LIBRARY OF THE NEW YORK STATE COLLEGE OF HOME ECONOMICS CORNELL UNIVERSITY ITHACA, NEW YORK 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/cu31924003519950 oi SO Id) 0) - — > M O 1^ 1- I^B^ 0-« '° ^f?' Q. "■ i-r- ■■ CO S==co eg s E^^^s PRACTICAL DIETETICS WITH REFERENCE TO DIET IN DISEASE ^ j, PRACTICAL DIETETICS WITH REFERENCE TO DIET IN DISEASE BY ALIDA FRANCES PATTEE Graduate, Department of Household Arts, State 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, Brockville, Ontario, Canada. EIGHTH EDITION Revised and Enlarged Price $1.50 F. PATTEE, Publisher Mount Vernon, New York 1914 n^M:UL i5ajui> -p Set up, electrotyped, printed, and copyrighted, June, 1903 Reprinted July, 1904, February, 1905, October, 1906, and November, 1908 Revised, reset, and recopyrighted December, 1910 Reprinted August, 1912, October, 1913 Copyright, 1903, 1904, 1905, 1910, by ALIDA FRANCES PATTEE Entered at Stationers' Hall All rights reserved ICo tbe Zi;raine& IRurec: TKIlbO0e t>sim life is a blessing to bumanit^ PEEPACB 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 value 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 FBEFACE 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 Feancbs Pattee. New York, December, 1910. EXTEACT FEOM PeEFACE 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. PEEPACE 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. Oilman 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 Peediatric 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 Peediatrist 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. Kathan Smith Davis, late Dean Northwestern Uni- 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 FIRST 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. Pattee. New York, July, 1903. XI 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. Eequirements 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 Ex- aminers of Nurses I am also able to quote the examination questions of various States. Course of Study in Dietetics Arranged by the American Hospital Association PRELIMINARY TERM Dietetics: Classification of foods, care of foods, cooking of foods, serving of foods. PiRST Year Tray setting and food serving; feeding the helpless and delirious patients; management of liquid diet. Second and Thibd Year Milk modification for infants according to different formulae; 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 xiT INTRODUCTION Second Yeab Theoretical Work Foods and food value; eight to fourteen hours. TSiRD Yeae Practical Work Diet kitchen practice, including the modification of milk, one to two mouths. Course of 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. Buttermilk. Fruit Juices. Broth. First Year Diet Cooking: 12 practical demonstrations, 2 hours each. INTRODUCTION xv Course of Study in Dietetics Arranged by the Michigan State Board of Examiners of Nurses LECTURE COURSE: JUNIOR YEAR Dietetics FOUR LECTURES 1. Foodstufifs and their classification. 2. Principles of cooking. 3. Beverages: Milk, etc. 4. Serving of food, combination of food and 12 lessons in practical demonstration in diet kitchen. Written examination to be held at the end of lectures. Course of Study in Dietetics Arranged by the Minnesota State Board SECOND 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, fa,ts 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 starch, 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, crolltons, 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, xvi INTRODUCTION creamed, esealloped and stuffed. Fruits — stewed and fresh. Sal- ads — French salad dressing, cooked salad dressing, mayonnaise. Vegetables. CoTirse of Study in Dietetics Arranged by fhe Missouri State Board of Examiners of Nurses Dietetics FIRST YEAR Probationary Course. Two to Four Months Tray setting and food serving; feeding of helpless patients; man- agement of liquid diet. FIRST YEAR Probationary Course. Two to Four Months Dietetics. (Theoretical and practical work.) Pattee's Practical Dietetics. Part 1. SECOND YEAR First Half. Intermediate Term (4% months) Dietetics. (Theoretical and practical work.) Pattee's Practical Dietetics. Part 2. Course of Study in Dietetics Arranged by the New York State Board PRELIMINARY TERM Dietetics, 14 hours Theory 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. 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. INTRODUCTION xvii Beverages: water, tea, coffee, cocoa, chocolate, wines, fruit juices,, malted milk, prepa'-ed foods. Milk: pas .i/L^, sterilizing, modification, kumyss, buttermilk (artificial) and whey. Eggs in various forms as liquid diet; gruels. Milk and eggs as food; custards; junket; white sauce; cottagft 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, i. 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; efl'ect 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. Fish : 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. Practical 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 term of service in the diet kitchen, practice in preparing and serving full meals should be given in connection with this series of lessons. xviii INTRODUCTION 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 nlake 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 ordered. Course of Study in Dietetics Arranged by the Oregon State Board of Examiners of Nurses PRELIMINARY TERM Dietetics Second Fouk 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. Buttermilk. Fruit Juices. Broth. First Yeab Diet Cooking: 12 practical demonstrations, 2 hours each. Course of Study in Dietetics Arranged by the Pennsylvania State Board of Examiners of Nurses Dietetics PRELIMINARY COURSE Second Week Serving of trays and feeding helpless patients. Three hours daily. TWO YEARS COURSE First Year Lecture I. Foodstuffs and their classification. Liecture II. Principles of cooking. Lecture III. Beverages, Milk. Lecture IV. Serving of food. Combination of food. INTRODUCTION xix Lecture V. Relation of diet and nutrition. Lessons ; Twelve. Practical demonstration in diet kitchen on care of gas range, electric range, cooking utensils and ice box. Preparations of trays. Feeding of helpless patients. Preparation of food. Second Yeab Lecture I. Carbohydrates; their sources, food values and prepara- tion. Lecture II. Meats; their food values and methods of preparation. Lecture III. Egga; their value, tests for freshness, and preparation. Lecture IV. Fish, clams, oysters; their food value, and prepara- tion. Lecture V. Special diets in different diseases. Lessons; Twelve. Practical demonstrations in diet kitchen, preparing and serving the different varieties of food. THREE YEARS COURSE The same as first and second year's Courne with the addition of the following matter: — Computing cost of foods. Computing food values. Planning menus for people in health and disease. Feeding of children, sick and well. Dietary for special diseases. Practical work in diet kitchen with instructor. Course of Study in Dietetics Arranged by the Vermont State Board of Examiners of Nurses Dietetics Classification of foods, care of foods, cooking of foods, serving of foods. Tray-setting and food serving: feeding of helpless and delirious patients; management of liquid diet. Course of Study in Dietetics Arranged by the Wisconsin State Board of Examiners of Nurses Dietetics FIRST YEAR Probationary Course. Three Months. Feeding helpless patients. Serving liquid diets under direction. Charting diets. XX INTRODUCTION SECOND TERM JANUARY 3 TO MAY 31 Dietetics. — Twelve classes. Theory, one-half hour. Demonstra- tion, one and one-half hours. Review physiology of digestion ; mechanical and chemical processes; absorption; assimilation, and elimination. Foods. — Classification, composition, and function. Food values. Principles to be observed in the preparation of foods. Practical IMetetics. — Preparation and serving of the following : Coffee, tea, chocolate, cocoa, broths, hot milk, oyster stew, egg-nog, eggs (poached, scrambled, jellied, baked), omelets, custards, toasts, cream sauce, light-desserts ( including ice cream ) , beefsteak, roasts, bacon, sweet breads, fish, chicken, breakfast foods, vegetables, fruits, and simple salads. Serving of trays. state Examination 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; chicken; 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? 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 ? 1911 1. {a) Define dietetics. (6) What are nitrogenous foods and what is their chief function ? 2. (o) What do you understand by predigested foods? (6) By modified milk? 3. Has skimmed milk any great value as a food? Give reason. 4. (o) By what signs do you know a fresh egg without break- ing? (6) Which are more easily digested, raw or soft-cooked eggs? (c) Give a proper method of preparing a soft-boiled egg. 5. {a) Which has the higher nutritive value, fish or meat? (6) Which is more easily digested? 6. (a) By what signs do you know good beef? (6) By what signs do you know good fish? 7. Give a good method of preparing beef juice and state what cuts of beef are best for this purpose? 8. (a) What is included under the head of light diet? (6) Why is butter valuable as a food? 9. How do you increase the digestibility of starchy foods? Give reason. 10. (o) What instruction have you had in dietetics? (5) Give name of one book on dietetics with which you are familiar. xxi xxii INTRODUCTION 1912 1. Define dietetics.' 2. What processes are necessary to make food of use to the body ? 3. Name two vegetables containing a large proportion of carbo- hydrates. 4. What food principles predominate in nuts? 5. Why is a. salt free diet often ordered where there is oedema? 6. How are broths made? Mention two ways of removing fats from soups. 7. How sterilize water? How oxygenate the same after it is sterilized ? 8. What do you understand by predigested food? By modified milk ? 9. Give a good method for preparing beef juice and state what cuts of beef are best for this purpose. 10. What should be the diet of a tubercular patient in the incipi- ent stage. 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 as far as possible, while giving a variety. 4. What useful function may be performed 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, 1910 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. INTRODUCTION xxiii 3. Mention the foods allowed according to the following classifi- cation: (1) 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) Roast beef ; (3) A tender steak? 8. What action has prolonged cooking on (1) starch grains; (2) albumin ? 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. January, 1911 1. Describe the diet to be given to a, patient after an operation on (a) the liver, (b) the stomach. 2. What diet would you give to a patient with scarlet fever ? Give your reasons. 3. What is the effect in cooking (a) meat, (b) vegetables? 4. State why green vegetables are valuable in diets. 5. Give the preparation of (a) koumiss, (b) whey. 6. Give a list of six fluid foods. 7. What are the best natural disinfectants? 8. What precautions would you take in the use of water where the supply is impure? 9. What are some of the diseases attributed to an impure water supply? 10. Describe fully one method of ventilation for a sick room. January, 1912 1. Of what use is gelatin as food? 2. What points must be observed in the cooking and serving of cereals ? 3. Name the five most important food compounds. 4. Name some of the points to be considered in the amount of food needed by an individual? 5. What action do the gastric fluids have on milk? How would you prepare milk to make it more digestible? 6. What is the effect of toasting bread? 7. State your reasons for adding salads to a diet? 8. What points should be considered in selecting a disinfectant? xxiv INTRODUCTION 9. In what ways is scarlet fever communicated? 10. What precautions would you take for both your patient and yourself before leaving quarantine for scarlet fever? January, 1913 1. State why food should be thoroughly masticated if good digestion is to result. 2. What are the uses of fruit in a diet? 3. Define the terms (a) Hygiene, (6) Dietetics. 4. State how you would prepare (a) barley water, (&) oatmeal ^ruel, (c) albumen water. 5. Describe fully how to prepare (a) beef broth, (6) mutton broth (c) beef juice. 6. What are predigested foods? 7. Why is the study of dietetics a valuable asset in the training of a nurse? 8. State what you know of the reason for the present movement against nurses wearing their uniforms on the street. 9. What are communicable diseases ? Give a list of them. 10. State fully how you would disinfect a room in a, private house after a case of typhoid fever. June, 1913 1. How would you prepare and serve (a) soft boiled egg^ (6) poached egg? 2. What is a, salt free diet, and in what diseases is it often ordered ? 3. Describe fully the diet for a rheumatic patient. 4. Describe the following diets and tell what can be given under the different headings, (a) Liquid, (6) Soft, (c) Light. 5. Give the preparations of a nutritive enema. 6. How is lime water prepared? Why is it added to milk? 7. Give some of the essential points for a, nurse to observe in serving meals to (a) a, weak convalescent, (6) a helpless patient, (o) an unconscious one. 8. What are the uses of condiments? Give a list of them. 9. Has a, nurse any duties in a home other than the care of her patient ? 10. Define the terms (o) contagion, (6) incubation, (c) crisis, (d) quarantine, (e) immunity. (Tabulate answers where, possible.) DISTRICT OF COLUMBIA 1908 1. Name three foodstuffs rich in albumin in the order of their importance. INTRODUCTION xxv 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 foodstuffs 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 follow- ing cereals : rolled oats, rice, and cornmeal mush. 5. Give the two complete food products furnished by the animal kingdom. ILLINOIS January, 1911 1. Define food and name the five principles. 2. What are some of the uses of water in the body? 3. What physical and mental conditions decrease the secretion of the digestive juices? 4. Discuss the value of (a) Milk, (b) Beef Tea, (c) Beef Juice. 5. Name some diseases that may be caused by the following errors in diet: (a) InsuflBcient food, (b) Lack of fresh food, (c) Overeating, (d) Improperly balanced diet. July, 1911 1. Discuss feeding the sick, under the following headings: Gen- eral rules, appetite, the tray. 2. Define food. Name the different classes of foodstuffs, according to their chemical composition, and give the special function of each. 3. What is meant by " certified milk," " pasteurized milk," " modi- fied milk"? 4. Outline one day's diet for a normal child three years of age. 5. What diseases may result from: improperly balanced diet, in- sufficient food, over-feeding, lack of fresh food. January, 1912 1. Classify food under (o) source, (6) chemical composition, (c) function. 2. Describe the gradual effect of increased heat on white of an egg (albumin). 3. What is lactose and where found? 4. (a) Of what use is sugar in practical dietetics? (6) What is the substitution for sugar, and where found? xxvi INTRODUCTION 5. What are the chief sources of fat in a general diet? 6. (a) What are the food uses of water? (6) What is distilled water and why not used as a beverage? 7.' Discuss diet in tuberculosis. July, 1912 1. (a) Give the theory of cooking starch. (b) What secretions assist in the digestion of starch? 2. (a) What are the characteristics of an ideal piece of toast? (b) How is toast to be served? 3. (a) Why does milk become sour? (b) Is sour milk harmful? (c) What preventive measures can be used in summer to keep milk from becoming sour? 4. (a) Define foodstuffs. (b) What are the uses of foods? 5. What is meant by a Calorie? (b) How many Calories are needed by the average advilt in health ? 6. Describe five ways of preparing milk and eggs, either separately or together, with which to vary a liquid diet. 7. Name four points which should be considered in the feeding of patients. 8. What changes take place in the making of wheat flour into bread? MISSOURI June, 1913 1. Name different classes of foodstuffs, and give an example of each. 2. Give theory of cooking starches, and tell where and by what digested. 3. (a) What is Predigested milk? (b) Modified milk? (c) Certified milk ? 4. (a) What is the composition of water? (b) Boiling pointy freezing point? (c) How would you render boiled water palatable? (d) How would you boil water for Tea? (e) Should Tea be an Infusion or a Decoction? 5. Describe the process of making (a) Beef Tea, (b) Beef Juice. 6. (a) What should be eliminated from the diet of a Dropsical patient ? (b) Why is the diet of such importance in Tuberculosis? 7. What is the value of (a) Sugar in food? (b) Mineral mat- ters in food? (e) Condiments? 8. How should an egg be cooked for an invalid, and how served? INTRODUCTION xsvii 9. What class of foods are restricted in Diabetes? Give one reason. 10. When is a healthy child considered able to digest starchy foods? Give reason. 11. State some of the advantages and disadvantages of milk in a case of Typhoid Fever. 12. What class of Vegetables are rich in Protein? 13. Give two formulas for Rectal feeding. September, 1913 1. Name different classes of foodstuffs, and give an example of each. 2. Give theory of cooking starches, and tell where and by what digested. 3. (a) What is Predigested milk? ,(b) Modified milk? (c) Certified milk? 4. (a) What is the composition of water? (b) boiling point, freezing point? (c) How would you render boiled water palatable? (d) How would you boil water for Tea? (e) Should Tea be an •Infusion or a Decoction? 5. Describe the process of making (a) Beef Tea, (b) Beef Juice. 6. (a) What should be eliminated from the diet of a Dropsical patient? (b) Why is the diet of such importance in Tuberculosis? 7. What is the value of (a) Sugar in food? (b) Mineral mat- ters in food? (c) Condiments? 8. How should an egg be cooked for an invalid, and how served? 9. What class of foods are restricted in Nephritis? Give one reason. 10. When is a healthy child considered able to digest starchy foods? Give reason. 11. State some of the advantages and disadvantages of milk in a case of Typhoid Fever. 12. What class of Vegetables are rich in Protein? 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, cornmeal 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? xxviii INTRODUCTION 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? 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 three 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 internally? 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. 11. 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 errors 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? INTRODUCTION xxix 15. What changes in diet should be made in advanced years? Why? February, 1911 1. Why should the nurse have a, working knowledge of dietetics? 2. Classify the food principles as (a) organic or inorganic, (6) nitrogenous or non-nitrogenous. 3. Explain why carbohydrates alone are not sufficient for a dietary. 4. Name the digestive ferments and give their functions. 5. Describe in detail the proper care of milk from the time it is drawn till it is used. 6. Compare the advantages and the disadvantages of sterilized milk with those of pasteurized milk. 7. Trace the digestion of a glass of milk. 8. State why it is important for a convalescent typhoid patient to resume solid food gradually. 9. What diet would you give to an anaemic patient, if the matter were left to your discretion? 10. What is the effect of heat on (a) starch, (6) albumen? 11. What is cellulose and what is its value? 12. What is the disadvantage of boiled water and how may this disadvantage be overcome? 13. Give four points to be considered in the preparation of au invalid's tray. 14. Give concisely the ingredients and the method of preparation of (a) beef tea, (6) oatmeal gruel. l.'i. Why is it best to surround the cups with cold water when putting custards in to bake? June, 1911 1. State the uses of food. 2. What processes are necessary to make food of use to the body? 3. What is the object of the digestion of food? 4. What food principles require digestion? 5. Name two vegetables containing a good proportion of proteid. 6. Name two vegetables containing a large proportion of carbo- hydrate. 7. Name two vegetables containing a, large amount of salts. 8. Why are fruits a valuable addition to a general diet? 9. What food principle predominates in nuts? 10. Why are meats restricted or forbidden in cases of nephritis ? 11. Why are carbohydrates restricted in cases of diabetes? 12. Why is a, salt-free diet often ordered in illness when there is edema? XXX INTRODUCTION 13. Why are meats more digestible when broiled or roasted than when fried? 14. Give the method of making chicken broth. 15. Mention two ways of removing fat from a soup. February, 1912 1. In what places and under what names is food stored in the body? 2. Give the mechanical processes of digestion. 3. Of what elements is proteid food composed? 4. In health what are the advantages of drinking large quantities of water? 5. Outline for a nephritic patient the three meals for one day. 6. What is (a) chyme, (6) chyle? 7. What are the uses of condiments? 8. Why is table salt an essential part of our diet? 9. What is a calorie? 10. What articles of food would you avoid giving to a rheumatic patient ? 11. What vegetables and fruits would you give to a, patient with a tendency to constipation? Why? 12. What food principle is lacking in eggs? 13. Explain briefly the process used in raising and baking bread. 14. How would you make and serve toast in order to increase its digestibility? 15. Describe the process of making tea, giving reasons for this process. June, 1912 1. What is a mixed diet? What are its advantages in health? 2. Why is fresh air necessary to nutrition? 3. What may be used as a substitute for sugar in cases where carbohydrate food is limited? 4. Mention four chief sources of fat in the diet. 5. Which is the more easily digested, fat or carbohydrate food? 6. What is distilled water? Why is it unsuitable for use as a beverage? 7. Why is salt used with ice in freezing ice cream? 8. What is buttermilk? What are its uses? 9. Mention two signs that indicate that an egg is fresh. 10. What kinds oit food would you give in cases of diarrhea? 11. What kinds of food would you give in cases of constipation? 12. What is broiling? What are its advantages over frying? 13. How would you peptonize a pint of milk by the cold process? 14. Tell how you would prepare and serve raw beef sandwiches. 15. Describe briefly the necessary steps in making mutton broth. INTRODUCTION xxxi January, 1913 1. Name three juices in the body that aid digestion. 2. Why do water and mineral salts not require digestion? 3. What is digestion ? 4. What is the name of the special substance in any digestive juice, which brings about chemical changes in the food? 5. Where in the body does the oxidation of food take place? 6. What is meant by the caloric value of food ? 7. What special value has proteid food? 8. Name the ferments in the pancreatic juice. 9. Outline three meals for a patient with chronic constipation. 10. Why is it now considered desirable not to restrict the diet in typhoid fever to fluids only? 11. What may be the advantage of giving eggs raw in cases of tuberculosis ? 12. How may hard drinking water generally be rendered soft? 13. Why should potatoes be thoroughly cooked? 14. Tell how you would make and serve oatmeal gruel. 15. Tell how you would cream oysters for one person. June 1913 1. Define (a) chyme, (6) chyle. 2. At what age may a healthy child begin to digest starches? 3. In what organs and by what enzymes are starches digested? 4. Mention three results gained by the cooking of food. 5. Give the freezing and the boiling point of (a) the Fahrenheit thermometer, ( 6 ) the centigrade thermometer. 6. Make a list of five tissue-building foods. 7. What does the term "top milk" mean? 8. When 10% top milk is uaed, what is the relative proportion of fat to proteid? 9. Outline the daily care of an ice box. 10. Contrast the cooking of meat in making broth and in broiling. 11. Describe the care of milk in the home. Give reasons for your answer. 12. How would you make junket? State the source of rennet. 13. Give the general rule for making cream vegetable soups. 14. Tell how you would make cocoa and give your reasons for thus making it. 15. Name two diseases in which carbohydrate food is limited. NORTH CAROLINA 1908 1. In what foods are ptomaine poisoning most likely to be found ? How may this be avoided? xxxii , INTRODUCTION 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 invalid. 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 during 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 fSi of beef tea? 12. Give a list of tissue-building foods. 13. What should be the diet of a case of acute nephritis? (6) 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. INTRODUCTION xxsiii 15. State some of the advantages and disadvantages of milk, as a food for invalids. June, 1912 1. Name the different sources of foods. 2. From what source do we have (a) Proteids, (b) Carbohy- drates, (c) Salts. 3. What elements do the different classes supply to the body — (a) Proteids, (b) Carbohydrates, (c) Salts. 4. What is the relative value of skimmed and unskimmed milk, and why? 5. What important fvmction does water perform in the body? 6. Mention some points to be remembered in serving food to patients. 7. Which is preferable, to serve too little or an overabundance to a patient, and why? 8. If you were doing private nursing and could not get ice, how would you keep eggs and milk fresh? 9. Name several ways of cooking eggs for invalids. 10. Give directions for making whey. November, 1912 1. (a) Define foodstuffs, (b) What are the uses of food? 2. (a) What causes milk to sour? (b) What preventive meas- ures can be used to keep milk from becoming sour? 3. Describe six ways of preparing milk and eggs, either separately or together, with which to vary a liquid diet. 4. What classes of foodstuffs should be excluded from a rheumatic diet, and why? 5. (a) Give the theory of cooking starch, (b) What secretions assist in the digestion of starches? 6. Mention some diseases in which the diet forms an important part in the treatment of disease, or in which errors in diet may have serious consequences. 7. What foods are excluded from a diabetic diet? and give the substitutes. 8. (a) Why is the diet of such importance in the treatment of tuberculosis? (b) Of what foods does the diet chiefly consist? 9. Why is thorough cooking of cereal foods especially important ? 10. (a) What is a Calorie? (b) How many Calories required daily by an adult? xxxiv INTRODUCTION NEW HAMPSHIRE May, 1911 1. Of what value is food to the human body? 2. What is the average composition of cow's milk? Mother's milk? 3. State in detail a method of peptonizing milk. 4. Why are different foods cooked? 5. What should be the diet of a, tubercular patient in the incipi- ent stage? 6. What is the usual form of diet in acute gastritis? 7. What foods should be avoided if there is a tendency to flatu- lency ? 8. What should be the general diet in diseases of the heart? 9. What class of foods is to be avoided in diabetes mellitus? 10. Give in detail a, day's diet for a diabetic patient. October, 1911 1. Compare mother's and cow's milk. 2. What are nitrogenous foods? 3. What foods can be given a patient with diabetes? Give a breakfast, dinner and supper for such a patient. 4. Of what value is beef broth as a food? 5. Give a detailed method of making baked custards for the sick. 6. What should be the diet of an habitually constipated person? 7. Give in detail the diet of a typhoid patient from the beginning to the termination of the disease. 8. How would you make corn-meal gruel? Oyster stew? Chicken broth ? 9. What is the diet in acute nephritis? 10. How would you prepare a steak? A chop? April, 1912 1. Name the chief classes of food. 2. When should water be boiled and why? 3. What value has nitrogenous food? 4. State in detail the preparation of egg-albumin for a typhoid patient. 5. State in detail how you would make chicken broth. C. Give a breakfast, dinner and supper diet for diabetes mellitus. 7. How would you make an egg-nog? tea? coffee? ' 8. How would you prepare and serve a steak? a chop? 9. What is milk? Name four milk products. 10. How would you peptonize milk? INTRODUCTION- xxiv October, 1913 1. How would you cook a steak? A chop? What are th3 ad- vantages of your method of cooking over other methods? 2. How long would you cook a cereal? Why? 3. How would you make a cup of coffee? Of tea? 4. Give a diabetic breakfast, dinner and supper in detail. 5. What is a proper diet to give in acute Bright's disease? 0. Of what value are the meat broths as foods? 7. What is the use of the Pure Food Laws? What is food adulteration? 8. How may foods be classified? 9. State in detail a method of peptonizing milk? 10. Of what value is milk as a food? OKLAHOMA October, 1912 1. Give definition of food. 2. Why is a mixed diet necessary as an ideal diet? 3. Describe the gradual effect of heat on the white of an egg. (Albumin.) 4. How should an egg be boiled and served to an invalid? 5. How would you make and serve toast to increase its digesti- bility? 6. What do you consider an ideal typhoid diet? 7. Why is cow's milk more likely to disagree with an infant dur- ing summer than in cold weather? 8. What is important in the cooking of starchy foods? 9. Give diet for obstetrical patient during first week. 10. Give one good nutritive enema. TEXAS November, 1912 1. Name the different classes into which food may be divided. 2. How would you make beef broth? Beef juice? 3. What class of foods should be excluded from a rheumatic diet and why? 4. Name three foodstuffs rich in albumin. 5. Give a general outline of diet for a typhoid fever patient. One for a diabetic patient. 6. Give a list of fruits to be recommended for laxative effect. 7. Why is a mixed diet necessary? 8. What effect does boiling have upon tea? 9. Why is thorough cooking especially important in cereal foods? 10. Give points to be observed in setting an invalid's tray. xxxvi INTRODUCTION VIRGINIA December, 1911 1. Name the principal chemical elements contained in the human body. 2. Why is a mixed diet necessary? 3. How would you prepare beef juice? How much juice will one pound of beef make? 4. Give examples of liquid and soft diet. 5. What would you give a typhoid patient when he is first al- lowed solid food? 6. What point should always be observed in cooking cereals? Mention a complete food. 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 anaemia? 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? INTRODUCTION xxxvii June, 1913 1. Name the uses of water in the body. 2. What are the special functions of the following food princi- pals? (a) Proteins, (b) Fats, (c) Carbohydrates. 3. What constitutes a perfect food? 4. Give formula for modifying milk for infant feeding, and your reasons for the need of modifying. 5. Give in detail the precautions you would talce to keep certified milk pure. 6. How is milk pasteurized? 7. Name several articles of food in which iron is available. 8. What general rules should be observed in the care and cooking of cereals? 9. Of what value are fruit juices? 10. Give dietetic treatment in acute rheumatism. 11. State briefly what instruction you have had in Dietetics. CONTENTS PAGE iNTKODUcriON xiii The American Hospital Association — Colorado — Illinois — Minnesota — New York State Board Ee- quirements in Dietetics. PAET I PEINCIPLES OP NUTKITIOK AND POOD PEEPAEATION CHAPTER I Food . . ... ... .3 General Object — Definition — Food Accessories (or Food Adjuncts) — Source — Composition of the Body — Composition of Food — Classification of Food — NiTKOGENOus, Protein and Extractives — Non-Niteo- 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. Resume of Digestion — Factors Determining Rate of Digestion. Absobption : — Protein — Fats — Carbohydrates — Mineral Matter — Water. Metabolisk : — Protein — Fats — Carbo- hydrates. Excbetion. 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 Sicas: .72 General Rules — Physicians' Directions — Feeding XXXIX XL CONTENTS CHAPTEB 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 — Rectal Feeding — Use of Alcohol in the Sickroom- — Keeping Ice in the Sick- room — Disinfecting Utensils. V The Tray . . 85 Attractive Arrangement of a, Tray. How to Serve (General Rules). VI Methods op Cooking and Caee of Food ... 88 Digestibility and Nutritive Value of Cooked Food — Success in Cooking — Objective Points in Cooking — Eflfect 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 Measubes 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 BEnfEBAGES 109 Acid Beverages 110 Recipes 110 CONTENTS XLI CHAPTEB Albuminous Beverages . Recipes .... Starchy Beverages . Recipes . Miscellaneous Beverages Tea Recipes Coflfee . ... Recipes . Chocolate . . . . Recipes ... ... Cocoa . Recipes Special Non-Nutritive Beverages Recipes IX Animal Foods Meat . Recipes Poultry and Game Recipes . Fish Recipes Fish Sauces . Recipes Shell Fish . . Oysters Recipes Clams Recipes . Recipes . Milk and Milk Products Recipes ... . .... Sweetbreads ' Recipes Gelatin . ... Recipes .... 204 Beef Preparations 212 Beef Juice 212 Recipes ... 214 PAGE 118 118 124 124 127 127 131 128 131 129 134 129 133 136 136 138 140 149 152 153 159 162 165 165 166 166 169 168 172 175 179 184 193 200 201 203 XLII CONTENTS CHAPTEK PAGE Beef Tea . . . . 213 Recipes . . . . 215 Raw Beef . . . 214 Recipes 217 Meat Broths . . . . .217 Recipes . . 219 Meat Jellies 217 Recipes . . 221 Soups . . 223 Recipes . . . . 223 Soup Accompaniments . . .229 Recipes . . .229 X Vegetable or 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 . . .... 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 XLiii CHAFTEB PAGE Fruits 276 Recipes 279 Nuts 283 Fungi and Algae 284 XI Nutritious Desserts 286 Hot and Cold Desserts 286 Soft Custards 287 Recipes 287 Baked Custards ... 288 Recipes 288 Whips and Souffles 290 Recipes 291 Junket 293 Recipes 293 Cornstarch Pudding or Blanc Mange 295 Recipes 295 Rice Puddings 297 Recipes 297 Tapioca .... 300 Recipes . 300 Bread Puddings 302 Recipes 302 Cracker Puddings 304 Recipes 304 Pudding Sauces 305 Recipes 305 Frozen Desserts 306 Ice Cream 306 Recipes 307 Sherbet 306 Recipes 312 Ices 306 Recipes 313 XII Cake 317 Recipes 318 XLiv CONTENTS PAET III HOSPITAL DIETAEIES — DIET IN" DISEASE — DIET IN SPECIAL CONDITIONS CHAPTEB 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 Vabiotjs 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 op Nutrition . 35S Diet in Diabetes — Diabetic Diet of Bellevue Hospi- tal — Diabetic Diet of Presbyterian Hospital — Dia- CONTENTS XLV CHAPTER PAGE betic 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-Urinaey System 390 Acute Bright's Disease — Chronic Bright's Disease — Nephritic Diet — Acute Nephritis, Uric Acid Gravel — Convulsion in Bright's Disease — Albumi- XIX Diet in Miscellaneous Affections . . 395 Nervous Disorders — Functional Disorders of the liiver ( Biliousness ) — Skin Diseases — Heart Dis- ease — Dietetic Management of Surgical Cases — Diet after laparotomy. Ovariotomy, etc. DIET IN SPECIAL CONDITIONS XX Mothekhood .... 401 Diet in Pregnancy — Vomiting of Pregnancy — (Vomiting of Seasickness) — Diet for the Mother after L.abor — Diet for a Nursing Mother or Wet Nurse. XLVi CONTENTS CHAPTER . PAGE XXI Infant Feeding ... 406 General Considerations — Breast Feeding — The Wet Nurse — Composition of Motlier's Milk — The Hygiene of Natural Feeding — Capacity of Babies' Stomachs — Schedule for Nursing — Weaning — Arti- ficial or Bottle Feeding — Difference Between Human and Govt's Milk — General Principles of Milk Modi- fications — What Dilution to Use — The Quantity to Feed — Laboratory Milk — Home Modification — The Nursing Bottle — Formulae for Infant Feeding — Top Milk Method (L. Emmett Holt, M.D.) Card for Per- centage Feeding of Infants (Maynard Ladd, M.D.) — Formulae 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 op Young Children .... 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 Diet for the Adolescent — Diet foe the Sedentary — Diet for the Aged . . 442 Index to Recipes 447 General Index 465 PART I PEINOIPLES OF NUTRITION AND FOOD PREPARATIONS 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. Poods 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 offices to perform. Composition of Food. Poods 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 "Pood 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. CIASSIFICATION OF FOOD 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. e. According to Function, as tissue-formers, or body-build- ers; energy (or work and heat) producers; and regulators of body processes. Organic Classification according to Chemical Composition ' Nitrogenous — Proteins r Carbohydrates J Non-nitrogenous j [starches (Mineral Matter Water Classification according to Function I Proteins Mineral Matter Water {Carbohydrates Fats Proteins 6 PRACTICAL DIETETICS T. 1 J. J! Tj J Ti f Mineral Matter Regulators of Body Processes \ vrr i 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: Nitrogen, — supplied by protein. Phosphorus, — in milk and cream, eggs (especially the yolk), meat, whole wheat, 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 chlorin. 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 FOB PEBFECT NUTBITION t Water — Supplies building material (forming 60 per cent, of the body), and helps to regulate body processes. CONDITIONS rOR PEKFECT NUTRITION For 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 sufficient 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; (3) Albuminoids or Gelatinoids, 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 r Proteins Simple Albumins, v. g Olobulins, e. g .Alcohol-soluble proteins e. g. White of egg. Casein of milk. Myosin of muscle. Fibrin of blood. Gluten of -wheat. ,Legumiu of legumes. . In grains. fGliadin of wheat. Lzein of maize. TNucleo-protein, e. g. in liver and sweetbread. LHramoglobin 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. For this reason, beef tea, beef extracts, etc., are of value to the sick. CooMng 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 CooJcing 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. 3. 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° F. the egg will be firm, soft, and jelly-like, and is readily digested. 4. When water reaches 313° F. the egg will be tough white jelly and less readily digested. 12 PRACTICAL DIETETICS 5. When egg is heated to 300° P. 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 fish. These will be considered further under their separate headings. NON-NITROGENOTTS FOODS CARBOHYDRATES (SUGAR AND STARCH): PATS 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 eon- 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 monosaccharides^ as typified in grape sugar; the disaccharides, as typified in cane sugar, and polysaccharides, including starch, dextrin, gums, cellulose and glycogen: (Grape Sugar (Dextrose or Glucose) Fruit Sugar (Levulose) (A miiture of dextrose and levulose is called Invert Sugar. Honey is the best example in nature) Carbohydrates Disaccharides CisHazOu r Cane Sugar Beet Sugar \ Maple Sugar Milk Sugar L Malt Sugar - Sucrose (Lactose) (Maltose) r Starch Polysaccharides \ ^f-^-^ CeHioOs I Qmj,g I Cellulose Sugar Defi,nition. Sugars are carbohydrates which are soluble, have a more or less sweet taste and many minor qualities which distinguish them from the starches. The disaccharides 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). DEXTROSE OR GRAPE 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 kinds 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-stufEs, it is a very economical source of energy. LACTOSE Milh 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 case 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 SUGAR Pure cane sugar is chemically the same as beet-sugar. Maple sugar would not be different from common sugar, if it were sufficiently 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 in 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 allowance 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 Cookery. 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 suffice, and would also suffice for dia- betic urine were it not for the fact that a shamming patient could deceive the nurse by placing common sugar in her urine. Starch and Other f olysaccharides 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 state, 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. Gums, 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., 313° 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 313° F. (300° F.-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 near 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. PATS AND OILS Definition. Fats are food-stuffs having the same ultimate chemical composition as carbohydrates; i. e., consisting of 30 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 substa,nces 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 differ 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 oleins 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 31 extent in medicine in the belief that it is of value as a food- drug and reconstituent. It is prepared from the j'olk 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, yihxle 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. Gilman 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. 22 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 Coohing. Fats 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. For 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 suffering 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 oil 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. Patty 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. Pats are not as easily digested as carbohydrates, but weight for weight they furnish two and one-fourth times as much energy. Tests for Fats. Fats 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 water 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. "UTien 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 blood and lymph a fluid medium by which WATER 25 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 DrinTcing 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 toughened by the lime and sodium chloride. Finally, for drinking purposes hard water may be subjected 26 PBACTIOAL DIETETICS to prolonged boiling and straining; by this means the car- bonic acid is driven oil 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 ilavor 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 cases 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 pif»es through which it fiows, it should be allowed to run several minutes before using if it has not been recently run off (as after standing 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 Sr 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 fiavor. 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, Apollinaris and Seltzer (effervescing waters) and Po- land water (uneffervescing). 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 diosid 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 Drinking Water. Luke-warm or tepid water (65° to 92° E.) 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° P.), hot (100° F. and over), cool (65° to 92° P.) or cold (32° 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. Pever 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 29 blood temperature, but the arrest is only temporary. A small quantity of crushed ice is known to relieve nausea. MINERAL MATTEE 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 virhich 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 phosphorus, iron, and sulphur, in the form of organic com- pounds, along with other salts in small quantities. Phos- phorus is found in the nuclei of all cells and is essential for growth. The red corpuscles are rich in iron, and the thyroid gland cells contain considerable 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 sufiicient 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 in 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 richest and most varied supply is com- monly found in the vegetable kingdom. 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 fi.ne 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- meal, peas 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 diseases 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 33 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 i^ 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 affection. 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 cases 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 OR ADJUNCTS CONDIMENTS — BEVERAGES 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 Jforthern 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 justiflcation. 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 OB 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 ofE 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. Grov?ing 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. CHAPTER II NUTRITION DIGESTION — ABSOKPTION — METABOLISM 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 DIGESTIOir OF 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 24 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, free 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 bile, and the intestinal juice. The hydrochloric acid of the stomach is indirectly respon- sible for the flow of the pancreatic juice, 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 3& 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 OF SECRETION ENZYMES ACTING ON PROTEIN PRODUCTS OF ENZYME ACTION Mouth Saliva None None Stomach Gastric Juice Eeunin Pepsin and Hy- drochloric acid Coagulates milk ("Acid Protein, • Proteoses, [Peptones Small Intestine Pancreatic Juice Bile Intestinal Juice Trypsin (in alka- line medium) None Erepsin (acts only on proteo- ses and pep- tones ) ("Alkali Protein, Proteoses, Peptones None Amino Acids 40 PRACTICAL DIETETICS DIGESTION OF FAT Pat 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 OF CARBOHYDRATES 1. Digestion of Starch. There is little doubt that prim- itive man accomplished much .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 pharjmgeal 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 enzjrme 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 : 48 PRACTICAL DIETETICS PART OP ALIMENTAET TRACT OF NAMK SECRETION ENZTMES ACTING ON STARCH PRODUCTS OF ENZYME ACTION Mouth Saliva Ptyalin Maltase fDextrins 1 Maltose Dextrose Stomach Gastric Juice None Small Intestine Pancreatic Juice Intestinal Juice Amylopsin Maltase fDextrins l_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 disaccharides. 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 disaccharides 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 €nzymes, sucrase, 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 PAET OF ALIMENTARY TRACT NAME OF SECRETION ENZYMES ACTING ON SUGARS PRODUCTS OP ENZYME ACTION Mouth Saliva Maltase Dextrose Small Intestines Pancreatic Juice Intestinal Juice Lactase (at times) Lactase Maltase Sucrase ["Dextrose \Galactose JDextrose \Galactose Dextrose rDextrose "[Levulose Mineral Matter and Water require no changes to prepare them for absorption. resume' 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 swallovsring, and of the intermediate and pyloric regions of the stomach in mixing the food vrith 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 Mouth Saliva Alkaline Ptyalin Starch r Soluble J Starch- ) Dextrins L Maltose Maltase Maltose Dextrose Stomach Gastric Juice Acid (0.2%- 0.4% H 01.) Pepsin Proteins f Acid J Protein j Proteoses I Peptones Kennin Protein (especially casein of milk) Coagulated Protein Lipase Emulsified Fats Fatty acids and glycerine Small Pancreatic Alkaline Trypsin Proteins r Alkali Intestines Juice J Protein 1 Proteoses . Peptones Steapsin Fats r Emulsified Fat — -i Fatty acids and glycerine Amylopsin Starch r Soluble J Starch — 1 Dextrins — . Maltose Lactase Lactose Dextrose (in young (Milk and L Galactose animals ) Sugar) Intestinal AlTraliTifi Erepsin Proteins in Amino Juice the form of Proteoses and Acids Su erase Peptones Sucrose Dextrose and Levulose Maltase 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, and 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 intestinal 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- Ippsin 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. FACTORS DETERMINING RATE OP 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 stomacli 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-stuffs 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 surrounded 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 ilavored 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 difBcult 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. Aisorption 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. Fats 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 Matter. 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 ileo-cecal valve. Proteins are absorbed by the villi, chiefly in the form of amino acids and pass through the portal vein to the liver. Fats 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 DIETETICS 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. metabolism: 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 going 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 less 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- trogen, 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). Metaholism, 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 diet. 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 ofE 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 used 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 kidneys, 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 unwise, 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 to 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 difficult, 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 Ca/rbohydrates. 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 content 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. T\Tien there is excessive putrefaction of the fecal matter, some of the soluble material is absorbed and eliminated 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. CHAPTER III FOOD VALTJES UITEOGEN BALANCE — ENERGY VAITJE OF POOD 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 BALANCE OR NITROGEN EQUIIIBRIUM 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 waste 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 putrefaction certain soluble poisonous substances form and are absorbed, requiring elimination by the kidneys. The excess of nitrogen which 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 effort ; 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 patientj 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 inYestigation of the amounts of nitrogen required under 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 35 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. Prom 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 ENERGY VAITTE 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, non-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 h^at. 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 tAtt 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 efficient 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 PRACTICAL 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 Pat yields 9 Calories 1 gram of Carbohydrate . . . yields 4 Calories DETERMINATION OF ENERGY VAITTE OE 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 38, 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 12 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 (2) To get the weight of protein, fat and carbohydrate in grams, we must first convert the total weight of bread into grams, 1 oz. =3 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 13 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 ^ 244 grams. 1 tablespoon brandy = 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 = 60 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 Priedenwald 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 2.65 = 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 percents in whole numbers. To illustrate, take a formula of the following composition: Protein 0.7% Fat 2.7% Carbohydrates 6.0% [Feedings per day 9, amount at each finding 1% oz. Hence Q=13.5 oz. (9X 1%) F=: 2.7 oz. S= 6 oz. P= 0.7 oz. (1) Q. X F 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 BEaTJIREMENTS OE 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 functions are more active than in adult life ; in old age they are somewhat less active. ENERGY REQUIREMENT 61 Por a man of average -weiglit (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. For 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 legs, body weight is approximately 3000 calories. In making estimates for any individual, age, weight, size and shape, season and climate, mechanical efiSciency, 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, 35^0 cal. per kilogram, and the very aged, about 37 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: 63 PRACTICAL DIETETICS ENERGY PEE DAY 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 1600-1800 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 NOEMAI OUTPUT OP 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 vroman weighing 120 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. Eeads 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 : : 2296 : X X= 1788 cal. — total energy requirement for a woman of 120 lbs., under the above conditions. ENEBGY REQUIREMENT 63 The protein requirement is conveniently estimated by pro- viding 10-12 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 tem- 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 TABIE SHOWING THE NUTRITIVE VALUE OF THE FOOD MA- TERIALS USED IN THE RECIPES IN THIS BOOK, CALCU- LATED FOR THE OUANTITIES COMMONLY REQUIRED IN COOKING SMALL PORTIONS FOOD MATERIAL (Uncooked) S I is >< A Almonds, Shelled Apples, Fresh " Dried Apricots, Dried Arrowroot Asparagus B Bacon Bananas Barley, Pearl " Crushed " Flour Bass, (edible portion) Beans, String Beef Broth Beef Juice Beef Marrow Beef Steak, Porterhouse... " " Rump u u a " " Sirloin u a K " " 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(2?i lbs.) 0.6 16 1 314 16 32 Cms. 160 ISO 8S 142 14+ 1247 18 454 100 27 14+ 16 227 100 454 100 907 u 14.1 16 454 3H 100 16 454 3H 100 16 454 3'/$ 100 16 454 3H 100 16 454 Gms. 33.6 0.5 1.4 6.6 22.4 1.6 43 0.8 2.2 1.1 1.3 19.0 18.6 84.3 2.4 1.8 16. S .31 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 10.4 269.4 0.3 0.1 0.2 2.5 2.8 12.6 1.02 9.3 0.6 13.1 420.8 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 ESTIMATES OF FOOD VALUES 65 FOOD MATERIAL (Uncooked) 3 •| 1 !8 il Gms. Gms. Gms. Gms. lOO 454 19.4 87.8 1.2 5.44 14+ 71 7.8 1.5 43.4 454 76.94 1.20 302.88 4.74 31.68 0.05 3 6 14.22 0.15 28.4 340 136 2.6 31.6 12.6 0.3 4.1 1.6 15.0 179.3 71.7 28.4 28.4 386.5 1.5 8.4 114 0.5 .30 4. 13.3 8.5 116.3 14+ 227 0.1 2.2 12.1 193 57 0.5 4.2 113 2.0 0.6 5.2 57 1.4 15 28.4 28 23 4.0 8.0 5.9 6.1 5.0 10.0 0.28 8.1 'i!2 O.S 100 454 21.4 97.5 2.5 11.3 28.4 454 3.65 58.5 13.8 220.9 8.59 137.4 100 100 906 8.6 0.2 2.0 1.0 6!8 2.0 0.2 1.6 14 7+ 3.0 4.1 5.3 100 454 57 454 16.5 74.8 15.7 125.6 0.4 1.8 0.2 1.4 B — (Continued) Blue Fish, (edible portion) Brandy Bran Brazil Nuts, Shelled tl u u u u u Bread, White *" Crumbs (dry) " Boston Brown " Gum Gluten Butter C Carrots Cauliflower Celery Cheese, American " " (fresh grated) " Cottage ** Creamed 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. 1 tbsp. 1 serving lib. 1 serving lib. Ozs. 16 16 Vi 'A 1 12 iH 1 1 13 2.0 4.0 2.0 1 1 3H 16 1 16 3^ 3M 32 H a 3H 16 2 16 Calor- ies 401 42 218 3048 47.6 142.8 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 64 515 66 PRACTICAL DIETETICS FOOD MATERIAL (Uncooked) S 1 1 g II 1 1 C— (Continued) Condensed Milk, Eagle Brand a u a a 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. 1 1 1 1 tbsp. 1 cup Ifig Hlb. lib. Idoz. 1 tbsp. fchopped) Ozs. .388 1 16 3K 32 10 5 5+ 8 8^ 1 S 8 8 2 >i 6 1 8 16 'A Gms. 11 28.35 450 100 906 28.4 10 142 10 156 151 10 14 227 14 227 28.4 142 227 227 159 45 25 13 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 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 i'.ii 5.6 4.2 i'.S 0.1 2.3 0.1 0.7 296.16 13.89 9.26 Gms. 6.07 15.66 250.60 0.4 1.6 53.9 7.1 106.8 9.5 197.4 110.2 7.6 0.7 10.2 0.5 6.8 .89 18 84 160.8 8 7.2 129.8 22.2 168.2 58.88 2.76 1.84 Calor- ies 38.25 98.59 1579.33 12 46 Corn 278 34 504 38 790 588 Crackers, Water 40 Cream. Thin (18%) 29 440 « Thick (40%) 57 864 Cucumbers, Fresh (edible port'n). 5 81 " Dried 728 D Dates 710 57 E Eggs, whole average size (without 60 Eggs White 13 « Yolk 48 P 34 616 Fiffs 95 T 718 Filberts, Shelled 3184 (1 u 150 u a 100 ESTIMATES OF FOOD VALUES 67 FOOD MATERIAL (Uncooked) g % ^ il s 1 & 1 S3 >• Color. Ozs. Gms. Gms. Gms. Gms. ies 1 tbsp. yi+ 16 1.3 0.2 12.5 57 1 cup 8 227 19.0 2.5 174.3 796 1 tbsp. a 8 3.46 .12 3. 48 29 1 cup •S 142 60 2.3 63 512.7 1 tbsp. H 8 1.3 0.2 6.8 34 1 cup 5 142 18.8 3.2 101.2 509 1 tbsp. 16 1,4 0.04 10.2 58 1 cup «'A 241 18.9 0.7 187.8 870 1 tbsp. H 8 0.5 0.07 6.3 28 1 cup 5 142 9.6 1.3 111.5 496 1 tbsp. H 8 0.9 0.08 6.0 28 1 cup s 142 15.9 1.4 106.2 500 1 serving 3K 100 19.3 16.3 224 lib. 16 454 87.5 73.9 1015 1 tbsp. %o 8.5 7.8 81 1 box 1H 34 31.1 125 J^box H 17 15.6 62 1 tbsp. M 8 3.46 .12 3.48 29 1 cup 5 U2 60 2.3 63 512.7 lib. 16 450 191 7.3 200 1629.7 1 slice 1 28.4 8.4 .30 8.5 70.3 lloaf 13 386.5 114 4 116.3 957.2 1 biscuit Ji 7 2.94 .13 3.15 25.5 1 cup 3H 100 45 4.2 32.5 350 1 serving 4 113 2.3 0.3 3.6 27 1 dozen 2 57 0.74 0.9 10.88 55 lib. 16 454 4.5 5.4 65,3 328 1 tbsp. H 14 3.8 15 1 cup 8 227 60.0 240 1 serving 3^ 100 17.2 0.3 72 lib. 16 454 77.9 1.36 324 1 serving 3'4 100 18.6 5.2 121 lib. 16 454 84.3 23.5 549 1 serving m 100 24.8 14.2 227 lib. 16 454 112.6 64.4 1029 lib. 16 454 69.76 305.6 51.68 3234 Jicup iVi 6.54 28.5 4.83 303 (chopped) 1 tbsp. (chopped) H 2.18 9.5 1.61 101 F — (Continued) Flour, Barley " Gum Gluten " " " " Graham " Rice 'v.'';!;;::];: a u « Rye .^"V."'^!"!!""" U a " Wheat (Roller Process) u a UK Fowl, (edible portion) G Gelatin, Granulated " Shredded..*.*.'.'"!!!.. Gum Gluten Flour u u u u a a ' Bread!!!!!!!!!!! " ■ Biscuit Crisp « " Noodles Greens Grapes, Malaga Grape Juice H Haddock, (edible portion) tl u u Halibut, (edible portion) Ham, Fresh, Lean u u u Hickory Nuts. Shelled PRACTICAL DIETETICS FOOD MATERIAL (Uncooked) I H — (Continued) Hominy Honey J JeU-O .-... E Kumyss L Lamb Chops (I u Lard Lemon Juice, (1 lemon) Lettuce Liquid Peptonoids Lobster, (edible portion) M Macaroni Mackerel, Fresh (edible portion) Salted, Malted Milk, Horlick's Milk, Whole " Skimmed Molasses Mutton Chops 1 tbsp. 1 cup 1 tbsp. 1 box 1 serving Iqt. 1 serving lib. 1 tbsp. lib. 3 tbsp. 1 head 1 tbsp. 1 serving lib. 1 cup 1 serving lib. 1 serving lib. 1 tbsp. 1 tbsp. 1 cup 1 quart 1 tbsp. 1 cup 1 quart 1 tbsp. 1 cup 1 serving lib. Ozs. H 3.5 .6 34.4 3J^ 16 0.5 16 IK 16 3H 3M 16 3K 16 H 0.7 8.6 34.4 0.7 8,6 34.4 16 Gms. 14 227 100 16 975 100 454 14 454 42 227 IS 100 454 100 454 100 454 20 244 975 20 244 975 27 317 100 454 Gms. 1.2 18,9 Gms. 0,1 1.4 .133 11,2 1.9 2,2 18.7 84.8 2,3 0.8 18,1 82,08 14.7 18.7 84.8 16,3 73.9 2.3 .066 8.0 32.2 0.7 8,3 33.1 0,6 7,6 16,0 72,5 2,1 28,3 128,3 14 484 1,1 4,96 1,0 7,1 32.16 17,4 78,9 1,2 0.8 9,3 39,0 0,06 0,7 2,9 33,1 150.1 Gms. 11,2 179,2 23.02 186.4 14,4 1.5 Calor- ies SO 805 92.5 4,2 5,7 2,1 0,5 2.24 81.1 9.5 1.0 12.2 48,8 1.0 12,5 49.7 18,7 219,7 395 66 329 1494 127 4083 17 36 28 84 382 392 139 629 222 1007 59,54 14 169 675 7 89 358 77 909 362 1640 ESTIMATES OF FOOD VALUES 69 FOOD MATERIAL (Uncooked) ^ 3 I N Noodles, Gluten O Oatmeal, Granulated Oats, Rolled Olive Oil, Nicelle Olives Onion Orange Orange Juice Oysters P Panopepton Peaches, Fresh Dried Peach Juice Peanuts, Shelled Peanut Butter Peas, Green " Canned Pecans, Shelled Pineapple, Fresh (edible portion) " Canned u u u a Port Wine {10%"'Alcohol) Potatoes, White Potatoes, Sweet Prunes Icup 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 1 tbsp. 1 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 prunes Ozs. 314 14 o.s 4 s 4 3 s 0.6 4 6K 3H Gms. 100 14+ 227 IS 14 113 142 14 227 28.4 170 113 85 14 227 142 16 113 184 227 85 227 680 100 100 142 28.4 Gms. 45 1.8 28.8 0.7 11.8 0.1 1.8 1.2 1.7 10.5 0.8 1.4 36.55 4.8 7.7 6.6 0.9 .4 0.9 2.6 2.2 1.8 2.5 0.5 Gms 4.2 0.9 14.7 0.3 5.2 15 2.8 0.3 0.3 0.3 2.0 0.1 1.8 54.7 7.7 0.5 0.4 0.7 .6 1.6 4.8 0.1 0.7 Calor- Gms. ies 32.5 434 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 22 31 82.6 247 18.4 27.4 88.1 17.6 16 282 135 31 56 77 6 104 14 ' 84 50 247 5 777 100 114 100 98 130.5 348 1044 10 83 123 363 72 yo PRACTICAL DIETETICS FOOD MATERIAL (Uncooked) ^•3 Quail R Raisins Raspberries, Fresh, Black, {edible portion) Raspberry Juice Rhubarb u Rice Rum S Salmon, (edible portion) Saltines Sardines,Canned Shad, (edible portion) " Roe Sherry Spinach Squabs Squash Strawberries, (edible portion) . . . Strawberry Juice Suet Sugar, Granulated " Loaf " Powdered 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 I serving 1 cup 1 cup 1 tbsp. lib. 1 tbsp. 1 cup 1 lump 1 cup 1 tbsp. 1 cup Ozs. 1 16 H 16 K 3H 16 3M 16 3J^ 4 3H i 6 16 1% 0.4 6.5 M 6.S Qms. 100 9 113 142 227 28.4 454 15 240 100 454 100 454 100 454 100 14 Ji 100 100 113 170 227 14 454 IS 210 7.6 184 12 184 Gms. 21.8 0.2 2.6 0.2 2.7 1.1 18.1 22 99.6 23 104.3 18.8 85.1 20.9 2.3 16.3 1.4 1.0 l.S .66 21.28 Gms. 8.0 0.3 3.4 1.4 0.2 3.2 0.04 0.7 Gms. 6.5 77.6 17.8 22.6 1.0 16.3 11.2 179.1 ESTIMATES OF FOOD VALUES 71 FOOD MATERIAL (Uncooked) S — (Continued) Sugar of Milk u u a Sweetbreads T Tomatoes Tapioca, Pearled ** Minute Tapioca . . Trout, (edible portion) Turnip Turkey, (edible portion)., a u u w Walnuts, English Whey Whitefish, (edible portion) 1 teaspooo (aver, size) 1 tbsp 1 serving lib. Ipair (med. size) 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. Ozs. "'.\(A .564 m 16 H+ 6.5 H 3% 16 3V2 16 SK 3H 16 Gms. 1 5 16 100 454 227 15 227 142 14 184 14 100 454 100 454 156 1 184 100 454 0} »i 2 d Afi ^ .n-a g c3- % a, Ci. Ph Calor- Gms. Gms. Gms. ies 100% 4 1 100% 20.5 100% 65.6 16.8 12.1 176 76.2 54.8 798 38.1 27.4 399 0.2 0.03 0.6 4 2.7 0.5 9.0 51 0.5 0.3 3.0 16 0.03 12.3 49 0.4 159.5 640 0.03 12.2 49 17.8 10.3 164 80.6 46.7 743 1.3 0.2 8.1 39 21.1 22.9 290.5 95.7 103.9 1317 25.8 98.8 25.1 093 .17 0.63 0.16 7 1.8 0.5 9.3 50 22.9 6.S ISO 103.8 29.4 681 - 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 approximate. The food values are given with sufficient accuracy to be within the limits of error of computations made on average analysis of food-stuffs. CHAPTEE IV FEEDING THE SICK GENERA! RtJXES 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 tBe performance of his duties, and adding to the com- fort and well-being of the patient. Physician's Directions. The nurse's directions 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, 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 instructiods 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 DIETETICS 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 food. 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 lyhole. If 4here is much hypersesthesia 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 Digestiqn. 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 sta.rved, simply from the want of attention to the means which alone make it possible for them to take food. For 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 1'5 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 arises 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 oifered, 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 bis 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. Sleep 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 teaspoonful 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 TEE SICK 1^ 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. Rectal 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 un- 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 formulas, 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 ; 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. 82 PRACTICAL DIETETICS FOKUULAE POR BECIAI. FEEDINQ I. Peptone-milk, Von Leube 250 e. c. milk =170 Cal. 60 c. u. peptone = 100 Cal. II. Egg-milk, Von Leube 250 c. c. milk =170 Cal. 3 eggs =200 Cal. 3 gms. salt. III. Starch-milk, Von Leube 250 e. c. milk =170 Cal. 70 gms. starch =: 250 Cal. IV. Sugar-milk, Von Leube 250 u. c. 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 *^ ^° 5 ^^ ( ^°"'" Whites of two eggs to six ounces ) Above used Per Rectum every two to four hours. 'Nutrient Enema: Milk 5 ^ ( °^^ ounce ) German Seltzer HjO 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. Btimulating Enema: Black Coffee 3 i^ (four ounces) Whiskey 3 " (two ounces) FEEDING THE SICE 83 Salt Solution: Sodium chloride : 3 i (one drachm) Aquae O i (one pint) Use of Alcohol in the Sich 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 Sich 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- other simple way of keeping ice is to put it in a dish pan, cover with a tin lid, and wrap in flannel 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 ease 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. CHAPTER Y, 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 refined, 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 OE 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. 12 o 9 3 =^\° ' / (\^ fr A\ r ■1- u \ { \ 4 Y u )] H J w y y 1 9 le a 18 y ;:::0 .11 "T lo ? 2 Proper Placing^ 1 Plate. 7 Knife. 2 Cup and saucer. 8 Fork. 3 Bread and butter plate. 9 Spoon. 4 Individual creamei and sugar. 10 Butter spread. 5 Tumbler. 11 Napkin. 6 Individual salt. 12 Flowers. 13 Salad knife. 17 After coffee spoon. 14 Soup spoon. 18 Soup or cereal or berry plate, 15 Oyster fork. etc. 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 served, should be carefully considered in relation THE TRAY 87 to the time of serving, for most palatable 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. Wlien 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 CAKE OF FOOD Cooking is the preparation of food for eating. Digestibility and Nutritive Value of cooked food depends to a considerable extent upon the manner in which it is cooked 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° P.; the starch granules dissolve when subjected to boiling water; cold water separates starch grains. 88 METHODS OF COOKING 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 CooTcing Any Food. These include: (1) A knowledge of the efEects of heat and moisture on the digestibility of the articles to be cooked. (3) The relation of the method to the extraction of soluble portions of the food materials. Principal Coohing Processes: 1. Boiling is cooking in boiling water (212° 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° F. 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° F.). 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 Cooking Process: 1. To retain the juice as in boiling, steaming, broiling, bak- ing, roasting, frying. 3. 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. Wooden spoons are preferable to metal ones for mixing and 90 PRACTICAL DIETETICS stirring, as metal spoons are too hard and may break oS 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. Folding-in is a term applied to the method of intro- ducing beaten white of egg slowly and gently into a soft mass, BO 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 measuring 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 measuring or mixing. It is desirable to work as much as possible in a small space; thus the measuring 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 CABE 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 difiScult 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 off. 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° P. 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 92 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. CAKE OF FOOBi 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 OP FOOD 93 ~ Foods should therefore be 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. Plies 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 DIETETICS many cereal 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 traflSc. 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 OF COOKING AND CABE 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 up 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 eases, 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 National 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 manufacturers, 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 !N"o. 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. 2 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 standard measuring 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 by the tablespoon or teaspoon ar& measured level. 98 MEASURES AND WEIGHTS 99 To measure a spoonful, fill the spoon and level it ofE 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 hutter meMed, measure before melting. When recipe calls for one tablespoon (or so) of melted luiter, measure after melting. TABLE OF MEAStJKES AND WEIGHTS 4 saltspoons =1 teaspoon, tsp. 3 teaspoons =1 tablespoon, tbsp. 4 tablespoons = i cup or J gill. 16 tablespoons (dry ingredients)..... = 1 eup, c. 16 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 finely chopped meat (packed solidly) = 1 pound. 2 cups of granulated sugar =1 pound. 2i cups of powdered sugar =1 pound. 2i cups brown sugar =1 pound. 2§ cups oatmeal = 1 pound. 41 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, 3 12 ounces = 1 pound, lb. APOTHECARIES MEASURES 60 minims (M) ^ 1 fluid drachm, f 3 8 fluid drachms =1 fluid ounce, f 5 16 fluid ounces =1 pint, or pt. 2 pints = 1 quart, qt. 4 quarts = 1 gallon, gal. APPBOXIUATE MEASURES One teaspoonful equals about 1 fluid drachm. One dessertspoonful equals about 2 fluid drachms. One tablespoonful equals about 4 fluid drachms. One wineglassful equals about 2 ounces. One cup (one-half pint) equals about 8 ounces. MEASURES AND WEIGHTS lOf METRIC SYSTEM 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 sufiBce. TABLES Measures of Volume In measuring small quantities the cubic centimeter is the unit. 1 cubic centimeter = 1.0 cc. 10 cubic centimeters = 10.00 cc. 1 cubic millimeter = 0.1 cc. 1-100 cubic millimeter I __ q qqj 1-1000 cubic centimeter etc., etc. :} = MEASURES OF WEIGHT In measures of weight the gram is the unit. 1 gram 1-0 gm. 1 decigram 0.1 gm. 1 centigram 0.01 gm. 1 milligram 0.001 gm. TABLE OF EQUIVALENTS Appended is a table of all the denominations of weights and 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 0.06 Cubic centi- metre 4 Cc. 30 Cc. 118 Cc. (i Liter) 236 Cc. (i Liter) 473 Cc. {i Liter) 1 Liter (1000 Cc.) 2 Liters. 4 Liters. 0.061 Cc. 1 fl. drachm 1 fl. oz 3.696 Cc. 29.574 Cc. 4-fl. ozs. or J pint .... 8 fl. ozs. or J pint 16 fl. ozs. or 1 pint. . . . 2 pints 4 pints or i gallon . . . 1 gallon 118.295 Cc. 236.590 Cc. 473.197 Cc. .946 Liter. 1.892 Liters. 3.785 Liters. 1 Cubic centimeter. 4 Cc 16 minims. 1 fluid drachm. I fl. oz. (4 fl. drs.) 61 fl. drs. 1 fl. oz. 2 fl. ozs. 3J fl. ozs. 4 fl. ozs. (i pint) 44 fl. ozs. 8 fl. ozs. (i pint) 8i 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. 15 Cc 4.057 fl. drs. 25 Cc 6.762 fl. drs. 30 Cc 1.014 fl. ozs. 60 Cc 2.029 fl. ozs. 100 Cc 3.381 fl. ozs. 120 Cc 4.057 fl. ozs. 125 Cc 4.227 fl. ozs. 235 Cc 7.945 fl. ozs. 250 Cc 8.453 fl. ozs. 300 Cc 10.144 fl. ozs. 470 Cc 15.892 fl. ozs. 500 Cc 1.056 pints. 2.007 pints. 2.113 pints. 1.056 gals. 950 Cc 1000 Cc. (1 Liter).... SOLIDS APPROXIMATE EQUIVALENT EXACT EQUIVALENT 1-500 grain 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. 1-120 gr 0.000540 Gm. 1-100 gr 0.000648 Gm. 1-64 gr 0.001013 Gm. MEASURES AND WEIGHTS 103 SOLIDS APPROXIMATE EQUIVALENT EXACT EQUIVALENT 1-50 gr 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 dedgrammes. ) 1 Gm. 2 Gm. 4 Gm. 3.5 Gm. 14.2 Gm. 28 Gm. 56 Gm. 113 Gm. 225 Gm. 450 Gm. 900 Gm. 0.001296 Gm. 1-40 sr 0.001620 Gm. 1-32 2T 0.002025 Gm. 1-25 2T 0.002592 Gm. 1-10 gr 1-3 gr 0.006479 Gm. 0.021599 Gm. 1 s^ 5 errs 0.064798 Gm. ■ 0.324 Gm. 15 ers 0.972 Gm. 30 grs 60 grs 1.944 Gm. 3.888 Gm. 1 oz 3.544 Gm. J oz 14.175 Gm. 28.350 Gm. 56.699 Gm. i lb U3.398 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 decigramme.) 1-65 grain. 1-6 gr. H grs. 15J grs. 60 grs. (1 dr. Troy) i oz. i oz. 1 oz. (437 J grs.) 2 ozs. 3i ozs. 0.015 grain. 0.154 gr. 1.543 grs. 15.4324 grs. 4 Gm 61.729 gra. 10 Gm. (1 deka- gramme) 25 Gm 154.324 grs. 385.81 grs. 28 Gm 432.107 grs. 56 Gm 1 oz. 426.7 grs. 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 gra. 104 PRACTICAL DIETETICS SOLIDS APPEOXIMATE EQUIVALENT EXACT EQUIVALENT 7 ozs. 410 grs. 8 ozs. 353 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 TABLE FOR PREPARING PERCENTAGE SOIXTTIONS 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 7680 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, iy weight, required to prepare one pint of a solution : 1. To Prepare One Pint of a Solution EEQUIRED TO CONTAIN OF A CERTAIN SUBSTANCE PEE CENT. TAKE OF THE SUBSTANCE BELOW STATED AMOUNT IN GRAINS WITH ENOUGH WATER TO MAKE 1 PINT. 1 per cent. ■nnr 1 TIT 1 "JIT 1 1 in 10,000 Grains 1 1 1 in in in 1 in 1 in 5,000 4,000 3,000 2,500 2,000 1,500 1,000 0.73 1.46 1.83 2.44 2.92 3.65 4.87 7.30 (ii (U) (13) (2J) (3) (3i) (43) (7i) ^ Arranged by the Public Charities and the Department of Bellevue and Allied Hospitals. MEASURES AND WEIGHTS 105 REQUIBED TO CONTAIN OF A CEETAIN SUBSTANCE i i i i 1 li 2 2i 3 4 5 10 20 25 50 PER CENT. per cent Grains TAKE OF THE SUBSTANCE BELOW STATED AMOUNT IN GRAINS WITH ENOUGH WATER TO MAKE 1 PINT. 14.60 18.25 24.33 36.50 73.00 97.33 146.00 182.50 219.22 292.00 365.00 730.00 1460.00 1825.00 3650.00 (14J) (181) (24i) (36J) (73) (97) (146) (180) (220) (290) (365) (730) (1460) (1825) (3650) 2. To Prepare One Fluid Ounce of a Solution REQUIRED TO CONTAIN OF A SUBSTANCE TAKE OF THE SUBSTANCE 0.1 per cent 0.5 1 2 " 3 4 5 6 7 8 9 10 APPBOX. 0.46 grain (J gr.) 2.28 ' (21 4.56 • (4i 9.13 ' (9 And 13.69 ' (13i enough 18.26 ' ' (181 water 22.82 ' (23 to 27.38 ' ' (27i make 31.95 ' (32 1 fluid ounce 36.51 ' • (36i 41.08 • ' (41 45.64 ' ' (45i 106 PRACTICAL DIETETICS THEBHOUETRY 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 chiefly 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 32° above 0. The boiling point of the latter is 100°, while that of the former is 212°. Hence, to change Fahrenheit to Centigrade, we subtract 32° from 212° in order that the freezing points correspond, which leaves 180° F.^ 100° C. A degree Centigrade is therefore 6/9 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 32° to the result. Examples: Change 212° Fahrenheit to Centigrade. 212°— 32°=i 180° X 5-9 = 100° C. Change 100° Centrigrade to Fahrenheit. 100° X 9-5 = 180° + 32° = 212° P. PART II BEVERAGES AKIMAL FOODS VEGETABLE POODS |]SrUTEITIOUS DESSERTS CHAPTEE VIII BEVERAGES ACID — AlBUMINOTJS — STARCHY — MISCELLANEOUS BEVER- AGES, INCLTTSING TEA, COFFEE, CHOCOLATE, AND COCOA, AND SPECIAL NON-NUTRITIVE BEVERAGES Beverages serve primarily to relieve thirst. The universal beverage is vrater.^ 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 182-140° P. 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 carried any distance, be sure that it is covered. iSse Water, page 23. 109 110 BEVERAGES ACID BEVERAGES 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 Drinks. 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. SUGAR STRTTP, 420 CALORIES % cup of sugar. % eup of boiling water. Mix the sugar and water and stir until the sugar is dis- ^ See Mineral Matter, p. 31. ACID BEVERAGES 111 solved. Boil slowly, without stirring, for fifteen minutes; cool slightly and bottle. LEUONADE, 137 CALOKIES 1 lemon. 2 tablespoons sugar. % cup 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. Kote. — The quantity of sugar used depends upon the acidity of fruit. FRUIT lEMONADE Add fresh fruit of all kinds to strong lemonade, using boil- ing water for the beverage, cool, and chill on ice. BRAN LEKONADE, 20 CALORIES % cup wheat bran. Juice 1 lemon. 2 cups cold water. Allow the bran and water to stand overnight. Strain, and add the juice of the lemon. SODA OR APOLLINARIS 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 thoroughly, and drink while effervescing. Note. — Put glass on plate when soda is added. Water and soda 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 ■yrater. Cool, add ice-cold water, strain and serve. Note. — Canned pineapple may be used or Hawaiian pine- apple juice. IRISH HOSS lEKONASE, 25 CALORIES i ^ 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 20 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. EGG LEMONADE See " Albuminous Beverages " for recipe. Page 121. ORANGEADE, 197 CALORIES 1 sour orange. 2 tablespoons sugar. % cup boiling water. % slice 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. FRUITADE, 45 CALORIES % cup grated pineapple 1 cup boiling water. Juice % lemon. Sugar. Juice % 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. * Without sugar. ACIB BEVERAGES 113 PINEAPPIE JUICE, ABOUT 50 CALORIES % 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 CAIOKIES 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 Phoa- 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. Ifote. — Horsford's Acid Phosphate can be substituted for lemon juice in any of the acid drinks. ACID PHOSPHATE WHEY, 56 CALORIES 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 whey 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. CREAU OF TARTAR DRINK 1 or ly^ 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 refrigerant drink and diuretic. MALTED MILK AND CURRANT JELLY, 85 CALORIES 1 tablespoon Horlick's Malted 1 tablespoon currant jelly. Milk. % cup cold water. 14 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 Horlick'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 barberry jelly. Very refreshing in fevers. Be sure ice is perfectly pure. ACID BEVERAGES US GRAPE WATEB, 135 CALORIES i 4 tablespoons grape jelly. % cup cold water. % 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 i %: cup currant juice or y, 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, sVeeten to taste, and add a little lemon juice, if desired. Serve cold. APPLE, WATER, 25 CALORIES i 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 i 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 let stand one-half hour. Sweeten to taste, strain and serve cold. ^ Without lemon juice or sugar. ' Without sugar. Estimated from average composition of preserves. 116 BEVERAGES TAUABIin) HALTED UILK, 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. GBAFE JTTICE (% 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. GBAFE LITHIA, 75 CALOBIES 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. GIIAFE NECTAB, 2750 CALOBIES (About 2 Quarts.) Boil together one pound of sugar and one-half pint of water until it spins a thread ; 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 PUNCH Pew 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 until cold. Then strain and serve in tall glasses, with shaved ice and slices of lemon. ACID BEVERAGES 117. TRUIT 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-FIIIJTTI PTJITCH, 2300 CAIORIES (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 Fruit 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 the 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- cholia. 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 used. 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. ENERGY VALTJE OP AN EGG 1 medium egg (without shell) ^60 Calories. 1 white of egg (average) '. = 13 " 1 yolk of egg (average) =48 " EGG BBOTH, 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 tljsp. trandy. 277 Calories if brandy is omitted. ALBUMINOUS BEVERAGES 119 Note. — Dried and 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! 1 egg. % eup 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. JUNKET EGG-NOG, 289 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 quieldy 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 BE£F EGO-NOG, 200 CAIORIES 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-HOG, 175 CALORIES i 1 egg. % scant cup milk or cream. 1% teaspoon sugar. % scant cup strong coflfee. Chill ingredients, and blend as for Egg-nog ISTo. II. FINEAFFIE EGG-NOG Prepare as per Egg-nog No. I or II ; omit the brandy and use pineapple juice to taste. EGG AND RTTM, 315 CALOKIES 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. l^ cup cold water. Nutmeg. Sugar. * Calculated with milk. ' Without sugar. ALBUMINOUS BEVERAGES 121 Beat the egg. Heat the water and wine together but not boiling; pour onto the egg, stirring constantly; flavor with sugar and nutmeg. EGG lEUONASE, 192 CALORIES 1 egg. 2 tablespoons lemon juice. 2 tablespoons sugar. 1 cup cold water. Beat the egg thoroughly, 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 MILK AND EGG, 120 CALORIES 1 tablespoon Horlick's Malted 20 drops acid phosphate. Milk. 1 tablespoon crushed ice. 1 tablespoon crushed fruit. % cup ice water. 1 egg. Mix the malted milk powder, crushed fruit and egg and beat five 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. STOEES MIXTTTKE Eggs and Brandy = 196 Calories. " 2 egg yolks, 50 c. c. of brandy, 120 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, 180 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. 133 BEVERAGES GRAFE JUICE AND EGO, 270 CALOEIES 1 egg. 1 tablespoon sugar. i/i cup rich milk. 14 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. MULLED WINE, 850-280 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 stiff froth, add sugar and pour on the mulled wine, and beat well. Serve at once. ALBUMINIZED MILK, 98 CALORIES % 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. Two teaspoons of Sanatogen added = 30 calories. Note. — The blending may be done in a lemonade shaker. ALBUMINIZED WATER, 13 CALORIES 1 % cup ice-cold water Lemon juice. (boiled 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 be- fore serving. Two teaspoons of Sanatogen added ^30 calories. 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 ^ Without lemon juice or sugar. 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. ALBTTIHIKIZEI) CLAU WATER, 18 CAIOBIES 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. ALBUMINIZED 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 and set on ice to cool. Serve cold. ALBTTMINIZED SHERRY, 22 CALORIES i White 1 egg. Sugar. % tablespoon sherry. Beat the white stiff, add slowly, while beating, the wine and siigar. Serve cold. Note. — 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. 124 BEVERAGES STARCHY BEVERAGES Starchy drinks consist of cereals or cereal products, cooked 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 CooTcing. As the chief ingredient is starch, long cooking is necessary, in water at a high temperature (312° P.), 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 WATEB, 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. Note. — 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. ^See Mineral Matter, p. 31. STARCHY BEVERAGES 125 BARLEY WATER (INFANT FEEDING), 19 CALORIES 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, 14 teaspoon salt. RICE WATER, 100 CALORIES 1 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 boiling water. Boil three hours; replenish the water as it 1 Without milk. 136 BEVERAGES boils 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. OATMEAl WATER NO. II, 220 CALORIES i >4 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. CRUST 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 ofE the liquid through a fine wire sieve ; season with salt ^ Estimated on one-half the oatmeal. 2 Without sugar. MISCELLANEOUS BEVERAGES 127 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 PANADA, 162 CALORIES 11/2 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-NU- 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 caflfein, tannic acid, and a volatile oil. Its flavor is due to the volatile oil; its stimulating prop- erties to the cafEein. 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 coffee 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 caffeol) 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 which reason it is used by many nurses when on night duty. It should never be given to children. Coffee or tea taken with 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, fat 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 Pat Carbo- Mineral Water Calories hydrates Matter per ]b. 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. ETJSSIAN 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 PERCOIATEE Breakfast Coffee. After-Dinner Coffee. 2 tablespoons coffee. Increase quantity of coffee 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. When 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 fine flavor 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 eup coffee. 6 cups boiling water. % 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 will keep hot but not boil. Serve in hot coffee cups with cream and sugar, or hot milk may be used in place of cream. !N"ote. — A favorite blend of coffee is three parts Java and one part Mocha. BOILED COFFEE (Individual Rule.) 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 eup and pour the boiling water slowly over the coffee. MISCELLANEOUS BEVERAGES 133 FILTERED COFFEE NO. 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. MALTED HIIK COFFEE, 59 CALORIES i (Individual Rule.) 1 tablespoon Horlick's Malted % cup boiling water. Milk. Sugar. I 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. Note. — 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. ^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. BKEAEFAST COCOA, 197 CALOBIES (Individual Rule.) 2 teaspoons Walter Baker's % eup boiling water, cocoa. % cup scalded milk. 1 teaspoon, sugar. Pollow 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 MILX 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 CALOKIES (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 saiicepan over hot water. Stir 1 Without sugar. MISCELLANEOUS BEVERAGES 135 constantly until the mixture is smooth and glossy. Add the hot milk and beat the mixture with 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. l^ ounce chocolate. % tablespoon sugar. Following directions for blending and cooking in preced- ing recipe. CHOCOLATE, VIENNA 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 ease use one teaspoon vanilla and three generous tablespoons sugar. CHOCOLATE HILE SHAKE, 295 CALORIES (Individual Rule.) 2 tablespoons chopped ice. % cup milk. 2 tablespoons chocolate syrup. Y^ 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 SYRUP — 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 PLAXSEED TEA 1 tablespoon whole flaxseed. Lemon juice to taste. 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 cassia. 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. IIME 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. BEAN TEA 14 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. SLIPPERY ELM 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. When 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. CHAPTEE IX ANIMAL FOODS The important foods derived from the animal kingdom are — Meat — Poultry and Game — Msh — 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-stuifs, 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 Eats 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 creatinin. Carbohydrates. The carbohydrates are represented mainly 138 ANIMAL FOODS 139 by lactose in milk, and glycogen in shellfish. As a rule, carbo- hydrates are negligible in animal foods. Water. "Water is present in all animal foods. Some ex- amples, showing the varying proportions in different kinds, are 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 ash constituents than any other animal foods. Calcium, iron and phosphorus especially, are here found in most available forms. Meats are not particularly useful in this respect. They are deficient in calcium, and while they contain considerable iron, it is not in as useful a form as that in eggs. Most of the ash constituents found in the body are, however, repre- sented in flesh foods. Digestibility. As a class, animal foods are easy of diges- tion. They contain little indigestible residue, and the nu- trients are very perfectly absorbed. Prepared for the table, they are more concentrated than most vegetable foods. Hence animal foods are frequently chosen for invalids and con- valescents, regardless of their high protein content. Disadvantage of a Purely Animal Diet. The chief dis- advantages of a purely animal diet are that it does not aiiord sufficient bulk to maintain the proper functioning of the alimentary tract, owing to the lack of indigestible residue; and that it loads the body with an excess of nitrogenous ma- terial, which is not only unnecessary for repair, but may cause harm if not speedily eliminated. Furthermore, pro- tein raises the metabolism so that more food is actually re- quired than if carbohydrates and fats are used as fuel. For further discussion of the relative merits of animal and veg- etable diets, see page 233. 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 veater. 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. Connective tissue which binds together the muscle fibers, this consisting chiefly of a protein called collagen, which yields gelatin on boiling. 3. Fat interspersed between the flbers. 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 coimective tissue is soft, and the tissues are easily masticated; but in older animals it becomes very firm, is hard to chew MEAT 141 and often escapes digestion unless softened or changed to gelatin by cooking. The nitrogenous extractives have no nutritive value, and in fact, represent products either of waste (katabolism) or of insufScient oxidation. Unless promptly excreted, they may cause an excess of uric acid or other disorders. However, they bestow upon cooked meat its characteristic flavor and odor; in the stomach, act as stimulants to the secretion of gastric juice; and exert on the nervous system a stimulating influence similar to that of tea and coifee. Diyesiihility of Meat. Meat is easily digested, the degree of ease depending upon the following conditions: (1) The age of the animal when killed, with the exception of veal, the flesh of the young animal is more easily digested, but .less nutritious than that of the older one; (2) the time the animal is kept before cooking; (3) the sex; (4) the care bestowed on the animal during life; (5) the quantity of fat. Lean meat is more easily digested than fat meat. Absorption of Meat. Meat is very readily absorbed and leaves little residue in the intestines ; only 3 per cent, of meat taken is lost in the process of digestion. Uncooked Meat. Ordinary raw meat is not quite as easily digested as cooked meat. Owing to color and flavor, it is not appetizing and could not be taken continuously. However, when chopped fine or scraped free from connective tissue, so as to be easily attacked by the digestive juices, it is more readily digested than cooked meat. Effect of Cooking Meat. Proper cooking makes meat more digestible, as it softens the connective tissues, thus causing a separation of the muscular fibers, and enabling the digestive juices to act more advantageously. The color and flavor are improved. There is a loss of weight by evaporation of water, and loss of mineral matter and some extractives. The loss of water concentrates the nutrients, and thus renders cooked meat proportionally more nutritious than raw meat. 142 ANIMAL FOODS Objective Points and Methods in CooTcing: 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. Note 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 liquid portion flows out readily; but if cooked too long the albumin inside coagulates and the meat loses its moisture, shrinks, and becomes tough. Effect of Cold and Hot Water on Meat. Cold water draws out the soluble albumin, the extractives and some of the salts ; thus in soups, broths and stews where all the nutriment pos- sible is desired in the liquid, the meat is first put into cold water and gradually brought to a higher temperature. Hot water or dry heat coagulates albumin, and since if subjected to too high a temperature this becomes tough and indigestible, we must note carefully the proper temperature of cooking. Often it is necessary to sacrifice a small amount of albumin by exposing the meat to a high temperature for a short time to form a coating on the meat, in order to re- tain the rest of the juices more effectively, after which the connective tissue can be softened by gentle simmering for several hours. The Quality of Meat depends upon the age, sex, environ- ment, care, feeding and time of hanging after slaughtering. It also depends greatly on the cuts used. The tougher and less expensive cuts, if properly cooked, are as nutritious and as easily digested as the expensive cuts ; however, tough meats take long, slow cooking to make them palatable, and the fuel used must be taken into consideration in the expense. Tough meats are muscles which the animal uses the most, as the legs (especially the lower part), neck, etc. ; they are more highly flavored on account of the freer circulation of blood through these portions. Cuts from the neck and shin are used for soups and broths. The tenderer and more expensive cuts are from the muscles which the animal uses the least, as the upper portion of the hind quarter (rump, sirloin) and fore ribs. The circulation of blood through these portions is less and they are not as juicy and well flavored, nor any more nutritious than tougher portions. These tenderer cuts are used for steaks and roasts. The remaining muscular portions of the animal (flank, shoulder 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 difiicult 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 it 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 Fig. 5 Fig. 5. — Diagrams of cuts of beef: 1, Neck; 2, chuck; 3, ribs; 4, shoul- 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, Office of Experiment Stations, United States Department of Agriculture.) Send for Bulletin for cuts of Veal and Pork. ^ This section is quoted from Atwater and Bryant, Bulletin No. 28, Office of Experiment Stations, United States Department of Agriculture, Washing- ton. D. 0. MEAT 147 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 different 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 portion of the loin, which is then sold as "rump steak." The portion of the round on the inside of the leg is regarded as more tender than that on the outside, and is frequently preferred to the latter. As the leg lies upon the butcher's table, this inside of the round is usually on the 148 ANIMAL FOODS upper or top side, and is therefore called " top round." Occa- sionally the plate is called the " rattle." 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 Iamb 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 " cliuck " in Fig. 7, to make a cut designated as " rib," and a pcrtion of the " flank " and " shoulder " to make a cut desigi-'ated as "brisket." The term "chops" is ordinarily used to designate portions of either the loin, ribs, chuck or shoulder, which are either cut or " ch'^pped " by the butcher into pieces suitable for frying or boiliLg. The chuck and ribs are sometimes called the " rack." MEAT 149 ENERGY VAITTE 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 BKOII 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 to 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. N"ote. — 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 CALORIES Vi cup butter. 1 tablespoon chopped parsley. % teaspoon salt. 1 tablespoon lemon juice. % saltspoon pepper. Eub the butter to a cream; add salt, pepper, parsley and lemon juice. Spread on hot beefsteak. PAN-BROILED BEEF CAKES 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. Do not add salt before cook- ing, as it toughens the meat. SCBAFES B££F See " Beef Preparations " for recipe. Page 317. MUTTON CHOPS BROILED i Cut away the tough outside skin, trim off a part of the fat. Broil same as steak — that 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. LAMB CHOPS BROILED 1 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. TRENCH 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, lieat the saute pau 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) BROIIED 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. Note. — 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 very hot. Put in strips of very thin sliced bacon. As fat is drawn out, pour it off into cup ; cook bacon until crisp and brown. Drain on brown paper. 1 Chops average 300 Cal. per 100 gms. 152 ANIMAL FOODS BROILED HAM 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 MEATS 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 rOR 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 boiling water, stirring constantly. Cook five minutes, season with salt and pepper, and strain. POULTRY 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 comparatively 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 expensive 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 he made tender without having all its flavor 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. Ducks and geese, having tougher fibers, require a longer time for thorough cooking. GENERAL ETIIE FOR CLEANING POTILTRY 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 may 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 DRESSING FOR STUFFING, 1100 CALORIES 1^4 cup stale bread crumbs. Powdered sage, marjoram, and 1/3 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 POULTRY After stuffing and sewing 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 POULTRY 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- utes. 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 from 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 ofl' 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 finely-chopped giblets. 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 stuff 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 aUAIL 100 grams = 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 SaUABS 100 grams = 390 Calories. Prepare, cook and serve the same as quail. BROILED SMALL 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 IN PAPER See chapter on Meats and follow directions for " Chops Broiled in Paper." Page 151. BROILED CHICKEN 100 grams = 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 ^ Ediljle portion. POULTRY AND GAME 157 minutes, turning often. The flesh 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. CREAMED CHICKEN, 210 CAIORIES i - (Individual Rule.) Va cup cold cooked chicken. % tablespoon butter. Speck celery salt. % tablespoon flour. Salt. V4 <^up 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 CHICKEN, 100 CALORIES 2 (Individual Rule.) 1 teaspoon gelatin. Vi 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 % ouBce of fowl. ' 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 flour. 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 QTJAIE 100 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 GAME, 540 CALORIES Crumbs % cup coarse dried bread crumbs. % small onion. % tablespoon butter. 1 tablespoon butter. Sauce 1 cup milk. Salt. % 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. nsH 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 : r Halibut Haddock Flounder Turbot White Fish Smelt Cod 1. Scaly or Vertebrate. White or lean, e. g. 2. Shell-flsh Dark or oily, e. g. Mollusks, e. g. Crustaceans, e. g. Salmon Mackerel Blue Fish Shad Herring Eel rOysters "l^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 flsh 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 rule, 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. FISR 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 flavor 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 he Observed 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 effect 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. ENEEGY VAItJE OF FISH See Table, under names of fish, as Halibut, Salmon, etc. See Table, page G4, for energy value of other ingredients. 162 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 off 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 fiesh side first and then turn. The time of cooking will vary with the thickness of fish. Fish 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 butter, salt and pepper. Garnish with parsley and slices of lemon. Or serve with Butter Cream and a border of potato balls. Note " Pish Sauces " for Butter Cream. BAKED 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 Sauces " for Egg Sauce. FISH 163 HALIBTTT A lA CKEOLE, 413 CALORIES % pound halibut. 1 clove. % cup tomatoes. % teaspoon sugar. % 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 FISH (Individual Rule.) % cup cooked fish, remove skin ^4 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 cases 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. SCALLOPED nSH 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 fisli 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. CREAMED CODFISH (FOR THE DIABETIC), 314 CALORIES % cup flaked codfish. % teaspoon Gum Gluten flour. 1 cup milk or cream. Yolk 1 egg. y„ 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 minutes, 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, lemon juice and parsley. FISH (FOR THE DIABETIC) Pish should be rubbed with salt and pepper and dipped in Gum Gluten Plour, or rolled in egg and Gum Gluten Cracker crumbs. Saute (or fry) in oil or butter. FISH SAUCES 165 riSH SAUCES BUTTER CREAM , Cream a little butter; season with salt, cayenne, lemon juice (speck salt and pepper, one-half teaspoon lemon juice). Add iinely 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.) % tablespoon butter. Va cup 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. Kote. — ■ Extra milk may be added if a thinner sauce is desired, using one-half cup milk. CREAM SATICE (FOR THE DIABETIC), 138 CALORIES % cup milk. Salt. 1 teaspoon Gum Gluten flour. Cayenne. 1 teaspoon butter. Melt the butter, add the flour and pour on gradually the scalded milk ; cook thoroughly and season. EGG SATICE, 434 CALORIES 2% tablespoons butter. Speck pepper. 1% tablespoons flour. % cup hot water. 14 teaspoon salt. 2 eggs. 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 EGG SAUCE HO. II To Cream or "RTiite Sauce add one hard-cooked egg chopped fine and a little lemon Juice if desired; or add to MTiite Sauce, yolk slightly beaten and a few drops of lemon juice. , TOMATO SATJCE, 80 CALORIES % tablespoon butter. Few grains salt. % tablespoon flour. Few grains pepper. l^ eup 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 toinato while heating. CTJCTTMBER RELISH, 15 CALORIES Grate one-half cucumber and add a small piece of red pep- per chopped fine; season with salt, pepper and vinegar and. serve \^ith fish. HOLLANSAISE, 484 CALORIES 1 egg yolk. Vs teaspoon salt. 4 tablespoons butter. White pepper. % tablespoon vinegar. 3 tablespoons boiling water. 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. SHELI-FISH OYSTERS AND CLAKS 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- SEELL-FISE 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 unfit for food. Principles to he Carefully Observed in Serving and Cook- ing Oysters for the Sich. (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 '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 OYSTERS 2 oysters ==14 Calories. 100 grams oysters =50 Calories. 1 cup (solid) oysters =3 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 PAN EOAST 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. BROILED OYSTERS, 320 CALORIES (Individual Rule.) 4 oysters. 4 teaspoons butter. Vi 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. CREAMED OYSTERS, 284 CALORIES i (Individual Rule.) 8 oysters. % cup rich milk or thin cream. 1 tablespoon butter. Salt. 1^4 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 NO. II, 340 CALORIES 2 (Individual Rule.) % cup thin cream or rich milk. 1 teaspoon butter. 1 tablespoon flour. 8 oysters. 14 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. SCALIOPED OYSTERS, 365 CAIOKIES (Individual Rule.) % cup oysters. Salt. % cup cracker crumbs. Pepper. Va cup stale bread crumbs. % 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. Never 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, 25a CAIORIES (Individual Rule.) % cup oysters. 1 tablespoon butter. 14 cup water. % tablespoon flour. 14 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 oif liquor and add to soup. Season, add oysters and serve immediately. OYSTER SOUP (FOB, 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. 14 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. 314 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. CLAM BROTH (Individual Rule.) 1 dozen clams. 2 tablespoons cold water. Wash 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. K'ote. — • Clam broth served in the several ways (as a variety) is invaluable in case of weak stomach, indigestion and general debility. CLAM WATER NO. II, 17 CALORIES (Individual Rule.) Vi 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. % teaspoon salt. % cup scalded milk. Speck pepper. 1 tablespoon butter. Soft part of 1 dozen clams. % tablespoon flour. Melt butter, add flour, add gradually the scalded milk and clam broth, and cook thoroughly. Season, add clams and serve hot. CIAM SOTTP, 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 off the tough parts; save the soft parts for the soup and keep warm. Scald the milk. Melt the butter, add the flour and pour on gradually the hot milk. Cook thoroughly; add soft parts of clams and juice, season with salt and pepper, and serve immediately and hot. CLAM BOTTILLON, 45 CALORIES (Two Servings.) % cup cold water. Salt. V2 cup dam broth. Pepper. % cup scalding milk. Celery sauce. 14 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. EOOS 175 CLAH BOUILLON BISftTTE, 355 CALOKIES (Two Servings.) 14 tablespoon butter. 14 tablespoon flour. 1 tablespoon chopped onion. 1 cup boiling water. % tablespoon chopped carrot. Yolk 1 egg. 1 cup clam broth. Yi 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. ALBUMINIZED CLAM WATER See " Albuminized Beverages " for recipe. Page 123. CLAM BEOTH NO. II See " Meat Broth and Jellies " for recipe. Page 320. CLAM BROTH ON TOAST See " Toast " for recipe. Page 258. CLAM FRAPPE See " Ices " for recipe. Page 313. CLAM SHERBET See " Sherbets " for recipe. Page 312. EGGS 1 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 32 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 Tiieir Uses as Food." Farm- er's Bulletin No. 128, U. S. Dept. of Agriculture, Wasliington, D. C. 176 ANIMAL FOODS Fuel val;^e Refuse Water Protein Fat Ash per pound calories Whole egg as purchased. . .12.2% 65.5% H.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 Yolk 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 almost 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 ammonia, 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. Eaw 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, anaemic, or in tubercu- 1 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 ■\vith 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 by 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 Cooking. The principal con- stituent of the egg is albumin, which should be cooked in such a manner as to require the least possible expenditure of force in digestion. Those who 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. Effect 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 just 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 eggs 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. (2) 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 even 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 ANHIAL FOODS will lower the temperature of the boiling water. Keep tem- perature about 160 degree Fahrenheit, or a little above. SOFT 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. HARD COOKED EGGS 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. STEAMED 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. BAKED 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 3/^ tablespoon of cream to each egg 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 tablespoonful of m'elted 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. EOGS 181 60ISEN-R0I) EGGS 1 hard-cooked egg = 60 Calories. 2 slices toast = 146 Calories. Sauce :^ 170 Calories. 2 teaspoons butter. Speck white pepper. 14 tablespoon flour. Salt. y^ 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 ilour and gradually the scalded milk; cook well and season with salt and pepper. EGG NESTS, 142 CALORIES 1 egg. 1 round of toast with toast % 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. FOAMY OMELET, 144 CALORIES 1 egg. Vz 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. 183 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- ters either whole or chopped, or creamed chicken, stewed or sliced tomatoes, asparagus tips, peas or jelly may be used. BAKED MEAT 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 OMELET, 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. Fol- 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 water. 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 IN MILE, 470 CALORIES 1 egg. Salt. IVs 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 sprinkle with cheese. Serve an toast. Cheese may be omitted. CODDLES OR SCBAUBLED 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. 14 teaspoon salt. 3 drops vinegar. Speck paprika. 1 teaspoon 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. Note. — 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 NO. 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. Rub 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. Fill the whites with the mixture and serve on lettuce, or in a bed of parsley. EGG DESSERTS See " Nutritious Desserts " for recipe. Page 386. ALBXTKIITOUS BEVERAGES See " Albuminous Beverages " 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 " Tlie Use of Milk as Food," Farmer's Bulletin No. 363, U. S. Dept. of Agriculture, Washington, D. C. MILK AND MILK 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 lactalbu:piin. 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 sufBcient 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 13 cents per quart, and should enter freely into the dietary. It need not be nsed 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 18? 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 MilTc. To insure a milk free from im- purities, the method of certification and pasteurization have been 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 vehenever 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° F., for a period of 30 to 45 minutes, and then rapidly cooled to 45° P. 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 (313° F.) 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° P. 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 lactic 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 Milk. 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. Buttermilk. 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. Metschniclcoff Artificially Soured MilJc. The announce-* ment some years ago by MetschnickofE 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 MetschnickofE 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 may 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 alpohol. 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 13 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 MILK 1 cup of whole milk = 169 Calories. 1 eup skimmed milk = 89 Calories. 1 cup cream ( 18% ) = 440 Calories. 1 cup cream (40%) := 864 Calories. PASTEURIZATION 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. Bemove to back of stove and keep milk at same temperature 30 to 45 minutes; then cool 194 ANIMAL FOODS quickly to 45 degrees or lower. To cool rapidly put bottlea 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. STERILIZATION The utensils and methods to sterilize milk are the same as for pasteurizing, except that the water is heated to the boil- ing point (212° 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. BAKED MILE 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. MALTED MILE, 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. PEPTONISED MILK, 338 CAIORIES Warm Process Put one-half cup (gill) of cold water and the powder con- tained in one of the Peptonising Tubes (Pairchild) 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 milJc until it becomes bitter. PAKTIAIIT PEPTONISED MILK, 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 milh " if properly prepared will not become hitter. PEPTONISED KILK, 338 CAIOSIES 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 (Fairchild) ; add a pint of 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 milk prepared by this recipe is especially ap- preciated hy patients who disliJce the taste of warmed or boiled milk, and ordinarily it is readily digested and assimi- lated. PEPTONISED MIIK 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 (Fairchild) ; 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. SPECIALLY PEPTONISED MILK, 338 CALOKIES Por Making Milk Jelly, Milk Punch, Milk Lemonade, and for Use with Fruit 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. EFEERVESCENT PEPTONISED MILK Into a glass put some finely cracked ice and fill it half- full of vichy, Apollinaris or siphon water, add immediately MILK AND MILK PRODUCTS 197 peptonised milk prepared by any of the prescribed metliods and drink while effervescing. Brandy or other spirits may be added if desired. THICKENED MILK See Flour Gruel. Page 239. RICE MILK, 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. RUM AND MILK, 186 CALORIES % cup milk. 1% 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. Va wineglass of sherry. Blend as for " Rum 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. Va 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 6l^ ounces whey = 50 Calories. 1 cup 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. 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. IIQTTID 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 Beverages " for recipe. Page 113. LEMON WHEY See " Acid Beverages" for recipe. Page 113. WINE WHEY See " Acid Beverages " 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. KTTMYSS, 328 CALORIES J cake Fleischmann's yeast. 1 tablespoon water. 1% 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-box). 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. MATZOON OR ZOOLAK (GERMAN HOSPITAL, NEW YORK 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, 169 CALORIES 1 cup 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 HOMEMADE BUTTERMILK 1 cup (whole milk buttermilk) =169 Calories. Pasteurize fresh, sweet milk, which may be new, or partly 300 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 30 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 miclein 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 VALUE 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 cup. 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. BROILED 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. CREAMED SWEETBREADS NO. I, 288 CALORIES (Individual Rule.) % tablespoon butter. l^ cup milk. % tablespoon flour. % 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. 202 ANIMAL POODS 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. CREAMED SWEETBREADS NO. II, 968 CALORIES (Three Servings.) 1 cup thin cream or rich milk. % 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. Kote. — May use equal proportions of cold cooked chicken and sweetbreads, reheat and serve in the cream sauce. FRICASSEED 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. 14 cup cream. % 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. ^ 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 No. 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 boil 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. Pood and Drug Products, 1909. Being Part II of the 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 35 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, acid 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 JELLY NO. I, 165 CALORIES (Individual Rule.) 1 teaspoon granulated gelatin. 2 tablespoons wine. 1 tablespoon cold water. 1 tablespoon orange juice. Vi cup boiling water. 1 teaspoon lemon juice. 2 tablespoons sugar. GELATIN 205 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 into 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.) % box shredded gelatin or 2 cups boiling water. 2 tablespoons granulated gelatin. 1 cup wine. % cup cold water. Speck salt. 1% 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 14 box gelatin. 2 tablespoons sugar. 4 tablespoons cold water. 1 tablespoon sherry wine. 8 tablespoons boiling water. 1 tablespoon Liquid Peptonoids. Soak gelatin in the 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. Y2 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. OEANGE JELLY NO. II, 152 CALORIES (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. ORAN&E BASKET^ "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. Fill 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 JELLY, 142 CALORIES (Individual Rule.) 1 teaspoon granulated gelatin. 2 tablespoons lemon juice. 1 tablespoon cold water. 2 tablespoons sugar. y^ 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 JELLY, 588 CALORIES (Individual Rule.) 1 tablespoon granulated gelatin. V4 cup sugar. Vi 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 served 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 JELLY, 130 CALORIES (Individual Rule.) 1 teaspoon granulated 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 Rule.) 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. PEPTONOIDS 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. CREAM 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. PEPTONISEI) MILK JELLY, 517 CALOEIES i (Three Servings.) 1 pint " specially peptonised Einds 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. PANOPEPTON JELLY, 342 CAIOBIES (Three Servings.) 1 ounce fresh celery (cut 2 dashes pepper. in small pieces ) . 6 tablespoons Panopepton. % small box best gelatin. 2 cups cold water. 14 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 309 PANOPEPTON JELLY WITH ORANGE, 379 CALORIES (Three Servings.) 14 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.) 14 box shredded gelatin or 1 cup sugar. 1 tablespoon granulated gelatin. 14 cup lemon juice. 14 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 stiffly-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 SFAmSH CREAM, 912 CALORIES (Three Servings.) 14 box shredded gelatin or Yolks 3 eggs. 1 tablespoon granulated gelatin. 6 tablespoons sugar. 14 cup cold water. y^ teaspoon salt. % eup 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 ISTo. 1, or with Whipped Cream. SPANISH CREAM, 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. % 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. 14 teaspoon vanilla. % cup milk. Yi 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 211 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 riTIFF, 957 CALORIES (Six Servings.) % box shredded gelatin or 1 cup Welch's grape juice. 1 tablespoon granulated gelatin. Juice 1 lemon. Yi 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 "V\Tiipped Cream or Soft Custard. ORANGE CHARLOTTE, 350 CALORIES (Individual Kule.) 2 teaspoons gelatin. 3 tablespoons orange juice. 1 tablespoon cold water. 1 tablespoon lemon juice. % cup boiling water. Whites 2 eggs. Yz 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. 313 ANIMAL FOODS STBAWBESRY MOUSSE, 2284 CALORIES (Six Servings.) 14 box shredded gelatin or 1 pint thick cream. 1 tablespoon granulated gelatin. % cup powdered sugar. 14 cup cold water. 1 cup strawberry juice. % 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 MADE-IN-A-MINTJTE 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 1 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 — BEEF TEA — RAW BEEF BEEF JUICE Composition. The juice of meat contains considerable pro- tein, in addition to salts and extractives. General Principles in CooTcing. From raw meat we can- not obtain as much juice as is easily taken from the same amount of meat when previously heated. ^ Calculated witliout 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 eflBcient 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 POODS 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 2 per cent. Nutritive Value. Beef tea is valuable in the sick room not as a food, but as a ilavoring; 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 ilavoring 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. Eaw 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 JTJIGE 100 grains (3% oz.) ^25 Calories. Select a piece of meat from the rump or top of the round. Remove 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 (FOR INFANTS), 20 CALORIES This food is very useful in forms of diarrhoea 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 (31/2 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 Fahrenheit (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. LIQUID PEPTONOIDS, 28 CALORIES 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 1/^ 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. Eemove fat with soft paper or bread. Eeheat 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. Very grateful to a fever patient. BEEF TEA WITH HYDEOCHIORIC ACID 100 grams (3% oz.) =25 Calories.i Select one-half pound of good beef ; remove everything that is 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. ICED PANOPEPTON, 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. PANOPEPTON — 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. BROTE AND MEAT JELLIES 217 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. SCRAPED 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. HAW 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. BROTH 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 following 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 difEers 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. (Fote " Gelatin," p. 303.) 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 VAIUE 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 16.5 Calories. Beef juice 100 grams yield 25 Calories. Clam bouillon 100 grams yield 2 Calories. Consomme 100 grams yield 12 Calories. BROTH 219 Food that may be added for extra 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. Remove 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. Note. — For weaker broth, use one quart of water to one pound of meat. BEEF BROTH 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 BROTH 3% 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 oflE 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 BEOTH Prepared same as Chicken Broth (use cut from loin or knuckle of veal). CLAM BROTH 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. % 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 331 EGG 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. EGG BROTH NO. 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 CALF'S FOOT JEIIT 100 grams = 65 Calories. 1 calf's foot. Eind of 14 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, wMle 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 the 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 233 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 chicken. 8 peppercorna. 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 ia double boiler. SOUP 223 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 blending: (a) Prepare vegetables, cook and strain. (6) 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 212 degrees Pahrenheit. CREAM OF ASPARAGUS SOUP, 313 CALORIES (Individual Eule.) 14 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 ofE the tips and put them into the serving dish; press the re- mainder through a colander. (&) Scald the milk. Melt the butter, add the flour and 334 ANIMAL FOODS pour on gradually the scalding milk. Cook thoroughly, stir- ring often. Blend (a) and (6) ; reheat, season to taste, strain over tips and serve at once with crisped wafer crackers. Note. — For individual quantity use one-half recipe. ASPARAGUS SOUP (FOR THE DIABETIC), 30 CAIORIES One-half pint of veal stock or water, boiled vnth five or six stalks of asparagus. Eeserve tips; mash and strain. Melt together one-half teaspoonful of butter with one-half teaspoon- ful of Gum Gluten Flour. Add stock and asparagus tips, and serve at once. CREAM or CORN SOUP, 493 CALORIES (Two Servings.) % cup corn. 1 cup milk. % cup cold water. 1 tablespoon flour. 34 slice onion. 1 tablespoon butter. Salt. Yolk 1 egg. Pepper. (a) Chop corn, add water and simmer twenty minutes; rub through a sieve. (&) Scald inilk with onion; remove onion. Melt butter, add flour and gradually pour on milk. Blend (a) and (&) ; 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. CREAM OF CELERY SOUP, 320 CALORIES (Two Servings.) 4 stalks celery. 1 tablespoon butter. % 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 tender and soft. Eenew the water if it boils away. Mash the celery in the water in which it was cooked. SOUP 225 (5) 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. CEEAII OF CELEKY SOUP (FOB THE SIABEIIC), 226 CALOBIES (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 SOUP, 215 CAIORIES ^ (Individual Rule.) 14 can peas. 1/3 cup milk. 14 teaspoon sugar. Vs tablespoon butter. 1/3 cup cold water. % tablespoon flour. Salt and pepper. (a) Drain peas from their liquor, rinse thoroughly, add sugar and cold water and simmer twenty minutes. Rub 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 OF ONION SOTJP, 297 CAIORIES (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 and cook well. Season with salt and pepper and strain. 236 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. CREAH OF POTATO SOTTP, 220 CALORIES (Individual Rule.) % cup milk. Vz tablespoon flour. 14 slice onion. ^ teaspoon salt. 14 cup mashed potatoes. Pepper. % tablespoon butter. (a) Scald milk with onion in it, remove onion and add milk slowly to potatoes. (&) 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. CREAM OF RICE SOUP, 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 SOUP (WITH BROTH), 110 CALORIES (Individual Rule.) % cup strained tomatoes. 1 cup water or stock. % tablespoon butter. 14 teaspoon salt. % slice onion. Speck pepper. 1 tablespoon flour. SOUP 327 (a) Cook and strain tomatoes, obtaining one-half cup juice. (&) Melt butter, add the onion and brown slightly; add the flour ; pour on gradually the boiling water or stock. Blend (a) and (b) ; 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. CEEAH OF TOMATO SOUP (FOR THE DIABETIC), 224 CALORIES (Two Servings.) % cup tomatoes. V2 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 BISaXTE SOUP, 324 CALORIES (Individual Eule.) '^ cup tomatoes. 1 tablespoon butter. Ys 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. (b) 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 croutons or crackers. DRIES FRTJIT SOUP, 209 CALORIES 1 Yi cup dried apricots. 1 cup cold water. 14 cup prunes. Sugar to taste. 1 Without sugar. 328 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 BOXriLION — HOT, 30 CAIOEIES 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 SOTTP (WITH BROTH), 619 CALORIES (Two Servings.) % cup lean chicken meat. 1 cup rich milk. 1 cup strong chicken broth. 14 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. CONSOMME 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. Keturn to sauce- pan, add a few thin slices of onion and one-half pound of lean beef chopped fine and clear. 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 Note. — To increase the mitrient 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. OTSTEB, SOTJP See chapter " Oysters " for recipe. Pages 171-173. OYSTER STEW See " Oysters " for recipe. Page 172. CLAM SOUP See chapter " Clams " for recipe. Page 174. CLAM BOUILLON See chapter " Clams " for recipe. Page 174. CLAM BOUILLON BISaUE 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 Saltine = 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. NOODIES FOR SOUP (FOR THE DIABETIC), 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. CHAPTEE 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 Lean 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 16.1 231 232 VEGETABLE OR PLANT FOODS Protein} (1) Gluten of wheat and some of the other cereals. (2) 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 unpolished; and white iiour than entire wheat flour. Presh 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 ferments acting readily upon the food-stu£Es 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. 8 Pats of vegetables, see p. 20. ^ Mineral matter, see p. 31. ^ See p. 17. CEREALS 233 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 bone) ; 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 GRUELS — BREAKFAST FOODS — STARCHY JELLIES — 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. 234 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 13 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 Oats 11.0 11.8 5.0 69.7 9.5 3.0 Rice 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 335 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. Per 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 that the digestive juices can act. In general, the more crude fiber a cereal contains, the longer it should be cooked. Reference to the table (p. 234) shows that oats requires more cooking than rice; whole or partially crushed grains than finely ground ones. There is danger in undercooked cereals, not only of loss of valuable nutriment through failure 336 VEGETABLE OR PLANT FOODS of digestion, but in irritation of the alimentary tract. This should be especially remembered in preparing partially cooked breakfast foods. \ATien 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. Eice 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. 134:-344.) 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 (313° F.). 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. For the normal healthy person cereal foods are very wholesome. In general, about 90 per cent, or more of CEREALS 237 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 OB PLANT FOODS GRUELS ARROWROOT GRTJEI, 205 CALORIES i (Individual Eule.) 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 CALORIES (Individual Rule.) 1 tablespoon barley flour. 1 eup 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. BARLEY GRUEL OR JELLY, 142 CALORIES i (Individual Rule.) 1 tablespoon barley flour. % cup milk (if desired). 2 tablespoons cold water. Salt. 1 eup 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. RICE OR OAT GRTTEL Eice or oat gruel may be made in same way as Barley Gruel No. I or II, using the prepared flour for the purpose. BARLEY GRUEL (WITH BROTH), 308 CALORIES (Two Servings.) 2 cups beef broth. 2 tablespoons cold water. 2 tablespoons barley flour. 1 saltspoon salt. ^ Calculated witli milk. GRUELS 239 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. CEACKEB OSTJEL, 243 CALOKIES (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. FLOUR GRUEL OR THICKENED MILK, 212 CALORIES (Individual Rule.) % cup scalded milk. Speck salt. l^ 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.) % tablespoon farina. % cup scalded milk. 14 cup cold water. Salt. 14 cup boiling water. 240 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. GLrTEH GBTTEI OR PORRIDGE (FDR THE DIABETIC), 185 CAL- ORIES 1 (Individual Rule.) % tablespoon Gum Gluten Mour. 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 MEAI GRUEL, 48 CALORIES 2 1 tablespoon Indian meal. 2 tablespoons cold water. % tablespoon flour. 2 cups boiling water. % 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. OATMEAL GRUEL NO. I, 70 CALORIES 2 14 cup coarse oatmeal. 1% cup boiling water. % 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. Kote. — Sugar, and a little port wine may be added if al- lowed and desired. ^ Calculated with milk. ^ Without milk or cream. GRUELS 341 OATMEAL GRUEL, SO. II, 70 CALORIES i % teaspoon salt. \% 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. OATMEAL GRTJEL NO. Ill, 140 CALORIES i % 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. Fill 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. EGG AND SHERRY GRTTEL, 388 CALORIES (Individual Kule.) 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. CATJDLE, 404 CALORIES 2 % 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. ^ Without sugar or liquor. 242 VEGETABLE OR PLANT FOODS FLOUR BALI OR BOILED OR BROWNED FLOUR GRUEL (FOR TEETHING 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 waterj and serve. This gruel is excellent for children afflicted 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 CORNUEAL UUSH, 182 CALORIES i (Individual Kule.) 14 cup cornmeal. % cup cold milk or water. V^ tablespoon flour. 14 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 243 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. HOMINY MUSH, 200 CALORIES (Individual Rule.) Vi cup fine hominy. I1/3 cups boiling water. y^ 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 of 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. OATMEAL MUSH FOB, 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 RICE See," Rice Puddings " for recipe. Page 397. 2U VEGETABLE OB PLANT FOODS STEAUED KICK See " Eice Puddings " for recipe. Page 298. STARCHY JELUES BARLEY JEILY, 270 CAIORIES (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 hours 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 Flour, see Barley Gruel, p. 338. RICE JEILY, 181 CAIORIES (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- Ijalf hours. Strain through a fine sieve. Pour into molds, chill and serve with fruit juice or cream and sugar. TAPIOCA JEIIY, 200 CAIORIES (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 JEIIIES See " Cornstarch Pudding " for recipe. Page 395. MACARONI 245 1LA.CAE0NI BOILED ITACABONI, 98 CALOBIESi (Individual Rule.) % 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 SAUCE, 152 CAIOKIES (Individual Rule.) 14 cup milk. % tablespoon flour. Yz tablespoon butter. l^ 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 SAUCE, 93 CALORIES (Individual Rule.) % 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 KACABONI 1 tablespoon, grated fresb cheese = 62 Calories. Pill a buttered baking-dish with alternate layers of maca- roni. White Sauce and cheese; then cover with buttered 1 Without milk or cream. 346 VEGETABLE OB PLANT FOODS cracker crumbs and bake until crumbs are a golden brown. Tomato Sauce may be substituted for White Sauce if desired. BTJTTERES CKACEER CRUUBS, 201 CALORIES 1 tablespoon butter. ^ cup cracker crumba. Melt butter and add cracker crumbs that have been rolled fine. 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. NOODLES (FOR THE DIABETIC), 596 CALORIES (Individual Rule.) I 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- five minutes after it comes to boil, or boil until it is tender. Season with pepper and butter. Serve with White Sauce. CREAM OR WHITE SAUCE (POR 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. Flavor with onion, lemon juice or parsley if desired. Pour over vegetables very hot. NOODLES ATT 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 247 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-stuil, 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 sufficient 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 2 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 ' From Fanner's BuUetin No. 389, U. S. Dept. of Agriculture, WasMng- ton, D. C. For further information, read ' ' Bread and Bread-Making,'^' Fanner's Bulletin No. 389. 348 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. Few 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. For if the stomach is hampered with quantities of unchanged starch it cannot 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 Fanner's Bulletin No. 389, U. S. Dept. o£ Agriculture, Washing- ton, D. 0. 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." Note. — Using the factor G.35 usually employed by the U. S. Government chemists. Standard Gluten Flour must there- fore show at least thirty-five (35) per cent, protein. Bread-Mahing. 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. 250 VEGETABLE OR 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 FLOUR 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- BBEAD 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 stiff 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. For 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 BREAD 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 OR 6RAHAS 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. N"ote. — Omit sweetening if desired. 252 VEGETABLE OR PLANT FOODS GITJTEN BREAD (FOR 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. BRAIT BREAD Follow rule for Gluten Bread, using one part of bran to four parts of Gluten Flour 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 sour milk. 1 cup rye flour. 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. GLUTEN BISCUIT (FOR THE DIABETIC), 950 CALORIES i 1 cup Gum Gluten Self-raising. 1 saltspoon salt. 1 tablespoon butter. Milk or water. iWithont milk. BREAD 253 Mix and sift dry ingredients, rub in the butter, add milk or water to make a soft dough. EoU and cut with biscuit cutter. Makes two large biscuits. GITJTEN DROP BISCUIT (FOR THE DIABETIC), 562 CALORIES i 1 cup Gum Gluten Flour. % teaspoon baking powder. 1 teaspoon butter. Milk or water. % 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. % cup (scant) milk or water. 14 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. V2 teaspoon salt. 1 cup milk, or part water. 1 egg. 'Without milk. 254 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. V4 cup butter. 1 cup flour. 3 tablespoons molasses. 1 teaspoon soda. I14 cups sour milk. Mix dry ingredients, rub in the butter with the tips of the fingers, add molasses and sour milk, put into hot mufRn 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. % teaspoon salt. % cup cornmeal. 1 egg. Vs cup sugar. 1 cup milk. 4 teaspoons Eumford 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. Speck salt. 1 cup milk. 1 cup flour. TOAST 255 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 BALLS 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. g56 VEGETABLE OR PLANT FOODS 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. 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 330. GITTTEN 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 261. WATER TOAST Toast the bread. Dip quickly in boiling salted water (al- lowing one-half 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 cup 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. CBEAK TOAST NO. I, 261 CALORIES (Individual Rule.) % 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: Eemove 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. % tablespoon flour. Va cup milk. 1/2 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, oji 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. 258 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 % 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. CLAM BROTH AND TOAST Follow directions as for Milk or Cream Toast, adding sufiB- 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. AVrap 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 VALUE 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. * Calculated -without bread. SANDWICHES 359 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. CHEESK SANDWICHES Chop stufEed 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. FRTJIT 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 274. 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. NTIT SANDWICHES Prepare same as lettuce sandwiches, adding chopped nuts to the mayonnaise. 260 VEGETABLE OB PLANT FOODS PEPTONOIDS 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. KAW BEEF SANDWICHES See chapter " Beef Preparations " for recipe. Page 317. 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. CRACKEES — WAFERS BRAN CRACKERS, 1513 CALORIES i 1% 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. GLUTEN CRACKERS (FOR THE DIABETIC), 2555 CALORIES 1 pound Gum Gluten Flour. Sweetina. l^ pound butter. Cold water. Salt. J Without milk. CRACKERS — WAFERS 361 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. GITTTEN WAFERS (FOR THE DIABETIC) 14 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 stifE 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. GITJTEN BISCUIT 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. GLUTEN CHEESE WAFERS (FOR THE DIABETIC), 882 CALORIES 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 SAUCES 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. Eoots 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 VEGETABLE 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, ^'egetables 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 Vegetalles. 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-stufEs, 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 363 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 Cooking. 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. Roots and Tubers. Boots 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 account 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 OR 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 4.00° F. 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 water 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. Radishes 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 VAITJE OP THE POTATO 1 medium potato (3% 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. BICED 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. MASHED 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 : 266 VEGETABLE OR PLANT FOODS 1 pint potatoes. % 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 Prom 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. STTRPRISE BAIIS 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 ofl; 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 HALF SHELL 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. Pill 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 AU GRATIN 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. CREAMED POTATOES, 180 CALORIES 1 cup cold sliced or cubed po- 14 teaspoon salt. tatoes. 14 teaspoon finely chopped pars- l^ 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. Note. — Make mashed potatoes from frames left after cut- ting out the balls. PARSLEY BUTTER, 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 jiiice if desired. ASPARAGUS 1/^ bunch asparagus ^60 Calories. i 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 N"o. 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. CATTIIFLOWER 1 serving (4 ozs.) =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 YEGETABLES 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 over 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 ofE 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 of bread crumbs and bake until crumbs are a golden brown. PEAS (GREEN OR CANNED) 1 serving (4 ozs.) =114 Calories. Green Peas. Eemove peas from pods, cover with cold water and let stand one-half hour. Skim off 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 OR 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 N"o. 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 TOMATOES 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. BAKED 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 371 place in a buttered tin; sprinkle with buttered cracker crumbs, bake twenty to thirty minutes in a hot oven. SCALLOPED TOMATOES (FOB, THE DIABETIC), 165 CALORIES (Individual Rule.) 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 CREAM OR WHITE SAUCE NO. I, 152 CALORIES i Use to pour over any vegetable. (Individual Rule.) % cup milk or thin cream. ^A 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. CREAM SATJCE NO. II, 134 CALORIES (Individual Rule.) 1/2 cup milk or thin cream. 1 teaspoon butter. 1/2 tablespoon flour. Vs teaspoon salt. 1 Calculated with milk. 273 VEGETABLE OB 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 oqe-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 373 forms an acceptable luncheon for the convalescent. It may also be served with dinner. FRENCH DRESSING, 270 CALORIES (Individual Eule, % of Recipe.) 1 tablespoon vinegar. % teaspoon salt. 2 tablespoons Nicelle olive oil. % saltspoon pepper. Mix all ingredients thoroughly and pour over salad just before serving. BOILED DRESSING, 483 CALORIES (Individual Eule, % of Recipe.) 1 teaspoon salt. 1 egg. Yg teaspoon mustard. % cup milk. Speck cayenne. 2 tablespoons butter. 2 tablespoons sugar. y^ 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. MAYONNAISE DRESSING, 2S70 CALORIES (Individual Rule, % of Recipe.) 1 teaspoon mustard. Yolks 2 eggs. 2 teaspoons powdered sugar. 1% cups Nicelle 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 stiS con- sistency. It should be a thick dressing and not added to food until just before serving. Note. — Have all ingredients and utensils thoroughly chilled and place mixing bowl in a pan of crushed ice while blending. 274 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. CBEAM 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. (a) 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 boiler, 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 FBTJIT 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. MARGUEBITE 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. UIXED 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. SWEETBBEAD 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. TOSIATO 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 LILY 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 WAEERS 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 BISCTTIT 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. FRTJITSi 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. C. FRUITS 277 centage of moisture falls to 30 per cent, or less, and the proportion of nutrients is correspondingly 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 psotein is so low as to be practically negligible. Carbohydrates are the chief nutrient present. In ripe fruits these are almost wholly in the form of sugars and other soluble carbohydrates, commonly called pectin bodies. In unripe fruits starch is 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 phosphoric acid, 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 ; stewed fruits are more easily digested than raw fruits. Personal idiosyncracy has also much to do with digestibility in case of this class of food materials. Oranges, lemons, grapes and peaches are very generally digested with ease. Oranges are much used in invalid dietaries, their juice being very effective in allay- ing thirst. Orange Juice is also commonly administered to infants, especially if fed artiflcially, 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, sweet cherry, grape and pear. The apple exerts a most excellent iniliience 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 povi^erful 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. Figs 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 friiits are chiefly valuable for their refreshing, appetizing qualities, and for their mineral 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 279 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 avoid germs. Digestive disturbances are more often caused by these germs than by the fruit itself. There is 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 every ten minutes. A little nutmeg may be added to the sugar, and a few drops of lemon juice to each apple. Care must be taken that apples do not lose their shape and break. STEWED APPLE SAUCE, 90 CALORIES 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 CTIBAN STYLE Pare and core sound, tart apples. 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 with jelly or the jellied juice. APRICOT AND PRUNE SATJCE, 178 CALORIES i y^ cup prunes. 1 cup cold water. 14 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. BAKES BANANA 1 medium banana = 64 Calories. Eaw, this fruit is often indigestible, but baked it acts as a stimulant 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 SATTCE OR JELLY 1 cup cranberries. % cup water. Ys 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. BAKES LEUON OB 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 stomach, 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 N'ote. — 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 BHTTBABB, 234 CALOBIES i 1 oup rhubarb (4 oz.). y^ to l^ eup 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. STEWED FIGS, 936 CALOBIES Yz pound figs. 1 eup cold water. 14 cup white sugar. Juice 14 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. Xote. — Cut figs in small pieces ; cook very slowly so as not to add more water. BATE BON BONS 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. Poll in powdered or granulated sugar and serve. * Calculated with % cup sugar ; with % cup sugar = 444 calories. NUTS 383 NUTSi Nuts 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 niits 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% Fats 40-50% Carbohydrates 6-10% The only 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. ISTuts are more often eaten raw than cooked. But the peanut is not considered palatable when 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. ISTut butters offer 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," Fanner's Bulletin No. 332, U. S. Dept. of Agriculture, Washington, D. C. 384 VEGETABLE OB PLANT POODS not 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 ALG^ 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. Algffi 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 sucenlent 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. CHAPTEE XI NUTRITIOUS DESSERTS HOT AND COLD DESSERTS — FROZEN DESSERTS SOFT CUSTARDS, BAKED CUSTARDS, WHIPS AND SOTTFFIES, JUNKET, CORNSTARCH PUDDINGS OR BIANC 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. 386 SOFT CUSTARDS 387 SOFT CTJSTARDS SOFT CUSTARD SO. I, 192 CALORIES (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 CUSTARD NO. II, 410 CALORIES (Two Servings.) 1 cup milk. % saltspoon salt. 2 eggs. Vi 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. CUSTARD 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. MERINGUE, 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 lemon juice to taste. Beat very little after adding the sugar. • 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 JSTo. II, pour over fruit and put meringue on top. BANANA CUSTARD Peel hananas and slice very thin with silver knife; put into serving dish and flavor with lemon juice. Chill Soft Custard No. II, pour over fruit and put meringue on top. ALMOND PUDDING Line a glass dish with slices of stale cake and put in some salted 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 milk. 1'% tablespoon sugar. 1 egg. % saltspoon salt. Flavoring to taste — nutmeg, 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 289 around 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 done, 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 CUSTARD NO. II, 262 CALORIES (Individual Rule.) % cup milk. Vs saltspoon salt. 1 egg. Nutmeg. 1% tablespoon sugar. Y4, teaspoon vanilla. Blend according to Baked Custard No. I. The smaller quantity of milk makes a little firmer custard. WHITE CTJSTARD, 163 CALORIES 1 egg white. % saltspoon salt. 1 tablespoon sugar. % eup rich milk. Beat white of egg until very light; add sugar and salt and pour on gradually the milk. Plavor 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 CUSTARD, 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. MAITES HUE CUSTARD, 107 CALORIES (Individual Kule.) 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 CARAMEL CUSTARD, 293 CALORIES (Individual Eule.) % 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- beaten egg. Add flavoring. Strain into buttered custard cups, place in a pan of hot water and bake until firm in a slow oven. PEPTONOIDS 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. 6 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 SOUFFLES Dainty and nutritious ways to serve the uncooked and slightly cooked white of eggs. WHIPS AND SOUFFLES 391 rRUIT WHIP, 125-150 CALOKIES (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 strawberries. % 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 CALORIES (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. 293 NUTRITIOUS DESSERTS OUEIET SOUFFLE, 230 CAIOBIES 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 i-ind if it will interfere me- dicinally. CTTSTARD SOUFFLE, 297 CALORIES (Individual Rule.) % tablespoon butter. Yolk 1 egg. 1% tablespoons flour. 1% tablespoons sugar. 14 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, until 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. 14 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 393 PEACH UERINGTTE, 210 CALORIES i (Individual Eule.) 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. Va 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 sugar. 294 NUTRITIOUS DESSERTS Kote. — 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 sugar and a grating of nutmeg. CUSTARD JUNKET, 512 CALORIES (Two Servings.) % cup hot milk. 2 tablespoons sugar. 1 egg. l^ teaspoon vanilla. 2 tablespoons sugar. 1/2 Hansen's Junket Tablet. % eup lukewarm milk. 2 teaspoons cold water. Beat the 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. When lukewarm add vanilla and the tablet dissolved in cold water; finish as for Plain Junket. COCOA JUNKET, 280 CALORIES (Individual Rule.) 1 tablespoon cocoa. 14 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 CORNSTARCH 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 slovrly 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 CREAM, 340 CALORIES (Individual Rule.) 1 cup milk. Speck salt. 114 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 FRUIT JELLY, 166 CALORIES 1 (Two Servings.) 1 cup raspberry juice. 2 tablespoons cornstarch. Sugar. ^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 with whipped cream and fresh, whole berries. HALTED UIIK BLANC UANGK, 280 CALORIES (Two Servings.) 2 tablespoons Horlick'a Malted Speck salt. Milk. 1 tablespoon sugar. 2 tablespoons powdered arrow- 1% cups boiling water, root. 14 teaspoon vanilla. Mix the arrowroot and Malted Milk powder with a little cold water 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 cofEee may be added to above before cooking, for Coffee Blanc Mange. iniTIlITIOTrS WHEAT PUDDING, 252 CALORIES (Individual Rule.) 1 cup milk. White 1 egg. 2% tablespoons flour. 14 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 (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. RICE 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 MOSS JELLY, 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.) Yi cup Irish moss. % saltspoon salt. 1% cups cold water. Va 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 398 NUTRITIOUS DESSERTS are soft. Turn into a strainer and pour over it one cup of iot 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. STEADIED BICE, 265 CALORIES (Individual Rule.) 1/3 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 boUer. 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 ■\i'ith fresh berries. Serve with sugar and cream. SOUTHERN SNOWBALLS, 367 CALORIES (Individual Rule.) 14 cup rice. 14 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 PIAIN RICE PUDDING, 746 CAIOMES (Individual Eule.) 1 cup steamed rice. 2 tablespoons sugar. 1 cup scalded milk. % saltspoon salt. % tablespoon butter. 14 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. Bake in a moderate oven until custard is set. Serve with Hard Sauce. Note. — Do not use raisins in case of bowel trouble. RICE MERINGUE, 528 CALORIES (Two Servings.) %, cup cold cooked rice. Egg yolk. 1 cup scalded milk. Vanilla. 2% tablespoons sugar. 1 egg white. 14 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 pudding and brown slightly in the oven. CREAM OF RICE PUDDING, 657 CALORIES (Three Servings.) Vi 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 CREAM, 483 CALOSIES (Two Servings.) 1% tablespoons Minute tapioca. 1 cup scalded milk, 3 tablespoons sugar. 1 egg. % 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. Eemove 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. % 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. 1% 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. ^ 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. RASFBEKKY TAPIOCA, 218 CALORIES (Three Servings.) 1% tablespoons Minute tapioca. % cup 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. DATE TAPIOCA, 660 CALORIES (Three Servings.) ly^ tablespoons Minute tapioca. 1 cup scalded milk. 1 tablespoon sugar. 1 egg. Yg saltspoon salt. % 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 UANOE, 827 CALORIES i (Three Servings.) 14 cup Minute tapioca. 1% cups hot chocolate or cocoa. 14 cup sugar. % 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. 1 Calculated with chocolate, recipe page 135. 303 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 BREAD PUDDING, 900 CALOKIES (Two Servings.) 1 cup stale bread. 2 tablespoons sugar (to taste). 1 cup milk. % saltspoon salt. 1 tablespoon butter. l^ 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 CAIORIES i (Two Servings.) 1 cup stale bread. 2 oranges. Yz 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. ^ Without sugar. BREAD PUDDINGS 303 lEMON BREAD PUDDING, 543 CAIORIES (Two Servings.) -/2 cup milk. 3 tablespoons sugar. Va eup soft bread crumbs. % tablespoon butter. Yolk 1 egg. Grated rind ^ lemon. Speck salt. 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 v?hite 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 medici- nally. For the crumbs, rub soft bread through a coarse strainer. 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.) % cup stale bread crumbs. 214 tablespoons sugar. 1 cup milk. 1 egg. 1/2 ounce (or square) Walter Speck salt. Baker's unsweetened chocolate. % teaspoon vanilla. Soak bread crumbs in milk. Melt chocolate over hot water and add to it the sugar and salt. To the chocolate mixture, add the soaked crumbs, the beaten egg and vanilla. Put into buttered custard cups and bake in a moderate oven about twenty minutes, or until custard is set. Serve hot, plain or with Hard Sauce. 304 NUTRITIOUS DESSERTS CHEESE FTTDDING (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 vrill 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 crimibs. Place bits of butter on top, put in slow oven, and bake. CEACKEE PUDDINGS CRACKER PUDDING, 397 CALORIES (Two Servings.) 1% soda crackers. Yolk 1 egg. 1 cup milk. 2 tablespoons sugar. Ya teaspoon salt. Eoll 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 ENGLISH WAINUTS AND BISCUIT CRISPS (FOR THE DIA- BETIC), 154 CALORIES (Individual Rule.) 2 Gum Gluten Biscuit Crisps. 4 walnut halves. 2 hot tablespoons thin cream. Parsley. % 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 SATTGE, 650 CALORIES (Four Servings.) 3 tablespoons butter. % white of egg. 6 tablespoons powdered sugar. % tablespoon cream. Nutmeg. 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. FOAMY SAUCE, 863 CALORIES (Three Servings.) l^ cup butter. 1/2 egg. 1/2 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 % cup thick cream (40%) =432 Calories. Do not have cream 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 stiffly-beaten cream. FRUIT SAUCE, 75 CALORIES (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 310. FROZEN DESSERT ICE CREAM — 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 beverages. 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 VANILLA ICE CREAM, 310 CALORIES i (Individual Rule.) % cup thin cream or %, cup % teaspoon vanilla. heavy cream and 14 cup milk. Speck salt. 1% 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 CEEAM, 353 CALORIES i (Individual Rule.) % cup thin cream or 14 cup 1% tablespoons sugar. heavy cream and % cup milk. 1 tablespoon boiling water. 14 square Walter Baker's choco- % 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 CREAM, 353 CALORIES 1 (Individual Rule.) % cup thin cream or 14 cup 1% tablespoons sugar. heavy cream and 14 cup milk. Speck salt. 1 tablespoon ground coffee. 14 cup milk. Mix coffee 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 CREAM, 690 CALORIES 1 (Two Servings.) % cup cream. Vs Hansen's Junket Tablet. % cup milk. 2 teaspoons cold water. 2% 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 General Eule. Note. — A variety may be made by. adding two teaspoons cocoa dissolved in a little boiling water. Add to mixture before adding the tablet. Serve the creams plain or with whole strawberries, etc. Note. — The junket improves the body or consistency of any cream. ^ Calculated with thin cream. ICE CREAM 309 GRAPE JUICE ICE CREAM, 490 CALORIES (Individual Rule.) % cup sugar. 14 cup Welch's grape juice. Scald one-half cup of the cream and add the sugar. Cool, add remainder of cream and the grape juice and freeze accord- ing to general directions. STRAWBERRY ICE CREAM, 356 CALORIES (Individual Rule.) % cup thin cream or 14 cup 2 tablespoons sugar. heavy cream and 14 cup milk. Speck salt. 14 cup strawberries. Mash the strawberries with the sugar and allow them to stand five minutes. Add the cream and milk and freeze in small pail according to general directions. Note. — -The berries may be mashed and strained through cheese-cloth. RASPBERRY ICE CREAM, 363 CALORIES (Individual Rule.) % cup thin cream or 14 cup 2 tablespoons sugar. heavy cream and 14 cup milk. Speck salt. 14 cup raspberries. Mash the raspberries and strain through cheese-cloth. Add cream, milk and sugar. Freeze in small pail according to general directions. PEACH ICE CREAM, 390 CALORIES (Individual Rule.) % cup thin cream or ^ cup 14 cup peaches, heavy cream and l^ cup milk. 2 tablespoons sugar. Mix peaches and sugar and press through a potato-ricer or sieve. Scald cream and milk. Cool and add peaches and sugar. Freeze in small pail according to general directions. 310 NUTRITIOUS DESSERTS CAHAMEL ICE CKEAII, 340 CALORIES (Individual Rule.) % cup thin cream or % cup ll^ tablespoons boiling water. thick cream and % cup milk. 14 teaspoon vanilla. 2 tablespoons sugar. Speck salt. Into saucepan place the sugar and stir constantly until melted. Add water and boil until reduced to one and one- half tablespoon. Add cream very slowly, vanilla, salt, and freeze. CARAMEL ICE CREAM HO. II, 5942 CALORIES (Ten Servings.) 1 pint milk. 2 eggs. 1 cup sugar. Speck salt. 5 tablespoons flour. 1 quart cream. 1 scant cup sugar for caramel. Scald the milk; mix one cup sugar, flour and salt, add the eggs and beat all together until perfectly smooth and light. Add the scalding milk gradually, beating until very smooth. Cook in double boiler twenty minutes. While cooking, prepare caramel. Put the second cup of sugar in saute pan, and cook until melted and a delicate brown; add gradually the custard, stirring constantly; strain and cool. Add the cream (which has been scalded and cooled) and freeze in large freezer. Note. — This may be used for vanilla ice-cream by omit- ting the caramel and using one tablespoon vanilla and enough of the second cup of sugar to sweeten. MALTED MILK ICE CREAM, 3900 CALORIES 1 (Ten Servings.) % pound Horlick's Malted Milk. 1 pint cream. 1 cup granulated sugar. 2 ounces chocolate. 1 quart water. 1 tablespoon vanilla. White 1 egg. Mix the malted milk powder, sugar and boiling water, stir- ring until smooth. Add cream and scraped chocolate and cook until chocolate is melted. Add vanilla, cool and freeze. 1 Thick cream. ICE CREAM 311 When partly frozen, add the well-beaten white of egg, and finish freezing. Note. — If strawberry or other flavor is desired, it may be used in place of vanilla. PEPTONOIDS ICE CREAM, 1274 CALOEIES 4 tablespoons Dry Peptonoids % piiit thin cream. Soluble. 1 oz. chocolate. % cup sugar. % tablespoon of vanilla. 1 pint of water. White of 1 egg. Mix Dry Peptonoids Soluble, sugar and boiling water. Stir until smooth. Add cream and scraped chocolate. Cook until chocolate is melted. Add vanilla; cool and freeze. Wben partially frozen, add well-beaten white of egg. FROZEN CUSTARD, 349 CALORIES (Two Servings.) 1 cup hot milk. 2 tablespoons sugar. 1 egg. % teaspoon vanilla. Speck salt. Beat the egg, add the sugar and salt and gradually the scalded milk. Cool, add flavoring and freeze. HOT COCOA SATTCE FOR ICE CREAM, 1035 CALORIES (Six Servings.) 1% cups water. 2 tablespoons Walter Baker's co- 1 cup sugar. coa. 1 tablespoon arrowroot. 1 teaspoon vanilla. Speck salt. Boil together the water and sugar for two minutes; add the arrowroot mixed with a little cold water, stir for a mo- ment, then boil until clear. Add the cocoa, which has been mixed with a little hot water, and the salt, and boil three minutes longer. Eemove from the fire and add the vanilla. 313 NUTRITIOUS DESSERTS SHERBET LEMON UIIK SHERBET, 299 CALORIES (Individual Rule.) % cup milk. Juice of i/4 lemon. 14 eup sugar. 1 drop lemon extract. Blend all the ingredients and freeze in small pail accord- ing to general directions. LEMON MILK SHERBET, NO. II, 2390 CALORIES (Six Servings.) 1 quart milk. Juice 2 lemons. 1 pint sugar. 1 teaspoon lemon extract. To the lemon juice add the sugar, milk and extract. Freeze immediately in large freezer. STRAWBERRY SHERBET, 357 CALORIES (Individual Rule.) % eup milk. ^ cup sugar. 1 cup strawberries. Mash the berries and strain. To the juice add sugar and milk. Freeze in small pail according to general directions. STRAWBERRY SHERBET NO. II, 2940 CALORIES (Six Servings.) 1 quart milk. 2 cups sugar. 2 quarts strawberries. Mash the berries and strain. Add sugar and milk. Freeze in large freezer. CLAM SHERBET, 128 CALORIES (Individual Rule.) % cup milk. Speck paprika. 14 cup clam broth. Blend and freeze according to General Eule. Serve in small dainty glasses with a teaspoon of unsweetened whipped cream on top. The milk and clam taken in this way are often more acceptable to the patient than when served in liquid form. SHERBET 313 Note. — The paprika may be omitted if condiments are not desirable. MALTED MILK SHERBET, 2148 CALORIES (Six Servings.) % pound Harlick's Malted Milk. 1 tablespoon vanilla. 1 cup granulated sugar. 2 ounces chocolate. 3 pints v^ater. White 1 egg. Make a smooth paste of the malted milk powder and a little of the water, then add the rest of the water gradually, the sugar, vanilla and the chocolate grated. Freeze. When partly frozen, add the well-beaten white of egg and finish freezing. GRAPE SHERBET, 3265 CALORIES (Ten Servings.) 3 cups Welch's grape juice. 3 cups sugar. 1 quart water. White 2 eggs. Blend the grape Juice, water and sugar. Partly freeze. Beat the whites of eggs lightly, add two tablespoons pow- dered sugar ; add to sherbet and continue freezing until hard. Eemove dasher and allow it to stand for one hour to ripen. Pack carefully. GRAPE AMBROSIA, 5243 CALORIES (Twelve Servings.) 1 quart milk. 1 pint Welch's grape juice. 2 quarts water. 1 can grated pineapple. 31/3 cups sugar. Juice 3 lemons. Whites 4 eggs. Mix together milk, water, sugar and fruit and partially freeze. Add the well-beaten whites of eggs and continue freezing until hard. ICES ORANGE ICE, 252 CALORIES (Individual Rule.) % cup water. 1 tablespoon lemon juice, juice 1% oranges. 514 NUTRITIOUS DESSERTS Mix together all the ingredients and freeze in small pail according to general directions. ORANGE ICE NO. II, 990 CALORIES (Four Servings.) 2 tablespoons shredded gelatin. 1 cup sugar. % cup cold water. 1 cup orange juice. 1% cups boiling water. Juice 1 lemon. Soak gelatin in the cold water twenty minutes; add boil- ing water; when gelatin is dissolved add the sugar, orange and lemon juice. Cool, strain and freeze in large freezer. ORANGE ICE NO. Ill, 1922 CAIORIES (Four Servings.) 1 pint orange juice. Grated rind 1 orange. Juice 2 lemons. 1 quart water. 1 pint sugar. Boil the water and sugar twenty minutes; add fruit juice and rind of orange. Cool, strain and freeze in large freezer. Note. — Do not use orange rind if it will interfere me- dicinally. LEMON ICE, 257 CALORIES (Individual Rule.) % cup water. 4 tablespoons sugar. Juice 1 lemon. Mix all the ingredients and freeze in small pail according to general directions. FRUIT ICE, 497 CALORIES (Individual Rule.) Vs banana. Juice % lemon. 1/3 cup strawberries. % "^^P '^o^'l water. Juice % orange. % cup sugar. Put the fruit into a coarse strainer (or a potato-ricer), rub- bing it through into a large bowl. Pour the cold water through the strainer. Add the sugar, stir well and freeze according to general directions. ICES 315 FIKEAFFIE ICE, 242 CALORIES (Individual Rule.) % cup Hawaiian grated pine- % cup water. apple. 2 tablespoons sugar. 1 tablespoon lemon juice. Boil the water and sugar together about three minutes; add pineapple and lemon juice. Cool, strain and freeze ac- cording to general directions. GRAPE FRAPPE, 2175 CALORIES (Six Servings.) 1 pint Welch's grape juice. 1 pint water. Juice 1 lemon. 2 cups sugar. Boil the water and sugar together for five minutes; cool and add the grape and lemon juice. Freeze to the con- sistency of a mush. Serve in tall glasses with sweetened whipped cream piled high on top. CLAM FRAPPE (Individual Rule.) % cup cold water. Speck paprika. % cup clam broth. Blend and freeze according to General Eule, to the con- sistency of a soft Water Ice. Serve in small punch-glasses or champagne glasses, with a teaspoon of unsweetened whipped cream on top — Delicious to serve for dinner in place of shellfish. SCALPICON OF FRUIT A delicious scalpicon is made by cutting all kinds of fresh fruits into small pieces flavoring with wine or lemon juice and sugar. Put into serving dish with Orange or Lemon Ice on top. Serve individually in champagne glasses on a small plate with doily, with a single rose or other flower to correspond with color of ice. ORANGE STRAWS Peel the orange or lemon lengthwise ; cut into long, narrow strips, about one-fourth of an inch wide. Put into saucepan 316 NUTRITIOUS DESSERTS and cover with cold water and bring to the boiling point and pour off the water; repeat this process five or six times, or until the bitter taste of peel is extracted. Drain thoroughly and cover with granulated sugar. Cook until sugar is dis- solved and is thick and hardens in cold water. Then roll straws in granulated sugar and cool. Serve with Orange Ice, etc., or as a bon-bon. CHAPTEE XII CAKE The two methods of making cake light are by means of air and of gas. Air is introduced by beating, or by the addition of beaten eggs, as in sponge cake. When the light- ness is entirely dependent upon air, the whites and yolks of eggs should be beaten separately. Gas may be generated from within by combining an acid and alkali and adding moisture; as cream of tartar and bicarbonate of soda; or sour milk and soda; or molasses and baking powder. The combination of both air and gas is used to raise butter cakes. General Directions for Cake Mahing. Before blending the cake, see that the oven is at right temperature for baking and the pans greased with a little beef fat and dredged with flour. The pan may be lined with paper to prevent cake burning on bottom when cake requires long baking or when the oven bakes too quickly on the bottom. Have all material at hand and measured. Use a round bottom bowl, and a wooden spoon for mixing; beat rather than stir the mixture and fold in ingredients. Put mixture in cake pans, slightly higher on the sides than in the center, as cake rises more quickly in the center. Layer cake takes a hotter oven than loaf cake. If cake is baked properly, it will rise, but not brown, during first quarter of the time required for baking; become slightly browned the second 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 sufficiently 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 lo6king 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. Eind and juice of % lemon. 14 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. COID WATER SPONGE CAKE, 1633 CALORIES 2 eggs. 2 teaspoons Rumford baking 1 cup sugar. powder. 6 tablespoons cold water. 1 tablespoon lemon juice. 1% 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 baking powder together three times and add grad- ually, beating thoroughly. Fold in the well-beaten whites. Bake in well-greased and floured gem tins, or shallow pan in a moderate oven. CAKE 319 HOT WATER SPONGE GAEE, 1460 CALORIES 2 , eggs. % saltspoon salt. 1 cup sugar. % teaspoon vanilla. 1 cup bread flour. 14 cup boiling water. 114 teaspoons Rumford 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 CALORIES 2 eggs. 4 tablespoons butter. % cup milk. 2 teaspoons Rumford baking 1 cup sugar. powder. 1% cups bread flour blended with 1 teaspoon flavoring or spices. 2 tablespoons corn-starch. 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 stiSly-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 flbured. GLUTEN NUT CAKE (FOR THE DIABETIC), 1436 CALORIES 1 1 tablespoon butter. 14 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. 320 CAKE season with salt and spices and add nut meats. Bake in moderate oven. BOILED FBOSTING, 853 CALORIES 1 cup sugar. White 1 egg. 14 teaspoon cream of tartar. % teaspoon flavoring. 14 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 cocoanut, etc. MAEGXTEBITE WAFERS Take " Long Branch " wafer crackers and spread with plain-boiled frosting, or add nuts, chocolate, cocoanut, etc. Put in oven a moment to dry, but not brown. Dainty to serve with lee 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 a 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 IF DISEASE DIET IN SPECIAL CONDITIONS CHAPTER XIII HOSPITAL DIETAEIES GENERAL TYPES OF DIET USED IN HOSPITALS IlftTJID OR rmiD 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, Apollinaris 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 SEHI-SOIID 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 FEOM VARIOUS HOSPITALS LIGHT DIET i (or Convalescent Diet) Breakfast. — Milk, tea, coflFee flr 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. ^ 1 Diet used at Nathan Littauer Hospital, Gloversville, New York. 323 324 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, Inilk 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 LIGHT DIET i Breakfast. — Oranges, coffee with milk and sugar, or tea ; milk, cream of wheat, eggs (spft cooked in shell), toast. Dinner. — Tea and milk, soup, crackers, bread and butter, baked potato, snow pudding., y- Supper. — Tea, milk, bread and butter, steamed rice, canned peaches, cake, jelly, MILK DIET 2 IJuring 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, FAKINACEOTTS i Cereals, bread, jellies, liquids, ice cream, custard, blanc-mange, puddings (without raisins), chicken. 1 Diet used at Nathan Littauer Hospital, Gloversville, New York. 2 Diet used at Bellevue Hospital, New York. 8 Diet used at the Presbyterian Hospital, New York. * Diet used at the Massachusetts General Hospital, Boston. TYPICAL HOSPITAL DIETS 335 PAKINACEOTJS DIET i Breakfast. — Tea or cofifee (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 cracker 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 ) . NITROGENOirS 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 DIETS 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. OXALTJRIA 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, Gtoversville, New York. ' Diet used at the Massachusetts General Hospital, Boston. 3 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 vrater should be forbidden and replaced by boiled or distilled water. Sugar should be prohibited, cofEee 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, toast, 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 SUGAR-FREE DIET Massachusetts General Hospital i See " Diabetic Diet." Page 357. SPECIAL FAT-FREE 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. in 0011. — 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, 30 gms.; rice, 50 gms. • SALT-FREE 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 337 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 e.c. 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. butter; 50 gms. toast. 4 P. M., one-half litre mild. Tfight. — Same 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, coSee or cocoa. FISH 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 1 Dr. Hewes, Physician to Out-Patients, Massachusetts General Hospital. 'Diet used at the Massachusetts General Hospital, Boston. 328 HOSPITAL DIETARIES foods such as farina, cornstarcli, rice, etc., should play an important role. Sometimes such a diet goes under the name of " soft food." HESTRICTED 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) . BELIEVUE HOSPITAL IN THE CITY OF HEW YORK, 1910 Dietary Table for Patients MONDAY Breakfast. — CoflFee, with milk and sugar, bread and butter, oatmeal, crackers, milk (1 qt. ) . Dinner. — Eoast beef, rice, soup, potatoes, vegetables, bread. Supper. — Tea ( with milk and sugar ) , bread and butter, stewed apples. TUESDAY Breakfast. — Cofifee (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. — CoflFce ( with milk and sugar ) , bread and butter, rice, crackers, milk (1 qt. ) . Dinner. — Roast 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 SATUEDAY Breakfast. — Coffee (with milk 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 OE 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) o;; 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 or 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 OBDEEED ONLY BY THE ATTENDING PHYSICIAN OE SUKGEON 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 FEVER IN GENERAL 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, cofi'ee, 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 FIIOII PEVER 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. Gilman Thompson, M.D. : "Practical Dietetics." New York. B. 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. — Eaw 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 harley 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 cup of hot chicken broth. Dinner. — Chicken panada. Bread. Light wine if desired. A little tapioca cream. 334 BIET IN DISEAiiE Lunch. — An eggnog. Supper. — Buttered dry toast. Baked sweet apples and cream. Tea. FOURTH DAY Breakfast. — An orange. Oatmeal (H. 0.), with cream and sugar. Poached egg on toast. Baked potato. Cocoa. Lunch. — One cup of hot, soft custard. Dinner. — Potato soup. CroUtons. 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 unlikely 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- * Ewald recommends Sanatoffen in milk and broth. 336 DIET IN DISEASE tion of the milk, and by ingesting it very slawly, so that n& 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 calo^ries 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 ia 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 delicaite 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 calorie,, in which it is aimed to give the patient far more eateries 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 difficult 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 caloric 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 difSculty 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. IiaUID DIET IN TYPHOID FEVER In the ordinary case, 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 ftieat 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. Farinaceous 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. TYPHOID FiriD DIET OF PBESBYTERIAN HOSPITAL i Milk, broth, egg albumin. TYPHOID FLUID DIET OF GLOVERSVILLE HOSPITAL ? Milk, strained broths of chicken, mutton, beef, clam broth, barley water, farina, arrowroot 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. Eelapses 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 cases which have run a mild course,, as soon as the temperature remains 1 Diet used at the Presbyterian Hospital, New York. " Diet used at the Nathan Littauer Hospital, Gloversvllle, N. Y. ' 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 toagt. 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. Rice, 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. ■'W. Gilman Thompson, M.D. : "Practical Dietetics." New York. D. Appleton & 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, a,s 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 Eice (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 - 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 cases are toxemia, continued fever, diarrhoea and vomit- ^ 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. 343 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 yery 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 diarrhoea 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 case 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 tj^phoid, 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 t5rphoid 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, but, 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 in the Massachusetts General Hospital. From 1886 to 1893, 233 cases were treated under a milk diet, with a mortality of 10 per cent. From 1893 to 1897, 147 cases have been treated 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, Vichy; peptogenic and peptonised milk; cream and water (i. e., less albumin), 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. Horlick's food, malted milk, carnipeptone, bovinine, somatoae. 4. Beef juice. 5. 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. TONSILITIS AND ariNSY 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 ailnul the pain momentarily, or in extreme cases the pharynx and tonsils may be sprayed with cocaine, and the •W. Oilman Thompson, M.D, . "Practical Dietetics." New York. D. Appleton & Co. FEVERS AND INFECTIOUS DISEASES Mil period of temporary anaethesia 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 suffers more, and stimulants may be given by the rectum if deglutition is inr- 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 diflSculty in swallowing. All food must be given in fluid form, of whiclj 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 1 W. 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. PNEUMONIA Thompson i Dietetic Treatment. The indications for treatment are to give a light diet, which 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, eflEorts 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 believQd 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 sud'den 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. Gilman 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 becouae normal, in order to make sure that a relapse of the fever is not likely to follow. In those cases 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 beneficial; 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. Prom its serving as a fuel, and thereby saving tissue waste in the muscles, the free use of alcohol in pneumonia undoubtedly saves many lives. BKONCHO-PNETTMONIA 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 vaters 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. MTJMPS Thompson i For mumps no special diet is required, beyond the neces- sity of giving fiuids or soft food while the swelling of the ^ W. Gilman Thompson, M.D. : "Practical Dietetics.'* New York. D. Appleton & Oo. 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 COTJGH 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, are recommended for patients who vomit solid food. The worst cases require nutrient enemata, as exhaustion becomes critical. DIET IN TTTBEKCTILOSIS, ESPECIALLY PULMONARY CONSTTMP- 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. Gilman Thompson, M.D. ; "Practical Dietetics." New York. D. Appleton & Co. 363 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, tliat a full diet antag-onizes the dis- ease. A tuberculous subject or one likely to become 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 flesh 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. Tor 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 modem 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, muflSns, gems. Fats. — Cream, butter, olive oil, Vegetables. — 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 Peptonoids. AVOID. — • Fried foods, salt fish, hashes, gravies, veal, pork, carrots, parsnips, cabbage, beets, turnips, cucumbers, macaroni, spaghetti, sweets, pies, pastry, sweet wines. CHAPTER XV DIET IN DISORDERS OF NUTRITION DIET IN DIABETES It is commonly believed that diabetes should be managed dietetically by a sugar-and-starch-free regimen, carried to such a degree that excess of sugar no longer appears in the 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 sufficient 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. Por a bev- erage we may give coflfee 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. (c) 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 OF BELLEVUE HOSPITAI i Meat. — Fat beef, mutton, ham and bacon. Fish. — Fresh 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, radishco, 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 BeUevue 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 OF THE MASSACHT7SETTS GENERAL HOSPITAL 2 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 SrGAR-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. Noon. — 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 200 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, 350 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. CHEONIC 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, calf's head, sausage, kidneys, pig's feet, tongue, tripe, game (all cooked free of flour, potatoes, bread or crackers ) . Farinaceous. — Gluten porridge, gluten bread, gluten gems, gluten biscuits, 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. STTBSTITTTTES FOE STAECH AND SiraAE Gum Gluten 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 CHART Joslin and Groodall 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 patients 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.B., Boston, Mass. (Reprinted from the Boston Medical and Surgical Journal, Vol. clviii, No. 8, pp. 248-251, Feb. 20, 1908.) D. C. Heath & Co., 120 Boylston St., Boston, Mass. ^60 DIET IN DISEASE < o iZi H fr* P O fi c o <3tS ■^ +J ca o SB in I Pi Ki IH-S ^ ca P CO M Pi < W PJ SQOH^N ta fln-S o ca HO ft- cS^ DISORDERS OF NUTRITION 361 i s p. 02 g < u 5 a § a C3 03 V s P « bo DO to ^ ro ho S S* w,s a .2 ■" TO p, m Qj CD ra g S " to 0) ^ tC 3 o ^?;1;s 55 'd cS 13 s 0.2 M _" CO 60 O 1^ CQ + o o to a ctJ CQ m 62^ rt'S'g h O o own Is 3 ^ + 3 .2 'i », 03 IS ft 4) ftjzj S ta £ PM« a «^-a OOOjOy a S 3 « " o S "-Sis i2 2i3«gg.S^3 9 fc. M _ C- 0) flj e ^ P-M O ttJ raw ■ft StaS ^ -idtuctjeaaior— 'P oft lUfttei3(DtO-3JHoC^ — tH ijajai!aO 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, hot 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 case 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. 373 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 iluid as pos- sible with his meals, but may quench his thirst between meals. By 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 fat. DIET: Fish. — All fresh white fish broiled or boiled. Meats. — Lean mutton or lamb, 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 flsh, rich soups, salt fish, veal, pork, sausage, fats, potatoes, oatmeal, hominy, macaroni, spices, rice, carrots, beets, turnips, parsnips, puddings, pastry, pies, sugar, sweets, cakes, cream, 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. CHEOITIC 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 be excessively large nor too small. My own bill of fare for the first week of the treatment is as follows : Eight 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. 1/3) 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. (J iii. 1/3) 127 White bread, two ounces 153 Butter, one-half ounce 107 One cup of cocoa, 200 gm. (3 vi. %) 101 Half past three o'clock: The 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 Eemond 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 (300 to 300 c.c.) 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, pastry, raw fruit and the like. In the following table I give an outline of diet which I ordinarily prescribe in this affection : OUTLINE OF DIET IN GASTRIC ULCER First Three Days Number of Calories. 7 A. M. : milk, 150 C.C. (five ounces) 101 8 " milk, 150 C.C. (five ounces) 101 > Max Einhorn, M.D. : "Disease of the Stomach." New York. Wil- liam V7ood & Go. DISEASES OF THE STOMACH 377 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 7 A . M.: 9 tc 11 tc 1 P . M. : 3 tc 5 tc 7 tc 9 cc 1.402 FomtTH TO THE TENTH DAY Number of Calories. milk, 300 C.C. (ten ounces) 202 milk, 300 C.C. (ten ounces) 202 milk with barley, rice, or oatmeal water, 300 C.C. . 160 one cup of bouillon, 200 C.C, and one egg beaten up in it 80 milk, 300 C.C 202 milk, 300 C.C 202 milk with barley water, 300 C.C 160 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 7 am. 11 1 p, 7 A. M. 10 1 p. M 4 6:30 FOUETEENTH TO THE SEVENTEENTH DAT Number of Calories. milk, 300 C.C 202 milk, 300 C.C 202 and two crackers (one ounce) 100 milk with barley, 300 C.C 342 scraped meat, 50 gm 60 two crackers, one cup of bouillon, 200 C.C 100 milk, 300 C.C 202 milk, 300 C.C 202 one egg (soft boiled) 80 two crackers 100 milk with farina, 300 C.C 342 milk, 300 C.C 202 2.134 Seventeenth to Twenty-Fourth Day Number of Calories. two eggs (soft boiled) 160 butter, 10 gm 81 toasted bread, 50 gm 130 milk, 300 C.C 202 milk, 300 C.C 202 crackers, 50 gm 166 butter, 20 gm 162 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 the same as at 10 A. M 530 milk with farina, 300 C.C 342 crackers, 50 gm 166 butter, 20 gm 162 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 hsematemesis, 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° F. Such a nourishing enema is given three or four times a day. The quantity of the feeding enema is 300-250 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; (2) Indian meal porridge with cream or salt; (3) potato puree, 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, iDiet used at the Massachusetts General Hospital, Boston. Dr. Hewes, Physician to Out-Patients, Massachusetts General Hospital. 380 DIET 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 1 1 J4 m 1 1 N 1 l-i 1 1 1 2 c.c. 200 200 Cms, Cms. Cms. Gmi. Gms. Cms. 2 3 3 300 4 4 400 20 5 5 500 20 6 6 600 30 7 7 700 30 35 8 8 800 40 70 100 9 8 900 40 70 100 20 10 8 1000 50 70 200 40 40 11 8 1000 50 70 200 50 20 12 8 1000 30 70 300 60 50 40 Continue for 3 weeks CHAPTER 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. Yegetahles. — 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, lice, 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 381 382 DIET IN DISEASE more than one cup at a time and taken slowly after a meal; un- fermented grape juiee. 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 IK 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 sufficiently 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. Fish. — Raw oysters, fresh fish of all kinds broiled or boiled. Meats. — Game, poultry, almost any fresh meats. Farinaceous. — Eye bread, brown bread, graham, corn and whole wheat bread, hominy, mush, cereals, Bran Cookies. Vegetailes. — 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. — Spirituous 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 IN 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 was due to or associated with gastritis. Hence foods known to be constipating must also be bland and easily digested. Pood 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: 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 Pepto- noids Soluble, Sanatogen and other semi-proprietary 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 eggs, eggs and milk, flour and milk puddings, boiled and peptonised milk, tea, custards, blane-mange, wine jelly, oatmeal, oysters, gruel, chicken. AVOID. — Soups, animal broths, fresh bread, fruits, vegetables, fried dishes, fish, 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 jttice, 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 amoebic form, the loss of strength, antemia, 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, Oilman Thompson, M.D. : " Practical Dietetics. ' ' New York. D. Appleton & Oo. 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 (DYSENTERY) Uassachusetts General Hospital i 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 or Sanatogen 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. Oilman Thompson, M.D. : "Practical Dietetics." New Torlc. D.. Appletou & Oo. 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 coflfee, barley water, albumin water, beef juice, Iriquid 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 " 8 " 8 3 3 6 with with with at 7 A.M. " 9 " " 11 " " 1 P.M. 11 " 1 A.M 3 " 5 " Skimmed Milk Skimmed Milk Tea or Coffee Beef Tea Chicken broth Barley Water Mellins' Food Albumin Water Beef juice Barley Water Buttermilk LiaUID ENTERIC DIET Cutler 2 8 oz. 4 times every 24 hours. with with with One soft boiled egg daily if desired or raw in milk. Diet used at the Massachusetts General Hospital, Bos- M.D. ; ' ' Diet used at the Massachusetts General ^ Dr. Yickery : ton. ' ' ''Elbridge G. Cutler, 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. 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 cases 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 hours 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. D. Appleton & Co. CHAPTER XVIII DIET IN DISEASES OF THE GENITO-URINARY SYSTEM ACUTE BRIGHT'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 oE 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 m.ust 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 flrst, 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 CHRONIC 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 cases 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. 393 DIET IN DISEASE As the patient improves the milk diet may be giyen 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. NEPHMTIC DIET Uassachusetts General 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 GRAVEI Dr. Hewes, Massachusetts General Hospital i 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, 1 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-URINABY SYSTEM 393 Vary diet from day to day in above limits. If oedema is 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. Rice, 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 Nephritio Diets (na.lpin) . No. 1. Milk, 1500-2000 c.c; white salt-free bread, 400-500 gms.; butter (salt-free), 40 gms. ; eggs, 4^6. (5-6 gms. NaCL contained.) No. 2. (Widal). Salt- free bread, 200 gms.; saltfree 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. (200O 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. CONVrLSIONS IN BRIGHT'S DISEASE Convulsions in Bright's Disease. In the course of Bright's disease convulsions 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 ALBTTUINTTRIA 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. ^ W. Oilman Tliompson, M.D. : "Practical Dietetics." New York. D. Appleton & Co, CHAPTEK XIX DIET IN MISCELLANEOUS AFFECTIONS NESVOTJS DISORDERS 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, malted milk and Sanatogen in milk or Vichy. 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. FUNCTIONAL DISORDERS OP THE LIVER (BILIOUSNESS) 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, lamb, 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, Btewed 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, seborrhcea 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 HEAST 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 be 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 MANAGEUENT OF SURGICAL CASES Not much special attention is paid to dietetics until a day or two before operation, with the exception of stomach cases. Whenever 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 fopd within six hours, the stomach should iirstbe 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 niiist 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 iirst 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 lAPABOTOMY, OVARIOTOMY, ETC. Thompson i After all operations involving opening the peritoneal cav- ity complete rest of the stomach is necessary for at least four or six honrs, and not infrequently for two or three days. Food an4 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. Appleton & 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. N'oth- 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 anaemic, 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 an 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, spiced dishes, and heating drinks. They often sufEer 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 1 W. Gilman Thompson, M.D.: "Practical Dietetics," New York. D. Appleton & Co. 401 403 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 diflBcult. 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 i 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 fi.rst 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. ' W. Gilmsn Thompson, M.D. : ' ' Practical Dietetics. ' ' New York. D. Appleton & Co. MOTHERHOOD 403 In any ease 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; pancreatinised milk; milk with sodium bicarbonate (ten grains), and cerium oxalate (five grains) ; milk and lime water ; Vichy or milk with Sanatogen ; milk and Vichy, soda, seltzer, or carbonic-acid water; kumyss and zoolak; beef ex- tracts 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 sometimes 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 given 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 coffee 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 OF A NUKSIWG MOTHER OR WET NURSE 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 beer, 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. iW. Oilman Thompson, M.D.; "Practical Dietetics." New York. D. Appleton & Go. 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 MilJc. Not 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 CONSIDERATIONS 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 efliort 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 ^2 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 NUaSE 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. COMPOSITION OF MOTHER'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), ' See table of feeding according to age. 408 BIET 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 NAITTBAX 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, diarrhoea, 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 BABT'S STOICACH Newly bom about 1 ounce. At 1 month about 2 J 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 difficulty is experienced at weaning time, or when breast feeding has to be partially or wholly discontinued for any reason. SCHEDULE FOK 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 very 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. No 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 subject 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. AHTIFICIAI OB, BOTTLE FEEDING 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. DIFFERENCE BETWEEN HTTMAN AND COW'S MILK 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 phosphor ized 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 413 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 milk is practically sterile. GENERAL FRIKCIFIES OF HUE UODIFICATIONS 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. Few 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. From % 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 customary 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 sufiBcient 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. Water 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- tion. WHAT DIITTTION TO USE 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 rich in calcium, it is doubtful whether this is as perfectly utilized as that in human milk. THE arANTITY TO EEEL 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 MILE 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 MODIFICATION 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 be cleansed daily with soda-water. INFANT FEEDING 415 THE NURSING 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- ciuirements are met by the Ilygeia 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 ruiknown or when refrigeration is lacking. Before feeding, the bottle of milk is warmed to 10.5° 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. liinse, 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. 1 To cork the 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 FOR 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 HILE METHOD I. Emmet Holt i Top-Milh. 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.D. ; "The DiEeases of Infancy and Childhood" Fifth Edition. Copyright, 1897, 1902, 190S, 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 difEerent 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 3.50). 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 difEerent 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. Fig. 2. Chapin's dipper for re- moving the up- 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 general, 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. Por 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, 2 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. (See p. 421.) 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 cu'-' •a O V0r005 »0 vo 00 O ^^ 4 loooqio 1 "S <> v^J vd o « « 3 a :s u +J M 8 S 8S °S^8S 1-3 tH CN (N CO pr^ ^ a 3 3 a ;s 1 II II II II II II E^ ^ a w *. ^ ^ .. 1— 6§ 3 3 3 5 « og o Q^ ^-f ■■s -s « s s 5: !s s t^ N* t^ H N t$ g o o o o o o $ cs fO-^tovOi>. o» ^ §* •t-4 :: 3 ^ :: 3 9 ■e^ Cis 9 S o o ■ =0 ^-§ :s « :s S a c • -o S ■ -cs '. '. o 4-» ^ >H S m 3 3 « :i a fe. V ^ s IS ta S> s B ca 'S s3^ ^ !_; 1-1 M > > i-H m1-i > 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 422 DIET IN SPECIAL CONDITIONS more of each ingredient ; for thirty ounces one-half more, etc. For twenty-five 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. Fat to proteids, 2 :1. 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 (3) by using three parts milk and one part (16 per cent.) cream. With these, as with the First Series, if more than twenty 1 For method of calculating any number of ounces of any formula derived from 10 per cent, milk, see footnote on page 423. INFANT FEEDING 433 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 Equal. 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 :7. Primary Formula. Whole milk: Pat 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 number of ounces which may he 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 — 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 &5 ss &: oo 00 c^ -§ c "OOOOOOOO 01 o ::::::: : w ■ " * : I : ; .* >>'2 loOOOOVQiOO Soddoooodd i^i^ ;::::::: ^ :::.... : S88S8888S bjo w ;:;:;:: : 4^00000000 ca«ooooo O fin o S5. Ss 3 i: a u 0, 0.^ ^ n^ a V M g a 4J a" " ts S! « 3 « o, a g= a » « 3 « 3 o» » " IhS a a a s a a a p. a ^ a J3a a a I ■< 1-1 l-H ►> t> M hH I- l-H (-1 C 1^ ^ (-< I. INFANT FEEDING 435 09 H M o CS |Z! M P (4 w «1 <] hS Ph o n ^ M CO CO (O ^ ^ Tj( -"flt ^ Tf" Tt< ■* H< ^ 1 ^ » (N» C^ 0 tO »0 "O lO i/l »0 1 1-H • fN» tO(OfO» '*^» 10101010"0» • iO«OlO» O • \0'00'0'0«'0 O » to» • 'fH-int • io» • vco-CO* • • r-t~» • • • oogooooOQOoo as ioio»nio»o»'j>o'nio>o>o»o'0'o»o»rno»oio>mo»o»o«o»ootn>') "1 agSgE8gRggH8SS8SK8SgSHSSgggggg Es.S888Sg^88888SgggSSS8SS88g8ggS ^ ^'TPuiio»o»oioio'0'dvO'0««'0^0'dvo'd«'Ot^t^t^t^r-e^'0»o 13 KSggS8SSSggggggSSSSS88g8888888 Ph ^WMWMMMMCSrOtOtOrOtOtO(0(OtOtOtO'*'*-*Tt'T(^"*r»«^^'^ o -.g-22*2SS22SSSSSSSSSag 426 DIET IN SPECIAL CONDITIONS For 25-ounce mixtures multiply the amount of each ingredient by I14 " 30 " " " " " " " " 1% " 35 " " " " " " " " 1% tt 4Q tt li t6 t< a it tt a 2 " 45 " " " " " " " " 214 * Combination impossible with strength of cream indicated. Table for Estimation of Fat Percentages in Cream To determine the fat percentage of the cream: One quart of whole milk, of 4% fat, will yield on an average, ap- proximately : Cream 10% fat in upper 11 ounces after standing 8 hours or more. 12% " " " 8 " " " 8 " " " 16% " " " 6 " " " 8 " " " " 20% " " " 4 " " " 8 " " " Fat-free milk is the lowest 8 ounces after standing 8 or more hours. A sugar measure is approximately one level tablespoonful. One measure to a twenty-ounce mixture gives 2 per cent, of sugar, from which fact one may easily increase or decrease the sugar percentage in any of the above formulae. INFANT FEEDING 437 TABIE II Theoretical Basis for Peeding a Healthy Infant M 2.00 Prema- 1.00 ture 1.50 At term End of adwk. 2. SO End of 3d. wk. 3.00 End of 4th wk. 3.50 End of 6th wk. 4.00 End of 8th wk. 4.00 End of 12th wk 4. 00 End of 4 mo. End of 5 mo. End of 6 mo. End of 8 mo. End of 9 mo. End of 10 mo. End of 11 mo. End of 12 mo. 4.00 4.00 4.00 4.00 4.00 4.00 4.00 4.00 4.00 0.25 4.50 0.25 5.00 0.50 5. SO 0.50 6.00 0.7S 6.50 1.00 7.00 1.00 7.00 1.25 7.00 1.50 7.00 1.50 7.00 1.75 7.00 2.00 7.00 2.50 7.00 3.00 6.00 3,00 5.00 3.00 4.75 3 50 Proteids if split. 0.25 0.25 0.50 0.25 0.50 0.25 0.50 0.25 0.75 0.25 0.75 0.50 O.SO 0.60 0.90 0.75 0.90 1.00 0.75 1.25 Amount at each feeding in t M ^ ta PI tl S o ?.9 r% 3 75- l-lj^ 24-18 22.50 1 2 '2^ 3 3 4 6 7 30 60 75 90 90 105 120 135 165 180 210 240 240 300 300 2 2 2 2 2y2 2M 2H 2M 3 3 3 3 3 3 3 10 10 9 Note.— The data giv- en in this table are sim- ply a guide to the rule for feeding of the aver- age healthy baby.They are only approximate, and not intended to be followed in cases of difficult feeding, with- out due consideration to the individual re- quirements. 428 DIET IN SPECIAL CONDITIONS TABLE III Method of Calculating Whey Mixtures from the Card The percentages of fats, proteids, and lime-water are calculated by the card. Three-fourths {%) of the proteid in the formula chosen will be caseinogen, and one-fourth (}^) whey proteids, that is, Formulae calling for 0.25 proteid give approximately 0.20 caseinogen. « « *' 0.50 " " " 0.40 " " '' " 0.75 « " " 0.50 " « « « 1 QQ « « « Q 75 « " " « 1.25 " " " 1.00 " « « « 1 5Q « « « 120 " To calculate the additional amount of whey needed to make the de- sired whey-proteid percentage, Let W = number of ounces of whey needed. " Y=percentage of whey proteid desired. " P= proteid percentage in the card formula. " Q = total number of ounces of mixture. Then(i)W=Q [y-^]. The maximum in the percentage of whey proteids in any formula is obtained when all the watery diluent is replaced by whey. To calculate the sugar required beyond that contributed by the cream, milk, and whey. Let S=percentage of sugar desired. " L=number of measures, or level tablespoonfuls, of sugar to be added. " Z = sugar percentage as given in last column of feeding card. Then(2)L=Q(S-Z)-5W Example: 5L Fat 4.00, sugar 7.00, whey proteid 0.90, caseinogen 0.75, lime-water 5.00. Amount, 20 oz. Solution: Formula 23 gives 0.75 caseinogen. Use 16% cream. Cream = 5 ounces. Pat-free milk = 1 " Whey = 20 [o. 90— -^1=13 Lime-water = 1 " nTn 20(7— 1.42)— 5X13 ,,^,,-,,. Milk sugar = — ^^ — ■ — j^ =1.16 (Ivs) measures. INFANT FEEDING 439 TABLE IV Caloiic Value of Formulae Crlven on Card No. No. No. 1. 334 calories. 11. 555 calories. 21. 642 calories. 2. 344 a 12. 566 tl 22. 648 U 3. 401 a 13. 576 U 23. 690 a 4. •411 a 14. 606 U 24. 710 u 5. 421 a 15. 626 (I 25. 720 u 6. 452 a 16. 591 u 26. 741 a 7. 458 it 17. 601 u 27. 762 a 8. 488 a 18. 631 ti 28. 782 u 9. 520 u 19. 642 u 29. 741 u 10. 545 u 20. 653 It 30. 720 a To Estimate the Caloric Value of Food Taken. Example : An infant takes 6 feedings of 210 c.c each of Formula 25, the caloric value of which is 720. The caloric value of the food ingested is, then, —^Kf^ X 720 = 906.2 calories. To Estimate Weight Development of an Infant. To estimate the weight development of any infant, calculate as fol- lows: — Weight of an infant Weight index = Weight of average infant of same age Example: An infant of 18 weeks weighs 12 lbs. Its weight index =i%4=.85. Its weight development = .85X100 = 85 per cent. 430 DIET IN SPECIAL CONDITIONS TABLE V Methods of Calcalating approximately the Percentage Composition of a Food from Known Amounts of Ingredients used Let C=number of ounces of cream used. " M=number of ounces of fat-free milk used. " L= number of measures of milk sugar (or level tablespoonfuls). " Q = total quantity of mixture in ounces. ^i_ /•« \ -r, i i CXfat percentage of cream Then (1) Fat percentage = pr — ^^ ,^.-r, ^ -A ^ 3.50 (C+M). (2) Proteid percentage = — (3) Sugar percentage Q 4.75 (C+M) +40 L. Q If whole milk is used in place of fat-free milk, add to the quotient in (1) the amount of fat contributed by the whole milk, M^ standing for number of ounces used; i. e., M1X4. (4) Fat percentage in milk = — pr — Example: A 20-ounce mixture consists of 7 ounces of 10 per cent, cream, 2 ounces of fat-free milk, 1 ounce of lime-water, 10 ounces of boiled water, 2M measures of sugar. 7X10 Solution: Fat percentage = — xr: — =3.50%. Proteid " =l:M^tl)=l.57%. Sugar « ^ 4.75(7+2^40X214 ,,,3^^, The fat percentage of cream must be calculated by reference to the cream table, page 426. Infant Food — Modified Milk Formula 6 ounces cream. 4 ounces lime water. 7 teaspoons sugar of milk. 18 ounces filtered or boiled 1% teaspoons Gum Gluten Flour. water. Thin gluten with a little cold water then add to the boiled water and let boil 15 minutes. When cool add to the other ingredients. This formula is for 4 full sized bottles or enough for ten feedings, infant being fed every two hours through the 24. As child grows older, reduce the amount of cream replacing the same with milk. INFANT FEEDING 431 rOEMTJIAE FOR PREPARING INFANT FOOD FROM PURE STER- ILIZES SUGAR OF UILE Fresh, Pure Milk, 1 ounce. (about 2 tablespoonfuls ) Fresh Cream, 1% ounces. (about 3 tablespoonfuls) Sugar of Milk, 3% drachms. (4 even teaspoonfuls) Bicarbonate of Sodium, 1 grain. (or use fresh limewater, 2 teaspoonfuls) Water, 5 ounces. (11/4 gills) Mix enough for one day's use, and sterilize. Be sure feeding bot- tles, nipples, etc., are kept perfectly clean. SCHEME FOR FEEDING BABIES Society of the lying-In Hospital, New York City i First Day. — Give from nursing bottles 30 C.C. (1 ounce) of 6 per cent, sugar water every 3 hours, from 6:45 P. M. to 9:45 p. m., inclusive, and if necessary one bottle at 3:45 A. M. Second Day. — 30 to 45 C.C. (1 ounce to 1% ounce) of Formula No I in nursing bottle, every 2 hours from 6:45 A. M. to 10:45 p. m., and 3:45 A. M. — ten feedings. Third Day. — Same as second day. Fourth Day. — If there is milk in mother's breast, nurse every 2 hours as on second day. If there is no milk in mother's breast, 30 to 45 C.C. (1 ounce to 1% ounce) of Formula No. II every 2 hours, as on second day. Fifth and Sixth Day. — For breast fed babies ten feedings as in second day. For bottle fed babies same as fourth day. Seventh to Fourteenth Days. — For breast fed babies ten feedings. For bottle fed babies 30 to 75 C.C. (1 ounce to 2% ounces) of Formula No. Ill for ten feedings. Formulae Sugar Solution 6 per cent.: Take 30 grams (1 ounce) sugar of milk and dissolve in 500 C.C. (1 pint) boiled water. Formula No. I Fat, 0.5 per cent.; sugar, 6 per cent.; proteid, 0.5 per cent.: Take 6 per cent, sugar solution, 7 parts. »Diet used at the Society of the Lying-in Hospital, New York City. 433 DIET IN SPECIAL CONDITIONS Plain milk 1 part, 60 C.C. (2 ounces) lime water for every 500 C.C. (1 pint) of food mixture. Formula No. II Fat, 1 per cent.; sugar, 6 per cent.; proteid, 0.5 per cent.: Take 6 per cent, sugar solution, 7 parts; 12 per cent, cream 14 part; milk % part. 60 C.C. (2 ounces) limewater for every 500 CO. (1 pint) of food mixture. FOKMUXA No. Ill Fat, 1.5 per cent.; sugar 6 per cent.; proteid 0.5 per cent.: Take 6 per cent, sugar solution, 7 parts; 12 per cent, cream 1 part. 60 C.C. (2 ounces) limewater for every 500 C.C. (1 pint) of food mixture. Formula No. IV Fat, 2 per cent.; sugar 6 per cent.; proteid 0.6 per cent.: Take 6 per cent, sugar solution, 5 parts; 12 per cent, cream 1 part. 60 C.C. (2 ounces) limewater for every 500 C.C. (1 pint) of food mixture. Formula No. V Fat, 2.5 per cent.; sugar 6 per cent.; proteid 0.8 per cent.. Take 6 per cent, sugar solution, 4 parts; 12 per cent, cream 1 part. 60 C.C. (2 ounces) limewater for every 500 C.C. (1 pint) of food mixture. Notes 1. For every 500 C.C. (1 pint) of food mixture add 60 C.C. (2 ounces) of lime water. 2. 12 per cent, cream is the top fifth of a bottle of milk after stand- ing about 5 hours. 3. It is the top 200 C.C. (7 ounces) of 1,000 C.C. (1 quart) of milk after standing about 5 hours. 4. If the milk is of rich quality the top 240 C.C. (8 ounces) can be taken. 5. Up to two weeks the amount of each feeding is 30 C.C. (1 ounce) to 75 C.C. (2% ounces) according to weight, digestion and capacity. From two to five weeks the amount of each feeding is 60 C.C. (2 ounces) to 100 C.C. (3% ounces). Number of daily feedings 10. From 6:45 a.m. to 10:45 P.M. From 10:45 P.m. to 6:45 a.m., one feeding should suffice. INFANT FEEDING 433 PEPTOGENIC MILK POWDER MODIFIES COW'S MILK by a physiological process, makes the casein of cows' milk sol- uble and digestible like the proteins of mothers' milk, and gives a food for infants which behaves in the stomach like the food that Nature provides under favorable conditions. Directions for Using Peptogenio Milk Powder Formula 'No. 1 — For Infants of First Few Weeks Milk, 6% ozs. (% cup). Cream, 1 oz. (or "top" milk, 2 Water, 16 ozs. (2 cups). ozs.). Peptogenic Milk Powder, 1% measure. The bottle cap is the measure Place the Peptogenic Milk Powder into a clean saucepan, add the pure cold water, mix perfectly; add the fresh cold milk and cream; mix well and heat with constant stirring until " lukewarm " ( 95 to 100° F.), not too hot to he agreeably borne by the mouth; keep at about lukewarm for 8 minutes, then bring quickly just to boiling point in the open saucepan, or " pasteurise " by heating to only 160- 165° F.; pour at once into a clean bottle, cork tightly, shake thor- oughly and put on ice or in a very cold place. When a feeding is required, pour out the portion and warm to proper temperature for nursing; always shake the bottle well before and after pouring out a feeding. Formula- No. 2 — - For Infants From 1 A Sample pint bottles gladly sent post- paid to nurses, physicians, sanitariums and hospitals. Send for descriptive literature and recipes for tasty sick- room delicacies. Free upon request. The Welch Grape Juice Co. Portage Street Westfield, N.Y, 485 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 pubUc that on]y 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. F*rlce list ft^rnishLeci on applioation. C. E. CHIVTIS, - ■ MOUNT VERNON, NEW YORK 486 ORIGINAL GENUINE ni i/TM/ \LIUI\ Pure full-cream milk combined with the extracts of selected grains reduced to powder form DELICIOUS, INVIGORATING, NOURISHING 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 patients. Samples Sent Free and Ex- press Paid. ASK FOR HORLICK'S OTHERS ARE IMITATIONS HORLICK'S MALTED MILK CO. RACINE, WIS. 487 HOYrS GUM GLUTEN GUM GLUTE.N THE PURE FOOD LAW U. S. Standard for G/ufen.— "GLUTEN FLOUR is the product made from flour by the removal 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." 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 eent, protein. is guaranteed to be much richer in protein than the Government Standard 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 prepared to digest J:hein, is very probale. 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 impossijble for an infant to retain other food in the stomach, Hoytls Gum Gluten Flour, made into a gruel, may be retained, and give strength, after which milk and milk-sugar may be added. SWE-ETINA A bottle will be mailed to any address upon receipt of 25c. NEW PR.ODUCTS GUM GLUTEN DAINTY FLUFFS These are most delicate and nutritious, containing more than 80j( protein and less than 10^ starch. GUM GLUTEN BREAD STICKS and BREAD ROLLS Are relished by all who are unable to use ordinary wheat bread. Contain over 60* protein. Children like them. HOW PROCURED As a rule the leading grocer in a city is agent for Hoyt's Gum Gluten. If not easily procured write us and we will gladly .send you name of our nearest agent, price-list and starch restricted menu. Send us a 2c stamp and we will forward you a sample of our DAINTY FLUFFS. PURE GLUTEN FOOD CO. 90 W. Broadway New York 488 w*-S^ fite% ""^ PURITY ABSOLUTE FLAVOR UNIQUE NOTHING FINER PRODUCIBLE "It is our opinion the analytical tests of the UNITED STATES BUREAU OF CHEMISTRY prove NICELLE OLIVE OIL superior to all known brands tested."— STILLWELL & GLADDING, Official Chemists to New York Produce Exchange, Its Use Recoinniended by Mia ALIDA FRANCES PATTEE Miss CORNELIA C. BEDFORD MU. FANNIE MERRIT FARMER Miu JANET MACKENZIE HILL Mrs. HELEN ARMSTRONG Mia. ANNA BARROWS AND OTHERS NICELLE OLIVE OIL CO. 96 Warren Street, New York City FOREIGN OFFICES : PARIS, 10 Avenue de I'Opera NICE, 7 Place Defly 489 "I am constant as the northern, star, Of whose transfix'd and resting quality- There is no fellow in the firmament." —Julius Coisar. 490 Dear- "^mvatvLQ of Kumyss as a tod, in almo^rt-ovcf'nj morbid condition espQCiall^ whentfio stomacii and nnm- tion are involved , is so well Known ihai it iseems supor- flttous to call your attention to it's meritiS^niuttliore are, just now.iSo maumjmitations and so much si^stitutin5 that I T^ish to call wur atten- tion to the fact tliar all the genuine is istoppered Kith crown caps marked DR. E. F. BRUSH LABORATORY. MOUNT VERNON, N. Y. N. Y. Office, 217 W. 123d St. 491 Liquid Peptonoids (Emergency Food) When there is dislike for ordinary food, or inability to digest or assimilate it, to main- tain strength and tide over the emergency. Lactopeptine (Digestant) When inability exists to digest food, and digestive secretions, enzymes and functional activity need to be assisted or augmented. Borolyptol (Antiseptic) Thoroughly, pleasantly and promptly disin- fects, deodorizes and opposes germ action without irritating or any change of poisonous action. The Arlington Chemical Company The New York Pharmacal Association The Palisade Manufacturing Company Yonkers, New York "~ 492 What Two of the World's Greatest Au- thorities on Invalid Dietetics say of SANATOGEN Professor C. A. Ewald of Berlin, writing in Zeitschrift fuer diaetetische & physicalische Therapie" says: "Sanatogen, on account of its being very easily absorbed and its perfectly non-irritating character, may be used with great advantage, that is, for the purpose of increasing the nutritive value of a given diet, in all cases of physical weakness, especially in those of a chronic nature, as well as in the acute stages of all those maladies which are ac- companied by high rise of temperature, and particularly in typhoid fe'ver." Professor C. von Noorden of Vienna, states: "As the result of my trial of Sanatogen, extending over a period of several years, I regard Sanatogen as an excel- lent protein preparation. An especially responsive class of cases to its use, com- prises all diseases in which the object is to promote tissue- building, such as various forms of anemia, particularly chlorosis and most varieties of mal-nutrition, since San- atogen most energetically promotes protein assimilation." It is safe for you to follow their lead and the lead of 18,000 physicians who have recommended Sanatogen over their signatures as a reconstructive tonic during Fevers and Convalescence, after Operations, in Gastro-Intestinal Disturbances, in Neurasthenia and wherever the object is quickly and effectually to improve the patient's strength and vitality. Sanatogen is purest albumin in combination with sodium glycerophosphate-it is free from purins, fatorstarch, and may be used safely for diabetic or gouty patients. Sample and literature free to Nurses. THE BAUER CHEMICAL CO. 30 IRVING PLACE :: :: NEW YORK The Grand Prix was awarded Sanatogen at the International Congress of Medicine, London, 1913. 493 A NEW EDITION REVISED AND ENLARGED INSTITUTION RECIPES FOR USE IN SCHOOLS, COLLEGES. HOSPITALS. AND OTHER INSTITUTIONS By EMMA SMEDLEY Superintendent of High-School Luncheons^ Philadelphia, Pa.; Formerly Instructor in Domestic Science, Drexel institute, Philadelphia ; and Instructor in Dietetics, The Johns Hopkins Hospital Training School for Nurses, Baltimore, Md. npHIS work will prove indispensable to the dietitian in schools, hospitals and other institutions where attractive, wholesome and economical food in large quantities is demanded. The recipes have been carefully tested in actual daily use, and, unlike the usual cookery book designed for use in the home, they are here given in quantities to serve either fifty or one hundred and fifty portions. In addition to the many valuable recipes, the book contains chapters which deal with the equipment of the institution kitchen, and the equipment, menu and ad- ministration of the high-school luncheon. " Institution Recipes " has been greatly appreciated by all who have used it, and this enlarged edition will answer the repeated requests for a fuller treatment of the subject. Price, $1.25 net By Mail, $1.35 C. 0. D., $1.50 FOR SALE BY A. F. PATTEE, Mt. Vernon, New York 494 COX'S Insta.nt Powdered GELATINE GELATINE was first made Ijy J. & G. Cox as a substitute for calves' feet in tlie preparation of a nutritious food for invalids, about tlie year 1845. For many years it was sold only by Druggists as a specific for invalids througb medical suggestion. COX'S liSTSTANT POWDEEED GEEATINE is produced under ideal condi- tions, and is the PUEEST and most economical Gelatine on the market. Sold by all Grocers. ALWAYS in the Eed, AVhite and Blue CHECIvEEBOAED Packages. Cox's Manual of Gelatine Cookery, containing over 200 recipes, will be sent, post- paid, on request. THE COX GELATINE CO. {Representing J. & G. Cox, Limited) 100 Hudson Street New York 495 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 496 THERAPEUTIC APPLICATION 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 integrating 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 anaemic and chlorotic conditions due to an insufficient supply of red blood corpuscles or lack of haemoglobin, or both, and more remotelv 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 Gum Gluten Flour should ,be added to cow's milk to keep it from coagulating and fermenting. 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. Write us for price-list and our new starch restricted diet-list to give out to your patients. PURE GLUTEN FOOD COMPANY 90 W. BROADWAY NEW YORK 497 THE fiazette Pocket Speller and Def iner {Second, Revised Edition) POCKET^PBLLER ■ DEFINKR' . . THIS uniqje volume is a combined Eng- lish and Medical Dic- tionary. It is a marvel of Correctness, Com- pactness and Complete- ness. Bound in leather and gilt. REF/EIVS An extremely conveni- ent little manual. —Med. Kecord, A very convenient vest- pocket reference book* — Jjitrnal A ni. Med. Assn. It is certain to be popu- lar.— yJ/^i-j. Med. Jo2ir- nal. It surpasses all the smaller dictionaries published. —Med. Brief, It is remarkably com- plete, condensed and comprehensive. — (ONE-FOURTH SIZE) Atlanta- Constitution. PRICE, 50 CENTS Send for Specimen Pages a?id Other Particulars THE DIETETIC AND HYGIENIC GAZETTE 206 Broadway New York City 498 THE Pennsylvania Orthopaedic Institute AND School Of Mechano-Therapy (Incorporated) 1709-1711 Green Street - - Philadelphia, Pa. OFFERS Scientific Courses in Mechanical Treatments. COURSES IN MEDICAL MASSAGE SvFedish Movements, Medical and Orthopaedic Gymnastics Term: 4 Months - - Tuition Fee. $85.00 Course in Electro-Therapy Term: 2 Months ... Tuition Fee, $25.00 Course in Hydro-Therapy in all its Forms Term: 6 Weeks - - - Tuition Fee, $30.00 Classes open in January, March, May, July and October All courses may be commensed at the same time and finished within four months. The instruction consists of daily clinical work and prac- tical lessons on patients referred to our clinics from various Hospital Dispensaries. Lectures and Quizzes on Anatomy, Physiology and Pathology by Physicians of the staff. Demonstrations and Instruction in the use of all mechanical apparatus. Complete Medico-Mechanical Zander Gymnasium. X-Ray Laboratory. 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 early application for admission is advisa- ble. A diploma is awarded at the end of the term. Private Sanatorium for Nervous, Medical and Surgical cases, connect- ed with the institute. Special attention paid to proper diet. STAFF OF INSTRUCTORS J. Madison Taylor, A... M.D.(Umv. of Penn.; Assoc. Prof.of Non-pharmaceu tic. Therapeutics, Med, Dept. Temple Univ.) Daniel M. Hoyt, M. D. (Univ. of Penn.) Howard A. Sutton, M.D.(ln5tnictor[Univ. of Penn.) Eldridge L. Eliason. M. D. (Instructor Univ. of Penn.) Fred D. Weidman, M.D (Instructor Univ. of Penn. and Woman's Med. College). fi. B.Vincent Lyon, M.D. (JohnHopkins Univ.; Bacteriologist and Pathologist to German and Methodist Hospitals.etc). Wm. Erwin, M. D, (Hahnemann and Rush Medical College.) For all further information and illustrated prospectus address the Superintendent. MAX J. WALTER, M. D., Supt. Louis H. A. von Cotzhausen, Ph.O.M.D. (Grad.Phila.Col.Pharm., Med. Dept.; Univ. Penn.; Penn. Orthopaedic inst.) Max J. Waller. M. D. (Univ. of Penn.; Royal Univ. Breslau, Germany, and lecturer to St. Joseph's, St. Mary's, Mt, Sinai, and W. Phila. Hospital for Women, Phila. General Hosp.[BlockIey] Cooper Hospital, etc.) Tyra Gowenius, (Royal Gymnastic Central Insj. and Dr. Arvedson's and Dr. Kjellberg'slnst. Stockholm, Sweden. ) LillieH. Marshall, Fannie S. Frantz 1 Edith W. Knight, Elizabeth Jamison I Pennsylvania Orthopaedic Institute. 499 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 500 Intforma are ready for wear and are sold by good stores in near- ly every city. They are the re- sult of many years of careful study of the needs of a train- ed nurse, and have a national reputa- tion for quality, splendid workman- ship and fit. Made in all sizes and various models and materials. An illustrated folder, swatches of mater- ials and name of local dealer gladly furnished. Write to HENRY A. DIX & SONS CO. NEW YORK Our label is on every garment for your protection. 501 "Not What We Have But What You Want" INC. MEDICAL HOUSE 52 West 39th Street, New York City DEPARTMENTS Home Bureau-Medical House Nurses—For every kind of a case hospital and private. Delicacies— For the Sick, Broths, Purees, Gruels, Beverages, Jellies, Eggs, etc., on hand and to order, Manuel Freres' Swiss products. Surgical Dressings—For Operations, Sterilized Maternity Outfits in sealed boxes. Laparotomy Kits, Adenoid and Tonsilitis Sets. Medical Supplies— of every kind for the sick room and the hospital. Invalid Furniture— Chairs, Back Rests, Bed Trays, Stretches, Oper- ating Tables, Sterilized Sheets, Towels, Surgeons' Gowns, etc., sold and rented. Invalids Moved— anywhere from city to country, and house to house, room to room, and up and down stairs. Rest Cure Apartments— attractively and daintily furnished for con- valesecent and test cure patients. Houses and Rooms— fumigated and disinfected by the most approved methods without annoyance to householders or patients. Purchases— made of anything for hospitals, physicians, nurses and in- valids. Photographs submmitted, estimates furnished. Mail Orders— for sick room and hospital supplies promptly and efficient- ly filled. Information— given about everything pertaining to the sick room and hospital. Sanatariums and Houses recommended. Open Day, Night, Sunday and Holidays 502 Coward Shoe R£C U.S PAT OFF Shoes that rest tired feet Every nurse knows what it is to have tired, aching feet. The remedy is to wear shoes that rest the foot muscles, and help them over the hard places. Your feet need the friendly offices of COWARD ARCH SUPPORT SHOES made on special Coward Lasts for nurses. Wear them, and your feet will feel very different at the end of your long day. The benefit is immediate — the easement lasts. Pain is relieved, muscles stop aching, ankles and arches are steadied and strength- ened — leaden steps become buoyant. Try them. Coward Arch Support Shoe and Extension Heel, have been made by James S. Coward in his Custom Department, for over 33 years. JAMES S. COWARD ''tiiillt.lZ't''- NEW YORK Mail Orders Filled SOLD NOWHERE ELSE Send lor Catalogue 503 Hand-I-Hold BABE MITS AND THEIR USES. ^ _^ TO PREVENT SCRATCHING. ECZEMA, THUMB SUCKING, LEFT HANDEDNESS, NAIL BITING. INVALUABLE IN HOSPITAL E R V I C E, ETC., ETC. •■HAND- I-HOLD' BABE MITS are light-weight, daintily enamelled balls, spun without seam from al uminum. They are ventilated 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, 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-I-Hold" Babe Mits. R. M. Clark & Co. 246 Summer St., BOSTON, MASS. 504 THE THREE (3) HYGEIA NURSING BOTTLES TAKE YOUR CHOICE THE NON-BREAKABLE HYGEIA is made without glass. There isnothing to break. Thecozy keeps the food warm. The food- bag collapses, and air does not enter the bottle. Only two parts to clean, and these two parts can be turned inside out, something im- posible with any other nurser. The food-bag is made of pure gum, and lasts a long time, so that the breast-nipple is about the only part necessaryto replace frequently. THE TWIN HYGEIA is open at both ends, so the food cavity is easily accessable for cleaning. It has two breasts one of which forms the base of the bottle. This can The Non-break- able Hygeia B — Breast J — Jacket open at the bottom V — Ventinjacket s— Food bag goes be vented or not, as preferred. down as food goes out. THE REGULAR HYGEIA so long and favorably known, is now brought out with a new breast, with hidden shield, which prevents baby taking any portion of the breast into its mouth. ALL PARTS SOLD SEPARATELY BY ALL DRUGGISTS THE BALL-CUP NIPPLE, which has the puncture at the bottom ofthe cup, away from the tip, where it is protected from enlargement, regu- lates feeding better than any other nipple on the market, and will not collapse. It is a •mail nipple for a small neck bottle only. WRITE FOR OUR BOOKLET The Twin Hygeia BaH-cup HYGEIA NURSING BOTTLE CO. DEPT. A. 1204 MAIN STREET BUFFALO, N. Y. 505 The BEST WORK PUBLISHED for HOSPITAL INTERNES and SURGICAL NURSES THE SURGICAL ASSISTANT (SECOND EDITION) BY WALTER M. BRIGKNER, 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 : Xhc Oeneral Conduct of the Assistant; the Interne; Assistance at Dressings. Fracture Reductions, etc. Preparation of an Operating Room. Xhe Technic of Asepsis In all Its Fractlcal Bearlnea. Prep- aration of the Pniient. The Anesthetist. Preservation and Sterili- sation of Instruments and Accessories. Formulas and Methods of Surgical Sterilization* Hovr to **Hand*' Instruments. Technics of Assistance In the "Various Operative manipulations. Immediate After-Cure of the Patient. Formulae of Solutions, etc. lustrnments and Accessories (and their preparation) for each operation, etc** etc. The only book that is devoted to the methods and duties of those who ASSIST the surg-eon, and contains descriptions of all the important operations, step by step,/riJ?« the assistants standpoint. Bound In Cloth, 363 Pages. Price, $2.00 Postpaid. 123 Original Illustrations. INTERNATIONAL JOURNAL OF SURGERY COMPANY Medical Publishers 100 WILLIAM STREET, £06 NEW YORK, U. S, A. Im^^^^^^ VAPORIZER IS SIX INCHES HIGH Established 1879 LASTS A LIFETIME Treatment without internal medication is highly desirable in Whooping Cough and. Spasmodic Croup, particularly in the very young. The value of Vapo-Cresolene depends upon its antiseptic power and the sedative influence of the vapor diffused through the air, and thus constantly breathed by the patient. Breathing becomes easy, desire to cough is allayed and the patient gains needful rest. The diseasesin which Cresolene has been especiallyutilized are Whoop- ing Cough, Spasmodic Croup, Bronchitis, Asthma, inflammatory condi- tions of the throat, the bronchial complications of Scarlet Fever and .Measles and as an aid in the treatment of Diphtheria. A \% solution of Cresolene in water kills the germs of Diphtheria, Typhoid Fever and pus at once. Cresolene is less toxic than carbolic acid and has a greater germicidal value. For sale by all Druggists. Literature on request. THE VAPO-CRESOLENE CO. 62 Cortlandt Street, New York City, Leeming-Miles E..nlding, Montreal, Canada. 507 EXCELSIOR QUILTING COMPANY The Excelsior Quilting Company make Quilted Pads of the correct weight for washing properly and of best material. Their "trade mark" is on every pad which they guarantee to be sanitary and perfect. Be careful and guard your beds against "sweat shop goods" and imi- tations which unscrupulous dealers oflfer you because they make more profit. Look carefully at this trade mark so you will know it when you go to 'shop". "None genuine without Trade Mark." 508 THE STORM BINDER AND ABDOMINAL SUPPORTER Patented IS ADAPTED TO USE OF MEN, WOMEN. CHILDREN AND BABIES NO WHALEBONES NO RUBBER ELASTIC Washable as Underwear Light Flexible Durable Comfortable SPECIAL support in cases of prolapsed kidney, stomach, colon, re- laxed sacroiliac articulations, and hernia; GENERAL support in pregnancy, obesity and general relaxation; a POSTOPERATIVE Binder after operation upon the kidney, stomacfi, bladder, appendix and pelvic organs, and after plastic operations and in conditions of irritable bladder to support the weight of the viscera. Try it for CHRONIC INDIGESTION due to Ptosis of Stomach or Colon. Send for Illustrated folder and testimonials of physicians. NURSES GIVEN AGENCIES UPON APPLICATION General Mail Orders Filled at Philadelphia KATHERINE L. STORM, M.D. 1541 Diamond Street PHILADELPHIA 509 THE "NEAL" POR.TABLE RUBBER BATHTUB FOR CHILDREN This unique and pretty little Sanitary Bathing Apparatus lor Infants is one of the best and most useful bathtubs on the market. It has boen 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 hct-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 tor catalogue and price list to Miss S. C. NEAL, Patentee and Manufacturer, 9(i FIFTH AVENUE, New York City, U. S. A. 510 Ask your physician A user of Mennen's recently wrote us the following letter: My brother had a long spell of typho-malaria fever and, of course, was com- pelled to lie in bed many weeks. He suffered very much from bed sores. They were very large on one of his heels, his hips, shoulders and elbows. The nurse began bathing these in alcohol and then covering them with Mennen's Borated Talcum Toilet Powder. They had almost en- tirely disappeared in about ten days. The nurse would use no other but Mennen's as she said it was pure and contained healing qualities." Your physician will tell you that Mennen's Borated Talcum Toilet Powder, because it is soft, pure and efficiently medicated, is the right powder to comfort and soothe the skin, and aid in keeping it healthy. Sample box 4c in stamps. Sold by all druggists. Manufactured by Gerhard Mennen Co. Newark, N. J. rUAUEMARK 511 Every Nurse should read this book PLASTER OF PARIS AND HOW TO USE IT Second Edition. Revised and Enlarged By MARTIN W. WARE, M.D. Adjunct Attending Surgeon Mount Sinai Hospital, New York, Surgeon to the Good Samaritan Dispensary; Instructor in Surgery New York Post-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 instruction upon the subject which this book so explicitly, practically and comprehensively covers, but because this knowledge 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 is adaptable in Surgery. The whole subject, from 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 ia presented in the artistic manner characteristic of the pro- ductions of the Surgery Publishing Company. It is printed upon coated book paper, and attractively bound in heavy blue buckram, stamped in white leaf and gold. Price, $1.00, Postpaid. 90 illustrations. Special Edition de Luxe, ooze leather, gold edges and stamped, $2,50. "This little book gives in a comprehensive way the various uses in which Plaster of Paris may be put by the surgeon. The subject is clearly presented, and with the illustrations, the book makes a manual of instruction"— Journa/ of The American Medical Association. "The book will be a help to the student or practitioner unfamiliar with the thousand and one ways in which plaster bandage may be most conven- iently used." — Surgery, Gynecology and Obstetrics, 1000 SURGICAL SUGGESTIONS By DR. WALTER M. BRICKNER Assistant Adjunct Surgeon Mount Sinai Hospital, and Chief of Surgical Department Mount Sinai Hospital Dispensary, New York; Editor-in-Chief American Journal of Surgery, AND DR. E. MOSCHCOWITZ Assistant Physician Mount Sinai Hospital Dispensary, New York; Associate Editor American Journal of Surgery. In this, the fourth edition, while we could not improve the quality, we have increased the number of "Suggestions," making this book, we believe, the most complete, practical and useful manual of surgical sugges- tions, practical diagnostic hints and useful therapeutic wrinkles ever produced. Regular Edition, cloth, Semi de Luxe, Stamped in gold. Printed upon heavy india tint paper, with Cheltenham type, marginal headings in con- trasting ink. Price, $1.00, Postpaid Special Full Library Edition de Luxe, limp ooze leather binding, artistically lined, stamped in gold, with gold edges, $2.25, postpaid. "They are of practical character, and the surgeon as well as the general practitioner may peruse them with profit."— j y^iu York State Medical Journal. "Will prove practically invaluable to every physician practicing major and minor surgery, as well as to the general practitioner as an aidin surgical diagnosis. A veritable store house."— A'eiy York Medical Journal, SURGERY PUBLISHING CO. J. MacDONALD, Jr., M.D., President, 92 William St., N.Y.. U.S.A. 513 GALEN HALL by the Sea ATLANTIC CITY, N. J. HOTEL AND SANATORIUM Resident physician and Nurses. Diet Kitchen also Bath Department giving 60 varieties of Tonic and Curative Baths. GALEN HALL in the Mountains WERNERSVILLE, PA. A First Class Hotel with the advantages of a Sana- torium. Resident physician and Baths, under same management as Atlantic City. 513 Of Interest to the Super= intendent and Nurse JOURNAL COMBINATION OFFERS THE FOLLOWING OFFERS APPLY y TO NEW SUBSCRIBERS ONLY J"V THE TRAINED NURSE ($2.00) and one ' f, 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).. $3.25 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) $2.50 A. F. Pattee 134 South First Avenue Mt. Vernon, N. Y 514 TRADE (^AVOL) "*f"< A NECESSITY IN EVERY HOME ^"^ SICK ROOM Cautery Sets Commode Seat Complexion Bulb Dental Dam Diapers Dilators Cupj}ing Cups Sanitary Covers Sheeting^ Stomach Evacuator Stomach Tubes Stoppers Breast Pipes Breast Pumps Breast Shields Face Hoods Face Bottles Finger Cots Fountain Syrioc-e Bairs Teething Pads * Teething Rings Vaporizers Water Bags Water Beds Water Bottles Water Caps Woman's Delight Tourniquets Tubing Turkish Bath Cushions Umbilical Belts DAVOL TRADE MARK "HOUSEHOLD" (registcred) 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 Baf 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 Syringes— Fountain Syringes— Gem Sjnringes — Infant Syringes— Ladies Syringes— Nasal Syringes -Rectal Syringes— Six-Ounce Bulb Syringes— Urethral Syringes— 171 cer and Ear Syringes- Vaginal Douche' Abdominal Coils , Air Beds . '^^'^ t-"""- w*^ "amc /p-^iw^p Air Pillows IS on every article you V jjMVVU , AtonSzers- purchase for home use. trademark Gem Cleansers Gloves Head Coils Hospital Cushions Hospital Air Cushions ' Household Syringes Hqjpsehold Ladies* Syringe Household Vaginal Douche Ice Bags Ice Caps Invalid Rii^s Irrigating Tubes Kelly's Operating Cushions i Kidney Pads 'Indies' Syringes 'Medicine Droppers Marsh Patented Finger Pads for counting money or papers SEE that the Name .ORX>SR FROM VOX7B. X>R.UGOIST 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 Pill9w Vents Plant Sprinklers Plaster Bowls Politzer Bags Powder Blowers Bandage Gum 'Bandages Barbers' Bibs Barbers' Atomizers Basin, Folding Bath Tubs ^Batb Spray DAVOL RUBBER COMPANY MANUFACTURERS OF STRICTLY HIGH-GRADE RUBBER GOODS FOR THE * PROVIDENCE, R. I., U. S. A. 515 'HOUSEHOLD" fiingham for Nurses' Uniforms A. F. PATTEE 134 South First Avenue Mount Vernon, N. Y. 516 "NO OIL TO SOIL" HOWARD EXTENSION HANDLE DUSTER MADE WITH FINE QUALITY LONG FIBRE COTTON WILL WEAR FOR YEARS THE LAST WORD IN DUSTLESS DUSTERS Howard Extension Handle Dusters Will dust where no other handle duster can reach. Covers more surface than any other duster made. Will dust equally well Furniture, Floors, Walls or Ceilings; under and around Radiators without stooping. Treated with our exclusive process. CLEAN AND STERILIZE WITH HOT WATER AND SOAP. „„y„„ ■ , ■• ., £ . . • u ji r House size $1.25 PRICE, mcludmg three-foot extension handle |j^_^;,^^,^ ^-^^ 5j_7g The Howard Dusters are used in more than 500 Schools in U. S. They are the Government Standard and the Standard of the world. St. Louis School Board have ordered 20,000. 12 Different Styles for all purposes. Send for Dust-book and Small free sample Look (or the Red Diamond Trade Mark HOWARD HOWARD DUSTLESS-DUSTER CO. 200 SUMMER STREET BOSTON, MASS. 517 B 5B5B5HSa5H5H5H5E5B5g5B5g5g5a5S5B5E5BSa a g West, North or Northwest C[ Be sure your tickets read via the ^ Chicago and North Western Railway, the pioneer line west and northwest of Chicago. ^ A through train service of recog- ^ nized superiority is maintained, that includes modernly equipped fast daily trains to the impor- tant cities in the West, North and Northwest and also to all the famous ocenic attractions found in 'Wisconsin, Northern Michigan, Minnesota, the Black Hills, Yellowstone National Park, Yosemite National Park, Colorado, Utah, California, Oregon, Waehington and the Pacific Northwest. Low Round Trip Summer Fares fll The palatial neiv Passenger Terminal in Chicago — is par- ^ ticularly adapted in many ways to the convenience of parties on extended tours. The Best of Everything Chicago and North Western Railway A. C. JOHNSON C. A. CAIRNS P. T. M. G. P. & T. A. Chicago. 111. NWa838 E5E5E5ESE5S5H5H5E5g5g5E5H5E5S5g5B5a5g5 I 518 Do Yott Play Solitaire? THE SMITH SOLITAIRE BOARD Can be used anywhere and in any position. No Table Needed The cards ate held securely in place and yet can be moved with ease. Can be used in bed. In a hammock. On the train. On the deck of a steamer. A luxury for the well and a necessity for the sick and con- valescent. Price $2.00 Express prepaid For further particulars write to The Smith Solitaire Board Co. 7600 Wornall Road KANSAS CITY, MO. 519 Pattee's Hand=Bag Diet Book Consisting of Measures and Weights, Recipes and Hospital Dietaries REPRINTED FROM Pattee's "Practical Dietetics with Reference to Diet in Disease" IN response to requests from a large number of nurses these extracts from the Pattee's "Practical Dietetics with Reference 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 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. 520 COUPON The possession of this coupon entitles any nurse to the right 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 Name Address- 521 INDEX TO SUPPLIES FOR THE HOSPITAL— HOME— PHYSICIAN— NURSE FOODS: Cox's Gelatine 495 Crackers— Bent's Water Crackers, Cracknels, N. B. C. Gra- ham Crackers, N. B. C. Oatmeal Crackers, Uneeda Bis- cuits, Water Thins, N. B. C. Zwieback 481 Dr. Brush's Kumyss '. 490-491 Horstord's Acid Phosphate 478 Horlick's Malted Milk 487 Hoyt's Gum Gluten 488-497 Jell-O 483 Junket 480 Junket Brand Buttermilk Tablets 480 Lactopeptine 492 Laibose 482 Liquid Peptonoids 492 Mellin's Food 463 Minute Tapioca 484 Nicelle Olive Oil 489 Panopepton 482 Peptonising Tubes 482 Preserves, etc.. Home-made 486 Rumford Baking Powder 446 Sanatogen 493 Walter Baker's Breakfast Cocoa 477 Welch's Grape Juice 485 MISCELLANEOUS SUPPLIES: Borolyptol 492 Chicago & North Western Railway 518 Coupon for Pattee's Handbag Diet Book 521 Coward Shoe 503 "Davol" Rubber Company 515 Dietitians' Registry 500 Dix-Make Uniforms 501 Excelsior Quilted Mattress Pads 508 Fellow's Syrup of the Hypophosphites 479 Galen Hall 513 Gazette Pocket Speller 49g Gingham for Nurses' Uniforms 516 "Hand-I-Hold" Babe Mits .' . . ' 504 Home Bureau 502 Howard Dustless Duster 517 Hygeia Nursing Bottle 505 Institution Recipes [ 494 Journal Combination Offer '.]'.'.'. 514 Mennen's Toilet Powder 5II "Neal" Bath Tub for Children '.'.'.'..'. 510 Packer's Tar Soap '\\ 464 Pattee's Handbag Diet Book ' ' 520 Pennsylvania Orthopaedic Institute and School of Mechaiio- Therapy 499 "Smith" Solitaire Board 519 "Storm" Binder and Abdominal Supporter \[[[ 5q9 Surgery Publishing Company .'.'.'.' 512 The Surgical Assistant ' 506 Vapo-Cresolene ] 50Y By writing to the above firms useful literature and samples will be forwarded upon request. In writing mention Pattee's Practical Dietetics and prompt attention will be given to your letter. 522