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.