White.Whole meal.Water40·043·5[a] Albuminoids or flesh-formers7·0[b]10·5Starch, dextrin, and sugar50·740·6Oil and fat0·61·6Cellulose and lignose0·51·8[c] Ash or mineral matter1·22·0(Church.)
[a] Calculated from total nitrogen present.[b] As much as 12·5 in some samples.[c] Includes common salt added.
Another writer who has worked out the facts arrives at closely similar conclusions. He sums up thus:—(a) The carbohydrates of bran are digested by man to but a slight degree. (b) The nutritive salts of the wheat grain are contained chiefly in the bran, and, therefore, when bread is eaten to the exclusion of other foods, the kinds of bread which contain these elements are the more valuable. When, however, as is usually thecase, bread is used as an adjunct to other foods which contain the inorganic nutritive elements, a white bread offers, weight for weight, more available food than does one containing bran. (c) By far the major portion of the gluten of wheat exists in the central four-fifths of the grain, entirely independent of the cells of the fourth bran-layer (the so-called “gluten cells”). Further, the cells last named, even when thoroughly cooked, are little if at all affected by passage through the digestive tract of the healthy adult. (d) In an ordinary mixed diet, the retention of bran in flour is a false economy, as its presence so quickens peristaltic action as to prevent the complete digestion and absorption, not only of the proteids present in the branny food, but also of other foodstuffs ingested at the same time. (e) Inasmuch as in the bran of wheat as ordinarily roughly removed there is adherent a noteworthy amount of the true gluten of the endosperm, any process which in the production of wheaten flour should remove simply the three cortical protective layers of the grain would yield a flour at once cheaper and more nutritious than that ordinarily used.
On this same subject theLancetremarks that bread which contains all the constituents of the wheat, except the outer, insoluble and irritating portion of the seed, seems, when the appetite for it has been obtained, to be more satisfying and digestible than the white and fashionable product which is found on most tables, of rich and poor alike. It is believed, too, that for children, the whole meal is the best for sustaining growth and for building up the skeleton strongly and in perfect form. The supply of whole-meal bread is now much facilitated by the improvements that have been introduced in the decorticated or granulated flour, to which Lady John Manners called public attention in her paper on Wheat-meal bread. In the decorticated whole meal the extreme outer coating of the wheat grain is, by a special process of abrading, to the perfection of which Dr. Morfit has rendered able service, cleverly removed. After the abrading process is completed, the whole of the grain is reduced to a fine flour, in which there is retained all the substances that are nutritious and digestible. Considering the fact that the whole-meal bread, when properly manufactured, is easily assimilated, we are led to the conclusion that it must be more nutritious generally than any other bread, in which starch predominates.
Oatmeal (Robinson’s for choice) is not adapted for making bread, but forms an excellent porridge—say 2 handfuls coarse oatmeal, 1½ pint water, well mixed, boiled ½ hour, and eaten with milk and treacle or brown sugar. The same may be said of Robinson’s Patent barley, which is wonderfully nutritious and adapted to youthful stomachs, besides being excellent in puddings (Keen, Robinson, and Co. are the makers).
Maize contains invaluable ingredients, and the preparation known as Brown and Polson’s corn-flour cannot be too extensively used, especially in custards and blancmanges.
Salt.—TheLancetpublishes the following:—“We have received from a correspondent a letter making some inquiries into the use of salt, and we are given to understand that among other follies of the day some indiscreet persons are objecting to the use of salt, and propose to do without it. Nothing could be more absurd. Common salt is the most widely distributed substance in the body; it exists in every fluid and in every solid; and not only is it everywhere present, but in almost every part it constitutes the largest portion of the ash when any tissue is burnt. In particular it is a constant constituent of the blood, and it maintains in it a proportion that is almost wholly independent of the quantity that is consumed with the food. The blood will take up so much and no more, however much we may take with our food; and on the other hand, if none be given, the blood parts with its natural quantity slowly and unwillingly. Under ordinary circumstances a healthy man loses daily about twelve grains by one channel or the other, and if he is to maintain his health that quantity must be introduced. Common salt is of immense importance in the processes ministering to the nutrition of the body, for not only is it the chief salt in the gastric juice, and essential for the formation of bile, and may hence be reasonably regarded as of high value in digestion, butit is an important agent in promoting the processes of diffusion, and therefore of absorption. Direct experiment has shown that it promotes the decomposition of albumen in the body, acting probably by increasing the activity of the transmission of fluids from cell to cell. Nothing can demonstrate its value better than the fact that if albumen without salt is introduced into the intestine of an animal no portion of it is absorbed while it all quickly disappears if salt be added. If any further evidence were required it would be found in the powerful instinct which impels animals to obtain salt. Buffaloes will travel for miles to reach a “salt-lick”; and the value of salt in improving the nutrition and the aspect of horses and cattle is well known to every farmer. The popular notion that the use of salt prevents the development of worms in the intestine has a foundation in fact, for salt is fatal to the small threadworms, and prevents their reproduction by improving the general tone and the character of the secretions of the alimentary canal. The conclusion therefore is obvious that salt, being wholesome, and indeed necessary, should be taken in moderate quantities, and that abstention from it is likely to be injurious.”
Weather.—The weather should govern our diet as much as it does our clothing. In cold weather we require to enrich our blood and fatten our bodies. We should then eat heartily of substantial food and drink milk and cocoa. In hot weather, “the lightest possible food should be taken, and that in moderation. Very little tea or coffee, plenty of milk, with fish, and but little meat, and that well cooked, and a moderate indulgence in iced drinks are indicated. Spirits and heavy wines are, of course, interdicted. It should be known that frequent and excessive thirst is often aggravated by an injudicious consumption of ice. Such extreme thirst will often be immediately allayed by hot drinks, a fact which has been often verified. It cannot be too strongly insisted on that over-feeding and over-drinking (of any fluid whatever) are most pernicious, especially either before or after prolonged or considerable exertion. The principal meal of the day should be taken at sunset.” (Lancet.)
Lightness is the first essential alike in the food and drink taken in warm weather. There is then less work to be done, less waste of tissue, less need of the pre-eminently muscle-forming and heat-producing substances, meat and bread; and fruit, as being both palatable and easily obtainable, is much in use. Its advantages are that it provides a seasonable change of diet, light and wholesome if well chosen, and a palatable tonic and stimulant of digestion with aperient properties. (Brit. Med. Jour.)
Anti-fat Diet.—There is inconceivable folly in the fear of fatness. We do not for a moment deny that it is possible the organism may be too heavily packed with adipose tissue, and that the action of its several parts may be hampered by this encumbrance, while, as a whole, it is needlessly burdened; but this is a totally different matter from the fatness against which the fears of the multitude are for the most part unreasonably directed. There is not the least physiological connection between the accumulation of fat and fatty degeneration. As a matter of fact, what is known as “fatty degeneration” occurs more frequently in those who are lean than in those who are “fat” in a popular sense. It is therefore a misconception to suppose that fatness is in itself a disease. It only becomes morbid when, by mechanical pressure, fat impedes the functions of the organs, or by weight it unduly burdens the body so as to exhaust the strength or make too large a demand on the resources of force and vitality. Unfortunately, the true nature of the objections to fatness are not explained, and misconception is rather confirmed than removed by the prevailing mode of urging arguments against “fat” and in favour of remedies by which it is proposed to get rid of it. Practically speaking, it is idle to suppose that fatness can be certainly prevented by dieting. There are many ways of fat-making, and those persons who have a tendency to its production will make fat however they are fed—in truth, almost as rapidly on one class of diet as on another. There are idiosyncrasies which may in a limited number of instances be taken advantage of to check the tendency to form fat, but these specialtiesof chemico-nutritive function are by no means common; and, speaking generally, it must be said that, except by starving the body as a whole, fatness cannot be prevented. The exceptions to this rule are chiefly such as may be explained on the principle of a special tissue appetite. Thus, for example, a man whose muscular system has been healthily developed somewhat in excess of the other parts of his organism may have what might be called a muscular-tissue appetite of such voracity that it will, so to say, seize upon the bulk of the nutriment supplied to the blood, and make muscle regardless of what may be left for the nutrition of nerves, &c. Such a person will lose fat without growing thin, so far as muscle is concerned, by a mere reduction of diet, without reference to the kind of food cut off, so that the latter do not chance to be essential to muscle nutrition. In the same way, though with different results, a “nervous” person, in the popular sense—that is, an individual whose nervous system is in perpetual activity, working incessantly and feeding voraciously—may consume so much of the food supplied for the body as a whole that only nervous tissue is nourished, and the rest of the body languishes. This is an instance of growing thin while feeding well, and it is the converse of the process by which, in another class of persons, growth of muscle persists in spite of a reduced diet. There are, in this way, persons whose specialty it is to make adipose tissue, and they will wax fat even when muscles, nerves, and the higher organisation are relatively in a condition approaching starvation. These and a score of other matters have to be taken into account when calculating the probabilities—or rather the improbabilities—of success in the endeavour to diminish the fatness of any individual by a system of dieting. As regards the use of drugs against fats, setting aside such obvious modes as robbing the blood of its proper nutriment by purging and nauseating, we do not believe it is practicable to prevent the formation of adipose tissue or even to promote an elimination of fat by the use of medicines, unless it be by correcting some error in the chemico-vital processes of the organic economy, to which a particular remedy may, as a temporary expedient in here and there a suitable case, be intelligently directed. Measures against fatness are, from the very necessities of the enterprise and the conditions under which it must be carried out in the great majority of instances, predestined to failure. It would save a deal of disappointment, and a great many incidental injuries to health might be avoided, if these facts could be more generally understood; and we think medical practitioners generally may be fairly asked to state and explain them. (Lancet.)
Diet for Night-work.—For night-workers, the best plan includes a hearty breakfast when they rise, which is generally between 12 and 3 o’clock; some outdoor exercise and relaxation should precede a good dinner, partaken between 6 and 9 o’clock at night, before beginning work. If the work is to continue until 4 or 5 o’clock in the morning, a light but nutritious repast should be eaten shortly after midnight, in order to fortify the system for labour during the hours immediately following, when the vital powers are most enfeebled. When the work is done, and before retiring, a very simple lunch should be taken in the form of good hot broth or beef tea, or a glass of light wine and a couple of biscuits. This will generally ensure sleep by withdrawing blood from the brain, where it has been concentrated by mental effort. In ordinary cases of sleeplessness, not confirmed by long-continued habit, a light meal of this kind will generally prove a remedy.
Diet for Children.—The great mortality of infants in this country is due to improper feeding. The following simple rules should be attended to. If the child can be nursed by the mother, give it nothing else for six months. If it cannot be so reared, give 1-1½ pint of good milk every day for the first 6 months, and 1½-2½ pints, with the addition of barley-water, or a teaspoonful or two of corn flour, till a year old. Take care that the milk is good and the bottles clean. As it gets its teeth, give it small quantities of more solid food, but do not indulge it in everything that comes to table. Growing children require a due proportion of meat.
With regard to condensed milk, it contains much less flesh-forming material than isgenerally supposed. Taking four per cent. for cow’s milk as a fair average, the directions on the can, if followed out, give unexpected results. For children’s use, we are told to dilute the condensed milk with 4 or 5 parts of water. Taking the lowest figure, we should then have 5 parts of diluted condensed milk which, according to Dr. Stutzer, would only contain 1·76 per cent. of flesh-formers, instead of 4 per cent., while the milk sugar would be increased from 4·5 to 10·85 per cent. We know that woman’s milk contains more sugar than cow’s, but still not in the above surprising proportions. Now that so much canned milk is used for infants brought up by hand, it becomes a question how far mothers who cannot suckle their children are responsible for the health and even lives of their children by giving them milk from the tin instead of that from the living animal.
Diet for underfed Subjects.—The following remarks are derived from Dr. Hodge’s essay before referred to.
As a stomach may become over-distended and permanently dilated by long gluttony or by the accumulated ingesta which a slow and feeble peristalsis refuses to move on, so may it also become contracted from the habitual want of sufficient victualling, sometimes to such a degree that the introduction of enough food can only be accomplished after the gradual dilatation of its receptacle. This may be effected by increasing the frequency of meals. The custom, common in America, of leaving a long interval between them is the reverse of that desirable for those who require extra feeding. The ordinary European arrangement adopts a system which is worthy of imitation, a “little and often” being the motto of the eater. It is useless to attempt too much at one time. The stomach conforms slowly, and rebels at a certain limit, but a brief respite and a short intermission put it in a less antagonistic attitude. If, for the reasons given, or from mere disinclination, 2 meals have been all which the subject under treatment declares can be “got down,” as is often the case, then 3 must be taken or the time between successive feedings shortened to 2 hours, according to the aggregate amount of nourishment intended to be given and the readiness with which its forced consumption is effected. It is an advantage, therefore, that certain periods of the day, not precisely fixed, but approximate, should be established as meal times. For instance, before rising, at the usual breakfast hour, in the middle of the forenoon, at the accustomed luncheon, in the middle of the afternoon, at the regular dinner, and on going to bed.
It is a common impression that to take food immediately before going to bed and to sleep is unwise. Such a suggestion is answered by a reminder that the instinct of animals prompts them to sleep as soon as they have eaten; and in summer an after-dinner nap, especially when that meal is taken at midday, is a luxury indulged in by many. Neither darkness nor season of the year alters the conditions. If the ordinary hour of the evening meal is 6 or 7 o’clock, and of the first morning meal 7 or 8 o’clock, an interval of 12 hours, or more, elapses without food, and for persons whose nutrition is at fault this is altogether too long a period for fasting. That such an interval without food is permitted explains many a restless night, and much of the head and back ache, and the languid, half-rested condition on rising, which is accompanied by no appetite for breakfast. This meal itself often dissipates these sensations. It is, therefore, desirable, if not essential, when nutriment is to be crowded, that the last thing before going to bed should be the taking of food. Sleeplessness is often caused by starvation, and a tumbler of milk, if drunk in the middle of the night, will often put people to sleep when hypnotics would fail of their purpose. It should be borne in mind that a full bladder is a frequent cause of early morning wakefulness. Rising and passing water will often send restless sleepers back to bed for a refreshing nap, which, without relief from this source of reflex irritation, would not have occurred.
Food before rising is an equally important expedient. It supplies strength for bathing and dressing, laborious and wearisome tasks for the underfed, and is a better morning “pick-me-up” than any hackneyed “tonic.”
Skilful feeding by a nurse who recognises the art which may be exhibited in coaxing food into the stomach is often of advantage. Food thus administered must be introduced in large mouthfuls. Every gourmet knows how necessary this is for the satisfaction of the palate, and the correctness of the fact is substantiated by reason and by analogy. Well-shaped wisely-seasoned, large morsels make a relishing and appetising mouthful, inviting repetition. In divided bits they quickly satiate or excite repugnance. By this epicurean method the stomach is rapidly and persuasively charged with a sufficient supply of nourishment, as it never can be by the feeble pickings of an apathetic eater.
In cases where food is urgently called for, its artificial introduction is an easy and beneficial manœuvre. It does not require a stomach tube, and has but little resemblance to the procedure resorted to with the insane. It may be practised with insignificant discomfort by means of a soft rubber catheter, not exceeding a No. 12 in size, fitted to a small glass funnel, into which the nutriment is poured, or it may be sent through the tube by a Davidson’s syringe. The catheter need enter but a short distance into the œsophagus. If no resistance be offered, the operation can be performed by almost any one, even by the patient himself. Milk, cream, broth, eggs, and homogeneous liquids are thus readily deposited, and to the desired extent, in the stomachs of those disinclined to eat.
The number of females, especially those who “do their own work,” whose food consists almost wholly of bread and tea is very large. How inadequately they are nourished is shown by the statement that, in order to get the required amount of aliment, persons who eat nothing else must consume about 4 lb. of bread. As this is so much more than any one can dispose of with comfort, the practice of eating butter with bread is almost universal. This not only meets the necessity for a heat-producing, non-nitrogenous food; but the unattractive character of dry bread as an eatable is compensated for by the relish of a savoury addition. In proportion as the use of butter is increased, the requisite quantity of bread may be decreased. To eat “more butter than bread” should not therefore be the reproach to growing children which it is often made, and the large amount of the former which may be profitably disposed of by the underfed, without “disturbing their stomachs,” is not surprising if the process by which oleaginous substances are taken into the system is recalled. “Fat, butter, and oily matter in general require no digestion; the emulsion into which they are mechanically converted, chiefly by the pancreatic and duodenal secretions, passes (almost directly) into the general circulation of the blood.” For reasons similar to those which make cream and butter such useful articles of diet, and because the habitual food of insufficient eaters is so lacking in fatty matter, cod-liver oil has acquired its well-deserved place among therapeutic and alimentary agents.
The tendency of those whose appetite is deficient to lay great stress upon their readiness to take food which does not require mastication makes them willing consumers of soup. And yet of all articles entering into the common dietary soups are perhaps the most deceptive, and certainly the most important to discountenance with the underfed. They fill up the stomach at the expense of solid, “staying” nourishment, and contain so little in the way of sustenance that they are therapeutically almost worthless. As a rule they are but some form of meat tea, and are now known to have a food value not unlike that which wine would possess, and which they resemble chemically. “They may have on the system a stimulant action somewhat analogous to theine. They may render more prompt and efficacious the assimilation of any wholesome food with which they may be associated, and they may even give so effective a fillip to an exhausted system as to enable it to dispense for a time with real food; but it is clear that they must not be looked to for direct nutrition.”
Broths, however—that is, soups which contain large quantities of solid matter, disintegrated meat, vegetables, macaroni, vermicelli,pâté d’Italie, rice, barley, sago, tapioca, &c.—are often, and in proportion to the consistency thus given, excellent alimentation. They are palatable and easily consumed in considerable quantities at a time.Soupe à la Reine purée de gibier, various vegetablepurées, chowder of fish,bisquesof oyster, clam, lobster, are illustrations of the perfection of this kind of cookery. That they may be what is sometimes called “rich” is no objection. The digestive powers of the underfed are usually good, though the owners of them may not think so. They are apt to be active and ravenous, even if the appetite is not.
The meat from which soup is made, allowed to become cold, should be compounded to a paste in a mortar, and then returned to the soup. Veal, pigeon, and rabbit are especially adapted to this procedure. “French” cooks prefer to make “chicken broth” from rabbit.
Notwithstanding its capacity to digest, there is, invariably, something repulsive to an insensible stomach in what are conventionally called “roasted joints.” This antipathy, together with considerations of convenience as regards the size of portions to be cooked, makes it almost imperative, for protesting but frequent eaters, that meats should be either broiled or stewed; and steaks of various kinds, chops, cutlets, chicken, game, some kinds of fish, and shell-fish become, therefore, the only really available resources of the caterer of an ill-ordered appetite. And yet no more difficult undertaking can be given non-hungry patients than that of eating beefsteak. Apart from its somewhat uncertain quality, nothing requires more mastication, and the class named always declare that there is no item of food of which they are already more “tired.” Any other variety of meat—mutton, veal, venison, &c.—cooked in the form of steak is more readily eaten. The short, compact fibre of mutton chops, especially those from the loin, makes them less likely than beefsteak to be badly cooked, and far easier to be consumed. Well-selected, carefully-cut lamb chops, in their proper season, are a delicacy of the highest order, and rarely fail to be appreciated by the most benumbed eater.
Meats stewed, or semi-stewed, and then partially browned in the oven (braised, as it is called in the language of cookery), are attractive and submissive preparations, and this method of cooking is an excellent one for purveying small portions of animal food. In the various forms and denominations of stewing and braising, thecordon bleufinds scope for the highest aspirations of culinary art.
They impart an appetising flavour to viands cooked to extreme tenderness, the perfection of these methods being found in their application to sweetbread—a costly luxury, but an article which, by its slight demand for mastication and its nutritious qualities, is peculiarly adapted to the requirements of an invalid eater. Others of the viscera, besides the pancreas, and the thymus gland—namely, the brains, the liver, the kidneys, the testicles of lambs, successfully lend themselves to this process of cookery, and like calves’ heads, pigs’ feet, and sheep’s tongues, are converted into delicate and easily-assimilated nutriment for those who are ignorant of, or can overcome, the associations which they suggest.
Of various mechanical processes available for rendering food easily eaten, preparatory mincing offers great advantages, and is particularly applicable to chicken and veal. A common and attractive method of serving both in the form of minced meat is that ofcroquettes, which are most easily prepared by the aid of Lovelock’s mincing machine.
Dr. Hodges does not hesitate to assert that of all the modes in which minced meat may be presented, the calumniated and much-libelled sausage is, in winter time, one of the most useful and successful articles for frequent feeding. Lean and fat meats, more digestible together than separately, are discriminately mixed in the compact and appetising form of this ubiquitous and popular comestible, the sole secret of whose easy digestion is that it should not be eaten except when it has become thoroughly cold after cooking. Bread and butter can be tolerated with complete immunity when hot buttered toast would provokeexasperating dyspepsia, and it is exactly thus that sausage cold stands in relation to that which is served hot. Presenting the albuminates and fat in an economical, savoury form, easily obtained and made ready for consumption, sausage, in some countries, might almost be said to have become a national food, and it offers to the fastidious or indifferent eater an article of diet from which great benefit may be derived. A trial of this stigmatised edible will be followed by a ready recognition of its alimentary value in the class of cases under consideration.
As has been remarked already, food, to be taken outside the conventional meal hours, must be of a kind easily obtained anywhere, readily “kept in the house,” and which does not demand preparation or delay. Few persons can command the services of a “professed cook,” or of a good “plain” cook, or have either at their disposal every two hours in the day. The practical articles of diet which meet these restricted requirements of convenience are few, and of these the chief in importance are eggs, milk, cream, butter, and bread.
“Raw albumen is one of the most digestible of foods; coagulated, it is comparatively indigestible.” Eggs, to be easily digested, must be eaten uncooked, since albumen under prolonged heat acquires progressive degrees of toughness. Eggs should not be cooked by boiling, but by placing them in hot water, and allowing them to remain there for 7-10 minutes.
When cooked, buttered, salted, and peppered, they are soon tired of as articles of food, and alleged to be “bilious.” Cooking, moreover, involves waiting and preparation. An uncooked egg is always ready and at hand, is clean to be kept anywhere, and scarcely needs to be broken into a glass. With a little knack it may be swallowed direct from the shell, as most persons know if in childhood they have had access to country barns. A raw egg weighs 2-2¼ oz., and is said to contain about the same flesh-forming and heat-giving material as an equal amount of butcher’s meat. It offers in perfection the quickest and neatest mode of taking a large equivalent of substantial and nutritious food at a swallow. Beaten-up eggs are a certain provocative of dyspepsia. When subjected to this process, an inviting draught of creamy froth is brought to the unfortunate recipient—a tumblerful of air, which has been introduced in the largest possible amount to a given quantity of egg, milk, wine, sugar, and nutmeg—than which nothing could be better devised to promote indigestion, abominable eructations, and the most uncomfortable flatulence or acidity. Every beer drinker has the good sense to blow off the “head” of his mug of beer, or to wait patiently for the froth to subside, before he imbibes the draught; and if crotchety persons will not learn the trick of swallowing an egg whole, they can compromise the difficulty by slowly stirring the white and the yolk, which may be thus mixed together, and made to seem a less revolting dose without the incorporation of air by beating. Taken as a medicine, and looked upon as such, eggs are at least equally palatable with cod-liver oil, for which they offer an equivalent substitute, adapted to winter or summer, as the latter hardly is, and far more rapidly digested. There is no limit to the number which may be taken with advantage continuously and for months at a time. Eighteen eggs are required to furnish the flesh-forming materials and other nutrients sufficient for the various needs of an adult man in one day.
Milk and cream are convenient, and therefore important and desirable articles of food. It is a common assertion of patients that milk “always disagrees with them”—that they have “never been able to take it.” This statement, which, as a rule, may safely be attributed to mere prejudice, is also in some cases a true one, simply for the reason that the milk is drunk too rapidly, or because it is not rich enough, an easy remedy being to take the given quantity more slowly, or to increase by addition the amount of cream which the milk naturally possesses, the trouble being due, in the first instance, to the fact that a large and solid cheese curd is suddenly formed in the stomach by the rapidity with which the milk is deposited in that organ, and in the second, to the hardness of the casein derived from milk with an insufficient percentage of cream, which is alwaysinconstant in amount (varying between 10 and 15 per cent.) or in composition, the water alone ranging from 45 to 65 per cent. Milk is often too poor, but never too rich, for purposes of enforced nutrition, and the fact is incontrovertible that it is the model food for digestibility.
By adding cream to milk the amount of fat is increased and the curd is softened; and its digestion can be still further facilitated by the disintegration of its coagula, accomplished by crumbling in bread, cracker, &c., or by the addition of a small amount of cooked meal or flour.
By this latter means cold milk is made warm, which gives it an increased efficacy. This end may also be attained and the distastefulness of warm milk removed by flavouring it with the preparations of cocoa, weak coffee, or some of the inert substitutes for the latter sold by grocers, the best of which perhaps is that known as “New Era coffee,” consisting simply of roasted and ground wheat. But, as hot milk demands a certain amount of trouble, cold milk alone, or with bread broken into it, is, after all, the only practical resource so far as its use for frequent nutriment is concerned; and 2 qt. of milk, or 3 pints of milk and 1 pint of cream, are not more than the minimum quantity desirable for ingestion in 24 hours. Clear cream may be administered in doses of a wineglassful after each meal, as any other medicine might be, and a great deal can be disposed of by eating it liberally added to cooked fruit and various dessert dishes.
Blanc mange, Italian cream, and the various forms in which many delicate farinaceous articles are cooked, may thus be made more eatable through the zest given them by this accompaniment. There is a great difference in the palatableness as well as digestibility of cream which is obtained from milk by centrifugal force, as is largely done for the market, and that which is skimmed after “setting.” This distinction should be borne in mind in prescribing cream which is to be taken uncooked. The last-named product is by far the more desirable article.
Very few patients, especially women, drink a sufficiency of water to maintain their health or an adequate nutrition. Water is an important constituent of food, is, indeed, the carrier of food into and through the system, and forms more than ⅔ of the whole body. Neglect to keep up the supply of water leads to a diminution in the quantity of blood, and lessens the body’s strength.
When it is remembered that there are daily eliminated 18-32 oz. of water from the skin by perspiration, 11 oz. from the lungs, and 50 oz. from the kidneys, it is easy to see that the amount consumed by many persons falls short of the demand, and that their bodies must be insufficiently supplied with the requisite degree of moisture; some 66 oz. of water alone, and in tea, coffee, beer, &c., being required for a daily supply over and above that which is contained in the solid food of a full ration to make good the average regular waste. The constipation which is so common in ill-nourished persons is largely due to a want of liquid in the intestinal canal. This, therefore, will be ameliorated by the free use of water, as is also the constipating tendency of milk, which is sometimes complained of, the curds being liquefied and reduced in size, and thereby made more readily digestible. Its effect on hardened fæcal masses or accumulated mucus in the intestines is equally obvious, and explains in part the intention as well as the success of the hot-water craze at present so popular.
The underfed are benefited, and the process of feeding is helped, by alcohol. But the amount of alcohol which such persons may take as a food adjunct with advantage is very small. The cumulative effects of a medicinal dose at stated intervals are of greater utility than the more instant result of a larger allowance swallowed in a single drink. A measure of alcohol which produces an effect quickly—that is, which flushes the face, or exhilarates, as a sherry-glass of wine does with most females, for instance—is a toxic dose, and will be followed by reaction. It is a quantity short of this which is allowable. A teaspoonful, or at most a dessertspoonful, three or four times a day, is usually as much as can be borne without such sequelæ as are above alluded to.
Spirits serve their purpose better than wine, for the reason that the relative quantity of alcohol administered is more measurable. Wines vary in strength; spirits are comparatively uniform. Tinctures even, or elixirs, may be given when spirits are objected to either on principle or from prejudice. In any case there should be a large dilution with water, as a more gradually stimulating effect is thus produced. Alcoholic medicines ought never to be taken on an empty stomach.
Great pains should be taken to discountenance everything which reduces the bodily heat, and employments or amusements which in any sense tax the strength ought to be abandoned when a forced diet is attempted. Even ordinary exercise is often objectionable, and its complete discontinuance sometimes so important that confinement to bed is a necessity. Those who raise animals are practically made aware that a restless disposition is fatal to successful growth in vigour and flesh. The truthfulness of this observation is equally apparent with human beings who need “building up” in the literal sense of these remarks.
Mere fattening is not the object of full feeding, but it is to a certain extent its necessary accompaniment. The motive of the measure, as has already been stated, is to add to the quantity and quality of the blood, and it is hardly possible for an individual to grow fat without a decided increase in the volume of his blood. Weighing at stated intervals is therefore an important procedure, and there is no other way to make sure that the subjects of treatment are sufficiently well fed to gain blood. Persons who put on fat rarely fail to improve in colour; their comfort is enhanced; warmth of body is gained, in itself no slight improvement; the pulse becomes fuller; the cheeks grow redder; the spirits are raised; the general mien becomes brighter; and these phenomena are explainable only by admitting that there has been an accession to their stock of blood. The scales thus become a thermometer of improving health and strength, by the aid of which the physician measures the progressive results of his regimen. Like the “pass book” used at banks, they reveal in a ready and serviceable way the healthful standing of an individual, the relation of his resources to the wear and tear checks which he is continually drawing, and whether his account is nearly or quite overdrawn, or superfluously plethoric. They ought not to be put into requisition too frequently, and only when there is reason to think that an encouraging increase of weight has taken place. This should manifest itself soon after systematic feeding has begun, and continue at the rate of 2 lb. a week, and not less than 1 lb., so long as improvement seems desirable, or until a weight has been reached, the minimum of which shall be equivalent to 2 lb. for each inch of stature.
Experience and observation have universally confirmed the expediency of a heartier and more systematised diet than recently prevailed. Its utilitarian advantages are publicly recognised. Within twenty years the rations of armies, of institutions, charitable, penal, and medical, have been liberally increased. Family habits in regard to eating, since the flush times of the civil war, have greatly changed, and the large allowance of food requisite for the maintenance of a sound health can scarcely be exaggerated in any statement of its details. In the application of this accepted dogma to special and personal cases there is much, however, still left to be desired. (R. M. Hodges.)
Drinks.—There are physiological facts in relation to drinking which ought to be recalled by those who know them, and brought to the knowledge of the unskilled in medicine, because they concern the promotion of health. Thus it is essential that there should be constantly passing through the organism a flushing, as it were, of fluid, to hold in solution and wash away the products of disassimilation and waste. Those who do not recognise the fact that ¾ of the entire organism is normally composed of fluid cannot fully realise the great need which exists for a copious supply. If there be not a sufficient endosmose, the exosmose must be restricted, and effete matters, soluble in themselves, but not dissolved because of the deficiency of fluid available, will be retained. Take, for example, the uric acid; this excrementitious product requires not less than 8000 timesits bulk of water at the temperature of the blood to hold it in solution; and if it be not dissolved it rapidly crystallises, with more or less disastrous consequences, as in gout, gravel, and probably many other less well-recognised troubles. We only mention this particular excrement by way of illustration. In all, it may be fairly concluded that not less than 3½ pints should be consumed by any person in the 24 hours, and when the body is bulky 4 or even 5 pints should be the average. It is, moreover, desirable that the fluid thus taken should be in the main either pure water, or water in which the simplest extracts are held in solution.
So far as the mere sensation of thirst is concerned, there can be no question that it is a mistake to drink too much or too frequently in hot weather; the fluid taken in is very rapidly thrown out again through the skin in the form of perspiration, and the outflow being promoted by this determination toward the surface, a new and increasing demand for fluid follows rapidly on the successive acts of drinking and perspiring, with the result that “thirst” is made worse by giving way to it. Meanwhile, it must not be forgotten that thirst is Nature’s call for fluid to replace that lost by cutaneous exudation in warm weather; and if the demand be not met, what may be regarded as the residual fluid of the tissues must be absorbed, or the blood will become unduly concentrated. To thirst and drink, and perspire and drink again, are the natural steps in a process by which Nature strives to maintain the integrity of those organic changes which the external heat has a tendency to impede. The natural and true policy is to supply an adequate quantity of fluid without excess. Therefore do not abstain from drinking, but drink slowly, so as to allow time for the voice of Nature to cry “Enough.” There is no drink so good aspurewater. For the sake of flavour, and because the vegetable acids are useful, a dash of lemon-juice may be added with advantage. The skin should be kept fairly cool, so that a sufficient quantity of the fluid taken may pass off by the kidneys.
Sufferers from certain common forms of indigestion forget the immediate effect of loading the stomach with cold drinks. If hot drinks are sometimes debilitating to the organ of digestion, cold drinks are certainly not always bracing, but, on the contrary, are often depressing. It is especially desirable to remember this fact when the weather is more than commonly lowering to the nervous tone of the organism. Even though the fluid taken may be what is called stimulating, the consequence of its being cold is to chill the gastric organ and depress the nerve centres, whence it derives its supply of nervous force. The peculiar form of indigestion now very prevalent, in which food is retained an unreasonable time in the stomach, with the result of flatulence, and it may be of irritative reaction on the part of the nerves of the viscus, and neuralgic pain as a consequence, is in a large proportion of instances the direct effect of persistent chilling of the gastric organ by copious draughts of cold drink. It is recognised that cold drinks are dangerous in very hot weather, acting as irritants, but it is not, apparently, understood that the mischief they do as depressants may be even greater, and that this effect is to be especially dreaded when the weather is itself depressing by cheerless or unseasonable cold. (Lancet.)
Water.—When fluid taken “as drink” is itself heavily charged with solid matter, it cannot fairly be expected to so entirely rid itself of this burden in the process of digestion and absorption as to be available for solvent purposes generally, although the separation between solid and fluid ingredients of the food is doubtless fairly complete in the processes preparatory to assimilation. The aim should, nevertheless, be to supply the organic needs in this particular abundantly, and with such fluids as are not overloaded with solids, but simple and readily available as solvents. Another urgent reason for drinking freely of bland fluids is to be found in the need of diluents. This is something slightly different from mere solution. Many of the solids of the tissue waste are of a nature to irritate and even disorganise the kidney, if they be brought to that organ for excretion in too concentrated form. There is no reason to suppose that the kidneys are liable to suffer from over-work if the specific secreting power of thekidney cells be not too heavily taxed. If only the products of disassimilation be diluted, so that they can be passed through the kidney by the simple process of exosmosis, the organ will discharge its function without injury or exhaustion. As a matter of fact and experience, those who drink innocuous and unstimulating fluids freely do not suffer from kidney trouble, but are almost uniformly healthy—at least, so far as the excreting functions are concerned. It is a popular fallacy that the kidneys may and ought to be relieved by the determination of fluid to the surface of the body and perspiration. Except in cases of organic disease of the kidney, or where, as in the elimination of a special product, it is desirable to use the skin as an emunctory, the fluid diverted from the kidney is wasted so far as flushing purposes are concerned.
But if water be the drink, how shall it be drunk? The means must have regard to the end required of them. To moisten food and prepare it for digestion it is hardly necessary to say that it should be taken with a meal; a couple of tumblerfuls at dinner is not an excessive quantity for most persons. For thirst-quenching properties nothing can surpass this simplest of drinks, and all which approach it in efficacy owe their power almost entirely to it. As to temperature, there is no real ground for supposing that one should not drink a sufficiency of cold water when the body is heated by exertion. The inhabitants of hot climates have no such objection. Some tropical wells are dug so deep that the water within them, even in hot seasons, is as cool as that of a European spring. In fevers, too, the use of ice in quantities sufficient to allay thirst is a part of rational and legitimate treatment. The shock which has to be avoided in all such states is not that which cools the mucous membrane, but that of sharp chill applied to the surface of the body. Some persons, however, find it convenient and beneficial to imbibe a certain amount of warm water daily, preferably at bedtime. They find that they thus obtain a bland diluent and laxative, without even the momentary reaction which follows the introduction of a colder fluid, and softened by abstraction of its calcareous matter in the previous process of boiling. This method, which is an accommodation to jaded stomachs, has its value for such, though it is not great even for them; but it affords no noticeable advantage for those of greater tone. The use of water as an aid to excretion deserves some remark. In certain cases of renal disease it has been found to assist elimination of waste by flushing, without in any way irritating the kidneys. Every one is probably aware of its similar action on the contents of the bowel when taken on the old-fashioned but common-sense plan of drinking a glass of water regularly morning and evening, without any solid food. Whatever may be true of harmless luxuries, enough has been said to show that health, happiness, and work find stimulus enough in the unsophisticated well of nature. The quality of water may be judged by its fauna and flora. It is a standing fact that water containing neither fish nor molluscs is unfit for drinking purposes. The presence of the common watercress (Nasturtium officinale) in a stream is sufficient evidence of the potability of the water; on the other hand, always avoid the water of a stream in which the duckweed or water lentil (Lemna minor) is found.
Tea.—Warm infusion of tea has been proved to have a marked stimulant and restorative action upon the brain and nervous system, and this effect is not followed by any secondary depression. It further increases the action of the skin, and raises the number of the pulse, while it has but little effect upon urination, excepting simply as a watery diuretic. It tends to lessen the action of the bowels. Dr. Parkes found that tea is most useful as an article of diet for soldiers. The hot infusion is a patent protective against extremes both of heat and of cold; and Sir Ranald Martin proved it to be particularly valuable in great fatigue, especially in hot climates. But the habit of tea-drinking is one that grows on its victims like the similar ones of opium or alcohol. Taken in strict moderation, and with due precautions in the mode of preparation, tea is, like alcohol, a valuable stimulant; in its abuse there is also a certain analogy. There is hardly amorbid symptom which may not be traceable to tea as its cause. This is a fact that general practitioners often use to their own satisfaction and to their patient’s advantage, if it happen to be that kind of patient who does not object to make some sacrifice in order to be rid of troubles. The alkaloid which tea contains appears to be less easily absorbed than that of coffee, owing to the very large quantity of tannic acid present. The tannic acid in tea is doubtless one of the causes why it is as a drink so attractive. It is slightly astringent and clean in the mouth, and does not “cloy the palate.” Tannic acid is also one of the dangers and drawbacks of tea. It is largely present in the common teas used by the poor. The rich man who wishes to avoid an excess of tannic acid does not allow the water to stand on the tea for more than 5, or at most 8 minutes, and the resulting beverage is aromatic, not too astringent and wholesome. The poor man or poor woman allows the tea to simmer on the hob for indefinite periods, with the result that a highly astringent and unwholesome beverage is obtained. There can be no doubt that the habit of drinking excessive quantities of strong astringent tea is a not uncommon cause of that atonic dyspepsia, which seems to be the rule rather than the exception among poor women. A word in reference to the now prevalent custom of dining late, and taking an afternoon tea. “Unless cautiously arranged, it is apt to produce dyspepsia. The rule should be that the tea should precede dinner by 3 hours, and not come sooner after lunch than 3 hours, supposing the lunch to have been a good meal; and that if any tea or coffee is taken after dinner, it ought to be immediately after, so as to constitute part of the same meal, and to partake in the same process of digestion. It is most injurious to take tea or coffee 1-2 hours after dinner, or any other full meal.” (Dobell.)
Coffee.—Coffee, like tea, when used as an article of diet, especially affects the nervous system. It is a brain and nerve stimulant; in very large doses, it produces tremors. It increases the action of the skin, and it appears to have a special power in augmenting the urinary water. It increases both the force and frequency of the pulse. Unlike tea, it tends to increase the action of the bowels. Coffee has been proved to be an important article in a soldier’s dietary, as a stimulant and restorative. Like tea, it acts as a nerve-excitant, without producing subsequent depression. It is serviceable against excessive variations of cold and heat, and its efficacy in these respects has been established in Antarctic expeditions, as well as in India and other hot climates. Dr. Parkes pointed out that coffee has a special recommendation in its protective influence against malaria. While admitting that the evidence on this point was not strong, he held it to be sufficient to authorise the large use of coffee in malarious districts. Coffee should be used as an infusion. If coffee be boiled, its delicate aroma is dissipated. (Brit. Med. Jour.) Coffee has a slight value as a nutriment, and a very high value as a stimulant; when mixed with boiling milk in the form ofcafé-au-laitit forms the ideal of breakfast foods for body workers and brain workers, and a very small quantity of black coffee taken after a full meal serves to stimulate the stomach to the necessary digestive effort, and to ward off that sleepiness which is often the attendant of satiety. Supposing all the dissolved matter to be available for the needs of the body, the dietetic value of a cup of coffee is more than twice that of a cup of tea, and if we assume that the stimulating power is due to the contained alkaloid, thenquâ stimulantthe cup of coffee has more than three times the value of the cup of tea. (Poore.)
Cocoa.—The theobromin of cocoa is, chemically, identical with the thein of tea, and the caffein of coffee. While tea and coffee are comparatively valueless as true foods, cocoa, by reason of the large quantity of fatty and albuminoid substances it contains, is very nourishing, and is of high dietetic value as a tissue-forming food. Compared with tea and coffee, it is a food rather than a stimulant, being akin to milk in its composition and place in the diet-scale. It is useful to sustain the weakly, and to support the strong in great exertion, as a readily assimilable and general form of nourishment. (Brit. Med. Jour.)
Malt Liquors.—The distinguishing characteristic of malt liquors as articles of diet is their feeding-power, and they owe this to the presence in the malt of diastase, by which the insoluble and innutritious starch—the largest fat and heat-producing element in our food—is converted into the soluble and easily assimilable glucose sugar. The use of these beverages, then, in moderation—say 2 glasses a day, one at dinner and the other at supper—seems to be indicated, and would probably prove advantageous, in convalescence from wasting disease, extreme thinness, feeble digestion, or where there is difficulty in maintaining the animal heat. The following table, showing the composition and relative strength of representative malt liquors, may not be uninteresting to the reader:—