Part 105

_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 | [b]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. [b] 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.