Effects of Excess.—The evil effects that follow the continued use of alcoholic stimulants in excess are so well known as hardly to need mention. Digestion becomes seriously disordered; there are all the symptoms of chronic gastric catarrh, with usually morning vomiting.

The heart is weak and the circulation feeble. Fatty degeneration and fibroid contraction of different organs are found in the later stages. The mental faculties are greatly impaired. The will is weak, and the impulses are uncertain. All this may take place without the individual ever taking enough at a time to make him intoxicated, or being, in the ordinary sense of the term, a drunkard. Occasional excess

in alcohol does not produce such marked effects, as the system has time to recover itself between the bouts.

Alcohol with Food. It has been already said that alcohol is not necessary to persons in perfect health, but to those who are of more feeble habit of body, with slow or imperfect digestive power, alcohol in limited amount is certainly often of use. It should, however, never be taken by such persons early in the day, or at any time as a stimulant to work upon, and it should be taken with or just after food, not upon an empty stomach. This is a good general rule; but it must be admitted that the local action of a very small quantity of alcohol upon the nerves of taste and upon the stomach may occasionally be applied with advantage at the beginning of a meal by those persons who, after some unusual fatigue, feel too tired to eat. sip of wine or of dilute spirits and water at the commencement of the meal sometimes makes all the difference to the food being enjoyed and digested. The habitual use of such appetisers as sherry-and-bitters before dinner cannot, however, even on this ground, be recommended. Persons of unstable nervous system should avoid alcohol altogether. The value of alcoholic beverages in acute disease has already been discussed (p. 141). Some other points may here be summarised.

A

Summary.-A small or moderate amount of alcohol is useful in all cases where the action of the heart is weak. This may occur either in the later years of life, or during convalescence from some acute illness, as well as during the course of acute disease, when there are signs of heart failure. The stimulant will, in these circumstances, help to sustain life, and so tide over a time of danger; and it is besides useful in so far as it increases appetite and aids the digestion of food. Alcohol without food is decidedly dangerous, and life cannot be continued for any length of time upon it alone.

CHAPTER XIX.

PREPARED AND PREDIGESTED FOODS.

GENERAL CONTENTS: Malted Farinaceous Foods-Predigested FoodsNutrient Enemata.

PREPARED AND PREDIGESTED FOODS.

SOME patients have difficulty in digesting starch, and in those cases where this defect exists the addition of malt to the farinaceous substance is very useful, partly on account of the nutritive qualities of the malt itself, but mainly because of the diastase and the action which that principle has in converting starch into dextrine and sugar.

Use of Malt.-Malt may be employed either in powder or in the form of an extract, and may be added to farinaceous foods, such as milk-pudding, just before they come to the table, and after they have cooled down to the temperature at which they can comfortably be eaten. If the malt extract be added while the temperature of the food is still high, the effect is lost, as the activity of the diastase is stopped by the heat. The malt may also, if preferred, be taken along with the food or immediately after it, but is comparatively useless if taken some considerable time after the food. Of prepared foods containing malt in combination with farinaceous substances, many varieties are now sold.

Prepared Foods. Many preparations usually named "foods for invalids and infants," and of which the basis is baked flour of some sort, with malt, and with or without dried milk, can be obtained. While these foods hold a

useful place in the dietaries of the two classes for whom they are intended, they are, it is to be feared, too often used as substitutes for, instead of adjuncts to, milk. Those foods that contain milk have, of course, the higher nutritive value, and those containing sugar and malt are most valuable as additions to milk. Without milk and sugar, they form by themselves a very insufficient food, but they may be added to broths or beef-tea, and given as useful alternatives to milk.

The predigestion of starch by heat was recognised before the introduction of prepared farinaceous foods, as is seen in the use of "tops and bottoms" for infants' food. A further great advance was made by the addition of malt to these foods, and a typical one early introduced is "Liebig's food for infants and invalids," containing malt powder, milk, baked wheaten flour, and saline matter. Another is that prepared by Messrs. Allen, Hanburys, & Co., of which they give the following analysis.

Analysis of Allen & Hanburys' Food.-One pound of malted food contains:

:

For one part of flesh-formers there are six parts of heatproducers, reckoned as starch.

Kepler's Extract of Malt.-A reliable form is the Kepler extract of malt. A small teaspoonful added to a farinaceous pudding or a plate of oatmeal porridge so acts upon the starch that in a comparatively few minutes liquefaction. takes place. When symptoms of mal-nutrition are present,

and especially when there is reason to believe that the system has difficulty in dealing with amylaceous substances, the malt extract should be given a fair trial.

Predigestion of Foods.-Predigestion of food is necessary in cases where the digestive powers are so enfeebled that suitable food in ordinary forms cannot be digested. In such circumstances predigested foods are undoubtedly useful. In functional disorders they are of doubtful value, and they should not be resorted to until ordinary means have been tried and have failed.

In organic diseases of the stomach and bowels they are very valuable, but they are useless, if not injurious, where it is the secondary digestive processes that are at fault. So much for the digestion of starch.

Pepsin and Pancreatic Ferments. Next come pepsin and the pancreatic ferments. Pepsin being the active principle of the gastric juice, retains its activity only in the presence of an acid; hence the addition of a little dilute hydrochloric acid frequently aids the action of pepsin. Pepsin should be given at or just after those meals at which animal food is taken, since it acts upon albuminoids, and not upon farinaceous substances, nor upon fats. Pepsin is useful in cases of weak digestion; for example, in the aged, or in persons recovering from acute diseases. It may be used in the form of powders or tabloids, which are very convenient, or in the liquid form. Of the last named, a useful combination is the acid glycerine of pepsin.

Pepsin with dilute hydrochloric acid may be used to predigest proteid foods, but it is found more convenient in practice to employ liquor pancreaticus, and to Sir William Roberts we are indebted for much valuable information of a practical sort as to its use. The pancreatic fluid extract acts in an alkaline medium only, and to meet this Sir William Roberts, in his experiments, combined an alkali with liquor pancreaticus, and gave the extracts some time after a meal, gastric acidity being then considerably reduced.