Undernutrition

“ Leslie Mackenzie, "is to promote deterioration of physique by exhausting the nervous system. Education of the underfed is a positive evil." What doctors understand by malnutrition is what the plain man calls starvation; and while it is, of course, due to other causes besides actual inability to procure sufficient food, the experience of those authorities which have undertaken the provision of meals in a thorough and systematic manner suggests that these statements as to the prevalence of malnutrition or starvation are by no means exaggerations. ”

“ Granted, then, that the general health of the nation is far from what it should be, and looking from effects to causes, may we not pertinently enquire whether our diet is not largely responsible for this state of things? May it not be that wrong feeding and mal-nutrition are at the root of most disease? It needs no demonstrating that man's health is directly dependent upon what he eats, yet how few possess even the most elementary conception of the principles of nutrition in relation to health? ”

“ Milk is not an ideal food for the sick, too large a quantity being required, and the large curds it forms in the stomach often rendering digestion difficult. Boiled with rice it forms an excellent diet.
In acute diseases lasting from four to six weeks no great effort should be made at forced feeding. Thin soups, flooding the stomach with unnutritious fluids, should be avoided. It is unnatural to take food [Pg 169] during physical or mental suffering. Appetite is wanting, and imperfect assimilation adds to the physician’s worries and the patient’s discomforts. ”

“ This condition is not necessarily caused by an insufficient amount of proper food, for the condition has been found more prevalent among the children of the wealthy than among those of the poorer classes. This shows that the cause for such malnutrition is within the child and not in the food that he is eating. In the large majority of cases it is either because the food is not being properly digested or is not being assimilated after it has been digested. It is quite necessary that there be a properly balanced diet, but even a perfectly balanced diet will not guarantee perfect assimilation. ”

“ The character of the disease also has much to do with the preliminary diet. In certain pathological conditions involving the gastro-intestinal tract, for example, the patient comes to the surgeon after medical treatment has failed to give relief and surgical intervention is necessary to save life. The body is found to be in a condition bordering on starvation, anemic and exhausted from insufficient nourishment. The functions of the blood-making organs have become out of gear, as it were, and the blood consequently is deficient in one or more of its essential elements. ”

“ Relapse.—One danger which the nurse must always be on the lookout for is the relapse into the acute stage. The diet is the chief treatment. In acute gastro-intestinal disturbances rest from food is essential for at least twenty-four hours. Some infants can easily endure starvation for this short period. However, when malnutrition has already been established, it is not wise to carry out the starvation treatment over-long. A cautious return to a normal diet may be made as soon as acute symptoms disappear. ”

“ But babies of people in moderate circumstances, and even of wealthy parentage, are at times badly nourished, and require the same exacting care, the same attention to the food, the fresh air, and the sunshine that the poorer babies need in order to survive. Malnutrition may be the result of insufficient food, and it may also be due to the lack of one definite food element. Again, it may be brought on by some deformity of the mouth or stomach, which make it impossible for the baby to get all the food which he requires for his maintenance and growth. ”

“ The more I study the question of nutrition in disease at the bedside of acute illness the more am I unable to comprehend the logic of giving the sick, and especially the very sick, a form of food that even in the most vigorous health cannot be borne, even for a single day, without a lowering of vital power; nay, that where even one meal of it cannot be put into the stomach of hunger without a clearly perceptible loss of power. ”

“ Diminished bodily activity and the fact that growth has ceased, render a smaller amount of food necessary to supply needs; and a decrease in the amount taken, in proportion to the age and the activity of the subject, must be made or health will suffer. The system will become clogged, the blood filled with imperfectly elaborated material, and gout, rheumatism, apoplexy, or other diseased conditions will be the inevitable result. The digestion of heavy meals is a tax upon vital powers at any time of life, but particularly so as age advances ”

“ Food in its preparation has long been subordinated to the sense of taste, and, ingested in excess of the amount required to make good the losses incurred through physical and mental activity, has entailed much unnecessary labor upon the processes of digestion and disposal of waste. Because of almost universal violation of the natural law of nutrition in respect to overeating, this vice, apparent though it be, and weakening and distressing in its effects as it is, calls for correction as does no other in the long list of offenses against nature. ”

“ I am now prepared to challenge all contradiction to the fact that the diet has been not only short of what it ought to be by the prescribed dietary, but, in the case of the bread, it has frequently been unfit for human food—such as very old or very young people could only touch under the pressure of famine, and could not, under any circumstances, sustain health upon. ”

“ My opinion, on the other hand, after a long experience, during which time my eyes have not been shut, is that the large majority of the diseases of humanity are due to mal-nutrition and that the form of that mal-nutrition is over-feeding—not under-feeding. This opinion should be taken for what it is worth. But to test it we should ask ourselves: What is the reason for the necessity to take food into the body? Is it to give strength and heat to the body? Or is it to restore the waste of the body sustained by the action on it of the force of life or zoo-dynamic which inhabits it? ”

“ They teach that when people are ill there is much waste, which is true, and that for this reason it is necessary to partake of a generous amount of nourishing food, so they give milk, broth, meat, toast and other foods, together with stimulants. Feeding during illness would be all right if the body could take care of the food, which it can not. In all severe diseases digestion is almost or quite at a standstill and the food given under the circumstances decomposes in the alimentary tract and furnishes additional poison for the system to excrete. ”

“ Causes.—Errors in diet, overwork, over-exercise, heredity, nervousness, worry, malformation of the mouth, throat, or stomach, heredity and certain pathological conditions, such as typhoid fever, tuberculosis, anemia, dysentery, etc., in which the breaking down of the tissues occurs more rapidly than they can be rebuilt.
Children are often emaciated on account of their unbalanced diet. They receive an insufficient amount of building food to cover their growth and development requirements. ”

“ The chief error in rearing the young is overfeeding; and a most serious one it is; but which may be easily avoided by the parent pursuing a systematic plan with regard to the hours of feeding, and then only yielding to the indications of appetite, and administering the food slowly, in small quantities at a time. This is the only way effectually to prevent indigestion, and bowel complaints, and the irritable condition of the nervous system, so common in infancy, and secure to the infant healthy nutrition, and consequent strength of constitution. ”

“ Among the operative part of the community we meet with innumerable examples of an opposite condition of the system, where, from excess of labour, a greater expenditure of energy and substance takes place than what [31] their deficient diet is able to repair. It is true that the disproportion is generally not sufficient to cause that immediate wasting which accompanies actual starvation, but its effects are nevertheless very palpably manifest in the depressed buoyancy, early old age, and shorter lives of the labouring classes. ”

“ Sir Andrew Clark, Grailly Hewett, Clifford Allbutt, and others, who have described the ailments which follow inadequate alimentation, have especially urged the necessity for greater attention to the question of diet in the bringing up of families.
The underfed constitute so considerable a class that a large part of medical practice is devoted to attempts at satisfying their importunate demands for “something which shall make them feel better.” To attack with drugs symptoms which are daily regenerated by starvation is labour in vain, so long as that condition is permitted to exist. ”

“ Following on the trail of indigestion and intestinal trouble come anemia and malnutrition. The anemic child, suffering with malnutrition, as the result of improper feeding, loses weight steadily, has vomiting and diarrhea, sleeps badly, is listless and pallid. ”

“ When we add to these conditions of human existence the influence of imperfect feeding and malnutrition, we get the state of physical degeneracy largely increased and emphasized. In the paper alluded to great stress was laid upon the diet of the town-dweller, as compared with that of the countryman, as tending to degeneracy and impaired health. ”

“ Due to disease, hunger was absent in the pregnant women, but a supply of nourishment sufficient to maintain the body of the mother and to build that of the forming child existed within and was utilized until natural hunger returned at the completion of the fast. This stored nourishment is always present in tissue structure; it is the factor of safety in physical economy, and it is eliminated only at the time when in the fast complete purification of the system has occurred and hunger is asserted. ”

“ That life was shortened by the more rapid loss of the tissues from the disease is to be taken into account in estimating time in starvation.{42}
IV.
Feeding the sick! Who that rule in kitchens and feed the well do not realize with weariness of brain the demands of the stomach that at each meal there shall be some change in the bill of fare?
The chief reliance of physicians for the maintenance of strength while sick bodies are being cured is milk. As a food, milk was mainly destined for the calf, and not for man—certainly not after the coming of the molars. ”

“ The reasons for much of the undernourishment among people in this country to-day are to be found in certain widespread misconceptions of long standing as to what constitutes a state of good nutrition or malnutrition and the value and purposes of different foodstuffs. For malnutrition does not necessarily describe a simple condition due to an insufficient amount of food, but to any one of several complex conditions due to a lack in the food of one or more essential substances. ”

“ As a rule their skin presents evidences of the need of proper diet, for it looks unhealthy and is often covered with boils. But apart from these cases, which so plainly indicate the origin of the poor condition of the blood, there are many instances in which, from the want of vegetable food and fruit, the system becomes greatly deranged. moreover, what is known as the blood being "out of order" is mostly due to an unsuitable diet, consisting of animal food in excess, and a corresponding deficiency of the other essentials. ”

“ Parents are often to blame for allowing the child to overeat of some of the food constituents at the expense of others. Sugar, for example, is very necessary in the diet of a growing active child, but all sugar and very little milk and eggs [Pg 448] will lead to an unbalanced diet which may bring about a condition of extreme thinness later on.
In Adults the constant eating of the wrong foods, overworking and persistent worrying, all contribute to the breaking down of the tissues which ends in emaciation. ”

“ Thus, if the diet be deficient in the bone-earths, the bones—as they do in badly-nourished children—become soft and yielding; if the diet is too exclusively composed of such farinaceous articles as rice, potatoes, &c., or with too much fat, it is incapable of yielding the elements of muscular flesh, and the strength declines; if vegetable food is wanting, scurvy is the result. Here, then, we have the first element of Physical Training: the real supply of nourishment calculated to afford every material required by the body. ”

“ Medical authors assert that food has a most important bearing in the production of corpulence. They forbid the use of meat, and recommend watery vegetables, such as spinage, sorrel, salad, fruit, &c., and for beverage water; and at the same time they direct the patient to eat as little as possible. These instructions, like too many others, are given because they are asked, and that in every disease, curable or incurable, the physician is bound to offer some advice. Medical men themselves put no faith in them, since they pronounce obesity to be incurable. ”

“ The more the labour of digestion is economised, the more energy is left for the purposes of growth and action. The functions of the stomach and intestines cannot be performed without a large supply of blood and nervous power; and in the comparative lassitude that follows a hearty meal, every adult has proof that this supply of blood and nervous power is at the expense of the system at large. If the requisite nutriment is obtained from a great quantity of innutritious food, more work is entailed on the viscera than when it is obtained from a moderate quantity of nutritious food. ”

“ A child may, with the one exception that he is fed on a pappy, super-saccharide diet, be brought up under ideal health conditions. He may live in the heart of a dry, open country, far from the darkness, dust, and tainted atmosphere of the town, sleep with the windows open all night, live out of doors all day, be fed on the most nourishing (too nourishing, it may be) food, be clothed after the most approved methods, and yet, in spite of all this, we may find his naso-pharynx packed with adenoids. ”