and carbonaceous elements. The fats themselves hold the first place as fat-forming foods. Those most frequently employed for this purpose are the fat of meat, butter, olive-oil, cream, and milk. Sugar and saccharine fruits and vegetables rank next in importance as fatformers. The organism has the power of transforming starch into fat, whence bread, potato, pastry, rice, arrow-root, etc., belong to this class. The malt liquors undoubtedly possess an extraordinary energy in the same direction, hence the use of beer and ale by nursing women; but it is undoubtedly true that milk is better for increasing the production of milk. Less force is lost in the conversion of cow's milk into human milk than in the complex process needed for transforming the nutritive elements of malt liquor. The same fact is true in regard to the relative facility of the appropriation of fatty aliment and of the ecnversion of saccharine and farinaceous food into fat. It is also true that, for the increase of muscular power, muscular tissues and juices are more easily applied by the organism.

In the scrofulous, mercurial, plumbic, syphilitic, and paludal cachexie, and in phthisis, a combination of the flesh and fat forming foods is necessary. The hunger or denutrition cure, as already explained, may be applied to the treatment of these cachexia, the object being to produce such waste and molecular changes as to cause the elimination of the morbific matters. On the other hand, the object sought to be accomplished in these states of disease and in phthisis, by improving the body nutrition, is to supplant by fresh material the lesions of the anatomical elements.

In rickets (mollities ossium) it is necessary to supply a food rich in phosphate of lime and other phosphate salts. Oatmeal, bread of unbolted flour, cracked wheat, etc., should be added to the dietary.

Gout, rheumatism, and the so-called uric-acid diathesis, require a diet composed chiefly of farinaceous vegetables and acid fruits. Animal food and saccharine substances are contraindicated in these disorders.

In no disease is the influence of diet more conspicuous for good or evil than in diabetes. I have already alluded to the milk-cure, revived by the Montpellier school and popularized in England by Dr. Donkin. All saccharine substances and fruits and vegetables containing them, and all farinaceous foods the starch of which is easily convertible into dextrine and sugar, are injurious in diabetes. In this prohibition are included bread, potato, beets, beans, peas, sugar, milk, pastry, and sweetmeats of all kinds. Tomatoes, celery, and raw cabbage, are not objectionable. In order to compensate for the loss of bread, the greatest deprivation endured by these diabetics, gluten and almond bread are now prepared. To supply the deficiency in the alimentation of diabetics caused by the withdrawal of the starch elements of the food, fats must be used, as butter, olive and cod-liver oil, fat of meat,

cream, etc.

FORMULE FOR VARIOUS ARTICLES OF DIET.

Lemonade. - "Put the juice of a lemon to a pint of water, in which an ounce of sugar has been dissolved; then add the white of an egg and froth it up. It may be iced."

Farina-Gruel.-" Stir two tablespoonfuls of farina into a quart of water in a milk saucepan; let this boil until it has grown quite thick; add a pint of milk, a little salt, and let it boil fifteen minutes longer; turn out into a bowl, and sweeten to taste."

Oatmeal-Gruel.-" Put a pint of boiling water into a saucepan; into this stir a couple of tablespoonfuls of oatmeal until quite smooth; let this boil well for ten or fifteen minutes, season with salt, then strain through a strainer, and add a little port wine and sugar, if the patient may have it."

Corn-Meal Milk-Gruel.-" Sweeten a quart of milk, and stir in two tablespoonfuls of corn-meal. This must be carefully cooked, as the meal is apt to scorch, and must be stirred while cooking. A little nutmeg grated on top after it is done makes a pleasant flavor. If the gruel is desired thick, more meal will be needed."

Tapioca Jelly." One cup of best tapioca put to soak with a pint of cold water; when soft put in a saucepan with one cup of sugar, the rind and juice of one lemon, a little salt, one pint more water; stir until it boils; turn into a mold; set to cool; add one glass of wine if desired."

Sago." Put half an ounce of sago into an enameled saucepan with three quarters of a pint of cold water, and boil gently for an hour and a quarter. Skim when it comes to a boil, and stir frequently. Sweeten with a dessertspoonful of sifted loaf-sugar. If wine be ordered, two dessert-spoonfuls; and, if brandy, one dessert-spoonful."

Arrow-root." Mix two teaspoonfuls of the best arrow-root with half a wineglassful of cold water; add a pint of boiling water; put it into an enameled saucepan, and stir over the fire for three minutes. Sweeten with three teaspoonfuls of sifted loaf-sugar. Add either a wineglassful of white wine, or a tablespoonful of brandy, if permitted."

Arrow-root Milk.- Mix two teaspoonfuls of arrow-root with a wineglassful of new milk; add half a pint of boiling milk; put it into an enameled saucepan, and stir over the fire for three minutes. Sweeten with a dessert-spoonful of sifted loaf-sugar."

Whipped Cream.-" Beat half a pint of fresh double cream with a whisk, add a dessert-spoonful of very finely powdered loaf-sugar, and twenty drops of essence of vanilla or any other flavoring; when firm it is ready for use, but much improved by being on the ice for an hour or two."

Corn-Starch Pudding.-"One quart of milk, four tablespoonfuls of cornstarch, four eggs, one tablespoonful of butter, six tablespoonfuls of sugar. Dissolve the corn-starch in a little cold milk, and, having heated the rest of the milk to boiling, stir this in and boil three minutes, stirring all the time. Take from the fire, and while still hot put in the butter. Set away until cold. Beat the eggs very light, whites and yolks separately. Stir the sugar and any flavoring desired in the yolks and then add the beaten whites, and stir in the cornstarch, beating thoroughly to a smooth custard. Turn into a buttered dish and bake half an hour. To be eaten cold."

Beef-Juice." Broil quickly some pieces of round or sirloin, of a size to fit in the cavity of a lemon-squeezer. Both sides of the beef should be quickly

scorched to prevent the escape of the juices, but the interior should not be fully cooked. As soon as ready, the pieces should be pressed in the lemon-squeezer, previously heated by being dipped in hot water. The juice, as it flows away, should be received into a hot wineglass, and, after being seasoned to the taste with salt and a little Cayenne pepper, eaten while hot. If preferred, the juice may be frozen."

Meat-Tea." Put one pound each of beef, mutton, and veal, cut into small pieces, into three pints of cold water. It should simmer for three or four hours, but not boil. When finished, the tea should be carefully strained, and seasoned with salt, and Cayenne pepper if preferred."

Cream-Soup.-"Take one quart of good stock (mutton or veal), cut one onion into quarters, slice three potatoes very thin, and put them into the stock with a small piece of mace; boil gently for an hour; then strain out the onion and mace; the potatoes should, by this time, have dissolved in the stock. Add one pint of milk, mixed with a very little corn-flour to make it about as thick as cream. A little butter improves it. This soup may be made with milk instead of stock, if a little cream is used."

Oatmeal-Soup. "Put two ounces of oatmeal in a basin, pour over it a pint of cold water, stir it, and let it stand a minute; then pour over it, quickly stirring all the time, a pint of good broth, pour through a fine strainer into a saucepan, taking care that none of the coarse part of the meal goes into the soup. Boil the soup for ten minutes, season and serve."

ARTIFICIAL DIGESTION.

We owe to Dr. Roberts, of Manchester, the introduction of partly digested foods, under the term "peptonized." The formulæ below show the manner in which they are prepared. The liquor pancreaticus mentioned is a solution of the pancreatic juice. This differs from the stomach-juice in that it requires an alkali to give it activity. It can now be obtained of the pharmaceutists or druggists.

Peptonized Milk.-" Fresh milk is diluted with water in the proportion of three parts of milk to one part of water. A pint of this mixture is heated to boiling, and then poured into a covered jug. When it has cooled down to about 140 Fahr., one or two teaspoonfuls of the liquor pancreaticus, and a small pinch of bicarbonate of soda (in solution), are mixed therewith. The jug is then placed under a 'cozy' in a warm situation for one hour. At the end of this time the product is again boiled for a couple of minutes. It can then be used like ordinary milk."

Peptonized Milk-Gruel.--" Half a pint of well-boiled gruel is added, while still boiling hot, to half a pint of cold milk in a covered jug. The mixture will have a temperature of about 125° Fahr. The liquor pancreaticus and the bicarbonate of soda are then added in the same proportion as in the preceding process. The jug is placed under a 'cozy' and kept warm for an hour and a half. The contents are then boiled for a couple of minutes, and the product is ready for use. By this second method the use of the thermometer is dispensed with."

Farinaceous foods are predigested by acting on their starchy constituents with malt or diastase. Of this variety are Mellin's, Hor

lick's, and Benger's. Mellin's is prepared of coarsely ground flour, to which malt and potash are added. The mixture is then exposed with some water to a moderate temperature, and dextrin and sugar formed. When used, a teaspoonful of the powder is mixed with two ounces of water and a half pint of milk. Horlick's food is similar. Both contain 60 to 70 per cent of carbohydrates in a soluble form, and about 10 per cent of albuminoids. Benger's is also a preparation of wheat flour to which pancreatic extract is added. In preparing for use, a tablespoonful is dissolved in two ounces of cold milk, and to this is added, slowly, a half pint of boiling milk. To prevent further action of the ferment, it is then raised to the boiling point for a few minutes.

Another variety of predigested foods consists of those acted on by diastase and then evaporated with milk and cream. The mode in which these foods are prepared is as follows: Flour of wheat, rye, or other grains, but chiefly wheat, is first made into dough, which is baked, ground, and, mixed with condensed cream or milk, is then dried at a regulated temperature. Malt or diastase added, the starch is converted into maltose and dextrin, and the albuminoids become more soluble.

Nestle's food, one of the most popular, is prepared from fresh cow's milk which is sterilized, and then wheaten bread crust, previously acted on by dextrin at a proper temperature, is added. Sufficient cane sugar is also added, and the mass is finally dried and pulverized.

Malted milk belongs to this group of predigested aliments. It is sterilized milk mixed with extracts of barley and wheat, and dried in vacuo. The starch is converted into dextrin, and the casein is predigested. The powder thus prepared is used by mixing a teaspoonful with a pint of water.

Various objections are now urged against the use of predigested aliments. As a rule they have a bitter and disagreeable taste, and are not relished by the sick. As regards milk-which may be referred to as representative-the following changes occur in its composition, according to Leeds: By sterilization at 212° Fabr. milk loses its amylolytic ferment, the casein coagulates less readily by the action of rennet, and the digestibility of the casein is impaired. Of the foods acted on by predigestion, the theory is that they do not require the agency of the stomach, and are already prepared for absorption. Recent experiences render this doubtful. Foods thus prepared do not seem to possess the active nutritive properties of aliments that undergo ordinary digestion. Whenever, therefore, the stomach can dispose of foods in the ordinary way, the method of predigestion should not be employed.

NUTRIENT ENEMATA.-It not unfrequently happens that the stomach will not receive and dispose of nutrient materials, when it becomes

necessary to employ nutrient rectal injections. It has been proposed to treat ulcer of the stomach by absolute rest of the organ, and the introduction of foods by the rectum. In cases of excessive irritabil· ity of the stomach the same practice is sometimes necessary. Esophagotomy and gastrotomy, as also wounds of the stomach, may render the use of nutrient enemata indispensable to save life. It should not be forgotten that the rectum is not an organ of digestion; hence nutrient enemata must contain the materials for artificial digestion. Furthermore, the mucus and fluids of the rectum are alkaline in reaction. To secure rapid osmosis, therefore, the enemata should have an acid reaction. The following formula is suitable for the purpose:

Beef-tea, prepared as before described, four ounces; hydrochloric acid, ten minims; glycerole of pepsin (Scheffer's), two drachms.

If the rectum is irritable, ten to twenty drops of the tincture of opium may be added to the injection. If stimulants are indicated, brandy may also be added. The rectum soon becomes intolerant of njections; hence, the greatest care should be used in practicing them, to avoid sudden distention of the bowel, and frequent introduction of nutrient materials should be avoided. Five times in the twenty-four hours should be the maximum-for artificial digestion is much slower than normal stomach digestion.

Leube recommends the following as a nutrient injection: "Take about five ounces of finely-scraped meat; chop it still finer, add to it one and a half ounce of finely-chopped pancreas free from fat, then add about three ounces of lukewarm water, and stir to the consistence of a thick pulp."

Or the following peptonized formula may be used: "A nutritive enema should be prepared in the usual way-of milk-or of milk with beef-tea or eggs-or of milk-gruel. To half a pint of the warm enema a tablespoonful of the liquor pancreaticus and thirty grains of bicarbonate of soda should be added. The enema can then be administered at once."

Supplementary Rectal Alimentation.-Under this designation, Dr. A. H. Smith, of New York, describes a method of rectal alimentation with defibrinated blood, which seems in a high degree useful. He ascertained that "three to four ounces of blood administered at night would be so completely absorbed in the course of eight or ten hours that no trace of it could be found in the morning evacuation." To retain the blood fluid, it must be defibrinated at the moment it is drawn, which may be done by stirring it with a bundle of twigs as it flows away. In chronic cases three to six ounces may be thrown into the rectum morning and evening; in acute cases every two to three hours. It may be used cold, but it is better to raise it to the temperature of the rectum. Constipation usually results, and in some instances the body exhales a rather fetid odor, and the stools are offensive. Another