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Historical Texts:
The Physiology of Digestion by Andrew Combe, M.B. (1837)

Part II. The Principles of Dietetics viewed in Relation to the Laws of Digestion

The Physiology of Digestion by Andrew Combe, M.D., Forth American Edition, was published By Marsch, Capen & Lyon in Boston in 1837. Andrew Combe was a physician in ordinary to their Majesties the King and Queen of the Belgians, and a Fellow of the Royal College of Physicians of Edinburgh. The third edition of this book was sold in 3000 copies. The text of this book of 310 pages will be found here, completely unchanged.

CHAPTER II.

ON THE PROPER QUANTITY OF FOOD.
    Quantity to be proportional to the wants of the system. - Appetite indicates these. - Cautions in trusting to appetite. - General error in eating too much. - Illustrations from Beaumont, Caldwell, Head, and Abercrombie. - Mixtures of food hurtful chiefly as tempting to excess in quantity. - Examples of disease from excess in servant-girls from the country, dressmakers, &c. - Mischief from excessive feeding in infancy. - Rules from preventing this. - Remarks on the consequences of excess in grown persons. - Causes of confined bowels explained - And necessity of fulfilling the laws which God has appointed for the reulation of the animal economy inculcated.

The next important step in the regulation of diet is to determine the QUANTITY which ought to be eaten.

To ensure easy digestion and sound health, the quantity of food ought always to be proportioned to the wants of the system; but this can be done only by a constant reference to the individual´s constitution and circumstances, and not by attempting to lay down any standard as admitting of universal application.

We have seen that, where waste is great and growth active, an abundant supply of food is required, and taht, in accordance with this relation, it is in such circumstances that the desire for food is most keenly felt. Generally speaking, appetite is a safe guide as to quantity; but, in following its dictates, we must take special care neither to eat so fast as to prevent it from giving timely intimation that we have had enough, nor to confound the mere gratification of taste, or the yearning of a vacant mind, with the natural craving of unsatisfied want. Dr. Beaumont´s remarks on this subject are characterized by so much soundness of judgment, that no apology can be required for soliciting the attention of the reader to the following very pertinent extract from his work.


William Beaumont, 1785-1853. This illustration is from a later source.

"There is no subject of dietetic economy, " says Dr. Beaumont, "about which people err so much, as that which relates to quantity. The medical profession, too, has been accessory to this error, in giving directions to dyspeptics to eat until a sense of satiety is felt. Now this feeling, so essential to be rightly understood, never supervenes until the invalid has eaten too much, if he have an appetite, which seldom fails him. Those even who are not otherwise predisposed to the complaint, frequently induce a diseased state of the digestive organs by too free indulgence of the appetite. Of this fact, the medical profession are, generally, not sufficiently aware. Those who lead sedentary lives, and whose circumstances will permit of what is called free living, are peculiarly obnoxious to these complaints. By paying particular attention to their sensations during the ingestion of their meals, these complaints may be avoided. There appears to be a sense of perfect intelligence conveyed from the stomach to the encephalic centre, which, in health, invariably dictates what quantity of aliment (responding to the sense of hunger and its due satisfaction) is naturally required for the purposes of life; and which, if noticed and properly attended to, would prove the most salutary monitor of health, and effectual prevention of disease. It is not the sense of satiety, for this is beyond the point of healthful indulgence, and is nature´s earliest indication of an abuse and overburden of her powers to replenish the system. It occurs immediately previous to this, and may be known by the pleasurable sensations of perfect satisfaction, ease, and quiescence of body and mind. It is when the stomach says enough, and is distinguished from satiety by the difference of the sensations, - the former felling enoug - the latter too much. The first is produced by the timely reception into the stomach of proper aliment, in exact proportion to the requirements of nature, for the perfect digestion of which a definite quantity of gastric juice is furnished by the proper gastric apparatus. But to effect this most agreeable of all sensations and conditions - the real Elysain satisfaction of the reasonable epicure - timely attention must be paid to the preliminary processes, such as thorough mastication and moderate or slow deglution. These are indispensable to the due and natural supply of the stomach, at the stated periods of alimentation; for if food be swallowed too fast, and pass into the stomach imperfectly masticated, too much is received in a short time, and in too imperfect a state of preparation, to be disposed of by the gastric juice.

"The quantity of gastric juice, either contained in its proper vessels or in a state of preparation in the circulating fluids, is believed to be in exact proportion to the proper quantity of aliment required for the due supply of the system. If a more than ordinary quantity of food be taken, a part of it will remain undissolved in the stomach, and produce the usual unpleasant symptoms of indigestion. But if the ingetion of a large quantity be in proportion to the calls of nature, which sometimes happens after an unusual abstinence, it is probable that more than the usual supply of gastric juice is furnished; in which case the apparent excess is in exact ratio to the requirements of the economy, and never fails to produce a sense of quiescent gratification and healthful enjoyment. A great deal depends on habit in this respect. Our western Indians, who frequently undergo long abstinence from food, eat enormous quantities when they can procure it, with impunity (Beaumont´s Observations, &c.; p. 63).

If the purposes for which eating is necessary be kept in mind, the keen appetite and vigorous digestion observable in growing youths, and in those who undergo much active exercise in the open air - and the weaker appetite and feebler digestion observed during the middle period of life, especially in persons of sedentary habits - will appear to be in strict harmony with the wants of the system in the respective circumstances. But from no attention being paid by either the old or the young to the principle by which the supply of nourishment ought to be regulated, and the hste with which every one labours to appease the cravings of hunger, it may be affirmed, as a general fact, that mankind eat greatly more than is required for their sustenance; and the indigestion thereby induced is a salutary provision of nature to prevent the repletion which would otherwise ensure.

Sir Francis Head, in his humorous book entitled bubbles from the Brunnens of Nassau, by an Old Man, expresses his astonishment at the "enormous quantity of provisions" which the invalids and sojourners at these watering-places "so placidly consume;" and, after noticing "the heavy masses which constitute the foundation of the dinner, and the successive layers of salmon-fowls-puddings-meat again-stewed fruit-and, lastly, majestic legs of mutton - which form the lighter superstructure," he adds: - "Nothing which this world affords could induce me to feed in this gross manner. The pig which lives in his sty would have some exuse, but it is really quite shocking to see any other animal overpowering himself at mid-day with such a micture and superabundance of food" (p. 71). In another page he returns to the subject, and quaintly enough remarks, "that almost every malady to which the human frame is subject is, either by high-ways or by-ways, connected with the stomach; and I must own, I never saw a fashionable physician mysteriously counting the pulse of a plethoric patient, or with a silver spoon on his tongue, importantly looking down his red inflamed gullet (so properly termed by Johnson ´the meat-pipe´), but I feel a desire to exclaim, ´Why not tell the poor gentleman at once - Sir, you´ve eaton too much, yoy´ve drunk too much, and you´ve not taken exercise enough!´ That these are the main causes of almost every one´s illness, there can be no greater proof than that those savage nations which live actively and temperately have only one great disorder - death. The human frame was not created imperfect - it is we ourselves who have made it so; there exists no donkey in creation so overladen as our stomachs; and it is because they groan under the weight so cruelly imposed upon them, that we see people driving them before them in herds to drink at one little brunnen" (p. 91-2).

Our supposed "Old Man" is by no means singular in his opinions. The celebrated Roman physician Baglivi, who, from practising extensively among Catholics, had ample opportunities of observation, mentions that in Italy an unusual large proportion of the sick recovered during Lent, in consequence of the lower diet which is then observed as part of the religious duties. This is a striking fact, and gives unequivocal proof, not only in favour of temperance, but in evidence of the assertion that excess in quantity is a prevailing error in society.

Professor Caldwell, of Transylvania University, Kentucky, in one of his vigorously-conceived aind very instructive essays, inveighs eloquently against the intemperance of his countrymen in eating as well as in drinking, and tells them that one American consumes as much food ad two Highlanders or two Swiss, although the latter are among the stoutest of the race. "Intemperate eating," says he, "is perhaps the most universal fault we commit. We are all guilty of it, not occasionally, but habitually, and almost uniformly. from the cradle to the grave. It is the bane alike of our infancy and youth, our maturity and age. It is infinitely mor e common than intemperance in drinking; and the aggregate of the mischief it does is greater. For every reeling drunkard that disgraces our country, it contains one hundred gluttons - persons, I mean, who eat to excess and suffer by the practice." How, indeed, he afterward exclaims, can the case be otherwise, while children and youth are regularly taught, hired, bribed, or tempted, "to overeat themselves from their birth! Do you ask me for evidence in proof of this charge? Go to our dining-rooms, nurseries, fruit-shops, confectionaries, and pleasure-gardens - go even to sick-rooms - and you will find it in abundance. You will witness there innumerable scenes of gormandizing, not only productive of disase in those concerned in them, but in many instances offensive to beholders. The frightful mess often consists of all sorts of eatable materials that can be collected and crowded together; and its only measure is the endurance of appetite and tha capacity of the stomach. Like the ox in rich pastureground, or the swine at his swill-trough, men stow away their viands until they have neither desire nor room for any more. I do not say that such eating-matches always and everywhere occur among us. But I do say that they occur too frequently, and that they form fit subjects for caricature pictures by European tourists of our domestic manners. I add, however, that similar scenes present themselves in every country I have visited, where provisions are abundant and cheap." (Transylvania Journal of Medicine for September, 1832, p. 313. See also Dr. Caldwells excellent Thoughts on Physical Education, and the True Mode of Improving the Condition of Man; reprinted for A. and C. Black, Edinburgh, 1836.)

This is a strongly-drawn picture, but, with a modification in degree, it is perhaps not less applicable to our own and other European countries than to the United States. The "Old Man´s" description of German feeding is, in its main features, essentially the same; and, so far as my observation and experience go, it is only in a less degree that we fall short of our brethren in America. As a general rule, we also exceed, though not to the same extent. This is owing partly to our more advanced civilization, and partly to the greater difficulty of procuring the means of excess; and if I have resorted to Germany and the United States for the most striking illustrations of the principle, it is not from want of examples at home, but because we are so much more alive to the errors of out neighbours than to our own, that the principle involved in their commission will be more readily recognised when pointed out in them than when its perception is made to imply condemnation of ourselves.

It is a trite observation, that medical men are constantly exclaiming against the eating propensities of their patients, and inculcating the practice of temperance. One of the most eminent physicians of the present day says: "I believe that every stomach, not actually impaired by organic disease, will perform its functions if it receive reasonable attention; and when we consider the manner in which diet is generally conducted, both in regard to quantity and to the variety of articles of food and drink which are mixed up into one heterogeneous mass, instead of being astinished at the prevalence of indigestion, our wonder must rather be that, in such circumstances, any stomach is capable of digesting at all. In the regulation of diet, much certainly is to be done in dyspeptic cases by attention to the quality of the articles that are taken; but I am satisfied that much more depends upon the quantity; and I am even disposed to say, that the dyspeptic might be almost independent of any attention to the quality of his diet, if he rigidly observed the necessary restrictions in regard to quantity." (Abercrombie on Diseases of the Stomach, &c., 1st ed., p. 72.) The latter opinion is obviously borne out by Dr. Beaumont´s observation of the power of digestion being limited by the amount of gastric juice which the stomach is capable of providing - an amount varying with the wants of the system, and consequently with the mode of life.

Cornaro, Cheyne, and others, have most absurdly attempted to determine a standard quantity of food for all mankind, and have fixed it at the lowest possible limit. The very attempt, however, is inconsistent with the laws of the animal economy; since the supply required must necessarily vary not only according to the age, ses, and constitution of the individual, but according to the mode of life and the circumstances by which he is surrounden; and it would be, therefore, not less injurious than unnatural for any one to adhere to the same invariable proportion.

Mixtures of different kinds of food are strongly condemned by almost all writers on dietetics, as injurious to digestion. So far, however, as my observation goes, they produce mischief much more by the inducement to excess in quantity which variety affords, than by the mere mixture of different substances. In a healthy stomach, indigestion is rarely ever induced by eating several kinds of food at one meal, provided the total amount consumed be not beyond the wants of the system, and do not exceed the due proportion to the quantity of gastric juice which the stomach is able to provide. When only one dish is partaken of, there is less temptation to exceed in quantity than where several are tried.

The first intimations of satisfied appetite are unquestinably the best warning we can have when to stop eating. If we do not go beyond this point, the subsequent sensations are pleasurable and invigorating, and, after a brief interval, we are perfectly disposed to return to active exertion. But, if we eat more than enough, fulness and oppression are almost immediately experienced, and a considerable time must elapse before either mind or body can effectually resume its activity.

Where, either from long over-indulgence or other causes, the appetite cannot be safely followed as a guide in regulating the quantity of food, we shall not err very far if we proportion our meals to the amount of the preceding exercise. When this has been active and in the open air, and waste has consequently been considerable, a liberal allowance of food will be more easily digested than perhaps half the quantity would be after a week´s inaction. Hence it is a great error to devour the same quantity of food daily, whatever our mode of life and bodily exertion may be; and yet nothing is more common than to see persons who have passed from a life of varied activity to one of a purely sedentary nature, continue to eat - merely because they have been accustomed to it - as much food as if they were still engaged in constant bodily exertion. Many females of the higher and middle classes, who scarcely ever stir out of doors except to church, nevertheless make as hearty meals twice or thrice a day as if they were undergoing pretty severe exertion; but they sooner or later reap their reward in bad digestion and annoying nervous disorders.

In towns we often observe the bad effects of overfeeding in young female servants recently arrived from the country. From being accustomed to constant exercise in the open air, and to the comparatively innutritious diet on which the labouring classes subsist, they pass all at once, with appetite, digestion, and health in their fullest vigour, to the confinement of a house, to the impure atmosphere of a crowded city, and to a rich and stimulating diet. Appetite, still keen, is freely indulged; but waste being diminished, while nutrition is increased, fulness is speedily induced, followed in its turn by inflammatory diseases or fever, which sometimes cust short life, where, with better management, health might have been preserved for years. In many instances, again, life is saved by the digestive powers being the first to give way, and refusing either to receive or to concoct the same quantity of aliment as before, and the patient then escapes with the minor evils of protracted dyspepsy or indigestion.

The operation of the same principle is still more conspicuous in girls sent from the country to the work-rooms of fashionable milliners and dressmakers in the larger towns. Transferred at once from activity in the open air to confinement all day, and often to a late hour at night, at a sedentary occupation, where there is scarcely even the means of changing their position, and much less of enjoying active muscular exercise, and where, consequently, there is little waste, the digestive powers speedily give way, because less food is now required to repair the diminished loss. If the individual adapts her eating to her change of circumstances, she may escape severe disease; but if, as generally happens, from pure ignorance, she continues to eat to the same extent as before, headaches, sickness, bilious disorder, and indigestion will be among the smallest of her evils, and she will have reason to be thankful if she does not become the victim of confirmed bad health. In establishments of this description, the provision of the means of exercise, even by dumb-bells, shuttlecock, or otherwise, in a large room with open windows for a few minutes, several times a day, would not only prevent much suffering, but even repay itself in an economical point of view, by producing an increased aptitude for work, and less frequent absence on account of illness. In these days of wide-spreading philanthropy, considerations of this kind ought to be more attended to.

The necessity of proportioning the supply of food to the expenditure incurred, and to the mode of life, is still further illustrated in the case of individuals changing from an agricultural or other employment carried on in the open air in the country, and involving no very great bodily labour, to one of a mechanical kind carried on in an impure atmosphere in a city, and requiring a severe and continued muscular exertion. It is a matter of experience, for example, that the stout young men from the country, who are generally selected as apprentices for the laborious occupation of letter-press printing, almost uniformly break down during the first ten or twelve months; and it is only after some years´ training that they are able to withstand the fatigue. The vitiated atmosphere in which they work has some share in producing this result; but the chief cause is, undoubtedly, the inadequacy of their ordinary diet to repair the great expenditure of muscular energy to which they are habitually subjected, and for which they have not been previously prepared. In the office where this volume is printed, four strong and healthy lads were engaged last summer as pressmen, and put to work along with an equal number of experienced men. Already (February) every one of the former has been laid up from sickness for weeks, although the whole of them are of the most sober and steady habits; while not one of the older and more experienced men has felt any inconvenience from his exertions. This very instructive fact is also deserving of attention, as corroborating what I have elsewhere said in regard to the necessity of proper management duriing the period of transition from youth to manhood - a period during two or three years of which more good or more mischief may be done to the human constitution, than during almost any other ten years of life. (Principles of Physiology, &c., chaps. vii. and x.) That, in times past, pressmen have suffered at least as much from their own mismanagement as from the nature of their employment, is rendered probable by their proverbial dissipation. In utter ignorance of the structure and laws of the animal economy, they not unnaturally sought to relieve the exhaustion under which they suffered by the stimulus of spirituous and other intoxication liquors, instead of seeking it - where only it can be effectually obtained, and at a cheaper rate - in a more wholesome and nourishing diet. It is gratifying to perceive, however, that in this, as in many other trades, the progress of knowledge is already leading to the prevalence of more rational ideas, and to the consequent formation of better habits.

There is no period of life during which it is of greater importance to follow the intentions of nature in the regulation of diet, both as to quantity and quality, than during the earliest part of childhood; for at no period is the neglect of them more fatal. Surprise is sometimes expressed at the number of children who are carried off before completing their first or second year; but when we consider the defective education, and entire ignorance of the human economy, not only of the nurses and servants, to whose care the young are intrusted, but of the parents themselves, our wonder ought to become greater that so many survive than that so many die. There is perhaps not one mother in ten thousand who, before becoming such, has ever inquired into the nature and wants of the newly-born infant, or knows on what principles its treatment ought to be directed; and hence the hurtful and superstitious notions of the human economy which still linger in the nursery, long after they have ceased to prevail in the world of science.

Those whose opportunities of observation have been extensive, will agree with me in opinion, that nearly one half of the deaths occuring during the first two years of existence are ascribable to mismanagement and to errors in diet. At birth, the stomach is feeble, and as yet unaccustomed to food. Its cravings are consequently easily satisfied, and frequently renewed. A healthy infant seeks the breast with avidity, but sucks a little at time. It leaves an interval for thoroughly digesting the little which it has swallowed; after which its appetite revives, and a fresh supply is demanded in a language which no mother can misinterpret. During the first months, appetite ought to be the mother´s guide in offering the breast; and if she know how to read the expression of her infant aright, she will want no other. At that early age, there ought to be no fixed time for giving nourishment. The stomach cannot be thus satisfied. In one child digestion may be slow, and the interval be consequently too short; in another it may be quick, and the interval too long. But the active call of the infant is a sign which needs never be mistaken, and none else ought to be listened to.

Many mothers consider every expression of uneasiness as an indication of appetite, and whenever a child cries they offer it the breast again, although ten minutes may not have elapsed since its preceding repast. Nothing can be more injurious than this custom. It overloads and oppresses the stomach, - excites griping and bowel-complaints, restlessness and fever, - and not unfrequently leads to fatal diseases in the brain. It does harm also by withdrawing the mother´s notice from the real source of uneasiness.

It is astonishing, indeed, with what exclusiveness of understanding eating is regarded even by intelligent parents as the grand solatium, or panacea for all the pains and troubles which afflict the young. If a child falls over a stone or bruises its leg, its cries are immediately arrested by a sugar-biscuit stuffed into its open mouth. If its temper is discomposed by the loss of a toy, it is forthwith soothed by an offer of sweetmeats, the ultimate effect of which is to excite colicky pains in its bowels, which are worse that the original evil, and for which, in their turn, it is presented with "nice peppermint drops," or some other equally pleasant antidote. Because the mouth is open when the child is crying, and the mouth leads to the stomach, parents jump to the conclusion that it is open for the purpose of being filled, and proceed to cram it accordingly; forgetting all the while that the mouth leads also to the windpipe, and may be open for the admission of air the lungs as well as of food to the stomach, and that if they stuff it with cake or pudding when it is open only for the reception of air, they run the risk of suffocating the little innocent when their only wish is to sooth him. Everybody must have seen fits of convulsive cough induced by fragments of food being drawn into the windpipe in such circumstances.

To confound crying and the expression of pain with the cravings of hunger, is far from being a matter of indifference to the child. If food be given when it wishes only to be relieved from suffering, the offending cause is left in activity, and its effects are aggravated by the additional ill-timed distension of its stomach. But so far is this important truth from being sufficiently impressed on the minds of parents and nurses, that nothing is more common, when the infant refuses to swallow more, but still continues to cry, than to toss it in the nurse´s arms, as if on purpose tho shake down its food, and then resume the feeding. And in such attempts it is too true that the perseverance of the nurse often gets the better of the child, and forces it at last to receive the food at which it really loathes.

"Let appetite, then, be the only rule, but allow it to appear, and do not attempt to provoke it. The breast ought not to be offered to the infant; it is for him to seek it. He has little need of sucking who takes it with indifference, or as if he were conferring a favour. He who is hungry acts very differently; all his gestures express clearly the want and the desire; his eye follows his nurse, and tries to interpret her every movement. If he is crying, his cries cease at her approach, and smiles replace his tears. If he is offered the breast, he seizes it with ardour, and the mother yields to a natural want." But it is far otherwise when real appetite is wanting, and "it then becomes an act of cruel perfidy to tempt the infant to resist the temptation, when the adult, whose appetite is already satisfied at the festive board, yields to the solicitations of the host, and gorges himself with aliments which he cannot digest?" (Londe, Elemens d´Hygiéne, vol. ii., p. 161.)

The same intelligent author remarks, that the lower animals instinctively avoid this error, and, instead of offering suck too often, rather allow themselves to be strongly solicited before yielding to the wishes of their young. By this provident arrangement, the latter are protected from the evils of too frequent eating. Many mothers imagine that milk is so bland a fluid that it is impossible for an infant to take too much of it; but the fallacy of the notion is exposed when we recollect that milk is coagulated the moment it reaches the stomach, and that the real subject of digestion is curd - a substance not quite so light as milk has the appearance of being.

The grand rule, then, during the early months of infancy, is to satisfy the clearly indicated and ascertained wants of the child, but neither to confine it to regular hours, not to offer it food when it is crying solely from pain and not from hunger. When the system has become more developed, and the stomach accustomed to the exercise of its functions, regularity in the distribution of its meals may be gradually and benefically introduced; because, in the animal economy, there is a natural tendency to periodicity, which greatly facilitates the formation of proper habits.

From the sudden change attending the introduction of the infant into the world, the many new sensations which it begins to feel, and the non-secretion of milk in the mother´s breasts for some hours after delivery, it seems to have been intended by nature that both parent and child should have some time for repose before a supply of food should be required by the one or furnished by the other. But, through pure ignorance and mistanken kindness, many nurses, imagining themselves wiser than nature, and conceiving that the newly-born infant must of necessity be starving after what they consider a nine month´s fast, hasten to fill its stomach with gruel or some other food. Not unfrequently, severe indigestion is thus induced at the very outset, which, in a delicate child, may be sufficient to lay the foundation of much suffering and bad health.

On the general principle that no physical want ever exists without the means of supplying it having been provided by nature, we may safely infer that, in ordinary cases, the secretion of milk will be bedun before the infant can possibly require it; and to counteract this arrangement is to set ourselves up in direct opposition to the Creator, and to give a species of food for which the stomach is not then adapted.

It is true that, in the artificial state of society in which we live, the secretion of milk is sometimes delayed so long as to endanger the welfare of the child. In such cases, it may be necessary to give a few teaspoonfuls of fresh cow´s milk diluted with water, as a temporary substitute for its natural food; but this ought to be only when the necessity is obvious, and in very small quantity at a time, otherwise the stomach and bowels will to a certainty suffer.

One evil result of the ignorance of the animal economy which prevails in society, is an habitual distrust of, or want of faith in, the efficiency of the laws which God has appointed for the regulation of the animal functions. We cannot rest satisfied with discovering and yielding obedience to his designs, but we also must do something to assist or correct them! At birth, for example, the stomach and bowels, never having been used for the purposes of digestion, contain a quantity of mucous secretion - meconium - which requires to be removed before they can enter upon their functions. To effect this object, nature has rendered the first portions of the mother´s milk purposely watery and laxative; and, on the part of the infant, nothing further is required than to allow it to follow its natural instinct and suck it in. Nurses, however, distrusting nature, often hasten to administer castor oil or some other active purgative in preference, and the result is the excitement of irritation in the stomach and bowels, which is not always easily subdued. If the young of the lower animals were treated after the same unnatural fashion, it can scarcely be doubted that the mortality among them also would be greatly increased.

That the prevalence of over-eating is a general error in society, especially among the sedentary classes, is strongly presumable, even without direct proof, from two almost characteristic circumstances - namely, the frequency of indigestion in one or other of its numerous forms, annd the almost universal use of purgative medicines, with a view to remove from the system the superfluous materials which have been poured into it without any natural demand.

It is perfectly certain that, in the natural state of man, the bowels are quite able to act regularly without the aid of laxatives. If they are not, the Creator must have failed in accomplishing his aim - a conclusion which no rational mind can arrive at. If, on the other hand, they are intended and constituted to act without external aid, it necessarily follows that a wide departure from the order of nature must have taken place somewhere, to produce the inactivity which is now so generally complained of, especially among the middle and higher classes, and among females. On the principle we have laid down, of nourishment requiring to be proportioned to waste, it will not be difficult to explain in what this departure consists. It is in the mode of life being by far too sedentary to admit either of the natural waste, which alone renders nourishment necessary, taking place, of of that constantly-recurring contraction and relaxation of the abdominal and respiratory muscles, which have been pointed out as aiding so effectually the peristaltic motions of the intestinal canal. If, in conformity with the diminished wants of the system, we reduce the quantity of food and increase the exercise, neither the oppression of repletion nor the need of opening medicine will be felt. But if, along with diminished exhalation and diminished muscular action, we persevere in eating copiously of nutritious aliments, either digestion must fail, the system becomes too full, or some artificial stimulus be given to aid the bowels in expelling its superfluous aliment.

Such, accordingly, are the results observable in every-day life. One is saved for a time from more serious evils by his stomach becoming enfeebled, and refusing to digest the excess of nourishment which it receives. In another, whose digestion is more vigorous, the system becomes full and excited to the brink of active or inflammatory disease, a sudden attack of which hurries him to the tomb. While a third gets rid of the load by stimulating the bowels to higher action than is natural to the mode of life; in other words, artificial waste is excited by purgatives, to supply the place of that which ought to result from the active use of the bodily powers, and which alone renders a full diet proper or safe.

It is not enough, then, to sit by the fire, blame nature, and lament over our unfortunate constitution, which obliges us to make such constant use of medicine. In the great majority of instances, nature is more willing to do her part than we are to do ours, and all that she requires of us is to fulfil those conditions without which she is powerless, and we are sufferers and unhappy. If we exercise our minds and bodies in healthful occupation, and seek to inhale the pure atmosphere which God has spread around us, so as to impart that gentle impulse to the stomach and bowels which I have already described as necessary to their action, we shall have no need of laxatives to assist them. But if we choose to neglect his laws, ant to live in bodily inaction within doors, and thus deprive the bowels of all natural aid, let us at least take the blame to ourselves, and not unjustly throw it upon the Ruler whose injunctions we thus practically despise. And if, while leading this inactive life, we continue to gratify taste by eating much more than waste requires, and thus stand in need of purgatives to enable us to throw off the load, let us at least be just, and, instead of lamenting over a defective constitution, let us deplore the ignorance which has hitherto blinded us to the perception of the truth, and led us to blame a Being whose arrangements are so evidently intended for our happiness.

During the active years of childhood and youth, when a strong instinct impels to much locomotion in the open air, how rarely do we find the stimulus of purgatives necessary to the proper action of the bowels, except after errors in diet or some unusual accident! And what is it that induces imperfect activity in later years, if not the change in the habits, occupations, and mode of life? If the lively and bounding girl, whose loose and unconstrained attire admits of the freest motion and fullest respiration, passes in a few months from the exuberant and playful indulgence of her feelings, intellect, and muscular system, to the quiet and composed inaction and confined dress of a sedate young lady, who never walks out except at a measured pace to school or to church, is it really wonderful that her stomach and bowels should begin to act with less vigour, and that, in time, her constitution should be so far imparied as to render necessary the constant use of laxatives? The stomach and bowels, in fact, are regarded very much as if they were independent powers residing within us, and placed there purposely for our molestation. So many heavy charges are continually brought against them, that they can scarcely ever be found in the right. They are blamed for every act of mischief which cannot be clearly proved against another organ; and yet, influential as they are in affecting our comfort, they are treated by us with very little care or ceremony. Their powers and wishes are consulted in nothing, but their backs are loaded at the caprice of the owners, worse, as Sir F. Head observes, than any pack-horse; nevertheless, we abuse them most emphatically when they sing to the earth overwhelmed by the weight imposed on them. They are, in short, the scape-goats which must bear all our physiological delinquencies, and save us the pain of blaming ourselves. If they feel uneasy after a heavy meal, it is not we who are to blame for having eaten it. No! it is the fish which lies heavy on the stomach, or the stomach which is unfortunately at war with soup, or potatoes, or some other well-relished article. We have nothing to do with the mischief except as meek and resigned sufferers. We never eat more than enough. We never devour lobsters, or oysters, or salmon, or cheese, or any thing which esperience has told us our enfeebled stomachs cannot digest! We are too prudent and self-denying for that. And yet, somehow or another, our stomachs get hold of all these things in spite of us, and we must pay the same penalty as if we had eaten them deliberately, and with malice prepense! The case is hard, no doubt, that we cannot lead indolent and slothful lives, and yet enjoy the incompatible luxury of having the appetite of a rustic and the digestion of a tiger; - but since we are so unfortunately constituted that we must act like rational creatures or suffer the penalty, would it not be a wise proceeding to set a better watch on the stomach, and try to subject it to more effectual control?

In mature and middle age, after the effervescence and boisterous activity of youth are over, still greater caution than before becomes requisite. Growth no longer goes on, and nourishment is needed merely to supply waste; and accordingly the appetite bedomes less keen, and the power of digestion less intense. If the individual continues from habit to eat as heartily as before, even after changing to a sedentary mode of life, the natural vigour of the digestive system may enable it to withstand the excess for a time, but ultimately dyspepsy, or some form of disease dependant on indigestion, will certainly ensue. The attempt to combine the appetite and digestive power of early youth with the altered circumstances and comparative inactivity of mature age, is the true source of the multitude of bilious complaints, sick-headaches, and other analogous ailments now so common and so fashionable in civilized society; and they will never be got rid of so long as their exciting causes are allowed to operate with unrestricted freedom.

The stomach, like every other organ of the body, is, for the wisest purposes, allowed a certain range, within which it may exercise its functions without injury to health; and it is only in virtue of such a power that it can adapt itself to the different circumstances in which an individual may be placed. If every trifling change in the quantity or quality of food were to be followed by mischievous consequences, no one could retain health for a single day; and if the stomach had no power of partially adapting itself to a particular kind of aliment, every change of place and of climate must soon have been attended by the loss of health and life; because there are scarcely any two places or countries in which precisely the same food would be set before us.

According to this law of adaptation, which, of course, has its limits, the stomach may be accustomed to the reception of either a larger or a smaller quantity of food than what the necessities of the system require. If it is accustomed to too much, and less than usual be allowed, an unpleasant feeling of vacuity will arise, accompanied by a craving for more; but after a few days the unpleasant sensation will disappear, and the feeling of satisfaction be as great as if a full meal had been taken, and digestion will become more healthy and vigorous; whereas, if more food continues to be taken than what the system requires, merely go gratify the temporary craving, ultimate bad health will be the inevitable result.

This is precisely the error which is generally fallen into. The stomach is accustomed during youth to receive and digest a larger quantity of food than what is requisite to carry on growth and repair the ordinary waste of the system; and from custom. not from want, we continue to fill it as liberally after growht is completed and waste is diminished as we did before, when both were at their height. And if by any chance we eat less for a day or two, we mistake the temporary sense of emptiness for the indications of appetite, and are not satisfied till is is removed. The natural consequence is, that we educate the stomach to demand more food than the system requires, and more than it can itself continue to digest; and hence the mumerous evils which we daily witness as fruits of indigestion.

In thus punishing us with the pangs of indigestion as a warning to more reasonable conduct, Providence displays the purest beneficence. To place this in a clear point of view, let us suppose digestion to continue perfect, notwithstanding the daily reception of an excess of food into the stomach, the result would necessarily be the regular formation of an undue quantity of chyle; this, in its turn, would produce an excess of blood through the whole system; and the individual would thus exist with all his functions in a state of constant oppression, and in continual danger of the rupture of a bloodvessel, till, from mere fulness, some active disease would be excited, requiring the instant and vigorous use of the lancet for its relief, or very probably cutting short life. If, then, man cannot restrain his appetites, and effectually subject them to the control of reason, another check against continued aberration is required; and, fortunately for us, it is to be found in the refusal of the stomach to continue to digest much more than the quantity demanded by the wants of the body- In practical life we meet, in fact, with both results. There are some persons constituted with such vigorous powers of digestion, that no quantity of food oppresses their stomachs. If they eat habitually more than what is required to supply waste and sustain the system, they speedily suffer from repletion, or some one or other of the diseases arising out of its existence, such as inflammation, apoplexy, rupture of bloodvessels, enlargement of the heart, or morbid growth in some organ of the body. In the greater number, however, of those who exceed in quantity, the stomach itself becomes enfeebled by the overexertion to which it is subjected, just as the muscles do from excess of labour; and the consequence is impaired digestion, which prevents the food from being duly converted into chyle, and thus protects the system from the fulness which would otherwise be induced. Accordingly, it is a familiar truth, that those who eat most are not always the best nourished - and that, on the contrary, the stoutest men are often those who eat comparatively little.

It is therefore of great importance to be able to read aright the instructions of nature, and to act in conformity with their meaning. In practical benefit to ourselves it will make a great difference whether we regard indigestion as merely an accidental and capricious occurence, unconnected with conduct, or as purposely meant to warn us from continuing to act against laws instituted to secure our well-being and happiness. In the former case, we may go on unsuspectingly in the road of destruction till it is no longer in our power to turn back; whereas, in the latter, we cannot feel a single pang of indigestion without being reminded of some aberration from the path of duty, and seeking to return by the shortest way. It is too true that, even when aware that we are going wrong, we do not always choose to retrace our steps; but it is not less true that we shall be more likely to fulfil the laws of nature when we are made acquainted with their existence and intention, than when left to the guidance of ignorance alone. It must be observed, also, that hitherto mankind have not been taught the requisite knowledge till after their habits of action were formed; and therefore no inference can be drawn from their conduct in circumstances so unpropitious, which can with any fairness be held as applicable to the time when knowledge shall be communicated to the young as an indispensable part of a useful education.

If over-feeding be the prevailing error among the middle and higher classes of the community, the opposite condition is as unquestionably that of a large proportion of the labouring poor. Pressed upon all sides by the powerful competition both of constantly improving machinery and of a superabundant population, the manual labourer is impelled to undergo an amount of ever-recurring bodily exertion which far exceeds the natural powers of his constitution, even when supported by the fullest supply of nourishment; and when, as often happens along wiht this excess of labour, his food, from inadequate wages, the size of his family, or his own injudicious management, is defective in quantity or in quality, the consequenses to his health and happiness are disastrous in the highest degree.

To those who have never reflected on the subject, it may seem like exaggeration to say that, as a general fact, at least nine tenths of the lower orders suffer physically, morally, and intellectually, from being over-worked and under-fed; and yet I am convinced that the more the subject shall be investigated, the more deeply shall we become impressed with the truth and importance of the statement. It is true that very few persons die from actual want of food; but it is not less certain that thousands upon thousands are annually cut off, whose lives have been greatly shortened by excess of labour and deficiency of nourishment. It is a rare thing for a hard-working artisan to arrive at a good old age. They almost all become prematurely old, and die off long before he natural term fo life. It is in this way that, as remarked by Dr. Southwood Smith, the mortality of a country may be considered as an accurate indication of the misery of its inhabitants. According to Villermé, the rate of mortality among the poor is sometimes double that among the rich. Thus it is found, he says, that in a poor district in France, on hundred die, while in a rich department only fifty are carried off; and that, on taking into account the whole population of France, a child born to parents in easy circumstances has the chance of living forty-two and a half years, while one born of poor parents can look for no more than thirty.

These are striking facts, and their truth is confirmed by every day´s experience in Britain as well as in France. Many causes concur to produce this melancholy result, but among the principal is unquestionably the disproportion so generally existing between toil and nutrition. In the army, the operation of the same principle has long been recognised in the inferior strength and health of the privates compared with the officers. The officers, being better fed, bether clothed, and better lodged than the common soilders, bear up successfully against fatigue and temporary privations byt which the latter are overwhelmed. During epidemics, too, the poor, from their impaired stamina, almost invariably become victims in a proportion far exceeding that the more wealthy classes. This is, no doubt, partly owing to their greater intemperance and want of cleanliness; but even these vices ofter derive their origin from the same root - the want of adequate repose and comfortable sustenance.

The bad consequences of defective nourishment are not confined in their operation to the bodily constitution of the labouring poor. Their minds also are deteriorated. The pressure of poverty in unfavourable to the growth of refinement and morality, and crime and turbulence are never so much to be dreaded as during times of scarcity and manufacturing or agricultural distress. Bodily health, satisfied appetite, and peace of mind, are great promotors of individual morality and public tranquility; and whenever these are encroached upon in any great class of the community, discontent and crime are sure to follow. In legislation this principle is seldom attended to, and laws are consequently enacted merely for the suppression of the result, while the source from which it springs is left altogether unnoticed and in the fulest activity.

Among the poorer classes, the children as well as the parents suffer much both physically and morally from insufficient food. Their diet, being chiefly of a vegetable nature, and consisting of porridge, potatoes, and soups, with very little butcher-meat, proves far from adequate to carry on vigorous growht in the one, ore repair waste in the other; hence arise in the young an imperfect development of the bodily organization, a corresponding deficiency of mental power, and a diminished capability fo resisting the causes of disease. In work-houses and other charitable institutions, ample evidence of these deficiencies obtrudes itself upon our notice, in the weak and stunted forms and very moderate capacities of the children. Under an empoverished diet, indeed, the moral and intellectual capacity is deteriorated as certainly as the bodily; and a full exposition of this fact, and the principles on which it is founded, would be a great public benefit.

Even among the children of the wealthier classes, a sufficiency of nourishing food is not always provided wht the care which it deserves. Both in families and in boarding-schools, it is no uncommon practice to stint the healthy appetites of the young, or to feed the with soups and other eatables which contain too little nutriment in proportion to their bulk. I am acquainted with many instances of this most injudicious error, and ahve seen scrofula and severe digestive affections brought on by persevering in it throug sheer ignorance, and even in belief that such "temperance" was healthful. Where adequate exercise is permitted, and the food is plain and nourishing, hurtful excess in eating will rarely occur, at least in healthy children.


Endoscopy Slide-Shows


Endoscopy Slide-Shows


October 4, 2015