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.