22. Cod-Liver Oil.
THE value of this agent in the treatment of many constitutional diseases is amply confirmed by long experience It should be regarded as food rather than medicine, although the minute amount of Iodine and Phosphorus it contains may account for its curative virtues in many cases in which cod-liver-oil has been the only remedy given.
The complaints in which cod-liver oil is of service need not be here enumerated, as it is prescribed in numerous instances in the following pages. We may however, state that it is especially valuable in the various forms of tubercular disease-chronic discharge from the ears, Ophthalmia, enlargement of the glands, Tubercular disease of the bones, Tubercular Abscesses, etc., and in short, in all diseases which require fatty substances as food, and Iodine as a remedy. Its assimilation is promoted, and its beneficial action greatly enhanced, by the addition of ten drops of the first dilution of Iodium to each pint of the oil. This addition is especially recommended in Phthisis Pulmonalis, and Atrophy.
In the treatment of Consumption, it stand pre-eminent, by almost universal consent; when given in suitable cases, its power in checking emaciation and raising the tone of the muscular structures is well known. Other forms of fat (cream, etc.) have also great value.
The value of cod-liver oil is often very marked in the sequelae of many acute disease or inflammations occurring in middle-aged and in old persons in whom the reparative powers are less active than in children; also in the after-effects of the acute fevers of children who have suffered, previous to such attacks, from impoverished health,-as chronic discharge from the ears and nose after Scarlet Fever and Measles; the after stages of Whooping- cough; Rickets; Chorea, etc., are generally much benefited by the administration of cod-liver oil. Chronic Rheumatism and Gout, chronic Bronchitis, colour skin diseases, and the degenerative diseases of the aged, are all more or less benefited by the employment of this great.
CAUTION.- Cod-liver oil should not, however, be administered indiscriminately. It is generally inadmissible during the persistence of acute febrile-symptoms, congestion, haemoptysis, or any active form of disease; digestion is then impaired, the mucous membrane irritable, and the oil is only likely to occasion disorder. The sphere of cod-liver oil is to remove exhaustion and increase general tone; this is best accomplished when active morbid processes and local irritation have subsided, for then the system is in a condition to appropriate a larger amount of nourishment.
Some caution is necessary to be observed in the administration of oil to obviate nausea or eructations. Such effects generally result from the quantity or quality of the oil used. The large quantity of oil taken in some cases occasions disorder of the digestive mucous membrane, or it passes off with the evacuations. The appearance of any oil unchanged in the evacuations is a sign that the quantity should be reduced, as more is given than can be digested. We generally recommended it at first, in teaspoonful doses, twice a day, with, or immediately after, food; if the stomach be intolerant of it, a teaspoonful, or for young children, ten or twelve drops, once a day. If there be still difficulty in retaining the oil, we prescribe it at bedtime, just as the patient is lying down to sleep. In cases of extreme irritability of the stomach, cod-liver oily may be introduced into the system by friction; a considerable amount of friction, as much as the patient can bear, facilitates absorption. When intolerance is really marked the attempt to administer cod-liver oil should be abandoned and reliance placed upon other fat foods, while in addition, Iodine, Phosphorus, or whatever drug seems best indicated can be given.
The disagreeable effects of oil, and the repugnance felt towards it, ave often been created by inferior and disgusting preparations. Probably the best method of rendering the oil palatable is to have it made up in bread, as it is then scarcely tasted. The proper proportion is two to four tablespoonfuls of the oil to one pound of dough. Small pieces of ice in each dose of oil also render it almost tasteless.
Claret or ginger wine are other vehicles for cod-liver oil. The oil should be poured upon the wine, so that it does not touch the glass, but floats on the wine as a large globule, in which way it may be swallowed without taste. A few morsels of agreeable food should then be eaten. A yet further plan to obviate taste and nausea is to take a pinch of salt immediately before and after the oil. And if the fish be not unsuitable, one or two teaspoonfuls may be given with a sardine, the oil being poured over in the absence of the child or patient. The modern preparations in the form of Emulsions are much more palatable than the ordinary oil.
23.- Food for Infants, Invalids, etc.
BEEF-TEA. – Put half a pound (or a pound, according to the strength required) of rump-steak, cut up into small pieces (shreds for preference), into a covered tin or copper saucepan, with one pint of cold water. Let this stand by the side of the fire for three or four hours, and let it then simmer gently for one hour. Skim well, and serve. If grease be specially repugnant the last traces may then be removed by lightly skimming the surface with pieces of blotting paper.
The meat used should be as fresh as possible-the fresher the better-and should be cleared beforehand of all fat or gristle. If this precaution be neglected, a greasy taste is given to the beef-tea, which cannot afterwards be removed, except by the above method, or by allowing it to become cold. The saucepan used should be made of copper or tin; iron saucepans should not be used, unless enamelled. In re-warming beef-tea which has been left to cool, care must be taken to warm the tea up to the point at which it is to be served, and no higher;l it should on no account be allowed to boil. When once allowed to get cold, it never regains the agreeable flavour it possessed when fresh.
ESSENCE OF BEEF.- Druitt directs its preparation as follows- Take a pound of lean beef, free from skin, bone and fat; chop it up; put it into a large earthen jar with cover; cement the edges with flour paste; tie it up tightly in a cloth; put it into a saucepan, and let it boil for two hours; pour off the liquid essence from the coagulated muscles; let it stand till cold; skim off the fat. This contains a large quantity of nutriment, is generally pleasant to the palate, and is particularly valuable in extreme exhaustion. A few teaspoonfuls may be given every three or four hours.
SKINNER’S LIQUID BEEF.- This is a very excellent preparation recommended by Dr. Skinner. The directions for preparing it are as follows-
Take one pound of rump-steak (gravy beef will not do, as it jellifies, and is not so easily digested as rumpsteak), remove the fat and membranous portions, cut the muscular fibre into pieces the size of a dice, and pack it into the empty jar. The jar many be filled to the top it there is enough of the meat. Before putting on the lid place a piece of calico or muslin over the bottom of the lid in order to ensure its being as water-, air, and steam-tight as possible. Place the jar in an open pot of cold water, bring it slowly to the boil, and then let it boil for half an hour the Liquid Beef is then ready. Undo the lid, and pour out the contents. At first an oily, yellowish fluid passes, and then a thick, grumous-looking fluid. These two constitute what I call my Liquid Beef. Lastly, pour into the jar sufficient hot water just to cover the remains of the meat, stir it round with a spoon, and pour off the liquid portion into a cup. This is very good beef-tea, which may be taken by itself, or added to the Liquid Beef. Taste what remains in the jar, and it will be found to be destitute of flavour, and to have no aroma of meat boiled cork-shavings is as near it as anything.
The quantity obtainable from a pound of rump-steak is small of the Liquid Beef, about half a teacupful, but it is extremely palatable and life-sustaining, as well as nourishing. All that it requires is a little salt added, to the taste of the patient. It will be observed that there is no water or salt, or anything added to the jar containing the muscular fibre-nothing but the meat alone.- See Homoeopathic World, vol. xxiv., p. 445.
COLD BEEF EXTRACT.- Take one pound of fresh beef, free from fat, chop it up fine, and pour over it eight ounces of soft water, add five or six drops of hydrochloric acid, and fifty or sixty grains of common salt, stir it well and leave it for three hours in a cool place. Then pass the fluid through a hair sieve, pressing the meat slightly, and adding gradually towards the end of the straining about two more ounces of water. The liquid thus obtained is of a red colour, tasting like soup. It should be taken cold, a teacupful at a time. If preferred warm it must not be put on the fire, but warmed in a covered vessel placed in hot water.
These beverages, in common with any nutritious soups, offer a fluid form of food just adapted to an imperfect condition of the general bodily functions, which being more or less suspended, require nourishment in a form easy of assimilation. It is on these accounts that their beneficial effects may, at least in part, be attributed. Taken after fatigue, they have a remarkable power of restoring the vigorous action of the heart, and dissipating the sense of exhaustion following severe or prolonged exertion. They are recommended in preference to the glass of wine which some take after preaching, watching, prolonged mental effort, etc.
If lean, raw meat is passed several times through the mincing machines, and every fragment of tendon removed, the ultimate produces is a soft homogeneous mass, which is not only easily digested, but possesses such such powers of stimulation and nutrition that in many sanatoria for Tuberculosis a great feature is made of its regular administration. It has great value also in convalescence after gastric ulcer, enteric, etc. It is not unpalatable, but its appearance sometimes distresses patients. It may then be given in sandwiches between thin slices of dry bread, or warm (not boiling) stocky may be poured over it and it may be taken like soup. The stock must not be so hot as to blanch the meat.
Rice (whole or ground), barley, isinglass, etc., may often be advantageously added to thicken the beef-tea.
MUTTON BROTH.- This may be made in a similar manner to beef-tea, either plain or thickened. For this purpose the best part of the sheep the end of the neck, free from skin and fat, bruised and cut into small pieces.
CHICKEN BROTH may be prepared from a full-grown young chicken, divested of head, neck, feet, skin, and fat. Toast should be given with it, or it will be rather insipid.
VEAL BROTH is not very palatable; and as it does not contain the nutritious qualities of beef-tea or mutton broth, it is scarcely advisable to introduce it to the sick-room, except for the skin of variety.
MUTTON CHOPS.- For a convalescent, a mutton chop broiled over a brisk, clear fire, rather than fried, is generally most suitable. It should be frequently turned on the fire, but not pricked.
FARINACEOUS FOOD.- In all cases of fever, enfeebled digestion, and general weakness, it is desirable to rely mainly on farinaceous food. Even beef-tea may some times be too stimulating.
OATMEAL PORRIDGE.- When properly made, this is both wholesome and nutritious, especially when a patient does not suffer from any form of bowel irritation. It has long been the staple food of the Scotch, and produces good muscular fibre and strong bone. It is a very nourishing diet for growing children. Common oatmeal is not equal to it; but it is not always easy to obtain the Scotch. It should be prepared as follows- Boil water according to quantity required, adding salt to taste; while boiling, sprinkle the meal slowly on the surface and stir it in; when enough is added, let all simmer for half an hour or longer, stirring occasionally.
PEARL BARLEY forms an excellent meal. It should be boiled for four hours, so tied in cloth that room is left for the grain to swell. Only so much water should be added from time to time as to feed the barley and supply the waste of evaporation, lest the goodness of the barley should be boiled out. It may be served with milk, or (if the patient can digest them) with preserves or butter.
RICE is regarded with prejudice by many, perhaps because it is cheap. But, prepared with milk, it is both wholesome and nourishing. It is easily digested, and is therefore most suitable for persons suffering from disorders of the alimentary canal, such as Diarrhoea and Dysentery; indeed, we have known the disorder arrested by simply taking boiled rice and drinking the rice-water. It requires less time to prepare than barely-one hour is sufficient; but it may be cooked and served in the same way. Old rice is better than new. Baked rice puddings form a pleasant variation. For these ground rice is preferable. Rice puddings, and all other farinaceous puddings made with milk, more wholesome when made without the addition of eggs.
MACARONI PUDDINGS.- There ounces of macaroni should be soaked for forty minutes in cold water, well mashed, then added to a pint of boiling milk. This should be stirred occasionally, while it simmers for half an hour; then two eggs added, beaten up with a dessertspoonful of sugar; also, if desired, a flavouring of lemon. This may then be baked in a pie-dish for twenty minutes. Vermicelli may be used instead of macaroni, but requires only twenty minutes’ soaking.
Part of a stale loaf of bread, (It is of great importance, especially when children are concerned, that bread should be pure. The following is a simple test for alum, the most common adulterant. If alum be present, a heated knife plunged into the loaf and allowed to remain till cool, with render its peculiar typical sourness perceptible on placing the knife in the mouth.) boiled, and served with wholesome food. Bread puddings made with eggs and milk, either boiled or baked, and sponge cake (Stale) puddings, made in the same way, diversify the diet.
There are many preparations of farinaceous foods. Some of them have acquired considerable reputation, and are really very excellent; some, on the other hand, are preparations of pulse, which are not adapted to weak digestion.
ARROWROOT, TAPIOCA, SAGO, JELLIES, etc., are little more than vehicles for the administration of other things. In themselves they afford but little nourishment. Isinglass, however, possess considerable nutritive qualities.
TOAST is rarely made well. Bread burnt on both surfaces, with the inside spongy, is unwholesome food. It should be stale, of moderate thickness, slowly and thoroughly baked through, nicely browned on the outside-in short, not toasted too fast. Such toast is wholesome to eat or to soak in water.
FARINACEOUS Foods.- Many years’ experience in the use of Neave’s Food justifies the recommendation of it as an excellent article of diet for infants, invalids, and persons of feeble the preparation to contain every constituent necessary for the nourishment of the body; and this has been abundantly confirmed by what we have frequently observed as the result of its use. For infants it should be prepared according to the directions supplied with the food, taking care not to make it too thick; and, in the majority of cases, it is the best substitute for the mother’s milk. It also makes a very agreeable and highly nutritive gruel.
One precaution is necessary. Neave’s food should be obtained fresh and in good deteriorates. Under favourable circumstances it keeps good for from six to twelve months, and may generally be procured in excellent condition from the leading homoeopathic chemists. Du Barry’s Revalenta, Benger’s, Mellin’s and Allen & Hanbury’s foods are all valuable. Sometimes a patient can take one and had another, so that it is desirable to have a choice of several.
Those foods which consist of nearly pure starch, as corn- flours, so called, and all those which thicken in like manner, contain but a small proportion of nutriment, being less sustaining, and also more difficult of digestion, than ordinary stale bread. For young infants and for children suffering from Diarrhoea, Indigestion, Constipation, Flatulence, Atrophy, or Aphthae, they are very unsuitable. In all cases, foods which contain traces of bran, and also gluten, gum, sugar, cellulose, and saline matter-especially the phosphates-in proportion to the starch, are to be preferred.
SUGAR-OF-MILK.- A preparation of cows’ milk a nd sugar-of-milk forms a still lighter food, and one which may be used when farinaceous food disagrees. Cows’ milk may be assimilated to human by dilution with water and the addition of sugar-of-milk. Cows’ milk contains fat (cream), and caseine, or cheese-matter, but less sugar, than women’s. When necessary to bring up a child by hand from birth, sugar-of-milk is most suitable to commence with.
Formula.- Dissolve one ounce of the sugar-of-milk in three- quarters of a point of boiling water. Mix, as wanted, with an equal quantity of fresh cows’ milk, and let the infant be fed with this from the feeding-bottle in the usual way. The bottle should be washed after feeding, and the teat kept in cold water until wanted again.
It is important to use only cows’ milk of a good quality, and always to administer it at the same temperature as that of breast milk. (See Diseases of Infants and Children. 6th Edition, 1899.) After the fourth or sixth month, Nave’s Farinaceous Food is generally more suitable.
CONDENSED MILK.- Residents in London and large towns, where it may be difficult to obtain good whole some milk, may find it advantageous to use the consolidated milk, imported in sealed tins from Switzerland and other parts. It is prepared by the evaporation of water and the addition of sugar, and when opened the milk is of the consistence of paste. It contains all the elements of pure milk and cream, with sugar in addition; so that it will require only careful dilution with warm water to adapt to the weak digestion of infants. In some instance, however, the excess of sugar proves deleterious, causing acidity and other gastric derangements. The modern preparation of dried milk, known as Glaxo, is a most excellent preparation, superior to any condensed milk. It is retained sometimes when every other food is rejected.
24.- Demulcent Beverages.
BARLEY-WATER.- Wash a tablespoonful of pearl barley in cold water; then add to it two or three lumps of sugar, the rind of one lemon, and the juice of half a lemon; pour on the whole a quart of boiling water, and let it stand for two or three hours; then strain it. Instead of lemon currant-jelly, orange-juice, or sliced liquorice may be used to flavour. Barley-water is a valuable demulcent in cords, affections of the chest, Hectic fever, etc. it is also useful in Strangury and other disease of the bladder and urinary organs.
LINSEED-TEA.- This is often a useful beverage for soothing irritation in Cough, Catarrh, Consumption, Pneumonia, Diarrhoea, Dysentery, Inflammation of the bowels, Leucorrhoea, difficult micturition, and other inflammatory disease. It is prepared by adding one ounce of linseed and half an ounce of sliced liquorice-root to two points of boiling water, and macerating in a covered vessel near the fire for two or three hours; it should then be strained through a piece of muslin, and one or two tablespoonfuls taken as often as necessary. Sliced lemon and sugar-candy will make it more palatable. Where liquorice is disliked it can be omitted in preparation.
RICE-WATER – is valuable in diarrhoea. Boil the best rife in a good measure of water for ten minutes, strain off the water, and add more; and so on till the goodness is boiled out of the rice. The water is ready to drink when cold. Cream may be added, if there be not high fever; a pinch of salt also, of desired.
TOAST-WATER-is rarely well made. A slice of state bread (crust is better) should be slowly baked through (not burnt), then put in a jug with a quart of boiling water poured over it, and allowed to stand covered till cool. It may be flavoured with lemon-peel.
Barley-Water, Toast-Water, and Linseed Tea are more or less useful in similar conditions, one being substituted for the other for the sake of variety.
LEMONADE.- Cut a lemon into slices, and put it into a jug with several pieces of loaf-sugar. Add a pint of boiling water, cover, and let stand till cold. After straining it is fit for use. Recommended to allay thirst, irritation of the throat, etc.
SWEETS.- It should be remembered by those who provide the diet of invalids that they soon tire of sweets, and that they gladly take something savoury. A perpertural round of sweetened drinks, jellies, etc., soon palls the appetite.
FRUITS.- Ripe fruits in season are palatable and refreshing to an invalid, and need rarely be withheld if well cooked, even in acute forms of stomach disorder. In all cases, whether cooked or not, the skins and seeds should not be eaten. Oranges, grapes, and strawberries stand first for delicacy and wholesomeness, although some patients have an idiosyncrasy that prevents them from taking strawberries. Apples pears, peaches, nectarines, etc., stewed, baked (not burnt), or boiled, may be served with sugar or syrup.