Bt\n |9or6 g>tate College of agriculture St Cornell ^Hnibersitp Stftaca, M. B. Eibrarp Cornell University Library RM 216.P31910 Practical dietetics, with reference to di ■T 1924 003 487 992 Cornell University Library The original of tliis book is in tine Cornell University Library. There are no known copyright restrictions in the United States on the use of the text. http://www.archive.org/details/cu31924003487992 PRACTICAL DIETETICS WITH REFERENCE TO DIET IN DISEASE ^ ^ PRACTICAL DIETETICS WITH REFERENCE TO DIET IN DISEASE BY ALIDA FRANCES PATTEE Graduate, Department o( Household Arts, Slate Normal School, Framingham, Mass. Late Instructor in Dietetics, Bellevue Training School for Nurses, Bellevue Hospital, New York City. Former Instructor at Mount Sinai, Hahnemann, and the Flower Hospital Training Schools for Nurses, New York City; Lakeside, St. Mary's, Trinity, and Wisconsin Training Schools for Nurses, Milwaukee, Wis.; St. Joseph's Hospital, Chicago, 111.; St. Vincent de Paul Hospital, Brockrflle, Ontario, Canada. SIXTH EDITION Revised and Enlarged Price $1.50 F. PATTEE, Publisher Mount Vernon, New York 1910 Set up, electrotyped, printed, and copyrighted, June, 1903 Reprinted July, 1904, February, 1905, October, 1906. and November, 1908 Revised, reset, and recopyrighted December, 1910 Copyright, 1903, 1904, 1905, igio, by ALIDA FRANCES PATTEE Entered at Stationers' Hall ^ Alt rights reserved JLo tbe ti:raine& murse: xmosc bail^ life is a blessing to bumanit^e PEEPACE TO THE SIXTH EDITION The very gratifying demand for this work has necessitated the preparation of a sixth edition. Advantage has been taken of this opportunity to revise the book and incorporate, as far as space allows, the latest results of research in die- tetics. To meet the growing tendency of physicians to pre- scribe the exact fuel value of a diet, the total energy value of each recipe has been calculated wherever data as to com- position of materials used are available, or the quantities of materials used are fairly constant. A table has also been introduced in which the food value of the materials used in the recipes is given. This will be useful in computing other food combinations, and in calculating the amount of protein^ fat or carbohydrates in any dietary, whenever required, with- out the tedious mathematical processes usually involved in such operations. It is hoped that a revised classification of food principles, greater emphasis on the valufe of mineral matter in the diet, and fuller discussion of the fundamental principles of nutri- tion, will add much to the usefulness of the book. In the introduction are presented outlines showing the re- quirements in dietetics of the various State Boards of Ex- aminers of Nurses, and the contents of the book have been rearranged to correspond directly with these requirements. This will materially aid the dietitian in arranging the course of study for the nurse so as to prepare her adequately for her State Examinations. Many years of experience as an instructor in dietetics in hospitals seem to the author to demonstrate that the "recipe book," so-called, should not be separate from the volume on "theory." Both theoretical and practical work should be vii viii PREFACE treated together, otherwise, while the subjects are naturally closely allied, the young student becomes confused and is not apt to apply the theory to the practice. In this book she cannot read a recipe without having her attention called to its function in nutrition. Furthermore, for convenience sake, the two should be combined in one book of moderate size. One hundred and fifty pages have been added to this edition with but little increase in bulk. I take pleasure in acknowledging the valuable assistance rendered by Dr. Mary D. Swartz Eose, Assistant Professor of Household Arts, Teachers College, Columbia University, 'New York, in the preparation of this', edition ; also again to express my thanks for valuable material used in the book to Mrs. Ellen H. Eichards, Dr. W. Gihnan Thompson, Dr. Max Einhorn, Dr. Henry Koplik, Dr. L. Emmett Holt, Dr. Louis Starr, Dr. Frederick C. Shattuck, Dr. Elbridge G. Cutler, Dr. Elliott P. Joslin, Dr. Harry W. Goodall and Dr. Maynard Ladd. Alida Erances Patteb. New York, December, 1910. Extract Fhom Preface to Fifth Edition I have been particularly pleased to see "Practical Dietet- ics " accepted as a text-book by so many educational and other authorities. Thus it is to be found in all hospitals of the United States Army ; it has been recommended for use by all the various State Boards of Examiners of Nurses that have thus far been appointed ; it has been adopted by the military authorities in Canada for the Permanent Schools of Instruc- tion for the Militia, and it has also been added to the Author- ized Text Book list of the New York City and Boston Public Schools. New York, November, 1908. PEEFACB TO THE SECOND EDITION The very cordial reception of the first edition of Practical Dietetics has encouraged a second presentation. In the preparation of the second issue the original matter has been thoroughly revised, and important additions made. For valuable material I am indebted to the following physicians, hospitals and publishers, and gratefully acknowl- edge their assistance and kind permission accorded by them to quote their several diets. Dr. W. Gilman Thompson, Professor of Medicine in the Cornell University Medical College in New York City and visiting physician to the Presbyterian and Bellevue Hos- pitals : Dr. Max Einhorn, Professor of Clinical Medicine at the New York Post-Graduate Medical School and Hospital, vis- iting physician to the German Dispensary: Dr. Henry Koplik, attending physician Mount Sinai Hos- pital, ex-president of the American Paediatric Society: Dr. L. Emmett Holt, Professor of Diseases of Children in the College of Physicians and Surgeons (Columbia Uni- versity), attending physician at the Babies' Hospital and Foundling Hospital, New York : Dr. Louis Starr, Consulting Paediatrist to the Maternity Hospital, Philadelphia; late Clinical Professor of Diseases of Children in the Hospital of the University of Pennsyl- vania : Dr. Frederick C. Shattuck, Professor of Clinical Medicine in Harvard University, visiting physician Massachusetts Gen- eral Hospital: Dr. Elbridge G. Cutler, Instructor in Theory and Prac- tice at Harvard Medical School, visiting physician Massa- chusetts General Hospital: ix X PREFACE Dr. Nathan Smith Davis, late Dean Northwestern TJni-, versity Medical School, Chicago: Bellevue Hospital, Mount Sinai Hospital, the Presby- terian Hospital, the Society of Lying-in Hospital (New- York), Massachusetts General Hospital, Boston: D. Appleton & Co., Blakiston & Co., William Wood & Co., and the publisher of the Dietetic and Hygienic Gazette: And sincere thanks are due Mrs. Ellen H. Eichards (In- structor in Sanitary Chemistry, Massachusetts Institute of Technology) for aid and information, also for permission to quote from the Eumford Kitchen Leaflets. A. F. Pattee. •New York, July, 1904. PEEFACE TO THE FIEST EDITION As instructor of dietetics at various hospitals I have con- stantly felt the need of a simple manual and text-book for the use. of the nurse in the classroom. None could be found which fulfilled the requirements as to simplicity, brevity, and exactness, with reference to dietetic treatment in disease. This same need has been expressed by mothers and nurses outside of the hospital. In the following pages I have endeavored to meet this need by giving the result of knowledge gained during the past eight years of practical classwork experience in hospitals of different cities. The preparation of food is a science as well as an art, the chemistry of which is as precise as the chemistry of the laboratory. When we are willing to be as exact and care- ful in this work as we are in chemical experiments, our suc- cess will become a certainty. No other technical art can, with so little practical knowledge, go as far in simplifying that which is otherwise complicated and laborious, or do more toward accomplishing that which is a chief result of all science — adding to the comfort and happiness of the human race. A. F. Patteb. New York, July, 1903. zi INTEODUCTION In response to the many requests of Superintendents of Training Schools and Dietitians for an outline of the va- rious State Board Eequirements in Dietetics, I herewith quote with permission the following outlines of courses of study recommended by the American Hospital Association, New York, Minnesota, Illinois and Colorado State Boards of Examiners of Nurses. Answers to all questions are to be found in this book. Requirements of other States when issued will be added in each new edition of " Practical Dietetics." These outlines will prove of assistance to the Dietitian in arranging her course of study for the nurse, and will also prove suggestive to the nurse in preparing for her State Examinations. Through the kindness of the various State Boards of Examiners of Nurses I am also able to quote the examination questions of various States. Course op Study in Dietetics Aerakged by the American Hospital Association PRELIMINARY TERM Dietetics: Classification of foods, care of foods, cooking of foods, serving of foods. First Year Tray setting and food serving; feeding the helpless and delirious patients; management of liquid diet. Second and Third Year Milk modification for infants according to diflferent formulse; also for fever patients and invalids. " It is recommended that continued and special attention be given throughout the second year, to dietetics, hygiene and the management of special diseases." xiii xh INTRODUCTION Second Yeak THeobetical Work Foods and food value; eight to fourteen hours. Third Year Practical Work Diet kitchen practice, including the modification of milk, one to two months. ' Course op Study in Dietetics Arranged by the Colorado State Board Dietetics FOOD — DEFINITION — CLASSIFICATION 1. Organic — a. Proteids. b. Fats. c. Carbohydrates. 2. Inorganic — a. Water. b. Salts. 3. The uses of foods in disease. 4. Practical work should be given in at least twelve (12) lessons and should include plain and fancy cooking for in- valids. 5. Pupils should be familiar with the text of either Pattee, Farmer or equivalent. Course of Study in Dietetics Arranged by the Illinois State Board PRELIMINARY TERM Dietetics Second Four Weeks Simple nourishments. Hospital diet lists. Times of feeding. Methods of feeding. Preparation of the following, to be served to patients : Milk, cold and hot. Malted milk, cold and hot. Lemonade. Beer. Gruel. Egg-nog. Orangeade. Root Beer. Soda-pop. Butter- milk. Fruit Juices. Broth. First Year Diet Cooking: 12 practical demonstrations, 2 hours each. INTRODUCTION xv Course op Study in Dietetics Arranged by the Minnesota Stath Board SECOiro YEAR Dietetics Theoretical Work (Anatomy and Physiology of digestion. Review subject as al- ready given in Anatomy, i. e. — mechanical and chemical processes, absorption, assimilation, metabolism, elimination.) Food — definition of, source, function, composition, classification and food adjuncts. Water — minerals, fats and oils, carbohydrates and proteids, each studied as to their composition, food value, digestion and compara- tive values. General principles to be observed in cooking of starcli, meat, eggs, poultry, game, fish, cereals and vegetables. Practical Work Dietetics — 24 two-hour lessons — individual class work under dietitian. (15 minutes to theory and remainder of period to prac- tical work.) Practical work to include the proper methods of preparing and serving: Coffee, tea, cocoa, chocolate, beef juice, beef broth, chicken broth, oyster broth, egg-nog, albumin, milk. Cream soups (tomato, corn, celery, pea). Toast, crofltons, pulled bread. Bread — graham, wheat, whole wheat, gluten, nut. Light desserts — cornstarch, gela- tin, ices, ice cream, baked apples. Eggs — soft-boiled, poached, creamed, custard, omelet. Beefsteak, lamb chops, roast beef, roast lamb, bacon, sweetbreads, scraped beef. Chicken and game. Baked and broiled whitefish, halibut, bass, brook trout, oysters. Rice, oat- meal, cream of wheat, rolled oats. Potatoes — baked, boiled, creamed, escalloped and stuffed. Fruits — stewed and fresh. Sal- ads — French salad dressing, cooked salad dressing, maydnnaise. Vegetables. Course of Study in Dietetics Arranged by the New York State Board PRELIMINARY TERM Dietetics, 14 hours Water: source, function, varieties of drinking water, source of disease. Beverages: tea, coffee, cocoa, chocolate; history and growth of plants; composition, nutritive value; physiological effects. xvi INTRODUCTION Constituents of milk: care and preservation; bacteria in milk; ef- fects of heat on milk; adulteration — digestibility; value of skimmed milk; whey, buttermilk, cheese. Infant feeding: comparison of human and cow's milk; modifica- tion of milk; certified milk; capacity of infant's stomach; symp- toms considered in regulating the feeding of infants. Practical Care of dining-room, gas range, cooking utensils, ice box and con- tents. Preparation of trays; how to make them attractive; how to serve; quantity, quality and temperature of food; how to feed helpless patients. Beverages: water, tea, coffee, cocoa, chocolate, wines, fruit juices, malted milk, prepared foods. Milk: pasteurizing, sterilizing, modification, kumyss, buttermilk (artificial) and whey. Eggs in various forms as liquid diet; gruels. Milk and eggs as food; custards; junket; white sauce; cottage cheese. INTERMEDIATE TEEM, FIRST HALF Dietetics, 10 two-hour lessons (under dietitian) Theoretical Digestion and absorption: review subject of digestion as already given in anatomy, 1. e., mechanical and chemical processes, absorp- tion, assimilation, metabolism, elimination of waste. Food: source, function, food adjuncts, definition of food, compo- sition, classification. Mineral matter: source and function. Carbohydrates: why so called, source, function, nutritive value. General principle in cooking cereals, vegetables, fruits, nuts and sugars. Eggs: composition; test for freshness; digestibility; nutritive val- ues; effects of temperature; advantages and disadvantages in use. Meat: composition; nutritive value; effect of hot and cold water; comparative value of tea and broth; raw compared with cooked; organs used as food; gelatin. Poultry: game. Fi^h: classes; composition; signs of freshness; care of fish; nutri- tive value; digestibility. Mollusks: crustaceans. Fats and oils: source, animal and vegetable; function; digestibil- ity; comparative value as fuel food. INTRODUCTION xvii Praciioal Toast; cereals; cornstarch; macaroni; rice; sandwiches. Starchy vegetables, legumes. Green vegetables, salads, dressings ( cream and oily ) . Fruit, fresh and cooked; fruit puddings. Soups, stock and creamy; broths. Broiled meats, giving cuts. Chicken and game. Fish, shell and scaly. Frozen desserts; sponge cake; wafers. If the pupils are not assigned to a terra of service in the diet kitchen, practice in preparing and serving full meals should be given in connection with this series of lessons. SENIOR TERM. Dietetics Theory, at least 6 hours Diet in childhood. Diet in disease. Food values. Comparison of animal, vegetable and mixed diets. Calculating dietaries. Planning menus. Practical During the term the nurse in charge of wards should make prac- tical application of the theory of dietetics and study food ordered for patients under her care, in connection with the cases for which it is 9rdered. State Examinatiosj Questions in dietetics COLORADO 1909 1. Mention one good nutritive enema. 2. What is included under the head of liquid diet? 3. How do you make albumin water? ^ 4. What is the appearance of healthy beef; chickeh; fish? .5. How would you feed a typhoid patient the, first week he gets solid food? 6. Describe all the correct methods you know of preparing food for the sick. 7. What is important in cooking starchy foods? 8. What foods contain the most albumin? 9. If you wish to keep the juice in meat, how do you cook it? xviii INTRODUCTION 10. Have you had any special training in dietetics? Of what did it consist? Name one book on dietetics. Do you own a book on dietetics ? CONNECTICUT Dietetics and Hygiene June, 1909 1. Name the different classes into which food may be divided. 2. Name two animal and two vegetable foods which contain fat. 3. Prepare a day's menu for a patient, excluding starchy foods aa far as possible, while giving a variety. 4. What useful function may be perfprmed by the indigestible parts of vegetables? 5. Show why a mixed diet is advisable. 6. Give one method of predigesting milk. 7. Prepare a day's menu of at least six meals for a patient with mild fever, excluding milk, but giving as much variety as per- missible in a fluid diet. 8. What are sweetbreads, and how would you prepare and serve them? 9. Why is a thorough cooking especially important in cereal foods and not in flesh foods? 10. Write the rules for preparing three desserts you would use in feeding a typhoid fever patient during convalescence. 11. Give a list of fruits you would recommend for their laxative effect. January, 1909 1. Give a brief description of the care of glass drinking tubes used by typhoid patients. 2. Give recipe for (1) partial peptonisation of milk; (2) junket. 3. Mention the foods allowed according to the following classifi- cation: (l)Liquid; (2) Soft; (3) Light. 4. How would you render the following sterile: (1) Woolen blankets; (2) Cotton sheets; (3) Rubber catheters; (4) Your hands? 5. In making up modification of milk give in detail from the time you receive the milk until you give it to the infant the pre- cautions you would take to keep certified milk pure. 6. Tell what you know of either tea or coffee, its production, preparation, use and abuse. 7. What cuts of beef would you select for the following purposes : (1) Beef juice; (2) Eoast beef; (3) A tender steak? 8. What action has prolonged cooking on (1) starch grains; (2) albumin? INTRODUCTION xix 9. What different methods would you employ in cooking chicken for (1) broths; (2) fricassee? Why? 10. Give minute details of your care of the linen used on the bed of a scarlet fever patient. DISTRICT OF COLUMBIA 1908 1. Name three food-stuflfs rich in albumin in the order of their importance. 2. Describe process of digestion and absorption of albuminoids. 3. What is the object of cooking vegetables and of cooking meats ? 4. Give frequency of feeding patient on liquid diet and on plain diet; why the difference? 5. Name any two diseased conditions which may be brought about by dietetic error; state how? 1909 1. Name the different classes of food-stuffs and give an example of each. 2. What are the chief ingredients in fruits? 3. Describe the action of the gastric juice on food. 4. State the length of time required to cook properly the fol- lowing cereals: rolled oats, rice, and eornmeal mush. 5. Give the two complete food products furnished by the animal kingdom. NEW YORK 1907 1. What effect has cooking on meat? 2. Give recipe for veal broth made from a half pound of veal. 3. State the length of time required to cook properly the follow- ing cereals: rolled oats, Irish oatmeal, steamed rice, eornmeal mush. 4. How would you make a flour ball? 5. Give recipe for making an oyster stew containing a pint of oysters. 6. How would you determine whether or not an egg is fresh? 7. Which is more quickly digested, a raw egg or a soft-boiled egg? Why? 8. Give a recipe for egg sandwich. 9. Give the general rules for making custards. 10. How would you bake a banana and prepare it for a patient? XX INTRODUCTION 1908 1. What are the uses of water in the body? 2. Name three vegetable acids. 3. Give three examples of foods in which starch is found. 4. Of what value is sugar as food? 5. Give th/ree examples of food containing fat. 6. What hygienic effect has heat on milk? 7. How should an egg be boiled? How should it be served to an invalid? 8. How would you make a raw beef sandwich? 9. Why is stale bread more easily digested than bread freshly baked ? 10. Give recipe for lemon jelly. 11. Outline a breakfast for a convalescent man. 12. Outline a dinner for a convalescent woman. 13. Give recipe for creamy rice pudding. 14. Of what value are fruits as food? 15. What are the requirements of food for a fever patient in order that proper nourishment may be obtained? 1909 1. What is meant by predigested food? 2. What effect on the system has hot water when taken in- ternally? 3. What effect has sterilization on milk? 4. What is condensed milk? State its value as a food. 5. How is limewater made? 6. What is farinaceous diet? 7. What are the most important food products derived from the vegetable kingdom? 8. State the effect of coffee on the system? 9. What are concentrated foods? State their chief use. 10. State the food value of green vegetables. 1 1. What are the diet requirements in ansemia ? 12. Mention some factors, apart from proper diet, that specially affect the digestion. 13. Name some diseases that may be caused by the following er- rors in diet: (a) insufficient food; (b) overeating; (c) lack of fresh food; (d) improperly balanced diet. 14. What are the reasons for limiting the diet of a young child to certain foods? 15. What changes in diet should be made in advanced years? Why? INTRODUCTION xxi NORTH CAROLINA 1908 1. In what foods are ptomaine poisoning most likely to be found? How may this be avoided? 2. What can you say of the effect of long or second cooking of albuminous foods? State whether or not this increases their di- gestibility. 3. Give a list of the easily-digested meats, (a) Describe method of cooking one of these, (b) Name those you would not give an invalid, giving reasons. 4. Give a list of foods you have been accustomed to giving con- valescents from typhoid fever, between the liquid and full diet period. 5. What foods have you given, your obstetrical cases during the first two weeks? 6. When is a healthy child considered able to digest starchy foods? 7. Name such foods as you would give a healthy child from 12 to 18 months of age. 8. What vegetables supply about the same elements for the sys- tem as meats? 9. What can you say of the long and second cooking of starchy foods ? 10. Name such vegetables and fruits as you would give an in- valid. State reasons. 1909 1. Give theory of cooking starches and tell where and by what digested. 2. Name the cereals that require long cooking and give approxi- mate time. 3. Why do we toast bread? 4. What disease is usually given a carbohydrate-free diet? 5. Name the heat and energy-giving foods. 6. What do you consider an ideal diet? 7. What should be the characteristics of an invalid's diet? 8. What are some of the advantages of vegetables and fruits in our own diet? 9. Why .is cow's milk more likely to disagree with infants dur- ing the summer than in cold weather? 10. Up to the present have we been benefited by the pure food laws? 11. Which contains more nourishment, fji of beef juice or fji of beef tea? xxii INTRODUCTION 12. Give a list of tissue-building foods. 13. What should be the diet of a ease of acute nephritis? B. A case of eclampsia preceding or following labor? 14. Give several ways in which milk and eggs may be prepared and flavored to give variety to liquid diet. 15. State some of the advantages and disadvantages of milk, as (I food for invalids. WASHINGTON 1909 1. State the length of time required to properly cook the follow- ing cereals: rolled oats, rice, cornmeal mush. 2. Of what value are fruits in digestion? 3. How should an egg be boiled? How should it be served to an invalid^ 4. How would you make a raw beef sandwich? 5. What are the requirements of food for a fever patient in order that the proper nourishment may be obtained? 6. Why is stale bread more easily digested than bread freshly baked? 7. What is meant by predigested food? 8. How would you prepare extract of beef from the raw beef? 9. Briefly outline a diet for diabetics. 10. Would you boil cocoa? Give reasons for your answer. 1910 1. How would you prepare a beefsteak? Give reasons for method employed. 2. Why is the saliva an important factor in the digestive process ? 3. If you wish to keep the juice in meat, how do you cook it? 4. Name one good nutritive enema. 5. What is important in cooking starchy foods? 6. What would you include in a soft diet for an invalid? 7. Briefly outline a diet for a patient suffering from pulmonary tuberculosis. 8. What are the diet requirements in a case of ansemia? 9. What class of foods should be excluded from a rheumatic diet and why? 10. How do you prepare an egg omelet? Coffee? Cocoa? Tea? CONTENTS PAGE Intboduction xiii The American Hospital Association — Colorado — Illinois — Minnesota — New York State Board Ee- quirejnents in Dietetics. PAET I PEINCIPLES OF N^UTEITION AND FOOD PEEPAEATION CHAPTER I Food . . . . 3 General Object — Definition — Food Accessories (or Food Adjuncts) — Source — Composition of the Body — Composition of Food — Classification of Food — Nitrogenous, Protein and Extractives — Non-Nitro- genous, Carbohydrates (Starch and Sugar), Fats — Water — Mineral Matter. Food Accessories — Condi- tions for Perfect Nutrition. II Nutrition ... . 36 Digestion : — Protein — Fats — Carbohydrates — Mineral Matter — Water. EesumS of Digestion — Factors Determining Rate of Digestion. Absorption : — Protein — Fats — Carbohydrates — Mineral Matter — Water. Metabousm : — Protein — Fats — Carbo- hydrates. Excretion. III Food Values . . ... ... . . 54 The Balance of Energy and Nitrogen Equilibrium, The Energy Value of Food — Energy Requirements of the Body — Tables Showing the Nutritive Value of Food. IV Feeding the Sick . . .... 72 General Rules — Physicians' Directions — Feeding xxiii xxiv CONTENTS CHAFTEE PAGE in Acute Disease — Evidences of Digestion — The Ap- petite — Punctuality in Serving — Quality and Quan- tity of Food — Temperature of Food — Details in Feeding — Bathing and Cleansing the Mouth — Time and Position for Feeding — Sleep and Feeding — Feeding the Helpless Patient — Feeding the Uncon- scious Patient — Forced Feeding — Nasal Feeding — Use of the Stomach Tube — Eectal Feeding — Use of Alcohol in the Sickroom — Keeping Ice in the Sick- room — Disinfecting Utensils. V The Teay 85 Attractive Arrangement of a Tray. How to Serve (General Rules). VI Methods of Cooking and Cake of Food .... 88 Digestibility and Nutritive Value of Cooked Food — Success in Cooking — Objective Points in Cooking — Eif eet of Heat — Principles Governing the Choice of a Method of Cooking Any Food — Principal Cook- ing Processes — The Object of each Cooking Process — Cooking Utensils — Blending Ingredients — Method of Working — Ice Box and Contents — Care of Food — Preserving Foods — Concentration — Predigestion of Food — Adulteration of Food. VII Measures and Weights 98 Table of Measures and Weights — Apothecaries Weight — Apothecaries Measure — Approximate Meas- ures — Metric System — Measures of Volume — Meas- ure of Weight — Table of Equivalents — Table for Pre- paring Percentage Solution — Thermometry. PAET II PEACTICAL APPLICATION OF PEIjSTCIPLES OP NUTEITION" EECIPES VIII Bemieages 109 Acid Beverages HO Eecipes \\q CONTENTS XXV CHAPTEB PAGE Albuminous Beverages 118 Recipes 118 Starchy Beverages 124 Recipes 124 Miscellaneous Beverages . . 127 Tea 127 Recipes . 131 Coffee ... 128 Recipes . 131 Chocolate ... . ... 129 Recipes 134 Cocoa . 129 Recipes ... . . 133 Special Non-Nutritive Beverages . . 136 Recipes . 136 IX Animal Foods . . 138 Meat 140 Recipes ... 149 Poultry and Game . 152 Recipes . . 153 Fish ... . 159 Recipes 162 Fish Sauces ... 165 Recipes 165 Shell Fish •....-... 166 Oysters . 166 Recipes . . 169 Clams . . 168 Recipes .... 172 Eggs .175 Recipes .... .... ... 179 Milk and Milk Products ... 184 ■ Recipes 193 Sweetbreads 200 Recipes 201 Gelatin 203 Recipes 204 Beef Preparations 212 Beef Juice 212 Recipes 214 xxvi CONTENTS CHAPTEB PAGE Beef Tea 213 Eecipes 215 Raw Beef 214 Eecipes ' . . .217 Meat Broths 217 Recipes . 219 Meat Jellies 217 Recipes 221 Soups . 223 Recipes 223 Soup Accompaniments . 229 Recipes ... 229 X Vegetable ob Plant Foods . 231 Cereals 233 Gruels 236 Recipes . .238 Breakfast Foods 235 Recipes 242 Starchy Jellies 244 Recipes 244 Macaroni 245 Recipes 245 Bread . 247 Recipes ... 250 Toast . V . .... . .255 Recipes . . . 256 Sandwiches 258 Recipes . ... . 259 Crackers and Wafers . 260 Recipes ... . . 260 Vegetables . ... .261 Recipes . 265 Vegetable Sauces . . 271 Recipes . . . 271 Salads . . . 272 Recipes 274 Salad Dressings 272 Recipes 273 CONTENTS XXVll CHAPTEE Fruits Recipes Nuts Fungi and Algae XI NUTEITIOUS Dessekts . . . . Hot and Cold Desserts Soft Custards . ... Recipes Baked Custards . Recipes .... ... Whips and Souffles Recipes . . Junket Recipes . . . . Cornstarch Pudding or Blanc Mange Recipes ... ... Rice Puddings Recipes . Tapioca Recipes . Bread Puddings Recipes . Cracker Puddings Recipes . Pudding Sauces Recipes . Frozen Desserts . Ice Cream . Recipes . Sherbet Recipes . Ices Recipes . XII Cake Recipes PAGE 276 . 279 . 283 . 284 . 286 . 286 287 . 287 . 288 . 288 290 . 291 .293 293 295 . 295 . 297 . 297 300 300 . 302 302 304 . 304 305 305 306 . 306 307 . 306 312 306 313 . 317 . 318 xxviii CONTENTS PAET III HOSPITAL DIETAEIES — DIET IN DISEASE — DIET IK SPECIAL CONDITIONS CHAPTER PAGE XIII Hospital Dietaries . . ... 323 General Types of Diet Used in Hospitals : — ■ Liquid or Fluid Foods — Soft or Semi-Solid Food — Solid Food. Typical Diets from Vabious Hospitals -. — Light Diet or Convalescent Diet ■=— Typical Light Diet — Milk Diet — Fluid Diet — Soft Diet — Soft Solids — Liquid or Farinaceous — Farinaceous Diet — Ni- trogenous Diet — Nutrient Diet — Oxaluric Diet — Strict Sugar-free Diet — Fat-free Diet — Salt-free Diet — Test Diet — Fish Diet — Broth Diet — Re- stricted Diet — Extra Diet — Dietary of the Bellevue Hospital, New York, 1910 — Dietary of the Presby- terian Hospital, New York, 1910. DIET IN DISEASE XIV Diet in Fevers and Infectious Diseases .... 331 Diet in Fever in General — Diet in Convales- cence from Fever — Typhoid Fever — Starvation Treatment of Typhoid — Liquid Diet in Typhoid — Liberal or Generous Diet — Liquid Diet in Typhoid — (1) Fluid Diet in Typhoid — (2) Fluid Diet in Typhoid — Diet in Convalescence from Typhoid — Diet in Typhoid after Two Days of Normal Tempera- ture — Diet in Typhoid after Two Weeks of Normal Temperature — Typhoid Delicacies — Typhoid Extra Diet — Liberal Diet in Typhoid (Frederick C. Shut- tuck, M.D. ) — Tonsilitis and Quinsy — Diphtheria — Pneumonia — Broncho-Pneumonia — Mumps — Whooping Cough — Diet in Tuberculosis, Especially Pulmonary Consumption. XV Diet in Disorders of Nutrition 355 Diet in Diabetes — Diabetic Diet of Bellevue Hospi- tal — Diabetic Diet of Presbyterian Hospital — Dia- CONTENTS XXIX betie Diet of Massachusetts General Hospital — Strict Sugar-free Diabetic Diet — Chronic Diabetes Diet — Substitutes for Starch and Sugar — A Diabetic Chart (Elliott P. Joslin, M.D.) — Menus for the Diabetic — Diet in Lithemia or Excess of Uric Acid — Acute Gout — Chronic Gout — Acute Rheumatism — Chronic Rheumatism — Diet in Obesity. XVI Diet in the Diseases of the Stomach 373 Acute Gastritis — Chronic Gastritis — Ulcer of the Stomach — Outline of Diet in Gastric Ulcer (Max Einhorn, M.D. ) — Gastric Ulcer Diet — Dr. Hewes's Diet, The Lenhartz Diet — The Lenhartz Diet Sheet. XVII Diet in Intestinal Diseases .381 Dyspepsia — Constipation — Diarrhoea — Dysen? tery — Diet for Acute Colitis (Dysentery) — Chronic Dysentery — Enteric Diet — Special Enteric Diet — Liquid Enteric Diet — Appendicitis. XVIII Diet in Disease of the Genito-Ubinaey System . . 390 Acute Bright's Disease — Chronic Bright's Disease — Nephritic Diet — Acute Nephritis, Uric Acid Gravel — Convulsion in Bright's Disease — Albumi- nuria. XIX Diet in Misceixaneous Affections 395 Nervous Disorders — Functional Disorders of the Liver (Biliousness) — Skin Diseases — Heart Dis- ease — Dietetic Management of Surgical Cases — _ Diet after Laparotomy, Ovariotomy, etc. DIET IN SPECIAL CONDITIONS XX Motherhood . ... . .... 401 Diet in Pregnancy — Vomiting of Pregnancy — (Vomiting of Seasickness) — Diet for the Mother after Labor — Diet for a Nursing Mother or Wet Nurse. XXX CONTENTS CHAPTER PAGE XXI Infant Feeding .... ... ... 406 General Considerations — Breast Feeding — The Wet Nurse — Composition of Mother's Milk — The Hygiene of Natural Feeding — Capacity of Babies' Stomachs — Schedule for Nursing — Weaning — Arti- ficial or Bottle Feeding — > Difference Between Human and Cow's Milk — General Principles of Milk Modi- fications — What Dilution to Use — The Quantity to Feed — Laboratory Milk — Home Modification — The Nursing Battle — Formulse for Infant Feeding — Top Milk Method (L. Emmett Holt, M.D.) Card for Per- centage Feeding of Infants (Maynard Ladd, M.D.) — Formulse for Preparing Infant Food from Ster- ilized Sugar of Milk — Scheme for Feeding Babies (Society of the Lying-in Hospital, New York City) — Peptogenic Milk Powder, Modifies Cow's Milk. XXII The Feeding of Young Childben .... 434 General Rules for Feeding Young Children — Table of Comparison, Food Required by Child and Man — Table showing Increase of Calories Required for a Growing Child — ^Dietaries for Young Children (Louis Starr, M.D.) — General Principles of Feeding Sick Children. xxiii dret foe the adolescent dlet for the sedentary — Diet for the Aged . . . 442 Index to Recipes . . 447 General Index 465 PAET I PEINCIPLES OP NUTEITION AND FOOD PEEPAEATIONS PRACTICAL DIETETICS CHAPTEE I FOOD: ITS OBJECT Maintenance of Life and Energy There are few subjects deserving of more careful consid- eration than that of food; its composition, preparation, and effect upon the human system ; together with the process of its conversion into complex animal tissue, as brain or muscle, blood or bone. The true science of feeding should be thoroughly studied, that we may understand what properties enter into food; what elements the system demands in order to build or re- pair; by what means the necessary substances are best sup- plied, and how to prepare them that the body may maintain its efficiency; so that in case of illness, the least possible de- mands upon the digestive and assimilative functions may be made. Apart from the labor of every-day life in which brain and muscle engage, an immense amount of, work is performed in the mere act of keeping alive. Nowhere in nature is work performed without a supply of energy, and also some wear and tear of the machine which does the work. This asser- tion is as true of the human body as of the locomotive, and just as the machine — whatever it may be — requires to-be supplied with the conditions necessary for the production of force, so the living body similarly demands a supply of, ma- terial from which its energy — the power of doing the work — can be taken. As the locomotive obtains the necessary con- 3 4 PRACTICAL DIETETICS ditions from the fuel and water (and air) which it consumes, so the living body derives its energy from the food, water and air upon which it subsists. Definition of Food. Foods are substances which when taken into the body supply the necessary elements for pro- moting its growth and repairing its waste ; and furnish it with material from which to produce heat and internal or external work. Substances that are unable to assist in either of these ways are called food accessories or food adjuncts. ■ Food Accessories or Food Adjuncts. These are substances which, although unable to fulfill the definition of foods, find an extensive use in the dietary, for a variety of reasons. They give flavor to food, increase the appetite, stimulate secretion, and thus aid the digestive functions. They com- prise two classes, viz., condiments and beverages. Source of Food. Food occurs in the mineral, plant and animal kingdoms. It occurs in all physical forms of matter — gases, liquids and solids. Gases are mentioned because oxygen is a true food and metabolized to a certain degree, being always present in the blood and tissues in loose chem- ical combination. Composition of the Body. The human body contains many chemical elements in varying amounts. Nitrogen, carbon, hydrogen, and oxygen are the four pres- ent in largest proportion; iron, phosphorus, calcium, mag- nesium, potassium, sodium, sulphur, chlorin, iodin, also have important ofiBces to perform. Composition of Food. Foods must contain the same ele- ments found in the body; thus it is that they are able to build and maintain the body structure. But no " one food " contains all these elements in proper proportions for all per- sons ; therefore, it is by combinations of the various food stuffs that we produce a suitable diet. These elements must further be supplied in forms which the body, can use. It cannot utilize carbon in the form of coal, for example, but must have it combined in special ways with hydrogen and oxygen. These combinations of elements or " Food Com- CLASSIFICATION OF FOOD 5 pounds " found in nature (sometimes called " alimentary " or "food principles" and "food stuffs"), are usually classi- ■fied as proteins, fats, carbohydrates, mineral matter (or salts) and water. Food, as it is taken into the body still differs in composi- tion from the material utilized by the tissues in growth, repair of waste, and production of energy in the form of work or heat. It must be finally prepared for the use of the body by the processes involved in Digestion. CIASSIEICATION OF POOD Foods may be classified in various ways: a. According to Source, as animal, vegetable, and mineral (including oxygen for combustion). b. According to Chemical Composition, as organic and in- organic, the organic foods being further subdivided into ni- trogenous and non-nitrogenous substances. c. According to Function, as tissue-fofmers, or body-build- ers; energy (or work and heat) producers; and regulators of body processes. Classification according to Chemical Composition Nitrogenous — Proteins Organic - ("Sugars Carbohydrates i ISTon-nitrogenous^ I Starches [Fats {Mineral Matter Water Classification according to Function r Proteins Tissue-formers or Body-builders \ Mineral Matter LWater {Carbohydrates Fats ProteiAS 6 PRACTICAL DIETETICS T> 1 J. J! -D J T) r Mineral Matter liegulators of Body Processes T w f Important Sources of Proteins: Milk, eggs, meat, fish, cheese, beans, peas, lentils, some nuts and cereals. Important Sources -of Fats: Olive oil, butter, cream, bacon and other fat meat, and nuts. Important Sources of Carbohydrates: Cereals, and cereal products ; sago, tapioca ; starchy veg- etables, such as potatoes ; sugar, honey, sweet dried fruits. Important Sources of Mineral Matter: a. Available in organic form: IsTitrogen, — supplied by protein. Phosphorus, — in milk and cream, eggs (especially the yolk), meat, whole vcheat, oatmeal, dried peas and beans. Iron, — in eggs (especially the yolk), meat, whole wheat, oatmeal, dried and fresh peas and beans, spinach, raisins and prunes. b. Available in organic or inorganic form : Calcium, in milk, dried beans and peas, oranges, spinach, turnips; other fresh fruits and vegetables, and whole grains. Magnesium, potassium, iodin, etc. — likely to be adequately supplied if the other ash constituents are provided for. The addition of sodium chloride (common salt) as a condiment usually supplies a surplus of sodium and ehlorin. Special Functions of each Food Principle: Proteins — Supply energy, nitrogen, sulphur, and some- times phosphorus. Fats — Supply energy in the most concentrated form. Carbohydrates — Supply energy in the form most econom- ical to the body. Mineral Matter — Supplies building material, except nitro- gen and sulphur, and helps to regulate body processes. CONDITIONS FOR PERFECT NUTRITION 7 "Water — Supplies building material (forming 60 per cent, of the body), and helps to regulate body processes. CONDITIONS rOR PERFECT NUTRITION Tor the proper support of the human system, a combina- tion of nitrogenous and non-nitrogenous foods is essential, ■with water to dissolve them and oxygen to burn them. Al- though air is not classified as a food it is essential to effect the chemical changes needful for assimilation. " About two thousand cubic feet of air need to pass through the lungs of an adult daily in order to furnish oxygen in sufiBcient quan- tity. If there is lack in this most important food-stuff (and nothing else can take its place), starvation as truly results as if other food were withheld, for the changes required for nutrition cannot take place, and furthermore incomplete de- composition occurs, which may result in more or less poison- ous products. "Fresh air — air with its quota of oxygen — is, then, a prime requirement in nutrition." — Ellen H. Eichards. A Perfect. Food. 1. " A perfect food must contain all the nutritive elements of the body : Proteins, carbohydrates, fats, minerals, and water. 2. It must contain these in their proper proportions. 3. It must contain in a moderate compass the total amount required daily. 4. The nutritive elements must be capable of easy absorp- tion, and yet leave a certain bulk of unabsorbed matter to act as intestinal ballast. It must be obtainable at a mod- erate cost." — Hutchinson. A Mixed Diet therefore is necessary, as no "one food" fulfills all the requirements of a "perfect food." A mixed diet must be taken whereby one food may be used to sup- plement what is lacking in another. The foods best for health are those best fitted to the needs of the individual. The cheapest food is that which furnishes the largest amount of nutriment at the least cost. The best food is that which is both healthful and cheapest. PRACTICAL DIETETICS NITROGENOUS FOODS Nitrogenous substances are those which contain nitrogen, an element which is essential to the life of every cell. Classification. In older classifications, the term Protein is used to include all food substances containing nitrogen, this class being further subdivided into (1) Proteids, those proteins which can alone maintain the nitrogen equilibrium of the body; (2) Albuminoids or Oelatinoids, those which contain nitrogen in a form which can replace other proteins only to a limited extent; (3) Extractives, containing nitro- gen in a form unable to make good the body loss of nitrogen. These extractives are properly food accessories. Proteins are now defined as compounds of carbon, hydrogen, oxygen, nitrogen, sulphur, and sometimes phosphorus, which contain nitrogen in a form which the body can use. They are variously classified, but a simple division is one into (1) Simple Proteins, (2) Compound Proteins, and (3) Albumi- noids. Examples of simple proteins are albumins, globulins, and certain alcohol-soluble proteins found in cereals, as the gliadin of wheat ; of compound proteins, the nucleo-protein of organs consisting chiefly of cells, as pancreas or sweetbread, and the haemoglobin of the blood; of albuminoids, the fa- miliar product, gelatin, formed from the collagen of connec- tive tissue : Proteins Simple Albumins, e. g Globulins, e. g Alcohol-soluble proteins e. g. 'White of egg. Casein of milk. Myosin of muscle. Fibrin of blood. Gluten of wheat. ^Legumin of legumes. In grains. fGIiadin of wheat. LZein of maize. {Nucleo-protein, o. g. in liver and sweetbread. Hsemoglobin of blood. Albuminoid Collagen of connective tissue. Compound NITROGENOUS FOODS 9 Source. The proteins of the diet are derived both from the animal and vegetable kingdoms. The principal animal pro- teins are obtained from meats, fish, eggs, and milk. Meat and fish proteins are derived principally from the muscles; egg proteins from both the white and yolk; milk proteins chiefly from the casein, which forms the main constituent of cheese and curds. Animal foods are much richer in protein than plant foods. The only substances of vegetable origin which can compare with animal nutrients in this respect are the legumes (peas, beans, lentils, peanuts, etc.), and certain nuts, such as almonds, pine nuts, cocoa beans (the source of cocoa and chocolate). The entire grain of some cereals pos- sesses a high percentage of protein; this is particularly true of so-called hard wheat, and in lesser degree of oats, Indian corn, rye, and barley. As a rule, flour and meal are about half as rich in protein as the dried grains from which they are prepared, though oatmeal and Indian meal lose but lit- tle through milling. Animal foods are usually digested with ease, and require less cooking and less mastication to insure good utilization; in the form of meat, they are liked because of their high flavor and stimulating properties. In vegetable foods, on account of the presence of cellulose, some of the protein is likely to escape digestion and absorption. For the invalid or convalescent, certain animal foods are preferred as a source of protein, as being more concentrated, and easier of digestion. Of ordinary vegetable food rich in protein, bread, either stale and dry, or thoroughly toasted, is perhaps the most suitable for invalids. Starchy roots and tubers (as potatoes), and green vegetables and fruits, though valuable for other dietetic reasons, are very poor in protein. Animal Proteins. The albumins in the ordinary diet are derived chiefly from animal foods. The white of egg is a very pure form of this compound, and eggs constitute one of the best sources of nitrogen in a compact and assimilable form, especially convenient as they are readily taken raw. Casein, the chief protein of. milk, represents the main 10 PRACTICAL DIETETICS source of this food element for infants and the sick. One quart of milk contains as much protein as six ounces of lean beeksteak, and is more valuable because of its rich supply of mineral matter, to say nothing of the fat and carbohydrate present. Myosin is the typical protein in muscle tissue. . After death it changes to a form called syntonin. Fibrin and Serum Albumin, found in blood, occur to a slight extent along with myosin in meat. The only albuminoid which requires consideration here is collagen, a protein found in all connective tissues, including the modified forms, such as cartilage and bone. This sub- stance is changed by boiling to gelatin. This is further al- tered by the gastric juice to gelatoses and gelatin-peptones, and finally absorbed, but it lacks certain elements found in albumins and other proteins, and consequently cannot be re- lied upon exclusively as a source of nitrogen for the body. It can replace about two-thirds of the ordinary protein re- quirement. Vegetable Proteins. These are chiefly globulins. The main representatives of the albumins in vegetable food are gluten of wheat and legumin of the legumes. A number of alcohol-soluble proteins occur, such as gliadin in wheat and zein in Indian corn. Vegetables contain a large number of nitrogenous substances which are not proteins. Thus while mushrooms contain much nitrogen, little of the latter is in a form which can be absorbed. Function of Proteins. Proteins are both body-builders and energy-producers, but are little utilized as fuel when carbo- hydrates and fats are well represented in the diet. As a fuel, they tend to burn up rapidly, and hence are not economical, and since in health only a small proportion of nitrogen is used from day to day, the part not needed being promptly excreted, it is not advantageous to have the diet largely com- posed of this food principle. During the periods of rapid growth, in the prenatal, infantile and adolescent states, when the body is forming new tissue at an unusual rate, there must NITROGENOUS FOODS 11 be a liberal nitrogen supply. This is also true in conva- lescence from wasting disease, and sometimes after excessive physical exertion, when the muscle tissue is actually increas- ing. In health, when fats and carbohydrates are liberally provided, so that the protein is not required as fuel, a com- paratively small amount is needed for repair of tissue. This is especially true in old age. Nitrogenous Extractives. Substances found in muscle juice, consisting chiefly of ereatin, creatinin, and purins (uric acid and related substances), are valuable only as stim- ulants. They give sapidity to meats and hence are appetiz- ing ; possess the power of stimulating the flow of gastric juice, and by their influence on the nervous system, gently in- crease the activity of the heart. Por this reason, beef tea, beef extracts, etc., are of value to the sick. Cooking of Protein. Of all the proteins, "Albumin," of which there are many varieties, is the most important and needs most care in the cooking to make it easily digested. The majority of albumins are soluble in cold water and vegetable acids; they are coagulated by heat, mineral acids and alcohol. The cooking of albumin should be governed by these facts. " As the white of the egg is nearly pure albumin it will serve as an excellent illustration for demonstrating the effect of heat on the principal constituent of albuminous foods." Effect of Temperature or Test for CooTcing Albumin Into a test tube put some white of egg, place in a sauce pan of cold water, heat gradually, and observe all changes. 1. Eaw white of egg is a sticky, clear, pale straw-colored liquid, and readily digested. 2. When water reaches the temperature 134° P. white streaks will be seen in a semi-solid white substance which is found to be readily digested. 3. When water reaches the temperature 160° P. the egg will be firm, soft, and jelly-like, and is readily digested. 4. When water reaches 313° P. the egg will be tough white jelly and less readily digested. 13 PRACTICAL DIETETICS 5. When egg is heated to 300° F. or higher (for example put the test tube directly over flame), the egg will almost immediately become hard and tenacious. These albumin tests demonstrate that albuminous foods are most tender and readily digested when cooked at a low temperature but when coagulated at too high a temperature are tough and indigestible. Eeheated albuminous foods are less digestible than freshly cooked because the albumin is much hardened by the second cooking. The principal foods requiring care^in preparation because of the albumin are eggs, meat, and fii^h. These will be considered further under their separate headings. NOW-NITROGENOUS FOODS CARBOHYDRATES (SUGAR AND STARCH): FATS Strictly speaking, any food substance not protein, even water and mineral water, is non-nitrogenous; but in the re- stricted sense of food as a source of energy, it is applied to two classes of organic compounds which contain no nitrogen, viz., carbohydrates and fats. CARBOHYDRATES Definition. Carbohydrates are food substances which con- tain carbon, hydrogen and oxygen. The oxygen and hydro- gen are usually present in proportion to form the water mole- cule (HjO). These substances have therefore been termed carbohydrates. A carbohydrate may be defined as a simple sugar, or a substance which yields simple sugar after hy- drolysis. Source. Carbohydrates come from the vegetable kingdom almost entirely. There are a few exceptions, such as glycogen and milk sugar. They abound throughout the plant world, but especially in grains, roots, tubers, or wherever the plant stores its reserves. Function. Carbohydrates are burned up in the body ' to produce energy in the form of work or heat. All that is taken in excess of immediate need is stored, first as glycogen NON-NITROGENOUS FOODS 13 or " animal starch " in the liver and muscles ; and when the capacity to store .glycogen is exhausted, in the form of fat. The fuel value of fat is two and one-fourth times that of sugars and starches, so that this is a very convenient form of storage of surplus carbohydrate. The Most Important Energy Producing Foods are cereals, potatoes, tapioca, sago, fats, sugar and honey. Classification. Carbohydrates include the monosaccJiarides, as typified in grape sugar; the disaccJiarides, as typified in cane sugar, and polysaccharides, including starch, dextrin, gums, cellulose and glycogen: Carbohydrates (Grape Sugar (Dextrose or Glucose) ^"^"a m^fture^^rd'exteose and levulose is called Invert Sugar. Honey is the best example in nature) CjHii Disaccharides Cj2"220il Polysaccharides CeHioOs " Cane Sugar ^ Beet Sugar >■ Sucrose Maple Sugar J Milk Sugar (Lactose) .Malt Sugar (Maltose) r Starch I Dextrin ■j Glycogen Gums I Cellulose Sugar Definition. Sugars are carbohydrates which are soluble, have a more ct less sweet taste and many minor qualities which distinguish them from the starches. The disafccharides yield monosaccharides under the influence of enzymes or on boiling with dilute acids. When heated to a high tempera- ture sugars form caramel. ' In dietetics we are especially concerned with grape sugar (dextrose), milk sugar (lactose) and cane sugar (sucrose). DEXTKOSE OE GBAPE SUGAR (GLUCOSE) Description. Dextrose occurs as a syrup, rarely in crystal- line form. It is much less sweet than cane sugar. Other sugars have to be changed to this form before the body can use them. 14 PRACTICAL DIETETICS Sources. It is found throughout the vegetable kingdom, and especially in fruits. A dried fig contains 65 per cent, of grape sugar. In nature it is formed from starch and so it may be produced in art by treating starch with acids. It is prepared on a large scale from cornstarch. Uses as Food. Dextrose or grape sugar is a fuel food in one of its most readily absorbed forms. It does not require digestion because this is the form to which carbohydrates of all kijids must be changed before they can be of use to the body. Taken in large quantities it is liable to ferment, or flood the system with sugar too rapidly, but as naturally present in sweet fruits, or in its artificial form in small quantities along with other food-stuffs, it is a very economical source of energy. LACTOSE MilTc Sugar or Lactose. This sugar is found almost ex- clusively in milk, from which it is commercially prepared. It has little sweetness and does not readily ferment. Until re- cently it has entered but little into practical dietetics, save in ease of infants or others subsisting wholly or partly on milk, but its ease of assimilation and its mild flavor, make it frequently a valuable source of energy in disease. CANE SUGAK Pure cane sugar is chemically the same as beet-sugar. Maple sugar would not be different from common sugar, if it were sufiBciently purified to remove the flavoring matter. Description. Cane sugar occurs naturally in crystals, some of which are extremely hard (rock candy) ; and in syrups, one of which is molasses. Sources, etc. Cane sugar is found in the sap or juices of a variety of plants, including sugar cane, the beet, the sugar maple, etc. Whether obtained by collecting sap or crushing, etc., it is always at first a syrup and all solid sugar is obtained from these juices by various methods. Uses as Food. Cane sugar enters into the dietary very largely, pure for table use, and in confectionery, or in com- NON-NITROGENOUS FOODS 15 binations with other foods in cookery. It is a very valuable source of energy, but must be used with discretion, because in too large amounts or in too concentrated form it is irri- tating to the stomach and liable to ferment, and also be- cause being quickly absorbed, it satisfies the appetite before the need for food has been entirely met, or blunts it so that other foods become distasteful. A pound of sugar and a pound of pure cornstarch are nearly equal in energy value. For children, it is much better to give sugar in the form of sweet fruits, because they are then supplied with valuable mineral salts which are entirely lacking in pure sugar. Substitute for Sugars. Since sugar is used not only as a fuel food but as a condiment, attempts have been made to secure a substitute for ■ use in cases where carbohydrate is limited or denied. The best known of these is " saccharin " or " sweetina," a crystalline coal-tar product. It is many times sweeter than sugar, but it has no food value. Use of Sugar in Practical Dietetics. Sugar taken in small quantities will replace starch weight for weight, and be more easily and quickly absorbed. The amount of sugar which can be taken ill place of other fuel food depends on the amount of exercise and the peculiarities of the individual. An excess of sweets may cause nausea and always blunts the appetite, thus cutting down the consumption of other foods. If a very large amount be taken, sugar will appear in the urine. The maximum advisable daily allowahce of sugar is considered to be about four ounces. Sugar should be avoided in gastric disorders, such dis- turbances of nutrition as gout, rheumatism, and especially diabetes. Being a highly concentrated food, it should be avoided in obesity. Uses of Sugar in Coohery. Glucose is not so sweet as cane sugar, so that when used for sweetening other foods a larger amount must be taken. In cooking fruits, sugar should be added when the process is nearly complete, as it tends to harden the fruit tissues. By boiling for a long time or in the presence of acids (whether naturally in the fruit or added 16 PRACTICAL DIETETICS to it) cane sugar is changed to invert sugar, which is a mixture of equal parts of dextrose and levulose. While dex- trose is not so sweet as cane sugar, levulose is very much sweeter, so that the resulting product has a peculiar, pene- trating sweetness that is not so well liked as the cane sugar flavor. This is another reason for reserving the sugar till the end of the cooking process. Test for Sugar. A simple test for sugar, irrespective of whether it is glucose or cane sugar, consists in adding a little 33 per cent, solution of caustic soda to the suspected solution, and boiling. If sugar is present the solution turns brown. The chief test for glucose or grape sugar alone is Fehling's. A test solution should be on hand, and may be obtained at any apothecaries. It should be obtained fresh. The test is based on the fact that glucose " reduces " salts of copper, i. e., by depriving them of some of their oxygen, an insoluble oxide of copper is precipitated. The test solution contains sulphate of copper, caustic potash and tartrate of sodium and potas- sium. To make the test, add to a portion of the test solution a few drops of the suspected solution in a test tube and boil. If a red substance precipitates, glucose is present. The sole use of this test for the nurse will probably be in connection with diabetes, when the nurse makes the test at the request of the medical attendant. In all other tests for sugar, the first test mentioned above will sufiBce, and would also suffice for dia- betic urine were it not for the fact that a shamming patient could deceive the nurse by placiiig common sugar in her urine. Starch and Other Polysaccharides Starchy foods form a large part of the ordinary diet of man ; they are the chief source of the carbohydrates. Starch, unlike sugar, is insoluble but may be made to pass into a soluble form by dry-heating at high temperature, -or by cer- tain digestive ferments. The first bodies formed are known as dextrins, but ultimately a sugar (maltose) is produced. The alimentary starches may be said to comprise starch NON-NITROGENOUS FOODS 17 proper; dextrins or soluble starches; and glycogen or animal starch, which is stored up in the liver. Source. Starch occurs widely in the vegetable kingdom, along with grape sugar. It is found in largest amounts in grains, seeds, roots and tubers. It is prepared for the market chiefly by mechanical means, being washed out of the finely cut vegetable substances. Its main commercial source is probably wheat, but it is also made largely from potatoes, rice, arrow-root, etc. Description. In its pure stale, i. e., when isolated from proteins, cellulose, gum, etc., starch is a shining white pow- der having a distinctive quality to the touch. Under the microscope it is found to consist of granules, which are in- soluble in cold water. When heated to a high temperature, these granules undergo a certain amount of transforma- tion into soluble starch and dextrin. Boiling the starch in water has the same results. The action of the group of ferments known as diastases is to transform starch suc- cessively into soluble starch, dextrin, and finally maltose (malt sugar). Uses as Food. Starch is seldom used pure in dietaries, but with other food principles in the form of various flours and bread made from them, or as breakfast cereals, legumes, po- tatoes, etc. The breads baked from wheat flour are among the most widely distributed foods. Other Polysaccharides. Aside from starch and sugar the polysaccharides contribute but little to dietetic uses. Cellu- lose, the framework of plants, constitutes the largest propor- tion of their bulk. It is the principal part of the so-called "indigestible residue" of digestion; and hence the amount of the residue varies greatly with the nature of the food eaten. Without nutritive value, it is still believed to be of service as a stimulant to intestinal peristalsis, by acting as a gentle mechanical irritant; by helping to retain moisture and keep the feces soft; and by giving such bulk that the intestinal muscles can act to good advantage. When attacked by bacteria, it forms acids which are valuable checks to in- 18 PRACTICAL DIETETICS testinal putrefaction. Unless it is desirable for some special reason to relieve the digestive tract of all work, a certain amount of cellulose should be included in the diet. In con- stipation the addition of some non-irritating form, as agar- agar has proved a successful therapeutic measure. Oums, taken incidentally into the body, represent little or no nutritive value, and like cellulose act as " ballast." Principles of Cooking Starch. The principles involved in the cooking of starch are of two types — chemical and me- chanical. Chemical Principles. Since raw starch is digestible only to a slight degree, it is essential to perfect digestion that starchy foods be cooked. In the presence of moisture, starch is made soluble at the temperature of boiling water, i. e., 212° F. By long boiling, this soluble starch can be converted into dextrin, a still more easily digested form than soluble starch. This principle is applied in the making of gruels, especially for invalids and infants. By dry heat, at a temperature considerably above 318° P. (300° P.-400° P.) starch can be converted quite readily to dextrin. This principle is applied in making toast. Some of the starch is further changed to caramel, giving a char- acteristic flavor to the crust of bread, toast, etc. Mechanical Principles. When foods composed almost en- tirely of pure starch, such as flour, cornstarch, etc., are to be cooked with a liquid, care must be taken to prevent the formation of lumps, for these are not only unsightly, but con- sist of an outer layer of soluble starch surrounding a center of unchanged material and preventing its being made di- gestible. There are three methods of avoiding lumps : — 1, By mixing the starch gradually with a small portion of cold water, -so that a smooth fluid mass is formed, before adding the boiling liquid. This method is useful in making gruels, etc. NON-NITROGENOUS FOODS 19 2. By mixing with fat before adding liquid. The melt- ing fat separates the starch granules. At least as much fat as starch must be used. The liquid is preferably added cold, and all at once. If added hot, it must be stirred in very gradually. This method is employed in making gravies, sauces, etc. 3. By mixing with sugar. The melting sugar serves to separate the starch grains. This is practicable only when the sugar is greater in amount than the starch, and the liquid must be added gradually. This method is applied in the case of desserts, such as cornstarch pudding. When foods consisting of a mixture of starch and cellulose, as cereal breakfast foods, are to be cooked, it is necessary to soften and break up the cellulose to enable the digestive juices to reach the starch. This, necessitates long cooking at a temperature neaT the boiling point. The longer such a cereal product is cooked, the easier of digestion it becomes. Hence it is an excellent rule to cook such foods for infants and others of feeble digestive powers, twice as long as is commonly recom- mended. Eeheating of starchy foods, therefore, tends to increase their digestibility. Zwieback (or twice-baked bread) is more digestible, for example, than fresh bread. Test for Starch. Starch is colored blue by iodin. Hence it is easy to detect its presence in any food. To make the test, a small portion of the material should be placed in a test tube, boiled with a little water, cooled, and two or three drops of dilute tincture of iodin added. If starch is present, the blue color will immediately appear. Dextrin gives a port- wine color with iodin, so that if any of this substance be present, the color is modified, becoming more or less purplish, or purple-red. FATS AND OIIS Definition. Fats are food-stuffs having the same ultimate chemical composition as carbohydrates; i. e., consisting of so PRACTICAL DIETETICS carbon, hydrogen and oxygen, but the latter element is pres- ent in less proportion than in carbohydrates. Fats were formerly spoken of as hydrocarbons, but this term is now reserved for substances which contain no oxygen at all, such as benzine. Description. True fats, whether solid or oily, are chem- ically compounds of fatty acids with glycerine, and difEer among themselves according to the particular fatty acids they contain. These commonly comprise stearic, palmitic and oleic acids. The stearates or combinations of stearic acid with glycerine (also generally spoken of as stearins) are solid fats as are also palmitates or palmitins. The oleates or oleius on the other hand are fluid at ordinary temperatures. It is therefore evident that solid fats contain much more stearin or palmitin than olein, while fat oils consist chiefly of olein. Stearin is found only in fat of animal origin. Animal fats are therefore a mixture of all three classes, while vegetable fats consist of mixtures of palmitins and oleins. Suet and tallow owe their firmness largely to the amount of stearin present, while lard owes its softness to the amount of olein present. Butter consists largely of palmitin. The most prominent of the animal fats are butter, cream, lard, suet, tallow, butterine, oleomargarine and cod-liver oil. The veg- etable oils are obtained from fruits and nuts (olive, cotton- seed, peanut, cocoanut, cocoa bean and almond). Vegetable oils and the liver oil of fish are composed chiefly of olein. Certain dietetic substances not usually thought of as fatty, contain much oil. Some of these are yolks of eggs, Indian corn and nearly all nuts except chestnuts. Artificial products like butterine are described elsewhere. They are often pre- ferred to butter because their melting point is lowered by the addition of suet or tallow (beef -drippings) so that they keep better in warm weather. Lecithin is a substance usually classed with fats and oils. Besides fatty acids it contains phosphorus. It is a necessary constituent of every living .cell and is especially plentiful in the nervous tissues. At present it is used to a considerable NON-NITROGENOUS FOODS 21 extent in medicine in the belief that it is of value as a food- drug and reconstituent. It is prepared from the yolk of egg and from brain substance. Feeding yolks of eggs is usually as advantageous and cheaper. Volatile Oils. These, as already stated, have little in com- mon with true oils. They stain paper only temporarily , while a fat stain is permanent. They vary much among themselves in composition and agree chiefly in their tendency to disappear by evaporation; and their odor, taste and pun- gency. A few of them are used in diet for flavoring. The oil of bergamot is obtained from orange peel, oil of lemon from lemon peel, etc. The act of cooking tends to volatilize them, so that such flavoring should be added at the last mo- ment. Sources of Fat in the Diet. The chief sources of fat in the diet are milk (yielding cream and butter), olive oil, meat fats (especially lard, bacon and salt pork, beef suet and drip- pings), and oily nuts. Cheap Forms of Fat. Butter, cream, olive oil, lard, etc., are all subject to adulteration with cheaper fats, but aside from the fraud in charging a high price there is a legitimate industry for making cheaper products representing these articles. Thus skim milk has its lost cream restored by a homogenized meat fat containing some butter.. A substitute for butter is produced from animal fats and sold under special names, etc. The industry is yet in its infancy, although half a century old. The more expensive fats are prized for their flavor, but the cheaper fats carefully refined have also a high nutritive value. Function. Fats are burned up in the body and produce energy in the form of work or heat. According to Dr. W. Oilman Thompson, the chief uses of fats are as follows: 1. To furnish energy for the development of heat. 2. To supply force. 3. To serve as covering and protection in the body. 4. To make more plastic various structures of the body and give rotundity to the form. 33 PRACTICAL DIETETICS 5. To spare the tissues from disintegration; for, although their combustion in the body results largely in the production of heat, they also take to some extent in tissue formation. 6. To serve for storage of energy. Source of Body Fat. Twenty per cent, of the normal "weight of man is fat. It is derived mainly from fatty foods and carbohydrates. Proteins are transformed into fat only to a very limited degree. It is most readily produced from car- bohydrates, or a mixture of carbohydrates and fats. Principles of Cooking. Pats are more digestible cold than hot, because hot fat tends to coat and intimately penetrate the food with which it is cooked or eaten, and as this coating is not dissolved by the digestive juices of the mouth or stomach, little or no digestion of carbohydrate and protein., can take place in either of these places under such circum- stances. Heating fat to a high temperature also changes its chemical nature, often producing irritating substances which interfere with digestion. Por such reasons fried food should never be given to invalids. Digestibility. The majority of fats are not very easily di- gested, consequently are not tolerated by those suilering from indigestion or by patients acutely ill; their use should be limited to finely divided forms, as in milk or yolk of egg; it is sometimes even necessary to reduce the fat in milk by skimming off the cream, or to limit the amount of yolk of egg, inasmuch as 30 per cent, of the yolk is fat. Other forms of fat valuable in the invalid's dietary are butter, cod- liver oil, and fat bacon cooked crisp. All fats, except limited quantities of butter and cream, should be forbidden in acute diseases of the stomach, intestines and liver, and in most of the chronic affections. Their uses should be limited also in the presence of gall stones. Fatty foods should be prescribed for children with rickets and for all who have diabetes. In the latter disease they partly replace the carbohydrates which cannot be used. Pat may be prescribed with benefit in chronic wasting disease such as tuberculosis, and during convalescence from severe WATER 23 acute disease. The most agreeable and digestible forms should be given. At first a small portion only should be taken, and the quantity increased in proportion to a patient's willingness to accept it. In a general way fats and oils are laxative; consequently useful in case of constipation and equally harmful where there is a tendency to diarrhoea. Comparative Value of Fat and Carbohydrates as Fuel Foods. Fats and carbohydrates serve the same purpose in the body, in that they furnish energy. Fats are not as easily digested as carbohydrates, but weight for weight they furnish two and one-fourth times as much energy. Tests for Fats. Pats are readily tested with paper; if they are present in a given substance a permanent grease- spot appears. If to a suspected substance a little solution of caustic soda is added a white precipitate forms, representing a hard soda soap. WATER Composition and Properties. Water is a compound of hy- drogen and oxygen, consisting of two parts by volume of oxygen to one of hydrogen. Absolutely pure water is color- less, odorless, and tasteless, but such wat^r is not found in nature, owing to its great solvent power, which causes it to dissolve substances with which it comes in contact. Water ordinarily, therefore, contains varying quantities of mineral and organic matter, including gases. To these substances in solution the characteristic flavor is due. Water from which, the air has been expelled by long standing in a warm place, or by boiling, has a " flat " taste. Water freezes at 33° F. On heating, the ice melts, and we may have ice water with a temperature of 33° F. When this water is warmed, the air dissolved in it begins to expand, and tiny bubbles appear, forming first on the sides of the vessel, and tending to rise to the surface. If the water there is not yet warmed, they contract and sink, but finally when the water is warm throughout, come to the surface and es- cape. After the air is thus expelled, if heating is continued. 24 PRACTICAL DIETETICS steam bubbles form in a similar manner. At 185° P., water bubbles below the surface, or simmers. When the bubbles reach the surface and break, giving off a cloud of steam, the boiling point has been reached, 213° F. Except under pres- sure, water can then become no hotter. Fast boiling simply means rapid evaporations and waste of fuel. Source of Water as Food. A considerable source of water is food itself. In green vegetables and fruits it constitutes as high as 85 per cent.-95 per cent, of the whole substance ; in potatoes and other starchy vegetables it is present in as large amount as 75 per cent. Even in seemingly dry foods, as crackers, there may be as much as 5 to 10 per cent. But since 60 per cent, of the body itself is composed of water, and water loss through the lungs, skin, kidneys, etc., is very con- stant, the supply in ordinary diet is not sufficient, and water must be added as a beverage. This may be in the form of ordinary drinking water, of tea, coffee, or other similar bev- erages and of medicinal waters; the latter, however, should be considered chiefly under the head of drugs. Functions of Water in the Body. Water undergoes no chemical change in the body, yet the consideration of it is of vital importance. Solution is an essential part of digestion. Water bathes the tissues and washes away our waste and ex- crementitious matter. As it does not itself undergo any chemical alteration it is not susceptible of liberating force, consequently is not an energy-producing agent, but contributes to chemical changes by supplying a necessary condition for their occurrence. Dr. Gilman Thompson summarizes the uses of water in the body as follows: 1. It enters into the chemical combination of the tissues. 2. It forms the chief ingredient of all the fluids of the body and maintains their proper degree of dilution. 3. By moistening various surfaces of the body, such as the mucous and serous membranes, it prevents friction and the uncomfortable symptoms which might result from their drying. 4. It furnishes in the Hood and lymph a fluid medium by which WATER .35 food may be taken to remote parts of the body and the waste material removed, thus promoting rapid tissue changes. 5. It serves as a distributor of body heat. 6. It regulates the body temperature by the physical processes of absorption and evaporation. Professional fasters have shown that one may live for weeks without food, but it may readily be demonstrated that a warm-blooded animal except in a state of hibernation or trance can subsist but a few days without water. Food Uses of Water. Water taken in considerable quan- tities with meals favors upward metabolism and increases the utilization of food. Thirst at meals does not always mean a true body demand for water, as it may be due to condiments, or to improper mastication of food. Under ordinary circum- stances, about three or four pints daily are necessary to make up loss of water that is constantly being eliminated through the skin, kidneys, lungs and intestines. The quantity ex- creted daily varies greatly under special conditions. The de- mand for water is much increased by hot weather, and vio- lent exercise, and diminished in the bedridden and sedentary. Babies, delirious patients, etc., should be fed water, as care- fully as other food. Classification of Varieties of Drinhing Waters. The clas- sification of water as food is based chiefly on its purity and palatability. Hard and Soft Water. Water containing calcium (lime) or magnesium salts is known as hard water ; and if it contains these salts in excess it is unsuited not only for drinking but for cooking and bathing, unless purified or softened. As only the carbonates can be expelled from the water, the purifi- cation is incomplete; chlorides and sulphates remain behind. For washing purposes the carbonate of lime may be precipi- tated by treating with lye, whereupon it rises to the surface and can be skimmed off. By adding soda to cooking water, a similar softening is obtained desirable in cooking vegetables, as they are toughene"d by the lime and sodium chloride. Finally, for drinking purposes hard water may be subjected 36' PRACTICAL DIETETICS to prolonged boiling and straining; by this means the car- bonic acid is driven off and the lime is set free. It must be remembered that a water not suited for domestic uses may still be fit for drinking if not taken in great excess, because lime and magnesium are natural ingredients of the body. In soft water only a small amount of salts are found and as a rule it is more desirable to use for cooking purposes, especially in the cooking of legumes or when the object is to extract the nourishment or flavor of food, as in making tea or soup, etc. Eain water is naturally pure but devoid of any mineral content, which is sometimes a disadvantage. It is not very palatable. It should be remembered that the first part of a rain fall carries down with it dust and impurities from the air, but the latter part of a shower furnishes as pure water as can be found from any source. Spring Water, well water, etc., vary greatly in the amount of mineral matter, organic matter, gases, etc., present. In many cases the mineral content or gas content is such as to confer a medicinal value. In other eases the mineral matter is a menace to health. In most ground-water there is organic matter which besides being undesirable in itself invites the presence of germs, which often threaten the health and safety of whole communities. Great care should be taken as to the location of a well ; deep spring water and water from artesian wells is usually pure. City water is usually filtered through sand beds and otherwise purified ; the law requires such waters to be frequently analyzed as to purity. As water may dissolve the lead from pipes through which it flows, it should be allowed to run several minutes before using if it has not been recently run off (as after standihg over night) to avoid the risk of lead poisoning. Filtered Water is water freed from organic matter of all kinds. It should be pure and palatable. But filtered water as a rule cannot be depended upon for purity owing to the fact that the domestic filters require constant cleansing and WATER 27 serve to condense the impure organic matter which putrefies upon the filter and renders the water passed through them fouler in place of purer. Small filters screwed on fau- cets are of no value whatever. There are charcoal and porcelain filters on the market that are very good, but are not effective unless often and thoroughly cleansed. "When there is the least doubt as to the purity of water it is best to boil it. Boiled Water. Water simply sterilized by boiling and kept in bottles in a cool place is extensively used when there is suspicion as to its purity. It is rather unpalatable. Boil- ing renders harmless all the organic impurities and precipi- tates salts of lime. It must always be borne in mind that typhoid fever, cholera, dysentery and other pestilences are largely water-borne diseases, and whenever there is any sus- picion that water is contaminated, the most available method for purification is boiling. Before filling the bottles, have them thoroughly cleansed and rinse with boiling hot water, as a few drops of unboiled water would be sufficient to con- taminate the whole. To prevent breaking, place bottles in pan of warm water before pouring in the boiling water. Distilled Water. This is water in its purest state. It is said by many authorities to be unsuited for a beverage be- cause of total absence of mineral matter and gases, on ac- count of which mineral matter is greedily abstracted from the walls of the stomach, thereby causing congestion and irri- tation. It is generally used for medicinal and chemical pur- poses. If employed as a beverage it should be aerated to improve the flavor. Carbonated Waters. Ordinary water may be artificially charged with carbon dioxid, as soda water, etc. Among the most common carbonated waters (naturally charged) are Vichy, ApoUinaris and Seltzer (effervescing waters) and Po- land water (uneiferveseing). These are valuable in case of fever and to tempt people to drink more water; also in re- lieving nausea and vomiting. They are used to advantage with acid drinks and to dilute alcoholic liquors. Carbonated 28 PRACTICAL DIETETICS water of any kind should not be taken in excess, as such waters are apt to produce indigestion, by retarding the action of the gastric juice. Alkaline Mineral Waters are carbonated (naturally charged) and differ from ordinary water in the greater amount of gaseous (carbon dioxid and sulphuretted hydro- gen) and solid matter , (sodium chloride, potassium, magne- sium, iron, sulphur, etc., etc.), which they contain. Some mineral waters have no medicinal value and are simply used for quenching thirst; others have purgative, laxative or diu- retic effect. The following are a few examples of the latter class — Sulphur Spring, Saratoga, Vichy, Hunyadi, London- derry, and Lithia Waters. ■ The benefit derived from the water cures so often pre- scribed is not usually from the water itself but from the change, treatment and quantity of water taken. Much bene- fit can be derived by following the same treatment at home. Temperature of Drinhing Water. Luke-warm or tepid water (65° to 93° P.) which in theory should be most suited for drinking is insipid and even repugnant to most people. Hence as a beverage water is either taken warm (93° to 100° R), hot (100° P. and over), cool (65° to 93° F.) or cold (33° to 65° P.). The taking of hot water in large quantities has been found of benefit for weak digestions and in much chronic invalidism. It acts as a stimulant to gastric digestion; re- lieves thirst more quickly than cold water ; is more quickly ab- sorbed, and leaves the stomach sooner. Cool water is the nor- mal beverage for quenching thirst. Ice water is unsuitable for all individuals when overheated, and with meals for dys- peptics and those in delicate health. Fever patients, however, may take it ad libitum ; for most robust individuals who crave it with or without meals it seems to do no great harm, if taken slowly and in moderation. Its coldness acts as a natural check against overindulgence. It probably slows the move- ments of the stomach and as long as the stomach is chilled the action of the pepsin is curtailed since this acts best near MINERAL MATTER 39 blood temperature, but the arrest is only temporary. A small quantity of crushed ice is known to relieve nausea. MINERAL MATTER Function. The mineral matter in the body serves the most varied ends. It gives solidity to the bones and teeth ^ its presence in body fluids, such as blood and lymph, im- parts to them a certain degree of concentration which is abso- lutely necessary to the vital processes. (Again, minute quan- tities of mineral matter are invariably present in living cells and are indispensable to their existence. The kind of min- eral matter in a given tissue or organ varies according to its function. The bones and teeth owe their stability to salts of calcium (lime) and magnesium, especially the phosphates. ' The salts which are necessary for the regulation_of_the body fluids comprise potassium, sodium, calcium and magnesium, especially in the form of chlorides. The substances essential to the active cells, as part of their normal_ structure comprise phospho rus, irnri r aTid snlpbur,, in tEe'form of organic com- pounds, along with other salts in small quantities. Phos - phoras is found in the nuclei of all cells and is essential for growth. The red corpuscles ar e rich^in iron, and the thyroid gland cells containconsjderable iodin.. Nearly all cells have traces of sulphur, mainly in the form of protein. ) Amount and Kind of Mineral Matter in the Organism. The mineral matter in the body amounts to about 5 or 6 per cent, by weight, occurring chiefly in the bones. The ele- ments needed in the body can all be found in food. The chemical elements found in the body comprise hydro- gen, oxygen, nitrogen, carbon, phosphorus, sulphur, silicon, fluorin, chlorin, iodin, all of the non-metal type; while of the metals are present sodium, potassium, calcium, magnesium, iron. Traces of manganese, aluminium, possibly also arsenic, are sometimes found. Any substance which exists in the soil may find its way into the body. 30 PRACTICAL DIETETICS There is more calcium (lime) in the body than any other of the metals, while phosphorus exists to a greater extent than any other non-metallic element, exclusive of those which go to form living matter. These elements predominate thus because the bones contain so large an amount of phosphate of lime. Lime is also present to a considerable extent as car- bonate. Magnesium phosphate comes next in amount. With the exception of these three bone compounds, mineral matter is present in relatively small quantities. The sodium and chlorin occur chiefly in the form of sodium chlorid, which is present in all the fluids and solids. The chlorin of hydrochloric acid of the gastric juice comes from the sodium chlorid. Some sodium is also present as car- bonate and phosphate, and these two are found in sufficient amount to give the blood and numerous fluids and secretions an alkaline reaction. Potassium occurs mainly in the form of potassium phosphate. Muscle-tissue is rich in this salt. The sulphur and phosphorus which enter the body in the form of protein in animal food are oxidized to sulphuric and phosphoric acids and these at once combine with bases to form sulphates and phosphates of lime, sodium, etc. Sulphates occur to a slight extent only, while as already stated phosphates are the most important constituents numerically. Source of Mineral Matter in the Food. The mineral mat- ter received into the body comes either from the solid food or dietetic fluids. With the exception of sodium chlorid (common salt) it is not usually added to the diet. Such ad- ditions, however, are often prescribed as medicine in states of ill^ health. Thus phosphates and hypophosphites of lime, sodium and potassium are used largely in rickets and scrofula. Iron is given for impoverished blood. It is better to give them in the form of food as far as possible, and care should be taken to see that the food is rich in the mineral elements needed even if they are at the same time being given in in- organic form, for the body can use food salts in many in- stances to much greater advantage. Animal food in general contains the same mineral con- MINERAL MATTER 31 stituents that are found in corresponding human tissues. Cow's milk is rich in calcium and phosphorus in organic forms, and contains small amounts of sodium, potassium, magnesium, iron and chlorin. Eggs contain iron and phosphorus in their most assimilable forms, especially in the yolks. Meats are lacking in calcium, and while red meats are comparatively rich i n iron , it is not in as available form as in eggs. ■""■ "" Since the animals used by us as food obtain their mineral matter from plants, the riche st and most v aried sup ply is com- monly found in the vegetable ki ngdom. Calcium is abundant, especially in such vegetables as beans and peas, fresh or dried, in other green vegetables, "in fruits and the outer parts of grains. There is little in polished rice or fine flour. Vegetable foods are rich in potassium, which usually oc- curs in the form of potassium phosphates. Spinach is richer in iron than almost any other plant food; whole wheat, oat- meaiT^eas and beans, raisins and prunes are also valuable sources of organic iron. ^ Vegetable Acids and, their Salts. Some authorities con- sider these substances under the head of mineral matter, although they have an organic origin and do not pre-exist in the soil. They comprise the acids of juicy fruits such as the citric acid of the citrus group, the malic acid of apples, pears, etc., and the tartaric acid of grapes. They exist partly in a state of combination with sodium and potassium. Prom a dietetic standpoint they may be placed in the same category as the carbonic acid gas and alkaline carbonates of the diet, because in the body they quickly become changed to car- .bonates, and assist in the maintenance of the proper reaction of the blood. Various tdiseases are believed to be due to an excess of acid in the diet, or what is the same thing, to a diminution of alkali. There is no doubt that substances con- taining these bodies and their compounds form a very useful and agreeable addition to dietaries. Importance of a Proper Supply of Mineral Matter. It 32 PRACTICAL DIETETICS was formerly thought that since mineral matter is universally present in food and drink, an individual need pay little at- tention to this phase of the feeding problem. Before the paths of elimination of ash constituents had been studied with any care, it was assumed that many such compounds were excreted in the feces without having ever been absorbed. Since more light has been thrown on the fact that the in- testines form the regular path of excretion of certain mineral matter, and on the chemical nature of the regulation of body processes, there has been greater realization of the fact that unless a diet is chosen from a wide range of food materials, there is danger of some of these constituents being supplied in too small quantities or not at all. This is especially true in the case of artificially-fed infants and of growing children, whose demand for building material is large, but it is not negligible even in adults, especially for the proper control of the body processes. If care is taken to provide iron, phosphorus and calcium in organic forms, there is little dan- ger of inadequate supply of the inorganic salts, since these are present in the milk, eggs, green vegetables and fruits which best supply the elements mentioned above. Use of Mineral Matter in Disease. In health, deprivation of salt soon leads to great loss of vitality, but in various diseases reduction in the consumption of salt is known to be beneficial. Thus in such conditions as Bright's Disease, sodium chlorid (common salt), appears to be so injurious that attempts are made to reduce the quantity ingested. This is known as "salt starvation." Epileptics who depend upon bromides to prevent their fits can do with much less of these substances if their salt is cut down, because bromin up to a certain extent displaces the chlorin in such compounds as sodium chlorid, and fails to fulfill its purpose in such a case. Lime-starvation is also practiced under certain circum- stances, and some animals can thrive fairly well if calcium is replaced by strontium, an allied substance never present nor- mally in animal tissues. It is common to find statements that FOOD ACCESSORIES OB ADJUNCTS 33 certain serious disorders like calculus disease, rickets, scurvy, tuberculosis, etc., are due primarily to too much or too little of some mineral ; but as already stated the real causes must lie deeper, although the possibility of such factors must never be underrated. Scurvy was once held to be due to too much salt, used as preservatives; later it was regarded as due less to excess of some salts than absence of others, as potassium. We only know that with a more liberal dietary, including vegetables and fruits, it has largely disappeared. Calculus disease of certain kinds is more frequent in districts where drinking water contains much lime, but most people escape the aflfection. Children with rickets often improve on preparations con- taining lime and sodium, as also do scrofulous children, but it is difficult to show that in such eases the remedies act by supplying any one kind of mineral food. The safe way is to supply foods containing all, unless some particular condition makes the elimination or addition of specific elements neces- sary. FOOD ACCESSORIES OB ADJUNCTS CONDIMENTS — BEVEBAGES CONDIMENTS Condiments are substances not necessarily possessing nutri- tive value, which are used to give sapidity to tasteless or un- appetizing dishes. To what -extent they have any specific action on the functions of the body is not clear. They tend to increase the flow of saliva, and thus in theory favor the digestion of starch. Classification. The number of condiments, if we include appetizing substances of all kinds, is very large. In some countries, olives, a bit of dried herring, in fact, anything pos- sessing pungency, may be served before a regular meal. Al- coholic beverages need not be considered here. Sauces perhaps represent the largest class of condiments and the great number and variety of their ingredients give 34 PRACTICAL DIETETICS us some idea of the number of individual condiments. They are added to food while eating. Spices (ginger, cinnamon, nutmeg and cloves) are used only in cooking. In this same category may be placed flavor- ing extracts. Mustard forms a condiment in itself. It is used both in preparing food and as an accessory while eating. Horserad- ish belongs in the same class. The flavor of these depends on a volatile oil peculiar to each substance. Such oils have no value as foods. Pepper, salt and vinegar form the most indispensable of table condiments. Of these, salt is, strictly speaking, a food. When, however, it is used in excess of body needs, simply to modify the flavor of food, it is prop- erly classed as a condiment. Condiments are taken for their mild stimulating effects on the tissues with which they come in contact. They are not required by a normal appetite, but are frequently used to obscure the flavor of poorly prepared food. Just as bread can be made of so delicate a flavor that it can be eaten without butter, most other foods can be so treated as to have a suffi- cient sapidity. In the Northern States, tomatoes and melons are eaten with various accessories ; in some parts of the South such fruits have so delicious a flavor that they are eaten plain. To add a cheap table sauce to a costly steak seems a gas- tronomic sin and certainly has no physiological justification. In short, the taste for condiments is largely an artificial one, and their use should be limited. A well-trained palate tires of these high seasonings more quickly than of the mild characteristic flavors of food perfect in its natural state or so cooked as to develop its inherent taste. The moderate use of condiments occasionally, for the sake of variety, or when the appetite is feeble, may be legitimate. They should be withheld (with the exception of salt), from the food of chil- dren, both because they destroy the appetite for milder foods, and because they are irritating to the mucous membrane of the alimentary canal. Because of their irritant properties they should also be given with caution to invalids, especially FOOD ACCESSORIES OR ADJUNCTS 35 those suffering from any inflammation of the digestive tract. A person properly trained to relish foods for their natural flavors does not crave condiments, and is better off without them. BEVERAGES These food accessories comprise milk, coffee, tea, cocoa and chocolate, alcoholic drinks, lemonade and other acid drinks, aerated and carbonated drinks. Milk is a food rather than a beverage, becoming a solid instead of a liquid food in the stomach. It is the only product in nature pro- vided solely for food. It contains not only protein, fat, and carbohydrates in good proportions, but also a rich supply of mineral salts in an available form. Growing children should have at least a quart of milk every day. Cocoa and chocolate are also valuable for their content of protein, fat, and car- bohydrate, and drinks from fruit Juices contain mineral salts, organic acids (which help to maintain the alkalinity of the blood), and some carbohydrate. In other cases, the value of beverages does not lie in their nutritive content. Stimulation. Coffee, tea, chocolate and cocoa contain a stimulating alkaloid which produces mild exhilaration without reaction. Alcoholic drinks while they tend to produce nar- cotic effects when taken in excess, act as stimulants and ap- petizers in small quantities. Thirst Quenching. Substances like lemonade, ginger ale, and aerated drinks in general use are used for this purpose. Sapidity. Coffee and its congeners are used largely for their delicate flavor, and this may be said to a certain degree of all beverages. Drinks especially designed for the invalid and the sick will be considered under other heads. CHAPTEE II NUTRITION SIGESTI0I7 — ABSORPTION — UETABOIISU Under this term is usually understood the digestion and absorption of nourishment, its assimilation and utilization, its storage in excess, and finally the elimination of the products of wear and tear, of combustion products, and of nutriment or waste which cannot be utilized. Those processes of nutrition which occur after absorption are now included in the term metabolism. To restate this in a simple form (adapted from Thompson), nutrition involves: 1. The secretion of digestive fluids, and their action upon food in the alimentary canal — in other words, digestion. 2. The passage of the ingredients of the digested food into the blood vessels and lymphathic vessels — absorption. 3. The utilization of the absorbed nutrition products by the cells — assimilation or upward metabolism. 4. The elimination of waste material — disassimilation or downward metabolism. The subjects of digestion and absorption will be treated in detail for each food principle, and then summarized at the end of each topic. DIGESTION DIGESTION OE PROTEINS Digestion in the Stomach. Protein is not chemically al- tered in the mouth. The process of chewing simply mois- tens and divides it into small particles so that it is easily swallowed and more readily attacked by the secretion of the stomach. Passing down the oesophagus, through the cardiac 36 DIGESTION 37 / sphincter guarding the entrance to the stomach, it enters that portion of the latter organ called the fundus. Here it rests quietly for some time, so that it is not immediately mixed with gastric juice, as formerly taught, but the outer portions of the mass are successively attacked and dissolved. These soft portions are then pressed into the intermediate and pyloric regions of the stomach and subjected to a thorough mixing. The gastric juice is an acid fluid which may be secreted in large quantities — as much as one or two gallons in 34 hours. Its acidity is due to the presence of about 0.2 per cent, to 0.4 per cent, of hydrochloric acid. This of itself is capable; of causing protein to swell and to some extent dissolve; of hydrolyzing the collagen of connective tissue; of decalcifying bone; and of preventing bacterial action. The gastric juice contains two enzymes which act on pro- tein, pepsin and rennin. Pepsin can act only in the presence of a definite percentage of hydrochloric acid, while rennin acts in a neutral solution. The relations of rennin and pep- sin are not yet very clearly understood. The function of rennin is to curdle milk, which causes it to remain in the stomach long enough to be digested by the pepsin. Action of Pepsin. The protein of the diet, more or less swollen, softened, and dissolved by the action of hydrochloric acid, is changed chemically by pepsin, into a series of in- creasingly simpler and more soluble products, namely, acid proteins, proteoses (often called albumoses) and peptones. The change to peptones is not complete, but these three products of peptic digestion tend to pass together into the intestine, when the pyloric sphincter which guards the en- trance to the duodenum opens to let them pass. The opening and closing of this sphincter is controlled by two factors: 1. The consistency of the partly digested food, solid particles tending to keep the pylorus closed. 2. The presence of free hydrochloric acid in the stomach contents. This is the more important factor. Protein is capable of absorbing and uniting chemically with 38 PRACTICAL DIETETICS a certain amount of acid. When it is so saturated, freie acid will be present, having now nothing with which to combine, and this free acid is the stimulus which causes the pyloric sphincter to relax and lets a little spurt of food into the duodenum. Once in the duodenum, this same acid acts as the stimulus to close the pylorus, and no more food enters the duodenum until the first portion has been neutralized. A clear understanding of the way in which the pyloric sphincter is regulated throws considerable light on stomach digestion. We can understand why a certain quantity of in- digestible residue, such as is present in most of our staple foods — meats, vegetables, fruits, etc. — is of service in re- taining food within the stomach for a time, giving the hydrochloric acid a chance to exercise its bactericidal power, and favoring thorough gastric digestion. It also explains why a meal of " bolted " food (or of food imperfectly masti- cated through absence of teeth), or a failure of free hydro- chloric acid in the stomach contents, as in hypoacidity or achylia gastrica, may set up such a continuous state of pyloric contraction that the stomach remains unemptied for a long period, with a good prospect of fermentation and gas pro- duction, of relief by vomiting, or of an attack of acute in- digestion, biliousness or diarrhoea. The nurse will under- stand why a diet of "liquids" for a person in relatively good health does not prove satisfactory. Liquids do not stay long enough in the stomach to give a sense of fullness, give the stomach little to do, and tend to pass into the intestine poorly prepared for the action of the digestive juices there. Digestion in the Intestines. On entering the duodenum, the acid chyme from the stomach meets'- three secretions, all alkaline in reaction, namely, the pancreatic juice, the hile, and the intestinal juice. The hydrochloric acid of the stomach is indirectly respon- sible for the flow of the pancreatic iuice^ for this begins only after acid food has entered the duodenum. The pancreatic juice contains an enzyme capable of digesting protein only after it has come into contact with the intestinal juice. This DIGESTION 39 enzyme is then called trypsin, and the changes which it pro- duces in protein are similar to those produced by pepsin; it acts, however, in an alkaline medium. The products of tryptic digestion are therefore alkali pro- tein, proteoses (albumoses) and peptones. The bile plays no significant part in protein digestion, ex- cept as it helps to neutralize the chyme. The intestinal juice contains an enzyme called erepsin, which completes the digestion of protein, breaking down the proteoses and peptones formed by pepsin and trypsin into still less complex compounds called amino acids. These are the "end-products" of protein digestion. The digestive process can go no farther. There are no enzymes acting on proteins in the large intestines. Summary. The chemical changes in protein during the process of digestion are shown in the following table: PART OP ALIMENTARY TRACT NAME OP SECRETION ENZYMES ACTING ON PROTEIN PRODUCTS OP ENZYME ACTION Mouth Saliva None None Stomach Gastric Juice Rennin Coagulates milk Pepsin and Hy- drochloric acid ["Acid Protein, ■ Proteoses, [Peptones Small Intestine Pancreatic Juice Trypsin (in alka- line medium) TAlkali Protein, ■ Proteoses, [Peptones Bile None None Intestinal Juice Erepsin (acts only on proteo- ses and pep- tones) Amino Acids 40 PRACTICAL DIETETICS SIGESTIOn or FAT Fat is not acted upon by the secretions of the mouth nor to any great extent by those of the stomach. The gastric juice contains an enzyme, called gastric lipase, which has the power of acting on emulsified fats, such as in cream or yolk of eggs. It plays a more important part in the digestion of infants than of adults. The presence of fat in the stomach retards the secretion of gastric juice. Hence a certain excess of fat in the stomach is sufficient to close the pylorus for a longer or shorter time, due to the failure of the appearance of free hydrochloric acid. This doubtless accounts for the fact that fat in the diet often seems to retard and otherwise disturb digestion. Digestion of fat takes place mainly in the small intestines. The pancreatic juice contains an enzyme called steapsin, which has the power of emulsifying fats and also of splitting them into fatty acids and glycerine. The bile contains no such enzymes, but it is nevertheless an important factor in the digestion of fat. It has the power of increasing greatly the activity of the pancreatic lipase (steap- sin), and of holding in solution the fatty acids formed by its action, so that they are more perfectly absorbed. When bile is lacking, much of the fat fails of absorption and is excreted through the intestines. Emulsification is an im- portant aid in the splitting of fat into fatty acids and glycer- ine, the forms in which fat is chiefly absorbed. DIGESTION 07 CARBOHYDRATES 1. Digestion of Starch. There is little doubt that prim- itive man accomplished mudh of the digestion of starch in the mouth. The saliva contains two enzymes, ptyalin, and mal- tase. By the action of ptyalin starch is changed to dextrins and these to maltose; by the action of maltase, maltose is converted into dextrose, the end-product of salivary digestion. The crude uncooked food required prolonged mastication be- fore it could be swallowed, and during this mastication the enzymes had opportunity for action. Eaw starch is so very DIGESTION 41 slowly affected by enzymes, that much of the food value of un- cooked cereals is lost, so that the practice of baking ground grain into bread developed very early. This fact in regard to starch digestion is often disregarded by advocates of a re- turn to raw foods. There is said to be some evidence that a pharyngeal reflex once existed which prevented the bolting of foods which are capable of salivary digestion, or which are not easily di- gestible without mastication. In recent years, Mr. Horace Fletcher has counseled a return to prolonged mastication, in order that salivary digestion may be carried to its fullest ex- tent. It is claimed that the more perfect utilization of all food eaten necessitates the taking of a smaller amount. There is no doubt that thorough mastication renders the di- gestion of starch easier and more complete, but it will not greatly alter the total food requirement. The starchy food mixed with saliva passes from the mouth to the stomach and lodges in the fundus, the portions last eaten always going to the center of the mass. Thus, while the gastric juice is at work upon the outer layer, attacking the protein of the diet, the inner portions remain alkaline for a considerable time, so that salivary digestion may continue undisturbed. From time to time, the soluble products of salivary and gastric digestion pass into the small intestine. Here the con- version of starch and intermediate products into simple sugars is completed. The pancreatic juice contains an enzyme called amylopsin, which acts like ptyalin, i. e., changes starch to "dextrins, and finally to maltose. The intestinal juice contains an enzyme capable of chang- ing maltose to dextrose, the final product in starch digestion. Summary. The chemical changes in starch during the process of digestion are shown in the following table : - 42 PRACTICAL DIETETICS PART OF ALIMENTAEY TRACT NAME OF SECRETION ENZYMES ACTING ON STARCH PRODUCTS OF ENZYME ACTION Mouth Saliva Ptyalin Maltase fDextrins [^Maltose Dextrose Stomach Gastric Juice None • Small Intestine Pancreatic Juice Intestinal Juice Amylopsin Maltase fDextrins 1 Maltose Dextrose 3. Digestion of Sugars. Although sugars are perfectly soluble and easily absorbed, they must all be converted into monosaccharides or simple sugars (chiefly dextrose), before they can be utilized by the body. Hence we find a number of enzymes in the alimentary tract acting upon disaecharides. Two of these have already been indicated in discussing the digestion of starch, i. e., the maltases of the saliva and in- testinal juice, which convert each molecule of maltose into two of dextrose. In the stomach, a slight hydrolysis of the disaecharides may occur through the influence of the hydro- chloric acid. In the intestines, provision is made for their complete transformation. Both the pancreatic and intestinal juices contain enzymes of this type. In young animals, or' older individuals on a milk diet, the pancreatic juice con- tains lactase, which converts lactose (milk sugar) into dex- trose and galactose. The intestinal juice contains three such enzymes, sucrose, acting on sucrose (cane sugar) ; lactase, acting on lactose ; and maltase, acting on maltose. Summary. The chemical changes in sugar during the process of digestion are shown in the following table: DIGESTION 43 PART OF ALIMENTARY TRACT NAME OF SECRETION ENZYMES ACTING ON SUGARS PRODUCTS OF ENZYME ACTION Mouth Saliva Maltase Dextrose Small Intestines Pancreatic Juice Intestinal Juice Lactase (at times) Lactase Maltase Sucrase ("Dextrose \Galactose /Dextrose \Galactose Dextrose TDextrose \Levulose Mineral Matter and Water require no changes to prepare them for absorption. RESTTUE OF DIGESTION The processes of digestion are both mechanical and chem- ical. By mechanical processes the foods are first softened and finely divided, so as to be non-irritating to the walls of the alimentary tract, and to expose as much surface as pos- sible to the action of the digestive enzymes; secondly, they are moved along the alimentary tract from time to time, to facilitate digestion and absorption, and to expel indigestible residues. The movements of the mouth in mastication, of the oesophagus in swallowing, and of the intermediate and pyloric regions of the stomach in mixing the food with the gastric juice; the rhythmic and peristaltic movements of the small intestines, by which the food is alternately churned in a stationary position and then pushed along to a new region to repeat the process; and finally, the anti-peristaltic move- ments of the first part of the large intestines and the slow peristalsis throughout its entire length, form a series of events of tremendous importance to the welfare of the organism. By chemical processes, complex food-stuffs are converted into simpler substances out of which the body can build the 44 PRACTICAL DIETETICS compounds essential to its persistence and activity. The di- gestive fluids and the enzymes contained therein, with the results of their activity, are most readily indicated by the following table: PART OF NAME OF SECRETION REACTION ENZYMES PRESENT FOOD PRODUCTS OF ALIMENTARY TRACT TO LITMUS PRINCIPLES ACTED UPON ENZYME ACTION Moutli Saliva Alkaline Ptyalin Starch r Soluble J starch- ) Dextrius I Maltose Maltase Maltose Dextrose Stomach Gastric Acid Pepsin Proteins f Acid Juice J Protein (0.2%- 1 Proteoses 0.4% I Peptones H CI.) Rennin Protein (especially casein of milk) Coagulated Protein Lipase Emulsified Fats Fatty acids and glycerine Small Pancreatic Alkaline Trypsin Proteins f Alkali Intestines Juice J Protein I Proteoses L Peptones Steapsin Fats r emulsified Fat — -i Fatty acids and L glycerine Amylopsin Starch r Soluble Starch — Dextrins — , Maltose Lactase Lactose Dextrose (in young (Milk and animals) Sugar) . Galactose Intestinal Alkaline Erepsin Proteins in Amino ■ Juice the form of Proteoses .and Acids Sucrase Peptones Sucrose Dextrose and Levniose Maltase Maltose Dextrose Lactase Lactose Dextrose and Galactose The bile contains no important enzymes, but greatly facilitates the diges- tion of fats. The intestinal juice contains an enzyme which makes trypsin an active enzyme, £nd a substance which helps to stimulate the flow of pancreatic juice. DIGESTION 45 Inspection of the table on page 44 shows that there are five so-called digestive juices, viz. : saliva, gastric juice, pancreatic juice, bile, and intestinal juice. All are produced intermit- tently except the bile, which is secreted continuously into the gall-bladder and discharged at intervals into the intestine. All are alkaline except the gastric juice. All contain power- ful enzymes except the bile. Enzymes which digest protein occur in the gastric juice (pepsin), the pancreatic juice (tryp- sin), and the intestina:! juice (erepsin). Ferments which transform starch to sugar occur especially in the saliva and pancreatic juices, and are commonly known as diastatic enzymes. Ptyalin is an old name for salivary diastase, amy- lopsin for pancreatic diastase. The principal fat-splitting enzyme occurs in the pan- creatic juice, and is known as pancreatic lipase or steapsin. Numerous enzymes of minor importance occur in the gastric, pancreatic, and intestinal juices. Bile in itself is able to emulsify fat as a step toward digestion. rACTORS DEIEEMIinNG BATE 0? DIGESTION We know of the existence of many factors which influence salivary and gastric digestion, but much less about intestinal digestion. Among these are the nature of the food, cook- ery, appetite, mastication, palatability, mental state, amount of fluid in the meal, the pyloric reflexes, etc. The nature of the individual plays a powerful role; some individuals can subsist almost wholly upon one or a few articles, while others quickly revolt against monotony of diet. Idiosyncrasy is another important factor; for example, some individuals can- not eat mutton, however disguised, while in others sugar is so strong a stimulant to peristalsis that it sets up a violent diarrhoea. The above being true of presumably healthy peo- ple, the factors which may influence digestion in the sick, invalid and convalescent must be still more uncertain. Hence tables which purport to give the relative digestibility of foods must be studied with allowances. We can study this problem in test tubes, or by examining the washings from the 46 PRACTICAL DIETETICS stomach after definite meals or in fistula patients, but the results can hardly be applied forthwith to all persons. The direct stimuli to the secretion of saliva are the sight, odor or taste of food; or the mechanical irritation produced by contact of food-stufEs with the mouth. Indirectly, the thought of food may be a psychic stimulus to the flow of saliva. Excitement may so check the flow of saliva that it is impossible to swallow dry food. The stimuli to the secretion of gastric juice are both psychic and chemical. Pawlow has demonstrated, in the case of dogs, that the sight of food or the chewing of food in the mouth may produce a very effective flow of gastric juice, to which he attributes great importance in digestion. How im- portant this preliminary flow before food enters the stomach may be in the case of man has not been very clearly demon- strated, but it seems reasonable that the desire for eating, the act of eating and the pleasure obtained therefrom exercise a favorable influence upon gastric secretion. It has recently been shown that the products of salivary digestion act as a stimulus to the flow of gastric juice, and that once the process of gastric digestion is initiated, the products of pep- tic activity cause the continuance of the secretion as long as the food remains in the stomach. The mere mechanical irritation caused by the presence of food in the stomach is ineffective. Thus white of egg will cause no flow. But cer- tain substances, such as meat extracts, bitters and condiments, promote secretion. The use of meat broths, gelatin jellies, peptones (i. e., products of gastric digestion), and toast (con- taining dextrins or products of salivary digestion), at the beginning of a meal, or to promote feeble gastric digestion in an invalid, is therefore a rational practice. ABSORPTION While absorption through a permeable animal membrane outside the body may be a simple physical process, following the ordinary laws of pressure, diffusion, osmosis, etc., the case ABSORPTION 47 is far otherwise in the alimentary tract, where the selective activity of the living cell becomes a positive factor. The pressure in secreting glands rises above blood pressure; sub- stances pass inward to the body through the mucous mem- brane without a corresponding movement in the opposite di- rection. Thus blood serum, placed in a loop of intestine is promptly absorbed, but if the loop be siirrounded with serum, it does not pass in a similar manner into the lumen of the section of intestine. The stomach is not primarily an absorbing organ, but a few substances, such as sugars and peptones, pass to a limited extent through its walls. The most important seat of absorp- tion is the small intestine, and second, the large intestine. Absorption in the small intestine is affected through the in- numerable little projections with which the intestine is lined, known as villi, which greatly extend the amount of surface. These villi contain a capillary network and a so-called lac- teal space. The capillaries by converging into larger vessels eventually form the portal vein which passes through the liver. The lacteal spaces are prolonged into lymphatic ves- sels which similarly converge to form the thoracic duct. The lacteals are intended almost wholly for the absorption of the fats, all other digestive products passing through the liver before reaching the general circulation. Absorption continues throughout the length of the large intestine, being especially flavored by antiperistalsis in the upper portions. Constipation sometimes results from the great absorptive power of this region, the feces being left dry and hard and hence difficult to evacuate. Absorption of Protein. This question still continues to be a riddle. At some point, either in the intestinal walls and villi or blood vessels, or in the blood itself, the amino acids formed in digestion are united to form body protein. We do not know how or where this transformation occurs. It is certain that a small amount of humanized albumin reaches the blood through the thoracic duct. The rest must enter the portal circulation and pass through the liver into the general 48 PRACTICAL DIETETICS blood stream. The end products of peptic digestion seldom are found in the blood, and when present, tend to pass at once into the urine. When food albumin for any reason enters the blood, it does not act as blood albumin, but is at once excreted by the kidneys as a poison. Proteoses and peptones behave similarly. As animals may be made to live in health on a diet of end products alone, we know that these repre- sent the utilizable portion of food albumin. Absorption of Fat. It is now commonly believed that fat is absorbed in the form of the end products of its digestion, i. e., fatty acids and glycerine, and that somewhere in the intestinal wall these are recombined into neutral fat. It is possible that some of the finely emulsified fat is able to pass unchanged through the intestinal wall. In either case, mi- nute fat droplets pass into the lacteals, and finally into the blood stream by way of the thoracic duct. A small portion finds its way directly into the blood. Pats having a low melting point are absorbed more quickly than solid fats, and pure fat more readily than fat inter- mingled with other food principles, as in fat meat, for ex- ample. Absorption of Carbohydrates. The end products of carbo- hydrate digestion pass to the blood by way of the portal sys- tem. The monosaccharides on reaching the liver enter the general circulation as dextrose if required for immediate use ; otherwise they are stored in the liver in the form of glycogen, which can be again transformed into sugar when demanded by the system to furnish energy. Sugars are so readily ab- sorbed that if taken in large quantities the body may be un- able to utilize them, and the excess is excreted in the urine. This is especially true in case of an excess of cane sugar or milk sugar. They may be absorbed before digestion, and there are no enzymes in the blood capable of converting them into dextrose so that they can be burned or stored. Under such circumstances they are useless and must be gotten rid of. If maltose is absorbed too rapidly, it may still be changed to dextrose by enzymes in the blood or tissues, and so be utilized. ABSORPTION 49 Absorption of Mineral Mailer. As salts are not digested in the ordinary sense of the word, they require nothing more than solution in the digestive fluids before absorption. The mineral matter is set free from food and diffuses more or less rapidly into the surrounding fluids. Common salt is most quickly absorbed. The chief locality for absorption is the small intestines. The older text books taught that salts were absorbed only by diffusion through the intestinal wall, which required that another solution must at the same time pass from the blood to the intestines until both fluids were of the same degree of concentration. It appears, however, that in the main, mineral matter is taken up in the intestinal wall without diffusion, and as fast as it can be incorporated with certain peculiar solvents is absorbed into the blood. Absorption of Water. Water is not absorbed by the stom- ach, but passes quickly in little spurts (if taken alone) into the intestines. Here it is very rapidly absorbed; it may be excreted through the kidneys within twenty minutes after ingestion. The rapidity of absorption may be considerably influenced by mineral matter dissolved in the water. Summary. Absorption is an active, not a passive process. It takes place mainly in the intestines, the larger part before the food reaches the i\eo-cecal valve. Proteins are absorbed by the villi, chiefly in the form of amino acids and pass through the portal vein to the liver. Pats are absorbed by the lacteals, chiefly in the form of fatty acids and glycerine, but pass to the lymphatics as neu- tral fat, and enter the blood stream from the thoracic duct. Carbohydrates are absorbed by the villi in the form of su- gar (chiefly dextrose) and pass through the portal vein to the liver. Unabsorbed material forms the feces (see Excretion, page 53). Undigested proteins, fats and carbohydrates are liable to attack by putrefactive and fermentative organisms in the intestines. The products of such bacterial action are absorbed to a considerable extent. Carbohydrates which escape diges- tion tend to produce lactic and other acids. This fermenta- 50 PRACTICAL DlETETiqS tion is not altogether an evil, for it checks the putrefaction of undigested meat. The latter is undesirable, as the products are likely to prove toxic. It is for this reason that lactic acid, especially in the form of buttermilk and artificially fermented sour milk, is largely employed as a remedial agent in intes- tinal indigestion. METABOnSM Metabolism is the sum of the chemical changes taking place in the cells of the body in connection with all biological processes, including growth, repair and waste, generation and maintenance of heat, all manifestations of functional activity, storage of surplus nutriment, etc. It comprises two phases, anabolism and katabolism. Anabolism embraces the changes involved in the upbuilding of the cells, and corresponds in a general way to nutrition. Assimilation is the selective act of the cells in appropriating the special form of nutriment in the circulating blood which is suited for their needs. The special phases of anabolism comprise the assimilation of nitrogen for growth and repair of protoplasm, the storage of a certain amount of fat and •carbohydrate, the assimilation of oxygen for maintenance of heat and functional activity, and the retention of inorganic salts in the bones and other tissues. Katabolism comprises the changes involved in the contin- uous molecular waste of the cells; in the constant oxidation ^oing on in the tissues; in the maintenance of animal heat; in the exercise of muscular, nervous and secretory activity; and perhaps in the breaking up of protein into oxidizable •carbohydrates and nitrogenous waste products. We speak Jess of the acts of katabolism than of the products of katabo- lism, which are a measure of those acts. The chief of these products are: (1) urea, the chief form of excretion of ni- irogen, and (3) carbon dioxide and water, which represent the products of energy-yielding oxidations. Elimination is the escape or expulsion of the, products of METABOLISM 51 katabolism from the tissues into the blood, and corresponds to disassimilation or denutrition. Excretion is the final ex- pulsion of the end products of katabolism from the excretory organs and includes the expulsion of unabsorbed aliment by the bowel. In the case of certain products of metabolism, it is hardly possible to state positively whether they represent anabolism or katabolism. Here belong especially the substances formed • in connection with secretion, as the digestive enzymes, the hydrochloric acid of the gastric juice, the iodothyrin of the thyroid gland and the adrenalin of the suprarenal gland. In. all likelihood both factors participate, for certain substances must be assimilated from the food to form these bodies which in turn are set free in the blood. It is also true that some of these substances act by their mere presence, without ap- parent waste (catalytic action). Metabolism of Protein. A relatively small proportion of protein is normally disposed of by oxidation for energy-forma- tion, when carbohydrates and fats enter fully into the ditt. But in their absence, protein, by virtue of the fact that it con- tains the elements of carbohydrates and fats (carbon, hydro- gen and oxygen) in its molecule, can furnish all the heat and. force required. Certain savages subsist wholly on meat and remain in good health, and in the so-called Salisbury treat- ment of obesity, etc., it can be demonstrated at will that a patient may subsist for weeks on raw beef without apparent detriment, provided plenty of water is drunk, the excess of water aiding in the elimination of unutilized protein. When absorbed protein reaches the liver, a large part of the nitrogen is split off and excreted as urea. The remaining' portion goes to make good the small daily waste of body*" protein. The portion of the protein molecule left after the nitrogen is split off is available as fuel. When carbohydrates and fats are liberally supplied, so that protein is not required for fuel, the daily amount needed is comparatively small. Even when the body is losing nitrogen rapidly, as in certain fevers, it has been found that this is partly because the body 53 PRACTICAL DIETETICS protein is being nsed as fuel, and the loss can be largely prevented by furnishing more energy in the form of carbo- hydrate or fat. Much confusion has arisen because the excess of nitrogen in the diet is to some extent identical in form with the waste products of cellular activity. Besides urea, some of the chief nitrogenous products of protein metabolism are ammonium salts, uric acid, creatin and creatinin. The non-nitrogenous portion of protein may be burned or possibly stored, but the nitrogen excess must be eliminated.. /Because of the fact that excess of nitrogen throws work on the llcidneys, it is assumed that an excessive protein diet is injuri- ous to the integrity of these organs. This is evident in dis- eased kidneys, but cannot be proved for healthy organs. However, it seems unnecessary to consume a great excess of protein and perhaps un\Wse, owing to the great frequency of fatal kidney diseases. At any rate, except where protein is specially advantageous for ease of digestion, it is unnecessary yto make it a large part of the diet. Metabolism of Fat. Fat, which is passed into the blood from the thoracic duct, is carried over the body and deposited in many organs and tissues, unless needed for immediate use as a source of energy, in which case it is oxidized to carbon •dioxide and water. It has been shown that diet-fat may be •deposited in the body in the same form as eaten, but the readiest means of forming body fat is usually to give an ■excess of carbohydrate. The ease with which carbohydrates form fat is shown in the case of cows which produce large quantities of butter fat on an herbivorous diet. It is also possible to form fat from protein, but it is diflBcult, as a con- siderable part of the energy of the protein molecule goes to get rid of the nitrogen, and protein increases the rate of metab- olism. We know very little of the details of fat metabolism. Some investigators hold that it must be converted into dex- trose before it can be oxidized. As already stated, an excess of carbohydrate may be stored in the form of fat. Metabolism of Carbohydrates. The blood maintains a con- stant sugar content of about 1.5 per cent. As fast as this EXCRETION 53 sugar is oxidized, it is replaced by more from the store of glycogen in the liver and muscles, or from newly-formed sugar of recently digested food. The final products of carbo- hydrate oxidation are carbon dioxide and water, but several intermediate products (as lactic acid) are first formed, prob- ably by the action of enzymes. When the body is unable to store any more carbohydrate as glycogen, all further storage of excess is in the form of fat. When sugar is lacking in the blood, as in starvation or failure to utilize carbohydrates, the sugar coHt^t is main- tained at the expense of protein. This explains why the dia- betic who is eating no carbohydrate, may still excrete sugar in the urine. There is some experimental evidence that su- gar may be formed also from fat. At any rate, fat is oxidized in absence of carbohydrate, and whether it is first changed to sugar, or oxidized directly, it is a compact means of storing energy, since one gram of fat will yield 214 times as much as an equal amount of protein or carbohydrate. EXCRETION The waste products of metabolism and all unutilized food, along with the products of oxidation, are eliminated from the system in several ways. Water escapes through the lungs, skin and kidneys. Aside from- the obvious fluid perspiration, a steady evaporation takes place from the skin (insensible perspiration). The carbon dioxide produced by oxidation escapes by the lungs, and nitrogenous products of protein me- tabolism by the urine. The feces are made up chiefly of the residues of food, but also contain biliary matters and other products of the body. When there is excessive putrefaction of the fecal matter, some of the soluble material is absorbed and elinlinated in the urine. Generally speaking, putrefac- tion (of nitrogenous food) and fermentation (of carbohy- drates) hold each other in check. It is known that fasting and starving people pass some feces, thus showing that the bowel is a true excretory organ. CHAPTEE III FOOD VALUES NITROGEN BAIANCE — ENERGY VALUE OF FOOD We are now in position to understand something of food "values, which depend on the food actually utilized in the body, to the exclusion of food unabsorbed, or eliminated because in excess of the demands of the system. Energy-yielding ma- terial which is not used at the time may be stored, but be- yond a certain point, stored nutriment must be regarded as undesirable, as in obese subjects. As stated by Atwater, the food supplies body wants in five ■ways: (1) tissue-building, (2) tissue-repairing, (3) storage for future use, (4) oxidation to maintain animal heat and (5) oxidation to supply energy; or we may say that according to function, foods are classified as tissue-formers, or body-build- ers; energy (or work and heat) producers; and regulators of body processes. (See page 5.) NITROGEN BAIANCE OR NITROGEN EQUILIBRIUM In body building and repairing, the nitrogen of protein food is indispensable. In the other functions, nitrogen is not utilized. Carbohydrates and fats are the natural and con- venient sources of energy, although the protein contains in itself non-nitrogenous material capable of oxidation. As al- ready stated, however, to depend largely upon protein for oxidizable food means the ingestion of an enormous 'quantity of unnecessary nitrogen, the getting rid of which involves Tvaste of energy and is thought to necessitate a strain upon the excretory system. Furthermore, when the diet consists chiefly of protein, much of the latter may not be digested and absorbed as such, but may remain in the intestine, there to 54 NITROGEN BALANCE 55 undergo putrefactive changes. In the course of putrefactiou certain soluble poisonous substances form and are absorbed, requiring elimination by the kidneys. The excess of nitrogen wJiich cannot be- utilized in tissue repair must also be elimi- nated by the kidneys. Thus while people may thrive on a, diet rich in protein, there is considerable evidence that vital- ity, endurance and resistance to disease are better attained with a diet in which the fuel foods (carbohydrates and fats) predominate. Nitrogen cannot be stored to any extent and is constantly eliminated in the urine as urea and other nitrogenous sub- stances. When the diet-nitrogen corresponds in amount with the eliminated nitrogen, the metabolism of nitrogen is bal- anced, or in a state of equilibrium. If too small a quantity of nitrogenous food is taken it does not compensate for the waste of body nitrogen which is inseparable from life. The same thing occurs when for any reason the food nitrogen is not absorbed, or is eliminated without being utilized. This condition of nitrogen starvation is characteristic of under- feeding, wasting diseases, defective assimilation, etc. Con- versely equilibrium between food nitrogen and excreted ni- trogen represents good nutrition, health and energy ; for while nitrogen cannot be permanently stored, it is possible for a balance to be maintained over long periods. It was once taught that increased elimination of nitrogen was due chiefly to the waste of tissue incidental to prolonged and severe muscular or nervous efEort; at a later period, however, it be- came apparent that this waste was comparatively little, and constant for the individual regardless of the amount of muscu- lar exercise, so that the urea nitrogen depends chiefly on the amount of diet nitrogen. The loss of nitrogen in wasting disease, starvation, etc., is, however, extensive ; so that in con- valescence the body is able to store some nitrogen. Nitrogen retention is greatly facilitated in all cases by a liberal supply of carbohydrates and fats. Nitrogen metabolism can hardly be studied in the ordinary patient, on account of the number and variety of tests which 56 PRACTICAL DIETETICS must be accurately made, so that our only guide is the results of scientific investigation of the amounts of nitrogen required Tinder given conditions, and the general well-being of the subject. If weight is maintained, along with a healthy state of functions, the ration in question is suitable for the sub- ject tested. If the individual be in the growing period, the ration should be such that the growth rate is normal. If he be a convalescent, the recovery of the original weight should be constantly progressive. Of late years, however, the em- phasis on nitrogen values alone has been largly superseded by greater attention to total fuel values as being of greater practical worth. It is known that a relatively small and easily obtained quantity of nitrogen is sufficient to repair waste in the average individual, but the food required for producing energy is very significant in amount. With a liberal supply of carbohydrates and fats, the ordinary daily waste of nitrogen in one adult may be reduced as low as 3 to 4 grams daily (corresponding to 20 to 25 grams of protein). To insure a full supply of nitrogen, and to maintain ni- trogen equilibrium at a higher level than the bare maintenance requirement, considerably more than this amount is commonly taken. From 80 to 100 grams of protein per day is re- garded as a liberal supply for an average man (weighing 70 kilograms or 154 lbs.) on an ordinary mixed diet of suitable energy value. THE ENEHGY VAITIE OF FOOD In Liebig's time it was recognized that animal heat was generated by carbohydrates and fats, but the physiologists of that day did not realize that these were the nutrients which furnished the body with energy for its activity. They thought that all muscular work was done at the expense of nitrogenous material. It has taken many years for us to realize fully that- animal energy in all its forms is derived primarily from carbohydrate material, secondly from fats, and thirdly from proteins only in so far as they yield combustible, Bon-nitrogenous bodies. ENERGY VALUE 57 Energy may be defined as the power to do work. This force manifests itself in different ways. It may be latent, or inactive; or it may be active in various forms, such as heat; chemical or electrical energy; or mechanical movement, which we call work. It may be changed from one of these forms into another without loss. The most convenient way to measure energy is by transforming it into heat. A unit has been devised to express different amounts of heat, correspond- ing to a definite number of work units; this is called the calorie. One calorie represents the amount of heat required to raise the temperature of one kilogram of water one degree Centigrade. This is called the large calorie, which is com- monly used in determining the energy value of food. The small calorie is Thu of a large calorie. Energy cannot be created. We must put into any machine as much force as we expect to get from it. Even in the most efficient machine we cannot recover all of the energy in the form of useful work; some of it is always transformed into heat, owing to friction. This is true even in the body, which is a most efReient machine, but here much of the waste energy in the form of heat is turned to good account in maintaining the body temperature. The source of energy for the body is food, just as much as the source of energy for the engine is coal. Plants store up the sun's energy, it is transferred to animals which eat the plants, and eventually man gets it by eating the plant and animal foods. The amount of energy in any given food ma- terial is measured by the amount of heat which it will pro- duce. In general, this is the same, whether the food be burned outside or inside the body, the total result in any case depending upon the amount of the food-stuff which is utilized by the body. An instrument devised for the measurement of heat is called a calorimeter. To determine the fuel value of any food material outside of the body, a given amount is placed in a calorimeter, where it is burned in an atmosphere of pure oxygen, in a vessel surrounded by water. The heat generated 58 PB ACTIO AL DIETETICS raises the temperature of the water, and the change is ob- served with a very delicate thermometer. From this the total heat evolved is calculated. To determine the fuel value of this material within the body, the average amount which is lost in digestion, or which is not completely oxidized before excretion, is deducted from the fuel value outside the body. The result is the physiological fuel value. Many years ago, Eubner determined averages for proteins, fats, and carbohy- drates from experiments on dogs. In recent times, further experiments made in this country on human subjects by Prof. Atwater and his associates have modified these factors some- what. The following are therefore accepted as the average energy values of food in the body to-day : 1 gram of Protein yields 4 Calories 1 gram of Fat yields 9 Calories 1 gram of Carbohydrate . . . yields 4 Calories BETERUINATION 01" ENERGY VALUE OF FOOD To determine the energy value of a given amount of any food, it is necessary to know first its composition, i. e., the percentages of protein, fat, and carbohydrate present. Tables are available giving the results of many analyses, as in Bulle- tin 28, Office of Experiment Station, United States Dept. of Agriculture, Washington, D. C, "The Chemical Composi- tion of American Food Materials." Second. From these percentages to determine the weight of protein fat and carbohydrate in grams, which can be ob- tained from a given amount of the food material. Third. To multiply these weights by the energy value of one gram of each of the three food principles. By way of illustration let us find the fuel value of one loaf of bread, weighing 13 ounces. (1) By referring to Bulletin 28, we find that white bread (miscellaneous) yields on the average, 9.3 % protein. 1.2 % fat. 52.7 % carbohydrate. ENERGY VALUE 59 (3) To get the weight of protein, fat and carbohydrate in grams, we must first convert the total weight of bread into grams, 1 oz. = 28.35 grams. 12 oz. = 340.2 grams. Then 340.2 X 0.093 = 31.64 grams of protein. 340.2 X 0.012 = 4.08 grams of fat. 340.2 X 0.527 = 179.28 grams of carbohydrate. (3) Multiplying the amount of each nutrient by the proper factor, 31.64 grams protein X 4 = 126.56 Calories 4.08 grams fat X 9 = 36.72 Calories 179.28 grams carbohydrate X 4:= 717.12 Calories Total 880.40 Calories Hence the total energy value of 1 loaf of bread weighing 12 ounces is 880.4 calories. To calculate the total energy value of any combination of foods, it is necessary to compute the fuel value of each in- gredient, and take the sum of the whole group. Thus for Egg Broth, page 118, it is necessary first to get the weight in grams of each of the following ingredients and then to estimate their energy value as indicated above. Yolk of 1 egg = 13 grams. 1 tablespoon sugar = 15 grams. 1 cup milk V = 244 grams. 1 tablespoon brandy '^13=, 14 grams. In this book the food values of all the materials used have been incorporated into a table, so that by reference to this the value of any combination is quickly made. Yolk of 1 egg = 48. Calories. 1 tablespoon sugar = -^0 Calories. 1 cup milk = 169 Calories. 1 tablespoon brandy i =: 42 Calories. Total energy value 319 Calories. *The energy value of alcohol is 7 calories per gram. It is necessary, therefore, to know the per cent, of alcohol in any liquor. 60 PRACTICAL DIETETICS To estimate the fuel value of any diet, it is simply necessary to compute the food value of each food material used and add the results together. To estimate the fuel value of an infant's diet, the following formula, adapted to the above factors for energy value from Friedenwald and Euhrah's Diet in Health and Disease, is very convenient. Formula for calculating the Calories of Any Period of Infant Feeding: ( 1 ) Quantity X F X 2.C5 — Calories from fat. (2) Quantity X (S + P) X 1.18 = Calories from protein and sugar. The sum of 1 and 2 gives the total calories. Quantity = 24-hour amount in ounces. F, S and P =^ fat, sugar, and protein respectively, with pereents in whole numbers. To illustrate, take a formula of the following composition: Protein 0.7% Fat 2.7% Carbohydrates 0.0% Feedings per day 9, amount at each finding I14 oz. Hence Q = 13.5 oz. (9 X I'/s) F= 2.7 oz. S= 6 oz. P= 0.7 oz. (1) Q. X P X 2.65 = 13.5 X 2.7 X 2.65 = 96.6 Cal. (2) Q. X (S + P) X 1.18 = 13.5 X (6 + 0.7) X 1.18 = 106.7 Cal. 96.6 + 106.7 = 203.3 Cal., total for day. THE ENERGY REatTIREMENTS OF THE BODY Work goes on continually in the living body, whether asleep or awake, idle or active, sick or well. In the resting body it consists of such internal work as that of digestion and absorp- tion, circulation, respiration, muscular tension, and intracellu- lar work. In youth these f unctioi)s are more active than in adult life ; in old age they are somewhat less active. ENERGY REQUIREMENT 61 For a man of average weight (154 lbs. or 70 kg.) from 1600 to 2000 cal. daily are required to supply energy for these internal activities. Children require somewhat more in proportion to their body weight, aged persons somewhat less. Beyond this, the factor of most significance in determining the total food requirement for any individual is the amount of ■muscular activity. A man requiring 100 cal. per hour at rest may by hard work raise his energy requirement as high as 500 or 600 cal. per hour. Por this reason a person en- gaged in a sedentary occupation needs less food than one whose work is physical, as a farmer or lumberman. Children are usually more active than adults, and hence in proportion to their weight require more food, while inactive aged per- sons require very little. Averages obtained from many observations on the amount of food consumed by individuals under different conditions, show that the energy requirement of the active man of 70 kgs. body weight is approximately 3000 calories. In making estimates for any individual, age, weight, size and shape, season and climate, mechanical efficiency, etc., must be considered as well as muscular activity. During the early months of life, children require about 100 cal. per kilogram of body weight. Throughout the years of childhood, they need about 80 calories per kilogram. The adult moderately active, 35-40 cal. per kilogram, and the very aged, about 27 cal. per kilogram. " The following table, computed by Eubner, shows the daily heat consumption, in units of heat (calories) in an adult, weighing 65 kilograms or 140 lbs." During rest in bed . . 1800 calories or 28 Cal. per kilogram. In repose 2100 calories or 32 Cal. per kilogram. In light work 2300 calories or 33 Cal. per kilogram. In moderate work.. 2600 calories or 40 Cal. per kilogram. In hard work 3100 calories or 48 Cal. per kilogram. The total energy requirement for individuals under differ- ent conditions of age, weight, and activity are approximately as indicated in the following table: 62 PRACTICAL DIETETICS ENERGY PER DAT CONDITIONS IN CALORIES Man at light work 2500-2800 Cal. Man at moderate work 3000-3500 Cal. Man at very hard work 4000-5000 Cal, Woman at light work 1800-2400 Cal. Woman at moderate work 2400-2800 Cal. Child from two to six 1200-1800 Cal. Child from six to fifteen 1800-2500 Cal. Aged Man 1800-2000 Cal. Aged Woman 1000-1800 Cal. The most convenient means of calculating the energy value is afforded by the following table, determined for the adult man of average weight. AVERAGE NORMAL OUTPUT OF HEAT FROM THE BODY AVERAGE CONDITIONS OF MUSCULAR ACTIVITy CALORIES PER HOUR Man at rest, sleeping 65 Calories Man at rest, awake, sitting up 100 Calories Man at light muscular exercise 170 Calories Man at moderately active muscular exercise . . 290 Calories Man at severe muscular exercise 450 Calories Man at very severe muscular exercise 600 Calories To illustrate the use of this table, let us calculate the energy requirement of a woman weighing 130 lbs., under the following conditions : Sleeps 9 hours 9 X 65 = 585 Cal. Works at desk 8 hours 8 X 100 = 800 Cal. Walks or does light exercise 3 hrs 3 X 170=: 510 Cal. Keads or sits quietly sewing 4 hrs 4 X 100 ^400 Cal. 2295 Cal. Since these factors are for a man weighing 154 lbs., for a •woman of 120 lbs. under above conditions, reduce this pro- portionately to her weight, 154 : 120 : : 2295 : X X := 1788 cal. — total energy requirement for a woman of 120 lbs., under the above conditions. ENERGY REQUIREMENT 63 The protein requirement is conveniently estimated by pro- Tiding 10-13 per cent, of the day's energy in the form of protein. Thus for a man whose energy requirement is 3000 cal. per day, 360 cal. from protein (13 per cent.) would correspond to 90 grams of protein, which would be a fairly liberal allowance. A tall thin person requires more food than a short fat person of equal weight. Also, the person of nervous tern- permanent, in whom muscular tension is high, may require more food than one of phlegmatic temperament. More en- ergy is lost in the form of heat in cold weather than in warm. Because of the numerous factors involved in any case, it is possible to calculate the absolute energy requirement only by rigid scientific experiment. The tables given above, how- ever, are a useful guide to the approximate amount of food required by different individuals. As an aid to easy estimation of the food value of any diet, the following tables have been introduced, showing the nutri- tive value of the food materials used in the recipes in this book, calculated for the quantities commonly required in cooking for individuals. The values for larger amounts will be easily obtained by simple multiplication. 64 PRACTICAL DIETETICS TABLE SHOWING THE NUTRITIVE VAIUE OF THE FOOD MA- TERIALS 1TSEB IN THE RECIPES IN THIS BOOK, GALCU- LATED FOR THE QUANTITIES COUUONLY REdUIREB IN COOKING SHALL PORTIONS FOOD MATERIAL (Uncooked) I I > A Almonds, Shelled Apples, Fresh « Dried Apricots, Dried Arrowroot Asparagus B Bacon Bananas Barley, Pearl " Crushed Flour a a Bass, (edible portion) li u u Beans, String Beef Broth Beef Juice Beef Marrow U tl Beet Steak, Porterhouse. . u u « " " Rump u a a " SIrloinV.V.'";! " " Top of Round 1 cup 1 medium 1 cup 1 cup 1 tbsp. 1 bunch 1 serving lib. 1 medium 1 tbsp. 1 tbsp. 1 tbsp. 1 cup 1 serving lib. 1 serving 1 serving 1 quart 1 serving 1 tbsp. lib. 1 serving lib. 1 serving lib. 1 serving lib. 1 serving lib. Ozs. 5.6 5+ 3 44(2K lbs.) Gms. 160 150 85 142 14+ 1247 0.6 18 16 4S4 m 100 1 27 ^ 14+ v,-\- 16 8 227 m 100 16 454 4 113 m 100 32 907 3H JOO V, 14.1 16 454 IV, 100 16 454 ■W 100 16 4.S4 3H 100 16 454 3K 100 16 454 Gms. 33.6 0.5 1.4 22.4 1.6 43 0.8 2.2 1.1 1.3 19.0 18.6 84.3 10.3 93.4 4.9 9.92 19.1 86.6 21.0 94.8 16.5 74.8 19.5 88.45 Gms. 87.8 0.5 1.8 1.4 10.4 269.4 0.4 0.3 0.1 0.2 2.5 2.8 12.6 0.3 0.3 2.7 420.8 18.0 81.2 13.7 62.1 16.1 73.0 7.3 33.1 Gms. 27.7 16 56. 2 88.5 13.8 41.0 Calor- Us 1035 70 247 ' 354 5S 276 lOO 2597 64 90 51 57 796 lOO 452 44 39S 25 120 382& 23g 1077 207 93S 211 957 144 652' ESTIMATEb OF FOOD VAlom^o 65 FOOD MATERIAL (Uncooked) B— (Continued) Blue Fish, (edible portion) . Brandy Bran Brazil Nuts, Shelled., Bread, White. Crumbs (dry). Boston Brown. a u Gum Gluten. . . Butter. , Carrots Cauliflower. . Celery Cheese, American . Cottage. . Creamed. , (fresh grated) . Chicken, (edible portion) . Chocolate, (unsweetened) . Clams, (edible portion) . Clam Bouillon Claret (10% Alcohol ) Cocoa Cod, Fresh, (edible portion). Cod Fish, Salt, Boneless! .... 1 serving lib. 1 tbsp. 1 cup lib. 1 nut 1 tbsp. chopped 1 slice lloaf 1 cup 1 small slice 1 slice lloaf 1 tbsp. 1 cup 1 small 1 serving 1 serving 1 tbsp. 2 tbsp. 1 serving 2 tbsp. (IM cubic inch) 1 serving lib. 1 square lib. 1 serving 1 serving 1 quart 1 tbsp. I tbsp. 1 serving lib. 1 serving lib. 314 16 H 2H 16 1 12 1 1 13 M 2.0 4.0 2.0 H 1 1 8 3}4 16 1 16 32 16 2 16 Gms. 100 454 14+ 71 454 28.4 340 136 28.4 28.4 386.5 14+ 227 57 113 57 IS 28.4 28 23 100 454 28.4 454 100 100 906 14 7+ 100 454 57 454 Gms. 19.4 87.8 76.94 1.20 2.6 31.6 12.6 1.5 8.4 114 0.1 2.2 0.5 2.0 4'.0 8.0 5.9 6.1 21.4 97.5 3.65 58.5 8.6 2 2.0 I Gms. Gms. 1.2 5.44 3.0 16.5 74.8 15.7 125.6 302.88 4.74 0.3 4.1 1.6 0.5 .30 4. 12.1 193 5.0 10.0 0.28 8.1 2.5 11.3 13.8 220.9 1.0 O.k 4.1 0.4 1.8 0.2 1.4 43.4 31.68 0.05| Calor- ies 88 401 42 218 3048 47.6 0.15 142.1 73 881 • 352 64' 70.3 957.2 109 1744 20 35 6 62 124 31 100 108 492 173 2772 51 2 23 10 70 70 315 64 SIS 15.0 179.3 71.7 13.3 8.5 116.3 4.2 S.2 1.4 'i'2 0.5 8.59 137.4 2.0 0.2 1.6 m PRACTICAL DIETETICS FOOD MATERIAL (Uncooked) C — (Continued) Condensed Milk, Eagle Brand... Consomme.. Corn , Cornmeal . , Cornstarch., Cracker Crumbs., Crackers, Water.. Cream, Thin (18%).. Thick (40%)".' Cucumbers, Fresh (edible port'n). Currants, Fresh.. Dried. Dates Dry Peptonoids, Soluble. E Eggs, whole average size (without shell) Eggs, White " Yolk Farina. Figs'. . 1 teaspoon 1 can 1 serving 1 quart 1 cup 1 tbsp. 1 cup 1 tbsp. 1 cup 1 cup 1 large 1 tbsp, 1 cup 1 tbsp. 1 cup 1 cup 1 cup 1 cup (with stones) 1 tbsp. Filberts, Shelled.. 1 tbsp. 1 cup Ifig H&. lib. 1 doz. 1 tbsp. fchopped) Ozs. .388 1 16 3}i 32 5 sii 5+ H H g 8 1 5 8 H Gms. 11 28.35 450 100 906 10 142 10 156 151 10 14 227 14 227 28.4 142 227 227 159 10 170 28.4 227 454 Gms. 0.88 2.27 36.33 2.5 10.0 7.9 0.8 13.0 16.5 1.2 0.4 5.6 0.3 4.99 23 2.12 5.44 4.0 6 5.4 3.3 2.1 1.0 18.7 1.3 9.7 70.72 3.3 2.21 Gms. 1.057 2.72 43.79 3.4 0.2 2.6 9.0 0.5 2.8 41.9 6.0 90.7 .06 pQ-O Gms. 6.07 15.66 250.60 C.4 1.6 53.9 7.1 106.8 9.5 197.4 110.2 7.6 0.7 10.2 0.5 6.8 I Calor- ies 3S.25 98. S9 1579.33 12 46 34 504 .89 0.1 2.3 0.1 0.7 296.16 13.89 9.26 160.1 8 7.2 129.8 22.2 168.2 58.88 2.76 1.84 38 790 588 40 29 440 57 864 81 728 710 57 34 616 95 718] 3184 ISO 100 ESTIMATES OF FOOD VALVES 67 FOOD MATERIAL (Uncooked) F — (Continued) Flour, Barley " Gum Gluten a a « " Graham a ** « Rice v.'"";]!!!;;! (I « " Rye .'.'.'. " Wheat (Rolier Process) a u ■3 N Noodles, Gluten O Oatmeal, Granulated Oats, Rolled Olive Oil, Nicelle OlivK Onion Orange Orange Juice a It Oysters a P Fanopeptcm Peaches, Fresh Dried Peach Juice a u Peanuts, Shelled Peanut Butter Peas, Green I " Canned Pecans, Shelled Pineapple, Fresh (edible portion) " Canned « ..» u u Port Wine (10% Alcohol) Potatoes, White Potatoes, Sweet Prunes 1 cup 1 tbsp. 1 cup 1 tbsp. 1 cup 1 tbsp. 2 or 3 1 serving 1 medium 1 tbsp. 1 cup 2 Icup (solid) 1 tbsp. 1 medium 1 cup l.tbsp. I'cup 1 cup 1 tbsp. 1 serving 1 cup 1 cup 1 slice 1 cup 1 can 1 tbsp. 1 medium 1 medium 1 cup 3 prdtaes Ozs. T4 2)4 Vi 0.5 4 5 a 4 3 5 0.6 4 63^ 5.5 3 8 24 3'A 3'A 5 .1 Gms, 32.5 9.9 158.2 2.7 46.9 1.2 11.2 17.4 1.6 25.6 1.0 6.3 2.5 11.3 56.2 1.1 17.6 34.55 2.8 19.6 18.0 Calor- ies 434 55 16 282 135 -31 56 77 6 104 14 84 50 247 5 777 100 114 100- 1145 22 98 31 130. S 82.6 348 247 1044 18.4 27.4 88.1 17.6 10 83 123 363 n 70 PRACTICAL DIETETICS FOOD MATERIAL (Uncooked) •s. 1 I s il 1 serving 1 dozen 1 cup 1 cup 1 cup 1 tbsp. 1 cup 1 tbsp. 1 serving lib. 1 wafer 1 serving 1 can 1 serving lib. 1 serving 1 tbsp. 1 serving 1 serving 1 serving 1 serving 1 cup 1 cup 1 tbsp. lib. 1 tbsp. 1 cup 1 lump 1 cup 1 tbsp. 1 cup Ozs. M 4 S 8 1 16 8H 16 i% 16 16 4 4 6 8 16 0.4 6.5 % 6.5 Gins. 100 9 113 142 227 28.4 454 IS 240 14 100 454 3 100 454 lOO 454 100 14 a 100 100 113 170 227 14 454 IS 210 7.6 184 12 184 Gms. 21.8 0.2 2.6 2.4 0.2 2.7 1.1 18.1 22 99.6 0.4 23 104.3 18.8 85. 1 20.9 2.3 16.3 1.4 1.0 1.5 .66 21.28 Gms. 8.0 0.3 3.4 1.4 0.2 3.2 0.04 0.7 12.8 57.9 0.5 19.7 89.2 9.5 43.0 3.8 0.3 36.2 O.S 0.7 1.0 11.59 371.0 Gms. 6.S 77.6 17.8 22.6 1.0 16.3 11.2 179.1 2.4 26" 3.6 9 7.9 11.9 11.4 15.0 210 7.6 184 12 184 Calor- ies 159 R Raisins 29 352 Raspberries. Fresh, Black, (edible portion) . . 94 90 Rhubarb 6 105 50 u 795 38 s 203 922 Saltines IS 269 1221 161 729 128 13 27 391 46 Strawberries, (edible portion) 42 63 45 107 u 3425 60 840 « Loaf 30 736 48 736 ESTIMATES OF FOOD VALUES n FOOD MATERIAL (Uncooked) S — (Continued) S igar of Milk, Patch's am f S 7eetbreads T Tomatoes Tapioca, Pearled a u " Minute Tapioca . . Trout, (edible portion). . . . a a u _ Turnip Turkey, (edible portion). . a u u w Walnuts. English Whey Whitefish, (edible portion) 1 .teaspoon (aver, size) 1 tbsp I serving lib. Ipair (med. bizc) 1 tbsp. 1 cup 1 medium (whole to- mato) 1 tbsp. 1 cup 1 tbsp. 1 serving lib. 1 serving 1 serving lib. 1 cup 1 meat 1 glass 1 serving lib. ■s Ozs. ".i64 .564 16 H+ H 6.S 'A i'A 16 16 SA 3H 16 Gms. 100 451 227 IS 227 142 14 184 14 100 454 100 454 156 1 100 454 1 1 ll Gms. Gms. Gms. 100% 16.8 76.2 38.1 12.1 54.8 27.4 0.2 2.7 0.5 0.03 0.5 0.3 0.6 9,0 3.0 0.03 0.4 0.03 12,3 159,5 12.2 17.8 80.6 10.3 46,7 1.3 0.2 8.1 21.1 95.7 22.9 103.9 25.8 .17 98.8 0.63 25,1 0,16 1.8 0.5 9.3 22.9 103.8 6.5 29,4 Calor- ies 4.1 20.5 176 798 399 4 51 16 49 640 49 164 743 39 290.5 1317 093 7 50 150 681 The weights assigned to the various measurements in this table have been determined carefully, but are the results of a limited number of experiments, and hence must be regarded as only nj^proximate. The food values are given with, sullicient accuracy to be within the limits of error of computations made on average analysis of food-stuffs. "A New Food Scale an aid in the administration of quantitative diets." Designed by T. Stewart Hart, M.D. For sale by Messrs. John Chatillon & Sons, 85 Cliff Street, New York. CHAPTEE IV FEEDING THE SICK GENERAL BrLES In the treatment of disease there are few questions which have to be considered so often in the daily routine of practice as those which concern the proper support and nourishment of the patient. A good nurse will never exceed or depart from the phy- sician's instructions ; but there are occasions when her posses- sion of accurate, even if limited, knowledge on the subject of chemical and physiological action of food will enable a physician to give more definite directions, greatly assisting him in the performance of his duties, and adding to the com- fort and well-being of the patient. Physician's Directions. The nutse's directiops in refer- ence to feeding her patient should be written, stating how much food may be given, its form, preparation and time of serving. In pneumonia, typhoid and all acute serious con- ditions, a record of all these details should be kept, also a record of the quantity of fluid and medicine taken. The nurse has a far better opportunity than the physician, to judge of all the conditions of the patient's digestion, and his likes and dislikes for different foods, and she should not fail to report them to the physician in charge and under- stand very definitely to what extent she is to be permitted to humor her patient, and substitute one form of food or drink for another. It may happen from lack of care or indefinite instruction, that the food served will neutralize the effect of the med- icine, either by overfeeding, or by irregularities in feeding, 72 FEEDING THE SICK 73 -which disturb digestion and interfere with the beneficial ef- fect of the medicine. Those who are ill are often allowed to drift into critical conditions through not being properly supplied with such nutritive material as their enfeebled powers can digest. Many have perished because those around them did not know how to feed them, and either withheld food altogether, or gave that which was unsuitable, through ignorance. Even when the patient is confined to bed and prevented from tak- ing any kind of voluntary exercise, he still requires heat and energy for the involuntary action of heart, lungs, and the other processes of living, and healthy nutrition must be pro- vided for by a supply of suitable food. Often the nurse may conscientiously serve one form of food ordered, offering it in spite of the patient's dislike and nausea with the result of half starving him. When her in- structions have not been specific, or have not provided for emergencies, she should make it a point to have them clearly understood at the next visit of the physician. To be able to carry out these instructions and ofEer nourish- ment intelligently, a thorough practical knowledge of dietetics is necessary, and should be the foundation of every nurse's training. If we wish to succeed in avoiding nausea, vomit- ing, loss of strength, and even loss of life, we must learn to offer food to the patient in a suitable form, in the quantity and at the times suited to his digestive power, and so adapt his food to his capabilities. This subject has been so ably treated by Dr. Thompson (Practical Dietetics, 2d ed.) in his chapter, "Administration of Food for the Sick," that permission has been asked, and kindly granted, to use extracts from that chapter; also, by the kindness of Mrs. Ellen H. Eichards, quotations have been made from the article, " Nourishment in Acute Disease," from the "Eumford Kitchen Leaflets." Feeding in Acute Disease. The preparation of food for those who are seriously ill is a matter of vital importance, for the life of the patient often depends either upon the 74 PRACTICAL DIETET-ICS maintenance of strength during the acute period of the dis- ease or on the recovery of power during convalescence. Since acute disease is accompanied by fever, we must consider the effect of feeding in cases where the temperature is febrile in character; also the amount of food, its quality and quantity, together with other conditions affecting its absorption. In acute disease accompanied by fever, what are the con- ditions? The body loses weight, urea is increased and car- bonic acid and water are excreted in larger amounts than in health. All of this loss is not dangerous if permitted to go on for a few days only, and if the amounts do not exceed certain limits. But to replace these losses we are at a dis- advantage as regards the ability of the system to assimilate iood. In fevers the appetite is small, or may be completely lost. The saliva, the gastric juice, pancreatic fluid, the bile, are less efficient in action or diminished in amount during high temperature. The stomach is very sensitive, in part, perhaps, through sympathy with the increased sensitiveness of the nervous sys- tem as a whole. If there is much hyperaesthesia of the diges- tive tract, as in typhoid, in peritonitis, in dysentery or gastro- enteritis, one must be careful not to give too much food at a time, and it should be in a liquid form and partially pre- digested. Note Typhoid Diet, page 337. Evidences of Digestion. Our attention should be devoted not only to what is put into the alimentary canal, but also to what goes out. For instance, if curds of undigested milk are found in the stools of a typhoid patient, the quantity of milk should be diminished, or it should be diluted. Every careful observer of the sick will agree that many patients are starved, simply from the want of attention to the means which alone make it possible for them to take food. Por example, if the patient has a fever with remis- sion and intermission, it is of the first importance to remem- ber that the ability to digest food at these intermissions is greater, and it is then that the most nourishing portions of diet should be given. FEEDING THE SICK 75 It must be borne in mind that, contrary to the prevalent notion, the increase of body heat is not entirely responsible for the wasting of the fever patient. The emaciation is due partly to the inability to receive and digest the food, which in turn al-ises from the irritable state of the stomach and bowels and the defective secretion of the digestive fluids. It is the administration of unsuitable food that must be guarded against, and also the giving of nourishment in quantities and at times unsuited to the digestive powers of the patient. All food is changed into liquid in the process of digestion before it can be absorbed into the blood. Liquid food, therefore, is given to the very sick because it can be digested with the smallest amount of labor to the body. Predigested milk possesses the decided advantage in that it aids the assimilation of the milk without adding to its bulk, as do lime water and other substances. By diluting milk, stimulants and gruels too much, the quantity of the fluid is so great that the patient soon tires of swallowing, and stops before enough nourishment has been obtained. One should not give what cannot be digested, nor less than can be assimilated. So the attendant must have a constant watch over the condition of the patient's powers of digestion, and it is necessary for her to know how to choose such variety in the diet as to include both what is palatable and what will afford a proper amount of nourishment. The Appetite. As the appetite of the sick often requires tempting, the greatest pains should be taken in the prepara- tion of the invalid's food. The lack of desire for food may be due merely to defective cooking, to the serving of meals at inopportune moments, or to the fact that the food selected is not to the patient's liking in kind, flavor, or appearance. A desire for food may exist, but not for the particular food offered, and it is the province of the nurse to differentiate. Punctuality in serving meals should be carefully observed, for an appetite ready at the accustomed hour may fail if the meal is delayed. There is much unconscious habit in re- gard to eating. Time for cooking food should be carefully 76 PRACTICAL DIETETICS considered with regard to the time for serving. Many foods properly cooked are spoiled by standing, which if served promptly would be delicious. The rule of serving food at stated intervals should be observed for the conscious as well as the unconscious or semi-unconscious patient. Quality and Quantity of Food. All foods supplied should be as pure and fresh as possible. Hence for the sick it is desirable to select the best quality obtainable. The amount should be regulated by the physician. When this is not done, care must be taken, on the one hand to see that sufficient is eaten, which often necessitates tempting the" appetite; and on the other to avoid overindulgence if the patient is voracious or has a fancy for certain articles of which large amounts are likely to be harmful. A well man, lying quietly in bed, requires from 1600 to 2000 calories per day, and if the body is being wasted by disease, he may need a great deal more. During conva- lescence, if the body has lost weight, food must be given for rebuilding, in addition to the ordinary daily need. Temperature of Food. The temperature of the food served is exceedingly important, as it has a marked influence upon digestion. As a rule, foods to be served "hot" should neither be served lukewarm nor too hot. Serve in hot dishes and cover in transit. Cold food should be served neither lukewarm nor ice cold. Under many conditions food at ex- treme temperatures interferes with digestion and absorption. Details in Feeding. The patient should be saved from thinking as well as from physical exertion, and it is unwise to ask him what he would like to eat, for it is often the un- expected that pleases. Personal idiosyncrasies should be con- sidered; for some foods easy of digestion, if repugnant to the patient, may prove nauseating and be rejected or disturb digestion. Only a small quantity of food should be given at one time so that the digestive organs may not be overtaxed. It is much better to do this often than to give too much at one time. A tablespoonful of nourishment every half hour may FEEDING TEE SICK 77 be retained and digested, and do the patient good, when if a larger amount were given the stomach would reject it. The majority of weak patients are unable to take food of any solid kind before eleven o'clock in the morning, yet before that time comes they are apt to become exhausted. This would not be likely to occur if a spoonful of some liquid nourishment or stimulant ordered by the physician were given every hour or two, from the early morning up to the time for taking the solid food, which the patient would then probably be able to do by noon. All noise in the preparation of food and smell of cook- ing should be kept from the sick room. The nurse should never eat her meal or taste the patient's food in his presence, and should always have a cheerful manner and a cleanly, tidy appearance. These things have much effect upon the patient's appetite. Bathing and Cleansing the Mouth. When possible, it is well to bathe the patient's face and hands before offering a meal. The mouth should be rinsed each time after eating with pure water, or diluted borax water (two teaspoonfuls to a tumbler of water). This takes away the after-taste of the food and he is less apt to tire of it. The mouth should be kept thoroughly cleansed, for if the lips are allowed to become parched and sour, the patient will refuse nourishment which he might otherwise take. When a patient cannot rinse his own mouth it must be frequently cleansed by the nurse with a swab of fresh cotton, fastened to a small flexible stick. A tongue scraper made of a whale- bone bent to a loop may be used before serving the food; thus the taste nerves will be uncovered and the appetite im- proved. Time and Position for Feeding. When the patient is first allowed to sit up for half an hour, it is well to utilize this time for giving the principal meal of the day, which is likely to be eaten with more relish, and perhaps better digested in consequence. If the patient is only allowed to partially sit up in bed, the nurse should see that the position is com- 78 PRACTICAL DIETETICS fortable, and that the food tray does not cramp the arms and legs, taking care that no crumbs get into the bed. Sleej} and Feeding. The awakening of a patient to take nourishment depends upon his need of the nutriment and upon his ability to go to sleep again. In serious cases it should be given at stated intervals if the patient drops to sleep easily after taking it. Some patients, however, are an- noyed by being awakened and cannot sleep again. In such cases it may be that the sleep will be more beneficial than food. Feeding the Helpless Patient. The effort of sitting up may become fatiguing to the invalid and so destroy his appe- tite before the meal is half done, or he may not be able to feed himself, or to raise his head. In such cases the diffi- culty can be obviated by placing the hand beneath the pillow and raising both together gently. In feeding fluids at these times always serve in small tumbler, not more than two-thirds filled; see that swallows are not taken during inspiration, and that each mouthful is swallowed before another is offered. In case the head cannot be raised, food may be given by means of a glass tube or a feeding cup. Feeding the Unconscious Patient. The feeding of uncon- scious patients demands especial care. They should be given only liquid nourishment, and fed with a spoon, or through a catheter. If the jaws are set, a medicine dropper may be utilized ; not over a teaspoonf ul should be given at once, and the nurse must be sure it is swallowed before she gives more. In the case of comatose children, or young infants, the nour- ishment may be poured into the nostril in place of the mouth. Feeding with the stomach tube is sometimes resorted to, when nasal feeding is not feasible. Forced Feeding. Forced feeding consists in introducing various liquid foods, as milk, eggs, meat-juice or extracts into the stomach by way of the nose or directly through the mouth by means of a stomach tube. This is seldom required of the nurse, but is usually -done by the physician himself. FEEDING THE SICK 79' This method is employed when the unconscious patient expe-- riences difficulty in swallowing; in gastric irritability; when a patient is unable to take sufficient food, owing to loss of appetite and disgust for food; and also in case of a refrac- tory patient who refuses to eat. Nasal Feeding. In nasal feeding a nasal tube is em- ployed or in case of infant a catheter. Have either well oiled and passed gently through the nose into the oesophagus and then into the stomach. Before pouring in the food wait a moment to see that the tube has not entered the larynx. Use of the Stomach Tube. The jaws must be kept open. In children without teeth, the finger may be employed; in grown persons a mouth gag or a roller bandage may be held between the teeth. The tube should be moistened, passed into the pharynx and thence rapidly into the stomach. If these two precautions are not observed, contraction of the muscles may occur, preventing the tube from entering the oesophagus. In passing the tube into the oesophagus, hold it well back from the end. When the tube is satisfactorily introduced, place a funnel in the free end and pour liquid nourishment slowly down the side of the funnel until the tube is filled, and the air in tube is expelled; this care pre- vents the air in tube entering the stomach. In removing the tube, it should be withdrawn rapidly in order not to excite vomiting. In some cases the physician orders the stomach washed out before introducing the food. When it is neces- sary to take special precautions to prevent regurgitation of the food, the ribs may be tickled to prevent contraction of the diaphragm. Eectal Feeding. This form of alimentation is necessary when the stomach cannot retain food. It is based on the fact that the rectal mucous membrane, while it possesses no di- gestive faculty, is able to absorb certain classes of nutriment. These include among the carbohydrates, sugars; among pro- teins, the native albumin as well as the end products of pro- tein digestion. The latter are believed to be much more absorbable than the first products (albumoses and peptones). 80 PRACTICAL DIETETICS Soluble starch (dextrin) is doubtless absorbable, but uir- changed starch and fats can hardly be taken up. It is prob- able that finely emulsified fats if thrown well up into the colon are absorbable to some extent. Although we cannot understand why certain substances nourish the patient, since they are theoretically not absorbable, they seem in some man- ner to be utilized, even when merely thrown into the rectum. As far as possible we should employ substances which we know positively to be capable of absorption; but in rectal feeding for a long period it is sometimes necessary to use a great variety of formula, making it out of the question to confine ourselves to the few articles which are theoretically best suited for the purpose. The rectum may be intolerant to almost any form of enema j even if retained for some time, it may be rejected without apparent change. Under the most favorable circumstances, at least three-fourths of the quantity injected will come away with the regular evacuation of the bowels. The amount of energy actually supplied must be far below the theoretical demands of the body. In some cases, it is of course possible to nourish the patient partly by the mouth and partly by rubbing a small amount of fatty matter into the skin. Some of the most available substances, such as solutions of sugar, are naturally irritating to the rectum. It is possible to keep a patient alive for weeks and even months by rectal feeding, but in many cases this resource for one reason or another fails outright to do what is expected of it. Hence we cannot be too careful as to technique and choice of material used. Of natural substances, milk and eggs have been very freely used. The albumin and sugar in the milk are probably utilized. In an emulsion of eggs, the native albumin is doubtless the constituent which nourishes the patient. We cannot be sure of the absorption of the fatty matter of the milk and eggs. Both these substances are relatively non-irritating. Peptonized milk answers well in some cases. It is best to carry on the peptonization for a long period, until the end products of digestion form, pep-. FEEDING TEE SICK 81 tones themselves being often irritating. Solutions of glucose and dextrin are useful, alone or combined with other in- gredients. For example, eggs may be combined with glucose, or plain milk with dextrin. For variety, any of the pre- digested foods, whether these come in solution or dried, and even bouillon and beef-tea may be tried. Starch emulsion is soothing in the rectum and may be utilized if first mixed with diastase. • The technique is most important. The rectum should first be cleaned by a high injection of decinormal saline solution, after which no attempt should be made to give a nourishing injection for at least an hour. It may be neces- sary for the physician to treat the rectum if hemorrhoids or great irritability exists. The patient's hips should be raised higher than the head to aid in retaining the enema. A tube specially designed for the purpose should be used, the enema being at body heat and allowed to flow" in by gravity from a funnel. The amount injected should never exceed 8 oz. and the enema cannot be repeated oftener than every 6 hours unless the quantity is small. As a rule, the smaller the enema the more frequently it may be used. After an injec- tion the patient should be kept perfectly quiet. Stimulants like black coffee and whisky are often given by the rectum, the whisky requiring dilution with two parts water. Wine is sometimes used for the purpose. Stimulat- ing and nutritive enemata may be combined. Injections of normal salt solution, seltzer water, etc., are sometimes used to supply the body with fluids and quench thirst. Useful additions to enemata comprise a little salt or sodium bicarbonate or a little starch emulsion ; at times a few drops of laudanum are of value in aiding retention. One should not be discouraged by early failure, as it is possible for tolerance to be established. 83 PRACTICAL DIETETICS FOSHTJLAE FOR RECTAL FEEDING I. Peptone-milk, Von Leube 250 c. c. milk =170 Cal. 60 e. c. peptone ; = 100 Cal. II. Egg-milk, Von Leube 250 c. c. milk =170 Cal. 3 eggs =200 Cal. 3 gms. salt. III. Stareh-milk, Von Leube 250 c. c. milk =170 Cal. 70 gms. starch = 250 Cal. IV. Sugar-milk, Von Leube 250 c. e. milk ' =170 Cal. 50 gms. grape sugar = 250 Cal. V. Pancreas, Von Leube 75 gm. pancreas substance = 300 Cal. 225 gm. beef =300 Cal. 35 gms. fat =350 Cal. (This enema, in semi-solid condition, is introduced into the rectum and allowed to digest therein. A piston syringe with a wide nozzle is required.) Nutrient Enema: Peptonised Milk 5 iv to J vi (four Whites of two eggs to six ounces) Above used Per Rectum every two to four hours. 'Nutrient Enema: Milk 5 i (one ounce) German Seltzer H-O 5 '^ (four ounces) Used in Icterus, every two hours. Nutrient Enemata — ^Malted Milk. Dissolve from three to four heaping teaspoonfuls of Horlick's malted milk powder in one-half pint of water, to which add one-half teaspoonful of salt. Use at body temperature, or two or three de- grees higher. The white of one egg may be incorporated if desired. Four to six ounces used per rectum every two to four hours. Stimulating ^nema: ' Black Coffee ^ \v (four ounces) Whiskey 3 ii (two ounces) FEEDING TEE SICK 83 Bait Solution: Sodium chloride 5 i (one drachm ) Aquae O i (one pint) Use of Alcohol in the Skh Room. The nurse may be re- quired to exercise her own judgment at times in the emer- gency use of alcoholics in the sick room. This necessity is most likely to occur with those patients having incurable maladies where the question of harm to the organism or to the morals of the individual does not come into consideration. Consumptives often show a remarkable tolerance to alcohol, and receive a notable stimulating effect from it, and it sometimes happens that an eggnog or milk punch will enable an advanced consumptive to dress and make his toilet in the morning when otherwise he would have to lie in bed. This is true to a less extent of some other incurable diseases. Severe acute or subacute conditions in which an alcoholic stimulant might require to be given in preference to any other for its emergency effect in averting unlooked-for cardiac failure comprise pyemia, septicemia and diphtheria. In the same class belong certain cases of acute poisoning due to mistakes or suicidal intent, such as those due to aconite and similar heart poisons. The propriety of giving alcoholics after simple collapse or syncope when no serious disease is present depends upon the nature of the case and whether other stimulants are available. Alcohol should perhaps never be given even in emergencies to subjects with neurosis or insanity or to victims of severe disease of the gastrointestinal organs. Keeping Ice in the Sick Room. The very best plan is to have a small refrigerator or a Japanese ice box, which may be had for a few dollars. If these little luxuries are im- possible, put the ice in a deep bowl, cover it with a plate, and place the bowl between two clean feather pillows. An- o'ther simple way of keeping ice is to put it in a dish pan, cover with a tin lid, and wrap in ilannel cloths and news- papers. It will keep a long time, as feathers, wool and paper are poor conductors of heat. 84 PRACTICAL DIETETICS Disinfecting Utensils. All dishes or utensils used in the sick room should be disinfected before being sent to the kitchen to be washed. A simple method is to scrape them clean and dip them in a basin of borax water (a teaspoonful of borax in a shallow bowl of water). In case of infectious diseases all dishes and utensils should be boiled in water containing 3 per cent, of sodium bicarbonate for one-half an hour to one hour. CHAPTEK V THE TRAY The writer's intention is only to suggest to the nurse the best and simplest methods of arranging the tray and a few of the important details. These things seem trivial, but it must be remembered that the horizon of the sick room is limited, and that the patient who has long been confined to bed with a serious illness thinks much of his immediate surroundings. He may seem too ill to notice these details, whereas he is only too ill to speak of them, for one feeds with the eyes quite as much as with the lips, and by some carelessness of the nurse the appetite of a reiined, fastidious, or nervous pa- tient may be wholly destroyed. While the natural stimulants to appetite, such as fresh air, exercise and enlivening companionship, are necessarily wanting, the taking of food is the chief event of the day, and too much care cannot be bestowed upon its preparation and service, as, has been said, the appearance and manner of offering have much to do with its acceptance or rejection. ATTRACTIVE ARRANGEMENT OF A TRAY The cover and the arrangement of the tray is of the ut- most importance, and the slightest departure from regularity and immaculate cleanliness should be avoided. The tray should be covered with fine linen damask, with- out crease or wrinkle — the best you can afford. Use the choicest silver, daintiest china and glassware; arrange neatly and conveniently. Place a single rose or flower on the tray; a quotation, added as a variety, will often attract the atten- tion, and it is well, when possible, to divert the patient's 85 86 PRACTICAL DIETETICS mind from his ailments while eating. This can easily be done in these little ways, and also by the introduction of some cheerful and interesting topic of conversation. Proper Placing 1 Plate. 2 Cup and saucer. 3 Bread and butter plate. 4 Individual creamer and sugar. 6 Tumbler. 6 Individual salt. 7 Knife. 8 Fork. 9 Spoon. 10 Butter spread. 11 Napkin. 12 Flowers. 17 After coffee spoon. 18 Soup or cereal or berry plate, etc. 13 Salad knife. 14 Soup spoon. 15 Oyster fork. 16 Salad fork. N.B. — 'The dots between numbers 7 and 2 reading from left to right represent numbers 13, 14, 15, and 17. Sharp edge of knife turned toward plate; tines of forks, bowl of spoons, all dishes and tumblers placed right side up. How to Serve. (General Eules.) The time of cooking food to be sefved, should be carefully considered in relation THE TRAY 87 to the time of serving, for most palatabl-e food may be spoiled by not serving it at the proper time. Avoid serving too many things on tray. Cover tray with a clean napkin or tray cover in carrying it to its destination. When the dietary ordered is very limited in variety, the pa- tient is often gratified by having his food served in courses, and will eat more than if given everything at once. Only a small quantity should be served at one time. *If possible, taste of all food and drinks before serving, to see if properly seasoned and at right temperature to serve. Always use separate spoon for tasting. Food to be served hot, should be served liot (not luke- warm), in heated dishes and covered in transit. Cold drinks and fruits are more healthful when served cool than ice-cold. When fluid foods are to be given, other receptacles should be used than those used for medicine, or the association of ideas may be strong enough to destroy what little appetite the patient has, and to even produce nausea. Do not fill cups or glasses full, but within one inch of the top. For individual dishes, for a luncheon, or drinks to be passed alone, use a small tray or plate, covered with a doily or folded napkin. The finger-bowl should be placed on a small plate, cov- ered with a dainty doily; fill one-fourth full of water, and put a few rose petals or green leaves in the water and on the side of the plate. When possible, cover all foods and drinks left standing in the sick room. The tray and all traces of a meal should be removed im- mediately after eating. Half-emptied cups or glasses should never be left in the room. If the patient is restricted to any especial diet, vary as far as possible in the preparation and serving. The diet of the patient should be under the supervision of the physician, and his directions followed implicitly, for much unnecessary suffering, and even death, has been the result of giving forbidden food. CHAPTER VI METHODS OF COOKING AND CAEE OF FOOD Cooking is the preparation of food for eating. Digestibility and Nutritive Value of cooked food depends to a C9nsiderable extent upon the manner in which it is cqoked'and served. The time and temperature of cooking should be carefully considered, in relation to the constituents of the food material. Success in Cooking depends in part upon the quality of material used, which should be the best. The measurements must be accurate. Care should be exercised in combining -ingredients and one should know the effect of various modes of cooking on the food under consideration. Training and experience are necessary for success. Objective Points in Cooking: 1. To improve the flavor of food, or render it more pal- atable. 2. To soften it that it may be more readily masticated and digested. 3. To produce chemical changes which increase digestibil- ity. 4. To destroy bacteria and parasites which may be pres- ent in raw food. Effects of Heat. Protein is coagulated by hot water and dry heat ; cold water dissolves soluble proteins, especially if a little salt is present. Starch is converted into dextrin by dry heat at a tempera- ture of 320° F. ; the starch granules dissolve when subjected to boiling water; cold water separates starch grains. 88 METHODS OP CObKING AND CARE OF FOOD 89 Sugars are changed to caramel at a high temperature. Fats are readily decomposed by heat, with production of free fatty acids. Principles Governing the Choice of a Method of Coohing Any Food. These include : (1) A knowledge of the effects of heat and moisture on the digestibility of the articles to be cooked. (2) The relation of the method to the extraction of soluble portions of the food materials. Principal Cooking Processes: 1. Boiling is cooking in boiling water (213° P.). Gentle boiling is as effective as rapid, and prevents waste of fuel if gas is used. 2. Stewing is long, slow cooking in water below the boil- ing point — 186° P. 3. Steaming is cooking in heat derived from the vapor of boiling water. It is of two types. (1) In a steamer (moist heat). (2) In a double boiler (dry heat). 4. Broiling is cooking over a glowing fire or over or un- der a flame. Pan broiling is cooking meat in a very hot frying-pan without fat, turning the meat often. 5. Baking is cooking in an oven by means of heated air. Eoasting is cooking before a glowing fire (direct heat). 6. Prying is cooking in a deep bath of hot fat (tempera- ture ranging from 350° to 400° P.). Other methods are used which differ but slightly from the above. Braizing is a combination of stewing and baking; fricasseeing of frying and stewing. The Object of Each Coohing Process: 1. To retain the juice as in boiling, steaming, broiling, bak- ing, roasting, frying. 2. To extract the Juices as in soups. 3. Partly to retain and partly to extract the juices as in stews, chowders, braising, and fricasseeing. Coolcing Utensils. A nurse should always have at hand a standard measuring cup, divided into thirds and fourths. iWooden spoons are preferable to metal ones for mixing and 90 PRACTICAL DIETETICS stirring, as metal spoons are too hard and may break off bits of enamel, and are also acted upon by acids. For beating egg-white, a spoon-shaped wire beater should be used; for the yolks, a fork or Dover egg beater is preferable. Use round bottom utensils when stirring is necessary during the cooking. Use earthen bowl and wooden spoons for mixing batters, etc. A double boiler should be used when cooking any food that burns easily (as milk) ; also when foods are to be cooked at low temperatures. Blending Ingredients. There are several ways of accom- plishing this purpose. 1. Stirring. This is simple mechanical mixing in which a mass of ingredients is made uniform. 2. Beating or whipping consists in so manipulating a soft mixture as to incorporate the air. A spoon or special device is so applied that the bottom of the mixture is steadily lifted to the top. 3. Polding-in is a term applied to the method of intro- ducing beaten white of egg slowly and gently into a soft mass, so as to render it light, the air being retained. 4. Cutting is used only in making pastry. Two knives are worked in opposite directions until the shortening is well incorporated in the flour. Suggestions as to Methods of Working. If a fire and oven are to be used these must be first of all attended to that they be in readiness when needed. All the cooking apparatus should be laid out and the materials to be cooked measured in preparations for mixing. It is advisable to be economical in the use of utensils. Thus one measureing cup may some- times be used in succession for dry materials, liquids and fats, in the order named. A receptacle should be at hand for soiled spoons and other utensils employed in measureing or mixing. It is desirable to work as much as possible in a small space ; thus the measureing and mixing should be done on a single table if possible. All soiled dishes should be put to soak; at odd moments they may be washed, dried and put away. The purpose underlying these principles is that the METHODS OF COOKING AND CARE OF FOOD 91 nurse may go into the family kitchen and prepare food for the patient without in the least interfering with the regular kitchen work of the household. Ice Box and Contents. The ice box should be maintained in a state of absolute cleanliness. This is not difficult in the case of a simple portable refrigerator without a drain pipe, which may be flushed out daily with boiling water con- taining borax or ammonia (half ounce to the gallon). How- ever, in the larger kinds of portable refrigerators, and in the set ice boxes where a tube is necessary for drainage, all the compartments and shelves should be washed with soap and hot water at least once in a week, while every day loose par- ticles of food which have escaped from dishes, etc., should be carefully removed ; or if advisable in certain cases, the food and 'shelves may be removed and wiped or brushed o£E. The drainage pipes must be cleaned with a brush made for the purpose at least once a week. It is advisable to sprinkle borax on the shelves after cleaning. Certain pungent articles can not be kept in an ice box without flavoring other foods such as butter, milk, etc. Institutions, if large enough, may use a refrigerating plant, which does away in part with the handling of ice; or by the aid of an ice machine, superintendents may assure them- selves of the purity of all ice designed for internal use. The drain pipe- of an ice box should not, for obvious rea- sons, communicate with the sewerage system. The temperature in the food compartments is sometimes much warmer than one would imagine; and it is desirable to get some idea of what the temperature fluctuations are by using a thermometer. The reading can hardly go lower than 40° P. and should not be over 60° F. The ice cake should be wrapped in cloth or paper, not only for economy's sake but because it may be dirty inside or out- side. No food should be placed in the box while warm, for the sudden cooling may set up undesirable changes. Canned food should not be placed on ice in the opened can, but in a fresh receptacle. When possible, each article should be 93 PRACTICAL DIETETICS placed in a separate container, or wrapped in paper. Mois- ture in the ice box, while unavoidable, should be kept down by wiping walls and shelves dry at intervals. CARE OF FOODi The care of food between the time of purchase and cooking, and that of cooking and serving is highly important. The fact that spoiled food represents an economic loss, important as it is, is much less significant than the fact that not only spoiled food, but good food which is contaminated with germ life, is a possible source of disease. Exposed food, i. e., food exposed to dust, insects, etc., be- comes contaminated with disease germs without necessarily becoming spoiled or in any way offensive to the senses. The most crisp salad or luscious fruit may be covered with dan- gerous microorganisms. By far the most frequent and abundant forms of micro- organisms, which grow at such rate as quickly to become vis- ible to the naked eye, are molds. These are not on the whole harmful to man, and their chief significance is that they give to foods a bad flavor and cause a certain amount of decompo- sition. These organisms attack food which is stored in dark, damp places, chiefly cellars, and although themselves gen- erally harmless, they are likely to be associated with poisonous bacteria. Certain butchers hang steaks until they become covered with mold, but the mold does not make the meat ten- der and highly flavored, for these changes are due largely to the bacteria of putrefaction which are also present, thriv- ing under the same conditions as does the mold. In case of substances which have a natural protective cov- ering, it is highly important that this should not be broken in handling. Thus when fruits and vegetables are bruised, the pulp is quickly attacked by microorganisms and local changes occur, resulting in economic waste, since such articles can only be partly utilized. '•For further information, note " Care of Food in the Home." Farmers* Bulletin, No. 375 U. S. Dept; of Agriculture, Washington, D. C. METHODS OF COOKING AND CARE OF FOOD 93 Foods should therefore he stored in places which admit plenty of sunlight and air, which will antagonize the growth of molds and putrefactive bacteria. Ice, by producing tem- peratures unfavorable for the growth of microorganisms, is a valuable aid in this sort of cleanliness. Some use of soap and water is necessary, but the benefits are partly lost if the shelves, etc., are left damp. In cellars repeated whitewashing is the most available resource for cleanliness. Food should be .bought in the freshest and cleanest state, should be placed in clean containers, and handled with clean hands. Foods should always be washed if there is any suspi- cion of contamination. The cases of violent cholera morbus which often follow the use of unripe apples, and even of ripe fruit like cherries, are believed to be due not to the irritating acids present in fruit, but to the presence of a well-known bacterium mingled with the dust which collects on such fruit. To be absolutely on the safe side, all fruits and vegetables should be eaten cooked, but this would deprive us of salads and fresh fruits and berries which form so large and pleas- urable a part of the average dietary. It has been found by experience that if celery, greens, asparagus, berries, etc., are washed repeatedly in cool or tepid water, they can at last become quite clean without losing their delicate flavor and consistency. As long as a particle of grit is present there is of course possibility of contamination by living organisms. They should be washed, therefore, until the wash water is clear. This is a rule which applies to all food that is to be eaten raw. With cooking such caution is not absolutely necessary. Potatoes, etc., are washed before boiling for esthetic reasons only. The worst cases of food poisoning, known as ptomaine poisoning, are mysterious in character, and are not entirely preventable. Chemical substances not usually formed in sim- ple decomposition are responsible. They may be present alike in raw, cooked, or frozen foods, and in fresh and preserved foods. In some cases there is abundant evidence of extreme decomposition. The use of rotten eggs in cookery by bakers 94 PRACTICAL DIETETICS has caused severe ptomaine poisoning. Cold storage meats are sometimes responsible. Pish poisoning, especially with shell fish, may be due to some unknown disease of the ani- mals themselves (although fish very readily undergo decom- position), and personal susceptibility is often a factor. The numerous cases of ice cream poisoning are usually due to mistakes of amateurs who do not understand the proper re- quirements of the art. Although we do not understand and cannot always foresee ptomaine poisoning, it is the more important that no step be neglected which will contribute in theory to securing clean food. Most cases occur in prolonged warm weather in which decomposition is favored. Sound, fresh food, thoroughly cooked and eaten at once could hardly cause ptomaine poisoning under any conditions. The articles which the ordinary careful nurse must think of in this connection are preserved foods of all kinds, shell fish, and milk products, the latter being of most significance, because milk, fresh cream, ice cream, etc., are often given freely to invalids. The care of milk, drinking water and other kinds of food is considered elsewhere. Special care of food in respect to fly pollution has become necessary since we have learned of the part played by this insect in causing typhoid fever, cholera, dysentery, etc. Both the feet and the excrement of flies are sources of contamina- tion. Dealers in food-stuffs in the main take but little pains against protecting their wares from fly contamination. Cook- ing and careful washing of food to be eaten raw, are our principal safeguards in respect to food as it reaches the house. There is the added danger that food when ready for con- sumption will be freshly contaminated. To obviate this, doors and windows of kitchens and dining rooms must be properly screened, and flypaper and similar precautions em- ployed. If typhoid is epidemic in a neighborhood, it is well to avoid raw food entirely, just as we avoid unsterilized water and milk. Flies are much more likely to abound in neighbor- hoods where manure, garbage^ etc., are allowed to accumulate, and are more dangerous than ordinary dust. METHODS OF COOKING AND CARE OF FOOD 95 Dealers usually are at some pains to keep their supplies free from dust, though their methods are not always sanitary, e. g., the use of the feather duster for fruit. Dust from the streets of cities abounds in germ life. Vegetables and cer- tain fruits in clusters which cannot be wiped (grapes, cur- rants, etc.) are most likely to be dusty. Washing succes- sively in a number of waters will usually remove the dust; but in the tropics where many diseases are dust-borne it is not considered safe to eat raw grapes at all. Whether washing is sufficient depends on the character of the dust and the degree of exposure to it. Preserving Foods. Foods to be preserved should be per- fectly fresh. Yeo gives four methods of preservation : ^1) Drying is the method most available for preserving peas, beans, prunes, apricots and other fruits. Milk and eggs may both be preserved by desiccation. (2) Exclusion of air may be applied in several ways. Smoking, which coagulates the outer surface and sterilizes it, serves for preserving ham, bacon, fish, etc. Packing in sawdust, etc., or dipping in wax preserves eggs. Canning in tins or jars under steam heat is used for preserving many kinds of food, all air thus being forced out before the can or jar is hermetically sealed. (3) Freezing and cold storage are used extensively for preserving fish, meat, jams, etc. Such foods must be cooked immediately upon thawing. (4) Antiseptics are used very extensively in food preserva- tion. The oldest and most widely known of these are salt, vinegar, alcohol and syrups. More recently a great variety of antiseptic chemicals have been used — benzoate of soda, salicylic acid, etc., etc. The advisability of their use, even in minute quantities, is questionable. Concentration. Most foods can be reduced to a dry or otherwise condensed state without loss of nutritive value or danger of decomposition; and on account of the resulting economy in price and storage room may enter into the dietaries of hospitals and institutions. Sugar, oil and starch, and 96 PRACTICAL DIETETIC IS many cf n-al products, are already in a state of concentration. Powdered milk and meat, egg powder, etc., are coming more and more into use. Condensed milk has long been a useful product (see milk and milk preparations), as have dried and evaporated fruits and vegetables. All these products can be used in cookery. Their chief use as mainstays will doubtless be in cases of temporary shortage of fresh foods, due to devastating storms, " strikes " and other happenings which interrupt trafBc. Predigestion of Food. Much is written against the use of predigested foods as a steady diet for the well. Many starchy foods on the market are partially digested by heat. The objection seems to rest on the theory that such foods give the digestive fluids and muscles of the digestive organs nothing to do, and that a sort of sluggishness is set up. It cannot be said truthfully that these claims have ever been backed up by facts. No one denies that thorough mastication is a great advantage, and with thorough mastication much of the starch is predigested in the mouth, or, after swallowing, in the fundus of the stomach.' Predigested proteins are not used as staple foods, and as little is gained by very finely masti- cating flesh foods, the stomach has plenty of work in digest- ing animal proteins. If there is fat in the diet the pancreas can never fall into a state of disuse. Hence the outcry against partially predigested breakfast foods does not seem justified on this score. ' It is true, however, that their absence of flavor, and the soft and pulpy character of some of them are recognized as possible drawbacks; for semi-solid and pultaceous foods are difficult to masticate, while their in- sipidity does not flavor a flow of digestive fluids. If ad- herence to these foods causes sluggish digestion and inability to deal with food in more natural condition, one would impute this not to predigestion, but to the fact that the tastelessness and the ease with which they may be bolted, are the real factors which bring about a passive state of the digestive functions. METHODS OP COOKING AND CARE OF FOOD 97 In a diet for the ill, the dyspeptic, the convalescent, etc., there can be no possible objection to predigestion ; on the con- trary, it is highly desirable np to a certain extent. But just as soon as possible the patient should return to foods in the natural state, bearing in mind that a small minority of cases, even the acutely ill, thrive on food which in theory would be hazardous to say the least. Apparently hopeless cases of sepsis have seemingly been rescued by placing pa- tients on food suited only for the healthy. Such patients must, however, have a natural appetite and be able to tolerate the food. Adulteration of Food. " Since the passage of the !N'ational Pure Food and Drugs Act, giving to the United States Gov- ernment authority to enforce stringent laws against the adul- teration and misbranding of foods which enter into inter- state commerce, and the more rigid enforcement of similar state laws which regulate these matters in many of the states, a great burden has been lifted from the shoulders of the buyer. This legislation has enormously decreased the deceptions formerly practiced by some mahufacturers, and since it in- sures that the name and description on bottle and package shall not misrepresent the contents, the buyer, if he knows what he wants, will have no difficulty in obtaining it, while the honest manufacturers and dealers (and they have with- out doubt always outnumbered the others) will also be pro- tected. This matter in its various aspects is taken up in publications of the Bureau of Chemistry^ of this Depart- ment." " For Table of Common Adulteration of Food- stuffs, note Farmer's Bulletin No. 25, of the United States Department of Agriculture, Division of Chemistry, Washing- ton, D. C. ' U. S. Dept. Agriculture Bureau of Chemistry, Bulletin 100; Year Book 1907, p. 321. "U. S. Dept. Agriculture, Bureau of Chemistry, Bulletin 325, p. 19. CHAPTEE VII MEASURES AND WEIGHTS Accurate measurement is necessary to insure success in cooking. All dry ingredients, such as flour, meal, confectioners' or powdered sugar, should be sifted before measuring. Mustard, cream of tartar, soda, and salt should be stirred before measuring, to lighten and free from lumps. A Standard Measuring Cup A stah,dard meaiuring cup contains one-half pint and is divided into fourths and thirds. To measure a cupful of dry material, put in the ingredients by spoonfuls, round slightly and level with back of case- knife, being careful not to shake cup. A cupful is measured level with the brim. A heaping cupful is measured level, with two table spoon- fuls extra added. A scant cupful is measured level, with two table spoonfuls taken out. All ingredients measured hy the tablespoon or teaspoon are measured level. 98 MEASURES AND WEIGHTS 99 To measure a spoonful, fill the spoon and level it oS with the back of case-knife. To measure a half -spoonful, first measure a spoonful and then cut it in halves, lengthwise. To measure a quarter-spoonful, measure a half-spoonful and divide it into half, crosswise, allowing a little more for tip of spoon. A saltspoon is one-fourth of a level teaspoon. A speck is a little less than one-eighth of a teaspoon. To measure butter, lard, and other solid fats, pack solidly into spoon or cup and level with knife. When recipe calls for one tablespoon (or so) of butter melted, measure before melting. When recipe calls for one tablespoon (or so) of melted luiter, measure after melting. TABLE OF MEASURES AND WEIGHTS .4 saltspoons =1 teaspoon, tsp. 3 teaspoons =1 tablespoon, tbsp. 4 tablespoons = i cup. or i gill. 15 tablespoons (dry ingredients) = 1 cup, c. 12 tablespoons (liquid) =1 cup. 100 PRACTICAL DIETETICS 2 gills = 1 cup. 2 cups ^1 pint. 2 pints := 1 quart. 4 quarts = 1 gallon. 2 tablespoons butter := 1 ounce. 1 tablespoon melted butter =1 ounce. 4 tablespoons flour = 1 ounce. 2 tablespoons granulated sugar =1 ounce. 2 tablespoons liquid =1 ounce. 2 tablespoons powdered lime =1 ounce. 1 cup of stale bread crumbs =2 ounces. 1 square Baker's unsweetened chocolate .... =1 ounce. Juice of one lemon = ( about) 3 tablespoons. . . 5 table spoons liquid ^1 wineglassful. 4 cups of sifted flour = 1 pound. 2 cups of butter (packed solid) =1 pound. 2 cups of flnely chopped meat (packed solidly) = 1 pound. 2 cups of granulated sugar =1 pound. 2g cups of powdered sugar =1 pound. 21 cups brown sugar =1 pound. 21 cups oatmeal =1 pound. 4| cups rolled oats ^1 pound. 9 to 10 eggs ^1 pound. 1 cup of rice := J pound. APOTHECARIES WEIGHTS "20 grains = 1 scruple, 3 3 scruples .- = 1 drachm, 3 8 drachms (or 480 grains) = 1 ounce, 5 12 ounces = 1 pound, lb. APOTHECARIES MEASURES «0 minims (M) = 1 fluid drachm, f 3 8 fluid drachms =1 fluid ounce, f ^ J6 fluid ounces =1 pint, or pt. 2 pints = 1 quart, qt. 4 quarts = 1 gallon, gal. APPROXIHATE MEASURES One teaspoonful equals about 1 fluid drachm. ■One dessertspoonful equals about 2 fluid drachms. One tablespoo;iful equals about 4 fluid drachms. One wineglassful equals about 2 ounces. One cup (one-half pint) equals about 8 ounces. MEASURES AND WEIGHTS 101 UEIRIC SYSTESC For the origin and underlying principles of the metric system consult any modern arithmetic (Milne's Standard, for example). The nurse should know the metric tables and the equivalents between the metric and common systems for meas- ures of volume and weight. She does not require linear and square measure, nor measures of capacity except in a few instances. The subjoined tables and equivalents will suffice. TABLES Measures of Volume In measuring small quantities the cubic centimeter is the unit. 1 cubic centimeter = 1.0 ce. 10 cubic centimeters = 10.00 cc. 1 cubic millimeter ^ 0.1 cc. 1-100 cubic millimeter 1 __ ^ ^qj ^^ 1-1000 cubic centimeter etc., etc. :} = MEASTTRES OE WEIGHT In measures of weight the gram is the unit. !1 gram 1.0 gm. 1 decigram 0.1 gra. 1 centigram 0.01 gm. 1 milligram 0.001 gm. TABLE OF EaUIVALENTS Appended is a table of all the denominations of weights aad measures, opposite which are placed the metric system, , with corresponding equivalents in wine measure and avoirdu- pois weights: 103 PRACTICAL DIETETICS LIQUIDS APPROXIMATE EQUIVALENT EXACT EQUIVALENT 1 minim 1 fl. drachm 1 fl. oz 4 fl. ozs. or i pint . . . 8 fl. ozs. or i pint . . . 16 fl. ozs. or 1 pint. . . 2 pints 4 pints or J gallon . . 1 gallon 1 Cubic centimeter 4 Ce 15 Cc 25 Cc 30 Cc 60 Cc 100 Cc 120 Cc 125 Cc 235 Cc 250 Cc 300 Cc 470 Cc 500 Cc 950 Cc 1000 Cc. (1 Liter) ... 4 Liters 0.06 Cubic centi- metre 4 Ce. 30 Cc. 118 Cc. (i Liter) 236 Ce. (J Liter) 473 Cc. (i Liter) 1 Liter (1000 Cc.) 2 Liters. 4 Liters. 0.061 Cc. 3.696 Cc. 29.574 Cc. 118.295 Cc. 236.590 Cc. 473.197 Cc. .946 Liter. 1.892 Liters. 3.785 Liters. 16 minims. 1 fluid drachm. i fl. oz. (4 fl. drs.) 61 fl. drs. 1 fl. oz. 2 fl. ozs. 3i fl. ozs. 4 fl. ozs. (i pint) 4i fl. ozs. 8 fl. ozs. (J pint) Si fl. ozs. 10 fl. ozs. 1 pint. 1 pint 1 fl. oz. 2 pints. 2 1-10 pints. 1 gallon. 16.23 mins. 1.082 fl. drs. drs. drs. 4.057 fl. 6.762 fl. 1.014 fl. 2.029 fl. 3.381 fl. 4.057 fl. 4.227 fl. 7.945 fl. 8.453 fl. 10.144 fl. 15.892 fl. 1.056 pints. 2.007 pints. 2.113 pints. 1.056 gals. ozs, ozs. ozs. ozs. ozs. ozs. ozs. ozs. ozs. SOLIDS APPROXIMATE EQUIVALENT EXACT EQUIVALENT 1-500 erain 0.00013 Gm. 0.00043 Gm. 0.00054 Gm. 0.00065 Gm. 0.001 Gm. (1 milligramme.) 0.000129 Gm. 1-150 gr. 0.000432 Gm. 0.000540 Gm. 0.000648 Gm. 1 (\d. ar 0.001013 Gm. MEASURES AND WEIGHTS 103 SOUDS APPROXIMATE EQtIIVAI.ENT EXACT EQUIVALENT 1-.50 ar 0.0013 Gm. 0.0016 Gm. 0.002 Gm. 0.0026 Gm. 0.0065 Gm. 0.021 Gm. 0.065 Gm. 0.3 Gm. (3 decigrammes.) 1 Gm. 2 Gm. 4 Gm. 3.5 Gm. 14.2 Gm. 28 Gm. 56 Gm. 113 Gm. 225 Gm. 450 Gm. 900 Gm. 001296 Gm 1 -40 ar 001620 Gm 1-32 er 002025 Gm. 1-25 er 0.002592 Gm. 1-10 gr 0.006479 Gm. 1-3 er 021599 Gm. " 1 er 0.064798 Gm. 0.324 Gm. 0.972 Gm. 30 grs 1.944 Gm. 60 grs 3.888 Gm. 3.544 Gm. ^ oz 14.175 Gm. 28.350 Gm. 2 ozs 56.699 Gm. 1 lb 113.398 Gm. 1 lb 226.796 Gm. 1 lb 453.592 Gm. 2 lbs 907.185 Gm. 1 milligramme (0.001 Gm.) .... 10 milligrammes (0.01 Gm.) (= 1 centigramme. ) 100 milligrammes (0.1 Gm.) 1-65 grain. 1-6 gr. li grs. 15 J grs. 60 grs. (1 dr. Troy) i oz. i oz. 1 oz. (437i grs.) 2 ozs. 3i ozs. 0.015 grain. 0.154 gr. 1.543 grs. 15.4324 grs. 4 Gm 61.729 grs. 10 Gm. (1 deka- gramme) 25 Gm 154.324 grs. 385.81 grs. 28 Gm 432.107 grs. 1 oz. 426.7 grs. 56 Gm 100 Gm. (1 hekto- gramme) 3 ozs. 230.7 grs. 113 Gm 4 ozs. (i lb.) 7 ozs. 3 ozs. 431.3 grs. 200 Gm 7 ozs. 24 grs. 104 PRACTICAL DIETETICS SOLIDS APPROXIMATE EQUIVALENT EXACT EQUIVALENT 7 ozs. 410 grs. 8 ozs. 358 grs. 15 ozs. 382 grs. 1 lb. 1 oz. 279 grs. 1 lb. 15 ozs. 327 grs. 2 lbs. 3 ozs. 120 grs. 225 Gm 250 Gm 450 Gm 500 Gm 900 Gm 1000 Gm. (1 kilo- gramme or Kilo) 8 ozs.' (J lb.) 81 ozs. 1 lb. (7000 grs.) 1 1-10 lbs. 2 lbs. 2i lbs. TABLE rOK f BEPARING PERCENTAGE SOLUTIONS Public Charities and the Department of Bellevue and Allied Hospitals 1 One fluid ounce of water, or 480 minims, weighs 456.4 grains. One pint of water, or 7C80 minims, weighs 7300, or practically 7300 grains. Hence, a 10 per cent, solution, for instance, is one which contains 730 grains of some substance in 1 pint. The following table will show at a glance the quantity of any substance, by weight, required to prepare one pint of a solution : 1. To Prepare One Pint of a Solution REQUIRED TO CONTAIN OF A CERTAIN SUBSTANCE PER CENT. TAKE OF THE SUBSTANCE BELOW STATED AMOUNT IN GRAINS WITH ENOUGH WATER TO MAKE 1 PINT. T^ per cent. A " ■ 10,000 5,000 4,000 3,000 2,500 2,000 1,500 1,000 Grains 0.73 1.46 1.83 2.44 2.92 3.65 4.87 7.30 (1) (U) (11) (2i) (3) (3i) (41) (7i) ^ Arranged by the Public Charities and the Department of Bellevue and Allied Ho£i)ita.lji. MEASURES AND WEIGHTS 105 KEQUIBED TO CONTAIN OP A CERTAIN SUBSTANCE PER CENT. TAKE OF THE SUBSTANCE BELOW STATED AMOUNT IN GRAINS WITH ENOUGH WATER TO MAKE 1 PINT. i per cent I i 1 IJ 2 2J 3 4 5 10 20 25 50 in 500 in 400 in 300 in 200 in 100 in 75 in 50 in 40 in 331 in 25 in 20 in 10 in 5 in 4 in 2 Grains 14.60 (14J) 18.25 (18i) 24.33 (24i) 36.50 (36i) 73.00 (73) 97.33 (97) 146.00 (146) 182.50 (180) 219.22 (220) 292.00 (290) 365.00 (365) 730.00 (730) 1460.00 (1460) 1825.00 (1825) 3650.00 (3650) 3. To Prepare One Fluid Ounce of a Solution BEQUIBED TO CONTAIN OF A SUBSTANCE TAKE OF THE SUBSTANCE 0.1 per 0.5 1 2 3 4 5 6 7 8 9 10 cent. APPROX. 0.46 grain (i Rr.) 2.28 it (2i " ) 4.56 " (4i " ) 9.13 (( (9 " ) And 13.69 C( (131 " ) enough 18.26 it (18i " ) water 22.82 €t (23 " ) to 27.38 tc (27i " ) make 31.95 ti (32 " ) 1 fluid ounce 36.51 It (36i " ) 41.08 (t (41 " ) 45.64 tt (45i " ) 106 PRACTICAL DIETETICS THERMOMETRY The thermometers used by the nurse in cookery, in regu- lating the heat of the room or in taking the patient's tempera- tures are chieily of the Fahrenheit scale. Scientists employ the Centigrade scale in most countries. While thermometers are made with both scales, it is a simple matter to translate the ordinary Fahrenheit to Centigrade. The freezing point of the latter is 0°, while that of the former is 33° above 0. The boiling point of the latter is 100°, while that of the former is 213°. Hence, to change Fahrenheit to Centigrade, we subtract 32° from 313° in order that the freezing points correspond, which leaves 180° F.i= 100° Cc A degree Centigrade is therefore 5/9 of a degree Fahrenheit. To change Centigrade to Fahrenheit, every -Fahrenheit' de- gree is 9/5 times as large as a Centigrade degree. It is also necessary to add 33° to the result. Examples: Change 212° Fahrenheit to Centigrade. 212°— 32°= 180° X 5-9 = 100° C. Change 100° Centrigrade to Fahrenheit. 100° X 9-5 = 180° -f 32° = 212° F. PAET II BEVEEAGES ANIMAL POODS VEGETABLE POODS NTJTEITIOUS DESSEETS CHAPTEE VIII BEVERAGES ACID — AlBTTMINOTJS — STARCHY — MISCEIIANEOTJS BEVER- AGES, INCLUDING TEA, COFFEE, CHOCOLATE, AND COCOA, AND SPECIAL NON-NTTTRITIVE BEVERAGES BcTerages serve primarily to relieve thirst. The universal beverage is water.^ Other beverages answer the' same pur- pose, because their chief constituent is -water. They are also taken for their temperature — cold or hot; for their flavor, which helps to arouse or appease the appetite; or for their stimulating properties. Usually they have little or no energy value, but when made with milk, eggs, cocoa, chocolate or other highly nutritive materials, they become a valuable means of administering food in a liquid form. All beverages need to be made with much care and served daintily. Hot drinks should be served at a temperature of 133—140° F. When water is used it should be freshly drawn, brought to a boil and used at once. This serves to sterilize it and also to develop a better flavor. Cold drinks should be given thoroughly cooled, but iced liquids lower the temperature of the stomach unless sipped very slowly, and thus tend to retard digestion. They are therefore better for serving between meals than with them. Do not use ice in a beverage unless it is made from pure water, but cool by placing the receptacle on ice. Use a separate spoon, and taste every beverage just before serving to be sure it is properly seasoned and of correct temperature. Never allow a drink to stand any length of time in a sick room. If it has to be carriedT any distance, be sure that it is covered. 1 See Water, page 23. 109 110 BEVERAGES ACID BEVEEAGES Beverages made from fruit juices are cooling and refresh- ing, and hence especially grateful to fever patients. They are valuable for the organic acids, mineral matter, and sugar which they contain. Some of them, as lemonade and orange- ade, have an added value in their diuretic and diaphoretic action. The organic acids are useful in constipation, as they stimulate peristaltic action. These acids vary with the kind of fruit; thus, apples contain malic acid; lemons, citric acid; grapes, tartaric acid, etc. These acids, as elsewhere stated,* occur in the form of acid salts, usually of potassium, and in the body are changed to carbonates, which preserve the alka- linity of the blood. Eipe pineapple juice contains a ferment capable of digesting proteins. Wash lemons and oranges, and in using the juice remove the seeds, as they give a bitter taste. When the rind of lemon or orange is undesirable medicinally, it should not be used. Serve acid beverages daintily in glasses or sherbet cups (three-fourths filled), pass on small tray or plate, covered with doily, and add a few wafer crackers, or a single flower. Sweetening Acid DrinJcs. For the diabetic, sugar must be replaced by Sweetina. Whenever cold water is to be used instead of very hot or boiling water in preparing the drinks, it is preferable to use " sugar syrup " for sweetening in place of sugar, which re- quires time for solution. As the acidity of fruit varies considerably with the kind, and with the season of year, this, fact must be borne in mind while preparing the foregoing recipes, otherwise too much sugar may be added. STTGAB, STRTTP, 420 CAIORIES i/g cup of sugar. % cup of boiling water. Mix the sugar and water and stir until the sugar is dis- * See Mineriil Matter, p. 31, ACID BEVERAGES 111 solved. Boil slowly, without stirring, for fifteen minutes; cool slightly and bottle. XEUONADE, 137 CALORIES 1 lemon. 2 tablespoons sugar. % eup boiling water. % thin slice lemon. Wash and wipe lemon; cut a very thin slice from middle. Squeeze juice into a bowl (keeping back the seeds), add the sugar and boiling water; cover, and put on ice to cool. Strain and pour into a glass or sherbet cup. Cut half the slice of lemon into two pieces, and use as garnish in glass; or a few berries or slice of orange may be used. Note. — The quantity of sugar • used depends upon the acidity of fruit. FEUIT LEMONADE Add fresh fruit of all kinds to strong lemonade, using boil-, ing water for the beverage, cool, and chill on ice. BRAN LEMONADE, 20 CALORIES % cup wheat bran. ^ ^ - Juice 1 lemon. 2 cups cold water. t Allow the bran and water to stand overnight. Strain, and add the juice of the Jemon. SODA OR AFOLLINa'rIS LEMONADE, 137 CALORIES Juice of 1 lemon. %, teaspoon soda, free from 1 or 2 tablespoons sugar. lumps. % cup cold water. Prepare the lemonade to taste, cool, add the soda, stir :horoughly, and drink while effervescing. Note. — Put glass on plate when soda is added. Water and ioda may be omitted and Apollinaris water substituted. PINEAPPLE LEMONADE, 186 CALORIES % cup grated pineapple or juice. % cup boiling water. Juice 1 lemon. 1 cup ice-cold water. 2 tablespoons sugar. 113 BEVERAGES Mix pineapple, lemon juice and sugar, and add the boiling water. Cool, add ice-cold water, strain and serve. Note. — Canned pineapple may be used or Hawaiian pine- apple juice. IRISH HOSS LEUONADE, 25 CALORIES i 14 cup Irish moss. 4 tablespoons lemon juice. 2 cups cold water. Sugar. Soak, pick over and wash the moss (soaking 15 minutes). Drain and add the cold water; cook in top of double boiler about 30 minutes or until syrupy. If it becomes too thick, add hot water. Strain, add the lemon juice and sugar to taste. Eeheat and serve hot. Excellent for sore throat and cold on the lungs, or any inflammation of the mucous membrane. GRAPE LEMONADE, 200 CALORIES Make one cup lemonade, rather sweet, add one-fourth cup Welch's Grape Juice. EGO LEUONABE See " Albuminous Beverages " for recipe. Page 131. ORANGEADE, 197 CALORIES 1 sour orange. 2 tablespoons sugar. % cup boiling water. % sli<^6 orange. Prepare as for lemonade. If orange is not very acid, add a little lemon juice or use less sugar. ORANGEADE NO. II, 77 CALORIES Put two tablespoons of crushed ice in dainty glasses and pour the juice of one orange over it. Sweeten if desired. ERUITADE, 45 CALORIES % cup grated pineapple 1 cup boiling water. Juice % lemon. Sugar. Juice Yg orange. Prepare fruit. Add the boiling water and one tablespoon sugar; allow to stand until cool. Add more water or sugar if necessary. Strain and serve cold. 1 Without sugar. ACID BEVERAGES 113 PINEAPI'LE JUICE, ABOUT 50 CAIORIES % cup Hawaiian Pineapple Juice. Crushed Ice. Pour the pineapple juice over crushed ice and serve in dainty glasses. This is delicious and has remedial qualities; especially valuable in throat and stomach trouble. lEMON WHEY, 96 CALORIES 1 cup hot milk. 2 tablespoons lemon juice. 2 teaspoons sugar. Heat the milk in a small saucepan over hot water, or in a double-boiler. Add the lemon juice. Cook without stirring until the whey separates. Strain through cheese-cloth, and add the sugar. Serve hot or cold. Garnish with small pieces of slice of lemon. WINE WHEY, 84 CALORIES 1 cup sweet milk. % cup sherry wine. Heat the milk to boiling point, add the wine, and cook with- out stirring until the milk separates. Strain through a fine strainer, and serve hot or cold. ACID PHOSPHATE Horsford's Acid Phosphate is a solution of the phosphates; of lime, magnesia, potash and iron with phosphoric acid,, in such form as to be readily assimilated by the system. It is thus a true nerve and tissue food. 1 teaspoon Horsford's Acid Phos- 1 cup hot or cold water, phate. Sugar. Mix the Acid Phosphate with the water and sweeten with sugar, if desired. If the above should seem too- strong, or be found too stimu- lating, use one-half teaspoon of the Acid Phosphate. Note. — Horsford's Acid Phosphate can be substituted for lemon juice in any of the acid drinks. ACID PHOSPHATE WHEY, 56 CAIORIES 1 cup hot milk. 1 teaspoon Horsford's Acid Phos- 2 teaspoons sugar. phate. 114 BEVERAGES Heat the milk in a small saucepan over hot water or in a double boiler. Add the Acid Phosphate, Cook without stirring until the wliey separates. Strain through cheese- cloth and add the sugar. If more acid is desired, add two or three drops of Horsford's Acid Phosphate. Serve hot or cold. CREAM OF TARTAR DRINK 1 or 1% teaspoons Cream. Lemon, of Tartar. Sugar. 1 pint boiling water. Dissolve the cream of tartar in the boiling water, and "flavor with lemon and sugar. When cold strain. Take as a i-efrigerant drink and diuretic. MALTED MILK AND CURRANT JELLY, 85 CALORIES t tablespoon Horliek's Malted 1 tablespoon currant jelly. Milk. % cup cold water. % cup boiling water. Cracked ice. Mix the malted milk powder with a little of the boiling water to make a smooth paste, add the jelly and the rest of the water, and stir till the jelly is dissolved. Add the cold water and ice, strain and serve daintily in glass or sherbet cup, partly filled, and set on a small plate with doily. MALTED MILK WITH WINE, 88 CALORIES 1 tablespoon Horliek's Malted 1 teaspoon port or sherry wine. Milk. 1 teaspoon sugar. 1 cup hot water. Mix the malted milk powder with enough of the hot water to make a smooth paste, then add gradually .the rest of the hot water, the wine, and sugar if desired. JELLY AND ICE With a large needle or pin, chip half a cup of ice into bits as large as a pea (or use an ice-scraper). Mix with it about the same quantity of lemon, currant, blackberry, or harberry jelly. Very refreshing in fevers. Be sure ice is perfectly pure. ACID BEVERAGES 115. GRAPE WATER, 135 CALORIES i 4 tablespoons grape jelly. % cup cold water. V2 cup boiling water. Lemon juice and sugar. Dissolve the jelly in the boiling water, then add the cold water, season to taste. Serve ice cold. CURRANT WATER, 100-125 CALORIES 1 14 cup currant juice or % cup cold water. 4 tablespoons currant jelly. Lemon juice and sugar. % cup boiling water. Dissolve the jelly in the boiling water (put over heat a. few moments if it does not dissolve quickly). When dis- solved add the cold water, sweeten to taste, and add a little lemon juice, if desired. Serve cold. APPLE, WATER, 25 CALORIES 1 1 sour apple. Lemon juice. 1 cup boiling water. Sugar. Wipe a rosy-cheeked sour apple, and, without paring it, cut it into small pieces. Add the boiling water and one table- spoon sugar. Cover, and let it stand till cold, then strain, and add lemon juice and sugar to taste. Serve cold. Note. — Dried apple may be substituted, or two baked ap- ples. RHUBARB WATER, 15 CALORIES 1 1 stalk rhubarb. Lemon juice. 1 cup boiling water. Sugar. Wash and wipe the rhubarb, and cut in thin slices, leaving^ on the skin. Add the boiling water and one tablespoon sugar. Cover, and let stand till cold. Strain, add lemon juice and sugar to taste, and serve cold. TAMARIND WATER, 60 CALORIES 2 2 tablespoons preserved tama- 1 cup boiling water, rinds. Sugar. Pour the water over the tamarinds and lef stand one-half hour. Sweeten to taste, strain and serve cold. 'Without lemon juice or sugar. 2 Without sugar. Estimated from average composition of preserves. 116 BEVERAGES lAKARIITS MALTED MILE, 115 CALORIES 2 tablespoons Horliek's Malted % cup hot water. Milk. % cup cold water. 1 tablespoon tamarinds. Cracked ice. Make a smooth paste of the malted milk powder and hot ■water, add preserved tamarinds and the cold water. Strain and chill, or add pure cracked ice. GKAFE JUICE (% cup = 120 Calories.) Partially fill a small glass with crushed ice, and add Welch's Grape Juice and serve. Grape juice is a tonic food and a medicine for the sick and convalescent. It may be served plain, cold or hot, or diluted with one-third water. It is preferable- to keep and serve the juice very cold. The bottles may be kept on ice until ready to serve. GRAPE LITHIA, 75 CALORIES Pour one ounce of Welch's Grape Juice into a glass, dis- solve in it two teaspoons of sugar, and add four ounces of lithia water. 6RAFE NECTAR, 2750 CALORIES (About 2 Quarts.) Boil together one pound of sugar and one-half pint of Tvater until it spins a thiread ; remove from the fire, and when cool, add the juice of six lemons and one quart of Welch's Grape Juice. Let stand over night. Serve with ice water, Apollinaris or plain soda. TEA PTTNCH Few beverages find readier favor during the hot weather than tea punch. To make it, pour boiling lemonade, sweet- ened to taste, over the tea leaves, and allow the liquid to stand nntil cold. Then strain and serve in tall glasses, with shaved ice and slices of lemon. ACID BEVERAGES 117 FRUIT PUNCH, 2100 CALORIES (3 Quarts.) 2 large teaspoons tea. 3 oranges. 2 quarts boiling water. 1 pineapple. 1 pound lump sugar. 5 bananas. 8 lemons. 1 pint strawberries. Steep the tea in the boiling water for five minutes, strain and add the sugar, stirring until thoroughly dissolved. Grate the rind of the lemons and extract all the juice. Cut the oranges into slices, shred the pineapple, slice the bananas very thin and hull the strawberries. When the tea is cold add all the fruit, and let stand in the refrigerator for several hours. Place a cube of ice in the punch-bowl, pour the mix- ture around it, and when well chilled serve in punch glasses. If desired, one cup of Maraschino cherries may be added. To get the best results from the pineapple, pare and remove the eyes, tear apart with a silver knife and fork, reject the core, sprinkle with sugar and let stand on ice for twelve hours. While fresh fruits are always preferable, canned berries and pineapples may be substituted. TUTTI-FRUTTI PUNCH, 2300 CALORIES (3 Quarts.) 2 quarts water. 2 tangerine oranges. 1 pound sugar. 4 slices pineapple. 2 lemons. 1 banana. 4 oranges. 1 pint Maraschino cherries. 2 dozen Malaga grapes. Boil together for five minutes the water and sugar. Add the grated rind of two lemons and four oranges, and continue boiling for ten minutes longer. Strain the syrup through cheese-cloth, and add one quart of cold water. Extract the juice from the lemons and oranges, strain and mix with two dozen Malaga grapes, cut in half and seeded, the tangerine oranges sliced, the pineapple shredded, the banana cut in slices, and one pint bottle of Maraschino cherries with their 118 BEVERAGES liquor. Add the fruit to the syrup, chill and serve same as JFruit Punch. ALBUMINOUS BEVERAGES When a large amount of nutriment is required the al- buminized drinks^are valuable. The egg is a fluid food until its albumin is coagulated by heat. Often the white of egg, dissolved in water or milk, and flavored, is given when the yolk cannot be digested, as 30 per cent, of thfe yolk is fat. Egg-nog is very nutritious, and is extensively prescribed in certain non-febrile diseases, especially for the forced alimentation of phthisis and melan- <;holia. There are occasional cases of bilious habit, in which eggs to be digested must be beaten in wine. But the combi- nation of egg, milk and sugar with alcohol, which constitutes egg-nog, is apt to produce nausea and vomiting in a feeble stomach, especially in fever. For this reason whole eggs are unfit for fever patients, and the whites only should be u^d. Albuminized drinks are most easily prepared cold. When a hot liquid is used, it must be poured very slowly into the well-beaten egg, stirring constantly, so that lumps of coagu- lated albumin do not form. For the Diabetic. In all the albuminous drinks substitute Sweetina for the sugar. The fuel value will be 60 calories less in every recipe than when one tablespoon of sugar is used. ENEKGT VAITJE OF AN EGG 1 medium egg (without shell) ^60 Calories. 1 white of egg (average) ^13 " 1 yolk of egg (average) =48 " EGG BROTH, 319 CALORIES i Yolk 1 egg. Speck salt. 1 tablespoon sugar. 1 cup hot milk. Brandy or some other stimulant if required. Beat egg, add sugar and salt. Pour on carefully the hot milk. Flavor as desired, if with brandy or wine, use about one tablespoon. ^ Calculated with 1 tbsp. brandy. 277 Calories if brandy is omitted. ALBUMINOUS BEVERAGES 119 Note. — Dried ahd rolled bread crumbs may be added, if desired. The whole egg may be used. Hot water, broth or coffee, may be substituted, for the milk; nutmeg may be sub- stituted for the stimulant. EGG-NOG NO. I, 231 CALORIES i 1 egg. % cup milk. Speck salt. 1% tablespoon wine or % tablespoon sugar. 1 tablespoon brandy (or less). Beat the egg, add the sugar and salt ; blend thoroughly, add the milk and liquor. Serve immediately. Note. — Have eggs and milk chilled before blending. A grating of nutmeg may be substituted for the stimulant. A. lemonade shaker may be used for the blending. EGG-NOG NO. II, 231 CALORIES i 1 egg. % cup milk. % tablespoon sugar. 1 tablespoon brandy (or less). Speck salt. Separate egg. Beat yolk, add sugar and salt, and beat*until creamy. Add the milk and brandy. Beat the white till foamy (not stiff and dry), and fold it in lightly. Serve im- mediately. JTTNKET EGG-NOG, 304 CALORIES i 1 egg. 2 teaspoons rum, brandy, or 1 cup milk. wine. 1 tablespoon sugar. % Hansen's Junket Tablet. .Beat white and yolk of egg separately, very light; blend the two. Add the sugar dissolved in the rum. Heat the milk lukewarm, stir into the egg mixture, and add quickly the tablet dissolved in cold water. Pour into small warm glasses, and sprinkle grated nutmeg over the top. Stand in warm room undisturbed until firm, and then put on ice to cool. This can be retained by the most delicate stomach. • Without liquor. 120 BEVERAGES BEEF EGG-NOG, 200 CAIOSIES 1 egg. % cup hot beef broth. Speck salt. 1 tablespoon brandy. 1 tablespoon sugar. Beat the egg slightly, add the salt and sugar; add grad- ually the hot broth; add brandy and strain. Sugar and brandy may be omitted if preferred. COFFEE EGG-NOG, 175 CALORIES i 1 egg. % scant cup milk or cream. lYg teaspoon sugar. % scant cup strong coffee. Chill ingredients, and blend as for Egg-nog No. II. PINEAPPLE EGG-NOG Prepare as per Egg-nog No. I or II ; omit the brandy and use pineapple juice to taste. • -.^ < EGG AND RTJM, 315 CALORIES - Famous in the Treatment of Phthisis 1 cup fresh milk. Speck salt. Yolk 1 egg. Few grains nutmeg. 1 tablespoon sugar. 1 tablespoon rum. Beat yolk, add sugar, salt and nutmeg; add milk and rum. Note. — For consumptives, taken at about 6 a. m., often prevents the exhausting sweats which accompany the morn- ing doze. Also may be given to a patient before dressing to prevent exhaustion. EGG AND BRANDY, 350 CALORIES 2 3 eggs. 4 tablespoons brandy. 4 tablespoons cold water. Sugar. Nutmeg. Beat the eggs, add cold water, brandy and sweeten to taste. A little nutmeg may be added. Give a tablespoonful at a time. EGG AND WINE, 125 CALORIES 2 1 egg. 1 wineglass sherry. % cup cold water. Nutmeg. Sugar. 1 Calculated with milk. ^ Without sugar. ALBUMINOUS BEVERAGES 131 Beat the egg. Heat the water and wine together but not boiling; pouv onto the egg, stirring constantly; flavor with sugar and nutmeg. EGG lEMONADE, 192 CAIORIES 1 egg. 2 tablespoons lemon juice. 2 tablespoons sugar. 1 cup cold water. Beat the egg thorouglily, add the sugar and lemon juice; pour in gradually the water, stirring until smooth and well mixed. Strain and serve. Two tablespoons of sherry or port may be added if desired. MALTED MIXK AND EGG, 120 CALORIES -1 — tnWcBpoon Horliek's Malted 20 drops acid phosphate. Milk. 1 tablespoon crushed ice. 1 tablespoon crushed fruit. % cup ice water. 1 egg. Mix the malted millf powder, crushed fruit and egg and beat iive minutes. Add the phosphate and crushed ice, blend- ing thoroughly. Strain and add ice water or cold carbonated "water, and a grating of nutmeg to flavor. STOKES MIXTUKE Eggs and Brandy = 196 Calories. " 2 egg yolks, 50 c. c. of brandy, 130 c. c. of aqua aurantii florun (sugar or syrup enough to sweeten), has consider- able nutritive, as well as stimulative, value, and is eligible for use when such a combination is indicated." GRAPE YOLK, 150 CALORIES 1 egg. 2 tablespoons Welch's Grape 1 tablespoon sugar. Juice. Speck salt. Separate egg. Beat yolk, add sugar and stand aside while the white is thoroughly whipped. , Add the grape juice to the yolk and pour this onto the whipped white, blending care- fully. Serve cold. ' Have all ingredients chilled before blend- ing. 122 BEVERAGES GRAFE jnCE AND EGG, 270 CALORIES 1 egg. 1 tablespoon sugar. % cup rich milk. ^ cup Welch's Grape Juice. Beat yolk and white separately very light. To the yolk add milk, sugar and grape juice, and pour into glass. To the white add a little powdered sugar and a taste of grape juice. Serve on yolk mixture. Chill all ingredients before using. KTrilES WINE, 2S0-2S0 CALORIES 1 ounce stick cinnamon. % cup sherry, port, or claret A slight grating nutmeg. wine. % cup boiling water. 2 tablespoons sugar. 1 egg. Put the spices into top of a double boiler with the water. Cover and cook over hot water ten minutes. Add wine to the spiced water and bring to the boiling point. Beat the egg to a stifE froth, add sugar and pour on the mulled wine, and beat well. Serve at once. ALBUniNIZES MILK, 98 CALORIES ^4 cup milk (sterile). Salt. White 1 egg. Put milk and white of egg in a glass fruit jar, cover with air tight cap and rubber band. Shake until thoroughly blended. Strain into glass. A few grains of salt may be added if desired. Note. — The blending may be done in a lemonade shaker. ALBUUIinZEI) WATER, 13 CALORIES i % cup ice-cold water Lemon juice. (Ijoiled and chilled). Sugar. White 1 egg. Blend as for " Albuminized Milk," serve plain or add lemon juice and sugar to taste. If set on ice to keep cool, shake before serving. ALBUMIN WATER (EOR INFANTS), 13 CALORIES Albumin water is utilized chiefly in cases of acute stomach and intestinal disorders in which some nutritious and easily ALBUMINOUS BEVERAGES 123 assimilated food is needed ; albumin water is then very useful. The white of one egg is dissolved in eight ounces or a pint of water which has been boiled and cooled. — Koplik. ALBTJUINIZED CIAH WATER, 18 CALORIES 1 cup cold water. White 1 egg. Clam Broth. To the water add the required amount of the clam broth to make the strength desired, add the unbeaten white of egg, and follow general directions for " Albuminized Milk." Serve cold in dainty glasses. This is a very nutritious drink, and will be retained by the stomach when other nourishment is rejected. Xote. — Milk may be substituted for the water. ALBUMINIZES ORANGE, 30 CALORIES i White 1 egg. Sugar. Juice 1 orange. To the unbeaten white add the orange juice, sweeten to taste and blend thoroughly. Strain ancl set on ice to cool. Serve cold. ALBUMINIZED SHERRY, 22 CALORIES i White 1 egg. Sugar. Yg to 1 tablespoon sherry. Beat the white stiff, add slowly, while beating, the wine and sugar. Serve cold. Xote. — Have all ingredients cold before blending. ALBUMINIZED GRAPE JUICE, 40 CALORIES i 2 tablespoons Welch's Sugar. Grape Juice. Chopped ice. White 1 egg. Put in a dainty glass the grape juice, and the beaten white of egg and a little pure chopped. ice; sprinkle sugar over the top and serve. 1 Without sugar. uga: 124 BEVERAGES STARCHY BEVERAGES Starchy drinks consist of cereals or cereal products, co(Jked thoroughly in a large amount of water and strained before serving. Arrowroot, cornstarch, tapioca, rice and rice flour are nearly pure starch. Oats, barley and wheat in forms which include the whole grains contain besides starch some protein and fat, and also valuable mineral matter, especially phosphorus, iron, and calcium salts.^ In starchy drinks, these ingredients are necessarily present in small amounts; hence they have little energy value, unless milk or other highly nutritive material is added. Such drinks are of value when only a small quantity of nutriment can be taken. ■Principles of Coolcing. As the chief ingredient is starch, long cooking is necessary, in water at a high temperature (213° F.), which softens the cellulose, and breaks open the starch grains, changing the insoluble starch to soluble starch and dextrin, so that it can be very readily digested. Time of cooking should be conscientiously kept by the clock. Digestion. The action of .ptyalin is very rapid, and if these drinks are sipped slowly, so as to be thoroughly mixed with saliva, a considerable portion of starch may be changed to sugar before reaching the intestines. BARLEY WATER, 180 CALORIES 2 tablespoons pearl barley. 1 quart cold water. Wash barley, add cold water and let soak several hours or over night; in same water, boil gently over direct heat two hours, or in a double boiler steadily four hours, down to one pint if used for infant feeding, and to one cup for the adult. Strain through muslin. Kote. — Cream or milk and salt may be added, or lemon juice and sugar. Barley water is an astringent or demulcent drink used to reduce laxative condition. 1 See Mineral Matter, p. 31. STARCHY BEVERAGES 125 BARLEY WATEK (INFANT FEEDING), 19 CAIORIES 1 teaspoon barley flour. 1 pint boiling water. 2 tablespoons cold water. Blend flour and cold water to a smooth paste in top of double boiler; add gradually the boiling water. Boil over direct heat five minutes, stirring constantly, then put over boiling water and cook 15 minutes longer, stirring frequently. Older infants take the barley water in much more concentrated form. Barley water is used as a diluent with normal infants and in forms of diarrhoea. Note. — For children or adults, use % tablespoon barley or rice flour, 1 cup boiling water, i/^ teaspoon salt. MCE WATER, 100 CALORIES i 2 tablespoons rice. Salt. 3 cups cold water. Milk. Wash the rice; add cold water and soak thirty minutes, heat gradually to boiling point and cook one hour or until rice is tender. Strain, reheat and dilute with boiling water or hot milk to desired consistency. Season with salt. Note. — ■ Sugar may be added if desired, and cinnamon, if allowed, may be cooked with it, and will assist in reducing a laxative condition. RICE WATER NO. II, 160 CALORIES 3 tablespoons rice. 1 tablespoon stoned raisins. 1 pint boiling water. Wash rice, put into saucepan with water and raisins; boil gently for one hour. Strain. When cold serve. Sugar or salt may be added to taste. Note. — Do not use raisins in bowel trouble. OATMEAL WATER, 50 CALORIES 1 tablespoon oatmeal. Speck salt. 1 tablespoon cold water. 1 quart boiling water. Mix oatmeal and cold water, add salt and stir into the Doiling water. Boil three hours; replenish the water as it ' Without milk. 136 BEVERAGES toils away. Strain through a fine sieve or cheese cloth. Season, serve cold. Different brands of oatmeal vary consid- erably in the amount of water which they take up in cooking, and sufficient should always be added to make this drink al- most as thin as water. OATMEAI WATER NO. II, 220 CALORIES i % cup fine oatmeal. 1 quart water. Use sterile water (boiled and cooled). Add oatmeal and stand in warm place (covered), for one and one-half hours. Strain, season, and cool. Sometimes used for dyspeptics. TOAST WATER, 350 CALORIES 1 cup stale bread toasted. Salt. 1 cup boiling water. Cut bread in thin slices and in inch squares. Dry thor- oughly in oven until crisp and a delicate brown. Measure, and break into crumbs; add the water and let it stand one hour. Eub through a fine strainer, season and serve hot or cold. The nourishment of the bread is easily absorbed in this way and valuable in cases of fever or extreme nausea. Note. — Milk or cream and sugar may be added. CRXrST COFFEE Take some pieces and crusts of brown bread and dry them in a slow oven until thoroughly hard and crisp. Place in a mortar and pound or roll. Pour boiling water over and let soak for about fifteen minutes. This when strained carefully is very acceptable to invalids who are tired of the ordinary drinks, such as lemonade, etc. CRACKER PANADA, 100 CALORIES 2 4 hard crackers. Sugar. 1 quart water. Break crackers into pieces and bake quite brown ; add water and boil fifteen minutes, allow to stand three or four minutes. Strain off the liquid through a fine wire sieve ; season with salt * Estimated on one-half the oatmeal. ' Without sugar. MISCELLANEOUS BEVEBAGES IS? and a little sugar. This is a nourishing beverage for infants that are teething, and with the addition of a little wine and nutmeg, is often prescribed for invalids recovering from a fever. BREAD FAITABA, 162 CALORIES 1% cups water. 14 cup white wine. 1 tablespoon sugar. 1 tablespoon lemon juice. 2 tablespoons stale white bread Nutmeg, crumbs. Put water and sugar on to cook, just before it commences to boil add the bread crumbs; stir well, and let it boil three or four minutes. Add the wine, lemon and a grating of nut- meg ; let it boil up once, remove from fire, and keep it closely covered until it is wanted for use. MISCELLANEOUS BEVERAGES TEA — COFFEE —CHOCOLATE — COCOA AND SPECIAL NON-NTT- TRITIVE BEVERAGES TEA Source. The tea of commerce is prepared from the leaves of a shrub cultivated for this purpose in China, Japan, India, Ceylon, and other portions of Southern^ and Eastern Asia. Classes of Tea. There are two great classes of tea, the green and the black. The difference lies in the mode of preparation. Green teas are quickly dried and fired; black teas are allowed to ferment a few hours before drying and firing. Active Principles of Tea. Tea has practically no food value. Its principal constituents are caffein, tannic acid, and a volatile oil. Its flavor is due to the -volatile oil; its stimulating prop- erties to the caffein. Tannic acid is a soluble, bitter sub- stance, which has a retarding effect on digestion. When tea leaves are placed in boiling water, caffein is ex- tracted very rapidly. Tannic acid is less soluble, and there- fore it is possible to make tea with little of this principle by letting the water stand on the leaves only a short time. In 128 BEVERAGES practice, the hot, but not boiling water, should stand on the tea from 3 to 5 minutes. The water should be soft, as lime in hard water tends to make tannin dissolve more freely. Green or mixed tea is more powerful than black tea. Effects of Tea. Tea is mildly stimulating and hence re- freshing, as it removes the sense of bodily fatigue. But the tannic acid retards the digestive action of the saliva and gas- tric juice, and tends to produce constipation. Tea is there- fore not suitable for persons suffering from gastric disorders. The caffein is over-stimulating to the nervous system of many persons, causing restlessness, sleeplessness and muscular tremors. It should not be given to children, nor to adults with a tendency to nervousness. If you wish to avoid the retarding effect of tea on salivary digestion, direct the patient not to sip the beverage with the meal, but to eat first and drink afterward; in this way time is given for the saliva to perform its intended functions. Tea is less likely to cause sleeplessness if lemon juice is substituted for milk. COFFEE Source. This beverage is prepared from the seeds of the cofiEee tree (Caffea arabica), which grows in many warm countries, though originally found in Arabia. The coffee berry is about the color and size of a ripe cherry, and con- tains two seeds placed face to face. Active Principles of Coffee. The active principles of cof- fee are essentially the same as those in tea. By the roasting process a volatile oil is liberated (called cafleol) to which the aroma is due. The caffein is chemically the same as in tea, and according to Hutchison (p. 310), a cup of black coffee contains about as large a quantity of caffein and tannic acid as a cup of tea. Effects of Coffee. Coffee has only a slight retarding in- fluence on salivary digestion, compared with tea, but an equally detrimental effect on gastric digestion. As a stimulant it effects more directly the central nervous MISCELLANEOUS BEVERAGES 129 system; the heart action is considerably increased in rate as well as strength. Indirectly, this results in an increased activity of the kidneys. The respiration is deepened and the cerebral centers excited. For this reason it often proves use- ful in cases of opium and alcoholic poisoning. In some per- sons these effects are very mild; in others, they are severe, producing nervousness and insomnia, and coffee should be •withheld. It removes the sensation of fatigue, for .v^hich reason it is used by many nurses when on night duty. It should never be given to children. Coffee or tea taken tvith either milk or sugar alone is much more healthful and less likely to cause ill effects than when both are used. Frequently after operation freshly made black coffee or tea without milk or sugar will be retained, and in some cases check vomiting. Give the patient one-half teaspoonful at frequent intervals. Many preparations have been put upon the market as coffee substitutes, but they lack the aromatic oil and caffein for which it is really prized. They make, however, pleasing hot beverages, and served with sugar and cream, have a food value. CHOCOLATE AND COCOA Source. Cocoa and chocolate are commercially prepared from the seeds of the cocao tree, Theobroma cocao. The seeds (or beans) are contained in a pulpy fruit 7-12 inches long, 3-5 inches in diameter, in shape intermediate between a melon and a cucumber. The fruit is gathered and allowed to re- main in a heap to ferment a few days, when the pulp becomes loosened. The seeds lose some of their bitterness during this process, upon which the flavor of the bean largely depends. They are then dried in the sun, cleaned and sorted, and care- fully roasted. After this the thin outer husks are removed and sold under the name of cocoa shells. The broken roasted beans constitute cocoa nibs. Chocolate is prepared by grinding the nibs between hot rollers to a great degree of fineness. The presence of 50 per 130 BEVERAGES cent, fiat causes the mass to form a paste. This is molded and cooled with or without the addition of sugar and flavor- ing. Cocoa consists of chocolate deprived of a part of the fat. Sugar or starch or both, are sometimes added. Resemblance to Tea and Coffee. Chocolate and cocoa con- tain a volatile oil, set free by the fermentation process and further modified by roasting, to which the characteristic flavor is due. They also contain tannic acid, but in smaller amount than in tea or coffee. The stimulating principle of chocolate and cocoa is an alkaloid closely allied to caffein, called theobromin. It is less apt to induce nervous symptoms than either tea or coffee, but in many persons their stimulat- ing power is distinctly felt. Nutritive Value. Unlike tea and coffee, chocolate and co- coa have a high food value, as shown by the following analysis : Protein Fat Carbo- hydrates Mineral Matter Water Calories per lb. Chocolate 12.5% 47.1% 26.8% 3.3% 10.3% 2720 Breakfast Cocoa 21.6% 28.9% 37.7% 7.2% 4.6% 2320 By reason of the high percentage of fat, chocolate is likely to cause indigestion when used to excess, or when taken in addition to an otherwise heavy meal. Cocoa, being less rich in fat, is free from this objection. The use of cocoa often makes milk acceptable when it would otherwise be refused. Hence this beverage is good in convalescence, if there are no digestive disturbances. When made weak, it can also be given to children in moderation. Principles of Coohing. Chocolate and cocoa both contain considerable starch, and hence should be boiled to be di- gestible. The cooked starch also serves to thicken the bev- erage somewhat, and to make it smoother and more homo- geneous. On account of the volatile oil to which the flavor is due, the cooking should be continued only long enough to alter the starch, otherwise the oil is lost. MISCELLANEOUS BEVERAGES 131 TEA (Individual Rule.). 1 teaspoon tea. 1 cup boiling water. Scald the teapot, which should be silver, crockery or granite ware, not tin. Put in the tea, add the freshly boiling water and let it infuse three to five minutes. By no means allow it to boil, for boiling dissipates the aroma and extracts the tannin. Strain into hot cup and serve with cream or milk and lump sugar, or with sugar and a slice of lemon. RUSSIAN TEA Heat cup, fill three-fourths full of boiling water and dip in it two teaspoons tea (put in tea-ball or fine small strainer), until strong enough. Serve hot with sugar and a slice of lemon. Note. — Lemon is a good substitute for milk. The lemon prevents the headache and sleeplessness which the milk in tea causes to some persons. COFFEE MADE IN THE FERCOIATER Breakfast CofiFee. After-Dinner Coffee. 2 tablespoons cofifee. Increase quantity of coflFee to 1 cup cold water. suit the taste. Prom the percolator take out the cup with its tube, fill the percolator with the quantity of water desired, replace cup and tube (covering tube with thumb), and put in the coffee, then put on the spreader plate and cover. Cook fifteen minutes. Note. — If warm or hot water is used it takes less time for cooking. Never use boiling water. It takes a little longer with the urns than with the pots. "WTien heat is applied to the foot of the pot, a jet of water lukewarm at first, but quickly increasing in temperature as the pumping process goes on, is forced up through the tube, falls on the spreader plate; by it, it is evenly distributed over the coffee, through which it percolates down into the pot again. This pumping continues until the water reaches the boiling point, when water and steam together come up through the tube. The coffee is thus ready to serve. 133 BEVERAGES Coffee made in this way has a delicious aroma, a fiae ilavor and an absence of the bitter taste caused by boiling. Many can drink coffee made in this way that cannot when made in other ways. Buy coffee in the berry and grind it fresh every day, for ground coffee soon loses its aroma. BOILED COFFEE (To make seven cups of coffee.) 1 cup coffee. 6 cups boiling water. Yji egg and shell. 1 cup cold water. Scald coffee pot. Wash egg, beat slightly and add crushed shell, coffee and one-half cup cold water. Put into scalded coffee pot, add boiling water and let boil up three times, stirring down after each time (or boil five minutes) ; then add one-half cup cold water. Let it stand 20 minutes where it M'ill keep hot but not boil. Serve in hot coffee cups with cream and sugar, or hot milk may be used in place of cream. Note. — A favorite blend of coffee is three parts Java and one part Mocha. BOILED COFFEE (Individual Bule.) 2 tablespoons coffee. % cup boiling water. 1 egg shell or 1 teaspoon % cup cold water, egg white. Follow general directions for blending in preceding recipe. Boil three minutes and keep hot 15 minutes. For the Diabetic. The following varieties may be used. Pour coffee into a slightly beaten egg or yolk ; or one teaspoon butter; or heavy cream. Substitute Sweetina for sugar. FILTERED COFFEE (Individual Rule.) 2 tablespoons finely ground % cup boiling water. coffee. Place a piece of filter paper over a strainer and put the coffee in it. Hold the strainer over a hot coffee cup and pour the boiling water slowly over the coffee. MISCELLANEOUS BEVERAGES 133 FILTERED COFFEE HO. II (Individual Rule.) 2 tablespoons coffee. 1 cup boiling water. Grind the coffee very fine, put it into the upper part of a double coffee pot and pour the boiling water through it. Let it stand a few minutes on the back of the stove, where it will not boil. Then remove it and serve hot. HALTED MILK COFFEE, 59 CALORIES i (Individual Rule.) . 1 tablespoon Horlick's Malted % cup boiling water. Milk. Sugar. 1 tablespoon ground coffee. Mix the malted milk powder, coffee and water, stirring well. Boil three minutes. Add sugar if desired. Or one to four teaspoons of malted milk powder may be put in a cup and ordinary coffee poured directly upon it, stirring constantly. CEREAL COFFEE (Two Cups.) 4 tablespoons cereal coffee. % saltspoon butter. 1 pint cold water. Put the cereal into coffee pot; add cold water and butter, when it reaches the boiling point, boil 15 minutes. Al- ways allow 25 minutes to make cereal coffee; 10 minutes to come to the boiling point and 15 minutes for the boiling (not violent boiling). Serve with sugar and hot milk or cream. Xote. — As cereal coffee is made of browned grain, it is a wholesome drink, and is not stimulating. Butter is added to keep the coffee from boiling over. BREAKFAST COCOA, 957 CALORIES (To make six cups of cocoa.) 3 tablespoons Walter Baker's 1 cup boiling water, cocoa. 3 cups scalded milk. 4 tablespoons sugar. 1 Without sugar. 134 BEVERAGES Scald milk in double boiler. Put the cocoa and sugar in a saucepan and slowly pour on the hot water, stirring all the time. Boil five minutes, add the scalded milk, beat until foamy with Dover egg beater to prevent formation of skin. Serve in heated cups. One-half cup of cream is a great addi- tion to cocoa. BREAKFAST COCOA, 197 CALORIES (Individual Rule.) 2 teaspoons Walter Baker's % cup boiling water, cocoa. % cup scalded milk. 1 teaspoon sugar. Follow general directions for blending and cooking in pre- ceding recipe. Boiling three minutes. Note. — Cocoa may be served hot or ice cold, with or with- out whipped cream. It may be served hot, poured over the beaten white or yolk of egg. One-third teaspoon of brandy may be added if ordered by the physician. MALTED MILK COCOA, 83 CALORIES i (Individual Rule.) 1 tablespoon Horlick's Malted % cup boiling water. Milk. Sugar. 1 teaspoon cocoa. Mix the malted milk powder, cocoa and water, stirring well. Boil three minutes. Add sugar if desired and serve hot. PLAIN CHOCOLATE, 1220 CALORIES (Eight Cups.) 1 quart milk. % tablespoon cornstarch. 2 ounces Walter Baker's choco- 3 tablespoons sugar, late. Speck salt. 2 tablespoons boiling water. Mix the cornstarch with one-fourth cup of the milk. Put remainder of milk in double boiler to heat. When the milk is scalded, stir in the cornstarch and cook ten minutes. Scrape the chocolate and put it in a small saucepan; add sugar and water and place the saucepan over hot water. Stir ^Without sugar. MISCELLANEOUS BEVERAGES 135 «onstantly until the mixture is smooth and glossy. Add the hot milk and beat the mixture M'ith egg beater until frothy; or it may be poured back and forth from the boiler to a pitcher, holding high the vessel from which it is poured. This will give a thick froth. Serve at once. Note. — If you prefer not to thicken the chocolate, omit the cornstarch. Whipped cream may be served with chocolate, or it may be poured onto the beaten yolk of egg. If desired, flavor with one-half teaspoon vanilla. PLAIN CHOCOLATE, 305 CALORIES (Individual Rule.) 1 cup milk. % tablespoon cornstarch. Yz ounce chocolate. % tablespoon sugar. Following directions for blending and cooking in preced- ing recipe. CHOCOLATE, VIEKWA STYLE, 1427 CALORIES (Eight Cups.) 1 quart milk. 3 tablespoons boiling water. 4 ounces Walter Baker's vanilla 1 tablespoon sugar. chocolate. Scald milk in double boiler. Scrape chocolate and put sugar and water into a small saucepan; heat over hot water, stirring till smooth and glossy. Stir this mixture into the hot milk and beat well with an egg beater. Serve at once, putting a tablespoon of whipped cream in each cup, and filling with the chocolate. The plain chocolate may be used instead of the vanilla, but in that case use one teaspoon vanilla and three generous tablespoons sugar. CHOCOLATE MILK SHAKE, 295 CALORIES (Individual Rule.) 2 tablespoons chopped ice. Vs cup milk. , 2 tablespoons chocolate syrup. % cup soda water or Apollinaris 3 tablespoons whipped cream. water. 136 BEVERAGES Shake or stir well before drinking. A tablespoon of vanilla ice-cream is a desirable addition. It is a delicious drink, even if the soda or Apollinaris water be omitted. A plainer drink is made by combining the syrup, three- fourths cup milk and the ice, and shaking well. CHOCOLATE SYErP — USED IN PRECEDING, 2093 CALORIES (One Tablespoon = 65 Calories.) 1 ounce (3 tablespoons) Walter 1 tablespoon vanilla. Baker's soluble chocolate. 2 cups sugar. 1 cup boiling water. Put chocolate in a saucepan and add the water gradually, stirring all the time. Add sugar and stir till it begins to boil ; boil three minutes, strain, cool and add one tablespoon vanilla. Bottle, and keep in a cold place. SPECIAL NON-NUTRITIVE BEVERAGES FLAXSEED TEA 1 tablespoon whole flaxseed. Juice 1 lemon. 2 cups cold water. Sugar. Wash flaxseed thoroughly, put it with the cold water in a saucepan, simmer one hour, add lemon juice and sugar to taste and strain. Note. — If too thick, add hot water. Valuable in case of inflammation of the mucous membrane., CINNAMON WATER 1 ounce stick cinnamon. 1 pint boiling water. Boil together fifteen minutes. Strain. Serve hot or cold. Note. — Good in bowel trouble. The pure cinnamon is quite different from the coarse bark usually sold for cinna- mon, which is really only cas^a. FLAXSEED AND LICORICE TEA 1 ounce flaxseed. 1 pint boiling water. 2 drachms licorice root. NON-NUTBITIVE BEVERAGES 137 Pour the boiling water over whole flaxseed and bruised licorice-root, cover and cook very slowly for four hours. Strain. LIJIE WATER 1 tablespoon of slaked lime. 1 quart boiled or distilled water. Put the lime and water in a corked bottle and shake thor- oughly two or three times during the first hour. The lime should then be allowed to settle, and after twenty-four hours the upper clear fluid carefully poured or siphoned off into a glass-stoppered bottle. Keep tightly corked, as it absorbs carbon dioxide from the air. Keep in a cool place. BRAN TEA % cup wheat bran. Egg shell. 2 cups cold water. Molasses, lemon juice. Boil the water and bran twenty minutes, and settle it with an egg shell or a little cold water. Sweeten with molasses, and lemon juice can be used if desired. SIIPPERY EIM TEA 2 teaspoons slippery elm pow- Sugar. der or piece of the bark. Lemon juice. 1 cup boiling water. Pour the water upon the slippery-elm powder or bark. "VATien cool, strain and flavor with lemon juice and sugar. This is soothing in case of inflammation of the mucous mem- brane. HERB TEA Pour one cup of boiling water over two tablespoons of herbs. Cover the bowl, set it over the tea-kettle and steep ten minutes. Sweeten if desired. GINGER TEA Mix one tablespoon of molasses with one-half teaspoon of ginger; pour on gradually one-half cup boiling water, and boil one minute. Add one-half cup milk and when thor- oughly heated, serve. CHAPTEB IX ANIMAL FOODS The important foods derived from the animal kingdom are — Meat — Poultry and Game — Fish — Shell Fish — Eggs — Milk and Milk Products — Sweetbreads — Gelatin — Beef Preparations — Meat Broth and Jellies. Composition. Milk is the only animal food in which all the nutrients are represented in forms and proportions suit- able to supply all the needs of the body. It is properly called a " complete food." Eggs, also often called " complete food," contain both body-building and fuel food-stufEs, but are in- complete in the sense that the amount of carbohydrate is so small as to be almost negligible. Meats are -valuable primarily as sources of protein. When fat is present they are also useful for fuel. Meat extracts are chiefly valuable for their flavor and stim- ulating properties. The Proteins of animal foods are of many forms, con- spicuous among which are albumin of egg-white; myosin of muscle; casein of milk; fibrin of blood; nucleo-protein of liver and sweetbreads; collagen of connective tissue. The Fats are chiefly mixtures of stearin, palmitin and olein in varying proportions; small amounts of esters of volatile fatty acids; and compounds of fats with phosphorus in the form of lecithin and related substances. Extractives. Nitrogenous extractives are found chiefly in meat, to which they help to give the characteristic flavor and the stimulating properties. They consist chiefly of purins (adenine, guanine, xanthine, hypoxanthine and uric acid) ; and creatin and preatinin. Carbohydrates. The carbohydrates are represented mainly 138 ANIMAL FOODS 139 y lactose in milk, and glycogen in shellfish. As a rule, carbo- ydrates are negligible in animal foods. Water. Water is present in all animal foods. Some ex- mples, showing the varying proportions in different kinds, re given in the following table : Oyster solids 88% Milk 87% Eggs .73% Lean beef 75% Salt cod 50% Mineral Matter. Milk and eggs are more valuable for their 3h constituents than any other animal foods. Calcium, iron ad phosphorus especially, are here found in most available 3rms. Meats are not particularly useful in this respect. They re deficient in calcium, and while they contain considerable ■on, it is not in as useful a form as that in eggs. Most of le ash constituents found in the body are, however, repre- ;ni:ed in flesh foods. Digestibility. As a class, animal foods are easy of diges- !on. They contain little indigestible residue, and the nu- •ients are very perfectly absorbed. Prepared for the table, ley are more concentrated than most vegetable foods. Hence Qimal foods are frequently chosen for invalids and con- alescents, regardless of their high protein content. Disadvantage of a Purely Animal Diet. The chief dis- Jvantages of a purely animal diet are that it does not afford ifBcient bulk to maintain the proper functioning of the limentary tract, owing to the lack of indigestible residue; ad that it loads the body with an excess of nitrogenous ma- !rial, which is not only unnecessary for repair, but may luse harm if not speedily eliminated. Furthermore, pro- dn raises the metabolism so that more food is actually re- nired than if carbohydrates and fats are used as fuel. For irther discussion of the relative merits of animal and veg- ;able diets, see page 333. 140 ANIMAL FOODS MEAT ^ The term meat includes the flesh of -all animals used for /food, as beef, veal, mutton, lamb, pork, poultry, game. Lean meat is almost a pure protein food. Composition of Meat : 1. Muscle fibers, composed of proteins, extractives, in- organic salts, and water. The principal protein is albumin. Muscle al- bumin is often called myosin. The extractives are largely nitrogenous. The mineral constituents in greatest abundance are phosphates and potash salts. 2., Cqinective tissue which binds together the muscle fibers, ""^ this consisting chiefly of a protein cajled collagen, which yields gelatin on boiling. 3. Fat interspersed between the fibers. Nutritive Value. Meat is rich in nitrogenous elements and fats, and contains important salts, chiefly potassium and iron. It is easily cooked and improves in flavor during the process ; requires less mastication and is more easily digested and as- similated than most vegetable food. Meat is lacking in carbohydrates, and unless a large amount of fat is present, is to be regarded as a source of nitrogen rather than of energy. Since protein burns up faster than other foods, and very little of the nitrogen can be retained in the body, it is most advantageously used in small amounts along with plenty of fats and carbohydrates. The most important food element in meat is the myosin or muscle albumin. The collagen belongs to a group of proteins often called gelatinoids or albuminoids,, because, unlike the albumins, they cannot sustain life alone. They are able, however, to replace other proteins to the extent of two-thirds of the ordinary nitrogen requirement. In young animals, the connective tissue is soft, and the tissues are easily masticated ; but in older animals it becomes very firm, is hard to chew MEAT 141 id often escapes digestion unless softened or changed to latin by cooking. The nitrogenous extractives have no nutritive value, and fact, represent products either of waste (katabolism) or of sufficient oxidation. Unless promptly excreted, they may use an excess of uric acid or other disorders. However, ey bestow upon cooked meat its characteristic flavor and or; in the stomach, act as stimulants to the secretion of stric juice; and exert on the nervous system a stimulating fluence similar to that of tea and coffee. Digestibility of Meat. Meat is easily digested, the degree ease depending upon the following conditions: (1) The e of the animal when killed, with the exception of veal, the :sh of the young animal is more easily digested, but less itritious than that of the older one; (2) the time the animal kept before cooking; (3) the sex; (4) the care bestowed on e animal during life; (6) the quantity of fat. Lean meat more easily digested than fat meat. Absorption of Meat. Meat is very readily absorbed and ives little residue in the intestines ; only 3 per cent, of meat ken is lost in the process of digestion. Uncoohed Meat. Ordinary raw meat is not quite as easily jested as cooked meat. Owing to color and flavor, it is not petizing and could not be taken continuously. However, len chopped fine or scraped free from connective tissue, so to be easily attacked by the digestive juices, it is more jdily digested than cooked meat. Ejfect of Cooking Meat. Proper cooking makes meat more jestible, as it softens the connective tissues, thus causing a Daration of the muscular fibers, and enabling the digestive ices to act more advantageously. The color and flavor are proved. There is a loss of weight by evaporation of water, d loss of mineral matter and some extractives. The loss of ter concentrates the nutrients, and thus renders cooked sat proportionally more nutritious than raw meat. 143 ANIMAL FOODS Objective Points and Methods in Cooking: 1. To retain the juice as in baking, broiling, boiling and frying. 3. To extract the juice as in soups. 3. To extract and retain the juice as in stews. The Principal Constituent of meat to be considered in cook- ing is the albumin. Kote page 11, for albumin. Cooking of Meat. Heat penetrates meat slowly. At a tem- perature of 158 degrees Fahrenheit, the meat assumes a gray color, as a result of the decomposition of the coloring matter of the blood. At the same time a peculiar odor of cooking develops, which is due to chemical changes produced by the heat. At a temperature above 104 degrees Fahrenheit, meat be- gins to lose weight from the separation of water, which con- tains salts and nitrogenous extractives. This process contin- ues as the temperature rises, except that coagulable proteins no longer separate with the water. Coagulation of the albumin is an important factor in cook- ing meat, and the degree varies with the mode of cooking. As broiling is the preferred way of preparing meat for the sick and convalescent, it is taken up in detail in this chapter." Broiling. In broiling, the meat is to be cooked in its own juices; it is, therefore, evident that these must be retained as completely as possible. At first the temperature should be sufficiently high quickly to coagulate, and even harden the albumin on the outside surface, so as to form a layer or pro- tecting coat over the whole ; then the heat should be modified so that the interior will be raised to a temperature that will cook it properly without loss of its nutritive properties. In broiling we partially sacrifice the outer layer of the meat, to preserve the inner portion. The time for exposure will be different for different kinds of meat. Beef and mutton require a shorter time than lamb, chicken or game. A piece of meat properly broiled swells, and when cut, the MEAT 143 [quid portion flows out readily; but if cooked too long the Ibumin inside coagulates and the meat loses its moisture^ brinks, and becomes tough. Effect of Gold and Hot Water on Meat. Cold water draws ut the soluble albumin, the extractives and some of the salts ; hus in soups, broths and stews where all the nutriment pos- ible is desired in the liquid, the meat is first put into cold rater and gradually brought to a higher temperature. Hot water or dry heat coagulates albumin, and since if ubjected to too high a temperature this becomes tough and ndigestible, we must note carefully the proper temperature of ooking. Often it is necessary to sacrifice a small amount f albumin by exposing the meat to a high temperature for short time to form a coating on the meat, in order to re- ain the rest of the Juices more effectively, after which the onnective tissue can be softened by gentle simmering for everal hours. The Quality of Meat depends upon the age, sex, environ- lent, care, feeding and time of hanging after slaughtering, t also depends greatly on the cuts used. The tougher and less expensive cuts, if properly cooked, re as nutritious and as easily digested as the expensive cuts ; owever, tough meats take long, slow cooking to make them alatable, and the fuel used must be taken into consideration 1 the expense. Tough meats are muscles which the animal ses the most, as the legs (especially the lower part), neck, tc. ; they are more highly flavored on account of the freer irculation of blood through these portions. Cuts from the eck and shin are used for soups and broths. The tenderer and more expensive cuts are from the muscles hich the animal uses the least, as the upper portion of the ind quarter (rump, sirloin) and fore ribs. The circulation E blood through these portions is less and they are not as licy and well flavored, nor any more nutritious than tougher ortions. These tenderer cuts are used for steaks and roasts. The remaining muscular portions of the animal (flank, loulder and brisket) are not as tender as the upper portion 144 ANIMAL FOODS of the hind quarter, but just as nutritious. They need longer cooking and are used for stews, braising and pot roast. Internal Organs or Animal Viscera used as food are the heart, tongue, brain, kidneys, liver, pancreas, thymus glands and paunch. Although some are as easily digested as most muscle tissue, they are not as nutritious, and most of them produce large quantities of uric acid. The heart, liver and kidneys, when properly cooked, are not as easily digested as other meats, on account of their close and firm texture, and should be eaten only by those of good digestive powers. The tongue is not very easily digested, for although the lean meat is tender, the fat is hard, and tends to retard diges- tion in the stomach. The brain is the most rapidly digested of meats, but a very high per cent, is of no use to the body. It is not suited for invalid diet on account of the high fat content. The paunch is the third stomach of the ox and called tripe. When properly cooked it is easily digested, but contains too much fat to give an invalid. The pancreas and thymus glands of the calf or lamb are sold under the name of sweetbreads. They are most easily digested, but give rise to uric acid. Note chapter on Sweet- breads. Beef, Beef, is without doubt, the most valuable kind of meat; it is nutritious, of excellent flavor, and comparatively easy of digestion. Test for Good Beef. The flesh is firm and fine grained in texture ; bright red in color when first cut and upon exposure to air; looks juicy and well-mottled and coated with fat, and the fat is of yellowish color and firm. The best beef is obtained from the steer of four to six years of age. After killing, the animal should hang for two to three weeks. Veal. The flesh of the calf is difficult of digestion and should only be used in the sick room for making broth. It should never be eaten by those of weak digestion. It con- MEAT 145 tains less albuminous substances, and more gelatin than beef. Test for Good Veal. It should be of a pinkish color, with clear, firm, white fat, fine grained and tender. The cut most used for broth and soup is the lower part of the leg known as the knuckle. Mutton. Next to beef, mutton is considered the most nutritious of meats, and by some considered as easily digested ; but it is known that fat of mutton, which consists largely of stearin, is not as easily digested. The best quality of mutton comes from a sheep from three to five years old; after killing it should be allowed to hang to ripen and to develop the flavor. Test for Good Mutton. The flesh is fine grained, bright pink in color, the fat is white, hard and flaky, and the skin comes off easily. The bones of mutton are white and smooth and round at the joints. Lamb. Lamb of the right age is as nutritious as beef or mutton but the flesh is milder in flavor. Lamb is sold as " spring lamb " when killed at six weeks to three months old. It is very expensive and comes into the market early in the year — February and March. Lamb is usually killed when a year old, and should be sold imme- diately after killing; in this respect it differs from beef and mutton, which should hang after killing to ripen and develop the flavor. Test for Lamb. Lamb can be distinguished from mutton by the pinkish color of the bone, and the serrated joints. Pork. The flesh of the pig is the most indigestible of all meats on account of the large percentage of fat which Jt contains, consequently it is not used in cookery for the sick, except sometimes a small amount of ham, salt pork or bacon, as the salty taste occasionally acts as a stimulant to the lost appetite of the convalescent. Ham and bacon are more easily digested than other cuts of pork, and when thin strips of bacon are cooked crisp they are easily digested. Bacon is from the flank of pork and is salted and smoked. Next to 146 ANIMAL FOODS butter and cream, bacon fat is the most easily assimilated of ordinary food fats. Cuts of Meat. * The methods of cutting sides of beef, veal, mutton, and pork into parts, and the terms used for the differ- ent "cuts," as these parts are commonly called, vary in different localities. The diagrams show the positions of the different cuts, both in the live animal and in the dressed car- cass, as found in the markets. The lines of division between the different cuts will vary slightly, according to the usage of the local market, even where the general method of cutting is as here indicated. The names of the same cuts likewise vary in different parts of the country. Cuts of Beef Pig. 5 Pie. 5. — Diagrams of cuts of beef: 1, Neck; 2, chuck; 3, ribs; 4, shonl- der-clod; 5, fore-shank; 6, brisket; 7, cross-ribs; 8, plate; 9, navel; 10, loin; 11, flank; 12, rump; 13, round; 14, second-cut round; 15, hind-shank. — (Atwater and Bryant, Bulletin No. 28, OfBce of Experiment Stations, United States Department of Agriculture.) Send for Bulletin for cuts of Teal and Pork, ' This section is (juoted from Atwater and Bryant, Bulletin No. 28, Office of Experiment Stations, United States Department of Agriculture, Washing- ton. D. C. MEAT Ur The general method of cutting up a side of beef is illus- trated in Fig. 5, which shows the relative position of the cuts in the animal and in a dressed side. The neck piece is fre- quently cut so as to include more of the chuck than is repre- sented by the diagrams. The shoulder-clod is usually cut without bone, while the shoulder (not included in diagram) would include more or less of the shoulder blade and of the upper end of the fore-shank. Shoulder steak is cut from the chuck. In many localities the plate is made to include all the parts of the fore-quarter designated on the diagrams as brisket, cross-ribs, plate, and navel, and difEerent portions of the plate, as thus cut, are spoken of as the " brisket end of plate " and " navel end of plate." This part of the animal is largely used for corning. The ribs are frequently divided into first, second, and third cuts, the latter lying nearest the chuck and being slightly less desirable than the former. The chuck is sometimes sub-divided in a similar manner, the third cut of the chuck being nearest the neck. The names applied to different portions of the loin vary considerably in different localities. The part nearest the ribs . is frequently called " small end of loin " or " short steak." The other end of the loin is called " hip sirloin " or " sirloin." Between the short steak and the sirloin is a portion quite generally called the " tenderloin,"' for the reason that the real tenderloin, the very tender strip of meat lying inside the loin, is found most fully developed in this cut. Porterhouse steak is a term most frequently applied either to the short steak or the tenderloin. It is not uncommon to find the flank cut so as to include more of the loin than is indicated in the figures, in which case the upper portion is called " flank steak." The larger part of the flank is, however, very frequently corned, as is also the case with the rump. In some markets the rump is cut so as to include a poition of the loin, which is then sold as " rump steak." The poittion of the round on the inside of the leg is regarded as riiore tender than that on the outside, and is frequently preferred to the latter. As the leg lies upon the butcher's table. tW,'^ inside of the round is usually on the 148 ANIMAL FOODS upper or top side, and is therefore called " top round.' sionally the plate is called the " rattle." Occa- Cuts of Lamb and Mutton Fig. 7 "Fig. 7. — Diagrams of cuts of lamb and mutton ; 1, Neck ; '2, chuck ; 3, shoulder; 4, flank; 5, loin; 6, leg. — (Atwater and Bryant, Bulletin No. 28, Office of Experiment Stations, United States Department of Agriculture.) Fig. 7 shows the relative position of the cuts in a dressed side of mutton or lamb and in a live animal. The cuts in a side of lamb and mutton number but six, three in each quar- ter. The chuck includes the ribs as far as the end of the shoulder blades, beyond which comes the loin. The flank is made to include all the under side of the animal. Some butchers, however, make a large number of cuts in the fore- quarter, including a portion of the cuts marked " loin " and " chuck " in Fig. 7, to make a cut designated as " rib," and a portion of the " flank " and " shoulder " t^ make a cut designated as "brisket." The term "cnoj5B^' is ordinarily used to designate portions of either the loin, ribs, chuck or shoulder, which are either cut or " chopped " by the butcher into pieces suitable for frying or boilin§»-.i^l ° chuck and ribs are sometimes called the " rack." ing,-^! ° ct MEAT 149 ENERGY VALUE OF MEAT See Table, under names of meat, as Beef — Mutton — Lamb — Bacon — Ham, etc. See Table, page 64, for energy value of other ingredients. TO BBOIL STEAK Wipe, trim off the superfluous fat and remove a little of the bone. Save the flank ends for broiled meat cakes. Heat and grease the broiler with some of the fat. Place meat in broiler with fat edge next t6 handle and broil over a clear fire, turning every ten seconds for the first minute, holding broiler near the coals that the surface may be well seared, thus preventing escape of juices ; then cook at lower tempera- ture, holding the broiler higher. Steak cut one inch thick will take five minutes if liked rare, and eight minutes if well done; one and one-half inch thick, eight to ten minutes. Serve on a hot platter and sea- son with butter, salt and pepper', or with Maitre d'Hotel But- ter. Note. — Steak should be cut at least one inch thick ; many prefer it much thicker. The most tender steaks are tender- loin, sirloin and cross-cut of rump. Sirloin, porterhouse (a thick slice of sirloin with tenderloin attached), cross-cut of the rump and top of the round are all good steaks. The top of round is solid meat and a cheap steak ; is tender if -cut from animal of right age and is the second or third cut from top of round. MAITRE D'HOTEI BUTTER, 443 CAIORIES ^ cup butter. 1 tablespoon chopped parsley. % teaspoon salt. 1 tablespoon lemon juice. 14 saltspoon pepper. Eub the butter to a cream; add salt, pepper, parsley and lemon juice. Spread on hot beefsteak. FAN-BROILED BEEF CAEES Use steak from upper part of round, and with a small piece of suet put all through a meat chopper; without seasoning. 150 ANIMAL FOODS shape into small, flat, circular cakes. Into saute pan put a little beef fat, when smoking hot, put in the cakes and cook a few moments on each side and turn; it will take about live minutes to cook them. Season well with salt, pepper and butter, and serve on hot platter. Eo not add salt before cook- ing, as it toughens the meat. SCRAFEB BEEF See " Beef Preparations " for recipe. Page 217. MUTTON CHOPS BROIIEB i Cut away the tough outside skin, trim off a part of the fat. Broil same as steak — t^at is, close to the glowing coals — for about one minute, turning every ten seconds, then cook at a lower temperature, holding the broiler higher. Will take four or six minutes for a chop one inch thick. Mutton, like beef, should be served rare. Season chops with salt and pepper, but not with butter, as the meat is rich and fat and does not require it. LAUB CHOPS BROILEBi Prepare and broil same as for mutton chops, except that they are to be well done instead of rare, to accomplish this about three minutes longer cooking will be required; for a chop one inch thick, from eight to ten minutes. FRENCH CHOPS 1 Trim a chop until there is nothing left but the round muscle at the thick end, with a little fat about it. Cut away all the meat from the bone, which will then look like a handle with a meat morsel at one end. Broil, and serve on hot platter with paper handles on chops, and garnished with pars- ley and peas. PAN-BROILED CHOPS i Chops are fairly good pan-broiled. The same principle is to be followed as in the cooking over coals — that is, a high degree of heat at first, to sear the outside before the juice ' Chops average 300 Cal. per 100 gms. MEAT 151 escapes, and a lower temperature afterward — therefore, heat the saute pan or spider exceedingly hot (use no fat), drop in the chop, count ten and turn, repeating for about one minute, then draw the pan to the back or side of the stove and finish cooking slowly. A chop one inch thick will be perfectly done in from five to seven minutes. If the pan is hot enough at first there will be no loss of juice or flavor. Season and serve in the same manner as broiled chops. CHOPS (OB BIRDS) BROILED IN PAPER i Prepare a chop as for pan-broiling. Spread a piece of paper evenly and thickly with butter. Lay on it a nicely trimmed chop and double the paper with edges together. Fold and crease the edges on the three sides, then fold and crease again, so that the butter cannot run out. These folds should be half-an-inch wide. It will be necessary to have the sheet of paper — foolscap or heavy white paper — consid- erably more than twice as large as the chop. Broil over coals, not too near, turning often so that the temperature will not get so high as to ignite the paper. A chop broiled in this way is basted in the butter and in its own juices, and is very deli- cate. A chop three-quarters of an inch thick will cook in five minutes ; one an inch thick, in eight. Should the paper ignite, it need not destroy the chop. Take it out and put into a fresh paper and try again. The chop should be served hot, seasoned with salt and pepper. Kote. — Birds may be broiled in the same way. BROILED BACON Cut bacon in as thin slices as possible, and remove rind; Put in broiler, placing broiler over baking pan, and cook in hot oven until crisp. CURLED BACON Heat saute pan ve^'y hot. Put in strips of very thin sliced bacon. As fat is drawn out, pour it ofE into cup ; cook bacon until crisp and brown. Drain on brown paper. * Chops average 300 Cal. per 100 gma. 152 ANIMAL FOODS BBOIIES HAU Cut slices of ham one-third inch thick. If very salt soak fifteen minutes in lukewarm water ; broil three minutes or un- til brown on both sides, turning frequently. A slice of boiled ham is very delicate cooked in this same way, cooking it less time. ROAST HEATS Prepare meat, put on rack in dripping pan, dredge with salt and flour and cook in hot oven until the surface is seared, reduce the heat and cook slowly the required time. Beef, rare 13 minutes per pound. Beef, rare (over 5 lbs.) ,. 18 minutes per pound. GRAVY FOR ROAST MEATS 1 tablespoon fat. 1 cup boiling water. 1 tablespoon flour. Pour fat from baking pan and return to pan the quantity desired. Add flour and when well browned pour on gradually the boilifig water, stirring constantly. Cook five minutes, season with salt and pepper, and strain. POITLTEY AND GAME^ Poultry and game are generally classed together, poultry being applied to domesticated birds raised for their flesh or eggs or both. Wild birds are all classed as game. Digestibility. Chicken may be introduced early into the dietary of the convalescent, for it is one of the most easily digested of meats. Chicken is more easily digested than •fowl, but is not as nutritious. The white meat of the breast is particularly free from fat, has short fibers and small amount of connective tissues, and is easier to digest than the dark meat. Squab, quail, pigeons and the white meat of turkey are also easily digested. Duck and goose contain a large quantity of fat and are not as easily digested. 'For further information, note "Poultry as Food." Farmer's Bulletin, No. 182, Dept. of Agriculture, Washington, D. C. POULTRY AND GAME 153 Game is compai:atively easy of digestion but too highly flavored for most invalids. The cuts from the breast are the best for an invalid. Test for Selecting a Chicken. The cartilage at the end of the breast bone must be soft and pliable, the skin smooth and the feet soft. There should be an abundance of pin feathers. Chickens are used for broiling and roasting. Test for Selecting a Fowl. The cartilage at end of the breast bone is firm, the feet are hard and dry. The pin feath- ers are largely replaced with long hair. An old fowl, not too fat, is best for broths. One from one to two years is best for roasting, or where the meat substance is desired. The propor- tion of bone to meat in chicken under this age makes them espensive eating. Principles of Cooking. In general same as for cooking of other meats. When the layer of meat over the bones is very thin, as in young chickens or squabs, broiling is preferable to roasting. An old fowl can sometimes be made tender without having all its fla;Vor stewed into the broth, by cooking in a small amount of water in a double boiler for a long time, or in a fireless cooker. A general rule for roasting chickens or turkeys is twenty minutes to the pound. Dupks and geese, having tougher fibers, require a longer time for thorough cooking. GENERAl KTIIE FOR CIEANING POULTRY Cut off head and feet and pull out pin feathers. If the bird has not been drawn, make an incision below the breast just large enough to admit the hand (or finger for the small birds). With the hand or finger, draw all the entrails out at one time. Care must be taken not to break them, especially the gall-bladder. Turn down the skin of the neck, cut off neck close to body and pull out wind pipe and crop. Cut out the oil bag. Cut through skin of the leg a little below the joint (not cutting the tendons), press against table and break and pull off foot with tendons, which will come out in break- 154 ANIMAL FOODS ing if chicken is young. In fowls you m^y have to pull them out separately with skewer. Singe the bird by holding it over a tablespoon of Burning alcohol, or paper (holding over sink). Wash by allowing the cold water to run through and over it, and dry well inside and out and prepare further for broiling or roasting, etc. DRY SRESSING FOR STVEFISG, 1100 CAIORIES 1% cup stale bread crumbs. Powdered sage, marjoram, and % cup butter (not melted). summer savory. Salt, pepper. Thoroughly mix ingredients and season to taste. Fill in both openings of bird and sew the skin at both ends, and turn the skin of neck over, and fasten to back. Oysters can be added to dressing if desired, omitting all seasonings but the salt and pepper. TO TRUSS POTIETRT After stufiSng and sewipg up the openings, draws the thighs close to body and secure in place by putting a skewer through them and the body. Fold wings under back by taking end of wing and place in under back which fastens it. Cross the drum-sticks and tie with long string and fasten to the tail, and tie string so that it will hold thighs close to the body. Cut and remove string before serving the bird. ROAST POTTLTRY , 100 grams = about 200 Calories.i Clean, stuff and truss bird and place it on its back on rack in dripping pan. Eub surface with salt and a butter and flour mixture (mix three tablespoons of butter and two table- spoons of flour and stir until creamy). Dredge bottom of pan with flour. Place in hot oven and in about ten minutes the flour should be well browned, then reduce heat of oven and cook more slowly. Baste every ten minutes with one-fourth cup of butter melted in three-fourths cup of water, after this ' Edible portion. POULTRY AND GAME 155 has been exhausted use fat in pan. Turn bird often while cooking that it may brown evenly. When cooked, remove to hot platter and make the gravy. A chicken four to five pounds will require about one and one-half to two hours for cooking. Turkey, nine pounds, two and one-half to three hours. Ducks (domestic), one to one and one-half hours. Duck (wild), twenty-five to thirty min- iites. Goose, nine pounds, two to two hours and one-half. GRAVY FOR ROAST POULTRY Clean the heart, liver and gizzard by removing the mem- brane, blood vessels and clotted blood from the heart. Cut liver ftfom the gall bladder and remove all green on liver. Clean gizzard and cut through edge carefully to sac, and re- move carefully not to break it, wash giblets (that is, the heart, liver, gizzard) and the neck and put on to cook in two and one-half cups of cold water, cook slowly at the simmering point until tender. After chicken has been removed from pan, pour off all the fat, strain and return to pan four tablespoons of fat and add four tablespoons of flour, brown together thoroughly, and add gradually the water the giblets were cooked in. Cook five minutes, stirring constantly, add hot water if gravy is too thick, and salt and pepper to taste, and the mely-chopped gibjets. TO BONE BIRDS Select bird that is fresh-killed, dry-picked, and not drawn. Cut off head and feet, singe and remove pin feathers, crop, and oil bag. Cut off wings close to body. Lay on board breast down and cut to bone the entire length of spine. Scrape the flesh from backbone the entire length of body, working toward the breast, cutting the tendinous portions as reached. When edge of breastbone is reached, care must be taken not to break through skin. Scrape flesh from second joint and drum- sticks, laying flesh back and pulling out bone (as if turning glove off inside out). Scrape flesh from lower part of back and withdraw from 156 ANIMAL FOODS carcass. Put flesh in original shape and broil, following directions for broiled quail; or stufE bird with stale bread crumbs and tie in shape with string and bake in hot oven. When cooked, remove bread and tie in shape with a bit of white baby ribbon and garnish with parsley and lemon. BROILED aiTAIL 100 grains = 160 Calories. Clean, cut off the head and feet, singe, and wipe with a damp cloth. With a sharp-pointed knife split the quail down the back, beginning at back of neck and cutting through the backbone the entire length of bird. Lay bird open and re- move contents. Cut through tendons at joints. Wipe thor- oughly. Season with salt and pepper, rub thickly with soft- ened butter and dredge with flour. Broil ten minutes over clear coals. Serve on hot buttered toast. Garnish with toast points, parsley and currant Jelly. BROILED SQUABS 100 grams = 390 Calories. Prepare, cooTc and serve the same as quail. BROILED SHALL BIRDS All small birds can be broiled according to the directions for quail, remembering that for very small ones it takes a very bright fire, as the birds should only be browned and the time required for cooking is brief. BIRDS BROILED IS BAFER See chapter on Meats and follow directions for " Chops Broiled in Paper." Page 151. BROILED CHICKEIT 100 grams =i 108 Calories.i Dress for broiling, following directions given under Broiled Quail. Season well with salt and pepper, and rub all over with softened butter, especially breast and legs. Put in a well-greased broiler and broil over a clear fire about fifteen 1 Edible portion. POULTRY AND GAME 157 minutes, turning often. The ilesh side must be exposed to the fire the greater part of the time as the skin side burns easily. When chicken is nicely browned, place in a dripping- pan, skin side down, in a moderate oven twelve minutes. Put on a hot dish, season with salt, pepper and butter, and serve immediately. This rule is for a chicken weighing about two and a half pounds, yielding 735 calories. CREAUED CHICKEN, 210 CALORIES i (Individual Rule.) Vs cup cold cooked chicken. % tablespoon butter. Speck celery salt. % tablespoon flour. Salt. Yi cup rich milk. Pepper. Melt butter in saucepan, add flour and pour on gradually the scalded milk. Cook thoroughly. Add chicken cut into dice, and seasonings. Heat well and serve on toast rounds, garnished with toast points and parsley; or use as a filling for Swedish timbales. Note. — Chicken may be used that is removed from chicken broth when it is tender. Chicken broth may replace part of the milk in making the sauce. SCALLOPED CHICKEN Put creamed chicken into a small baking dish, cover with dried bread or cracker crumbs, dot with small pieces of but- ter, and brown in oven. JELLIED C&ICKEN, 100 CALORIES 2 (Individual Rule.) 1 teaspoon gelatin. 14 cup chopped chicken. 2 tablespoons cold water. Salt, celery salt. 8 tablespoons strong chicken broth. Soak gelatin in the cold water five minutes, and add the boiling hot broth, stir until dissolved. Season to taste. Dip 1 Calculated with 1% ounce of fowl. 2 About 100 calories. 158 ANIMAL FOODS mold into cold water and pour in enough gelatin to cover bottom, put in ice box to harden, when firm decorate with a slice of hard-cooked egg; or cook a couple slices of carrots and cut a small round from one slice to form the center of a daisy and cut the other slice into strips to represent the petals and put in bottom of mold, add a few drops of gelatin to keep the decoration in place, and put on ice to harden. Mix the chicken with remainder of gelatin and pour into mold and set to harden. Serve on leaf of lettuce or garnish with parsley. LARDED GROUSE Clean and wash the grouse. Lard the breast and legs. Eun a small skewer through the legs and tail. Tie firmly with twine. Dredge with salt, rub the breast with softened butter, then dredge with iiour. Put into a quick oven. If desired rare, cook twenty minutes; if well done, thirty min- utes. Serve on hot platter garnished with parsley and Bread Sauce. LARDED aUAIL lOO grams =: 160 Calories'. The directions for cooking and serving are the same as for grouse, except that quail cook in fifteen minutes. Larding gives richness to dry meat that does not have fat enough of its own. BREAD SAUCE TOR 6AUE, 540 CALORIES Crumbs % cup coarse dried bread crumbs. % small onion. % tablespoon butter. 1 tablespoon, butter. Sauce 1 cup milk. Salt. 14 cup fine bread crumbs. Pepper. Prepare Crumbs. Dry in a warm oven; sift. Cook the coarse bread crumbs in the butter until a delicate brown, and use to cover breast of bird. Prepare Sauce. Put the fine bread crumbs, milk and FISH 159 onion on to scald ten minutes, then skim out the onion, add the butter and seasoning, and serve as a gravy for birds. FISH Fish is one of the important protein foods. The term is usually applied to all kinds of water animals used for food. They may be classified as follows : Classes 1. Scaly or Vertebrate. White or lean, e. g. l2. Shell-flsh Halibut Haddock Flounder Turbot White Fish Smelt Cod Dark or oily, e. g. Mollusks, e. g. Crustaceans, e. g. 'Salmon Mackerel Blue Fish Shad Herring Eel rOysters "I^Clams Crabs Lobsters Shrimps Turtles .Terrapin In the white-fleshed fish the fat is found principally in the liver. This is the only class usually considered in the cookery for the sick. In the dark-fleshed fish the fat is found distributed through- out the body. A considerable amount of the protein of fish is in the form of gelatin. Fish is less rich in extractives, and hence less stimulating than meat. Digestibility. The digestibility of scaly fish depends upon the quantity of fat present and the coarseness of the fiber. 160 ANIMAL FOODS. The white-fleshed fish are less nutritious and stimulating than the dark-fleshed fish as they contain less fat and extractives and more water. They are consequently more easily digested. With the exception of cod, white fish is useful for a con- valescent diet, for those of sedentary habits, for children, and others for whom the stimulating extractives of meat are not desirable. Oily fish should not be eaten by those of weak digestion or given to the sick. In some cases they may be served dur- ing advanced convalescence. Salt fish is not as easily digested as fresh fish, as the fibers are apt to be hardened in the process of salting. Salt codfish is an exception, for if finely divided and served in an ap- petizing manner it is a valuable and inexpensive form of protein food. As a rule, dried, smoked or pickled fish should not be given to the sick. By some persons, fish cannot be eaten without causing in- digestion or biliousness. A complete diet of fish is said to cause an affection of the skin. The fat sometimes disagrees, causing acidity and eructations of the stomach. Composition. In composition fish is similar to meat, con- taining proteins, extractives, fats, salts and water. As a riile, fish contains more water and less fat than meat, therefore it is more easily digested ; and it is due to this, its easy digesti- bility, that white fish by some is considered a brain food, and not, as is popularly supposed, to the amount of phosphorus it contains; in fact, fish does not contain as much phosphorus as some meat. Fish contains less extractives than meat and it is due to this that people tire more quickly of it than of meat. Lemon juice and vinegar are desirable condiments to serve with fish. The acid is a desirable neutralizing agency, as the juice of fish, especially shellfish, is of an alkaline nature. Nutritive Value. The chief nutritive constituents of fish, as of meat, are their proteins and fats. Their energy value depends largely on the amount of fat they contain. FISH 161 When Fish are in Season. Halibut, haddock, flounder and cod, are in season all the year. Turbot, October to May; shad, February to May; salmon. May to September; blue fish and mackerel. May to October; sturgeon, April to September; trout (lake), April to August. Test for Freshness. In fresh fish the gills are red, the eyes bright and protruding, the flesh is firm and there is no un- pleasant odor. The first two tests disappear after the fish has been out of water a short time, and although the fiavor of the fish is not as good, it is not spoiled. But if the last two tests are not present the fish should not be used. Great care should be taken that fish is perfectly fresh, in season, and thoroughly cooked, or it will be indigestible and sometimes poisonous. Unless these conditions are known to exist, fish should not be served to the sick. " In many European cities fish are sold alive, the customer selecting his fish as it swims in a tank. It would seem that this excellent method might be used in our cities, especially those situated on the seaboard, at least for customers who are fastidious and who are willing to pay an extra price for ,a special article when it is warranted." (Farmer's Bulletin No. 375.) Principles to ie Ohserved in Coolcing Fish. As in meat, albumin is the principal constituent to be considered in the cooking of fish. Hence the same principles which apply to the cooking of meat apply also to the cooking of fish. See page 11, for eifect of heat on albumin. Objective Points and Methods: To Eetain the Juice. — Baking, Broiling, Boiling and Fry- ing. To Extract the Juice. — Soup. To Extract and Eetain the Juice. — Chowder. ENERGY VALUE OF FISH See Table, under names of fish, as Halibut, Salmon, etc. See Table, page 64, for energy value of other ingredients.- 163 ANIMAL FOODS BROILED FISH White fish, trout, small blue fish, mackerel, shad and small cod should be split down the back, and broiled whole, and if preferred, cut ofE the head and tail. Halibut and salmon should be cut into inch slices and turned often while broil- ing. Clean Fish. Wipe with a cloth wet in salt-water, and dry- on a fish towel. Season ; oily fish need only salt and pepper, but dry white fish should be spread with butter and salt and pepper before broiling. Use a double wire broiler greased well with salt pork rind. Put thickest edge of fish next middle of broiler, turn often while broiling; with split fish sear the flesh side first and then turn. The time of cooking will vary with the thickness of fish, rish is done when flesh separates easily from the bone. The fire should be .hot and clear. When ready to serve, loosen the fish from broiler on each side. Open broiler, slide fish onto platter, having flesh side uppermost. Spread with hutter, salt and pepper. Garnish with parsley and slices of lemon. Or serve with Butter Cream and a border of potato balls. Note " Fish Sauces " for Butter Cream. BAKES FISH Clean fish. Wipe with cloth wet in salted water, dry on a fish towel and bake on a greased fish sheet, placed in a drip- ping pan. A strip of cotton cloth, by which it may be lifted from the pan, may be substituted for the fish sheet. Sprinkle with salt and pepper, brush over with melted butter, dredge with flour, and place around fish small pieces of fat salt pork. Bake in hot oven until fish separates from bone when lifted -with fork. Baste every ten minutes. Serve plain with melted butter, or with Egg Sauce. Note " Fish Sauefes " for Egg Sauce. FISH 163 HAIIBTTI i XA CREOLE, 413 CALORIES Yz pound halibut. 1 clove. % cup tomatoes. % teaspoon sugar. Vi cup water. % tablespoon butter.. Small piece onion. % tablespoon flour. Sprig parsley. • Salt and pepper. Tomato Sauce. Blend tomatoes, water, onion, parsley, clove and sugar, and cook ten minutes. Melt the butter, add the flour and pour on gradually the hot mixture. Add salt and pepper to taste, cook five minutes and strain. Clean fish. Wipe with cloth wet with cold salted water and dry thoroughly. Put in baking tin, pour around half the sauce and bake until fish separates easily from bone, basting often. Serve on hot platter, pour around it the re- mainder of the sauce and garnish with parsley. CREAMED EISH (Individual Rule.) y^ cup cooked fish, remove skin 14 cup cream or white sauce and bone, and flake the flesh ( note Fish Sauces ) . with a fork; season with salt, pepper, and a little lemon juice. Blend the fish and white sauce, reheat and serve on toast, garnish with parsley and half -slice of lemon; or serve in bread eases made of slices of bread cut two inches thick, round off edges, scoop out center, leaving case, brush with softened butter and brown in oven. Note. — White sauce may be poured on one egg yolk before adding fish. SCALLOFES PISH Put creamed fish into small baking dish, cover with dried bread or cracker crumbs; dot with bits of butter and brown. in oven. CREAMED CODFISH, 828 CALORIES Flake salt codfish in small pieces, remove the bone ; the fish should be put into several cold waters to remove some of the 164 ANIMAL FOODS salt. Prepare the potatoes, cutting them into eighths, or if small into fourths, add the shredded fish and boiling water to cover; cook until potatoes are tender, drain off the water |( saving it for the sauce), add a little butter and season with pepper, and mash lightly and heap in center of platter. Sauce 1 pint fish and potato water. 4 tablespoons flour. 4 tablespoons butter. Pepper. Melt the butter, add the flour and pour on gradually the potato water. Cook thoroughly, season with pepper, and pour about the codfish, and garnish with slices of hard-cooked egg and parsley. CBEAMED CODFISH .(POR THE DIABETIC), 314 CALORIES % cup flaked codflsh. % teaspoon Gum Gluten flour. 1 cup milk or cream. Yolk 1 egg. % teaspoon butter. Pepper. Soak the fish in two waters ; melt the butter, add the flour and pour on gradually the scalded milk ; cook thoroughly, add codfish and egg, cook five minutfes, season and serve on Gum Gluten toast or fresh bread. CREAMED FISH (FOR THE DIABETIC), 208 CALORIES % cup cooked fish. % cup cream sauce. Salt, pepper, lemon juice. Gum Gluten bread crumbs. Season fish with salt, pepper and lemon juice, add cream sauce, put into ramikins or cups, sprinkle with Gum Gluten crumbs, and bake. BAKED FISH (FOR THE DIABETIC), 480 CALORIES For baked fish make a dressing with one cup of Gum Gluten bread crumbs, one-half an onion, chopped fine; one tablespoon celery, chopped fine, one tablespoon of butter ; pep- per, salt, lempn juice and parsley. FISH (FOR THE DIABETIC) Fish should be rubbed with salt and pepper and dipped in Gum Gluten Flour, or rolled in egg and Gum Gluten Cracker crumbs. Sautd (or fry) in oil or butter. FISH SAUCES 165 FISH SAUCES BUTTER CREAM Cream a little butter; season with salt, cayenne, lemon juice (speck salt and pepper, one-half teaspoon lemon juice). Add finely minced parsley or chopped pickle, such as cucum- ber or olive. Prepare quantity according to size of fish. Put it on the fish, and place in oven a moment until butter is melted. CREAM OR WHITE SAUCE, 125 CALORIES (Individual Rule.) 14 tablespoon butter. % eup hot milk. 14 tablespoon flour. Salt. Melt butter, add flour, remove from fire, and pour on gradually the milk, stirring constantly. Bring to the boiling point, cook thoroughly and season. Note. — Extra milk may be added if a thinner sauce is desired, using one-half cup milk. CREAM SAUCE (EOR THE DIABETIC), 138 CALORIES % cup milk. Salt. 1 teaspoon Gum Gluten flour. Cayenne. 1 teaspoon butter. Melt the butter, add the fiour and pour on gradually the scalded milk; cook thoroughly and season. EGG SAUCE, 434 CALORIES 2% tablespoons butter. Speck pepper. 11/3 tablespoons flour. % cup hot water. 14 teaspoon salt. 2 Melt one-half the butter; add flour and seasoning and pour on gradually the hot water. Boil five minutes and add remainder of butter in small pieces. Add two hard-cooked eggs cut into one-fourth inch slices, or the beaten yolks may be added to hot sauce with one-half teaspoon lemon juice. 166 ANIMAL FOODS EOG SATTCE NO. II To Cream or "White Sauce add one hard-cooked egg chopped fine and a little lemon juice if desired; or add to "WTiite Sauce, yolk slightly beaten and a few drops of lemon juice. TOMATO SAUCE, 80 CAIOB,IES % tablespoon butter. Few grains salt. % tablespoon flour. Few grains pepper. Vt '^^P strained tomato juice. Brown butter, add flour and stir until slightly browned; remove from fire and pour on gradually, stirring constantly, the heated tomato. Cook thoroughly and add salt and pepper. Note. — A sprig of parsley, one clove and a small piece of onion may be added to tomato while heating. CUCUMBEIl HELISH, 15 CAIORIES Grate one-half cucumber and add a small piece of red pep- per chopped fine; season with salt, pepper and vinegar and serve with fish. HOIIANDAISE, 484 CALORIES 1 egg yolk. % teaspoon salt. 4 tablespoons butter. White pepper. % tablespoon vinegar. Put one tablespoon butter in top of double boiler, add the other ingredients. Place over hot water and stir constantly while butter is melting. Add second tablespoon of butter and stir until melted, repeat this process until all butter is used. As soon as the mixture begins to thicken remove from hot water. Vary by adding a little chopped parsley, grated horse-radish root. SHELL-FISH OYSTERS AND CLAUS Only the mollusks are considered in this book, because the crustaceans are not easily digested, and therefore are not suit- able for an invalid diet. Oysters. Oysters are valuable food for invalids and con- 8HELL-FISH 167 valescents. Their nutritive value is not high, but they are easily digested and possess a delicate flavor which is ac- ceptable to most palates. Composition. The five food principles are represented in oysters. Eeckoned as " solid," i. e., removed from the shell, oysters contain 88.3 per cent, of water, 6.1 per cent, protein, 1.4 per cent, fat, and 3.3 per cent, carbohydrate. Oysters come nearer to milk than almost any other common food material, both in amount and proportion of nutritive prin- ciples. The carbohydrate is in the form of glycogen, being found, in the liver, which constitutes a large proportion of the oyster. Digestibility. The soft part of the oyster or clam is made up largely of the stomach and liver and is easily digested when cooked in a variety of ways — broiling, roasting, stew- ing, panning and steaming — but not fried when served to the sick. The hard part of shellfish is the muscle which fastens the animal to the shell, and is rendered tougher by all forms of cooking; therefore, when whole oysters are to be eaten, they are more easily digested when served raw or broiled slightly in the shell. They can be digested by fever patients and those suffering from many forms of gastric disorders. It is desirable in acute illness to serve only the soft part of the oyster, but in the later stages of convalescence the whole oyster can be served raw or in stew and soups, which, are recommended on account of their liquid form and warmth. When in Season. Oysters are in season from September to May. During the rest of the year they are insipid and unfii> for food. Principles to be Carefully Observed in Serving and Cook' ing Oysters for the Sick, (a) Make every effort to have the oyster alive when used, or as fresh as can be obtained from a reliable dealer. Many serious cases of illness and even death have been caused by eating oysters so long dead that poisonous substances had formed in them. Great care should also be taken that oysters are not procured from beds where 168 ANIMAL FOODS the water has been contaminated in any way. " As it is in general impossible to learn their origin the rule of never eat- ing them in the raw state is adopted by many. The practice of fattening or 'floating' oysters in fresh or in brackish water robs them of much of their fine flavor, and since the most accessible supply of such water is at the outlet of streams, and as such streams are frequently polluted by sew- age, many persons believe that this practice should be for- bidden by law." ^ (b) Oysters contain an albuminous substance which in- creases in hardness with an increase of temperature, just as the albumin of an egg does. When oysters are cooked with reference to this albuminous substance, they are also cooked in the best possible manner with reference to their other con- stituents; therefore subject them to a low temperature, for a short time, bearing in mind that 160 to 180 degrees Fahren- heit is the cooking temperature of albumin. General rule is to remove the oyster from heat as soon as the body grows plump and the edges curl, if cooked be- yond this stage they are over-cooked. Varieties. In New York State the " Blue Points " are considered the finest for serving raw. They come originally from Blue Point, Long Island. In Massachusetts the " Cove " Oyster is considered the fin- est for serving raw. They come from a still water cove near Plymouth. Clams. Clams are similar in composition to the oyster and same general rules followed in preparing and serving. They are much used for food and considered a great delicacy. They contain a tough portion that is not used in sick-room cookery, but the clear juice, on account of its digestibility and stimulating properties, is invaluable in the sick room. Clams are in season all the year around. Varieties. There are two varieties, the hard and soft shell clams. The hard shell are known as quahaugs. The small 1 Farmer's Bulletin No. 375. OYSTERS 169 or round " little neck clams " take the place of Blue Points to serve raw when oysters are out of season. ENERGY VAItTE OF OYSTEES 2 oysters =14 Calories. 100 grams oysters =50 Calories. 1 cup (solid) oysters =84 Calories. See Table, page 64, for energy value of other ingredients. RAW OYSTERS Wash, scrub the shells well under a stream of water with a vegetable brush. With a hammer break the thin edges of the shell so that a knife may be inserted to sever the muscle which holds the two parts of the shell together; when this is cut remove the upper half and wipe the edges free from any grains of sand. Then sever the muscle which joins the oyster to the other shell, so that it may be easily lifted out without the necessity of cutting. Arrange six oysters on an oyster- plate on crushed ice, and serve with salt, black pepper and lemon juice. A quarter of lemon cut lengthwise may be placed in the center of plate, and bit of parsley. OYSTERS ROASTED IN THE SHELL Wash the shells very carefully with a brush. Put them in a wire broiler over glowing coals, the round side of shell down so as to hold the juice. Cook them quickly, turning once or twice until the shell opens. They may also be cooked in a hot oven. When done remove the upper half of the shell ; season them quickly with salt, pepper and a tiny bit of but- ter and vinegar, if liked, and serve them while very hot. The true oyster flavor is delightfully developed by pre- paring in this way. They may also be served with melted butter, salt, pepper and lemon juice. TO WASH OYSTERS Place oysters in strainer over a bowl and pour one table- spoon of water over each one-half cup of oysters. Take each oyster up in fingers and remove any particle of shell that may adhere to tough muscle. 170 ANIMAL FOODS FAN ROAST OYSTERS Wash oysters and put in saute pan or chafing dish and gently stir with spoon. When bodies grow plump and the edges curl remove from heat. Season with salt and pepper and a little butter and serve on rounds of toast, with eighth of lemon for individual dishes; or serve on platter and garnish with toast points, watercress and lemon. BROIIES OYSTERS, 320 CALORIES (Individual Rule.) 4 oysters. 4 teaspoons butter. 14 cup cracker crumbs. Salt and pepper. Select large oysters. Wash, drain and dry between towels. Melt butter. Season cracker crumbs with salt and pepper. With silver fork lift each oyster by tough muscle, and dip first in butter, then in crumbs. Place on a buttered fine wire broiler and broil, turning often until brown and the juice be- gins to flow. Serve plain, garnished with parsley and a piece of lemon or prepare cream toast and sprinkle with fine chopped celery, and place the broiled oysters on top. CREAKED OYSTERS, 284 CALORIES 1 (Individual Hule.) 8 oysters. % cup rich milk or thin cream. 1 tablespoon butter. Salt. 114 tablespoon flour. White pepper,. Wash, drain and dry oyster between towels. Melt butter and remove from fire, add the flour and pour on gradually the scalded milk. Season with salt and pepper. Cook thor- oughly. Add the oysters and heat until the edges curl and the bodies grow plump. Serve at once on rounds of toast and garnish with toast points and parsley or in crisped " bread cases." See " Creamed Pish." CREAMED OYSTERS ITO. II, 340 CALORIES 2 (Individual Rule.) 14 cup thin cream or rich milk. 1 teaspoon butter. 1 tablespoon flour. 8 oysters. Yi. teaspoon salt. " Calculated with whole milk. ' Calculated with thin cream. OYSTERS 171 Wet the flour with a little cold milk ; scald the cream, add' the flour and cook well. Just before serving add the drained oysters and cook until they grow plump and the edges curl; add the salt and butter. Serve in Swedish timbale shells, lit- tle scooped-out buns, or on rounds of toast. SCALLOFES OYSTEBS, 365 CALORIES (Individual Rule.) ^^ cup oysters. Salt. % eup cracker crumbs. Pepper. % cup stale bread crumbs. l^ tablespoon cream. 1 tablespoon- melted butter. 1 tablespoon oyster- liquor. ■ Prepare the oysters. Stir together crumbs and melted but- ter. Butter a small baking dish and sprinkle part of the crumbs in it. Put in half the oysters, sprinkle with salt and pepper, then a layer of crumbs, pour over enough cream or oyster liquor to moisten well, add the remaining oysters, season, and finish with a layer of crumbs on top. Bake in a hot oven about ten minutes, till oysters are plump and crumbs browned. Serve hot. N^ever allow more than ,two layers as they will not cook evenly. A sprinkling of mace or nutmeg is considered an improvement by some. Sherry wine may be used in place of cream. OYSTER SOUP, 253 CALORIES (Individual Rule.) % cup oysters. 1 tablespoon butter. % cup water. % tablespoon flour. % cup milk. Grating of mace. Bit of onion. Salt and pepper. Scald the milk. Melt the butter, add the flour and pour on gradually the scalded milk ; add mace and onion, and cook thoroughly. Put oysters in a strainer placed over a bowl, add water and carefully pick over oysters to remove particles of shell. Heat liquor which has drained from oysters to the boiling point, strain through two thicknesses of cheese-cloth and return to 172 ANIMAL FOODS saucepan, add oysters and cook until plump and edges curl. Drain off liquor and add to soup. Season, add oysters and serve immediately. OYSTER SOXJF (rOR THE DIABETIC), 107 CALORIES (Two Servings.) One-half pint of oysters, heated in their own liquor ; strain. Put in saucepan one-half teaspoonful butter and a scant half- teaspoonful of Gum Gluten Flour, add liquor, and, when slightly thick, oysters, pepper and salt. For variety, add occasionally a tablespoonful of cream. OYSTER STEW, 205 CALORIES (Individual Rule.) % cup oysters. y^, teaspoon salt. % cup milk. Speck pepper. % tablespoon water % tablespoon butter. Scald the milk. Put oysters in a strainer placed over a bowl, and add water. Carefully pick over oysters to remove particles of shell. Heat the liquor which has drained from the oysters to the boiling point, and strain through the finest' strainer and cheese-cloth, return to saucepan and put in the oysters and simmer, but do not boil, until they begin to grow plump and the edges curl and separate. Strain the liquor into the scalded milk, season, add oysters and serve imme- diately. CLAMS ENERGY VALUE OF CLAMS % dozen clams ^40 Calories. 31/3 ounces clam bouillon = 2 Calories. 1 quart clam bouillon ! . = 23 Calories. See Table, page 64, for energy value of other ingredients. LITTLE NECK CLAMS Serve raw on the half-shell in same manner as raw oysters. STEAMED CLAMS For steaming, clams should be bought in the shell. Wash in several waters, scrubbing thoroughly. Put into kettle. CLAMS 173 allowing one-fourth cup water to one quart clams. Cover closely and steam until clams partially open. Care should be taken not to overcook them. Serve with melted butter. A few drops of lemon juice may be added to butter. CLAU BROTH (Individual Rule.) 1 dozen clams. 2 tablespoons cold water. AVash clams and scrub with a brush, changing the water several times. Put in saucepan, add water, cover, and cook until shells open. Eemove clams from shell, adding liquor which comes from them, to liquor already in saucepan. Strain liquor through double thickness of cheese-cloth. Serve hot, cold, or frozen. CLAM WATER (Individual Rule.) % cup cold water. Clam Broth. To the water add the required amount of the clam broth to make the strength desired. Serve hot, cold, or frozen. "When necessary, serve in small quantity and repeat at short intervals. Note. — Clam broth served in the several ways (as a variety) is invaluable in case of weak stomach, indigestion and general debility. CLAU WATER NO. II, 17 CALORIES (Individual Rule.) ^ cup Clam Broth. Pepper. 1 tablespoon milk. % teaspoon butter. % cup hot water. Blend the clam broth, milk and hot water, season with pepper and add the butter. Serve hot. Note. — The pepper and butter may be omitted when neces- sary. 174 ANIMAL FOODS CLAU STEW, 250 CALORIES (Individual Rule.) % cup clam broth. Vs teaspoon salt. 1/2 cup scalded milk. Speck pepper. 1 tablespoon butter. Soft part of 1 dozen clams. Yg tablespoon flour. Melt butter, add flour, add gradually the scalded milk and clam broth, and cook thoroughly. Season, add clams and serve hot. CLAU SOTTF, 276 CALORIES (Individual Rule.) % dozen clams. % tablespoon butter. % cup cold water. % tablespoon flour. 1 cup milk. Salt and pepper. Wash and scrub clams and put in kettle with cold water. Cook until shells open. Take from shell and cut ofE the tough parts; save the soft parts for the soup and keep warm. Add the milk to the juice. Melt the butter, add the flour and pour on gradually the hot liquid. Cook thoroughly; season with salt and pepper, add soft parts of clams, and serve immediately and hot. CLAU BOTTILLON, 45 CALORIES (Two Servings.) % cup cold water. Salt. % cup clam broth. Pepper. % cup scalding milk. Celery sauce. Yg teaspoon butter. White of egg or whipped cream. Blend the water and clam broth, heat to the boiling point, then add the scalding milk, the butter, and stir well ; season with salt, pepper and celery sauce to taste. A small quan- tity of cracker crumbs, may be added to thicken it.. Serve in heated bouillon cups and garnish with two teaspoons of whipped cream or well-beaten white of egg. EGQS 175 clah bouillon bisque, sss calories (Two Servings.) % tablespoon butter. % tablespoon flour. 1 tablespoon chopped onion. 1 cup boiling water. % tablespoon chopped carrot. Yolk 1 egg. 1 cup clam broth. 14 cup cream. Melt the butter, add the finely chopped onion and carrot, cover and cook until the onion and carrot are tender, stirring it occasionally. Add the flour, blending well; then pour on gradually the boiling water and the clam broth. Cook five minutes, strain and return to saucepan. Mix the yolk of egg with the cream, and add it slowly to the Bisque. Pour into heated bouillon cups, and serve with small oyster crackers. ALBTJIiIimZEI) CLAK WATER See " Albuminized Beverages " for recipe. Page 133. CLAM BROTH NO. II See " Meat Broth and Jellies " for recipe. Page 230. CLAM BROTH ON TOAST See " Toast " for recipe. Page 358. CLAU PRAFFE See " Ices " for recipe. Page 315. CLAM SHERBET See " Sherbets " for recipe. Page 313. EGGSi Many kinds of eggs are eaten, but hens' eggs are the only ones necessary of consideration as a staple article of diet. The shell constitutes about 1.1 per cent, of the weight of the whole egg, the yolk 33 per cent., and the white 57 per cent. Composition. Eggs are albuminous in nature and con- sist practically of the following substances — protein, water, fat and mineral matter. The composition of the hen's egg is as follows: * For further information, note " Eggs and Their Uses as Food." Farm- er's Bulletin No. 128, U. S. Dept. of Agriculture, Washington, D. C. 176 ANIMAL FOODS Fuel value Refuse Water Proteia Fat Ash per pound calories Whole egg as purchased. ..12.2% 66.5% 11.9% 9.3% 0.9% 635 Whole egg, edible portion. . 73.7% 13.4% 10.5% 1.0% 720 White 86.2% 12.3% 0.2% 0.6% 250 Yollc 49.5% 15.7% 33.3% 1.1% 1705 From this table it may be seen that the white of egg con- sists of eight-tenths water, the remaining portion being prin- cipally protein (albumin), with a little mineral matter, etc., the yolk is about half water, one-third fat, and nearly one- sixth protein, with ahnost twice as much mineral matter as the white. Varieties. By eggs the product of the domestic fowl are commonly meant. The eggs of the duck, goose, turkey, etc., are edible, but are hardly suited for the sick, because of their stronger flavor. The purely white eggs are usually selected for the invalid, but many regard the brown-shelled egg as the more delicate. Digestibility. Eggs are easily digested and very thoroughly absorbed in the intestines. If the absorption is delayed, de- composition follows with production of sulphuretted hydrogen and ammyiia, which causes considerable gastro-enteric disturb- ance. The yolk is usually the cause of this disturbance. The digestibility of an egg depends upon its freshness and the manner in which it is cooked. ^Carelessness in cooking and serving may make an egg difficult of digestion and un- appetizing, when, if it is cooked properly, it would be more palatable and easy of digestion. A raw egg, on account of its blandness, does not stimulate the flow of gastric juice and is not as easily digested as a soft-cooked egg; but by heating a raw egg the albumin is finely divided and is more quickly acted upon by gastric juice, consequently is digested about as quickly as a soft-cooked egg. Raw eggs are added to various foods, as milk and broth, etc., to give extra nutriment. Eggs are freely prescribed for those suffering from loss of flesh and strength, as the convalescent, aneemic, or in tubercu- ^See Albumin, p. 11. EGGS 177 losis; in such cases as many as twelve eggs being given in as many hours. A soft-cooked egg digests very quickly. A medium-cooked egg is not as easily digested as either the raw, soft or hard-cooked, and should not be served cooked in this manner to the sick. A hard-cooked egg as commonly cooked is difficult to di- gest, but cooked at proper temperature and chopped very fine will digest about as quickly as a soft-cooked egg. Nutritive Value. Eggs are a very nutritious food, com- parable with' meat, milk, cheese, and other animal foods, both as regards total food material and the total protein and fat furnished by them. At twenty-five cents per dozen they are commonly considered very expensive, but this must not be interpreted too literally. Many persons will be satisfied with an egg who would not be with the equivalent food value in the form of meat, and eggs are valuable for giving variety to the diet and for furnishing an easily digested protein food, especially for the sedentary. For children they are much better than meat, because the fat is in an emulsified, and hence easily digested form, and because of their ash con- stituents. The yolk is rich in compounds of iron, phosphorus, calcium, magnesium. The protein of egg yolk is combined with lecithin, a phosphorized fat which has come to be re- garded as an important constituent of food, especially for the growing animal. Egg yolks are frequently prescribed for invalids requiring an easily assimilated, concentrated food. It should be remembered that when fat is barred from the diet, egg yolk should not be given. Egg white is valuable chiefly as a source of protein. Be- cause of its mild flavor it can be combined with many sub- stances, especially milk and other beverages (See "Al- buminous Beverages," page 118), to increase the nutritive value of a liquid or semi-solid diet. With some persons, eggs induce constipation, or have a slight aphrodisiac effect. They contain sulphur, and unless digested before decomposition occurs in the alimentary tract. 178 ANIMAL FOODS give rise to hydrogen sulphide gas. They should not be eaten hy those suffering from flatulent dyspepsia, gastric dilatation, or any severe gastric derangement. They are contraindicated in acute Bright's disease. Principles to be Observed in CooJcing. The principal con- stituent of the egg is albumin, which should be cooked in £uch a manner as to require the least possible expenditure of force in digestion. Those vrho are ill cannot afford to waste energy, and whether they are forced to do so or not depends much upon those who prepare their food. E-ffect of Temperature on Albumin. See " Albumin," page 11. The proper cooking temperature of egg albumin is 160 to 180 degree Fahrenheit, when it is found to be tender, soft, jelly-like, and in an easily digested state. But cooked at the boiling point of water, 312 degrees Fahrenheit, albumin is found to be firm, compact, tough and indigestible. With this knowledge we can appreciate the necessity of cooking eggs at a temperature below that of boil- ing water. It is often advisable to cook the white and yolk ■of eggs separately, as the yolk when hard cooked (at proper temperature) and mealy is more easily digested than the soft cooked yolk, and the white more easily digested soft cooked. Suggestions. Eggs should be kept in a cool, dry place. Always wash eggs ]ust before using. Save the shell for mak- ing boiled coffee, as the shells of three eggs is as effective in settling coffee as one whole egg. "When using several egg^ break them separately in a saucer to test the quality of each. In beating fresh eggs to a stiff froth the albumin entraps' the air, forming bubbles which expand and stiffen when ex- posed to heat and blended with batter and dough, thus mak- ing the food light and spongy. Stale eggs lose this quality of frothiness. Test for Fresh Eggs. (1) The shell of a fresh egg is slightly rough ; held to the ear and shake slightly there should be little sound, held in front of electric light or candle in EGGS 179 a dark room if they look more transparent in center they are fresh, if more transparent at ends, are stale. (3) In a solution made of two ounces of common salt and one pint of water, an egg one day old will sink (not quite reach the bottom) ; three days old will barely float above the surface, and seven days old will float above the surface. This is due to the loss of water and to the development of gases of putrefaction. Unless air is excluded from eggs they very quickly deteriorate in value and decompose. The water in the egg evaporates through the shell, which is porous, and air rushes in to take its place, causing decompo- sition of the organic matter of the egg, the result being the formation of various gases — principally sulphuretted hydro- gen, due to the action of putrefactive bacteria which enter the shell with air. Eggs eaten in this state may cause gastric and intestinal disorders, therefore, unless eggs are perfectly fresh, they should not be given to a child or a person of delicate digestion or the sick. ENERGY VALUE OF AN EGG 1 average egg =60 Calories. 1 average white of egg =13 Calories. 1 average yolk of egg =48 Calories. See Table, page 64, for energy value of other ingredients. SOFT COOKED EGGS Wash one egg and put it in a small saucepan of boiling water to cover; remove to back of stove, or where the water will keep very hot, but" not boil. Cook seven to ten minutes, according to consistency desired. Serve in slightly heated cups. Note. — A stone crock is nice to use, as it keeps more event heat. A double boiler may be used, putting boiling water in top and bottom, set on back of stove and cook six to seven minutes, according to size of egg. Care must be taken that the size of utensil is in accordance with the number of eggs to be cooked, so that the cold eggs 180 ANIMAL FOODS "will lower the temperature of the boiling water. Keep tem- perature about 160 degree Fahtenheit, or a little above. SOPT COOKED EGGS NO. II Wash one egg and put it in a small saucepan of cold water to cover. Bring just to boiling point, remove and serve in slightly heated cups. HABD COOKED E06S Follow directions for soft cooked eggs No. I, allowing egg to remain in water forty-five minutes. Chop fine and add one-half teaspoon butter and a -few grains salt, serve in slightly heated cups. STEAUED EGGS Butter an egg shirrer or a small sauce-plate and pour in the eggs. Salt, place in steamer over boiling water, and cook till white is firm. Cooked in this manner, the white is tender and light and can be eaten by invalids. BAKES EGGS Plain baked eggs make a pretty breakfast dish. Take a deep earthen plate, butter it and break in the eggs, adding salt, pepper, bits of butter, and bake in a moderate oven until the white is set. Garnish with curled parsley and serve with buttered toast. Use a small dish to prepare one egg. Note. — Before cooking i/^ tablespoon of cream to each €gg may be poured over them, and in. serving a little grated cheese may be sifted over the top. BAKED EGGS (FOB, THE DIABETIC) Break an egg into a baking-cup, pour gently over it a large tablespocnful of melted butter sauce; then add a thick layer of grated cheese ; sprinkle with Gum Gluten cracker crumbs, and dot with bits of butter. Bake until the egg is set, and serve at once. EGGS 181 GOLDEN-ROD £G&S 1 hard-cooked egg = 60 Calories. 2 slices toast := 146 Calories. Sauce = 170 Calories. 2 teaspoons butter. Speck white pepper. • l^ tablespoon flour. Salt. % cup scalded milk. Prepare the sauce. Add the white of egg chopped fine, pour over the toast and rub the yolk through a strainer over the top. Serve at once. Sauce. Melt butter, add flour and gradually the scalded milk; cook well and season with salt and pepper. EGG NESTS, 142 CALOBIES ■ 1 egg. 1 round of toast with toast 14 teaspoon butter. points. Salt to taste. Toast bread. Separate egg. Beat white to a stiff froth. Salt to taste. Spread toast with butter and put white of egg on in shape of nest. Make a depression in center, put in the butter and drop the yolk in the hollow. Cook in a moderate oven three or four minutes. Note. — May be cooked in tumbler placed in pan of water, allowing the water to heat gradually, and as the white rises, make a depression and drop in yolk. It may be served with Tomato Sauce. FOAHT OKELET, 144 CAIOBIES 1 egg. V2 saltspoon salt. 1 tablespoon milk. Speck pepper. 2 teaspoons butter. Separate egg and beat white to a stiff froth. Beat yolk till light, add milk, salt and pepper; lightly fold the yolk into the white. Put butter into saute pan, when it bubbles pour in the mixture. Gently shake pan so omelet will not adhere to it ; lift up at sides with a knife to see when done, and when a delicate brown set pan in oven a minute to absorb moisture on top. Fold omelet, half over, turn on a hot dish, and serve immediately. 182 ANIMAL FOODS Variations. Mix one tablespoon ham, or any meat, chopped fine, with foamy omelet, and cook as directed. Or when omelet is cooked, the chopped meat may be spread over before folding. A little chopped parsley may be added. Oys- iers either whole or chopped, or creamed chicken, stewed or sliced tomatoes, asparagus tips, peas or jelly may be used. BAKED UEAT OMELET Prepare Foamy Omelet and add to it the chopped meat. Put it into a buttered pudding-dish, set it in a pan of hot water and bake until firm. BREAD OUEXET, 164 CALORIES 2 tablespoons bread crumbs. Speck pepper. 2 tablespoons milk. 1 egg. Speck salt. 1 teaspoon butter. Soak bread crumbs in the cold milk for ten minutes, add the salt and pepper. Separate egg and beat until light. Add -the crumbs and milk to the yolk and fold in the white. Pol- low general directions as for Foamy Omelet. POACHED OR DROPPED EGGS Toast a square or round piece of bread and four toast points ; put on hot plate with points at each side and garnish with a sprig of parsley. Have a shallow pan two-thirds full of boiling salted water, allowing one teaspoon salt to one pint 'B'ater. Put a slightly buttered muffin ring on a buttered skimmer in the water. Break an egg into the ring. The -water should cover the egg. When there is a film on top and the white is firm, carefully take up skimmer, remove ring, loosen egg with a knife and place on the toast; salt slightly. The toast may be buttered if desired. EGG POACHED ITSt UILK, 470 CALORIES 1 egg. Salt. lYg teaspoons butter. 2 tablespoons grated cheese. % cup thin cream. Melt butter in top of double boiler, add cream and when hot drop in carefully the egg. Cook until white is nearly EGGS 183 firm, add salt and Bprinkle with cheese. Serve on toast. Cheese may be omitted. CODDLED OR SCBAUBIED EGGS, 180 CALORIES 1 egg. 1 saltspoon salt. % cup milk. Speck pepper. 1 teaspoon butter. Beat egg in top of double boiler until light, add milk and rest of ingredients and stir over boiling water until it thick- ens; allow it to stand a few minutes without stirring, to set. Serve on toast or hot rice. EGG SANDWICHES, 96 CALORIES 1 hard-cooked egg. % teaspoon mustard. Yi teaspoon salt. 3 drops vinegar. Speck paprika. 1 tea-spoon butter. Mince the egg very fine with a silver fork, add seasonings and butter, and mix thoroughly. Butter very thin slices of bread, spread with egg mixture, cover it with watercress leaves, or bits of nasturtium leaves, or lettuce. Cover with another slice of bread, and cut in triangles or rounds. Serve on small plate and doily. Ifote. — Minced ham may be added to egg mixture.- SHIRRED EGGS Butter an egg shirrer, ramikins, or small earthen cups; put one egg in each without breaking yolk ; dust with salt and white pepper, put in pan of hot water and cook on back of range or in a moderate oven until white is set. If baked,, cover with a buttered paper to keep from browning. SHIRRED EGGS HO. II Butter small, deep earthen dishes and line with fine white bread crumbs moistened to a paste, and seasoned with salt and pepper. Break an egg in each, sprinkle with a few grains, of salt, cover with more paste and bake in a pan of hot water, placed in the oven. When egg is set, serve with two table- spoons of tomatoes or cream sauce poured over it, and garnish, with a sprig of parsley. 184 ANIMAL FOODS FILLED EGGS, 96 CALORIES 1 hard-cooked egg. % teaspoon mustard. 1 teaspoon butter or Paprika. 1 teaspoon olive oil. Salt. Eemove the shell and cut the egg in halves lengthwise. Take out the yolk carefully without breaking the white. Eub the yolk to a smooth paste, adding the butter or oil and the seasonings, and mix thoroughly. A small quantity of finely chopped ham, tongue or chicken may be added. Pill the whites with the mixture and serve on lettuce, or in a bed of parsley. EGG DESSERTS See " ISTutritious Desserts " for recipe. Page 386. ALBUUINOUS DRINKS See " Albuminous Drinks " for recipe. Page 118. MILK AND MILK PRODUCTS ^ Milk is the only substance in nature designed expressly for the nourishment of the young animal. It contains all the compounds necessary to support life, in remarkably good pro- portions and in very assimilable forms. It is a perfect food for infants, and is specially suited to the needs of certain classes of invalids and sedentary persons. Por the active adult it is undesirable as the sole article of diet, because the proportion of water is so high that large quantities have to be taken to supply the necessary energy; because the propor- tion of protein is unnecessarily high ; and because it furnishes no indigestible residues to supply bulk for the perfect func- tioning of the intestines. Composition. Milk contains the five food principles, the proportions varying somewhat with different species, and also with individuals of the same species. Cow's milk, which is most extensively used, is the only kind which will be con- sidered here. Milk has a specific gravity of 1.027 to 1.035. ^ For further information, note "The Use of 'Mi[^c as Food,** Farmer's Bulletin No. 363, U. S. Dept. of Agriculture, Washington, D. C. MILK AND MILE PRODUCTS 185 The chief bulk is water, which averages 87 per cent. The solid matter is made up of proteins, fats, carbohydrates and mineral matter. The average percentages are as follows: Protein, 3.3 per cent. ; fat, 4 per cent. ; carbohydrates, 5 per cent ; mineral matter, 0.7 per cent. The principal protein is casein, a compound containing both phosphorus and sulphur. Casein is precipitated (or coagulated) by the addition of acid or in neutral solutions, by rennet. Milk also contains lactalbumin, arranging about 1/7 of the total protein. The character of the curd depends largely on the relative proportions of casein and lactalbumin. The fat of milk varies widely in amount. It is found throughout the milk in globules, i. e., as an emulsion. On standing, the fat rises to the top and forms cream chemically. Several fats are present, chiefly stearin, palmitin and olein, with smaller amounts of others, which give the characteristic flavor to butter. The chief carbohydrate is lactose or milk sugar. This remains in the whey when the casein and fat are removed. The ash constituents are mainly phosphates and chlorides of calcium, sodium and potassium. Digestibility. While milk is taken as a liquid, it should really be regarded as a solid food, for in the stomach it is coagulated by the action of the enzyme rennin in the gastric juice. If the milk is swallowed hastily, a large, tenacious curd may form, which will remain long in the stomach, and the milk will be regarded as difficult of digestion. If the milk is sipped slowly — or eaten with a spoon — the curds will be small, and hence readily acted on by the gastric juice. For this reason, the combination of milk with another food material, as bread or cereal gruel, may render it more easily digestible. Many persons think that they cannot digest milk. This is seldom true, if the above precautions are taken. Nutritive Value. Milk is a high protein food. In infancy it therefore furnishes the nitrogen necessary for the forma- tion of new protoplasm. Throughout the growing period, it furnishes the most valuable source of protein, as it is non- 186 ANIMAL FOODS stimulating, and less liable to putrefaction in the alimentary tract than meat proteins. Given a quart of milk and an egg each day, a child under eight years of age on a suitable diet of proper fuel value, will have sufficient protein for all body needs. The fat of milk, being in- an emulsified form, is more readily digested than the fat of meats and other similar foods. The carbohydrates of milk require only transformation to simple sugars by the intestinal enzyme lactase, to be per- fectly utilized. Often the energy value of milk is increased for infants and invalids, by addition of this soluble, mild- flavored compound. The ash of milk contains the elements required for the bony tissues in particularly assimilable forms. It is lack- ing in iron, so that this element must be supplied by other foods (as yolk of egg) when milk is the chief source of nutri- ment. The value of milk as a food is not appreciated by many people. It is frequently regarded as a beverage rather than nutriment, while in fact a quart of milk is equivalent in food value to half a loaf of bread (six ounces) or three-quarters of a pound of lean beef. It contains as much protein as one- third of a pound of lean beef, at approximately the same price, and in addition about as much fat as is daily con- sumed at the table in the form of butter, over one and one-half ounces of milk sugar, and valuable mineral salts. Compared with other animal foods milk is a cheap food, even at 10 or 12 cents per quart, and should enter freely into the dietary. It need not be used as a beverage if disliked, but can be combined with other materials in soups, sauces for vegetable, custards and the like, or used in cooking cereals, in place of water. The value of skim milk as a food also needs to be empha- sized. It has lost most of the fat in the skimming processes, but is correspondingly richer than whole milk in protein, carbohydrates and ash. It is not as rich in flavor as whole milk, but used in combination with other foods it forms a very inexpensive source of valuable nutriment, two and one- MILK AND MILK PRODUCTS 187 half quarts of skim milk will yield as much protein as a pound of lean round steak, at less than one-fourth the cost. Care of milk. The importance of keeping milk clean can- not be over-emphasized. Aside from all esthetic considera- tions, absolute cleanliness is essential as a protection to health. Milk is an excellent culture medium for bacteria, and these organisms may not only be of types producing changes in the character of the milk, such as alterations in flavor, odor, color, decomposition of proteins, formation of gases, alcohol, lactic acid, etc., but also disease germs, especially those of tuberculosis, scarlet fever, typhoid fever, and diph- theria. Commercially, care of milk is important as effecting the keeping qualities. For all these reasons, milk should come from a healthy animal in a sanitary environment. Milking must be done under conditions which protect the milk as fully as possible from contamination through impurities on the cow herself, on the hands or clothing of the milker, in the receptacles used for the milk, and in the air, in the place where the milking is done. Milk should be immediately cooled, and transported to the consumer in sealed bottles; cooling prevents the growth of bacteria. Such cautions necessarily increase the price of milk, but even then milk is a cheap food and the additional security is worth paying for. Certification of Milk. To insure a milk free from im- purities, the method of certification and pasteurization have heen widely adopted. Certification involves a specific testing of milk against all accidental and harmful contamination. To secure it the services of chemists, bacteriologists and veterinary surgeons are required. The most vital object desired is the exclusion of tubercule bacilli from milk, which involves a special in- spection of dairy herds and rejection of tuberculous cows. Other pernicious germs, pus corpuscles, etc., are also sought for. Certification of milk requires periodical inspection of 188 ANIMAL FOODS dairies, of bottled milk bought in open market, etc. All milk must correspond to a number and variety of tests, too numer- ous to be mentioned in this connection. Every branch of the milk trade is covered. Such milk receives a certificate which should contain the date of milking and is naturally ex- pensive, but it should be used whenever possible for infants and little children, and for all purposes in households which buy the best grades of other food materials. Pasteurization. This is the process by which milk is ren- dered more or less sterile through destruction of active bac- teria by heat. Various standards as to temperature and time have been adopted, but in general the milk is heated to a temperature not exceeding 167° P., for a period of 20 to 45 minutes, and then rapidly cooled to 45° F. or lower. Most harmful bacteria and lactic acid bacteria are killed. Spores are not killed, and if the milk is not kept cold or is allowed to stand too long, putrefactive organisms develop. These putrefactive changes are very undesirable, so that the care of pasteurized milk is Just as important as that of fresh milk. If carelessly handled, the fact that it does not sour readily is a menace to health rather than a benefit. Commercial pasteurization is a cheap and effective means of preventing the spread of ordinary infectious diseases. The degree of heat used does not change materially the flavor nor the chemical composition of the milk. It does destroy the enzymes naturally present in milk, and how much this affects the value of milk for infants is still unsettled. When clean fresh milk cannot be absolutely insured, it is safer to pas- teurize. But this process cannot make bad milk good nor dirty milk clean. If bacteria have already produced poison- ous products it will not destroy them. Sterilization. Sterilization is accomplished by keeping milk at boiling temperature (212° P.) for 10 or more minutes, preferably in the vessel in which it is to remain. This will kill all living bacteria, but will not destroy spores. Hence to render milk absolutely sterile, repetition of the process on successive days is necessary. This is rarely done, as the MILK AND MILK PRODUCTS 189 spores are not likely to develop if the milk is kept at a temperature of 40° F. or less. Sterilized milk is not an ideal food. Boiling changes the taste, the cream does not rise as quickly, and it is less easily coagulated by the action of rennet. Lecithin is decomposed, diminishing the amount of organic phosphorus compounds, and increasing the inorganic phosphorus which is not as use- ful to the body. The calcium salts are changed, and the ferments of the milk destroyed. Sterilization should be re- garded as an emergency measure, for hot weather, when cool- ing facilities are lacking. MILK PRODUCTS Butter. Butter consists almost entirely of separated milk fat. Churning causes the fat globules to unite into a solid mass. The cream is first allowed to ripen for some hours. This process gives the characteristic taste and odor, which is due to action of bacteria. When kept, butter tends to turn rancid, owing to the fermentation of a small quantity of casein present. Salt is added largely to prevent this change. But- ter is very palatable, and one of the most digestible forms of fat. Cheese. Cheese is made from full milk, skim milk or cream. It consists of the casein of the milk and more or less of the fat and mineral matters. The flavor is due to the action of enzymes in molds or bacteria. Cheese is a very concentrated nutritious food, and very thoroughly assimilated. It is not usually well borne by invalids and convalescents, however. Cream. Cream is the fatty layer which forms at the top of milk which is allowed to stand undisturbed. It contains the fat of the milk, water, some protein, carbohydrates and mineral matter. The percentage of fat is exceedingly vari- able, ranging from about 16 per cent, to 40 per cent. The cream which rises on milk after 24 hours is called gravity cream and contains about 16 per cent. fat. The richer creams are obtained by centrifugalizing the milk. Cream in large 190 ANIMAL FOODS quantities is less easily digested than an equal amount of whole milk because of the large amount of fat, but this form of fat is easily digested compared with other food fats, and hence is often ordered by physicians. Curds. When milk sours, owing to the formation of lactic acid by the action of laqtic acid bacteria upon the sugar, or when the enzyme rennet is added to fresh milk at body temperature, and the clot is stirred, the curds separate from the whey. Curds consist of coagulated casein, which commonly car- ries with it the fat ; gentle heat facilities this separation, but a high temperature renders the curd tough and indigestible; with or without the addition of cream, curds are used as cottage cheese. It is a very cheap, nutritious food. Junket. If sweet milk is allowed to stand undisturbed after the addition of rennet, the thickened, custard-like mass is called junket. This is a valuable method of using milk, especially for invalids, children, and those who from personal idiosyncrasy cannot drink milk. Whey. This substance may be either sweet when formed by junket or sour when otherwise produced. It contains most of the lactose, lactalbumin and ash constituents of the milk, but has so little nutritive value, owing to the removal of the milk fat and casein, that it may be regarded as a beverage. See page 185. Sour MilTe. When whole milk sours, with the formation of " curds and whey," the entire product is known as clabber or bonny-clabber. It is wholesome, and nutritious, since it contains all the ingredients naturally present in milk. By some it is used as a beverage. When not so relished, it can be used to good advantage in cooking, adding its nutritive value to any dish in which it is incorporated. Buttermilh. True buttermilk, which is common on farms, is seldom found in commerce. Unless produced where sold, its genuineness may be a matter of question. Those who are familiar with the genuine article state that the delicacy of its flavor, its consistency, etc., are much superior to the so- MILK AND MILK PRODUCTS 191 called buttermilk of commerce. The composition of the two articles is practically the same. When skim milk, the cream having been removed by the separator, is allowed to sour, it is said to resemble ordinary buttermilk, and the fluid which goes by the latter name, sold extensively throughout Greater New York, is said to be sour skim milk. Metschnickojf Artificially Soured Milk. The announce- ment some years ago by Metschnickoff that the foregoing products were of very great hygienic and therapeutic value in disinfecting the intestines has resulted in the wholesale pro- duction of a substance which differs from ordinary sour milk in that it is prepared from a pure culture of lactic- acid germs. This product is doubtless destined to replace the older ones on account of its freedom from undesirable forms of bacteria. The technique for preparing it, devised originally by Metschnickoff himself, also places it in a higher class than the older preparations. The pure culture is sold in the solid form as Buttermilk Tablets. Fermented Milk. Milk which has been fermented is really a derivative of native milk, and in parts of Europe and Asia constitutes an important article of diet. The fermentation is either the lactic alone or lactic and alcoholic together. The ferments used consist chiefly of various " leavens " or cultures which cause lactic acid fermentation. People who have subsisted on this milk for centuries simply use a por- tion of old fermented milk to leaven fresh milk. These leavens vary considerably in composition, and the milk used 2nay be from one of several domestic animals. Some leavens contain yeast germs, as that alcohol may or may not be present. The native preparations which have been imitated in this country are kumyss, kefir and matzoon. Kumyss was prepared originally from mares' milk. The leaven contains lactic acid germs and yeast. The product therefore contains lactic acid, alcohol, and carbonic acid gas, representing an acid, effervescing, mildly alcoholic bev- erage. The casein curd is finely broken up and partially digested. Kumyss has been imitated in America by adding 193 ANIMAL FOODS yeast to milk and allowing fermentation to proceed twenty- four hours or over. Kefir was made originally from cows' milk with a leaven of kumyss. This has been sold in tablet form like the ren- net ferment. Kefir resembles kumyss so closely that no further description is necessary. Matzoon differs from the preceding chiefly in containing no alcohol. Modified Milk is milk containing definite proportions of fat, sugar, proteids, etc., put up usually according to the formula of a physician, who prescribes the quantity of the different constituents he desires. For sick children and in convalescence it is of great value to obtain a modification in which the composition is definite and accurate. It can then be known what mixtures will agree with the patient. Malted Milk is a pure food prepared from rich full-cream milk, combined with the valuable nutritive extracts of malted barley and wheat. This product being highly concentrated and partially predigested, supplies a large amount of nutrition with little tax upon the digestive organs. It is a valuable nutrient in dyspepsia or impaired digestion, for fever and wasting diseases, the convalescent, nursing mothers, and the aged. Peptonised Milk is milk in which the casein or curd has been made soluble and diffusible by means of the Peptonising Tubes. In these Peptonising Tubes, extractum pancreatis, containing the pancreatic ferment which acts especially upon the proteins of milk, is combined, with soda bicarbonate in due proportion, and each tube contains sufficient peptonising powder to peptonise a pint of milk. Milk may be peptonised by various methods — by the "cold process," "immediate process," "warm process," etc. The method and degree of peptonisation suitable for any special case is soon determined by experience, by the agreeability of the milk and its digesti- bility. ^ Condensed Milk. Preservation of milk by condensation MILK AND MILK PRODUCTS 193 constitutes a very extensive commercial industry. There are several processes in vogue, and the product is either sweet- ened or unsweetened. Ordinary unsweetened milk contains about 12 per cent, each of protein and fat and 16 per cent, of the native milk sugar, making the total solids 40 per cent. Cane sugar may be added to the amount of about 40 per cent, more, making the total solids 80 per cent. Milk may also be condensed by forcing filtered air through it, until its vol- ume is reduced to one-fourth the original amount. This product is sold in sterile bottles. Condensed milk is very generally used as a substitute for fresh milk. It is especially valuable in tropical regions and on ocean voyages. It is important that condensed milk be made from clean milk, and kept free from bacteria contamination. The unsweetened brands are especially liable to putrefaction, and should be cared for, when opened, like fresh milk. Desiccated Milk. When the process of condensation has been carried to complete expulsion of all fluid matter, a powder may be obtained which is sold as milk powder, des- iccated milk, etc. ENERGY VALTTE OF MILE 1 cup of whole milk := 169 Calories. 1 cup skimmed milk = 89 Calories. 1 cup cream ( 18% ) = 440 Calories. 1 cup cream (40%) := 864 Calories. FASTETJRIZATIOIT Methods of Preparing. Put bottle into kettle of cold water and slowly bring to the boiling point. Boil ten minutes. After which fill immediately nearly full with milk ; cork with absorbent cotton which has been baked in the oven until a delicate brown. Place bottles on a rest in a deep pan so that they will not touch bottom, and fill the pan with cold water to reach as high as the milk in bottles. Heat water gradually to 155 to 167 degrees Fahrenheit, or until small bubbles appear in the milk next to the glass. Eemove to back of stove and keep milk at same temperature 30 to 46 minutes; then cool 194 ANIMAL FOODS quickly to 45 degrees or lower. To cool rapidly put bottles :first into lukewarm water and then cold water until milk is cold, then surround with ice water. Keep in cold place and do not remove stoppers until ready to use. Note Pasteuriza- tion, page 188. Utensils. A convenient form of apparatus for pasteuriza- tion is known as the Hygeia Pasteurizer or Sterilizer. Or a covered tin pail answers well for the larger vessel, and an inverted pie pan with perforated bottom can serve as the false bottom. A hole may be punched in the cover of the pail, a cork inserted and a chemical thermometer put through the cork so that the bulb dips in the water, thus enabling one to watch the temperature closely without removing the cover, or an ordinary dairy thermometer may be used from time to time by removing the lid. STERIIIZATIOH The utensils and methods to sterilize milk are the same as for pasteurizing, except that the water is heated to the boil- ing point (313° P.) and the time for boiling is ten or more minutes. Note Sterilization, page 188. EVAPORATED MILK It is sometimes of advantage, as in cases of dilated stom- ach or whenever the total amount of fluids must be cut down to a given point, to heat the milk in a pan over which is placed an inverted funnel. Much of the water of the milk passes off as vapor, while the solids remain in the pan. BAKES UIIK Into a stone jar put one-half gallon of sweet milk; cover with writing paper and tie it on. Bake in moderate oven nine to ten hours. It will be the consistency of thick cream. HALTED MILK, 59 CALORIES Mix one tablespoon of Horlick's Malted Milk powder with a little tepid water to make a smooth paste ; add three-fourths cup water, hot or cold, stirring briskly and serve. MILK AND MILK PRODUCTS 195 Note. — May be prepared with hot milk instead of water and a little cream added if desired. FEFIONISED MILK, 338 CALORIES Warm Process Put one-half cup (gill) of cold water and the powder con- tained in one of the Peptonising Tubes (Fairchild) into a clean quart bottle and shake thoroughly; add a pint of cold fresh milk and shake again; then place the bottle in a pail or kettle of warm water — about 115° P., or not too hot to immerse the whole hand in it without discomfort. Keep the bottle in the water bath for five or ten minutes, or longer if it is desired to peptonise the milk quite completely, then put it immediately on ice — directly in contact with the ice — in order to check the process of digestion and keep the milk from spoiling. The degree of peptonisation is very simply regulated in this process by the length of time during which the milk is kept in the water bath. It is seldom necessary to peptonise milk until it becomes bitter. PABTIALLY FEFTONISED MILE, 338 CALORIES Put one-half cup (gill) of cold water and the powder con- tained in one of the Peptonising Tubes (Pairchild) into a clean saucepan, and stir well; add a pint of cold fresh milk, and heat, with constant stirring, to boiling point. The heat should be so applied that the milk will come to a boil in ten minutes. Let it cool to about lukewarm, then strain into a clean bottle or glass jar, cork tightly and keep in a cold place. The bottle or jar should always be well shaken before and after pouring out a portion. The milk may be taken cold or hot as the physician may direct. " Partially peptonised milk " if properly prepared will not become bitter. PEPTONISED MILK, 338 CALORIES Cold Process Put one-half cup (gill) of cold water into a clean quart bottle and dissolve in it by shaking thoroughly the powder 196 ANIMAL FOODS contained in one of the Peptonising Tubes (Fairehild) ; add a pint df cold fresh milk, shake the bottle again, and im- mediately place it on ice — directly in contact with the ice. The bottle should always be well shaken before and after pouring out a portion. Peptonised milh prepared by this recipe is especially ap- preciated iy patients who dislike the taste of warmed or boiled milk, and ordinarily it is readily digested and assimi- lated. PEPTONISED MILK Immediate Process Put two tablespoons (1 oz.) of cold water into a goblet or glass; dissolve in this one-quarter of the contents of a Peptonising Tube (Pairchild) ; add eight tablespoonfuls (4 ozs.) of warm milk — not boiling; drink immediately, sipping slowly; 85 calories. To prepare half a pint of milk, use half the contents of a Peptonising Tube, 4 tablespoonfuls of water, a half pint of milk; 169 calories. SPECIAILT PEPTONISED MILE, 338 CALORIES For Making Milk Jelly, Milk Punch, Milk Lemonade, and for Use with Pruit Juices or Acids Peptonise a pint of milk by the "Warm Process," keep- ing the bottle in the water bath for one hour; pour the pep- tonised milk into a saucepan and heat to boiling, when it is ^ready for use if it is required hot ; or it may be put on ice, in a bottle or any suitable container, to be used for punches, lemonade, etc. It is necessary to peptonise the milk quite completely — for one hour — so that it will not curdle when mixed with lemon juice or acid. The bitter taste of this " specially peptonised milk" is not evident in the jellies, punches, etc., and these foods are very agreeable and exceedingly assimil- able. EFFERVESCENT PEPTONISED MILK Into a glass put some iinely cracked ice and fill it half- full of vichy, Apollinaris or siphon water, add immediatelv MILK AND MILK PRODUCTS 197 peptonised milk prepared by any of the prescribed methods and drink while effervescing. Brandy or other spirits may be added if desired. THICKENED UILK See Elour Gruel. Page 239. RICE MIIK, 458 CALORIES 1 ounce rice. 1 saltspoon salt. 1 pint scalded milk. 1 teaspoon sugar. Soak rice twelve hours, strain and add the scalded milk, salt and sugar. Stir well and cook slowly one hour. Eub through a fine sieve (thin with more hot milk if desired). Taste and add more seasoning if necessary. Sago or tapioca may be used in the same way. RTTU AND JBILK, 186 CALORIES % cup milk. i% teaspoon sugar. % tablespoon rum or brandy. Use fresh or pasteurized milk. Put ingredients into a lemonade shaker or fruit jar (using rubber band and cover) ; cover well and shake until frothy. Serve in glass three- fourths filled. SHERRY OR BRANDY AND MILK, 173 CALORIES % cup fresh milk. % teaspoon sugar. % tablespoon brandy or Nutmeg. % wineglass of sherry. Blend as for " Eum and Milk." Fill glass three-fourths full and add a grating of nutmeg on top. CINNAMON AND MILK, 132 CALORIES i % cup new milk. Sugar. Stick cinnamon. Vs teaspoon brandy. Boil milk, with sufficient cinnamon to flavor pleasantly, and sweeten. This may be taken cold with the brandy. Very good in cases of diarrhoea. Children may take it warm without brandy. 1 Without sugar. 198 ANIMAL FOODS WHEY 6V4 ounces whey = 50 Calories. 1 cup fresh milk. 1 teaspoon cold water. % Hansen's Junket Tahlet. Heat the milk until lukewarm; add the tablet, dissolved in the cold water. Allow j,t to jelly in a warm place. Then break up the curd and strain through two thicknesses of cheese-cloth, being careful to remove all the casein. Serve cold, with or without sweetening, and flavor as desired. LIQTTID PEPTONOIDS AND WHEY Place one tablespoonful of finely cracked ice in a small tea- cup. Pour over it one tablespoonful of Liquid Peptonoids; stir, fill the cup with whey and drink slowly. ACID PHOSPHATE WHEY See " Acid Drinks " for recipe. Page 113. lEMON WHEY See " Acid Drinks " for recipe. Page 113. WINE WHEY See " Acid Drinks " for recipe. Page 113. PANOPEPTON WITH WHEY Put into a small teacup one or two teaspoonfuls of clean crushed ice; add one tablespoonful of Panopepton, stir, then fill the cup with whey. Drink slowly. This is very refresh- ing and nourishing — an admirable liquid food for fever patients and convalescents. KTJMYSS, 328 CALORIES i cake Fleisehmann's yeast. 1 tablespoon water. 114 tablespoons sugar. 1 quart milk. Make a thin syrup of the sugar and water and cook one minute. Soften the yeast in two tablespoons of lukewarm milk. Heat the milk until lukewarm, add other ingredients and shake. Put in sterile patent beer bottles, place in up- right position for twelve hours, at 70 degrees Fahrenheit (or comfortably warm room) ; then turn on side at heat MILK AND MILK PRODUCTS 199 50 degrees Fahrenheit (lower part of ice-hox). Eeady for use after the first twenty-four hours ; often kept several days, but the longer it is kept the less palatable it is. Do not open a bottle of kumyss without a champagne tap, or the cork may be punctured with a stout needle to let the gas escape. It should look like thick, foamy cream. Kumyss is especially suited for many forms of indigestion, nausea, fever and gastric trouble, pulmonary consumption and other wasting disease. Dr. Brush's prepared kumyss is recommended on account of its superiority over the home-made preparations, as the milk supply is controlled, and the method of preparing is carried out upon scientific bases. It is also more convenient, as it is ready for immediate use. UATZOON OR ZOOLAK (GERKAN HOSPITAL, NEW YORE CITY) 1 pint = 338 Calories. Take forty-five pints of milk, boil thoroughly. Cream two or three times; that is, until all the cream is removed. When the milk is still quite warm add two (3) bottles of prepared bottled Zoolak. Mix thoroughly. Bottle quickly in pint bottles, not entirely full. Cork tightly immediately, and put in a warm place till the liquid shows creamy through the bottles. Then place and keep in a cold place. N. B. — If chilled before it is thick it remains thin and the flavor is spoiled. If not kept very cold after it is made the fermentation is carried too far. JUNKET, lee CALORIES 1 eup fresh milk. 1 teaspoon cold water. 14 Hansen's Junket Tablet. Heat the milk until lukewarm; add the tablet dissolved in the cold water ; allow it to jelly in a warm place ; chill in ice-box; serve plain or in the various ways as directed in chapter " Nutritious Desserts." ARTIFICIAL OR HOUEMASE BTTTTERMILE 1 cup (whole milk buttermilk) =169 Calories. Pasteurize fresh, sweet milk, which may be new, or partly 200 ANIMAL FOODS skimmed, or entirely fat-free, as desired, by heating it to between 160 and 175 degrees F, and holding at such tem- perature for at least 20 minutes, cool to 100 degrees. Dissolve one Junket Brand Buttermilk Tablet in a table- spoon of cold milk or water and add a quart or less of the pasteurized milk. Leave in warm room until thick, 34 to 36 hours. When milk has thickened, place in refrigerator. When cold, " Churn " by shaking the bottle vigorously for a minute or two. Or the milk may be prepared in a fruit jar, a bowl or a pitcher and beaten with an egg beater, until smooth and creamy. If the acid flavor is too mild, let stand cold another day. If desired, the milk may be diluted with one-fourth water. A pinch of salt may be added. Junket Buttermilk may be kept on ice or in refrigerator for a week or longer. SWEETBREADS Among epicures sweetbreads are considered a dainty and are certainly a most acceptable food for the sick, as they are easily digested, but they must not be used to excess on account of the large amount of uric acid which they produce. Definition. Sweetbreads are the pancreas and thymus glands of the calf, the word being used for either one or both organs. The thymus glands are removed and used for food while the animal lives on milk. The pancreas of the calf is sometimes called stomach sweetbread, and the thymus gland the neck or throat sweetbread. The latter is con- sidered somewhat more easily digested than the former. Digestibility. It is an error to state that sweetbreads are more digestible because they contain digestive ferments in life, for these are destroyed by cooking. The tenderness of these bodies is due doubtless to the delicate character of the connective tissue, and to the soft character of the gland tis- sue itself, which is rich in nucleo-protein. The presence of SWEETBREADS 201 this nuclein is objectionable for gouty and other patients with uric acid disorders, but this is no contraindication for an occasional use of them by invalids. ENERGY VAIXTE OF SWEETBREADS 100 grams (3% oz.) sweetbreads = 176 Calories. 1 pair sweetbreads, medium size {8 oz.) . . ^399 Calories. 1 pair sweetbreads, medium size (8 oz.), when cooked, freed from membrane, pipe, etc., and cut into cubes, measures three-fourths «up. TO PREPARE SWEETBREADS (To Parboil.) Eemove from paper as soon as received from market, plunge into cold water and allow to stand one hour. Drain. Place immediately in boiling water salted water to cover, allowing one-half tablespoon each of salt and vinegar to a pair of sweetbreads. Simmer twenty minutes; again drain and plunge into cold water that they may keep white and firm. Free from membrane fat and veins, and serve as desired. Sweetbreads are always prepared in this way for subse- quent cooking and are spoken of as parboiled. BROIIED SWEETBREADS Parboil and cut in halves cross-wise. Sprinkle with salt and pepper, place on a greased fine wire broiler, and broil five minutes over a clear fire. As soon as sweetbread is heated brush both sides with a little melted butter. Serve with creamed butter to which has been added a little lemon juice or simply spread with soft butter. CREAHED SWEETBREADS NO. I, 288 CALORIES (Individual Rule.) l^ tablespoon butter. % cup milk. % tablespoon flour. Vs cup sweetbreads. Melt the butter, add flour and pour on gradually the scald- ing milk. Cook thoroughly and season. Add the parboiled sweetbreads cut in small pieces, reheat and serve on toast and garnish with parsley. 203 ANIMAL FOODS Note. — For Scalloped Sweetbreads put creamed sweetbreads in small baking dish ; cover with cracker crumbs and dot with bits of butter ; bake until crumbs are a golden brown. CREAUEI) SWEETBBEABS NO. II, 968 CALORIES (Three Servings.) 1 cup thin cream or rich milk. Yg teaspoon salt. 2 teaspoons butter. % cup sweetbreads. 2 tablespoons flour. Parboil sweetbreads and cut into one-half inch cubes. Blend flour with a little cold milk to make a smooth mixture ; scald cream in double boiler, add the flour mixture and cook thoroughly. Just before serving add the prepared sweet- breads, salt and butter. Serve hot on toasted rounds, and garnish with parsley, or use as a filling for Swedish tim- bales. Note. — May use equal proportions of cold cooked chicken and sweetbreads, reheat and serve in the cream sauce. TBICASSEES SWEETBREADS, 240 CALORIES i (Three Servings.) Parboil and cut sweetbread into one-half inch pieces. Make a sauce using: 2 teaspoons butter. % cup hot strong chicken broth. 1 teaspoon flour. % cup cream. y^ teaspoon lemon juice. Salt and pepper. Melt the butter, add the flour, allow it to simmer until a golden brown, then add the hot broth gradually, stirring constantly, lastly the cream. Season with salt, pepper and lemon juice. A speck of curry powder may be added if desired. Put the cut sweetbread into the sauce, simmer five minutes and serve on sippets or squares of dry toast; garnish with parsley. SWEETBREADS WITH PEAS 1 cup of canned peas = 100 Calories. Parboil and broil sweetbreads, arrange in center of plat- ter, and serve the peas (cooked and seasoned) around them. I * Calculated without the sweethreads GELATIN 303 Or the peas may be piled in center of platter and the broiled sweetbreads arranged as a border. A cream sauce may be poured over all; for it, use the recipe in Creamed Sweet- breads Xo. I or II. GELATIN Source. Gelatin is a nitrogenous food classed with pro- teins, under the division called gelatinoids or albuminoids, and derived from " collagen," the chief constituent of connective tissue with its various modifications, as tendons, "chondri- gen" of cartilage, or the "ossein" of bone. "By proper treatment, any form of connective tissue can be made to yield gelatin. Hide clippings yield glue, a crude form of gelatin, and much commercial gelatin is simply a purified glue, derived from such a source. Isinglass, obtained from the swimming bladder of the sturgeon and other fish,^is the purest form of gelatin; the gelatin obtained from calves' feet is also of high quality." ^ General Principles in Coohing. Gelatin is insoluble in cold water, but when allowed to stand in it will swell from absorption of water. " Gelatin is very soluble in boiling water, and on cooling sets into a jelly. This jellying will occur in a solution containing as little as 1 per cent, of gelatin." ^ Gelatin is decomposed by boiling and conse- quently if allowed to boll will not solidify on cooling. Digestibility. Gelatin is very easily digested in the stom- ach, and readily absorbed from the small intestines. Nutritive Value. Although gelatin is a protein food, it ' cannot alone support life. Proteins are made up of groups of amino acids, most of which it seems necessary to have represented in the diet, to secure complete repair of the waste of nitrogenous tissue. In gelatin two important acids are lacking ; hence not more than two-thirds of the day's nitrogen requirement should be given in the form of gelatin. Because 1 state of Connecticut. Report of The Connecticut Agricultural Experi- ment Station. Food and Drug Products, , 1909. Being Part II of tile Biennial Report of 1909-1910. 204 ANIMAL FOODS it can to this extent take the place of other proteins, gelatin has often been called a " protein-sparer," rather than a true protein. In the ordinary intake of animal food, not more than one-eighth of the total nitrogen is in the form of gelatin. It is usually not convenient to take more than 25 to 30 grams (about 1 ounce) in a day. Six ounces of calf's foot jelly (which would be a large helping) contain less than half an ounce of gelatin. Jellying will occur in a solution con- taining as little as 1 per cent, of gelatin. Gelatin has the advantage (along with other proteins) of fixing a good deal of acid in the process of stomach digestion and is thus of service in cases of hyperacidity of the stomach, when given in other forms than acid jellies. It seems also to promote the secretion of gastric juice. It is useful in febrile states as it really belongs with liquid foods, melting as it does at body temperature. In convalescence, aeid jellies (orange, lemon, etc.,) are of service as a pleasant supplement to the ordinary diet, but the actual nutriment which they supply is small. Extra nutriment can be added to gelatin by combining it with eggs and milk, as in Snow Pudding, Charlottes of various kinds, Spanish Cream, etc., all of which are attrac- tive forms of invalid diet. Meat Jellies are condensed form of broth, and are prepared by taking any meat containing a large proportion of connec- tive tissues and cooking long and slowly. ' (Note broths, page 217 for directions and recipes.) Home-made jellies, prop- erly prepared, have a pleasing flavor and are an agreeable addition to diet of an invalid, although their nutritive value is low. WINE JEIIY NO. I, 165 CALORIES (Individual Rule.) 1 teaspoon granulated gelatin. 2 tablespoons wine. 1 tablespoon cold water. 1 tablespoon orange juice. ->4 cup boiling water. 1 teaspoon lemon juice. ' 2 tablespoons sugar. GELATIN 305 Soak gelatin in the cold water 5 minutes; add the boiling water and dissolve. Add sugar, wine, orange and lemon juice. When sugar is dissolved, strain through a cheese- cloth iijto cold, wet molds; or chill in shallow soup plate and when firm cut into one-half inch cubes and serve in sherbert or champagne glasses, or half orange shell with a little whipped cream on top. WINE JELLY NO. II, 1530 CALORIES (Six Servings.) ^2 tox shredded gelatin or 2 cups boiling water. 2 tablespoons granulated gelatin. 1 cup wine. '/4 cup cold water. Speck salt. 1V4 cups sugar. Cover gelatin with the cold water and let it stand about one-half hour. Add the boiling water, sugar and salt. Stir till gelatin is dissolved and add the wine. Strain through cloth and strainer into cold, wet molds and set in cold place to harden. Serve plain or with whipped cream. PEPTONOIDS WINE JELLY, 192 CALORIES 1/4 box gelatin. 2 tablespoons sugar. 4 tablespoons cold water. 1 tablespoon sherry wine. 8 tablespoons boiling water. 1 tablespoon Liquid Peptonoids. Soak gelatin in tJie cold water 5 minutes; add the boiling water, sugar, wine and Liquid Peptonoids. "When sugar is dissolved, strain and, pour into cold, wet molds. Put on ice to harden. ORANGE JELLY NO. I, 1020 CALORIES (Six Servings.) % box shredded gelatin or 1 cup sugar. 2 tablespoons granulated gelatin. 1 cup orange juice. y, cup cold water. Juice 1 lemon. 2 cups boiling water. Soak the gelatin in the cold water one-half hour; add the boiling water and dissolve. Add sugar and fruit juice, strain through a cloth and strainer into cold, wet molds 206 ANIMAL FOODS and set away to harden. Serve plain or with whipped cream. ORANGE TELLY HO. II, 152 CALOKIES (Individual Rule.) 1 teaspoon granulated gelatin. 3 tablespoons orange juice. 1 tablespoon cold water. 2 teaspoons lemon juice. 1 tablespoon boiling water. 2 tablespoons sugar. Make same as preceding. Soaking gelatin five minutes. Cut orange in half, crosswise, remove pulp with spoon and strain through cheese-cloth. Fill halves with jelly ; when it is hardened cut with sharp knife into thirds (which leaves the rim filled with jelly). Serve three pieces on small plate with whipped cream in center. ORANGE BASKETS Wash oranges. Eemove two sections from the upper half of an orange, leaving a band of peel for a handle. Dig out the pulp and scrape clean. Pill with lemon or orange jelly, cut into cubes. An attractive form to serve to children. Note. — If these shells are wrapped in a damp cloth they will retain their shape for hours. LEMON TELLY, 142 CALORIES (Individual Rule.) 1 teaspoon granulated gelatin. 2 tablespoons lemon juice. 1 tablespoon cold water. 2 tablespoons sugar. % cup boiling water. Soak gelatin in the cold water 5 minutes; add the boiling water, sugar and fruit juice. When the sugar is dissolved, pour into cold, wet molds and put on ice to harden. GRAPE TELLY, 588 CALORIES (Individual Rule.) 1 tablespoon granulated gelatin, y^ cup sugar. 14 cup cold water. Juice 1 lemon. 1 cup boiling water. % cup Welch's grape juice. Soak gelatin in the cold water ; add boiling water and dissolve. Add sugar, lemon juice and grape juice; strain, pour into cold, wet molds and cool. GELATIN 207 This recipe may be seryed in another and very inviting form; when the gelatin is firm, force it through a potato ricer. Keep on ice until ready to serve. PEACH TELLY, 130 CALORIES (Individual Rule.) 1 teaspoon granvilated gelatin. 1 teaspoon lemon juice. 1 teaspoon cold water. 1 tablespoon sherry wine. 1 tablespoon boiling water. 1% tablespoons sugar. 3 tablespoons peach juice. Soak gelatin in the cold water 5 minutes; add boiling water and dissolve. Add fruit juice, wine and sugar, strain and pour into a cold, wet mold. COFFEE JELLY, 529 CALORIES (Individual Eule.) 1 teaspoon granulated gelatin. 2 tablespoons sugar. 1 tablespoon cold water. 7 tablespoons cream. 2 tablespoons strong hot coffee. Soak gelatin in the cold water 5 minutes. Add the hot coffee and dissolve; add sugar and strain. Set bowl into chopped ice, or ice water to cool, stirring occasionally until it thickens. Then' add the cream, and pour into cold, wet molds to chill. JEPTONOIDS COFFEE JELLY, 255 CALORIES i 14 box granulated gelatin. Sugar to taste. 4 tablespoons cold water. 8 tablespoons Liquid Peptonoids. 8 tablespoons boiling coffee. Soak gelatin in the cold water 5 minutes ; add the boiling coffee, sugar and Liquid Peptonoids. When sugar is dis- solved, strain and pour into cold, wet molds. Put on ice to harden. CREAU JELLY, 330 CALORIES (Individual Rule.) 1 teaspoon granulated gelatin. 1 tablespoon sugar. 1 tablespoon cold water. Speck salt. 3 tablespoons scalded milk. Vanilla to taste. 4 tablespoons thick cream. 1 Without sugar. 208 ANIMAL FOODS Soak gelatin in the cold water 5 minutes; add the scalded milk and dissolve. Add the sugar, salt, cream and vanilla. Stir occasionally until the mixture thickens; pour into cold, wet after-dinner coffee cups, or egg cups, and chill. Serve with Soft Custard, or cream and sugar. PEFTONISED MILK JELLY, 517 CALORIES i (Three Servings.) 1 pint " specially peptonised Rinds and juice of one fresh: milk," hot. lemon and orange. % box gelatin. 2 or 3 tablespoons best St. Croix Sugar to taste. rum, or brandy, etc. Soak the gelatin in a cup of cold water, pour the hot milk over it and add the sugar; stir until dissolved, then throw in the lemon and orange rinds. Squeeze the juice of the lemon and orange into a glass and strain ; stir in the rum or brandy, etc., then mix with the milk and gelatin; strain. When the mixture has cooled to a syrup so as to be almost ready to set, pour into molds or glasses wet in cold water and put on ice or in cold water or in a cold place to harden; if it is too warm when poured into the molds, it is apt to separate in setting. FANOFEFTON JELLY, 242 CALORIES (Three Servings.) 1 ounce fresh celery (cut 2 dashes pepper. in small pieces). 6 tablespoons Fanopepton. y^ small box best gelatin. 2 cups cold water. y^ teaspoon salt. Soak the gelatin in one-half cupful of cold water for one hour ; put the water and celery in a double boiler on the fire and simmer one-half hour; add the salt, pepper, and soaked gelatin and stir until it is dissolved; remove from fire, add Panopepton; stir, and strain through linen into a jelly-jar, and set near ice. Serve in small quantities. 'Without sugar. GELATIN 209 PANOPEPTON JEIIY WITH ORANGE, 379 CALORIES (Three Servings.) % small box best gelatin. Juice and peel of 1 orange. 1 tablespoon sugar. 1 pint cold water. 6 tablespoons Panopepton. Put the gelatin, orange peel (cut in small pieces), orange juice, and cold water in a dish and let it stand for one hour, then put in a double boiler on the^fire, add the sugar and stir until it is dissolved ; now strain through linen, add the Pano- pepton and stir well. Pour into a jelly-jar and set near ice. Serve in small quantities. MEAT JELLIES See " Meat Jellies " for recipe. Page 221. STARCHY JELLIES See- " Starchy Jellies " for recipe. Page 244. SNOW PUDDING, 934 CALORIES (Six Servings.) % box shredded gelatin or 1 cup sugar. 1 tablespoon granulated gelatin. % cup lemon juice. ^4 cup cold water. Whites 3 eggs. 1 cup boiling water. 1 teaspoon lemon extract. Soften gelatin in cold water, add boiling water and dis- solve. Add sugar, fruit juice and extract, and stir until sugar is dissolved. Set bowl into chopped ice, or ice water, to cool, stirring occasionally; when jelly is quite thick fold in the stifBy-beaten whites of eggs, and put into cold, wet molds. Put on ice to harden. When firm, remove from molds and serve with Soft Custard No. 1. SNOW PUDDING, 222 CALORIES (Individual Rule.) 2 teaspoons granulated gelatin. 1% tablespoons lemon juice. 3 tablespoons cold water. 3 tablespoons sugar. 1/3 cup boiling water. White 1 egg. Make same as preceding. 210 ANIMAL FOODS SPANISH CREAM, 912 CALORIES (Three Servings.) 14 box shredded gelatin or Yolks 3 eggs. 1 tablespoon granulated gelatin. 6 tablespoons sugar. Yt cup cold water. % teaspoon salt. % cup boiling water. Whites 3 eggs. 2 cups milk. 1 teaspoon vanilla. Soften the gelatin in the cold water, add the boiling water and dissolve. Heat the milk in a double-boiler. Beat the yolk of eggs, add sugar and salt, and pour the hot milk gradually onto the mixture. Eeturn to double-boiler and cook until it thickens, stirring constantly. Add the strained gelatin and the flavoring, and fold in carefully the well- beaten whites. Pour into cold, wet molds to harden. Serve with Soft Custard No. 1, or with Whipped Cream. SPANISH CREAH, 303 CALORIES (Individual Rule.) 1 teaspoon granulated gelatin. 2 tablespoons sugar. 1 tablespoon cold water. Speck salt. 3 tablespoons boiling water. White 1 egg. % cup milk. Vi teaspoon vanilla. Yolk 1 egg. Make same as preceding, and serve with Orange Sauce. ORANGE SAUCE, 136 CALORIES (Three Servings.) Beat white of one egg very light, add two tablespoons sugar gradually, beating constantly, then add one and one-half tablespoon orange juice and one teaspoon lemon juice. BAVARIAN CREAM, 205 CALORIES (Individual Rule.) 1 teaspoon gelatin. % tablespoon sugar. 1 tablespoon cold water. % teaspoon vanilla. l^ cup milk. % cup whipped cream. Yolk 1 egg. Soak gelatin in cold water 5 minutes. Heat the milk and pour into the beaten yolk of egg and add this mixture to gela- GELATIN 311 tin ; stir until gelatin is dissolved and flavor. Set in ice water to cool, beating almost constantly. When it begins to stiffen, fold in the whipped cream. Pour into molds. Serve with whipped cream. Note. — Chocolate may be added by omitting flavoring and add chocolate to hot milk and dissolve before adding to the yolk. GRAPE riTJFF, 957 CALORIES (Six Servings.) 1/4 box sliredded gelatin or 1 cup Welch's grape juice. 1 tablespoon granulated gelatin. Juice 1 lemon. % cup cold water. Whites 3 eggs. % cup sugar. Soften the gelatin in cold water and dissolve by standing the dish in hot water. Dissolve the sugar in the fruit juice, and strain the gelatin into it. Set in ice and water, and stir occasionally until the mixture begins to thicken, then add gradually the well-beaten whites of eggs, and beat until the whole is very light and stiff enough to hold its shape. Pile lightly in glass serving-dish, or mold and serve with WTiipped Cream or Soft Custard. ORANGE CHARLOTTE, 350 CALORIES (Individual Rule.) 2 teaspoons gelatin. 3 tablespoons orange juice. 1 tablespoon cold water. 1 tablespoon lemon juice. Yg cup boiling water. Whites 2 eggs. l^ cup sugar. Blend as for Orange Gelatin and set the bowl into chopped ice or ice-water to cool; stir occasionally. When jelly is quite thick, fold in the stiffly-beaten whites of eggs. Mix well and pour into cold, wet molds. Put on ice to harden. When firm, remove by dipping mold quickly in warm water; loosen with knife, allowing air to enter. Serve with Soft Custard No. 1. Note. — Line molds with lady fingers or slices of sponge cake and pour in the- charlotte. 213 ANIMAL FOODS STRAWBERRY MOTJSSf , 2284 CALORIES (Six Servings.) % box shredded gelatin or 1 pint thick cream. 1 tablespoon granulated gelatin. % cup powdered sugar. Vi Clip cold water. 1 cup strawberry juice. Vi cup boiling water. Soften the gelatin in the cold water; add the boiling water and dissolve. Whip the cream until stiff, and add the pow- dered sugar. To the gelatin add the strawberry juice, fold the cream in carefully, turn into a wet mold and pack in salt and ice for two hours. When ready to serve, turn out of mold onto a large glass dish and garnish with fresh straw- berries and whipped cream. THE MASE-IN-A-HIITUTE DESSERT, 395 CALORIES Dissolve one package of Jell-0, any flavor, in a pint of boiling water. Pour into a bowl or mold and put in a cold place to harden. When set turn out on a plate and serve. JELL-0 WITH FRUIT, 395 CALORIES i Dissolve a package of Jell-0, any flavor, in a pint of boil- ing water. Pour into a bowl or mold. Just as Jell-0 is beginning to set, arrange in it, with the aid of a fork, sliced oranges or bananas, or cherries and currants, or peaches and strawberries, or any other fruit that may be preferred for the purpose. Set away to harden. Serve plain or with whipped cream. BEEF PREPARATIONS BEEF JUICE — BEEP TEA — RAW BEEF BEEF JUICE Composition. The juice of meat contains considerable pro- tein, in addition ,to salts and extractives. General Principles in Cooking. Prom raw meat we can- not obtain as much juice as is easily taken from the same amount of meat when previously heated. 1 Calculated without fruit. BEEF PREPARATIONS 213 The reason for this is that the envelope enclosing the muscular tissue is a tough substance, which swells and dis- solves when heated, yielding gelatin, and the liquid portion of the meat is easily expressed. If cooked too long the pro- tein largely coagulates and the meat loses most of its moisture and becomes tough. A steak thoroughly heated through swells, and when cut the liquid portion flows out readily. One pound of meat yields about four ounces of juice. Care in Serving. In administering beef juice great care should be taken in reheating not to heat it above 136 degrees' Fahrenheit, at which temperature albumin coagulates in flakes. Substitutes for Beef Juice. A solution of white of egg flavored with meat extract makes a cheap and efficient sub- stitute for beef juice. Prepared extracts' of good make may be used to advantage with beef juice to add flavor and make it more appetizing. Absorption. Beef juice is absorbed in the rectum to nearly the same extent as complete peptones and is an excellent article of diet where solid foods cannot be given. Comparative Food Value of Beef Juice and Beef Tea. Beef juice, although fourteen times as rich in protein as beef tea, is raw in flavor, and is rejected by many palates. In such a case, add a small quantity of beef tea or prepared beef extract for flavor. Thus by the union of two bodies, one rich in protein and the other rich in flavor, we have a superior food. Prepare a small quantity at a time, as it does not keep well. BEEF TEA Composition. Meat treated with hot water contains only a small percentage of solids and almost no protein except extractive matter and soluble mineral matter. The clear liquid which remains when the coagulated albumin is strained out of beef tea contains only extractive or flavoring sub- stances with the soluble mineral matter of the meat. There- 214 ANIMAL FOODS fore it should not be strained, and if properly prepared the albumin will not be coagulated, to so great an extent. Even in strong beef tea which is carefully made the amount of proteids present has been found to be less than 3 per cent. Nutritive Value. Beef tea is valuable in the sick room not as a food, but as a flavoring; the liquid with the heat of the water acts as a stimulant. Beef Extracts are prepared in both liquid and solid form. They have but slight nutritive value, containing but 4 to 5 per cent, of protein, but are valuable for their flavoring prop- erties. They are used to advantage in combination with beef juice, adding flavoring and making it more palatable and appetizing. RAW BEEF Uncooked Meat. Kaw meat is not quite as easily digested as cooked meat, and owing to color and flavor is not appetiz- ing, and could not be taken continuously. However, when chopped fine, or scraped free from connective tissue, it is very readily digested and can be served disguised or very slightly cooked in many dainty ways. Comparative Food Value of Raw Beef and Beef Tea. It can readily be seen that raw meat served chopped fine or scraped contains all the nutriment of the meat, whereas beef tea as seen from the manner of preparation, contains only the extractives and soluble mineral matter of meat. BEEF JTTICE 100 grams (3% oz.) =25 Calories. Select a piece of meat from the rump or top of the round. Eemove all fat and broil or warm slightly one or two min- utes, to set free the juices; lay on plate and cut meat in various directions that more juice may be extracted; then squeeze out the juice by means of a press, lemon squeezer or potato ricer into a slightly warmed cup. Salt if necessary, and serve at once. Prepare only enough to serve, as it does not keep well. Serve in dainty china cup to disguise color. One pound of meat yields four ounces of juice. BEEF PREPARATIONS 215 BEEF JUICE (FOB INFANTS), 20 CAIOBIES This food is very useful in forms of diarrhcea and dysen- tery. A half pound of chopped lean meat is made into an oval, flat mass, placed on a broiler and slightly browned. The juice is then expressed with a small meat press, mixed with equal parts of barley water and salted to suit the taste. — Koplik. BEEF ESSENCE 100 grams (3% oz.) =23 Calories. Put one-half pound round steak (freed from fat, etc.) through a meat chopper; put into small- glass fruit jar with one tablespoon cold water. Place jar in a kettle of cold water, heat gradually and keep at temperature 150 degrees Pahrenheit (which is 62 degrees below the boiling point of water) for two hours. Strain and press the meat to obtain all the juice. Season with salt. Serve in slightly heated dainty china cup to disguise color. Note. — A small piece of raw beef, broiled slightly, then cut up and added to above, gives a better flavor. Liquid thus obtained should be red with albuminous juice in solution and not coagulated; it is nutritious, and may be kept in refrigerator twelve hours. Serve in small quantity slightly heated; or it may be made into beef tea by diluting with boiling water. Beef essence given ice cold is often grateful to a fever patient. IIQUII) FEFTONOISS, 28 CAIOBIES Add one tablespoonful of Liquid Peptonoids to one-half cup of boiling water; add pinch of salt. Sip slowly. This will be found particularly grateful in painful affections of the throat. Note. — To serve cold, pour one tablespoonful Liquid Pep- tonoids over a small glass of finely cracked ice. Allow it to chill thoroughly and sip slowly. BEEF TEA % pound steak. Salt. 1 cup cold water. 216 ANIMAL FOODS Wipe steak, remove all fat and cut in small pieces. Put in glass fruit jar, add the cold water and let it stand fifteen minutes to draw out the juice. Cover jar, using rubber band and cover, place on trivet in a kettle and surround with cold water. Allow water to heat slowly to 150° F. (no higher), and keep at this temperature two hours. Strain and season with salt. Remove fat with soft paper or bread. Reheat over hot water to 130° F. and serve in heated cups. Note. — If possible cool beef tea before serving that fat may be removed more thoroughly. BEEF TEA FROZEN Beef tea may be frozen to the consistency of a water ice. yery grateful to a fever 'patient. BEEF TEA WITH HYDROCHIOBIC ACID 100 grams (SVi oz.) =25 Calories.i Select one-half pound of good beef ; remove everything that 13 not clear meat. Chop it fine. Put in pint fruit jar and add one cup cold water and five drops dilute hydrochloric acid. Stir and set in refrigerator or any cold place for two hours to digest. Then strain, season with salt and serve in some dainty china cup on account of color. If one should object to color, heat the tea in a double boiler just till color changes. Do not strain. Beef tea made in this way is recommended by physicians for feeble children and patients much weakened by sickness. ICES FANOPEFTON, 30 CALORIES To a small glass half-full of clean crushed ice add one tablespoonful of Panopepton ; let it stand a moment and then sip slowly. FANOFEPTON — HOT, 36 CALORIES To a small teacup -two-thirds full of boiling water, add one tablespoonful of Panopepton, and one teaspoonful of fresh lemon juice — a little sugar, if desired — stir. Drink im- 1 Calculated as beef juice. BROTH AND MEAT JELLIES 317 mediately, sipping slowly. This gives a pleasant sense of warmth when one is chilly, and is excellent in cases where light nourishment is required before retiring. SCRAPES BEEF 100 grams = 142 Calories. Wipe a small piece of steak, cut from top of round. Lay it on a meat board, and with a sharp knife scrape off the soft part until there is nothing left but the tough, stringy fibers. Make it into little flat, round cakes half an inch thick and broil them two minutes. Season with salt and pepper if allowed. Serve on rounds of buttered toast. Do not add salt before cooking, as it toughens the meat. RAW BEEF SANDWICHES 1 ounce scraped beef =40 Calories. 1 ounce bread ( 1 slice) =73 Calories. Prepare meat as for scraped beef, season and spread on bread cut very thin. Put slices on top, sandwich-fashion, and cut in fancy shapes. Serve in this manner or toast daintily. BEOTH AND MEAT JELLIES Broth is a liquid containing the juices of soluble parts of meat and bone, which have been extracted by long, slow cook- ing. This liquid is more or less solid when cold, according to the gelatinous nature of the ingredients. It varies greatly in quantity, according to the manner in which it is prepared and the material used. The cheaper, inferior parts of meat yield more nutriment than the- expensive cuts. Composition. Broth contains almost no protein except ex- tractive matter with soluble mineral matter and gelatin. Objective Point and General Principles in Cooking. The chief object in making broth is to obtain the largest possible amount of nutriment from the meat. This is best accom- plished by observing the f ollowiog rules : 218 ANIMAL FOODS Cut meat into small pieces. Soak in the cold water before heating. Use a careful selection and proportion of meat, bone and water. (The usual proportion is one pint of water to one pound of meat.) Season judiciously. Use steam-tight kettle; simmer (not boil), that the juice may be fully extracted. Make it the day before using, that the fat may be removed more easily. Long, slow cooking. Broth may be made from beef, mutton or chicken. Eice, barley, Dry Peptonoids Soluble, white or whole egg, etc., may be added, if allowed, to increase the quantity of nourishment. Comparative Value of Broth and Beef Tea. Broth differs from beef tea in that it contains gelatin, besides the extrac- tives or flavoring substances and soluble mineral matter that are found in beef tea. Gelatin is obtained from meat and bones by long, slow cooking, and it is useful in convalescence and in febrile states. (Note " Gelatin," p. 203.) Meat Jellies are a condensed form of broth, which forms an agreeable way of serving protein food to an invalid, and are especially valuable in febrile states. Although they do not entirely replace protein in the diet, they produce a consid- erable quantity of energy. (Note " Gelatin," p. 303, for nutritive value.) ENERGY VALUE OF BROTH Very few analyses of broths are available ; hence no attempt has been made to state the calories under each recipe. The following table gives an approximate idea of their energy value : Beef broth 100 grams yield 44 Calories. Beef juice 100 grams yield 25 Calories. Clam bouillon 100 grams yield 2 Calories. Consomme 100 grams yield 12 Calories. BROTH 219 Pood that may be added for extia nutriment 1 whole egg (average) .... 45 grams yield 60 Calories. White of 1 egg (average) . 25 grams yield 13 Calories. Yolk of 1 egg (average) .. 13 grams yield 48 Calories. 1 tablespoon Dry Peptonoids Soluble yield 57 Calories. 1 tablespoon rice 15 grams yield 50 Calories. 1 tablespoon barley 27 grams yield 90 Calories. MUTTON BROTH 2 pounds mutton, cut from fore- Speck pepper. quarters. 2 tablespoons boiled rice or bar- 1 quart cold water. ley. 1 teaspoon salt. Wipe meat, remove skin and fat and cut into small pieces. Put in a kettle with bones that have been well broken, add cold water and let it stand one-half hour to extract the juices. Heat gradually to boiling point, skim, and when partly cooked season with salt and pepper. Simmer four hours, or until meat is tender. Do not allow it to boil. Eemove fat and strain through a coarse sieve. Serve hot. If broth is made the day before it is used, it can be cooled thoroughly and the fat be removed easily. In reheating use double boiler. Two tablespoons of cooked rice or barley may be added if desired. The barley should be soaked over night or several hours before cooking. Taste and season before serving, a tea- spoon of chopped parsley may be added just before serving if desired. Xote. — For weaker broth, use one quart of water to one pound of meat. BEES' BBOTH Prepared same as Mutton Broth. BROTH WITH GRAINS 1 quart hot broth. 1 tablespoon rice or barley. To the hot broth add the well-washed rice. Simmer slowly until the rice is tender, adding more broth if it evaporates. The broth should be strained before using. 220 ANIMAL FOODS CHICKEN BSOTH 31/2 pounds chicken. 1 teaspoon salt. 3 pints cold water. Speck pepper. 2 tablespoons rice. Thoroughly clean a chicken (see " Poultry," p. 153), re- move skin and fat; separate at the joints and wipe with a wet cloth. Put in kettle and add the cold water and let stand one-half hour. Heat very slowly and simmer three hours, or until meat is tender. When half-cooked skim off fat and add the rice and seasonings (and if desired, a small onion). When meat is tender, skim off fat and strain, taste and season properly and serve hot. When possible, make broth the day before using, that it may be thoroughly cooled and the fat removed easily. Eeheat in a double boiler. The rice may be cooked, and rubbed through strainer before add- ing to broth, or it may be omitted if desired. An old fowl, not too fat, is best for broth. VEAL BROTH Prepared same as Chicken Broth (use cut from loin or knuckle of veal). CLAM BKOIH NO. I Take five clams, wash and scrub well and put in saucepan with cold water to cover. Cook until shells open, remove from pan and take out clams. Chop and put them back into broth. Cook fifteen minutes. Strain through muslin; serve hot. If too strong flavor, add hot water. Note. — If made in large quantity, use two or three clams to one cup water. This broth may be frozen to the consistency of a frappe. CLAM BROTH NO. II % cup clam broth. Pepper. 1 cup water or milk. 14 teaspoon butter. Blend the clam broth and water (or milk), and heat to the boiling point. Season with salt to taste, and if allowed, a little pepper and the butter. Serve hot in dainty cups. MEAT JELLIES 221 EOG BROTH If one cannot conveniently get protein from meat, a very nutritious broth may be made by means of hot water into which an egg has been stirred. Heat three tablespoons of water to not above 149 degrees Fahrenheit (below the sim- mering point), and pour it gradually into a raw egg. The liquid is milky if the yolk is used ; clear if only the white is used. It has little taste, which is an advantage with many patients ; or it may be flavored with beef extract. EGO BROTH SO. II 1 cup hot beef broth. % teaspoon salt. 1 egg- Beat the white and yolk of egg separately. To the yolk add gradually the hot broth, stirring continually. Add the salt and fold in the well-beaten white. Eeheat in double boiler, taking care not to coagulate the albumin. Serve very hot. Note. — The white or yolk of egg may be used separately. MEAT JELLIES CAIF'S FOOT JELLY 100 grams = 65 Calories. 1 calf's foot. Rind of V4 lemon (yellow part 1 quart cold water. only ) . 3 cups sherry wine (best Topaz). % cup cut or cube sugar. Juice of one lemon. Clean calf's foot and put into the cold water ; bring slowly to boiling point, and boil five hours ; skim if necessary, while cooking. Strain through cheese-cloth and allow it to stand until firm and remove the fat. Mix lemon juice, wine, the whites and shells of eggs, sugar, and beat all together until the sugar is dissolved, then add to tlie jelly. Place on the fire in an enamel stewpan, and stir constantly until the mixture is very hot, but not boiling; strain through a jelly bag, made of cotton flannel, and allow 222 ANIMAL FOODS the jelly to drip through same slowly, pour into molds or glass jars, and put in cold place to harden. Note. — Several varieties may be made by substituting the different flavors, brandy, rum, port wine, champagne, orange and lemon juice. CHICKEN JELLY 3 pounds cliicken. 8 peppercorns. 1 quart cold water. Salt. Prepare chicken as for chicken broth and cut flesh and ■ bone into small pieces. Put into saucepan with cold water and peppercorns and let stand one-half hour. Bring slowly to the boiling point, remove scum and cook five or six hours or until meat is very tender and water is reduced to one pint, ■while cooking keep it below the boiling point. Skim fre- quently while cooking, strain through double thickness of cheese-cloth, season to taste and let stand until firm. Ee- move fat, reheat and turn into glass fruit jars or individual molds and cool ; put in ice box until jellied. Additional flavor may be added if desired, a stalk of celery or a small piece of bay leaf may be cooked with the chicken. Note. — Mutton Broth Jelly may be treated in the same way. BEEF JELLY 3 pounds solid meat from the 4 quarts cold water. shoulder or shin. 2 teaspoons salt. 3 pounds bone from same. Take off the dried skin and any soft or bloody portion. Cut the meat into small pieces and put it with the cracked bone into an earthen jar. Cover with the cold water. Set in slow oven and cook from eight to twelve hours. Strain through a colander. Add salt to taste; cool quickly. When cold remove the fat. Serve cold as a jelly, or reheat in double boiler. SOUP 22,3 SOUP AND SOUP ACCOMPANIMENTS Soup is a light and suitable form of food for the sick. There are two classes — those made with meat and those without meat. The soups with meat .are an infusion of meat, flavored with salt and some condiment. They are treated in the chapter on broths. The foundations of soups without meat are milk, vegetables and water. They are dainty and nutritious, and an excellent way of serving milk and the starch and mineral matter of the vegetable. They may be served as a luncheon, with crisp crackers, or as the first course of a dinner. Serve daintily in heated bouillon cups, partly filled, on small plate and doily. General Rule for Mending: {a) Prepare vegetables, cook and strain. (&) Prepare cream sauce: Melt butter, add the flour and gradually pour on the scalded milk or water. Cook thor- oughly. (c) Blend (a) and (&). Season, strain and serve imme- diately. In the preparation of these soups great care must be taken that the starch of the vegetable and of the flour used in the thickening is thoroughly cooked. Cooking temperature of starch is 312 degrees Fahrenheit. CKEAU OF ASFARA6TJS SOUP, 313 CALOBIES (Individual Rule.) % bundle asparagus. % tablespoon flour. 1 cup milk. Salt. % tablespoon butter. Pepper. (a) Wash the asparagus and cook in boiling salted water, boiling gently thirty minutes. Take from the water, cut ofc the tips and put them into the serving dish; press the re- mainder through a colander. (6) Scald the milk. Melt the butter, add the flour and 224 ANIMAL FOODS pour on gradually the scalding milk. Cook thoroughly, stir- ring often. Blend (a) and (&) ; reheat, season to taste, strain over tips and serve at once with crisped wafer crackers. Note. — For individual quantity use one-half recipe. ASPARAGTTS SOUP (FOR THE DIABETIC), 30 CAIORIES One-half pint of veal stock or water, boiled with five or six stalks of asparagus. Eeserve tips; mash and strain. Melt together one-half teaspoonful of butter with one-half teaspoon- f ul of Gum Gluten Flour. Add stock and asparagus tips, and serve at once. CREAU OF CORN SOUP, 493 CALORIES (Two Servings.) % eup corn. 1 cup milk. % cup cold water. 1 tablespoon flour. 14 slice onion. 1 tablespoon butter. Salt. Yolk 1 egg. Pepper. (a) Chop corn, add water and simmer tvrenty minutes; rub through a sieve. (6) Scald milk with onion; remove onion. Melt butter, add flour and gradually pour on milk. Blend (a) and (6) ; cook thoroughly, season to taste with salt and pepper and pour onto the beaten yolk. When well blended, serve hot. Note. — The yolk of egg may be omitted. CREAH OF CELERT SOTTP, 320 CAIORIES (Two Servings.) 4 stalks celery. 1 tablespoon butter. 14 cup boiling water. 1 tablespoon flour. Salt. 1 cup rich milk. Pepper. (a) Wash and scrape the celery and cut into small pieces, add the water and cook until very tend^er and soft. Eenew the water if it boils away. Mash the celery in the water in which it was cooked. SOUP 325 (6) Scald milk. Melt the butter in a saucepan, add flour and pour on gradually the scalded milk. Cook thoroughly, stirring carefully. Blend (a) and (6) ; season to taste; strain and serve im- mediately with croutons or crisped crackers. CREAM OF CELERY SOTTP (FOR THE DIABETIC), 226 CALORIES (Three Servings.) 6 stalks celery. Speck cayenne pepper, salt. 1 slice onion. % teaspoon butter. 1 cup water. % teaspoon Gum Gluten Flour. 1 cup hot milk. Boil, mash and strain the first three ingredients, add the hot milk or cream. Melt the butter, add the flour and pour on gradually the hot soup stock ; season and cook thoroughly. CREAM OF PEA SOTJF, 215 CALORIES (Individual Rule.) 14 can peas. 14 cup milk. Y2 teaspoon sugar. % tablespoon butter. 14 cup cold vifater. % tablespoon flour. Salt and pepper. (a) Drain peas from their liquor, rinse thoroughly, add sugar and cold water and simmer twenty minutes. Eub through a sieve; reheat. (6) Scald milk. Melt butter, add flour and pour on grad- ually the scalding milk. Cook thoroughly, stirring carefully. Note. — Peas that are too old to serve as a vegetable may be used for soup. One-half slice onion may be cooked in the milk. CREAM 07 ONION SOUP, 297 CALORIES (Individual Rule.) 1 onion; % tablespoon butter 1 cup milk. % tablespoon flour. Cut onion in small pieces and scald in milk. Melt butter, add flour and add gradually the milk mixture. Season with salt and pepper and strain. 226 ANIMAL FOODS ONION SOUP (FOR THE DIABETIC), 30 CALORIES One Bermuda or three green onions boiled until tender in stock or water ; mash and strain. Add one-half teaspoon Gum Gluten Flour, one-half teaspoonful butter and a little chopped parsley. One tablespoon of cream, if desired. CREAU 07 FOIATO S0TT7, 220 CALORIES (Individual Eule.) % cup milk. Vi tablespoon flour l^ slice onion. % teaspoon salt. % cup mashed potatoes. Pepper. y^ tablespoon butter. (a) Scald milk with onion in it, remove onion and add milk slowly to potatoes. (6) Melt butter, add flour and pour on gradually the hot mixture. Cook thoroughly and season to taste. A little celery salt may be added if desired. A little finely-chopped parsley may be sprinkled over top of soup. CREAU OF RICE SOTTF, 302 CALORIES (Individual Rule.) 1 tablespoon rice. Stalk celery. 1 cup milk. % bay leaf. % tablespoon butter. Salt. % small onion. Pepper. Scald the milk, add the well-washed rice and cook in double boiler thirty minutes, covered closely. Melt butter in saut6 pan, add the sliced onion and cook till tender, but not brown. Add celery sliced, and turn into scalded milk; add the bay leaf, cover and let stand on back of stove fifteen minutes. Strain, season with salt and pepper, reheat and serve. Note. — If soup is too thick, add a little heated milk. TOMATO SOTTF (WIlTH BROTH), 110 CALORIES (Individual Eule.) % cup strained tomatoes. 1 cup water or stock. % tablespoon butter. % teaspoon salt. % slice onion. Speck pepper. 1 tablespoon flour. SOUP 327 (a) Cook and strain tomatoes, obtaining one-lialf cup juice. (b) Melt butter, add the onion and brown slightly; add the flour ; pour on gradually the boiling water or stock. Blend (a) and (6) ; cook thoroughly, season with salt and pepper, strain and serve. Note. — Two tablespoons of cream may be added. Beef or mutton broth strained may be used in place of water if desired. CREAM OP TOMATO SOTTP (FOB, THE DIABETIC), 224 CALORIES (Two Servings.) % cup tomatoes. % teaspoon butter. 1 slice onion. % teaspoon Gum Gluten Flour. 1 cup milk. Salt, pepper. Stew and strain the tomatoes and onion, reheat and add a tiny pinch of soda. When effervescing subsides add milk. Melt the butter, add the flour and pour in gradually the hot stock. Season and cook thoroughly. MOCK BISQUE SOtJF, 324 CALORIES (Individual Rule.) % cup tomatoes. 1 tablespoon butter. % saltspoon soda. % tablespoons flour or corn- Salt and pepper. starch. 1 cup milk. (a) Steam tomatoes until soft enough to strain juice; strain, add soda and allow gases to pass off. This prevents the acid of the tomato curdling the milk. (&) Scald milk; melt butter in quart size saucepan, add the flour and pour on gradually the scalding milk. Cook thor- oughly, stirring carefully. Blend (a) and (&) ; reheat, season to taste, strain and serve immediately with croiitons or crackers. DRIES FBXTIT SOUP, 209 CALORIES i 14 cup dried apricots. 1 cup cold water. ii cup prunes. Sugar to taste. 1 Without sugar. 228 ANIMAL FOODS Pick over and wash fruit until perfectly clean. Cook in the water until very soft. Strain and squeeze out all the juice; sweeten to taste. Thicken if liked. Thickening. — 1 slightly rounding teaspoon rice flour to 1 cup liquid. CoOk twenty minutes to remove raw taste of starch. PANOPEPTON BOUILLON — HOT, 30 CALORIES Put one tablespoonful of Panopepton into a small teacup; fill the cup nearly full of boiling water, and flavor to taste with celery salt, or plain salt and pepper ; stir, and sip slowly.. This is a very nourishing and pleasantly stimulating drink. VICTORIA SOUP (WITH BROTH), 619 CALORIES (Two Servings.) % cup lean chicken meat. 1 cup rich milk. 1 cup strong chicken broth. % cup cracker crumbs. % teaspoon salt. Yolks 2 eggs. Pepper. Soak the crumbs in a little of the milk. Cook yolks of eggs in hot water until hard. Chop the chicken, mix with the soaked cracker crumbs, press the hard-cooked yolks through a coarse strainer, add the seasonings and the broth and cook all together five minutes over direct heat or one-half hour in double boiler. Serve hot. CONSOUME Make a beef or any broth according to the strength re- quired. While cooking skim frequently, and when reduced to one-third of its quantity take from saucepan and strain; season well, cool quickly and remove fat. Eeturn to sauce- pan, add a few thin slices of onion and one-half pound of lean beef chopped fine and dear. To Clear Soup. To each quart of stock add the slightly beaten white and broken shell of one egg and a few shavings of lemon rind. Place on front of range, and stir constantly until boiling point is reached; boil two minutes. Set back where it may simmer twenty minutes ; remove scum and strain through double thickness of cheese-cloth. SOUP ACCOMPANIMENTS 229 N"ote. — To increase the nutrient value and improve flavor. Dry Peptonoids Soluble may be added to any stock. Its com- plete solubility and concentration have caused it to be recom- mended most highly for this purpose. OYSTER SOUP See chapter " Oysters " for recipe. Pages 171-173. OYSTEK STEW See " Oysters " for recipe. Page 172. CIAM SOUP See chapter " Clams " for recipe. Page 174. CLAM BOUILLON See chapter " Clams " for recipe. Page 174. CLAM BOUILLON BISQUE See chapter " Clams " for recipe. Page 175. MEAT SOUPS Foundation for same, see chapter " Broths." Page 219. SOUP ACCOMPANIMENTS GLUTEN BISCUIT CRISPS 1^25 Calories. Serve plain or butter slightly and bake until heated through. CRISPED CRACKERS 1 Sal tine =; 15 Calories. Split common crackers or use saltines. Put in pan and bake until thoroughly heated. Serve plain or buttered slightly. TOASTED CRACKERS Butter crackers, put in pan and bake until a delicate brown. Serve on small plate with doily. 230 ANIMAL FOODS CROUTONS 1 ounce (1 slice) bread = 73 Calories. Take a slice of stale bread about half an inch thick, cut into half -inch cubes ; put them in a shallow pan and dry thor- oughly, then brown delicately. Stir often to brown evenly. Serve on small plate with doily. A little butter may be spread on the bread if desired. EDUCATOR CRACKERS Serve plain or butter slightly and bake until well heated. NOODLES POR SOTJF (FOR THE SIASETIC), 596 CALORIES . 1 egg. 5 ounces Gum Gluten Flour. 1 tablespoon milk. Beat the egg very light, add the milk and Gum Gluten. Eoll very thin and cut in straws. Cook in any soup. GLUTEN CRISP (FOR THE DIABETIC) See chapter " Toast " for recipe. Page 256 CHAPTER X VEGETABLE OR PLANT FOODS The important food products derived from the vegetable kingdom are the Cereals, Legumes — Eoots and Tubers — Green Vegetables — Fruits — Nuts — Fungi — Lichens. Composition. Vegetable or plant foods contain the five proximate principles, namely, proteins, fats, carbohydrates, water and mineral matter. In this they resemble animal foods. The food principles in the two classes are,, however, in different proportions, animal foods being rich in proteins or fats, and seldom containing carbohydrate in appreciable amounts; while vegetable foods are, as a rule, rich in carbo- hydrates, and poor in, proteins and fats. These differences are clearly shown in the following table: Pro. Fat. Carb. % % % Lean round of beef. Free from all vis- ible fat 23.2 2.5 L«an round of beef. Very fat 16.1 23.1 .... Wheat flour (entire wheat) 13.8 1.9 71.9 Potatoes 1.8 0.1 14.7 Apples 1.6 2.2 66.1 The legumes and most nuts are exceptional in containing high percentages of protein or fat or both, but unlike meats, they also contain a very considerable amount of carbohydrate, as shown by the following analyses : Pro. Fat. Carb. % % % Beans, dried 22.5 1.8 59.6 Peas 24.6 1.0 62.0 Almonds 21.0 54.9 17.3 Walnuts 16.6 63.4 16.1 331 233 VEGETABLE OR PLANT FOODS Protein.^ (1) Gluten of wheat and some of the other cereals. (3) Legumin found in legumes. (3) Vegetable albumin as found in some vegetables. Carbohydrates of Vegetables ^ include — starch, sugar, veg- etable gums and cellulose. Fats of Vegetables '" are in the form of oils and are similar in composition to animal fats, but are more easily digested and equal in nutritive value. Water. Dry vegetable foods, such as cereals, dried beans and peas, nuts, dried fruits, etc., do not, as a rule, contain as much water as animal foods, but fresh vegetables and fruits contain frequently from 90 per cent, to 95 per cent, of water. This gives them a low nutritive value compared with their bulk. In cooking, water is added to most dry vegetable foods, so that when served they resemble fresh or succulent vegetable foods in this respect. 'Mineral Matter.* All vegetable foods contain valuable ash constituents. In cereals, these are largely in the outer part of the grain, and are lost if the entire grain is not utilized. Thus polished rice is much poorer in ash constituents than nnpolished; and white flour than entire wheat flour. Fresh vegetables and fruits are desirable in the dietary for their salts and organic acids. Digestibility. Vegetable foods are less easily digested than animal foods, owing to their complex composition, and espe- cially to the intimate mixture of the nutrients with cellulose. This prevents the digestive fermtats acting readily upon the food-stuffs so that they are digested more slowly and less com- pletely than animal foods. Although cellulose is indigestible, its presence under normal conditions in proper amounts, is advantageous,^ but it should be thoroughly softened by cook- ing, except in the case of tender young vegetables such as lettuce. ^ Protein, see p. 10. ^ Carbohydrates, see p. 16. 3 Fats of vegetables, see p. 20. ^Mineral matter, see p. 31. ' See p. 17. CEREALS 333 Comparative Value of Animal and Vegetable Diets. An animal diet is concentrated and easily digested. If the ani- mal foods taken are eggs and milk, no serious objection can be urged against them, except that they lack bulk. The food is so fully absorbed that the large intestine has no stimulus to action and no material for its muscles to act upon, and serious complications are likely to arise from constipation. If the animal food is largely meat, it is undesirable, not only for the reason above mentioned, but because excessive quan- tities of nitrogenous extractives are taken, which are likely to cause uric acid disorders and other disturbances, and also because important mineral salts are lacking (such as calcium, ■which carnivorous animals get by eating hone) ; and because the acids formed from the protein (phosphoric and sulphuric) tend to deprive the body of salts already present in the tissues. A strict vegetable diet, on the other hand, while free from these objections, is necessarily very bulky, owing to the high percentages of water and cellulose, and to the fact that extra allowance must be made because it is less perfectly absorbed. Unless special care is taken, a vegetable diet is also likely to be low in protein. Legumes and nuts must form a consid- erable part of the dietary to provide this. When eggs, milk and milk products are added to the vegetable foods, the diet becomes mixed, and these objections no longer hold. An Ideal Diet contains a mixture of animal and vegetable foods, so that protein, fat, carbohydrate and mineral matter are supplied in proper proportions and in available forms, and sufficient bulk is afforded for proper intestinal action. CEREALS GEUEi:S — BREAKFAST FOODS — STARCHY JEIIIES — MACA- RONI Wherever it is possible to grow grains, they are staples of man's diet. No food products of the vegetable kingdom equal them in importance. They are cheaply and easily grown, and contain all the food principles in unusually good proportion. 334 VEGETABLE OB PLANT FOODS They can be kept for long periods, are not difficult to cook, and furnish a palatable and digestible article of diet. Cereals alone supply nearly one-fourth of the total food in a large number of the American families. Wheat, corn, rye, oats, barley, rice and buckwheat are in commonest use. The natural grain is surrounded by an indigestible husk ■which is always removed. Grains simply hulled or husked, and- slightly crushed are called groats or grits ; more finely crushed, they constitute meal ; ground to a powder and sifted they form flour. Composition. Cereals contain all the food principles, with considerable cellulose, especially in the outer skin, which forms bran in milling. They are comparatively dry materials, hav- ing an average water content of about 10 per cent. The pro- tein content is fairly high, averaging 12 per cent.-13 per cent.^ The fat is never large in amount, and varies within wide limits, being greatest in corn and oats and their products, and lowest in rice. The nutrients in largest proportion are the carbohydrates, which frequently constitute 75 per cent, of the whole. The ash content is as large as in most common food materials, and some of the grains, as oats and wheat, are especially valuable for their soluble phosphates of calcium, potassium, magne- sium, etc. The chemical composition of some of the most common cereals is shown in the following table : Carbohydrates Water Protein Fat Starch, etc. Crude Fiber Ash Per Cent. Per Cent. Per Cent. Per Cent. Per Cent. Per Cent. Barley 10.9 12.4 1.8 69.8 2.7 2.4 Corn (maize) ... 9.3 9.9 2.8 74.9 1.4 1.5 Cats 11.0 11.8 5.0 59.7 9.5 3.0 Eice 12.4 7.4 0.4 79.2 0.2 0.4 Wheat (spring) ..10.4 12.5 2.2 71.2 1.8 1.9 It will be seen that corn is relatively rich in fat; oats in both protein and fat; rye and wheat in protein with a mod- erate amount of fat; rice is notably free from crude fiber and fat, and also very low in ash. 'For further information, see "Cereal Breakfast Foods," Farmer's Bulle- tin No. 249, Agricultural Dept., Washington, D. C. CEREALS 235 Cereal Breakfast Foods are very similar in composition to the grains from which they are made. Macaroni is much like wheat breakfast foods in composition and food value. Principles in Cooking. Cooking improves cereals in many ways. Por the average person, proper cooking has almost as much to do with the nutriment finally obtained as the pro- portions of nutrients originally present. Flavor and appear- ance are improved, with the gain in digestibility that comes from appetizing foods which stimulate the flow of digestive juices. Cooking to convert nutrients into more digestible forms, is very important in the case of cereals which contain so much starch; and since the starch in these foods is sur- rounded by cell-walls of crude fiber (largely cellulose) upon which the digestive juices are unable to act, these walls must be broken down. Part of this disintegration may be accom- plished in milling, and part by thorough mastication but com- plete digestion of the starch is assured only by thorough cooking. Parching is one of the simplest methods of cooking grains. The invisible moisture in the cells is expanded by the heat, and the cell walls burst. Some of the starch is also made soluble or changed to dextrin by this process. The digestibil- ity of protein seems to be lessened by cooking at high tem- peratures, but the starch can be made almost perfectly di- gestible. The softening of cellulose is more perfectly accomplished by cooking for a long time in the presence of a large amount of moisture, as in steaming, or cooking with water or milk in a double boiler. The. glutinous material which surrounds the starch grains and prevents their digestion is disintegrated so thart the digestive juices can act. In general, the more crude fiber a cereal contains, the longer it should be cooked. Eeference to the table (p. 234) shows that oats requires more cooking than rice; whole or partially crushed grains than fiLnely ground ones. There is danger in undercooked cereals, not only of loss of valuable nutriment through failure 236 VEGETABLE OB PLANT FOODS of digestion, but in irritation of the alimentary tract. This should be especially remembered in preparing partially cooked breakfast foods. When cereals are cooked in water some of it is absorbed, and soluble substances in the food pass into the remaining water. If this is thrown away, as when rice is boiled in a large quantity of water and subsequently drained dry, a con- siderable part of the nutriment is lost. Kice water frequently contains enough dissolved starch to form a jelly on cooling. For this reason steaming is a preferable method. Practical application of the fact that certain nutrients in cereals are soluble is made in the preparation of all kinds of cereal waters and starchy jellies. (See Eecipes, pp. 12i-244.) Gruels are thin porridges made from flour or other finely ground grain products, with either water or milk. They are cooked for a long time to insure the starch being changed to soluble starch, or even partially dextrinized. Time for cook- ing should therefore be conscientiously kept by the clock. By passing the material through a cheese-cloth or sieve, the coarser, undissolved portions are removed, and the smooth product does not irritate weakened digestive organs; hence this method is desirable for invalids and young children. In cooking all cereal products, the following points should be observed: Use a double boiler. Observe carefully the correct proportions of cereal, water and salt. Cook at boiling temperature (312° P.). Watch the time by the clock, and always cook the full time prescribed, preferably longer. Serve attractively. Improper cooking and poor serving are largely responsible for unpopularity of cereal foods. Digestibility. The digestibility of cereals is greatly in- fluenced by the mode of preparation and the thoroughness of insalivation. Por the normal healthy person cereal foods are Tery wholesome. In general, about 90 per cent, or more of CEREALS 337 the organic matter is assimilated. The carbohydrates are most completely digested ; the protein shows a wide variation, but is less perfectly assimilated than the other nutrients, owing partly to the fact that it is often hardened in cooking and partly that it is intimately bound up with cellulose in the bran coats. For this reason white flour shows a higher degree of digestibility for protein, than do whole wheat prepa- rations. Among cereal breakfast foods, rolled wheat ranks first in digestibility, rolled oats next, and corn preperations among the lowest. The partially digested or ready-to-eat cereals supply more digestible material than the plain grains when well cooked. Nutritive Value. Cereals supply actual digestible nutri- ments to the body more cheaply than any other class of foods except the dried legumes. All animal foods, especially meats, are more expensive, even as sources of protein, than cereals. A glance at their composition shows that they are chiefly fuel- foods, because of their high carbohydrate content. Their cost varies with the cost of labor and fuel in preparing the food. The comparatively expensive ready-to-eat breakfast foods do not yield any extra nutritive value. Their only ad- vantages are pleasant flavor and ease of serving. Cereal products yield on the average between 1600 and 1700 calories per pound. Thus: 1 lb. flour furnishes 1665 calories. 1 lb. entire wheat flour furnishes 1675 calories. 1 lb. corn meal furnishes 1655 calories. 1 lb. cornstarch furnishes 1675 calories. 1 lb. wheatlet furnishes 1685 calories. 1 lb. hominy furnishes 1650 calories. 1 lb. granulated corn meal furnishes 1665 calories. 1 lb. wheat germ furnishes 1695 calories. 1 lb. tapioca furnishes 1650 calories. Care of Cereals. Cereals must be kept in a cool, dry place ; warmth will favor the development of the maggot eggs; and moisture, when absorbed, makes them musty. 238 VEGETABLE OR PLANT FOODS GRUELS ABROWROOT OSTTEL, 205 CALOBIES i (Individual Rule.) 2 teaspoons arrowroot. 1 cup boiling water or milk. 2 tablespoons cold water. Salt. Sugar, lemon juice, wine or brandy as required. Blend the arrowroot and cold water to a smooth paste. Add to the boiling water or milk. Cook in double boiler two hours. Add salt. Strain and serve hot. Arrowroot is the purest form of starch, and beneficial in case of diarrhoea if not given too hot. BARLEY GRUEL, 248 CALOBIES (Individual Rule.) 1 tablespoon barley flour. 1 cup scalded milk. 2 tablespoons cold milk. Salt. Blend the barley flour with the cold milk and stir into the scalding milk. Cook in double boiler twenty minutes. Season with salt to taste, and add sugar if desired. Strain. BABLEY GBUEL OB JELLY, 142 CALOBIES i (Individual Rule.) 1 tablespoon barley flour. % cup milk (if desired). 2 tablespoons cold water. Salt. 1 cup boiling water. Blend carefully the barley flour and the cold water; add gradually to the boiling water and cook twenty minutes. Add milk and salt to taste, reheat to boiling point, strain and serve or bottle for keeping. Note. — For jelly omit the milk and strain. BICE OR OAT GBUEL Eice or oat gruel may be made in same way as Barley Gruel No. I or II, using the prepared flour for the purpose. BABLEY GBUEL (WITH BBOTE), 308 CALOBIES (Two Servings.) 2 cups beef broth. 2 tablespoons cold water. 2 tablespoons barley flour. 1 saltspoon salt. ^Calculated with milk. GBUELS 339 Mix barley flour and salt with the cold water to form a smooth paste. Add gradually to the boiling stock and boil one-half hour. Strain and serve very hot. CRACKER GRUEL, 243 CALORIES (Individual Rule.) 2 tablespoons sifted cracker 1 cup scalded milk. crumbs. ^ teaspoon salt. Pour hot milk gradually onto cracker crumbs, stirring con- stantly. Cook in double boiler five minutes or two minutes over direct heat. Note. — Before preparing crumbs, crackers may be baked in a slow oven until a delicate brown; or graham crackers may be used. A convenient way to prepare the crumbs is to put them several times through a meat chopper and then sift. TLOUR GRUEL OR THICKENED MILK, 212 CALORIES (Individual Rule.) % cup scalded milk. Speck salt. 14 cup cold milk. 1 dozen raisins. % tablespoon flour. Scald the milk. Mix the flour with the cold milk to make a smooth mixture, and stir into the scalding milk. Cook in a double boiler one-half hour or on back of stove in a sauce- pan. Stone and quarter the raisins, then add water enough to cover; cook slowly until water has all boiled away. Add to gruel just before serving. Add salt. Strain and serve, or it may be eaten with the raisins in it. Note. — This gruel may be made without the raisins. Never use raisins in bowel troubles. FARINA GRUEL, 102 CALORIES (Individual Rule.) 14 tablespoon farina. Va cup scalded milk. 34 cup cold water. Salt. y^ cup boiling water. 340 VEGETABLE OB PLANT FOODS Mix the farina ■with the cold water, add to the boiling water and boil thirty minutes. Add the scalding milk. Taste and season properly. A little sugar may be added if desired, or an egg may be beaten and the gruel poured into it. GIUTEN GRTJEL OR PORRIDGE (FOR THE DIABETIC), 185 CAL- ORIES 1 (Individual Rule.) Yg tablespoon Gum Gluten Four. 1 cup hot water or milk. 1 tablespoon cold water. Salt. Add cold water slowly to Gluten Flour to form a thin paste, then add gradually to boiling water, while stirring con- stantly; cook fifteen minutes. Season with salt. Is an ex- cellent food for the sick ; for baby food it may be sweetened. INDIAN MEAL GRTJEL, 48 CALORIES 2 1 tablespoon Indian meal. 2 tablespoons cold water. % tablespoon flour. 2 cups boiling water. 14 teaspoon salt. Milk or cream. Blend the meal, flour and salt with the cold water to make a smooth paste, and stir into the boiling water. Boil gently one hour and a half. Dilute with hot water, milk or cream. Strain. OATUEAL GRVEL NO. I, 70 CALORIES.2 % cup coarse oatmeal. 1% cup boiling water. Yg teaspoon salt. Milk or cream. Add oatmeal and salt to the boiling water, and cook four to five hours in a double boiler, adding more water if necessary. Strain and dilute with hot milk to make it of the right con- sistency. Eeheat and serve. Note. — Sugar, and a little port wine may be added if al- lowed and desired. ' Calculated vrith. milk. 'Without milk or cream. GRUELS 241 OATKEAL GRUEL, NO. II, 70 CALOEIES i % cup rolled oats. ' 14 teaspoon salt. 1% cup boiling water. Milk or cream. Mix the oats, water and salt in top of double boiler. Cook over direct heat five minutes and then over hot water one hour. Strain, bring to the boiling point and add milk or cream as desired. OATSCEAI. GRTTEI NO. Ill, 140 CALORIES 1 14 cup coarse oatmeal. Salt. 2 cups water. Milk. Pound the oatmeal in a mortar until it is mealy, then put it into a tumbler and fill it with cold water. Stir, and pour off the mealy water into a saucepan. Pill tumbler again, stir and pour off, and repeat until the above quantity of water is exhausted. Boil the oatmeal water thirty minutes, stirring frequently. Season with salt to taste. Thin with milk or cream to desired consistency. EGa AND SHERRY GRUEL, 388 CALORIES (Individual Rule.) 1 egg. 1 tablespoon sugar. 1 wineglass sherry. ' Grating of nutmeg. 1 teaspoon lemon juice. 1 cup smooth, hot gruel. Beat the egg; add wine, lemon, nutmeg and pour on the hot gruel. CAUDLE, 404 CALORIES 2 y^ cup Scotch oatmeal. Juice % lemon. 2 quarts water. Sugar, cinnamon, brandy, or Salt to taste. wine. % cup raisins. Boil oatmeal, water and salt four or five hours. Strain; if too thick add a little hot water and whip it with a wooden spoon. Eemove seeds from raisins, cook a short time in hot water, and add raisins and water to above. Add lemon juice, and sugar, cinnamon, brandy or wine to taste. 1 Without milk or cream. ' Witliottt sugar or liquor. 242 VEGETABLE OR PLANT FOODS JIOTJR BAIL OR BOILED OB, BROWNED FIOTTR GRUEL (FOR TEETHIKG CHILDREN) Tie one cup of wheat flour in a thick cloth, and boil it in one quart of water for three hours ; remove the cloth and ex- pose the flour to the air, or heat until it is hard. Grate from it when wanted. Put one tablespoonful into half a pint of new milk, and stir over the fire until it comes to a boil; add a pinch of salt and a tablespoon of cold water, and serve. This gruel is excellent for children afilicted with summer com- plaint. Or brown a tablespoon of flour in the oven, or on top of the stove in a baking tin ; feed a few pinches at a time to a child, and it will often check diarrhoea. BREAKFAST FOODS Fruits served with breakfast foods make them more ap- petizing. Follow directions on package for preparing patent or pre- pared cereals, allowing double the given time for cooking. HASTY PUDDING OR CORNMEAL MUSH, 182 CALORIES i (Individual Rule.) % Clip cornmeal. ^ cup cold milk or water. % tablespoon flour. % cup boiling water. % teaspoon salt. Mix the meal, flour and salt with the cold milk or water ; when smooth, stir into the boiling water. Cook in a double boiler one hour or more; or over direct heat one-half hour. Serve with cream and sugar, turn into tins to cool if wanted for sauteing. Cut into slices, dip in flour and saute in drip- pings or butter. GLUTEN BREAKFAST FOOD (FOR THE DIABETIC), 665 CAL- ORIES (Two Servings.) Yg cup Gum Gluten Breakfast 2 cups cold water. Food. Salt. Would suggest partly cooking the Breakfast Food the day ^ Calculated with milk. BREAKFAST FOODS 343 before using, as a long cooking improves the quality. Put the food in the water and cook over direct heat for fifteen minutes, then put in double boiler and cook for about one hour, adding salt to taste when nearly done. It is then neces- sary to cook it but twenty minutes in the morning. Serve with cream. HOUINY HUSH, 200 CALORIES (Individual Rule.) ^ cup fine hominy. 1% cups boiling water. Yi teaspoon salt. Put all together in a double boiler and cook two hours. Add more water if mush seems stiff and thick; all prepara- tions iDf corn absorb a great deal of water in cooking, and hominy usually needs a little more than four times its bulk. "Note. — Hominy is exceedingly indigestible unless well cooked, but sweet and nutritious when subjected to a high temperature for a long time. OATUEAI MirSH FOR CHILDREN AND INVALIDS, 880 CALORIES (Four Servings.) 1 cup granulated oatmeal. 1 scant quart boiling water. 1 teaspoon salt. Put the oatmeal and salt in a double boiler, pour on the boiling water and cook three or four hours. Eemove the cover just before serving, and stir with a fork to let the steam escape. If the water in the lower boiler be strongly salted, the oatmeal will cook more quickly. Serve with sugar or salt and cream or milk. Note. — Baked sour apples, apple sauce and apple jelly are delicious eaten with oatmeal. They should be served with the mush, and sugar and cream poured over the whole. They give the acid flavor which so many crave in the morning. Coarse oatmeal is not advisable in any form of water brash, acidity or bowel irritations. It often causes eruptions on the skin in warm weather. BOILED BICE See " Kice Puddings " for recipe. Page 297. 244 VEGETABLE OR PLANT FOODS STEAMED BICE See " Eice Puddings " for recipe. Page 398. STAECHY JELLIES BARLEY JEILY, 270 CALORIES (Three Servings.) 3 tablespoons pearl barley. % saltspoon salt. 1 quart cold water. Soak barley over night, drain and add the quart of fresh "water; add salt; and cook in double boiler steadily for four liours down to one pint, adding water from time to time; strain through muslin. When cold this makes a thick jelly. Two tablespoons dissolved in eight ounces of warmed and sweetened milk may be given at single feeding for infants. Note. — Oatmeal wheaten grits and rice grains may be used in same way. Jelly made with Barley Plour, see Barley Gruel, p. 338. RICE TELLY, 181 CALORIES (Three Servings.) 1% tablespoons rice % cup milk. 1 cup cold water. 1 white of egg. Speck salt. Wash the rice and soak In cold water two hours, drain off the water and add the milk, cook in double boiler one and one- lialf hours. Strain through a fine sieve. Pour into molds, chill and serve with fruit juice or cream and sugar. TAPIOCA JELLY, 200 CALORIES (Three Servings.) 4 tablespoons pearl tapioca. % cup boiling water. 1 cup cold water. Speck salt. Soak tapioca in cold water three hours; add boiling -water and salt; cook in double boiler two and one-fourth hours. Serve hot, plain with cream, wine and powdered sugar, or flavor while hot with lemon juice, and chill. CORNSTARCH JELLIES See " Cornstarch Pudding " for recipe. Page 395. MACARONI 345 MACARONI BOIIED MACAEONI, 98 CALORIES i (Individual Rule.) 14 cup macaroni. 1 teaspoon salt. 3 cups boiling water. Cream or milk. Break macaroni into one-inch pieces, put into a strainer and rinse with cold water. Cook in boiling salted water twenty minutes, or until tender. Strain, pour a little cold water over it to prevent pieces from adhering; add cream, reheat and season with salt; or serve with White or Tomato Sauce and grated cheese. WHITE SATJCE, 152 CALORIES (Individual Rule.) % cup milk. % tablespoon flour. % tablespoon butter. 14 teaspoon salt. Scald the milk. Melt the butter, remove from stove and add the flour and mix thoroughly, then pour on gradually the hot milk, stirring constantly while blending. Cook thor- oughly until there is no raw taste of starch and season with, salt. TOMATO SATJCE, 93 CALORIES (Individual Rule.) 1/3 cup strained tomato juice. % tablespoon flour. % tablespoon butter. Salt and pepper to taste. Scald the tomatoes. Melt the butter and remove from, stove, add the flour and mix thoroughly, then pour on grad- ually the hot tomato, stirring constantly while blending ; cook thoroughly until there is no raw taste of starch and season, with salt and pepper. BAKED MACARONI 1 tablespoon grated fresh, cheese =: 62 Calories. Fill a buttered baking-dish with alternate layers of maca- roni. White Sauce and cheese; then cover with buttered ^ Without milk or cream. 246 VEGETABLE OB PLANT FOODS cracker crumbs and bake until crumbs are a golden brown. Tomato Sauce may be substituted for White Sauce if desired. BTTTTEKEI) CRACKER CRUMBS, 201 CALORIES 1 tablespoon butter. >/4 cup cracker crumbs. Melt butter and add cracker crumbs that have been rolled jine. To be used for the top of any scalloped dish. Cracker crumbs or bread crumbs may be used and bits of butter dotted over top. KOOSIES (FOR THE DIABETIC), 596 CAIORIES (Individual Rule.) 1 egg, well beaten. 5 ounces Gum Gluten Flour. 1 tablespoon milk. Beat egg, add milk and gradually add the Gluten Flour. Eoll out and cut in thin strips. Serve with any soup. BOILED NOODLES (FOR THE DIABETIC) Put the noodles into cold, salted water ; cook at least forty- ^ive minutes after it comes to boil, or boil until it is tender. Season with pepper and butter. Serve with White Sauce. CREAK OR WHITE SAUCE (FOR THE DIABETIC), 130 CALORIES (Individual Rule.) %-cup milk. ' 1 teaspoon Gum Gluten Flour. 1 teaspoon butter. Melt the butter without browning it, add the flour, then pour in the scalded milk gradually, stirring all the time. Cook five minutes. Season with salt and red pepper to taste. Plavor with onion, lemon juice or parsley if desired. Pour over vegetables very hot. NOODLES AU GRATIN (FOR THE DIABETIC) 1 tablespoon grated fresh cheese = 62 Calories. Boil the noodles as above. Place them in a baking-dish in alternate layers with grated cheese, having cheese form the top layer; season with pepper and butter. Pour over the mixture the water in which the noodles were cooked; or, if preferred, cream or stewed tomatoes may be used to moisten. BREAD 34r BREAD From the most remote times, bread has been an important part of the diet of mankind. It is to-day probably more gen- erally and extensively used than any other one food-stufE, with the possible exception of milk. It is therefore extremely important to know what constitutes good bread and what are its nutritive properties. Composition. The ingredients of bread are very simple — flour, water, yeast and salt. Any cereal, cleaned, crushed and sifted to a powder, may serve as the flour, but wheat flour makes the most satisfactory bread, because its proteins in the form of gluten have more elasticity than those of other cereals. " Bread contains from 34 to 40 per cent, of water, and the remainder, about 60 per cent, at least, is nutritive material. It Contains a large amount of carbohydrates, a moderate amount of protein, a small amount of mineral matter, and almost no fat. Owing to the excess of carbohydrates and deficiency of protein in wheat, bread could not serve alone for the proper nutritive of the body, because an amount of bread sufiicient to supply the requisite protein would furnish much more carbohydrates than necessary. In a mixed diet this discrepancy is of little importance, as it is supplied by the other protein foods eaten. Most methods of increasing the protein contents of bread have a tendency to increase the cost, but skim milk can be used in place of water in the mixing with little added expense, and it will add about 3 per cent, increase as to protein." ^ Digestibility and Nutritive Value. "The nutritive value of bread depends, not only on its chemical composition, but also on its digestibility, and digestibility in its turn seems to depend largely on the lightness of the loaf. It is the gluten in a dough which gives it the power of stretching and rising as the gas from the yeast expands within it, and iFrom Fanner's Bulletin No. 389, U. S. Dept. of Agriculture, Washing- ton, D. 0. For further information, read "Bread and Bread-Making, * Farmer's Bulletin No. 389. S48 VEGETABLE OR PLANT FOODS hence of making a light loaf. Eye has less gluten proteids than wheat, while barley, oats and maize have none, so that they do not make a light, porous loaf like wheat. It is pos- sible that of the various kinds of wheat flour those con- taining a large part of the bran — entire wheat and graham flours — furnish the body with more mineral matter than fine white flour; but it is not certain that the extra amount of mineral matter furnished is of the same value as that from the interior of the grain. They do not yield more digestible protein than the white flours, as was for a time supposed. It seems safe to say that, as far as is known, for a given amount of money, white flour yields the most actual nourish- ment with the various food ingredients in good proportion. " It should be remembered, however, that all kinds of bread are wholesome if of good quality, and the use of several kinds is an easy means of securing variety in the diet." ^ As compared with most meats and vegetables, bread has prac- tically no waste, and is very completely digested. Pew foods yield so much energy for so little money. A diet of. bread and milk can be perfectly balanced and will be tired of less easily than any other equally simple diet. All bread-stuffs should be eaten slowly and thoroughly masticated, in order that time may be given for the saliva to act upon the starch. Por if the stomach is hampered with quantities of unchanged starch it CMinot perform its work without effort. Fermentation results or the intestines have more than their share of work to do and rebel. If these foods were eaten slowly much of the resultant dyspepsia would be avoided. Gluten Bread. When, for any reason, persons are denied starch in the diet, as in diabetes, they find it a great priva- tion to do without bread, and many attempts have been made to provide an acceptable substitute. Sometimes bran is used, or inulin or Iceland moss, but none of these is nutritious. One of the best materials for this purpose is gluten flour. ^From Parmer's BuUetin No. 889, U. S. Dept. of Agriculture, Washing- ton, D. C. BREAD 249 It is prepared by washing the starch, wholly or in part, from wheat flour. The grayish, tough, elastic, sticky mass left after this process is largely gluten, and since gluten is a protein, it has been sometimes called " the lean meat of the vegetable kingdom." The washed gluten, dried and ground, is called gluten flour. It still contains considerable starch, so that it is necessary for the physician to know the .exact composition of the brand employed, to insure good results. Gluten Standards. The necessity for a Standard for Gluten Flour is very apparent to chemists who have had occasion to analyze the various kinds on the market. For years millers have supplied dealers with middlings, entire wheat flour and mixtures containing bran to be sold as gluten flour. Igno- rant of those facts, physicians advise their patients to use gluten, but, of course, have invariably been disappointed in results. United States Standard for Gluten: " Gluten Flour is the product made from flour by the re- moval of starch, and contains not less than five and six- tenths (5.6) per cent, of Nitrogen, and not more than ten (10) per cent, of Moisture." ISTote. — Using the factor G.25 usually employed by the U. S. Government chemists, Standard Gluten Flour must there- fore show at least thirty-five (35') per cent, protein. Bread-Making. The two practical methods of making ■ bread are with yeast (fermented bread) and with cream of tartar and bicarbonate of soda (unfermented bread). Fermented Bread. The raising or leavening of bread is usually brought about by allowing yeast to develop in it. Yeast is an exceedingly minute form of plant life, which, when given food, flour, moisture and warmth, grows; and by this growth produces carbon dioxide and alcohol. The carbon dioxide, in its effort to escape, puffs up the flour dough, but owing to the viscous nature of the gluten (the elastic, strength-giving substances of flour) it is caught and retained. 850 VEGETABLE OB PLANT FOODS Each little bubble of gas occupies a certain space, and when the bread is baked the walls around these spaces harden and the result is a porous loaf. The alcohol escapes into the oven in the baking. To bake bread requires a hot oven. The bread should continue to rise for about fifteen min- utes after being placed in the oven, then the rising should cease and the loaf begin to brown. We bake bread to kill the yeast plant, to render the starch soluble, to expel the alcohol and carbon dioxide and to form a nice flavored crust. The making of good bread requires care and intelligence on the part of the cook. Use a good brand of flour, fresh yeast, remembering that yeast is a plant and must be put at a proper temperature to grow. Watch each process carefully. "Lightness and sweetness of bread depends as much on the way in which it is made as on the materials used. The greatest care should be used in preparing and baking the dough and in cooking and keeping the finished bread." Unfermented Bread. Carbon dioxide is obtained to lighten bread by causing cream of tartar and bicarbonate of soda to unite chemically. To one part soda use two parts cream of tartar. When given moisture and heat carbon dioxide is obtained. Baking powder is a combination of the following in- gredients : Bicarbonate of soda 84 grammes to Cream of tartar 188 grammes Starch 5 to 20 per cent. WHITE I'LOTTR BREAD 1 slice (1 oz.) =73 Calories. 1 pint hot milk (or water). 1 tablespoon salt. 1 pint cold milk (or water). 1 Fleischmann's yeast cake. 1 tablespoon sugar. Flour. 2 tablespoons butter or lard. Into mixing bowl put the scalded milk, add the butter; when melted add the sugar, salt and cold milk. Save one- BREAD 251 half cup of this liquid, and when lukewarm soften the yeast in it and stand where it will keep warm. To above mixture add warmed sifted flour (sift twice before using) to make a thin batter, add softened yeast and more flour until stifE enough to knead. Knead until light and spongy. Care should be taken not to add more flour than is absolutely neces- sary. Butter a large stone crock or bowl, place bread in it and cover. Let rise three and one-half hours at about 75 degrees Fahrenheit (in a medium warm room). Then re- move from jar and knead about twenty minutes until smooth and velvety, put into pans, cover carefully and let rise one hour or until double its bulk. Bake in a hot oven from forty-five minutes to one hour, depending upon size of loaves. If hard crust is desired, remove from pans and cool in a draft of air. Por soft crust, before bread cools roll it in a clean cloth. This quantity will make three good sized loaves; one-half the amount may be used for one large loaf. ENTIRE WHEAT BBEAS 1 slice (1 oz.) =70 Calories. 2 cups scalded milk. 2 yeast cakes dissolved in % cup 2 cups boiling water. lukewarm water. 3 tablespoons butter. 2 cups white flour. 3 tablespoons salt. Entire wheat flour enough to 5 tablespoons molasses. knead. Make as for wheat flour bread, and add molasses after the first rising. One-half of recipe may be used. WHOLE WHEAT OB GRAHAM BREAD Make the same as wheat flour bread, adding two table- spoons of sugar or molasses. Make a batter with white flour, using three or four cups, then use whole wheat or graham flour. Let rise longer than for white bread, and put imme- diately into pans without second kneading. Note. — Omit sweetening if desired. 252 VEGETABLE OR PLANT FOODS GLUTEN BREAD (FOB, THE DIABETIC) 1 slice (1 oz.) =71 Calories. % yeast cake. 3% cups Gum Gluten Flour. 2 cups lukewarm water. ^ teaspoon salt. Soften the yeast in a small portion of the water and add to the ingredients. Mix to a stiff dough and knead thor- oughly, using more gluten if necessary to keep it from stick- ing to the board. Shape into a loaf, place in a buttered pan for about two and one-half hours to rise until the dough is about twice its bulk. Then bake for forty-five minutes. If desired the dough may be given a second mixing after the first rising, letting it rise again before baking. Note. — Gum Gluten Bread may be made the same as ordi- nary wheat flour bread with the exception of shortening, which is not required. Avoid having the water too warm or the bread will be sticky; the chill taken off is all that is necessary. If desired, one cup of nut meats cut in small pieces may be added to dough just before putting into pans. BRAN BREAD Follow rule for Gluten Bread, using one part of bran to four parts of Gluten Mour with one cup of moisture. If the bran is increased the moisture must be lessened. BOSTON BROWN BREAD, 2530 CALORIES 1 small slice (1 oz. ) =; 64 Calories. 1 cup granulated Indian meal. 2 cups spur milk. 1 cup rye ilour. 2 teaspoons soda. 1 cup graham flour. % cup molasses. 1 teaspoon salt. Mix dry ingredients (except soda) together; dissolve soda in sour milk and add, then, molasses. Pour into buttered tins and steam three or four hours. GIXTTEN BISCTTIT (FOR THE DIABETIC), 950 CALORIES i 1 cup Gum Gluten Self-raising. 1 saltspoon salt. 1 tablespoon butter. Milk or water. 1 Without milk. BREAD 253 Mix and sift dry ingredients, rub in the butter, add milk or water to make a soft dough. Eoll and cut with biscuit cutter. Makes two large biscuits. GLUTEN DROP BISCUIT (FOR THE DIABETIC), 562 CALORIES i 1 cup Gum Gluten Flour. y^ teaspoon baking powder. 1 teaspoon butter. Milk or water. Yg teaspoon salt. Mix and sift dry ingredients, rub in the butter, add milk or water to make a stiff batter. Drop from spoon into a buttered pan, and bake very quickly. Makes three. BRAN BISCUIT, 416 CALORIES i % cup wheat bran. 1 teaspoon melted butter. % cup improved graham flour. 1 saltspoon salt. 1 teaspoon Rumford baking pow- Milk, der. Sift dry ingredients, rub in the butter and add milk to make a soft dough. Eoll it out and bake in hot oven. BAKING POWDER BISCUIT, 694 CALORIES 1 cup flour. 1 tablespoon butter or beef drip- 2 teaspoons Rumford baking ping. powder. y^ cup (scant) milk or water. % teaspoon salt. Sift dry ingredients twice, rub in the butter with tips of fingers; using knife, stir in gradually the liquid; mix as soft as can be handled; put dough on a well-floured board, pat lightly to one inch thickness, cut with biscuit cutter, put on a shallow buttered tin, heated, and bake in a hot oven. Put a little milk on top of each biscuit before baking to make them brown well. Note. — Dough may be lightly kneaded as for bread, and then cut. GLUTEN MUFFINS (FOR THE DIABETIC), 755 CALORIES 1 cup Gum Gluten Self-raising. % teaspoon salt. 1 cup milk, or part water. 1 egg. 1 Without milk. 354 VEGETABLE OR PLANT FOODS Beat egg and add the milk. Sift the Gluten and salt and gradually add the liquid and beat thoroughly. Bake in hot buttered gem pans. BRAN MUFFINS, 1850 CALORIES 2 cups bran. % cup butter. 1 cup flour. 3 tablespoons molasses. 1 teaspoon soda. 1% cups sour milk. Mix dry ingredients, rub in the butter with the tips of the fingers, add molasses and sour milk, put into hot mufiBn tins and bake in a hot oven. WHITE GEMS, 1627 CALORIES 2 cups flour. 2 tablespoons butter. 1 teaspoon salt. 2 tablespoons sugar. 4 teaspoons Rumford . baking 2 eggs. powder. 1 cup milk. Sift dry ingredients into mixing bowl, add melted butter and rub it in with tips of fingers. Add the well-beaten eggs and ,the milk gradually and beat all well together. Have gem pans well greased and heated; fill two-thirds full and bake in a very hot oven fifteen or twenty minutes. Put a little melted butter on each gem before putting it into the oven. They are sufficiently cooked when tested with a fine washed knitting needle and it comes out dry. CORNMEAL GEMS, 1370 CALORIES ^ 1 cup flour. Ye teaspoon salt. % cup cornmeal. 1 egg. Ya cup sugar. 1 cup milk. 4 teaspoons Rumford baking 1 tablespoon melted butter, powder. Sift dry ingredients into mixing bowl, add the milk and well-beaten egg and the melted butter. Put into well-greased hot gems and cook in a quick oven. POP-OVERS, 730 CALORIES 1 egg. 1 cup milk. Speck salt. 1 cup flour. TOAST 355 Beat egg until very light, add milk and salt and sift in the flour very carefully — beat very light, never stirring. Have ready gem pans or stone custard cups, -well greased and heated. Pour in mixture, filling two-thirds full, and bake in quick oven. This will make six large pop-overs. The success of these pop-overs lies in beating the batter well and in having the cups very hot before putting in the mixture. Note. — These cannot be cooked successfully in tin. BUTTER BAILS 1 teaspoon butter = 36 Calories. Cut butter in small pieces size of balls desired, and put in ice-water. Soak the butter paddles in boiling water ten minutes, then chill in ice-water. Hold a paddle firmly in the left hand and roll each piece of butter with the right paddle until round. If butter sticks it must be chilled longer, or paddles must be rubbed with salt and reheated. One pound of butter will make about thirty balls. TOAST In ordinary wheat bread, starch is the principal constituent. Starch when subjected to a high degree of heat is changed into an easily digested substance called dextrin. In the ordinary cooking of a loaf of bread the starch, in the outer layer is changed into dextrin, which gives the crust its sweet flavor. Slices .of bread toasted undergo a similar change. Bread is toasted not merely to brown it, but to take out all the moisture possible, so that it may be more thoroughly moistened with the saliva, and thus easily digested; also to give it a better flavor. The correct way to make toast is to use stale bread cut in uniform slices, and to dry it thor- oughly before browning. Toast prepared in this way, even if moistened with milk or water, may be easily and thoroughly acted upon by the digestive fluids. 256 VEGETABLE OR PLANT FOODS ENEEGY VALUE OF BREAD 1 slice (1 oz.) white bread =73 Calories. I slice (1 oz.) entire wheat bread =i70 Calories. 1 slice (1 oz. ) gluten bread ^71 Calories. 1 small slice (1 oz.) Boston Brown Bread.. =64 Calories. See Table, page 64, for energy value of other ingredients. SIPPETS Cut thin slices of bread, and from them make oblongs an inch wide by four inches long. Toast carefully so that they will not break, and pile on a small bread-plate with doily if they are to be served dry. TOAST STICKS Take a slice of fresh home-made bread (made without short- ening), or French bread, cut five-eighths of an inch thick, re- move crust and cut in narrow strips. Place on rack in pan, and dry and brown in a slow oven. CROUTONS See chapter " Soup Accompaniments " for recipe. Page 230. GLUTEN CRISP (FOR THE DIABETIC) Cut Gum Gluten Bread into thin slices, and dry in slow oven' until the moistening is thoroughly evaporated, or the bread may be cut in cubes and slightly browned. Serve in. soups or in milk. Note. — Gluten Biscuit Crisps, page 361. JM m;( ,ii WATER TOAST V, Toast ithe bread. Dip quickly in boiling salted water (al- lowing onBrhalf teaspoon salt to one cup water). Spread with butter. Serve on hot plate. TOASTED CRACKERS 1 Saltine=15 Calories. Toast oblong crackers daintily, and butter. Serve on plate •with doily, piled log-cabin fashion. TOAST 357 MILE TOAST, 388 CALORIES Put a eup of rich milk in a saucepan and place it on the stove. While it is heating, toast three slices of bread to a delicate brown. Put them into a covered dish, and when the milk is scalding hot, season it with a saltspoon of salt, and pour it over the toast. Note. — A little butter may be spread on each slice before the milk is added, but it is a more delicate dish without it. CKEAM TOAST NO. I, 261 CALORIES (Individual Rule.) 14 tablespoon butter. % cup milk. % tablespoon flour. 1% slices bread. % saltspoon salt. Scald the milk. Melt butter, add flour, remove from fire and add the milk gradually. Stir over heat constantly until smooth, cooking five minutes after blending, or until the starch is thoroughly cooked. Toast: Remove crust if desired, cut in oblong pieces and toast. Serve on small platter with cream sauce poured over it, and garnish with toast points. Note. — If you wish the toast very soft, it may be dipped very quickly in boiling salted water before adding the cream sauce. CREAM TOAST NO. II, 261 CALORIES % tablespoon butter. 1 tablespoon cold water. 14 tablespoon flour. % cup milk. % saltspoon salt. 1% slices toast. Scald milk. Mix flour and salt and add the cold water gradually, making a smooth, thin paste. Add to scalded milk; cook in double boiler twenty minutes, stirring con- stantly until it thickens. Add butter. Pour over toast, and serve hot, on hot platter. CELERY TOAST 4 ounces celery = 12 Calories. Clean celery and cut into one-inch pieces; cover with boil- ing water and cook until tender ; drain off water. 358 VEGETABLE OB PLANT FOODS Prepare Cream Sauce in Cream Toast No. I; add cooked celery and pour on small slices of buttered toast. Garnish ■with toast points. FRENCH TOAST (FOR THE DIABETIC), 144 CALORIES i Vi cup milk. Salt. 1 egg. Gluten bread. Beat the egg, add milk and salt; dip into this mixture slices of Gum Gluten bread. Saute and brown in a little butter. CIAU BROTH AND TOAST Follow directions as for Milk or Cream Toast, adding suffi- cient Clam Broth (to taste) to the Sauce, and pour over toast. Serve hot. SANDWICHES TO PREPARE SANDWICHES Use white, entire wheat, graham, gluten or Boston brown bread. Bread may be buttered before cutting from loaf, spread with soft, plain butter cut into very thin slices, cover with another slice, press together, cut in fancy shapes, or roll. Wrap in waxed paper or cover with a dry napkin, over which place a slightly moistened one, until ready to serve. Bread may be baked purposely for sandwiches by filling one-half pound baking powder boxes half full of dough, let rise and bake. Serve sandwiches on a dainty doily on a small plate. ENERGY VAITTE OF BREAD 1 slice (1 oz.) white bread =73 Calories. 1 slice (1 oz.) entire wheat bread =70 Calories. 1 slice (1 oz.) gluten bread =71 Calories. 1 small slice (1 oz.) Boston Brown Bread.. =64 Calories. 1 teaspoon butter =36 Calories. See Table, page 64, for energy value of other ingredients. 1 Calculated without bread. SANDWICHES S59 BREAD AND BUTTER SANDWICHES Butter bread slightly, cut very thin and put slices to- gether. Cut in fancy shapes. BOSTON BROWN BREAD SANDWICHES Steam Boston brown bread in one-half pound baking pow- der cans. Butter and cut in thin slices and add a thin round of white bread. The combination of the two makes a pleas- ing variety. CHEESE SANDWICHES Chop stuffed olives fine and add equal quantity of cream cheese and spread on bread and butter sandwiches. A lettuce leaf may be added if desired. CHICKEN SANDWICHES Chop cold boiled chicken, add mayonnaise dressing and spread on bread and butter sandwiches. Or, instead of mayonnaise, moisten with strong chicken broth and season with salt and pepper. Minced celery may be added. EGG SANDWICHES See chapter " Eggs " for recipe. Page 183. TRTTIT SANDWICHES Spread bread and butter sandwiches with stewed dates, figs or prunes, seasoned with a little lemon juice or chop dates, raisins and nuts very fine and moisten with " Cream Dressing." See page 3,74. lETTTJCE SANDWICHES Spread bread and butter sandwiches with a little mayon- naise dressing, lay in fresh, crisp lettuce leaves washed and dried thoroughly, and cut even. NUT SANDWICHES * Prepare same as lettuce sandwiches, adding chopped nuts to the mayonnaise. 260 VEGETABLE OR PLANT FOODS 7EFT0N0IDS SANDWICHES Cut slices of bread in fancy shapes, butter and spread with layer of Dry Peptonoids Soluble, adding salt, pepper, paprika or celery salt, if desired. Note. — Dry Peptonoids Soluble may be blended with mayonnaise dressing, cream, chopped nuts or eggs, for filling. SAW BEEP SANDWICHES See chapter " Beef Preparations " for recipe. Page 217. SARDINE SANDWICHES Eemove oil and bones from canned sardines. Mix with Boiled Dressing (page 273) to form a paste and spread. Chopped olives or gherkins may be added. CRACKERS — WAFERS BRAN CRACKERS, 1513 CALORIES i IV2 cups wheat bran. % teaspoon salt. 1% cups sifted flour. 4 tablespoons butter. 1 teaspoon cream of tartar. Milk. ^ teaspoon soda. Blend all ingredients, using enough cold milk to make a stiff dough. Eoll to one-eighth inch thickness and cut with a small biscuit cutter. Great care is needed in baking that they do not burn and at the same time that they are thor- oughly cooked. They keep well a long time if put in a tin box. They should be eaten at each meal if needed as purgative medicine. EDUCATOR CRACKERS The various varieties of Educator Crackers may be served plain or buttered slightly and heated in oven. GLUTEN CRACKERS (FOR THE DIABETIC), 2555 CALORIES 1 pound Gum Gluten Flour. Sweetina. % pound butter. Cold water. Salt. » Without milk. CRACKERS — WAFERS 261 Mix thoroughly the Gum Gluten Flour with the butter, add salt and Sweetina to taste. Add cold water to make a soft dough. Toss on floured board, roll thin, cut into shape, bake. 61TITEN WAFERS (FOR THE DIABETIC) % cup thick cream = 432 Cal- Gum Gluten Flour (1 cup = 513 ories. Calories ) . 1 saltspoon salt. Add salt to the cream and add the Gluten gradually to make a stiff dough. Toss on a floured board and roll as thinly as possible and cut in strips with sharp knife or shape with a cutter. Bake in a buttered sheet in a slow oven until delicately browned. GLUTEN BISCTTIT CRISPS (FOR THE DIABETIC) 1 biscuit crisp = 25 Calories. Gum Gluten Biscuit Crisps may be served plain, or but- tered and heated slightly in oven. GITTTEN CHEESE WAFERS (FOR THE DIABETIC), 882 CAIORIES 1 cup Gum Gluten Flour. Yolks 2 eggs. 3 tablespoons cream. 1 saltspoon salt. 3 tablespoons grated cheese. Nutmeg. Mix in order given, roll thin and bake. VEGETABLES — VEGETABLE SATJCES LEGUMES — ROOTS AND TUBERS — GREEN VEGETABLES Vegetables include nearly all kinds of plant food except fruits, grains and nuts. Classification. Vegetables are classified as — Legumes — as peas, beans and lentils. Roots and Tubers — as potatoes, beets, turnips, etc. Green Vegetables — as lettuce, spinach, celery, etc. Composition. All vegetables have a high percentage of water, and with the exception of legumes, a relatively small proportion of protein. The chief nutrients are starch and 262 YEGETABLE OR PLANT FOODS sugar. The fats are usually small in amount and chiefly in the form of oils. A variety of mineral salts are present, chiefly salts of potash and soda united with organic acids. Vegetables give bulk to food and possess antiscorbutic prop- erties. Digestibility. As the gastric ferments play no part in carbohydrate digestion, vegetables are digested mainly in the intestines. The presence of cellulose prevents the ready di- gestion of the nutrients, hence it may be stated as a general rule that vegetable food is less completely digested and ab- sorbed than animal food. It would seem desirable to restrict this type of food for persons of very weak digestive powers. General Rules for Coohing Vegetables. Wash thoroughly; pare, peel, or scrape, according to the kind. Let them stand in cold water until ready to cook, to keep them crisp, to freshen them when wilted, or to prevent them from turning dark. Cook in enough freshly boiling salted water to cover, and keep the water boiling (not rapid boiling, as tender vegetables are easily broken). Allow one teaspoon of salt to one quart of water. Salt may be added when vegetables are put in, except in the case of delicate green vegetables, as peas, spinach, etc., when it should not be added until nearly done. To preserve the color, cook green vegetables uncovered. Vegetables should be cooked only until tender, drained im- mediately, and served promptly. Overcooking injures their flavor and makes them tough. Time for cooking vegetables varies with the size, age and freshness. Legumes. Of this class of food-stuffs, peas and beans are the most important. Lentils and peanuts are also valuable, but less widely used. Composition. Fresh legumes, such as peas and beans, con- tain from 2 per cent, to 9 per cent, of protein, a trace of fat and from 7 per cent, to 30 per cent, of carbohydrate. Dried legumes, such as dried peas and beans, on account of the lessened amount of water, contain from 18 per cent, to 35 per cent, of protein, over 1 per cent, fat, and as high as VEGETABLES 263 65 per cent, carbohydrate. They form one of the chief sources of protein in a strictly vegetarian diet. Digestibility. Digestibility depends largely upon the method of cooking and the amount eaten. The more the cellulose is softened or removed, the more completely they are utilized. Legumes are apt to produce fermentation, ■which causes, flatulence and gastro-intestinal disturbance. They are more suitable for those leading an active outdoor life than for invalids, convalescents, or those of sedentary habits. Principles of GooTcing. The attractiveness and digestibility of dried legumes depends very greatly on proper cooking. Hard water must not be used, as it makes them hard and unpalatable, and causes a considerable loss of protein. Water softened by boiling is more desirable than that soft- ened by baking soda. When cooked in the former, the dried legumes, especially beans, keep their shape better, are only very slightly colored yellow, and are more mealy, conse- quently more digestible, as the digestive juices can more easily mingle with the particles of the food. Boots and Tubers. Eoots and tubers contain the reserve material stored up by the plant, and some of them are among the important food-stuffs. Their nutritive value is largely due to starch and sugar. On accounl of the small proportion of protein and fat, and the large proportion of water, they are inferior in nutritive value to both legumes and cereals. The mineral matter is an important constituent of these, as of other vegetable foods. Sodium, potassium and iron salts, and sulphur and phosphorus compounds, are the common ash constituents. In combination with organic acids, etc.,, they contribute much to the flavor of these foods. As a class they may be divided into the following groups : 1. Starch-yielding vegetables, as potatoes and sweet pota- toes. 2. Succulent roots, as beets, carrots, parsnips and onions. 3. Condimental or flavoring roots, as horse-radish and gin- ger. 364 VEGETABLE OB PLANT FOODS The potato is the most important of the starch-yielding class of vegetables. It is a tuber or thickened underground stem. The composition of the potato (Letheby) is as follows : Water 75.00 per cent. Starch 18.80 per cent. Nitrogenous matter 2.00 per cent. Sugar 3.00 per cent. Fat 20 per cent. When pared before cooking, there may be a considerable loss of nutritive material, especially of mineral matter. By cooking in the skin, this loss is largely prevented. To be easily digestible, a potato must be mealy, so as to be readily acted on by digestive juices. This is best accomplished by baking in an oven at 380 to 400° P. When a patient begins to take solids, the vegetable usually first prescribed is a baked potato. Beets, carrots, parsnips, salsify, turnips and onions are the most common of the class of succulent roots. They con- tain, as a rule, more vi^ater than the starch-yielding class of vegetables, and their carbohydrates are frequently- in the form of sugars, pectins, and other polysaccharide carbohydrates than true starch, some of which have no nutritive value. The percentage of crude fiber is greater than in the starch-yield- ing class. The characteristic flavors and odors are in many cases due to the presence of volatile organic compounds of sulphur. These are often advantageous in making the vegetables pal- atable, and adding variety to the diet. The beet contains a large percentage of starch and sugar. Carrots and parsnips also contain much sugar, and when young and tender form a very nutritious food. Onions contain considerable nutriment, but are most val- uable for their pungent oil, which is rich in sulphur. They have diuretic properties, and are useful in constipation. Eadishes contain a large amount of cellulose and should not be eaten by invalids. They are chiefly used as a relish. VEGETABLES 265 Green Vegetables. These vegetables have a fuel value of less than 200 calories per pound; they are useful chiefly for their mineral salts, and for the bulk, variety and relish they give to the diet. Asparagus is easily digested, even by invalids. It has a diuretic action, and imparts a characteristic odor to the urine for some hours. Cabbage contains considerable sulphur and therefore fre- quently causes flatulence. Cauliflower belongs to the cabbage family, but is easily digested. Celery is more digestible cooked than raw. Spinach is especially valuable for its large amount of iron. ENERGY VALUE OP THE POTATO 1 medium potato (314 ozs.) =83 Calories. See Table, page 64, for energy value of other ingredients. BOILED POTATOES Select potatoes of uniform size. Wash, pare and put into cold water to keep from discoloring. Put them into sauce- pan, cover with boiling water, boil and when partly cooked, add one tablespoon salt to every six potatoes. Cook until soft, about twenty-five to thirty minutes, drain very dry, and shake the pan, without a cover, gently over the stove till the potatoes are mealy. Do not serve in covered dish. BICEB POTATOES Add salt and pepper to boiled potatoes, and rub them through a heated potato-ricer or squash-strainer into the (hot) dish they are to be served in. Serve immediately, or pour a little milk over the top and brown in the oven. HASHED POTATOES, 305 CALORIES For mashed potatoes the uneven sizes may be used; the larger ones should be cut, so all will be of uniform size. Prepare as for boiled potatoes. When cooked and dried, add salt, butter, pepper and cream in following proportion : 366 VEGETABLE OB PLANT FOODS 1 pint potatoes. Yg saltspoon white pepper. % teaspoon salt. 2 teaspoons hot cream or milk. 1 tablespoon butter. To the potatoes add the salt, pepper and butter, and mash, leaving them in saucepan cooked in, and on stove so as to, keep them hot. Use open-wire masher or fork and beat quickly, so they may be light and dry, not " gummy." Lastly put in the cream, beat for a moment and serve immediately. POTATO CAKES From cold mashed potatoes make slightly flattened balls. Put them in a floured tin, brush each over with milk and bake in a hot oven five minutes, or till a delicate brown. Note. — These cakes may be sauteed in a little beef fat or butter if desired. SXTRPRISE BAILS Eoll the potatoes into balls as above, and with a teaspoon press a hollow in the top. Chop fine some cold, lean meat, season it with salt, pepper and gravy and put one teaspoon of the meat into the hollow of the potato ball. Put a little milk or melted butter on top and brown in oven or saute. BAKED POTATOES Select potatoes of uniform size, not very large, wash and scrub thoroughly, cut off a small piece at each end in order that the steam may escape. Bake in hot oven from forty-five to fifty minutes. When baked break open slightly, that steam may escape, and serve on folded napkin. POTATOES BAKED IN THE HAIF SHEIL Cut off top of baked potato and scoop out inside. Mash and season well as for mashed potatoes and add the well- beaten white of egg. Fill the skins with the mixture, heap- ing it lightly on top, brush over with milk or slightly beaten' white of egg and brown slightly. Potatoes may be sprinkled with grated cheese before putting into oven. VEGETABLES 267 POTATOES ATT GBATIIT Cut cold boiled potatoes into cubes and put into a buttered baking dish. Cover with white sauce, put buttered cracker or bread crumbs on top and bake until golden brown. Note. — A little grated cheese added to the White Sauce just before pouring over the potatoes adds a pleasant flavor. CBEAUKD POTATOES, 180 CALOBIES 1 cup cold Sliced or cubed po- 14 teaspoon salt. tatoes. % teaspoon finely chopped pars- Vi cup milk. ley. % tablespoon butter. Speck white pepper. Heat the milk, add the potatoes, and cook until they have nearly absorbed the milk. Add butter and seasoning, cook five minutes longer, add parsley and serve hot. POTATO BALLS Prom large potatoes cut balls with a French potato cutter and throw them into cold water. Cook for twelve minutes or more in enough boiling water to cover. Salt at end of six minutes. Drain and let them stand a few minutes to dry. Serve as a vegetable, with cream sauce, or with parsley butter, or use as a garnish for broiled fish. Test potatoes with a needle to see when tender. Xote. — Make mashed potatoes from frames left after cut- ting out the balls. PARSLEY BTTTTER, 358 CALORIES 1 tablespoon butter. Juice % lemon. 1 teaspoon chopped parsley. 1 pint potato balls. Cream the butter, add lemon juice and chopped parsley. Add to the hot potato balls, heat five minutes and serve. Omit lemon juice if desired. ASPARAGUS 14 bunch asparagus =60 Calories. 1 slice toast (1 oz.) =73 Calories. Boiled Asparagus. Prepare asparagus by cutting off lower part of stalk at the point at which they will snap. Wash, 268 VEGETABLE OR PLANT FOODS remove scales and tie together or cut into one inch pieces. Cook in boiling salted water until soft, twenty to thirty-five minutes. As the tips are more tender keep them out of water the first ten minutes of the cooking. Drain, place in hot serving dish, spread with one-half teaspoon butter and sprin- kle with salt. Asparagus on Toast. Serve boiled asparagus on buttered toast, moistened with a little of the liquid the asparagus is cooked in. Cream Asparagus, Plain or on Toast. Pour Cream Sauce No. I over boiled asparagus and serve hot, or serve boiled asparagus on toast and pour Cream Sauce No. I over same. CARROTS 1 small carrot (2 ozs.) =20 Calories. Boiled Carrots. Wash, scrub and scrape off the very thin skin. Cut each carrot into slices from one-fourth to one- fifth inch thick, cut into cubes and cook in boiling salted water until soft, forty-five to sixty minutes. They may be served plain with a little melted butter, salt and pepper, or they may be mashed and seasoned as above. Creamed Carrots. Pour Creamed Sauce No. I over boiled cubed carrot, reheat and serve. CAULIFLOWER 1 serving (4 ozs.) :r=35 Calories. Boiled Cauliflower. Cut off stalk and remove leaves of cauliflower. Soak thirty minutes in cold water to cover, head down. Cook, head up, twenty to thirty minutes, or until soft, in boiling salted water. Drain and separate flowerets. Creamed Cauliflower. Pour Cream Sauce No. I over boiled cauliflower, reheat and serve. CELERY 1 serving (2 ozs.) =6 Calories. Scrape celery. Cut stalks in one-half inch pieces and cook uncovered in boiling salted water twenty to thirty min- utes. Serve with Cream Sauce No. I poured over it. Sauce VEGETABLES 269 can be made using part milk and part water in which celery was cooked. SPINACH — DANDELIONS — BEET GREENS 1 serving (4 ozs.) ^27 Calories. Eemove roots, pick oyer carefully (discarding wilted leaves) and wash thoroughly in many waters until free from sand; cook in boiling salted water, allowing one-fourth as much water as greens. Cook twenty-five to thirty minutes. Drain and chop if desired, reheat, season with butter and salt ; gar- nish with slices of hard-cooked egg. Serve with vinegar, ONIONS 1 serving (4 ozs.) =56 Calories. Boiled Onions. Put onions into pan of cold water and peel under water. Put them into boiling water with one teaspoon salt and one-fourth teaspoon soda to one quart water. After cooking five minutes pour off the water and add fresh boiling salted water, and after ten minutes change the water again. Boil until tender — forty-five to sixty minutes. Drain off the water and add a little milk, cook a few moments and add butter, salt and pepper. Creamed Onions. Pour Cream Sauce No. I over boiled onions, reheat and serve. Scalloped Onions. Place onions in a baking dish and add Cream Sauce No. I. Cover top with buttered cracker or bread crumbs and bake until crumbs are a golden brown. PEAS (GREEN OR CANNED) 1 serving (4 ozs.) =114 Calories. Oreen Peas. Eemove peas ivprn pods, cover with cold water and let stand one-half hour. Skim ofE small peas that come to the top and drain remaining peas. Cook until soft, thirty to forty-five 'minutes, in a small quantity of water. There should be little or no water to drain from peas when they are cooked. A small quantity of sugar may be added if the natural sweetness of the peas has been lost. Season with butter and salt. 370 VEGETABLE OB PLANT FOODS Canned Peas should be drained and thoroughly rinsed, cover with boiling water, boil two minutes and again drain, then add a small quantity of boiling water and cook from five to ten minutes. Season with butter, salt and pepper. Creamed Peas No. I. To one-third cup of cooked peas add one teaspoon of flour mixed with one-eighth teaspoon of sugar. Cook slightly and add one tablespoon of cream, and salt and pepper to taste.= 75 calories. Creamed Peas No. II. Pour Cream Sauce No. I over drained cooked peas, reheat and serve. STRING BEANS 1 serving (4 ozs.) =44 Calories. Eemove strings from beans and cut or snap into one inch pieces. Wash and cook in boiling water until tender (one to three hours). Drain and season with butter and salt. Cook beans in as little water as possible. Select fresh beans that will snap easily. STEWED TOKATOES 1 medium tomato =16 Calories. 1 eup canned tomato =51 Calories. Canned or fresh tomatoes may be used. To prepare fresh tomatoes wash, pour boiling water over them and then peel and cut into pieces, put in saucepan and cook slowly twenty minutes, stirring occasionally. Add a few bread or cracker crumbs and season with butter, salt and pepper. Bread and cracker crumbs, may be omitted. A little sugar may be added if tomatoes are very acid. BAKEb TOMATOES 1 medium tomato = 16 Calories. Wash, dry and remove a thin slice from stem end of to- mato. Eemove seeds and pulp, and drain off most of the liquid; to the pulp add an equal quantity of cracker crumbs, season with salt and pepper and a little chopped onion, or a few drops of onion juice. EefiU tomatoes with mixture and VEGETABLE SAUCES 271 place in a buttered tin; sprinkle with buttered cracker crumbs, bake twenty to thirty minutes in a hot oven. SCALLOPED TOMATOES (FOR THE DIABETIC), 165 CALORIES (Individual Eule.) 1 large ripe tomato. 3 Gum Gluten Biscuit Crisps. Salt, pepper. 2 teaspoons butter. Into a well-buttered individual baking dish place one crushed Biscuit Crisp; and place on top of this one-half the tomato, from which the skin has been removed and then cut in small pieces; season well with salt, pepper and bits of butter. Add another layer of crumbs (one crushed Biscuit Crisp), then the remaining tomato and seasoning, lastly crumbs. Place bits of butter on top, put in slow oven and bake twenty to thirty minutes. VEGETABLE SAUCES CREAK OR WHITE SATTCE KG. I, 152 CALORIES i Use to pour over any vegetable. (Individual Kule.) ^4 eup milk or thin cream. Yi saltspoon salt. % tablespoon butter. Speck white pepper. % tablespoon flour. Scald the milk. Melt the butter in a saucepan, remove from stove, add the flour, then the scalding milk gradually, put over heat and cook, stirring constantly, until smooth and there is no raw taste of starch. This sauce may be used in many ways — with creamed oys- ters, sweetbreads, any cream dish or any scalloped dish. If a thick sauce is desired, use one tablespoon of flour in place of one-half. CREAU SAUCE NO. II, 134 CALORIES (Individual Rule.) % cup milk or thin cream. 1 teaspoon butter. % tablespoon flour. % teaspoon salt. > Calculated with milk. 272 VEGETABLE OR PLANT FOODS Scald the cream. "Wet the flour with a little cold milk to make a smooth mixture, and add to the hot cream. Cook well. Just before serving add the butter and salt, and pep- per if desired. Sauce blended in this way is especially easy of digestion. If a thick sauce is desired, use one tablespoon of flour in place of one-half. SALADS AND SALAD DRESSINGS The salad plants, such as lettuce, celery, water cress, en- dives, etc., contain little nutriment, but are especially rich in mineral matter, and served uncooked in the form of salad, all this mineral matter is preserved. They are very valuable, as these mineral substances are necessary for the healthy condition of the blood and should form a large part of the daily diet. Salads should not be eaten by dyspeptics or those having delicate bowels. Salads should be prepared daintily, arranged attractively and always be served cold. Lettuce and other salad plants should be fresh, crisp, and dry. Wash thoroughly, on account of danger of germs from dust, soil, etc., chill in very cold water until crisp and dry by placing on a clean towel so that the water will drain from the leaves; or fold lightly in a towel and place on ice until serving time. Parsley is re- vived quickly by sprinkling with cold water and putting it into an air-tight fruit jar and keeping it in a cold. place. Treated in this way it will keep fresh a long time. Dressing should not be added to green vegetables until just before serving, as it tends to wilt them. Meat to be used in salads should be free from skin and gristle, and should be cut into small cubes, mixed with French dressing and allowed to stand some time before combining with the vegetables. A dainty salad served with a crisp cracker or cheese wafer SALAD DRESSING 273 forms an acceptable luncheon for the convalescent. It may also be served with dinner. FRENCH DRESSING, 270 CALORIES (Individual Bule, 1/3 of Recipe.) 1 tablespoon vinegar. % teaspoon salt. 2 tablespoons Nieelle olive oil. % saltspoon pepper. Mix all ingredients thoroughly and pour over salad just before serving. BOIIED DRESSING, 483 CALORIES (Individual Rule, V2 of Recipe.) 1 teaspoon salt. 1 egg. % teaspoon mustard. % cup milk. Speck cayenne. 2 tablespoons butter. 2 tablespoons sugar. 14 cup vinegar. Mix all dry ingredients. Beat egg in double boiler, add dry ingredients, butter and milk; cook over hot water, stir- ring constantly until thick like custard; add vinegar; cool and serve. Note. — If it curdles, beat over cold water until smooth. UAYONNAISE DRESSING, 2570 CALORIES (Individual Rule, 14 of Recipe.) 1 teaspoon mustard. Yolks 2 eggs. 2 teaspoons powdered sugar. 1% cups Nieelle olive oil. 1 teaspoon salt. 2 tablespoons vinegar. Speck cayenne. 2 tablespoons lemon juice. Mix dry ingredients, add to yolks and mix thoroughly. Add a few drops of oil at a time until one-half cup is used, beating with egg-beater or wooden spoon. Then add al- ternately a few drops of vinegar and lemon juice and the remainder of the oil, using care not to lose the stifE con- sistency. It should be a thick dressing and not added to food until just before serving. N"ote. — Have all ingredients and utensils thoroughly chilled and place mixing bowl in a pan of crushed ice while blending. 274t VEGETABLE OB PLANT FOODS If dressing curdles, take another egg yolk and add the curdled mixture to it slowly, beating constantly. Note, — One-half or one-fourth of recipe may be prepared. As it will keep well it is best to prepare in larger quantity, thus saving labor. CREAM DRESSING, 1697 CALORIES (For Fruit Salads.) % cup butter. 1 teaspoon mustard. 2 tablespoons flour. 1 tablespoon cider vinegar. 1 cup scalded milk, 1 teaspoon salt. 3 yolks of eggs. % cup vinegar. 3 whites of eggs. % cup sugar. (ft) Melt butter in a saucepan, add flour and pour on gradually the scalding milk, cook thoroughly, stirring con- stantly. (6) Beat yolks in top of double bqiler, add the mustard (dissolved in one tablespoon of vinegar), salt and vinegar. Pour (a) gradually on the egg mixture and cook over hot water until it thickens like soft custard, remove from fire, add the sugar and fold in the stiffly-beaten white of eggs. Pour into glass fruit jar, cool and cover and keep on ice. This dressing will keep a long time and is especially delicious to serve with fruit salads. CHICKEN SALAD, 856 CALORIES (Six Servings.) 2 cups cut chicken. % saltspoon pepper. 1 cup cut celery. 1 tablespoon vinegar. 2 tablespoons Nicelle olive oil. 2 tablespoons mayonnaise. 1 saltspoon salt. ^ Mayonnaise, olives, celery leaves or white lettuce for gar- nishing. Cut the cold chicken into small dice ; cut the cleaned celery, into small uniform pieces. Mix these together and pour over the oil. Mix well, then sprinkle with salt and pepper to taste; add the vinegar, blend and put in colander to drain; set in a cold place for two or three hours. Just before serv- ing add the mayonnaise, put on a bed of lettuce and garnish. Note. — Do not mince chicken. SALADS 275 ' FRUIT SALADS Any combination of fruit desired may be used served with " Cream Dressing." An attractive combination is a banana peeled, cut in half crosswise. Cut one-half lengthwise, ar- range on lettuce leaf, add a little Cream Dressing and gar- nish with malaga grapes (cut in half and seeded) and small pieces of English walnuts. MASGU£RIT£ SALAD One hard-cooked egg cut crosswise. Eemove yolk. Cut white in slices, petal fashion, arrange on lettuce leaf like a marguerite and fill the center with the yolk put through the potato-ricer or strainer. Garnish with parsley and serve with French, boiled or mayonnaise dressing. MIXES SALAD Equal proportions of green peas (cooked and drained), celery cut in thin slices and English walnuts cut into small pieces. Season with salt and pepper, add mayonnaise and serve on lettuce leaves. Garnish with ripe cherries on the stem with blanched hazel nuts put in place of stones. SWEETBREAD SALAD Mix equal parts of parboiled sweetbreads cut into one-half inch cubes and celery cut into thin slices. Season with salt and moisten with mayonnaise dressing. Arrange daintily on lettuce leaves. TOMATO SALAD Take some medium sized tomatoes, cover with boiling water, remove skin and put in refrigerator until ready to serve. Then cut off top of tomato, scoop out a part of the inside and fill with finely cut celery mixed with boiled dress- ing or with mayonnaise. Serve tomato on lettuce leaf and garnish with sprig of parsley. WALDORF SALAD Mix equal parts of apples, pared and cut into small cubes, celery sliced in thin circles and English walnuts cut into 276 VEGETABLE OR PLANT FOODS small pieces. Season with salt and moisten with mayonnaise. Serve on lettuce leaf, garnished with a spoonful of whipped cream and halves of English walnuts or pecans. WATER LILT SALAD One hard-cooked egg. Cut in halves crosswise in fence fashion-; remove yolk, put through strainer and refill white. Serve on shredded lettuce leaves and garnish with parsley. Serve with French, boiled or mayonnaise dressing. CHEESE WAFERS Butter wafer crackers and sprinkle thickly with grated cheese. Put in oven and bake till cheese is melted and crack- ers are a delicate brown. Arrange on small plate with doily. Serve with salad. CHEESE GLUTEN BISCUIT CRISPS (FOR THE DIABETIC) Put grated cheese on Gum Gluten Biscuit Crisps, place in moderate oven until the cheese is melted. Serve while hot. Gum Gluten Biscuit Crisps may be spread with cream cheese and served with salad. FRUITSi Fruits are the seed-bearing portions of plants. Some products of this class, such as melons, are sometimes called fruits and sometimes vegetables ; and a few vegetable products which are not fruits in the strict sense, are included in this class of food products because they have a similar place in the diet. Composition. Fresh fruits contain a high percentage of water, varying from about 75 per cent, to over 95 per cent. It has been suggested that those containing 80 per cent, or more of water be classed as flavor fruits, and those with less than 80 per cent, as food fruits : Bananas, grapes and fresh figs are the commonest examples of the latter class. When the water is removed by evaporation, as in drying, the per- ' For further information, note " Uses of Fruit as Food." Farmer's Bulle- tin No. 293, U. S. Dept. of Agriculture, Washington, D. 0; FRUITS 377 centage of moisture falls to 30 per cent, or less, and the proportion of nutrients is eorrespoAdingly raised, so that dried fruits would fall into the class of food fruits. Pre- served fruits have their nutritive value raised by the addition of water, and usually by some loss of water in preparation. As a class, fruits contain little or no fat. The olive is a remarkable exception. The proportion of protein is so low as to be practically negligible. Carbohydrates are the chief nutrieiit present. In ripe fruits these are almost wholly in the form of sugars and other soluble carbolr^dratgg, commonly called pectin bodies. In unripe fruits starchjs often found - — notably in the ordinary banana. ) The principal sugars are sucrose or cane sugar, dex- trose or grape sugar,, and levulose or fruit sugar. A mix- ture of the last two is common, and is called invert sugar. Fruits contain characteristic organic acids, such as malic in apples, citric in lemons, etc. These acids exist in the form of salts, usually of potassium. A little phosphoricaeid, lime, iron, etc., also occur. The flavor is due partly to the sugars and acids, and partly to characteristic ethereal bodies present in small quantities.. Chemists have isolated the ethers and oils which give the peculiar flavor to bananas, strawberries and other fruits. Digestibility. Digestibility of fruits varies with the kind of fruit eaten and its mode of preparation; stewe d fruits. are more easily digested than jw_frui^ Personal idiosyncracy has also much to dp with digestibility in case of this class of food materials. (jOranges, lemons, grapes and peaches are very generally digested with ease. Oranges are much used in invalid dietaries, their juice being very effecti ve in alla y- ingjhirst, ) Orange juice is also commonly administered to infants, especially if fed artificially, for the sake of the min- eral matter and to prevent constipation. It is important to those who are obliged to exclude sugar from the dietary to know that fruits containing the least sugar are the plum, peach, apricot and raspberry. Those 278 VEGETABLE OR PLANT FOODS containing the largest amounts are the apple, -eweet cherry^ grape and pear. The apple exerts a most excellent influence upon the liver and kidneys, and is valuable in cases of acidity of the stom- ach. The juice of the ripe pineapple contains a remarkable ac- tive digestive principle, similar to pepsin, termed bromelin, and so powerful is its action upon proteids that it will digest as much as one thousand times its weight within a few hours. It is especially valuable in diphtheria and diabetes. Pigs and prunes are valuable for inactivity of the liver and most excellent laxatives. The banana contains a large amount of starch, as much as the potato ; therefore it should not be eaten in an unripe state. For invalids and children and others of delicate digestion, it should always be cooked . Grape juice and other freshly expressed juices are refresh- ing and wholesome beverages, and can often be given to in- valids when the pulp would prove irritating. Nutritive Value. Fresh fruits are chiefly valuable for their re freshing, appetizing (qualities, and for their minera l constituents. The organic acids' form carbonates in the body, and by their alkalinity assist in the regulation of, "body processes. In disturbed conditions of metabolism it is often important to know just what salts and acids fruits contain. As already stated, the chief nutrients are carbohydrates. In fuel value, fresh fruits resemble given vegetables, as is shown by the following figures : Kind of Fresh Fruit. Calories Per. Pound. . Apples 290 Blackberries 270 Oranges 240 Peaches 190 Kind of Green Calories Vegetables. Per. Pound. Beans, string, fresh 195 Beets, fresh 215 Carrots, fresh 210 Onions, fresh 205 FRUITS 379 The dried fruits- compare favorably with bread, dried beans and similar foods as to energy value, but the latter contain protein in considerable amounts, while in fruits it occurs only in small quantities. The fuel value of fruits is often in- creased by the sugar added in cooking or serving. Fruits are also valuable for bulk" which is an essential factor in diet. Most of them contain a considerable propor- tion of indigestible matter. Intelligently used, fruits are a valuable part of a well-balanced diet, and their use should be encouraged. Precautions in the Use of Fruit. Over-ripe or unripe fruit should not be eaten raw; besides inferior flavor there is dan- ger of digestive disturbance. Before serving, all fruit should be thoroughly washed to ^void germs. Digestive disturbances are more often caused by these germs than by the fruit itself. There ii danger also of acquiring harmful intestinal parasites from raw fruits; in all doubtful cases, the food should be cooked. BAKED APPLES 1 medium apple = 70 Calories. Wipe and core apples. Put in a shallow dish with one tablespoon water to each apple; more may be added during cooking if necessary, put into the center of each apple two teaspoons sugar. Bake in a hot oven twenty to thirty min- utes, or until soft; baste with the syrup evei-^ten minutes. A little nutmeg may be added to the sugar, and a few drops of lemon j-uice to each apple. Care must be taken that apples do not lose their shape and break. STEWED APPLE SAUCE, 90 CAIORIES Wash, pare, core and slice one apple; put in saucepan and add one teaspoon sugar and enough boiling water to partly cover. Cover and cook slowly without stirring until trans- parent and tender. Appetizing to serve with any breakfast food. Pears and peaches may be cooked in the same way. 280 VEGETABLE OR PLANT FOODS APPLES CUBAN STYLE Pare and core sound, tart ajjples. Steam until almost ten- der; remove to a buttered pan; fill cavities with cocoanut, stick apples full of blanched almonds,, baste with syrup made of sugar, water and lemon juice. Finish cooking in a hot oven, basting often. When serving, fill the cavities wi,th jelly or the jellied juice. APRICOT AND PRUNE SAUCE, 178 CALORIES i Yi cup prunes. • 1 cup cold water. % cup dried apricots. Sugar to taste. Wash fruit carefully; soak over night and cook slowly for two hours. If cooked properly the fruit will need very little sugar, as the sugar in the fruit is developed by this method of cooking. BAKED BANANA 1 medium banana = 64 Calories. Eaw, this fruit is often indigestible, but baked it acts as a stimulunt to the nerves, being at once received and rapidly assimilated by the stomach. Cut bananas in halves; put in shallow pan; sprinkle with sugar and a little lemon juice and bake until soft. Note. — The banana contains starch and should be thor- oughly ripened before eating. CRANBERRY SAUCE OR JELLY 1 cup cranberries. % cup water. 14 cup sugar. Pick over and wash cranberries. Put in saucepan and add sugar and^water, bring to the boiling point and boil fifteen minutes. Strain and cool. For jelly use one-half cup sugar and one-quarter cup water and after straining put into molds. BAKED LEMON OR ORANGE Bake a lemon or a sour orange in a moderate oven for twenty minutes. When done, open at one end and take out 1 Without sugar. FRUITS 281 the inside. Sweeten with sugar or molasses. This is excel- lent for hoarseness and pressure on the lungs. ORANGE SUNFLOWER Wash the orange. Put a three-tined fork into the stem end. Cut off each end down to pulp, leaving the stem end on fork, then pare off rind to pulp, cut out each section and place on small plate in sunflower fashion, the pieces of pulp for petals; fill centre with granulated sugar. Serve cold. Note. — To cut nicely have a large, firm, cold orange and a sharp knife. ORANGE NO. II 1 medium orange = 77 Calories. Select a large, firm orange ; wash, cut and peel skin down in eight parts, leaving them connected to stem end of orange to form the petals, folding them under the pulp. Separate pulp in sections and put ice between petals before serving. PINEAPPLE, 131 CALORIES 1 slice Hawaiian pineapple. 1 Maraschino cherry. Serve pineapple on small tea plate with cherry in center. To eat a slice' of pineapple after a meal is quite in accord- ance with physiological indications, as pineapple juice con- tains a remarkable digestive principle similar to pepsin. It aids the work of digestion in the stoinach, also in the intes- tinal tract. The Hawaiian Pineapple comes in three forms — sliced, crushed and grated. The sliced pineapple is usually served just as it comes from the can ; the crushed and grated are used like apple sauce and also in delicious made desserts and beverages. STEWED PRUNES 3 prunes = 72 Calories. Wash and look over the prunes, cover with clear cold water and allow to stand on the back of range over night. In the morning put the saucepan where they will cook slowly for four hours. 282 VEGETABLE OB PLANT FOODS Note. — No sugar-is needed as prunes are 18 per cent, sugar, and by this manner of cooking are made very sweet. This simmering process renders them rich and juicy, while boiling toughens the skin. A little lemon juice is a pleasant addi- tion. Prunes are a valuable nutrient, and their use as a laxative is scarcely second to figs. STEAMED RHTJBAKB, 234 CALORIES i 1 cup rhubarb (4 oz.). V4 ^o Vz cup sugar. Wash the rhubarb and cut it into inch pieces without re- moving the skin, as this gives a pretty pink color to the juice. Put it into an agate double boiler without water and steam one-half hour, or until soft. Do not stir, as it breaks the pieces. Sweeten to taste at once on taking from fire. If rhubarb cooks a minute too long — which means after it has gone to pieces — it will lose its delicious flavor. Ehubarb is rich in oxalic acid, which does much to tone the system. STE.WES FIGS, 936 CALORIES % pound figs. 1 cup cold water. >4 cup white sugar. Juice % lemon; Wash figs. Dissolve sugar in the water ; add figs and bring slowly to boiling point. Stew two and one-half hours ; when tender, add lemon juice. Note. — Cut figs in small pieces ; cook very slowly so as not to add more water. SATE BON SONS 1 date = 20-25 Calories. 1 walnut meat = 6-8 Calories. Put salted almonds, or fourths of English walnuts into the inside of dates that have been cut open and stones removed. Eoll in powdered or granulated sugar and serve. 1 Calculated with Vt, cup sugar; with V4 cup sugar =444 calories. NUTS 283 NUTSi Kuts enter but little into the invalid's dietary, but as more attention is being paid to means of rendering them di- gestible, a word concerning them is not out of place. Composition. The edible substance of nuts is concentrated food, containing little water, and with few exceptions, much fat. In general, nuts are also rich in protein. The average composition is as follows: Water 1-4% Protein 6-15% Tats 40-50% Carbohydrates 6-10% The onl}" common nut containing much carbohydrate is the chestnut, which contains 73 per cent. The pignolia, peanut, butternut, almond, beechnut and pistachio contain over 20 per cent, of protein. The pecan, brazil nut, butternut, filbert, hickory nut and walnut contain over 60 per cent, of fat. The ash content is comparatively high. Walnuts, almonds, etc., are rich in phosphoric acid. Cooking of Nuts. Nuts are more often eaten raw than cooked. But the peanut is not considered palatable wheii raw, and the chestnut is very indigestible unless the starch is cooked, when it becomes very easily digestible. Almonds are widely used in confectionery. Nuts may be used as staple articles of diet, in salad, soups, desserts, etc. To insure the best utilization of nuts they must be thor- oughly prepared for digestion by grinding or mastication. Nut butters ofEer much less resistance to digestion than raw, nuts hastily eaten. On account of the high fat content, these products must be fresh, or the fat is likely to decompose (become rancid) and be irritating. Nut flours and meals are made into bread or porridge. Almond meal (containing no starch and very little sugar) is often utilized as a bread for diabetics. The chestnut can- 1 For further information, note " Nuts and Their Uses as Food," Farmer's Bulletin No. 332, U. S. Dept. of Agriculture, Washington, D. 0. 384 VEGETABLE OR PLANT FOODS no^ be so used, on account of its high content of starch. The peanut contains about 11 per cent, of carbohydrates, and hence is undesirable for this purpose. Digestibility. Nuts have been considered very indigestible. This is due largely to improper mastication or other prepara- tion for digestion; to the fact that they are a very concen- trated food, and are often eaten when not needed. While nut protein, as nuts are ordinarily eaten, is not so easily nor completely digested as meat protein, there are experiments showing that- on the whole, they are as thoroughly digested as an ordinary mixed diet. No experiments have been re- ported on the ease or rapidity of nut digestion. Nutritive Value. Nuts are a concentrated food. This is clearly shown by the following figures : 1 lb. of Almonds yield 2895 Calories. 1 lb. of Brazil nuts yield 3120 Calories. 1 lb. of Filberts yield 3100 Calories. 1 lb. of Hickory yield 3345 Calories. 1 lb. of Peanuts yield 2610 Calories. 1 lb. of Walnuts yield 3075 Calories. The high fuel value is due to the absence of water and the large amount of fat present. Nuts can be most- advan- tageously used along with bulky foods, such as fruits and vegetables, and those lacking in fat, such as bread. In a vegetarian diet they become a valuable source of protein. FUNGI AND ALGM These substances have little nutritive value. They may be considered as food adjuncts, rather than foods proper. Of fungi, mushrooms are the most commonly eaten. They are prized for their delicate flavor. Chemical analysis shows a high percentage of nitrogen, but although reported as pro- tein, it is largely in an indigestible form. Algse and lichens are much used as food in some parts of the world and high claims are sometimes made for their nutritive value, but digestion experiments show that, although FUNGI AND ALG^ 285 they have a similar carbohydrate content to other succulent vegetable foods, these carbohydrates are not attacked by the ordinary digestive enzymes of the alimentary tract. The most important alga, from the dietetic standpoint, is Irish moss. It is commonly used in making jellies or sooth- ing beverages for invalids, but it has no nutritive value whatsoever. The lichen most used as food is Iceland moss. It has frequently been recommended as a food for diebetics, but it is practically indigestible. CHAPTER XI NUTRITIOUS DESSERTS HOT AND COLD DESSERTS — FROZEN DESSERTS SOFT CUSTARDS, SAKED CUSTARDS, WHIPS AND SOUFEIES, JUNKET, CORNSTARCH PUDDINGS OR BLANC MANGE, RICE, TAPIOCA, CRACKER AND BREAD PUDDINGS, SAUCES Properly prepared, the dessert may constitute a very large part of the nutriment represented in a meal. Dishes con- taining eggs, milk, cream, starches, etc., in large proportion are necessarily of high nutritive value, and become a useful means of administering these foods to patients who do not care for the flavor of plain milk, raw eggs, cereals, etc., or who are likely to become tired of them. For invalids, com- binations of foods should always be simple, because the more complex the mixture of protein, fat and carbohydrate, the longer and more complicated is the process of digestion. Hence junket, which is simply flavored, coagulated milk, is one of the most digestible of desserts. As a rule, less sugar is relished in sickness than in health; an excess is apt to cause nausea. Dainty service is most important. Baked custards and junkets are usually best served in the original individual molds to avoid danger of breaking, or in case of junket, of becoming watery. Sauces should never be poured over pud- dings till the moment of serving. Care must be taken to see that cold desserts are thoroughly chilled; a lukewarm custard is frequently nauseating and always unappetizing. SOFT CUSTARDS 287 SOFT CUSTARDS SOFT CUSTARD NO. I, 192 CAIORIES (Individual Rule.) Yolk 1 egg. Speck salt. 1 tablespoon sugar. % cup milk. Scald milk in double boiler. Beat yolk, add salt and sugar and pour on gradually the scalded milk. Pour back into top of double boiler and stir constantly until it looks creamy or it coats the spoon and the foam has disappeared; then re- move immediately from hot water. Cool and add flavoring desired; vanilla, orange or lemon extract. Note. — If custard curdles, place saucepan over cold water and beat until smooth. This custard is usually used for pudding sauces. SOFT CTTSTARD NO. II, 410 CALORIES (Two Servings.) 1 cup milk. Yg saltspoon salt. 2 eggs. % teaspoon vanilla or grating of 2 tablespoons sugar. nutmeg. Eeserve one egg white for meringue. Blend according to Soft Custard No. I. This custard is usually used as a foundation for puddings. CTTSTARD SUITABLE FOR A DIABETIC, 230 CALORIES (Two Servings.) 1 egg. Speck salt. Sweetina to taste. 1 cup milk. Scald the milk and add the liquid Sweetina to taste; pour on to the well-beaten eggs. Cook and flavor as in preceding rule for soft custard or bake according to Cup Custard. KERIN6UE, 110 CALORIES i 1 egg white. 2 tablespoons powdered sugar. Speck salt. Lemon or orange juice. Beat the egg until stiff and dry; add the salt, sugar and Jemon juice to taste. Beat very little after adding the sugfr. * Without lemon and orange juice. 288 NUTRITIOUS DESSERTS FLOATING ISLAND, 506 CALORIES Chill Soft Custard No. II; pour into serving dish and put meringue on top. ORANGE CUSTARD Peel, slice and remove seeds of oranges, put into serving dish. Chill Soft Custard No. II, pour over fruit and put meringue on top. BANANA CUSTARD Peel bananas and slice very thin with silver knife; put into serving dish and flavor with lemon juice. ChiU Soft Custard No. II, pour over fruit and put meringue on top. ALUOND PUDDING Line a glass dish with slices of stale cake and put in some saked almonds. Pour a little sherry wine on the cake. Chill Soft Custard No. II and pour over. Put meringue on top, with some salted almonds in it. PEACH CUSTARD Put into serving dish alternate layers of stale cake and slices of fresh or canned peaches. Chill Soft Custard No. II, pour over fruit and put meringue on top. APPLE CUSTARD Cool baked apples and put in serving dish. Heap meringue on top and brown slightly in the oven. Serve with Soft Custard No. I. BAKED CUSTARDS BAKED OR CUP CUSTARD, 319 CALORIES (Individual Rule.) 1 cup milki 1^2 tablespoon sugar. ' 1 egg. Va saltspoon sal^. Flavoring to taste — ntftmeg, cinnamon, vanilla, or lemon extract. Scald the milk ; beat egg, add sugar and salt and pour on gradually the scalded milk. Flavor to taste and pour into custard cups; place in deep pan and pour boiling water BAKED CUSTARDS 389 sround until it almost reaches the top of cups. Bake in moderate oven about twenty minutes. If cinnamon is used for flavor, put one-half square inch into the milk when scald- ing. Note. — To test when dolie, dip a pointed knife into water and plunge into the middle of the custard. If it looks set and the knife comes out clear, the custard is done; if milky, it is not cooked enough. If cooked too long the custard will curdle. BAKED CUSTARB NO. II, 262 CALOBIES (Individual Rule.) % cup milki , 1/3 saltspoon salt. 1 cgg^ Nutmeg. 1^4 tstblespoon sugar. l^ teaspoon vanilla. Blend according to Baked Custard No. I. The smaller quantity of milk makes a little firmer custard. WHITE CTTSTARI), 163 CALORIES 1 egg white. % saltspoon salt. 1 tablespoon sugar. % cup rich milk. Beat white of egg until very light; add sugar and salt and pour on gradually the milk. Flavor with vanilla, orange or lemon extract. Bake in cups set in pan of boiling water in a moderate oven about twenty minutes. When firm set on ice and serve cold. This may be taken by patient when the yolk of egg is prohibited. CHOCOLATE CTTSTARS, 250 CALORIES (Individual Rule.) 2 teaspoons Walter Baker's choc- 2 egg yolks, olate. 2 teaspoons sugar. 2 tablespoons milk. Speck salt. 6 tablespoons rich milk. Grate chocolate and mix with the two tablespoons milk; stir over the fire until smooth, add the rich milk, the well- beaten egg yolks, sugar and salt. Pour into custard cups set in pan of hot water (nearly to the top). Cook until custard is set. Serve hot or cold. 290 NUTRITIOUS DESSERTS Note. — The chocolate and yolk of egg contain a large amount of fat. Do not serve to a patient who cannot digest it. MALTED HILK CXTSTARD, 107 CALORIES (Individual Itule.) 1 tablespoon Horlick's Malted % cup hot water. Milk. Salt. 1 egg yolk. Mix the Malted Milk powder with enough of the hot water to make a smooth paste, add remainder of water and pour it gradually on to the well-beaten yolk. Butter custard cup, pour in the mixture and let it stand in a pan of boil- ing water in a moderate oven until custard is set. BAKED OABAKEL CUSTARD, 293 CALORIES (Individual Rule.) % cup milk. 2 tablespoons sugar. 1 egg. A few drops of vanilla. Speck salt. Scald the milk. Put the sugar in a small saucepan, place over heat and stir constantly until the sugar is melted and a light brown color. Add milk and pour over the slightly- heaten egg. Add flavoring. Strain into buttered custard cups, place in a pan of hot water and bake until firm in a slow oven. FEFTONOIDS CUSTARD, 452 CALORIES 2 tablespoons of Dry Peptonoids Yolks of 2 eggs. Soluble. 2 teaspoons of sugar. 2 tablespoons of milk. A pinch- of salt. C tablespoons of thin cream. Dissolve Dry Peptonoids Soluble in the milk. Add the well-beaten egg yolks, sugar and salt. Pour into custard cups, set in pan of hot water, cook until set. WHIPS AND SOTJITLES Dainty and nutritious ways to serve the uncooked and slightly cooked white of eggs. WHIPS AND SOUFFLES 291 rRXriT WHIP, 125-150 CALOEIES (Two Servings.) Any fruit, fresh, canned or dried (properly prepared), or jellies may be used. 2 to 4 tablespoons fruit pulp. 2 tablespoons powdered sugar White 1 egg. (or to taste). Lemon juice. Prepare the fruit pulp by scraping, grating or rubbing through a strainer. Beat the white of egg on platter until stiff. Add pulp, sugar and lemon juice to taste, and beat until very stiff. Heap in center of serving dish and pour Soft Custard No. I around it. Note. — The apple is a favorite fruit for these whips. The juice of fresh fruits in season used with the raw white of egg makes an appetizing as well as a very nutritious lunch for the sick. STRAWBERRY WHIP, 327 CALORIES (Four Servings.) 1 cup fresh strawberr'ies. 1/3 cup powdered sugar. Whites 2 eggs. Wash and hull the strawberries and mash slightly. Beat whites of eggs until stiff, add sugar and berries; beat until very stiff, using a broad bowl and a wire egg-beater, beating with a long, steady stroke. Pile lightly in a glass dish and serve with white or sponge cake. GRAPE WHIP, 1445 CAIORIES (Six Servings.) % cup Welch's grape juice. 5 tablespoons sugar. White 1 egg. 1 cup double cream. Beat the white of egg until foamy, add the grape juice mixed with the sugar and, lastly, the cream, then beat with a whip churn. Take off the froth as it rises and drain on a sieve. Pour the unwhipped mixture into small, high glasses, and pile the whip on top. Serve cold. 292 NUTRITIOUS DESSERTS OMELET SOUFFLE, 230 CALORIES i (Individual Rule.) Yolk 1 egg. Speck salt. 3 tablespoons powdered sugar. Whites 2 eggs. 2 tablespoons lemon juice. Strawberry or fruit jam. To the well-beaten yolk add the sugar, salt, lemon juice and rind. Beat the whites to the stiffest possible froth, then cut and fold into the yolk. Have ready a small baking dish, buttered and spread with a layer of the fruit ; pour the omelet over it and bake in a moderate oven fifteen or twenty min- utes. Test as for baked custard. Serve at once. Note. — Do not use lemon rind if it will interfere me- dicinally. CirSTARS SOUFFLE, 297 CALORIES (Individual Rule.) % tablespoon butter. Yolk 1 egg. I'/i tablespoons flour. 1% tablespoons sugar. Yi cup scalded milk. White 1 egg. Melt butter, add flour and gradually the scalding milk. Cook thoroughly, pour on to the well-beaten yolk, add sugar and cool. Fold into mixture the well-beaten white. Turn into buttered custard cups and bake about fifteen minutes, ujitil firm — determined by pressing with the finger. Take from oven and serve at once, or it will fall. Serve with Foamy Sauce. LEMON SOUFFLE, 275 CALORIES (Individual Rule.) Yolk 1 egg. l^ cup sugar. Juice 14 lemon. White 1 egg. Thoroughly beat yolk, add sugar, slowly, beating con- stantly; add lemon juice. Fold in the white beaten until dry. Pour into buttered custard cups, set in pan of hot water and bake twenty minutes or until firm, testing by press- ing with finger. Serve plain or with Foamy Sauce. ' Without jam. JUNKET 293 PEACH UERINOITE, 210 CALORIES i (Individual Rule.) 1 cup yellow peaches. Bread crumbs. Sugar to taste. White 1 egg. Yolk 1 egg. 1 tablespoon powdered sugar. Stew peaches in a very little water, sweeten to taste and stir in the well-beaten yolk. Butter a pudding dish and cover bottom with fine bread crumbs, put in the peaches and bake fifteen minutes. Cover with meringue made of white of egg and the powdered sugar; brown slightly in the oven. Serve cold. JUNKET ' Junket is a healthful and dainty dessert made simply of pure milk, and containing enough of the active principle of rennet found in the Junket Tablet to coagulate the milk. It is nutritious and has the added advantage of being easily digested. Milk or cream that has been boiled, sterilized, condensed or evaporated cannot be used in making junket, and care must be taken not to heat the milk more than lukewarm, as hot milk spoils the action of the tablet. _: For diabetic patients Sweetina may be used as a substitute for sugar in these recipes. PLAIN JTTNKET, 296 CALORIES (Individual Rule.) 1 cup milk. % Hansen's Junket Tablet. 2 tablespoons sugar. 1 teaspoon cold water. % teaspoon brandy or wine. Heat the milk until lukewarm, add sugar and flavoring; when sugar is dissolved add the tablet dissolved in the cold water. Pour mixture immediately into sherbet cups or cham- pagne glasses, partly fill. Stand in warm room undisturbed until firm like jelly, then put on ice to cool. Serve with whipped cream heaped on top, with one-half teaspoon bright jelly for garnish. 1 Without bread crumbs and suear. 294 NUTRITIOUS DESSERTS Note. — For variety, whole strawberries or raspberries may be served with junket, or chopped English walnuts with the whipped cream. For garnish, candied cherries may be used. If desired, the brandy and sugar may be omitted in making junket and served plain, with suga,r and a grating of nutmeg. CUSTARD JUNKET, 512 CALORIES (Two- Servings.) Yo c"P hot milk. 2 tablespoons sugar. 1 egg. % teaspoon vanilla. 2 tablespoons sugar. % Hansen's Junket Tablet. % cup lukewarm milk. 2 teaspoons cold water. Beat th^ egg, add two tablespoons sugar; pour on grad- ually the hot milk. Cook in top of double boiler; stir con- stantly until it thickens; take at once from the fire and cool. Mix two tablespoons sugar with the lukewarm milk, add to the cooled custard and blend thoroughly. AVhen lukewarm add vanilla and the tablet dissolved in cold water; finish as for Plain Junket. COCOA JUNKET, 280 CAIORIES (Individual Rule.) 1 tablespoon cocoa. % Hansen's Junket Tablet. 2 teaspoons sugar. 1 teaspoon cold water. 2 tablespoons boiling water. 3 drops vanilla. 1 cup milk. Mix the cocoa, sugar, boiling water, and cook over heat and rub to a smooth paste; add gradually the fresh cool milk.. Heat until lukewarm (not more), add vanilla and then tablet dissolved in the cold water. Finish as for Plain Junket and serve with sweetened cream, or a Soft Custard. COFFEE JUNKET, 289 CALORIES (Individual Rule.) 2 tablespoons boiled coffee. % Hansen's Junket Tablet. 1 scant cup milk. 1 teaspoon cold water. 2 tablespoons sugar. Heat the milk until lukewarm, add the coffee and sugar; when sugar is dissolved add the tablet dissolved in the cold water. Finish as for Plain Junket. CORNSTARCH PUDDING OR BLANC MANGE 295 CORNSTAECH PUDDING OR BLANC MANGE Starch of various kinds is used in milk puddings. For children, invalids and dyspeptics such puddings are admirable. They must be thoroughly cooked, that the action of the heat may affect the starch. The combination of starch and milk gives a wholesome nutritive food, and the addition of eggs increases the food value. CORNSTARCH PUDDING, 329 CALORIES (Individual Rule.) 1 cup milk. Speck salt. 1% tablespoons cornstarch. White 1 egg. 1% tablespoons sugar. Vanilla. Scald the milk in double boiler. Mix cornstarch, sugar and salt thoroughly; add slowly the scalded milk, stirring constantly. Eeturn to top of boiler and cook twenty min- utes, stirring constantly for the first five or six minutes, then occasionally. Eemove from fire and while very hot fold in lightly, but thoroughly, the well-beaten white of egg. When partially cooled add flavoring to taste; put into wet cups or molds, cool and then stand for several hours on ice. Ee- move from molds. Serve with a soft custard, mashed fresh berries, or whipped cream. Vary the pudding by adding a little Walter Baker's chocolate, melted. PINEAPPLE CREAU, 340 CALORIES (Individual Rule.) 1 cup milk. ■> Speck salt. 1% tablespoons cornstarch. White 1 egg. 11/2 tablespoons sugar. 2 tablespoons grated pineapple. Follow directions for Cornstarch Pudding, adding the pineapple instead of vanilla. Pour into individual molds and serve cold with cream. CORNSTARCH FRTTIT JELLY, 166 CALORIES 1 (Two Servings.) 1 cup raspberry juice. 2 tablespoons cornstarch. Sugar. 1 Without sugar. 296 NUTRITIOUS DESSERTS Sweeten the juice to taste and heat to boiling point. Make a smooth paste of the cornstarch and a little cold water, add slowly to the juice and cook thirty minutes in top of double boiler, stirring constantly at first. Pour into cold, wet molds. Serve cold ^xh. whipped cream and fresh, whole berries. MALTED UILE BLANC IIAK6E, 280 CALORIES (Two Servings.) 2 tablespoons Horlick's Malted Speck salt. Milk. 1 tablespoon sugar. 2 tablespoons powdered arrow- 1% cups boiling water, root. %, teaspoon vanilla. Mix the arrowroot and Malted Milk powder with a little cold wajt^r into a smooth paste. Add the boiling water slowly, cook in double boiler about twenty minutes, or until arrow- root is thoroughly cooked, add vanilla and pour into cold, wet molds. Chill and serve with Soft Custard or whipped cream. Note. — One teaspoon powdered coffee may be added to above before cooking, for Coffee Blanc Mange. ^' NUTRITIOUS WHEAT PUDDING, 252 CALORIES (Individual Rule.) 1 cup milk. White 1 egg. 2% tablespoons flour. % teaspoon vanilla. Speck salt. Blend flour with a little of the cold milk. Scald remainder of milk and add flour mixture; cook thoroughly; add salt and flavoring and fold in the white of egg beaten slightly. Put into cold, wet mold, cool and set in ice box to harden. Serve with Soft Custard or whipped cream, or sprinkle with powdered sugar and pour over it one-fourth cup of fresh fruit juice or crushed fruit. GLUTEN PUDDING (FOR THE DIABETIC), 861 CALORIES o ( Six Servings. ) 3 tablespoons Gum Gluten Flour. 1 teaspoon butter. 1 pint hot milk. 1 saltspoon salt. 1 pint cold milk. Cinnamon. 1 egg. Sweetina. mCE PUDDINGS 297 Blend Gum Gluten Flour with a little of the cold milk, add gradually to one pint hot milk. Cook thoroughly. Beat egg, add cold milk, the cooked mixture and salt, cinnamon and Sweetina to taste. Bake thirty minutes. A little fruit improves the flavor. Serve with whipped cream. IRISH UOSS JELLT, 677 CALORIES (Three Servings.) % cup Irish moss. Juice 1 lemon or orange. 2 cups boiling water. % cup sugar. 4 figs. Soak, pick over and wash the moss. Put it into the boil- ing water, add the figs cut into strips and simmer about twenty minutes, or until it is very thick when dropped on a cold plate. Add lemon juice and sugar. Strain into a cold, wet mold. IRISH MOSS BLANC MANGE, 296 CALORIES (Four Servings.) % cup Irish moss. 14 saltspoon salt. 1% cups cold water. 14 teaspoon vanilla. 1% cups milk. Soak the moss in cold water about fifteen minutes. Ee- move from water, pick over and put into double boiler with the milk. Cook about twenty minutes, or until it thickens when dropped on a cold plate. Add salt, strain and flavor. Strain again and turn into small cold, wet molds. Chill and serve with cream and sugar or sliced fruit. RICE PUDDINGS BOILED RICE, 100 CALORIES (Individual Rule.) 2 tablespoons rice. % teaspoon salt, 2 cups boiling water. Wash rice thoroughly and add gradually to the boiling salted water, care being taken that the water does not stop boiling. Boil uncovered twenty minutes, or until grains 298 NUTRITIOUS DESSERTS are soft. Turn into a strainer and pour over it one cup of hot water and drain, put in oven a few moments to dry, with oven door open. Serve as a cereal with sugar or cream or as a pudding with cooked dates and whipped cream, or plain with Soft Custard. Note. — Keep rice well covered with water while cooking. Dates. — Cut in small pieces, add a little water to partly cover and cook until soft. Simmer and do not stir. STEAMED RICE, 265 CALOBIES (Individual Rule.) % cup rice. % teaspoon salt. 1 cup boiling water. Pick over the rice, wash in three or four waters; put it with the boiling water and salt in upper part of double boiler. Do not stir while cooking. Steam one hour, or until the grains are tender. Serve as a cereal with sugar or cream or as a pudding with Soft Custard, or with sugar and cream. Note. — A few dates cut in narrow strips may be added just before serving if desired. Part milk may be used in the cooking. PEACHES AND RICE Serve boiled or steamed rice with sections of fresh, juicy peaches, or with fresh berries. Serve with sugar and cream. SOUTHERN SNOWBALLS, 367 CALORIES (^Individual Rule.) % cup rice. ^4 teaspoon salt. 1 cup milk. Pick over rice, wash in several waters and put with milk and salt in top of double boiler. Cook until the milk is ab- sorbed and rice is tender. Do not stir while cooking. Dip egg cups in cold water and pack with rice carefully but tightly, turn out on serving dish, sprinkle with powdered sugar, put a candied cherry or a strawberry on top, and serve with whipped cream. EICE PUDDINGS 299 PLAIN RICE PUDDING, 74G CALORIES (Individual Eule.) 1 cup steamed rice. 2 tablespoons sugar. 1 cup scalded milk. % saltspoon salt. 1 tablespoon butter. i^ cup stoned raisins 1 egg. Scald milk and add butter. Beat egg, add sugar and salt and pour on slowly the scalding milk. Put in pudding dish with rice and raisins. Put bits of butter on top and bake in a moderate oven until custard is set. Serve with Hard Sauce. Xote. — Do not use raisins in case of bowel trouble. RICE UERINGUE, 526 CALORIES (Two Servings.) % cup cold cooked rice. Egg yolk. 1 cup scalded milk. Vanilla. 2% tablespoons sugar. 1 egg white. % saltspoon salt. 2 tablespoons powdered sugar. Blend rice and milk and soak until soft. Beat the yolk, add sugar and salt and gradually the hot milk and rice. Cook until it thickens like soft custard. Add flavoring to taste and pour into pudding dish or custard cups. Make a meringue of the white of egg and powdered sugar, cover the padding and brown slightly in the oven. CREAH OF RICE PUDDING, 657 CALORIES (Three Servings.) ^/4 cup rice (well washed). 1 saltspoon salt. 2 tablespoons sugar. 1 pint milk. Mix all ingredients in a small baking dish. Bake two hours, slowly at first until rice is softened and thickened in the milk. Cut the crust several times, stirring to the bottom gently. The crust will then dissolve in the pudding, giving it a creamy color. Then let it brown slightly. 300 NUTRITIOUS DESSERTS TAPIOCA PUDDINGS TAPIOCA CREAU, 483 CALORIES (Two Servings.) 11/2 tablespoons Minute tapioca. 1 cup scalded milk. 3 tablespoons sugar. 1 egg. Yg saltspoon salt. Flavoring. Scald milk in double boiler. Mix tapioca, sugar and salt; add slowly to the scalding milk, return to double boiler and cook fifteen minutes. .Add the yolk and white of the egg, beaten separately. Remove from fire and add flavoring de- sired. Serve plain or with any fresh fruit in season. PLAIN TAPIOCA, 451 CALORIES (Three Servings.) 1% tablespoons Minute tapioca. 1 cup scalded milk. 2 tablespoons sugar. Vi cup raisins. Salt. Nutmeg. Scald milk in double boiler and gradually add the tapioca and sugar. Cook fifteen minutes. Add salt, nutmeg to taste and seeded raisins. Serve with cream and sugar. Note. — Eaisins should never be used in bowel trouble. PINEAPPLE TAPIOCA, 718 CALORIES (Three Servings.) 14 cup Minute tapioca. IVi cups boiling water. % cup sugar. 1 cup canned grated pineapple.- Speck salt. Mix tapioca, sugar and salt, pour on slowly the boiling water and cook in double boiler until clear, about fifteen min- utes. Pour over the grated pineapple and decorate the top of the pudding with currant jelly. APPLE TAPIOCA, 345 CALORIES 1 (Three Servings.) 14 cup Minute tapioca. 1 pint boiling water. 1 tablespoon sugar. 3 tart apples. Speck salt. Sugar, nutmeg. 1 Without extra sugar. TAPIOCA PUDDINGS 301 Mix tapioca, sugar and salt, pour on slowly the boiling water, and cook in double boiler fifteen minutes. Pour this onto the apples, which have been pared and cored and the holes filled with sugar and a little nutmeg. Cover the dish and bake one-half hour. Serve with cream and sugar. RASPBERRY TAPIOCA, 218 CAIORIES (Three Servings.) 1% tablespoons Minute tapioca, y^ eup raspberry juice. 1% tablespoons sugar. Juice % lemon. 1 cup boiling water. Speck salt. Mix tapioca, sugar and salt, pour on slowly the boiling water and cook in double boiler fifteen minutes. Add rasp- berry and lemon juice. When it begins to jelly, beat smooth ■with a spoon. Serve plain or with whipped cream. SATE TAPIOCA, 660 CALORIES (Three Servings.) 1% tablespoons Minute tapioca. 1 cup scalded inilk. 3 tablespoons sugar. 1 egg. % saltspoon salt. 14 cup chopped dates. Mix tapioca, sugar and salt; add gradually the hot milk and cook in double boiler fifteen minutes. Add the beaten' egg yolk and cook three minutes longer. Stir in the dates. Make a meringue of the white of egg, heap it on top and brown delicately in the oven. CHOCOLATE OR COCOA BLANC MANGE, 827 CALORIES 1 (Three Servings.) 14 cup Minute tapioca. 1% cups liot chocolate or cocoa. 14 cup sugar. 14 teaspoon vanilla. 14 teaspoon salt. Mix tapioca, sugar and salt; pour on gradually the hot cocoa and cook in double boiler about twenty minutes. Ee- move from heat, add vanilla and pour into cold, wet molds. Serve cold, plain or with whipped cream or Soft Custard. > Calculated with chocolate, recipe page 135. 302 NUTRITIOUS DESSERTS BREAD PUDDINGS The principle of employing farinaceous matter which has already been subjected to heat (so that a considerable con- version of starch has gone on before the human salivary diastase comes into play) is carried out in practice in the form of bread puddings. PLAIN BKEAD PUDDING, 900 CALORIES (Two Servings.) 1 cup stale bread. 2 tablespoons sugar (to taste). 1 cup milk. % saltspoon salt. 1 tablespoon butter. 14 cup seeded raisins. 1 egg- Scald milk and add butter. Beat the egg and add sugar and salt; pour on gradually the scalding milk. Cut the bread into one-half inch cubes and add with the raisins. Pour into well-buttered pudding dish, put bits of butter on top and bake in a moderate oven until the custard is set. Serve with Hard Sauce or cream and sugar. Note. — Do not serve raisins in bowel trouble. ORANGE BREAD PUDDING, 710 CALORIES 1 (Two Servings.) 1 cup stale bread. 2 oranges. % cup milk. Sugar to taste. 2 eggs. Soak bread. in the milk until soft and beat lightly with fork; add the grated rind of one orange and the juice of both; sweeten. Beat the whites very light and add to above mixture. Pour into custard cups and cook as for baked cus- tard — about fifteen or twenty minutes. Serve plain or with Hard Sauce. Note. — Omit orange rind if it will interfere medicinally. 1 Without sugar. BREAD PUDDINGS 303 LEMON BREAD f USSING, 543 CALORIES (Two Servings.) % cup milk. 3 tablespoons sugar. % eup soft bread crumbs. % tablespoon butter. Yolk 1 egg. Grated rind Vi lemon. Scald milk and add butter. Beat the egg yolk, add sugar and salt and pour on gradually the scalded milk. Add the bread crumbs and grated lemon rind ; pour into^ a buttered pudding dish and bake in a moderate oven about fifteen min- utes, or until set like baked custard. Make a meringue by beating the white of egg very stiff, adding two tablespoons powdered sugar and juice of one- fourth lemon. Cover the pudding with it and set in the oven till a dainty brown. Note. — Do not use lemon rind if it will interfere me- dicinally. JELLY BREAD PUDDING Prepare the same as for Lemon Bread Pudding, omitting the lemon rind and Juice. Spread any tart jelly over pudding when baked and add meringue. CHOCOLATE BREAD PUDDING, 904 CALORIES (Two Servings.) 1 cup stale bread crumbs. 2% tablespoons sugar. 1 cup milk. 1 egg. 1 ounce (or square) Walter Speck salt. Baker's unsweetened chocolate. 14 teaspoon vanilla. Soak bread crumbs in milk. Melt chocolate over hot water and add to it the sugar and salt. To the soaked crumbs add the chocolate mixture, the beaten egg and vanilla. Put into buttered custard cups and bake in a moderate oven about twenty minute's, or until custard is set. Serve hot, plain or with Hard Sauce. 304 NUTBITIOUS DESSERTS CHEESE PUDDING (FOR THE DIABETIC), 1400 CALORIES (Two Servings.) 2 eggs. Speck soda. 1 cup milk. 1 tablespoon butter. % cup cheese. Salt. 1 cup Gum Gluten bread crumbs. Cayenne. Dry the bread, roll and soak a short time in the milk. Beat the eggs lightly, add the milk and crumbs, grated cheese, salt and cayenne pepper to taste. Beat well, pour into but- tered pan and bake in a hot oven half an hour. Serve im- mediately, as five minutes' delay will spoil. GLUTEN BROWN BETTY (FOR THE DIABETIC), 222 CALORIES i 3 Gum Gluten Biscuit Crisps. Sugar. 1 large sour apple. Cinnamon. 2 teaspoons butter. Into a well-buttered individual baking dish place one crushed Biscuit Crisp; onto this put one-half apple cooked as for apple sauce or raw cut in thin slices or chopped; season with sugar, speck of cinnamon and bits of butter. Add another layer of crumbs (one Biscuit Crisp), then the remaining half of apple and seasoning, lastly crumbs. Place bits of butter on top, put in slow oven, and bake. CRACKER PUDDINGS CRACKER PUDDING, 397 CALORIES (Two Servings.) 1% soda crackers. Yolk 1 egg. 1 cup milk. 2 tablespoons sugar. Ys teaspoon salt. EoU the crackers and soak in the milk. Beat yolks and sugar well together and add to pudding with salt. Bake one-half hour. Make a meringue with the whites of the eggs, pile lightly on top and put in oven till golden brown. Serve hot. ' Without sugar. PUDDING SAUCES 305 ENGIISH WALNUTS AND BISCTTIT CRISPS (FOR THE DIA- BETIC), 154 CALORIES (Individual Rule.) 2 Gum Gluten Biscuit Crisps. 4 walnut halves. 2 hot tablespoons thin cream. Parsley. Yi teaspoon butter. Butter Biscuit Crisps and place in oven until well heated through. Dip the nuts in melted butter and cook, turning often until heated. Cover each Crisp with one tablespoon of hot cream and serve two nuts on each Crisp; garnish with sprig of parsley. Note. — Buttered Biscuit Crisps may be served heated and served with ground nut meats over top. PUDDING SAUCES HARD SAUCE, 650 CALORIES (Four Servings.) 3 tablespoons butter. % white of egg. 6 tablespoons powdered sugar. % tablespoon cream. Jfutmeg. Cream butter; add sugar gradually. When light and creamy add the unbeaten white of egg and the cream, a drop or two at a time. Season highly. Heap on serving dish and cool. ■BOAUY SAUCE, 863 CALORIES (Three Servings.) 14 cup butter. % egg. % cup powdered sugar. 1 tablespoon wine. Cream butter; add sugar gradually, the well-beaten egg and the wine. Heat over hot water, beating constantly. Serve immediately. TO WHIP CREAM i/a cup thick cream (40%) =432 Calories. Do not have creani too thick; season with sugar and any flavoring desired ; put in bowl and set bowl in another utensil containing a little cold water and ice. Beat cream with Dover 306 ^ NUTRITIOUS DESSERTS egg-beater until stiff enough to keep its form. Set on ice to keep cold. Note. — Do not beat too long or it may turn to butter. To one-half cup thick cream add three tablespoons milk. WHIPPED CREAM NO. II. 1 egg white = 10 to 15 Calories. Follow the above recipe, and add the white of one egg beaten stiff, folding it into the stiflBy-beaten cream. FRUIT SAUCE, 75 CAIORIES (Two Servings.) 6 tablespoons fruit juice. % teaspoon arrowroot or corn- starch. Blend starch with a little cold water and pour into the hot fruit juice. Boil two or three minutes. Sweeten if de- sired. ORANGE SAUCE See chapter " Gelatin " for recipe. Page 210. FBOZEN DESSEET ICE CREAK — SHERBET — ICES Frozen dishes not only constitute an acceptable form of serving nutriment, but often are a means of furnishing addi- tional liquid and relieving thirst. Ices and sherbets made with fruits and water, have a dietetic value similar to acid heverages. Frozen cream, milk, junkets, custards, etc., have the same nutritive value as the same foods served without freezing. ' In giving all very cold dishes, care must be taken not to interfere with the digestion of other foods. Chilling the mouth hinders the formation and activity of saliva; chilling the stomach retards gastric digestion. The latter effect can be avoided by eating ice-cold food very slowly, so that it is partially warmed before reaching the stomach. Frozen foods should not be given when ptyalin digestion is especially im- portant. ICE CREAM 30r General Rules for Freezing. Ice (or snow) and salt are required for the process of freezing. The salt melts the ice, and in melting absorbs heat from the mixture, thus causing it to freeze. The finer the ice, the more quickly the freezing will be accomplished. In packing a freezer allow three level measures of ice to one of salt. This proportion is found best for fine-grained mixture. The can should not be filled more than three-fourths full, as the liquid expands in freezing, and if over-crowded, the .cream will become coarse-grained and the cover may be pushed up allowing the salt water to get in. Freezing in Small Amounts. Put mixture to be frozen into a water-tight baking powder can, or a small tin pail with cover, and stand in large pail or bowl. Pack the ice and salt alternately under and around it (ice pounded fine), using one part salt to three parts ice. Eemove cover, and beat •mixture with Dover egg-beater until foamy, replace cover and turn can, or pail, back and forth; remove cover occasionally and scrape the frozen mixture from side of can, and beat thoroughly with fork. The mixture will freeze in twenty minutes. When frozen, place a narrow strip of cloth, dipped in melted beef fat or lard, around the outside of cover to keep out the salt water. Eepack in ice, or ice and salt, and cover well until wanted. Serve frozen dishes in sherbet, champagne, or high glasses ; pass on small plate covered with doily, and at the side of the plate a small cake, wafer or a few orange straws may be added ; a rose will add to the attractiveness. ICE CREAM VANILIA ICE CEEAM, 310 CAIORIES i (Individual Rule.) 1/2 cup thin cream or % cup % teaspoon vanilla. heavy cream and 14 cup milk. Speck salt. , 11/2 tablespoons sugar. Blend all the ingredients; when sugar is dissolved, freeze in a small pail according to general directions. 1 Calculated with thin cream. 308 NUTRITIOUS DESSERTS CHOCOLATE ICE CREAM, 353 CALOBIESl (Individual Rule.) % eup thin cream or 14 cup 1% tablespoons sugar. heavy cream and %, cup milk. 1 tablespoon boiling water. Vi square Walter Baker's chooo- ^ teaspoon vanilla. late. Speck salt. Melt the chocolate over hot water, add the boiling water, sugar and hot cream. Cool, add vanilla and salt and freeze in small pail according to general directions. COFFEE ICE CBEAU, 352 CALORIES 1 (Individual Rule.) % cup thin cream or % cup 1% tablespoons sugar. heavy cream and 14 <^"P niilk. Speck salt. 1 tablespoon ground coflfee. 14 ^^^P milk- Mix coifee and milk, put into double boiler and cook five minutes. Strain through cheese-cloth and strainer; add sugar, salt and cream. Cool and freeze in small pail, accord- ing to general directions. JUNKET ICE CREAK, 690 CALORIES 1 (Two Servings.) % cup cream. % Hansen's Junket Tablet. % cup milk. 2 teaspoons cold water. 214 tablespoons sugar. % teaspoon vanilla. Heat the milk until lukewarm, add the sugar and vanilla; ■when sugar is dissolved add the tablet dissolved in the cold water. Allow it to stand in warm room until firm, then beat thoroughly and turn into small pail and freeze according to quarter ; well browned during the third; and shrink from the pan during the fourth. If the oven is too hot, a crust will form over the top be- fore the cake has risen sufficiently and the cake will break 317 318 CAKE open on the top. If the oven is too cool the cake will rise too much and will be of coarse texture. Place pans in oven in such position that they may remain and do not move them before the third quarter of the baking. If the top of the cake should brown too quickly cover with a piece of light weight paper, slightly buttered on the one side and next to the cake. Cake is sufBciently baked when it shrinks slightly from the edge of the pan and feels firm to the touch; if when tested with a fine washed and heated knitting or darning needle and it comes out clear. In looking at cake do not open the oven door too wide and only for a moment, and care must be taken not to jar the door in closing. SPONGE CAKE, 1390 CALORIES 4 eggs. 1% teaspoons Rumford's baking 1 cup powdered sugar. powder. % cup bread flour. Rind and juice of Vz lemon. y^ teaspoon salt. Beat eggs separately, very light. To the yolks add the sugar and lemon, sift in carefully the flour blended with the baking powder and beat about five minutes. Then fold in the whites. Bake in a well-greased and floured angel cake tin in a moderate oven. Cake is done if when tested with a fine (washed) knitting needle it comes out clear, or when the cake shrinks from the pan. coil) WATER SPONGE CAKE, 1633 CALORIES 2 eggs. 2 teaspoons Rumford baking 1 cup sugar. powder. 6 tablespoons cold .water. 1 tablespoon lemon juice. IVs cups bread 'flour. Beat the yolks and whites separately. To the yolks add the sugar and beat well ; add lemon juice and cold water ; sift flour and bakipg powder together three times and add grad- ually, beating' thoroughly. Pold in the well-beaten whites. Bake in well-greased and floured gem tins, ox shallow pan in a moderate oven. CAKE 319 HOT WATEE SPONGE CAKE, 1460 CALORIES 2 eggs. 1/^ saltspoon salt. 1 cup sugar. i/^ teaspoon vanilla. 1 cup bread flour. % cup boiling water. ly^ teaspoons Kumford baking powder. Beat the eggs very light, add the sugar ; sift dry ingredients together and add gradually; add flavoring and beat well. Lastly add the boiling water, and bake in well-greased and floured gem tins, or shallow pan, in a moderate oven. PLAIN CAKE, 2230 CALOBIES 2 eggs. 4 tablespoons butter. , % cup milk. 2 teaspoons Rumford baking 1 cup sugar. powder. 1% cups bread flour. 1 teaspoon flavoring or spices. Line the pan with buttered paper; separate eggs. Cream the butter, add the sugar gradually, add. the well-beaten yolks and flavoring. Add alternately the milk and the flour with the baking powder sifted in it. Beat well and fold in the stiffly-beaten whites. Put at once in a well-lined and greased pan, and bake in a hot oven about thirty minutes, or until it shrinks from the pan, or until a fine (washed) knitting needle comes out dry. The cake may be varied by adding one-fourth cup currants, or a few raisins and a little citron, or mixed spices, or a little melted chocolate. Before adding fruit to cake it should be slightly floured. GLUTEN NUT CAKE (FOR THE DIABETIC), 1436 CALORIES i 1 tablespoon butter. % teaspoon Sweetina. Yolks 2 eggs. Salt and spices. Whites 2 eggs. 1 cup nut meats. % cup sour milk. Gum Gluten Flour. 1 teaspoon soda. Cream the butter, add the well-beaten yolks and Sweetina syrup, then the sour milk in which the soda has been blended. Add Gum Gluten Flour gradually to make a stiff batter; 1 Without gluten flour. §20 CAKE season with salt and spices and add nut meats. Bake in moderate oven. BOILED PKOSTING, 853 CALORIES 1 cup sugar. White 1 egg. 14 teaspoon cream of tartar. % teaspoon flavoring. % cup cold water. Boil the sugar, cream of tartar and cold water without stir- ring until it threads from spoon, and gradually pour on to the well-beaten white? of egg. Add any flavoring to taste. Beat until thick and spread quickly. A little chocolate may be added for variety, or chopped nuts or eocoanut, etc. HARGTJERITE WAFERS Take " Long Branch " wafer crackers and spread with plain-boiled frosting, or add nuts, chocolate, eocoanut, etc. Put in oven a moment to dry, but not brown. Dainty to serve with Ice Cream, Ices and Sherbet. GINGER BREAD, !2600 CALORIES 1 egg. % cup boiling water. 1 cup molasses. 1 teaspoon ginger. 7 tablespoons melted butter. 1% cups bread flour or 1 teaspoon soda. 2% cups pastry flour. Beat egg in mixing bowl ; add molasses, melted butter, and gradually one cup of flour. To the remaining flour add the soda and ginger, sift and add to mixture; beat well and add the boiling water. Bake in well-greased and floured gem tins, or shallow pan, in a hot oven about twenty minutes. Test with 4 fine (washed) darning needle ; when it comes out clear, or the cake shrinks from the pan the cake is done. PAET III HOSPITAL DIETARIES DIET IN" DISEASE DIET IN SPECIAL CONDITION'S CHAPTEE XIII HOSPITAL DIETARIES GENERAL TYPES OF DIET USED IN HOSPITALS LIQUII) OR TLTJID FOODS Acid, starchy and miscellaneous drinks. Eaw eggs in ""the form of all albuminous drinks. Milk in different ways as given in recipes under chapter; thus milk may be flavored with cocoa, chocolate, coffee or meat broth; diluted with lime water, ApoUinaris or Vichy ; combined with starchy drinks or strained gruels. Broths of various kinds; beef juice; beef tea ; beef extract. Soups, both clear and creamy ; oysters and clams. SOFT OR SEMI-SOLID FOOD Milk and water gruels. Water, milk or creamy toast. Starchy and meat jellies. Custards in various forms. Whips and souffles. Junkets, cornstarch puddings or blanc-mange, gelatins. Ice cream, sherbet, ices. Plain cream, butter, olive oil, mayonnaise dressing, cod liver oil, plain or emulsified. SOLID FOODS Gruels and mushes. Various forms of bread, toast and crackers. Eggs prepared in many forms. Meats cooked in various ways; as beef, mutton, lamb; chicken, turkey or game; sweetbreads; fish, oysters, clams. Suitable vegetables and fruits. TYPICAL DIETS FROM VARIOUS HOSPITALS LIGHT DIET i (or Convalescent Diet) Breakfast. — Milk, tea, coffee or cocoa (with milk and sugar). Bread and butter, white bread, graham bread, or toast. Cereals with cream. Eggs (any style except fried). Fruit: fresh in season or dried. » Diet used at Nathan Littauer Hospital, Gloversville, New York. 323 334 HOSPITAL DIETARIES Dinner. — Tea (milk). Soup, with stock or broths; or cream soup. Crackers, bread and butter. Eggs: soft boiled or poached or raw (if desired). Vegetables: baked or stuffed potato or rice. Desserts: light puddings or ices or ice cream or jellies or custards or fresh or stewed fruits or baked apples. Supper. — Tea (milk). Fruit: (fresh in season), dried, canned or preserved. Bread and butter: white bread, toast, milk toast; egg or fruit sandwich. Vegetables: baked or, stuffed potato, creamed baked potato; rice, baked bananas or macaroni (plain). Eggs (any style except fried). Light puddings or custards, jellies, plain cakes. TYPICAL IIGHT DIET i Breakfast. — Oranges, coffee with milk and sugar, or tea ; milk, cream of wheat, eggs (soft cooked in shell), toast. Dinner. — Tea and milk, soup, crackers, bread and butter, baked potato, snow pudding. Supper. — Tea, milk, bread and butter, steamed rice, canned peaches, cake, jelly. MILE DIET 2 During the day give 6 to 8 ounces every two hours. During the night give 6 to 8 ounces every three hours. (When very ill give every two hours during the night.) FLUID DIETS Milk, beef tea, chicken broth, mutton broth, egg albumin. SOFT DIET 3 Cereals, soft eggs, milk toast, custard, farinaceous puddings, tea, coffee, cocoa, milk. SOFT SOLIDS 1 Soft toast, soft eggs, crackers in milk or broth, jellies of all kinds, ice cream, soft puddings without raisins, liquids of all kinds, soups strained, very weak tea, coffee or cocoa. Avoid: meat, potatoes, vegetables. LIQUID OB FARINACEOUS « Cereals, bread, jellies, liquids, ice cream, custard, blanc-mange, puddings (^without raisins), chicken. ' Diet used at Nathan Littauer Hospital, Gloversville, New York. ^ Diet used at Bellevue Hospital, New York. ^ Diet used at the Presbyterian Hospital, New York. •Diet used at the Massachusetts General Hospital. Boston. TYPICAL HOSPITAL DIETS 335 FARINACEOUS DIET i Breakfast. — Tea or coffee (milk and sugar). Bread and butter: white bread or graham bread or rolls or muffins or toast. Cereals. Dinner. — Soup: vegetable or macaroni or barley broth. Bread or crackers. Vegetables: baked potatoes or tomatoes or French beans or rice or macaroni or samp. Puddings: rice or bread or crack6r or tapioca or farina or cornstarch or arrowroot. Supper. — Tea (milk and sugar). Bread and milk or milk toast or hominy or boiled rice or puffed rice with custards or milk or farina or banana or potatoes baked. Fruit: apples (stewed or baked) or prunes or pears or peaches or apricots (other fruits ) . NITSOGENOUS DIET 2 Meat, fish, eggs (not fried), oysters, junket, custard, ice cream, string beans, soup and oatmeal; with crackers, fruit, butter and let- tuce. Breakfast. — Milk or tea or coffee (with milk). Bread and butter: graham bread. Meats: eggs or fresh fish or stew without vegetables or meat or hash without potatoes. Dinner. — Soup: stock or chowder, graham bread. Meats: beef (roast or boiled) or fresh fish or Irish stew. Vegetables: spinach, lettuce, celery or string beans. Desserts: custards. Supper. — Tea (milk), graham bread and butter or bread and milk, eggs or cold meat. NUTRIENT DIET 3 Two eggs strained through muslin into a tablespoon of cold water until dissolved. Add this to four to six ounces of cold milk, add one-half drachm salt, dissolved in water. If pa- tient is very low add tincture opii (deodorized). At times beef juice, one-half drachm is added, but is not necessary. OXAIURIA DIET 2 Oxaluria, as the name signifies, is an excess of oxalate of lime in the form of crystals in the urine, usually affecting the nervous, irritable dyspeptic. It is considered that possibly the 1 Diet used at Nathan Littauer Hospital, Gloversville, New York. = Diet used at the Massachusetts General Hospital, Boston. »Elbridge' J. Cutler, M.D. : Diet used at the Massachusetts General Hos- pital, Boston, Mass. 326 HOSPITAL DIETARIES frequency of the disease among the poorer classes is due to an excessive vegetable diet, sugar and starch foods, com- bined with irritating activities. The diet should be carefully regulated, though liberal. All vegetables and drugs contain- ing oxalates must be avoided; all lime or hard water should be forbidden and replaced by boiled or distilled water. Sugar should be prohibited, coffee and tea replaced by milk. Avoid asparagus, celery, cauliflower, green beans, tomatoes, spinach, rhubarb, potatoes, sorrel, carrots, parsnips, berries, apples, pears, plums, grapes, chocolate and cocoa. Cut carbo- hydrates low. Give this: (1) eggs, to£(st, milk; (2) meat or fish, green vegetables, except those forbidden; peas, onions, custard, fruit, ice cream; (3) cereals, cold meat, cooked fruit, except forbidden forms. STRICT SrGAK-FREE DIET Massachusetts General Hospital i See " Diabetic Diet." Page 367. SPECIAL FAT-EREE DIET i Breakfast. — Lean meat, 100 gms. ; toasted bread, 50 gms. ; coffee with a little milk and saccharine (no butter, no cream, no sugar). 11 A. M., albumin water of 2 eggs. tioon. — Clear soup, fat-free; bread, 50 gms.; lean meat, 100 gms. 4 P. M., albumin water of 2 eggs. Supper. — Lean meat, 100 gms.; bread, 50 gms.; rice, 50 gms. SAIT-EREE DIET i See Nephritis Diet. Page 393. TEST DIETS 1 Much stress is laid upon test-diets in order to determine the ability of the patient to properly assimilate fats, proteins or carbohydrates. These test-diets are known as " fat-free days," " sugar-free days/' " vegetable days," " oatmeal days," and a diet giving the proper amount of bulk, containing little pro- teids and carbohydrates, with the caloric value of the fat so low that it is styled "starvation days." ^ Diet used at the Massachusetts General Hospital, Boston. TYPICAL HOSPITAL DIETS 327 The main test-diet is the Schmidt diet as modified by Dr. Hewes.^ It runs three days, beginning with breakfast, and is as follows : Schmidt Diet Morning. — Fifty grammes zwieback; % litre oatmeal gruel, made of 40 gms. rolled oats, 200 c.c. milk, 300 c.e. water, 1 egg, 10 gms. butter. 11 a.m., % litre milk. Noon. — 125 gms. chopped beef broiled and made palatable with. 20- gms. butter; 250 gms. potato mashed with 10 gms. btrfter; 50 gms. toast. 4 P. M.', one-half litre milk. Night. — ^ame as morning. (Stools third and fourth days.) It is carefully weighed, measured, and prepared, and one-fifth ad- ditional of the amount served is sent to the laboratory for analysis. All the patient does not consume is weighed and deducted; all urine and feces are calculated. HOSPITAL EXTRA DIET 2 Chicken, eggs, stale bread and toast, scraped beef, sand- wiches, blanc-mange, soft custard without raisins ; raw -oys- ters, milk, broths, gruels, soups, milk whey, oranges, lemonade, crackers, jelly, ice cream, weak tea, coffee or cocoa. PISE DIET Consists of a ration of bread, ten ounces, and fish, eight ounces (the uncooked measure), such as haddock, cod or sole, or similar fish, potatoes, eight ounces, cocoa, one ounce, with half an ounce of sugar and a sixth of a pint of milk. This is a serviceable form of diet for those for whom large quantities of meat are not only unnecessary but injurious. BROTH DIET In children's hospitals a diet is sometimes classified as the "broth diet," consisting of mutton broth flavored with veg- etables, and bread and butter, with milk ; or a " beef tea diet," in which beef tea replaces the broth. In the lighter diet of children, gruels, bread and molasses, and simple farinaceous iDr. Hewes, Physician to Out-Patients, Massachusetts General Hospital. 5 Diet used at the Massachusetts General Hospital, Boston. 338 HOSPITAL DIETARIES foods such as farina, cornstarch, rice, etc., should play an important role. Sometimes such a diet goes under the name of " soft food." RESTRICTED DIET Breakfast. — Tea or coffee (with milk and sugar). Farinaceous food (with milk). Eggs. Dinner. — Soup ; raw oysters, roast beef, steak or chicken and veg- etables. Pudding (bread, rice, tapioca or cornstarch). Supper. — Tea (with milk and sugar). Bread (with butter). Fruit (fresh or dried). BELLEVUE HOSPITAL IN THE CITY OF NEW YORK, 1910 Dietary Table for Patients MONDAY Breakfast. — Coffee, with milk and sugar, bread and butter, oatmeal, crackers, milk (1 qt.). Dmner. — Roast beef, rice, soup, potatoes, vegetables, bread. Supper. — Tea (with milk and sugar), bread and butter, stewed apples. TUESDAY Breakfast. — Coffee (with milk and sugar), bread and butter, hominy, crackers, milk (1 qt.). Dinner. — Mutton stew, potatoes, vegetables, bread, bread pudding. Supper. — Tea ( with milk and sugar ) , bread and butter, prunes. WEDNESDAY Breakfast. — Coffee (with milk and sugar), bread and butter, rice, crackers, milk (1 qt.). . Dinner. — Eoast beef, barley soup, potatoes, bread. Supper. — Tea (with milk and sugar), bread and butter, stewed prunes. THURSDAY Breakfast. — Coffee (with milk and sugar), bread and butter, oatmeal crackers, milk (1 qt.). Dinner. — Beef stew, potatoes, vegetables, bread. Supper. — Tea (with milk and sugar), bread and butter, stewed apricots. FRIDAY Breakfast. — Coffee (with milk and sugar), bread and butter, two eggs, crackers, milk (1 qt. ) . Dinner. — Baked fish, potatoes, vegetables, bread, rice pudding. Supper. — Tea (with milk and sugar), bread and butter, prunes. TYPICAL HOSPITAL DIETS 329 SATURDAY Breakfast, — Coffee (with milt and sugar), bread and butter, hominy, crackers, milk (1 qt.). Dinner. — Mutton stew, potatoes, vegetables, bread. Supper, — Tea (with milk and sugar), bread and butter, stewed prunes, apples. SUNDAY Breakfast. — Coffee (with milk and sugar), bread and butter, crack- ers, milk (1 qt.), two eggs. Dinner. — Corn beef, bean soup, potatoes, bread, cornstarch pudding. Supper. — Tea (with milk and sugar), bread and butter, prunes. MILK DIET To be prescribed by the attending physician or surgeons. ARTICLES OF SPECIAL DIET Beefsteak, beef tea, chicken, chicken soup, rice and milk, eggs, milk. DIETARY OF THE PRESBYTERIAN HOSPITAL IN THE CITY OF NEW YORK, 1910 HOUSE DIET Breakfast. — Tea or coffee (milk and sugar). Bread and butter: White bread or Graham bread or corn bread or rolls or toast. Porridge: Oatmeal, or wheaten-grits or Indian meal or hom- iny or farina or samp. Meats: Hash or eggs or salt fish or fresh fish or stew. Dinner. — Soup: Stock or mutton broth with barley or vegetable or chowder; dry bread. Meats: Beef (roast or boiled) or mut- ton (roast or boiled) or corned beef or fresh fish or Irish stew. Vegetables: Potatoes, baked, boiled or mashed and tomatoes or baked beans or French beans or turnips or beets or rice or macaroni or samp. Pudding: Rice or bread or tapioca or farina or cornstarch or custard. Supper. — Tea (sugar and milk), bread and butter or toast and butter. Fruit: Apples stewed or baked or prunes or pears. CONVALESCENT DIET Breakfast. — Tea or coffee (milk and sugar). Bread and butter. White bread or Graham bread or corn bread or rolls or toast. Porridge: Hominy or farina. Meats: Eggs or fresh fish or stew (plain). Dinner. — Soup: Stock or chicken or mutton broth with barley or vegetable. Dry bread. Meats: Beef (roast or boiled) or 330 HOSPITAL DIETARIES chicken or fish (fresh). Vegetables: Potatoes (baked) or rice or macaroni or samp. Pudding: Rice or bread or tapioca or farina or cornstarch or custard. Supper. — Tea (milk and sugar). Bread and milk or milk toast or bread and butter or toast and butter. Fruit: Apples stewed or baked or prunes or pears. NITROGENOUS DIET Breakfast. — Tea or coffee (milk), bread and butter, Graham bread. Meats: Eggs or fresh fish or stew without vegetables or meat, hash without potatoes. Dinner. — Soup : Stock or chowder, Graham bread. Meats : Beef (roast or boiled) or mutton (roast or boiled) or fresh fish or Irish stew. Vegetables: Spinach or lettuce or celery or string beans. Pudding: Custard. Supper.— Tea. (milk), Graham bread and butter or bread and milk, eggs qr cold meat. FARINACEOUS DIET Breakfast. — Tea or coffee (milk and sugar). Bread and butter: White bread or Graham bread or corn bread or rolls or toast. Porridge: Hominy or farina or Indian meal. Dinner. — Soup : Vegetable or macaroni or barley broth ; dry bread. Vegetables: Baked potatoes and tomatoes or French beans or rice or macaroni or samp. Pudding: Rice or bread or tapioca or farina or cornstarch. Supper. — Tea (milk and sugar) bread and milk or milk toast or hominy or boiled rice or farina. Fruit: Apples stewed or baked or prunes or pears. MILK DIET Breakfast. — One quart of milk. Dinner. — One quart of milk. Supper. — One quart of milk. EXTRAS ORDERED ONLY BY THE ATTENDING PHYSICIAN OR SURGEON Mutton chops, beef steak, scraped beef, beef tea (made with hydro- chloric acid), chicken (broiled, fricasseed or roast), chicken broth, eggs, milk, oysters, clam broth, gruels, crackers, ginger bread, custard, milk toast. CHAPTEE XIV DIET IN DISEASE One of the most striking differences between the older and more recent methods of treatment of disease is the careful attention bestowed upon the diet at the present day. For it is now recognized that the proper selection of food, both solid and fluid, is of as much importance as the use of medicaments. In the management of diseases affecting the digestive organs proper, and in all affections of metabolism (gout, obesity and diabetes, for example) the diet may be said to represent the treatment, and there is hardly any disease which may not be benefited by intelligent feeding. These matters, however, are left entirely to the medical prac- titioner, and it is only exceptionally that the nurse is required to assume any responsibility. She should know in a general way, however, the types of food suitable in different diseased conditions, so that she may avoid harmful foods when not given specific instructions, and so that she may adapt the prescribed diet to the tastes of the individual. For this pur- pose, an outline of the diets in use in common diseases is included in this volume. DIET IN FEVERS AND INFECTIOUS DISEASES DIET IN TEVER IN GEKEBAL In fevers due to poisons circulating in the blood, there is an interference with heat regulation, so that the heat gen- erated in the body cannot be gotten rid of in the normal way; an increased metabolism; and a disturbance of the di- gestive and absorptive functions. It is, therefore, desirable to give easily digested food, in small quantities at frequent in- 331 333 DIET IN DISEASE tervals, preferably in liquid form, as substances dissolved in water are more readily absorbed, and water tends to aid in cooling the body to normal temperature. For the first three or four days, patients previously strong, should be given only fluid foods. But since a normal man, lying quietly in bed, requires about 2000 calories to com- pensate for daily loss of energy, and in the increased metab- olism of fever, this requirement is increased, it is necessary that more substantial food be incorporated into the diet as far as is possible without disturbing digestion. DIET. — Milk is the staple food, but must be given with care, swallowed very slowly and diluted with limewater, soda, seltzer or other effervescent water — one part to two parts milk. If milk can be taken, two or three pints should be given — four ounces every two hours, or six ounces every three hours. In case milk does not agree, whey may be given as a substitute for milk in part or in whole. Modified milk or peptonized milk may be given. Sometimes the milk may be flavored with tea, coffee, cocoa or malted milk and junket used. Next to milk the most important article of diet is beef juice and broths. Next come well cooked gruels. Later well prepared cereals and malt extract are valuable, and plain or cocoa junkets. Usually there is thirst, and all acid drinks, such as grape juice, may be taken. Panopepton with crushed ice, peptonised milk, clam, mutton and chicken broth, beef tea, clear soups, thickened with some farinaceous substance, gelatin jellies, are all of value. Liquids. — Pure cold water, toast water, any of the acid drinks, all sipped slowly, are recommended both to relieve thirst and on account of facilitating the speed with which the waste matter re- sulting from increased metabolism of the fever is eliminated through the kidneys. AVOID. — Any solid or vegetable food or fruits, until permitted by the physician in charge. DIET IN CONVALESCENCE FEOM FEVER Thompson i Convalescents who have long subsisted solely upon fluids must be careful in resuming solid diet, for the rapidity of recuperation of the digestive organs varies in different per- 'W. Oilman Thompson, M.D. : "Practical Dietetics." New Yorlc. D. Appleton & Co, FEVERS AND INFECTIOUS DISEASES 333 sons, and taking meats or other solid foods too soon may cause rise in temperature, rapid heart action, and possibly visceral congestion. The first meat given, therefore, should be in a finely subdivided state, such as scraped beef or minced chicken. During convalescence from protracted fevers the more easily digested forms of starchy foods are found to be very useful, especially if there has been much loss of weight. Sago and tapioca, and dried bread crumbs rolled through a fine sieve may be added to thicken clear meat broths. Crackers and zwieback are useful. Other ingredients which may be added to thicken soups during convalescence are panada, semolina, tapioca, and maca- roni. Custard puddings, cooked fruit, wine and beef jellies, blanc-mange, or baked custard, may be allowed. " Mush," fine hominy, cornstarch, farina, and boiled rice, with beef Juice, can be ordered. The following dietary will serve as a general guide for feeding convalescents from fevers of ordinary severity in which special lesions of the alimentary canal are not present. FIRST DAY Breakfast. — Poached egg on toast. Cocoa. Lunch. — Milk punch. Dinner. — Raw oysters. Cream crackers. Light wine if desired. Lunch. — One cup of hot meat broth. Supper. — Milk toast. Wine jelly. Tea. SECOND DAY Breakfast. — Soft cooked egg. Milk punch. Coffee with sugar and cream. Lunch. — One cup of soft custard. Dinner. — Cream of celery soup. Sippets of toast. A little barley pudding, with cream. Sherry wine if desired. Lunch. — Milk punch. Supper. — Water toast, buttered. Wine jelly. Tea. THIRD DAY Breakfast. — Coddled eggs. Cream toast. Cocoa. Lunch. — One cvip of hot chicken broth. Dinner. — Chicken panada. Bread. Light wine if desired. A little tapioca cream. 334 DIET IN DISEASE Lunch. — An eggnog. Supper. — Buttered dry toast. Baked sweet apples and cream. Tea. FOURTH DAY Breakfast. — An orange. Oatmeal (H. O.), with cream and sugar. Poached egg on toast. Baked potato. Cocoa. Lunch. — One cup of hot, soft custard. Dinner. — Potato soup. Crolltons. A small piece of beefsteak. Creamed potatoes. Baked custard. Coffee. Lunch. — One cup of chicken broth, with rice. Supper. — Raw oysters. Banquet crackers. Graham bread, toasted Wine jelly. Tea. FIFTH DAY Breakfast. — An orange. Coffee. Oatmeal, with cream and sugar. Broiled mutton chop. Toast. Lunch. — One cup of mulled wine. Dinner. — Chicken soup. Bread. Creamed sweetbreads. Duchess po- tatoes. Snow pudding. Cocoa. Lunch. — Siphon soda, with coffee syrup and cream. Supper. — Buttered dry toast. Orange jelly. Sponge cake and cream. Tea. A further discussion of this topic will be found in the sec- tion upon Convalescence in Typhoid Fever. While brandy and whiskey constitute the best form in which to give alcohol in the acute stage of fever, in con- valescence it is often advisable to use some other alcoholic drink, and an occasional change from one variety to another renders the patient somewhat less liable to the danger of acquiring a permanent alcoholic habit. For convalescence, if the patient's purse can afford it, champagne, port wine, sherry, Madeira, or a good claret or Burgundy, may be taken with advantage, in the class of cases above mentioned. TYPHOID FEVER The modern dietetics of typhoid may be conveniently con- sidered under three plans of feeding as follows : 1. Starvation Treatment of Typhoid. This ancient method of feeding or omitting to feed typhoid patients has recently been revived with alleged good results, but those who have tested the method are thus far few in number and it is very FEVERS AND INFECTIOUS DISEASES 335 unlikeljf that the profession as a whole will ever adopt it, especially since we know what may be done with liberal feed- ing. Typhoid subjects are commonly young, vigorous and well nourished and can naturally subsist for a long time on their own stored-up nutriment ; while by " starvation " they are protected from intestinal fermentation of undigested food. Hence such patients may seem to do well for a number of days on water alone given in unlimited quantities. But this represents but one aspect, and that a narrow one, in the prob- lem of feeding typhoid patients, and is applicable only to particular cases and particular stages of such cases. Much would also depend, perhaps, on other methods of treatment in use. Thus if the fever were kept down by cold baths, the demand for nutriment would doubtless be less than were the fever allowed to pursue its course. With advancing age the mortality rate increases greatly, and patients above thirty-five or forty doubtless require nutri- ment to a greater extent than the youthful. 2. Liquid Diet in Typhoid. This consists chiefly of milk, varied with broths and cereal decoctions. The milk which is the mainstay, is given in amounts up to two quarts in twenty- four hours, other articles being given only now and then to vary the monotony. Milk may itself be administered in various forms — peptonised milk, whey, malted milk and junket, kumyss and artificially-soured milk. Water is also given freely. This mode of dieting has been for many years the prevailing one for the acutely dangerous period of the disease, having succeeded the earlier beef tea diet. Under liquid diet may also be mentioned the various predigested foods, which, by reason of their concentrated state, are of value when there is difficulty in ingesting enough milk to make up the proper fuel value for the day. Of late years, it has been claimed that milk is unsuited for diet in typhoid because it forms an ideal culture medium for bacteria. A much older objection is the necessary forma- tion of irritating curds from the cows' milk usually given. This last objection has been met to some extent by peptonisa- 336 DIET IN DISEASE tion of the milk, and by ingesting it very slowly, so that no large clot can quickly form. Milk already curdled and emul- sified, as in the form of kumyss and other fermented products escapes this objection, and is less favorable to putrefaction. But the most weighty objection to -a fluid diet is probably found in the belief that it gives too few calories in propor- tion to the volume of food injected, and hence like the starvation treatment is not adapted for routine use but only for special cases and special periods. 3. Liberal or Generous Diet. This in its widest sense is doubtless the only sound routine plan, for it permits the use of semi-solid food if the patient can take it and digest it. It allows considerable variety, for such dishes as custard, ice cream, arrowroot, calf's foot jelly and the like, usually re- served for convalescence, may often be taken safely at an early period in the disease. There is, in fact, hardly any line drawn as to how far a person may go, provided he does not go beyond the dietary proper for delicate stomachs. Baked potato, baked apple, rice pudding, water toast and similar articles are gradually added to the diet and even lamb chop and soft-boiled eggs are given while the temperature is still elevated. This, of course, is in direct violation of the older rule of giving liquid food until fever has completely subsided. The justification appears to lie in the fact that liberal diet often saves life, and in cases where the chances seem against recovery it is one of the reserve cards to play. Because if the patient is likely to die in any case, the solid diet, if it can be tolerated, cannot add to the risk and may be of incalculable value. This observation was made long ago in connection with such diseases as childbed fever, blood poisoning, erysipelas, meningitis, gangrene and similar mala- dies with a natural tendency to go from bad to worse; and the severest types of typhoid belong in the same category of diseases. Note. — " High Caloric Feeding " in typhoid which has been tested in recent years is known as the high caloric, in which it is aimed to give the patient far more calories than he FEVERS AND INFECTIOUS DISEASES 337 should utilize in health, even at the hardest labor and on the most liberal diet. This is the exact antithesis of the water or starvation diet, in which the patient subsists on his own. tissues. In the high caloric plan the theory is to supply such an excess of nutriment that the least possible loss of tis- sue occurs; so that the period of convalescence and recupera- tion should be greatly shortened. Certain physicians have actually claimed a gain in weight during the fever under plans of this character. It is obviously very difBcult to feed typhoid patients with food having the highest calorific value. Even the blandest fats are badly tolerated, as is also cane sugar. It is possible, however, to use glucose, dextrin, and especially lactose, along with brandy, more or less in connec- tion with ordinary feeding, to such a degree that in in- dividual cases the number of calories in the ordinary liberal diet may be practically doubled. Whatever shortcomings exist in connection with calorie feeding are naturally increased with the amount of food. There is practically no limit to what can be ingested in twenty-four hours, but there may be a limit to utilization. The amount of calories actually used can only be determined by painstaking investigation of the excreta. There is also great individual variation in the oxidation of special food- stuffs, as is seen notably in alcohol. The greater the daily intake, the greater the difficulty in establishing common standards. For this and other reasons it is best to regard caloric feeding as merely a check, on the older methods and on common experience. It is hardly likely, therefore, that high caloric feeding will ever come into vogue, although it may have a field in the individual case or at some special period in a case. llftTJID DIET IN TYPHOID FEVER In iJhe ordinary ease, two and a half pints of milk and a pint and a half of beef, mutton or chicken broth will be a fair average supply, given in divided quantities, alternately. Give ten ounces at a time, every three hours; the broths will 338 DIET IN DISEASE come in after every second supply of milk. The amount of meat broths must be governed by the state of the bowels. If diarrhoea, then broths must not be given, or should be given in very small quantities. Broths tend to increase diarrhoea. In some cases meat jelly iced or extract of meat may be taken in place of broths, a teaspoon being given at a time. The chief guide in the matter of food in typhoid must be found in the condition of the stools. The physician in charge of the case should himself see the feces daily. If any signs of undigested food appear, there is something regarding the dietary that is wrong. If masses of hard curd appear in the motion, there is probably too much milk given in the twenty- four hours, or it is being given in too large quantities at a time. It may be that the quantities are not wrong, and that dilu- tion of the milk, or the addition of an alkali, or of some farinaceous material in powder well cooked in milk will an- swer the purpose by preventing the formation of the firm curd. Milk, if not retained or digested, should be peptonised. The chill may be taken from milk by adding a little hot water, and twenty drops of the saccharated solution of lime in each supply will secure alkalinity. Parinaceous substances to use in milk are arrowroot and baked flour, to aid in subdi- vision of the curd. Food should .not be given as the- nurse sees fit, but definite directions should be laid down as to the quantity to be given at a time and the mode of its administra- tion. Indication for the use of alcohol lies in the condition of the heart. A small, frequent, easily compressed pulse, espe- cially if associated with feebleness of the first sound of the heart, is a clear indication that alcohol is required. The amount given should be small — from a teaspoon to a table- spoon, or one ounce of wine. Alcohol, on account of effect only lasting for a short time, should be given every two hours, so that stimulation is kept FEVERS AND INFECTIOUS DISEASES 339 up. In giving alcohol, you get an effect first of stimulation, then depression. The use of alcohol is not advocated by some physicians. TTPHOID FLriD DIET OF PKESBYTEMAN HOSPITAl i Milk, broth, egg albumin. TYPHOID FLUID DIET OF 6I0VEBSVII1E HOSPITAL 2 Milk, strained broths of chicken, mutton, beef, clam broth, barley water, farina, arrovi^root and other gruels, custards, egg- nog, weak tea, bouillon, junket, cream, egg albumin, gelatin. DIET IN CONVALESCENCE FROM TYPHOID Thompson 3 As the fever subsides, it becomes an important question how soon to allow a return to solid food. Eelaps'es are very easily induced by indiscretion in this regard. The patient's appetite is always a dangerous guide to fol- low in this disease. After four or five weeks of an exclusive milk or milk and broth diet, when the temperature subsides, and often before it has become normal, he becomes ravenous. Like a long-starved man, he thinks of nothing but food, and demands something new to eat every day. A hospital ward containing a- dozen convalescing typhoid fever patients, is difficult to manage, as a bread riot is constantly menaced. Ill- advised but sympathetic friends attempt to smuggle in all manner of forbidden fruits, and the patient just arrived at the hungry state is tempted to steal solid food from his more advanced neighbors. In the milder cases it is undoubtedly both safe and wise to allow a strengthening diet at an early date, and it will greatly prolong convalescence to forbid it. Light farinaceous diet — tapioca, rice, vermicelli, cream-toast, a cracker soaked in cream, etc. — may be given with impunity in eases which have run a mild course, as soon as the temperature remains 1 Diet used at the Presbyterian Hospital, New York. 2 Diet used at the Nathan Littauer Hospital, Gloversville, N. Y. 3 W. Gilman Thompson, M.D. : "Practical Dietetics." New York. D. Appleton & Co. 340 DIET IN DISEASE normal. Meat broth may be thickened with rice, sago, or vermicelli. In a day or two more, the soft part of oysters or a chop are permissible in cases which have presented no need of prolonging a fluid diet for fear of intestinal injury. The following is a list of fluids suitable for the different days of convalescence, commencing a day or two after disap- pearance of all fever. Milk should still be given, until grad- ually wholly replaced by solid food : DIET IN TYPHOID AFTER TWO DAYS OF NORMAL TEMPERA- TURE i First Day. — Chicken broth thickened with thoroughly boiled rice. Milk toast or cream toast once only during the day. Beef juice. Second Day. — Junket, mutton broth, and bread crumbs. Cocoa. Milk toast. A piece of tender steak may be chewed but not swallowed. One of the prepared farinaceous foods, such as Horlick's, may be given with a cup of hot milk. Third Day. — A small scraped beef sandwich at noon. A soft cooked egg or baked custard for supper. Boiled rice or potato purge strained. Arrowroot gruel. Fourth Day. — The soft part of three or four oysters. Meat broth thickened with a beaten egg. Cream toast. Rice pudding or blanc-mange and whipped cream, or Bavarian cream. Fifth Day. — Scraped beef sandwich. A tender sweetbread. Bread and milk. A poached egg. Wine jelly or calf's foot jelly. Macaroni. Sixth Day, — Mush or crackers and milk, scrambled eggs, chicken jelly. Bread and butter. The soft parts of raw oysters. Seventh Day. — A small piece of tenderloin steak or a little breast of broiled chicken. Bread and butter. Boiled rice. Wine jelly. Sponge cake and whipped cream. Eighth Day. — A slice of tender rare roast beef, a thoroughly baked mealy potato served with butter or mashed with cream. Other food as before. 'Ninth Day. — A little broiled fresh fish for breakfast. Beef steak at dinner. Eice, macaroni, eggs. Sago, rice, or milk pudding. A baked apple. Tenth Day. — Mush and milk. A squab or breast of partridge or roast chicken. Other foods as before. Ice cream. 1 W. Gilman Thompson, M.D. : "Practical Dietetics." New York. Appieton & Co. FEVERS AND INFECTIOUS DISEASES 341 For the next four or five days the patient may select articles from the menu of the previous day, so that three good meals a day are taken, besides three or four glasses of milk between meals. It is often desirable to give a little alcoholic stimulant, especially if there is much difference in the frequency of the pulse between lying and sitting or standing, or if the pulse rate is very low, say 56, as it sometimes is. A glass of sherry or a good, sound Burgundy, or a tumbler of ale may be drunk, but with meals only. DIET IN TYPHOID AFTER TWO WEEKS OF NORMAL TEMPERA- TURE Presbyterian Hospital i Strained vegetable soups, baked apples, baked potatoes, oat- meal.. TYPHOID DELICACIES Presbyterian Hospital i Rice (well cooked), junket, custard, gruels, milk toast, scraped beef, eggs. TYPHOID EXTRA DIET Presbyterian Hospital i Broths, beef soups, oysters, white fish, beef, chops, mutton, steak, custard, eggs, chicken, rice, white bread, toast, farina- ceous puddings. Avoid vegetables, fruit, pastry or hot bread; LIBERAL DIET IN TYPHOID FEVER Shattuck 2 When typhoid fever kills it does so either by perforation or exhaustion, the proportion of the former being estimated at 5 to 10 per cent. The main factors in producing the ex- haustion which causes the death of at least nine-tenths of the fatal eases are toxemia, continued fever, diarrhcea and vomit- 1 Diet used at the Presbyterian Hospital, New York. 2 Frederick C. Shattuck, M.D. — Bead by title in the Section on Practice of Medicine at the Forty-eighth Annual Meeting of the American Medical Association at Philadelphia, Pa, June 1-4, 1897. 342 DIET IN DISEASE ing, and intestinal hemorrhage. The heart is ordinarily the best index of the presence and degree of exhaustion, and the most frequent serious pulmonary complication, hypostasis, in its various forms, degrees and consequences, is the direct out- growth of the cardiac weakness. Moreover, typhoid fever is not short and sharp like pneumonia, but of long course, and usually attended with decided, often with very great wasting of the muscular and fatty tissues. Most of us are agreed that we are not as yet acquainted with any therapeutic measures which will either abort or very materially shorten the course of the disease. "We are, I think, unanimous in believing that husbanding the strength from the start through skillful nursing, the Judicious use of water externally and internally, and the supervision of a wise at- tendant on the watch for and prepared to meet such indica- tions as may arise, materially modifies the course of the dis- ease and lessens its mortality. If what I have assumed to be facts be really facts, the question of diet must be a very important one in the management of typhoid fever. It is through the food which is assimilated, not through that which is merely put into the stomach, that we seek to limit the tis- sue waste while the process is active, and also try to land the patient on the low shore of convalescence with as much of his property as may be; for the recovery of his property is a necessary preliminary to the attainment of the high tableland of full health. Under the old doctrines as to inflammation, fever was an unfailing indication for depletion; directly by venesection, pukes, sweats and purges; indirectly by starvation. Indis- criminate direct depletion is now a thing of the past, and since the time of Todd the fact has gradually been more and more clearly recognized that the febrile state is often an indication for more, rather than less, nourishment, with selec- tion as to quality, rather than diminution as to quantity. In the shorter essential fevers a few days' starvation cannot do much harm, and may even be of great service with a certain class of patients. But suppurative fever for instance, whether FEVERS AND INFECTIOUS DISEASES 343 of tubercular or other origin, especially if chronic, we feed to the largest limit; and we do this because we treat the con- dition and not the disease, individualizing our cases. Since our knowledge of gastric chemistry has been enriched by the adaptation of the soft catheter to another hollow viscus at the opposite extremity of the abdomen, a more complete explana- tion has been afforded for the fact which we knew by practical experience before, that gastric digestion is often weakened in the febrile state. But the same practical experience teaches us that it is not always so, or very materially so, and when theory and practice conflict, the former must prevail. Have we not fully escaped from the domination of the old doctrine as to the lowering treatment of inflammation, or are there valid reasons why we should be less bold in feeding our typhoid patients than our chronic febrile consumptives? Three such reasons deserve special consideration. In .the first place, typhoid is far more frequently a self-limited disease than is phthisis ; but the fact of a self -limitation does not seem to me to warrant us in underfeeding, for the less the patient loses the less does he require to regain. In the second place, typhoid has constant intestinal lesions which may bleed or perforate, and which may be accompanied by a general catarrhal state of the intestinal tract. I may perhaps add here that diarrhoea is not nearly as constant a symptom in typhoid fever as the books lead students to believe. In at least 50 per cent, of my hospital cases no diarrhrea was pres- ent at any time. We must therefore have reference to the local intestinal lesions as well as to the general state. In a disease of such long course it is impossible to prevent acci- dents by putting the bowels in splints, even if it were de- sirable to do so. More or less peristalsis must go on, and waste matter must pass over the ulcerated surfaces ; and how deep or extensive the ulcerated surface may be in any par- ticular ease no symptom or group of symptoms enables us to measure. Hence, it seems rational, quite apart from the fever, to withhold from the diet any articles the residue of which is liable to irritate either the mucous membrane in 344 DIET IN DISEASE general or the ulcerated portion in particular. This would seem a fair explanation for the popularity of milk as a diet for typhoid, containing as it does a large proportion of water, and every principle necessary to nutrition, so combined as to make relatively small demands on the digestion of most per- sons, and leaving a residue which, though notoriously large, is not mechanically irritating. The objection to milk is that it is repugnant to a few persons, and becomes either repugnant or monotonous to a considerable number sooner or later. It is not necessary here to specify the many expedients which may and often must be resorted to to overcome this objection, and in some cases to render it digestible whether palatable or not. Milk is likely to maintain a very important, perhaps leading place in the diet of typhoid, as well as of other dis- eases and conditions. For a number of years I adhered as strictly as possible to an exclusively milk diet in typhoid fever until at least a week had elapsed from the date of the first normal evening temperature. I closed my ears to the clamors of adults, and my eyes and heart to the tears of children, as I now believe, unnecessarily. Thirdly, it was only comparatively recently the general opinion of the pro- fession that relapse is or may be due to errors in diet. I well remember the time when a fresh access of fever led my teachers and me to carefully inquire into the kindness of officious friends. It was often proved that forbidden fruit actually or metaphorically had been brought in by a visitor, and this was an entirely satisfactory explanation. When proof could not be had, the fact of relapse was strong pre- sumptive evidence of sin. We know better now, and while we recognize that errors in diet may produce fever, as may fatigue or excitement in convalescence from any severe dis- ease, we do not believe that they can start up a fresh invasion of bacilli from within. One of the things which set me thinking on this question of the diet in typhoid was the favorable course run by several acute febrile cases for whom I ordered a full diet because they were weak; believing at the time of so doing that typhoid could be excluded, but being FEVERS AND INFECTIOUS DISEASES 345 forced to the conclusion later that only typhoid fever could explain the whole course of the disease. These patients did perfectly well, were happier and convalesced more rapidly than my recognized typhoid cases fed exclusively on milk. For five years now, I have been enlarging the diet of my typhoid cases, and have seen no reason to regret this course, hut, on the contrary, found cause for satisfaction. During the twelve years, 1886 to 1897 (both inclusive), 380 cases of typhoid fever have come under my personal care dn the Massachusetts General Hospital. From 1886 to 1893, 233 cases were treated under a milk diet, with a mortality of 10 per cent. From 1892 to 1897, 147 cases have been freated under a much more extended diet with a mortality of 8.1 per cent. I know well the liability to reach false conclu- sions in reasoning from too small figures in a disease like typhoid fever. And it is also true that water has been used more efficiently of late than in former years. But I can see nothing in my figures to contravene my observation that an enlarged diet has not been injurious. I would not be understood as advocating an indiscriminate diet. My plea is simply for treating the patient rather than the disease; for feeding him with reference to his digestive power rather than solely or mainly with reference to his fever; for the view that the danger of accidents from the local intestinal ulceration is not increased by allowing him to partake of articles which leave no. irritating residue, and which cautious trial shows are digested without disturbance or discomfort. At one end of the scale are the cases with such irritability or weakness of the stomach as to lead to the unfortunate term gastric fever, or those with pronounced diarrhoea and un- digested food in the stools; at the other end are those more numerous cases with clean tongue and a desire for food. Between the two is every gradation. The life of the former may depend on the skill and ingenuity of the doctor, as- sisted by the intelligent devotion of the nurse. The com- fort and the duration of disability of all others may be materially modified for good by careful study and wise in- 346 DIET IN DISEASE dividualization of our cases. A long list of permissible ar- ticles, from which selection can be made for different cases, and for the same case at different times under varying cir- cumstances, can be given. That which I append makes no claim to completeness, but is meant merely to be suggestive and illustrative: 1. Milk, hot or cold, with or without salt, diluted with lime water, soda water, Apollinaris, Viehy; peptogenic and peptonised milk; cream and water (i. e., less alhumin), milk with white of egg, slip buttermilk, kumyss, matzoon, milk whey, milk with tea, coffee, cocoa. 2. Soups: beef, veal, chicken, tomato, potato, oyster, mutton, pea, bean, squash; carefully strained and thickened with rice (powdered), arrowroot, flour, milk or cream, egg, barley. , 3. Jlorlick's food, malted milk, carnipeptone, bovinine, somatose. 4. Beef juice. 0. Gruels: strained cornmeal, crackers, flour, barley-water, toast- water, albumin, water with lemon-juice.. 6. Ice cream. Water ice. 7. Eggs, soft boiled or raw, egg-nog. 8. Finely minced lean meat, scraped beef. The soft part of raw oysters. Soft crackers with milk or broth. Soft puddings without raisins. Soft toast without crust. Blanc-mange, wine jelly, apple sauce and macaroni. TONSIIITIS ANS aUINSY Thompson i Dietetic Treatment. These diseases require no special care in the acute stage, beyond giving food in such fluid form as can be most easily swallowed. The pain caused by this act is often so extreme that it is advisable to concentrate all food, to lessen the number of necessary acts of deglutition. Meat juice, peptonoids, beaten eggs and brandy, may be added to good milk. Plain vanilla ice cream may be given. Its cold- ness is sometimes soothing to the pharynx. Holding cracked ice in the mouth before swallowing will sometimes annul the pain momentarily, or in extreme cases the pharynx and tonsils may be sprayed M^ith cocaine, and the >W. Gilman Thompson, M.D. : "Practical Dietetics." New York. D. Appleton & Co. FEVERS AND INFECTIOUS DISEASES 347 period of temporary ansethesia may be utilized for swallowing considerable nourishment. This is rarely necessary, for un- less the patient is emaciated by previous serious illness, he is not apt to be in need of much food for a day or two. In bad cases of suppurative tonsilitis the strength sufEers more, and stimulants may be given by the rectum if deglutition is im- possible. After all forms of tonsilitis there is apt to be considerable anaemia, and the patient for a week or two should eat abundantly of animal food. Egg-nog and milk punches are often needed for the first few days of convalescence. DIPHTHERIA Thompson i Dietetic Treatment. "Alimentation occupies the first place in the general treatment" (Trousseau). Throughout the active stage of the disease, while the fever lasts, there is difficulty in swallowing. , All food must be given in fluid form, of which milk is the best, or if, as sometimes happens, semi-solid material is more easily swallowed, the food must be thickened with cream, gelatin, eggs, or farinaceous articles ; or Dry Peptonoids Soluble, malted milk, etc., may be added for this purpose to other foods^ The use of pineapple juice is recommended because it contains an enzyme which belongs to the proteolytic group. The diet should consist chiefly of nutritious beef or chicken broth and beef tea, egg albumin, egg-nog, milk, and milk punch. Plain vanilla ice cream is nutritious, and if not too sweet, it is well borne, and is frequently very grateful to the inflamed throat. Simple farinaceous foods, such as arrow- root, thoroughly cooked rice, soft cream toast, and gruels, may be taken. Continued disgust for food is a very bad prognostic sign, and every effort must be made to counteract it by offering variety. When the child is unable to swallow on account of pain in accumulation of membrane in the iW. Oilman Thompson, M.D. : "Practical Dietetics." New York. D. ' Appleton & Co. 348 DIET IN DISEASE throat, forced feeding with a nasal or stomach tube may be better than nutrient enemata. FNETTIIONIA Thompson i Dietetic Treatment. The indications for treatment are to give a light diet, Vhich will not excite the cough in swallow- ing, or increase dyspnoea by distention of the stomach, or augment the enfeeblement of the heart action by, overtaxing the digestive powers. Vomiting should be especially guarded against, and if nausea exists, efforts should be made at once to control it. It is not necessary to keep the patient upon a rigid milk diet, but if milk is well borne, it is advisable to give nothing else while the acute symptoms last; otherwise, whey, meat juice, broths, and egg albumin may be allowed. Starchy and saccharine food must be withheld. . Cold drinks are both acceptable and beneficial to the patient, and water plain or aerated, such as ApoUinaris or soda water, may be drunk in considerable quantity. It is believed by some au- thorities that the activity of the kidneys may be thus pro- moted, and that the poison which occasions the constitutional symptoms of the disease may be better eliminated. There are cases, however, among persons with robust circulation, in which the onset is very sudden and violent. The pulse' is full and bounding, and the heart is greatly overworked by the effort to propel a large volume of imperfectly aerated blood. In such instances the addition of large quantities of fluid to the circulation, besides what is actually required for nutrition, may have the effect of still further straining the heart. It is stated that carbonated waters reduce the viscidity of the sputum, which is often very tenacious. The diet should be kept fluid until defervescence has oc- curred, with a normal temperature and commencing disap- pearance of the exudation — in fact, it is well to prolong ' W. Oilman Thompson, M.D. : "Practical Dietetics." New York. D. Appleton & Co. FEVERS AND INFECTIOUS DISEASES 349 the fluid diet for three or four days after the temperature has become normal, in order to make sure that a relapse of the fever is not likely to follow. In those eases in which resolution is postponed, and the patient becomes more and more feeble, although the temperature may be nearly or quite normal, it may be desirable to give a little properly prepared solid food somewhat earlier, and scraped beef, with toast, or a soft-cooked egg may be added to the milk 'diet. During the entire period of convalescence the diet must be very nourishing and of easy digestion; milk may still be given, and after slowly returning to the regulation three meals a day (see Diet in Convalescence from Typhoid Fever, p. 339, patients do well to take milk punch, or egg-nog, or a glass of wine and a biscuit three or four times a day in the intervals. Alcohol is exceptionally well borne, and it undoubtedly serves both as a food and a support to the overworked heart. The fact that it is thoroughly oxidized in the circulation or tissues is demonstrated by the large quantities which patients can often digest and absorb without toxic symptoms. Doses may be thus tolerated which in health would ordinarily pro- duce drunkenness. In alcoholic subjects who have been drink- ing up to the time of the onset of the disease, it is indispen- sable to continue the use of alcohol, for the sudden withdrawal of its stimulating effect on the organism may give rise to rapid collapse. In aged and constitutionally weak persons it is also important that its use should be begun early in con- siderable quantities. In extreme cases as much as an ounce every two hours, or twelve ounces in the day, may be given with benefit, but ordinarily from six to eight ounces will suffice. There are other cases found among robust subjects who do not need such stimulating, and possibly may not require alcohol at all. The custom now in vogue of prescribing other forms of cardiac stimulants, such as strychnine and vasodilators, like nitroglycerin, makes the employment of excessive doses of alcohol less imperative. It should always be remembered 350 DIET IN DISEASE that it is undesirable to produce toxic symptoms of alcoholism in pneumonia, as well as in any other disease. So long as the pulse is slowed and its force strengthened, the use of alcohol may be regarded as beneticial; but if delirium is in- creased, and the odor of whiskey or brandy is strong in the breath an hour or two after it has been given, it is an indi- cation that the patient is receiving more than is desirable, and the dosage should be reduced. From its serving as a fuel, and thereby saving tissue waste in the muscles, the free use of alcohol in pneumonia undoubtedly saves many lives. BRONCHO-PITEUIIONIA Thompson i Dietetic Treatment. Broncho-pneumonia is always a very critical disease, and the utmost care is required in nursing and feeding. The diet should consist of such articles as meat juice, predigested milk, and egg albumin. Stimulation is early required, and in considerable quantity. Brandy or whiskey, sweetened with a little sugar, and cold water, should be systematically given, especially to young children, who are unable to make their want of drink known. Hot milk and Vichy, in the proportion of one part of Vichy to two of milk for older children, or half-and-half for young infants, may have the effect of loosening the tenacious mucous and easing the cough. If there is any tendency to flatulency, aerated waters had better be avoided. When the disease oc- curs in children the diet should be adapted to foster the strength and tax the digestive organs as little as possible. At first food should be given every two hours, and milk is usually all that is required. Later it may be alternated with or supplemented by egg albumin, expressed meat juice, plain beef or mutton broths, arrowroot, or other gruels. MUMPS Thompson i For mumps no special diet is required, beyt)nd the neces- sity of giving fluids or soft food while the swelling of the ^ W. Oilman Thompson, M.D. : "Practical Dietetics." New York. D. Appleton & Co. FEVERS AND INFECTIOUS DISEASES 351 parotid glands and fever last. The suggestions for the die- tetic treatment of tonsilitis apply to this disease. Anaemia is apt to be extreme during convalescence, and meat should therefore be plentifully supplied. Cod-liver oil is very ap- propriate in protracted convalescence. WHOOPING COUGH Thompson i In whooping cough the paroxysms of coughing are so severe as to give rise to vomiting, and in bad cases they are excited by taking food which does not have an opportunity to become assimilated, and nutrition may suffer very seriously in consequence, adding to the general exhaustion which accompanies the disease. All food must be made easily as- similable. It is best to give food regularly in moderate quan- tity at each time, and it should be predigested if neces- sary. Pancreatinised milk, kumyss, the prepared amylaceous foods, cream toast, eggs, Junket, chicken broth, malted farina- ceous foods, custard, milk puddings, gruels thickened with meat extracts, and stimulants in the form of egg albumin in sherry, egg-nog or milk punch, at-e recommended for patients who vomit solid food. The worst cases require nutrient enemata, as exhaustion becomes critical. DIET IN TTJBERCUIOSIS, ESPECIAIIY PriMONARY CONSTTUP- TION Before we learned of the contagious character of this affec- tion, and its dependence on the tubercle bacillus, it was the custom to regard tuberculosis as a disease of nutrition, curable only by abundant feeding — all that a patient could tolerate — and especially feeding with fats and mineral matter. Even in modern times the custom of overfeeding is largely re- sorted to, and when the patient has but little appetite, the stomach sound is often used to give large quantities of con- centrated liquid food, perhaps predigested. Many physicians strongly disapprove of this practice, claiming that it is utterly ' W. Oilman Thompson, M.D.; "Practical Dietetics." New York. D. Appletou & Co, 353 DIET IN DISEASE irrational and throws an enormous amount of extra work on the organs of digestion, assimilation and elimination. It is as true, as ever, that a full diet antagonizes the dis- ease. A tuberculous subject or one likely to becomp so, is not , capable of much physical exertion, and save in the hectic fever stage, has not much temperature. The poison of the disease deprives him of a natural appetite, and unless he is able to assimilate a normal amount of food, he loses iiesh progressively, as in any other affection with loss of appetite or indigestion. Hence his diet does not differ much from that of the convalescent in the composition of food; but on account of the enfeebled appetite and digestion the in- dividual articles best borne are those used in severe indiges- tion from any cause. That is, they are to be concentrated, bland, and as varied as possible. As in dyspepsia, the pa- tient does best on small and frequent meals. Considerable use can be made of milk, cream, buttermilk, kumyss, etc. The remarkable and inexplicable curative effects of a certain amount of fat in the diet should never be for- gotten. The frequent repugnance to fat has in fact been connected with the development of disease. This distaste does not usually extend to cream, butter and salad oil, and many forms of emulsions of fat with or without hypophos- phites have a deserved reputation. So important is a cer- tain amount of fat that many physicians have it rubbed into the skin and even injected subcutaneously. ' The patient is not limited to a fixed daily quantity, but is given as much as he can tolerate. A certain amount of alcohol in some form is so well borne in tuberculosis as to make it a dietetic article of value. It is probable that both fat and alcohol act by protecting the protein. Both have a high caloric value, sO' that the amount of other nutriment can be restricted, and should consist largely of eggs, milk and an occasional piece of tender meat. For an average consumptive, without fever, but with no desire for food, six small meals may be given daily. FEVERS AND INFECTIOUS DISEASES 353 1. 8 A. M. Milk, taken slowly, two glasses, with a roll or toast and butter and a little marmalade. 2. 10 A. M. Milk punch, taken slowly. 3. 1 p. M. A course dinner may be given for the sake of variety: cup of broth, a few bites each of fish, beef, potato and anything else craved as an entree (as a bit of smoked tongue). Also a mouthful or two of some kind of dessert. The patient may aid the appetite by taking wine, or some form of malt liquor. 4. 4 p. M. Two glasses milk slowly sipped. 5. 7 p. M. Like dinner, but much smaller. A plate of soup, a chop and a little preserve with a glass of wine. 6. Bed time. Two glasses of milk slowly sipped. In this way up to 2500 calories may be taken without over- feeding. If a patient technically tuberculous, but with good appetite and digestion can take 3000 to 3500 calories daily without discomfort, he may do so, even though his quiet life would not otherwise make such a quantity desirable. The fat and alcohol which help so materially to swell the number of calories tend to fortify the body against" the progress of the disease. On the other hand, patients in advanced or confirmed phthisis can hardly be saved by any plan of feeding. They often suffer from severe complications like incessant diarrhoea or laryngeal phthisis which make any plan of feeding difficult. Each case, therefore, must be a law to itself. The modern custom is to feed them all they can tolerate, especially of solid food, to supply energy, for the paroxysms of coughing and the exertion necessary to dress and get about in the out- door air. DIET: Soups. — Turtle or oyster soup, mutton, clam or chicken broth, purge of barley, rice, peas, beans, cream of celery or tomatoes, whole beef tea, peptonised milk gruel. Fish. — All kinds of fresh fish, boiled or broiled, oysters or clams, raw, roasted or broiled. Meats. — Rare roast beef or mutton, lamb chops, ham, fat bacon, sweetbreads, poultry, game, tender steaks, hamburger steak rare. 354 DIET IN DISEASE Eggs. — Every way except fried. Farinaceous. — Oatmeal, wheaten grits, mush, hominy, rice, whole wheat bread, corn bread, milk toast, biscuits, mufiSns, gems. Fats. — Cream, butter, olive oil, Scott's Emulsion. Yegetailes. — Potatoes, baked, boiled or creamed, string beans, spinach, onions, asparagus, tomatoes, green peas, all well cooked, cresses, lettuce (alone or with oil dressing), celery. Desserts. — Farina, sago, tapioca, apple or milk pudding, floating island, custards, baked or stewed apples with fresh cream, cooked fruits, rice with fresh cream. Liquids. — Fresh milk, cool, warm, or peptonised, cocoa, chocolate, buttermilk, pure water, tea, coffee, Liquid Feptonoids. AVOID. — Fried foods, salt fish, hashes, gravies, veal, pork, carrots, parsnips, cabbage, beets, turnips, cucumbers, macaroni, spaghetti, sweets, pies, pastry, sweet wines. CHAPTEE XV DIET IN DISORDERS OF NUTRITION DIET IN DIABETES It is commonly believed that diabetes should be managed dietetieally by a sugar-and-starch-free regimen, carried to such a degree that excess of sugar no longer appears in tlie urine. As a matter of fact, such teaching may be very mis- leading. A diabetic, in the early stages at least, must lead a fairly active life, and requires the usual number of calories for such living. If sugars and starches are removed wholly from the diet, the requisite calories must be derived from protein and fat, and this may prove a strain both on the desire for food and its digestion and utilization. It is there- fore rational to allow a certain percentage of carbohydrates,, as they occur in such common articles of food as bread, cereals, potatoes, etc., even if they favor the appearance of sugar in the urine. We know that in this disease, the starch and sugar in the diet becomes a poison if carried beyond a certain stage. The tissues then become saturated with saccharine products, and readily succumb to chance infec- tions, the microbes of which behave as they do in sweetened culture media. But in a vigorous subject leading an active life, there is always a point within which the bodily activities are sufiBcient to oxidize most of the carbohydrate intake; and a certain amount of escape of excess products in the urine is then relatively insignificant. A characteristic diet is as follows : (a) First Breakfast. This should consist of lean and fat meat, such as occurs naturally in ham or bacon. For a bev- erage we may give coffee sweetened with saccharine. If there is a craving for bread, starch-free gluten bread should be added. 355 356 DIET IN DISEASE (b) Second Breakfast. Cream, eggs, beef juice, kumyss, or other liquid or semi-liquid food. (e) Noon Meal. A course dinner, beginning with broth enriched with an egg, meat, or bits of green vegetable. To this should be added small portions of fish, roast, entree, game, etc. As extras, salad, cheese, etc. Wine, etc. A small amount of bread and butter and potatoes if craved. First Evening Meal. Coffee and cream, sweetened with saccharine. An egg added if craved. Second Evening Meal. This, usually served at bed time, is meant to give the patient a chance to make up for de- ficiencies. He may indulge especially in sapid food, as fish, oysters, clams, caviare, sardines, etc., with plenty of salad vegetables. Bread and butter, cheese, nuts, etc., if craved during the meals of abstention may be given if allowed. The foregoing menu is intended for those stages of the disease in which the patient profits by some use of carbohy- drates. With the advance of the affection, a point is reached at which such foods are actually pernicious. It then becomes a problem to nourish these individuals with a diet practically free from sugars and starches. It is only necessary for the nurse to have at hand tables of food containing the exact percentage of carbohydrates; for in this way she may protect the sufferer. A point is reached at last in which a certain excess of carbo- hydrates may precipitate a fatal termination. DIABETIC DIET OE BELLEVITE HOSPITAL i Meat. — Fat beef, mutton, ham and bacon. FisTh.— Fieah fish, salted codfish, canned salmon, sardines, oysters and clams. Farinaceous. — Gluten bread and biscuits. Vegetables. — String beans, spinach, lettuce with olive oil and vinegar, cabbage, cucumbers, onions, tomatoes, cauliflower, asparagus, celery, watercress, radishes, pickles and olives. Cream cheese. Dessert. — Custards, jellies and creams (without sugar), walnuts, Brazil nuts and pecans. Drinks.^- Tea, or coffee without sugar, water and buttermilk. ^ Diet used at Bellevue Hospital, New York. DISORDERS OF NUTRITION 357 DIABETIC DIET OF PRESBYTERIAN HOSPITAL i Buttermilk, kumyss, beef tea, coffee, cocoa, tea, saccharine in lieu of sugar, clams (thin soup), fish, poultry, beef, mutton, bacon, eggs, string beans, cabbage, tomatoes, lettuce, spinach greens, lemons, apples, oranges, strawberries. No milk or sugar. DIABETIC DIET OE THE MASSACHUSETTS GENERAL HOSPITAL z DIET. — Meats of all kinds (except liver), fish except lobsters or oysters, poultry, game, eggs, cheese, butter, lettuce, celery, cucum- bers, watercress, dandelions, young onions, cabbage, cauliflower, spinach, beet-tops, string beans, artichokes, filberts, mushrooms, almonds, butternuts, walnuts, eocoanut, sour oranges, grape fruits, currants, alkaline waters. AVOID. — Sugar, syrup of all kinds, potatoes, beets, peas, parsnips, carrots, beans, arrowroot, sago, tapioca, oatmeal, barley, sweet fruits, chocolate, cider, malt liquors, champagne, sparkling or sweet wines and milk. STRICT SUGAR-FREE DIET 2 (Diabetic Diet) Diabetic Diet (Strict — Sugar^free). Contains about 20 gms. of carbohydrates, calories 2800, proteid 110 gms. Breakfast. — Bacon, 100 gms.; eggs, 2; orange, 1; coffee with saccha- rine and cream. 11 A. M., Cheese: cream or Swiss, 50 gms. Nocn, — Beef, veal, lamb or chicken, 100 gms.; lettuce or tomato salad with oil; spinach, onions, cabbage or cauliflower, olives; cus- tard made of eggs and cream with saccharine or ice cream made the same way. 4 P. M., Soft cooked egg with butter. Supper. — Fish, 100 gms.; cucumber salad with oil; asparagus or beet tops; mushrooms, nuts; give all cream and butter possible. Vary diet within above limits. 60 per cent, centrifugal cream is used, diluted with water. At start give above diet with addition of 300 gms. bread. After two to four days, decrease bread gradually 100 gms. — 50 gms. to strict diet. If acidosis increases with strict diet, give large doses of soda. Control in this way, and by changing diet. "If patient has increasing acidosis on strict diet add soda 8 ' Diet used at the Presbyterian Hospital, New York. 'Diet used at the Massachusetts General Hospital, Boston, Mass. 358 DIET IN DISEASE oz. a day, try method of starvation one day, vegetable diet (no carbohydrate) one day, oatmeal, 260 grammes one day, alternating. The same plan may be tried if there is failure to get sugar-free urine on strict diet; but first try plan of cutting down protein on strict diet, replacing protein with more cream and butter,, as sugar is made from protein. Keep on strict diet one month after using sugar-free; then add bread 25 gms., etc. CHRONIC DIABETES DIET DIET. — Soups: Soups or broth of beef, chicken, mutton, veal, oysters, clams, terrapin or turtle (not thickened with any farinaceous substances), beef tea. Fish. — Shell fish and all kinds of fish, fresh, salted, dried, pickled or otherwise preserved (no dressing containing flour). Eggs. — In any way most acceptable. Meats. — Fat beef, mutton, ham or bacon, poultry, sweetbreads, <;alf's head, sausage, kidneys, pig's feet, tongue, tripe, game (all cooked free of flour, potatoes, bread or crackers ) . Farinaceo'us. — Gluten porridge, gluten bread, gluten gems, gluten tiseuits, gluten wafers, gluten griddle cakes, almond bread or cakes, bran bread or cakes. Vegetables. — String beans, spinach, beet- tops, chicory, kale, let- tuce, plain or dressed with oil and vinegar, cucumbers, onions, toma- toes, mushrooms, asparagus, oyster plant, celery, dandelions, cresses, radishes, pickles, olives. Desserts. — Custards, jellies, creams (without any sugar), walnuts, almonds, filberts, Brazil nuts, cocoanuts, pecans. Drinks. — Tea or coffee ( without any sugar ) , pure water, pepto- nised milk, buttermilk. AVOID. — Liver, sugars, sweets or starches of any kind, wheaten bread or biscuits, corn bread, oatmeal, barley, rice, rye bread, arrow- root, sago, macaroni, tapioca, vermicelli, potatoes, parsnips, beets, turnips, peas, carrots, melons, fruits, puddings, pastry, pies, ices, honey, jams, sweet or sparkling wines, cordials, cider, porter, lager, chestnuts, peanuts. SUBSTITUTES FOB STARCH AND SUGAR Gum Oluten Flour can be made into bread and a great variety of •dishes, and is the most satisfactory substitute for the wheat flour bread or bread in common use, and the effects are particularly no- ticeable in the reduction of sugar in the daily tests. Sweetina is in the pure crystal form, and is made into a syrup by DISORDERS OF NUTRITION 359 adding cold water. Distilled water is preferable. It is sold in small bottles at 25 cents each, the contents of which is equal to eight pounds of sugar in sweetening power. One bottle of crystals makes one pint of syrup, of which a tea- spoonful is equal to a cupful of sugar. Sweetina is an improved product from coal tar. A DIABETIC CHAKT Joslin and Goodall i The intelligent management of a case of diabetes mellitus requires frequent comparisons between the diet, the urinary analyses and the weight of the patient. These data are often printed or written down in four or five different places, and the labor of uniting them is so great that it is seldom at- tempted. Any accurate study of a case is thus extremely difficult, and in hospitals past records are almost useless. To facilitate the treatment of diabetic pa,tients and to eliminate some of the annoying sources of error, we have used a chart for some years upon which some of these facts were recorded. Our chart was designed chiefly for the benefit of the physician, in contrast to the charts in use in various German clinics, which have a broader application and are of direct help not only to the physician, but also to the nurse and the patient as well. By this latter arrangement the chart becomes the nurse's record, and upon it the nurse writes what the patient actually eats. We have attempted to combine the two meth- ods on the following chart, and hope that it will be found helpful and suggestive in the treatment of diabetic patients. Space is reserved upon the chart for the Doctor's orders and the nurse's record, as well as the urinary analyses. There is given, in addition, a statement of the foods com- monly allowed in a strict diabetic diet, with the percent of carbohydrates in other foods which are occasionally em- ployed. lA Diabetic Chart by Elliott P. Joslin, M.D., and Harry W. Goodall, ■ M,D., Boston, Mass. (Reprinted from the Boston Medical and Surgical Journal, Vol. clviii, No. 8, pp. 248-261, Feb. 20, 1908.) D. C. Heath & Co., 120 Boylston St., Boston, Mass. 360 DIET IN DISEASE < u u o M H P O 13 T3 ■a fu o Pi (U u pqfe fa fe-S ^2; !M ni O .i 6 , .St) Pi > w M Pi < w Pi ^ p3 5|§ «OOH^N O t/1 01 fa Ph. o ca HO Si's 2 Cj ™ rt ■? -S So 3 Is DISORDERS OF NUTRITION 36] a § 4) a a P § 3 cS o u to bo ■" S? 2 MSB' si e-i. m S £^ C3 ffl B OJ « ^ pC n en to 03 pfi ta 3 o s o h + o o OQM 5«s h o o A< u 2 »> m o E a*3 ^H OJ ta ft 4) ft^ eB^ aS5 I 3 «U M-I h^ •f-l « 02 -" a « ° + o a s^ a a a " " o "3 m Pi o oT " O rO CO fe Efl _, fl (Dm "S 3 a 3 SOQ) Qj a tj a o>4 &i>>^ 3 ^ -g a a acn ••■si* » a=j4 ■ft oooixi •a p '1^ 51.5 p-c^ ftS P E3 S _- ojfta^iuKipMoP^ •- W. Oilman Thompson, M.D. : ' ' Practical Dietetics.' ' New York. D. Appleton & Co. DISORDERS OF NUTRITION 369 toms are acute, such as pain and swelling of the joints, the patient should be put upon a fluid diet. The majority of cases do best at this time with an exclusive milk or bread- and-milk diet. Those patients who cannot take milk, how- ever, may be allowed soups and broths flavored with vegetable extracts, chicken tea, milk toast, barley or oatmeal gruel, clam broth. Thirst is often a prominent symptom, especially if there- be much fever, and it is advisable for the patient to drink fluid freely to assist in washing out the waste products from the body. Lemonade and slightly acid drinks of various kinds, such as dilute phosphoric acid or the effervescent min- eral waters, are recommended. Boiled milk and Seltzer or Vichy may be drunk, or oatmeal or barley water flavored with lemon. Alcohol should be avoided while the acute symp- toms last, unless the complication of inflammation of the endocardium or pericardium enfeeble the heart action, if pro- longed and ansemia is considerable, alcohol may be given as a tonic two or three times a day in the form of a glass of claret or Burgundy (one to two ounces), or diluted whiskey. During convalescence the appetite is not usually vigorous,, and it is not necessary to urge the taking of much food at first. The diet 'should be principally farinaceous, but not saccharine. Such articles may be-given as rice (plain or spiced), arrow- root, oatmeal, cornmeal, semolina, wheaten grits, panada, milk toast, simple unsweetened puddings, wine jelly, blanc-'mange and malted foods. The return to solid diet should be gradual, and for a long^ time the patient should abstain from eating meats as well as from pastry and sweets. Fagge states that no meat or fish should be allowed for at least a week after subsidence of the fever and acute symptoms, or, better, for a fortnight, and many believe that beef tea is harmful. Meat can undoubtedly induce a relapse. When convalescence becomes established, eggs, fish, oysters, and white, meat of broiled or roasted chickens may be given,. SrO DIET IN DISEASE and one or two such vegetables as asparagus, spinach, or stewed celery, with a baked apple or fresh fruit, but sweets and alcohol should long be withheld. The patient should be fed often, having one or two extra lunches during the day, for anaemia is apt to prevail for some time, and abundant nutriment is required. KHEUMATISU Massachusetts General Hospital i BIET. — Graham or brown bread, white bread limited (% slice daily), corn, granum, rice, milk, eggs, flour, puddings, crackers, beans, peas, all kinds of vegetables (except potatoes aiid cooked tomatoes), rhubarb, fresh fish; butter, cheese, buttermilk, cream, alkaline waters, toast. AVOID. — ^Red meats, starch or potatoes, white bread, sugars. CHRONIC RHETTUATISK DIET: Soup. — Beef tea, chicken and mutton broth in small quantities. Fish. — Raw oysters or clams, white fleshed fresh fish — broiled or boiled. Meat. — Sweetbreads, chicken, tripe, broiled fat bacon or boiled ham ( all sparingly ) . Farinaceous. — Boston brown bread, corn, whole wheat bread, cornstarch, rice, milk toast, dry toast, graham bread, granum, butter, crackers. Vegetables. — All except potatoes and cooked tomatoes. Desserts. — Plain puddings, rhubarb; junket (all without sugar). Liquids. — Milk, cream, buttermilk, malted milk, alkaline waters, tea, cocoa (no sugar), pure water, plain or with lemon or lime (no sugar). . AVOID. — Red meats, pork, turkey, goose, duck, veal, fried fish, cooked oysters or clams, salted, dried, potted or preserved fish or meats (except ham and bacon). Lobsters, crabs, salmon, eggs, rich pies, made dishes, gravies, potatoes, tomatoes, asparagus, mushrooms, rich puddings, candies, nuts, cheese, coffee, cider, malt liquors, wines. DIET IN OBESITY This is one of the most important features of ' dietetic therapy, and is older and better known than any other, prob- ably because of its connection with conditioning athletes for 'Diet used at the Massachusetts General Hospital, Boston. DISORDERS OF NUTRITION 371 all kinds of contests and also from the cosmetic point of view, as superfluous flesh generally implies advanced years. Unlike many other plans of diet it concerns the nominally healthy rather than the sick and invalid. The old trainer of athletes knew little or nothing of any scientific regimen for reducing adipose tissue. For him re- duction of weight was merely a matter of getting rid of superfluous water, to be accomplished by sweating, purgation and abstinence from fluids. He rejected certain articles of diet as "bad for the wind," but this is as near as he came to specializing in diet. Exercise, without profuse perspira- tion, meant nothing to him. The steady grind of a worker who burns up so much, excess fat daily, yet without any un- usual degree of perspiration, is something he took no account of. Of recent years it has been learned that abstinence, hoi; baths and purgation, are far less efficacious in keeping down weight than continuous and vigorous exercise within the fa- tigue limit. It is much less a matter of starvation and elimination than of a steady oxidation of superfluous tissue by graded and varied exercises extending throughout the day. But while constant exercise is the chief essential, it is also important to curb the appetite for food and drink, and to- keep the excretory organs active. Otherwise, in the ease of novices at least, increased exercise will provoke increased, appetite for food and drink, so that not a few people gain flesh while trying to lose it. Doubtless the best plan for reducing flesh without suffering and violence is to do a great amount of work daily, severe enough in character to oxidize much body fat, but without profuse waste of fluids by sweating, etc. In regard to the meals, these should be small, light and as frequent as desired. Nothing should be taken to provoke thirst. Any food-article whatever which is especially rich in starch, sugar or fat, along with alcoholics, must be omitted. Such individuals thrive best on toast or biscuit without butter; lean meats, fish and eggs; and vegetables which grow' above ground. 372 DIET IN DISEASE The selection of food differs but little from the diabetic regimen, but some carbohydrates are allowed, while the fatty articles, including milk, permissible in diabetes, are to be avoided. The patient is not to be stinted in quantity pro- vided he takes the necessary amount of exercise. He may breakfast freely on eggs, meat and toast, dine on meats and salad vegetables, etc. He should take as little fluid as pos- sible with his meals, but may quench his thirst between meals. vBy masticating his food thoroughly he materially reduces the demand, and does away with eating for the mere sake of eat- ing. By simple measures of this sort an individual may reduce his weight to as great degree as desirable, and the process will not be painful but the reverse. ■ He simply oxidizes and otherwise utilizes a little more matter than he takes in, and thereby prevents a pathological and unsafe accumulation of Jat. DIET: Fish. — All fresh white fish broiled or boiled. Meats. — Lean mutton or Iamb, beef chicken, game (sparingly). Eggs. — Cooked in all ways (not fried). Farinaceous. — Dry toast or crusts, stale bread (sparingly). Vegetables. — Lettuce, celery, spinach, cresses, asparagus, cauli- flowers, white cabbage, onions, tomatoes, radishes, olives. Liquids. — Coffee or tea, one cup without milk, cream or sugar; pure water one glass, drank slowly after the meal. AVOID. — Dark flesh fish, rich soups, salt fish, veal, pork, sausage, fats, potatoes, oatmeal, hominy, macaroni, spices, rice, carrots, beets, turnips, parsnips, puddings, pastry, pies, sugar, sweets, cakes, «ream, milk, spirituous liquors, beers, sweet rums, champagne. CHAPTER XVI DIET IN DISEASES OF THE STOMACH ACUTE GASTRITIS Einhorn i During the first or second day of illness it is best not to give the patient anything substantial to eat. Strained barley or rice water, or weak tea may be taken. On the third day,, as soon as the appetite reappears, the patient is permitted to partake of water soup (bread and hot water) oatmeal or bar- ley gruel, rice soup, and perhaps one soft-cooked egg. Later on French bread, butter and oysters may be added to the dietary. If the improvement is steadily progressing the fourth day begin with meat once a day, and thus slowly return to the usual bill of fare. CHRONIC GASTRITIS Einhorn ^ The regulation of the diet is of prime importance in the treatment. The dietary to be selected will depend on the severity of the symptoms." At the beginning, therefore, a light diet will be called for. The patient should partake of four meals daily. The articles of food should be given largely in liquid and semi- liquid forms; that is, milk, kumyss, matzoon, barley, oat- meal, and rice soup prepared in milk; chicken soup with an egg beaten up in it ; soft-cooked eggs, mashed potatoes, scraped meat, raw, or boiled, toasted bread, and also French white bread (not too fresh) ; butter; tea and cocoa. •Max Einhorn, M.D. : "Disease of the Stomach." New York. Wil- liam Wood & Co. 373 '374: DIET IN DISEASE The quantity of nourishment for each meal should neither he excessively large nor too small. My own bill of fare for the first week of the treatment is as follows : lEiglit o'clock: Calories. Two eggs 160 Two ounces of French white bread 156 One-half ounce of butter 107 One cup of tea (100 gm. of tea, .150 gm. milk) 101 Sugar 10 gm. (3 iiss.) 40 Half past ten o'clock: Kumyss or matzoon or milk, 250 gm. (J viii. Vs) 168 Crackers, 30 gm. (one ounce) 107 Butter, 20 gm. (3 v.) 163 Half past twelve o'clock: Two ounces of tenderloin steak, or of white meat of chicken . 76 Mashed potatoes, or thick rice, 100 gm. (3 iii. %) 127 White bread, two ounces 153 Butter, one-half ounce 107 One cup of cocoa, 200 gm. (5 vi. %) 101 Half past three o'clock: TJhe same as half past ten 438 Half past six o'clock: Farina, hominy, or rice boiled in milk, one plateful, 250 gm. (3 viii. 1/3) 440 Two scrambled eggs 160 Bread, two ounces 156 Butter, one-half ounce 107 2.863 The patient having been kept on this diet for a week or two, the diet must be gradually changed to one suitable for the lighter forms of chronic gastritis. Here the following rule will apply: The diet should correspond as nearly as possible to the common mode of living. In this way the dis- tribution of the meals should be arranged according to the customs prevailing in those places in which the patient lives. All food derived from the vegetable kingdom should be given in large portions, while the quantity of meat should be somewhat limited. DISEASES OF THE STOMACH 375 In order to permit the patient to have a greater variety in his food, it is best not to point out a few articles he should eat, but to mention only those he should avoid. For- bid meat with very tough fibers, meat from too old animals or too fresh meat (right after slaughtering), meat that con- tains too much fat, like pork; forbid sausages, lobster, sal- mon, chicken salad, mayonnaise, cucumbers, pickles, cabbage, strong alcoholic drinks like liquors. It must be impressed upon the patient to masticate the food thoroughly, to eat slowly, not to think of business dur- ing meals, and to stop eating before the sensation of satiety appears. The latter advice is only necessary in persons who are accustomed to high living. Chronic gastric catarrh is frequently combined with con- stipation. The diet can be arranged as to facilitate move- ment of the bowels. All foods which contain a large per- centage of cellulose (undigested matter) increase the quantity of feces, thereby effecting a stronger peristalsis of the larger bowel. All kind of green vegetables (spinach, asparagus, green peas) and rye bread are therefore very suitable. Many or- ganic acids possess the property of increasing intestinal peri- stalsis. Almost all kinds of fruits contain a certain quantity of these organic acids, and act like mild aperients. The use of cooked pears, stewed or baked apples, stewed prunes, is in many instances effective. Ewald recommends a mixture of two parts of prunes to one part of dried figs. The taste is agreeable, and the cathartic action mild. The custom of eating an orange in the morning for its laxative effect is well known. To these dietary remedies we may also add the use of a glassful of either very cold or warm water, or a glass of milk in arising, in the fasting condition. There are many persons in whom one of these latter means produces a good movement of the bowels. 376 DIET IN DISEASE ULCER OF THE STOUACH Einhorn i The diet consists of liquids — milk, milk with strained barley, or oatmeal, or rice water; plain water, weak tea and peptone (one teaspoon to a cup of water). Debove and Pemond have suggested the addition of lactose and of meat powder to the milk, in order to make the diet richer in nourishment substances. As a rule, we employ the above-named additions, which fulfill the same purposes, besides varying the monotonous bill of fare. Pirst week. During the first week we give the patient half a cup (about 100-150 c.c.) of either, every hour. Every- thing the patient takes must be neither cold or very warm, and should be taken slowly (sipping, or with a spoon). Second week. During the second week we order the same kind of food, with this difference, that he is nourished every two hours, and gets a cupful or a cupful and a half (200 to 300 e.e.) at a time. Occasionally we now allow the patient one raw egg beaten up in the milk, once or twice a day. In the beginning of the third week we feed the patient every three hours; he is al- lowed barley, farina, and rice (well cooked) in milk, soft- cooked eggs, crackers softened in milk, in. addition to his previous foods; in the third day of the third week we begin to give the patient meat, first raw, well scraped, then broiled. Thereafter we go over to the ordinary daily diet, exclud- ing heavy salads, pastrj^, raw fruit and the like. In the following table I give an outline of diet which I ordinarily prescribe in this affection: OTJIIIITE OF DIET IN GASTRIC ULCER FiKST Three Days Number of Calories. 7 A. M.: milk, 150 C.C. (five ounces) 101 8 " milk, 150 C.C. (five ounces) 101 'Max Kinhorn, M.D. : "Disease o( the Stomach." New York. Wil- liam Wood & Co. DISEASES OP THE STOMACH 37Y 9 A. M. ; milk, 150 C.C. (five ounces) 101 10 " milk and strained barley water (aa, 150 C.C.) .... 80 11 " milk, 150 C.C 101 12 " milk, 150 C.C 101 1 p. M. : bouillon either alone or with the addition of one to two teaspoonfuls of a peptone preparation, 150 C.C 30 2 " milk 101 3 " milk 101 4 " milk 101 5 " milk with strained barley or oatmeal 80 6, 7, 8, 9 p. M. : milk, 150 C.C 404 1.402 Fourth to the Tenth Day Number of Calories. 7 A. M.: milk, 300 C.C. (ten ounces) 202 9 " milk, 300 C.C. (ten ounces) 202 11 " milk with barley, rice, or oatmeal water, 300 C.C. . 160 1 p. sr. : one cup of bouillon, 200 C.C, and one egg beaten up in it 80 3 " milk, 300 C.C 202 5 " milk, 300 C.C 202 7 " milk with barley water, 300 C.C 100 9 " milk, 300 C.C 202 1.410 Eleventh to the Fourteenth Day Number of Calories. 7 A. M. -. milk, 300 C.C 202 9 " milk, 300 C.C 202 and two crackers softened (one ounce) 100 11 " milk with barley water, 300 C.C 160 1 p. M. : one cup of bouillon, 200 C.C, one egg, and two crackers 180 3 " milk, 300 C.C.,. and one egg 282 5 " milk, 300 C.C, 202 and two crackers 100 7 " milk, with barley water 160 9 " milk, 300 C.C 202 1.790 378 DIET IN DISEASE FOUBTEENTH TO THE SEVENTEENTH DAT Number oi Calories. 7 am.: milk, 300 C.C 202 9 " milk, 300 C.C 202 and two crackers (one ounce) 100 11 " milk with barley, 300 C.C 342 1 P. M. : scraped meat, 50 gm 60 two crackers, one cup of bouillon, 200 C.C 100 3 " milk, 300 C.C 202 5 " milk, 300 CO 202 one egg (soft boiled) 80 two crackers 100 7 " milk with farina, 300 C.C 342 9 " milk, 300 C.C 202 2.134 Seventeenth to Twenty-Fourth Day Number of Calories. 7 A. M.: two eggs (soft boiled) 160 butter, lOgm 81 toasted bread, 50 gm 130 milk, 300 C.C 202 10 " milk, 300 C.C 202 crackers, 50 gm 166 butter, 20 gm 162 1 p. M : lamb chops (broiled) , 50 C.C 60 mashed potatoes, 50 gm 44 toasted bread, 50 gm 130 butter, 10 gm. ; one cup of bouillon, 200 C.C 81 4 " the same as at 10 A. M 530 6 :30 " milk with farina, 300 C.C 342 crackers, 50 gm 166 butter, 20 gm 162 9 " milk, 300 C.C 202 2.820 In cases of ulcer of the stomach presenting a more severe type — violent pains, frequent vomiting, inability to take food on account of the pains — or after haematemesis, I usually have the patient abstain from any food whatever. DISEASES OF THE STOMACH 379 given by the mouth, for a period of five days. The patient is then fed by the rectum. This is done in the following way : early each morning the patient receives a large enema of about a quart of lukewarm water, in which a teaspoonful of common tablesalt has been dissolved as a cleansing enema. About an hour after the patient has emptied the injected water, the first nourishing enema is given; this may consist either of a glassful of milk (about 200 c.c.), in which a raw egg has been well beaten and a pinch of salt added, or of a cupful of water in which a tablespoon of a good peptone preparation has been dissolved. The temperature of either must be about 100° P. Such a nourishing enema is given three or four times a day. The quantity of the feeding enema is 200-250 c.c, and it is slowly injected by means of a foun- tain syringe and a soft-rubber rectal tube., The patient may frequently wash his mouth with cold water, and is allowed from time to time to keep a small piece of chopped ice in his mouth, and to swallow the melted water. The five days being over, the mode of diet is the same as described above for the ordinary form of ulcer. GASTRIC ULCER DIET Massachusetts General Hospital i 1. Dr. Hewes's Diet for Gastric and Duodenal Ulcer. Two oz. milk, 1 soda cracker (powdered), 1 oz. sugar, every two hours. Give two to three days, then increase to 6-8 oz. milk, 1-2 oz. sugar, 4 soda crackers, every two hours. Continue for two to three weeks, then adopt the following : Eight feed- ings in 24 hrs. : (1) milk and crackers; (3) Indian meal porridge with cream or salt; (3) potato pur^e, jelly; (4) milk and whites of two eggs; (5) soft custard; (6) hot choco- late; (7) pea puree strained through fine wire mesh; (8) milk and crackers. 2. "The Lenhartz Diet." The "Lenhartz diet" begins with 100 c.c. milk and one egg daily, in teaspoonful doses, J Diet used at the Massachusetts General Hospital, Boston. Dr. Hewes, Physician to Out-Patients, Massacliusetts General Hospital. 380 PIET IN DISEASE gradually increasing until at the end of four weeks a liberal mixed diet is allowed, always avoiding coarse vegetables and irritating substances. The gradual increase of food appears in the accompanying scale. In preparing the eggs they are beaten very light, without salt, a small amount of sugar frequently added, the bowl kept in a pan of cracked ice. At first the milk is given with shaved ice. Some of the milk, eggs, and sugar are made into custard on the tenth day. The beef is scraped and weighed, after cooking; the ham is chopped very fine; occasionally lime water has to be added to the milk, and, if large curds form, the milk is diluted with barley water. Great care is exercised in the transition stages from liquids to semi-solids and finally to full diet. Lenhartz' Diet (3 1 s % 5 1 1 IS) 1 1 3 1 1 CO. 200 Gms. Gms. Cms. Gms. Gms. Gms. 2 2 200 3 3 300 4 4 400 20 5 5 500 20 6 6 600 30 7 7 700 30 35 8 8 800 40 40 70 100 9 8 900 70 100 20 10 8 1000 50 70 200 40 40 11 8 1000 SO 70 200 SO 20 12 8 1000 30 70 300 60 50 40 , Continue for 3 weeks CHAPTEE XVII DIET IN INTESTINAL DISEASES DIET IN DYSPEPSIA Modern clinical medicine does not recognize such a dis- ease as dyspepsia. In a great variety of local and general conditions digestion is more or less disordered. It may be too rapid, too slow, difficult, imperfect for one or more of the classes of foods, or abolished outright. Specialists base diets largely on the results of test-meals, so that the diet in a given case becomes individualized. If a person with ordi- nary symptoms of chronic indigestion is to be dieted, and. the cause of the affection is not known, the regimen for chronic gastritis will answer (p. 373). But if in addition to indigestion there is unusual irritability of the stomach, the diet must consist of most easily digested articles of solid food, and if necessary of semi-solid or liquid food. In other words, he is dieted like a convalescent from some severe acute dis- ease, or a child at weaning time. DIET : Soup. — Oysters and thin, clear beef and mutton soup. Fish. — Fresh mackerel, bass, perch, shad, cod, raw oysters. Meats. — Game, sweetbreads, tender meats, chopped meats, broiled calf's head, tongue, tripe, lamb, chicken, mutton and beef. Eggs. — Eggs raw, soft and hard cooked. Farinaceous. — Graham bread, whole wheat bread, corn bread, stale bread, dry toast, crackers, tapioca, sago, cornstarch, rice, oats, hominy, cracked wheat. Vegetailes. — Asparagus, celery, cresses, lettuce, green peas, string beans, sweet corn, spinach. Desserts. — Ripe fruit — raw or stewed ; apple tapioca, apple snow, baked apples, custards, junkets, rice, tapioca, cornstarch, or bread puddings. Liquids. — Liquid Peptonoids on cracked ice, pure cold water, hot water and milk (equal parts), malted milk, weak tea and coffee, not 381 '^83 DIET IN DISEASE more than one cup at a time and taken slowly after a meal; un- fermented grape juice. AVOID. — Ice water, spirituous liquors, nuts, cheese, ice cream, pastry, pies, candies, salmon, lobster, crabs, sausages, ducks, goose, salted, smoked or preserved fish; pickled, potted, corned or cured meats, kidney, liver, fried foods, gravies, potatoes, turkey, stews, hashes, pork, veal, rich soups, chowder. DIET IN CONSTIPATION It is almost as difficult to prescribe a diet for constipation as it is for dyspepsia, and for the same reason, namely, con- stipation is not in itself a disease, but a symptom or result of many diseases. As a general rule, however, a certain diet is more or less suitable for any kind of constipation. By the latter term we usually mean a delayed action of the bowels due to a natural weakness of the muscles of the intestines, or to an acquired weakness due to too concentrated a form of 'nourishment or to a sedentary life. In a certain percentage of cases the delayed action of the bowels is due to temporary spasm of the intestinal muscle, and this may even occur in association with weakness of the muscle, as is seen in hysteri- cal women. There is finally delayed bowel action in a great number and variety of diseases. The resources employed in treating the diseases which cause constipation include many plans beside diet, yet the latter is indispensable. A mixed diet is very necessary, for purely animal food products, as meat, fish, eggs, milk, cheese, etc., conduce to constipation because absorption of such foods is so nearly complete that not enough residue remains in the intestines to stimulate peristalsis. On the other hand, a diet of vegetables, involving a large indigestible residue, causes large fecal mo- tions, but these are not promptly expelled unless the intestine is healthy. Much extra work is thrown upon the intestine when a vegetarian diet is used exclusively; and as a result of such excessive work the intestine becomes in time weak- ened. Constipation from whatever cause and of whatever nature INTESTINAL DISEASES 383 may be, when sufBciently pronounced, sufficient to render a healthy man or woman sick. Digestion becomes impaired, appetite lost. This fact alone teaches us that in dieting a constipated subject we often have to deal with a sick in- dividual. It has often been stated that a patient or his life- long companions are better judges as to his diet than a physician hastily consulted. Ewald, and doubtless most stomach specialists, are opposed to an exclusive calorie plan of feeding in all gastro-intestinal diseases. This is natural because food which is theoretically indicated cannot be managed by the digestive organs. If an attempt is made to feed a patient thus affected with 3000 calories of food, the result will be complete repugnance to all food. The amount of food ingested in these cases, in the most palatable and digestible form, cannot come up to the calorie standard. The quantity ingested in such pa- tients is so low as to be quite beneath the efficient level. The inference is natural that such patients must draw on their reserve fund to make up the calories. Hence the only course to pursue is to cure the condition which causes the constipation as soon as possible. For mere sluggish action of the bowels, not amounting to disease, many popular dietetic remedies are employed. It is by no means certain that this delayed action in many healthy persons is other than natural or temperamental. Fletcher has shown that as a result of his reduced diet and excessive mastication of food which contains not much indigestible residue, sterile and odorless feces are formed which cause no discomfort, and insists that such people need have no anxiety about their bowels. On the other hand, very many people who have reg- ular daily evacuations suffer from retention, of fecal matter; only careful palpation of the sigmoid flexure will inform us as to whether the bowels are actually empty. Of household dietetic procedures for securing daily evacua- tions, the most common is the drinking of cold water on ris- ing — one, two or more glasses. To this a little common salt may be added. Many men depend for their morning evacua- 384 DIET IN DISEASE tion on smoking a cigar after breakfast. Women, as already stated, find, the morning draught of cold water valuable. The use of fruit at or before breakfast often causes an evacua- tion during the day. This is true especially of apples, pears, oranges, etc. Buttermilk is also largely used for this purpose. The vegetable acids with the large amount of indigestible residue make certain fruits valuable as laxatives. This is true also of berries, although those which contain tannin (blackberries) may tend to constipate. Dried fruits, such as figs and prunes are especially useful. The! use of sweet cider as a marked laxative seems to illustrate again the laxative power of vegetable acids. Very sweet substances in large amounts, chiefly honey and molasses are notably laxative. Oatmeal, among the cereal foods, is noted for its laxative powers. Beans and peas, popularly believed to be laxative, are really constipating; but the fermentation of the large amount of cellulose gives the illusion of impending diarrhoea. Oils and fats are laxative to many people. A word of cau- tion must here be inserted. Many of these substances care- lessly spoken of as laxatives, often behave as violent purga- tives, especially in individuals who alternate between consti- pation and diarrhoea. The severe diarrhoea set up at times by sweet cider, molasses and other relatively inert sub- stances should teach us caution in giving such articles to patients. No more important hygienic regimen can be adopted than the fol- lowing: 1. Eat fruit before retiring (experiment and find what fruit seems to agree). 2. Three-quarters of an hour before breakfast drink two glasses of cold water and exercise ten minutes in room before open window or take a brisk walk. If this regimen were followed daily by children and grown people there would be less illness. DIET: Soup. — Oyster soup, meat broths, Liquid Peptonoids bouil- lon. . V - -■ Fish. — Raw oysters, fresh fish of all kinds broiled or boiled. Meats. — Game, poultry, almost any fresh meats. ._ Farinaceous. — Rye bread, brown bread, graham, corn and whole wheat bread, hominy, mush, cereals. Educator Bran Cookies. Yegetables. — Salads with oil, string beans, green peas, green corn. INTESTINAL DISEASES 385 asparagus, potatoes, cauliflower, spinach, brussels sprouts, onions, boiled. Desserts. — Simple and light-apple and fig puddings, plain pud- ding, as custards, whips, and gelatin, etc., junkets, ice cream, sherbet, ices, hominy, raisins, cherries, huckleberries (the blue seedless kind), grapes, melons, apples, oranges, pears, ripe peaches, baked apples, with cream, figs, stewed prunes. Liquid. — Unfermented grape juice, plenty of pure water, cold or hot; black coffee, cocoa, new cider, buttermilk, orange juice, malted milk. -^ — — — ~" AVOID. — Spirii^uous liquors, pineapple, cheese, nuts, tea, sweets, milk, pastry, rich puddings, rice, tapioca, new bread, eggs, liver, pork, salt, smoked, potted or preserved fish or meats. DIET Iir DIARRHOEA « The term diarrhoea, like dyspepsia and constipation, repre- sents only a symptom or result of various diseases. While this affection cannot be cured by a dietetic plan alone, certain foods are known to be constipating and in treating the under- lying conditions attention to diet is all-important. It con- sists as much in avoiding laxative articles as in using consti- pating articles. Thus cheese and hard-boiled eggs are highly constipating to most individuals, yet they could not be em- ployed in a diarrhoea which Vfas due to or associated with gastritis. Hence foods known to be constipating must also be bland and easily digested. Food nearly all of which may be absorbed naturally antagonizes diarrhoea from any cause. The commonest articles used in this class are flour porridge,^ cooked white of eggs, boiled milk, toasted crackers, zwieback, rice, chocolate. Meat should be of the most tender and diges- tible nature, as sweetbreads, tongue, tenderloin of beef, etc. Dried beef powder may be mixed with 5 per cent, tannic acid. Articles which naturally contain the latter are useful if di- gestible. Acorn coffee is recommended by some. In a daily menu compiled by Ewald the following articles enter : Acorn coffee, soft eggs, milk, toasted bread, zwieback, scraped beef, breast of chicken, the most digestible kinds of fish, soups and broths (to the latter may be added Dry Pep- tonoids Soluble, nutrose and other semi-proprietory condensed 386 DIET IN DISEASE protein foods). Articles used in diet list for constipation must be avoided. Uassachusetts General Hospital i DIET. — Stale bread, dry toast, crackers, butter, rice, soft cooked *ggs, eggs and milk, flour and milk puddings, boiled and peptonised milk, tea, custards, blanc-mange, wine jelly, oatmeal, oysters, gruel, chicken. AVOID. — Soups, animal broths, fresh bread, fruits, vegetables, fried dishes, ilsh, saccharine foods, salt meats, veal, lamb and pork. DYSENTERY Thompson 2 During an attack of acute dysentery the patient should be kept absolutely quiet in bed, and should not be allowed to rise for the movement of the bowels, making use of a bed- pan instead. Throughout the active stage the diet must be strictly confined to easily digestible food, and in most cases it is wisest to give only predigested fluid articles. Peptonised or pancreatinized milk, or boiled milk, pressed-meat Juice, whey, or raw egg albumin beaten with sherry and flavored with nutmeg are recommended. Many patients do best upon a diet of raw scraped beef or meat balls. In cases of acute dysentery, and especially in the amcebie form, the loss of strength, ansemia, and emaciation progress very rapidly, and the strength must be supported by stimula- tion, for which brandy is preferable to whiskey. During convalescence the diet must be very cautiously in- creased, and confined to food which is promptly and com- pletely digested, leaving but little residue. For this purpose animal food should be chiefly eaten, while fish, tender beef- steak, roast beef, boiled or broiled chicken, eggs, custard, blanc-mange, dry toast, junket, well-boiled rice, or wine Jelly, may be given. All fruits and vegetables must be forbidden, and butter and cream should be taken sparingly. If the disease occurs in infancy, the child, if possible, should be fed at the breast. Otherwise all milk and water ^ Diet used at the Massachusetts General Hospital, Boston. = W. Gilman Thompson, M.D. : "Practical Dietetics." New York. D. Apj>leton & Co. INTESTINAL DISEASES 387 given should be Pasteurized. Beef tea and mutton broth may be allowed in moderation, and special care should be observed not to overfeed. DIET FOR ACUTE COLITIS (DYSENTEET) Ilassachusetts General Hospital t Purge and starve one day, then: lean meat, 100 gms., 3 times daily ; albumin water of 3 eggs, 6-8 times daily. Con- tinue for 4 days, then add : skimmed milk, 16 oz. ; toast (no butter), 3 slices with maple syrup; rice, 50 gms. daily. After 10 days increase toast, give butter, macaroni, tapioca, cream cheese and Indian meal mush. CHRONIC DYSENTERY Thompson 2 ' Chronic dysentery is often best treated by an exclusive milk diet of from two and a half to three quarts a day, with rest in bed or on the lounge. In other cases rare steak or roast beef or chicken and egg albumin may be allowed, with dry toast, zwieback, or crackers. The milk and meat diet may be advantageously combined. In Osier's opinion, if there is much ulceration of the colon, meat is not well borne, and it is better to keep the patient upon a diet which will give but little residue, such as boiled or peptonised milk. The stools must be examined every day or two to ascertain the presence of undigested fragments of milk curds or meats, oil globules, mucus, blood, etc. If improvement does not occur, the patient may be put upon a diet of egg albumin with beef juice, or some of the preparations of beef meal or peptonoids, with pancreatinised milk. Eeturn to solid diet must be very gradual, and may be conducted on the lines directed for convalescence from typhoid fever. ^Diet used at the Massachusetts General Hospital, Boston. -W. Gilman Thompson, M.D. ; "Practical Dietetics." New Tork. D. Appletou & Co. 388 DIET IN DISEASE ENTERIC DIET Dr. Vickery i Milk, strained gruels, broths and strained soups, milk whey, buttermilk, slips, eggs (soft cooked or raw), milk flavored occa- sionally with tea or coffee, barley water, albumin water, beef juice. Liquid Peptonoids. SPECIAL ENTERIC DIET Cutler 2 Skimmed Milk Mellins' Food Skimmed Milk Eggs and Milk Beef juice Barley water Skimmed Milk Tea Chicken- Broth Barley Water Buttermilk Skimmed Milk Beef Tea Skimmed Milk Albumin Water 8 oz. 8 " 3 " 8 3 3 6 i 4 3 8 8 8 8 8 with with with at 7 A.M. " 9 " " 11 " " 1 P.M. " 3 " " 9 " "11 " " 1 A.M " 3 " " 5 " Skimmed Milk Skimmed Milk Tea or Cofl'ee Beef Tea Chicken broth Barley Water Mellins' Food Albumin Water Beef juice Barley Water Buttermilk LIQUID ENTERIC DIET Cutler 2 8 oz. 6 " with with with 4 times every 24 hours. One soft boiled egg daily if desired or raw in milk. 1 Dr. Vickery: "Diet used nt the Massachusetts General Hospital, Bos- ton." 2 Elhridge G. Cutler, M.D. : ' ' Diet used at the Massachusetts General Hospital, Boston." INTESTINAL DISEASES 389 APPENDICITIS Thompson i Dietetic Treatment. The dietetic treatment of appendici- tis, which has not yet passed into the surgeon's hands, should consist in giving only such foods as will be thoroughly ab- sorbed, leaving as little residue as possible to irritate the lower bowel and excite peristalsis. -I Until the outcome of the attack is decided it is best to put the patient upon a fluid diet, consisting chiefly of nutritive broths. Beaten eggs may be allowed, and a moderate quan- tity of pancreatinised milk, whey, or buttermilk. Cocoa may be given, and strained gruels of rice and barley. In recurrent eases the patient should be cautioned to eat moderately and avoid all coarse or hard food, such as grits, coarse oatmeal, tough meats, fibrous vegetables, the skin of fruits or potatoes — in short, everything likely to overload the intestine with accumulated waste. The operative cases should have the diet recommended after laparotomy. 'Usually the digestive organs require al- most absolute rest for twenty-four hovirs after the operation, and hot water may be sipped. No food at all should be given for fully six hours before operation. ^ W. Gilman Thompson, M.D. : "Practical Dietetics." New York. T>. Appleton & Co. CHAPTEE XVIII DIET IN DISEASES OF THE GENITO-URINARY SYSTEM ACUTE BBIGHT'S DISEASE In dieting a patient suffering from acute Bright's disease, one fact to be kept prominently in mind is the difficulty that the system has in getting rid of its waste material — espe- cially of its nitrogenous waste. Another point is that the diet should be such as to assist in carrying off those inflam- matory products by which we know that, the tubules of the kidneys are to a greater or less extent blocked. The amount of nitrogenous elements in foods must be kept down, and aid must be given for washing out the products of inflammation from the uriniferous tubules. Water is the best diuretic. — Hot water and hot diluent drinks. Diluted milk is the food that answers best, and skimmed milk has a high reputation as a diuretic. Buttermilk, whey and kumyss are useful. From two to three pints of milk, well diluted, given in the twenty-four hours, will in most cases be sufficient at first, but if the disease be protracted and tends to become chronic, a more liberal allowance of liquid food must be ordered, and broths may be added to the dietary. When milk alone is given it should be given in divided quantities at stated in- tervals — half a pint every three or four hours, diluted with half as much hot water or effervescing water. Between supplies of milk drink freely of diluent drinks. Diluent Drinks. Plain water, toast water, barley water, cream of tartar and lemon drinks, and the acid drinks are all useful diluents. Give between meals and drink slowly. 390 GENITO-URINABY SYSTEM 391 CHROmC BRIGHT'S DISEASE The kidneys are great agents in the work of excreting ni- trogenous waste, and if these organs become clogged with ac- cumulation of nitrogenous waste products they are not able to perform their functions. As soon as we have evidence sufficient to prove that the kidneys are laboring and are burdened by their work, we must endeavor to remove the strain by regulating the diet ; and one clear indication is to limit the supplies of nitrogenous foods. Large amounts of animal food and the use of alcohol must be stopped, and better stopped altogether. In many cases the effect of feeding the patient for six weeks, or even two or three months, upon an exclusive milk diet, is remarkably gratifying. The quantity of milk to be prescribed for an exclusive milk diet in Bright's disease must depend on the age and size of the patient, as well as upon his ability to take exercise and use up force in muscular en- ergy. If the patient is invalided so as to be confined to his room or the house, from five to seven pints of milk daily are quite sufficient. If the patient loses weight on a milk diet, although it otherwise agrees with him, it may be well to add farinaceous food in the shape of rice or bread. In the worst eases it is desirable to give the milk at brief intervals, in quantities of six ounces, once an hour during the day- time, with an extra tumblerful at night, and on awakening in the morning. The quantity of milk necessary to support life for any length of time and maintain good nutrition, especially if the patient is exercising at all, is considerable, and he must take from fourteen to eighteen, or even twenty-two six-ounce tumblerfuls of milk in the twenty-four hours. It is usually impossible to commence at this rate without producing gastric disturbances from souring of the milk in the stomach, and possibly diarrhoea. The latter symptom is an almost certain indication that the milk is being im- perfectly digested, and a temporary reduction in its quantity is advised. 392 DIET IN DISEASE As the patient improves the milk diet may be given up, but it should never be too suddenly abandoned. In adopting any other diet it is. a good rule never to let the nitrogenous food bear a greater proportion to the non-nitrogenous than one to four. When, after a milk diet, the change is to be made to a more liberal menu, the hours of taking the milk may be reduced in frequency, and some of the milk may be replaced by the more hearty food. DIET: Soup. — Vegetable or fish soup, broths with rice or barley. Fish. — Raw oysters or clams, fresh fish broiled or boiled. Meats. — Eat sparingly, chicken, game, fat bacon, fat ham. Farinaceous. — Stale bread, whole wheat bread, toast, milk toast, biscuits, macaroni, rice, cereals of all kinds. Vegetables. — Onion, cauliflower, mashed potatoes, mushrooms, let- tuce, watercress, spinach, celery, cabbage. Desserts. — Ripe raw fruits, stewed fruits, rice, tapioca, bread and milk puddings, junkets, cocoa. Liquids. — Toast water, weak tea, pure water, peptonised milk, malted milk, fresh buttermilk, milk with hot water equal parts, whey, unfermented grape juice. AVOID. — Fried fish, corned beef, hashes, stews, pork, veal, heavy bread, batter cakes, lamb, mutton, beef, gravies, beans, peas, malt or spirituous liquors, tobacco, coffee, ice cream, cake, pastry. NEPHRITIC DIET Kassachusetts G-eneral Hospital i Bread, soft puddings without eggs, all vegetables, except peas and beans, fruits of all kinds, gruels and broths. AVOID. — Meat, eggs, peas, beans. DIET FOR ACUTE NEPHRITIS, URIC ACID GRAVEL Dr. Hewes, Massachusetts General Hospital ^ Four days. Milk, 800 c.c; 32 per cent, cream, .300 c.c; bread, 200 gms. ; butter. Feed six times a day with mixture of milk, 150 gms. ; cream, I oz. ; bread, % slice. Fifth day adopt the following: Milk, 800 c.c; cream, 300 c.c; rice, 50 gms.; tapioca, 50 gms.; bread, 100 gms. Occasionally ice cream or custard. ^ Diet used at the Massachusetts General Hospital,- Boston, Mass. Dr. Hewes, Physician to Out-Patients, Massachusetts General Hospital. GENITO-URINARY SYSTEM 393 Vary diet from day to day in above limits. If oedema ia present and fails to disappear change above to dry salt-free diet. At the start give no more liquid than above; after the oedema is gone water can be given as desired. Special Dry Salt-Free Diet. Morning. Salt-free bread, 2 slices (toasted if desired) ; an abundance of salt- free butter; maple syrup if desired. 10 A. M. Rice with small amount of cream or sugar (no syrup). Noon. Mashed potatoes with butter, no salt; salt-free bread, 2 slices ; salt-free butter. 4 P. M. Kice, tapioca, or baked custard. Supper. Salt-free bread, 2 slices; salt-free butter; 2 eggs, soft cooked; 1 orange daily. Caution. Limit liquids to one pint a day, including milk and water. Salt-Free IJephritio Diets (Halpin). No. 1. Milk, 1500-2000 c.c; white salt-free bread, 400-500 gms.; butter (salt-free), 40 gms.j eggs, 4-6. (5-6 gms. NaCL contained.) No. 2. (Widal). Salt-free bread, 200 gms.; salt-free butter, 50 gms.; salt-free beans or rice, 250 gms.; meat, 200 gms. (beef, chicken, or mutton) ; sugar, 40 gms. (1500 calories). (1-2 gms. NaCL con- tained.) No. 3. Potatoes, 700 gms.; salt-free bread, 200 gms.; salt-free butter, 50 gms.; cream cheese, 50 gms. (2000 calories.) 1-2% gms, NaCL contained.) No. 4. Potatoes, 1000 gms. without salt; meat, 400 gms. without salt; salt-free butter, 80 gms.; sugar, 100 gms. (2000 calories). (1-2 gms. NaCL contained.) No. 5. Potatoes, 16 oz. (without salt) ; rice, 6 oz. (without salt) ; meat, 4 oz. (without salt),- cream, 8 oz. ; eggs, 2 (without salt); sugar to taste. COHVUISIONS IN BKIGHT'S DISEASE Convulsions in Brighfs Disease. In the course of Bright's disease eonvulsions and unconsciousness may occur. The course to adopt is to encourage the action of the skin, there- fore place the patient in bed between warm blankets, pack hot water bottles around him, and send for medical assist- ance. — During this period the patient should live upon the exclusive milk diet. 394 DIET IN DISEASE ALBUMINURIA Thompson i Dietetic Treatment. The frequent return of functional albuminuria should be regarded as an indication of special weakness of the kidneys in the same way that frequent glycosuria invites suspicion of the strength of the digestive power of the liver, and it demands a careful regulation of the diet. Meat should be reduced in quantity, or temporarily forbidden, as well as all forms of alcoholic drinks, or other substances liable to produce renal irritation, and the diet should consist chiefly of fruits, vegetables, and milk. Care- ful attention must be paid to increasing the activity of the bowels. When functional albuminuria is observed in children and adolescents, it is not necessary, nor is it advisable in ordi- nary cases, to wholly exclude nitrogenous food, but it should be restricted, especially in regard to eating butcher's meat and eggs, and the evening meal should be made very simple, consisting of food such as bread, crackers, rice or porridge, and milk. 1 W. Gilman Thompson, M.D. : "Practical Dietetics." New York. D. Appleton Sc Co, CHAPTEE XIX DIET IN MISCELLANEOUS AFFECTIONS NERVOUS SISOBSERS Dietetic Treatment. The first thing to be done for a per- son suffering from nerve exhaustion is to adopt a dietary and a habit of life that will rebuild the nerve cells. The lost energy must be gently and slowly " coaxed " back — not through medicines, but through proper environments, proper employment and proper food. There is no disease that re- quires so little medicine as nerve exhaustion. The dietary should be simple and nutritious, abounding in lettuce, pars- ley and the fresh green edibles in season. If there is much intestinal disturbance, potatoes and foods that are rich in starch should be discarded. Active stimulants should be en- tirely eschewed. Take freely of unfermented grape juice and malted milk. In functional nervous disease, such as hysteria and hy- pochondriasis, the appetite, muscular elasticity, and mental powers will often be observed to be deficient in the early part of the day, and to recover their tone in the evening. At this latter time, therefore, it is advisable to make the principal meal. ETJNCTIONAI DISORDERS OF THE LIVER (BIIIOTJSNESS) DIET: Soups. — Light broths, vegetable soups, with crackers or a little toasted bread. Fish. — Broiled or boiled fresh white flesh fish, raw oysters. Meats. — Eat very sparingly of lean mutton, Iamb, chicken or game. Farinaceous. — Whole wheat bread, graham bread, dry toast, crack- ers, cereals, tapioca, arrowroot (well cooked). Vegetables. — Mashed potatoes — almost all fresh vegetables (well cooked), plain salads of watercress, lettuce and dandelions. 395 396 DIET IN DISEASE Desserts. — Plain milk pudding of tapioca or cornstarch, junkets, stewed or fresh fruits (all without sugar). Liquids. — Weak tea or coffee (without sugar or cream), hot water, pure, plain or aerated water. AVOID. — Articles of diet that are rich and highly seasoned, as curries, pies and pastry, strong soups, foods rich in fats, salmon, herrings, eels, mackerel, and other fish of an oily nature, elaborate entries, also rich sweets and creams, cheese, dried fruits and nuts, malt liquors, sweet wines, such as champagne, Madeira, brown sherry and port. DIET IN SKIN DISEASES Nearly all affections of the skin of constitutional or reflex (gastro-intestinal) origin, especially acne, eczema, psoriasis, seborrhoea capitis, pruritus, urticaria, etc., improve under dietetic measures and often recover under these alone. While no special plan applies to all, the elimination of sugar and sweets of all kinds, and substances rich in fat, as cheese, nuts, fried articles, etc., is essential. Pure fats like butter, cream, salad oil, etc., are, however, well enough in small amounts. Malt liquors and sweet wines disagree, largely because of the sugar therein; but alcohol itself is also prej- udicial in many cases. It is well to take all food in small rations, and masticate it thoroughly; for the prejudicial effect of food in skin dis- eases is often directly attributable to fermentation, favored by atony of the digestive tract, dilated stomach, constipa- tion, etc. Physical exercise is of great benefit in most -of these cases. The diet and other regimen in skin diseases is much like that for obesity, gout and diabetes. All these metabolic dis- orders tend to produce skin diseases. DIET IN HEAKT DISEASE In disease of the heart which has passed the period of com- pensatory activity, so that the organ is no longer able to discharge its functions perfectly, it is highly important that the stomach be not overloaded by heavy meals, and that the likelihood of flatulency be minimized as much as possible by MISCELLANEOUS AFFECTIONS 397 care in eating, for distention of the stomach from any cause may be quickly felt by the pressure upon the weakened heart. Many fatalities come about in this manner; hence meals should be small, repeated when necessary. The food should bo concentrated and should contain little waste material. Certain articles of food prone to ferment should be excluded, the patient's own experience being the best guide. On the other hand, it is also important to avoid increasing the blood pressure by giving too much water, which should be kept within a certain daily limit conformable to the good results obtained. Patients should not try to live on milk or take any mineral water cure. Anything which produces thirst — like salted food, spices, etc., should be avoided, as should exposure to very hot weather. DIETETIC MANAGEMENT OF SURGICAL CASES Not much special attention is paid to dietetics until a day or two before operation, with the exception of stomach cases. AVhenever a patient is to be operated on for a stomach affec- tion, many surgeons advocate the free use of articles rich in vegetable acids, believing that such articles are natural anti- septics for the stomach and intestines. These substances, while technically acids, are quickly changed to alkalies in the body, and tend to lessen the total acidity of the latter. Some German surgeons even allow such patients to eat freely of sauerkraut, sour milk, etc. In other cases,, the patient is placed in bed, or is in com- plete rest for several days, and fed on very simple and nutri- tious articles in moderate quantities only. The old custom of fattening or building patients up before operating on them has largely died out. If the bad general state of the patient is due to the condition which is to be operated on, nothing is gained by such attempts. In the case of a rapidly prog- ressing disease, every hour lost before operating may dimin- ish the chance for recovery, immediate or ultimate. If the patient is in bad condition for withstanding an operation, he may often be operated on safely under local anesthesia. 398 DIET IN DISEASE There are many resources to-day for minimizing the dangers of shock and hemorrhage. As a general rule the sooner a patient is operated on, the better, irrespective of the urgency of the condition. To live for weeks and months in anticipa- tion of an operation is believed by its depressing effect to off- set alleged attempts at strengthening patients. When a general anesthetic is to be given the patient must fast beforehand to such an extent that the stomach is empty at the hour of anesthesia. As operations are usually per- formed in the forenoon, the patient should take but little supper and no breakfast. Should the operation be performed late in the day, he may have a light breakfast. In emergency operations, the patient having taken food within six hours, the stomach should first be washed out. This is also done as a routine procedure in all operations involving the stomach itself. Water may be given at any time. After the operation there is such a natural tendency to nausea that little or no attempt should be made to feed the patient for some hours. Only in exceptional cases in which the stomach is not upset and the patient complains of hunger, a little tea and toast, or milk may be given. In the great majority of cases no food is given until the follow- ing day. As soon as the stomach will tolerate it, however, simple nutritious food should be given in proper amounts. The tendency to-day is toward getting up early after operations, and against everything which tends to make the patient pas- sive and bedfast. The patient therefore needs more food than if he were to be bedridden. In patients who from any reason' are unconscious or de- lirious after operation, some plan of artificial treatment is necessary, involving the use of the nasal, stomach or rectal tube. In any condition in which post operative vomiting will undo the results of operation, the diet should be extremely light and bland until healing has occurred, and it may be necessary to feed by the rectum. If the patient is unable to MISCELLANEOUS AFFECTIONS 399 masticate he must be given only liquid or very soft foods. As a rule, when post operative feeding is left wholly to the discretion of the nurse, a certain rule is adopted as fol- lows: No food at all for the first twenty-four hours. Water may be given in sips for the intolerable thirst and in addition to plain water, the patient may receive a swallow of carbonic water, cracked ice, a little hot tea or black coffee, or some alcoholic stimulant. Toward the end of the period a tea- spoonful or two of milk diluted with lime water may be given. During the second twenty-four-hour period about one-half a pint of milk or some other liquid food may be given in small doses and this amount may be doubled on the third day. The third or fourth day usually coincides with normal bowel action, the patient having received laxatives on the day preceding. The patient as soon as this has occurred may go upon a semi-solid diet, so increased as to be regular at the end of a week or ten days. The diet varies notably with the patient and the kind of operation and its outcome and the responsibility for special provisions suited to individual cases falls upon the medical attendant and are modified from day to day under his direc- tions. DIET AFTER LAPAROTOMY, OVARIOTOMY, ETC. Thompson ^ After all operations involving opening the peritoneal cav- ity complete rest of the stomach is necessary for at least four or six hours, and not infrequently for two or three days. Food and stimulants may be given by enemata. If fed per os for the first three days, not over a tablespoonful of pancrea- tinised milk or milk with lime water or barley water should be allowed, once in two or three hours. Later the quantity * W. Gilman Thompson, M.D. : *' Practical Dietetics." New York. D. AppJeton & Co. 400 DIET IN DISEASE may be increased and the intervals diminished, and beef tea, beef peptonoids, and egg albumin may be added. In these cases the duration of anesthesia has usually been prolonged, and the shock is considerable. The danger from the occurrence of vomiting, fermentation of food, and flatu- lent distention of the abdomen is far worse than that of in- anition from abstinence. It is well also to precede the opera- tion by a day or two of dieting in order to lessen the bulk of intestinal waste matter. To this end the diet should, when possible, consist chiefly of lean meat and dry toast, vegetables and especially sweets being avoided. After wounds and operations affecting the stomach or in- testines no food at all should be given by the mouth. Noth- ing but a little cracked ice should be so administered, and all nourishment must be supplied for several days by the rectum. The return to mouth-feeding must be made very slowly and cautiously by at first giving not over one or two tablespoonfuls of pancreatinised milk or beef juice at a time. There is often much thirst following operations involving the peritonaeum, which is relieved more by hot fluids than by ice, which sometimes irritates the throat and increases the desire for drink. If there is danger of all fluids exciting emesis, a salt-water enema once in three or four hours will alleviate thirst. CHAPTER XX DIET IN SPECIAL CONDITIONS MOTHERHOOD DIET IN PREGNANCY Thompson i It is not customary to adopt any definite system of diet for pregnancy unless complications arise. If serious vomit- ing occurs in the early months, this should be treated in the manner described in following article. If albuminuria is discovered, meat and other nitrogenous food must be re- stricted, in accordance with the directions given for al- buminuria. If the patient becomes very ansemic, without albuminuria, meat, eggs, and milk should be eaten in abund- ance. The " longing " of pregnant women for various indigestible articles, such as pickles, chalk, etc., are largely mythical, and occurs, if at all, only as ah accompaniment of a general hys- terical condition, not as a peculiarity, of the period of preg- nancy. Pregnant women, , however, should live simply and avoid foods which are likely to produce dyspepsia, heartburn, and colic, such as sweets, pastry, fried food, rich sauces, spiced dishes, and heating drinks. They often suffer from constipation, in which case fruits and coarse cereals, such as oatmeal or wheaten grits, may be of service. The stomach, especially at night, should not be overloaded. • The idea formerly prevalent that pregnant women need to eat food containing abundant phosphates and lime salts, to furnish the embryo with material for making > W. Oilman Thompson, M.D. : " Practical Dietetics. ' ' New York. D, Appleton & Co. 401 402 DIET IN SPECIAL CONDITIONS bones, as a hen eats lime to make egg shells, is no longer accepted. The salts in question are sufficiently contained in an ordinary mixed diet, such as any pregnant woman may eat, if plainly cooked. Another theory, equally ingenious and directly opposed to the one above mentioned, is only interesting historically, for efforts to aid Nature in a process which she is abundantly competent to regulate unaided are now regarded as futile. This theory was that the agonies of labor would be less severe if the pregnant woman lived upon a diet of fruits and meats, avoiding bread and fresh vegetables during gestation, on the ground that the lime salts which they contain would favor early ossification of the infant's bones, and thus make the labor proportionately difficult. It will be observed that the first theory favors the child, and the second the mother, but practically it has been found that diet has little or no influence either way, so long as it is digestible, nourishing and sufficient to keep the mother in good general condition. VOMITING — SEASICKNESS — VOMITING OF PREGNANCY Thompson ^ The first principle in the dietetic treatment of vomiting from any cause is to give the stomach rest. If it has been overloaded with a large bulk of food, or with indigestible material, it is well to encourage emesis, and distressing retch- ing may be overcome by taking large draughts of lukewarm water. A quart or two will rinse out the stomach and allay irritation to a marked degree. Well nourished patients when serious vomiting first occurs should usually refrain from taking food of any kind for from ten or twelve or even twenty-four hours. Exceptions to this rule are sometimes found in that type of seasickness, and sometimes in the vomiting of pregnancy, in which, as soon almost as the stomach is emptied, there is a desire to re- plenish the loss. 1 W. Gilman Thompson, M.D. : "Practical Dietetics." New York. D, Appleton & Co. MOTHERHOOD 403 In any case in which the gastric irritation is persistent, it is necessary to give fluid food, and only in small oft-re- peated doses, preferably in predigested form. The food is. best given cold, as a rule, although some persons can relieve nausea by sipping very hot water. A teaspoon of prepared milk, or in extreme cases but a few drops, given with a medicine dropper once in ten or fif- teen minutes, may be all that the stomach will at first toler- ate. The following is a list of dietetic substances which are- commonly prescribed for the relief of nausea and vomiting,, or for nourishment while those conditions exist: Cracked ice; panereatinised milk; milk with sodium bicarbonate (ten grains), and cerium oxalate (five grains) ; milk and lime water; milk and Vichy, soda, seltzer, or carbonic-acid water; kumyss and zoolak; beef extracts and Liquid Peptonoids; Dry Peptonoids Soluble; raw meat pulp, scraped; strong black coffee; sour lemonade or lemonade and Vichy; clam broth. Dry crackers, dry toast, and ginger snaps will some- times be retained in seasickness, or a cracker buttered and sprinkled with a little Cayenne pepper; brandy and soda;, iced dry champagne; iced brandy diluted with water, soda water, or Apollinaris. Very severe and protracted cases may require lavage or nutrient enemata. Vomiting after abdominal surgical opera- tions is often controlled by lavage. DIET FOR THE MOTHER AFTER LABOR Society of the lying-In Hospital, New York City i Immediately after labor in a normal case milk diet is givert for the first six hours ; at the end of that time regular diet. In abnormal cases the diet is ordered by the physician. In our regular diet stewed fruits and cereals are given: very frequently ; no veal or pork is allowed. In cases of severe engorgement of breasts, fluids are re- stricted; a dry diet is given, which consists of the regular ^Diet used at the Society of the Lying-in Hospital, New York City. 404 DIET IN SPECIAL CONDITIONS diet and one glass of milk with each, meal; no tea or cofEee and no fluid between meals. In cases of eclampsia milk is always given; also a large quantity of water, either hot or cold, and cream of tartar drink. All nursing women have extra quantities of milk. DIET or A NURSIITG UOTHER OB WET NTTIISE Thompson i The diet of the nursing mother or wet nurse must be regu- lated to prevent noxious substances from passing into the breast milk, and to keep her in good health, so that she does not suffer from constipation, indigestion, or anaemia. Her weight should not alter, and if she has menstruated once or twice the milk changes and may disagree. If milk does not make her constipated or bilious, she may drink it abundantly. She may take gruels and meat broths, and she should eat simple nourishing food, meat, eggs, veg- etables, and fruits. The latter, even if sour, do not react unfavorably upon the child, provided the mother's digestion is good, and they serve to keep the child's bowels active. The mother should forego the drinking of much tea and coffee. Beer and wine also should not be drunk unless they are es- pecially prescribed as a tonic. Wet nurses often demand Tseer, ale, or porter with their meals if they have been accus- tomed to it; but the popular idea that such beverages are especially beneficial is fallacious. Malt liquor sometimes causes the secretion of more milk, because more fluid is drunk, but the milk is no better for it. A reasonable quan- tity of fluids should be drunk, however, or the secretion of milk will suffer. The fluid may be in the form of plain or effervescing water, milk, soups, etc. The mother or wet nurse should avoid all fatigue, worry, and emotional excitement of any kind, which may inhibit her digestive functions, and should take daily outdoor exercise. >W. Gilman Thompson, M.D. : "Practical Dietetics." New York D Appleton & Co. MOTHERHOOD 405 On the whole, the best indication for the dietetic treatment of the wet nurse is the study of the condition of the child's digestion, bowels, and nutrition. A too meager diet for the nurse is soon evident in lack of nutrition and development of the infant. Drugs in Human Milk. ISTot many drugs pass unchanged into the milk which are likely to poison the child through its food, but there are some which should be carefully avoided on this account. Such are belladonna, opium, morphine, and other alkaloids; iodin and its preparations; mercury and its salts; salicylic acid. "When, for any reason, it becomes necessary to discontinue the nursing and to stop further secretion of milk, the diet should at once be made as dry as possible, and a minimum quantity only of fluid is allowed. CHAPTER XXI INFANT FEEDING GENERAL CONSISERATIOKS Infants may be fed naturally, artificially or by a combina- tion of both methods. When the child is at the breast of its own mother or another nursing woman, there is no indi- cation for artificial feeding as long as breast milk is plentiful and of good quality. If the infant no longer thrives on mother's milk or the_ mother .is unable to nurse it, and there is no other breast milk available, bottle feeding is then indi- cated. It goes without saying that many infants, chiefly foundlings, have to be bottle fed from the start, but every effort should be made to secure to the child its birthright of mother's milk. The subject of breast feeding and choice of a wet nurse are discussed thoroughly in special works which the nurse is obliged to study, and hardly belong to the general subject of dietetics. This is also true to a large extent of artificial feeding, because the physician's orders are so ex- plicit that they may be carried out by \the mother or any intelligent woman. However, cases may occur, as they fre- quently do in hospitals, where the nurse is largely respon- sible for the thriving of the child, and is given only general instructions, if any, from the practitioner. For this reason a brief resume of the whole subject seems desirable. BREAST FEEDING The baby is first allowed to nurse after the mother has had some hours of sleep following delivery. This, however, is not actual feeding for the milk is not secreted as such until the second twenty-four hour period after birth. The first 406 INFANT FEEDING 407 flow, called colostrum, differs from true milk in its compo- sition, providing a small amount of nourishment ready for absorption without digestion. The first attempt at nursing aids the mother by assisting the empty uterus to contract; while the colostrum aids the infant by stimulating the diges- tive tract and arousing peristalsis. In addition to the colos- trum the infant should receive only warm water for the first twenty-four hours. Should there be much delay in the secre- tion of mature milk it may be necessary to give the infant a little modified cow's milk having a very low protein content (1/4 per cent, to y2 per cent.). Under ordinary conditions the mother begins to secrete mature milk by the second twenty-four hour period. Up to the third or fourth day, this milk is mixed with colostrum in increasingly small amounts, but this may be disregarded in practice. The child must be taught to nurse at stated intervals, for fifteen or twenty minutes at a time, alternating the use of the breasts.'- THE WET NURSE When the mother is unable for any reason to nurse her child or to supply it with enough nutriment, the ideal sub- stitute is the milk of another nursing mother, who should be in perfect health and have a child of about the same age as the infant to be nursed. When the wet nurse is a hireling the moral risk is very great, for the nurse's own child if still living is largely sacrificed for the good of the other. It is also difficult to find a wet nurse of good character or educa- tion. It is particularly necessary to supervise her diet for she may be intemperate. Her own child may be illegitimate ; she herself may suffer from some venereal or parasitic dis- ease. COUFOSITION OF KOTHEB'S MILK It is often advisable to collect enough milk with the breast pump to permit of an analysis. Milk within normal limits should average fat, 4 per cent.; carbohydrates (milk sugar), . 1 See table of feeding according to age. 408 DIET IN SPECIAL CONDITIONS 7 per cent., and protein, 1.5 per cent. Such an analysis is unnecessary when the infant keeps well' and gains in weight. . Maternal nursing is of such vital importance that artificial feeding should be looked upon as a last resort and necessary evil, and carefully guarded against. If the mother's milk is found to be poor in non-protein elements and over-rich in protein, attempts should be made to remedy the disproportion by proper treatment for the mother. THE HYGIENE OF NATTJIIAL FEEDING As a nursing baby spends most of its time sleeping, dur- ing which state it grows and develops, there must be some relationship established between sleeping and feeding. When it wakes from normal causes, it needs nourishment. Every- thing possible should be done to keep it from being wakened unnecessarily. Hence it is best left alone, in a dark and quiet room, with clothing properly adjusted. The baby should be weighed at birth and at regular inter- vals. It is natural for it to lose weight for the first week or so, but by the end of the second week it should have re- turned to its birth weight, and after that should gain steadily. Up to the fifth month, it should gain on an average from five to eight ounces a week and hence should then weigh double its birth weight. During the next ten months it should again gain its own weight, so that if it weighed eight pounds at birth it should weigh sixteen pounds at the end of five months and twenty-four pounds at the end of fifteen months. Teething, diarrhcea, hot summer weather, etc., tend to re- tard somewhat the natural gain. If it fail to gain from no apparent cause, the breast milk should be examined and a strict plan of feeding introduced. If there is too little breast milk, as very often happens, the mother should drink from one to two quarts of good milk daily, at regular intervals, during the night as well as the day hours. Some attention should be paid to the capacity of the in- fant's stomach, in all plans of systematic feeding, as shown by the following table : INFANT FEEDING 409 CAPACITY OF BABY'S STOMACH Newly born about 1 ounce. At 1 month about 2J ounces. At 2 months about 3i ounces. from then on, up to the first six months, the gain is only fractional, so that at that time it is barely four ounces. One should bear in mind that the baby often craves water, rather than milk, and should always be offered it at intervals. It takes in this way one and one-half ounces or more each day, usually at the rate of two teaspoonfuls every four hours. This use of water tends to prevent overfeeding. It is a good plan to give the water in a nursing bottle, as in this way the child becomes accustomed to its use, and less difficiilty is experienced at weaning time, or when breast feeding has to be partially or wholly discontinued for any reason. SCHEDULE rOR NURSING Up to two months of age the baby will normally demand the breast about ten times in twenty-four hours, or roughly speaking, every two hours, day and night. After the second month, the night nursings may be cut down to one, so that eight feedings in twenty-four hours will suffice, intervals from two to three hours. After the third month, and up to the sixth, it may be fed every three hours, in the daytime only. From the sixth to twelfth month, five feedings will suffice, all in the daytime, intervals from three to four hours. From the twelfth month to weaning time, four feedings suffice, about four hours apart, in the daytime only. The tendency of the mother's milk to grow scanty is usually yery marked long before the nursing period is over. As al- ready stated, she should use milk freely as a milk maker. The use of malt liquors no doubt increases the milk supply, but if the child has any ailment, especially of the skin, this will almost surely be aggravated. Fo drugs have any power to increase the flow of milk. When the mother's milk is inadequate and no other breast 410 DIET IN SPECIAL CONDITIONS milk is available, mixed feeding will be necessary. The baby receives just enough artificial food to make up the deficit. This is only what happens naturally at the weaning period, and is simply an anticipation of the latter. WEANING Children can be nursed for two or three years, but in the great majority of cases, a period not earlier than twelve or later than eighteen months is chosen to begin mixed feed- ing, so that the process may be made gradual or rapid as circumstances demand. As there is absolutely no difference between artificial feed- ing as a supplement to breast feeding and the same as an entire diet, the subjeqt of substitute feeding is usually dis- cussed without special reference to the former. It must be remembered that breast feeding continued too long be- comes a confirmed habit, like a drug habit, against the in- fant's own welfare. It then is necessary to make it repug- nant by putting aloes, etc., on the mother's nipple. AKIIPICIAl OR BOTTLE EEEDINO When there is no breast milk available for the newly-born child, or for an infant of any age during the nursing period; or when the child has some breast milk, but not enough to nourish it; or when it has reached the weaning period and must be taken off the breast either suddenly or gradually, the general conditions are much the same; viz., the child must be nourished by some artificial fluid which closely ap- proximates mother's milk in composition. For this purpose ass's milk seems especially suitable, as its composition and behavior in the stomach are very similar to human milk; but as a rule, no better results are obtained with any kind of foreign milk than that of the cow, properly modified to ob- tain the right proportion of protein, fat, and carbohydrate. SIEEEBENCE BETWEEN HUMAN AND COW'S UILK Cow's milk has a larger protein content than human milk, and is richer in mineral matter. Human milk has a larger INFANT FEEDING 411 sugar content and therefore a somewhat sweeter taste. The fat content of the two kinds of milk is about the same, and this is also true of the total solids. The following table shows the average composition of the two kinds of milk: Human Cow's Water 87% 87% Total solids 13% 13% Fatty matter 4% 4% Lactose 7% 5% Protein (see second table) 1.5% 3.5% Mineral matter 0.2% 0.7% The fat of cow's milk differs with the breed of milch cow, and may be as low as 2 per cent, or 3 per cent. The fat in human milk is quite constant in amount, but the protein content may vary from 1 per cent, to 2 per cent., the 1.5 per cent, in the table being an average. Human milk, in comparison with cow's milk, is very poor in casein, but rich in lactalbumin and hence, when coagulated, does not form large curds like cow's milk. The relations between casein and lactalbumin in the two kinds of milk are shown in the following table : Human Cow's Total protein 1.80 3.50 Casein 60 3.00 Lactalbumin 1.20 .50 The high protein content and large proportion of casein in cow's milk are advantageous to the calf, with its rapid rate of growth, and complex system of stomachs in which large curds can be completely digested; but for the more slowly-growing baby, whose digestion is largely intestinal, the proportion of protein and the character of the curd must be modified. The fat of mother's milk contains more olein and more phosphorized fat (lecithin) than cow's milk. The lactose is chemically the same. Freshly drawn cow's milk is neutral or amphoteric in reaction to litmus. Basic elements predominate in both cow's and human milk, and hence they are both technically alkaline. The acidity of cow's milk to 412 DIET IN SPECIAL CONDITIONS certain indicators is due to the presence of acid salts, such as acid calcium phosphate. On standing, true acid is formed by the action of lactic acid bacteria upon the lactose. For this reason, cow's milk frequently reacts acid to litmus. Breast mil^ is practically sterile. GENERAL FEINCIFIES OF MILE MODIFICATIONS It must be constantly borne in mind that anything but mother's milk is a foreign substance in the stomach of the child, and even to make a mixture agreeing in chemical com- position with the natural food is not to insure success. The general principles must be applied in a special way to each individual case. » The first step in modification is the dilution of the pro- tein. Pew new-born infants can digest pure cow's milk. Some require more dilution than others. Where the diges- tive powers are unknown, it is wise to begin with a low strength and advance as rapidly as the condition of the child will permit. Prom % to 1 per cent, protein is commonly recommended for the early weeks. The second step is the adjustment of the fat. Individual infants differ in their tolerance of fat as of protein. But inasmuch as the chemical and physical differences are not as great in the case of fat, it is usually not necessary to reduce it below 2 per cent., and it should approximate the propor- tion in mother's milk as rapidly as possible. When whole milk is diluted, if more than one volume of water be added, the percentage of fat is less than two, and for greater fat content, fat must be added in the form of cream. Since it is difficult to get the right percentage in this way, it is custemary to select a milk with such a ratio between the protein and fat that diluting one to the desired strength dilutes the other also to the required degree. This is accomplished by taking the upper layers of milk which has been standing five hours or more for the cream to rise. The upper layers have much fat and little protein; the lower. INFANT FEEDING ,413 much protein and little fat, and the adjustment is readily made by taking a certain number of ounces for dilution. In the laboratory, the exact fat and protein content can be de- termined by direct analysis. The third step in modification is the adjustment of the milk sugar. This can usually be given of the full strength found in mother's milk (7 per cent.). Since lactose com- mercially prepared from cow's milk is of the same composi- tion as that in mother's milk, it is only necessary to know the percentage already present in the mixture to be fed, and then add sufiicient to make the desired strength. Besides these three main steps in artificial feeding, we may have as a further consideration the selection of a diluent. AVater is the first choice, but to aid in the modification of the character of the curd, cereal waters or gruels, lime water, proprietary foods, etc., are sometimes prescribed. Carefully prepared, and regarded mainly as diluents and not as sub- stitutes for milk, the cereals and prepared foods are often useful ■ aids. Lime water causes the mucin of the milk to swell, and tends to send the curd in soft condition into the intestines. It is also beneficial as a corrective of constipa- iion. WHAT DILUTION TO TISE The degree of dilution varies with the age of the child. Advance is made from low strength to higher as rapidly as the child is able to digest stronger food. Since it is usually necessary to begin with a formula weaker than mother's milk, it is desirable that stronger formulae be given as soon as practicable to compensate for this early loss. This is par- ticularly true as regards mineral constituents. On diluted cow's milk, the child gets less iron and phosphorus than in mother's milk, and while cow's milk is rjch in calcium, it is doubtful whether this is as perfectly utilized as that in human milk. THE ftrANTITY TO FEED The amount of milk taken by the breast-fed child is the usual guide as to quantity. (See Capacity of Baby's Stom- 414 DIET IN SPECIAL CONDITIONS ach.) Both under-feeding and over-feeding are undesirable. The best criteria of proper feeding are the normal weekly- gain in weight (averaging at least four ounces) and the gen- eral well-being of the child. A determination of the energy value of the diet is desirable as a control. For the first year, a child requires on the average 100 calories per kilogram of body weight. Seventy calories per kilogram is minimum for existence, and does not ordinarily provide for storage in growth. LABORATORY MILK "With the development of the milk laboratory, it has be- come possible to obtain by prescription, pure milk of any given composition. Such milk is necessarily expensive, and since slight variations in the composition of formulae are not serious for the ordinary healthy child, the use of laboratory milk is largely limited to sick babies or those of rich parents. HOME UOSIFICATION For the average child, milk can be successfully modified at home. The chief requirements are fresh clean milk, absolute cleanliness in its treatment, and careful following of direc- tions in making up the feedings. Clean raw milk is preferable to any other kind. Therefore certified milk should be used if it can be afforded. If this is impossible, then the best bottled milk. If this is pasteur- ized, the pasteurization should be at a low temperature. Loose grocery milk should be avoided. When the milk comes into the house, the bottles should be carefully washed, and set in the cold until needed. All apparatus used in preparing the baby's food should be kept by itself on a tray or table. Every vessel should be washed in soapsuds and then scalded in clear water before use. If there is a special nursing refrigerator, it should ba cleansed daily with soda-water. INFANT FEEDING 415 THE NUBSIN6 BOTTLE The tube bottles should never, under any con- sideration, be used. No matter how carefully these tubes and outfits are washed, small particles of milk will remain in the tiny crevices and cause inflammation of the intestines. Select the plain, graduated cell, without neck, wide-mouthed, covered with breast-nipple. Such a bottle can be thoroughly and easily cleaned. These re- quirements are met by the Hygeia nursing bottle. When filled, the bottles are corked with non-absorbent cot- ton.^ They are plugged loosely, so that the steam may es- cape, if the milk is pasteurized in the bottles before putting into the refrigerator, as is necessary when the quality of the milk is unknown or when refrigeration is lacking. Before feeding, the bottle of milk is warmed to 105° F. (40.5° C), so that the milk may not chill the stomach of the infant, and thereby suspend digestive processes. After the nursing, the bottle should be carefully rinsed with cold water, then bottle and nipple washed with a suds of soap and water. Einse, boil in clear borax water for twenty minutes (nipples for two or three minutes), and set away in a porcelain dish filled with boric acid solution, one teaspoonful to a quart of water, or they may be emptied and filled with a plug of sterilized baked absorbent cotton, and will remain sterile until ready to use. The twenty-four-hour supply should be prepared at one time. For removing the milk from the bottle a dipper is most satisfactory, as the cream is not disturbed. A siphon may also be used. The milk sugar to be added should be dissolved in a little boiling water and strained. A bottle of sterile water should be at hand for diluting the milk. The proper number of bottles for the day's feedings (pre- viously sterilized) should be each filled with the prescribed amount, stoppered and put in the refrigerator, or if necessary, pasteurized and then quickly cooled. > To cork tile Hygeia bottle, a sterilizer cap is used to cover the cell. The cap has a small opening, which is corked With non-absorbing cotton. These caps are on sale by druggists. 416 DIET IN SPECIAL CONDITIONS FORMULAE FOE INFANT FEEDING Many systems for percentage feeding of infants have been evolved. One of the simplest is the top milk method. The cream is allowed to rise. The upper third of the bottle con- taining practically all the fat, will contain approximately 10 per cent, of fat; .the upper half 7 per cent, of fat. In the upper third, the ratio of fat to protein is 3.1; in the upper half, 2.1; in whole milk, 1.1 (approximately). TOP UILK METHOD 1. Emmet Holt i Top-Milk. To secure a milk for infant feeding which is fresh and at the same time one which contains an extra amount of fat, the practice has come largely into vogue of using the upper portion — a third, fourth, or fifth from milk purchased and delivered in bottles — after it has stood only a few hours. To this the term "top-milk" or "upper- milk" has been given. Different percentages of fat may be obtained by varying the amount removed and the length of time the milk has been allowed to stand. Top-milk and thin cream are practically identical in composition, although they may differ in freshness. If cow's milk from a mixed herd is put into bottles soon after it is drawn and rapidly cooled, it will be found that after four hours the upper fourth will contain nearly all the fat that will rise as cream, and that the upper layers will have nearly the same percentage of fat whether the milk has stood for four hours, for eight hours, or over night. This has been demonstrated in a series of experiments made for me by Messrs. Upton & Jeffers, at the Walker-Gordon Farm at Plainsboro. After the milk had been standing under the conditions mentioned, fat-tests were made with the Babcock apparatus of the different four-ounce layers of bottled milk which contained originally 4 per cent, of fat. The different ^L. Emmett Holt, M.B. : "The Diseases of Infancy and Childhood." Fifth Edition, Copyright, 1897, 1902, 1905, 1907, 1909. D. Appleton & Co. INFANT FEEDING 417 layers were carefully removed with a siphon, with the follow- ing results: Percentage of fat in — After four After eight Over night, hours. hours. Upper 4 oz 20.50 21.25 22.00 Second 4 oz 6.00 6.50 6.50 Third 4 oz 1.50 1.40 1.00 Fourth 4 oz 1.20 1.00 0.30 Fifth 4 oz 1.00 1.00 0.20 Each of these percentages represents the averages, each test having been repeated many times, 110 different tests in all having been made. It will be seen that after four hours the composition of the separate layers does not change very much with the period of standing. With this knowledge, it becomes a comparatively simple matter to secure almost any desired percentage of fat by simply varying the number of ounces removed from the upper part of the quart. This will of course not be the same with all milks, but will vary considerably according as the supply is from a good herd of selected cattle of mixed breeds (average 4 per cent, fat), a Jersey or Alderney herd (5.35 to 5.50 fat), or from widely scattered farms such as make up the general supply of any large town or city (3.25 to 3.60). It is therefore absolutely necessary for the physician to know with which one of these he is dealing, if the milk for infant feeding is to be modified at home from the different layers of top-milk. More mistakes are made just here than at any other step in. this method of feeding. The tables given below are sufficiently accurate for home: modification, provided the fat percentage of the whole milk is known. From 4 per cent. Milk To secure approximately a 10% fat, remove the upper 11 oz., or about one-third. To secure approximately a 7% fat, remove the upper 16 oz., or about one-half. 418 DIET IN SPECIAL CONDITIONS From 525 to 5.50 per cent. (Jersey) Milk To secure approximately a 10% fat, remove the upper 15 oz., or nearly one-half. To secure approximately a 7% fat, remove the upper 24 oz., or nearly three-fourths. From 3.25 to 3.50 per cent. Milk To secure approximately a 10% fat, remove the upper 8 oz., or about one-fourth. To secure approximately a 7% fat, remove the upper 11 oz., or about one-third. How to Obtain the Formulas Required for General Use. If one has at command three series or groups of formulas in which the fat has certain definite relations to the proteids, he will be equipped for the great majority of cases met with in practice. The three groups are as follows : First Series, those in which the fat is three times the pro- teids. Second Series, those in which the fat is twice the proteids. Third Series, those in which the fat and proteids are nearly equal. Fig. 2. Chapin's dipper for re- moving the up- Fig. 1. The percentage of fat in different layers per layers of of milk. milk INFANT FEEDING 419 Once thoroughly familiar with these groups of formulas, variations from them to suit the needs of the particular case can readily be made. In generalj the First and Second Series, in which the fat is considerably higher than the pro- teids, are adapted to the early months, because at this period the infant as a rule has more difficulty in digesting proteids than in digesting fat. In the later months a higher propor- tion of proteids can be taken with the same percentage of fat. There are, however, other conditions besides age which must be taken into account, such as the vigor of constitution, the weight, and most of all, the peculiarities of the child's diges- tion. It is, therefore, impossible to say that at certain months certain proportions are desirable, and certain others at another period. Formulas in Which the Fat is Three Times the Proteids. This is nearly the relation which the fat and proteids bear to each other in a good sample of woman's milk. The easiest way to arrive at this would seem to be, first, to secure some milk or milk combination containing three times as much fat as proteids, and then dilute this according to the infant's age and digestion. After such dilution it will be necessary only to add the requisite amount of sugar and, when desired, lime water to complete the modification. This, in brief, is the whole process. The most convenient combination for dilution is one con- taining 10 per cent, fat and 3.3 per cent, proteids. I shall call it a 10 per cent, milk, and refer to it subsequently as the primary formula of the First Series. The 10 per cent, milk may be obtained by removing the upper portion (see Fig. 1) from a quart bottle of milk, as described (p. 417, 418). This method will answer for persons who can obtain milk fresh from the cow, or for those who use bottled milk, provided the bottling is done at the dairy before the cream rises. The upper milk may be taken off with a siphon, spoon, or small dipper (Fig. 2) ; pouring off is not so accurate. For those who do not get their milk as above described, the additional fat can be secured by adding cream to the milk. 420 DIET IN SPECIAL CONDITIONS To secure a combination containing 10 per cent, fat, equal parts of plain milk and the ordinary (16 per cent.) cream should be used. The next step is the manner and degree of dilution of the primary formula. It is convenient^ in our calculation to make up twenty ounces of the food at a time. For such a twenty-ounce mixture it is seldom necessary to use less than two ounces of our 10 per cent. milk. When one wishes to strengthen the food he gradually increases the amount of the 10 per cent, milk, one ounce at a time, making it successively three ounces, four ounces, five ounces, six ounces, etc., in a twenty-ounce mixture, the water, of course, being reduced by the same amount. These mixtures may readily be translated into percentages by remembering that the percentage of fat is always exactly one-half the number of ounces of the 10 per cent, milk used in a twenty-ounce mixture. Thus, using three ounces will give 1.5 per cent, fat; four ounces, 3 per cent, fat; six ounces, 3 per cent, fat, etc. The proteids will continue to be in every instance exactly one-third the fat, as in the primary formula. The amount of milk sugar needed to bring this up to the percentage usually required (5.5 to 6.5) is one ounce in each twenty-ounce mixture. One may obtain from a druggist a box holding exactly one ounce of sugar, or may measure in a tablespoon, calculating two and one-half even tablespoonfuls as one ounce. This sugar is dissolved in the water used for diluting the milk. The usual proportion of limewater added is 5 per cent., or one ounce in a twenty-ounce mixture; this may be easily in- creased to any desired quantity. The foregoing directions may be expressed in the following table : , First Series of Formulas. Fat to proteids, 3 :1. Primary Formula. 10 per cent, milk — or fat 10 per cent., sugar 4.3 per cent, proteids 3.3 per cent. Obtained (1) as upper portion of bottled milk (p. 418), or (2) equal parts milk and (16 per cent.) cream. INFANT FEEDING 431 fUm 3 ^ o »o CO ^H a Cj o OOO-H^ Ph 1-. m . 3 oo 01 i/^ VO \0 vo vO ^HCStSCOCO 6? » o CO -^ lO ^ t-- •g a - ^ ;s :: O O • M:s ^ ;± ;i :± ■ -o 8 ?> ■£ ■^ ID VO t^ 00 ON O OO §5 = =. = ;:-» gOg •-t 1-t O ^ '-I /-^ : :° :j2 !3 «) "i iSS "^ McScy ---""-" MgCT > Making more than a twenty-ounce mixture will be found very simple if we calculate for twenty-five, thirty, thirty-five ounces, etc. Thus for twenty-five ounces we add one-fourth 423 DIET IN SPECIAL CONDITIONS more of each ingredient ; for thirty ounces one-half more, etc. For twenty-iive ounces of eleven, therefore, the exact formula would be : 10 per cent, milk, three and three-quarter ounces ; milk sugar, one and one-quarter ounces; limewater, one and one-quarter ounces; water q. s. to make twenty-five ounces — i. e., twenty ounces.^ Formulas in Which the Fat is Twice the Proteids. Here we first obtain a combination, or primary formula, in which the fat and proteids stand in the relation of two to one, and then dilute this, adding milk sugar and limewater to complete the modification. The primary formula most conveniently obtained for this purpose is one containing 7 per cent, fat and 3.5 per cent, proteids, or a 7 per cent. milk. This we may get by removing the upper portion from a quart bottle of milk, as described on page 418. Or in case milk and cream are used, instead of this upper milk, it will be necessary to add one part ordinary (16 per cent.) cream to three parts milk. The dilution is accomplished in the same general way as with the First Series. These formulas may readily be translated into percentages by remembering that the percentage of fat in any formula is exactly seven-twentieths, or about one-third, the number of ounces of the 7 per cent, milk in a twenty-ounce mixture. Thus three ounces in the mixture will give about 1 per cent, fat; five ounces will give 1.6 per cent.; nine ounces about 3 per cent., etc. In the following table these directions are expressed : Second Series of Formulas. Fattoproteids,3:l. (Seep. 421). Primary Formula. 7 per cent, milk — or fat 7 per cent., sugar 4.40 per cent., proteids 3.50 per cent. Obtained (1) as upper portion of bottled milk (p. 418), or (2) by using three parts milk and one part (16 per cent.) cream. With these, as with the First Series, if more than twenty ' For method of calculating any number of ou. -ces of any formula derived from 10 per cent, milk, see footnote on page 423. INFANT FEEDING 423 ounces are required, we may make twenty-five, thirty, or forty ounces by using of each ingredient one-quarter more, one-half more, or twice as much.^ Formulas in Which the Fat and Proteids are Nearly Eqiml. In general formulas are more often used for healthy infants during the later months; but there are many conditions of disturbed digestion in which formulas having this relation of fat and proteids are desirable during the early months. This series of formulas is obtained by using as a starting-point plain milk and variously diluting it. The exact percentages of fat and proteids obtained with the different dilutions of milk, and the amount of sugar necessary to bring this up to the desired quantity, are shown in the table below. The sugar in the higher formulas is reduced for the reason that with them the child will probably be taking a considerable part of his carbohydrates in the form of starch. Third Series of Formulas. Pat to proteids, 8 tT. (Seep. 424.) Primary Formula. Whole milk: Fat 4 per cent., sugar 4.5 per cent., proteids 3.5 per cent. (When using Jersey or Alderney milk add one-fourth water.) 1 One may readily calculate any formula of any numbep of ounces which may be desired in either the first or the second series in the following way: There is wanted, for example, 35 ounces of a mixture containing 3 per cent fat. 6 per cent sugar, 1.50 per cent proteids. In this combination the fat is twice the proteids. It will therefore be derived from 7 per cent. milk. 35 (No. ounces needed) X 3 (percentage fat desired) =105 (parts of fat required). 105-4-7 (parts of fat in milk used) = 15 (No. ounces of 7 per cent, milk needed). . , . . . . „ The amount of sugar required is found as follows. 7 per cent, milk has 4.40 per cent, sugar. , . ^, , 15 X 4 40 i= 66 (parts of sugar in the milk used in the formula). 66 — 35 = 1.88 (percentage of sugar in the formula of 35 ounces). There is needed, therefore, an addition of about 4 per cent, of sugar to bring it to the desired percentage. ,, .. 4 per cent, of 35 = 1.40 (No. ounces sugar to be added). 424 DIET IN SPECIAL CONDITIONS ^ ^ S hO n, m . O uo S 13 Ph CLi eg B s a SSJ2 2 gS ■.-Ht-I^H C^ cscs gdo'dooooo a 8 a a as:!: pioS ^& ■ : OVO*^ ugar 4.00 5.00 88S8SS a a a ^ (© lO »OtOu^lOIO "J ; : 1.20 1.60 2.00 00 r4 1?§g2ggSS8 s !S a « a a 3 II II II II II II II II 1 S 3 S II a II II a a s 1 it" ft = s s "K ft' ' a - !s a a a '^ ^' a s s ^ E a a s vOOOO a a a a S5 o -S i 1- a a a a a a El CUa 3 fe?. s- - ft o «• l=ltl> > >> Ti t^ '-' *-" INFANT FEEDING 425 CO H o C6 M n CJ ■as H f!i P4 o f» p o n n Hi ! >tO ooo^^o^iHO»-<*-<*MC*iMOOi-<*Hno^»-i^e*ic>Jc*5'*'^'^ M g JS:' MS Ow 9 w (S* i.o.. ^s? • Oi-iMiO* • » e^* • • » «H fj to Ov Ot 0\ s;s; jssjs; s:is^s;:s e*I r4 «>H r^ c<4 N r4 N cs CS e«3 CO r^ r^ tC t^ (^ f*) c^ to ro *1< ^ 1^"^ ^ ^ ^ «^ ^ ^ «• N M M CO fO *0 fO f*J l*> to « ro • id*'^-^-4<* lO lO m »o lO to lO >o lO • (M* rOtO(0» i^Tt"* I01010»0>0» • I0t0»0» • • o « \o *o to ^o "O O « *0» • ^^» • to* » >0*0>0\0» * » t*t^» • • • 000000000000 lo lo I.O V} lo lo lo to >mo lO to lO to >o to >0 lO lO lO >o >o to lO to (O >o lO to to •OOiOOlOOOtOOOtOOioOOOiOOtoOOtOOiOOOOOOO C«JiOOIiO»^OtO*~-OtOt^O«NtOOtOr-0»-iiO>Ot^OCS«OOiOOOO OOOOOiHOOiMOO^^i nes (N to tOfO I to too O O to O to O O O O O to to O O lO to to o o o o o o 5 o o to ^^I0l0t0i0t0t0'0\00\0'0*00v0'000t0»0*0t»t^»^**»c»-t-~'0t0 ^ ^^ OOOtototOOOOOOOtOtOtOtOiOOOOOOOOOOO csNe*tCSesCNC^tOrorotOroeOtOrOco(OtO^^T}<^^<^^^W^ 426 DIET IN SPECIAL CONDITIONS For 25-ouiice mixtures multiply the amount of each ingredient by 114 ft ntk ft tt (t it ft ({ it ' n 11/ " 35 " " " " " " " " 1% " 40 " " " " " " " " 2 it Ar t( tc tt etween meals, and forbidding all pastry, coffee, tea, alcoholics and carbonated drinks, in the case of children of any age. Those under seven years of age are allowed no preserved meats or fish, no hot bread, griddle cake, or nuts, no corn, cucumbers or egg plant. For those under four years no stews, tomatoes, bananas, or any fruit in hot weather. Children up to the age of eighteen months are to be limited entirely to milk, meat broths, orange juice and cooked and strained cereals; with, in exceptional cases, zwieback, biscuit and soft-cooked eggs. Such education means much for the development of hardy mon and women. Undernutrition is not due alone to pov- erty; much of it comes from ignorance. GENERAL RULES FOB FEEBIKG YOUNG CHILDREN Thompson i 1. Allow time for meals. 2. See that the food is thoroughly masticated. 3. Do not allow nibbling between meals. 4. Do not tempt the child with the sight of rich and in- digestible food. 5. Do not force the child to eat against its will, but exam- ^W. Gilman Thompson, M.D. : "Practical Dietetics." New York. D. Lppleton & Co. 43G DIET IN SPECIAL CONDITIONS ine the mouth, which may be sore from erupting teeth; and examine the food, which may not be properly cooked or flavored. If good food is refused from peevishness merely, remove it and do not offer it again before the next time. 6. In acute illness reduce and dilute the food at once. Table of Comparisons, Food Required by Child and Man A child under 2 requires 0.3 the food of a man doing moderate work. A child of 3 to 5 requires 0.4 the food of a man doing moderate work. A child of 6 to 9 requires 0.5 the food of a man doing moderate work. A chifd of 10 to 13 requires 0.6 the food of a man doing mod- erate work. A girl of 14 to 16 requires 0.7 the food of a man doing mod- erate work. A boy of 14 to 16 requires 0.8 the food of a man doing moderate work. Prof. W. 0. Atwatee. Table showing Increase of Calories required for a Growing Child Carbo- Age. Proteid. Fat. HYDRATES. Calories. years. grammes. grammes. grammes. 1% 42.5 35.0 100 909.7 2 45.5 36.0 110 972.4 3 50.0 38.0 120 1050.4 4 53.0 41.5 135 1156.8 5 56.0 43.0 145 1224.0 8 to 9 60.0 44.0 150 1270.0 12 to 13 72.0 47.0 245 1736.8 14 to 15 79.0 48.0 270 1877.3 Hutchison, p. 453. Schroeder, Archiv. fiir Hygiene, iv. 39, 1886. DIETARIES FOR YOUNG CHILDREN Starr i Diet from the twelfth to the eighteenth month: 7 A. M., stale bread soaked in a breakfast cup of new milk. 10 A.M., milk, six ounces, and' soda biscuit, or a thin slice of but- tered bread. » Louis Starr, M.D.: "Hygiene of the Nursery." Philadelphia. Blak- iston. TEE FEEDING OF YOUNG CHILDREN 437 2 P. M., beef tea, six ounces, bread, and a tablespoonful of rice and milk pudding. 6 P. M., same as first meal. 10 p. M., a. tablespoonful of Mellins' Food in eight ounces of milk. In alternation, a lightly boiled egg with bread crumbs and six ounces of milk may be given at 7 A. M., and at 2 p. M. a mashed baked potato, moistened with four tablespoonfuls of beef tea, two tablespoonfuls of junket. Diet from the eighteenth to the thirtieth month: 7 A. M., new milk, eight ounces ; the yolk of an egg lightly boiled ; two thin slices of bread and butter, or else milk, and two table- spoonfuls of well-cooked oatmeal or wheaten grits, with sugar and cream. 11a. m., milk, six ounces, with a soda biscuit' or bread and butter. 2 p. M., one tablespoonful of rare mutton pounded to a paste, •bread and butter, or mashed potatoes moistened with good dish gravy, a saucer of junket; or else a breakfast cupful of beef tea or mutton or chicken broth, a thin slice of stale bread, a saucer of rice and milk pudding. 6:30 P.M., a breakfast cupful of milk with bread and butter, or soft milk toast. Diet from two and a half to three and a, half years of age; children uho have cut their milk teeth: 7 A. M., one or two tumblers of milk, a saucer of thoroughly cooked oatmeal or wheaten grits, a slice of bread and butter. 1 1 A. M. ( if hungry ) , a tumbler of milk or a, teaeupf ul of beef tea with a, biscuit. 2 P. M., a slice of underdone roast beef or mutton, or a bit of roast chicken or turkey, minced as fine as possible, a mashed baked potato moistened with dish gravy, a slice of bread and butter, a saucer of junket or rice and milk pudding. 7 p. M., a, tumbler of milk and a slice or two of soft milk toast. Diet from three and a half years up: Breakfast. — Every day: milk, porridge and cream, bread and butter. One dish only each day: Fresh fish, eggs lightly boiled, poached, eggs scrambled, eggs (plain omelet), chicken hash, stewed kidney, stewed liver. ^ Sound fruit may be allowed before and after the meal, accord- ing to taste, as oranges without pulp, grapes (seeds not to be swallowed), peaches, thoroughly ripe pears, and cantaloupes. Dinner. — Every day: Clear soup, meat roasted or broiled and cut into small pieces, bread and butter. 438 DIET IN SPECIAL CONDITIONS Two dishes each day: Potatoes baked, potatoes mashed, spinach, stewed celery, cauliflower, hominy, macaroni (plain), peas, string beans (young), green corn (grated). Junket, rice and milk or other light puddings, and occasionally ice cream, may be allowed for dessert. Supper. — Every day: Milk, with toast or bread and butter, stewed fruit. rrom the third to the fifth year the child has twenty teeth, and often three meals a day sufiice, although from the third to the fourth year four may be given. After three years of age it is not possible to lay down definite rules for the quantity of food allowed. In, health the appetite may be taken as a fair guide, and thfe child will not eat too much if taught to eat very slowly, and thoroughly chew each mouthful. When the second set of teeth begin to replace the deciduous' or milk teeth, which gradually decay, digestion is sometimes interfered with temporarily, from lack of ability to masticate thoroughly, and food should be subdivided before it is offered to the child. GENERAL PRINCIPLES OF FEEDING SICK CHILDREN Since this work has been chiefly devoted, as the title im- plies, to the relationship between diet and disease, the amount of space given to the feeding of presumably normal children may occasion some wonderment. But the chief difference be- tween the dietetics of the infant and adult lies in the fact that the bottle infant and the weanling, nominally healthy, have to be dieted to prevent disease. This has now come to be realized on all sides. In classic and mediaeval times an infant which could not get breast milk usually perished. The wean- ing period was somewhat less trying, but millions of children must have succumbed to the ordeal of changing to solid food. Improvement in feeding means a direct lessening of infant mortality, as modern statistics testify. Colic and Vomiting (Regurgitation) are almost physiolog- ical, so common is their occurrence; they do not arise from any single cause, and the fact that breast-fed infants suffer almost as frequently as the bottle-fed, often more so, shows THE FEEDING OF YOUNG CHILDREN 439 that such ailments are not entirely preventable by care in feed- ing. In breast-fed children, these symptoms are best con- trolled by lengthening the period between feedings. In bottle- fed children, besides lengthening the nursing interval, special pains should be taken in the modification of the milk. These symptoms may occur quite independently of diet. Chilling of the body surface, coughing, improper handling, a too snug binder, etc., may be the true cause of the trouble. Even in breast-fed infants under ideal conditions, the mother's milk may not be well-borne. It may in fact be so rich in fat and protein as to require dilution; which of course in the breast- fed may be accomplished only by giving the infant water be- fore or after nursing. Gavage. Of late years the use of the stomach sound in feeding sick nurslings has come into considerable vogue in foundling asylums and the like. This resource has a con- siderable range of application. Thus in premature infants (which do not nurse readily) ; in all infants which refuse to nurse ; and in infants sick from any cause, especially when the nerve centers, swallowing or breathing apparatus are involved, or when continuous vomiting is present, the use of the stom- ach tube may save life. Very young babies are fed much more readily than older ones, since they are less liable to fright. The tube used is a soft rubber catheter, which is coupled with a small funnel. The catheter is first passed down the gullet. In order to have plenty of leeway, it is an advantage to unite the catheter to a second rubber tube with a piece of glass tubing. The second rubber tube is then coupled to the funnel. If the case be one of vomiting, it is often necessary to wash out the stomach before the introduc- tion of nourishment, however given. The term lavage, used for washing out the stomach, must not be confounded with gavage, which means literally forced feeding. Complete de- tails will be found in works on obstetrics and obstetric nurs- ing. Edgar says of gavage, that the infant to be fed should lie on its back in the nurse's arms, its own arms held to its iides, while an extra assistant steadies the head. The tube 440 DIET IN SPECIAL CONDITIONS • having been passed, the modified milk or other nutriment is poured into the funnel, and as the latter empties itself the tube is pinched to prevent escape. While regurgitation may occur and necessitate a repetition of the act, it very often happens that food taken in this manner is much better re- tained than if taken by nursing the breast or bottle. The exertion required by nursing, the swallowing of air, etc., are avoided in gavage. To recapitulate, the conditions in which gavage has been found life saving, are given by Edgar in the following order: Prematurity (especially in incubator babies) ; after opera- tions on the nose and throat; habitual vomiting; pneumonia, diphtheria and scarlet fever. The Jaws of the nursling can usually be separated to receive the gavage-tube. But if there is inflammation of the mouth or locking of the jaws (or if intubation has been required for diphtheritic cases) it may be necessary to resort to nasal feeding (see p. 79). Diarrhoea. Under this familiar term, which includes the mildest looseness of the bowels as well as the severest symp- toms of cholera and dysentery, may be included the greater part of the morbidity of the nursling. Death certificates of babies, especially in summer months, chiefly specify this cause. The diarrhoea makes itself felt in a variety of ways. If con- joined with vomiting we may term it a gastro-enteritis, and state that a given child died from inability to profit by its nourishment. But many infants succumb, not because their nourishment is rejected outright, but rather from the fact that it is not utilized. We can understand death when due to vio- lent vomiting and diarrhoea; but the slow death from non- utilization of food, such as occurs so extensively in bottle-fed tenement house children, still remains largely a mystery, which has been explained in the most diverse ways. The amount and character of gastro-intestinal disturbance present is not suflBcient, in many cases at least, to explain the total failure of nutrition. It is in the effort to combat this condition that so many methods of feeding have come into use. As in all stubborn and imperfectly understood conditions, with a bad THE FEEDING OF YOUNG CHILDREN 441 outlook for recovery, many substances have been tested, and many recoveries have been recorded. If a threatening diar- rhoea appears, with or v^ithout vomiting, the best course to pursue at first seems to be fasting. Sterile water may be al- lowed but milk is prohibited. There is in these cases some special reason for forbidding plain milk (see remarks on the use of whey-free milk, p. 190). It is believed by some authorities that cow's milk or the milk of any animal is poi- sonous in these cases. Others would state that milk is danger- ous because of one or another solid ingredient, or because it furnishes a culture medium for germs. In any case some pre- -digested food like panopepton, or some cereal decoction like rice or barley water seems better borne. It may also be ad- visable at this stage to use certain drugs to control vomiting. When the latter has ceased for twenty-four hours, normal feed- ing ihay be cautiously resumed. The treatment of these cases taxes the utmost resources of the physician, and the mortality is enormous. The nurse's duties lie rather in the direction of prevention; but if these cases develop, rest of the stomach is imperative at first and milk must not be resumed until all symptoms are passed. Diarrhoea, dysentery and all gastro- intestinal troubles in older children are dieted on the same principles as are the same affections in adults. Constipation in nurslings is a condition difficult to over- come entirely by diet. The familiar remedies are sugar and cream, an excess of either of which, over dietetic requirements, may loosen the bowels. A prescription of laboratory milk may meet .this obstacle, or the corresponding home modifica- tion. Fruit juices, oatmeal gruel, etc., are sometimes em- ployed. Marasmus and Rickets are two conditions generally in- cluded under diseases amenable to diet. Infantile Scurvy should be named in the same connection. There is no special regimen, however, for such affections. A full normal diet cannot be improved on. CHAPTER XXIII THE ADOLESCENT — THE SEDENTARY — THE AGED DIET FOE THE ADOLESCENT The growing youth needs extra protein food for the build- ing of protoplasm and a sufficiency of salts for the rapidly- forming tissues; earthy salts for bones, iron for blood, phos- phorus for nervous tissue and its general influence on growth, obtained from the average liberal mixed diet with milk, eggs, fresh fruit and green vegetables, so that no special plan of feeding is required. If the adolescent lead a very active ex- istence, equivalent to hard labor in an adult, he will naturally require the same amount of food with necessary reduction for weight, and some allowance for extra protein. Many ado- lescents, however, are very sluggish and lead inactive lives, and need encouragement to activity, with food in proportion to its degree. Again the appetite is npt always a safe guide, especially for girls; for the period of adolescence coincides with the development of " hysterical " tendencies which may be manifested by excessive or diminished craving for food without any reference to the actual physical demands. An active adolescent may have but little appetite while a slug- gish one may be a glutton, or may continually dj ink water. The perverted cravings for substances of no nutritive value and without appetizing quality, which accompany this period, are well known. It is therefore necessary that the diet of this period be as carefully supervised as that for the little child. The food must conform to the subject's physical requirements, and must be administered with discretion, for a large percent- age of food aversions are acquired at this time, and it is es- sential to the well-being of the individual, and the comfort of others, that his eating habits be normal. 443 TEE SEDENTARY 443 DIET FOR THE SEDENTARY 'No exact rules can be laid down for the dietetics of the sedentary. An individual may lead a technically sedentary life, and yet use up a great amount of energy, only standing and walking muscles being in disuse just as in a person whose occupation requires standing and walking, little use may be made of arm, shoulder and trunk muscles. A better distinc- tion is between out-door and in-door life, or quiet and active existence. True sedentary persons lead both a quiescent and an in-door existence, chiefly in the sitting posture. The less the exertion, the less the requirement for food. Excess of food over actual demands is usually manifested by the putting on of flesh or by the development of indigestion or metabolic disturbances. In theory there should be no such thing as a permissible diet for the sedentary, because no one should allow himself to lead a purely quiescent existence. It is pos- sible to compress a good deal of active exercise in a couple of hours of the twenty-four, so that the sedentary person passes virtually into the next class above, corresponding to light active labor extending through a number of hours. While individual estimates vary, it is probable that 1600- 2000 calories suffice for the average individual on the usual basis of 145 pounds weight with the usual reduction for sex. As the sedentary person finds it difficult to digest heavy arti- cles of food, the food should be easily digestible. Fruit and succulent vegetables (salads) are usually well borne by seden- tary people, as they induce daily evacuations of the bowels, and are not fattening. They are the reverse of condensed and highly nutritious foods. DIET FOR THE AGED As there is a radical distinction between a person merely old in years and one who is actually senile, no dietary can be devised to suit the case of all those of advanced years. A man is technically old at sixty. In theory he should require less protein in proportion to carbohydrates than a younger man. Many people of both sexes, however, preserve their 444 DIET IN SPECIAL CONDITIONS working capacity far into the sixties and even into the seven- ties. Many people can put on flesh up to the age of sixty, and it is very important that they do not do so. Their regi- men should be practically that of the corpulent. After the age of sixty the weight may remain at an equilibrium for some years, or with the advent of senile change, the flesh may be- .gin to disappear, this loss being physiological. At this period less depends on the selection of food than on the quantity and thoroughness of mastication. An active, healthy man can preserve his condition by cutting down the amount of food greatly, and chewing it thoroughly. The demand for protein will very likely be satisfied with a small quantity. The total fuel requirement will depend upon whether the in- dividual exercises or leads a sedentary life. Sedentary elderly people can subsist on very little food, and do not difEer much in this respect from middle-aged sedentary people. A senile person is practically an invalid, and his dietetic demands do not differ greatly from those of other invalids (aside from the convalescent). If the teeth are more or less useless, and mastication cannot be effected by the gums, the individual becomes a confirmed dyspeptic. The problem of starch digestion becomes a serious one. Milk can be used largely. In theory sugars could partially replace starches. An ex- cellent food under the circumstances is toasted bread, which may be dipped in coffee to soften it. In toast the starch be- comes changed to dextrin, which is but one step removed from sugar. Well-cooked cereals, vegetables (potatoes, greens, etc.) and fruits may be used in small quantities in the e:^pectation, that they will be digested by the pancreatic juice. Special Kegimen: As already suggested, this cannot differ in kind from that of the confined invalid or dyspeptic. DIET 1 : Soup. — Nutritious soups, such as chicken or fish purge, beef tea, mutton or chicken broth. Purges of all kinds. Fish. — White fish as sole, whiting, smelts, flounders, etc. (best when boiled). ' Food suitable for the Aged According to Yeo. THE AGED 445 Eggs. — Egg lightly cooked, or beaten up with milk, etc. Meats. — Young and tender chicken and game. Other tender meats. Potted chicken, game and other potted meats. Sweetbreads, bacon grilled. Farinaceous. — Bread and butter (bread at least a day old) to be soaked in tea or milk or water. Bread and milk, porridge and oat- meal gruel. Puddings of ground rice, tapioca, arrowroot, sago, maca- roni. Prepared foods consisting of predigested starches. Vegetables. — Potatoes, carrots, spinach and other succulent veg- etables, stewed celery, boiled onions. Desserts. — Fruit jellies, stewed or baked fruit. Pulp of perfectly ripe raw fruit in small quantity, farinaceous puddings. Liquids. — Milk in all forms, and with the addition of warm Vichy or warm water, fruit juice. RUMFORD "THE WHOLESOME" Baking Powder BEST of the HIGH GRADE Powders. Pure and Wholesome. Rumford Is different from and superior to all other powders, it being made of the genuine Professor Horsford's phosphate, thus supplying the food with an element, the strength-giving phosphates, absolutely neces- sary to health. Fine wheat flour is of little value as a strength- ening food because it is deprived of its phosphates in bolting. Rumford Baking Powder supplies these phosphates. Perfect Baking Quality. Its action in the dough is thorough, making cake, biscuit, muifins, etc., of the finest texture, which will retain their fresh condition longer than when made with ordinary baking powder or cream tartar. No "Baking Powder" taste. Rumford contains no alum or cream tartar and gives no bitter or "baking powder " taste to the food. Biscuit, etc., made with it retain the natural flavor of the grain and it will not impair the most delicate flavoring used in cake, etc. Every Can Warranted, Rumford will retain its strength indefinitely and we guarantee every can 'to give satisfaction or money refunded. Beasonable Price, Recent improvements enable us to sell Rumford at a reasonable price, much less than the ordinary high-priced powders. RUMFORD CHEMICAL WORKS Main Offices, Providence, R. I. 446 INDEX TO RECIPES A. Acid Beverages . Acid Phosphate Acid Phosphate Whey Apple Water . Apollinaris Lemonade . Bran Lemonade Cream of Tartar Drink Currant Water Effervescent Lemonade Egg Lemonade . Pruit Lemonade Fruit Punch . . . Fruitade Grape Juice " Iiemonade . " Lithia . . . " Nectar . " Water . . . Irish Moss Lemonade . Jelly and lee . Lemonade . . . , Lemon Whey . Malted Milk Currant Jelly Malted Milk with Wine Orangeade . Orangeade No. II . Pineapple Juice Pineapple Lemonade . Hhubarb Water Soda or Apollinaris Lem- onade Tamarind Malted Milk Tamarind Water . Tea Punch .... Tutti Frutti Punch . Wine Whey .... Acid Phosphate (Hobs ford's) .... Acid Phosphate Acid Phosphate Whey 110 113 113 115 111 111 114 115 111 121 111 117 112 116 112 116 116 115 112 114 111 113 114 114 112 112 113 111 115 ■ 111 116 115 116 117 113 478 113 113 PACE Albuminous Beverages . 118 Albumin Water . . .122 Albuminized Clam Water 123 Grape Juice 123 Milk " Orange " Sherry Water Beef Egg-nog . Coffee Egg-nog Egg Broth . . . " Lemonade . Egg-nog .... Egg-nog No. II •. Egg and Brandy . " and Rum . " and Wine . Grape Yolk • . . " Juice and Egg Junket Egg-nog Malted Milk and Egg Mulled Wine Pineapple Egg-nog Stokes' Mixture Albuminous Jellies Beef Jelly . . . Calf's Foot Jelly . Chicken Broth Jelly Panopepton Jelly 122 123 123 122 120 120 118 121 119 119 120 120 120 121 122 119 121 122 120 121 221 222 221 222 208 Jelly with Orange 209 Peptonoids Coffee Jelly . 207 " Wine Jelly . 205 Apples Apple Cuban Style . . 280 " Custard . . .288 " and Prunes . . 280 " Tapioca . . .300 Water . . . 115 Baked Apples . . . 279 Stewed Apples .... 279 Apricoi and Prune Sauce 280 447 448 INDEX TO RECIPES PAGE PAGE Arrowroot Gbuel . . . 238 Dry Peptonoids Soluble . 492 Asparagus on Toast . . 268 Liquid Peptonoids 215 Soup . . 223 -224 Panopepton 210 Boiled Asparagus 267 Raw Beef Sandwiches 217 Creamed Asparagus . 268 Scraped Beef 217 Beet Greens 269 B. Beverages Acid Beverages 110 Bacon, Broiled . 151 Albuminous Beverages 118 Curled Bacon . 151 Miscellaneous Beverages . 127 Baked Custards Starchy Beverages . , 124 Baked or Cup Custard . 288 Birds (Note Poultry) , 152 " Caramel Custard .' 290 Biscuit Custard No. II . 289 Baking Powder Biscuit . , 253 Chocolate Custard 289 Bran Biscuit , 253 Malted Milk Custard . 290 " Muffins , 2.54 White Custard 289 Cornmeal Gems , 254 Bakino Powder (Rumford) Gum Gluten Biscuit . 252 446 " Drop Biscuit 253 Bananas Baked 280 " Muffins , 253 Banana Custard 288 Pop Overs , , 254 BARLESr White Gems , 254 Barley Oruel . . . . 238 Blanc Mange .... , 295 Gruel with Broth 238 Chocolate Blanc Mange . 301 Gruel or Jelly . 238 Boiled Frosting 320 Jelly . . . 244 Bouillon, Claji , 174 " Water . . 124 Clam Bouillon Bisque . 175 Water (for In- Bran Tea . 137 fants ) 125 Bran Lemonade . , in Bavarian Creasi 210 BrJndy and Milk . 197 Beep Bread ... . . , , 247 Beef Broth 219 Baking Powder Biscuit . . 253 " Egg-nog . . . . 120 Boston Brown Bread . , 252 " Jelly ... 222 Bran Bread 252 " Sandwiches 260 " Biscuit , 253 Broiled Beef Steak- . . 149 " Muffins . . . 254 ' Mattre D-HOtel Butter 149 Cornmeal Gems , 254 Pan Broiled Beefsteak Entire Wheat Bread , 251 Cakes . . . 149 Gum Gluten Biscuit . . 252 Roast Beef . 152 " Bread . 252 Scraped Beef . 217 " Drop Biscuit 253 Beef Preparations 212 " Muffins . 253 Beef Essence 215 Pop Overs .... 254 " Juice . 214 White Flour 'Bread . 250 " .Juice (for Infants) 215 White Gems . . . 254 " Tea . . . . 215 Whole Wheat or Graham " Tea Frozen . 216 Bread .... . 251 " Tea with Hydro- Bread Crumbs Buttered 246 chloric Acid . . . . 216 Bread Panada . . . . 127 INDEX TO RECIPES 449 Bread Pudding . 302 Caudle 241 Cheese Bread Pudding 304 Cauliflower 268 Chocolate " 303 Boiled . . 268 Gluten Brown Betty . 304 Creamed 268 Jelly Bread Pudding . 303 Cet,f.ry . .... 268 Lemon " 303 Boiled . ... 268 Orange " 302 Creamed . 268 Plain " 302 Soup . 224 Bread Sauce fob Game 158 " (Diabetic) 225 Breakfast Foods 242 Toast . . 257 Boiled Rice . 297 Cereals 233 Cornmeal Mush 242 Breakfast Food 242 Gum Gluten Breakfast Gruels . 238 Food 242 Starchy Gruels 244 Hasty Pudding . 242 Charlotte, Orange . 211 Hominy . 243 Cheese Oatmeal Mush . 243 Cheese Bread Pudding 304 Steamed Rice . 298 Wafers . . . 276 Broths 217 Gluten Biscuit Crisps 276 Beef Broth . . 219 Gluten Cheese Wafers 261 Broth with Grains 219 Sandwiches . 259 Chicken Broth . 220 Chicken Clam Broth No. I . 220 Broiled Chicken 156 « Broth No. 11 220 Chicken Broth . . 220 Egg Broth (Milk) . . 118 Broth Jelly 222 " Broth (Hot Water) 221 Salad 274 " Broth (Beef Broth) 221 Creamed Chicken . 157 Mutton Broth . 219 Jellied 157 Veal Broth .... 220 Roast 154 BUTTEB BaIXS 255 Gravy . 155 BUTT^B CKEAM 165 Stuffing 154 Buttermilk (Artificial) . 199 Trussing . 154 Buttered Crumbs . 246 Scalloped Chicken 157 To clean Chicken . 153 Chocolate (Walter Bak- C. er's) .... 477 Chocolate Blanc Mange . 301 Cake 317 " Bread Pudding 303 Boiled Frosting . . . 320 " Custard 289 Cold Water Sponge Cake . 318 " Ice Cream . 308 Ginger- Bread . 320 Milk Shake 135 Gum Gluten Nut Cake . 319 " Sauce for Ice Hot Water Sponge Cake . 319 Cream 311 Marguerite Wafers 320 Chocolate Syrup 136 Plain Cake 319 Vienna Style . 135 Sponge Cake .... 318 Plain Chocolate 134 Carrots .... 268 " Chocolate (Ind.) . 135 Boiled 268 Chops Creamed .... 268 Chop Broiled in Paper . 151 450 INDEX TO EECIPES Prench Chops . Lamb Chops Broiled Mutton Chops " Pan Broiled Chops Cinnamon Water . Milk . . Clams .... PAGE . 150 150 150 150 136 . 197 172 Albuminized Clam Water 123 Clam Bouillon .... 174 " Bouillon Bisque . 175 " Broth .... 173 '• Broth No. II . . 220 " Broth on Toast . . 258 " Frappg .... 315 " Sherbet . . . .312 " Soup ... .174 " Stew 174 " Water . . . .173 " Water No. II . . 173 Little Neck Clams . . 172 Steamed Clams . . 172 Cocoa (Waltbb Baker's) . 477 Breakfast Cocoa . . .133 Cocoa (Ind) .134 Cocoa Junket .... 294 Malted Milk Cocoa . .134 Codfish Creamed Codfish . Codfish (Dia- betic) 164 Coffee Boiled Cofl'ee .... •' Coffee (Ind.) . . Cereal Coffee .... Coffee Egg-nog ... " Ice Cream . " Jelly " Junket .... Filtered Coflfee . . . Coffee No. II . Malted Milk Coffee . . Perculator Coffee. . Peptonoids Coffee Jelly . Condensed Milk (Eagle Brand) ... .479 163 132 132 133 120 308 207 294 13? 133 133 131 207 Consomme Corn Soup Cornmeal Gems " Mush 228 224 254 242 PAGE Cornstarch Pudding . . 295 Cornstarch Fruit Jelly . 295 " Pudding . . 295 Malted Milk Blanc Mange 296 Pineapple Cream . . . 295 Cbaokers Baby Educator . . . 501 Bran Crackers .... 260 Cheese Wafers . . .276 Cracker Crumbs (but-' tered) 246 Cracker Gruel . . . 239 Cracker Panada . . .126 " Pudding ... 304 Crisped Crackers . . 229 Educator Crackers . . 260 Gluten Cheese Wafers 261 " Crackers . . 260 " Biscuit Crisps 261 Wafers . . . .261 Marguerite Wafers . '. 320 Toasted Crackers . . . 256 Cranberry Jelly . . . 280 Cranberry Sauce . . . 280 Cream Sauce Cream Sauce (Fish) . . 165 " (Macaroni) . 245 " " (Noodles) . 246 " (Scalloped Bishes) 271 Cream Sauce (Toast) . 257 " (Vegetables) 271 Cream op Tartar Drink . 114 Cream (Whipped) . . 305 Croutons ... . . 230 Crumbs (Buttered) . .246 Crust Coffee . . 126 Cucumber Relish . . .166 Currant Water . . 115 Custards Baked Custards . . 288 y Custard Junket . . . 294 Custard Souffle . 292 Frozen Custard . . .311 Soft Custards .... 287 > INDEX TO RECIPES 451 D. Orange Bread Pudding PAGE . 302 Dandelion Greens . . . 269 Plain " " . . 302 Date Bonbons . . . 282 Cornstarch or Blanc " Tapioca . . . . 301 Mange ... 295 Desserts (Frozen) . . . 306 Cornstarch Fruit Jelly . 295 Ice Cream . . . 306 Cornstarch Pudding 295 Caramel Ice Cream . . 310 Gum Gluten 296 " lee Cream ^ ro. II 310 Irish Moss Blanc Mange . 297 Chocolate Ice Cream . . 308 " " Jelly . . 297 Coffee . . 308 Malted Milk Blanc Mange '296 Frozen Custard . . 3H Nutritious Wheat Pudding 296 Grape lee Cream . . 309 Pineapple Cream . 295 Hot Cocoa Sauce fo i- Ice Cracker Pudding . 304 Cream . . 311 Walnut, Biscuit Crisps 305 Junket Ice Cream . . 308 Plain Cracker Pudding . 304 Malted Milk Ice Ores im . 310 Custards Peach 309 Baked Custards . 288 Peptonoids " " . 311 Baked Caramel Custal-d . 290 Raspberry " " . 309 or Cup 288 Strawberry " " . 309 Custard No. II . 289 Vahilla . 307 Chocolate Custard 289 Ices . ... . 313 Malted Milk " . . 290 Clam Frappg . . . 315 Peptonoids " 290 Fruit Ice . . 314 White " . . 289 Grape Frappg . . 315 Soft Custards . 287 Lemon Ice . . . 314 Almond Pudding . 288 Orange " . 313 Apple Custard . . . . 288 " No. II . . 314 Banana " 288 " No. Ill . 314 Floating Island 288 Orange Straws . . 315 Meringue 287 Pineapple Ice . 315 Orange Custard 288 Scalpicon of Fruit . . 315 Peach Custard . 288 Sherbet . . 312 Soft Custard No. I 287 Clam Sherbet . . 312 " Custard No. II 287 Grape Ambrosia . 313 " Custard (Diabetic) 287 Grape Sherbet . . . 313 Junket 293 Lemon Milk Sherbet . . 312 Cocoa Junket . 294 n « « iSTcII 312 Coffee " . . 294 Malted Milk . . 313 Custard " ' . 294 Strawberry " . 312 Plain " 293 Strawberry " No. II 312 Junket Ice Cream 308 Desserts (Hot and Cold) 286 Pudding Sauces . . 305 Bread Puddings . . 302 Foamy Sauce . 305 Cheese Bread Pudding Fruit 306 (Diabetic) . . . . 304 Hard " . . . 305 Chocolate Bread Pudding 303 Orange " ... . 210 Gluten Brown Betty . . 304 Whipped Cream . 305 Jelly Bread Pudding . . 303 Whipped Cream No. II 306 Lemon " . . 303 EioE Puddings , 297 452 INDEX TO RECIPES PAGE Boiled Rice 297 Cream of Rice Pudding 299 Peaches and Rice . . . 298 Plain Rice Budding . . 299 Rice Meringue .... 299 Southern Snow Balls . . 298 Steamed Rice . . 298 Tapioca Puddings . . . 300 Apple Tapioca . . . 300 Chocolate Blano Mange . 301 Date Tapioca ... 301 Pineapple Tapioca . . 300 Plain " . 300 Raspberry " 301 Tapioca Cream . 300 Whips and Souffles . ,291 Custard Souffle 292 Eruit .Whip ... 291 Grape Whip . 291 Lemon Souffle . . . 292 Omelet Souffle ... 292 Peach Meringue 293 Strawberry Whip . 291 Dressing foe Poultry . 154 " Salads . 272 Dried Fruit Soup . . . 227 Dry Peptonoids Soluble 492 Peptonoids Sandwiches . 260 E. Eggs 175 Albuminized Clam Water 123 Grape Juice 123 MilK . 122 Orange . 123 Sherry . . 123 Water . 122 Albumin Water (for In- fants) .... 122 Baked Custard . . 288 Baked Eggs .... 180 " Eggs (Diabetic) . 180 Baked Meat Omelet 182 Beef Egg-nog . . . .120 Coddled Eggs (Scrambled) 183 Coffee Egg-nog . . .120 Egg Broth (Milk) . . 118 PACE Egg Broth (Water) . .221 " Broth (Beef) . . 225 " Lemonade .... 121 " Nests 181 " -nog No. I . . . . 119 " -nog No. II . . .119 " Sandwiches . . . 183 " Sauce 165 " Sauce No. II . . 166 " and Brandy . . . 120 " " Rum .... 120 " Wine .... 120 " " Sherry Gruel . 241 Filled Eggs 184 Golden Rod Egg . . .181 Grape Juice and Egg . .122 Grape Yolk 121 Hard Cooked Egg . . 180 Junket Egg-nog . 119 Malted Milk and Egg . 121 Marguerite Salad . .275 Mulled Wine . . .122 Omelet (Bread) . .182 " (Foamy) . . : 181 (Meat) . . 182 Pineapple Egg-nog 122 Poached or Dropped Egg . 182 " Egg in Milk . 182 Shirred Egg . . '. . 183 " Eggs No. II . .183 Soft Cooked Egg . . .179 " No. II . 180 " Custard . 287 Steamed Eggs . . .180 Stokes' Mixture . . .121 Water Lily Salad . . .276 Whips and Souffles . 291 Emulsion (Scott's), . . 493 F. Farina Gruel . . . 239 Fish .159 Baked Fish 162 Baked Fish (Diabetic) 164 Broiled Fish . . 162 Creamed Cod Fish . . 163 Cod Fish (Dia- betic) 164 INDEX TO RECIPES 455 PAGE Creamed Fish . . . .163 Fish (Diabetic) 164 Fish (Diabetic) . . 164 Halibut a la Creole . . 163 Scalloped Fish . 163 Fish Sauces . . . 165 Butter Cream . . 165 Cream or White Sauce 165 Cream Sauce (Diabetic) . 165 Cucumber Relish . ' .166 Egg Sauce . . .165 " Sauce No. II . 166 Hollandaise Sauce . . . 166 Tomato Sauce . 166 Flaxseed Tea .... 136 Flaxseed and Licorice Tea 136 Floating Island .... 288 Flour Gkuel or Thickened Milk 239 Flour Ball ... .242 FRAppf Clam Frappg . . .315 Grape " .... 315 Frosting ... . 320 Frozen Custard . . . 311 Frozen Desserts (See Des- serts) ... . 306 Fruits 276 Apples — Cuban Style . 280 Baked . . 279 " Stewed . . 279 " and Prunes . 280 Apricot and Prune Sauce 280 Baked Banana . . . .280 Cranberry Sauce or Jelly 280 Date Bonbons Figs, Stewed Lemon Baked . Orange Baked . No. II . " Straws . " Sunflower . Pineapple Prunes Stewed . Rhubarb Steamed . Fruit Ice . . . . Fruit Punch Fruit Pudding Sauce Feuit Salad . 282 282 280 280 281 315 281 281 281 282 314 117 306 275 PAGE Fruit Sandwiches . . 259 I'RUiT Soup . . .227 Fruit Whip . . .291 Fruitade ... . . 112 G. Game (Note Poultry) . .152 Gelatin . 203 Bavarian Cream . 210 Coffee Jelly . . .207 Cream " . ... 207 Grape Fluff . 211 Grape Jelly . 206 Jell-0 212 Lemon Jelly . . . 206 Made in a Minute Dessert 212 Orange Baskets . . . 206 " Charlotte . .211 " Jelly . 205 " Jelly No. II 206 Panopepton Jelly . . . 208 Panopepton Jelly with Orange ... . 209 Peach Jelly . ... 207 Peptonoids Coff'ee Jelly . 207 " Wine Jelly 205 Peptonised Milk Jelly . 208 Snow Pudding . . 209 " (Ind.) . 209 Spanish Cream . . .210 " (Ind.) 210 Strawberry Moussg . 212 Wine Jelly . . 204 " No. II . . 205 Sauces: Served with Gel- atin Orange . . . . Soft Custard Whipped Cream Gems 210 287 305 Cornmeal Gems White Gems Ginger Bread Ginger Tea . 254 254 320 137 Grape Juice (Welch's) . 486 Albuminized Grape Juice 123 Grape Ambrosia . . ,313 454 INDEX TO RECIPES Grape Frappg " Fluff . . " Jelly . . " Ice Cream . " Juice, plain " Juice and Egg " Lemonade " Lithia " Nectar " Sherbet . . " Water . . " Whip . . " Yolk . . Geavy fob Roasts . PAGE 315 211 206 309 116 122 121 116 116 313 115 291 121 152 " " Roast Poultry 155 Grouse, Larded . . . .158 Gruels 238 Arrowroot Gruel . . . 238 Barley Gruel . . . .238 " with Broth . 238 " of Jelly . 238 Browned Flour Gruel . ,. 242 Caudle "241 Cracker Gruel . . .239 Egg and Sherry Gruel . 241 Farina Gruel ... 239 Flour Gruel . . . .239 Flour Ball .... 242 Gum Gluten Gruel . 240 Indian Meal Gruel . . 240 Oatmeal Gruel No. I . . 240 " No. II .241 " No. Ill . 241 Rice or Oat Gruel . . 238 Rice Jelly . . . . 244 Tapioca Jelly ... 244 Gum Gluten — How Pro- cured .... 488-497 Baked Egg . . . . 180 Biscuit . . . 252 Crisps . . . 261 (a) Drop ... .253 (b) Plain 252 Bread .... .252 Breakfast Food . . 242 Cheese Biscuit Crisps . 229 Crisps 256 Cakes (Gluten Nut) . .319 Fish 164 PAGE Fish, Baked . . .164 Creamed .... 164 Creamed Codfish . . .164 Gruel or Porridge . . 240 Mufiins 253 Noodles .... . 246 Boiled Noodles . . 246 Noodles Au Gratin . . 246 " for Soup 246 White Sauce .... 246 Puddings Brown Betty . . . 304 Cheese . . . . 304 Walnuts, Gluten Biscuit Crisps . . . . 305 Plain . . . 304 Sauces Cream . .... 246 White . . ... 246 Soups Asparagus . .... 224 Cream of Celery . . . 225 " Tomato . . 227 Oyster . . . . 172 Toast French 253 Wafers Cheese .... 261 Plain . . .261 Halibut a la Creole . .163 Ham Broiled . . . . 152 Hard Sauce . . . 305 Hasty Pudding . . 242 Herb Tea ... .137 HOLLANDAISB SaUCE . . 166 Hominy Mush . . . 243 Hot Cocoa Sauce . 311 Hot and Cold Desserts . 286 I. Ice Cream .... 307 Caramel Ice Cream . .310 " No. II 310 Chocolate Ice Cream . . 308 Coffee Ice Cream . . . 308 INDEX TO RECIPES 455 FACE Frozen Custard . . .311 Grape Ice Cream . . . 309 Hot Cocoa Sauce for Ice Cream 311 Junket Ice Cream . . . 308 Malted Milk Ice Cream . 310 Peach Ice Cream . . . 309 Peptonoids Ice Cream . .311 Raspberry Ice Cream . . 309 Strawberry Ice Cream . 309 Vanilla lee Cream . . 307 Ices .313 Clam Frappg . .315 Fruit Ice . . .314 Grape FrappS . . .315 Lemon Ice . . .314 Orange Ice ... 313 " " No. II . 314 " " No. Ill . 314 " Straws . 315 Pineapple Ice . . . 315 Sealpicon of Fruits . 315 Indian Meal Gkuel . . . 240 Irish Moss Blanc Mange . . . 297 Jelly .... . 297 Lemonade 112 Jellies Gelatin Jellies . . 203 Jelly and Ice . . .114 Meat Jellies . . 221 Starchy Jellies . . . .244 Jell-O ... .483 Jell-0 with Fruit . . .212 Made in a Minute Dessert 212 Jelly Bread Pudding . . 303 Junket Tablets (Han- son's) Junket Cocoa Junket . Coffee Custard " Junket Egg-nog Junket Ice Cream Plain Junket . Whey . . . . 480 294- 294 294 119 308 199 198 K. KUMTSS Dr. Brush's Kumyss, 482, 198 Home-made Kumyss . .198 L. Lamb Chops Broiled in Paper French Chops . Lamb " Broiled . Pan Broiled Chops Ij:mon Soufele . Lemonade ApoUinaris Lemonade . Bran Lemonade Effervescent Lemonade Fruit Grape Irish Moss Pineapple Soda Lemon 151 150 150 150 292 111 111 111 121 HI 112 112 111 111 280 303 314 206 312 198 492 492 Baked . " Bread Pudding " Ice . " Jelly . . . " Milk Sherbet Whey . . Liquid Peptonoids Dry Peptonoids Soluble Dry Peptonoids with Broth 218 " " Sandwiches 260 Liquid Peptonoids Cold . 215 Hot . 215 " " with Whey 198 Peptonoids Coffee Jelly 207 Custard . 290 " Ice Cream . 311 Wine Jelly . 205 Lettuce Sandwiches 259 Lime Water . . .137 Jlf. Macaroni ... . . 245 Baked Macaroni . . 245 456 INDEX TO RECIPES Boiled Macaroni . Boiled Noodles . Noodles (Diabetic) Au Gratin PACE 245 . 246 . 246 . 246 Sauces and Accessories . 245 Buttered Cracker Crumbs 246 Cream or White Sauce . 245 Sauce (Diabetic) 246 Tomato Sauce .... 245 Made in a Minute Dessert 212 MaItre D'Hotel Butter . 149 Malted Milk (Hoklick's) 487 Malted Milk . . . 194 " Blanc Mange 296 " Cocoa . 134 " Coffee . . 133 " Custard . . 290 " " Ice Cream . 310 " Plain . . 194 " Sherbet . . 313 " " and Currant Jelly 114 Malted Milk and Egg . 121 " with Tamarind 116 " with Wine . 114 Matzoon . 199 Meat . . . 140 Broiled Bacon . 151 Curled 151 Broiled Ham . . . 152 Broiled Steak 149 Chops or Birds Broiled in Paper . 151 Lamb Chops Broiled . 150 French Chops . . . 150 Mutton Chops Broiled . 150 Pan Broiled Beef Cakes 149 Pan Broiled Chops . . 150 Roast Meats 152 Gravy . . 152 Scraped Beef . 217 M^AT Jellies 221 Beef Jelly . . . 222 Calf's Foot Jelly 221 Chicken Jelly . 222 Panopepton Jelly . . 208 PAGE Peptonoids Coffee Jelly . 209 " Wine Jelly . 205 Meat Soups (See Beoths) 217 287 299 184 122 194 197 199 197 Meringue Rice Meringue .... Milk .... Albuminized Milk Baked Milk .... Brandy and Milk Buttermilk (Artificial) Cinnamon and Milk . Condensed Milk (Eagle Brand) ... Evaporated Milk Junket .... Kumyss .... Milk Toast . . . Malted Milk . . . Matzoon or Zoolak . Modified Milk . . Pasteurization . Peptonised Milk Effervescent By the Cold Process " " Warm Process Immediate Process '. Partially Peptonised Specially " Rice Milk .... Rum and Milk . Sherbets Sherry and Milk . Sterilization Thickened Milk . . Whey .... Acid Phosphate . Lemon Liquid Peptonoids with Whey 479 194 199 198 257 194 199 192 193 195 196 195 195 196 195 196 197 197 312 197 194 239 198 113 113 198 Panopepton with Whey 198 with Orange 209 Wine Whey Minute Tapioca Miscellaneous Cereal Coft'ee . Cocoa (Ind. ) Breakfast Cocoa . Malted Milk Cocoa 113 . 484 Beverages 127 . . . 133 . 134 133 134 INDEX TO RECIPES 457 PAGE Coffee 132 Boiled Coffee ... 132 " (Ind.) . . 132 Filtered " ... 132 " No. II . 133 Malted Milk Coffee . 133 Perculator Coffee . .131 Chocolate ... 134 Milk Shake . 135 Syrup . 136 Vienna Style 135 " Plain . . 134 " (Ind) . . 135 Special Non-Nutritive Bev- erages . . 136 Bran Tea . . 137 Cinnamon Water 136 Flaxseed Tea . . .136 Ginger Tea . 137 Herb Tea . . 137 Lime Water ... 137 Slippery Elm Tea 137 Tea ... . 131 Russian Tea . . 131 Mock Bisque Soup . 227 Moussf, Steawbebbt . 212 Muffins Bran MufiSns . . . 254 Gum Gluten Muffins . . 253 Mulled Wine .... 122 Mush (See Breakfast Food) 242 Mutton Broth . . .219 Mutton Chops Broiled . 150 N. Noodles (Diabetic) . . 246 Au Gratin . . 246 Boiled .... 246 Non-Nutritious Beverages 136 Bran Tea 137 Cinnamon Water . . 136 Flaxseed and Licorice Tea 136 Flaxseed Tea . . 136 Ginger Tea . . . 137 Herb Tea ... . 137 Lime Water ... 137 PAGE Slippery Elm Tea . . .137 Nutritious Desserts . . 285 Nutritious Wheat Pud- ding . . 296 Nuts .... . 283 0. Oatmeal Caudle .... Oat or Rice Gruel Oatmeal Gruel . " No. II " No. Ill Mush . . Water " No. II Olive Oil (Nioelle) Salads Salad Dressings Onions Boiled . . . , Creamed Scalloped Soup ... Omelet Baked Meat Omelet Bread Omelet Foamy Omelet . Meat Omelet . Omelet Souffle . . Oranges Albuminized Orange Baked Orange . Orange Baskets " Bread Pudding " Charlotte . " Custard " Ice . . . " No. II " No. Ill " Jelly No. I " No. II " Plain . . " Sauce . " Straws " SunfloYi^er Orangeade . 241 238 240 241 241 243 125 126 489 272 273 269 269 269 225 182 182 181 182 292 123 280 206 302 211 288 313 314 314 205 206 281 210 315 281 112 458 INDEX TO RECIPES PAGE Otstebs 166 Broiled 170 Creamed .... 170 Creamed No. II . . .170 Pan Roasted .... 170 Raw 169 Roasted in the Shell . . 169 Scalloped . .171 Soup 171 Soup (Diabetic) . . 172 Stew . . . 172 To Wash Oysters . . .169 P. Panada (Crackeb) . . 126 (Bread) . . .127 Pan Broiled Beef Cakes 149 Panopepton 485 lee Panopepton . . .216 Panopepton Bouillon Hot 228 " Hot . . 216 Jelly . . .208 " Jelly with Orange 209 Panopepton with Whey . 198 Pasteubization .... 193 Pasteurizer (Hygeia) . 194 Paesley Butteb .... 267 Peas Gbeen . ... 269 " Canned . . . .270 " Creamed No. 1 . . 270 " No. II . 270 Peach Ice Ckeam . . . 309 " Jelly 207 " Meringue . . .293 and Rice . . . .298 Peptonising Tubes ( Faib- ciiiLD Bros. & Fosteb) 485 Peptonised Milk . . . 195 Effervescent . . . .196 By the Cold Process . 195 " " Warm Process . 195 Immediate Process . . 196 Partially Peptonised . . 195 Specially " . . 196 Peptonoids (Liquid) . . 492 Dry Peptonoids Soluble . 492 Dry Peptonoids with Broth 218 " " Sandwiches 260 Liquid " Cold . 215 " Hot . . 215 " with Whey 198 Peptonoids Coffee Jelly . 207 " Custard . . .290 " Ice Cream . 311 " Wine Jelly . . 205 Phosphate (Horsford's) . 478 Acid Phosphate . 113 Whey . .113 Pineapple (Hawaiian) . 495 Pineapple Cream . . . 295 Egg-nog . . 120 Ice . . 315 Juice . . .113 " Lemonade . .111 Tapioca . . 300 pop-ovees .... 254 Potatoes . . . 265 Baked . . . 266 Boiled 265 Creamed . 267 Mashed . . 265 Potatoes Au Gratin . 267 Potato Balls . . . .267 Cakes 266 " in Half Shell . 266 Rieed Potatoes . 265 Surprise Balls 266 Poultry 152 Birds Broiled in Paper . 151 Breaded Sauce for Game . 158 Broiled Chicken . . 156 Quail . . 156 Small Birds 156 " Squabs . . .156 Creamed Chicken . . . 157 Dry Dressing for Stuffing 154 General Rule for Cleaning ~ "■ 153 155 157 158 158 154 154 155 Poultry Gravy for Uoast Poultry Jellied Chicken Larded Grouse . " Quail . Roast Poultry Dry Dressing . Gravy INDEX TO RECIPES 459 To Bone Birds . To Clean Poultry To Truss Scalloped Chicken Prunes Stewed Pudding Sauces Foamy Sauce Fruit Hard Orange " Whipped Cream " No. II Punch Fruit Punch Tea Tutti Frutti Punch 0- Quail Broiled Broiled in Paper . Breaded Sauce for Game Larded Quail . PAGE 155 153 154 157 281 305 305 306 305 210 305 306 117 116 117 EuM AND Milk S. PAGE 197 156 156 158 158 R. Easpbeert Ice Cream . . 309 Tapioca . . .301 Khubakb Steamed . ^82 Water ... 115 KlCE Boiled Rice 297 Cream of Rice Pudding 299 Peaches and Rice . . 298 Plain Rice Pudding . . 299 Rice Gruel 238 " Jelly . . .244 " Meringue . . 299 " Milk 197 " Water .... 125 " Nq. II . . 125 Southern Snow Balls . . 298 Steamed Rice . . . .298 Roasts of Meats . . . 152 Salads Chicken Salad . Filled Eggs Fruit Salad . Marguerite Salad Mixed Sweetbread Tomato Waldorf Water Lily Salad Accompaniments Cheese Gluten Biscuit Crisps Cheese Wafers . Salad Dkess'ings Boiled Dressing Cream Dressing French " Mayonnaise . Sardine Sandwiches Sauces for Ice Creani (Hot Cocoa) 272 274 184 275 275 275 275 275 275 276 276 276 276 272 273 274 273 273 260 311 Macaroni and Noodles 245-246 Meat Scalloped Dishes . Fish . . . Pudding .... Vegetable Sandwiches Boston Brown Bread Bread and Butter . Cheese Sandwiches Chicken 'Egg " Fruit " Lettuce " Nut ■ Peptonoids " Raw Beef " Sardine " ScALPicoN of Fruits Scraped Beef Shell-Fish . Oysters . Broiled 149 271 165 305 271 258 259 259 259 259 183 259 259 259 260 217 260 315 217 166 166 170 460 INDEX TO RECIPES PAGE PAGE Creamed . . 170 Soft Custard (Diabetic) . 287 Creamed No. 11 . . . 170 Souffles ob Whips . . . 291 Pan Roasted . . . 170 Soups 223 Raw . . . . . 169 Asparagus Soup (Cream) 223 Roasted in the Shel I . 169 Soup (Diabetic) 224 Scalloped . . 171 Clam Bouillon . . . . 174 Soup .... . 171 " Bouillon Bisque 175 Soup (Diabetic) . 172 " Soup 174 Stew .... . 172 Consomme 228 To Wash Oysters . 169 Cream of Asparagus . 223 Clams 172 " Celery . . . 224 Albuminized Clam Water 123 " Celery (Dia- Clam Bouillon . 174 betic) . . . . . 225 " Bouillon Bisque . 175 Cream of Corn 224 " Broth . . . 173 " Onion . . . 223 " Broth No. 11 . 220 " Pea . 225 " Broth on Toast . 258 " " Potatoes . . 226 " Frappg . 315 " Rice . . . 226 " Sherbet . 312 " Tomato Soup " Soup . . 174 (Diabetic) . . . . 227 " Stew . 174 Dried Fruit Soup . 227 " Water . . . 173 Meat Soup . . . . 217 " No. 11 . 173 Mock Bisque Soup 227 Little Neck Clams . 172 Onion Soup (Diabetic) . 226 Steamed Clams . 172 Oyster Soup 171 Sherbet " (Diabetic) . 172 Clam Sherbet . . . 312 " Stew . . . . 172 Grape Ambrosia . . 313 Panopepton Bouillon 228 Grape Sherbet . 313 Tomato Soup with Broth 226 Lemon Milk Sherbet . 312 Victoria Soup . . . . 228 " No . 11 312 Soup Accompaniments . 229 Malted Milk Sherbet . 313 Crisped Crackers 229 Strawberry Sherbet . 312 (5ro11tons . . . . 230 " No . n 312 Educator Crackers 230 Sherry (Albuminized) . 123 Gum Gluten Crisps 256 Sherry and Milk . . 197 " " Biscuit Crisps 220 Slippery Elm Tea . 137 " Noodles 230 Sippets . ... . 256 Toasted Crackers ' . 229 Soda Lemonade . . Ill Sponge Cake . . .318 -319 Soft Custard . 287 Special Non-Nutbitive Bev- Almond Pudding ■ . 288 erages 136 Apple Custard . . 28S Bran Tea . , . 137 Banana Custard . 288 Cinnamon Water . 136 Floating Island . 288 Flaxseed and Licorice Tea 136 Meringue . 287 Tea . . 136 Orange Custard . 288 Ginger Tea . . . . 137 Peach Custard . . 288 Herb Tea . . . 137 Soft Custard No. I . 287 Lime Water . . . . 137 No. 11 . 287 Slippery Elm Tea . . 137 INDEX TO RECIPES 461 PAGE PAGE Spinach . 269 Date Tapioca .... 301 Squabs, Bkoiled . . 156 Pineapple Tapioca . 300 String Beans . . . . 270 Plain Tapioca 30O Starchy Beverages 124 Raspberry Tapioca 301 Barley Water . 124 Tapioca Cream . 300 " for Infants 125 Tapioca Jelly .... 244 Bread Panada . . 127 Tea Cracker Panada 126 Bran Tea 137 Crust Coffee . 126 Flaxseed and Licorice Tea 136 Oatmeal Water 125 Tea ... . 136 " No. II . 126 Ginger Tea . 137 Eice Water . 125 Herb Tea 137 " No. II . 125 Russian Tea 131 Toast Water . . 126 Slippery Elm Tea 137 Stabchy Jeulies 244 Tea 131 Barley Jelly 244 Tea Punch ... 116 Cornstareh Jellies . . 295 Toast .... 255 Eiee Jelly . . 244 Celery Toast . . 257 Tapioca Jelly . 244 Clam Broth Toast . 258 Steak (See Beef) . . 149 Cream Toast . 257 Sterilization of Milk . 194 " No. II . . 257 Sterilizer (Hygeia) . 194 Crisps (Gum Gluten) 256 Steamed Clams . 172 Crotitons .... 230 Stew, Oyster . . 172 Fren'ch Toast (Diabetic) . 258 Stokes' Mixture . 121 Gum Gluten Crisps . 256 Strawberry Ice Cream . 309 " Biscuit Crisp i 261 " Mouasg , . 212 Milk Toast . 257 Whip . 291 Sippets .... 256 Sugar of Milk (Patch's) 499 Toast Crackers 256 SuGAJj Stbup . . 110 " Sticks . . . 256 Sweet Breads 200 " Water . 126 Broiled . . . 201 Water Toast .... 256 Creamed 201 Tomato Sauce for Fish . 166 No. II . 202 (For Maca- Fricasseed . 202 roni and Noodles) . 245 Parboiled Sweet Bread , 201 Tomatoes Salad . 275 Baked 270 Sweet Breads with Peas , , 202 Mock Bisque Soup 227 SWEETINA 488 Scalloped 271 Sypup (Sugar) . . 110 Stewed ... 270 Salad 275 ' Soup with Broth 226 T. Turkey (See Poultry) 152 Tdtti Frutti Punch . . 117 Tamarind Water . 115 Malted Milk , 116 Tapioca (Minute) . . . 484 V. Apple Tapioca . 300 Chocolate Blanc Mange 301 Vanilla Ice Cream 307 462 INDEX TO RECIPES PAGE PAGE Veal Broth .... . 220 Victoria Soup . . 228 Vegetables .... . 261 Asparagus on Toast . . 208 W. Boiled .... . 207 Creamed .... . 268 Wafers Beet Greens 209 Cheese Wafers . . . 276 Carrots . . . . . 268 Gluten Cheese Wafers . 261 Boiled . . . . 268 Marguerite Wafers . 320 Creamed . 268 Water (Albuminized) . 122 Cauliflower . . 268 Whey Boiled . 268 Acid Phosphate . 113 Creamed . 268 Lemon .... . 113 Celery . 268 Liquid Peptonoids with Boiled . . . . 268 Whey . . 198 Creamed . 268 Panopepton with Whey . 198 Dandelion Greens . 269 Wine Whey 113 Onions . . 269 Whipped Cream . . 305 Boiled . . . 269 Whips and Souffles . 291 Creamed . 269 Custard Souffle . . . 292 Scalloped . . 269 Fruit Whip . . . . 291 Peas, Green . 269 Grape Whip . 291 " Canned . 270 Lemon Souffle . 292 " Creamed No. I . . 270 Omelet Souffle . . .292 No. 11 . 270 Peach Meringue . 293 Potatoes . 265 Strawberry Whip . . 291 Baked . . . 266 White Sauce for Boiled . . . . 265 Fish . 165 Creamed .... . 267 Macaroni . 245 Mashed . 265 Noodles . 246 Potato Au Gratin . . 267 Scalloped Dishes . . 271 Balls . . 267 Vegetables . . 271 Cakes . . . . 266 Wine Jelly No. I . 204 Half Shell . 266 " No. 11 . . 205 Riced Potatoes . 265 (Mulled) . . . 122 Surprise Balls . 266 " Whey . . 113 Spinach . . 269 String Beans . . 270 Tomatoes 270 Y. Baked . Scalloped . Stewed . . . . . 270 . 271 . 270 Yeast Fleischmann's Yeast . . 249 490 Vegetable Sauces . 271 Cream or White Sauce . 271 Z. " Sauce No. II . . 271 Parsley Butter . . 267 ZOOLAK .... . 199 GENERAL INDEX Systematic Shampooing WITH PACKER'S TAR SOAP (PINE-TAR, GLYCERINE. VEGETABLE OILS) CONTROLS DANDRUFF by removing dead scales, freeing the pores and substantially increasing the resisting power of the scalp tissues. IMPARTS VITALITY TO THE HAIR by the foregoing and — by bringing more blood, to the scalp, thus increasing its nutrition. PREVENTS PREMATURE BALDNESS by all the foregoing and — by loosening the scalp, ventilating the hair roots and establish- ing hygienic conditions. Systematic care of the hair and scalp fully described in our booklets. Free on request. THE PACKER MFG. CO., Suite 86 B, 81 Fulton St., New Yoric 464 GENERAL INDEX A. Absorption 46 " of Carbohydrates 48 of Fats ... 48 " of Mineral Matter 49 " of Protein . . 47 of Water ... 49 Absorption, Summary of . 49 Acid, Hydrochloric . . 30, 37 PAGE Appetite of the Sick . . 75 Appetizers (See under Bev- erages ) . Apples .... . . 278 Asparagus . . . 265 Assimilation . 50 B. Acidosis, Dietetic Treatment 357 Acid Phosphate . .113 Acids, Fatty ... .20 Acids, Vegetable . . . . 31 Salts of 31 Adolescent, Diet of . . 442 Aged, Diet for . . . 443 Albumin, Cooking of . 11 " Effects of Heat on 178 Albuminoids . . 8-10-140 Albumins . . . . . 9-10 Albuminuria, Diet in . , 394 Alcohol, in Pneumonia . . 349 Use of in Sick Room 83 " Value of in Tuber- culosis 352 Alcoholics as Beverages . . 35 AIg» 284 Amino Acids 39 Amylopsin 45 Anabolism . ... 50 Animal Food (See Protein, Meats, Eggs, Milk, Etc.). Antiseptics in Food Preser- vation 95 Appendicitis, Diet in . . 389 Appetite (See under Diges- tion). 465 Baby's Stomach, Capacity of 409 Beans ( See Legumes ) . Beating in Cookery ... 90 Beef 144 " Cuts of 146 " Drippings .... 20 " Extracts . . . .214 " Juice 212 " " Absorption of . .213 " " Care in Serving . 213 " " Composition of .212 Beef Juice, Substitutes for . 213 " " vs. Beef Tea . . 213 " Preparations . . 212 " Principles of Cooking . 213 " Raw 214 "Tea 213 " " Composition of . 213 " " Nutritive Value of 214 " " vs. Beef Juice . . 213 . 218 . 144 . 264 35, 109 110 " vs. Broth . Tests for Good . Beets Beverages Acid . '' Sweetening of 110 Albuminous . .118 as Appetizers . 35 466 GENERAL INDEX PAGE Beverages, Miscellaneous . 127 " Nutritive ... 35 Sapid .... 35 " Stimulating . . 35 Thirst Quenching 35 " Special Non-Nu- tritive 136 Beverages, Starchy . . 124 Digestion of . . .124 Principles of Cooking . . 124 Bile ....... 38 Biliousness, Diet in . . . 395 Body, Composition of . . 4 " Energy Requirements of 60 Bottle Feeding . . . .410 Bread, Composition of . . 247 " Digestibility of . . 247 Energy Value of . 256 " Fermented . . .249 Gluten . . . .248 Making of . . . 249 " Nutritive Value of . 247 " Puddings . . . .302 Toasted . . . 255 " Unfermented . . 250 Breakfast Foods . . 235, 242 Breast Feeding .... 406 Bright's Disease, Acute, Diet Bright's Disease, Chronic, Diet in 391 Bromelin . .... 278 Broncho-Pneumonia, Diet in 350 Broth 217 " Composition of . .217 " Energy Value of . . 218 " Principles of Cooking 217 " vs. Beef Tea . . . 218 Butter 189 Butterine 20 Buttermilk^ . . . . 190 C. Cabbage 265 Cake 317 " General Directions for . Making 317 PAGE Calcium Phosphate ... 29 Calories 57 Calorimeter 57 Cane Sugar 14 " " Description of . 14 " Food, Uses of . 14 " Sources of . 14 Carbohydrates .... 12 " Absorption of 48 " Classifications of . . .13 Definition of . 12 " Digestion of 40 " Function of 12 " of Animal Food 138 " Source of . 12 Carbonates . ... 30 Carrots .264 Casein . . . . 9, 185 Caulifiower .... 265 Celery . . . .265 Cellulose .... 17, 235 Centigrade Scale, Change to Fahrenheit . . . .106 Cereal Breakfast Foods . 235 Cereals 233 " Care of . .237 " Composition of 234 " Digestibility of . 236 Nutritive Value of . 237 " Principles of Cook- ing ... . . 235 Cheese 189 Chicken, How to Select 153 Children, Feeding Sick . . 438 Chlorides 29 Chocolate .... .129 " Compared with Tea and Coffee . . . .130 Chocolate, Nutritive Value of 130 "' Principles of Cook- ing of 130 Chocolate, Source of . . .129 Cinnamon 34 Clams 168 " Varieties of . . . 168 Cloves .... . . 34 Cocoa 129 Codliver Oil 20 GENERAL INDEX 46r PAGE Coffee 128 " Effects of . . . 128 " Sources of . . . .128 Colic, Dietetic Treatment of, in Children . . 438 Collagen ... 10, 140 Condiments . . .33 Classification of . . .33 Constipation, Diet in . 382 " in Nurslings, Treatment of . .441 Consumption (See Tubercu- losis ) . Convalescence, Diet in . . 332 Cooking, Blending Ingredi- ents in . . . 90 Cooking, Methods of . . 88 " Objective Points in 88 " Principles of . . 89 " Processes, Objects of 89 " Processes, Principal 89 " Success in . . .88 " Suggestions in Method of Working in . 90 Crackers ...... 260 Cream . . . 185, 189 Curds ... .190 Cutting in Cookery ... 90 Dessert, Frozen . . . 306 Desserts, Nutritious . . . 286 Dextrin .... .40 Dextrose ... .13 " Description of . . 13 Food Uses of . . 14 " Sources of . . .14 Diabetes, Diet in . . . 355 eWomc, Diet of . -^58 Diabetic Chart (Joslin and Goodall) ... .359 Diabetic Diet of Bellevue Hospital 356 Diabetic Diet of Massachu- setts General Hospital . 357 Diabetic Diet of Presbyterian Hospital, N. Y. . . . 357 Diarrhoea, Diet in . . . 385 Diet, after Laparotomy, etc. 399 " Animal, Disadvantages of Exclusive . . IS* Diet, Bellevue Hospital . 328 " Broth 327 " Convalescent . . . 323. " Diabetic, of Bellevue / Hospital . . 35S' Diet, Diabetic, of Massachu- setts Hospital . . 357 Diet, Enteric .... 38& " Extra, for Typhoid, in Presbyterian Hospital, N. Y 341 Diet, Farinaceous . 324-5 " Fat Free . . . .326- " Fish 327 " High Caloric, in Ty- phoid . . . . 336 Diet, Hospital, General Type of . . . 323 Diet, Hospital Extra . . 327 Diet, Ideal .... 233 " in Acute Bright's Dis- ease . . . 390 Diet in Acute Gastritis . 373 " in Acute Gout . 367 " in A c u t e Nephritis, Mass. Gen'l Hosp. 392 Diet in Acute Rheumatism. 368 " in Adolescence . . . 442 " in Appendicitis . 389 " in Albuminuria . 394 " in Biliousness . . . 395 " in Broncho- Pneumonia 350 " in Chronic Diabetes 358 " in Chroni(r Gastritis . 373 " in Chronic Gout -^ 368 " in Constipation . ~. 382 " in Convalescence from Fever . . . 332 Diet in Convalescence from Typhoid . . 339 Diet in Diarrhoea . . 385 " in Diphtheria . 347 " in Disease ... 331 " in Diseases of the Gen- ito Urinary System . 390 468 GENERAL INDEX Diet in Disorders of Nutri- tion .... . 355 Diet in Dysentery . . 386-387 " in Dyspepsia. - - . .381 " in Fevers . . 331 " in Gastric Diseases . 373 " in Heart Disease . 396 " in Infectious Diseases . 331 " in Intestinal Diseases . 381 " in Lithemia . 367 ^' in Lying-in Period 403 " in Mumps .... 350 ^' in Nervous Disorders 395 " in Obesity ... 370 " in Old Age . 443 " in Oxaluria . . 325 " in Pneumonia 348 " in Pregnancy . 401 ^' in Quinsy . . .346 ^' in Skin Diseases 396 " in Surgical Cases . . 397 ■" in the Sedentary 443 " in Tonsilitis . . .346 " in Tuberculosis (e s p e- cially Pulmonary Con- sumption) 351 Diet in Typhoid, Late Con- val eseent ( Presbyterian Hospital, N. Y.) . . 341 Diet in Typhoid, Summary of 337 " in Ulcer of the Stomach 376 " in Vomiting of Preg- nancy ... . 402 " in Whooping Cough . 351 Diet, Liberal, in Typhoid Fever . . 336, 341 Diet, Light ... . 323^ " Liquid Enteric . . 388 " Liquid, in Typhoid 335, 337 " Meat, Exclusive . 51 " Milk . 324 " Mixed . . . 7 ■" Nephritic ... 392 " Nitrogenous . . . 325 " Nutrient 325 " of Nursing Mother 404 " of Wet Nurse . . 404 Diets, Presbyterian Hospital, N. Y 329 PAGE Diet, Restricted . 328 " Salt-free 393 " Schmidt 327 " Special Enteric . . .388 " Starvation, in Typhoid 334 " Vegetable vs. Animal . 233 " Strictly Sugar-free . 357 " Test 326 Dietaries for Young Chil- dren . 43G Dietaries, Hospital . . 323 Digestion . . . 36 " Evidences of in Sick 74 Digestion of Fat . 40 " of Protein, Prod- ucts of . . . .37, 39 Digestion of Protein, Sum- mary of . . . 39 Digestion of Proteins 36 " of Proteins in In- testines . . 38 Digestion of Proteins in Stomach . . 36 Digestion of Starch . 40 Products of . . 41 Summary of . . 41 Digestion of Sugars . . 42 Products of . . . 42 Summary of . . 42 Digestion, Salivary . . 41 " Rate of 45 Resume of . 43 Diphtheria, Diet in . . 347 Disease, Acute, Feeding in 73 Diet in . . 331 Disinfection of Utensils . 84 Drinks, Cold . . 109 Drinks, Hot ... . 109 Dysentery (Acute Colitis), Diet in . . . 387 Dyspepsia, Diet in . . 381 E. Eggs Composition of . Cooking of . . 175 . 175 11-12 GENERAL INDEX 4:69 PAGE Eggs, Digestibility of . .176 Energy Value of 118, 179 Nutritive Value of . . 177 Principles for Cooking 178 Suggestions Concerning 178 Test for Fresh . . 178 Varieties of . . 176 Enteric Diet . . .388 Equivalents, Table of Metric 101 Erepsin . . 39 Excretion . ... 53 Extractives, Nitrogenous 11, 138 144 Extracts, Flavoring . 34 F. Fahrenheit Scale, Change to Centigrade . 106 Fat 19 " Absorption of . . 48 " Animal . . 138 " Cheap Forms of . 21 " Definition of . . . 19 " Description of . . 20 " Digestibility of . 22 " Digestion of . 40 " Function of . . . 21 " Percentages in Cream, Table Showing . . 426 Fat, Principles of Cooking . 22 " Sources of . . 21 " Tests for . . 23 " vs. Carbohydrate as Food ... . 23 Fat, Value of in Tuberculosis 352 Feeding, Details of . . .76 " Forced .... 78 " in Acute Disease . 73 Feeding, Infant . . 406 Artificial . 406 " Breast . . . .406 " Hygiene of Natural 408 Feeding, Nasal .... 79 Feeding of Young Children . 434 " of Young Children, General Rules for . . 435 Rectal . . . 79 ■ " the Helpless Pa- tient ; 78 PAGE' 72; 72. 77 77 78. 78 331 10' 278 159 160 159 16L 160' Feeding the Sick the Sick, Physi- cians' Directions for Feeding the Sick, Position in " the Sick, Time for " the Unconscious Pa- tient Feeding and Sleep Fever, Diet in " Typhoid (See Typhoid Fever). Fibrin . . . Figs Fish " Composition of " Digestibility of " Energy Value of . " Nutritive Value of " Principles of Cooking 161 " Salt . . 160 " Sauces . . .165 " Season for .... 161 " Test for Freshness of 161 Fletcher, Mr., on Mastication 41 Folding In, in Cookery 90 Food Accessories . . 4, 33 " Adjuncts . . 4, 33 " Adulteration of . . 91 " Animal 138 " Animal, Carbohydrates of Food, Animal, Composition of .... Food, Animal, Digestibility of Food, Extractives of " Mineral Matter of . " Animal, Proteins " Animal, Water of " Care of .... " Care of, in Markets and Kitchens . Food, Classification of 5, " Composition of " Concentration of . " Definition of . . . " Effects of Heat on . " Determination of Energy Value of .... 5& 138 138 139 138 139 133- 139 92 92 6 4 95 4 88 470 GENERAL INDEX anti- Pood, Fly Pollution of . " How to Serve . " Methods of Cooking " Liquid (Fluid) . " Nitrogenous Classification of Source of . JTood, Non-Nitrogenous " Object of . . . " Predigestion of " Preservation " Preservation by septics . Tood Preservation by D r y- ing . . . rood Preservation by Exclu sion of Air Tood Preservation by Freez- ing . . Tood, Quantity and Quality of, for Sick Food, Soft (Semi-Solid) " Solid . . " Source of . " Storage of . " Temperature of, for Sick Tood Values 95 95 76 323 323 i 93 76 54 Values, Tabulation of 64-71 Carbohy- PACE 94 86 88 323 8 8 9 12 3 96 95 95 231 232 31 232 232 Vegetable " Vegetable, drates of Tood, Vegetable Composition of . . Tood, Vegetable, Digestibil- ity of . . Food, Vegetable, Fats of " Vegetable, Mineral Matter of . . . .232 Tood, Vegetable, Protein of . 232 " Vegetable, Water of . 232 " Washing of Uncooked 93 TormuliE for Infant Feeding 416 Fowl, How to Select . 133 Freezing, General Hules for 307 " in Small Amounts 307 Fruits 276 as Ballast . . .279 " Composition of . . 276 PAGE Fruits, Digestibility of . . 277 " Dried 279 " Flavoring Principle of 277 " (Fresh) and Vegeta- bles, Agreement between 278 Fruits, Fuel Value of . . 278 " Nutritive Value of . 278 " Precautions in Use of 279 " Sugar-content of '. . 277 Fungi .... . . 284 Gf. Galactose 42 Game (See Poultry). Gastric Juice ... .37 Gastritis, Acute, Diet in . 373 " Chronic, Diet in . 373 Gavage .... . 439 Gelatin ... .10, 203 " Digestibility of . 203 " Nutritive Value of . 203 " Source of . . . .203 " Principles of Cooking 203 Gelatinoids . . . 8-10, 140 Ginger 33 Glucose (See Dextrose). Gluten Bread .... 248 " Standards . . 249 Gout, Acute, Diet in . 367 " Chronic, Diet in . . 368 Grape Sugar (See Dextrose). Grapes 278 Gruels 236, 238 Gums 18 B. Heat, Average Normal Out- put from Body . . .62 Heart Disease, Diet in . . 396 Helpless, Feeding the . 78 Horse-radish 33 Hospital Dietaries . . 323 Ice Box and Contents . .91 Ice Cream 307 GENERAL INDEX 471 Ice, Keeping of, in Sick Eoom 83 Ices .... . . 313 Infant Feeding .... 406 Artificial . 410 Caloric Val- ues of 429 Infant Feeding, Formulse for 416 " " Hygiene of Natural 408 Infant Feeding, Maynard Ladd Table for . . . 425 Infant Feeding, Scheme of at Lying-in Hospital, N. Y 431 Infant Feeding, Table Show- ing Proportions for Healthy Child . . .427 Intestinal Diseases, Diet in . 381 Iron . . . . .29 Jellies, Starchy Juice, Gastric " Intestinal " Pancreatic Junket . K. Katabolism Kefir Kumyss . 244 . . 38 . . 38 . . 38 190, 293 50 192 191 Laetalbumin . . . .185 Lactase . . 42, 186 Lactose . . -141 185 Lamb ... . 145 " Cuts of .... 148 " Test for Good . . 145 Laparotomy, Diet after . . 399 Lecithin 20 Legumes ... . . 262 " Composition of 262 " Digestibility of . 263 page: 43 284 32 40 367 403 Levulose Lichens Lime Starvation Lipase Lithemia, Diet in Lying-In Period, Diet in il. Macaroni . . . . 235 Magnesium . . .29 " Phosphate . . 29 Maltase . . . . 40 Maltose ...... 40 Marasmus in Infants, Die- tetic Treatment of . . 441 Mastication . . . 41 Matzoon . ... 192 Measures ... .98 " Apothecaries' . . lOO " Approximate . . 100 " of Volume, Metric System 101 Measures of Weight, Metric System .... 101 Measures, Table of . . 99 Measuring Cup, Standard . 98 Meat 140 Absorption of . 141 Broiling of . 142 Composition of . . . 140 Cooking . 142 Cuts of 143, 146 Digestibility of . 141 Effect of Cooking . . 141 Principles of Cook- ing 263 " Effects of Water on . 143 " Energy Value of . 149 " Jellies . . 204, 218, 221 " Nutritive Value of 140 " Quality of . . . .143 " Uncooked . . . 141 Metabolism of Carbohydrates 52 " Fat ... 52 " " Protein . .51 Metric System . 101 Milk as a Beverage . . 35 " Ash of . . . 185, 186 " Care of 187 473 GENERAL INDEX PAGE Milk, Certification of . . 187 " Composition of . . . 184 " Condensed . . . .192 " Desiccated . . . .193 " Difference Between Hu- man and Cows . . . 410 Milk, Digestibility of 185 " Energy Value of . 193 " Evaporated . . 194 " Eats of . . . 18S, 186 (See Cream, Butter.) Milk, Fermented . . 191 " Formulae, Fat to Pro- tein =3:1 ... 419 Milk, Formulse, Fat to Pro- tein=;2:l ... 422 Milk, Formulae, Fat to Pro- tein, nearly Equal . . 423 Milk, Home Modification of 414 " Human, Drugs in . 405 " Laboratory . . 414 '' Metschnikoff's Arti- ficially Soured Milk . 191 Milk Modification . . 412 " Modification, What Di- lution to Use . . 413 Milk, Modified ... 192 " Mothers, Composition of 407 Milk, Nutritive Value of 185 Pasteurisation of . 188 " Peptonized . . . .192 " Products 189 " Quantity to Use in In- fant Feeding . . 413 Milk, Skimmed . . . .186 " Sour . . .190 " Sterilisation of 188 Milk, Sugar (See Lactose) . Mineral Matter .... 29 " " Absorption of 49 " " Amount and Kind of in Body . . 29 Mineral Matter, Function of 29 " " Importance of .31 Mineral Matter in Plants . 31 " " in Animal Food 30, 139 Mineral Matter, Source of , 30 " " Uses of in Disease 32 Moss, Iceland . . . . , . 285 " Irish ■ . . 285 Mouth, Cleansing of, before Feeding . . . . 77 Mumps, Diet in . . 350 Mushrooms ... . 284 Mustard . . 34. Mutton ... . 145 Cuts of . . . 148 " Test for Good . 145 Myosin 10, 140 2f. Nasal Feeding .... 79 Nephritic Diet . . .392 Nervous Disorders, Diet in . 395 Nitrogen Balance . S4 Nursing Bottle . . . .415 " Mother, Diet of . 404 " Schedule for . . 409 Nut Butters ... 283 " Flours . . 283 Nutmeg ... 34 Nutrition . 36 " Conditions for Per- fect ... 7 Nutrition, Diet in Disorders of ... . . 355 Nuts .... 283 " Composition of . 283 " Cooking of . . . .283 " Digestibility of . 284 " Nutritive Value of 284 0. Obesity, Diet in . 370 Oils . . . 19 Volatile . . . . 21 Olein . . 20 Oranges . 277 Oleomargarin . 20 Onions . 264 Ovariotomy, Diet after 399 Oysters . 166 GENERAL INDEX 473 Oysters, Composition of . 167 " Digestibility of . . 167 " Energy Value of . 169 " Principles for Cook- ing . . . . 167 Oysters, Season for . . . 167 " Variety of .168 P. Palmitin 20 Pancreatic Juiee . 38 Parsnips . . . 264 Pasteurisation 193 " Apparatus for 194 Peas ( See Legumes ) . Pectin Bodies . 277 Pepper 34 Pepsin ... . . 37 Action of . . . 37 Peptogenic Milk Powder in Infant Feeding . .433 Peptones . . .37, 39 Percentage Solutions, Tables for Preparing . . . 104 Phosphorus . . . . 20, 29 Physicians' Directions for Feeding the Sick . . 72 Pineapples . 278 Pneumonia, Alcohol in . 349 " Diet in 348 Polysaccharides . . . 16-19 Pork ... 145 Potassium 29 Potatoes .... 264 " Energy Value of . 265 Poultry ... .152 Digestibility of .152 General Rule of Cleaning . ... 153 Poultry, Principles of Cook- ing .. . . 153 Pregnancy, Diet in .401 Prematurity, Feeding in . 440 Protein, Absorption of . .47 " Acid . . . . 38 Alkaline . 39 Animal . . 138 " Cooking of . . 11 Protein, Digestion, Table of 39 Function of . .10 " Vegetable . 10 Proteoses . . 39 Prunes . . . 278 Ptomaine Poisoning 93 Ptyalin 40 Puddings, Bread .... 302 Punctuality in Serving Meals .... 75 Purins ... . . 11 Quinsy, Diet 346 R. Radishes 264 Rectal Feeding . . . 79-83 " Formulae for 82 " Technique of 81 Reflex, Pharyngeal ... 41 " Pyloric . . . 38 Rennin 37 Rheumatism, Acute, Diet in 368 Chronic, Diet in 370 Diet in . . . 370 Rickets in Infants, Dietetic Treatment of . . .441 Roots 263 S. Saccharin 15 Salad Dressings .... 272 Salads . . .... 272 Salsify 264 Salt (See Sodium Chloride) 34 Sandwiches . . . 258 Sauces 33 Salt Starvation .... 32 Scurvy, Infantile, Dietetic Treatment of . .441 Seasickness, Dietetics of . 402 Sedentary, Diet of . 443 Shell-Fish .... .166 Sherbets . . 312 Sick, Feeding the ... 72 474 GENERAL INDEX PAGE Skin Diseases, Diet in . . 396 Sodium ... . . 29 Sodium Chloride .... 30 " " as a Condi- ment 34 Soup 223 " Accompaniments . 229 " General Bule for Blending. . . . 223 Spices 34 Spinach ... .265 Starch 16 " Cooking of . . .18 " Description of , . ... 17 " Digestion of ... 40 " Food Uses of . . 17 " Source of ... 17 " Test for . . . 19 Starvation Diet . . . .334 Steak, Broiled .... 149 Steapsin (See Lipase) Stearin 20 Sterilisation ... . 194 Stirring in Cookery ... 90 Stomach 36 " Fundus of . . .37 " Pyloric Sphincter of 38 Tube, Use of . .79 Strontium 32 Sucrase 42 Sugar 13 " Dietetic Uses of . . 15 " Digestion of . . .42 " Invert 277 " of Milk (See Lac- tose). Sugar Starvation .... 357 " Substitutes for . . 15 " Tests for .... 16 " Use of in Cookery . 15 Sulphur .29 Surgical Cases, Dietetic Management of . . . 397 Sweetbreads 200 " Definition of . 200 Digestibility of 200 " Energy Value of 201 Sweetina 15, 110 Syntonin 10 T. Tallow 20 Tea 127 " Active Principles of . 127 " Effects of .... 128 Thermometry ... .106 Top Milk Method . . .416 Toast .... . . 255 Tubers (See Roots) . . .263 Tuberculosis, Diet in . . 351 Turnips .... . 264 V. Ulcer, Gastric, Diet in . . . 376 " " . in . Massachusetts Gen'l Hospital 379 Unconscious, Feeding the . 78 Uric Acid Excess (See Lithsemia). Utensils, Disinfection of . 84 Veal 144 " Test for Good . 145 Vegetables 261 Digestibility of . 262 " Composition of . 261 " Green . . . 265 " Principles of Cooking . ... 262 Vegetable Sauces . . .271 Vinegar 34 Viscera, Animal, Food Uses of 144 Vomiting, Diet in . . . 402 " in Young Chil- dren, Dietetic Treatment of 438 W. Wafers Water 260 23 GENERAL INDEX 475 PAGE Water , Absorption of Alkaline . . 49 . 28 Boiled . . . 27 Carbonated . . 27 Classification of . 25 Composition of Distilled . . . 23 . 27 Drinking . Filtered . . . 25 . 26 Food Uses of . 25 Functions of . . 24 Hard . . . . 25 in Animal Food . 139 Properties of Eain . 23 26 Soft . . . 25 Sources of 24 Spring Temperature of 26 28 PAGE Water, Well . . .26 Weaning 410 Weight Development of In- fant, Computation of . 429 Weights 98 Table of ... 99 " Apothecaries . . 100 Wet Nurse 407 " Diet of . . . 404 Whey . . . .190 Whey-made Formulae . . 424 Whey Mixtures, Method for Calculating . . . .428 Whooping Cough, Diet in . 351 Zwieback 19 INDEX TO PUEE FOODS — SUPPLIES FOE THE DIET- KITCHEN — SUPPLIES FOE THE SICK-EOOM " Good nutrition depends upon pure and healthful food." There is no subject which should more engross attention an the purity of the preparations that are used in the va- )us compounds for the human stomach, and in the siek- am. A. P. P. HIGHEST IN HONORS iWalter Baker & Co.'s CocoaiChocolate 4 ^ ^ Years of Constantly Increasing Sales Hlghes Europe and America KO Highest Awards In A medical writer says — "The use of a thoroughly reliable prep- aration of cocoa should be uni- ] versally encouraged, and it is the I consensus of opinion among med- ical men as well as laboratory workers that the breakfast cocoa manufactured by Walter Baker & Co Ltd., not only meets the indications, but accomplishes even more than is claimed for it." Registered V. S. rat. offlce WALTER BAKER & CO. Ltd. Established 1780 DORCHESTER, MASS. A Drink in Fevers A teaspoon of Horsford's Acid Phos- phate added to a glass of cold water makes a cooling and refreshing acidulous drink for the patient during convalescence from typhoid and other febrile conditions. Its superiority over Dilute Phosphoric Acid, or any other acid, is due to the fact that it contains the phosphates of cal- cium, sodium, magnesium and iron, which means increased nutrition. Horsford's Acid Phosphate /s more palatable and strengthening than lemonade, lime Juice, or any other acidulous drink. If yonr druggist cannot supply yon tre mil send small bottle prepaid on receipt of 25 cents RUMFORD CHEMICAL WORKS Providence, R. I. BORDEN'S EAGLE BRAND Condensed Milk Is a safe food for Infants. It is half a century past the ex- v perimental stage. The Best for Nursery and Household. BORDEN'S CONDENSED MILK COMPANY "Leaders of Quality" Established 1857 479 JUNKET ^ Perfect Milk Food JUNKET TABLETS contain absolutely nothing but the pure Rennet Ferment and a little pure table salt. No chemicals whatever enter into their manufacture. Ideal for the preparation of WHEY, MODIFIED or HUMANIZED MILK, JUNKET PUDDINGS ,and ICE CREAM in endless variety. 10 tablets for lo quarts, loc. lOO tablets in a package, 7Sc. JunKet Brand Buttermilk Tablets Compressed Lactic Ferment Culture prepared at the bacteriological department of Chr. Hansen's Laboratory, Copenhagen, Denmark. Converts sugar of milk into lactic acid, rendering the milk palatable and healthful, and a preventive and curative for many intestinal disorders. 15 tablets in a vial, 25c. 75 tablets in a package, $1.00. At all druggists, manufacturers. or by mail direct from the CHR. HANSEN'S LABORATORY Box 1709 y 9 Little FaLlls. N. Y. 480 Infant Feeding P XCEPT that derived from the healthy mother's breast, the ^-^ best food for an infant is the milk of licalthy cows, if these animals receive proper food and care. PVERY common-sense detail that it is possible to observe '—' is practiced in Dr. Brush's milk dairy. Nothing but the whole grist of the best grain — no refuse of any description —is used as food. All the care and attention to the cows is given with an ■' intelligent desire to produce good milk. TT is delivered in New York City at 15 ^ cents per quart ; orders addressed to me will receive prompt attention. E, F. BRUSH, M.D., Mount Vernon, N. Y. 481 ' I am constant as the northern star, Of whose transfix'd and resting quality There is no fellow in the firmament." ^Julias Cmsar. THERE are few useful products that have been more numerously and less successfully imi- tated than "BRUSH'S KUMYSS" THE same word, often the same lettering as directions on the label, the same colored ink, and sometimes a ^evice that imitates closely the trade-mark, may cover a base imitation. Only the word "BRUSH" will make your order definite. 482 The ConveJescent who has subsisted long upon fluids muS resume solid diet with care, and the capricious appetite muit be appealed to with an at- tradive, dainty, yet nutri- tive dish like which is prepared from pure crystal gelatine and sugar. Jell-O is cool and sparkling and appeals to the patient. As a result of psychological and physiological processes, the glandular and gastric secretions are stimulated, to the en- couragement of a normal appetite and digestion. Jell-O is not only a dish for the sick and convalescent but is a delic- ious dessert for everybody. It can be prepared in a minute. All gfocefs sell it, 1 cts, a package, THE GENESEE PURE FOOD COMPANY, Le Rny, N. Y., and Bridgebarg, Canada. 483 FOR SICK OR WELL MINUTE TAPIOCA IS EQUALLY GOOD It is made from only the most carefully selected material. It is prepared under the most favorable conditions — by skilled employees in a factory perfect as regards light, ventilation and sani- tation. It requires no soaking, and with it can be prepared in a few minutes any one of an al- most endless variety of delightful desserts. Try the recipes for Minute Tapioca in this book. If you want to know more way's of preparing it, write us for our free Minute Cook Book. Ask your grocer for Minute Tapioca and take no other. Look for the red Minute Man on the package. MINUTE TAPIOCA COMPANY 193 W. Main St., Orange, Mass. ♦ ♦♦♦♦^♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦f -t-M-M-f-M^ ♦♦♦♦♦» 484 PEPTONISING TUBES , FAIRCHILD By means of the Peptonising Tubes — Fairchild — and the Fairchild peptonising process, foQ^s which are adequate for the nourishment of the healthy and vigorous are adapted to the weakened digestive functions of the sick. Peptonised milk, peptonised milk gruel, etc., are genuine foods, and resources of well-known value in the nutrition of the sick, convalescents, invalids and dyspeptics. PANOPEPTON Panopepton presents in a highly agreeable solution the two great types of food, beef and wheat, freed from innutritions and indigestible substance, peptonised and ready for assimi- lation. Panopepton has a fixed standard of composition, in which the ratio of protein to carbohydrate has been carefully con- sidered, is uniform, absolutely sterile, contains no chemical preservative and no cane sugar. PEPTOGENIC MILK POWDER FOR PREPARING MILK FOR INFANTS Peptogenic Milk Powder not only adjusts cows' milk to the percentage composition of norrhal mothers' milk, but goes further, and makes the casein soluble and non-coagulable like the albuminoids of mothers' milk — the crucial point in advance of every other method of modification. The Peptogenic Milk Powder and Process were introduced in 1884. ESSENCE OF PEPSINE FAIRCHILD Essence of Pepsine — Fairchild — is a true extract of the gas- tric juice, obtained by direct extraction from the secreting glands; contains the enzymes, and has the digestive and seda- tive properties of the gastric juice;' useful in the digestive dis- orders of adults and infants and for making junket and \yhey. Junket and whey, as prepared with Essence of Pepsine — Fairchild— are infused with the gratefully stomachic qualities of the Essence, and are therefore peculiarly valuable under the condi- tions in which these foods are indicated. FAIRCHILD BROS. & FOSTER ^i^^ 4b5 rape Juice It's Jvist the Pure, Unfermented Juice — o/ == Choicest Concord Grapes Welch's Grape Juice contains no alcoliol, preserva- tive or chemical of any kind. The expressed juice of the full-ripe grapes is sterilized without delay and hermetically sealed in glass. When rehottled in the usual sizes it is again sterilized. Welch's Grape Juice is a splendid temperance bev- erage. It is in no way a stimulant, but possesses the dietetic value of fresh Concord grapes. It is of spe- cial value in convalescence, particularly from fevers. Literature free. Sample 3 oz. bottle by mail, 10c. Sold by druggists and grocers everywhere. BUT BE SUEE TO GET WELCHES. JTHE WELCH GRAPE JUICE CO.. Westfield, N. Y. 486 A Delicious, Nourishing Diet in the Sick Room and Hospital Ward Selected recipes will be found in this book for preparing original delicacies from Horlick's Malted Milk, that will not fail to tempt the appetite of fastidious invalids. Samples sent, free and prepaid, upon request. Specify "Horlick's" Malted Milk, the original and only genuine. Others are imitations. HORLICK'S MALTED MILK CO. RACINE, WIS., U. S. A. 487 Hoyt's Gum Gluten GUM GLUTEN HOW PROCURED As a rule, the. leading grocer ip a city is agent for Gum Gluten. If not easily ppocured, 'write to the manufacturers, The Pure Gluten, Food Co!, 90 We^t Broadway, New York, for name of the nearest 'agent, and their latest literature on Gluten. , THE PURE FOOD LAW XJ. -^ Stgindard for;Ohiten.—"(il,VTEN FLOUR is the product made -from flour^bytlie removal of starch, and contains net less than five and .s]^x -tenths (5.6) per cent, of Nitrogen,' and not less than ten (10) -per cent, of Moisture." NOTE.— Using the factor, 6.25, usually employed by the U. S. Government chemists. Standard Gluten Flour must, therefore, show at least thirty-five (35) per cent, protein. is guaranteed to he much richer in protein than the Government Stand- ard prescribes. The increase of diabetes among young children is noteworthy; that it may be due to the increased use of malted and dextrinized cereal foods, at a time when the digestive organs are not pre- pared to digest them, is very probable. Cow's milk differs from mother's milk in that the casein of cow's milk coagulates as soon as it reaches the stomach and comes in contact with the rennet ferment, into a cheese-like mass, which is not easily broken up and digested 'by the delicate stomach of the infant; while the casein of mother's milk forms a flaky coagula, which is easily penetrated by the digestive juices. To prevent cow's milk from coagulating into a cheese-like mass, various food substances are added. Hoyt's Gum Gluten Flour is especially suited to this purpose. Hoyt's Gum Gluten resembles milk in that its chief element is nitrogenous, and of the same muscle-forming character as casein, and require essentially the same ferments for their proper digestion. When impossible for an infant to retain other food in the stomach, Hoyt's Gum Gluten Flour, made into a gruel, may be retained, and give strength, after which milk and milk-sugar may be added. GUM GLUTEN BISCUIT CRISPS are most delicate and nutritious— a popular and convenient form of Gluten. Higher in protein than any other biscuit or cracker on the market. More nourishing than meat, without the heat and fat- producing qualities. Invaluable when a child requires some kind of a biscuit or cracker; also tor adults when a starch restricted diet is required. Send 2c. stamp for sample box of Crisps and complete price list, etc. SWEETINA A bottle will be mailed to any address upon receipt of 25c. PURE GLUTEN FOOD CO. 90 WEST BROADWAY, NEW YORK ^^ UNIVERSALLY APPRECIATED mwe. m COMPANY- NEW YOKH ;,JP)URITV- ABSOLUTE fi,,Vi«liSlVOR~ UNIQUE p-BJlfttaANCY-SUPBEME pomiN&'FriiEti.BRODuciBU PURITY ABSOLUTE FLAVOR UNIQUE NOTHING FINER PRODUCIBLE NIGELLE OLIVE OIL " It is our opinion the analytical tests of the UNITED STATES BUREAU OF CHEMISTRY prove NICELLE OLIVE OIL superior to all known brands tesled." Stillwell & Gladding, Chemists to New York Produce Exchange. Its Vs^ Recommended by Miss ALIDA FRANCIS PATTEE Miss CORNELIA C. BEDFORD Miss FANNIE MERRIT FARMER Miss JANET MACKENZIE HILL Miss HELEN ARMSTRONG Miss ANNA BARROWS AND OTHERS NICELLE OLIVE OIL COMPANY OF PIM-OLA FAME NEW YORK 489 FLEISGHMANN'S COMPRESSED YEAST HAS NO EQUAL 490 BFor Upwards of Forty »jl ... Years the Use of !j \ Tcllo(v$' Syrup of i I l)ypopbo$pbite$ | 1^ has been recommended by the m B Leading Medical Specialists m ..- in aU Countries H B '^ SI Bo _;- -^..^Worthless Substitutes RfJ ^^'^"^PreparaUons "Just as Good* wA MODERN DIETETICS considers not only the potential value of food -stuffs, but their actual nutrient content. Liquid Pepfonoids NUTRIENT AQSNT Total Solids Protela Carbo- hydrates Fat Ash Water % % % % % % Milk 12.8 3.5 4.9 3.7 0.7 87.2 Buttermilk 9.0 3.0 4.8 0.5 0.7 91.0 Whey 7.0 1.0 5.0 0.3 0.7 93.0 Beef Juice 4.28 2.19 . . 2.09 95.72 Beef Tea 3.72 1.02 2.7 96.28 Barley Water .... 0.23 0.09 6.06 0.05 0.03 99.77 Egg Albumen Water 1.S 1.5 • • Alcohol • • 98.5 Liquid Peptonoids . 20.0 5.25 13.8 17.5 0.95 62.5 Dry Peptonoids (Soluble) is a highly concentrated food, every particle of which is of nutrient value. It dissolves freely in any fluid used as food, and is of agreeable flavor. It contains no extractive or waste material. Both preparations are, therefore, of great ser- vice to the nurse, both as Emergency Nutrients in Acute Diseases and Auxiliary Food Tonics during Convalescence or in Cachectic or Debil- itated Conditions. THE ARLINGTON CHEMICAL CO. Yonkers, N. Y. Samples to Nuraes on request .„„- WHY IS Scott's Emulsion THE BEST IN THE WORLD? BECAUSE it is made of the purest and best ingredients obtainable. BECAUSE it contains MORE healing, strengthening and up-building material than any other Emulsion. BECAUSE it is a perfect product of a scientifically perfect process. BECAUSE there is no alcohol or other harmful ingredient in it. BECAUSE every drop of it is clean, pure and healthful. BECAUSE it is recommended by more phy- sicians than any other preparation of Cod Liver Oil. ^ ^& ^^ y f 1 11 ^ FOR Anemia and Loss of Flesh, Coughs Colds Lung and Chest Troubles For these, and other reasons, it has become the standard through- out the world. 493 Perfect Circulation" And Absence of Odors in your refrigerator is only possible by using the Bohn Syphone System. It insures a rapid and unobstructed circulation of. cold, dry air, enabling you to keep butter and milk in the same compartment with cantaloupe or onions, without contamination. The BOHN SYPHON REFRIGERATOR has been proven superior to all others only after severe tests. All the great railroads, hotels and restaurants use it. They know what is best. No scrubbing necessary to keep it clean. Just wipe with a damp cloth. No inaccessible pipes, crevices or slots, no dark comers to hold germs. GENUINE "VITREOUS" Porcelain Enamel Lining applied by lock joint, making practically a one- piece lining. The glossy white surface of the enamel will never discolor, crack or peel off. A low and uniform temperature is assured always with the least con- sumption of ice. WHITE ENAMEL REFRIGERATOR CO OF NEW YORK 59 W. 42d Street NEW YORK Factory: St. Paul, Minn 494 SLICED Packed the day it is picked on the field where it grows in the highest state of pineapple perfection. EAT ALL THE HAWAIIAN PINE- APPLE YOU WANT— it's good for you — wholesome and digestible. Serve the Sliced as a fruit course for any meal; try it as a breakfast fruit; use it for desserts — for there is nothing in a can of Hawaiian Pineapple that isn't pure and healthful, and the fruit is the choicest pineapple in the world — the best of Hawaiia's crop. If your grocer hasn't it send his name for booklet of pineapple recipes. irse TRIBUNE BUILDING NEW YORK CITY 495 GOOD THINGS TO EAT THAT ARE HOME MADE PRESERVES, MARMALADES, PICKLES, RELISHES, JELLIES, MINCE MEAT, PLUM PUDDING. This Kitchen is under the personal supervis- ion of Miss Chivvis, who assures the public that only the purest and best goods are used in her establishment. SPECIALTIES GINGER PEARS, GRAPE CONSERVE,. SPANISH PICKLE, CENTURY RELISH. Special prices to Hospitals, Hotels, Clubs, etc. Price list furnislneci orx application. C. E. CHIVTIS, - ■ MOUNT TERNON, NEW YORK 496 THERAPEUTIC APPLIGATIOli OF GUM GLUTEN Dyspepsia, Gastritis, etc. — Being non-fermentative and quickly reduced by the digestive fluids. Gum Gluten is a food in perfect harmony with the action of the stomach and can be eaten in the form of gruel. Convalescence.— As Gum Gluten is, remarkably rich in nucleo-albumen and all other cell-building material, it Is capable of greatly quickening and intensifying the integrat- ing processes of cell life and giving impulsive energy and force in the revival of the system to its normal metabolism. Rheumatism, Gout and Uric Acid Diathesis.— Being non- acid making and non-fermenting, and digested by the action of the stomach. Gum Gluten has a distinct specific value in all rheumatic conditions. Obesity.— As Gum Gluten is the muscle-building element of wheat, it is the rational unfailing cure of this uncomfortable condition. Diabetes Mellitus.— Gum Gluten can be made into bread and a great variety of dishes, and is the most satisfactory substi- tute for the wheat flour bread or bread in common use, and the effects are particularly noticeable in the reduction of sugar in the daily tests. Other Conditions.— All ansemic and chlorotic conditions due to an insufficient supply of red blood corpuscles or lack of haemoglobin, or both, and more remotely to a disordered nutri- tion, are furnished the one thing needed by Gum Gluten. For Nursing Mothers.— It enriches the lacteal secretions. For Infants' Food.— To increase the amount of protein it should be freely used. For the expectant mother It supplies the prenatal aliment par excellence, since it is rich in all those elements which serve to maintain the nutritive system at its best. For the Aged, the Enfeebled, the Invalid, and all whose vital powers are waning, Gum Gluten will be found a most wholesome, sustaining and helpful food. In its blood-making property it restores to the system the loss which has resulted in enervation and decline. PURE GLUTEN FOOD CO. 90 WEST BROADWAY NEW YORK 497 Boohs that Every Woman Should Possess KNOW THYSELF SERIES TWELVE BOOKS BY SUSANNA COCROFT NO WORK HAS HERETOFORE BEEN PUBLISHED, EXCEPT THE TEXT-BOOK PHrSIOLOGY, WHICH GIVES SO INTELLIGENT A SCIEN- TIFIC KNOWLEDGE OF THE MECHANISM AND WORKINGS OF THE HUMAN BODY. THE VITAL FUNCTIONS ARE NOT ONLY EXPLAINED IN THESE LECTURES, BUT ALL VITAL ORGANS ILLUSTRATED BY COLORED PLATES. MISS COCROFT BELIEVES THAT ALL THE QUALITIES THAT MAKE A WOMAN WELL, WHOLESOME, MAGNETIC AND ATTRACTIVE ARE HERS IF SHE USES THE INTELLIGENCE GIVEN TO HER, AND IN HER LECTURES SHE POINTS THE WAY. THEY VITALLY CONCERN EVERY WOMAN AND ARE THE CLEAREST, MOST COMPLETE HANDLING OF THE SUBJECTS WHICH PERTAIN TO THE HEALTH OF WOMAN AND THE HAPPINESS OF HOME. GROWTH IN SE-ENCE. POISE AND SYMMETRY OF HGURE. (Obesity and Leanness.) IDEALS AND PRIVILEGES OF WOMAN. CIRCULATION— Heart and Longs. BODY MANIKIN. CHARACTER— As Expressed in the Body. (Illustrated.) THE NERVOUS SYSTEM— Effect of Habit upon Life. SELF-SUFFiaENCY— Mental Poise. MOTHERHOOD.— Tlie Generative Organs. THE VITAL ORGANS— Liver, Stomach, Intestines and Kidneys, their Use and Abuse. BEAUTY— Hair, Eyes, Teeth, Hands, Feet and Ears. FOODS— Nutritive Value and Digestibility. Twelve books bound separately in pure white, cream and brown heavy art, deckle-edge paper, $4.00. Single copies, 40 cents— except Body Manikin, which is 50 cents. Bound in brown flexible leatherette cover, $6.50. Single copies, 60 cents. A. F. PATTEE MEDICAL PUBLISHER AND BOOKSELLER MT. VERNON, N. Y. 498 Doctors Prescribe Nurses Recommend Patch's Pure Sterilized ^ Sugar of Mill( WHY? "Because they realize the impor- tance of using the best that can be obtained in the market. A Milk Sugar free from acids, alkaline earths, casein residues, fer- ment germs and other faulty contamina- tions. The cans are thoroughly cleansed and sterilized, and tightly sealed. It starts right, it keeps right, and many years of esperience has convinced careful observers that Patch's is THE Sugar of Milk. The E. L. Patch Co., Boston, Mass, Manufacturers of a Full Line' of Pharmaceuticals. 499 GOOD NUTRITION DEPENDS" also upon COOKING. The cook will always transmute even the plainest of foods into tempting delicacies if the Kitchen contains THE SEELY SANITARY FIRELESS COOKER. FOOD Is boiled but a, fewmlnntes on tbe stove and then placed In the Gooker,where twenty-one hours elapse before the tem- perature In the institutional sizes falls to 150° Fahrenheit. The original cells, tissues and flavors are practically intact; there is no occasion for stirring: and long, slow cooking is completely accomplished in a moist, high heat. MIGATS retain their Juices, lose but little weight and even the toughest be- come thoroughly tender. w ^ «,.ni .. i Y^ ^», , ^ ,„- FISH possess a sweetness hitherto un- No. 4. 2 l;t-Qt. Aluminum Kettles, feeds 130. fcnovn. VEGETABLES are unbroken in shape and retain all mineral salts. CANNED VEGETABLES brought to the boll and ri pened In the Cooker equal the fresh in flavor. SOUPS AND BROTHS are rich In concentrated goodness with one-tenth the labor of preparation. CEREALS AND STARCHF FOODS are as delicious as desserts and expand abnormally, requiring but little more than half the usual measure to prepare. FRESH FRUITS, Apples, Pears, Cranberries, etc.. are particularly delicious. DRIED AND EVAPORATED FRUITS swell to their original size, full and perfect and equal to the best home-made preserves. FOOD may be prepared In a central kitchen at any convenient hour, distrib- uted where wanted and served hot even tw^enty-four hoars later. THE SAVING in fuel and labor required to prepare food is fully eighty per. cent. ALL USERS testify that the Cooker pays for Itself In a fe-w weeks. Those having steam apparatus give preference to the Cooker for superiority of product and saving in supplies. THE SEELY SANITARY FIRELESS COOKER is an all metal washable utensil lined with tinned copper — no cushions or felt at any point— durable— continuous service without re- pairs — made in sizes to suit all requirements of Institutions or Individuals. For full information and prices address: THE FRANCES A. SEELY CO. 5809 ROSALIE COURT, CHICAGO, ILL. PHTSICIAlSrS AND NURSES will find the Cooker inraluable both for their own nse and those nnder their care. Special terms to those no. i. i2Qt.,2 3-i!t.,i6-Qt. Ennmei answering this advertisement. Kcttlea — for small famillea and nurses. CRACKED ICE KEPT CONTINUOUSLY at hand and practically without meltluar In THE SEELY SANITARY PORTABLE COOLER. First made by request of a large hospital and found completely successful— all washable metal— compact. Not affected by tem- perature of room— stands on the floor wherever most convenient for Surgeons and Nurses. "Write for partlcnlars. 500 Dr. JOHNSON'S EDUCATOR CRACKERS START LIFE RIGHT BY PROVIDING THE FOOD RING FOR TEETHING INFANTS Follow this with a variety of EDUCATOR CRACKERS which form a perfect cereal diet for young and, old, well and ill. JOHNSON EDUCATOR FOOD CO. BOSTON NEW YORK PHILADELPHIA PROVIDENCE NEWBURYPORT 501 Gingham for Nurses' Uniforms Orders filled promptly for Ging- ham or Chambray for Nurses' Uni- forms, by piece only (38 to 58 yards in piece), 124 cents per yard. Send sample and state number of yards required, and we will send as near as possible the quantity required. Goods sent CO D. express collect. A. F. PATTEE 134 South First Avenue Mount Vernon, N, Y. 602 Get f?id of the Dast ^%£to.< The medical profession is agreed that dust and dirt are the com- monest sources of disease. The germ-laden dust is every- where—even the cleanest hospital Is not exempt. The only means for its complete annihilation is vacuum cleaning. Many vacuum cleaners have been devised, but the one perfect clean- er — recognized everywhere as the Standard of excellence — is the port- able electric The Santo combines both a high, even and continuous suction with a large volume of air. It is the only cleaner having both suction ana volume which is necessary for thorough cleaning. It runs without vibration and less npise than a light-running sewing machine. Xlse it in hos- pital or sick-room without the slightest annoy- liiice to the patient. The Santo removes every particle of dust and dirt from all the furnishings, floors and woodwork, aerates bedding, etc. It puts an end to sweeping and dusting. Cost to operate, less than two cents per hour. Weight only 50 lbs. Complete tool equipment for 20 different uses, including massaging by suction. It is very simple, and is sold under an unlimited written guaranty. Used and endorsed by U. S. Government and over 60,000 homes, churches, hospitals and other institutions. Write for book, "The Dustless Home," which gives full particulars. Mailed free. J^ellstt IVIatiofaetuiTitig Co., Phlladelpbla 503 Bectif ual view Simple'^ nothing to get out of order. lDept. P.O. 20th Anniversary Announcement OF THE Home Bnreau= Medical House 1890=1910 To Doctors, Nurses Hospitals* and the Public The Home Bureau- Medical House, as evidence of the steady and rapid growth it has enjoyed since its inception twenty years ago, beg;^ to submit the following facts : In 1890 started with:— No Capital — i Room i Employee — 6 Quarts of Broth 500 Booklets for Advertising In 1910 has:— Incorporated Co. Medical House, Larg:e Building; — 30 Employees, Extensive Diet Kitchen, Largfest Reg'istry Nurses in World, Surgical Dressings, Supplies, Obstetrical Sets, District Nurses' Bags, Invalid Furniture, Invalids Moved, Houses Disinfected, Rest Cure Apartments, 50,000 Booklets for Advertising. 504 Physicians', Nurses and Mothers' Headquarters for all necessities of the hospital, sick room and nursery. Let us send Anniversary information of the Home you a copy of our Bookletwhich gives full concerning the work Bureau-Medical House. MEDICAL HOUSE Home Barean-Medical House 52 West 39th Street New York Tel. 406-407-408-409 Murray Hill. iNe< MEDICAL HOUSE 505 THE PENNSYLVANIA ORTHOPAEDIC INSTITUTE AND SCHOOL OF MEGHANO -THERAPY (Incorporated) 1711 Creen Street Philadelphia Pa. OFFERS TO NURSES SCIENTIFIC OOITSSES IST MECELAJTICAi:. TKEATMENTS Course in Medical Massage Snredlsh MoTements, medical and Orthopsedic Gymnastics Term: 3 Montlis Tuition Fee, |75.00 Course in Electro-Therapy Term: 2 Montlis Tuition Fee, $26.00 Course in Hydro-Therapy in all its forms Term: 6 Weelis . . ... Tuition Fee, $30.00 Clnsses open in January, llareli. May, July, September, and NoTember. All courses may be commenced at the same time and finished within three months. The instruction consists of daily clinical work and practical lessons on patients referred to our clinics from the various Hospital Dispensaries. Lectures and Quizzes on Anatomy, Physiology and Pathology by Physicians of the stafE. Demonstrations and Instruction in the use of all mechanical apparatus. Complete Medico- Mechanical Zander Gymnasium. Original Swedish (Ling) system, and Weir Mitchell's Rest-Cure system. All pupils attend clinics at several city hospitals. Payments can be made to suit your convenience. Particulars and illustrated booklet on Massage upon request. An enrly application for admission is advisable. A diploma is awarded at the end of the term. STAFF OF ijrsTaxrcTOK.B WM. EGBERT ROBERTSON, M.D. (Professor of Medicine, Temple University). HOWARD T. KARSNER, M.D. \ (Instructors University of Pennsyl. HOWARD A. SUTTON, M.D. / vania). ELDRIDGE L. BLIASON, M.D. (Instructor University of Penna.) LOUIS H. A. VON COTZHAUSEN, Ph.G., M.D. (Graduate Phila. College of Pharmacy, Med. Dept. University of Penna., Penna. Orthopaedic Institute). WM. BRWIN, M.D. (Hahnemann and Rush Med. Col.) MAX J. WALTER (Univ. of Penna., Royal Univ., Breslau, Germany, and lecturer to St. Joseph's, St. Mary's, Philadelphia General Hospital (Blockley), Mount Sinai and W. Phila. Hosp. for Women, Cooper Hosp., etc.) HELENS BONSDORFF (Gym.^Ins., Stockholm, Sweden). EDITlFw KNIGirr^^''' I (Pennsylvania Orthopaedic Institute). MARGARET A. ZABEL (German Hospital, Philadelphia, Penna. Ortho- paedic Institute). For all further information, especially date of opening of classes, address the Sutertntendent. ^^ ^_ WAtTEK. Supt. 506 Welcome Support to the tired and sagging muscles of the arch is given by. the Coward Arqh Prop Shoe, which provides natural and adequate support to the weakened ligaments. The special construction of the shoe holds the arch up into place, relieves the ache and restores strength and tone to the foot structure. SOLD NOWHERE ELSE JAMES S. COWARD 264-274 Greenwich St., N. Y. (near warren street) Mail Orders Filled | Send for Catalogue 507 There M\ist be Sc R. e ©^ s o n ! Visible Writing Visible Keyboard The Model 10 Smith Premier Typewriter wats awarded the niLST GRAND PRIZE over all other >vriting mat- chines at the Exposition Uni- verse lie. Brussels 1910. '^ Write for literature concerning the special machine we are building for the medical profession. : : , : : : "Bhe Smith Premier Typewriter Co. 319 Broadwaty. cor. TKoina.s St., Neve York City 5U8 The BEST WORK PUBLISHED for HOSPITAL INTERNES and SURGICAL NURSES THE SURGICAL ASSISTANT (SECOND EDITION) BY WALTER M. BRICKNER, B.S., M.D. Assistant Adjunct Surgeon, Mount Sinai Hospital, New York, and Chief in Surgical Out-patient Department; Surgeon to N. Y. Sanitarium for Hebrew Children, The Most Comprehensive Manual on Operating Room Technic and Methods. It is replete with definite instructions, useful hints and valuable "wrinkles" not elsewhere set down in print. It details : Xhe General Condnct or the Asststant; the Interne; Aaslatance at DresalUKs. Fracture Reductions, etc. Preparation of an Operating Room. TFhe Xechnlc of Asepsis In all Its Practical Bearings. Prep- aration of the Patient. Xhe Anesthetist. Preservation and Sterlll* zatlon of Instruments and Accessories. Formulas and Bfethods of Surgrlcal Sterilization. Hovp to **lland" Instruments. Technics of Assistance In the Varloas Operative manipulations. Immediate After-Cure of the Patient. Formulae of Solutions, etc. Instruments and Accessories (and their preparation) for each operation, etc., etc. The only hook that is devoted to theynethods and duties of those who ASSIST the surgeon^ and contains descriptions of all the important operations, step by step,yr(7OT the assistant's standpoint. Bound In Cloth, 363 Pages. Price, $2.00 Postpaid. 123 Original Illustrations. INTERNATIONAL JOURNAL OF SURGERY COMPANY Medical Publishers 100 WILLIAM STREET, ^„„ NEW YORK, U. S. A. 509 Im^l^^^^ " CURES WHILE YOU SLEEP" VAPORIZER IS SIX INCHES HIGH LASTS A LIFETIME Treatment without iuternal medication is highly desirable in Whooping Cough arid Croup, particularly in the very young. In the use of vaporized Cresolene such a method is available. For thirty years Cresolene has been used as a remedy for Croup and Whooping Cough with great success, and is becoming more and more popular with physicians, in the treatment and prevention of Measles, Scarlet Fever, Diphtheria and Bronchitis, Laboratory tests show that vaporized Cresolene destroys the germ of Diphtheria ; also a one percent, solution of Cresolene with water kills the germs of Diphtheria, Typhoid Fever and Pus, at once. Thus the value of Cresolene rests upon the fact of its great germicidal power^ and the method of treatment. For sale by all Druggists. Literature on application. THE VAPO-GRESOLENE CO., 180 FULTON ST., NEW YORK. Lee'mlng-Mlles Building, Montreal, Canada. 510 National Head- quarters f o r DIETITIANS HOSPITALS desiring dietitians can secure the services of grad- uates from leading Schools of Household Arts by applying to us. Prompt attention given to request and no charge is made for this service. DIETITIANS desiring hospital positions are invited to register with A. F. PATTEE 134 South First Avenue, Mt. Vernon, New York 511 QUILTED MATTRESS PADS AN acknowledged luxury for the bed. and endorsed by physicians for the nursery and for obstetrical purposes. These pads are made of bleached white muslin, both sides quilted, with white wadding of the best grade between. Keeps bed clean and sweet, mattress in a sanitary con- dition. Restful to sleep on. Saves labor and money. Babies can be kept dry and in. comfort. Easily washed. Send for Sample. Made in fourteen sizes. The pop- ular sizes are: 18x34, 27x40, 36x76, 42x76. 54x76. FOR SALE IN DRYGOODS STORES JShe Excelsior Quilting Co. .15 LAIGHT STREET NEW YORK CITY 613 Woman's Belt, Front View A Supporter in Harmony with 3Iodern Surgery The "Storm" Binder and Abdominal Supporter Patented July 10, 1906 The "Storm" Binder and Ab- dominal Supporter is light (5 oz.), flexible, washable and durable, and without steel or rubber in its construction. It is used for any purpose for which an abdominal supporter may be needed for a man, woman or child. It is perfectly adapted for general support, and by the special application of the rein- forcing strap with a pad may be used for local support as for hernia. It is especially valuable for movable kidney and for re- laxation with ptosis of stomach, liver or intestines, giving rise to symptoms of pain and obstinate indigestion. ' As a. Post Operative Binder it has no superior for comfort and effi- ciency, and may be adapted' to the upper, middle, lower or lateral ab- dominal regions, thus making it an ideal binder after operations upon the kidney, gall bladder, appendix or pelvic organs. The "Storm" Binder is a greart comfort to women during pregnancy and the pnerperhim, and in conditions of bladder or pelvic inflammation marked relief is experienced by lifting the super-imposed weight from the congested parts by means of this soft elastic supporter. Illustrated folder giving styles, prices and diagram for measuring and partial list of physicians using "Storm" Binder sent on request. All mail orders filled within twenty-four hours on receipt of price. No Whalebones— No Rubber Elastic— No Leather Washable as Underwear— It Supports with Comfort The invention which took the prize offered by the Managers of the Woman's Hospital of Philadelphia L KATHERINE 1. STORM, M.D. i' 1612 Diamond Street Philadelphia Office Hours, 10 to 4, and by appointment 5io Man's Belt, Front View Hand-I-Hold BABE HITS ?? AND THEIR USES. ^ . T^C^'7T2Ti/T A TO PREVENT J—'V^'t-fCriVlxl., SCRATCHING. THUMB SUCKING, LEFT HANDEDNESS, NAIL BITING. "HAND- I-HOLD" \ INVALUABLE IN BABEMITS X ^^^„„^^,^ are light-weight, N** O S P I T A L daintily enamelled balls|>v C 'R R V I C E spun without seam from al-^v ' uminum. They are ventilated \ ETC., ETC and have sleeves of wash fabric. \ The hands are confined in the balls, which makes it absolutely impossible for the child to scratch, suck his thumb, bite his finger nails, or pick at bandages. \ Yet it is all done so gently and humanely that the ] child is made happy by their use, for his arms, r^^j wrist, and fingers are practically free from restraint. So sure are we of results that we guarantee satis- \ faction or refund your money. Whether you have \ children in your home, or not, it will be well worth your while to drop a postal card for our FREE BOOKLET "D." which will tell you all about "Hand-l-Hold" Babe Mits. R. M. Clark & Co. 246 Summer St., BOSTON, MASS. 514 Hygeia Nursing Bottle Co., Buffalo, N. Y Boa Baby. No trouble to wean baby with the Hy- geia nursing bottle, because it has a breast, and it is the only nursing bottle with a breast. The breast is reinforced, reversible, and is easily turned inside out for cleansing. The receptacle is not a bottle, but an open cell. It is filled without a fiinnel, cleaned without a brush, and serves as a cup for the breast-nipple, during the interim of feeding. Both breast and cell are so constructed, that they are sanitary in the fullest sense of the The breast ^^^j^ The Hygeia Sterilizer, or Pasteurizer, is as simple in construction as the Hygeia nursing bot- tle. For use, and for cleanliness, it is beyond com- pare, and unexcelled for simplicity. The food-cell of the sterilizer is the same as the cell of the Hygeia nursing bottle. The cell is covered with a steri- lizer cap, which is open at the top, so that it can be corked with cotton. The rack, that supports the food-cells, is above which is used in the sterilizer, for the heating of The rack covers the water, then there is a cover to the sterilizer, so that the heat is confined, and the desired temperature sooner reached. Sample of the Hygeia nursing bottle furnishedon appli- cation. Write for liter- ature in reference to these unique inventions. Manufactured by HYGEIA NURSING BOTTLE CO., Buffalo, N. Y. the water, the food. 515 THE "NEAL" PORTABLE RUBBER BATHTUB FOR CHILDREN This unique and pretty little Sanitary Bathing Apparatus for Infants is one of the best and most useful bathtubs on the market. It has been in active use over fifteen years and has found its way into some of the finest Nurseries on both continents. The "Neal" Bathtub has been successfully used in place of an incubator for premature and delicate babies. By wrapping the infant in soft woolen blankets and placing hot-water bags around the child, the rubber keeps its uniform heat, and at the same time insures plenty of fresh air, and is of easy access to Physician and Nurse. This has been successfully tried in a number of cases. The inventor of this little bathtub is a graduate of the New York City Hospital Training School for Nurses. For further particulars send for catalogue and price list to Miss S. C. NEAL, Patentee and Manufacturer, 114 FIFTH AVENUE, New York City, U. S. A. 616 Good Nurses and Careful Mothers are particular about using no other but MENNEN'SfiL^ViS TOILET POWDER because it is freely recommended above all others by physi- cians everywhere. MENNEN'S is the safest and purest of Toilet Powders. It not only smooths the skin but soothes the skin, not only hides roughness and rawness,' but heals them. It enables you to easily retain that pleasing appearance of fresh cleanliness. Guaranteed by G. Mennen Chemical Co. under the Food and Drugs Act, June 30, 1906, Serial No. 154'3. For Sale Everirwhere, or by Mall for 25 Cents, Postpaid Sample Box for 4-cent Stamp MENNEN'S Borated Skin Soap (blue \VTapper) should be used always in con- nection with MENNEN'S Borated Tal- cum Toilet Powder, -for the health of the skin. For sale everywhere, or by mail for 25 cents, postpaid. Samplo cake for 4 cents. GERHARD MENNEN CO., 517 Newark, N. J. BOOKS THAT NUItSES KEEP PRACTICAL POINTS IN ANESTHESIA Bv FKEDKRICK-EMIL NEEF, B. S., B. L., M. L., M. D., NE^V YORK This very practical monograph presents the author's impressiODs on the correct use of chloroform, eiher, etc., and is a. simple and coherent working method. Among the subjects covered are: Induction of Aneatheala VomltliiK during Anesthesia Recession of Tongue after Nar- CardlHc and Bespiratoi-y Cnllnpse Obetrucled Brentliing cokIb When Bliall tlie Patluiit bu Duularud Uno of the Breathing Tube Poat-Operatlve DIstrosR Ready for Operation ludicationH for Stimulation Minor Aut^utheBla with Ethyl, Maintenance of the Surgical Plane Infiimncc* ofMorphlrit> on Nnrcoais Chloride of AneBthiisla General Course of Aueathesia Intubation, Anesthesia Important ReHexea Awakening £tc.. Etc. It is of especial value to those general practitioners and nurses who are so situated that the services of an expert anesthetist can not be secured. This extremely practical and useful little book is condensed to about fifty pages, but every page Is replete with valuable data. Printed upon heavy india tint special Cheltenham paper with Cheltenham type, with marginal headings in con- trasting colored ink. Regular Ifidition, Sem! de Luxe, cloth binding, stamped in gold, Price, 60 Cents, PoMtpald. Special Full Xilltrury de J^uxe Xldlilon, liexible ooze leather bound, with gold edges, stamped in gold, $1.50, postpaid. 700 SURGICAL SUGGESTIONS By dr. WALTER M. BRICKNER Assistant Adjunct Surgeon Mount Slnni Hoapltal, and Chief of Surgical Department Mount Slnal Hospital Dispensary, New York ; Kditor-in-Chief American Journal uf Surgery, ANn DR. E. MOSCHCOWiTZ Assistant FhyRician Mount Slnal Hospital Diapensary, New York ; AHSociattt Editor American Journal ol Surgery, lu this, the third edition, while we could not improve tbe quality, we have increased the number of " Suggestions, " making this book, we believe, the most complete, practical and useful manual of surgical suggestions, practical diagnos- tic hints and useful therapeutic wrinkles ever produced. Regular Kdltlon, cloth, Semi de Luxe, stamped in gold. Printed upon heavy india tint paper with Cheltenham type, marginal headings in contrasting ink. Price, »1.00, postpaid. Special Full r.lbrary Sdltlon de l.uxe, limp ooze leather binding, artisti- cally lined, stamped in gold, with gold edges, SS.SS, postpaid. Every Norse should read the book PLASTER OF PARIS AND HOW TO USE IT By martin W. ware, M, D; Adjunct Attending Snrgeon Mount Slnal Hospital, New York ; Surgeon to the Good Samaritan Dispensary ; Instructor In Surgery New York PoBt-Graduate Medical School. This Is one of the most useful books ever presented, not only on account of the general demand for the Information and instr< ction upon the subject which this book so explicitly, practically and comprehensively covers, but because this knowl- edge was not previously available except from such a large experience as enjoyed by Dr. Ware, or. In part, by reference to many books on allied subjects. It Is a concise narrative, PROFUSELY ILLUSTRATED, of the many uses to which Plaster of Paris la adaptable in Surgery. The whole subject, fi-om the making of the bandage to Its use as a support in every form of splint, corset or dressing, Is graphically described and Illustrated. The book is presented in the artistic manner characteristic of the productions of the Surgery Publishing Company, It is printed v/pon coated book paper and attractively boundin lieavy red buckram, stumped in white leaf and gold. Price, 91.00, postpaid 12mo. 72 llluatratiiina. Si>eclal Fdltlon de rtuxc, ooze leather, gold edges and stamped, SS.OO. SURGERY PUBLISHING CO. J. MacDON ALD. Jr., M.D..Presldent, 92 WiUlam St., N. Y.. V. S. A. 518 THE Gazette Pocket Speller and Def iner {Second^ Revised Edition) THIS uniqae Tolume is a combined Kog- liEh and Medical JJic- iiorery. It is a marvel cf Cc-rrectness, Com- pactness and Complete- ness. Bound in leather and gilt. REVIEWS An extremely conveni- ent little manual. —Med. Record. A very convenient vest- pocket reference book" ^Journal Am. Med. Assn. Tt is certain to be popu- lar. — Mass. Med. Jour- nal. It surpasses all the smaller d ictionaries pablished. —Med. Brief, It is remarkably com- plete, condensed and comprehensive.— (ONE-FOURTH SIZE) Atlanta Constitution. PRIC£, 60 CENTS Send for Specitnen Pages and Other Particulars THE QAZGTTB PUBLISHINQ CO. 36 We«t 4ad Street New York City 519 Of Interest to the Super= intendent and Nurse JOURNAL COMBINATION OFFERS THE FOLLOWINQ OFFERS APPLY TO NEW SUBSCRIBERS ONLY THE TRAINED NURSE ($2.00) and one copy of Pattee's "PRACTICAL DIE- TETICS" ($1.50) $3.00 THE AMERICAN JOURNAL OF NURS- ING ($2.00) and one copy of Pattee's "PRACTICAL DIETETICS" ($1.50).. $3.00 THE DIETETIC AND HYGIENIC GA- ZETTE ($1.00) and one copy of Pattee's "PRACTICAL DIETETICS" ($1.50).. $2.00 THE CANADIAN NURSE ([$1.25) and one copy of Pattee's "PRACTICAL DIETETICS" ($1.50) $2.25 THE NURSE'S JOURNAL OF THE PACIFIC COAST ($1.50) and one copy of Pattee's "PRACTICAL DIE- TETICS" ($1.50) $2.50 THE NATIONAL HOSPITAL RECORD ($1.25) and one copy of Pattee's "PRAC- TICAL DIETETICS" ($1.50) $2.25 A. F. Pattee 134 South First Avenue Mt. Vernon, N. Y 530 1874 TRADE (PAVOO "^"'^ 1910 A NECESSITY IN EVERY HOME ^"^ SICK ROOM Cautery Sets Commode Seat Complexion Bulb Dental Dam Diapers Dilators Cup_ping- Cups Sanitary Covers Sheetine Stomacn Evacuator Stomach Tubes Stoppers Breast Pipes Breast Pumps Breast Shierds Kace Hoods DAVOL TRADE MARK "HOUSEHOLD" (registered) Face Bottles Finger Cots Fountain Syringe Bags Teething Pads Teething Rings Vaporizers Water Bags Water Beds Water Bottles Water Caps Woman's Delight Tourniquets Tubing Turkish Bath Cushioos .Umbilical Belts RUBBER GOODS Urinals Rectal Tubes Bathing Caps WE make everything for the " Household " in Rubber Goods and the largest and best line of Atomizers on the market. Bulb Enemas Bed Pans Throat Water Bag^ Insist on having a DAVOL WATER BOTTLE and a DAVOL FOUNTAIN SYRINGE and NOT-" SOMETHING JUST AS GOOD" Syringe Pipes Syringe Shut Offs Syringe Tubing Syringes — Aural Syringes— Bag Syringes— Bulb Syringes — Combined Fountain Syringes— Eye and Ear Syri nges — Fountain Syringes — Gem Sjrringes— Infant Syringes— Ladies Syringes — Nasal Syringes -Rectal Syringes— Si x-Ounce Bulb Syringes — Urethral Syringes — Ulcer and Ear Syringes- Vaginal Douche Abdominal Coils SEE that the Name /srrrj^rr^ ^;lmoVs i3 on every article you ^^VOL) Aprons purchase for home use . trade mark Atomizers - ^^^^^^— — -_ Gem Cleansers Gloves Head Coils Hospital Cushions Hospital Air Cushions Household Syringes Ho^usehold Ladies' Syringe Household Vaginal Douche Ice Bags Ice Caps Invalid lUngs Irrigating Tubes Kelly's Operating Cushions Kidney Pads Ladies' Syringes Medicine Droppers Neck Pillow Nipple Shields Nipples Nursing Bottle Fittings Nursery Sheeting Obstetrical Cushions Chair Cushions Chemists' Covers Chemists' Culture Caps Chemists* Stoppers Colon Tubes Pessaries Pile Pipe Pillow Vents Plant Sprinklers Plaster Bowls Politzer Bags Powder Blowers- Bandage Gum Bandages Basin, Folding Bath Tubs Bath Spray OXIDKR KROM YOUR DRUGGUST DAVOL RUBBER COMPANY MANUFACTURERS OF STRICTLY HIGH-GRADE RUBBER GOODS FOR THE PROVIDENCE, R. I., U. S. A. 521 HOUSEHOLD" jfilycoXhymolme CmRRML CONDITIONS NASAL^THROar INTESTINAL STOMACH, RECTAL >&UTERO-VAGINALr KRESS &c OWEN COMPANY 210 Fulton it..'New YorKjj 522 Is a Perfect Antiseptic Plastic Dressing From the moment its constituent parts go into tlie sterilized com- pounding machine, the Antiphlogistine is not touched by human hands until the nurse removes it from the can for bedside application, thus keeping it free from bacteria. Antiphlogistine has superseded the old- fashioned, germ-laden flaxseed poultice in treating such conditions as Boils, Sprains, Felons, Ulcers, Superficial Burns, Croup, Mumps, Ton- sillitis and Laryngitis, as well as in deep-seated inflammations, like Pneumonia, Pleurisy, Bronchitis and Peritonitis. The nurse should heat Antiphlogistine by partially immersing the can in boiling water until the product is as hot as can be comfortably borne by the patient. Then it should be thickly applied directly to the skin and covered by a plentiful amount of absorbent cotton and a ban- dage. The dressing should be renewed, if necessary, when it will peel off readily, usually in 24 hours. Antiphlogistine can be applied to any part of the body, and, being antiseptic, can be used on abraded surfaces to advantage. UPON RECEIPT OF A NURSE'S PROFESSIONAL CARD, A PAD OF NURSE'S CLINICAL REPORT BLANKS WILL BE SENT. THE DENVER CHEMICAL MT'G CO.. NEW YORK 533 Hotel Martha Washington 29 East 29th Street New York EXCLUSIVELY FOR WOMEN 450 Rooms en suite and single. $1.50 per day and up. European plan. Telephone in every room. Numerous baths on each floor free to guests. Caters to women especially trav- elling or visiting New York alone. Convenient to surface and sub- tpi Way transportation, theatre and shopping districts. RESTAURANT AND TEA ROOM FOR LADIES AND GENTLEMEN Cuisine exceptionally good Absolutely fireproof. A. W. EAGER 524 Eighteen Splendid Trains San Francisco "Overland Limited" — Electric-lighted. Only three days Chicago to San Francisco. Leaves Chicagfo 7.00 p. m. daily, Chicago, Union Pacific CSl» North Western Line/ The Los Angeles Limited — Electric-lighted. Leaves Chicago 10.16 p. m. daily. Arrives Los Angreles 4.30 p. m. the third day. Chicago CS. North 'Western Ry., Union Paciftc R. R. and Salt Lake Route. The Ore(£on- Washington Limited — Electric-lighted. Leaves Chicago 10.16 p. m. daily. Arrives Portland 8.00 p. m. the third day. Only 72 hours enroute. Chicago, Union Pacific CSk North "Western Line. The China and Japan Fast Mail — Leaves Chicago daily at 10.45 p. m. for Denver, Portland, San Francisco and Los Angeles. The "'Denver Special" — Electric-lighted. Only one night to Denver. Leaves Chicago 6.00 p. m. daily. Chicago, Union Pacific and North W^estern Line. The Duluth Superior Limited — Electric-lighted. Daily Chicago to Superior and Duluth. Leaves Chicago 6.25 p. m. The North Western Limited — Electric-lighted. Daily between Chicago, St. Paul and Minneapolis. Leaves Chicago 6.35 p. m. The St. Paul and Minneapolis Express — Electric-lighted daily train between Chicago, St. Paul, Minneapolis and Uuluth. Leaves Chicago 10.10 p. m. The Iron and Copper Country Express — Electric-lighted. Daily to the Lake Superior Iron and Copper Country. Leaves Chicago 6.30 p. m. (Connects at Appleton Jet. for Ashland.) The North Shore Special — One of twenty-four daily trains be- tween Chicago and Milwaukee. Leaves Chicago 8.00 p. m. The Ashland Limited — Daily between Chicago and Ashland, Wis. Leaves Chicago 5.00 p. m. The Bad|£er State Express — Daily to St. Paul and Minneapolis. Daylight ride through picturesque W^isconsin. Leaves Chicagocg.30 a. m. The Wisconsin Special — Leaves Chicago 3.00 p. m. for Green Bay and Menominee. Menominee and Escanaba Express — Leaves Chicago 9.00 a m. for Green Bay, Menominee and Escanaba. The Black Hills Express — Chicago to the Black Hills and Hot Springs, daily, via Omaha, at 10.45 p. m. Minnesota and Black Hills Express — Betv^een Chicago and the Black Hills and Hot Springs, via Pierre and the P., R. C. Ca. N. W. Ry. Leaves Chicago daily 8.04 p. m. Minnesota and Dakota Special — Between Chicago and Pierre,Hot Springs and the Black Hills. Leaves Chicago daily 8.30 a. m. The Omaha and Sioux City Llmlted^ — Electric-lighted. Daily train to Omaha and Sioux City. Leaves Chicago 6.05 p. m. Other fast trains to Illinois, Iowa, Pf^isconsin. north- ern Mirhigan, Minnesota, North and South Dakota, Nebraska, IVyoming and the Black Hills. A. C. JOHNSON Passenger Traffic Manager, C. & N. W. By, Chicago, III. 525 Pattee's Hand-Bag Diet Book Consisting of Measures and Weights, Recipes and Hospital Dietaries RBPRINTBD FROM Pattee's "Practical Dietetics with Reference to Diet in Disease" AT the request of a large number of nurses /-\ these extracts from the Sixth Edition of ■^ -^ Pattee's "Practical Dietetics with Refer- ence to Diet in Disease " have been collated into a small book, suitable for the nurse's hand-bag. It is bound in heavy paper and is sold only to nurses, purchasers of the complete edition. Those who do not purchase both the complete- book and the Hand- Bag Diet Book at the same time can obtain the latter only when the coupon on the opposite page is forwarded to the publisher or bookseller from whom book was purchased and is accompanied by the nurse's professional card or hospital order and the price of the book. Orders will not be filled unless these instructions are followed. Price of the complete Sixth Edition of Pattee's "Practical Dietetics" ($1.50 postpaid) with one copy Pattee's Hand-Bag Diet Book, $1 .75 postpaid. This booklet is not published for general circula- tion, simply for the convenience of the nurse for her hand-bag equipment. 536 COUPON This coupon entitles any nurse who is the possessor of the Sixth Edition of Pattee's " Practical Dietetics " to purchase one copy of Pattee's Hand- Bag Diet Book. Send this coupon with your professional card or hospital order and 30 cents to the publisher or to the bookdealer from whom the book was purchased, and a copy will be forwarded postpaid. A. F. PATTEE, Publisher Mount Vernon New York Na Address- 527