Chapter M: E. James: ‘How to Decorate our Ceilings, Walls, and Floors.’ (43)

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 | Alcohol. | Carbonic | Water.
| Extract. | | Acid. |
-----------------------------+----------+----------+----------+-------
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.

=Laying and Waiting at Table.=--The following suggestions are condensed from a series of articles on the subject by H. Burleigh in the indispensable _Queen_, intended for households with 2 to 7 servants. Housewives with smaller establishments may still benefit much by the instructions given.

No table ought to be laid, no tablecloth brought into the room, until the hearth has been thoroughly swept up, and the mantelpiece and sideboard well dusted. The neglect of this spoils the look of a room. Then another most important item is the proper preparation in the pantry. Most half-taught servants, which means 19 out of 20, will be continually running backwards and forwards between the pantry and the dining room bringing things piecemeal, instead of first preparing every article and bringing up everything, and then shutting the door on themselves, and quietly laying the table, without the confusing scramble that the former want of method produces. Servants cannot know these things unless a mistress has it in her to teach and train them. It behoves good women to learn each one for herself how to do everything in her house, so that she may teach those who enter her service.

For each meal--breakfast, luncheon, and dinner--there are different rules for laying the table and sideboard. We may call breakfast and luncheons movable feasts, for each day the laying of the table for these meals varies according to the food to be sent up, as at these meals everything is put on at once; whereas for dinner there is one invariable rule, whether there be many or few courses.

_Breakfast._--Before you begin to lay your cloth, look to the fire, that it is not in a half-lighted and half-dying condition. If there is one time more than another in which we value a good clear fire, it is in the early morning, when the members of a family come down cold and hungry; but how miserable to descend to a hearth scattered over with half-burned wood and paper, and a cold fire with a hollow in the middle. A good stir, a little more coal, a good sweeping up of bars and hearth ought to be done before the cloth is laid.

The sideboard for breakfast in a small household of 2 or 3 servants ought to have a sideboard cloth, with a joint or a ham on it, with a pile of plates on it according to the number of the family; 2 knife rests, a carving knife and fork, and small knives and forks arranged in stiff rows on each side of the pile of plates, which at breakfast ought to be in the middle of the sideboard, in front of the joint. On the right side should stand the bread board, with white and brown bread, and a bread knife; and on the left side a silver tray, for handing letters when they arrive, and also if the bell has to be rung for anything needed or forgotten, the tray is there ready. In larger households there ought to be a side table, with different cold comestibles, of course a much larger variety than in a smaller establishment; but the same rule holds good, that a sideboard and a side table ought to be straightly and stiffly laid for breakfast.

For the table it is quite absurd to put tablespoons at the corners with saltcellars. Put any tablespoons that are needed at the right side of the dish whose contents require one, or in front of the dish. For each person lay 2 small silver forks, 1 small steel knife, and 1 silver knife. It is a very slovenly way to put only 1 steel knife to each person, for after eating bacon or any meat with the steel knife, it is very nasty to use the same knife for marmalade or butter. Small second-hand silver knives are not expensive to buy for breakfast or for meat teas; keep them for that purpose, and for children’s fruit at lunch, and it saves the nicer dessert knives and forks being used.

In laying your cloth take the greatest care that your tablecloth is exactly in the centre, if not your whole table is thrown out. The laundress ought to be taught to fold the cloths with 2 outside seams and 1 inside fold, not in half and in half again. The former way makes them set so much better. Measure with your apron the distance of the side folds from the edge of the table. The distances ought to be exact.

Be careful before arranging your table for every and any meal to think what will be the general effect on entering the room. Think of what it will look like from the door, which is almost without exception farthest from the head of the table, and therefore so arrange the articles of china and silver that the tallest are nearest to the hand, and thus the effect of each thing is seen as it slopes down to the bottom of the table.

One thing has always to be taught to a new servant, and that is to put knives, forks, and spoons an inch on the table, I. e. to leave 1 in. between the edge of the table and the handles. It is wretched to see the handles over the edge, and the least touch in passing swings them round, to say nothing of the untidy effect. Do not leave a straggling space between the knives and forks for each person, only sufficient for the width of a plate, and let the prongs and handles be exactly and precisely together top and bottom. Care in these details makes such a very great difference in the whole look of a table. If there are flowers in the centre there will not be room for large casters. It is quite the proper thing to have casters on the table for breakfast and lunch, as at these meals every one waits on himself, except in a few uncomfortably grand houses, and, therefore, though it is a vulgarity to put the casters on a dinner table, it is quite right to put them on a breakfast or luncheon table.

After you have arranged your table so far, see that marmalade or honey, or both, rolled butter, sardines, and all cold things, are arranged on the table before you bring up the urn, or coffee or tea, or any hot things. Also have all your sideboard and side table arranged before any hot things come up. Then remember that it is very bad style to bring them in in a straggling and single way. After the urn or kettle and the coffee and tea have been placed on the table, wait until the cook has placed everything on your tray--eggs, muffins, or rolls or buttered toast, bacon, fish, hot milk, &c.--and bring it all up at once, and place them one after the other quickly on the table. In arranging your table take this simple rule--let nothing touch another, be able to pass your finger at least round each article, and place the coffee-pot, teapot, milkjugs, sugar basins, and slop basin so that each is seen, and has its clear and distinct place. Let marmalade and butter correspond, and saltcellars occupy a rather central position at a breakfast table. If small casters are used, containing salt, pepper, and mustard, they can, of course, be placed at corners.

Have perfectly clean and freshly made mustard for each meal. Nothing is worse than to open the lid of a mustard-pot, and see the inside and the spoon clogged with old dry mustard. Cast your salt in an old wineglass, and turn it out in a shape. Place a toast-rack always on a large plate, or else the crumbs make the cloth untidy.

Put a table napkin to each person, and see that your moist-sugar spoon is not clogged with sugar, but thoroughly clean. If you place a knife and fork in front of a breakfast dish, or a spoon and fork, place them so that they meet top and bottom--i.e. let the bowl of the spoon meet the end of the handle of the fork, and the prongs of the fork meet the handle of the spoon; the same with a knife and fork. Do not put a spoon on the preserve glass, but at the side; the same with a butter knife.

To each person at the breakfast table there ought to be, in addition to the usual plate, an extra one, very small, for eggs. In buying a breakfast service, it is better to get more plates and dishes than are usually sold with a set, otherwise the cook is fond of sending up dinner plates and dishes, which make an ugly conglomeration. When it is time to remove the breakfast things, whether it is done by the cook, parlour-maid, or man-servant, it is a most painful ordeal to a methodical mistress unless she teaches them how to do it. A tin tray, not too clean underneath, popped down on the white damask cloth, and everything put upon it promiscuously, plates upon plates with forks and knives left in them, others ditto on the top of that, silver mixed up with knives, delicate glass butter-dishes smashed in among bacon dishes, &c.

Now for the proper method--a much easier one in the end, both as regards the comfort of any one sitting in the room, and of the servant when she deposits the things in the pantry. First take away the silver; take the slop basin in your left hand, and go round the table and put into it each dirty teaspoon, fork, eggspoon, and tablespoon, and put the slop basin on the tray, which should be on a table outside the door. On the same tray put every other silver article except the urn, and carry down this tray and leave it, and bring up another. Then remove the urn; then on the tray take down bread, meat, and dirty dishes, and take the large plate that the toast rack has stood on, and place on it every dirty knife, placing the handles in the plate, which makes less rattling. Then collect plates neatly in piles, and all the saucers in piles, the cups two together, and you will see how much less room they occupy. When the last tray has been removed, bring up your dust shovel and brush, your hearth brush, crumb brush, or towel and a duster. Brush the cloth free from crumbs, and fold it up on the table; also the sideboard cloth, in their exact folds. Leave them on the table and brush up the hearth, brush up the crumbs under the table, and dust the top of the sideboard and mantelpiece, arrange the chairs, and, if allowed, open the window to get rid of the odours of breakfast, and you thus leave the room neat and ready for morning occupation.