diff options
Diffstat (limited to '26718-8.txt')
| -rw-r--r-- | 26718-8.txt | 7266 |
1 files changed, 7266 insertions, 0 deletions
diff --git a/26718-8.txt b/26718-8.txt new file mode 100644 index 0000000..bf16e2c --- /dev/null +++ b/26718-8.txt @@ -0,0 +1,7266 @@ +The Project Gutenberg EBook of Health on the Farm, by H. F. Harris + +This eBook is for the use of anyone anywhere at no cost and with +almost no restrictions whatsoever. You may copy it, give it away or +re-use it under the terms of the Project Gutenberg License included +with this eBook or online at www.gutenberg.org + + +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 + +Character set encoding: ISO-8859-1 + +*** START OF THIS PROJECT GUTENBERG EBOOK HEALTH ON THE FARM *** + + + + +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 +Literature in Agriculture (CHLA), Cornell University) + + + + + + + + + +[Transcriber's Notes: + +Inconsistencies with regards to hyphenated words have been left as in +the original. Inconsistencies in spelling and other unexpected spelling +have been retained as in the original book.] + + + + +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. + + + + + +End of the Project Gutenberg EBook of Health on the Farm, by H. F. Harris + +*** END OF THIS PROJECT GUTENBERG EBOOK HEALTH ON THE FARM *** + +***** This file should be named 26718-8.txt or 26718-8.zip ***** +This and all associated files of various formats will be found in: + http://www.gutenberg.org/2/6/7/1/26718/ + +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 +Literature in Agriculture (CHLA), Cornell University) + + +Updated editions will replace the previous one--the old editions +will be renamed. + +Creating the works from public domain print editions means that no +one owns a United States copyright in these works, so the Foundation +(and you!) can copy and distribute it in the United States without +permission and without paying copyright royalties. Special rules, +set forth in the General Terms of Use part of this license, apply to +copying and distributing Project Gutenberg-tm electronic works to +protect the PROJECT GUTENBERG-tm concept and trademark. Project +Gutenberg is a registered trademark, and may not be used if you +charge for the eBooks, unless you receive specific permission. If you +do not charge anything for copies of this eBook, complying with the +rules is very easy. You may use this eBook for nearly any purpose +such as creation of derivative works, reports, performances and +research. They may be modified and printed and given away--you may do +practically ANYTHING with public domain eBooks. Redistribution is +subject to the trademark license, especially commercial +redistribution. + + + +*** START: FULL LICENSE *** + +THE FULL PROJECT GUTENBERG LICENSE +PLEASE READ THIS BEFORE YOU DISTRIBUTE OR USE THIS WORK + +To protect the Project Gutenberg-tm mission of promoting the free +distribution of electronic works, by using or distributing this work +(or any other work associated in any way with the phrase "Project +Gutenberg"), you agree to comply with all the terms of the Full Project +Gutenberg-tm License (available with this file or online at +http://gutenberg.org/license). + + +Section 1. General Terms of Use and Redistributing Project Gutenberg-tm +electronic works + +1.A. By reading or using any part of this Project Gutenberg-tm +electronic work, you indicate that you have read, understand, agree to +and accept all the terms of this license and intellectual property +(trademark/copyright) agreement. If you do not agree to abide by all +the terms of this agreement, you must cease using and return or destroy +all copies of Project Gutenberg-tm electronic works in your possession. +If you paid a fee for obtaining a copy of or access to a Project +Gutenberg-tm electronic work and you do not agree to be bound by the +terms of this agreement, you may obtain a refund from the person or +entity to whom you paid the fee as set forth in paragraph 1.E.8. + +1.B. "Project Gutenberg" is a registered trademark. It may only be +used on or associated in any way with an electronic work by people who +agree to be bound by the terms of this agreement. There are a few +things that you can do with most Project Gutenberg-tm electronic works +even without complying with the full terms of this agreement. See +paragraph 1.C below. There are a lot of things you can do with Project +Gutenberg-tm electronic works if you follow the terms of this agreement +and help preserve free future access to Project Gutenberg-tm electronic +works. See paragraph 1.E below. + +1.C. The Project Gutenberg Literary Archive Foundation ("the Foundation" +or PGLAF), owns a compilation copyright in the collection of Project +Gutenberg-tm electronic works. Nearly all the individual works in the +collection are in the public domain in the United States. If an +individual work is in the public domain in the United States and you are +located in the United States, we do not claim a right to prevent you from +copying, distributing, performing, displaying or creating derivative +works based on the work as long as all references to Project Gutenberg +are removed. Of course, we hope that you will support the Project +Gutenberg-tm mission of promoting free access to electronic works by +freely sharing Project Gutenberg-tm works in compliance with the terms of +this agreement for keeping the Project Gutenberg-tm name associated with +the work. You can easily comply with the terms of this agreement by +keeping this work in the same format with its attached full Project +Gutenberg-tm License when you share it without charge with others. + +1.D. The copyright laws of the place where you are located also govern +what you can do with this work. Copyright laws in most countries are in +a constant state of change. If you are outside the United States, check +the laws of your country in addition to the terms of this agreement +before downloading, copying, displaying, performing, distributing or +creating derivative works based on this work or any other Project +Gutenberg-tm work. The Foundation makes no representations concerning +the copyright status of any work in any country outside the United +States. + +1.E. Unless you have removed all references to Project Gutenberg: + +1.E.1. The following sentence, with active links to, or other immediate +access to, the full Project Gutenberg-tm License must appear prominently +whenever any copy of a Project Gutenberg-tm work (any work on which the +phrase "Project Gutenberg" appears, or with which the phrase "Project +Gutenberg" is associated) is accessed, displayed, performed, viewed, +copied or distributed: + +This eBook is for the use of anyone anywhere at no cost and with +almost no restrictions whatsoever. You may copy it, give it away or +re-use it under the terms of the Project Gutenberg License included +with this eBook or online at www.gutenberg.org + +1.E.2. If an individual Project Gutenberg-tm electronic work is derived +from the public domain (does not contain a notice indicating that it is +posted with permission of the copyright holder), the work can be copied +and distributed to anyone in the United States without paying any fees +or charges. If you are redistributing or providing access to a work +with the phrase "Project Gutenberg" associated with or appearing on the +work, you must comply either with the requirements of paragraphs 1.E.1 +through 1.E.7 or obtain permission for the use of the work and the +Project Gutenberg-tm trademark as set forth in paragraphs 1.E.8 or +1.E.9. + +1.E.3. If an individual Project Gutenberg-tm electronic work is posted +with the permission of the copyright holder, your use and distribution +must comply with both paragraphs 1.E.1 through 1.E.7 and any additional +terms imposed by the copyright holder. Additional terms will be linked +to the Project Gutenberg-tm License for all works posted with the +permission of the copyright holder found at the beginning of this work. + +1.E.4. Do not unlink or detach or remove the full Project Gutenberg-tm +License terms from this work, or any files containing a part of this +work or any other work associated with Project Gutenberg-tm. + +1.E.5. Do not copy, display, perform, distribute or redistribute this +electronic work, or any part of this electronic work, without +prominently displaying the sentence set forth in paragraph 1.E.1 with +active links or immediate access to the full terms of the Project +Gutenberg-tm License. + +1.E.6. You may convert to and distribute this work in any binary, +compressed, marked up, nonproprietary or proprietary form, including any +word processing or hypertext form. However, if you provide access to or +distribute copies of a Project Gutenberg-tm work in a format other than +"Plain Vanilla ASCII" or other format used in the official version +posted on the official Project Gutenberg-tm web site (www.gutenberg.org), +you must, at no additional cost, fee or expense to the user, provide a +copy, a means of exporting a copy, or a means of obtaining a copy upon +request, of the work in its original "Plain Vanilla ASCII" or other +form. Any alternate format must include the full Project Gutenberg-tm +License as specified in paragraph 1.E.1. + +1.E.7. Do not charge a fee for access to, viewing, displaying, +performing, copying or distributing any Project Gutenberg-tm works +unless you comply with paragraph 1.E.8 or 1.E.9. + +1.E.8. You may charge a reasonable fee for copies of or providing +access to or distributing Project Gutenberg-tm electronic works provided +that + +- You pay a royalty fee of 20% of the gross profits you derive from + the use of Project Gutenberg-tm works calculated using the method + you already use to calculate your applicable taxes. The fee is + owed to the owner of the Project Gutenberg-tm trademark, but he + has agreed to donate royalties under this paragraph to the + Project Gutenberg Literary Archive Foundation. Royalty payments + must be paid within 60 days following each date on which you + prepare (or are legally required to prepare) your periodic tax + returns. Royalty payments should be clearly marked as such and + sent to the Project Gutenberg Literary Archive Foundation at the + address specified in Section 4, "Information about donations to + the Project Gutenberg Literary Archive Foundation." + +- You provide a full refund of any money paid by a user who notifies + you in writing (or by e-mail) within 30 days of receipt that s/he + does not agree to the terms of the full Project Gutenberg-tm + License. You must require such a user to return or + destroy all copies of the works possessed in a physical medium + and discontinue all use of and all access to other copies of + Project Gutenberg-tm works. + +- You provide, in accordance with paragraph 1.F.3, a full refund of any + money paid for a work or a replacement copy, if a defect in the + electronic work is discovered and reported to you within 90 days + of receipt of the work. + +- You comply with all other terms of this agreement for free + distribution of Project Gutenberg-tm works. + +1.E.9. If you wish to charge a fee or distribute a Project Gutenberg-tm +electronic work or group of works on different terms than are set +forth in this agreement, you must obtain permission in writing from +both the Project Gutenberg Literary Archive Foundation and Michael +Hart, the owner of the Project Gutenberg-tm trademark. Contact the +Foundation as set forth in Section 3 below. + +1.F. + +1.F.1. Project Gutenberg volunteers and employees expend considerable +effort to identify, do copyright research on, transcribe and proofread +public domain works in creating the Project Gutenberg-tm +collection. Despite these efforts, Project Gutenberg-tm electronic +works, and the medium on which they may be stored, may contain +"Defects," such as, but not limited to, incomplete, inaccurate or +corrupt data, transcription errors, a copyright or other intellectual +property infringement, a defective or damaged disk or other medium, a +computer virus, or computer codes that damage or cannot be read by +your equipment. + +1.F.2. LIMITED WARRANTY, DISCLAIMER OF DAMAGES - Except for the "Right +of Replacement or Refund" described in paragraph 1.F.3, the Project +Gutenberg Literary Archive Foundation, the owner of the Project +Gutenberg-tm trademark, and any other party distributing a Project +Gutenberg-tm electronic work under this agreement, disclaim all +liability to you for damages, costs and expenses, including legal +fees. YOU AGREE THAT YOU HAVE NO REMEDIES FOR NEGLIGENCE, STRICT +LIABILITY, BREACH OF WARRANTY OR BREACH OF CONTRACT EXCEPT THOSE +PROVIDED IN PARAGRAPH F3. YOU AGREE THAT THE FOUNDATION, THE +TRADEMARK OWNER, AND ANY DISTRIBUTOR UNDER THIS AGREEMENT WILL NOT BE +LIABLE TO YOU FOR ACTUAL, DIRECT, INDIRECT, CONSEQUENTIAL, PUNITIVE OR +INCIDENTAL DAMAGES EVEN IF YOU GIVE NOTICE OF THE POSSIBILITY OF SUCH +DAMAGE. + +1.F.3. LIMITED RIGHT OF REPLACEMENT OR REFUND - If you discover a +defect in this electronic work within 90 days of receiving it, you can +receive a refund of the money (if any) you paid for it by sending a +written explanation to the person you received the work from. If you +received the work on a physical medium, you must return the medium with +your written explanation. The person or entity that provided you with +the defective work may elect to provide a replacement copy in lieu of a +refund. If you received the work electronically, the person or entity +providing it to you may choose to give you a second opportunity to +receive the work electronically in lieu of a refund. If the second copy +is also defective, you may demand a refund in writing without further +opportunities to fix the problem. + +1.F.4. Except for the limited right of replacement or refund set forth +in paragraph 1.F.3, this work is provided to you 'AS-IS' WITH NO OTHER +WARRANTIES OF ANY KIND, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO +WARRANTIES OF MERCHANTIBILITY OR FITNESS FOR ANY PURPOSE. + +1.F.5. Some states do not allow disclaimers of certain implied +warranties or the exclusion or limitation of certain types of damages. +If any disclaimer or limitation set forth in this agreement violates the +law of the state applicable to this agreement, the agreement shall be +interpreted to make the maximum disclaimer or limitation permitted by +the applicable state law. The invalidity or unenforceability of any +provision of this agreement shall not void the remaining provisions. + +1.F.6. INDEMNITY - You agree to indemnify and hold the Foundation, the +trademark owner, any agent or employee of the Foundation, anyone +providing copies of Project Gutenberg-tm electronic works in accordance +with this agreement, and any volunteers associated with the production, +promotion and distribution of Project Gutenberg-tm electronic works, +harmless from all liability, costs and expenses, including legal fees, +that arise directly or indirectly from any of the following which you do +or cause to occur: (a) distribution of this or any Project Gutenberg-tm +work, (b) alteration, modification, or additions or deletions to any +Project Gutenberg-tm work, and (c) any Defect you cause. + + +Section 2. Information about the Mission of Project Gutenberg-tm + +Project Gutenberg-tm is synonymous with the free distribution of +electronic works in formats readable by the widest variety of computers +including obsolete, old, middle-aged and new computers. It exists +because of the efforts of hundreds of volunteers and donations from +people in all walks of life. + +Volunteers and financial support to provide volunteers with the +assistance they need, is critical to reaching Project Gutenberg-tm's +goals and ensuring that the Project Gutenberg-tm collection will +remain freely available for generations to come. In 2001, the Project +Gutenberg Literary Archive Foundation was created to provide a secure +and permanent future for Project Gutenberg-tm and future generations. +To learn more about the Project Gutenberg Literary Archive Foundation +and how your efforts and donations can help, see Sections 3 and 4 +and the Foundation web page at http://www.pglaf.org. + + +Section 3. Information about the Project Gutenberg Literary Archive +Foundation + +The Project Gutenberg Literary Archive Foundation is a non profit +501(c)(3) educational corporation organized under the laws of the +state of Mississippi and granted tax exempt status by the Internal +Revenue Service. The Foundation's EIN or federal tax identification +number is 64-6221541. Its 501(c)(3) letter is posted at +http://pglaf.org/fundraising. Contributions to the Project Gutenberg +Literary Archive Foundation are tax deductible to the full extent +permitted by U.S. federal laws and your state's laws. + +The Foundation's principal office is located at 4557 Melan Dr. S. +Fairbanks, AK, 99712., but its volunteers and employees are scattered +throughout numerous locations. Its business office is located at +809 North 1500 West, Salt Lake City, UT 84116, (801) 596-1887, email +business@pglaf.org. Email contact links and up to date contact +information can be found at the Foundation's web site and official +page at http://pglaf.org + +For additional contact information: + Dr. Gregory B. Newby + Chief Executive and Director + gbnewby@pglaf.org + + +Section 4. Information about Donations to the Project Gutenberg +Literary Archive Foundation + +Project Gutenberg-tm depends upon and cannot survive without wide +spread public support and donations to carry out its mission of +increasing the number of public domain and licensed works that can be +freely distributed in machine readable form accessible by the widest +array of equipment including outdated equipment. Many small donations +($1 to $5,000) are particularly important to maintaining tax exempt +status with the IRS. + +The Foundation is committed to complying with the laws regulating +charities and charitable donations in all 50 states of the United +States. Compliance requirements are not uniform and it takes a +considerable effort, much paperwork and many fees to meet and keep up +with these requirements. We do not solicit donations in locations +where we have not received written confirmation of compliance. To +SEND DONATIONS or determine the status of compliance for any +particular state visit http://pglaf.org + +While we cannot and do not solicit contributions from states where we +have not met the solicitation requirements, we know of no prohibition +against accepting unsolicited donations from donors in such states who +approach us with offers to donate. + +International donations are gratefully accepted, but we cannot make +any statements concerning tax treatment of donations received from +outside the United States. U.S. laws alone swamp our small staff. + +Please check the Project Gutenberg Web pages for current donation +methods and addresses. Donations are accepted in a number of other +ways including checks, online payments and credit card donations. +To donate, please visit: http://pglaf.org/donate + + +Section 5. General Information About Project Gutenberg-tm electronic +works. + +Professor Michael S. Hart is the originator of the Project Gutenberg-tm +concept of a library of electronic works that could be freely shared +with anyone. For thirty years, he produced and distributed Project +Gutenberg-tm eBooks with only a loose network of volunteer support. + + +Project Gutenberg-tm eBooks are often created from several printed +editions, all of which are confirmed as Public Domain in the U.S. +unless a copyright notice is included. Thus, we do not necessarily +keep eBooks in compliance with any particular paper edition. + + +Most people start at our Web site which has the main PG search facility: + + http://www.gutenberg.org + +This Web site includes information about Project Gutenberg-tm, +including how to make donations to the Project Gutenberg Literary +Archive Foundation, how to help produce our new eBooks, and how to +subscribe to our email newsletter to hear about new eBooks. |