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
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 a morbid 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.)