Dietetics
Dietetics.—The naturally proper introduction to the art of serving meals is a knowledge of the science of eating. To gain this it is not necessary to study anatomy, nor physiology, nor even chemistry; it is sufficient for the ordinary individual to make himself familiar with the main facts relating to the nutritive and digestive qualities of the various foods, and to exercise a moderate amount of common sense in applying the facts to his own particular case.
Quantity and Quality of Food needed.—The subject has recently been attacked in very sensible language by Dr. R. M. Hodges, in a paper read before the Boston Society for Medical Improvement, from whom much that follows is quoted.
Dr. Hodges remarks that the amount of food required by a healthy adult will surprise most persons, even those who are good feeders. While this varies with the work performed, the heat or cold of the weather, and the condition and quality of the food taken, it has been estimated that, in the case of a man in health and of average size, the total daily ration should weigh about 6 lb. 13¼ oz., of which 1 lb. 5¼ oz. consist of dry food substance, the remaining 5½ lb. being water.
According to Church, under ordinary circumstances a daily ration should contain something like the following proportions and quantities of its main ingredients:—
| Water | 5 lb. | 8 oz. | 320 gr. |
| Albuminoids, or flesh-formers | 0 lb. | 4 oz. | 110 gr. |
| Starch, sugar, &c. | 0 lb. | 11 oz. | 178 gr. |
| Fat | 0 lb. | 3 oz. | 337 gr. |
| Common salt | 0 lb. | 0 oz. | 325 gr. |
| Phosphates, potash, salts, &c. | 0 lb. | 0 oz. | 170 gr. |
This might be furnished by a mixed diet of the following foods:—
| oz. | |||
| Bread | 18 | } | |
| Butter | 1 | } | |
| Milk | 4 | } | |
| Bacon | 2 | } | Altogether these quantities |
| Potatoes | 8 | } | will contain about |
| Cabbage | 6 | } | 1 lb. 5¾ oz. of dry substance, |
| Cheese | 3½ | } | though they weigh |
| Sugar | 1 | } | in all 6 lb. 14½ oz. |
| Salt | ¾ | } | |
| Water alone and in tea, coffee, | } | ||
| beer, &c. | 66¼ | } |
It will be seen that the weight of this allotment exceeds by 1 oz. even when the solid matter contained in beverage is omitted—that of the analytic table which precedes it. This excess is mainly owing to the fact that in all articles of food actually used there are small quantities of matters (cellulose, &c.) which cannot be reckoned as having a real feeding value. (A. H. Church, ‘Food.’)
Authorities on the subject of diet say that nitrogen is the most essential of all foods, and that a certain amount—about 316 gr.—should be taken daily by an adult man. If the minimum quantity of nitrogen (which, for the sake of argument, may be put as low as 250 gr.) be not consumed, the various functions of the body languish, and a degree of weakness is induced, with greater or less rapidity, according as the quantity falls much or little below 250 gr. per diem. But let the consumption drop to an average of only 138 gr., which is the smallest amount necessary for the bare maintenance of life, and in a year or two (not at once, for every body contains a store of nitrogen) important modifications of the nutritive processes, with distinct predispositions to disease, will inevitably be established. (Parkes.)
These results of experimental investigation have a practical significance. They find expression in the fact that a failure to consume all the essential elements of full rations, whether nitrogenous or non-nitrogenous, will sooner or later, as in the disastrous Irish and Lancashire famines, give rise to a train of symptoms which have been justly denominated those of “chronic starvation.”
From the small knowledge of the value of food possessed by individuals as well as the public, a diminution in its adequate supply easily escapes attention; loss of appetite is looked upon with indifference, and the first steps are inadvertently taken toward a condition which is as full of meaning in the case of a single person as when a whole community are its subjects. The absence or the keenness of appetite affords no indication of the amount of food which the stomach will digest and the body assimilate or an individual be benefited by swallowing.
The body requires not only to be fed, but filled; and the object of eating is as often to bring up past arrears as to supply present demands. Quality of food, with all the heat and force it may contain, will not make up for quantity, which is required for constructive and reparative purposes. The constant waste of flesh and blood can only be compensated for by an equivalent assimilation of actual materials. Yet, in spite of this self-evident proposition, a large proportion of the better educated classes of the community readily deceive themselves and mislead others in regard to the amount of food necessary for their welfare and nutrition.
From a practice, often beginning in infancy with the common maternal prejudice against giving solid food at a sufficiently early period and in adequate amount, persisted in through childhood from an erroneous idea that “meat once a day” is an ample supply of animal food, still continued during adolescence, especially in the case of girls, under the conceit that eating heartily, or “between meals,” is neither wholesome nor lady-like, a habit of going without enough sustenance is finally established in adult life which is further perpetuated and confirmed by a great variety of influences. Among the more common may be mentioned personal temperament, disturbed mental conditions, languid indoor life, fatigue and exhaustion, theoretical dietetic prejudices, fastidiousness as to eatables, unwise distribution of meals, insufficient variety of food, too rigid domestic economy, and, pre-eminently, the revived fashion of tight lacing. These, and a multitude of similar agencies, apart from pathological derangements, are well-recognised causes of deficient bodily nourishment and prolific sources of disturbed health, revealing themselves in deficient weight, “weakness,” anæmia (want of blood), feeble circulation, neuralgia, cough and throat trouble, constipation, headache, backache, nausea, and a variety of phenomena, unconnected with sensible organic alterations, but characterised by neurotic and functional symptoms easily magnified by the patient and overtreated by the physician.
As testifying to the widespread ignorance relating to food and feeding, the following extract may be quoted from the Medical Times and Gazette, May 24, 1884, p. 712:—“At the existing (1884) International Health Exhibition, London, the ‘Vegetarian Society’ are furnishing a sixpenny dinner to 400-500 people daily. From a carefully kept account of the substances used for the bill of fare the following ‘food equivalents’ have been reduced, showing that each diner receives, of
| Albuminoids | 0·63 oz. |
| Fat | 0·44 oz. |
| Carbohydrates | 3·17 oz. |
| Mineral matters | 0·09 oz. |
Physiologists lay down the standard diet for ordinary labour pretty much as follows:—
| Albuminoids | 4·2 oz. |
| Fat | 1·6 oz. |
| Carbohydrates | 18·7 oz. |
| Mineral matters | 1·0 oz. |
It appears, therefore, that it would require about six of the sixpenny dinners to support a man during a day’s hard labour.”
The consequences of an insufficient dietary, says Hodges, are most frequently exemplified in young people, of both sexes, growing school children, boys fitting for college, débutantes in society, young mothers of families, seamstresses, shop girls, &c.; and, although they also appear at other periods of life, and under other circumstances than those which have been enumerated, it is during the years of adolescence that the utilisation of feeding has its supreme value, and its prophylactic and curative effects, as a therapeutic method, are most easily obtained. Sir Andrew Clark, Grailly Hewett, Clifford Allbutt, and others, who have described the ailments which follow inadequate alimentation, have especially urged the necessity for greater attention to the question of diet in the bringing up of families.
The underfed constitute so considerable a class that a large part of medical practice is devoted to attempts at satisfying their importunate demands for “something which shall make them feel better.” To attack with drugs symptoms which are daily regenerated by starvation is labour in vain, so long as that condition is permitted to exist. But if the famished tissues of those who say they are not sick, and there is nothing the matter with them, only that they “do not feel well,” and “cannot eat,” be permeated with the fat which is so often loathed in food—if veins be filled with a more bounteous supply of blood, and if outdoor air be made attainable without the expenditure of an already slender supply of strength—their bodily functions will take on renewed vigour and be reanimated from better life-giving resources, force will be stored up, energy will be developed, and innumerable discomforts evicted. The futile use of iron, quinine, bitters, elixirs, and other so-called “tonics,” either when self-prescribed or methodically directed by physicians, and the insuccess of medicines, as a rule, to relieve the wearisome complaints daily listened to from persons whose mode of living is an injustice to themselves, do not always serve as a reminder that suitable nutriment, in some form or other, is the only real “tonic,” and that its methodical consumption can alone relieve the protean afflictions of many, if not most, of these querulous supplicants. To say to them in a vague and general way that a nourishing diet should be taken, and that anxiety and overwork are to be avoided, is to give weak advice. The most rigid and literal obedience to fixed and precise rules in regard to the quantity and character of their food and the times of taking it—in fact, the carrying out of a process of “stuffing,” practised at short intervals of time, without regard to appetite and pushed to the stomach’s maximum capacity of digestion—is necessary to extricate them from their deplorable situation.
The theoretical standard of a full ration has been given. The conventional standard, however, is an unsettled one. The statement that a person eats as much as other members of his or her family may mean a great deal or nothing, for there are large and small eaters both by habit as well as by example, and there can be no criterion of the amount proper to be eaten under given circumstances except that which is determined by a physician’s judgment. This amount, as has been said, should not only be specified exactly, but its consumption ensured, and nothing but precise and positive evidence accepted in regard to the fulfilment of the specifications given. (R. M. Holmes.)
Function of Food.—The subject is treated from another point of view by F. W. Moinet, in a lecture on Food and Work, read before the Pharmaceutical Society, who observes that as the food we eat or drink—the latter term applying only to the condition of the article used whether fluid or solid—is the only source from which the elements forming the constituents of the body are derived, it naturally follows that no article of food can satisfy the requirements of life which fails to comply with this condition. But as comparatively few articles of food contain all these elements, or in their proper proportion, it follows that we must combine different articles of food together to make a satisfactory meal, i.e. a meal not only sufficient to satisfy the appetite, but also capable of supplying the different elements required by the tissue to replace what has been spent on work. Hence the reason and necessity of living on a varied diet, which experience taught our ancestors long before the scientific facts on which it is founded were discovered. For with the exception of milk, which is a perfect food, no ordinary article of diet contains all the necessary elements. But this is not only a necessity, but also a great advantage, as our food would be very apt to pall on our palates were it always the same, so nature liberally supplies us with a great variety to choose from, which are nearly equally capable of nourishing the body, and at the same time suiting different tastes, which to some individuals is a matter of importance, either from habit or natural peculiarity, still more valuable to the invalid whose recovery sometimes depends not on medicine, but on diet.
Another reason of this variety in nature is that all animals and vegetables are not found to flourish under the same conditions of climate and soil; hence in different countries the food supply is often obtained from different sources, plants and animals, especially the former.
The function of food may be described as twofold:—1st, to afford material to replace what is spent in labour, physical or mental, muscular or brain; 2nd, to supply fuel which is spent in force.
A considerable proportion of our food, especially the fatty and starchy matters, after being digested and assimilated and stored up in the various tissues, is slowly burnt or oxidised by the oxygen which has been carried from the lungs by the blood; the fat is decomposed into carbonic acid and water, which are given off by the lungs and the kidneys and skin. By this oxidation, or burning, heat and force are generated to keep up the temperature of the body and keep the vital functions going, and to supply physical and mental energy, all the internal and external work of the body being performed by the combustion of the stored-up fat in the tissue. Hence the necessity of a regular and constant supply of food to warm the body, supply mental and physical energy, and repair the waste of the tissues. This brings us naturally to consider next whether this twofold function of food is performed by the same or any article of food. In some cases it is; but as most articles of food do not contain the substance required in suitable proportion to perform both these functions, we require to take more than one article of food to make up what the other lacks, and in this way we get a diet sufficient to fulfil both these functions. It is for this reason that articles of food, or their nutritive principle, have been classified according as they contribute especially to the growth and nutrition of the body, or to the production of heat and force, into two great classes:—(a) Heat-producers; (b) Flesh-formers, or non-nitrogenised and nitrogenised compounds.
| (a) Heat-producing, or Non-nitrogenised. | |||||
| Sugar | } | { | Carbon | ||
| Starch | } | composed of | { | Hydrogen | |
| Gum | } | { | Oxygen | ||
| Oils and Fats | } | ||||
| (b) Flesh-forming, or Nitrogenised. | |||||
| { | Carbon | ||||
| Albumen | } | { | Hydrogen | ||
| Gluten | } | { | Nitrogen | ||
| Fibrin | } | composed of | { | Oxygen | |
| Casein | } | { | Sulphur and | ||
| Legumin | } | { | Phosphorus | ||
Of these compounds those which contain nitrogen are used principally for building up the muscles, while those which contain no nitrogen are burnt up in the body to yield heat and force. The flesh-forming compounds are not obtained solely from animal food, as gluten and legumin are derived from the vegetable kingdom, from cereals and peas and beans respectively; while the heat-producers, with the exception of some oils and fats, are obtained solely from the vegetable kingdom. So that for perfect health our food must contain sufficient of both these two classes of compounds to repair the tissues, and to supply heat and force (the mineral substances being contained in these compounds, also partly supplied by the water we drink). As to the relative proportion in which they should be present in our food, there is no hard and fast line; this would be an impossibility unless we were to weigh and analyse every article we eat. We judge by experience what will satisfy the appetite and enable us to feel up to our work. Besides, it must vary considerably according to circumstances,—1st, the amount of work or exercise; 2nd, the climate. Thus physical or bodily exercise compels us to eat more than when idle, our increased hunger or appetite being nature’s method of indicating to our minds that our bodies require food to replace what has been expended in force and to repair the waste of the tissues. Then the colder the climate more food is required, especially of the heat-giving varieties, as more will be spent in keeping up the warmth of the body. Cold is also more conducive to physical work than warm weather, so that for this reason also more food is required in a cold climate.
The following table by Dr. Stevenson Macadam gives an idea of the relative amount of flesh-formers and heat-producers in certain articles of food, showing the amount of heat-producing elements they contain for every 10 parts of flesh-formers.
| Flesh-forming. | Heat-producing. | |
| Rice | 10 | 123 |
| Potatoes | 10 | 115 |
| Barley | 10 | 57 |
| Oatmeal | 10 | 50 |
| Wheaten Flour | 10 | 44 |
| Milk | 10 | 40 |
| Fat Pork | 10 | 30 |
| Fat Mutton | 10 | 27 |
| Beans | 10 | 22 |
| Beef | 10 | 17 |
| Hare | 10 | 2 |
| Veal | 10 | 1 |
In the tropics, where little exercise can be taken, the waste of tissues is small, so that little nitrogenous food is required, and only a moderate amount of fat is taken; the need of heat-producers is comparatively small, so that starchy products, as millet and rice, are the principal articles of food. But gradually as we come north there is a marked increase both in the fatty and nitrogenous articles of food, until in the Arctic zone oily substances and animal food are the staple articles of existence, the amount of them that an Esquimaux will eat being something almost incredible, yet necessary to resist the severe cold.
The vegetable kingdom alone can supply all that is necessary for the human body both of flesh-forming and heat-producing substances, and we must not for a moment imagine that animal food is the only source of flesh-formers, as the world’s population is supported to a large extent on vegetable products, especially in tropical regions, while in colder climates, where vegetable products are hardly to be obtained, flesh and fat are indispensable. Thus man is clearly omnivorous; while men may be advantageously almost vegetarians in one climate, mixed eaters in another (as with us), and almost exclusively flesh eaters in a third, as in the Arctic regions. But there are some people who live exclusively on a vegetable diet (vegetarians) in our country, believing that such a diet is right in principle. Only those are true vegetarians who exclude milk, butter, eggs and cheese, as these are the very essence of animal food.
Man is capable of deriving all that is required for living and working from the animal or vegetable articles of food, either separately or combined. The question, therefore, is whether a purely vegetable diet or a mixed diet of vegetable and animal food is the better suited for our existence. To judge the question we have some facts to go upon. (1) We are so physically constructed as to be able to derive our nourishment from both animal and vegetable food. (2) In the Arctic regions hardly any vegetables are to be obtained. (3) Man alone has the intelligence to obtain food from all sources, and, by cooking, to render it fit for nourishment. It apparently follows, therefore, that while we are suited for either diet, or rather a combination of both, we may also select to some extent our diet according to our individual taste, habit of body, and other circumstances, as work and climate, experience having taught us that for the enjoyment of good health our diet must be regulated by the circumstances we have mentioned.
Nutritive values of Foods.—The following tables, based on those published by Letheby,[2] show the nutritive values (per lb.) of various food-stuffs, with their composition.
(a) Animal Food-stuffs.
| Value per lb. | Carbon. | Nitrogen. | |
| d. | Grains per lb. | Grains per lb. | |
| Butter, fresh | 16 | 6456 | — |
| Butter, salt | 12 | 4585 | — |
| Lard | 9 | 4819 | — |
| Bacon, dry | 9 | 5987 | 95 |
| Cheese, cheddar | 8 | 3344 | 306 |
| Beef | 8 | 1854 | 184 |
| Bacon, green | 8 | 5426 | 76 |
| Suet | 7 | 4710 | — |
| Pork, fat | 7 | 4113 | 106 |
| Dripping | 6 | 5456 | — |
| Mutton | 5 | 1900 | 189 |
| Herrings, red | 4 | 1435 | 217 |
| Cheese, skim | 3 | 1947 | 483 |
| Liver, bullocks’ | 3 | 934 | 204 |
| White fish | 2 | 871 | 195 |
| Milk, new | 2 | 599 | 44 |
| Milk, skimmed | 1 | 438 | 43 |
| Buttermilk | ½ | 387 | 44 |
| Whey | ½ | 154 | 13 |
(b) Vegetable Food-stuffs.
| Value per lb. | Carbon. | Nitrogen. | |
| d. | Grains per lb. | Grains per lb. | |
| Sugar | 5 | 2955 | — |
| Cocoa | 4 | 3934 | 140 |
| Oatmeal | 2 | 2831 | 136 |
| Pearl barley | 2 | 2660 | 91 |
| Rice | 2 | 2732 | 68 |
| Flour, seconds | 1½ | 2700 | 116 |
| Bread, bakers’ | 1½ | 1975 | 88 |
| Rye meal | 1¼ | 2693 | 86 |
| Peas, split | 1 | 2698 | 248 |
| Maize meal | 1 | 3016 | 120 |
| Barley meal | 1 | 2563 | 68 |
| Carrots | 1 | 508 | 14 |
| Parsnips | 1 | 554 | 12 |
| Beer and porter | 1 | 274 | 1 |
| Treacle | 1 | 2395 | — |
| Potatoes | ½ | 769 | 22 |
| Turnips | ½ | 263 | 13 |
| Vegetables, green | ½ | 420 | 14 |
Digestibility of Foods.—There cannot be the least doubt that in the matter of digestion no rule holds good for all stomachs alike, and it is absurd to attempt to lay down a hard and fast line. At the same time, some idea of the relative period required to digest various substances may be gained from a study of the published results of experiments, though one very doubtful element is left out of the case altogether, namely, the quality of the cooking, which every one knows influences the digestibility of the food. The most complete list is that by Dr. Beaumont, from observation of the process in the stomach of a wounded soldier.
This may be compared with the following table of precedence in digestibility of some animal foods, on the authority of Chambers:—
| Sweetbread and Lambs’ Trotters. | Roast Veal. |
| Boiled chicken. | Boiled Veal, Rabbit. |
| Venison. | Salmon, Mackerel, Herring, Pilchard, Sprat. |
| Lightly Boiled Eggs, New Toasted Cheese. | Hard-boiled and Fried Eggs. |
| Roast Fowl, Turkey, Partridge, and Pheasant. | Wood Pigeon, Hare. |
| Lamb, Wild Duck. | Tame Pigeon, Tame Duck, Goose. |
| Oysters, Periwinkles. | Fried Fish. |
| Omelette (?), Tripe (?). | Roast and Boiled Pork. |
| Boiled Sole, Haddock, Skate, Trout, Perch. | Heart, Liver, Lights, Milt, and Kidneys of Ox, Swine, and Sheep. |
| Tripe and Chitterlings. | Lobsters, Shrimps, Prawns. |
| Mutton. | Caviare. |
| Roast Beef. | Smoked, Dried, Salt, and Pickled Fish. |
| Boiled Beef. | Crab. |
| Rump Steak. | Ripe Old Cheese. |
The contradictions are sufficiently glaring.
From some recent experiments by Jessen it would seem that raw meat is more digestible than cooked, which is perhaps not astonishing when due allowance is made for the way in which that operation is often performed. Thus the times required for digestion were:
Klenze, experimenting on 18 kinds of cheese, found that cheddar was digested in the shortest time (4 hours), while unripe skim Swiss cheese required 10 hours for solution. There is no difference in the digestibility of all sorts of hard cheese, or all soft cheese, but all fat cheeses are dissolved the most rapidly, because, being open by reason of the fat, they are the more readily attacked by the solvent. There is no connection between the digestibility and the percentage of water present in the cheese, but there is some connection with the percentage of fat and the degree of ripeness.
Animal Foods.—There is surely no need to insist on the value of animal foods. At the same time there can be no doubt of a general tendency among town dwellers to eat too much meat. Twice a day is quite often enough for a meat meal, and then it should not form more than about ⅕ of the whole meal. Fresh fish is an excellent and wholesome substitute for meat, especially in the case of brain workers. Cheese is highly nutritious, but digestible only by those living out of doors; this does not apply, however, to the soft cream-cheeses. Lard, dripping, butter, and even butterine or bosch, have great value as heat-producing foods.
Vegetable Foods.—Few people rightly estimate the true value of vegetables, apart, that is to say, from the starchy products of the vegetable kingdom, such as potatoes, sago, rice, &c. Many people hardly think of eating cabbage or spinach with their meat, yet there is no more wholesome food as an adjunct to the dinner table. The same may be said of many other vegetables. On the authority of the Medical Record, asparagus is a strong diuretic, and forms part of the cure for rheumatic patients at such health resorts as Aix-les-Bains. Sorrel is cooling, and forms the staple of that soupe aux herbes which a French lady will order for herself after a long and tiring journey. Carrots, as containing a quantity of sugar, are avoided by some people, while others complain of them as indigestible. With regard to the latter accusation, it may be remarked, in passing, that it is the yellow core of the carrot that is difficult of digestion—the outer, a red layer, is tender enough. In Savoy the peasants have recourse to an infusion of carrots as a specific for jaundice. The large sweet onion is very rich in those alkaline elements which counteract the poison of rheumatic gout. If slowly stewed in weak broth, and eaten with a little Nepaul pepper, it will be found to be an admirable article of diet for patients of studious and sedentary habits. The stalks of cauliflower have the same sort of value, only too often the stalk of a cauliflower is so ill-boiled and unpalatable that few persons would thank you for proposing to them to make part of their meal consist of so uninviting an article. Turnips, in the same way, are often thought to be indigestible, and better suited for cows and sheep than for delicate people; but here the fault lies with the cook quite as much as with the root. The cook boils the turnips badly, and then pours some butter over it, and the eater of such a dish is sure to be the worst for it. Try a better way. What shall be said about our lettuces? The plant has a slight narcotic action, of which a French old woman, like a French doctor, well knows the value, and when properly cooked is really very easy of digestion.
Fruits.—There are few who cannot enjoy fruit in one form or another. For diabetics only the least desirable kinds, as certain nuts and almonds, are available, all others, as containing sugar, being forbidden. Sufferers from acid dyspepsia must select carefully, and limit their consumption to the least irritating—a few strawberries or a few grapes. Diarrhœa and dysentery preclude the use of all fruit. On the other hand, for constipated persons it is sometimes the only trustworthy remedy which they can use continuously with comfort; it is also of benefit in renal diseases, by its action on the bowel. Atonic persons generally take it well, and feel the better for its digestive property Those in normal health may eat almost any ripe fruit. The bland varieties are the most wholesome and nutritious—strawberries, apples, pears, grapes, and gooseberries. The last named, however, with currants and raspberries, are less wholesome than the others. Stone-fruits are apt to disagree with the stomach; but the more watery, as peaches and large plums, are better than the smaller and drier, as apricots and damsons. The pulp of oranges renders them heavy. Among other foreign fruits, bananas are wholesome. Dried fruits and the skin of fruits in general are indigestible. Nuts, the edible part of which is really the seed, contain much albumen and some fat in a condensed form, and are particularly difficult of digestion. Fruit may be taken with a meal or on an empty stomach. In the former case it promotes digestion by its gently irritating effect on the mucous membrane of the stomach and intestine. If an aperient effect be desired, it had better be taken in the morning before breakfast or between meals. A succulent and pleasantly acid variety is best for both of these purposes, while it is also a food. The quantity of fruit which should be taken depends on the kind. If it belongs to the bland nutritious class, a healthy person may now and then partake of it as freely as of any other wholesome food; but he will gain most benefit if he take only a little, and take it regularly. The same may be said of the invalid with whom fruit agrees. Cooking removes much of the acidity from crude fruit, and renders it lighter as well as more palatable. So treated, it is productive of good and no harm; but it is a fundamental principle that whatever fruit is eaten uncooked must be fully ripe and not over-ripe. This may sound trite, and indeed the principle is commonly admitted, but not, it would seem, by all, for we still find people, and not a few, who will themselves deliberately take, and worse, will give to their children, green gooseberries, green apples, &c., the very hardness of which, apart from their acid pungency, suggest their unfitness for digestion. Such people use as food an acid irritant poison, whose necessary action is to cause excessive intestinal secretion, with more or less of inflammation. Hence arises diarrhœa. On the other hand, fruit which is over-ripe, in which fermentation has begun, is a frequent cause of this disorder, and equally to be avoided, and perhaps also more difficult to avoid because the insidious beginning of decay is not easily recognised. It should never be forgotten by any who incline to follow the season in their feeding, that the want of such precautions as the above may produce that dysenteric form of diarrhœa, “British cholera,” which is occasionally as rapidly fatal as the more dreaded Asiatic type of that disease. (Brit. Med. Jour.)
Bread and other Grain Foods.—Arguments on the bread question threaten to be endless, probably because the champions on both sides have just enough scientific knowledge to enable them to misstate the case. The most reasonable review of the whole circumstances is contained in one of Prof. Church’s papers in Nature. He deals first with variations in composition in the grain itself. These variations, chiefly affecting the percentage of nitrogen, depend upon hereditary qualities in different strains of the wheat-plant; upon climate and season: and, to some extent, but not so largely as is often stated, upon cultivation, soil, and manure. The hard translucent wheats, blés durs et glacés, are of high specific gravity, about 1·41, and, owing to their lengthened and wrinkled shape, of low weight per bushel; these wheats are rich in nitrogen. The soft opaque wheats, of less specific gravity, about 1·38, and, owing to their rounded and plump form, of high weight per bushel, are poor in nitrogen. The hard wheats grown in Poland, in Southern Russia, in Italy, and in Auvergne, are used in the manufacture of macaroni, vermicelli, semolina, and pâtés d’Italie. The softer and more starchy wheats are especially appropriate for the production of fine white flour. According to the most recent analyses, the percentage of nitrogen in different varieties and samples of air-dry wheat may range from 1·3 up to 2·5—numbers corresponding to 8·23 and 15·83, respectively, of gluten or flesh-forming substances. But the same variety of wheat may give a grain having 3 per cent. more gluten in a bad season than when matured in a fine summer. More than this, one may select from the same field, the same plant, or even the same ear, individual grains which shall show quite as wide a variation in gluten as that just cited.
Church next considers “how much flour and how much bran will 100 parts of ordinary soft wheat yield on the ordinary system of low-milling adopted in England?” As the averages from an immense number of independent estimates we may put down the flour at a total of 80, the bran at 17, and the loss at 3. Thus, from an economical point of view, we appear to lose ⅕, or 20 per cent., of our wheat by submitting it to the numerous treatments involved in the manufacture of flour. But is this really the case? We think not. For much of the nitrogen in the rejected parts is not in the form of flesh-forming matter, and much that does so exist in the bran passes unaltered and unused through the alimentary canal, because of its close incorporation with fibre. But on the other side we must not forget that bone-forming materials are clearly deficient in wheaten flour, and that those phosphatic compounds present in bran are readily soluble to a large extent, not only in the several digestive secretions with which they come in contact in the body, but also in pure water.
But in comparing and contrasting bread made from flour with that made from whole wheat, Church considers other points. We shall find it impossible to make, by means of leaven or yeast, a light spongy loaf from whole wheat finely ground, the so-called cerealin of the bran inducing chemical changes which result in a moist, clammy, dense product. Even whole wheat merely crushed into meal, and not ground, partakes of the same defect. Fine flour, on the other hand, yields a bread which is light enough before mastication, but which, when masticated, possesses a marked tendency to become compacted into dense lumps which may never become penetrated by the gastric and intestinal juices, and which are a frequent cause of constipation. Whole-meal bread cannot be charged with this defect; indeed it acts medicinally as a laxative, and by reason of its mechanical texture is hurried rather too quickly along the digestive track, so that the full virtue of such of its nutrients as are really soluble becomes in part lost. Yet there is no doubt that for many persons, especially those who have passed middle age and are engaged in sedentary occupations, whole wheaten meal in the form of bread, biscuits, scones, &c., forms an invaluable diet.
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 | 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.
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 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.)
Coffee.—Coffee, like tea, when used as an article of diet, especially affects the nervous system. It is a brain and nerve stimulant; in very large doses, it produces tremors. It increases the action of the skin, and it appears to have a special power in augmenting the urinary water. It increases both the force and frequency of the pulse. Unlike tea, it tends to increase the action of the bowels. Coffee has been proved to be an important article in a soldier’s dietary, as a stimulant and restorative. Like tea, it acts as a nerve-excitant, without producing subsequent depression. It is serviceable against excessive variations of cold and heat, and its efficacy in these respects has been established in Antarctic expeditions, as well as in India and other hot climates. Dr. Parkes pointed out that coffee has a special recommendation in its protective influence against malaria. While admitting that the evidence on this point was not strong, he held it to be sufficient to authorise the large use of coffee in malarious districts. Coffee should be used as an infusion. If coffee be boiled, its delicate aroma is dissipated. (Brit. Med. Jour.) Coffee has a slight value as a nutriment, and a very high value as a stimulant; when mixed with boiling milk in the form of café-au-lait it forms the ideal of breakfast foods for body workers and brain workers, and a very small quantity of black coffee taken after a full meal serves to stimulate the stomach to the necessary digestive effort, and to ward off that sleepiness which is often the attendant of satiety. Supposing all the dissolved matter to be available for the needs of the body, the dietetic value of a cup of coffee is more than twice that of a cup of tea, and if we assume that the stimulating power is due to the contained alkaloid, then quâ stimulant the cup of coffee has more than three times the value of the cup of tea. (Poore.)
Cocoa.—The theobromin of cocoa is, chemically, identical with the thein of tea, and the caffein of coffee. While tea and coffee are comparatively valueless as true foods, cocoa, by reason of the large quantity of fatty and albuminoid substances it contains, is very nourishing, and is of high dietetic value as a tissue-forming food. Compared with tea and coffee, it is a food rather than a stimulant, being akin to milk in its composition and place in the diet-scale. It is useful to sustain the weakly, and to support the strong in great exertion, as a readily assimilable and general form of nourishment. (Brit. Med. Jour.)
Malt Liquors.—The distinguishing characteristic of malt liquors as articles of diet is their feeding-power, and they owe this to the presence in the malt of diastase, by which the insoluble and innutritious starch—the largest fat and heat-producing element in our food—is converted into the soluble and easily assimilable glucose sugar. The use of these beverages, then, in moderation—say 2 glasses a day, one at dinner and the other at supper—seems to be indicated, and would probably prove advantageous, in convalescence from wasting disease, extreme thinness, feeble digestion, or where there is difficulty in maintaining the animal heat. The following table, showing the composition and relative strength of representative malt liquors, may not be uninteresting to the reader:—
| Malt Extract. | Alcohol. | Carbonic Acid. | Water. | |
| Burton ale | 14·5 | 5·9 | 0 | 79·6 |
| Edinburgh ale | 10·9 | 8·5 | 0·15 | 80·45 |
| Porter (Barclay and Perkins) | 6·0 | 5·4 | 0·16 | 88·44 |
| Bavarian beer | 5·8 | 3·8 | 0·14 | 90·26 |
Malt extract has lately been brought into the market, and may be used where alcohol is for any reason considered undesirable. (Philip Foster, ‘Alcohol.’)
Smoking.—Though hardly a branch of dietetics, the habit of smoking is now so general (and to some people as necessary as their meals through long habit) as to deserve a few words of notice. Concerning its merits or demerits doctors are far from being agreed. One fact, however, is certain. Ptyalin, the active principle of the saliva or juice of the mouth, is identical in chemical composition with diastase, and has been supplied to us by nature for the purpose of effecting the necessary change of starch into sugar. Now the expectoration which so often accompanies smoking, and is unduly increased by it, means the loss of large quantities of this invaluable fluid.
As to the actual effects of tobacco smoke, Dr. Zulinski has recently published in a Warsaw medical journal the results of a long series of experiments made by him both upon human beings and animals with a view of verifying the physiological effects. He found in the first place that it is a distinct poison even in small doses. Upon men its action is very slight when not inhaled in large quantities, but it would soon become powerful if the smoker got into the habit of “swallowing the smoke,” and Dr. Zulinski ascertained that this toxical property is not due exclusively to the nicotine, but that tobacco smoke, even when disengaged of the nicotine, contains a second toxical principle called colidine, and also carbon oxide and hydrocyanic acid. The effects produced by tobacco depend, he says, to a great extent upon the nature of the tobacco and the way in which it is smoked. The cigar-smoker absorbs more poison than the cigarette-smoker, and the latter in turn than those who smoke pipes, while the smoker who takes the precaution of using a narghilie, or any other apparatus which conducts the smoke through water, reduces the deleterious effects of tobacco to a minimum. As a rule, the light-coloured tobaccos are supposed to be the mildest, but Dr. Zulinski says that a great many of the tobaccos are artificially lightened by the aid of chemical agents which are not always free from danger. He adds that several light tobaccos are also open to the objection of emitting a burning smoke, owing to the large proportion of wooden fibres which they contain, notably the French “caporal” and the English “bird’s-eye,” and that the smoke from these tobaccos is of such a high temperature as often to cause slight inflammation of the tongue, which with people of mature age is not unlikely to lead to cancer. The dark tobaccos are often adulterated, too, but Dr. Zulinski thinks that upon the whole they are the less dangerous. If tobacconists would only introduce a very cheap stem for pipes, smokers could afford to use a new stem every time they lit up, and by this means most of the evils of smoking pipes would disappear.
On cigarette smoking Sir Henry Thompson lately communicated the following remarks to the Lancet. (a) The cigarette, without a mouthpiece, is really never smoked more than half-way through in the East, where cigarettes are very cheap. It is well understood there, as it is by all practised cigarette smokers, that every inhalation from a cigarette slightly deteriorates in quality from the first. A small deposit of the very offensive oil of tobacco is deposited in the finely cut leaf, which acts as a strainer, and intercepts the deposit as it passes. Very little of this arrives in the smoker’s mouth if he stops when half is consumed. Many Oriental smokers consume no more than a third. (b) If a cigarette with a card mouthpiece is employed, the noxious matter may be intercepted by always introducing a light plug of cotton wool into the tube. If now the cigarette is nearly consumed, a considerable quantity of brown and very offensive matter will be found in the cotton wool, from the evil of which the smoker is thus preserved. The wool requires renewal after half-a-dozen cigarettes. (c) The maximum pernicious influence which occurs through cigarette smoking is attained by the practice of inhaling the smoke largely direct into the lungs, where it comes into immediate contact with the circulation, and the toxic effect is strongly perceptible after three or four consecutive inhalations, and felt by a sensitive person to the very tips of the fingers. Such smoking ought to be exceptional. All the fragrance, with a little only of the toxic effect, is obtained by admission of the smoke into the mouth only, still more by passing it through the passages of the pharynx and nose; but pulmonary inhalation, often associated with cigarette smoking, and rarely with the pipe, constitutes the great mischief of the cigarette.