestionably receive the preference. It should not be understood that
the writer is in any way advocating their use, but the facts of
experience compel him to state frankly that the least harmful of all
alcoholic beverages is whisky, or its near relatives.

_Wines._--There are a large number of fermented juices of fruits that are
known as wines. They are either sweet or acid in taste, and both are
peculiarly prone to induce dyspepsia in persons with delicate stomachs.
Irrespective of their delicate flavor, which, in many instances, appeals
strongly to the palate, the only virtue that they may be said to possess
is that they contain alcohol in small amounts; this, however, is off-set
entirely by their large percentage of sugars and acids, causing them to
be much more unwholesome than plain whisky.

_Beers and Malt Liquors._--It is very fortunate that in those states of
the American Union that have recently enacted prohibition laws, beer and
other malt liquors are now being widely sold under the plea that they are
non-intoxicating and that they are in no way unwholesome. While it is
true that the former claim is in a measure correct, it is a fact well
understood by those who have given the matter study that they are perhaps
the most unwholesome of all alcoholic beverages. Those in the habit of
using them are almost universally under the impression that they are
harmless, and as the taste for them is easily cultivated, those who once
acquire the habit are very apt to take them in greater or less quantities
daily. As a result of this, chronic digestive disturbances are always
sooner or later set up, and the victim in the course of time often
acquires a gouty tendency, which is all the more dangerous for the
reason that in America it scarcely ever manifests itself in acute joint
inflammations. The patient gets into what has been called a "lithemic"
state, which is but another name for gout, and sooner or later is
exceedingly apt to develop a chronic form of Bright's disease. It is
greatly to be deplored that some of our professional national
school-masters do not address themselves to this subject rather than to
appealing to the worst passions of the ignorant in attacking the great
institutions of our country, and in assailing the fundamental principles
of our government that come down to us as a priceless heritage from the
wise and patriotic statesmen who first brought our nation into life.

In addition to the three great classes of alcoholic beverages already
considered there are innumerable others, fortunately but little known to
the general public, and prized only by connoisseurs in such matters. As
we happily have no problem confronting us in any way similar to the
absinthe-habit, so common in France, it is not deemed necessary here to
do more than merely to refer to them.




CHAPTER XI

IMPORTANCE OF GOOD COOKING


Reference has already been made to certain misconceptions concerning
cooking diligently circulated in recent years by various quacks. The
victim is advised that he must take large quantities of raw eggs and
milk, and at the same time is instructed to eat a number of other
specially prepared articles furnished at a stiff price and certified as
being raw by the "medical company" furnishing the "treatment." Since it
is quickly discovered by those who are entrapped by charlatans of this
kind that the only raw foods that they can take with comfort and without
disgust are milk and eggs, they naturally practically live on these
alone, and as these foods are extremely digestible and nutritious,
improvement in the patient's condition not uncommonly results.

Nevertheless, it is unquestionably true that the vast majority of foods
are greatly improved in digestibility, and are rendered much more
palatable by thorough cooking. After being properly cooked there develop
in foods certain flavors and odors that are highly appetizing, and
unquestionably aid in the subsequent digestion of the same. With but few
exceptions, foods are so altered by heat that their proper mastication
becomes much easier, and cooking, therefore, materially aids in reducing
them to a state in which they are much more readily acted upon by the
digestive juices. It should never be forgotten, also, that cooking is of
the utmost importance from the standpoint of killing bacteria and animal
parasites that may be present in food. If we were to adopt universally
the habit of eating everything raw, the general mortality would certainly
be considerably increased.

_Cooking of Starchy Foods._--Nothing in the whole art and science of
preparing food for the human being is of so much importance as the proper
cooking of starches. As a result of the heat employed, certain chemical
changes are induced in the starch-granules, as a consequence of which
they are rendered digestible. It is of fundamental importance that at
all times and under all circumstances the cooking of this class of foods
should be as thorough as is possible, for when this is not done digestive
disturbances are sure to follow, and much of the food is actually wasted.
There are but few cardinal principles in the ordinary hygiene of life
that are so commonly neglected as this, since it is the habit of a large
proportion of the American people to consume three times a day masses of
tenacious starch which has not been acted upon by heat sufficiently to
render it digestible.

Of all the different methods of cooking starches, by far the most common,
and, therefore, the most important, is the process called baking. While
it is not possible in this volume to go into the subject with the
thoroughness that it deserves, the principal points deserve some mention.
They may be briefly stated as follows:

     (1) The flour must be made into a dough in which are incorporated
     substances that produce a gas called carbon dioxide, which, forming
     in innumerable small bubbles throughout the mass, cause the whole
     to swell; when this is completed the bread is said to have
     "risen." Of course the object of this is to produce a thorough
     breaking up of the sticky dough--with the result that when the
     bread is finally cooked it is light and fluffy, and can be readily
     masticated.

     (2) After the process just described has been completed the bread
     should be thoroughly cooked, for reasons which have already been
     explained.

     (3) After cooking has been accomplished the bread should be
     thoroughly dried, either by keeping it hot until this occurs, or,
     what is better, permitting it to remain warm for a time and then
     allowing the process to be completed in a natural way by putting
     the bread aside for several days. It is necessary for bread to be
     dried in order that it may be thoroughly soaked in saliva during
     the process of chewing.

If the principles above enunciated be properly followed out, good
wholesome bread will result. There are, of course, many details connected
with the preparation of food known to expert cooks into which it will not
be possible for us to go here, and for which the reader is referred to
any good cook-book.

Some starchy foods such as rice and potatoes, do not lend themselves
readily to the production of breads, and are consequently usually cooked
in some other manner. It cannot be too strongly insisted upon that they
should be rather _steamed_ than boiled,--the process being usually
carried out by placing a small amount of water with them and allowing it
to boil away; we should remember also that the principles just insisted
upon in connection with making bread apply here with equal force--we
should cook thoroughly and serve both as dry as is possible.

_Cooking of Meats._--Here again it is necessary to insist upon the
necessity of thorough cooking. The error has long prevailed that raw
meats are wholesome, but within recent years it has been clearly
demonstrated that this old view is erroneous. The muscle-fibers that
constitute the bulk of the nourishment of meats are separated from each
other by a substance which cannot be acted upon by the juices of the
stomach until it has been heated to a temperature which results in the
cooking of the entire mass. It is true that the muscular substance proper
may be digested without heat--resembling in this way the white of the
egg, to which it is chemically closely related; by scraping meat with
some dull instrument the muscle fibers may be separated in a more or
less pure state--leaving the substance that requires heat in order to
become digestible behind--and after having been removed in this way, of
course, may be eaten in a raw or semi-cooked condition without ill
effects. In preparing meat it is not absolutely essential that it be
cooked until thoroughly "done"--a slight tinge of red being allowable.

_Healthful Recipes._--In an Appendix to this volume will be found a
series of recipes for the preparation of common foods, for which the
author is indebted to Dr. Mary E. Lapham, of Highlands, N. C. They will
be found extremely practicable for making not only very palatable but
thoroughly wholesome dishes; and are earnestly recommended to young
housewives, who err through ignorance, as a rule, rather than because of
carelessness or of lack of good materials. It has often been said that
the road to a man's heart lies through his stomach. It would not be
surprising to learn that this aphorism fell first from the lips of some
wise woman who had observed that in a great number of cases unhappiness
in home-life had resulted primarily from lack of home-comfort, and
chiefly from unvaried, unappetizing meals and table-service. Another
point is well worth remembering, especially by young married women: a man
whose home is pleasant and comfortable is likely to spend as much of his
time there as he can--if it is otherwise, he will seek some place that
has these desirable qualities, such as his club, or an arm-chair in some
corner saloon. Furthermore, a man who is not only abundantly, but
_nicely_ fed, has far less desire for the stimulants which lead to
drunkenness, than the man who is denied at home the properly cooked and
seasonably varied food which his system craves. No better work in the
"Temperance cause" can be done than to make an attractive home.

These are facts which many a young housewife needs to learn and keep in
mind; and it is for her benefit that Dr. Lapham has prepared her simple
but excellent cooking directions presented in the Appendix.




CHAPTER XII

SEVEN AVOIDABLE DISEASES


MALARIA FEVER.

Malaria, in its various manifestations, has ever constituted the
principal obstacle to the civilization of all tropical and semi-tropical
countries, and as a consequence vast tracts of the richest and fairest
portions of the world have remained uncultivated and unredeemed from
their primitive savage state. Recent investigations have shown that this
disease can be easily prevented if the matter is taken up intelligently.

Malaria is a disease produced by a parasite belonging to the very lowest
order of animal life--the _Plasmodium malaria_, which is conveyed from
man to man by that genus of mosquitoes called the Anopheles. The parasite
attacks and destroys the red cells of the blood, and produces a poison
that causes the symptoms characteristic of malaria.

_Course of the Disease._--The most common and well-recognized symptoms of
malaria are those that occur in that variety of the disease which is
known as malarial or intermittent fever. In this type the patient--who
may or may not have at intervals for some days noticed chilly sensations,
a feeling of fullness in the head, and general bodily depression--is
suddenly seized with a chill followed by a high fever and subsequent
profuse perspiration; after these symptoms subdue, which generally
requires several hours, the patient returns to a practically normal
condition and feels, on the whole, well until the next attack occurs.
These chills-and-fever paroxysms occur at various intervals depending
upon the character of the parasite inducing them, the most common form
being that which produces a chill every day. In some instances the malady
comes on more insidiously, there being no marked chills but only
periodical elevations of temperature.

In the more chronic forms of the disease the unfortunate victim is
frequently subjected for years to attacks of fever coming on at irregular
intervals, the patient being more or less of an invalid throughout the
course of the disease. In other instances the brain becomes affected,
producing very alarming symptoms; and in quite a proportion of cases the
malady ultimately terminates in chronic Bright's disease.

_Treatment of the Disease._--Most fortunately, we have in quinine, when
properly administered, a medicine that in practically all instances acts
as a specific in this affection; but it should be used only on the advice
and under the directions of a physician. In the more chronic forms of the
disease, combinations of arsenic, with such tonics as nux vomica, iron,
and small doses of some of the preparations of mercury, produce permanent
cures where quinine has failed. It is of the utmost importance that
attention be given to the treatment, as, so long as the patient remains
with the parasites in his blood, so long is he a menace to his friends
and neighbors.

_Mode of Infection Through Mosquitoes._--The most brilliant triumph in
modern medicine, and one of the most creditable achievements of human
ingenuity, has been the absolute demonstration that malaria is carried
from man to man by means of the Anopheles mosquito, and that the disease
can, in nature, be produced in absolutely no other way. This is not a
theory, but it is a fact which has been demonstrated in its every detail
beyond dispute, and we are now happily in a condition to reject our
venerable notions concerning bad air, miasma, etc.

     Before describing the method by which infection takes place, it is
     well to say a few words concerning the mosquito that acts as a
     carrier of the disease, which may be easily differentiated from
     other similar gnats. The malarial mosquito has a body which is
     placed parallel to and almost on the same plane with the front
     portions of the insect, and as a consequence, when at rest on walls
     or other objects, the back of the body sticks out almost or quite
     at right angles with the surface upon which it is resting. The back
     portion of the common mosquito forms an angle with the front part
     of its body, with the effect that both ends of the insect point
     toward the object upon which it rests. There are still other
     differences that clearly differentiate the malarial from the common
     mosquito, but the one given ordinarily serves to distinguish
     between them. The malarial mosquito is pre-eminently a house-gnat,
     being scarcely ever seen in the woods or open, but may be
     found--oftentimes in great numbers--in all malarial localities,
     lying quietly during the day in dark corners of rooms or stables.
     This mosquito practically never bites in the day, but will do so
     in a darkened room, if a person will remain perfectly quiet; their
     favorite time for feeding is in the early parts of the night and
     about daybreak--all of which accounts for the fact, long observed,
     that malarial fever is almost invariably contracted at night. The
     malarial mosquito bites and then goes back to some dark corner
     where it remains quiescent for forty-eight hours, at the end of
     which time it again descends to feed. Contrary to the general
     opinion mosquitoes bite many times, and frequently remain alive for
     months--the malarial mosquito particularly living in cellars and
     attics oftentimes throughout the entire winter.

     If one of these mosquitoes bite a person with malaria, the
     parasites are sucked in along with the blood and pass into the
     stomach of the gnat, making their way ultimately into the body
     substance; here the parasites undergo a series of multiplications,
     a single one of them sometimes producing as many as ten thousand
     young malarial parasites. After the parasites have developed fully,
     which requires eight days in warm weather, they make their way to
     the venom-gland of the mosquito and there remain until it bites,
     when they are injected into the body of the individual attacked
     along with the poison.

     After getting into the human blood, each parasite attacks a
     red-blood cell, bores into it, and grows at the expense of the cell
     until it reaches maturity, at which time it divides up into from
     seven to twenty-five young parasites which are liberated and each
     in turn attacks a new cell. This process goes on until a
     sufficient number of parasites are produced in the individual to
     cause the symptoms of malaria, and the new subject of the disease
     thereafter becomes a source of danger to others in the vicinity
     through the intervention of still other malarial mosquitoes.

_Malaria Avoidable._--From the foregoing it is seen that the proper way
to avoid malaria is so to screen houses that mosquitoes cannot enter
them. Persons in malarial districts should not sit on open porches at
night, and should be careful to sleep under properly constructed nets. If
this be done, there is absolutely no danger of anyone ever contracting
the disease. It will be well observed that these precautions are not
necessary in the daytime, as the malarial mosquito rarely attempts to
bite during this period.

It should be remembered by those who have the disease that they are a
constant source of danger to people living in the vicinity, and they
should be doubly careful as long as the disease persists to avoid being
bitten by mosquitoes at night. It is furthermore their duty to vigorously
treat the disease until the parasites are no longer present in their
bodies, at which time they cease to be a menace to others.

Many children have malaria without showing symptoms, and, if allowed to
sleep without being properly covered with a net, are very apt to infect a
large number of malarial mosquitoes; the blood of children in malarial
localities should be examined from time to time, and if the parasites be
found, the children should be given the proper remedies until a cure is
effected.

Particular attention should also be directed to the fact that almost all
Negroes in malarial localities of the South harbor the parasites, though
very few of them show symptoms of their attacks. It is, therefore, very
important that they be treated properly, and their white neighbors should
see to it, for their own safety, that they do not sleep in houses
unprotected by nets.

If the precautions herein detailed were properly carried out, for even a
few months, malaria would practically cease to exist wherever this was
done, and would not recur unless individuals from other places suffering
from the disease were to come into the districts where the Anopheles
mosquito is present, and so give it to the gnats--to be by them
recommunicated to humanity.


TUBERCULOSIS.

Of all the enemies of mankind, tuberculosis, in its various forms, takes
the first rank. Of protean manifestations, occurring in almost every part
of the body and producing diseases of the brain, of the nerves, of the
bones, of the skin, and of all of the internal organs--pre-eminent is the
terrible malady we call consumption, which is tuberculosis of the lungs.
It has been estimated that one-seventh of all the people born into the
world die as a result of this malady in some one of its various forms,
and it is probable that one person out of every three dying between the
ages of fifteen and sixty years, succumb to this disease. As a result of
the labors of thousands of patient, self-sacrificing investigators--many
of the most distinguished of whom have died of this disease while
carrying on their work--the peculiarities of this affection are now
fairly well understood, and if we were to apply the knowledge which we
now possess in our attempts to free ourselves from its ravages, there is
no question but that within a comparatively short period of time the
disease would practically cease to exist.

_Character and Course of the Disease._--Tuberculosis is produced by a
minute vegetable parasite known as the _Bacillus tuberculosis_, a germ
which not only occurs in the human being, but is widely distributed among
the lower animals. Tuberculosis of the lungs (to restrict ourselves to
this most important manifestation) generally comes on insidiously, there
being usually no definite period from which the sufferer can date the
onset of the malady. In the early stages there is usually loss of
appetite and a pronounced feeling of weakness followed by a slight cough;
the latter symptom frequently leads patients to erroneously believe that
their trouble began with a bad cold, when as a matter of fact, the
catarrhal trouble of the throat and bronchial tubes was originally
produced by the germs of tuberculosis--there being no such thing as a
cold changing into consumption. As the disease progresses the patient
complains of fever and chills, these symptoms being oftentimes
periodical, and lead to the belief that the trouble is malarial fever:
this mistake is very common, and whenever such symptoms appear a good
physician should be immediately consulted. The patient also suffers from
exhausting night-sweats in many instances, though this is not invariable.
A rapid loss of flesh is one of the earliest and most common symptoms.
The symptoms above enumerated continue and grow worse, and in quite a
proportion of the cases there is, in addition, spitting up blood, which
in some instances may be so pronounced that it becomes a distinct
hemorrhage. In the more rapid or "galloping" forms of the disease the
patient frequently dies within a few weeks or a month or so, while in the
less severe types the malady may persist for many years before death
occurs.

_Treatment._--The treatment of tuberculosis by drugs has proven an entire
failure, but a large number of persons afflicted with this disease will
recover, if placed under proper hygienic conditions.

The patient should be put on a porch or in a tent, whether it be winter
or summer, and kept in bed at absolute rest as long as there is any
fever, and should be fed in abundance with good, wholesome food. While
this treatment appears simple it should always be carried out under the
directions of a physician, as it is only possible for those having a
thorough knowledge of the subject to give such directions as would lead
to a rapid cure of the patient.

_Modes of Infection._--Hereditary tuberculosis, notwithstanding a popular
idea to the contrary, is very rare, but there is no question that those
persons in whose family tuberculosis exists are much more prone to
contract the disease than others. In just what manner the germ of
consumption gains entrance to the human body, we are more or less
uncertain, but there are reasons for the belief that in many instances
they pass in by means of the inhaled air; there is no doubt that in a
small percentage of cases the bacillus gains entrance to the body through
an abrasion of the skin or of some mucous membrane; finally the bacteria
are often taken in with the foods that we eat, or by putting objects
upon which the germs are present into the mouth, or eating with hands
which have been contaminated and not washed. Of the foods that contain
the germs of consumption, milk is unquestionably the most common, as
there can be no question that fully 25 per cent. of our cows have this
disease, and under such circumstances their milk is usually infected with
the bacillus that produces the malady; meats, likewise, often contain
germs of this disease, but, as they are usually cooked, no harm, as a
rule, results.

Of quite as much importance as the introduction of the germ into the body
is the resisting power of the individual at the time when this occurs,
since the disease can make no progress unless the tissues have become
susceptible through lowered resistance. All things then that have the
effect of lowering the vitality of the body act as predisposing causes to
consumption; such, for example, as _WANT OF PROPER FOOD_, _LACK OF
SLEEP_, _IMPROPER CLOTHING IN COLD AND WET WEATHER_, _AND LIVING IN DAMP
AND IMPROPERLY VENTILATED HOUSES_; excesses, _PARTICULARLY THE TAKING OF
ALCOHOL_, conduce to the development of the disease--long-continued
inebriety being beyond doubt the cause that most frequently leads to
consumption. It is a common error that alcoholic stimulants tend to ward
off consumption, and it is absolutely certain that these substances not
only do not act in a curative way in those who have already contracted
the disease, but are positively detrimental. In order then to avoid
consumption--and this is particularly of importance for those in whose
family there is a predisposition to the disease--the individual should
live soberly, should try at all times to obtain a reasonable amount of
good food, should sleep a sufficient number of hours, and should be
clothed properly, particularly in the winter. Those who devote their time
and energy to the performance of their work--being careful of course not
to labor excessively--are much more apt to escape consumption than those
who do otherwise. It is particularly of importance that those who have a
tendency towards consumption should early learn, and throughout life
practice, the habit of _BREATHING THROUGH THE NOSE_: if this rule be
followed a large percentage not only of the germs of consumption, but
other bacteria as well, are filtered out during their passage through the
nose and do not reach the lungs. Cleanliness is also of much
importance--a bath taken each morning in moderately cold water being
conducive to health, not only as regards consumption but other diseases
as well. It is of course necessary that dwelling houses should be kept
thoroughly clean.

     _Advice to Diseased Persons._--In all cases where a person observes
     in himself, or in those for whom he is responsible, the symptoms
     already detailed, it is his duty to at once consult an intelligent
     physician, and if it be found that tuberculosis is present, every
     precaution should be taken by the diseased individual to prevent
     the further spread of the malady. _IN SUCH A CASE THE SPUTUM THAT
     IS CONSTANTLY BEING COUGHED UP CONTAINS MYRIADS OF THE GERMS,_ and
     it is of the utmost importance in order to prevent other persons in
     the neighborhood from being infected that this _SPUTUM BE
     DESTROYED_. The patient should at all times carry about with him
     either a small receptacle into which the sputum can be
     expectorated, or a large cloth which would answer the same
     purpose, and in either case the sputum should be burned; if this be
     impracticable, it should be placed in some good antiseptic, such as
     a saturated solution of carbolic acid or a 1-to-1,000 solution of
     corrosive sublimate in water. The patient's handkerchiefs should be
     thoroughly boiled, and his clothing should receive like treatment.
     Every precaution should at all times be observed in order to
     prevent the sputum getting onto the furniture or floors, as, under
     such circumstances, it quickly dries and being broken up into small
     particles is carried by means of the air to other parts of the
     house.

     The patient should always remember that the quicker he is placed
     under proper treatment the more the chances of ultimate recovery;
     in the early stages almost all of the cases of this kind are
     curable, but later this is not often accomplished.


TYPHOID FEVER.

Of all of the infectious diseases prevalent in the United States, typhoid
fever is one of the most common and fatal. As a result of its ravages a
vast amount of invalidism, suffering and financial loss is brought about
each year, and a frightful mortality results. It has for some time been
recognized that typhoid fever is among the most preventable of all
diseases, and if our people would bestir themselves and carry out the
comparatively simple rules that are necessary for its prevention, the
scourge would, in a short time, practically cease to exist among us.

_Character and Course of the Disease._--Typhoid fever, enteric fever, or
abdominal typhus, is an infectious disease believed to be caused by a
specific bacterial germ known as the _Bacillus typhosus_. It develops, as
a rule, quite slowly, the first symptoms being loss of appetite,
headache, and a marked fatigue on slight exertion. These symptoms
gradually grow worse, fever develops, and the patient oftentimes suffers
with chilly sensations; the temperature gradually rises, and in the
course of from a few days to a week reaches a height of 102 degrees, 103
degrees, 104 degrees, or 105 degrees F. In many cases no symptoms exist
that indicate trouble with the bowels, but in the severe forms of the
disease diarrhoea generally comes on during the first week and continues
throughout the course of the disease.

During the second week the symptoms above detailed continue, becoming
often more severe, and there develops great nervousness and delirium.
About this time there are frequently observed over the chest, abdomen and
thighs, minute reddish spots resembling flea-bites; these spots last for
a few days and then pass away and are followed by a fresh crop in other
situations. During this period of the disease inflammation of the
bronchial tubes frequently comes on, and now and then pneumonia develops.
Bleeding from the bowels is an occasional highly characteristic symptom
of the second week. When the disease follows a normal course, the
symptoms during the third week begin gradually to abate; the fever
lessens, and the patient, though much emaciated, gradually returns to a
normal condition.

     Unfortunately, however, the disease does not always pursue this
     favorable course, for, in quite a proportion of instances, the
     symptoms increase in severity during the second or third week, the
     patient becomes profoundly prostrated, the delirium deepens, and
     death occurs. The hemorrhage from the bowels, in some instances, is
     so severe that death is produced even in comparatively early stages
     of the affection.

     In many instances, through indiscretion, usually as a result of
     eating solid food, patients who are apparently on the road to rapid
     recovery, relapse, and the disease repeats the course already
     detailed.

     It is of importance to remember that now and then so-called walking
     cases of typhoid fever occur, the disease in these instances being
     characterized by the fact that the symptoms are so slight that the
     sufferer does not feel it necessary to go to bed. However, in these
     mild cases, fatal hemorrhage from the bowels is as frequent as in
     the severer types, and as a consequence the patient should receive
     careful attention. Moreover, it is of importance to remember that
     from this mild form of the affection the most malignant varieties
     of the disease may be contracted.

     The mortality in typhoid fever varies from five to twenty per
     cent., depending upon the character of the disease and the nature
     of the nursing and treatment that the patient receives.

_Modes of Infection._--It is clear that typhoid fever is the result of
the entrance into the body of some minute form of germ-life, whether this
be the bacterium generally supposed to induce the disease or not. This
contagion is beyond question a living something which multiplies with
great rapidity under proper conditions, and, escaping from the bodies of
those infected with the disease, in one way or another, reaches other
individuals. It is beyond question true that the virus passes from the
body of those infected by means of the urine and feces, and it is likely
that the secretions from the mouth and nose frequently contain the germs
that cause the fever.

As the germs are certainly extraordinarily minute, a very small amount of
any of these excretions might produce the disease in healthy individuals
if it were to get into their bodies through water, milk, or any uncooked
food, or if it were to find lodgment about the nose or mouth, or get upon
the hands of other persons. It should also be remembered that the virus
may easily get upon cooking-utensils, drinking-cups, bed-linen, and other
articles with which we are constantly brought into close contact, and
that the disease might be transmitted in this way. It is also true that
the malady may be carried from place to place by insects, particularly
flies; the latter may readily get enough infectious material upon their
legs in various ways, and then, crawling over the food, leave the deadly
poison deposited upon it.

_Treatment of Typhoid Fever._--As soon as the symptoms appear, a
physician should be called and his directions faithfully and carefully
followed out. Nothing in this disease is of more importance than careful
nursing, and it is absolutely necessary that the patient receive only
liquid diet until the physician permits other food.

Wherever possible then, patients with typhoid fever should be completely
isolated, since, if this is not done, other members of the family are
almost sure to contract the malady--a result which almost everyone has
seen who has had any experience with the disease. Wherever possible
patients should be sent to a hospital, but where this cannot be done they
should be placed in an outhouse, if practicable, or in an isolated room,
which should be thoroughly disinfected after the patient's recovery. No
one should visit a typhoid-fever patient, except when compelled to do so,
and we should be particularly careful to prevent children from coming in
contact with them, as it has been shown that they contract the disease
much more readily than grown people. It is also of importance that
persons should not sit for any length of time in the sick room, and,
above all, under no circumstances, should cooking and eating be done
there. The room in which the patient is placed should be furnished only
with those things absolutely necessary, and it is particularly desirable
that carpets and curtains should be removed. It is well to wash the floor
each day with some antiseptic solution.

Those persons who come in contact with typhoid fever should wear outer
clothing which can be easily washed and boiled. After touching the
patient, or any of his clothing, the hands should be at once thoroughly
scrubbed in an antiseptic solution. Of course, under no circumstances,
should the nurse eat or drink from the same vessels that the patient
does.

None of the excretions from persons afflicted with typhoid fever should
ever be emptied until thoroughly disinfected with creo-carboline or
strong lime-water, and under no circumstances should these be poured out
in the neighborhood of springs or wells. Towels, handkerchiefs, and
clothing that comes in contact with the patient should be thoroughly
disinfected before being sent to the laundry. This is best accomplished
by thorough boiling, but in cases where this can not be at once carried
out, it is advisable to use some chemical antiseptic; of these, perhaps
the best is creo-carboline, which may be employed in a 1-500 solution in
water; where this solution is not obtainable, a 5-per-cent. solution of
carbolic acid in water will answer. It should also be remembered that the
water in which typhoid-fever patients are bathed necessarily becomes
infected, and this should always be thoroughly disinfected before being
emptied. These precautions should be carried out for some time after the
patient has recovered, as it is well known that persons, under such
circumstances, for some time frequently contain the poison in their
evacuations.

     After the patient recovers, the room should be disinfected with
     formaldehyde gas obtained from the substance known as "formalin."
     This gas may now be obtained from the formalin without the use of
     heat in the following manner: When everything is ready, and the
     room properly sealed, thirteen ounces of permanganate of potash to
     each quart of formalin are placed in a large vessel, the room being
     closed immediately after the two substances are put together; it is
     important that the permanganate be placed in the vessel first. When
     this method is employed a quart of formalin should be used to each
     one thousand cubic feet of air-space in the room. As the gas, by
     this process, comes off with great rapidity, it is not necessary
     to keep the room closed more than about four hours. This method is
     to be advised for the reasons that it acts more quickly than the
     older one, and there is never danger of fire.

     In cases where houses are too open to permit of disinfection by
     means of gas, the sick chamber should be thoroughly washed with a
     solution of corrosive sublimate, carbolic acid or some other good
     disinfectant.


HOOK-WORM DISEASE.

It has been only recently recognized that a large percentage of the
invalidism and a great number of the deaths yearly in the southern
portion of the United States are caused by a very small intestinal
parasite known as the _Necator americanus_, or hook-worm. This parasite
has unquestionably existed over the area just named since the advent of
the Negro--recent investigations having shown that the worm is in all
probability of African origin. This hook-worm disease is probably the
most common of all the serious diseases prevalent in the South, and as it
is easily curable, and can be readily prevented, there is no matter which
should be of greater interest to the people in the infected regions,
especially those who live in villages or on farms.

_Character of the Disease._--The animal parasite called hook-worm closely
resembles, externally, the pin-worm which so often occurs in children.
The female, which is larger than the male, measures somewhat more than
half an inch in length, and has the thickness of a knitting-needle; the
male is between a quarter and three-eighths of an inch in length as a
rule. The parasite possesses around its mouth a row of minute plates
somewhat resembling hooklets, by means of which it grasps hold of the
mucous membrane of the intestine and bruises it sufficiently to cause the
blood to flow; with this blood the parasite nourishes itself. At the same
time the worm injects into the tissues a poison which has much to do with
the symptoms that occur in the disease that it produces.

These worms are usually present in great numbers, there being as a rule
from 500 to 2,000 of them, and as they unquestionably live at least eight
or ten years, the unfortunate victim suffers for a long period of time as
a result of their presence. While living in the intestines the females
lay enormous numbers of eggs which pass out with the feces, and under
suitable conditions of temperature and moisture there develops within
each of them, within from two to three days, a minute snake-like embryo
which bursts through the shell of the egg and passes into the neighboring
earth. Here the embryos live for considerable periods of time, and,
ultimately, may infect other individuals, or those from whom the eggs
were passed. There are at least two ways by which these embryos gain
entrance into the human body. Some do so by getting into drinking-water
and being swallowed; but, extraordinarily, they most frequently penetrate
through the skin. When this happens the parasite, in passing through the
skin, produces the disease known as "ground-itch." The vast majority of
the victims of this affection are children with whose skin the embryo
comes in contact while they go barefooted during the summer months.

_Course of the Disease._--Having entered through the skin, the embryos of
the hook-worm, moving by a circuitous route finally reach the intestines,
and, grasping hold of the mucous membrane with their saw-like teeth, they
begin to suck blood and grow until they reach the size of the adult worm
in about a month or six weeks. Depending upon the number which have
gained entrance, and the susceptibility of the individual, there now
begins to develop symptoms of profound anæmia; the skin of the child
becomes very pale, and assumes a sort of yellowish hue, and in cases
where there is a severe infection, the victim begins to suffer with
shortness of breath and dropsy. When this occurs the patient sometimes
dies, but more commonly death results from contracting some other
disease, which, under ordinary conditions, would produce no serious
results. One of the most unfortunate effects of this malady is that when
children become infected they cease to grow, and frequently retain the
appearance of early youth even after they have reached full maturity in
years. These unfortunates are generally incorrectly regarded as
dirt-eaters. The symptoms frequently last over a period of many years, as
in the intestines of these victims the worms that originally infect them
live certainly eight or ten years, and during this period it is beyond
question true that additions to the original number are frequently
received.

_Diagnosis and Treatment._--There is no disease that can be
diagnosticated with more ease and certainty; the eggs are present in the
feces in great numbers, and by means of a microscope they can always be
detected. In all cases where the disease is suspected, a half-teaspoonful
of the feces of the person supposed to be infected should be placed in a
bottle and sent to a competent microscopist for examination. This is done
free of charge at the laboratories of most State Boards of Health in
those parts of the country where the malady exists. Whenever an
individual shows the symptoms above detailed, an intelligent physician
should at once be called. We have medicines that act as specifics, and
the disease can always be cured in a very short period of time.

_Preventive Measures._--Of course the best method of preventing this
disease is to administer to those already infected the proper medicines,
and cause the expulsion from the intestines of the worms that lay the
eggs.

The indiscriminate scattering of the feces around the stables, so very
common in many districts, should be absolutely forbidden. Around the
house where individuals have lived who have the disease every care should
be taken to prevent contact with the earth in the neighborhood of places
where the ground might have become infected. It would be advisable for
children and others to wear shoes for at least a year after the last
individual having the disease was cured; and as a precautionary measure
it should be insisted upon that properly constructed privies or
water-closets should be at every house, and that they should be used by
everyone in whom there is a possibility that the disease exists.


DIPHTHERIA AND ITS TREATMENT.

Loeffler's discovery in 1884 of the germ of diphtheria, and its relation
to the disease of the same name, established the specific infectious
nature of this malady, and demonstrated beyond a doubt that membranous
croup is not ordinarily an independent affection, but is almost always
simply diphtheria of the wind-pipe. The discovery of antitoxin, some time
later, reduced the mortality of diphtheria from an average of 30% to 10%
in ten years; its use has also shortened the course of the disease, and
decreased greatly the frequency of the paralytic conditions that not
uncommonly follow this malady.

_Character and Course of Diphtheria._--Diphtheria is an affection caused
by a bacterial microbe which produces a poison that acts locally upon the
tissues invaded, and also, as a result of its introduction into the
general circulation, brings about more or less profound effects on the
entire system.

The period of incubation is from two to ten days. The onset is generally
characterized by a rise of temperature from 100°F. to 104°F., chilliness,
headache, and pain in the back and limbs. Albuminuria is common. The
glands of the neck often become swollen. In mild attacks a slight sore
throat is all that is complained of. In the majority of cases the disease
attacks the throat and tonsils, and is characterized locally by the
appearance of a membrane, which is usually gray or yellowish-white,
elastic, and adheres tightly to the surface upon which it lies. At
times, however, the membrane is soft and pliable, and is easily separated
from the tissue; such cases are frequently diagnosticated as follicular
tonsillitis. A bad cold is occasionally the only symptom of the disease.
The diagnosis should always be confirmed by bacteriologic examination. In
some instances the wind-pipe is primarily attacked, but when the disease
affects this part of the throat it is generally a consequence of the
extension of the membrane downward from the region of the tonsils. In the
former case the diagnosis is somewhat difficult, as cultures taken from
the throat may not show the presence of diphtheria bacilli, though
material that is coughed up may contain myriads of the germs; in this
phase of the disease interference with respiration is the symptom most to
be feared. The mucous membrane of the nose, eyes, ears and generative
organs, may be affected. Wounds are also liable to become infected with
this organism. In rare instances the membrane may extend down into the
bronchial tubes and lungs, and has been found on post-mortem examination
covering the inside of the stomach.

As complications we may have broncho-pneumonia, acute Bright's disease,
inflammation of the internal structures of the ears, bleeding from the
nose, inflammation of the valves of the heart, and sometimes paralysis of
this organ, with death; the last named sequel of diphtheria comes on
during convalescence, usually from two to four weeks after the subsidence
of local symptoms, and is due to inflammation of the nerves that control
the heart. Much less commonly paralytic conditions of the palate, throat,
eye muscles and the nerves of taste occur, and under rare conditions,
paralysis of the lower extremities. Paralysis of some kind follows in
from ten per cent. to fifteen per cent. of the cases, and appears with
equal frequency after the mildest as well as following the most severe
cases.

_Mode of Infection._--The germs of diphtheria may be carried in articles
used by persons with the disease, or they may be communicated by direct
contact. The micro-organism is found in the secretions from the mouth,
throat, or nose, and in particles of detached membrane. Bedding,
utensils, etc., used in the room where a patient has diphtheria, are
liable to carry the germs if taken from the sick-room, and consequently
should be always properly disinfected before being removed. Milk-bottles
carried into the sick-room, or handled by persons caring for the patient,
should never be returned to the dealer without being disinfected. Cats,
and less frequently dogs, may contract the disease and convey it to those
with whom they come in contact. Unrecognized mild cases are a frequent
means of spreading the disease, as also is a too early release of
patients after recovery. It is a much safer method of procedure to
require at least two negative examinations before releasing a patient
from quarantine, as during convalescence the germs may be entirely absent
on one day and a few days later be quite abundant. The bacilli may remain
in the throat from a few days to several years after the disease is
apparently entirely well, and under such circumstances the persons
carrying them become quite as great, if not a greater, menace to those
with whom they came in contact as they were during the height of the
disease. A thorough disinfection of the room and everything used about
the sick person should be carried out after the patient is released.
Complete isolation should be observed during the illness, and as long as
the bacilli remains in the throat.

_Treatment._--Diphtheria antitoxin is the specific treatment of this
malady, and should be given early in the disease. The chances of recovery
decrease in proportion to the length of time existing between the onset
of the affection and the time of administration of the drug. Antitoxin
may be repeated in six hours after the initial injection if improvement
is not noticed, but ordinarily twenty-four hours should elapse between
doses. It is well to remember that it is safer to give too much antitoxin
than too little. The initial curative dose varies from 2,000 to 5,000
units, according to the age of the patient and the severity of the
disease. When a case is seen late it is often advisable to begin with a
large dose,--it being good practice under such circumstances to use at
once as much as 10,000 units or even more. The average case requires from
the beginning to the end of the treatment a total of from 10,000 to
20,000 units, but occasionally 50,000 or even 100,000 units may be
necessary. There are very few risks in giving antitoxin. In a series of
50,000 cases treated with it only two deaths occurred sufficiently early
after the injections to warrant the belief that this unhappy result was
produced by the drug. It is worth remembering that asthmatic cases bear
the administration of antitoxin very poorly; a marked and sometimes
serious embarrassment of respiration, with cyanosis, unconsciousness, and
general collapse may follow its use, but recovery is usual in such cases.

     A condition known as anaphylaxis or hypersensitiveness, which at
     present is being much studied, may sometimes occur in the human
     being. This hypersensitiveness is manifested by the extraordinary
     peculiarity that any number of doses of antitoxin may be given
     provided they are administered within a period of less than ten or
     twelve days. On the other hand a single minute dose may induce this
     state after the period named, and, as we never know whether a
     patient is going to develop it or not, it becomes a question as to
     the safety of giving a second injection after ten or twelve days
     have elapsed following the administration of the initial treatment.
     As it is true that this hypersensitiveness once established in
     animals may continue throughout life, it becomes a question as to
     whether or not it is quite safe to administer antitoxin to an
     individual who has had the drug given him at some prior time, and
     we are not as yet in a position to definitely determine the risks
     that are involved in such a procedure. There is no reason to doubt
     that this hypersensitiveness is much less marked in man than in the
     lower animals, and there can be no question that it much less
     commonly develops, but notwithstanding this it would be the part of
     prudence to avoid a second administration of the drug after the
     interval referred to in all instances where this seems possible.
     Anaphylaxis is thus seen to bear an important relationship to what
     is commonly called the "immunizing treatment" to prevent
     diphtheria, which consists in giving a moderate dose of antitoxin
     to a person immediately after exposure to the disease. Under such
     circumstances a degree of immunity is undoubtedly secured, but this
     passes off in the course of a few weeks, and the patient then
     becomes just as susceptible as he was before. Should he now
     contract diphtheria, we would be confronted with the possibility
     that the treatment by means of antitoxin might possibly produce
     serious and even fatal results.

     Occasionally rashes occur several days after the inoculation, but
     such disturbances are insignificant except for the immediate
     discomfort experienced. Antitoxin concentrated by the Gibson method
     has reduced to a considerable extent the number of cases in which
     rashes occur.

Treatment other than by antitoxin is symptomatic. Where the disease
occurs in the wind-pipe, it may be necessary to pass a tube into its
upper opening to allow the patient to breathe, and in other instances the
wind-pipe is itself opened from the outside in order to permit a
sufficient amount of air to enter the lungs to maintain life.

It is of the utmost importance that patients be kept in bed until all
danger of complications has passed. Death from heart-failure several
weeks after the diphtheria in the throat is well, is not an uncommon
result of the disease, and is especially prone to follow even the
slightest exertion. Patients under such circumstances have been known to
die from raising themselves up in the bed.


CEREBROSPINAL MENINGITIS.

Meningitis, or spotted fever, is one of the most terrible and fatal of
all diseases, every case proving fatal in some local epidemics.

Although the cause of the disease has been known for a number of years,
the exact method by which the germ that produces it spreads from man to
man was until quite recently entirely unrecognized, and even now it
cannot be said that the whole matter has been demonstrated.

_Character and Course of the Disease._--Cerebrospinal meningitis is
produced by a minute vegetable (bacterium), the _Micrococcus
intracellularis_. This germ does not appear to occur normally in any of
the lower animals, nor has it been found in the outer world, and is
therefore to be regarded as distinctly a human parasite. It is very
fortunately a germ of low vitality, as it develops only at about blood
heat, and when expelled from its normal dwelling-place in the human body
it dies very quickly.

     The accompanying illustration shows how these bacteria appear under
     the microscope; the drawing was made from fluid taken from the
     spinal canal of a patient suffering from cerebrospinal meningitis.
     These germs get within the skull and spinal canal, and produce
     violent inflammation of the coverings of the brain and cord; these
     membranes are called "meninges," hence the name "cerebrospinal
     meningitis." Within a short time after their entrance pus is
     produced, and the condition becomes practically one of abscess
     around the brain and spinal cord.

In almost all cases the disease is preceded by a slight catarrhal
condition of the nose and throat, the symptoms being those of an
ordinary cold. The symptoms that point to the covering of the brain being
attacked come on with great suddenness; there is usually a chill,
followed by intense headache, vomiting, restlessness, with great dread of
noises and bright light; in many cases reddish spots appear beneath the
skin, and these are usually tender on pressure. In some cases the muscles
of the neck become very stiff, and contract so that the head is drawn
backward. The temperature is somewhat irregular, but is always above
normal in the beginning, and sometimes goes very high; the pulse as a
rule is normal, or but little accelerated. After the patient remains in
this condition for a period varying from a few hours to several days, he
generally becomes unconscious, and in a comparatively short time dies. In
some cases the symptoms after starting off very violently quickly
subside, and the patient makes a comparatively rapid recovery. In other
instances the disease begins more mildly, the patient having more or less
of the usual symptoms, but not so severely as is ordinarily the case; in
such cases the patient may die, after lingering weeks or months; or may
make a protracted recovery, frequently with partial paralytic conditions
that permanently remain.

     Unfortunately we possess no specific for this disease. Recently
     there has come into vogue a treatment by a serum supposed to have
     antitoxic power against this disease, but its exact value is, as
     yet, by no means settled; it must be used early if any good is to
     be expected from it. In addition to the antitoxin all that can be
     done is to keep the patient quiet with anodynes, and to minister to
     his comfort in every way possible. Ice applications to the head
     sometimes alleviate the intense headache. As the disease is
     practically an abscess around the brain and cord, perhaps the most
     rational treatment would be to open up the skull and let the pus
     drain away.

_Mode of Infection._--As this disease is one that is due to a specific
germ it is obvious that it cannot exist without the presence of this
organism; the malady is therefore infectious, and must necessarily be to
a certain extent contagious, notwithstanding the fact that it is
generally thought not to be so. The reason that the affection has not
been thought to be contagious may be explained by the following facts:
Recent investigation has shown that in many, if not all, instances of
this disease, the germ may be found in the nose and throat, where, as
has already been explained, it sets up a condition resembling an ordinary
cold. In all probability the infection takes place in the nasal cavity
first, and the germ ultimately finds its way to the coverings of the
brain. Now there is every reason to believe that in many, and probably in
a great majority of instances, the germ goes no further than the mucous
membrane of the nose, and the patient merely has as a consequence what he
considers an ordinary cold. It is clear, however, that if another
individual, who was very susceptible to this germ, should contract the
disease from this person, he might have the meningeal form of it. In
other words, it is probably true that the vast majority of people who are
attacked by this organism simply get colds as a consequence, and only now
and then does a person get meningitis as a result. This explains why the
disease does not ordinarily appear contagious.

The facts above stated are of much importance in combating the spread of
this disease. People who are exposed to those having meningitis should be
exceedingly careful not to get upon their persons any of the secretions
that come from the patient, and during periods of epidemics those who
observe a bad cold coming on should promptly consult their physicians,
and do everything to prevent the development of all catarrhal conditions
in their noses.

During epidemics persons with colds should be very careful not to allow
other people to become infected from them. As cold and wet are
undoubtedly predisposing causes to colds it is well for everyone to shun
such exposure during periods when meningitis is prevalent; debilitating
influences, such as alcoholic excess and lack of sleep, should also be
avoided.


HYDROPHOBIA.

This disease, as it occurs in man, is practically always conveyed by the
bite of some animal, the dog being the usual offender. The poison is
present in the saliva of the diseased animal and is transmitted through
wounds made by its bite.

As observed in the dog, there are two types of the disease,--one the
"furious," the other the "paralytic."

     _In the furious type_ the animal first appears to be restless and
     somewhat excited. He seeks dark places and apparently prefers to be
     by himself. In this stage of the disease the dog's appetite is good
     and may be excessive; he responds to orders although his attention
     can be attracted only for a moment at a time. As the malady
     progresses the animal becomes more and more restless, and develops
     a desire to tear those things about him into pieces. There is
     described a peculiar bark at this stage of the disease; instead of
     ending as it ordinarily does, it is prolonged and terminates in a
     higher pitched note simulating a cry. This is supposed to be very
     characteristic at this stage of the affection. The appetite
     gradually diminishes, food is refused, and swallowing becomes
     difficult. As the symptoms gradually progress the dog shows signs
     of delirium and begins to wander. As a rule, he goes about with his
     tail hung, mouth wide open, and with a wild look in his eyes,
     biting as he goes, anything that happens to be directly in his
     path; seldom does he turn aside to disturb anything or anybody. In
     the later stages of the disease paralysis generally develops,
     beginning in the hind legs and soon involving the body. If the
     animal be now carefully observed it will be seen that he cannot
     swallow. There is no dread of water, as the name "hydrophobia"
     implies, and as is commonly thought, the animal often attempting to
     drink, but owing to the paralysis of the muscles of the throat this
     is impossible. Inability then to swallow either water or solid food
     is one of the surest and most reliable signs of rabies. Weakness
     becomes very marked, and the animal finally lies down in a stupor
     and dies. The entire course of this type may last from six to ten
     days; generally it is four or five.

     _The paralytic type_ of the disease occurs in fifteen or twenty per
     cent. of the cases. The onset is, as a rule, the same as that
     observed in the furious type. Instead, however, of the dog
     beginning to wander, as previously mentioned, the animal becomes
     paralyzed, the paralysis first affecting the muscles of the jaw,
     later of the tongue. As is the case in the furious type of the
     disease, the animal loses the power to swallow both solids and
     liquids, but has no fear of water. The mouth remains wide open, the
     tongue protruding, and an abundant amount of thick saliva exudes.
     The animal remains quiet, does not attempt to bite any animal or
     individual. Death occurs on the second or third day of the disease.

_Precautions._--When an individual is bitten by an animal either supposed
or known to be rabid, the wound should be immediately cauterized with
some caustic, preferably concentrated nitric acid. This should be applied
without fear because it is safer to use too much than too little. In case
this is not available any strong caustic may be used. Punctured wounds
should be laid open with a knife and the surfaces freely cauterized. It
should not be forgotten that the slightest scratch from the tooth of a
rabid animal may lead to the development of hydrophobia in man, and it
therefore behooves all persons bitten by dogs to take every precaution
possible. Even though the animal at the time may appear to be healthy,
some strong antiseptic should be applied to the wound, and the animal
carefully watched until all possibility of his having the disease has
passed. Many persons have died from slight wounds inflicted by animals
appearing at the time to be perfectly well.

Attention should also be directed to the fact that wounds where the teeth
of the animal pass through the clothing are not so dangerous as those
where no such protection intervenes. Bites about the face and head are
much more frequently followed by rabies than those inflicted on the
extremities, and, of course, where wounds are deep the chances of
infection are much greater; where injuries of the latter kind are
inflicted it is practically out of the question to thoroughly cauterize
them, and the patient should immediately receive the Pasteur treatment.
It is probable that if thorough cauterization be not done within five
minutes that it cannot be relied on to prevent the development of the
disease; where there is any doubt the only safety lies in the Pasteur
treatment. Where a person is bitten by a dog supposed to be rabid the
animal should be caught, if possible, and kept carefully isolated for at
least ten days; should it appear well after the expiration of this period
no fear need be felt as to the results of its bite, but if it should die
the head should be cut off, packed in ice, and sent to some laboratory
for examination.

_Under no condition should the animal be killed, as the best possible
proof of the harmlessness of its bite would lie in its continuing to
live._

_Treatment._--Since the epoch-making researches of Pasteur, laboratories
have been installed in various parts of the world for the purpose of
making a vaccine by means of which it is possible, by gradual
immunization, to prevent the development of hydrophobia in persons bitten
by rabid dogs. This is done by a series of injections of a weak virus
prepared according to the directions of Pasteur. _It should always be
remembered that no harm can come from the treatment whether the patient
was bitten by a rabid dog or not, and that in all cases of doubt no
hesitation should be felt in resorting to it._




CHAPTER XIII

HYGIENE OF THE SICK ROOM


Far too little attention is generally accorded to the proper care of the
sick,--the prevailing opinion being that the royal road to recovery under
the circumstances is opened up only through the taking of drugs, and that
provided the appropriate ones be given in sufficient quantities recovery
will result. No greater mistake is possible. As a matter of fact, there
are very few diseases for which we have medicines that act in a specific
manner, and far more is usually to be hoped for from good nursing.
Fortunately the general public is beginning to recognize the truth of the
statements just made. It has only been a short time since the trained
nurse was unknown except in the larger medical centres, but now her
presence and beneficent influence is being felt from one end of the land
to the other, and her importance is destined to increase with the onward
march of time; she is undoubtedly the greatest advance that we have made
in medicine during the last decade.

Where persons are ill they should always be attended by a trained nurse
if possible, but if this is out of the question a few suggestions as to
the sick room and its hygiene should certainly not be omitted from any
book dealing with rural sanitation.

_Ventilation and Warmth._--The sick room if possible should be located on
the sunny side of the house, and should have fire in a fireplace if the
weather be cold. It is of the utmost consequence that the room have
windows and doors by means of which it can be at all times thoroughly
ventilated. At all seasons of the year a room on the lowest floor of the
house is more satisfactory, since it is warmer in the winter and cooler
in the summer. The room should not be uncomfortably cold, though it is
much better to have the temperature too low than to have the air stuffy.
In most diseases ventilation is of supreme importance, and should be
secured at any cost. Where, however, it is compatible with thorough
ventilation, a temperature of about 70°F. is generally considered most
desirable.

Before a patient is moved into a room all superfluous furniture should be
taken out, particularly carpets and hangings of all kinds. It is likewise
of the utmost importance that all insects, particularly flies, be
excluded by proper screening.

The patient's bed should be narrow, and a mattress is much to be
preferred to a feather bed. The mattress should be protected by a rubber
sheet or newspaper pads; oil-cloth cracks and wrinkles too badly to be of
service for this purpose. The rubber sheet should of course be kept under
the sheet nearest the mattress. The cover should consist of a sheet which
is long enough to fold back at the head over the other covering for some
distance, and blankets should be used for warmth in preference to quilts.
The bed should be kept scrupulously clean, and the linen and covering
should be removed when soiled. The nurse should see to it that
bread-crumbs do not remain in the bed.

In removing soiled bed-clothes the following plan is the one usually
adopted. The patient is moved to one side of the bed as near the edge as
possible, and the sheet beneath him loosened at the head and the foot and
on the opposite side; it is then rolled up toward the patient and pushed
well up under him, leaving the side of the bed opposite to that upon
which he is lying bare; upon this the new sheet is placed, which is then
tucked under the edges of the mattress, and the patient rolls or is
pulled back over on it. The soiled sheet is then removed and the edges of
the fresh one pulled over the portions of the bed still uncovered, and
secured in the usual way.

_General Precautions._--The room should also be kept scrupulously clean;
all sweepings should be burned. Soiled linen and all excretions from the
patient should be promptly removed, and if the latter need not be
preserved for the inspection of the physician, should be at once
disinfected and properly disposed of. Milk and other food should not be
left in the sick room; and soiled glasses and dishes should be removed
and washed at once in boiling water.

Persons who are ill should not be allowed to have company. There is
nothing more important in connection with the looking after patients with
infectious diseases than this precaution. The writer has often seen in
the country districts patients with typhoid fever and other infectious
diseases surrounded by the neighbors from miles around,--the entire
company often eating and drinking in the room occupied by the afflicted
person. The strain that results on the patient from a practice of this
kind might well in many cases have fatal consequences, and there is no
question whatever that many diseases, particularly typhoid fever, are
scattered in this way from house to house and from one community to
another.

The diet should be given regularly and should consist strictly of only
such things as are allowed by the physician.

All medicines should be given absolutely according to directions, as
otherwise having a doctor is worse than useless.

All patients should have a daily bath, special attention being given to
their hair, teeth, mouth and nails. In many cases it is necessary to
wash the patient's mouth frequently with some antiseptic wash. This
should only be done on the expressed instructions of the doctor.




CHAPTER XIV

EMERGENCIES AND ACCIDENTS


Few things are of greater importance, and nothing is more neglected than
instructing school-children how to act in emergencies. Particularly is
such knowledge of value in the country. In cities the need of
understanding matters of this kind is not so great, since it is usually
possible to secure at short notice some one capable of dealing with any
situation that may arise. Children very quickly grasp knowledge of this
character, and opportunities frequently offer for an actual demonstration
of the proper remedies in the case of accidents. When the instructor
speaks of cuts and burns they at once understand what is meant.

The most serious result of our neglect in this particular is that our
children pass through life with the most meagre knowledge of the proper
way in which to meet accidents of all sorts, for where they are not
taught during their school days they, for the most part, remain ignorant
of matters of this kind throughout their maturer years. It is much to be
hoped--though this is somewhat of a digression--that the old unscientific
and senseless system of teaching, which persists even in the present time
to a considerable degree, may in the future give way to a more rational
and practical plan of instruction--one that will deal with perceptible
needs rather than abstractions.

The most common emergencies will now be taken up and considered in
detail.

_Drowning._--The subject of drowning is one of especial interest in rural
districts, since it is here that accidents of this kind are most apt to
occur, and skilled attention is most difficult to obtain. It is of the
utmost importance to remember that people may be resuscitated after
having been under the water for considerable periods of time, and we
should, therefore, look upon no ordinary cases as hopeless until the
proper restorative measures have failed.

On removing the body from the water we should not waste time by
attempting to drain the water from the victim's mouth, as the amount of
this substance that enters the air-passages under such circumstances is
so trifling that it may be entirely disregarded. The drowned person
should be placed face down upon the ground with the head slightly turned
to the left, and we should begin at once with artificial respiration.

_Artificial Respiration._--This is accomplished by the operator kneeling
between the separated legs of the patient and placing his hands on the
small of his back, the thumbs nearly meeting at the middle of the spine,
and the other fingers spread out over the lower portion of the chest; the
operator then sways his body downward and forward slowly, counting three
during the movement, then quickly swinging backward releasing the
pressure on the patient's chest; again count three and repeat the
original movement. The pressure should be brought to bear from twelve to
fourteen times a minute, and the movement should be kept up until the
patient begins to show evidences of being restored, or until it is quite
evident that life is extinct.

This system of artificial respiration was originated by Professor
Schafer, as the head of a commission appointed by the British
Government, and is now universally regarded as being by far the most
satisfactory of all such methods.

In the accompanying figures are shown the positions assumed by the
patient and operator while carrying on artificial respiration.

It should be remembered that the victims of accidents of this kind suffer
considerably from lowering of the temperature of the body as a
consequence of the long exposure to water, and we should, therefore, also
direct our attention toward bringing about an immediate reaction by means
of warm blankets and hot bottles, and by vigorous rubbing of the
patient's body.

_Danger from Wounds._--Wounds may be produced by a great variety of
objects, but chiefly, of course, by cutting instruments. Where they are
caused by duller objects, producing more or less tearing and bruising of
the tissues, they are more apt to be followed by infection with
disease-producing germs than where smoothly cut, and consequently require
greater care in treatment. Germs sufficient to produce death may be
introduced into the body by the most minute wound; it is for example well
known that fatal consequences have resulted from the bites of various
insects, and the writer has personally seen a case where a pin-prick was
followed by lockjaw and death. Such facts teach us that we should be
careful in avoiding wounds of all kinds, and, that after they have been
received, they deserve attention, however insignificant they may appear
to be.

     Wounds resulting from objects more or less covered with dirt are
     particularly dangerous, since under such circumstances the germs of
     lockjaw are apt to be introduced into the body, and fatal
     consequences not uncommonly ensue. It is astonishing how frequently
     the disease just referred to follows where a barefooted child
     sticks a dirty splinter or a rusty nail into its foot, and it
     cannot be too strongly urged that it is the duty of the parent in
     such instances to call in a competent physician at once. The reason
     that injuries of this kind are so apt to be followed by lockjaw is
     that the germ that produces the disease lives practically
     everywhere in the earth--being especially common in the rich soil
     of gardens and other highly fertilized earths; and the germs are so
     minute that thousands of them might be present on the point of a
     pin without being visible to the naked eye. The bacilli of lockjaw
     do not grow at all where exposed freely to the oxygen of the air,
     and as a consequence of this fact we rarely see the disease that
     they produce developing after slight superficial wounds; much more
     commonly the malady results from a wound made by some penetrating
     object, such as a splinter of wood, a nail, or a pin.

     The lesson that these facts teach is that where wounds are small
     and deep it is the part of wisdom to cut them open freely in order
     that they may be cleansed as far as is possible, and at the same
     time allow the air to obtain free access to their deepest portions;
     a wound of this kind should not be sewn up, but should be left open
     and allowed gradually to heal up.

     The reason why lockjaw so frequently follows wounds from the
     premature explosion of fireworks is that the paper used in fire
     crackers, etc., often contains the germs of the disease and is
     driven deeply into the tissues. In view of the very considerable
     mortality that yearly occurs among the children of this country it
     seems incomprehensible that our legislatures--which commonly
     exhibit such an uncontrollable desire to regulate their neighbors
     in every possible way--should not long ago have placed the ban on
     fireworks of all kinds.

_Treatment of Wounds._--The treatment of wounds necessarily depends to a
considerable extent on their character and general severity: there are
certain practices, however, that apply in all cases, and should,
therefore, be resorted to wherever injuries of this kind occur. Where the
wound is superficial the bleeding is as a rule trifling in character,
and very quickly stops of its own accord. In other cases, particularly
where deep, larger blood-vessels may be severed, and if they be of any
considerable size, the hemorrhage will not cease until the subject
becomes exceedingly weak, and in some instances the bleeding will go on
until death results. Where bleeding is profuse, it may generally be
assumed that one of the larger vessels has been cut, and under such
circumstances it should be compressed until skilled assistance arrives.
There is a popular but very erroneous impression that arteries can only
be stopped by tying; as a matter of fact any one possesses sufficient
strength in the fingers to pinch them enough to stop the hemorrhage. If
possible, the operator should get his finger down into the wound, after
which he can quickly discover the exact point where pressure stops the
bleeding. One who is unaccustomed to surgical practices would, of course,
hesitate at doing this, but it cannot be too strongly urged that a
procedure of this character produces little or no pain after the finger
is first introduced, and that no one should be deterred by foolish
squeamishness from immediately doing that which in many instances can
only save the life of the victim.

     Where arteries are evidently bleeding--which may be inferred from
     the spurting character of the hemorrhage--a tight bandage above the
     seat of the wound, if on one of the extremities, will often be
     followed by a cessation of the bleeding, and where only small
     vessels are cut, a bandage tightly applied over the wound itself
     may accomplish a similar result. Under such circumstances the
     reader should be warned that it is not safe to leave a limb tightly
     bandaged in this way for any considerable length of time, as
     complete death of the part below may result. Where then a ligature
     is placed above or over a wound, it should be loosened cautiously
     every twenty or thirty minutes, and should be left off for a time.
     If the wounded artery begins to bleed, one should resort to local
     pressure upon it with the finger for five or ten minutes, after
     which the bandage may again be applied.

As soon as all bleeding has ceased, the wound should be thoroughly washed
out by means of water that has been boiled and allowed to cool; the
operation may be greatly assisted by using a rag or a piece of cotton
that was boiled in the water. If there be grease or other dirt that does
not readily come away soap may be freely used.

After the wound has been thoroughly cleansed, some sort of antiseptic had
better be applied. Unquestionably the best of all of these is tincture of
iodine, a small amount of which should be poured directly into the wound.
A saturated solution of carbolic acid in water is also a fairly good
disinfectant, and may be employed where the tincture of iodine cannot be
obtained. A solution of corrosive sublimate in water--one part of the
former to one thousand parts of the latter--is much used as an antiseptic
by surgeons, but when placed directly in wounds has a tendency to cause
much irritation, and is by no means so efficient as either of the
disinfectants just referred to. In the country it is an old custom to use
turpentine, or resins from several different species of pines; these are
fairly efficient antiseptics, and should be employed where it is
impossible to obtain those that are better. It should always be
remembered that thorough washing out with boiled water and soap is in
itself a procedure that will remove a considerable proportion of any
germs that may have got into the wound, and that if carefully done, it
is almost as efficient as the best antiseptic.

After the wound has been thoroughly cleansed by water and antiseptics, it
should then be bandaged with a cloth that has been previously boiled and
dried, if no regular surgical dressing is at hand. Every precaution
should then be taken to prevent it being reopened. Collodion is sometimes
used over small wounds, and is quite efficient in that it forms a coating
over any surface upon which it is placed that is impermeable to both air
and water. Small wounds that have been thoroughly cleansed and
disinfected with tincture of iodine may be safely and satisfactorily
closed by means of the substance just mentioned, but it should never be
forgotten that the germ of lockjaw--which is the one, ordinarily, most to
be dreaded in such injuries--lives and grows best in the absence of the
oxygen of the air, and that a covering of collodion would materially
assist in the development of this dreadful disease.

In those instances where pus forms in wounds, they should be at once
reopened and allowed to drain. It very often follows after
cuts--particularly if they be not properly cleansed--that a scab forms on
the outside, holding beneath a greater or less amount of pus. The
presence of the latter can generally be inferred by a wound presenting a
red and angry appearance around its edges, and from swelling and pain. As
soon as such a condition is observed, the scab should be thoroughly
soaked in water and removed, and it is then necessary that the wound be
kept open and allowed to drain freely until it heals up from the bottom.
A failure to observe precautions of this kind may result in
blood-poisoning, and finally even in death. After a wound begins to
suppurate it does little good to put antiseptics into it, as they cause
considerable irritation, and under no circumstances do they put an end to
the pus formation. Open drainage of the wound, and keeping up the general
health of the patient, are the only means that we possess of successfully
combating conditions of this kind.

Inasmuch as we possess an antitoxin that unquestionably has the power of
preventing lockjaw, if given sufficiently early, it is the part of
wisdom to administer at once a sufficient dose of this substance to any
child who has received a penetrating wound from some dirty object, or
from the explosion of fire-crackers. Statistics show that under such
circumstances lockjaw may be prevented in almost all cases. If we wait
until the disease develops, the antitoxin is of no value.

_Care of Sprains._--The seriousness of sprains is very generally
underestimated, and as a consequence many persons go through life with
ankles that are abnormally weak, and even painful in bad weather, and in
which there is a tendency to swell and become exceedingly troublesome
after a slight wrench. In all true sprains there is more or less actual
tearing of the ligaments that bind the joint together, and, if the injury
be not properly treated and the joint thoroughly supported, complete
recovery in many instances never takes place.

As soon as a sprain occurs the injured joint should be immersed in water
just as warm as can be borne, and hot water should be from time to time
added in order to keep the temperature sufficiently high. The bath should
be continued for several hours--the longer the better. Thus the pain and
swelling will be greatly reduced, and the tenderness which, in the
beginning, is so excruciating, will largely disappear. The next step is
to properly support the injured parts in order that unnecessary movement
may be prevented, thus avoiding further tearing of the ligaments. This
may be accomplished by means of various splints--the most popular being
those made of plaster of Paris, or silicate of sodium, either of which
will require the services of a physician in order to have them properly
applied.

     Within recent years a treatment has come much into vogue, which is
     exceedingly satisfactory, and has the advantage that it does not
     require the service of an expert in order to have it properly
     carried out. This consists in the application of strips of adhesive
     plaster to the skin over the seat of the injury and for some
     distance both above and below the joint affected. Ordinary
     sticking-plaster is not the best for this purpose, though in an
     emergency it might be used; much better is the so-called mole-skin
     plaster, which is much thicker, and does not require moistening
     before being applied. The plaster should be torn into strips about
     three-fourths of an inch wide and twelve to eighteen inches long.
     Where the ankle is the seat of the trouble, a strip is firmly
     applied to the back of the foot, beginning just behind the toes,
     and is brought around the ankle and carried up on to the calf of
     the leg--thus partially winding the plaster around the leg. The
     first strip having been applied, another is put on in a similar
     way, the edges of the latter overlapping those of the former. This
     is continued until one side of the ankle is fairly well covered,
     after which we may begin operations on the opposite side, carrying
     the strips around the leg in such a way as to meet and overlap
     those first put on. This process is continued until the entire
     joint is completely covered with the plaster. It is of the utmost
     importance that the foot be put in a natural position before we
     begin to apply the plaster, as, otherwise, it will be left in a
     constrained and uncomfortable position, which will do away largely
     with the good effects of the splint. Where carried out in the
     proper way it is in the highest degree astonishing to see how
     perfectly the joint is supported, with the effect that the use of
     the injured limb may be immediately resumed. The writer recalls
     having seen a young lady with a frightful sprain, who could not
     bear to touch her foot to the floor, improve to such an extent
     under the treatment as outlined that she was able to go to a ball
     and dance through the evening on the day the injury occurred.

Not only does the immediate resuming of the use of an injured limb, when
treated in this way, appear not to be injurious, but the ultimate
recovery seems actually hastened. After a day or so it is well to remove
the plaster splint first applied and put on another, as the former has by
this time usually ceased to fit the injured joint--owing to the
diminution in the swelling. The splint may be changed three, four, or
even five times, if deemed necessary, though two or three applications
generally amply suffice. _This or some other splint should be kept on the
injured joint for at least a month or six weeks, as otherwise complete
recovery frequently fails to occur, with the permanent weakening of the
joint as a consequence._

Of course it is always desirable to have a physician apply the splints
for a sprain where this is feasible, but with a little care it may be
done by any intelligent person who will observe closely the directions
given. The plaster should be put on moderately tight, but the utmost care
must be exercised in not carrying this to an extreme, as in such cases
serious results might ensue. In order that it may be determined as to
whether or not the splint is too tight, it is advisable to watch the
patient's toes for some hours after the plaster is put on, and should
they be found to be very cold, and particularly should they begin to show
a dusky discoloration, it is evidence that the strips are exerting too
much pressure, and they should be at once removed. Under such
circumstances, in a half an hour or so, the splint could be reapplied
with safety.

The mole-skin plaster, which is used in making the splint just referred
to, may be obtained in rolls of any width from all druggists; and as the
plaster keeps practically indefinitely, it should be in the
medicine-closet of everyone living at a distance from skilled medical
aid.

After a sprained ankle the patient should wear shoes that come well up
above the injured joint, and they should be laced tightly until some time
after all symptoms of trouble have disappeared; it would be on the safe
side to wear shoes of this kind from six months to a year, depending upon
the severity of the injury.

_Treating Bruises._--Bruises are not usually followed by serious
consequences if properly treated. They result from injuries that tear
the tissues beneath the skin to such a degree that hemorrhage from many
minute blood-vessels occurs in the injured part. In the course of a few
hours they often present a truly alarming appearance, being swollen and
greatly discolored, but they are not as a rule followed by any permanent
ill results. Where bruises are slight no treatment of any kind is
required, as in a short time the effused blood is absorbed, and the part
returns to a normal condition. Where more severe it is not a bad practice
to cover them with flannels wrung out from hot water, the same being
renewed from time to time, and the applications kept up for from six to
twelve hours. Usually at the end of this time the soreness and swelling
will have considerably abated, and the injured tissues quickly return to
a normal condition.

_The reader should be warned that under no circumstances should the skin
be opened, even though it may be quite obvious that there is a bluish
mass of blood immediately beneath._ Where this mistake is made, infection
of the injured tissues with the germs that produce pus inevitably
results, and as a consequence the patient suffers with a discharging
wound for a considerable period of time. In rare cases germs get into the
injured parts without the skin having been opened, and there results
under such circumstances a condition which closely resembles that of an
ordinary abscess. The probability that this undesirable complication has
arisen is shown by the swelling becoming greater and more painful some
days after the injury has occurred, and under such circumstances a good
physician should be at once consulted, as it will be necessary to make an
incision into the diseased area.

_Soothing Burns._--One of the most common and painful of injuries are
burns. Small superficial burns require no particular treatment. Where,
however, they are of sufficient severity to merit attention, the simplest
and best of all treatments is to immerse the diseased part in cold water,
and here it should remain at least some hours, or until competent medical
aid can be secured. Medical treatment of injuries of this kind is not
particularly satisfactory, though there are some drugs that may be used
with more or less benefit. Chief among them is picric acid, which may be
applied by means of a cloth wrung out of a one per cent. solution of this
substance in water. Another treatment which has some merit, and which has
long enjoyed a certain vogue among both medical men and the laity, is a
combination of equal parts of lime-water with either olive or linseed
oil; this is called carron oil and is applied in the same way as the
picric acid solution. All three of the remedies referred to act largely
by preventing the access of air to the burned surface, and they,
therefore, may be replaced by any bland and non-poisonous substance which
accomplishes like results.

_Accidents from Heat and Cold._--The climate of the United States is
characterized by extreme variations--there being over almost its entire
extent during the winter months a series of "cold waves," during which
excessively low temperatures are often experienced,--particularly in the
northern and western portions of the country. During the summer, on the
other hand, we have almost everywhere periods during which the
temperature goes very high--often accompanied by excessive atmospheric
moisture. As a consequence of these extremes in temperature it could only
be expected that we would often experience bad effects, so that serious
illness, and even death, occasionally result.

Of the two extremes, excessive heat is much the more dangerous, and is by
far more frequently followed by fatal results--particularly in crowded
cities. Fortunately for the dwellers in rural districts the precise
conditions under which excessive heat is followed by serious consequences
are not so frequently encountered as in the more populous centers, and as
a result we find that serious ill effects from high temperatures are by
no means so common in the former as in the latter. There are, however,
two quite well defined and distinct morbid conditions that are the result
of high temperatures, and inasmuch as they differ in their symptoms as
well as in their treatment, it will be necessary to consider them
separately.

_Sunstroke._--Sunstroke is characterized by a rapid onset, the patient
usually complaining of an uncomfortable sense of burning heat and a
feeling of dizziness and depression. Nausea, vomiting, and diarrhoea are
common, frequently an intense headache, and sooner or later a muttering
delirium. The patient's skin is dry and hot, the face is flushed, and the
eyes suffused, and a thermometer will show a bodily temperature of from
105° to 110° or even 112°F. In fatal cases it is usually some hours
before the patient dies, though sometimes he succumbs almost instantly.

When attacked, the patient should at once be removed to some shady place,
and should be held in a sitting posture against any suitable object that
may be at hand. The clothing should be loosened at once, and every
endeavor should be directed towards lowering the temperature of the
victim. This is best done by pouring ice-water or the coolest water that
can be secured freely over the entire body of the patient. This treatment
should be continued until the temperature approaches the normal--the
vigor of the measure employed gradually decreasing, as the patient shows
signs of getting better. Improvement is shown by a gradual return of
consciousness.

_Heat-Prostration._--Like true sunstroke, heat-prostration comes on with
an extreme suddenness. The patient becomes suddenly dizzy, and sinks to
the ground in a state of collapse. The skin is pale and cool, the pulse
limp and weak, and the thermometer shows the temperature to be somewhat
below normal. The patient should be laid on the ground in a cool, shady
place, and stimulants at once given. By far the most efficient of them is
a hypodermic injection of morphine and atropine, to which strychnine in
appropriate doses may be added.

_Guarding against Sunstroke and Heat-Prostration._--Excessive heat is the
basis of both of these conditions, but there are many contributing causes
which play a more or less important part in their production.
Notwithstanding the fact that they are regarded as being different, and
that the treatment and symptoms of the two conditions vary widely, there
can be no doubt that certain depressing influences, in every way similar,
play an important part in their causation.

     Foremost among such influences alcohol claims first place, and
     unquestionably not only predisposes to all diseases brought on by
     heat, but lends much greater gravity to an attack--the drunkard
     rarely recovering from true sunstroke, and frequently dying from
     the much less dangerous heat-prostration. It is said that the
     latter condition is particularly prone to occur after freely
     indulging in beer or other malt liquors. Not only does alcohol
     predispose to these morbid states, but other influences that
     depress the general vitality are more or less apt to predispose to
     the production of both, such as loss of sleep, overwork, worry,
     excessive eating, and insufficient food. The danger is greater when
     there is excessive moisture in the air, so that at such times we
     should particularly avoid excesses of all kinds, and as far as
     possible, keep out of the direct rays of the sun.

_Frost-bite._--In the extreme northern and northwestern portions of the
United States frost-bite is not uncommon in winter. The part attacked
becomes suddenly bloodless, presenting much the appearance of the skin
after death. The victim is usually not aware of the fact as at first
there is no pain. As soon as a condition of this kind is observed,--and
in cold countries persons are quick to inform the victim when they notice
it,--the place should be vigorously rubbed with a piece of ice, or with a
handful of snow, and this should be continued until the circulation again
returns as evidenced by the parts becoming reddened. A rapid warming of
the affected parts is not advisable, the result being not unlike that of
a burn.

_Chilblains._--Many persons suffer during the winter from
chilblains--this being a state in which more or less pain and itching is
produced in a part as the result of poor circulation. Such a condition is
usually the result of a combination of cold with the affected part being
more or less compressed, and as a consequence, we find that troubles of
this kind are more frequently in the feet--particularly where tight shoes
are worn. The remedy for troubles of this character is to wear
loose-fitting shoes, and to thoroughly protect the parts by appropriate
woolen socks. It is particularly of importance to change the socks often,
since as soon as they become moistened with perspiration a tendency to a
recurrence of the trouble is very great. Drugs are of no particular use
in conditions of this kind. Chilblains are more commonly suffered in
Europe than in America. One young American lady in Paris acquired them
one winter, and "knowing no better," as she told the writer, cured
herself by "boiling the chilblains"--soaking her feet in the hottest
water she could endure. The affliction did not return; and the novel
recipe was delightedly followed by all the art-students of the
neighborhood.

_Blisters._--Small blisters on the feet are not uncommon as the result of
wearing tight, or ill-fitting shoes. Wherever possible, they should be
quickly relieved from all compression, and should under no circumstances
be opened.

     The treatment is very simple and quite efficient, provided it be
     instituted while the skin is still intact, and consists simply in
     placing over the affected area a small piece of mole-skin plaster,
     which should extend for a short distance out on the normal skin
     surrounding the blister; the same sort of plaster should here be
     used as was recommended for supporting sprained joints, and is an
     article so useful that it should be kept in every house. Where
     blisters have ruptured, the better plan is to apply some
     antiseptic, like tincture of iodine, and after having allowed it to
     dry, stick on some plaster as already directed. If no antiseptic be
     at hand the plaster should be used any way, but it should be
     frequently removed in order to see that no suppuration is occurring
     beneath. Small blisters, the result of burns, may be treated in a
     similar way with good results.

_Tooth-ache._--Tooth-ache is a condition for which there is no excuse in
the present state of knowledge. As soon as decay begins in a tooth it
should receive the attention of a competent dentist, and where this is
done a true tooth-ache never occurs. Where one has been so neglectful as
to permit the exposure of the nerve of a tooth, he can only be saved from
much suffering by going at once to a dentist. In the meantime, various
measures may be adopted to diminish the pain. A piece of cotton dipped in
dilute carbolic acid and thrust into the cavity will almost immediately
relieve the suffering for the time being. Oil of cloves, or a mixture of
this substance with chloroform, applied in a similar way will bring about
a like result. The reader cannot be too often reminded of the fact that
bad teeth not only cause much suffering, but likewise lead to many
digestive disturbances, and as a consequence little could be of more
importance to the health of the body than to see to it that they be kept
in perfect order. Where teeth are knocked out, they will often grow back
and render good service for many years afterwards if replaced
immediately in their sockets.

_Bites of Animals._--Wounds of this character, particularly those
produced by dogs and cats, are not at all uncommon. Where it is
definitely known that the animal is not rabid, the treatment should be
that of punctured wounds,--to the chapter on which the reader is referred
for further information.

Where there is reason to suspect that the animal has hydrophobia, it
should be, if possible, at once confined, and watched for developments.
Under no circumstances should it be killed. If the animal is rabid, it
will be unable to eat or drink, and will die in the course of a few days;
should it survive not the least fear need be felt as to it having had
hydrophobia, as no instance is on record where the disease was followed
by recovery. For further information on this subject, the reader is
referred to the special article on hydrophobia (page 211).

_Hiccough._--Hiccough is a condition caused by a spasm of the diaphragm.
All methods for the relief of this somewhat annoying condition are based
upon the idea of having the patient hold his breath as long as is
possible. The remedy is best applied by the sufferer holding his breath
and leaning as far backward as is possible, and in the meanwhile
distracting the attention by pointing the index finger of one hand
towards the nose, and bringing the former toward the latter as slowly as
is possible. Sticking the tongue out and holding the breath at the same
time will often relieve hiccough, or if the victim can be induced to
sneeze the distressing symptom will at once cease. The _slow_ swallowing
of a few sips of water will frequently put an end to the trouble.




CHAPTER XV

WHAT TO DO WHEN POISONED


The vast majority of cases of poisoning occur in children, and are,
almost without exception, due to carelessness of their elders, and
therefore preventable.

As soon as it is recognized that anyone has swallowed a poison of any
kind, a competent physician should be summoned with the utmost haste, and
in the meantime much may be done, in most cases, to minimize the effects
of the substance taken. The patient should at once be urged to drink as
much water as is possible, in order that the poison may be diluted, and
every effort should be made to induce vomiting; this may often be brought
about as soon as the stomach is full of water, by tickling the throat
with the finger, or with any other object that can be readily introduced
through the mouth. As quickly as possible, some warm water should be
secured, to a quart of which either a teaspoon of salt or mustard should
be added, and the patient urged to drink until the stomach is thoroughly
distended; following this, particularly where aided by tickling the
throat, vomiting may be generally induced, with the effect, of course, of
expelling a greater or less proportion of the poison from the stomach. If
it be known that the poison is an _acid_, ordinary cooking soda should be
added to the water that the patient drinks, as in this way all acid
substances are at once neutralized.

If the patient has taken an _alkaline_ poison, he should immediately be
given diluted vinegar, or water into which the juice of lemons or oranges
has been squeezed; such harmless acids neutralize poisonous alkaloids
just as harmless alkalies antidote poisonous acids.

_Arsenic poisoning_ usually results from the accidental swallowing of
rat-poison or some insecticide, as Paris green, or else some sort of
green dye, many of which contain salts of arsenic in some form. An emetic
should be at once given, to be followed by the whites of several eggs
dissolved in a small amount of water; sweet milk may also be
administered with benefit.

Accidental poisoning by _phosphorus_, results usually from children
eating the heads of matches, and it is rarely the case that enough of the
substance is taken to produce serious results. The poison, however, is a
deadly one if taken in sufficient quantity, and where it is found that
substances containing it have been swallowed the most energetic measures
should at once be resorted to. Warm water containing mustard or some
other emetic should at once be given, and this should be followed by
whites of eggs and sweet milk. It is well also to try to get rid of any
of the phosphorus that might remain in the stomach by giving the patient
some saline purgative like Epsom salts.

Where _carbolic acid_ has been taken, the fact can be readily determined
by noting the characteristic smell of this substance on the patient's
breath, and by observing that the mouth and throat present a more or less
whitish appearance. The treatment to be of any avail, should be of the
most energetic character. The patient should at once drink largely of
water, and vomiting should be induced as quickly as possible. Either
milk or the white of an egg should then be given. Ordinary quick-lime, or
even plaster from the walls of the house, may be stirred up in water and
administered to the sufferer, as both have a distinct value in antidoting
the effects of this poison. Burns of the skin with carbolic acid are
rarely followed by serious consequences. As soon as the accident occurs
the part should be thoroughly washed with water, and if at hand a little
alcohol may be rubbed over the part; the affected tissues return to a
normal condition in the course of a short time in the vast majority of
cases.

_Strychnine poisoning_ is comparatively rare, except when this substance
is given with suicidal or murderous intent. Water should be given,
immediately followed by an emetic. A mass of crystals of permanganate of
potash as big as a pea may be administered in a glass of water, if this
substance be at hand. After the poison has been absorbed nothing is
usually of any avail if the amount was originally sufficient to produce
death.

One of the commonest forms of poisoning is from _opium_ in the form of
morphine, paregoric or laudanum. When this happens the stomach should be
washed out by water frequently, even where the drug was administered
hypodermatically. This is best accomplished by causing vomiting by warm
water to which a small amount of mustard has been added. The patient
should be given strong coffee or tea at frequent intervals, and
artificial respiration should be practiced. Where it is possible to
obtain it, permanganate of potash in a watery solution should be given,
enough of the chemical being used to make the water a deep purple color;
this may be frequently repeated, as the substance is not poisonous in
ordinary doses, and destroys morphine and other alkaloids of opium very
rapidly.

_It should never be forgotten that infants and children are poisoned by
comparatively very small doses of opium, and consequently nothing
containing any derivative of this substance should be given them except
on the advice of a competent doctor._

Many soothing syrups advertised for the relief of the minor ailments of
children contain opium, and there can be no doubt that many deaths have
occurred as a consequence of taking such nostrums.

_Mushroom poisoning_ in this country is relatively rare, but there are
quite a number of popular notions on this subject that are totally
incorrect, chief among which is the idea that there is a difference
between mushrooms and toad-stools, the former being generally regarded as
edible, and the latter poisonous. As a matter of fact, those conversant
with this subject make no distinction between the two, using the terms
toad-stool and mushroom as interchangeable. It is likewise a common error
to suppose that we possess any tests by which the poisonous toad-stools
can be told from those that are wholesome. Although a skilled student of
the subject can almost at a glance determine which are poisonous and
which are not, it is hazardous in the extreme to consume those selected
by one who is inexperienced. As a matter of fact, for all practicable
purposes, there is only one species that is generally eaten,--the
_Agaricus campestris_, or meadow mushroom. This grows for the most part
in open fields, and in many parts of the world may be gathered in great
number throughout the warmer seasons immediately following rains. This
mushroom has also the great advantage that it is the only one of the
edible species that can be cultivated.

Just as we have only one common mushroom that is ordinarily eaten, there
is only one common species of these plants that is highly dangerous,--the
_Amanita phalloides_, which contains one of the most deadly poisons
known--and one for which we possess no adequate antidote. This mushroom
is very common, being frequently seen along the roadside, and at the
edges of fields; it also grows in forests, and is occasionally
encountered in treeless areas.

     It presents a rather attractive appearance, being rather large, and
     having a glistening white cap with a long stem, around which there
     may always be seen a distinct collar; on carefully removing the
     soil from around its roots, it will be seen that its stem is
     surrounded just below the surface of the earth by a sheath-like
     structure, the so-called "death-cup," which, together with the
     peculiarities already mentioned, clearly stamp this mushroom as
     being one of the most deadly of all known natural objects. In
     addition to the rather inviting appearance of this toad-stool, its
     flavor is agreeable, thus in every way insidiously inviting, it
     would seem, the unwary to their doom. Less common than the species
     just considered is another closely related fungus known as the
     _Amanita muscarius_, or fly-agaric; this handsome mushroom presents
     the same peculiarities of structure exhibited by the _Amanita
     phalloides_, but differs from it in the fact that the tip of its
     cap is scaly, and is of a reddish-yellow color. The fly-agaric is
     quite as poisonous as its more common relative, and is equally to
     be shunned. The reader should be warned that even handling either
     of the fungi just considered may result in poisonous
     symptoms--probably as a consequence of multitudes of the tiny
     spores of the plants being carried into the nose and mouth by the
     air.

Some hours after eating the _Amanitas_, the patient is taken with
vomiting, diarrhoea, cramps, and extreme prostration; in children,
convulsions may occur. Most unfortunately evidences of this poisoning do
not usually develop until some hours after eating it. As a consequence, a
considerable amount of the poison has usually been absorbed into the body
before the victim is aware that anything is wrong, and it, therefore,
becomes impossible, as a rule, to greatly help matters by attempting to
remove the offending material from the stomach by emetics.
Notwithstanding this it would be proper to administer warm water, into
which a small amount of mustard had been stirred, in order to assist
nature by washing out of the stomach whatever portions of the fungus
might remain. When exhaustion begins to appear, it should be combated
with doses of aromatic spirits of ammonia, and by the external
application of heat. As it is believed that atropine possesses some
antidotal powers to the poison of the _Amanitas_, this substance should
be injected hypodermatically in the usual dose as quickly as possible,
and an experienced physician should be called at once.

_Ivy Poisoning from Touch._--One of the two species of _Rhus_, is
exceedingly common in all portions of the United States, producing a
severe inflammation of the skin when handled, or even in some persons by
merely being near the plants or in the smoke of a fire where they are
burning. There are two varieties of the _Rhus toxicodendron_, one being
the shrub commonly called _poison oak_, and the other a climbing vine
generally known by the name of poison ivy. The _Rhus venenata_ grows in
swampy localities all over the United States, and is known as
poison-sumac, swamp dog-wood, poison-elder, and poison dog-wood. About
twenty-four to forty-eight hours after the exposure, the skin begins to
itch, and this is shortly followed by an inflammation accompanied by the
formation of numerous small blisters, and still later by scaling. It
should not be forgotten that the berries and other portions of these
plants are poisonous when taken internally, giving rise under such
circumstances to vertigo, faintness, dilation of the pupils, trembling,
confusion of the senses, and, in some instances, convulsions. Should it
be discovered that anyone has been exposed to poisoning by these plants,
the skin should be washed as quickly as is possible with alcohol, or some
substance like whisky that contains it; where this cannot be obtained,
hot water and soap should be liberally applied--the object, in either
case, being the removal of as much of the poison as is possible. After
the irritation of the skin has begun, the parts may be bathed in a one
per cent. solution of carbolic acid, to be repeated every few hours, as
the necessities of the case may demand. Lead-water is also frequently
used with benefit, lime-water also appears to be of use, but the various
powders and salves sold in stores rarely help the patient much. The best
thing after all is soap and water as hot as it can be borne; and
ordinarily the itching and inflammation will disappear in four or five
days, followed by scaling.


VENOMOUS SNAKES AND SNAKE BITES.

Much popular misapprehension exists on the subject of snakes, both as to
the results of their bites and the appropriate treatment under such
circumstances. It is not generally understood that a very large
percentage of our American snakes are entirely harmless--the poisonous
ones being decidedly more the exception than the rule.

Within the confines of the United States there exist only two families of
venomous serpents. By far the most numerous are three genera of viperine
snakes, including the rattlesnakes and moccasins; all of these have a
pit-like depression between the nose and eyes, and hence are called
_pit-vipers_. In the southern portion of our country there are two
species of a colubrine genus closely related to the dreaded cobra of the
East, one of them being called the coral-snake or harlequin snake, and
the other, which occurs in the southwest, is known as the Sonoran
coral-snake.

While there are three genera of vipers in America, two of them are so
closely related, and present characteristics that are so similar that the
ordinary observer would regard them as being identical, and inasmuch as
the character of their poison seems in every way similar, for practical
purposes it would seem desirable to include them under one head; in both
genera, the species have rattles on the tips of their tails, the more
common being the ordinary rattlesnakes (genus _Crotalus_), of which there
are twelve species in the United States, and the ground-rattlesnakes
(genus _Sistrurus_), of which there are two species.

Closely related to the rattlesnakes are the true moccasins, of which
there are two species, one being the cotton-mouth or water-moccasin
(_Ancistrodon piscivorus_), and the other the highland moccasin,
pilot-snake or copper-head, (_Ancistrodon contortrix_).

The two species of poisonous colubrine serpents already referred to are
known respectively as the _Elaps fulvius_, and the _Elaps euryxanthus_,
both of which occur in the southern portions of the United States. These
snakes are fortunately of a very mild disposition, and rarely attempt to
bite, even when handled. That their poison is exceedingly deadly is
attested by the fact that out of eight instances where it was known that
persons were bitten by them, six died, and they should, therefore, be
looked upon as among the most deadly of North American serpents. Mention
should be made of the fact that there are at least six harmless reptiles
that resemble the coral-snakes very closely, and as a consequence of the
former being mistaken for the latter, the assertion has been frequently
made by the ignorant that our elapine serpents are harmless.

A short description of the really deadly reptiles encountered in this
country that would enable even the novice to distinguish them from those
that are harmless would seem not inappropriate here, for where a person
is bitten by a snake it becomes at once a matter of vital importance to
determine, if possible, its true character. Most non-venomous serpents
will viciously bite when cornered, and while they may produce slight
wounds, with a small amount of bleeding, such injuries are entirely
devoid of danger, and need occasion no fear on the part of the victim.
There now follows a brief description of our venomous snakes, by means of
which it will be easy for any one to distinguish them from their innocent
relatives.

_True Rattlesnakes._--There are twelve species of these reptiles in the
United States, all of which, with but two exceptions, live west of the
Mississippi. They vary very greatly in color, but the common eastern
forms generally have alternate transverse yellow and brownish-black marks
over their bodies. All possess rattles. The body of the snake is thick in
proportion to its length, and the head, which is more or less
diamond-shaped, is much larger than, and is quite distinct from the neck.
The pupils of the eye are elliptical--a peculiarity which the pit-vipers
alone possess of all the North American snakes. Between the eye and nose
there is a comparatively deep depression or pit which gives to this group
of snakes their name. There are two large, exceedingly sharp fangs in the
front of the mouth, in the position of a dog's canine teeth, that are
folded up against the roof of the mouth when the snake is in
repose;--being brought forward in a position for stabbing as the serpent
strikes. The scales on the under surface of the body back of the anus do
not divide along the middle line into two rows, as in harmless snakes.

_Ground Rattlesnakes._--There are two species of the pygmy or
ground-rattlesnakes. They attain to a length of only about twenty inches,
and present the general characteristics of the true rattlesnakes, with
the exception that the rattle is small, consisting of but one single
button at the end of the tail. These serpents are exceedingly vicious,
and usually bite without warning. Contrary to the general opinion,
however, the wounds they inflict are rarely, or never, followed by
serious consequences in man. One species is southern. The other occurs
from Ohio to Nebraska, where it is called massasauga.

_Cotton-Mouth Moccasin._--The largest specimens of the cotton-mouth
moccasin attain to a length of about six feet. The full grown reptile is
of a dingy brownish-black color, but the young are pinkish, with coppery
bands running transversely across the body. With the exception that this
reptile has no rattles, it answers in its general peculiarities to the
description already given of its near relatives the rattlesnakes. The
cotton-mouth moccasin is semi-aquatic, being found around the edges of
streams and other bodies of water.

_The Copper-head, or Highland Moccasin._--This serpent is found from
Florida and Illinois to southern Massachusetts; also in parts of Texas.
The largest specimens have a length of about three feet. They resemble
the cotton-mouth moccasin in their general peculiarities, being, however,
somewhat lighter in color. The head has a coppery tinge, from which the
snake gets its name, while the body is of a brownish color, with
transverse Y-shaped bands of reddish-brown. Its favorite habitat is rocky
hill-sides and the banks of mountain water-courses.

_Coral-snakes._--The two coral-snakes resemble each other very closely,
and are long slender serpents, whose heads are quite small, and scarcely
differentiated from their bodies. The pupils are round, and the head has
no pits. They possess two short permanently erect fangs, which are by no
means so well developed as those of the viperine reptiles--though perhaps
capable of inflicting more deadly wounds than any of the latter,--with
the possible exception of the diamond-back rattlesnake of the extreme
southern portion of the country. Their coloration is exceedingly
beautiful, and when properly interpreted, entirely characteristic. From
the head to the tail their skins exhibit alternate rings, or encircling
bands of black, red and yellow--each band of the two former colors being
bordered by yellow; _in other words there are as many yellow stripes as
there are both black and red together._ Stress is laid upon the
characteristics just mentioned, for the reason that half a dozen species
of harmless serpents that greatly resemble them may, without exception,
be differentiated from the true coral-snakes by the fact that there are
as many _black bands as both red and yellow_. Where a snake has been
killed, it is of course quite easy to determine whether or not it is
venomous by a search for the fangs, which are never present in the
non-poisonous reptiles. Fortunately, the coral-snakes are only found in
the extreme southern portion of the United States, live under ground for
the most part, and are rarely encountered.

_Treatment of Snake-Bite._--As soon as a person has been bitten by a
poisonous serpent, a tight bandage, or ligature of any kind, should be
applied above the wound if the injury has been received on any of the
extremities,--which is fortunately the case in the vast majority of
instances. The part bitten should be at once exposed, and search made for
the point of entrance of the fangs. It should be particularly noted as to
whether there are one or two wounds, as it is true in about one-half of
the cases that only one fang enters the flesh,--in which case, of course,
the probabilities of serious consequences resulting are largely
diminished. With a pocket-knife or other sharp instrument the wound
should be enlarged, and, if possible, someone should be persuaded to suck
the wound; this should not be done by one with decayed teeth, as under
such circumstances the poison might be absorbed and produce unpleasant
consequences. A doctor should be summoned as quickly as is possible, but
it must be confessed that in the present state of knowledge, unless he
should happen to possess--which he probably will not--some antitoxin for
the particular snake doing the damage, his services will likely be of no
great value.

     It has been asserted by some that very large doses of strychnine
     are directly antidotal to snake venom, but more recent experience
     does not tend to confirm this view; still there is no harm in
     making the trial, and if the services of someone capable of giving
     the injections can be secured, the treatment is certainly worth the
     trial. The immediate injection into the tissues around the wound of
     a one-per-cent. watery solution of chromic acid or potassium
     permanganate is thought to be of value by destroying the poison,
     but in order to be efficient it must be administered within a short
     time after the bite has been received. Should the patient's
     condition become serious, and the breathing finally stop,
     artificial respiration may be resorted to. As soon as the remedies
     suggested have been tried, it is time for us to go back to the
     ligature, which cannot be suffered to remain around the limb
     indefinitely, as by cutting off the blood-supply it will sooner or
     later produce death of the tissues. From time to time we should
     slowly loosen the bandage, thus allowing a little of the poison to
     pass into the body, and at the same time permit the entrance of a
     small quantity of blood into the tissues of the limb beyond the
     ligature; the bandage should of course be tightened at the end of a
     half a minute, and it should be alternately loosened and tightened
     every half hour until the patient is considered to be out of
     danger.

The reader cannot fail to have observed that nothing has been said
concerning the use of alcohol in the treatment of snake-bite, and the
matter is only here referred to for the purpose of condemning it as being
unsound in theory and bad in practice.

     The idea that this drug is of value in snake bite doubtless
     originally arose from the fact that those bitten by poisonous
     serpents were depressed, and, as in the past alcohol was considered
     the best of all stimulants, it is not surprising that its use was
     generally considered to be essential. As we now know, however, that
     alcohol is a depressant rather than a stimulant, and as numerous
     experiments carried out on animals have clearly shown that it does
     harm in snake bite rather than good, there is every reason why we
     should cease to endanger the lives of those already poisoned by
     adding to the trouble by using this drug. There is but little doubt
     that many more persons have been killed by the alcoholic treatment
     for snake bites than have died from the effects of snake venom.
     Inasmuch as there is a deep-rooted superstition among most people
     that alcohol is the panacea for snake bite--and such notions die
     hard--it may be well to say that all of the authenticated cases of
     this character that have occurred in this country have recently
     been collected, with the result that it was shown that only about
     one man in ten dies who is bitten by a venomous serpent, and it is,
     therefore, quite easy to understand why alcohol has maintained its
     reputation as being an antidote in such cases--the chances being
     nine to one in the victim's favor without any treatment whatever.

As soon as the patient's needs are attended to, it is well to find if the
snake that inflicted the wound was killed, and an examination of it
should at once be made as by determining the size and character of the
reptile an accurate forecast to the probable results may be made. In many
instances it will be found that the snake was not venomous, it having
made only a few scratches which are of no more consequence than the prick
of a brier. If it be found that the serpent inflicting the wound belongs
to one of the groups already referred to, the probabilities of a serious
result will depend upon the size and character of the snake, and also to
a considerable degree on whether one or both fangs entered the victim's
body. A full grown diamond-back rattlesnake, which may attain the extreme
length of eight feet, is perhaps the most dangerous of all the American
poisonous reptiles, though a fully grown coral-snake may be regarded as
almost, if not quite as, deadly. Next to these a large sized cotton-mouth
moccasin is perhaps most to be dreaded, to be followed, depending upon
their size, by the other varieties of rattlesnakes, the copperheads, and
finally the ground-rattler. The larger the serpent inflicting the wound
the greater is the result to be dreaded; naturally it also follows that
the larger the individual bitten the less the danger.




APPENDIX

RECIPES FOR COOKING COMMON FOODS

By DR. MARY E. LAPHAM

PREPARATION OF MEATS


_Roast Beef._--The problem of roasting beef is to have it sufficiently
cooked in the center without hardening and over-cooking the outside.
Burned edges and a raw center testify to a lack of intelligence.

The English way of baking beef is to allow nine minutes to the pound for
a rib-roast and eight minutes for a sirloin. Sprinkle pepper and salt
over the meat and sprinkle with flour. Pour a little boiling water into
the pan and bake in an oven hot enough to crisp and brown peeled raw
potatoes cooked in the same pan. Do not forget to baste often. This
method gives a rich flavor to the beef and the gravy, but the outside is
apt to be cooked too hard while the inside is not enough cooked. Too hot
a fire tends to make meat tough and dry.

The French have a safer way, especially for small roasts. The beef is
cooked in a cool oven--so cool that a peeled, raw potato will cook tender
without browning. Allow about an hour and a quarter for a four-pound
rib-roast. In this way the heat penetrates to the center without
hardening the outside. When properly done the outside is very little more
cooked than the inside, and the roast throughout is tender, rare, and
juicy, with no hard-burned edges. This way of baking makes inferior beef
more tender and juicy than the English way. It has the disadvantage of
not leaving any gravy in the pan. When baked after the English method the
fat fries out into the pan, and a delicious, rich, brown gravy may be
made by adding flour and water. Strain the juice through a fine sieve and
allow to stand a few minutes so as to be able to skim or pour off all the
grease. Do not serve gravies with half an inch of pure grease on top. It
does not require a scientific education nor a herculean effort to remove
the grease.

_Pot Roast._--If the beef is of an inferior quality, the best way to cook
it is in a heavy iron kettle, preferably with a sloping bottom. Sprinkle
the meat with salt and pepper; place a little fat in the bottom of the
kettle--enough to keep the meat from sticking--and allow the roast to
brown slowly for half an hour. Now put a pint of boiling water in the
pot. Cover very closely and let it simmer on the back of the stove for
about four hours, adding small quantities of hot water as necessary, and
turning often. When cooked take up the meat; skim the fat from the gravy
and thicken with flour.

_Hamburg Steaks._--Another way of preparing inferior cuts of beef is to
make Hamburg steaks. Chop the meat in fine pieces. Season with salt,
pepper and a little onion juice, and shape into thin cakes. Put three or
four slices of fat salt pork into a frying-pan, and when brown remove it
and place the steaks in the fat. Fry four minutes; turn, and fry three
more, and serve on a hot platter. Put a tablespoonful of flour into the
fat and stir until brown. Gradually add a cupful of water or preferably
milk and boil three minutes; season well, pour over the meat, and serve
immediately.

_Broiled Beef._--Broiling is the simplest, easiest, and most delicious
method of cooking meats, but, as a rule, ignorance instinctively turns to
the frying-pan, and broiling is unknown in many homes. This is partly due
to not knowing how to manage the fire. It seems so much easier to fry on
top of the stove than to plan beforehand an adequate preparation of the
coals. It is necessary to have a bed of clear, hot coals with no smoke.
Have the steak cut three-quarters of an inch thick; place in a wire
broiler; put over the coals and cover with a baking-pan. Turn every
minute or two until the meat is sufficiently cooked. When done, place on
a hot platter, and season well with salt, pepper, and butter. Serve
immediately. It should take about ten minutes to cook a steak or thick
mutton chop.

_Fried Beef._--If beef must be fried, have a hot fire; heat a thick iron
frying-pan and grease it just enough to keep the meat from sticking. Have
the meat three-quarters of an inch thick; place in the hot pan and turn
as soon as it is well seared. Turn often until done and then season well
and serve at once. There should be no gravy in the pan; all the juices
should be in the meat.

_Beef Hash._--Take equal parts of beef and cold potatoes, chopped
moderately fine. Chop a small onion and fry in plenty of butter until
brown; add the meat and potatoes and just enough milk to keep from
sticking. Cook for half an hour, stirring frequently. Serve with thin,
dry toast or toasted crackers. Poached eggs are a very nice addition.

_Veal._--Veal, when properly cooked, is delicious and delicate. Like pork
it should be cooked slowly for a long time to develop its full flavor.
Unfortunately it is usually half-cooked, tough, and insipid. The
housewife who can cook veal properly has a distinct advantage over her
less fortunate neighbor.

_Leg Roast of Veal._--Take out the bone and fill the space with stuffing
made as follows: Take one half-cupful of chopped fat pork, or unsmoked
bacon, and fry with a finely chopped onion until delicately brown. Add
two cupfuls of bread crumbs; season with salt and pepper and moisten with
a little milk. Tie the veal closely; sprinkle with pepper and salt; rub
thoroughly with flour and cover with buttered paper. Into the baking-pan
put a generous number of thin slices of unsmoked bacon, an onion and half
a can of tomatoes. Add just enough boiling water to steam the veal. Cook
gently in a moderate oven, allowing twenty-five minutes to the pound, and
baste very frequently, turning the meat about every half-hour. When done,
put it on a hot platter in the warming oven, and add enough water to make
the requisite amount of gravy. Thicken with browned flour, strain, and
pour over the roast.

_Fried Veal._--Fried veal steak or cutlets are delicious, but very
difficult to prepare properly. As a usual thing veal cutlets are either
half raw, or cooked until dry and hard. When properly cooked veal should
be spongy, soft, and velvety. The chops should be not quite a half inch
thick. Melt a little lard in a hot frying-pan; sprinkle some salt and
pepper on the veal and fry quickly until brown on both sides. Then cover
tightly, and place on the back of the stove and steam until thoroughly
tender. It requires from forty to forty-five minutes to fry veal.

_Broiled Veal._--The veal should be cut thin, broiled quickly until
brown, and seasoned with salt, pepper, and melted butter, to which a
little chopped parsley and lemon juice have been added. Serve on a hot
platter and eat at once. If the veal is fat, tender and nicely broiled,
it is almost as good as game.

_Veal Stew or Pot-pie._--Cut the meat from a knuckle of veal into pieces
not too small; put them into a pot with some small pieces of salt pork,
and plenty of pepper and salt; pour over enough hot water to cover it
well, and boil until the meat is thoroughly done. While the water is
still boiling drop in, by the spoonful, a batter made as follows: Two
eggs well beaten, two and a half or three cupfuls of buttermilk, one even
teaspoonful of soda, and flour enough to make a thick batter. Cover the
pot, and as soon as the batter is well cooked serve it.

_Veal Stew._--This is an exceedingly nutritious, economical, and
appetizing dish. Cut the veal into small pieces about an inch square; add
three or four thin slices of salt pork; one or two onions and potatoes
cut up fine, and a little turnip, carrot, parsley and celery, if you have
them. Cover well with boiling water and cook over a brisk fire until the
meat is tender and the water pretty well cooked away. This will require
about an hour. Cover the meat well with fresh milk; season to taste with
pepper, salt, and a generous quantity of butter; let the mess simmer on
the back of the stove about twenty minutes, and serve it in a hot covered
dish.

_Jellied Veal._--Jellied veal gives the impression of an expensive
preparation, and yet nothing is cheaper or simpler. Put a knuckle of veal
into a pot that can be tightly covered; season well with two or three
slices of unsmoked bacon, the heart of an onion, salt, pepper and a
little butter, adding just enough water to steam the meat thoroughly
(replenishing it from time to time as needed), and cook over a slow fire
until tender--probably about four hours. When done there should be about
two teacupfuls of broth. Prepare three cold hard-boiled eggs. Cut the
veal into pieces the size of a walnut. Now choose a dish just large
enough to hold the meat, the eggs and the broth. Slice the eggs and place
a few pieces on the bottom of the dish. Now put in a layer of veal; then
more egg and continue in this way until the veal is used. Strain the
broth over the veal and set it away in a cool place, preferably on ice,
until quite firm. When about to serve it, loosen by slipping a knife,
warmed in water, between the meat and the dish. Garnish with parsley or
lettuce, and serve with salad of any kind.

_Roast Pork._--Pork should be thoroughly cooked in a medium hot oven. For
the leg or the shoulder allow twenty-five minutes to the pound. For the
spareribs allow fifteen minutes. Sprinkle the spareribs well with salt,
pepper, sage, and a little chopped onion, or bake a few onions in the
same dish. Put a little water in the pan and add to it as it cooks away.
The leg, the loin, and the shoulder may be stuffed with well-seasoned
sage stuffing. To make this, cut a few strips of fat pork into small dice
and fry over a slow fire. Add a finely chopped onion and cook until
brown. Crumble as many slices of dry bread as you will need, and fry with
the onion and pork over a slow fire until nicely browned. Moisten a
little with milk or cream, and fill the space left by removing the bones.
Sew tightly together and bake thoroughly. Peeled, raw potatoes are very
nice baked in the same dish with the pork. A medium sized potato will
require a little over an hour to bake in a moderate oven. Apple sauce,
sauerkraut, or cabbage cooked with a little vinegar, are nice to serve
with pork.

_Broiled Pork._--Very thin slices cut from a leg of pork, or the cutlets,
or the chops, are extremely nice and delicate when broiled. They must be
cut thin; the coals must be bright and hot; and the meat turned very
often. Serve on a hot platter.

_Fried Pork._--For frying, pork should not be cut over a half an inch
thick: Cook slowly from forty minutes to an hour, with the pan closely
covered, to keep in the steam. Pork requires a long, slow process to
develop its flavor and tenderness. Nearly everyone cooks it too fast, and
for too short a time. When thoroughly steamed and nicely seasoned with
salt, pepper, sage and a little onion, well fed pork is as toothsome and
dainty as turkey. Make a brown gravy and pour over the meat. Serve with
apple sauce.

_Boiled Pork._--Take a leg of pork, or a shoulder, and remove the bones.
Tie closely together and let it cook slowly in a tightly covered pot for
half an hour, adding a little fat if necessary to keep the meat from
sticking. Now sprinkle with salt, pepper and sage. Put two whole onions
in the pot, and just enough boiling water to thoroughly steam the meat.
Place it on the back of the stove and cook over a slow fire for four or
five hours until thoroughly tender and velvety. When done put on a hot
platter in the warming-oven. Thicken the gravy with flour, adding a
little water or milk if necessary, then let it boil for five minutes and
strain. When properly cooked this is delicious cold, and almost as good
for salad as chicken or turkey. If desired, peeled raw potatoes may be
browned in the pot with the meat. These will take about an hour to cook.

_Curing Ham and Bacon._--To have good ham and bacon the meat must first
be properly cured so that the lean part is pink, tender and soft to the
touch, while the fat is clear and white. In many country homes the lean
meat is about as tough, hard, and indigestible as sole leather. A good
recipe for curing is as follows: For every gallon of water take two
pounds of coarse salt and one-half ounce of soda. Boil all together and
skim well, and, while hot, pour over the meat. Put in a cold dry place
with a stone to keep the meat well below the water. After three weeks,
hang the meat and let it dry for two or three days before smoking.

_Broiled Ham._--Nothing is more appetizing for supper than broiled ham,
served with mashed potatoes, milk toast, or a poached egg on dry toast.
Cut the ham as thin as possible, and broil quickly over hot coals,
turning constantly until the fat begins to shrivel. Have everything else
ready so that it can be eaten immediately. Cold cabbage salad is nice
with this.

_Boiled Ham._--If quite salty, soak the ham twenty-four hours. Put it in
a large kettle with a generous supply of water, and allow twenty-five
minutes to the pound for boiling. Take the pot from the fire and let the
meat remain in the water until nearly cold. Sprinkle with pepper and rub
thoroughly with brown sugar; put the ham and the fat from the liquor into
a baking-pan and brown for about an hour in the oven. Cut as thin as
possible when serving.

_Frying Ham._--Cut the ham in the thinnest possible slices, with a large,
sharp knife. Have the frying-pan hot, and cook the meat just enough to
give the fat a delicate brown, turning frequently. To cook ham too much
is to make it tough, hard, dry, and indigestible. Put the ham on a hot
platter in the warming oven. Add a cupful, or more, of fresh milk to the
grease and thicken with flour. Serve with boiled potatoes. Instead of
making a gravy, eggs may be fried in the fat. To do this nicely the fat
must not be burned. The eggs should be dropped in one by one, allowing
them plenty of room to spread out. Cook slowly and with a spoon baste the
yolks with the hot fat until they sear, being careful not to cook the egg
too hard. These eggs are very nice served on thin, dry toast, or one may
be placed on each slice of ham.

_Fried Bacon._--Cut the bacon into very thin slices, and cook in a hot
frying-pan just long enough to turn the fat to a delicate brown. If
cooked too long it is hard and indigestible, besides losing its delicacy
of flavor. A very nice way to cook bacon, instead of frying it, is to
roll the slices up into curls, skewer them with toothpicks, and place
them in a baking-pan on the grate of a hot oven until they are slightly
brown. Serve on dry toast. They should be eaten at once.

_Broiled Bacon._--Bacon can be broiled like ham. A very nice way to serve
it, especially for an invalid, is to toast it before the fire; split a
hot biscuit and make a sandwich with the bacon. Bacon toasted this way
and eaten when very hot has a peculiarly appetizing flavor.

_Unsmoked Bacon._--Cut in thin slices; roll in flour or meal; dust
lightly with pepper; fry over a moderately hot fire until delicately
brown and crisp, and put on a warm platter in the warming closet. Add
sufficient fresh milk to the fat to make the requisite amount of gravy.
Season with a little salt and pepper, and thicken with flour. Do not pour
over the meat. Serve in separate dish.

_Boiled Mutton._--Mutton should be cooked very much like beef,--just
enough to leave a faint pink, but not enough to make it hard and develop
a strong taste. For boiled mutton allow ten minutes to the pound. Add a
little rice to make the meat whiter and tenderer. Cover with boiling
water and cook rapidly for fifteen minutes; then place on the back of the
stove where it will simmer nicely for two hours. Young turnips, boiled
with the mutton are a very nice addition.

_Mutton Cutlets._--The chops should be thick. Grease the bottom of a hot
frying-pan just enough to keep the chops from sticking; place over a hot
fire, and turn the meat constantly to keep it from burning until the
center is a faint pink. Season with salt, pepper, and melted butter to
which a little lemon juice and parsley may be added.

_Roast Mutton._--The French roast mutton in a slow oven in order that the
heat may penetrate to the center without injuring the outside. Allow
twenty minutes to the pound, or, if a very large roast, twenty-five
minutes may not be too much, providing the oven is not too hot. Season
with salt and pepper, and put a generous supply of boiling water in the
pan. Baste frequently, and turn the meat every half hour. Place two or
three peeled raw potatoes in the pan, and watch them; if they begin to
brown, the oven is too hot. The potatoes should keep pace with the
mutton, and when the latter is half done the former should be cooked to
the same degree.

_Broiled Mutton Chops._--The chops should be cut an inch thick. Trim off
the fat and scrape the bones. Roll in a little melted butter or oil, and
broil over a hot fire, turning constantly until just pink within. Have
ready a mound of hot mashed potatoes and lay the chops around it. Pour a
little melted butter over them and serve with green peas.


PROPER COOKING OF CEREALS.

Starchy foods in any form must be well cooked. Gluey, slimy oatmeal, full
of hard lumps of half-cooked grains, the whole forming a raw, horrid
mass, is very different from the smooth, well cooked, easily digestible,
oatmeal prepared by a good cook. Rolled oats are more easily cooked than
oatmeal, as they are already prepared. For four people, put a quarter of
a teaspoonful of salt into four cups of _hot_ water and stir in slowly
one cup of rolled oats, being careful not to allow lumps to form. Cook
for an hour in a double boiler.

_Hominy._--Hominy is seldom well cooked. It is often lumpy and raw, and
yet has a burned taste which comes from being cooked in too little water,
while if too much is used it goes all to soup and can never be made good.
Salt a quart of boiling water, and very carefully stir into it a cup of
hominy. Stir often and add a little water from time to time if it gets
too dry. Cook until every grain is thoroughly done.

_Rice._--Rice is rarely well prepared, the greatest trouble being to get
each grain well cooked without making it mushy. When properly cooked each
grain will be firm and distinct, and at the same time soft and tender.
Wash half a cupful of rice thoroughly, put it in a quart of boiling
salted water, and let it boil for half an hour; then drain it thoroughly
and steam it in a colander for an hour.

_Corn-Bread._--Corn-bread should be something like rice: every particle
thoroughly cooked and soft, and yet not sticking together, so that the
inside is dry and crumbly while the outside is crisp and nutty. The
thinner corn-bread is baked the more perfectly it cooks. It should not be
more than an inch thick and preferably less. A cannon-ball of raw meal,
with only the thinnest of surfaces decently baked, is an insult to a
man's intelligence as well as to his digestion. This is the way to
prepare it properly. Sift a teaspoonful of baking powder into a pint of
corn meal. Mix in a piece of butter the size of a walnut and add sweet
milk until you get a dough that can be kneaded into a cake. Bake in a hot
oven until brown and well done. A little richer corn-bread is made by
heating a pint of sweet milk and pouring it over a pint of corn-meal.
Melt a piece of butter the size of a walnut, beat two eggs, add a little
salt, and mix well into the meal. Put in a shallow dish, and bake about a
half hour in a quick oven.

_Biscuits._--Biscuits should be thin, crisp, delicately browned and free
from flour. The inside of a biscuit should be flaky and dry. Thick,
soggy, heavy biscuits impose a severe task upon digestion. Make the
biscuits about two inches in diameter, and three-quarters of an inch
thick. Bake them brown on both the top and the bottom. It is much easier
to make light, wholesome biscuits with baking-powder than with soda.
Buttermilk biscuits are very delicate and palatable, but not quite so
certain to turn out well. If soda is not properly used you will have a
yellow, evil-smelling compound, or else there will not be enough soda to
make the biscuits rise, and they will be dangerously heavy. To make
soda-biscuits sift one level teaspoonful of soda, one half-teaspoonful
salt, and one quart of flour together three times so as to get the soda
thoroughly well mixed in. Now rub two tablespoons of lard into the flour
and add enough buttermilk to make a soft dough. Roll out into a sheet,
cut into small thin biscuits and bake in a hot oven until well browned.
Baking-powder biscuits are made in the same way, by using two
teaspoonfuls of baking-powder in place of the soda, and sweet milk
instead of buttermilk.

_Yeast._--Put three hops in a pot containing two quarts of cold water.
Place on the stove and see that it boils twenty minutes. Have a pint of
flour in a large bowl and mix into it a tablespoonful of sugar, one of
salt and a teaspoonful of ginger. Strain the water from the hops into
this, stirring constantly. Allow it to cool. When lukewarm put in a cup
of yeast or a yeast-cake.

_Rolls._--At night take one half-cup of lukewarm water, one
half-teaspoonful of salt, three-quarters of a cup of yeast, and enough
flour to make a thin batter. In the morning add to this a pint of milk, a
teaspoonful of sugar, a half-cup of butter and beat in flour until it is
no longer sticky. Set it in a warm place to rise and when well up knock
back. Repeat this process, and when it comes up the third time make it
into rolls. Let it rise once more and then bake it.


METHODS WITH CHICKEN.

The simplest and easiest way to cook chicken is to fry it. A poorly fed
chicken is better stewed. For baking and broiling the chicken must be
fat. In whatever way the chicken is cooked there is danger of its being
tough, dry, stringy, and tasteless. Plain, artless, boiling results in
insipidity. Quick, superficial frying means tough stringy fibres; and a
hot oven frequently dries the meat until it is not fit to eat.

_Fried Chicken._--All housewives think they can fry chicken, but the
results are vastly different, according to the way it is done. You may
have a tender, rich, delicious morsel, or tough masses of meat, stringy,
tasteless and almost impossible to chew. Of course the condition of the
chicken has a great deal to do with the results. A tender, well-fed
chicken will fry far better and much more quickly than a thin, scrawny
one. The thinner the chicken the greater the necessity for care in
cooking it. It must be cooked slowly, over a moderate fire, in a tightly
covered pan, until it is perfectly tender. Melt a little fat in the
frying-pan; flour, salt, and pepper the pieces of chicken and fry them in
the fat until nicely browned on both sides. Now cover closely and place
on the back of the stove where the chicken will steam for half an hour.
When tender take up on a hot platter and put in the warming oven. Make a
rich, brown gravy and pour over it.

_Boiled Chicken._--Chickens may be boiled whole or cut into pieces. To
boil whole place a few pieces of unsmoked bacon in a stew-pan that is
deep enough to hold the chicken and can be tightly covered. Cook slowly
for an hour without adding water, turning it often until it is evenly
browned. Now add a small onion, some raw peeled potatoes not larger than
an egg, and a little boiling water. Cook over a brisk fire for
three-quarters of an hour. Salt and pepper the chicken and put it and the
potatoes in a baking-dish in a hot oven while making the gravy. A couple
of hard-boiled eggs chopped very fine, and a little chopped parsley,
improve the gravy.

_Baked Chicken._--A properly baked chicken is tender, juicy, and has a
rich flavor, while one improperly baked is tough, dry, stringy, and
tasteless. To bake a chicken properly the oven must not be too hot; the
chicken must be repeatedly basted, and cooked until it is tender, but not
until all dried up. Stuffing the chicken improves the flavor. To make the
dressing, melt enough of any kind of wholesome fat in a hot frying-pan to
keep the bread crumbs from sticking, and fry in it a large onion,
chopped fine, until it is tender. Place the dry bread-crumbs into the
fat, and cook for half an hour over a slow fire, stirring often to keep
from sticking, until the crumbs are slightly browned and well dried.
Season with salt, pepper and a little celery-salt, and moisten with just
enough milk to make it stick together. Always taste the dressing to see
if it is properly seasoned. A well-fed chicken can be baked more rapidly
than a thin one. If the chicken is thin add plenty of fat to the water in
the baking-pan; cover closely and cook slowly and carefully until it is
tender, turning very often; if it is fat and well-fed put plenty of
wholesome grease in the baking-dish, and without covering it, cook in a
hot oven, basting frequently. A young, fat chicken will bake in an hour.
An older fowl may require two or three hours. It is a good plan to allow
the chicken plenty of time and then, if done too soon, to cover it
closely and keep it warm on the back of the stove. Use just enough water
while baking to keep the fat from sputtering. If the water is cooked out
towards the end, and the chicken is thoroughly basted, the skin will take
on a rich, thick glazing that is highly creditable to the skill of the
cook. Delicious gravy can be made of the fat by adding milk and
thickening with flour.

_Smothered Chicken._--Use a frying-size chicken. Split it down the back
and rub with a little salt. Put it in a pan with a slice of bacon and a
pint of water. Cover the pan closely and let it simmer on top of the
stove from one to two hours, or until the chicken is thoroughly tender.
When done sprinkle with flour and baste well. Add a small tablespoon of
butter, and put in the oven and cook until brown.

_Broiled Chicken._--A young, tender, fat chicken is better broiled than
any other way. It has a finer flavor; is tenderer, more juicy and more
easily digested; in fact broiled chicken is one of the most delicious
dishes that can be served. There is no earthly use, however, in trying to
broil a chicken that is not fat and nice. If the chicken is a little too
old to broil whole the breast will still be tender. Flatten the chicken
by pounding it. Have a bed of clear, bright coals and a hot gridiron well
greased to prevent sticking. Cover with a baking-dish and turn often,
allowing the bony side to stay down longer than the other side. From
fifteen to twenty minutes should be enough, but it is always best to test
with a fork by pulling the fibres apart to see that they are not raw. As
soon as the raw look has disappeared the chicken is done. The least
over-cooking injures the flavor. Serve on a hot platter. Pour over a
little melted butter, seasoned with lemon juice and chopped parsley.

To bake or boil a turkey proceed the same as for chicken, simply allowing
more time. An eight-pound turkey will require three hours to roast.


MAKING GOOD SOUPS.

_Vegetable Soups._--The simplest and most easily prepared soups are those
made from peas, beans, tomatoes, asparagus, celery, carrots, onions, and
potatoes. They require neither meat nor any previous preparation, but can
be made and eaten at once. These soups are somewhat paradoxical because
they are both cheap and rich; deliciously simple and simply delicious.
Take enough of any of these vegetables to furnish sufficient soup after
they have been rubbed through a strainer and thinned with milk or cream.
Cook the vegetables thoroughly until perfectly soft, so that they can be
easily rubbed through a coarse strainer. Add enough milk to this purée to
make it about the thickness of cream. Season with salt, pepper, and a
little celery-salt, and serve with bits of bread browned crisp in the
oven.

When the vegetables can be got fresh from the garden nothing is more
delicious than these soups, and in winter, canned peas and dried beans
make excellent substitutes. In making potato purée two onions boiled with
the potatoes improve the flavor. Potato soup without onion is tasteless;
a little celery boiled in with the potatoes and onion, makes it still
nicer. Tomato soup is also better slightly flavored with onion and a
little carrot. A little cold boiled rice, simmered for a half-hour in the
soup after the milk has been added, is an excellent addition. These soups
are also delicious when made rather thin with milk and then thickened by
putting the well-beaten yolks of two eggs into the hot soup-tureen, and
stirring vigorously while adding the soup; this last soup must be served
at once, as it cannot stand after the eggs are added.

_Meat Soups._--These soups should always be made the day before required
in order to thoroughly remove the fat, which cannot be done until it
hardens on the top of the soup. Nothing is more disgusting than greasy
soup. The foundation for an infinite variety of soups is made by boiling
about a pound of meat in three pints of water. After the meat is cooked
to pieces strain it out and keep the well-skimmed liquor, or "stock," as
it is called, in a stone jar in a cool place. It should form a jelly, and
in order to prepare a different soup for each day, it is only necessary
to heat some of the jelly and flavor it differently. For instance: Chop
fine one small onion to each person and fry it in butter, or in some of
the grease taken off the soup, until tender and slightly brown. Pour over
enough stock and let stand for half an hour. Serve with a little grated
cheese. Cabbage soup is made in the same way except that it takes longer
to cook the cabbage. Instead of one vegetable several may be used.
Turnips, cabbage, onions, and carrots in about the same proportion,
chopped fine and fried tender, without any water, and added to the soup,
make what is known in France as Julienne soup.


EGGS IN SEVERAL FORMS.

_Coddled Eggs._--The most delicate way to cook an egg is to coddle it.
Put six into a vessel that will hold two quarts. Fill with boiling water,
cover closely, and let it stand in a warm place for ten minutes. If you
desire them better cooked let them stay in the water longer. If you want
to do but one egg, put it in a quart of boiling water, cover and let
stand five minutes.

_Shirred Eggs._--To shirr an egg break it into a saucer or any small dish
that has been well greased. Put into a hot oven and leave until glazed.
Season and serve at once.

_Scrambled Eggs._--Heat a teaspoonful of milk to each egg in a sauce-pan
not more than a quarter of an inch deep and about the right size to hold
the quantity of eggs desired. Add a little salt, pepper, and butter. When
hot put in the eggs, and as they lie on the bottom of the pan, scrape off
with a spoon letting the raw part take the place of those portions
already cooked, and continue this until a creamy custard is formed. Be
careful not to cook the eggs so long that this custard is changed to a
hard mass.


PROPER COOKING OF VEGETABLES.

The general tendency in cooking vegetables is to use altogether too much
water so that they become soaked and tasteless. The ideal way to cook
most vegetables is to use as little water as possible; just a little in
the bottom of the pot so that the vegetables will not stick and burn, but
steam through in their own juices until thoroughly tender and full of
their own flavor. The fire should not be too hot; the pot should be
tightly covered; a sufficient amount of butter must be added when the
vegetable is about half done; and plenty of time given to allow it to
simmer and steam until thoroughly flavored. Onions, beans, carrots, and
cabbage are most delicate when chopped fine, cooked until tender in a
very little water, seasoned with salt, pepper, and butter, covered with
milk, and allowed to stand on the back of the stove for twenty minutes
until the flavor is thoroughly developed.

_Boiled Potatoes._--Potatoes should not be peeled before boiling, but
should be thoroughly washed and rinsed. They should be put in an
abundance of boiling water, well salted, and covered tightly. When tender
pour off all the water, cover the pot with a towel and let it stand on
the back of the stove for ten minutes.

_Baked Potatoes._--If baked potatoes stand they lose their flavor. A
baked potato, eaten as soon as done, is sweet, dry and mealy. Allow them
to stand even for ten minutes and the flavor is lost, and they become wet
and tasteless. A pleasant change is to peel the potatoes before baking.
These must be eaten as soon as they come from the oven or they lose their
crispness.

_Beans._--Nothing is more valuable for winter food than beans. They give
as much strength as beefsteak and are far less expensive. Soak them in
plenty of water over night; add a generous piece of unsmoked bacon; let
simmer on the back of the stove until they are tender and the water is
well cooked away; cover with milk, and either let them stand on the back
of the stove until the milk is thickened, or put them into a shallow
baking-dish and bake until nearly dry. Serve either hot or cold.


SOME CAPITAL DESSERTS.

_Apple Pudding._--Peel and slice enough apples to nearly fill your
pudding-dish, sugar to taste, and grate over them a little nutmeg. Also
add a little water. Now make a batter as follows: Three quarters of a cup
of sugar; a piece of butter the size of a small egg, one half-cup of
milk, one egg, a pinch of salt, a teaspoonful of baking-powder, and one
and one-eighth cups of flour. This is an extremely nice, wholesome
pudding, which can be served with either cream or hard sauce.

To make hard sauce take a half-cup of butter and cream it with a fork;
add a cupful of sugar and beat until nicely mixed and creamy. Flavor to
taste and sprinkle a little nutmeg over it.

_Cottage Pudding._--One cupful of sugar, one tablespoonful of butter, one
half-cupful of milk, two eggs, one and one-half cupfuls of flour, and one
teaspoonful of baking-powder. For the sauce, take three and a half
cupfuls of boiling water and stir in it a cupful of sugar, and a
tablespoonful of either flour or corn-starch rubbed smooth with a little
cold water. Cook well for two or three minutes; take the pan from the
fire, add the butter and flavor as you prefer.

_Batter Pudding Boiled or Baked._--One quart of milk, six eggs beaten
separately, six tablespoonfuls of flour worked gradually into the yolks
of the eggs, and a pinch of salt. Bake or boil about three-quarters of an
hour. Serve with sauce.

_Cream of Corn-starch._--One quart of milk, four eggs, one half-cupful
sugar, four tablespoonfuls of corn-starch dissolved in a little milk.
Into a pint of the milk put the sugar, and place on the stove to heat.
When very hot gradually stir in the corn-starch and beat well. Have ready
the whites of the eggs, and beat them into the milk; flavor as preferred.
Take the other pint of milk, the four yolks and four light tablespoonfuls
of sugar, and place them over the fire, stirring constantly. This makes a
nice custard. Just before serving pour the custard over the pudding.

_Caramel Custard._--One egg for each person; also one teaspoonful of milk
for each person. Put the yolks and milk together with a tablespoonful of
sugar to each egg. Have ready some caramel, and stir in enough to give a
decided flavor. Put this into cups or baking-dishes, and set in a pan of
hot water on top of the stove for twenty minutes; then in the oven until
the custard sets. Serve cold. For the caramel, take two cupfuls of sugar
(preferably brown) and put it in a frying-pan with a teaspoonful of
water. Cook until well burned. Add a cup of water, and, when cold, put it
in a bottle or fruit-jar. This quantity will last a long time.

_Brown Betty Pudding._--Take a cupful of grated bread-crumbs, two cupfuls
of finely chopped, tart apples, half a cupful of brown sugar, a
teaspoonful of cinnamon, and one tablespoonful of butter. Butter a deep
pudding-dish, and put a layer of apples on the bottom; then sprinkle with
sugar, cinnamon and bits of the butter. Put in another layer of apples,
and proceed as before until all the ingredients have been used. Cover the
dish and bake for three-quarters of an hour in a moderate oven; remove
the cover now and brown the pudding. Serve with sugar and cream.

_Rice Pudding._--One cupful of boiled rice (better if still hot), three
cupfuls of milk, three-quarters of a cup of sugar, a tablespoonful of
corn-starch, and two eggs; add flavoring. Dissolve the corn-starch with a
little of the milk, and stir it into the rest of the milk; also add the
yolks of the eggs and the sugar beaten together. Put this over the fire
and when hot add the rice. Stir it carefully until it begins to thicken,
then take it off and add the flavoring. Put it into a pudding-dish and
bake in the oven.


THE END




INDEX


  A

  Accidents, 223.

  Acid, carbolic, for _Rhus_ poisoning, 260;
    in wounds, 231;
    poisoning by, 253;
    of fruit, 133, 146;
    picric, 241;
    uric, 149.

  Acrodinia, 9.

  _Agaricus campestris_, 256.

  Air, 181.

  Air-space, 45.

  Albumin, 105.

  Albumins, 98, 104, 117, 131.

  Alcohol and its effects, 155;
    for _Rhus_ poisoning, 260;
    of no value in snake-poisoning, 270;
    predisposes to consumption, 183;
    predisposes to heat-prostration, 244.

  _Amanita muscarius_, 258.

  _Amanita phalloides_, 257.

  Ammonia, aromatic spirits of, 259.

  Anaphylaxis, 204.

  _Ancistrodon contortrix_, 263.

  _Ancistrodon piscivorus_, 262.

  Animals, bites of, 249;
    location of quarters, 61.

  _Anopheles_, 41, 171, 174.

  Antidotes for poisons, see under names of poisons.

  Antiseptics, 231, 247.

  Antitoxin, for diphtheria, 198, 203;
    for lockjaw, 233.

  Apples, 147.

  Arrowroot, 112.

  Arsenic, 252.

  Arteries, 229.

  Artichokes, 136.

  Asparagus, 142.

  Atropine, 259.


  B

  _Bacillus tuberculosis_, 179.

  _Bacillus typhosus_, 186.

  Bacon, broiled, 282;
    curing of, 280;
    fried, 282;
    importance of, 121, 122;
    unsmoked, 282.

  Baking, process of, 166.

  Baths, for sick people, 221;
    hot and cold, 13;
    importance of, 12;
    sea, 5.

  Beans, bad, give lathyrismus, 9;
    how to cook, 294;
    value of, 133, 134.

  Bed-bug, 9.

  Bedmaking, 219.

  Beef, broiled, 275;
    fried, 275;
    Hamburg steak, 274;
    hashed, 276;
    pot-roast, 274;
    roast, 273;
    value of, 20.

  Beer, 162.

  Beets, 136, 138.

  Beri-beri, 113.

  Beverages, 30;
    alcoholic, 32;
    medicinal, 33;
    "soft drinks," 32.

  Biliousness, 93.

  Biscuits, 285.

  Bites of animals, flies, mosquitoes and snakes, see under several
  subjects.

  Bleeding, how to stop, 228;
    in consumption, 180;
    in typhoid fever, 187.

  Blisters, 247.

  Blood-vessels, 95.

  Bottle, for infants, 73.

  Brandy, 160.

  Bread, and its relations, 104;
    baking of, 166;
    corn-bread, 108, 111, 285;
    diseases derived from decomposed, 9;
    graham-bread, 107;
    rye-bread, 108;
    why wheat-bread is the best, 106.

  Bricks, 40.

  Bright's disease, 95, 145, 156, 157, 158, 163, 173, 201.

  Broncho-pneumonia, 201.

  Bruises, 238.

  Brussels-sprouts, 139.

  Burns, 240.

  Buttermilk, 150.


  C

  Cabbage, 138.

  Cake, 115.

  Calomel, 94.

  Calories, 102.

  Carbohydrates, 98.

  Carron-oil, 241.

  Carrots, 136.

  Cat, conveys diphtheria, 10;
    harbors tapeworms, 10.

  Cauliflower, 139.

  Caustic, 213.

  Celery, 141.

  Cellulose, 131.

  Cereals, 284.

  Charlatans, 7.

  Chewing, 29.

  Chicken, baked, 288;
    boiled, 288;
    broiled, 290;
    fried, 287;
    smothered, 289.

  Chickory (salad), 142.

  Chilblains, 246.

  Child, diseases of, 82, 89;
    exercise of, 79;
    hygiene treatment of, 88;
    ill-treatment of, 64;
    instruction in cases of accident, 223;
    sleep necessary to, 79;
    syringe for, 84.

  Chills-and-fever, see Malaria.

  Chocolate, 31.

  Cholera, 8, 9, 140.

  Chromic acid, 209.

  Cisterns, 59.

  Clams, 122.

  Cleanliness, 220.

  Clothing, 18.

  Cocoa, 31.

  Cod-liver oil, 125.

  Coffee, 31, 151.

  Cold, accidents arising from, 41.

  Cole, 139.

  Colic, cause of, 67;
    treatment of, 84.

  Collodion, 232.

  Color, in clothing, 21.

  Constipation, 85.

  Cooking, 164, 170.

  Copper-head, 263, 266.

  Coral-snakes, 262, 263, 267.

  Corn, 110.

  Corn-starch, 112.

  Corrosive sublimate, 231.

  Cotton-mouth, 262, 266.

  Cows, carry tapeworm, 51;
    infected with tuberculosis, 182.

  _Crotalus_, 262.

  Croup, membranous, 198;
    treatment of, 86.

  Cucumber, 141.


  D

  Dandelion, 138.

  "Death-cup," 257.

  Dextrose, 126.

  Diarrhoea, reason for, 144;
    treatment of, 82.

  Diet, for the sick, 221;
    vegetarian, 130.

  Diphtheria, conveyance of, 9;
    description and treatment, 198.

  Dipsomaniac, 157.

  Dirt-eaters, 196.

  Diseases, avoidable, 171;
    contagious, 89;
    contraction of, 8;
    digestive, 82.
    See also names of diseases.

  Disinfectants, 192.

  Dog, conveys diphtheria, 9;
    dangers of, 62;
    description of rabies in, 211;
    harbors tapeworm, 9, 10.

  Drinks, see Beverages.

  Drowning, 224.

  Dry-closet system, 53.

  Dysentery, 8, 9, 43, 140.

  Dyspepsia, 145, 158.


  E

  Earth, diseases contracted from, 8.

  Eating, 28;
    importance of, 92;
    over-eating too prevalent, 95.

  Eggs, coddled, 292;
    in vegetarian diet, 130;
    nitrogenous food, 118;
    scrambled, 293;
    shirred, 293;
    value of, 123.

  _Elaps euryxanthus_, 263.

  _Elaps fulvius_, 263.

  Emergencies, 223.

  Emetics, 251-259.

  Endive, 142.

  Ergot, 108.

  Ergotism, 9.

  Ethers, compound, 98.

  Exercise, 79.


  F

  Fabrics, 20.

  Fats, 98, 103;
    in vegetables, 131;
    unwholesomeness of, 115;
    value of, 123.

  Fever, malaria, see Malaria;
    scarlet, 90;
    typhoid, contraction of, 8, 9, 43, 140, 221;
    description and treatment, 185;
    yellow, 9, 41, 43.

  Figs, 146.

  Filaria, 9.

  Fireplace, 47.

  Fish, decomposed, source of ptomaine poisoning, 9;
    nitrogenous food, 118;
    value of, 122.

  Fly, conveyor of disease, 9, 10, 43;
     sick-room, 219.

  Fly-agaric, 258.

  Flukes, 140.

  Foods, 28, 99;
    albuminous, 119;
    amount necessary, 96;
    breakfast-foods, 113;
    diseases contracted from, 8;
    in sick-room, 221;
    Mellin's food, 86;
    nitrogenous, 98, 117;
    nutritive substances in, 98;
    raw, 105, 164;
    starchy, 104, 165, 168;
    tables, 100.

  Formaldehyde gas, 192.

  Frost-bite, 245.

  Fruits, as food, 30;
    dangers in, 144;
    diseases contracted from, 9;
    not nutritious, 146.

  Furnace, 46.


  G

  Game, 122.

  Garlic, 140.

  Gin, 160.

  Glanders, 10.

  Glucose, 126.

  Gout, 156, 163.

  Grape-fruit, 147.

  Greens, 138.

  Ground-itch, 195.


  H

  Haig, a physician, 148.

  Ham, boiled, 281;
    broiled, 281;
    curing of, 280;
    fried, 281;
    wholesomeness of, 121.

  Headache, 33.

  Health, 5.

  Heat, accidents arising from, 241;
    for house, 45;
    in sick-room, 218.
    See also Calories.

  Heat-prostration, 244.

  Hiccough, 250.

  Hog, 51.

  Hog-meats, 120.

  Hominy, 284.

  Hookworm, 8;
    method of transmission, 50, 52;
    description and treatment of disease, 193.

  Horses, convey glanders, 10;
    killed by bad corn, 109.

  House, materials for, 39;
    sanitation of, 35.

  Husks, 107.

  Hydrophobia, from dog's bite, 9, 249;
    description and treatment, 211.

  Hygiene, 1, 6;
    of infancy and childhood, 63;
    of the person, 12;
    of the sick-room, 217.

  Hypersensitiveness, 204.


  I

  Indigestion, 145.

  Infants, hygiene and feeding of, 63;
    weaning of, 67.

  Iodine, as antiseptic, 231;
    in blisters, 247.


  K

  Kak-ke, 9, 113.

  Kala-azar, 9.

  Kissing, 89.


  L

  Lathyrismus, 9.

  Lead-water, 261.

  Leeks, 140.

  Legumes, 133.

  Legumins, 98, 118.

  Lemons, 146.

  Lentils, 133, 134.

  Lettuce, 139.

  Ligature, 230, 270.

  Lime-water, 71, 261.

  Liquids, 148.

  Liquors, malt, 162.

  Liver, 93;
    cirrhosis of the, 158.

  Lockjaw, 227;
    antitoxin for, 232.

  Loeffler, discovered diphtheria germ, 198.


  M

  Malaria, conveyed by mosquito, 9, 41, 43;
    description and treatment, 171.

  Maltose, 86.

  Massasauga, 266.

  Mastication, 96.

  Meat, cooking of, 168;
    nitrogenous food, 118;
    source of ptomaine poisoning, 9;
    value of, 119.

  Medicine, 221;
    patent, 91, 158.

  Meninges, 207.

  Meningitis, cerebrospinal, 206.

  _Micrococcus intracellulais_, 207.

  Milk, an ideal food, 128;
    apt to promote indigestion, 150;
    as a drink, 31-32;
    in vegetarian diet, 130;
    infected with tuberculosis, 182;
    malted, 86;
    modified cow's, 67;
    mother's, 65;
    peptonized, 75;
    sterilized (Pasteurized), 74;
    table for calculating proportions of milk to be fed, 70.

  Mint, 142.

  Moccasin (snake), 261, 262, 263, 266.

  Mosquito, 9, 41, 171, 173.

  Mouse, 9.

  Mushrooms, 256.

  Mutton, boiled, 283;
    chops, 284;
    cutlets, 283;
    roast 283;
    value of, 120.


  N

  _Necator Americanus_, 193.

  Nervousness, 88.

  Nipple, 73.

  Nose, 184.

  Nursing, 217.


  O

  Oatmeal, 114, 284.

  Okra, 142.

  Opiates, 85.

  Opium, 254.

  Oysters, 118, 122.


  P

  Pains, rheumatic, 145.

  Paris green, 252.

  Parsley, 142.

  Parsnips, 136.

  Pasteur, 214.

  Pastries, 115.

  Peaches, 146.

  Peanuts, 133, 134.

  Peas, 133, 134.

  Pellagra, 9, 109.

  Peppers, green, 142.

  Phosphorus, 253.

  Pickles, 144.

  Pieplant, 142.

  Pilot-snake, 262.

  Pit-vipers, 261, 265.

  Plague, bubonic, 9.

  _Plasmodium malaria_, 171.

  Plaster, for blisters, 247;
    for sprains, 235.

  Poison-dogwood, 260.

  Poison-elder, 260.

  Poison-ivy, 259.

  Poison-oak, 259.

  Poisons, acid and alkaline, 252;
    ptomaine, 9;
    treatment of poison cases, with antidotes, 251.

  Poison-sumac, 260.

  Pork, boiled, 280;
    broiled, 279;
    fried, 279;
    roast, 279.

  Potassium permanganate, 254, 255, 269.

  Potatoes, 135, 136;
    baked, 294;
    boiled, 294;
    cooking of, 167;
    disadvantages of, 112.

  Poultry, 122.

  Privies, 49, 52, 198.

  Ptomaines, poisoning by, 9.

  Puddings, apple, 295;
    batter, 295;
    brown betty, 296;
    caramel custard, 296;
    cottage, 295;
    cream of corn-starch, 296;
    rice, 297.

  Pumpkin, 143.

  Pus, 232.


  Q

  Quacks, medical, 4, 7.

  Quinine, 173.


  R

  Rabies, see Hydrophobia.

  Radishes, 136.

  Rat, 9.

  Rat-poison, 25.

  Rattlesnake, 261, 262, 264;
    ground-rattlers, 262, 265.

  Recipes, 273.

  Resins, 231.

  Respiration, artificial, 225.

  Rest, need of, 22.

  Rhubarb, 142.

  _Rhus_, poisoning by, 259.

  _Rhus toxicodendron_, 259.

  _Rhus venenata_, 259.

  Rice, boiled, 285;
    cooking of, 167;
    value of, 113.

  Rochdale, system of, 53.

  Rolls, 286.

  Rum, 160.


  S

  Salad plants, 139.

  Saliva, 29.

  Sanitation, 35.

  Sauerkraut, 139.

  Scab, 233.

  Schafer, Prof., system of artificial respiration, 225.

  Screens, 41, 176, 219.

  Sewage, disposal of, 49.

  Shallots, 140.

  Sheet, rubber, 219.

  Sick-room, 217.

  _Sistrurus_, 262.

  Sleep, 26, 78.

  Sleeping-sickness, 1.

  Snake, harlequin, 262.

  Snake-bites, 268.

  Snakes, columbine, 262, 263;
    elapine, 263;
    non-venomous, 264;
    venomous, 261;
    viperine, 261.

  Soups, meat, 292;
    vegetable, 290.

  Sours, 147.

  Spinach, 138.

  Splints, 235.

  Sprains, 234.

  Sputum, 184.

  Squash, 143.

  Starches, 98, 104;
    changes in, 165;
    in cooking, 97;
    in vegetables, 131;
    raw, 105.

  Steam, 46.

  Stove, 47.

  Streams, 60.

  Strychnine, as antidote, 269;
    poisoning by, 254.

  Sugar, consumption of, 126;
    from beets, 136;
    in vegetables, 131;
    kinds of, 125;
    raw, 105.

  Sunstroke, 242.

  Swamp-dogwood, 260.

  Syringe, 84.

  Syrups, 33;
    soothing, 255.


  T

  Tapeworm, 8, 9, 51.

  Tea, 31, 152.

  Teeth, care of, 80, 248;
    teething of infants, 80;
    tooth-ache, 248.

  Toadstool, see Mushroom.

  Tobacco, 34.

  Tomato, 141.

  Tonsillitis, follicular, 200.

  Tooth-ache, 248.

  Treatment, immunizing, 205;
    pasteur, 214.

  Tricina, 18.

  Tuberculosis, 94, 95, 156;
    description and treatment, 178.

  Tubers, 135.

  Turnips, 136, 137, 138.


  V

  Vaccination, 88.

  Veal, boiled, 277;
    fried, 277;
    jellied, 278;
    roast, 276;
    stew or pot-pie, 277.

  Vegetables, cooking of, 293;
    digestibility of, 132, 133;
    diseases contracted from, 9.

  Ventilation, 48, 218.

  Vinegar, 133, 136, 147.

  Vipers, 262. See also pit-vipers.

  Vomiting, 67, 87.


  W

  Waffles, 107.

  Wall-paper, 41.

  Water, as a drink, 30, 148;
    dangers of, 140;
    diseases contracted from, 8;
    for heating, 46;
    for poisons, 251;
    for wounds, 230.

  Water-supply, 57.

  Wells, 58.

  Whisky, 160.

  Wines, 161.

  Work, 22.

  Worms, 140.

  Wounds, 227.


  Y

  Yams, 135.

  Yeast, 286.







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