Part 48

To judge of an oven’s heat, try the oven every ten minutes with a piece of white paper. If too hot, the paper will blaze up or blacken. When the paper becomes dark brown, darker than ordinary meat, pie crust, the oven is fit for small pastry. When light brown, the color of nice pastry, it is ready for tarts. When the paper turns dark yellow you can bake bread, large meat pies, or pound cakes. If it is just tinged, the oven is fit for sponge cake and meringue.

VINEGAR PREVENTS COOKING SMELL.

When cooking by gas always place a tin of water in the oven. A bowl of vinegar and water placed beside the stove will prevent the smell of cooking from spreading through the house.

SAUCES FOR MEAT.

With roast beef, grated horseradish. With roast veal, tomato or horseradish sauce. Roast mutton, currant jelly. Roast pork, apple sauce. Roast lamb, mint sauce. Roast turkey, chestnut dressing, cranberry jelly. Roast venison, black currant jelly or grape jelly. Roast goose, tart apple sauce. Roast quail, currant jelly, celery sauce. Roast canvasback duck, apple bread, black currant jelly. Roast chicken, bread sauce. Fried chicken, cream gravy, corn fritters. Roast duck, orange salad. Roast ptarmigan, bread sauce. Cold boiled tongue, sauce tartare or olives stuffed with peppers. Veal sausage, tomato sauce, grated parmesan cheese. Pork sausage, tart apple sauce or fried apples. Frizzled beef, horseradish. Pork croquettes, tomato sauce. Corned beef, mustard. Lobster cutlet, sauce tartare. Sweetbread cutlet, sauce bechamel. Reed birds, fried hominy, white celery. Cold boiled fish, sauce piquant. Broiled steak, maitre d’hotel butter or mushrooms. Tripe, fried bacon and apple rings. Broiled fresh mackerel, stewed gooseberries. Fresh salmon, cream sauce and green peas. Cream sauce with sweetbreads. Orange salad with roast chicken. Celery sauce with quail. Stuffed olives with fish balls. Horseradish sauce with boiled beef. Horseradish and fried onions with liver. French dressing with sardines. Mint sauce with lamb. Yorkshire pudding with roast beef. Hard-boiled eggs and parsley with boiled salmon. Cream gravy, strawberry preserves with fried chicken. Oyster dressing for turkey. Celery and onion dressing with roast duck. Tart grape jelly with canvasback duck. Currant jelly with roast goose. Cucumber catsup with corned beef.

FOOD AND NUTRITION IN DISEASE.

A physician, writing to the New York Medical Journal, says the chemical composition of the body is quite similar to the composition of the foods which nourish it. Protein, fats, carbohydrates, mineral salts, and water are the compounds we need in our foods, and they are found in flesh foods and vegetables. Protein, the most important element, is derived principally from meat, eggs, and milk. It is also furnished by some vegetables, as beans, peas, and the gluten of wheat; but in these it is mixed with too much extraneous matter, as husks, bulbs, woody fiber, etc., to be useful in the diet of the sick. Extractives, as beef-tea, are included in the nitrogen compounds, but they neither build tissue nor furnish energy; they are appetizers and stimulants. Animal and vegetable fats are useful; these are found in meat, fish, milk, eggs, some cereals, olives, and nuts. The carbohydrates include sugars, starches, cellulose, and the fibers of plants. Potatoes, sago, farina, and arrowroot are rich in them. Fats should be used with caution in disease, because they retard the formation of hydrochloric acid, which excites the pancreatic secretion, an important factor in digestion. Man can live better without a stomach than without a pancreas. Physicians realize that they must rely on diet rather than drugs to cure indigestion, as the food varies in its proportion of fat, protein, and carbohydrates; the digestive juices are poured out or repressed and altered in strength and quantity.

Milk is not an ideal food for the sick, too large a quantity being required, and the large curds it forms in the stomach often rendering digestion difficult. Boiled with rice it forms an excellent diet.

In acute diseases lasting from four to six weeks no great effort should be made at forced feeding. Thin soups, flooding the stomach with unnutritious fluids, should be avoided. It is unnatural to take food during physical or mental suffering. Appetite is wanting, and imperfect assimilation adds to the physician’s worries and the patient’s discomforts. When there is no appetite the digestive juices are absent. Feed a convalescent when, through conversation about some dainty dish, interest is aroused and saliva is secreted.

DIET-LIST.

=Liquid diet= consists of: Water of all kinds. Cocoa. Ginger ale. Kumiss. Lemonade. Buttermilk. Orangeade. Milk punch. Albumin water. Malted milk. Broths. Milk. Tea. Cream. Coffee. Egg-nog.

=Soft diet= consists of: Liquids of all kinds. Soups (vegetable and strained). Milk toast. Soft-boiled eggs. Gravy “ Oysters. Bread without crusts. Baked apple. Cereals. Apple sauce. Custard. Stewed fruits (no seeds). Rice. Mashed potato. Ice cream. Baked “ Milk puddings. Purées and milk. Plain “ Toast. Soft-poached eggs.

=Light diet= consists of soft diet, including: Whitefish. Quail. Codfish. Sweetbreads. Finnan haddock. Chicken. Bacon. Chops. Scraped-beef. Steak. Squab. Vegetables only when ordered.

=Typhoid diet=, as soon as food is ordered, is as follows: First week— Coffee for breakfast. Tea for dinner. Cereals (well cooked and strained). Eggs lightly boiled. Poached eggs and soft toast. Broths (chicken, oyster, and meat). Scraped-beef. Custards. Bread without crust. Ice cream. Milk toast. Orange-juice. A glass of milk, t. i. d. To the foregoing may be added for Second week— Dry toast. Chicken. Baked potato. Whitefish. Baked apples. Rice. Asparagus. Farinaceous puddings. Chops. Milk soup. Steak. Purées. No vegetables, pastry, or raw fruits are allowed. Liquid— 1. Milk, 3 parts; Lime-water, 1 part. 2. Albumen-water. 3. Clear chicken or beef broth may be given three times in 24 hours.

DIABETIC DIET.

White of eight eggs; Dry oatmeal, ℥xij (by weight); Butter, ℥viij-x.

Procedure.—Cook oatmeal 2 hours. When done, beat into it the melted butter. Then fold in the beaten whites of eggs.

MOTOR TEST-MEAL.

A. White meat of chicken or fish. B. Coarse vegetables. C. Jam seeds (raisins or currants). D. Potatoes. E. Tea. F. Two slices of bread.

EWALD’S TEST-BREAKFAST.

A. 2 shredded wheat biscuits, or 2 slices of bread. B. 1½ glasses of water.

OBSTETRICS.

=Puberty.=—This is the period of transformation from childhood to adolescence. There is a marked development of the throat and chest, the breasts become fuller, more rounded, and there is also an enlargement of the pelvis. These outward signs are combined with certain internal changes, affecting especially the ovaries and the uterus, that are described under the terms of ovulation and menstruation.

=Ovulation.=—The ovaries produce ova that are retained in cavities termed ovisacs (Graafian follicles), which are scattered throughout the ovary. Sometimes an ovisac contains more than one ovum, but usually each ovisac contains but one. When the ovary becomes functionally active, some of the ovisacs in the deeper part of the organ increase in size and develop toward the surface. From time to time one of these ovisacs, having continued to increase in size so as to form a projection on the surface of the ovary, actually bursts and sets free an ovum. This frequently occurs in association with menstruation, but may take place at other periods. While this development of the ovisac has been taking place there is a special flow of blood to the pelvic contents, and the fringe-like processes of the Fallopian tube become more closely applied, so that a cup is formed by the fimbriated extremity of the Fallopian tube, into which the ovum drops. Eventually the ovum reaches the cavity of the uterus, and, unless it becomes fertilized or impregnated, it is in due course cast off from the uterus in the menstrual discharge and perishes.

When the uterus has become the seat of a fertilized ovum there is no further ripening of ovisacs. After the escape of an ovum from the ovisac the follicle is filled with blood, and this takes part in the formation of a structure known as the corpus luteum, which is formed within the burst ovisac. The corpus luteum varies in its development according as the ovum becomes fertilized or not. If pregnancy takes place it remains to its close, but if the ovum is not fertilized it disappears in about three months. The ruptured ovisac always contains the elements of a corpus luteum, but its development depends on the fate of the ovum. Ovulation has been said to commence before menstruation; ovisacs may sometimes ripen and burst in childhood. Conception may take place before menstruation has set in.

=Menstruation.=—The blood is derived from the mucous membrane of the uterus (endometrium) and not from that of the cervix. The endometrium becomes swollen and thickened prior to the commencement of the flow, and the blood-vessels are distended. With the beginning of the flow this swelling gradually diminishes. A few superficial cells of the endometrium are usually cast off during menstruation, and this is regenerated during the interval between the periods. The mucous membrane of the uterus is thus never at rest until menstruation ceases for good.

=Conception.=—Fertilization of the ovum may occur anywhere in its course from the ovisac to the uterus, but ordinarily it takes place in the uterus. Certain changes take place in the uterus preparatory to the arrival of the fertilized ovum. The whole organ enlarges, it contains more blood than before; the mucous membrane becomes soft, spongy, thickens greatly, and is thrown into folds which are called the decidua vera.

=Decidua Vera.=—The part of the decidua vera to which the ovum becomes attached and where the placenta afterward forms is called the decidua serotina. The presence of the ovum acts as an irritant to the spot where it lodges, and active growth takes place. At the same time the ovum burrows into the mucosa and gradually becomes embedded. The vera closes over the ovum. The decidua vera is a mold of the interior of the uterus. The external surface is rough where it has been torn from the underlying tissues of the uterus, and the internal aspect which is in contact with the ovum is smooth. It is thickest at the third month; after this time the membrane becomes thinner and thinner, until by the end of pregnancy it is very thin. It is to a considerable extent expelled at labor and forms part of the membranes.