January 1, 1870
Food in Health and Disease
Yeo describes the scientific knowledge concerning the metabolism of fat and protein, alluding to rabbit starvation where only protein is eaten. "The supporting influence of fat under great muscular fatigue is strongly maintained by Ebstein and it is stated that the German Emperor, in the war of 1870, recognised this fact by requiring that each soldier should have served out to him daily 250 grammes of fat bacon!"
In the next place we must consider the purposes achieved by the class of fats or hydrocarbons in nutrition. Liebig's views with regard to this subject also have been shown to be erroneous. He considered the function of fats to be entirely respiratory, and that by combining with oxygen, admitted into the system in respiration, they were consumed in the production of heat, and that the completeness of this combustion depended on the amount of inspired oxygen. But it has been observed that when an exclusive diet of fat has been taken, there has been less fat metabolised and less oxygen absorbed than in fasting, and also that, in certain circumstances, the whole of the albumen in the food is metabolised in the body, and the fat is appropriated to increase the body-weight ; an inversion of the formerly assumed roles of hydrocarbons and albuminates. From which it would appear that, under certain conditions, fat is split up into simpler bodies with greater difficulty than albumen, and must not, therefore, be regarded as the same easily combustible substance in the organism that it is outside.
It is not, then, through the direct action of oxygen that the non-nitrogenous foods any more than the nitrogenous ones are split up into simpler products, but by the agency of the cellular tissues, and the oxygen enters into these products "little by little." Indeed, under the influence of fat tissue-waste is lessened, and, therefore, less oxygen is taken into the system ; less oxygen being abstracted from the blood by the products of metabolism.
We thus see that one of the great purposes served by fat in the food is to diminish albuminous metabolism, and it is, therefore, regarded as an "albumen-sparing" food. "If flesh alone be given, large quantities are required in order that nutrition and waste may balance one another, but if fat be added the demand for flesh is less." (Bauer.)
But the fats have also an important relation in the body to the production of force and heat, to body-work and body-temperature. While, unlike the albuminates, the metabolism of hydrocarbons is independent of the amount taken in as food, it is notably affected by bodily exercise, which produces little effect on nitrogenous metabolism. The fats, therefore, undoubtedly minister to force-production, and undergo destruction and oxidation in the process ; so that the amount of carbonic acid given off" during exercise is much greater than during rest.
External temperature also influences the meta- bolism of the hydrocarbons, and therefore the amount of carbonic acid excreted ; the lower the temperature, so long as that of the body itself is maintained, the greater the metabolism of non-nitrogenous foods, and the greater the amount of carbonic acid discharged from the body. This is one of the chief means of regulating the temperature of the body, and keeping it constant.
When, however, the temperature of the body itself is disturbed, as in fever, then the higher the tempera- ture the greater the waste of the non-nitrogenous, as well as of the nitrogenous, constituents of the body, and the greater the excretion of carbonic acid, as well as of urea.
It is probably through the nervous system that the exteiThil temperature influences the metabolic processes in the body, and especially through the peripheral sensory nerves.
It would appear that albuminates and fats are, to a certain extent, opposed to one another in their action on the organism, as the former increase waste and promote oxidation, while the latter have the effect of diminishing them, and this they do prbably by affecting the metabolic activity of the cells of the tissues themselves. It is a matter of common observation that fat animals bear privation of food better than thin ones ; in the latter, their small store of fat is quickly consumed, and then the albumen is rapidly decomposed. It is for the same reason that corpulent persons, even on a very moderate amount of food, are apt to become still more corpulent.
The influence of fat in the storage of albumen is exemplified by the fact that if 1,500 grammes of lean meat be given alone, it will be wholly decomposed ; but if 100 to 150 grammes of fat be added, then it will yield only 1,422 grammes of waste. It has also been shown that the balance of income and expenditure of albuminates, although the amount taken in the food may be very small, is readily established as soon as one adds a certain quantity of fat. A dog who took daily 1,200 grammes of lean meat was observed to be still losing some of the albuminous constituents of the body ; whereas, with only 500 grammes of flesh and 200 grammes of fat, the nutritive balance was rapidly re-established. The same has been observed in man. Rubncr found that an individual taking daily 1,435 grammes of meat, containing 48.8 grammes of nitrogen, lost by the kidneys 50.8 grammes of nitrogen ; whereas another taking meat and bread containing 23.5 grammes of nitrogen, to which were added 191 grammes of fat, only eliminated 19 grammes of nitrogen on the second day of the diet ; so that a small quantity of albumen, when combined with fat, is sufficient to maintain the albuminous structures of the body. As a practical conclusion from these considerations, we should note, that if we wish to increase the weight of the body and add to its con- stituents, we must not rely on an excess of albu- minates, as these given alone only lead to increased waste ; but if we combine fats with albuminates in proper proportions, an appreciable increase of both the nitrogenous and non-nitrogenous constituents of the body can be maintained for a considerable time.
We see, then, how a proper use of fat economises the albuminous elements of food and checks the waste of the albuminous tissues. Fat enters into all the tissues. By its decomposition and oxidation it yields muscular force and heat, and it is therefore largely consumed in muscular exercise. By its capacity of being stored up in the body as adipose tissue, it provides a reserve store of force-producing and heat- generating material which can be utilised as required.
The supporting influence of fat under great muscular fatigue is strongly maintained by Ebstei : and it is stated that the German Emperor, in the war of 1870, recognised this fact by requiring that each soldier should have served out to him daily 250 grammes of fat bacon!
January 1, 1885
FUNCTIONAL AND INFLAMMATORY DISEASES OF THE STOMACH. BY SAMUEL G. ARMOR, M.D., LL.D.
Functional Dyspepsia (Atonic Dyspepsia, Indigestion).
The dietary treatment of dyspepsia was described: the diet, for instance, of bodily labor should consist largely of digestible nitrogenous food, and meat, par excellence, should be increased in proportion as muscular exercise is increased.
FUNCTIONAL AND INFLAMMATORY DISEASES OF THE STOMACH.
BY SAMUEL G. ARMOR, M.D., LL.D.
Functional Dyspepsia (Atonic Dyspepsia, Indigestion).
As a rule, the food should be such as will require the least possible exertion on the part of the stomach. Raw vegetables should be forbidden; pastries, fried dishes, and all rich and greasy compounds should be eschewed; and whatever food be taken should be eaten slowly and well masticated. Many patients digest animal better than vegetable food. Tender brown meats, plainly but well cooked, such as beef, mutton, and game, are to be preferred. Lightly-cooked mutton is more digestible than beef, pork, or lamb, and roast beef is more digestible than boiled. Pork and veal and salted and preserved meats are comparatively indigestible. Bread should never be eaten hot or fresh—better be slightly stale—and bread made from the whole meal is better than that made from the mere starchy part of the grain. Milk and eggs and well-boiled rice are of special value.
But to all these general dietetic rules there may be exceptions growing out of the peculiarities of individual cases. These should be carefully studied. The aged, for obvious reasons, require less food than the young; the middle-aged, inclined to obesity and troubled with feeble digestion, should avoid potatoes, sweets, and fatty substances and spirituous liquors; persons suffering from functional derangements of the liver should be put, for a time, on the most restricted regimen; while, on the contrary, the illy fed and badly-nourished require the most nutritious food that can be digested with comfort to the patient.
To these general predisposing causes may be added indigestion occurring in febrile states of the system. The cause here is obvious. In all general febrile conditions the secretions are markedly disturbed; the tongue is dry and furred; the urine is scanty; the excretions lessened; the bowels constipated; and the appetite gone. The nervous system also participates in the general disturbance. In this condition the gastric juice is changed both quantitatively and qualitatively, and digestion, as a consequence, becomes weak and imperfect—a fact that should be taken into account in regulating the diet of febrile patients. From mere theoretical considerations there can be no doubt that fever patients are often overfed. To counteract the relatively increased tissue-metamorphosis known to exist, and the consequent excessive waste, forced nutrition is frequently resorted to. Then the traditional saying of the justly-celebrated Graves, that he fed fevers, has also rendered popular the practice. Within certain bounds alimentation is undoubtedly an important part of the treatment of all the essential forms of fever. But if more food is crowded upon the stomach than can be digested and assimilated, it merely imposes a burden instead of supplying a want. The excess of food beyond the digestive capacity decomposes, giving rise to fetid gases, and often to troublesome intestinal complications. The true mode of restoring strength in such cases is to administer only such quantities of food as the patient is capable of digesting and assimilating. To this end resort has been had to food in a partially predigested state, such as peptonized milk, milk gruel, soups, jellies, and beef-tea; and clinical experience has thus far shown encouraging results from such nutrition in the management of general fevers. In these febrile conditions, and in all cases of general debility, the weak digestion does not necessarily involve positive disease of the stomach, for by regulating the diet according to the digestive capacity healthy digestion may be obtained for an indefinite time.
Exhaustion of the nerves of organic life strongly predisposes to the atonic forms of dyspepsia. We have already seen how markedly the digestive process is influenced by certain mental states, and it is a well-recognized fact that the sympathetic system of nerves is intimately associated with all the vegetative functions of the body. Without a certain amount of nervous energy derived from this portion of the nervous system, there is failure of the two most important conditions of digestion—viz. muscular movements of the stomach and healthy secretion of gastric juice. This form of indigestion is peculiar to [p. 441]the ill-fed and badly-nourished. It follows in the wake of privation and want, and is often seen in the peculiarly careworn and sallow classes who throng our public dispensaries. In this dyspepsia of exhaustion the solvent power of the stomach is so diminished that if food is forced upon the patient it is apt to be followed by flatulence, headache, uneasy or painful sensations in the stomach, and sometimes by nausea and diarrhoea. It is best treated by improving in every possible way the general system of nutrition, and by adapting the food, both in quantity and quality, to the enfeebled condition of the digestive powers. Hygienic measures are also of great importance in the management of this form of dyspepsia, and especially such as restore the lost energy of the nervous system. If it occur in badly-nourished persons who take little outdoor exercise, the food should be adapted to the feeble digestive power. It should consist for a time largely of milk and eggs, oatmeal, peptonized milk gruels, stale bread; to which should be added digestible nitrogenous meat diet in proportion to increased muscular exercise. Systematic outdoor exercise should be insisted upon as a sine quâ non. Much benefit may be derived from the employment of electric currents, and hydrotherapy has also given excellent results. If the indigestion occur in the badly-fed outdoor day-laborer, his food should be more generous and mixed. It should consist largely, however, of digestible nitrogenous food, and meat, par excellence, should be increased in proportion to the exercise taken. Medicinally, such cases should be treated on general principles. Benefit may be derived from the mineral acids added to simple bitters, or in cases of extreme nervous prostration small doses of nux vomica are a valuable addition to dilute hydrochloric acid. The not unfrequent resort to phosphorus in such cases is of more than doubtful utility. Some interesting contributions have been recently made to this subject of gastric neuroses by Buchard, Sée, and Mathieu. Buchard claims that atonic dilatation of the stomach is a very frequent result of an adynamic state of the general system. He compares it to certain forms of cardiac dilatation—both expressions of myasthenia. It may result from profound anæmia or from psychical causes. Mathieu regards mental depression as only second in frequency. Much stress is laid upon poisons generated by fermenting food in the stomach in such cases. It may cause a true toxæmia, just as renal diseases give rise to uræmia. Of course treatment in such cases must be addressed principally to the general constitution.
But of all predisposing causes of dyspepsia, deficient gastric secretion, with resulting fermentation of food, is perhaps the most prevalent. It is true this deficient secretion may be, and often is, a secondary condition; many causes contribute to its production; but still, the practical fact remains that the immediate cause of the indigestion is disproportion between the quantity of gastric juice secreted and the amount of food taken into the stomach. In all such cases we have what is popularly known as torpidity of digestion, and the condition described is that of atony of the stomach. The two main constituents of gastric juice—namely, acid and pepsin—may be deficient in quantity or disturbed in their relative proportions. A certain amount of acid is absolutely essential to the digestive process, while a small amount of pepsin may be sufficient to digest a large amount of albuminoid food. [p. 442]Pure unmixed gastric juice was first analyzed by Bidder and Schmidt. The mean analyses of ten specimens free from saliva, procured from dogs, gave the following results:
Lack of the normal amount of the gastric secretion must be met by restoring the physiological conditions upon which the secretion depends. In the mean time, hydrochloric and lactic acids may be tried for the purpose of strengthening the solvent powers of the gastric secretion.
EXCITING CAUSES.—The immediate causes of dyspepsia are such as act more directly on the stomach. They embrace all causes which produce conditions of gastric catarrh, such as excess in eating and drinking, imperfect mastication and insalivation, the use of indigestible or unwholesome food and of alcohol, the imperfect arrangement of meals, over-drugging, etc.
Of exciting causes, errors of diet are amongst the most constantly operative, and of these errors excess of food is doubtless the most common. The influence of this as an etiological factor in derangement of digestion can scarcely be exaggerated. In very many instances more food is taken into the stomach than is actually required to restore tissue-waste, and the effects of such excess upon the organism are as numerous as they are hurtful. Indeed, few elements of disease are more constantly operative in a great variety of ailments. In the first place, if food be introduced into the stomach beyond tissue-requirements, symptoms of indigestion at once manifest themselves. The natural balance betwixt [p. 443]supply and demand is disturbed; the general nutrition of the body is interfered with; local disturbances of nutrition follow; and mal-products of digestion find their way into the blood. Especially is this the case when the excessive amount of food contains a disproportionate amount of nitrogenous matter. All proteid principles require a considerable amount of chemical alteration before they are fitted for the metabolic changes of the organism; the processes of assimilative conversion are more complex than those undergone by fats and amyloids; and it follows that there is proportional danger of disturbance of these processes from overwork. Moreover, if nitrogenous food is in excess of tissue-requirement, it undergoes certain oxidation changes in the blood without becoming previously woven into tissue, with resulting compounds which become positive poisons in the economy. The kidneys and skin are largely concerned in the elimination of these compounds, and the frequency with which these organs become diseased is largely due, no doubt, to the excessive use of unassimilated nitrogenous food. Then, again, if food be introduced in excess of the digestive capacity, the undigested portion acts directly upon the stomach as a foreign body, and in undergoing decomposition and putrefying changes frets and irritates the mucous membrane. It can scarcely be a matter of doubt that large groups of diseases have for their principal causes excess of alimentation beyond the actual requirements of the system. All such patients suffer from symptoms of catarrhal indigestion, such as gastric uneasiness, headache, vertigo, a general feeling of lassitude, constipation, and high-colored urine with abundant urates, together with varied skin eruptions. Such cases are greatly relieved by reducing the amount of food taken, especially nitrogenous food, and by a systematic and somewhat prolonged course of purgative mineral waters. Europe is especially rich in these springs. The waters of Carlsbad, Ems, Seltzer, Friedrichshall, and Marienbad, and many of the alkaline purgative waters of our own country, not unfrequently prove valuable to those who can afford to try them, and their value shows how often deranged primary assimilation is at the foundation of many human ailments. The absurd height to which so-called restorative medicine has attained within the last twenty years or more has contributed largely to the production of inflammatory forms of indigestion, with all the evil consequences growing out of general deranged nutrition.
The use of indigestible and unwholesome food entails somewhat the same consequences. This may consist in the use of food essentially unhealthy or indigestible, or made so by imperfect preparation (cooking, etc.). Certain substances taken as food cannot be dissolved by the gastric or intestinal secretions: the seeds, the skins, and rinds of fruit, the husks of corn and bran, and gristle and elastic tissue, as well as hairs in animal food, are thrown off as they are swallowed, and if taken in excess they mechanically irritate the gastro-intestinal mucous membrane and excite symptoms of acute dyspepsia, and not unfrequently give rise to pain of a griping character accompanied by diarrhoea. Symptoms of acute dyspepsia also frequently follow the ingestion of special kinds of food, such as mushrooms, shellfish, or indeed fish of any kind; and food not adapted to the individual organism is apt to excite dyspeptic symptoms. Appetite and digestion are also very much influenced by the life and [p. 444]habits of the individual. The diet, for instance, of bodily labor should consist largely of digestible nitrogenous food, and meat, par excellence, should be increased in proportion as muscular exercise is increased. For all sorts of muscular laborers a mixed diet is best in which animal food enters as a prominent ingredient. Thus, it has been found, according to the researches of Chambers, that in forced military marches meat extract has greater sustaining properties than any other kind of food. But with those who do not take much outdoor exercise the error is apt to be, as already pointed out, in the direction of over-feeding. It cannot be doubted at the present time that over-eating (gluttony) is one of our popular vices. Hufeland says: "In general we find that men who live sparingly attain to the greatest age." While preventive medicine in the way of improved hygiene—better drainage, better ventilation, etc.—is contributing largely to the longevity of the race, we unfortunately encounter in more recent times an antagonizing influence in the elegant art of cookery. Every conceivable ingenuity is resorted to to tempt men to eat more than their stomachs can properly or easily digest or tissue-changes require. The injurious consequences of such over-feeding may finally correct itself by destroying the capacity of the stomach to digest the food.
Food may also be introduced into the stomach in an undigestible form [p. 445]from defects of cookery. The process of cooking food produces certain well-known chemical changes in alimentary substances which render them more digestible than in the uncooked state. By the use of fire in cooking his food new sources of strength have been opened up to man which have doubtless contributed immeasurably to his physical development, and has led to his classification as the cooking animal. With regard to most articles the practice of cooking his food beforehand is wellnigh universal; and especially is this the case with all farinaceous articles of food. The gluten of wheat is almost indigestible in the uncooked state. By the process of cooking the starchy matter of the grain is not only liberated from its protecting envelopes, but it is converted into a gelatinous condition which readily yields to the diastasic ferments. Roberts, in his lectures on the Digestive Ferments, points out the fact that when men under the stress of circumstances have been compelled to subsist on uncooked grains of the cereals, they soon fell into a state of inanition and disease.
Animal diet is also more easily digested in the cooked than in the raw state. The advantage consists chiefly in the effects of heat on the connective tissue and in the separation of the muscular fibre. In this respect cooking aids the digestive process. The gastric juice cannot get at the albumen-containing fibrillæ until the connective tissue is broken up, removed, or dissolved. Hot water softens and removes this connective tissue. Hence raw meat is less easily digestible. Carnivorous animals, that get their food at long intervals, digest it slowly. By cutting, bruising, and scraping meat we to a certain extent imitate the process of cooking. In many cases, indeed, ill-nourished children and dyspeptics digest raw beef thus comminuted better than cooked, and it is a matter of observation that steamed and underdone roast meats are more digestible than when submitted to greater heat.
Some interesting observations have been made by Roberts on the effects of the digestive ferments on cooked and uncooked albuminoids. He employed in his experiments a solution of egg albumen made by mixing white of egg with nine times its volume of water. "This solution," says Roberts, "when boiled in the water-bath does not coagulate nor sensibly change its appearance, but its behavior with the digestive ferments is completely altered. In the raw state this solution is attacked very slowly by pepsin and acid, and pancreatic extract has no effect on it; but after being cooked in the water-bath the albumen is rapidly and entirely digested by artificial gastric juice, and a moiety of it is rapidly digested by pancreatic extract."
It is a mistake, however, to suppose that cooking is equally necessary for all kinds of albuminoids. The oyster, at least, is quite exceptional, for it contains a digestive ferment—the hepatic diastase—which is wholly destroyed by cooking. Milk may be indifferently used either in the cooked or uncooked state, and fruits, which owe their value chiefly to sugar, are not altered by cooking.
The object in introducing here these remarks on cooking food is to show that it forms an important integral part of the work of digestion, and has a direct bearing on the management of all forms of dyspepsia.
October 25, 1949
Nunamiut, Among Alaska's Inland Eskimos
A diet of tough caribou meat with practically no fat becomes dismal after a time.
It is October.
An important event is now imminent. Very soon the southward autumn migration of the caribou from the tundra to the mountains will begin. Great herds will go through the Anaktuvuk Pass during a comparatively short time. The Eskimos will then have to shoot sufficient caribou bulls, which until the mating season are very fat, to ensure our main fat requirements for the winter. Later the beasts become skinny, and without sufficient fat, people on a meat diet throughout a long, cold winter are in an awkward position.
But something is. wrong. Day after day we range far over the countryside in every direction but see nothing but one or two small herds of lean bulls. A few animals are brought down, and we keep going more or less, but meals are scanty for both men and dogs.
The shortage of fat is now becoming serious. The only form of fat we have is the marrow in the bones; it is eaten raw and is a dish more delicious in times like these than words can describe. But as a caribou has only four legs and few beasts are shot, not much of this delicacy comes the way of each individual. No, a diet of tough caribou meat with practically no fat becomes dismal after a time. It is a diet which gives one the same empty feeling under the breastbone as when one has nothing to eat at all. We can eat almost unlimited quantities without feeling satisified. One's condition suffers accordingly; one feels the cold more: I have to make an effort to do things which otherwise would have been easy.
"It's rather like eating moss," Paniaq says with a smile as we attack the tough meat. And when we are out hunting together and look out from the heights over a wide area and do not see a living creature on the snow, only cold and nakedness as far as the eye can reach, he sometimes says in his dry manner: "A hungry land."
It is becoming common to borrow meat from one another. Here the Eskimos' sense of duty toward their nearest relations is clearly shown. When the hunter returns to the settlement with game, his wife immediately cuts off a few good portions of meat and gives them to her parents and parents-in-law. This diminishes the uncertainty which attaches to a single hunter's bag. In a way the community functions in hard times like a kind of mutual benevelent society.
Our situation would be more difficult if we had not a quantity of reserve provisions running about high up in the steepest mountains--the wild sheep. They are the bright spots in our existence. Leaving the lean caribou meat for the fat, tender mutton is like changing from bread and water in prison to the choicest dish at the Cafe de Paris. The sheep keep fat longer than the caribou, from the beginning of July to April.
Now and again we go out hunting sheep. But the beasts are rather scattered and in small herds, so even if we bring down some, they do not go far among sixty-five people(and 200 dogs).
But there was a report ahead, and I saw a ram in flight far away. There sat Paniaq, smoking his pipe beside a big ram.
We rolled and pulled the animal down to the foot of the mountain; as usual we ate the glands between the hooves and the dainty neck fat on the spot.