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Other documents randomly have
different content
 The following analysis may present some of the foregoing
statements in a cleared light, and may add some additional
particulars of interest. They represent, so far as a couple of sets of
average results can do so, the percentage composition of ordinary
white bread and of the whole-meal bread made by Hill and Son:—

White. Whole meal.

Water 40·0 43·5
[a] Albuminoids or flesh-formers
7·0 [b]10·5
Starch, dextrin, and sugar 50·7 40·6
Oil and fat 0·6 1·6
Cellulose and lignose 0·5 1·8
[c] Ash or mineral matter 1·2 2·0
(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 the case, 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 the Lancet remarks 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.—The Lancet publishes 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, but it 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 specialties of 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 is generally 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 vegetable purées,
chowder of fish, bisques of 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, the
cordon bleu finds 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 of
croquettes, 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 provoke exasperating 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 always
inconstant 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 times its 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 as pure water. 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 the kidney 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