DIETARY FOR THE SICK. 113 



distinguish between a dietary suitable for acute disease, when we 

 have to wait and tide over difficulties, and one that may be better 

 adapted to restore a convalescent or weakly patient. The highest 

 nutritive value may not be (I think it is not) the most essential 

 point to have regard to in selecting a dietary in acute diseases.* 



In most cases of acute disease, beef tea, freshly prepared, can 

 well be taken and digested. It is now often peptonized, and I be- 

 lieve for clinical purposes this is generally unnecessary, unless 

 there is manifest failure of secretion of gastric juice. This re- 

 mark applies equally to milk, which is also too often given pep- 

 tonized. I feel sure that we do best to administer nutriment in 

 the most natural and unaltered forms when possible that is, with 

 as little of culinary or medicinal interference as may be ; to give 

 it, in fact, fresh from Nature's laboratory. 



In many illnesses it is well to vary the broths given, changing 

 from beef to mutton, veal, or chicken, and so providing variety 

 for the patient. Milk and veal broth may often be given together^ 

 Alcoholized liquids are best not administered with animal broths. 

 These are better given separately, but brandy, rum, or whisky 

 may be given with milk. 



It is, unfortunately, a good rule to boil milk before using it, 

 especially in the case of children and young persons. This no 

 doubt averts many of the evils of milk diet, and may also prevent 

 some specific diseases. I say unfortunately, because I suspect 

 boiling much damages the nutritive value of a secretion such as 

 milk. Dilution with barley water, lime water, or the addition of 

 sodium bicarbonate, certainly aids its digestibility in children and 

 adults, both in health and disease ; the bicarbonate being prefer- 

 able if there is constipation. Whey is of considerable value for 

 many dyspeptics, and also in enteritis, typhlitis, and intestinal 

 obstruction, and may be freely given. Isinglass boiled in milk is 

 very useful, and children readily take this in the form of blanc- 

 mange when not too firm in consistence. Alum whey is of much 

 avail in diarrhoea, and in cases of enteric fever with haemorrhage. 

 One drachm of powdered alum is added to a pint of hot milk, and 

 the whey strained off. Cream with an equal volume of hot water 

 can often be taken when milk disagrees. 



Koumiss has considerable value in cases of great irritability of 

 the gastric mucous surface. Koumiss one week old I find the most 

 useful, and I have often known troublesome vomiting checked by 

 it. Few plans are better than that of employing milk with one 



* Thus alcohol, which is by some denied to have any nutrient property whatever, will, 

 with water, maintain life for days hi some cases of acute illness, to the exclusion of any 

 other articles of diet. I consider alcoholized liquids as /ooc?, for both ordinary and clinical 

 purposes 



VOL. XLIII. 9 



