tfd?te3 6fco COLUMBIA UNIVERSITY EDWARD G. JANEWAY MEMORIAL LIBRARY THE STARVATION TREATMENT OF DIABETES With a Series of Graduated Diets as u8ed at the MASSACHUSETTS GENERAL HOSPITAL BY LEWIS WEBB HILL, M.D. AND REN A S. ECKMAN (dietitian) With an Introduction by RICHARD C. CABOT, M.D. Boston, Mass. W. M. LEONARD 1915 ( ' \1 ,2309 COPTEIGHTED, 1915, BY W. M. Leonard b b CONTENTS. Introduction, by Richard C. Cabot 5 Preface 7 Details op Treatment ......... 9 Examination op the Urine . . . ... . . . 15 Diets , . 19 Diet Lists 21 .lii. H <£Z Digitized by the Internet Archive in 2010 with funding from Open Knowledge Commons http://www.archive.org/details/starvationtreatmOOhill INTRODUCTION. A LTHOUGH Dr. Allen's modifications of the /jk classical treatment of saccharine diabetes ■*■ ■*- have been in use only for about two years in the hands *of their author, and for a much shorter time in those of other physicians, it seems to me al- ready clearly proven that Dr. Allen has notably ad- vanced our ability to combat the disease. One of the difficulties which is likely to prevent the wide adoption of his treatment is the detailed knowl- edge of food composition and calory value which it requires. Dr. Hill's little book should afford sub- stantial aid to all who have not had opportunity of working out in detail the progressive series of diets which should be used after the starvation period. These diets, worked out by Miss Eckman, head of the diet kitchen at the Massachusetts General Hospital, have seemed to me to work admirably with the patients who have taken them, both in hos- pital and private practice. The use of thrice boiled vegetables, as recommended by Dr. Allen, seems to be a substantial step in advance, giving as it does a considerable bulk of food without any considerable carbohydrate portion, and with the semblance of some of the forbidden vegetables. It is of course too early to say how far reaching and how permanent the effects of such a diet will be in the severe and in the milder cases of diabetes. All we can say is that thus far it appears to work admir- ably well. To all who wish to give their patients the benefit of this treatment I can heartily recommend this book. Richard C. Cabot. PREFACE. THE purpose of this little book is to furnish to the general practitioner in compact form the details of the latest and most successful treat- ment of diabetes mellitus. The "starvation treatment" of diabetes, as ad- vanced by Dr. Frederick M. Allen of the Rockefeller Institute Hospital, is undoubtedly a most valuable treatment. At the Massachusetts General Hospital it has been used for several months with great suc- cess, and it is thought worth while to publish some of the diets, and details of treatment that have been used there, as a very careful control of the proteid and carbohydrate intake is of the utmost importance if the treatment is to be successful. In carrying out the Allen treatment the physician must think in grams of carbohydrate and proteid — it is not enough simply to cut down the supply of starchy foods; he must know approximately how much carbohydrate and proteid his patient is getting each day. It is not easy for a busy practitioner to figure out these dietary values, and for this reason the calculated series of diets given here may be of service. The various tests for sugar, acetone, etc., can, of course, be found in any good text-book of chemistry, but it is thought worth while to include them here for the sake of com- pleteness and ready reference. The food table covers most of the ordinary foods. We wish to thank Dr. Roger I. Lee and Dr. Wil- liam H. Smith, visiting physicians, for many helpful suggestions. DETAILS OF TREATMENT. The details of the treatment of diabetes as carried out at the Massachusetts General Hospital, are as follows : — For forty-eight hours after admission to the hos- pital the patient is kept on ordinary diet, to deter- mine the severity of his diabetes. Then he is put to bed, and no food allowed save whiskey and black coffee. The water intake need not be restricted. The whiskey is given in the coffee: 1 ounce of whiskey every two hours, from 7 a.m. until 7 p.m. This fur- nishes roughly about 800 calories. Soda bicarbonate may be given, two drachms every 3 hours, if there is much evidence of acidosis, as indicated by strong ace- tone and diacetic reactions in the urine, or a strong acetone odor to the breath. In most oases, however, this is not at all necessary, and there is no danger of producing coma by the starvation. This is indeed the most important point that Dr. Allen has brought out in his treatment. The patient is kept in bed and starved until he is sugar-free. (The daily weight and daily urine examinations are, of course, recorded.) The disappearance of the sugar is rapid : if there has been 5 or 6 per cent, after the first starvation day it goes down to perhaps 2 per cent., and the next day the patient may be entirely sugar-free, or perhaps have 2 or 3 per cent, of sugar. Occasionally it may take longer ; the longest we have starved any patient is four days. The patients tolerate starvation 10 STARVATION TKEATMENT remarkably well; in no cases have we seen any bad results from it. There may be a slight loss of weight, perhaps three or four pounds, but this is of no mo- ment, and indeed, Allen says that a moderate loss of weight in most diabetics is to be desired. A moder- ately obese patient, weighing say about 180 pounds, may continue to excrete a small amount of sugar for a considerable period, if he holds this weight, even if he is taking very little carbohydrate; whereas, if his weight can be reduced to 170 or 160, he can be kept sugar-free, with ease, on the same diet. We have not found that the acetone and diacetic acid output be- haves in any constant manner during starvation; in some cases we have seen the acetone bodies disappear during starvation; in others we have seen them ap- pear when they were not present before. Their ap- pearance is not necessarily a cause for alarm. The estimation of the ammonia in the urine is of some value in determining the amount of acidosis present, and this can be done readily by the simple chemical method given below. If the 24 hourly ammonia out- put reaches over 3 or 4 grams, it means that there is a good deal of acidosis — anything below this is not remarkable. When the patient is sugar-free he is allowed up and is put upon a diet of so-called "5% vegetables,'' i.e. vegetables containing approximately 5% carbo- hydrate. These vegetables must be thrice boiled, with changes of water. In this way their carbohydrate content is reduced, probably about one-half. A mod- erate amount of fat, in the form of butter, can be OF DIABETES 11 given with this vegetable diet if desired. The amount of carbohydrate in these green vegetables is not at all inconsiderable, and if the patient eats as much as he desires, it is possible for him to have an intake of 25 or 30 grams, which is altogether too much; the first day after starvation the carbohydrate intake should not be over 15 grams. Tables No. 1 and 2 rep- resent these vegetable diets. The patient is usually kept on diet 1 or 2 for one day, or if the case is a particularly severe one, for two days. The day after the vegetable day, the proteid and fat are raised, the carbohydrate being left at the same figure (diets 2, 3 and 4). No absolute rule can be laid down for the length of time for a patient to remain on one diet, but in general we do not give the very low diets such as 2, 3 and 4, for more than a day or two at a time. The diet should be raised very gradually, and it is well not to raise the proteid and carbohydrate at the same time, for it is important to know which of the two is causing the more trouble. The proteid intake may perhaps be raised more rapidly than the carbo- hydrate, but an excess of proteid is very important in causing glycosuria, and for this reason the proteid intake must be watched as carefully as the carbo- hydrate. This is one of the important points brought out in Allen's treatment. The fat may soon be raised to 200 grams ; higher than this we do not generally go. If sugar appears in the urine during the process of raising the diet we drop back to a lower diet, and if this is unavailing, start another starvation day, and raise the diet more slowly. But it will be found if the diet is raised very slowly, sugar will not appear. 12 STAKVATION TEEATIENT It is not well to push the average case ; if the patient is taking a fair diet, say proteid 50, carbohydrate 50, and fat 200, and is doing well, without any glyco- suria, it is not desirable to raise the diet any further. The caloric intake may seem rather low in some of these diets, but it is surprising how well most patients do on 1800 or 2000 calories, and how little weight they lose. If it is desired to raise the caloric value of the diet, fat can be added in the form of cream, bacon or butter. It will be seen that the treatment can be divided into three stages: — (1) The stage of starvation, when the patient is becoming sugar-free. (2) The stage of gradually working up the diet to the limit of tolerance. During the first two stages a daily weight record should be kept, and the urine should be examined every day. In the case of an intelligent patient, he can be easily taught to test his own urine for sugar. (3) The stationary stage, when the diet is kept at a constant level. During this period the urine should be tested for sugar twice a week, and if sugar is pres- ent the patient should go back to a lower diet. If he cannot be made sugar-free by taking a lower diet, he should be starved again. If this treatment is to be successful, it is absolutely necessary for the patient to adhere very strictly to the diets, and to measure out everything very care- fully ; the meat especially should be weighed. It will be noticed in some cases the calories in the OF DIABETES 13 diets do not tally exactly with the proteid, fat and carbohydrate values. The reason for this is that for the sake of convenience the calories have been given in round numbers — 5 or 10 calories one way or the other makes no difference. The essential points brought out by Allen's treat- ment are as follows: — (1) It is not dangerous to starve a diabetic, and two or three days of starvation almost always make a patient sugar-free, thus saving a good deal of time, as contrasted with the old treatment of gradually cut- ting down the carbohydrate. (2) It is not desirable for all diabetics to hold their weight. Some cases may do much better if their weight is reduced ten, fifteen, or even twenty pounds. (3) After starvation, the diet must be raised very slowly, to prevent recurrence of glycosuria. (4) An excess of proteid must be regarded as pro- ducing glycosuria, and the proteid intake must be restricted a good deal more than has been the custom in treating diabetes. EXAMINATION OF THE URINE. Directions for Collecting Twenty-four Hour Urine. Pass the urine at 7 a.m. and throw it away. Save all the urine passed after this up to 7 a.m. the next day. Pass the urine exactly at 7 a.m., and add it to what has previously been passed. Qualitative Sugar Tests. (1) Fehling's Test : — Boil about 4 c.c. of Fehling's* solution in a test tube, and add to the hot Fehling's an equal amount of urine, a few drops at a time, boil- ing after each addition. A yellow or red precipitate indicates sugar. For practical purposes in the following of a diabetic's daily urine, this is a valuable test, and the one which we always use. (2) Benedict's Test:— To 5 c.c. of Benedict 'sf re- agent add 8 drops of the urine to be examined. The fluid is boiled from 1 to 2 minutes and then allowed to cool of itself. If dextrose is present there results * Fehling's solution is prepared as follows : (a) Copper sulphate solution: 34.65 gm. of copper sulphate dissolved in water and made up to 500 c.c. (b) Alkaline tartrate solution: 125 gm. of potassium hydroxide and 173 gm. of Rochelle salt dissolved in water and made up to 500 c.c. These solutions are kept in separate bottles and mixed in equal volumes when ready for use. f Benedict's solution has the following composition: Copper sulphate, 17.3 gm. Sodium citrate, 173.0 gm. Sodium carbonate (anhydrous), 100 gm. Distilled water to 1000 c.c. 16 STARVATION TREATMENT a red, yellow, or green precipitate, depending upon the amount of sugar present. If no sugar is present the solution may remain perfectly clear or he slightly turhid, due to precipitated urates. This is a more delicate test than Fehling's. Quantitative Sugar Tests. (1) The Fermentation Test: — The fermentation test is the simplest quantitative test for sugar, and is quite accurate enough for clinical work. It is per- formed as follows: The specific gravity of the 24° urine is taken, and 100 c.c. of it put into a flask, and a quarter of a yeast cake crumbled up and added to it. The flask is then put in a warm place (at about body temperature) and allowed to remain over night. The next morning a sample of the fermented urine is tested for sugar. If no sugar is present the urine is made up to 100 c.c. (to allow for the water that has evaporated) and the specific gravity taken again. The number of points loss in specific gravity is multi- plied by .23, and this gives the percentage of sugar in the urine. (2) Benedict's Test: — The best quantitative test for dextrose (excepting polaroscopic examination, which is too complicated for ordinary work) is Bene- dict's test. It is performed as follows : Measure with a pipette 25 c.c. of Benedict's solution into a porcelain dish, add 5 or 10 gm. (approximately) of solid sodic car- bonate, heat to boiling, and while boiling, run in the urine until a white precipitate forms. OF DIABETES 17 Then add the urine more slowly until the last trace of blue disappears. The urine should be diluted so that not less than 10 c.c. will be required to give the amount of sugar which the 25 c.c. of reagent is cap- able of oxidizing. Calculation : 5, divided by the number of c.c. of urine run in, equals the per cent, of sugar. Benedict's quantitative solution is prepared as follows: Dissolve 9.0 gm. of copper sulphate in 100 c.c. distilled water. (The copper sulphate must be weighed very accurately.) Dissolve 50 gm. anhy- drous sodic carbonate, 100 gm. sodic citrate, and 65 gm. of potassium sulpho cyanate in 250 c.c. of dis- tilled water. Pour the copper solution slowly into the alkaline citrate solution. Then pour the mixed solution into the flask without loss, and make up to 500 c.c. ; 25 c.c. of this solution is reduced by 50 mgm. of dextrose, 52 mgm. of levulose or 67 mgm. of lactose. (3) Acetone Test: — To 5 c.c. of urine in a test tube add a crystal of sodium nitro prusside. Acidify with glacial acetic acid, shake a moment, and then make alkaline with ammonium hydrate. A purple color indicates acetone. (4) Diacetic Acid Test: — To 5 c.c. of urine in a test tube add an excess of a 10%> solution of Ferric chloride. A Burgundy red color indicates diacetic acid. Quantitative Test for Ammonia. To 25 c.c. of urine add 5 c.c. of a saturated solu- 18 STARVATION TEEATMENT tion of potassium oxalate and 2 to 3 drops of phe- nolphthalein. Bun in from a burette deeinormal sodic hydrate, to a faint pink color. Then add 5 c.e. of formalin (40% commercial) and again titrate to the same color. Each c.c. of the deeinormal alkali used in this last titration equals 1 c.c. of n/10 ammonia, or .0017 gm. of ammonia. Multiply this by the number of c.c. n/10 sodic hydrate used in the last titration; this gives the number of grams of ammonia in 25 c.c. urine. Note: — The potassium oxalate and the formalin must both be neutral to phenolphthalein. DIETS. In the following diets the vegetables listed, except- ing lettuce, cucumbers, celery, and raw tomatoes, are boiled. In the very low carbohydrate lists they are thrice boiled. When possible to obtain the figures, the analyses for boiled vegetables have been used in computation. As the allowance becomes more liberal the person preparing the diet will be able to vary the menu in many ways. Soups, ice cream, custards, salads, — all may be prepared from the articles mentioned. Sea- sonings of salt, pepper, paprika, also flavorings and vinegar are allowed. When the patient is compelled to remain on a very limited diet for a considerable length of time and becomes very hungry, the lists representing most bulk should be selected. In addition to this, bran cakes may be given, made by the rule as stated below. As each cake yields no carbohydrate and only about 18 calories from the protein and fat, the patient may take 6 or 8 in one day or even more. BRAN CAKES. 2 cups bran 2 tablespoons melted butter 2 whole eggs 1 egg white y 2 grain saccharine — salt 20 STARVATION TREATMENT Tie bran in a piece of cheese cloth and wash by squeezing water through and through. Wring dry. Dissolve saccharine in 1 teaspoon water. Mix bran, beaten eggs, saccharine and salt. Beat remaining egg white stiff and fold in at the last. Shape with knife and tablespoon into twenty-five small cakes. Bake until golden brown. DIET LISTS. Abbreviations used in diet lists : tbsp. = tablespoon, h. = heaping. TABLE I. Protein, 10 grams Fat 7 grams Carbohydrate, 15 grams Calories, 200. Breakfast. String beans (canned).. 120 grams. . . 4 h. tbsp. Asparagus (canned) . . .150 grams. . . 4 h. tbsp. Tea or coffee. Dinner. Carrots (cooked) 70 grams. . . 2 h. tbsp. Spinach (cooked) 135 grams. . . 3 h. tbsp. Tea or coffee. Supper. Cucumbers 75 grams. . .12 slices. Celery 100 grams ... 6 pieces. about 6 in. long. Tea or coffee. 22 STARVATION TREATMENT TABLE II. Protein, 7 grams Fat, 6 grams Carbohydrate, 15 grams Calories, 150 Breakfast. Asparagus (canned).. . . 75 grams. . . 2 h. tbsp. (chopped). Cabbage 65 grams ... 2 h. tbsp. Tea or coffee. Dinner. Onions (cooked.) 100 grams. . . 2 h. tbsp. Celery (raw) 50 grams. . . 3 pieces about 6 in. long. Tea or coffee. Supper. Spinach 100 grams. . . 2 h. tbsp. Celery 50 grams ... 3 pieces 6 in. long. Tea or coffee. OF DIABETES 23 TABLE III. Protein, 27 grams Fat, 140 grams Carbohydrate, 15 grams Calories, 1470 Breakfast. Bacon (raw). String beans.. Coffee. Butter. Cream. , 50 grams, .100 grams 3 slices 6 in. long. 3 h. tbsp. Dinner. Chicken 20 grams. Turnips 100 grams. Cabbage 100 grams . Butter. Cream. Tea. Supper. Egg 1 Turnips 100 grams. Spinach 100 grams. Butter. Cream. Tea. Allow during day: Butter 30 grams . Cream, 40% 7 ounces. 1 small slice. iy 2 h. tbsp. ,3 h. tbsp. li/2 h. tbsp. 2 h. tbsp. 3 squares. 14 tbsp. 24 STARVATION TREATMENT TABLE IV. Protein, 26 grams Fat, 149 grams Carbohydrate, 17 grams Calories, 1560 Breakfast. Egg 1 Asparagus 100 grams ... 2 h. tbsp. Carrots 100 grams. . . 3 h. tbsp. Cream. Butter. Coffee. Dinner. Chicken 25 grams. Bacon (raw) 25 grams. Cauliflower 100 grams. Turnips 140 grams. Cream. Butter. Tea. 1 very small slice. 2 slices. 2 h. tbsp. 2 h. tbsp. Supper. Salt pork (raw)... 50 grams Cabbage String beans... Butter. Cream. Tea. 100 grams 100 grams, 3 slices about 6 in. long. 3 h. tbsp. 3 h. tbsp. Allow during day: Butter 35 grams . Cream, 40% 5 ounces. 3% squares. 10 tbsp. OF DIABETES 25 TABLE V. Protein, 26 grams Fat, 151 grams Carbohydrate, 17 grams Calories, 1580 Breakfast. Bacon (raw) 50 grams. . . 3 slices about 6 in. long. Parsnips 100 grams. . . 4 slices. Coffee. Butter. Cream. Dinner. Chicken 35 grams. . . 1 small slice. String beans 100 grams ... 3 h. tbsp. Cabbage 100 grams. . . 3 h. tbsp. Butter. Cream. Tea. Supper. Parsnips 100 grams. . . 4 slices. Cauliflower 120 grams... 2 h. tbsp. Spinach 100 grams. . . 3 h. tbsp. Butter. Cream. Tea. Allow during day: Butter 50 grams. . . 5 squares. Cream, 40% 7 ounces. . .14 tbsp. 26 STAKVATION TEEATMENT TABLE VI. Protein, 35 grams Fat, 175 grams Carbohydrate, 15 grams Calories, 1840 Breakfast. Bacon (raw) 50 grams. . . 3 slices about 6 in. long. Parsnips 200 gr^ms ... 8 slices or 2 h. tbsp. Butter. Cream. Coffee. Dinner. Chicken 70 grams. . . 1 moderate slice. Cauliflower 120 grams. . . 2 h. tbsp. Cabbage 100 grams ... 3 h. tbsp. Butter. Cream. Tea. Supper. String beans 100 grams. . . 3 h. tbsp. Spinach 100 grams. . . 2 h. tbsp. Butter. Cream. Tea. Allow during day: Butter 75 grams . . . 7% squares. Cream, 40% 7 ounces. . .14 tbsp. OF DIABETES 27 TABLE VII. Protein, 35 grams Fat, 175 grams Carbohydrate, 15 grams Calories, 1860 Breakfast. Bacon 100 grams . . Asparagus 100 grams . . Cream. Butter. Coffee. Dinner. Steak 100 grams. . Carrots 100 grams . . Cream. Butter. Tea. Supper. Lettuce 20 grams . . Cucumbers 100 grams, Celery 50 grams . Cream. Butter. Tea. 6 slices 6 in. long. 2 h. tbsp. 1 slice, 4 oz. 3 h. tbsp. . 3 medium leaves. .16 thin slices. . 4 stalks 6 in. lom Allow during day: Butter 65 grams . . . 6% squares. Cream, 40% 5 ounces. . .10 tbsp. 28 STARVATION TREATMENT TABLE VIII. Protein, 35 grams Fat, 147 grams Carbohydrate, 17 grams Calories, 1560 Breakfast. Bacon (raw) 50 grams. . . 3 slices about 6 in. long. Asparagus 100 grams. . . 2 h. tbsp. or stalks 4 in. long (canned). Parsnips 100 grams ... 4 slices. Butter. Cream. Dinner. Steak (raw) 100 grams. . . 1 slice. Turnips (cooked) .140 grams... 2 h. tbsp. Parsnips 100 grams ... 4 slices. Cabbage 100 grams ... 3 h. tbsp. Butter. Tea. Cream. Supper. Spinach (cooked). 100 grams... 2 h. tbsp. String beans " 100 grams... 3 h. tbsp. Cauliflower " 120 grams... 2 h. tbsp. Butter. Tea. Cream. Allow during day: Butter 50 grams ... 5 squares. Cream, 40% 5 ounces. . . 10 tbsp. OF DIABETES 29 TABLE IX. Protein, 40 grams Fat, 152 grams Carbohydrate, 16 grams Calories, 1640 Breakfast. Egg 1 Asparagus 100 grams ... 2 h. tbsp. or 9 stalks 4 in. long (canned). Parsnips 100 grams. . . 4 slices. Butter. Coffee. Cream. Dinner. Steak 100 grams ... 1 slice. Turnips 140 grams. . . 2 h. tbsp. Parsnips 100 grams ... 4 slices. Cabbage 100 grams. . . 3 h. tbsp. Butter. Cream. Tea. Supper. Bacon (raw) 50 grams. . . 3 slices about 6 in. long. Spinach (cooked). 100 grams. . . 2 h. tbsp. String beans (canned) 100 grams. . . 3 h. tbsp. Cauliflower 100 grams. . . 2 h. tbsp. Butter. Cream. Tea. Allow during day: Butter 50 grams ... 5 squares. Cream, 40% 5 ounces... 10 tbsp. 30 STAKVATION TEEATMENT TABLE. X. Protein, 50 grams Fat, 164 grams Carbohydrate, 15 grams Calories, 1790 Breakfast. Bacon 50 grams. . . 3 slices 6 in. long. Egg 1 String beans (canned) 100 grams. . . 3 h. tbsp. Butter. Cream. Coffee. Dinner. Chop 100 grams ... 1 chop. Cabbage (cooked). 100 grams. . . 3 h. tbsp. Cucumbers 100 grams. . .16 slices, thin. Tea. Butter. Cream. Supper. Egg 1 Asparagus (canned) 100 grams. . . 2 h. tbsp. Cauliflower (cooked) .. 100 grams. . . 2 h. tbsp. Butter. Cream. Tea. ! Allow during day: Butter 50 grams ... 5 squares. Cream, 40% 5 ounces.. .10 tbsp. OF DIABETES 31 TABLE XL Protein, 60 grams Fat, 151 grams Carbohydrate, 15 grams Calories, 1780 Breakfast. Bacon (raw) 50 grams. . . 3 slices 6 in. long. Eggs 2 Spinach (cooked) .100 grams. . . 2 h. tbsp. Butter. Cream. Coffee. Dinner. Steak 100 grams ... 1 slice. Tomatoes (canned) 100 grams... 2y 2 h. tbsp. Butter. Cream. Tea. Supper. Chicken (cooked). 50 grams... 1 small slice. Lettuce 20 grams. . . 3 leaves. Celery 100 grams. . . 8 stalks 6 in. long. Butter. Cream. Tea. Allow during day: Butter 50 grams ... 5 squares. Cream, 40% 5 ounces.. .10 tbsp. 32 STARVATION TREATMENT TABLE XII. Protein, 38 grams Fat, 187 grams Carbohydrate, 20 grams Calories 2070 Breakfast. Bacon 30 grams ... 2 slices 6 in. long. Egg 1 Spinach 100 grams. . . 2 h. tbsp. Coffee. Butter. Cream. Dinner. Steak 50 grams . . Salt pork 65 grams . . Cabbage 100 grams. . Onions 100 grams. . Butter. Cream. Tea. 1 very small slice. 4 slices. 3 h. tbsp. 3 h. tbsp. Supper. Beef balls 40 grams. . . =1 1/3 oz. Celery salad 100 grams ... 8 slices 6 in. long. Olive oil 26 grams. . . 2 tbsp. Tomatoes 100 grams. . . 2y 2 tbsp. Allow during day: Butter 50 grams ... 5 squares. Cream, 40% 5 ounces. ..10 tbsp. OF DIABETES 33 TABLE XIII. Proteid, 35 grams Fat, 100 grams Carbohydrate, 16 grams Calories 1135 Breakfast. Egg 1 Cabbage 100 grams ... 3 h. tbsp. Tomatoes 100 grams. . . 2y 2 h. tbsp. Butter. Coffee. Cream. Dinner. Steak 80 grams . Spinach 100 grams . Turnips ;140 grams. Egg, white 1 Butter. Cream. Tea. 1 slice. 2 h. tbsp. 2 h. tbsp. Supper. Cauliflower 120 grams. . . 2 h. tbsp. Onions , .100 grams. . . 2 h. tbsp. Lettuce 10 grams ... 2 leaves. Olive oil 13 grams. . . 1 tbsp. Tea. Butter. Cream. Allow during day: Butter 25 grams . . . 2% squares. Cream, 40% 3 ounces. . . 6 tbsp. 34 STAKVATION TEEATMENT TABLE XIV. Protein, 40 grams Fat, 200 grams Carbohydrate, 21 grams Calories 2110 Breakfast. Bacon 50 grams . . Cauliflower ....... 120 grams . . Butter. Cream. Coffee. Dinner. Squab 1 Carrots 100 grams. . Tomatoes 100 grams . . Olive oil 25 grams. . Butter. Cream. Tea. Supper. Turnips 140 grams . . Asparagus 100 grams. . Celery 100 grams . . Butter. Cream. Tea. 3 slices 6 in. long. 2 h. tbsp. 2 h. tbsp. 2 h. tbsp. 2 tbsp. (scant) 2 h. tbsp. 2 h. tbsp. 8 stalks 6 in. long. Allow during day: Butter 50 grams. . . 5 squares. Cream, 40% 7 ounces. . . 14 tbsp. OF DIABETES 35 TABLE XV. Protein, 40 grams Fat, 200 grams Carbohydrate, 20 grams Calories 2125 Breakfast. Bacon 30 grams. . . 2 slices 6 in. long. Egg 1 Spinach 200 grams. . . 4 h. tbsp. Cream. Butter. Dinner. Steak 50 grams . . Cabbage 100 grams . . Tomatoes 100 grams . . Onions 100 grams. . Butter. Cream. Tea. Supper. Salt pork 65 grams . . Scraped beef 40 grams . . , Celery 100 grams . . Olive oil 26 grams. . Cream. Butter. Tea. 1 small slice. 3 h. tbsp. 2 h. tbsp. 2 h. tbsp. 4 slices. 1 1/3 oz. 8 stalks 6 in. long. 2 tbsp. Allow during day: Butter 55 grams . . . 5y 2 squares. Cream, 40% 5 ounces.. .10 tbsp. 36 STARVATION TREATMENT TABLE XVI. Protein, 39 grams Fat, 199 grams Carbohydrate, 22 grams Calories, 2100 Breakfast. Egg 1 Asparagus 100 grams. Butter. Cream. Coffee. . 2 h. tbsp. Dinner. Chop 100 grams. . Peas 50 grams. . Celery 50 grams. . Olive oil 32 grams . . Butter. Cream. Tea. 1 medium. 1 h. tbsp. 4 stalks 6 in. long. 2i/ 2 tbsp. ( Supper. Cauliflower... . String beans... Mayonnaise. . . Butter. Cream. Tea. .120 grams. .100 grams . 21 grams 2 h. tbsp. 2 h. tbsp. 1 tbsp. Allow during day: Butter 50 grams ... 5 squares. Cream, 40%..... 6 ounces.. .12 tbsp. OF DIABETES 37 TABLE XVII. Protein, 39 grams Fat, 206 grams Carbohydrate, 29 grams Calories, 2195 Breakfast. Bacon Peas (canned) Butter. Cream. Coffee. 50 grams 75 grams. 3 slices. 2% h. tbsp. Dinner. Broth — 6 ounces with vegetables : Cabbage 25 grams. . . 2 teasp. Tomatoes 25 grams ... 2 teasp. Turnips 25 grams. . . 2 teasp. Celery 50 grams. Steak 100 grams ... 1 small slice. Squash 50 grams. . . 1 h. tbsp. Tomatoes 75 grams . . . 2y 2 h. tbsp. Butter. Cream. Tea. Supper. Turnips 175 grams. Celery 100 grams . Olive oil 21 grams. Salt pork (raw) ... 50 grams . Allow during day: Butter 50 grams . Cream, 40% 5 ounces. 2i/ 2 h. tbsp. 8 stalks 6 in. long. iy 2 tbsp. 3 slices about 6 in. long. 5 squares. 10 tbsp. 38 STARVATION TREATMENT TABLE XVIII. Protein, 40 grams Fat, 178 grams Carbohydrate, 29 grams Calories, 1940 Breakfast. Bacon 50 grams ... 3 slices about 6 in. long. Egg 1 Parsnips 100 grams ... 4 slices. Butter. Cream. Coffee. Dinner. Chicken 50 grams. . . 1 small slice. Cabbage 100 grams. . . 3 h. tbsp. Asparagus 100 grams ... 2 h. tbsp. Cauliflower 120 grams. . . 2 h. tbsp. Butter. Cream. Tea. Supper. Salt pork 100 grams ... 6 slices about 6 in. long. Parsnips 100 grams ... 4 slices. Turnips 140 grams. . . 2 h. tbsp. String beans 100 grams. . . 3 h. tbsp. Bread 25 grams. . . 1 slice, 3x3x% in. Butter. Cream. Tea. Allow during day: Butter 40 grams ... 4 squares. Cream, 40% 6 ounces. . .12 tbsp. OF DIABETES 39 TABLE XIX. Protein, 42 grams Fat, 206 grams Carbohydrate, 36 grams Calories 2230 Breakfast/ Bacon 50 grams ... 3 slices about 6 in. long. Peas 75 grams. . . 2 h. tbsp. Tomatoes 100 grams. ..3b. tbsp. Butter. Cream. Coffee. Dinner. Broth — chicken, lamb or beef . Steak 100 grams , Turnips 200 grams Celery 150 grams Olive oil 21 grams . Butter. Cream. Tea. 6 ounces. 1 slice. 3 h. tbsp. 12 stalks 6 in. long Supper. Salt pork ( raw ) . . .100 grams Squash 50 grams . Beets 100 grams . Cabbage 25 grams Butter. Cream. Tea. 6 slices about 6 in. long. 1 h. tbsp. 3 h. tbsp. 1 h. tbsp. Allow during day: Butter 50 grams ... 5 squares. Cream, 40% 5 ounces. . .10 tbsp. 40 STARVATION TREATMENT TABLE XX. Protein, 43 grams Fat, 201 grams Carbohydrate, 36 grams Calories 2080 Breakfast. Bacon (raw) 50 grams, Parsnips 100 grams . Potatoes (boiled) Butter. Cream. Coffee. 50 grams 4 slices 6 in. long. 4 slices or 2 h. tbsp. 1 very small one. Dinner. Broth 6 ounces. Squab 1 Cabbage 100 grams . Celery 100 grams . Butter. Cream. Tea. Supper. Salt pork (raw) ... 50 grams. Cucumbers 100 grams . Parsnips 100 grams . Cauliflower 120 grams . Milk 4 ounces. Butter. Cream. Tea. Allow during day: Butter 50 grams. Cream, 40% 7 ounces. 3 h. tbsp. 8 stalks about 6 in. long. 3 slices 6 in 16 slices. 4 slices. 2 h. tbsp. % glass. long. 5 squares. 14 tbsp. OF DIABETES 41 TABLE XXI. Protein, 50 grams Fat, 200 grams Carbohydrate, 35 grams Calories, 2195 Breakfast. Orange 100 grams . . Bacon 100 grams . . Spinach 100 grams. . Butter. Cream. Coffee. Dinner. Broth 180 c.c Steak 100 grams . . Parsnips 100 grams . . Carrots 100 grams. . Butter. Cream. Tea. 1 small. 6 slices, 6 in. long. 2 h. tbsp. 1 glass or cup. 1 slice, medium. 4 slices=2 h. tbsp. 2 h. tbsp. Supper. Egg 1 Lettuce 25 grams . Olive oil 21 grams . Cream. Tea. Butter. Bread. Allow during day: Butter 50 grams. Cream, 40% 7 ounces. Bread 20 grams . 3 leaves. 1 tbsp. 5 squares. 14 tbsp. , 1 very thin slice. 42 STAKVATION TKEATMENT TABLE XXII. Protein, 51 grains Fat, 201 grams Carbohydrate, 41 grams Calories, 2240 Breakfast. Bacon 50 grams. . . 3 slices 6 in. long. Bread 20 grams ... 1 slice, 3x3x% in. Spinach 100 grams. . . 2 h. tbsp. Butter. Cream. Coffee. Dinner. Broth 180 c.c 1 glass or cup. Steak 100 grams. . . 1 slice. Cabbage 100 grams. . . 3 h. tbsp. Olive oil 20 grams. . . V/ 2 tbsp. Lettuce 100 grams. . . 12 leaves. Butter. Cream. Tea. Supper. Egg 1 Onions 100 grams. . . 2 h. tbsp. Bread, 3x3x x /4 .... 15 grams ... 1 slice very thin. Milk 4 ounces. . . 8 tbsp. Butter. Cream. Tea. Allow during day: Butter 50 grams ... 5 squares. Cream, 40% 7 ounces.. .14 tbsp. OF DIABETES 43 TABLE XXIII. Protein, 61 grams Fat, 201 grams Carbohydrate, 30 grams Calories, 2240 Breakfast. Bacon 50 grams . Egg 1 Tomatoes 100 grams . Cream. Butter. Coffee. Dinner. Steak (raw) 100 grams. Salt pork (raw) . . . 100 grams . Turnips 420 grams . Cucumbers 100 grams . Onions 100 grams . Butter. Cream. Tea. Olive oil 21 grams . Supper. Chicken (cooked).. 50 grams. Lettuce 100 grams . Celery 100 grams . Spinach 100 grams. Butter. Tea. Cream. Allow during day: Butter 15 grams . Cream, 40% 6 ounces. 3 slices 6 in. long. 2y 2 h. tbsp. 1 slice — 4 oz. 8 small slices. 6 h. tbsp. 16 thin slices. 2 medium sized. 1% tbsp. , 1 small slice. 12 medium leaves 8 stalks 6 in. long . 2 h. tbsp. 1% squares. 12 tbsp. 44 STAEVATION TREATMENT TABLE XXIV. Protein, 63 grams Fat, 209 grams Carbohydrate, 31 grams Calories, 2325 Breakfast. Bacon 50 grams ... 5 slices. Peas 75 grams . . . 1% h. tbsp. Butter. Cream. Coffee. Dinner. Broth — 100 c.c. with vegetables : Cabbage 25 grams ... 1 h. teasp. Tomato 25 grams. . . 1 h. teasp. Turnip 25 grams. . . 1 h. teasp. Celery 50 grams. . . 2 h. teasp. Steak 100 grams ... 1 slice. Squash 50 grams ... 1 h. tbsp. Tomato 75 grams. . . 1% h- tbsp. Butter. Cream. Tea. Supper. Chicken 75 grams. . Turnips 175 grams. . Celery 100 grams . . Olive oil 21 grams . . Salt pork 50 grams . . Allow during day: Butter 50 grams. . Cream, 40% 5 ounces. . Olive oil 21 grams . . 1 slice. iy 2 h. tbsp. 8 stalks 6 in. long. iy 2 tbsp. 3 slices. 5 squares. 10 tbsp. iy 2 tbsp. OF DIABETES 45 TABLE XXV. Protein, 61 grams Fat, 201 grams Carbohydrate, 30 grams Calories, 2245 Breakfast. Bacon 50 grams ... 3 slices 6 in. long. Vgg. . 1 Turnips 140 grams ... 3 h. tbsp. Butter. Cream. Coffee. Dinner. Steak 100 grams . Celery 100 grams . Cucumbers 100 grams . Lettuce 100 grams . Spinach 100 grams. Olive oil 21 grams . Butter. Cream. Tea. . 1 slice. . 8 slices 6 in. long. .16 thin slices. .12 leaves. . 2 h. tbsp. . iy 2 tbsp. Supper. Chicken 50 grams. . Salt pork 100 grams . . Turnips 280 grams . . Onions 100 grams. . Tomatoes 100 grams . . Butter. Cream. > Tea. 1 small slice. 6 slices 6 in. long. 4 h. tbsp. 2 h. tbsp. 2 h. tbsp. Allow during day: Butter 50 grams. . . 5 squares. Cream, 40% 5 ounces. . .10 tbsp. 46 STAKVATION TKEATMENT TABLE XXVI. Protein, 61 grams Fat, 199 grams Carbohydrate, 31 grams Calories, 2230 Breakfast. Bacon 60 grams . . . Sy 2 slices, 6 in. long. Eggs 2 Turnips 140 grams ... 2 h. tbsp. Dinner. Steak 100 grams ... 1 slice. Spinach 50 grams. . . 1 h. tbsp. Parsnips 150 grams ... 6 slices. Onions 100 grams. . . 2 h. tbsp. Beets 50 grams ... 1 h. tbsp. Butter. Cream. Tea. Supper. Ham 50 grams ... 1 small slice. Lettuce 100 grams ... 12 leaves. String beans 50 grams ... 1 h. tbsp. Celery 100 grams. . . 8 stalks 6 in. long. Asparagus 50 grams ... 1 h. tbsp. Allow during day: Butter 40 grams. . . 4 squares. Cream, 40% 8 ounces.. .16 tbsp. OF DIABETES 47 TABLE XXVII. Protein, 43 grams Fat, 201 grams Carbohydrate, 36 grams Calories, 2190 Breakfast. Bacon 50 grams . . Parsnips 100 grams . . Potatoes (mashed) Butter. Cream. Coffee. Dinner. Broth 180 c.c Squab 100 grams . . Cabbage 100 grams . . Celery 100 grams . . Butter. Cream. Tea. 3 slices. 4 slices. 1 h. tbsp. 1 glass. 1 squab. 3 h. tbsp. 8 stalks 6 in. long. Supper. Salt pork 50 grams. String beans 100 grams. Cucumbers. ...... 100 grams . Oil 5 grams . Parsnips 100 grams . Cauliflower 120 grams . Milk 120 c.c Butter. Cream. Tea. Allow during day: Butter 50 grams . Cream, 40% 7 ounces. . 3 slices. . 2 h. tbsp. .16 slices, thin. . 1 teasp. . 4 slices. . 2 h. tbsp. y 2 glass. , 5 squares. 14 tbsp. 48 STARVATION TREATMENT TABLE XXVIII. Protein, 50 grams Fat, 200 grams Carbohydrate, 40 grams Calories, 2253 Breakfast. Bacon 50 grams ... 3 slices. Egg 1 Parsnips 100 grams ... 4 slices. Bread 35 grams ... 1 slice, Butter. 3x3%x% in. Cream. Coffee. Dinner. Broth 180 c.c 1 glass or cup. Chop 100 grams ... 1 Cauliflower 120 grams. . . 2 h. tbsp. Carrots 100 grams ... 2 h. tbsp. Butter. Cream. Tea. Supper. Lettuce 25 grams... 3 leaves. String beans 100 grams ... 2 h. tbsp. Peas 55 grams. . . 1 h. tbsp. Butter. Cream. Tea. Allow during day: Butter 50 grams ... 5 squares. Cream, 40% 7 ounces.. .14 tbsp. OF DIABETES 49 TABLE XXIX. Protein, 50 grams Fat, 194 grams Carbohydrate, 48 grams Calories, 2201 Breakfast. Orange 100 grams ... 1 small. Eggs 2 Bacon 50 grams. . . 3 slices, 6 in. long. Bread 10 grams. . . 1 slice, 2xlx% in. Butter. Cream. Coffee. Dinner. Steak 100 grams . Lettuce 100 grams . Spinach 100 grams . Butter. Cream. Tea. 1 slice. 12 leaves. 2 h. tbsp. Supper. Cold ham 50 grams . Asparagus.. 50 grams . Strings beans .... 100 grams . Bread 25 grams . Butter. Cream. Tea. 1 small slice. 1 h. tbsp. 2 h. tbsp. 1 slice, 3x3x% in. Allow during day: Butter 40 grams. . . 4 squares. Cream, 40% 8 ounces. . . 16 tbsp. 50 STARVATION TREATMENT TABLE XXX. Protein, 53 grams Fat, 169 grams Carbohydrate, 54 grams Calories, 2020 Breakfast. Orange 100 grams ... 1 small. Bacon 50 grams ... 3 slices 6 in. long. Egg 1 Bread 20 grams. . . 1 slice, 3x2x1/2 in. Butter. Cream. Coffee. Dinner. Boiled ham 100 grams ... 1 large slice. Brussels sprouts. . 100 grams ... 3 h. tbsp. Milk 6 ounces. . . 1 glass. Butter. Tea. Cream. Supper. Scotch broth 6 ounces. . . 1 glass. Lettuce 50 grams ... 6 leaves. Bread 20 grams. . . 1 slice, Sx2xy 2 in. Allow during day: Butter 70 grams ... 7 squares. Cream, 40% 4 ounces.. . 8 tbsp. OF DIABETES 51 TABLE XXXI. Protein, 52 grams Fat, 190 grams Carbohydrate, 50 grams Calories, 2190 Breakfast. Orange 100 grams ... 1 small. Bread 25 grams ... 1 slice, 3x2x% in. Egg 1 Bacon 50 grams ... 3 slices 6 in. long. Butter. Cream. Coffee. Dinner. Chop 100 grams ... 1 medium chop. Asparagus 100 grams ... 2 h. tbsp. Butter. Cream. Tea. Supper. Egg 1 Cucumbers 100 grams. . .16 slices (thin). Lettuce 10 grams. . . 3 leaves (small). Bread 25 grams ... 1 slice, 3x2x% in. Allow during day: Butter 50 grams ... 5 squares. Cream, 40% 8 ounces.. .16 tbsp. 52 STAKVATION TEEATMENT TABLE XXXII. Protein, 53 grams Fat, 190 grams Carbohydrate, 50 grams Calories, 2190 Breakfast. Baeon 60 grams . . . 3% slices. Orange 150 grams ... 1 medium. Egg , 1 Bread 20 grams ... 1 slice, 3x2x% in. Butter. Cream. Tea. Dinner. Steak String beans... Lettuce Butter. Cream. Tea. 50 grams ... 1 small slice. . 50 grams ... 1 h. tbsp. 100 grams ... 12 leaves. Supper. Ham 50 grams . . Asparagus 50 grams . . Spinach 50 grams . . Bread 15 grams . . Butter. Cream. Tea. 1 small slice. 1 h. tbsp. 1 h. tbsp. 1 slice, 3xlx% in. Allow during day : Butter 40 grams. . . 4 squares. Cream, 40% 8 ounces. - .16 tbsp. OF DIABETES 53 TABLE XXXIII. Protein, 101 grams Fat, 232 grains Carbohydrate, 51 grams Calories, 2780 Breakfast. Orange 50 grams . . . % orange. Steak 100 grams. . . 1 slice. Egg 1 Bread 20 grams ... 1 slice, 3x2x% in. Butter. Cream. Tea. Dinner. Lamb chop 180 grams. . . 2 small. Potato 50 grams ... 1 small. Turnip 140 grams ... 2 h. tbsp. Lettuce 10 grams. . . 2 leaves. Tomato (raw).. ..100 grams... 1 medium. Custard — made with one egg and part of the cream. Butter. Tea. Supper. Bacon 50 grams ... 3 slices 6 in. long. Eggs 2 Onions 50 grams. . . 1 h. tbsp. Cabbage 100 grams ... 3 h. tbsp. Bread 20 grams ... 1 slice, 3x2x% in. Butter. Cream. Tea. Allow during day: Butter 50 grams ... 5 squares. Cream, 40% 6 ounces.. .12 tbsp. 54 STARVATION TREATMENT TABLE XXXIV. Protein, 60 grams Fat, 200 grams Carbohydrate, 55 grams Calories, 2380 Breakfast. Orange 100 grams ... 1 small. Bacon 100 grams. . . 6 slices 6 in. long. Egg 1 Spinach 100 grams. . . 2 h. tbsp. Bread 25 grams ... 1 slice, 3x2x% in. Butter. Cream. Coffee. Dinner. Broth 180 c.c Steak 100 grams . . Parsnips 100 grams . . Carrots 100 grams . . Butter. Cream. Tea. 1 glass. 1 slice. 4 slices, 2 h. tbsp. 2 h. tbsp. Supper. Egg 1 Lettuce 25 grams . String beans 100 grams Bread 25 grams Butter. Cream. Tea. 3 leaves. 2 h. tbsp. 1 slice, 3x2xy 2 in. Allow during day: Butter 50 grams ... 5 squares. Cream, 40% 7 ounces.. .14 tbsp. OF DIABETES 55 TABLE XXXV. Protein, 60 grams Fat, 207 grams Carbohydrate, 54 grams Calories, 2400 Breakfast. ~®gg ! „ ■ Bacon 100 grams. . . 6 slices. Tomatoes 100 grams. . . 2 h. tbsp. Bread 35 grams. . . 1 slice, 3x3xy 2 in. Butter. Cream. Tea. Dinner. Broth 180 c.c Squab 100 grams Cabbage 100 grams. Onions 100 grams Butter. Cream. Tea. glass. 1 squab. 3 h. tbsp. 2 h. tbsp. Supper. Egg 1 Lettuce 25 grams. . . 3 leaves. Celery 100 grams. . . 8 stalks 6 in. long. Bread 30 grams. . . 1 slice, 3x3x% in. Allow during day: Butter 50 grams ... 5 squares. Cream, 40% 7 ounces. . .14 tbsp. 56 STARVATION TREATMENT TABLE XXXVI. Protein, 63 grams Fat, 210 grams Carbohydrate, 61 grams Calories, 2460 Breakfast. Grape fruit 100 grams ... % grape fruit. Bacon 100 grams ... 6 slices 6 in. long. Kgg. 1 Cauliflower 120 grams. . .2 h. tbsp. Bread 30 grams ... 1 slice, 3x3x1/2 i n - Butter. Cream. Coffee. Dinner. Broth 180 c.c Squab 100 grams . Carrots 100 grams . Lettuce 100 grams . Butter. Cream. Tea. 1 glass. 1 squab. 2 h. tbsp. 12 leaves. Supper. Egg 1 Asparagus 100 grams. . Spinach 100 grams . . Bread 30 grams . . Butter. Cream. Tea. 2 h. tbsp. 2 h. tbsp. 1 slice, 3x3x^/2 in. Allow during day: Butter 50 grams ... 5 squares. Cream, 40% 7 ounces.. .14 tbsp. OF DIABETES 57 TABLE XXXVII. Protein, 60 grams Fat, 200 grams Carbohydrate, 62 grams Calories, 2380 BREAKFAST; Orange 100 grams ... 1 Bacon 100 grams. . . 6 slices 6 in. long. Egg ,. 1 Bread 35 grams ... 1 slice, 3x3x% in. Butter. Cream. Tea. Dinner. Broth 180 c.c Steak 100 grams . Turnips 140 grams . Parsnips 200 grams . String beans 100 grams. Butter. Cream. Tea. 1 glass. 1 slice. 2 h. tbsp. 8 slices, 4 h. tbsp 2 h. tbsp. Supper. Egg 1 Lettuce 25 grams . Cucumbers 100 grams . Bread 30 grams . Butter. Cream. Tea. Allow during day: Butter 50 grams . Cream, 40% 7 ounces. 3 leaves. 16 slices (thin). , 1 slice, 3x3x1/2 in. 5 squares. 14 tbsp. 58 STAEVATION TEEATMENT TABLE XXXVIII. Protein, 74 grams Fat, 200 grams Carbohydrate, 62 grams Calories, 2420 Breakfast. Bacon 100 grams. . . 6 slices 6 in. long. Egg 1 Bread 30 grams ... 1 slice, 3x3x% in. Butter. Cream. Tea. Dinner. Broth 180 c.c 1 glass. Chicken 100 grams. . . 1 slice. Baked potato 100 grams... 1 medium. Tomato 100 grams. . . 2 h. tbsp. Lettuce 25 grams ... 3 leaves. Olive oil 13 grams. . . 1 tbsp. Butter. Cream. Tea. Supper. Vgg 1 Cabbage 100 grams . . Celery 100 grams . . Onions 100 grams. . Butter. Cream. Tea. Allow during day: Butter 50 grams . . Cream, 40% 7 ounces. . 3 h. tbsp. 8 slices 6 in. long. 2 h. tbsp. 5 squares. 14 tbsp. OF DIABETES 59 TABLE XXXIX. Protein, 71 grams Fat, 205 grams Carbohydrate, 60 grams Calories, 2440 Breakfast.* Bacon 100 grams ... 6 slices 6 in. long. Egg ; 1 Asparagus 100 grams ... 2 h. tbsp. Bread 25 grams ... 1 slice, 3x2x% in. Butter. Cream. Coffee. Dinner. Broth 180 c.c 1 glass. Steak 100 grams ... 1 slice. Spinach 100 grams. . . 2 h. tbsp. Carrots 100 grams. . . 2 h. tbsp. Butter. Cream. Tea. Supper. Egg 1 Lettuce 100 grams . Lima beans 100 grams . Cauliflower 120 grams. Beef juice 4 ounces . Bread 25 grams . Butter. Cream. Tea. 12 leaves. 2 h. tbsp. 2 h. tbsp. , 8 tbsp. 1 slice, 3x3x1^ in. Allow during day: Butter 50 grams ... 5 squares. Cream, 40% 7 ounces.. .14 tbsp. 60 STAKVATION TEEATMENT TABLE XL. Protein, 72 grams Fat, 208 grams Carbohydrate, 65 grams Calories, 2490 Breakfast. Bacon 100 grams ... 6 slices 6 in. long. Eggs 2 Bread 25 grams ... 1 slice, 3x2x1/2 in. Butter. Cream. Coffee. Dinner. Broth 180 c.c 1 glass. Squab 100 grams. . . 1 Lettuce 25 grams ... 3 leaves. Cucumbers 100 grams ... 16 thin slices. Turnips 140 grams ... 2 h. tbsp. Strawberries 100 grams. . . 2 h. tbsp. Bread 25 grams ... 1 slice, 3x2x% in. Butter. Cream. Tea. Supper. Fish (Haddock) . . 50 grams. . String beans 100 grams . . Parsnips 200 grams . . Bread 25 grams . . Butter. Cream. Tea. 1 small helping. 2 h. tbsp. 8 slices. 1 slice, 3x2x1/2 in. Allow during day: Butter 50 grams ... 5 squares. Cream, 40%. .... 7 ounces.. .14 tbsp. OF DIABETES 61 TABLE XLI. Protein, 71 grams Fat, 204 grams Carbohydrate, 65 grams Calories, 2455 Breakfast. * Bacon 100 grams . Egg 1 Bread 20 grams . Carrots 100 grams . Butter. Cream. Coffee. . 6 slices 6 in. long. . 1 slice, 3x2x3/2 in. . 2 h. tbsp. Dinner. Broth 180 c.c 1 glass. Roast lamb 100 grams ... 1 slice. Baked potato 100 grams. . . 1 medium. Lettuce 100 grams ... 12 leaves. Asparagus 100 grams. . . 2 h. tbsp. Butter. Cream. > Tea. Supper. Eggs 2 Cauliflower 120 grams. . Spinach 100 grams . . Bread 20 grams . . Butter. Cream. Tea. Allow during day: Butter 50 Cream, 40% 7 grams . ounces. 2 h. tbsp. 2 h. tbsp. 1 slice, 3x2x3/2 in. . 5 squares. 14 tbsp. 62 STAKVATION TKEATMENT TABLE XLII. Protein, 77 grams Fat, 200 grams Carbohydrate, 68 grams Calories, 2453 Breakfast. Bacon 100 grams . Eggs 2 Tomatoes 100 grams . Butter. Cream. Tea. 6 slices 6 in. long. 6 slices or 1 medi- um tomato. Dinner. Broth 6 ounces. Haddock 100 grams . Cabbage 100 grams . Onions 100 grams . Baked potato 100 grams. Butter. Cream. Tea. Supper. Cold boiled ham.. 75 grams. Bread 25 grams . Peas 100 grams . Lettuce 25 grams . Celery 100 grams . Butter. Tea. . . 1 glass. 1 medium helping. 3 h. tbsp. 2 h. tbsp. 1 medium 1 slice, large. 1 slice, 3x2x% in. 2 h. tbsp. 3 leaves. 8 stalks 6 in. long. Allow during day: Butter Cream, 40% 50 grams. 7 ounces. 5 squares. 14 tbsp. OF DIABETES 63 TABLE XLIII. Protein, 77 grams Fat, 203 grams Carbohydrate, 69 grams Calories 2486 Breakfast. Bacon 100 grams ... 6 slices 6 in. long. Eggs 2 Bread 50 grams ... 2 slices, 3x2xy 2 in. Butter. Cream. Coffee. Dinner. Broth 6 ounces. Steak 100 grams. Turnips 140 grams . Lettuce 25 grams . Bread 25 grams . Cream. Tea. ' 1 glass. 1 slice. 2 h. tbsp. 3 leaves. 1 slice, 3x2x1/2 in. Supper. Cold veal 50 grams . Parsnips 200 grams . String beans 100 grams. Cucumbers 100 grams . Bread 25 grams . Cream. Tea. . 1 small slice. . 8 slices. . 2 h. tbsp. .16 slices (thin). . 1 slice, 3x2x1/2 in. Allow during day: ■ Butter 50 grams ... 5 squares. Cream, 40% 7 ounces. . .14 tbsp. 64 STARVATION TREATMENT TABLE XLIV. Protein, 74 grams Fat, 201 grams Carbohydrate, 71 grams Calories, 2458 Breakfast. Egg 1 Bacon 100 grams ... 6 slices 6 in. long. Parsnips 100 grams. . . 4 slices, 2 h. tbsp. Butter. Cream. Coffee. Dinner. Broth 6 ounces. . . 1 glass. Chicken 100 grams ... 1 slice. Squash 50 grams ... 1 h.tbsp. Turnips 140 grams ... 2 h. tbsp. String beans 100 grams ... 2 h. tbsp. Baked potato 100 grams... 1 medium. Butter. Cream. Tea. Supper. Egg 1 Parsnips 100 grams ... 4 slices, 2 h. tbsp. Lettuce 25 grams ... 3 leaves. Cucumbers 100 grams. . .16 slices (thin). Bread 40 grams ... 1 slice, 3x3y 2 xi/ 2 in. Olive oil 13 grams ... 2 teasp Butter. Cream. Tea. Allow during day: Butter 50 grams ... 5 squares. Cream, 40% 7 ounces.. .14 tbsp. OF DIABETES 65 TABLE XLV. Protein, 75 grams Fat, 205 grams Carbohydrate, 71 grams Calories, 2496 Breakfast. Bacon 100 grams . . Egg 1 Asparagus 100 grams. . Potato (boiled)... 50 grams.. Butter. Cream. Tea. . 6 slices 6 in. long. . 2 h. tbsp. . 1 very small. Dinner. Steak 100 grams ... 1 slice. Potato (boiled).. .100 grams. . . 1 medium. Spinach 100 grams. . . 2 h. tbsp. Cauliflower 120 grams. . . 2 h. tbsp. Butter. Cream. Tea. Supper. Egg 1 Cottage cheese.... 50 grams. Lettuce 100 grams . Carrots 100 grams . Bread 35 grams . Butter. Cream. Tea. Allow during day: Butter 50 grams . Cream, 40% 7 ounces. li/ 2 xli/ 2 xli/ 2 in. 12 leaves. 2 h. tbsp. 1 slice, 3x3x1/2 i n> 5 squares. 14 tbsp. 66 STAKVATION TREATMENT TABLE XL VI. Protein, 99 grams Fat, 305 grams Carbohydrates, 101 grams Calories, 3660 Breakfast. Oranges 200 grams ... 2 small. Bacon 75 grams ... 5 slices. Eggs 2 Bread 35 grams ... 1 slice, Butter. 3x3y 2 xy 2 in. Cream. Coffee. Dinner. Lamb chop 100 grams . Peas 100 grams . Olives 50 grams. Almonds • • • • 50 grams . Bread 25 grams . Butter. Cream. Tea. Supper. Salmon 100 grams. Salad : Lettuce 25 grams . Fresh tomato . . 100 grams . Mayonnaise..... 21 grams. American cheese 25 grams . Bread 40 grams . Allow during day: Butter 50 grams . Cream, 40% 10 ounces. 1 chop. 2 h. tbsp. .13 small olives. 26 small almonds. , 1 slice, 3x3x1/2 in. 1 average. helping. 3 leaves. 1 medium. , 1 tbsp. . 11/2x1x1 in. . 1 slice, 3x31/2x1/2 in. 5 squares. 20 tbsp. OF DIABETES 67 TABLE XLVII. Protein, 101 grams Fat, 225 grams Carbohydrate, 101 grams Calories, 2919 Breakfast. Grape fruit 100 grams . . . y 2 medium. Eggs 2 Bread 50 grams ... 2 slices, 3x2x1/9 in. Butter. Cream. Coffee. Dinner. Chops 200 grams ... 2 medium. Potato 75 grams ... 1 medium or 1% tbsp. of mashed. Lettuce 50 grams ... 6 leaves. Bread 25 grams ... 1 slice, 3x2x% in. Walnuts 25 grams ... 5 whole walnut meats. French dressing Oil 16 grams ) , , Vinegar J ■ 2 tbs P' Supper. Cold chicken 50 grams. . . 1 small slice. Egg 1 Bread 25 grams ... 1 slice, 3x2x% in. Celery 50 grams ... 6 stalks 6 in. long. Peach 100 grams ... 1 peach. Butter. Cream. Tea. Allow during day: Butter 50 grams ... 5 squares. Cream, 40% 6 ounces.. .12 tbsp. 68 STAKVATION TKEATMENT TABLE XLVIII. Protein, 99 grams Fat, 228 grams Carbohydrate, 126 grams Calories, 3043 Breakfast. Lamb chop 100 grams. . . 1 chop. Eggs 2 Bread 50 grams ... 2 slices, Butter. 3x2x% in. Cream. Coffee. Dinner. Steak 100 grams. . . 1 slice. Potato 200 grams ... 2 small ones. Cabbage 100 grams. . . 3 h. tbsp. Bread 25 grams ... 1 slice, 3x2x% in. Butter. Tea. Custard or ice cream, using part of cream, and one- half egg (extra). Supper. Bacon. 100 grams. . . 6 slices. Egg 1 Peas 100 grams ... 2 h. tbsp. Beets 100 grams ... 2 h. tbsp. Peach (as purchased) 100 grams... 1 peach. Bread 25 grams ... 1 slice, 3x2x% i n - Butter. Cream. Tea. Allow during day: Butter 50 grams ... 5 squares. Cream, 40% 6 ounces.. .12 tbsp. OF DIABETES 69 TABLE XLIX. Protein, 101 grams Fat, 292 grams Carbohydrate, 150 grams Calories, 3744 Breakfast. Grape fruit 300 grams ... 1 medium. Bacon 75 grams ... 5 slices. Eggs 2 Bread 35 grams ... 1 slice 3x3x% in. Butter. Cream. Tea. Sugar. Dinner. Lamb chop 100 grams. . . 1 medium. Peas 100 grams ... 2 h. tbsp. Lettuce 25 grams ... 3 leaves. Fresh tomato 100 grams... 1 medium. Mayonnaise 21 grams. . . 1 tbsp. Bread 25 grams ... 1 slice, 3x2x% in. Butter. Tea. Supper. Cold roast beef.. . . 100 grams ... 1 slice. Olives 50 grams ... 13 small olives. Almonds 20 grams. . .26 small almonds. Cream cheese 50 grams... I^xI^xIMj i n - Bread 40 grams ... 1 slice, Butter. 3x3i/ 2 xy 2 in. Cream. Tea. Allow during day: . Butter 50 grams ... 5 squares. Cream, 40% 5 ounces. . .10 tbsp. Sugar 40 grams. . . 4 h. teasp. Dr. Edwin A. Locke's book of food values has been of much value in making up these diets. 70 STARVATION TREATMENT The following food values are taken from Locke's Abstract of Atwater and Bryant's Bulletin No. 28, 1906, United States Department of Agriculture. Fractions of per cents, have been left off in order to make the use of the table more simple, and the values given will be found quite accurate enough for clinical purposes. Food Stuffs. Quantity. Raw. Meat. Beef 100 gm. Chicken " Bacon " Fish. Fish (average) " Oysters i c c c t i i i Eggs. Eggs " Eggs legg Dairy Products. Butter 100 gm. Cheese (American).. Cheese (Neufchatel) Milk (whole) Milk (whole) 1 qt. Milk (skim) 100 gm. Milk (skim) 1 qt. Cream (gravity).. . .lOOgrn. Cream (gravity) 1 pt. Cereal Products. Oatmeal (cooked).. .100 gm. Rice (cooked) " Protein. Grams. Fat. Grams. Carbo- hydrate. Grams. Total Calo- ries. 22 28 357 32 4 2 181 10 64 646 20 4 1 105 6 1 4 52 13 10 159 7 5 72 1 85 795 28 35 2 453 19 27 2 337 3 4 5 72 34 38 43 670 3 0.3 5 37 35 10 43 400 3 16 5 180 14 77 22 860 3 0.5 12 63 3 0.1 24 112 OF DIABETES 71 Food Stuffs. Raw. Quantity. Protein. Grams. Macaroni (cooked).. " Bread " Soda crackers " Cake (average) " 3 9 10 6 Carbo- Total Fat. hydrate. Calo- Grams. Grams. ries. 16 53 73 63 91 268 424 369 Vegetables. Asparagus 100 gm. 2 Beans (dried) " 22 Beans (string) " 2 Beets " 2 Cabbage " 2 Carrots " 1 Cauliflower ' ' 2 Celery ' ' 1 Corn (green) " 3 Cucumbers " 0.8 Lettuce " 1 Mushrooms " 3 Onions " 1 Peas (dried) ... " 24 Peas (green) " 7 Potatoes (white).. . . " 2 Potatoes ( sweet) . . . . " 2 Spinach " 2 Squash " 1 Tomatoes " 0.9 Turnips ..." 1 The values for all the vegetables are the raw vegetables. 2 2 0.3 0.1 0.3 0.4 0.5 0.1 1 0.2 0.3 0.4 0.3 1 0.5 0.1 0.7 0.3 0.5 0.4 0.2 3 59 7 7 6 9 5 3 20 3 3 7 10 62 16 18 27 3 9 4 8 21 354 40 41 32 46 31 19 104 18 20 46 49 365 102 85 126 24 47 23 41 calculated from Fruits. Apples 100 gm. Bananas " Blackberries " Cherries " 0.4 1 1 0.1 0.5 14 0.6 22 1 11 1 15 64 101 15 76 72 STARVATION TREATMENT Carbo- Total Food Staffs. Quantity. Protein. Fat. hydrate. Calo- Raw. Ghams. Grams. Grams. ries. .. " 0.4 0.6 10 47 Currants .. " 1 13 58 Figs (dried) .. " 4 0.3 74 325 Grapes .. " 1 1 14 74 Huckleberries. . . . .. " 0.6 0.6 16 76 Lemon juice 10 40 Muskmelons .. " 0.6 9 41 .. " 0.8 0.2 11 53 Peaches .. " 0.7 0.1 9 42 Pears .. " 0.6 0.5 14 65 Prunes (dried)... .. " 2 73 309 Raisins (dried). . .. " 2 3 76 354 Pineapples .. " 0.4 0.3 10 44 .. " 1 20 87 Raspberries .. " 1 12 56 .. " 1 0.6 7 40 0.4 0.2 7 31 Nuts. . . 100 gm. 21 54 17 668 Chestnuts .. " 6 5 42 246 . . " 25 38 24 564 Walnuts . . " 18 64 13 728 Miscellaneous. Chocolate 100 gm. Whiskey 50 c.c. Lager beer 250 c.c. 13 48 30 631 43% alcohol 152 4.5% alcohol 130 COLUMBIA UNIVERSITY LIBRARY This book is due on the date indicated below, or at the expiration of a definite period after the date ~ " ?tpt.- ; r. as provided by the rules of the Libr^- -■ rangement with the Li^" DATE DUE "WKW T ^ 'V^V-- •j|PP * ft r r i - INTING DEMCO 38-296 a. I 0041077687