LIBRARY OFTHE 
 NEW YORK STATE COLLEGE 
 OF HOME ECONOMICS 
 
 CORNELL UNIVERSITY 
 ITHACA, NEW YORK 
 
Cornell University 
 Library 
 
 The original of tliis book is in 
 tine Cornell University Library. 
 
 There are no known copyright restrictions in 
 the United States on the use of the text. 
 
 http://www.archive.org/details/cu31924003497132 
 
NUTRITION 
 AND SPECIFIC THERAPY 
 
THE MACMILLAN COMPANY 
 
 mWYOSK ■ BOSTON ■ CHICAGO ■ DALLAS 
 ATLANTA ■ SAN FEANCISCO 
 
 MACMILLAN & CO., Luoted 
 
 LONDON ■ BOMBAY • CALCUTTA 
 UELBOimNB 
 
 THE MACMILLAN CO. OF CANADA. Lm. 
 
 TOKONTO 
 
NUTRITION 
 AND SPECIFIC THERAPY 
 
 BY 
 
 DOROTHY E. LANE, S.B. 
 
 THE MACMILLAN COMPANY 
 1922 
 
 All rights reserved 
 
FEINTED IN THE UNITED STATES OF AMEEICA 
 
 
 ^--^ 
 
 '.ij^^- i^o^i^^ 
 
 a 
 
 COPTMOHT, 1922, 
 
 By the MACMILLAN COMPANY. 
 
 Set up and printed. Published May, 1922. 
 
 Press of 
 
 J. J. Little & Ives Company 
 
 New York, U. S. A. 
 
To The Memory op Mt HirgBAin) 
 MICHAEL A. LANE 
 
 SCIEITTIST, SOCIOLOQIST, SCHOLAB 
 AKD LEADER 
 
 I DEDICATE THIS BOOK 
 
 "Strong like the sun, and like the sunlight kind, 
 Heart that no fear, but every grief might move 
 Wherewith men's hearts were bound of powers that bind." 
 
 Swivhwme. 
 
PREFACE 
 
 The many demands during tlie past seven years for a 
 book, based on my dietetic lectures to students, have 
 prompted me to gather my material, and publish it in this 
 little volume. 
 
 The book is the result of my own convictions and experi- 
 ments, based, except where the author is quoted, on scien- 
 tific facts and the researches of many of the best authorities 
 of the world. 
 
 To the reader, the chapters discussing the cooking of 
 foods, the value of milk as an article of diet both for chil- 
 dren and adults (infants excepted), and the chapter on a 
 meat diet, may appear somewhat reactionary. But to these 
 readers I wish to say that it is due to my somewhat radical 
 convictions that my experience with diet patients has been 
 successful. 
 
 I have endeavored to present the subject matter in a very 
 concise and practical form, and to give some information 
 which possibly cannot be found as yet in other books of 
 this nature. With this in mind, the chapters have been 
 written on Auto-intoxication, Bacteeiologt of thb 
 Digestive Tbact, Refokming the Intestinal Floka, 
 and ViTAMiNES, subjects which are of vital importance 
 taken in conjunction with the study of nutrition. The 
 hope is entertained that these chapters, together with the 
 chapters on Diet in the Common Diseases, and In- 
 fants' Diets; Children's Diets, based on many of the 
 most recent researches, if not convincing — either through 
 omission or error on my part — ^may prove to stimulate in- 
 terest and many questions. The remaining chapters have 
 been planned to lend interpretation to these subjects. 
 
viii PREFACE 
 
 I wish to express my deepest appreciation of the great 
 inspiration that my husband's companionship afforded me 
 in my work, and of the reports on clinical cases, from his 
 pathological laboratory, based on the results of my diets, — 
 without these much of the material in this book would 
 have been impossible. 
 
 DoKOTHT E. Lane 
 
 March 19, 1922 
 
CONTENTS 
 
 CHAPTER FAQB 
 
 I. Explanation op the Subject op Nutrition . 1 
 
 II. Food Pbepakation 20 
 
 Eaw Poods and Eppects op Cooking upon 
 Foods and Conclusions 
 
 III. Meat or Mixed Diet versus Vegetarian or 
 
 Lacto- Vegetarian Diet . . . , . 29 
 
 IV. Auto-intoxication 46 
 
 V. Bacteriology op the Digestive Tract . . 58 
 
 VI. Eeforming thb Intestinal Flora ... 65 
 
 VII. Diet in the Common Diseases 76 
 
 VIII. Inpants' Diets; Children's Diets ... 96 
 
 IX. Vitamines 136 
 
 X. A Few Healthful Recipes; Some Invalid 
 
 Recipes 150 
 
 Miscellaneous Subjects 
 
 Index l^T 
 
 a 
 
NUTRITION 
 AND SPECIFIC THERAPY 
 
NUTRITION AND 
 SPECIFIC THERAPY 
 
 CHAPTEE I 
 
 EXPLANATION OP THE SUBJECT OF NUTRITION 
 
 We hear and read that God intended the human race to 
 eat certain foods, while others He did not create for human 
 consumption. But it is a known fact that the great major- 
 ity of people eat what they like and want, what environ- 
 ment and habit have accustomed them to demand, regard- 
 less of what is best for their bodies, and they exert a vast 
 amount of labor in making many God-made natural foods 
 as unnatural and artificial as possible. 
 
 The study of evolution proves the human race is what it 
 is to-day because of its reactions to environment, and the 
 foods it has eaten. Had man cultivated and eaten, of his 
 own free will, other foods than those he has chosen, he 
 would be a very different organism than he is to-day. 
 
 The study of immunology teaches that some people are 
 immune to certain diseases, while others are not. This 
 fact is also a result of the reactions of man to environment 
 and of the chosen foods. What is food for one man is 
 many times poison for another in the same locality, and in 
 different environments under different conditions of living 
 there is much diversity in the foods favored, or those relied 
 upon through necessity. Strawberries, for example, are 
 
 1 
 
2 NUTRITION AND SPECIFIC THERAPY 
 
 a food for one person, but a poison for another in the same 
 town. Again, a person can digest some foods on a cold 
 day that cause nausea on a hot day. It is well known many 
 people are immune to certain diseases in summer, but are 
 very susceptible to them in winter. , 
 
 It must be concluded that man to-day is what he is 
 because of his habits through countless ages, and there- 
 fore, he will be to-morrow and in the far future a result 
 of what his habits are to-day. So it is of the greatest 
 importance that he choose the foods that are best for his 
 own particular body in the environment in which he lives. 
 
 This is what the subject of nutrition teaches. It ex- 
 plains the composition of foods, how much heat and 
 energy they produce, and how much new tissue they build ; 
 it tells about the digestibility and assimilation of foods; 
 it takes up the subject of age, sex, occupation, and climate 
 in relation to the different foods; and lastly it considers 
 the food question in relation to diseases. 
 
 In order to do justice to this subject of nutrition and 
 therefore to the human body, it is absolutely necessary to 
 have a certain amount of knowledge of inorganic, organic, 
 and physiological chemistry, of bacteriology and pathology. 
 The lack of knowledge in these subjects accounts for much 
 of the confused literature published on the food question 
 and its relation to the body. With the above subjects in 
 mind, the meaning of food composition should first be 
 considered. 
 
 Food Composition. — All foods are, composed of the so- 
 called five food principles, — ^protein, fat, carbohydrate, 
 mineral matter and water, or any combination of these. 
 
 Protein is a combination of the elements carbon, hy- 
 drogen, oxygen, nitrogen, generally sulphur, and some- 
 times phosphorus and iron; or it is, in other words, a 
 complex of amino-acids linked together, with generally 
 sulphur united in probably several different ways, and 
 sometimes phosphorus and iron. 
 
THE SUBJECT OF NUTRITION 
 
 3 
 
 There are many different kinds of simple proteins, and 
 the variety of ways in which the different amino-acids are 
 combined, determines the different kinds of proteins in 
 foods. 
 
 AMiNO-Acros IN Common Proteins (Hammarsten and Hedin).' 
 
 Osborne 
 
 and 
 
 Clapp 
 
 Osborne 
 
 and 
 
 Clapp 
 
 Osborne 
 
 and 
 
 Quest 
 
 Osborne, 
 Jones, 
 
 Ola/pp 
 
 Legumin 
 
 Hordein 
 
 Gliadin. 
 
 Zein 
 
 GlycocoU 
 
 Alanine 
 
 Valine 
 
 Leucine. 
 
 Isoleucine 
 
 Serine 
 
 Aspartic Acid. 
 Glutamic Acid 
 
 Cystine 
 
 Phenylalanine. 
 
 Tyrosine 
 
 Proline 
 
 Oxyproline 
 
 Tryptophane. . 
 
 Histidine 
 
 Arginine 
 
 Lysine 
 
 0.38 
 2.08 
 1.0' 
 8.0 
 
 0.51 
 5.3 
 
 13.8 
 
 3.75 
 1.55 
 3.22 
 
 2.42 
 
 10.12 
 
 4.29 
 
 0.0 
 0.43 
 0.13 
 5.67 
 
 43.19 ' 
 
 5.03 
 
 1.67 
 
 13.73 
 
 1.28 
 2.16 
 0.00 
 
 0.68' 
 2.0 
 3.38 
 6.62 
 
 0.13 
 0.58 
 
 43.66 
 0.45 
 2.35 
 1.20 
 
 13.22 
 
 0.0 
 
 9.79 
 
 1.88 
 
 19.55 
 
 1.02 
 
 1.71 
 
 26.17 
 
 6.55 
 
 3.55-10' 
 
 9.04 
 
 1.00 
 0.61 
 3.16 
 0.00 
 
 0.82 
 1.65 
 0.00 
 
 ■. Abderhalden and Babkln. 
 ^ Osborne and Jones. 
 ■ Abderbalden and Samuely. 
 " Kutscher. 
 
 Take for example the legumin of peas, and the gliadin 
 of wheat, — ^the former is lacking in isoleucine, cystine, 
 oxyproline and tryptophane, while the latter is lacking only 
 in isoleucine and oxyproline. (This fact is important and 
 will be referred to later on.) There is the protein of bar- 
 ley called hordein, the protein of com called zein, the 
 * "A Text-book of Physiological Chemistry." 
 
4 NUTRITION AND SPECIFIC THERAPY 
 
 protein of milk called casein, the protein of egg called egg 
 albumin, the protein of muscle called myosin, etc. The 
 list of the many kinds of protein in foods is a long one. 
 
 Proteins differ in another respect also which gives a very 
 interesting and important classification, — and in this they 
 are divided into animal protein and vegetable protein. 
 There is more nitrogen in vegetable protein and more car- 
 bon in animal protein. The nitrogen of vegetable protein 
 is not as well absorbed as the nitrogen of animal protein 
 for two reasons — first, it is more or less surrounded by 
 starch and cellulose and for this reason it is difficult for 
 the digestive juices to penetrate to it, and secondly, some 
 of the nitrogen seems to be tied up chemically in such a 
 way that it cannot be so completely absorbed. These facts 
 are some of the arguments put forth against vegetarian- 
 ism. (The significance of these facts will be discussed in 
 Chapter III.) Atwater and Bryant give the absorption 
 of animal and vegetable proteins as follows : — 
 
 Kind Protein Utilized 
 
 Animal foods 97 per cent. 
 
 Cereals 85 " " 
 
 Dried legumes 18 " " 
 
 Vegetables 83 " " 
 
 Fruits 85 " « 
 
 These two kinds of protein, animal and vegetable, how- 
 ever, perform the same mission. They are called "tissue- 
 builders." This is their purpose, but they are relied upon 
 also to some extent, under certain conditions, to produce 
 heat and energy for the body. Protein enters into the com- 
 position of all the body fluids and is a part of every cell 
 nucleus. No life can exist without it. Therefore, since 
 it is of such great importance, the absorbing question 
 arises, — how much protein does man need in his food each 
 day? The answer is one that has called forth endless 
 
THE SUBJECT OF NUTRITION S 
 
 quantities of discussion and investigations, and will be 
 considered in this ehapter under the subject of the calorific 
 value of protein. 
 
 The following foods give this daily supply of protein : — 
 meats, eggs, milk, cheese, cereals, legumes and nuts. Other 
 foods contain a very much smaller proportion of protein 
 — such as fruits, vegetables, roots and tubers, but because 
 of their small amount of protein, they are not classified as 
 protein foods. 
 
 Fat is a combination of the elements carbon, hydrogen 
 and oxygen. In other words, it is a compound of fatty 
 acids with an alcohol. There are many different kinds of 
 fats, depending upon the different fatty acids and alcohols 
 of which they are composed. But the common fats of 
 plants and animals are principally combinations of the 
 fatty acids, oleic, palmitic and stearic with the triatomic 
 alcohol glycerol (commonly called glycerin). The fats of 
 fishes and of marine mammals contain other fatty acids 
 than these and other alcohols than glycerol. When these 
 fatty acids are combined with glycerol, they are called 
 glycerides, — and when these three glycerides, triolein, tri- 
 palmitin and tristearin, are combiued in a fat, the melting- 
 point of the mixture depends upon the amount of each 
 glyceride present, — ^the greater the amount of tristearin 
 present the higher the melting-point, and the greater the 
 amount of triolein present, the lower the melting-point. 
 
 The melting-point of common fats is as follows: 
 (Taylor) 
 
 Horse Fat 60°-65° 0. (Has most tristearin) 
 
 Mutton Pat 50°-55° G. 
 
 Beef Fat 45°-50° 0. 
 
 Lard 35°-40°C. 
 
 Human 35°-40° 0. 
 
 Butter 30°-35°C. 
 
 Olive Oil — 5° C. (Has most triolein) 
 
6 NUTRITION AND SPECIFIC THERAPY 
 
 The melting-points of the fats have a great bearing 
 upon their digestibility, for the lower the melting-point, 
 the easier the digestibility. 
 
 This is true of uncooked fats, but not true of fats when 
 raised to the frying and smoking temperature. When fats 
 are raised to this high degree of heat, they are decomposed, 
 and substances are produced which are irritating to the 
 stomach. Therefore, when fats are cooked and raised to 
 the temperature of frying, the fats with the highest melt- 
 ing-point are the most desirable because less of these irri- 
 tating substances are formed. The frying temperature 
 averages 350°-400° F. or l76°-205° C, which is far be- 
 low the smoking temperature of the first fats in the follow- 
 ing column. 
 
 Average Smoking Temperature op Edible Fats 
 
 Cotton-seed 233° 0. 
 
 Snowdrift 232° 0. 
 
 Crisco 231° C. 
 
 Leaf Lard 221° 0. 
 
 Butter 203° C. 
 
 A Much Used Lard 190° C. 
 
 All persons familiar with cooking know there is much 
 smoke produced when frying in butter or in a much used 
 lard, and the reason is clearly shown in the above table, 
 for the temperature necessary for frying is above the 
 smoking temperature of butter and lard. In other words, 
 when frying, Snowdrift, cotton-seed oil and Crisco are 
 more desirable. The irritating substances formed are cer- 
 tain free fatty acids and the aldehyde, acrolein. These are 
 irritating to the stomach, but in the normal digestion of 
 fats in the intestines, the free fatty acids are not irritating 
 and, for the most part, are formed into soaps by uniting 
 with sodium, potassium, calcium and magnesium. 
 
 Fats are absorbed in the intestine^ to a large extent as 
 soaps, and their ultimate end is to produce heat and energy 
 for the body, and to form a certain amount of protective 
 
THE SUBJECT OF NUTRITION T 
 
 tissue. To supply this the following foods are important : 
 — olive oil, butter, eggs, cheese, nuts and soy beans. 
 (Cheese is included in the list, but not recommended.) 
 
 The third food principle to consider is carbohydrate. 
 It is a combination of carbon, hydrogen and oxygen, the 
 same elements composing it as are found in fat, but the 
 chemical arrangement of these elements is different. Car- 
 bohydrates may be divided into four main classes, — ^mono- 
 saccharides; disaccharides, trisaccharides, and tetrasaccha- 
 rides; polysaccharides; and celluloses. The monosaccha- 
 rides are the building blocks and are the simple com- 
 pounds or sugars from which all the others are formed. 
 The term disaccharides indicates there are two molecules 
 of simple sugars, trisaccharides indicates there are three 
 molecules of simple sugars, and tetrasaccharides indicates 
 there are four molecules of simple sugars. In the poly- 
 saccharides there is an indeterminate large number of 
 molecules of primary sugars, while the celluloses are of 
 still larger molecular dimensions. 
 
 The following classification explains carbohydrates in 
 detail : — 
 1. Monosaccharides, 
 
 Hexoses 
 (Ci>H«0.) 
 
 'Glucose (Dextrose or Grape 
 
 Sugar) 
 Fructose (Levulose or Fruit 
 
 Sugar) 
 Galactose 
 
 i?oXsT]^- c°™ 
 
 The monosaccharides, — ^bioses, trioses, tetroses, pentoses and 
 heptoses are less commonly found than the hexoses. 
 
 (a) DisACCHARTOES, 1. Saccharose (Cane Sugar), — 
 
 (CuHaOii) hydrolyzes to 1 molecule of glu- 
 
 cose and 1 molecule of levulose 
 through the action of heat and 
 ■water in the presence of an 
 -^ acid, and the enzyme, invertase, 
 
 the latter taking place in the 
 intestines. 
 
8 NUTRITION AND SPECIFIC THERAPY 
 
 2. Lactose (Milk Sugar), — ^hy- 
 drolyzes to 1 molecule of galac- 
 tose and 1 molecule of glucose 
 in the intestines through, the 
 enzyme lactase. 
 
 3. Maltose i(Malt Sugar), — hy- 
 drolyzes to 2 molecules of glu- 
 cose through the enzyme mal- 
 tase in the intestines. It is 
 formed through the action upon 
 starch of diastase in malt, the 
 ptyalin in saliva, and the 
 amylase in the intestines, and 
 in the partial hydrolysis of 
 starch and dextrin by acids. 
 
 4. Trehalose, — ^hydrolyzes to 2 
 molecules of glucose. (Un- 
 common.) 
 
 6. Melibiose, — hydrolyzes to 1 
 molecule of glucose and 1 mole- 
 cule of galactose. (Uncommon.) 
 
 (b) Trisacohartoes, hydrolyze to 1 molecule each of 
 
 (OmHmOm) levulose, galactose and glucose. 
 
 Eaffinose is a sugar belonging to 
 this class, and is found in molasses, 
 in sugar made from beets, in bar- 
 ley and in other grains. 
 
 (c) Tetrasaccharides,. . hydrolyze to 2 molecules of galac- 
 (CaJIiaOsi) tose, 1 of glucose and 1 of levulose. 
 
 Lupeose in peas belongs to this 
 class. 
 3. Polysaccharides, 1. Starches. 
 
 (CeHioO.)X 
 
 2. Dextrins 
 (Products of starch hydrolysis) 
 
 3. Glycogen 
 (Chiefly of animal origin, but also 
 
 found in certain fungi.) 
 
 4. Gums. . 
 
 "hydrolyze to mole- 
 cules of dextrose 
 through the action 
 of acids and 
 through the action 
 of the ptyalin of the 
 saliva and the amy- 
 lase and maltase in 
 the intestines. 
 Certain gums hy- 
 drolyze to molecules 
 of a pentose or hex- 
 Lose. 
 
THE SUBJECT OF NUTRITION 9 
 
 5. Mucilages 
 
 6. Inulin,. ..hydrolyzes to mole- 
 
 cules of leTulose. It 
 occurs in the dande- 
 lion, chicory and other 
 vegetables. 
 
 4. CiajLULosES, hydrolyze to molecules of dextrose 
 
 (CjHmOjJx through the action of heat and 
 
 water and sulphuric acid, and 
 through the action of the digestive 
 enzymes of certain animals. 
 
 The purpose of carbohydrates in foods is the same for 
 the most part as that of fats, — ^to produce heat and energy. 
 In digestion in the intestines they are all reduced to the 
 simple sugars, — ^glucose, fructose and galactose with the 
 exception of the celluloses which man does not digest, al- 
 though these are digested by many animals. 
 
 The following foods are the main sources of supply of 
 carbohydrates, — sugars, cereals, legumes, roots, tubers and 
 fruits. 
 
 The combustions for the support of work first attack the 
 carbohydrates of the body, and if these be present or supplied 
 up to the need, work will be supported by combustion of car- 
 bohydrate alone. The body burns sugar in preference to fat 
 if choice be presented. The sugar reaches the tissues of com- 
 bustion in thirty to fifty minutes after ingestion.^ 
 
 In the absence of sugar, the body will burn fat (of the diet 
 or fat from the body depots) for the support of work, though 
 the efficiency is a little lower than in the case of sugar. For 
 extreme exertions, however, fat is the better food, since it is 
 possible to ingest in a day more Calories in the state of fat 
 than in the form of sugar. The diet should, however, always 
 contain enough carbohydrate to avoid acidosis, and to save the 
 catabolism of excessive protein. 
 
 In the presence of carbohydrate, the catabolism of protein is 
 not modified or exaggerated by muscular work. Very exces- 
 
 ' Taylor, "Digestion and Metabolism." 
 
10 NUTRITION AND SPECIFIC THERAPY 
 
 sive work, and especially work with untrained muscles, may 
 lead to increase in total nitrogenous catabolism, but this is an 
 abnormal reaction. Normally, work does not affect the pro- 
 tein catabolism. In a word, physical work under normal 
 conditions does not noticeably affect the up-keep and wear- 
 and-tear of the cells. In the absence of carbohydrate and 
 fat, heavy work can be supported on the combustion of exog- 
 enous protein alone, but it is an exaggerated process, and 
 under such circumstances, the endogenous protein catabolism 
 is also exaggerated. 
 
 The fourth food principle is mineral matter. It in- 
 cludes principally the organic and inorganic salts of so- 
 dium, potassium, calcium and magnesium. There are 
 other salts which are present in exceedingly small amounts. 
 Iron, iodin, and organic phosphorus and sulphur are 
 sometimes classified as mineral matter, but should be 
 properly termed "elements" for they exist as organic com- 
 pounds. 
 
 The principal inorganic acids are hydrochloric, sul- 
 phuric, carbonic and phosphoric, and there are many or- 
 ganic acids, principally tartaric, citric, malic, oxalic and 
 benzoic. 
 
 Mineral matter is absolutely essential to all living tis- 
 sues and fluids, and for neutralizing poisonous and waste 
 products. (See Chapters II, VI, VII, VIII.) 
 
 Fruits and vegetables should be relied upon for the main 
 supply of mineral matter. It is also found in a consider- 
 able quantity in milk, cereals, legumes, eggs, nuts, roots 
 and tubers, but these foods should be eaten principally for 
 other purposes, previously stated. 
 
 In other words, all fruits and vegetables have a certain 
 amoimt of organic and inorganic salts, — elements such as 
 sodium, potassium, calcium and magnesium, united with 
 an organic or inorganic acid. (See page 11.) 
 
 The fifth food principle is water. This serves the func- 
 tion of carrying in solution gases and substances used in 
 
THE SUBJECT OF NUTRITION 11 
 
 Organic Acids in Common Fruits and Vegetables 
 
 Apple Malic 
 
 Banana " 
 
 Cantaloupe Citric 
 
 Cherry Malic 
 
 Cranberry Malic — Citric — ^Benzoic 
 
 Currant Citric — Malic 
 
 Gooseberry " " 
 
 Peach Malic 
 
 Watermelon " 
 
 Spinach Oxalic 
 
 Lettuce Citric 
 
 the metabolism of all body cells. It also regulates the 
 osmotic conditions of the body and likewise the tempera- 
 ture of the body. 
 
 Calorific Value of Foods. — The second subject to be con- 
 sidered in the study of nutrition is the calorific value of 
 foods. By a calorie in physics is meant the amount of 
 heat required to raise 1 gram of water 1° C. But thig is 
 the small calorie. For measuring the heat value of food, 
 the large Calorie is used which is the amount of heat re- 
 quired to raise 1 liter of water 1° C. or 1 pound of water 
 4° r. Take 1 gram of the food in question, — ^how many 
 pounds of water will it raise 4° F. when burned, or, as it 
 is termed, oxidized? The result gives the calorific value 
 of 1 gram of that particular food. 
 
 These results were obtained by burning protein, fat and 
 carbohydrate in a machine called a calorimeter and these 
 three food principles have the same heat value in the body 
 as in the calorimeter. 
 
 The researches of Kubner were the first to give the fol- 
 lowing figures : — 1 gram of protein has the calorific value 
 of 4.1 Calories; 1 gram of fat has the calorific value of 
 9.3 Calories; 1 gram of carbohydrate has the calorific 
 value of 4.1 Calories. Mineral matter, cellulose and water 
 
12 NUTRITION AND SPECIFIC THERAPY 
 
 have no calorific value, although they are of equal impor- 
 tance in other ways. 
 
 Therefore, protein, fat and carbohydrate are for differ- 
 ent purposes, but in the end each is oxidized, and for every 
 gram oxidized in the body, the stated heat values are ob- 
 tained. 
 
 Because fat gives about 21/4 times the energy of carbo- 
 hydrate and protein is no reason why it should be eaten in 
 greater quantities. Fat is excellent in cold climates to 
 produce heat and energy. It can replace carbohydrate to 
 some extent, but it cannot replace protein, a certain amount 
 of which is absolutely necessary to the cells and fluids of 
 the body. Fat and carbohydrate can be stored in the body 
 when eaten in excess of the required needs, but protein can- 
 not be stored, — what is eaten in excess of the required 
 needs is excreted. This is one of the great reasons why 
 just the right proportion of protein should be eaten daily, 
 — neither too much, nor too little, and if either of these 
 errors is committed, sickness of some nature generally 
 develops. 
 
 The best health is maintained on a mixed diet of pro- 
 tein, fat and carbohydrate with the required amount of 
 mineral matter, cellulose and water and an adequate sup- 
 ply of vitamines. 
 
 The question may occur to the student, — why does fat 
 give so much more heat and energy than carbohydrate? 
 The answer is found in the number of carbon atoms in the 
 fat molecule, for there are about three times as many as 
 in the carbohydrate molecule. The exact molecular weight 
 of protein molecules is still a mystery. 
 
 For those who wish to know how to obtain the calorific 
 value of any particular food, the following rule is given, 
 with illustrations. 
 
 The calorific value of any amount of food is obtained 
 by reducing the amount of food in question to grams; 
 know the percentage composition of this food; multiply 
 
THE SUBJECT OF NUTRITION 
 
 13 
 
 the amount of food in grams by the percentage composi- 
 tion of each of the three food principles; multiply these 
 results by the calorific value of each of the three food 
 principles ; add the total Calories together. 
 
 Roast Beef (Lean) — 2 ounces = 56 + grams 
 Per Cent. 
 
 Water 55.3 56 X -292 = 
 
 Protein 29.2 56 X -082 = 
 
 Fat 8.2 16.3 X 4.1 Calories = 
 
 Carbohydrate.. 0.0 4.5x9-3 " = 
 Mineral Matter. 1.4 
 
 16.3 grams protein 
 
 4.5 " fat 
 66.83 Calories 
 41.85 " 
 
 108.68 " 
 108.68 Calories in a slice of lean roast beef. 
 
 BuTTEB — % ounce = 14 + grams 
 Per Cent. 
 
 Water 9.1 14 X -013 = -18 grams protein 
 
 Protein 1.3 14 X -829 = 11.60 " fat 
 
 Fat 82.9 .18 X 4.1 Calories = .73 Calories 
 
 Carbohydrate . . 0.0 11.60 X 9-3 " = 107.88 " 
 
 Mineral Matter. 6.7 
 
 108.61 " 
 108.61 Calories in % ounce butter. 
 
 Bread — ^ ounce ^ 14 + grams 
 Per Cent. 
 
 Water 40.0 14 X -065 = .91 grams protein 
 
 Protein 6.5 14 X -01 = .14 " fat 
 
 Fat 1.0 14 X .512 = 7.16 " carbo- 
 hydrate 
 Carbohydrate.. 51.2 .91 X 4.1 Calories = 3.73 Calories 
 Mineral Matter. 1.0 7.16 X 4.1 " = 29.35 " 
 Cellulose 3 .14x9-3 " = 1.30 " 
 
 34.38 " 
 34.38 Calories in ^^ ounce of bread. 
 
 The question now arises, — ^how many Calories a day 
 does a man, woman or child require to maintain perfect 
 health ? This brings up the subject of standard dietaries 
 so much discussed with many differences of opinion. Age, 
 
14 NUTRITION AND SPECIFIC THERAPY 
 
 sex, climate and occupation are important factors in de- 
 termining the required number of Calories for a particular 
 individual. A child requires far less than an adult be- 
 cause of size, but again he requires more because be is 
 growing ; women require a little less than men ; less food 
 is required in a warm climate than in a cold climate; a 
 hard working laborer requires more than a brain-worker. 
 
 The old standard dietaries for an adult doing an average 
 amount of work advocated about 100 grams of protein, 
 50-100 grams of fat and 500 grams of carbohydrate. But 
 the most recent standards give figures much lower, per- 
 haps half this number, although there still is much diver- 
 sity of opinion. Professor Chittenden of Yale has proved 
 by laboratory experiments that it is possible to maintain 
 life and do a certain amount of work upon 50—57 grams of 
 protein a day. Professor Henry C. Sherman of Columbia 
 University gives the figure of 45 grams of protein for a 
 man weighing about 150 pounds. These figures are both 
 low compared with those of Voit, Hutchison, Benedict, 
 Meltzer and Cohnheim, whereas the figures of Folin's ex- 
 periments range between the highest and lowest standards 
 for protein requirement. Kubner has even declared that 
 nitrogen equilibrium can be maintained on 35 grams of 
 protein a day for a person of average weight, while Klemp- 
 erer has obtained nitrogen equilibrium on 33 grams. 
 Landengren, then Siven, Cedercreutz and Ernberg con- 
 firmed this low figure by an entirely different method. The 
 figures of Hindhede are also extremely low. 
 
 The latest and probably the best calculated figures range 
 around 2,400 Calories a day from the three food prin- 
 ciples, — protein, fat and carbohydrate. This figure dem- 
 onstrates that scientific research acknowledges people have 
 been eating far too much for health, and that man requires 
 far less food than has been imagined. Herein lies part of 
 the great secret to banishing many diseases which will be 
 discussed in other chapters. Diabetes may be cited here 
 
THE SUBJECT OF NUTRITION 15 
 
 as an example, for it is much more prevalent among obese 
 people than those of average weight. 
 
 A very satisfactory rule in the author's work to deter- 
 mine the number of Calories required a day for any per- 
 son in health doing moderate work is the following : — 
 
 Multiply the body weight by 1.3 to obtain the number 
 of Calories of protein required a day. From this figure 
 it is a very simple process to determine the number of 
 grams of protein this figure represents, — simply divide 
 the number of Calories of protein by 4.1 and the result is 
 tibe number of grams of protein. 
 
 A person weighing 150 pounds would require 150 X 1-3 
 Calories of protein = 195 Calories of protein. Divide 
 this figure by 4.1 and the result is about 48 grams of pro- 
 tein a day. However, if the person is a brain-worker, this 
 figure should be even less. In other words, one-half pound 
 of English walnuts would give the total protein require- 
 ment a day for this person. But many people do not con- 
 sider one-eighth of a pound of nuts at the end of the third 
 meal of the day as a food of any importance, — it is merely 
 a finishing touch. When the protein intake from bread, 
 butter, eggs, cereals, salad, meat, milk, potato, legumes, 
 vegetables and fruits, that the majority of people eat in 
 their three meals daily, is calculated, the number of guilty 
 parties who have violated one of the laws of health would 
 be enormous. 
 
 It is the author's opinion that if the number of Calories 
 of protein for each particular person is accurately calcu- 
 lated, the carbohydrate and fat Calories take care of them- 
 selves to a large extent. The protein Calories should be 
 kept about the minimum, — in other words, "nitrogen 
 equilibrium" should be maintained which means that the 
 intake of protein should equal the amount excreted, — any 
 quantity above or below this is harmful. When it is said 
 the fat and carbohydrate Calories will take care of them- 
 selves, this does not mean a person can indulge in quanti- 
 
16 NUTRITION AND SPECIFIC THERAPY 
 
 ties of commercial, concentrated, animal and vegetable fats, 
 and sugars in the form of candies, pastries and sauces. 
 One of the purposes of this book is to demonstrate that 
 such foods are unnatural and many times harmful in many 
 ways. Man requires many more Calories of carbohydrate 
 than of protein or fat, but if the Calories of protein are 
 carefully figured, a man may eat as much fat and carbo- 
 hydrate food in a natural form as he desires to satisfy 
 his appetite, and need not calculate their Calories, and 
 will not go far astray. (Cane sugar and cream cheese are 
 examples of commercial, artificial foods.) 
 
 In closing the discussion on Calories, it is fitting to call 
 attention to a special kind of advertisements one reads 
 everywhere in connection with the calorific value of foods. 
 It is stated a certain number of Calories in a certain food 
 costs a very few cents, and that the same number of 
 Calories in other foods costs many times more. However 
 excellent such a food may be, it cannot claim all the ad- 
 vantages of a mixed diet. 
 
 The entire aim in eating is not a question of obtaining 
 the greatest number of Calories ; the aim is to obtain the 
 required amount of "complete protein" to maintain nitro- 
 gen equilibrium, a sufficient amount of carbohydrate and 
 fat for heat and energy, a balanced mineral ration for the 
 body's fluids and cells, and for neutralizing waste products, 
 an adequate supply of the three or more vitamines neces- 
 sary for growth and health, and a generous amount of 
 cellulose to create active peristalsis. In other words man 
 cannot live on a single article of food and maintain health, 
 for there is no article of food that will supply the needs 
 enumerated, except the mother's milk for the nursing 
 infant. 
 
 Digestion and Assimilation of Foods. — This subject 
 will close the chapter outlining the explanation of the 
 subject of nutrition except for diets in special diseases 
 which will be discussed in different chapters. 
 
THE SUBJECT OF NUTRITION 17 
 
 By digestion is meant the ease with which the food is 
 disposed of in the stomach. 
 This is dependent upon : — 
 
 1. Kinds of Foods ; 
 
 2. Preparation of Foods; 
 
 3. Combination of Foods. 
 
 The order in which different kinds of foods leave the 
 stomach are, — carbohydrate, carbohydrate plus protein, 
 protein, fat, and lastly fat plus protein which accounts for 
 the delay of fried foods in the stomach. 
 
 Some protein foods require more pepsin than others, — 
 for example, the gluten of bread requires five times as 
 much pepsin as the casein of milk, but this fact does not 
 necessarily mean that it takes five times as long for bread 
 to leave the stomach, for some foods cause the gastric 
 juice to flow faster than others. 
 
 It is therefore evident that when there is a great variety 
 of food in the stomach, there is "indigestion" of some 
 kind; for the food is delayed in its digestion and this 
 always indicates bacterial fermentation or putrefaction. 
 (See Chapters IV, V, VI.) 
 
 The conclusion is this : — The less variety at one meal, 
 the quicker the digestion, and the better for the health ; but 
 the greater the variety, the three meals a day considered, 
 the better for the health. Serve as few foods as possible 
 at each meal, but serve generously of these foods, and vary 
 each of the three meals a day, and the meals of each day 
 of the week if possible. By following this rule, the seeker 
 for health will obtain a "complete protein," sufficient fat 
 and carbohydrate, a balanced mineral supply, an adequate 
 amount of vitamines, and a generous proportion of cellu- 
 lose. Variety is of the greatest importance in the ques- 
 tion of health, and one of the primary reasons is because 
 it provides a "complete protein" diet. Mendel, Osborne, 
 McCoUum, Hawk and others have devoted much of their 
 time to researches along this line. 
 
18 NUTRITION AND SPECIFIC THERAPY 
 
 There are twenty-six known amino-acids derived from 
 simple proteins required to keep the body in nitrogen 
 equilibrium. Seventeen of these are the most common. 
 Some foods contain only part of these, a very few contain 
 all required for health, while still others may contain all, 
 but not in the right proportion. The human body demands 
 all these amino-acids, and in the required proportion. A 
 varied protein food diet will insure this end. Foods known 
 to contain "complete protein" are meat, milk, and eggs, — 
 the soy bean ^ and peanut * (Rats were used in these ex- 
 periments), coconut (See Chapter IX) and possibly the 
 potato. Hindhede,^ experimenting on men, also Thomas, 
 Rose and Cooper (1917) have published extremely inter- 
 esting information concerning the protein of the potato, 
 and its power to maintain nitrogen equilibrium. McCol- 
 lum * and his coworkers, however, in experiments on rats, 
 conclude the nitrogen of the potato for growth has no 
 greater value than an equivalent amount from com and 
 wheat. F. A. Oajori ^ has found many of our imiportant 
 nuts furnish ar adequate protein for rats. 
 
 According to recent investigations by Sherman * and 
 his collaborators the protein of wheat, com and oats will 
 keep the body in nitrogen equilibrium if 9/10 of the pro- 
 tein is derived from these cereals, the remainder being fur- 
 nished by apple or milk. These research men * also claim 
 the proteins of oats and maize are of virtually equal nu- 
 tritive value, and this is true whether the proteins con- 
 stitute practically the sole nitrogen food or are supple- 
 mented by a constant small amount of milk protein. 
 Human subjects were used in these experiments. 
 
 ' T. B. Osborne and L. B. Mendel, J. Biol. Chem., Dec, 1917. 
 
 •A. L. Daniels and R. Loughlin, J. Biol. Chem., Feb., 1918. 
 
 •"Protein and Nutrition." 
 
 •E. V. McCollum, J. Biol. Chem., Oct., 1918. 
 
 V. Biol. Chem., Dec, 1921. 
 
 "J. Biol. Chem., Jan., 1920. 
 
 'J. Biol. Chem., Aug., 1919. 
 
THE SUBJECT OF NUTRITION 19 
 
 Osborne and Mendel ^^ conclude, in experiments on 
 rats, there is evidence tliat the total proteins of rice and 
 barley, in contrast with com and oats, when furnished in 
 diets containing 16 to 17 per cent of protein, supply 
 enough of all the amino-acids for growth. 
 
 The conclusion to be drawn from these researches is 
 that not all of the evidence is absolutely conclusive, and 
 that experiments on different animals and on men do not 
 always prove the same facts. This statement can also be 
 applied to many other researches, especially on vitamines 
 and mineral matter. But a certain amount of the results 
 can be accepted as facts, and the questionable results point 
 to many future researches in these subjects. 
 
 In conclusion, it may be said, the kind of food is of 
 primary importance. The preparation of food should re- 
 ceive fully as much attention. This brings up the ques- 
 tion of cooked and uncooked foods, the effects of cooking 
 on the food principles, and the most desirable methods of 
 cooking to obtain the best results for health. 
 
 'V. Biol. Ghent,., June, 1918. 
 
CHAPTEE II 
 
 FOOD PREPARATION 
 
 Raw Foods and Effects of Cooking. — Heat codgulatea 
 protein, rendering both animal and vegetable protein less 
 digestible at as low a heat as 1Y0° F. or 77° 0. When 
 the protein is coagulated, a longer time is required for 
 the pepsin, activated by the hydrochloric acid, to reduce 
 it to peptones ; and since this is true, the food may be de- 
 layed in the stomach, and bacterial fermentation and putre- 
 faction may develop to a greater or less degree. Again, 
 the acidity of the stomach contents becomes greater the 
 longer the food is delayed in the stomach, and this fact 
 adds to the length of time the food remains in the stomach, 
 should the acid fermentation from the bacteria develop. 
 It may, therefore, be said there are three objections to 
 cooking protein, the resulting coagulation, and possible 
 putrefaction and excess acidity. 
 
 Beef 
 
 Raw digests in 2 hrs. Wholly-boiled digests in 3 lirs. 
 
 Half-boiled digests in 2% hrs. Roasted digests in 3-4 hrs. 
 
 Heat affects fat by causing a decomposition if it is 
 raised to a sufficiently high temperature, with the libera- 
 tion of free fatty acids and an aldehyde which are irri- 
 tating to the stomach, and delay digestion. 
 
 Dry heat changes starch into dextrin at 300° F. or 
 149° C and moist heat causes the cellulose which sur- 
 rounds the starch granules to rupture and liberate the 
 granules and these become swollen with water. The diges- 
 
 20 
 
FOOD PREPARATION 21 
 
 tive juices can then digest the granules much more readily, 
 and therefore, the starch is more completely absorbed when 
 cooked. But it cannot be said to be more digestible, for in 
 the cooked state, it is more readily attacked by bacteria in 
 the stomach, possibly causing fermentation which delays 
 its digestion in the stomach. On reaching the intestines, 
 this fermentation may continue. Sugars are unaffected 
 by moist heat, except in the presence of acids. 
 
 Cellulose is affected in much the same way by moist heat 
 as starch, for it may be made a more favorable medium 
 for bacterial fermentation, with the production of oxalic, 
 butyric and acetic acids and others that are harmful. 
 These facts bear laboratory proof. 
 
 The great reason for cooking foods containing cellulose 
 for the majority of people is to soften it. They think it 
 is more digestible, perhaps better assimilated. Cellulose 
 is not assimilated by man, for man has no enzyme either 
 in the stomach or in the intestines to hydrolyze cellulose 
 to dextrose. Man requires cellulose for bulk, and this is 
 its greatest value, — that of promoting peristalsis. Cooked 
 cellulose is far inferior to raw cellulose for promoting per- 
 istalsis. If the digestion is normal, an abundance of fresh 
 salads should be eaten. Fresh fruits should be thoroughly 
 washed before eaten, but not pared. Grape skins and the 
 skins of potatoes should not be discarded. 
 
 Mineral matter in an inorganic form is not so readily 
 affected by heat, but in the organic form, the changes are 
 much more numerous, — ^it may be either thrown out of its 
 organic combination, or it may be made from a soluble 
 into an insoluble compound. An example of the latter is 
 found in the boiling of lemon juice, when the citric acid of 
 the lemon is changed from soluble^ triealcium citrate into 
 insoluble calcium citrate. Insoluble compounds some- 
 times are more difficult of absorption. 
 
 With these facts in mind, a very important question is 
 presented. Is cooked or uncooked food the more desirable 
 
22 NUTRITION AND SPECIFIC THERAPY 
 
 for health ? Naturally the answer is, — if heat coagulates 
 protein, thus rendering it less digestible, and perhaps pro- 
 moting bacterial action, it should be cooked as little as 
 possible, or not at all. If protein foods are cooked, they 
 should be cooked at as low a temperature and as short a 
 time as possible. The greater the temperature at which 
 they are cooked, the tougher and homier they become. 
 This fact is very clearly seen in the boiling of meat on the 
 stove as compared with cooking it in a fireless cooker, and 
 in the boiling of the white of an egg over the flame as 
 compared with dropping the egg into boiling water and 
 setting the pan on the back of the stove for 20 minutes. 
 
 However, there is one great problem with which to con- 
 tend. It is true that meat eaters must cook their meat to 
 kill the bacteria contained in it, and the meat should be 
 cooked until all rawness has disappeared. Underdone 
 meats contain many pathogenic bacteria such as those of 
 splenic fever, tuberculosis, malignant edema, septicemia, 
 chicken cholera, — tapeworm, trichina, etc. 
 
 It unquestionably follows that because heat at high 
 temperatures decomposes fat with the liberation of irritat- 
 ing substances they also should be eaten in their natural 
 state or cooked at a low temperature. 
 
 Since moist heat may prepare starches and celluloses 
 for bacterial fermentation, and partly destroys the great 
 value of cellulose for promoting peristalsis, these should 
 never be cooked, except when absolutely necessary. Sol- 
 uble starch and sugar is also lost many times in the differ- 
 ent cooking processes. 
 
 The student has been taught that starch grains must be 
 liberated to insure perfect assimilation. The membranes 
 envelopiiic; raw starch grains have been regarded as im- 
 pervious to fligestive juices. So it has been taught that 
 it is very desirable to cook starch, and it has been said no 
 starch appears in the feces after a meal of well cooked 
 bread, potato or legumes. Despite these traditional teach- 
 
FOOD PREPARATION 23 
 
 ings, it has been found from recent investigations that raw 
 starch is digested to a large extent. Langworthy and 
 Deuel ^ have proved that raw starch granules are not swol- 
 len or broken, yet ingested quantities exceeding 200 grams 
 a day disappear from the intestines. Raw corn and wheat 
 starches were found to be completely assimilated, — 78 per 
 cent raw potato starch was assimilated. 
 
 Since cooking throws mineral matter out of its organic 
 combination many times, and also changes it at other times 
 from a soluble into an insoluble compound, and since also 
 much is lost in draining vegetables, cereals, legumes, roots 
 and tubers in many of the cooking processes, the conclu- 
 sion must necessarily follow that foods relied upon for 
 their mineral content should not be cooked. 
 
 Lastly, there are the enzymes and vitamines to consider 
 in connection with cooking. Both are destroyed to a large 
 extent, — some do escape, but why should the risk be taken 
 of killing such vital substances ? ( See Chapter IX. ) 
 
 With the above reasons in mind, it must be admitted 
 raw foods have a great advantage over cooked foods for 
 health. For instance, Instead of cooking oatmeal two to 
 three hours as cook-books advise, cook it ten to twenty 
 minutes. (A recipe is given in the last chapter.) 
 
 Since cooking is almost universally the practice, the 
 different methods of cooking many of the common foods 
 are given in the following discussion: — 
 
 Food Adulteration by the Consumer.^ — Much has been 
 heard about food adulteration by the pi;oducer and the 
 many ways in which he has striven to delude the public 
 into believing that it is obtaining money value in the prod- 
 ucts purchased. Every one enjoys the satisfaction of 
 knowing that he has received value for value. The fact 
 is, however, that the producer is by no means the only 
 party that may not give fair returns to the consumer, for 
 the consumer may not give fair returns to himself. 
 
 " J. Biol. Chem., May, 1920. 
 
24 NUTRITION AND SPECIFIC THERAPY 
 
 If every home-maker in turn were asked how she pre- 
 pares her vegetables, potatoes, cereals and legumes for the 
 table the answer, aside from frying and baking, with but 
 few exceptions, would be that in the case of potatoes they 
 are peeled, thrown into boiling, salted water and cooked 
 until tender; they are then drained from their water, sea- 
 soned and prepared in the various ways; in the case of 
 spinach, celery, cauliflower, asparagus, cabbage, com, peas 
 and beans, the answer would invariably be that they are 
 boiled in salted water tiU tender, and then drained. These 
 facts are one of the great crimes of the culinary art, and 
 show that the consumer adulterates the food and is cheated 
 in nutritive value, flavor and cost. In this process of cook- 
 ing, these foods lose in all their nutritive principles and 
 absorb water in exchange. The food principles that are 
 diminished mostly are the mineral matter, and carbohy- 
 drate, while some vitamines are destroyed, or lost. 
 
 Every home-maker would be horrified at the idea of 
 throwing away the water in which fruits had been stewed. 
 The fact is, however, that the water in which vegetables 
 are cooked, which is generally thrown away, will average 
 about the same in vitamines and mineral substances. 
 
 The body's great need for mineral matter and vitamines 
 in carrying on its vital processes is apparent. The skele- 
 ton, muscles, nerves and blood all demand them, and the 
 fruits and vegetables, principally, together with cereals, 
 legumes, nuts, roots and tubers, and milk for infants, 
 should be the chief source of supply. In these substances 
 fruits and vegetables supplement the cereals, legumes, 
 nuts, roots and tubers. (See Chapter IX.) 
 
 The American people are suffering from lime starvation, 
 a fact plainly seen in the general decay of the teeth. (See 
 Dental Caries and Pyorrhea, Chapter IX. ) Milk has the 
 largest proportion of calcium of any of our foods, and this 
 is one of the reasons why it is recommended to so great an 
 extent. Human milk contains the required amount for 
 
FOOD PREPARATION 25 
 
 infants, but cow's milt should not be relied upon for cal- 
 cium for adults, as there are other foods with an adequate 
 supply that are far superior for adults, which will be dis- 
 cussed in full elsewhere. 
 
 M. S. Rose ^ says : — "It seems possible to meet the re- 
 quirement of the adult human organism for calcium, 
 largely if not wholly, from carrots." This statement illus- 
 trates the importance of roots, tubers, fruits and vegetables 
 as the principal sources of mineral matter. Cereals, 
 legumes and nuts may be included, although they repre- 
 sent three of our protein foods. 
 
 It happens that calcium constitutes a larger proportion 
 of the body than any other of the inorganic elements. To 
 repeat: — It is required for bones, teeth, muscles, nerves, 
 for the coagulation of the blood, for the digestive juices, 
 and probably for many other functions. When the food 
 consists principally of meat and cereals, the calcium re- 
 quirement is not sufficient. But if the diet is rich in miUc 
 (recommended for adults only through necessity), yolk of 
 eggs, legumes, fruits, vegetables, roots, and tubers, calcium 
 equilibrium will be maintained. (See also Pellagra, 
 Chapter IX.) 
 
 Sodium is a very important element of the blood and 
 fluids of the body. It aids in the formation of the hydro- 
 chloric acid and other digestive juices. It is necessary for 
 the formation of cartilage, it is found in the brain and it is 
 necessary for the neutralization of waste products. 
 
 Iron is a constituent of hemoglobin, necessary for the 
 supply of oxygen. It forms a part of the nucleins and 
 nucleoproteins. It is necessary for the action of certain 
 enzymes. 
 
 Iron derived from the hemoglobin of meat is not well 
 absorbed, a fact which makes it all the more imperative 
 that the preservation of fruit and vegetable iron should 
 be guarded. 
 V. Biol. Chem., March, 1921. 
 
26 NUTRITION AND SPECIFIC THERAPY 
 
 Magnesium is important in the construction of bone 
 and cartilage; it lends flexibility to the bones and con- 
 tractility to the muscles. It also forms phosphates which 
 are excreted in the urine. 
 
 Potassium is necessary as a tissue base and is to the 
 muscles and softer tissues what the calcium is to the bones. 
 It likewise aids in neutralizing poisonous products of 
 metabolism. 
 
 There is practically no evidence that the body ever ab- 
 sorbs any greater quantity of mineral matter than is re- 
 quired in repair and elimination. If there is an accumu- 
 lation in any particular tissue, the fault should be ascribed, 
 in the majority of cases, to wrong diet first (many times 
 a high protein diet), and the remedy should not be to re- 
 duce the amount of mineral matter, but to correct the 
 faulty diet. 
 
 Since this mineral matter is so often lacking in the 
 blood, and since the neutrality of the blood must be main- 
 tained, the body tissues themselves in these cases are re- 
 quired to give up their NHj groups, or inorganic elements, 
 calcium for example, to neutralize the acids in the blood. 
 Were this not the case, people would suffer much more fre- 
 quently from acidosis than is now the case. However, if 
 the body cells are called upon to continue this work, death 
 is the result. 
 
 For those who wish to eat cooked food, the important 
 question is, — what are the ideal methods for cooking vege- 
 tables, cereals, legumes, roots and tubers, foods that should 
 be relied upon so extensively for their mineral content as 
 well as for their carbohydrate, protein and vitamines ? 
 
 For the sake of health, frying will be omitted and five 
 methods will be considered in the order of their priority. 
 
 1. (a) Boiling in so small a quantity of water that 
 none is left for draining, — peeled potatoes cut 
 up small, carrots, turnips, parsnips, peas, beans, 
 
FOOD PREPARATION 27 
 
 lentils, spinach, cabbage, com, celery, asparagus, 
 onions, cereals. (Require close watching.) 
 
 (b) Stewing in double boiler, — cereals and all suc- 
 culent vegetables. 
 
 (c) Baking, — any vegetable, root, tuber or legume 
 and some cereals. 
 
 2. Steaming with skins on, — roots and tubers. 
 
 3. Boiling with skins on (draining necessary), — 
 roots and tubers. 
 
 4. Steaming (large vegetables), — com on cob, 
 cauliflower, roots and tubers. 
 
 5. Boiling in large quantity of water and draining, 
 — ^vegetables, roots, tubers, cereals and legumes. 
 
 If this last method is employed, the water in which 
 these foods were cooked should be saved and used for soups 
 or sauces. 
 
 In each of these processes the nutritive value and flavor 
 in the end is different, and the one whereby none or the 
 least water is drained off is the one that has retained the 
 most nutritive value and flavor. 
 
 The losses in nutritive value from boiling and draining 
 are about as follows: — spinach loses 50 per cent mineral 
 matter, cabbage 35 per cent, carrots 12 per cent. In 
 steaming about 10 per cent is lost. 
 
 This means a gain in the water content of these foods. 
 
 Per Cent. Per Cent. 
 
 Water in Water in 
 
 Raw State Cooked State 
 
 Parsnips 82.0 92.2 
 
 Cabbage 89.0 97.5 
 
 Spinach 90.0 98.0 
 
 Cauliflower 90.1 96.4 
 
 McCoUum and Simmonds * make the following state- 
 ment : — 
 •A. J. Physiol., June, 1918. 
 
28 NUTRITION AND SPECIFIC THERAPY 
 
 Young animals cannot grow when fed a single seed or a 
 mixture of seeds, even though, the latter is supplemented with 
 purified protein and a fat containing fat-soluble A vitamine. 
 The inorganic content is the first limiting factor, and sodium, 
 calcium and chlorine must be added before growth becomes 
 possible. 
 
 Certainly these reasons in favor of preparing vegetables, 
 cereals, legumes, roots and tubers with the greatest econ- 
 omy, especially in mineral matter and vitamines, with the 
 idea of the promotion and preservation of health, should 
 appeal to every one as facts that cannot be neglected. 
 
CHAPTER III 
 
 MEAT OE MIXED DIET VERSUS VEGETARIAN OR LACTO- 
 VEGETARIAN DIET 
 
 It Las been said that the greatest value of meat lies 
 in the fact that the quality of the albumin most nearly ap- 
 proaches that of our own tissues. But this statement has 
 very little significance because both animal and vegetable 
 proteins are bydrolyzed to the same amino-acids before 
 they can be absorbed. 
 
 The statement has been made that a minimum protein 
 diet for adults is necessary for health. The question may 
 now be asked, — in what form should this protein be eaten, 
 — should it be eaten as animal or vegetable protein ? This 
 subject has been discussed by some of the most able minds 
 of the day. 
 
 The great naturalists, physiologists, and anatomists, 
 Cuvier, Owen, Linnaeus, Ray, Hunter, Carpenter, Bell 
 and others have declared that the structure of the teeth 
 and stomach show men to be properly adapted to a diet not 
 of flesh, but of fruits, nuts and grains. 
 
 Most of the strongest, largest, longest lived animals are 
 vegetarian, — ^the elephant, rhinoceros, bujBfalo, hippopota- 
 mus, bison, bull, stag, camel and horse represent this class. 
 "All the carnivorous beasts are prowlers and most of them 
 are stupid." 
 
 The observation has sometimes been made that "great 
 nations are flesh-eating, but these nations have risen to 
 greatness on a simple diet, and have acquired riches, have 
 eaten expensively, and after a few score or a few hundred 
 
 29 
 
30 NUTRITION AND SPECIFIC THERAPY 
 
 years, have fallen into decay." Length of life and activity 
 in old age are certainly more common among frugal vege- 
 tarians than among eaters of a mixed diet. 
 
 It has been proved that men living on a vegetarian diet 
 lack initiative and great energy, — yet they have untiring 
 capacity for labor and are less nervous. A difference is 
 also seen in animals. The panther paces wildly, but the 
 elephant, camel and horse are comparatively reposeful 
 and have wonderful endurance. 
 
 William Lawrence, Professor of Anatomy and Surgery 
 to the Eoyal College of Physicians, has said : 
 
 The teeth of man have not the slightest resemblance to those 
 of the carnivorous animals, except that the enamel is confined 
 to the external surface. The teeth and jaws of men are in 
 all respects much more similar to those of monkeys than of 
 any other animals. The skull of the orang-utang has the first 
 set of teeth, the number is the same as in man and the form 
 so closely similar that they might be mistaken for human 
 teeth. 
 
 Man possesses a large cecum and a cellular colon which I 
 believe are not found in any carnivorous animal. 
 
 The carnivora have claws, a rasping tongue, pointed molar 
 teeth, small salivary glands, a simple stomach, a smooth colon 
 and an intestinal canal three times the length of the body. 
 Man has nails, a smooth tongue, blunt molar teeth, well 
 developed salivary glands, a stomach with a duodenum, a con- 
 voluted colon and an intestinal canal twelve times the length 
 of the body. The saliva in the carnivora is acid, in man it is 
 alkaline. 
 
 Bouchard and Charles Darwin have said that in ancient 
 times man probably subsisted upon fruits. 
 
 Darwin proved that man does not belong to the car- 
 nivorous order such as the lion and the leopard, but to the 
 herbivorous and frugivorous order such as the gorilla and 
 the chimpanzee. Man's masticatory movements compare 
 with those of the higher apes, while the jaws of the car- 
 
MEAT VERSUS VEGETARIAN DIET 31 
 
 nivora work like giant shears. Herbivorous animals se- 
 crete much more saliva in proportion to their size, and they 
 have a long alimentary canal while the carnivorous have 
 a short one. In the carnivora the hydrochloric acid is 
 much stronger in order to prevent putrefaction, and their 
 liver is much more powerful. The herbivora have a sac- 
 culated colon, while the carnivora have a smooth colon. 
 The human alimentary canal is about ten times the length 
 of the body, — that of the lion is only about four times the 
 length of the body. 
 
 This latter fact seems to prove that man requires a 
 vegetarian diet which provides bulk in the form of cellu- 
 lose for the intestines. Meat protein is hydrolyzed to pep- 
 tones in the stomach, and has only one more stage to reach 
 before it is ready for absorption, — a long intestine would 
 seem to be entirely unnecessary for this final chemical 
 change. But on a vegetarian diet, the protein, fat, carbo- 
 hydrates, and mineral matter are surrounded by cellulose 
 and the digestive juices cannot readily reach them. There- 
 fore, a long intestine seems necessary to furnish plenty of 
 time and space for the digestive juices to accomplish their 
 work, and for the quantity of bulk necessary on a vegeta- 
 rian diet. Much larger quantities of food must be eaten 
 on a vegetarian diet than on a meat diet, as the food prin- 
 ciples are not so concentrated. 
 
 Frugiyorous and herbivorous animals can be made to 
 live on flesh. This has been tried in the case of the pigeon, 
 horse, monkey and other animals. 
 
 Honorable E.. Kussell gives the following interesting 
 facts concerning the diets of the different nations ^ : — 
 
 It is estimated that three-fourths of mankind in all 
 known periods have been practically vegetarian. There 
 have been, however, a good many races which have sub- 
 sisted largely on flesh and some almost wholly, — the Eski- 
 mos and the Greenlanders for example. 
 
 * "First Conditions of Human Prosperity" ; "Strength and Diet." 
 
82 NUTRITION AND SPECIFIC THERAPY 
 
 Professor Lawrence mentions the Lapps, Samoides, 
 Ostiacs, Turgocaes and Burats as living on flesh and as 
 being among the weakest and least brave people of the 
 globe. 
 
 Sir John Sinclair, of the early part of the last century, 
 describes the Tartars as living wholly on flesh. Their 
 strength was great, but their character extremely low and 
 ferocious. 
 
 In the eighteenth century, the common food in Scot- 
 land was brose, porridge, oatmeal, flummery and greens, 
 boiled with a little salt. Beer or milk was drunk. Scarcely 
 any flesh was eaten. Both men and women were robust 
 and subject to few diseases ; none were of a nervous nature. 
 In the lowlands of the north, to these foods were added 
 some mixture of barley, rye or peas, potatoes, onions and 
 butter. Brindley, the engineer, found that his workmen 
 from Lancashire and Yorkshire whose fare was oat cakes, 
 hasty pudding and water, did more work than the laborers 
 of the south who ate bacon, bread, cheese and beer. In 
 recent years the Scotch children have been fed on bread, 
 tea and flesh and are not nearly as strong as formerly. 
 
 The l^orwegians used to live on bread made of mixed 
 rye, barley and potato, and later on, rye and barley bread, 
 milk and cheese and occasionally slices of fish. They were 
 healthy, strong and long-lived. The young people were 
 able with ease to run by a carriage going full speed for 
 twelve miles. Cheese, smoked reindeer, bacon and fish 
 are now much eaten. 
 
 The staple food of the Swedish peasantry is rye bread. 
 Milk and dairy products are abundant. The Swedes have 
 been a fine strong race. 
 
 In Germany as in England and most countries of the 
 world, well-to-do people have for a long time eaten flesh 
 in large quantities, but the mass of the population has sub- 
 sisted chiefly on black bread, milk, peas, potatoes and other 
 vegetables. 
 
MEAT VERSUS VEGETARIAN DIET 33 
 
 The Flemish lahorer has for breakfast, bread and butter, 
 chicory, cojBFee and milk ; for dinner, he has potatoes, vege- 
 tables and bread ; for supper he has the same. Very sel- 
 dom a little bacon and other flesh is eaten. 
 
 The Finns thrive chiefly on grain and vegetables, but 
 also on some flesh. 
 
 The Swiss peasantry have lived on bread, cheese, milk, 
 potatoes, vegetables and fruits, with flesh rarely in the 
 country and frequently in the towns. 
 
 The government reports on dietaries of the laboring 
 people of Europe in 1872 show that in most countries the 
 fare was almost entirely non-flesh, but that in several coun- 
 tries flesh was eaten occasionally, as once a week or on 
 Saints' days. 
 
 The Russians have lived on about a pound of coarse 
 black bread and garlic, working for 10-18 hours a day. 
 The fare of the peasantry has generally been black bread, 
 milk, cucumbers, cabbage and other vegetables. Even in 
 the towns, flesh was rarely eaten half a century ago. 
 
 The French peasantry, till recently, fared chiefly on 
 plant foods, and are said to have lived longer and in better 
 health than those who now consume more animal food and 
 stimulating drink. In many parts of France in 1875, the 
 peasantry only ate flesh once or twice a year, and in Brit- 
 tany not at all. 
 
 The Italian peasants were wont to fare almost entirely 
 on cakes and porridge of chestnut flour and wheat bread 
 and Indian com. They were a splendid, hardy people. 
 The Italians in general live largely on maize, rice, vege- 
 tables, macaroni, eggs and fruit. 
 
 The food of the Spaniards for many generations con- 
 sisted chiefly of coarse brown bread and grapes. 
 
 The Egyptian peasantry has lived on coarse wheaten 
 bread, Indian meal, lentils and vegetables, and they have 
 been among the finest of people. 
 
 The peasantry of Palestine have lived for the most part 
 
34 NUTRITION AND SPECIFIC THERAPY 
 
 on bread dipped in oil, rice, olives, grape treacle, gourds 
 and melons. 
 
 The Greek boatmen were wont to live on rye or wheat 
 bread, grapes, raisins and figs. 
 
 In Poland the chief diet has been bread and potatoes, 
 and the Poles have been noted for their endurance. 
 
 The Arabs have lived chiefly on dates and milk. Their 
 agility, endurance and strength are extraordinary. The 
 rich classes have beef, goose and vegetables. 
 
 Rice has been the commonest food of most of the hot 
 countries of Asia. In the Northwest Provinces, unleav- 
 ened bread made of wheat has been the staple food, and 
 has produced a hardy population. 
 
 The Chinese and Japanese peasantry who have lived on 
 rice and vegetables with fish occasionally are about the 
 strongest and most enduring workmen in the world. They 
 use also pulses, fruits, roots and herbs. The rich classes 
 include flesh. They do not use milk. (See end of Chap- 
 ter VIII.) Soy bean cheese is a common food. 
 
 The Jews have for thousands of years lived on a mixed 
 diet, — bread, lentils, dairy products, beans, vegetables, 
 honey, fruit and flesh. They have been a fairly strong 
 race. 
 
 The people of New England were accustomed to live 
 on baked beans, potatoes, cod or mackerel. They were re- 
 markable for physical and intellectual strength. 
 
 In Mexico and Peru, maize and bananas have long been 
 the staple food. 
 
 The Chilian laborers have subsisted on figs, bread and 
 beans. 
 
 An interesting view of the diet recommended by Socra- 
 tes is given in Plato's "Republic" : — 
 
 They will live I suppose on barley and wheat, baking cakes 
 of the meal, and kneading loaves, salt, olives, cheese, boiled 
 onions and cabbage, — figs, peas, beans and myrtleberries and 
 beech nuts roasted at the fire, and wine in moderation. And 
 
MEAT VERSUS VEGETARIAN DIET 35 
 
 thus passing their days in tranquillity, they wiU, in all prob- 
 ability, live to an advanced age. 
 
 In these diets of nations, the fact is strikingly conspicu- 
 ous that the great majority of the people have been vege- 
 tarian, either in the strict sense or the less strict sense 
 when dairy products have been included, and they have all 
 been noted for strength and endurance. 
 
 For untold centuries Buddhists and Brahmins have lived 
 on a vegetarian diet. The old Greeks built their peerless 
 empire on a meatless diet, and the armies of the Csesars 
 achieved their military victories principally on wheat. 
 Pythagoras, Plato and Plutarch were vegetarians, and in 
 modern times, Jean Jacques Rousseau, the social philoso- 
 pher, and Shelley, the poet. 
 
 A high protein diet, which is synonymous with a meat 
 diet combined with perhaps a quantity of dairy products 
 and eggs, is undoubtedly responsible in whole or in part 
 for many common diseases of to-day, — chronic rheuma- 
 tism, kidney diseases, biliousness, pernicious anemia, 
 neurasthenia, intestinal catarrh, colitis, arteriosclerosis, 
 diabetes and many others. 
 
 Researches at the Pasteur Institute in Paris have indi- 
 cated that animal protein decomposes twice as fast as vege- 
 table protein in the intestines, and Bunge found that the 
 toxins are four times as abundant in the intestines of flesh 
 eaters as in those of persons living on a low, protein, vege- 
 tarian diet. Other research men have confirmed this 
 figure. 
 
 A further argument in favor of a vegetarian diet is the 
 fact that it is not subject to tuberculosis, anthrax, foot-and- 
 mouth disease, septicemia, chicken cholera, tapeworm., 
 trichinae and other parasites. 
 
 Flesh foods as purchased are always in a state of putre- 
 faction which is not destroyed by ordinary cooking, and 
 bacteria enter the stomach where they often thrive in spite 
 
36 NUTRITION AND SPECIFIC THERAPY 
 
 of the hydrochloric acid, and then enter the intestines. 
 Here this cooked protein is a most favorable medium for 
 the countless putrefactive bacteria already thriving there. 
 Paratyphoid, Bacillus enteriditis,^ and streptococcus in- 
 fections have been produced many times through flesh 
 foods, and the Bacillus botulinus has been responsible for 
 many deaths. 
 
 In the previous chapter the importance of lime was dis- 
 cussed. Meats are almost wholly lacking in lime, for one 
 pound contains only one-half grain, but a pound of peas 
 contains eight grains. Man does not eat the blood and 
 bones of the animal as do the flesh-eating beasts, and con- 
 sequently does not get all the necessary elements of life. 
 Man drains off the blood containing the valuable mineral 
 matter, and throws away the bones. The result is a gen- 
 erous supply of protein, potassium and extractives, or waste 
 products, such as urea, uric acid and creatinine. 
 
 The following tables by Bunge show to what extent cer- 
 tain mineral matter is lacking in meat : — 
 
 100 Grams Dried Substance Yields Milligrams Iron as 
 Follows (Bunge) : 
 
 Eggs 10.-21. Strawberries 8.6 
 
 Milk 2.24 Blackberries 7.2 
 
 Human milk 2.3 Raspberries 4. 
 
 Spinach 33. Lentils 10. 
 
 Asparagus 20. Peas 6.2-6.6 
 
 Carrots 8.6 Almonds 10. 
 
 Cabbage 4.5 Potatoes 6.4 
 
 Outer leaves cabbage. 17. Wheat-flour 1.6 
 
 Apples 13. Wheat 5.5 
 
 Red cherries 10.6 Rye 5. 
 
 Dates 2. Pearl barley 1.4 
 
 Figs 3.9 Rice 1.-2. 
 
 Pears 2. Beef 4. 
 
 Grapes 6. 
 
 All infants are born with a large amount of iron, which 
 accounts for the above low figure. 
 »M. J. Eosenau and H. Weiss, J. A. U. A., Dec, 1921. 
 
MEAT VERSUS VEGETARIAN DIET 87 
 
 100 Grams Dried Substance Yields Milligrams Lime as 
 ToLLOWs (Bunge) : 
 
 Cow's milk 1423 Yolk of egg 380 
 
 Human milk 243 White of egg 130 
 
 Strawberries 483 Graham bread 7Y 
 
 Figs 400 White bread 46 
 
 Dates 108 Butter 411 
 
 Prunes 160 Potatoes 100 
 
 Pears 95 Beef 24 
 
 Iron of Common Fruits in Order of Per Cent. 
 
 Strawberries Grapes Apples and clives 
 
 Watermelon Prunes Figs 
 
 Gooseberries Blueberries Peaches 
 
 Cherries 
 
 Calcium of Common Fruits in Order of Per Cent. 
 
 Strawberries Olives Pears 
 
 Watermelon Grapes Peaches 
 
 Figs Cherries Blueberries 
 
 Prunes Apples 
 
 Iron of Common Vegetables in Order of Per Cent. 
 
 Spinach Cabbage Cauliflower 
 
 Lettuce Asparagus Carrots 
 
 Radishes Onions Potatoes 
 
 Calcium of Common Vegetables in Order of Per Cent. 
 
 Spinach Radishes Carrots 
 
 Cabbage Onions Cauliflower 
 
 Lettuce Asparagus Potatoes 
 
 Lentils have the highest per cent of iron of the legumes, 
 — peas and beans have about one-half the amount of lentils. 
 
 Beans have the most calcium, lentils contain a little less, 
 and peas have the least. 
 
 Iron of Cereals in Order of Per Cent. 
 
 Barley Wheat and Rye 
 
 Oats Corn and Rice 
 
 Buckwheat 
 
38 NUTRITION AND SPECIFIC THERAPY 
 
 Calcium op Cereals m Okdee of Pee Cent. 
 
 Oats 
 
 Wheat 
 
 Corn 
 
 Buckwheat 
 
 Rye 
 Rice 
 
 Barley 
 
 Sodium, potassium and magnesium can be considered in 
 this same way and the vegetables, fruits, cereals, legumes, 
 roots and tubers will be found to be rich in all these ele- 
 ments. 
 
 Eggs and nuts also have a very large amount of all 
 these mineral substances, but they should be relied upon 
 for their protein and fat principally. The author recom- 
 mends only a small amount of eggs. 
 
 In the foregoing discussion it has been said that meats 
 are laden with bacteria when purchased ; they are twice as 
 putrefactive in the human intestines as vegetable protein ; 
 they are many times laden with infectious diseases; they 
 are lacking in mineral matter ; and because of their high 
 protein content, a most favorable medium for bacteria in 
 the colon, they produce numerous times many of our acute 
 and chronic diseases. These diseases are further encour- 
 aged on a high protein or meat diet for the reason that 
 animal protein is too completely absorbed, inducing con- 
 stipation. Man needs bulk and this he acquires by eating 
 a certain quantity of cellulose each day. 
 
 There must be some reason for the universal American 
 malady, constipation, — and the answer is lack of cellulose 
 and a high protein diet. The most stubborn case of consti- 
 pation can, in all probability, be cured if the patient will 
 live on a low protein diet with an adequate amount of 
 cellulose derived from fruits and vegetables, combined 
 with cereals, legumes, roots and tubers (with the skins) 
 and a generous amount of water. 
 
 The author is forced to conclude that a meat diet is 
 against the laws for health for adults, and that it is par- 
 ticularly wrong for young children as their immunizing 
 
MEAT VERSUS VEGETARIAN DIET 39 
 
 organs have not been developed which aid in destroying 
 the toxic substances produced by bacteria from meat in 
 the intestines. Many authorities think the thyroid gland 
 is the most important of these organs. These facts will 
 be brought out clearly in the following chapter. 
 
 The majority of people think a vegetarian diet very lim- 
 ited. On the contrary, it stands for a diet of the greatest 
 variety, as a greater variety of foods is desired when meat, 
 is not included. In this diet, cereals, legumes, nuts, or 
 possibly eggs to supply the required protein, should be 
 included each day. 
 
 The author does not include milk to supply required 
 protein, mineral substances and vitamines for adults, al- 
 though most authorities favor it. In some cases it may be 
 valuable for a limited time, for example, in certain irri- 
 tations of the digestive tract in which the foods preferably 
 recommended by the author are not tolerated because of 
 certain idiosyncrasies. In other cases it is sometimes valu- 
 able when a rapid gain in weight is desired, but milk as 
 the sole article of diet should not be continued for too long 
 a period in these cases, for it has been known to produce 
 rheumatism and other infections because of too great a 
 proportion of protein and putrefaction. 
 
 Milk is dirty and bacteria laden by the time it reaches 
 the consumer, even though certified ; it comes many times 
 from diseased animals ; it gives too high a protein diet and 
 too many bacterial toxins absorbed from the intestines if 
 relied upon as the sole article of diet, so often recom- 
 mended in digestive disturbances, or if taken with the 
 average meal ; it is constipating because it is almost com- 
 pletely absorbed; it is the food primarily adapted to the 
 calf. 
 
 Cheese has all the same objections as milk, plus the ob- 
 jection that there are no cheese standards such as those 
 required for milk. 
 
40 NUTRITION AND SPECIFIC THERAPY 
 
 McCoUum says: — 
 
 Lacto-vegetarianism should not be confused with strict 
 vegetarianism. The former is, when the diet is properly 
 planned, the most highly satisfactory plan which can be 
 adopted in the nutrition of man. The latter is fraught with 
 grave danger unless the diet is planned by one who has exten- 
 sive and exact knowledge of the special properties of the 
 various food-stuffs employed. 
 
 These statements are in perfect accord with the author's 
 convictions, which favor the strict vegetarian diet only for 
 those who possess this exact knowledge. When strict vege- 
 tarianism is applied scientifically to the demands of the 
 body, the reaction of the colon is acid, which has a decid- 
 edly favorable influence upon health. (See Chapters IV, 
 V, VI.) 
 
 When a high protein diet is accused of being the cause 
 of many diseases, the author does not include the acute 
 and chronic infectious diseases in the same sense as that 
 of the acute and chronic organic diseases, or possibly some 
 deficiency diseases. Infectious diseases are caused by lack 
 of specific antibodies (neutralizing and destroying sub- 
 stances) in the blood and tissues, and deficiency diseases 
 by lack of specific vitamines in the foods and perhaps also 
 mineral substances, and by an "incomplete protein." The 
 author is convinced that certain of these antibodies are 
 lacking a great many times because of wrong diet, espe- 
 cially a high animal protein diet lacking in mineral matter, 
 and vitamines, but there is no conclusive laboratory proof 
 of this fact. (See end of Chapter IV.) However, there 
 is considerable laboratory proof that a high animal protein 
 diet, or a diet insufficient for nitrogen equilibrium causes 
 many acute and chronic organic diseases, — and that the 
 lack of vitamines is either the sole cause or a contributing 
 cause, combined with a high or too low protein diet, lack- 
 ing in mineral matter, of deficiency diseasciS. 
 
MEAT VERSUS VEGETARIAN DIET 41 
 
 In closing this chapter, it is only fair to enumerate the 
 great objections that have been read relative to a vege- 
 tarian diet: — 
 
 1. Tendency toward poor utilization of the food prin- 
 ciples. 
 
 2. Blandness of such a diet, and lack of desirable stimu- 
 lating qualities. 
 
 3. Necessity of consuming a large volume of food to 
 furnish the requisite nutriment. 
 
 The author's answer is, — ^man's great aim should not be 
 to absorb all he eats, — ^to keep the intestines free from 
 harmful bacteria is fully as important; a vegetarian diet 
 is not bland if one is not already overloaded with food, — 
 on the contrary it is very stimulating if the person is 
 hungry; man requires a large volume of food, — in other 
 words a quantity of cellulose, to promote peristalsis and 
 prevent the universal malady of constipation. 
 
 The following statements have been repeated many 
 times (Tibbies) : 
 
 Vegetarians contend that their diet tends to health and 
 longevity. But, it must be stated that the vegetarian is quite 
 as Sable to contract disease through his food or to suffer food 
 poisoning as the flesh-eater. 
 
 The vegetarian urges that meat causes diseases of the liver, 
 gout, stone, gravel, chronic rheumatism, skin diseases, disturb- 
 ances of the vascular system, arteriosclerosis, kidney disease, 
 migraine and kindred ailments ; that ptomaine-poisoning may 
 follow the consumption of meat; that the animal consumed 
 may be the subject of anthrax, pneumonia, tuberculosis, glan- 
 ders, various worms and other diseases, communicable to man. 
 But quite as many examples can be produced against a veg- 
 etarian diet. 
 
 An excess of bread or other starchy food from the vegetable 
 kingdom produces and promotes obesity, and sugar wiU pro- 
 duce evils similar to those following an excess of starch; it 
 especially causes catarrh of the stomach, attended by an 
 
42 NUTRITION AND SPECIFIC THERAPY 
 
 abundant secretion of mucus. The ingestion of hard fruit, 
 nuts and fibrous vegetables is a frequent cause of indigestion. 
 The communicability of disease is by no means confined to 
 flesh foods. The advice of medical practitioners in the tropics 
 is, — "Bat no uncooked vegetables, or any raw fruit, unless 
 you can pare it or peel it." Enteric fever, dysentery, cholera, 
 diarrhea and various other diseases have often been traced to 
 a disregard of such advice. Even in northerly and temperate 
 climates the consumption of raw, unripe or over-ripe fruit is 
 a frequent cause of diarrhea. Actinomycosis is due to the 
 ray fungus which enters the organism with green vegetables, 
 such as watercress, celery, lettuce, etc. Ergotism is a disease 
 which commonly affects the consumers of rye-bread. In fact, 
 the superior freedom of the vegetarian diet from disease-giv- 
 ing properties vanishes entirely when the subject is carefully 
 considered. 
 
 These remarks seem to fail to present a fair argument. 
 It goes without saying that an excess of bread, etc., or an 
 excess for that matter of any kind of food is harmful. All 
 thinking vegetarians admit commercial cane sugar is detri- 
 mental to health. Indigestion is not caused from nuts, 
 fruits and vegetables if properly masticated and eaten 
 when ripe unless the person has a certain idiosyncrasy for 
 these foods. The advice to avoid raw fruits and vegetables 
 in the tropics is worthy of consideration because disease 
 germs are much more abundant in these climates. How- 
 ever, this objection is nothing against a vegetarian diet 
 because fruits can be peeled and vegetables should be 
 cooked when necessity demands this, and in this form they 
 are far superior to meats and other animal foods in these 
 hot climates where putrefaction in the intestines would be 
 still more abundant on a meat diet, both because of the 
 meat itself, and because of the sedentary life of the people 
 in these climates. 
 
 To complete this comparison of a meat diet with a vege- 
 tarian diet, the average food composition of each of the 
 principal groups of foods is given: — 
 
MEAT VERSUS VEGETARIAN DIET 
 
 Meats (Average Composition) 
 
 Water 75.0 per cent. (Varies with the kind 
 
 Protein 16.0 " " of meat and the cut.) 
 
 Connective tissue 3.0 
 
 Fat 4.5 
 
 Mineral Matter 1.0 
 
 Extractives 5 
 
 Milk (Average Composition) 
 
 Water 8Y.0 per cent. 
 
 Protein 3.0 " " 
 
 Fat 4.0 " " 
 
 Carbohydrate 5.0 " " 
 
 Mineral Matter 7 " " 
 
 Cheese (Average Composition) 
 
 Water 36.0 per cent. 
 
 Protein 31.0 " " 
 
 Fat 28.0 " " 
 
 Mineral Matter 5.0 " " 
 
 Eggs (Average Composition) 
 
 The yolk is exceed- 
 
 Water 73.7 per cent 
 
 Protein 14.8 " " 
 
 Fat 10.5 " " 
 
 Carbohydrate 0.0 " " 
 
 Mineral Matter 1.0 " " 
 
 ingly rich in protein, 
 fat and compounds of 
 calcium, phosphorus 
 and iron. The white is 
 rich in protein, phos- 
 phorus and calcium. A 
 small amount of carbo- 
 hydrate is also present. 
 
 Dry Cereals (Average Composition) 
 
 Water 10.0-12.0 per cent. 
 
 Protein 10.0-12.0 
 
 Fat 1.0-5.0 
 
 Carbohydrates 65.0-75.0 
 
 Mineral Matter 2.0- 3.0 
 
 Cellulose 2.0 
 
 The bran and the germ of cereals are removed in the 
 milling, and the result is a great loss in mineral matter, 
 
44. NUTRITION AND SPECIFIC THERAPY 
 
 protein and vitamines. These valuable substances are 
 sold by the millers as feed for cattle, hogs and poultry. 
 These animals, fed according to scientific rules, are not 
 anemic and nervous. 
 
 There are many advertisements of "entire wheat flour" 
 in all the magazines and labelled as such on the packages. 
 But if the people will read a little further in these adver- 
 tisements, they probably will see in very small print, — 
 "(with part of the bran removed)." There is very little 
 whole wheat flour on the market that is entirely "whole," 
 and people who wish this, and all the substances so valu- 
 able for health will do well to send to some pure food store 
 in one of the large cities or to some mill and have the 
 flour sent direct to them. 
 
 One of the best cereal foods known to the author is the 
 whole grain wheat itself, washed and then boiled in slightly 
 salted water for about forty-five minutes, and not drained. 
 A little experience will accomplish this in the given time. 
 Probably the majority of people would prefer this cereal 
 cooked longer as it will not be very tender at the end of 
 this period, but the merits of short periods of cooking 
 have already been discussed. Whole grain wheat can be 
 purchased at pure food stores and cooked as desired, or it 
 can be purchased already cooked and canned. This is 
 served with butter or cream, with or without sugar. 
 
 Dry Legumes (Average Composition) 
 
 Water 12 per cent. (The Soy Bean and 
 
 Protein 21 
 
 Fat 1.5 
 
 Carbohydrate 55 
 
 Mineral Matter 2-5 
 
 Cellulose 2-6 
 
 Peanut excepted.) 
 
 It is interesting to compare the average composition of 
 dried legumes and cereals, — ^their protein content being the 
 important difference. 
 
MEAT VERSUS VEGETARIAN DIET 45 
 
 Nuts (Average Composition) 
 
 Water 4^ 5 per cent. 
 
 Protein 15-25 
 
 Fat 50-70 
 
 Carbohydrate 10 
 
 Mineral Matter 2 
 
 Cellulose 1-5 
 
 Roots and tubers are primarily a carbohydrate food, 
 although their mineral content is of great value. The 
 following diagram compares their average food composi- 
 tion with that of vegetables and fruits. 
 
 VBQETABLXB (ATEBAQB COMFOSITIOir) 
 
 p. c. 
 
 Water 92.0 '\ 
 
 ^,^ Protein 1.0~,..\ 
 
 Fruits — Same^— Pat fi "^ — Same — ^RooTS and Tubers 
 
 Water 85. p. c.\^ Carbohydrate ... 5.0 ^^ Water 85. p. c. 
 
 Carbohydrate. 5.— 20. " ^Mineral Matter.. l.O^'^-^ Carbohydrate. 5.-20. " 
 OeUuloBe 8. " OeUulose l.O-^ 
 
 In other words, vegetables, fruits, roots and tubers are 
 very similar in their protein, fat, mineral matter and 
 cellulose content. Fruite, roots and tubers have less water 
 and more carbohydrate than vegetables, and compare 
 favorably vdth each other in their average composition of 
 these two food principles, although the carbohydrate of 
 roots and tubers is for the most part in the form of starch, 
 while that of fruits is in the form of sugars. Fruits are 
 higher in cellulose than vegetables, roots and tubera. 
 
CHAPTEK IV 
 
 AUTO-INTOXICATION 
 
 AuTO-niTTOxicATiow is a very inclusive term, and gen- 
 erally misunderstood in its exact meaning. A great many 
 people have heard and read of this so-called disease, but 
 have never had sufficient interest to inquire into this very 
 absorbing subject and study its causes, effects and bearing 
 upon the general health of the body. It may be termed a 
 disease in itself, or it may countless of times be the fore- 
 runner of a great many of our common acute and chronic 
 organic diseases, — and in the author's opinion it may also 
 account for many infectious diseases, and be a contributing 
 cause of deficiency diseases. It works like a thief in the 
 night, slowly and surely poisoning the tissues, of every 
 kind, and robbing them of their special functions. 
 
 The term, auto-intoxication, is disliked by many of the 
 medical profession, yet there must be some name to apply 
 to the body when metabolic and bacterial products from 
 the intestines accumulate in it which prevent the normal 
 functioning of the body's organs. 
 
 The chapters on cooked and uncooked foods, and on a 
 meat versus a vegetarian diet have led up to this exceed- 
 ingly important subject. 
 
 In studying the literature on auto-intoxication, the defi- 
 nition given by Professor Combe of the University of 
 Lausanne, Switzerland, is in accordance with the author's 
 convictions, and for this reason, a number of statements in 
 his book are incorporated in this chapter.^ 
 
 ' "Auto-intoxication." 
 
 46 
 
AUTO-INTOXICATION 47 
 
 This investigator says, — "Auto-intoxication is a toxemia 
 caused by substances formed through the influence of the 
 vital processes of the body," and further states that it does 
 not included infections or toxemias from tainted foods. 
 According to his definition it is of two kinds, — from the 
 functions of the tissues of the body and from the func- 
 tions of the digestive canal. 
 
 The first type is again divided into two classes, — ^those 
 auto-intoxications produced by the tissues and those pro- 
 duced by the antitoxic glands. Those produced by the 
 tissues are the result of the metabolic decomposition of the 
 living cells of the body, and are the normal products of 
 the nutritive changes in the tissues. For example, — ^when 
 the nucleins are destroyed into uric acid, purine bodies, 
 xanthine, etc., and retained, uric acid diathesis of ar- 
 thritis is the result. Secondly, when the albumins and 
 fats are destroyed in too great quantity, the result is an 
 accumulation of acetone and an acid intoxication. This 
 type of auto-intoxication accompanies insufficient food, 
 certain grave anemias, many 'intestinal affections and 
 grave diabetes, — that is, it is observed whenever the fats 
 and albumins of the body are destroyed in exaggerated 
 proportions. The liver plays a very important role in con- 
 nection with preventing this form of auto-intoxication by 
 transforming, oxidizing and conjugating the harmful 
 catabolic products into harmless ones which are for the 
 most part excreted by the kidneys. It is claimed it reduces 
 to one-fourth the toxicity of the poisons eliminated by the 
 kidneys. 
 
 The second type of auto-intoxication produced from the 
 functions of the tissues is a toxemia produced by insuffi- 
 ciency of the antitoxic glands ("immunizing glands"). 
 These are divided into glands of external secretion and 
 glands of internal secretion. To the first group belong 
 the kidneys, liver, intestinal mucosa, respiratory tract, 
 sweat glands and salivary glands. Consequently, when 
 
48 NUTRITION AND SPECIFIC THERAPY 
 
 the kidneys do not function normally the result ia uremia 
 with an accumulation of toxic substances from the diges- 
 tive canal and from the catabolism of the body tissues; 
 when the liver is at fault the result is cholemia ; when the 
 intestinal mucosa does not prevent toxic bodies from enter- 
 ing the circulation, many grave results follow; when the 
 respiratory tract, which eliminates carbonic acid, ammonia 
 and perhaps acetone, and the sweat glands which elimi- 
 nate small quantities of urea, ammonia, phenols, indol, 
 and volatile fatty acids, and the salivary glands which at 
 times may eliminate such substances as urea, do not per- 
 form these functions, the result ia an auto-intoxication 
 from these glands of external secretion. 
 
 To the second group belong the antitoxic glands of in- 
 ternal secretion. These furnish the body with substances 
 indispensable to health or they destroy by their antitoxic 
 power substances noxious to the body. Whenever one of 
 these glands does not function normally, toxic substances 
 accumulate in the body. 
 
 In this way tetany is produced from insufficiency of the 
 parathyroid bodies, myxedema from insufficiency of the 
 thyroid gland, acromegaly from insufficiency of the pitu- 
 itary body, Addison's disease from insufficiency of the 
 suprarenal capsules, diabetes from insufficiency of the 
 pancreas, etc. These are the glands also that render sub- 
 stances harmless which have been absorbed from the ali- 
 mentary canal, and which have been produced as a result 
 of the breaking down of the body cells. 
 
 The second kind of auto-intoxication, according to 
 Combe, is produced from the functions of the digestive 
 canal, and is a toxemia caused by qualitative or quantita- 
 tive alterations in normal digestion. In this is included 
 the digestion by enzymes of the stomach, intestines and 
 pancreas and also that by the bacteria which inhabit the 
 digestive tract. 
 
 The digestive enzymes convert starches into sugar, fats 
 
AUTO-INTOXICATION 49 
 
 into fatty acids and glycerol, and proteins into amino- 
 acids and ammonia. The bacteria do the same, but the 
 action of the bacteria is not limited to producing these 
 products. They carry the process farther and produce 
 from these substances such products as hydrogen, carbonic 
 acid, hydrogen sulphide, and methane; they produce irri- 
 tating acids such as caproic, valeric, butyric, and propri- 
 onic; they produce aromatic bodies such as indol, phenol 
 and skatol, and ptomaines such as cadaverine and putre^ 
 seine. The above substances are not always harmful, but 
 are when produced in quantities above normal, while cer- 
 tain ptomaines are always harmful even in very small 
 amounts (Armand Gautier). 
 
 To elucidate the chemical changes that take place 
 through this bacterial action, the following examples of 
 its effect upon hydrolyzed and native food principles are 
 given : — 
 
 The putrefaction of tyrosine gives cresol and phenol 
 (carbolic acid) ; the putrefaction of tryptophane gives 
 skatol, indol and pyrrol; the fermentation of sugars and 
 the putrefaction of fatty acids produce oxalic and butyric 
 acids, carbonic acid, etc. ; the putrefaction of certain 
 amino-acids, cystine for example, gives hydrogen sulphide, 
 etc., and this gas is probably always harmful. The me- 
 chanical action of carbon dioxide and hydrogen is gener- 
 ally beneficial if not produced in too great quantities. 
 
 Most of the phenol and indol enter the liver where oxi- 
 dation and combination occur, and so they enter the circu- 
 lation in a much less harmful form. In this way indican 
 is produced, — ^this is present in all stagnations of the 
 small intestines. It is not necessarily the result of con- 
 stipation, although generally speaking, this condition is 
 present. Sometimes indican indicates certain diseases, 
 such as those of microbic suppuration. It is often found 
 in anemia, tuberculosis and diabetes. 
 
 One-tenth of the protein in our food may be said to be 
 
50 NUTRITION AND SPECIFIC THERAPY 
 
 subject to bacterial decomposition. If a larger proportion 
 than this is putrefied, the toxic substances produced by 
 the bacteria increase beyond the control of the glands of 
 external and internal secretion, and auto-intoxication is 
 the result. 
 
 The conclusion regarding the bacteria in the intestines 
 is that they are useful when they carry digestion as far as 
 the digestiYO enzymes, but that they are harmful when 
 they transform the digestive tract into a laboratory of 
 poisons. Protein putrefaction occurs almost entirely in 
 the large intestines where the reaction is alkaline, and 
 fermentation of carbohydrates in the small intestines. 
 This fermentation makes the reaction of the small intes- 
 tines acid in spite of the alkalinity of the digestive juices 
 there. Sometimes both putrefaction and fermentation 
 take place in the stomach. 
 
 If one antitoxic or eliminating organ fails to perform 
 its function, others may supplement it and auto-intoxica- 
 tion may be delayed for a time. This condition, however, 
 cannot continue indefinitely and the liver, kidneys and 
 other organs, overstimulated as they have been, finally 
 are forced into a condition of hypoactivity. At this point 
 the toxins from the catabolism of the body tissues and from 
 the digestive tract begin to accumulate and the result is a 
 hyperproduction and a hypodestruction of toxins and the 
 various acute and chronic organic and perhaps certain 
 infectious diseases ensue. These may be various heart 
 diseases, nervous diseases, glandular diseases, skin dis- 
 eases, etc., according to the particular person in question. 
 Often there is an effort on the part of the body to throw 
 off these toxic substances through vomiting, diarrhea, 
 bilious attacks and salivation. 
 
 Every stomach that does not promptly digest its food 
 is transformed into a laboratory of fermentation and putre^ 
 faction, and this condition is then produced in the small 
 
AUTO-INTOXICATION 51 
 
 and finally in the large intestines, and many abnormal 
 states of the body may result, — constipation, diarrhea, 
 diseases of the intestines, appendicitis, dilatations, dys- 
 pepsia, pyloric stenosis, flatulency, etc. To this list may 
 be added headaches, fever, dizziness, tonsillitis, asthma, 
 urticaria, diseases of the gums, diabetes, kidney diseases, 
 arteriosclerosis, anemias, etc. 
 
 When once the condition of auto-intoxioation is estab- 
 lished, what is offered in the way of treatment ? Accord- 
 ing to many authorities, the antiputrefactive diet is a 
 lacto-farinaceous diet (meat excluded). It has been 
 proved there are four times as many toxins produced on a 
 meat diet as on a lacto-farinaceous diet. But this is the 
 same as saying that the replacing of meat with milk does 
 not prevent putrefaction, but that it only reduces it. The 
 pure culture sour milk preparations made with the Bulga- 
 rian bacillus prove more beneficial than sweet milk in this 
 diet, although the value of these milks has been overesti- 
 mated. 
 
 With the exclusion of meats and milk from the diet, 
 the farinaceous foods are the only ones remaining on the 
 list, with the exception of eggs, which should be classed 
 with meat and milk, but which, in the author's opinion, 
 do not seem to produce the harmful substances if eaten in 
 small amounts. An added advantage is that eggs are 
 sterile and not laden with bacteria like meat and milk. 
 Although classed as protein foods, cereals, legumes and 
 nuts may also be designated as farinaceous foods since they 
 all contain starch. To these should be added the fari- 
 naceous foods, — roots and tubers, and to a lesser degree 
 the fruits and vegetables may be included as farinaceous 
 or carbohydrate foods. 
 
 The author's treatment consists in following the sixteen 
 antitoxic rules for reforming the intestinal flora outlined 
 in Chapter VI, giving special thought to maintaining 
 
52 NUTRITION AND SPECIFIC THERAPY 
 
 nitrogen equilibrium on a protein diet little above the 
 minimum, this depending upon the age, sex, climate, occu- 
 pation and weight of the person. (See Chapter I.) 
 
 Professor Combe gives the following treatment: — Di- 
 minish nitrogenous putrefaction in the intestines so as to 
 bring it back to normal if the antitoxic organs are com- 
 petent. Bring nitrogen putrefaction to a point below nor- 
 mal if the antitoxic organs are insufficient. Stimulate the 
 antitoxic functions when they have become insufficient. 
 
 All authorities admit that in convalescence and growth 
 the protein ration must exceed considerably the minimum 
 of nitrogen equilibrium. 
 
 Many authorities do not advocate raw foods because 
 they claim they are laden with bacteria. But repeated 
 investigations have proved that sterile, vegetarian food 
 modified the proportion of bacteria very little in the in- 
 testines. (See Rule 15, Chapter VI.) 
 
 Author's sumcmary : Auto-intoxication may be a disease 
 in itself caused by a temporary fermentation or putrefac- 
 tion ; it may be the direct or secondary cause of acute and 
 chronic, organic and deficiency diseases produced by wrong 
 foods, which are the primary, indirect cause; it may be 
 the indirect, secondary cause of some infectious diseases, 
 the lack of antibodies being the tertiary cause, and the 
 bacteria, themselves, the direct cause. In other words, it 
 is caused by too much or too little wrongly prepared and 
 combined foods, or wrong foods, deficient in mineral mat- 
 ter and vitamines, which stagnate, ferment and putrefy in 
 the alimentary canal, and these toxic products are absorbed 
 which cause the eliminative organs and antitoxic glands 
 to become overstimulated and finally worked into a state 
 of hypoactivity. Vitamines and mineral matter are lack- 
 ing which are necessary for metabolism, the vitamines per- 
 haps being necessary for the fixation or functioning of the 
 mineral matter. Coincident with this condition the body's 
 metabolism is wholly deranged and the products of catab- 
 
AUTO-INTOXICATION 63 
 
 olism are not eliminated, and accumulate, and finally are 
 expelled through various channels. In the meantime the 
 many acute and chronic organic, and possibly some infec- 
 tious and deficiency diseases may have made their inroads. 
 
 The production of indol in the colon from tryptophane 
 by bacterial putrefaction and its transformation into indi- 
 can by the liver in which form it is rendered comparatively 
 harmless and as such is excreted in the urine, has long 
 been known. 
 
 The advocates of a low protein, vegetarian or lacto- 
 vegetarian diet, are daily confronted with the following 
 question : — ^Why is it that in the case of two persons living 
 under the same conditions and eating the same food, say 
 a high protein meat diet, one is perfectly well while the 
 other has many symptoms of auto-intoxication, such as, 
 neurasthenia, muscular exhaustion, constipation or dia- 
 betes? The answer may be found in the fact that there 
 may be the same amount of indol and other poisons formed 
 in the intestines of these two persons, but in the case of 
 one, the lining of the intestines does not permit the poi- 
 sons, for some reason, to pass through into the blood, while 
 in the case of the other, the lining does not act as a defen- 
 sive agent, and these poisons are allowed to pass through. 
 In the first case, therefore, it would be expected that there 
 would be a considerable quantity of these poisons in the 
 feces and very little in the urine. In the other case, con- 
 ditions should naturally be the opposite. Again in these 
 two persons, the epithelial lining of the intestines may 
 act to a very slight degree as a protection against putre^ 
 factive poisons and consequently large quantities may be 
 carried to the liver from the intestines. Here, however, 
 there may be a difference in the protective power of the 
 liver in these two persons. In the healthy person these 
 poisons may be conjugated, oxidized and otherwise trans- 
 formed into harmless substances such as the conjugation 
 of indol with potassium and sulphur which is indican ; in 
 
54. NUTRITION AND SPECIFIC THERAPY 
 
 the sickly person the liver may not readily perform these 
 functions. Innumerable such reasons might be cited as an 
 explanation of the many times asked query. The answer 
 to this mystery may be found in temporary impaired 
 functioning of the sympathetic nervous system through 
 causes other than diet. As a result, indican and other 
 poisonous substances in the urine are not always a sign 
 of auto-intoxication. But generally an analysis of the 
 poisonous and waste products of the urine is significantly 
 indicative. 
 
 To illustrate the effect of meat poisons absorbed from 
 the intestines, the following experiment was demonstrated 
 at the laboratory of Professor Pawlow: — ^A dog with Eck's 
 fistula (the portal vein, which carries the toxin laden 
 blood to the liver to be rendered harmless, was attached 
 to the vena cava), recovered in a few days on a vegetarian 
 diet; but when it was fed on a meat diet, the dog died 
 within three days because the toxins from the meat were 
 carried into the general circulation without being rendered 
 harmless by the liver. A dog has a liver four times as 
 large as a man's in proportion to his size. A dog for this 
 reason can thrive on a meat diet far better than man. 
 
 All literature seems to point to the increase of diabetes, 
 kidney diseases, appendicitis, neuritis, rheumatism, dis- 
 eased tonsils, pyorrhea, etc. Surely there is some power- 
 ful cause which produces these pathological conditions, 
 and it is the author's conviction that this cause can be con- 
 trolled if educators will make it a part of required educa- 
 tion to teach enough of the subjects outlined in the begin- 
 ning of this book to enlighten people about the functions 
 of their own bodies. How many people are as well versed 
 in the physiology and requirements of their own bodies as 
 they are in the different arts, — and the innumerable other 
 studies and subjects that occupy all their thinking hours? 
 
 There is an old saying, — "Most men dig their graves 
 with their teeth," and another one says, — "The science of 
 
AUTO-INTOXICATION 65 
 
 living begins at the mouth." Never were two statements 
 more true. 
 
 A very common symptom of auto-intoxication is indic- 
 anuria in children. These children are irritable and diffi- 
 cult to control, and extremely fickle in their appetites. 
 Their circulation is often at fault, and they are constantly 
 taking cold. Their susceptibility to tonsil infections may 
 be due to this cause. Their sleep is perturbed. 
 
 These children do not appear exactly ill, and a physician 
 is therefore seldom consulted. So these cases drift along, 
 restless, anemic, and unhappy. By the time adult life is 
 reached, there are pronounced, abnormal symptoms of per- 
 haps the heart, the kidneys, the appendix, the bladder, the 
 pancreas, etc. These unwary sufferers begin to think and 
 question and wonder how and why their bodies' functions 
 have become disturbed, — and the majority never are en- 
 lightened, or understand, but try many useless cures from 
 that time on till death finally claims these unfortunate vic- 
 tims of auto-intoxication. 
 
 Paul R. Cannon ^ says after eliminating cases of chronic 
 infections in the digestive tract or elsewhere and those 
 which have been shown to be the result of nervous reflexes, 
 "there are still many instances of acute and chronic condi- 
 tions in man in which no fecal infections have been found, 
 and in which there is definite evidence of an intoxication 
 of intestinal origin." He states there is a contrast in the 
 tendency of animal and vegetable proteins to encourage 
 putrefaction in the intestinal tract. "Torrey pointed out 
 this peculiarity when he found that vegetable proteins do 
 not offer the slightest encouragement to the growth of the 
 intestinal putrefaction types of bacteria. My experiments 
 agree with those of Torrey in that vegetable proteins not 
 only reduced the relative proportion of proteolytic types, 
 both aerobic and anaerobic, but also encouraged the over- 
 growth of a nongas-producing aciduric flora ; animal pro- 
 V. Infect. Dis., Oct., 1921. 
 
56 NUTRITION AND SPECIFIC THERAPY 
 
 teins on tlie other hand, such as meat, fish and eggs, led to 
 an enormous overgrowth of gasrforming proteolytic types." 
 
 Underhill and Simpson ^ have found that the diets 
 which give rise to the excretion of phenol and indican in 
 large quantities are the ones that lead to the overgrowth 
 of putrefactive bacteria in the intestines. Meat led to a 
 marked increase of phenols and indican, whereas casein 
 caused much less phenol and indican. These research 
 men found vegetable proteins to produce the same amount 
 as casein, but the experiments of Cannon and Torrey, ac- 
 cording to the above statement, do not confirm these results. 
 
 In connection with the author's convictions that auto- 
 intoxication may be caused by deficiencies in the diet, 
 which may be a contributing cause of infectious diseases, 
 the following researches by S. S. Zilva * are of interest and 
 point to a broad field of research in this subject. He states 
 that besides the radical changes produced by deficient nu- 
 trition already recorded, it is quite possible that decided 
 modifications may take place in the body tissues and fluids 
 which are not discernible macroscopically or microscopi- 
 cally, but which may nevertheless restrict physiologically 
 the functions of the organism. In this connection arises 
 the interesting problem whether the resistance to disease 
 of the animal is in any way influenced by deficient nutri- 
 tion. (See Pernicious Anemia.) 
 
 Zilva carried out experiments with deficient diets on 
 amboceptor and agglutinin formation and the complement 
 content, but says that owing to the complexity of the sub- 
 ject, the experiments can be considered only of a prelimi- 
 nary character. The results obtained, although of an un- 
 expected nature, are nevertheless of general interest, and 
 suggest the necessity of future investigations. Eats and 
 guinea pigs were used in these experiments. 
 
 The influence of the following dietetic deficiencies on 
 
 *J. Biol. Chem., Oct., 1920. 
 *Biochem. J., May, 1919. 
 
AUTO-INTOXTCATION 57 
 
 the production of these antibodies (neutralizing and de- 
 stroying substances) was studied. 
 
 1. Deficiency of calcium, iron, potassium, flhlorine, 
 phosphorus. 
 
 2. Deficiency of certain amino-acids. 
 
 3. Deficiency of the three vitamines. 
 
 Only the group which received a diet deficient in phos- 
 phorus showed a decidedly poorer response to the inocu- 
 lations in the production of amboceptor and agglutinins. 
 Growth was restricted in these experiments. 
 
 In conclusion, he states that a systematic study of the 
 infiuence of nutrition on the production of immunity, al- 
 though complex and laborious, is urgently called for, and 
 may not only prove to be of direct clinical value, but may 
 elucidate many obscure points in the complicated mech- 
 anism of immunity. 
 
CHAPTEE V 
 
 BACTERIOLOGY OF THE DIGESTIVE TRACT 
 
 In the preceding chapter, the author's conviction is 
 stated that certain bacteria of the alimentary tract are the 
 principal cause of auto-intoxication, which in turn may be 
 the cause or a contributing cause of organic, infectious, 
 or deficiency diseases. Bacteria in this region are always 
 present, and harmful, with a few exceptions, when carry- 
 ing digestion farther than the enzymes. 
 
 According to F. P. Underbill and Gr. E. Simpson "the 
 pioneer work of Herter and Kendall, and more recently of 
 Pettger and his coworkers, and of Torrey shows that diet 
 is effective in regulating the character of the intestinal 
 flora." The author is indebted to Professor Herter ^ for 
 some points of interest concerning the characteristic in- 
 testinal flora of childhood and adult age. 
 
 Because the digestive tract is extremely abundant with 
 bacterial forms, many research men in this subject have 
 endeavored to solve the meaning of this fact. There are 
 some animals of the arctic regions such as polar bears, 
 seals, reindeer and ducks that have no bacteria in their 
 digestive tracts. 
 
 Many experiments have been carried on to determine 
 whether bacterial life in the intestines is essential to de- 
 velopment, — some investigators have said yes, while others 
 have said no. But the fact remains that in the tropical 
 and temperate climates it is impossible to avoid the en- 
 
 * "Bacterial Infections of the Digestive Tract." 
 
 68 
 
BACTERIOLOGY OF THE DIGESTIVE TRACT 59 
 
 trance of bacteria into the digestive tract. Some forms 
 seem to have a beneficial effect, such as those that produce 
 lactic acid, while others are pronouncedly harmful. But 
 the normal body is provided with more or less efficient 
 methods of defense against the harmful bacteria; the 
 acidity of the gastric juice destroys them; the pepsin of 
 the stomach, the trypsin of the intestines, and other en- 
 zymes digest many of these bacteria ; the intestinal mucosa 
 prohibits the passage of many bacteria into the tissues ; the 
 liver destroys many others that do escape through the in- 
 testinal lining ; the spleen destroys others through its pro- 
 duction of antibodies, — and other defenses exist which are 
 not so well understood. 
 
 These bacteria may be classified into three groups,^— the 
 aerobes, the anaerobes and the facultative anaerobes. The 
 aerobes are those bacteria which require free oxygen for 
 their development; the anaerobes thrive where there is no 
 free oxygen ; the facultative anaerobes multiply best in the 
 presence of free oxygen, but can also increase under the 
 same conditions as the anaerobes. 
 
 The aerobes are the bacteria found in the normal colon 
 and are antagonistic to the anaerobes, because of certain 
 acids which they produce, — especially lactic acid. Many 
 facultative anaerobes are also present in the normal, 
 healthy colon. The strict anaerobes are those that charac- 
 terize the colon of auto-intoxication where the medium is 
 alkaline, and not acid as in the healthy colon. They, in 
 other words, are those that produce putrefaction. 
 
 Bacteria, like all living things, require nitrogen for 
 their development. Therefore, protein and protein deriva- 
 tives are utilized by bacteria for their growth and energy, 
 and carbohydrates and fats are also a source of energy. 
 
 These bacteria can be absolutely regulated by the diet 
 chosen in any particular locality. The character of the 
 food, its solubility and its volume, together with the com- 
 position of the digestive juices, determine the bacteria of 
 
60 NUTRITION AND SPECIFIC THERAPY 
 
 the digestive tract. Roger has said there are about 160 
 varieties in the alimentary canal. 
 
 First Bouchard, then Roger, MetchnikofF, Tissier and 
 others took up the subject of these bacteria. 
 
 While bacteria are always present in the digestive tract, 
 yet they are not always the same at all times of life. 
 Professor Distaso, assistant to Metchnikoff, at the Pasteur 
 Institute, Paris, in an exhaustive research in relation to 
 the intestinal bacteria, found the following to be true, 
 which also confirmed work done by Professor Tissier, also 
 of the Pasteur Institute : — ^Within a few hours after birth 
 a protective germ, the Bacillus bifidus is found in the 
 intestines. So long as the reign of this germ lasts, the 
 infant remains in a healthy condition. But when the in- 
 testines become infected with the Bacillus coli and others 
 through cow's milk during the nursing period, and later 
 through the many other foods given a young child such as 
 meat broths, meats, eggs, etc., these delicate bifidus germs 
 are driven out, and the way prepared for the development 
 of the putrefactive bacteria. These are the bacteria that 
 are responsible for the majority of the ills of infancy, 
 childhood and adult age. The bifidus germs that are not 
 destroyed aid in stimulating the colon and preventing 
 constipation. 
 
 In nurslings the bacteria of the intestines are very 
 simple. A few examples are the Bacillus bifidus of Tis- 
 sier, the Bacillus lactis aerogenes, and the Bacillus acid- 
 ophilus. There are a few of the Bacillus coli and Bacil- 
 lus aerogenes capsulatus, also called Bacillus welchii 
 Bacillus perfringens, the gas bacillus, and other names. 
 
 Bottle-fed children have a great number of bacteria even 
 when the milk has been pasteurized or sterilized. The 
 number of bacteria in raw cow's milk ranges from 1000- 
 2000 per c.c. in certified milk, to several million per c.c. 
 in uncertified milk. Ordinary cow's milk contains 100,000 
 per C.C. 
 
BACTERIOLOGY OF THE DIGESTIVE TRACT 61 
 
 There is, therefore, a striking difference between the 
 bacteria of the intestines of nurslings and the bacteria of 
 the intestines of infants fed on cow's milk, for in the case 
 of the latter there are many more of the Bacillus coli and 
 many less of the Bacillus bifidus. There are numerous 
 others such as diplococci, the Streptococcus lacticus, cer- 
 tain staphylococci, the Bacillus aerogenes capsulatus, the 
 Bacillus proteus vulgaris which forms indol and skatol 
 from casein, the Bacillus putrificus, etc. Streptococci are 
 known to produce severe cases of ileocolitis in infants and 
 children. 
 
 According to Paul Heinemann, there are two kinds of 
 streptococci in market cow's milk. The one that produces 
 intestinal disturbances and septic sore throat is the patho- 
 genic, fecal and sewage streptococcus; the other is the 
 Streptococcus lacticus which is the ordinary bacterium 
 which cooperates with the Bacillus aerogenes lacticus in 
 producing lactic acid in milk. 
 
 In other words, the lactic and succinic acid forming 
 bacteria (beneficial bacteria) become less and less numer- 
 ous and the putrefying bacteria become more and more 
 numerous as age advances, according to the food ingested, 
 or in other words, the aerobes decrease and the anaerobes 
 and facultative anaerobes increase. 
 
 It is found there is a great difference between the num- 
 ber of anaerobes in the intestines of adults on a meat diet 
 as compared with the number on a vegetarian diet. The 
 anaerobes are diminished by two-thirds in the presence 
 of large quantities of carbohydrate and cellulose. The 
 conclusion is evident, namely, that a vegetarian diet pro- 
 duces acid forming bacteria in the intestines which prevent 
 putrefaction. 
 
 In view of this fact> it is interesting to cite some im- 
 portant facts concerning the Bacillus coli, so universally 
 present and commonly discussed. 
 
 In the first place its action can be controlled by the diet 
 
62 NUTRITION AND SPECIFIC THERAPY 
 
 chosen, — it can be rendered either beneficial or harmful, 
 or it may be said that the diet can be so regulated as to 
 force the Bacillus coli either to produce fermentation or 
 putrefaction. Secondly, this bacillus cannot hydrolyze 
 native protein (the proteins as found in unchanged foods), 
 but the Bacillus aerogenes capsulatus and other anaerobes, 
 especially Bacillus putrificus, can hydrolyze native pro- 
 teins. On a meat diet, there are many of the Bacillus 
 aerogenes capsulatus and similar bacteria present, and a 
 great deal of unabsorbed cooked, partly digested protein 
 reaches the large intestines. These anaerobes then hydro- 
 lyze the proteins that escaped absorption, and being very 
 numerous, they also attack any fats and sugars that 
 escaped absorption. There are quantities of prepared food 
 for the Bacillus coli, in the case of a high protein diet, 
 from which to produce toxic substances, and other facul- 
 tative anaerobes together with the strict anaerobes add to 
 these toxic products. Examples of such substances are 
 butyric acid, hydrogen sulphide, phenol, skatol, indol, 
 putresoine and cadaverine. Thus the Bacillus coli is forced 
 to produce quantities of indol on a meat diet or a high 
 protein diet. 
 
 There is, therefore, the greatest necessity for a low pro- 
 tein diet and for prompt absorption, when practically no 
 unabsorbed protein reaches the colon. Under these con- 
 ditions the anaerobes cannot thrive and the Bacillus coli 
 and others of this class are compelled to produce fermen- 
 tation because of the great quantity of carbohydrate pres- 
 ent, especially if much of the food has been eaten in the 
 raw state in the form of salads, fresh fruits, figs, dates, 
 prunes and raisins, and nuts, or if it has been cooked for 
 only a short period. The reason for this is that a con- 
 siderable quantity of carbohydrates escapes absorption 
 through increased peristalsis, and consequently reaches the 
 colon where the Bacillus coli flourishes. 
 
BACTERIOLOGY OF THE DIGESTIVE TRACT 63 
 
 Much has heen written about the Bacillus coli in rela- 
 tion to its producing deadly poisons which give rise to 
 degeneration of the liver, kidneys, hlood-vessels, nerves, 
 etc., and as has been said, these poisons are produced 
 mainly from animal protein; whereas in the presence of 
 an abundance of carbohydrates and cellulose, the colon 
 germ produces harmless acids instead of deadly poisons. 
 
 In an article published by Dr. Robert Morris, the fol- 
 lowing statements have been made: — The Bacillus coli 
 probably stands next to the tubercle bacillus in the pro- 
 portion of deaths which it causes. Dr. Morris charges this 
 bacillus with being the cause of diseases of the appendix 
 and inflammation in the region of the pylorus and duo- 
 denum and many cases of gastric disturbances. It is said 
 sometimes to cause gall-stones, and that diabetes may be 
 the result of an inflammation of the pancreas set up by 
 the colon bacillus. It is also said that hardening of the 
 liver and arteries may be caused by it more than by 
 syphilis or alcohol, and that it may prepare the way for 
 infantile paralysis, and may cause many cases of neu- 
 rasthenia. In scarlet fever, diphtheria, measles, typhoid 
 fever and other infectious diseases, this bacillus is often 
 the only one found in the urine. Cases in which patients 
 have suffered from albumin in the urine have been cured 
 by the removal of an inflamed appendix from which the 
 colon bacillus entered the circulation. 
 
 The author's conclusion is that in these infections the 
 toxins produced on a high protein diet, lacking in mineral 
 matter, may have interfered with the production of anti- 
 bodies for combating these particular infectious diseases. 
 
 Professor Herter has made numerous experiments for 
 the purpose of determining the effects of indol (formed 
 from the amino-acid tryptophane) upon the body produced 
 by the colon bacillus and other bacteria under anaerobic 
 conditions, and has found that this poison produces head- 
 
64 NUTRITION AND SPECIFIC THERAPY 
 
 ache, insomnia, irritability, coated tongue, sallow com- 
 plexion, dullness of mind, cold hands and feet and a score 
 of other symptoms. 
 
 Professor Herter gives the following types of chronic 
 excessive putrefaction : — 
 
 1. Indolic. 
 
 2. Saccharo-Butyric. 
 
 3. Combination of the two. 
 
 In the first the Bacillus coli may invade the small in- 
 testine and produce indol there as well as in the large 
 intestine. In the second type the Bacillus aerogenes cap- 
 sulatus is the most prominent. This bacillus thrives on 
 carbohydrate as well as protein and produces much butyric 
 acid and gas. This type of putrefaction is widespread 
 among adults, and it is claimed there are few people who 
 do not suffer from it from time to time. They experience 
 great muscular and mental fatigue, mental depression and 
 emotional irritability. Ammonium butyrate is formed in 
 large quantities which is very irritating, often producing 
 diarrhea and irritation of the entire digestive tract. 
 
 There seems to be little doubt that in time these types 
 of putrefaction will lead to many of the common afflictions 
 of man, — colitis, appendicitis, kidney diseases, acidosis, 
 rheumatism, neuritis, etc., and that they will prepare the 
 way for many other types of diseases. 
 
CHAPTEE VI 
 
 REFORMING THE INTESTINAL FLORA 
 
 Having considered the different types of bacteria that 
 are ever present and thrive in the intestinal tract and the 
 effects produced by them, the next question of interest 
 is to determine how best to regulate their growth which 
 has so great a determining influence upon health. 
 
 From the foregoing chapter, it is fully evident that the 
 diet should be so regulated that the acid forming bacteria 
 predominate. All scientific men interested in the subject 
 of diet agree on the beneficial effects of lactic acid in the 
 large intestines, a fact first popularized by Metchnikoff. 
 Every reader has doubtless read or heard much on the 
 subject of conveying to, or producing in the large intes- 
 tines, lactic acid which, as has been said, antagonizes 
 anaerobes and combats putrefaction. Much literature has 
 been written concerning the consumption of large quan- 
 tities of buttermilk, kumiss, kefir, etc. 
 
 It is the author's opinion that the value of these foods 
 containing lactic acid or lactic acid forming bacteria has 
 been greatly overestimated. When lactic acid is taken 
 directly in the food, it is generally completely absorbed 
 before it reaches the colon, and if the bacteria themselves 
 are ingested, they are in all probability killed or digested 
 before they reach the large intestines. Pure culture lactic 
 acid milks very probably hasten digestion in the stomach 
 because the clot formed by the rennin is smaller and not 
 so tough ; they also may favor peristalsis in the small in- 
 testines and consequently in the large intestines, — ^these 
 two reasons may speak favorably for the lactic acid prepa- 
 
 65 
 
66 NUTRITION AND SPEaFIC THERAPY 
 
 rations, but they do not confirm the hopes that the acid 
 itself or the bacteria ever reach the colon. For those who 
 wish to prepare buttermilk for the above reasons, the 
 Yogurt tablets may give a certain amount of satisfaction. 
 
 The best knovni of the beneficient germs or aerobes is 
 the Bacillus bulgaricus discovered by Grigoroff. This 
 germ produces lactic acid from glucose and consequently 
 this bacillus has been put up in tablet form to be eaten as 
 such three times a day or used for producing buttermilk, 
 in the hopes of flooding the colon with lactic acid to combat 
 putrefaction. But the fact that sugar is generally com- 
 pletely absorbed before it reaches the colon gives the Ba- 
 cillus bulgaricus a very poor chance to develop in the 
 colon, even if it escaped the eifect of the hydrochloric 
 acid, and later, digestion in the small intestines, especially 
 on a meat diet in which the carbohydrate ration is low. 
 By what scheme then can the Bacillus bulgaricus and 
 similar bacteria be developed in the colon ? The answer 
 would seem to suggest itself in the light of what has been 
 written in the previous chapters. On a vegetarian diet, 
 and especially a raw diet, some of the starch and sugar 
 necessarily would seem to escape absorption in the small 
 intestines and would reach the colon. There the bacteria 
 that hydrolyze starch to sugar, and oxidize the sugar to 
 lactic acid are in the majority, and the perplexing prob- 
 lem would seem to be solved. In other words, the author's 
 conclusion is that the most efficient method whereby to 
 obtain lactic acid in the colon is not through eating these 
 tablets or drinking lactic acid preparations, but by living 
 on a low protein diet (so-called vegetarian diet), with a 
 generous supply of salads and fruits, for under these con- 
 ditions the aerobes that normally thrive in the colon will 
 be forced to produce the much desired lactic acid. 
 
 To show the presei-vative effects of lactic acid, an inter- 
 ested experimenter immersed a piece of beefsteak in but- 
 termilk made from a culture of the Bacillus bulgaricus, 
 
REFORMING THE INTESTINAL FLORA 67 
 
 and kept it in a state of preservation for several years. 
 If this is true, the fact is clearly demonstrated that lactic 
 acid antagonizes anaerobes and prevents putrefaction. 
 
 With these facts in mind, the foUov^ing rules for en- 
 couraging the growth of aerobes will prove helpful : — 
 
 Sixteen Rules for Reforminiof the Intestinal Flora. — 
 1. To reform! the intestinal flora completely, all animal 
 protein must be excluded for the time being, which in- 
 cludes meats and fish of all kinds, and also milk, cheese 
 and eggs. In extreme cases of putrefaction and auto- 
 intoxication this is absolutely necessary (tests for CO2 in 
 the blood, and indican, uric acid and urea in the urine are 
 indicative). In milder cases some eggs may be allowed. 
 
 The most efficient procedure for completely reforming 
 the intestinal flora would be to withhold all food for 24 
 hours, giving nothing but water and possibly a cathartic 
 of Pluto water. At the end of this period, give only fresh 
 fruit juices for 24 hours. Then gradually increase the 
 diet according to the rules enumerated. 
 
 2. The diet should consist of unrefined cereals, legumes 
 (cooked no longer than is absolutely necessary), nuts and 
 possibly some eggs (in other words, the four most ideal 
 protein foods according to the author). Nuts should be 
 eaten as the principal protein food of the meal and not 
 at the end of the meal as a side dish. Combine these four 
 protein foods with a generous supply of roots and tubers, 
 fresh vegetables and fruits. The cereals should be unre- 
 fined except in cases of an irritated digestive tract, and 
 should never be drained after cooking. The roots and 
 tubers should be eaten with the skins if possible, because 
 of their protein, mineral matter, vitamine and cellulose 
 content. 
 
 Prunes, figs, dates and raisins are excellent fruits if 
 purchased in a sanitary condition. Honey is an excellent 
 food. 
 
 3. Drink several pints of water a day. 
 
68 NUTRITION AND SPECIFIC THERAPY 
 
 4. Take some kind of physical exercise. 
 
 5. Do not overeat. This is best accomplished by omit- 
 ting animal foods. 
 
 Never eat merely because it is meal time. Appetite and 
 hunger should not be confused. There is an old saying, — 
 
 "Three meals for animals, two for man and one for 
 angels." 
 
 There are many people who live on two meals a day, 
 especially during the summer months. The author rec- 
 ommends two meals a day the year round for many brain 
 workers. 
 
 A person should not eat too often. Those so-called 
 pangs of hunger without reason in the middle of the fore- 
 noon or afternoon do not denote hunger. They are prob- 
 ably due to customary reactions of the stomach formed 
 through the habit of eating between meals. A person 
 who has formed this habit should realize that "a single 
 caramel or nougatine may furnish sufficient energy to sup- 
 ply the extra heat needed to walk a mile." ^ Another cal- 
 culation says that "one-half doughnut or six walnuts give 
 enough Calories (80) to walk from the bottom to the top 
 of Washington Monument.^ Perhaps it can be learned 
 from this how futile a constitutional walk is in any at- 
 tempt to combat the accumulating energy from undue eat- 
 ing between meals." 
 
 6. Do not eat too little. Nitrogen equilibrium must 
 be maintained, sufficient carbohydrate and fat must be 
 eaten to produce the required amount of heat and energy, 
 there must be a balanced mineral ration for all the tissues 
 and body secretions, a sufficient quantity of cellulose to 
 promote normal peristalsis and an adequate supply of 
 vitamines for health. 
 
 7. Habitual use of tea and coffee should be prohibited 
 as far as possible. The tannin interferes with digestion 
 and the caffeine paralyzes the sympathetic nerves of the 
 
 I'O. G. Benedict^ F. G. Benedict, Boston M. and S. J., Oct., 1919. 
 
REFORMING THE INTESTINAL FLORA 69 
 
 intestines, and aids in causing arteriosclerosis. They often 
 produce gastric catarrh, nausea, headache and other 
 symptoms. 
 
 8. Tobacco and alcohol produce many pathological 
 conditions, — gastric catarrh, dyspepsia, irritation of the 
 mucous membranes, irregular heart . action, defects of 
 vision, arteriosclerosis, etc. 
 
 9. Condiments should be prohibited, — ^horseradish, 
 mustard, pepper and spices. All are generally constipat- 
 ing and irritating to the digestive tract, liver, blood-veaeels 
 and kidneys. 
 
 10. Vegetable fats should be chosen in preference to 
 animal fats, v^hich are more difficult to digest and more 
 easily putrefied. Nuts with their 50 per cent fat, olive 
 oil, etc., and soy beans (18 per cent fat) are excellent. 
 
 11. Cane sugar should be eaten in very small quan- 
 tities. Large amounts (100 grams) give rise to gastric 
 catarrh, and produce oxalic acid which in large quantities 
 gives rise to oxaluria. The symptoms of this condition 
 are dyspepsia, nervous exhaustion, and mental distress. 
 It also produces alcoholic fermentation, gas and the irri- 
 tating butyric acid. Calcium in the body very readily 
 combines with oxalic acid, forming calcium oxalate, which 
 appears as "gravel" in the urine. As a result, the body 
 is robbed of its necessary calcium. In this connection it 
 is interesting to read that in 1598 Heutzer, a German 
 traveller, thus describes Queen Elizabeth, then 65 years 
 old,- — "Her nose is a little hooked, her lips narrow and 
 her teeth black, a defect the English seem subject to from 
 their great use of sugar." 
 
 Commercial cane sugar is probably the most concen- 
 trated, artificial food product on the market, for the sugar 
 cane juice is bleached, neutralized, coagulated, filtered, 
 centrifuged, clarified and evaporated in vacuo, — and the 
 American citizen is reported to average one-fourth pound 
 
70 NUTRITION AND SPECIFIC THERAPY 
 
 a day of this artificial product, wliicli depresses gastric 
 secretion.^ 
 
 Cane sugar is wholesome in small amounts as found in 
 all fruits and some vegetables, roots and tubers, cereals 
 and legumes. But the sugars to which the stomach and 
 intestines are adapted in larger quantities are milk sugar, 
 malt sugar (produced by the action of the ptyalin of the 
 saliva on starch, and also by the pancreatic enzyme, 
 amylopsin in the small intestines) and dextrose and levu- 
 lose. Beet sugar and maple sugar are chemically indis- 
 tinguishable from the product of the sugar cane. 
 
 A word here may be added in favor of a small amount 
 of unbleached molasses, which is the residue from the re- 
 fining of the juice of the sugar cane. Sorghum, so exten- 
 sively grown in this country, is made from the African 
 millet, and is a wholesome food if unbleached with sul- 
 phur compounds. 
 
 12. Avoid iced drinks and very hot drinks. Iced 
 drinks chill the stomach and retard digestion. The 
 stomach has few sensory nerves and consequently does not 
 react against the hot liquids so frequently poured into it 
 that in reality have almost burned the mouth. 
 
 A very safe rule is to drink before or at the end of a 
 meal, or drink in small quantities with a meal, water that 
 is neither ice cold nor very hot. Drinking with meals as 
 a rule causes one to drink too much, and this may result 
 in dilatation of the stomach, or it may cause the food to 
 be swallowed in lumps and consequently digestion is de- 
 layed in the stomach and bacterial fermentation and putre- 
 faction result. Sipping small amounts of water vrith 
 meals may prove beneficial by stimulating the flow of 
 gastric juice. A. C. Ivy * says : — "The ingestion of water 
 with the meals (400—800 c.c.) increases the amount, and 
 the free and total acidity of the gastric juice. The inges- 
 
 *A. J. Physiol., Aug., 1920. 
 'A. J. Physiol., April, 1918. 
 
' REFORMING THE INTESTINAL FLORA 71 
 
 tion of water witli the meals decreases the emptying time 
 of the stomach, due to the dilution of the stomach con- 
 tents." 
 
 13. Avoid fresh breads and pastries of all kinds. They 
 are prone to produce fermentation and putrefaction in 
 the stomach and intestines. 
 
 14. Avoid complicated menus for reasons previously 
 stated. 
 
 15. Wash all fresh fruits and vegetables very thor- 
 oughly before serving them raw. (The Bacillus putrificus 
 is often on the surface.) 
 
 16. Avoid cathartics except in cases of emergency. 
 They do not decrease the intestinal putrefaction when 
 habitually used, except as they stimulate peristalsis and 
 force a mechanical voiding of the anaerobes. The reduc- 
 tion in these bacteria is merely transient, and is followed 
 by the usual putrefactive bacterial development. 
 
 With these rules in mind, a pint of water drunk at night 
 and the use of a certain amount of sterilized bran each 
 morning vsdll probably combat the most stubborn case of 
 constipation. (See Cathartics, Chapter X.) 
 
 These sixteen rules signalize unretarded digestion and 
 prompt absorption. In other words, these are the rules 
 for reforming the intestinal putrefactive regime, and for 
 combating constipation, and the resulting numerous dis- 
 eases. Peristalsis may be stimulated to such a degree that 
 there are two movements a day, but this is a result to be 
 desired rather than one to cause worry. 
 
 Referring to Rule 7, the chemical composition of tea, 
 coffee and chocolate is given on pages 72 and 73. 
 
 The amount of caffeine in the two kinds of tea does not 
 materially differ, but the percentage of tannic acid shows 
 a much larger proportion in green tea. This fact is ac- 
 counted for by the process of fermentation to which the 
 black tea is subjected which renders a portion of the tannic 
 acid insoluble. 
 
72 NUTRITION AND SPECIFIC THERAPY 
 
 Tea 
 
 Green Black 
 
 Per cent. Per cent. 
 
 Water 5.96 8.2 
 
 CafPeine 2.33 3.2 
 
 Albumin 16.83 17.2 
 
 Alcoholic Extract 7.05 6.7 
 
 Dextrin 5 
 
 Pectin 3.2 2.6 
 
 Tannic Acid 27.1 16.4 
 
 ChlorophyU 4.2 4.6 
 
 Cellulose 25.9 34.0 
 
 Mineral Matter 6. 6.2 
 
 Pectin present in tea and many vegetables, roots and 
 fruits is a kind of carbohydrate, a substance which has 
 not yet been prepared in a pure state. It gives to fruit 
 juices their property of gelatinizing. If fruits are too 
 ripe, the properties of the pectin are lost, and the juices 
 cannot be formed into jelly. 
 
 Caffeine is a trimethyl purine and theobromine, the cor- 
 responding substance in chocolate and cocoa, is a dimethyl 
 purine. They are almost identical with uric acid which 
 is formed as a waste product of the body. 
 
 Chlorophyll is the green coloring matter of plants, par- 
 ticularly associated with vitamine A. 
 
 Coffee 
 
 Per cent. 
 
 Water 6 
 
 Caffeine .8 
 
 Saccharin Matter 4 
 
 Tannic Acid 4.7 
 
 Alcoholic Extract 14.1 
 
 Eat and Oil 13.5 
 
 Legumin 11.2 
 
 Dextrin 1.2 
 
 Cellulose 48.6 
 
 Mineral Matter 4.5 
 
REFORMING THE INTESTINAL FLORA 73 
 
 The caflFeine and tannic acid in coffee are present in a 
 mucli smaller amount than that found in tea, but the 
 amount of each in an infusion of tea and coffee is approxi- 
 mately the same because a much stronger infusion of coffee 
 is generally demanded. A cup of coffee or tea contains 
 about four grains of caffeine and five grains of tannic 
 acid. About 35-40 per cent of the coffee used in making 
 the infusion goes into solution. 
 
 Cocoa Bean 
 Per cent. 
 
 Water 5.2 
 
 Fat 50.4 
 
 Carbohydrate 4.2 
 
 Albumin 6.3 f oit 1 j 1 « 4. 1 
 
 Taimic Acid 5.Y (4.Y in coffee) ] ^ xTt} \ 
 
 Gum "^1 ^ "^^^^ ^ 
 
 Cellulose 6.4 f23and3 2l 
 
 Theobromine 8 (same as coffee) \ ' ■ +„„ ' e 
 
 Cocoa Eed 2.2 
 
 Mineral Matter 2.7 
 
 Cocoa preparations from the bean have much less fat, 
 about 26 per cent and consequently more carbohydrate, 
 about 25 per cent, and more protein, about 20 per cent. 
 Sweet chocolate contains about 50 per cent fat and 40 per 
 cent cane sugar. Many people cannot digest chocolate 
 because of its high fat content. 
 
 Honey 
 
 Per cent. 
 
 Water 20. 
 
 Dextrose 35. 
 
 Levulose '. 40. 
 
 Gums, Wax, Essential Oils, Coloring Matter, 
 
 Mineral Matter 5. 
 
 Bhubarb and Spinach. — This is perhaps a fruit and a 
 vegetable that should be generally forbidden. Their prin- 
 
74 NUTRITION AND SPECIFIC THERAPY 
 
 cipal acid is entirely different from the other vegetable 
 and fruit acids such as citric, malic and tartaric. These 
 acids are oxidized in the body and form carbonates. But 
 the high per cent of oxalic acid in rhubarb and spinach 
 is a poison,* and cannot be oxidized, and is excreted in the 
 urine for the most part as calcium oxalate. Only a mere 
 trace of this acid is found in the majority of fruits and 
 vegetables, but there is a considerable amount in tea, cof- 
 fee, cocoa, sorrel and pepper. McCoUum ^ says there may 
 be an injurious effect brought about by prolonged admin- 
 istration of oxalic acid. (See Cane Sugar, Chapter VI.) 
 
 The body produces and eliminates daily, from protein, 
 fat and carbohydrate, and also from fermentation in the 
 intestines, about .02 gram.* In eating one-fourth pound 
 of rhubarb or spinach, one would ingest about four grains 
 of oxalic acid or about thirteen times the amount which 
 the body normally eliminates daily. (If drained, iron as 
 well as oxalic acid is removed from spinach.) 
 
 An occasional meal of spinach or rhubarb has no ill 
 effects, but spinach is habitually recommended by physi- 
 cians for anemic patients and infants and children as a 
 daily necessity. What is the reason for this with the 
 above facts in mind, and why are not quantities of lettuce 
 and many other foods, — cabbage, apples, strawberries, oat- 
 meal, lentils, etc., with their extremely high iron content 
 recommended with the same enthusiasm as spinach. 
 Spinach may have a slightly higher percentage of iron, but 
 patients quickly tire of spinach and will relish larger 
 amounts of these other foods for a longer period of time. 
 It is the author's opinion that lettuce and cabbage (green 
 is the best, — see Chapter IX) should be greatly favored 
 in place of spinach. They can be cooked, but are best 
 served in salads. They should be advised twice a day 
 
 *"A Text-book of Physiological ChemiBtry," Eammarsten and 
 Hedin. 
 
 ■"The Newer Knowledge of Nutrition." 
 
REFORMING THE INTESTINAL FLORA 75 
 
 for anemic patients, serving them once in a vegetable 
 salad and then again in a fruit salad. 
 
 Loeper ® has published numerous articles on the subject 
 of oxalic acid in gout in the last ten years, and his experi- 
 ence has demonstrated more and more the pathogenic 
 action of retention of oxalic acid. It affects the liver, 
 muscles, and nervous system, but the joints suffer first. 
 It involves mainly the small joints of the hands and fingers, 
 settling in connective tissue and bone rather than the 
 cartilage and periarticular tissue for which uric acid dis- 
 plays a predilection. Uric acid gout is accompanied by 
 vasomotor congestion and high blood pressure, — oxalic 
 acid gout by low blood pressure and anemia. 
 
 Other symptoms of oxaluria are neuralgia, eczema, dys- 
 pepsia, nervous exhaustion and mental distress. 
 'J. A. M.A., Sept., 1921. 
 
CHAPTEK VII 
 
 DIET IN THE COMMON DISEASES 
 
 In tlie previous chapter the sixteen rules were outlined 
 which may prevent the majority of the acute and chronic 
 organic diseases and possibly some of the infectious and 
 deficiency diseases. When once these have gained a foot- 
 hold, the question of diet must always be of the utmost 
 importance, based upon the etiology of the particular dis- 
 ease; sometimes the same disease is produced by entirely 
 different causes, and the diet in these cases would natu- 
 rally be somewhat different. (Certain type of diabetes 
 and anemia for example.) 
 
 Hyperchlorhydria. — Chronic cases of hyperacidity are 
 extremely common and the question of the diet has pro- 
 voked much controversy. Some authorities advocate a 
 high protein diet because the protein combines with the 
 free hydrochloric acid and therefore diminishes the gastric 
 acidity. Others advocate a lacto-vegetarian diet, and still 
 others a carbohydrate diet based upon the experiments of 
 Pawlow, which show that the gastric secretion is less 
 stimulated by these substances than by protein. Von 
 Noorden and Zweig are in favor of a mixed diet as they 
 claim that neither protein nor carbohydrates have any 
 appreciable effect upon the gastric acidity. 
 
 The following diet has been carried out with success 
 in the author's experience : — 
 
 1. Avoid drinking with meals as water stimulates the 
 flow of gastric juice. 
 
 2. Avoid all flesh because it demands much hydro- 
 chloric acid to reduce it to peptones. 
 
 76 
 
DIET IN THE COMMON DISEASES 77 
 
 3. Avoid condiments, tea, coffee and large amounts of 
 cane sugar for reasons previously given. 
 
 4. Eat little salt as this stimulates secretions. 
 
 5. Avoid acid fruits. Eat ripe bananas, prunes, figs, 
 dates, raisins, plums, pears, watermelon, grapes and baked 
 apples. 
 
 6. Eat easily digested fats, sucb as olive oil, butter, nut 
 butters, ripe olives, — perhaps Yogurt buttermilk and 
 eggnog. 
 
 (Eats inhibit the flow of hydrochloric acid.) 
 
 7. Eoods should be taken in the form of a puree 
 (vegetables, cereals and legumes) as chewing stimulates 
 the flow of gastric juice. 
 
 8. All cereals and legumes should be allowed as they 
 are an important protein food and also contain much 
 required carbohydrate. 
 
 9. All roots, tubers and vegetables should be advised 
 because of their high mineral and vitamine content. 
 
 10. Eating little at one time should be urged in order 
 that the food may pass out of the stomach as quickly as 
 possible. Four meals a day may be given if necessary 
 when the meals are small. 
 
 Hypochlorhydria. — The majority of the rules are oppo- 
 site those for hyperacidity. 
 
 1. Highly peptogenic foods should be eaten as they 
 demand much hydrochloric acid. These include cereals, 
 legumes, nuts and eggs. The cereals and legumes should 
 be served whole and cooked only a short time, and they 
 should be thoroughly masticated. 
 
 2. Eoots and tubers should be eaten with the skins, 
 especially baked potato. There should be a liberal supply of 
 fruits and vegetables, eaten in the raw state as far as pos- 
 sible, which requires more thorough mastication than when 
 these foods are cooked, thereby stimulating secretions, 
 
 3. Avoid quantities of fats which inhibit hydrochloric 
 acid. 
 
78 NUTRITION AND SPECIFIC THERAPY 
 
 4. Avoid tea, coffee, condiments, meats, cheese and 
 cane sugar for reasons previously given. 
 
 5. In some cases pure culture buttermilk may be 
 advised. 
 
 Anachlorhydria. — Foods should naturally be advised 
 which make little demand upon the stomach. Small 
 meals and probably four a day will prove most beneficial. 
 
 The following foods have given good results : — 
 
 Buttermilk (pure culture). 
 
 Rice in all forms. 
 
 Tapioca. 
 
 Wheat flakes (with sterilized milk or cream if desired). 
 
 Com flakes. (Ripe fruits are excellent in place of 
 cream. ) 
 
 Raw eggs (may be beaten and added to fruit juices). 
 
 Pulp of potato. 
 
 Purees of peas, beans and lentils. 
 
 Vegetable broths. 
 
 Vegetable purees. 
 
 Ripe fruits (according to the patient). 
 
 Colitis — Gastritis — Gastric Ulcer — Appendicitis — En- 
 teritis. — ^AU require practically the same diet except gas- 
 tric ulcer and acute appendicitis, when generally the 
 initial nourishment should be given per rectum. Rectal 
 injections of glucose every other day may be given and 
 sterilized milk and raw egg can be given every day. 
 
 At first give only water and vegetable purees orally. 
 Gradually other foods are added. Olive oil can be given 
 to the amount of 150 c.c. a day. Two to three eggs a day 
 may prove of benefit in the later stages. Strained cereal 
 gruels, potato and rice purees, cauliflower and lettuce 
 purees and ripe fruit juices have given good results. 
 
 Migraine. — This may be the result of a high protein 
 diet, arteriosclerosis, great muscular or brain fatigue and 
 other causes. 
 
 Follow the diet rules according to the etiology. 
 
DIET IN THE COMMON DISEASES 79 
 
 Dilatation — Flatulency — Heart Diseases. — Disinfect 
 the stomach and intestines by giving a diet of fruit juices 
 and water for two days. (This may be omitted in heart 
 diseases.) A dry dietary is advised because it promotes 
 mastication, and therefore prevents overloading the 
 stomach. Small quantities of food should be given four 
 times a day, and no water allowed with the meals. 
 
 The following foods are especially advised : — 
 
 Prepared dry cereals Nuts 
 
 Toast Raw fruits 
 
 Corn bread Whole-grain wheat 
 
 Baked potato with skin Raw vegetable salads 
 
 Figs — Dates — Raisins — Popped com 
 
 Prunes (washed and uncooked) 
 
 Gall-stones — Jaundice. — The following diet may some- 
 times obviate an operation. The great aim is to stimulate 
 all secretions through reflex action. 
 
 Four hundred grains of cellulose (or approximately one 
 ounce) a day may be advised. 
 
 A generous amount of water probably will prove bene- 
 ficial. 
 
 A laxative diet gives good results, consisting of fresh 
 vegetables, and fresh fruits eaten without paring, olive oil, 
 unrefined cereals cooked a very short time, legumes, roots 
 and tubers with the skins, and nuts. 
 
 The following table will give the approximate number 
 of ounces of foods necessary to furnish 400 grains of 
 cellulose. These figures can be compared with those rec- 
 ommended in Europe in what is called the grape cure for 
 auto-intoxication, acne and allied diseases. In this cure 
 about 6 pounds of grapes a day are given, approximately 
 96 ounces. Naturally many of these figures are high 
 because of the high per cent of water in fruits and 
 vegetables. 
 
80 NUTRITION AND SPECIFIC THERAPY 
 
 A variety of the following foods each day should make 
 up the sum total: — 
 
 Eaw 
 Asparagus 
 Beans .... 
 Beets .... 
 Brussels Sprouts 
 
 Ounces 
 
 Give 400 
 Grains 
 Cellulose 
 . . Y6 
 . . 100 
 . . 76 
 . . 54 
 
 Cabbage 44 
 
 Carrots 80 
 
 Cauliflower 82 
 
 Celery 5Y 
 
 Green Peas 43 
 
 Lettuce 114 
 
 Onions 115 
 
 Parsnips 45 
 
 Dried Peas 14 
 
 Baked Potato 73 
 
 Tomatoes 99 
 
 Turnip 61 
 
 Prunes 40 
 
 Apples 80 
 
 Pears 27 
 
 Peaches 80 
 
 Eaw 
 
 Ounces 
 Give 400 
 
 Grains 
 Cellulose 
 
 Plums 53 
 
 Cherries 40 
 
 Eed Easpberries 108 
 
 Huckleberries 6.5 
 
 Blackberries 16 
 
 Strawberries 40 
 
 Currants 23 
 
 Bananas 226 
 
 Figs 18 
 
 Apricots 32 
 
 Cranberries 16 
 
 Polished Eice 200 
 
 Unpolished Eice 109 
 
 Com Meal 40 
 
 Com Flakes 40 
 
 Dried Beans 100 
 
 Dried Peas 13 
 
 Lentils 20 
 
 Graham Bread 67 
 
 Sterilized Bran 2 
 
 Diarrhea (Adults') 
 Only water for 24 hours in severe cases. 
 
 Eice 
 
 Eice Flakes 
 Eice Pudding 
 Cornstarch Pudding 
 Tapioca Pudding 
 Puree of Lettuce or Cauli- 
 flower 
 
 Cereal Gruels 
 White Bread Toast 
 Albumin Water 
 Cocoa 
 No Sugar 
 
 Colon irrigation and Pluto water may prove advisable 
 at the onset. 
 
DIET IN THE COMMON DISEASES 81 
 
 Diarrhea (Infants'). — There are several varieties of 
 acute infants' diarrhea. One is caused by the dysentery 
 bacillus, — B. dysenterise (Flexner), B. dysenterise 
 (Shiga), B. dysenterise (Kruse), — another by a gas- 
 forming bacillus, the B. aerogenes capsulatus, and very 
 recently ^ another type has been described by K. Mita of 
 Fukuoka, Japan, — that produced by the paratyphoid 
 bacillus and the paradysentery bacillus. In the B. dysen- 
 terise types, albumin water may prove beneficial (white of 
 one egg to one cup of water 3—4 times a day) ; give plain 
 cool water also. In the B. aerogenes capsulatus variety, 
 cereal waters and fruit juices may prove beneficial. 
 
 Diarrhea in infants may also be due to over- or under- 
 feeding, to a mechanical obstruction, to some particular 
 infection or to fat intolerance. If fermentation is the 
 cause (albumin water is recommended), it is confirmed 
 by the frequent, green, watery stools. 
 
 If diarrhea is due to overfeeding or to some particular 
 infection, give only water for twelve hours, and a table- 
 spoon of mineral oil, "Milk of Magnesia," or Pluto water, 
 or sufficient to cause a complete evacuation of the colon. 
 
 If fat intolerance is the cause, give fat-free milk, per- 
 haps modified with oatmeal water (oats contain an easily 
 digested fat) and olive oil, which gives excellent results in 
 many cases. (See Modification and Schedule, Chapter 
 VIII.) 
 
 Calcium caseinate milk has been employed in cases of 
 fermentation. This is low in carbohydrate and fat. A. 
 G. DeSanctus and L. V. Paider of New York give the 
 following formula ^ : — Two-thirds ounce calcium casein is 
 used to 16 ounces of whole milk and 16 ounces of boiled 
 water. It is well to use % milk and % water for infants 
 under four months (10 ounces milk to 20 ounces water). 
 Mix the calcium casein with 4 ounces of cold water. Bring 
 
 »J. Infect. Dis., Dec, 1921. 
 'Areh. Pediat., April, 1921. 
 
82 NUTRITION AND SPECIFIC THERAPY 
 
 the milk to a boil and add the calcium casein and boil 
 5 minutes. Strain, and add 16 ounces of boiled water. 
 
 Other authorities have found pure culture lactic acid 
 milk beneficial in underfed infants. 
 
 Kidney Diseases. — The great aim is not so much to 
 spare the kidney cells as to correct the cause of the dis- 
 ease. Wordley has demonstrated that variations in the 
 amount of protein in the diet have no effect on the amount 
 of albuminous matter excreted in the urine. Bacteria and 
 toxins are the chief causes. Von Noorden has concluded 
 that an exclusive milk diet advocated by many physicians 
 in cases of albuminuria produces very harmful results 
 such as stenocardia attacks, ocular disturbances, etc. He 
 recommends an average amount of water, which is con- 
 trary to many authorities. 
 
 Rice has also been greatly recommended because it is 
 so easily digested and leaves no residue. The author's 
 conclusion has been that quantities of polished rice and 
 an exclusive milk diet would tend to promote albuminuria 
 because of the high protein content in the milk and the 
 low mineral, vitamine and protein content of polished rice. 
 A high protein diet with lack of mineral matter, vitamines 
 and cellulose probably is the cause of the majority of 
 kidney diseases. The explanation is found in the chapter 
 on Auto-intoxication. 
 
 The following rules have produced excellent results : — 
 
 1. Average amount of water between meals or a very 
 little with meals. 
 
 2. No meat, fish, fowl or game. 
 
 3. A moderate amount of eggs (one a day if desired), 
 but they are not necessary. 
 
 4. Peas, beans and lentils as desired. 
 
 5. All cereals are allowed. 
 
 6. Roots and tubers are allowed. 
 
 7. All fresh vegetables are excellent, spinach excepted. 
 
 8. All fresh fruits are excellent, rhubarb excepted. 
 
DIET IN THE COMMON DISEASES 83 
 
 9. Prunes, figs, dates and raisins as desired. 
 
 10. All kinds of nuts as desired. 
 
 11. Very little cane sugar. 
 
 12. Little or no tea, coffee, milk or condiments. 
 
 Gout. — The diet is practically the same as that recom- 
 mended for kidney diseases. In this disease uric acid or 
 oxalic acid is deposited in the joints in the form of urates 
 or oxalates and for this reason, foods that produce purines 
 and calcium oxalate should be more restricted. It is be^ 
 cause of this fact that legumes are often forbidden. Gout 
 is accompanied by flatulency, high blood pressure, neural- 
 gia and constipation, and sometimes by low blood pressure 
 and anemia; all these complications will be benefited by 
 the diet recommended for kidney diseases. (See Eule 11 ; 
 Spinach and Rhubarb, Chapter VI.) 
 
 The following foods are very rich in purines : — Sweet- 
 breads, liver, kidney, sardines, yeast. 
 
 Foods containing purines in moderate quantities are : — 
 Beef, veal, mutton, pork, tongue, chicken, goose, fish, 
 caviar, oysters, crab, lobster, spinach, peas, beans and 
 lentils, tea, coffee and cocoa. 
 
 There is a small proportion of purines in lettuce, rad- 
 ishes, caulMower, celery, asparagus, potatoes, carrots and 
 string beans, but not sufficient to eliminate them from the 
 diet for gout. Cereals, nuts, eggs and fruits are prac- 
 tically free from purines. 
 
 Pernicious Anemia. — There have been many theories 
 regarding the etiology of this disease. Whatever the 
 cause, diet is of primary importance, and should the dis- 
 ease be produced by the B. aerogenes capsulatus, Balan- 
 tidium coli (A. H. Logan) , ^ or other parasite in the intes- 
 tines, which some authorities claim manufactures a hemo- 
 lytic toxin, then the diet becomes a still greater factor in 
 the questionable cure of this disease. In this case, raw 
 foods should be chosen as far as possible, and no sweet 
 'Am. J. M. Sc, Nov., 1921. 
 
84 NUTRITION AND SPECIFIC THERAPY 
 
 milk, eggs or meats should be allowed. In certain cases 
 of pernicious anemia, some eggs and pure culture butter- 
 milk may be given. Inorganic iron may be recommended, 
 although it has been a much disputed question whether 
 inorganic iron is assimilated. Some authorities claim it 
 is undoubtedly absorbed to a certain extent, and if so, 
 probably produces the best results in anemias other than 
 pernicious anemia. The interpretation of this fact is that 
 the cause, and not the result of pernicious anemia should 
 be the all-absorbing problem. If, however, certain organ- 
 isms in the intestines should be one of the causes, then, in 
 reforming the intestinal flora, inorganic iron might be a 
 beneficial factor. An acid medium in the colon will 
 antagonize these forms of life, and, therefore, should be 
 produced through diet. 
 
 Quantities of lettuce, cabbage, lentils and oatmeal 
 should be given, and the other unrefined cereals and 
 legumes at times. To these, add nuts well masticated, and 
 a very generous quantity of the fruits and vegetables rich 
 in iron, given in Chapter III, the latter prepared in salad 
 form, including lettuce, cabbage, tomatoes, cucumbers, 
 onions, celery, radishes, watercress, etc. 
 
 A cathartic may be advisable at the beginning of the 
 treatment, and only a limited quantity of fruit juices al- 
 lowed for 24 hours, keeping the patient in bed. 
 
 The Bulletins of The Johns Hopkins Hospital have 
 been publishing during the last few years some interesting 
 data on pernicious anemia, but the studies are not con- 
 clusive. 
 
 "In anemias * of various types the protective power of 
 the serum is diminished, and is most marked in anemias 
 which are hemolytic in character, and in conditions in 
 which the spleen is involved." 
 
 This statement appeals to the author as a further proof 
 that the disease is caused by a bacterial toxin, since in 
 *Bull. Johns Hopkins Hosp., Oct., 1921. 
 
DIET IN THE COMMON DISEASES 86 
 
 mammals a great number of the specific antibodies are 
 made in the spleen. Professor Preston Eyes ® has been 
 conducting this extremely interesting research. Professor 
 Eyes found that in immunized rabbits to certain antigens 
 (infectious organisms and other foreign protein bodies), 
 the antibody content of the spleen was one hundredfold 
 the antibody content of the serum. 
 
 D. H. Morris and F. D. Bullock ® say the work done 
 regarding the relation of the spleen to infectious diseases 
 is fragmentary, unconvincing and conflicting. Concern- 
 ing work hitherto done, the most convincing is that of 
 Pfeiffer and Marx. They claim that while removal of 
 the spleen prior to the immunizing process did not prevent 
 the formation of immunity, it was found that if the im- 
 munization was attempted before splenectomy, immunity 
 failed subsequently to develop. These results of Pfeiffer 
 and Marx for cholera have been confirmed by numerous 
 other observers. 
 
 Splenectomized animals can weather a critical disease, but 
 in this case the bone marrow or the lymphatic system prob- 
 ably compensate for the loss of the spleen. 
 
 The blood changes can be said to furnish positive evidence 
 of an impaired abihty on the part of the body to resist iafec- 
 tion, and it seems possible that the anemia and leucocytosis 
 which are temporarily observed are an indication of increased 
 susceptibility to infection. 
 
 The work of Hektoen points strongly to the spleen and 
 other lymphatic tissues as being concerned in the production 
 of lysins, agglutenins, opsonins and precipitins. 
 
 One type of the B. influenzae produces a hemolytic toxin, 
 
 and streptococci "^ from the throats of scarlet fever patients 
 
 produce such a toxin. If these two types of bacteria, as 
 
 'J. Imrrmnologif, Feb., 1916; J. Infect. Dis., Sept., 1915, and 
 March, 1916. 
 ' Annals of Surgery, Nov., 1919. 
 ' Bull. Johns Hopkins Hosp., Oct., 1921. 
 
86 NUTRITION AND SPECIFIC THERAPY 
 
 examples, produce a hemolytic toxin, is it not reasonable 
 to assume that another variety of bacteria produces perni- 
 cious anemia, especially since this disease is most grave in 
 cases where the spleen is affected which produces probably 
 the majority of antibodies in mammals ? For this reason it 
 seems advisable to try to eliminate the questionable organ- 
 isms from the intestines as far as possible, going on the 
 supposition that they can produce a hemolytic toxin which 
 is absorbed into the blood, which may produce this type 
 of anemia. The diet recommended will prove of benefit 
 in either case, and may aid the spleen in its production of 
 antibodies for another variety of bacteria producing a 
 liemolytic toxin elsewhere, caiising this disease. In other 
 words, choose a diet which will give the spleen every pos- 
 sible opportunity to manufacture the specific antibodies 
 within its power for this disease, and broadly speaking, 
 for every infection. 
 
 The persistent absence of hydrochloric acid is practically 
 a constant finding in cases of pernicious anemia. It is 
 often present years before the blood shows any of the 
 typical changes. For this reason the disease should be 
 suspected in its infancy and preventive measures under- 
 taken. (See S. S. Zilva, Chapter IV.) 
 
 Fevers. — Tuberculosis, — Typhoid Fever, — Diphtheria, 
 — Scarlet Fever, — Pneumonia, — Influenza, — Measles, — 
 Whooping-Cough, — Bronchitis. 
 
 The terrible wasting, caused by toxins acting upon the 
 cells, which results from fevers, may be prevented by a 
 free use of carbohydrate, for it spares body protein and 
 fat. It also has the advantage of not producing putrefac- 
 tion in the colon. 
 
 Every fever patient should have 8—12 pints of liquid 
 daily — some may be given per rectum. 
 
 A diet of fiTiit juices is excellent, 6—8 pints daily when 
 this is the principal food. This can be given every hour 
 
DIET IN THE COMMON DISEASES 87 
 
 or five or six times during the day. Malt sugar, 4—6 oz. 
 a day may prove beneficial in severe cases. 
 
 As the patient improves, semi-solid foods should be 
 added, such as vegetable purees, potato soup, soft eggs, 
 legume purees, cereal purees and gruels. Gradually add 
 the more solid foods given under the 16 antitoxic rules. 
 
 Torry * has demonstrated the striking effect of various 
 high-Calorie diets on the fecal flora of typhoid patients. In 
 some cases the addition of 250-300 gms. of lactose a day 
 to the other ingredients of the ration brought about a trans- 
 formation of the fecal flora from the ordinary type to one 
 strongly dominated by B. acidophilus. 
 
 In more recent investigations on dogs he has further 
 established the promptness and uniformity with which they 
 respond to diet changes in their predominant alimentary 
 bacteria. 
 
 Contrary to most authorities, it is the author's opinion 
 that milk should not be given in typhoid fever, because it 
 is an excellent culture medium for the typhoid bacillus. 
 
 The amount of food and the number of meals a day 
 will depend upon the patient. 
 
 In tuberculosis some authorities have advised an ultra 
 liberal intake of food regardless of the digestive disturb- 
 ances which might result. Forced feedings and a high 
 protein diet so commonly given are decidedly harmful. 
 Not over 60 grams of protein a day should be allowed for a 
 man of average weight. 
 
 All the foods included under the 16 antitoxic rules 
 should be given. 
 
 Eczema — Asthma — Urticaria. — These afflictions may be 
 the result of anaphylaxis brought about by some special 
 protein in the food. They may be the result of auto-in- 
 toxication. Follow the 16 antitoxic rules, — and if neces- 
 sary eliminate different protein foods with intervals of 
 
 'J. M. Resewrch, Jan., 1919. 
 
88 NUTRITION AND SPECIFIC THERAPY 
 
 time sufficient to prove that the particular food eliminated 
 is or is not the cause. 
 
 Diabetes. — Diabetes mellitus' has probably always been 
 associated with some form of constipation which existed 
 before the sugar appeared in the urine. This suggests 
 that auto-intoxication may be the probable cause of this 
 particular form of the disease. 
 
 Elliott P. Joslin * has recently published considerable 
 literature on the association of diabetes with obesity, which 
 again suggests a toxic condition from overfeeding. 
 
 It has been claimed by many that too high a carbohy- 
 drate diet is the cause of diabetes ; others' have claimed 
 that too high a protein diet is the probable cause which 
 has overtaxed all the organs and tissues of the body with 
 the result that the liver is no longer able to store glycogen, 
 and the pancreas cannot secrete its internal secretion neces- 
 sary for the oxidation of the sugar in the blood. 
 
 The author's own conclusion is that neither a high car- 
 bohydrate nor a high protein diet is the cause, but that 
 the real cause is a combination of a generous meat diet 
 (producing an excess of toxins) with a refined carbohy- 
 drate diet, both lacking in mineral matter and in peristal- 
 tic stimulation. Lack of vitamines also may play a certain 
 role in its causation, as they appear to bear a certain rela- 
 tion to the proportion of the other food principles ingested. 
 
 Until recently the diet has been carbohydrate free as 
 far as possible, — and even in the latest literature it has 
 been pointed out by a number of writers that the exclusion 
 of fruits and many vegetables is necessary because of their 
 content of carbohydrate. It is for this reason that some 
 physicians to-day employ the so-called "thrice-cooked 
 vegetables," which are prepared by boiling and draining 
 three times in order to eliminate as much soluble carbo- 
 hydrate as possible. 
 
 The most generally discussed cure is some modified form 
 V. A.. M. A., Jan., 1921. 
 
DIET IN THE COMMON DISEASES 89 
 
 of tlie Allen Cure, which is used in hospitals, but which 
 can also be carried out at home. 
 
 The main points in connection with this diet are the 
 following: — The patient is put to bed and "starved" for 
 1-3 days or until sugar free. As soon as the sugar has 
 disappeared in the urine, he is placed upon a 5 per cent 
 carbohydrate vegetable diet, and the diet is gradually 
 increased, perhaps up to the 20 per cent carbohydrate 
 foods. At the* same time eggs, meat, cereals, legumes and 
 nuts are given to test the patient's protein tolerance and 
 fats are given to> test the fat tolerance. This diet is in no 
 way monotonous, — ^the principal factor emphasized being 
 to reduce the amount of all foods, and keep the reduction 
 as low as possible, according to the patient's tolerance of 
 protein, fat and carbohydrate. 
 
 According to Allen, life, strength and assimilation can 
 be preserved for a much longer time by a degree of under- 
 nutrition suited to the severity of the case, and in this 
 connection he emphasizes a limitation of fat in the diet. 
 
 The author's conclusion in regard to this diet must be 
 obvious. All meats for diabetics are harmful, and thrice- 
 cooked vegetables are practically worthless with their great 
 mineral, vitamine and carbohydrate loss, and the cellulose 
 robbed of its great value. A certain amount of carbohy- 
 drate is absolutely necessary, a certain amount of protein 
 is absolutely necessary, and to a smaller degree a certain 
 amount of fat is necessary, while the vital importance of 
 the mineral matter and vitamines need not be repeated: 
 Raw fruits and vegetables (some may be cooked) are 
 excellent in diabetes for- their carbohydrate and mineral 
 salts, the very sweet fruits, especially plums and bananas 
 being excepted. The carbohydrate of potato, oats and the 
 soy bean seems to be particularly well borne in this dis- 
 ease, according to some authorities. 
 
 Von Noorden was the first to point out that diabetics 
 were greatly benefited by a diet principally of oatmeal, 
 
90 NUTRITION AND SPECIFIC THERAPY 
 
 perhaps for a week or two. Since his announcement the 
 giving of oatmeal in cases of diabetes has been extensively 
 employed. Large quantities of oatmeal in the diet seem 
 to have the best results in the most severe cases, while in 
 the very mild cases it is not well borne. The soy bean 
 seems to have the same beneficial effects as oatmeal in 
 some cases. 
 
 Von ISToorden, following the advice of Mosse, has also 
 recommended the potato as an excellent food in diabetes. 
 
 The author regards the value of oatmeal in the diet for 
 diabetes as being attributed to the excellent supply of 
 mineral matter, the particular kind of protein, the higher 
 percentage of fat and cellulose, and the somewhat lower 
 proportion of starch, as compared with the other cereals. 
 The following table gives the chemical composition of 
 wheat and oats which will serve to demonstrate the state- 
 ment just made : — 
 
 Oats Wheat 
 
 Protein 11.8 per cent. 11.8 
 
 Fat 5.0 " " 2.0 
 
 Carbohydrate 59.7 " " 72.0 
 
 Mineral Matter 3.0 " " 1.9 
 
 CeUulose 4.5 " " 1.8 
 
 The potato may possess a "complete protein" (see 
 Chapter I), although the proportion is very low. Its 
 mineral content is excellent and high. 
 
 Soy beans also have a high per cent of a "complete pro- 
 tein." They are also high in fat and mineral matter, 
 having a larger amount than oats. The carbohydrate is 
 about half that found in oats. (See Chemical Composi- 
 tion, Chapter X.) 
 
 It would seem that oats and soy beans are much better 
 balanced foods than wheat. This fact may solve the rea- 
 son in some cases for the excellent results obtained through 
 their use in diabetes. It hardly seems plausible that there 
 can be any special inherent quality in the particular kind 
 
DIET IN THE COMMON DISEASES 91 
 
 of carbohydrate in these foods. Different starches have 
 different gelatinization points, and some are digested more 
 promptly than others, but they all are reduced to the same 
 simple products in digestion. For this reason it is diffi- 
 cult to reason that one variety of starch can claim priority 
 over that of another in diabetes. There seems to be only 
 one factor that might cause one variety of starch to be 
 superior to another, — that is that lactic acid might be 
 produced in greater amounts from some than from others 
 which would prevent bacterial putrefaction in the intes- 
 tines, and decrease the amount of toxins that enter the 
 circulation. 
 
 Legumes can be given for their protein. A few eggs 
 may be allowed also for their protein. Any of the nuts 
 may be included in the diet for their protein (fat and 
 mineral content), except in the severe cases, when fats 
 must be greatly restricted. 
 
 Sajous,^" the eminent authority on internal secretions, 
 says that diabetes mellitus is characterized by an excessive 
 excretion of sugar which is due to the hypersensitiveness 
 of the test-organ, and to the presence in the blood of waste 
 products or other irritating substances which keep this 
 organ, and through it the adrenals, overactive. An excess 
 of adrenoxidase is thus produced and the intrinsic metab- 
 olism of all tissues is correspondingly activated. The pan- 
 creas is thus caused to secrete, besides its other ferments, 
 an excess of amylopsin, and consequently the hepatic and 
 muscular glycogens are converted into sugar with unusual 
 rapidity, and the surplus of sugar formed is eliminated 
 by the kidneys. The pancreas is finally destroyed organ- 
 ically through excessive stimulation to the point where its 
 function is inhibited with cessation of the production of 
 the internal secretion from the Islands of Langerhans 
 necessary for oxidization of sugar in the blood. Sajous' 
 conclusion is that disease of the pancreas is not the pri- 
 10 "The Internal Secretions and the Principles of Medicine." 
 
92 NUTRITION AND SPECIFIC THERAPY 
 
 mary cause of diabetes, but that the pancreatic lesions are 
 due to overstimulation of this organ. 
 
 If this is true, combined with the fact that a surplus of 
 sugar is formed by the body cells, "the prevailing method 
 of depriving the patient of starches and sugars is unscien- 
 tific. The morbid process being an excessive consumption 
 of these substances in the body at large, including the 
 hepatic glycogen, their withdrawal from the blood can 
 have but -one ejflect, namely, to place at the mercy of the 
 amylolytic triad of the blood what carbohydrate remains 
 in the tissues. The body is thus depleted of physiological 
 components of the highest importance to its welfare. The 
 sugar in the urine naturally diminishes, but this does not 
 prove in the least that the disease is counteracted ; it only 
 shows that the patient has been drained effectively of his 
 main sources of muscular heat and energy. iKTor does the 
 meat diet to which the patient is relegated protect him 
 against the renal complications feared, since glycosuria is 
 known frequently to persist under such a diet, and to pro- 
 mote the appearance of acetonuria and acidosis. That 
 abstention from starches and sugar is harmful under such 
 conditions is shown by the fact that the restoration of car- 
 bohydrates often causes both acetonuria and acidosis to 
 disappear." 
 
 To the above objections it may be added that if carbo- 
 hydrates are withdrawn, the protein of the food is required 
 to produce heat and energy instead of being used for main- 
 taining nitrogen equilibrium. As long as enough sugar 
 is oxidized, there is no harm in a small proportion, or even 
 a considerable amount, passing through the kidneys. The 
 presence of the sugar itself does no harm, but the cause 
 of the sugar does do harm. 
 
 Croftan states that in many cases it is well known that 
 the sugar excretion only stops when the amount of meat is 
 considerably reduced. This seems to be in line with 
 Sajous' statement that the formation of wastes or irritat- 
 
DIET IN THE COMMON DISEASES 93 
 
 ing substances finally destroys the normal functioning of 
 the organs of the body. 
 
 It is also known that 58 per cent ^^ of protein is avail- 
 able as dextrose in metabolism (casein and a few others 
 excepted), which fact would further account for the ap- 
 pearance of sugar in the urine on a protein diet. There 
 is no necessity for a carbohydrate radical in casein since 
 milk contains a large percentage of sugar. 
 
 Croftan further states that withdrawal or reduction of 
 meat appreciably increases the tolerance of carbohydrate. 
 He urges, moreover, "that the chief danger incident to 
 complete withdrawal of carbohydrates is . . . acidosis and 
 coma," and also "that it is surprising how often the admin- 
 istration of a little carbohydrate in cases that are on a 
 rigid diet, or of added carbohydrate in cases that are receiv- 
 ing only small quantities of carbohydrate will cause all 
 these dangerous phenomena to disappear." 
 
 Sajous relates that "a lugubrious commentary upon the 
 true meaning of all these facts is suggested by the case of 
 a man in the last stages of .the disease observed by Lepine 
 to whom sugar was granted owing to his hopeless condition, 
 and who began to improve. This suggested honey as an 
 appropriate food." 
 
 Many authorities advise alkaline mineral water. But 
 if the patient eats fresh raw fruits and vegetables daily, 
 this may not be necessary. 
 
 Sajous also defines a second type of diabetes which he 
 calls asthenic glycosuria, due to hypoactivity of the ad- 
 renal system, caused by diseases such as gout, syphilis, 
 influenza, by poisons that result from worry, exhaustion 
 or grief and by injury. The pancreas is reduced, there- 
 fore, as far as its functions are concerned, to the condition 
 which prevails in the late stage of diabetes mellitus. Diet 
 in this type plays no particular role as far as the diabetes 
 itself is concerned. 
 " Bull. Johns Hopkins Hosp., June, 1917. 
 
94 NUTRITION AND SPECIFIC THERAPY 
 
 The author has quoted Sajous at considerable length as 
 his lucid explanation of the causes of diabetes is of great 
 significance in connection with the diet recommended for 
 this disease in this book. 
 
 The following recent conclusions of Lenne ^^ bear out 
 still further the points emphasized in this disease : — 
 
 It is not the purpose of treatment to eliminate glycosuria 
 under all circumstances. Often we must be content if we 
 can get the diseased organism to perform its functions rea- 
 sonably well so as to improve the general condition of the 
 patient both subjectively and objectively, even though the 
 glycosuria persists. Many patients feel better in every way 
 on a more liberal diet with slight glycosuria than they do on 
 a stricter diet with sugar-free urine. If we recognize the 
 different effects of various proteins on glycosuria, we must 
 not forget that there is also a marked difference in the way 
 various carbohydrates affect different types of patients. Some 
 patients assimilate one carbohydrate better, and some an- 
 other. For example, it is wrong to assume that oatmeal is 
 goiag to agree equally well with all patients, — it will be 
 found good for some and bad for others. The same is true 
 of potato starch and rice starch. If on substituting other 
 carbohydrates, it is found that the capacity for improvement 
 in assimilation has been lost, this is the time when further 
 limitation of proteins and the introduction of fast days are 
 indicated, after which the diseased organism takes on new 
 strength, as is shown by a better assimilation of carbohy- 
 drates. If such reaction is waited for in vain, in spite of all 
 measures, it is a bad sign. 
 
 Dr. W. H. Holmes ^* has published an article in which 
 he simplifies the method of calculation of protein, fat and 
 carbohydrate of Dr. R. T. Woodyatt by the preparation of 
 tables which will prove of value to those interested in the 
 subject of diet in diabetes. 
 
 "J. A. M. A., Oct., 1921. 
 "J. A. M. A., Jan., 1922. 
 
DIET IN THE COMMON DISEASES 95 
 
 He states that, according to Woodyatt, the ratio of the 
 higher fatty acids to glucose in the diabetic diet should be 
 as 1.5 is to 1. if acidosis is to be avoided, and that 1 gm. 
 per kilogram body weight is necessary to maintain nitro- 
 gen equilibrium. 
 
 The total glucose tolerance is roughly the amount of 
 glucose in the carbohydrate foods, plus 58 per cent of the 
 protein and 10 per cent of the fat, minus the amount of 
 glucose eliminated in the urine. 
 
 Arteriosclerosis. — The diet should be practically the 
 same as that for diabetes with emphasis laid upon reducing 
 the amount of food as far as possible. 
 
CHAPTEE VIII 
 
 INFANTS' DIETS; CHILDREN'S DIETS 
 
 The literature on the subject of infants' and children's 
 diets is most confusing. There are very few authors who 
 agree on the diet for a bottle-fed infant, whether the infant 
 has a normal digestion or one that falls into the category 
 of the many abnormal varieties common in infancy. 
 
 The great desire in this chapter has been to reduce con- 
 fusion to a minimum as far as possible, and to present the 
 subject in a concise form, with scientific reasons for all 
 conclusions, although the author is fully aware that the 
 conclusions may fall short of the truth. 
 
 The great difficulty with the question of bottle-fed in- 
 fants lies in the fact that it is necessary to give a food that 
 nature did not manufacture for the human infant. Some 
 modification is therefore required, but the human infant's 
 digestive tract is not adapted even to the most perfect 
 modification. Infants possess many idiosyncrasies, and 
 the natural consequence is multiple variety and formulas 
 for modifications of milk, each aiming to satisfy the par- 
 ticular demands of each individual infant deprived of 
 mother's milk. Confusion in this subject is inevitable, 
 and the author makes no attempt to outline a diet for the 
 innumerable individual cases that require special formulas. 
 The aim in this chapter is to give modifications and diets 
 that suit the normal infant deprived of mother's milk, 
 with a few suggestions for some difficult cases. There are 
 many normal cases which have been diagnosed as difficult, 
 simply because the right modification was not used in the 
 beginning. 
 
 96 
 
INFANTS' DIETS; CHILDREN'S DIETS 97 
 
 The difficulties in connection with the diet of an infant 
 should not be numerous when the infant is breast fed. If 
 the mother is in good health, the child receives milk that 
 has the five food principles in the right proportion, and 
 milk that is bacteria free. The Bacillus bifidus is in the 
 intestines to combat putrefaction. 
 
 But when the mother's milk is lacking in amount or in 
 the proper proportion of the five food principles, compli- 
 cations arise. Cow's milk or milk from some other animal 
 must be resorted to in part or in whole, a food for an 
 entirely different kind of mammal. This means a great 
 change in the intestinal flora, and putrefaction of some 
 kind takes place, and the way is paved for the numerous 
 ailments and diseases of infancy and childhood. Faulty 
 diet on the mother's part generally is to blame for inferior 
 quality or lack in quantity in her milk. 
 
 If mother's milk is lacking only in quantity, it should 
 be complemented by modified milk, — that is, the infant 
 should receive breastrmilk from one or both breasts, empty- 
 ing them completely, and then enough bottle-milk to 
 complete the feeding. Through this method, there is a 
 greater production of mother's milk than if the infant is 
 given a certain number of breast feedings, and then a 
 certain number of bottle feedings a day. 
 
 J. C. Drummond and K. H. Coward ^ state one prelimi- 
 nary experiment shows that the winter feeding of cows 
 may have the effect of lowering the food value of the milk 
 unless considerable care is exercised in the selection of the 
 animal's diet. The natural conclusion is, if this is true, 
 human milk can be altered in the same way. 
 
 G. A. Hartwell,^ experimenting with rats, concludes 
 excess protein in the mother's diet probably alters the 
 composition of the milk, and after a time causes the milk 
 supply to cease. Excess carbohydrate appears to have no 
 
 ^Biochem. J., Nov., 1920. 
 'Bioohem. J., Vol. XV, No. 1, 1921. 
 
98 NUTRITION AND SPECIFIC THERAPY 
 
 effect. Excess fat in the mother's diet has a slightly de- 
 pressing effect on the growth of the litter, but the absence 
 of fat seems to make practically no difference. (Accord- 
 ing to these experiments, excess protein in the mother's 
 diet may be responsible for the large number of infants 
 deprived of mother's milk. ) 
 
 A comparison of cow's milk with human milk will em- 
 phasize the inevitable results following the use of cow's 
 milk. 
 
 Cow's Milk Human Milk 
 
 Water 87. -88. per cent. BY. per cent. 
 
 Protein 3. - 3.5 " " 1.6 " " 
 
 Fat 3.5- 4.5 " " 3.1 " " 
 
 Carbohydrate ... 4. -5. " " 6.2 " " 
 
 Mineral Matter. .7 " " .27 " " 
 
 Eeaction Amphoteric Keaction Slightly Alkaline 
 
 It will be noticed that human milk is lower in all the 
 food principles but one. This is the sugar. The ques- 
 tion of primary importance is, — how similar to human 
 milk can cow's milk be made ? An attempt will be made 
 to answer this question in detail. 
 
 The superiority of cow's milk in these food principles 
 is due to the more rapid growth of the calf. The calf 
 doubles its weight in seven weeks; the human infant re- 
 quires six months to double its weight. 
 
 This pertinent comparison can be carried to the milk 
 of other animals. Rabbit's milk contains three times as 
 much protein as cow's milk and five times as much calcium 
 and phosphorus, and the rabbit doubles its weight in six 
 days. 
 
 In this connection it is highly interesting to note the 
 composition of the milk of other animals given by Konig 
 (Hammarsten and Hedin). (See p. 99.) 
 
 Under the fat is included also the lecithin, and the pro- 
 portion of lecithin is greater in woman's milk than in cow's 
 milk. The reason for this is that the infant requires this 
 
INFANTS' DIETS; CHILDREN'S DIETS 99 
 
 
 "Water 
 
 Protein 
 
 Fat 
 
 Sugar 
 
 Salts 
 
 Doff 
 
 754.4 
 816.3 
 869.1 
 835.0 
 871.7 
 900.6 
 
 9oo:o 
 
 823.7 
 678.5 
 486.7 
 698.0 
 
 99.1 
 90.8 
 36.9 
 57.4 
 35.5 
 18.9 
 21.0 
 60'.9 
 30.9 
 
 94.3 
 
 95.7 
 
 33.3 
 
 40.9 
 
 61.4 
 
 36.9 
 
 10.9 
 
 13»0 
 
 64.4 
 
 195.7 
 
 437.6 
 
 194.0 
 
 31.9 
 49.1 
 44.5 
 39.6 
 48.8 
 66.5 
 63.0 
 40.4 
 88.5 
 
 7.3 
 
 Cat 
 
 5.8 
 
 Goat 
 
 8.6 
 
 Sheep 
 
 Cow 
 
 6.6 
 
 7.1 
 
 Horse 
 
 3.1 
 
 Ass 
 
 3.0 
 
 Pig 
 
 10.6 
 
 Elephant 
 
 Dolphin 
 
 Whale 
 
 6.5 
 4.6 
 9.9 
 
 
 
 substance for muscles, blood corpuscles, blood plasma, 
 lymph, bile, 'bone marrow, spinal marrow, and for the 
 development of the nerves and brain, especially the myelin 
 sheath of the motor nerves, which * may serve to prevent 
 the spreading of impulses from one fiber to another and 
 as a medium of nutriment for the axis cylinder. A calf, 
 however, is bom with its nervous system practically de- 
 veloped. Its movements are coordinated, and it can go 
 after its food and kick with a purpose in mind. 
 
 According to Burow, there are 3.05 parts of lecithin 
 to every 100 parts of protein in human milk, and only 
 1.40 parts to every 100 parts of protein in cow's milk. 
 
 Levene and Rolf * of the Rockefeller Institute for Medi- 
 cal Research have published some interesting results con- 
 cerning lecithin in the brain. It has the same composition 
 as that of egg yolk. Lecithins differ in the character of 
 their fatty acids. 
 
 The question of the lesser amount of lecithin h . woman's 
 milk is a serious problem as this deficiency has not yet 
 been made up in the modification of cow's milk. 
 
 The author had considered the addition of a small 
 
 'Albert P. Mathews, "Physiological Chemistry." 
 */. Biol. Ohem., May, 1921. 
 
100 NUTRITION AND SPECIFIC THERAPY 
 
 amount of egg yolk, using in this case a little less cream in 
 the modification, or legume water in place of cereal water 
 to supply the desired lack of lecithin in cow's milk. But 
 circumstances prevented the completion of this experi- 
 ment. The egg yolk might also furnish certain amounts 
 of required amino-acids, from the albumin and vitellin, 
 which are low in cow's milk, and iron which is low in 
 modified cow's milk. (See page 135.) 
 
 The following table gives the amounts of lecithin in the 
 cereals and legumes according to Bunge : — 
 
 One hundred grams dried substance yields milligrams lecithin 
 as follows: — 
 
 Peas 1050 Barley 470 
 
 Lentils 1700 Eye 570 
 
 Beans 1000 Com 250 
 
 Wheat 430 Buckwheat 530 
 
 The yolk of a hen's egg weighs about 15 grams, of 
 which, according to Parke, 471.9 parts are water and 528.1 
 parts are solids. Of these solids, 107.2 parts are lecithin, 
 
 Not only does cow's milk contain a much greater pro- 
 portion of protein than woman's milk, but the proteins 
 differ in themselves. There are two kinds of protein in 
 milk, — casein and albumin. CoWs milk contains six to 
 ten parts of casein to one part of albumin, while human 
 milk contains only two to five parts of casein to one of 
 albumin. According to Szontagh, cow's milk casein de- 
 velops paranuclein in the stomach, while human milk 
 casein does not. The casein from human milk is pre- 
 cipitated with greater difficulty in the stomach, and the 
 clot formed from it is not tough and large as in cow's milk, 
 but small and flocculent. This advantage will be dis- 
 cussed in detail further in the chapter. 
 
 The fat in the two kinds of milk also differs. The fat 
 of human milk, according to Ruppel and Laves, is poorer 
 in volatile fatty acids, and the non-volatile fatty acids 
 consist of one-half oleic acid, which is a larger proportion 
 
INFANTS' DIETS; CHILDREN'S DIETS 101 
 
 than is found in cow's milk ; therefore, the fat of human 
 milk has a lower melting-point and is more digestible than 
 that of cow's milk. In human milk 2.5 per cent of the 
 total fat consists of volatile fatty acids and in cow's milk 
 27 per cent of the total fat consists of these acids. It is 
 for this reason that some physicians are recently advocat- 
 ing the use of olive oil in modified cow's milk. This con- 
 sists almost wholly of triolein and tripalmitin and is free 
 from the volatile fatty acids found in so large an amount 
 in cow's milk. The proportion recommended is 1 tea- 
 spoon to every 4 ounces of whole milk. (See schedule in 
 this chapter for milk modification for 'bottle-fed infants.) 
 Should diarrhea or vomiting appear, the fat should be 
 reduced. 
 
 Many investigators 'have analyzed the mineral matter 
 in cow's milk and woman's milk. Bunge's figures are 
 often quoted. The mineral matter of human milk is much 
 better assimilated by the nursing child. Calcium and 
 phosphorus are present in much smaller amounts in human 
 milk, there being six times as much calcium and three 
 times as much phosphorus in cow's milk. In human milk 
 the phosphorus is almost entirely in an organic form, while 
 in cow's milk less than one-half is in this form. In view 
 of the fact that phosphorus is extremely necessary to the 
 infant, and that the organic compound is much more 
 easily assimilated than the inorganic compound, it must 
 be admitted "that the difference in this respect is a serious 
 one for the bottle-fed infant. 
 
 The only food principle that is the same in kind in the 
 two species of milk (water not considered) is the milk 
 sugar, but in quantity human milk is superior. The en- 
 zymes, internal secretions and vitamines all have their dif- 
 ferences. In other words, a truly humanized cow's milk 
 is an absolute impossibility, l^ew modifications arise 
 every year, but all fall short of the perfect food for the 
 human infant. 
 
102 NUTRITION AND SPECIFIC THERAPY 
 
 For these reasons the author concludes that "the milk 
 of one species of mammals cannot be substituted for that 
 of another without injury. The child that is bottle-fed 
 is apt to prove a weakling, an easy prey to the diseases of 
 childhood, and an heir to the many diseases of adult life." 
 
 But if cow's milk is absolutely necessary for an infant, 
 how should it be prepared and modified? Some author- 
 ities say it should be given raw, others say pasteurized, 
 while still others say sterilized. In connection with these 
 important questions, most of the authorities say it should 
 be modified in some way. In order to understand the dif- 
 ferences in these milks, the advantages and disadvantages 
 of each will be considered. 
 
 Sterilizing milk means heating it to 110° C for about 
 five minutes (milk boils at a higher temperature than 
 water) . 
 
 Czemey and Keller give the following chemical changes 
 produced by sterilization : — 
 
 1. The milk sugar is caramelized under the formation 
 of lactic acid. 
 
 2. The coagulated casein and albumin are brought by 
 the acid to an early precipitable condition. 
 
 3. The rennet action on milk'ia very much impaired 
 through the fact that the calcium salts are in part 
 rendered insoluble. 
 
 4. The;milk gases, especially carbonic, are expelled. 
 
 5. The ferment action of the milk is destroyed. 
 
 6. The fat in part separates from its emulsified state. 
 
 7. The lecithin is split up and the more organic phos- 
 phorus combinations of the milk are more or less 
 changed into inorganic. 
 
 8. Boiled milk undergoes putrefaction, raw milk does 
 not. 
 
 9. The taste of the milk is disagreeably changed. 
 
INFANTS' DIETS; CHILDREN'S DIETS 103 
 
 10. The antiseptic and antitoxic properties of the milk 
 are lost. 
 
 11. Hydrogen sulphide is recognized if the milk is 
 boiled longer than five minutes. 
 
 To the above changes may also be added the bacterial 
 changes, since cow's milk is never sterile by the time it 
 reaches the consumer. 
 
 Sterilization destroys all bacteria, including the lactic 
 acid bacillus and all pathogenic bacteria with the exception 
 of certain spores which require a temperature of 120° C. 
 for 15 minutes to destroy them. 
 
 In view of all these changes, what are the advantages 
 to be gained in sterilized milk ? One of the great advan- 
 tages lies in the fact that it kills all pathogenic bacteria. 
 The second great advantage is found under the second 
 change given above, for when the rennet action on the 
 milk is impaired, the casein does not form in a tough mass, 
 but rather in a flaky mass which resembles that of human 
 milk in the stomach, and in this form it is much more 
 readily digested. 
 
 The disadvantages which result from the sterilization of 
 milk are : — the lactic acid bacillus is killed which antago- 
 nizes the putrefying and pathogenic bacteria, and when 
 the former are destroyed, the latter can develop with much 
 greater rapidity ; the emulsification of the fat is destroyed, 
 the protein is coagulated, and so is harder to digest; the 
 en2;ymes and any similar substances are for the most part 
 destroyed, all of which are most necessary for normal 
 health. It is claimed also that sterilized milk produces 
 constipation. 
 
 However, when the advantages and disadvantages of 
 sterilization are weighed against each other, the result is 
 in favor of the sterilized milk, for the worst objections 
 against it can be overcome in the following ways. To 
 
104 NUTRITION AND SPECIFIC THERAPY 
 
 prevent the multiplication of harmful bacteria because of 
 the destruction of the lactic acid bacillus, sterilized, modi- 
 fied milk should be prepared with the greatest care (see 
 rules for milk modification in this chapter) and should 
 never be used when over 24 hours old. The enzymes and 
 yitamines are for the most part destroyed and constipation 
 may also be produced, but these disadvantages are over- 
 come by the feeding of certain amounts of orange juice, 
 or substitute, starting when the infant is only a few days 
 old, and increasing the amount as the infant grows older. 
 The orange juice has an abundance of these substances 
 destroyed in the milk, either through raising it to the boil- 
 ing point or through the aging of the milk. 
 
 The coagulation of the protein, the destruction of the 
 emulsification of the fat, and the change, in part, of the 
 organic phosphorus into an in,orgamc form, are objections 
 that cannot be overcome, but these are small in the mind 
 of the author, compared to the objections found in using 
 raw or pasteurized milk. 
 
 Pasteurized milk is milk that should not contain over 
 50,000 bacteria per c.c. 
 
 The temperatures and time vary which are used for 
 the pasteurization of milk. Generally it is heated to 
 60° C. or 140° F. for 20 minutes. Some authorities give 
 10° C. or 158° F. 
 
 Pasteurized milk has the following characteristics : 
 
 1. The food principles, namely the protein, fat and 
 mineral matter, are not affected. 
 
 2. The enzymes, vitamines and internal secretions are 
 partly destroyed. 
 
 3. The clot in the stomach is not made more digestible. 
 
 4. It does not undergo putrefaction as readily as steril- 
 ized milk as the lactic acid bacillus is not destroyed. 
 (This bacillus is destroyed at 93.3° C. in 30 min- 
 utes.) 
 
INFANTS' DIETS; CHILDREN'S DIETS 105 
 
 5. It does not kill the gas-forming bacillus (bacillus 
 aerogenes capsulatus), — also certain alkali and pep- 
 tonizing bacilli survive. 
 
 6. It may or may not kill the tubercle bacillus. This 
 bacillus is sometimes destroyed at 60° C. in 10 min- 
 utes, while sometimes a temperature of 70° C. for 
 one hour is required, according to some investigators. 
 
 7. It does kill most pathogenic bacteria such as those of 
 diphtheria, scarlet fever, dysentery, cholera, typhoid 
 fever, infantile paralysis, etc. 
 
 In vievp of these changes, v^hat are the advantages to be 
 gained in pasteurized milk? The principal advantage 
 lies in the fact that it destroys most pathogenic bacteria 
 and does not destroy the lactic acid bacillus. The second 
 advantage is the fact that the protein is not coagulated, 
 the fine emulsification of the fat is not destroyed and the 
 organic mineral matter is not rendered inorganic. 
 
 The disadvantages in pasteurization are the follow- 
 ing : — it does not kill all pathogenic bacteria ; it does kill 
 some of the enzymes and similar substances ; it does not 
 render the casein clot in the stomach soft and flocculent. 
 
 In the opinion of the author, in spite of the fact that 
 Uiere are a few advantages in pasteurized milk, the dis- 
 advantages are such that there is no question as to the 
 superiority of sterilized over pasteurized milk. 
 
 Kaw milk has some of the same objections of pasteur- 
 ized milk, namely a possibility of containing many patho- 
 genic bacteria and of forming a dense casein clot in the 
 stomach. 
 
 Raw milk has in its favor the fact that the food prin- 
 ciples, protein, fat and mineral matter are in their natural 
 form, and the enzymes and vitamines are unchanged if 
 the milk is absolutely fresh. But the disadvantages of 
 raw milk, even though certified, are so great in the author's 
 opinion that there should be no question as to the superior- 
 
106 NUTRITION AND SPECIFIC THERAPY 
 
 ity of sterilized milk, with orange juice or its substitute 
 given in connection with it. (See chapter on Vitamines.) 
 It is interesting at this point to quote some of Dr, 
 Emmett Holt's statements concerning cow's milk, 
 
 A calf at birth usually has eighteen teeth, indicating its 
 early capacity for digesting other food than milk. . . . The 
 human infant does not acquire teeth until the seventh or 
 eighth month, a strong suggestion that up to this time, other 
 food is unnecessary for normal growth. 
 
 In the case of infants who are artificially fed this is a 
 serious question. "Although the defects of cow's milk 
 have not been wholly understood, the great advantages 
 have lately been seen of the earlier use of other articles 
 of diet, — fruit juices, egg, fresh vegetables, beef juice and 
 broth." The author does not recommend the latter two. 
 
 Osborne and Mendel in 1914 found that the gain in weight 
 with 9 per cent of the food solids in the form of casein was 
 very low unless cystine (amino-aeid) was added, but if the 
 casein was doubled to 18 per cent a normal gain in weight 
 was seen. This important fact may shed light on some fail- 
 ures and successes in infant feeding. 
 
 Dr. Holt ® says : 
 
 We once thought we were supplying the infant's protein 
 needs when we gave as much protein in coVs milk as the 
 protein in woman's milk. Evidently we were wrong. It 
 now seems clear that some of our failures were not due to the 
 fact that we were giving too much fat, but that we were not 
 supplying in the protein given the amino-aeids required for 
 normal growth. 
 
 In other words, the infant requires more cystine for 
 growth than the caK. 
 'Arch. Pediat., Jan., 1916. 
 
INFANTS' DIETS; CHILDREN'S DIETS 107 
 
 In a more recent article,® Dr. Holt repeats liia conclu- 
 sions given in the previous article: — Vegetable proteins 
 are low in amino-acids necessary for growth, while animal 
 proteins are much richer in these acids. While vegetable 
 proteins might be sufficient for maintenance, the animal 
 proteins are needed for growth in children. Woman's 
 milk is high in amino-acids, cow's milk is much lower. 
 Therefore it is necessary to give two or three times as much 
 protein as is contained in woman's milk. 
 
 It was stated in conclusion that no experiments had 
 been done, nor in fact was it possible to determine the 
 exact protein requirement of growing children, 
 
 E. V. McCoUum, 'N. Simmonds and W. Pitz,'' how- 
 ever, are convinced they have demonstrated otherwise, 
 for gelatin containing 6 per cent lysine, added to a mix- 
 ture of wheat and oats, does not improve the protein which 
 is lacking in lysine. But the addition of wheat gluten to 
 either wheat or maize kernel proteins supplements them 
 so as to improve growth. They therefore conclude the 
 improvement is produced through a higher protein intake 
 rather than to a supplementary relationship between the 
 proteins, and that results of feeding maize proteins with 
 wheat gluten are of particular interest because of their 
 effect in promoting growth, despite the relatively low 
 lysine content of both wheat and maize proteins. 
 
 Through further experiments these investigators have 
 found that gelatin supplements the protein of oats (lack- 
 ing in lysine), but that zein (the protein of maize) also 
 supplements the protein of oats, although zein is lacking 
 in tryptophane and lysine and is one of the poorest in 
 cystine, — and furthermore that gelatin does not supple- 
 ment maize. 
 
 If gelatin supplements oats, then it should supplement 
 maize, which it does not, and if gelatin supplements oats, 
 
 'Arch. Pediat., July, 1921. 
 V. Biol. Chem., Jan., 1917. 
 
108 NUTRITION AND SPECIFIC THERAPY 
 
 then zein should not, and it does, — ^that is, if the amino- 
 acid lysine is the determining factor. 
 
 These research men conclude that in the protein of oats, 
 therefore, these amino-acids are eliminated as being pos- 
 sibly the essential amino-acids determining growth. 
 
 The author ventures the suggestion that perhaps the 
 fat-soluble A vitamine, or the water-soluble B vitamine 
 combined with the necessary supply of mineral matter, is 
 the determining factor in these experiments, although it 
 is unquestionably admitted that a balanced amino-acid 
 ration is necessary for growth. However, the argument 
 is interesting, if not convincing, and points to many future 
 researches along this line. 
 
 Referring to Dr. Holt's criticism of vegetable proteins 
 given above, the difference between animal and vegetable 
 protein has been explained in Chapters I and III, and it 
 is true that animal proteins are richer in amino-acids and 
 more completely absorbed. But the author cannot con- 
 clude vegetable proteins might be sufficient for mainte- 
 nance, but not for growth, for vegetable proteins contain 
 all the amino-acids found in animal proteins, only in 
 smaller proportions. It is, therefore, only necessary to 
 allow more vegetable than animal protein in the diet to 
 make up the deficiency for growing children, emphasizing 
 that it be obtained from a variety of vegetable proteins 
 to insure securing the adequate amount of each amino- 
 acid. (Chapter VI, Sixteen Rules.) 
 
 The author also would not sanction giving two or three 
 times as much protein in cow's milk as is found in woman's 
 milk. This might give the required amount of lysine, or 
 cystine, or other necessary amino-acids, but would also give 
 far too great a proportion of many other amino-acids. 
 Excellent results have been obtained, in the case of young 
 infants, from cow's milk that contained the same amount 
 of protein as woman's milk, combined, however, with 
 cereal gruels, vegetable purees, thin potato and carrot 
 
INFANTS' DIETS; CHILDREN'S DIETS 109 
 
 purees, a small amount of yolk of egg (at the third month) 
 and fruit juices. In some cases that do not gain, a small 
 additional quantity of skimmed milk might be added to 
 the formulas given in this chapter, reducing the sugar, 
 or in place of some of the cereal water, using of course the 
 given quantity of whole milk in each formula as the basis 
 of the modification. (See page 100, Egg Yolk.) 
 
 Dr. Holt, while being a firm believer in a high protein 
 diet in the case of cow's milk for infants, lays much blame, 
 in cases of acute intestinal disturbances, to carbohydrates, 
 especially the sugars, and in conclusion states that more 
 fat and protein can be tolerated if the sugar is low. 
 
 These variations from the modifications given further 
 in the chapter may prove beneficial in certain cases. 
 
 This argument certainly bears significance, and it is the 
 author's opinion that some other foods should always be 
 given in connection with cow's milk, such as ripe fruit 
 juices, vegetable juices and cereal waters when the infant 
 is very young, and also thin legume gruels (strained) and 
 some egg yolk when the infant is three months old. These 
 should be tried one at a time, and in very small amounts 
 which should be increased to several teaspoons if digestion 
 permits. A teaspoon of egg yolk every day may prove 
 valuable for the amino-acids of the protein, for the lecithin 
 lacking in cow's milk and for a better balanced mineral 
 ration than is found in cow's milk for the infant. In other 
 words, quality is as important as quantity in the food 
 principles. 
 
 The orange juice or substitute (Chapter IX) should be 
 strained through muslin when the infant is very young. 
 Two teaspoons a day in connection with sterilized milk 
 may be given to a newborn infant, and this amount should 
 be increased each month until at 9 months the infant is 
 receiving 4-5 tablespoons of orange juice or substitute. 
 
 Dr. Joseph Brennemann * of Chicago has done some 
 'Arch. Pediat., Feb., 1917. 
 
110 NUTRITION AND SPECIFIC THERAPY 
 
 very interesting work in connection witli the digestion of 
 raw, pasteurized and sterilized milk. He was fortunate 
 in securing the willing services of a man in whom the 
 vomiting reflex was readily elicited by digital irritation of 
 the fauces. The following results were obtained from his 
 experiments : — 
 
 In the stomach the size of the curds of raw milk are some- 
 times two inches long and one inch thick and they are often 
 hard and as large as a walnut. But if the milk is sterilized, 
 the curds are reduced to the size of a pea and many of the 
 curds are like sand, and the general consistency is very dif- 
 ferent from the hard and rubbery curd of raw milk. 
 
 The curds of pasteurized milk in the stomach are much 
 like that of raw milk. 
 
 Even after five hours, the hard curds of raw milk are still 
 found in the stomach. Mucus is found very abundantly, 
 especially after the first half hour and the curds are slippery 
 and covered with mucus, and more or less bound together by 
 it. At the end of a half hour, the stomach contents are 
 neither offensive nor bitter. But after one hour, and even 
 more marked after two or more hours, they have a very offen- 
 sive, sour, fatty acid odor. 
 
 In sterilized milk, the whey is less definitely separated 
 from the curd. 
 
 The less the proportion of fat in the milk, the harder and 
 larger are the curds in the stomach; the greater the amount 
 of fat, the longer the milk remains in the stomach and the 
 slower the digestion. 
 
 Milk taken very slowly forms a larger curd than when 
 taken rapidly. This is a startling conclusion, but the ex- 
 planation probably lies in the fact that all the casein has 
 coagulated in a few curds so large that they cannot be re- 
 turned, for five hours later the curds have been digested to a 
 returnable size. 
 
 The greater the dilution with water, the finer are the curds 
 in the stomach. 
 
 Alkalies and sodium salts very greatly inhibit coagulation, 
 even may stop it completely if in sufficient amounts. 
 
INFANTS' DIETS; CHILDREN'S DIETS 111 
 
 Precoagulated milk such as buttermilk, pegnin milk or 
 eiweissmilch (Finkelstein) shows very little tendency to re- 
 coagulation. 
 
 Dried and condensed milks as a rule form a medium curd. 
 Starchy decoctions such as barley water have a very decided 
 influence in lessening the size of the curd, much more than 
 a simple watery dilution. 
 
 Soluble carbohydrates such as dextrins and sugars (milk, 
 cane or malt sugar) have apparently no appreciable influence 
 on the curd. 
 
 Dr. Brennemann said that after having used raw and 
 sterilized milk each for many years, there was no doubt in 
 his mind that infants are in general harder to feed on raw 
 milk than on sterilized milk, and that the explanation is 
 a physiological rather than a bacteriological one. Kaw 
 milk is only in appearance a liquid food. Milk in the 
 stomach must contain finely divided curds in the case of 
 infants. All the therapeutic measures that aim to adapt 
 cow's milk to the baby have one thing in common, and that 
 is to make the large, hard curd more like the small, soft 
 curd of mother's milk. This is the aim in diluted, boiled, 
 pasteurized, condensed, dried, malted, precoagulated by 
 acids or reimin, alkalinized, citrated, whey milks, etc. 
 
 Straight milk can be given much earlier when boiled. 
 Commercial pasteurization is not reliable, and pasteuriza- 
 tion at home has many difficulties, and only partly solves 
 the bacteriological problem, while the physiological re- 
 mains unsolved for the most part. 
 
 Although sterilization of milk, with the addition of 
 orange juice, solves the most difficult problems in conueo- 
 tion with bottle-fed infants, this should not minimize the 
 necessity for procuring clean milk in the beginning. All 
 milk should be as free from filth as possible before steri- 
 lization, and this is best accomplished by centrifugally 
 cleansing it of the udder wastes, and other foreign and 
 impure substances it may contain. Most milk is contami- 
 
112 NUTRITION AND SPECIFIC THERAPY 
 
 nated with particles of dust, manure, hair, insects, etc. 
 Some of these float on the surface, while others settle to 
 the bottom. Udder waste, pus and bacteria, together with 
 the greater part of the dirt, are thrown out by the applica- 
 tion of centrifugal force, and come out as a slimy mass. 
 
 The following points ® concerning centrifuged milk are 
 briefly outlined : — 
 
 1. The insoluble dirt is effectively removed. 
 
 2. Cellular elements are removed to a large degree. 
 
 3. Bacteria are removed in varying amounts, the larger 
 more readily than the smaller. 
 
 4. Clarified milk trends more closely towards typical 
 lactic acid fermentation, while unclarified mili will 
 manifest obnoxious signs. 
 
 5. Unclarified milk develops molds in abundance and 
 putrid decomposition. 
 
 6. Carbon dioxide develops in abundance in clarified 
 milk. 
 
 7. Obnoxious odors are detected in unclarified milk. 
 
 Raw milk causes a large percentage of infant deaths 
 from intestinal diseases ; it often is the cause of septic sore 
 throat, typhoid fever, scarlet fever, tuberculosis and diph- 
 theria. Certified milk cannot furnish a guarantee, for not 
 only has tuberculosis constantly been found in the cows of 
 certified herds to some extent, but sometimes to a large 
 extent. It is always difficult to keep cows free from udder 
 disease, and sore udders contaminating the milk with 
 streptococci, are dangerous as the cause of septic sore 
 throat. 
 
 The following rules are those that in the author's expe- 
 rience have produced excellent results in the case of the 
 average normal infant : — 
 
 The modification naturally changes with the individual 
 infant, and with the age of the infant. Some infants re- 
 •C. E. Ikfershall, Am. J. Pub. Health, Feb., 1920. 
 
INFANTS' DIETS; CHILDREN'S DIETS 113 
 
 quire a diflferent proportion of protein, others a different 
 amount of fat, and still others a greater or less amount of 
 sugar. These facts must be determined by the digestion 
 of each particular infant. The following symptoms will 
 serve as somewhat of a guide : — 
 
 Emphasis must be given not to feed an infant too often 
 or too fast, since both induce physical disorder. Twenty 
 minutes is none too long for each feeding. 
 
 If the infant is overfeeding, regurgitation and vomiting 
 result, and sometimes diarrhea and colic. Vomiting is 
 also caused by fast feeding and the swallovsdng of air. 
 
 Too much fat in the milk produces vomiting, regurgita- 
 tion, an acid stomach and constipation or perhaps diar- 
 rhea. In this case, either reduce the fat or try olive oil 
 (1 teaspoon or less to every four ounces of whole milk 
 used in the author's modification). There generally is 
 much mucus in the stools if the fat has not been well 
 tolerated, and they are formed, and of a light color. Some- 
 times fat stools are granular. 
 
 F. Friedberg and C. Noeggerath ^^ describe the remark- 
 able improvement of certain very sick infants when fed 
 -with breast milk from which the fat has been removed by 
 centrifuging, especially in cases of decomposition, as well 
 as ordinary toxicosis, the length of time this is fed depend- 
 ing upon the infant. 
 
 Too great a proportion of protein in the milk may pro- 
 duce colic, vomiting, curds and much mucus in the stools. 
 The stools are semiformed and often watery. Sometimes 
 the color is olive green with a glossy aspect. There may 
 be alternating constipation and diarrhea. In this case 
 use less milk in the modification and more cereal water 
 with perhaps a little more cream, sugar or egg yolk. 
 
 Carbohydrate stools are easier to detect. They are read- 
 ily stained with dilute tincture of iodin, the particles of 
 undigested starch staining blue or black. The stools are 
 ^Arch. Pediat., Oct., 1921. 
 
114. NUTRITION AND SPECIFIC THERAPY 
 
 loose, acid in reaction, and light brown, excoriating and 
 contain much mucus, indicating undigested cereals. 
 
 In this case, try different cereals, or less cereal, adding 
 a little more sugar to the mixture. 
 
 Indigestion of sugar produces frequent, excoriating, 
 watery and very acid stools. They are green if sucrose or 
 lactose has been used in the modification, and brown if 
 maltose has been used. There may be much gas and flatu- 
 lence as a result of the fermentation of the sugar. 
 
 In this case use a different sugar in the modification 
 (lactose or maltose) and if there is then no improvement, 
 reduce the sugar, or possibly reduce it with the addition of 
 a little more cream or whole milk in the mixture; or use 
 protein milk which may be made by heating and precipi- 
 tating the casein in a quart of fat-free milk by essence 
 of pepsin or rennin; the resulting curd is rubbed through 
 a sieve with enough water to make one pint. (See also 
 Infants' Diarrhea, Chapter VII.) 
 
 Dr. John Howland ^^ says, — in prolonged intolerance 
 of carbohydrate, protein milk should be advocated, and 
 continued until the stools are firm, distention is very slight, 
 gas is not in excess, and the appetite is good. 
 
 The foregoing symptoms indicate that the problem of 
 feeding a bottle-fed infant is one that should demand the 
 greatest care and attention. The number of stools, their 
 consistency, color and the presence of mucus and blood are 
 all of great significance in relation to the health of the 
 infant. (For further details,^^ see article by Joseph I. 
 Grover of Harvard University.) 
 
 Breast-fed infants have from two to four stools a day, 
 while bottle-fed infants have from one to two, and may 
 often skip a day if a laxative is not given. This should 
 be avoided in every case possible. If constipation is pres- 
 ent, but otherwise the infant seems in good health, give 
 
 '^Arch. Pediat., July, 1921. 
 "./. A. M. A., Feb., 1921. 
 
INFANTS' DIETS; CHILDREN'S DIETS 116 
 
 more orange juice. If this does not remedy the case, 
 change the milk modification, using perhaps less fat and 
 more milk or sugar, or less fat and less milk and more 
 sugar and cereal gruel or puree. (See Chapter X.) 
 
 Evaporated, condensed and malted milks have been in 
 vogue for many years, but they should be regarded as 
 very questionable and used only when better products are 
 not obtainable. They may produce many physical dis- 
 orders. 
 
 In some cases, however, malt soup extracts (a different 
 product from malted milks) may be highly recommended. 
 They have the disadvantage of being high in price, but in 
 difficult cases of diarrhea and constipation with loss of 
 weight, they have often given excellent results. 
 
 The use of malt soup extract dates back many years to 
 the days of Von Liebig who first used it for normal infants 
 deprived of mother's milk. His original formula has been 
 abandoned and that by Keller is used to-day for infants 
 suffering from intestinal disorders, either constipation or 
 diarrhea. The directions come with the preparations. 
 It has been employed perhaps more in cases of diarrhea, 
 but is coming to be used more extensively in cases of con- 
 stipation. Naturally the same formula could not be used 
 in both cases, and so it is modified to counteract either con- 
 stipation or diarrhea. 
 
 Malt soup eixtract contains 50 to 70 per cent maltose, 
 5 to 15 per cent dextrin, 5 to 12 per cent soluble protein, 
 20 to 25 per cent water, and small amounts of potassium 
 carbonate, phosphoric and lactic acids, etc. 
 
 Maltose is quickly absorbed and better tolerated than 
 lactose or cane sugar if an infant does not tolerate sugar 
 well. Potassium carbonate is used because human milk 
 contains this in a larger amount than it does the other 
 salts, and because it is probably the alkali that combines 
 principally with acids in acid intoxication which is often 
 the case where milks have not agreed. 
 
116 NUTRITION AND SPECIFIC THERAPY 
 
 In the preparation of the food, wheat water is generally 
 used because it ferments less readily with the maltose than 
 the other grains ; and any cereal water prevents mechani- 
 cally the formation of tough curds. Oats is used in cases 
 of constipation. Boiled, whole milk is added to the prepa- 
 ration. 
 
 The presence of potassium carbonate produces good re- 
 sults in the correction of constipation. It has been shown 
 by Holt that loose stools contain a larger proportion of 
 potassium and sodium than constipated stools. 
 
 An infant should be started on a weak formula, pre- 
 ceded by starvation and purgation. A case that does well 
 will have no vomiting and will gain weight. If the infant 
 vomits, and this is not controlled by limiting the amount 
 or by giving a weaker formula, or if the infant has loose 
 stools with much mucus, and they give a blue starch reac- 
 tion to iodin, this food should be discontinued. A little 
 vomiting may be permitted if the infant is gaining. If 
 the infant retains this food, is not constipated, and does 
 not gain in weight, increase the malt soup extract. 
 
 From the foregoing discussion, it is clearly seen that, 
 while malt soup extract is a valuable food in certain diffi- 
 cult cases of infant feeding, there is no hard and fast rule 
 concerning its preparation. The directions that come with 
 the preparation must be varied to suit the individual cases. 
 The food should be prepared the same as any other, mak- 
 ing enough each time for twenty-four hours' use, and bot- 
 tling it in as many bottles as there are to be feedings a day. 
 
 The following formulas by A. G. Mitchell of Philadel- 
 phia will serve as a guide in the use of malt soup extract : — 
 
 In the preparation of the soup itself, the amount of flour 
 ordered should be mixed with a small amount of water to 
 make a paste, the rest of the water ordered is added, and 
 this is boiled for twenty minutes. Then the amount of malt 
 soup extract ordered is mixed with this starch and water 
 solution, constantly stirring. The milk ordered should then 
 
INFANTS' DIETS; CHILDREN'S DIETS 117 
 
 be added, and the whole brought to a boil again. Water is 
 added to bring up the amount lost in boiling. 
 
 In Dr. Mitchell's^* work at The Children's Hospital 
 he has used several different formulas which have been 
 found convenient in increasing the percentages. These, 
 with the approximate percentages of fat, carbohydrate and 
 protein are given as follows: — 
 
 (Use unrefined cereal flour. — ^Author.) 
 Formula A — % ounce wheat flour 
 10 ounces skimmed milk 
 10 ounces water 
 1 ounce malt extract 
 Fat, 0.2 per cent.; carbohydrate, 7.5 per cent, (of which 
 2 per cent, is starch) ; protein, 2.3 per cent. 
 
 Formula B — y^ ounce wheat flour 
 5 ounces skimmed milk 
 5 ounces whole milk 
 10 oimces water 
 1 ounce malt extract 
 Fat, 0.2 per cent.; carbohydrate, 7.5 per cent, (of which 
 2 per cent, is starch) ; protein, 2.2 per cent. 
 
 Formula C — % ounce wheat flour 
 10 oimces whole milk 
 10 ounces water 
 1 ounce malt extract 
 Fat, 2 per cent.; carbohydrate, 7.5 per cent, (of which 
 2 per cent, is starch) ; protein, 2.2 per cent. 
 
 Formula D — 1 ounce wheat flour 
 10 ounces whole milk 
 10 oimces water 
 1% ounces malt extract 
 Fat, 2 per cent.; carbohydrate, 14 per cent, (of which 5.7 
 per cent, is starch) ; protein, 2.9 per cent. 
 ^Ardh. Pediat, Jan., 1916. 
 
118 NUTRITION AND SPECIFIC THERAPY 
 
 These formulas made witli any extract of malt would 
 give about the same percentages. 
 
 Barley flour may be used instead of wheat flour in cases 
 of diarrhea. Wheat flour is probably better because the 
 combination of wheat flour and malt extract is least apt 
 to ferment, and produces the smallest amount of acids. 
 
 Using the proportions given in these formulas, make 
 up the correct amount of ounces for the twenty-four hours' 
 feeding, and apply to the hour schedule. In other words, 
 make up about one-half again as much for the first and 
 second months' feedings. For example, add ^4 ounce 
 wheat flour, 5 ounces skimmed milk, 5 ounces water and 
 % ounce malt extract to Formula A. After the second 
 month make up about two times any of the formulas. The 
 correct amount of ounces according to age, and the hour 
 schedule are given under the modification generally used 
 by the author. 
 
 The reason for choosing this modification is as follows : 
 
 Human milk contains: 
 
 Protein 1.5 per cent. 
 
 Fat 3.5 " " 
 
 Carbohydrate 6.5 " " 
 
 Mineral Matter 2 " " 
 
 Cow's milk contains: 
 
 Protein 3.5 per cent. 
 
 Fat 4.0 " « 
 
 Carbohydrate 4.5 " " 
 
 Mineral Matter 1 " " 
 
 Cereal water contains : 
 
 Protein 05 per cent. 
 
 Fat 051 " " 
 
 Carbohydrate 3.2 " " 
 
 Mineral Matter 015 " " 
 
 This percentage composition of cereal water is obtained 
 using the proportion of 2 tablespoons of flour to 20 ounces 
 of water. 
 
INFANTS* DIETS; CHILDREN'S DIETS 119 
 
 By mixing equal quantities of whole cow's milk and 
 cereal water, the average per cent will be : 
 
 Protein 1.8 
 
 Fat 2.0 
 
 Carbohydrate 3.8 
 
 Mineral Matter 35 
 
 This makes the proportion of protein ahout right, but 
 leaves the fat and sugar too low, while the mineral matter 
 is too high. To remedy this lack in fat and sugar, add to 
 every four ounces of the milk, 2 teaspoons of cream, and 
 to every four ounces of the cereal water 2 teaspoons of 
 lactose or maltose, or dextri-maltose. 
 
 The resulting mixture is about right, except for a small 
 excess of mineral matter. This defect may be overcome 
 by a very small amount of lime water, although it is the 
 author's opinion that too much lime water is generally 
 used, and it might be well to omit it almost entirely when 
 sterilized milk is employed. While the addition of lime 
 water would seem to tend to increase the mineral content 
 of the mixture, it nevertheless has the opposite effect in 
 relation to absorption, by changing part of the calcium 
 and phosphorus already present in cow's milk from a 
 soluble to an insoluble form. Through this change, the 
 clot in the stomach is made less dense, — this is the purpose 
 of the lime water. But sterilization accomplishes this 
 aim also, and it does not have the questionable result pro- 
 duced by the addition of the lime water of perhaps reduc- 
 ing the amount of soluble calcium and phosphorus in cow's 
 milk to a point below that in human milk. 
 
 This problem ^* has been discussed by H. I. Bowditch 
 and A. W. Bosworth through experiments conducted in 
 Boston. An infant requires .18 grams of calcium daily 
 (Schabad). One of the striking differences brought out 
 in comparing cow's milk with human milk is in the amount 
 "Boston M. & 8. J., Dec., 1917; J. Biol. Chem., Jan., 1917. 
 
120 NUTRITION AND SPECIFIC THERAPY 
 
 of insoluble, inorganic calcium and phosphorus. There 
 is only a small amount of this in human milk, but a large 
 amount in cow's milk, in the form of insoluble, dicalcium 
 phosphate. It has been found that children over four 
 months can utilize some of this, while younger ones can- 
 not. There is also much soluble calcium and phosphorus 
 in cow's milk. 
 
 This fact has special significance in connection with 
 the addition of lime water to cow's milk, as the addition 
 of the lime water results in the precipitation of insoluble, 
 dicalcium phosphate : — 
 
 CaCla + 2NaH2P04 + Ca(0H)2 = 2NaCl + 
 2CaHP04 + 2H2O 
 
 Therefore it is possible by the addition of lime water 
 to reduce the soluble calcium and phosphorus in modified 
 mixtures to amounts less than those in human milk, which 
 contains these for the most part in an easily assimilable 
 organic form. This fact may have a bearing upon certain 
 abnormalities found in infant feeding. 
 
 In discussing ^^ the possible efl^ect of the addition of 
 lime water to infant's food, it is interesting to note the 
 results of some investigations by Dr. Alfred Hess and Dr. 
 Lester J. linger of New York who have conducted experi- 
 ments to a very large extent in infants' foods. In a recent 
 article they speak of the deleterious effect of the alka- 
 lization of modified milk. Orange juice, the prototype of 
 antiscorbutics, is damaged within 24 hours through being 
 rendered twentieth normal alkaline to phenolphthalein. It 
 is evident, therefore, that the antiscorbutic vitamine is pe- 
 culiarly sensitive to alkalization, more so than the fat- 
 soluble A and the water-soluble B vitamine. 
 
 Doctors Hess and linger cite the following case: — ^An 
 infant was fed on malt soup extract with cereal water and 
 "J. Biol. Ohem., March, 1919. 
 
INFANTS' DIETS; CHILDREN'S DIETS 121 
 
 cod liver oil (rich in vitamine A) and had not been gain- 
 ing in weight ; the potassium carbonate in the formula was 
 discontinued with the result of an immediate gain in 
 weight. Therefore, there is a question as to the amount 
 of potassium carbonate to be used in malt soup prepara- 
 tions. This salt is used in many proprietary foods for 
 infants because it renders the food less subject to acid 
 fermentation, and because it counterbalances the relative 
 poverty of this salt in cow's milk. 
 
 Feeding top milk also has produced many evil effects in 
 the, author's opinion. Milk should be thoroughly shaken 
 before the correct amount is measured. John Lovett 
 Morse has given some wise counsel on this subject. He 
 asks why physicians have advised top milk and gives the 
 following reasons: — "Many physicians have unintention- 
 ally disregarded the teachings of those who have known 
 how to use fat; the erroneous idea prevalent years ago, 
 and long since discarded, that fat cannot do any harm to 
 an infant ; the knowledge of the fact that fat may act as a 
 laxative, and the ignorance of the fact that it may consti- 
 pate ; the desire to make the infant gain ; the carelessness 
 of physicians in directing mothers how to prepare the 
 food ; the laziness of physicians in that they will not take 
 the trouble to learn how to modify milk properly." 
 
 All questions considered, it is the author's opinion that 
 sterilized, whole, certified milk, diluted with cereal water, 
 with the addition of sterilized cream, milk or malt sugar, 
 or dextri-maltose, and perhaps 14 ounce of lime water 
 (about % tablespoon to 30 ounces of the mixture) gives 
 the most ideal modification for the normal infant. Orange 
 juice should be combined with this daily, according to the 
 age of the infant, and given between feedings. Soon other 
 juices, and gruels, and egg yolk should be added. 
 
 During the first 48 hours, the infant receives practically 
 no nourishment, — about 6 ounces a day at intervals of six 
 
122 NUTRITION AND SPECIFIC THERAPY 
 
 hours. It should be given a few teaspoons of warm, steri- 
 lized water. On the third day the regular feedings begin, 
 and the infant should be roused from sleep if necessary. 
 
 During the first two months, the feedings should be be- 
 tween one and two, and four and five in the night, but after 
 that, it will require but one night feeding, and after five 
 months, no night feeding. 
 
 One to two ounces of sterilized warm water should be 
 given each day to a nursing infant, and three to four 
 ounces, three times a day, should be given a child a year 
 old. The water can be given cool after the third month 
 if it is better relished. 
 Approximate Gain in Weight, First Tear (Crozer and Griffith) 
 
 First Month 7 oz. a week 
 
 Third and Fourth Month 51/2 " " " 
 
 Fifth and Sixth Month 4% " « " 
 
 Eemainder of the Year 3% " " " 
 
 An infant generally loses in weight up to the third or 
 fourth day, and may not regain its original weight until 
 the fourteenth day. 
 
 Milk Modification. — The following steps are necessary 
 in any properly prepared modification. 
 
 1. Pure, fresh milk from a healthy cow or herd should 
 be used. It should be kept in the original bottles 
 on ice until the food is prepared, just before which 
 the bottles should be well shaken to mix the top and 
 bottom milk. 
 
 There should be as many nursing bottles as the 
 infant is to be fed times a day, standing the bottles 
 in a wire rack until used. 
 
 2. Pour entire quantity of milk into a sterilized pitcher, 
 and from this take the quantity advised in each 
 formula according to the age of the child. Entire 
 quantity for the twenty-four hours should be pre- 
 pared at once. If possible, use a glass graduate for 
 
INFANTS' DIETS; CHILDREN'S DIETS 123 
 
 measuring in ounces. (2 level tablespoons = one 
 ounce, is a reliable measure for small amounts.) 
 
 3. Mix required amount of cereal flour, barley, wheat or 
 oats, using oats if the infant is constipated, about two 
 level tablespoons with a little cold water and a pinch 
 of salt, until the seventh month, — after this double 
 the proportion of cereal flour. 
 
 4. Stir cereal paste into 20 ounces of hot water and 
 cook in a double boiler 20 minutes; add enough 
 water to make 20 ounces when finished. 
 
 5. Pour gruel into a sterilized pitcher. Add the milk 
 or malt sugar (2 level teaspoons to every 4 ounces), 
 and stir. (Use one-third to one-half this amount of 
 cane sugar if other sugars are not available.) 
 
 6. Stand pitcher in cold water until the gruel is 98° 
 Fahrenheit. 
 
 7. Take required amount of whole milk while the gruel 
 is cooling, the cream having been added (2 teaspoons 
 to every four ounces) to the nailk before it was steri- 
 lized. 
 
 8. Measure correct amount of lime water (% ounce up 
 to the seventh month) and add to the milk. 
 
 9. Strain the gruel, pour it into the milk and stir. 
 
 10. Pour this modified milk into bottles needed for the 
 24 hours. 
 
 11. Cork bottles firmly with twisted wads of sterilized 
 cotton or white waxed paper fastened on with a 
 rubber band. 
 
 12. Cool the bottles by standing the rack in a pan of 
 cold water, 
 
 13. Place rack in the ice-box. 
 
 14. Stand bottles in hot water before each feeding until 
 the milk is 98° Fahrenheit. 
 
 15. Remove cotton or paper, adjust nipple, invert bottle, 
 and test heat of milk on the wrist. (It should be 
 body temperature.) 
 
IM NUTRITION AND SPECIFIC THERAPY 
 
 16. Put on woolen bag to keep milt warm, and serve at 
 once. 
 
 Care of Bottles and Nipples. — ^Always boil a new nipple 
 for five minutes. After using, rinse it in cold water. 
 Eacb day turn nipples inside out and scrub witb warm 
 water and soap and rinse. Keep in a covered cup of borax 
 water. Have as many nipples as bottles. 
 
 Immediately after using, rinse bottle in cold water. 
 Wash all bottles for 24 hours' use in hot, soapy water with 
 a bottle brush. Rinse bottles in hot water and boil for 
 twenty minutes. Nipples may be boiled with the bottles 
 as a further precaution. Keep bottles inverted in a wire 
 rack until used. 
 
 Olive oil referred to previously in this chapter may be 
 tried in place of the cream if a fat intolerance eixists, 
 always using about one-half as much as the amount of 
 cream called for. 
 
 If milk or malt sugar are not available, use only one- 
 third to one-half as much cane sugar as milk or malt sugar 
 called for in each formula. Maltose sometimes has too 
 great a laxative effect. Dextri-maltose, generally made 
 from potato-starch, is much cheaper, and, therefore, rec- 
 ommended more for general use. 
 
 The orange juice should always be given between feed- 
 ings, and diluted with boiled water if sour. At the third 
 month it may be advisable to give also juices from the 
 potato, tomato, carrots, lettuce, a teaspoon of egg yolk, and 
 a few teaspoons of legume gruels. 
 
 First Month 
 
 Milk 15 ounces 
 
 Cereal Water 15 ounces 
 
 Maltose or Lactose Y% level teaspoons 
 
 Cream 7% teaspoons 
 
 Lime Water ^ ounce (Yz tablespoon) 
 
 Orange Juice 2 teaspoons a day 
 
INFANTS' DIETS; CHILDREN'S DIETS 125 
 
 One to two night feedings. 
 
 Give 3-4 ounces for 7 feedings depending upon the indi- 
 vidual child. (Some authorities advise only 6 feedings.) 
 
 Second Month 
 
 Milk 15 ounces 
 
 Cereal Water 15 ounces 
 
 Maltose or Lactose 7% teaspoons (3 level tablespoons) 
 
 Cream 71/2 teaspoons (3 " " ) 
 
 Lime Water %^ ounce 
 
 Orange Juice 3 teaspoons a day 
 
 One to two night feedings. 
 Give 4 ounces for 7 feedings. 
 
 Third and Fourth Months 
 
 (Other foods previously stated may be added.) 
 
 Milk 18 ounces 
 
 Cereal Water 18 ounces 
 
 Maltose or Lactose 9 teaspoons (3 level tablespoons) 
 
 Cream 9 teaspoons (3 " " ) 
 
 Lime Water % ounce 
 
 Orange Juice 4%-6 teaspoons a day 
 
 Give 4-5 ounces for 7 feedings. 
 One night feeding. 
 
 Fifth and Sixth Months 
 
 Milk 18 ounces 
 
 Cereal Water 18 ounces 
 
 Maltose or Lactose 9 teaspoons (3 level tablespoons) 
 
 Cream 9 teaspoons (3 " " ) 
 
 Lime Water Vi ounce 
 
 Orange Juice 7%-9 teaspoons a day (3 table- 
 spoons) 
 
 Give 6-7 ounces for 5 feedings. 
 No night feeding. 
 
 Seventh, Eighth and I^inth Months 
 
 Double the strength of the cereal water. Gradually 
 accustom the child to other foods, such as lettuce and car- 
 rot puree, potato puree, soft egg yolk and soft, ripe pulp 
 
126 NUTRITION AND SPECIFIC THERAPY 
 
 of raw peaches and pears, and stewed prunes and baked 
 apples, if these foods have not already been given. 
 
 Milk 20 ounces 
 
 Cereal Water 20 ounces 
 
 Maltose or Lactose 10 teaspoons (SVs tablespoons) 
 
 Cream 10 teaspoons (3% " ) 
 
 Lime Water % ounce 
 
 Orange Juice 10%~13V2 teaspoons a day (About 
 
 4-5 tablespoons) 
 
 Give 8 ounces for 5 feedings. 
 
 Tenth, Eleventh and Twelfth Months 
 
 At this age the infant may be weaned. If it is breast 
 fed and doing well, it may be best not to wean an infant 
 until it is a year old. Gradually withdraw either mother's 
 or cow's milk, adding only one new food at a time, allow- 
 ing enough time between each new food to test the merits 
 of each for the particular infant in question. If a certain 
 vegetable, fruit, potato, egg, etc., does not agree, try an- 
 other, for each child is a different problem. 
 
 Milk 20 ounces 
 
 Cereal Water 20 ounces 
 
 Maltose or Lactose 10 teaspoons (3% tablespoons) 
 
 Cream 10 teaspoons (3% " ) 
 
 Lime Water % ounce 
 
 Orange Juice 5-6 tablespoons a day 
 
 Give 10 ounces for 4 feedings. 
 
 Many formulas for the modification of milk are very 
 different from those given above. For instance, some have 
 a much larger proportion of cereal water than milk during 
 the early months, and generally one ounce of lime water 
 is added. As the infant grows older, the milk is grad- 
 ually increased until it is in a proportion considerably 
 larger than the cereal water. In some cases these formu- 
 las might be better, but they do not resemble mother's milk 
 in the percentage of the food principles. A larger amount 
 
INFANTS' DIETS; CHILDREN'S DIETS 127 
 
 of milk may be advisable in some cases in wMcb there 
 is not the normal gain. In these cases a reduction in the 
 sugar may be advisable. 
 
 Diet for a Child One Year Old. — The diet recommended 
 by the author for a child one year old is different from 
 that found in the majority of books on this subject. The 
 main difference centers around the elimination of cow's 
 milk as far as possible, other foods furnishing the same 
 nutritive requirements being selected in its place. This 
 is a radical change, and one that is attempted with con- 
 siderable misapprehension by physicians and mothers. 
 However, if the child is normal, and the foods are chosen 
 with a scientific knowledge, the fears are unfounded, and 
 the child is benefited. The bacterial and dirt problem of 
 cow's milk is solved in its elimination from the diet, and if 
 the child is inclined toward constipation, this problem is 
 also solved. Why do physicians insist on advising an 
 abundant supply of cow's milk to all weaned children, a 
 food suited primarily by nature for the nourishment of 
 the calf, when dozens of other foods in proper combina- 
 tion have every advantage of cow's milk and none of the 
 disadvantages? We read, "No child should receive less 
 than a pint of milk a day." The milk question is univer- 
 sally considered a serious one, and every day literature 
 and text-books are filled with its problems. 
 
 M. J. Eosenau has written a book of about three hun- 
 dred pages on the problems of this food. He asks, — "Why 
 do we have a milk question ?" He answers the question 
 by saying that "milk is apt to be dangerous to health," — 
 and that "we cannot do without milk." He further states 
 that "it is the most difficult of all our standard articles of 
 diet to obtain, and handle in a safe and sanitary manner. 
 Milk decomposes more quickly than any other food. It is 
 probably accountable for more sickness and more deaths 
 than all other foods put together. There probably is no 
 single problem in the whole realm of modern sanitation 
 
128 NUTRITION AND SPECIFIC THERAPY 
 
 and hygiene that is so complex, so involved, so intricate 
 and so harassing." 
 
 The author admits that this question is more or less 
 difficult in the feeding of children whose parents have no 
 knowledge of the chemistry of foods, and their digestion, 
 and the requirements of the healthy body. But this fact 
 is what has been lamented elsewhere in this little volume, 
 for this knowledge should be a requirement, and not omit' 
 ted or optional, in the education of every young man and 
 woman. If milk is responsible for more sickness and 
 deaths than all other foods combined, surely it should be 
 eliminated from the diet after the nursing period, — and 
 if used at all, it should be sterilized. There is not the 
 slightest question that substitutes for milk can be used 
 in the diet after the nursing period, but custom and habit 
 are such dominant factors in the daily life of man that it 
 is well-nigh impossible to omit milk from the diet for 
 children and adults. 
 
 W. W. Cadbury,^* of Canton, China, writes that "milk, 
 butter and cheese are rarely used in China, — children 
 grow strong without milk. Rachitis practically is never 
 seen. When an infant is weaned he is given rice gruel." 
 
 In eliminating milk from the diet after the nursing pe- 
 riod, the author would not recommend so limited a diet 
 as that on which the Chinese children are raised. Variety 
 of the right kind of foods is a safeguard against all dis- 
 eases, but the fact remains, nevertheless, that the Chinese 
 children have been raised for centuries on a very limited 
 diet with the exclusion of milk. 
 
 The question is often asked, — why does a person who 
 has been put on a milk diet because of a "run-down condi- 
 tion" gain ? Such a person probably has been on a meat 
 and high protein diet, and a change from this always would 
 prove beneficial. Should this same person be put on a diet 
 consisting of the legumes, cereals and nuts as the protein 
 
 " Am. J. Dis. Child., Jan., 1920. 
 
INFANTS' DIETS; CHILDREN'S DIETS 129 
 
 fooda, combined with tubers, raw fruits and vegetables, 
 the benefits would probably be even more pronounced. 
 (See Milk, Chapter III.) 
 
 In discussing the value of milk for children, especially 
 in connection with cereals, one writer makes the following 
 statement : — 
 
 Cereals produce phosphoric and sulphuric acids in diges- 
 tion, and these must be neutralized or an acidosis will re- 
 sult. Milk, which contains a large quantity of lime, is 
 most valuable for neutralizing the acids produced from the 
 cereals. 
 
 Such an argument fails to convince, because protein is 
 absolutely necessary for life and almost every protein con- 
 tains sulphur and many of our most valuable foods con- 
 tain phosphorus including milk itself. Milk contains much 
 lime, but fruits and vegetables also contain much lime, 
 and as has been explained, should be relied upon for their 
 mineral content and neutralizing power. Milk has the 
 many disadvantages already enumerated, while fruits and 
 vegetables possess none of these. The author of the above 
 remarks seems to be unmindful of these important facts. 
 (See Calcium and Carrots, Chapter II; Milk, Chapter 
 III.) 
 
 A very excellent dish for either children or adults ia 
 some cereal, to which has been added a fresh fruit, — 
 oranges, berries, etc., or dates, stewed prunes, raisins, etc. 
 
 The majority of books on this subject also advise against 
 short periods of cooking of cereals and vegetables, and lay 
 emphasis on prolonged and thorough cooking of the 
 starches. This the author has also found to be unnecessary. 
 Instead of cooking cereals one to three hours, cook them 
 perhaps one-half hour or as long as necessary to soften 
 them sufficiently to rub through a very fine puree sieve for 
 the child one year old. (See Chapter II.) 
 
 Short periods of cooking starches sometimes produce a 
 slightly laxative effect because of the fact that less of the 
 
130 NUTRITION AND SPECIFIC THERAPY 
 
 Btarcli is assimilated, and as a result lactic acid may be 
 produced from it in the colon, but this is to be desired 
 unless the symptom is too pronounced. Short periods of 
 cooking the cellulose of cereals and vegetables may also 
 produce the same effect. (See Chapter II.) If the laxa- 
 tive effect is too pronounced, longer periods of cooking 
 may then prove beneficial, but two to three movements 
 a day are beneficial if not too loose. 
 
 If the diet of fruit juices, thin purees of succulent vege- 
 tables, unrefined cereal gruels, thin legume purees, roots 
 and tubers, and soft boiled eggs proves a too laxative diet 
 for a particular child of this age, then sterilized, certified 
 milk can be given for such a period as this symptom of 
 the child demands. 
 
 Again, almost every authority advises the giving of meat 
 broths and meats. According to the author's conviction 
 it is a great mistake to give these foods to young children 
 whose glands of internal secretions are undeveloped, which 
 aid in destroying the bacterial poisons generated in the 
 intestines, and which are absorbed and circulate through 
 the entire system. 
 
 Meat broths are not only food for bacteria in the in- 
 testines, but they are worthless as far as the question of 
 any nourishment is concerned. This is contrary to the ac- 
 cepted idea. They are practically nothing but water 
 laden with waste products, — ^urea, uric acid, xanthine, 
 creatine, creatinine, etc., and a very small amount of salts 
 and gelatin. Some of the nourishment has been drained 
 off in the blood, and the muscle fiber and other proteins 
 which furnish nutriment are not present in broth. The 
 very small percentage of mineral matter and protein in 
 meat broths can be supplied far better in many other foods. 
 
 The following diets for children, one to four years old, 
 have given excellent results in the author's experience. 
 
 Let it be emphasized in the beginning that thirst should 
 not be mistaken for hunger. Care should be taken that 
 
INFANTS' DIETS; CHILDREN'S DIETS 131 
 
 the child should receive an adequate amount of water daily. 
 
 During the second year, a child may have four meals a 
 day at four-hour intervals, and this schedule may be con- 
 tinued up tc the fourth year. 
 
 When weaned, children may be given the pulp and 
 juices of succulent vegetables, such as those of lettuce, 
 cauliflower, cabbage, tomatoes, and of the roots and tubers, 
 — carrots, turnips and beets, — ^baked or boiled potato 
 (peeled after cooked), cereal and legume purees very thin 
 (these are thicker than cereal gruels), soft eggs, espe- 
 cially the yolk two or three times a week, the ripe juices 
 and soft pulp of fresh fruits such as those of oranges, 
 peaches, pears and plums, the juice of lemons and pine- 
 apple, sweetened with milk or malt sugar, the stewed pulp 
 of prunes and apples, and the juices of berries. 
 
 Never drain vegetables, cereals or legumes in their prep- 
 aration. 
 
 During the third year, it is not necessary to rub the 
 vegetables, cereals and legumes through a puree sieve. 
 The vegetables can be given chopped fine, the cereals can 
 be given whole, and the legume purees may be thicker. 
 Dates and raisins cut up fine may be added, and peanut 
 butter may be spread on toast (also advised at 18 months). 
 
 If milk or cream is added to the menu, always give it 
 sterilized, both for bacteriological and physiological rea- 
 sons. 
 
 During the fourth year, any of the foods recommended 
 in this book may be given, taking into account the diges- 
 tion of each particular child. 
 
 Ettles Woeth Obsebving 
 
 1. If a child refuses plain bread and butter between 
 meals, give him nothing, for he is not hungry. 
 
 2. Give little variety at a time. Generally too great 
 a variety is given. 
 
132 NUTRITION AND SPECIFIC THERAPY 
 
 3. Allow plenty of time for eacli meal. If a cliild plays 
 with his food, remove it, and offer him no food until 
 the next meal. 
 
 4. Do not force a child to eat. Do not offer him sweets 
 when simple food is refused. 
 
 5. Teach him to chew his food thoroughly. 
 
 6. Keep the child happy at meal time. 
 
 7. Thirst is often mistaken for hunger. 
 
 8. Little or no cane sugar is needed if the child receives 
 the required amount of fruit juices, dates, prunes, 
 and raisins, or perhaps honey. 
 
 9. Do not give highly seasoned foods from the family 
 dish. Serve the child's meal before the spices are 
 added. 
 
 10. Never give fried foods of any kind, hot breads, cakes, 
 canned or preserved fruits. Graham crackers may 
 sometimes satisfy the desire for sweets. 
 
 The following is a typical one day's food chart for a 
 child during the second year : — 
 
 6 A. M. — % cup oatmeal puree. 
 10 A. M. — i tablespoons boiled carrots mashed through a 
 puree sieve. (Vary this with any succulent veg- 
 etable given above.) A pinch of salt and butter 
 or olive oil may be added. % cup unrefined corn- 
 meal puree. (Vary this with unrefined wheat 
 and oats.) 
 
 2 p. Mi. — ^Yolk of soft boiled egg every other day. Mashed, 
 boiled or baked potato with a pinch of salt and a 
 little butter or olive oil. When egg is not given, 
 prepare a cup of pea or bean puree and serve with 
 this % cup of vegetables instead of the potato. 
 
 6 p. M. — Pulp of baked apple, prunes or that of fresh ripe 
 peaches, pears or plums, or the juices of berries. 
 1 slice of oven dried toast. 
 
INFANTS' DIETS; CHILDREN'S DIETS 133 
 
 There shoiild be no constipation on this diet. If there 
 is a tendency towards diarrhea, some sterilized milk may 
 be given instead of some of the legumes, and no fruit 
 pulp, but fruit juices should be continued. Less vegetables 
 and more potato may also prove beneficial to counteract 
 this tendency. 
 
 Children's Diet with Milk. — For those for whom it 
 seems impossible to break away from the time-honored cus- 
 tom of feeding children with cow's milk, the following 
 day's food chart for a twelve months' child is given : — 
 
 6 A. M. — 12 ounces sterilized whole milk. 
 
 1^ slice oven dried toast. 
 8 A. M. — % cup orange juice. 
 10 A. M. — % cup oatmeal puree, and 14 cup boiled, mashed 
 
 carrots; or yolk of an egg, and a baked potato; or 
 
 pea puree and a vegetable. 
 2. p. M. — 12 ounces sterilized, whole milk and % slice oven 
 
 dried toast. 
 6 p. M. — Cornmeal puree cooked in double boiler in 8 ounces 
 
 milk; (% cup when cooked) a small amount of 
 
 sugar and a pinch of salt may be added. 
 
 14 cup fruit juice. 
 
 During the fourth year, breakfast may be given at 7 
 A.M., orange juice at 10 :30 a.m., luncheon at 1 p.m., and 
 dinner at 5 :30 p.m. 
 
 At an early age, the majority of books recommend meats 
 in many forms. In place of these the author recommends 
 peas, beans and lentils, all cereals, especially whole grain 
 wheat and oatmeal, eggs and nut butters, such as peanut 
 butter and soy bean butter. (See Chapter X.) These 
 foods should be combined with any of the vegetables, roots, 
 tubers and fruits. The value of honey is again empha- 
 sized. Cocoa may occasionally be given. 
 
 If these dietaries for infants and children are carried 
 out with thought, and a genuine desire for the child's wel- 
 
134! NUTRITION AND SPECIFIC THERAPY 
 
 fare, good results and a lack of the common ailments and 
 diseases of childhood are practically inevitable. 
 
 Goat's Milk. — Goat's milk has been used especially for 
 infant feeding from early historic times, particularly in 
 Italy, Switzerland, France and Germany. Its use has 
 certain advantages over that of cow's milk, and it is con- 
 cerning these that J. K. Culvin ^^ writes an article that is 
 worthy of consideration, and from which the following 
 points of interest are taken: — 
 
 Spargo states that the neglect of the goat as a milk animal, 
 especially for infants, is much to be deplored. Eosenau says 
 that the goat's milk seems to be well fitted for the human 
 infant, and that it is a great pity it is not more generally 
 employed. Goats are practically immune to tuberculosis. 
 
 The goat is especially useful to those who desire a small 
 amount of milk, and do not have room or cannot afford to 
 keep a cow, and great benefit is thus derived from having 
 fresh milk at hand at a low cost. 
 
 Chemical Composition op Goat's Milk 
 
 Water 86.88 
 
 Protein 3.Y6 
 
 Pat 4.0Y 
 
 Carbohydrate 4.64 
 
 Ash 0.85 
 
 From these figures it is clearly seen that the food prin- 
 ciples in cow^s milk and goat's milk are very similar 
 quantitatively. 
 
 Chemically, there is more difference. The casein eoagulum 
 is a little more firm than that of cow's milk. The fat closely 
 resembles that in human milk. Goat's milk fat is richer in 
 insoluble acids than cow's milk fat, but on the whole there 
 is very little difference. Eegarding the salt content, goat's 
 milk differs from cow's milk in containing tricalcium phos- 
 phate, di- and tri-magnesium phosphate, monopotassium 
 
 "Aroh. Pediat., Sept., 1921. 
 
INFANTS' DIETS; CHILDREN'S DIETS 135 
 
 phosphate and no monomagnesium or dipotassitun phosphate. 
 There are more chlorides in goat's than in human and cow's 
 milk, and sodium and potassium chlorides are present in the 
 former but not in the latter. 
 
 The goat has been called the "poor man's cow" because 
 the expense of keeping a goat is much less, and the goat pro- 
 duces much more milk in proportion to its size. They are 
 hardy animals, and will supply sufficient milk for the average 
 family, and can be kept where it would be impossible to keep 
 a cow. A goat can be kept on a small plot of grass, and 
 fresh, pure milk can be easily procured. 
 
 Dr. DeSanctis' ^^ conclusion regarding the cause of the 
 benefit derived from the egg yolk is different from that 
 stated by the author as the possible cause throughout the 
 chapter. 
 
 This experimental proof of the value of egg yolk in the 
 feeding of nursing infants should shed new light on the 
 modification of cow's milk in certain difficult cases at least, 
 if not in the case of all normal infants. 
 
 One teaspoon of soft boiled egg was added daily to the 
 formula. The response was an immediate gain in weight 
 in a three months' old infant which had been receiving 
 whole milk, water and dextri-maltose. The yolk was 
 gradually increased until the whole yolk was added daily. 
 Dr. DeSanctis attributes the 8—12 ounces gained weekly 
 to the addition of the fat-soluble A vitamine. Since the 
 first experiment, he has used the egg yolk in many cases 
 with the same results, even in cases in which orange juice 
 had been used. 
 
 " "Egg Yolk in Infant Feeding," Arch. Pediat., Feb., 1922. 
 
 (This article was published after this book was in press.) 
 
CHAPTEE IX 
 
 VITAMINES 
 
 The subject of vitamines is not more than eleven years 
 old. Vitamines have existed through countless ages, yet 
 man has been entirely ignorant of them, and even at the 
 present time, very little is known of their nature. 
 
 However, one very important fact concerning them has 
 been learned, and that is that they are absolutely neces^ 
 sary for a healthy body. For this reason they have been 
 appropriately designated as the "sixth food principle." 
 
 A great deal of research work is being devoted to them 
 both in Europe and America. In our own country Dr. 
 L. B. Mendel of Yale University, Dr. T. B. Osborne of 
 the Connecticut Experimental Station, Drs. E. V. Mc- 
 CoUum and N. Simmonds of The Johns Hopkins Univer- 
 sity, Drs. Alfred Hess and L. J. Unger of New York, 
 Drs. H. Steenbock, E. B. Hart, P. W. Boutwell, H. E. 
 Kent of The University of Wisconsin, — Drs. S. S. Zilva, 
 A. Hardin, J. 0. Drummond, K. H. Coward, F. G. Hop- 
 kins, E. Mellanby, E. M. Hume, H. Chick of England 
 and others of Europe and America have proved interest- 
 ing facts. 
 
 Vitamines are as yet substances very poorly defined. 
 The word was first proposed by Casimir Funk, a Pole. 
 They have also been termed "accessory food substances" 
 by Hopkins of England, a very misleading designation. 
 Much criticism has been expended on the term vitamine. 
 The termination "amine" denotes nitrogen is present, 
 while the first part of the word signifies the necessity of 
 
 136 
 
VITAMINES 137 
 
 this substance to life. But, as a matter of fact, the char- 
 acter of these substances is a mystery. 
 
 There is a general opinion to-day that certain diseases 
 are caused by deficiencies in the diet, and that these defi- 
 ciencies are in other words, vitamines. Each "deficiency 
 disease" is said to be produced by the absence of a par- 
 ticular vitamine. In this sense the vitamines must be 
 specific. Xerophthalmia, and beri-beri are said to be the 
 result of the absence of certain vitamines in the food, 
 although Dr. Hess says that even in beri-beri the degenera- 
 tions are not so sharply defined as in scurvy. Scurvy, 
 although conclusions concerning this disease are very con- 
 flicting, rickets, pellagra, anemia, neurasthenia and other 
 diseases are claimed to be the result, in part, of the ab- 
 sence of these substances. 
 
 There are three known vitamines, — ^the fat-soluble A, 
 the water-soluble B, and the water-soluble 0. The first is 
 sometimes called the antirachitic vitamine, the second the 
 antineuritic vitamine, and the third the antiscorbutic 
 vitamine. 
 
 In general, the foods that are lacking in these vitamines 
 are refined cereals, salted and dried meats, canned foods, 
 dried foods, foods subjected to- long periods of cooking and 
 a few to short periods of cooking. "Storage organs," such 
 as cereals and white potatoes, are low in vitamine A. 
 Leafy foods, such as lettuce, cabbage and cauliflower, are 
 valuable for vitamine A. Alkalies have a tendency to de- 
 stroy at least the antiscorbutic vitamine. For this reason 
 soda should not be added to the water in which vegetables, 
 navy beans, etc., are cooked. Foods which are acid, such 
 as oranges and tomatoes, retain their potency when raised 
 to high temperatures, or dried. 
 
 It is said that a certain amount of vitamines can take 
 care of only a limited amount of carbohydrate. This fact 
 in the author's opinion may account for many acute and 
 chronic diseases, especially among people who are given 
 
138 NUTRITION AND SPECIFIC THERAPY 
 
 to eating excessive quantities of cane sugar lacking in min- 
 eral matter. 
 
 Prominent among the detailed facts, so far as research 
 men have been able to ascertain, certain points of interest, 
 concerning the three vitamines, are given as follows : — 
 
 The antirachitic or fat-soluble A vitamine is abundant 
 in butter fat, egg yolk, cod-liver oil, and, to a little less 
 degree, in beef fat, and the glandular organs of animals. 
 It is found in small quantities, in comparison to these 
 foods, in the fats and oils of the vegetable kingdom, in 
 fruits, cereals, legumes, nuts, lettuce, cabbage, carrots, 
 potatoes, etc. It is more abundant in foods in which yel- 
 low coloring matter is present. H. Steenbock,^ P. W. 
 Boutwell and others have found considerable quantities in 
 carrots and sweet potatoes, and these may be classed, in re- 
 spect to the fat-soluble vitamine, with the leafy foods, 
 spinach, celery, lettuce, cabbage, beet greens, etc. Yellow 
 maize for the same reason is high in this vitamine, while 
 white maize is low. Cereals, white potatoes, parsnips and 
 beets have a small proportion in comparison to these foods 
 rich in yellow and green coloring matter. This vitamine 
 is not very resistant to heat, for it is destroyed by aera- 
 tion at 100° C, the length of time varying with the differ- 
 ent foods. Drying is not as fatal to it as to water-soluble 
 C. Its absence has many times been charged as the cause 
 of rickets, or as a contributing cause of this disease, but 
 the most recent investigations seem to prove that the lack 
 of fat-soluble A is not the only cause. 
 
 Dr. Alfred Hess ^ has made numerous experiments, and 
 concludes that sunlight has a dominant influence on the 
 etiology of rickets, and that it not only brings about a 
 clinical cure of the characteristic lesions, but also brings 
 about an increase in the inorganic phosphorus of the blood. 
 Drs. Hopkins and Mellanby of England, and Funk have 
 
 ^J. Biol. Chem., Jan., 1920. 
 V. A. M. A., Jan., 1922. 
 
VITAMINES 139 
 
 claimed it was caused by the absence of the fat-soluble A 
 vitamine, while Dr. Hess claims that an abundance of 
 vitamine A does not prevent rickets. He maintains that 
 an all around complete diet is a determining factor in this 
 disease. 
 
 Howland and Kramer claim a low content of inorganic 
 phosphorus in the blood of a child is nearly conclusive evi- 
 dence of rickets. 
 
 Eric Pritchard of England has said rickets may be due 
 to an acidosis, in which case the mineral matter may be 
 withdrawn from the bones for the purpose of neutraliza- 
 tion. Children frequently well fed develop it. 
 
 McCoUum, Osborne and Mendel have claimed that this 
 vitamine is necessary for growth, and that its absence gives 
 rise to xerophthalmia. 
 
 Sidney Walker,^ however, claims that the lack of fat- 
 soluble A produces xerophthalmia in a variable percentage 
 of experimental animals, and that there is obviously 
 another factor or factors causing this disease not yet 
 worked out. 
 
 McCoUum and Simmonds * have published the follow- 
 ing recent conclusions regarding the etiology of rickets : — 
 
 Mellanby has reported the production of rickets in puppies 
 by diets deficient in their content of fat-soluble A. Unfortu- 
 nately it has not been possible to evaluate Mellanby's results 
 by reading his published writings since he has never supplied 
 objective proof of the production of rickets in the form of 
 illustrations showing the appearance of his specimens through 
 the microscope. This omission has been unfortunate in as 
 much as the diagnosis of this disease can be made with cer- 
 tainty only on the evidence derived from microscopic changes 
 in the bones. The gross deformities which characterize 
 rickets can be simulated in other pathological conditions. 
 Evidence afforded by the X-ray is not convincing. 
 
 •J. A. M. A., Jan., 1922. 
 
 * Bull. Johns Hopkins Hosp., May, 1921. 
 
140 NUTRITION AND SPECIFIC THERAPY 
 
 Througli experiments these investigators conclude : — 
 
 Diets which were low in their content of fat-soluble A and 
 phosphorus produced, in the majority of the young rats 
 placed upon them, pathological conditions of the skeleton hav- 
 ing a fundamental resemblance to rickets. The pathological 
 conditions produced were not identical, however, with that 
 disease as it usually manifests itself in the human being. 
 
 When the deficiency in the phosphorus was compensated 
 for by the addition of a complete salt mixture containing the 
 phosphorus ion, the deficiency in fat-soluble A still existing, 
 no pathological changes of rachitic nature developed. The 
 addition of the phosphorus ion to the diets deficient in it 
 and in the organic factor, prevented therefore, the develop- 
 ment of any changes of a rickets-like nature. 
 
 The phosphorus ion in the diet may be a determining in- 
 fluence for or against the development of rickets. 
 
 If the phosphorus content of the diet is suflSciently high, a 
 deficiency of fat-soluble A cannot cause rickets-like changes 
 in the skeleton. A deficiency in fat-soluble A cannot be Sie 
 sole cause of rickets. Conversely, it is necessary that the diet 
 be low iu its content of phosphorus, all other factors, except 
 fat-soluble A, being optimal for rickets-like conditions to 
 develop. 
 
 Since the addition of the phosphorus ion to the diet pre- 
 vented the development of the rickets-like changes in the 
 skeleton, but had no effect in preventing xerophfiiabnia, it 
 seems permissible to infer that xerophthalmia and rickets do 
 not have an identical etiology. 
 
 The above results do not in our opinion exclude the fat- 
 soluble A from consideration as an etiological factor in the 
 production of rickets and kiudred diseases, since the level of 
 the blood phosphorus is, in all probability, determined in 
 part by the amount of the fat-soluble A available for the 
 needs of the organism. 
 
 P. G. Shipley, E. A. Park, E. V. McCoUum, N. Sim- 
 monds, and H. T. Parsons * have found that cod-liver oil 
 •J. Biol. Ohem., Jan., 1921. 
 
VITAMINES 141 
 
 causes calcium salts to be deposited in the cartilage and 
 bones in rats and that therefore, its administration is bene- 
 ficial in rickets. 
 
 E. A. Park and J. Howland ® claim cod-liver oil is a 
 specific for rickets. 
 
 This disease is very common, and is characterized by 
 impaired nutrition, extreme sensitiveness, fever and soft 
 muscles and bones. 
 
 The antineuritic or water-soluble B vitamine was dis- 
 covered about the same time by a different group of in- 
 vestigators. Funk proved that butter fat has no power 
 to cure polyneuritis in birds or beri-beri in man, and later 
 McCoUum solved the question, and designated these two- 
 substances as A and B. B is abundant in unrefined 
 cereals and yeast and present in smaller amounts in 
 legumes, eggs, milk, fruits, vegetables, roots, tubers, nuts 
 and glandular organs. It is the most abundantly distrib- 
 uted in nature and is the most resistant to heat as it resists 
 autoclaving for an hour. 
 
 Beri-beri which is caused by the absence of this vita- 
 mine, in part, if not entirely, is characterized by numb- 
 ness, cramps, catarrh, edema, pain and swelling in the 
 limbs, and finally paralysis. 
 
 The third vitamine that has created much interest is 
 the antiscorbutic or water-soluble vitamine. But ac- 
 cording to McOoUum and his coworkers there is doubt as 
 to the relation of this vitamine to scurvy, as they claim 
 there is no protective substance against this disease, and 
 that it is not a deficiency disease in the same sense of 
 xerophthalmia and beri-beri. Other authorities claim the 
 lack of this vitamine is the cause of scurvy. Dr. Funk 
 was the first to pronounce this fact. Vitamine is the 
 most abundant in fresh fruits, vegetables, roots and tubers, 
 especially oranges, lemons, tomatoes, cabbage, potatoes and 
 turnips. Milk is low in this vitamine. It is also found 
 
 "Bull. Johns Hopkins Hosp., Nov., 1921. 
 
142 NUTRITION AND SPECIFIC THERAPY 
 
 in germinated cereals and legumes, according to Chick 
 and Hume. 
 
 "Heat seems to affect water-sokible vitamine differ- 
 ently in different foods. For instance, heat apparently 
 destroys it in milk, but not in orange juice, tomatoes, or 
 potatoes, that is if they are not subjected to long periods 
 of cooking. Generally speaking, this vitamine is the most 
 susceptible to heat. 
 
 Some investigators claim aging destroys water-soluble 
 C vitamine more than heat. However, it is difficult to 
 reconcile this conclusion to the fact that scurvy has been 
 known to develop in breast-fed infants. In this case the 
 mother's milk may be at fault, and this vitamine present 
 in an insufficient amount. Drummond, Coward and 
 Watson '' say it was originally shown by MeCoUiun, Sim- 
 monds and Pitz (1916) and confirmed by Drummond 
 (1918) that the milk secreted by the lactating female will 
 tend to be deficient in vitamines unless her diet contains 
 adequate amounts of these substances. More recently a 
 great deal of experimental evidence has been obtained in 
 support of these observations, and from our own observa- 
 tions we are inclined to believe that this cause is by far the 
 most iraportant in causing such variations. 
 
 Dr. Hess claims that aging causes the destruction of this 
 vitamine through oxidation. This theory has been con- 
 firmed by Zilva at the Lister Institute of Medical Research 
 in London. The facts at present available point to the 
 sensitiveness of both the fat-soluble A and the water-sol- 
 uble C vitamine toward oxidative influences, whereas the 
 water-soluble B vitamine seems far more stable towards 
 heat and oxidation. 
 
 Dr. Hess has had unusual opportunities to observe the 
 results of milk modifications in New York, and has made 
 a special study of scurvy. He says cases of scurvy have 
 developed upon almost every diet given to children, — on 
 
 ■•Bioohem. J., Vol. XV, No. 4, 1921. 
 
VITAMINES 143 
 
 pasteurized milk, milk rich or poor in fat, buttermilk, 
 albumin milk, raw milk and mother's milk. It is prob- 
 able that all these milks had lost their antiscorbutic power 
 through aging, mother's milk excepted, or that they were 
 poor in mineral substances, or lacking in vitamine 0. 
 
 His classification of scurvy is as follows : — 
 
 In the latent stage there is stationary weight, pallor, 
 and anorexia, edema, exaggerated knee jerks and cardio- 
 respiratory syndrome. 
 
 In the sub-acute stage the above symptoms are more 
 marked, and there is enlargement of the heart, irritability, 
 redness of gums, tenderness of extremities, and perhaps 
 blood and albumin in the urine. 
 
 In the florid stage there are hemorrhagic disturbances. 
 
 It is a well-known fact that the first two stages are often 
 unrecognized. 
 
 W. Pitz * claims lack of calcium may be a contributing 
 cause of scurvy. An "incomplete protein," and the char- 
 acter of the flora of the digestive tract may also play a part 
 in its development. Pitz has suggested that calcium salts 
 may control the permeability of various animal tissues and 
 thereby afford protection against invading agents. The 
 various functions of calcium are again emphasized. 
 
 Shipley, McCollum and Simmonds * have found that 
 rats fed a diet complete, except for the absence of vita- 
 mine B, developed lesions in the bones essentially identical 
 with those seen in guinea pigs suffering from acute and 
 uncomplicated scurvy. Pats confined to the same diet 
 supplemented with B do not show these changes. The 
 bones of rats on a diet which is only deficient in A are 
 osteoporotic, but have no other resemblance to the bones 
 of scorbutic animals. These results appear very puzzling, 
 and some future explanation is hoped for from these in- 
 vestigators. 
 
 V. Biol Chem., Nov., 1918. 
 V. Biol. Chem., Dec, 1921. 
 
144 NUTRITION AND SPECIFIC THERAPY 
 
 Orange juice is heralded as the prototype of antiscor- 
 butics, — it invariably helps and generally cures this 
 disease. 
 
 Dr. Hess has spent considerable time in trying to find 
 a substitute for orange juice as this is expensive for many 
 families. He tried yeast and found it did not produce 
 good results. Potato water with some of the pulp, and 
 tomato juice, however, proved most beneficial. (Allow 
 twice the amount of these of orange juice, following the 
 schedule in Chapter VIII.) The juices of oranges and 
 tomatoes may be given in a nursing bottle when they 
 amount to four or six ounces, according to the age of the 
 child. Canned tomatoes may be substituted for fresh 
 tomatoes, if necessary, and given when orange juice is not 
 tolerated or available. 
 
 Pellagra has been said to be another deficiency disease, 
 although the exact cause is very doubtful along with 
 rickets and possibly scurvy, and beri-beri. It has been 
 claimed that the true cause was worked out at the Univer- 
 sity of Rome by Professors Alessandrini and Scala whose 
 conclusions were that it is a chronic acid intoxication, 
 and not an infection, and is caused by drinking soft water 
 coming from a clay soil, and prevented by drinking water 
 rich in calcium and magnesium carbonates. 
 
 The author does not deny these facts, but if the lack of 
 carbonates is the cause, why should not foods lacking in 
 these minerals be a cause also, — why should the cause be 
 limited to soft drinking water? Foods lacking in these 
 minerals, through kind or preparation, would seem to be 
 the more probable cause. These investigators claim pel- 
 lagra is cured by the hypodermic injection of a 10 per cent 
 solution of sodium citrate, in doses of 1 c.c. daily for 15-30 
 days, according to the severity of the case, then on alter- 
 nate days for as long a time. Why should hypodermic 
 injections of an alkali be necessary when many foods are 
 
VITAMINES 145 
 
 rich in liiese minerals, and would supply them with none 
 of the risks of hypodermic injections? 
 
 Pellagra has been known frequently to develop among 
 well-to-do classes as well as among the poorer classes. 
 From this fact the cause seems to point to an auto-intoxi- 
 cation caused by a diet lacking in mineral substances, and 
 possibly "complete protein" and vitamines A and B. 
 Those interested in the subject know that pellagra can be 
 cured by a scientific diet 
 
 McCoUum, Simmonds and Parsons ^'* hold the view that 
 pellagra may be caused by the lack of mineral substances 
 in the diet, especially calcium, and the lack of fat-soluble 
 A and a deficient protein. H. 0. Sherman, J. 0. Winters, 
 V. Phillips and E. V. McCoUum think an infective agent 
 is involved in pellagra, induced by faulty nutrition. This 
 conclusion again substantiates the author's conviction con- 
 cerning the lack of antibodies, produced in part by an 
 inadequate mineral supply, as a contributing etiological 
 factor in some so-called deficiency diseases. Where pel- 
 lagra is common large amounts of refined wheat, rice and 
 corn, and much sugar, molasses and meat, especially pork, 
 are used. The diet is lacking, for the most part, in milk, 
 eggs, leafy vegetables and fruits. Leafy vegetables, fruits 
 and milk are rich in calcium, and vitamine A, and eggs 
 have a smaller amount of calcium and a larger amount of 
 vitamine A. Leafy v^etables and fruits supplement the 
 cereals, legumes, roots and tubers in mineral substances, 
 protein and vitamine A, according to McCoUum and his 
 coworkers. They also supplement meats in mineral sub- 
 stances and vitamines. 
 
 Pellagra is characterized by weakness, indigestion, 
 nervous affections and eruptions. 
 
 Conclusion. — These many facts concerning vitamines 
 should require much consideration in all manipulations to 
 
 "J. Biol. Ohem., May, 1919. 
 
146 NUTRITION AND SPECIFIC THERAPY 
 
 which foods possessing these necessary substances are sub- 
 jected, and again special emphasis should be laid on the 
 value of fresh, raw fruits and vegetables, and short periods 
 of cooking. 
 
 Vitamine D. — Casimir Funk and Harrv E. Dubin ^^ 
 have separated from vitamine B a substance which they 
 call, provisionally, vitamine D, and which acts on micro- 
 organisms. Vitamine D appears to be a definite and spe- 
 cific substance stimulating the growth of yeast. 
 
 It may develop that the vitamine D and the vitamine- 
 like substance obtained from proteins such as casein, may 
 have some special function in the body, and such experi- 
 ments are now being planned. 
 
 Dental Caries and Pyorrhea. — Percy E. Howe,^^ assist- 
 ant Professor of Dental Research, Harvard University, 
 gives the following results of some of his researches which 
 appear to be of special interest in connection with the 
 study of the effects of the lack of mineral matter and vita- 
 mines in the diet, and the possible cause of many infections 
 as suggested by the author: 
 
 If the profession of dentistry is to undertake to prevent 
 dental diseases it will have to apply other measures than are 
 at present employed. We clean the teeth to prevent decay. 
 A few hours and the process must be repeated. The cleansing 
 must be kept up continuously ... on the other hand, native 
 races do not clean their teeth, do not need to and yet do not 
 have dental caries. And so it is with the cavities in the 
 teeth. They are filled. The fillings are on an average good 
 for, say, 5 years. Disintegration of the teeth recurs. The 
 teeth are again filled, and the filling lasts for a few more 
 years. Then the process is repeated. We have not in either 
 case removed the cause of the caries. 
 
 Our preventive measures are based on the theory of Miller, 
 who held that caries is due to the fermentation of carbohy- 
 drate with the formation of lactic acid. 
 
 "J'. Biol. Ghem., Oct., 1921. 
 ''The Dental Cosmos, Nov., 1921. 
 
VITAMINES 147 
 
 Now, while Miller was able to affect some extracted teeth 
 in a test tube by fermenting bread with saliva, he was unable 
 to produce any effect upon the teeth of living animals. He 
 thinks that it is the structure of the teeth that prevents the 
 decay. He continuously speaks of tooth structure as a most 
 decided factor in caries. But be this as it may, the fact 
 remains that when Miller's theory is applied to living animals, 
 it produces no effect upon the teeth. I have elsewhere stated 
 that after feeding 30 guinea pigs for a year upon various 
 sugars and starches and microorganisms, no effect upon their 
 teeth was discernible. The teeth of the guinea pig are very 
 easily decalcified in a test tube, decalcification being only a 
 matter of an hour or so, while the human tooth requires a 
 number of days. It is evident then that the structure of 
 the teeth of these animals is very favorable for the fermenta- 
 tion process to affect it, yet in the living state acids from 
 fermentation have no effect. 
 
 It is now possible entirely to decalcify the teeth of guinea 
 pigs by an alteration in their diet which may be compared 
 to the difference between natural foods and refined foods. 
 ... In some instances distinct cavities have formed. Ground 
 sections show that the dentin is badly disintegrated. The 
 destructive effects are rapid and severe. This seems to be 
 very similar to true dental caries. 
 
 Secondly, the alveolar process is absorbed, the teeth become 
 very loose and protrude from their sockets, and the articula- 
 tion is disarranged. Inflammatory and degenerative changes 
 occur in the peridental tissues. Indeed the condition closely 
 resembles pyorrhea. Elsewhere we have shown that the in- 
 jection of microorganisms into the gums produces no condi- 
 tion that simulates pyorrhea. The infection then is not the 
 causative factor but is secondary. . . . 
 
 Irregularities of the teeth occur — carious areas are found 
 in the jaws . . . considerable areas of the jaws become decal- 
 cified. Upon a return to normal diet large plaques of new 
 bone form. 
 
 It is a common theory to associate tooth difficulties with 
 eye troubles. Eunning eyes occur with regularity in scor- 
 butic feeding . . . many of our specimens of guinea pigs' 
 
148 NUTRITION AND SPECIFIC THERAPY 
 
 skulls show decalcified areas of the bone in the orbit, usually 
 at the base of the teeth. 
 
 In young mothers, whose diets are deficient in respect to 
 vitamines . . . some have cloudy spots upon the coatings of 
 the eye. With normal feeding these disappear. One animal 
 was born with no eyes. ... In another, opacity of the lens of 
 both eyes had gradually occurred. . . . After feeding her large 
 quantities of orange juice it entirely cleared up. . . . When 
 we consider how common dental caries is, and how many 
 youngsters have eyes that need correction we may, in the light 
 of these experiments, reason that a faulty nutritional diet 
 lies behind both. 
 
 Joint infection regularly follows deficiency in the anti- 
 scorbutic vitamine . . . looseness of the teeth occurs at the 
 same time. . . . Both are indicative of the same general dis- 
 turbance. 
 
 Zilva ^^ states that the pulps of the teeth are one of the 
 first things affected in antiscorbutic deficiency, and that the 
 teeth are profoundly affected. He believes a great deal of 
 latent scurvy exists and that caries may be a result of it. 
 
 In calcium disturbances of this kind, two things are to be 
 considered, — first, a sufiBcient supply of calcium, second, the 
 necessary elements for inducing the fixation of the calcium. 
 The fixation seems to be governed by the vitamine content of 
 the food. 
 
 Dr. Hov^e's researches and conclusions are extremely in- 
 teresting not only in relation to the diseases of the jaws 
 and teeth, but also in relation to the influence of calcium 
 and vitamines in many diseases of the body. 
 
 The author has been convinced of the supplementary 
 relationship of niineral matter and vitamines in the sev- 
 eral years of lecture work, and the lack of this in a high 
 protein diet. Elsewhere in this little volume this has been 
 said to be the cause of many organic diseases, and suggested 
 as the possible cause of some infectious diseases. 
 
 In this chapter these research men seem to prove that 
 
 "Proceedings of Koyal Society of London Series B., Vol. 90, 1919. 
 
VITAMINES 149 
 
 lack of vitamines and mineral substances are primarily 
 responsible for deficiency diseases, and are the primary 
 cause of some infections, the bacteria themselves being the 
 secondary cause. 
 
 Pyorrhea is a disease which has probably received more 
 attention than any other branch of dentistry, and its prob- 
 lem is only partly solved. 
 
CHAPTEE X 
 
 A FEW HEALTHFUL RECIPES; SOME INYALID RECIPES 
 
 MISCELLANEOUS SUBJECTS 
 
 Chestnut Puree (for those desiring cream). — Boil one 
 pound of chestnuts a few minutes, drain and remove skins. 
 Boil again until tender. Drain and press them through a 
 nut-butter grinder. Sweeten, flavor with vanilla and 
 moisten with a little cream. Put the puree in a sauce- 
 pan and stir over a slow heat until dry. Then press the 
 puree through a colander or potato press onto the dish in 
 which it is to be served. Form it into a circle, taking 
 care not to destroy its lightness and form. Serve with 
 whipped cream in the center of the ring. 
 
 Chestnuts are the best balanced of the nuts. Their 
 chemical composition is as follows: — 
 
 Chestnuts Other Nuts 
 
 Protein 6.6 per cent. 15.-25. 
 
 Fat 8.0 " " 50.-70. 
 
 Carbohydrate 45.0 " " 10.00 
 
 Mineral Matter l.Y " " 2.00 
 
 Cellulose 7 " " 1.-5. 
 
 Water 38.0 " " 4.^5. 
 
 A much greater amount of carbohydrate is required for 
 health than protein and fat, and the above figures clearly 
 demonstrate the excellent proportion of food principles in 
 chestnuts. 
 
 The peasantry of France and Italy often eat two meals 
 a day of chestnuts. 
 
 150 
 
MISCELLANEOUS SUBJECTS 151 
 
 Baked Lentils (Meat Substitute) 
 
 2 cups lentils % cup bread crumbs 
 
 % cup onions 2 cups tomatoes 
 
 Yi cup butter % cup cream (if preferred) 
 
 1% tablespoon salt Pinch of soda 
 
 1 tablespoonful celery salt 
 
 Wasli the lentils and soak in cold water several hours. 
 (Do not drain.) Add tlie onions and boil one liour or un- 
 til tender. Add salt and celery salt when they are half 
 done. Press tomatoes through a fine sieve, add the soda 
 and cream, and heat to the boiling point. Add this to the 
 lentils which should be boiled sufficiently dry so that drain- 
 ing is not necessary. Place them in a buttered baking 
 dish, cover with buttered bread crumbs, and bake in the 
 oven until the crumbs are a golden brown. 
 
 Lentils are not as popular as peas and beans, yet they 
 are an even more valuable food. They are richer in pro- 
 tein and have a much higher mineral content. The largest 
 supply comes from Egypt. 
 
 Lentil Toast. — This is made from lentils prepared as 
 in the above recipe before they are baked, adding sufficient 
 cream and tomato juice to allow them to be poured onto 
 buttered toast. This makes a pleasant variation from 
 milk toast or egg on toast for invalids. 
 
 Soy Bean Croquettes (cream may be omitted). — Soak 
 % pound soy beans over night. In the morning do not 
 drain; boil them several hours, until moderately tender. 
 (They will not be as tender as navy beans unless cooked 
 underpressure.) Add salt when half done. There should 
 be % cup of liquid when the boiling is completed. 
 
 To this % cup bean stock, add % cup cream and two 
 level tablespoons cornstarch, and stir until dissolved. Put 
 this on to boil and add thyme and bay leaf to flavor. To 
 1% cups tomato juice, add a pinch of soda and heat. Add 
 the tomato juice gradually to the bean stock and cream 
 and season with salt and pepper to taste. 
 
152 NUTRITION AND SPECIFIC THERAPY 
 
 Pass tlie drained boiled beans through a meat grinder, 
 and add to them two small onions cut fine, one egg yolk, 
 and salt and pepper to taste. To this mixture, add the 
 cooked oatmeal which is used as a binding agent (% the 
 quantity of the soy beans). (Recipe for oatmeal toast 
 used.) 
 
 Mix thoroughly, and form into croquettes. Heat them 
 in the sauce already prepared, and serve garnished with 
 water cress. 
 
 Oatmeal Toast. — To 1% cups boiling, salted water, add 
 1 cup oatmeal, stirring constantly until thick and stiif, 
 which will require but a few minutes' boiling. (This is 
 used as a binding agent in the above recipe.) 
 
 To serve as oatmeal toast, turn it into a bread pan. 
 When cold, cut in thin slices, and fry in Orisco or Snow- 
 drift. 
 
 Soy Bean Cookery. — For those who are interested in 
 soy bean cookery and its beneficial results, there are many 
 recipes for gruels, muffins, breads and cakes. However, 
 almost any recipe for these can be used substituting one- 
 half of the wheat flour called for with soy bean flour. 
 
 The bean is so rich in fat that in China and Japan a 
 variety of cheese is made from it. In England a new 
 vegetable milk has been produced from it in the following 
 manner: — The beans are soaked for a few hours, and 
 finely ground in a meat grinder. They are then boiled 
 in about three times their volume of water for a half hour. 
 The liquid is then drained, and it has an appearance of a 
 milky emulsion very similar to cow's milk. This vege- 
 table milk can be used in breads, cakes, custards, etc. It 
 has a slightly acid reaction, it curdles through the action 
 of rennet, and upon standing, it develops lactic acid. This 
 is often of great value in certain cases of diarrhea and 
 malnutrition. 
 
 A product similar to peanut-butter can be made from 
 the soy bean. This is especially recommended by the 
 
MISCELLANEOUS SUBJECTS 163 
 
 author as an excellent food for children for spreading on 
 bread and toast. It is easily prepared by passing the dry 
 beans through a meat grinder, and then through the nut- 
 butter grinder. (The latter is difficult to use the first 
 time.) Place the giound beans in a shallow pan in the 
 oven and parch, stirring frequently. Mix with them salt 
 and enough olive oil or other vegetable oil to make a paste. 
 
 Chemical Composition of the Soy Bean (Average) 
 
 Water 10.00 per cent. 
 
 Protein 37.13 " 
 
 Fat 18.38 " 
 
 Carbohydrate 24.40 ^^ 
 
 Lecithin 1.60 
 
 Mineral Matter 4.30 " 
 
 Cellulose 4.47 " 
 
 Almond Milk. — This is another vegetable milk that is 
 creating considerable interest. It is recommended for 
 adults in cases of typhoid fever, intestinal putrefaction, 
 nephritis, anemia, malnutrition, fermentation, for infants 
 with whom cow's milk or mother's milk does not agree, 
 and in cases of rickets. It ferments much less readily 
 than cow's milk, and its protein is less subject to putrefac- 
 tion in the intestines. It has a higher fat content than 
 cow's milk and a lower sugar content, and contains a 
 large amount of phosphorus, and a smaller amount of 
 sodium chloride. 
 
 To prepare the milk, the nuts are finely ground, covered 
 with water, and allowed to stand in the refrigerator over 
 night. They are then pressed through a potato rieer and 
 strained through gauze. One hundred grams of nuts may 
 be covered with 200 grams of water, and when strained 
 this is diluted up to 300 c.c. water. This milk must be 
 kept cold to prevent fermentation. 
 
 The chemical composition of this milk compared with 
 that of cow's milk is as follows : — 
 
154 NUTRITION AND SPECIFIC THERAPY 
 
 Almond Mile Cow's Milk 
 
 Protein 4.4 per cent. 3.0 per cent. 
 
 Fat T.O " " 4.0 " " 
 
 Carbohydrate 1.2 " " 5.0 " " 
 
 Mineral Matter ... .55 " " .7 " " 
 
 Water 86.0 " " 87.0 " " 
 
 Nut, Date Ai^fD Brajs Muffins (for Diabetes) 
 
 3 cups bran % teaspoons soda 
 
 4 eggs % " salt 
 
 3 teaspoons butter % cup English walnuts 
 
 1^ cups sour cream or but- % cup dates 
 termilk 
 
 Cream the butter, and add the beaten yolks. Add the 
 cream, soda, salt, walnuts, dates and bran. Lastly add the 
 beaten whites. Bake in a moderate oven 30 minutes if 
 muffins are large. 
 
 Nest Eggs. — This may be called a complete food, and 
 no other kind need necessarily be served with it as the egg 
 furnishes the protein, fat, vitamines, and a liberal amount 
 of mineral matter, while the potato supplies a generous 
 amount of mineral matter, carbohydrate and vitamines, 
 and also a small amount of a so-called "complete protein." 
 
 Wash and bake one large potato. Cut in half, scoop out 
 the inside and mash. To % cup mashed potato, add % 
 tablespoon butter, 1 tablespoon cream and a pinch of salt. 
 Line the potato shell with this mixture, place the yolk 
 or whole egg, if the potato shell is large enough, in the 
 cavity, sprinkle with salt and buttered crumbs, and bake 
 until the potato mixture is slightly browned. 
 
 Rice may be used in the same way, as natural brown 
 rice is a substitute for potato in many respects, if the 
 potato is eaten with the skin. 
 
 Rice versus the Potato — Every one probably has heard 
 much about rice as a potato substitute. Standard head 
 rice such as is generally purchased is not a substitute for 
 
MISCELLANEOUS SUBJECTS 165 
 
 the potato. This rice, lacking in salts, protein and vita- 
 mines must not be confounded with the potato which is 
 rich in salts and vitamines, especially if it is eaten with 
 the skin, according to McCoUum,^ and which has an almost 
 "complete protein." Hindhede of Copenhagen and others 
 have published valuable information on potato protein. 
 Natural brown rice, however, is a good substitute for the 
 potato, although it cannot claim all the qualities possessed 
 by its rival. (See Scurvy, Chapter IX; Protein, Chap- 
 ter I.) 
 
 The potato contains six times as much calcium, twenty 
 times as much phosphorus and five times as much iron as 
 standard head rice. It costs considerable money to mill 
 this refined rice, while it costs only about one-sixth as 
 much to mill natural brown rice. The average consumer 
 prefers the snow-white appearance of the denatured, re- 
 fined product to the healtb-producing substances of the 
 natural product, which includes mineral substances, vita- 
 mines A and B, and a small amount of protein. 
 
 The commercially known "Unpolished Kice" is very 
 misleading. One would be led to believe that the outer 
 bran had not been removed. However, it has partly been 
 removed, and the rice is then treated with glucose . and 
 talcum, although not to the extent that these substances 
 are applied to the ordinary commercial rice. I^^atural 
 brown rice can be purchased at certain pure food stores. 
 
 While the potato is an excellent food, it is not an ideal 
 food, as it is too low in calcium, sodium and chlorine and 
 vitamine A for the promotion of nutrition at the optimum 
 rate. McCoUum compares the properties of the potato to 
 the cereals, and says it remains for future investigators 
 to show whether or not the coagulated protein of the 
 potato has a higher biological value than those of the 
 cereals. Like the seeds, "it consists largely of reserve 
 food materials and relatively little of cellular elements." 
 
 * "The Newer Knowledge of Nutrition." 
 
156 NUTRITION AND SPECIFIC THERAPY 
 
 Therefore, its mineral and vitamine content should be 
 supplemented by leafy foods. 
 
 SoufSed Eggs. — Beat the white of an egg until stiff and 
 season with a pinch of salt. Butter a tumbler or cup, pour 
 the white into it, and place the cup in a pan of warm 
 water, allowing the water to heat gradually until the boil- 
 ing point is reached. As the white rises, make a depres- 
 sion and drop in the yolk,' allowing it to remain until thor- 
 oughly hot. 
 
 Steamed Eggs. — Butter smaU molds, and sprinkle with 
 finely chopped parsley. Carefully slip an egg into the 
 mold, and sprinkle with salt. Place the mold in a pan of 
 boiling water to % its depth, and allow the egg to cook 
 until the white is fum, keeping the water below the boil- 
 ing-point. Remove from the mold, and serve with tomato 
 sauce. 
 
 Egg Timbales. — Beat 1 egg slightly, add 1 tablespoon 
 of cream, a few drops of onion juice if desired, and a pinch 
 of salt and celery salt. Turn the mixture into a small 
 buttered mold. Set it in a pan of hot water, until firm. 
 Remove the mixture from the mold, and serve with cream 
 or tomato sauce 
 
 Oatmeal Cookies. — These are especially recommended 
 for children in place of sweets. The ingredients, before 
 baked, will be found difficult to bind together, — a little 
 pressure, however, after they are dropped onto the baking 
 sheet will overcome this difficulty. 
 
 iy2 cups rolled oats 1 tablespoon vaniUa 
 
 ^ cup sugar (brown) 1 " melted butter 
 
 2 eggs ^ teaspoon salt 
 
 Mix ingredients thoroughly, drop from a spoon onto a 
 baking sheet, and bake about five minutes or until a golden 
 brown. 
 
 Gruels for Infants and Invalids. — Gruels can be made 
 either from the grain or from the flour of any cereal or 
 
MISCELLANEOUS SUBJECTS 157 
 
 legume. If the flour is used, it should first he mixed with 
 a little cold water, then added to the boiling water. If 
 made with milk, they should be cooked in a double boiler. 
 For young infants they should be strained through a fine 
 puree sieve before being served. 
 
 Mix 1 tablespoon unrefined cereal flour with a little 
 cold water, and add, gradually, to a pint of boiling water 
 (or milk, if preferred). Add 2 level teaspoons milk or 
 malt sugar, a pinch of salt, and boil the mixture for ten 
 minutes very gently. If too much water boils away, add 
 sufficient water to make a cup of gruel when it is served. 
 Legume and cereal gruels may be served very thick if 
 desired by doubling or tripling the amount of cereal flour 
 or legumes. (Recommended in certain difficult cases.)'* 
 
 Legume Purees. — Legume purees for children and in- 
 valids are made by boiling the legumes in salted water 
 until tender, then rubbing them through a puree sieve. A 
 binding agent is sometimes desirable, and this is furnished 
 through mixing a small amount of wheat flour with a little 
 cold water, or with butter and adding it to the puree. 
 These also can be served thick or thin, and different herbs 
 added for flavoring, or a few drops of onion juice or to- 
 mato juice. (The odor and flavor of the onion is due to 
 allyl sulphide which is claimed to stimulate the flow of 
 gastric juice, and to act as a mild laxative.) 
 
 Albumin Water for Infants and Invalids. — Beat the 
 white of an egg until light, and strain through muslin. 
 Add four ounces of water and a pinch of salt. A teaspoon 
 of malt or milk sugar may be added in fever cases, and 
 also a small amount of orange or lemon juice. 
 
 Drinks for Children and Invalids. — These are especially 
 recommended in fevers : — 
 
 Jelly and Ice. — With an ice scraper, chip % cup ice 
 very fine. Mix with it the same quantity of any kind of 
 
 jelly. 
 
 'H. R. Mixsell, Arch. Pediat., Aug., 1920. 
 
158 NUTRITION AND SPECIFIC THERAPY 
 
 Gbape oe Cueeent Watee 
 
 6 tablespoons jelly l^ cup cold water 
 
 % cup boiling water Lemon juice 
 
 Dissolve the jelly in the boiling water, add the cold 
 water and lemon juice. Serve ice cold. 
 
 Apple Watee 
 
 1 apple Lemon juice 
 
 1 cup boiling water Sugar 
 
 Cut the apple with the skins into small pieces. Add 
 the boiling water, sugar and lemon juice to taste, strain 
 and serve ice cold. 
 
 Egg Lemonade 
 
 1 egg 3 tablespoons lemon juice 
 
 S tablespoons sugar 1 cup cold water 
 
 Beat the egg, and add the sugar, lemon juice and water. 
 Serve ice cold. 
 
 Steawbeeey Whip 
 
 1 cup fresh strawberries 
 
 Whites of 2 eggs 
 
 14 cup powdered sugar 
 
 Mash the berries, beat the whites until stiff and add the 
 berries and sugar. 
 
 Albuminized Oeange oe Geape Juice 
 
 White of 1 egg beaten stiff 
 Juice of 1 orange or grape juice 
 Sugar to taste 
 
 Serve ice oold. 
 
MISCELLANEOUS SUBJECTS 169 
 
 Gbape Juice and Egg 
 
 1 egg 
 
 1 tablespoon sugar 
 
 3 tablespoons grape juice 
 
 Beat yolk and white separately. Add the grape juice 
 and sugar to the yolk and fold in the beaten white. Serve 
 ice cold. 
 
 Coconut. — The coconut has a lower percentage of pro- 
 tein and fat and a higher percentage of carbohydrate than 
 the other nuts (chestnuts excepted). For this reason it is 
 a better balanced food, and an excellent food when thor- 
 oughly masticated. A great deal of the so-called indiges- 
 tion resulting from nuts is produced because they are not 
 properly masticated, and because they are eaten in con- 
 junction with many other foods. They should be the main 
 dish at whatever meal they are served. 
 
 Carl O. Johns, A. F. Finks and Mabel S. Paul * have 
 shown that the globulin of the coconut produces normal 
 growth in rats when used as the sole source of protein in 
 an otherwise complete diet. Commercial coconut press 
 cake furnishes the necessary protein for growth at almost 
 a normal rate. 
 
 Coconut press cake contains sufficient water-soluble 
 vitamine and experiments indicate that it also contains 
 some fat-soluble vitamine. 
 
 Yeast Cure. — If quantities of popular advertising and 
 a common topic of conversation possess any virtue at all, 
 the "yeast cure," both for internal and external use, must 
 be awarded the highest reputation. The majority of people 
 admit a certain degree of ill health of some nature and all 
 are grasping for the much-heralded panacea. They seem 
 to feel if they can take a kind of medicine which at the 
 same time is considered a food, miracles will result. But 
 V. Biol. Chem., April, 1919. 
 
160 NUTRITION AND SPECIFIC THERAPY 
 
 if certain healthful foods are suggested to these people as 
 a cure, lacking in the medicine attribute, generally they 
 have not the slightest interest unless these foods are those 
 for which they have a particular liking. 
 
 The chemical composition of yeast * is given by Zellner 
 as follows : 
 
 Per cent. 
 
 "Insoluble Albumin 12 
 
 Nucleins and Peptones 45.2 
 
 Albumoses 1.6 
 
 Ammonia Compounds 1.48 
 
 Fatty Bodies 
 
 Olein 
 
 Glucose 
 
 Invertine 
 
 Glycogen 
 
 Cholesterin 
 
 Succinic Acid 
 
 Nitrogenous 
 Substances 
 48.4 per cent. 
 
 Ternary 
 Substances 
 11.8 per cent, 
 
 Mineral 
 Substances 
 13.8 per cent. 
 
 Pbospboric Acid 51.1 
 
 Potassium 38.6 
 
 Magnesium 4.1 
 
 Calcium 1.9 
 
 Sulphates of Soda and Silica 4.0 
 
 The high protein content of yeast resembles casein, and 
 much of the nitrogen is non-protein represented by such 
 substances as nucleic acid and its derivatives. Yeast is 
 very rich in mineral matter. There is one other substance 
 which it contains, in large quantities, — the water-soluble 
 B vitamine. 
 
 It is admitted that certain cures have been wrought 
 through the feeding of yeast. It has been known to cure 
 disease among encamped armies. But its use for human 
 consumption has been suggested only recently, for the most 
 part, since the great war. During the war in Germany, 
 owing to the scarcity of meat, 50-75 grams were commonly 
 consumed daily. 
 *Zeits. f. Hygiene, XLIL, p. 3. 
 
MISCELLANEOUS SUBJECTS 161 
 
 But yeast contains certain substances tliat speak against 
 it. These are the purines, and in these its content is very 
 high. For this reason yeast produces much uric acid in 
 the body. 
 
 Yeast should never be allowed in gastric dilatation asso- 
 ciated with motor insufficiency as in these cases it remains 
 in the stomach too long. At times yeast produces diar- 
 rhea, vomiting and intestinal irritation. 
 
 Cow's milk is low in vitamine B, the amount present 
 being dependent upon the vitamine content of the food 
 of the cow. For this reason yeast has been recommended 
 for infant feeding in coimection with cow's milk. These 
 experiments proved that yeast produces diarrhea, followed 
 by losses in weight, and that it should not be used as a 
 means of increasing the antineuritic content of infants' 
 foods for the cure of boils or to influence the rate of 
 growth.^ 
 
 Diarrhea is only an exaggerated effect of one of its 
 much prized virtues, for it is claimed that yeast produces 
 lactic and succinic acids in the colon, and that therefore it 
 antagonizes putrefactive bacteria. As was clearly ex- 
 plained in the chapter on reforming the intestinal flora, 
 lactic acid stimulates peristalsis and prevents putrefac- 
 tion. If peristalsis is exaggerated, naturally diarrhea 
 results. 
 
 For this reason yeast has been much advocated in dis- 
 eases of auto-intoxication. 
 
 There are two kinds of yeast, brewer's yeast and grape 
 yeast, — ^both are used, but the best results seem to follow 
 from the use of the grape yeast, and in this connection this 
 yeast is often obtained by taking the so-called "grape cure," 
 when four or five pounds of grapes are eaten daily. 
 
 Jacquemin claims that the failure of brewer's yeast is 
 due to the fact that it is not always pure, and that the 
 yeast is not always collected at the time of its greatest 
 
 " A. L. Daniels, Am. J. Dis. Child., Jaji., 1922. 
 
162 NUTRITION AND SPECIFIC THERAPY 
 
 activity. Brewer's yeast is a ferment whicli develops in 
 an almost neutral culture medium, and at a generally low 
 temperature. On reaching the stomach it encounters an 
 acid medium, a high temperature and unfavorable sur- 
 roundings. So it is prevented from producing any bene- 
 ficial effect. He therefore advocates the grape yeast which 
 is accustomed to high temperatures. 
 
 The conclusion concerning the yeast cures is that the 
 effect is only transient. This is the natural supposition, 
 unless the cure were continued indefinitely through life. 
 
 In other words, health is dependent upon a certain 
 amount of protein, mineral matter and vitamines daily 
 (fat, carbohydrate and cellulose not entering into this 
 particular discussion) and the production of lactic acid in 
 the intestines. There are innumerable foods that contain 
 the above three food elements, and that produce lactic acid 
 for the prevention of putrefaction, — raw fruits, vegetables, 
 cereals, legumes, roots and tubers. There is every rea- 
 son in favor of eating these valuable foods daily, and of 
 not consuming quantities of yeast in a great effort to ob- 
 tain something Adtal that can be procured in wholesome 
 foods of many kinds. There is no question of securing 
 favorable results from these foods, — it is a guaranteed 
 fact and never a problematic one as in the case of brewer's 
 or grape yeast. 
 
 Physiological Action of Olive Oil (E. J. Asnis) : — 
 
 1. Olive oil inhibits the flow of hydrochloric acid. 
 
 2. It exercises a protective action from irritating foods 
 in inflamed and ulcerated areas. 
 
 3. It is an antispasmodic affecting the musculature of 
 the pylorus, thus causing relaxation of the pylorus. 
 
 4. It hastens passage of foods other than protein from 
 the stomach. 
 
 5. It is resistant to the action of fermentation in the 
 stomach. 
 
MISCELLANEOUS SUBJECTS 163 
 
 6. It combats constipation on a normal diet. 
 1. It overcomes dysentery and diarrkea on a liquid 
 diet. 
 
 8. It increases the flow of watery bile, and therefore 
 aids in the passage of gall-stones. 
 
 9. One tablespoon is equal to a glass of milk in calories. 
 Cohnheim's conclusions are as' follows (Friedenwald, 
 
 Kuhrah) : — 
 
 1. Cases of dilatation of the stomach due to spasm, 
 caused by an ulcer or fissure at the pylorus are cured, or 
 markedly relieved by the use of large quantities of oil 
 (100-150 grams). 
 
 2. Cases of stenosis of the pylorus due to organic disease 
 with secondary dilatation are also usually relatively cured 
 by the use of large quantities of oil ; that is, in these cases 
 the oil acts mechanically by relieving friction. 
 
 3. Cases of relative stenosis of the pylorus and duo- 
 denum which are clinically marked by a continuous hyper- 
 secretion and pylorospasm several hours after meals, are 
 much improved or cured by the oil treatment. 
 
 4. The pylorospasm found in cases of carcinoma of the 
 pylorus is much diminished or relieved by the oil treat- 
 ment. 
 
 5. Cases of ulcer of the pylorus associated with or 
 without hyperchlorhydria are quickly cured by means of 
 the oil treatment, or by an emulsion of sweet almonds. 
 (See Almond Milk, page 153.) 
 
 6. The oil is best taken three times daily, half to one 
 hour before meals; as a rule it is best to administer a 
 wineglassful early in the morning and two dessertspoon- 
 fuls before dinner and supper. In mild cases an emulsion 
 of sweet almonds may be substituted for it. 
 
 7. The oil fulfills three indications: it overcomes py- 
 lorospasm; it relieves friction and tends to improve the 
 general nutrition. 
 
164 NUTRITION AND SPECIFIC THERAPY 
 
 8. The oil acts as a narcotic in cases of pylorospasm, 
 producing, however, no unfavorable effects — neither eruc- 
 tation nor diarrhea. 
 
 9. In that form of gastric neurosis, manifested by pain 
 ■when the stomach is empty, very favorable symptomatic 
 relief has been obtained from the use of olive oil. 
 
 10. A certain number of cases of stenosis of the pylorus 
 accompanied by a consequent gastrectasia can often be so 
 much relieved by the oil treatment that no operative pro- 
 cedure need be undertaken. A trial should be made of the 
 oil treatment in all cases of stenosis of the pylorus before 
 advising operative procedure. 
 
 11. The treatment prevents prophylactically the pro- 
 duction of gastrectasia and prevents relapses when util- 
 ized in favorable cases, 
 
 Rutherford's conclusions are as follows: — Upon the 
 internal administration of olive oil, typical cases of chronic 
 dysentery, practically without exception, show changes 
 in their condition as follows: — 
 
 1. Positive evidence of increased quantities of bile in 
 the feces. 
 
 2. Decrease in the number of daily bowel movements, 
 and marked improvement in the character of the same. 
 
 3. Gradual cessation of signs of fermentation and putre- 
 faction along the intestinal tract, and consequent subsi- 
 dence of pain and tenderness. 
 
 4. General systemic improvement; gain in appetite; 
 repair of digestive faculties ; symptoms of improved ner- 
 vous system ; rapid gain in strength and weight. 
 
 5. Apparent positive cure after an average time of two 
 months and upward, with few recurrences. 
 
 The treatment is started by giving an ounce of olive oil 
 three times a day for three days, when the quantity is 
 doubled. Rutherford advocates a milk diet and egg albu- 
 min with this treatment. Later oil is given in dosei of 
 3 ounces three times a day. This treatment may neces- 
 
MISCELLANEOUS SUBJECTS 165 
 
 sarily be kept up for two montlis. Gradually the patient 
 is restored to a normal diet. 
 
 The author would not advise the milk in this diet, but 
 in its place would give cereal gruels, thin legume purees, 
 vegetable purees, soft eggs and fruit juices. 
 
 The Value of Salt in Food. — For many hundred years 
 man has added salt to his diet. It was first used as an 
 aliment at the time of transition from the nomadic to the 
 agricultural life. The use of salt seems to have been un- 
 known to the North American Indians at the time of the 
 discovery of America. There are still many tribes of peo- 
 ple living remote from civilization that have never tasted 
 salt. But among civilized people salt is used to-day in 
 excessive amounts. 
 
 It was repeatedly stated in Chapter II that sodium and 
 chlorine are essential to the body, and it has been proven 
 in recent years by the researches of Morse, Achard and 
 many others that foods in their natural state contain a 
 sufficient amount of salt for the requirements of the body 
 without the addition of commercial sodium chloride. This 
 addition seems to be craved by civilized man, and the more 
 civilized he is, and the more artificial and complex his 
 life, the greater is the quantity of sodium chloride that he 
 desires in his food. 
 
 It is an established fact that a certain amount of sodium 
 chloride is necessary. With an insufficient amount of 
 chlorides, the elimination of chlorine decreases constantly 
 in the urine, and finally may stop entirely, while the tis- 
 sues at the same time retain their chlorides. Chlorine 
 starvation has a marked influence on certain functions and 
 the digestive juices, especially the gastric juice. 
 
 Bunge has said the craving for the addition of salt to a 
 vegetarian diet is natural as many of this class of foods, 
 noteworthy among these the -potato, are rich in potash. 
 But other investigators make contrary claims. Eichet has 
 demonstrated that the foods required per day on a vege- 
 
166 NUTRITION AND SPECIFIC THERAPY 
 
 tarian diet contain naturally half a dram of salt, and that 
 this amount is what is required daily by the body, and that 
 therefore no addition is needed. 
 
 One result of an excess of salt is the greater activity of 
 the kidneys, for the greater the quantity of commercial 
 salt ingested, the greater the quantity of water demanded 
 by the body to maintain the normal specific gravity of the 
 blood. 
 
 As a natural consequence of the addition of sodium 
 chloride to the diet, the blood pressure is raised, but this 
 is relieved through water-drinking, by sweating and 
 through the kidneys. 
 
 The excessive use of salt in the diet has been claimed 
 by some investigators to produce eczema, dyspepsia and 
 Bright's Disease. The elimination of added salt to the 
 diet is of great value in the treatment of dropsy. The 
 following amounts of sodium chloride per pound in cer- 
 tain foods are given by Strauss: — 
 
 Uncooked Grains 
 
 Fruits 4.2 
 
 Vegetables 7.0 
 
 Cereals 7-^.0 
 
 White of Egg 13.3 
 
 Tolk of Egg 1.04 
 
 Meat 7.0 
 
 Milk 12.6 
 
 Goiter as Influenced by lodin. — Dr. E. E. Hayhurst ' 
 has published an article worthy of serious consideration 
 concerning the question of the significance of iodin in the 
 prevention of goiter. The main facts are outlined as 
 follows : — 
 
 The subject has been investigated by Marine, Kimball, 
 Lenhart, Gaylord, Marsh and others. "Sloan, following 
 Marine's suggestion for animals, advocates an iodized salt 
 
 V. A. M. A., Jan., 1922. 
 
MISCELLANEOUS SUBJECTS 167 
 
 for the use of human beings, the proportion of the sodium 
 iodid to salt to be 1-5000, and he observes that, in the 
 evaporation of salt brines, the mother liquor which is re- 
 moved, takes with it the natural content of iodin which is 
 originally 'found in most of the salt brines from <vhich salt 
 is crystallized.' Both Forbes and Beegle, and Bohn report 
 the entire absence of iodin in various forms of market salt 
 examined." 
 
 Of the four halogens, iodin is by far the rarest in natural 
 distribution, but it always occurs in sea water (Abel and 
 Halla). (Chlorin, bromin, iodin and fluorin represent the 
 four halogens.) 
 
 The chief natural iodin salt is sodium iodid, and it is about 
 five times as soluble as sodium chlorid. This difference in 
 solubility undoubtedly explains why there is plenty of the 
 former in the earth's deposits, and very little of the latter. 
 In the drying up of seas in ages past, sodium chlorid was 
 the first substance deposited, and often the supernatant liquid 
 escaped with its sodium iodid still in solution. In the second 
 place, such sodium iodid as may have been deposited has 
 been very largely dissolved out for ages through the agency 
 of percolating rains and subsoil waters. Finally, pent up 
 sea brines or supernatant salt solutions of both surface and 
 subterranean types have been subjected so long to similar 
 land-water perfusions as to lose practically all of their more 
 soluble constituents. Thus higher surface altitudes are 
 freest from iodin, while mineral springs, which represent 
 drainings from, higher altitudes, show it as among the last 
 places of its occurrence. 
 
 This is the explanation given for the absence of iodids and 
 other soluble salts in the great natural salt deposits of the 
 Alps and elsewhere throughout the world. 
 
 The relative infrequency of goiter along the sea coasts, and 
 its mild type when present, is mentioned in most text books. 
 
 All the salt plants of the United States are inland vpith 
 the exception of those along the California coast where 
 sea water is the source of supply, but in its manufacture, 
 even this is freed from iodin. The finished product aver- 
 
168 NUTRITION AND SPECIFIC THERAPY 
 
 ages 96 per cent sodiuni chloride, 3 per cent moisture 
 and the balance principally magnesium chloride. 
 
 This brings us to but one logical conclusion. If land ani- 
 mals, including man, must have iodin as a necessary content 
 of their food intake, its one, natural, reliable source is sea 
 water which, however, must be handled and provided in a 
 manner to retain the iodin, and this probably in its organic 
 form. This raises the important question, — should not total 
 sea salts be used as the proper and complete condiment for 
 man and land animals ? It must be remembered that it con- 
 tains, not only the two discussed essentials, sodium chlorid 
 and sodium iodid, but also many other physiologically im- 
 portant salts and salines. It is not poisonous. It can be 
 filtered free of foreign matter, even bacteria. Plants and 
 animals, both sea and land forms, show a selective action for 
 such elements as they need for their functions. 
 
 While it is true that most of the sea water elements are 
 widely distributed in the balance of nature, and found in 
 our usual foods, the great solubility of the combinations in 
 which they exist in sea water would appear to warrant giving 
 them, in toto, serious consideration in the dietary of man and 
 domestic animals. May not also the absence of some of the 
 rarer elements, bromin for example, from our usual food 
 intake play an important part in the occurrence of various 
 excitomotor conditions. 
 
 The author has known tbe drinking of sea water before 
 breakfast to benefit cases of constipation and neurasthenia. 
 
 Uncontaminated sea water has been recommended for 
 bread making in France, both on account of its various 
 salts required for health, and its magnesium chloride 
 which has an affinity for water, and so causes the bread 
 to keep moist longer ; but the yeast must be prepared with 
 fresh water. 
 
 Canned Foods,— -Canned foods should be used only wben 
 fresh foods are not obtainable. Generally some kind of 
 fresh fruit and vegetables are in the market throughout 
 
MISCELLANEOUS SUBJECTS 169 
 
 tlie year. However, necessities of various kinds demand 
 that either home canned or commercially canned foods be 
 used. When this is the case, the fact should be borne in 
 mind that the temperature and time of processing, and also 
 the period of storage have affected the vitamines. The 
 duration of the heating process destroys more vitamines 
 than the degree of temperature. Some commercially 
 canned foods, peas for example, are subjected to a treat- 
 ment called blanching which is destined to remove any 
 mucous substance and a part of the green coloring matter 
 that a clear liquor may be in the can. This blanching 
 water is thrown away. As a result, 3.3 per cent protein 
 of peas is thrown away, while the mineral content of 
 blanched peas is found to be 46 per cent less than that of 
 fresh peas. 
 
 When canned peas, beans, asparagus and sometimes 
 corn are prepared for use, they are many times drained 
 from the liquor in the can, and as a result there is an 
 added loss of soluble protein, carbohydrate, vitamines and 
 mineral salts. The natural conclusion is that canned 
 foods should not be drained, despite the directions that 
 may be given in cook books. 
 
 The bacteriological problem also enters into the ques- 
 tion of canned foods, especially in connection with the 
 Bacillus botulinus which has proved fatal through its 
 toxin in many cases. This bacillus is found both in canned 
 meats and vegetables, such as string beans, spinach, aspar- 
 agus and ripe olives. 
 
 Boiling destroys the toxin, but not the spores of the 
 Bacillus botulinus unless kept at this temperature for 
 several hours. 
 
 Harvey Weiss '' says the thermal death point of spores 
 varies with the hydrogen ion concentration of the particu- 
 lar food in question, canned fruits requiring shorter pe- 
 
 V. Infeot. Dis., Oct., 1921. 
 
170 NUTRITION AND SPECIFIC THERAPY 
 
 riods of boiling than vegetables ; it also depends upon the 
 concentration of the food, the more fluid products requir- 
 ing a shorter period of boiling; it is influenced by the 
 presence and concentration of the syrup, the heavier the 
 syrup, the longer the boiling period required. 
 
 Paul F. Orr * emphasizes the importance of early diag- 
 nosis in botulism as in tetanus and diphtheria because of 
 the fact that the beneflts of the antitoxin depend upon 
 early administration : — 
 
 There are at least two distinct types of botulinus toxin 
 known as A and B. The antitoxin is prepared against 
 each type and is specific. These facts clearly indicate the 
 importance of using both types of antitoxin, provided the 
 specific type for the toxin is not known. 
 
 The method of type determination consists in the intra- 
 peritoneal injection in each of a number of white mice of 
 about .05 c.c. of the filtrate of the infected food. Some of 
 the mice have been previously injected with type A anti- 
 toxin, and some with type B antitoxin. If previously im- 
 munized mice are not available, it is good to mix some of 
 the suspected toxin with type A antitoxin, and some with 
 type B antitoxin, and then inject the mixture into the mice 
 intraperitoneally. Mice of 15-20 gm. weight tolerate 
 1 c.c. of non-irritating fluid in the peritoneal cavity very 
 well. If the food contains the toxin of type A, the mice 
 receiving no antitoxin and those receiving type B anti- 
 toxin will die, while those receiving type A antitoxin will 
 survive. On the other hand, if the food contains toxin of 
 type B, only those receiving type B antitoxin will live. 
 In this way both the presence and the type of the toxin 
 may be determined in from 4—6 hours. 
 
 R. Graham and H. R. Schwartz * have published some 
 interesting researches on this bacillus. 
 
 » J. Infect. Dis., Sept., 1921. 
 
 ' J. Bacterial, Jan., 1921 ; J. Infect. Dis., April, 1921 ; J. A. M. A., 
 June, 1921. 
 
MISCELLANEOUS SUBJECTS 171 
 
 The fact should be empliasized that these canned foods 
 may contain this bacillus without any visible signs of de- 
 composition, but the cases of botulism are comparatively 
 rare. 
 
 The possibility of ptomaine poisons must not be over- 
 looked in canned foods. 
 
 The use of any coloring-matter in canned food is an ob- 
 jection, for many of the coal tar dyes used are harmful. 
 
 Copper and zinc may be used to color canned peas. 
 Lead from solder may be absorbed by canned foods. Acids 
 of the foods often erode the tin in which they are con- 
 tained and preservatives such as sulphuric, boric and 
 salicylic acids are sometimes used in these foods. 
 
 Purgatives, Cathartics and Laxatives. — The sale of 
 purgatives, cathartics and laxatives probably averages the 
 largest of all the drugs of the present day, and the prin- 
 cipal cause for the enormous demand for these prepara- 
 tions is the widely prevailing malady, constipation, — the 
 other reasons for their demand are small in number. 
 
 In many cases it is a gain to purge the intestinal tract 
 when reforming the intestinal flora. At other times quick 
 evacuation is demanded for special reasons. But cathar- 
 tics and laxatives as a regular regime should be highly 
 discouraged, for they lessen putrefaction only for the mo- 
 ment, and the constipated condition is aggravated rather 
 than lessened. 
 
 Since, however, there are cases in which a limited num- 
 ber of administrations of a cathartic or laxative are bene- 
 ficial, the following classifications are enumerated, with a 
 few comments respecting the advisability of each. 
 
 Catharsis is an exaggerated activity or stimulation of 
 the normal function of the intestines, and consequently its 
 action produces irritation and inflammation in a greater 
 or less degree. Therefore, the drug which will produce 
 the desired effect with the least degree of irritation and 
 inflammation and injury throughout the body is the one 
 
172 NUTRITION AND SPECIFIC THERAPY 
 
 that sliould be chosen. A cathartic is a laxative in a 
 large amount. It acts either by increasing the amount 
 of fluid in the intestines or by increasing the activity of 
 peristalsis. The increase of fluid is drawn from the sur- 
 rounding blood-vessels. 
 
 CLASSIFICATIOlir OP THE PeIWCIPAL OEGASriC LaXATIVES 
 AND CaTHAETICS 
 
 1. Cathartics Derived from Anthracene. — Senna, Oas- 
 cara Sagrada, Rhubarb, Aloes, Frangula. — Cascara 
 sagrada and rhubarb are the least irritating. They affect 
 the large intestines principally in about 5 hours, sometimes 
 8—12 hours. There may be a certain amount of griping, 
 but no severe inflammation, and they are best administered 
 at night. They may be present in the milk of nursing 
 mothers. 
 
 2. Purgative Oils. — Castor Oil, Croton Oil. — They 
 affect principally the small intestines. 
 
 These oils are hydrolyzed in the intestines, with the 
 production of free'fatty acids which are irritating. Croton 
 oil is generally far too violent, and causes severe griping; 
 castor oil produces no griping, and is recommended in 
 cases of abdominal pain. 
 
 Castor oil produces action in 3—6 hours and croton oil 
 in 1—2 hours. Castor oil is generally given at night. 
 Both may be present in the milk of nursing mothers. 
 
 3. Olive Oil, Cotton-Seed Oil. — They affect the small 
 intestines. 
 
 These are laxatives and also foods. Ten to fifteen c.c. 
 (% oz.) a day are given in the case of a young infant. 
 One-half to one wine glass is givea in the case of an adult, 
 although this may be insufficient. Should the patient be 
 inclined towards obesity, this would be contraindicated. 
 In such a case, liquid petroleum should be advised. 
 
 These oils should be contraindicated in hypoacidity and 
 diabetes (Chapter VII). 
 
MISCELLANEOUS SUBJECTS 173 
 
 4. Resinous Cathartics. — Jalap, Podophyllum, Colo- 
 cynth, Gamboge, Scammony. — These are very irritating 
 and include the drastics. They affect principally the 
 small intestines. They are administered at night or be- 
 tween meals. 
 
 5. Phenolphthalein (Carbolic Acid, Phthalic Anhy- 
 dride and Sulphuric Acid). — This may be classified as a 
 laxative, and is valuable in mild cases, and affects prin- 
 cipally the large intestines in 8-12 hours. 
 
 6. Agar-Agar, Manna, Liquid Petroleum, Mineral Oil 
 or Liquid Paraffin. — They are used to soften the feces and 
 increase their bulk. They are mild, non-irritating, un- 
 absorbed, indigestible and incapable of decomposition by 
 bacteria. They affect both the small and the large intes- 
 tines in 8-12 hours, and are given at night or 2 hours 
 after meals. When the desired effect is not obtained, the 
 dose should be increased. 
 
 7. Salines. — Salts of Tartaric and Citric Acids. — 
 These affect both the small and large intestines, and are 
 very rapid in action. They may produce some griping. 
 They are not absorbed. 
 
 Eochelle Salts (sodium, potassium tartrate) and Citrate 
 of Magnesia are well-known examples. 
 
 8. Bran. 
 
 Chemical Composition of Bean 
 
 Per cent. 
 
 Water 12.5 
 
 Protein 16.4 
 
 Fat 3.5 
 
 Carbohydrate 43.6(Varies) 
 
 Mineral Matter 6.0 
 
 Cellulose 18.0 
 
 The carbohydrate content is variable, ranging in dif- 
 ferent samples from 10-40 per cent and when this per- 
 centage is low, naturally those of the other food principles 
 are higher. 
 
174 NUTRITION AND SPECIFIC THERAPY 
 
 Some of the cellulose gives rise to gas and acid, both of 
 -which are laxative. Bran absorbs water, thus increasing 
 peristalsis. It is not irritating in cases of constipation 
 without complication, although this is contrary to many 
 statements. It is also an excellent food with its high 
 content of protein, carbohydrate and mineral matter and 
 a certain amount of vitamines A and B ^^ (about six level 
 tablespoons served in hot water or with fruit at breakfast) . 
 It is especially recommended by the author for "poor" 
 teeth. 
 
 If large amounts of fruits and vegetables do not relieve 
 constipation, bran should be the first laxative recom- 
 mended. If patients cannot be persuaded to eat it plain 
 in hot water or mixed with some food such as prune sauce, 
 then it should be made a part of every-day cookery, adding 
 it to mush, cakes, cookies and breads. It can replace white 
 flour to the extent of 50 per cent. 
 
 A very generous portion of bran in hot water once a 
 day, preferably at breakfast, and a pint of water drunk at 
 night should relieve the majority of cases of obstinate 
 constipation. 
 
 Classification of Iwoegaitic Cathartics 
 
 1. Salines, or Hydragogue Cathartics. — Salts of Sul- 
 phuric, Phosphoric and Carbonic Acids, "Milk of Mag- 
 nesia" (mild) and Magnesium Oxid. — These affect both 
 the small and large intestines, and are very rapid in action. 
 They may produce some griping and are not absorbed. 
 
 It is well to administer both the organic and inorganic 
 salines before breakfast, allowing 1 hour for them to take 
 action. They cause a marked increase of fluid from the 
 blood into the intestines as a result of osmotic pressure, 
 and also because of special properties peculiar to the salts. 
 
 Epsom Salt and Pluto Water (sodium and magnesium 
 sulphate principally) and Glauber's Salt (sodium sul- 
 "A. D. Stammers, Biochem. J., Vol. XV, No. 4, 1921. 
 
MISCELLANEOUS SUBJECTS 175 
 
 phate) are well-known examples. Hunyadi Water is sim- 
 ilar to Pluto Water. 
 
 2. Mercurials. — Calomel (mild mercurous chloride), 
 Blue Mass (more mild than calomel). Calomel acts prin- 
 cipally on the duodenum in 2-8 hours. 
 
 It is irritating to the mucous membrane of tiie intestines, 
 and is best administered at night. 
 
 Its value is attributed to its powerful action, and to its 
 antiseptic properties. 
 
 Calomel should be followed by a dose of one of the 
 salines, liat none may remain in the intestines. 
 
 Except in special cases, the author considers the salines 
 the best cathartics, as they are not absorbed, their action 
 is thorough, and rapid, and they produce little irritation. 
 
 Enemas. — Oil enemas and water enemas are given 
 when the oral administration of cathartics is contraindi- 
 cated by gastric and intestinal disturbances. They are 
 given also for their soothing action in excessive colonic 
 and rectal irritation. The oil enema is not as effective 
 as the water enema to soften the feces, and is not as well 
 retained. 
 
 Water enemas may be of several kinds, — ^plain water, 
 salt water, soapy water and mixtures of water with mag- 
 nesium sulphate and glycerin. 
 
 Emetics. — ^Vomiting is often necessary to expel quickly 
 the contents of the stomach. Drugs used for this purpose 
 produce the effect in two different ways : first, by stimulat- 
 ing the wall of the stomach, causing it to contract and 
 expel the contents ; secondly, through being absorbed into 
 the blood, causing nerve impulses to be sent to the walls 
 of the stomach to contract them. 
 
 Ipecac is probably the most commonly used drug and 
 is obtained from the roots of a plant of South America. 
 The vomiting is due chiefly to cephaeline and emetine, ac- 
 tive alkaloids of the drug. It acts principally on the lining 
 of the stomach. A small portion may be absorbed. It ia 
 
176 NUTRITION AND SPECIFIC THERAPY 
 
 usually expelled for the most part from tlie stomach, and 
 therefore is prevented from producing any harmfid results 
 through absorption. 
 
 Ipecac is also used as a reliable specific for ameba in 
 the intestines, emetine being the destructive principle. In 
 this case it should be given in coated pills to prevent its 
 acting on the stomach walls. 
 
 Mustard is frequently used to produce vomiting, — about 
 one tablespoon to a glass of \rarm water. The dose may 
 be repeated if the desired effect is not obtained. 
 
 Salt is often given in a concentrated form. 
 
INDEX 
 
 Accessory food substances, 136, 
 
 and see Vitamines 
 Adulterations, food, 23 
 Aerobic bacteria, in digestive 
 
 tract, 59 
 Agar-agar, 173 
 Alanine, 3 
 
 Albumin, in milk, 100 
 Albumin water, recipe for, 157 
 Albuminized orange or grape 
 
 juice, recipe for, 158 
 Alcohol, effects of, 69 
 Almond milk, compared with 
 cow's milk, 154 
 composition of, 154 
 preparation of, 153 
 Amino-acids, in gliadin, 3 
 in legumin, 3 
 in proteins, 3, 18 
 in zein, 3 
 Anachlorhjdria, diet in, 78 
 Anaerobic bacteria, in digestive 
 tract, 59 
 facultative, 59 
 number varies with diet, 61 
 Anemia, pernicious, diet in, 83 
 due to lack of vitamines, 137 
 theories of, 83, 84, 85 
 Animal protein, 4 
 absorption of, 4 
 Anthracene, cathartics derived 
 
 from, 172 
 Antineuritic vitamines, 141, and 
 see Vitamines, water-solu- 
 ble B. 
 Antiputrefactive diet, 51 
 Antirachitic vitamines, 138, and 
 see Vitamines, fat-soluble 
 A. 
 
 Antiscorbutic vitamines, 141, 
 and see Vitamines, water- 
 soluble C 
 Antiscorbutics, 144 
 Antitoxic glands, in auto-intox- 
 ication, 47, 50 
 Appendicitis, diet in, 78 
 Apple water, recipe for, 158 
 Arginine, 3 
 
 Arteriosclerosis, diet in, 95 
 Aspartic acid, 3 
 Assimilation of foods, 16 
 Asthma, diet in, 87 
 Auto-intoxication, 46 
 
 antitoxic glands in, 50 
 
 caused by bacteria, 49 
 
 caused by fermentation, 49 
 
 caused by digestive disturb- 
 ances, 48 
 
 caused by putrefaction, 49, 50 
 
 definition of, 47 
 
 glands of internal secretion in, 
 48 
 
 "immunizing glajids" in, 47 
 
 lacto -farinaceous diet in, 51 
 
 summary of, 52 
 
 symptoms of, 55 
 
 treatment of, 51 
 
 types of, 47 
 
 Bacillus, acidophilus, 60 
 
 aerogenes capsulatus, 60, 61, 
 
 62, 64 
 aerogenes lactis, 60, 61 
 bifldus, 60, 61 
 bulgaricus, 66 
 coli, 60, 61, 62, 63, 64 
 perfringens, 60 
 proteus vulgaris, 61 
 
 177 
 
178 
 
 INDEX 
 
 Bacillus, putrifieuB, 61, 62 
 
 welchii, 60 
 Bacteria, and see Intestinal 
 flora 
 
 aerobes, in digestive tract, 59 
 
 anaerobes, in digestive tract, 
 59 
 
 cause of auto-intoxication, 49 
 
 facultative anaerobic, in diges- 
 tive tract, 59 
 
 in digestive tract, 58 
 
 in intestines, 49, 50 
 
 in milk, 60 
 Bacteriology of digestive tract, 
 
 58 
 Baked lentils, recipe for, 151 
 Baking, 27 
 
 Beef, calorific value of, 13 
 Beri-beri, due to lack of vita- 
 mines, etc., 137, 141 
 Blue mass, 175 
 Boiling, 26, 27 
 Bottles, feeding, care of, 124 
 Botulism, 170 
 Bran, 173 
 
 composition of, 173 
 Bread, calorific value of, 13 
 Brewerg' yeast, 161 
 Bronchitis, diet in, 86 
 Broths, meat, not for children, 
 
 130 
 Butter, calorific value of, 13 
 
 Caffeine, 71, 72, 73 
 
 effects of, 68 
 Calcium, in cereals, 38 
 
 in fruits, 37 
 
 in milk, 24, 101, 119 
 
 in vegetables, 37 
 
 lack of, in scurvy, 148 
 
 requirement of body, 25 
 Calcium caseinate, in milk, 81 
 Calomel, 175 
 Calories, defined, 11 
 
 large, 11 
 
 number required, 13, 15 
 
 small, 11 
 Calorific value of foods, 11 
 
 to calculate, 12 
 
 Cane sugar, 7 
 
 effects of, 69 
 Canned foods, 168 
 Carbohydrates, 7 
 
 calorific value of, 11 
 
 classification of, 7 
 
 combustion of, 9 
 
 purpose of, 9 
 
 source of, 9 
 
 stools, 113 
 Caries, dental, and vitamines, 
 
 146 
 Casein, in milk, 100 
 Castor oil, 172 
 Cathartics, abuse of, 71 
 
 derived from anthracene, 172 
 
 hydragogue, 174 
 
 inorganic, classification of, 
 174 
 
 organic, classification of, 172 
 
 resinous, 173 \ 
 
 Celluloses, 9 
 
 effect of heat on, 21 
 Cereal water compared with 
 
 milk, 118 ■ 
 Cereals, as food, 129 
 
 calcium in, 38 
 
 composition of, 43 
 
 iron in, 37 
 
 lecithin in, 100 
 Centrifuged milk, 112 
 Certified milk, 112 
 CheesOj composition of, 43 
 Chestnut puree, recipe for, 150 
 Chestnuts, composition of, 150 
 Children's diet, 96, 130 
 
 at 1 year old, 127 
 
 in 1st year, 127, 131 
 
 in 2nd year, 131, 132, 133 
 
 in 3rd year, 131 
 
 in 4th year, 131 
 
 rules for, 131 
 
 with milk) 133 
 Children, drinks for, 157 
 Chlorophyll, 72 
 Chocolate, 73 
 Citrate of magnesia, 173 
 Cocoa, composition of, 73 
 Coconut, 159 
 
INDEX 
 
 179 
 
 Coffee, composition of, 72 
 
 efEects of, 68 
 Colitis, diet in, 78 
 Combustion of carbohydrates, 9 
 Complete proteins, 18 
 Condensed milk, 115 
 Condiments, effects of, 69 
 Constipation, 38, 174 
 Cookies, oatmeal, recipe for, 156 
 Cooking, effects of, 20 
 
 of foods, 20 
 
 of vegetables, 26 
 Cotton seed oil, 172 
 Cow's milk, and see Milk 
 
 compared with almond milk, 
 154 
 
 compared with cereal water, 
 118 
 
 compared with human milk, 
 98, 118 
 Croton oil, 172 
 Currant water, recipe for, 158 
 Cystine, 3 
 
 Deficiency diseases, 137 
 Dental caries, and vitamines, 146 
 Dextrins, 8 
 Dextrose, 7 
 
 Diabetes, Croftan's views on, 92 
 diet in, 88 
 Allen's, 89 
 Joslia's, 88 
 von Noorden's, 90 
 liennfi's method in 'diabetes, 
 
 94 
 Sajous' views on, 91, 93 . 
 Woodyatt's method in dia- 
 betes, 94 
 Diarrhea, infantile, 81 
 causes of, 81 
 diet in, 81 
 varieties of, 81 
 Diet, and see Feeding 
 antiputrefactive, 51 
 for children, 96, 130 
 at 1 year old, 127 
 in 1st year, 127, 131 
 in 2nd year, 131, 132, 133 
 in 3rd year, 131 
 
 Diet, for children in 4th year, 131 
 
 rules for, 131 
 
 with milk, 133 
 for infants, 96 
 in anachlorhydria, 78 
 in appendicitis, 78 
 in arteriosclerosis, 95 
 in asthma, 87 
 in auto-intoxication, 51 
 in bronchitis, 86 
 in colitis, 78 
 in common diseases, 76 
 in diabetes, 88 
 
 Allen's, 89 
 
 Joslin's, 88 
 
 von Noorden's, 90 
 in diarrhea, infantile, 81 
 in dilatation of stomach, 79 
 in diphtheria, 86 
 in eczema, 87 
 in enteritis, 78 
 in fevers, 86 
 in flatulency, 79 
 in gall-stones, 79 
 in gastric ulcer, 78 
 in gastritis, 78 
 in gout, 83 
 in heart diseases, 79 
 in hyperchlorhydria, 76 
 in hypoehlorhydria, 77 
 in infantile diarrhea, 81 
 in influenza, 86 
 in jaundice, 79 
 in kidney diseases, 82 
 in measles, 86 
 in migraine, 78 
 in pernicious anemia, 83 
 in pneumonia, 86 
 in scarlet fever, 86 
 in tuberculosis, 86 
 in typhoid fever, 86 
 in urticaria, 87 
 in whooping cough, 86 
 laeto-farinaceous, in auto-in- 
 toxication, 51 
 lacto -vegetarian, versus meat 
 
 diet or mixed diet, 29 
 meat, versus vegetarian or 
 lacto-vegetarian diet, 29 
 
180 
 
 INDEX 
 
 Diet, mixed, versus vegetarian or 
 laeto-vegetarian diet, 29 
 vegetarian, 39 
 
 objections to, 14 
 versus meat diet or mixed diet, 
 29 
 Dietaries, standard, 14 
 Digestion, 17 
 
 of milk, 110 
 Digestive disturbances, as cause 
 
 of auto -intoxication, 48 
 Digestive tract, bacteriology of, 
 
 58 
 Dilatation of stomach, diet in, 
 
 79 
 Diphtheria, diet in, 86 
 Disaccharides, 7 
 Drinks, for children, 157 
 for invalids, 157 
 iced, effect of, 70 
 
 Eczema, diet in, 87 
 
 Egg lemonade, recipe for, 158 
 
 Eggs, composition of, 43 
 lecithin in, 100 
 souffled, recipe for, 156 
 steamed, recipe for, 156 
 timbales, recipe for, 156 
 
 Emetics, 175 
 
 Enemas, 175 
 
 Enteritis, diet in, 78 
 
 Epsom salt, 174 
 
 Evaporated milk, 115 
 
 Facultative anaerobic bacteria, 
 
 in digestive tract, 59 
 Fat, or Fats, 5 
 
 absorption of, 6 
 
 calorific value of, 11 
 
 decomposition of, 6 
 
 digestibility of, 6 
 
 edible, smoking temperature 
 of, 6 
 
 effect of heat on, 20 
 
 in milk, 100 
 
 melting point of, 5 
 
 source of, 7 
 
 Feeding, and see Diet, and 
 Poods 
 of infants, 96 
 
 formulas for, 117 
 
 in Ist month, 124 
 
 in 2nd month, 125 
 
 in Srd and 4th months, 125 
 
 in 5th and 6th months, 125 
 
 in 7th, 8th, and 9th months, 
 
 125 
 in 10th month, 126 
 in 11th month, 126 
 in 12th month, 126 
 rules for, 113 
 Feeding bottles, care of, 124 
 Fermentation, auto-intoxication 
 
 due to, 49 
 
 Fevers, diet in, 86 
 
 Flatulence, diet in, 79 
 
 Foods, adulteration of, 23 
 
 assimilation of, 16 
 
 calorific value of, 11 
 
 to calculate, 12 
 canned, 168 
 composition of, 2 
 cooking of, 20 
 digestion of, 16, 17 
 effect of heat on, 20 
 iron in, 36 
 lime in, 37 
 preparation of, 20 
 Formulas for infant feeding, 117 
 Fructose, 7 
 
 Fruits, calcium in, 37 
 iron in, 37 
 organic acids in, 11 
 Fruit sugar, 7 
 
 Galactose, 7 
 
 Gall-stones, diet in, 79 
 
 Gastric ulcer, diet in, 78 
 
 Gastritis, diet in, 78 
 
 Gelatin, as supplement of pro- 
 teiii, 107 
 
 Glands, antitoxic, in auto-intox- 
 ication, 47, 50 
 "immunizing," in auto-intoxi- 
 cation, 47 
 
INDEX 
 
 181 
 
 Glands, of internal secretion, in 
 
 auto-intoxieation, 48 
 Glauber's salt, 174 
 Gliadin, amino-aeids in, 3 
 Glucose, 7 
 Glutamic acid, 3 
 GlycoeoU, 3 
 Glycogen, 8 
 
 Goat's milk, as food for infants 
 and children, 134 
 
 composition of, 134 
 Goiter, as influenced by iodin, 
 
 166 
 Gout, diet in, 83 
 
 oxalic acid in, 75 
 Grape juice, albuminized, recipe 
 for, 158 
 
 and egg, recipe for, 159 
 Grape sugar, 7 
 Grape water, recipe for, 158 
 Grape yeast, 161 
 Gruels, for infants, 156 
 
 for invalids, 156 
 Gums, 8 
 
 Heart diseases, diet in, 79 
 Heat, effect of, on cellulose, 21 
 effect of, on fats, 20 
 effect of, on proteins, 20 
 effect of, on starch, 20 
 Hexoses, 7 
 Histidine, 3 
 
 Honey, composition of, 73 
 Hordein, amino-acids in, 3 
 Hot drinks, effect of, 70 
 Human milk, compared with ce- 
 real water, 118 
 compared with cow's milk, 98, 
 118 
 Hunger pangs, 68 
 Hydragogue cathartics, 174 
 Hyperehlorhydria, diet in, 76 
 Hypochlorhydria, diet in, 77 
 
 Iced drinks, effect of, 70 
 "Immunizing" glands, in auto- 
 intoxication, 47 
 Indican, 49 
 Indicanuria, 55 
 
 Infant's diet, 96 
 Infant feeding, formulas for, 
 117 
 
 in 1st month, 124 
 
 in 2nd month, 125 
 
 in 3rd and 4th months, 125 
 
 in 5th and 6th months, 125 
 
 in 7th, 8th, and 9th months, 
 125 
 
 in 10th month, 126 
 
 in 11th month, 126 
 
 in 12th month, 126 
 
 rules for, 113 
 Infant's gain in weight in first 
 
 year, 122 
 Infants, gruel for, 156 
 Infantile diarrhea, 81 
 
 causes of, 81 
 
 diet in, 81 
 
 varieties' of, 81 
 Influenza, diet in, 86 
 Internal secretion, glands of, in 
 
 auto-intoxieation, 48 
 Intestines, bacteria in, 49, 50, 
 
 61 
 Intestinal flora, reforming the, 
 65 
 
 rules for, 67 
 Inulin, 9 
 Invalids, drinks for, 157 
 
 gruels for, 156 
 Iodin, influence on goiter, 
 
 166 
 Ipecac, 175 
 Iron, in foods, 36 
 
 requirements in body, 25 
 Isoleucine, 3 
 
 Jaundice, diet in, 79 
 Jelly and ice, recipe for, 157 
 
 Kidney diseases, diet in, 82 
 
 Lactic acid, bacteria, 65, 66 
 preservative effect of, 66 
 to obtain, in colon, 66 
 value of, 65 
 
 Lacto-farinaeeous diet in auto- 
 intoxieation, 51 
 
182 
 
 INDEX 
 
 Laeto-vegetarian diet, versus 
 meat diet ot mixed diet, 
 29 
 Lacto-vegetarianism, 40 
 Lactose, 8 
 Laxatives, 171 
 
 classification of, 172 
 Lecithin, in cereals, 100 
 
 in eggs, 100 
 
 in legumes, 100 
 
 in milk, 98, 99 
 Legumes, composition of, 44 
 
 lecithin in, 100 
 
 pur6e, recipe for, 157 
 Legumin, amino-acids in, 3 
 Lemonade, egg, recipe for, 158 
 Lentil toast, recipe for, 151 
 Lentils, baked, recipe for, 151 
 Leucine, 3 
 Levulose, 7 
 Lime, in foods, 37 
 Lime starvation, 24 
 Lime water, addition of to in- 
 fant's food, 120 
 Liquid paraffin, 173 
 
 petroleum, 173 
 Lupeose, 8 
 Lysine, 3 
 
 Magnesia, citrate of, 173 
 Magnesium requirements of 
 
 body, 26 
 Malt soup extract, 115 
 Malt sugar, 8 
 Malted milk, 115 
 Maltose, 8 
 
 for infants, 115 
 Manna, 173 
 Mannose, 7 
 Measles, diet in, 86 
 Meat broths, not for children, 
 
 130 
 Meat diet, versus vegetarian or 
 
 lacto-vegetarian diet, 29 
 Meats, composition of, 43 
 
 not for children, 130 
 Melibiose, 8 
 Mercurials, 175 
 Migraine, diet in, 78 
 
 Milk, albumin in, 100 
 
 almond, composition of, 154 
 compared with cow's milk, 
 
 154 
 preparation of, 153 
 
 bacteria in, 60 
 
 calcium in, 24, 101, 119 
 
 calcium caseinate, 81 
 
 casein in, 100 
 
 eentrifuged, 112 
 
 certified, 112 
 
 children's diet with, 133 
 
 composition of, 43, 99 
 
 condensed, 115 
 
 cow's compared with human, 
 98, 118 
 compared with almond milk, 
 154 
 
 digestion of, 110 
 
 evaporated, 115 
 
 fat in, 100 
 
 goat's, as food for infants and 
 children, 134 
 composition of, 134 
 
 human, compared with cow's 
 98, 118 
 
 lecithin in, 98, 99 
 
 malted, 115 
 
 mineral matters in, 101 
 
 modification, 122 
 
 pasteurized, 104 
 advantages of, 105 
 characteristics of, 104 
 digestion of, 110 
 disadvantages of, 105 
 
 phosphorus in, 101, 120 
 
 protein in, 100 
 
 question, 127 
 
 raw, advantages of, 105 
 compared with sterilized 
 
 milk. 111 
 dangers of, 112 
 digestion of, 110 
 disadvantages of, 105 
 
 sterilized, 102 
 advantages of, 103 
 chemical changes in, 102 
 compared with raw milk, 
 111 
 
INDEX 
 
 183 
 
 Milk, sterilized, digestion of, 
 110 
 
 streptococci in, 61 
 Milk sugar, 8 
 Mineral matters, 10 
 
 in milk, 101 
 
 source of, 10 
 Mineral oil, 173 
 Mixed diet, versus vegetarian or 
 
 lacto-vegetarian diet, 29 
 Modification of milk, 122 
 Molasses, 70 
 Monosaccharides, 7 
 Mucilages, 9 
 Mustard, as an emetic, 176 
 
 Nest eggs, recipe for, 154 
 Neurasthenia, due to lack of 
 
 vitamines, 137 
 Nipples, care of, 124 
 Nitrogen equilibrium, 15 
 Nutrition, explanation of, 1 
 Nuts, composition of, 45, 150 
 Nut, date, and bran muffins, 
 
 recipe for, 154 
 
 Oatmeal cookies, recipe for, 156 
 Oatmeal toast, recipe for, 152 
 Oil, castor, 172 
 
 cotton seed, 172 
 
 croton, 172 
 
 mineral, 173 
 
 olive, 172 
 physiological action of, 162 
 
 purgative, 172 
 Olive oil, 172 
 
 physiological action of, 162 
 Orange juice, albuminized, re- 
 cipe for, 158 
 
 as antiscorbutic, 144 
 
 as infant food, 109, 111 
 Organic acids, in fruits and 
 
 vegetables, 11 
 Overeating, 68 
 Oxalic acid, in gout, 75 
 Oxaluria, 75 
 Oxyproline, 3 
 
 Paraffin, liquid, 173 
 Pasteurized milk, 104 
 
 advantages of, 105 
 
 characteristics of, 104 
 
 digestion of, 110 
 
 disadvantages of, 105 
 Pectin, 72 
 Pellagra, cause of, 144 
 
 deficiency disease, 144 
 
 due to lack of vitamines, etc., 
 137 
 Pernicious anemia, diet in, 83 
 
 due to lack of vitamines, 137 
 
 theories of, 83, 84, 85 
 Petroleum, liquid, 173 
 Phenolphthalein, 173 
 Phenylalanine, 3 
 
 Phosphorus, deficiency of in 
 etiology of rickets, 140 
 
 in milk, 101, 120 
 Pneumonia, diet in, 86 
 Polysaccharides, 8 
 Potassium requirements in body, 
 
 26 
 Potato, as food, 155 
 
 versus rice, as a food, 154, 
 155 
 Preparation of food, 20 
 Proluie, 3 
 Protein, 2 
 
 amino-acids in, 3, 18 
 
 amount required, 4 
 
 animal, 4 
 
 calorific value of, 11 
 
 complete, 18 
 
 effect of heat on, 20 
 
 gelatin as supplement of, 107 
 
 in milk, 100 
 
 source of, 5 
 
 vegetable, 4 
 Ptomaines, origin of, 49 
 Purges, legume, recipe for, 
 
 157 
 Purgative oils, 172 
 Purgatives, 171 
 
 Putrefaction, auto-intoxication 
 due to, 49, 50 
 
 types of chronic, 64 
 Pyorrhea and vitamines, 146 
 
184. 
 
 INDEX 
 
 Raffinose, 8 
 
 Raw milk, advantages of, 105 
 
 compared with sterilized milk, 
 111 
 
 dangers of, 112 
 
 digestion of, 110 
 
 disadvantages of, 105 
 Recipes, 150 
 
 for albumin water, 157 
 
 for albuminized grape juice, 
 158 
 
 for albuminized orange juice, 
 158 
 
 for almond milk, 153 
 
 for apple water, 158 
 
 for baked lentils, 151 
 
 for chestnut piirfie, 150 
 
 for currant water, 158 
 
 for drinks, 157 
 
 for egg lemonade, 158 
 
 for egg timbales, 156 
 
 for grape juice and egg,' 
 159 
 
 for grape water, 158 
 
 for gruels, 156 
 
 for jelly and ice, 157 
 
 for legume purees, 157 
 
 for lentil toast, 151 
 
 for nest eggs, 154 
 
 for nut, date, and bran muf- 
 fins, 154 
 
 for oatmeal cookies, 156 
 
 for oatmeal toast, 152 
 
 for souffled eggs, 156 
 
 for soy bean cookery, 152 
 
 for soy bean croquettes, 151 
 
 for steamed eggs, 156 
 
 for strawberry whip, 158 
 Resinous cathartics, 173 
 Rhubarb, 73 
 
 Rice, as substitute for potato, 
 154, 155 
 
 unpolished, 155 
 Rickets, deficiency of phosphorus 
 in etiology of, 140 
 
 due to lack of vitamines, etc., 
 137 
 
 etiology of, 138, 139 
 Rochelle salts, 173 
 
 Saccharose, 7 
 Salines, 173, 174 
 Salt, as an emetic, 176 
 Salt in food, excessive use of, 
 166 
 
 value of, 165 
 Scarlet fever, diet in, 86 
 Scurvy, classification of, 143 
 
 due to lack of vitamines, etc., 
 137 
 
 etiology of, 141 
 
 lack of calcium in, 143 
 Serine, 3 
 
 Sodium requirements in body, 25 
 Sorbose, 7 
 Sorghum, 70 
 
 Souffled eggs, recipe for, 156 
 Soy bean, chemical composition 
 of, 153 
 
 cookery, 152 
 
 croquettes, recipe for, 151 
 Spinach, 73 
 Starches, 8 
 
 cooking of, 129 
 
 effect of heat on, 20 
 Steamed eggs, recipe for, 156 
 Steaming, 27 
 Sterilized milk, 102 
 
 advantages of, 103 
 
 chemical changes in, 102 
 
 compared with raw milk, 
 111 
 
 digestion of, 110 
 
 disadvantages of, 103 
 Stewing, 27 
 Stomach, dilatation of, diet in, 
 
 79 
 Stools, carbohydrate, 113 
 
 of infants, 114 
 Strawberry whip, recipe for, 158 
 Streptococci in milk, 61 
 Sugar, and see Cane sugar 
 
 cane, 7, 69 
 
 fruit, 7 
 
 grape, 7 
 
 indigestion from, in infants, 
 114 
 
 malt, 8 
 
 milk, 8 
 
INDEX 
 
 185 
 
 Tannic acid, 71, 72, 73 
 Tannin, effects of, 68 
 Tea, composition of, 72 
 
 effects of, 68 
 Tetrasaccharides, 8 
 Timbales, egg, leeipe for, 156 
 Tissue builders, 4 
 Tobacco, effects of, 69 
 Top milk, use of for infants, 
 
 121 
 Trehalose, 8 
 Trisaecharides, 8 
 Tryptophaae, 3 
 Tuberculosis, diet in, 86 
 Typhoid fever, diet in, 86 
 Tyrosine, 3 
 
 Ulcer, gastric, diet in, 78 
 Unpolished rice, 155 
 Urticaria, diet in, 87 
 
 Valine, 3 
 
 Value of foods, ealorifle, 11 
 
 to calculate, 12 
 Vegetable protein, 4 
 
 absorption of, 4 
 Vegetables, calcium in, 37 
 
 composition of, 45 
 
 cooking of, 26 
 
 iron in, 37 
 
 organic acids in, 11 
 Vegetarian diet, 39 
 
 objections to, 41 
 
 versus meat or mixed diet, 29 
 Vitamines, 136 
 
 A, low in potato, 155 
 A and B in bran, 174 
 antibodies, relation to, 40 
 antineuritic, 141 
 antirachitic, 138 
 antiscorbutic, 141 
 auto-intoxication, relation to, 
 
 52 
 
 B, in yeast, 160 
 
 B, low in milk, 161 
 
 Vitamines, chlorophyll, associa- 
 tion with A, 72 
 D, 146 
 
 dental caries and, 146 
 diabetes, may influence, 89 
 diseases due to lack of, 
 
 137 
 fat-soluble A, 137, 138 
 
 foods iu which found, 138 
 foods lacking in, 137 
 in cooking, destroyed or lost, 
 
 24 
 in cooking, vegetables, etc., 28 
 pyorrhea and, 146 
 in mixed diet, 12 
 in pasteurization, partly de- 
 stroyed, 104 
 necessary for growth and 
 
 health, 16 
 removed in milling, 44 
 water-soluble B, 137, 141 
 
 foods in which found, 141 
 water-soluble, C, 137, 141 
 aging of, 142 
 effect of heat on, 142 
 foods in which found, 142 
 
 Water, 10 
 
 when to drink, 70 
 
 Weight of infant, gain in dur- 
 ing first year, 122 
 
 Wheat water, in infant foods, 
 116 
 
 Whooping cough, diet in, 86 
 
 Xerophthalmia, due to lack of 
 vitamines, etc., 137, 139 
 
 Yeast, brewers', 161 
 
 composition of, 160 
 
 grape, 161 
 Yeast cure, 159, 160, 162 
 
 Zein, amino-acids in, 3 
 
DATE DUE