Chapter X: Diet in Abnormal Conditions (2)

Meats, eggs, and legumes should be eliminated from the diet. A free drinking of water, milk with limewater, cereals, buttermilk, kumyss, barley water, toast water, lemonade, orangeade, vegetables, and fruit should form the diet.

Exercise and free breathing of fresh air are imperative. All food should be thoroughly masticated.

[Sidenote: Excess of Uric Acid]

When this condition appears it is due to too great an amount of animal or nitrogenous food. It causes dizziness, ringing in the ears, general nervousness, and insomnia.

Uric acid does not render the urine acid but when the acidity of the urine is increased, due to too much animal food, the tendency of the uric acid to form a crystalline deposit is increased. This deposit, as “gravel,” may occasion attacks of renal colic or become the basis, when mixed with mucus, for kidney stones or stones in the bladder.

Headaches if due to uric acid will often cease when animal food is lessened.

Too much candy or sweet foods, or too much fat, eaten in connection with much protein, by deranging the liver function, change the character of the urine and favor the production of uric acid, causing such chronic ailments as bronchitis, asthma, severe nerve depression, gout, and neuralgia.

The natural relief is obtained by control of the diet, supplying less protein. One may either eliminate the proteins from the diet, or may cut down the entire quantity of food. Free elimination through a free action of the kidneys, the pores of the skin, and the lungs, is necessary.

Systematic exercise, deep breathing, copious drinking of water, and fresh air day and night, are the best aids. Exercise and deep breathing promote a free elimination of waste through the pores of the skin, and the free drinking of water creates a greater elimination through the kidneys, thus throwing off the excess of acid.

The skins of fruits contain various acids which favor the alkalinity of the blood. Therefore it is better, when there is an excess of uric acid, to eat unpeeled fruits. Apples, eaten raw and unpeeled, because of the acids, are of benefit. Citrus fruits, such as lemons, oranges, and grapefruit, are advised. Pears, and other sweet or bland fruits, because of the lack of acid, are less valuable.

Pea pods when young may be cooked with the peas. String beans, spinach, celery, and asparagus are of value.

All rich sauces and gravies must be avoided.

[Sidenote: Gout]

Osler remarks that “gout is evidence of an overfed, overworked, and consequently clogged machine.”

It is usually the result of high living. It most often attacks people past middle age, who have indulged in large quantities of food, especially the nitrogenous foods which are not thoroughly oxidized due to sluggish circulation and shallow breathing. The process, imperfectly carried on, allows the accumulation of the waste material which cannot be excreted by the kidneys unless completely transformed by oxidation. These insoluble materials are deposited in the joints, act as irritants, and occasion the attacks of pain, swelling, and tenderness which usually mark the acute condition.

It is most common in those who habitually overeat, take little exercise, or who have frequently indulged in alcohol.

Sugar and fat in quantities are injurious as the oxidation of the protein is not carried on as completely when these are in excess. In fact, the entire system is more sluggish. Fat also interferes with gastric digestion as it passes through the stomach unchanged, and if the particles of food have a coat of the fat liquefied by the heat of the stomach, it is difficult for the gastric juice to exert its power.

The use of meat and sugars tends to make the urine acid and the use of vegetables favors its alkalinity, rendering it less acid. Therefore it becomes necessary to eliminate meat from the diet, to cut down the fats and carbohydrates, and to eat freely of fruits and vegetables.

Alcohol is absolutely prohibited.

In _acute cases_ a diet of bread and milk, or toast and milk, with light vegetable broths, should be followed for from one to three days.

In _chronic cases_ the diet may consist of the following:

_Soups._—Vegetable broths.

_Fish._—Fresh fish, shell fish, raw oysters.

_Meats._—It is better to omit all meats. If meat is eaten at all, it should be confined to game, chicken, and fat bacon.

_Farinaceous._—Cereals, crackers, dry toast, milk toast, macaroni, graham or whole wheat bread, rye bread, oatmeal, and any of the breakfast foods.

_Vegetables._—Celery, lettuce, watercress, all greens, without vinegar, string beans, green peas, potatoes, carrots, and beets.

_Fruits._—All fruits, stewed or fresh. Unpeeled apples are especially recommended. (Greens, without vinegar and unpeeled apples, increase the action of the kidneys.)

_Desserts._—Plain puddings, junket, rice, stewed or fresh fruits.

_Liquids._—Pure water, toast water, barley water, buttermilk, malted milk, milk.

Eat eggs sparingly, and in severe cases, not at all.

AVOID.—Alcohol, coffee, tobacco, dried fruits, nuts, cheese, candies, pastries, pies, spices, rich puddings, fried foods, vinegar, pickles, lemons, rhubarb, mushrooms, asparagus, sweet potatoes, tomatoes, gravies, patties, rich soups, lobster, salmon, crabs, mackerel, eel, veal, pork, goose, duck, turkey, salted, dried, potted, or preserved fish or meat (except bacon).

It is not sufficient to eliminate the foods to be avoided. To reduce the quantity of food is also necessary; yet this must be watched as the diet should not be so rigid as to cause a lowering of vitality. Eating between meals should not be allowed.

In an acute attack the diet should be confined to milk, vegetables, and fruits.

[Sidenote: Diabetes]

This is the result of a serious disturbance of nutrition. Since its presence is made manifest by the appearance of sugar in the urine, it is considered among the derangements of the kidneys. However, one should not be apprehensive of diabetes if the urine test for a day shows sugar. This may be due to an excess of carbohydrates, particularly of sugar, in the diet a day or two previous and all trace of it may disappear in a day or two. If continued tests show an excess, nutritional disturbances are indicated. The treatment is almost entirely dietetic.

The most usual form of diabetes is _diabetes mellitus_. It is supposed to be due to a disturbance in the metabolism of sugar. It may be aided by defective pancreatic ferments, the lack throwing more work on the liver in the metabolism of sugar.

The difficulty which confronts the dietitian is to prescribe a diet restricting the carbohydrates which will keep up the body weight and not disturb the nutritive equilibrium. The patient has a craving for sugars and starches, but the system cannot make use of them, and the heat and energy must be supplied by fats.

The diet must consist largely of protein and fat. One danger lies in the tendency of acetic and other acids to accumulate in the blood, which affects the nervous system.

While, as a rule, the craving for certain foods is an indication that the system needs the elements contained in them, the desire of the diabetic patient for sugars and starches _must not_ be indulged more than absolutely necessary, because of the inability of the system to utilize them.

There is often a distaste for fat, but its use is imperative when it is well borne, because the weight and general vitality must be maintained. If all carbohydrates are eliminated from the diet, the system will often suffer severely. Therefore the dietitian must determine the diet suited to the individual case, since complicated conditions may exist and the diet for one patient will work harm to another. The fleshy patient can stand a rigid diet, eliminating sugars and starches, much better than one who is thin and emaciated. A thin, weak patient often cannot endure too rigid a diet.

The following list of foods contain least carbohydrates: clear soup of meat without vegetables, all acid fruits, eggs, clams, and lobsters, fresh fish of all kinds, fresh meat of all kinds, and most smoked meat, olive oil, butter, peas, beans, all fresh vegetables (except carrots, parsnips, squash), onions, artichokes, cauliflower, cabbage, and asparagus.

Fats may be supplied in the yolks of eggs, cream, butter, cheese, bacon, and oily nuts, as butternuts, Brazil nuts, almonds, hazel nuts, walnuts, pecans; all should be well chewed.

In beginning a diet, the change must not be too sudden. Potatoes, when they agree, may be used in small quantities as a substitute for bread. At least a week’s time should be allowed for the elimination of all sugar and starch. Begin by eliminating sugars and next bread, cereals, anything made with flour, and potatoes.

Sometimes it is necessary to begin with an all milk diet for a day or two.

Van Noorden gives the following diet, free from carbohydrates, which has been in general use in Europe and America.

_Breakfast_

Tea or coffee, 6 ounces.

Lean meat (beefsteak, mutton chop, or ham), 4 ounces.

Eggs, one or two.

_Lunch_

Cold roast beef, 6 ounces.

Celery, or cucumbers, or tomatoes with salad dressing.

Coffee, without milk or sugar, 2 ounces.

_Dinner_

Bouillon, 6 ounces.

Roast beef, 7-1/2 ounces.

Green salad, 2 ounces.

Vinegar, 2-1/2 drams.

Butter, 2-1/2 drams.

Olive oil, 5 drams, or spinach with mayonnaise, large portion.

_Supper, 9 P. M._

Two eggs, raw or cooked.

Van Noorden includes alcohol, in whisky, in his diet and most physicians follow the theory that alcohol aids in the digestion and absorption of fats; the need is recognized since fats must be supplied, yet the sweet wines and beers contain sugar while the sour wines contains acids, which may disturb digestion.

_DERANGEMENTS OF LUNGS AND BRONCHI_

[Sidenote: Asthma]

In this affection the free entrance of air into the lungs as well as its free exit is hampered by a condition of the bronchial muscles, the mucous membrane of the bronchi, and the muscles of the diaphragm. The muscles contract spasmodically without due or proper relaxation. This causes a congestion and swelling of the mucous membrane of the bronchi which still further hamper the ingress and egress of air.

Any digestive derangement which causes the formation of gas distends the stomach and intestines, interferes with the free action of the diaphragm, and prevents the free movement of the abdominal muscles.

The chemical action of the undigested and fermenting substances in the digestive tract irritates the nerves and may cause the spasm of the muscles. Digestive derangements will often cause the onset of an attack of asthma in those afflicted with this disorder.

The correction of the conditions in the stomach and intestinal tract will often ameliorate the attacks. Care must be taken not to overload the stomach and intestines, to eat easily digested foods which agree in the particular case. All food found to cause any digestive disturbance should be avoided.

Constipation must be remedied by gentle exercises and massage of the abdomen as free elimination removes material which might aid in inciting an attack.

Many asthmatics are comparatively comfortable during the day, the attacks coming on toward evening or during the night. In this case, the evening meal should be light and easily digested, the heavy meal being taken at noon.

Hot stuffy rooms increase the disorder and plenty of fresh air should be secured both by night and by day.

Many of these individuals make no exertion, fearing to bring on an attack.

Exercise, particularly of the lungs in breathing, should be gradual at first and be increased as improvement is shown. Exercises directed to expansion of the deeper cells of the lungs and to equalize the circulation throughout the entire system will call the excess of blood from the bronchial tubes and in many cases will cause the difficulty to disappear. A forceful, equalized circulation, with regulation of digestion, will do more for asthma than any known agency.

[Sidenote: Tuberculosis]

Derangements in digestion, common in this affection, are due to several conditions.

The increased temperature is caused by the efforts of the system to counteract the poisons produced by the action of the bacillus. The increase in temperature in the stomach lessens the secretions and the peristaltic action, causing the food to ferment and to be vomited or to pass practically undigested into the intestine, thus throwing an excess of work on the intestinal secretions.

The bacilli-laden sputum, if swallowed, is apt to produce disorders of the stomach. This still further complicates the question of digestion.

Malnutrition, because of these derangements, increases the unfavorable outlook for the patient in this disease. Hence the diet, especially in chronic cases, is of great importance.

When means are ample, the question is much simplified, because by travel, change of scene, and pleasant surroundings the appetite is stimulated and greater variety in the diet can be gained. For those in moderate circumstances, save when free sanatoriums exist for the care of the tuberculous, it is most difficult to keep the diet from becoming monotonous and wearisome.

The appetite, especially in young people, is apt to be capricious, and it is important that the food be served daintily to tempt the patient to eat.

Growing children crave sweets and as these furnish energy they may be allowed to tuberculous children, in moderation, if they seem to be well assimilated. Any interference with digestion, however, must be guarded against.

It is better to give food in smaller quantities and oftener in order to guard against disturbed digestion from overloading the stomach. For this reason also it is better to give the heartiest food during the forenoon when the temperature is lowest.

Milk, butter, cream, olive oil, bacon, and cod-liver oil furnish the fat needed by the system in the most easily digested form and should be taken freely, if there is no irritation in the stomach which will prevent their assimilation. Variation in their use will often secure greater tolerance.

In chronic cases in which there is little or no fever, the fats are generally well assimilated and are beneficial.

The disease causes great wasting, and fats are especially important in counteracting this tendency. They may be given in alternation or be omitted from the diet for a day or two to avoid turning the patient against them.

If diarrhea exists fats must be given guardedly and if fats produce diarrhea they must be lessened or omitted until the diarrhea is controlled.

If one gains in flesh the chances are very strong that the case has been wrongly diagnosed, or that the disease, if present, is being overcome.

Milk, when it agrees, should form a large part of the diet. A glass may be taken with meals and two glasses between meals. The milk should be sipped slowly; lime water or carbonated water may be added to aid milk digestion.

Buttermilk, made by means of buttermilk tablets, from milk from which the cream has not been removed, or buttermilk mixed with one-fourth cream, kumyss, or cream and water, if relished, may take the place of milk.

Eggs are also important aids in the diet, especially the yolk, because of the fat and iron it contains. If they disagree they may be taken with a few drops of lemon juice, orange juice, or grape juice, as these partially digest the egg.

The beaten and strained whites are very easily digested, and in that form may be taken in quantity of from six to twelve a day.

Tender, juicy meats, especially beef and mutton, may be taken, also meat juices and beef soups.

Highly seasoned foods should be avoided.

Fresh fish, clams, and oysters are permissible. Cereals, especially the coarse ones, that stimulate the bowel movements, if constipation exists, are valuable; oatmeal, rice, and corn-meal mush are especially good; also Graham or bran bread, and zwieback made with bran. If there is diarrhea bran should not be used.

Easily digested vegetables are of value, especially if cooked in little water so that most of the salts and other nutrients, which are so frequently boiled out of the vegetable, are retained. Baked apples or raw fruits, especially oranges, may be taken the first thing in the morning, or used as a dessert. Grapes, peaches, and other fruits in season may be taken in moderation.

Tea and coffee are best omitted.

The following constitutes a typical menu in ordinary cases. It must be varied to suit the individual case.

_Breakfast_: Fruit, cereal, two eggs (poached or boiled) with or
without a few slices of bacon; two slices of toast or
bread, one-half ounce of butter, and a glass of milk.

_10 a.m._: Two or three eggs beaten in a glass of milk.

_Luncheon_: Fish, chop, or steak, or some tender meat, one-half
ounce of butter, one or two slices of bread, baked
potato, or a dish of rice or hominy, green vegetables,
or a salad of lettuce or tomato with olive oil, a
dessert of custard or junket or some other nutritious
dish, and a glass of milk.

_3 p.m._: Milk and eggs, meat broth and egg, milk and egg
custard, or Graham crackers and milk.

_Dinner_: Soup if desired, a glass of milk, a liberal helping of
some special meat, roast beef, lamb, or mutton,
chicken or turkey, potatoes, or a farinaceous vegetable,
and a green vegetable, dessert, and a small
piece of cheese.

This menu approximates the number of calories desirable in cases of tuberculosis that have not advanced to a stage in which complete rest is necessary. In that case a liquid or semiliquid diet is given.

When it is necessary that the diet be less expensive, beans, lentils, and eggs may take the place of meat at some meals, and oleomargarine may be substituted for butter. Milk and eggs, however, in the quantity advised, should be taken if possible.

If signs of overfeeding appear, due to the lessened activity of the digestive organs, shown by biliousness, coated tongue, etc., the food may be lessened in quantity until the condition is corrected.

If the tongue becomes coated the mouth should receive the care directed on page 95.

In all cases of weak lungs and chronic lung trouble, the diet should consist of easily digested foods. Those that cause flatulence should be avoided, as the distended stomach presses on the diaphragm and interferes with proper breathing and with the heart action.

_DERANGEMENTS OF THE NERVES_

No disturbance in any part of the body requires less medicine than a disturbance in the nerves. The correction must come through general hygienic treatment and directing the mind to optimistic thoughts.

Regular exercise, alternated with regular rest periods, the formation of the habit of complete nerve relaxation, the general regulation of an easily digested, nutritious diet, with deep breathing exercises, are the best remedies. The patient should be out of doors as much as possible and, unless too weak, should be employed at light work for mental diversion.

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[Sidenote: Neurasthenia]

In cases of Neurasthenia, or “tired nerves,” all vital organs are more or less affected, because the nerves do not properly direct digestion, absorption, assimilation, or elimination.

The excessive use of stimulants, tea, coffee, or alcohol, is often an exciting cause, because of overstimulation of an already exhausted nervous system.

Complete rest of body and mind must be secured.

The diet should be light and of easily digested foods, but must be nutritious and taken regularly and systematically. Each case needs individual treatment, and the diet must be that most easily assimilated by the individual.

_A free, correct breathing of fresh air, day and night, is imperative._

It is important also to thoroughly masticate all food and drink freely of water.

A change of thought, induced by a change of scene or companions, is helpful.

One of the most essential treatments of neurasthenia is to surround the patient with love and tenderness, but the patient should be led to avoid self-pity. This sets up a disagreeable trend of thought which relaxes nerve and vital forces and disturbs nutrition. Sympathy, good cheer, and an attitude of courageous optimism are the best nerve tonics.

Due to the weakened condition of the nerves, troubles which at other times seem trifles are as mountains and very real. Patience and intelligent sympathy, not apparent pity, are the best of medicines.

The tone of the nervous system is quickly altered by the state of mind of the individual. The reaction is a double one, constituting a “vicious circle.” The nerves, disordered from worry, excessive fatigue, or other drains on the vitality, as a persistent pessimistic outlook on life, do not stimulate the natural digestive processes. The faulty digestion may fail to prepare a sufficient amount of food for use by the system. The nerves are thus underfed, which still further increases their inability to send motor and secretory impulses to the digestive and eliminative organs. Emaciation, general debility, and anemia may result.

Hence the importance, in the relief of any nervous condition, to see first that the attitude of mind be calm and quiet with the substitution of thoughts of hope and cheer for those of gloom and depression. The afflicted one must make a brave struggle because the tired body affects his thoughts as well as his thoughts his body.

There is no one food or set of foods which directly affect any nervous trouble unless this trouble be localized by disturbance in some particular organ. Then the effort must be to correct the difficulty in that organ.

Rest is imperative.

If thin, a fat-building diet should be followed to store energy-building reserve in the nerve centers.

In many cases of nerve debility the nerves seem to be stronger in the latter part of the day. When this is the case the hearty meal should be eaten at this time.

[Sidenote: Neuralgia]

The condition of the blood is affected by the lack of its necessary ingredients, which may occur through faulty digestion as well as through improper diet. The resultant anemia of the nerves may produce neuralgic pains in any one or several of the tissues and organs, as the stomach, the intestines, the muscles, or the liver, etc. Neuralgia of the liver is sometimes mistaken for gallstone colic.

When underlying conditions of disease have been excluded by means of careful tests of the urine and blood, the diet becomes of importance and may result in the disappearance of the pain.

These pains occur chiefly in those who take little exercise and use improper food, which does not give the correct proportion of the needed elements to the system.

Exercise, as the body is usually weak, should be begun moderately but as soon as possible be made brisk and active to stimulate the vital organs to a more perfect performance of their function.

Plenty of oxygen must be secured by day and night and thorough elimination be maintained.

The diet must be nutritious and richer than is ordinarily taken. Milk, butter, cream, bacon, olive oil, and all fatty food should be freely used if assimilated. Beefsteak, roast beef, fresh vegetables, and eggs are valuable. Cocoa or chocolate, a glass of milk with a beaten egg, or a cup of broth into which an egg has been beaten may be regularly taken between meals.

If the digestion is feeble, light foods should first be taken and increased as the system becomes able to assimilate more hearty food.

Coffee, tea, highly spiced foods, alcohol, fried food, rich pastry, and much candy or sweet stuffs should be avoided.

Pain referred to the liver, if not caused by gall-stones, usually indicates overwork of that organ, and fats, sweets, and starches should be avoided to give the liver rest.

Pain referred to the stomach is often caused by tobacco smoking or improper food, as too much candy or preserves, or too strong tea or coffee. Attention to the diet will usually relieve this variety of pain. If the pain comes on when the stomach is empty, due to a disorder of the nerves, the food should be lessened in quantity, be light, easily digested, and taken at shorter intervals.

Many conditions of the system due to dietetic errors which result in impoverished blood are accompanied by pains in the stomach. These are often neuralgic.

Poor assimilation of foods or indigestion produces pain because the tone of the nervous system is affected from the poor blood.

Neuralgia of the stomach often occurs in anemic conditions associated with constipation. In these cases a good, nutritious, but easily digested diet and better elimination will often cure, but as the changes in the blood and nerves are slow, one must be patient and persistent.

There is no better nerve tonic than pure air, exercise, cheerful thoughts, and rest.

Sweets, fried food, rich sauces, pastry, and highly seasoned food should be avoided.

When neuralgia of the stomach, due to an underlying condition such as rheumatism, gout, or diabetes occurs, the diet appropriate to the condition will often affect the cure of the neuralgia.

[Sidenote: Chorea]

The diet is of the greatest importance in this difficulty, as it is usually accompanied by anemia. Rest and a very nourishing and easily digested diet are essential. Sometimes a complete rest in bed and a milk diet, or a diet composed largely of milk, is the best means of treatment.

If possible the patient should be isolated and in the care of a trained nurse who is naturally cheerful and bright.

Children are especially liable to this malady. They are usually anemic and care should be exercised that they be not overworked in school and that they retire early and get from ten to twelve hours’ sleep.

Their eyes must be kept from strain and the nervous system not allowed to become tense from too much excitement, as teasing by playmates or the family, etc.

They should be given the diet for Anemia on page 249.

_DIET IN SKIN DISEASES_

An improper diet or a lowered nerve tone are often shown by the condition of the skin.

When the waste of the system is not being properly eliminated through the other excretory organs the skin is required to throw off more than its normal amount.

The muddy complexion in biliousness or the congestion of the facial capillaries in the alcoholic are familiar examples.

Overeating, especially of food too rich or too concentrated, causes fermentation from non-digestion, or imperfect oxidation, due to too large an amount of nutriment for the amount of oxygen furnished to the tissues.

An inactive skin results in an accumulation of fat in the sebaceous glands with clogging of the ducts; germ infection in these clogged glands often results in pimples and boils. An excess of acid in the secretion of the sweat glands irritates the skin and causes eruptions.[15]

Chronic skin troubles are always increased and made more troublesome when there are errors in the diet, and they are often benefited and in some cases cured when the dietetic errors are corrected.

Skin troubles often occur when for any reason the nervous system is run down, because the weakened nerves cause the tissues or organs they supply to become inactive. The skin thus becomes affected with the rest of the body and derangements of its function appear. Increasing nerve tone will result in a disappearance of the skin disorders. This takes time.

All rich food and highly seasoned preparations, veal, pork, tea, coffee, pastry, too much sweets and fats, and any fruits and vegetables that cause flatulence should be avoided.

A diet of fruit, water, and Graham bread for three or four days, every week or two, daily exercise and deep breathing of pure air will usually clear the skin.

The skin of the face is materially cleared by the use of facial exercises which promote its activity and the elimination of waste. Exercises for increasing the tone of the skin and the muscles are as essential for the face as for the body.

In all skin troubles alcohol must be prohibited.

* * * * *

[Sidenote: Urticaria (Hives)]

This is characterized by distressing itching and may be caused by any article of food which disagrees. A more or less irritant food or one difficult of digestion, such as strawberries, shellfish, pork, cheese, and sausage, are the foods which most usually produce it, if taken into an inactive stomach. When the intestines are in a sluggish condition the stomach does not act well, and any food which does not digest promptly is liable to excite an attack.

It is remedied, by eating very lightly, by fasting for a day or two, by drinking _much_ water, exercising, breathing deeply, and securing activity of the bowels. Care must be taken to avoid foods known to disagree.

[Sidenote: Eczema]

The cause of this disorder is often difficult to ascertain, but it is aggravated or relapses occur when too much or too rich food is eaten. The skin is not able to dispose of all the material sent to it.

It often occurs in those who are excessive eaters of meat.

The diet may have to be confined to fruit, bread and milk, or crackers and milk for a few weeks.

Meat, if allowed, should be taken sparingly and not oftener than once a day—better only every other day. Beef and chicken are the preferable meats. If no improvement occurs, or if it be slight, meat should be omitted altogether. Eggs may be substituted for meat. A little fresh fruit, if thoroughly ripe, may be taken, but all made desserts must be avoided and very little sweets used. Cracked wheat, or other wheat cereal, with a little cream, may be eaten.

Oatmeal may provoke an attack because of the amount of fat in it. Foods may cause an attack in one case that have no detrimental action in another.

Skin eruptions, eczema-like, often occur if for any reason the diet has been too limited, as in the semi-starvation seen in poor children. In these cases a more nutritious diet will often cure.

Bananas, apples, cabbage, or fried foods, often cause a temporary attack or aggravate an existing condition.

The food must be thoroughly masticated, must be taken at regular times, and not in excess. As this condition sometimes accompanies other diseases, any underlying condition must be sought, but all diet should be as simple as the needs of the system will bear. The foods which are found to increase the irritation of the skin are the ones to be avoided in each case.

[Sidenote: Pruritus (Itching)]

The all-prevalent American habit of eating fried food often produces an intense itching of the skin in various parts of the body. It occurs often in those who eat food highly seasoned with pepper or other condiments. The articles of food causing the overstimulation must be avoided, and all fried food, pastries, or food containing much fat, must be greatly lessened or omitted altogether.

Itching is sometimes caused during the change of seasons due to the effect of the changing temperature on the nerves of the skin. To rub the skin with oil for two or three days to soften the dead cells and to aid their removal from the surface will secure a better circulation in the skin and help to eliminate the cause of the itching. A free drinking of water, fresh air, and exercise will help the condition.

[Sidenote: Acne]

The rapidly changing system of the growing boy and girl is especially liable to disorders, due to improper eating, irregular habits, worry, lack of rest, or improper food. Eruptions, especially on the face, appear as a result. The sebaceous glands are especially active, and any alteration in the structure of the blood, due to deranged digestive processes and defective elimination by the skin, causes too great an amount of deposit in the fat glands. Their contents become hardened and infected by germs, with consequent irritation and reddening, and the condition known as acne is the result.

Once well established it is difficult to cure, but it often rapidly improves under a simple diet, rested nerves, cheerful, kind thoughts, and better digestion and elimination.

The food should be thoroughly masticated. Young people are prone to eat too hastily, and thus not thoroughly mix the food with saliva. If careful attention is paid to mastication of the food, water at meals is an aid to digestion. Water should be taken freely between meals, on rising and before retiring, for its diuretic and laxative effect.

All candy, and sweets, hot breads, corn bread, pastry, soups with much fat, rich hashes and sauces, fried food, pork, and veal should be eliminated from the diet.

A badly blotched face is an embarrassment, and no restriction in the diet should be deemed a hardship as a means to an improved digestion, increased mental vigor, and improved health.

A pimple on the face should be treated as antiseptically as a boil. The pus from a pimple which has “come to a head” should not be allowed to infect the surrounding skin. Infection may take place from towels or wash cloths used by one afflicted with acne. Care should be exercised to sterilize the surrounding skin by peroxide of hydrogen or alcohol before a pimple is opened and its contents should be taken up with absorbent cotton. A pimple should never be severely squeezed as the skin will be irritated and other pimples may result.

Often the infection from one pimple is spread by the hands or by the wash cloth. Care should be taken to avoid this.

_Exercise directed to the facial muscles and to the liver and digestive organs, deep breathing, plenty of oxygen by night and day, wholesome thoughts, plenty of sleep, and simple food, will eliminate or improve most skin difficulties. Care should be taken, by frequent bathing and friction baths, to aid the eliminative work of the skin._

* * * * *

[Sidenote: Rheumatism]

Since the medical profession is unable to determine just what rheumatism is, it is difficult to prescribe a diet. The theory so long believed that it is caused by an excess of uric acid in the system is no longer held by most of the advanced physicians. Uric acid, however, sometimes accompanies the disease.

Some authorities hold that it is a nerve difficulty; others that it is caused by an excess of lactic acid; others hold that it is caused by infection from the tonsils and the gums.

Assuming that it is due to the failure of the system to promptly eliminate its waste, whether this failure to eliminate be through a weakened condition of the nerves, and the consequent failure to properly direct the body activities, the correction of the difficulty must lie in building up the general vitality and in aiding the system in its elimination.

Hot sweat baths, a free use of water, and a free use of fruits and fruit juices, particularly the citrus fruits, such as lemons, oranges, limes, etc., are desirable in moderation, because they increase the alkalinity of the blood, and because of their diuretic effect. Lemonade, orangeade, and all fresh fruits and vegetables are diuretic.

The diet should be cut down in quantity. If an excess of uric acid exists, meat may be eliminated and the suggestions given in the diet for Gout may be followed.

The food must be plain and well cooked, not highly seasoned, and the amount must be confined to the needs of the system as shown by the general condition.

Regular exercise, until the body is thoroughly heated, deep breathing of pure air day and night, and a copious drinking of water are necessary.

* * * * *

[Sidenote: Leanness]

No definite diet can be given here for flesh building, because a lack of sufficient fat to round out the figure is due to faulty digestion or assimilation.

It may be that the strength of the muscles and nerves of the stomach, liver, and intestines should be built up by exercises and deep breathing, and it may be that the habit of nerve relaxation must be established. When the nerves are tense much nourishment is consumed in nervous energy and the nerves to the digestive organs and muscles being disordered, they interfere with digestion and assimilation.

It is apparent that the cause of the lack of flesh must first be corrected. Merely to give a fat-building diet may overload deranged digestive organs with sugars, starches, and fats, further weakening them.

Often leanness is due to inability to digest the starches or sugars, and when this is the case the condition must be remedied by strengthening the digestive organs through exercises for the muscles of the stomach and intestines, exercises to create a free activity of the liver and to strengthen the nerves controlling digestion. Deep breathing habits to insure sufficient oxygen to put the waste in condition for elimination are necessary. Most often sufficient food is eaten, but due to nerve tension or to sluggish circulation, particularly through the vital organs, it is not assimilated.

Usually, however, bodily flesh may be increased by increasing the liquids and the carbohydrate consumption and also the fat if these are assimilated.

If habits of life, overwork, improper food, unhealthy thoughts, nerve exhaustion, excessive nerve tension, or disease are responsible, they must first be corrected. Often the nerve tension must be relaxed by change of habit of both body and mind before the flesh will accumulate.

There must be no mental strain, and plenty of sleep must be secured.

If they can be assimilated, the diet should contain soups, butter, milk, cream, cocoa, chocolate, well-cooked cereals, as oatmeal, bread, tapioca, or rice puddings with cream and sugar, bread, potatoes, leguminous foods, as peas and beans, cake, honey, especially sweet fruits, carrots, parsnips, and other vegetables; meat not oftener than once a day.

Vinegar and too much spice, pastry, coffee, and tea should be avoided.

The free drinking of liquid is most important.

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[Sidenote: Obesity]

Obesity is caused by a disturbed balance of nutrition occasioned, often, by more food being taken than the body requires. The resultant fat is deposited in and among the tissues.

It is most often seen in those in middle life of sedentary habit who continue to eat as heartily as ever without using a little thought to determine the actual body needs for food.

An excess of fat is often seen in light eaters, however. This is usually due to a weakness of nerve tissue, which does not direct the regular activities of the body—digestion assimilation, elimination, etc.—with sufficient force to burn up the normal amount of fat in automatic activities.

In all cases breathing is usually faulty, oxidation is incomplete, and little exercise for the vital organs is taken. Anemia may exist in such individuals.

The body fat is formed from various elements in foods, and a food which may cause obesity in one individual may not produce it in another. Fat meats, alcoholic drinks, or the excessive use of starches and sugars may cause it. The food at fault in each case must be determined and largely reduced or eliminated from the diet.

Many obesity cures are in existence, and have had considerable vogue from time to time. Anti-fat remedies are dangerous, as they lower the vitality of the system and render it liable to be attacked by disease. All such remedies act by decreasing the appetite and causing impairment of the digestion.

The rational method is to limit both the amount of food and the liquid to be taken, to increase oxidation by deep breathing and exercise. By restricting the carbohydrates and fats consumed the body calls on that stored in the tissues. In obesity, unless there is an underlying condition of disease, the amount of water should be limited while reducing and none should be drunk with the meals. Soup, milk, and all juicy fruits and all foods made from cereals should be taken sparingly; sugar must usually be forbidden and fat in the food limited to a little butter. One need not starve under this treatment for the diet may be varied enough to prevent monotony even though restricted.

Fresh green vegetables, fruit, and lean meat should form the main ingredients of the diet, but if gastric disturbances arise the diet must be varied to correct them. Meat should be eaten but once a day.

Extremes in diet should be strictly avoided; a sudden restriction of diet produces changes in the blood which may do harm. For this reason the amount of food taken should be gradually but steadily reduced and one article after another eliminated until the system becomes accustomed to the reduction.

_Thorough elimination must be secured through exercise and deep breathing._

All alcoholic liquors must be omitted.

_All diets for obesity must be prescribed for the individual condition. A diet suited to one person may be entirely unsuited to another. For this reason, and because of the danger of one following a diet which may be unsuited to the condition, diets for obesity are not given here._

_Exercise and deep breathing must constitute an appreciable part of reduction methods to cause a combustion of the fat liberated._ These are the natural, scientific means of reduction.

_If one reduces by diet alone the excess of fat may not come from the part desired._ One is likely to show the results first in the face and neck. One should exercise the parts desired to be reduced so as to oxidize the fat stored about these particular tissues.

A large number of the obese are afflicted with rheumatism, sluggish livers, sluggish action of the intestines, and weak nerves, and the diet must be governed accordingly.

The regulation of food for reduction of flesh must also be governed by age, sex, by the manner of breathing, and by the amount of daily exercise. The food must be regulated in accordance with the quantity of carbohydrates and fats daily consumed in heat and energy.

A rational study of the needs of the system and a persistent following of the indicated regimen will result in a steady reduction, renewed vitality, and a sense of “being fit.” The better elimination secured by exercise and increased oxygen will aid the muscles to release the fat which may have caused them to become flabby.

Reduction must not be accomplished too suddenly, but it can be gained by a little self-denial and determination.

One who carries too much fat is much more liable to gout, rheumatism, apoplexy, high blood pressure, asthma, and bronchial affections.

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[Sidenote: Feeding the Convalescent]

When an individual is recovering from an illness the appetite often becomes excessively active, and his demands for food, if yielded to by the family or attendant, may produce digestive derangements from which recovery is slow.

On the other hand, too much food is often urged on the convalescent from a mistaken idea that large quantities of food are necessary in order to rebuild the enfeebled system.

Care must be taken not to return too rapidly to a solid diet when a liquid diet has been followed for some time. The digestive system shares in the general weakness and must not be overloaded.

The more easily digested foods, as ice cream, milk, tapioca, crackers and cream or cream toast, cream soups and meat broths thickened with bread crumbs rolled from toasted bread, custards, stewed fruits, corn meal, mush, in some conditions, cornstarch blancmange, boiled rice, and poached eggs may be given.

Later, when meat is added to the diet it should be scraped or finely minced so as to give the stomach as little work as possible until it regains its tone.

Potatoes, if allowed, should be baked or mashed.

Sweetbreads in cream, sponge cake or lady fingers with light cream may also be allowed.

At least a week should be taken in returning to a solid diet and the orders of the physician must be strictly followed. Pickles, nuts, or solid meats should not be allowed. They will often occasion a return of fever and possibly a relapse.

After typhoid fever or other lingering illness, the appetite is usually much increased, but great care must be exercised not to allow solid food before the condition of the stomach and intestines shows that danger is past. It is usual not to allow solid food in typhoid fever for two weeks after the fever has disappeared.

It is possible to make great variety in the diet even if it be light and easily digested and common sense must govern in the kind as well as the quantity of food allowed the convalescent.

Scraped beef or scraped chicken may be seasoned, lightly pan broiled, and made into a sandwich. The first solid meat may be creamed sweetbread, a bit of broiled tenderloin steak, or breast of chicken.

It is better to give small amounts both because of the lessened work of digestion and because large amounts of food often destroy rather than aid the appetite.

If the appetite is capricious, or lacking, it needs to be stimulated by food appetizingly prepared and daintily served. A sloppy tray with half-cold tea or coffee will often cause complete loss of appetite.

The face and hands of an invalid should always be bathed before a meal; the fresh feeling induced is often an aid to the appetite. The mouth should be carefully cleansed after eating in order that no fermenting food particles may be carried into the stomach to cause disturbance there. Swabbing the mouth with cotton dipped in an alkaline wash or rinsing the mouth with listerine and water or peroxide of hydrogen and water will add greatly to the comfort of the sick, especially when the tongue is coated and the mouth bitter.

Great care should be taken not to allow bread crumbs to fall into or under the bedclothes, as a small bread crumb is often a source of great discomfort. The skin is especially sensitive and a small bread crumb may so disturb the mind as to cause a patient, otherwise doing well, to become restless and disturbed.

The invalid frequently forgets to ask for water and the attendant should see that a sufficient amount of water is taken. A glass of water should be placed where it is within easy reach and it should not be allowed to become warm. Cool water is one of the prime requisites in the invalid’s dietary.

FOOTNOTES:

[15] For treatment of pimples, see _Let’s Be Healthy_, by Susanna Cocroft.