,transcriber's ,note ,the three diagrams in the text have been rendered approximately using ,,ascii art4 ,the tilde 77 symbol has been used to indicate bold text4 ,subscripted numbers are indicated by an underscore 771 with the subscripted item enclosed in braces 7x74 ,the single superscript number is indicated with a carat 774 ,with the large number of tables1 lists and diagrams in this text1 it is recommended that it is viewed using a monospaced font1 such as ,courier1 and that the text is not rewrapped4 ,table #d in the ,appendix was very wide1 and has been split into two pieces by page4 ,,the ,,macmillan ,,company ,,new ,,york 4 ,,boston 4 ,,chicago 4 ,,dallas ,,atlanta 4 ,,san ,,francisco ,,macmillan ,,co41 ,,limited ,,london 4 ,,bombay 4 ,,calcutta ,,melbourne ,,the ,,macmillan ,,co4 ,,of ,,canada1 ,,ltd4 ,,toronto ,,dietetics ,,for ,,nurses ,,by ,,fairfax ,t4 ,,proudfit ,,instructor ,,and ,,clinical ,,dietitian1 ,,memphis ,,general ,,hospital1 ,,and ,,st4 ,,joseph',s ,,hospital1 ,,consulting ,,dietitian1 ,,memphis ,,associated ,,charities1 ,,and ,,public ,,health ,,nursing ,,association1 ,,memphis1 ,,tennessee ,,second ,,edition ,completely ,revised ,,new ,,york ,,the ,,macmillan ,,company #aibc ,all rights reserved ,,printed ,,in ,,the ,,united ,,states ,,of ,,america ,,copyright1 #aiah ,,and #aibb1 ,,by ,,the ,,macmillan ,,company4 ,set up and electrotyped4 ,published ,november1 #aiah ,second ,edition completely revised and reset ,published1 ,july1 #aibb ,press of ,j4 ,j4 ,little ,ives ,company ,new ,york1 ,u4 ,s4 ,a4 ,dedicated to the ,great ,army of ,nurses in the ,service ,,preface ,,to ,,second ,,revised ,,edition ,the old order of things is passing4 ,the keynote of to-day's work is prevention1 rather than cure1 children are taught to eat correctly that they may grow into the strong1 healthy men and women which are needed to make any nation great4 ,this instilling of good health habits must rest upon the nurse1 the nutrition worker1 the physician and the home-maker4 ,close cooeperation is necessary among these workers and a definite understanding of the way to accomplish the best results1 in this respect1 must come from the training of those who are undertaking this all important work4 ,the present revision of this text is the outgrowth of several years of close attention to the progress1 changes and adjustments which are being made daily in this important subject of nutrition4 ,the changes made in this revised edition are all in the line of constructive teaching4 ,the material has been reorganized that no time may be lost in a search for the proper word to illustrate a definite point4 ,the method of project teaching used in this edition1 is not a new one1 although the name may possibly be unfamiliar to some4 ,every good teacher recognizes the value of motivation as a means of getting an idea across4 ,the revision of this text was undertaken with the idea of leading the student to think for herself and to put into practice the scientific facts learned in class room and ward4 ,the author is indebted to many of her colleagues for the encouragement and constructive criticism which enabled her to make the changes which will1 it is hoped and believed1 materially aid the student nurse in the study of ,dietetics4 ,she also wishes to express her appreciation for the many helpful suggestions made by her co-workers in this respect1 especially to ,misses ,l4 ,h4 ,gillett and ,l4 ,willson for valuable criticism and to ,miss ,h4 ,buquo for assistance in the preparation of the manuscript4 ,f4 ,t4 ,p4 ,,preface ,,to ,,first ,,edition ,no other science has so much to do with the general welfare of mankind as the study of food and its effects in the human body4 ,when we use the term dietetics as representing the effect of the food in the human body1 we do so in a very broad sense1 for the subject is a big one1 requiring comprehensive terms to express it4 ,the problems of nutrition are many4 ,food alone is no small subject and a still greater one is the utilization of food materials in such a way that the body may gain the greatest value with the least expenditure of vital forces4 ,these problems are discussed in this text and the methods of overcoming them are given in the simplest possible language4 ,for this purpose the subject of nutrition has been divided into groups3 7#a7 a comprehensive study of the sources of food1 its composition and nutritive value2 7#b7 the effect of food in the body under normal conditions1 as in health2 and 7#c7 its behavior and effect when conditions in the body become abnormal1 as in disease4 ,in this way much of the non-essential material is eliminated from the course of study and only that included which it is necessary for the nurse to understand and which she will constantly use both in the hospital and later on in the practice of her profession4 ,the simple methods of study presented in this text are given with the idea of avoiding confusion in the mind of the average pupil nurse by fitting in the course with her other studies rather than by making it stand out as a separate subject4 ,in this way she will be able to see at a glance the connection between the body processes and the materials which are used to carry them on4 ,thus her study of physiology1 anatomy and bacteriology go hand in hand with that of dietetics1 each bearing a distinct relationship to the others4 ,,contents ,,section ,i ,,food ,,and ,,its ,,significance ,,chapter ,,page ,i ,,food #a ,,ii ,,fuel ,,value ,,of ,,food #cf ,,iii ,,food ,,requirements ,,of ,,the ,,body #db ,,section ,,ii ,,laboratory ,,or ,,diet ,,kitchen ,,work ,,iv ,,methods ,,of ,,feeding ,,in ,,normal ,,and ,,abnormal ,,conditions #ei ,v ,,food ,,materials ,,and ,,their ,,preparation #ha ,,vi ,,infant ,,foods ,,and ,,formulas ,,used ,,in ,,abnormal ,,conditions #adj ,,section ,,iii ,,the ,,human ,,machine ,,vii ,,the ,,human ,,body #afe ,,section ,,iv ,,dieto-,,therapy ,,viii ,,pregnancy ,,and ,,lactation #aia ,,ix ,,infant ,,feeding #aii ,x ,,care ,,and ,,feeding ,,of ,,children ,,in ,,normal ,,and ,,abnormal ,,conditions ,,and ,,in ,,infectious ,,diseases #bca ,,xi ,,feeding ,,of ,,adults ,,in ,,diseases ,,of ,,the ,,gastro-,,intestinal ,,tract #bde ,,xii ,,diseases ,,of ,,the ,,intestinal ,,tract #bfc ,,xiii ,,fevers ,,in ,,general #bha ,,xiv ,,typhoid ,,fever #bhh ,,xv ,,diseases ,,of ,,the ,,respiratory ,,tract #cja ,,xvi ,,dietetic ,,treatment ,,before ,,and ,,after ,,operation #cab ,,xvii ,,urinalysis #cbc ,,xviii ,,acute ,,and ,,chronic ,,nephritis #ccf ,,xix ,,diseases ,,of ,,the ,,heart #cfe ,,xx ,,diabetes ,,mellitus #cgb ,,xxi ,,diseases ,,of ,,the ,,liver #djd ,,xxii ,,gout1 ,,obesity ,,and ,,emaciation #dah ,,xxiii ,,other ,,conditions ,,affected ,,by ,,diet #dea ,,appendix ,table ,i4 ,edible ,organic ,nutrients and ,fuel ,values of ,foods #dfa ,table ,,ii4 ,ash ,constituents of ,foods in ,percentage of the ,edible ,portion #dgb ,table ,,iii4 ,showing #ajj-;,calorie ,portions of some ,common ,foods1 ,together with ,their ,protein1 ,nitrogen1 and ,mineral ,content #dgh ,table ,,iv4 ,composition and ,fuel ,value of most of the ,foods used in the ,invalid ,dietary #dhd ,table ,v4 ,vitamines in ,foods #dif ,heights and ,weights for ,children under ,five ,years of ,age #dii ,height and ,weight ,table for ,boys #ejj ,height and ,weight ,table for ,girls #eja ,pelidisi ,chart #ejb ,the ,nutritional ,index--,the ,pelidisi #ejc ,index #eje ,,section ,i ,,food ,,and ,,its ,,significance ,,preliminary ,,course ,,of ,,lectures ,,and ,,laboratory ,,work ,,chapter ,i ,,food ,the value of a knowledge of food and its effect in the human body cannot be overestimated4 ,in health1 this knowledge leads to higher standards1 since by pointing out the errors in one's mode of living1 good health habits may be established1 which will1 undoubtedly assure the individual of a better nourished and a more vigorous body4 ,there is no question as to the value of health either from the standpoint of comfort or of economy4 ,and the knowledge which will enable one to spread the good work intelligently cannot but raise the standards of living throughout the entire community4 ,in taking up the study of dietetics1 the student is introduced to some of the fundamental principles governing the health and well-being of a people1 since dietetics includes a study of food and its relation to the body4 ,the relationship between right food and good health is very close2 how close is being demonstrated constantly in experimental fields of scientific research4 ,to be able to judge whether the food one eats daily is giving the best possible value from a physiological and economic standpoint1 requires a definite knowledge of food1 its source1 composition and nutrient value1 as well as its relation to the body in health and disease4 ,no one is capable of giving constructive advice upon matters pertaining to diet1 unless he has acquired this knowledge through training4 ,a nurse should obtain this training during her course in the hospital1 through the class room1 the wards and the diet kitchen4 ,the dividing line between health and disease is frequently almost imperceptible1 and without a knowledge of the normal body1 it is1 at times1 impossible to tell where the normal leaves off and the abnormal begins4 ,for this reason a nurse must understand normal nutrition1 that is1 the behavior of food in the healthy body1 before undertaking the task of ministering to the body attacked by disease4 ,in a text of this kind1 it is impossible to cover all phases of the subject1 especially since day by day new discoveries are being made with relation to food and its uses in the body4 ,but with careful attention to the principles set forth1 a nurse should be able to carry out the dietary orders given her by the physician and dietitian in the hospital4 ,and1 when her course of training is finished1 she should find herself equipped to assist in raising the standard of health through her knowledge of dietetics4 ,with this brief summary of the aims and object of the study of dietetics1 we will begin the actual work with a study of ,food4 ,food ,materials4--,food is the name given to any substance which1 taken into the body1 is capable of performing one or more of the following functions3 #a4 ,building and repairing tissue1 maintenance1 growth1 and development of the muscles1 bones1 nerves1 and the blood4 #b4 ,furnishing the energy for the internal and external work of the body4 #c4 ,regulating the body processes1 maintaining the proper alkalinity and acidity of the various fluids throughout the body1 regulating the proper degree of temperature1 and determining the osmotic pressure1 etc4 ,for the convenience of study scientists have arranged the foodstuffs in groups3 #a4 ,according to type2 #b4 ,according to their chemical composition2 #c4 ,according to the function they perform in the body4 ,all foods are composed of certain chemical elements2 namely1 carbon1 oxygen1 hydrogen1 nitrogen1 sulphur1 phosphorus1 iron1 magnesium1 potassium1 chlorine1 sodium1 calcium1 with traces of various others4 ,the manner in which these elements are combined and the amounts in which they occur determine the group to which the combination belongs1 and give to the foodstuff its characteristic position in human nutrition4 ,,composition ,,of ,,the ,,foodstuffs ,the chemical elements are combined in food and in the body1 as3 7a7 carbohydrates1 composed of carbon1 oxygen and hydrogen2 7b7 fats1 composed of carbon1 oxygen and hydrogen2 7c7 proteins1 composed of carbon1 oxygen1 hydrogen1 nitrogen and sulphur2 7d7 water1 composed of hydrogen and oxygen2 7e7 mineral salts4 ,the first three foodstuffs constitute the ,organic ,food group4 ,the last two include the remaining chemical elements1 calcium1 phosphorus1 sodium1 potassium1 chlorine1 magnesium1 iron and traces of others which make up the ,inorganic ,food group4 ,each of the foodstuffs belonging to the organic group is capable of being burned in the body to produce heat for3 7a7 the maintenance of the body temperature2 7b7 internal and external work4 ,neither water nor mineral salts alone can be burned to produce heat2 nevertheless1 they enter into the composition and take part in every function performed by the carbohydrates1 fats and proteins2 therefore one foodstuff cannot be said to be of greater importance than another1 since the needs of nature are best met by a judicious combination of all4 ,however1 the wear and tear of life can be more efficiently accounted for1 and the strain upon the organism reduced more nearly to a minimum when the various foodstuffs are furnished in amounts which science is proving to be necessary for the health and well-being of the organism4 ,the sixth essential food substance1 the ,vitamines1 together with the adjustment of the five foodstuffs just mentioned--the amounts and types of each in the dietary which will assure the body of the best results--has been1 and still is a subject of grave interest4 ,even on the most perfect adjustment of these foodstuffs1 the diet would fail to give the desired results without the inclusion of the sixth1 or vitamine factor1 which has proved to be essential for the growth and development of the normal body1 as well as for its protection against certain deficiency diseases4 ,in order to obtain the best results from food1 both from a health and an economic standpoint1 it is necessary to become familiar with the foodstuffs as they are combined to make up the various common food materials4 ,one foodstuff may be a producer of heat1 but may lack certain chemical elements which are essential to the building of tissues2 another may be able to accomplish both functions in the body1 but will prove too expensive to use as fuel1 except when it is absolutely necessary to do so4 ,thus1 it is essential for the nurse to understand where and how both the foodstuffs and the vitamines occur in nature1 in order to make use of them more advantageously4 ,the following table gives the sources of the foodstuffs1 after which a description of the individual foodstuffs and vitamine factors will serve to point the way to their use in the dietary3 ,milk1 cheese 7especially skim milk cheese74 ,eggs4 ,meat 7lean meat in particular74 ,poultry1 game4 ,fish4 ,proteins ,cereals1 corn1 wheat1 rye1 oats1 etc4 ,bread and breadstuffs 7crackers1 pastry1 macaroni1 cake74 ,beans1 peas1 lentils4 ,cotton seed4 ,nuts4 ,gelatin4 ,wheat products 7bread1 cake1 crackers1 pastry1 macaroni1 spaghetti74 ,cereal grains1 breakfast foods4 ,corn products1 corn meal1 green corn4 ,rice1 sago1 tapioca1 taro4 ,potatoes 7white and sweet74 ,carbohydrates ,starchy fruits 7bananas74 ,sweet fruits 7oranges1 grapes1 pineapples74 ,dried fruits 7prunes1 dates1 raisins1 currants74 ,sugar cane1 sorghum cane4 ,sugar beets1 sugar maples4 ,products made from sugar 7candy1 jellies1 preserves1 marmalade74 ,butter1 cream1 cheese4 ,olive oil1 cotton seed oil1 peanut oil1 corn oil1 almond oil4 ,soy bean4 ,corn meal1 cotton seed meal and flour1 oatmeal4 ,fats ,pork 7bacon especially71 other fat meat4 ,codfish 7and other fatty fish74 ,eggs 7yolk74 ,cocoa1 chocolate4 ,brazil nuts1 almonds1 pecans1 and other nuts rich in fat4 ,water ,all foodstuffs except those which have been put through a drying process4 ,nitrogen 7in proteins1 meat1 eggs1 milk1 fish1 gluten of wheat1 zein of corn meal1 legumen of ,mineral salts beans1 peas1 and lentils74 7organic form7 ,phosphorus 7eggs1 yolk especially1 cream1 vegetables1 whole wheat1 cereals1 breadstuffs1 oatmeal1 dried beans and peas74 ,eggs1 milk1 lean meat1 cereal products1 whole ,iron 7organic and wheat1 dried beans and peas1 vegetables1 inorganic form7 spinach in particular1 onions1 mushrooms1 fruits1 port wine4 ,milk4#a ,eggs4 ,soft tissues and fluids of all animals1 skeleton and teeth of animals4 ,calcium 7organic ,wheat 7the entire grain71 flour1 oatmeal1 and inorganic polished rice4 form7 ,dried beans and peas4 ,green vegetables 7beets1 carrots1 parsnips1 turnips1 potatoes74 ,fruits 7apples1 bananas1 oranges1 pineapples1 dried prunes74 ,nuts 7almonds1 peanuts1 walnuts74 ,lean beef1 eggs1 milk4 ,sulphur 7organic ,wheat flour1 entire wheat1 and inorganic ,the proteins crackers1 etc4 form7 ,oatmeal4 ,beans1 peas4 ,potatoes4 ,these elements are associated with the other ,sodium1 potassium1 mineral salts in foods1 and a diet in which magnesium1 iodine1 they are adequately supplied furnishes chlorine sufficient magnesium1 potassium1 chlorine1 sodium1 and iodine for the general needs of the body4 ,fat soluble ,a4 ,butter1 cream1 whole-milk4 ,whole-milk powder4 ,whole-milk cheese4 ,cod liver oil1 eggs4 ,brains1 kidney4 ,cabbage 7fresh-dried74 ,carrots1 chard1 lettuce4 ,spinach1 sweet potatoes4 ,water soluble ,b4 ,yeast 7brewers'74 ,yeast cakes1 yeast extract4 ,whole-milk1 whey4 ,milk powder 7whole and skimmed74 ,vitamines#b ,nuts1 cereals 7corn embryo1 wheat embryo1 wheat-kernel1 rice 7unpolished774 ,beans 7kidney1 navy1 soy74 ,cotton seed1 peanuts1 bread4 ,cabbage1 carrots1 celery4 ,cauliflower1 onions4 ,parsnips1 potatoes4 ,peas 7fresh71 spinach4 ,rutabaga1 fruit1 grapefruit4 ,orange1 lemon1 tomato1 raisins4 ,water soluble ,c4 ,fruits3 ,orange1 lemon1 tomatoes 7canned74 ,tomato 7fresh71 grapefruit1 limes1 apples4 ,vegetables3 ,spinach1 lettuce1 cabbage 7raw74 ,peas 7fresh71 onions1 carrots1 cauliflower4 ,potatoes 7to a less extent74 ,whole-milk 7to a less extent74 ,,the ,,individual ,,foodstuffs ,,and ,,vitamine ,,factors ,a study of the individual foodstuffs and vitamines will furnish the first link in the chain which constitutes our present knowledge of dietetics4 ,,carbohydrates ,in the ordinary mixed diet of man1 the carbohydrates predominate1 being not only the most abundant1 but also the most economical source of energy4 ,the term carbohydrate covers all of the simple sugars and those substances which can be converted into simple sugars by hydrolysis2 the ones of special interest in this study are divided into three groups1 known as1 ,monosaccharides 7,c#f;,h#ab,o#f72 ,disaccharides 7,c#ab;,h#bb,o#aa7 and ,polysaccharides 7,c#f;,h#aj,o#ae74 ,monosaccharides4--,glucose1 ,fructose and ,galactose are substances whose monosaccharide molecules contain one sugar radical2 hence they cannot be hydrolized to simpler sugars 7sugars of lower molecular weight74 ,those constituting this group of sugars are all soluble1 crystallizable and diffusible substances1 which do not undergo changes from the action of the digestive enzymes1 consequently these sugars will enter the blood stream in their original form1 unless attacked by the bacteria which inhabit the stomach and intestinal tract4 ,the monosaccharides are all susceptible to alcoholic fermentation4 ,each member of the group is utilized in the body for the production of glycogen and for the maintenance of the normal glucose of the blood4 ,disaccharides4--,sucrose1 ,maltose and ,lactose are substances yielding1 upon hydrolysis1 two molecules of simple sugar3 each of these sugars is crystallizable and diffusible3 all are soluble in water1 and to a less degree in alcohol--sucrose and maltose are more soluble than lactose4 ,when attacked by the digestive enzymes1 these sugars are changed to monosaccharides4 ,polysaccharides4--,starch1 ,dextrin1 ,glycogen and ,cellulose are substances more complex in character than the above-mentioned groups4 ,they are built up of many sugar molecules1 which yield upon complete hydrolysis many molecules of simple sugar4 ,the polysaccharides are insoluble in alcohol1 and only soluble to a certain extent in pure water4 ,some members of this group swell and become gelatinous in the presence of moisture and heat2 some become of a colloidal form in water1 and will pass through filter paper2 others remain unchanged4 ,a brief description of the various members of these different groups of carbohydrates will assist the nurse in the ways and means of utilizing them in the dietary to the best advantage4 ,glucose1 which is abundant in the juice of plants and fruits1 and to a more or less degree in the blood of all animals 7usually about #j4a7 occurs free in nature4 ,this sugar is likewise obtained from many carbohydrates1 either through the action of acids1 or as the result of the digestive enzymes1 and as such becomes the principal form in which the animal body utilizes the carbohydrates ingested4 ,under normal conditions the glucose in the blood is constantly being burned and replaced2 it is only when the body loses to a greater or less degree the ability to burn the glucose that it accumulates in the blood1 from which it must escape by way of the urine4 ,there are times1 such as when very large quantities of carbohydrates are eaten at once1 when glucose will also appear in the urine2 but under such circumstances it is generally found to be merely temporary1 and for this reason1 the condition is known as temporary glycosuria4 ,as a rule1 however1 the surplus of glucose absorbed1 whether it be eaten as such1 or is found as the result of enzymic action upon the other carbohydrates1 is converted into glycogen and stored in the liver and to a less extent in the muscles4 ,glycogen is readily reconverted into glucose1 which is used by the body for the production of energy4 ,it has been estimated that over half the energy manifested in the human body is derived from glucose1 and it is in this form that the tissues of the body will ultimately make use of most of the carbohydrates in food4 ,practically all of the fruits1 and many of the vegetables1 are rich in this form of carbohydrate1 but grapes contain more than any of the other fruits1 while sweet corn1 onions1 and unripe potatoes contain appreciable amounts4 ,fructose4--,the second member of the monosaccharide group is more or less associated with glucose in plant and fruit juices1 and is used like that substance for the production of glycogen in the body4 ,eaten as such1 or produced as the result of digestive action upon cane sugar1 fructose is changed into glycogen1 chiefly upon entering the liver1 and for this reason will not be found to enter largely into the blood of the general circulation4#c ,honey is the most abundant source of fructose in nature4 ,galactose4--,this sugar1 unlike the other members of this group1 is not found free in nature1 but it is produced as the result of hydrolysis of milk sugar1 either by enzymes or by acids4 ,like glucose and fructose1 galactose seems to promote the production of glycogen in the body4 ,certain substances known as galactosides1 which are combinations of galactose and some substances other than carbohydrates1 are found in the nerve and brain tissues of the animal body4 ,disaccharides4--,of the second group of carbohydrates1 we are probably more familiar with sucrose1 or cane sugar1 than with either of the other two1 since it is in this form that the greater part of the sugar eaten is purchased4 ,sucrose4--,by far the greater part of the sugar entering into the average dietary is manufactured from sugar and sorghum canes1 and from sugar beets2 but appreciable quantities are derived from the sugar maple and sugar palms4 ,many of the sweet fruits are rich in this form of sugar2 pineapples are said to contain at least half of their solids in sucrose2 and although other fruits and vegetables do not contain so high a percentage of this sugar1 oranges1 peaches1 apricots1 dates1 raisins1 prunes1 carrots and sweet potatoes contain goodly quantities1 which are associated with glucose and fructose4 ,sucrose is readily hydrolized1 either by acids or enzymes4 ,the inverting enzyme 7invertase7 of yeast and sucrase of the intestinal juice1 convert sucrose to fructose and glucose1 in which forms it is absorbed into the portal blood4 ,it is believed that when sucrose is eaten in very large quantities1 it is sometimes absorbed from the stomach4 ,in these cases it does not become available for use in the body1 but acts in the same manner as when injected directly into the blood stream1 being excreted unchanged by way of the kidneys4 ,according to ,herter1 sucrose is much more susceptible to fermentation in the stomach than either maltose or lactose2 and since it has no advantage over these sugars from a standpoint of nutrition1 they are frequently substituted for sucrose in cases where the dangers arising from fermentation must be avoided4 ,maltose 7,malt sugar7 is an important constituent of germinating grains--malt and malt products being formed as the result of enzymic action 7amylases7 on starch4 ,a similar action takes place in the mouth as the result of the ptyalin in the salivary juices and in the intestines from the action of the starch-splitting enzyme1 amylopsin1 in the pancreatic juice4 ,the maltose thus formed is further converted into glucose by the sugar-splitting enzyme in the intestinal juice1 and in this form it is chiefly absorbed4 ,maltose is also an intermediate product formed during the manufacture of commercial glucose as the result of the boiling of starch with dilute acids4 ,lactose 7sugar of milk7 is one of the most important constituents in the milk of all mammals4 ,in freshly secreted human milk1 lactose occurs in quantities ranging from #f to #g1 and in the milk of cows and goats from #d to #e4 ,lactose is much less soluble than sucrose1 and decidedly less sweet2 hence1 owing to this latter property1 as well as to its lack of susceptibility to fermentation1 lactose is frequently used to bring up the sugar content of infant formulas to the desired percentage1 and the diets used in the abnormal conditions when additional energy material is needed4 ,during the process of digestion1 lactose is hydrolized by the lactase in the intestinal juice1 yielding one molecule of glucose and one of galactose4 ,like maltose1 little if any of this sugar is absorbed in its original form1 since experiments made with injections of lactose into the blood result in the rapid and almost complete elimination by way of the kidneys4 ,no such results are obtained when even large amounts of lactose are taken by way of the mouth4 ,polysaccharides4--,this group of carbohydrates is complex in character1 built up of many sugar molecules1 and upon digestion must be broken down into simple sugars before they can be utilized by the body4 ,starch is the form in which the plant stores her supply of carbohydrates4 ,it is found in this form in roots and 7mature7 tubers1 three-fourths of the bulk of which is made up of this material4 ,from one-half to three-quarters of the solids of grains is made up of starch also4 ,pure starch is a fine white powder1 odorless and almost tasteless4 ,it is insoluble in cold water and alcohol1 but changes from an insoluble substance to a more soluble one upon the application of heat4 ,upon hydrolysis starch gives first a mixture of dextrin and maltose1 then glucose alone as an end-product4 ,this hydrolysis may be the result of enzymic action1 as occurs upon bringing starch in contact with the ptyalin in the saliva1 or with the amylopsin in the pancreatic juice2 or it may be the result of boiling starch with acid1 as is seen in the manufacture of commercial glucose4 ,dextrin1 as has already been stated1 is an intermediate product of the hydrolysis of starch by acid or enzymes4 ,glycogen is the form in which the carbohydrates are stored in the body1 just as starch is the form in which they are stored in plants4 ,it is found in all parts of the body1 but is especially abundant in the liver4 ,here it is stored in the cell substance rather than in the nucleus4 ,the storage of glycogen in the human body depends largely upon the mode of life and upon the diet4 ,active muscular work1 especially out of doors1 uses up the store of glycogen with great rapidity2 while rest and a sedentary life promotes its storage4 ,the body readily converts its supply of glycogen into glucose1 the form in which the body uses the carbohydrates for fuel4 ,cellulose is a woody1 fibrous material insoluble in water and to a certain extent impervious to the action of the digestive enzymes4 ,this carbohydrate constitutes the skeleton of plants just as the bones constitute that of the animal body4 ,it is probable that owing to the length of time required for this carbohydrate to be broken down in digestion1 much of it escapes oxidation entirely4 ,hence1 it passes down the digestive tract lending bulk to the food mass and thus promoting peristalsis throughout the whole of the digestive tract4 ,organic ,acids4--,certain of the carbohydrate foods 7fruits and green vegetables7 contain appreciable amounts of organic acids or their salts2 oranges and lemons1 for example1 are rich in citric acid2 grapes contain considerable quantities of potassium acid tartrate1 apples and other fruits have malic acid2 many of the fruits have succinic acid2 a few foods contain oxalic acid1 or oxalates4 ,all of these organic acids are burned in the body to produce energy1 with the possible exception of the oxalates1 which seem to have little1 if any1 food value4 ,according to ,sherman1 these organic acids have a lower fuel value1 per gram1 than carbohydrates1 but are reckoned as such in computing a food in which they exist4 ,the function of these acids is chiefly that of neutralizing the acids formed in the body in metabolism4 ,being base-forming in character1 they function after absorption and oxidation in the body as potential bases--the base associated with the acid in their ash combining with carbonic acid to form carbonates1 which act as above described4 ,bacterial ,action upon ,carbohydrates of ,foods4--,the bacteria that act chiefly upon the carbohydrates belong to the fermentative type4 ,the substances formed as a result of this activity are certain acids--lactic1 butyric1 formic1 acetic1 oxalic1 and possibly alcohol4 ,certain forms of carbohydrates are more susceptible to bacterial fermentation than others4 ,herter claims that sucrose and glucose are much more so than lactose1 maltose1 or starch4 ,the substances thus formed through bacterial activity are not believed to be toxic in character1 but merely irritating4 ,however1 the irritation arising from excessive fermentation in the stomach may lead to gastric disturbances of a more or less serious nature2 hence the amount of carbohydrate taken under certain conditions must be adjusted carefully4 ,the ,effect of ,heat upon ,carbohydrates4--,the changes wrought in the carbohydrates as a result of heat have already been discussed to a certain extent4 ,it is seen that the sucrose 7cane sugar7 is soluble alike in hot and cold water2 the same is true of maltose2 but lactose is much more soluble in hot water than it is in water which has not been heated4 ,so far as their digestibility is concerned1 the application of heat 7boiling7 neither increases nor decreases the utilization of these sugars by the body4 ,with starch it is an entirely different matter4 ,it has been found that the application of heat1 either as dry heat1 or in the presence of moisture1 brings about a definite change in the character of the foodstuff4 ,pure starch admixed with water and boiled1 passes into a condition of colloidal dispersion1 or semi-solution1 known as starch paste 7,sherman74 ,this is graphically illustrated in the cooking of potatoes1 in which the starch and water are mixed in nature2 and in the cooking of cereals and like starchy foods1 to which water is added in preparation for their cooking4 ,in both cases the application of heat adds greatly to the digestibility of the raw material by reason of the change which is wrought in these substances1 causing them to be more readily acted upon by enzymes in the digestive juices4 ,this solubility of carbohydrates in hot water may be utilized in the washing of utensils in which these substances have been prepared2 thus saving much time and effort on the part of the nurse in either the diet kitchen or in the home4 ,,fats ,the second member of the organic food group1 and one which is almost as widely distributed throughout animal and vegetable life as the carbohydrates1 is found in the fats4 ,this foodstuff1 while composed of the same chemical elements that go to make up the carbohydrates1 contains these elements in different proportions2 that is1 fats contain less oxygen and more hydrogen than carbohydrates4 ,typical ,fats4--,the fats 7as already shown in the ,table on page #e7 are derived from both animal and plant life1 but1 like the carbohydrates1 do not always occur in the same form4 ,those of animal origin include3 ,adipose ,tissue of man and animals1 tallow of mutton1 suet1 and oleo oil of beef1 lard of pork4 ,phosphorized ,fats1 which include lecithin and lecithans1 occur abundantly in the brain and nerve tissues and to a less extent in the cells and tissues of man1 animals1 and plants of which it seems an essential part4 ,egg yolk is the most abundant source of phosphorized fat in food material1 but milk likewise furnishes an appreciable amount4 ,cholesterol 7fat-like substances74--,the fatty secretions of the sebaceous glands of man and of the higher animals which furnish the natural oil for hair1 wool and feathers1 7,starling71 lanoline1 which is a purified wool fat1 consist chiefly of cholesterol4 ,according to ,mathews1 cholesterol is an essential constituent of the blood1 and is found in the brain and in nearly all living tissues4 ,it is likewise believed to be the mother substance from which bile acids are derived4 ,fat ,soluble ,a4--,the vitamine factor which occurs dissolved in certain fats1 namely1 milk 7whole71 butter1 egg yolk1 the organs of animals1 and codfish liver4 ,definition of ,fat4--,the fats are all glycerides2 that is1 they are substances made up of combinations of fatty acids and glycerine1 which constitute a definite group of chemical compounds1 certain members of which are liquid in form1 while others are solid1 or semi-solid4 ,the liquid fats are known as fatty oils4 ,the fatty acids in which we are chiefly concerned in this study are3 ,butyric1 ,stearic1 ,oleic1 and ,palmitic4 ,most of the common fats owe their form and flavor to the type and amount of the various fatty acids of which they are composed4 ,for example1 butter is made up of ten fatty acids2 but its soft1 solid form is due to the olein and palmitin 7glycerides of oleic and palmitic acids7 which it contains2 and its characteristic flavor1 as well as its name1 to its butyric acid content 7about #e to #f74 ,it is evident that the degree of softness or hardness of a fat may be determined chiefly by the amount of oleic acid in its composition4 ,most of the common oils with which we are familiar in food are composed chiefly of olein4 ,stearin 7the glyceride of stearic acid7 is the hardest of the fatty acids1 while palmitin1 although classed with the solid fats1 is not so hard as stearin4 ,lard and butter are higher in olein and palmitin and are consequently semi-solid1 while suet and tallow1 consisting chiefly of stearin1 are much harder than the other food fats4 ,characteristics of ,fats4--,the fats are all insoluble in water1 and only partially so in cold alcohol1 but they dissolve readily in ether4 ,as a rule1 the fat occurring in the animal body is more or less characteristic of the species4 ,for example1 animals that live on land have a harder fat than those living in the water2 warm blooded animals1 harder fats than cold blooded ones 7fish72 and carnivorous animals1 harder fats than herbivorous species4 ,fats are lighter than water1 hence will float in it4 ,an emulsion is a suspension of fat in a fluid1 and the fat in this case must be very finely divided and mixed with some other material which will prevent a coalescence of the fat globules4 ,in milk1 which is one of the best natural emulsions1 the additional substance is protein4 ,effect of ,heat upon ,fat4--,when fats are brought to a high temperature1 the glycerine which they contain decomposes with the production of a substance known as acrolein1 which has an irritating effect upon the mucous membranes4 ,it is possible that the over-heated fatty acids add their quota to the production of irritating fumes4 ,as a rule1 it is inadvisable to use frying as a method of preparing food for the sick or for children4 ,doubtless1 if every cook understood the exact degree of heat to apply in frying1 and knew just how moist to have the food mixture which she intended to cook in this manner1 better results would be obtained2 but since the average cook knows little about the scientific application of heat to fat or the changes brought about thereby1 it is safer to make use of other methods of food preparation under the circumstances4 ,functions of ,fat4--,this foodstuff undoubtedly serves as the most compact form of fuel available to the body for the production of energy4 ,weight for weight1 fat furnishes twice as much heat as the carbohydrates1 and in bulk the difference is even more striking2 for example 7about7 two tablespoonfuls of sugar are required to produce #ajj calories1 whereas one scant tablespoonful of olive oil will produce a like number of heat units4 ,as a source of supply for reserve energy in the body1 fat is most valuable4 ,this reserve fuel is stored in the form of adipose tissues underlying the skin and surrounding the vital organs1 lending contour to the form and protecting the organs from jars and shocks4 ,distributed throughout the body1 fat may be found as 7a7 cholesterol 7in the cells of the muscles1 organs1 and nerve tissues71 which acts as a protection against the destruction of the red blood cells2 7b7 phosphorized fat 7lecithin71 the universal distribution of which1 according to ,starling1 seems to indicate that it plays an important part in the metabolic process of the cells1 serving as a source of phosphorus which is required for the building up of the complex nucleoproteins of the cell nuclei4 ,,proteins ,upon investigation it was found that neither the fats nor carbohydrates were the chief constituents of the active tissues4 ,it was found1 in fact1 that the carbohydrates occurred in very small quantities only in the muscles1 and that frequently the quantity of fat was likewise limited4 ,other substances1 containing nitrogen and sulphur in addition to carbon1 oxygen1 and hydrogen1 which were invariably present1 and which are essential constituents of all tissues and cells1 both in animals and in plants1 must be necessary to all known life4 ,to these substances1 believed at the time to be the fundamental constituents of all tissues1 ,mulder gave the name ,protein1 from the ,greek1 meaning to take first place4 ,later investigations proved that1 while the proteins were essential to the building and repairing of the tissues and cells in general1 they were not the only factors concerned in the work2 that certain mineral salts were necessary constituents of all tissues1 and must be present in order for any normal growth and development to occur4#d ,composition of ,proteins4--,the average nitrogen content of common proteins is about #af2 that is1 in #ajj grams of protein there will be approximately #af grams of nitrogen1 or in #f4be grams of protein there will be #a gram of nitrogen4 ,to estimate the protein content of a food when the percentage of nitrogen is known1 it is necessary simply to multiply the percentage of nitrogen present1 by the nitrogen factor1 #f4be2 or1 if the amount of nitrogen is desired1 when the percentage of protein is given1 to divide by same factor4 ,construction of ,proteins4--,in plant structure the building up of the proteins is accomplished by the plants from inorganic substances existing in the soil and air2 but in the animal body this is not possible1 because the construction of the tissues requires the use of other proteins--the most available ones being found in food4 ,each animal 7or species7 forms the proteins characteristic of its own tissues1--while the proteins of food are similar to those found in the body1 they cannot be utilized in their original form1 but must be split into simpler substances from which the cells of the various tissues throughout the body may select those particularly adapted for their purpose4 ,these transformed substances are known as amino acids1 the production of which is a result of digestion in the digestive tract4 ,there are about seventeen of these acids entering into the construction of the common proteins4 ,one scientist has likened these units to letters of the alphabet1 which1 being combined1 spell many proteins4 ,when a protein contains all of the essential units1 it may be said to be complete1 the best example of which may be seen in milk1 eggs1 and meat4 ,when a protein lacks some of the essential elements1 or letters of the protein alphabet1 it is said to be incomplete4 ,gelatin is the best example of this type of protein1 but the cereals and beans must likewise be supplemented by other substances2 milk being the one most generally used for this purpose4 ,for the purpose of building young tissues1 and maintaining those already mature1 it is logical to use foods containing the foodstuffs in their best form2 that is1 those that not only contain the complete protein1 but also the requisite mineral salts and vitamines4 ,foods lacking in some of these respects become adequate when supplemented by these foods which can supply the missing constituents2 hence1 the use of such incomplete protein foods need not necessarily be abandoned1 for1 as in the case of cereals1 the foods are both economical and palatable1 and1 when used in addition to milk1 furnish valuable adjuncts to the dietary4 ,classification of ,proteins4--,a brief description of some of the more important proteins with which we are chiefly concerned will serve to simplify the formulation of a diet4 ,those assuming the most important position in nutrition and food are globulins1 albumens1 nucleoproteins1 phosphoproteins1 hemoglobins1 and derived proteins such as proteoses and peptones4 ,the albumens and globulins associated together occur in the tissues of both animals and plants4 ,the albumens are richer in sulphur than the globulins and are found more abundantly in the animal fluids1 such as the blood1 while the globulins predominate in the more solid tissues of animals and in plants4 ,the close association of these two proteins is particularly noticeable in the blood and cells4 ,they have different characteristics1 however4 ,albumins4--,the best examples are found in egg albumin 7white of egg71 lactalbumin 7milk71 serum albumin 7blood71 leucosin 7wheat71 legumelin 7peas74 ,albumins are all soluble in pure water1 and are coagulable by heat4 ,coagulation1 due to the action of the ferments in the body1 takes place in milk1 blood1 and muscle plasma4 ,certain albumens are particularly adapted for the building and repairing of tissues4 ,among those that have been used in feeding experiments to determine whether or not they were capable1 when used as the sole protein in the diet1 of maintaining animals in normal nutrition1 and of supporting normal growth in the young animal1--may be cited lactalbumin and egg albumin4 ,these experiments provided diets adequate in other respects1 the object being to determine the value of the various proteins4 ,it was found that the albumin from milk was more efficient in this respect than the egg albumin4#e ,in the invalid dietary the solubility of the albumins in water makes them of especial value as reinforcing agents1 since they may be introduced into fluids without materially altering either their flavor or their bulk4 ,globulins4--,simple proteins1 insoluble in pure water1 but soluble in neutral salt solutions2 examples1 muscle globulin1 serum globulin 7blood71 edestin 7wheat71 physelin 7beans71 legumin 7beans and peas71 tuberin 7potatoes71 amandin 7almonds71 arachin1 and conarachin 7peanuts74 ,alcohol-,soluble ,proteins4--,simple proteins soluble in alcohol of from #gj-hj strength4 ,insoluble in absolute alcohol1 water and other neutral solvents4 ,examples of these proteins may be seen in the gliadin of wheat1 zein of corn1 and hordein of barley4 ,albuminoids4--,these substances represent one group of incomplete proteins1 inasmuch as they cannot alone support protein metabolism4 ,however1 they are classed with the proteins and may be substituted for at least a part of these compounds in the daily dietary1 since they are able to do much of the work of the pure proteins4 ,the best example of this group is seen in gelatin4 ,this substance contains many of the structural units of meat protein but in very different relative amounts4 ,it has not1 therefore1 the chemical units necessary to repair the worn-out parts of cell machinery4#f ,conjugated ,proteins3--,nucleoproteins1 ,phosphoproteins and ,hemoglobin4 7a7 ,nucleoproteins4--,this type of protein is characteristic of all cell nuclei1 and is particularly abundant in the highly nucleated secreting cells of the glandular organs1 such as the liver1 pancreas1 and the thymus gland4 ,the nucleoproteins are composed of simple proteins and nuclein4 ,nucleic acid is rich in phosphorus and upon decomposition yields some of the purin bases 7xanthin1 adenin1 guanin71 a carbohydrate and phosphoric acid4#g 7b7 ,phosphoproteins4--,compounds in which the phosphorus is in organic union with the protein molecule otherwise than a nucleic acid or lecithin4 ,examples3 caseinogin 7milk71 ovovitellin 7egg yolk74 7c7 ,hemoglobin4--,much of the greater part of the iron existing in the body occurs as a constituent of the hemoglobin of the red blood cells4 ,when the intake of iron is not sufficient to cover the output1 there must be a consequent diminution in the hemoglobin of the blood with a corresponding development of anemia4 ,the importance of knowing these characteristic proteins is apparent4 ,not only will such knowledge lead to a more intelligent use of protein foods in the normal dietary1 but it will prove of the greatest assistance in the adjusting of the foodstuffs in diet for individuals suffering from certain abnormal conditions4 ,in abnormal conditions this knowledge of the various proteins--their composition1 source1 and behavior in the body assumes a position of the greatest importance2 since it represents the means for safeguarding a patient from the results caused by the wrong kind of food4 ,in certain types of nephritis1 for example1 it is perfectly safe to give milk where the ingestion of meat and eggs might cause serious1 if not fatal1 results4 ,in treating gout1 when it is deemed advisable to limit the purin foods in order to control in a measure the retention of uric acid in the body1 the realization that certain of the nucleoproteins1 upon being broken down in the body1 yield the purins1 which in turn give rise to the production of uric acid1 will permit the nurse to adjust the diet so as to eliminate such foods entirely 7see ,gout74 ,the importance of keeping the hemoglobin content of the blood normal has already been mentioned4 ,the ,effect of ,heat upon ,proteins4--,the fact that certain proteins are most susceptible to heat has already been stated1 but the application of this knowledge in the preparation of protein foods is important4 ,in milk1 for example1 whole raw milk forms a large hard curd2 whereas boiled milk curdles in a much finer and softer form4 ,pasteurized milk shows smaller curds than raw whole milk1 but larger than the boiled whole milk4#h ,an egg cooked by the application of a long-continued high temperature 7#bab deg4 ,f47 has a tough white2 whereas an egg cooked until hard at a temperature under the boiling point shows a tenderness in the white which renders it distinctly more palatable4 ,soft-cooked eggs leave the stomach in less time than is required for hard cooked ones2 poached 7cooked in water under the boiling point71 shirred eggs 7cooked in hot dish71 and soft-cooked eggs are among the most readily digestible forms of eggs4 ,raw eggs are slightly less stimulating to acid secretion in the stomach and require a longer time to leave the stomach than boiled eggs4 ,thus it is seen that in many cases the difference in preparation of the protein foods may make a difference in the way in which the digestive tract handles them4 ,necessarily1 this point is emphasized more in abnormal than in normal conditions2 for example1 albuminized orange juice gives rise to a distinct gastric secretion1 and leaves the stomach rapidly--a great advantage in certain abnormal conditions1 and especially in those requiring liquid diet of high nutriment value4 ,the knowledge of the coagulation of proteins by heat points out the advantage of using cold water over hot in the preliminary cleansing of utensils in which protein foods have been prepared4 ,certain members of this group are soluble in pure water1 and will readily dissolve2 whereas1 if the water is heated1 their coagulation would prevent this taking place so readily4 ,functions of ,protein in the ,body4--,the proteins serve two distinct uses in the body2 first1 that of building and repairing tissues and furnishing1 in conjunction with other substances1 material for growth2 second1 that of producing energy for the internal and external work of the body4 ,for this latter function a large percentage of the proteins ingested is used2 consequently1 since the carbohydrates and fats are primarily the energy furnishing material most readily used by the organism1 it is clearly demonstrated that the average individual takes more protein into the body than is necessary for its maintenance4 ,except during the period when an allowance for growth must be made1 it is probable that a much smaller daily consumption of protein could be made without disadvantage to the organism1 leaving the bulk of the work1 in so far as the running of the engine is concerned1 to the other organic foodstuffs4 ,,water ,man can exist for days1 even weeks1 without food1 but without water life soon becomes extinct4 ,this substance is composed of hydrogen and oxygen in the proportion of two to one2 that is1 to each atom of oxygen there will be found two atoms of hydrogen4 ,this is always the case no matter where it is found4 ,when foods are put through a drying process the water is taken out and the rest of the chemical composition of the food remains unchanged4 ,this foodstuff1 unlike those belonging to the organic group1 is not changed during the process of digestion1 nor does the application of heat or cold affect it1 save from a physical standpoint4 ,water boils at a temperature of #ajj deg4 ,c4 7#bab deg4 ,f471 and freezes at a temperature of #j deg4 ,c4 7#cb deg4 ,f474 ,function of ,water4--,the uses of water in the body are many1 and the advantage arising from a sufficient amount of this foodstuff in the dietary cannot be overestimated4 ,it is no longer considered an error in diet to drink a moderate amount of water with the meals1 so long as it is not used as a substitute for mastication1 and as a means of washing the food into the stomach4 ,in the diet1 both as a beverage and as a part of most of the food materials ingested1 water serves to moisten the tissues2 to furnish the fluid medium for all of the secretions and excretions of the body2 to carry food materials in solution to all parts of the organism2 to stimulate secretory cells producing the digestive juices1 thereby aiding in the processes of digestion1 absorption and excretion2 to promote circulation2 to furnish material for free diuresis1 thus preventing to a great extent the retention of injurious substances by the body1 which might otherwise take place4 ,factors ,determining the ,amount of ,water ,needed4--,in normal conditions it is probable that the kind and amount of exercise taken has more to do with the amount of water needed by the body than any other factor1 since the vigorously worked body excretes more water by way of the skin than the quiescent one4 ,with a normal amount of exercise1 it is advisable to drink from six to eight glasses of water each day1 increasing the amount to a certain extent when exercise causes a great loss through perspiration4 ,it is always advisable1 however1 to keep in mind that an excessive amount of fluid taken into the body throws a corresponding amount of work on the organs 7the stomach1 kidneys and heart74 ,in certain abnormal conditions1 the body's water supply is depleted4 ,this is particularly true in the case of hemorrhage1 vomiting1 and diarrhea4 ,under other conditions 7certain types of nephritis71 the body becomes overburdened through the excess of water retained1 owing to the difficulty which the kidneys show in eliminating it4 ,this retention of water by the tissues gives rise to the condition known as edema4 ,,mineral ,,salts ,ash4--,the eight remaining chemical elements1 i4e41 calcium1 magnesium1 sulphur1 iron1 sodium1 potassium1 phosphorus1 chlorine1 constituting the mineral salts or ash1 are likewise classed as food on account of the work which they perform in the body4 ,some of these elements enter the body as essential constituents of the organic compounds1 and are metabolized in the body as such1 becoming inorganic only upon oxidation of the organic materials of which they form a part4 ,importance of the ,mineral ,salts4--,the way in which the mineral elements exist in the body and take part in its functions1 has been graphically outlined by ,sherman as follows4 7#a7 ,as bone constituents1 giving rigidity and relative permanence to the skeletal tissues4 7#b7 ,as essential elements of the organic compounds which are the chief solids of the soft tissues 7muscles1 blood cells1 etc474 7#c7 ,as soluble salts 7electrolytes7 held in solution in the fluids of the body2 giving to those fluids their characteristic influence upon the elasticity and irritability of muscle and nerve2 supplying material for the acidity and alkalinity of the digestive juices and other secretions2 and yet maintaining the neutrality1 or slight alkalescence1 of the internal fluids as well as their osmotic pressure and solvent power4#i ,the above outline1 showing the various ways in which the mineral constituents enter and take part in the various functions1 as well as in the structure of the body1 make it evident that the same close attention and study which was given to the other foodstuffs must be accorded to these substances4 ,when the student realizes that the presence of certain salts dissolved in the blood assists in the regulation of the vital processes of the body such as the digestion1 circulation and respiration2 that they are responsible for the contraction and relaxation of the muscles2 that they assist in controlling the nerves2 that they are1 in a way1 instrumental in releasing the energy locked up in food--the value of these elements becomes very evident1 and their importance in the dietary inestimable4 ,some of the mineral salts are more widely distributed in food than others1 and the danger arising from their deficiency in the diet is not so great as is the case with others2 hence attention is called to those found by investigators to be most often lacking or deficient in the average diet2 i4e41 calcium1 phosphorus1 and iron4 ,a brief summary of the special parts played by these elements will be outlined here4 ,calcium4--,physiology teaches that about eighty-five per cent4 of the mineral matter of the bone1 or at least three-quarters of the ash of the entire body1 consists of calcium phosphates4 ,it has long been known that this mineral salt is necessary for the coagulation of the blood1 and science has demonstrated that the alternate contractions and relaxations which constitute the normal beating of the heart are dependent1 at least in part1 upon the presence of a sufficient1 but not excessive concentration of calcium salts in the fluid which bathes the heart muscles4#aj ,phosphorus4--,according to ,sherman1 phosphorus compounds are as widely distributed in the body1 and as strictly essential to every living cell as are proteins4 ,science has also proved that they are important constituents in the skeleton1 in milk1 in glandular tissue1 in sexual elements1 and in the nervous system2 that these compounds take part in the functions of cell multiplication1 in the activation and control of enzyme actions1 in the maintenance of neutrality in the body2 that they exert an influence on the osmotic pressure and surface tension of the body1 and upon the processes of absorption and secretion4 ,like calcium1 phosphorus is absolutely essential to the growth and development of the body1 and1 as in the case of the mineral1 its presence in the dietary must be accorded strict attention1 in order to avoid the results accruing from its deficiency4 ,casein1 or caseinogen of milk and egg yolk 7ovovitellin71 are the substances richest in this mineral salt4 ,the fact that the phosphorus existing in grains 7cereals7 may be removed largely in the process of milling1 makes it advisable to consider the use of the breads made from the whole grains4 ,iron4--,the presence of iron as an essential constituent of hemoglobin has already been discussed4 ,that which is not in the hemoglobin is chiefly found in the chromatin substances of the cells4 ,the body does not keep a reserve store of iron on hand as is the case with calcium and phosphorus in the bone tissues1 but must depend upon the daily intake in food to supply its needs4 ,the iron content of food materials is not large1 but a careful regulation of the iron bearing foods 7see ,table on page #e7 will make it easy to cover the demands of the body with a material which has been found to do its work most efficiently4 ,medicinal iron has received much attention in the determination of the essential needs of the body4 ,whether medicinal iron actually serves as material for the construction of hemoglobin is not positively known1 but we have what appears to be a good evidence that food iron is assimilated and used for growth and for regeneration of the hemoglobin to much better advantage than are inorganic or synthetic forms1 and that when medicinal iron increases the production of hemoglobin1 its effect is more beneficial in proportion as food iron is more abundant--a strong indication that the medicinal iron acts by stimulation rather than as material for the construction of hemoglobin4 7,sherman7 ,the newborn infant has a store of iron already on hand1 derived from the mother through the placenta before birth4 ,after the birth1 and through the nursing period1 the child receives a certain amount of iron from the mother's milk4 ,this supply is not altogether reliable1 however1 since any disturbance of the digestion will tend to interfere with its absorption1 and consequently deprive the organism of what would otherwise be used for the building up of the blood supply4 ,thus it is clearly indicated that the infant's safest source of iron is from the mother during the pre-natal period4 ,this supply must necessarily come from her diet during this time1 and is made possible by regulating day by day the iron bearing foods in her dietary4 ,after the original store of iron is reduced to that of the adult 7after the child has tripled in birth-weight1 generally at #ab or #ac months71 and during the remainder of the growth period1 it is very necessary to regulate the iron-bearing food in the diet1 in order to insure the child of an adequate amount to cover the demands made by the increasing blood supply4 ,,vitamines ,up to a few years ago it was believed a complete diet should contain an adequate amount of protein of a proper type1 a sufficient amount of calcium1 phosphorus and iron1 and enough carbohydrates and fats to furnish the body with sufficient fuel to cover its energy expenditures4 ,this belief was proved to be incorrect a number of years ago by ,dr4 ,hopkins of ,england4 ,in making certain feeding experiments with rats1 ,dr4 ,hopkins showed that some substance or substances present in milk1 other than those already mentioned1 was essential for the growth of the animal2 that animals deprived of this material grew for a time1 but gradually ceased to do so4 ,later on1 ,osborne1 ,mendel1 ,mc,collum and ,davis discovered a like substance in butter fat2 and still later ,dr4 ,mc,collum found the same growth stimulating material1 or one very like it1 existing in the leaves of plants4 ,these scientists found1 upon investigation1 that there were probably two substances in milk--one soluble in the fat1 the other in the protein-free and fat-free whey--both of which were essential for normal growth4 ,in #aiaa ,dr4 ,funk discovered in rice polishings a substance which he believed to be a cure and preventive of ,beri-beri2 to this substance1 which is now believed to be identical with the second substance found in milk1 he gave the name vitamine4 ,dr4 ,funk's name ,vitamine is now accepted to cover a number of substances essential to growth1 and for the prevention and cure of certain diseases4 ,to the first two has been added a third member of the vitamine family1 which has proved to be a cure and preventive of scurvy4 ,these substances are called--on account of the substances in which they are soluble--,fat soluble ,a1 ,water soluble ,b1 and ,water soluble ,c4 ,the table on page #dif shows the sources from which these factors may be obtained4 ,the four plus system is used by ,dr4 ,eddy to describe the abundance with which they occur4#aa ,function of ,fat ,soluble ,a4--,all investigators agree that the ,a vitamine is an essential factor in the growth of young tissue1 and the repair of mature tissues4 ,mc,collum claims that this vitamine is likewise a factor in the prevention of the eye disease known as xerophthalmia1 and other scientists also hold this opinion4 ,eddy states that a diet lacking in the ,a vitamine will1 in the majority of cases1 result in stunted growth and the development of the eye disease1 and that the appearance of the latter may be taken as a sure indication of the absence or deficiency of this vitamine4 ,the following diagram shows the effect of adding fat soluble ,a to the diet which was adequate in other respects4 ,this chart represents the growth curve of young rats4#ab #bcj -------------------- #aij -------------------_/ _/ _/ _/ _/ _/ #aej -------------_/------ _/ ,with _/ ,fat _/ ,soluble _/ ,a _/ #aaj --------_/----------- _/ _/ _/ _/ _/ #gj --_/----------------- _/ _/ ,without ,fat ,soluble ,a -------------------- #cj -------------------- #j #a #b ,figure showing the effect upon growth of adding fat soluble ,a to a diet adequate in all other respects4 ,courtesy of ,dr4 ,e4 ,v4 ,mc,collum4 ,mellanby of ,england believes the ,a vitamine to be a factor in the prevention of rickets4 ,scientists of ,america have recently investigated this disease1 and ,dr4 ,hess 7,new ,york7 has found cod liver oil to be a remedy for it4 ,cod liver oil is known to be rich in ,fat soluble ,a1 but whether the cure of rickets is due to the presence of this vitamine in the oil1 or to a possible fourth vitamine1 is still undetermined4 ,effect of ,heat on the ,a ,vitamine4--,heat1 as applied in the ordinary methods of cooking1 is not believed to exert a great deal of destruction upon the ,a type of vitamine2 but hydrogenation1 the process used in the hardening of certain fats in the manufacture of lard substitutes1 is said to destroy it completely4 ,water ,soluble ,b4--,the second vitamine discovered in milk and believed to be identical with the ,funk vitamine is more widely distributed than the ,a vitamine4 ,for this reason it is not so likely to be deficient in the diet as is found to be the case with the ,a4 ,a glance at the table shows that the best sources outside of yeast are the seeds of plants and the milk and eggs of animals4 ,in beans and peas the ,b vitamine is distributed throughout the entire seed1 but in the cereal grains it is found chiefly in the embryo4 ,as a result1 bread made from fine white flour or meal is much more apt to be deficient in vitamine of the ,b type than that which is made from the whole grain2 the same is true of rice and other cereals4 ,spinach1 potatoes1 carrots and turnips show an appreciable amount of the vitamine1 but beets are known to be extremely poor in it4 ,nuts too are considered a valuable source4 ,function of the ,b ,vitamine4--,like the ,a vitamine1 water soluble ,b is believed to be essential to growth4 ,funk established its value as a preventive and cure of ,beri-beri1 the disease common in the ,orient among people living largely upon a diet of polished rice and fish4 ,besides being a growth-stimulating substance and an antineuritic1 the ,b vitamine is highly valued for its stimulating effect upon the appetite4 ,to this property is probably due at least part of the credit for which certain substances work for the promotion of growth in animals4 ,this can be utilized to good advantage for children showing a disposition to refuse food1 by supplementing formulas made from milk1#ac with the expressed juice of vegetables and fruits known to be rich in the ,b vitamine4 ,effect of ,heat on the ,b ,vitamine4--,this vitamine also shows a resistance to heat2 that is1 as applied in the methods generally used in cooking1 pasteurization temperatures do not materially affect the vitamine property of the formula as far as the ,a and ,b factors are concerned4 ,the ,effect of ,alkali 7,soda7 upon the ,b ,vitamine4--,it has been an ordinary practice to add soda to the water in which certain vegetables are cooked1 for the ostensible purpose of softening the vegetables and hastening their cooking4 ,the practice has been condemned by many scientists who are making experiments along these lines1 on account of its destructive power upon the ,b vitamine4 ,chick and ,hume in ,england claim that when the amount of food given contains originally just sufficient vitamines to cover the growth factor the use of soda in the cooking water does serious harm to these vitamines4 ,this is a point well worth remembering4 ,it is often difficult to persuade certain individuals to eat vegetables in appreciable quantities2 if the vitamines were reduced though the method of preparing the food1 these individuals would not obtain a sufficient quantity of the vitamines4 ,water ,soluble ,c4--,the third member of the vitamine family is known for its antiscorbutic property2 that is1 it is the best known cure and preventive of scurvy4 ,it likewise exerts a certain amount of influence upon the growth of the animal and must be present in the diet1 in order that the health and well-being of the individual may be safeguarded4 ,the ,c vitamine1 like the ,b vitamine1 is soluble in water1 and is present to an appreciable extent in the fresh juices of the fruits and vegetables4 ,some are richer in this respect than others 7orange and tomato juice71 while the cereals1 grains1 seed of plants1 sugars1 oils1 and meats are singularly deficient4 ,milk 7whole7 does not contain a great amount of the ,c vitamine1 and this amount is still further reduced under certain methods of preparation4 ,milk powders1 made either from the whole or the skimmed milk1 are found to contain only very small amounts of this essential substance4 ,condensed milk and cream are supposed to be free of ,c1 and the same is true of eggs4 ,effect of ,heat on ,c ,vitamine4--,all authorities agree that the ,c vitamine is much more sensitive to heat than the other two2 and for this reason much of the value obtained from this vitamine in uncooked material may be lost when the food containing it is subjected to long-continued heat4 ,hess claims that the temperature used for pasteurizing milk for some time1 is more destructive to this vitamine than boiling water temperature continued for a few minutes only4#ad ,there is need for care in formulating the diet for children to see that they are given fresh fruit every day2 or when that is not possible1 to see that they are at least given tomato juice4 ,this substance is rich in the antiscorbutic vitamine1 and according to experiments made by ,sherman1 ,le,mer and ,campbell1 loses fifty per cent4 of its antiscorbutic power when boiled one hour4 ,dr4 ,delf at the ,lister ,institute experimented with raw and cooked cabbage1 and found that when this material was cooked for one hour at temperatures ranging from #hj deg4 to #ij deg4 ,c the loss in antiscorbutic power amounted to #ij in the cooked leaves over the raw material4 ,dr4 ,delf also concluded from her experiments that it was advisable to add neither acid nor alkali in the cooking of vegetables if these substances were to give their maximum value of vitamines4 ,from the foregoing description of these vitamine factors1 it is readily seen why so many dietaries are deficient in these essential substances4 ,the limited sources from which to obtain the ,a vitamine2 the sensitiveness of the ,b vitamine to the action of alkalies2 the sensitiveness of the ,c vitamine to heat1 alkali and acid1 moreover the limitation of its presence chiefly to the fresh fruits and plant juices1--all point to the need of special care in the selection of the food materials and of the manner in which these materials are prepared for consumption4 ,,summary ,in the descriptions just given of the various foodstuffs1 especially in regard to their function in the body1 it is readily seen that no one foodstuff is used to the exclusion of another4 ,it is further seen that in the upkeep of the body1 which includes not only the building and repairing of its tissues1 but the running of the engine and maintaining of its normal temperature1 the organism uses each and all of the organic food substances for the production of heat4 ,furthermore1 while the tissues are chiefly built from protein material1 and physiology teaches that protein can be built only from other protein1 these tissues contain a certain amount of carbohydrate1 fat1 mineral salts1 and water2 this furnishes distinct evidence that the building of the cells and tissues of the body cannot be accomplished by means of protein alone1 but by the judicious balancing of all the foodstuffs in the dietary4 ,science has gone even further than this1 as has just been demonstrated1 and has proven that without the substances known as vitamines the normal growth and development in the young would be arrested1 and that the maintenance of the adult body would be impaired4 ,it has also proven that certain diseases owe their development to deficiencies in the vitamine supply to the body4 ,,problems 7a7 ,outline briefly what is believed to be the essentials of an adequate dietary4 7b7 ,list the fuel foods and show their most economical source4 7c7 ,list the best sources of the complete proteins4 7d7 ,show how the incomplete protein foods may be made adequate for growth4 ,,footnotes3 #a ,one quart of milk contains more calcium than a quart of clear saturated solution of lime water4 #b ,for complete list1 see ,eddy's ,table1 in ,appendix4 #c ,chemistry of ,food and ,nutrition 7revised edition71 by ,sherman4 #d ,scientists are proving the need for certain vitamine factors in the diet in order that the growth and development of young tissues and the repair of adult tissues may proceed4 ,the part played by these substances will be discussed later4 #e ,chemistry of ,food and ,nutrition 7#b;d ed471 by ,sherman4 #f ,the ,basis of ,nutrition1 by ,graham ,lusk4 #g ,food ,products1 by ,henry ,sherman4 #h ,abstracts made from thirteen papers from the ,laboratory of ,physiological ,chemistry1 ,jefferson ,medical ,college1 ,philadelphia2 published in the ,american ,journal of ,physiology and ,science1 by ,minna ,c4 ,denton4 ,u4,s4 ,department of ,agriculture4 #i ,chemistry of ,food and ,nutrition 7revised71 p4 #ccc1 by ,henry ,sherman4 #aj ,chemistry of ,food and ,nutrition 7revised edition71 by ,sherman4 #aa ,the ,vitamine ,manual1 p4 #fd1 by ,walter ,eddy #ab ,courtesy of ,dr4 ,e4 ,v4 ,mc,collum4 #ac ,milk from cows whose diet has been deficient in vitamines shows a like deficiency in vitamine content--the same is true of mother's milk4 #ad ,the ,vitamine ,manual1 p4 #fd1 by ,walter ,h4 ,eddy4 ,,chapter ,,ii ,,the ,,fuel ,,value ,,of ,,food ,science has proved that the human body is composed of certain chemical elements and that food materials are combinations of like elements2 it has likewise proved that the body will utilize her own structure for fuel to carry on the work of her various functions unless material is supplied for this purpose from an outside source1 namely1 food1 which in chemical composition so closely resembles that of the human body4 ,amount and ,type of ,food4--,the next point of investigation would logically be the amount and kind of food necessary to best accomplish this purpose4 ,to be able to do this it was necessary to have some standard unit by which to measure the amount of heat each food was capable of producing when burned outside the body1 after which it was more or less simple to calculate the heat production of each of the food combinations within the organism4 ,an apparatus known as the ,bomb ,calorimeter#ae was devised by ,berthelot1 and adapted for the examination of food materials by ,atwater and ,blakesley4 ,the food material to be tested was placed within the bomb1 which was charged with a known amount of pure oxygen4 ,the bomb was then sealed and immersed in a weighed amount of pure water1 into which a very delicate thermometer was inserted4 ,the food within the bomb was ignited by means of an electric fuse1 and the heat given off by the burning of the material was communicated to the surrounding water and was registered upon the thermometer4 ,it was evident that some definite name had to be devised by which these heat units might be known4 ,hence the name calorie1 which represents the amount of heat required to raise the temperature of #a kilogram of pure water #a degree centigrade1 or about #d pounds of water #a degree ,fahrenheit4 ,transformation of ,foods into ,available ,fuel4--,a comparison has been made between the human body and steam engine1 but this comparison is not adequate1 since the food does not produce heat within the body originally1 but energy of which heat is a by-product4 ,each food combination has a certain amount of dormant energy within its structure and this energy does not become active nor can it be utilized by the body until the food1 of which it is a part1 is changed within the organism to substances more nearly like its own4 ,this liberated active energy is then used as a motive power to carry on the internal and external work of the body1 and the heat1 which is invariably the consequence of any active energy 7motion71 leaves the body as such4 ,it will be seen1 then1 that the human body acts not as a steam engine1 but rather as a transforming machine by means of which the dormant energy of the food is transformed into an active agent of which heat is a natural result4 ,in the calorimeter it was found that the carbohydrates and fats burned to the same end products1 namely1 carbon dioxide and water1 while the proteins1 upon oxidation1 produced carbon dioxide1 water and nitrogen gas4 ,in the body it was found that the carbohydrates and the fats acted in exactly the same manner as in the calorimeter1 producing the same end products4 ,but this was not the case with the proteins2 the oxidation process of this chemical combination was found to be not nearly so complete within the body as in the calorimeter1 and instead of the free nitrogen as produced in the apparatus there were urea and other nitrogenous substances eliminated which1 while combustible1 represented a less complete oxidation of the proteins4 ,the following table represents the amount of heat produced as the result of a complete oxidation of the foodstuffs in the calorimeter4 ,,table#af ,carbohydrates #d4a cal4 per gram ,fats #i4de cal4 per gram ,protein 7nitrogen x #f4be7 #e4fe cal4 per gram ,the loss of potential energy due to the incomplete oxidation of the proteins in the body is approximately #a4c calories to each gram of protein in food2 consequently in calculating the fuel value of protein foods1 due allowance must be made for these losses4 ,allowance must also be made for the incomplete digestion1 or losses occurring in the digestion1 of the foodstuffs4 ,these losses1 as well as the approximate amount of each constituent absorbed1 are represented in the following table4#ag ,lost ,absorbed ---------------------------------------- ------------- ,carbohydrates #b per cent4 #ih per cent4 ,fats #e per cent4 #ie per cent4 ,proteins #h per cent4 #ib per cent4 ,the physiological fuel factors of food1 or the amount of heat produced as the result of combustion of #a gram of organic food material after the above-mentioned losses have been accounted for1 may be obtained as follows4#ah ,carbohydrates #d4a x #ih #d cal4 per gram ,fats #i4de x #ie #i cal4 per gram ,proteins #d4ce x #ib #d cal4 per gram ,,effect ,,of ,,heat ,,and ,,cold ,,upon ,,the ,,foodstuffs ,in primeval days1 when man led a more natural life1 his very existence depended upon his ability to wrest from the earth his #d--i--d2 these1 then1 constitute what are known as the physiological fuel factors of carbohydrates1 fats1 and proteins respectively4 ,determination of ,fuel ,value of ,food4--,in determining the amount of heat produced by a given amount of food1 it is first essential to reduce the amount to grams 7for example1 #a lb4 equals #dhj grams73 first1 because the gram is a unit of weight commonly used in dietetic calculations2 second1 because the fuel factors are based on the amount of heat produced by the burning of one gram of organic foodstuffs4 ,knowing the composition of food1 that is the number of hundredths of protein1 carbohydrate and fat it contains1 it is a simple matter to estimate its fuel value by multiplying the amount of each contained in one gram by its physiological fuel factor #d4d4i4 ,thus if the composition of a food is #c-c_/aj protein1 #d fat and #e carbohydrate1 one gram would contain 4#jcc gram of protein1 4#jd gram of fat and #j4e gram of carbohydrate4 ,hence one gram of milk would produce 4#jcc x #d 4#acb calorie from protein 4#jd x #i 4#cf calorie from fat 4#je x #d 4#bj calorie from carbohydrate or 4#fib calorie in all ,but it is not necessary to estimate the fuel value of so small a quantity as one gram1 and1 since the value of protein1 carbohydrates and fats is always the same it is more satisfactory to estimate the amount of the organic constituents contained in the entire given quantity of food1 rather than stopping to figure out the fuel value of the small quantity4 ,this is done by multiplying the entire number of grams of food given by the amount of protein1 fat and carbohydrate contained in one gram1 then multiplying these results by the physiological fuel factor of each4 ,thus #ajj grams of milk would yield #ajj x 4#jcc #c4c x #d #ac4b calories from protein #ajj x 4#jd #d4j x #i #cf4j calories from fat #ajj x 4#je #e4j x #d #bj4j calories from carbohydrates or a total of #fi4b calories from #ajj grams of milk4 ,the ,standard or #ajj ,calorie ,portion4--,just as it has been more convenient to estimate a larger rather than a smaller quantity of food material1 so it is frequently more desirable to estimate a hundred calories1 rather than one calorie4 ,this is especially useful when dietaries of high caloric 7fuel7 value are to be estimated1 or dietaries in which foods of like composition and fuel value are to be interchangeable4 ,in such cases it is a simple matter to select the desired number of #ajj calorie portions of those foods which are to make up the dietary4#ai ,method of ,estimating the #ajj ,calorie ,portion4--,the number of calories yielded by #ajj grams of food material is taken as a basis upon which to estimate the #ajj calorie portion1 and ,x represents the number of grams required to yield this portion4 ,the problem is one of simple proportion1 for example1 take the #ajj grams of milk just estimated1 we found that #ajj grams 7or c4c47 furnished #fi4b calories of heat1 then1 #ajj3fi4b 33 ,x3#ajj--ade2 or #ade grams of milk are required to furnish #ajj calories of heat4 ,suppose it is desirable to substitute eggs for a part of the milk in the diet1 eggs have a higher fuel value per unit of weight than milk1 their average composition being #ac4d protein1 and #aj4e fat 7no appreciable amount of carbohydrates71 #ajj grams of eggs would yield #ajj x 4#acd #ac4d x #d #ec4f calories from protein #ajj x 4#aje #aj4e x #i #id4e calories from fat1 or a total of #adh calories4 ,the ,standard or #ajj calorie portion of eggs would be1 #ajj3adh 33 ,x3#ajj #fh or the number of grams required to yield #ajj calories4 ,thus it is seen that in using the fuel value of a hundred grams of food material for estimating the standard or #ajj calories portion the extremes are always the same4 ,hence1 the weight of the #ajj calorie portion may always be obtained by multiplying the extremes and dividing the result by the number of calories furnished by #ajj grams of food material4 ,,problems 7a7 ,compare the fuel value of the various common food materials4 7b7 ,how does the fuel value of a chicken salad compare with that of fruit salad8 7c7 ,figure the fuel value of a cupful of cream of tomato soup and compare it with that furnished by the same quantity of beef broth4 7d7 ,weigh and measure a #ajj-;calorie portion of spinach and compare it with a #ajj-;calorie portion of sweet potato4 ,,footnotes3 #ae ,for full description and methods used1 see ,journal of ,the ,american ,chemical ,society1 ,july1 #aijc4 #af ,chemistry of ,food and ,nutrition 7revised edition71 by ,sherman4 #ag ,chemistry of ,food and ,nutrition1 by ,sherman4 #ah ,chemistry of ,food and ,nutrition 7revised71 by ,sherman4 #ai ,see ,table of ,standard or #ajj ,calorie ,portions1 in ,appendix4 ,,chapter ,,iii ,,the ,,food ,,requirements ,,of ,,the ,,body ,the human body1 as far as can be judged1 does not use one nutrient to the exclusion of another1 but science has proved that the best results are obtained from diets balanced to suit the needs of the body1 providing the fuel and repair materials in the amounts which are calculated to give the maximum value with the minimum expenditure on the part of the organism4 ,for while no two individuals are exactly alike1 there are factors which govern or influence the food requirements of all1 and thus make it possible to estimate the needs of the body with a fair degree of accuracy4 ,it has been found1 by means of calorimeter experiments 7direct and indirect71 that a certain amount of heat is produced within the body1 regardless of external movement or food2 that is1 when a body is lying absolutely quiet with no movement save that of breathing1 the internal work of the organism1 which is continuous1 releases so much heat1 and this is produced whether there is food to replace it or whether the body structure is burned4 ,this is known as the basal rate of metabolism1 and constitutes the normal basal requirements4 ,any external movement will increase this rate2 the greater the activity the higher the increase4 ,consequently external work calls for food in addition to that which is used to run the engine1 in order to save the body from destruction4 ,du,bois#bj finds ,basal ,metabolism above normal in exophthalmic goiter1 in fevers1 in lymphatic leukemia1 and in pernicious anemia1 in severe cardiac disease1 and in some cases of severe diabetes and cancer2 it is lower than normal in cretinism1 and in myxedema1 in old age1 in some wasting diseases and perhaps in some cases of obesity4 ,this fluctuation in the ,basal ,rate of metabolism furnishes a factor in the diagnosis of disease1 not only recognized but coming more and more in use4 ,,factors ,,determining ,,the ,,food ,,requirements ,,of ,,the ,,body ,for the ,adult4--,muscular activity1 ,age and ,size1 are most important factors influencing the food requirements4 ,the physical condition and environment of the individual also exert a certain amount of influence upon the intake of food4 ,work4--,muscular activity1 as already stated1 increases the body expenditures2 consequently the more active the work the greater amount of energy food needed per unit of weight4 ,age4--,as the individual grows older1 the rate of metabolism decreases until1 in old age1 it is not more than a third to a fifth of what it was in earlier life4 ,this is due to a general slowing down of the machinery1 the heart does not beat so rapidly1 nor is the respiration so quick4 ,the digestive organs1 the heart1 the liver1 and the kidneys1 cannot handle the volume of food which was required during the period of greatest physical activity4 ,hence1 any great excess over and above that which is needed for the maintenance of the body in health will be a source of danger to the elderly person4 ,von ,noorden claims the food requirements of individuals from #fj to #gj years of age to be reduced #aj2 for people from #gj to #hj years of age to be reduced #bj2 for people from #hj to #ij years of age to be reduced #cj4 ,sex4--,science has proved1 that there is little difference in the food requirements of men and women1 provided they are alike in age1 weight and size1 and are doing the same amount and type of work4 ,but women1 as a rule1 weigh less than men1 hence their food requirements are approximately less4 ,murlin finds the food requirements of pregnant women to be some what higher than of non-pregnant ones1 and the requirements of the nursing mother to be higher than either 7see chapter on ,pregnancy and ,lactation74 ,for the ,child4--,the factors influencing the food requirements are different1 to a certain extent1 from those of the adult4 ,the main difference lies in the fact that the adult needs food only for the maintenance and repair of the body1 while the child must have food1 not only to cover its maintenance requirements1 but to support the growth and development which should be continuous from birth to maturity4 ,resistance1 too1 must be developed during this period in order to safeguard the child through life4 ,the rate of metabolism in the infant is greater than at any other period of life1 consequently1 even if a child were one-third the weight of its parent1 it would inevitably cease to grow and would become malnourished1 if its food requirements were reckoned at only one-third that of the parent4 ,adjusting the ,food ,requirements4--,taking these factors as guides for estimating the food requirements of man1 it is evident that no hard and fast law can be laid down to cover all1 that each individual must adjust the food intake according to the weight and activity of the body4 ,sherman has arranged the following table showing the energy expenditures per hour for the average man 7#aed pounds71 per pound of body weight 7these are approximate averages only74 ,,table#ba ,sleeping quietly #fj-gj calories per hour ,awake1 lying still #gj-he calories per hour ,sitting at rest #ajj calories per hour ,standing at rest #aae calories per hour ,tailoring #ace calories per hour ,typewriting rapidly #adj calories per hour ,light exercise 7stationary bicycle7 #agj calories per hour ,shoemaking #ahj calories per hour ,walking slowly 7about #b-a_/d miles an hour7 #bjj calories per hour ,carpentry or metal work #bdj calories per hour ,active exercise 7stationary bicycle7 #bij calories per hour ,walking briskly 7about #c-c_/d miles an hour7 #cjj calories per hour ,stone working #djj calories per hour ,severe exercise1 such as sawing wood #dej calories per hour ,running 7about #e-a_/b miles an hour7 #ejj calories per hour ,very severe exercise 7stationary bicycle7 #fjj calories per hour ,the above table1 calculated for an average man weighing #aed pounds1 may seem less simple to use than one based on the energy requirements per pound of body weight per hour1 of an average individual4 ,for example1 a man weighing #abc pounds and performing practically the same amount and type of work as done by the man weighing #aed pounds would require practically one-fifth less calories than the latter individual4 ,hence1 to facilitate the estimation of the food requirements for average individuals1 the following table is included4#bb ,sleeping #j4db calorie per hour1 per lb4 of body wt4 ,sitting at rest #j4fe calorie per hour1 per lb4 of body wt4 ,light muscular exercise #a4aj calories per hour1 per lb4 of body wt4 ,active muscular exercise #a4ij calories per hour1 per lb4 of body wt4 ,severe muscular exercise #c4jj calories per hour1 per lb4 of body wt4 ,possibly a few explanatory words1 as to the terms used in the above tables1 will assist the nurse in making the necessary calculation4 ,sleeping quietly makes allowance for no movement save that of respiration2 any undue restlessness will call for an increase in the above allowance4 ,sitting at rest includes the time spent at meals1 sitting in class room1 ward office1 studying or reading4 ,it does not include much walking about the room1 rising frequently1 or nervous restlessness4 ,light exercise includes all light house work1 running an ordinary sewing machine1 walking about office or ward1 7receiving ward included74 ,it does not include washing1 sweeping or scrubbing4 ,active exercise includes washing1 sweeping1 scrubbing1 general house work1 carpentry1 and such sports as tennis1 basket ball1 and ordinary gymnasium work4 ,severe exercise includes road workers 7working with pick and shovel7 fast running1 baseball1 football1 and swimming4 ,very severe exercise includes the work done by miners1 handling of freight1 and lumbermen1 especially those working in extreme cold1 where the severe cold makes extra demands on the fuel supply4 ,by making use of the averages just mentioned it should be a simple matter to calculate the food requirements of any normal individual4 ,it is necessary to know the weight of the person in question1 and the manner in which the twenty-four hours are spent1 and1 in the case of elderly individuals1 make the reductions believed to be necessary for health4 ,method of ,using the ,tables4--,let us take a nurse in training for this purpose4 ,suppose the nurse weighs #aaj pounds1 and spends the twenty-four hours as follows1 ,sleeping #h hours ,sitting at meals #b hours ,studying #b hours ,in class #a hour ,on duty #i hours ,off duty 7walking briskly7 #b hours ,her daily food requirements would probably be approximately #b1bce calories4 ,this estimate would be increased1 if she were obliged to do much heavy lifting1 scrubbing of beds1 or other duties requiring the expenditure of much effort4 ,it would be decreased if the hours spent in study and class room work were increased and the hours on the ward shortened4 ,the estimation may be made as follows1 ,sleeping #h hrs4 #aaj x #j4db x #h #cgj calories ,sitting at meals #b hrs4 #aaj x #j4fe x #b #adc calories ,sitting in class #a hr4 #aaj x #j4fe x #a #ga4e calories ,studying1 #b hrs4 #aaj x #j4fe x #b #adc calories ,on duty #i hrs4 #aaj x #a4aj x #i #ajhi calories ,off duty 7walking briskly7 #b hrs4 #aaj x #a4ij x #b #dah calories --------------- ,total for day #bbcd4e calories ,this estimate may be made to suit any individual1 the man in the office or the one working on the streets1 the woman living at home or the one spending eight or ten hours scrubbing the floors of a great office building2 it is simply a matter of adjusting the calories in the dietary to meet the requirements of body weight and muscular activity4 ,energy ,requirements for ,children4--,in estimating the energy needs of children1 the above method is not satisfactory1 since the storage of material for growth must be considered1 as well as the activities of the body4 ,the growth period includes the years from birth to the eighteenth year1 after which time the food requirements of the body are made on a basis of weight and muscular activity1 as in all adults4 ,the table on the following page shows the food allowances made for healthy children2 in the feeding of malnourished or underweight children1 more food in proportion to age is given in order to overcome the handicap under which they are suffering4 ,,food ,,allowances ,,for ,,healthy ,,children#bc ,,age ,,calories ,,per ,,day ------------------------------------- ,years ,boys ,girls ------------------------------------- ,under #b #ijj-abjj #ijj-abjj #b-c #ajjj-acjj #ihj-abhj #c-d #aajj-adjj #ajfj-acfj #d-e #abjj-aejj #aadj-addj #e-f #acjj-afjj #abbj-aebj #f-g #adjj-agjj #acjj-afjj #g-h #aejj-ahjj #achj-afhj #h-i #afjj-aijj #adfj-agfj #i-aj #agjj-bjjj #aeej-ahej #aj-aa #aijj-bbjj #afej-aiej #aa-ab #bajj-bdjj #agej-bjej #ab-ac #bcjj-bgjj #ahej-baej #ac-ad #bejj-bijj #aiej-bbej #ad-ae #bfjj-cajj #bjej-bcej #ae-af #bgjj-ccjj #baej-bdej #af-ag #bgjj-cdjj #bbej-bejj ,,calories ,,per ,,pound ,,of ,,body ,,weight ,,per ,,day4#bd ,years ,calories per pound1 per day ---------------------------------------- ---- ,under #a year #de #a-b #dj-dc #c-d #cg-dj #d-e #cg-dj #e-f #ce-cg #f-g #cd-ce #g-h #cb-cd #h-i #cj-ce #i-aj #cj-ce #aj-aa #bh-cb #aa-ab #bh-cb #ab-ac #bh-cb #ac-ad #be-cj #ad-ae #bj-be #ae-af #bj-be #af-ag #bj-be ,after which time the food requirements are based on degree of muscular activity1 boys and girls of seventeen years and over requiring as much food as men and women4 ,children1 like adults1 differ in degrees of activity2 that is1 one child may be very active1 running and playing more strenuously than another4 ,hence a margin of safety must be allowed to cover the energy expenditures of the more active child1 to safeguard it against becoming malnourished4 ,to facilitate the computation of the food requirements of children a schedule showing the number of calories per pound of body per day is included on opposite page4 ,the food requirements are such as to allow of a steady increase in the weight and stature of the child2 the rate of gain for normal children should be as follows3 ,,average ,,rate ,,of ,,gain ,,per ,,week1 ,,for ,,normal ,,children ,age ,average ,boys gain1 ,ounces ---------------------------------------- - ,first year #c-a_/b - #d-a_/b ,second year #b-a_/b - #c ,third year #a-c_/d - #b ,fourth to eighth year 7inclusive7 #a-a_/d - #a-a_/b ,ninth to eleventh year 7inclusive7 #a-c_/d - #b ,twelfth to thirteenth year 7inclusive7 #b-c_/d - #c ,fourteenth to sixteenth year 7inclusive7 #c - #d ,age ,average ,girls gain1 ,ounces ---------------------------------------- - ,first year #c-a_/b - #d-a_/b ,second year #b-a_/b - #c ,third year #a-c_/d - #b ,fourth to eighth year 7inclusive7 #a-a_/d - #a-a_/b ,ninth to twelfth year 7inclusive7 #a-c_/d - #b-a_/d ,thirteenth to fifteenth year 7inclusive7 #b-c_/d - #c-a_/d ,sixteenth and seventeenth year 7inclusive7 #a - #b ,the averages just given are for healthy children2 those who are underweight for their age and height should show a more rapid increase in weight with an increased food allowance4 ,it must also be remembered that a simple gain in weight is not sufficient evidence of a child's normality2 a freedom from gastro-intestinal disturbances1 and a resistance to disease1 are equally essential4 ,there have been tables arranged to show the proper weight for height for boys and girls of different ages 7see appendix74 ,these are valuable since1 by their use1 attention is called to the child who is not up to the average4 ,medical examination of such children frequently shows reason for their underweight1 and measures may be instituted which may save the child from a lifetime of poor health4 ,dr4 ,pirquet has arranged a scale 7,pelidisi ,chart7 showing the state of nutrition in children1 based upon the sitting height 7in centimeters71 to weight 7in kilograms74 ,see appendix4 ,,protein ,,requirements ,there is never a period in life in which protein is not needed4 ,during the early years it is essential that the proteins1 or at least a goodly portion of them1 be obtained from animal sources1 milk and eggs in particular2 when cereals and legumes 7beans and peas7 are used to provide for the protein requirements1 they must be supplemented by milk or eggs 7or both71 in order that the growth and development of the child may proceed at a normal rate4 ,adults require protein for the repair of old tissues and to furnish material for the building of new cells1 and again it is believed advisable to have at least a portion of this protein from animal sources1 milk1 meat or eggs4 ,,mineral ,,requirements ,just as energy foods and proteins must be adjusted in the dietary to safeguard the health of the body1 so the mineral salts must be adjusted for a like purpose4 ,studies made of the dietaries of a number of families brought to light the fact that the children more often suffered from a deficiency of calcium1 phosphorus and iron in their diets than they did from too little protein1#be proving that it is quite as essential to adjust the mineral salts in the diet as it is that of the organic constituents4 ,according to ,sherman the diet of an adult should contain each day per pound of body weight3 ,protein #j4e gram or more ,phosphorus #j4ja gram or more ,calcium #j4jje gram or more ,iron #j4jjja gram or more ,these averages1 while covering the needs of the mature body1 do not furnish the necessary amount of protein1 or mineral salts to support the growth and development of the child4 ,hence1 it has been deemed advisable to reckon the requirements of the latter per thousand calories1 instead of per pound of body weight1 in this way obviating some of the danger of protein and mineral deficiencies4 ,mc,collum1 ,simmonds and ,pitz have shown that a deficiency in the inorganic content of a diet may result in a retarding or suspension of growth4 ,this result has been overcome on the introduction of the proper mineral salts into the diet4 ,this salt mixture is such as to make the total ash1 approximate that found in the composition of milk ash4 ,the following diagram illustrates this point4 #bdj ---------------------------------------- -- _/ _/ _/ #bjj ----------------------------------_/---- -- ,w _/ _/ e _/ _/ i _/ _/ g ,normal_/ _/ h _/ _/ t #afj ------------------------_/------------_/ --- _/ _/ i _/ _/ n _/ _/ ---,period ,i----_/------,period ,,ii--_/------ ,g _/ _/ r #abj -------------_/--------------_/--------- - a _/ _/ m _/ _/ s _/ _/ _/ _/ _/ _/ #hj ------_/------------_/------------------ --- _/ _/,effect of _/ _/added ,salt _/ _/ ,mixture _/ _/ ,x_/ #dj ---------------------------------------- - #j #a #b #c #d ,time in ,months ,effect upon growth of adding to a diet otherwise adequate a salt mixture of such composition as to make the composition of the total ash similar to that of milk ash2 immediate resumption after entire suspension of growth4 ,courtesy of ,dr4 ,e4 ,v4 ,mc,collum4 ,the following outline will serve as a guide in making the estimates for the food requirements of children3 ,,the ,,diet ,,of ,a ,,child ,,should ,,contain ,,for ,,every #ajjj ,,calories ,,furnished ,,by ,,the ,,foodstuffs1 ,protein #be4jj grams or more ,phosphorus #j4dh gram or more ,calcium #j4be gram or more ,iron #j4jje gram or more ,vitamine ,needs4--,we have seen the manner in which the energy and protein foods have been adjusted in the diet1 but these can not alone assure the body1 and especially the growing body of a normal maintenance and repair of its tissue1 or support the growth which is essential at this time4 ,this function is believed to belong to the vitamines1 since feeding experiments have demonstrated the fact that animals soon cease to grow1 develop deficiency diseases1 and finally die1 when deprived of the essential constituents4 ,gillett advises1 as a safe rule1 the use of one1 and preferably two foods known to be rich in the fat soluble vitamine1 in each day's food allowance1 milk and leafy vegetables1 for example4 ,if the foods containing phosphorus1 calcium1 and iron are taken in sufficient quantity1 the second1 or ,b vitamine needs1 will probably be adequately covered1 but the presence of the ,c vitamine must be carefully attended to2 some fresh fruit or vegetables 7see table7 is obligatory each day to insure the individual against the development of scurvy4 ,factors ,affecting the ,food ,selection4--,the estimation of the energy needs of the body1 and the selection of the foods to furnish the fuel for this purpose1 depend largely upon the individual4 ,the digestion of the fats1 as well as the way in which the body utilizes them1 makes the use of this foodstuff more or less limited according to the ability of the individual to take care of them1 the minimum allowance for children being between #b and #c ounces per day4 ,according to ,gillett1 ,if boys and girls get at least this amount from butter and its substitutes1 cream1 bacon1 fat meat and oils1 additional amounts from their food will provide a margin of safety1 without overtaxing the digestive system4 ,after determining the amount of fat required in each day's food allowance1 it is a simple matter to adjust the carbohydrates4 ,it is safer from a health standpoint1 to obtain the greater portion of this foodstuff from starchy foods rather than from the sugars1 many foods rich in starch1 likewise contain appreciable amounts of protein and fat1 whereas sugar is practically one hundred per cent4 carbohydrate4 ,the ease1 too1 with which this substance ferments in the stomach1 and the manner in which it destroys the appetite for other foods1 makes the use of much of it in concentrated form unadvisable1 especially in the diet of children4 ,the amount of sugar allowed each day1 should be limited to an ounce or ounce and a half 7#b to #c tablespoonfuls71 and a less quantity is desirable4 ,in order to obtain the best results1 with the least deleterious effect on the body1 it is advisable to give sugar in dilute form4 ,a piece of pure candy after a meal may not harm the child2 but just before1 or between meals1 as well as the habit of making the breakfast cocoa and cereal of syrup-like sweetness is deplorable1 and should in all instances be discouraged4 ,the ,american ,red ,cross recommends the following method for estimating the amount of sugar in the dietary3 ,add one-half the weight of such foods as jellies1 jams and preserves1 and three-quarters the weight of such foods as candy1 honey and syrup1 to the weight of sugar used4 ,the amount of sugar consumed1 as such1 by the adult each day1 is not of such paramount importance as it is in the case of children1 but even for adults an excessive amount of carbohydrate in this form is not considered advisable from a health standpoint4 ,in order to assure each member of the family of getting all of the materials needed for the growth1 repair and regulation of their bodies1 as well as the necessary fuel material with which to run the engine and to maintain the proper body temperature1 the following practical method is suggested for the planning of the daily dietary4 ,,the ,,diet ,,each ,,day ,,should ,,contain3 #a4 ,milk3 ,one quart for each child under two years of age4 ,from #a pint to #a quart for each child from two to five years of age4 7,m4 ,s4 ,rose of ,teachers' ,college advises at least a quart for every child of six years and under1 at least #a pint for children from six to sixteen1 and one half of a pint thereafter47 #b4 ,cereals and ,breadstuffs3 7,activity of person determining the amount47 ,for children under two years of age #a-c oz4 a day ,for children from two to five years #b-e oz4 a day ,for children from five to twelve years #e-i oz4 a day ,for all over twelve years of age #i-af oz4 a day #c4 ,meat or its ,substitute3 ,for children under five years no meat is needed4 7a7 ,meat3 ,for children from five to ten years #a-b oz4 7no more7 a day ,for children from ten to fourteen years #b-d oz4 7no more7 a day of meat or fish4 ,for individuals over fourteen years #b-f oz4 should be the maximum for the day4 7b7 ,eggs3 ,for children under two years no eggs are given4#bf ,for children from two to five years #c-e eggs may be given each week1 being substituted for part or all of the meat4 7c7 ,beans1 ,peas1 ,cheese3 ,for children it is necessary to use milk abundantly when beans or peas are substituted for the meat or egg proteins4 #d4 ,vegetables3 ,for children under six months#bg no vegetables need be given4 ,for children from six to nine months #a oz4 gradually increased to #f oz4 of strained vegetable soup 7see formula1 page #bbc74 ,for children from twelve to fifteen months #a small baked potato may be added1 and such vegetables as peas1 string beans1 carrots1 spinach1 squash1 lima beans 7strained74 ,two vegetables1 one of which should be potatoes 7white71 should be given each day4 ,a leafy vegetable 7spinach greens1 string beans1 kale1 lettuce7 should be given from three to four times each week and oftener if possible4 #e4 ,fruit3 ,for children from six months on 7earlier if physician approves7 #a-b tablespoons orange or prune juice a day4 ,for children from first to second year #a-c tablespoons twice daily4 ,for children from two to five years #c-d tbsp4 or more1 twice daily 7amount governed by health of child74 ,all children should be given fresh fruit three or four times a week2 some fruit given every day4 ,adults may be served dried fruit most days1 but some fresh fruit should be given each week4 #f4 ,desserts3 ,one sweet dish 7custards1 cereal puddings1 junkets7 once or twice a day1 but little if any clear sugar should be given 7cereals should be served with very little if any sugar74 #g4 ,fats3 ,for each person over five #b-c oz4 of fat 7purchased as such7 a day1 depending upon the age and ability of the individual to digest fats4 ,suggestions for ,serving ,meals4--,after reckoning the number of calories needed for the day1 it is well to remember that the protein must be adequate in type and amount2 that there should be an abundant supply of vitamines and iron in each day's ration2 that milk should always be included in order to make sure of having a sufficient amount of calcium in the diet2 that there should be only one heavy protein dish at any one meal1 and that it is unwise to serve a meal in which the fluids predominate on account of their deficiency in energy and proteins4 ,if a meal is made up of the right kind of foods1 in the proper proportion1 and each individual eats sufficient to assure the maintenance of the normal weight1 is free from gastro-intestinal disturbances1 and shows a normal resistance to disease1 it is more than probable that a sufficient quantity is being consumed each day4 ,all foods should be carefully selected1 and properly prepared in order to derive the maximum benefit therefrom1 and the regularity and attractiveness with which the meals are served have almost as much to do with the health and happiness of the individual1 as the character of the foods included in the day's dietary4 ,,problems 7a7 ,calculate the dietary requirements of a nurse weighing #abe pounds1 who spends #h hours sleeping1 #h hours on duty1 #b hours at meals1 #b hours brisk walking1 #b hours in the class room1 and #b hours reading or studying4 7b7 ,calculate the diet for a child of ten years of age1 weighing #fe pounds1 showing the number of calories1 the amount of protein1 calcium1 phosphorus and iron necessary to make this diet cover the requirements of the child4 ,,footnotes3 #bj ,archives of ,internal ,medicine1 ,vol4 ,,xxvii 7#aiaf71 p4 #iaf4 #ba ,chemistry of ,food and ,nutrition1 7revised71 p4 #ahf1 by ,henry ,sherman4 #bb ,the ,same4 #bc ,gillett1 ,a4 ,i4 ,c4 ,p4 of ,n4 ,y4 #bd ,table compiled from material in ,feeding the ,family1 by ,rose4 #be ,the ,adequacy and ,economy of ,some ,city ,dietaries1 by ,sherman and ,gillett4 #bf ,part of soft-cooked egg may be given at the beginning of eleventh month2 this must be given at the noon meal1 and should not be included in each day's meal 7two or three times a week is sufficient74 #bg ,dr4 ,hess advises the use of canned tomato juice as a substitute for orange juice when the latter is unobtainable4 ,,section ,,ii ,,laboratory ,,or ,,diet ,,kitchen ,,work ,,chapter ,,iv ,,methods ,,of ,,feeding ,,in ,,normal ,,and ,,abnormal ,,conditions ,there are several methods of feeding which have been adopted to meet the needs of the individual under various conditions3 ,feeding by mouth1 gavage or forced feeding1 rectal feeding 7nutrient enemata71 and inunction4 ,feeding by ,mouth4--,the first method is the one used in health and in the majority of abnormal conditions4 ,in cases where there is a certain abnormal development of the mouth or throat1 and in some cases of insanity or unconsciousness1 where for some reason it is impossible for the individual to swallow1 this method cannot be used4 ,forced ,feeding4--,with very young children and babies gavage or forced feeding is found at times to be necessary4 ,in these cases a small rubber catheter is introduced into the stomach through the nostrils and the milk or other fluid poured through the tube4 ,in unconscious or insane patients it is often found necessary to insert a gag 7a cork will serve the purpose7 between the teeth to prevent the biting of the tube when it is inserted through the mouth into the stomach4 ,food ,used for ,forced ,feeding4--,the food in these cases consists of reenforced soups1 milk gruels1 or nutrient beverages1 not more than six or eight ounces given at one time4 ,finely chopped meat and vegetable purees have been given in this way when the digestion of the patient was not impaired1 but when conditions rendered it necessary to resort to this method of feeding4 ,technique of ,gavage4--,the apparatus used in gavage consists of a moderate sized soft rubber tube to which is attached a rubber or glass funnel and a pinch cock4 ,the tube should be filled with water to prevent air entering the stomach and causing pain or discomfort4 ,in certain cases the patient refuses to swallow the tube and it will be found necessary to use some means to force the passage if the throat is shut off4 ,by closing the nostrils the patient will be obliged to breathe through the mouth1 thus opening the passage into the throat through which the tube may be quickly slipped4 ,in certain abnormal conditions the gastric organ is so badly impaired as to render it impossible for the patient to retain food taken in by way of the mouth4 ,it is often found that food introduced into the stomach by means of the stomach tube will be retained and utilized which otherwise would be rejected4 ,it is disagreeable1 however1 and should only be used when it is impossible to feed otherwise4 ,rectal feeding is used when the other organs of digestion are impaired to such an extent as to render the need of more food obligatory4 ,many investigators believe that rectal feeding is absolutely useless1 while others have firm faith in its efficacy4 ,technique of ,rectal ,feeding4--,the rectum should be cleansed by flushing with a soapsuds enema one hour before the nutrient enema is given4 ,this should be done once a day1 in the morning4 ,the cleansing enema may be either soapsuds1 a solution of bicarbonate of soda1 or boric acid 7#a teaspoonful to the pint71 or a saline solution4 ,when there is much mucus1 or if the rectum is inflamed1 the soda or boric acid solution may be more soothing than the saline or soapsuds enema4 ,after one hour's rest the patient should be given a nutrient enema4 ,the method of administering nourishment through the rectum is important4 ,a nutrient enema injected only into the lower bowel not only does no good1 but may actually cause a good deal of unnecessary discomfort to the patient4 ,temperature of ,enema4--,care must be taken not to have the temperature of the nutrient enema too hot or too cold or it will be promptly rejected4 ,the patient is placed on the side with one knee flexed2 the solution is poured into a fountain syringe bag or an enamel container 7heat the container before pouring the solution into it or the latter will be chilled74 ,the bag or container has attached to it a rubber tube with a cock adjusted so that only a small stream will flow in at a time4 ,to the end of this tube a rubber rectal tube or catheter--#a cm4 7about #a_/b inch7--is attached4 ,this should be well greased 7do not use glycerin as this substance is irritating to the mucous lining of the rectum74 ,the liquid should be allowed to fill the tube before it is inserted into the rectum1 to prevent any air passing in with it4 ,the tube should be inserted with a gentle twisting movement1 using very little force or the tender mucous membranes will be injured4 ,insert the tube twelve or more inches1 since the solution is more completely absorbed if given high up in the bowel4 ,the bag containing the solution should be held only a few inches higher than the rectum1 thus allowing only a small stream to pass in and allowing an air space above the stream for the passage of gas which may be accumulated in the upper part of the rectum4 ,the tube should be allowed to remain in the rectum for fifteen or twenty minutes1 then very gently withdrawn to prevent the liquid from being rejected4 ,a pad of gauze may be pressed against the anus to assist the patient in retaining the enema4 ,it is well to divert the attention of the patient also1 to further assist her in retaining the liquid4 ,duration of ,rectal ,feeding4--,rectal feeding cannot be substituted for a great length of time1 first1 because the patient cannot absorb sufficient nourishment in this way to fully cover the body requirements1 and1 second1 because the rectum becomes more or less sensitive and will reject the liquid before it has an opportunity to be absorbed4 ,from three to four nutrient enemas a day is about the limit for the average patient4 ,between the nutrient enemas it is advisable to give one of saline solution4 ,the following regime is practiced during the ,total ,abstinence ,period in the treatment of gastric ulcer3 #g ,a4,m41 cleansing enema2 #h ,a4,m41 nutrient enema2 #a ,p4,m41 nutrient enema2 #c ,p4,m41 saline enema2 #f ,p4,m41 nutrient enema4 ,one saline and one nutrient enema may be given during the night if the patient is very weak4 ,she should not be wakened1 however1 to be given the enema4 ,feeding by ,inunction4--,this method consists in the rubbing into the body of certain nutrient oils1 such as olive oil1 cocoanut oil1 cocoa butter1 etc4 ,it is of little value1 but is occasionally resorted to with very much emaciated and underfed infants1 when digestional disorders make it impossible to introduce enough food by mouth to cover the needs of the body4 ,,special ,,diets ,there are a number of diets formulated to meet the various normal and abnormal conditions4 ,in hospitals these are classified as follows1 for the convenience of both nurse and doctor3 ,house ,diet4--,that which is served to the hospital staff1 the nurses1 and those patients not requiring special diets4 ,liquid or ,fluid ,diet4--,consisting of milk1 nutrient and other palatable beverages1 broths1 and thin gruels4 ,light1 ,semi-solid or ,convalescent ,diet4--,composed of thick or cream soups1 eggs1 toast1 cereals1 custards1 jellies and ice cream1 and later vegetable purees1 broiled birds1 chicken1 lamb chops1 and rare beefsteak4 ,mixed ,diet4--,the diet used in normal conditions and for those not affected by any special food4 ,special ,diets4--,those designed to be used for certain pathological conditions1 such as scarlet fever1 nephritis1 etc4 ,these diets are classified as follows3 ,milk ,diet4--,a diet in which milk is the sole article of food4 ,carbohydrate-free ,diet4--,one in which the sugars and starches are eliminated4 ,purin-free ,diet4--,one in which the foods rich in purin bases are eliminated4 ,this is used in gout1 arteriosclerosis1 etc4 ,salt-free ,diet4--,diet in which sodium chloride 7salt7 is as far as possible excluded4 ,it is used in certain cases of nephritis when edema is present4 ,nephritic ,diet4--,a diet used in nephritis and diseases complicated by nephritis 7scarlet fever74 ,in this diet the protein foods1 meat in particular1 are restricted1 milk being the exception4 ,diabetic ,diet4--,a diet in which the carbohydrates are restricted or eliminated4 ,allen ,treatment of ,diabetes consists chiefly of starvation for a given period and a reeducation of the organs to a toleration for carbohydrates4 ,emaciation ,diets4--,those containing a high percentage of fat-forming foods1 such as milk1 cream1 eggs1 cereals1 potatoes1 etc41 olive oil4 ,obesity ,diets4--,those containing as few of the fat-forming foods as possible1 such as cream1 olive oil1 potatoes1 white bread1 etc41 pastry and desserts1 candy and soda water1 and containing lean meats1 fish or shellfish cooked and served without butter or other fats1 fresh or stewed fruit without sugar1 green vegetables and salads served without oil or other fats2 one egg a day two or three times a week1 coffee and tea without sugar or cream1 toasted gluten bread 7#a slice7 without butter1 saccharine substituted for sugar4 ,there are a number of other diets1 but they come more or less under the above heads4 ,,the ,,tray ,as the patient's tray assumes an important part of the daily regime1 it is necessary to give close attention to the arrangement and serving of it4 ,there are certain definite rules to observe3 7#a7 ,the linen1 silver1 glassware1 china1 and food must be absolutely clean4 7#b7 ,the tray must be sufficiently large not to appear crowded4 7#c7 ,the arrangement of the obligatory articles1 such as salt and pepper1 silver1 water glass1 napkin1 etc41 must be alike at every meal2 this not only facilitates the service by making it easy for the nurse to see whether any of these necessary articles are left off1 but it also enables the patient to find them without trouble4 ,the ,linen4--,the linen cover of the tray must be clean and uncreased4 ,the napkin likewise must be clean and unwrinkled4 ,the china must be free from chips and cracks4 ,care must be taken not to put a collection of odd pieces on the tray as it gives an untidy appearance4 ,the ,silver4--,the silver must be bright and in cold weather made slightly warm1 as must also the china4 ,the chill of cold silver may readily obliterate a fragile appetite1 and to place hot food in cold dishes will deprive it of much of its palatability4 ,the foods intended to be hot must be really hot1 not warm1 and those which are intended to be cold should be thoroughly chilled before being served to a patient4 ,the placing of flowers on a tray is a questionable addition to it2 a single flower laid across the folded napkin may add daintiness and attractiveness1 but it is poor judgment to over-decorate1 either with flowers or by garnishing the dishes4 ,arranging the ,tray4--,if the nurse will place the necessary articles upon the tray and memorize their position so that she will be able to duplicate the same at each meal1 she will be able to tell at a glance if everything needed is in its proper place1 thereby saving herself unnecessary steps and the patient the worry of having to wait until they can be brought4 ,food should not be allowed to stand in the sickroom1 and glasses or plates in which food has been served should be removed from sight as soon as the patient finishes with them4 ,care must be taken1 however1 not to create the impression of hurry or the patient will be made nervous and either will lose her appetite or have indigestion4 ,the nurse should be careful of her topics of conversation during the meal hour4 ,especially must disagreeable subjects and business matters be rigidly excluded if the invalid is to obtain the full benefit of the food served her4 #a4 ,setting the ,tray4--,tray should be sufficiently large not to give the appearance of being crowded1 but not too large4 #b4 ,tray cover must be spotless1 and of a size to just cover the edges of tray2 if too large1 make a pleat down the center4 #c4 ,place service plate directly in front of patient4 #d4 ,knife1 cutting edge in1 to the right of plate2 fork1 tines up1 to the left of plate4 #e4 ,spoons1 bowls up1 next to the knife4 #f4 ,napkin on the lower left side of tray1 open edges to the lower right side4 #g4 ,bread and butter plate on top of napkin4 #h4 ,soup tureen in lower right corner1 with cup and saucer above it4 #i4 ,tea or coffee pot and hot water pot in upper right-hand corner of tray1 with sugar bowl next to hot pot and cream pitcher next to sugar bowl4 #aj4 ,place salt and pepper next to cream pitcher 7to the left74 #aa4 ,water glass in upper right corner of tray4 #ab4 ,second vegetable dish placed on the upper right side of dinner plate4 #ac4 ,place dessert to the upper left of dinner plate4 ,suggestions for ,serving4--,make tray as attractive as possible4 ,in the cases requiring special diets1 the nurse should make out the diet sheet for the day4 ,in hospitals this is passed to the dietitian1 who carries out the directions laid down by the physician4 ,the nurse1 however1 should carefully check the tray before serving it1 since mistakes sometimes occur1 and to give the wrong food to a patient suffering from certain disorders may give rise to serious trouble1 causing pain and discomfort and at times death4 ,contamination of ,food4--,food should always be protected from dirt and dust and from contamination and pollution from flies and other insects4 ,typhoid fever and certain intestinal disturbances have been known to result from flies coming in contact with raw food--milk1 for example4 ,poisoning due to polluted water used to freshen vegetables has already been spoken of4 ,all of these types of poisoning may be avoided by using care in the handling of the fresh foods4 ,ptomaines1 however1 are not easy to prevent4 ,their source cannot always be traced to one particular article of diet4 ,they may be present in cooked1 raw1 frozen1 or canned foods4 ,at times the evidence of extreme decomposition will be found in the foods themselves1 while at other times there will be no such evidence in the food1 but the result of the ptomaine will be perfectly evident whenever certain individuals partake of that food4 ,this is a personal idiosyncrasy which it is impossible to account for4 ,food ,poisoning4--,poison caused by decomposed eggs has manifested itself in individuals who have partaken of cake in which such eggs were used4 ,canned meat and fish have produced the most violent types of ptomaine poisoning4 ,as a rule in these cases the canned article has begun to decompose and while the decomposition may not have advanced sufficiently far to be discernible from the flavor or odor1 it is there1 and if the resistance of the individual eating this food is not great1 serious danger may result4 ,poisoning develops in some individuals upon the eating of shellfish1 strawberries1 oranges1 pimentos1 and various other foods1--another evidence of personal idiosyncrasy against certain articles of diet4 ,there is no way to overcome these idiosyncrasies2 the only thing to do is to warn the individuals so affected to let the offending foods alone4 ,,adulteration ,,of ,,food ,the adulteration of food1 which formerly was practised by unscrupulous dealers to cover up inferior articles1 or by manufacturers to prevent or arrest decomposition in canned goods1 is regulated by law4 ,the passage of the ,national ,pure ,food and ,drug ,act gave the ,government authority to regulate the preservatives and coloring matter used in canned and bottled goods1 forcing the manufacturers to state on the label the exact contents of each bottle or can4 ,there are likewise stringent laws governing the adulteration of milk1 butter1 and other articles of food4 ,tests for ,adulterants4--,boric acid1 borax1 and formaldehyde are the preservatives more often found in milk4 ,these chemicals are introduced to arrest the natural souring and decomposition which takes place after milk reaches a certain age4 ,occasionally salicylic acid and sodium carbonate are used4 ,formaldehyde may be detected by placing about #bj c4c4 of milk in a small glass vessel or tube4 ,dilute with an equal amount of pure water1 add commercial sulphuric acid1 allowing it to flow gently down the inside of the tube4 ,a purple ring will appear at the zone of contact if formaldehyde is present4 ,boric acid and borax may be detected by adding a drop or two of hydrochloric acid to a few drops of milk in a white dish and then several drops of a saturated alcoholic solution of turmeric4 ,the dish is then heated gently for a few minutes1 and1 if boric acid or borax is present1 a pink or dark red color will appear4 ,a dark blue-green should appear when the dish is cooled and a drop of ammonia added4#bh ,canned goods must be carefully examined before being used4 ,the domestic canned goods are rarely adulterated1 but imperfect sterilization and defective cans may bring about a condition of fermentation and gas formation due to bacterial action4 ,cans should have a concave appearance on the top4 ,if there is a bulging of the can it may be due to gas formation1 and a small hole should be made in the can to note any escape of this gas4 ,should there be any indication of fermentation1 the contents should be discarded4 ,it is advisable to look with suspicion on cans that appear old1 rusty1 and soiled2 they are probably left-over stock and liable to be bad4 ,peas which have been imperfectly sterilized produce a type of gas which is soluble in the liquid4 ,after decomposition has occurred there will be no apparent evidence by the escape of gas1 but the liquid will be found to be excessively acid1 and will present a muddy appearance4 ,certain foreign importations of canned goods are preserved in color by the introduction of certain color preservatives4 ,peas--petits pois1 for example--and the very small string beans which are imported are intensely green from the copper sulphate used4 ,its presence may be detected by adding a few drops of hydrochloric acid to some of the colored material1 then dropping in a bright steel nail1 knitting needle1 or knife blade4 ,there will be a deposit of copper salts 7like copper plating7 upon the steel if the preservative is present in the can4 ,canned corn is often artificially sweetened with saccharine1 which may be detected by shaking several tablespoonfuls of the liquid in an equal amount of chloroform4 ,saccharine is soluble in chloroform1 while sugar is not4 ,allow the mixture to stand a few minutes and remove some of the chloroform which has settled at the bottom4 ,place in a small dish1 evaporate the chloroform by gently heating the dish2 taste the residue2 if sweet1 saccharine is present4 ,coffee is adulterated more often when it is put up in ground or powdered form than when sold in the bean4 ,real coffee contains a small percentage of oil1 and will float when thrown into a glass of water4 ,substitutes generally sink to the bottom4 ,coffee substitutes are often made up of starch-containing materials1 such as cereals1 beans and peas4 ,this starch may be detected by mixing one tablespoonful of the suspected coffee in a little cold water1 adding one cup of boiling water2 allow it to boil two minutes1 filter through cotton1 and pass the liquid through charcoal to remove the color4 ,when it is cold1 add a few drops of dilute iodine solution4 ,if starch is present1 a blue color will appear4 ,,methods ,,used ,,in ,,the ,,preparation ,,of ,,food ,food is prepared for consumption by a number of methods and the method by which the food is prepared either increases or decreases its digestibility1 palatability1 and general usefulness4 ,certain foods1 as has already been stated1 require a high degree of temperature to make them wholesome1 but if this temperature is applied by means of heated fat1 as in frying1 the food is changed from a wholesome to a more or less indigestible article4 ,in health the organs of digestion are capable of overcoming much of the harm wrought by wrong preparation1 but even in the healthy1 normal individual a steady diet of fried food will eventually undermine what is known as good digestion4 ,in abnormal conditions 7illness7 frying is a method seldom1 if ever1 used4 ,preparation of ,food4--,the various methods to which food is subjected in preparation for human consumption may be summed up as follows3 boiling1 simmering1 steaming1 baking1 roasting1 broiling1 frying1 sauteing4 ,boiling is cooking in water raised to the boiling point1 #bab deg4 ,f4 7sterilizing74 ,this method is commonly used in the cooking of starchy vegetables and cereals1 and in the cooking of green vegetables1 such as spinach1 carrots1 beets1 corn1 asparagus1 etc4 ,stewing is a form of boiling4 ,as a rule water is used1 and the vessel is left uncovered1 so that as the food is cooked the surplus moisture evaporates1 leaving the food tender4 ,dried fruits1 such as prunes and apricots1 are prepared by this method4 ,simmering is cooking in water1 the temperature of which is not raised to the boiling point1 but kept between #bjj deg4 ,f4 and #baj deg4 ,f4 ,this method is used in the preparation of eggs and dishes in which eggs predominate1 since proteins are made tough if subjected to a high degree of temperature4 ,coddled eggs1 for example1 are prepared by placing the egg in a clean vessel and pouring over it the boiling water1 then covering the vessel and allowing it to stand for ten or fifteen minutes4 ,the vessel and the cold egg reduce the temperature of the water to about #ahe deg4 or #aij deg4 ,f4 and in this way prevent a toughening of the albumen of which eggs are chiefly composed4 ,soups1 broths1 ragouts1 etc41 are prepared by this method4 ,steaming is cooking over hot water or by steam4 ,this method may be accomplished on the top of the stove in a double boiler or in the oven in a deep covered pan fitted with a rack to hold the article to be cooked4 ,either method allows the vessel in which the food is placed to be surrounded by boiling water1 but does not insure sufficient heat to raise the food within to the boiling point4 ,baking and roasting are both brought about in the oven4 ,bread1 biscuits1 pies and other pastry1 potatoes1 cakes1 etc41 are baked1 while meats1 roast of beef1 lamb1 veal1 mutton1 as well as chicken1 turkey1 duck1 and large fish are roasted4 ,the heat in the oven may be intense4 ,the outside or cut surface of the meat is seared1 the soluble albumens are coagulated1 thus sealing the juices within4 ,if the meat is placed in a pan surrounded by cold water and then placed in the oven1 the juices are drawn out in the water4 ,these juices contain the flavoring matter or extractives4 ,meat so treated is not so palatable or highly flavored as that which has first been subjected to intense heat1 the water for the gravy added later4 ,frying and sauteing is cooking in hot fat4 ,food may be fried in deep fat1 as is demonstrated in the cooking of croquettes1 doughnuts1 etc41 or it may be sauted in butter or oil in a shallow frying pan or griddle4 ,the latter method is used in making hashed brown potatoes1 for example2 also in the cooking of griddle cakes1 etc4 ,broiling4--,in broiling or grilling the article to be cooked is exposed to direct heat1 either to the blaze or to a very hot surface4 ,the result is the same as in roasting4 ,the outer surface is seared1 sealing the juices within4 ,meat to be broiled is generally cut thinner than that to be roasted4 ,the article1 whether it is meat 7steak71 chops1 birds1 or chicken1 is placed about three inches away from the flames and turned frequently until the surfaces are seared1 after which the article is placed in a cooler part of the stove to allow the interior to be cooked4 ,pan broiling is done on top of the stove4 ,the article to be broiled is placed directly upon a very hot surface1 there is no grease used and the meat must be turned frequently to prevent burning4 ,poaching4--,this term is applied chiefly to the cooking of eggs in a shallow pan of water heated just below the boiling point4 ,to be properly poached an egg must be perfectly fresh1 or the white and yolks will run together and present an unappetizing1 unpalatable appearance4 ,the following time-table should be used in the preparation of food to insure correct cooking3 ,,time-,,table ,material ,method ,time ---------------------------------------- -------------------------- ,beef 7fresh7 ,boiled #d to #f hours ,corned beef ,boiled #d to #g hours ,shoulder or leg of mutton ,boiled #c to #e hours ,shoulder or leg of lamb ,boiled #b to #c hours ,fowl 7#d to #e pounds7 ,boiled #b to #d hours ,chicken 7#c-lb4 hen7 ,boiled #a to #a-a_/b hours ,ham ,boiled #d to #f hours ,lobster ,boiled #be to #cj minutes ,salmon 7whole7 ,boiled #aj to #ae minutes ,vegetables3 ,asparagus ,boiled #be to #cj minutes ,string beans ,boiled #a to #b hours ,dried beans ,boiled #a to #b hours ,beets 7new7 ,boiled #de minutes to #a hour ,beets 7old7 ,boiled #d to #f hours ,beet greens ,boiled #a hour or more ,brussels sprouts ,boiled #ae to #bj minutes ,cabbage 7for creamed cabbage7 ,boiled #aj to #ae minutes ,cabbage ,boiled #cj to #hj minutes ,cauliflower ,boiled #a to #a-a_/b hours ,celery ,boiled #b to #b-a_/b hours ,corn 7green7 ,boiled #aj to #bj minutes ,onions ,boiled #de minutes to #b hours ,oyster plant 7salsify7 ,boiled #de minutes to #a hour ,parsnips ,boiled #cj to #de minutes ,peas ,boiled #bj to #fj minutes ,carrots ,boiled #bj to #dj minutes ,potatoes 7white7 ,boiled #bj to #ce minutes ,potatoes 7sweet7 ,boiled #bj to #cj minutes ,rice ,boiled #bj to #cj minutes ,squash ,boiled #bj to #cj minutes ,spinach ,boiled #ae to #bj minutes ,tomatoes 7stewed7 ,boiled #bj to #cj minutes ,turnips ,boiled #de to #fj minutes ,coffee ,boiled #c to #e minutes ,beef 7ribs or loin1 rare7 per pound ,roasted #h to #aj minutes ,beef 7ribs or loin1 well done7 per pound ,roasted #ab to #ae minutes ,beef 7rolled1 rare7 per pound ,roasted #ab to #ae minutes ,beef 7rolled1 well done7 per pound ,roasted #ae to #bj minutes ,leg of lamb per pound ,roasted #aj minutes ,leg of mutton per pound ,roasted #ae minutes ,mutton 7stuffed1 forequarter7 per pound ,roasted #ae to #bj minutes ,lamb1 well done1 per pound ,roasted #ae to #ah minutes ,veal1 well done1 per pound ,roasted #bj to #be minutes ,pork1 well done1 per pound ,roasted #bj minutes ,chicken1 well done1 per pound ,roasted #ae to #bj minutes ,turkey 7#h to #aj pounds7 ,roasted #c hours ,ducks 7domestic7 ,roasted #a to #a-a_/b hours ,ducks 7wild7 ,roasted #bj to #cj minutes ,small birds ,roasted #ae to #cj minutes ,large fish ,roasted #de minutes to #a hour ,fish steaks1 stuffed ,roasted #de minutes to #a hour ,steak1 #a inch thick ,broiled #f to #ab minutes ,steak1 #a-a_/b inches to #b inches thick ,broiled #ae to #bj minutes ,lamb chop or mutton chop ,broiled #aj to #ae minutes ,quail ,broiled #ab to #bj minutes ,squab ,broiled #ab to #bj minutes ,spring chicken 7broiler7 ,broiled #bj to #dj minutes ,shad ,broiled #ab to #ae minutes ,bluefish ,broiled #ab to #ae minutes ,bread 7loaf7 ,baked #de minutes to #a hour ,rolls 7risen7 ,baked #bj to #be minutes ,biscuits ,baked #aj to #ab minute ,muffins ,baked #bj to #be minutes ,sponge cake 7loaf7 ,baked #de to #fj minutes ,layer cake ,baked #bj to #be minutes ,cookies ,baked #aj to #ae minutes ,custards ,baked #bj to #fj minutes ,steamed brown bread ,steamed #b to #c hours ,pastry ,baked #cj to #de minutes ,potatoes ,baked #cj minutes to #a hour ,scalloped dishes ,baked #bj minutes ,steamed puddings ,baked #a to #d hours ,plum pudding ,baked #b hours 7after steaming #aj hours7 ,,care ,,of ,,ice-,,box ,,and ,,contents ,the ice-box plays an important role in the preservation of the health and comfort of the family1 as well as that of the invalid4 ,therefore the first consideration is the cleanliness of it4 ,the old-fashioned boxes were constructed without ventilation4 ,this was clearly a mistake1 since many foods absorb both the odor and flavor of the substances about them if allowed to stand for any great length of time in a closed compartment with them4 ,the ice-boxes or refrigerators of to-day have a ventilation system which insures a circulation of air constantly throughout the interior of the box4 ,the drain pipes require special attention1 because no matter how clean the box itself is kept1 the melting of the ice causes a slime to accumulate on the inside of the pipe which will clog it and become offensive unless it is flushed out often4 ,this may be accomplished by pouring through it a solution made by dissolving one-half ounce of borax1 washing soda1 or ammonia in one gallon of boiling water4 ,the adjustable part of the pipe can be removed and cleaned with a long brush made for the purpose4 ,the pipe is then replaced and the boiling water poured through4 ,in this way the entire drainage system of the box is completely cleaned4 ,all loose bits of food which may drop from the containers to the floor and shelves should be carefully removed each day and the interior of the box and shelves thoroughly wiped out4 ,three times a week is sufficient to wash and flush the box and pipes unless milk1 cream1 or other food materials have been spilled1 in which case it should be washed at once before it has an opportunity to sour or spoil and become offensive4 ,ice should always be washed off before being put in the box1 and all milk and cream bottles should likewise be wiped with a clean wet cloth before being placed on the ice4 ,hot food must never be put in the ice-box1 as the heat from the food will raise the temperature of the air in it4 ,in some cases the sudden chilling of the food itself is undesirable1 but this is not so often the case4 ,however1 the best results are obtained by first allowing the food to cool1 and then placing it on ice4 ,this is particularly the case with jellies made from gelatin4 ,milk and milk products1 cream1 butter1 buttermilk1 cheese1 etc41 meat1 fish1 and1 at times1 eggs should be kept in a refrigerator or in a cold place such as the cellar in the country1 when it is impossible to procure ice4 ,broths of all sorts1 beef juice1 and meat jellies will sour and decompose unless kept close to the ice4 ,carbonated waters1 such as ,vichy1 ,apollinaris1 ,white ,rock1 etc41 as well as champagne and other sparkling wines1 must be kept in a dark1 cool place1 lying on the side4 ,it is better to put only one or two bottles on the ice at a time1 since the wine flattens 7loses its sparkle7 if it is ever allowed to become warm after once being placed on ice4 ,koumiss and other fermented milk products must be treated in a like manner to assure having them served at their best4 ,,rules ,,governing ,,selection ,,of ,,food ,there are certain fundamental rules to be observed in the selection of our food materials1 whether they are intended for those in health or for those suffering from pathological conditions4 ,these rules are definite and obligatory4 ,all food materials must be of good quality2 that is1 they must be of known purity and cleanliness1 and adulteration should not be tolerated4 ,in health the small amount of preservative used in certain canned and bottled foods would probably have little if any effect on the individual1 but in sickness this is not always the case4 ,with regard to milk1 this point has particular significance4 ,to obviate danger1 the nurse should use discrimination in the selection of the dealer from whom the meat1 milk1 eggs1 fruit1 and vegetables are purchased1 as well as the grocer who supplies the remainder of the food materials used by the patient4 ,,the ,,care ,,of ,,foods ,,and ,,utensils ,the next point of consideration is the care of the food materials4 ,this is quite as important as the selection1 for even the best of food may be ruined by careless handling1 not only in the preparation1 but likewise during the period before it is prepared for the invalid's consumption4 ,the rules governing the handling of food materials before they reach the consumer are subject to inspection by law1 but the housekeeper or nurse has no such rules to guard or govern her2 hence she may be wantonly careless or ignorantly unsanitary unless taught the right way to care for the food in her charge4 ,perishable fruits and vegetables must be kept in a cool place to preserve their freshness4 ,method of ,washing ,dishes4--,cleanliness must be observed in the care of all food materials and the utensils in which they are to be prepared4 ,if the nurse will observe the scientific rules governing the solubility of the foodstuffs1 she will be able to save herself much time and trouble4 ,for example1 it is a known scientific fact that starch is insoluble in cold water and more or less soluble in boiling water1 hence it would be a useless waste of time to try to wash a utensil in which a starchy food has been cooked in cold water4 ,fats solidify under the influence of cold and melt under the influence of heat1 so that hot water should be used in conjunction with soap or an alkali to remove grease from dishes and silver and utensils4 ,albumens are soluble in cold water and are coagulated in hot1 therefore to remove milk1 egg white1 and like protein substances from glasses1 spoons1 etc41 it is advisable to soak first in cold water to wash out the food material1 and then to wash thoroughly in hot soapsuds to cleanse and polish4 ,the dishcloths used in the washing and drying of dishes and kitchen utensils should be washed after using in hot soapsuds1 rinsed in clear water1 then dried in the sun4 ,when this is impossible1 they should at least be hung in the fresh air to make them sweet and clean before the next using4 ,in contagious diseases the care of the utensils and dishes used by the patient is of the utmost importance4 ,they should be thoroughly sterilized before being placed with those used by the rest of the family1 otherwise the disease may be communicated to the unaffected members4 ,a word about the handling of glasses and spoons used in administering medicine in the sickroom3 ,it is advisable when possible to keep these separate from those used on the tray1 as many medicines have a very lasting and disagreeable taste1 which is more than apt to cling to the spoons or glasses in which they are measured and in turn be communicated to the food1 making it distinctly unpalatable4 ,this has been found to be the case with asafetida1 valerian1 ichthyol1 etc4 ,,metric ,,measure ,the metric system is a system of weights and measures expressed in the decimal scale4 ,the principal units with which we are concerned are3 ,the liter--,l4 ,cubic centimeter--c4c4 ,the gram--gm4 ,centigram--cgm4 ,milligram--mgm4 ,these units have prefixes to show how they are divided decimally1 i4e43 deci4--#j4a centi4--#j4ja milli4--#j4jja ,,units ,,of ,,weight #aj milligrams #a centigram 7cgm47 #aj centigrams #a decigram 7dgm47 #aj decigrams #a gram 7gm47 #aj dekagrams #a hektogram 7hgm47 #aj hektograms #a kilogram 7kilo47 #ajjj kilograms #a metric ton ,a cubic centimeter of water weighs #a gram2 #bh4ce grams #a ounce4 ,a liter of water weighs #a kilogram2 #a kilogram of water #b4b lb4 ,,household ,,weights ,,and ,,measures #d saltspoons #a tsp4 #c tsp4 #a tbs4 #d tbs4 #a_/d cup or #a_/b gill #h tbs4 #a_/b cup or #a gill #af tbs4 #a cup or #a_/b pint #h oz4 #bbg gm4 #b cups 7c47 #a pint #ded gm4 #b pints 7pt47 #a quart 7qt47 a little less than #a liter #d qt4 #a gal4 #b tbs4 butter #a ounce 7oz47 #b cups butter 7solid7 #a pound 7#af oz47 #b cups granulated sugar #a pound #b-a_/b cups powdered sugar #af oz4 #a lb4 #d cups flour 7sifted7 #af oz4 #a lb4 #a pt4 milk or water #af oz4 #a lb4 #a pt4 chopped meat #af oz4 #a lb4 #aj medium size eggs #a lb4 7with shells7 #h eggs1 without shells #a lb4 #b cups rice #a lb4 #d tbs4 butter #b oz4 #a_/d cup #b tbs4 sugar #a oz4 #d tbs4 flour 7sifted7 #a oz #d tbs4 coffee 7powdered7 #a oz4 #b tbs4 powdered lime #a oz4 #b tbs4 lemon juice #a oz4 #b tbs4 orange juice #a oz4 #a glass orange juice #h oz4 or #a_/b pint #b-b_/c cup oatmeal #a lb4 #d-c_/d cup rolled oats #a lb4 #bh4ce grams #b tablespoons #a ounce of the following substances3 arrowroot1 barley flour1 brandy1 butter1 grape juice1 lemon juice1 orange juice1 molasses1 cream1 dry peptonoids1 liquid peptonoids1 milk 7whole1 skimmed71 buttermilk1 malted milk1 rice flour1 oatmeal1 olive oil1 wine4 ,materials requiring #c tablespoons to weigh #bh4ce gm4 or #a oz43--corn meal1 farina1 gum gluten flour1 ,graham flour1 white flour4 ,material requiring #d tbs4 to weigh #a oz43 cocoa4 ,the standard measuring cup holds #h ounces or #af tablespoonfuls4 #a ordinary glass 7water7 #h ounces #a coffee cup #h ounces #a tea cup #f ounces #a wine glass #b ounces ,the following list shows the approximate weights and measures of the foods comprising dietaries3 ,asparagus1 #h stalks1 ,e4,p4 #b ounces ,apple 7#a medium size7 #e ounces ,bread1 #a slice1 home-made1 #d in4 x #c-a_/b in4 x #a_/b in4 #a ounce ,bread1 #a slice1 baker's1 #d in4 x #c-a_/b in4 x #c_/d in4 #a ounce ,bread1 #a slice1 whole wheat1 #b-a_/b in4 x #b-c_/d in4 x #a_/d in4 4#g ounce ,bread1 #a slice1 corn1 #c in4 x #c in4 x #a_/b in4 #b ounces ,bread1 muffin1 #a small1 or biscuit #a_/b ounce ,banana1 #a medium size #e ounces ,chicken1 #a serving #c ounces ,chicken 7creamed7 #b tbs4 #a-a_/b ounces ,cream1 #b tbs4 #a ounce ,custard 7soft1 #a_/b cup7 #d-a_/b ounces ,custard 7baked1 #a_/b cup7 #d ounces ,cream 7ice1 #a_/b cup7 #d ounces ,custard 7rice1 #a_/b cup7 #c-a_/b ounces ,dates 7#c medium size7 #a ounce ,eggs 7scrambled1 #a_/d cup7 #b ounces ,eggs 7poached1 #a egg7 #a-a_/b ounces ,fish1 medium serving1 #b-a_/b in4 x #c in4 #b-a_/b to #c ounces ,honey1 #d tsp4 #a ounce ,hominy 7cooked1 #a_/b cup7 #d ounces ,lamb chop1 ,e4,p41 #b x #b x #a_/b inch #a4f ounces ,lemon or other jellies1 #a_/b cup #c4h ounces ,steak 7sirloin71 #c x #a_/b x #c_/d in4 #c ounces ,vegetables3 ,beets1 #a medium size 7#d slices7 #b ounces ,carrots1 #a_/c cup diced #b-a_/b ounces ,peas 7canned or drained71 #a_/c cup #c ounces ,potatoes1 baked1 sweet1 #a medium size #f ounces ,potatoes1 baked1 white1 #a medium size #c ounces ,spinach1 cooked1 #a serving1 #a_/b cup #d ounces ,tomatoes1 #a medium size--fresh #c to #d ounces ,soups3 ,cream1 #a_/b cup #d ounces ,clear soup1 #a cup #g-a_/b ounces ,,percentage ,,calculation ,a percentage of a number is the result obtained by taking the stated number of hundredths of it4 ,the rate per cent4 is a fraction whose denominator is #ajj and whose numerator is the given number of hundredths2 thus #f of a number is #f_/ajj of that number4 ,the method of figuring the per cent4 of foodstuffs in a food material is simple4 ,milk1 for example1 has a percentage composition of #c protein1 #d fat1 and #e sugar4 ,to find the definite amounts of these foodstuffs in #a ounce of milk it is best to reduce the ounce to grams1 since the gram is the unit of measurement generally used4 #a ounce #bh4ce grams ,in #a oz4 there will be #bh4ce x 4#jc #j4he gram protein ,in #a oz4 there will be #bh4ce x 4#jd #a4ac grams fat ,in #a oz4 there will be #bh4ce x 4#je #a4da grams sugar ,,thermometry ,there are two scales used in thermometry1 the ,fahrenheit and the ,centigrade4 ,the former is generally used4 ,however1 since many of the scientific calculations are made using the ,centigrade scale it is wise for the nurse to understand how to translate one to the other4 ,centigrade has #j deg4 as the freezing point and #ajj deg4 as the boiling point1 while ,fahrenheit has #cb deg4 as freezing point and #bab deg4 as boiling point4 ,to change ,fahrenheit to ,centigrade it is necessary to subtract #cb from #bab in order to make the freezing points correspond4 ,this would read #bab-cb #ahj deg4 ,f4 #ajj deg4 ,c2 hence a degree ,centigrade represents #e_/i of a degree ,fahrenheit4 ,to change ,centigrade to ,fahrenheit it is necessary to remember that every ,fahrenheit degree is #i_/e times as large as the ,centigrade and the addition of #cb deg4 must also be made4 ,for example3 ,change #aje deg4 ,f4 to ,centigrade3 #aje deg4-#cb deg4 x #e_/i #da deg4 ,c4 ,change #ej deg4 ,c4 to ,fahrenheit3 #ej deg4 x #i_/e #cb deg4 #ij deg4 #cb deg4 #abb deg4 ,f4 ,,footnote3 #bh ,diseases of ,nutrition and ,infant ,feeding1 by ,morse and ,talbot4 ,,chapter ,v ,,food ,,materials ,,and ,,their ,,preparation ,dairy ,products4--,milk1 cream1 and other dairy products form such an important part of the invalid dietary that they require especial care in their selection4 ,certified ,milk is the safest4 ,this is protected by special inspection4 ,the methods and standards governing the production and distribution of certified milk were adopted by the ,american ,association of ,medical ,milk ,commissions1 ,may #a1 #aiab4 ,the sanitary condition of the dairy1 the cleanliness of the vessels into which the milk is placed1 the health of the milkers1 and a surety that no member of their family with whom they come in contact has any kind of contagious disease1 are all obligatory4 ,the feed for the cows and the purity of the water given them to drink must be inspected and made to conform to the standard laid down for certified milk4 ,the milk of sick cows and those having tuberculosis is absolutely condemned4 ,the composition of certified milk is standardized as follows3 the fat standard shall be #d1 with a permissible range varying from #c4e to #d4e4 ,the proteins shall be #c4e1 with a permissible range varying from #c to #d4 ,certified milk shall not contain more than #aj1jjj bacteria to the cubic centimeter when it is delivered4 ,this inspection and standardizing necessarily raises the price of certified milk above that of milk not so rigidly cared for1 and when the additional expense makes it impossible for the patient to afford certified milk1 the only thing to do is to be sure of the reliability of the dealer from whom the milk is purchased and the cleanliness of the dairy from which it is procured4 ,buttermilk and butter are the milk products which require some attention as to selection4 ,the former grows sour with age and the odor of advanced fermentation and decomposition is readily recognized4 ,sweet butter1 butter without salt1 is less apt to be old when purchased than the salted variety1 as the flavor of rancid fat is unmistakable in butter which has not been especially treated4 ,milk4--,milk is without a doubt the most valuable food in the invalid dietary1 furnishing not only a highly nutritious beverage1 but likewise acting as a carrier of additional nourishment when such is necessary4 ,its form1 its lack of definite flavor and odor1 all add to its value as a food in sickness4 ,milk is one of the few foods which includes in its composition all of the chemical combinations known as foodstuffs4 ,the carbohydrates1 comprising #d4hh to #e of the solids in milk1 occur as lactose or milk sugar4 ,this sugar belongs to the disaccharide group1 and is1 in the majority of cases1 readily digested by even the most delicate digestive apparatus4 ,this form of sugar lends itself particularly well as a reinforcing agent1 and is generally used in such cases as typhoid fever1 etc4 ,the fat in milk1 comprising #d of the solids and occurring as butter fat 7cream71 is made up chiefly of olein and of palmitin1 with smaller amounts of stearin and from #e to #f of its composition in the form of butyric acid 7the fatty acid to which butter owes its name and flavor7 and traces of other fatty acids1 as well as small quantities of cholesterin1 lecithin1 and a yellow coloring matter4 ,the proteins of milk1 which form the curd or larger part of the solids1 according to ,van ,slyke#bi are in the form of casein and albumen4 ,there are #c4f parts casein to #a part soluble proteins1 but these figures vary somewhat at times4 ,casein is insoluble in pure water1 but dissolves readily in water to which an alkali or calcium carbonate is added4 ,the soluble protein in the form of lactalbumen is one of the constituents of whey4 ,this substance contains more sulphur than does casein1 but no phosphorus4 ,whey is the opalescent fluid which remains when the casein is precipitated1 and is composed of water #ic4h1 total ash #j4dd 7,koenig74 ,mineral salts1 #j4g of milk1 are made up of calcium1 potassium1 sodium1 magnesium1 iron1 sulphur1 phosphorus1 and chlorine4 ,milk is so rich in calcium that it requires only #djj c4c4 7or about #b-a_/b cups7 to furnish #a gram of calcium4 ,this is the amount believed to be necessary for the welfare of man each day and this must be derived from food4#cj ,water4--,the fluid part of milk is composed chiefly of water1 constituting #hg of whole milk4 ,milk as a food for infants will be discussed in another chapter4 ,as has already been said1 no food has so far been discovered which could be effectually substituted for milk4 ,there is no food1 however1 which requires more attention in its selection and care4 ,it is very susceptible to both odors and flavors1 absorbing them both readily1 as will be found if milk be placed in the same compartment with foods of strong odor and flavor1 without being properly covered and protected4 ,this is particularly noticeable with cucumbers1 melons1 etc4 ,milk also furnishes a splendid medium for bacterial growth1 and if left exposed to the air1 put into unclean receptacles1 or kept in a warm place1 will immediately become more or less contaminated1 after which it is unwise to use it4 ,sterilization and pasteurization will in a measure overcome the bacterial contamination1 but milk purchased from a dairy which is not clean or milked under unsanitary conditions will remain dirty1 hence unfit for human consumption4 ,when the morning's milk supply is brought to the house it should be in clean1 well-stoppered bottles1 but before placing it in the ice-box the tops of the bottles should be carefully wiped off with a wet cloth to remove any superficial dust which may be adhering to them4 ,every time a portion of the milk is removed thereafter the tops should be again cleansed before the milk is poured out4 ,this is a wise precaution1 and often prevents contamination from the hands1 etc4 ,the amount of water in milk prevents its being an adequate food for adults except in certain pathological conditions4 ,however1 it furnishes a supplementary food unequaled by any other beverage known4 ,there are fortunately only a few individuals who are unable to drink milk4 ,there are many who fancy they cannot do so1 but if the nurse has the ingenuity to utilize some of the various methods whereby milk is made more digestible1 it will generally be found that the patient can take it without trouble4 ,in cases of personal dislike1 if the milk is flavored or colored or made up into soup1 cocoa1 chocolate1 junket1 custards1 blanc-mange1 etc41 it will usually prove acceptable4 ,application of ,heat4--,a word as to the changes which are brought about as the result of heat as applied to milk4 ,these changes are demonstrated in the two methods commonly used in the preparation of milk known as pasteurization and sterilization4 ,pasteurization is rather an indefinite term to use1 unless the time and the temperature to which the milk is subjected are given4 ,according to ,morse and ,talbot the term sterilization should never be applied to the processes used in the preparation of milk for the feeding of infants1 because the milk is never rendered bacteriologically sterile by them4#ca ,as a rule the flavor and odor of milk are not changed by heat until the temperature reaches nearly to the boiling point4 ,a scum then forms on boiling milk1 composed of casein #ej4hf1 fatty matter #de4db1 ash #d4gb 7,rosenau74 ,prolonged boiling changes the color of milk from a creamy white to a yellowish brown which deepens with boiling4 ,this is due to the caramelization of the milk sugar4 ,cream will not rise 7or its rise will be very slow7 on milk which has been subjected to a temperature of #aej deg4 ,f4 for thirty minutes or more because the fat droplets are broken down so that they cannot hold together at that temperature and become more completely distributed throughout the fluid4#cb ,pasteurization is acknowledged to be preferable to sterilization in milk used for infant feeding because the higher the temperature the greater the change in the chemical composition of the fluid4 ,according to ,morse and ,talbot#cc the temperature of the pasteurization should be as low as possible4 ,pasteurization at #adj deg4 ,f4 for #bj minutes is sufficient2 lower temperatures are not4 ,at this temperature there is no change in the taste1 odor1 or color of the milk1 no noteworthy changes in the chemical composition are produced1 the ferments and bactericidal action are unaffected and bacterial toxins and non-spore-bearing microorganisms are destroyed4#cd ,rosenau#ce states that the bacillus of typhoid1 diphtheria1 and dysentery1 as well as the cholera vibrio and other pathogenic non-spore-bearing bacteria which are often found in milk1 are destroyed at a temperature of #adj deg4 ,f4 for twenty minutes1 and at higher temperatures for shorter lengths of time4 ,sommerfield's#cf investigations prove that butyric acid bacilli are destroyed at a temperature of #bab deg4 ,f4 for from #a to #b minutes4 ,it must be understood that no matter what method is used to insure purity in milk1 nothing does away with the necessity for keeping the milk both clean and cold4 ,the receptacles in which the milk is allowed to stand1 the vessels in which it is measured1 and the person who handles it must be absolutely clean1 and the nurse must keep in mind the fact that pasteurization does not completely destroy the bacterial growth in milk1 that it merely diminishes it1 and she must see that the milk which has undergone the pasteurizing process is kept cold1 otherwise the microoerganisms which are present1 even if to a less extent than in raw milk1 will undoubtedly multiply4 ,adulteration of ,milk4--,there is not nearly so much adulteration of milk to-day as there was a few years ago4 ,the stringent laws governing the care and composition of the milk make it unprofitable for the dairymen to practise it4 ,however1 there are times when such things are done and care must be taken to prevent it4 ,milk is1 as has already been stated1 very susceptible to contamination1 and that which is infected with putrefactive bacteria is not fit for food even if the dealer has doctored it with formaldehyde4 ,however1 the danger to-day is not so much from drugs as from lack of care in the handling of the milk4 ,it is well to remember1 however1 that water is an adulteration just the same as formaldehyde and perhaps more pernicious1 since the quantities of the latter are so small in an ordinary quantity of milk as not to make a great deal of difference except in the feeding of invalids and children1 while watered milk is a swindle not only to the pocketbook but to the body also1 since the requisite nutritive value is lacking4 ,selection and ,care of ,milk4--,there are a few essential facts to keep in mind in regard to milk3 7#a7 ,be sure of the source of the milk supply1 especially in the feeding of the sick and of infants4 ,milk for such cases should always be purchased from inspected dairies when it is possible4 7#b7 ,keep the milk cold2 the best milk in the world will spoil if left in a warm place4 7#c7 ,always keep the milk bottle well covered1 thus eliminating the danger of contamination1 flies1 etc4 ,,albuminized ,,milk #ace-aeb calories #f ounces 7#c_/d glass7 fresh whole milk4 #a-b eggs 7whites only74 ,have the milk thoroughly chilled4 ,clip egg whites with scissors and strain through cheesecloth to remove stringy parts4 ,now stir into the milk with a fork4 ,if patient does not object to foam1 the mixture may be placed in a milk shaker with pieces of ice and shaken until creamy1 then poured over cracked ice4 ,,albuminized ,,milk ,,shake #ace calories #f oz4 7#c_/d glassful7 fresh whole milk #a egg white ,place the milk on ice to become thoroughly chilled4 ,clip the egg white with scissors and strain through cheesecloth to free it from strings2 stir into cold milk4 ,if patient does not object to foam1 the milk and egg whites may be placed in a milk shaker1 and agitated for #d or #e minutes1 then poured over cracked ice4 ,this beverage may be flavored to suit the taste of patient4 ,vanilla1 caramel1 or coffee may be used to give variety4 ,to add additional nourishment #a teaspoonful of ,sanatogen1 or ,plasmon may be added1 or #a tablespoonful of ,panopepton or liquid peptonoids used instead of the casein products4 ,,milk ,,and ,,ginger ,,ale 7,,or ,,sarsaparilla7 #ei calories #c oz4 milk #c oz4 ginger ale or sarsaparilla ,pour into a milk shaker and shake with cracked ice until foamy4 ,,milk ,,punch #bih calories #d oz4 rich milk #b oz4 cream #a tbs4 whisky 7or sherry7 #a tbs4 sugar 7or less7 #a egg white 7if additional nourishment is desired7 ,a grating of nutmeg on top4 ,place ingredients in shaker as directed above1 and shake a few minutes to thoroughly mix ingredients4 ,pour over cracked ice1 grate nutmeg or cinnamon over the top4 ,the milk may be peptonized if necessary1 using #a_/b tube of ,fairchild's peptonizing powder4 ,,peptonized ,,milk #cad calories #a pt4 of milk #a tube of 7,fairchild's7 peptonizing powder ,dissolve the powder in #a gill of cold water1 and place in a clean quart jar 7glass74 ,pour in #a pint of cold milk and stop the bottle with cotton1 shake well and place the bottle in a saucepan containing water just warm enough to allow of the hand being immersed without being burned 7#aae deg4 ,f474 ,keep the water at this temperature for #e to #aj minutes or longer according to the degree of peptonization desired4 ,lift out of the warm water and plunge into cold1 then place at once on ice4 ,the milk may be poured from bottle into a clean saucepan and brought quickly to a boil to prevent further peptonization2 this process1 however1 is apt to make the milk very bitter and should not be used unless it is to be flavored with fruit juice4 ,,peptonized ,,milk ,,punch #bab calories ,take a goblet about one-third full of finely crushed ice1 add a tablespoonful of ,st4 ,croix rum1 a dash of curacao or any liquor that is agreeable to the taste2 fill the glass with specially peptonized milk1 stir well1 and grate a little nutmeg on top4 ,add #a tablespoon sugar4 ,,buttermilk 7,,bulgarian7 #fbg calories #a qt4 fresh whole milk 7or skimmed if desired7 #a-a_/b to #b oz4 7,bulgarian7 starter1 or #a buttermilk tablet#cg ,if latter is used dissolve tablet in #a gill of cold water4 ,stir the buttermilk starter into the cold milk and place in a one-half gallon glass jar1 place the cover on loosely and allow the jar to stand for #ab hours or until the milk is well clabbered4 7,insert a thin-bladed knife close to the jar so that the rest of the milk is not disturbed to see if the coagulation is complete47 ,when this is accomplished place the jar in the ice-box4 ,after the milk has become thoroughly cold1 beat thoroughly4 ,the mixture is like any well-made buttermilk4 ,if the cream is removed before adding the culture the milk will be lower nutrient value1 but in many cases this is necessary since it is often the fats which cause a disturbance4 ,,cocoa #adg-aff calories #b tsp4 cocoa #a-b tsp4 sugar #a_/b cup boiling water #b_/c cup milk ,mix cocoa and sugar together and add boiling water slowly4 ,boil #c to #e minutes2 heat milk in double boiler and add cocoa mixture4 ,beat with ,dover egg beater to distribute cocoa and prevent scum forming4 ,serve with or without whipped cream4 ,cocoa may be reinforced as directed in broths with albumen or the whole or yolk of one egg well beaten4 ,if the white alone is used1 care must be observed that the liquid is not hot enough to coagulate the albumen4 ,proprietary foods and casein preparations are used in like manner4 ,,plain ,,junket #afa calories #b_/c cup milk #a_/b junket tablet #a_/d tsp4 vanilla extract or a grating of nutmeg #a tbs4 sugar ,heat milk to #ajj deg4 ,f4 ,add junket tablet dissolved in #a tbs4 cold water4 ,mix in sugar and flavoring1 and pour into molds to jelly4 ,when junket becomes firm1 place in ice until needed4 ,,junket ,,ice ,,cream #dbh calories #a_/b cup each cream and rich milk #a junket tablet #b tbs4 sugar #a_/b tsp4 vanilla ,heat cream and milk to #ajj deg4 ,f4 and proceed as in junket4 ,when mixture is jellied turn into freezer1 as any ice cream4 ,this is the most wholesome of ice creams and especially suited for children and patients who have tuberculosis complicated with gastric disturbances4#ch ,,plain ,,vanilla1 ,,lemon1 ,,or ,,almond ,,ice ,,cream ,,with ,,or ,,without ,,egg ,,white#ci #ehe-fjb calories #a cup thin cream #b tbs4 sugar 7more if desired7 #a_/b tsp4 vanilla1 lemon extract1 or almond extract ,method ,i4 ,whip cream1 add sugar and flavoring1 and freeze4 ,method ,,ii4 ,scald half the cream and cool4 ,whip the remaining half1 add sugar and flavor and freeze4 ,method ,,iii4 ,make boiled custard1 as directed1 add one-half the amount of cream and freeze4 ,to reenforce ice cream3--,add #a or #b egg whites1 beaten or unbeaten2 these may be added in the beginning1 or after the mixture begins to freeze4 ,a tablespoonful of maple sirup1 caramel sirup 7#a tbs4 sugar melted and browned and dissolved in #a tbs4 boiling water71 or chocolate sirup may be poured over the ice cream to vary the flavor4 ,make chocolate sirup by boiling #b tbs4 water1 #a tbs4 sugar1 and #a tbs4 chocolate to a sirup4 #adc4c calories4 ,,frozen ,,custard #bhi-cbi calories #a egg 7or #b yolks7 #a tbs4 sugar #a_/h tsp4 salt #a cup of milk ,few drops of vanilla ,prepare as soft custard1 freeze4 ,,lactone ,,buttermilk #fbg calories #a qt4 fresh milk #a gill cold water #a lactone tablet 7or #a-a_/b oz4 buttermilk starter7 7,parke1 ,davis ,co4's and ,hanson ,co4's buttermilk tablets are practically the same47 ,dissolve tablet in cold water and stir into fresh milk 7which may or may not be skimmed1 according to the directions of the physician1 but the finished product is more palatable using whole milk74 ,pour into a clean jar or wide-mouthed bottle2 plug with cotton or close not tightly1 allow to stand in room temperature #gj deg4-#ge deg4 ,f4 #bd hours1 shaking the bottle occasionally to keep the cream from rising4 ,at the end of this time pour the milk out 7if sufficiently fermented71 and beat briskly for #e to #f minutes with egg beater or with churn2 place on ice until ready to serve4 ,,malted ,,milk 7#a7 #gg-if calories #a tbs4 malted milk #a-b tsp4 sugar #f oz4 boiling water #a_/d tsp4 salt #c to #e drops vanilla ,heat water to boiling and mix malted milk 7,horlick's7 with a little cold water4 ,stir into the boiling water1 add sugar and salt1 and serve with or without cream4 ,,malted ,,milk 7#b7 #ajg-aee calories #a_/b to #a tbs4 malted milk #c oz4 each milk and water #a-b tsp4 sugar #a_/d tsp4 salt ,proceed as above4 ,,malted ,,milk ,,chocolate ,,or ,,cocoa #bcj-cjj calories #a tbs4 malted milk #a tbs4 cocoa or grated chocolate #f oz4 milk #b oz4 water #a-b tsp4 sugar #d-e drops vanilla extract ,mix cocoa or chocolate with water and boil #b-c minutes4 ,pour milk into a double boiler and heat1 mix malted milk with a little water and stir into the hot milk1 add the cocoa paste1 sugar1 and vanilla1 mix thoroughly1 beat the mixture briskly to mix ingredients thoroughly1 and serve with or without cream4 ,milk or ,cream ,soups ,,milk ,,or ,,cream ,,sauce ,,for ,,soups #eii-abbi calories #b tbs4 flour #b tbs4 butter #a pt4 milk or thin cream #a_/b tsp4 salt ,cream butter and flour to a smooth paste1 heat milk in double boiler on an asbestos mat over the flame2 when it is scalding hot1 stir in the butter and flour paste1 stir until smooth and the mixture begins to thicken1 cover and allow to cook without boiling for #ae minutes2 strain4 ,the sauce may be used at once or put into a glass jar in the ice-box until needed4 ,,cream ,,of ,,asparagus 7#a7 #bac calories #b_/c cup cream sauce #a_/c cup asparagus puree ,heat sauce and puree in separate saucepans1 and when about ready to serve1 stir them together1 strain carefully1 season with salt1 and serve with or without croutons of toast or whipped cream4 ,if the sauce is made from the cream instead of milk1 the fuel value will be much higher 7#cjb4g calories74 ,,cream ,,of ,,asparagus 7#b7 #baf calories #h medium stalks of asparagus #a qt4 water #a tsp4 salt #a tbs4 flour #a_/b cup cream sauce ,cut off the tips of the asparagus in #a-;inch pieces1 and place with the rest in a saucepan1 and cover with water2 add salt and cook until the tips are tender2 lift out and put aside to be used instead of the toast croutons4 ,after the water in which the asparagus is cooked is of sufficiently strong flavor1 strain and add the extra spoonful of flour1 mixed in a tablespoonful of water2 cook #ae minutes1 measure #a_/b cupful1 and proceed as directed above4 ,,cream ,,of ,,potato #bei calories ,boil and cream the potato4 ,make sauce and add potato puree2 stir until well blended and serve with toast croutons4 ,when boiling potato if a sprig of parsley is added and strained out1 and a little of the potato water is used to make the puree smooth1 the soup will have more character4 ,,cream ,,of ,,spinach1 ,,celery1 ,,peas ,,or ,,carrots #bbd-dfa calories #c_/d cup cream sauce #a_/c cup vegetable puree ,proceed as in making other cream soups4 ,,oyster ,,soup #agi calories #f oysters #a cracker 7soda7 or #h oyster crackers #c_/d cup milk #a_/d tsp4 salt ,a dash of pepper ,put oysters 7and their liquor7 into a saucepan1 and heat gently2 skim thoroughly4 ,heat milk in separate pan2 when very hot add to oysters4 ,roll the cracker and add to soup just before it is served4 ,add salt and pepper at the same time4 ,eggs ,eggs4--,the table shows eggs to have a chemical composition of water #gc4g1 protein #ad4h1 fat #aj4e1 and mineral salts 7ash7 #a4j4 ,fuel value per pound1 #fgb calories4 ,the white of the egg1 constituting #eg of the entire weight1 is composed chiefly of albumen and water with a small percentage of mineral salts in the form of calcium1 potassium1 magnesium1 sodium1 phosphorus1 chlorin1 sulphur1 and iron4 ,typical albumens are always rich in sulphur1 and in eggs the sulphur content is much greater in the egg white than it is in the yolk4 ,the yolk of eggs contains more protein and fat than the white1 and less water4 ,the protein of the yolk is chiefly in the form of ovovitellin1 while the fats occur as palmitin1 olein1 and stearin4 ,there is also #e of coloring matter in the yolk of eggs besides lecithin1 nuclein1 salts of iron1 potassium1 magnesium1 and phosphorus4 ,the latter mineral salt comprises #a4j in yolk1 while in the white there is only 4#jc4 ,eggs have a position in the invalid dietary second only to that of milk4 ,they are nutritious1 easy of digestion1 and exceedingly palatable if properly selected and correctly prepared4 ,the albumen in the white is very susceptible to the effect of heat4 ,at a temperature of about #ace deg4 ,f4 the clear1 pale yellowish white begins to change to an opalescent tint1 and1 as the temperature is gradually increased1 the texture changes from a viscid1 sticky substance to an opaque1 jelly-like mass which solidifies with an ever increasing temperature4 ,hard cooked white of egg1 unless it is very finely divided1 is considered difficult of digestion1 but if the heat is applied gradually and is not raised to the boiling point 7#bab deg4 ,f47 there is no reason why the hard cooked white of the egg should not be digested4 ,however1 it is unwise to cook eggs in this manner for invalids or children4 ,any of the other methods1 with the exception of frying1 which should never be used1 is decidedly preferable4 ,egg albumen is soluble in water and fresh fruit juices1 so that it may be used with great success as a reinforcing agent4 ,in fact1 the whole egg may be so used1 but it is more difficult to disguise the yolk in a beverage than it is the white1 and for this reason it is not so adaptable in many cases4 ,eggs may be cooked by the following methods in the invalid dietary3 coddled1 soft-cooked1 poached1 creamed1 omelet1 scrambled1 or in custard4 ,uncooked eggs may be given in water1 milk1 wine1 or fruit juices4 ,the selection of eggs is equally as important as the selection of other foods4 ,there are new-laid eggs1 fresh eggs1 and just eggs4 ,the latter are generally storage and should not be used for the sick or for infants4 ,as a rule old eggs will not stand poaching1 the whites and yolks mingle and form an unappetizing mass4 ,it does not make any difference whether the color of the shell is white or brown2 if the egg is absolutely fresh the white and yolk should be distinct and easily separated1 and when they are not it is safer to discard the egg entirely4 ,fruit ,beverages ,,orangeade #aah calories ,juice of #a orange #a tbs4 sugar ,juice of #a_/b lemon ,enough water to fill the glass ,sweeten the juice of orange and lemon and pour into a glass filled with crushed ice4 ,fill glass with plain or carbonated water4 ,,albuminized ,,orangeade #aeb calories ,make orangeade as directed in above recipe1 without the addition of water4 ,break the whites of #b eggs into a saucer and with scissors cut the albumen until free from membrane and strain1 stir this into the orange juice and add several pieces of cracked ice4 ,this is both nourishing and palatable1 and the taste of the egg cannot be detected4 ,,albuminized ,,lemonade #ajg calories ,juice of #a lemon #a tbs4 sugar ,whites of #b eggs ,cut as directed for ,albuminized ,orangeade4 ,mix until sugar is dissolved4 ,pour over a glassful of cracked ice4 ,fill glass with plain or carbonated water4 ,,pineappleade #aea calories #b oz4 7#a_/d cup7 grated pineapple #h oz4 7#a cup7 cold water1 or sufficient quantity carbonated water to fill glass ,juice of #a lemon #a drop of lemon extract or a little of the peel1 grated #a tbs4 sugar ,mix lemon juice1 water1 and pineapple together2 add sugar1 if not sweet enough1 but the less used the better1 in all beverages4 ,add extract and pour into a shaker with a few lumps of ice4 ,shake well to mix ingredients and pour the pineapple over crushed ice4 ,if this proves too much at a time1 make half the recipe4 ,serve in tall thin glasses holding from #d to #f ounces after the ice is put in1 or serve in punch glasses with small spoons4 ,,albuminized ,,grape ,,juice ,albuminized ,grape ,juice is made without the addition of lemon juice unless the white grape juice is substituted for the black1 in which case add one or two teaspoonfuls to relieve the flat taste and proceed as in ,albuminized ,orangeade1 using #c oz4 of grape juice4 ,,egg ,,white ,,and ,,mint #eg calories #a egg #b tsp4 sugar #a tsp4 lemon juice ,several sprigs of fresh spearmint ,whip white of egg2 add sugar and lemon juice4 ,crush lower parts of mint leaves slightly and place in glass4 ,pour mixture over ice in glass2 stir well and serve at once4 ,fill glass with carbonated water1 ,vichy1 ,white ,rock1 ,apollinaris1 etc4 ,this is especially good when patient suffers from nausea4 ,,cream1 ,,egg ,,and ,,vichy #bcb calories #a egg white #b tsp4 sugar #c oz4 7#f tbs47 cream ,a few drops of vanilla extract ,celestine 7,french7 ,vichy to fill glass ,whip egg white to stiff froth2 whip cream stiff and sweeten1 add vanilla2 lastly1 the egg4 ,pour over cracked ice and fill up the glass with ,vichy4 ,,coffee #b tbs4 ground coffee #b tsp4 white of egg #a cup boiling water #a_/d cup cold 7boiled7 water ,mix coffee with #a tablespoonful of cold water and egg white in small pot 7after scalding pot71 add boiling water2 allow to boil #c minutes2 stir down and add cold water2 set pot where coffee will stay hot1 but not boil1 for #aj to #ae minutes1 serve with cream and sugar or use to flavor hot milk4 ,,plain ,,eggnog #bfg calories #a egg #b tbs4 cream #a tbs4 rum #a tbs4 whisky #a tbs4 sugar ,beat yolk of egg and sugar together2 add cream1 rum1 and whisky4 ,beat egg white stiff and stir into the mixture2 pour into glass with or without cracked ice4 ,nutmeg may be grated over top for those who like it4 ,,coffee ,,eggnog ,follow recipe for plain eggnog1 substituting #b tablespoonfuls of strong coffee for the rum4 ,,panopepton ,,or ,,liquid ,,peptonoid ,,eggnog #bcc-beg calories ,is made as directed for plain eggnog1 panopepton being substituted for the rum1 using #a ounce instead of #a tablespoonful4 ,this will probably more than fill a glass1 but the whole amount must be made to keep the proportions correct4 ,the whisky may be left in1 if desired1 or sherry wine may be substituted in its place to give flavor and additional stimulation4 ,,malted ,,milk ,,eggnog #bfd-caf calories #a egg #a tbs4 malted milk #d oz4 milk #a tbs4 sherry wine or whisky #a_/b-a tbs4 sugar #a tsp4 cream ,mix milk as directed above and chill thoroughly4 ,beat egg yolk with sugar and whisky or wine and add to the mixture4 ,beat egg white stiff and stir into the rest of the ingredients4 ,pour into shaker and shake with cracked ice until thoroughly chilled4 ,the cream may be served on top1 or beaten into the eggnog4 ,,foamy ,,omelet #acj calories #a egg #a tbs4 water #a_/b tbs4 butter #a_/h tsp4 salt and dash of pepper ,beat yolk until light colored and thick2 add water1 salt1 and pepper4 ,beat white until stiff and dry4 ,turn the yolk over the beaten white and cut and fold the white into the yolk mixture4 ,have pan hot and buttered1 turn in the mixture1 spread evenly in pan and allow to stand about two minutes on the top of the stove at a moderate heat2 then remove the pan1 place in a moderate oven and cook until a knife thrust into the center comes out nearly clean4 ,remove from oven1 cut across center at right angles with handle of pan and turn over on a hot platter4 ,omelets may be varied by the use of different garnishes and flavors4 ,,coddled ,,eggs #ge calories #a pt4 water #a egg ,allow water to boil2 wash egg2 drop into boiling water and place saucepan where water will keep hot1 but not boil2 allow to stand #g to #h minutes4 ,serve with salt4 ,,soft-,,cooked ,,eggs #ge calories ,proceed as for coddled eggs1 but allow egg to remain from #aj to #ae minutes or even longer1 if very soft eggs are not desired4 ,,poached ,,eggs #ge calories ,have small1 shallow saucepan half filled with boiling water or milk--if an egg poacher is at hand1 use that2 otherwise1 lower a flat perforated spoon into water and place where the water cannot boil4 ,break the egg carefully into the spoon1 taking care not to break the yolk2 allow to stand in hot water until the white is of the consistency of jelly2 lift out--slide egg on to hot toast1 taking care not to break4 7,a broken poached egg is very unappetizing1 as well as untidy in appearance47 ,,creamed ,,egg ,,on ,,toast ,with milk #aca calories ,with cream #agj calories ,cut the crust from one slice of bread and cut bread in one-inch cubes2 toast while preparing egg4 ,beat egg with egg beater until light colored2 stir into it #b tablespoonfuls of rich milk2 pour into a double boiler1 over hot water2 add #a teaspoonful butter1 a little salt and pepper2 stir until like thick boiled custard4 ,pour over toasted cubes of bread and serve at once4 ,,egg ,,nest #bjd calories #a egg #a_/b tbs4 butter #a slice of bread 7#c_/d in4 thick7 ,salt and pepper to taste ,toast the bread on one side1 butter and place on a plate 7one which will not break in the oven74 ,beat egg white stiff1 and pile roughly upon the toast1 leaving a slight depression in the center4 ,slip the unbroken yolk into the depression 7take care not to break the egg yolk or the appearance and significance of the dish will be ruined74 ,set plate in oven to brown the white 7the oven must not be too hot or the white will brown before the yolk is sufficiently cooked to be palatable74 ,place the remaining butter on the yolk1 dust with salt and pepper and serve at once4 ,,soft ,,custard #bhi to #cbi calories #a egg 7or #b yolks7 #a tbs4 sugar #a cup milk ,a few drops of vanilla ,heat milk in double boiler4 ,beat egg and sugar together4 ,when milk has reached the scalding point 7small bubbles form around the edge of the saucepan71 stir in the egg4 ,care must be taken not to allow the water under the saucepan to become too hot1 as the custard will curdle if the egg is cooked at too high a degree of temperature4 ,the custard must be stirred constantly in the beginning until it begins to thicken1 then several times a minute until it is of the desired consistency and the raw taste is cooked out of the egg4 ,this mixture is done when it will form a coating upon the spoon4 ,serve with whipped cream on top 7#eg calories extra with cream74 ,,baked ,,custard #bdi calories #a egg #a tbs4 sugar #c_/d cup milk ,a few drops of vanilla ,beat egg and sugar together1 stir into the milk1 grease custard cup with butter1 pour in the mixture4 ,set cup on several layers of paper in a deep pan1 surround with hot water 7to about half its depth74 ,set pan in moderate oven and allow to cook slowly until custard is firm in the center4 ,it may be served hot or chilled and turned out1 with a tablespoonful of whipped cream on top4 ,care must be taken not to allow the oven to get hot1 or the egg will coagulate1 making a watery1 unpalatable1 and indigestible mixture4 ,,caramel ,,custard #cjf calories ,caramel custard is made exactly the same as baked custard1 except that the cup is lined with a caramel made as follows3 ,in a small frying pan1 place #a tablespoonful of sugar1 place on the stove and stir constantly until it melts and turns a golden brown 7do not allow to burn74 ,fold a cloth about the custard cup and pour in the caramel1 moving the cup about until the sides and bottom are well coated4 ,pour in the custard mixture and proceed as in baked custard4 ,,floating ,,island #cha calories #a egg and #a extra yolk #a cup milk #b lady fingers ,few drops vanilla #a tbs4 sugar ,make soft custard1 using the two yolks 7no white74 ,chill custard thoroughly4 ,line individual ice cream cup with the lady fingers2 pour the custard over4 ,beat the white of egg and place on top4 ,serve at once4 ,the lady fingers may be dipped in sherry wine if desired1 using about #b tablespoonfuls of wine4 7#bf calories extra47 ,cereals and ,breadstuffs ,,corn ,,meal ,,gruel #aja calories #b tbs4 corn meal #a cup water #a_/b tsp4 salt ,allow water to boil1 mix corn meal with #c or #d teaspoonfuls of cold water4 ,as soon as water begins to boil1 stir briskly until gruel begins to thicken4 ,then place on a cooler part of the stove1 and cook gently for #b hours1 replacing water as it evaporates4 ,strain through a coarse sieve if it lumps4 ,,farina #ahc calories #c tbs4 7#a oz47 farina #a_/b cup rich milk #a_/b cup boiling water #a_/d cup cold water #a_/d tsp4 salt ,mix farina into a paste with cold water4 ,stir into boiling water1 allow to cook for half an hour 7if water boils out1 add boiling water74 ,add milk1 and place the saucepan in a hot water bath 7double boiler72 allow to cook half an hour longer1 stirring occasionally4 ,,rice 7#a7 #ii calories #b tbs4 7#a oz47 rice #a pt4 boiling water #a_/b tsp4 salt ,soak rice for #a hour in cold water4 ,sprinkle into the briskly boiling water1 taking care not to stop the boil4 ,allow to cook until tender2 test by pressing a grain between thumb and finger2 there should be no hard center4 ,when the rice is done1 turn it into a colander and allow water from cold faucet to run over it to wash off surplus starch4 ,return to saucepan place on stove where moisture can be dried out of the rice without burning it4 ,,rice 7#b7 #b-c servings1 #caf calories #d tbs4 rice #a_/d tsp4 salt #c_/d cup water #c_/d cup milk ,wash rice and soak it in cold water for #a hour 7or overnight74 ,place in an earthenware baking dish1 cover with the milk1 water and salt4 ,cover and set in the oven2 allow to cook until all of the moisture is absorbed 7if the rice is not done by the time the moisture has evaporated1 add more milk1 or milk and water1 and continue until the grains are tender74 ,if the given amount of moisture is not absorbed by the time the rice is tender1 drain off the surplus and return the dish to the oven for a few moments4 ,each grain should be separate1 when the dish is prepared correctly4 ,,milk ,,toast #adi calories #a slice bread1 toasted #a tsp4 butter #a_/d cup milk1 heated #a_/f tsp4 salt ,toast the bread on both sides and butter2 place in a deep plate and pour over it the hot milk4 ,,cream ,,toast #bdj calories #a slice bread #a_/d cup thin cream #a tsp4 flour #a tsp4 butter #a_/d tsp4 salt ,cream butter and flour together cold1 and stir into hot milk4 ,stir until the mixture begins to thicken1 cover the boiler and allow to cook for #ae minutes4 ,slice the bread and cut into cubes2 toast a delicate brown1 and pour over it the cream sauce4 ,strain the sauce if there are any lumps4 ,,wine ,,panada #ahe calories #b water crackers #b tbs4 sherry wine #a_/b cup hot or cold milk #a_/d tsp4 grated nutmeg ,sugar may be sprinkled over crackers if desired1 but it is not ordinarily done4 ,place the crackers in a deep plate and pour over each cracker #a tablespoonful of wine1 dust with nutmeg and pour over the hot or cold milk4 ,,oatmeal ,,cookies #cccc 7about7 calories #b cups flour #a_/d cup sugar #a_/b cup milk #a_/b cup oatmeal #b tsp4 butter1 lard1 or ,crisco #a cup seeded raisins #a egg #a_/b cup shelled peanuts ,mix shortening and sugar together4 ,mix oatmeal and peanuts 7broken into small pieces7 into the flour4 ,add milk and well-beaten eggs1 then the raisins2 mix into a dough1 roll into a thin sheet1 and cut into small cakes4 ,bake in quick oven4 ,,baked ,,tapioca #eej calories #a cup milk 7scalded7 #b egg yolks #c tbs4 sugar #f dates #b tbs4 minute tapioca ,beat sugar and egg together1 stir in the tapioca and dates1 cut into small pieces4 7,the dates may be omitted1 if desired47 ,pour mixture into custard cups and bake slowly 7as rice custard7 until the tapioca is clear and the custard is fairly firm in center4 ,,orange ,,tapioca #egj calories #a_/b cup milk #a_/b cup orange juice #a_/d cup sugar #b tbs4 minute tapioca #b egg yolks #f drops orange extract ,mix and bake as directed in plain baked tapioca custard4 ,any other fruit juice may be substituted for the orange1 raspberry1 pineapple1 or grape juice4 ,,apple ,,tapioca #dge calories #a apple 7pared and cored7 #a egg #c_/d cup milk #b tbs4 sugar #a-a_/b tbs4 tapioca #a_/h tsp4 nutmeg ,beat egg and sugar together4 ,heat milk in double boiler and add egg when milk is scalding hot4 ,stir in tapioca4 ,cook #bj minutes4 ,place apple in cup a little larger than the apple and pour the tapioca custard over the apple4 ,cover the cup and bake #cj minutes in a moderate oven4 ,,brown ,,betty #dgj calories #b slices bread #a large tart apple 7or #a_/b cup blueberries may be substituted for the apple7 #b tbs4 sugar #a tbs4 butter #a_/b tsp4 nutmeg or cinnamon ,toast bread and break into small pieces1 line the bottom of the individual baking dish with toast bits1 cover with a layer of apple or berries1 sprinkle with sugar and nutmeg or cinnamon1 add butter in bits over this1 continue the process until the dish is filled1 place bits of butter on top of the last layer of toast and set dish in oven2 bake about #bj minutes in a slow oven2 serve with whipped cream or hard sauce4 ,starchy ,desserts ,,rice ,,custard #cji calories #a tbs4 raw rice1 broiled #a egg #a tbs4 whipped cream #a_/b cup milk #a tbs4 sugar #a doz4 raisins if desired ,a few drops of vanilla ,beat sugar and egg together4 ,stir into the milk1 stir in the rice and flavor 7add raisins if desired--#bi calories74 ,grease custard cup and fill with the mixture4 ,bake slowly 7in a pan of hot water7 until custard is firm in center4 ,serve with whipped cream4 ,,orange ,,rice ,,custard #ecb calories #b oz4 orange juice #b tbs4 sugar #a_/b cup milk #b egg yolks #a_/b cup boiled rice 7or #a_/d cup uncooked7 ,beat egg1 sugar1 and orange juice together4 ,mix milk with rice and stir the two mixtures together4 ,bake as directed in plain rice custard4 ,,snow-,,balls #cef calories #a_/d cup rice #a cup milk #a_/d tsp4 salt ,place in a double boiler and cook without stirring until milk is absorbed and rice is tender4 ,then either pack in egg cups 7wet first so that rice will slip out without breaking71 or take a square of cheesecloth #h inches square1 dust with flour and place about #d tablespoons of the cooked rice in center1 draw the corners together and tie firmly into a ball4 ,set the ball in a steamer and steam #a hour4 ,remove the cloth gently to prevent breaking the balls4 ,they may be served with custard as a dessert1 or as a vegetable with tomato dressing4 ,,tapioca ,,custard #ejc calories #a cup milk #b tbs4 tapioca 7minute tapioca7 #a egg #c tbs4 sugar ,flavor with vanilla or nutmeg1 or #a_/d square chocolate grated4 ,scald milk4 ,boil tapioca in hot water until transparent like jelly1 using one cupful of boiling water4 7,if tapioca does not absorb all of the water1 pour off the surplus47 ,beat egg and sugar together and add with the milk to the tapioca4 ,pour into a double boiler1 and cook until the raw egg flavor has disappeared4 ,flavor as desired4 #dc calories extra with chocolate4 ,,sponge ,,pudding #ggb calories #b tbs4 sugar #a_/d cup flour #b eggs #b tbs4 butter #a cup milk #a_/d tsp4 vanilla ,sift flour and sugar together and make into a thin paste with part of the milk1 heat the remainder of the milk and stir in the flour paste4 ,when the mixture is thick and smooth1 stir in the butter1 then the beaten yolks and last1 the whites 7well beaten7 are folded in4 ,the mixture is now turned into a baking dish and baked 7in a pan of hot water as any other custard7 until it is firm in the center and well puffed up and brown4 ,serve with foamy sauce4 ,,sunshine ,,cake #agaf calories #g egg whites #e egg yolks #a cup flour 7sifted #c or #d times7 #a cup sugar #a_/c tsp4 cream of tartar #a_/d tsp4 salt ,beat whites of eggs until foamy and add cream of tartar2 beat until dry and stiff1 add the sugar gradually and fold in the well-beaten yolks4 ,sift the flour and gradually fold into the rest of the ingredients2 pour into ungreased sponge cake pans and bake in a moderate oven for #cj to #dj minutes4 ,,angel ,,food ,,cake #gba4e calories #d egg whites #a_/b cup sugar #a_/b cup flour 7pastry7 #a_/d tsp4 cream of tartar ,whip eggs until foamy and add cream of tartar1 whip until stiff and dry1 add sugar gradually1 then fold in the flour 7the flour must be sifted #d or #e times74 ,pour batter into an ungreased angel food cake pan and bake in a slow oven for #be or #cj minutes4 ,care must be taken not to disturb the cake during the baking1 or it will fall4 ,,cereal ,,pudding #adgj calories #a_/b cup fine cereal #a cup milk 7scalded7 #a_/d cup molasses #a egg #a tbs4 butter #a_/b tsp4 salt #a_/b tsp4 soda #a_/b cup dates or other dried fruit ,stir cereal into scalded milk and cook until mixture thickens1 remove from fire1 add rest of the ingredients except eggs4 ,when mixture has cooled somewhat1 add the lightly beaten eggs1 turn into a buttered baking dish and steam #c hours4 ,this pudding may be made without steaming by cooking the cereal and milk in double boiler for #a hour1 then add rest of ingredients and bake #cj minutes4 ,sauces for ,puddings ,,foamy ,,sauce #did-dig calories #a_/b cup powdered sugar #a_/d cup butter #a_/b one egg yolk and #a whole egg white #a tbs4 sherry wine or #a tbs4 hot milk #a_/d tsp4 vanilla ,cream butter and sugar 7powdered sugar must be used in this recipe74 ,stir in the well-beaten yolk1 add sherry and pour into saucepan over hot water2 stir until thick and creamy1 lift from hot water and cool as quickly as possible1 fold in the stiffly beaten white of egg and serve over pudding at once4 ,,wine ,,or ,,fruit ,,sauce #cha-dcd calories #a egg #a_/b cup powdered sugar #a wineglass sherry wine or whisky1 or #a_/b glass orange juice #a tbs4 lemon juice #a tsp4 hot milk ,beat yolk and white of egg separately1 add sugar to yolk and beat until creamy1 add wine or fruit juice1 fold in the egg white and add the hot milk last2 serve at once4 ,,hard ,,sauce #bca calories #a tbs4 butter #b tbs4 sugar #a_/b egg white may be added if desired #a_/b tsp4 vanilla1 or #a_/b tsp4 nutmeg ,cream butter and sugar together until there are no lumps or grains in mixture4 ,beat the egg white stiff and fold into the sugar and butter mixture4 ,flavor4 ,,foamy ,,sauce #gid-gig calories #a_/b cup powdered sugar #a_/d cup butter #a_/b one egg yolk and #a whole egg white #a tbs4 sherry wine or #a tbs4 hot milk #a_/d tsp4 vanilla ,cream butter and sugar 7powdered sugar must be used in this recipe74 ,stir in the well-beaten yolk1 add sherry and pour into saucepan over hot water2 stir until thick and creamy1 lift from hot water and cool as quickly as possible1 fold in the stiffly beaten white of egg and serve over pudding at once4 ,,sauce ,,for ,,puddings #geh4d calories #a egg #a_/b cup powdered sugar #a wineglass sherry wine or whisky1 or #a_/b glass orange #a tbs4 lemon juice #a tsp4 hot milk ,beat yolk and white of egg separately1 add sugar to yolk and beat until creamy1 add wine or fruit juice1 fold in the egg white and add the hot milk last2 serve at once4 ,meats ,,beef1 ,,lamb1 ,,veal1 ,,poultry1 ,,fish ,,and ,,shellfish ,meats4--,the flesh of animals1 poultry1 and fish comes under the head of meat4 ,these food materials form one of the most important sources of protein in the diet1 the foodstuff being in concentrated form easily handled by the digestive apparatus and absorbed almost completely1 leaving little residue in the intestinal tract4 ,the chemical composition of different meats is very much alike1 as will be seen in the table1 the bulk of the weight being water1 while the proteins range from #ah4c 7,e4,p47#dj in beef to #i4i in bacon4 ,the fats range from #ag4i in beef to #fd4h in smoked bacon4 ,the mineral salts or ash1 as they are found in meat3 ,sodium occurs in the animal body chiefly as chlorid in the fluids and blood1 and to a less extent in the other tissues4 ,potassium1 on the other hand1 is much more abundant in the soft solid tissues1 in the corpuscles of the blood and the protoplasm of the muscles and other organs4 ,potassium sulphate in the blood reacts to some extent with sodium chlorid1 forming potassium chlorid and sodium sulphate1 both of which are rapidly eliminated by the kidneys4 ,the greater part of the sulphur with which we are concerned in nutrition enters the body by way of the protein1 the percentage in lean beef being from #j4ie to #a4jj4da ,phosphorus in meat occurs as phosphoprotein in the nucleoproteins of cell nuclei1 and lecithoproteins in the brain and to a less extent in other tissues as phosphorized fats4 ,meat is poor in calcium1 containing only about #j4ja gram per hundred grams of substance4 ,meat with eggs yields a considerable amount of what is known as acids in the body4 ,quality of ,meats4--,the quality of meat depends upon several factors3 age1 sex1 care1 feeding1 and the length of time it is hung4 ,cold storage beef is much more apt to be tender than that cut from a freshly killed animal4 ,animals that are not allowed to run over a large area1 but are kept in a small inclosure and fed on fattening foods1 produce meat of a high quality4 ,this is because the muscular tissue has not been hardened with exercise4 ,the worked muscle is always tougher than the quiet one4 ,for this reason the tenderloin of beef is more tender than the flank4 ,it is situated in the part of the animal that is exercised the least4 ,the tough parts1 however1 are not lacking in flavor or nourishment1 but the manner in which they must be cooked to assure them of being tender deprives them of much of their original flavor4 ,this is demonstrated in broths and soups made from the tough cuts of meat4 ,the extractives from which meat derives its flavor and the soluble albumens are drawn out by the water1 and if it is to be used as hash1 croquettes1 etc41 needs to be seasoned1 since the broth1 while it has taken very little of the actual nourishment from the meat1 has deprived it of practically all of its flavor4 ,in making broth or soup1 if the meat is covered with cold water instead of hot1 more of the extractives will be drawn out and the broth will be more highly flavored and much more stimulating4 ,the color1 odor1 and freshness of the muscular and fatty tissues of meat are all indicative of their quality4 ,fresh meat is firm in texture and free from offensive odor4 ,stale beef and that cut from an old steer exhales a pungent odor of butyric acid4 ,the color of beef should be dark purplish when fresh cut but this changes quickly to a bright red2 it should contain preservatives of no kind and must be cut from animals free from all disease4 ,the fat should be of a yellowish white and be crumbly1 and should be distributed throughout the muscular tissue and around the organs4 ,veal1 being the flesh of an immature creature1 is not so highly flavored as the flesh of older animals1 but the bones and cartilages are softer1 and when this meat is used for broth1 more of the gelatin 7collagen and elastin from the bones and connective tissue7 is dissolved out1 giving a slightly higher percentage of nutriment in the broth4 ,selecting of ,chicken and ,turkey4--,in selecting chicken for the diet of invalids1 use only the young birds for broiling1 those a few months older for baking and roasting1 and the fowls for soup and broth4 ,to test a chicken for broiling and roasting1 select one in which the cartilage at the end of the breastbone is soft and pliable2 the pinions 7lower part of the wings7 and the feet should be soft and readily bent4 ,the breastbone of a fowl is firmer and the wings and feet harder than those of the younger chicken4 ,the young chicken has an abundance of pin feathers while the old fowl has not4 ,in fact1 one of the means of differentiating between the old chicken and the young1 even if they are practically of the same weight1 is the presence of the long hairs instead of pin feathers4 ,the fowl selected for broth should not be very fat1 as this fat will melt into the broth1 causing it to be greasy and unpalatable4 ,turkey1 even when it is young1 is not quite so digestible as young chicken2 the fibers are longer and the connective tissue more abundant4 ,goose and duck are richer in fat and not so desirable as chicken in the invalid dietary4 ,squab1 quail1 and young squirrel are all palatable and readily digested4 ,the squirrel must1 however1 be young1 or the flesh will be tough and more difficult of digestion4 ,fish4--,fish should be given consideration in the dietary of the invalid since it is a valuable source of protein and readily digested in the majority of cases4 ,as a rule fish is not so well liked as meat1 but since it contains a smaller percentage of extractives and purin bases it is exceedingly valuable in certain pathological conditions4 ,the lean varieties of fish1 halibut1 flounder1 trout1 perch1 haddock1 turbot1 whitefish1 are more readily digested than the dark fish1 which contain a higher percentage of fat4 ,to this latter class belong the bluefish1 mackerel1 salmon1 shad1 and herring4 ,shellfish4--,of the shellfish1 the oyster and the clam are exceedingly useful4 ,the soft parts of the oyster are palatable and easily digested4 ,they are not highly nutritious1 but give a nice variety to the diet4 ,when used in broth or for the juice1 clams are particularly useful4 ,many cases of nausea are relieved by the taking of iced or very hot clam juice when they resist other remedies4 ,the necessity of having both oysters and clams absolutely fresh is of the greatest importance1 since a type of poison results from tainted shellfish which is exceedingly dangerous4 ,pork in the ,diet4--,fresh pork is rarely ever included in the invalid dietary save in diabetic diets4 ,meat from this animal must always be thoroughly cooked1 not only because underdone pork is exceedingly indigestible but because there is an infectious bacterium sometimes found in pork which is only destroyed by thorough cooking of the meat4 ,well-cooked bacon is digestible if the surplus fat is poured off instead of allowed to soak into the cooked bacon4 ,the most efficient method of cooking bacon is to place the strips upon a broiler under the flame4 ,in this way the hot fat drips down into the pan beneath1 leaving the bacon crisp and delicate4 ,the meats to be used for the invalid must be selected with care4 ,the quality of this item of food is most important4 ,it is not always necessary to purchase the most expensive cut4 ,if it is to be broiled or roasted then it is necessary to select parts of the animal which are tender1 but for broths1 soups1 scraped or ground meat1 or the meat to be used for the juice only1 it is wasteful to buy these tender1 expensive pieces when those costing less will serve the purpose equally well4 ,the names given to the different cuts vary slightly in different parts of the country1 but those in general use only will be mentioned here4 ,the following table shows the manner in which the beef is cut and the method in which it is generally used3 ,,table ,beef ,cut ,method of ,preparation ---------------------------------------- ---------------------------- ,hindquarter more or less free ,broth1 soup1 beef juice1 scraped ,round from fat beef4 round steak ,hamburg steak 7ground meat74 ,broiled 7this is a cheaper and less tender cut than the loin steaks74 ,rump steak ,broiled1 cheaper cut steak4 roast ,roasted1 cheaper cut roast4 lean meat ,broth1 soup1 beef juice4 ,loin #c ribs1 #ast1 #b;d ,roasted4 and #c;d cuts sirloin steak ,broiled4 porterhouse steak ,broiled4 steak ,broiled4 ,tenderloin roast ,roasted4 fillet ,broiled or roasted1 larded or plain4 ,ribs 7prime7 ,roasted4 ,ribs1 chuck roast or ,roasted or broiled4 steak ,forequarter ,brisket ,corning4 ,broth1 soup1 scraped1 meat juice4 ,hamburg steak4 ,salisbury steak4 ---------------------------------------- ---------------------------- ,,cuts ,,of ,,lamb ,,and ,,mutton ---------------------------------------- ---------------------------- ,lamb ,neck ,soup1 broth1 etc4 ,chuck 7including shoulder ribs74 ,shoulder chops are not so tender as loin chops4 ,broiled4 ,flank ,soup1 broth4 ,loin 7chops7 ,broiled4 ,leg ,roasted4 ,veal ,neck ,soup1 broth4 ,chuck ,soup1 broth1 roast1 broiled4 ,cutlets ,broiled 7breaded or plain74 ,chops 7rib7 ,broiled4 ,breast ,roasted1 stuffed or plain4 ,leg ,roasted4 ,hind shank 7veal ,soup1 broth4 ,fore shank knuckles7 ,broths and ,soups ,,standard ,,broth ,,beef1 ,,veal1 ,,mutton1 ,,or ,,chicken #a ,pint1 #hj calories1 with rice or barley #aje calories ,two pounds of meat 7beef1 mutton1 veal1 or chicken72 #b quarts of water2 #b pounds of bones2 #a teaspoonful of salt2 #b tablespoonfuls of rice or barley may be added if desired and parsley or celery may be used to give the additional flavor4 ,wipe meat with a clean wet cloth and cut into small pieces1 break the bones1 place all together in a deep saucepan1 cover closely and allow to stand in a cool place for one hour2 then place pan on the back part of the stove1 or on an asbestos mat over a gas burner1 and heat gently to the boiling point 7broth must never do more than simmer71 allow to simmer for three or four hours1 skim1 strain1 and cool4 ,when thoroughly cold1 remove all of the fat1 using blotting paper to absorb the fine particles of grease4 ,if parsley and celery are to be used to flavor the broth they may be added during the last hour of cooking4 ,barley requires to be soaked overnight when it is used in broth2 rice should be soaked one hour4 ,when either are to be left in the broth it is better to cook the broth for three hours1 strain1 return to the fire1 adding the rice or barley4 ,allow it to simmer for an hour or more and proceed as directed4 ,when the broth is taken from the fire1 it should be measured1 and boiling water added to bring the amount up to the original quantity4 ,this will give what is known as standard broth4 ,bouillon is clarified broth1 most of the already small amount of nutrient material being thus strained and cleared from the broth1 leaving a liquid of practically no fuel value4 ,,clam ,,or ,,oyster ,,broth #aa4e calories without milk2 #afb4e calories with milk #a doz4 clams or oysters #a tbs4 whipped cream #a pt4 water or #a cup each milk and water ,a dash of pepper ,scrub clams and place in an iron spider and allow to heat gently until the shells open4 7,when oysters are used allow to heat until the edges curl47 ,chop1 cover with hot water1 and allow to simmer #ae minutes1 strain through cloth1 add salt and a dash of pepper4 ,if milk is to be used in place of part of the water1 add it during the last #e minutes of the cooking4 ,clam broth without milk may be served hot or cold2 it will not jelly as other broths but may be frozen if desired4 ,,clam ,,broth ,without milk1 #ee4f calories2 with milk1 #aac4d calories #a_/b cup 7#d oz47 clam juice #a_/b cup hot water or milk ,salt and pepper to taste #a tbs4 whipped cream ,mix clam juice 7bottled7 with water2 heat1 add salt and pepper1 pour into cup1 place whipped cream on top1 and serve at once4 ,,beef ,,juice ,one-fourth pound lean beef4 ,wipe clean with damp cloth1 cut in inch pieces and sear on a hot griddle1 place in a meat press and remove all juice from meat4 ,care must be taken not to cook the meat4 ,the juice may be reheated by placing in a hot cup in hot water1 not allowing the temperature to exceed #aee deg4 ,f4 ,,chicken ,,jelly #cjh calories #a serving1 #ge4h calories #a_/b small chicken #c pt4 water #a_/b cup celery #a sprig of parsley #a tbs4 gelatin soaked in #a_/d cup cold water #a_/b tsp4 salt #a_/d tsp4 red pepper #a egg white ,cut the chicken in pieces1 break the bones1 place in a saucepan with all of the ingredients except the gelatin and egg white1 cover with the water and boil until the meat falls from the bones4 ,press out as much of the juice as possible1 strain and allow to cool1 remove all of the grease1 and return to the fire4 ,reduce to #a pint1 add the gelatin1 stir in the beaten egg white1 and allow to boil #e minutes1 strain again into molds and set aside to congeal4 ,,calf',s-,,foot ,,jelly #cgf4f calories #b small calf's-feet #a_/b small fowl #a cup of ,rhine wine #a lemon #a_/b stick of cinnamon #a egg white 7well beaten7 ,cut the fowl and the calf's-feet into small pieces and place them in a saucepan with #c pints of cold water and the cinnamon4 ,cook until the meat falls from the bones 7the quantity should be reduced to #a pint74 ,strain and squeeze out as much of the juice as possible1 allow to cool1 and remove all of the grease4 ,add wine and lemon juice 7and sugar if desired7 and reduce the amount of broth one-half1 add the egg white and allow to boil #e minutes4 ,clear and strain into molds4 ,,broiled ,,quail ,,or ,,squab #dah-edc calories ,split down the back and place on the broiler1 cut surface uppermost4 ,or place upon a hot pan1 cut surface next to the hot surface so that the cut side may sear quickly1 thus keeping in the juices instead of having them wasted in the pan by slow cooking4 ,the process requires about #ae to #bj minutes4 ,serve on toast1 with butter1 pepper and salt4 ,quail or squab cooked inside the stove is often more palatable than that cooked on a broiler4 ,the bird is split as for broiling1 and placed in a small pan just large enough to hold it2 a strip of bacon pinned about the breast2 add #a tablespoonful of butter in bits1 dust the cut surface first with salt and pepper1 then with flour2 add #a_/b cup of hot water4 ,turn another pan over the bird 7it must fit closely to keep in the steam71 place inside the oven and cook about #aj minutes2 turn the bird over and cook #aj minutes longer4 ,lift the bird from the pan and place it where it will keep hot1 add a tablespoonful more water and a teaspoonful more flour to the gravy in the pan1 stir briskly to remove any lumps1 remove bacon and place the bird upon a slice of nicely browned toast2 pour over it the gravy1 garnish with a sprig of parsley1 and serve at once4 ,,birds ,a ,,la ,,bain-,,marie #a small chicken1 or bird #b tbs4 butter #a tbs4 parsley ,salt and pepper ,split birds or chicken as for broiling1 place one-half in a chafing dish or double boiler 7bain-marie71 dot the cut surface with butter1 sprinkle over it the parsley1 dust with pepper and salt2 place the other half of the chicken or bird on top of this1 add the rest of the butter1 dust with salt and pepper1 cover1 and place the pan over the hot water pan2 allow to steam for about #a hour1 lift from hot water pan and place in oven or under the flames to brown lightly4 ,serve on buttered toast4 ,,chicken 7,,one-,,half7 #cee calories ,split small chicken 7broiler7 down the back1 flatten the breast bone with knife before placing upon the broiler1 proceed as in broiling birds1 allowing from #be to #cj minutes for the process4 ,chicken is very palatable and dainty if cooked after the manner described in cooking quail and squab inside the stove4 ,the process is called smothering4 ,serve upon buttered toast1 garnished with parsley4 ,,roast ,,chicken1 ,,turkey ,,or ,,duck ,draw the fowl and wash thoroughly inside and out4 7,if it is purchased from the market1 it is well to wash the inside with soda water to remove any stale flavor that may be present47 ,make a dressing from one-third of a small loaf of bread broken into small pieces2 #a_/d cup chopped celery1 #a tablespoonful of chopped parsley1 #a tablespoonful of butter and one egg beaten lightly4 ,stuff the cavity with dressing1 sew up the opening and place in dripping pan4 ,place pan under the flame for a few minutes to brown1 unless a regular roasting pan 7savory roaster7 is used2 allow to bake from #de minutes to an hour and a half for chicken and duck according to the size1 and from an hour and a half to three hours for turkey according to size4 ,a cupful of boiling water may be poured into the pan in which the chicken1 etc41 is being roasted and flour may be sifted over the top2 dust with salt and pepper4 ,when an ordinary pan is used for baking1 the fowl will require frequent basting to keep it moist and tender4 ,just as the baking is finished1 more butter1 flour1 and seasoning may be added1 with a cup or more of boiling water to make additional gravy4 ,,sweetbreads #bji calories #a_/d set of sweetbreads #a lemon #a_/b tsp4 of salt #a_/d tsp4 of pepper 7red7 ,wash sweetbreads carefully and allow to stand #a hour in ice water1 allow the water containing the lemon juice1 salt and pepper to come to a boil and drop in the sweetbreads1 cook for #ae to #bj minutes or until tender when pierced with fork4 ,remove from hot water and pour ice water over them to blanch4 ,serve either in cream sauce or split in half and broil upon a slightly greased broiler until light brown2 season with a dash of salt and pepper4 ,,broiled ,,oysters #agd calories #f oysters #b tsp4 butter #a slice toast ,salt and pepper to taste ,grease broiler or hot frying pan slightly1 place oysters upon the heated surface and place under the flame or on top of the stove2 cook until the edges curl 7#b to #c minutes71 lift to a hot dish containing the butter1 place toast upon small plate 7toast and plate must be hot71 dispose the oysters upon the toast1 and pour over them the butter4 ,,beefsteak #bfg calories #c inches long by #b inches wide by #a-a_/b inches thick 7weighing about #c ounces74 ,wipe steak off with a wet cloth and dry before cooking4 ,slightly grease the broiler and place under the flame1 count ten as the clock ticks and turn the steak over1 count ten again and again turn2 continue this for about #c minutes or until the steak is seared upon both sides1 lift the broiler to a lower part of the oven and continue the cooking for #e to #h minutes2 run a sharp-pointed knife between the meat and the bone 7if the steak is a porterhouse or sirloin71 and if the flesh is red1 continue the cooking a minute or more4 ,if it is pink1 lift to a hot plate1 place #a teaspoonful of butter upon it1 dust the surface with salt and pepper and serve hot4 ,pan broiling is done on the top of the stove in a flat frying pan4 ,wipe the pan with a clean wet cloth1 place upon the stove and heat piping hot1 and place the steak 7without greasing the pan7 upon the hot surface4 ,proceed as in broiling under the flame4 ,after the first #c minutes of cooking1 place the pan on a cooler part of the stove to finish the cooking4 ,,lamb ,,or ,,mutton ,,chops #b chops1 #cjd calories #a to #b inches thick will require from #aj to #ae minutes' cooking4 ,scrape the bone clean and wrap in paper or dough to prevent the bone from becoming charred4 ,proceed as in cooking beefsteak4 ,,veal ,,cutlets #b cutlets1 #bge 7about7 calories ,dip cutlets first in egg 7mix one yolk with #a tablespoonful of water7 then in bread crumbs2 pan broil 7grease the frying pan slightly71 or broil under the flame as directed in cooking beefsteak4 ,veal cutlets may be served plain1 or with tomato sauce4 ,cutlets or chops may be cooked in paper bags if desired4 ,wrap the chop in a thin slice of bacon1 grease the paper 7a piece of heavy brown paper71 place the chop inside and secure the ends with paper clips or pins2 place in a pan and cook in the oven1 or under the flame4 ,it is wise to slip the bag containing the chop inside of another bag2 in this way the meat will not taste of scorched paper if the outer bag should burn4 ,,bacon 7#a ,,slice7 #aid calories ,place bacon on a rack and place rack in a dripping pan1 set in oven and bake until crisp and brown4 ,or1 arrange bacon on broiler1 place pan beneath to catch the drippings and prevent the fat from catching afire1 broil as beefsteak4 99 99 99 99 99 ,when steak or chops are served1 parsley or sliced lemon may be used as garnishes4 ,chops may be served garnished with green peas1 and the beefsteak served with potatoes cooked in any way2 all meats should be served very hot4 ,it is best to cover with a plate4 ,,fish ,split down the back1 and broil as beefsteak4 ,fish does not require more than from #aj to #ae minutes to broil unless very large4 ,serve with teaspoonful of parsley and butter4 ,,fish ,,steaks1 ,,stuffed ,,with ,,oysters #c ounces1 #afh4c calories 7about7 ,halibut1 trout1 or any good baking fish1 #bce4h calories 7about7 #b slices of fish #a - #a-a_/b in4 thick #a doz4 oysters #a cup bread crumbs #d tbs4 butter ,salt and pepper ,lay fish for one hour in a ,french dressing made from #a_/b cup of oil1 #a_/c cup of vinegar1 salt and pepper2 drain and place upon slices of bacon1 placed upon a fish sheet or dripping pan4 ,dip oysters first in melted butter1 then in bread crumbs1 and place upon the slice of fish1 adjust second slice above1 cover top with bread crumbs1 dot with butter and bake #cj to #de minutes in moderate oven4 ,serve with hollandaise sauce4 ,,lobster ,,or ,,crab #a serving lobster1 #aeg calories #a serving crab1 #aed calories #a lobster #a tbs4 butter or #a crab #b tsp4 butter #b tbs4 bread crumbs #a_/d tsp4 salt #a_/h tsp4 pepper ,boil lobster or crab until bright red1 lift from boiling water4 ,split lobster down the back and carefully remove cord1 gall sack1 and sand bag before broiling or serving4 ,serve with melted butter4 ,pick meat from shell of crab1 and mix with salt1 pepper and butter4 ,stuff into shell4 ,cover top with bread crumbs1 and brown in the oven4 ,,hollandaise ,,sauce #agh calories2 #a tablespoonful1 #bb calories #a egg 7yolk only7 #b tbs4 lemon juice #a tbs4 butter #a_/d cup boiling water ,salt and pepper to please ,beat egg yolk with lemon juice2 add one-half the butter2 place in double boiler over hot 7not boiling7 water4 ,stir until it begins to thicken and add remainder of butter2 stir in boiling water1 cook until of the consistency of boiled custard4 ,vegetables and ,fruits ,among the plants known as vegetables1 some are seeds1 some leaves1 some stems or bulbs1 some roots or tubers1 and some are the fruit surrounding the seeds4 ,under the head of seeds we find peas1 beans and lentils1 this class of vegetables being spoken of as legumes or pulses2 they are rich in protein 7especially when dried7 and contain an appreciable amount of carbohydrates as well1 some contain fat4 ,green1 or fresh legumes are more easily digested than the dried legumes4 ,they are important sources of iron and phosphorus and contain a certain amount of calcium2 in the body they act as neutralizing agents since the base-forming elements in these plants predominate over the acid-forming elements4#db ,among the leafy vegetables we find1 lettuce1 cabbage1 spinach1 beet1 turnip and mustard greens1 chard and parsley4 ,these vegetables are not only prized for their mineral content but furnish a recognized source of the fat soluble vitamine1 ,a4 ,tomatoes1 squash1 cucumbers and pumpkin are vegetables whose fleshy fruit surround the seed but are eaten as vegetables instead of as fruit4 ,potatoes1 carrots1 parsnips1 onions1 beets and turnips are among those whose stems1 roots or tubers are eaten as vegetables4 ,more and more are we coming to see the importance of this class of foods in the dietary1 they are important on account of their mineral salts1 their vitamine factors and for the bulk which they lend to the food mass which facilitates its passage along the digestive tract4 ,the majority of vegetables furnish organic acids or their salts which function in the body1 as potential bases1 assisting in the neutralization of the acids formed in the body as a result of the breaking down of the proteins4 ,fruits4--,fruits have practically the same value from a dietetic standpoint as vegetables1 and the same care must be given to their selection4 ,some fresh fruit should be given to children every day to safeguard them against scurvy4 ,and adults should have fresh fruit several times a week1 the remainder of the time dried fruits may be used4 ,canned fruits while good are not so valuable as fresh fruits and are more expensive than the dried fruit4 ,the fruits and vegetables will here be considered4 ,some of the fruits and vegetables contain high percentages of sugar1 aside from the mineral salts1 for which they are especially valuable4 ,this class includes the sugar cane1 sugar beet1 raisins1 dates1 figs1 etc41 while others such as the potato1 taro1 banana1 etc41 furnish an appreciable amount of starch4 ,all of the vegetables and fruits are rich in mineral salts1 which are as important to the work of the body as the proteins1 carbohydrates1 and fats4 ,hence it is essential to add the foods containing these mineral salts to the daily dietary both in health and in disease4 ,both fruits and vegetables should be free from blemishes4 ,those to be served raw1 such as lettuce and other salad vegetables1 must be purchased from reliable markets4 ,unscrupulous vendors have been known to sprinkle old wilted vegetables1 to restore their freshness1 with water from stagnant pools teeming with typhoid bacteria1 thereby spreading infection broadcast4 ,vegetables which require cooking before they are eaten are1 for this reason1 safer4 ,canned foods should be avoided in the diet of the invalid whenever it is possible2 but1 when it is not1 care should be observed that no can is used in which there is the least sign of fermentation4 ,beans and peas are sometimes artificially colored1 but this custom is not so prevalent now as it used to be4 ,,peas #aba calories #a_/b cup fresh peas #a pt4 boiling water #a tsp4 butter #a_/d tsp4 salt ,add salt and peas to boiling water2 allow to cook from #cj to #fj minutes1 or until they are perfectly tender1 drain and add butter and additional salt if necessary1 or #a tablespoonful of cream sauce4 ,in gastro-intestinal disorders and with young children1 it is best to press peas through sieve or remove the indigestible parts4 ,,string ,,beans #id calories #a cupful of string beans 7measured after the strings are removed and the beans cut into small pieces7 #a tsp4 butter #a_/b tsp4 salt ,cover with boiling water and cook until tender1 drain1 and serve hot4 ,,spinach #ij calories #a_/b lb4 spinach #a_/b tsp4 salt #b tsp4 butter ,wash thoroughly through about ten waters1 until spinach is entirely free from grit1 remove the tough stems1 lift the spinach from water and place in a saucepan without additional water1 sprinkle over with salt1 cover saucepan and cook until tender 7requires about #ae minutes74 ,cut very fine with sharp knife1 or press through sieve1 add butter and serve hot4 ,,carrots 7,,with ,,cream ,,sauce ,,or ,,butter7 #hb-aag calories ,carrots1 about #a_/b cupful after they are cut in cubes1 or #c-a_/b ounces4 ,serve with #b tablespoonfuls of cream sauce1 or with #b teaspoonfuls of butter and a little salt and pepper4 ,scrub carrots and scrape off the skins2 cut into slices or cubes1 drop into slightly salted boiling water and cook until tender2 drain and add butter or cream sauce4 ,,baked ,,potato 7,,white7 #adj calories #a potato weighing about #c ounces2 scrub well with a brush2 dry and slightly grease surface1 place in moderately hot oven and bake about #de or #ej minutes4 7,the potato should feel tender upon pressure47 ,when done1 make an incision of #a inch in the skin and gently press out the steam2 cover closely with cloth and keep in a warm place until ready to serve4 ,put teaspoonful 7about #a_/f ounce7 of butter in the cut and serve very hot4 ,,creamed ,,potato #ahb calories #a_/d tsp4 salt #a medium size potato #b tsp4 milk #a tsp4 butter ,pare and boil potato until tender when pierced with a fork2 drain off the water and return the saucepan to the stove2 shake the pan 7to prevent burning7 until the potato looks dry2 mash with fork or potato ricer1 add milk1 butter1 and salt4 ,beat briskly until creamy4 ,serve at once or brown in oven4 ,,potato ,,stuffed ,,with ,,meat #aig4e calories #a potato 7baked7 #a_/d tsp4 salt #a tbs4 cold chopped beef #a tsp4 butter ,dash of pepper ,bake potato1 split in half and remove the contents1 mix with the chopped meat1 add salt1 pepper1 and butter2 return to the two halves1 set in oven to brown1 then serve at once4 ,,scalloped ,,potatoes #bej4h calories #a potato #a_/d cup milk #b tsp4 butter ,boil potato1 not quite tender1 and slice in moderately thin slices2 arrange in layer in an individual earthenware baking dish 7ramekin71 add butter in bits between layers1 pour the milk over2 set dish in oven1 cover and bake slowly for #ae minutes1 until most of the milk is absorbed and the potatoes are nicely browned on top4 ,in cases where the patient is allowed cheese1 #b teaspoonfuls may be sprinkled between the layers1 giving #ca additional calories4 ,vegetable and ,fruit ,salads ,,cucumber #fb4e calories #a_/b cucumber 7#g in4 long7 #a_/b tbs4 vinegar #a tsp4 olive oil #a_/f tsp4 salt ,few grains of pepper ,slice cucumber in thin slices and allow to stand thirty minutes in ice water1 drain and serve with ,french dressing4 ,,tomato 7,,no4 #a7 with mayonnaise1 #fa calories with ,french dressing1 #aca calories ,wash tomato carefully1 cut in shape of flower by cutting almost through the tomato making six sections4 ,place on lettuce leaf and serve with dressing4 #a tsp4 mayonnaise or #a tbs4 ,french dressing ,,tomato 7,,no4 #b7 #fc calories ,remove skin from #a medium sized tomato1 remove pulp1 fill cavity with following mixture4 #a_/b medium stalk celery ,the tomato pulp #a tsp4 mayonnaise dressing ,,fruit ,,salad 7,,no4 #a7 #c grapefruit #a cup celery 7chopped7 #a_/d head of lettuce #a cupful of mayonnaise ,remove skin and inner membranes from grapefruit1 mix with celery and mayonnaise4 ,serve on lettuce4 ,this salad may be poured into a tin 7baking powder can1 or mould71 packed in ice and salt and frozen4 ,then served in slices upon lettuce4 ,,fruit ,,salad 7,,no4 #b7 #abag calories 7about7 #a cup of grapefruit #a thick slice of pineapple 7chopped7 #a green pepper 7#a oz47 #a cup of celery #a cup of mayonnaise or ,french dressing ,if mayonnaise is used the mixture may be frozen4 ,if ,french dressing is used1 serve on lettuce without freezing4 ,,tomato ,,jelly #gg calories #a cup tomatoes 7canned7 #c_/d cup water #f cloves #a_/b cup celery #a_/d cup vinegar #a tbs4 of parsley #a_/b tsp4 red pepper #a tbs4 granulated gelatin soaked in #a_/d cup cold water ,one slice of onion may be added if there is nothing to contra-indicate it1 but care must be taken in adding onion1 as it is apt to disagree with many people4 ,boil all of the ingredients together 7except the gelatin7 for #bj minutes1 press through a sieve1 then through a cloth1 return to the stove and allow to boil up2 add the gelatin and boil #e minutes2 strain into wet molds4 ,,whole ,,tomato ,,stuffed ,,with ,,rice #afg calories #a medium size tomato #b tbs4 rice 7uncooked7 #a tsp4 butter ,dash of pepper and salt ,remove the center from the tomato1 dust the inside with salt and a very little pepper and set aside4 ,boil the rice1 when about half done 7#aj minutes7 add the tomato pulp1 from center of tomato4 ,cook #aj minutes longer1 drain the water from the rice1 add the butter1 salt1 and a little pepper4 ,fill the center of tomato with rice4 ,set the tomato upon a greased paper and bake in a moderate oven for #bj minutes4 ,,broiled ,,tomatoes #cec calories ,slice #a tomato in three or four slices #a tbs4 butter #a slice of bread 7round preferred7 #a_/d cup of cracker crumbs ,salt and pepper ,heat broiler or frying pan very hot1 grease lightly2 season crumbs with salt and pepper2 dip slices of tomato in cracker crumbs1 covering both sides well1 and place upon the broiler2 when one side is browned1 turn over carefully1 to prevent breaking1 and allow the other side to brown4 ,lift the broiler to the lower half of the oven and let the tomatoes cook gently for #aj minutes4 ,place bits of butter upon each slice1 then arrange these on the buttered toast4 ,,stewed ,,tomatoes ,,on ,,toast #aga calories #a_/b cup canned tomatoes #a_/b cup water #a slice bread #b tsp4 butter #a_/d tsp4 salt ,pour tomatoes and water in a saucepan and allow to cook slowly for #bj minutes1 add salt and a dash of pepper4 ,toast and butter the bread1 pour the cooked tomatoes over it and serve at once4 ,,french ,,dressing #aca calories #a tbs4 oil #a_/c tbs4 vinegar1 or lemon juice ,dash of pepper and salt ,have all ingredients cold2 mix salt and pepper together2 stir in the oil1 add vinegar or lemon juice slowly1 beating briskly to form an emulsion2 use immediately or ingredients will separate4 ,use as little salt as possible in nephritic conditions4 ,,mayonnaise ,,dressing #baji calories #a egg 7yolk only7 #b tbs4 lemon juice 7or vinegar7 #a_/b tsp4 salt #a_/b tsp4 mustard 7dry7 ,dash red pepper #a cup olive oil ,method of ,mixture3 ,mix dry ingredients with yolk of egg thoroughly2 add all the acid 7use ,dover beater74 ,now add1 one teaspoonful at a time1 the olive oil2 beat continually until the mixture thickens 7after #h teaspoons of oil have been added74 ,put in oil by tablespoonfuls until all is incorporated4 ,this method shortens the time of making at least one-half1 and the dressing rarely curdles as it often does in the old methods4 ,whipped cream may be added to dressing before serving4 ,mayonnaise will keep if placed in a cool place1 and the above quantities are more easily handled than smaller amounts4 ,gelatin ,jellies ,,lemon ,,jelly #aej calories #b lemons 7juice only7 #a_/d cup sugar #c tsp4 granulated gelatin #a tbs4 cold water #a egg white #a cup boiling water ,,orange ,,jelly #bhj calories #c tsp4 granulated gelatin #a tbs4 cold water #a_/d cup boiling water #f tbs4 lemon juice #c tbs4 sugar #b drops orange extract #a_/b cup orange juice ,,grape ,,juice ,,jelly #cae calories #a_/d cup boiling water #a_/b cup boiling grape juice #c tsp4 granulated gelatin #a tbs4 cold water #a tbs4 lemon juice #c tbs4 sugar ,method for ,fruit ,jellies4--,soak gelatin in cold water about #b or #c minutes1 then pour over it the boiling liquid2 add sugar and fruit juice2 strain through cloth into wet molds4 ,set in cold place to stiffen2 when firm1 unmold4 ,serve with whipped cream1 or pour liquid into baskets made from oranges or grapefruit hollowed out and the edges scalloped1 or pour into shallow pans1 and cut in #a_/b-;inch blocks when firm1 and serve on a bed of whipped cream4 ,,wine ,,jelly #abg calories #a_/b cup boiling water #c tbs4 sherry wine #a-;inch piece of cinnamon #a tsp4 lemon juice and the yellow rind from #a_/d lemon #c tbs4 sugar ,method for ,wine ,jelly4--,put water1 wine1 lemon juice1 peel1 cinnamon1 and sugar into a saucepan1 allow to boil #e minutes1 pour over gelatin 7which has been soaked in cold water74 ,if jelly looks cloudy return to saucepan1 and add #a_/b egg white beaten stiff1 allow to boil #a minute1 stirring constantly1 and strain into mold4 ,serve with whipped cream4 ,water ,ices ,,lemon #bgf4e calories #b lemons 7juice only7 #a_/d cup sugar #a egg white #a cup water ,,orange #caa calories #a_/b cup orange juice #a lemon #a_/d cup sugar #a cup water #a_/d tsp4 orange extract #a egg white ,,grape ,,juice #cfb4f calories #a_/b cup grape juice #a tbs4 lemon juice #a_/d cup sugar #a egg white ,,method ,,of ,,mixture ,mix sugar and water and boil to a rich sirup 7about #ae minutes71 cool1 and add fruit juice 7and extract when it is used74 ,pour into freezer and surround with a mixture of #a part salt and two parts ice4 ,when sherbet is about half frozen1 stir in the stiffly beaten egg white and continue the freezing until mixture is hard4 ,in diseases where it is found inadvisable to give albumen1 #a teaspoonful of gelatin may be substituted4 ,,apricot #chd calories #a_/b cup apricot puree #a cup water #a_/d cup sugar #a tsp4 granulated gelatin #a lemon 7juice only7 ,make sirup of water and sugar1 soak gelatin in a little cold water and add to the hot sirup2 press apricots through a sieve and add to the sirup as soon as it is cool2 freeze as directed in other ices4 ,,strawberry ,,and ,,raspberry #cdf-cic calories #a cup fruit juice #a_/c cup sugar ,juice of #a lemon and #a egg white4 ,proceed as in other ices4 ,,currant #ebf calories #a cup fresh currants #a cup water #a_/b cup sugar #a tbs4 lemon juice ,wash currants carefully and place in a saucepan on a warm but not hot part of the stove1 allow to heat gently until the currants are soft1 press through a cloth1 and add the water and sugar2 stir until dissolved 7or make a sirup of the water and sugar and add the currant juice and lemon and freeze as directed in other ices74 ,the egg white may be added if desired4 ,,lemon ,,cream1 ,,or ,,milk ,,sherbet #c cups 7#bd ounces7 milk #d lemons #a cup cream 7#h oz47 #c_/d cup of sugar ,mix cream1 milk and #a_/d cup of sugar and pour into freezer2 freeze until half frozen 7mushy74 ,add juice of #c lemons and #a whole lemon 7peel and pulp7 shaved into very thin slices sweetened with remainder of sugar 7if not sufficiently sweet add more sugar and make allowances for same in fuel value74 ,continue the freezing until sherbet is of the right consistency4 ,miscellaneous ,desserts ,,nut ,,charlotte with wine #geh calories2 without wine #gde calories ,two servings #a_/b cup #dj cream #b tbs4 sugar #h pecan or walnut meats #a_/d tsp4 vanilla or #a tbs4 sherry wine ,dissolve sugar in the cream and beat solid1 add flavoring or sherry and nuts4 ,,orange ,,charlotte #fca calories #a_/b cup of orange jelly mixture 7see directions for making under jellies7 #a_/b cup double cream #a tbs4 sugar 7the above quantity will require about #b tsp4 of granulated gelatin74 ,pour jelly mixture into a bowl and surround with cracked ice2 when it begins to stiffen1 fold in the stiffly beaten cream4 ,pour into molds or ice cream glasses and set aside in the ice-box to become set4 ,,snow ,,pudding #dbh calories for orange pudding ,orange1 lemon1 grape juice1 or pineapple may be used in preparing this pudding4 #a_/b cup fruit juice #b tsp4 gelatin #a tbs4 cold water #a_/d cup sugar #a egg white and #a_/d cup soft custard ,make jelly mixture as already directed and place the bowl in a pan of cracked ice2 when the mixture begins to stiffen1 fold in the well-beaten egg white 7beat it in with an egg beater74 ,pour the mixture into a mold or individual glasses and set aside on ice to become set4 ,when ready to serve1 unmold and pour on the soft cold custard4 ,,prune ,,or ,,prune ,,fig ,,whip #ahd4d or #bdd4i calories #f prunes or #d prunes and #a fig #a egg white #b tbs4 sugar ,cook the prunes and figs in sufficient water to cover them until they are perfectly soft1 press through a sieve1 add sugar1 chill thoroughly1 and fold in the stiffly beaten egg white4 ,the above mixture may be put in individual cups and baked in a slow oven 7in a pan surrounded with hot water7 until they are firm in the center and a light brown4 ,serve with or without whipped cream4 ,,footnotes3 #bi ,archives of ,pediatrics1 ,vol4 ,,xxii1 p4 #eae1 by ,van ,slyke4 #cj ,chemistry of ,food and ,nutrition1 by ,henry ,sherman4 #ca ,diseases of ,nutrition and ,infant ,feeding1 by ,morse and ,talbot4 #cb ,bulletin #ef1 ,hyg4 ,lab41 ,public ,health ,service1 #aijh2 ,circular #aec1 ,u4 ,s4 ,dept4 ,agric41 ,bureau of ,animal ,industry1 #aiaj4 #cc ,diseases of ,nutrition and ,infant ,feeding1 p4 #agc1 by ,morse and ,talbot4 #cd ,quoted from ,diseases of ,nutrition and ,infant ,feeding1 p4 #agc1 by ,morse and ,talbot4 #ce ,rosenau3 ,bulletin #ef1 ,hyg4 ,lab41 ,public ,health ,service1 #aiji2 ,circular #aec1 ,u4 ,s4 ,dept4 ,agric41 ,bureau of ,animal ,industry1 #aiaj4 #cf ,sommerfield3 ,handbuch der ,milchkunde1 ,j4 ,f4 ,bergman1 ,wiesbaden1 #aiji4 #cg ,buttermilk ,tablets may be purchased from the ,chas4 ,hanson ,co4 ,lab41 ,n4 ,y41 or from ,parke1 ,davis ,co4 ,the ,buttermilk ,starter is prepared by the first mentioned firm and is ready to use1 directions coming with each sample4 #ch ,recipes for coffee1 egg1 cocoa and chocolate junket will be found in junket recipes1 from the ,chas4 ,hanson ,co4 #ci ,egg white is frequently added to increase the nutrient value of ice creams and water ices4 #dj ,edible ,portion4 #da ,chemistry of ,food and ,nutrition1 by ,henry ,sherman4 #db ,food ,products1 by ,henry ,sherman4 ,,chapter ,,vi ,,infant ,,foods ,,and ,,formulas ,,used ,,in ,,abnormal ,,conditions ,formulas ,used ,in ,feeding ,infants ,,whey ,put one pint of skimmed milk into a clean saucepan and heat to a temperature of #ajj deg4 ,f4 7lukewarm74 ,to this milk add #b teaspoonfuls of liquid rennet1 essence of pepsin1 or #b junket tablets1 stir until well mixed1 and allow to stand at room temperature 7#gj deg4 ,f47 until firmly jellied4 ,break up with a fork until it is finely divided1 strain through thicknesses of cheesecloth2 return the fluid part to the stove and raise to a temperature of #aej deg4 ,f4 to destroy the rennet left in the whey4 ,the whey is then cooled before it is added to the milk or cream4 ,,barley ,,water #c decoction starch#dc #d rounded tsp4 barley flour #a pt4 water ,mix a small amount of the water with the barley flour and put the rest of the water into a clean saucepan and allow to heat2 when boiling add thin barley mixture1 stir thoroughly1 and allow to boil #bj minutes2 remove from stove1 measure1 and replace with hot water that which was lost through evaporation to make up the original pint2 strain through two thicknesses of cheesecloth4 ,,oat ,,water #d rounded tsp4 oat flour #a pt4 water ,mix and proceed as in making barley water4 ,,albumen ,,water ,,with ,,brandy #h oz4 water 7cold7 #a egg white #a tsp4 brandy ,mix egg and water and add brandy slowly to prevent coagulating egg white4 ,,beef ,,juice ,composition3 #j4fj fat1 #b4ij protein1 and considerable extractive matter4#dd ,place a piece of round steak upon a hot griddle and turn once or twice until the outside is seared and the meat is hot throughout4 ,remove from griddle and cut into small pieces and place in a small meat press made for the purpose4 ,a lemon squeezer may be used when the press is not available4 ,salt lightly4 ,begin by giving one teaspoonful and increase the amount gradually to #a ounce 7#f teaspoonfuls74 ,according to ,morse and ,talbot1 it is never wise to give babies more than #b ounces of beef juice even in their second year1 as it is apt to disturb digestion4 ,also babies are often made restless or sleepless by taking beef juice4 ,,malt ,,soup #cdg calories #a-a_/b - #b tbs4 malt soup extract 7reduce if necessary7 #a level tbs4 sifted flour #a pt4 milk #ah oz4 water 7hot and cold7 ,dissolve malt soup extract in #a_/b cup of hot water and measure in enough cold water to cool the mixture4 ,with the remaining cold water mix the flour until it is free from lumps2 and to the malt soup mixture1 add milk4 ,pour all into a clean saucepan and bring slowly to the boiling point2 simmer 7not boil7 for #bj minutes4 ,now increase the heat and allow the mixture to boil #e minutes2 strain and use as directed4 ,this is a fattening mixture and the amount of malt soup and whole milk may be increased as the child is able to handle it1 taking care1 however1 not to increase the strength of the mixture too rapidly or too much1 or digestional disturbances will result4 ,,buttermilk ,,mixture ,,for ,,infants #edd4f calories #a tbs4 wheat flour1 #d tbs4 dextri-maltose1 #h oz4 hot water plus enough hot water to replace that which is lost through evaporation 7about #f oz474 ,buttermilk1 sufficient quantity to make #a quart of mixture4 ,mix flour with a little cold buttermilk4 ,dissolve sugar 7dextri-maltose7 in the hot water4 ,stir two mixtures together and add enough buttermilk to make #a quart4 ,place on stove and bring mixture quickly to a boil4 ,boil for #bj minutes1 stirring constantly1 strain1 measure1 and add enough boiling water to replace that which is lost in cooking4 ,place on ice and use as directed4 ,the nurse will soon be able to tell how much water is lost in evaporation and add the additional amount to the mixture before beginning the boiling4 ,,eiweissmilch#de 7,,protein ,,or ,,albumen ,,milk7 #a quart fresh whole milk #a pint of fresh buttermilk #d teaspoons essence of pepsin1 ,heat whole milk to #ajj deg4 ,f41 add essence of pepsin and stir thoroughly4 ,allow to stand at same temperature until the curd is formed4 ,pour mass into muslin bag and drip the whey from the curd4 ,when the mass is as dry as it is possible to have it1 remove it from the bag to a fine strainer4 ,press curd through the strainer with a wooden spoon or potato masher 7the author has found that a potato ricer with a piece of copper gauze1 such as is used in a chemical laboratory1 inserted1 facilitates the breaking up of the curd74 ,the mass must be passed several times through the strainer in order to make the precipitate sufficiently fine to look like milk4 ,during the process of straining1 the buttermilk is added4 ,the composition of above formula is1 according to ,finkelstein and ,meyer1 as follows3 ,protein #c1 ,fat #h4e1 ,sugar #a4e1 ,salts #j4e4 ,there are several prepared ,eiweissmilch mixtures on the market1 ,beebe1 ,hoose and others4 ,larasan ,roche is also a prepared mixture having a composition much like that of the original ,eiweissmilch1 it is easily prepared1 and the results from feeding this milk have been found generally good4 ,,formulas ,,used ,,in ,,diet ,,for ,,constipation ,,prunes ,,and ,,figs #a_/b lb4 each prunes and dried figs #a oz4 senna leaves ,boil from #b to #c hours as directed in preparing prunes as above4 ,lift fruit from hot sirup1 place in quart jars1 strain the juice and pour over the fruit4 ,use as needed4 ,,conserve #a_/c lb4 prunes 7pits removed7 #a_/c lb4 raisins 7seeded7 #a_/c lb4 figs #a oz4 senna leaves ,boil prunes just enough to allow of the pits being removed4 ,cool and pass with the senna leaves1 figs and raisins through the food chopper4 ,after passing through once return to chopper and pass through a second time4 ,see that the senna leaves and fruit are thoroughly mixed and finely chopped4 ,place in a quart jar and give in doses of from #a to #b teaspoonfuls night and morning4 ,,bran ,,gems 7,,no4 #a7 #efj calories #b tbs4 molasses #a_/b tsp4 salt #a_/b cup milk #a-a_/b cup bran #a_/b tsp4 soda #a egg ,mix soda into bran1 add salt1 stir milk and molasses together and stir into bran2 add well-beaten egg4 ,bake in #f well-greased gem pans4 ,,bran ,,gems 7,,no4 #b7 #hcb calories #a-a_/b cups bran #a tbs4 sugar #b tbs4 melted butter #a egg #a cup milk #b tsp4 baking powder ,mix together and bake in #f well-greased gem pans4 ,,bran ,,biscuits #gjf calories #a cup of bran #a_/b cup of flour #a_/b tsp4 salt #b tbs4 butter and lard mixed #a-a_/b tsp4 baking powder #a_/c cup of milk ,mix flour1 salt1 baking powder and shortening together4 ,add milk to make a soft dough4 ,mold into biscuits1 and bake in a quick oven #aj to #ab minutes4 ,,bran ,,cookies #bahg4e calories #a_/b cup of sugar #a_/b cup of molasses #a_/d cup of butter and lard mixed #a-a_/b cups of bran #a cup of flour #a tsp4 cinnamon #a tsp4 ginger #a_/b tsp4 cloves #a_/b tsp4 nutmeg #b eggs #a_/b cup raisins or nuts may be added1 due allowance being made for the additional fuel value4 ,cream butter and sugar together1 add molasses4 ,sift flour1 salt and spices together4 ,add eggs 7well beaten71 to sugar mixture and stir in the remainder of ingredients4 ,drop from spoon on a well-greased pan1 bake in moderate oven to a delicate brown4 7,see ,protein-free cookies1 p4 #cdj47 ,nutrient ,enemas#df ,,no4 #a4 ,,milk ,,and ,,egg #f oz4 milk1 #a egg #a tsp4 pure peptone 7this may be omitted7 #a_/b oz4 normal saline solution #a tube peptonizing powder dissolved in #a tbs4 water ,mix thoroughly and peptonize at a temperature of #aaj deg4 ,f4 for #a hour4 ,,no4 #b #h oz4 milk #c eggs #c grains table salt ,,no4 #c #h oz4 milk #b oz4 glucose 7grape sugar7 ,,no4 #d4 ,,singer',s ,,enema #abe gm4 7about #d oz47 milk #abe gm4 7about #d oz47 wine #a or #b egg yolks ,salt #a tsp4 ,witte's peptone ,,no4 #e4 ,,boas' ,,enema #bej c4c4 7#h oz47 milk #b egg yolks ,small quantity of salt #a tbs4 of red wine #a tbs4 ,kraftmehl ,health ,flour ,,no4 #f #f oz4 bouillon #d oz4 red wine #a egg yolk #a to #b tsp4 dry peptones ,,no4 #g4 ,,milk ,,and ,,starch ,,enema--,,von ,,leube #bej c4c4 7about #h oz47 milk #gj grains starch ,,malted ,,milk ,,enema ,dissolve #a oz4 of malted milk in #h oz4 of hot water #a egg and #a_/b tsp4 salt or #a_/b oz4 saline solution ,,normal ,,saline ,,solution #a dram sodium chloride 7common salt7 #a pt4 7#af oz47 water1 7boiled7 ,formulas ,used in ,diabetes#dg 99 ,,bran ,,agar ,,wafers ,makes #cj wafers4 #b-a_/b quarts washed bran 7dry7 #cf gms4 agar-agar #a-a_/b tsp4 salt #b saccharin tablets 7#a_/b gr47 #fjj c4c4 of cold water ,mix agar-agar1 saccharin1 salt and water4 ,boil until dissolved4 ,pour over dry bran4 ,mix thoroughly and mold into muffin tins while hot4 ,bake in a slow oven about #bj minutes1 or until wafer is dry and will whirl in the tin4 99 ,,agar ,,jelly #a tsp4 or #g gms4 agar-agar #a cup cold water #a tsp4 mild citric acid #a_/b gr4 saccharin #a_/d tsp4 flavoring ,coloring--as desired ,dissolve agar-agar in water4 ,add citric acid and saccharin4 ,put over flame and boil4 ,remove from fire--add flavoring and coloring4 ,put in cool place to harden4 ,this jelly has no food value4 99 ,,spinach ,,and ,,egg ,,salad #c gms4 gelatin #b tbs4 cold water1 melt and swell over hot water4 ,add3 #f tbs4 cold water #b tbs4 vinegar #ej gms4 fresh cooked spinach #a hard cooked egg ,salt as desired ,surround mold with slices of hard cooked egg1 placing the spinach in the center4 ,pour over this the gelatin mixture2 allow to mold and serve on lettuce4 99 ,,mayonnaise ,,dressing #b egg yolks #cfj gms4 of salad oil #fj c4c4 vinegar #h gms4 salt and pepper ,beat egg yolks4 ,gradually add oil until all has been used 7beating the mixture constantly74 ,then add the remainder of the ingredients4 ,put in a covered jar and keep in a cool place4 ,the percentage composition of this dressing is ,fat--#hc4 ,protein--#j4i ,,cellu ,,bran ,,crackers #a_/b cupful cellu flour #a cupful dry1 washed bran #a tablespoonful ,india gum #a teaspoonful baking powder #a_/b teaspoonful salt #c tablespoonfuls mineral oil #a_/b grain saccharin ,hot water ,makes #ab crackers about #d inches by #d inches and #a_/h inch thick 7resembling ,graham crackers74 ,mix all dry ingredients4 ,add mineral oil and saccharin dissolved in a small amount of water4 ,then add sufficient hot water to make a soft dough4 ,spread on a baking sheet or in flat baking pans and cut into twelve wafers4 ,bake in a slow oven until dry4 ,these crackers have practically no food value4 99 99 99 99 99 ,soya ,manna may be secured from ,vitae ,health ,food ,company1 #cfd ,roy ,street1 ,seattle1 ,washington4 ,soya ,manna muffins may be substituted for hepco cakes in any of the following recipes3 9999 ,,olmsted ,,brancakes 7,recipe #da7 #c cupfuls bran1 washed #b eggs #b egg yolks #a_/d teaspoonful salt #ej grams lard or crisco1 melted #ahj grams water #a_/b teaspoonful baking powder ,mix ingredients in order given and bake in a moderate oven4 ,this recipe makes #ah muffins4 ,food value of #f muffins1 #a gram carbohydrate1 #e grams protein1 #bc grams fat4 9999 ,,soya ,,manna ,,muffins 7,recipe #db7 #b eggs #fj grams cream--#bj #adj grams ,soya ,manna #bj grams butter #a_/b teaspoonful baking powder #ajj grams water ,beat eggs1 add cream and then flour1 beating all the time4 ,add water and melted butter4 ,mold into #ab cakes and bake4 ,each cake contains #f grams protein1 #f grams fat3 approximately #ge calories4 9999 ,,noodle ,,soup 7,recipe #dc7 #a_/b pint broth--clear #a egg noodle #e grams butter ,few grains salt and pepper ,beat eggs until stiff and bake in #e grams of butter as an omelet2 let cool1 cut into strips as noodles4 ,heat broth and add noodles4 ,if desired1 add vegetables1 cut in cubes1 using such variety and quantity as give flavor to soup adding their food value to diet4 ,food value #f grams protein1 #aj grains fat4 9999 ,,chicken ,,supreme 7,recipe #dd7 #ej grams chicken weighed cooked #a_/b egg #ej grams milk #be grams celery ,few grains salt and pepper ,beat egg slightly1 add chicken1 cut in small pieces1 milk salt and pepper4 ,put in mold1 set in pan of hot water and bake in moderate oven until firm4 ,food value #d grams carbohydrate1 #ah grams protein1 #ac grams fat4 9999 ,,salisbury ,,steak 7,recipe #de7 #ge grams steak--fat1 weighed uncooked #be grams onion1 uncooked ,few grains salt and pepper ,grind the meat1 add seasoning and make into firm balls4 ,sear in hot mineral oil1 then cook at a lower temperature4 ,food value1 #b grams carbohydrate1 #ag grams protein1 #bb grams fat4 9999 ,,veal ,,bird 7,recipe #df7 #ge grams meat #b ,olmsted brancakes1 crumbed #be grams chopped celery ,few grains salt and pepper #ajj grams skim milk ,have meat cut in one thin slice4 ,use the trimmings chopped fine in dressing of crumbs1 celery and seasoning moistened with water4 ,spread dressing on meat1 roll and tie or skewer with toothpicks4 ,put in casserole and bake in milk until done4 ,food value1 #f grams carbohydrate1 #bc grams protein1 #ai grams fat4 9999 ,,salmon ,,molded 7,recipe #dg7 #ajj grams salmon #a egg yolk #e grams butter #ej grams skim milk #b tablespoonfuls vinegar ,few grains salt #a_/b teaspoonful gelatin #a tablespoonful cold water ,remove the salmon from the can1 weigh1 separate in flakes4 ,add beaten yolks1 melted butter1 milk and vinegar and salt4 ,cook over boiling water1 stirring constantly until mixture thickens4 ,soak gelatin1 strain and add to salmon4 ,fill individual molds1 chill1 and serve with cucumber sauce4 ,food value1 #c grams carbohydrate1 #bf grams protein1 #bc grams fat4 9999 ,,cabbage ,,souffle 7,recipe #dh7 #ajj grams cabbage1 cooked #ae grams lean meat1 cooked1 minced #ce grams sour cream--#af #a egg #aj grams ,american cheese ,few grains salt and pepper ,chop cabbage fine1 add meat1 cream1 beaten egg1 salt and pepper4 ,put into mould and sprinkle grated cheese over top4 ,bake in a moderate oven until firm and brown4 ,food value1 #e grams carbohydrate1 #ae grams protein1 #ag grams fat4 9999 ,,celery ,,ramekins #ej grams milk #a_/b hepco cake #be grams celery #a egg #e grams butter ,few grains salt and pepper ,heat milk2 add crumbed hepco cake1 grated celery and seasonings1 let come to a boil1 add butter1 remove from fire2 add beaten egg yolk4 ,fold into beaten white4 ,put in ramekin and bake #bj or #cj minutes in slow oven until well browned4 ,food value1 #c grams carbohydrate1 #aa grams protein1 #ae grams fat4 9999 ,,baked ,,onion #ej grams onion1 uncooked #aj grams ground meat1 lean cooked #ae grams whole milk ,few grains salt and pepper ,parboil the onion1 scrape out the inside1 leaving only shell4 ,weigh shell and scrapings to #ej grams4 ,add meat and return to shell4 ,put into casserole1 add milk and bake until tender4 ,food value1 #d grams carbohydrate1 #d grams protein1 #b grams fat4 9999 ,,squash ,,pie 7,recipe #ib7 #a egg #aej grams squash cooked #ej grams cream--#af #a_/b teaspoonful cinnamon #a_/d teaspoonful nutmeg ,few grains salt #a_/b grain saccharin ,beat egg1 add mashed squash1 cream1 spice1 salt and saccharin dissolved in #a teaspoonful of cold water4 ,bake until firm in center1 using cellu flour recipe for pie crust4 ,food value1 #ab grams carbohydrate1 #aj grams protein1 #ad grams fat4 9999 ,,spice ,,cookies 7,recipe #ic7 #b eggs #a_/b grain saccharin #aj grams cream--#af #a teaspoonful spices--cinnamon1 cloves1 nutmeg #bj grams ground almonds ,beat the yolks1 add saccharin dissolved in cream1 then spices and ground almonds4 ,add to the stiffly beaten whites4 ,drop from spoon on oiled pan and bake in hot oven4 ,food value1 #d grams carbohydrate1 #af grams protein1 #be grams fat4 ,,cream ,,of ,,cauliflower #a_/d cup cauliflower puree #b_/c cup chicken or beef stock #a_/d tsp4 onion juice 7if desired7 #b tbs4 #dj cream ,salt and pepper ,add cauliflower to stock1 and allow to come to a boil1 season and add cream4 ,serve at once4 ,,tomato ,,bisque #a cup creamed tomatoes #a_/b cup water #a sprig 7#a tbs4 chopped7 parsley #c cloves #a_/b tsp4 salt #a_/h tsp4 soda #a-a_/b oz4 7#c tbs47 #dj cream ,cook tomatoes with cloves1 parsley1 and water for #bj minutes4 ,press through sieve and return to fire4 ,add soda2 when effervescence ceases1 add cream1 and serve at once4 ,,spinach ,,soup #cj gm4 cooked spinach #ae c4c4 #dj cream #a egg yolk ,cook spinach until tender and press through a sieve2 add the broth2 allow to cook about #e minutes and add the well-beaten yolk and cream4 ,place the saucepan over hot water and cook #aj minutes4 ,season and serve at once4 ,other ,cream ,soups1 except ,tomato ,bisque1 are made by the same recipe4 ,,vegetables ,the nurse must be governed in the selection of the vegetables by the physician1 using those from the #e group until otherwise ordered4 ,these must be boiled in three separate waters to further reduce their carbohydrate content4 ,cream or butter is added to them when diet permits2 in the beginning 7after starvation7 only salt or 7in case the vegetable is given in form of a salad7 a little lemon juice with a little salt and pepper added4 ,grated onion1 a small quantity of celery seed1 or a tiny bit of chopped green pepper may be added for additional seasoning4 ,when some fats are allowed1 butter1 olive oil1 and cocoanut cream may be used2 the latter is prepared as follows3 #a small cocoanut grated2 this is washed in cold water slightly acidulated with vinegar to remove the sugar1 then washed to remove the vinegar4 ,over the washed cocoanut pour #a pint of boiling water2 allow to stand until cold enough to squeeze through a cloth2 press as much of the water out as possible4 ,pour the water into a shallow dish and allow to stand until the cream rises2 skim off and serve with lemon juice on salad as a dressing4 ,,boiled ,,corned ,,beef ,,with ,,cabbage ,,and ,,other ,,vegetables#dh ,a portion containing #ej-ge grams meat and #ajj grams of each vegetable makes an excellent meal4 ,horseradish 7sauce7 is recommended by ,joslin as a seasoning1 and some pickles made from group of #e vegetables and without sweetening4 ,curry powder1 tarragon1 bay leaves1 capers may likewise be used in moderation to vary the monotony of the diet4 ,,parsley ,,butter #e gm4 butter #a tsp4 chopped parsley ,salt1 pepper1 and #a_/b tsp4 lemon juice1 if desired ,cream butter1 add lemon juice1 salt1 and pepper4 ,stir in parsley4 ,serve on meat or fish4 ,,neufchatel ,,cheese ,,salad #a_/c ,neufchatel cheese #a_/d green pepper #a tbs4 cream 7#dj7 #a tsp4 lemon juice ,season with salt and paprika and dress with cream dressing4 ,,cheese ,,salad ,mash cream cheese with fork2 add tablespoonful chopped pecan nuts to #a_/c ,neufchatel cheese4 ,season with salt and pepper and dress with ,french dressing4 ,,tuna ,,fish ,,salad #a_/b cup tuna fish #a_/b cup chopped celery ,dress with ,french ,dressing4 ,,egg ,,salad ,cook #a egg hard4 ,cut into rings2 arrange on lettuce leaf2 dress with cream dressing4 ,,tomato ,,aspic #a cup canned tomatoes #a_/b cup celery 7hearts7 #a tsp4 celery seed #a_/b small onion #a_/b cup water #a_/d cup vinegar #c-d cloves #a_/b bay leaf #b tsp4 granulated gelatin1 soaked in tbs4 water ,boil all ingredients 7except gelatin and celery hearts7 #bj minutes4 ,measure4 ,add hot water or tomato juice to make one cup2 add gelatin2 allow to cool2 cut celery fine1 place in mold2 pour in the tomato aspic and allow to jelly in a cold place4 ,bread ,substitutes ,,bran ,,biscuits1 ,,or ,,muffins #a cup washed bran #a tsp4 baking powder #a egg #a tbs4 melted butter #b tbs4 cream #a_/d tsp4 salt ,tie bran in cheesecloth bag and attach to cold water faucet2 allow water to pass through bran1 removing starch by squeezing the water through2 using dry4 ,beat egg separately2 add cream2 mix with bran1 add melted butter1 salt1 and baking powder4 ,grease muffin rings and pour in the mixture4 ,bake in moderate oven4 ,,diabetes ,,muffins#di 7,the ,equivalent of an ,egg7 ,recipe for ,hepco ,cakes1 so arranged that one cake is equivalent to an egg3 #adj gm4 ,hepco flour ,protein #fj ,fat #bi #b eggs ,protein #ab ,fat #ab #fj c4c4 #dj cream ,protein #b ,fat #bd #aj gm4 butter ,fat #i ,make twelve cakes2 each cake contains #f grams of protein1 #f grams of fat1 and approximately #ge calories4 ,,lister ,,muffins ,so arranged that each muffin is equivalent to one egg3 #fj gm4 ,lister flour 7one box7 ,protein #db ,fat #j #a egg ,protein #f ,fat #f #de c4c4 #dj cream ,protein #b ,fat #ah #cj gm4 butter ,fat #be ,make #ag muffins2 each muffin contains #f grams protein1 #f grams fat4 ,,bran ,,biscuits ,,for ,,constipation 7,by ,f4 ,m4 ,allen7 #fj gm4 bran #a_/d tsp4 salt #f gm4 powdered agar-agar #ajj c4c4 7#a_/b glass7 cold water ,tie bran in cheesecloth and wash under tap until water is clear4 ,bring agar-agar and water 7#ajj c4c47 to boiling point4 ,add washed bran and salt and agar-agar solution 7hot74 ,mold into ten cakes2 place on oiled paper and let stand #a_/b hour1 then when firm and cool1 bake in moderate oven #cj to #dj minutes4 ,the bran muffins are more palatable if butter and eggs are added4 ,this may be done1 provided the patient allows for them in the diet4 ,,casoid ,,flour ,,and ,,bran ,,muffins #a oz4 7#cj gm47 casoid flour #a level tbs4 7#ae gm47 butter #a oz4 7#cj c4c47 #dj cream #a_/d tsp4 salt #a egg white 7whole egg may be substituted for #a egg white7 #a-a_/b tsp4 baking powder #a cup washed bran ,total food value3 protein1 #ah grams2 fat1 #bd grams2 carbohydrates1 #a gram2 calories1 #cjj4 ,one muffin3 protein1 #c grams2 fat1 #d grams2 carbohydrates1 trace2 and calories1 #ej4 ,the flours and meals used in this recipe are prepared by ,cutlard1 ,stewart ,walt1 ,ltd41 ,london 7casoid flour74 ,theo4 ,metcalf ,co41 ,boston 7soya bean meal74 ,lister ,brothers1 ,andover1 ,mass4 7,lister diabetic flour74 ,,lister ,,flour ,,and ,,bran ,,muffins1 ,,or ,,biscuits #a cup washed bran #cj gm4 ,lister flour #a tsp4 baking powder #a tbs4 butter #a egg #a_/b tsp4 salt #b tbs4 #dj cream ,sufficient water to make a drop batter 7about #a_/d cup7 ,squeeze all the water from the bran1 then add flour and melted butter1 salt1 well-beaten egg yolk and cream4 ,whip egg white stiff and fold into mixture4 ,add baking powder and enough water to make thick batter4 ,use less water if biscuits instead of muffins are desired1 and knead into a dough4 ,roll out into a sheet one-half inch thick and cut with biscuit cutter4 ,after making muffin batter1 grease muffin ring with melted lard1 and pour half full of above mixture4 ,bake in moderate oven about #bj or #cj minutes4 ,,soya ,,meal ,,and ,,bran ,,muffins#ej #a oz4 7#cj gm47 soya meal #a level tbs4 7#ae gm47 butter #a oz4 7#cj c4c47 #dj cream #a_/d tsp4 salt #a cup washed bran #a egg white 7one whole egg may be substituted for one egg white7 #a-a_/b tsp4 baking powder ,mix soya meal1 salt1 and baking powder4 ,add to washed bran2 add melted butter and cream4 ,beat egg white and fold into mixture2 add enough water to make thick drop batter4 ,bake in six well-greased muffin tins until golden brown from #ae to #be minutes4 ,total food value3 protein1 #aa grams2 fat1 #bg grams2 carbohydrates1 #b grams2 calories1 #cjd2 one muffin1 protein1 #b grams2 fat1 #d4e grams2 carbohydrates1 trace2 calories1 #ej4 ,,almond ,,biscuits #a cup almond meal #a oz4 cream #a egg #a grain 7or less7 saccharin1 dissolved in #a tsp4 of water #a-a_/b tsp4 baking powder #c-d drops vanilla ,beat egg yolk until light1 add cream and saccharin2 stir this into almond meal4 ,fold in the stiffly beaten white4 ,drop on a greased paper and bake until golden brown in a moderate oven4 99 99 99 99 99 ,almond meal or flour is prepared as follows3 ,blanch #a pound of almonds2 dry and pass through grinder1 or pound in mortar until powdered4 ,place in a muslin bag and immerse in a pan of water acidulated with vinegar to remove sugar2 allow to stand #ae minutes4 ,squeeze dry and place in a warm 7not hot7 oven to remove all moisture4 ,grind or pound once more4 ,almond flour does not keep well2 it must be made in small quantities and kept in a glass jar in a cool place4 ,,cocoanut ,,flour ,grate cocoanut and treat as almonds to remove sugar2 dry thoroughly and grind or pound to fine meal4 ,,cocoanut ,,biscuits #a cup cocoanut #a egg white 7or whole egg if desired7 #a-a_/b tsp4 baking powder #a_/b grain saccharin 7,a biscuit may be made without saccharin for bread substitute47 ,,spanish ,,cream #e tbs4 coffee1 or ,infusion of cocoa nibs #a tsp4 gelatin #a tbs4 cold water #cj c4c4 7#a oz47 #dj cream #a egg ,saccharin to sweeten ,pour coffee1 or cocoa infusion1 into a double boiler1 beat egg yolk and saccharin dissolved in #a tsp4 of water1 and stir into hot coffee4 ,cook gently until mixture coats the spoon 7raw flavor of egg has disappeared72 add gelatin and mix thoroughly4 ,whip cream and egg white4 ,place on ice to set4 ,,lister ,,cream ,,puff ,this is made by pouring #cj grams of soft custard 7diabetic7 over #a ,lister biscuit4 ,,custard #a_/b cup cream #a_/d grain saccharin #a egg #c-d drops vanilla or almond extract ,beat egg until it is well broken up1 but not light2 stir into the cream2 dissolve saccharin in teaspoonful of water and add to mixture4 ,if custard is to be baked1 pour into molds and place upon a rack1 or on a folded cloth in a pan half filled with hot water2 bake in moderate oven until firm in center4 ,if soft custard is desired1 pour mixture into double boiler and cook gently until mixture coats the spoon and the raw egg flavor has disappeared4 ,,snow ,,pudding ,make #a_/b cup gelatin1 as directed below4 ,whip in #a egg white4 ,when gelatin is half congealed1 mold and set on ice4 ,when ready to serve1 unmold and serve with custard1 or #a tbs4 whipped cream4 ,jellies #a tbs4 cold water to #b tsp4 granulated gelatin is used in making the following jellies3 ,,lemon #af4f calories #a_/b cup boiling water #a_/d to #a_/b saccharin tablet dissolved in #a tbs4 water #a_/b lemon or #b tbs4 juice and #a_/b rind sliced thin ,,irish ,,moss ,,pudding ,carefully pick over and wash through several waters #a tbs4 ,irish moss4 ,place in double boiler with #a_/c cup of water and #c tbs4 #dj cream and #a_/d grain saccharin4 ,cook until mixture thickens when dropped upon a cold saucer4 ,pour over #a stiffly beaten egg white2 add #c-d drops of vanilla extract4 ,mold and set on ice4 ,irish moss may be used as a substitute for gelatin4 ,the carbohydrates in this substance are not believed to be utilized for the manufacture of glucose in the human body4 ,,orange #ed calories #a_/d cup boiling water #a_/b tbs4 lemon juice #a_/b cup orange juice #a_/d to #a_/b saccharin tablet dissolved in #a tbs4 water #b drops orange extract ,,wine #dj4h calories #a_/b cup boiling water #c tbs4 sherry wine #a tsp4 lemon juice and the yellow rind from #a_/d lemon #a-;inch piece of cinnamon #a_/d to #a_/b saccharin tablet dissolved in #a tbs4 water ,,method ,,for ,,fruit ,,jellies ,soak gelatin in cold water about #b or #c minutes1 then pour over it the boiling liquid2 add saccharin and fruit juice1 strain through cloth into wet molds4 ,set in cold place to stiffen2 when firm1 unmold4 ,serve with whipped cream1 or pour liquid into baskets made from orange or grapefruit1 hollowed out and the edges scalloped1 or pour into shallow pans1 and cut in #a_/b-;inch blocks when firm and serve on a bed of whipped cream4 ,,wine ,,jelly ,put water1 wine1 lemon juice and peel1 cinnamon1 and saccharin into a saucepan1 allow to boil #e minutes1 pour over gelatin 7which has been soaked in cold water74 ,if the jelly looks cloudy1 return to saucepan1 and add #a_/b egg white beaten stiff2 allow to boil #a minute1 stirring constantly1 and strain into mold4 ,serve with whipped cream4 ,ices ,,lemon #cj calories #a_/c cup water ,fruit juice1 #a lemon #a_/d to #a_/b saccharin tablet #a egg white ,,orange #ge4e calories #a_/b cup water #a large or #b small oranges #a_/b lemon #a_/d to #a_/b saccharin tablet #a egg white ,sweeten fruit juice with saccharin instead of sugar4 ,clip egg white with scissors1 or beat with ,dover egg beater1 add mixture and freeze4 ,,ice ,,cream 7#a7 ,use recipe for soft custard1 freezing after the custard has become thoroughly cold4 7#b7 #a_/c cup cream #a tbs4 chopped nuts #a_/d grain saccharin or enough to sweeten1 dissolved in #a tsp4 water #c-d drops vanilla1 orange1 or almond extract ,whip cream1 add saccharin and nuts4 ,pour into a small #a_/d-pound baking powder can1 seal the edges of mold or can with a thin strip of buttered muslin4 ,pack in equal parts of salt and ice for two hours4 ,sugar-free ,milk4--,a sugar-free milk has been advised by ,williamson4 ,it is made from washed cream as follows3 #c tablespoonfuls of cream are shaken in a pint of water and set aside until the cream rises1 it is then skimmed off and mixed with the white of one egg and diluted with pure water4 ,this furnishes a beverage not unlike milk in appearance and flavor4 ,,nut ,,charlotte #fj c4c4 7#b oz47 #dj cream #cj gm4 chopped walnuts ,saccharin to sweeten #c-d drops vanilla ,whip cream stiff2 add saccharin1 nuts1 and vanilla4 #a tbs4 sherry wine and #a tsp4 gelatin soaked in #a tbs4 cold water and melted over hot water may be substituted for vanilla to vary the above recipe4 ,,orange ,,charlotte #ge c4c4 7#e tbs47 orange juice #de c4c4 7#c tbs47 #dj cream #a_/b egg white #a tsp4 gelatin #a tbs4 cold water ,saccharin to sweeten ,soak gelatin in cold water2 dissolve over hot water1 add to orange juice2 add saccharin2 set aside until it begins to jelly4 ,whip cream and add to partially jellied orange juice2 fold in the stiffly beaten egg white2 mold4 ,serve #cj grams4 ,,footnotes3 #dc ,when a #a4ej decoction is desired1 use #b rounded teaspoonfuls to the pint of water4 ,diseases of ,nutrition and ,infant ,feeding1 p4 #bbb1 by ,morse and ,talbot4 #dd ,beef juice is not the same as 'dish gravy1' since the latter contains a large amount of cooked fat and is often highly indigestible4 ,morse and ,talbot's ,diseases of ,nutrition and ,infant ,feeding4 #de ,formula suggested by ,finkelstein and ,meyer4 #df ,diet in ,disease1 by ,freidenwald and ,ruhraeh and other sources4 #dg ,formulas marked with one star are those used in the ,presbyterian ,hospital1 ,chicago1 ,ill4 ,courtesy of ,miss ,r4 ,straka1 ,dietitian4 ,formulas marked with two stars are used in the ,olmsted ,hospital1 ,mayo ,clinic1 ,rochester1 ,minn4 ,courtesy of ,misses ,foley and ,ellithorpe1 ,dietitians4 ,formulas unmarked are used by the author in ,memphis ,general and ,st4 ,joseph's ,hospitals1 ,memphis1 ,tenn4 #dh ,treatment of ,diabetes1 p4 #ech1 by ,joslin4 #di ,the ,treatment of ,diabetes ,mellitus1 p4 #eca1 by ,joslin4 #ej ,starvation ,treatment of ,diabetes1 p4 #dc1 by ,hill and ,eckman4 ,,section ,,iii ,,the ,,human ,,machine ,,chapter ,,vii ,,the ,,human ,,body ,chemical ,composition of the ,body4--,it has been estimated by various writers that the human body has an approximate average chemical composition#ea of-- ,oxygen about #fe per cent ,carbon about #ah per cent ,hydrogen about #aj per cent ,nitrogen about #c per cent ,calcium about #b per cent ,phosphorus about #a per cent ,potassium about #j4ce per cent ,sulphur about #j4be per cent ,sodium about #j4ae per cent ,chlorine about #j4ae per cent ,magnesium about #j4je per cent ,iron about #j4jjd per cent ,iodine ,fluorine very minute quantities ,silicon ,dependence of the body upon ,food4--,the human body1 like any other piece of machinery1 undergoes a constant wear and tear incidental to the work it performs1 but in the human machine this is not all that must be included in its upkeep4 ,the replacing of the dead and cast out cells with new ones1 the repairing of the worn cells1 the furnishing of heat1 not only for the running of the engine but for the maintenance of the body temperature1--all of these must be considered and cared for if life is to continue4 ,in man-made machinery1 the renewal of the worn parts1 and the replacing of those no longer useful must be accomplished by an outside agency4 ,but in the body this work is performed by the organism2 and the material used for the purpose1 as well as that which is used to furnish the heat necessary for the internal and external activities of the body is food4 ,exceptions to this ,rule4--,under normal conditions the body never uses its own structure either for fuel or to replace tissue losses4 ,in starvation the body rebuilds its important tissues1 such as the nerves and glands1 at the expense of the less important ones1 such as the connective tissues and the skeletal muscles 7,taylor74 ,science has proved that for the most part the body does not use the food materials in their original form1 but carries them through a series of transformations into substances more easily handled by the organism4 ,roughly speaking1 we may say that the body carries the foodstuffs through practically four processes on the pathway through the body1 namely1 digestion1 absorption1 metabolism1 elimination4 ,processes ,included in ,digestion4--,there are several processes concerned in this transformation of the food materials4 ,some are purely mechanical and have to do with the movement of the food mass through the digestive tract3 others are of a chemical character and bring about distinct changes in the food materials themselves4 ,these mechanical and chemical processes with the retarding and stimulating agents that influence them are called digestion4 ,absorption4--,after the food materials have undergone digestion1 or simplification into more available substances1 these substances are absorbed1 that is1 they are passed through the membranes lining the walls of the intestinal tract1 and thence to the blood4 ,metabolism4--,the utilization of the transformed food materials and their final fate in the human body is included under the term ,metabolism4 ,elimination4--,after the food materials have been utilized to the extent of the body's ability to handle them1 their waste products are cast out of the organism by way of the skin1 the lungs1 the intestines and the kidneys4 ,a brief description of these processes seems desirable here4 ,digestion4--,mechanical digestion begins in the mouth1 where through the action of the teeth1 the tongue and the muscles of the jaw1 the food material is ground up and liquefied to a certain extent and made ready for the chemical action which takes place1 to a limited degree only1 as a result of the salivary enzyme in the mouth4 ,the eating of food causes a flow of saliva from the three pairs of large salivary glands1 and from the numerous secretory cells situated in the membranes of the mouth4 ,as a rule the food stays for too short a time in this organ for any appreciable amount of chemical action to take place1 but the liquefaction of the food mass with the salivary juices which contain the ferment 7ptyalin71 prepares for its passage into the gastric organ1 and allows the digestion of the starch 7the only foodstuff affected by salivary digestant71 to continue in that part of the stomach until its action is checked by the hydrochloric acid in the gastric juice4 ,arrangement of ,food in the ,stomach4--,to simplify the study of the gastric organs it may be well to think of the stomach as being divided into three regions1 i4e41 the fundus1 the middle region1 and the pyloric end1#eb each of which differs slightly from the other4 ,after being swallowed1 the food enters the region situated at the cardiac end1 known as the fundus4 ,motor ,processes in the ,stomach4--,there are no peristaltic waves in the fundus of the stomach1 and the movement of the food mass is accomplished through the stretching and contraction of the muscular walls of the organ which tends to churn and further mix it with the salivary juices as it is gently pushed out into the middle region4 ,in this region the peristaltic waves begin and travel toward the pylorus and increase in force as digestion progresses1 ceasing only with the emptying of the organ4 ,when the first stratum of food reaches the middle of the stomach it is caught by these oscillating peristaltic waves and forced forward through the pyloric region and against the pylorus1 from whence it is returned back through rings of constriction4 ,this forward and backward movement continues as long as there is food in the stomach1 thus thoroughly mixing the mass with the gastric juice and allowing the enzymes existing in the juices to have an opportunity for action 7chemical digestion74 ,passage of ,food from ,stomach4--,the material prepared in the stomach1 known as chyme1 is passed into the duodenum through the pylorus4 ,the opening of this sphincter is controlled1 according to ,cannon1 to a certain extent by the liquefication of the chyme1 but more especially by the presence of free acid in the stomach side of the pyloric orifice4 ,behavior of ,food in the ,intestines4--,the food does not pass at once along the canal1 but waits in the duodenum until several portions have passed through4 ,as the food mass is made alkaline in the presence of the intestinal juices1 the pyloric valve closes1 opening again as the contents nearest it on the stomach side are acidified4 ,intestinal ,movements4--,the peristaltic waves in the small intestines begin in the upper part and start a course ever downward4 ,these waves in the intestines are two-fold in character2 the quick shallow wave which forces the food string forward1 breaking it up into segments1 and backward joining the segments together again1 and the strong deep wave which carries the entire mass forward after each segmentation4 ,this method of movement in the small intestines is the best one possible under the conditions which prevail in this region of the digestional apparatus1 since it not only mixes the food material with the juices necessary for its digestion1 but likewise spreads it out over a wide space1 insuring a greater contact with the absorbing walls of the small intestines4 ,the ,effect of ,muscular ,constrictions4--,the muscular constrictions occurring in the intestines producing segmentation of the food string have1 according to ,sherman1 the effect of 7#a7 further mixing of the food and digestive juices1 7#b7 bringing the digested food into contact with the absorbing membrane1 7#c7 emptying the venous and lymphatic radicles in the membrane1 the material which they have absorbed being forced into the veins and lymph vessels by the compression of the intestinal walls4#ec ,movements in the ,large ,intestine4--,the movements in the large intestine or colon are much like those in other parts of the digestive tract4 ,the small and large intestine are divided by a valve known as the ileocecal valve1 and any food which passes through it cannot return1 since the valve is a competent one4 ,the cells in the walls of the larger intestine secrete fluids of a lubricating character1 containing no enzymes of digestion but aiding in moving the fecal matter toward the rectum4 ,distribution of ,secretory ,cells4--,secretory cells are distributed in each of the three regions of the stomach1 but are more numerous in the middle region than at either end4 ,the third region includes the pyloric vestibule through which all foods must pass before they can enter the small intestine1 and terminates in the pylorus1 the valve which shuts off the stomach from the duodenum and the rest of the intestinal canal4 ,chemical ,digestion4--,the chemical changes in the food materials1 after they are eaten1 are brought about through the action of certain substances known as soluble ferments or enzymes4 ,these enzymes exist in every tissue of the body1 and their province is first to break down the food materials themselves into simpler compounds1 and then to reconstruct the simpler substances into those of a more complex character1 which are more available for the various uses of the organism4 ,action of the ,enzymes4--,as ,sherman has stated1 all fermentation is brought about either directly or indirectly by the activity of animal or vegetable organisms or cells4 ,when the organisms or cells act directly and the chemical changes occur only in their presence1 the fermentation is said to be due to an organized ferment4 ,when the action is not brought about directly by the cell itself1 but by means of a substance secreted by the cell but acting apart from it1 this substance is called a soluble or unorganized ferment or 'enzyme4' ,the enzymes concerned in digestion and metabolism1 their source and their action1 may be found in the following table3 ,,table ,,of ,,enzymes#ed ,,source ,,and ,,action ,,of ,,enzymes ,where chiefly ,enzymes found ,action ---------------------------------------- ------------------------------ ,ptyalin 7salivary ,salivary ,converts starch amylase7 secretions to maltose ,amylopsin ,pancreatic juice ,converts starch 7pancreatic to maltose amylase7 ,liver diastase ,liver ,converts glycogen to glucose ,muscle diastase ,muscles ,converts glycogen to glucose ,act upon ,invertase 7sucrase7,intestinal juice ,converts glycogen carbohydrates to glucose and fructose ,maltase ,intestinal juice ,converts maltose to glucose ,lactase ,intestinal juice ,converts lactose to glucose and galactose ,glycolytic enzymes ,muscles1 etc4 ,split and oxidize glucose ,lipase 7steapsin7 ,gastric1 and ,splits fats to ,acts on pancreatic fatty acids and fats secretions1 blood glycerin and tissues ,pepsin ,gastric juice ,splits proteins to proteoses and peptones ,trypsin ,pancreatic juice ,splits proteins to proteoses1 peptones1 ,act on polypeptids and proteins amino acids ,erepsin ,intestinal juice ,splits peptones to amino acids and ammonia ,autolytic enzymes ,tissue generally ,split body proteins to simpler substances ,guanase ,thymus1 adrenals1 ,changes guanin pancreas to xanthin ,adenase ,spleen1 pancreas1 ,changes adenin ,act on purins liver to hypoxanthin ,oxidases ,lungs1 liver1 ,changes hypoxanthin muscles1 etc4 to xanthin and to uric acid ,classification of ,enzymes4--,sherman classifies the enzymes of the body according to their effects3 #a4 ,the hydrolytic enzymes3 7a7 ,proteolytic or protein-splitting enzymes4 7b7 ,lipolytic or fat-splitting enzymes4 7c7 ,amylolytic or starch-splitting enzymes4 7d7 ,sugar-splitting enzymes4 #b4 ,the coagulating enzymes1 such as thrombin or thrombase 7the fibrin ferment7 and rennin1 which causes the clotting of milk4 #c4 ,the oxidizing enzymes or oxidases 7which1 if the oxidation be accompanied by a splitting off of amino groups1 may be called deaminizing enzymes74 #d4 ,the reducing enzymes or reductases4 #e4 ,those which produce carbon dioxide without the use of free deamidizing oxygen1 such as zymase of yeast4 #f4 ,enzymes causing the breaking down of a larger into a smaller molecule of the same composition1 as in the production of lactic acid from glucose4 ,,digestion 7,,chemical7 ,salivary ,digestion4--,the table shows that enzymic action begins in the mouth4 ,saliva1 the characteristic secretion of this region1 contains the enzyme ptyalin which exerts its influence upon the starches and dextrins4 ,the food mass remains in the mouth for so short a time1 however1 that a very small percentage of the starch is changed to maltose under salivary digestion4 ,the action of ptyalin1 however1 continues in the fundus of the stomach until stopped by the acid in the gastric juice4 ,gastric ,digestion4--,the conditions existing in this region of the gastric organ of digestion are particularly favorable to the continuance of salivary digestion on account of the neutral character of the juices secreted by the cells there1 and because there is so little movement taking place4 ,the cells in the middle region1 however1 secrete a fluid rich in acid1 and as the food mass is gradually pushed forward by the contraction of the stomach walls into this portion of the stomach1 further conversion of starch and dextrin to maltose is checked4 ,gastric juice is secreted by cells situated in all parts of the stomach4 ,the character of the secretions differs in different parts of the organ4 ,however1 that in the fundus is neutral in character or even slightly alkaline1 according to ,howell1 while that in the middle region is highly acid4 ,the pyloric end of the stomach exhibits strong peptonizing powers and much of the hydrolysis of protein takes place here4 ,as the food is pushed out of the fundus it is caught by the waves of peristaltic action and swept toward the pylorus4 ,this movement of the food mass to and from the pylorus under the influence of the muscular constriction in the stomach tends to mix it thoroughly with the juices in all parts of the stomach1 and in a measure to liquefy it to the souplike mixture known as chyme4 ,rate of ,carbohydrates1 ,proteins1 and ,fats4--,carbohydrates1 for example1 do not require any acid for their digestion1 hence all of the acid with which they come in contact can go toward acidifying them1 while the proteins require hydrochloric acid before the enzymes can begin to exert their activities4 ,consequently they leave the stomach much more slowly than the carbohydrates4 ,the fats leave more slowly than any of the other food combinations4 ,if carbohydrates and proteins are taken together they leave the stomach more slowly than if the carbohydrates were fed alone1 but more quickly than they would if the meal consisted of protein alone4 ,when the meal consists of fats and proteins1 the stomach is emptied more slowly than is the case when either is fed alone4 ,intestinal ,digestion4--,digestion proceeds in an orderly manner throughout the intestinal canal4 ,the pancreatic juice1 bile1 and intestinal juice are poured upon the food mass on its entrance into the duodenum4 ,the enzymes work simultaneously4 ,trypsin in the pancreatic juice takes up the hydrolysis of the proteoses and peptones and those proteins which have escaped gastric digestion4 ,the amylopsin likewise in the pancreatic secretion acts upon the starch and dextrin1 changing them to maltose4 ,the lipases split the fats to fatty acids and glycerol4 ,the erepsin in the intestinal juice1 succus entericus1 brings about further change in the proteins1 with the production of amino acids4 ,the bulk of the carbohydrates are converted into monosaccharids in the small intestines4 ,the lactose1 maltose1 and sucrose are changed through the activity of the lactase1 maltase1 and invertase into glucose4 ,sherman states that it is possible that the splitting of the lactose 7milk sugar7 may occur in the intestinal wall rather than in the food mass4#ee ,bile4--,human bile1 the secretion most actively concerned in the digestion and absorption of the fats1 contains water1 bile salts1 bile acids1 bile pigments1 cholesterin1 lecithin1 and a peculiar protein derived from the mucous membranes of the bile ducts and gall bladder4 ,stimulation of ,intestinal ,secretions4--,the flow of the intestinal juices is stimulated by a substance or hormone known as secretin4 ,this hormone is the result of the action of hydrochloric acid upon some substance in the intestinal wall4 ,starling claims that the formation of hormones and their circulation through the blood to the reactive tissues is sufficient to account for the activity of the pancreas2 he doubts if the nervous system plays any part in the activity of that organ4 ,secretion of ,water in the ,stomach4--,the secretion of water by the cells of the stomach is such1 according to ,taylor1 as to produce chyme of quite constant consistency1 the solid particles being held in suspension in the fluid medium4 ,factors ,influencing ,gastric ,digestion4--,the factors influencing digestion in the stomach constitute all those mechanical1 electrical1 chemical1 and psychical factors which stimulate or retard the action of the gastric juices4 ,the movements in the stomach are involuntary1 but their activities may be stimulated by the flow of gastric juice4 ,sleep retards digestion in the stomach by retarding the movements in the organ itself4 ,stimuli to ,gastric ,flow4--,the division and liquefaction of the food in the mouth hastens gastric digestion by making the food better fitted for the action of the enzymes in the gastric juice4 ,the type as well as the character of the food acts as a stimulus to the gastric secretion4 ,water is probably the best of all the agents for stimulating the secretion of gastric juice1 while dextrin 7toast1 zwieback7 and the extractives of meat likewise exert similar powers4 ,retarding the ,gastric ,flow4--,the nervous system1 on the other hand1 at times checks or entirely inhibits a flow of these juices4 ,worry1 excitement1 anger1 fatigue1 chill2 each plays its part in promoting poor digestion in the gastric organ4 ,as chemical factors1 water and salts are the two necessary substances for gastric digestion1 since the enzymes in the juices cannot act except in their presence4 ,alkaline carbonates and fatty foods both check the flow of gastric juice1 and retard digestion4 ,the psychic factors which result in a stimulation of the secretory cells in the stomach are exerted through the sight1 smell1 and taste4 ,one often hears the expression3 ,the food looked1 smelled1 or tasted so good that it made my mouth water4 ,this actually occurs2 hence the secretion has been named appetite juice4 ,this appetite juice acts as a direct stimulant to the cells in the mucous lining of the stomach1 causing a flow of gastric juice4 ,it cannot be said to cause digestion1 but it certainly institutes that process1 thus starting the whole digestional procedure4 ,digestion in the ,larger ,intestine4--,science has proved that most of the nourishing part of the food ingested is digested and absorbed before it reaches the larger intestine4 ,the two portions of the alimentary canal known as the small and large intestine are separated by the ileocecal valve4 ,cannon claims that this valve is competent1 that is1 under normal conditions the food mass which passes through into the colon cannot be forced back into the small intestine4 ,the food mass sometimes contains materials which have escaped digestion1 likewise some of the active enzymes which bring about their hydrolysis1 in which case a certain amount of their digestion may continue in the large intestine4 ,so far1 investigators have found no enzymes in the fluids secreted by the cells in the walls of the large intestine1 but they have found an alkaline fluid which assists in completing the digestion of the foods which has started in other parts of the intestinal tract4 ,absorption4--,absorption of food occurs in all parts of the intestinal canal1 but the major portion of it occurs in the small intestines1 the mucous membrane lining of which seems particularly adapted for this purpose4 ,according to ,taylor there is no absorption of fats1 carbohydrates1 or proteins in the stomach4 ,other investigators believe that some of the protein is absorbed and also some glucose in concentrated solution4 ,however1 the stomach cannot be considered of great value as an absorbing organ4 ,physiology teaches that the absorption of the products of digestion occurs by means of the millions of small projections or villi with which the intestinal wall is lined4 ,these villi contain numerous capillary blood vessels and spaces known as lacteals4 ,the former converge into the portal vein1 the latter into the lymphatic vessels and thence into the thoracic ducts4 ,the ,absorption of ,fat4--,the fats1 as has been described1 are split into their two constituents1 fatty acid and glycerol4 ,the former is dissolved by the bile to form soap2 the latter is readily soluble in water4 ,these constituents thus dissolved pass through the walls and recombine in the form of neutral fat droplets1 probably during the passage through the walls1 since they appear in this form in the cells4 ,they pass into the thoracic duct and thence into the blood stream4 ,absorption of ,carbohydrates4--,the carbohydrates are chiefly absorbed in the form of monosaccharids4 ,this has been proved by introducing cane sugar or lactose into the blood vessels and getting the greater portion of it back unchanged by way of the urine4 ,as the monosaccharids are taken up by the capillaries lining the walls of the small intestines1 they are passed on to the portal vein and carried by the portal blood into the liver1 where they are stored temporarily as glycogen1 and given out to the blood in the form of glucose as needed4 ,after a meal rich in carbohydrates1 the portal blood will be rich in glucose1 while the blood in general circulation contains about the same amount as usual1 about #j4a4 ,absorption of ,proteins4--,the absorption of the products of protein digestion occurs through the capillary blood vessels and passes on to the portal vein4 ,the metabolism of protein is more complex than that of any of the foodstuffs4 ,it is probable that each living cell contains enzymes which are capable of breaking down the body proteins with the production of amino acids just as the proteins of the food are broken down by enzymes of digestion1 and according to ,sherman it is not improbable that protein synthesis also may be brought about by every living cell4 ,the ,absorption of ,water4--,this does not occur in the stomach1 as was formerly believed1 but in the small intestines4 ,the ,absorption of the ,mineral ,salts4--,this occurs in conjunction with the other food material4 ,some of the mineral salts are much more soluble than others and are more readily absorbed4 ,the function of the mineral salts in the body has already been described1 and since they form a part of every tissue and fluid in the body their absorption and fate in metabolism must be studied with that of the other chemical combinations4 ,,absorption ,,in ,,the ,,large ,,intestines ,the digestion of the food as it is passed into the last portion of the alimentary canal has been largely completed4 ,however1 that part which has escaped digestion in the small intestine is finished and absorbed here4 ,the important peristaltic waves occurring in this region are antiperistaltic in character and have the property of churning the food thoroughly and bringing a larger portion of it in contact with the absorbing walls4 ,the water which is left in the food mass together with the products of the digestion of the foodstuffs is absorbed in the first part of the large intestine1 leaving the remainder more solid4 ,this residue is known as feces or fecal matter4 ,the diagram on page #agi shows the various processes through which the foodstuffs pass after absorption4#ef ,bacterial ,action in the ,alimentary ,canal4--,the changes in the foods so far mentioned have been chiefly the result of the activity of the enzymes existing in the various digestive processes throughout the body4 ,but there are other changes which occur in the foods during their sojourn in the digestive tract which are not accountable to enzymic action1 but which1 in fact1 modify to a certain degree the changes wrought by the enzymes4 ,these are the result of the activity of certain specific bacteria which inhabit the entire digestive tract of the individual from a few hours after birth until death4 ,some of these have so adapted themselves to the existing conditions that1 unless present in overwhelming numbers1 they are not only harmless1 but they actually assist in protecting the organism from the inroads of more harmful species4 ,many experiments have been made to find whether or not bacteria are essential to human nutrition1 and the results of these experiments prove that they are not4 ,however1 since they are so firmly established in the body it is well to study the various types and learn as much as possible of the products of their activity and the influence which they exert in human nutrition4 ,cells and ,tissues _/ ,anabolism _/ ,catabolism ,assimilation _/ ,dissimilation _/ ,foodstuff ,end ,products _/ _/ _/ _/ ,combustion ,types of ,bacteria4--,it would be impossible and unnecessary to consider the action of all of the bacteria in the body in this text1 but it is necessary to consider those which are prominent in bringing about decomposition of the foods in the digestive tract4 ,sherman holds that there are three main types having this property3 7#a7 the bacteria of fermentation1 such1 for example1 as the lactic acid bacteria2 7#b7 the putrefactive bacteria1 such as the anaerobic ,b4 aerogenes capsulatus2 7#c7 bacteria of the ,b4 coli type1 showing the character of both the fermentative and putrefactive organisms but tending in general to antagonize the putrefactive anaerobes4#eg ,fermentation in the ,stomach4--,in the stomach1 fermentation of the carbohydrates with the production of organic acids1 and at times alcohol1 occurs4 ,the types of fermentation taking place in the stomach are alcoholic1 lactic1 butyric1 acetic1 formic1 oxalic1 and cellulose4 ,the bacteria inhabiting the gastric organs are dependent upon air for existence1 while those in the intestines are not4 ,factors ,influencing ,excessive ,fermentation4--,the factors influencing excessive fermentation in the stomach are lack of tone and motility in the organ1 insufficient amount or absence of free hydrochloric acid in the gastric secretion1 dilatation of the stomach1 and an excess of carbohydrate foods in the diet4 ,of the latter1 sucrose and glucose are especially susceptible to the action of fermentative bacteria4 ,under normal conditions1 that is1 in health1 the conditions prevailing in the stomach are very unfavorable to the development of bacteria of the putrefactive type1 the gastric juice exhibiting decided germicidal properties4 ,then1 too1 the presence of air acts against their development4 ,much of the so-called gastric fermentation does not occur in the stomach but rather in the duodenum4 ,bacterial ,action in the ,intestines4--,in the lower part of the small and in the large intestines1 the bacteria of the anaerobic type increase1 conditions more favorable to their development existing there than farther up in the intestinal tract4 ,however1 there are a great many bacteria in the whole of the small intestine4 ,those producing decomposition of the unabsorbed proteins are especially prominent in the colon4 ,herter#eh states that the presence in the colon of immense numbers of obligate micro-organisms of the ,b4 coli type may be an important defense of the organism in the sense that they hinder the development of that putrefactive decomposition which1 if prolonged1 is so injurious to the organism as a whole4 ,we have in this adaptation the most rational explanation of the meaning of the myriads of colon bacilli that inhabit the large intestine4 ,this view is not inconsistent with the conception that under some conditions the colon bacilli multiply to such an extent as to prove harmful through the part they take in promoting fermentation and putrefaction4 ,effect of ,bacterial ,activity in the ,body4--,in summarizing the effects of bacterial action in the body it is found that with the exception of oxalic acid1 which is exceedingly injurious1 and which1 according to ,herter1 results from the eating of large quantities of meat and sugar1 the products of fermentation are simply irritating in character1 while those resulting from putrefaction are distinctly toxic4 ,among the substances deserving mention under this head we have indol1 skatol1 cresol1 and phenol4 ,these substances are very soluble and upon absorption combine with the sulphuric acid formed in the body and are excreted by way of the kidneys where they appear in the urine as conjugated sulphates1 the chief of which is indican4 ,the amount of indican in the urine is taken as a measure of the intensity of the putrefaction taking place in the body4 ,metabolism4--,under the term metabolism we understand the series of processes through the foodstuffs and carried 7a7 in the conservation of the tissues of the body and 7b7 in the maintenance of body temperature and physical work 7,taylor74 ,the processes concerned in metabolism are chiefly those of building up1 anabolism1 and breaking down1 catabolism4 ,in the processes of anabolism the products absorbed are built into the tissues and cells of the body4 ,in catabolism1 the worn particles from the cells1 and the dead cells no longer useful are broken up and thrown out of the body4 ,according to ,taylor1 side by side with these processes are the reactions of combustion1 whereby the temperature necessary for the life of the cells is maintained1 and the energy needed for external work furnished4 ,behavior of ,carbohydrates in ,metabolism4--,as ,sherman#ei has said3 ,at least two kinds of enzymes are believed to be involved in the combustion of glucose in the tissue cells1 7#a7 cleavage enzymes1 which split the molecule into fragments more easily oxidized1 and 7#b7 oxidizing enzymes or oxidases which stimulate the oxidation of the cleavage products4 ,both kinds of enzymes are widely distributed through the body and are believed to be normal constituents of all active cells4 ,production of ,energy4--,it has been proved that the energy for external and internal work is produced largely from the glucose brought by the blood and oxidized in the muscles4 ,when a surplus amount of carbohydrate food is eaten1 over and above the immediate needs of the body for fuel1 it is stored in the liver and muscles as glycogen1 which can be readily reconverted into glucose4 ,when the supply of carbohydrate food is greatly in excess of the body's needs1 that is when the liver and muscles cease to store glycogen1 it is built up into adipose tissue and furnishes a readily available source of emergency fuel4 ,fate of the ,carbohydrates4--,after their oxidation the end products of carbohydrates1 that is1 the substances which are no longer available for use in the body1 leave it in the form of carbon dioxide and water by way of the kidneys 7urine71 the skin1 the lungs1 and the intestines4 ,fate of the ,fats4--,the fats upon absorption are taken up by the lymph vessels instead of the capillaries and enter the blood with the lymph4 ,according to various investigators1 the fat which causes the turbidity of the blood plasma at the height of absorption will1 as a rule1 disappear after a few hours1 part of it being burned as fuel1 producing energy for the internal and external work of the body1 and at least a part of the fats eaten being rebuilt into body fat4 ,the end-products of fat metabolism1 like those of the carbohydrates1 consist of carbon dioxide and water1 and leave the body by the same excretory channels4 ,when the normal oxidation of the fatty acids is interfered with or is overtaxed1 a different reaction from that which usually occurs may take place1 and this results in an excretion of acetone in the urine 7see ,chapter on ,diabetes74 ,protein metabolism is certainly more complex than that of either of the other active organic food groups4 ,the amino acids which are the products of protein digestion are taken up by the capillary blood vessels in the intestinal walls and are passed by them into the portal vein1 soon to become available for the needs of the body4 ,fate of the ,proteins4--,after utilization in the body1 the proteins1 like the other foods1 leave certain waste products which indicate to a greater or lesser extent the completeness with which the organism has made use of the food materials4 ,the end-products of protein metabolism are3 urea1 ammonium salts1 purin bodies1 and creatinin4 ,these products leave the body chiefly in the urine4 ,the chief end-product in man is urea4 ,this substance represents from #hb-hh of the total nitrogen excreted by the kidneys4 ,however1 the less highly oxidized products represent the incomplete products of protein metabolism and thus indicate the changes through which these products must pass before being changed into urea4 ,if for any reason there is an impairment of the liver through which they must pass and where the change into urea is accomplished1 there will be a rise of ammonia and a corresponding decrease in the output of urea in the urine4 ,thus1 ammonia is formed at the expense of the urea4 ,this occurs in fevers1 diabetes1 and certain structural diseases of the liver4 ,according to ,sherman3#fj ,normally about #b to #f of the total nitrogen eliminated is in the form of ammonium salts1 the amount depending largely upon the relation between the acid-forming and base-forming elements in the food4 ,acid-forming and ,base-forming ,foods4--,mendel#fa states3 ,there are foods which act as potential acids and others which function as bases in the organism4 ,when burned up either in the laboratory or in the body cells1 they have a preponderance of acid or base1 as the case may be1 in their ash4 ,in this respect potatoes1 apples1 raisins1 and cantaloupes1 for example1 are base-forming foods which depress the output of ammonia and increase the solubility of uric acid in the urine1 whereas meal1 cereals1 and prunes 7the latter with their content of benzoic acid7 furnish acids in predominance4 ,purin ,bases4--,these compounds are formed in the body as cleavage products of nucleoproteins or taken into the body in food4 ,the chief of these products are adenin1 guanin1 hypoxanthin1 xanthin1 and uric acid4 ,the latter is the most highly oxidized of all the purin bases and is the form in which they are chiefly eliminated in the urine4 ,formation of ,uric ,acid4--,the formation of uric acid can in a measure be controlled by attention to the diet1 eliminating those foods known to be purin-bearing4 ,normally from #a to #c of the nitrogen eliminated will be in the form of uric acid4 ,the normal human being oxidizes about half of the purins eaten and excretes about half1 mainly in the form of uric acid4 ,according to ,mendel1 the formation of uric acid takes place throughout the body1 and its partial destruction is accomplished by the kidneys1 muscles1 and liver4 ,the formation of purins in the body and their elimination in the form of uric acid is especially significant in certain pathological conditions1 gout1 for example1 in which the body has difficulty in eliminating these compounds4 ,the purin bodies are both endogenous and exogenous--that is1 they may be brought into the body in food as such1 or they may be formed as a result of the metabolism of the body tissues4 ,for this reason the damage wrought by these substances may to a certain extent be controlled by eliminating the purin-bearing foods from the diet4 ,flesh-foods are high in purins1 especially the highly nucleated glandular organs1 liver1 thymus 7sweetbreads71 etc41 kidney1 beef1 mutton1 veal1 pork1 chicken1 turkey1 goose1 sardines1 anchovies1 all kinds of fish except cod4 ,among the vegetable foods asparagus1 beans1 peas1 and spinach are highest in purins4 ,boiling extracts much of the purins from food4 ,meat especially should be prepared by this method1 if used in the diet of individuals suffering from gout4 ,eggs and milk are purin free1 and may be used freely4 ,certain substances increase the difficulty of eliminating uric acid4 ,alcoholic beverages for example are especially deleterious4 ,creatinin4--,this end-product of protein metabolism is1 like uric acid1 endogenous and exogenous4 ,it is one of the normal constituents of the urine4 ,the quantity is fairly constant for the individual1 averaging about #j4jb gram per kilogram of body weight per day4 ,mineral ,metabolism4--,a study of the organic foodstuffs reveals the fact that many of the mineral salts concerned in nutrition enter the body in organic combination with those constituents4 ,certain of the mineral salts1 however1 enter1 exist in and leave the body in the same organic form in which they occur in the food materials4 ,this is true of chlorine1 which for the most part1 functions in and leaves the body in the form of chlorides 7chiefly sodium chloride74 ,a small part of the chlorine is used in the production of the hydrochloric acid of the gastric juice4 ,sulphur and iron1 both enter the body as essential constituents of proteins1 and their metabolism occurs with that of these foodstuffs2 the sulphur being converted largely into sulphuric acid must be neutralized at once1 and it leaves the body by way of the urine as inorganic sulphates4 ,part of the sulphates are excreted as ethereal 7conjugated7 sulphates2 the amount excreted in this form depending largely upon the extent of purification in the intestinal tract4#fb ,phosphorus4--,this mineral salt is found to be present as an essential constituent of certain proteins1 fats and carbohydrates4 ,it also enters the body in the form of inorganic phosphates4 ,during the digestion and metabolism of the organic foodstuffs the phosphoric acid radical is split off and eventually nearly all of the phosphorus leaves the body in inorganic form 7inorganic phosphates74 ,calcium4--,being the chief constituent of the bones1 large quantities of calcium salts are stored in the skeleton of the child both before and after birth4 ,the functions of calcium have already been discussed4 ,that part not stored1 which has finished its work in the body is excreted through the intestinal wall and leaves the body by way of the feces1 only a small part of the calcium concerned in metabolism being excreted in the urine4 ,the ,process of ,osmosis in the ,body4--,the influence exerted upon the process of osmosis in the body is one of the most important parts played by the mineral salts in metabolism4 ,the fact that these chemical substances are indispensable to the metabolic processes makes it necessary for the nurse to know where they can be found in food and how best to use them4 ,metabolism of ,body ,tissues4--,the constant breaking down and building up of the tissues of the body and the evolution of heat as a by-product of the energy expended may be summed up in the term metabolism4 ,the metabolism of the body is normally supported by the food ingested4 ,however1 it is a known fact that were no food eaten the processes would continue just the same1 the difference only being the use of the body structure instead of food materials4 ,according to ,sherman1 the chemical changes and energy transformations are of course inseparable4 ,it has become customary to speak of the metabolism of matter and the metabolism of energy1 and to regard the extent of the metabolism of any material substance as measured by the amount of its end products eliminated1 and the extent of the energy metabolism as measured by the amount of heat or of heat and external muscular work which the body gives off4 99 99 99 99 99 ,in summarizing the important factors in the utilization of food by the body several distinct points are made evident3 #a4 ,the composition of the body1 and the composition of food1 are practically the same4 #b4 ,food must make good the losses resulting from metabolic processes and physical activity4 #c4 ,utilization of food by the body necessitates3 7a7 ,transformation through a series of processes3 7#a7 ,digestion4 7#b7 ,absorption4 7#c7 ,metabolism4 7#d7 ,elimination4 7b7 ,factors influencing use of food3 7#a7 ,stimulation of secretory cells through appetite juice 7stomach72 hormone secretin 7intestines74 7#b7 ,factors retarding use of food3--,fear1 worry1 anger1 nervous excitement1 fatty foods and alkaline carbonates 7bacterial action causing fermentation and putrefaction74 ,,problems 7a7 ,outline the processes through which a slice of bread and butter must pass1 from the time it is eaten until it reaches the blood stream4 7b7 ,outline with a diagram the manner in which the foodstuffs are utilized in the body4 7c7 ,show in the form of a table the effect of the enzymes on proteins1 on fats1 on carbohydrates4 ,,footnotes3 #ea ,chemistry of ,food and ,nutrition1 by ,henry ,sherman4 #eb ,chemistry of ,food and ,nutrition1 by ,sherman4 #ec ,chemistry of ,food and ,nutrition1 by ,henry ,sherman4 #ed ,compiled from ,textbook of ,physiology1 by ,howell1 and ,chemistry of ,food and ,nutrition1 by ,sherman4 #ee ,chemistry of ,food and ,nutrition1 by ,henry ,sherman4 #ef ,this scheme applies to the protein1 fat and carbohydrates with quantitative variations only4 ,courtesy of ,dr4 ,a4 ,r4 ,taylor1 ,leland ,stanford ,university4 #eg ,chemistry of ,food and ,nutrition1 by ,sherman4 #eh ,herter's ,bacterial ,infections of the ,digestive ,tract 7#aijg74 #ei ,chemistry of ,food and ,nutrition1 by ,sherman4 #fj ,chemistry of ,food and ,nutrition1 by ,sherman4 #fa ,newer ,points of ,view ,regarding the ,part ,played by ,different ,foodstuffs in ,nutrition1 by ,lafayette ,mendel1 ,ph4,d4 ,read at the ,sixty-fifth ,annual ,meeting of the ,american ,medical ,association1 ,june1 #aiad4 #fb ,see ,bacterial ,action in the ,body1 p4 #aha4 ,,section ,,iv ,,dieto-,,therapy ,,chapter ,,viii ,,pregnancy ,,and ,,lactation ,there are many traditions in regard to the food requirements of the prospective mother4 ,many of these have been proved fallacies4 ,as a matter of fact it is the woman more than the developing child who is likely to suffer if the diet is insufficient or badly balanced4 ,factors ,affecting ,diet during ,pregnancy4--,in formulating a dietary for the pregnant woman1 then1 not only must the needs of the child be considered but those of the mother also1 since the developing embryo draws from the body of the woman materials necessary for its growth1 and if these needs are not covered by an increase in the diet1 her body and that of the child also will show evidences of lack of nourishment4 ,phosphorus and ,calcium ,requirements4--,if1 for example1 the mother's diet is lacking in those materials which produce growth1 or is deficient in those mineral salts1 such as those of phosphorus and calcium1 which are requisite and necessary for the growth of bones in the infant1 the mother's bones and teeth will show this loss and in all probability the baby will sooner or later also show a like deficiency4 ,however1 it must be remembered that the pregnant woman is under a strain1 both physical and mental4 ,she must not be encouraged to eat beyond her needs or the digestion will be disturbed4 ,nutritional ,disturbances in ,early ,months4--,the nutritional disturbance manifested by nausea and vomiting in the morning is due1 not to the stomach or any disturbance therein1 but to the fact that a mild form of poisoning occurs1 resulting from the substances produced through the formation of the placenta reaching the general circulation on account of the incomplete establishment of the connection between the embryo and the mother4 ,as soon as this connection is complete and fetal circulation is established this morning sickness disappears4 ,food ,requirements of ,prospective ,mother4--,the food requirements of the prospective mother are not materially affected during the first four months of gestation1 and even after this1 when the infant is developing rapidly1 and up to the date of its birth1 the mother's requirements are only increased about #bj4 ,the amount of food necessary to cover the body needs1 for maintenance and energy of a woman living a sedentary or moderately active life1 plus #bj for building materials for the growing child1 will be adequate for the pregnant woman4 ,thus1 if her needs are ordinarily from #b1jjj to #b1djj calories per day1 after the fourth month they will probably be increased to #b1djj or #b1hjj calories a day and will rarely ever be more than #c1jjj calories a day4 ,dietetic ,treatment of ,normal ,pregnancy4--,the peculiar conditions surrounding the woman at this particular time must be taken into consideration in arranging her diet4 ,the building foods which are necessary for the developing child must be given in the simplest form1 milk and eggs being used liberally and meat sparingly to obviate any unnecessary tax being placed upon the kidneys4 ,the use of fruit and green vegetables to supplement the milk and eggs is urged4 ,it has been found advisable at such times to give small meals frequently rather than the regular meal three times a day4 ,the feeling of fullness which often occurs during the last two or three months of gestation makes it more comfortable for the pregnant woman to eat less at a time and oftener4 ,if1 for example1 she be given a glass of rich milk or a nutrient beverage1 either of enforced malted milk1 albumenized orange juice1 buttermilk1 zoolak1 or koumiss1 at about eleven o'clock in the morning and again about four o'clock in the afternoon1 she will have taken sufficient nourishment to meet the new requirements without taxing her digestion or imposing extra work upon the kidneys4 ,abnormal ,symptoms4--,the chief point to keep in mind is any abnormal symptom which may develop4 ,the chief of these is albumen in the urine4 ,the urine must be examined frequently and measures taken immediately to overcome albuminuria should it occur4 ,it is wise1 as has already been stated1 to restrict the meat in the diet1 and in cases where albumen is found in the urine even when the meats are restricted1 it may be necessary to place the patient upon a milk diet for a time until the urine clears up4 ,supplementary ,feeding4--,cereals1 especially the whole cereals1 must be used liberally4 ,gruels made with milk are often found valuable additions to the dietary4 ,the prospective mother must be urged to take a regular amount of gentle exercise1 not to become over-tired1 or excited1 to eat sparingly at night1 and to drink plenty of water4 ,she must avoid becoming constipated by eating plenty of green vegetables and fruit4 ,sample ,diet ,sheets4--,the following dietary is suggested3 ,breakfast should consist of thoroughly cooked cereals1 wheatena1 cream of wheat1 malt breakfast food1 cracked wheat1 rolled or cracked oats1 served with cream or sugar or both1 whole wheat bread1 muffins1 or biscuits1 with butter1 raw or stewed fruit1 coffee1 tea or cocoa with milk4 ,luncheon may consist of milk or vegetable soups1 eggs in any form1 boiled potatoes1 sweet potatoes1 string beans1 greens1 or any green vegetables1 simple desserts such as custards1 rice or tapioca puddings1 bread pudding1 etc41 milk1 tea1 cocoa1 buttermilk1 zoolak or koumiss as beverages4 ,for dinner1 if albuminuria is not present1 a small piece of meat may be taken1 together with green vegetables1 rice1 potatoes1 simple salads1 and a simple dessert1 milk or coffee with milk as a beverage4 ,selection of ,food4--,the following foods may be used to formulate the diet sheet3 ,wheat1 oat1 or corn cereals1 rice1 tapioca1 made into simple puddings or served as breakfast foods2 fruits1 oranges1 prunes1 apples1 raisins1 dates1 figs1 or grapefruit1 stewed or raw4 ,the fruit juices may be used instead of the whole fruit if the latter disagrees4 ,vegetables3 peas 7green or dried71 beans 7string beans or dried beans71 spinach1 greens 7turnip1 mustard1 or beet71 cabbage1 onions1 celery1 lettuce1 served as vegetables or in soups1 potatoes4 ,meat3 lightly broiled beefsteak or stewed or boiled meat or chicken served not more than once a day or three times a week4 ,eggs1 prepared in different ways4 ,cheese dishes4 ,breakfast bacon or ham in moderate quantities1 butter1 olive oil 7or other salad oils7 in moderation1 whole wheat1 graham or bran bread1 ,boston brown bread and crackers1 milk1 cocoa1 chocolate1 buttermilk1 malted milk1 koumiss1 or zoolak2 coffee and tea in moderation4 ,the diet1 as has already been stated1 may be supplemented by nutrient beverages or milk gruels4 ,,diet ,,in ,,lactation ,the diet of the nursing mother1 as has been explained in a previous chapter1 must not only cover her own requirements but must likewise be adequate to furnish the extra requirements imposed by the nursing infant4 ,food ,requirements of ,nursing ,infant4--,when the baby is a month old he should be growing rapidly1 and his food requirements at this period and until he is about three months old will be approximately fifty calories per pound of body weight in the twenty-four hours4 ,as he grows older his requirements grow gradually less in proportion to his weight4 ,this is because the rate of growth is less1 so that for the next three months the requirements are from #dc to #dj calories per pound of body weight per day1 and #ce calories per pound during the last three months1 or by the end of the first year of life4 ,it has been estimated1 as before stated1 that the average infant will take #b-a_/c to #b-a_/b ounces of mother's milk per day#fc to each pound of body weight and that every ounce of mother's milk will yield on an average #bj calories4 ,hence a month-old baby weighing ten pounds will be taking about #bc ounces a day1 yielding #dfj calories4 ,scientists have estimated that for every calorie produced by the milk two extra calories must be provided by food1 so that for the baby requiring #dfj calories per day1 to cover his requirements the mother will be obliged to consume extra food to yield #ibj calories1 or the regular amount to meet her normal requirements plus the extra food to make sufficient food for the baby4 ,diet of ,nursing ,mother4--,the diet of the nursing mother need not be different from that to which she is accustomed4 ,she should be warned against overwork or over-fatigue1 nervous excitement and worry1 since these factors affect the digestion of the nursing baby4 ,she must be careful not to eat indigestible foods or foods which disagree with her1 as such things will undoubtedly affect the digestion of the infant4 ,when an article of food does cause digestional disturbances in the baby1 it should be carefully omitted from the mother's diet4 ,factors ,retarding and ,stimulating ,milk ,secretion4--,constipation in the mother reacts quickly and unfavorably upon the secretion of milk4 ,the same has proved to be the case when she becomes excited1 nervous1 worried1 or over-tired4 ,the average diet for the normal woman is safe for the nursing mother4 ,if her supply of milk is deficient1 it may be at times increased or stimulated by the drinking of a glass of milk between meals or by taking a cup of hot cereal milk gruel4 ,it was formerly believed that beer1 ale1 or stout acted directly upon the mammary glands1 stimulating the secretion of milk1 but there is little proof of this and the drinking of alcoholic beverages need not be encouraged on this account1 since often more nourishing beverages fulfill the purpose more efficiently and without bad results4 ,,summary ,gastric ,disturbances4--,the nausea and vomiting so often a part of early pregnancy is not believed to be the result of a disordered stomach but primarily a mild form of poisoning resulting from the incomplete establishment of the fetal circulation4 ,adjusting the ,diet4--,the adjustment of the diet to cover the needs of the prospective mother and those of the developing child is essential4 ,the amount of food taken by the mother is not materially changed during the first three months of gestation4 ,an average normal diet is all that is necessary4 ,after this time a twenty per cent4 increase in the woman's diet will furnish adequate means both for her maintenance and for the growth and development of the child4 ,type of ,food4--,the kind of food which is necessary for the pregnant woman to take during this period is very similar to that taken ordinarily4 ,it is necessary to furnish food materials rich in calcium and phosphorus1 with an adequate supply of proteins in their simplest form in order to meet the requirement of the growing organism4 ,milk and eggs furnish the most efficient foods in this respect and the prospective mother should see that they form the chief items of her daily dietary4 ,milk furnishes calcium in its most available form for the developing skeleton of the growing infant1 hence it is necessary to provide the mother with food to replace the mineral which is withdrawn from her body4 ,meat in the ,diet4--,meat should be eaten sparingly by the prospective mother1 as it imposes needless work upon the already taxed kidneys and1 if eaten in excess1 will give rise to dangerous complications4 ,milk and eggs will provide ample protein for all purposes4 ,albumen in the ,urine4--,albuminuria is one of the most frequent complications in pregnant women4 ,it should be combated and controlled as soon as possible4 ,the allowance of meat should be cut down or entirely eliminated from the diet until the urine clears up4 ,when albuminuria is persistent in spite of efforts to overcome it1 the patient must be placed upon a strict milk diet as used in acute nephritis1 to prevent dangerous complications arising4 ,,lactation ,diet of ,mother4--,her dietary need not differ materially from that to which she is accustomed4 ,she must avoid indigestible foods or any article which has been proved to disagree with either the infant or herself4 ,factors ,regarding ,secretion of ,milk4--,constipation1 worry1 nervous excitement1 and over-fatigue all have an unfavorable effect upon the secretion of milk and must therefore be avoided by the nursing mother4 ,the ,bowels4--,constipation of the mother reacts quickly and unfavorably upon the health and comfort of the baby1 hence it should be avoided by eating coarse breads1 green vegetables1 and fruits1 when they do not disagree with the baby1 by drinking plenty of water and taking a certain amount of outdoor exercise to keep her own health in good condition4 ,stimulating the ,milk ,production4--,when the milk supply is deficient it will be advisable for the mother to drink a glass of milk or a bowl of cereal milk gruel between meals4 ,alcoholic beverages are not necessary to insure an adequate secretion of milk4 ,the milk or milk gruels answer the purpose more efficiently and without bad results4 ,energy ,requirements of ,infant4--,the average baby requires fifty calories per day per pound of body weight to cover his energy growth and development needs for the first three months of life1 after which the rate of growth is less and his requirements decrease from forty-three to forty1 then to thirty-five calories per day per pound by the end of his first year4 ,amount of ,milk ,needed for ,infant4--,approximately two and one-third ounces to each pound of body weight per day covers the needs of the average baby4 ,fuel ,value of ,mother's ,milk4--,each ounce of milk yields twenty calories4 ,the ,making of ,milk4--,it has been estimated that for every calorie yielded by milk1 two extra calories must be provided by food4 ,,problems 7a7 ,formulate a dietary for a pregnant woman1 allowing for a twenty per cent4 increase over her normal requirements4 7b7 ,show how the diet may be made to cover the need for additional iron1 calcium and phosphorus4 7c7 ,formulate a diet for a nursing mother with an infant two months old and weighing twelve pounds4 ,,footnote3 #fc ,feeding the ,family1 p4 #ic1 by ,mary ,swartz ,rose4 ,,chapter ,,ix ,,infant ,,feeding ,in taking up this part of our study on nutrition1 there are several points to be kept in mind by the nurse3 7#a7 that it will be difficult1 if not impossible1 to understand the metabolic changes taking place in abnormal conditions unless those occurring in the normal human body are understood2 7#b7 that certain diseases are due directly to errors in diet2 7#c7 that in other diseases1 diet plays the chief part both in the bringing about and in the relieving of the conditions2 7#d7 whereas there are certain other diseases not affected by diet1 save in so far as well or poorly selected and prepared food always affects the individual1 whether normal or abnormal1 and that in the latter conditions the organism is more susceptible to bad influences4 ,this being the case it behooves the nurse to examine herself to find whether or not she understands the fundamental principles underlying the nutrition of the human body1 that she may efficiently deal with the changes which occur more or less when the body is attacked by disease4 ,we include normal infant feeding in this section1 because in no other age is it quite so necessary for care to be observed in formulating and carrying out a diet4 ,errors during this period may only appear to exert a local influence1 causing disturbance which may readily be relieved1 but the danger is in laying too little stress upon these disturbances1 forgetting that the delicate organism of a child may be permanently injured by a constant disregard of nature's mandates4 ,in the words of the old adage1 the pitcher may go once too often to the well1 and an injured digestive apparatus is even more difficult to mend than the proverbial pitcher4 ,in this section1 then1 the metabolic changes due to pathological conditions and the dietetic treatment thereof will be discussed4 ,age and ,weight4--,as has already been stated1 there are certain points to be kept in mind in attempting to provide an adequate diet for the human machine2 ,first1 the age and weight4 ,the gain during infancy should be steady--an allowance of #dj calories per pound of body weight to cover the energy requirements and #d protein calories per pound to cover the nitrogen needs4 ,during the second and third years the energy requirements will be covered by #cj to #dj calories per pound and the nitrogen needs by #c to #d protein calories per pound4 ,from the fifth to the eighth year the nitrogen needs continue to be covered by #c to #d protein calories per pound and the energy requirements by #ce to #cg calories per pound during the fifth year2 #cb to #cd calories per pound during the seventh year4 ,after the body has reached its full development its requirements will be met if sufficient protein is provided to cover its maintenance needs and if the energy calories are regulated according to the amount of exercise taken1 keeping in mind that the energy requirements of a man at rest 7sitting7 will be about #b1jjj calories per day and that exercise1 especially that taken in the open air1 raises the energy needs of the body4 ,daily ,gain4--,in estimating the relative daily gain in body weight of children of different ages1 ,mendel#fd gives the following table3 ,,table ,in the first month1 about #a4jj per cent ,at the middle of the first year #j4cj per cent ,at the end of the first year #j4ae per cent ,at fifth year #j4jc per cent ,maximum in later years for boys #j4jg per cent ,maximum in later years for girls #j4jd per cent ,retention of ,nitrogen in ,infancy4--,when the baby is gaining in weight and strength there is a retention of both nitrogen and salts1 and when the baby is not gaining there may be a loss of both of these bodies2 when one is retained in the body the other is apt to be retained4#fe ,,normal ,,infant ,,feeding ,much has been written in the past few years on the care and feeding of infants and children4 ,this is well1 since statistics show an alarming increase in the rate of infant mortality during the early years of life1 and anything which can be done to check this lamentable and often avoidable waste of valuable life should be resorted to with care and attention4 ,food for ,infants4--,the natural food of all young mammals is the milk of their own mother4 ,the rate of growth and development differs in every species2 the calf1 for example1 doubles birth weight much more quickly than does the baby of the same age4 ,however1 the milk of the cow1 which meets the needs of the calf perfectly1 falls short of meeting the requirements of the infant1 whose rate of growth is not nearly so rapid4 ,for this reason if for no other1 it would be advisable to give the baby its natural food rather than to attempt a substitute which is1 at best1 a poor one4 ,weight4--,the average infant weighs from six to seven pounds at birth4 ,this weight should be doubled in the first five or six months of life and tripled by the end of the first year4 ,the most important business1 then1 in the life of the child during the early years is growth and development4 ,to achieve this properly the baby's habits must be adjusted to his needs4 ,regularity in ,feeding4--,he must have the proper food and enough of it1 and have it given at regular intervals1 by the clock1 for guesswork is fatal in infant feeding4 ,he must be given water between meals4 ,babies often cry from thirst when they are thought to be doing so from hunger or temper1 or both4 ,the healthy baby sleeps about twenty-two hours out of twenty-four during the early months1 and even during the latter six months of the first year more time is spent in sleeping than in waking4 ,the ,bowels4--,the bowels should move several times a day1 the stools being smooth and of a yellowish color1 of the consistency of pea soup4 ,after the first month1 twice a day is about the normal number of stools for the healthy baby4 ,the infant should be placed upon a vessel held in the lap of the nurse at regular times1 preferably right before the morning bath1 and in the evening4 ,in this way regularity in evacuating the bowels is obtained1 and a habit formed which will prove valuable through life4 ,the ,bath4--,the daily bath is likewise necessary for the health and comfort of all babies2 so1 too1 are fresh air and sunshine4 ,as has already been stated1 breast milk is much better for babies than cow's milk or any artificial food4 ,there is something in the mother's milk which gives strength and resistance to the baby which is absolutely lacking in any other food no matter how carefully it is selected and prepared1 and for this reason young mothers must be prevailed upon to nurse their babies whenever it is possible for them to do so4 ,when circumstances1 such as having to be away all day at work1 make it impossible for a mother to nurse her baby at regular intervals1 she can be taught how necessary are two or three breast feedings a day to the future welfare of her child4 ,when social reasons or lack of desire on the part of the mother make her unwilling to nurse her baby1 it is the part of the nurse to lay the case before her and let her judge whether or not she is willing to accept the responsibility of bringing into the world a life for which she is unwilling to provide weapons with which to fight the good fight4 ,habits of ,mother4--,the mother must be taught how to efficiently nurse her baby2 she must keep in mind that upon her good health and temperate habits depend the health and comfort of her baby4 ,it devolves upon her to provide food efficient in quality and quantity4 ,to do this1 her own diet must be simple and wholesome4 ,the nursing mother must remember that she has to provide1 not only for her own maintenance and energy requirements1 but also for the infant whose fuel requirements are ever demanding more food to provide for its rapid growth4 ,food and ,its ,relation to ,milk4--,it is believed that two calories of food extra are necessary to produce one calorie of milk1 and since a month-old baby requires #b-a_/c ounces of mother's milk to every pound of his body weight1 and one ounce of mother's milk will yield #bj calories1 it is clearly seen that the mother will have to increase her diet to cover the requirements of the baby4 ,for example1 if the baby weighed #ab pounds1 he would require #bh ounces of milk in #bd hours1 or #efj calories4 ,thus if it requires two calories of extra food to make one calorie of milk1 the mother's diet would have to provide #a1abj calories extra1 or about as much food as would fulfill the needs of a laboring man1 #c1jjj to #c1ejj calories1 even if she were doing practically no actual work2 while if she were actively employed and doing a certain amount of physical labor1 her rations would have to approximate those of a man doing heavy muscular work 7about #c1ejj to #d1jjj calories per day74#ff ,breast ,milk versus ,cow's ,milk4--,consensus of opinion shows that breast-fed infants require less energy than the ones who must be nourished artificially4 ,this is probably due largely to the fact that the constituents of human milk are in a more available form than those in cow's milk1 the former requiring a lesser expenditure of energy on the part of the organism to become available than the latter4 ,very active babies1 ones who kick and throw themselves about or cry violently1 have a greater energy requirement than the more placid baby who sleeps more and is more quiet in movement and who cries less when awake4 ,breast-fed babies are generally more quiet than their less fortunate artificially fed brothers4 ,it has been demonstrated that the artificially fed baby has a much harder fight for existence than the baby who receives his natural food2 hence the necessity of using every available means to make the food digestible1 and to lessen the danger arising from the additional work put upon the entire apparatus4 ,cow's milk contains practically the same chemical elements as are found in human milk1 but these elements are combined in a slightly different manner1 and are not so easily handled by the immature organs4 ,the proteins of milk consist of casein1 which is insoluble1 and albumen1 which is soluble4 ,according to ,van ,slyke the proportion of insoluble to soluble protein in cow's milk is #c4f3a1 while in human milk the proportion is only #a3a4 ,the ash constituents in cow's milk are in excess of the needs of the infant organism1 but since a great part of these salts is in an inorganic form they are not retained to the same extent as those contained in human milk1 which are in an organic form4 ,rules and ,regulations4--,it is not possible to lay down hard and fast laws to cover the subject of infant feeding4 ,the food must be adapted to the individual needs of the baby in question4 ,the nurse must see that the milk is obtained from a responsible dealer1 certified milk being of course the safest4 ,the bottles of milk should be wiped off carefully and placed directly on the ice as soon as they are received4 ,the milk generally used in infant feeding has a fat content of #d4 ,that having a higher percentage of fat is technically cream4 ,the following table showing the fat1 sugar1 and protein composition of whole milk1 cream1 skimmed milk1 and whey was arranged by ,morse and ,talbot3#fg ,,table ,fat ,milk ,sugar ,protein ---------------------------------------- ---------------------- ,whole milk #d4jj #d4ej #c4ej #g cream #g4jj #d4de #c4dj #aj cream #aj4jj #d4dj #b4be #af cream #af4jj #d4bj #c4je #cb cream #cb4jj #c4dj #b4ej ,skimmed milk #a4jj #e4jj #c4ee ,separated milk 7fat-free7 #j4be #e4jj #c4fe ,whey #j4be #e4jj #j4ij ,seven per cent4 7#g7 cream is obtained from the upper #af ounces of a quart bottle of milk which has been allowed to stand undisturbed for six hours4 ,the upper third of the bottle contains #aj fat1 while the whole fat layer from the quart bottle1 regardless of the number of ounces1 contains about #af of fat4 ,methods of ,artificial ,feeding4--,the use of whole milk1 top milk1 or skimmed milk1 diluted with water1 and either milk sugar1 malt sugar1 or sucrose 7cane sugar7 added1 is the method of feeding most commonly used1 and upon it are based the formulas universally advised by infant specialists4 ,there are cases in which simple dilution is not advisable4 ,in premature or very young infants1 for example1 the whey mixtures have been found to give the best results4 ,in toxic diarrheas1 where the putrefactive bacteria make the use of all but the minimum amount of protein inadvisable1 the above method is contraindicated1 as it is likewise in cases where vomiting of casein curd is a prominent feature4#fh ,the ,use of ,alkalies4--,there are many cases in which the physician deems it advisable to add an alkali to the milk mixture4 ,the one generally selected is limewater4 ,however1 sodium citrate and sodium bicarbonate are also used4 ,the reasons for adding alkalies to the milk mixtures are3 7#a7 to check the coagulation of the casein1 7#b7 to hasten the emptying of the stomach1 or 7#c7 to chemically change the formation of the curd4 ,in certain cases it is only necessary to delay the coagulation of the casein in the stomach1 in which case a certain amount of limewater is used4 ,its action is to swell the protein of the milk and in this way effect the precipitation of the casein4 ,in other cases it is found advisable to prevent the formation of curd and hasten its departure from the stomach4 ,cannon#fi claims that milk before it coagulates leaves the stomach quickly like water in gushes4 ,hence1 if an alkali like limewater1 bicarbonate or citrate of soda is added to the milk this coagulation will be checked and the digestion be facilitated4 ,amount and ,type of ,alkali ,used4--,the amount of alkali#gj necessary to bring about any change in the general effect of the formula must be determined by the amount of milk and cream in the mixture1 since these constituents alone determine the acid content4 ,however1 it is impossible to judge exactly the amount of alkali to add1 but an approximate estimate is made from the work done by the various investigators4 ,it has been estimated that from #be to #ej of limewater must be added to milk to change it to any marked degree4 ,in using bicarbonate of soda1 a much less quantity brings about the desired result1 #a-a_/b grains of bicarbonate of soda being equal to one ounce of limewater4 ,the action of these two alkalies is different4 ,the soda acting upon the milk causes the curds to be more porous1 and therefore more easily acted upon in digestion4 ,sodium citrate likewise tends to prevent the formation of tough curds4 ,it is added in amounts of #a to #b grains to each ounce of milk or cream in the mixture whenever it is found necessary to use it at all4 ,the addition of any alkali to the formula is resorted to if the symptoms indicate the need for it1 but the type and quantity is entirely within the province of the physician1 not the nurse4 ,the ,addition of ,sugar4--,lactose is the form in which the carbohydrates are found in milk1 and it has been a general rule to employ this sugar in making up the sugar content of a formula1 using from #f to #g of the mixture in this form to cover the necessary energy requirements of the infant4 ,other sugars are used1 however2 and of late years malt sugar has been widely employed for this purpose4 ,the form now generally accepted is known as dextri-maltose1 which is a combination of dextrin and maltose1 both of which are readily acted upon by the sugar-splitting enzymes of the digestive juices4 ,in digestion1 lactose or milk sugar is split to dextrose and galactose and utilized in the body1 both as a source of energy and as a food for the lactic acid bacteria which are active in the small intestine4 ,malted ,foods4--,the addition of malted foods or malt sugar to the food of infants tends to bring about a more rapid gain1 both in energy and in body weight1 than is generally the case where other sugars are used4 ,this sugar is used as a substitute for milk sugar in many formulas1 especially in those cases in which the casein of cow's milk needs to be made more digestible in form4 ,malt sugar is indicated in the following conditions3#ga 7#a7 in severe atrophies1 7#b7 in cases of fat indigestion before the atrophic stage is reached1 7#c7 in cases where there is slight curd indigestion1 indicated by some vomiting and slow gain in weight1 7#d7 in cases where excessive intestinal fermentation is manifested by gas and colic4 ,malt sugar 7dextri-maltose7 is contraindicated to a slight degree in cases of simple acute diarrhea where lactose1 by supplying fermentative media1 more easily restores the normal bacterial balance4 ,diluents4--,barley and oatmeal water are used as diluents to the amount of one-fourth or more of the mixture4 ,oatmeal water or jelly is used more during the winter months than in the hot summer months4 ,as the fat content of the oatmeal gives it a more laxative effect1 it is undesirable to use it at the season in which the summer diarrheas are prevalent4 ,barley water has something of a colloidal action upon the casein1 causing the curds to be finer and less tough in character4 ,both barley and oatmeal water are used in place of plain water for babies when this colloidal effect upon the curd of the milk is desired1 also where the weight of the infant shows a disposition to remain stationary1 especially where there are no other symptoms to account for the lack of gain4 ,whey is used with babies who cannot digest the insoluble protein of cow's milk4 ,this is often the case in premature babies and is manifested by a persistent vomiting of curd4 ,the energy requirements are obtained by the addition of cream and lactose to the whey4 ,buttermilk ,mixtures and ,eiweissmilch4--,it is often found desirable to use some other form of milk than whole1 top1 or even skimmed milk1 and for this purpose lactic acid1 milk and the albumen or ,eiweissmilch are substituted4 ,in the buttermilk mixtures the precipitation of the casein is brought about by lactic acid bacilli 7,bulgarian culture74 ,this prevents the coagulation of the casein into tough curds4 ,lactose buttermilk or lactic acid milk is used in the feeding of infants who have persistent green stools1 and in cases of acute toxic diarrhea brought about through the action of gas bacillus4 ,buttermilk is more difficult to administer to babies than formulas made from plain milk by reason of its flavor4 ,however1 the results are remarkable in the above-mentioned conditions4 ,eiweissmilch is used in atrophic cases where there are bad green stools4 ,homogenized ,milk4--,dr4 ,ladd of the ,children's ,hospital in ,boston has presented many cases of infants who showed an intolerance for butter fat4 ,these cases he has treated with formulas containing foreign fat1 usually olive oil4 ,this milk is subjected to a treatment which brings about a more complete emulsification of the fat than is possible in cow's milk1 causing it to resemble in character the quality of the mother's milk4 ,homogenized milk has been used with success in cases where it was impossible to supply the infant with breast milk4 ,the process is accomplished by the use of an apparatus known as an homogenizer#gb2 in this machine the fat globule is crushed and so finely divided as to prevent its re-formation4 ,the greatest drawback to the use of this process lies in the scarcity of available machines4 ,cod liver oil is now used in many cases where the infant shows a failure to gain or is in possible danger of developing rickets1 with the homogenizer it is possible to add the oil to the formula1 thus facilitating its use4 ,technique of ,milk ,modification4--,the absolute necessity for cleanliness has already been dwelt upon in respect to milk1 and in infant feeding the vigilance which must be observed in the preparation of the food cannot be too strongly emphasized4 ,the milk itself must be of known purity4 ,where there is any uncertainty about its source1 it must be sterilized or pasteurized according to the doctor's orders4 ,the bottles and nipples should be washed as soon as they are used1 first with plain water to remove the milk1 then with soapsuds and a bottle brush4 ,the bottles should then be filled with boric acid or bicarbonate of soda solution until needed1 when they should be emptied and placed in a deep pan filled with cold water and allowed to boil for a few minutes4 ,they should not be taken from the water until they are to be filled with the milk mixture4 ,the nipples are washed thoroughly and boiled once a day and dropped into a solution of boric acid or bicarbonate of soda when not in use4 ,the plain black rubber nipples are best as they can easily be turned inside out and cleaned4 ,if the milk drops too slowly from the bottle1 the nipple may be pierced in one or two places with a darning needle4 ,the morning is the best time in which to prepare the baby's food2 the milk has not stood too long and it is easier to regulate the feedings if a fresh start is made each morning4 ,let the bottles and the rubber corks with which they must be stopped be boiled and cooled while the milk mixture is being prepared4 ,preparation of ,diluents4--,if barley or oatmeal water is to be used as a diluent1 let that be prepared first1 that it may be cool before adding it to the milk4 ,cover the table with a clean cloth or oilcloth1 upon this place the pitcher in which the milk is to be modified1 have the funnel1 milk dipper1 and spoon which are to be used boiled with the bottles1 cover the mouth of the pitcher with a clean square of gauze or cheesecloth1 read the formula carefully and measure the sugar1 dextri-maltose1 lactose1 ,mellin's ,food1 or cane sugar as directed and place it in a clean glass2 now measure the diluent1 water1 oatmeal water1 barley water1 or whey2 use part of this diluent to dissolve the sugar4 ,measuring ,milk according to ,percentage of ,fat4--,now dip off the required layer of top milk1 that is1 the layer containing the desired percentage of fat and protein4 ,mix this thoroughly and dip out the requisite number of ounces into the pitcher4 ,if there is not sufficient cream in one quart bottle to fill the formula1 the cream must be dipped from a second bottle and mixed with that of the first before it is measured into the pitcher4 ,the dissolved sugar and rest of the diluent1 together with the correct amount of limewater1 are strained into the pitcher1 mixed thoroughly1 and strained through the absorbent cotton lining the funnel into the bottles1 allowing the correct number of ounces for each feeding in every bottle4 ,pasteurizing the ,milk4--,the corks are then adjusted1 the bottles placed in the pasteurizer#gc and pasteurized for the desired number of minutes4 ,the water in the pasteurizer must be cold in the beginning and the rise of temperature recorded on the thermometer1 which is adjusted at a convenient place in the pasteurizer where the scale can be read easily4 ,if the temperature of the water is too high1 add cold water and lower the flame beneath the pasteurizer4 ,when the desired number of minutes has elapsed1 lift the bottle rack above the water for a few minutes and allow a stream of cold water to flow into the pasteurizer1 taking care not to chill the bottles too suddenly or they will crack4 ,cool the bottles as quickly as possible and place on ice until needed1 warming the bottle of milk as needed in warm water4 ,amount ,given at ,each ,feeding4--,at birth a baby will usually take from one half to one ounce at each feeding1 this amount is increased at the rate of a quarter of an ounce each week until the baby is receiving eight ounces at each feeding4 ,or the food is measured to allow of from one ounce to an ounce and a half more than the child's age in months4 ,for example a baby six months old would receive from seven to seven and a half ounces at each feeding4 ,some babies are bigger and stronger than others and require the maximum amount1 while others are less vigorous and the amount of food which they can handle at a feeding may fall slightly short of the above amounts1 but the quantities indicated above will serve as a guide in measuring the formula4 ,method of ,calculation of ,formula4--,the calculation of a formula consists in determining the amount 7in grams or ounces71 of the various constituents contained in the formula when the percentage of each is known4 ,or1 in determining its percentage composition when the amount of fat1 protein1 carbohydrate and diluent is given4 ,there are certain inaccuracies in all simple methods of calculation and the use of the ,babcock tester to determine the fat content in the milk to be used1 is advised in all milk or formula rooms4 ,the following method of calculation has been found satisfactory1 and the nurse must master it in order to intelligently carry out the directions of the pediatrist4 ,determining the ,composition of ,formula4#gd--;,gravity cream and skimmed milk are used in this method1 the cream is estimated as containing #af fat1 and consists of the entire cream layer from a quart bottle of milk which has been allowed to stand without being disturbed for six hours or longer4 ,the cream must be dipped off with a cream dipper1 or poured off4 ,if there is not a sufficient number of ounces in one bottle of milk1 a second must be used1 the entire cream layer taken1 then mixed with that obtained from first bottle1 before the required number of ounces are measured off4 ,skimmed milk is estimated as being fat-free 7although this is not entirely accurate74 ,both gravity cream and skimmed milk are estimated as containing #c4b protein1 and #d4e sugar4 ,in this method1 one rounded tablespoonful of milk sugar is estimated as weighing one half ounce 7dextri-maltose may be estimated in the same way74 ,with this brief explanation of the terms used we will proceed with the method itself4 ,it is always essential before beginning the calculation of the formula1 to know what percentages of fat1 sugar1 and protein it is to contain1 and the amount to be given in twenty-four hours2 it is also necessary to know how much lime water is to be added if this substance is to form a part of the formula4 ,suppose a thirty-two-ounce mixture is to be made containing #c of fat1 #f of sugar1 #b of protein1 and lime water sufficient to equal #be of the cream and skimmed milk in the mixture4 ,the fat in the food must be derived from cream1 since it is the only substance containing fat to be used in the formula4 ,if the food was composed entirely of gravity cream it would contain #af of fat4 ,since it is to contain but #c of fat it is evident that only #c_/af of the mixture must be gravity cream1 #c_/af of thirty-two ounces is six ounces4 ,six ounces of gravity cream will1 therefore1 provide the #c of fat desired in the mixture4 ,the gravity cream contains protein as well as fat4 ,there are six ounces of gravity cream in the thirty-two-ounce mixture4 ,the protein content of gravity cream is #c4b4 ,the protein content of a thirty-two-ounce mixture containing six ounces of gravity cream is evidently #f_/cb of #c4b or #j4fj4 ,two per cent protein is1 however1 desired in the mixture4 ,the gravity cream has provided only #j4fj4 ,one and forty hundredths per cent of protein1 the difference between the percentage of protein desired and that furnished by the gravity cream1 must be obtained in some other way4 ,it must be obtained1 moreover1 from some substance which does not contain fat4 ,skimmed milk is such a substance4 ,skimmed milk contains #c4b protein4 ,in order to get #a4dj per cent in the mixture by the use of skimmed milk1 it is evident that #adj_/cbj of the mixture must be skimmed milk4 #adj_/cbj of thirty-two ounces is fourteen ounces4 ,fourteen ounces of skimmed milk will1 therefore1 provide the additional #a4dj of protein desired4 ,both gravity cream and skimmed milk contain #d4ej milk sugar4 ,twenty ounces of gravity and skimmed milk are required to furnish the desired percentages of fat and protein4 ,these twenty ounces in a thirty-two-ounce mixture must add #bj_/cb or #d4ej of sugar to the mixture4 ,twenty thirty-seconds of #d-a_/b or #bj_/cb of #i_/b #ahj_/fd1 or practically #c of milk sugar4 ,it is1 however1 desired to have #f of milk sugar in the mixture4 ,that is1 #c more of milk sugar is required4 ,this additional sugar must be added in the form of dry milk sugar4 ,three per cent of thirty-two ounces is #c_/ajj of thirty-two4 ,this will give the amount of sugar desired in ounces4 ,the sugar is to be measured in rounded tablespoonfuls1 or half ounces4 ,if the figures given above are multiplied by two1 the result will be the number of rounded tablespoonfuls needed4 ,that is1 #c_/ajj of #cb x #b #aib_/ajj rounded tablespoonfuls1 or for all practical purposes1 two rounded tablespoonfuls4 ,it is also desired to have the amount of lime water in the mixture equal to #be of the cream and milk in the mixture4 ,there are twenty ounces of cream and milk in the mixture4 ,twenty-five per cent of twenty ounces is five ounces4 ,five ounces of lime water must therefore be added4 ,the total quantity of the mixture is to be thirty-two ounces4 ,the milk sugar goes into solution and1 therefore1 does not add to this quantity4 ,the difference between thirty-two and twenty-five ounces is seven ounces4 ,seven ounces of water must1 therefore1 be added to make up the quantity desired4 ,changing the ,formula4--,it is often found necessary to change the formula when using artificial feeding for infants1 and under these circumstances it is necessary to know the percentages of the food constituents contained in the formula already in use4 ,for this purpose the following method1 quoted from ,diseases of ,nutrition and ,infant ,feeding1#ge is included3 ,morse and ,talbot's ,method4--,suppose that a baby is taking a food made up of-- ,gravity cream #ab ounces ,skimmed milk #ah ounces ,limewater #f ounces ,barley water #ab ounces ,milk sugar #d rounded tablespoonfuls ,the barley water is made with two teaspoonfuls of barley flour in a pint of water4 ,the total quantity of the mixture is #dh ounces4 ,gravity cream contains #af fat4 ,twelve ounces of gravity cream in a #dh-ounce mixture will give1 therefore1 #ab_/dh of #af of fat1 or #d fat4 ,both gravity cream and skimmed milk contain #c4bj protein4 ,there are #cj ounces of gravity cream and skimmed milk in the mixture2 #cj ounces in a #dh-ounce mixture will give #cj_/dh of #c4bj of protein1 or #b4jj of protein4 ,both gravity cream and skimmed milk also contain #d4ej of sugar4 ,thirty ounces of gravity cream and skimmed milk in a #dh-ounce mixture will therefore furnish #cj_/dh of #d-a_/b which is the same as #cj_/dh of #i_/b or almost #c4jj of milk sugar4 ,four rounded tablespoonfuls of milk sugar are equal to two ounces4 ,two ounces of sugar in a #dh-ounce mixture is equal to #b_/dh of #ajj or #d4 ,the total percentage of sugar is1 therefore1 #g4 ,two teaspoonfuls of barley flour in a pint of water makes a #a4ej decoction of starch4 ,twelve ounces of barley water of this strength in a #dh-ounce mixture will give #ab_/dh of #a4ej or about #j4ce starch4 ,there are six ounces of limewater in the mixture and #cj ounces of gravity cream and skimmed milk4 #f_/cj of #ajj is #bj4 ,the limewater is1 therefore1 #bj of the milk and cream4 ,the mixture thus contains #d fat1 #g sugar1 #b protein1 and #j4ce starch1 while the limewater is in the proportion of #bj of the cream and milk4 ,if1 therefore1 the nurse will follow out the plan suggested by ,drs4 ,morse and ,talbot1 it should be a simple matter to change the percentage of any of the food constituents in any formula4 ,the following schemes for feeding well babies are included to facilitate the work in the home4 ,a nurse may teach the mother the manner in which these schemes are used1 keeping in mind that there can be no iron clad rule for feeding all babies4 ,no nurse should recommend a formula without directions from a physician4 ,and no formula should be changed without his permission4 ,the following milk formulas are used in the ,nathan ,straus ,pasteurized ,milk ,laboratories of ,new ,york3 ,formula ,no4 #a4--;,infants from #ast to #dth week1 by ,a4 ,r4 ,green4 #bd ounces of mixture divided into #h feedings of three ounces each1 fed at intervals of #b-a_/b hours3 #c_/d oz4 #af cream #c oz4 full milk #ai oz4 water #a-a_/d oz4 limewater #a-a_/b oz4 milk sugar ,formula ,no4 #b4--;,infants #ast to #c;d month1 by ,dr4 ,r4 ,g4 ,freeman4 #a-a_/b oz4 #af cream #c oz4 full milk #ac oz4 water #a_/b oz4 limewater #a oz4 milk sugar ,divided into #f feedings of #c oz4 each1 fed #c hours apart4 ,formula ,no4 #c4--;,infants #b;d to #fth month1 by ,dr4 ,r4 ,g4 ,freeman4 #ah oz4 full milk #af-a_/b oz4 water #a-a_/b oz4 limewater #a-a_/b oz4 milk sugar ,divided into #f feedings of #f ounces each1 fed at intervals of #c hours4 ,formula ,no4 #d4--;,infants #c;d to #gth month1 by ,dr4 ,a4 ,jacobi4 #ah oz4 full milk #ah oz4 barley water #a oz4 cane sugar #bj grains salt 7less than #a_/d tsp47 ,divided into #f feedings of #f ounces each1 fed at intervals of #c hours4 ,formula ,no4 #e4--;,infants #gth to #ith month1 by ,dr4 ,a4 ,jacobi4 #b-a_/b oz4 full milk #g-a_/b oz4 oat or barley water #a-a_/b oz4 cane sugar #cj grains 7about #a_/d tsp47 table salt ,divided into #e feedings of #f ounces each1 fed at intervals of #c-a_/b hours4 ,,scheme ,,for ,,feeding ,,normal ,,infants 7,first ,year7 ,scheme based on ,holt and ,shaw's ,save the ,babies4 ,pub4 by ,am4 ,med4 ,ass'n4 ,,whole ,,milk ,,method ---------------------------------------- -------------------------- ,intervals ,number ,time ,milk ,water ,sugar of of ,ounces ,ounces ,feeding ,feedings ---------------------------------------- -------------------------- #ast and #b;d #a to #c tbs4 days every #c-d hours #c;d and #dth days #c #g #b tsp4 #c #g #eth and #gth days #d #h #c tsp4 #c #g #hth day #e #aj #a-a_/b tbs4 #c #g #hth day to ,increase ,increase #a_/b ,increase #c #g-f end of #c;d #a_/b oz4 oz4 every #a_/b oz4 month every #d #h days every #b days weeks ,end of #c;d month #af #af #d-a_/d tbs4 #c #f ,beginning ,increase ,reduce #a_/b #d #d #f-e of #dth #a_/b oz4 oz4 every #b month to every #f weeks4 7,cook end of #fth days barley in month water if food disagrees7#gf ,end of #fth month #bd #ab #d #d #e ,beginning ,increase ,reduce #a_/b #d #d #e of #gth #a_/b oz4 oz4 every month to every #b weeks end of #ith week if month food is well digested and child seems hungry ,end of #ith #cj #aj oz4 7in #b tbsp4 #d #e month which #c tbs4 of cereal is cooked7 ,beginning ,increase ,cereal gruel ,reduce #a #d-e #e-d of #ajth #a oz4 as above tbs4 per month to per month month end of #abth month ---------------------------------------- --------------------------- ,at the beginning of #gth or #hth month1 or earlier if necessary1 it is advisable to add orange juice1 giving from #a-b tablespoonfuls between the two morning feedings4#gg ,after the #dth month it is well to eliminate the night feeding between #aj ,p4,m4 and #f ,a4,m4 ,at end of #aath month add #a-b pieces of stale bread1 toast or zwieback4 ,part of soft-cooked egg may be given every other day at noon meal by end of #aath month4 ,the orange juice may be increased to #c tbs4 if bowels are not loose4 ,the strained cereal should be given twice daily by the end of the first year1 and the milk should be undiluted at this time unless the digestion of the infant forbids4 ,cooled boiled water should be given several times each day between feedings4 ,babies cry from thirst as well as from hunger4 ,,scheme #b ,,for ,,feeding ,,well ,,babies ,scheme based on ,dr4 ,richard ,m4 ,smith's ,the ,baby's ,first ,two ,years4 ,a full-term baby will usually take a formula made as follows3 ,cream #b ounces ,skimmed milk #b ounces ,boiled water #ab ounces ,sugar of milk #f level tsp4 ,after #c;d day increase cream and milk at the rate of #a ounce each week1 and sugar #a tsp4 every other day until at one month the baby will be receiving a formula such as-- ,cream #e ounces ,skimmed milk #e ounces ,boiled water #bb ounces ,sugar of milk #c-a_/b level tbs4 ,at two months-- ,cream #f ounces ,skimmed milk #f ounces ,boiled water #bj ounces ,sugar of milk #d level tbs4 ,from this point the formula may be increased by adding #b ounces of skimmed milk each month until the baby is eight months old4 ,for each ounce of milk added1 an equal amount of water should be omitted4 ,the sugar in the formula should be reduced one half tbs4 every three months4 ,at six months the baby would be taking-- ,cream #f ounces ,skimmed milk #ad ounces ,boiled water #ab ounces ,sugar of milk #c-a_/b level tbs4 ,at eight months-- ,cream #f ounces ,skimmed milk #ah ounces ,boiled water #h ounces ,sugar of milk #c level tbs4 ,this amount will not be found sufficient in quantity for a twenty-four-hour mixture for children of this age4 ,increasing the amount of the last formula in the same proportion1 it will be-- ,cream #i ounces ,skimmed milk #bg ounces ,boiled water #ab ounces ,sugar of milk #d-a_/b level tbs4 ,at this age the formula usually may be changed so as to be made from whole milk instead of cream and skimmed milk4 ,the formula may be made as follows3 ,whole milk #cf ounces ,boiled water #ab ounces ,sugar of milk #d-a_/b level tbs4 ,from this point on the formula may be increased by replacing the boiled water with whole milk1 two ounces each month up to thirteen months4 ,at this age the boiled water may be omitted from the formula one ounce each week4 ,beginning at the age of eight months the sugar may be eliminated from the formula1 one tablespoonful each month4 ,barley ,water4--,at the age of five months1 or at any time thereafter1 barley water may be substituted for boiled water in the formula4 ,this should be substituted when the baby is not gaining in weight4 ,it may be substituted in many instances when the movements are not well digested4 ,lime ,water4--,it is frequently found to be advisable to add lime water4 ,it is not necessary in every instance1 but should be given if the baby is inclined to spit up1 or in cases where the stools are too frequent in number and are slightly green in color4 99 99 99 99 99 ,determining the ,fuel ,value of a ,formula4--,the computation of the fuel value of a formula is very essential since the growth and development of the infant depends largely upon whether or not its energy expenditures are well covered4 ,the method is simple1 requiring the same methods used in the computing of other dietaries4 ,take the formula just calculated1 its fuel value would be estimated as follows3 ,thirty-two ounces are equal to #ifj grams4 ,in each #ajj grams there would be #c grams of fat1 #b grams of protein and #f grains of sugar4 ,hence in #i4f one-hundred-calorie portions there would be #i4f x #c--bh4h grams of fat1 #i4f x #b--ai4b grams of protein1 and #i4f x #f--eg4f grams of sugar1 in a thirty-two-ounce mixture4 ,to determine the fuel value of the formula1 these results must be multiplied by their physiological fuel factors1 #i and #d and #d respectively4 ,thus3 #bi x #i #bfa calories from fat #ai x #d #gf calories from protein #eh x #d #bcb calories from sugar1 or a total of ---- #efi calories for the entire mixture4 ,scheme for ,adding ,solids to ,infants' ,diet4-- ,from #ith to #aeth month3 #f ,a4,m4--,milk formula 7bottle74 #h ,a4,m4--,orange juice #a_/b ounce1 or prune pulp or prune juice4 #aj ,a4,m4--,bottle1 cereal 7strained7 and bread and butter or zwieback4 #b ,p4,m4--,mutton1 chicken1 or veal soup cooked with cereal2 small portion of baked potato1 small portion of strained spinach or carrots2 orange gelatin or cornstarch pudding4 #f ,p4,m4--,bottle4 ,from #ae months to #b-a_/b years3 #h ,a4,m4--,stewed fruit or orange juice2 cereal1 crisp bacon1 alternated with soft-cooked or poached egg2 bread and butter or toast1 milk or weak cocoa4 #ab or #a ,p4,m4--,meat or vegetable soup thickened with cereal2 lamb chop1 scraped beef or chicken or beef juice2 baked or mashed potato2 strained spinach2 carrots2 turnips or celery2 gelatin1 custard1 or cornstarch pudding4 #c ,p4,m4--,crackers and milk4 #f or #g ,p4,m4--,bread and milk or cereal2 baked apple or apple sauce4 ,from #c to #f years3 #h ,a4,m4--,stewed fruit or orange2 cereal2 bacon or egg 7soft-cooked or poached72 bread and butter2 milk or cocoa4 #ab or #a ,p4,m4--,soup2 lamb chop1 scraped beef1 chicken1 or roast meats2 potato2 all vegetables2 celery1 lettuce2 light desserts3 custards1 gelatin1 lady fingers4 #c ,p4,m4--,milk2 fruit and crackers4 #f ,p4,m4--,milk or cocoa2 stewed fruit2 bread and butter2 cereals2 eggs4 ,,vegetable ,,soup #a_/d lb4 beef1 lamb or chicken #a potato #a carrot #b stalks celery #a tablespoonful pearl barley #b tablespoonfuls rice #b qts4 water #a pinch salt ,finely divide the vegetables4 ,add the vegetables1 barley and rice to #b qts4 of water4 ,boil down to #a qt41 cooking #c hours4 ,add pinch of salt4 ,pass through fine sieve4 ,morse and ,talbot advise baked potato1 plain boiled macaroni1 rice and wheat germ1 bread and butter1 baked custard1 plain blanc-mange1 and plain boiled tapioca to be given when the child is #a-a_/b years old4 ,when the child is nearly two years old they add meat in the most digestible forms1 such as the white meat of chicken1 lamb or mutton chops1 and scraped beef4 ,the following dietary is suggested for a child two years old3#gh ,whole milk1 butter1 mutton broth1 chicken broth1 beef juice1 soft-cooked eggs1 dropped eggs1 white meat of chicken1 lamb or mutton chops1 scraped beef1 ,french bread1 stale bread1 toasted bread1 whole wheat bread1 milk toast1 zwieback1 plain white crackers1 plain ,educator crackers1 barley1 jelly1 oatmeal1 cream of wheat1 wheat germ1 ,ralston's ,farina1 rice1 baked potato1 plain boiled macaroni1 orange juice1 baked apples1 stewed prune pulp and juice1 junket1 baked custard1 cornstarch pudding1 plain blanc-mange1 plain tapioca4 ,it is not advisable1 as a rule1 to begin green vegetables until the baby is #b-a_/b years old4 ,it will be seen in the foregoing dietaries how authorities differ in their beliefs as to the requirements of the child4 ,the dietaries included in this text are selected from those used in different parts of the country by physicians who have successfully cared for the infants and children under their charge4 ,,the ,,feeding ,,of ,,premature ,,infants ,the digestion of premature infants is naturally not as strong as that of infants born at term4 ,very little is positively known1 but the consensus of opinion goes to show that in the majority of cases the tolerance for sugar is greater than that of either the proteins or fats4 ,the loss of heat is relatively greater in proportion to its surface area in small than in large bodies4 ,this is a well-known fact1 hence the premature baby must require more food in proportion to its weight than the baby who is born at the normal time4 ,then1 too1 as the premature infant is thinner he does not keep warm like the older infant1 and this must be taken into consideration in feeding him4 ,breast milk is of course by far the best food for such babies1 not only because its constituents are in a more available form for the feeble digestive organs1 but because the mother's milk furnishes a resistance which is lacking in even the most carefully modified of milk formulas4 ,energy ,requirements of ,premature ,infants4--,experiments made upon premature infants have proved that the caloric needs of these babies are greater than in the case of full-time babies2 that is1 they require more per kilogram of body weight4 ,according to ,morse1#gi most premature babies need #abj calories per kilogram of body weight4 ,but there are many exceptions1 some thriving on as little as #gj calories per kilogram4 ,no attempt should be made to reach #abj calories per kilogram during the first few days4 ,thirty calories per kilogram is as much as is wise to give in the first #bd hours of feeding4 ,this amount should be gradually increased each day1 watching carefully for symptoms of indigestion and diminishing it if these appear4 ,one hundred and twenty calories per kilogram can be given in about #aj days4#hj ,necessary ,dilution4--,even breast milk must be diluted with an equal amount of water or a #c sugar solution4 ,the amount of milk should be increased and the amount of dilution decreased until the undiluted breast milk is given in four or five days4 ,like older babies1 the next best food for premature babies is the properly modified cow's milk1 but the utmost care will have to be observed1 as these babies are more easily upset than older and stronger ones4 ,premature ,infant ,feeding4--,the following method of feeding may be suggested1 keeping in mind that it is an easy matter to increase the strength of a mixture if the baby shows the need of such an increase4 ,the premature baby is rarely strong enough to take the breast4 ,method of ,administering ,milk4--,the most satisfactory method of administering the food in such cases is by means of the ,brick feeder1 which consists of a graduated glass tube1 open at either end4 ,on the small end is placed a small nipple like those seen on medicine droppers2 this one is perforated and goes into the mouth of the baby4 ,a large rubber finger cot is attached to the other end of the tube4 ,the milk is forced into the mouth by pressing the finger cot4 ,in case the infant is too feeble even for this method of feeding1 the desired amount is dropped into the mouth from a medicine dropper2 #e c4c4 7about #a dram or #a teaspoonful7 of diluted milk being given at each feeding4 ,this amount is increased gradually from day to day4 ,whey ,mixtures4--,whey mixtures have been found to meet the needs of premature infants more efficiently than ordinary mixtures4 ,as the proteins in whey are in a more digestible form1 they throw less work on the immature digestive apparatus4 ,as a rule the casein and whey are in proportion of #a3a4 ,the following formulas#ha show the amounts in which the food constituents are combined and are suitable for premature babies3 ,fat #a4jj ,milk sugar #d4jj ,total proteins #j4be ,lime water #be of cream and milk mixture or ,fat #a4jj ,milk sugar #d4ej ,total proteins #j4ej ,lime water #be of cream and milk mixture ,,proprietary ,,foods ,a word as to the use of ,proprietary ,infant ,foods3 ,these prepared foods may be classified under four heads1 as follows3 7#a7 condensed milks2 7#b7 malted foods1 those consisting chiefly of carbohydrates in the form of maltose and dextrins2 7#c7 those consisting almost entirely of starch1 and 7#d7 those composed partly of soluble and partly of insoluble carbohydrates4 7#a7 ,condensed milk may be sweetened or unsweetened4 ,these milks are never given undiluted1 the directions calling for one part condensed milk to nine parts water1 which gives a mixture containing #j4ij fat1 #e4di sugar1 and #j4hj protein if ,eagle ,brand ,condensed ,milk is used4#hb 7#b7 ,malted ,foods3 ,mellin's ,food and malted milk are examples of this group4 ,these foods contain the carbohydrates in soluble form and when added to milk make an acceptable addition1 as they furnish the carbohydrates in the most digestible form4 ,when fed alone1 diluted only with water1 they result in a mixture deficient in both fat and protein4 7#c7 ,imperial ,granum is an example of this group1 and there are several others with similar compositions4 ,these foods are very much like wheat flour which has been subjected to heat1 changing to a small extent the starch to dextrose and dextrin4 7#d7 ,nestle's ,food1 ,eskay's ,albumenized ,food1 and ,allenbury's ,food are examples of this group1 each containing sugar and a percentage of starch4 ,upon dilution with water1 the amount of fat in the mixture is just a trace4 ,incomplete ,foods as a ,source of ,danger4--,the ease with which the majority of these foods are prepared and the way in which they agree with the baby constitute the chief danger of their use4 ,if they are added to milk1 with the exception of the condensed milk1 they result in a modified milk containing the carbohydrates in a more or less digested form4 ,but they are expensive1 and give no better result as a rule than a carefully modified milk containing a cereal gruel4 ,the giving of foods like malted milk alone is dangerous because they are deficient in some of the most necessary constituents1 and babies fed in this way1 while growing fat1 are apt to have soft or brittle bones and muscular tissue higher in fat and water than in protein1 so that they do not grow and develop in a normal way1 and when they are attacked by the diseases so prevalent in the early years of life1 they succumb rapidly1 because the resistance given by a properly modified food is lacking4 ,condensed milks act in a like manner4 ,that is1 in the sweetened milks the carbohydrate content is far in excess of the needs1 and the proteins and fats are deficient1 so that while the baby fattens he does not receive the building foods commensurate with his body requirements4#hc ,many mothers adopt the use of these foods because they mean less work than in modifying the milk properly1 but the nurse should point out the facts just mentioned1 explaining that while these proprietary infant foods are undoubtedly valuable at times to fill a place when the milk formula has not proved satisfactory1 the use of these foods as a regular custom is expensive1 not only from a financial standpoint but from a standpoint of health1 since their disadvantages far outweigh their advantages in the long run4 ,,summary ,breast ,milk as a ,food4--,the superiority of breast milk over any other known food cannot be too strongly emphasized4 ,regularity in ,feeding4--,the absolute need for regularity in feeding--feeding by the clock and not by guess or when the baby cries4 ,indications of ,health4--,the normal growth and development to be used as guides as to the physical well-being of the infant2 also as an indication of the use of the proper modification of milk for the individual needs of the child4 ,dilution4--,the amount of dilution necessary--cereal waters1 whey1 etc4--to increase the digestibility and nutrient values of the formula4 ,the ,addition of ,alkali4--,the addition of alkalies to milk formulas to accomplish a like purpose4 ,milk ,sugar1 ,malt ,sugar1 ,cane ,sugar4--,the use of the different sugars1 namely1 dextri-maltose1 lactose1 or cane sugar under various circumstances as the condition of the infant demands4 ,substitutes for ,whole ,milk4--,the substitution of different milk1 such as lactic acid milk1 ,bulgarian culture buttermilk1 ,eiweissmilch1 cream and whey mixtures1 as the individual needs of the infant demand4 ,technique of ,milk ,modifications4--,the absolute need for the nurse to understand the technique of milk modification before attempting the care of an artificially fed infant4 ,percentage ,computation4--,a knowledge of percentage1 that an accurate computation of a formula may be accomplished4 ,preparation of ,food4--,a sufficient knowledge of food preparation to enable the nurse to prepare any food which may be deemed necessary by the physician for the welfare of the child4 ,water4--,the importance of giving the baby water aside from that used in modifying the milk4 ,many babies cry from thirst when they are believed to be crying from hunger or temper4 ,increasing the ,diet4--,the necessity for increasing the amount and strength of the formula with the age1 growth1 and development of the child by the addition of solid food as soon as the physician deems it advisable4 ,feeding ,premature ,infants4--,the method of feeding a premature infant differs from that employed in feeding an infant born at term3 7a7 because its development has not progressed so far2 7b7 because its digestive apparatus being more or less immature1 food handled with ease by an older baby will be totally unfit for the premature one1 both as to quality and quantity4 ,wet ,nurse4--,the advisability of procuring a wet nurse when the mother is unable to nurse the infant1 7a7 on account of the more digestible character of the food constituents1 especially the proteins1 in mother's milk over those of cow's milk2 7b7 on account of the resistance furnished by the natural food which has been proved to be very much greater than that furnished by any other food1 no matter how carefully the modification of the milk is made4 ,premature ,infants4--,their caloric needs are greater than in full-term babies1 hence their food must be adjusted to meet these needs4 ,in fact the nurse must have an understanding of the behavior of foods in the metabolism of infancy and the laws which govern their use in the organism of the child4 ,,problems 7a7 ,write a formula for a two months' old infant weighing twelve pounds1 which contains #c fat1 #b protein1 and #f sugar4 7b7 ,change this formula so that it will contain #c fat1 #a4e protein1 and #f sugar4 7c7 ,write a formula for an eight months' old baby1 using whole milk instead of cream and skimmed milk4 7d7 ,write a formula for a premature baby containing #a fat1 #d sugar1 and #j4be protein 7allowing #cj calories per pound of body weight74 ,,footnotes3 #fd ,childhood and ,growth1 p4 #ah1 by ,lafayette ,mendel4 #fe ,diseases of ,nutrition and ,infant ,feeding1 by ,morse and ,talbot4 #ff ,feeding the ,family1 by ,mary ,swartz ,rose4 #fg ,diseases of ,nutrition and ,infant ,feeding1 p4 #bah1 by ,morse and ,talbot4 #fh ,generally ,accepted ,methods for ,artificial ,feeding of ,infants with ,indicatives and ,contra-,indicatives1 by ,orville ,r4 ,chadwell1 ,m4,d4 ,reprinted from ,new ,england ,medical ,gazette1 ,june1 #aiaf4 #fi ,mechanical ,factors of ,digestion1 by ,cannon4 #gj ,diseases of ,nutrition and ,infant ,feeding1 p4 #bjd1 by ,morse and ,talbot4 #ga ,new ,england ,medical ,gazette1 ,june1 #aiaf4 ,reprint by ,orville ,chadwell4 #gb ,the best substitute for the homogenizer is found in an electric mixer2 a formula prepared with a fat other than cream can be made by means of this mixer to approximate very closely that of homogenized milk4 #gc ,there are a number of pasteurizers on the market2 one sold by the ,walker ,gordon ,laboratory and one designed by ,dr4 ,r4 ,g4 ,freeman of ,new ,york are both satisfactory4 #gd ,method suggested by ,morse and ,talbot1 ,diseases of ,nutrition and ,infant ,feeding1 pp4 #bcd-bce4 #ge ,diseases of ,nutrition and ,infant ,feeding1 pp4 #bbe and #bbf1 by ,morse and ,talbot4 #gf ,one-half tbs4 barley flour may be cooked in the water used as diluent2 it should be boiled #bj minutes1 strained and cooled before adding to formula4 #gg ,when babies are fed upon pasteurized1 sterilized1 or dried milk it is advisable to use orange or prune juice earlier than the seventh month4 ,dr4 ,hess suggests the use of canned tomato juice as substitute for orange juice4 #gh ,diseases of ,nutrition and ,infant ,feeding1 p4 #bcf1 by ,morse and ,talbot4 #gi ,morse3 ,american ,journal of ,obstetrics1 #aije4 ,hess3 ,american ,journal ,diseases of ,children1 #aiaa4 #hj ,diseases of ,nutrition and ,infant ,feeding1 p4 #bch1 by ,morse and ,talbot4 #ha ,diseases of ,nutrition and ,infant ,feeding1 p4 #bci1 by ,morse and ,talbot4 #hb ,diseases of ,nutrition and ,infant ,feeding1 by ,morse and ,talbot4 #hc ,the proprietary foods on the market are many1 but those given above as suggested by ,morse and ,talbot represent the best known infant foods4 ,,chapter ,x ,,care ,,and ,,feeding ,,of ,,infants ,,and ,,children ,,in ,,abnormal ,,conditions ,,and ,,in ,,infectious ,,diseases ,digestive ,disturbances4--,it is a well-established fact that artificially fed infants are more subject to disturbances due to diet than breast-fed infants1 the digestional disturbances of the latter yielding more readily to treatment4 ,as a rule1 with the breast-fed baby it is largely a question of adjusting the diet of the mother1 of increasing the fluid in her diet1 of seeing that she takes the requisite amount of exercise in the open air1 and of lengthening the intervals between feedings or of giving the baby water just before putting him to the breast4 ,with the artificially fed infant it is an entirely different proposition4 ,causes in ,artificially ,fed ,infants4--,the digestive disturbances may arise from any one of half a dozen or more causes4 ,the constituents in the milk may be in the wrong proportion4 ,the amount given at a feeding may be too great or too little4 ,the dilution may be too great or too small to meet the needs of the infant4 ,or the milk may contain the microoerganisms which bring about fermentation or putrefaction4 ,any or all of these causes may assail the artificially fed baby4 ,consequently1 all the care that can be exercised must be resorted to in the feeding of these babies1 not only after digestional disturbances arise1 but as a means of their prevention4 ,in the preceding chapter the methods generally used in the feeding of normal infants were discussed4 ,we now proceed to the feeding under abnormal or pathological conditions4 ,errors in ,diet4--,the majority of the ills from which the baby suffers can be traced primarily to errors in diet and in most of these cases the treatment consists chiefly in adjusting the formula to suit the condition4 ,as a rule1 these errors may be placed under two heads3 those that are brought on by under-feeding and those induced by over-feeding4 ,the pathological conditions arising from under-feeding are due not only to a lack of food1 but chiefly to the improper balancing of the different food constituents in the formula4 ,as has already been stated1 so much food is required to cover the energy expenditures1 so much for maintenance1 and so much for storage for the growth and development necessary during the entire period from birth to maturity4 ,these constituents must be regulated to the individual needs of the infant4 ,over- and ,under-dilution4--,if the dilution is too great1 the infant1 while receiving the correct amount of the mixture1 may have the necessary food constituents so reduced as to have them fail completely to do their appointed work in the body4 ,or if the amount of diluent is too small the baby may be receiving too strong a mixture1 and develop nutritional disturbances therefrom4 ,under the first head the child suffers from under-feeding2 the appetite is satisfied before enough of the actual food is ingested to meet his various needs4 ,however1 it is probable that the artificially fed infant suffers from the results of over-1 rather than of under-feeding4 ,,diseases ,,due ,,to ,,errors ,,in ,,diet ,gastro-intestinal disturbances1 colic1 enterocolitis1 colitis1 etc41 rickets1 scurvy1 nephritis1 and diabetes are among the diseases most apt to develop from injudicious feeding1 and in these cases the dietetic treatment plays the most important part in combating the condition4 ,the disturbances caused by food are recognized by the general symptoms3 vomiting1 rise of temperature1 subnormal temperature1 and the stools1 the latter being the chief point of observation4 ,fats as ,cause4--,when the fats are causing the disturbance1 the rise of temperature is apt to be high1 but not of long duration4 ,the baby vomits frequently1 the vomitus being acid in reaction and odor1 the latter due to the presence of fatty acids1 butyric acid1 etc4 ,diarrhea often develops in a more or less acute form4 ,in these cases there is a loss of sodium and other alkaline salts in the feces1 and a consequent excess of ammonia in the urine1 resulting in acidosis4 ,acid intoxication has been known to develop as a result of this loss of alkaline salts4 ,the chief symptoms of this condition are rapid and deep respiration1 stupor or restlessness1 and cherry-red lips4#hd ,symptoms of ,excess ,fat in ,diets4--,the general symptoms in infants receiving an excess of fat in their food take the form of loss of appetite1 with more or less loss of weight1 or failure to gain4 ,when the cases are not chronic1 soft curds may often be seen1 which are at times mistaken for casein curds1 but may be distinguished from them by their translucent appearance and their solubility in ether4 ,the color of the stools due to the excess of fat under the above-mentioned conditions is shiny and gray4 ,in the majority of cases1 especially of a more chronic character1 the stools are apt to be large and dry1 at times hard and crumbly4 ,the fat in such stools is combined with magnesium and calcium salts1 forming the characteristic soap stools4#he ,the combined loss of these salts in the feces has a definite effect on the general metabolism and nutrition1 giving rise to rickets4 ,regulating the ,fat4--,the treatment consists chiefly of regulating the amount of fat in the formula1 and of cutting it out altogether in the beginning when the symptoms show acute acid conditions4 ,in many cases1 if the baby is given breast milk1 the trouble disappears4 ,at other times it is necessary to substitute a foreign fat such as olive oil for the butter fat4 ,dr4 ,ladd in the ,children's ,hospital in ,boston treated many babies who manifested an intolerance for butter fat with ,homogenized ,milk1 which consisted of skimmed or separated milk and a certain percentage of olive oil1 placed in an apparatus which brought about a more complete division of the fat1 causing it to mix with the milk as an emulsion closely resembling human milk4 ,fat intolerance is most difficult to overcome1 the baby being apt to relapse into the acute stage unless the utmost caution is observed in adding the fats to the formula4 ,it is not safe1 however1 to feed the baby upon a fat-free milk for any great length of time4 ,excess ,protein in ,food4--,the digestional disturbances arising from too much protein in the food are as a rule readily overcome in breast-fed infants4 ,when it is due to nervousness or worry in the mother1 it disappears as soon as the mother ceases to worry or does something to remove the cause of the nervous condition4 ,when the breast milk is high in protein1 more exercise in the open air at times adjusts the percentage of protein1 provided the mother does not become over-tired1 in which case the percentage of protein in breast milk increases4 ,evidences of ,excess ,protein4--,the symptoms of excess protein in the diet of the breast-fed baby are colic and flatulence1 which are often persistent and difficult to overcome4 ,vomiting is not so common in these babies as in those who are artificially fed4 ,the stools are increased in number1 are either brown or green1 and generally loose and watery4 ,in artificially fed infants the symptoms are much the same1 except that the vomitus often contains large curds which are tough and leathery4 ,the baby suffers from gas formation and colic4 ,the stools are at times normal1 except for the presence of large1 hard curds2 at other times they are increased in number1 and are of a watery consistency and alkaline in reaction4 ,regulating the ,protein in ,formula4--,when the stools are watery and brown and musty in odor as the result of disturbed protein digestion1 the treatment consists of taking out the proteins from the formula and of substituting cereal water1 to which dextri-maltose or milk sugar is added1 the milk being added as soon as possible to prevent too great a loss of body protein4 ,as a rule the whey proteins do not cause the disturbances so often as the casein proteins2 and at times it is possible to use whey mixtures with babies who cannot tolerate the casein at all4 ,buttermilk also is used in cases of protein indigestion1 as is ,eiweissmilch and peptonized milk4 ,regulating the ,carbohydrates4--,when the disturbances are due to the carbohydrates in the formula1 they may be digestional or nutritional4 ,in this form the milk sugar is more apt to be the cause of the trouble than the dextri-maltose preparations which are at times used4 ,in the latter1 when the disturbance becomes nutritional1 the cause of the trouble can usually be traced to an excess of starch4 ,when the percentage of milk sugar is greater than can be handled by the digestive apparatus of the baby1 it is manifested by frequent attacks of colic1 with the passage of watery green stools1 highly irritating1 in character on account of their acidity4 ,in acute cases the loss of weight is often marked1 and symptoms of intoxication may develop4 ,the outlook is grave in the very severe cases1 but if the baby can survive forty-eight hours after the acute symptoms develop1 he is apt to pull through the attack4 ,adjusting the ,sugars4--,the treatment in these conditions consists of eliminating the milk sugar from the formula2 in less severe cases dextri-maltose may be substituted4 ,as a rule1 coincident with indigestion caused by sugar there will be found to be an intolerance for much fat1 so that this must be adjusted as well as the milk sugar4 ,skimmed milk mixtures1 containing a certain amount of barley or oatmeal water1 are generally found to be suitable in these cases4 ,dextri-maltose may be added after a few days in order to maintain the fuel needs of the body4 ,eiweissmilch is at times used1 but whey mixtures are contraindicated on account of their high sugar content4 ,dextri-maltose also disagrees at times4 ,the baby has colic and flatulence1 the stools are usually loose or watery and dark brown in color4 ,the dietetic treatment consists of an immediate withdrawal of the dextri-maltose preparation and a substitution of milk sugar after a few days4 ,evidences of ,excess ,starch in ,formula4--,the disturbances arising from an excess of starch in the diet are1 as has already been stated1 more apt to be of a chronic than an acute character4 ,vomiting is not a common symptom under these conditions1 although colic is frequent4 ,the stools are at times loose and brown1 at other times dry and small4 ,the baby at times suffers from diarrhea and at others from constipation4 ,when the disturbance is acute the starch must be entirely eliminated from the formula4 ,if proprietary foods are being used containing starch1 whether it is dextrinized or unchanged1 they must be at once abandoned1 and a formula made up of protein with sugar and fat4 ,,modified ,,milk ,,formulas ,,suggested ,,by ,,morse ,,and ,,talbot ,,for ,,these ,,conditions ,fat #a4jj ,fat #b4jj ,milk sugar #d4jj or ,milk sugar #e4jj ,protein #j4ge ,protein #a4be ,they likewise advise whey and whey mixtures under these circumstances4 ,fermentation4--,fermentation is often the cause of infantile indigestion4 ,at times it is acute and may cause a decided elevation of temperature owing to the absorption of the toxic substances formed as a result of the bacterial action4 ,in almost every case of indigestion brought on by fermentation there will be an accompanying diarrhea4 ,as a rule the carbohydrates are more liable to the attacks of bacteria in the stomach than the other food constituents4 ,treatment4--,the treatment consists first of starvation1 no food being given for at least twenty-four hours4 ,then water or weak tea1 sweetened with saccharin1 may be given1 but nothing else4 ,the medical treatment must be left to the discretion of the physician4 ,when the condition warrants a return to food the formula must be made weaker than that which has caused the disturbance4 ,malt soup mixtures1 buttermilk mixtures1 whey and albumen water may be added as the condition of the baby improves4 ,in older children the period of starvation may have to exceed that of infants1 but a gradual return to normal diet is made4 ,weak tea and toast may be given after the first twenty-four hours and well skimmed meat broths1 soft-cooked eggs1 liquid peptonoids1 and malted milk added to the diet as the condition of the child improves4 ,,enterocolitis ,the dietetic treatment for enterocolitis must be adjusted according to the principal symptom4 ,in some of these cases diarrhea is most prominent1 while in others constipation is the most marked symptom4 ,hence the diet must be such as not only to do no harm to the child1 but one that will aid in his ultimate recovery4 ,,diarrhea ,the treatment for diarrhea1 whether it is from fermentation or putrefaction of food1 has already been explained4 ,the grave danger in the putrefactive diarrhea is the absorption of the toxic substances which result from bacterial action upon the unabsorbed food material in the small and large intestine4 ,in these cases auto-intoxication may develop and the baby may die before the condition yields to treatment4 ,the entire intestine must be cleansed as a rule4 ,the stomach of the baby may be reached with little trouble by using a small rubber catheter attached to a glass funnel and a solution of bicarbonate of soda4 ,the bowels may be emptied by means of a soapsuds enema4 ,older children may be given oil1 but this of course comes under the jurisdiction of the physician4 ,,constipation ,constipation is one of the most frequent troubles visited upon people of all ages4 ,it is not a disease1 it is a condition in which the number of stools is less or the consistency of the stools is greater than is normal for the individual at the given time4#hf ,it may be caused by neglect of the bowels1 which should be evacuated once or twice every day during infancy and once a day after that period4 ,if the habit of emptying the bowels every day is established in infancy it adds much to the health and comfort of the individual during the entire remainder of life4 ,babies are sometimes constipated as the result of the opium administered in soothing sirups4 ,others inherit constipation1 while still others are constipated by the taking of the wrong kind of food or too little food4 ,in any case it is decidedly bad to resort to drugs1 since the habit of taking cathartics is so easily acquired and so difficult to overcome4 ,factors ,inducing ,constipation4--,with artificially fed babies a formula which contains too high a percentage of diluent and too low a percentage of solids will cause constipation1 chiefly because the solids are so completely absorbed that they have no residue to form feces4 ,a formula with too low a fat content in proportion to its protein and carbohydrates may cause constipation because the latter two constituents are almost entirely absorbed1 and the feces1 which is largely made up of the fat1 is correspondingly small4 ,excess of fat1 however1 has been proved to be one of the chief causes of constipation in infants1 as has also been the case with excess starch4 ,boiling the milk for the baby at times results in constipation4 ,hence sterilization is more frequently to blame for the condition than the pasteurization of milk4 ,constipation during ,second ,year4--,during the second year1 if the child is given too much milk and too little solid food1 constipation is very apt to be the result4 ,a maximum quantity of from thirty-two to forty ounces may be given4 ,in many diseases brought on by malnutrition1 constipation is an obstinate condition to be overcome4 ,this is especially the case in rickets and anemia4 ,use of ,laxative ,foods4--,after the baby is a few months old1 orange juice is given between the morning feedings4 ,malted foods likewise exert a laxative effect4 ,the higher the percentage of maltose1 the more laxative the food4 ,the nurse must keep this point in mind in feeding babies4 ,with older children and adults1 the question of diet for constipation is quite as important as it is for infants4 ,prunes or figs cooked with senna leaves and thoroughly strained furnish an excellent adjunct to the diet under such conditions4 ,the coarse breads such as bran and ,graham or wholewheat bread should be used instead of white flour breads4 ,care should be taken in advising a cereal diet for children1 since cereals1 with the exception of oats1 are apt to be constipating4 ,fresh fruits1 stewed fruits1 and fresh vegetables are all good under the above-mentioned conditions4 ,young children require the vegetables strained or cut fine4 ,adults should include one coarse vegetable a day in their dietary to obviate the development of constipation4 ,children should be taught to drink plenty of water1 and babies should not be neglected in this respect4 ,as a rule very few adults drink as much water as is necessary for the general welfare of their bodies4 ,,scurvy ,there is probably no disease of infancy which has come in for more study in the past few years than scurvy4 ,cause4--,the disease is believed to be directly due to a deficiency in the diet of the antiscorbutic vitamine1 known as ,water soluble ,c4 ,treatment4--,for many years it was known that lime juice exerted a curative effect upon scurvy4 ,but recently the efficiency of this fruit juice has proved to fall far short of that effected by either orange1 or tomato juice4 ,feeding experiments have proved that animals1 fed upon rations consisting of dry food without the addition of green1 will develop scurvy4 ,and that the milk of such animals will show a deficiency in the ,c vitamine which will lead to a development of the disease in infants fed upon such milk4 ,milk is1 in fact1 by no means a perfect food1 so far as its vitamine content is concerned4 ,first1 because the presence of the vitamine in milk is so dependent upon the diet of the mother or the animal1 second1 because the pasteurization temperatures used to insure cow's milk of purity from a bacterial standpoint1 destroys in it the greater part of its antiscorbutic power4 ,either of which makes it necessary to supplement the formula of the artificially fed infant1 and1 in case of the former1 the mother's milk of the breast-fed baby1 with orange1 or canned tomato juice4 ,the amount of either of the fruit juices which is necessary to insure the child of a freedom from scurvy1 is small1 ranging from one-half to one ounce of strained juice daily1 this amount is increased gradually until the child is taking from one and one-half to two ounces each day4 ,it has been found advisable to administer the fruit juice between the two morning feedings4 ,as a rule1 the fruit juices are given at the beginning of the seventh month1 but they may be given at a much earlier date1 the time being adjusted by the physician4 ,,rickets ,rickets1 like scurvy1 is being discussed by scientists both in ,america and abroad4 ,the disease is widespread1 particularly in its subacute form1 and its effect upon the health of the child is so serious that no amount of effort to prevent its development should be considered too great4 ,calcium ,retention in ,rickets4--,the disease is characterized by a failure of the bones to lay down lime salts1 this failure causes a softness and flexibility in the structure of the bones which permits them to bend into deformities4 ,then1 too1 it is a well established fact that any interference with the calcium metabolism in the body1 will inevitably bring about disaster4 7,see ,mineral ,metabolism1 page #ahe47 ,factors ,inducing ,rickets4--,according to ,dr4 ,eddy1 ,it is impossible at present to determine whether rickets is a true avitaminose or a consequence of deficiency in a series of factors4 ,treatment4--,for breast-fed babies it is necessary to adjust the diet of the mother to include more of the vitamine bearing foods1 since milk contains vitamines only in proportion to the amount eaten in food4 ,for artificially fed children1 the giving of cod liver oil has recently been adopted as the surest and safest method of curing and preventing the development of the disease4 ,like treatment is used with breast-fed infants if the need arises4 ,the value of cod liver oil in this respect has only been recently recognized4 ,mellanby of ,england claims that the oil owes its curative and preventive properties to the presence of the ,a vitamine4 ,but scientists in this country have not fully accepted this view4 ,eddy states1 ,it may be that the power of the oil is due to its ',a' vitamine content1 in which it is known to be rich1 or it may be due to a new vitamine1 but the fact that the oil is a preventive in this respect gives the pediatrist another agent to insure normal growth4 ,sunshine as a ,factor4--,it has been found that the disease rickets is more prevalent in winter than in summer2 this is believed to be due to the fact that sunshine during the summer months exerts a distinctly beneficial influence over the disease4 ,dr4 ,hess's report of the good results which he has found to be derived from the use of the ultra violet rays as a substitute for sunshine in winter1 would seem to confirm this view4 ,,malnutrition ,malnutrition is not confined to the children of the poor1 though it is more common with infants of parents who have not the means to secure the best milk and give them the benefit of wholesome surroundings and plenty of sunshine4 ,but babies of people in moderate circumstances1 and even of wealthy parentage1 are at times badly nourished1 and require the same exacting care1 the same attention to the food1 the fresh air1 and the sunshine that the poorer babies need in order to survive4 ,malnutrition may be the result of insufficient food1 and it may also be due to the lack of one definite food element4 ,again1 it may be brought on by some deformity of the mouth or stomach1 which make it impossible for the baby to get all the food which he requires for his maintenance and growth4 ,he may be born prematurely and his digestive apparatus not be sufficiently developed to care for the amount or type of food necessary for his needs1 or he may have some congenital weakness which interferes with the absorption and assimilation of his food4 ,all of these points must be considered4 ,evidences of ,correct ,feeding4--,if the baby shows a steady gain1 both in weight and growth of stature1 without digestional disturbances1 the food given him is probably correct1 but it must be kept in mind that nutritional disturbances1 such as rickets and scurvy1 are slow in developing1 and do not manifest themselves with anything like the rapidity of digestional disturbances4 ,hence the nurse must take care as far as she is able1 not only to prevent the food from causing indigestion1 but also to see that it is not given in such a form as to induce those graver and more lasting nutritional disturbances which affect the entire system from infancy throughout the life of the individual4 ,,summary ,breast ,feeding versus ,artificial ,feeding4--,there is no doubt about the fact that the breast-fed baby suffers less from digestional disturbances and has more resistance to disease than the baby fed even upon a perfectly prepared artificial food4 ,the majority of diseases manifested by artificially fed infants have their origin in the following errors in diet4 ,over-,feeding4--,resulting in acute gastro-intestinal disturbances 7colic1 enterocolitis1 colitis1 constipation74 ,under-,feeding4--,resulting in chronic1 and acute deficiency diseases 7scurvy1 rickets1 malnutrition74 ,evidences of ,dietetic ,errors4--,the stools1 showing characteristic evidences of excessive quantities of1 protein1 fat1 or carbohydrates in the formula4 ,loss of weight or failure to gain4 ,the development of deficiency diseases 7scurvy1 rickets1 xerophthalmia1 rickets and malnutrition74 ,evidences of ,correctness in ,feeding4--,normal gain1 freedom from gastro-intestinal disturbances1 and deficiency diseases4 ,rosy cheeks1 bright eyes1 and a vigorous body4 ,treatment in ,abnormal ,conditions4--,the treatment consists in adjusting the diet to meet the needs of the particular disturbance manifested4 ,plenty of fresh air1 sunshine and sleep4 ,relapse4--,one danger which the nurse must always be on the lookout for is the relapse into the acute stage4 ,the diet is the chief treatment4 ,in acute gastro-intestinal disturbances rest from food is essential for at least twenty-four hours4 ,some infants can easily endure starvation for this short period4 ,however1 when malnutrition has already been established1 it is not wise to carry out the starvation treatment over-long4 ,a cautious return to a normal diet may be made as soon as acute symptoms disappear4 ,fevers in ,general4--,it requires very little deviation from the normal to raise the temperature of a child4 ,a slight attack of indigestion1 a slight soreness of the throat1 will bring up the temperature of some children out of all proportion to the seriousness of the disorder4 ,diet in ,fevers of ,short ,duration4--,as a rule1 in the fevers of short duration1 such as intermittent fever1 malarial fever1 etc41 the diet is a simple matter4 ,milk is given when it agrees1 with buttermilk1 koumiss1 broths1 and albuminized beverages to vary the diet4 ,diet in ,infectious ,diseases4--,when1 however1 the fever is induced by specific bacteria1 such as in the case of typhoid and scarlet fever1 the diet is a different matter altogether4 ,the disease may be one in which the diet is the chief item of importance2 such is the case with typhoid and scarlet fever1 with the former because of its long duration1 the increased rate of metabolism due to both the fever and the action of the bacteria making it necessary to increase the normal amount of food to meet the new requirements of the body2 and with the latter on account of the kidney complications which must be guarded against1 and which can only be handled by regulating the diet4 ,infant ,feeding4--,the feeding of infants under febrile conditions resolves itself into an adjustment of the milk formula to meet the existing state of affairs4 ,the digestion is always more or less disturbed by fever1 especially during the early stages4 ,restricting the ,food4--,it is not always possible to diagnose the disease immediately1 so that the safe thing to do is to lengthen the intervals between the feedings for the breast-fed baby and to stop food entirely for twelve to twenty-four hours for those who are artificially fed1 when there is any doubt as to the cause of the rise of temperature4 ,some mothers find it difficult1 if not impossible1 to institute this period of starvation4 ,in these cases barley water or albumen water may be given at stated intervals4 ,many physicians give very weak tea1 slightly sweetened1 under the above conditions2 it does no harm to the baby and relieves the mother from the belief that her child is being starved to death4 ,in twenty-four hours1 if the fever arises from disturbed digestion1 some manifestation of the condition will be observed4 ,bacterial ,activity4--,in cases of intestinal putrefaction the fever is apt to rise at an alarming rate and is controlled only by removing the cause4 ,the proteins which have escaped digestion and absorption in the intestines furnish the best medium for the growth of putrefactive bacteria4 ,hence this food constituent must be given in its most digestible form4 ,dietetic ,treatment4--,milk in most instances is the best form in which to give protein food1 especially to young children and babies4 ,at times1 however1 it will be found that milk disagrees2 it must be peptonized1 or one of the fermented milks1 such as buttermilk 7,bulgarian culture71 ,eiweissmilch1 or koumiss must be substituted4 ,in cases where the putrefactive bacteria make it unwise to use milk at all1 for a time the proteins should be furnished in the form of cereal gruels1 and the juice of an orange strained and diluted given once or twice a day between the morning and evening feedings4 ,whey is contraindicated in cases where the fever is brought on by putrefaction in the intestine1 chiefly because it furnishes one of the best mediums known for the growth of the offending bacteria4 ,patience is required in handling the diet for fevers in infancy4 ,as has already been stated1 it requires a very slight cause to raise the temperature of a child1 but for this very reason especial care must be observed that no enlightening symptom escapes the notice of the nurse4 ,complications4--,tuberculosis or scurvy may be in an incipient stage1 and may be overcome if recognized in time4 ,the nurse has a better opportunity for observing changes in an infant or child under her care than the physician who comes once a day or less4 ,the nurse should make note of these changes1 that the physician may have a chance to regulate the diet accordingly4 ,fluid ,diet4--,with children1 as with adults1 the energy output in fever is greater than in health1 hence the need for plenty of fluids to help eliminate the waste products due to the increased metabolism4 ,these fluids may consist of water1 fruit beverages1 cereal water1 whey1 and broth4 ,it is well for the nurse to remember that when the child is confined to bed1 he will not need so much food as he would if he were up and about1 but that if the fever is of long duration1 as in typhoid1 the increased rate of metabolism must be met by an increased amount of food1 as the ordinary requirement standards for a child in health cannot be applied to the diet of a child under these conditions4 ,,scarlet ,,fever ,scarlet fever is an acute infectious disease1 characterized by high fever1 sore throat1 a red rash1 and a tendency to nephritis4 ,the disease usually begins suddenly with an attack of vomiting2 the temperature rises to #ajd deg4 or #aje deg4 and on the first or second day a rash appears1 first on the chest and neck1 and spreads over the entire body4 ,this lasts from three to seven days1 desquamation begins soon after the rash disappears and lasts from two weeks to six1 the palms of the hands and soles of the feet peeling last4 ,the appearance of the tongue is very characteristic1 being coated1 and through this coating are seen a few bright red points1 producing the well-known strawberry tongue4 ,after a few days the coating disappears1 leaving the tongue bright red4 ,in mild cases the tonsils are enlarged and the throat very red4 ,in severe cases there may be difficulty in distinguishing the disease from diphtheria without a culture being taken4 ,the tendency of the child to develop nephritis during the second or third week makes the treatment largely dietetic in character4 ,dietetic ,treatment4--,milk is the chief diet for the first three weeks4 ,if it disagrees1 it should be modified or peptonized to suit the condition4 ,koumiss and buttermilk may be substituted when it is impossible to prepare the milk so that it will not cause digestional disturbances4 ,this1 however1 is seldom found to be the case during infancy4 ,malted milk and even condensed milk1 or some of the dextrinized and malted foods at times prove valuable when whole milk disagrees4 ,but the nurse must remember that a baby runs a risk of developing nutritional diseases of a grave character if fresh milk is eliminated from the diet for any great length of time4 ,older children may have plain vanilla ice cream and plain junket1 oyster or clam broth made with milk1 the oysters and clams carefully strained out4 ,lemonade and orange juice may be given1 but no meat broths or albumenized beverages or egg dishes can be admitted to the dietary4 ,development of ,nephritis4--,nephritis must be guarded against4 ,the skin1 being covered with a rash1 is put out of commission as an excretory organ2 in consequence all of the work of this description is placed upon the kidneys4 ,in the first part of this text the work of the kidneys was defined2 it was found that they were the chief organs for the excretion of the end-products of protein metabolism4 ,it can be readily understood that when these organs are given not only their own work but that of the other organs to perform1 unless the food requiring the greatest amount of effort on the part of the kidneys is confined to those types which can be most easily taken care of1 such as milk1 the kidneys stand a great chance of becoming impaired4 ,such is the case in nephritis4 ,convalescent ,treatment4--,the return to normal diet must be made with the greatest caution4 ,specimens of urine must be taken often1 for in this way alone can the development of nephritis be reckoned with4#hg ,should nephritis develop in spite of efforts to prevent it1 a farinaceous diet#hh such as is given in these conditions must be resorted to4 ,after three weeks1 if the patient shows no disposition toward nephritis1 and if convalescence is progressing satisfactorily1 the diet may be increased day by day1 adding milk toast1 cereals1 cream soups1 rice1 baked potato1 then custards and soft eggs1 the soft part of oysters1 broiled or baked fish1 broiled breast of chicken1 and1 still later1 rare beef and lamb chops4 ,meat1 however1 must not be given until all danger from nephritis has passed4 ,,diphtheria ,diphtheria4--,the feeding in diphtheria follows the regime given in acute fevers4 ,the body must be kept in good condition4 ,at the same time it is necessary to understand the complications which make the dietetic treatment of this disease assume a place of importance4 ,complications4--,it may be complicated by broncho-pneumonia1 albuminuria1 carditis1 endocarditis1 and dilatation of the heart4 ,anemia must be combated1 but care should be used not to push the diet to such an extent as to impose too great a tax upon the already weakened heart4 ,dietetic ,treatment4--,while the fever lasts the diet must be fluid1 milk1 buttermilk1 malted milk1 and some of the proprietary infant foods such as ,mellin's ,food1 ,eskay's ,food1 and like preparations4 ,milk gruels1 made with milk and some cereal such as farina1 barley flour1 fine cornmeal1 arrowroot1 strained oatmeal1 etc41 are at times more easily swallowed than the unthickened liquids4 ,liquid beef peptonoids1 panopeptone1 and like predigested beef preparations prove valuable in many cases4 ,convalescent ,diet4--,as convalescence progresses1 or in cases where the patient finds it easier to swallow a semi-solid than a liquid1 soft custards1 gelatin1 well-cooked cereals1 and ice cream may be given4 ,eggnog and milk punch are at times given1 but only upon the advice of the physician in charge4 ,rectal ,feeding4--,when the condition of the patient makes it necessary to nourish in other ways than by mouth1 nutrient enemas#hi may be given4 ,in certain cases of diphtheria1 young infants can be fed more successfully through a tube inserted by way of the nose into the stomach than by feeding in the ordinary way4 ,the formula is prepared in the same way as for bottle feeding1 and is poured into a glass funnel and through the soft rubber catheter into the stomach4 ,care must be observed to prevent the patient struggling on account of the heart weakness which invariably complicates this disease4 ,,whooping ,,cough ,in the early months of life it is probable that whooping cough is one of1 if not the most fatal of the diseases to which the infant is subjected4 ,the period of incubation of this disease is from one to two weeks1 the cough at first not appearing different from those accompanying colds of all sorts4 ,however1 in from ten days to two weeks the characteristic whoop occurs1 differentiating this disease from all others4 ,the symptoms aside from the whoop are the difficulty of taking breath and the great prostration after the paroxysm and the frequent vomiting of the food1 brought on by the violent coughing4 ,in very young infants the whoop does not always occur4 ,but the child coughs and holds its breath until it is blue in the face4 ,at times young babies may have convulsions4 ,the so-called spasmodic stage1 during which the child may have from a few to a great number of paroxysms of coughing a day1 lasts from a month to six weeks1 and in some cases even longer4 ,as the disease declines the cough gradually disappears and the child appears to be suffering with ordinary bronchitis4 ,the characteristic whoop may return at any time during the ensuing six months or year if the child has an attack of bronchitis and is inclined to cough4 ,complications and ,after-effects4--,the complications and after-effects of whooping cough give it a serious character4 ,hemorrhage may occur from the nose4 ,according to ,ruhraeh3 ,paralysis may follow from meningeal hemorrhage1 broncho-pneumonia1 acute emphysema1 and collapse of the lung may occur4 ,diarrhea1 convulsions1 and albuminuria are also met with4 ,tuberculosis and chronic bronchitis may follow4#ij ,dietetic ,treatment4--,the diet plays an important part in whooping cough4 ,the serious complications and after-effects of this disease upon children necessitate a rigid observance of dietary laws4 ,with infants it is always best1 when it is possible1 to give breast milk4 ,as this is the natural food it requires less effort on the part of the digestive apparatus to become available4 ,it has been proved that even during the time when the baby is nursing the milk is projected in spurts into the duodenum without waiting to be attacked by digestive enzymes in the stomach1 and for this reason the breast-fed infant is more apt to be efficiently nourished than the artificially fed baby1 who loses his dinner by vomiting before absorption has had a chance to occur4 ,diet under ,ten ,years of ,age4--,for children under ten years1 a fluid diet is necessary1 at least in the beginning of the disease while there is a fever1 and later1 if the vomiting is persistent4 ,milk1 buttermilk1 koumiss1 broths1 albuminized beverages1 and cereal gruels such as barley and oatmeal gruel and arrowroot gruel can be given4 ,later1 if the fluids are retained1 cream of wheat1 farina1 junket1 soft custards1 and soft-cooked eggs may be added4 ,care must be taken in giving toast1 unless it is softened with milk or broth1 for the crumbs may bring on a paroxysm of coughing and vomiting4 ,the best results in feeding with whooping cough are obtained by giving the food in small quantities and oftener4 ,a few ounces given every two hours are less apt to be vomited than a larger quantity4 ,it is also easier for the child to take the small amount after an attack of coughing and vomiting than it would be for him to attempt a larger meal4 ,use of ,stimulants4--,in many cases where weakness is great1 it has been found advisable to add some stimulant to the diet4 ,with infants this is best given in albumen water1 a small amount of good brandy acting better than other stimulants4 ,with young children some of the predigested liquid beef preparations1 such as liquid peptonoids1 are found valuable4 ,these foods are given alternately with the other fluid foods4 ,hygiene and ,sanitation4--,infants and children suffering with whooping cough require plenty of fresh air and sunshine4 ,they must be kept out of doors as much as possible and sleep in well-ventilated rooms or sleeping porches4 ,they must be protected from drafts and excitement1 and never allowed to become over-tired4 ,in this way the anemia which so often results from prolonged attacks of whooping cough is in a measure held in check4 ,at times it is found necessary to give some kind of an iron tonic1 but this comes under the jurisdiction of the physician instead of the nurse4 ,when bad effects do occur in spite of all the care exercised during the attack of whooping cough1 they must be accorded the treatment especially devised to meet the situation4 ,,measles ,this is an acute1 infectious disease characterized by a red eruption which appears on the fourth day4 ,measles is one of the most contagious of all the diseases of childhood4 ,it may be acquired by direct contact with another case or by being in the room with a case4 ,the infection may also be carried through the air and occasionally by a third person4 ,measles is more prevalent in the winter than in summer4 ,in cities it often occurs in epidemics4 ,the period of incubation is from ten days to three weeks1 occurring generally at about two weeks after exposure4 ,the attack may begin with the child showing a languid attitude1 complaining of headache4 ,then a cough develops1 with nausea and fever at times4 ,the fever is often high1 reaching #ajd deg4 ,f4 on the second day4 ,as a rule the fever gradually falls after the second day and becomes normal in almost a week4 ,however1 the temperature varies in different cases4 ,complications4--,measles is not considered dangerous in itself1 but the after-effects sometimes prove fatal4 ,this is especially the case in broncho-pneumonia1 which frequently develops during or after the attack4 ,the gastro-intestinal1 as well as the respiratory1 tract is attacked in measles1 diarrhea being especially common4 ,very weak children have been known to develop gangrenous stomatitis2 paralysis and tuberculosis#ia likewise develop in some cases as the direct result of measles4 ,thus it is demonstrated that measles is not to be lightly treated4 ,even if it is not in itself fatal1 the results of the disease are so dangerous that the care of the nurse is especially necessary4 ,the great trouble is that so often a nurse is not in attendance and the child suffers through ignorance of the mother4 ,dietetic ,treatment4--,the dietetic treatment of measles is important4 ,for infants milk is the exclusive diet1 the formula for bottle-fed babies having to be weakened on account of the catarrhal condition of the gastro-intestinal tract4 ,for older children it is necessary to confine the diet to fluids as long as the fever lasts1 and at times longer if the stomach gives evidence of digestional disturbances4 ,milk is the chief food1 with milk soups1 buttermilk1 and koumiss used to vary the diet4 ,orangeade and lemonade may be given to allay thirst4 ,a return to normal diet must be made gradually1 giving cereal gruels1 milk toast1 and broth before the more solid articles of diet suitable to the age of the child4 ,when there are complications they must be treated1 as in whooping cough1 according to their symptoms4 ,,summary ,gastro-intestinal ,disturbances are responsible for much of the fever manifested during infancy and childhood4 ,infectious ,diseases are all more or less accompanied by an elevation of temperature4 ,incipient ,diseases1 especially tuberculosis and scurvy1 may likewise cause a rise of temperature4 ,the relief of either disease or the fever depends largely upon how quickly the conditions are discovered and the means instituted to overcome them4 ,metabolism in ,febrile ,conditions of children1 as well as of adults1 is rapidly increased1 hence the energy output is greater1 and for this reason the fluid intake must be augmented in order to eliminate the toxic substances produced as a result of the rapid breaking down of the body tissues4 ,the ,kidneys are more or less strained to eliminate the products of the increased metabolism and for this reason it is especially necessary to adjust the diet in order to limit1 as far as possible1 the foods which add to the burden already imposed upon the organs of excretion4 ,the ,skin is an organ of excretion which1 under normal conditions1 shares the work of the kidneys4 ,in infectious conditions1 accompanied by eruptions which more or less cover the entire surface of the body1 this organ is temporarily out of commission1 hence its work1 as well as their own1 must be accomplished by the kidneys4 ,dietetic ,treatment in the majority of infectious diseases may be divided into three periods3 ,starvation1 ,fluid ,diet1 and ,convalescent ,diet4 ,starvation1 during which time no food is given for twenty-four hours or longer1 in order to allow the digestive apparatus to rest and to give time for any substance which may be causing the elevation of the temperature to pass from the body4 ,this treatment is also wise because it furnishes an opportunity for the symptoms of the disease to manifest themselves2 ,fluid ,diet1 given when acute symptoms subside1 and ,convalescent ,diet when danger from relapse is over4 ,scarlet ,fever is treated with two main ideas in view--preventing the development of nephritis and relieving the condition should it develop4 ,dietetic ,treatment is logically the only means of treating or relieving nephritis4 ,for the first three weeks1 during which time this complication is apt to develop1 a milk diet is necessary4 ,this may be in the form of whole milk1 milk soups1 malted milk1 etc4 ,at the end of this time1 if there are still no symptoms of nephritis1 a convalescent diet1 beginning with cereals and soft toast and progressing through the simple digestible foods such as rice1 baked potatoes1 soft eggs1 etc41 may be given4 ,this is continued until the patient is well on the road to recovery4 ,meat should not be added until practically all danger of nephritis is passed4 ,nephritis4--,if1 during the course of the disease this complication1 should develop1 the treatment described for acute nephritis on page #ccf should be immediately instituted4 ,diphtheria4--,dangerous complications at times develop as a result of diphtheria1 making the treatment of this disease of the utmost importance4 ,heart symptoms1 pneumonia1 albuminuria1 and anemia are among the complications to be dreaded and combated4 ,dietetic ,treatment in diphtheria is most important4 ,it consists of a fluid diet made up of milk1 malted milk1 or buttermilk4 ,at times the condition of the throat makes a slightly thickened mixture more easily swallowed than one which is distinctly fluid in character1 and for this purpose farina1 arrowroot1 or barley flour may be used4 ,increasing the ,diet4--,as convalescence advances the semi-solids1 soft toast1 soft custards1 gelatin1 and cereals may be given4 ,should the heart show symptoms of being affected1 the intake of fluid must be restricted4 ,gavage and ,rectal ,feeding are at times necessary4 ,infants may be successfully fed by passing a small rubber tube through the nose into the stomach and administering the milk formula to which they are accustomed4 ,rectal feeding is likewise valuable in cases of extreme anemia accompanying diphtheria4 ,care must be observed by the nurse in giving gavage to babies1 since any struggling on the part of the child may result in death from heart disease4 ,whooping ,cough4--,on account of the character of the disease and the proneness of the stomach to eject the food during paroxysms of coughing1 dietary measures are more or less necessary in order to enable the child to receive sufficient food to cover his daily needs4 ,complications4--,hemorrhage1 pneumonia1 albuminuria1 diarrhea1 and convulsions may occur during the disease1 while tuberculosis and chronic bronchitis may follow as after-effects4 ,dietetic ,treatment4--,breast milk is by far the best food for the baby1 in this as in all conditions4 ,in whooping cough the fact that this fluid leaves the stomach almost as soon as it enters lessens the chances of the baby losing its meal by vomiting it4 ,older children do well with frequent small meals1 since they are not so apt to give rise to pressure which brings on the paroxysms of coughing and vomiting4 ,when the meal is vomited1 a second should be given in order to keep the child from suffering from malnutrition4 ,stimulation is found to be necessary in certain cases4 ,albumen water containing a spoonful of brandy or some of the prepared beef preparations1 such as liquid peptonoids1 may prove valuable under the circumstances4 ,measles4--,complications and after-effects developing as a result of measles make the dietetic treatment of this disease important4 ,gastro-intestinal disturbances1 especially diarrhea1 are apt to occur1 and tuberculosis has been known to develop as a result of measles4 ,dietetic ,treatment4--,the fluid diet as used in any acute febrile condition is used as long as the temperature is elevated4 ,milk1 buttermilk1 malted milk1 and milk soups constitute the chief items in the diet4 ,orangeade and lemonade are found valuable in relieving the thirst4 ,,problems 7a7 ,list the evidences of errors in the diet of infants2 show how they may be corrected in the formula4 7b7 ,outline the processes in the preparation of ,eiweissmilch 7protein or albumen milk74 ,what constituent is particularly low in this milk1 and how was its reduction accomplished8 ,,footnotes3 #hd ,diseases of ,nutrition and ,infant ,feeding1 by ,morse and ,talbot4 #he ,ibid4 #hf ,diseases of ,nutrition and ,infant ,feeding1 p4 #cjg1 by ,morse and ,talbot4 #hg ,see chapter on ,urinalysis1 p4 #cbc4 #hh ,consisting of cereal gruels1 rice1 and other starchy foods4 #hi ,see ,nutrient ,enemas1 p4 #ade4 #ij ,diseases of ,infants and ,children1 p4 #cbf1 by ,ruhraeh4 #ia ,a ,manual of ,diseases of ,children1 p4 #cai1 by ,ruhraeh4 ,,chapter ,,xi ,,the ,,feeding ,,of ,,adults ,,in ,,diseases ,,of ,,the ,,gastro-,,intestinal ,,tract ,,acute ,,and ,,chronic ,,gastritis ,predisposing ,factors4--,the majority of diseases affecting the stomach have as their predisposing factors1 and owe their development to1 one or all of the following conditions3 7#a7 errors in diet2 7#b7 disturbed secretory processes2 7#c7 disturbed motility and tone4 ,it is probable that in the beginning the first factor was the chief offender in the case1 bringing about the development of one or both of the other conditions4 ,the other factors to be considered in this respect are heredity1 occupation1 poverty1 and diseases which involve to a greater or lesser degree the digestion of the stomach and intestines4 ,a child may inherit a weakened organism through excesses or disease on the part of the parent4 ,if this weakness is not overcome while the child is growing1 the probabilities are that the digestion steadily declines until in adult life it becomes a pathological condition4 ,lack of fresh air1 poor and dirty food1 unwholesome surroundings1 crowded and badly ventilated sleeping rooms1 insufficient water1 and overwork1 all act in making the digestion bad4 ,these must be overcome if permanent good is to result4 ,errors in ,diet4--,errors in diet arise more often through ignorance than from any other cause4 ,a child may be allowed to eat any and all kinds of unwholesome and unsuitable food4 ,when the stomach rebels1 showing the serious danger signals of nature1 medicines are given but the diet is unheeded1 until the time comes when even the medicines fail to give temporary relief1 and the organs of digestion are in some instances permanently impaired4 ,disturbed ,secretory ,processes4--,consensus of opinion goes to show that the majority of cases of acute and chronic gastritis 7catarrhal7 and gastric ulceration are due primarily to a disturbance of the secretory processes1 while the impaired motility and lack of tone in the stomach probably influence their development and aggravate the disease already present4 ,composition of ,gastric ,juice4--,in a former chapter the processes of gastric digestion were explained4 ,the gastric juice1 composed of from #j4b to #j4c free hydrochloric acid and several important enzymes and lipases1 which act upon the proteins and emulsified fats1 must be sufficient in quantity to assure good digestion1 and when anything arises to interfere with the secretion of this fluid a deviation from the normal is bound to occur4 ,disturbed ,motility and ,tone4--,again1 it has been proved that good gastric digestion1 like good intestinal digestion1 depends more or less upon the way in which the food mass is mixed with the digestive juices and moved along the alimentary canal4 ,anything which interferes with the secretion of the juices or delays the food over its normal length of time in the stomach surely exerts unfavorable influences on the general metabolism of the food1 for while1 as we have already found1 gastric digestion is not essential to the final utilization of the food in health1 in disease it undoubtedly exerts a marked influence upon the general nutrition of the individual4 ,,hypochlorhydria ,the lack of hydrochloric acid in the gastric juice lowers the resistance to bacterial action1 for this constituent exerts a decided germicidal influence in gastric digestion1 preventing fermentation with the production of organic acids and probably alcohol4 ,in conditions due to hypochlorhydria 7lack of hydrochloric acid7 foods which leave the stomach quickly must be given with enough of the other necessary constituents in their simplest and most easily digested form to balance the diet and prevent the occurrence of the other disorders as troublesome as the original disorder4 ,dietetic ,treatment4--,the following points must be kept in mind in formulating a dietary for patients suffering from a deficiency of hydrochloric acid3 7#a7 boil the drinking water to destroy any bacteria which may be present2 7#b7 use carbohydrates in the form of starch rather than sugar1 since starch is less liable to fermentation from bacteria than sugar2 7#c7 limit the foods which delay the passage of the food mass from the stomach2 fats pass into the duodenum more slowly than other foods and when fed with other foods delay their passage materially2 7#d7 avoid the use of soda bicarbonate1 as it tends to reduce the normal acid content of the stomach1 thus preventing its germicidal action upon the fermentative bacilli2 alkaline carbonates likewise inhibit the flow of gastric juices2 7#e7 give especial attention to the attractiveness of the food served2 let it be appetizing and savory1 for by such means is the appetite juice and incidentally an increased flow of the gastric juices stimulated2 7#f7 condiments and spices1 meat broths high in extractives1 and salt foods such as caviar and endives may be given at the discretion of the physician2 it is seldom advisable to give the foods which are indigestible1 even when they act as stimulants to the secretory cells of the stomach4 ,,hyperchlorhydria 7,excess secretion of acid in the stomach7 ,the ,effect of ,excess ,acid4--,an excessive flow of hydrochloric acid has been found to be the cause of much of the acute and chronic gastritis1 in fact more of the cases are traceable to an excess than to a lack of hydrochloric acid4 ,this acid is more or less irritating in character1 and the tender mucous membranes lining the gastric organ being constantly bathed in a secretion composed chiefly of acid must necessarily in time suffer a certain amount of irritation and inflammation1 causing the development of a pathological condition which may be temporary or permanent1 that is1 it may result in acute or chronic gastritis1 according to the amount of acid secreted and the length of time the hypersecretion is allowed to continue4 ,determining the ,acid ,content of ,stomach4--,the difference between the cases brought about by an excess flow of hydrochloric acid are more or less difficult to distinguish from those caused by a lack of this constituent in the gastric juice1 chiefly because in the latter case the organic acids formed as the result of bacterial action upon the food exert an equally irritating effect upon the membranes of the stomach1 and the only sure method of determining the cause of the disturbance is by an analysis of the stomach contents1 by which means the percentage of hydrochloric acid is determined4 ,lavage4--,it has been found advisable1 in some cases of acute gastritis which do not yield readily to rest and liquid diet1 to wash the stomach and allow a certain period of rest before giving any food2 in this way the organ is rid of all of the offending material and thus has a better chance of a quick recovery4 ,,acute ,,gastritis ,dietetic ,treatment4--,the following dietetic treatment for acute gastritis is advised3 ,as the stomach is the chief seat of disturbance1 all unnecessary work must be taken from this region for a certain period3 7#a7 ,that any obscure cause may manifest itself and the diagnosis may be rendered more accurately and more quickly4 7#b7 ,that by resting the organ the offending materials may pass out of the body and thus prevent further trouble4 ,starvation ,period4--,twenty-four hours of total abstinence from food may seem extreme1 but as a rule in acute cases of gastritis it is the only sane and safe method of instituting a diet and thus beginning to overcome the cause of the disturbance4 ,after the period of starvation the diet is begun with caution4 ,fluid ,diet4--,fluids should be given first in the form of well-skimmed broths1 which may be reenforced with egg or cereal flours when the patient is very thin or anemic4 ,buttermilk1 made with the ,bulgarian cultures1 koumiss and other fermented milk foods1 liquid beef preparations such as peptonoids or panopepton1 albumenized orange juice1 cereal gruels treated with ,taka diastase when it is found necessary1 and peptonized milk4 ,these may be given in from four to six ounces at a time1 every two hours on the second day4 ,increasing the ,diet4--,on the third day if the attack is slight the diet may be increased by adding toast1 softened with peptonized milk1 an ordinary serving 7#c ounces7 of farina1 cream of wheat or rice1 reenforced meat broth with two crackers1 a cup of tea and a slice of toast1 and one or two soft-cooked eggs4 ,if the acute symptoms are still present on the third day1 the diet advised for the second day must be continued until they disappear4 ,convalescent ,diet4--,on the fifth day1 if progress is satisfactory1 lightly broiled chicken or a small piece of rare broiled beefsteak may be added to the diet and the meals reduced in number from six to four4 ,relapse4--,the patient must be warned against overeating or eating any of the articles which are known to cause an acute attack in his individual case1 since one attack predisposes to another1 and chronic gastritis may develop as the result of the continual gastric disturbance4 ,,chronic ,,gastritis ,the treatment in chronic gastritis is very like that in the more acute form2 that is1 it must be combated by removing the cause4 ,lack of fresh air and exercise have much to do with the development of chronic gastritis1 but even they combined with a judicious amount of rest would be wasted without a proper adjustment of the diet to cover the main points of the disturbance4 ,as has already been mentioned1 the cause may be a lack of gastric juice or it may be an excess of it2 it may be intensified by an atonic condition of the organ or from the food passing too quickly into the duodenum4 ,test ,meals4--,as a rule it is not safe to make a snap diagnosis as to the cause of this disorder4 ,since in many instances the more serious disorders may be traced to a disregard for nature's danger signals1 the physician as a rule advises a test meal1 this meal consisting of a glass and a half of water or a cup or two of tea without cream or sugar and from one to two slices of toast or water rolls4 ,in from three-fourths to one hour or longer this is removed from the stomach by means of a stomach pump and analyzed1 the result of the chemical and bacterial analyses forming the basis for diagnosis4 ,this meal is generally given in the morning before any other food has been eaten4#ib ,dietetic ,treatment4--,the foods constituting the diet in chronic gastritis must be of the simplest character and prepared in the simplest manner4 ,no fried foods are permissible4 ,pastries1 griddle cakes1 rich puddings and sauces1 candies1 and alcoholic beverages must be omitted from the diet as well as the following articles of food3 pork1 veal1 shellfish except oysters1 sardines1 canned meats and canned fish1 highly seasoned and spiced dishes1 twice-cooked meats1 vinegar1 pickles1 olives1 cold slaw1 pickled beets1 catsup1 mustard1 coarse fibered vegetables such as cabbage1 old onions1 old turnips1 and cucumbers1 strong tea1 coffee1 or chocolate1 rich cream or dishes made entirely of cream4 ,in cases of excessive acidity due to a hypersecretion of ,h,cl the extractives of meat are contraindicated1 hence all gravies and outside parts of roasted meat must be omitted or limited in the diet4 ,,gastric ,,ulceration ,gastric ulcer may develop without an apparent cause4 ,as a rule1 however1 it manifests itself in individuals between the years of fifteen and forty1 particularly after prolonged digestional disturbances1 especially those accompanied by a hypersecretion of acid4 ,as the disease progresses1 anemia is more or loss severe1 adding difficulty to the feeding problem4 ,many of the symptoms are like those of chronic gastritis1 such as pain4 ,however1 the character of this pain may be different1 beginning soon after eating and radiating toward the back4 ,this point may be affected by position4 ,as a rule there is a tenderness over the seat of the ulcer4 ,this is detected by palpation4 ,vomiting is one of the most general symptoms in gastric ulceration4 ,this may begin from one to two hours after eating when the pain is at its height1 or it may start as soon as food enters the stomach4 ,as a rule the latter condition is found more often in very nervous women whose mental attitude affects the stomach to such an extent as to make it difficult to give them sufficient food to nourish them4 ,hemorrhage4--,hemorrhage occurs in about half of the cases4 ,the bleeding may be profuse and the blood bright red1 or it may be less severe and the color of the blood changed by contact with the gastric juices to a dark brown like coffee grounds4 ,excess ,acid4--,hyperacidity is present in the majority of the cases1 the percentage of ,h,cl rising at times fifty per cent4 or more4 ,other cases occur in which all of the just mentioned symptoms except dyspepsia are missing1 the first intimation of the ulcer being hemorrhage or perforation4 ,the patient with gastric ulcer may recover entirely and never have a return of the trouble1 but care and close attention are necessary1 since the ulcers are apt to recur1 at times a series of ulcers developing one after another4 ,death may occur from exhaustion or from perforation and peritonitis4 ,surgical intervention is as a rule necessary when the ulcers persist1 as they generally develop at or near the pyloric opening2 and the constant development of cicatricial tissue brings about an obstruction of the pylorus1 which if not relieved would allow the patient to starve4 ,diet ,treatment4--,there are a number of treatments used in overcoming this condition4 ,after the test meal and the diagnosis1 the patient is placed upon a diet directed to overcome the chief symptom2 for example1 if the ulcer developed as a result of hyperacidity1 the diet would be directed toward the relieving of that symptom4 ,boas#ic divides the treatment into three stages3 7#a7 hemorrhage2 7#b7 the intermediate stage2 7#c7 the convalescent stage4 ,starvation ,treatment4--,the majority of physicians institute a total abstinence period for the first stage1 allowing no food or water to be taken by mouth4 ,if the patient is very weak and anemic from the extended course of the disease1 nutrient enemas are given from four to six times a day1 alternating with saline enemas4 ,this total abstinence continues from three to six days4 ,some cases have been known to be fed in this way for a month or six weeks with obvious success4 ,however1 this is not the rule but the exception4 ,the diet must be adjusted to the needs of each individual1 but a few general rules may be found helpful4 ,dietetic ,treatment4--,milk is the food generally utilized in the beginning4 ,this may require peptonizing to be digested1 or it may have to be modified with limewater4 ,protein foods require ,h,cl for their digestion4 ,if these foods are fed they will absorb some of the excess acid1 and in this way save the already irritated wall of the organ from additional irritation4 ,when protein foods are given they must be in the form of soft-cooked eggs1 scraped raw beef or beef juice1 milk soups1 and like protein foods4 ,when there is a dilatation of the organ there is more or less danger of fermentation taking place1 with the formation of organic acids4 ,these acids are exceedingly irritating1 and every care must be observed to prevent their production4 ,the following dietetic regime may be used as a guide in many cases of gastric ulceration3 ,milk ,diet4--#a_/b glass 7#d ounces7 of milk peptonized at #aae deg4 ,f4 for #bj minutes1 every hour for three or four days4 ,after this the interval between feedings is lengthened to two hours and the amount of milk increased to #c_/d of a glass 7#f ounces74 ,this is continued from a week to ten days4 ,the patient may be given a cup of well-strained meat broth1 reenforced with an egg1 once or twice a day1 to vary the monotony of the diet4 ,during the third week the milk may be given in the form of milk soups4 ,these may be slightly thickened with barley1 rice1 or farina flour4 ,the soups may be flavored with beef extract1 but only a small quantity must be used1 owing to the stimulating properties of these substances4 ,water as a ,stimulus to ,gastric ,secretion4--,water is exceedingly stimulating to the acid secreting cells of the stomach1 hence it is advisable to limit the amount of water taken by mouth1 allowing the patient just enough to wash out the mouth without swallowing any4 ,the thirst is relieved by saline enemas4 ,it has been found1 in many cases of gastric ulceration1 especially those accompanied by hemorrhage1 that glucose gives better results when used in rectal alimentation1 than any other substance4 ,the strength of the solution varies from a five to a twenty-five per cent4 solution4 ,the number of glucose enemas given each day must be regulated by the physician4 ,the method used is the same as in other rectal feedings1 the enema is given high1 and the flow regulated 7drip-method74 ,convalescent ,diet4--,during the fourth week1 if the pain and discomfort are decreasing1 soft-cooked or creamed eggs may be added to the diet1 together with thoroughly boiled rice1 farina1 cream of wheat1 wheatena and other finely ground wheat foods1 wine or fruit jelly1 sweetened slightly1 or by using a small amount of saccharin for the purpose1 junket and plain vanilla ice cream4 ,at the end of the fourth week a very small portion of meat may be given once a day4 ,it may be scraped raw beef spread upon toast or zwieback1 or very lightly broiled beefsteak1 broiled lamb chop or chicken 7breast only71 or boiled or broiled sweetbreads or brains4 ,spinach or green peas pressed through a sieve are the first vegetables allowed4 ,after these young tender carrots and string beans may be given4 ,tea1 coffee1 and chocolate are eliminated from the diet4 ,milk flavored with coffee or cocoa may serve as a hot drink in the morning when the desire or need for such a drink is manifested4 ,butter is the best form of fat to be used in cases of gastric ulceration1 but this must be given with the greatest caution4 ,in cases where this fat is used in the form of cream1 the amount must be cut down or entirely abandoned when there are evidences of butyric fermentation4 ,buttermilk1 koumiss1 and other fermented milk drinks are often found very satisfactory adjuncts to the diet4 ,these may be given between meals1 or at meals they may be substituted entirely for the milk when other foods are being given4 ,they are not sufficiently nourishing to take the place of the milk diet otherwise4 ,albumenized orange juice and cream1 egg and vichy may be given to add variety to the diet4 ,anemia4--,when anemia is severe1 as is often the case in gastric ulceration1 the diet must be reenforced to overcome it4 ,some of the concentrated milk foods such as plasmon1 encasin1 sanatogen1 etc41 as well as the predigested meat foods1 such as panopepton1 liquid beef peptonoids1 and like preparations1 may be used to reenforce the diet4 ,bland ,diet4--,in certain cases of gastric ulceration it has been found more advisable to use what is known as a bland diet4 ,this consists of farinaceous foods such as farina1 arrowroot1 cream of wheat1 corn meal1 wheatena1 malted breakfast foods cooked thoroughly and given in the form of gruels1 and some of the proprietary infant foods1 such as ,mellin's ,food1 ,eskay's ,food1 ,racahout4 ,these foods may require the addition of ,taka diastase to make them more readily digested4 ,they leave the stomach more rapidly than any of the others1 and for this reason will be found to give less discomfort than the foods containing a high percentage of protein and fat4 ,this diet1 however1 cannot be prolonged on account of its lack of balance4 ,if the gruels are made with milk instead of with all water they become more evenly balanced4 ,samples of the stomach contents may be taken for analyses from time to time4 ,lavage4--,when lavage is necessary the patient must be allowed to rest after the process before being given food1 otherwise it is apt to be vomited4 ,instructions to ,nurse4--,the treatment for gastric ulceration is thus seen to be strenuous4 ,in the beginning the patient is placed on a liquid or semi-solid diet1 or is not fed at all for a time4 ,this is done that the diseased organ may have a chance to adjust itself as far as possible and to give the physician an opportunity of studying the changes taking place in that organ4 ,during the course of the disease the general symptoms which develop from time to time1 causing more or less pain and discomfort to the patient1 are nervousness1 which in some individuals amounts to melancholia1 extreme anemia and an utter distaste for food1 all of which require patience on the part of the physician1 the nurse1 and the patient herself to overcome4 ,the nurse must see that the patient is not disturbed or made unhappy by having business or home cares talked over in her presence2 she must be kept as cheerful and as comfortable as her condition permits and urged to use care in her diet4 ,after the ulcer is healed1 to prevent a return of the trouble she must be warned against eating too fast or when over-tired1 and she must be advised against very hot and highly seasoned foods1 for1 in the observance of these simple common-sense precautions only is she even in a measure saved further attacks4 ,special ,diets ,used for ,gastric and ,duodenal ,ulcer4--,there are several well-known diets used in these conditions4 ,among those that have been found most satisfactory may be mentioned the ,sippi diet1 the ,lenhartz diet4 ,all of these diets require the most careful adjustment as to regulation of intervals of feeding1 type of food material used1 and method of preparation and administration of food4 ,the treatment is directed toward the reduction of the free hydrochloric acid in the stomach in order that the ulcer may have an opportunity for healing4 ,sippi ,diet4--,equal quantities of heavy cream and whole milk1 beginning with #a_/b ounce each every hour during the day4 ,alkaline powders are given with the meal and one-half hour after the meal4 ,these consist of #ae grains each of sodium bicarbonate and bismuth subcarbonate with the feeding1 and #aj grains of light oxide of magnesia and #ae grains of sodium bicarbonate between feeding4 ,the cream and milk are increased at the rate of one-half ounce each at each feeding for two days1 the powders are continued as on the first day4 ,on the fourth day an egg is added to the diet1 the milk and cream are given in quantities of one and one-half ounce each1 every hour4 ,on the fifth day two eggs are added4 ,on the sixth day one helping of oatmeal or other soft cereal is added to the above diet4 ,the diet is in this way increased until the patient is taking three eggs and nine ounces of cooked cereal each day in addition to the cream and milk mixture4 ,the amount given at one time must be small1 never exceeding six ounces 7according to ,carter1 ,howe and ,mason74 ,an accurate control of the acidity of the stomach should be maintained1 this is accomplished by withdrawing a certain amount of the gastric contents by means of the stomach tube4 ,the ,lenhartz ,diet4--,this diet is likewise given in hourly feedings1 consisting of milk and raw eggs in the beginning1 then a small portion of sugar is added1 next scraped beef is added to the milk1 eggs and sugar1 already given1 then boiled rice4 ,next a small quantity of zwieback 7or soft toast71 and continuing in this way1 chicken1 and butter are admitted4 ,in the beginning the quantity of milk is #ajj c4c4 and the number of eggs #b1 given raw4 ,it is served iced1 and with a teaspoon4 ,when the sugar is added it is beaten up with the eggs 7#bj gm474 ,the milk and eggs are divided into separate feedings and given at hourly intervals from #g ,a4,m4 to #g ,p4,m4 ,it is rarely possible to give the amounts called for in the ,lenhartz diet after the sixth day1 but as much as possible should be given without risking an acute disturbance4 ,women1 as a rule1 find it more difficult to take the full amount ordered than men4 ,the following outlines represent the diet for the first1 third1 sixth1 seventh and tenth day3 ,,first ,,day #g ,a4,m4 ,egg #h ,a4,m4 ,milk1 #bj c4c4 #i ,a4,m4 ,egg #aj ,a4,m4 ,milk1 #bj c4c4 #aa ,a4,m4 ,egg #ab noon ,milk1 #ae c4c4 #a ,p4,m4 ,egg #b ,p4,m4 ,milk1 #ae c4c4 #c ,p4,m4 ,egg #d ,p4,m4 ,milk1 #ae c4c4 #e ,p4,m4 ,egg #f ,p4,m4 ,milk1 #ae c4c4 ,total3 ,milk1 #ajj c4c4 ,eggs 7raw71 #b4 ,,third ,,day #g ,a4,m4 ,egg2 sugar1 #b gm4 #h ,a4,m4 ,milk1 #ej c4c4 #i ,a4,m4 ,egg2 sugar1 #c gm4 #aj ,a4,m4 ,milk1 #ej c4c4 #aa ,a4,m4 ,egg2 sugar1 #c gm4 #ab noon ,milk1 #ej c4c4 #a ,p4,m4 ,egg2 sugar1 #c gm4 #b ,p4,m4 ,milk1 #ej c4c4 #c ,p4,m4 ,egg2 sugar1 #c gm4 #d ,p4,m4 ,milk1 #ej c4c4 #e ,p4,m4 ,egg2 sugar1 #c gm4 #f ,p4,m4 ,milk1 #ej c4c4 #g ,p4,m4 ,egg2 sugar1 #c gm4 ,total3 ,milk1 #cjj c4c4 ,eggs 7raw71 #d4 ,sugar1 #bj gm4 ,,sixth ,,day #g ,a4,m4 ,egg2 sugar1 #d gm4 #h ,a4,m4 ,milk1 #ajj c4c4 #i ,a4,m4 ,egg2 sugar1 #d-a_/b gm42 scraped beef1 #ab gm4 #aj ,a4,m4 ,milk1 #ajj c4c4 #aa ,a4,m4 ,egg2 sugar1 #d-a_/b gm4 #ab noon ,milk1 #ajj c4c4 #a ,p4,m4 ,egg2 sugar1 #d-a_/b gm42 scraped beef1 #ab gm4 #b ,p4,m4 ,milk1 #ajj c4c4 #c ,p4,m4 ,egg2 sugar1 #d-a_/b gm4 #d ,p4,m4 ,milk1 #ajj c4c4 #e ,p4,m4 ,egg2 sugar1 #d gm42 scraped beef1 #ab gm4 #f ,p4,m4 ,milk1 #ajj c4c4 #g ,p4,m4 ,egg2 sugar1 #d-a_/b gm4 ,total3 ,eggs 7raw71 #g4 ,milk1 #fjj c4c4 ,sugar1 #cj gm4 ,scraped beef1 #cf gm4 ,,seventh ,,day #g ,a4,m4 #a soft-cooked egg #h ,a4,m4 ,milk1 #ajj c4c4 #i ,a4,m4 ,egg2 sugar1 #ac gm4 #aj ,a4,m4 ,milk1 #ajj c4c42 scraped beef1 #bc gm42 boiled rice1 #cc gm4 #aa ,a4,m4 #a soft-cooked egg #ab noon ,milk1 #abe c4c4 #a ,p4,m4 ,egg2 sugar1 #ac gm4 #b ,p4,m4 ,milk1 #abe c4c42 scraped beef1 #bc gm42 boiled rice1 #cc gm4 #c ,p4,m4 #a soft-cooked egg #d ,p4,m4 ,milk1 #abe c4c4 #e ,p4,m4 ,egg2 sugar1 #ad gm4 #f ,p4,m4 ,milk1 #abe c4c42 scraped beef1 #bd gm42 boiled rice1 #cd gm4 #g ,p4,m4 #a soft-cooked egg ,total3 ,eggs 7raw71 #d2 7soft-cooked71 #d4 ,milk1 #gjj c4c4 ,sugar1 #dj gm4 ,scraped beef1 #gj gm4 ,boiled rice1 #ajj gm4 ,,tenth ,,day #g ,a4,m4 #a soft-cooked egg #h ,a4,m4 ,milk1 #aff c4c4 #i ,a4,m4 ,egg2 sugar1 #ac gm4 #aj ,a4,m4 ,milk1 #afh c4c42 scraped beef1 #bc gm42 boiled rice1 #ff gm42 butter1 #d gm4 #aa ,a4,m4 #a soft-cooked egg2 zwieback 7or soft toast71 #bj gm42 butter1 #d gm4 #ab noon ,milk1 #aff c4c42 minced chicken1 #be gm4 #a ,p4,m4 ,egg2 sugar1 #ac gm4 #b ,p4,m4 ,milk1 #aff c4c42 scraped beef1 #be gm42 boiled rice1 #ff gm42 butter1 #d gm4 #c ,p4,m4 #a soft-cooked egg2 butter1 #d gm42 toast or zwieback1 #bj gm4 #d ,p4,m4 ,milk1 #afh c4c42 minced chicken1 #be gm4 #e ,p4,m4 ,egg2 sugar1 #ad gm4 #f ,p4,m4 ,milk1 #aff c4c42 scraped beef1 #bd gm42 boiled rice1 #fg gm42 butter1 #d gm4 #g ,p4,m4 #a soft-cooked egg ,total3 ,eggs 7raw71 #d2 7soft-cooked71 #d4 ,milk1 #ajjj c4c4 ,sugar1 #dj gm4 ,scraped beef1 #gj gm4 ,minced chicken1 #ej gm4 ,butter1 #bj gm4 ,boiled rice1 #bjj gm4 ,toast or zwieback1 #dj gm4 ,,gastric ,,cancer ,as a rule the seat of the gastric cancer is the pylorus4 ,the patient gives evidence of chronic gastritis with continued pain1 localized tenderness1 vomiting of partially digested food and at times dilatation from extreme fermentation4 ,the hemorrhages are as a rule not large1 the blood having changed to a brownish color resembling coffee grounds4 ,vomiting1 in cases where the pylorus is involved1 generally occurs several hours after eating1 the vomitus being in an advanced state of fermentation4 ,upon analysis of the stomach contents there is found to be a lack of free ,h,cl4 ,dietetic ,treatment4--,in the dietetic treatment of cancer of the stomach the most digestible forms of foods must be given1 milk forming in this1 as in other gastric disorders1 the chief article of diet4 ,as too much food cannot be tolerated1 the meals must be small1 even if given more frequently4 ,the patient is often found to evince a distaste for meat1 in which case fish may be substituted4 ,when meat is given1 it must be simple in form and preparation1 such as boiled or broiled sweetbreads or brains1 scraped beef or stewed chicken4 ,rice1 farina1 cornmeal mush1 and other fine cereals1 cooked with or without milk1 are valuable additions to the diet4 ,well-cooked and strained spinach1 green peas1 cauliflower1 carrots1 and tender string beans and boiled or baked potatoes well mashed may be recommended4 ,tea1 coffee1 or cocoa may be used to flavor the milk4 ,these must be given in small portions4 ,the following diet list is recommended by ,friedenwald and ,ruhraeh3 ,calories #h ,a4,m4 #ajj grams of milk with tea #ajj4j #cj grams of milk toast #acj4j #aj ,a4,m4 #ajj grams of baked trout #ajf4j #ajj grams of milk #fg4j or #cj grams panopepton 7#eg4e7 #aj grams of butter #ha4j #ej grams of toast #acj4j #ej grams of sherry #fj4j #ab ,m4 ,bouillon with #e grams somatose #af4j #ajj grams of chicken #ajf4j or #ajj grams squab 7#ajj7 or #ajj grams of calves' sweetbreads 7#ij7 or #ajj grams of calves' brains 7#adj7 #fj grams of macaroni #bab4j or #ajj grams of mashed potatoes 7#abg7 or #ajj grams of spinach 7#aff7 or #ajj grams of asparagus 7#ah7 #be grams of stale wheat bread #fe4j #d ,p4,m4 #bj grams of toast #acj4j #bj grams of butter #afb4j #dj grams of caviar #eb4j #g ,p4,m4 #acj grams of milk 7#ajj7 with #e grams somatose 7#af7 #aaf4j #ajj grams of rice cooked in milk #agg4j #ej grams of wheat bread #acj4j #i ,p4,m4 #cj grams of panopepton #eg4e ------ #bjbd4e ,,summary ,,factors ,,inducing ,,gastric ,,disturbances #a4 ,errors in ,diet4--,over-feeding1 under-feeding1 improper food1 unbalanced diet4 #b4 ,disturbed ,secretory ,processes4-- 7a7 ,over- or under-secretion of gastric juice4 7b7 ,an excess or deficiency of hydrochloric acid in the juices4 #c4 ,impaired ,motility and ,tone of the ,gastric ,organ4--,the peristaltic waves and muscular contraction of the stomach walls becoming sluggish prevent the food mass from passing into the intestines at a normal rate of speed1 thus giving rise to a fermentation of the food and a consequent dilatation of the organ from the gas thus produced4 ,other ,factors4--,lack of fresh air and exercise1 indoor occupation1 bad hygiene1 unsanitary surroundings1 heredity1 certain diseases which are accompanied by gastric disorders4 ,diseases of ,gastric ,organ4--,acute and ,chronic ,gastritis1 ,gastric-,ulceration1 ,gastric ,cancer4 ,treatment4--,tests--,test meals1 ,x-,ray examinations 7pictures and ,fluoroscope74 ,patient is given no breakfast on day of test4 ,in ,x-,ray laboratory a bismuth or barium meal is given1 this meal consists of a pint of fluid1 either buttermilk or malted milk1 into which a certain amount of bismuth or barium chloride is mixed4 ,starvation ,period4--,a period of abstinence from food is instituted in most of the gastric disorders1 7a7 to determine the extent and character of the disease1 7b7 to rest the digestive tract4 ,dietetic ,treatment4--,diet adjusted to meet the needs of the individual case as determined by the medical examination4 ,instruction to ,patient4--,individual warned against overeating1 drinking and constipation4 ,,problems 7a7 ,formulate a diet order for a patient suffering from chronic gastritis4 7,individual's food requirements must be observed47 7b7 ,formulate a diet for gastric ulceration4 ,list the available foods2 the avoidable foods4 7c7 ,outline a diet to be used in case of gastric cancer2 show how it differs from the one used in gastric ulceration4 ,,footnotes3 #ib ,it is also customary to give the patient a bismuth or barium meal in order that an ,x-ray and fluoroscopic examination may be made to determine the character and extent of the disturbance4 #ic ,diseases of the ,stomach1 by ,boas4 ,,chapter ,,xii ,,diseases ,,of ,,the ,,intestinal ,,tract ,,acute ,,and ,,chronic ,,diarrhea 7,,catarrh71 ,,enterocolitis1 ,,dysentery1 ,,constipation1 ,,appendicitis1 ,,chronic ,,constipation1 ,,auto-,,intoxication ,diarrhea1 like gastritis1 may be a symptom of many diseases and a result of many digestional disturbances4 ,enteritis1 enterocolitis1 dysentery1 typhoid fever1 and certain cases of tuberculosis and syphilis are all accompanied by an inflamed condition of the mucous lining of the intestinal walls1 and in each of these pathological conditions we may find diarrhea as a resulting symptom4 ,causes4--,diarrhea may be acute or chronic in character4 ,it may be brought on by errors in diet1 warm weather1 certain drugs1 ptomaines1 bad hygiene1 polluted water or milk1 and by overeating4 ,idiosyncrasies against certain kinds of food have been found in both adults and children2 these idiosyncrasies are manifested by pain and diarrhea whenever the offending foods have been eaten4 ,acute diarrhea has also been brought on in children by the drinking of cold lemonade when over-heated4 ,diarrhea in ,children4--,all diarrheas in children1 and especially those developing during the hot months1 must be looked on with suspicion and given immediate attention before they have an opportunity to develop serious features which may terminate in death before the seriousness of the condition is realized4 ,as a rule1 almost any diarrhea in children will raise the temperature4 ,this does not occur so often with adults unless the diarrhea results from infectious fevers1 ptomaines1 etc41 in which case it may rise suddenly and to a considerable height4 ,,acute ,,enteritis 7,,diarrhea7 ,the ,bowels4--,the symptoms of this condition are too liquid or too frequent stools1 the number varying from three to twelve or more a day4 ,they may be greenish yellow in color and contain particles of undigested food and mucus4 ,in prolonged diarrheal attacks the stools sometimes contain blood4 ,the attack may be accompanied by more or less pain of a colicky nature1 due to the formation of gas in the intestinal tract4 ,in ptomaine poisoning this pain is sometimes very intense4 ,as a rule the intestinal tract is emptied by means of salt1 oil1 etc41 but this is generally directed by the physician4 ,a soapsuds or salts and glycerin enema to flush the colon will often give quick relief by dispelling the gas4 ,starvation4--,the entire digestive tract requires absolute rest for a certain period2 no food and very little water1 the latter in the form of bits of ice only1 are given for a period lasting from twelve to thirty-six hours or more1 depending upon the violence of the attack and the condition of the patient4 ,this is to allow the toxic substances which are probably causing the disturbance to pass out of the body1 either in the feces or in the urine4 ,when the acute symptoms subside1 that is1 when the pain and distention of the intestines have disappeared1 and the bowel movements become more normal in number and character1 the dietetic treatment suitable to the condition is instituted4 ,dietetic ,treatment4--,the first day the patient is given a small cup of weak tea1 half a glass of buttermilk or peptonized milk1 or a cup of well-skimmed meat broth1 every three or four hours4 ,if the patient is weak1 the nourishment may be given oftener1 and in those cases it is often found advisable to give a small amount of alcohol in the form of brandy in albumen water1 or panopepton or liquid peptonoids4 ,these may be administered in tablespoonful doses every two hours4 ,whole milk1 unless it is peptonized1 and at times even then1 is not advisable in diarrheal conditions on account of its liability to form curds which decompose with the production of toxic substances1 known to be exceedingly irritating to the already inflamed mucous membranes lining the intestinal walls4 ,increasing the ,diet4--,as the diarrhea and inflammation subside1 the following foods are gradually introduced into the dietary1 keeping in mind always that a return of the acute symptoms is apt to occur4 ,hence the patient must never be overfed4 ,it is better to err on the side of too little than too much food during the early convalescent period4 ,diet4--,soft-cooked eggs1 toast 7slightly buttered71 cocoa made with water instead of milk1 chicken1 calf's-foot or wine jelly2 later1 well-cooked rice1 junket1 and soft custard2 still later1 lightly broiled beefsteak1 lamb chops1 chicken1 squab or quail1 sweetbreads or brains4 ,not until the patient is entirely free from all symptoms of diarrhea or intestinal disturbance may the following foods be given3 cream or cream dishes such as cream toast1 cream chicken1 or cream soup1 raw or stewed fruit1 green vegetables1 salt foods1 spiced foods of any description2 pastries1 confectionery and desserts in general1 unless they are simple in character and are sweetened with saccharin instead of sugar1 as the latter substance is particularly susceptible to fermentation4 ,anemia as a ,result4--,anemia is one of the most common results of prolonged diarrheal attacks1 especially in those toxic diarrheas resulting from infectious diseases1 dysentery1 etc4 ,the blood-making tissues suffer from a lack of nourishment and are in consequence incapable of producing blood of the best quality4 ,hence the starvation treatment cannot be carried on over a very extended period or the resulting anemia may be more difficult to overcome than the original trouble4 ,selecting and ,regulating the ,diet4--,the following points must be kept in view when regulating the diets of individuals who are prone to develop diarrhea3 ,preparing the ,diet4--,only such foods as are known to agree with the individual1 and these prepared in the simplest manner possible1 must have a place in the dietary4 ,fermentation4--,all foods that are subject to fermentation either in the stomach or intestines must be withheld1 at least until the attack is well over4 ,sugar is an example of such foods2 saccharin may be substituted when necessary4 ,avoidable ,foods4--,pork1 veal1 and shellfish must be left out of the dietary1 possibly for months1 since they have been found frequently not only to bring about a return attack of diarrhea but also to have been the cause of the original one4 ,fatty foods of all sorts had best be avoided as long as there are symptoms of diarrhea2 these foods are handled with difficulty by the digestive apparatus and impose extra work upon the intestine1 which is already taxed by the disease4 ,restricting ,fluids4--,fluid foods should be more or less limited in the diet1 since they require more effort on the part of the intestines than the more concentrated foods4 ,proprietary ,foods4--,certain proprietary infant foods#id are at times found to be exceedingly valuable1 since they furnish food in a concentrated and digestible form4 ,among these ,mellin's ,food1 ,racahout1 and ,imperial ,granum may be mentioned4 ,,chronic ,,enteritis ,the ,stools4--,when the diarrhea is chronic in character1 the character of the stools indicates the seat of the inflammation4 ,when there is a great deal of undigested food found in them the upper part of the bowel is more affected2 when the stools contain more mucus than food the lower bowel is the chief seat of the trouble4 ,the frequency and fluidity of the stools impose a great strain upon the entire body1 causing a progressive emaciation and anemia4 ,the treatment is similar to that instituted in acute attacks4 ,the starvation regime cannot be carried out for a long period4 ,efforts must be made to ascertain the cause of the trouble and to overcome it4 ,this is1 as a rule1 more easily accomplished with adults than with infants and children4 ,dietetic ,treatment4--,the diet is the chief point of observation and attention4 ,the same care must be observed as is found necessary in the after-treatment of acute diarrhea4 ,the patient must be cautioned not to eat indigestible foods or those which are known to cause trouble in this respect4 ,she must be warned against eating when over-tired4 ,,enterocolitis ,enterocolitis is an inflammation of the lower intestines and colon4 ,the stools contain more mucus than those occurring when the inflammation is higher up in the intestines and blood is also more frequent in these stools4 ,the prostration is more marked and the fever apt to be higher than in ordinary diarrheal attacks4 ,however1 acute attacks of enterocolitis do not produce the marked anemia or the emaciation which are so common in the chronic cases of enteritis4 ,dietetic treatment the same as that used in acute diarrhea4 ,,acute ,,dysentery ,dysentery is a disease in which the seat of inflammation is the colon4 ,the bowels are distended and tender1 the pain at times is acute and spasmodic1 and the fever moderate4 ,the constant desire to defecate and the straining which accompanies each effort1 as well as the small stools1 containing both blood and mucus1 furnish the characteristic symptoms of this disease4 ,rest in bed is absolutely necessary2 the patient must be induced to use a bedpan4 ,dietetic ,treatment4--,the diet consists entirely of liquids as in acute diarrhea1 the same careful regime being observed as in those conditions4 ,the soreness in the abdomen is at times relieved by spice poultices or a hot turpentine stupe4 ,,chronic ,,dysentery ,when the above conditions become chronic1 the patient loses weight and strength rapidly1 becomes anemic and emaciated4 ,the treatment1 like that used in the acute disease1 consists of rest and liquid diet4 ,the medicinal treatment is left entirely in the hands of the physician4 ,,appendicitis ,appendicitis is an inflammation of the vermiform appendix4 ,it may be acute or chronic in form4 ,symptoms4--,the disease is manifested by sudden pain in the right side1 tenderness over the seat of the inflammation1 and a localized rigidity of the right iliac fossa4 ,the attack is as a rule accompanied by fever which may run as high as #ajc deg4 or #ajd deg4 ,f4 ,the patient may suffer from nausea and vomiting4 ,constipation is generally an annoying symptom of the disease4 ,rest in ,bed4--,the treatment of the acute attack consists of total abstinence from food for twelve or more hours until the most acute stage has passed and the patient either passes into the hands of the surgeon or the symptoms begin to subside in violence4 ,it is necessary that the patient be kept in bed1 not being allowed to rise for anything4 ,the nurse must make him understand that his recovery1 possibly his very life1 depends upon his absolute quiet during the early stages of the disease4 ,dietetic ,treatment4--,when the first acute symptoms have passed1 the diet must consist of fluids1 well-skimmed meat broths1 buttermilk1 peptonized milk1 albumen water or albumenized orange juice4 ,no solid food must be given until the acute symptoms have disappeared4 ,when the tenderness in the right side has entirely left him and he no longer suffers the pain or nausea1 a gradual return to a normal diet may be made4 ,the patient must be cautioned against eating indigestible foods1 as an attack of intestinal indigestion may readily start up an irritation in the susceptible appendix and cause a second attack of appendicitis which is often of a more serious nature than the first4 ,convalescent ,diet4--,the return to solid food is made gradually as in other intestinal disorders1 by giving the most digestible foods first4 ,soft toast1 soft eggs1 fine cereal gruels1 well-cooked rice1 well-baked white potatoes1 meat1 wine or fruit jellies2 then lightly broiled beefsteak1 lamb chop1 chicken1 sweetbreads1 or brains given in small quantities until the intestinal tract has regained its vigor4 ,foods to ,be ,avoided4--,highly seasoned foods must be avoided on account of their astringent qualities1 which may cause constipation4 ,long1 tough-fibered meats1 coarse vegetables1 rich foods1 in fact anything which may cause intestinal indigestion1 must be eliminated from the dietary4 ,a decomposition of the foods lying in the lower part of the small intestine is dangerous to such individuals1 since such products are highly toxic in character and exceedingly irritating to the already tender appendix4 ,,chronic ,,constipation ,chronic constipation is so universal a condition that it must be treated and overcome whenever it is possible4 ,this condition is not only the cause but the result of disease4 ,it may be induced by improper food1 poor hygiene1 sedentary habits1 lack of exercise1 the taking of drug preparations such as cough sirups which contain opium in some form1 the constant taking of cathartics and enemas1 or it may be an hereditary condition4 ,diet1 ,exercise1 and ,fresh ,air4--,the chief means of overcoming this deplorable chronic condition is by regulating the diet and increasing the amount of exercise in the fresh air4 ,at times it is necessary to resort to artificial stimulation of the intestinal movements2 at others1 on account of the disease of which it is only one of the symptoms1 it is dangerous to irritate the already inflamed mucous membranes lining the intestinal wall4 ,in these cases the physician prescribes the method of procedure4 ,in ordinary cases1 however1 the following suggestions may be used as a guide in overcoming the condition4 ,available ,foods4--,it must be borne in mind that the food must not be too concentrated in character or it will be so completely absorbed as to leave little or no residue for the feces1 and since the waste products of metabolism1 both of food and body materials1 must be eliminated1 a certain amount of fecal matter is necessary to assist in this work4 ,vegetables1 such as celery1 turnips1 lettuce1 asparagus1 string beans1 spinach1 and beans1 lentils1 lima beans1 and onions2 fruits1 such as raisins1 figs1 and prunes2 and cereals which have not had all the bran removed1 such as cut oats1 cracked wheat1 etc41 on account of the cellulose they contain1 act admirably in overcoming chronic constipation4 ,it is found1 however1 that when even these are not sufficient in certain cases1 bran added to the food1 either alone1 with the breakfast cereal1 or in the form of biscuits1 muffins1 or cookies1 will give just the necessary amount of ballast to the food mass to make it stimulate the peristaltic movements by its pressure upon the intestinal walls4 ,stimuli to ,peristalsis4--,foods yielding certain acids exert a stimulating action upon intestinal peristalsis4 ,available ,foods4--,those particularly valuable for this purpose are limes1 oranges1 apples1 prunes1 figs1 raisins1 and most fruit juices 7with the exception of blackberries1 which are constipating71 tomatoes1 and rhubarb4 ,the fruit juices may be diluted with water or carbonated water 7in the latter case the action is increased because of the gas contained in the water71 and taken the first thing in the morning1 or the fruit may be eaten at night before retiring1 and in the morning on an empty stomach4 ,prune pulp or prune jelly may be given to children as well as to adults4 ,the action of this fruit is augmented by the addition of senna leaves4 ,a conserve made of prunes1 figs1 and raisins given in teaspoonful doses at night and before breakfast often gives splendid results in curing chronic constipation4 ,gas-forming ,foods4--,the eating of foods which give rise to a slight formation of gas owing to their tendency to ferment likewise acts as a stimulus to intestinal movements4 ,among these may be mentioned honey1 molasses1 cauliflower1 cabbage1 spinach1 and onions4 ,if the honey and molasses are poured on bran muffins or biscuits1 on breakfast food1 or added as sweetening agents to cookies1 they will be found particularly valuable4 ,care must be taken1 however1 not to give too much of either of these foods or they will disturb the digestion and do more harm than good4 ,use of ,salt ,foods4--,foods such as herring1 caviar1 anchovies1 ham1 etc41 on account of the salt they contain1 exert a stimulating effect upon the movements in the small and large intestines4 ,graham bread1 spread with brown sugar1 molasses1 or honey1 makes an acceptable addition to the meal of the majority of children and to that of many adults4 ,fats and ,mineral ,oils4--,the use of fats is often recommended2 olive oil may be given in tablespoonful doses before breakfast and at night or it may be served on vegetables and salads4 ,if one or two tablespoonfuls are taken at night and before breakfast1 it may act as a laxative4 ,in many cases1 however1 this oil is completely absorbed in the small intestine and hence there is none left to lubricate the passage for the food mass4 ,when vegetable oils do not prove satisfactory1 mineral oils may be substituted4 ,these oils have absolutely no fuel value and are not digested in the intestinal canal but mix with the fecal mass1 softening it and stimulating its passage through the large intestine4 ,there are certain individuals with whom the mineral oils do not act as lubricants and instead of softening the feces and lubricating the passage will slip through the intestinal canal without carrying the feces along4 ,sample ,diet ,sheets4--,the following menus are suggested for the use of individuals suffering with chronic constipation3 ,,breakfast #g ,a4,m4 ,orange juice and water4 #h ,a4,m4 #a bran muffin with honey and cream4 #a or #b slices of bacon4 ,whole wheat biscuits4 ,a cup of coffee1 cereal coffee1 or hot milk 7not boiled74 ,,luncheon #a ,p4,m4 ,casserole of beef made with lean beef4 ,turnips and potatoes4 ,graham bread or muffins and honey or preserves4 ,milk or hot water tea4 ,,dinner ,tomato bouillon4 ,roast lamb4 ,string beans4 ,potatoes baked with jackets on4 ,celery salad1 dressed with plenty of oil and lemon juice4 ,prune jelly with whipped cream4 ,,breakfast ,prunes and figs cooked together4 ,slice of ham with #a soft-cooked1 poached1 or scrambled egg4 ,whole wheat or bran biscuits4 ,coffee with cream and sugar4 ,,luncheon ,vegetable soup4 ,pork and beans4 ,boston brown bread4 ,baked apple 7skin eaten74 ,oatmeal wafers4 ,,dinner ,roast beef4 ,spinach or cauliflower served with butter sauce4 ,cold slaw4 ,pineapple jelly 7pineapple left in71 whipped cream1 or ,date and fig pudding4 ,,auto-,,intoxication ,auto-intoxication is a condition produced by the absorption of the decomposition products of food in the intestinal canal4 ,absorption of ,toxins4--,as a rule the condition occurs in individuals suffering more or less from constipation which may be due to errors in diet or a lack of tone in the intestines1 giving rise to a sluggishness in the peristaltic movements in this region of the alimentary canal4 ,in certain individuals the liver is more or less sluggish1 or in some way fails to do its regular work of detoxifying the products of metabolism brought in by the blood stream1 in which case these toxins are reabsorbed into the system and induce a condition known as auto-intoxication4 ,care of ,bowels4--,as a rule the patient has more or less fever1 nausea and at times vomiting4 ,the head aches and the abdomen may be distended by the formation of gas in the intestines4 ,the treatment is like that used in the majority of intestinal disorders4 ,the bowels are emptied by means of soapsuds or salts and glycerin enemas4 ,certain physicians recommend an enema made with equal quantities of milk and molasses1 with enough hot water added to make a thin1 warm solution4 ,care must be used in preparing this flatus enema on account of the danger of curdling the milk with the acid in the molasses and the hot water4 ,if the solution should curdle it must be discarded and a fresh solution prepared4 ,a flatus enema containing salts1 glycerin1 and a few drops of turpentine is also valuable in removing the gas formed by the action of the putrefactive bacteria upon the unabsorbed food mass4 ,this enema must be given high so as to reach the spot in the colon where it may efficiently do its work4 ,dietetic ,treatment4--,the diet may consist of fluids for the first few days1 or as long as the fever continues4 ,buttermilk is probably the best fluid food to use under such conditions1 since it not only nourishes1 but likewise furnishes lactic acid bacteria which aid in the destruction of the more harmful bacteria1 especially numerous under the conditions just mentioned4 ,when whole milk is given it is best to peptonize it4 ,well-strained meat broths may be given occasionally to vary the diet and albumenized orange juice or orange juice in carbonated water may also be given once or twice daily during the febrile period4 ,after this1 the patient may have well-cooked cereal gruels4 ,these may be dextrinized with vegetable diastase 7,taka diastase7 if necessary4 ,a return to normal diet is made gradually to prevent a return of the trouble4 ,the patient should be advised against overeating1 and eating highly seasoned or indigestible foods4 ,convalescent ,diet4--,the diets recommended for use during convalescence from other intestinal disorders may serve here1 reducing1 however1 the allowance of meat1 since meat proteins are particularly susceptible to attacks of putrefactive bacteria4 ,dietary ,precautions4--,after the body has returned to its normal state1 the patient must keep in mind the danger arising from constipation and intestinal putrefaction4 ,the following menu is given as a guide to aid the individual in selecting a diet which will in a measure assist in preventing future attacks of intestinal putrefaction and auto-intoxication3 #g ,a4,m4 #a glass of water with orange or lime juice4 ,,breakfast #h ,a4,m4 ,stewed prunes or figs4 ,cereal and cream4 ,buttered toast4 ,crisp bacon4 ,coffee4 ,,luncheon ,vegetable or tomato soup4 ,green vegetables such as cauliflower1 greens1 or tomatoes2 or ,baked dishes such as macaroni and cheese1 scalloped macaroni and tomatoes2 or ,baked potatoes1 or potatoes au gratin1 or stuffed tomatoes with rice4 ,stewed fruit or fruit jelly4 ,sponge cake with simple sauce4 ,junket4 ,toasted crackers or bread4 ,,dinner ,milk soup4 ,cream of spinach1 celery1 peas1 or tomatoes4 ,baked eggs1 cheese souffle or nut loaf4 ,tender green peas1 cauliflower1 spinach1 boiled or creamed potatoes1 well-boiled rice4 ,fruit1 vegetable1 tomato1 or cheese salad4 ,simple dessert1 such as cottage pudding with simple sauce1 fruit pudding1 prune whip1 or frozen desserts2 ice cream or water ices2 or ,cheese and crackers4 ,coffee4 ,,summary ,,diarrhea ,character4--,acute or chronic1 accompanying many pathological conditions1 especially in children in whom diarrhea in any form must be given immediate attention4 ,causes4--,errors in diet1 polluted water or milk1 ptomaines1 bad hygiene1 and certain drugs4 ,bowels4--,the stools vary in number from three to twelve a day4 ,they may be greenish yellow in color1 containing mucus and particles of undigested food and1 in prolonged cases1 blood4 ,treatment4--,rest in bed and total abstinence from food for from twenty-four to forty-eight hours4 ,salines are usually given by mouth or by rectum1 but this is left to the discretion of the physician4 ,very little water is given by mouth during the period of total abstinence4 ,thirst is relieved by bits of ice1 and enemas are given if necessary4 ,administration of ,diet4--,when acute symptoms have disappeared and the stools are becoming more normal in character and number1 a fluid diet of from four to six ounces is administered every three or four hours or oftener if patient is very weak4 ,brandy may likewise be given in cases in which exhaustion is marked4 ,dietetic ,treatment4--,concentrated foods of the simplest character and only those known to agree4 ,proprietary infant or invalid foods1 except malted foods1 which exert a laxative effect2 among those found to be good may be mentioned ,mellin's ,food1 ,imperial ,granum1 and ,racahout4 ,foods to ,be ,avoided4--,fatty foods2 pork1 veal1 and shellfish2 all foods that are subject to fermentation in the stomach or intestinal tract 7sugar74 ,foods to ,be ,limited4--,fluids1 soup1 beverages1 etc41 because they impose more work on the intestines4 ,,enterocolitis ,seat of ,inflammation4--,lower intestine and colon4 ,differentiating ,characteristics4--,more mucus and blood in stools2 greater prostration2 greater rise of temperature2 and less anemia than in chronic enteritis4 ,dietetic ,treatment4--,practically the same as in other diarrheas4 ,,dysentery ,characteristic ,symptoms4--,acute and spasmodic pain1 tenderness and distention in the bowels1 moderate fever1 straining and a constant desire to defecate1 small stools containing blood and mucus1 loss of weight and marked anemia when condition becomes chronic4 ,treatment4--,rest in bed absolutely necessary2 the use of the bedpan made obligatory2 soreness relieved by hot turpentine stupes or spice poultices4 ,dietetic ,treatment4--,no food for a period of from thirty-six to forty-eight hours1 after which fluids and the regime recommended in acute diarrhea are advisable4 ,in chronic dysentery the diet is practically the same4 ,the extreme exhaustion and anemia accompanying these conditions make it necessary to increase the diet carefully but soon to offset as far as possible the devastating effects of the disease4 ,,appendicitis ,treatment4--,confinement to bed is absolutely necessary while acute symptoms prevail4 ,the life of the patient may depend upon the care with which this quiet period is carried out4 ,no food should be given for twelve or more hours to enable the physician to make a proper diagnosis and to allow the intestinal tract and appendix complete rest from the irritating effects of food passing down the canal4 ,dietetic ,treatment4--,acute ,stage3 ,total abstinence for a period1 after which fluids as given in other acute intestinal disorders4 ,no solid food until acute symptoms have subsided2 then a gradual return to normal4 ,convalescence4--,when tenderness in right side has disappeared1 the return to a normal diet is made gradually4 ,gelatin1 soft eggs1 soft toast1 fine cereal gruels1 well-cooked rice1 well-baked white potatoes1 tender rare beefsteak or lamb chops1 the breast of chicken1 sweetbreads1 and brains are recommended4 ,relapse or ,recurring ,appendicitis4--,the patient must be warned against eating indigestible foods or any kind of foods liable to cause constipation2 also against overeating or eating when over-heated or over-tired4 ,one attack predisposes to another1 hence the above precautions are necessary to prevent the condition from becoming chronic4 ,,chronic ,,constipation ,causes4--,improper foods1 indoor occupations leading to a lack of fresh air and exercise1 bad hygiene1 certain drugs1 such as cough sirups1 etc41 containing opium in some form1 constant use of cathartics and enemas to move the bowels1 heredity4 ,dietetic ,treatment3 ,foods to ,be ,avoided4--,highly spiced foods must be avoided on account of their astringent qualities1 too concentrated foods because they fail to furnish the necessary bulk without which the waste matter cannot pass out of the body at a sufficient rate of speed to prevent putrefaction taking place in the intestinal tract4 ,foods ,stimulating ,peristalsis on account of their bulk3 ,bulky foods1 such as vegetables1 cabbage1 turnips1 cucumbers1 spinach1 beans1 celery1 lettuce1 etc42 cereal foods containing a high percentage of bran1 bran bread and cookies1 fruits such as raisins1 prunes1 figs4 ,foods ,acting as ,stimuli to ,intestinal ,movements on account of their acid content3 ,limes1 oranges1 apples1 prunes1 figs1 raisins1 most fruit juices 7blackberries excepted71 rhubarb1 tomatoes1 cauliflower1 spinach1 onions1 honey1 and molasses2 senna leaves likewise have a distinct action upon the peristaltic movement of the intestines1 hence are included here4 ,precautions4--,emphasis should be placed upon the dangers of 7#a7 overeating any of the foods indicated in the above list and thus bringing about conditions more dangerous in result than the original disturbance2 7#b7 the taking of drugs to move bowels on account of the ease with which the habit is acquired and the consequent inability of the bowels to move without such whips2 7#c7 the taking of too little water1 thereby allowing a too concentrated condition of the food mass and a consequent accumulation of substances which inhibit peristaltic action4 ,use of ,fats and ,mineral ,oils4--,olive and other vegetable oils1 if not completely absorbed1 are advised on account of their lubricating effects4 ,the same can be said of the mineral oils which have no food value but in many cases furnish the lubricant necessary in certain individuals suffering from sluggish intestinal peristalsis4 ,,problems 7a7 ,list the food used in the treatment of enterocolitis2 outline the method of administering the diet4 7b7 ,formulate a convalescent diet for diarrheal cases4 7c7 ,list the foods used in chronic constipation2 list the avoidable ones4 ,,footnote3 #id ,malted foods are contraindicated1 as malt exerts a very laxative effect4 ,,chapter ,,xiii ,,fevers ,,in ,,general ,fever is an abnormal condition characterized by an elevation of body temperature1 quickened respiration and circulation1 and a certain amount of tissue waste4 ,this elevation of temperature may be due to various conditions1 such as local inflammation1 infectious diseases1 disturbed metabolism and food poisoning 7ptomaine74 ,tissue ,waste in ,fevers4--,fevers of short duration1 such as accompany colds1 tonsillitis1 chicken pox and intermittent fever1 remittent fever1 and at times malarial fever1 do not cause sufficient tissue waste to make the nutrition the important feature of the treatment4 ,in ptomaine poisoning the tissue waste may be great1 but it is the result of the poisoning1 as is the fever1 so that the diet needs to be adjusted only after the disturbance has abated4 ,in the beginning1 starvation is instituted and the fever disappears when the poisoning is controlled4 ,treatment of ,fevers of ,short ,duration4--,in all fevers of short duration then1 the treatment is directed with the following points in mind3 7#a7 relieving the cause1 7#b7 preventing gastro-intestinal disturbances1 7#c7 saving the heart1 kidneys1 etc41 extra strain4 ,dietetic ,treatment4--,in doing this the diet is so formulated as to meet the above-mentioned conditions1 and fluids seem the best form in which food can be given to bring about the desired results4 ,the quantity of fluids should be small and the intervals between feedings short4 ,two-hour intervals seem best in the beginning4 ,these intervals are lengthened as the fever decreases and the amount of food at each feeding increased4 ,when convalescence is established1 semi-solid1 soft or convalescent diet may replace the fluids and the patient gradually brought back to a normal diet4 ,fluid ,diet4--,the following foods constitute a fluid diet3 milk1 whole milk1 plain1 peptonized1 or albumenized1 buttermilk1 koumiss1 malted milk1 milk shake1 milk punch1 cream1 whey2 fruit beverages1 plain1 albumenized1 or mixed with whole raw egg2 eggnog1 milk and ginger ale1 cocoa1 strained gruels1 broths reenforced with egg or plain4 ,carbonated water may be added to milk or fruit beverages4 ,schedule of ,feeding4--,the following schedule may be used as a guide in fevers of short duration3#ie ,i #g ,a4,m4 #f oz4 hot milk or cocoa4 #i ,a4,m4 #f oz4 broth reenforced with egg4 #aa ,a4,m4 ,milk shake4 #a ,p4,m4 ,oatmeal gruel1 #d oz42 #b oz4 cream4 #c ,p4,m4 ,albumenized orange juice1 #d oz42 #a egg white4 #e ,p4,m4 #f oz4 broth reenforced with egg white4 #g ,p4,m4 #f oz4 cocoa4 #i ,p4,m4 #f oz4 malted milk4 #ab ,m4 #d oz4 hot milk and #b oz4 cream4 and #d ,a4,m4 ,the above furnishes approximately #gej calories4 ,,ii #g ,a4,m4 #f oz4 cocoa4 #i ,a4,m4 #d oz4 oatmeal gruel1 #b oz4 cream4 #aa ,a4,m4 ,eggnog4 #a ,p4,m4 ,milk broth reenforced with egg4 7#c oz4 milk1 #c oz4 broth1 #a egg white47 #c ,p4,m4 ,cream1 egg and vichy4 #e ,p4,m4 ,albumenized milk1 #f oz4 #g ,p4,m4 ,hot malted milk chocolate1 #f oz4 #i ,p4,m4 ,milk broth reenforced with egg4 #ab ,m4 #d oz4 oatmeal gruel1 #b oz4 cream4 #d ,a4,m4 #f oz4 malted milk 7half water1 half milk74 ,furnishing approximately #aejj calories4 ,,iii #g ,a4,m4 ,oatmeal gruel1 #d oz41 #b oz4 cream4 #i ,a4,m4 ,orange eggnog4 #aa ,a4,m4 ,malted milk chocolate 7#c oz4 milk1 #c oz4 water74 #a ,p4,m4 ,clam broth 7milk71 #f oz4 #c ,p4,m4 ,milk shake1 #d oz42 #b oz4 cream4 #e ,p4,m4 ,cornmeal gruel1 #d oz42 #b oz4 cream4 #g ,p4,m4 ,hot cocoa1 #f oz4 #i ,p4,m4 ,hot malted milk4 #ab ,m4 ,hot milk1 #d oz42 #b oz4 cream4 #d ,a4,m4 ,hot milk1 #d oz42 #b oz4 cream4 ,furnishing approximately #adfj calories4 ,the two night feedings may be omitted if patient is asleep4 ,these diets will be seen to be below the maintenance requirements in health1 but the need for care in preventing gastro-intestinal disturbances makes it safer to have it so for a few days1 especially if the elevation of temperature is great4 ,after the temperature becomes normal the following foods may be added to the diet3 ,soft or ,convalescent ,diet4--,cream soups1 soft-cooked1 creamed1 or poached egg1 soft or baked custard1 junkets1 egg1 cocoa1 or plain vanilla ice cream1 soft toast1 milk or cream1 buttered toast1 cereals1 gelatin jellies1 fruit1 wine1 or meat jellies1 vegetable purees1 baked white potato1 apple sauce1 baked apple1 fruit whip1 blanc-mange1 broiled lamb chops1 beefsteak1 or chicken1 sweetbreads1 broiled or creamed brains4 ,sample ,menus4--,the following menu is a sample convalescent dietary3 ,,breakfast #g3cj ,a4,m4 ,cream of wheat #c oz41 cream #a oz4 #a soft-cooked or poached egg4 #a slice of toast buttered4 #f oz4 cocoa or milk flavored with coffee4 #b tablespoonfuls of strained prune pulp with #b oz4 cream4 #aj3cj ,a4,m4 ,albumenized orange juice4 ,,dinner #ab3cj ,p4,m4 ,cream of pea soup1 #f oz4 #a baked potato with butter4 #a slice of buttered toast4 #a cup of cocoa or #a glass of milk or buttermilk4 #c3cj ,p4,m4 ,ginger ale and milk1 #c oz4 each4 ,,supper #f ,p4,m4 #b slices of buttered toast moistened with #d oz4 milk and #b oz4 cream4 #a soft-cooked egg or #c tablespoonfuls of well-cooked cereal or #b tablespoonfuls of boiled rice4 #b tablespoonfuls of apple sauce served with #a tablespoonful of cream4 #a cup of cocoa1 malted milk1 whole milk1 or buttermilk4 #i ,p4,m4 #d oz4 hot milk1 #b oz4 cream1 or #a cup of cocoa or malted milk4 ,the return to normal diet is made with caution that the digestion of the patient may not be upset or the temperature raised again by over-feeding4 ,energy ,requirements4--,in fevers of short duration it is not difficult to regulate the amount of food necessary for the maintenance of the patient1 since the body will1 as a rule1 adjust itself when the cause of the fever has been removed4 ,at times1 however1 it is necessary to make an effort to tempt the appetite of the patient when convalescence is established1 that recovery may be made more rapid and complete4 ,care of the ,mouth4--,probably there is nothing more essential in the treatment of fevers in general and typhoid fever in particular than the care of the mouth4 ,well-nourished patients rarely ever show the dry1 cracked tongue and lips that was formerly one of the common occurrences in typhoid fever4 ,however1 in any febrile condition the mouth is apt to acquire a disagreeable taste2 this bad taste is so prominent in certain cases as to render it difficult for the patient to eat4 ,this can be1 to a great extent1 eliminated by the use of aseptic mouth washes4 ,when the patient is not strong enough to rinse the mouth before and after eating1 the nurse must use a swab for the purpose4 ,the food must be carefully selected and attractively served and every effort made to make food as dainty and palatable as possible4 ,thirst4--,thirst is relieved with crushed ice1 fruit beverages1 and carbonated waters4 ,in certain conditions it is necessary to limit the fluids1 but in typhoid fever the giving of the requisite amount of liquids is one of the most difficult tasks confronting the nurse4 ,it is wise to find out the beverages particularly liked by the patient and1 whenever it is possible1 make use of them4 ,as a rule alcohol is not necessary in the diet of typhoid fever patients4 ,however1 in certain cases of that disease1 as well as in febrile conditions induced by other causes1 the use of alcoholic stimulation may be necessary2 it must be left to the discretion of the physician to prescribe it4 ,,summary ,intestinal ,disturbances are accountable for the majority of the fevers of short duration during infancy and childhood1 and in many of those cases in adults4 ,malaria causes an elevation of temperature which is1 as a rule1 of short duration4 ,contagious ,diseases1 such as scarlet fever1 measles1 whooping cough1 and mumps1 are likewise accompanied by more or less elevation of temperature4 ,treatment consists of a period of rest in bed1 with an abstinence from food1 in order that the disease may manifest itself1 and also that any offending food material which may cause the fever may have an opportunity to pass out of the body4 ,the ,heart1 in some of the diseases accompanied by an elevation of temperature1 is more or less strained2 this is particularly true in tonsillitis1 diphtheria1 etc4 ,the ,kidneys are likewise taxed in certain diseases1 even when the fever is not great or lasting2 this is found to be the case in scarlet fever1 tonsillitis1 etc4 ,dietetic ,treatment consists in giving no food for a period lasting from twenty-four to forty-eight hours4 ,this is followed by a liquid diet1 milk and broth particularly1 which is continued as long as the fever remains4 ,convalescent ,diet is instituted as soon as the fever has disappeared and acute symptoms subside4 ,thirst is apt to be great with any elevation of temperature4 ,it is relieved by water1 crushed ice1 and fruit beverages4 ,the ,mouth requires much care1 even in fevers of short duration4 ,a simple antiseptic wash should be used several times each day4 ,nitrogen ,equilibrium is not sufficiently disturbed in such cases to require taking into account4 ,should the disease1 however1 develop into one causing a material breaking down of the body tissues1 measures must be instituted to prevent the upsetting of the nitrogen balance in the body4 ,,problems 7a7 ,outline the dietetic treatment for malarial fever4 7b7 ,outline a diet order1 using liquids only4 ,show method of reinforcing this diet4 7c7 ,show how the solids are added as convalescence progresses4 ,,footnote3 #ie ,in scarlet fever and other conditions in which the kidneys may be involved the above diet is not given unless advised by physician in charge4 ,,chapter ,,xiv ,,typhoid ,,fever ,definition4--,typhoid fever is an acute infectious disease excited by specific bacteria 7,eberth74 ,the intestines become the seat of ulcerations 7,peyer's patches71 which at times perforate4 ,the chief symptoms of the disease are fever1 headache1 abdominal distention and tenderness1 more or less diarrhea and a rose-colored abdominal rash4 ,the source of infection is found in the intestinal contents of a typhoid fever patient1 which in some way come in contact with and infect drinking water1 milk1 etc4 ,energy ,expenditure in ,febrile ,conditions4--,in febrile conditions the energy expenditures increase as much as twenty-five per cent4 ,in some cases1 and when bacterial activity is added to this1 as is the case in typhoid fever1 the tissue waste becomes correspondingly greater2 hence the nutrition assumes the chief role in such cases1 for in no other way can the tissue waste and energy expenditure be met and overcome4 ,energy ,expenditures in ,typhoid4--,in typhoid fever the problem of meeting these expenditures1 and at the same time protecting the heart and kidneys from the abnormal strain placed upon them in handling the toxic substances produced as the result of bacterial action in the intestines1 becomes very real4 ,it requires eternal vigilance and patience not only from the physician but especially from the nurse1 with whom so much responsibility rests4 ,the dietetic treatment necessarily is the principal point to which all efforts must be directed4 ,by this is understood not only the type and amount of food given the patient1 but the behavior of this food in the body as manifested by the symptoms1 namely1 the appearance of the patient1 the condition of the mouth1 the abdominal distention1 tenderness1 diarrhea1 nausea1 and vomiting1 the hemorrhage which at times occurs in spite of all care1 and perforation which sometimes results in death1 and acidosis or acetonuria4 ,all of which makes this disease one requiring the most efficient attention from a nutritional standpoint4 ,energy ,requirements in ,typhoid ,fever4--,in a previous chapter the energy expenditures of the normal individual were dealt with2 it was seen that a man at rest1 that is1 in bed1 not rising for anything1 had a normal expenditure of energy requiring from #aijj to #bbjj calories per day4 ,now1 if these expenditures were increased twenty-five per cent4 by the fever and still more by the bacterial activities1 it is clearly seen that the diet must be increased in proportion if the tissue waste is to be prevented and the normal body weight of the patient maintained4 ,high ,calorie ,diet4--,dr4 ,warren ,coleman1#if to whom we owe so much for his pioneer work in feeding in typhoid fever1 devised the so-called ,high ,calorie ,diet4 ,this consists of foods of the most digestible type prepared in the simplest way4 ,the weight of the patient is considered and the diet directed with the following points in view3 7#a7 to cover the energy requirements of the body2 7#b7 to make good the tissue waste which at times amounts to a loss of from #ae to #bj grams of nitrogen a day 7or from #a_/d to #c_/d pound of muscle72#ig 7#c7 to check or prevent the development of serious complications1 kidney1 heart1 etc4 ,in the ,metabolism ,ward at ,bellevue ,hospital1 ,new ,york1#ih the best results are obtained by the giving of diets furnishing from #fj to #hj calories per kilogram per day1 or from #djjj to #eejj calories4 ,fluid ,diet4--,it is clearly seen that it would be practically impossible to obtain a sufficient number of calories by using milk alone or even a mixed fluid diet to supply the above requirements4 ,since milk alone in such a diet would probably cause such discomfort as to make it unwise to continue it1 the ideal diet would seem to be one in which the fats1 proteins and carbohydrates are furnished in a semi-solid or solid form1 together with a sufficient amount of liquids to prevent too great concentration in the food1 to relieve thirst1 and to act as a carrier of reenforcing substances1 such as lactose1 eggs1 casein products1 etc4 ,absorption ,food4--,the question as to whether the food is absorbed when given to typhoid fever patients has often been asked4 ,that it is has been proved in the series of calorimeter experiments conducted in the ,metabolism ,ward1 ,bellevue ,hospital4#ii ,here it was demonstrated that under the high calorie diet the patient consumed large amounts of food with relish and that which was not utilized by the organism immediately was stored for future needs4 ,diarrhea and ,tympanites4--,constant attention and study of various typhoid patients taking a maximum amount of food a day has proved that the diarrhea and tympanites which at times occur in these as well as other cases are due to too much of one or another of the food constituents rather than to the general amount of the diet4 ,diarrhea may then be traced to an excess of cream1 and the tympanites to an excess of lactose1 and a reconstruction of the dietary will often obviate the trouble4 ,increasing the ,diet4--,it is always advisable to go slow in adding new foods to the diet2 milk1 cream1 eggs and lactose are the principal articles constituting the diet4 ,to this are added fine cereal gruels1 well-cooked rice1 rice custard1 tapioca custard1 junket1 ice cream1 wine or fruit jellies1 toast1 eggs 7soft-cooked1 poached1 creamed1 or raw1 in milk71 or fruit beverages1 cocoa1 buttermilk1 koumiss1 certain proprietary infant foods such as ,mellin's ,food1 ,eskay's ,food1 ,racahout and malted milk1 with a well-baked potato1 milk1 cream or buttered toast added as the condition and appetite warrant4 ,milk ,diet4--,the following milk diets#ajj were devised by ,dr4 ,coleman to be given in certain cases of typhoid fever during the acute stage4 ,these formulas consist of milk1 cream and lactose and furnish from #ajjj to #cjjj calories per day4 ,calories #ajjj calories per day-- ,milk1 #ajjj c4c4 7#a qt47 #gjj ,cream1 #ej c4c4 7#a-b_/c oz47 #ajj ,lactose1 #ej gm4 7#a-b_/c oz47 #bjj ,this furnishes eight feedings1 each containing ,milk1 #abj c4c4 7#d oz47 #hj ,cream1 #h gm4 7#b dr47 #ae ,lactose1 #f gm4 7#a-a_/b dr47 #bd #bjjj calories per day-- ,milk1 #aejj c4c4 7#a-a_/b qt47 #ajjj ,cream1 #bdj c4c4 7#h oz47 #ejj ,lactose1 #abe gm4 7#d oz47 #ejj ,this furnishes seven feedings1 each containing ,milk1 #baj c4c4 7#g oz47 #adj ,cream1 #cj c4c4 7#a oz47 #fj ,lactose1 #ah gm4 7#d-a_/b dr47 #gb #cjjj calories per day-- ,milk1 #aejj c4c4 7#a-a_/b qt47 #ajjj ,cream1 #dhj c4c4 7#a pt47 #bjjj ,lactose1 #bej gm4 7#h oz47 #ajjj ,this furnishes eight feedings1 each containing ,milk1 #ahj c4c4 7#f oz47 #abj ,cream1 #fj c4c4 7#b oz47 #abj ,lactose1 #cj gm4 7#a oz47 #abj ,varying the ,diet4--,it has been found possible1 even advisable1 to vary the above diets in many cases4 ,the disease extends over such a long period that if a fluid diet is adhered to the patient would grow exceedingly tired and even disgusted if milk alone was given1 hence a mixed fluid diet such as is used in the ,presbyterian ,hospital1 ,new ,york ,city is suggested4#aja ,,presbyterian ,,hospital ,,diet ,,list #h ,a4,m4 ,milk and coffee1 each #abj c4c4 7#d oz474 #aj ,a4,m4 ,milk1 hot or cold1 #bdj c4c4 7#h oz474 #ab ,m4 ,oatmeal gruel1 #abj c4c4 7#d oz471 with milk #fj c4c4 7#b oz474 #b ,p4,m4 ,junket with cane and milk sugar4 #d ,p4,m4 ,oatmeal gruel1 #abj c4c4 7#d oz471 with milk #fj c4c4 7#b oz474 #f ,p4,m4 ,junket with cane and milk sugar4 #h ,p4,m4 ,hot milk1 #bdj c4c4 7#h oz474 #aj ,p4,m4 ,whey1 #ahj c4c4 with #a whole egg and sherry4 #ab ,m4 ,oatmeal gruel1 #abj c4c4 7#d oz47 with milk4 #b ,a4,m4 ,junket with #fj c4c4 7#b oz47 can and milk sugar4 #d ,a4,m4 ,milk1 #bdj c4c4 7#h oz474 #f ,a4,m4 ,milk1 #bdj c4c4 7#h oz474 #ae gm4 7#a_/b oz47 of lactose added to each of the four milk feedings4 ,the following foods and diet lists are used with success in various hospitals3 ,from #a to #a-a_/d quarts of milk and #a pint of cream and lactose1 beginning with #a tablespoonful in each milk feeding and raising the amount day by day until the patient is taking #b oz4 7#d tablespoonfuls7 at each milk feeding1 given in eight feedings4 ,this may be given as milk1 hot or cold1 or it may be made into cocoa1 soup1 ice cream1 junket1 or on the cereal4 ,,liquid ,,diet ,milk4 ,cream4 ,buttermilk4 ,whey4 ,koumiss4 ,zoolak4 ,fermillac4 ,albumenized fruit juices1 egg1 and orange juice4 ,milk shake4 ,broths 7chicken1 beef1 mutton or clam71 reenforced with lactose or egg or given plain4 ,proprietary infant foods4 ,cream soups1 beef juice1 liquid peptonoids1 panopepton4 ,orangeade4 ,lemonade4 ,eggnog4 ,milk punch4 ,malted milk4 ,malted milk shake4 ,albumenized milk4 ,strained gruels 7except oats74 ,cream1 egg and vichy4 ,chocolate malted milk4 ,milk gruels4 ,,soft ,,or ,,semi-,,solid ,,diets ,eggs--creamed1 soft-cooked1 poached1 custards1 baked custards4 ,toast--milk or cream toast4 ,gelatin--meat1 fruit1 or wine jellies4 ,junkets--plain1 egg1 or cocoa4 ,cereals--fine1 strained cereals1 except oats4 ,rice--boiled or in custard4 ,tapioca--custard4 ,baked or mashed potato4 ,cornstarch or arrowroot pudding4 ,ice cream4 ,meat is not given until convalescence is established1 and then in only the most digestible form1 such as rare beefsteak or lamb chop or a small piece of broiled breast of chicken4 ,,diet ,,list ,,used ,,in ,,high ,,calorie ,,diets ,,for ,,typhoid ,,fever ,time ,material ,amount ,calories ---------------------------------------- ----------------------------- #f ,a4,m4 ,hot milk #d oz4 #gh ,cream #b oz4 #gf ,lactose #a_/b oz4 7#ae gm47 #fj #h ,a4,m4 ,milk #c oz4 #ei ,water #c oz4 ,cocoa ,cocoa #b tsp4 #ce ,cream #a oz4 #ch ,sugar #b tsp4 #dj ,lactose #a_/b oz4 7#a tbs47 #fj ,egg #a #fj ,toast #a slice 7well moistened7 #gc ,butter #a_/b oz4 #gc #aj ,a4,m4 ,buttermilk #f oz4 #ef #ab ,m4 ,cream of pea soup #f oz4 #cjj ,mashed potato #bj gm4 #bh ,toast #a slice #gc ,butter #bj gm4 #hd ,coffee and milk #c oz4 each #ei ,cream #b oz4 #gf ,sugar #b tsp4 #dj ,lactose #bj gm4 #hj ,orange juice #c oz4 #ch #c ,p4,m4 ,orange juice ,egg #a #fj and egg ,lactose #cj gm4 #abj #e ,p4,m4 ,farina #c oz4 #ajb ,milk #b oz4 #ei ,cream #b oz4 #gf ,lactose #bj gm4 #hj ,egg #a #fj ,apple sauce #a oz4 #cj ,cream #a oz4 #ch ,cocoa #f oz4 #ajh or ,tea and #c oz4 #j ,milk #c oz4 #gh ,sugar #b tsp4 #dj ,toast #a slice #gc #g ,p4,m4 ,gruel #d oz4 #ajb ,cream #b oz4 #gf ,lactose #ae gm 7#a_/b oz47 #fj #i ,p4,m4 ,broth #f oz4 #ah ,egg white #a #ac #ab ,m4 ,milk #d oz4 #gh ,cream #b oz4 #gf ,lactose #bj gm4 #hj #c ,a4,m4 ,milk or #d oz4 #gh ,malted milk #a tbs4 #eh ,cream #b oz4 #gf ,lactose #bj gm4 #hj ,total calories #cade ,advantages of ,newer ,treatment4--,a marked difference is noticed in the patients treated by the old starvation diets and those given the high calorie diet4 ,dr4 ,coleman states#ajb that while the range of temperature is apparently unaffected1 the total duration of the disease is shortened in some instances by months through the shortening of convalescence4 ,he further states that certain symptoms which have hitherto been attributed to the specific action of the typhoid bacillus have been discovered to be due to faulty methods of treatment1 particularly to an inadequate or improperly balanced diet4 ,the various investigators who have made the study and treatment of this disease a lifework claim that the mortality from this disease has been tremendously reduced by the use of the high calorie diets which maintain the nutrition of the patient throughout the disease1 thus eliminating the horrors of the long1 tedious convalescence which tried the nerves and patience of the patient1 the nurse1 and the physician4 ,there is no doubt that so far as the administering of this diet is concerned it requires more effort on the part of the nurse than the old treatment of a glass of milk every two or three hours4 ,it is necessary for the nurse to be able to carry out the orders as expressed in the diet lists1 to be able to compute the proteins 7nitrogen71 fats1 and carbohydrates in a food or recipe4 ,but this is readily done by studying the tables given in the first section of this text4 ,she must likewise be able to recognize the symptoms as they arise4 ,in hospitals1 the urinalysis is made as a routine procedure4 ,in private cases the physician will either have the analyses made or expect the nurse to be able to make the simple tests4#ajc ,one of the greatest difficulties attending the administering of the high calorie diet is persuading the patient to take sufficient food for his needs4 ,the fluids are often more difficult to give in quantity than the more solid foods1 and it requires much tact on the part of the nurse to prevent a refusal of the necessary fluids4 ,however1 if the patient is possessed of even ordinary intelligence1 an explanation of the reasons for the large amount of food will as a rule be all that is necessary4 ,few individuals will willingly prolong an illness attended with the discomforts generally present in typhoid fever4 ,hemorrhage occurs in a certain percentage of cases of typhoid regardless of the diet1 whether it be a strictly milk diet or the high calorie diet just described4 ,the measures to combat them are essentially the same4 ,it is necessary to guard against excessive tympanites since the pressure therefrom against the ulcerated intestinal walls may cause perforation resulting in hemorrhage4 ,lactose at times causes an evolution of gas as do fats under certain circumstances4 ,hence it is necessary to follow symptoms and watch the stools in order to determine which food material is to blame for the tympanites and reduce the allowance of that food in the diet4 ,idiosyncrasies against ,milk4--,certain individuals manifest an inability to take milk4 ,this may be real or imaginary4 ,when it is a true idiosyncrasy1 it may be found necessary to substitute some other food for the milk in the diet1 but great care should be taken to determine the real character of the disagreement before eliminating so invaluable a food from the diet4 ,when the disagreement proves merely a distaste for milk1 some of the different methods used in disguising it1 such as flavoring or coloring1 may be practiced4 ,otherwise1 it is well under the circumstances to use some of the pre-digestive methods in order to increase its utilization4 ,it is well to emphasize the value of accurate data on this subject as it is exceedingly difficult to administer a high calorie diet without milk in some form4 ,essential ,points4--,thus the dietary in typhoid fever is seen to be the most important part of the treatment4 ,a careful study of the tables will enable the nurse to do her part in nourishing the patient4 ,it is necessary that she be able to compute the nitrogen1 carbohydrates1 and fats in a diet and arrange these constituents in such a way as to give the desired amount of each in the dietary and in a form acceptable to the patient4 ,,summary ,rate of ,metabolism is greatly increased in typhoid fever even over other febrile conditions1 not only on account of the elevation and duration of the fever1 but also on account of the activities of the specific bacteria in the intestinal tract which differentiate this disease from other febrile conditions4 ,energy ,expenditures and ,requirements of the body in typhoid fever1 on account of the character of the disease1 are much greater than those of the normal individual and must be met by an increase in the diet if the body is to be saved from destruction4 ,the ,bowels4--,diarrhea develops during any period of the disease due to excess amount of fat or to a disagreement of some of the other food constituents4 ,it is advisable to cut down the allowance of cream temporarily and to watch stools and other symptoms for evidences of dietetic errors4 ,hemorrhage must be guarded against by eliminating1 as far as possible1 all substances liable to cause an excessive gas formation in the intestines4 ,absorption of ,food is as a rule good4 ,the patient is usually able to handle a large quantity of food provided it is judiciously administered with a due regard to the symptoms manifested at the time4 ,simplicity of ,diet is absolutely essential4 ,all the materials must be selected carefully according to the physician's orders and prepared with the greatest care in order to prevent digestive disturbances4 ,high ,calorie ,diet is one in which the fuel value of the food ingested meets or exceeds the energy expenditures of the patient4 ,foods composing the diet are1 milk and eggs for the proteins1 with carbohydrates and fats in their simplest and most digestible form to balance the diet4 ,administering a ,high ,calorie ,diet is accomplished successfully provided the nurse exercises care with regard to the symptoms arising from time to time4 ,these must be carefully noted and reported to the physician1 for in this way only is it possible to give a sufficient quantity of food to cover the excessive breaking down of the body due to the disease4 ,fluid ,diet is at times necessary since certain patients cannot tolerate a high calorie diet1 but this is a point decided by the physician4 ,a fluid diet consists of fluids alone1 milk in particular1 with broths and fruit beverages as ordered4 ,the milk is given in definite amounts and at stated intervals4 ,milk ,diet is one consisting solely of milk or in which the bulk of the nourishment is furnished by milk4 ,it may be reenforced or not as desired4 ,lactose is the substance commonly used as a reenforcing agent4 ,it is impossible to cover the energy expenditures of typhoid fever with a milk diet even if it is perfectly administered1 but certain complications make it1 at times1 the only rational method of feeding4 ,the ,advantages of ,high ,calorie ,diet over other diets are distinctly noticeable in typhoid fever patients4 ,those treated by this method are more comfortable during the course of the disease and are saved a long1 tedious convalescence which has made the starvation treatment a thing of horror in the past4 ,the return to health is attended by a much better physical condition when the patients are well nourished than is possible when they are kept on practically a starvation ration4 ,the mortality from the disease has been materially lessened by the administration of the high calorie diet4 ,acidosis may develop in typhoid fever patients and must be guarded against4 ,the behavior of the fat in the body should be carefully watched and the amount reduced at the first evidence of acidosis4 ,at the same time an increase in the carbohydrates may assist in overcoming the condition4 ,this adjusting of the diet1 however1 is entirely in the hands of the physician4 ,the ,kidneys in typhoid fever patients are under a great strain1 chiefly on account of the increased rate of metabolism4 ,great care must be exercised in the dietetic treatment to prevent these organs from being overworked with a consequent development of nephritic conditions4 ,care of the ,mouth in any febrile condition is important1 but especially so in typhoid fever1 where the disease itself causes a most unpleasant taste in the mouth4 ,this prevents the taking of nourishment with any degree of comfort1 hence the mouth should be cleansed before and after each feeding4 ,any of the aseptic mouth washes may be used4 ,thirst may be relieved by plain or carbonated waters1 fruit beverages1 and crushed ice4 ,when in certain complications the fluids in the diet are in a measure restricted1 ice is used and water is given in spoonful doses4 ,this1 however1 is the exceptional1 rather than the ordinary state of affairs4 ,increasing the ,diet after a fluid diet must be made with great care in order to prevent a relapse4 ,following the high calorie diet the increase is simple4 ,the patient passes from the prescribed foods to meat with apparently no effort4 ,the increase should not be made1 however1 until convalescence is firmly established4 ,reenforcing the ,diet4--,on account of the great increase in the rate of metabolism and because of the difficulty of furnishing the requisite number of calories in the diet1 reenforcing agents such as lactose1 eggs1 some forms of casein1 or beef preparations are used4 ,idiosyncrasies against certain foods are1 at times1 manifested by patients4 ,efforts must be made to determine whether they are real or imaginary before eliminating any food which may be of importance to their future welfare4 ,,problems 7a7 ,give a sample diet order1 using liquids only4 ,raise the fuel value of the diet from #bjjj to #cjjj calories4 7b7 ,formulate a diet order1 using the high calorie diet1 fuel value #cejj calories4 ,,footnotes3 #if ,warren ,coleman1 ,university and ,bellevue ,hospital ,medical ,college1 ,visiting ,physician1 ,bellevue ,hospital1 ,new ,york ,city4 #ig ,diet in ,typhoid ,fever1 by ,warren ,coleman1 ,journal of ,american ,medical ,association1 ,oct4 #i1 #aiji1 ,vol4 ,,liii4 #ih ,diet in ,typhoid ,fever1 by ,warren ,coleman1 reprint from ,journal of ,american ,medical ,association1 ,june #i1 #aiji4 #ii ,determined by calorimeter observation from the ,russell ,sage ,institute of ,pathology in affiliation with the ,medical ,division of ,bellevue ,hospital1 under ,warren ,coleman and ,eugene ,du,bois4 #ajj ,american ,journal of ,medical ,sciences1 ,january1 #aiab1 by ,warren ,coleman4 #aja ,f4 ,p4 ,kinnicut1 ,diets ,used in the ,presbyterian ,hospital1 ,new ,york ,city4 #ajb ,journal of ,american ,medical ,association1 ,aug4 #d1 #aiag4 #ajc ,see urinalysis1 p4 #cbc4 ,,chapter ,,xv ,,diseases ,,of ,,the ,,respiratory ,,tract ,,tuberculosis1 ,,pneumonia1 ,,and ,,tonsillitis ,,tuberculosis ,the dietetic treatment for tuberculosis must1 as in any other pathological condition1 depend largely upon the general condition of the patient1 and the symptoms manifested at the time4 ,character of ,disease4--,the disease may have reached an acute stage in which the rise of temperature is marked and the progress of the tuberculous symptoms rapid1 or it may be found to be an old chronic condition in which the progress is slow4 ,again1 the patient may be found to be suffering from a tuberculosis which is neither acute nor very slow4 ,each of these stages requires slightly different treatment which1 however1 for the main part is much the same4 ,individuals having an incipient form of tuberculosis have been known to develop an acute form of the disease upon being subjected to a strenuous treatment for some other and entirely different condition4 ,this has been especially noticeable in certain individuals to whom the starvation treatment is given4 ,dietetic ,treatment in ,acute ,stage4--,the dietetic treatment of the acute tuberculosis under such circumstances must necessarily be adapted to that of the original disease for which starvation was believed to be necessary4 ,the forbidden foods must still be omitted from the dietary1 but in these cases it is found advisable not to prolong the starvation treatment but to substitute foods which will do the least harm under the circumstances4 ,this is necessary to cover the energy requirements of the body and to make good the tissue wasted through the development of the specific disease4 ,dietetic ,treatment in ,chronic ,stage4--,the diet for tuberculosis has been so widely discussed and so universally used that a few words only seem necessary here4 ,one of the chief points to be emphasized is the danger arising from gastro-intestinal disturbances4 ,the digestive apparatus of the tuberculous individual is more apt to be impaired1 so that any undue exertion required to digest a meal is likely to bring about disturbances more or less serious in character4 ,method of ,administering ,diet4--,for this reason it is no longer the custom to stuff the patient in an effort to overcome the inevitable tissue waste1 since such treatment in many cases defeats the end for which it was intended1 bringing on acute indigestion1 or at times diarrhea1 which might readily cause a greater loss of body weight than could possibly be produced by the surplus food given4 ,adjusting the ,diet4--,more and more is it coming to be understood that the diet must be adjusted to suit the individual4 ,three wholesome meals a day are insisted upon1 with lunches given between the morning and midday meal and during the course of the afternoon4 ,many patients are found to sleep better after they have partaken of a light lunch1 consisting of hot milk1 malted milk1 or like beverages and crackers1 so that this third meal is added to the other five4 ,in this way the individual suffering with tuberculosis is assured of an efficient diet to meet the needs of the body without overburdening the digestive apparatus or overtaxing the excretory organs4 ,the increased metabolism taking place in such patients1 due both to the specific bacteria and to the febrile condition1 is1 as far as possible1 provided for4 ,schedule of ,diets4--,the following dietary regime may be useful in formulating menus for tubercular patients3 ,,breakfast ,fruits4 #e oz4 cereals with cream4 #a or #b eggs1 simply prepared to prevent indigestion4 #b slices of bacon1 ham2 fish cake or chop4 #b slices of toast or crusty rolls with butter4 ,coffee1 tea1 or cocoa1 with or without cream4#ajd ,,lunch ,vegetable or cream soups4 ,cold meat1 lamb chops1 oysters1 or fish4 ,baked white or sweet potato4 #a green vegetable1--greens1 cabbage1 spinach1 or string beans4 ,stewed fruit or baked apple4 ,rice or tapioca pudding4 ,tea4 ,bread and butter4 ,at the end of the meal one glass containing two-thirds milk and one-third cream4 ,if the latter disturbs the digestion reduce the amount temporarily1 or add one-half the contents of a tube of peptonizing powder1 or one-quarter of a glass of limewater4 ,,dinner ,meat1 lamb1 mutton1 chicken1 duck1 game1 or fish4 ,mashed or creamed potatoes4 #a or #b green vegetables4 ,simple salads4 ,simple desserts consisting of puddings1 custards1 wine or fruit jellies1 ices or ice cream1 sponge cake or angel food cake4 ,the milk and cream is taken at the end of the meal as directed above4 ,,lunches #aa ,a4,m41 #d ,p4,m41 #i ,p4,m41 consisting of milk1 malted milk1 junket1 buttermilk1 albumenized broth1 albumenized fruit juices1 cream1 egg1 and vichy1 eggnogs1 served with crackers or sponge cake2 cereal gruels and raw eggs taken with water1 milk1 or sherry may likewise form a part of this diet1 since the nourishment in them is both concentrated and palatable4 ,use of ,eggs4--,the old method of forcing the patient to eat a dozen or more raw eggs a day is no longer used1 but three or four a day will be of undoubted value to the patient1 provided they agree4 ,there are patients1 however1 with whom eggs act almost as a poison1 and in these cases it is decidedly unwise to force them4 ,use of ,milk4--,milk is to be used abundantly4 ,if it should disagree1 it may be peptonized or modified with limewater4 ,at any rate1 every effort should be made to enable the patient to drink at least one quart a day1 and more1 if possible4 ,if it fails to agree even when so treated1 it should be abandoned1 since the discomfort caused under the circumstances is more detrimental to the welfare of the individual than any benefit which he may gain by the small amount which may be absorbed4 ,high ,calorie ,diet4--,as long as the patient is in bed the diet cannot be as full as it is made when he is up and about1 as the body is then using more material to provide for the extra exertion and needs more food to replace that which has been utilized4 ,consequently the high calorie diet#aje will be found as a rule sufficient4 ,as soon as the patient is able to receive more food without incurring digestional disturbances1 it should be supplied1 keeping ever in mind the danger of its upsetting his digestion4 ,advice to ,patients4--,the patient must be impressed with the necessity for living a simple1 wholesome life1 free from excesses of all kinds4 ,the need for a regular regime in the beginning must be strongly emphasized4 ,too strenuous exercise and the consequent over-fatigue at times completely overcome all the good which has been accomplished in weeks or even months of studied effort1 so that rest is an essential part of the tuberculous regime4 ,the patient should sleep from eight to ten hours out of every twenty-four1 and if this sleep is taken in the open1 that is1 in a tent or on a sleeping porch1 the benefits derived therefrom are inestimable4 ,the ,bowels4--,the bowels should move every day1 even if some gentle laxative or an enema has to be used to bring about the desired result4 ,in a majority of cases1 mineral oil or bran muffins1 prunes1 raisins1 and figs prepared with senna will be entirely sufficient1 however1 and these substances are much less harmful than drugs1 for the habit of taking purgatives becomes a fixed one in a short time1 and is especially liable to become so when the patient is forced1 by reason of the sedentary life1 to depend on some such measures4 ,massage4--,massage has been found beneficial in many cases1 giving the needed exercise to the body1 which it is otherwise unable to obtain4 ,,chronic ,,tuberculosis ,in chronic tuberculosis1 the patient should be instructed in the care necessary for his protection4 ,he should be advised to report to the physician any symptoms occurring during the course of the disease1 especially any hemorrhage4 ,he must be reassured of the chances of recovery1 even after hemorrhage has occurred4 ,it is not well to encourage the habit of taking the temperature or weighing daily1 since the knowledge of the fluctuations which inevitably occur in these conditions may worry the patient to such an extent as to interfere with his final recovery4 ,rest1 ,sleep1 and ,fresh ,air4--,moderation in physical exertion1 wholesome food at regular intervals1 plenty of rest and sleep1 preferably in the open1 and an effort made to look forward to a complete recovery will go far toward bringing about the desired result4 ,the tuberculous patient who sets his mind on recovery1 refusing to be discouraged by the numerous setbacks which may from time to time occur1 has a much greater chance of living a long and useful life than the patient who makes no effort in this direction4 ,reenforcing the ,diet4--,the following reenforced foods have been found valuable in the diet for tuberculosis1 especially in those cases which are confined to bed and in which the effort to eat causes more or less gastric distress3 ,milk1 whole milk1 milk and cream1 milk diluted with ,apollinaris water1 peptonized1 modified milk1 reenforced with egg or egg white or reenforced with one to four tablespoonfuls of lactose1 malted milk1 buttermilk1 cream1 egg1 and vichy1 milk shake1 milk punch1 malted milk shake1 chocolate or cocoa malted milk1 albumenized fruit juices1 egg and orange1 egg and wine1 reenforced1 if desired1 with lactose1 albumenized broths1 proprietary infant foods1 such as ,eskay's ,food1 ,nestle's ,food1 ,mellin's ,food1 ,racahout1 cream soups reenforced with lactose or egg1 junkets1 and ice cream4 ,,pneumonia ,the diet in pneumonia is of considerable importance1 since in this condition the strength of the patient is taxed by reason of the character of the disease1 and the only means of attaining endurance to carry him through this trying period is by providing proper nourishment4 ,dietetic ,treatment4--,the same general outline of diet is used as in acute infectious fevers1 milk forming the basis of the diet4 ,the patient is given an abundance of water and other beverages in addition to the other fluid foods to relieve the thirst which is so often a common symptom in this disease4 ,it is sometimes found advisable1 however1 on account of the vomiting which may occur1 to give a more concentrated form of nourishment1 in which case liquid peptonoids1 trophonine1 and panopepton furnish a form of nourishment which is both strengthening and stimulating in character1 and for these reasons particularly desirable4 ,freidenwald and ,ruhraeh advise against the use of starches and sugars in most cases of pneumonia4 ,daily ,diet ,schedule4--,the same fluid diets used in acute fevers and administered at two-hour intervals are advisable here4 ,the following regime is used in pneumonia3 #f ,a4,m4 #f oz4 malted milk4 #h ,a4,m4 #f oz4 cocoa4 #aj ,a4,m4 #d oz4 oatmeal or cornmeal gruel with #b oz4 cream4 #ab ,m4 #f oz4 chicken broth reenforced with #a egg white4 #b ,p4,m4 #f oz4 malted milk chocolate4 #d ,p4,m4 #f oz4 albumenized orange juice4 #f ,p4,m4 #f oz4 chicken or beef broth1 reenforced with egg white4 #h ,p4,m4 #f oz4 hot milk4 ,night feeding consisting of milk1 malted milk1 or reenforced broth may be given at #ab ,m4 and #d ,a4,m4 if patient is awake4 ,the above diet may be varied by adding some of the beverages mentioned in the diet for tuberculosis or fevers4 ,convalescent ,diet ,schedule4--,as the acute symptoms subside and convalescence advances1 the following diet may be instituted3 ,i ,breakfast #c to #d oz4 cereal gruel with #b oz4 cream4 #a soft-cooked egg4 #aj3cj ,a4,m4 #f oz4 chicken broth1 reenforced with egg1 or #f oz4 albumenized orange or grape juice4 #a ,p4,m4 #f oz4 oyster soup with rolled crackers4 #a_/d cup wine jelly with #a tbs4 cream4 #a glass 7#f oz47 milk--#b parts milk1 #a part cream4 #c ,p4,m4 ,milk shake 7#d oz4 milk1 #a egg white74 ,supper #d oz4 farina with #a oz4 cream4 #f oz4 cocoa4 #i ,p4,m4 #f oz4 malted milk4 ,hot milk1 broth1 or malted milk may be given during the night at #ab or #d ,a4,m4 if patient is awake4 ,,ii ,breakfast #d oz4 orange juice on cracked ice4 #c or #d oz4 strained oatmeal with cream or butter4 #a slice soft toast4 #f oz4 cocoa4 #aj ,a4,m4 #a soft-cooked egg on toast4 #f oz4 milk4 ,dinner #f oz4 cream of celery soup4 #b oz4 rice4 #d oz4 custard 7soft or baked74 #f oz4 milk or cocoa4 #c ,p4,m4 #e oz4 cream1 egg1 and vichy4 ,supper #a soft-cooked egg4 #a small baked potato4 #f oz4 cocoa or malted milk4 ,,iii ,breakfast ,stewed prunes4 #c or #d oz4 cream of wheat with #a oz4 cream4 #a soft-cooked egg4 #a slice of toast with butter4 #f oz4 cocoa or milk4 #aj3cj ,a4,m4 ,eggnog 7#a egg1 #d oz4 milk1 #b oz4 cream1 #a tbs4 whisky or sherry wine74 ,dinner ,cream of spinach soup4 #b oz4 mashed potatoes4 #b oz4 green peas4 #a slice toast with butter4 #b oz4 rice or tapioca custard4 #c ,p4,m4 #f oz4 albumenized fruit juice4 ,supper #a slice toast4 #a poached egg4 #f oz4 cocoa or hot milk4 #b or #c oz4 stewed fruit or prune whip4 ,the diet may be reenforced with lactose and meat added only when convalescence is well established4 ,tuberculosis ,nursing4--,the nurse must keep in mind that the lungs are in a condition more or less out of commission1 and their work of excretion is forced upon the kidneys4 ,for this reason1 as well as on account of the increased strain upon the heart1 it is necessary to keep the diet light and avoid all foods which may in any way exert an unfavorable influence upon either the kidneys or the heart4 ,milk ,diet4--,a strict milk diet has been found necessary in certain cases of pneumonia1 but this is used only while the febrile condition lasts1 after which the diet is gradually increased1 as in the case of acute nephritis and in diseases of the heart1 to meet the needs of the individual4 ,,tonsillitis ,dietetic ,treatment4--,the diet in this condition is much the same as that used in other acute febrile conditions1 that is1 a fluid diet1 the basis of which is1 as a rule1 milk4 ,the development of nephritis and certain cardiac symptoms at times follow attacks of tonsillitis1 and for this reason the urine must be examined frequently and the diet carefully adjusted to avert1 if possible1 this danger4 ,when acute nephritis does follow the attack of tonsillitis1 the diet must necessarily be adjusted to meet that condition rather than that of the original disease4 ,special ,diets4--,the ,mosenthal diet1 and at times the ,karell ,cure1 is used with more or less success4 ,this1 however1 is adjusted by the physician4 ,it remains for the nurse to report any unfavorable symptoms as soon as they occur1 and to carry out the line of dietetic treatment deemed advisable by the physician4 ,,summary ,,tuberculosis ,form4--,acute and chronic in character4 ,the chief aim of the treatment in the former is to prevent its development into a chronic form4 ,rest4--,sleep1 preferably in the open air1 in a tent or on a sleeping porch4 ,proper ,surroundings should be striven for4 ,the patient should be kept tranquil in mind and body1 free from disturbing worries and assured of the possibility of recovery with proper care4 ,diet should be adequate without being too abundant2 stuffing the patient is no longer considered necessary1 in fact it is believed that forcing the eating of large quantities of eggs1 etc41 defeats its own ends1 upsetting the digestion and causing a disgust for food almost impossible to overcome4 ,gastro-intestinal ,disturbances are apt to develop as the disease progresses4 ,these are treated as in other conditions so complicated1 except that the period of starvation must necessarily be limited on account of the metabolic waste already taking place from the disease itself4 ,,pneumonia ,the ,lungs1 as in pulmonary tuberculosis1 are the seat of infection and are temporarily hampered in their work of excretion4 ,the ,kidneys bear the brunt of the extra work caused by the impairment of the lungs1 consequently all unnecessary work must be spared these organs if they are to be prevented from being overtaxed4 ,nephritis is one of the complications apt to develop when the kidneys are not sufficiently strong to carry on their own work and that generally done by the lungs4 ,the ,heart4--,cardiac symptoms are also likely to develop during attacks of pneumonia and make the disease one to be dreaded and guarded against4 ,the ,diet4--,the dietetic treatment in pneumonia is like that used in acute infectious diseases1 fevers in general1 fluids constituting the form of diet and milk the chief food1 as long as there is an elevation of temperature4 ,,tonsillitis ,the ,heart4--,as in pneumonia1 the development of cardiac symptoms must be guarded against4 ,these symptoms may not develop at once but show later during or after convalescence4 ,the ,kidneys4--,nephritis also develops in some patients and the treatment is directed as far as possible to prevent its developing into a chronic form4 ,dietetic ,treatment is the same as used in acute infectious conditions1 fevers of short duration1 taking care to institute the diet for acute nephritis should the patient show evidences of this disease4 ,,problem ,write a diet order for a tuberculous patient weighing #ace pounds1 allowing #cjjj calories and fifty per cent4 of the protein to be derived from animal sources4 ,,footnotes3 #ajd ,the addition of cream to coffee produces acute indigestion in certain individuals1 hence the nurse must be governed by this point in formulating the diet4 #aje ,see ,high ,calorie ,diet for ,typhoid ,fever1 ,chapter ,,xiv4 ,,chapter ,,xvi ,,dietetic ,,treatment ,,before ,,and ,,after ,,operation ,,preoperative ,,feeding ,the dietetic treatment which is essential before and after operations is deserving of attention here1 since it constitutes one of the points so frequently overlooked or slighted4 ,as a rule the treatment depends 7#a7 upon the character of the disease for which surgical intervention is necessary1 and 7#b7 upon the general health and physical condition of the patient in question4 ,preparatory ,treatment4--,in many cases it is found to be advisable to build up the patient before subjecting her to the shock of an operation1 and the more serious the operation the more necessary this building-up process4 ,the character of the disease also has much to do with the preliminary diet4 ,in certain pathological conditions involving the gastro-intestinal tract1 for example1 the patient comes to the surgeon after medical treatment has failed to give relief and surgical intervention is necessary to save life4 ,the body is found to be in a condition bordering on starvation1 anemic and exhausted from insufficient nourishment4 ,the functions of the blood-making organs have become out of gear1 as it were1 and the blood consequently is deficient in one or more of its essential elements4 ,for such patients it is wise to attempt to reenforce and strengthen their bodies before operation1 that they may have more endurance to withstand the shock which is more or less unavoidable4 ,adjusting the ,diet4--,in any case where preliminary diet is prescribed the condition for which the operation is necessary determines the nature of the diet2 for example1 if the operation is to be upon the kidney1 the diet beforehand would naturally be in the nature of a nephritic one to save the diseased organ unnecessary work4 ,if the stomach or intestinal tract required surgical care1 the diet would necessarily be formulated to meet the particular needs of the organ in question1 an analysis of the stomach content furnishing the keynote of the diet4 ,in any case the food must be simple in character and well prepared4 ,all food in any way liable to bring about indigestion should be studiously avoided4 ,habits4--,the habits of the patient must be regulated so that she may not overdo2 at the same time1 gentle exercise may be the very thing needed to give an impetus to the appetite and thus assist in the adding of strength for the approaching ordeal4 ,many patients respond readily to a change of air and scene and frequent small meals instead of a few large ones1--a lunch in the mid-morning and mid-afternoon hours1 consisting of a glass of milk and a cracker or malted milk chocolate or reenforced fruit juices4 ,a cup of warm milk before retiring induces the much-needed sleep1 hence is advisable under the circumstances4 ,the ,bowels4--,the bowels must be kept open4 ,coarse bread such as that made from bran or graham flour is advisable4 ,prunes and figs cooked with senna leaves are likewise simple laxatives which are both palatable and effective4 ,for stubborn cases of constipation it is often found that a teaspoonful of a conserve made with a third of a pound each of raisins1 prunes1 and figs ground fine1 with an ounce of senna leaves added1 taken at bedtime and before breakfast1 will overcome the condition and make the patient more comfortable and the general health better4 ,preliminary ,light ,diet4--,the day before the operation the diet must be light2 the intestinal tract must not be filled with a food mass which is difficult to get rid of4 ,on the morning of the operation the patient is given no food if the operation is to be performed at an early hour1 otherwise a cup of tea1 coffee1 weak cocoa1 or broth with a cracker is given4 ,some physicians give a glass of milk at this time1 while others do not4 ,it is the physician who must decide the question if there is any doubt about it4 ,the stomach must be empty before administering the anesthetic4 ,in certain emergency operations when it has been impossible to prepare the patient ahead1 the difficulties attending the administering of the ether are sometimes greatly increased4 ,the cleansing of the stomach and intestinal tract oftentimes eliminates or materially decreases the nausea and vomiting which so often forms one of the most dreaded sequences of the operation4 ,for this reason many surgeons require the patient to be given lavage before leaving the operating room4 ,total ,abstinence4--,no food is given for twenty-four hours following the operation 7#a7 on account of the nausea and vomiting which so often follows the giving of an anesthetic--ether particularly--and 7#b7 because the entire organism is better for a complete rest4 ,routine ,treatment4--,the routine treatment in uncomplicated cases is rest1 then water1 very hot or iced1 or carbonated1 or vichy in spoonful doses1 then albumen water1 broth1 etc41 then milk1 buttermilk1 koumiss1 etc41 after which the semi-solids1 etc41 until a normal diet is reached4 ,after a week or more the character of the operation certainly determines the dietetic treatment4 ,to quote ,dr4 ,thomas ,s4 ,brown1#ajf ,to give the same diet after pyloroplasty1 gastro-enterostomy1 gall bladder operation1 or gastric resection as we would after operations for fracture of the thigh or cancer of the breast shows a basic ignorance of the pathologic physiology of the former group of cases4 ,we should remember that hyperacidity remains long after the underlying cause has been removed and it is tempting providence1 to say the least1 to ply these patients with tomato soup1 salad dressing1 and coarse food in the early stages of their convalescence4 ,character of ,diet4--,it must be kept in mind that the character of the diet is of vital importance1 especially in the after-treatment of operations upon the stomach4 ,in gastro-enterostomy1 for example1 the food mass passes from the stomach directly into the upper part of the small intestine through the new opening4 ,thus the semi-liquid food highly acid in character comes in direct contact with the delicate intestinal walls which are accustomed1 not to the acid1 but to a neutral or alkaline medium4 ,adjusting ,diet to ,disease4--,thus it is demonstrated that unless care is used in selecting the diet this portion of the intestinal tract will be injured2 hence the nurse must understand which foods are liable to stimulate an excess flow of acid in the stomach and avoid them4 ,she must also keep in mind that the foods given must be in a semi-liquid or very finely divided condition1 since the mechanical efforts made by the musculature of the gastric organ act as a direct stimulant to the secretory cells of that organ4 99 99 99 99 99 ,much of the responsibility thus rests upon the nurse whose business it is to administer the diet4 ,the efforts of the best surgeon in the world may be entirely overcome by a careless1 thoughtless1 or ignorant nurse4 ,rectal ,feeding4--,in some cases it is found necessary to nourish the patient more than is possible by mouth4 ,this is especially so with emaciated and very weak patients and for those who have undergone operations upon the mouth or throat and in some of the above-mentioned stomach cases when the passage of any food over the newly-operated-upon surfaces is inadvisable4 ,in these cases rectal feeding is resorted to and from two to three nutrient enemas#ajg alternated with saline enemas are given daily4 ,under ordinary conditions when the patient has not been operated upon for gastro-intestinal disorders1 gall bladder or kidney diseases1 the dietetic regime is as follows3 ,postoperative ,feeding4--,first day3 starvation1 a little hot or cold water or carbonated water may be given if there is no nausea or vomiting4 ,if nausea or vomiting persists1 a few spoonfuls of champagne or clam broth or juice will often check or relieve it entirely4 ,fluids alone must be given during the first forty-eight hours after the operation4 ,when stimulation is necessary1 albumen water or coffee containing a spoonful of brandy#ajh will be found useful4 ,when nausea entirely disappears1 well-skimmed broth milk1 clam or oyster broth1 buttermilk1 koumiss1 malted milk1 may be given4 ,a gradual return to the normal diet is made1 adding soft toast1 soft-cooked eggs1 junket1 ice cream1 meat1 wine1 or fruit jellies before solid food is introduced into the dietary4 ,after-care in ,feeding4--,care must be observed to prevent indigestion after almost any operation1 but especially after abdominal operations there is a great tendency to form gas1 hence anything which in any way increases the tendency may bring about a condition of extreme discomfort and even acute pain to the patient4 ,for this reason it is unwise to follow too closely the desires of the patient as to the food to be eaten2 for example1 corned beef and cabbage may be the thing of all others desired by the patient1 but it would be the height of folly to risk such a meal until all danger of digestional disturbances is at an end4 ,it is wiser to avoid such disturbances than to trust to relieving them after they occur4 ,the digestion of even a perfectly normal individual is at a disadvantage when that individual is deprived of outdoor exercise4 ,how much more so will it be when the entire organism is taxed by the ordeal through which it has just passed4 ,convalescence is never hastened by imprudent eating1 and a condition as bad as the original may be brought on by lack of care on the part of the one whose business it is to feed the patient4 ,,conditions ,,requiring ,,special ,,diets ,diet ,after ,appendicitis4--,after a simple operation for appendicitis the same regime is carried out as in stomach and intestinal operations3 fluids on the second day1 soft diet on the third1 and solid food of the simplest character and prepared in the simplest way may be given on the fifth and sixth days4 ,when1 however1 the operation has been of a more serious character1 for example1 when there was pus formation or a gangrenous appendix1 the feeding by mouth must not be instituted for five days or more1 nutrient enemas being used instead4 ,patients have been known to die from exhaustion after operations upon the stomach and intestines1 not on account of the operation but on account of the lack of reserve power and endurance to carry them through the ordeal without a sustaining diet to overcome it4 ,under the circumstances ,dr4 ,f4 ,ehrlich#aji advises the following routine method3 ,so soon as the nausea from the anesthetic has worn off the patient gets tea1 red wine1 and gruel2 on the day after the operation he is given sweetbreads in bouillon even if it nauseates him2 if the nausea is persistent1 his stomach is washed4 ,on the second day finely chopped cooked squab1 chicken1 or veal1 is added2 on the third day1 beef1 potato puree and cakes2 on the fourth1 chopped 7raw7 ham1 soft zwieback1 and soft-boiled eggs4 ,on the fifth1 white bread and spinach4 ,after the seventh day the meat is not chopped1 and the patient returns gradually to normal diet4 ,the bowels are regulated by oil enemas4 ,diet ,after ,operation upon ,gall ,bladder or ,liver4--,the dietetic treatment in these cases is like that of any other abdominal operation except for the character of the food4 ,fats are not well handled by the body of such individuals and should be eliminated as far as possible from the diet4 ,broths must be skimmed carefully to remove fat1 and milk when given should be skimmed or given in the form of buttermilk or koumiss4 ,diet ,after ,operations upon the ,kidneys4--,the diet administered after operations upon these organs is logically one in which those foods which are entirely dependent upon the kidneys for their elimination are restricted4 ,in a former chapter the fate of the foods in metabolism was explained2 the protein foods were seen to be the ones leaving the body chiefly by way of the kidneys and for this reason in the diet after operations upon these organs1 as well as in that administered in disturbances affecting their functioning powers1 this food constituent1 the protein of meat in particular1 must necessarily be restricted4 ,the upsetting of the nitrogen equilibrium is for so short a period after kidney operations that this feature need not be considered here4 ,the diet under the circumstances is essentially the same as that given during acute attacks of nephritis4 ,,summary ,factors ,affecting ,diet before and after operations must be considered under two heads1 namely1 the character of the disease for which the operation is considered necessary and the general physical condition of the patient at the time4 ,emaciation and ,anemia are often encountered in patients having certain gastro-intestinal disturbances for which surgical intervention was found to be necessary4 ,at times a preliminary up-building treatment is required before it is considered wise to submit the patient to the shock of so serious an operation4 ,adjusting the ,diet according to the character of the disease for which the operation is to be performed is most important4 ,it is not always possible to build up the body beforehand1 but in many cases it is necessary to make the effort4 ,at times the reenforcing of the diet and a certain amount of gentle massage will enable the patient to pass through the trying ordeal more comfortably than would otherwise be possible4 ,selecting the ,diet to conform to the character of the disease is as important a factor in the recovery of the patient as food itself4 ,this selection is left largely to the nurse1 consequently it is necessary that she should understand just which foods are indicated or contraindicated under the circumstances1 and adjust the diet after the abstinence period accordingly4 ,for example1 the diet fulfilling all the needs of a patient who has just undergone an operation for a broken leg might be highly injurious for a patient just operated upon for some disturbance of the liver or kidneys4 ,the diet given after must be essentially like that given just before the operation1 in order that the affected organ may have an opportunity to heal and return to its normal functioning power4 ,gastro-intestinal ,disturbances must be avoided1 both before and after the operation4 ,in the preliminary treatment1 when every effort is being made to increase the strength and endurance of the patient1 such disturbances do away with any gain brought about by judicious dieting4 ,after the operation1 attacks of indigestion not only cause pain and discomfort as a result of the gas formation1 but may cause symptoms far-reaching and even dangerous in their effects4 ,the diet1 then1 must be composed of the simplest food and prepared in the most careful manner1 the amount of food given at a time must be small--it is wiser to feed the patient oftener than to run the risk of indigestion by giving more than can be readily handled by the already taxed digestive apparatus4 ,the ,bowels must be kept open in the majority of cases4 ,peristalsis is stimulated by the giving of water and fruit beverages as soon as it is advisable to give anything by mouth4 ,reenforcing the ,diet is at times necessary in order that the patient's strength may be kept up4 ,in such cases lactose1 eggs and some of the predigested casein or beef preparations are found to be valuable4 ,before the ,operation the patient must be made ready to take the anesthetic4 ,this is done by preventing an accumulation of food in the intestinal tract4 ,the day before the operation1 then1 it is necessary to limit the diet materially by giving food in small amounts4 ,the light diets prescribed in acute conditions are as a rule suitable1 unless otherwise indicated4 ,the ,day of the ,operation a cup of tea1 coffee1 or broth may usually be given1 with a cracker1 unless the operation is to be performed early in the morning1 in which case the patient is given no food at all4 ,some physicians allow a glass of milk on the day of the operation1 but this is left entirely to the physician in charge4 ,after ,operation a period of total abstinence from both food and water is necessary in order not to increase or induce nausea and vomiting4 ,as soon as these symptoms subside1 unless otherwise indicated1 a certain amount of hot1 cold1 or carbonated water may be given4 ,after this1 albumen water may form the first nutrient administered4 ,milk1 broth and fruit beverages follow the giving of albumen water1 after which the semi-solids1 such as soft eggs1 gelatin and milk soups1 constitute the convalescent diet4 ,the ,character of the ,diet after the operation depends wholly upon the nature of the disease for which the operation was deemed necessary4 ,diet ,after ,gastro-enterostomy must be adjusted in order not to increase the acid content of the gastric organ1 otherwise the delicate mucous linings of the intestines would be subjected to direct contact with materials which are irritating in character1 owing to the fact that the mass passes through the new opening and has thus been deprived of the neutralizing agents found in the upper part of the intestinal tract4 ,under the circumstances milk1 albumen water and fine cereal gruels are the best foods from which to formulate the diet after the necessary period of abstinence and fluid diet4 ,after ,appendicitis1 as a rule1 no food is given for five days in cases where there has been a pus formation and the appendix gangrenous4 ,otherwise the routine treatment diet is given--water1 then albumen water1 followed by broth1 milk and fruit beverages1 fine cereal gruels1 etc4 ,after ,liver and ,gall bladder ,operations the character of the food must be considered4 ,the fats are not well handled in such conditions and must be avoided as far as possible4 ,broths must be well skimmed and the milk fat free4 ,buttermilk and koumiss are probably the most suitable forms in which to give milk in these cases4 ,after ,kidney ,operations the work of elimination through kidney must be limited as far as possible in such cases4 ,while it is impossible to rest the organ entirely1 the giving of a proper diet under the circumstances will do much toward relieving the strain placed upon it4 ,the protein foods1 with the exception of milk1 must be excluded from the diet4 ,the regime practiced in acute nephritis gives the most satisfactory results4 ,,problems 7a7 ,write a diet order for patient operated upon for gastric ulcer4 7b7 ,formulate diet to be used after a gall bladder operation4 7c7 ,outline diet used after operation upon the kidney4 ,,footnotes3 #ajf ,some ,gastro-intestinal ,notes1 ,the ,medical ,clinics of ,north ,america1 ,vol4 ,i1 ,no4 #a1 pp4 #aib-aic1 by ,thomas ,r4 ,brown1 ,johns ,hopkins ,hospital4 #ajg ,see ,formulas for ,nutrient ,enemas1 p4 #ade4 #ajh ,see ,albumen ,water with ,brandy1 p4 #ada4 #aji ,diet in ,health and ,disease1 p4 #eee1 by ,friedenwald and ,ruhraeh4 ,,chapter ,,xvii ,,urinalysis ,the importance of the kidney functions has been clearly demonstrated4 ,urine1 which is the fluid secreted by these organs1 is one of the most important sources of information1 not only as to the manner in which the body utilizes food in health1 but as an index to certain pathological conditions1 the processes of which are more or less indicated by the products excreted in the urine4 ,function of the ,kidneys4--,the kidneys1 as has already been stated1 furnish a means by which the greater part of the waste products of the body are eliminated and in addition to this function they adjust the salts in the body4 ,in an early chapter the function of the salts in food was explained4 ,a certain amount of these substances1 we know1 is absolutely necessary to carry on the work in the body1 but harm comes when a surplus is retained in excess of that which can be used in performing the various processes4 ,consequently the function of the kidneys to adjust the salts balance is by no means their least important one4 ,elimination of the ,toxins4--,the toxic substances manufactured in the body and those resulting from bacterial action upon unabsorbed proteins are likewise eliminated in the urine4 ,thus it can be readily understood how necessary it is to keep these organs in good repair1 that they may continue their work in an efficient manner4 ,it is necessary from a pathological standpoint for the nurse to understand the making of some of the simpler tests1 that she may simplify her own work and that of the physician4 ,excretion of ,carbon ,dioxide and ,water4--,we have already spoken of the combinations of carbon and hydrogen compounds4 ,these substances being oxidized1 the carbon dioxide produced is eliminated by way of the lungs and the water is excreted partly by way of the lungs and skin1 but chiefly by way of the kidneys4 ,oxidation and ,excretion of ,nitrogenous ,substances4--,when the nitrogenous substances are oxidized1 the used-up oxygen products are eliminated by the kidneys in the form of urea and more or less highly oxidized substances1 such as ammonia and other salts1 purin bases1 and creatinin4 ,uric ,acid1 the chief of the oxidation products of nucleoproteins1 is produced in the body and from food1 and is always in the urine1 being one of its normal constituents4 ,it is only when this substance is in excess in the urine that a pathological condition is indicated4 ,examination of the ,urine1 then1 is made for several different purposes3 7#a7 to ascertain whether the kidneys are doing their work properly2 7#b7 to find if the kidneys1 or any part of the urinary tract1 are either temporarily or permanently diseased2 7#c7 to be able to judge from the various substances in the urine whether there is any abnormal process taking place in the body4 ,tests4--,in the examination of the urine for the above purposes1 certain definite tests are made4 ,these tests differentiate between the abnormal and the normal4 7#a7 ,color4 7#b7 ,amount in twenty-four hours4 7#c7 ,odor4 7#d7 ,specific gravity4 7#e7 ,reaction1 acid or alkaline4 7#f7 ,albumen1 indican1 acetone bodies4 7#g7 ,sugar4 7#h7 ,microscopic examination for casts1 cells1 bacteria1 etc4 ,the ,color of normal urine varies1 especially with the amount voided4 ,the variations in color range from the pale straw color of individuals who are voiding large quantities to the deep lemon or amber of those who void much less4 ,pathological conditions are indicated to a certain extent by the color of the urine4 ,fevers heighten the color1 small quantities of blood cause a smoky appearance1 while bile changes the color of the urine to a greenish yellow4 ,precipitates in the ,urine4--,when the urine has been allowed to stand for a time there is sometimes a brick-red deposit due to the precipitate of urates4 ,this disappears upon heating and is not an evidence of any diseased condition4 ,turbidity of ,urine4--,the turbidity of fresh urine then is the only kind which need be considered1 since standing in the cold often brings about this condition1 due to the growth of bacteria and deposits of both phosphates and urates4 ,requirements in ,testing ,urine4--,urine to be tested should be fresh1 and when it is not possible to make the examination at once it should be preserved with chloroform1 or some other harmless preservative1 until ready to use4 ,bacteria in ,urine4--,the changes due to bacterial growth in the urine are manifested not only by the turbid character of the urine but also by the odor of ammonia4 ,the ,amount of ,urine4--,the amount of urine voided in twenty-four hours varies with the individual in health as well as in disease4 ,many individuals void a great quantity during the twenty-four hours1 chiefly because they drink a great quantity of water and other beverages4 ,the average amount of urine passed in twenty-four hours by an adult1 or a child over eight years1 is from #ajjj to #bjjj c4c4 ,it represents from #fj to #gj of the amount of water ingested4 ,collecting the ,urine for ,testing4--,in measuring the urine it is necessary to begin collecting it after the bladder has been emptied the first thing in the morning4 ,the patient should void just before the end of the twenty-four-hour period to be sure that the amount formed by the kidneys during this time is accounted for4 ,diseases in ,which ,urine ,is ,diminished4--,in certain diseases the amount of urine passed is diminished4 ,this is found to be true in diarrhea and dysentery1 when water is lost in the feces1 in hemorrhage from any part of the body and from vomiting4 ,it is likewise at times the case after abdominal operations and in nervous conditions1 such as hysteria4 ,the urine is diminished when there is an organic obstruction in the urinary tract and certain obstructive diseases of the heart1 the lungs and the liver4 ,in these latter cases1 there is seen to be a retention or suppression of urine4 ,in both acute and chronic nephritis and in certain fevers1 the bladder at times must be emptied by means of a catheter4 ,at other times1 the condition is relieved as far as possible by limiting certain articles of food in the diet4 ,at any rate1 these points must be kept in mind when examining the urine4 ,effect of ,food upon the ,urine4--,the odor of normal urine is changed after eating certain foods1 such as onions and asparagus4 ,in disease1 the odor of urine has a distinct value as a means of diagnosis2 cystitis gives a foul odor1 certain bacteria bringing about a decomposition in the urine and giving rise to an odor of putrefaction4 ,in cases where there is a fistula connecting the bladder and rectum1 the urine has a fecal odor4 ,specific ,gravity of ,normal ,urine4--,the density or specific gravity of urine means the weight of any volume of urine as compared with that of equal volume of distilled water4 ,the specific gravity of normal urine varies from #ajab to #ajbd1 that is1 in a thousand cubic centimeters of urine there are found from #aa to #ah grams of solid material4 ,in health it is necessary to know the amount of urine passed in twenty-four hours1 to be able to judge whether the amount of solids is too high or too low4 ,specific ,gravity of ,diabetic ,urine4--,in conditions like diabetes mellitus1 where there is a wastage of sugar taking place in the body--that is1 instead of being oxidized to carbon dioxide and water and glucose1 the sugar is passing into the urine without completing its oxidation--the specific gravity rises in these cases to #ajcj and over1 showing distinctly that a greater amount of solid material is in the urine than is present normally4 ,in chronic ,bright's disease and diabetes insipidus1 the specific gravity is low4 ,method of ,determining ,specific ,gravity4--,the specific gravity is determined by the use of an instrument known as a urinometer4 ,the urine is poured into a tube and the urinometer is dropped into it4 ,the different figures are marked upon the stem of the instrument and it is a simple matter to read off the figures of the level to which the stem sinks4 ,reaction to ,litmus4--,in a former chapter it was stated that normal urine was1 as a rule1 acid1 that is1 it turns blue litmus red4 ,certain diseases render the urine alkaline4 ,a like result is brought about upon the ingestion of sodium citrate or bicarbonate of soda4 ,urine which stands and becomes decomposed is alkaline in reaction1 due to the bacterial action1 with the production of ammonia4 ,albumen in the ,urine4--,the presence of albumen in the urine is important1 since normal urine does not contain this material in quantities sufficient to be recognized by ordinary tests4 ,hence in disease its presence is an indication of pathological processes taking place either in the kidney or the urinary passages4 ,the chief abnormal condition indicated by the presence of albumen in the urine is nephritis4 ,traces of albumen may occur in patients with fever or a heart weakness4 ,blood and pus in the urine likewise indicate albumen4 ,when the nephritic condition is chronic1 the kidneys themselves are diseased and the presence of albumen may be in traces only1 while during the acute attack large quantities may be passed1 but the urine will clear up after a time4 ,benedict's ,qualitative ,sugar ,test4--,boil #e c4c4 of ,benedict's solution2 add #h drops of urine to be examined2 hold the tube over the flame and allow to boil vigorously for #c minutes and set aside to cool of itself4 ,in the presence of sugar the entire solution will be filled with a precipitate which may be greenish1 yellow1 or red1 according to the amount of sugar present4 ,when the percentage of sugar is low 7under #j4c7 the precipitate will form only upon the cooling of the solution4 ,if there is no sugar present1 the solution will either remain clear or show a slight turbidity1 due to the precipitation of urates4 ,the nurse must remember that to be useful the test must be made accurately4 ,there must never be more than #aj drops of urine and #h drops is the usual quantity4 ,the boiling must be vigorous and the solution allowed to cool spontaneously4 ,fehling's ,test for ,sugar4--,fehling's alkaline solution and ,fehling's copper solution must be kept in separate bottles until ready for use4 ,then about #b c4c4 of ,fehling's alkaline solution is poured into a test tube and #b c4c4 of ,fehling's copper solution is added4 ,this is diluted with hydrant water to #h c4c4 ,half of this quantity is sufficient for the test4 ,the upper half of the solution is boiled over flame 7gently agitated while heating71 and while still boiling a few drops of urine are added4 ,if no change appears1 it is boiled again and a few drops more of urine are added4 ,if a reddish precipitate appears1 sugar is present4 ,the chemical reaction taking place is the reduction of copper sulphate to cuprous oxide4 ,sometimes a partial reduction occurs when urates are in excess1 but once having seen the real reduction1 a partial one cannot mislead the examiner4 ,haines's ,test4--,pour #a teaspoonful of ,haines's solution into a test tube and boil gently over a ,bunsen burner2 add #f or #h drops of urine and again heat to boiling4 ,a yellow or red precipitate will indicate the presence of glucose4 ,,quantitative ,,test ,,for ,,sugar ,benedict's ,test4#aaj--,the simple quantitative test for sugar is the one devised by ,benedict4 ,this is simpler than the polariscopic examination and better suited for ordinary use4 ,place #e c4c4 of ,benedict's quantitative solution in a small dish1 add a little less than one-fourth of a teaspoonful of sodium carbonate and one-eighth of a teaspoonful of talcum and add #aj c4c4 of water4 ,dilute urine 7#a part urine to #i parts water7 except where the qualitative test showed a low percentage of sugar1 that is1 when the precipitate turns green instead of yellow1 in which case it will be unnecessary to dilute the urine4 ,place dish over burner and bring the contents to a boil4 ,pour the urine into a graduated pipette4 ,now add the urine drop by drop to the contents in the dish until the blue color entirely disappears4 ,this test should be done over several times to assure an accurate calculation4 ,the calculation is made as follows3 #e c4c4 of ,benedict's quantitative copper solution are reduced by #j4ja gram of glucose1 consequently the quantity of undiluted urine required to reduce #e c4c4 ,benedict's solution contains #j4ja gram of glucose4 #j4ja ------ x #ajj per cent4 x c4c4 of undiluted urine4 x ,example2 #aejj c4c4 urine in #bd hours4 #e c4c4 used to reduce 7decolorized7 ,benedict's solution4 #j4ja ------ x #ajj #j4b per cent4 #e #aejj x #j4jjb 7#j4b per cent47 #c grams of sugar in #bd hours4 ,example3 ,if the urine had been diluted with #i parts water1 in other words1 #aj times1 the calculation would be #e c4c4 diluted urine #j4e c4c4 actual urine4 #j4ja ------ x #ajj #b per cent4 #j4e #aejj x #j4jb 7#b per cent47 #cj grams of sugar in #bd hours4 ,hill and ,eckman perform the ,benedict's quantitative test as follows3#aaa ,measure with a pipette #be c4c4 ,benedict's solution into a porcelain dish1 add #e or #aj grams approximately of solid sodic carbonate1 heat to boiling1 and while boiling1 run in urine until a white precipitate forms1 then add urine more slowly until the last trace of blue disappears4 ,the urine should be diluted so that not less than #aj c4c4 will be required to amount of sugar which #be c4c4 of reagent is capable of oxidizing4 ,calculation3 #e divided by number of cubic centimeters of urine run in equals per cent4 of sugar4 ,fermentation ,test for ,quantity of ,sugar in ,urine4--,if the urine is #gj deg4 ,f4 7room7 temperature when the specific gravity is taken at both the beginning and end of the test1 it will assure accuracy4 ,to #ajj c4c4 of urine of known specific gravity1 add one-fourth of fresh yeast cake thoroughly broken up4 ,mix thoroughly and set aside at a temperature between #he deg4 and #ie deg4 ,f4 for twenty-four hours1 after which time test with ,benedict's or ,fehling's solutions4 ,if reduction is obtained1 it will be necessary to allow the fermentation to continue until it is complete4 ,when no further reduction is obtained1 the specific gravity is taken after the urine has reached a temperature of #gf deg44 ,the difference in the specific gravity at the beginning and end of the test multiplied by #j4bc gives the percentage of sugar in the urine4 ,the following formulas represent the various solutions used in the above test3 ,,benedict',s ,,qualitative ,,solution ,gm4 or c4c4 ,copper sulphate 7pure crystals7 #ag4c ,sodium or potassium citrate #agc4j ,sodium carbonate 7anhydrous7 #ajj4j ,distilled water to make #ajjj4j ,,fehling',s ,,solution 7#a7 ,copper ,sulphate ,solution3 #cd4fe grams copper sulphate dissolved in water and sufficient water added to make #ejj c4c4 7#b7 ,alkaline ,solution3 #abe grams potassium hydroxide4 #agc grams ,rochelle salts dissolved in water q4s4 to make #ejj c4c4 ,keep solution in separate bottles and mix in equal quantities when ready to use4 ,,haines',s ,,solution ,copper sulphate 7pure7 #cj grams 7dissolved in #a_/b oz4 7#ae c4c47 distilled water7 ,add #a_/b oz4 pure glycerin1 mix thoroughly1 and add #e oz4 liquor potassae4 ,,benedict',s 7,,quantitative7 ,,solution ,copper sulphate 7pure crystals7 #ah grams ,sodium carbonate 7crystallized7 7or #ajj grams of anhydrous salt7 #bjj grams ,sodium or potassium citrate #bjj grams ,potassium sulphocyanide #abe grams #e solution of potassium ferrocyanide #e c4c4 ,distilled water to make total volume of #ajjj c4c4 ,dissolve the carbonate1 citrate1 and sulphocyanide with the aid of heat and enough water to make #hjj c4c4 of mixture4 7,filter1 if necessary47 ,weigh exactly the copper sulphate crystals and dissolve in #ajj c4c4 of water1 now add it to the first solution2 stirring constantly4 ,add the ferrocyanide solution2 cool and dilute to exactly #a liter4 #ej mg4 7#j4jej gm47 of sugar will reduce #be c4c4 of the above solution4 ,gerhardt's ,ferric ,chloride ,reaction for ,diacetic ,acid4--,to #aj c4c4 of fresh urine1 add carefully a few drops at a time of undiluted aqueous solution of ferric chloride ,u4,s4,p4 ,a precipitate of ferric phosphates first forms1 but upon the addition of a few more drops of the same solution it is dissolved4 ,a ,burgundy red 7red wine7 color is obtained in the presence of diacetic acid4 ,the depth of this color is indicative of the quantity of acid present4 ,joslin#aab records the intensity of the reaction as follows1 1 1 1 or 4 ,according to ,joslin1 it must be remembered that similar reaction is obtained in the urine of individuals taking salicylates1 antipyrin1 cyanates1 or acetates1 but it is a simple process to differentiate between the color produced as a result of diacetic acid and that produced by the above-mentioned drugs4 ,if the solution is boiled for two minutes1 the color from diacetic acid will disappear1 owing to the unstableness of that substance1 while that from the drugs will remain unchanged4 ,test for ,acetone4--,pour #e c4c4 of urine to be tested into a test tube1 add a crystal of sodium nitroprusside1 acidify with glacial acetic acid1 shake well1 and then make alkaline with ammonium hydrate4 ,the presence of acetone is indicated by a purple color4 ,,tests ,,for ,,albumen ,the heat test#aac is the simplest4 ,this consists of first filtering the urine through filter paper1 then pouring some of the clear urine into a test tube1 holding the test tube in a flame so that only the upper layer boils1 then adding a few drops of #b solution of acetic acid and boiling again4 ,if there is albumen present1 a very faint1 or a heavy cloudiness 7precipitate of coagulated albumen7 forms on boiling and persists or becomes heavier on the addition of a few drops of dilute acetic acid 7#b7 and boiling again4 ,if a precipitate occurs at the first boiling1 but clears up again entirely on adding acetic acid1 it is not albumen but harmless phosphates or carbonates4 ,,heller',s ,,test ,,for ,,albumen ,into a test tube pour a few drops of nitric acid1 filter the urine and allow a small quantity of it to trickle from a pipette down the side of a test tube until it comes in contact with the acid4 ,if albumen is present a distinctly formed white ring is seen at the zone of contact4 ,,test ,,for ,,indican ,this material is found in cases of obstinate constipation and in other intestinal disturbances where the passage of the food mass in the small intestines is delayed and the putrefactive bacteria exert their activities upon the unabsorbed protein4 ,test4--,mix equal quantities of urine and fresh hydrochloric acid and add drop by drop fresh concentrated solution of chloride of lime 7#e to #a1jjj74 ,indican is indicated by the appearance of a blue color4 ,,summary ,urinalysis represents one of the most important means for determining the health of an individual1 since it is the urine that shows those substances produced in the body as a result of the breaking down of the body tissues and protein foods4 ,composition of ,normal ,urine must be familiar to the nurse in order that she may recognize any change taking place in the urine of her patient which may indicate pathological conditions in the body4 ,the ,specific ,gravity of urine is one of the points by means of which the presence of certain substances more or less abnormal in character is determined4 ,other ,points1 such as color1 odor1 quantity1 reaction1 and chemical composition1 likewise show any deviation from the normal in the individual4 ,urine ,tests are necessary to determine the composition of the secretion4 ,the character of these tests and the methods used in making them form an essential part in the training of the nurse4 ,tests for the presence of albumen1 sugar1 and possibly indican in the urine1 should be made by the nurse4 ,the latter substance represents the extent of putrefaction taking place in the body and for this reason should be included in the urine tests4 ,collecting the ,urine for testing is important4 ,the amount includes all that has been voided throughout the entire twenty-four hours beginning after the bladder has been emptied on the first morning and ending after the first specimen has been voided on the morning of the second day4 ,preserving the ,urine for testing is usually necessary1 especially during the warm weather4 ,the specimens should be collected in a wide-mouthed sterile glass jar4 ,this should be kept in a cold place4 ,some harmless preservative such as chloroform should be added to assure its keeping4 ,,problems 7a7 ,outline tests used in urinalysis2 state when they are used4 7b7 ,list the equipment needed for making the simple tests4 7c7 ,make tests in laboratory and list results in note-book4 ,,footnotes3 #aaj ,treatment of ,diabetes ,mellitus1 pp4 #ahb-ahc1 by ,joslin4 #aaa ,starvation 7,allen7 ,treatment for ,diabetes ,mellitus1 by ,hill and ,eckman4 #aab ,treatment of ,diabetes ,mellitus1 p4 #ahf1 by ,joslin4 #aac ,chemistry for ,nurses1 by ,reuben ,ottenburg4 ,,chapter ,,xviii ,,acute ,,and ,,chronic ,,nephritis ,nephritis is a disease of the kidneys1 in which changes occur in the tissues of the organs themselves2 these changes may be caused by inflammation of the kidneys and renal passages brought on as results of the retention of certain poisonous substances in the blood1 or from the action of specific bacteria4 ,the disease may be acute or chronic in form and develop as a result of prolonged exposure to cold and wet1 of tonsillitis1 scarlet fever1 typhoid fever1 and to a less extent of malaria1 syphilis1 pregnancy1 and tuberculosis1 as well as from the effects of certain irritating drugs1 such as cantharides and turpentine4 ,directing the ,treatment4--,in any case the treatment must be directed toward the relief of the acute symptoms in the beginning and followed up by a general treatment which will tend to strengthen and relieve the overtaxed organs and to increase their power to functionate normally4 ,causes and ,effects4--,in acute nephritis1 the chief symptoms are uremia1 and edema2 the urine is materially diminished in quantity and at times suppressed2 it is often found to be rich in albumen and containing hyaline and blood casts1 red and white blood cells1 and various pigments4 ,in chronic nephritis1 which may be the result of an acute attack1 or as a sequel of other diseases already mentioned1 there is seen to be a progressive loss of flesh and strength1 marked anemia1 gastro-intestinal disturbances1 increased blood tension and edema1 the latter especially in the face on arising in the morning4 ,uremia may develop at any time4 ,limiting the ,work of the ,kidneys4--,in both acute and chronic nephritis1 great effort must be put forth to relieve the tax upon the kidneys and to stimulate their functioning power4 ,in other diseases1 in which definite organs are involved1 the treatment consists chiefly of resting the affected parts 7#a7 by starvation1 7#b7 by deflecting the work to other organs when it is possible1 chiefly by changing the diet until the disturbance is overcome4 ,this is generally effectual in most cases1 as has been specially demonstrated in the treatment of gastro-intestinal diseases4 ,problems to ,be ,considered4--,but in nephritis1 there are other problems to consider1 which make it impossible to institute such a treatment as will effect a perfect rest of the renal organs4 ,the kidneys represent the chief source whereby the waste products of the body are eliminated4 ,this waste consists not only of the end-products of the nitrogenous foods ingested1 but also the end-products of tissue metabolism1 which is the inevitable result of the wear and tear of life4 ,hence1 when the functions of the kidneys are disturbed1 these products1 often toxic in character1 are retained instead of excreted4 ,thus instead of forming normal constituents of the urine they find their way into the general circulation1 exerting a damaging effect upon the tissues1 especially of the kidneys with which they are brought into such direct contact4 ,substances ,difficult of ,excretion4--,it has been proved that the kidneys in nephritis find it difficult to excrete certain substances1 namely1 urea1 water1 salts1 and the purin bodies4 ,many authorities claim that the uremia manifested in acute nephritis is the result of the retention of end-products of the protein metabolism already mentioned and that the edema is due to a like retention of water and salts4 ,the greatly diminished quantity of urine voided during the acute attack would seem to prove this theory4 ,martin ,fisher1#aad however1 claims the condition to be due to an acidulation of the tissues with a consequent osmosis of water1 and directs his treatment to overcome this condition1 not by restricting the quantity of water and salt1 as is generally practised1 but by injecting a saline solution into the body in large quantities with the effect of increasing the flow of urine by concentrating the salt content of the blood and therefore its osmotic power4 ,the fluids are withdrawn from the tissues1 thus adding fluidity to the blood stream1 which in turn flushes the kidneys1 ridding them of the poisons which interfere with their normal functioning4 ,adjusting the ,diet4--,the uremia and edema must be relieved4 ,since it is an undisputed fact1 in the majority of cases1 that good results from the regulating of the diet so as to minimize as far as possible the work of the kidneys1 the various diet cures will be included here4 ,milk ,cure4--,milk1 as a rule1 forms a basis of most of the nephritic diets chiefly because of its low salt and protein content and on account of its non-toxic end-products4 ,the percentage of water in milk is likewise known and for this reason the fluid content of a milk diet can be easily calculated4 ,however1 it is also true that the greatest drawback to a diet consisting solely of milk is the large amount of water therein compared with its nutrient value4 ,resting the ,kidneys4--,during the acute stage of nephritis the kidneys are given as much rest as possible by eliminating all food and restricting the amount of water entering the body4 ,the thirst is relieved by small sips of plain or carbonated water or by ice pellets held in the mouth1 or1 as is sometimes necessary1 by injections of water into the rectum4 ,adjusting the ,fluids4--,the amount of fluid1 however1 must be adjusted to meet the condition of the patient1 taking into consideration the amount of urine voided and the uremic symptoms manifested4 ,if the urine is not suppressed the amount of water taken may be slightly in excess of the urine voided1 thus promoting diuresis4 ,in many cases an excellent diuretic drink consisting of one pint of water and one teaspoonful of cream of tartar with a half a lemon and perhaps a little sugar1 serves the purpose of relieving the thirst1 which is at times acute during this period4 ,the extent of the starvation treatment must depend upon the patient himself4 ,as a rule1 however1 it is not carried out longer than two days1 after which milk may be substituted1 allowing from twenty to thirty ounces per day1 which is as much fluid as an ordinary nephritic patient can handle4 ,the regulation nephritic diet1 which is bland in character1 contains nothing that will tend to increase the irritation and inflammation of the kidneys1 and furnishes a certain amount of nourishment when the symptoms of the disease warrant the giving of any food other than milk4 ,the following diets used in cases of high urea or severe hypertension3 ,,low ,,protein ,,diet#aae ---------------------------------------- ------------------------- ,protein,carbohydrates ,fats ,grams ,grams ,grams ---------------------------------------- ------------------------- ,breakfast3 #f4g #afj #ea ,cooked ,farina 7#ajj grams7 ,total calories for day1 #aaib ,butter 7 #bj grams7 ,fruit 7#ajj grams7 ,lactose 7 #cj grams7 #bjj grams of fruit juice served between meals ,dinner3 ,asparagus 7#ajj grams7 ,butter 7 #bj grams7 ,fruit 7#ajj grams7 ,lactose 7 #cj grams7 ,supper3 ,carrots 7#ajj grams7 ,fruit 7#ajj grams7 ,butter 7 #bj grams7 ,lactose 7 #cj grams7 ---------------------------------------- ------------------------- ,,protein ,,free ,,diet ---------------------------------------- ------------------------- ,protein,carbohydrates ,fats ,grams ,grams ,grams ---------------------------------------- ------------------------- ,breakfast3 ,protein-free cookies#aaf 7#e7 ,fruit juice 7#ajj grams7 #j #aff4e #ci ,lactose 7 #ae grams7 ,dinner3 ,protein-free cookies 7#e7 ,total calories1 #ajde ,fruit juice 7#ajj grams7 ,lactose 7 #ae grams7 ,supper3 ,each cookie weighs #aj grams ,protein-free cookies 7#e7 ,fruit juice 7#ajj grams7 ,lactose 7 #ae grams7 ---------------------------------------- ------------------------- ,doctors ,chase and ,rose advise farina used more frequently than oatmeal1 and the plain cream soup1 rice or potato1 more often than soups made of celery or asparagus 7the latter used to break the monotony74 ,they also advise the more frequent use of green string beans and asparagus in preference to other vegetables4 ,elimination of ,salt4--,in many cases of nephritis1 especially those belonging to the parenchymatous type1 the kidneys manifest a difficulty in eliminating salt1 and instead of excreting the normal quantity1 find it impossible to eliminate more than two or three grams or less a day4 ,the retained salts pass into the fluids of the tissues1 giving rise to or increasing the already existing edema4 ,tests#aag have been devised to find the extent of the kidney function to excrete salt4 ,the following diets are among those commonly used3#aah #c liters of milk 7this contains #e gm4 sodium chloride and #ajj gm4 protein7 or ,strauss ,diet1 consisting of #c_/d liter milk1 #d eggs1 #aej gm4 bread1 and enough fruit and fruit juice1 tea and sugar to make it palatable4 7,this diet contains about #c gm4 of salt47 ,if the kidneys are able to excrete the amount of salt contained in these diets1 salt may be added in quantities of from #e to #aj grams4 ,salt-poor ,diets4--,when the kidneys are unable to eliminate the normal amount of salt1 some of the salt-poor diets should be advised4 ,coleman claims1#aai however1 that these diets have not fulfilled the promises held out by them4 ,coleman groups the salt-poor diets under three headings3 7#a7 ,the strict salt-poor diet1 of which ,widal's diet is an example4 7#b7 ,the medium strict salt-poor diet1 allowing from #b4e to #e grams of salt a day4 ,under this heading the milk diet was placed1 in which #b to #c grams of salt is served a day at table4 7#c7 ,the moderate salt-poor diet1 in which from #e to #aj grams of salt are allowed each day4 ,in using this diet it is not necessary to prepare a special menu for the patient1 but take precautions to leave the salt shaker off the tray and exclude bacon1 ham1 and other salty foods from the dietary4 ,limiting the ,amount of ,food4--,it must be kept in mind that the nephritic condition makes it imperative to fall below rather than exceed the food requirements of the individual4 ,,widal',s ,,diet#abj ,salt-free bread #bjj gm4 ,meat 7beef1 chicken1 or mutton7 #bjj gm4 ,vegetables 7beans or rice71 salt-free #bej gm4 ,butter1 salt-free #ej gm4 ,sugar #dj gm4 ,contains #fj grams of protein1 #a to #b grams of ,na,cl1 and furnishes approximately #aejj calories4 ,strouse and ,perry arranged a dietary from the above diet as follows3 #h ,a4,m4 ,bread1 #fj grams2 lamb chop1 #ej grams2 butter1 #aj grams2 rice1 #ajj grams2 sugar1 #dj grams4 #ab ,m4 ,bread1 #fj grams2 roast beef1 #ajj grams2 butter1 #bj grams2 beans1 #aej grams4 #e ,p4,m4 ,bread1 #hj grams2 butter1 #bj grams2 chicken1 #ej grams4 ,,halpin',s ,,salt-,,free ,,nephritic ,,diet ,milk1 #aejj to #bjjj c4c41 white salt-free bread1 #djj to #ejj grams2 salt-free butter1 #dj grams2 eggs1 #d to #f4 ,this diet contains from #e to #f grams of salt4 ,,karell ,,cure ,karell has devised the milk cure1 which is used possibly more than any other diet4 ,it not only furnishes a dietary regime1 which is used in nephritis1 but it is likewise advocated in organic diseases of the heart and blood vessels4 ,methods of ,administering the ,karell ,cure4--,the cure is begun by giving from #c to #f ounces of milk three or four times a day4 ,karell makes a point of using small quantities to begin with and having the milk skimmed4 ,the milk is given at regular intervals1 is warmed in winter and given at room temperature in the summer4 ,it may be given plain or diluted with limewater4 ,after a week if the stools remain solid1 the daily allowance of milk is increased to two quarts4 ,constipation is an indication of the agreement of this diet and the patient's utilization of the milk4 ,if1 however1 he manifests gastro-intestinal disturbances1 resulting in diarrhea1 the amount must be temporarily reduced4 ,karell advocates boiling the milk and relieving the constipation with enemas or mild laxatives4 ,the addition of small quantities of coffee to the morning portion of milk1 or of stewed prunes or a baked apple to the afternoon feeding1 also tends to overcome the condition4 ,thirst4--,the extreme thirst may be relieved by adding plain water1 limewater1 or seltzer to the feedings4 ,if during the second or third week of the cure the hunger becomes too great for the patient to endure1 a small piece of herring or stale bread may be given4 ,once a day a milk soup thickened with a cereal may be given4 ,the above diet is carried out from five to six weeks1 after which the patient is gradually returned to a normal diet4 ,milk1 however1 should still constitute an important part of the diet4 ,the ,karell cure is modified more or less to meet the condition of the patient1 the amount of milk administered in some cases being more and in others considerably less than mentioned in the above regime4 ,limiting the ,proteins4--,the extent of the damage caused by the end-products of protein metabolism cannot be easily estimated1 but it is wise not to err on the side of an over-supply1 since the retaining of these materials in the body gives rise to a certain type of intoxication 7uremic poisoning74 ,relative ,toxicity of the ,animal ,proteins4--,the difference between the various animal proteins as to their relative toxicity has been the subject of much discussion4 ,as far as their nutrient value is concerned1 they are practically the same1 that is1 the protein of beef and the protein of chicken show very similar analyses4 ,the beef contains1 however1 more extractives1 which we know are high in purins4 ,these substances have proven detrimental to the welfare of a nephritic patient4 ,selection and ,preparation of ,foods4--,for this reason the so-called red meat is sometimes boiled instead of roasted1 as the latter mode of preparation increases the formation of purins on the brown outer surfaces of the meat4 ,chicken and fish contain less purin bases and for this reason are often included in the diet when beefsteak and lamb chops are excluded4 ,meat soups and broths contain little nutrient value1 consisting as they do chiefly of water1 salt1 and extractives1 all of which are looked upon with disfavor1 and classed with the offending articles of food in the nephritic diet4 ,cream soups1 except bean or pea soup1#aba may be given in moderation4 ,they are non-toxic in character and of high nutrient value1 furnishing a valuable addition to the diet when the gastro-intestinal symptoms permit of such addition4 ,,convalescent ,,nephritic ,,diet#abb ,advisable ,foods4--,the following foods are used in the formation of diet for an advanced convalescent nephritic patient when not otherwise contraindicated3 ,cereals1 potatoes1 rice1 green vegetables and salads1 fruits1 fresh and stewed1 ham1 bacon1 or beef once or twice a week1 chicken1 lamb1 or mutton#abc several times a week1 simple desserts1 such as junket1 prune or fig whip1 orange1 lemon1 grape1 pineapple or apricot gelatin1 bread1 rice or tapioca pudding1 plain vanilla ice cream4#abd ,foods to ,be ,avoided4--,the following foods are avoided except the meats1 which must be given not more than once to three times a week1 as directed by physician3 ,meat broths1 especially those made from commercial meat extracts1 bouillon cubes1 etc4 ,strong tea or coffee4 ,alcoholic beverages1 unless especially prescribed by the physician4 ,liver1 kidney1 sweetbreads4#abe ,meat croquettes and other made dishes4 ,rich sauces or gravies4 ,condiments and spices of all sorts4 ,rich pastries4 ,the salt must be limited and water and other fluids restricted4 ,sample ,diet ,sheets4--,the following menus#abf formulated from the above diet list are suggested3 ,no4 #a4--h ,a4,m4 ,sliced oranges1 cream of wheat with cream1 buttered toast1 cocoa4 #aj3cj ,a4,m4 #f ounces of milk with crackers4 #ab3cj ,p4,m4 ,cream of spinach soup1 rice1 string beans1 orange gelatin1 bread and butter4 #c ,p4,m4 #f ounces of buttermilk with crackers4 #f ,p4,m4 ,cereal and cream1 baked potato1 apple sauce1 cocoa1 bread and butter4 ,no4 #b4--h ,a4,m4 ,stewed prunes1 wheatena and cream1 milk or dry toast with butter1 cocoa4 #aj3cj ,a4,m4 #f ounces of malted milk with crackers or #a slice of zwieback4 #ab3cj ,p4,m4 ,cream of corn soup1 mashed potatoes1 beet tops or mustard greens1 lettuce salad1 dressing made with lemon juice and olive oil1 rice pudding4 #c ,p4,m4 #f ounces of orange or grape juice with crackers4 #f ,p4,m4 ,cream toast1 sliced peaches1 cocoa4 ,no4 #c4--h ,a4,m4 ,half a grapefruit1 farina and cream1 toast and butter1 cocoa4 #aj3cj ,a4,m4 #f ounces of buttermilk with crackers4 #ab3cj ,p4,m4 ,cream of tomato soup1 creamed potatoes1 buttered beets1 celery salad1 apple tapioca pudding1 bread and butter4 #c ,p4,m4 #f ounces of milk with crackers4 #f ,p4,m4 ,ralston's ,health ,food with cream1 baked potato1 tomato salad1 toast and butter1 cocoa4 ,no4 #d4--h ,a4,m4 ,stewed prunes1 grits and cream1 toast and butter1 cocoa4 #aj3cj ,a4,m4 #f ounces of malted milk with crackers4 #ab3cj ,p4,m4 ,cream of asparagus soup1 creamed cauliflower1 boiled rice1 lettuce salad1 bread and butter1 pineapple gelatin4 #c ,p4,m4 #f ounces of orange juice with crackers or zwieback4 #f ,p4,m4 ,creamed toast1 escalloped potatoes1 fruit salad1 toast1 cocoa1 and cocoa junket4 ,,chronic ,,nephritis 7,,bright',s ,,disease7 ,chronic nephritis may develop as a sequel to an acute attack1 and an individual suffering from chronic nephritis may at any time develop acute symptoms4 ,in any case the dietetic treatment would necessarily have to be made to cover the existing symptoms4 ,dietetic ,treatment4--,in cases where the patient has entirely recovered from uremia but still manifests symptoms of water and salt retention1 the diet would be naturally directed to cover the latter1 at the same time taking care not to strain the weakened functions by giving more food than could be readily handled4 ,the water and salts still have to be restricted1 but a certain amount of fat and carbohydrate with small additions of nitrogenous food materials may be added from time to time as the kidneys show improvement4 ,it must be borne in mind1 however1 that at this time it is very easy to overtax the renal organs and it is safer to err on the side of under rather than over feeding4 ,the logical treatment1 therefore1 consists of utilizing the improved functions while those still failing to react are getting further rest4 ,adjusting the ,proteins in ,diet4--,if the individual shows a definite anemia1 as is often the case after acute attacks1 either as a result of the disease itself or the necessarily low diet1 which the acute symptoms of uremia and edema made necessary1 other measures are necessary to bring the body back to a normal condition4 ,it has been found that in these cases where there has been no permanent damage to the renal organs1 but merely a temporary impairment of the functioning power1 the treatment must be1 first1 a rest to the affected parts2 second1 the temporary restriction of all articles of food which impose a tax on the kidneys to eliminate2 the third1 the gradual return to normal diet as the acute symptoms decrease and the function of the kidneys no longer shows impairment4 ,such a case is cited by ,strouse and ,perry#abg as occurring in the ,michael ,reese ,hospital4 ,mr4 ,x4 recovered from the acute stage of nephritis and all signs of edema and uremia disappeared2 the man was kept on a low salt and low protein diet for a long time4 ,his urine was clearing up1 but he did not feel up to standard and remained anemic4 ,thinking in all probability that his symptoms were due to a low protein diet1 meat was slowly added to his dietary until he was receiving #fj grams of protein a day4 ,there was an immediate general improvement in his condition with no increased renal disturbance4 ,it is an obvious fact that chronic nephritis1 like any other chronic condition1 requires a different method of treatment from that practised to relieve the acute stage4 ,the very fact that it is chronic proves that the strenuous methods are neither necessary nor wise4 ,testing the ,kidney ,functions4--,the authorities of to-day endeavor to ascertain the extent of the damage to the renal organ by testing its functioning power4 ,these renal function tests have been the subject of much interest and investigation4 ,probably the ones most commonly employed are those devised by ,hedinger and ,schlayer#abh and adapted for use in the ,johns ,hopkins ,hospital by ,mosenthal4 ,diets ,used in ,tests4--,the diet employed in making these tests consists of different amounts of certain substances known to be diuretic in character4 ,this diet is rigidly adhered to and a careful analysis of the urine passed1 the total quantity and specific gravity of each specimen made and in this way the various functions of the kidneys and the impairment thereof are tested4 ,thus an intelligent adjustment of the diet may be made4 ,renal ,functional ,tests4--,the following schedule is used by ,mosenthal1 of the ,johns ,hopkins ,hospital1 in making what is known as the ,two-,hour ,test for ,renal ,function3 ,,hedinger-,,schlayer-,,mosenthal ,,diet#abi ,for ,date ,all foods to be salt-free from the diet kitchen1 salt for each meal will be furnished in weighed amounts4#acj ,all foods or fluids not taken must be weighed or measured after each meal and charted in spaces below4 ,allow no food or fluid at any time except at meal times4 ,note any mishaps or irregularities that occur in giving the diet or collecting the specimens4 ,breakfast #h ,a4,m4 ,boiled oatmeal #ajj grams ,sugar #a to #b teaspoonfuls ,milk #cj c4c4 #b slices of bread #cj grams each ,butter #bj grams ,coffee #afj c4c4 ,sugar #a teaspoonful #bjj c4c4 ,milk #dj c4c4 ,dinner--,noon ,meat soup #ahj c4c4 ,beefsteak #ajj grams ,potatoes1 boiled1 mashed or baked #acj grams ,green vegetables as desired #b slices bread--each #cj grams ,butter #bj grams ,tea1 #ahj c4c4 ,sugar1 #a tsp4 #bjj c4c4 ,milk1 #bj c4c4 ,water #bej c4c4 ,pudding1 tapioca or rice #aaj grams ,supper #e ,p4,m4 #b eggs cooked any style #b slices of toast #cj grams each ,butter #bj grams ,tea1 #ahj c4c4 ,sugar1 #a tsp4 #bjj c4c4 ,milk1 #bj c4c4 ,fruit1 stewed or fresh #a portion ,water #cjj c4c4 #h ,a4,m4 ,no food or fluid is to be given during the night or until #h o'clock next morning 7after voiding7 when the regular diet is resumed4 ,patient is to empty bladder at #h ,a4,m4 and at the end of each period as indicated below4 ,the specimens are to be collected for the following periods in properly labeled bottles3 #h ,a4,m4 to #aj ,a4,m42 #aj ,a4,m4 to #ab ,noon2 #ab ,noon to #b ,p4,m42 #b ,p4,m4 to #d ,p4,m42 #d ,p4,m4 to #f ,p4,m42 #f ,p4,m4 to #h ,p4,m42 #h ,p4,m4 to #h ,a4,m4 ,chart ,used in ,johns ,hopkins ,hospital4--,the following chart is inserted here to show the method used in the ,johns ,hopkins ,hospital for carrying out the ,two-hour ,renal ,test3 ,urine ,na,cl ,nitrogen ,time of ,day ---------------------------------------- ----------- ,specific ,c4,c4 ,gravity ,per cent,grams,per cent,grams ---------------------------------------- -------------------------- #h ,a4,m4-#aj ,a4,m4 #aj ,a4,m4-#ab ,noon #ab ,noon-#b ,p4,m4 #b ,p4,m4-#d ,p4,m4 #d ,p4,m4-#f ,p4,m4 #f ,p4,m4-#h ,p4,m4 #h ,p4,m4-#h ,a4,m4 ,total day ,night1 #h ,p4,m4 to #h ,a4,m4 ,total #bd hours ,intake of fluid ,na,cl ,urine to be collected punctually every two hours and kept in the ice-box1 every specimen having twenty drops of tutuol added to insure preservation4 ,another modification of the ,hedinger-,schlayer diet is used in the ,peter ,bent ,brigham ,hospital1#aca ,boston1 ,massachusetts1 as follows3 #g ,a4,m4 ,coffee1 milk1 sugar1 toast1 and butter4 #aj ,a4,m4 ,milk1 toast1 and butter4 #ab3cj ,p4,m4 ,bouillon1 broiled steak1 butter1 mashed potatoes1 toast1 coffee1 milk1 sugar4 #d ,p4,m4 ,tea1 milk1 sugar1 crackers4 #g ,p4,m4 ,soft egg1 blanc-mange 7#a egg1 sugar1 cornstarch1 and milk7 and cream4 ,amounts sufficient to give #bejj calories1 #aejj c4c4 fluid1 #gf grams of protein1 #abg grams of fat1 #bde grams of carbohydrate1 and from #e to #h grams of sodium chloride4 ,on two days previous to the test the patient usually had a diet containing #bjjj calories1 #ge grams of protein1 #d grams of sodium chloride4 ,the test diet is a mixed diet containing known amounts of water1 nitrogen1 and chloride1 together with the food diuretics 7purins1 salt1 and water71 as can be seen4 ,the diet is divided into unequal portions containing known but varying amounts of fluid1 nitrogen1 and salt4 ,two-hour specimens are collected from #g ,a4,m4 to #i ,p4,m41 and one night specimen is obtained containing all the urine passed between #i ,p4,m4 and #g ,a4,m4 ,each specimen is analyzed for volume1 specific gravity1 total nitrogen1 nitrogen concentration1 total chloride1 and chloride concentration4 ,purpose of ,tests4--,the purpose of the test is to find out to what extent and in what manner the diseased kidney under stimulation by the various diuretics taken in the food reacts in putting out the varying amounts of salt4 ,dr4 ,o',hara likewise describes another test known as ,the ,added ,urea and ,salt ,test1 which was first described by von ,monakow and also carried out in the ,peter ,bent ,brigham ,hospital4 ,the method used was as follows3 ,,added ,,urea ,,and ,,salt ,,test ,patient is given #ge grams of protein1 #d grams of sodium chloride1 and #aejj c4c4 of water1 with a caloric value of from #bjjj to #bbjj calories4 ,after the output of fluid1 salt and nitrogen reaches an equilibrium on this diet on one day #aj grams of additional salt is given and several days later the patient receives #bj grams of urea4 ,this order may be reversed4 ,the daily output of urine1 salt1 and nitrogen is determined and charted4 ,after the salt and nitrogen is added to the diet in normal individuals1 their excretion after forty-eight hours returns to its previous level4 ,in diseased kidneys this may not be the case4 ,value of ,tests4--,thus it is seen that in these tests for kidney functions1 an effort is made to determine the extent of damage wrought by the disease upon the renal organs and the manner in which they react under definite circumstances4 ,however1 it is not so simple as it would seem to formulate a dietary based on the findings resulting from the renal tests4 ,notwithstanding this1 these tests are coming more and more into use1 both in hospitals and private practice1 and a nurse must understand just how they are carried out1 and must realize that unless her part is performed with absolute accuracy the entire value of the test will be obliterated4 ,too much stress cannot be laid upon this phase of the test1 if it is to be of any value whatsoever in determining the condition of a diseased kidney4 ,,chronic ,,interstitial ,,nephritis ,this form of nephritis is more insidious in character1 developing more slowly and manifesting different characteristics1 than those seen in some of the other types already mentioned4 ,the condition is1 as a rule1 associated with heart symptoms and high blood pressure4 ,the blood shows an increase in urea and other end-products of protein metabolism1 whereas there is no manifest change in the metabolism of salt or water4 ,the great increase in volume of urine voided would show an inability on the part of the kidneys to eliminate a highly concentrated urine4 ,this hypothesis is further demonstrated in the urine tests4 ,urinalysis4--,upon analysis the urine in these cases shows less albumen and fewer casts than found in other types of nephritis4 ,the disease is manifested by slight headache1 gastric disturbances1 and a frequent desire to urinate4 ,dietetic ,treatment4--,the treatment here depends upon the extent of the impairment of the functions of the kidney4 ,if the damage is not extensive and the diagnosis has been sufficiently early to insure prompt improvement upon treatment1 the diet is so directed as to prevent the occurrence of any of the acute symptoms4 ,the patient is warned against overeating and drinking1 over-exercise and nervous excitement4 ,when it is possible1 a change to a warm1 dry climate is advisable with more rest and sleep and less work and worry4 ,he is advised to eat less at meals and if hungry to eat a light lunch of milk or buttermilk with crackers in the mid-morning4 ,the same dietary precautions must be taken in these disturbances as in other nephritic conditions1 keeping always in mind the fact that the kidneys are the chief organs of excretion in the body1 and through them must pass the majority of all end-products of nitrogen metabolism4 ,limiting the ,nitrogen4--,the nitrogenous foods cannot be eliminated entirely1 especially if1 as is often the case1 the individual suffers from chronic nephritis and is up and about attending to business2 but they can be judiciously regulated in the diet4 ,all such foods as fried foods1 rich pastries1 rich sauces and gravy1 spices of all kinds1 tea and coffee1 celery and asparagus1 must be avoided4 ,limiting the ,fluids4--von ,noorden limits the amount of fluid to #a-a_/d liters per day4 ,this does not include the water content of the various foodstuffs4 ,he advises a period of observation to determine the amount best suited to the condition of the patient and reducing this amount from #bej to #aej c4c4 a day until the desired quantity is reached4 ,he advises a drinking day once a week1 allowing the patient to drink as much water as he likes4 ,development of ,uremia4--,whenever evidences of uremia appear the treatment must be changed to meet the condition4 ,it is necessarily more strenuous than that used ordinarily in the chronic nephritis4 ,if the uremia becomes positive1 then the treatment laid down for acute nephritis already described must be at once instituted4 ,the patient must be put to bed at once and every effort made to assist the body in getting rid of the causes4 ,in certain cases of nephritis1 in which uremic poisoning is due to the retention of the end-products of nitrogen metabolism1 or to the toxins formed as a result of the tissue changes due to the disease1 the water then instead of being restricted in the dietary is greatly increased to encourage a free diuresis with a consequent washing out of the accumulated poison4 ,certain authorities recommend a strict milk and water diet1 as has already been described in the beginning of the chapter4 ,a light or soft diet is advised until the condition improves1 resting the renal organs as far as possible4 ,this diet may consist of fruit juices1 strained cereals with cream1 cocoa1 milk1 buttermilk1 toast1 butter1 strained apple sauce1 cream soups1 except those made with beans or peas4 ,the above diet is gradually increased by adding a mashed or baked potato1 well-cooked green vegetables1 stewed or raw fruit1 rice and tapioca pudding1 and chocolate blanc-mange4 ,selection and ,preparation of ,food4--,the preparation of foods for the nephritic differs in certain particulars from that used in other pathological conditions1 namely1 the restriction of certain food constituents2 dishes made with meat and eggs are cut out of the diet1 and salt is used as sparingly as possible1 when it is used at all4 ,the nurse must weigh or measure out the maximum quantity allowed and divide this in portions for each feeding1 measuring carefully any that is not used and charting it4 ,in this way it is possible to increase or decrease the amount according to the symptoms of the individual4 ,the water content of the various foods comprising the diet is1 as a rule1 not considered1 but it is necessary to adhere strictly to the orders of the physician and to curtail the beverages1 water1 tea1 coffee1 etc41 until the amount conforms to that laid down in the dietary4 ,the nitrogenous foods1 with the exception of milk1 are as a rule eliminated from the nephritic diet4 ,the nurse must study the tables and learn which food materials come under this head4 ,it may seem difficult to prepare diet for the sick without eggs1 but it is possible and at times obligatory4 ,combating ,anemia4--,in chronic 7ambulatory7 nephritis the anemia must be reckoned with4 ,it is not safe to upset the nitrogen equilibrium of the body1 but it has been proved that this may be maintained on as little as #cj or #dj grams of protein a day4 ,this will be seen not to be difficult to obtain when milk forms an important part of the diet4 ,the wheat and oat cereals1 as well as the bread1 contain protein1 and a judicious use of these foods will enable the nurse to give her patient the necessary quantity to offset1 in a measure1 the anemia which is at times most troublesome4 ,advice to ,patient4--,one important point must be observed by the nurse and impressed upon the patient when he leaves her care4 ,this is moderation in the amount of food eaten4 ,the kidneys must never be overtaxed1 even with foods which in themselves seem harmless4 ,as danger lies in overindulgence1 this point cannot be too strongly emphasized4 ,advice to the ,nurse4--,the use of the formulas included in this text is left to the discretion of the nurse4 ,in those calling for seasoning1 such as pepper1 mustard1 etc41 the condiments must be omitted4 ,a small amount of celery salt may be substituted in certain instances if the dish is unpalatable without something of the kind4 ,in cases where the salt is restricted the dishes are prepared as directed1 with the exception of the salt4 ,the recipes calling for eggs and meat are not to be used unless directed by the physician4 ,cornstarch1 sago1 and tapioca may be used instead of gelatin4 ,the following menus may be used as guides in selecting foods to prepare for the nephritic patient after the rigid regime is to a certain extent relaxed3 ,,full ,,nephritic ,,diet 7,,nitrogenous ,,foods ,,restricted7 ,,breakfast ,grapefruit1 orange1 prunes1 pears1 peaches1 or strawberries4 ,cereals3 cream of wheat1 farina1 ,pettijohn's1 ,ralston's1 hominy1 grits1 and oatmeal with cream4 ,toast1 buttered or creamed4 ,cocoa1 tea1 or coffee1 as directed by the physician4 ,,dinner ,milk or cream soup1 well-cooked green vegetables with butter or cream sauce4 ,potatoes1 white or sweet1 baked1 mashed1 or boiled1 with butter1 bread or rolls4 ,stewed tomatoes1 rice4 ,salads3 lettuce1 tomato1 romaine1 chicory1 or fruit salad1 with a dressing of oil and lemon1 or cream and lemon4 ,simple desserts3 junkets1 cornstarch1 sago or tapioca pudding1 baked bananas1 rice pudding1 apple tapioca1 orange tapioca1 and ice cream4 ,beverages3 cocoa or tea1 as directed by the physician4 ,,supper ,cereals and cream4 ,baked or escalloped potatoes4 ,baked or stewed apples4 ,salads1 excepting those made with meat or eggs4 ,junket1 raw or stewed fruit4 ,toast or rolls with butter4 ,cocoa4 ,meat1 fish or poultry once a day4#acb ,,breakfast ,stewed or fresh fruit4 ,cereals with cream4 ,toast with butter4 ,cocoa1 milk1 or tea4 ,,dinner ,cream soups4 ,boiled chicken or fish4 ,potatoes1 white or sweet4 ,green vegetables4 ,salads1 except with meat or eggs4 ,simple desserts4 ,rolls or bread and butter4 ,milk or buttermilk4 ,,supper ,cereals or rice with cream or butter4 ,baked or escalloped potatoes4 ,stewed or escalloped carrots4 ,salads1 except those made with meat or eggs4 ,fresh or canned pears1 cherries1 or pineapple4 ,bread pudding1 junkets1 or cornstarch blanc-mange4 ,bread1 rolls1 or toast1 with butter4 ,cocoa1 milk1 tea1 or buttermilk4 ,,table ,,salt ,,content ,,of ,,food#acc ,according to ,leva ,analysis marked thus3 99 from ,atwater ,bryant4 ,per ,cent4 of ,sodium ,chloride in ,raw ,material ,meats ,mutton #j4ag ,veal #j4ac ,calf's brains #j4bj ,calf's kidney #j4cb ,calf's liver #j4ad ,beef 7lean7 #j4aa ,pork 7lean7 #j4aj ,fish ,trout #j4ab ,halibut #j4cj ,herring #j4bg ,cod #j4af ,carp #j4jhf ,salmon #j4jfa ,mackerel #j4bh ,haddock #j4ci ,poultry ,duck #j4ad ,goose #j4bj ,chicken #j4ad ,pigeon #j4ae ,turkey #j4ag ,venison #j4aa ,oysters 7washed7 #j4eb ,oysters 7with sea water7 #a4ad ,prepared ,foods ,plasmon #j4ba ,roborat #j4jjea ,sanatogen #j4db ,somatose #j4ff ,bovril's preparations #j4bf-ad4a ,valentine's meat juice #j4jh-a4bj ,egg 7white and yolk7 #j4ba ,egg 7white alone7 #j4ba ,egg 7yolk alone7 #j4jci ,caviar #c4jj ,milk 7whole7 #j4af ,cream #j4ac ,buttermilk #j4af ,whey #j4aa-j4ae ,condensed milk #j4dj ,butter 7unsalted7 #j4jb-j4ba ,butter 7salted7 #a4jj-c4jj ,peanut butter #d4aj ,oleomargarine #b4ae ,palmin #j4jjaf ,fructin #j4aj ,smoked and ,salted ,foods ,ham 7raw7 #d4ae-e4hf ,ham 7boiled7 #a4he-e4ce ,salmon 7smoked7 #g4ej ,bacon 7smoked7 7,german7 #a4ja ,bacon 7smoked7 7,american7 #aa4fa ,corned beef 7,german7 #b4jd ,corned beef 7,american7 #aa4eb ,cod 7salt799 #bc4ej ,cod 7salt1 boneless799 #aj4jj ,herring 7smoked7 #aa4gj ,mackerel 7salt dressed7 #aj4dj ,salmon 7salted1 smoked7 #aj4cg ,sardines 7,french in oil7 #a4cd ,cod liver oil #j4ag ,gelatine 7dry7 #j4ge ,beef marrow #j4aa ,sausages 7,frankfurters7 #b4bj ,sausages 7various kinds7 #b4ij-h4aj ,anchovy paste 7,cross ,blackwell's7 #dj4aj ,meat ,extracts ,liebig's #b4fj ,kemmerich's #a4dj ,various bouillon capsules1 extracts1 etc4 #i4dj-bb4j ,foods ,prepared for ,table ,bouillon #j4e-a4j ,thick soups #j4ed ,roast beef #j4ih ,roast pork #a4ed ,chops #j4ig ,roast chicken #j4ci ,sauces #j4g-a4e ,spinach #j4ia ,cauliflower #j4di ,stewed pears #j4jai ,macaroni 7a la ,napolitaine7 #a4jd ,scrambled eggs 7salted7 #a4aj ,carrots #j4df ,apple sauce #j4da ,tapioca pudding 7unsalted7 #j4jbf ,rice1 with apples #j4ah ,vegetables ,potatoes #j4jaf-j4jgh ,beets #j4jec ,beans #j4ji ,peas #j4jeh ,lentils #j4ac-j4ai ,lentils 7dried7 #j4aee ,artichokes #j4jcf ,cauliflower #j4je-j4ae ,cucumber 7fresh7 #j4jf-j4jh ,horseradish #j4jb-j4jf ,radish #j4jge ,celery1 stalks #j4be-j4di ,celery1 roots #j4jhi ,asparagus #j4jd-j4jf ,spinach #j4jhd-j4ba ,tomatoes #j4jid ,cabbage #j4aa-j4dd ,onions #j4jaf-j4ji ,canned ,vegetables ,green corn99 #j4dj ,green peas99 #j4gj ,tomatoes #j4aj ,mushrooms #j4jd-j4jf ,cheese ,parmesan #a4ic ,swiss #b4jj ,american 7pale7 #j4hb ,pineapple cheese #b4ac ,edam #c4cj ,english cream cheese #j4gj-a4ae ,infant ,foods ,nestle's ,food #j4bi ,rademan's #j4jc ,robinson's patent groats ,trace ,bread1 etc4 ,graham bread #j4fa ,pumpernickel #j4df ,white bread #j4ah-j4bj ,zwieback #j4ch ,macaroni #j4jfg ,cereals1 etc4 ,barley #j4jcg ,oats #j4jdf ,rye #j4jad ,wheat #j4jac ,rice #j4jci ,corn 7maize7 #j4jai ,wheat flour #j4jjb-j4jjh ,oatmeal 7,american7 #j4bi ,oatmeal 7,german7 #j4bh ,quaker oats #j4jhb ,sago #j4ai ,fruits ,pineapple #j4jga ,orange #j4jeg-j4jee ,apricot #j4jjdg ,lemon #j4jjde ,strawberry #j4jaj-j4jbj ,chestnuts #j4jde-j4jaj ,cherry #j4jac ,cocoanut juice #j4jce ,olives #j4jjh-j4baj ,plums #j4jjdf ,gooseberry #j4jba ,watermelon juice #j4jaa ,grape #j4jbd ,almonds1 dry #j4jaj ,walnuts1 dry #j4jai ,cane sugar #j4aaj ,lump sugar #j4jdi ,chocolate 7,lindt7 #j4jgc ,spices ,capers 7preserved in salt7 #b4aj ,capers 7preserved in vinegar7 #j4bj ,pepper1 black #j4ea ,pepper1 white #j4jai ,mustard #b4ff ,vanilla #j4jee ,cinnamon #j4jfa ,cocoa beans #j4je-j4jie ,coffee1 roasted #j4jde ,tea #j4ae ,drinks ,ground water #j4jjab-j4jjfj ,spring water #j4jjjee-j4jjdf ,ale #j4jjag ,beer1 ,german #j4jaf ,beer1 ,english #j4aj ,champagne 7,moet ,chandon7 #j4jjde ,apollinaris #j4jdc ,fachinger #j4jci ,giesshuble 7,mattoni7 #j4jjba ,vichy #j4jec ,,summary ,the kidneys find difficulty in eliminating certain substances1 namely1 the end-products of protein metabolism--urea1 water1 salts1 and purin bodies4 ,the ,urine constitutes the chief point of investigation4 ,analysis shows the presence of albumen1 casts1 blood cells1 and pigments1 with a corresponding deficiency in the normal constituents1 water1 urea1 and salts4 ,volume of ,urine4--,the volume of urine is reduced1 and at times suppressed1 owing to the difficulty with which the kidneys eliminate water in nephritic conditions4 ,the ,blood shows the presence of the toxic substances on account of the inability of the kidneys to eliminate them properly4 ,edema is a common symptom and is probably due to the retention of salts and water by the tissues of the body4 ,it is treated and at times relieved by limiting the intake of fluids and reducing the amount of sodium chloride in the diet4 ,uremia is the most dreaded symptom and develops as a result of the retained toxins in the blood4 ,its development is prevented1 if possible1 by reducing the amount of fluid and food1 even of milk1 in the diet4 ,uremic ,poisoning is an acute intoxication due to the abnormal retention of these poisons and the inability of the kidneys to eliminate them4 ,it is combated by instituting a starvation treatment which is followed by the above-mentioned restricted diet4 ,gastro-intestinal ,disturbances1 especially diarrhea1 are apt to develop in chronic nephritis4 ,care must be taken to keep the meals small in size1 simple in proportion1 and constituted only from the allowed foods4 ,anemia follows the acute attack and is especially noticeable in those cases in which a rigid starvation regime has been found necessary4 ,it may likewise be the result of a long-continued diet in which the proteins have been reduced to the lowest possible amount4 ,the simple proteins in the diet must1 at times1 be increased and the patient advised to take plenty of fresh air and sunshine1 in order to overcome this progressive anemia4 ,restrictions in the diet are essential4 ,these consist of limiting the amount of food and fluids as well as the type of food ingested4 ,restricting the ,proteins4--,proteins are restricted on account of the difficulty with which the end-products are eliminated by the kidneys1 also on account of the toxic character of these substances4 ,restricting the ,fluids4--,it is necessary1 on account of their difficulty of elimination and because they impose an excessive tax upon the circulatory organs4 ,treatment is largely dietetic in character by reason of the advantages just mentioned4 ,starvation ,treatment is instituted in order that the work of the kidneys may be lessened4 ,this treatment consists of abstinence from food with a definite reduction in the fluid intake4 ,it is found to be necessary during the acute stage of the disease4 ,extreme ,thirst1 which is apt to be an annoying symptom at this time1 is relieved1 as far as possible1 with small sips of water or ice pellets held in the mouth4 ,nephritic ,cures are devised1 as far as possible1 to relieve the acute symptoms and to prevent the disease from developing into a chronic condition4 ,milk is the basis of most of these cures4 ,it is given in definite amounts at stated intervals2 the quantity and frequency with which it is given being adjusted to the state of the disease and the condition of the patient4 ,the ,karell ,cure is one of the best known diet cures used in the relief of acute nephritis4 ,it consists of the giving of skimmed milk three or four times a day in doses ranging from three to six ounces for one week1 at the end of which time1 provided the stools remain solid1 an increase to two quarts a day is made4 ,constipation under the circumstances is a favorable symptom1 indicating as it does the agreement of the milk4 ,diarrhea as a result of gastro-intestinal disturbances has directly the opposite indication4 ,in these cases the milk must be reduced4 ,karell advises the boiling of milk and relieving the constipation by means of mild laxatives or enemas4 ,duration of the ,karell ,cure is from four to six weeks1 after which a gradual return to a normal diet is made4 ,hunger is apt to be prominent at this stage of the treatment and is relieved during the second or third week by giving a small piece of dry bread and milk1 soup thickened with a cereal1 once a day4 ,functional ,kidney ,tests are made to determine the character and extent of the impairment of the functions of the kidneys4 ,the diets used in these tests contain definite amounts of certain diuretic substances1 and the analysis of the urine voided during the twenty-four-hour period required by the test shows the nature of the impairment and furnishes1 in a measure1 a means of determining the amount of food and fluid which is safe for the patient to take4 ,it likewise shows the extent to which the restrictions in the salt and proteins are necessary4 ,salt-free1 or ,salt-poor ,diets are necessary in some cases4 ,while restriction in the amount of salt used in the preparation of food for the nephritic patient is always advisable1 if there is a tendency to edema1 the salt shaker should be left off the tray1 and when there is a definite amount of salt prescribed1 it should be weighed or measured for the day rather than for the meal1 and the amount consumed recorded after each feeding4 ,special ,points for the nurse to remember are the necessity for an early recognition of unfavorable symptoms--of instructing the patient upon leaving her care in the need for keeping the size of the meals small2--of the danger of indulging in alcoholic or other stimulating beverages2--of eating highly spiced foods1 or of eating anything which may cause gastro-intestinal disorders4 ,she should emphasize the need for regular examination of the urine and the value of rest and freedom from nervous excitement1 and the need of living in the sunshine as much as possible4 ,the nurse should study the diet list and become familiar with the foods allowed and those to be avoided4 ,the tables show the foods which are rich in salts and proteins4 ,she should likewise understand and be able to make the simple test for albumen in the urine and the method of collecting the urine for the test made in the laboratory4 ,,problems 7a7 ,outline a salt-poor diet for patient in which the fluids are limited to #aejj c4c4 per day4 7b7 ,formulate a diet for child of ten years with nephritis following scarlet fever4 7c7 ,write a diet order1 using a salt-free diet4 ,,footnotes3 #aad ,fisher's ,solution4 ,sodium carbonate 7pure crystals7 #ad ,sodium chloride #aj ,water #ajjj #aae ,the above diets used in the ,olmstead ,hospital1 ,rochester1 ,minn4 ,courtesy of ,m4 ,foley and ,d4 ,ellithorpe1 ,mayo ,clinic4 #aaf ,see ,section of ,recipes1 p4 #ade4 #aag ,for more extensive lists see ,table of ,ash ,constituents of ,common ,food1 pp4 #dgb to #dgg4 #aah ,journal of ,internal ,medicine1 ,vol4 ,,xiv1 #aiad4 #aai ,ibid4 #abj ,food for the ,sick1 p4 #ajh1 by ,strouse and ,perry4 #aba ,beans and peas belong to the class of foods known as legumes1 which are high in protein and must be treated as any other protein food4 #abb ,author's list and diet sheets4 #abc ,meats of all sorts should be boiled1 or only the inside portions allowed4 #abd ,some physicians exclude ice cream from the diet1 while others permit a small portion1 provided it is not so rich as to cause digestional disturbances4 #abe ,boiled sweetbreads are sometimes allowed1 but should never be given without the advice of a physician4 #abf ,the preparation of the menus requires care and attention2 meal must be small and all fried foods avoided4 #abg ,food for the ,sick1 p4 #aab1 by ,strouse and ,perry4 #abh ,medical ,clinics of ,chicago1 ,vol4 ,,ii1 ,no4 #e1 #aiag4 #abi ,copied from ,medical ,clinic of ,chicago1 ,vol4 ,,ii1 ,no4 #e1 #aiag4 #acj ,na,cl1 #b to #c grams in a capsule accompanying each meal4 ,any salt unused is returned to the diet kitchen1 where it is weighed and the amount used is indicated on the chart4 #aca ,carried out by ,dr4 ,henry ,christian and described by ,james ,o',hara in the ,archives of ,internal ,medicine1 ,vol4 ,,xvii4 #acb ,the outside parts of roast meat must be avoided1 even when meat is allowed once a day4 ,meat is only added after the condition materially improves4 #acc ,coleman1 in ,forchheimer's ,therapeusis of ,internal ,diseases1 ,vol4 ,i1 p4 #fdb4 ,,chapter ,,xix ,,diseases ,,of ,,the ,,heart ,the dietetic treatment in diseases of the heart has been the subject of much study1 especially during the past few years4 ,the ,diet4--,in this pathological condition1 as in many other diseases in which one or more of the functions of the body have become impaired1 there can be no hard and fast rule covering the treatment or diet for all cases1 but1 as in nephritis1 the condition of the individual1 his symptoms1 and the progress and extent of the disease must be taken into consideration in order to formulate a diet calculated to adequately nourish the body1 while at the same time imposing the smallest amount of work with the least expenditure of labor upon the part of the diseased organ4 ,division of ,treatment4--,the treatment of the disease then may be said to be divided into three stages3 first1 the stage of compensation2 second1 that of moderate compensation2 third1 that of decompensation4 ,the diet is directed1 first1 toward relieving as far as possible the strain which is imposed more or less by all the food eaten2 and second1 keeping up the general nutrition of the body4 ,dietetic ,treatment4--,no matter what has caused the impairment of the heart functions1 the treatment must necessarily remain the same as far as diet is concerned4 ,the patient is no longer able to handle a full and unrestricted diet4 ,as long as compensation is good1 the restrictions are scarcely noticeable2 alcoholic beverages and possibly tobacco may have to be1 to a certain extent1 curtailed1 and in some cases avoided altogether4 ,however1 if the individual desires to live and be comfortable while so doing1 he must lead a wholesome1 simple life1 since he cannot with safety indulge in any excesses1 either in diet or in any other particular4 ,diet in ,second ,stage4--,when the second stage sets in1 that is1 when the heart muscle is unable to perform its normal function1 attention must be directed toward two main points2 first1 the work of the heart2 second1 the pressure upon that organ from other sources1 namely1 the stomach and intestines4 ,as long as the food does not disagree1 that is1 so long as there is no fermentation or putrefaction of the food material in the stomach and intestines the flatulence arising from the evolution of gas in those organs is slight and the pressure upward upon the heart inconsiderable4 ,restricting the ,fluids4--,the heart must be spared all unnecessary work4 ,this can only be accomplished by limiting the amount of food and fluids ingested4 ,the latter imposes an extra burden upon the impaired organ to eliminate4 ,consequently1 the amount of fluid should be limited to #aejj c4c4 a day at most1 and in many cases considerably less than that quantity4 ,regulating the ,meals4--,the meals should be small and the intervals of feeding regular4 ,it has been found best to give the fluids between meals rather than with the food4 ,in many cases of heart disease1 as in certain nephritic conditions1 edema is a prominent symptom1 so that it is necessary to direct our efforts toward overcoming that particular condition4 ,the ,karell ,cure#acd and the salt-poor diet are used with excellent results4 ,the latter is not so low as the former1 and in many cases will accomplish all that is required4 ,a modified ,karell diet is used in the ,michael ,reese ,hospital#ace in ,chicago as follows3 ,,modified ,,karell ,,treatment 7,salt-free7 ,milk #bjj c4c4 at #h ,a4,m41 #ab ,m41 #d ,p4,m41 and #h ,p4,m41 for five to seven days4 ,eighth day--,milk same as above4 #aj ,a4,m4 one soft egg2 #f ,p4,m4 #b slices of dry toast4 ,ninth day--,milk as above4 #aj ,a4,m4 one soft egg and #b slices of toast4 ,tenth to twelfth day--,milk as above4 #ab ,m4 chopped meat1 rice boiled in milk1 easily digested vegetables4 #f ,p4,m4 one soft-boiled egg4 ,the diet is gradually increased until a full tray is reached4 ,all meats and vegetables should be chopped or scraped at first1 and the heavier foods should be given only when the heart is practically compensated4 ,rules and ,regulations4--,there are a few general rules which it has been found advisable to impress upon individuals suffering from a disease in which the muscles of the heart have become weakened4 ,the compensation of the organ may improve1 but there is still a danger of a reoccurrence or a further development more or less serious1 and at times fatal4 ,so for this reason1 certain rules must be observed throughout life3 ,first3 the necessity for keeping the meals small1 simple1 and digestible4 ,death at times occurs with symptoms of gastric disturbance1 which is1 after all1 due to the heart4 ,consequently it is not wise to invite such disaster by overeating1 or by the partaking of any food which is liable to bring about indigestion1 either in the stomach or in the intestines4 ,most authorities advise four or five meals a day rather than the regulation three1 and limit the fluids at meal time to a few ounces only1 when any are allowed1 and to a maximum amount of #aejj c4c4 during the day1 chiefly between meals4 ,second3 the need for limiting the amount and type of exercise taken1 especially after eating1 since the work of digestion requires all the power and strain of which the heart is capable1 and since an additional tax placed upon it by muscular exertion might readily be just the final straw1 the added fraction which weighs down the balance on the scale of life4 ,third3 the advisability of abstaining from alcoholic beverages1 unless specially prescribed by the physician in charge4 ,certain elderly people suffer from a condition known as senile heart1 which is more or less associated with arteriosclerosis and high blood pressure4 ,these individuals should be prevailed upon to take the precaution of regulating their habits of life1 avoiding excesses of all kinds1 not only on account of the weakened condition of the heart1 but also on account of the condition of the arteries4 ,they should avoid excitement and worry1 since the very fact that they are worrying increases the blood pressure4 ,simple foods in limited quantities1 five meals a day instead of three1 and an avoidance of too much fluid1 should be the keynote of their daily regime4 ,tact on the part of the nurse is necessary in all cases1 both young and old4 ,it is often more difficult to instill good dietary habits in heart patients1 after acute symptoms have subsided1 than to carry them out during the acute attack1 when the life itself depends upon a rigid adherence to the diet prescribed4 ,but as these rules and regulations are essential to the future welfare of the patient1 he must be taught with care1 and in such a way that he will not be alarmed to an extent when more harm than good will come of the teaching4 ,the diet should consist chiefly of milk1 eggs1 rare meat in moderation 7mutton1 chicken1 fish1 and oysters71 well-baked bread1 well-cooked cereals1 potatoes and green vegetables1 and simple desserts4 ,all foods which in any way cause gastric or intestinal disturbances must be avoided4 ,if these disturbances arise during the course of the disease1 the patient should be promptly returned to the strict milk diet4 ,when edema is prominent1 it is treated as already described in the treatment for the like condition in nephritis by the ,karell or salt-free diet4 ,the dietetic treatment given here is merely a guide to be used under certain conditions4 ,the physician formulates the diet1 and the nurse must understand what to expect and how to apply the treatment as the symptoms arise4 ,,summary ,dietetic ,treatment1 adjusted to relieve the weakened heart muscles and to save the organ from all possible strain4 ,three ,stages1 during which the treatment changes according to the extent and progress made by the disease4 ,first ,stage3 ,the diet is practically normal4 ,compensation is good1 consequently no dietary measures save the limiting of alcoholic beverages are necessary4 ,second ,stage3 ,the compensation is only moderate and the heart cannot perform its normal functions1 hence the diet must be directed toward relieving any pressure upon the organs from other organs and toward lessening the work of the heart itself4 ,third ,stage3 ,in which the compensation is decidedly impaired and for this reason the dietetic treatment undergoes a decided change4 ,digestional ,disturbances in which there is an evolution of gas in the stomach or intestines may cause a pressure against the heart which is distinctly bad for it4 ,limiting the ,fluids in the diet in heart disease is necessary when the compensation is only moderate1 as they impose an extra burden upon the organ to eliminate them4 ,amount of ,food must also be limited4 ,the meals must be small and taken without fluid4 ,the latter should be taken between meals4 ,edema occurs in a number of cases and must be treated as in nephritic conditions by limiting the fluids and by confining the diet to salt-poor foods4#acf ,karell ,cure or modification thereof has been used with good results in many cases of heart disease4 ,exercise must be limited in amount and confined to types which will not impose a tax upon the weakened heart muscles4 ,exercise after eating is especially to be discouraged1 as this1 together with the efforts required for the digestion of food1 might readily prove too much for the heart to accomplish4 ,elderly ,patients must be warned against exercises of all kinds1 not only on account of the condition of the heart1 but also on account of the condition of the arterial walls4 ,these harden with age and break down under undue pressure4 ,the ,nurse should instruct the patient on the points necessary for the saving of the heart4 ,she should teach the necessity for keeping the meals small and having them more frequently if necessary2 of limiting the fluids at meals to a few ounces or leaving them out altogether at this time4 ,she should know how necessary is the reduction of the fluid4 ,she should also warn against the taking of alcoholic beverages except with the permission and advice of a physician4 ,excitement and ,worry increase the blood pressure1 hence must be avoided by individuals suffering with any form of heart disease4 ,,problems 7a7 ,write a diet order for an elderly patient with severe cardiac disturbance4 7b7 ,outline the method of administering the ,karell diet4 ,,footnotes3 #acd ,see ,karell ,cure1 p4 #cdb4 #ace ,food for the ,sick1 p4 #aej1 by ,strouse and ,perry4 #acf ,see ,salt-poor ,diets1 p4 #cda4 ,,chapter ,,xx ,,diabetes ,,mellitus ,definition4--,diabetes is a disease which is characterized by an inability on the part of the body to utilize the carbohydrates1 in consequence of which there is abnormal excretion of glucose in the urine4 ,sugar in the ,urine4--,the appearance of sugar in the urine may not necessarily signify diabetes1 it may be merely a temporary glycosuria due to certain pathological conditions1 such as infectious diseases1 diseases or trauma which affect the pancreas1 and which disappear upon the recovery from the disease4 ,but any appearance of sugar in the urine should be looked upon with suspicion1 since the future welfare of the patient depends largely upon an early diagnosis in any form of diabetes4 ,true ,diabetes4--,allen claims that true diabetes may always be distinguished from nervous glycosuria by the application of the laws governing these conditions 7,allen's ,paradoxical ,law#acg71 which is whereas in normal individuals the more sugar given the more is utilized1 the reverse is true in diabetes4 ,manufacture of ,sugar from ,other ,foods4--,if the carbohydrate foods alone caused all the trouble in diabetes1 the disease might be more easily controlled4 ,this1 we found1 however1 not to be true1 since in certain conditions the body utilizes the protein foods for the manufacture of glucose also4 ,consequently in diabetes if the absolute sugar output of the body is to be controlled1 the intake of nitrogenous foods must be likewise adjusted4 ,functions of ,carbohydrates4--,in the chapter describing the functions of the carbohydrates in the human body it was demonstrated that their energy-producing properties did not cover the extent of their usefulness4 ,it has been proved that this food constituent normally acts as neutralizing agent for the toxic acids produced within the organism as a result of the breaking down of the fats4 ,hence1 when this function of the carbohydrates becomes impaired1 these acids1 ,oxybutyric acid1 ,diacetic acid and ,acetone1 fail to be neutralized and are consequently absorbed into the blood stream1 giving rise to a form of intoxication known as acidosis4 ,when acidosis becomes extreme1 the diabetic patient is apt at any time to succumb to the dreaded diabetic coma4 ,keeping ,urine ,sugar ,free4--,thus it is seen that the treatment of diabetes mellitus consists not alone of freeing the urine from sugar and keeping it free1 but of controlling the acidosis which may at any time develop4 ,diabetic ,cures4--,numberless so-called diabetic cures have been brought forward and more or less tested for years1 but whether they have really accomplished cures has not been satisfactorily proved4 ,not until ,dr4 ,allen instituted what is known as the ,allen's ,starvation ,treatment has the disease been so universally treated1 at least by one method or modification of one method4 ,dr4 ,joslin1 who has used this treatment most successfully1 does not claim to have accomplished a cure1 but states that he is watching the results of the treatment in his patients with interest4 ,starvation ,treatment4--,the ,allen ,starvation ,treatment consists of first a period of about forty-eight hours in which the patient is given an ordinary diet1 during which time the daily weight is taken and the urine examined and recorded4 ,acidosis4--,it has been found in some cases1 such as with elderly patients or those in whom there is an evident acidosis1 advisable to precede the period of starvation by a preliminary treatment4 ,method of ,treatment4--,joslin#ach suggests the following method of procedure3 ,without otherwise changing the diet omit fat4 ,after two days1 omit protein1 then halve the carbohydrates daily until the patient is taking only ten grams1 then fast4 ,in the ,michael ,reese ,hospital1 the following series of test diets are given to determine the severity of the diabetes3 ,,diabetic ,,test ,,diets#aci ,,breakfast ,grapefruit #a_/b ,eggs #b ,bacon #bj grams ,bread #be grams ,butter #aj grams ,cream #ae c4c4 ,coffee #a cup ,,dinner ,cream soup #c oz4 ,roast beef #ge grams ,spinach #ajj grams ,kohl-rabi #ajj grams ,lettuce salad #ej grams ,ripe olives #ae grams ,bread #be grams ,butter #bj grams ,wine gelatin #d oz4 ,coffee ,cream #ae c4c4 ,,supper ,lamb chop #a ,asparagus tips #ej grams ,eggplant #ej grams ,tomato salad #ej grams ,custard 7diabetic7 ,coffee ,cream #ae c4c4 ,butter #bj grams ,bread #be grams ,diet in ,mild ,cases4--,this diet contains approximately #gj grams of protein1 #ajj grams of fat1 and #gj grams of carbohydrates1 and the patient is kept on it for at least two days2 then the carbohydrates are cut down by taking away #be grams of bread every day4 ,,diabetic ,,diets#adj ,,key ,a ,carbohydrate ,b ,protein ,c ,fat ,d ,calories ,e #e ,vegetable ,f ,orange ,g ,oatmeal ,h ,shredded ,wheat ,i ,uneeda ,j ,potato ,k ,bread ,l ,egg ,m ,cream #bj ,fat ,n ,bacon ,o ,butter ,p ,meat ,q ,fish ,r ,skimmed ,milk ,s ,name of ,diet ,t ,maintenance ,diets ,diets ,diet in with ,grams ,test ,diets which to-------------------------------------- ------- become ,sugar free ,a ,b ,c ,d ,e ,f ,g ,h ,i ,j ,k ,l ,m ,n ,o ,p ,q ,r ,s ---------------------------------------- --------------- ,t4 ,d4#a #ahihiaeabdgcjjcjj #a #bdjij #ijabjdhj #a ,t4 ,d4#b #ajbeh #j #fdjcjjcjj #a #abj #ahjcjj #b ,t4 ,d4#c #fdcc #j #chhcjjcjj #fj #ijbdj #c ,t4 ,d4#d #cfbg #j #bebcjjbjj #ijabj #d ,t4 ,d4#e #ae #e #j #hjcjj #ej #e ---------------------------------------- --------------- ,carbohydrate ,protein and ,fat ,t 7,c7 7,,pf7 ---------------------------------------- --------------- ,c#a ,,pf#a #ajaa #f #achcjj #a #a ,c#b ,,pf#b #bbacah #cjbcjjajj #a #fj #b ,c#c ,,pf#c #cbbdbd #ddjfjjajj #b #fj #c ,c#d ,,pf#d #dbbici #fcefjjbjj #b #fjcj #d ,c#e ,,pf#e #ebcbec #hacfjjbjjae #b #fjcjae #e ,c#f ,,pf#f #fcdcfeajjifjjbjjcj #b #ijcjae #cj #f ,c#g ,,pf#g #gceagjaabffjjcjjcj #b #ijcjae #fj #g ,c#h ,,pf#h #hceihgaceafjjcjjcj #b #b #ijcjcj #ij #h ,c#i ,,pf#i #iffbicadfifjjcjjcja_/bb #babjcjcj #ij #i ,c#aj,,pf#ajajgfcicaeagfjjcjjcj #a #b #babjcjcj #ij #aj ,c#aa,,pf#aaacageihagjffjjcjjcj #a #babj #babjcjcjabj #aa ,c#ab,,pf#abaeegiihahahfjjcjjcj #a #bbdj #babjcjcjabj #ab ,weight in ,approximate ,food grams equivalent ,orange #cjj ,one and one-half 7large size7 #e per cent vegetables #cjj ,three moderate portions ,skimmed milk #dhj ,one pint 7#af ounces7 ,fish #abj ,two small portions ,potato #bdj ,two medium sized potatoes ,meat #ij ,one moderate portion ,bread #ij ,three small slices ,oatmeal 7dry wgt47 #cj ,one large saucerful ,cream #fj ,four tablespoonfuls ,bacon #cj ,four crisp strips ,butter #cj ,three medium portions ,the ,test ,diets are designed for the period during which the patient becomes gradually sugar free4 ,on successive days advances can be made from ,test ,diet #a to ,test ,diet #e1 and if on the fifth day the patient is not sugar free1 fasting can be employed for one or more days4 ,the ,maintenance ,diets are for use so soon as the urine of the patient is free from sugar4 ,if this occurs as a result of ,test ,diet #e the patient begins with ,maintenance ,diet ,c#a,,pf#a4 ,the actual articles of food representing the carbohydrate in the diet for the first day are given under the heading of carbohydrate1 for convenience described ,c#a1 #b1 #c1 etc4 ,the articles referred to under protein and fat are under that heading1 which for the same reason is described as ,,pf#a1 #b1 #c1 etc4 ,certain cases of diabetes can proceed steadily day by day from ,c#a,,pf#a to ,c#ab,,pf#ab1 without showing sugar4 ,if sugar does appear in the urine1 drop back two days in the carbohydrate group1 wait till sugar free1 then advance in the protein and fat group until sufficient calories are obtained4 ,thus1 if sugar shows on ,c#g,,pf#g the diet prescribed would be that included in ,c#e,,pf#g and thereafter progression could be made in the ,,pf group until twenty-five to thirty calories per kilogram body weight were furnished the patient4 ,occasionally the patient becomes sugar free on ,test ,diet #b1 #c1 or #d4 ,it is then unnecessary to begin with ,maintenance ,diet ,c#a,,pf#a1 but instead with a maintenance diet which contains a value for carbohydrate similar to that of the test diet upon which the patient became sugar free4 ,if the protein and fat are too high for the individual on a given day it is easy to advance the carbohydrate and decrease to an earlier day on protein and fat4 ,the plan is arbitrary and the majority of cases will demand some modification4 ,it is arranged to enable patient or nurse to see in advance the general plan of treatment4 7,courtesy of ,dr4 ,joslin and ,thomas ,groom ,co41 ,boston47 ,if the case is a mild one1 this may be sufficient to free the urine from sugar1 but the diet is given primarily to enable the physician to find out by means of urinalysis just how great is the functional impairment4 ,in some cases1 which are mild in character1 the urine is made free of both sugar and acetone without further dietetic measures4 ,however1 when a severe diabetes is manifested and a high percentage of glucose and in some cases acetone bodies are found in the urine a more rigid treatment will be found necessary4 ,preliminary ,diet4--,many physicians find it advisable1 as has already been stated1 to cut down the food allowance before stopping it entirely4 ,in the ,michael ,reese ,hospital this is done by first giving a practically fat-free diet1 followed by one or two days in which three or four eggs1 #bej to #cjj grams 7#h or #aj ounces7 of #e vegetables are given1 after which it is found safe to institute the starvation treatment4 ,sample ,menus4--,the following menus are given to illustrate the dietetic treatment which it is deemed advisable to institute in cases where the starvation treatment cannot be given at once3 ,after the test diet of forty-eight hours1 the following regime is instituted3 ,,third ,,day ,protein ,fat ,carbohydrate ,gm4 ,gm4 ,gm4 ,calories ---------------------------------------- ----------------------------- ,breakfast3 #a_/b grapefruit #e #bj #a egg #e4c #d4a #ei #a slice bread #cj gm4 #b4f 4#c #ae #gc ,tea or coffee ---------------------------------------- ,total for meal #g4i #d4d #bj #aeb ,dinner3 ,broth #ahj c4c4 #c4g 4#ag 4#cd #ah ,chicken 7breast7 #ij gm4 #ah4b #b4a #ib ,spinach #ajj gm4 #b4j #c4j #bj ,potato 7#a medium7 #ij gm4 #a4h 4#ji #ae4f #gj ,lemon jelly #ij gm4 #d4b #b4g #bg ---------------------------------------- ,total for meal #bi4i #b4c #ba4f #bbg ,supper3 ,lamb chop #ej gm4 #i4c #ad4a #abf ,asparagus #ajj gm4 #a4e #c #ah ,bread #bj gm4 #a4f 4#b #aj #dh ,tea or coffee ---------------------------------------- ,total for meal #ab4d #ad4c #ac #aib ,total for day #dj4b #ba #ed4f #ega ,,fourth ,,day ,protein ,fat ,carbohydrate ,gm4 ,gm4 ,gm4 ,calories ---------------------------------------- ----------------------------- ,breakfast3 #a_/b grapefruit #e #bj #a egg #e4c #d4a #ei #a slice bread #bj gm4 #a4f 4#b #aj #dh ,coffee or tea ---------------------------------------- ,total for meal #f4i #d4c #ae #ajg ,dinner3 ,tomato bouillon #ahj gm4 #b4b 4#bc #b4e #ae ,whitefish #ij gm4 #b #e #bh ,boiled onions #ajj gm4 #a4e 4#c #g4e #dj ,bran muffin 7#a7 #e #g #d4e #aja ,tea or coffee ---------------------------------------- ,total for meal #be4g #af4b #bj4e #cbb ,supper3 #a egg #e4b #d4a #ei ,tomato 7baked7 #ajj gm4 4#f #b #aj ,bran muffin 7#a7 #a #e #g #aja ,tea or coffee ---------------------------------------- ,total for meal #f4h #i4a #i #agj ,total for day #ch4d #bi4f #dd #eac ,,fifth ,,day ,protein ,fat ,carbohydrate ,gm4 ,gm4 ,gm4 ,calories ---------------------------------------- ----------------------------- ,breakfast3 #a_/b grapefruit #e #bj ,broiled tomato #ajj gm4 #a4e #c #ah ,tea or coffee ---------------------------------------- ,total for meal #a4e #h #ch ,dinner3 ,broth #abj c4c4 #c #ab ,lettuce #ej gm4 4#e #a4e #h ,cauliflower #ij gm4 #a4e 4#d #c4i #be ,tea or coffee ---------------------------------------- ,total for meal #e 4#d #e4d #de ,supper3 #a egg #e4ce #d4af #ei ,string beans #ajj gm4 #b #e #bh ,celery #ej gm4 4#e #a4e #h ,tea or coffee ---------------------------------------- ,total for meal #g4he #d4af #f4e #he ,total for day #ad4c #ab4e #ai4i #afh ,,sixth ,,day ,protein ,fat ,carbohydrate ,gm4 ,gm4 ,gm4 ,calories ---------------------------------------- ----------------------------- ,breakfast3 ,asparagus tips #fj gm4 #a4e #c #ah ,spinach #fj gm4 #a4a #a4h #a4h #cb ,tea or coffee ---------------------------------------- ,total for meal #b4fh #a4h #e4h #ej ,dinner3 ,stewed celery #ajj gm4 #a 4#aj #b4a #ae ,string beans #ej gm4 #a4e #b4e #af ,tea or coffee ---------------------------------------- ,total for meal #b4e 4#a #e4f #ca ,supper3 ,beet tops #ge gm4 #a4e #b4e #af ,onions 7boiled7 #ge gm4 #a4e 4#c #g4e #dd ,tea or coffee ---------------------------------------- ,total for meal #c 4#c #aj #fj ,total for day #aa4b #b4b #ba4d #ada ,,fast ,method of ,administering ,treatment4--,in many cases the patient is first put to bed during the starvation treatment1 but recently ,dr4 ,allen has emphasized the value of exercise1 claiming that it assists in utilizing the sugar4 ,in any case1 the starvation regime remains the same4 ,the patient is given only coffee or clear broth with or without whisky 7one ounce every two hours7 and the treatment continued from one to four days1 or until the urine becomes sugar free4#ada ,it has rarely been found necessary to continue the fast longer than four days1 since in most cases the sugar decreases rapidly upon the discontinuance of food4 ,loss of ,weight4--,the slight loss of weight1 which may be noticeable as the result of starvation1 is not undesirable1 especially in those cases where obesity is a prominent feature4 ,in fact care must be exercised in the follow-up treatment to prevent the taking on of weight by the diabetic individual1 since1 according to ,allen1 it is often found that even moderately obese patients 7#ahj lb47 continue to excrete a small amount of sugar so long as they hold this weight1 even upon a low carbohydrate diet1 whereas those same patients show no difficulty in becoming sugar free if the weight is reduced by ten or fifteen pounds4 ,,schedule ,,for ,,treatment ,,and ,,methods ,,of ,,determining ,,food ,,tolerances ,a number of schedules have been devised to enable the nurse successfully to carry out the ,allen ,treatment4 ,in following out this treatment and reeducating the organs afterward to tolerate foods which they have been unable to handle on account of the impairment of the sugar-making organs1 it is necessary to make a series of tests whereby the diet is gradually increased in its various constituents until the diabetic patient is able to handle a reasonable amount of carbohydrates as well as other foods which have given more or less trouble in the past4 ,the following schedule1 after ,joslin1#adb is included1 and a careful study of it is advised in order that the nurse may intelligently carry out the ,allen ,treatment4 ,schedule4--,fasting in many cases begins at once and the patient experiences no ill effects from it4 ,however1 in severe1 long-standing cases many patients do better if the fats are omitted at once and the rest of the diet left unchanged for two days4 ,then the proteins in the diet are omitted and the carbohydrates cut in half4 ,this halving of the carbohydrates is continued daily until only #aj grams remain1 after which they too are omitted4 ,the fast is thus made complete and remains so until the urine is entirely free from sugar4 ,carbohydrate ,tolerance is determined by giving1 as soon as the urine has been sugar-free for twenty-four hours1 #aej grams of #e vegetables4 ,this is equivalent to from #h to #aj grams of carbohydrates4 ,after this #e grams of carbohydrates1 or #ge grams of #e vegetables1 are added daily to the diet until the patient is taking #bj grams4 ,then the addition of #e grams of carbohydrates is made every other day1 using the fruits and vegetables belonging to the #aj and #ae carbohydrate group1 until potatoes and oatmeal and finally bread can be tolerated unless sugar appears in the urine before this or the tolerance reaches #c grams to each kilogram of body weight or1 in other words1 until a man weighing #aej pounds is consuming #bbe grams of carbohydrates per day4 ,protein ,tolerance4--,in making the test for the protein tolerance it is necessary to wait until the urine has been sugar free for forty-eight hours2 #bj grams of protein is then given4 ,this is equivalent to #c eggs1 and daily additions of #e grams protein are made1 usually in the form of meat1 until the patient is receiving #a gram of protein to every kilogram of his body weight per day unless his carbohydrate tolerance is zero1 in which case it is wise to add only three-fourths of a gram of protein per day4 ,fat ,tolerance4--,a determination of the fat tolerance is made coincidently with that of the protein4 ,no additional fat is allowed until the protein tolerance reaches #a gram per kilogram of body weight1 unless the patient's tolerance for protein is less than that4 ,after which #be grams of fat per day are added until there is no further loss of weight1 taking care never to allow more than #dj calories per kilogram of body weight4 ,reappearance of ,sugar4--,should the urine again show the presence of sugar1 another period of fasting lasting for twenty-four hours1 or until the urine is again sugar free1 must be instituted4 ,after the second fast the increase in the diet may be twice as rapid as used after the first fast4 ,however1 it is not advisable to increase the amount of carbohydrates to more than half of that determined by the former tolerance for a period of two weeks1 during which time the urine has been entirely sugar free1 then the increase is made more slowly and the amount given should not exceed #e grams a week4 ,weekly ,fast ,days4--,one day in seven should be set aside by the diabetic patient for fasting1 when the carbohydrate tolerance is less than #bj grams4 ,when1 however1 the tolerance is between #bj and #ej grams of carbohydrates1 the patient may take one-half of his daily allowance of protein and fat and a certain amount of #e vegetables as well upon the weekly fast day4 ,when the tolerance reaches between #ej and #ajj grams per day1 vegetables of a higher carbohydrate content may also be included4 ,if the carbohydrate tolerance should exceed #ajj grams per day1 the carbohydrates upon the fast day may be simply half of the amount allowed upon other days4 ,the ,giving of ,alkalies4--,if acidosis is evident1 as may be indicated by an excretion of diacetic acid1 oxybutyric acid1 or acetone in the urine1 alkalies may be given4 ,bicarbonate of soda may be given in doses of #b grams every #c hours1 as suggested by ,hill and ,eckman1#adc but this is not as a rule necessary1 for1 as ,jacobi aptly remarks3 ,prevention is the treatment of acidosis in children1 and those susceptible to acidosis should not have fat4 ,what he has said for children holds good for adults4 ,however1 it is likewise true that fat must constitute a large part of a diabetic diet and the only way to prevent it poisoning1 is to raise the fat in the diet gradually until the tolerance is determined4 ,determining the ,extent of ,acidosis4--,it will be remembered that in an earlier chapter it was found that the excretion of ammonia in the urine to a certain extent indicated the extent of the acidosis in the body1 that is1 if the ammonia output exceeds three or four grams a day 7twenty-four hours71 the extent of the acidosis is considerable1 while if it falls below that amount it is not alarming4 ,more exact methods1 however1 for the determining of the severity of the acidosis will be found in another part of this text1 where the test for sugar and the acetone bodies will be explained in detail4 ,dietetic ,treatment4--,the patient is placed upon a vegetable diet consisting of vegetables containing not more than five per cent4 carbohydrate4#add ,these vegetables have their carbohydrate content still further reduced by changing the water in which they are cooked three times4 ,in many cases this will reduce their content as much as one-half4 ,a small amount of fat usually in the form of butter is allowed with these vegetables4 ,the amount of #e vegetables given must be carefully adjusted since the patient might readily take too much if allowed to follow the dictates of his appetite4 ,the carbohydrate intake during the first one or two days must be limited to #ae grams4 ,this allows about #aj grams of protein1 #g grams of fat1 and #ae grams of carbohydrates4 ,tea or coffee1 without sugar or cream1 may be given at each of the three meals4 ,the following table is included1 showing the various foods arranged according to their carbohydrate content3 ,,table#ade ,,strict ,,diet ,meats1 fish1 broths1 gelatin1 eggs1 butter1 olive oil1 coffee1 tea1 and cracked cocoa4 ,foods arranged approximately according to per cent of carbohydrates #e #aj #ae #bj ---------------------------------------- -------------------------- ,lettuce ,pumpkin ,greens ,potatoes ,cucumbers ,turnip ,peas ,shell beans ,spinach ,kohl-rabi ,artichokes ,baked beans ,asparagus ,squash ,parsnips ,green corn ,rhubarb ,beets ,lima beans ,boiled rice ,f ,endive ,carrots 7canned7 ,boiled macaroni r ,marrow ,onions ,prunes ,v e ,sorrel ,mushrooms e s ,sauerkraut g h ,beet greens e ,dandelion t o ,swiss chard a r ,celery b ,brussels sprouts l ,c ,water cress e a ,sea kale s n ,okra 1 n ,cauliflower e ,eggplant d ,cabbage ,radishes ,leeks ,string beans ,broccoli ,tomatoes ---------------------------------------- -------------------------- ,ripe olives ,lemons ,apples ,plums ,f 7#bj fat7 ,oranges ,pears ,bananas r ,grapefruit ,cranberries ,apricots u ,blackberries ,blueberries i ,gooseberries ,cherries t ,peaches ,currants s ,pineapple ,raspberries ,watermelon ,huckleberries ---------------------------------------- -------------------------- ,butternuts ,brazil nuts ,almonds ,peanuts #dj ,n ,pignolias ,black walnuts ,english walnuts ,chestnuts u ,hickory ,beechnuts t ,pecans ,pistachios s ,filberts ,pine nuts ,m ,unsweetened and unspiced ,reckon available carbohydrates i pickle1 clams1 oysters1 in vegetables of #e group as #c1 s scallops1 liver1 fish of #aj group as #f4 c roe4 4 #cj grams 7#a oz47 contains approximately3 ,protein,fat,carbohydrate ,gm4 ,gm4 ,gm4 ,calories ---------------------------------------- ---------------------------- ,oatmeal1 dry weight #e #b #bj #aaj ,meat 7uncooked ham7 #f #c #j #ej ,meat 7cooked ham7 #h #e #j #ge ,broth #j4g #j #j #c ,potato #a #j #f #be ,bacon #e #ae #j #aee ,cream1 #dj #a #ab #a #abj ,cream1 #bj #a #f #a #fj ,milk #a #a #a4e #bj ,bread #c #j #ah #ij ,butter #j #be #j #bdj ,egg 7one7 #f #f #j #ge ,brazil nuts #e #bj #b #baj ,orange or grapefruit 7one7 #j #j #aj #dj ,vegetables1 #e and #aj groups #j4e #j #a or #b #f or #aj ,oysters #f #a #d #ej ---------------------------------------- ---------------------------- ,,table#adf ,carbohydrate equivalent of #a slice of white bread 7#a oz4 or #cj gm47 containing approximately #ae gm4 of starch ,uncooked ,household ,cooked ,household ,flours1 etc4,measure#adg;,gm4 ,vegetables ,measure ,gm4 ---------------------------------------- ---------------------------- ,barley #a h4 tbs4 #ba ,artichokes #a medium #cbj ,buckwheat #a h4 tbs4 #ai ,beans 7baked ,corn meal #a h4 tbs4 #bj canned7 #b h4 tbs4 #ge ,farina #a h4 tbs4 #bj ,beans1 lima #a-a_/d tbs4 #ej ,hominy #a h4 tbs4 #ah ,beets #f tbs4 #bjj ,macaroni #a h4 tbs4 #bj ,carrots #ac tbs4 #ddf ,noodles #a-a_/b h4 tbs4 #bj ,okra #d tbs4 #bjj ,oatmeal #a h4 tbs4 #bb ,onions #c tbs4 #cjj ,rice #a h4 tbs4 #ah ,parsnips #d slices #abj ,rye flour #a h4 tbs4 #ah ,peas1 green #c h4 tbs4 #ajj ,spaghetti #a-a_/b tbs4 #bj ,potatoes ,vermicelli #a-a_/b tbs4 #ba 7baked7 #a_/b medium #fj ,wheat flour #a tbs4 #bj ,potatoes 7boiled7 #a_/b medium #gj ,potatoes 7mashed7 #a-a_/b h4 tbs4 #hj ,potatoes1 sweet 7boiled7 #a_/c medium #ce ,squash #b h4 tbs4 #ajj ,turnips #c #baj ,bread and ,cooked ,cereal ,crackers ,force #e h4 tbs4 #ah ,bread #a slice #cj ,farina #b-a_/b h4 tbs4 #abe ,breakfast ,grape-,nuts #a-a_/b h4 tbs4 #bj biscuit1 ,hominy #a-a_/b h4 tbs4 #ij ,huntley ,macaroni #b h4 tbs4 #ajj and ,palmer #c #ah ,oatmeal #b-a_/b h4 tbs4 #acj ,corn bread #a slice #cb ,rice #a_/b h4 tbs4 #fj ,roll1 ,vienna #c #ah ,shredded wheat ,zwieback #a-a_/c #bj biscuit #c_/d #bb ,fruits ,apple #a medium #abj ,apricots #b large #abj ,dried ,fruit ,banana ,apples #c small #bb 7without skin7#a_/b medium #ge ,apricots #c large #bd ,cherries #ij ,currants #a-a_/b h4 tbs4 #bj ,currants #e h4 tbs4 #abj ,dates #c #ai ,grapefruit #a_/b small #aej ,figs #a large #ab ,huckleberries #c-a_/b tbs4 #ij ,prunes #b large #bd ,lemons #b medium #baj ,raisins #aj large #bc ,muskmelon #a_/c #cjj ,nectarine #a #ajj ,milk and ,household ,olives 7green7 #bj #ahj ,cream ,measure ,c4,c4 ,orange #a_/b large #aej ,buttermilk #a-a_/b tumbler #cjj ,peaches #a-a_/b medium #aej ,cream1 #af #a-a_/b tumbler #cjj ,pear #a small #ajj ,cream1 #dj #a-a_/b tumbler #cjj ,pineapple #c slices #aej ,koumiss #a-a_/b tumbler #cjj ,plums #c medium #ge ,whole milk #a-a_/b tumbler #cjj ,raspberries #d-a_/b h4 tbs4 #abj ,strawberries #h h4 tbs4 #bjj ,nuts ,gm4 ,watermelon large slice #cjj ,almonds #fj #ij ,brazil #cj #ahj ,chestnuts 7roasted7 #ae #dj ,cocoanut #a slice 7#c x #b in47 #ej ,filberts #ajj #aaj ,peanuts #dj #hj ,pecans #ce #aaj ,pistachios #aij #ie ,walnuts #cj #abe ,,table#adh ,caloric equivalent of #aj gm4 steak in carbohydrate-free meat or fish ,food ,gm4 ,fat ,protein ,calories ,gm4 ,gm4 ---------------------------------------- ------------------------ ,steak #aj #a4j #b4d #ai ,roast beef #e #a4d #a4a #ah ,tongue #g #a4d #a4f #bj ,lamb chop #e #a4e #a4a #ah ,roast lamb #h #a4c #a4f #bj ,sweetbreads #aa #j4a #d4d #ai ,boiled ham #g #a4d #a4e #ai ,fried ham #e #a4g #a4a #bj ,roast pork #i #j4i #b4f #ai ,bacon #i #a4g #j4i #bj ,chicken #aj #a4j #b4d #ai ,duck #i #a4c #a4h #ai ,guinea hen #ab #j4h #b4h #ai ,squab #i #a4a #b4a #ai ,turkey #g #a4c #b4j #bj ,bluefish #ac #j4f #c4e #bj ,halibut #af #j4g #c4c #bj ,mackerel #ae #a4j #b4e #bj ,sardines in oil #g #a4d #a4f #bj ,approximate equivalent in #cj c4c4 7#a oz47 of whisky in liquors containing #b per cent or less of carbohydrates ,household ,c4,c4 ,measure ---------------------------------------- ------------------- ,gin1 rum1 brandy #cj #b tbs4 ,claret1 ,burgundy ,hock1 ,rhine and ,moselle wines #acj-afj #c_/d tumbler ,,carbohydrate-,,free ,,menus ,the following menus are suggested as meeting the carbohydrate-free diet requirements with a nutrient value of from #bjj to #ejj calories3 ,breakfast--,black coffee 7cream1 #bj c4c47 ,bacon1 #b slices 7#a oz47 #cj grams ,egg--#a ,dinner--,broth1 #f ounces #ahj grams ,steak1 #a small piece1 #a-a_/c oz4 #dj grams ,stewed tomatoes1 #c-a_/c oz4 #ajj grams ,lettuce 7lemon juice and olive oil7 #be grams ,supper--,broth #ahj grams ,whitefish #dj grams ,spinach #ajj grams ,cabbage salad #ajj grams ,coffee ,breakfast--#a_/b grapefruit #a egg ,bacon #dj grams ,coffee #ej grams ,cream #bj c4c4 ,dinner--,broth #ahj c4c4 ,kohl-rabi #ajj grams ,lettuce #be grams ,cheese salad #ej grams ,roast beef #dj grams ,coffee ,butter #e grams ,supper--,cold chicken #be grams ,baked tomatoes #ajj grams ,water cress #ej grams ,coffee ,cream #bj c4c4 ,butter #e grams ,,table ,,key3 ,a ,protein ,gm4 ,b ,fat ,gm4 ,c ,carbohydrate ,gm4 ,d ,calories ,material ,measure ,a ,b ,c ,d ---------------------------------------- --------------------------- ,apple #a medium 7#aej gm47 4#e 4#e #af #gj ,almonds#adi #aj small 7#aj gm47 #b #e #b #fc ,apricots 7dried7 #a oz4 7#cj gm47 #a4e 4#bh #ag4e #gh ,asparagus #f large stalks #a4c 4#ad #b4e #af 7#gd gm47 ,bacon 7raw7#adi #d slices1 #f in4 long1 #aj #fd #fcf #b in4 wide ,bacon 7cooked7#adi #d slices1 #f in4 long1 #aj #cb to #chh to #b in4 wide #df #dfh ,beef juice#aej #ajj gm4 #d4i 4#f #be ,beef roast#adi #a-a_/b in4 x #a_/h in4 #f #g #hi ,cheese#adi 7,neufchatel7 #a cheese #b-a_/d in4 x #af #bc #a #bhd #a-a_/b in4 x #a-a_/d in4 ,cream1 gravity #af #a glass 7#g oz47 #e #cb #aj #cei ,cream1 #dj #cj c4c4 7#b tbs47 4#f #ab #a #aad ,cracker 7,uneeda #a biscuit #a 4#e #a #af biscuit7 ,dry peptonoids#aej #a tbs4 #f #h #eg ,egg #a medium 7#de to #ed #d4b #fj #ej gm47 ,fowl #c-a_/b oz4 7#ajj gm47 #ai4c #af4c #bbd ,grapefruit #a_/b #e #bj ,ham 7lean7 #ej gm4 #ab4d #g4a #aac ,lemon juice#aea #c tbs4 7#dc gm47 #d4b #ai ,lemon ,jelly#aeb #c oz4 7#ij gm47 #b4f #a4d #af ,milk 7whole7 #a glass 7#h oz47 #g4i #i4f #aj #aeh #bdj c4c4 ,oatmeal#aec #a tbs4 7#ej gm47 #a #f #cc ,oatmeal #a_/b cup 7#c4f oz47 #b4a 4#a #h4b #ej ,potato#aec 7size large egg7 #a 7#ajj gm47 #b 4#h #hc #e vegetable#aec uncooked #a tbs4 #b4e #aj #e vegetable 7boiled once7 #a tbs4 #a4g #g #e vegetable 7boiled thrice7 #a tbs4 #a #d ,orange #a large #a4g 4#b #bb4g #ajj ,orange#aec #a medium #a #ac #eg ---------------------------------------- --------------------------- ,increasing the ,diet4--,the following menus show the manner in which the diet is increased after the starvation treatment3 ,first ,day ,approximately #aej grams of vegetables with tea or coffee2 value3 protein #b1 fat trace1 carbohydrate #d4 ,breakfast--,string beans #bj grams ,celery hearts #bj grams ,lunch--,spinach #be grams ,lettuce #be grams ,supper--,tomatoes #be grams ,cucumbers #be grams ,second ,day ,three eggs1 #aej grams of #e vegetables1 tea or coffee2 value approximately3 protein #ah1 fat #ab1 carbohydrate1 #d1 calories #aih4 ,breakfast--#a poached egg ,spinach or beet tops #ej grams ,coffee or tea ,dinner--#a hard-cooked egg ,string beans #be grams ,lettuce #be grams ,tea ,supper--#a soft-cooked egg ,asparagus tips #be grams ,tomatoes #be grams ,third ,day ,approximately #ai grams protein1 #ae grams fat1 #e grams carbohydrate1 #bcj calories4 ,breakfast--#a egg ,string beans #ej grams ,tomatoes #be grams ,coffee ,dinner--,cauliflower #ej grams ,celery #ej grams ,tea ,supper--,asparagus #ge grams ,lettuce #ej grams ,fourth ,day ,approximately #bf grams protein1 #ae grams fat1 #aj grams carbohydrate1 #bgi calories4 ,breakfast--#a egg ,string beans #ge grams ,coffee with cream #ae c4c4 ,dinner--,tomato bouillon #f oz4 7#ahj c4c47 #a egg ,asparagus #ge grams ,lettuce #be grams ,tea ,supper--#a egg ,celery #ej grams ,cauliflower #ajj grams ,fifth ,day ,approximately #bj grams protein1 #df grams fat1 #ae grams carbohydrate4 ,breakfast--,egg omelet 7#a egg7 ,butter #aj grams ,vegetable hash #ajj grams ,coffee or tea ,cream #ae grams ,dinner--,chicken broth #ahj c4c4 #a poached egg ,tomatoes #ajj grams ,tea ,supper--#a soft-cooked egg ,spinach #ajj grams ,cucumbers #ej grams ,tea or ,coffee ,cream #ae grams ,sixth ,day ,approximately #cc grams protein1 #ce grams fat1 #ab grams carbohydrate1 #die calories4 ,breakfast--#a_/b grapefruit #a egg ,butter #e grams ,spinach #ej grams ,coffee ,cream #ae grams ,dinner--,broth #ahj grams ,fish #ej grams ,string beans #ajj grams ,lettuce #ej grams ,asparagus #ej grams ,supper--#b eggs ,tomato1 baked 7#a medium7 #ge grams ,cabbage salad #ge grams ,tea ,cream #ae grams ,seventh ,day ,approximately #ch grams protein1 #de grams fat1 #ag grams carbohydrate1 #fbe calories4 ,breakfast--#a_/b grapefruit #b eggs ,butter #aj grams ,coffee ,cream #ae grams ,dinner--,beef broth #ahj grams #a lamb chop #ej grams ,cauliflower #ajj grams ,tomato #aej grams ,lettuce #ej grams ,butter #aj grams ,supper--#a egg ,tuna salad #ej grams ,string beans #ajj grams ,butter #e grams ,tea ,eighth ,day ,approximately #cb grams protein1 #af grams fat1 #bj grams carbohydrate1 #fbe calories4 ,breakfast--#a egg ,string beans #ajj grams ,raw tomatoes #ajj grams ,coffee ,cream #ae grams ,dinner--,chicken #ej grams ,cabbage #ajj grams ,asparagus #ajj grams ,water-cress salad #ej grams ,tea ,supper--#a egg ,greens #ajj grams ,celery salad #ej grams ,tea ,cream #ae grams ,the following menus are used after the diet has been more or less increased3 ,first ,day ,breakfast--#a soft-cooked egg #b slices of bacon #a bran muffin1 #e gm4 butter ,coffee with #ae c4c4 of #dj cream ,lunch--#f oz4 tomato bouillon #b oz4 7#fj gm47 roast lamb #fj gm4 string beans #ej gm4 lettuce and celery salad #be gm4 lemon jelly with #ae gm4 cream ,dinner--#fj gm4 chicken #ge gm4 asparagus #d olives #ej gm4 cauliflower #cj gm4 ice cream #a ,lister roll1 #e gm4 butter ,black coffee ,second ,day ,breakfast--#a_/b grapefruit #a scrambled egg #a ,lister roll1 #h gm4 butter ,coffee with #ae gm4 cream ,lunch--#fj gm4 baked halibut with #aj gm4 parsley butter #gj gm4 cauliflower #ej gm4 lettuce #a ,lister roll1 #h gm4 butter ,tea ,dinner--#f oz4 chicken broth #fj gm4 roast beef #ge gm4 cabbage #ge gm4 string beans #cj gm4 coffee jelly with #ae gm4 cream ,black coffee ,third ,day ,breakfast--#a soft-cooked egg #b slices bacon #a ,casoid flour and bran muffin with #e gm4 butter ,coffee with #ae gm4 cream ,lunch--#ajj gm4 cabbage #dj gm4 corned beef #ej gm4 tomato salad #a soya meal muffin1 #h gm4 butter ,tea ,dinner--#fj gm4 beefsteak #ge gm4 asparagus #ge gm4 spinach #cj gm4 tomato aspic #cj gm4 soft 7diabetic7 custard ,black coffee ,fourth ,day ,breakfast--#a scrambled egg with #bj gm4 chipped beef #a ,casoid flour muffin with #h gm4 butter ,coffee with #cj gm4 or less cream ,lunch--#f oz4 tomato bisque #fj gm4 tuna fish salad #ge gm4 vegetable hash #a ,lister roll1 #h gm butter ,tea ,dinner--#fj gm4 broiled chicken #ge gm4 string beans #ge gm4 cauliflower #cj gm4 tomato and celery salad #cj gm4 wine jelly1 with #ae gm4 whipped cream ,black coffee ,fifth ,day ,breakfast--#a_/b grapefruit #a soft-cooked egg #a bran muffin with #h gm4 butter ,coffee1 #ae gm4 cream ,lunch--#dj gm4 broiled beefsteak #ge gm4 spinach #ge gm4 boiled onion #a soya meal muffin with #h gm4 butter ,tea ,dinner--#f oz4 tomato bouillon #hj gm4 baked fish with parsley sauce #ge gm4 ,brussels sprouts with #e gm4 butter #a ,lister roll with #e gm4 butter ,coffee jelly1 #cj gm41 with #ae gm4 whipped cream ,sixth ,day ,breakfast--#a poached egg #b slices bacon #a bran and ,casoid muffin with #e gm4 butter ,coffee with #ae gm4 cream ,lunch--,ham omelet 7#a egg1 #a tbs4 cream1 #ae gm4 minced ham7 #ge gm4 spinach #a soya meal muffin with #h gm4 butter ,tea ,a departure from the now almost universally used ,allen-,joslin ,starvation ,diet1 is seen in the ,newburg-,marsh ,high ,fat ,diet4 ,the use of a high fat diet in the treatment of diabetes is based primarily on one fact--namely1 that if the food eaten is not sufficient for the needs of metabolism1 the body itself supplies the deficiency4 ,fat is used as long as it lasts1 body protein being drawn upon for fuel when this is exhausted4 ,it is of distinct advantage to the patient to have a diet of sufficient fuel value to run his body machine and permit him a moderate degree of exercise4 ,for by this means he is not obliged to use his own body substance to carry on metabolic processes4 ,we thereby avoid the condition of extreme emaciation 7though it is to be emphasized that gain in weight is to be carefully guarded against7 with its constant lowering of the general health4 ,the system of feeding consists of a series of four diets1 examples and standards of which are given below4 ,the diet is made up of protein on the basis of approximately #b_/c of a gram per kilogram of body weight at the time the patient leaves the hospital1 a quantity of carbohydrate known to be well tolerated and the balance of the calories in fat4#aed ,,diabetic ,,diet ,,no4 #a #ah-bb ,proteins #ab-ae ,carbohydrates #hjj-ajjj calories ---------------------------------------- -------------------------- ,weight,protein,fat,carbo- ,food ,gm4 ,gm4 ,gm4hydrate,calories ,gm4 ---------------------------------------- -------------------------- ,dinner3 ,fish #ej #h4i #e4a #hb with ,butter #aj 4#a #h4e #gg ,cabbage #ej 4#h 4#a #b4h #af with mayonnaise 4#g #ch4b #cec ,tomatoes #ajj #a4b 4#b #d4j #bc ,broth--,tea ,supper3 ,string beans #hj #a4h 4#b #e4i #cc with bacon #aj #a4j #f4e #fb ,spinach soup-- ,spinach #aj 4#b 4#c #b ,cream #aj 4#b #d4j 4#c #ch ,broth to fill bowl ,celery #bj 4#b 4#g #d ,broth--,tea ,breakfast3 ,omelet-- #a egg #f4g #e4b #gd with butter #aj 4#a #h4e #gg ,coffee ---------------------------------------- -------------------------- #ba4i #gf4e #ad4j #hdb ,,diabetic ,,diet ,,no4 #b #be-cj ,proteins #ah-bb ,carbohydrates #abjj-afjj calories ---------------------------------------- -------------------------- ,weight,protein,fat,carbo- ,food ,gm4 ,gm4 ,gm4hydrate,calories ,gm4 ---------------------------------------- -------------------------- ,dinner3 ,pork chops #fj #aj4j #ah4j #bjb ,cabbage #ajj 4#b 4#c #e4f #cb 7,use pork drippings7 ,spinach #ajj #b4a 4#c #c4b #bd with butter #bj 4#b #ag4j #aed ,broth--,tea ,supper3 ,asparagus salad-- ,lettuce #aj 4#a 4#c #b ,asparagus #hj #a4b 4#a #b4a #ac ,mayonnaise #ej 4#g #ch4h #cch ,tomatoes #ajj #a4b 4#b #d4j #bc with butter #aj 4#a #h4e #gg ,nut charlotte-- ,walnuts1 chopped #aj #a4h #f4d #a4c #gj ,cream #ej #a4a #bj4j #a4e #aij ,broth--,tea ,breakfast3 ,bacon #bj #b4a #ac4j #abe with #a egg #f4g #e4b #gd ,coffee with cream #cj 4#g #ab4j 4#i #aad ---------------------------------------- -------------------------- #bh4b #aci4h #ah4i #adch ,,diabetic ,,diet ,,no4 #c #cj-ce ,proteins #be-cj ,carbohydrates #afjj-bjjj calories ---------------------------------------- -------------------------- ,weight,protein,fat,carbo- ,food ,gm4 ,gm4 ,gm4hydrate,calories ,gm4 ---------------------------------------- -------------------------- ,dinner3 ,beef tenderloins #hj #ac4j #ai4e #bbg with butter #aj 4#a #h4e #gg ,asparagus #ajj #a4e 4#a #b4h #ah with butter #aj 4#a #h4e #gg ,squash #ajj #a4d 4#e #i4j #df with butter #aj 4#a #h4e #gg ,broth--,tea ,supper3 ,string bean salad-- ,lettuce #aj 4#a 4#c #b ,string beans #ej #a4a 4#a #c4g #bf ,pimento #aj 4#b 4#d #b ,onion #aj 4#b #a4j #e ,mayonnaise #cj 4#e #bc4c #bbh ,tomatoes #abj #a4d 4#b #d4h #bh with butter #bj 4#b #ag4j #aed ,chocolate pudding-- ,cream #ajj #b4b #dj4j #c4j #cha ,cocoa1 #a_/b tsp #a 4#b 4#c 4#d #e ,broth--,tea ,breakfast3 ,bacon #cj #c4b #ai4d #ahg with #a egg #f4g #e4c #gd ,coffee with cream #cj 4#g #ab4j 4#i #aad ---------------------------------------- -------------------------- #cb4i #afc4b #bf4c #agbh ,,diabetic ,,diet ,,no4 #d #ej-fj ,proteins #cj-dj ,carbohydrates #bjjj-bejj calories ---------------------------------------- -------------------------- ,weight,protein,fat,carbo- ,food ,gm4 ,gm4 ,gm4hydrate,calories ,gm4 ---------------------------------------- -------------------------- ,dinner3 ,veal steak 7roast7 #ajj #ai4i #aj4h #agg ,onions #abf #a4i 4#d #aa4i #di with cream #ej #a4a #bj4j #a4e #aij ,tomatoes #aej #a4h 4#c #f4j #ce with butter #cj 4#c #be4e #bca ,fruit salad-- ,lettuce #aj 4#a 4#c #b ,celery #ej 4#f #a4f #i ,grapefruit #hj 4#f 4#b #h4a #cg ,whipped cream #cj 4#g #ab4j 4#i #aad ,tea--,broth ,supper3 ,cream of celery soup-- ,celery #ej 4#f #a4f #i ,cream #ge #a4f #cj4j #b4b #bhe ,broth to fill bowl ,boiled ham #cj #f4a #f4g #he ,custard-- #b egg yolks #d4g #aj4j #aji ,cream #ij #b4j #cf4j #b4g #cdc ,tea ,breakfast3 ,eggs 7#b7 #ac4d #aj4e #adh with butter #cj 4#c #be4e #bca ,coffee with cream #bj 4#d #h4j 4#f #gf ,broth ---------------------------------------- -------------------------- #ef4a #aie4i #cg4d #bacj ,nurse's ,directions for ,collecting and ,testing the ,urine in ,diabetes ,mellitus4--,the first urine voided in the morning at #g ,a4,m4 should be thrown away1 after which the entire quantity during the ensuing twenty-four hours1 including that at #g ,a4,m4 the following morning1 should be collected in a thoroughly clean1 wide-mouth bottle sufficiently large to contain the entire quantity4 ,this should be kept in a cool place to prevent decomposition4 ,after the urine has been measured1 four or five ounces are removed for testing purposes4 ,there is no necessity for having an elaborately equipped laboratory for making the simple tests of the diabetic urine4 ,the nurse is only required to make the simple tests1 leaving the more elaborate one for the physician4 ,the articles necessary for these tests must be kept perfectly clean in order to make the tests accurate4 ,the bottle in which the urine is collected must be washed and sterilized daily before the collection begins4 ,one small three-inch white enameled or porcelain dish1 one #aj c4c4 graduated pipette1 #f test tubes1 #a small alcohol lamp or ,bunsen burner1 #a box of sodium carbonate1 #a box talcum1 and the reagents necessary for making the test1 namely1 ,benedict's solution1 ,fehling's solution1 and ,haines's solution4 ,,summary ,diabetes ,mellitus is a disease in which the body becomes more or less unable to utilize the sugars and starches1 consequently there is an abnormal amount of glucose in the urine4 ,manufacture of ,sugar in the body from other food constituents besides carbohydrates has been proved with regard to proteins1 hence the intake of nitrogenous substances must be restricted in diabetes--to a less extent1 however1 than the sugars and starches4 ,acetone ,bodies4--,diacetic acid1 oxybutyric acid1 and acetone develop in diabetes as a result of the breaking down of the fats and the lack of certain neutralizing agents found chiefly in carbohydrate foods4 ,acidosis is a form of intoxication due to the retention of these toxic acids in the body4 ,if not combated and overcome1 it will result in the diabetic coma which is fatal in so many cases4 ,diet ,treatments4--,the best known treatments are those devised and used by ,drs4 ,allen and ,joslin ,the ,starvation ,treatment for ,diabetes ,mellitus1 and the ,high ,fat ,diet formulated by ,drs4 ,newburg and ,marsh4 ,all cases cannot be handled alike and it is for the physician to determine the treatment calculated to give the best results in the definite case4 ,training for ,diabetic ,nursing4--,so much depends upon the administration of the treatment in this pathological condition that in many hospitals special training is being given to the nurses in the care of diabetic patients that they may be able intelligently to carry out the necessary regime1 both in the hospital and in private practice4 ,symptoms4--,she must be able to recognize symptoms both from the findings resulting from the urinalysis and from those manifested otherwise by the patient4 ,the ,record4--,she must keep an absolute record of all that occurs during the course of treatment and instantly report any unusual happening4 ,urine ,tests4--,it is advisable to make the tests in the morning2 those for sugar and diacetic acid should be made every day or1 in some cases1 every other day1 as directed by the physician1 and those for ammonia and albumen about once a week4 ,weighing the ,patient4--,patient should be weighed each day before breakfast1 and the weight of the clothes also carefully recorded separately4 ,the ,bowels must move daily1 even if it is necessary to resort to mild laxatives or an enema4 ,formulating and ,calculating the ,dietary4--,the menus of the day must be formulated and the chemical composition and nutrient value of the foods calculated4 ,the vegetables belonging to the five per cent4 group should be in readiness and the amount to be used weighed after they have been boiled in clean1 separate water to reduce their carbohydrate content still further4 ,commercial ,diabetic ,foods4--,it may be well to mention the danger of putting faith in the so-called diabetic foods so widely advertised4 ,some of these foods are of undoubted worth1 but it is never safe for the nurse or the patient to judge of the merits of the various diabetic foods without first knowing their chemical composition1 and not even then without the definite directions from the physician4 ,diabetic ,flours4--,the diabetic flours used in the recipes included in this text have been approved by some of the leading specialists in diabetes in this country1 but the nurse should not include them in the diet for her patient unless they are prescribed by the physician in charge4 ,,problems 7a7 ,outline test diets for determining the severity of the disturbance4 7b7 ,give examples of diets used in testing for tolerance of carbohydrates1 fats1 proteins4 7c7 ,give an example of a diet order showing the use of the high fat method of feeding4 ,why is it used8 ,,footnotes3 #acg ,allen's ,paradoxical ,law1 quoted from ,treatment of ,diabetes ,mellitus1 p4 #ah1 by ,joslin4 #ach ,treatment of ,diabetes ,mellitus1 p4 #cje1 ,joslin4 #aci ,food for the ,sick1 by ,strouse and ,perry4 #adj ,courtesy of ,dr4 ,joslin and ,thomas ,groom ,co41 ,boston4 #ada ,the giving of coffee or clear broth1 with or without whisky1 does not materially affect the starvation and serves to make the patient more comfortable during this trying period4 #adb ,dr4 ,joslin has given a very complete schedule in his ,treatment of ,diabetes ,mellitus1 from which the above schedule is taken4 #adc ,hill and ,eckman's ,starvation 7,allen7 ,treatment of ,diabetes4 #add ,see #e vegetable1 p4 #chc4 #ade ,table used by ,dr4 ,joslin in his treatment of diabetes mellitus4 ,it is convenient1 and many changes in the diet may be made by substituting one food for another of like carbohydrate content4 ,this table can be purchased on cards from ,thomas ,groom ,co41 ,boston1 ,mass4 #adf ,table devised by ,h4 ,o4 ,mosenthal showing accessory diets rich in carbohydrates4 ,medical ,clinics of ,north ,america1 ,july1 #aiag4 #adg h represents household measure4 #adh ,mosenthal3 ,medical ,clinics of ,north ,america1 ,july1 #aiag4 #adi ,starvation ,treatment of ,diabetes1 by ,hill and ,eckman4 #aej ,practical ,dietetics1 by ,alidia ,pattee4 #aea ,food for the ,sick1 p4 #fb1 by ,strouse and ,perry4 #aeb ,sweetened with saccharin4 #aec ,starvation ,treatment of ,diabetes1 by ,hill and ,eckman4 #aed ,courtesy of ,r4 ,eckman and ,d4 ,m4 ,stewart1 ,university of ,michigan ,hospital1 ,ann ,arbor1 ,michigan4 ,,chapter ,,xxi ,,diseases ,,of ,,the ,,liver ,much of the so-called biliousness from which the human family is so prone to suffer is nothing more or less than one of ,nature's danger signals by means of which man may understand that some part of the delicate organism called the human body is being overworked4 ,close investigation of these conditions has proved that it is the liver which has been overtaxed1 in many cases to such an extent that in a measure it slows down1 as any overtaxed machine will do1 and has become clogged with material which1 owing to its condition1 it is not able to prepare properly and send out on time4 ,work of the ,liver4--,when one considers the vast amount of work performed by this organ1 one marvels that so little trouble is manifested4 ,in another part of this text the functions of the liver were defined4 ,it was found to be the largest secretory organ in the body1 producing a constant supply of bile by means of which the fats were dissolved and the digestion and absorption of the other food materials facilitated4 ,we likewise found that the greater part of the fuel foods was transformed within this organ into available energy1 either for immediate or future use4 ,as a ,detoxifying ,agent4--,to the liver must also be credited the detoxifying of the various poisons produced within the body during the process of metabolism or brought in by way of food4 ,too much cannot be said as to the value of the liver in this respect1 the importance of which is made known as soon as anything happens to the organ to put it even temporarily out of commission4 ,causes of ,liver ,disorders4--,is it any wonder1 then1 that with such abuses as overeating and drinking1 especially of those foods rich in fats and carbohydrates which depend upon the liver for their availability in the body1 ,nature cries aloud for help and for the comparative rest of this1 her largest organ8 ,the taking of alcohol in excess has been found to bring about tissue changes in the liver4 ,hence it must be avoided by individuals with a tendency to biliousness or to any disease in which the liver is involved4 ,the ,bowels4--,the bowels are as a rule constipated1 and one of the first means of relief is the overcoming of this condition4 ,the method of doing this depends upon the individual1 and the treatment must be decided on by the physician4 ,dietetic ,treatment4--,the dietetic treatment consists in abstaining from food or reducing the amount to a minimum while the attack lasts and while the intestines are being thoroughly emptied4 ,all stagnant material which has clogged the bowels and which has been subjected to the activities of putrefactive bacteria must be gotten rid of4 ,the diet must be especially low in fat4 ,oyster or clam broth1 soft-cooked eggs1 toast1 cereal1 or rice1 with a little milk instead of cream and very little sugar1 tea1 and baked apple or stewed prunes are given4 ,convalescent ,diet4--,after the attack the diet may be gradually increased until it is again normal4 ,moderation must be observed in the amount of food eaten2 no highly seasoned or spiced foods1 pickles1 or condiments1 such as peppers1 mustard1 or horseradish1 should be taken4 ,salads should be dressed without oil4 ,lean beef1 lamb chops1 fish1 chicken1 sweetbreads1 quail1 squab1 eggs 7except fried or hard cooked71 green vegetables 7except radishes1 onions1 water-cress1 and celery7 in abundance1 a small amount of potato1 rice1 or tapioca1 fresh and cooked fruit with little1 if any sugar1 junket1 custards1 fruit jellies1 weak tea and coffee should constitute the diet4 ,certain individuals find that milk increases the tendency to constipation2 this is probably due to the small amount taken2 large quantities do not as a rule produce this effect4 ,buttermilk1 koumiss1 and modified milk are advised in severe cases4 ,diet for ,constipation4--,individuals inclined to biliousness should endeavor to overcome the constipation which is one of the most prominent features4 ,this is done by proper diet more successfully than by drugs 7cathartics73 bran bread1 vegetable soup1 fresh fruit1 stewed fruit1 fruit beverages1 plenty of water4 ,the following menus are suggested3 ,breakfast--,stewed prunes ,oatmeal with milk 7no sugar7 ,weak tea or coffee ,toast 7milk toast or dry toast7 ,lunch--,tomato soup #a small baked potato #a lean lamb chop 7broiled7 or a poached egg on toast ,cup of weak tea ,dinner--,vegetable soup #a slice of lean1 rare beef 7cut from the inside of the roast7 ,spinach ,rice ,lettuce and tomato salad ,lemon jelly ,breakfast--,grapefruit ,hominy with milk ,poached egg on toast ,weak coffee 7milk and little sugar7 ,lunch--,cream of green pea soup ,tomato jelly ,broiled sweetbreads ,weak tea ,toast ,dinner--,small portion of lean lamb or chicken ,boiled or mashed potatoes ,string beans ,sliced tomatoes ,prune whip ,advice to ,patient4--,the above menus are merely suggested4 ,the diet may be selected from the list of foods already mentioned4 ,the patient must be warned against overeating and drinking4 ,pastry1 rich cakes and puddings1 confectionery1 gravies1 etc41 must be avoided4 ,in certain individuals beer will induce a bilious attack4 ,by them it should be avoided4 ,,cirrhosis ,,of ,,the ,,liver ,the cause of this disease and the stage in which it exists must determine the treatment necessary4 ,however1 it matters not what produced the disease1 whether it is the result of alcoholism1 syphilis1 etc41 the diet plays an important role in its cure4 ,the ,diet4--,the diet in this disease1 as in any other1 must be determined by the condition of the patient4 ,unfortunately1 many patients do not know of their condition until the disease is well advanced and symptoms of obstruction are prominent4 ,a study of these must be made before the diet can be formulated4 ,when the symptoms are mainly those arising from disturbed digestion of the stomach and intestines1 without kidney or heart complication1 the diet for chronic gastritis is used4 ,restricting the ,fluids4--,when the heart is involved1 it is sometimes found necessary to restrict the fluids 7dry diet7 to #a quart 7about #ajjj c4c47 per day4 ,the ,karell ,cure has been used advantageously in many of these cases4 ,in cases where the kidneys are involved1 the diet will depend upon the condition of these organs4 ,restricting the ,diet4--,the diet in any case must be restricted4 ,individuals with a tendency to cirrhosis and those coming of a family in which liver diseases are frequent should be especially warned about the dangers of overeating and drinking4 ,alcohol should be avoided especially by such individuals4 ,they should keep their diet simple in character and moderate in amounts4 ,avoidable ,foods4--,all foods1 such as condiments and spices1 meat extracts1 the outside browned portions of roasted meat1 alcoholic beverages1 which exert a stimulating or irritating effect upon the liver1 should be studiously avoided and the fats and carbohydrates restricted1 since1 as it has already been demonstrated1 it is upon the liver that the body depends for the preparation of these substances for their utilization4 ,when1 for example1 the flow of bile is lessened1 an incomplete emulsification of the fats exists and the fatty acids which are highly acid in character cannot be efficiently dissolved or neutralized1 or when the liver is diseased and for this reason the conversion of glycogen into glucose is interfered with1 the utilization of the carbohydrate foods is thus impaired4 ,,gallstones ,factors ,influencing ,their ,formation4--,according to ,friedenwald and ,ruhraeh#aee the two factors that in all probability exert the most influence on the formation of gallstones are the stasis of bile and the inflammation of the bile passages and gall bladder4 ,dietary ,rules4--,there are certain dietary rules which should be observed by all persons who have had gallstone attacks4 ,these are 7#a7 to prevent stasis of bile1 7#b7 to avoid fats4 ,everything should be done to prevent the formation of the stones1 and this can only be accomplished by observing these rules4 ,the flow of bile must be free2 this is encouraged by keeping the intestinal tract in good condition4 ,stimulating ,peristalsis4--,peristalsis must not be allowed to become sluggish1 for it is only during the process of digestion when the food mass passes along the intestinal canal that there is an ejection of bile into the intestines4 ,when the passage is abnormally slow the bile is in a measure dammed back with a formation of gallstones as a result4 ,the restriction of the fats has already been discussed in another part of the chapter4 ,it has been demonstrated that these substances have a chemical influence upon the formation of gallstones as well as upon the intestinal stasis which leads to their formation4 ,dietetic ,treatment4--,hence the diet should be so directed as to 7#a7 increase the flow of bile1 and 7#b7 to avoid all foods that are liable to cause indigestion which may bring about putrefaction in the intestinal tract and a consequent irritation and inflammation of the bile passages and gall bladder4 ,the meals should be regular and an abundant diet advised to increase the flow of bile and stimulate peristalsis in the intestines4 ,exercise4--,exercise is especially recommended4 ,horseback riding1 swimming1 rowing1 golf1 and tennis are especially valuable in forcing the bile from the gall bladder and liver4 ,the ,clothing4--,the clothing should be loose enough to be perfectly comfortable4 ,certain cases of gallstone attacks in women have been said to have been traced to tight lacing1 which interfered with the normal flow of the bile4 ,the ,bowels4--,constipation should be avoided1 and the diet should be directed with this point in view4 ,the meals must be frequent1 ranging from four to six a day4 ,in this way only is the flow of bile encouraged4 ,the breakfast should be ample in order to utilize the bile secreted in the night season4 ,with all this1 care must be observed not to give more food than can be adequately handled by the digestive apparatus1 since food which is not digested becomes a prey to the actions of the putrefactive bacteria which infest it1 and the toxic substance thus formed produces the very result which all of our efforts are directed to prevent4 ,available ,foods4--,the following foods low in fats may be used in formulating the diet3 ,soups3 ,meat broth 7made from lean meat7 from which all the fat has been removed4 ,meats3 ,lean beef1 lamb1 chicken1 squab1 quail1 lean fish 7in small quantities and not too frequently74 ,green vegetables3 ,except peas and carrots2 beets and turnips may be taken sparingly4 ,fruits3 ,oranges1 lemons1 grapefruit1 and unsweetened stewed fruit4 ,cereals3 ,wheat cereals1 oatmeal1 rice1 and tapioca in moderation4 ,bread3 ,whole wheat1 white1 rye1 and graham bread1 toast1 and crackers4 ,fluids3 ,weak tea and coffee 7without cream1 and a little sugar71 orange and lemonade1 mineral waters1 water1 skimmed milk1 whey4 ,eggs3 7except hard-cooked or fried74 ,desserts3 ,fruit gelatin1 fruit whips1 raw or stewed fruit4 ,avoid the following foods3 ,fats1 oils1 mutton1 liver1 brains1 sardines1 and caviar1 oily fish1 rich gravies and sauces1 sweet fruit1 peas1 carrots1 condiments and spices1 pastry and confectionery1 pickles1 alcoholic beverages4 ,restrict carbohydrates1 yolks of eggs1 milk 7cream must be skimmed off if too rich74 ,,daily ,,diet ,,sheets ,i ,breakfast--,baked apple with milk ,cream of wheat with milk ,weak coffee or tea ,dry toast #aa3cj ,a4,m4--#f oz4 orange juice1 #a egg white ,dinner--,beef broth 7well skimmed7 with crackers ,rice ,stewed pears ,weak tea ,toast or rolls #c3cj ,p4,m4--,albumenized fruit juice with crackers ,supper--,wheatena with milk ,milk toast ,stewed prunes ,toast and tea #i ,p4,m4--,well-skimmed chicken broth with crackers ,,ii ,breakfast--,stewed apples with milk ,milk toast ,coffee without cream #aj3cj ,a4,m4--,well-skimmed broth with crackers ,dinner--,tomato bouillon with crackers ,baked potato--#a small potato ,puree of spinach ,orange gelatin ,toast #c ,p4,m4--,albumenized lemonade ,supper--,oatmeal or cream of wheat with milk ,toast ,tea ,stewed fruit #i ,p4,m4--,well-skimmed broth with crackers ,,iii ,breakfast--,grapefruit ,oatmeal with milk ,toast ,weak coffee #aj3cj ,a4,m4--,orangeade with graham crackers ,dinner--,cream of spinach soup 7skimmed milk7 ,small piece of the breast of chicken ,mashed or boiled potatoes ,asparagus on toast ,sliced oranges #c3cj ,p4,m4--,well-skimmed broth with crackers ,supper--,farina or cream of wheat or wheatena1 with milk ,baked potato ,baked apple with milk ,toast and tea #i ,p4,m4--,albumenized orange juice ,,iv ,breakfast--,sliced oranges ,oatmeal ,toast ,coffee #aj3cj ,a4,m4--,beef gruel1 #f oz4 ,dinner--,cream of asparagus soup1 skimmed milk ,thin slice of roast beef or whitefish ,rice or potatoes ,tender string beans ,fruit ,toast ,buttermilk #c3cj ,p4,m4--,orangeade ,supper--,stewed fruit with puffed wheat or rice ,milk toast ,tea #i ,p4,m4--,broth ,,summary ,functions of ,liver4--,to transform fuel foods into available energy2 to detoxify those poisonous substances produced as the result of metabolism of body tissue or brought in in food1 and to select those available for use2 to secrete bile4 ,factors ,influencing ,disorder of ,liver4--,errors in diet3 7a7 overeating2 7b7 excessive drinking2 and 7c7 unbalanced diet1 especially as regards the amount of fats and carbohydrates in the diet4 ,the ,bowels1 in most of the disturbances affecting the liver1 become constipated1 thus causing much additional work on the part of the liver in handling the products produced as the result of putrefactive bacteria upon the accumulated mass in the colon4 ,tissue ,changes in the liver have been caused by the taking of alcohol1 which should therefore be avoided by all individuals having any disease involving the liver and by those with a predisposition to liver disturbances4 ,exercise and ,lack of ,exercise are potent factors in the treatment of conditions involving the liver4 ,first1 because the liver requires exercise to enable it to empty itself more completely and assure a free flow of bile2 second1 because exercise directly affects the energy output of the body1 causing an increased rate of metabolism and a better utilization of the food ingested4 ,lack of exercise acts in exactly the opposite direction1 and it has been found that with the majority of patients suffering from diseases of the liver too little exercise and too much food are at the bottom of the trouble4 ,dietetic ,treatment in the majority of diseases affecting the liver is much the same4 ,the keynote in each is a balanced diet4 ,constant overeating and excessive drinking have proved the foundation of the majority of such diseases1 especially of the bilious type1 while an excess of fat and carbohydrates in the diet lead to the more serious disorders4 ,biliousness requires abstinence from food for a short period and a cleansing of the entire gastro-intestinal tract1 the measures being directed by the physician4 ,after the bilious symptoms have subsided1 a simple1 well-regulated diet should be established1 in which no rich foods of any sort are allowed4 ,all condiments and spices which have an astringent effect upon the bowels are strictly prohibited1 and alcoholic beverages had best be eliminated from the diet4 ,cirrhosis of the liver is apt to be insidious in its development1 taking a firm hold before the character of the disorder is discovered4 ,dietetic treatment of this disturbance is most important and should be directed toward overcoming not only the liver symptoms but other symptoms as well4 ,gastro-intestinal ,disturbances1 manifested in cirrhosis of the liver1 are treated by the diet used in chronic gastritis 7see p4 #bej74 ,heart ,symptoms sometimes occur during the course of the disease and require especial attention to the diet4 ,the fluids at times must be restricted1 in which case a modification of the ,karell ,cure will prove valuable 7see p4 #cdb74 ,kidney ,complications develop in a certain percentage of cases1 and it then becomes necessary to institute one of the various diets devised to meet the needs of those special conditions 7see ,chapter ,,xviii74 ,restricting the ,diet will be found to be necessary for those individuals showing a tendency to cirrhosis1 also for those in whose family diseases of the liver are of frequent occurrence4 ,such individuals should be warned of the dangers arising from overindulgence in food or alcoholic beverages4 ,prohibited ,foods are those which by reason of their astringent qualities favor the development of constipation1 such as condiments and spices2 those foods which exert a stimulating and irritating effect upon the liver and bile passages1 such as alcohol1 malt extractives1 etc42 and fats and carbohydrates in excessive quantities1 on account of the extra amount of work required of the liver in order to make them available in the body4 ,gallstones develop as the result of inflammation or clogging of the bile passages4 ,treatment is dietetic in character and is directed toward relieving or preventing inflammation in the bile passages1 also in stimulating the flow of bile in order that it may not become sluggish and thus give rise to the development of the gallstones4 ,the ,fats1 therefore must be restricted in the diet1 as they1 more than any of the other food constituents1 favor the above conditions4 ,peristalsis in the intestinal tract must be stimulated to facilitate a free flow of bile1 which will not occur where the movements are sluggish4 ,stasis of the bile must be prevented or stones will be apt to form4 ,dietetic ,treatment for gallstones is therefore directed to increase the flow of bile and to avoid the inflammation of the gall bladder and bile passages which may result from the product of intestinal putrefaction4 ,the ,diet consists of foods simple in character1 low in fats1 but abundant in quantity1 in order to prevent constipation4 ,it must be selected carefully that digestional disturbances may not develop4 ,the ,meals should be frequent1 from four to six a day1 in order to encourage a free flow of bile4 ,breakfast should be ample in order that the bile secreted and accumulated during the night may be utilized as soon as possible4 ,constipation must be avoided1 and the foods particularly adapted to prevent or overcome this condition should have a prominent place in the diet4 ,any accumulation of unabsorbed food in the lower intestines becomes a breeding ground for putrefactive bacteria1 the product of whose activity imposes a serious tax upon an already overworked organ4 ,,problems 7a7 ,formulate a diet for a patient suffering from gallstones4 ,outline method of administration4 7b7 ,list available foods for diets used in disturbances of the liver4 ,list the foods to be avoided in such cases4 ,,footnote3 #aee ,diet in ,health and ,disease1 p4 #cii1 by ,friedenwald and ,ruhraeh4 ,,chapter ,,xxii ,,gout1 ,,obesity1 ,,emaciation ,gout is a constitutional disease characterized by an inflammatory condition of the joints4 ,it is caused by or associated with a retention of uric acid in the blood4 ,gout is also characterized by the deposit of uric acid or sodium salts which occurs in different parts of the body1 the joints1 the lobe of the ear1 the knee and the elbow being common points where the deposit of these salts ordinarily occurs4 ,the amount of uric acid is lessened in the urine in cases of true gout1 except in acute attacks1 and in this way it is distinguished from the so-called goutiness in which a urinalysis shows an excess of uric acid4 ,according to ,strouse1 this excess of uric acid in the urine means a physical-chemical change in the urine and is quite different from the small amount usually excreted4#aef ,source of ,uric ,acid4--,in man the uric acid which is eliminated in the urine is derived from two sources4 ,it may be taken with the body as purins in food1 in which case it is spoken of as being an exogenous product1 or it may be formed in the body from the breaking down of the nucleoproteins 7the highly nucleated cells of the glandular organs particularly74 ,when the uric acid is formed in this manner as the result of the metabolism of the body tissues1 it is known as endogenous4 ,in the normal body approximately one-half of the uric acid formed is oxidized1 while the remaining half is eliminated from the body by way of the urine4 ,elimination of ,uric ,acid4--,in gout such is not the case1 the body loses to a certain extent the ability to eliminate the uric acid1 hence it is retained within the body1 causing an excess in the blood stream1 and it is this excess uric acid in the blood which causes the acute attacks and general pain and discomfort which inevitably occur in chronic gout4 ,purin-bearing ,foods as ,sources of ,uric ,acid4--,formerly no difference was made in food2 all were supposed to cause uric acid formation1 but with the exhaustive investigation of food materials this sweeping condemnation has been to a great extent removed or narrowed down to a few foods1 those rich in purins being the chief offenders4 ,chief ,causes of ,gout4--,without a doubt1 overeating1 overindulgence in alcoholic stimulation1 lack of exercise1 etc41 are chiefly to blame for the large percentage of the cases1 but upon investigation it will be seen that those individuals are as a rule large protein eaters and that their mode of living is not such as to assist the body in throwing off the poisons which form as the result of their self-indulgence4 ,rules to ,combat ,gout4--,to successfully combat the retention of a large percentage of uric acid in the blood there are certain definite rules to be observed3 7#a7 ,the general diet must be reduced not only in amount but also in purin-bearing foods2 7#b7 ,all foods which are liable to cause digestional disturbances1 with the attending evils of intestinal putrefaction and constipation1 must be avoided4 ,alcohol in ,gout4--,if the patient is accustomed to alcoholic stimulants and has been in the habit of taking them constantly for years1 the amount of alcohol consumed daily must be radically reduced and only the amount prescribed by the physician taken4 ,alcohol without a doubt assists in the retention and increases the difficulty of uric acid elimination by the body4 ,in view of the present knowledge of the cause and effect of uric acid in the body1 the treatment of gout is directed with the object of relieving the condition 7#a7 by facilitating the elimination of uric acid from the body1 and 7#b7 by so regulating the diet as to exclude as far as possible those purin-bearing foods which1 by reason of their chemical composition1 augment the general amount of uric acid formed within the organism4 ,in gout1 as in other abnormal conditions1 no set rule can be laid down to cover the treatment of every case4 ,the individual must be taken into consideration1 his daily habits studied and the extent and character of the disease known before it is possible to prescribe a treatment or formulate a diet which would adequately meet his needs under the existing conditions4 ,obesity and ,glycosuria4--,gouty individuals often become obese and show evidences of glycosuria4 ,consequently it is important to regulate the carbohydrates as well as the purin-bearing foods in the diet4 ,only the simplest foods are permissible4 ,in acute attacks it has been found that milk and alcohol cause less disturbance than meat and alcohol4 ,while the acute symptoms exist all meat should be avoided and the daily allowance of alcohol cut down4 ,tea and coffee both contain purins and should be avoided while the acute stage of the disease continues4 ,cereal coffee1 hot water tea1 hot milk or buttermilk may be substituted4 ,purin-free ,diet4--,a purin-free diet is advisable during the acute attack4 ,the following is a sample menu of such a diet3 ,breakfast--,banana1 apple1 grapefruit1 orange or peach1 etc4 ,cereals3 farina1 hominy1 or cream of wheat with cream and sugar #a egg1 soft-cooked ,buttered toast ,cereal1 coffee with sugar and cream or hot water tea 7milk and hot water7 with cream and sugar ,lunch or ,dinner--,poached egg on toast1 #a large baked potato with butter1 #a mold of fruit jelly with cream ,supper--,rice and butter1 bread or toast with hot milk ,apple sauce with cream ,purin ,per ,cent4 ,cocoa contains #a4jj per pint ,tea #a4bj per pint ,coffee #a4gj per pint ,purins are soluble in water1 hence those foods that are boiled contain less than those prepared by other methods of cookery4 ,foods ,more or ,less ,condemned4--,salt has a tendency to bring about a deposit of sodium urates in the body1 and for this reason should be sparingly used in the preparation of the diet4 ,alkaline waters are inclined to produce a like result1 consequently should be avoided by the gouty individual4 ,condiments and spices are conducive to constipation1 a condition to be avoided if possible under the circumstances4 ,certain physicians prohibit the use of oranges in the diet of gout1 while others do not4 ,strawberries are likewise condemned and should be eliminated from the diet for both chronic and acute gout4 ,diet in ,chronic ,gout4--,in chronic gout it is necessary to maintain the general health of the patient by a well-balanced diet4 ,this is not difficult even if the dietary is so regulated as to be well within the limits of his energy requirements4 ,it is necessary to limit the purin-bearing foods4 ,meats are used sparingly and these should be boiled rather than roasted or broiled4 ,eggs and cheese and milk should be substituted for at least part of the regular allowance of meat4 ,exercise and ,massage4--,the patient should be recommended to take a certain amount of mild exercise in the open air1 or massage if he is accustomed to living an indoor life or is confined to office work4 ,he must be warned against overindulgences of all kinds1 especially of overeating and drinking4 ,a glass or two of hot water before breakfast is recommended4 ,treatment of ,obesity4--,the treatment of obesity when occurring in gouty patients is much like that used in other conditions4 ,ebstein regards obesity under such circumstances as an unfavorable symptom4 ,he advises a reduction in the carbohydrates to the smallest possible amount and allows meat and fats in the diet4 ,allowable ,foods4--,the following foods are practically purin-free and may be used in the diet of gout3#aeg ,milk1 cheese1 butter1 eggs1 nuts1 gelatin1 fruits1 sugar1 breads made with white flour1 cereals1 cream of wheat1 farina1 rice1 hominy1 tapioca1 cornstarch1 potatoes and other root vegetables1 green vegetables1 except asparagus1 spinach1 and all fats4 ,avoidable ,foods4--,the following foods are rich in purins and should be avoided in the diet for gout3 ,sweetbreads1 liver1 kidneys1 beef1 mutton1 veal1 pork1 turkey1 chicken1 goose1 rabbit1 duck and other game1 fish1 with the exception of cod1 sardines1 and anchovies1 tea1 coffee1 and cocoa4 ,the following list shows the purin content of some of the above-mentioned foods4 ,the purins are computed by ,hall as follows3 #a kilogram contains1 ,grams ,purin ,milk ,butter ,eggs ,cheese ,farina ,rice ,hominy ,potato #j4jb ,flour ,bread ,cauliflower ,eggplant ,cabbage ,lettuce ,sugar ,peas #j4ci ,asparagus #j4ba ,lentils #j4ch ,halibut #a4jj ,cod 4#je ,salmon #a4jj ,mutton #j4if ,beef #a4aj-b4jj ,veal #a4aj ,ham #a4aj ,pork #a4bj ,oatmeal #j4ec ,beans #j4fc ,chicken #a4bj ,sherry ,claret ,whisky ,brandy ,beer #j4ab ,porter #j4ad ,ale #j4ad ,chocolate per pint #j4gj ,to keep the body in good condition and to help rid it of accumulated poisons1 the following diet lists are recommended3 ,daily ,dietaries3 #g ,a4,m4--,hot water1 #h oz4 #h ,a4,m4 ,breakfast--,stewed prunes1 wheatena and cream #b eggs #b slices of buttered toast #a cup of milk flavored with cocoa or coffee or #a cup of cereal coffee with cream ,dinner--,cream of pea soup ,boiled codfish with cream sauce ,mashed potatoes ,cauliflower ,rice pudding ,supper--,cream toast ,baked potatoes ,egg nest ,apple sauce ,hot milk flavored with coffee1 cocoa1 or #a cup of cereal coffee #g ,a4,m4--,hot water1 #h oz4 #h ,a4,m4 ,breakfast--,grapefruit ,cereal and cream ,soft scrambled eggs ,cereal coffee1 or milk and coffee ,buttered toast #ab3cj ,lunch--,cream of tomato soup ,cottage cheese and cream ,baked potato ,baked apple ,bread and butter #f ,p4,m4 ,dinner--,chicken1 small piece1 no gravy or rich dressing ,candied sweet potatoes ,baked eggplant ,lettuce salad 7lemon juice instead of vinegar7 ,bread and butter ,orange or wine jelly ,milk ,breakfast--,cereal and cream ,baked apple with cream #a slice of bacon #a soft-cooked egg ,toast--butter ,cereal coffee1 or milk flavored with coffee ,lunch--,vegetable soup ,scalloped potatoes ,cream cheese ,bread1 butter ,stewed pears ,dinner--,halibut steak ,creamed potatoes ,string beans ,fruit salad ,sponge cake1 orange sauce ,small coffee ,,obesity ,probably no one problem affecting the human family is more widely discussed than that of obesity4 ,there are numberless cures suggested1 most of which contain some good1 but they are as a rule more strenuous than the average fat person cares to attempt1 or1 if attempted1 persist in4 ,causes of ,obesity4--,it is stated that at least fifty per cent4 of the obesity is of hereditary origin1 while the rest may be due to overeating and drinking1 unbalanced diets1 metabolic changes due to the approach of menopause in women1 and diseases such as gout in which there is a certain amount of disturbance in the blood and excretory organs and in which the diet or the disease may be accountable for the gain of surplus adipose tissue4 ,women approaching menopause may not change their diet in the least and there may still be the noticeable increase of fat4 ,obesity ,cures4--,a great number of the cures are undertaken not from a health standpoint but from the esthetic point entirely4 ,it makes no difference what reason is brought forward for instituting the treatment1 it is the results which count4 ,of the cures undertaken which are in themselves good1 but which are too strenuous for the average fat person to stick to may be mentioned some of the early cures instituted and recommended by ,banting1 ,oertel1 and ,ebstein4 ,obesity1 then1 may be said to be due to 7#a7 heredity1 7#b7 overeating and drinking1 7#c7 lack of exercise 7sedentary life71 7#d7 a combination of the above causes4 ,whether the obesity is due to the lack of exercise or the lack of exercise is due to the accumulation of fat which causes a disinclination to move on the part of the individual1 can only be judged when a thorough examination into the life and habits of the patient is made4 ,comparison of ,food ,intake and ,energy ,output4--,many fat people who claim to be small eaters in reality constantly consume more food than their age1 weight1 or mode of living would necessitate4 ,if such patients could be prevailed upon to keep a correct chart of their daily intake of food and the amount of exercise taken1 they would be astounded to find how much greater was the intake in comparison to the output of energy1 in other words1 how much more food they ate than they required to keep them in health4 ,a glance at the first tables in this text will show which foods are utilized by the body chiefly as a source of energy4 ,uses of ,food in ,body4--,physiological chemistry proves that when more food is taken than is needed for the internal and external work of the body1 the surplus is stored for future use1 first1 in the liver and muscles as glycogen for the general expenditures1 and1 second1 as adipose tissue for future use4 ,thus it is seen that when the intake is constantly greater than the energy expenditure there must necessarily be some way in which the body can store up the surplus fuel1 and so long as the digestion remains good and the amount of exercise limited there is no reason why there should not be a constant and steady accumulation of surplus fat which inevitably terminates in obesity4 ,water as a ,fat ,maker4--,that water is in itself fattening is of course untrue4 ,a chemical analysis of this fluid shows that it is inorganic in character and cannot alone either produce energy or build tissue4 ,however1 this food constituent plays a most important part in all the functions of the body4 ,in the first place the body cannot utilize food unless it is in solution2 water is also one of the best known stimuli to the flow of gastric juice1 and for this reason is an important factor in the preparation of the food for its absorption and utilization2 since water forms the bulk of the blood1 it acts as a distributor or carrier of food to the different parts of the body4 ,limiting the ,fluids in ,obesity4--,thus it is seen that when the intake of fluids is limited1 the body will call upon that surplus which is stored in every nerve1 tissue1 and fluid throughout the entire organism to assist in the necessary work of the organs1 thus reducing the body weight just that much4 ,exercise4--,the athlete who is overweight1 due to adipose tissue1 increases his exercise at times1 even adding to the weight of his clothing1 causing an increased energy output1 profuse perspiration1 etc41 all of which causes the body to use its surplus fuel in the form of the stored fat4 ,exercise does not break down a muscle1 it builds it up4 ,thus many individuals who increase the strenuousness of their exercise complain that their weight is increased even when they observe a noticeable improvement in their general feelings and appearance4 ,the ,appetite4--,the great trouble with most women who undertake an obesity cure which calls for an increased amount of energy is that they will develop an increased appetite thereby which they appease with food instead of forcing the body to use the store in hand1 thus entirely doing away with any good the treatment might have accomplished4 ,no amount of exercise without a proper regulation of the diet will prove satisfactory as far as the reduction of fat is concerned4 ,the following methods recommended by ,banting1 ,oertel1 and ,ebstein are included here4 ,,obesity ,,diets ,,and ,,cures ,banting ,method4--,this method is said to be unsuited to those with weak digestions4 ,following its use such individuals have been known to develop renal colic or gallstones2 constipation may be present and the entire system may become so deranged as to render the patient liable to disease4#aeh ,banting ,diet for ,obesity4--,breakfast at #i ,a4,m41 consisting of #e-f ounces of animal food1 meat or boiled fish 7except pork or veal71 #a small biscuit or #a ounce dry toast4 ,total solids1 #e-f ounces4 ,coffee or tea 7without milk or sugar71 #i ounces4 #b ,p4,m4--,dinner3 ,fish or meat 7salmon1 eels1 herring1 pork1 and veal excepted71 poultry or game2 any vegetable except potatoes1 parsnips1 carrots1 turnips1 or beet roots2 dry toast1 #a ounce2 fruit cooked and unsweetened2 good claret1 sherry1 or ,madeira1 #aj ounces4 ,total solids1 #aj-ab ounces4 #f ,p4,m4--,tea3 #b-c ounces cooked fruit2 #a-b ounces rusks2 #b-d ounces solids2 #i ounces tea1 without milk or sugar4 #g ,p4,m4--,supper3 ,meat or fish as at dinner2 claret or sherry and water1 #g ounces4 ,total daily solids1 #ba-bg ounces4 ,total fluids1 #ce ounces4 99 99 99 99 99 ,oertel pointed out the great benefits which might be derived by those individuals suffering from certain types of heart disease which are accompanied by obesity4 ,he made it distinctly understood that while the treatment in no way affected the heart lesion1--that is1 in so far as altering the character of the disease1--it greatly reduced the work imposed upon the circulatory organ and permitted a more complete oxidation of the blood4#aei ,oertel's ,method4--,oertel bases his dietetic treatment of obesity upon the heart changes and those which naturally follow in the circulation4 ,he makes the following suggestions1 taking always into consideration the condition of the patient1 whether he is anemic or plethoric4 7a7 ,where there is an abnormally increased amount of fat in plethoric patients with unimpaired or only beginning changes in the heart action1 the diet should aim at3 7#a7 ,an increased supply of protein4 7#b7 ,a decrease in the fat-forming substances4 7#c7 ,little or no diminution in the supply of liquids below the physiologic amount 7#aejj c4c4--#c pt47 7b7 ,where there is obesity in anemic patients1 viz4 serious plethora1 the diet should aim at3 7#a7 ,an increase in the quantity of proteins4 7#b7 ,a diminution in amount of fat-forming substances and eventually 7#c7 a decrease in the amount of fluid4 7c7 ,where there is obesity in adults with anemic symptoms in whom not only the amount of protein but also the abnormally increased amount of fat is slowly wasting away1 they require3 7#a7 ,an increase in the amount of protein taken4 7#b7 ,a sufficient amount of fat and carbohydrates or even an increase of same to prevent the falling off of fat4 7#c7 ,a diminution in the amount of fluid taken4 ,oertel claims that the simplest method of reducing the fat-forming elements in a diet is to decrease the amount of fat and allow a certain amount of carbohydrates1 regulating the diet according to the individual4 ,the following table is given by him as showing the minimum and maximum amount of the different food constituents constituting the obesity diet3 ,protein ,fat ,carbohydrate,calories ,gm4 ,gm4 ,gm4 ---------------------------------------- ------------ ,minimum #aef #be #ge #aahj ,maximum #agj #de #abj #afjh ,in instituting a treatment for obesity ,oertel insists upon a certain amount of exercise daily in the open air1 the amount to be regulated by the physician according to the individual case4 ,he suggests that five or six small meals a day be given rather than a few large meals4 ,he eliminates soups1 tea1 and coffee while the cure is being given4 ,ebstein suggests a diet in which the carbohydrates and fluids are reduced but in which the fats are allowed to a considerable extent4 ,the diet consists of meat1 eggs1 fish1 vegetables 7green7 and fruits4 ,the following menu demonstrates his dietary regime3 ,breakfast3 ,large cup of tea 7no milk or sugar72 #b oz4 bread with plenty of butter4 ,dinner3 ,soup #d-a_/b to #e-a_/b oz42 meat with fat sauce2 green vegetables2 fresh fruit2 #b-c glasses light wine4 ,afternoon3 ,tea as at breakfast4 ,supper3 ,tea1 #a egg1 fat roast meat or ham1 smoked fish2 about #a oz4 bread with plenty of butter2 a little cheese and fresh fruit2 potatoes1 sweets and sugars forbidden4 ,dietetic ,treatment4--,the following menus are suggested by the author3 ,the carbohydrates and fats are restricted and the fluids reduced to a minimum4 ,the meals as far as possible are kept dry2 soups1 milk1 cocoa are avoided2 water is not permitted at meals2 alcoholic beverages1 white bread1 butter1 potatoes1 sugar1 candy1 pastry1 cakes1 puddings1 gravies1 sauces1 bread dressings1 griddle cakes1 sirups1 molasses1 honey1 ice cream1 cereals1 pork of all sorts1 ham1 bacon pork chops1 etc41 olive oil1 spaghetti1 macaroni1 and noodles are prohibited4 ,allowable ,foods4--,the following foods are allowed3 ,black coffee or tea1 small cup twice daily without milk1 cream1 or sugar--saccharin may be used to sweeten if desired2 fresh or stewed fruit with the exception of bananas1 raisins1 and dates1 served without sugar2 all green vegetables cooked or served without butter or fat of any description2 salads1 except potato or banana1 served with a special dressing 7no oil or sugar72 water ices2 watermelon and other melons served without sugar2 #a egg a day2 gluten toast1 no butter2 brown bread or muffins made with gluten flour and prepared bran4 ,the following menus may be used as guides in the treatment of obesity3 ,breakfast--#a sliced orange 7no sugar7 #a small cup coffee or tea without cream1 milk1 or sugar 7sweeten with saccharin if desired7 #a poached egg on #a slice of gluten toast 7no butter7 ,lunch--,cottage cheese and lettuce salad with special dressing #b broiled lamb chops #a slice gluten bread2 #c ounces 7#a serving7 apple sauce 7sweetened if necessary with saccharin7 ,dinner--,roast beef ,spinach or greens 7cooked without fat meat7 ,green peas ,tomato and lettuce salad with special dressing ,orange or wine jelly 7sweetened with saccharin7 #a slice of gluten bread or toast #g ,a4,m4 or #a hour before breakfast--#a cup of water containing juice of #a_/b lemon ,breakfast--#a_/b grapefruit without sugar #a small cup black coffee or tea ,beefsteak broiled and served without butter 7lean7 #a slice of gluten toast ,lunch--,tuna fish salad 7no olive oil in dressing7 #a bran muffin or #a slice 7#a oz47 gluten toast #a baked apple 7without cream or sugar7 ,dinner--,roast or boiled chicken 7no gravy or bread dressing7 ,green vegetables 7peas1 string beans1 cabbage1#afj turnips1 artichokes 7without butter77 ,fruit salad 7special dressing7 ,lemon ice ,amount of ,food4--,the amount of food is limited to a certain extent4 ,green vegetables may be eaten in abundance1 but the protein foods such as meat1 fish and eggs must be limited4#afa ,the bread 7even gluten and bran breads7 must be limited to #a-b slices at each meal4 ,all meals are eaten without fluids except breakfast1 when one small cup of coffee or tea without milk1 cream1 or sugar is allowed4 ,if fruit juice is to be served instead of fruit1 it must be prepared with little if any water and no sugar4 ,the juice may be poured over cracked ice1 if desired4 ,the following reducing diet is suggested by ,dr4 ,rose for the use of over-fat women3 ,,reducing ,,diet ,,for ,,obese ,,women#g ,fuel value #ajeb calories--ordinary requirements #bbjj calories ,measure ,weight,protein ,total ,oz4 ,calories,calories ---------------------------------------- --------------------------- ,breakfast3 ,apple #a medium #d4i #b #fe ,egg #a egg #b4d #bg #ge ,toast #a slice #j4e #g #ej ,coffee#afb #a cup ,skim milk #a-a_/b tbs4 #a4j #c #aj #aj3cj ,a4,m4 ,bouillon #a_/b cup #d4j #aj #ab ,water cracker #a cracker #j4a #a #aj ,luncheon3 ,lean cold roast beef ,medium serving #c4e #ig #aej ,rye bread #b thin slices #j4g #g #ej ,lettuce and cottage cheese salad3 ,lettuce ,ad libitum #dj #he ,cheese #b-a_/b tbs4 #d3cj ,p4,m4 ,tea with lemon#afc #a cup ,water cracker #a cracker #j4a #a #aj ,dinner3 ,boiled cod with lemon ,large serving #h4b #bji #bbe ,boiled potato #a_/b medium #a4h #f #ej ,cauliflower 7plain7 ,large serving #c4j #f #be ,butter #a tsp4 7scant7 #j4a #cj ,water-cress and egg salad3 ,water-cress ,ad libitum ,egg #a egg #bg #aaj ,french dressing #a_/b tbs4 ,orange #a_/b large #d4g #c #ej ,black coffee ,demi-tasse #aj3cj ,p4,m4 ,hot skim milk #a_/b cup #d4c #af #de ,total calories #ajeb ,,author',s ,,reducing ,,diet ,approximate fuel value #ife4e calories ,carbo- ,material ,amount ,proteinhydrate ,fat,calories ,gm4 ,gm4 ,gm4 ---------------------------------------- ----------------------------- ,breakfast3 ,orange #a medium #a4e #ag4d #j4c #gh4c ,poached egg #a egg #e4c #d4f #fb4f on ,toast 7gluten7 #a slice 7#a oz47 #h4d #h4e #j4c #gj4c ,coffee 7black7 #a cup #baa4b ,luncheon3 ,lettuce and cottage cheese salad3 ,lettuce ,ad libitum ,cheese #b tbs4 #e4i #a4b #j4b #cj4b ,dressing #a tbs4 #a4e #c4d #cf4f ,lamb chop #a chop #i4b #ab4g #aea4c ,gluten bread or toast #a slice #h4i #h4e #j4c #gj4c ,apple sauce #a serving1 about #a_/h cup #j4f #bb4e #j4g #ig4e #che4i ,dinner3 ,roast beef #b thin slices 7#b oz47 #aa4d #d4h #hh4h ,spinach #a_/b cup #b4c #c4f #j4c #bf4c ,green peas #a_/b cup #d4h #aa4a #j4b #fe4d ,lettuce ,ad libitum ,tomato #a medium #j4d #c4a #j4b #ae4h ,dressing #a tbs4 #a4e #c4d #cf4f ,orange jelly3 ,orange juice #a_/b cup 7#h tbs47 #ad4b #ef4h ,lemon juice #a tbs4 ,gelatin #a tsp4 #b4a #h4d ,water #a tbs4 ,saccharin #a tablet or less ,bread 7gluten7 #a slice #h4d #h4e #j4c #gj4c ,total grams #gb4b #ih4f #ca4g #cfh4d ,total calories #ife4e ,approximate fuel value #icj4e calories ,carbo- ,material ,amount ,proteinhydrate,fat ,calories ,gm4 ,gm4 ,gm4 ---------------------------------------- ----------------------------- ,breakfast3 ,fruit #a orange #j4he #ab4je #j4ae #ec4j ,gluten toast #b slices #ag4h #ag4j #j4f #adj4j ,egg 7poached or soft-cooked7 #a egg #e4c #d4f #fj4j ,coffee 7black7 #a cup #bec4j ,luncheon3 ,oyster cocktail #f oysters #c4e #d4bj #j4fh #cg4j ,cold roast beef #a slice 7#a oz47 #e4g #b4d #dd4j ,cold slaw3 #a_/b cup ,cabbage #a_/b cup #j4jjb #j4jja #j4jcd #d4e ,dressing #a tbs4 #a4e #c4d #cf4j ,gluten toast #b slices #ag4h #ag4j #j4f #adj4j #bfa4e ,dinner3 ,chicken 7without #c oz4 one stuffing7 serving #ah4b #b4a #ib4j ,broiled mushrooms #f medium size #a4e #c4j #j4ah #ai4j ,string beans #c oz4 one serving #a4ie #f4bi #b4bi #cd4d ,pineapple salad3 ,lettuce ,ad libitum ,pineapple #a slice #d4j #ca4j #j4f #abi4e ,dressing #a tbs4 #a4e #b4d #cg4j ,apple float3 #a apple #a apple #j4f #bb4b #j4gg #ih4a #a_/b egg white #a_/b egg white #a4e #j4jb #f4j ,saccharin to sweeten ,total grams #daf4j ,total calories #icj4e ,rules and ,regulations4--,the following directions and menus are given to be used when a reduction in weight is necessary4 ,care must be taken not to allow large amounts of even the non-fat-forming foods in the dietary1 since under certain conditions the body will manufacture adipose tissue of any surplus organic material ingested4 ,breakfast must be limited as demonstrated in the tabulated diet sheet4 ,keeping the ,weight ,down4--,after the individual has been reduced to approximately the desired weight the diet may be made a trifle more liberal1 keeping in mind1 however1 that moderation is the keynote in the obesity regime and will have to be practised to a certain extent always4 ,it is wise to continue the dry meals and to limit the amount of butter1 cream1 and other fatty foods1 to a certain extent4 ,pork1 with the exception of crisp bacon several times a week at breakfast1 had best be avoided1 and alcoholic beverages should be omitted entirely except when prescribed by the physician4 ,the outdoor exercise should be continued and only the amount of sleep requisite to health indulged in4 ,if the individual will faithfully carry out these directions1 there is no reason why the weight should continue to be a burden4 ,it must be remembered that it is never safe to diet indiscriminately and without the advice of a physician1 since much harm may come of so doing4 ,value of ,massage4--,massage is an advisable accompaniment to an obesity diet and will help to prevent a sagging of the tissues which have been deprived of the supporting fat4 ,the tissues of the face1 neck1 and breast are especially apt to wrinkle unless given the exercise and stimulation from massage4 ,cold baths are likewise advisable1 since they stimulate the body to burn up the fat4 ,,obesity ,,menus ,lunch--,tuna fish salad ,cauliflower ,baked apple ,dinner--,soft-shell crabs ,roast lamb ,spinach ,tomato jelly ,grapefruit ,lunch--,corned beef and cabbage ,stewed pears ,dinner--,clam cocktail ,roast chicken ,asparagus ,fruit salad ,lunch--,broiled oysters2 cold lamb ,boiled turnips ,water-cress salad ,dinner--,roast beef ,stewed tomatoes ,string beans ,lettuce and tomato salad ,sliced peaches ,lunch--,broiled calves' liver ,greens 7mustard1 turnip1 beet tops1 or dandelion7 ,orange jelly ,dinner--,crab-flake cocktail ,broiled squab ,artichokes ,stewed celery ,lettuce1 ,russian dressing ,lunch--,kippered herring ,veal croquettes 7baked instead of fried1 with tomato sauce2 this dressing is made by adding #a teaspoonful of chili sauce to the regular dressing used in obesity diets7 ,asparagus ,apple sauce ,dinner--,baked halibut steak1 stuffed with oysters ,boiled onions ,boiled carrots ,pineapple and grapefruit salad ,lunch--,broiled calves' brains ,vegetable salad ,melon ,dinner--,broiled chicken ,boiled beets ,string beans ,cucumber and young onion salad ,raspberry ice ,lunch--,stuffed eggs ,sliced tongue with spinach or greens ,carrots or beets ,fruit ,dinner--,roast turkey1 cranberry sauce ,cauliflower ,tomatoes stuffed with celery1 green peppers and onion dressing ,peach whip ,lunch--,hashed beef ,boiled onions ,stewed prunes ,dinner--,oysters ,baked rabbit ,eggplant 7baked7 ,spinach ,fruit jelly ,,emaciation ,emaciation as a rule is a symptom of an abnormal condition rather than a disease in itself4 ,certain individuals are said to be constitutionally thin and upon investigation it is often found that this thinness extends back in many cases for generations1 many members of a family being thin no matter what measures are taken to overcome the condition4 ,however1 constitutional emaciation is not so prevalent as constitutional obesity and1 as has already been stated1 is more often a symptom of some metabolic disturbance or pathological condition4 ,causes of ,emaciation4--,errors in diet--insufficient or improper food--are accountable for most of the cases seen in infants and children4 ,over-exercise1 that is1 when the amount of exercise taken is not commensurate with the intake of food1 is accountable for other cases4 ,this type of emaciation is found especially in growing children4 ,disease as a ,cause4--,wasting diseases1 such as tuberculosis and anemia1 bring about a loss of weight1 while in fevers in general and typhoid fever especially not only the febrile condition hastens the metabolic processes but also the activities of the bacteria act together and break down the tissues of the body1 causing a falling off from the normal body weight4 ,loss of sleep1 unhygienic or unsanitary surroundings1 and capricious appetites probably cause some of the cases of excessive thinness4 ,thinness in ,children4--,parents are to blame for much of the thinness seen in children1 especially the nervous high-strung children whose energies outweigh their desire for food or1 as is more often the case1 their willingness to eat the proper foods4 ,it is a mistaken kindness to cater to the whims and fancies of a child's appetite1 and much harm is wrought by allowing the trash to overbalance the necessary building or repair food in the dietary4 ,not that sugar is not necessary1 for it is particularly so at the age when the metabolic processes are faster than later in life1 but it must be remembered that the body is being built up both in height and breadth4 ,the ,need for ,building ,foods4--,the skeleton and the muscular tissues cannot be constructed from sugar1 hence the diet which consists chiefly of this food constituent is unbalanced and will sooner or later bring about disturbances which are very apt to result in emaciation4 ,the causes of emaciation may be summarized as follows3 7#a7 ,those cases which are due to pathological conditions such as tuberculosis1 anemia1 typhoid fever1 etc42 7#b7 ,those induced by errors in diet and bad habits such as insufficient or improper food1 loss of sleep1 over-exercise1 lack of ventilation in the sleeping apartment1 which destroys the appetite2 7#c7 ,malformation or deformities of mouth1 throat1 or stomach which make it impossible for the individual to partake of sufficient food to cover the needs of the body2 7#d7 ,heredity 7constitutional thinness74 ,regulating the ,diet4--,as has been stated in a former chapter1 any persistent loss of weight or failure to gain on the part of an infant whose chief business in life should be to grow1 should be given immediate and careful attention4 ,as a rule the diet is to blame2 it is either improperly balanced1 insufficient in amount1 or poorly prepared1 any of which might readily cause a disturbance to the delicate apparatus of the child4 ,diet and ,habits4--,in adults1 the diet and habits of life are in many cases to blame for the excessive thinness seen in many individuals4 ,if the trouble can be traced to some abnormal condition1 it can only be removed by relieving or checking the disease which induced it4 ,the older methods of treating typhoid fever1 for example1 did nothing to prevent the progressive emaciation which was the result not only of the accelerated metabolism from the fever but also from the invasion of the intestinal tract by the specific bacteria which brought about a like result4 ,in tuberculosis a similar breaking down of the tissues occurs1 as is likewise the case in anemia and other diseases in which the functions of the blood-making organs are interfered with4 ,any of the above diseases may cause emaciation1 and the treatment in most of the cases resolves itself in removing the cause as far as possible and in adjusting the diet4 ,selection of ,food4--,the dietetic treatment for emaciation is practically the only one which will materially change the weight of the individual1 since by food alone is the body built4 ,certain foods are more capable of being readily converted into adipose tissue than others1 and these must have a prominent place in the dietary4 ,rules and ,regulations4--,in obesity it was found that it was necessary to curtail the sleep and rest1 increase the amount of exercise and decrease the amount of food4 ,in emaciation practically an opposite regime is adopted4 ,the patient is urged to eat plenteously1 drink copiously of water and nutrient beverages1 soup1 etc41 avoid worry and excitement1 over-exertion and indigestion1 to take one or two naps every day1 to retire early1 to avoid hot baths and take a warm cleansing bath followed by a cold shower or sponge bath4 ,exercise must be of a mild character2 the patient must be warned against becoming exhausted1 since this condition precludes a gain in weight4 ,dietetic ,treatment4--,the meals must be carefully selected1 well prepared and daintily served1 that all of the psychical benefits from such efforts may be attained4 ,a nutrient beverage such as cream1 egg1 and vichy1 reenforced fruit beverages1 malted milk1 with egg and chocolate1 cereal and milk gruels1 etc41 may be given between breakfast and lunch1 lunch and dinner and before retiring4 ,the meals must consist of the simplest foods that the digestion may not be overtaxed by the quantity ingested4 ,allowable ,foods4--,the following foods may be used in the treatment of emaciation3 ,all dairy products1 milk1 cream1 butter and cheese1 eggs cooked in various ways1 soups of all kinds1 meats in moderation1 vegetables1 especially potatoes1 olive oil1 and the various salad oils1 cereals1 tapioca1 macaroni1 spaghetti1 noodles1 rice1 bread of every description1 fruit including bananas1 grapes1 dates1 raisins1 prunes1 etc41 ice creams1 farinaceous puddings1 sauces1 except those containing vinegar1 grape juice and other fruit juices sweetened with sugar1 cocoa and chocolate1 malted milk and proprietary infant foods1 honey1 molasses and sirups1 cakes1 cookies and pastry in moderation4 ,it is advisable to make milk the chief fluid food2 to this is added cream1 malted milk1 lactose1 eggs1 and other reenforcing agents4 ,milk ,cure4--,certain physicians advise milk alone1 giving from one to two gallons a day for three weeks or longer4 ,many individuals complain that milk makes them bilious but1 as a rule1 this is because the amount taken is small and the solids insufficient to lend the necessary bulk to the feces1 consequently the peristaltic action becomes sluggish and the passage of the food mass delayed in the intestinal tract1 furnishing a medium for bacterial growth and activity4 ,when larger quantities are ingested such is not the case and the fluid so high in nutrient qualities is utilized by the body for the building up of the depleted tissues4 ,when the emaciation is the result of disease the diet is necessarily adjusted to meet the condition4 ,at times it is most difficult to overcome the anemia and accompanying emaciation on account of the disease precluding the giving of the foods especially designed by nature to produce flesh4 ,this is especially the case in the progressive emaciation in diabetes4 ,however1 in this case the ,allen starvation treatment1 with the reeducation of the organs to a toleration for carbohydrates1 has gone far toward overcoming this distressing condition4 ,readjusting the ,habits4--,when the loss of weight is found to be the result of close application to work1 lack of fresh air and sleep1 or from errors in diet1 a change of climate and occupation should be made1 together with a readjustment of the daily habits1 such as substituting a cool bath for the regular hot one1 and sleeping out of doors or on a sleeping porch instead of in a poorly ventilated bedroom4 ,the patient must be urged to eat1 regardless of appetite1 for in this way only can the body weight be increased4 ,the dietary must be made up largely of the fat-forming foods1 but not to such an extent as to upset the nitrogen equilibrium4 ,the following diet sheet is given to be used as a guide in the treatment of emaciation4 ,other foods of a similar composition and fuel value may be substituted for those given here1 to vary the diet4 ,,emaciation ,,diet ,,sheet ,approximately #eajf calories ,,key ,a ,protein ,gm4 ,b ,carbohydrate ,gm4 ,c ,fat ,gm4 ,d ,total ,calories ,material ,amount ,a ,b ,c ,d ---------------------------------------- ----------------------- ,breakfast3 ,stewed prunes #f prunes #a4jb #ce4bf #ade4 ,sugar #a tbs4 #ad4g #ef4f ,oatmeal #a tbs4 7dry7 with cream and #b tbs4 cream #c4b #be4j #f4f #agb4b sugar #a tbs4 sugar ,poached egg #a egg #e4ce #d4af #eh4h ,toast #c slices ,butter #a tbs4 #g4i #dd4g #ac4j #cbh4 ,coffee #a cup with cream and #a tbs4 cream 4#dj 4#dj #b4h #ec4i sugar #b tsp4 #i4de ,milk and cream #b_/c cup milk #a_/c cup cream #chi4 #aa ,a4,m4 ,cereal milk gruel #h oz4 7#a cup7 with cream #a ounce #bdh4 ,lunch1 #a ,p4,m4 ,cream of pea soup #h oz4 7#a cup7 #f4 #ag4fe #g4ff #ahe4i ,potato salad #c4e oz4 7#a serving7 #a4ge #ae4e #ae4cc #baj4 ,bread #c slices #g4h #dd4g #a4jd ,butter #a tbs4 4#h #a4d #e4f #cbh4 ,cocoa made with milk #a cup ,sugar #b tsp4 #bg4 #bg4f #da4d #ffa4 ,milk #b_/c cup ,cream #a_/c cup #cbi4 #c3cj ,p4,m4 ,cream1 egg1 vichy #h oz4 #d4i #ab4d #cf4 #cic4 ,dinner3 ,tomato bouillon #a cup #ch4 with whipped cream #a tbs4 4#cj 4#db #e4fg #ec4i ,beefsteak #a serving 7#c oz47 #ah4f #ag4cd #bcj4e ,mashed potatoes #a_/c cup #a4af #g4e #c4e #ff4e ,cauliflower #a serving #a4ec #b4ii 4#db #ba4h ,asparagus salad #f stalks #b4jj #c4gb 4#bd with #b tsp4 4#ja #a4de #i4jj #aaa4h mayonnaise ,bread #b slices #e4b #bi4h 4#fh ,butter #b tbs4 4#bh #bd4ji #dai4 ,charlotte russe #a serving #b4c #aa4a #bb4f #beg4 ,milk #b_/c cup and cream #a_/c cup #chi4 ,black coffee if desired #a_/b cup ,at bed time3 ,malted milk #a cup made with milk and reenforced #h4d #da4 #aj4b #bhh4e with lactose #a ounce ,methods of ,increasing the ,diet4--,the above diet furnishes three times as much food as is needed to maintain the body living a sedentary life1 or about as much as would be needed to maintain a lumberman at hard outdoor labor in the ,maine woods4 ,it would be impossible for an ordinary individual to handle such an abundant diet without making the increase in the diet gradually4 ,this is best done by adding the milk and cream at the end of each meal and a glass of milk between meals and at bedtime1 then gradually adding the fattening foods already mentioned until the diet approximates the diet sheet here computed4 ,,summary ,,gout ,gout is a constitutional disease characterized by an inflammatory condition of the joints4 ,the ,joints are the seat of chalky deposits of uric acid or sodium salts4 ,metabolism in gout is disturbed1 with a consequent retention instead of elimination of uric acid by the body4 ,the ,blood contains an excess of uric acid which increases greatly during an acute attack4 ,the ,urine in true gout does not contain an excess of uric acid except during an acute attack1 whereas in the so-called goutiness there is a constant excess of this acid4 ,uric ,acid is produced as the result of the metabolism in the human body of the nucleoproteins and in food of the purin bodies4 ,alcohol undoubtedly assists in the retention and increases the difficulty of uric acid elimination by the body4 ,chief ,causes of ,gout4--,overeating1 excessive alcoholism1 and too little exercise1 especially in the open air4 ,treatment consists in regulating the diet both as to the quantity and type of food eaten2 reducing or eliminating the alcohol in the dietary1 and increasing the amount of outdoor exercise4 ,dietetic ,treatment4--,the best results are obtained by reducing the size of the meals and avoiding the purin-bearing foods as far as possible4 ,eggs are purin-free and may be substituted for much of the meat in the diet4 ,in chronic gout it is impossible to eliminate meat entirely from the diet1 but the quantity can be materially reduced and that which is eaten may be rendered less harmful if it is boiled instead of roasted or broiled1 as in this way much of the purin is dissolved out4 ,highly spiced and seasoned foods1 rich gravies1 etc41 are apt to cause an acute attack and should be omitted4 ,excesses of all kinds must be avoided to enable the patient to live a fairly comfortable life1 free from frequent painful attacks of gout4 ,,obesity ,causes4--,heredity1 overeating1 unbalanced diet1 chronic alcoholism1 and disturbed metabolism1 as manifested in gout and other pathological conditions4 ,cures are more or less of a risk1 except when undertaken upon the advice and under the care of a competent physician4 ,as a rule they are too strenuous to be carried out alone and are of no good unless persisted in4 ,among the best known obesity cures may be mentioned those formulated by ,banting1 ,oertel and ,ebstein4 ,most physicians have their own methods of treating obesity1 but all are based primarily on diet and exercise4 ,food is the chief cause of obesity and since some foods are more readily converted into adipose tissue than others1 it is necessary to understand the behavior and functions of the various food combinations in the body before it is possible to say which are the offending articles of diet4 ,water has no fattening properties of its own4 ,this is proved by a glance at its chemical composition1 but as it acts as a distributor and carrier of food to the various parts of the body and since the bulk of all the secretions is composed of water and every tissue in the body stores this fluid1 thus adding to the weight1 a consideration of the intake of water for obesity patients is most essential4 ,appetite requires attention4 ,the majority of obese patients eat more than their energy output calls for1 consequently it is necessary to curb the appetite and increase the energy output in order to utilize the material on hand in the form of adipose tissue4 ,exercise is absolutely essential in order to force the body to burn up its surplus fat as fuel4 ,the best form of exercise is that which is taken out of doors4 ,the well-worked muscle is heavier than one which is unaccustomed to exercise4 ,the latter is infiltrated with fat and weighs less than muscular tissue1 but a muscular body can endure more than one which is covered with adipose tissue4 ,the ,heart of obese patients becomes more or less affected as obesity advances and it becomes absolutely necessary in many cases to get rid of some of the surplus fat in order that the patient may live4 ,this is best accomplished by dietetic treatment4 ,circulatory ,changes likewise occur as the heart becomes affected1 making it necessary to institute some dietary measures at once4 ,glycosuria in obese patients suffering from gout is not at all unusual and to relieve this condition the carbohydrates in the diet must be at once reduced4 ,dietetic ,treatment is most important4 ,it constitutes the only rational method of ridding the body of its surplus fat4 ,to do this it is necessary to regulate the diet both as to quantity and type4 ,fat-forming foods are those which the body utilizes most easily for the production and storage of fat4 ,any food1 no matter whether it is fat-forming or not1 if taken greatly in excess of the needs of the body1 will be stored as adipose tissue4 ,chief ,points to be remembered in formulating a diet and instituting an obesity treatment are the necessity for small meals and dry meals1 no fluid given at all during the meal except perhaps one or two small cups of coffee per day1 without sugar or cream1 the avoidance of fat-forming foods1 sugars and starches in all forms1 milk1 cream1 butter and oil1 potatoes1 bananas1 fat meats of all descriptions1 especially pork1 soups of every description and alcoholic or malted beverages4 ,it is necessary to limit the amount of sleep1 prohibiting naps during the day1 and to increase the amount of outdoor exercise4 ,massage is advisable1 especially in those patients who are unable1 on account of their excessive weight or heart symptoms1 to take the requisite amount of exercise necessary for their future welfare4 ,massage likewise makes the muscles firmer1 often preventing the disfiguring sagging of the skin caused by depriving it of its padding of fat4 ,,emaciation ,causes4--,errors in diet1 overwork1 over-exercise1 heredity1 nervousness1 worry1 malformation of the mouth1 throat1 or stomach1 heredity and certain pathological conditions1 such as typhoid fever1 tuberculosis1 anemia1 dysentery1 etc41 in which the breaking down of the tissues occurs more rapidly than they can be rebuilt4 ,children are often emaciated on account of their unbalanced diet4 ,they receive an insufficient amount of building food to cover their growth and development requirements4 ,parents are often to blame for allowing the child to overeat of some of the food constituents at the expense of others4 ,sugar1 for example1 is very necessary in the diet of a growing active child1 but all sugar and very little milk and eggs will lead to an unbalanced diet which may bring about a condition of extreme thinness later on4 ,in ,adults the constant eating of the wrong foods1 overworking and persistent worrying1 all contribute to the breaking down of the tissues which ends in emaciation4 ,weight is an index to health4 ,any persistent loss of weight on the part of an adult or loss or even failure to gain in a growing child1 are indications that all is not right and immediate measures must be taken to locate and relieve the trouble4 ,loss of ,weight due to pathological conditions can only be relieved by removing the cause1 after which the diet may be adjusted to suit the condition4 ,dietetic ,treatment is practically the only means of combating and overcoming emaciation1 since it is by food alone that the body is built4 ,fat-forming foods1 which in obesity were prohibited1 have a prominent place in the diet for emaciation4 ,padding the nerves and organs with a layer or covering of fat protects them from the jars and shocks incidental to daily life1 besides lending grace and contour to the body4 ,foods ,which ,produce ,fat are nutrient beverages of all sorts2 milk1 malted milk and cream are especially valuable2 water1 because of its particular properties and functions in the body2 and fruit beverages1 which are made chiefly of water and sugar1 are always included in the dietary4 ,milk and cream1 soups and milk gruels1 as well as all dishes made with milk or cream1 add materially to the fat-forming quality of the diet4 ,butter1 olive and other salad oils1 as well as cereals1 potatoes1 bread and simple desserts are advised4 ,the diet must be bountiful1 the meals frequent1 and lunches consisting of milk or cream with crackers will hasten the gain in weight4 ,rest1 preferably lying down1 is absolutely essential4 ,a period of relaxation covering from fifteen to thirty minutes should be taken before or after each meal4 ,the body derives the use of the food for the storage of fat which would otherwise be required to cover its energy expenditures4 ,sleep is essential to gain1 consequently the patient should retire early and take one or two naps during the day4 ,baths should be warm1 not hot1 followed by a cold shower or sponge4 ,exercise must be mild in character2 over-exertion precludes a gain in weight and exhaustion undermines the forces which make it possible for the body to store fat as adipose tissue4 ,nervous ,excitement and ,worry must be avoided4 ,gastro-intestinal ,disturbances should be guarded against1 since all the pounds gained through months of treatment may be quickly lost during one acute attack of diarrhea or auto-intoxication4 ,massage is advised4 ,the kneading and gentle manipulation of the muscles stimulates them to utilize more food material1 besides enabling the patient to eat more by reason of an increased appetite4 ,the ,milk ,cure has been used extensively in overcoming extreme emaciation4 ,it consists in the taking of large quantities1 ranging from one to two gallons per day4 ,it is given every hour or oftener for a period of one month to six weeks4 ,reenforcing the ,diet with eggs and lactose is often found of great value in increasing the weight quickly1 as is the giving of one-third of a glass of cream and two-thirds of a glass of milk after each meal and at bedtime4 ,the whole scheme of putting on pounds resolves itself into the giving of proper food in larger quantities than are ordinarily given1 but dividing it up into frequent meals in order not to upset the digestion and do away with the good already accomplished4 ,,problems 7a7 ,formulate a diet order for a patient with gout in which the purin foods are eliminated4 7b7 ,formulate a diet order for an obese patient whose heart is more or less affected4 7c7 ,list the foods of special value in the diet for emaciation4 ,write a diet order for day suitable for a patient 7woman7 weighing #aaj pounds1 whose normal weight is #ace pounds4 ,,footnotes3 #aef ,food for the ,sick1 p4 #ig1 by ,strouse and ,perry4 #aeg ,the amount of food must be limited1 since overeating will precipitate an acute attack4 ,it is best to limit the amount to about a maintenance allowance or a little more1 temporarily4 #aeh ,diet in ,health and ,disease1 by ,freidenwald and ,ruhraeh4 #aei ,ibid41 p4 #edd4 #afj ,boiled vegetable dinners must be prepared without fat meat and potatoes4 #afa ,scientific investigation has proved that both carbohydrates and fats may be formed in the body from protein4 ,hence any excess above that required to keep the body in nitrogen equilibrium is utilized by the organism for fuel or stored as fat4 #afb ,feeding the ,family1 p4 #hd1 by ,mary ,swartz ,rose4 #afc ,saccharin may be used to sweeten4 ,,chapter ,,xxiii ,,other ,,conditions ,,more ,,or ,,less ,,affected ,,by ,,diet ,,ptomaine ,,poisoning1 ,,acidosis ,,and ,,pellagra ,,ptomaine ,,poisoning ,the poisoning due to ptomaine is very similar to that brought about by overeating and other dietetic errors4 ,however1 it is not so easy to avoid being poisoned by ptomaines as it is to observe moderation in the quantity of food eaten4 ,origin4--,these substances are believed to be of an infective bacterial origin and may be present in foods which are otherwise seemingly fresh and good4 ,the fact that they cannot be detected in food without an analysis makes them more of a menace than they would otherwise be1 for any substance which is not discernible to our senses1 the taste1 sight1 or smell1 and which exerts a baleful influence1 such as ptomaine1 cannot be anything but a menace to humanity4 ,infected ,food ,materials4--,we may congratulate ourselves in the knowledge that these substances are not present in many foods1 and if we avoid eating nitrogenous materials1 which may have become polluted1 either through imperfect canning or by standing in unclean vessels1 we may avoid much of the poisoning which may otherwise be due to the action of ptomaines4 ,chicken ,salad and ,ice ,cream ,poisoning4--,certain violent attacks of so-called ptomaine poisoning may be traced to chicken salad which has been allowed to stand overnight in tin receptacles or to ice cream which has melted and been re-frozen4 ,in any case the treatment remains the same4 ,treatment4--,the patient is put to bed and the intestinal tract cleansed by means of enemas and in many cases purgatives 7salts1 castor oil1 etc47 as directed by physician4 ,the symptoms usually present in those suffering from ptomaine poisoning are nausea1 vomiting1 dizziness1 pain more or less violent in character1 and prostration which is at times alarming4 ,dietetic ,treatment4--,the treatment instituted under the circumstances is very much the same as that used in other forms of acute poisoning4 ,all food is withheld for a period2 the duration of this starvation must necessarily depend upon the condition of the patient1 the violence of the poison and the extent of the prostration4 ,rectal ,feeding4--,when the prostration is great1 it is sometimes necessary to give saline enemas and even rectal alimentation to prevent collapse4 ,fluid ,diet4--,after the violent attack subsides1 the patient is placed upon a fluid diet similar to that used in auto-intoxication and practically the same as the diet for acute infectious diseases4 ,the diet must be gradually increased until it becomes normal and the nurse must remember that the patient is in a condition to suffer a relapse with the least indiscretion4 ,it is advisable to have a thorough investigation made to ascertain the source of the original attack1 that the patient may be able to avoid future trouble from partaking of the same food4 ,personal ,idiosyncrasies4--,it may be that there is a personal idiosyncrasy against one particular food1 and in this case it becomes more or less of a simple matter to prevent future attacks4 ,certain individuals are1 for example1 invariably poisoned by eating shellfish1 others manifest a similar idiosyncrasy against strawberries4 ,thus is the old proverb demonstrated3 ,what is one man's meat is another man's poison4 ,and he who wantonly flies in the face of the danger signals ,nature provides for his guidance must necessarily suffer the consequences of his folly4 ,it has been proved with certain individuals that the foods that at one time cause an attack of poison at another time may be eaten with impunity4 ,thus it would seem to remain a question not so much of the type of poison1 ptomaines1 etc41 as the amount of resistance manifested at the time by the individual partaking of the infected food4 ,,acidosis ,metabolism of ,fats4--,acidosis is a condition believed to be due primarily to some impairment in the metabolism of fat in the body1 in consequence of which there is an accumulation of substances more or less irritating and at times toxic in character in the blood4 ,these substances1 known as acetone bodies1 are especially apt to appear in the urine of individuals suffering from diabetes1 likewise in those undergoing starvation1 whether as a result of treatment to overcome a definite pathological condition1 as in diabetes1 or as the result of disease itself4 ,malnutrition as a ,source4--,certain individuals1 children especially1 develop symptoms of acidosis under many different circumstances2 for example1 in many cases of malnutrition the evidences of acidosis are almost invariable4 ,the treatment in these cases must be1 of course1 prompt in order that the condition may not assume a serious aspect4 ,dietetic ,treatment4--,the diet is adjusted in order to neutralize the effect of the acid in the blood4 ,this is done in two ways3 first1 by reducing the fat1 and second1 by increasing the amount of base-forming foods in the diet4 ,the following table#afd illustrates the foods in which the acid-forming elements and base-forming elements predominate3 ,,foods ,,in ,,which ,,acid-,,forming ,,elements ,,predominate ,estimated ,excess ,acid-forming ,elements ,equivalent to ,c4,c4 ,normal ,acid per #ajj ,calories ,beef1 free from visible fat #aj ,eggs 4#i ,round steak #f4g ,oatmeal #c4b ,wheat flour #b4g ,wheat1 entire grain #b4f ,rice #b4d ,bacon #a ,corn1 entire grain 7high protein7 4#a ,,foods ,,in ,,which ,,base-,,forming ,,elements ,,predominate ,estimated ,excess ,base-forming ,elements ,equivalent to ,c4,c4 ,normal ,alkali per #ajj ,calories ,celery #dj ,cabbage #aj-ac4f ,potatoes #i-ab ,prunes #g4i ,turnips #f4f-ab4e ,apples #e ,milk #c4c ,beans #b4i-f4h ,peas #a4i ,corn1 entire grain 7low protein7 4#h ,the fruits likewise show a predominance of base-forming elements over acid-forming elements and for this reason may be used to balance the diet4 ,diabetic ,acidosis4--,the acidosis during diabetes has been already discussed in the chapter devoted to that disease4 ,it has been found advisable in the majority of cases of acidosis to restrict the fat in the diet of all patients who1 during the course of a disease1 have given evidence of this condition2 at the same time it is well to remember that fat is one of the essential food constituents and absolutely necessary to the welfare of the individual1 consequently it is impossible to eliminate it from the diet entirely4 ,the only feasible method1 then1 to pursue under the circumstances is to restrict the fats in the diet so long as there are symptoms of acidosis and to add them gradually and in very small amounts until the individual's tolerance for fats is determined4 ,balancing the ,diet4--,in many cases of acidosis due to starvation1 no matter what the cause1 the diet must be necessarily regulated and properly balanced4 ,it would be decidedly unwise to attempt to build up the body by giving building foods alone1 without due consideration to the foods containing the agents provided by ,nature to neutralize the acid formed during the process of their metabolism4 ,it is readily seen in the table just given that meat and eggs show a marked excess of acid-forming elements1 whereas vegetables and fruits yield an excess of base-forming elements4 ,with these data1 it becomes more simple to balance the diet and to avoid the acidosis which may arise from impairment of the fat metabolism of the body4 ,,pellagra ,the enormous increase in the number of cases of pellagra in ,america during the last twenty years makes it necessary for something to be done to arrest its progress4 ,the cause of this disease is still under discussion1 but much has been done to find out definitely the reason for the tremendous increase in the number of cases1 especially in the ,southern ,states1 where the increase has been most noticeable4 ,cause4--,this disease has been the subject of much study and discussion in this country in recent years4 ,voegtlin1 in an article published in a ,report of the ,united ,states ,public ,health ,service 7,reprint #eig of ,public ,health ,report71 summarizes the current findings on pellagra as follows3 #a4 ,the hypothesis that there is a causal relation between pellagra and a restricted vegetable diet has been substantiated by direct proof to this effect and has led to results of considerable practical and scientific value4 #b4 ,the metabolism in pellagra shows certain definite changes from the normal1 which point to decreased gastric secretion and increased intestinal putrefaction4 #c4 ,in the treatment and prevention of pellagra1 diet is the essential factor4 ,the disease can be prevented by an appropriate change in the diet without changing other sanitary conditions4 #d4 ,a diet of the composition used by the pellagrins prior to their attack by the disease leads to malnutrition and certain pathological changes in animals1 resembling those found in pellagra4 ,a typical pellagrous dermatitis has not been observed in animals4 ,pellagrous symptoms have been produced in man by the continued consumption of a restricted vegetable diet4 #e4 ,the nature of the dietary effect has not been discovered1 although certain observations point to a combined deficiency in some of the recognized dietary factors as the cause of the pellagrous syndrome4 ,dietetic ,treatment4--,the diet in pellagra is one which is well balanced in all its particulars1 and one in which the proteins are carefully adjusted as to type4 ,the best results have been observed on diets in which the complete proteins 7milk1 meat and eggs7 have a prominent place4 ,as a rule1 in the diet of an adult suffering from pellagra1 at least forty grams 7about #fj per cent7 of the necessary proteins should be in this form4 ,the diet for pellagra must necessarily be such as to overcome as far as possible the progressive emaciation which is an important symptom4 ,however1 it must be kept in mind that gastro-intestinal disturbances are likewise prominent and that diarrhea is often most difficult to overcome4 ,for these reasons it is essential to formulate a diet which will not interfere with the treatment for the disease1 and which will be at the same time one on which the patient can gradually be built up1 and in this way benefit1 as far as possible1 under the circumstances4 ,the diet used in the treatment of anemia seems to be the one best suited to meet the requirements of the patient suffering with pellagra2 changes may be made in this diet1 however1 by the physician1 who will be able to judge the need of the individual under his care4 ,whether pellagra can be cured by dietetic treatment is very uncertain1 but the condition of the patient can undoubtedly be materially improved1 provided the treatment is begun sufficiently early2 that is1 before the disease has progressed to such an extent that neither diet nor anything else can bring about a cure4 ,the above dietetic treatment is not claimed to be infallible4 ,it is merely given as a suggestion to be used at the discretion of the physician4 ,in all probability the treatment of pellagra will undergo a definite change in the near future1 but at present our best results accrue from the giving of an adequate1 well-balanced diet4 ,the extent of the relief of such dietetic measures depends1 as has already been stated1 upon taking the disease in its early stage4 ,,summary ,food ,poisoning is more or less common1 being induced by polluted water1 milk1 or other foods1 bad sanitation1 and imperfect canning1 as well as by certain obscure substances known as ptomaines4 ,shellfish have often been found to cause poisoning in certain individuals4 ,stale fish may cause the most violent type of poisoning in any individual4 ,chicken ,salad which has been kept overnight in tin receptacles has been known to cause violent attacks of poisoning4 ,ice ,cream which is melted and re-frozen is likewise a source of a number of the cases reported4 ,symptoms4--,very like those of auto-intoxication1 and violent intestinal disturbances are manifested4 ,prostration may be great1 according to the violence and duration of the attack4 ,anemia follows many cases of poisoning as a result not only of the impairment and lack of nutrition of the blood-making organs1 but also on account of the other symptoms1 especially diarrhea occurring in the disease4 ,,acidosis ,this condition is more or less common1 especially in the disturbances manifested by children4 ,cause of acidosis is believed to be an impairment of metabolism1 especially in regard to the fats4 ,starvation or ,malnutrition is believed to produce many cases of acidosis in childhood and adults suffering from diseases in which certain foods have been limited4 ,dietetic ,treatment like that used in acute gastro-intestinal disturbances begins with a starvation period and is followed by a simple fluid diet until violent symptoms subside4 ,examination of the stools and the material vomited will1 at times1 furnish an insight as to the source of the poison4 ,convalescent ,diet is begun after the violent symptoms have subsided1 but care must be taken not to increase the diet too rapidly1 owing to the danger from relapse4 ,method of ,administering ,diet4--,first3 a period of total abstinence from food4 ,second3 fluid diet consisting of broth1 buttermilk1 or some of the predigested liquid beef preparations which furnish both food and stimulation necessary in such cases4 ,rectal ,feeding may be found necessary when the prostration is great4 ,personal ,idiosyncrasies should be taken into account and effort made to find whether or not the attack is caused by any one food material or by bad sanitation or unclean food4 ,the patient should be warned against the danger of taking a food which has caused a previous attack of poisoning1 especially in cases where a personal idiosyncrasy against a food has been manifested4 ,,pellagra ,the cause and cure for this disease are still a matter of discussion4 ,whether it is due to the presence or absence of certain substances in the food materials1 is as yet to be determined4 ,diet in ,pellagra is most important4 ,it is impossible to say that pellagra is a nutritional disease1 but it is certain that in balancing the diet much has been done toward relieving the condition4 ,diarrhea is one of the chief symptoms of the disease and great care is needed in formulating the dietary in order not to increase this condition4 ,conclusion4--,the diet is thus shown to be directed toward overcoming the emaciation and anemia and relieving or preventing the gastro-intestinal disturbances which are so apt to occur4 ,it must be remembered that even a well-balanced diet will not materially relieve the condition unless it is instituted sufficiently early4 ,,problems 7a7 ,formulate a diet for an adult in which the base-forming elements predominate4 7b7 ,formulate a diet for child suffering from acidosis4 7c7 ,arrange a well balanced diet for pellagra in which forty grams of protein shall come from milk1 meat or eggs4 ,,footnote3 #afd ,chemistry of ,food and ,nutrition 7revised71 by ,henry ,sherman4 ,,appendix ,,table ,i#afe ,,edible ,,organic ,,nutrients ,,and ,,fuel ,,values ,,of ,,foods#aff ,e4,p4 signifies edible portion2 ,a4,p4 signifies as purchased4 ,,key3 ,a ,protein 7,n x #f4be7 ,per ,cent ,b ,fat ,per ,cent ,c ,carbohydrate ,per ,cent ,d ,fuel ,value per ,pound ,calories ,e #ajj ,calorie ,portion ,grams ,food ,a ,b ,c ,d ,e ---------------------------------------- --------------------- ,almonds ,e4,p4 #ba4j #ed4i #ag4c #bidj #ae ,a4,p4 #aa4e #cj4b #i4e #afae #bh ,apples ,e4,p4 4#d 4#e #ad4b #bhe #aei ,a4,p4 4#c 4#c #aj4h #bad #bab ,apricots ,e4,p4 #a4a -- #ac4d #bfc #agd ,a4,p4 #a4j -- #ab4f #bdg #ahd ,artichoke1 ,french ,e4,p4 #c4d 4#e #ab4j #cjj #aea ,a4,p4 #a4g 4#c #f4j #aej #cjb ,asparagus1 fresh ,e4,p4 #a4h 4#b #c4c #ajj #dej cooked ,a4,p4 #b4a #c4c #b4b #bac #bac ,avocado ,e4,p4 #b4a #bj4a #g4d #iic #df ,a4,p4 #a4d #ac4b #d4h #feb #gj ,bacon1 smoked ,e4,p4 #aj4e #fd4h -- #bhdj #af ,a4,p4 #i4e #ei4d -- #bcgb #ai ,bananas ,e4,p4 #a4c 4#f #bb4j #ddg #aja ,a4,p4 4#h 4#d #ad4c #bij #aef ,barley1 pearled #h4e #a4a #gg4h #afae #bh ,beans1 dried #bb4e #a4h #ei4f #aefe #bi ,lima1 dried #ah4a #a4e #fe4i #aehf #bi ,lima1 fresh ,e4,p4 #g4a 4#g #bb4j #eeg #hb ,a4,p4 #c4b 4#c #i4i #bej #ahb string1 fresh ,e4,p4 #b4c #c4 #g4d #ahd #bda ,a4,p4 #b4a #c4 #f4i #agf #bei baked1 canned ,a4,p4 #f4i #b4e #ai4f #ehc #gh red kidney1 canned #g4j 4#b #ah4e #dga #if ,beef1 brisket1 medium fat ,e4,p4 #ae4h #bh4e -- #addi #ca ,a4,p4 #ab4j #bb4c -- #aacj #dj chuck1 average ,e4,p4 #ai4b #ae4d -- #igh #df ,a4,p4 #ae4h #ab4e -- #gig #eh corned1 average ,e4,p4 #ae4f #bf4b -- #acec #cd ,a4,p4 #ad4c #bc4h -- #abcj #cg cross ribs1 average ,e4,p4 #ae4i #bh4b -- #addj #cb ,a4,p4 #ac4h #bd4h -- #abfb #cf dried1 salted1 and smoked ,e4,p4 #cj4j #f4e 4#d #hag #ef ,a4,p4 #bf4d #f4i -- #gfj #fj flank1 lean ,e4,p4 #bj4h #aa4c -- #hch #ed ,a4,p4 #bj4e #aa4j -- #hba #ee fore quarter1 lean ,e4,p4 #ah4i #ab4b -- #hdb #ed ,a4,p4 #ad4g #i4e -- #fee #fi fore shank1 lean ,e4,p4 #bb4j #f4a -- #fdg #gj ,a4,p4 #ad4j #c4i -- #dad #aaj heart ,e4,p4 #af4j #bj4d #a4j #aadj #dj ,a4,p4 #ad4h #bd4g 4#i #abib #ce hind quarter1 lean ,e4,p4 #bj4j #ac4d -- #ijg #ej ,a4,p4 #af4g #aa4b -- #geg #fj hind shank1 lean ,e4,p4 #ba4i #e4d -- #fag #ge ,a4,p4 #i4a #b4b -- #bee #agi hind shank1 fat ,e4,p4 #bj4d #ah4h -- #aaga #dj ,a4,p4 #i4i #i4a -- #eeb #hc liver ,e4,p4 #bj4d #d4e #a4g #ehd #gh ,a4,p4 #bj4b #c4a #b4e #ecg #he loin ,e4,p4 #ai4g #ab4g -- #hgg #eb ,a4,p4 #ag4a #aa4a -- #gfd #fj neck1 lean ,e4,p4 #ba4d #h4d -- #gcb #fb ,a4,p4 #ae4a #e4i -- #dic #ic neck1 medium fat ,e4,p4 #bj4a #af4e -- #ajdj #dd ,a4,p4 #ad4e #aa4i -- #gdi #fa plate1 lean ,e4,p4 #ae4f #ah4h -- #ajea #dc ,a4,p4 #ac4j #ae4e -- #hfg #eb ,porterhouse steak ,e4,p4 #ba4i #bj4d -- #abcj #cg ,a4,p4 #ai4a #ag4i -- #ajgg #db rib rolls1 lean ,a4,p4 #bj4b #aj4e -- #gie #eg ribs1 lean ,e4,p4 #ai4f #ab4j -- #hde #ed ,a4,p4 #ae4b #i4c -- #fed #fi ribs1 fat ,e4,p4 #ae4j #ce4f -- #agba #bf ,a4,p4 #ab4g #cj4f -- #adhj #ca round1 lean ,e4,p4 #ba4c #g4i -- #gji #fd ,a4,p4 #ai4e #g4c -- #fdi #gj round1 free from visible fat #bc4b #b4e -- #eab #hg rump1 lean ,e4,p4 #bj4i #ac4g -- #idj #di ,a4,p4 #ai4a #aa4j -- #gif #eg rump1 fat ,e4,p4 #af4h #ce4g -- #agfc #bf ,a4,p4 #ab4i #bg4f -- #acfa #cc sides1 lean ,e4,p4 #ai4c #ac4b -- #hij #ea ,a4,p4 #ae4e #aj4f -- #gae #fd sirloin steak ,e4,p4 #ah4i #ah4e -- #ajii #da ,a4,p4 #af4e #af4a -- #ifj #dh sweetbreads ,a4,p4 #af4h #ab4a -- #gii #eg tenderloin ,a4,p4 #af4b #bd4d -- #abij #ce tongue ,e4,p4 #ah4i #i4b -- #gag #fc ,a4,p4 #ad4a #f4g -- #ebi #hf ,beets1 cooked ,e4,p4 #b4c 4#a #g4d #ahj #beb fresh ,e4,p4 #a4f 4#a #i4g #bji #bag ,a4,p4 #a4c 4#a #g4g #afg #bga ,blackberries ,a4,p4 #a4c #a4j #aj4i #bfb #agc ,blackfish ,e4,p4 #ah4g #a4c -- #cic #aaf ,a4,p4 #g4d 4#g -- #afc #bgi ,bluefish ,e4,p4 #ai4d #a4b -- #djb #aac ,a4,p4 #aj4j 4#f -- #bjf #bbj ,boston crackers #aa4j #h4e #ga4a #ahce #be ,brazil nuts ,e4,p4 #ag4j #ff4h #g4j #cafb #ad ,a4,p4 #h4f #cc4g #c4e #aeia #bh ,bread1 ,boston brown #f4j #f4c #ed4j #acde #cd graham #h4i #a4h #eb4a #aahi #ch rolls1 water #i4j #c4j #ed4b #abfh #cf toasted #aa4e #a4f #fa4b #ache #cc white1 home made #i4a #a4f #ec4c #aaii #ch milk #i4f #a4d #ea4a #aaeh #ci ,vienna #i4d #a4b #ed4a #aaii #ch average white #i4b #a4c #ec4a #aahb #ch whole wheat #i4g 4#i #di4g #aaac #da ,buckwheat flour #f4d #a4b #gg4i #aehj #bi ,butter #a4j #he4j -- #cdia #ac ,buttermilk #c4j 4#e #d4h #afb #bhj ,butternuts ,e4,p4 #bg4i #fa4b #c4e #cjfe #ae ,a4,p4 #c4h #h4c 4#e #dag #aji ,cabbage ,e4,p4 #a4f 4#c #e4f #adc #cag ,a4,p4 #a4d 4#b #d4h #aba #cgf ,calf's-foot jelly #d4c -- #ag4d #cid #aae ,carrots1 fresh ,e4,p4 #a4a 4#d #i4c #bjd #bba ,a4,p4 4#i 4#b #g4d #aeh #bhf ,cauliflower ,a4,p4 #a4h 4#e #d4g #aci #cbh ,celery ,e4,p4 #a4a 4#a #c4c #hd #edb ,a4,p4 4#i 4#a #b4f #fh #fgb ,celery soup1 canned #b4a #b4h #e4j #bdc #ahg ,cerealine #i4f #a4a #gh4c #afdj #bh ,chard ,e4,p4 #c4b 4#f #e4j #agc #bfb ,cheese1 ,american pale #bh4h #ce4i 4#c #aiij #bc ,american red #bi4f #ch4c -- #bajb #bb ,cheddar #bg4g #cf4h #d4a #bjhj #bb cottage #bj4i #a4j #d4c #dii #ia full cream #be4i #cc4g #b4d #ahij #bd ,fromage de ,brie #ae4i #ba4j #a4d #aagj #ci ,neufchatel #ah4g #bg4d #a4e #adhd #ca pineapple #bi4i #ch4i #b4f #bahj #ba ,roquefort #bb4f #bi4e #a4h #afde #bh ,swiss #bg4f #cd4i #a4c #aide #bc ,cherries1 fresh ,e4,p4 #a4j 4#h #af4g #ced #abh ,a4,p4 4#i 4#h #ae4i #ccg #acd canned ,a4,p4 #a4a 4#a #ba4a #djg #aab ,chestnuts1 fresh ,e4,p4 #f4b #e4d #db4a #ajih #da ,a4,p4 #e4b #d4e #ce4d #ibj #di ,chicken1 broilers ,e4,p4 #ba4e #b4e -- #dic #ib ,a4,p4 #ab4h #a4d -- #bhi #aeg ,chocolate #ab4i #dh4g #cj4c #bgfh #af ,cocoa #ba4f #bh4i #cg4g #bbeh #bj ,cod1 dressed ,a4,p4 #aa4a 4#b -- #bji #bag salt ,e4,p4 #be4d 4#c -- #dgc #if ,a4,p4 #ai4j 4#d -- #cfa #abf ,consomme1 canned ,a4,p4 #b4e -- 4#d #ec #hfb ,corn1 green1 canned #b4h #a4b #ai4j #dee #ajb sweet1 fresh ,e4,p4 #c4a #a4a #ai4g #dei #ii ,a4,p4 #a4b 4#d #g4g #agh #bee ,corn meal #i4b #a4i #ge4d #afbj #bh ,cowpeas1 dried #ba4d #a4d #fj4h #aeej #bi green ,e4,p4 #i4d 4#f #bb4g #fjc #gf ,crackers1 butter ,a4,p4 #i4f #aj4a #ga4f #ahhg #bc cream ,a4,p4 #i4g #ab4a #fi4g #aich #bc graham ,a4,p4 #aj4j #i4d #gc4h #aije #bd soda ,a4,p4 #i4h #i4a #gc4a #ahge #bd water ,a4,p4 #aj4g #h4h #ga4i #ahee #bd ,cranberries ,a4,p4 4#d 4#f #i4i #bab #bab ,cream #b4e #ah4e #d4e #hhc #ej ,cucumbers ,e4,p4 4#h 4#b #c4a #gi #ege ,a4,p4 4#g 4#b #b4f #fh #fff ,currants1 fresh #a4e -- #ab4h #bei #age dried ,zante #b4d #a4g #gd4b #adee #ca ,dandelion greens #b4d #a4j #aj4f #bgg #afd ,dates1 dried ,e4,p4 #b4a #b4h #gh4d #aege #bi ,a4,p4 #a4i #b4e #gj4f #adaf #cb ,doughnuts #f4g #ba4j #ec4a #aida #bc ,eggplant ,e4,p4 #a4b 4#c #e4a #abf #cdi ,eggs1 uncooked ,e4,p4 #ac4d #aj4e -- #fgb #fh ,a4,p4 #aa4i #i4c -- #eid #gf ,farina #aa4j #a4d #gf4c #afdj #bh ,figs1 dried #d4c 4#c #gd4b #adcg #cb ,flounder ,a4,p4 #e4d 4#c -- #aaj #dab ,e4,p4 #ad4b 4#f -- #bhb #afa ,flour1 rye #f4h 4#i #gh4g #aeij #bi wheat1 ,california fine #g4i #a4d #gf4d #aehe #bi wheat1 entire #ac4h #a4i #ga4i #afcj #bh wheat1 graham #ac4c #b4b #ga4d #afbh #bh wheat1 patent baker's grade #ac4c #a4e #gb4g #afbc #bh wheat1 straight grade #aj4h #a4a #gd4h #afjh #bh wheat1 average high and medium #aa4d #a4j #ge4a #afaj #bh wheat1 average low grade #ad4j #a4i #ga4b #afbe #bh ,fowls ,e4,p4 #ai4c #af4c -- #ajag #de ,a4,p4 #ac4g #ab4c -- #geb #fj ,gelatin #ia4d 4#a -- #affj #bg ,grape butter #a4b 4#a #eh4e #ajhh #db ,grapes ,e4,p4 #a4c #a4f #ai4b #dcg #ajd ,a4,p4 #a4j #a4b #ad4d #cbh #ach ,grapefruit ,e4,p4 4#f 4#a #ab4b #bce #aic ,a4,p4 4#d 4#a #h4i #agb #bfd ,haddock ,e4,p4 #ag4b 4#c -- #cbd #adj ,a4,p4 #h4d 4#b -- #afj #bhc ,halibut steaks ,e4,p4 #ah4f #e4b -- #eej #hc ,a4,p4 #ae4c #d4d -- #deg #ajj ,ham1 fresh lean ,e4,p4 #be4j #ad4d -- #ajdb #dd ,a4,p4 #bd4h #ad4b -- #ajcj #dd fresh1 medium ,e4,p4 #ae4c #bh4i -- #adeh #ca ,a4,p4 #ac4e #be4i -- #acjc #ce smoked1 lean ,e4,p4 #ai4h #bj4h -- #abji #ch ,a4,p4 #ag4e #ah4e -- #ajgc #db ,herring1 whole ,e4,p4 #ai4e #g4a -- #fdd #gj ,a4,p4 #aa4b #c4i -- #cfb #abe smoked ,e4,p4 #cf4i #ae4h -- #acae #ce ,a4,p4 #bj4e #h4h -- #gca #fb ,hominy #h4c 4#f #gi4j #afji #bh ,honey 4#d -- #ha4b #adha #ca ,huckleberries 4#f 4#f #af4f #ccf #ace ,kohl-rabi ,e4,p4 #b4j 4#a #e4e #adj #cbd ,koumiss #b4h #b4a #e4d #bcd #aid ,lamb1 breast ,e4,p4 #ai4a #bc4f -- #acaa #ce ,a4,p4 #ae4d #ai4a -- #ajeh #dc chops1 broiled ,e4,p4 #ba4g #bi4i -- #afad #bh fore quarter ,e4,p4 #ah4c #be4h -- #ache #cc ,a4,p4 #ad4i #ba4j -- #aabg #dj hind quarter ,e4,p4 #ai4f #ai4a -- #aadi #dj ,a4,p4 #af4e #af4a -- #iec #dh leg roast #ai4g #ab4g -- #hgf #eb side ,e4,p4 #ag4f #bc4a -- #abfc #cf ,a4,p4 #ad4a #ah4g -- #ajae #de ,lard1 refined -- #ajj4j -- #djhj #aa ,lemon juice -- -- #i4h #agh #bee ,lemons ,e4,p4 #a4j 4#g #h4e #bja #bbf ,a4,p4 4#g 4#e #e4i #adj #cbc ,lettuce ,e4,p4 #a4b 4#c #b4i #hg #ebe ,a4,p4 #a4j 4#b #b4e #gb #fcc ,liver1 beef ,e4,p4 #bj4d #d4e #a4g #ehc #gh ,a4,p4 #bj4b #c4a #b4e #ech #hd veal ,e4,p4 #ai4j #e4c -- #efb #ha ,lobster1 whole ,e4,p4 #af4d #a4h 4#d #cgi #abj ,a4,p4 #e4i 4#g 4#b #aci #cbf canned ,a4,p4 #ah4a #a4a 4#e #chb #aai ,macaroni #ac4d 4#i #gd4a #afbe #bh ,macaroons #f4e #ae4b #fe4b #aibb #bd ,mackerel ,e4,p4 #ah4g #g4a -- #fbi #gb ,a4,p4 #aj4b #d4b -- #cef #abg salt ,e4,p4 #ba4a #bb4f -- #acje #ce ,a4,p4 #af4c #ag4d -- #ajje #de ,marmalade1 orange 4#f 4#a #hd4e #aedh #bi ,milk1 condensed1 sweetened #h4h #h4c #ed4a #adhj #ca skimmed #c4d 4#c #e4a #afg #bgc whole #c4c #d4j #e4j #cad #ade ,mince meat1 commercial #f4g #a4d #fj4b #abhj #cf home made #d4h #f4g #cb4a #idb #dh ,molasses1 cane #b4d -- #fi4c #acjb #ce ,mushrooms ,a4,p4 #c4e 4#d #f4h #bjd #bbc ,muskmelons ,e4,p4 4#f -- #i4c #ahj #beb ,a4,p4 4#c -- #d4f #hi #eaj ,mutton1 fore quarter ,e4,p4 #ae4f #cj4i -- #aedc #bi ,a4,p4 #ab4c #bd4e -- #abbc #cg hind quarter ,e4,p4 #af4g #bh4a -- #adej #ca ,a4,p4 #ac4h #bc4b -- #aaig #ch leg ,e4,p4 #ai4h #ab4d -- #hfc #eb ,a4,p4 #af4e #aj4c -- #gah #fc side ,a4,p4 #ac4j #bd4j -- #abae #cg ,e4,p4 #af4b #bi4h -- #aeab #cj ,nectarines ,e4,p4 4#f -- #ae4i #bii #aeb ,a4,p4 4#f -- #ad4h #bhj #afb ,oatmeal #af4a #g4b #fg4e #ahaa #be ,okra ,e4,p4 #a4f 4#b #g4d #agb #bfd ,a4,p4 #a4d 4#b #f4e #aeb #cjj ,olives1 green ,e4,p4 #a4a #bg4f #aa4f #aceg #cc ,a4,p4 4#h #bj4b #h4e #iie #df ripe ,e4,p4 #a4g #be4j #d4c #aacj #dj ,a4,p4 #a4d #ba4j #c4e #idg #dh ,onions1 fresh ,e4,p4 #a4f 4#c #i4i #bbj #bjf ,a4,p4 #a4d 4#c #h4i #aii #bbh ,oranges ,e4,p4 4#h 4#b #aa4f #bcc #aie ,a4,p4 4#f 4#a #h4e #afi #bfh ,oxtail soup1 canned ,a4,p4 #c4h 4#e #d4b #aff #bgd ,oysters ,e4,p4 #f4b #a4b #c4g #bbh #aii in shell ,a4,p4 #a4b 4#b 4#g #dc #ajfe canned ,a4,p4 #h4h #b4d #c4i #cbh #ach ,parsnips ,e4,p4 #a4f 4#e #ac4e #bid #aed ,a4,p4 #a4c 4#d #aj4h #bcf #aib ,pea soup1 canned ,a4,p4 #c4f 4#g #g4f #bcb #aif ,peaches1 canned ,a4,p4 4#g 4#a #aj4h #bac #bac fresh ,e4,p4 4#g 4#a #i4d #ahh #bdb ,a4,p4 4#e 4#a #g4g #aec #big ,peanuts ,e4,p4 #be4h #ch4f #bd4d #bdij #ah ,a4,p4 #ai4e #bi4a #ah4e #ahgg #bd ,pears1 fresh ,e4,p4 4#f 4#e #ad4a #bhh #aeh ,a4,p4 4#e 4#d #ab4g #bef #agg ,peas1 canned ,a4,p4 #c4f 4#b #i4h #beb #ahj dried #bd4f #a4j #fb4j #afaa #bh green ,e4,p4 #g4j 4#e #af4i #ded #ajj ,a4,p4 #c4f 4#b #i4h #beb #ahj ,peppers1 green ,e4,p4 #a4a 4#a #d4f #aji #dag ,persimmons ,e4,p4 4#h 4#g #ca4e #fae #gd ,pies1 apple #c4a #j4h #db4h #abcc #cg custard #d4b #f4c #bf4a #hjf #ef lemon #c4f #aj4a #cg4d #aaef #ci mince #e4h #ab4c #ch4a #acjj #ce squash #d4d #h4d #ba4g #hag #ef ,pineapples1 fresh ,e4,p4 4#d 4#c #i4g #aif #bcb canned ,a4,p4 4#d 4#g #cf4d #fie #fe ,pine nuts 7pignolias7 #cc4i #di4d #f4i #bgeg #af ,pistachios1 shelled #bb4c #ed4j #af4c #bijj #af ,plums ,e4,p4 #a4j -- #bj4a #chc #aah ,a4,p4 4#i -- #ai4a #cfc #abe ,pomegranates ,e4,p4 #a4e #a4f #ai4e #ddg #ajb ,pork chops1 medium ,e4,p4 #af4f #cj4a -- #aecj #cj ,a4,p4 #ac4d #bd4b -- #abcj #cg chuck ribs and shoulder ,e4,p4 #ag4c #ca4a -- #aehe #bi ,a4,p4 #ad4a #be4e -- #abih #ce fat1 salt ,a4,p4 #a4i #hf4b -- #ceee #ac sausage ,a4,p4 #ac4j #dd4b #a4a #bjcj #bb side ,e4,p4 #i4a #ee4c -- #bdbc #ai ,a4,p4 #h4j #di4j -- #bade #ba tenderloin ,a4,p4 #ah4i #ac4j -- #hge #eb ,potato chips ,a4,p4 #f4h #ci4h #df4g #beih #ag ,potatoes1 white1 raw ,e4,p4 #b4b 4#a #ah4d #cgh #abj ,a4,p4 #a4h 4#a #ad4g #cjb #adi sweet1 raw ,e4,p4 #a4h 4#g #bg4d #eeh #ha ,a4,p4 #a4d 4#f #ba4i #ddg #ajb ,prunes1 dried ,e4,p4 #b4a -- #gc4c #acfh #cc ,a4,p4 #a4h -- #fb4b #aafj #ci ,pumpkins ,e4,p4 #a4j 4#a #e4b #aag #chi ,a4,p4 4#e 4#a #b4f #fj #gec ,radishes ,e4,p4 #a4c 4#a #e4h #acc #cda ,a4,p4 4#i 4#a #d4j #ia #dhh ,raisins ,e4,p4 #b4f #c4c #gf4a #aefb #bi ,a4,p4 #b4c #c4j #fh4e #adjg #cb ,raspberries1 red #a4j -- #ab4f #bdg #ahd black #a4g #a4j #ab4f #cjj #aea ,rhubarb ,e4,p4 4#f 4#g #c4f #aje #dcc ,a4,p4 4#d 4#d #b4b #fc #gad ,rice #h4j 4#c #gi4j #aeia #bi ,salmon1 dressed ,a4,p4 #ac4h #h4a -- #ehb #gh whole ,e4,p4 #bb4j #ab4h -- #ibc #di ,a4,p4 #ae4c #h4i -- #fdb #ga ,sausage1 ,bologna ,e4,p4 #ah4g #ag4f 4#c #ajfa #dc ,a4,p4 #ah4b #ai4g -- #aace #dj farmer ,e4,p4 #bi4j #db4j -- #bbdj #bj ,a4,p4 #bg4i #dj4d -- #baef #ba ,shad1 whole ,e4,p4 #ah4h #i4e -- #gbg #fa ,a4,p4 #i4d #d4h -- #cfg #abd roe #bj4i #c4h #b4f #ehb #gh ,shredded wheat #aj4e #a4d #gg4i #affj #bg ,spinach1 fresh ,a4,p4 #b4a 4#c #c4b #aji #dag ,squash ,e4,p4 #a4d 4#e #i4j #bji #bag ,a4,p4 4#g 4#b #d4e #ajc #ddc ,strawberries #a4j 4#f #g4d #afi #bfi ,succotash1 canned #c4f #a4j #ah4f #ddd #ajb ,sugar -- -- #ajj4j #ahae #be ,tomatoes1 fresh ,a4,p4 4#i 4#d #c4i #ajd #dch canned ,a4,p4 #a4b 4#b #d4j #ajc #ddc ,tuna 7tunny fish7 ,e4,p4 #bf4f #aa4d -- #idf #dh ,turkey ,e4,p4 #ba4a #bb4i -- #acbj #cd ,a4,p4 #af4a #ah4d -- #ajdb #dc sandwich1 canned #bj4g #bi4b -- #aefh #bi ,turnips ,e4,p4 #a4c 4#b #h4a #agh #bef ,a4,p4 4#i 4#a #e4g #abd #cfg ,veal1 breast ,e4,p4 #bj4c #aa4j -- #hag #ef ,a4,p4 #ae4c #h4f -- #fbi #gb cutlet ,e4,p4 #bj4c #g4g -- #fhc #ff ,a4,p4 #bj4a #g4e -- #fgj #fh fore quarter ,e4,p4 #bj4j #h4j -- #fij #ff ,a4,p4 #ae4a #f4j -- #eag #hh hind quarter ,e4,p4 #bj4g #h4c -- #gae #fd ,a4,p4 #af4b #f4f -- #ecd #he side ,e4,p4 #bj4b #h4a -- #fig #fe ,a4,p4 #ae4f #f4c -- #eci #hd ,vegetable soup1 canned #b4i -- 4#e #fb #gce ,walnuts1 ,california or ,english ,e4,p4 #ah4d #fd4d #ac4j #caii #ad ,a4,p4 #d4i #ag4c #c4e #hei #ec black ,e4,p4 #bg4f #ef4c #aa4g #cjaa #ae ,a4,p4 #g4b #ad4f #c4j #ghj #ei ,watermelons ,e4,p4 4#d 4#b #f4g #acf #ccb ,a4,p4 4#b 4#a #b4g #eg #hjj ,wheat1 cracked #aa4a #a4g #ge4e #afce #bh ,whitefish ,e4,p4 #bb4i #f4e -- #fhj #fg ,a4,p4 #aj4f #c4j -- #cae #add ,zwieback #i4h #i4i #gc4e #aiae #bd ,,footnotes3 #afe ,courtesy of ,dr4 ,henry ,sherman4 #aff ,the percentages of nutrients are taken from ,bull4 #bh1 ,office of ,experiment ,stations1 ,u4 ,s4 ,department of ,agriculture4 ,the fuel values are calculated from these percentages by the use of the factors explained in ,chapter ,,ii1 viz4--protein1 #d calories2 fat1 #i calories2 carbohydrate1 #d calories per gram4 ,,table ,,ii#afg ,,ash ,,constituents ,,of ,,foods ,,in ,,percentage ,,of ,,the ,,edible ,,portion 7,compiled from various sources7 ,,key3 ,a ,calcium 7,ca7 ,b ,magnesium 7,mg7 ,c ,potassium 7,k7 ,d ,sodium 7,na7 ,e ,phosphorus 7,p7 ,f ,chlorine 7,cl7 ,g ,sulphur 7,s7 ,h ,iron 7,fe7 ,food ,a ,b ,c ,d ,e ,f ,g ,h ---------------------------------------- -------------------------- ,almonds 4#bci 4#bea 4#gda 4#jai 4#dfe 4#jcg 4#afj 4#jjci ,apples 4#jjg 4#jjh 4#abg 4#jaa 4#jab 4#jje 4#jjf 4#jjjc dried 4#jcb 4#jcg 74#fbc774jej7 4#jdh 74#jbe7 8 74#jjae7 ,apricots 4#jad 4#jaj 4#bdh 4#jch 4#jbe 4#jjb 4#jaj 74#jjjc7 dried 74#jff774jdg77a4aeg774agg774aag7 74#jji7 8 74#jjad7 ,asparagus 4#jbe 4#jaa 4#aif 4#jjg 4#jci 4#jci 4#jda 4#jjaj ,bacon 7,see ,meat7 ,bananas 4#jji 4#jbh 4#dja 4#jcd 4#jca 4#abe 4#jaj 4#jjjf ,barley1 entire 4#jdc 4#ada 4#dgg 4#jgf 4#djj 4#jaf 4#aec 4#jjda pearled 4#jbj 74#jgj7 74#bda774jcg7 4#aha 74#jaf774abj774jjbj7 ,beans1 dried 4#afj 4#aef #a4bbi 4#jig 4#dga 4#jcb 4#bae 4#jjgj kidney1 dry 4#acb 4#aci #a4add 4#jda 4#dge 4#jda 4#bbg 4#jjgb ,lima1 dry 4#jga 4#ahh #a4gda 4#bdi 4#cch 4#jbf 4#afa 4#jjgj ,lima1 fresh 4#jbh 74#jgj7 74#fac774jhh7 4#acc 74#jji774jeg7 4#jjbj string1 fresh 4#jdf 4#jbe 4#bd 4#jai 4#jeb 4#jbd 4#jcj 4#jjaa ,beef 7,see ,meat7 ,beer 4#jjd 4#jjh 4#jeh 4#jac 4#jbh 4#jjf 4#jae 4#jjja ,beets 4#jbi 4#jba 4#cec 4#jic 4#jci 4#jeh 4#jaf 4#jjjf ,blackberries 4#jag 4#jba 4#afi 74#jjg7 4#jcd 74#jaj7 4#jbj 4#jjjf ,blood 7avg47 4#jjh 4#jjd 4#jge 4#bfa 4#jca 4#bhj 4#acg 4#jebf ,blueberries 4#jbj 4#jjg 4#jea 4#jaf 4#jjh 4#jjh 4#jaa 4#jjji ,bluefish 7,see ,fish7 ,bread1 ,boston brown 4#abi 4#jgh 74#bcb774cid7 4#ahe 74#fjg7 4#bja 74#jjcj7 entire wheat 74#je7 74#je7 74#bjh774cid774age7 74#fjg774abj774jjaf7 graham 74#je7 74#je7 74#bia774cid774bah7 74#fjg7 4#aej 74#jjbe7 rye 4#jbd 4#jci 4#aea 4#gja 4#adh #a4jbe 4#ajd 74#jjaf7 white 4#jbg 4#jbc 4#ajh 74#cid7 4#jic 74#fjg7 4#aje 4#jjji ,breadfruit 4#jhd 4#jjg 4#bce 4#jbg 4#jfh 4#ajj 4#jdi ,brussels sprouts 4#jbg 4#jdj 4#cge 4#jjd 4#abj 4#jdj 4#aid 74#jjaa7 ,buckwheat flour 4#jci 4#jdh 4#acj 4#jbg 4#bbf 4#jab 4#jga 4#jjab ,butter 4#jae 4#jja 4#jad 74#ghh7 4#jag 7#a4bab774jaj7 4#jjjb ,buttermilk 4#aje 4#jaf 4#aea 4#jfd 4#jig 4#jii 4#jbf 4#jjjbe ,cabbage 4#jde 4#jae 4#bdg 4#jbg 4#jbi 4#jbd 4#jff 4#jjaa ,cabbage greens 4#ajf 4#jcj 4#eab 4#jbe 4#jii 4#jfh 4#agc 4#jjah ,cantaloupe 4#jag 4#jab 4#bce 4#jfa 4#jae 4#jda 4#jad 4#jjjc ,capers 4#abb 4#jbb 4#bji 4#jea 4#jfb -- -- -- ,carp 7,see ,fish7 ,carrots 4#jef 4#jba 4#bhg 4#aja 4#jdf 4#jcf 4#jbb 4#jjjf ,cauliflower 4#abc 4#jad 4#bbb 4#jfh 4#jfa 4#jej 4#jhf 4#jjjf ,caviar 4#acg 4#jbb 4#dbb 4#hgd 4#agf #a4hai -- -- ,celery 4#jgh 4#jad 4#caf 4#jhd 4#jcg 4#aef 4#jbb 4#jjje ,chard 4#aej 4#jga 4#cah 4#jhf 4#jdj 4#jci 4#abd 74#jjbe7 ,cheese 4#ica 4#jcg 4#jhi 4#fjf 4#fhc 4#hhj 4#bfc 4#jjac ,cherries 4#jai 4#jaf 4#bac 4#jbc 4#jca 4#jad 4#jaa 4#jjjd ,cherry juice 4#jag 4#jaa 4#bjj 4#jac 4#jah 4#jjc 4#jjf 74#jjjc7 ,chestnuts 4#jcd 4#jea 4#efj 4#jfe 4#jic 4#jjf 4#jfh 4#jjjg ,chicken 7,see ,meat7 ,chocolate 4#jib 74#bic7 74#efc7 4#jab 4#dee 74#jea7 4#jhe 74#jjbg7 ,cider 4#jjh 4#jaa 4#jie 4#jbj 4#jji 4#jjf 4#jjf 74#jjjb7 ,citron 4#aba 4#jah 4#baj 4#jaa 4#jcc 4#jjc 4#jbj -- ,clams1 round 4#ajf 4#jih 4#aca 4#gje 4#jdf #a4bbj 4#bbd -- soft1 long 4#abd 4#jgi 4#bab 4#ejj 4#abb 4#iaj 4#bac -- ,cocoa 4#aab 4#dbj 4#ijj 4#jei 4#gji 4#jea 4#bjc 4#jjbg ,coconut1 dried 4#jei 4#jei 4#eig 4#jgc 4#aee 4#bci 74#jef7 -- fresh 4#jbd 4#jbj 4#cjj 4#jcf 4#jgd 4#abj 4#jbh -- ,coconut milk 4#jbj 4#jji 4#add -- 4#jaj -- 4#jjh -- ,cod 7,see ,fish7 ,corn 7maize71 mature 4#jbj 4#aba 4#cci 4#jcf 4#bhc 4#jde 4#aea 4#jjbi meal 4#jah 4#jhd 4#bac 4#jci 4#aij 4#adf 4#aaa 4#jjji sweet 4#jjf 4#jcc 4#aac 4#jdj 4#ajc 4#jad 4#jdf 4#jjjh sweet1 dried 4#jba 4#aba 4#dad 4#adf 4#cgf 4#jej 4#afg 4#jjbi ,cotton seed meal 4#bfe 4#dfb #a4cij 4#bcd #a4aic 4#jcg 4#dhe -- ,cowpeas 4#ajj 4#bjh #a4djb 4#afa 4#def 4#jdj 4#bdj -- ,crackers 4#jbb 4#jaa 4#ajj 74#eid7 4#ajb 74#iaj7 4#abe 4#jjae ,cranberries 4#jah 4#jjg 4#jgg 4#jaj 4#jac 4#jji 4#jjg 4#jjjf ,cream 4#jhf 4#jaj 4#abf 4#jce 4#jfg 4#jhj 4#jcj 4#jjjbb ,cucumbers 4#jaf 4#jji 4#adj 4#jaj 4#jcc 4#jcj 4#jbj 4#jjjb ,currants1 dried 4#jhb 4#jdd 4#hgc 4#jha 4#aie 4#jfj 4#jdd 74#jjbe7 fresh 4#jbf 4#jag 4#baa 4#jjg 4#jch 4#jjf 4#jad 4#jjje ,currant juice 4#jba 4#jaj 4#ahe 74#jjf7 4#jah 4#jjd 4#jje -- ,dandelion 4#aje 4#jcf 4#dfa 4#afh 4#jgb 4#jii 4#jag 4#jjbg ,dates 4#jfe 4#jfi 4#faa 4#jee 4#jef 4#bbh 4#jgj 4#jjcj ,duck 7,see ,meat7 ,eggplant 4#jaa 4#jae 74#adj774jaj7 4#jcd 4#jbd 4#jaf 4#jjje ,eggs 4#jfg 4#jaa 4#adj 4#adc 4#ahj 4#ajf 4#aie 4#jjcj ,egg white 4#jae 4#jaj 4#afj 4#aef 4#jad 4#aee 4#baf 4#jjja ,egg yolk 4#acg 4#jaf 4#aae 4#jge 4#ebd 4#jid 4#aff 4#jjhf ,endive 4#ajd 4#jac 4#chj 4#aji 4#jch 4#afg 4#jce -- ,farina 4#jba 4#jbe 4#abj 4#jfe 4#abe 4#jgf 4#aee 4#jjjh ,figs1 dried 4#afb 4#jga 4#ifd 4#jdf 4#aaf 4#jdc 4#jef 4#jjcj fresh 4#jec 4#jbb 4#cjc 4#jab 4#jcf 4#jad 4#jaj -- ,fish#afh ,flaxseed 4#bjd 4#beb 4#ija 4#jej 4#fbg 4#jbb 4#agj -- ,flour1 buckwheat 4#jaj 4#jdh 4#acj 4#jbg 4#agf 4#jab 4#jga 4#jjab entire wheat 4#jca 74#jij7 74#bgd774jcg7 4#bch 74#jgj774ahj7 4#jjbe graham 4#jci 74#acc7 74#deg774jcg7 4#cfd 74#jgj7 4#ahc 4#jjcg white 4#jbj 4#jah 4#aae 4#jfj 4#jib 4#jgd 4#agg 4#jjaj rye 4#jah 4#jha 4#dfc 4#jai 4#bhi 4#jee 4#abc 4#jjac ,fowl 7,see ,meat7 ,gluten feed 4#bdg 4#bba 4#bej 4#dbj 4#edb 4#jij 4#eeh -- ,goose 7,see ,meat7 ,gooseberries 4#jce 4#jad 4#aig 4#jch 4#jca -- 4#jaa 4#jjje ,grapefruit 4#jba 4#jji 4#afa 4#jjd 4#jbj 4#jje 4#jaj 4#jjjc ,grape juice 4#jaa 4#jji 4#ajf 4#jje 4#jaa 4#jjb 4#jji 4#jjjc ,grapes 4#jai 4#jaj 4#aig 4#jae 4#jca 4#jje 4#jbd 4#jjjc ,guava 4#jad 4#jjh 4#chd -- 4#jcj 4#jde -- -- ,haddock 7,see ,fish7 ,halibut 7,see ,fish7 ,ham 7,see ,meat7 ,hazelnuts 4#bhg 4#adj 4#fah 4#jai 4#ced 4#jfg 4#aih 4#jjda ,herring 7,see ,fish7 ,hominy 4#jaa 4#jeh 4#agd 4#jbj 4#add 4#jdf 74#acf774jjji7 ,honey 4#jjd 4#jah 4#chf 4#jja 4#jai 4#jbi 4#jja 4#jjjg ,horseradish 4#jif 4#jci 4#dfh 4#jfb 4#jgf 4#jaf 4#aij -- ,huckleberries 4#jbj 4#jjg 4#jea 4#jaf 4#jjh 4#jjh 4#jaa 4#jjji ,huckleberry wine 4#jji 4#jjd 4#jdb 4#jjf 4#jjd 4#jja 4#jjf -- ,jam#afi ,jelly 4#jad 74#jaj7 74#ajj774jac7 4#jjh 74#jjd774jjg774jjjc7 ,kohl-rabi 4#jgg 4#jcc 4#cgj 4#jej 4#jga 4#jec 4#jeg 4#jjjf ,lamb 7,see ,meat7 ,leeks 4#jeh 4#jad 4#aii 4#jha 4#jjf 4#jbd 4#jgb -- ,lemons 4#jcf 4#jjg 4#age 4#jjd 4#jbb 4#jjb 4#jaa 4#jjjf ,lemon juice 4#jbd 4#jaj 4#abg 4#jji 4#jaj 4#jjc 4#jjf -- ,lemon1 sweet 4#jcj 4#jjf 4#ddb -- 4#jdb 4#jac 4#jaf -- ,lentils1 dry 4#ajg 4#aja 4#hgg 4#jfb 4#dch 4#jej 4#bgg 4#jjhf ,lettuce 4#jdc 4#jag 4#cci 4#jbg 4#jdb 4#jgd 4#jad 4#jjjg ,limes 4#jee 4#jad 4#cej 4#jfb 4#jcf 4#jci 4#jaa -- ,lime juice -- -- -- -- -- -- 4#jjc -- ,linseed meal 4#dac 4#dcb #a4jhc 4#bea 4#gda 4#jhe 4#cif -- ,lupins1 dry 4#aia 4#aia 4#hdj 4#jgc 4#ebj 4#jcd -- -- fresh 4#jec 4#jbb 4#cjc 4#jab 4#jcf 4#jad 4#jaj -- ,macaroni 4#jbb 4#jcg 4#acj 4#jjh 4#add 4#jgc 4#agb 4#jjab ,mackerel 7,see ,fish7 ,mamey 4#jji 4#jab 4#cde -- 4#jbh 4#adj -- -- ,mango 4#jba 4#jjg 4#bce -- 4#jag 4#jai 4#jac -- ,mangolds 4#jbf 4#jcj 4#ccd 4#jga 4#jch 4#jhb 4#jbf -- ,maple syrup 4#ajg 4#jcd 4#bjh 4#jaj 4#jac 74#jaj774jje774jjc7 ,meat#agj ,meat extract1 solid 4#jhe 4#cfc #g4cdg #b4cid #b4hjj #c4aag -- -- ,meat peptone 4#jbe 4#abd #b4ddj 4#fda #a4acj 4#efa 4#bbb -- ,milk 7cow's71 whole 4#abj 4#jab 4#adc 4#jea 4#jic 4#ajf 4#jcd 4#jjjbd skimmed 74#abb774jab7 74#adi774jeb774jif7 74#aaj774jce7 4#jjjbe condensed 74#cjj774jcb7 74#cgd774acd7 4#bce 74#bhj774jij7 4#jjjf buffalo 4#bjc 4#jaf 4#jii 4#jch 4#abe 4#jfb -- -- camel's 4#adc 4#jba 4#aad 4#jai 4#jih 4#aje -- -- goat's 4#abh 4#jac 4#ade 4#jgi 4#ajc 4#jad 4#jcg -- human 4#jcd 4#jje 4#jdg 4#jaj 4#jae 4#jce -- -- mare's 4#jhc 4#jjg 4#jha 4#jaj 4#jed 4#jbi -- -- sheep's 4#bjg 4#jjh 4#ahg 4#jcj 4#abc 4#jga -- -- ,millet 4#jad 4#afg 4#bij 4#jhe 4#cbg 4#jai -- -- ,molasses 4#baa 4#jfh #a4cdi 4#jai 4#jdd 4#cag 4#abi 4#jjgc ,mushrooms 4#jag 4#jaf 4#chd 4#jbg 4#ajh 4#jba 4#jea -- ,muskmelon 4#jag 4#jab 4#bce 4#jfa 4#jae 4#jda 4#jad 4#jjjc ,mustard 4#dib 4#bfj 4#gfa 4#jef 4#gee 4#jaf #a4bcj -- ,mutton 7,see ,meat7 ,oatmeal 4#jfi 4#aaj 4#cdd 4#jfb 4#cib 4#jfi 4#bjb 4#jjch ,okra 4#jga 4#jaj 4#jce 4#jdc 4#jai -- -- -- ,olives 4#abb 4#jjb #a4ebf 4#abh 4#jad 4#jjd 4#jbg 4#jjbi ,onions 4#jcd 4#jaf 4#agh 4#jaf 4#jde 4#jba 4#jgj 4#jjjf ,oranges 4#jde 4#jab 4#agg 4#jab 4#jba 4#jjf 4#jaa 4#jjjb ,orange juice 4#jbi 4#jaa 4#ahb 4#jjh 4#jaf 4#jjc 4#jji 4#jjjb ,oysters 4#jeb 4#jcg 4#jia 4#dei 4#aee 4#eij 4#ahg 4#jjde ,paprika 4#bbi 4#afd #b4jge 4#agh 4#cda 4#aee -- -- ,parsnips 4#jei 4#jcd 4#eah 4#jjd 4#jgf 4#jcj 4#jcf 4#jjjf ,peaches 4#jaf 4#jaj 4#bad 4#jbb 4#jbd 4#jjd 4#jji 4#jjjc dried 4#jcd 4#jef 74#hcj7 4#jhb 4#adf -- 4#bab 74#jjab7 ,peanuts 4#jga 4#ahj 4#fed 4#jej 4#cii 4#jef 4#bbd 4#jjbj ,pears 4#jae 4#jaa 4#acb 4#jaf 4#jbf 4#jaa 4#jaj 4#jjjc ,pear juice 4#jji 4#jjh #a4dj -- 4#jaa -- 4#jji -- ,peas1 dried 4#jhd 4#adi 4#ijc 4#ajd 4#djj 4#jce 4#bai 4#jjeg fresh 4#jbh 4#jch 4#bhe 4#jac 4#abg 4#jbd 4#jfc 4#jjag ,pecan nuts 4#jhi 4#aeb 74#ccb7 -- 4#cce 4#jej 4#aac 4#jjbf ,pepper1 green1 fresh 4#jjf 4#jaj 74#aci7 -- 4#jbf 4#jac 4#jad 4#jjjd ,pepper1 black1 dry 4#ddj 4#aef #a4adj 4#aca 4#ahh 4#cab -- -- ,pepper1 white1 dry 4#dbe 4#aac -- -- 4#bcc 4#jbi -- -- ,perch 7,see ,fish7 ,persimmons 4#jbb 4#jji 4#bib 4#jaa 4#jba 4#jjb 4#jje -- ,pineapple 4#jah 4#jaa 4#cba 4#jaf 4#jbh 4#jea 4#jji 4#jjje ,plums 4#jbj 4#jaa 4#bjc 4#jai 4#jcb 4#jjb 4#jji 4#jjje ,pomegranate 4#jaa 4#jje 4#jfc 4#jhe 4#aje 4#jjc -- 4#jjjd ,pork 7,see ,meat7 ,potatoes 4#jad 4#jbh 4#dbi 4#jba 4#jeh 4#jch 4#jcj 4#jjac sweet 4#jai 4#jbh 4#cig 4#jci 4#jde 4#jid 4#jbd 4#jjje ,prunes1 dried 4#jed 4#jee #a4jcj 4#jfi 4#aje 4#jag 4#jcg 4#jjcj ,pumpkin 4#jbc 4#jjh 74#cbj7 4#jfe 4#jei -- 4#jba 74#jjjh7 ,radishes 4#jba 4#jab 4#bah 4#jfi 4#jbi 4#jed 4#jda 4#jjjf ,raisins 4#jfd 4#jhc 4#hbj 4#acc 4#acb 4#jhb 4#jea 4#jjba ,raspberries 4#jdi 4#jbd 4#agc -- 4#jeb -- 4#jag 4#jjjf ,raspberry juice 4#jba 4#jaf 4#acd 4#jje 4#jab -- 4#jji -- ,rhubarb 4#jdd 4#jag 4#cbe 4#jbe 4#jca 4#jcf 4#jac 4#jjaj ,rice1 brown -- -- -- -- 4#bjg -- -- 4#jjbj white 4#jji 4#jcc 4#jgj 4#jbe 4#jif 4#jed 4#aag 4#jjji ,romaine 7salad7 4#jde 4#jcb 4#cjf 4#jaf 4#jec 4#jgc 4#jai -- ,rutabagas 4#jgd 4#jah 4#cii 4#jhc 4#jef 4#jeh 4#jhc -- ,rye1 entire 4#jee 4#acj 4#dec 4#jce 4#che 4#jbe 4#agj 4#jjci 7,see also ,bread and ,flour7 ,salmon 7,see ,fish7 ,sapota 4#jbf 4#jjh 4#agi -- 4#jjf 4#jhg -- -- ,shredded wheat 4#jda 4#add -- -- 4#cbd -- -- 4#jjde ,shrimp 4#jif -- -- -- -- -- -- -- ,soup1 canned 4#jcf -- 4#jcc -- 4#jcj -- -- -- canned vegetable 4#jbe 4#jac 4#aja -- 4#jch -- 4#jbe -- ,spinach 4#jfg 4#jcg 4#ggd 4#abe 4#jfh 4#jgd 4#jch 4#jjcf ,squash1 summer1 seeds removed 4#jah 4#jjh 4#aej 4#jjb -- -- -- 74#jjjf7 with seeds 4#jbd 4#jab 4#ahj 4#jjd -- -- -- 74#jjjf7 ,squash1 winter 4#jai 4#jaa 4#cbj 4#jjd -- -- -- 74#jjjf7 ,strawberries 4#jda 4#jai 4#adg 4#jej 4#jbh 4#jjf 4#jad 4#jjjh ,tamarind 4#jjg 4#jba -- -- 4#jgb 4#jjg 4#jji -- ,tapioca 4#jbc -- -- -- 4#jij 4#jah 4#jbi 4#jjaf ,tomatoes 4#jaa 4#jaj 4#bge 4#jaj 4#jbf 4#jcd 4#jad 4#jjjd ,tomato juice 4#jjf 4#jaj 4#caj 4#jae 4#jae 4#jee -- -- ,truffles 4#jbd 4#jah 4#djd 4#jgg 4#jfb 4#jci -- -- ,turnips 4#jfd 4#jag 4#cch 4#jef 4#jdf 4#jda 4#jfe 4#jjje ,turnip tops 4#cdg 4#jbh 4#cjg 4#jhb 4#jdi 4#afh 4#jfi -- ,veal 7,see ,meat7 ,vinegar 7cider7 4#jaf 4#jjh 4#afe -- 4#jac -- 4#jag 74#jjjc7 ,walnuts 4#jhi 4#acd 74#ccb7 -- 4#ceh 4#jdj 4#agb 4#jjba ,water cress 4#ahg8 4#jcd 4#bhg 4#jii 4#jje 4#jfa 4#afg 4#jjai ,watermelon 4#jaa 4#jjc 4#jgc 4#jjh 4#jjc 4#jjh 4#jjg -- ,wheat1 entire 4#jde 4#acc 4#dgc 4#jci 4#dbc 4#jfh 4#aha 4#jjej 7,see also ,bread and ,flour7 ,wheat bran 4#abj 4#eaa #a4bag 4#aed #a4bae 4#jij 4#bdg 4#jjgh ,wheat germ 4#jga 4#cdb 4#bif 4#gbb #a4jej 4#jgj 4#cbe -- ,wheat gluten 4#jgh 4#jde 4#jjg 4#jbh #b4jj 4#jej 4#ibj -- ,whey 4#jdd 4#jjh 4#aeg 4#jch 4#jce 4#aai 4#jji 8 ,whortleberries1 entire 4#jca 4#jba 4#bfa 4#jba 4#jdb -- -- -- flesh only 4#jbj 4#jaa 4#jhg -- 4#jah -- -- -- ,wine 7avg47 4#jji 4#jaj 4#ajd 4#jjh 4#jae 4#jaa 4#jae 74#jjjc7 ,,footnotes3 #afg ,from ,sherman's ,chemistry of ,food and ,nutrition1 by courtesy of the author4 #afh ,average fish is estimated to contain per #ajj grams of protein as follows3 #j4aji gram ,ca2 #j4acc gram ,mg2 #a4fga grams ,k2 #j4cgc gram ,na2 #a4adh grams ,p2 #j4ebh gram ,cl2 #a4aai grams ,s2 #j4jjee gram ,fe4 #afi ,the percentages of the ash constituents in jams are believed to average about two thirds those of the corresponding fruits4 #agj ,average meat is estimated to contain per #ajj grams protein as follows3 #j4jeh gram ,ca2 #j4aah gram ,mg2 #a4fid grams ,k2 #j4dba gram ,na2 #a4jgh grams ,p2 #j4cgh gram ,cl2 #a4adf grams ,s2 #j4jaej gram ,fe4 ,,table ,,iii ,showing #ajj-;,calorie ,portions of ,some ,common ,foods--,together with ,their ,protein1 ,nitrogen1 and ,mineral ,content#aga ,,key ,a ,protein ,calories ,b ,protein ,grams ,c ,nitrogen ,grams ,d ,calcium ,grams ,e ,phosphorus ,grams ,f ,iron ,grams ,material ,measure ,a ,b ,c ,d ,e ,f ,portion ---------------------------------------- --------------------------- ,almonds #ab - #ae nuts #ab4i #c4b 4#jea4jcg 4#jgb4jjjf ,apples1 dried #a_/b cup1 #a4b oz4 #b4e 4#f #j4aj 4#ajh 4#afc4jjje ,apples1 fresh #a large apple1 #g4e oz4 #b4d #j4f 4#jif4jab 4#jbj4jjje ,apricots1 dried #i halves1 #a4c oz4 #g4f #a4i #j4cj 4#abc 4#jdd4jjje ,asparagus1 fresh #bj stalks1 #h in4 long1 #ae4i oz4 #cb4d #h4a #a4bi 4#abb 4#agg4jjde ,bacon1 fried #d - #e small slices1 #e oz4 #f4h #a4g 4#bg 4#jja 4#jah4jjjc ,bananas #a large1 #e4e oz4 #e4c #a4c 4#jb 4#jji 4#jca4jjjf ,beans1 ,lima1 dried#b tbs41 #a oz4 #bc4b #e4h 4#ib 4#jbj 4#jif4jjbjj ,beans1 ,lima1 fresh#a_/b cup1 #b4i oz4 #bc #e4g 4#ib 4#jja 4#jjg4jjjaa ,beans1 string #b-a_/b cups1 cut in pieces1 #h4e oz4 #bb4d #e4f 4#hi 4#aaj 4#abf4jjbg ,beans1 white1 dried #b tbs41 #a oz4 #bf4j #f4e #a4d 4#jdg 4#acg4jjbj ,beets #d beets1 #b in4 diam41 #g oz4 #ad4j #c4e #j4ef 4#jfd 4#jhd4jjac ,beef1 round1 lean #a slice1 #c x #c x #a-a_/b in41 #b oz4 #dh4j #ab4j #a4ib 4#jjg 4#abi4jjah ,beef feet slice1 #e x #b-a_/b x #a_/d in41 #a4f oz4 #cj4j #g4e #a4f 4#jjd 4#jha4jjaa ,butter #a 7scant7 tbs41 #j4e oz4 #a4f #j4d 4#jfd4jjb 4#jjb4jjjjc ,cabbage #e cups1 sliced1 #aa4b oz4 #bj4d #e4a #j4hi 4#adc 4#jib4jjce ,carrots #d - #e young car41 #aj4e oz4 #i4f #b4d #j4chd4abd 4#aja4jjac ,cauliflower #a small head1 #aa4e oz4 #bc4f #e4i #j4idd4djc 4#bjj4jjbj ,celery #d cups1 in #a-;in4 pieces #e4b #a4c #j4bj 4#dba 4#bja4jjbg ,clams #f clams1 #a_/b cup1 #g4f oz4 #gi4b #ai4h #c4af 4#bhe 4#bhb4jjig ,cheese1 ,american #a-a_/h in4 cube 7#j4h oz47 #bd4d #f4a #j4ig 4#baa 4#aef4jjjc ,cherries 7stoned7 #a cup1 #d4e oz4 #d4h #a4b #j4ai 4#jbe 4#jci4jjje ,chicken1 lean meat1 roasted #b-a_/b oz4 #gi4f #ai4i #c4ai 4#jjf 4#jge4jjbi ,crackers1 soda #d crackers #i4f #b4d #j4ch 4#jjf 4#jbe4jjjd ,cornmeal #c tbs41 #a oz4 #aj4d #b4f #j4da 4#jje 4#jec4jjjc ,corn #a_/c cup1 #c4f oz4 #ab4d #c4a #j4di 4#jjf 4#ajb4jjjh ,chocolate1 unsweetened #c_/d x #a_/d x #g_/h in4 piece #h4d #b4a #j4cc 4#jae 4#jge4jjjd ,cocoa #c-a_/b tbs41 #j4g oz4#ag4f #d4d #j4di 4#jbc 4#adc4jjje ,cream1 #ah 7thin7 #a_/d cup1 #a4h oz4 #e4b #a4c #i4bj 4#jej 4#jdd4jjja ,cream1 #dj 7thick7#a-a_/c tbs41 #j4i oz4 #b4d #j4f #j4jif4jbj 4#jbj4jjjje ,dates #d-a_/b dates1 #a4a oz4 #b4d #j4f #j4jif4jai 4#jaf4jjji ,eggs #a-a_/c eggs #cf4d #i4a #a4de 4#jde 4#abb4jjba ,egg whites #g whites1 #f4i oz4 #if4dhbd4abc4he 4#jbj 4#jbb4jjjbj ,egg yolks #b yolks1 #a oz4 #ag4bh #d4cb 4#fia4jcf 4#aah4jjbcj ,farina #c tbs41 #a oz4 #ab4d #c4a 4#dif4jjf 4#jce4jjjb ,fish1 lean piece1 #c x #c x #a_/b in41 #b4d oz4 #ij4d #bb4f #c4fa 4#jbe 4#bei4jjab ,fish1 oily #ec4b #ac4c #b4ab 4#jae 4#aec4jjjg ,figs #a-a_/b large figs1 #a4a oz4 #e4f #a4d 4#bbd4jea 4#jcg4jjaj ,flour1 entire wheat #c tbs41 #a oz4 #ae4f #c4i 4#fbd4jji 4#jff4jjjg graham #c tbs41 #a oz4 #ad4h #c4g 4#eib4jaa 4#aja4jjaj rye #c tbs41 #a oz4 #h4j #b4j 4#cb 4#jje 4#jhb4jjjd white #d tbs41 #a oz4 #ab4h #c4b 4#egb4jjf 4#jbf4jjjb ,gelatin #bg grams #ih4h #bd4i #c4ih ,grapefruit #b-c_/d tbs4 #e4jj #a4be 4#jdj 4#jcf4jjjeh ,grapes 7,concord7 #a large bunch1 #e oz4 #e4f #a4d #j4b 4#jai 4#jcb4jjjc ,grape juice #a_/b cup1 #c4f oz4 #a4dj #j4ce 4#je 4#jaa 4#jaa4jjjc ,hominy #c-a_/b tbs41 #a oz4 #i4f #b4d #j4ce 4#jjb 4#jbg4jjjc ,honey #a tbs41 #a4a oz4 4#d #j4a 4#jjb 4#jjf4jjjc ,lamb #a slice1 #c-a_/b x #d-a_/b x #a_/c in41 #a4h oz4 #be4f #f4d #a4jb4jjd 4#jfi4jjaj ,lemons #c large1 #aa4d oz4 #i4b #b4c #j4cf4jha 4#jdi4jjad ,lettuce #b large heads1 #ah4e oz4 #be4b #f4c #a4j 4#bbd 4#bbd4jjgi ,lentils 7dried7 #b-a_/b tbs41 #a oz4 #bi4f #g4d #a4ah 4#jcaa4bf 4#jjbe ,macaroni #a cup #ad4h #c4g #j4ei 4#jjf 4#jdj4jjjc ,milk1 whole #c_/h cup1 #e4a oz4 #ai4b #d4h #j4gf 4#agd 4#acd4jjji skimmed #c_/h cup #cg4b #i4c #a4dh 4#cca 4#bfb4jjjg unsweetened1 canned #c-c_/d tbs41 #b4a oz4#bc4b #e4h #j4ib 4#ahh 4#adf4jjjd sweet1 canned #a-a_/b tbs41 #a4a oz4#aj4d #b4f #j4da 4#jif 4#jgb4jjjb buttermilk #a-a_/h cup1 #aj4j oz4#cc4f #h4d #a4cd 4#bid 4#bga4jjjg ,milk powder#agb #a oz4 malted 7,horlick's7#agca-a_/b tbs41 #a4b oz4 ,molasses ,mutton #a slice1 #c x #c-a_/d x #a_/h inch #bd4h #f4b #j4ii 4#jjd 4#jfg4jjji ,oatmeal #a_/c cup1 #a oz4 #af4h #d4b #j4fg 4#jag 4#jii4jjaj ,onions #c - #d med41 #g4b oz4 #ac4b #c4c #j4eb 4#jfi 4#jic4jjaj ,orange #a large1 #i4e oz4 #f4d #a4f #j4be 4#jhh 4#jdj4jjjd ,oysters 7raw7 #f - #ab oys41 #b_/c cup1 #g4b oz4 #di4b #ab4c #a4jf 4#ajf 4#cjf4jjhi ,parsnip #b medium1 #g4j oz4 #aj4j #b4e #j4dj 4#jia 4#aag4jjji ,peas1 fresh #c_/d cup1 #c4e oz4 #bf4j #f4e #a4jd 4#jbf 4#abj4jjag ,peaches1 fresh #c medium1 #fj4e oz4 #c4h #a4g #j4bg 4#jch 4#jeg4jjjg ,pears #a large1 #f4c oz4 #d4j #a4j #j4af 4#jbd 4#jda4jjje ,peanuts #bj - #bd single1 #j4f oz4 #ah4h #d4g #j4ge 4#jac 4#jgc4jjjdi ,pecans #ab single1 #j4ea oz4 #e4b #a4c #j4b 4#jab 4#jde4jjjd ,pepper 7green7 #ah4j #d4e #j4gb 4#jcd 4#ade4jjbb ,pineapple #b slices #a in4 thick1 #h4b oz4 #c4f #j4i 4#jda 4#jfd4jjab ,plums #c - #d large1 #d4d oz4 #d4h #a4b #j4ai 4#jbd 4#jch4jjjf ,potatoes 7sweet7 #a_/b medium1 #c4f oz4 #f4j #a4e #j4bd 4#jaf 4#jcg4jjjd ,potatoes 7white7 #a medium1 #e4c oz4 #aj4h #b4g #j4dc 4#jaf 4#jfi4jjaf ,prunes #d medium1 #a4d oz4 #b4h #j4g 4#aa 4#jah 4#jce4jjaj ,radishes #cf small1 #ab oz4 #ag4f #d4d #j4g 4#jgc 4#jih4jjba ,rhubarb #d cups1 cut in small pieces1 #ae4c oz4 #aj4d #b4f #j4da 4#ahi 4#acd4jjdc ,rice #c tbs41 #a oz4 #i4b #b4c #j4cf 4#jjd 4#jbg4jjjc ,shredded wheat #a biscuit1 #j4i oz4 #ad4j #c4e #j4ee 4#jaa 4#jhi4jjab ,spinach #c cups1 #ad4g oz4 #ce4b #h4h #a4dj 4#bha 4#bhe4jaej ,squash1 summer #ab4d #c4a #j4di 4#jci 4#jce4jjac winter #ab4d #c4a 4#jch 4#jfi4jjac ,strawberries #a-a_/c cups1 #i4j oz4#aj4bd #b4efj4dj 4#ajd 4#jgb4jjba ,tapioca #c tbs41 #a4j oz4 #j4dd #j4aaj4jag4jjd4jbe 4#jjje ,tomatoes1 fresh #b - #c medium1 #ae4e oz4 #af4j #d4j #j4fd 4#jej4aac 4#jjah canned #a-c_/d cup1 #ae4f oz4 ,turnips #b cups1 cut in cubes1 #ac4j oz4 #ac4b #c4c #j4eb 4#afa4aag 4#jjac ,veal slice1 #b x #b-c_/d inches1 #b4c oz4 #eh4j #ad4e #b4cb 4#jjh4aef 4#jjbb ,walnuts1 ,english #af - #ah nuts1 #j4e oz4 #aj4d #b4f #j4da 4#jac4jae 4#jjjc ,watermelon #aa4g oz4 #e4b #a4c #j4bj 4#jch4jaj 4#jjaj 7edible portion7 ,,footnotes3 #aga ,table compiled from ,chemistry of ,food and ,nutrition1 ,sherman4--,a ,laboratory ,handbook for ,dietetics1 and ,feeding the ,family1 ,rose--and other sources4 #agb ,milk powders now on market are made from skimmed or partially skimmed milk4 #agc ,horlick's malted milk4 ,analysis made in ,horlick's ,laboratories4 ,,table ,,iv ,,composition ,,and ,,fuel ,,value ,,of ,,most ,,of ,,the ,,foods ,,used ,,in ,,the ,,invalid ,,dietary ,all determinations allow #bh4ce grams to the ounce4 ,all calculations are made using the factor #d calories for protein1 #d calories for carbohydrates1 and #i calories for fats4 ,the materials are measured in standard #h-ounce measuring cups1 or tablespoons4 ,the measures are exactly level unless otherwise stated4 ,in calculating beverages containing alcohol1 it is necessary to know the percentage of alcohol contained therein4 ,alcohol has a fuel value of #g calories per gram4 7,whether this heat is available for the needs of the body is still a question47 ,,key ,a ,nitrogen ,gm4 ,b#a ,proteins ,per ,cent ,b#b ,proteins ,gm4 ,c#a ,fats ,per cent ,c#b ,fats ,gm4 ,d#a ,carbohydrates ,per ,cent ,d#b ,carbohydrates ,gm4 ,e ,fuel ,value ,material ,weight ,measure ,a ---------------------------------------- ---------------------------- ,almonds #a_/b oz4 #f 4#dh ,apples #e4e oz4 #a medium 4#ji ,apricots #i halves -- ,arrowroot #a oz4 #h tablespoonfuls -- ,artichoke1 ,french #a oz4 4#ae ,asparagus1 fresh #d oz4 #f stalks 4#cc ,asparagus1 canned #d oz4 #a_/b cup 4#bh ,bacon #a oz4 #b slices 4#ce ,bananas1 ,e4,p4#agd #c-a_/b oz4 #a medium 4#bj ,barley1 pearled #a oz4 #c tablespoonfuls 4#ci ,barley flour #a_/b oz4 #a tablespoonful 4#af ,bass #c oz4 #a serving #b4ec ,beans1 string #c oz4 #a serving 4#ca ,beans1 butter #c oz4 #a serving #a4bf ,beans1 ,lima1 dried #a oz4 4#ha ,beans1 baked1 canned #a oz4 4#ca ,beef broth #a oz4 #b tablespoonfuls #j4a ,beef broth #f oz4 #a cup #j4c ,beef soup#age #f oz4 #a cup #a4ah ,beef juice #a oz4 #b tablespoonfuls 4#bb ,beef marrow #a_/b oz4 #a tablespoonful 4#je ,beefsteak1 porterhouse #c oz4 #a serving #b4ii ,beefsteak1 sirloin #c oz4 #a serving #b4eg ,top of round #c oz4 #a serving #b4fe ,roast beef1 second cut #b oz4 #a slice #a4hd ,roast beef1 second cut #a oz4 #a thin slice 4#ia ,beets1 cooked #a oz4 4#aj ,bluefish #c oz4 #a serving #b4fe ,brandy #a_/b oz4 #a tablespoonful -- ,bran #b-a_/b oz4 #a cup #a4be ,bread #a oz4 #a slice1 #c_/d in4 thick 4#db ,boston brown #a oz4 #a slice 4#bg ,rolls #a oz4 4#da ,whole wheat #a oz4 4#dd ---------------------------------------- ---------------------------- ,b#a ,b#b ,c#a ,c#b ,d#a ,d#b ,e ---------------------------------------- --------------- #ba4j #b4ig #ed4i #g4gh #ag4c #b4de #ib4 #j4d 4#f #j4e 4#gh #ad4b #bb4 #ig4d #e4a #a4i #j4a 4#d #fa4 #bb4e #ajj4 -- -- -- -- #fi4b #ai4f #gh4 #c4d 4#if #j4e 4#ad #ab4 #c4d #ah4g #a4h #b4jd #j4b 4#bc #c4c #c4gd #be4 #a4e #a4g #j4a 4#aa #b4h #c4ag #ba4 #i4 #b4e #eh4 #af4 -- -- #add4 #a4c #a4bi #j4f 4#f #bb4j #ba4hc #ih4 #h4e #b4da #a4a 4#ca #gg4 #bb4 #ajj4 #aj4d 4#ih #b4b 4#ba #gb4f #g4 #cc4 #ah4f #ae4h #b4h #b4cg -- -- #hd4 #b4c #a4ie 4#bf 4#bb #e4a #d4ce #bg4 #i4c #g4i #j4f 4#ea #bi4b #bd4h #ace4 #ah4 #e4a #a4e 4#db #fe4i #ah4g #ii4 #f4i #a4if #b4e 4#ga #ai4f #e4e #cf4 #a4h 4#e #j4a 4#c -- -- #d4g #a4h #c4 #j4a #a4h -- -- #bh4 #d4c #g4d #c4f #f4a #a4a #a4h #ib4 #d4i #a4ci 4#f 4#ag -- -- #f4 #b4b 4#ca #ib4 #ac4 -- -- #aah4 #bb4j #ah4fi #bj4d #ag4ce -- -- #bdj4 #ai4j #af4jh #ah4e #ae4gb -- -- #bje4h #ai4e #af4eh #g4c #f4ba -- -- #ajf4b #bj4b #aa4e #h4d #d4h -- -- #hi4 #bj4a #e4g #h4e #b4d -- -- #dd4 #b4c 4#fe 4#a 4#jc #g4d #b4a #aa4c #ai4f #af4f #a4b #a4 -- -- #ge4 -- -- -- -- -- -- #db4 #aa4j #g4h #b4a #a4e #fa4 #dc4 #bag4 #i4b #b4f #a4c 4#cg #ec4 #ae4 #gc4g #f4 #a4g #f4c #a4gi #ed4 #ae4c #hd4a #i4 #b4ee #c4 4#he #ed4b #ae4d #gi4e #i4g #b4ge 4#i 4#bf #di4g #ad4a #fi4g ---------------------------------------- ---------------- ,material ,weight ,measure ,a ---------------------------------------- ---------------------------- ,bread crumbs #e oz4 #a cup #b4jh ,bread1 graham #a oz4 #a slice 4#dj ,bread1 gluten#agf #a oz4 #a slice1 #a_/b in4 thick #a4cd ,maryland biscuit 7,southern beaten biscuit7 #a oz4 #b small biscuits 4#ch ,butter #a oz4 #b tablespoonfuls 4#jd ,butter #a lb4 #b cups 4#gb ,cabbage #a oz4 4#jg ,carrots #c oz4 #a medium 4#ae ,carrots #a oz4 4#je ,cauliflower #c oz4 #a serving 4#bd ,cauliflower #a oz4 4#jh ,celery #a oz4 #a stalk1 medium sized 4#je ,chard #a oz4 4#ae ,cherries1 fresh #a oz4 4#jd ,chestnuts #a oz4 4#bh ,clam bouillon #a oz4 #b tablespoonfuls 4#ja ,clam bouillon #f oz4 #b_/c cup 4#ja ,cheese1 ,american #a oz4 #b tablespoonfuls1 grated #a4ca ,cottage cheese 7curds7 #a oz4 #b tablespoonfuls 4#ie ,cream cheese 7,neufchatel7 #a oz4 #a_/b block 4#he ,chicken1 broiler1 ,e4,p4 #a oz4 4#ig ,chicken1 broiler1 ,e4,p4 #c oz4 #a serving #b4ib ,chocolate1 unsweetened #a oz4 #a square 4#eh ,cocoa #a oz4 #d tablespoonfuls 4#ih ,cocoa #a_/h oz4 #b teaspoonfuls 7#a serving7 4#ab ,cod1 dressed #a oz4 4#ej ,condensed milk1 sweetened 7,eagle ,brand7 #a oz4 #b tablespoonfuls 4#dj ,condensed milk1 or evaporated1 unsweetened #a_/h oz4 #a teaspoonful 4#jg ,consomme #f oz4 #b_/c cup #a4jf ,corn1 canned #a oz4 #b tablespoonfuls 4#ac ,corn1 green1 ,e4,p4 #a oz4 #b tablespoonfuls 4#ad ,cornmeal1 granular #a oz4 #b tablespoonfuls 4#db ,cornflakes1 toasted #a oz4 4#be ,cornstarch #a oz4 #c tablespoonfuls -- ,crackers1 graham #a_/c oz4 #a cracker 4#ae ,crackers1 water #a_/c oz4 #a cracker 4#ai ,crackers1 oyster #a oz4 4#ea ,cracker crumbs #b-a_/b oz4 #a_/b cup #a4cb ---------------------------------------- ---------------------------- ,b#a ,b#b ,c#a ,c#b ,d#a ,d#b ,e ---------------------------------------- ---------------- #i4c #ac4j #a4b #a4g #ec4 #ge4 #cfg4 #h4h #b4e #a4h 4#ea #eb4 #ad4g #gc4e #bi4e #h4d #a4a 4#c #cj4 #h4e #gj4 #h4d #b4ch #e4f #a4e #fj4 #ag4 #ia4g #a4j 4#bh #he4 #bd4ji -- -- #bah4 #a4j #d4ec #he4 #che4e -- -- #cdhh4 #a4f 4#de #jj4c 4#ji #e4f #a4ei #i4 #a4a 4#ic #jj4d 4#cd #i4c #g4ia #cg4e #a4a 4#ca #jj4d 4#aa #i4c #b4fc #ab4e #a4h #a4ec #jj4e 4#db #d4g #c4ii #be4h #a4h 4#ea #jj4e 4#ad #d4g #a4cc #h4f #a4a 4#ca #jj4a 4#jc #c4c 4#ic #e4b #c4b 4#ia #jj4f 4#ag #e4 #a4da #aj4h #a4 4#bh #jj4h 4#bc #af4g #d4gc #bb4 #f4b #a4gf #e4d #a4ec #db4a #aa4id #fh4f #j4b 4#jeg -- -- #j4b 4#jeg 4#de #j4b 4#cdb -- -- #j4b 4#cdb #c4 #bh4h #h4af #ce4i #aj4ah #j4c 4#ji #abd4f #bj4i #e4ib #a4j 4#bh #d4c #a4bb #ca4 #ah4g #e4bd #bg4d #g4gg #a4e 4#db #ic4 #bj4g #e4h #h4c #b4ce -- -- #dd4ce #bj4g #ag4d #h4c #g4je -- -- #acc4 #ab4i #c4fe #dh4g #ac4h #cj4c #h4ei #agc4 #ba4f #f4ab #bh4i #h4ai #cg4g #aj4fi #ada4 #ba4f 4#gf #bh4i #a4jb #cg4g #a4cc #ag4f #aa4 #c4ab #j4b 4#jf -- -- #ac4 #h4h #b4di #h4c #b4ce #ec4i #ae4c #ib4 #g4e 4#bg #h4c 4#bi #i4g 4#cd #e4 #b4e #d4be -- -- #j4d 4#fh #ai4g #b4h 4#gi #a4b 4#cd #ai4 #e4ci #bh4 #c4a 4#hh #a4a 4#ca #ai4g #e4eh #bh4f #i4c #b4fc #a4i 4#ed #ge4e #ba4d #aja4 #e4e #a4ef #a4e 4#dc #ha4b #bc4 #ajb4a -- -- -- -- #hi4a #be4be #aja4 #aj4 4#id #i4c 4#hh #gc4h #f4ig #ci4e #aa4g 4#gg #e4 4#dg #ge4g #g4 #ce4c #aa4c #c4b #aj4e #b4ih #gj4e #ai4ih #aai4e #aa4f #g4h #f4 #d4c #gb4i #ea4g #bgf4g ---------------------------------------- ---------------- ,material ,weight ,measure ,a ---------------------------------------- ---------------------------- ,cranberries #a oz4 #b tablespoonfuls 4#jb ,cream1 #ah 7single ,x7 #a oz4 #b tablespoonfuls 4#ac ,cream1 #dj 7double ,x7 #a oz4 #b tablespoonfuls 4#aj ,cucumber1 ,e4,p4 #a oz4 4#jd ,currants1 dried #a oz4 #b tablespoonfuls 4#aa ,dates1 dried #a4a oz4 #d-a_/b 4#ji ,dry peptonoids #a oz4 #b tablespoonfuls 4#if ,eggs1 whole1 without #a4h oz4 or shell #e gms4 #a medium sized #a4 ,egg white #a4b oz4 #a white 7#cd gm4 wt47 4#fg ,egg yolk 4#f oz4 #a yolk 7#ag gm4 wt47 4#dc ,eggplant #a oz4 4#je ,farina #a oz4 #c tablespoonfuls 4#ej ,figs1 dried #a oz4 #a fig 4#ai ,fish #a oz4 4#hd ,flour1 barley #a oz4 #b tablespoonfuls 4#df ,flour1 gum gluten #a oz4 #c tablespoonfuls #a4fe ,flour1 graham #a oz4 #c tablespoonfuls 4#fj ,flour1 wheat #a oz4 #c tablespoonfuls 4#ea ,flour1 wheat #a_/c oz4 #a tablespoonful 4#ag ,flour1 entire wheat #a oz4 #c tablespoonfuls 4#fc ,fowl1 ,e4,p4 #a oz4 4#hh ,fowl1 ,e4,p4 #c-a_/b oz4 #a serving #c4ji ,gelatin1 granulated #a oz4 #d4ae ,gelatin1 granulated #a_/d oz4 #a tablespoonful #a4jd ,gum gluten bread #a oz4 #a slice #a4cd ,gum gluten biscuit #a_/d oz4 #a biscuit 4#dg ,greens 7,a4,p471 beet tops #d oz4 4#ch ,greens1 cooked #d oz4 #a serving 4#cg ,grapes1 malaga #b oz4 about #ab grapes 4#ab ,grapes1 malaga #a lb4 4#ie ,grapefruit #a oz4 -- ,grape juice #a oz4 #b tablespoonfuls -- ,grape juice #d oz4 #a_/b cupful -- ,halibut 7,e4,p47 steak #c oz4 #a serving #b4ec ,ham1 lean1 smoked1 ,e4,p4 #a-a_/b oz4 #a serving 7#a slice7 #a4ce ,ham1 medium fat1 smoked #a oz4 #a slice 4#gd ,hominy #a oz4 #b tablespoonfuls 4#ch ,hickory nuts1 shelled #a oz4 #b tablespoonfuls 4#gj ,honey #a oz4 #b tablespoonfuls 4#jb ---------------------------------------- ---------------------------- ,b#a ,b#b ,c#a ,c#b ,d#a ,d#b ,e ---------------------------------------- ---------------- #j4d 4#aa #j4f 4#ag #aj4j #b4h #ac4 #c4 4#h #ai4g #e4f #d4i #a4d #ei4 #b4b 4#fb #dj4 #aa4cd #c4 4#he #ajh4 #j4h 4#bc #j4b 4#jf #c4a 4#hh #e4 #b4d 4#fh #a4g 4#dh #gd4b #ba4jd #ia4 #b4j 4#eg #b4h 4#gi #gh4d #bb4b #g4e #ba4a #f4 -- -- #bh4b #h4 #ef4 #ac4d #f4h #aj4e #e4cf -- -- #ge4 #ab4c #d4ah 4#b #j4jg -- -- #ag4 #ae4g #b4fg #ca4j #e4bg -- -- #eh4 #a4b 4#cd 4#c 4#ji #e4a #a4de #h4 #aa4j #c4aa #a4d 4#ci #gf4d #ba4fe #ajc4 #d4c #a4ba #j4c 4#ji #gd4a #ba4 #hi4f #ah4 #e4bd #a4d 4#d -- -- #bd4f #aj4b #b4i #b4b 4#fb #gb4g #bj4f #ii4g #cf4c #aj4c #a4c 4#cf #cf4i #aj4dd #hf4b #ac4c #c4gg #b4b 4#fb #ga4d #bj4bd #aja4f #aa4b #c4ah #a4j 4#bh #ge4b #ba4ca #ajj4e #aa4b #a4jf #a4j 4#ji #ge4b #g4a #cc4e #ac4h #c4ia #a4i 4#ec #ga4i #bj4ch #ajb4 #ai4c #e4dg #af4c #d4fe -- -- #fc4e #ai4c #ai4 #af4c #af4c -- -- #bbb4 #ia4d #be4ia #j4a 4#jbh -- -- #ajc4h #ia4d #f4dg #j4a 4#jjg -- -- #be4i #bi4g #h4d #a4a 4#cj #cj4j #h4e #gj4c #da4i #b4i #a4h 4#ac #dd4d #c4ae #be4d #b4a #b4d #c4c #c4g #c4b #c4f #eg4 #b4j #b4c #j4c 4#c #c4b #c4f #bf4c #a4c 4#gd #a4f 4#i #ai4b #aj4hh #ed4e #a4c #e4i #a4f #g4b #ai4b #hg4jd #dcf4 4#f 4#ag 4#a 4#jc #ab4b #c4df #ad4h -- -- -- -- #be4j #g4ji #bh4c -- -- -- -- #be4j #bh4cf #aac4d #ah4f #ae4ha #e4b #d4db -- -- #ajc4 #ai4h #h4da #ba4j #h4ic -- -- #aad4 #af4c #d4fb #ch4h #aa4 -- -- #aag4e #h4c #b4ce #j4f 4#ag #gi4j #bb4ci #ajj4e #ae4d #d4cf #fg4a #ai4 #aa4d #c4bc #bja4c #j4d 4#aa -- -- #ha4c #bc4jd #ib4f ---------------------------------------- ---------------- ,material ,weight ,measure ,a ---------------------------------------- ---------------------------- ,jell-,o #c4e oz4 #a box #a4gi ,jell-,o 4#f oz4 #a serving 4#cj ,kohl-rabi #a oz4 4#ji ,koumiss #a litre #ajjj c4c4 #d4ja ,koumiss #d oz4 #a_/b glassful 4#ea ,lactose 7sugar of milk7 #ajj carbohydrates #a oz4 #b tablespoonfuls -- ,lady fingers #a_/b oz4 #c lady fingers 4#bj ,lamb chops1 broiled #c oz4 #b chops1 medium size #b4ie ,lamb1 leg1 roasted #a oz4 #a serving 7small7 -- ,lard #a oz4 #b tablespoonfuls -- ,lemon juice 7#a lemon7 #a-a_/b oz4 #c tablespoonfuls -- ,lemon juice #a oz4 #b tablespoonfuls -- ,lettuce #h oz4 #a head 4#dd ,lettuce #b oz4 #a serving 7#a_/d head7 4#aa ,liver #a oz4 -- ,liquid peptonoids #a oz4 #b tablespoonfuls 4#bf ,lentils #a oz4 #b tablespoonfuls #a4ag ,lobster #b oz4 #a serving #a4ge ,macaroni #d oz4 #a_/b cupful #b4dc ,mackerel1 fresh1 ,e4,p4 #c oz4 #a serving #b4ed ,mackerel1 salt dressed1 ,e4,p4 #b oz4 #a serving 7small7 #a4eg ,malted milk 7,horlick's7 #a_/b oz4 #a tablespoonful 4#cg ,milk 7whole7 #a oz4 #b tablespoonfuls 4#ae ,milk 7whole7 #h oz4 #a glassful #a4bj ,milk 7skimmed7 #a oz4 #b tablespoonfuls 4#ae ,milk1 dried 7whole7 #a oz4 #b tablespoonfuls #a4a ,milk1 dried 7skim7 #a oz4 #b tablespoonfuls #a4e ,molasses1 cane #a oz4 #b tablespoonfuls 4#aa ,mushrooms #a oz4 -- ,muskmelons #h oz4 #a_/b small melon 4#bb ,noodles 7gluten7 #b oz4 #c_/d cupful #b4je ,oatmeal #a_/b oz4 #a tablespoonful 4#ch ,oatmeal gruel #d oz4 #a_/b cupful 4#ba ,oats1 rolled #a oz4 4#gf ,okra #a oz4 4#jg ,olives #a_/b oz4 #c medium sized 4#jb ,olive oil #a oz4 #b tablespoonfuls -- ---------------------------------------- ---------------------------- ,b#a ,b#b ,c#a ,c#b ,d#a ,d#b ,e ---------------------------------------- ---------------- #aa4b #aa4 -- -- #hf4d #hf4 #chh4 #aa4b #a4i -- -- #hf4d #ad4g #ff4 #b4 4#ef 4#a 4#jc #e4e #a4ef #h4h #b4h #be4d #b4a #ai4e #e4d #dh4i #dgc4 #b4h #c4ag #b4a #b4ch #e4d #f4ab #eh4e -- -- -- -- #ajj4j #bh4ce #aac4d #h4g #a4bc #e4 4#gj #gj4e #aj4 #ea4b #ba4h #ah4ed #cj4 #be4ea -- -- #cjc4g #ai4g #e4eh #ab4g #c4f -- -- #ed4g -- -- #ajj4j #bh4ce -- -- #bee4a -- -- -- -- #i4g #d4ab #af4d -- -- -- -- #i4h #b4gg #aa4 #a4b #b4gb #j4c 4#fh #b4i #d4eb #ce4 #a4b 4#fh #j4c 4#ag #b4j #a4ac #h4gg #bj4d #e4gh #d4e #a4bh #a4g 4#dh #cf4e #e4f #a4f -- -- #ad4h #d4b #bc4 #be4g #g4bi #a4j 4#bh #ei4b #af4gh #ih4h #ah4a #aj4bf #a4a 4#fb #j4e 4#bh #dh4 #ac4d #ae4bj #j4i #a4j #gd4a #hd4 #djf4 #ah4g #ae4ij #g4a #f4jc -- -- #aag4h #ag4c #i4h #bf4c #ad4he -- -- #agc4 #af4b #b4c #h4e #a4b #fg4 #i4e #eh4 #c4c 4#id #d4j #a4ac #e4j #a4da #ai4f #c4c #g4eb #d4j #i4jd #e4j #aa4bh #aef4h #c4d 4#if #j4c 4#ji #e4a #a4de #aj4d #bd4c #f4hi #bh4e #h4jh #cf4h #aj4dc #adb4 #cc4i #i4f #a4 4#bh #ee4 #ae4f #ajc4c #b4d 4#fh -- -- #fi4c #ai4fe #ha4c #c4e 4#ii 4#d 4#aa #f4h #a4ic #ab4g #j4f #a4cf -- -- #i4c #ba4 #hi4dd #de4 #be4e #d4a #b4c #cb4e #ah4d #aif4d #af4a #b4c #g4b #a4 #fg4e #i4e #ef4d #a4a #a4c #j4d 4#de #j4f #g4c #ch4d #af4g #d4gc #g4c #b4jg #ff4b #ah4gg #aab4f #a4f 4#de 4#b 4#jf #g4d #b4a #aj4gd #a4a 4#ae #bg4f #c4ia #aa4f #a4fd #db4d -- -- #ajj4 #bh4ce -- -- #bee4a ---------------------------------------- ---------------- ,material ,weight ,measure ,a ---------------------------------------- ---------------------------- ,onion #b oz4 #a medium sized 4#jg ,orange #e oz4 #a medium sized 4#ag ,orange 7juice7 #a oz4 #b tablespoonfuls -- ,oysters #a oz4 #c small 4#bh ,panopepton #a oz4 #b tablespoonfuls 4#cb ,parsnips #a oz4 #a medium size -- ,peaches1 ,e4,p4 7fresh7 #c oz4 #a medium size 4#aj ,peaches1 canned #c oz4 #a serving 4#aj ,peanut butter #a oz4 #b tablespoonfuls #a4cc ,peanuts1 shelled #b-a_/b oz4 #a_/b cupful #c4cb ,pears1 fresh #c oz4 #a medium size 4#jh ,pears1 canned #c oz4 #a serving 4#jd ,peas1 green1 fresh1 ,e4,p4 #c oz4 #a serving1 about #a_/b cup 4#ie ,peas1 canned #d oz4 #a_/b cup 4#fe ,peas 7dried1 split peas7 #a oz4 #c tablespoonfuls #a4ab ,peppers1 green #a oz4 4#je ,pineapple 7canned7 #c oz4 #a thick slice 4#jg ,pineapple 7fresh1 ,e4,p47 #c oz4 #a serving 4#je ,pecans1 shelled #b-a_/b oz4 #a_/b cup 4#eh ,plums #a oz4 4#jd ,port wine 7#aj alcohol7 #a_/b oz4 #a tablespoonful -- ,potatoes1 white1 raw #c oz4 #a medium size 4#cj ,potatoes1 sweet1 raw #d oz4 #a medium size 4#cj ,prunes1 ,a4,p4 #a oz4 #c prunes 4#jh ,prunes1 ,e4,p4 #d oz4 #a cupful 4#ch ,quail #c-a_/b oz4 #a_/b quail1 #a serving #a4jj ,raisins #a oz4 #c dozen 4#ab ,raspberries1 black1 fresh #a oz4 #c tablespoonfuls 4#jh ,raspberry juice1 fresh #d oz4 #a_/b cup -- ,rhubarb1 fresh1 ,e4,p4 #a oz4 4#jc ,rice #a oz4 #b tablespoonfuls1 #a serving 4#cf ,rum #a oz4 #b tablespoonfuls -- ,salmon1 canned #a oz4 4#ii ,salmon1 canned #a lb4 #a can #ae4hb ,saltines 7crackers7 #a oz4 4#dh ,saltines 7crackers7 #a lb4 #a box #g4fh ,sardines1 canned #a oz4 #a small serving #a4jh ---------------------------------------- ---------------------------- ,b#a ,b#b ,c#a ,c#b ,d#a ,d#b ,e ---------------------------------------- ---------------- #a4f 4#i #j4c 4#ag #i4i #e4f #bg4e #j4f 4#he #j4a 4#ad #h4e #ab4je #ec4 -- -- -- -- #aa4c #c4b #ab4h #f4b #a4ge #a4b 4#cd #c4g #a4jd #ad4b #g4a #b4 -- -- #ag4c #e4 #bh4 #j4a 4#jc 4#e 4#ad #ac4e #c4hc #af4gj #j4g 4#fj #j4a 4#ji #i4d #g4ii #ce4a #j4g 4#fj #j4a 4#ji #aj4h #i4ah #ci4i #bi4c #h4ca #df4f #ac4bj #ag4a #d4he #aea4d #bi4c #bj4gg #df4e #cc4 #e4h #d4ab #cif4e #j4f 4#ea #j4e 4#db #ad4a #ab4 #ec4h #j4c 4#bf #j4c 4#bf #ah4a #ab4d #ec4 #g4 #e4ie 4#e 4#db #af4i #ad4cg #he4 #c4f #d4jh #j4b 4#bc #i4h #aa4aa #fb4h #bd4f #f4ig #a4j 4#bh #fb4j #ag4eg #ajj4g #a4a 4#ca #j4a 4#jc #d4f #a4c #f4ga #j4e 4#d #j4g 4#f #cf4d #ca4 #aca4 #j4d 4#cd #j4c 4#bf #i4g #h4be #cf4g #i4f #f4h #gj4e #ej4j #ae4 #aj4f #eai4f #a4 4#bh -- -- #bj4a #e4g #bc4i -- -- -- -- -- -- #aj4 #b4b #a4hg #j4a 4#ji #ah4d #ae4fe #gj4i #a4h #b4jd #j4g 4#gi #bg4d #ca4jg #aci4f #a4h 4#ea -- -- #fb4b #ag4fc #gb4f #b4a #b4ch -- -- #gc4c #hc4ab #cdb4 #ba4 #bj4c #h4 #g4i -- -- #aeb4c #b4f 4#gd #c4c 4#id #gf4a #ba4eg #ig4g #a4g 4#dh #a4j 4#bh #ab4f #c4eg #ah4g -- -- -- -- #aj4j #aa4c #de4b #j4f 4#ag #j4g 4#bj #c4f #a4jb #f4f #g4i #b4bf #j4c 4#ji #gi4j #bb4ci #ii4ce -- -- -- -- -- -- #gf4 #bb4 #f4bd #ab4h #c4fc -- -- #eg4f #bb4 #ii4h #ab4h #eg4f -- -- #ibb4 #aj4f #c4 #ab4g #c4f #fh4e #ai4db #abc4 #aj4f #dh4 #ab4g #eg4f #fh4e #caj4g #aifh4 #bc4 #f4gb #ai4g #e4eh -- -- #gg4 ---------------------------------------- ---------------- ,material ,weight ,measure ,a ---------------------------------------- ---------------------------- ,shad #c oz4 #a serving #a4if ,shad roe #a oz4 #a small serving 4#ie ,sherry wine #a oz4 #b tablespoonfuls -- ,spinach #d oz4 #a_/b cup 4#ch ,squab #b-a_/b oz4 #a_/b squab #a4hf ,squash #c oz4 #a serving 4#aj ,strawberries #c oz4 #a serving1 about #a_/b cup 4#ac ,strawberry juice #d oz4 #a_/b cup -- ,suet #a oz4 #b tablespoonfuls 4#ba ,sugar 7granulated7 #a oz4 #b tablespoonfuls -- ,sugar 7loaf7 #a_/b oz4 #a lump -- ,sugar 7powdered7 #a_/c oz4 #a tablespoonful -- ,sweetbreads #c-a_/b oz4 #a serving #b4bh ,sweetbreads #h oz4 #a set #f4jh ,tapioca #a oz4 #b tablespoonfuls 4#jb ,tapioca 7minute7 #a oz4 #b tablespoonfuls 4#jb ,toast #a oz4 #a thick slice 4#eb ,tomatoes 7fresh7 #e oz4 #a whole tomato 4#jg ,tomatoes 7canned7 #a oz4 #b tablespoonfuls 4#je ,trout #c oz4 #a serving #b4df ,trout #a oz4 4#hb ,turnips 7fresh7 #c oz4 #a serving 4#ah ,turkey #b-a_/b oz4 #a serving 7#b slices7 #b4ci ,turkey #a oz4 4#if ,veal cutlet #a oz4 -- ,walnuts #a oz4 4#hd ,walnuts #e-a_/b oz4 #a cupful #d4ei ,watermelon1 ,e4,p4 #a oz4 4#jb ,wheat 7shredded7 #a oz4 #a biscuit 4#ee ,wheat flakes #a oz4 #a cupful 7about7 4#fa ,whey #f oz4 #a cup 7scant7 4#bg ,whitefish1 ,e4,p4 #a oz4 #a_/c serving #a4jd ,zwieback #a oz4 #c small slices 4#dd ---------------------------------------- ---------------------------- ,b#a ,b#b ,c#a ,c#b ,d#a ,d#b ,e ---------------------------------------- ---------------- #ah4h #aa4 #i4e #h4jg -- -- #aaf4f #bj4i #e4ib #c4h #a4jh #b4f 4#gc #cf4c -- -- -- -- -- -- #bh4 #b4a #b4ch 4#c 4#cd #c4b #c4fc #bg4 #af4c #aa4e #cf4b #be4fe -- -- #bgg4 #j4g 4#fj #j4b 4#ag #d4e #c4hc #ah4c #a4j 4#he #j4f 4#ea #g4d #f4bi #cc4 -- -- -- -- #d4h #e4d #bb4 #d4g #a4cc #hb4 #bc4ai -- -- #bae4 -- -- -- -- #ajj4j #bh4ce #aac4d -- -- -- -- #ajj4j #g4a #bh4d -- -- -- -- #ajj4j #i4de #cg4h #af4g #af4de #ab4a #ab4 -- -- #agc4h #af4g #ch4 #ab4a #bg4d -- -- #cih4f #j4d 4#aa #j4a 4#jc #hh4 #bd4ie #ajj4e #j4d 4#aa #j4a 4#jc #hh4 #bd4ie #ajj4e #aa4e #c4bf #a4f 4#de #fa4b #ag4ce #hf4e #j4i #a4bg #j4d 4#eg #c4i #e4e #cb4 #a4b 4#cd #j4b 4#jf #d4 #a4ac #f4d #ah4 #ae4c #aj4c #h4gf -- -- #adj4 #ah4 #e4a #aj4c #b4ib -- -- #df4g #a4c #a4aa #j4b 4#ag #h4a #f4i #cc4f #ba4a #ad4id #bb4i #af4bb -- -- #bjf4 #ba4a #e4ih #bb4i #f4di -- -- #hb4d #bj4c #e4ge #g4g #b4ah -- -- #db4f #ah4d #e4bb #fd4d #ah4bf #ac4j #c4gi #bjj4 #ah4d #bh4ga #fd4d #ajj4dc #ac4j #bj4hd #aajj4 4#d 4#aa 4#b 4#jf #f4g #a4i #h4eh #aj4e #b4ih #a4d 4#d #gh4 #bb4 #ajc4e #ac4d #c4h #a4d 4#ci #gd4c #ba4jf #ajc4 #a4j #a4gj #j4c 4#ea #e4 #h4e #de4d #bb4i #f4e #f4e #a4hd -- -- #db4ef #i4h #b4gg #a4j #b4hj #gc4e #bj4hc #aai4f ---------------------------------------- ---------------- ,,footnotes3 #agd ,edible portion4 #age ,beef soup is not so thoroughly strained or so well skimmed as broth4 #agf ,gum gluten has a smaller percentage of starch than ordinary gluten flour4 ,,table ,v#agg ,,vitamines ,,in ,,foods ,foodstuff ,a ,b ,c ---------------------------------------- ------------------ ,meats3 ,beef heart 8 ,brains 8 ,codfish 8 ,cod testes ,fish roe 8 ,herring 8 ,horse meat ,kidney ,lean muscle #j #j 8 ,liver 8 ,pancreas #j ,pig heart 8 ,placenta ,thymus 7sweetbreads7 #j #j #j ,vegetables3 ,beetroot ,beet root juice 8 ,little ,cabbage1 dried ,cabbage1 fresh ,carrots ,cauliflower ,celery 8 8 ,chard 8 ,dasheens 8 ,lettuce ,mangels 8 ,onions 8 ,parsnips ,peas 7fresh7 ,potatoes #j ,potatoes 7sweet7 8 ,rutabaga ,spinach ,cereals3 ,barley 8 ,bread 7white7 8 ,bread 7whole meal7 8 ,maize ,in yellow 8 #j ,in white ,oats #j ,rice 7polished7 #j #j #j ,rice 7whole grain7 #j ,rye #j ,corn embryo ,corn 7kaffir7 ,corn 7see maize7 ,corn pollen ,malt extract #j #j #j ,wheat bran #j #j ,wheat embryo #j ,wheat endosperm #j #j #j ,wheat kernel #j ,other seeds3 ,beans1 kidney ,beans1 navy #j ,beans1 soy #j ,cotton seed ,flaxseed ,hemp seed ,millet seed ,peanuts ,peas 7dry7 8 #j ,sunflower seeds ,fruits3 ,apples ,bananas 8 ,grapefruit ,grape juice ,grapes #j ,lemons ,limes ,oranges ,pears ,raisins ,tomatoes ,oils and fats3 ,almond oil #j #j ,beef fat #j #j ,butter #j #j ,cocoanut oil #j #j #j ,cod liver oil #j #j ,corn oil #j #j #j ,cotton seed oil #j 8 #j #j ,egg yolk fat #j #j ,fish oils #j #j ,lard #j 8 #j #j ,oleo1 animal #j #j ,oleo1 vegetable #j #j #j ,olive oil #j #j #j ,pork fat #j 8 #j ,tallow #j #j #j ,vegetable oils #j 8 #j #j ,nuts3 ,almonds ,brazil nut ,chestnut ,cocoanut ,english walnuts ,filbert ,hickory ,pine ,dairy products3 ,butter #j #j ,cheese 8 ,condensed milk #j ,cream 8 ,eggs #j ,milk powder 7skim7 8 ,milk powder 7whole7 8 ,milk whole ,whey ,miscellaneous3 ,alfalfa 8 ,blood ,varies with source ,clover 8 ,honey #j ,malt extract #j #j #j ,nectar #j #j #j ,timothy ,yeast1 brewers' #j #j ,yeast cakes #j #j ,yeast extract #j #j ,table ,v taken from ,the ,vitamine ,manual1 by ,walter ,s4 ,eddy1 published by ,williams ,wilkins ,co41 ,baltimore1 ,md4 ,,footnote3 #agg ,courtesy of ,dr4 ,walter ,s4 ,eddy4 ,,heights ,,and ,,weights ,,for ,,children ,,under ,,five ,,years ,,of ,,age 7,based on ,data ,published by the ,children's ,bureau1 ,u4 ,s4 ,department of ,labor7 ,,boys ,,girls ,age ---------------------------------------- ,height ,weight ,height ,weight ,inches ,pounds ,inches ,pounds ---------------------------------------- ---------- ,birth #bj4f #g4f #bj4e #g4b #c mo4 #bc4e #ac4j -- -- #f mo4 #bf4e #ah4j #be4i #af4h #i mo4 #bh4a #bj4d #bf4f #ai4a #ab mo4 #bi4d #ba4i #bh4i #bj4h #ae mo4 #cj4h #bc4f #cj4a #ba4i #ah mo4 #ca4h #bd4f #ca4a #bc4d #ba mo4 #cb4i #be4h #cb4c #bd4h #bd mo4 #cc4h #bg4a #cc4d #bf4d #bg mo4 #cd4h #bi4j #cc4i #bg4c #cj mo4 #ce4d #bi4e #cd4i #bh4c #cc mo4 #cf4a #cj4f #ce4f #bi4a #cf mo4 #cg4a #cb4c #cf4h #cj4e #ci mo4 #cg4i #cc4a #cg4c #ca4f #db mo4 #ch4f #cc4h #ch4j #cb4e #de mo4 #ci4j #cd4e #ch4e #cc4c #dh mo4 #ci4e #ce4i #ci4j #cc4h #e years #da4f #da4d #da4c #ci4g ,,height ,,and ,,weight ,,table ,,for ,,boys ,h ,i #e #f #g #h #i #aj #aa #ab #ac #ad #ae #af #ag #ah e n i c ,y ,y ,y ,y ,y ,y ,y ,y ,y ,y ,y ,y ,y ,y g h r r r r r r r r r r r r r r h e s s s s s s s s s s s s s s t s 4 4 4 4 4 4 4 4 4 4 4 4 4 4 ---------------------------------------- ------------------- #ci #ce #cf #cg #dj #cg #ch #ci #da #ci #dj #da #db #da #db #dc #dd #dc #dc #dd #de #df #dd #de #df #df #dg #de #dg #dg #dh #dh #di #df #dh #di #ej #ej #ea #dg #ea #eb #eb #ec #ed #dh #ec #ed #ee #ee #ef #eg #di #ee #ef #eg #eh #eh #ei #ej #eh #ei #fj #fj #fa #fb #ea #fj #fa #fb #fc #fd #fe #eb #fb #fc #fd #fe #fg #fh #ec #ff #fg #fh #fi #gj #ga #ed #fi #gj #ga #gb #gc #gd #ee #gc #gd #ge #gf #gg #gh #ef #gg #gh #gi #hj #ha #hb #eg #ha #hb #hc #hd #he #hf #eh #hd #he #hf #hg #hh #ij #ia #ei #hg #hh #hi #ij #ib #id #if #ig #fj #ia #ib #ic #id #ig #ii #aja #ajb #fa #ie #ig #ii #ajb #ajd #ajf #ajh #aaj #fb #ajj #ajb #ajd #ajf #aji #aaa #aac #aaf #fc #aje #ajg #aji #aaa #aad #aae #aag #aai #fd #aac #aae #aag #aah #aai #abj #abb #fe #abj #abb #abc #abd #abe #abf #ff #abe #abf #abg #abh #abi #acj #fg #acj #acj #acb #acc #acd #ace #fh #acd #ace #acf #acg #ach #aci #fi #ach #aci #adj #ada #adb #adc #gj #adb #add #ade #adf #adg #ga #adg #adi #aej #aea #aeb #gb #aeb #aed #aee #aef #aeg #gc #aeg #aei #afj #afa #afb #gd #afb #afd #afe #aff #afg #ge #afi #agj #aga #agb #gf #agd #age #agf #agg ,prepared by ,dr4 ,thomas ,d4 ,wood ,,about ,,what ,a ,,boy ,,should ,,gain ,,each ,,month ,age #e to #h #f oz4 #h to #ab #h oz4 #ab to #af #af oz4 #af to #ah #h oz4 ,weight and measures should be taken without shoes1 and in only the usual indoor clothes4 ,courtesy of ,child ,health ,organization of ,america ,,height ,,and ,,weight ,,table ,,for ,,girls ,h ,i #e #f #g #h #i #aj #aa #ab #ac #ad #ae #af #ag #ah e n i c ,y ,y ,y ,y ,y ,y ,y ,y ,y ,y ,y ,y ,y ,y g h r r r r r r r r r r r r r r h e s s s s s s s s s s s s s s t s 4 4 4 4 4 4 4 4 4 4 4 4 4 4 ---------------------------------------- ------------------- #ci #cd #ce #cf #dj #cf #cg #ch #da #ch #ci #dj #db #dj #da #db #dc #dc #db #db #dc #dd #dd #dd #de #de #df #de #df #dg #dg #dh #di #df #dh #dh #di #ej #ea #dg #di #ej #ea #eb #ec #dh #ea #eb #ec #ed #ee #ef #di #ec #ed #ee #ef #eg #eh #ej #ef #eg #eh #ei #fj #fa #ea #ei #fj #fa #fb #fc #fd #eb #fb #fc #fd #fe #ff #fg #ec #ff #fg #fh #fh #fi #gj #ed #fh #fi #gj #ga #gb #gc #ee #gb #gc #gd #ge #gf #gg #ef #gf #gg #gh #gi #hj #ha #eg #ha #hb #hc #hd #he #hf #eh #he #hf #hg #hh #hi #ij #ia #ei #hi #ij #ia #ic #id #ie #if #ih #fj #id #ie #ig #ii #ajj #ajb #ajd #ajf #fa #ii #aja #ajb #ajd #ajf #ajh #aji #aaa #fb #ajd #ajf #ajg #aji #aaa #aac #aad #aae #fc #aji #aaa #aab #aac #aae #aag #aah #aai #fd #aae #aag #aah #aai #abj #aba #abb #fe #aag #aai #abj #abb #abc #abd #abe #ff #aai #aba #abb #abd #abf #abg #abh #fg #abd #abf #abg #abh #abi #acj #fh #abf #abh #acj #acb #acc #acd #fi #abi #aca #acc #ace #acf #acg #gj #acd #acf #ach #aci #adj #ga #ach #adj #adb #adc #add #gb #ade #adg #adh #adi ,prepared by ,dr4 ,thomas ,d4 ,wood ,,about ,,what ,a ,,girl ,,should ,,gain ,,each ,,month ,age #e to #h #f oz4 #h to #aa #h oz4 #aa to #ad #ab oz4 #ad to #af #h oz4 #af to #ah #d oz4 ,courtesy of ,child ,health ,organization of ,america ,,scale ,,for ,,judging ,,the ,,state ,,of ,,nutrition ,,in ,,children1 ,,prepared ,,by ,,professor ,,pirquet#agh ,,pelidisi ,,chart 7,,for ,,school ,,children7 ,sitting ,height ,percentage 7,pelidisi7 in ,cm4 #he #hf #hg #hh #hi #ij #ia #ib #ic #id #ie #if #ee #aj4j #aj4d #aj4g #aa4a #aa4e #aa4i #ab4c #ab4g #ac4a #ac4f #ad4j #ad4d #ef #aj4f #aj4i #aa4d #aa4g #ab4b #ab4f #ac4j #ac4d #ac4i #ad4c #ad4h #ae4c #eg #aa4a #aa4e #aa4i #ab4d #ab4h #ac4b #ac4g #ad4b #ac4f #ae4a #ae4f #af4a #eh #aa4g #ab4a #ab4f #ac4j #ac4e #ac4i #ad4d #ad4i #ae4d #ae4i #af4d #af4i #ei #ab4d #ab4h #ac4b #ac4g #ad4b #ad4g #ae4b #ae4g #af4b #af4g #ag4c #ag4h #fj #ac4j #ac4d #ac4i #ad4d #ad4i #ae4d #ae4i #af4e #ag4a #ag4f #ah4b #ah4h #fa #ac4g #ad4a #ad4f #ae4b #ae4g #af4b #af4h #ag4c #ag4i #ah4e #ai4a #ai4g #fb #ad4c #ad4h #ae4d #ae4i #af4e #ag4a #ag4f #ah4b #ah4h #ai4d #bj4j #bj4g #fc #ae4j #ae4f #af4a #af4g #ag4c #ag4i #ah4e #ai4a #ai4g #bj4d #ba4j #ba4g #fd #ae4h #af4c #af4i #ag4e #ah4a #ah4h #ai4d #bj4j #bj4g #ba4d #bb4a #bb4h #fe #af4e #ag4a #ag4g #ah4c #ai4j #ai4g #bj4c #ba4j #ba4g #bb4d #bc4a #bc4i #ff #ag4c #ag4i #ah4e #ai4b #ai4i #bj4f #ba4b #ba4i #bb4g #bc4d #bd4b #be4j #fg #ah4g #ah4g #ai4d #bj4a #bj4h #ba4e #bb4b #bc4j #bc4g #bd4e #be4c #bf4a #fh #ah4i #ai4f #bj4c #ba4j #ba4g #bb4e #bc4b #bd4j #bd4h #be4f #bf4d #bg4c #fi #ai4h #bj4e #ba4b #bb4j #bb4g #bc4e #bd4b #be4j #be4i #bf4g #bg4f #bh4e #gj #bj4f #ba4d #bb4a #bb4i #bc4g #bd4e #be4c #bf4b #bg4j #bg4i #bh4h #bi4h #ga #ba4e #bb4c #bc4a #bc4i #bd4g #be4f #bf4d #bg4c #bh4b #bi4a #cj4a #ca4c #gb #bb4d #bc4b #bd4a #be4j #be4h #bf4f #bg4f #bh4e #bi4d #cj4d #ca4d #cb4d #gc #bc4d #bd4c #be4a #bf4j #bf4i #bg4h #bh4h #bi4h #cj4g #ca4g #cb4h #cc4h #gd #bd4d #be4c #bf4b #bg4a #bh4j #bi4j #cj4j #ca4j #cb4j #cc4j #cd4j #ce4b #ge #be4d #bf4c #bg4b #bh4b #bi4b #cj4b #ca4b #cb4c #cc4b #cd4c #ce4e #cf4f #gf #bf4d #bg4d #bh4d #bi4d #cj4c #ca4c #cb4g #cc4e #cd4f #ce4g #cf4i #ch4b #gg #bg4e #bh4d #bi4e #cj4f #ca4f #cb4f #cc4h #cd4h #cf4j #cg4b #ch4d #ci4f #gh #bh4f #bi4f #cj4g #ca4h #cb4h #cc4i #ce4j #cf4b #cg4d #ch4f #dj4j #da4a #gi #bi4g #cj4h #ca4h #cc4j #cd4j #ce4b #cf4d #cg4g #ch4h #dj4a #da4e #db4h #hj #cj4h #ca4i #cc4a #cd4b #ce4d #cf4f #cg4i #ci4j #dj4d #da4g #dc4j #dd4e #ha #cb4j #cc4b #cd4c #ce4e #cf4g #ch4j #ci4c #dj4e #da4i #dc4c #dd4g #df4a #hb #cc4b #cd4d #ce4f #cf4h #ch4a #ci4d #dj4h #db4j #dc4e #de4j #df4d #dg4i #hc #cd4d #ce4g #cf4i #ch4b #ci4f #dj4h #db4c #dc4g #de4a #df4f #dh4j #di4f #hd #ce4g #cg4j #ch4b #ci4f #da4j #db4c #dc4h #de4c #df4h #dh4c #di4i #ea4e #he #cg4j #ch4b #ci4f #da4j #db4d #dc4i #df4d #df4i #dh4e #ej4j #ea4f #ec4d #hf #ch4c #ci4f #da4j #db4e #dd4j #de4e #dg4j #dh4g #ej4b #ea4i #ec4g #ee4d #hg #ci4f #da4j #db4e #dd4j #de4e #dg4a #dh4g #ej4c #eb4j #ec4h #ee4e #eg4b #hh #da4j #db4e #dd4j #de4e #dg4b #dh4g #ej4d #eb4j #eh4h #ee4e #eg4e #ei4c #hi #db4e #dd4j #de4e #dg4a #dh4h #ej4e #eb4b #ec4i #ee4g #eg4e #ei4f #fa4b #ij #dd4j #de4d #dg4j #dh4g #ej4d #eb4b #ed4j #ee4h #eg4e #ei4e #fa4e #fc4d ,sitting ,height ,percentage 7,pelidisi7 in ,cm4 #ig #ih #ii #ajj #aja #ajb #ajc #ajd #aje #ajf #ajg #ajh #ee #ad4i #ae4d #ae4h #af4d #af4i #ag4d #ag4i #ah4d #ai4j #ai4f #bj4a #bj4g #ef #ae4g #af4b #af4h #ag4c #ag4i #ah4d #ah4i #ai4e #bj4a #bj4f #ba4b #ba4h #eg #af4f #ag4a #ag4g #ah4b #ah4h #ai4d #bj4j #bj4f #ba4b #ba4h #bb4d #bc4j #eh #ag4e #ah4j #ah4f #ai4b #ai4h #bj4d #ba4j #ba4f #bb4c #bb4i #bc4f #bd4b #ei #ah4d #ai4j #ai4f #bj4b #bj4i #ba4e #bb4b #bb4h #bc4e #bd4a #bd4h #be4f #fj #ai4c #bj4j #bj4f #ba4b #bb4j #bb4f #bc4c #bd4j #bd4f #be4d #bf4a #bf4h #fa #bj4c #ba4j #ba4g #bb4d #bc4a #bc4g #bd4d #be4b #be4i #bf4f #bg4d #bh4b #fb #ba4d #bb4a #bb4h #bc4d #bd4b #bd4i #be4g #bf4d #bg4b #bh4j #bh4h #bi4f #fc #bb4d #bc4b #bc4h #bd4f #be4d #bf4b #bg4j #bg4h #bh4f #bi4d #cj4b #ca4a #fd #bc4e #bd4c #be4j #be4h #bf4h #bg4d #bh4b #bi4a #cj4j #cj4h #ca4f #cb4f #fe #bd4f #be4e #bf4b #bg4j #bg4i #bh4h #bi4f #cj4e #ca4d #cb4b #cc4b #cd4b #ff #be4g #bf4f #bg4d #bh4b #bi4b #cj4j #ca4j #ca4i #cb4h #cc4h #cd4h #ce4h #fg #bf4i #bg4h #bh4f #bi4e #cj4f #ca4d #cb4d #cc4d #cd4c #ce4d #cf4c #cg4d #fh #bh4b #bi4a #cj4j #cj4i #cb4j #cb4i #cc4h #cd4i #ce4i #cf4i #ch4j #ci4a #fi #bi4g #cj4d #ca4c #cb4c #cc4d #cd4d #ce4d #cf4d #cg4e #ch4f #ci4g #dj4i #gj #cj4g #ca4f #cb4g #cc4h #cd4h #ce4h #cg4j #ch4a #ci4a #dj4c #da4e #db4f #ga #cb4a #cc4a #cd4a #ce4b #cf4d #cg4d #ch4f #ci4g #dj4i #db4j #dc4b #dd4e #gb #cc4e #cd4e #ce4f #cf4g #ch4j #ci4j #dj4c #da4e #db4f #dc4i #de4a #df4h #gc #cd4i #cf4j #cg4j #ch4b #ci4e #dj4g #db4j #dc4b #dd4e #de4g #dg4a #dh4d #gd #cf4c #cg4d #ch4f #ci4h #da4a #db4d #dc4g #de4j #df4d #dg4f #di4j #ej4d #ge #cg4h #ci4j #dj4a #da4d #db4h #dd4a #de4d #df4i #dh4c #di4e #ej4i #eb4e #gf #ci4c #dj4e #da4g #dc4a #dd4e #de4i #dg4c #dh4g #ej4c #ea4e #ec4j #ed4e #gg #dj4i #db4g #dc4e #dd4h #df4d #dg4g #di4b #ej4g #eb4c #ec4f #ee4b #ef4h #gh #db4e #dc4i #de4b #df4f #dh4b #di4f #ea4j #eb4f #ed4c #ee4g #eg4c #eh4i #gi #dd4a #de4e #df4i #dh4d #ej4j #ea4e #ec4a #ed4g #ef4e #eh4j #ei4f #fa4c #hj #de4i #dg4c #dh4g #ej4b #eb4j #ec4f #ee4a #ef4i #eh4f #fj4a #fa4h #fc4g #ha #dg4f #di4a #ej4f #eb4a #ed4j #ee4e #eg4c #ei4j #fj4h #fb4e #fd4c #ff4j #hb #di4i #ea4j #eb4e #ed4a #ef4j #eg4f #ei4e #fa4c #fc4j #fg4i #ff4g #fh4e #hc #ea4b #eb4i #ed4e #ef4a #eh4a #ei4g #fa4g #fc4e #fe4c #fg4b #fi4a #ga4j #hd #ec4j #ed4h #ef4e #eh4b #fj4b #fb4j #fd4j #fe4h #fg4g #fi4g #ga4f #gc4f #he #ee4j #ef4h #eh4e #fj4d #fb4d #fd4c #ff4c #fh4b #gj4j #gb4a #gd4b #gf4c #hf #eg4a #eh4i #fj4g #fb4f #fd4f #ff4e #fh4e #gj4e #gb4g #gd4h #gf4i #gi4j #hg #ei4a #fj4i #fb4i #fd4g #ff4i #fi4j #ga4j #gc4j #ge4b #gg4e #gi4f #ha4h #hh #fa4b #fc4j #fe4j #fg4j #fi4c #ga4d #gc4e #ge4e #gg4h #hj4j #hb4d #hd4g #hi #fc4c #fe4c #fg4c #fi4d #ga4f #gc4f #gf4j #gh4a #hj4e #hb4i #he4b #hg4e #ij #fe4d #fg4e #fi4e #ga4e #gd4j #gf4d #gh4f #hj4i #hc4d #he4g #hh4a #ij4e ,instructions for use3 ,to determine the pelidisi1 locate in the left-hand column the child's sitting height in centimeters4 ,with a ruler follow the weights in kilograms to the right until the proper figure is reached4 ,trace upward in that column to the heavy figure at the top1 which indicates the pelidisi4 ,,footnote3 #agh ,this material was published in the ,american ,medical ,journal1 ,vol4 #gg1 ,no4 #bj1 ,nov4 #ab1 #aiba1 by ,dr4 ,william ,e4 ,carter1 ,dept4 ,pediatrics1 ,university of ,california ,medical ,school1 ,san ,francisco1 ,calif4 ,,the ,,nutritional ,,index--,,the ,,pelidisi ,pirquet believes that the sitting height is a basis for the more accurate estimation of the nutritional state than is the standing height4 ,it was demonstrated that the cube of the sitting height in centimeters is approximately ten times the weight in grams of the normal person4 ,with this formula in mind1 it becomes easy to compute the nutritional state in percentages1 when the sitting height and the weight are known4 ,the formula would read3 #aj times the weight ------------------- #ajj per cent4 ,sitting height#c or #c _/ v #aj times the weight ----------------------- #ajj per cent4 ,sitting height ,,addenda ,,to ,,index ,diet1 in fevers1 #bdd in infectious diseases1 #bdd1 #bdd;j ,diphtheria1 #bdd;d1 #bddk complications of1 #bdd;d1 #bddk convalescent diet in1 #bdd;e1 #bddk dietetic treatment of1 #bdd;e1 #bddk gavage in1 #bddk rectal feeding in1 #bdd;e1 #bddk ,fevers1 diet in1 #bdd ,infant feeding1 in infectious diseases1 #bdd ,infectious diseases1 diet in1 #bdd1 #bdd;j infant feeding in1 #bdd restricting diet in1 #bdd;a ,measles1 #bdd;h1 #bddl complications of1 #bdd;h1 #bddl dietetic treatment of1 #bdd;i1 #bddl ,nephritis in scarlet fever1 #bdd;c1 #bdd;j ,scarlet fever1 #bdd;b1 #bdd;j convalescent treatment in1 #bdd;d dietetic treatment of1 #bdd;c1 #bdd;j nephritis in1 #bdd;c1 #bdd;j ,whooping cough1 #bdd;e1 #bddk after-effects of1 #bdd;f complications of1 #bdd;f1 #bddk dietetic treatment of1 #bdd;f1 #bddk hygiene and sanitation in1 #bdd;g ,,index ,absorption1 #aff1 #agf defined1 #aff in large intestine1 #agh of carbohydrate1 #agg of fat1 #agg of mineral salts1 #agh of proteins1 #agg of water1 #agg ,acetone bodies1 in diabetes1 #dja ,acetone in urine1 test for1 #ccc ,acid1 uric1 see ,uric acid ,acid content of stomach1 determining of1 #bdh ,acid-forming foods1 #ahd1 #ded ,acidosis1 #dec1 #ded1 #deh dietetic treatment in1 #dec1 #deh fat metabolism in1 #dec in diabetes mellitus1 #cgb1 #chb1 #dja1 #ded in typhoid fever1 #bii ,acids1 amino1 #ai organic1 #ac ,added urea and salt test1 #cea ,adenase1 #aga ,adenin1 #ahd ,adipose tissue1 #ae ,adult1 factors influencing food requirement of1 #dc ,agar jelly1 preparation of1 #adg ,age1 influence of on food requirements1 #dc ,albumen1 in urine1 #ccc tests for1 #ccc ,albumen milk1 preparation of1 #adb ,albumen water1 with brandy1 preparation of1 #ada ,albumenized grape juice1 preparation of1 #ig lemonade1 preparation of1 #ig milk1 preparation of1 #hg milk shake1 preparation of1 #hg orangeade1 preparation of1 #if ,albumins1 #bj ,albuminoids1 #ba ,albuminuria1 #ccc of pregnancy1 diet in1 #aig ,alcohol in gout1 #dah ,alfalfa1 vitamines in1 #dih ,alkalies1 effect of on vitamine ,b1 #cb in diabetes mellitus1 #chb in infant feeding1 #bje1 #bjf ,alkaline carbonates1 effect of on gastric secretion1 #age ,allen's ,paradoxical ,law1 #cga starvation treatment in diabetes1 #fc1 #cgb ,almond biscuits1 preparation of1 #aeg ,almond flour1 preparation of1 #aeh ,almond ice cream1 preparation of1 #ia ,almond meal1 preparation of1 #aeh ,almonds1 ash constituent of1 #dgb composition of1 #dhd food content of1 #dgh fuel value of1 #dfa1 #dhd nutrient value of1 #dfa standard portion of1 #dgh ,amino acids1 #ai ,ammonium salts1 #ahc ,amylopsin1 #aga1 #agd ,anabolism1 #aha ,anemia1 in gastric ulceration1 #bee ,angel food cake1 preparation of1 #aaj ,appendicitis1 #bfh1 #bgh convalescent diet in1 #bfi1 #bgh dietetic treatment in1 #bfi1 #bgh after operation1 #cag1 #cba food to be avoided in1 #bfi recurring1 #bgh relapse in1 #bgh ,apples1 ash constituent of1 #dgb composition of1 #dhd food content of1 #dgh fuel value of1 #dfa1 #dhd nutrient value of1 #dfa standard portion of1 #dgh vitamines in1 #dig ,apple tapioca pudding1 preparation of1 #ajg ,apricot ice1 preparation of1 #acg ,apricots1 ash constituent of1 #dgb composition of1 #dhd food content of1 #dgh fuel value of1 #dfa1 #dhd nutrient value of1 #dfa standard portion of1 #dgh ,arrowroot1 composition of1 #dhd fuel value of1 #dhd ,artificial feeding of infants1 #bje ,artificially fed infants1 digestive disturbances in1 #bca ,artichoke1 composition of1 #dhd fuel value of1 #dfa1 #dhd nutrient value of1 #dha ,ash1 #be ,ash constituents of foods1 #dgb1 #dgc1 #dgd1 #dge1 #dgf1 #dgg ,asparagus1 ash constituent of1 #dhd composition of1 #dhd food content of1 #dgh fuel value of1 #dfa1 #dhd nutrient value of1 #dfa standard portion of1 #dgh ,auto-intoxication1 #bgc absorption of toxins in1 #bgc care of bowels in1 #bgc convalescent diet in1 #bge dietetic treatment of1 #bgc ,autolytic enzymes1 #aga ,avocado1 fuel value of1 #dfa nutrient value of1 #dfa ,bacon1 ash constituent of1 #dgb composition of1 #dhd food content of1 #dgh fuel value of1 #dfa1 #dhd nutrient value of1 #dfa standard portion of1 #dgh ,bacteria1 action of in alimentary canal1 #agh types of1 #ahj ,bacterial action1 in body1 #ahj upon carbohydrates1 #ac ,bacterial activity1 #aha ,baked custard1 preparation of1 #ajb ,baked onion1 preparation of1 #aea ,baked potato1 preparation of1 #acj ,baked tapioca1 preparation of1 #ajf ,baking1 #ga ,bananas1 ash constituent of1 #dgb composition of1 #dhd food content of1 #dgh fuel value of1 #dfa1 #dhd nutrient value of1 #dfa standard portion of1 #dgh vitamines in1 #dig ,banting's method for obesity1 #dbf1 #dbg ,barley1 ash constituent of1 #dgb composition of1 #dhd fuel value of1 #dfa1 #dhd nutrient value of1 #dfa vitamines in1 #dif ,barley water1 #bbj preparation of1 #adj ,basal metabolism1 #db ,basal requirements1 #db ,bass1 composition of1 #dhd fuel value of1 #dhd ,beans1 ash constituent of1 #dgb composition of1 #dhd food content of1 #dgh fuel value of1 #dfa1 #dhd nutrient value of1 #dfa standard portion of1 #dgh vitamines in1 #dig ,beef1 and see ,meats ash constituents of1 #dgb cuts of1 #aag food content of1 #dgc fuel value of1 #dfb1 #dfc1 #dhd composition of1 #dhd methods of preparing1 #aag nutrient value of1 #dfb1 #dfc standard portion of1 #dgh vitamines in1 #dif ,beef broth1 preparation of1 #aah ,beef juice1 preparation of1 #aai1 #ada ,beef steak1 preparation of1 #abc ,beer1 ash constituents of1 #dgb ,beets1 ash constituent of1 #dgb composition of1 #dhd food content of1 #dgh fuel value of1 #dfc1 #dhd nutrient value of1 #dfc standard portion of1 #dgh vitamines in1 #dif ,benedict's solution1 #cca1 #ccb ,benedict's test for sugar in urine1 #cbh1 #cbi1 #cca1 #ccb ,bile1 #agd ,biliousness1 #djd1 #dad ,birds a la bain-marie1 preparation of1 #aba ,blackberries1 ash constituent of1 #dgb fuel value of1 #dfc nutrient value of1 #dfc ,blackfish1 fuel value of1 #dfc nutrient value of1 #dfc ,blood1 ash constituent of1 #dgb vitamines in1 #dih ,bluefish1 ash constituent of1 #dgb composition of1 #dhd fuel value of1 #dfc1 #dhd nutrient value of1 #dfc ,body1 #afe chemical composition of1 #afe food requirements of1 #db1 #ej1 #afe metabolism of tissues of1 #ahg ,boas' enema1 preparation of1 #adf ,boiled corn beef with cabbage and other vegetables1 preparation of1 #aec ,boiling1 #gj ,bomb calorimeter1 #cf ,borax1 test for1 #fh ,boric acid1 test for1 #fh ,boston crackers1 fuel value of1 #dfc nutrient value of1 #dfc ,bowels1 of nursing mother1 #aig ,boys1 height and weight of1 #ejj ,brains1 vitamines in1 #dif ,bran1 composition of1 #dhd fuel value of1 #dhd ,bran agar wafers1 preparation of1 #adf ,bran biscuits1 preparation of1 #adi1 #aee1 #aef for constipation1 #aef ,bran cookies1 preparation of1 #ade ,bran gems1 preparation of1 #add ,bran muffins1 preparation of1 #aee ,brandy1 composition of1 #dhd fuel value of1 #dhd ,brazil nuts1 fuel value of1 #dfc nutrient value of1 #dfc ,bread1 ash constituent of1 #dgb composition of1 #dhd1 #dhf fuel value of1 #dfc1 #dfd1 #dhd1 #dhf nutrient value of1 #dfc1 #dfd vitamines in1 #dif ,breadfruit1 ash constituent of1 #dgb ,breadstuffs1 preparation of1 #ajc ,bread substitutes1 preparation of1 #aee ,breast feeding versus artificial feeding1 #bdc ,breast milk1 as a food1 #bbh versus cow's milk1 #bjc ,brick feeder1 #bbe ,bright's disease1 see ,nephritis ,broiled oysters1 preparation of1 #abc ,broiled quail1 preparation of1 #aba ,broiled squab1 preparation of1 #aba ,broiled tomatoes1 preparation of1 #acc ,broiling1 #ga ,broths1 preparation of1 #aah standard1 #aah ,brown betty1 preparation of1 #ajg ,brussels sprouts1 ash constituent of1 #dgb ,buckwheat flour1 ash constituent of1 #dgb fuel value of1 #dfd nutrient value of1 #dfd ,bulgarian buttermilk1 preparation of1 #hi ,butter1 ash constituent of1 #dgb composition of1 #dhf food content of1 #dgh fuel value of1 #dfd1 #dhf nutrient value of1 #dfd standard portion of1 #dgh vitamines in1 #dig1 #dih ,buttermilk1 ash constituent of1 #dgb fuel value of1 #dfd nutrient value of1 #dfd ,buttermilk1 ,bulgarian1 preparation of1 #hi ,buttermilk mixtures1 #bjh for infants1 #adb ,butternuts1 fuel value of1 #dfd nutrient value of1 #dfd ,cabbage1 ash constituent of1 #dgb composition of1 #dhf food content of1 #dgh fuel value of1 #dfd1 #dhf nutrient value of1 #dfd standard portion of1 #dgh vitamines in1 #dif ,cabbage souffle1 preparation of1 #aej ,calcium1 #bg1 #ahf requirements in pregnancy and lactation1 #aia retention in rickets1 #bda source of1 in food1 #f ,calculating formulas for infant feeding1 #bab ,calf's-foot jelly1 fuel value of1 #dfd nutrient value of1 #dfd preparation of1 #abj ,calorie1 defined1 #cg ,calorie allowance for children1 #dh ,calorie portion1 #dj1 #dgh ,calories1 in carbohydrates1 #ch in fats1 #ch in proteins1 #ch ,calorimeter1 #cf ,cancer1 gastric1 dietetic treatment of1 #bfj ,canned goods1 #fh1 #abh adulteration of1 #fh ,cane sugar1 in infant feeding1 #bbh ,cantaloupe1 ash constituent of1 #dgb ,capers1 ash constituent of1 #dgb ,caramel custard1 preparation of1 #ajc ,carbohydrates1 #g absorption of1 #agg bacterial action upon1 #ac calories in1 #ch composition of1 #g effect of heat upon1 #ad enzymes acting upon1 #aga fate of1 #ahb function of1 #cgb metabolism of1 #ahb rate of digestion of1 #agc regulation of1 #bce source of1 #e tolerance of in diabetes1 #chj ,carbohydrate-free diet1 #fc ,carbohydrate-free meat and fish1 calorie equivalent of1 #chf ,carbon dioxide1 excretion of1 #cbd ,carbonates1 alkaline1 effect of on digestion1 #age ,carp1 see ,fish ,carrots1 ash constituent of1 #dgb composition of1 #dhf food content of1 #dgh fuel value of1 #dfd1 #dhf nutrient value of1 #dfd standard portion of1 #dgh vitamines in1 #dif with cream sauce or butter1 preparation of1 #abi ,casoid flour and bran muffins1 preparation of1 #aef ,catabolism1 #aha ,cauliflower1 ash constituent of1 #dgb composition of1 #dhf food content of1 #dgh fuel value of1 #dfd1 #dhf nutrient value of1 #dfd standard portion of1 #dgh vitamines in1 #dif ,caviar1 ash content of1 #dgb ,celery1 ash constituent of1 #dgc composition of1 #dhf food content of1 #dgi fuel value of1 #dfd1 #dhf nutrient value of1 #dfd standard portion of1 #dgi vitamines in1 #dif ,celery ramekins1 preparation of1 #aea ,celery soup1 fuel value of1 #dfd nutrient value of1 #dfd ,cellu bran crackers1 preparation of1 #adh ,cellulose1 #ab ,centigrade scale1 #hj ,cereal pudding1 preparation of1 #aaj ,cerealine1 fuel value of1 #dfd nutrient value of1 #dfd ,cereals1 preparation of1 #ajc vitamines in1 #dif1 #dig ,certified milk1 #ha ,chard1 ash constituent of1 #dgc composition of1 #dhf fuel value of1 #dfd1 #dhf nutrient value of1 #dfd vitamines in1 #dif ,cheese1 ash constituent of1 #dgc composition of1 #dhf food content of1 #dgi fuel value of1 #dfd1 #dhf nutrient value of1 #dfd standard portion of1 #dgi vitamines in1 #dih ,cheese salad1 preparation of1 #aed ,chemical digestion1 #afi1 #agb ,cherries1 ash constituent of1 #dgc composition of1 #dhf food content of1 #dgi fuel value of1 #dfd1 #dhf nutrient value of1 #dfd standard portion of1 #dgi ,cherry juice1 ash constituent of1 #dgc ,chestnuts1 ash constituents of1 #dgc composition of1 #dhf fuel value of1 #dfd1 #dhf nutrient value of1 #dfd vitamines in1 #dih ,chicken1 and see ,meat composition of1 #dhf food content of1 #dgi fuel value of1 #dfe1 #dhf nutrient value of1 #dfe preparation of1 #abb selection of1 #aad standard portion of1 #dgi ,chicken a la bain-marie1 preparation of1 #aba ,chicken broth1 preparation of1 #aah ,chicken jelly1 preparation of1 #abj ,chicken salad1 poisoning by1 #dea ,chicken supreme1 preparation of1 #adi ,children1 care of in abnormal conditions1 #bca diarrhea in1 #bfc1 #bgf energy requirements of1 #dg errors in diet in1 #bcb1 #bdc feeding of1 in abnormal conditions1 #bca food allowance for1 #dh food requirements of1 #dd1 #eb gain in weight in1 #di heights and weights for1 #dii malnutrition in1 #bdb nutrition in1 #ejb over-feeding1 #bdc under-feeding1 #bdc ,chlorine1 source of in food1 #f ,chocolate1 ash constituent of1 #dgc composition of1 #dhf food content of1 #dgi fuel value of1 #dfe1 #dhf nutrient value of1 #dfe standard portion of1 #dgi ,cholesterol1 #ae ,cider1 ash constituents of1 #dgc ,citron1 ash constituents of1 #dgc ,clams1 ash constituents of1 #dgc composition of1 #dhf food content of1 #dgi fuel value of1 #dhf standard portion of1 #dgi ,clam broth1 preparation of1 #aai ,clover1 vitamines in1 #dih ,cocoa1 ash constituents of1 #dgc composition of1 #dhf food content of1 #dgi fuel value of1 #dfe1 #dhf nutrient value of1 #dfe preparation of1 #hi standard portion of1 #dgi ,cocoanut1 ash constituents of1 #dgc vitamines in1 #dih ,cocoanut biscuits1 preparation of1 #aeh ,cocoanut flour1 preparation of1 #aeh ,coddled eggs1 preparation of1 #ajj ,codfish1 and see ,fish composition of1 #dhf fuel value of1 #dfe1 #dhf nutrient value of1 #dfe vitamines in1 #dif ,coffee1 adulteration of1 #fi preparation of1 #ih ,coffee eggnog1 preparation of1 #ii ,coleman's high calorie diet in typhoid fever1 #bhi1 #bia1 #bid1 #bie1 #bih1 #bii ,condensed milk1 composition of1 #dhf for infants1 #bbf1 #bbg fuel value of1 #dhf vitamines in1 #dih ,conserve1 preparation of1 #adc ,consomme1 composition of1 #dhf fuel value of1 #dfe1 #dhf nutrient value of1 #dfe ,constipation1 #bch1 #bgj1 #bgi ,constipation1 bran biscuits for1 #aef dietetic treatment of1 #bga1 #bgi diet for1 #adc1 #bci1 #bga1 #bgb1 #bgi1 #djf in nursing women1 #aig ,convalescent diet1 #fb ,cookies1 protein-free1 #cdj ,cooking1 time-table for1 #gb ,copper1 test for1 #fh ,corn1 ash constituents of1 #dgc composition of1 #dhf food content of1 #dgi fuel value of1 #dfe1 #dhf nutrient value of1 #dfe standard portion of1 #dgi vitamines in1 #dig ,cornflakes1 composition of1 #dhf fuel value of1 #dhf ,corn meal1 composition of1 #dhf food content of1 #dgi fuel value of1 #dfe1 #dhf nutrient value of1 #dfe standard portion of1 #dgi ,cornstarch1 composition of1 #dhf fuel value of1 #dhf ,cotton seed1 ash constituents of1 #dgc vitamines in1 #dig ,cowpeas1 ash constituents of1 #dgc fuel value of1 #dfe nutrient value of1 #dfe ,crab1 preparation of1 #abf ,crackers1 ash constituents of1 #dgc composition of1 #dhf food content of1 #dgi fuel value of1 #dfe1 #dhf nutrient value of1 #dfe standard portion of1 #dgi ,cranberries1 ash constituents of1 #dgc composition of1 #dhh fuel value of1 #dfe1 #dhh nutrient value of1 #dfe ,cream1 ash constituents of1 #dgc composition of1 #dhh food content of1 #dgi fuel value of1 #dfe1 #dhh nutrient value of1 #dfe standard portion of1 #dgi vitamines in1 #dih ,cream egg and vichy1 preparation of1 #ih ,cream of asparagus1 preparation of1 #ic of carrots1 preparation of1 #id of cauliflower1 preparation of1 #aeb of celery1 preparation of1 #id of peas1 preparation of1 #id of potato1 preparation of1 #id of spinach1 preparation of1 #id ,cream sauce for soups1 preparation of1 #ic ,cream soups1 preparation of1 #ic ,cream toast1 preparation of1 #aje ,creamed egg on toast1 preparation of1 #aja ,creamed potatoes1 preparation of1 #acj ,creatinin1 #ahe ,cucumber1 ash constituents of1 #dgc composition of1 #dhh fuel value of1 #dfe1 #dhh nutrient value of1 #dfe ,cucumber salad1 preparation of1 #aca ,currant ice1 preparation of1 #acg ,currant juice1 ash constituents of1 #dgc ,currants1 ash constituents of1 #dgc composition of1 #dhh fuel value of1 #dfe1 #dhh nutrient value of1 #dfe ,custard1 preparation of1 #ajb1 #aei ,dairy products1 #ha vitamines in1 #dih ,dandelion greens1 ash constituents of1 #dgc fuel value of1 #dfe nutrient value of1 #dfe ,dasheens1 vitamines in1 #dif ,dates1 ash constituents of1 #dgc composition of1 #dhh food content of1 #dgi fuel values of1 #dfe1 #dhh nutrient value of1 #dfe standard portion of1 #dgi ,desserts1 preparation of1 #ach ,dextri-maltose1 #bcf in infant feeding1 #bjg ,dextrin1 #ab ,diabetes mellitus1 #cga acetone bodies in1 #dja acidosis in1 #cgb1 #chb1 #dja1 #ded alkalies in1 #chb ,allen's starvation treatment in1 #cgb carbohydrate-free diets in1 #chg1 #chi carbohydrate tolerance in1 #chj determination of food tolerance in1 #cgi dietetic treatment in1 #chb diets in1 #cgd1 #chb in mild cases1 #cgc fast days in1 #cha fasting in1 #cgi ,diabetes mellitus1 fat tolerance in1 #cha formulas used in1 #adf ,joslin's diet in1 #chc menus for1 #cgf1 #cgg1 #chc1 #chi1 #cig protein tolerance in1 #cha schedule of treatment for1 #chj starvation treatment of1 #cgb test diets in1 #cgd urine in1 #cbh1 #cbi1 #ccj1 #cga1 #dja1 #djb ,diabetic acidosis1 #ded ,diabetic cures1 #cgb ,diabetic diet1 #fc1 #cgd ,diabetic flours1 #djc ,diabetic foods1 commercial1 #djc ,diabetic muffins1 preparation of1 #aee ,diacetic acid in urine1 ,gerhardt's test for1 #ccb ,diarrhea1 #bfc1 #bgf1 and see ,enteritis causes of1 #bfc1 #bgf dietetic treatment of1 #bfd in children1 #bfc dietetic treatment of1 #bcg ,diastase1 #aga ,diet1 or ,diets1 and see under the various diseases carbohydrate-free1 #fc convalescent1 #fb diabetic1 #fc emaciation1 #fc fluid1 #fc house1 #fb light1 #fb liquid1 #fb milk1 #fc mixed1 #fc nephritic1 #fc1 and see ,nephritis obesity1 #fc1 and see ,obesity protein-free1 #cdj purin-free1 #fc salt-free1 #fc semi-solid1 #fb special1 #fb1 #fc ,dietary1 for child1 #bba1 #bbc sample1 #ed ,dieto-therapy1 #ahi ,digestion1 #afg chemical1 #afi1 #agb gastric1 #agb intestinal1 #agc1 #agf processes included in1 #aff salivary1 #agb ,digestive disturbances in infants and children1 #bca ,diluents1 in infant feeding1 #bjh preparation of1 #baj ,dilution for premature infants1 #bbe ,disaccharides1 #h1 #aj ,dish gravy1 #ada ,dishes1 washing1 #gf ,doughnuts1 fuel value of1 #dfe nutrient value of1 #dfe ,dry peptonoids1 composition of1 #dhh fuel value of1 #dhh ,duck1 see ,meat ,dysentery1 dietetic treatment of1 #bfh1 #bgh ,ebstein's method for obesity1 #dbi ,egg1 or ,eggs1 #ie ash constituents of1 #dgc composition of1 #dhh coddled1 #ajj food content of1 #dgi fuel value of1 #dfe1 #dhh nutrient value of1 #dfe standard portion of1 #dgi vitamines in1 #dig1 #dih ,egg nest1 preparation of1 #aja ,eggnog1 preparation of1 #ii ,eggplant1 ash constituents of1 #dgc composition of1 #dhh fuel value of1 #dfe1 #dhh nutrient value of1 #dfe ,egg salad1 preparation of1 #aed ,eggwhite and mint1 preparation of1 #ih ,eiweissmilch1 #adb1 #bjh1 #bji ,elimination1 #afg ,emaciation1 #dch allowable foods in1 #dda dietetic treatment in1 #ddj diet in1 #fc1 #dci diet sheets1 #ddb1 #ddc in children1 #dch method of increasing diet in1 #ddd milk cure in1 #dda need for building foods in1 #dci regulating diet in1 #dci selection of foods in1 #ddj ,endive1 ash constituents of1 #dgc ,enema1 or ,enemas1 malted milk1 #adf milk and egg1 #ade milk and starch1 #adf nutrient1 #ade temperature of1 #fa ,energy output compared with food intake1 #dbe production of1 #ahb ,enteritis1 acute1 #bfd1 and see ,diarrhea ,enteritis1 acute1 dietetic treatment of1 #bfd1 #bfe1 #bff1 #bgf1 #bgg foods to be avoided in1 #bff1 #bgg ,enteritis1 chronic1 #bfg dietetic treatment in1 #bfg ,enterocolitis1 #bfg1 #bgg dietetic treatment of1 in infants1 #bcg ,enzymes1 #agj1 #aga acting1 on carbohydrates1 #aga on fats1 #aga on proteins1 #aga on purins1 #aga action of1 #agj1 #aga amylolytic1 #agb autolytic1 #aga classification of1 #agb coagulating1 #agb deaminizing1 #agb glycolytic1 #aga hydrolytic1 #agb lipolytic1 #agb oxidizing1 #agb proteolytic1 #agb reducing1 #agb source of1 #aga sugar-splitting1 #agb table of1 #aga ,erepsin1 #aga1 #agd ,errors in diet1 in infants and children1 #bcb1 #bdc ,fahrenheit scale1 #hj ,farina1 ash constituents of1 #dgc composition of1 #dhh food content of1 #dgi fuel value of1 #dfe1 #dhh nutrient value of1 #dfe preparation of1 #ajd standard portion of1 #dgi ,fast days1 in treatment of diabetes1 #cha ,fat1 or ,fats1 #ad1 #ae absorption of1 #agg calories in1 #ch cause of gastro-intestinal disturbances in children1 #bcc effect of heat upon1 #af enzymes acting on1 #aga excess of1 in diet of infants and children1 #bcc fate of1 #ahb functions of1 #ag metabolism of1 in acidosis1 #dec phosphorized1 #ae rate of digestion of1 #agc regulation of1 in diet1 #bcc source of1 #e1 #ddh tolerance of1 in diabetes1 #cha vitamines in1 #dig1 #dih ,fat soluble ,a1 #ae effect of heat upon1 #ca function of1 #cj foods containing1 #f1 #dif1 #dig1 #dih ,fatty foods1 effect of1 upon gastric secretion1 #age ,feeding1 by inunction1 #fb by mouth1 #ei correct1 evidences of1 #bdc forced1 #ei in diseases of gastro-intestinal tract1 #bde infant1 see ,infant feeding methods of1 #ei post-operative1 #caf1 #cai1 #cbj pre-operative1 #cab1 #cah1 #cbj rectal1 #fj1 #fa ,fehling's solution1 #cca ,fehling's test for sugar in urine1 #cbh ,fermentation1 and see ,enzymes cause of infantile disorders1 #bcf1 #bcg in stomach1 #ahj ,fermentation test for sugar in urine1 #ccj ,fever1 or ,fevers1 #bha care of mouth in1 #bhe convalescent diet in1 #bhc dietetic treatment in1 #bha energy expenditure in1 #bhh energy requirements in1 #bhe fluid diet in1 #bhb nitrogen equilibrium in1 #bhf sample menus for1 #bhd schedule of feeding in1 #bhb soft diet in1 #bhc thirst in1 #bhe tissue waste in1 #bha typhoid1 see ,typhoid fever ,figs1 ash constituents of1 #dgc composition of1 #dhh food content of1 #dgi fuel value of1 #dfe1 #dhh nutrient value of1 #dfe standard portion of1 #dgi ,fish1 #aae ash constituents of1 #dgc composition of1 #dhh food content of1 #dgi fuel value of1 #dhh standard portion of1 #dgi ,fish roe1 vitamines in1 #dif ,fish steaks stuffed with oysters1 preparation of1 #abe ,flaxseed1 ash constituents of1 #dgd vitamines in1 #dig ,floating island1 preparation of1 #ajc ,flounder1 fuel value of1 #dfe nutrient value of1 #dfe ,flour1 ash constituents of1 #dgd composition of1 #dhh food content of1 #dgi fuel value of1 #dfe1 #dhh nutrient value of1 #dfe standard portion of1 #dgi ,flours1 diabetic1 #djc ,fluid diet1 #fb in fevers1 #bhb ,foamy omelet1 preparation of1 #ajj ,foamy sauce1 preparation of1 #aaa1 #aab ,food1 or ,foods1 #a1 and see ,foodstuffs acid-forming1 #ahd1 #ded adulteration of1 #fg allowance for children1 #dh arrangement of1 in stomach1 #afg as fuel1 #bd1 #cf1 #ci ash constituents of1 #dgb1 #dgc1 #dgd1 #dge1 #dgf1 #dgg base-forming1 #ahd1 #ded care of1 #gf chemical composition of1 #c1 and #dhd to #die contamination of1 #ff defined1 #b diabetic1 #djc effect of cold upon1 #ci effect of heat upon1 #ci fuel value of1 #cf1 #ci1 #bba1 #dfa to #dga1 and #dhd to #die functions of1 #b idiosyncrasies to1 #deb incomplete1 as source of danger1 #bbg intake of1 compared with output of energy1 #dbe materials1 #b mineral matter in1 #be nutrient value of1 #dfa to #dga passage of1 from stomach1 #afh preparation of1 #fi1 #gj purin content of1 #dba relation of1 to mother's milk1 #bjc requirements of body1 #db1 #dc1 #ea1 #eb factors influencing1 #dc1 #dd salt content of1 #ceh1 #cei1 #cfj selection of1 #eb1 #ge sources of1 #b1 #c1 #d transformation of into fuel1 #cg uses of1 #b1 #dbe vitamines in1 #dif1 #dig1 #dih which produce fat1 #ddh ,food materials1 #b ,food poisoning1 #ff1 #dea ,foodstuffs1 heat produced by oxidation of1 #ch ,forced feeding1 #ei ,formaldehyde1 test for1 #fg ,formulas1 determining fuel value of1 #bba for constipation1 #adc for feeding infants1 #adj1 #bab ,fowls1 and see ,meat composition of1 #dhh fuel value of1 #dff1 #dhh nutrient value of1 #dff ,french dressing1 preparation of1 #acd ,frozen custard1 preparation of1 #ia ,fructose1 #i ,fruit1 preparation of1 #abf1 #abg1 #abh vitamines in1 #dig ,fruit beverages1 preparation of1 #if ,fruit jellies1 method for1 #ace preparation of1 #afj ,fruit salads1 preparation of1 #aca1 #acb ,fruit sauce1 preparation of1 #aaa ,frying1 #ga ,fuel value of food1 #cf to compute1 #ci1 #bba ,galactose1 #i ,gall bladder1 diet after operations on1 #cah1 #cba ,gallstones1 #djh available foods1 #daj dietetic treatment for1 #djh1 #dji diet sheets for1 #daa1 #dab1 #dac ,gastric1 and see ,stomach ,gastric cancer1 #bfj dietetic treatment in1 #bfj ,gastric digestion1 #agb factors influencing1 #age ,gastric1 disturbances1 factors inducing1 #bfa1 #bfb ,gastric hemorrhage1 #bea ,gastric juice1 composition of1 #bdf retardation of1 #age stimulation of1 #age ,gastric secretion1 effect of alkaline carbonates on1 #age effect of fatty foods upon1 #age water as a stimulant1 #bec ,gastric ulcer1 #bea bland diet in1 #bee convalescent diet in1 #bed dietetic treatment in1 #beb1 #bef lavage in1 #bee ,lenhartz diet in1 #beg starvation treatment of1 #beb ,gastritis1 acute1 #bdh dietetic treatment in1 #bdh1 #bdi ,gastritis1 chronic1 #bej dietetic treatment of1 #bej ,gastro-enterostomy1 diet after1 #cba ,gastro-intestinal disturbances1 relapses in1 #bdd ,gastro-intestinal tract1 feeding in diseases of1 #bde ,gavage1 #fj ,gelatin1 composition of1 #dhh food content of1 #dhj fuel value of1 #dff1 #dhh nutrient value of1 #dff standard portion of1 #dhj ,gelatin jellies1 preparation of1 #ace ,gerhardt's test for diacetic acid1 #ccb ,girls1 heights and weights for1 #eja ,globulins1 #bj ,glucose1 #h ,gluten food1 ash constituents of1 #dgd ,glycogen1 #ab ,glycolytic enzymes1 #aga ,goose1 see ,meat ,gooseberries1 ash constituents of1 #dgd ,gout1 #dag alcohol in1 #dab allowable foods in1 #dbj avoidable foods in1 #dbj1 #dba dietaries in1 #dbb dietetic treatment in1 #dbj1 #dde foods to be condemned in1 #dbj glycosuria in1 #dai obesity in1 #dai purin-free diet in1 #daj ,grape butter1 fuel value of1 #dff nutrient value of1 #dff ,grapefruit1 ash constituents of1 #dgd composition of1 #dhh food content of1 #dhj fuel value of1 #dff1 #dhh nutrient value of1 #dff standard portion of1 #dhj vitamines in1 #dig ,grape juice1 ash constituents of1 #dgd composition of1 #dhh food content of1 #dhj fuel value of1 #dhh standard portion of1 #dhj vitamines in1 #dig ,grape juice ice1 preparation of1 #acf1 #acg ,grape juice jelly1 preparation of1 #ace ,grapes1 ash constituents of1 #dgd composition of1 #dhh food content of1 #dhj fuel value of1 #dff1 #dhh nutrient value of1 #dff standard portion of1 #dhj vitamines in1 #dig ,greens1 composition of1 #dhh fuel value of1 #dhh ,guanase1 #aga ,guava1 ash constituents of1 #dgd ,gum gluten1 composition of1 #dhh fuel value of1 #dhh ,haddock1 and see ,fish fuel value of1 #dff nutrient value of1 #dff ,haines' solution1 #cca ,haines' test for sugar in urine1 #cbi ,halibut1 and see ,fish composition of1 #dhh fuel value of1 #dff1 #dhh nutrient value of1 #dff1 #dhh ,halpin's salt-free nephritic diet1 #cdb ,ham1 and see ,meat composition of1 #dhh fuel value of1 #dff1 #dhh nutrient value of1 #dff ,hard sauce1 preparation of1 #aaa ,hazel nuts1 ash constituents of1 #dgd ,heat1 application of to milk1 #hd effect of on carbohydrates1 #ad effect of on fats1 #af effect of on proteins1 #bb effect of on vitamine ,a1 #ca effect of on vitamine ,b1 #cb effect of on vitamine ,c1 #cc produced by oxidation of foodstuffs1 #ch ,hedinger-,schlayer-,mosenthal diet1 #cdh1 #cej ,heights and weights for children1 #dii1 #ejj1 #eja ,heller's test for albumen in urine1 #ccc ,hemoglobin1 #bb ,hemorrhages1 gastric1 #bea ,hempseed1 vitamines in1 #dig ,herring1 and see ,fish fuel value of1 #dff nutrient value of1 #dff vitamines in1 #dif ,hickory nuts1 composition of1 #dhh fuel value of1 #dhh ,high calorie diet1 in tuberculosis1 #cjd in typhoid fever1 #bhi1 #bia1 #bid1 #bie1 #bih1 #bii ,hollandaise sauce1 preparation of1 #abf ,hominy1 ash constituents of1 #dgd composition of1 #dhh food content of1 #dhj fuel value of1 #dff1 #dhh nutrient value of1 #dff standard portion of1 #dhj ,homogenized milk1 #bji ,homogenizer1 #bji ,honey1 ash constituents of1 #dgd composition of1 #dhh food content of1 #dhj fuel value of1 #dff1 #dhh nutrient value of1 #dff standard portion of1 #dhj vitamines in1 #dih ,horse meat1 vitamines in1 #dif ,horseradish1 ash constituents of1 #dgd ,house diet1 #fb ,household weights and measures1 #gh ,huckleberries1 ash constituents of1 #dgd fuel value of1 #dff nutrient value of1 #dff ,huckleberry wine1 ash constituents of1 #dgd ,hydrochloric acid1 in gastric juice1 #bdf ,hyperchlorhydria1 #bdg ,hypochlorhydria1 #bdf ,ice-box1 care of1 #gc ,ice cream1 poisoning by1 #dea preparation of1 #afa to reenforce1 #ia ,ices1 preparation of1 #afa ,idiosyncrasies1 to milk1 #bif to foods1 #deb ,ileocecal valve1 #agf ,indican1 test for in urine1 #ccd ,infancy1 retention of nitrogen in1 #bja ,infant1 or ,infants1 and see ,children bath for1 #bjb bowels of1 #bjb care of in abnormal conditions1 #bca daily gain in weight1 #bjj danger of incomplete foods1 #bbg digestive disturbances in1 #bca energy requirements of1 #aih enterocolitis in1 #bcg errors of diet in1 #bcb1 #bdc feeding1 see ,infant feeding food for1 #bja foods1 see ,infant foods over-feeding1 #bdc premature1 see ,premature infants proprietary foods for1 #bbf quantity of milk needed for1 #aih under-feeding1 #bdc weight of1 #bja ,infant feeding1 #aii alkalies used in1 #bje1 #bjf amount given at each meal1 #baa artificial1 #bje breast versus artificial1 #bdc cane sugar in1 #bbh diluents in1 #bjh1 #bbh formulas for1 #adj1 #bab1 #bbi in abnormal conditions1 #bca lime water in1 #bjf1 #bba malt sugar in1 #bbh method of calculating formulas for1 #bab milk sugar in1 #bbh ,morse and ,talbot's method in1 #bae normal1 #bja over-dilution in1 #bcb regularity in1 #bja1 #bbh rules and regulations for1 #bjd scheme for1 #bag1 #bai sugar in1 #bjg under-dilution in1 #bcb water in1 #bbi ,infant foods1 #adj addition of alkali to1 #bbh dilution of1 #bjh1 #bbh increasing1 #bbi percentage1 computation of1 #bbi preparation of1 #bbi scheme for adding solids to1 #bba ,infected food materials1 #dea ,intestinal digestion1 #agc ,intestinal secretions1 stimulation of1 #agd ,intestinal tract1 diseases of1 #bfc ,intestines1 behavior of foods in1 #afh movements of1 #afh1 #afi muscular contractions in1 #afi ,inunction1 feeding by1 #fb ,invertase1 #aga ,iodine1 source of in food1 #f ,irish moss pudding1 preparation of1 #afj ,iron1 #bh sources of in food1 #e ,jam1 ash constituents of1 #dgd ,jellies1 ash constituents of1 #dgd preparation of1 #aei ,jello1 composition of1 #dij fuel value of1 #dij ,joslin's treatment in diabetes1 #chc ,junket1 preparation of1 #ij ,junket ice cream1 preparation of1 #ij ,kidneys1 function of1 #cbc functional tests for1 #cdg1 #cdh1 #cdi1 #cea limiting work of1 #ccg operations on1 diet after1 #cah1 #cba resting of1 in nephritis1 #cch vitamines in1 #dif ,kohl-rabi1 ash constituents of1 #dgd composition of1 #dij fuel value of1 #dff1 #dij nutrient value of1 #dff ,koumiss1 composition of1 #dij fuel value of1 #dff1 #dij nutrient value of1 #dff ,lactase1 #aga ,lactation1 diet in1 #aia1 #aid1 #aig ,lactone buttermilk1 preparation of1 #ia ,lactose1 #h1 #aa composition of1 #dij fuel value of1 #dij in infant feeding1 #bjg ,lady fingers1 composition of1 #dij fuel value of1 #dij ,lamb1 #aab1 and see ,meats composition of1 #dhj cuts of1 #aag food content of1 #dhj fuel value of1 #dfg1 #dij nutrient value of1 #dfg standard portion of1 #dhj ,lamb chops1 preparation of1 #abd ,lard1 composition of1 #dij fuel value of1 #dfg1 #dij nutrient value of1 #dfg vitamines in1 #dig1 #dih ,lavage1 #bdh in gastric ulceration1 #bee ,leeks1 ash constituents of1 #dgd ,lemon1 ash constituents of1 #dgd food content of1 #dhj fuel value of1 #dfg nutrient value of1 #dfg standard portion of1 #dhj vitamines in1 #dig ,lemonade1 albumenized1 preparation of1 #ig ,lemon cream1 preparation of1 #ach ,lemon ice1 preparation of1 #acf1 #acg1 #afa ,lemon ice cream1 preparation of1 #ia ,lemon jelly1 preparation of1 #ace1 #aei ,lemon juice1 ash constituents of1 #dgd composition of1 #dij fuel value of1 #dfg1 #dij nutrient value of1 #dfg ,lenhartz diet1 in gastric ulceration1 #beg ,lentils1 ash constituents of1 #dgd composition of1 #dij food content of1 #dhj fuel value of1 #dij standard portion of1 #dhj ,lettuce1 ash constituents of1 #dgd composition of1 #dij food content of1 #dhj fuel value of1 #dfg1 #dij nutrient value of1 #dfg standard portion of1 #dhj vitamines in1 #dif von ,leube's enema1 preparation of1 #adf ,limes1 ash constituents of1 #dgd vitamines in1 #dig ,lime juice1 ash constituents of1 #dgd ,lime water1 in infant feeding1 #bjf1 #bba ,linen1 #fd ,linseed meal1 ash constituents of1 #dgd ,lipase1 #aga ,liquid diet1 #fb ,liquid peptonoid eggnog1 preparation of1 #ii ,liquid peptonoids1 composition of1 #dij fuel value of1 #dij ,lister cream puff1 preparation of1 #aei ,lister flour and bran muffins or biscuits1 preparation of1 #aef ,lister muffins1 preparation of1 #aee ,liver1 cirrhosis of1 #djg avoidable foods for1 #djh dietetic treatment in1 #djg composition of1 #dij diseases of1 #djd convalescence1 diet in1 #dje dietetic treatment in1 #dje1 #dad fuel value of1 #dfg1 #dij functions of1 #dac nutrient value of1 #dfg operations on1 diet after1 #cah1 #cba vitamines in1 #dif work of1 #djd ,lobster1 composition of1 #dij fuel value of1 #dfg1 #dij nutrient value of1 #dfg preparation of1 #abf ,lupins1 ash constituents of1 #dgd ,macaroni1 ash constituents of1 #dhj composition of1 #dij food content of1 #dhj fuel value of1 #dfg1 #dij nutrient value of1 #dfg standard portion of1 #dhj ,macaroons1 fuel value of1 #dfg nutrient value of1 #dfg ,mackerel1 and see ,fish composition of1 #dij fuel value of1 #dfg1 #dij nutrient value of1 #dfg ,magnesium1 source of in foods1 #f ,maize1 vitamines in1 #dif ,malnutrition1 #bdb ,maltase1 #aga ,malt extract1 vitamines in1 #dig1 #dih ,malt soup1 preparation of1 #ada ,malt sugar1 in infant feeding1 #bjg1 #bjh ,malted foods1 for infant feeding1 #bjg1 #bbf1 #bbg ,malted milk1 composition of1 #dij fuel value of1 #dij preparation of1 #ib ,malted milk chocolate1 preparation of1 #ib ,malted milk cocoa1 preparation of1 #ib ,malted milk eggnog1 preparation of1 #ii ,malted milk enema1 #adf ,maltose1 #h1 #aj ,mamey1 ash constituents of1 #dge ,mango1 ash constituents of1 #dge ,mangolds1 ash constituents of1 #dge vitamines in1 #dif ,maple syrup1 ash constituents of1 #dge ,marmalade1 fuel value of1 #dfg nutrient value of1 #dfg ,mayonnaise1 preparation of1 #dge ,meals1 serving suggestions for1 #ef1 #ff ,measures and weights1 #gg household1 #gh ,meat extract1 ash constituents of1 #dge ,meat peptone1 ash constituents of1 #dge ,meats1 #aab ash constituents of1 #dge carbohydrate-free1 calorie equivalent of1 #chf cuts of1 #aag quality of1 #aac selection of1 #aaf vitamines in1 #dif ,metabolism1 #aff1 #aha basal1 #db mineral1 #ahe of body tissues1 #ahg of carbohydrates1 #ahb of proteins1 #ahc ,metric system1 #gg ,milk1 #hb adulteration of1 #hf application of heat to1 #hd ash constituents of1 #dge breast versus cows'1 #bjc care of1 #hf certified1 #ha composition of1 #bje1 #dij condensed1 see ,condensed milk diet1 #fc fats in1 measuring according to1 #baj food content of1 #dhj formulas1 #bab1 #bad1 #baf1 #bag fuel value of1 #dfg1 #dij homogenized1 #bji idiosyncrasies against1 #bif method of administering to premature infants1 #bbe modification of1 technique of1 #bji1 #bbh nutrient value of1 #dfg pasteurization of1 #he1 #baa quantity of needed for infant1 #aih relation of food to1 #bjc secretion of1 factors retarding1 #aie1 #aig factors stimulating1 #aie1 #aig selection of1 #hf standard portion of1 #dhj sterilization of1 #hd substitutes for whole1 #bbh sugar-free1 #afb use of in nephritis1 #afb vitamines in1 #dih ,milk and egg enemas1 preparation of1 #ade ,milk and starch enemas1 preparation of1 #adf ,milk cure in nephritis1 #cch ,milk powder1 food content of1 #dhj standard portion of1 #dhj vitamines in1 #dih ,milk punch1 preparation of1 #hh ,milk sauce1 preparation of1 #ic ,milk shake1 preparation of1 #hg ,milk sherbet1 preparation of1 #ach ,milk soups1 preparation of1 #ic ,milk sugar1 in infant feeding1 #bbh ,milk toast1 preparation of1 #aje ,millet1 ash constituents of1 #dge ,millet seed1 vitamines in1 #dig ,mince meat1 fuel value of1 #dfg nutrient value of1 #dfg ,mineral metabolism1 #ahe ,mineral oils1 use of in constipation1 #bgi ,mineral requirements of body1 #ej ,mineral salts1 #be1 #bf absorption of1 #agh sources of in foods1 #e ,mixed diet1 #fc ,molasses1 ash constituents of1 #dge composition of1 #dij food content of1 #dhj fuel value of1 #dfg1 #dij nutrient value of1 #dfg standard portion of1 #dhj ,monosaccharides1 #g ,morse and ,talbot's method of infant feeding1 #bae ,mother's milk1 fuel value of1 #aih making of1 #aih ,mouth1 care of in typhoid1 #bii ,muffins1 diabetic1 preparation of1 #aee ,mushrooms1 ash constituents of1 #dge composition of1 #dij fuel value of1 #dfg1 #dij nutrient value of1 #dfg ,muskmelon1 ash constituents of1 #dge composition of1 #dij fuel value of1 #dfg1 #dij nutrient value of1 #dfg ,mustard1 ash constituents of1 #dge ,mutton1 and see ,meat cuts of1 #aag food content of1 #dhj fuel value of1 #dfh nutrient value of1 #dfh standard portion of1 #dhj ,mutton broth1 preparation of1 #aah ,mutton chops1 preparation of1 #abd ,nectar1 vitamines in1 #dih ,nectarines1 fuel value of1 #dfh nutrient value of1 #dfh ,nephritic diet1 #fc ,nephritis1 #ccf acute1 #ccf adjusting diet in1 #cch adjusting fluids in1 #cch advisable foods in1 #cdd causes of1 #ccf ,chase and ,rose's diet in1 #cdj chronic1 #ccf1 #cdf dietetic treatment in1 #cdf functional tests in1 #cdg1 #cdh1 #cea protein diet in1 #cdf chronic interstitial1 #ceb dietetic treatment in1 #ceb limiting fluid in1 #cec limiting nitrogen in1 #cec selection and preparation of food in1 #ced convalescent diet in1 #cdd diet in1 #cci1 #cde1 #cef effects of1 #ccf elimination of salt in1 #cdj foods to be avoided in1 #cdd ,halpin's diet in1 #cdb ,karell cure in1 #cdb limiting the amount of food in1 #cda milk cure in1 #cch preparation of food in1 #cdc problems to be considered in1 #ccg proteins in1 #cdc resting the kidneys in1 #cch selection of foods in1 #cdc thirst in1 #cdc ,widal's diet in1 #cda ,neufchatel cheese salad1 preparation of1 #aed ,nitrogen1 retention of in infancy1 #bja source of in foods1 #e ,nitrogenous substances1 oxidation and excretion of1 #cbd ,noodles1 composition of1 #dij fuel value of1 #dij ,noodle soup1 preparation of1 #adi ,normal saline solution1 preparation of1 #adf ,nucleoproteins1 #ba ,nursing infant1 food requirements of1 #aid ,nursing mother1 constipation in1 #aig diet of1 #aie habits of1 #bjc ,nuts1 vitamines in1 #dih ,nut charlotte1 preparation of1 #ach1 #afb ,nutrient enemas1 #ade ,nutrition in children1 #ejb ,nutritional index1 #ejc ,oatmeal1 ash constituents of1 #dge composition of1 #dij food content of1 #dha fuel value of1 #dfh1 #dij nutrient value of1 #dfh standard portion of1 #dha ,oatmeal cookies1 preparation of1 #ajf ,oats1 composition of1 #dij fuel value of1 #dij vitamines in1 #dif ,oat water1 preparation of1 #ada ,obese women1 ,rose's reducing diet for1 #dca1 #dcb ,obesity1 #dbd allowable foods in1 #dbi amount of food to be taken in1 #dca ,banting's method in1 #dbf1 #dbg cures for1 #dbe1 #dbf dietetic treatment of1 #dbf1 #dbi1 #ddf diets for1 #fc1 #dbf ,ebstein's method in1 #dbi exercise in1 #dbf in gout1 #dai limiting fluids in1 #dbf massage in1 #dbe menus for1 #dcj1 #dce1 #dcf1 #dcg ,oertel's method for1 #dbg ,proudfit's menu for1 #dbi1 #dcc1 #dcd ,rose's diet for1 #dca1 #dcb ,oertel's method in obesity1 #dbg ,oils1 vitamines in1 #dig1 #dih ,okra1 ash constituents of1 #dge composition of1 #dij fuel value of1 #dfh1 #dij nutrient value of1 #dfh ,oleo1 vitamines in1 #dig1 #dih ,olives1 ash constituents of1 #dge composition of1 #dij fuel value of1 #dfh1 #dij nutrient value of1 #dfh ,olive oil1 composition of1 #dij fuel value of1 #dij ,olmstead bran cakes1 preparation of1 #adh ,onion1 ash constituents of1 #dge composition of1 #dib food content of1 #dha fuel value of1 #dfh1 #dib nutrient value of1 #dfh standard portion of1 #dha vitamines in1 #dif ,operations1 diet in relation to1 #cab ,orange1 ash constituents of1 #dge composition of1 #dib food content of1 #dha fuel value of1 #dfh1 #dib nutrient value of1 #dfh standard portion of1 #dha vitamines in1 #dig ,orangeade1 preparation of1 #if ,orange charlotte1 preparation of1 #ach1 #afb ,orange ice1 preparation of1 #acf1 #acg1 #afa ,orange jelly1 preparation of1 #ace1 #afj ,orange rice custard1 preparation of1 #ajh ,orange tapioca1 preparation of1 #ajf ,organic acids1 #ac ,over-dilution of infant's food1 #bcb ,over-feeding of infants and children1 #bdc ,oxidases1 #aga ,oxtail soup1 fuel value of1 #dfh nutrient value of1 #dfh ,oyster broth1 preparation of1 #aai ,oyster soup1 preparation of1 #id ,oysters1 ash constituents of1 #dge composition of1 #dib food content of1 #dha fuel value of1 #dfh1 #dib nutrient value of1 #dfh standard portion of1 #dha ,pancreas1 vitamines in1 #dif ,panopepton1 composition of1 #dib fuel value of1 #dib ,panopepton eggnog1 preparation of1 #ii ,paprika1 ash constituents of1 #dge ,parsley butter1 preparation of1 #aed ,parsnips1 ash constituents of1 #dge composition of1 #dib food content of1 #dha fuel value of1 #dfh1 #dib nutrient value of1 #dfh standard portion of1 #dha vitamines in1 #dif ,pasteurization1 #he1 #baa ,pea soup1 fuel value of1 #dfh nutrient value of1 #dfh ,peaches1 ash constituents of1 #dge composition of1 #dib food content of1 #dha fuel value of1 #dfh1 #dib nutrient value of1 #dfh standard portion of1 #dha ,peanut butter1 composition of1 #dib fuel value of1 #dib ,peanuts1 ash constituents of1 #dge composition of1 #dib food content of1 #dha fuel value of1 #dfh1 #dib nutrient value of1 #dfh standard portion of1 #dha vitamines in1 #dig ,pears1 ash constituents of1 #dge composition of1 #dib food content of1 #dha fuel value of1 #dfh1 #dib nutrient value of1 #dfh standard portion of1 #dha vitamines in1 #dig ,pear juice1 ash constituents of1 #dge ,peas1 ash constituents of1 #dge composition of1 #dib food content of1 #dha fuel value of1 #dfh1 #dib nutrient value of1 #dfh standard portion of1 #dha vitamines in1 #dif1 #dig ,pecans1 ash constituents of1 #dge composition of1 #dib food content of1 #dha fuel value of1 #dib standard portion of1 #dha ,pelidisi1 the1 #ejc ,pelidisi chart1 #ejb ,pellagra1 dietetic treatment in1 #dee1 #def1 #dei ,peppers1 ash constituents of1 #dgf composition of1 #dib food content of1 #dha fuel value of1 #dfi1 #dib nutrient value of1 #dfi ,pepsin1 #aga ,peptonized milk1 preparation of1 #hh ,peptonized milk punch1 preparation of1 #hi ,peptonoids1 dry1 composition of1 #dhh fuel value of1 #dhh liquid1 composition of1 #dij fuel value of1 #dij ,percentage calculations1 #gi1 #bbi ,perch1 see ,fish ,persimmons1 ash constituents of1 #dgf fuel value of1 #dfi nutrient value of1 #dfi ,phosphoproteins1 #ba ,phosphorized fats1 #ae ,phosphorus1 #bg1 #ahf requirements in pregnancy and lactation1 #aia sources of in food1 #e ,pies1 fuel value of1 #dfi nutrient value of1 #dfi ,pig heart1 vitamines in1 #dif ,pineapple1 ash constituents of1 #dgf composition of1 #dib food content of1 #dha fuel value of1 #dfi1 #dib nutrient value of1 #dfi standard portion of1 #dha ,pineappleade1 preparation of1 #ig ,pine nuts1 fuel value of1 #dfi nutrient value of1 #dfi ,pistachios1 fuel value of1 #dfi nutrient value of1 #dfi ,placenta1 vitamines in1 #dif ,plums1 ash constituents of1 #dgf composition of1 #dib food content of1 #dha fuel value of1 #dfi1 #dib nutrient value of1 #dfi standard portion of1 #dha ,pneumonia1 #cjf1 #caa convalescent diet in1 #cjg diet schedules for1 #cjg dietetic treatment in1 #cjf1 #cjg1 #caa ,poached eggs1 preparation of1 #aja ,poaching1 #ga ,poisoning1 food1 #ff1 #dea ,polysaccharides1 #h1 #aa ,pomegranates1 ash constituents of1 #dgf fuel value of1 #dfi nutrient value of1 #dfi ,pork1 #aaf1 and see ,meat fuel value of1 #dfi nutrient value of1 #dfi vitamines in1 #dih ,port wine1 composition of1 #dib fuel value of1 #dib ,postoperative feeding1 #caf1 #cai1 #cbj ,potassium1 sources of in food1 #f ,potato chips1 fuel value of1 #dfi nutrient value of1 #dfi ,potatoes1 ash constituents of1 #dgf composition of1 #dib food content of1 #dha fuel value of1 #dfi1 #dib nutrient value of1 #dfi standard portion of1 #dha vitamines in1 #dif ,potatoes stuffed with meat1 preparation of1 #acj ,poultry1 #aab1 and see ,meats ,pregnancy1 #aia albuminuria in1 #aig diet in1 #aib1 #aic1 #aid1 #aif1 #aig nutritional disturbances in1 #aia ,premature infants1 dilution of food for1 #bbe energy requirements of1 #bbd feeding of1 #bbd1 #bbe1 #bbi ,pre-operative feeding1 #cab1 #cah1 #cbj ,presbyterian ,hospital diet list in typhoid fever1 #bib ,protein milk1 preparation of1 #adb ,proteins1 #ag alcohol-soluble1 #ba calories in1 #ch classification of1 #ai composition of1 #ah conjugated1 #ba construction of1 #ai effect of heat upon1 #bb1 enzymes acting upon1 #aga excess of in infant's and children's food1 #bcd fate of1 #ahc function of in body1 #bc metabolism1 #ahc in nephritis1 #cdc rate of digestion of1 #agc requirements in body1 #ej sources of1 #d tolerance of in diabetes1 #cha ,proudfit's menu for obesity1 #dbi reducing diet for obesity1 #dcc1 #dcd ,prune fig whip1 preparation of1 #aci ,prunes1 ash constituents of1 #dgf composition of1 #dib food content of1 #dha fuel value of1 #dfi1 #dib nutrient value of1 #dfi standard portion of1 #dha ,prunes and figs1 preparation of1 #adc ,prune whip1 preparation of1 #aci ,ptomaines1 #ff poisoning by1 #dea dietetic treatment for1 #dea1 #deb ,ptyalin1 #aga ,pumpkins1 ash constituents of1 #dgf fuel value of1 #dfi nutrient value of1 #dfi ,punch1 milk1 preparation of1 #hh ,purin bases1 #ahd content of food1 #dba ,purin-free diet1 #fc in gout1 #dai ,purins1 enzymes acting upon1 #aga ,quail1 composition of1 #dib fuel value of1 #dib ,radishes1 ash constituents of1 #dgf food content of1 #dha fuel value of1 #dfi nutrient value of1 #dfi standard portion of1 #dha ,raisins1 ash constituents of1 #dgf composition of1 #dib fuel value of1 #dfi1 #dgf nutrient value of1 #dfi vitamines in1 #dig ,raspberries1 ash constituents of1 #dgf composition of1 #dib fuel value of1 #dgj1 #dib nutrient value of1 #dgj ,rectal feeding1 #fj1 #fa1 #cae ,respiratory tract1 diseases of1 #cja ,requirements1 basal1 #db ,rhubarb1 ash constituents of1 #dgf composition of1 #dib food content of1 #dha fuel value of1 #dgj1 #dib nutrient value of1 #dgj standard portion of1 #dha ,rice1 ash constituents of1 #dgf composition of1 #dib food content of1 #dha fuel value of1 #dgj1 #dib nutrient value of1 #dgj preparation of1 #ajd standard portion of1 #dha vitamines in1 #dif ,rice custard1 preparation of1 #ajh ,rickets1 #bda calcium retention in1 #bda dietetic treatment of1 #bda ,roast chicken1 preparation of1 #abb ,roast duck1 preparation of1 #abb ,roast turkey1 preparation of1 #abb ,roasting1 #ga ,romaine1 ash constituents of1 #dgf ,rose's reducing diet for obese women1 #dca1 #dcb ,rum1 composition of1 #dib fuel value of1 #dib ,rutabaga1 ash constituents of1 #dgf vitamines in1 #dif ,rye1 and see ,bread1 and ,flour ash constituents of1 #dgf vitamines in1 #dig ,saccharine1 test for1 #fi ,salad1 egg1 preparation of1 #aed ,salads1 fruit1 preparation of1 #aca vegetable1 preparation of1 #aca ,saline solution1 normal1 #adf ,saliva1 #agb ,salivary digestion1 #agb ,salisbury steak1 preparation of1 #adi ,salmon1 and see ,fish composition of1 #dib fuel value of1 #dgj1 #dib nutrient value of1 #dgj ,salmon1 molded1 preparation of1 #aej ,salt1 elimination of in nephritis1 #cdj ,salt content of foods1 #ceh1 #cei1 #cfj ,salt-free diet1 #fc ,salt-poor diet for nephritis1 #cda ,saltines1 composition of1 #dib fuel value of1 #dib ,sapota1 ash constituents of1 #dgf ,sardines1 composition of1 #dib fuel value of1 #dib ,sauce for puddings1 preparation of1 #aaa1 #aab ,sausage1 fuel value of1 #dgj nutrient value of1 #dgj ,sauteing1 #ga ,scalloped potatoes1 preparation of1 #aca ,scurvy1 #bdj treatment of1 #bdj ,secretin1 #agd ,secretory cells1 distribution of1 #afi ,secretory processes disturbed in diseases of stomach1 #bdf ,seeds1 vitamines in1 #dig ,semi-solid diet1 #fb ,serving meals1 suggestions for1 #ef1 #ff ,shad1 composition of1 #did fuel value of1 #dgj1 #did nutrient value of1 #dgj ,shellfish1 #aab1 and see ,meats ,sherry wine1 composition of1 #did fuel value of1 #did ,shredded wheat1 ash constituents of1 #dgf food content of1 #dha fuel value of1 #dgj nutrient value of1 #dgj standard portion of1 #dha ,shrimp1 ash constituents of1 #dgf ,silver1 #fd ,simmering1 #gj ,singer's enema1 preparation of1 #adf ,sippi diet1 in gastric ulceration1 #bef ,snow-balls1 preparation of1 #ajh ,snow pudding1 preparation of1 #aci1 #aei ,soap stools1 #bcc ,sodium1 sources of in food1 #f ,soft-cooked eggs1 #ajj ,soft custard1 preparation of1 #ajb ,soups1 ash constituents of1 #dgf preparation of1 #aah ,soya manna muffins1 preparation of1 #adh ,soya meal and bran muffins1 preparation of1 #aeg ,spanish cream1 preparation of1 #aeh ,special diets1 #fb1 #fc ,spice cookies1 preparation of1 #aeb ,spinach1 ash constituents of1 #dgf composition of1 #did fuel value of1 #dgj1 #did nutrient value of1 #dgj vitamines in1 #dif ,spinach and egg salad1 preparation of1 #adg ,spinach soup1 preparation of1 #aeb ,sponge pudding1 preparation of1 #aji ,squab1 composition of1 #did fuel value of1 #did ,squab pie1 preparation of1 #aea ,squash1 ash constituents of1 #dgf composition of1 #did food content of1 #dha fuel value of1 #dgj1 #did nutrient value of1 #dgj standard portion of1 #dha ,standard broth1 preparation of1 #aah ,standard portion of foods1 #dj1 #dgh ,starch1 excess of in food formulas1 #bcf ,starchy desserts1 preparation of1 #ajh ,starvation1 in treatment of diabetes1 #cgb ,steaming1 #gj ,steapsin1 #aga ,sterilization1 #hd ,stewed tomatoes on toast1 preparation of1 #acd ,stomach1 and see ,gastric acid content of1 determining1 #bdh arrangement of food in1 #afg diseases of1 predisposing factors in1 #bde disturbance of motility and tone of1 #bdf disturbance of secretory processes in1 #bdf fermentation in1 #ahj passage of food from1 #afh secretion of water in1 #agd ,strawberries1 ash constituents of1 #dgf composition of1 #did food content of1 #dha fuel value of1 #dgj1 #did nutrient value of1 #dgj standard portion of1 #dha ,strawberry ice1 preparation of1 #acg ,strawberry juice1 composition of1 #did fuel value of1 #did ,string beans1 and see ,beans preparation of1 #abi ,succotash1 fuel value of1 #dgj nutrient value of1 #dgj ,sucrase1 #aga ,sucrose1 #h1 #aj ,suet1 composition of1 #did fuel value of1 #did ,sugar1 adjusting of1 in food formulas1 #bce composition of1 #did fuel value of1 #dgj1 #did in infant feeding1 #bjg in urine1 in diabetes1 #cga tests for1 #cbh1 #ccj1 #cca nutrient value of1 #dgj ,sugar-free milk1 #afb ,sugar-splitting enzymes1 #aga ,sulphur1 sources of in food1 #f ,sunflower seeds1 vitamines in1 #dig ,sunshine cake1 preparation of1 #aaj ,sweetbreads1 composition of1 #did fuel value of1 #did preparation of1 #abc vitamines in1 #dif ,tallow1 vitamines in1 #dih ,tamarind1 ash constituents of1 #dgf ,tapioca1 ash constituents of1 #dgg composition of1 #did food content of1 #dhb fuel value of1 #did standard portion of1 #dhb ,tapioca custard1 preparation of1 #aji ,test meals1 #bej ,thermometry1 #hj ,thirst1 in nephritis1 #cdc in typhoid fever1 #bii ,thymus1 vitamines in1 #dif ,timothy1 vitamines in1 #dih ,toast1 composition of1 #did fuel value of1 #did preparation of1 #aje ,tomatoes1 ash constituents of1 #dgg composition of1 #did food content of1 #dhb fuel value of1 #dgj1 #did nutrient value of1 #dgj standard portion of1 #dhb vitamines in1 #dig ,tomato aspic1 preparation of1 #aed ,tomato bisque1 preparation of1 #aeb ,tomato jelly1 preparation of1 #acb ,tomato juice1 ash constituents of1 #dgg ,tomato salad1 preparation of1 #aca1 #acb ,tomato stuffed with rice1 preparation of1 #acc ,tonsillitis1 dietetic treatment of1 #cji1 #caj ,toxins1 elimination of1 #cbc ,tray1 #fd arranging1 #fe ,trout1 composition of1 #did fuel value of1 #did ,truffles1 ash constituents of1 #dgg ,trypsin1 #aga1 #agd ,tuberculosis1 #cja1 #cje dietetic treatment in1 #cjb high calorie diet in1 #cjd reenforcing the diet in1 #cjf schedule of diets in1 #cjg ,tuna1 fuel value of1 #dgj nutrient value of1 #dgj ,tuna fish salad1 preparation of1 #aed ,turkey1 composition of1 #did fuel value of1 #dgj1 #did nutrient value of1 #dgj selection of1 #aad ,turnips1 ash constituents of1 #dgg composition of1 #did food content of1 #dhb fuel value of1 #dgj1 #did nutrient value of1 #dgj standard portion of1 #dhb ,turnip tops1 ash constituents of1 #dgg ,typhoid fever1 #bhh1 #big absorption of food in1 #bij1 #big acidosis in1 #bii care of mouth in1 #bii ,coleman's high calorie diet in1 #bhi1 #bia1 #bid1 #bie1 #bih1 #bii energy expenditures in1 #bhh1 #big energy requirements in1 #bhi1 #big essential points in dietary1 #big hemorrhage in1 #bif1 #bih high calorie diet in1 #bhi1 #bia1 #bid1 #bie1 #bih1 #bii idiosyncrasies in1 #cjj increasing diet in1 #bij1 #cjj liquid diet in1 #bij1 #bic milk diet in1 #bia1 #bih ,presbyterian ,hospital diet list for1 #bib rate of metabolism in1 #big reenforcing diet in1 #cjj semi-solid diet in1 #bic soft diet in1 #bic thirst in1 #bii tympanites in1 #bij varying diet in1 #bib ,under-dilution of infants' foods1 troubles due to1 #bcb ,under-feeding in infants and children1 #bdc ,urea and salt test1 #cea ,uremia1 #cec1 #cfa ,uremic poisoning1 #cfa ,uric acid1 #cbd elimination of1 #dag formation of1 #ahd source of1 #dag ,urinalysis1 #cbc ,urine1 acetone in1 test for1 #ccc albumin in1 tests for1 #ccc analysis of1 #cbc1 #cbd collection of1 #cbf1 #ccd diacetic acid in1 test for1 #ccb diseases in which it is diminished1 #cbf effect of food upon1 #cbf examination of1 #cbc1 #cbd in diabetes1 #cbh1 #cbi1 #ccj1 #cga1 #dja1 #djb indican in1 test for1 #ccd preserving1 #cce sugar in1 tests for1 #cbh1 #cbi1 #ccj1 #cca ,utensils1 care of1 #gf ,vanilla ice cream1 preparation of1 #ia ,veal1 #aab1 #aad1 and see ,meats composition of1 #did cuts of1 #aag food content of1 #dhb fuel value of1 #dgj1 #did method of preparation1 #aag nutrient value of1 #dgj standard portion of1 #dhb ,veal bird1 preparation of1 #aej ,veal broth1 preparation of1 #aah ,veal cutlets1 preparation of1 #abd ,vegetable oils1 vitamines in1 #dih ,vegetable salads1 preparation of1 #aca ,vegetable soups1 fuel value of1 #dga nutrient value of1 #dga preparation of1 #bbc ,vegetables1 preparation of1 #abf1 #abh1 #aec vitamines in1 #dif ,vinegar1 ash constituents of1 #dgg ,vitamines1 #bi fat soluble ,a1 #ae in foods1 #dif1 #dig1 #dih functions of1 #cj1 #ca in foods1 #dif1 #dig1 #dih requirements of in body1 #eb source of in foods1 #f1 #g water soluble ,b1 #ca in foods1 #dif1 #dig1 #dih water soluble ,c1 #cc in foods1 #dif1 #dig1 #dih ,walnuts1 ash constituents of1 #dgg composition of1 #did food content of1 #dhb fuel value of1 #dga1 #did nutrient value of1 #dga standard portion of1 #dhb vitamines in1 #dih ,water1 #bd absorption of1 #agg administration of to infants1 #bbi as a fat maker1 #dbe as a stimulant to gastric secretion1 #bec excretion of1 #cbd factors determining amount needed1 #be function of1 #bd sources of in foods1 #e ,water soluble ,b1 #ca effect of alkalies upon1 #cb effect of heat upon1 #cb functions of1 #ca in foods1 #f1 #dif1 #dig1 #dih ,water soluble ,c1 #cc effect of heat upon1 #cc in foods1 #g1 #dif1 #dig1 #dih ,water-cress1 ash constituents of1 #dgg ,water ices1 preparation of1 #acf ,watermelon1 ash constituents of1 #dgg composition of1 #did food contents of1 #dhb fuel value of1 #dga1 #did nutrient value of1 #dga standard portion of1 #dhb ,weights and measures1 #gg household1 #gh metric1 #gg ,weights and heights of children1 #di1 #dii1 #ejj1 #eja ,wet nurses1 #bbi ,wheat1 ash constituents of1 #dgg composition of1 #did fuel value of1 #dga1 #did nutrient value of1 #dga vitamines in1 #dig ,whey1 #hc ash constituents of1 #dgg composition of1 #did fuel value of1 #did vitamines in1 #dih ,whey mixtures1 #bbf ,whitefish1 composition of1 #did fuel value of1 #dga1 #did nutrient value of1 #dga ,whortleberries1 ash constituents of1 #dgg ,widal's diet in nephritis1 #cda ,wine1 ash constituents of1 #dgg ,wine jelly1 preparation of1 #acf1 #afj1 #afa ,wine panada1 preparation of1 #aje ,wine sauce1 preparation of1 #aaa ,work1 influence of upon food requirements1 #dc ,yeast1 vitamines in1 #dih ,zwieback1 composition of1 #did fuel value of1 #dga1 #did nutrient value of1 #dga ,transcriber's ,note ,minor punctuation errors have been repaired4 ,hyphenation and accent usage has been made consistent4 ,there are some errors in calculation in places2 these have been preserved as printed4 ,for example1 addition errors in the table on pp4 #cgg-h4 ,variable spelling is preserved as printed 7e4g4 sirup and syrup74 #ab ,m4 has been used inconsistently1 to indicate either #ab ,midnight or #ab ,midday4 ,it has been preserved as printed in all cases4 ,calorie count or separate ingredients lists are omitted from some recipes2 these are left as printed4 ,the ',eggs' section1 starting on page #ie1 has no recipes included4 ,however1 the following ',fruit ,beverages' section has a large number of egg recipes included in it4 ,whether this was an error or intentional is unclear1 so the sections and ordering of recipes have been preserved as they appeared in the original publication4 ,the recipe for ,foamy ,sauce appears twice1 once each on page #aaa and #aab4 ,there is no apparent difference apart from the calorie amount4 ,both versions have been left in place4 ,the recipe for ,sauce for ,puddings 7page #aab7 appears identical to the recipe for ,wine or ,fruit ,sauce 7page #aaa71 except for the recipe name and calorie amounts4 ,both versions have been left in place4 ,the table heading on page #aag refers to cuts of lamb and mutton1 while the table itself refers to lamb and veal4 ,this has been left as printed4 ,there are two instances of a recipe called ,beef ,juice1 on pages #aai and #ada4 ,both have been left in place as printed4 ,the following amendments have been made3 ,page #cj--,mellanbly amended to ,mellanby--,mellanby of ,england believes the ,a vitamine to be a factor 444 ,page #ca--or amended to of--,effect of ,heat on the ,a ,vitamine4 ,page #gg--the first reference to centigram has been amended from c4 to cgm4 ,page #hj--;in amended to is--444 that every ,fahrenheit degree is #i_/e times as large 444 ,page #ib--;erroneous 'or' removed from second malted milk recipe 7original called for either milk and water or salt74 ,page #aaa--omitted word 'juice' added to ingredients list in ,wine or ,fruit ,sauce recipe4 ,page #abe--omitted subheading for ,fish added4 ,page #abh--repeated heading ',vegetables and ,fruits' removed4 ,page #aca--omitted 'or' added to dressing options in ,tomato 7,no4 #a7 recipe4 ,page #acd--;in the ingredients for ,french ,dressing1 paprika amended to salt1 to follow the recipe4 ,page #ade--superfluous 'and' deleted between paragraph starting #a_/b cup raisins 444 and paragraph starting ,cream butter and sugar 444 ,page #adf--;chlorid amended to chloride--#a dram sodium chloride 7common salt7 ,page #adf1 footnote--,ellithorp amended to ,ellithorpe-- ,courtesy of ,misses ,foley and ,ellithorpe1 ,dieticians4 ,page #adg--;agar gar amended to agar-agar--#a tsp4 or #g gms4 agar-agar ,page #aef--superfluous 'grams' removed following calorie count in ,casoid ,flour and ,bran ,muffins recipe4 ,page #aef--omitted '1 trace2' added to carbohydrate quantity for one muffin in the ,casoid ,flour and ,bran ,muffins recipe4 ,page #aeg--omitted 'protein1' added to #b grams quantity for one muffin in the ,soya ,meal and ,bran ,muffins recipe4 ,page #agb--;dioxid amended to dioxide--,those which produce carbon dioxide without the use 444 ,page #aid--;grapefuit amended to grapefruit--444 dates1 figs1 or grapefruit1 stewed or raw4 ,page #bac--proced amended to proceed--444 we will proceed with the method itself4 ,page #bai--zweiback amended to zwieback--444 pieces of stale bread1 toast or zwieback4 ,page #bda--,mellenby amended to ,mellanby--,mellanby of ,england claims that the oil owes its curative 444 ,page #bdd;f--empysema amended to emphysema--444 broncho-pneumonia1 acute emphysema and collapse of the lung 444 ,page #bei--,soft-cooked egg 7#a7 has been amended to #a soft-cooked egg in the #aa ,a4,m4 section of the ,seventh ,day diet1 for consistency with other entries4 ,page #bgb--omitted heading ',,breakfast' added4 ,page #bha--tonsilitis amended to tonsillitis--444 as accompany colds1 tonsillitis1 chicken pox 444 ,page #ccg--omitted 'of' added--444 the end-products of the nitrogenous foods ingested1 444 ,page #cdi--;grams amended to c4c4--,supper #e ,p4,m4 444 #bjj c4c4 444 ,page #che--;,huntly amended to ,huntley 7,breakfast biscuit entry on table74 ,page #djg--;bilous amended to bilious--,in certain individuals beer will induce a bilious attack4 ,page #dce--supportting amended to supporting--444 which have been deprived of the supporting fat4 ,page #dgf--,sapato amended to ,sapota 7in table74 ,page #dha--;,horlick amended to ,horlick's 7milk powder entry in table74 ,page #eai--,the index entry for ,organic acids originally followed ,over-feeding of infants and children4 ,it has been moved to the correct place4 ,page #ebc--,the index entry for ,utensils originally followed ,under-feeding in infants and children4 ,it has been moved to the correct place4