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.