DIETETICS FOR 
NURSES 
BY > 
JULIUS FRIEDENWALD, M. D. 
PROFESSOR OF GASTRO-ENTEROLOGY IN THE UNIVERSITY OF MARYLAND 
SCHOOL OF MEDICINE AND COLLEGE OF PHYSICIANS AND SURGEONS, 
BALTIMORE 
1 
AND 
/ 
JOHN RUHRAH, 
PROFESSOR OF DISEASES OF CHILDREN TN THE UNIVERSITY OF MARYLAND 
SCHOOL OF MEDICINE AND COLLEGE OF PHYSICIANS AND SURGEONS, 
BALTIMORE 
FIFTH EDITION, REVISED AND ENLARGED 
* PHILADELPHIA AND LONDON 
W. B. SAUNDERS COMPANY 
1924 Copyright, 1905, by W. B. Saunders and Company. Reprinted November, 1906, 
and April, 1907. Revised, reprinted, and recopyrighted April, 1909. 
Reprinted July, 1910, and August, 1912. Revised, reprinted, and 
recopyrighted June, 1913. Reprinted April, 1914, April, 1915, 
November, 1915, and February J1917. Revised, reprinted, 
and recopyrighted July, 1917. Reprinted April, 1918, 
January, 1919, October, 1920, and July, 1923. Revised, 
reprinted, and recopyrighted March, 1924. 
Copyright, 1924, by W. B. Saunders Company / 
MADE IN U. S. A. 
PRESS OF 
W. B. SAUNDERS COMPANY 
PHILADELPHIA TO 
MISS ADELAIDE NUTTING, 
SUPERINTENDENT OF THE JOHNS HOPKINS TRAINING SCHOOL. 
Dear Miss Nutting:- 
We take great pleasure in inscribing this little book to you 
in appreciation of the splendid work you are doing in 
maintaining a high standard for the nursing profession. 
Very sincerely, 
JULIUS FRIEDENWALD, 
JOHN RUH RAH. PREFACE TO THE FIFTH EDITION. 
The continued cordial reception of this little book 
has made it a pleasure to add to it the changes neces- 
sary to bring it up to date. The subject of diet is 
receiving more and more attention of late, and the 
studies in metabolism both in health and disease are 
leading to a new conception of the subject. While we 
have made a large number of changes in this new edi- 
tion, we have not added anything which is not pretty 
generally accepted, and will let the test of a few years 
of experience show whether many of the new ideas are 
valid before adding them to the already overburdened 
curriculum of the nurse in training. 
We trust that this little volume may be of service 
not only to the nurse but to the layman in search of 
information on the subject of dietetics. For a more 
extended treatment of any of the subjects the reader 
is referred to our larger book, "Diet in Health and 
Disease." 
Baltimore, Md. 
March, 1924. 
3 PREFACE. 
This little book has been prepared to meet a need in 
the training-school and as a handbook for nurses and 
laymen who are interested in the subject of feeding the 
sick. 
At present the nurse must rely upon a knowledge of 
dietetics gleaned either from her text-book on invalid 
cookery or from one of the larger reference works upon 
the subject. The former contains too little, and the 
latter is much too large and too technical to be of great 
service to the busy nurse. 
The aim of this book is to give the essentials of 
dietetics. The physiology of digestion has been briefly 
reviewed. The various classes of foods and the part 
they play in nutrition have been considered. The sub- 
jects of infant feeding and the feeding of the sick have 
been fully discussed, and a brief outline has been given 
of the principles involved in the nourishment of patients 
suffering with the various diseases in which diet plays 
an important part in the management. Rectal alimenta- 
tion and the feeding of operative cases have been fully 
described. Diet lists and instructions have been added 
which should enable the nurse to comprehend and to 
intelligently carry out the orders of the physician. A 
5 6 
PREFACE. 
large number of recipes for the invalid's dietary have 
been added. 
Should the reader desire further information on any 
of the subjects mentioned or concerning other dietetic 
topics he should consult our larger work, " Diet in Health 
and Disease." CONTENTS. 
CHAPTER I. 
PAGE 
The Chemistry and Physiology oe Digestion n 
Digestion and Absorpiton-The Relation of Food to Various 
Inherent Conditions-The Influence of Various Factors Upon 
Digestion-Absorption of Foods-Quantity of Food Required. 
CHAPTER II. 
Classes of Foods 40 
Animal Foods-Milk and Milk Production-Eggs-Meats and 
Meat Preparations-Fish-Vegetable Foods-Cereals-Leg- 
umes-Roots and Tubers-Green Vegetables-Fruits-Nuts- 
Fungi, Algae, and Lichens-Sugars-Spices and Condiments- 
Fats and Oils-Salts-Beverages and Stimulants-Water- 
Tea-Coffee-Cocoa-Alcohol. 
CHAPTER HI. 
Various Factors in Their Bearing on Diet 102 
Concentration of Food-Preservation of Food-Artificial Food 
Preparations-Cooking of Foods-Diseases Caused by Errors in 
Diet and by Various Food Poisons-Food Adulteration-Simple 
Tests for the Detection of Preservatives-The Determination 
of Artificial Colors. 
CHAPTER IV. 
Feeding of Infants and Children 127 
Milk Modification-Pirquet System of Nutrition-Premature 
Infants-Feeding During the Second Year-Diet of School 
Children-Feeding in Infant Asylums. 
7 8 
CONTENTS. 
CHAPTER V. 
PAGE 
The Feeding of Sick Infants 171 
Stationary Weight; Loss of Weight-Vomiting-Colic-Gavage 
-Nasal Feeding-Feeding in Inflammations of the Mouth- 
Diseases of the Stomach-Diarrhea-Chronic Intestinal Indi- 
gestion-Constipation-Wasting Diseases-Rickets. 
CHAPTER VI. 
Diet for the Aged 184 
CHAPTER VII. 
Diet During Pregnancy and the Puerperium 187 
CHAPTER VIII. 
Rectal I eeding 189 
Procedure-Recipes for Nutrient Enemata-Other Methods of 
Nourishing the Body-Duodenal Alimentation-Saline Irriga- 
tions and Infusions-Plain Water Injections-Other Solutions. 
CHAPTER IX. 
General Rules for Feeding the Sick 200 
Feeding Unconscious and Refractory Patients-Forced Feeding 
-Feeding in Fever. 
CHAPTER X. 
Feeding in the Infectious Diseases 210 
Typhoid Fever-Typhus Fever-Smallpox-Scarlet Fever- 
Measles - Mumps - Whooping-cough - Diphtheria - Rheu- 
matism-Yellow Fever-Tetanus-Rabies-Tuberculosis. 
CHAPTER XI. 
Diet in Diseases of the Stomach 244 
Leube's Diet Scale-Beaumont's Table-Penzoldt's Diet-lists- 
Liquid Foods in Gastric Disorders-Special Factors Bearing on 
' the Diet-Special Cures-Diet in Dysphagia-Acute Gastritis- 
Chronic Gastritis-Dilatation of the Stomach-Atonic Dys- 
pepsia-Ulcer of the Stomach-Sippy Diet-Hemorrhage from 
the Stomach-Carcinoma of the Stomach-Nervous Gastric 
Disorders-Hyperacidity. CONTENTS. 
9 
CHAPTER XII. 
PAGE 
Diet in Intestinal Diseases 285 
Antiputrefactive Diet-Antifermentative Diet-Intestinal 
Dyspepsia-Acute Intestinal Catarrh-Chronic Intestinal 
Catarrh-Dysentery-Ulcer of the Intestine-Malignant 
Growths of the Intestine-Acute Intestinal Obstruction- 
Chronic Intestinal Obstruction-Appendicitis-Dietetic Treat- 
ment of Nervous Conditions of the Intestine-Hemorrhoids 
-Diarrhea-Habitual Constipation-Peritonitis. 
CHAPTER XIII. 
Diet in Diseases of the Liver 304 
CHAPTER XIV. 
Diet in Diseases of the Respiratory Organs 307 
Pleurisy-Empyema-Laryngitis-Asthma-Chronic Lung 
Disease-Pneumonia. 
CHAPTER XV. 
Diet in Diseases of the Circulatory System 310 
Diet in Diseases of the Heart-General Directions-Oertel 
Treatment-Aneurysm; Dilatation of the Blood-vessels-An- 
gina Pectoris-Anemia-High Blood-pressure. 
CHAPTER XVI. 
Diet in Diseases of the Genito-urinary System 317 
Urine and Food-Acute Inflammation of the Kidney; Nephritis 
-Chronic Inflammation of the Kidney-Movable and Floating 
Kidney-Calculous Affections-Surgical Diseases of the Genito- 
urinary Tract. 
CHAPTER XVII. 
Diet in Diseases of the Nervous System 325 
Neuralgia-Insomnia and Disturbed Sleep-Epilepsy-Chorea 
-Apoplexy-Alcoholism-Rest Cure-Diet for the Insane. 
CHAPTER XVIII. 
Diseases in Which Diet is a Primary Factor 341 
Diabetes Mellitus-Gout and Goutiness-Arthritis Deformans- 
Scurvy-Obesity-Leanness-Diet in Skin Diseases-Acidosis. 10 
CONTENTS. 
CHAPTER XIX. 
PAGE 
Special Diet Cures 368 
CHAPTER XX. 
Dietetic Management of Surgical Cases 363 
Before the Anesthesia-Anesthesia and Diet-Diet After Op- 
eration-Operations About the Head-Hare-lip and Cleft Pal- 
ate Operations-Esophageal or Laryngeal Operations-Diet 
and Laparotomies-Nausea and Vomiting-Thirst-Care of 
the Bowels-Dietetic Management of Shock-Diet After Op- 
erations on the Various Organs-Feeding Through Gastric and 
Intestinal Fistulas. 
CHAPTER XXI. 
Hospital Diet 382 
CHAPTER XXII. 
Recipes 384 
Beverages-Cereals and Cereal Gruels-Bread-Vegetables- 
Soups Without Meat-Milk Preparations-Eggs-Meats- 
Soups-Methods of Preparing Raw Beef-Panopepton-Meat 
Jellies Without Gelatin-Foods for Diabetics. 
CHAPTER XXIII. 
Cuts of Meats 433 
Weights and Measures 440 
Index 443 Dietetics for Nurses 
CHAPTER I. 
THE CHEMISTRY AND PHYSIOLOGY OF 
DIGESTION. 
Food is the matter taken into the body to supply heat 
and energy, to build up the body, and repair tissue waste. 
Every movement we make uses up a certain amount 
of energy; this and all the heat that is dissipated from 
our bodies must be supplied by the food. The energy 
in the food is present in a resting or latent form in the 
power which binds atoms together in molecules and the 
molecules together into a mass. When the complex food 
forms are broken up into simpler compounds this energy 
is set free and is used by the body as energy or con- 
verted into heat. The excess is stored up in the body, 
usually as fat, in the subcutaneous tissue, or as glycogen 
in the liver and muscles. This energy is liberated by a 
series of changes which may be compared to the burning 
of coal or wood in a furnace, the difference being that 
the chemic changes are much more complicated, and the 
body is a much more perfect furnace than any which man 
has devised, as it can utilize a greater proportion of energy 
with much less waste. 
The structures of the body-bones, muscles, nerves, 
etc.-are built up after birth by material which is taken 
into the body as food. The wear and tear of the body 
11 12 
DIETETICS FOR NURSES. 
necessitates continual repair of these tissues, and the 
material used for this also comes from the food. 
Food, as it is taken into the body, differs very much 
in composition from the material that can be utilized by 
the tissues in growth and the repair of waste. The proc- 
esses which prepare it for the use of the body are spoken 
of as digestion. 
The chemic elements contained in the body are also 
found in the food. Some fifteen elements are present in 
the body, the principal ones being oxygen, hydrogen, 
carbon, nitrogen, calcium, phosphorus, and sulphur. 
The compound substances which these make are classi- 
fied under the headings protein, fats, carbohydrates, 
mineral matter or salts, vitamins, and water. 
Water.-Water enters into the composition of every 
tissue in the body and forms over 60 per cent, of the 
entire body-weight. It is not burnt up, however, and so 
does not supply any energy. 
Salts.-These form about 6 per cent, of the weight 
of an adult man. They are present in the bones, teeth, 
and other tissues. The principal salts of the body are 
calcium phosphate and the various compounds of potas- 
sium, sodium, magnesium, and iron. The mineral salts 
are very necessary to life and health. 
Protein.-Under this heading are included most of 
the food-stuffs containing the element nitrogen. Protein 
is found in both animal and vegetable food, familiar ex- 
amples of it being the lean and gristle of meat, the white 
of egg, the gluten of wheat, and the curd of milk. The 
word " proteid " is used by some writers to describe these. 
Various writers classify the proteins into albumins, as 
the white of egg; globulins; glutelins; albuminoids, etc. 
These classifications are frequently changed and need 
not concern us here. CHEMISTRY AND PHYSIOLOGY OF DIGESTION. 
13 
The Amino-acids.-Protein is a very complex sub- 
stance and exceedingly difficult to analyze, but modern 
chemists have shown that it is built up of simpler sub- 
stances known as the amino-acids. In the neighborhood 
of twenty of these have been described, and the more 
important are called glycocoll, valin, leucin, tyrosin, 
cystin, and tryptophane. In the process of digestion 
the proteins are split into these simpler compounds, 
and it is thought that these are absorbed directly into 
the blood and circulate in it, and are used to build up the 
tissues and repair the wear and tear very much like 
various building materials being carried to buildings, 
where each need is supplied for construction and also 
for repair. Some amino-acids contain essential things 
which others lack. For perfect nutrition and growth it 
is necessary to have proteins which are suitable, and an 
animal may be supplied with a superabundance of certain 
proteins and then not thrive because they do not contain 
the correct building material. Sometimes the amino- 
acids are compared to the alphabet and the various 
tissues to words. One readily sees how it is impossible 
to spell certain words if any of the letters are absent. 
It also makes plain how there can be so many different 
kinds of proteins with specific reactions, as is shown by 
modern serologic work, as with eighteen letters millions 
of different combinations may be made. In the intestines 
these amino-acids may be acted on by bacteria and vari- 
ous poisonous or objectionable substances formed, like 
indol, skatol, and others. Some of these produce dele- 
terious effects if absorbed into the body. 
The proteins are necessary for life. They are the only 
form of food which can build up and repair the body, 
if we accept the fatty tissues, which may be replaced by 
protein, carbohydrate or fat. They also supply energy 
and heat. If they are not supplied in sufficient quantity 14 
DIETETICS FOR NURSES. 
the body will waste and a condition of malnutrition 
come on. 
Carbohydrates contain no nitrogen. They are com- 
posed of carbon, hydrogen, and oxygen, the last two in 
the proportion to form water, hence the name carbohy- 
drate. They include starch, sugar, and the vegetable 
fiber or cellulose. Carbohydrates are burnt up in the 
body and are the most important source of heat and 
energy. Excesses taken are converted into fat and 
stored up in the body. The superficial fat of the body 
protects it from cold and acts as a storehouse for the fat, 
which can be converted into heat and energy. 
Fats.-It is the fashion nowadays to group together 
substances of a greasy feel which are soluble in chloro- 
form and other fat solvents and insoluble in water. 
These substances are called lipins, and the term in- 
cludes a great many substances differing widely in a 
general way. The principal ones are fats, which are 
solid or semisolid at ordinary temperatures, as lard; 
fatty oils which are fluid at room temperature, as olive 
oil; essential oils which are volatile and usually have a 
marked odor, as oil of cloves; waxes, as beeswax; and 
sterols or solid alcohols. There are others of interest to 
chemists and physiologists. 
Fat serves the same purpose as the carbohydrates. 
Fat supplies more heat and energy, weight for weight, 
than carbohydrates, but is neither so easily digested nor 
so available. Fat is found in animal and vegetable food, 
as in the fat part of meat, butter, olive oil, and is present 
in large quantities in the yolk of egg. 
Vitamins.-This term is used for several substances, 
sometimes called food accessory substances, which are 
at present not fully understood. These substances are 
present in foods in small and variable quantities. If CHEMISTRY AND PHYSIOLOGY OF DIGESTION. 
15 
any of them are insufficient in the diet certain rather 
definite changes occur in the body. These changes may 
be stopped and health restored by adding foods con- 
taining the missing substances to the diet, provided the 
alterations in the body have not progressed too far. 
They are intimately connected with growth, and at- 
tention to this factor in the diet of growing children is 
of the greatest importance. There are at present many 
conflicting opinions regarding vitamins. 
The following have been described: 
Vitamin A, or fat-soluble A, whose absence causes a 
lack of growth and an eye disease, xerophthalmia. 
Vitamin B, or water-soluble B, whose absence causes 
lack of growth and the development of beriberi in man 
and polyneuritis in fowls. 
Vitamin C, or the antiscorbutic vitamin, whose ab- 
sence causes scurvy. 
Vitamin D, or the calcium-depositing vitamin, whose 
absence together with a diet deficient in calcium or 
phosphorus causes rickets. 
Vitamin A, or Fat-soluble A.-This is found in large 
quantities in butter fat, cod-liver oil, in glands used 
for food, such as liver and kidney, sparingly in some 
animal fats, while in some it is absent. It also occurs 
in some of the green vegetables, as spinach, cabbage, and 
the like. When it is absent or deficient in the diet the 
body wastes, the young animal ceases to grow, and 
changes occur in the cornea which may eventually de- 
stroy the sight. Some attribute rickets to a lack of this 
vitamin. 
Vitamin B, or Water-soluble B, is present in most foods, 
but there is a great variation in the quantities. It is 
present in large amounts in yeast, eggs, milk, meats, 
especially in glands like liver and kidney, in the germ 16 
DIETETICS FOR NURSES. 
of seeds, in sprouting grain and legumes, in bran, in 
nuts, in almost all fruits, in almost all vegetables, es- 
pecially in potatoes and turnips, and in leafy vegetables, 
such as spinach and cabbage. Polished rice and bolted 
white flour are particularly deficient in water-soluble 
B. A deficiency or absence of this vitamin is the cause 
of beriberi in man, while fowls and certain animals de- 
velop polyneuritis when fed on diets which do not con- 
tain it. In preventing or curing beriberi, rice polishings, 
bran, yeast, the embryos of wheat or rice, whole grain of 
wheat, milk, and germinating pulses have been found most 
valuable. Fresh meats and onions are also of service. 
Vitamin C, or the antiscorbitic vitamin, is found chiefly 
in plants in the leaves, juices, and roots. The amounts 
vary. Foods rich in vitamin C are orange juice, lemon 
juice, fresh or canned tomato juice, potatoes, onions, 
green salads, as lettuce and romaine, cabbage, beans, and 
berries. It is present in small quantities in fresh milk. 
This vitamin is low or lacking in yeast and yeast ex- 
tracts, embryos of grain, yolk of eggs, olive oil, butter, 
cod-liver oil, prunes, beets, and foods dried, heated, or 
cooked for a long time. 
The Calcium-depositing Vitamin.-Mellanby has shown 
that a lack or absence of this vitamin will cause rickets 
when the calcium in the diet is low and the phosphorus 
sufficient, or when the phosphorus is low and the calcium 
sufficient. Adding the salts to the diet will not effect 
a cure, but adding cod-liver oil will. This vitamin is 
little known, but is present in cod-liver oil, to a less 
extent in butter, and there is some in plant leaves. Sun- 
light and certain kinds of artificial light have a marked 
preventive and healing effect in rickets. 
The following table, a modification of one given by 
Atwater, shows the uses of the different food elements: CHEMISTRY AND PHYSIOLOGY OF DIGESTION. 
17 
Nutritive Ingredients of Food. 
Edible portion-e. g., flesh 
of meat, yolk and white 
of egg, wheat, flour, etc. 
Water. 
Food as 
purchased 
contains- 
Protein. 
Fats. 
Carbohydrates. 
Mineral matter. 
Nutrients 
Refuse-e. g., bones, entrails, shells, bran, etc. 
Uses of Nutrients in the Body. 
Protein-forms tissues-e. g., white (albumin) of eggs 
curd (casein) of milk, lean meat, gluten of wheat, etc. 
Fats-are stored as fat-e. g., fat of meat, butter, olive 
oil, oils of corn, wheat, etc. 
Carbohydrates-are transformed into fat-e. g., sugars, 
starches, etc. 
Mineral matters (ash)-share in forming bone, assist 
in digestion-e. g., phosphates of lime, etc., potash, 
soda, etc. 
All serve as fuel 
to yield energy 
in the forms of 
heat and mus- 
cular power. 
Vitamins exert an influence on growth and nutrition. 
The changes which take place in the body in "burn- 
ing up" the food material are designated metabolism. 
The heat value of the various foods may be determined 
by the use of an instrument known as a bomb calor- 
imeter, the result being expressed in calories. A calorie 
is the amount of heat that is necessary to raise the tem- 
perature of one kilogram of water i° C. It is nearly 
the same as the amount required to raise one pound of 
water 40 F. This expressed in the mechanical force, 
that is, the amount of work it would do, means that a 
calorie would raise a ton about 1.54 feet, or that it is 
equal to 1.54 foot tons. Some authors use gram calories, 
and their figures are 1000 times greater than those in 
most general use. 
According to Atwater, the fuel-value of the various 
classes of food as ordinarily supplied is as follows: 
I gram of protein =4 calories; 1 pound =1820 calories. 
I " fat =8.9 " ; 1 " ==4040 " 
I " carbohydrate = 4 " ; I " =1820 " 18 
DIETETICS FOR NURSES. 
These figures are somewhat lower than the figures 
given by older estimations, and are based upon the most 
recent experiments. The fuel-values formerly given were : 
protein and carbohydrates, 4.1 calories per gram; fat, 
9.3 calories per gram. It will be observed that fat has a 
very high food-value, which doubtless explains why it is 
stored up as a reserve fuel. 
The amount of energy used in mental work has never 
been determined. In an experimental chamber, where 
as slight an exertion as turning over in bed will be regis- 
tered by the thermometric scale, no change was produced 
by the inmate working out the most difficult mathematic 
problems. 
Acids and Alkalis.-Another side of nutrition that 
is being studied to great practical advantage is the sub- 
ject of acid production on the body. When the body is 
starved, late in diabetes and in other conditions, the fats 
which should be oxidized or burnt up in the body and 
finally be excreted as water and carbon dioxid are side- 
tracked, as it were, and form certain acids which are poi- 
sonous. The body, to offset this condition, furnishes 
ammonia, and the overproduction of acid in the body 
may be studied by observing the amount of ammonia 
excreted. Sometimes sodium bicarbonate is given for 
its alkaline effect. Certain foods are used in the body 
with the ultimate production of acids, as examples: 
meats, cereals, and prunes; other foods furnish alkalis 
or bases, as potatoes, apples, cantaloupes. Milk is half- 
way between the two extremes. In overproduction of 
acids the foods which furnish bases (alkalis) may be 
chosen to form a major part of the diet. 
Acidosis.-The body is normally alkaline in spite of 
the fact that acids are being constantly formed in the 
process of nutrition. Carbonic acid, as given off in CHEMISTRY AND PHYSIOLOGY OF DIGESTION. 
19 
respiration as carbon dioxici, and the acid urine take 
away others. The remainder is neutralized by the forma- 
tion of ammonia. There is also a reserve supply of 
alkalis in the tissue. When, owing to faulty metab- 
olism, there is an overproduction of acids or a lessened 
excretion of them, a condition known as acidosis comes 
on. This is seen chiefly in cyclic vomiting, after anes- 
thesia, in severe diarrhea, and in diabetes. This condi- 
tion is sometimes combated by giving sodium bicarbon- 
ate by mouth, by rectum, and sometimes intravenously 
or subcutaneously. 
DIGESTION AND ABSORPTION. 
The digestion of food takes place through a number of 
changes brought about by the action of a number of fer- 
ments or, as they are often called, enzymes. The food is 
so changed that the useful part can be absorbed and used 
by the body, while the remainder is passed off as refuse. 
Enzymes are supplied by a number of glands, as 
ptyalin in the saliva, pepsin in the gastric juice, and trypsin 
in the intestine. There are enzymes which change starch 
into sugar, some which change protein into soluble sub- 
stances, others which break up fats, still others acting on 
sugars, etc. The chemistry of these changes is usually 
that the enzyme causes the food substance to unite with 
water and separate into two simpler compounds. 
On being taken into the mouth the food is broken up 
by chewing and mixed with the salivary juice, which acts 
on the starches and changes them into sugar. The 
chemic reaction of the saliva is alkaline. The food then 
passes into the stomach. The chemic reaction of the 
stomach or gastric juice is acid, and the action of the 
salivary juice is soon stopped. In the stomach the food 
is liquified and the proteins changed into peptones by the 
action of the pepsin. Milk is curdled by the action of 20 
DIETETICS FOR NURSES. 
another enzyme-rennin. Appetite is a great factor in 
the secretion of the gastric juice, as Pawlow and others 
have shown. Food introduced without the knowledge 
of the individual is not digested as rapidly, nor as much 
gastric juice secreted, as when the appetite has been 
excited. After digestion has begun there are certain 
substances which cause a second and more uniform flow 
of gastric juice. These have been called hormones. 
The bodies which most easily cause this flow of gastric 
juice are the products of protein digestion, so that where 
the flow has been started by appetite it goes on more 
satisfactorily. Meat juices also contain such substances, 
and meat soups or broths are, therefore, very useful in 
stimulating the flow of gastric juice. After from one to 
several hours, according to the quality and quantity of 
food taken, the liquid mixture in the stomach is passed 
into the intestines. Here the reaction is alkaline. A 
number of different juices act on the food at the same 
time. The liver supplies bile, the pancreatic gland a 
juice, the intestinal glands a secretion. 
The pancreatic juice contains several enzymes : trypsin, 
which acts like pepsin ; amylopsin, which acts like ptyalin, 
so that the digestion commenced in the mouth and stom- 
ach is completed. It also contains steapsin, which acts 
on the fats, emulsifying them, that is, dividing them into 
little droplets like cream or a cod-liver oil emulsion, and 
also splitting the fats into glycerin and fatty acids. The 
bile from the liver assists in emulsifying fat and exerts an 
influence over the food, hindering putrefaction. The in- 
testinal juices aid in emulsifying fats, and act upon the 
starches and sugars. 
Absorption.-This occurs in two ways: either by 
the material absorbed entering directly into the blood 
through the capillaries in the intestines, and passing CHEMISTRY AND PHYSIOLOGY OF DIGESTION. 
21 
thence through the portal veins, or it is absorbed by 
little vessels in the lining of the intestine called lacteals, 
and from these it passes through the thoracic duct, a 
long tube connecting them with the veins (left jugular 
and subclavian), returning the blood from the upper part 
of the body. The food material in the second case enters 
directly into the blood-current. Little or no absorption 
takes place in the stomach. The food enters the small 
intestine in a liquid condition and remains from 5 to 20 
hours, and is then passed into the large intestine, where 
the excess of water is absorbed and the refuse or feces 
passed off in a more or less solid form. 
Almost all the absorption of food takes place in the 
small intestine. The large intestine may absorb food 
under certain conditions, as when it is injected into the 
bowel (see Rectal enemata). 
The liver plays an important part in nutrition. It 
supplies bile, but that is a small matter compared to what 
is called its glycogenic function. The carbohydrate food, 
on reaching the liver, is changed to glycogen or animal 
starch. This glycogen is stored up in the liver and also 
in the muscles, and is burnt up in muscular action. 
The liver also takes care of the waste formed by the 
changes taking place in the body. These waste products 
are brought to the liver by the blood and changed into 
compounds which can be passed off from the body. 
There are a number of waste products, most important 
of which is urea, which may also be formed in the mus- 
cles. This urea enters the blood-stream and is passed 
off by the kidneys. 
The Digestion of Infants.-The salivary digestion 
is very feeble in early life. The salivary glands are fairly 
active by the fourth month, and begin to play a more 
important role in the digestion about the eighth or ninth 22 
DIETETICS FOR NURSES. 
month. The stomach digestion is of less importance in 
infancy. One of the principal changes is the coagulation 
of the casein (curd) of milk. 
THE RELATION OF FOOD TO VARIOUS CONDITIONS. 
Heredity.-Certain diseases or conditions which are 
affected by diet are apt to run in families, the most im- 
portant of these are obesity, gout, diabetes, and alcohol- 
ism. Food idiosyncrasies may be often inherited, as the 
urticaria (hives) caused by eating strawberries or shell- 
fish. 
Sex.-Women, as a rule, require about four-fifths as 
much food as men, this may partly be due to the seden- 
tary life led. 
Age.-Children require proportionately more food 
than adults. Atwater gives the following table of food 
requirements: 
Boy of 15-16 years requires 0.9 the food of a man at moderate work. 
Girl of 15-16 " 0.8 " " " 
Boy of 13-14 " 0.8 " " " 
Girl of 13-14 " 0.7 " " " 
Boy of 12 " 0.7 " " " 
Girl of 10-12 " 0.6 " " " 
Boy of xo-11 " 0.6 " " " 
Child of 6-9 " 0.5 " " " 
Child of 2-5 " 0.4 " " " 
Child under 2 " 0.3 " " " 
Old people require less than vigorous adults. 
Race and Climate.-Various races use different 
diets, depending much on the climate they live in. Cli- 
mate affects the diet largely by the supply it affords. 
More fat is required in cold climates and during cold 
weather than in warm. The well clad require less food 
than those exposed to cold. 
Si^e and Weight.-Other things being equal, the 
larger the body the more food is needed. CHEMISTRY AND PHYSIOLOGY OF DIGESTION. 
23 
Rest and Exercise.-Much less food is required 
during rest than during exercise. In exercise the mus- 
cular activity increases oxidation and tissue waste, and 
this waste must be counterbalanced by an increased con- 
sumption of food. 
Individual tendencies have some effect on the amount of 
food required. Some persons are obese and eat but little, 
and vice versa. 
THE INFLUENCE OF VARIOUS FACTORS UPON THE 
DIGESTION. 
Apart from the selection of a proper diet, important 
factors that especially affect the digestion are the follow- 
ing: i. The hours, order, and frequency of meals. 2- 
Variety in diet. 3. The appetite. 4. The temperature 
of food. 5. Rest and exercise before and after meals. 
6. Emotion. 
1. Order and Frequency of Meals.-It is usually 
customary to fix certain hours for taking of meals; these 
hours vary with the occupation of the individual. In 
large cities, where the noon hour is taken up largely with 
active business pursuits, evening is selected as the most 
convenient hour for dinner. Sir Henry Thompson states 
that three general systems are in use, according to which 
two, three, or four meals are taken daily. The first sys- 
tem, which consists of two meals a day, is followed in 
France and other countries on the continent of Europe. 
A substantial meal, consisting of fish or meat and other 
courses of solid food, is eaten about noon; no food is 
taken before the noon meal, except on arising, when a 
cup of coffee or chocolate and a small quantity of bread 
and butter are taken. The second meal, which is dinner, 
is eaten between 6 and 7 o'clock in the evening. This 
meal is the largest meal of the day, and consists of soup, 24 
DIETETICS FOR NURSES. 
fish, meat, vegetables, salads, dessert, and black coffee. 
The second system, commonly in vogue in England, con- 
sists of four meals daily. The first meal, or breakfast, is 
taken at about 8 a. m., and consists of cocoa, tea or coffee, 
bread, butter, bacon, fish, or eggs; dinner is eaten be- 
tween i and 2 p. m. and consists of soup, meat, fish, vege- 
tables, and pudding; tea is taken at 5 p. m., and supper 
is served at 8 p. m., and consists of meat, fish, vegetables, 
and stewed fruits. Dinner is taken in the evening by the 
well-to-do classes, and a substantial lunch is usually taken 
at noon. The third system, practised in this country, 
consists in taking three meals daily. In many towns it 
is customary to dine at noon; in others, in the evening. 
The usual breakfast, taken between 7 and 8 a. m., con- 
sists of fruits, breakfast food or cereals, eggs, bacon or 
salt fish, tea, cocoa or coffee, and bread and butter. 
Luncheon, eaten between 12.30 and 2 o'clock, consists 
of cold meat or a chop, vegetables, salads, and dessert. 
Dinner, eaten between 6.30 and 8 p. m., is the heaviest 
meal of the day, and consists of soup, fish, meats, vege- 
tables, salads, and fruit. 
The frequency of meals must be regulated according 
to individual conditions. Patients suffering from diges- 
tive disturbances and those who take very small quanti- 
ties of food at a time require nourishment at frequent 
and regular intervals; whereas, those whose digestion is 
feeble, should allow six or seven hours to elapse between 
meals; ordinarily the intervals between meals should be 
about four or five hours, this being about the time neces- 
sary for complete digestion of a mixed meal in the stom- 
ach. The habit of habitually omitting the noon luncheon, 
so commonly practised by busy Americans, should be 
discouraged. 
2. Variety of Diet.-In order thoroughly to satisfy CHEMISTRY AND PHYSIOLOGY OF DIGESTION. 
25 
the needs of the body the diet must be varied. Although 
a diet restricted to but a few articles of food may contain 
a sufficient quantity of the alimentary principles to sus- 
tain the body nutrition, yet the monotony of such a diet 
becomes so objectionable that it cannot be digested 
thoroughly. With a mixed diet the same person will 
digest a larger proportion of nutrients than with a diet 
composed of a single food material. Certain races re- 
strict the variety of food from religious motives, such as 
the Jewish restriction of ham, pork, and oysters. 
3. Appetite.-Appetite is the desire for food, and is 
dependent upon various conditions. It is controlled by 
the sensation of hunger, and is often induced by the 
sight, smell, and taste of food. Simple bitters or some 
form of alcoholic drink will at times induce this sensa- 
tion. The appearance of badly prepared or improperly 
served food will often dispel the appetite. In children 
the appetite is usually good, whereas in the aged it is 
lessened. Some persons have voracious appetites and 
abnormal craving for food. This is often the case in 
diabetic and other conditions, when, at times, the appetite 
cannot be satisfied. 
4. Temperature of Food.-The temperature of 
food when taken is of considerable importance. The 
ideal temperature is that of the body, from 98° to ioo° F. 
(Uffelmann). The limits of safety being between 450 and 
1300 F. According to Hutchison, extremes of tempera- 
ture of food are apt to give rise to gastric disturbances, 
such as gastric catarrh. Uffelmann states that a drink 
at a temperature of 1220 F. increases the body-tempera- 
ture 0.1 to 0.30 C. It is believed by many that ulcer of 
the stomach, so common in cooks, is often due to the 
taking of too hot foods. 26 
DIETETICS FOR NURSES. 
5. Rest and Exercise Before and After Meals.- 
It is often advisable to rest, but not to sleep, after meals. 
The larger part of the work of the stomach should be 
completed before retiring at night, otherwise the sleep is 
apt to be disturbed. About one to two hours should 
be allowed to elapse between a light evening meal and 
bedtime, and three to four hours between a heavy meal 
and sleep. From personal observations the authors have 
concluded that digestion is improved by rest after meals, 
but impaired by sleep. In many instances a period of 
rest before eating meals is a valuable aid to digestion. 
Violent exercise immediately after meals inhibits diges- 
tion, whereas moderate exercise one or two hours after 
meals materially aids this process. 
6. Food and Emotion.-Severe mental strain and 
strong emotion disturb the digestion, and for this reason 
food should not be taken until a period of rest and com- 
posure has intervened. On the other hand, pleasurable 
sensations aid the digestion, and pleasant conversation 
at the table is, therefore, to be recommended. 
ABSORPTION OF FOODS. 
Food absorption takes place chiefly in the small intes- 
tine ; in the stomach and in the large intestine it takes 
place only to a limited degree. In determining the de- 
gree of absorbability of food, the amount of the element- 
ary food principles ingested must first be ascertained, 
and the proportion that has not been absorbed determined 
from the feces. The degree of absorbability of a food 
indicates, in a measure, its nutritive value. According to 
Atwater,1 from an ordinary mixed meal an average of 
1 Principles of Nutrition and Nutritive Value of Food, Farmers' 
Bulletin No. 142, United States Department of Agriculture. CHEMISTRY AND PHYSIOLOGY OF DIGESTION. 
27 
92 per cent, of protein, 95 per cent, of fats, and 97 per 
cent, of carbohydrates is absorbed in the body. " The 
proportion of the several nutrients which the body re- 
tains for its use are commonly called percentages or 
coefficients of digestibility." The following table, taken 
from Atwater, gives these coefficients of digestibility: 
Coefficients of Digestibility and Fuel-value per Pound of 
Nutrients in Different Groups of Food-materials. 
Kind of food. 
Protein. 
Fat. 
Carbohydrates. 
Digesti- 
bility. 
Fuel- 
value 
per 
pound. 
Digesti- 
bility. 
Fuel- 
value 
per 
pound. 
Digesti- 
bility. 
Fuel- 
value 
per 
pound. 
Per ci. 
Calor- 
ies. 
Per ct. 
Calor- 
ies. 
Per ct. 
Calor- 
ies. 
Meats and fish 
91 
1940 
95 
4040 
98 
1730 
Eggs 
97 
1980 
95 
4090 
98 
1730 
Dairy products 
Animal food (of mixed 
97 
1940 
95 
3990 
98 
1730 
diet) 
97 
1940 
95 
4050 
98 
1730 
Cereals 
«5 
1750 
90 
3800 
98 
i860 
Legumes (dried) .... 
78 
J570 
90 
3800 
97 
1840 
Sugars . . 
98 
1750 
Starches 
98 
i860 
Vegetables 
8.3 
1410 
90 
3800 
95 
1800 
Fruits 
Vegetable foods (of mixed 
85 
1520 
90 
389° 
9° 
1630 
diet) 
84 
1840 
90 
3800 
97 
1820 
Total food (of mixed diet) 
92 
1820 
95 
405° 
97 
1820 
Absorption of Protein.-Eighty per cent, of pro- 
teins are absorbed in the small intestine, and 14 per cent, 
in the large intestine. The proteins of animal food are 
much more completely absorbed than are those of vege- 
table origin. 
Absorption of Fats.-Fats, like proteins, are ab- 
sorbed mainly in the small intestine. This absorption of 
fat is very complete. 
Absorption of Carbohydrates.-Carbohydrates are 
absorbed more completely than either the fats or the pro- 28 
DIETETICS FOR NURSES. 
teins ; consequently, these foods leave but a small residue 
in the intestine. 
As Rubner, Atwater, and others have pointed out, 
foods taken in combination are absorbed more completely 
than when taken alone. Atwater has shown that the 
following proportions of the alimentary principles are 
absorbed when the individual takes a mixed diet: 
Protein. 
Fat. 
Carbohydrates. 
Animal foods 
. 98 per cent. 
97 per cent. 
100 per cent. 
Cereals and sugars . . . 
. 85 " 
96 " 
98 " 
Vegetables and fruits. . 
. 80 " 
90 " 
95 " 
Food that leaves a small quantity of unabsorbed residue 
in the intestine is not undesirable, in that this residue 
stimulates peristalsis and thus regulates the condition of 
the bowels. 
Absorption of Meat.-Meat leaves a very small 
residue in the intestines-about 3 per cent, of that ingested 
is not absorbed. On this account meat is a most valu- 
able article of food. 
Absorption of Fish.-Fish is very completely ab- 
sorbed in the intestines. According to Langworthy, 95 
per cent, of total solids, 97 per cent, of protein and 90 
per cent, of fat are absorbed. 
Absorption of Milk.-When milk is taken alone, 
only 90 per cent, of the constituents are absorbed; if 
two liters of milk are taken daily, the loss of dry sub- 
stance, according to Rubner, is 5.7 to 7.8 per cent.; if 
three liters, the loss is 10.2 to 11.6 per cent. When 
taken with other foods, however, milk is much more com- 
pletely absorbed. 
Infants and children absorb milk much more completely 
than do adults. In childhood milk leaves a residue of 4 per 
per cent., whereas in adults 10 per cent, is not absorbed. 
Absorption of Eggs.-Eggs are very thoroughly CHEMISTRY AND PHYSIOLOGY OF DIGESTION. 
29 
absorbed in the intestine. Rubner states that hard-boiled 
eggs are absorbed almost as completely as meat, only 
5 per cent, being lost. 
Absorption of Vegetable Foods.-Vegetables are 
more or less completely absorbed in the intestine. If 
the bulk of the vegetables is not too great and the amount 
of cellulose is not too large, they will be almost entirely 
absorbed. On account of their bulk and the large pro- 
portions of cellulose which they contain, most vegetables 
are, however, incompletely absorbed. The protein is 
here the element that is not absorbed completely, the 
carbohydrates and fats undergoing complete absorption. 
Absorption of Cereals.-Such cereals as rice are 
very completely absorbed ; the starch is entirely absorbed, 
and 19 per cent, of the protein is lost. 
Absorption of I/egumes.-The legumes, such as 
peas and beans, if given in a finely divided state, are very 
completely absorbed. Rubner finds that even when given 
in amounts of 600 grams daily the loss is but slight. If, 
however, these substances are not given in a finely divided 
state, the loss in proteins is very great-according to 
Rubner, as high as 40 per cent. 
Absorption of Roots and Tubers.-The absorption 
of roots and tubers, such as carrots, potatoes, etc., depends 
upon the quantity of cellulose they contain. Inasmuch 
as the potato contains but little cellulose, it is very com- 
pletely absorbed. 
Absorption of Green Vegetables.-Most green 
vegetables are very incompletely absorbed in the intes- 
tine. They leave a large residue, which acts as a stimu- 
lant to intestinal peristalsis. 
Absorption of Fruits.-Fruits, like green vegeta- 
bles, are usually incompletely absorbed; according to 30 
DIETETICS FOR NURSES. 
Hutchinson, 80 per cent, of the protein, 90 per cent, of 
the fat, and 95 per cent, of the carbohydrates are ordi- 
narily absorbed. 
QUANTITY OF FOOD REQUIRED. 
This varies necessarily under special conditions. The 
adult requires more food than does the child; a man at 
work more than one at rest; an emaciated individual less 
than when he was in robust condition. The selection of 
a proper diet is dependent upon a knowledge of the 
amount of the four alimentary substances-proteins, car- 
bohydrates, fats, and vitamins-necessary to maintain the 
nutritive equilibrium and consequently the body weight. 
Dietaries are formulated by computing the quantities 
of the alimentary principles required under special con- 
ditions. 
Protein.-The quantity of protein disintegrated daily 
by a fasting healthy individual weighing 70 kilograms is 
60 grams; it is obvious, therefore, that at least this amount 
should always be present in every computed dietary. 
Ordinarily from 100 to 125 grams of protein are con- 
sumed daily. As has been stated elsewhere, 1 gram of 
fat can replace 2.4 grams of protein or carbohydrates 
and the protein can replace and be partly replaced by the 
carbohydrates and fats. Fats and carbohydrates are, 
therefore, protein economizers. That part of the protein, 
however, required for organization of the body cannot be 
replaced by the carbohydrates or fats. 
how Protein Standards.-Chittenden and others 
believe that the best diet is that which contains the small- 
est amount needed to maintain life, together with fat and 
carbohydrates to cover the needed calories. They urge 
that health and weight may be maintained on this, and CHEMISTRY AND PHYSIOLOGY OF DIGESTION. 
31 
that mental and physical efficiency is greater than when 
more food is taken. They believe that the protein is oxi- 
dized by the formation of substances more or less difficult 
of excretion, and that the presence and excretion of these 
products increase the wear and tear of the body without 
increasing its efficiency. There is no question that such 
diets may be taken and the individual still maintain 
health, and the experiments are of especial value in teach- 
ing us that in various diseases, such as gout, nephritis, 
and others in which it is desirable to reduce the protein 
to a minimum, that small amounts of protein are not in- 
compatible with health and efficiency. There would seem 
to be certain objections to the continued use of a diet 
very low in protein, and it has been suggested that it 
renders the body less resistant to infection, and that it 
may also ultimately cause certain disturbances of metab- 
olism. In certain cases the increased amounts of fat 
and carbohydrates necessary may mean undesirable bulk 
and strain on the digestive organs. 
Protein Optimum.-The best amount of protein for 
an individual is still an open question. For a person of 
average size it is probably not well to go over 120 grams 
a day or under 60. This leaves a rather wide range, and 
it is safe to say that the optimum lies between the two. 
In certain diseases, as in tuberculosis, increases may be 
made above the maximum limit, and in certain diseases, 
as in nephritis and fevers, the amount may be reduced. 
In some diseases the kind of protein is a matter of con- 
siderable importance, and this is probably true of gout. 
Purin Metabolism. (See also Gout?)-Certain forms 
of protein contain nitrogen in a form called the purin 
basis or purin bodies. These substances occur in such 
foods as liver and sweet bread, and is, to a somewhat less 
extent, in other meats, and they are also found in legumes 32 
DIETETICS FOR NURSES. 
and in some other food. The products from these bodies 
are difficult of excretion, and in certain diseases it is a 
good thing to lessen the amount taken, particularly in 
nephritis and gout. The foods which contain the largest 
amounts are of the meats, liver, kidney, sweet breads, 
and beef tea and pigeon; of the fish, herring, sardines, 
sardellen, and anchovis; of vegetables, mushrooms and 
spinach, although there is less in these substances than 
in ordinary meat. Peas, beans, and lentils of various 
kinds also contain considerable amounts, while milk, 
cheese and eggs, most vegetables, fruit, cereals, and bread- 
stuffs are free from purin nitrogen. There is a question 
about oatmeal, and it is generally ordered omitted from 
diets where the excretion of nitrogen is difficult. 
Carbohydrates and Fats.-Carbohydrates diminish 
nitrogenous waste and are also sparers of the fats, 240 
grams of carbohydrates being equal to 100 grams of 
fat. If 100 grams of protein are taken and absorbed 
with 600 grams of carbohydrates, the amount of fat can 
be completely protected. Fat alone, however, cannot 
check the waste of the nitrogenous tissues. The inges- 
tion of large quantities of fat increases the accumulation 
of fat in the body, and this continues until the quantity 
administered reaches 300 grams, when no more can be 
digested. Gelatin is a valuable protector of protein, 100 
grams of gelatin being equivalent to about 35 grams of 
protein or 200 grams of carbohydrates; it does not, 
however, protect against fat loss so well as do carbo- 
hydrates or fat, 100 grams of gelatin being equiva- 
lent to about 25 grams of fat. Ordinarily about 500 
grams of carbohydrates and 50 grams of fat are consumed 
daily. 
Protein, Carbohydrates, and Fats in Combina- 
tion.-If fat is combined with the protein, less than half CHEMISTRY AND PHYSIOLOGY OF DIGESTION. 
33 
the quantity of protein is required to maintain the nitrog- 
enous equilibrium. If more protein, fat, or carbohy- 
drate be supplied under these conditions, fat will be de- 
posited in the tissues. Inasmuch as food contains a vari- 
able proportion of proteins, carbohydrates, and fats 
combined, the food-value must be determined from the 
standpoint of the combined effect of the three alimentary 
principles contained therein. 
In order to supply the requirements of the organism 
a certain amount of potential energy is needed to over- 
balance the amount dissipated in waste and in the pro- 
duction of body-heat. More potential energy is consumed 
during work than when the individual is at rest. The 
following table, computed by Rubner, shows the daily 
heat consumption, in units of heat (calories), in an adult, 
weighing 65 kilograms: 
During rest in bed .... 1800 calories or 28 calories per kilo. 
In repose 2100 " " 32 " " " 
In light work 2300 " " 33 " " " 
In moderate work .... 2600 " " 40 " " " 
In hard work 3100 " " 48 " " " 
From Rubner's investigations we learn that1- 
1 gm. of protein = 4.1 calories. 
I gm. of fat = 9.3 " 
I gm. of carbohydrates = 4.1 " 
It has also been determined that 1 gram of alcohol 
equals 7 calories. In other words, the number of grams 
of proteins, fats, and carbohydrates required daily can be 
converted into their calorimetric equivalents, and inas- 
much as we have already seen that the alimentary princi- 
ples can in a degree be substituted for one another (law 
of isodynamics), the daily food requirements can be easily 
1 Compare Atwater's determinations on p. I J, Dietary computations 
differ slightly, owing to the fact that some use Rubner's standards and 
some Atwater's. 34 
DIETETICS FOR NURSES. 
estimated in calories of heat. Thus, in order to calculate 
the caloric value of any food in preparing a dietary, the 
number of grams of proteins contained are multiplied by 
4.1 ; the number of grams of fat by 9.3 ; and the number 
of grams of carbohydrates by 4.1; the total is then ascer- 
tained by adding. Bearing the weight of the individual 
in mind, a dietary can easily be constructed according to 
the following method: 
The quantity of protein consumed daily is loo gm. X = 410 
" " carbohydrates " " 500 " X4 I = 2O5° 
" " fats " " 50 " X 9-3 = 465 
2925 
The average number of calories required daily in an 
individual, according to this calculation, is therefore 3000. 
While diet-lists are easily prepared according to the 
method just outlined, it must always be remembered that 
the digestibility and absorbability of food play a most 
important role and are not to be neglected in formulating 
the dietary; for while a certain food may contain a great 
many more calories than an equal weight of another 
food, yet its relative indigestibility makes it less available 
as an article of diet. For example, while 4 ounces of 
sausage produce 510 heat calories, 4 ounces of cheese 
520, and 4 ounces of beef only 280, yet the beef is far 
more digestible than either the sausage or cheese, and 
thus more valuable as an article of food. As has been 
aptly said, " We live not upon what we eat, but upon 
what we digest." Therefore, a diet-list giving quantities 
of food principles or calories is useful only as it suggests 
general principles that may be modified to meet individual 
conditions in health and in disease. 
The following is a very instructive table, compiled by 
Cautley in Sunderland's System of Diet and Dietetics: CHEMISTRY AND PHYSIOLOGY OF DIGESTION. 
35 
0-5- 
5-io. 
10-20. 
20-30. 
30-40. 
40-50. 
50-60. 
60-70. 
70-80. 
80-90. 
90-100. 
100-125. 
Over 125. 
Vegetable 
marrow. 
Spinach. 
Seakale. 
Onion. 
Turnip. 
Savoy 
cabbage. 
Cauli- 
flower. 
Parsnip. 
Beetroot. 
Carrot. 
Scarlet- 
runner 
(un- 
cooked). 
Celery. 
Cucum- 
ber. 
Lettuce. 
Tomato. 
Radish. 
Butter- 
milk. 
Aspara- 
gus. 
Broccoli. 
Artichoke. 
Broad 
beans. 
Green 
peas. 
Brussel 
sprouts. 
W ater- 
melon. 
Whey. 
Leeks. 
Salsify. 
Green arti- 
choke. 
Petit pois. 
Haricot 
beans. 
Beetroot 
(uncooked). 
Strawberry. 
Pineapple. 
Lemon. 
Cranberry. 
Orange. 
Raspberry. 
Blackberry. 
Apricot. 
Apple. 
Pear. 
Nectarine. 
Benger's 
food 
(cooked). 
Most farina- 
ceous 
foods. 
Koumiss 
Egg-white. 
Hake. 
Potatoes. 
Cherries. 
Prunes. 
Figs. 
Grapes. 
Bananas. 
Crab 
(tinned). 
Lobster 
(tinned). 
Smelts. 
Dory. 
Sole. 
Whiting. 
Plaice. 
Turbot. 
Cod. 
Lemon 
sole. 
Tea. 
Jam. 
Milk. 
Baked 
beans. 
Lentils. 
Macaroni. 
Scotch 
oatmeal. 
Haddock. 
Gurnet. 
Trout. 
Roach. 
Red mul- 
let. 
Halibut. 
Jam. 
Dried 
peas. 
Whole 
egg. 
Mackerel. 
Brill. 
Lobster 
(potted). 
Crab 
(potted). 
Sprats. 
Salmon. 
Herring. 
Tunny. 
Chicken 
(fricas- 
seed). 
Coffee. 
Breads: 
Daren. 
Manhu. 
Cytos. 
Hovis. 
Brown. 
Salt her- 
rings. 
Eels. 
Roast 
lamb. 
Roast 
beef. 
Veal cut- 
lets. 
Roast 
veal. 
Arrow- 
root. 
Breads 
(white). 
Berma- 
line. 
Graham. 
Pork 
sausage. 
German 
sausage. 
Toffee. 
Sardines. 
Roast tur- 
key. 
Mutton 
(legs, 
roasted 
or boiled). 
Ham. 
Cheese 
(Dutch). 
Camembert. 
Chestnuts. 
Treacle. 
Roast 
pork. 
Brie 
cheese. 
Parmesan 
cheese. 
Currants 
(dried). 
Figs 
(dried). 
Filberts. 
Maple 
sugar. 
Egg yolk. 
Polony. 
Roast mut- 
ton. 
Uncooked 
cereals. 
Milk. 
Cream 
cheese. 
Gorgonzola 
cheese. 
Cheddar 
cheese. 
Gruyere 
cheese. 
Cheshire 
cheese. 
Gloucester 
cheese. 
American 
cheese. 
Roquefort 
cheese. 
Raisins. 
Dates. 
Walnuts. 
Cocoanut. 
Cane-sugar. 
Beet-sugar. 
Honey. 
Bacon 
(ribs). 
Stilton 
cheese. 
Neuchatel 
cheese. 
Peanuts. 
Sweet 
almonds. 
Cocoas. 
Chocolate. 
Butter. 
The Caloric Value of Common Foods per Ounce. 
(Meat, fish, and cereals are cooked. Vegetables are boiled.) 36 
DIETETICS FOR NURSES. 
The following table, taken from Mrs. E. H. Richards, 
gives an ideal ration of solid food. For a further con- 
sideration for the method of computing dietaries the 
reader is referred to Mrs. Richards' admirable little work, 
entitled The Dietary Computer: 
An Ideal Ration of Solid Food.-{Mrs. E. H. Richards.') 
Material. 
Amounts. 
Protein. 
Fat. 
Carbo- 
hydrates. 
Calor- 
ies. 
Gm. 
Oz. 
Gm. 
Oz. 
Gm. 
Oz. 
Gm. 
Oz. 
Bread 
453-6 
16 
3*-75 
1.12 
2.26 
0.08 
257.28 
4.04 
1206.82 
Meat 
226.8 
8 
3402 
I.2O 
11.34 
0.40 
243-72 
Oysters 
226.8 
8 
12.42 
0.44 
2.04 
0.07 
70.01 
Breakfast cocoa . . . 
28.3 
6.60 
0.23 
7-50 
0.26 
9.60 
0.34 
135-42 
Milk 
"3-4 
4 
3 63 
0.13 
4.42 
0.16 
4.88 
0.17 
75-55 
Broth 
453-6 
16 
18.14 
0.64 
18.14 
0.64 
90.72 
3.20 
613.21 
Sugar 
28.3 
I 
27.36 
0.96 
FI2.I7 
Butter 
14.17 
Ji 
0.14 
12.27 
118.62 
Total 
106.80 
57-97 
389.80 
2574-60 
Nutritive Ratio.-In order to give some idea of the 
value in nitrogen or protein to the other constituents of 
the food, what is called the nutritive ratio is often stated 
in speaking of diet or foods. 
This may be expressed as 
Protein : Carbohydrate + 2^ Fat : : I : x 
„ Carbohydrate + 2j^ Fat 
r' Protein. 
In other words, it expresses the ratio between the amount 
of digestible protein and the amount of digestible carbo- 
hydrates plus the digestible fats. The fats are expressed 
in terms of carbohydrates, and I gram of fat is considered 
equal to grams of carbohydrate. For example, in 
Voit's standard dietary, there is 
Protein 118 grams. 
Fats 56 " 
Carbohydrates 500 " CHEMISTRY AND PHYSIOLOGY OF DIGESTION. 
37 
The digestible part may be obtained by using the co- 
efficients of digestibility, and we find these amounts: 
Digestible protein Il6 x 0.92 = 108.56 
Digestible fat 56 x 0.95 = 53.20 
Digestible carbohydrates 500 x 0.97 = 485 
The fat in terms of carbohydrates is 52.20 X 2.25 = 
119.7. 
The total fat and carbohydrate in terms of carbohy- 
drates is 485 + 119.7 = 604.7. 
The nutritive ratio is 108.56 : 604.7 or 1 : 5.5. 
Under ordinary conditions the ratio should not vary 
below 5 nor above 7. Of late the tendency is to widen 
the ratio, that is, to increase the carbohydrate factor. 
The table on pages 38 and 39 was prepared by the 
nurses in the class in dietetics in the Johns Hopkins 
Training School. It shows the method used in deter- 
mining the fuel-value of the food per capita. 38 
DIETETICS FOR NURSES. 
Materials. 
Weight, grams. 
Protein 
grams. 
Fat 
grams. 
Carbo- 
hydrate 
grams. 
Protein 
calories. 
Fat 
calories. 
Carbo- 
hydrate 
calories. 
Total 
calories. 
Oranges 
31,837 G50 oranges) 
186 
31.0 
2,646 
765 
289 
10,848 
11,904 
Wheatena 
2,547 (5 lbs. 10 oz.) 
282 
43-0 
1,922 
i,i59 
402 
7,884 
9,445 
Eggs in shell 
9,966 (175 eggs) . . 
1,309 
948.0 
5,367 
8,818 
14,185 
Bouillon 
43,468 (24 quarts) . . 
956 
43 0 
86 
3,920 
404 
356 
4,681 
Chickens, roasting . . . 
33,960 (75 lbs.) . . . 
6,554 
5535-0 
26,872 
57,480 
78,352 
Butter 
679 
6 
577 ° 
27 
5,369 
5,396 
Butter 
453 
4 
384-0 
18 
3,579 
3,597 
Flour 
283 
3° 
3-o 
212 
125 
28 
869 
1,023 
Potatoes, mashed .... 
19,026 bushel) . 
344 
18.0 
2,801 
1,412 
175 
11,485 
13,073 
Milk 
2,718 
9° 
108.0 
136 
369 
1,009 
558 
1,937 
Butter 
679 
678 
577-o 
27 
5,369 
5,396 
Beans, dried lima .... 
3,171 (7 quarts) . . 
573 
47-o 
12,089 
2,353 
442 
8,567 
11,363 
Butter 
453 
4 
384.0 
18 
3,579 
3,597 
Radishes 
4,53° 
41 
4.0 
181 
168 
4i 
778 
988 
fruit jelly ; 
Gelatine 
268 
226 
0.2 
927 
2 
93° 
Sugar 
2,716 
2.7l6 
xi.138 
11,138 
Lemons 
i,358 (3 doz.) . . . 
13 
90 
115 
55 
88 
473 
616 
Oranges 
4,983 (2 doz.) . . . 
29 
4.0 
424 
121 
40 
1,73° 
1,893 
Bananas 
2,716 (2 doz.) . . . 
21 
10.0 
380 
89 
100 
i,S59 
1,749 
Strawberries 
905 (2 lbs.) . . . 
8 
5-o 
63 
34 
50 
259 
343 
Custard: 
Milk 
6,339 ....... 
209 
253-0 
316 
857 
2,357 
1,299 
4,515 
Eggs 
1,132 
144 
109.0 
589 
1,010 
1,599 
Sugar 
9°5 
905 
3,712 
3,712 
Sponge cake: 
Sugar 
2,264 
2,264 
9,282 
9,282 
Eggs 
3,396 
432 
327-0 
1,767 
3,030 
4,797 
Flour 
2,264 
245 
25.0 
1,696 
1,004 
232 
6,955 
8,193 
Beef, rib roast, cold . . . 
q,o6o (20 lbs.A . . . 
1,539 
2408.0 
3,812 
22,402 
26,214 
Egg salad: 
Eggs 
9,966 (175 eggs) . . 
1,309 
948.0 
5,267 
8,818 
14,185 
Lettuce 
2,264 
22 
4-o 
56 
92 
42 
229 
363 
Table Showing the Method of Computing the Full Value of Foods in a Given Diet List. CHEMISTRY AND PHYSIOLOGY OF DIGESTION. 
39 
Boiled dressing: 
Eggs 
Milk 
Sugar 
Butter 
Strawberries 
Macaroons 
Butter 
Sugar 
Bread 
Cocoa 
Milk 
Rolls 
849 
1,811 
"3 
226 
19,017 (42 lbs.) . . . 
2,356 . . 
8,154 (18 lbs.) . . . 
9,702 ....... 
'9,932 (50 loaves) . . 
634 (1 lb. 6 oz.) . 
45,280 (12% gallons) 
13,590 (20 doz. rolls) 
125 
59 
2 
171 
153 
8l 
1,857 
137 
i,494 
1,209 
89.0 
72.0 
192.0 
114.0 
358.0 
6937-0 
238.0 
183.0 
1811.0 
557-o 
9° 
1'3 
',33' 
1,536 
9,702 
10,516 
239 
2,264 
7,7°5 
5i5 
245 
9 
701 
628 
332 
7,6'3 
563 
6,126 
4,958 
829 
6/3 
1,789 
1,061 
3,332 
64,532 
2,210 
1,706 
16,834 
5,181 
371 
464 
5,458 
6,300 
39,781 
43,116 
982 
9,282 
3',592 
1,344 
1,290 
464 
1,798 
7,220 
10,259 
64,864 
39,78i 
52,939 
3,250 
32,252 
4b733 
Totals 
79,004 
223,302 
215,121 
517,427 
Protein 
grams. 
Fat 
grams. 
Carbo- 
hydrate 
grams. 
Protein 
calories. 
Fat 
calories. 
Carbo- 
hydrate 
calories. 
Total 
calories. 
Atwater . . . 
125 
125 
45° 
512.5 
1162.5 
1845 
3520.0 
Hutchison . . 
125 
50 
500 
512.5 
465-0 
2050 
3027.5 
Mrs. Richards 
Maximum 
Minimum 
125 
IIO 
125 
90 
450 
420 
512.5 
451.0 
1162.5 
837.0 
1845 
1722 
3520 0 
3000.0 
Standard nutritive ratio: Atwater, 1 : 5.5; Hutchison, 1 : 5.3. 
Authorities referred to for food composition: The Chemical Composition of American Food Materials, W. O. Atwater; Dietary Computer, 
Ellen H. Richards. 
The above results were obtained by the students of the Class in Dietetics. The menu was the one used in the Nurses' Home, May 1, 1904. 
Nutritive ratio (ratio of proteins to fats and carbohydrates), 1 ; 5.5. Fuel-value per person, 3449 calories. 
Standard Amounts of the Different Nutritive Constituents Required Daily, According to the Following Authorities. 
Proteid 
grams. 
Fat 
grams. 
Carbo- 
hydrate 
grams. 
Protein 
calories. 
Fat 
calories. 
Carbo- 
hydrate 
calories. 
Total 
calories 
per capita. 
128 
160 
35° 
525 
1,488 
1,435 
3,449 
Summary of the Different Nutritive Constituents per Capita. CHAPTER IL 
CLASSES OF FOODS. 
Animal foods contain much digestible matter, chiefly 
proteins, a considerable quantity of fat, in some foods 
carbohydrates, and, in addition, water and mineral salts. 
Being thoroughly digested, they leave but little residue 
in the intestine. The various forms of animal foods- 
milk, meat, fish, and gelatin-will now be described. 
ANIMAL FOODS. 
MILK AND MILK PRODUCTION. 
Milk, the most important of animal foods, contains all 
the elements necessary for the maintenance of life, and 
constitutes a complete food. 
Composition.-Milk contains varying proportions of 
each of the four classes of food principles, protein, fats, 
carbohydrates, and mineral salts, and 84 to 90 per cent, 
of water, this latter varying with the quality of the milk. 
In a general way this is true of all milks, which are more 
or less alike, but which contain different percentages of 
the constituents. 
Milk forms the exclusive diet for young, growing 
mammals, but owing to the fact that the proportions of 
protein and fat are in excess of the carbohydrates, it is 
unsuited as an exclusive diet for adults. Unless other- 
wise stated, cows' milk is meant by milk in this volume. 
Cows' milk is most extensively used for food, but the 
milk of goats, asses, and some other animals is used to 
some extent. Fresh cows' milk has a sweetish taste, a 
40 CLASSES OF FOODS. 
41 
characteristic odor, and is yellowish white in color. On 
standing it separates in two distinct layers, the upper 
being more yellow in color, of lighter specific gravity, 
and containing more fat. For dietetic purposes it is well 
to think of cream as milk containing varying proportions 
of fat. The lower part, called skim milk after the re- 
moval of the cream, is of a bluish-white color, and may 
be considered relatively free from fat. 
The specific gravity of milk varies from 1.027 to 1.035, 
and it freezes at a slightly lower temperature than water. 
Freshly drawn, the milk of most carnivora is acid to the 
litmus reaction, human milk is usually alkaline, though 
not always, and cows' milk usually neither one nor the 
other, but becoming acid' soon after milking. 
The principal nitrogenous compound of milk is casein, 
which differs from the other protein compounds in that it 
contains both phosphorous and sulphur. Milk also con- 
tains other proteins, as lactalbumin, which is similar to 
the serum albumin of the blood. The total proteins aver- 
ages about 3.3 per cent, of the bulk of the milk, or about 
25 per cent, of the total solids. The fats of milk consist 
of the glycerids of palmitic, stearic, and oleic acids. The 
fat is suspended in the milk in the form of minute glob- 
ules, which give the milk its white color and opacity. The 
fat globules in some milks are larger than in others, and 
they are smallest from a herd of mixed common cows 
and largest in the milk of Jerseys and Guernseys. Fat 
averages about 4 per cent, of the milk, or about 31 per 
cent, of the total solids. 
The chief carbohydrate of milk is lactose, or milk-sugar, 
which is not nearly so sweet as ordinary sugar, and is less 
soluble in water. In the presence of the lactic acid bacil- 
lus it is converted into lactic acid, which causes the milk 42 
DIETETICS FOR NURSES. 
to turn sour. Lactose forms about 38 per cent, of the 
total solids. 
Milk contains about 0.7 per cent, of salts, which exist 
chiefly in the form of phosphates, chlorides, and sulphates. 
Calcium salts, which are found in the milk, are very es- 
sential to young, growing animals, inasmuch as they play 
a very important part in the formation of bone. 
Variations in Milk.-There are wide variations in 
the composition of the milk of different animals. While 
human milk contains more sugar and less protein than 
cows' milk, the full value is about the same. Dogs' milk 
seems to be the richest, while that which comes from the 
horse is exceedingly poor, as may be seen from the fol- 
lowing table: 
Comparative Composition of Various Kinds of Milk.x 
Kind of milk. 
Water. 
Total 
solids. 
Total solids. 
Fuel- 
value 
per 
pound. 
Protein. 
Fat. 
Carbo- 
hydrates 
(milk- 
sugar) . 
Mineral 
matters 
(ash). 
Ca- 
sein. 
Albu- 
min. 
Total 
pro- 
tein. 
Per ct. 
Per ct. 
Pr ct. 
Pr ct. 
Pr ct. 
Pr ct. 
Per ct. 
Perct. 
Calor- 
ies. 
Woman . . . 
87-4 
12.6 
1.0 
*•3 
2-3 
38 
6.2 
o-3 
3*9 
Cow .... 
87.2 
12.8 
30 
0.5 
3-5 
3-7 
4 9 
°-7 
313 
Dog .... 
75-4 
24.6 
6.1 
5-i 
II.2 
9.6 
3-i 
0.7 
671 
Ewe .... 
80.8 
19.2 
5-° 
i-5 
6.5 
6.9 
4-9 
0.9 
5°3 
Buffalo . . . 
81.4 
18.6 
58 
o-3 
6.1 
7 5 
41 
0.9 
506 
Cat 
82.1 
17.9 
3-1 
6.0 
9.1 
3-3 
4-9 
0.6 
400 
Goat .... 
85-7 
143 
3-2 
4 3 
4-8 
4-4 
0.8 
36s 
Llama . . . 
86.5 
135 
3-o 
0.9 
3-9 
3-2 
5-6 
0.8 
312 
Ass 
89.6 
10.4 
0.7 
1.6 
2-3 
1.6 
6.0 
o-5 
222 
Mare .... 
9'-5 
8.5 
0.1 
i-3 
1.2 
5-7 
°3 
180 
Not only is there a wide variation in the milk of differ- 
ent animals, but cows' milk itself is subject to great 
changes in the percentage composition of its ingredients. 
These may be attributed to many causes, the breed and 
1 Konig, Chemie der menschlichen Nahrungs- und Genussmittel, 3d ed., 
vol. i., pp. 267-362. CLASSES OF FOODS. 
43 
conditions of the animals, and the food and care they 
receive being responsible, in a great degree, for these 
changes. As a rule, a young cow gives better milk than 
an old one, and a well-fed animal yields richer milk than 
one that is poorly fed. The milk flow is greater shortly 
after calving, but the milk increases in richness as the 
quantity becomes smaller. Milk also contains certain 
ferments, and there may be specific ferments which ex- 
plains the desirability of milk of a particular species as 
food for animals belonging to it. 
Action of Heat.-The amount of change taking 
place in milk on heating depends upon the degree of heat 
and length of exposure. Heating up to 6o° C. does not 
appreciably change the appearance or taste, although 
some changes, which defy detection, evidently occur. 
When milk reaches a little over 6o° C., a scum, composed 
largely of fatty matter and casein, forms on the surface. 
Acid milks are coagulated more easily and more quickly 
than milk which is not acid. Boiling milk changes its 
taste and color, the cream will not rise as quickly, if at 
all, and it is less easily coagulated by the action of rennet, 
and less easily pancreatized. The change in color is due 
to the production of a certain amount of caramel from 
the milk-sugar. Some of the more complicated com- 
pounds are broken up and some of the salts are pre- 
cipitated. 
Sterilisation and Pasteurisation.-Heat is em- 
ployed very frequently in keeping milk, and there are 
two methods in vogue, spoken of as sterilization and 
pasteurization. 
Sterilization of milk is accomplished either by boiling, 
preferably in the vessel in which it is to be kept, or by 
placing the bottles. in one of the numerous forms of 44 
DIETETICS FOR NURSES. 
sterilizers that are on the market. The essential part of 
the process is that the milk is heated to 212° F., and 
maintained at that temperature, or 
for ten minutes or longer, suffi- 
cient to kill off the living bacteria 
which the milk contains. It is to 
be noted, however, that the spores 
and spore-bearing bacteria are 
not killed by this temperature, 
and that if the milk is kept under 
suitable conditions for bacterial 
growth, bacteria will develop from 
the spores and the milk may 
spoil in consequence. 
In order to secure perfectly 
sterile milk it is, therefore, neces- 
sary to repeat the sterilization 
three times on three successive days. In practical work 
this is rarely done, except in the production of culture- 
media for bacterial researches or in preparing milk for long 
voyages. Ordinarily, milk heated once and then kept cold, 
400 or under, will keep perfectly well till the length of time 
required in its ordinary consumption. There are certain 
objections to sterilized milk. Certain changes are pro- 
duced in the milk which have been detailed under the 
heading of the " Effects of Heat." Sterilizing also kills 
all the ferments, and places the milk in the class of life- 
less foods. Sterilizing on a large scale has never become 
popular in America, perhaps on account of the change in 
taste and the added expense. It may be used with 
advantage, however, in keeping milk in very hot weather, 
especially when the ice supply is deficient. 
By pasteurization is meant the process by which the 
Fig. i.-Arnold sterilizer. CLASSES OF FOODS. 
45 
milk is rendered more or less sterile by heating to 
167° F., and in some instances to a lower temperature, 
maintaining this degree of heat for from twenty to forty- 
five minutes, and then cooling the milk rapidly to 400 or 
450, or lower. This degree of temperature is sufficient 
to kill off most of the bacteria, and especially the patho- 
genic bacteria, but it does not render the milk absolutely 
sterile, so that it does not keep as well as that which has 
been heated to a higher temperature. It has the advan- 
tage, however, of not changing materially the com- 
position of the milk. Pasteurized milk should be kept 
cold or it will spoil nearly as rapidly as unheated milk. 
It is useful in summer, and in keeping milk which is to 
be fed to babies, and is being used at the present time 
very extensively for keeping commercial milk. In the 
household, for the purpose of infant feeding, pasteurization 
is done in two ways. Best, by using one of the special 
forms of pasteurizers, such as Freeman's, which consists 
of two parts, a pail for the water and receptacle for the 
bottles of milk. The pail is a simple pail with a cover; 
there is a groove extending around the pail to indicate 
the level to which it is to be filled with water, and sup- 
ports inside for the receptacle for the bottles of milk to 
rest on. The receptacle for the bottles of milk consists 
of a series of hollow zinc cylinders fastened together; 
this fits into the pail, so that the lower end of the 
cylinders is immersed in the water. This receptacle has 
two sets of horizontal supports, the upper set continuous 
around the receptacle, for use while the milk is being 
heated; the lower interrupted set is used for raising the 
receptacle during cooling. Such receptacles are made 
for ten 6-ounce bottles, seven 8-ounce bottles, three 
1-pint and one |-pint bottles, and two 1-quart bottles. 46 
DIETETICS FOR NURSES. 
There is also a large apparatus for the use of hospitals 
or public institutions, which has a receptacle for forty- 
three 6-ounce or 8-ounce bottles. 
The apparatus is used in the following way: The pail 
is filled to the level of the groove with water, covered, 
and put on the stove, the receptacle for the bottles being 
left out. The bottles of milk are then filled, stoppered 
with cotton, and dropped into their places in the cylinders. 
Sufficient water is poured into each cylinder to surround 
Fig. 2.-Freeman's Pasteurizer. 
the body of the bottle. As soon as the water in the pail 
boils thoroughly it is taken from the stove and set on a 
mat or table, or other non-conductor, in a place where 
there is not a draft of wind blowing on it. The lid of 
the pail is removed and the receptacle placed on the 
upper continuous supports. The lid is then rapidly put 
on the pail, and the pail is thus allowed to stand for 
three-quarters of an hour. During the first fifteen 
minutes the temperature of the milk rises to about its 
maximum, or above 65° C., the point desired for pas- 
teurizing, and remains there the remaining thirty minutes. 
During the last fifteen minutes the cover of the pail is 
removed, the receptacle is lifted and given a turn so as to 
rest on the lower supports, thus bringing the top of the CLASSES OF FOODS. 
47 
cylinders containing the bottles above the level of the 
pail. The pail is then put under a cold-water faucet, and 
the water is allowed to run into the pail and overflow, but 
it should not run into the cylinders. Thus the hot 
water is replaced by cold water, and in fifteen minutes the 
milk in the bottles is of about the temperature of the cold 
water used. The bottles may then be put into a refrig- 
erator until required for feeding. This rapid cooling is a 
most important part of a low-temperature sterilization, 
the importance of which is apt to be overlooked. 
When there is no special apparatus at hand, reasonably 
good results may be obtained by placing the milk bottles 
in a pail, filling the pail to the height of the milk in the 
bottles, and bringing just to a boil, then setting to one side 
for thirty minutes. In commercial pasteurization special 
forms of apparatus are used, in which large quantities of 
milk may be heated to the required temperature for 
twenty minutes. 
The advantages of pasteurization are that it is a cheap 
and effective method of preventing the ordinary infectious 
diseases, which may at times be spread by milk, and 
doubtless lessens the number of cases of infantile 
diarrhea. It should be remembered that pasteurization 
cannot make bad milk good or dirty milk clean, and 
when used for infants or invalids it must be modified in 
the same manner as unheated milk. 
The disadvantages of pasteurized milk are that it is 
usually done a long way from the place of production, 
the milk may be spoiled before it is pasteurized, and while 
the bacteria are for the most part killed, the toxins, which 
may have been formed, are not destroyed, and so dan- 
gerous milk may be sold for good milk. This is, however, 
counterbalanced by the real lessening of infantile diarrhea. 48 
DIETETICS FOR NURSES. 
Another disadvantage is that the milk producer is apt to 
become careless and trust to pasteurization to kill off the 
bacteria, instead of using cold and cleanliness. Pasteur- 
ized milk is popularly supposed to be less digestible than 
unheated milk, especially for infants. The difference in 
digestibility of pasteurized and unheated milk is certainly 
slight, but the best results in infant feeding are obtained 
with unheated milk. We are of the decided opinion that 
unheated milk is far superior in the long run where it can 
be obtained of sufficient purity to permit of its use. 
There are other objections sometimes urged, such as it 
favors the development of scurvy. This is evidently 
true, but is a lesser evil than diarrhea. 
For infant feeding, unheated milk, when good milk can 
be obtained and can be kept cold, is best of all. If the 
weather is warm and the milk not above suspicion, it 
should be pasteurized. The average city milk in sum- 
mer should be pasteurized. Sterilizing may be resorted 
to where the milk supply is very poor and where the ice 
supply is deficient, and where it has been found that the 
milk will not keep without it. 
Sterilizing milk under pressure is rarely resorted to 
outside of laboratories. A temperature of 220° F. for 
thirty minutes is ordinarily considered to produce sterile 
milk, but sometimes even this is insufficient. 
Digestion of Milk. -When milk enters the stomach 
it is coagulated by the hydrochloric acid and the rennin of 
the gastric juice. These curds, or coagula, consist of pre- 
cipitated casein and a portion of the fat that has become 
entangled in the curd. They vary in size and consistence 
according to the amount and the dilution of the milk 
taken. The casein soon undergoes a change, being con- 
verted into some form of peptone, and the fat is again CLASSES OF FOODS. 
49 
liberated. The albuminous envelope of the fat-globules 
is dissolved and the fat coalesces, forming larger drops, 
in which condition it passes into the duodenum. A por- 
tion of the water and some of the salts are absorbed in 
the stomach. The curd that has not been acted upon by 
the gastric juice, together with the water, salts, and car- 
bohydrates that still remain, also pass into the intestine, 
where their digestion is completed. Boiling increases the 
digestibility of milk, the precipitate being deposited in a 
more flocculent form. If the milk is previously diluted 
with lime-water, barley-water, or one of the aerated 
waters, such as Vichy, the curds formed are smaller and 
softer, and the milk often rendered more palatable. Bread 
and crackers added to milk make a good mechanical 
diluent by mingling with it and maintaining a soft condi- 
tion of the curds. The addition of alkalis may be re- 
sorted to with a view to neutralizing the acids. This has 
the effect of coagulating the casein more slowly, and 
forming flocculi rather than cheesy masses. 
Color of Milk.-Various changes in the color of milk 
are not uncommon, the best known of which is a blue 
milk due to the action of bacteria. Red milk may be due 
to the presence of blood due to injury of the udder or 
mammary gland, to the cows having fed on plants con- 
taining red pigments, such as the madder plant, and, more 
rarely, to the action of bacteria. Green, yellow, chocolate- 
colored, and black milk have been described, and are also 
due to the action of bacteria. 
Slimy or Ropy Milk.-This is a very curious change 
which occasionally takes place in milk, and is due to the 
action of certain bacteria. The milk becomes slimy or 
ropy, and can be drawn out into long, thin threads, even 
as long as ten feet. In some countries, particularly Nor- 50 
DIETETICS FOR NURSES. 
way, slimy milk is produced by the addition of certain 
leaves to the milk and the product used as food; the 
leaves contain the slime-producing bacteria. This change 
is also induced for the manufacture of certain cheeses, 
particularly Edam. 
Bitter Milk.-This is very common, most frequently 
being caused by the cows having fed on plants contain- 
ing bitter substances. It may also occur during the last 
stages of lactation, and sometimes by the presence of cer- 
tain bacteria. 
Alkaline Fermentation of Milk.-Milk which has 
been boiled does not sour through spontaneous fermen- 
tation, but if exposed to the air at ordinary temperature 
it becomes alkaline in reaction, sometimes develops a bit- 
ter taste, and then curdles. Later on the curd dissolves, 
and a more or less clear fluid is left. These changes are 
due to bacteria. 
Flavors in Milk.-The flavor of milk may vary from 
time to time, and this may be due to the food, such things 
as wild onion, even in small quantities, affecting the flavor 
of the milk very markedly; and disorders in the cow may 
also cause unusual flavors for a few days. Milk also ab- 
sorbs odors, and if kept in an ice-box with odoriferous 
substances it may take on their flavor. The growth of 
bacteria also alters the taste of milk very materially, and 
may impart many different flavors to it. 
Bacteria in Milk.-Milk is a most excellent culture- 
medid for bacteria, and most germs grow luxuriously in 
it at the expense of the quality of the milk. The changes 
produced are largely those of decomposition, many of 
them are exceedingly complex, resulting in the production 
of changes in the flavor, odor, color, and the quality of 
the milk. The proteins may become decomposed, the CLASSES OF FOODS. 
51 
sugar converted into gases, alcohol or acids, while the 
fats are but little changed. The number of bacteria in 
milk varies greatly, the very best milk containing but a 
few thousand bacteria per cubic centimeter, while very 
poor milk may contain many millions in the same quan- 
tity. In Rochester, and many other cities, 100,000 per 
cubic centimeter is regarded as the limit in milk fit for 
human food. Milk containing more than this should be 
regarded as unfit for human consumption, and especially 
for infants and young children. The nature of the bac- 
teria present is important, as disease-producing germs are 
dangerous to the public health. As a rule, milk which 
contains but few bacteria will contain none of the disease- 
producing varieties, or but very few, while milk contain- 
ing large numbers of bacteria is very liable to contain 
those which produce disease. Nearly all the disease- 
producing bacteria grow better at or near the body tem- 
perature, and grow slowly, if it at all, in milk which is 
cold enough to prevent the rapid growth of bacteria. To 
prevent bacteria in the milk from increasing it should be 
chilled to 450 or 400 F., and kept at that temperature 
until used. 
Each time milk is handled, such as pouring from one 
vessel to another, there is an increase in the number of 
bacteria. The chief source of bacteria in the milk is from 
the dirt which gets in at the time of milking, and from 
the milk being placed in dirty utensils. 
Souring; of Milk.-With but few exceptions, milk 
will sour in various lengths of time, and it may be re- 
garded as a normal phenomenon. As a matter of fact, 
milk which does not sour under ordinary conditions should 
be regarded with suspicion and tested for preservatives. 
When the milk reaches a certain stage of acidity it DIETETICS FOR NURSES. 
52 
curdles. Ordinarily the souring of milk is due to one or 
two varieties of bacteria, but there are many other bacteria 
which may occasionally cause it to turn. The most com- 
mon cause of the souring is a germ called the lactic acid 
bacillus, which grows best when the milk is kept in deep 
vessels, where the air is more or less excluded. Milk 
soured by this bacillus has a firm clot with a little whey 
on top, and is free from gas. When the curd is broken 
up by shaking, it separates from the whey and sinks to the 
bottom. Such milk has a pleasant acid taste, and is much 
used for food, either as clabber or curds and whey or 
cottage cheese. The next most common acid-producing 
bacteria grows best when the milk is in shallow pans, and 
it produces gas, so that the curd is broken up and con- 
tains gas-bubbles. These bacteria are a source of trouble 
to manufacturers of cheese. 
There is a peculiar belief that a thunder shower will 
sour milk, but it is probable that the conditions which 
produce thunder showers are those favorable to the 
growth of bacteria which sour milk, and during the hot 
weather milk frequently sours apart from thunder storms, 
and also that milk cooled immediately after milking and 
kept properly cooled will not sour during a thunder storm. 
Milk Production.-The production of milk, which 
will keep a reasonable length of time and be free from 
objectionable features, is a comparatively simple matter, 
but it requires care and constant supervision and is best 
undertaken by persons trained in dairying. The first con- 
sideration is the cow herself, and to produce good, pure 
milk the cow must be healthy and must be kept clean. 
Sick cattle should be separated from the herd, and if a 
herd is to be kept free from tuberculosis, no cow should 
be added to it without first having been tested by tuber- CLASSES OF FOODS. 
53 
culin, and the entire herd should be tested from time to 
time. The cow should be groomed regularly, the same 
as a horse, the oftener the better, and this reduces the 
bacterial contamination of milk very materially. Some 
dairymen cut off the longer hairs about the flanks and tail 
to lessen the danger of having them soiled with feces. 
The grooming should be done before milking, and the 
cow should not be allowed to lie down until she has been 
milked. The stables should be clean, light, and airy, and 
a special milking-room is desirable, unless the barn is of 
good construction and of sufficient size. Anything 
which stirs up dust should be avoided. The barnyard 
should be kept clean and drained. The employees should 
be healthy and clean, and the hands should be thoroughly 
scrubbed before milking. Many large dairy farms supply 
sterile suits to their employees to be worn at milking 
time. No one who has, or who has recently had, or who 
is associated in any way with any contagious disease, 
should be allowed to have anything whatever to do with 
the milk production. 
The milk pails and all milk receptacles should be kept 
clean, and scalded as thoroughly as possible, and steril- 
izing with live steam should be done wherever practicable. 
The water supply of the dairy is of great importance, and 
many large dairy companies now insist upon special 
examination of the water and water-supply before re- 
ceiving milk from farms. 
Specially constructed milk pails, which, in a large 
measure prevent the dirt and dust from falling into the 
milk, are sometimes used, and assist in reducing the con- 
tamination of the milk. 
The Transportation and Delivery of Milk.- 
This cannot be fully considered here, but it may be 54 
DIETETICS FOR NURSES. 
stated that the milk should be transported in sterile cans 
or bottles; that the pouring of milk from one can to 
another, or to bottles, should only be allowed in a room 
provided especially for that purpose, free from dust and 
other source of contamination. The milk should be 
kept cold the entire time until it reaches the consumer, 
and by him until used. The selling of milk from open 
cans in grocery and provision shops should be pro- 
hibited. The safest method of marketing milk is in 
sealed bottles, and, unless some other solution of the 
problem offers, this should be the only way. Selling 
from cans, the way it is done in the United States, is open 
to a number of objections, but the public has not been 
educated to demand pure bottled milk, although much 
has been done in this direction. 
Adulteration of Milk.-The most frequent adulter- 
ation of milk consists in the removal of part of the cream 
and adding water. In other instances, good milk and 
skim milk are mixed together; in both instances the 
consumer is robbed by paying for an article of food which 
does not have the nutritive value it is commonly sup- 
posed to possess. The addition of water brings the 
added danger of contaminating the milk, as a milk dealer, 
sufficiently unscrupulous to add water to his milk, would 
be apt to disregard the character of water used, and, as a 
matter of fact, a number of typhoid epidemics have been 
caused in this way. Milk is artificially colored, but this 
practice is not common, as is popularly supposed. Al- 
most all communities have laws forbidding the adulter- 
ation of milk in any way. 
The Use of Preservatives.-Chemical preserva- 
tives are frequently added to the milk to prevent the 
growth of bacteria, and it is done after the milk has CLASSES OF FOODS. 
55 
partly spoiled. The most frequently used articles are: 
formaldehyd, boric acid, borax, salicylic acid, and benzoic 
acid. But small amounts are needed to check the growth 
of bacteria, but the unscrupulous dealer usually adds a 
great deal more than is necessary. Milk which does not 
sour within a reasonable length of time, under favorable 
conditions for souring, should be tested for preservatives. 
The use of all such preservatives should be prohibited by 
law. 
Examination of Milk.-Testing the quality of milk 
requires a more or less expert knowledge of chemistry 
and of bacteriology. In testing milk the specific gravity 
is usually taken by means of a lactometer; the amount of 
fat present is estimated by use of a special apparatus 
known as the Babcock testing machine; the amount of 
protein present may also be estimated; the number and 
nature of the bacteria present is frequently gone into by 
bacteriologists, and the milk is tested for the presence of 
preservatives. 
Cream.-When milk is allowed to stand undisturbed, 
the fat droplets, being of lower specific gravity than the 
remainder of the milk, gradually rise to the top, and the 
longer the milk stands up to a certain limit the more 
cream will be found. Creams are usually spoken of with 
reference to the amount of fat they contain, so one speaks 
of a 16 per cent, cream, 20 per cent, cream, etc. The 
cream which rises on average milk after twenty-four 
hours usually contains about 16 per cent, fat, and is 
spoken of as gravity cream. Some gravity cream may 
contain as much as 18 or 20 per cent, fat, while the richer 
creams are obtained by centrifugalizing the milk. The 
composition of the various percentages of creams are 
given in the following table from Holt: 56 
DIETETICS FOR NURSES. 
Whole milk. 
Cream. 
I. 
II. 
III. 
IV. 
V. 
Fat . . 
. . 4.00 
8.00 
12.00 
16.00 
20.00 
40.00 
Sugar . . 
. . 4-5° 
4-5° 
4.20 
4-°5 
3-9° 
3-oo 
Protein . 
• ■ 3-50 
3-4° 
3-3° 
3.20 
3°5 
2.20 
Salts . . 
• ■ o-75 
0.70 
0.65 
0.60 
o-55 
o-45 
The fat droplets in cream vary in size in the different 
varieties of cows. In the Alderneys and Guernseys the 
droplets are larger, less uniform in size, and more 
numerous than in milk from the ordinary milch cow. 
The small uniform fat droplets of milk from the average 
herds are to be preferred in infant feeding. Cream rises 
best on milk that has been cooled quickly after mixing, 
and that has been handled but little. Milk which has 
been shaken up frequently, and frozen and thawed, does 
not yield as much cream nor as quickly. 
Skim Milk.-This is the residue remaining after the 
removal of cream from ordinary milk, and differs from it 
in having most of the fat removed, and in being slightly 
richer in casein and milk-sugar. It is easily digested by 
most people, and is frequently sold as whole milk. 
Blitter.-Butter is made from milk by churning, which 
causes the fat globules in the milk to coalesce, thus form- 
ing a solid mass. It is made most rapidly from cream 
that has been ripened from twelve to twenty-four hours, 
and churned at a temperature between 65° and 700 F. 
In this way butter may be separated in from twelve to 
thirty minutes. The process of ripening depends on the 
presence of certain bacteria, and in some creameries in- 
stead of depending on chance bacterial invasions of the 
milk, which may produce at times unpleasant flavors, it 
is the practice to inoculate the milk with a culture of bac- CLASSES OF FOODS. 
57 
teria known to impart a desirable flavor. On account of 
the ease with which fresh butter is digested it is one of the 
most valuable of the fatty foods. 
When butter is kept too long it becomes rancid, and 
this is due chiefly to the fermentation of the small amount 
of casein remaining in the butter. To avoid this the but- 
ter should be kept cold. Salting is largely used for pre- 
venting this fermentation. The amount used should not 
exceed 2 per cent., but should be worked into the butter 
so that no undissolved particles remain. Butter is often 
colored, largely because the public still like a dark-yellow 
color. Anatto is largely used for this purpose. The 
United States standard for butter is that it should not 
contain more than 16 per cent, of water nor less than 
82.5 per cent, of butter-fat. 
Renovated butter is made from butter which has be- 
come rancid, by melting and then washing with water. 
It is afterward given a better flavor by mixing with a 
certain amount of sour cream. 
Buttermilk.-The residue left in the churn is called 
buttermilk, and is largely used as a beverage, as it is 
nutritious and easily digested. It contains the casein of 
the milk in a finely coagulated form, has a pleasant acid 
taste, and contains lactic-acid bacilli. The buttermilk 
left after churning fresh milk has approximately the same 
composition as skim milk. Buttermilk from ripened 
cream varies somewhat in its composition. 
A preparation similar to buttermilk is also frequently 
made from the whole milk by inoculating with lactic-acid 
bacilli. It has the advantage that it contains all of the 
fat. Such milk is much in vogue at the present time, and 
is used in feeding invalids, especially those with certain 
forms of gastric and intestinal disorders, and in the feed- 58 
DIETETICS FOR NURSES. 
ing of infants. Conserved buttermilk, made somewhat 
after the manner of condensed milk, is also used, es- 
pecially for infant feeding. 
Acidophilus Milk.-Bacillus acidophilus when given 
by mouth in the form of a milk culture effects an im- 
plantation and colonization in the intestinal tract pro- 
ducing a marked decrease in the number of colon organ- 
isms, and thus supplants many of the intestinal toxico- 
genic bacteria. This effect is increased by the addition 
of lactose. Inasmuch as the Bacillus acidophilus is the 
predominant bacterial constituent of the intestinal flora 
of the breast-fed infant, but soon disappears when the 
milk no longer forms the chief part of the child's diet, 
its implantation in the intestine has been found useful 
in the treatment of certain intestinal affections. It has 
been especially found of value in overcoming chronic 
constipation. 
Bonnyclabber.-This is soured milk in which the 
curd and whey are served in the same dish and usually 
eaten with the addition of sugar. Curd and whey, or 
junket, is milk where the coagulation has been brought 
about by the action of rennet. In many instances the whey 
is removed and used as a food for invalids and infants. 
Cheese.-Cheese is made of the curd and a certain 
proportion of the fat of milk, and varies in composition 
and consistence according to the method employed in 
the manufacture. The simplest form of cheese is the so- 
called cottage cheese, in which the curd is separated from 
the whey and eaten a short time after it is made. The 
other cheeses are kept a certain length of time to insure 
ripening. Sometimes the coagulation is produced by ren- 
net and sometimes by lactic acid, while various forms of 
bacteria growing in the cheese and also certain moulds CLASSES OF FOODS. 
59 
impart to the different varieties their peculiar flavors. 
Some cheeses are hard and some are soft, the difference 
being due to the amount of pressure used in hardening 
them. As a rule, the harder cheeses keep very much 
longer than the softer ones, and the harder the cheese 
the more indigestible it is. Like milk, cheese may con- 
tain certain poisonous substances, due to bacterial action, 
and severe poisoning may follow the eating of such 
cheese. The average composition of cheese, as shown 
by Parks, is as follows: 
Water 36.0 
Protein 31.0 
Fats 28.5 
Salts 4.5 
Condensed Milk.-This is manufactured by heating 
the milk to 212° F. to sterilize it and then evaporating 
in a vacuum until it becomes thick and jelly-like. To 
this considerable amounts of cane-sugar are added. In 
some cities fresh condensed milk may be obtained which 
has not had sugar added to it. The composition of con- 
densed milk is as follows : 
Unsweetened con- 
Total solids 
per cent. 
Protein 
per cent. 
Fat 
per cent. 
Milk-sugar Cane-sugar 
per cent. 
per cent. 
densed milk • 
40 
12 
12 
l6 
O 
Sweetened con- 
densed milk . 
80 
12 
12 
18 
40 
Condensed milk is largely used as a substitute for fresh 
milk by many people, is of especial value in the tropics 
and on voyages, as well as being a useful food under cer- 
tain conditions for infants. It is easily digested, and the 
better brands are reasonably pure, but in the dilutions 
usually used it is too high in sugar percentage and too 60 
DIETETICS FOR NURSES. 
low in fat. It produces fat, pale, flabby babies, with a 
tendency to rickets and scurvy, and a lowered resistance 
to infections. On the other hand, it is most valuable in 
infants with feeble digestive powers, and those who are 
not gaining in weight, and in hot summer weather is to 
be recommended where the fresh milk is of questionable 
purity. (See Infant Feeding.) It should be remembered 
that condensed milk may be made from dirty milk, and 
so be objectionable, and that it may contain large numbers 
of bacteria. We have found Borden's Eagle Brand satis- 
factory. Among other brands the Anglo-Swiss and the 
Ideal may be mentioned. 
Another method of conserving milk, known as the 
Campbell method, has been recently introduced, and the 
product is now obtainable in some places. Pure milk is 
placed in a concentrating vat and warmed to 1400 F. A 
blast of filtered air is driven through it for about three 
hours or until the original volume is reduced to one 
quarter. This is then bottled in sterile bottles. It may 
be used just as it is in coffee or tea, diluted one-half in 
place of cream, or with three times the amount of water 
in place of ordinary milk. The milk is marketed under 
the name of White Cross Milk. 
Predigestion of Milk.-Milk may be partly or 
wholly predigested in order to render it more easily di- 
gestible for individuals suffering from gastro-intestinal 
disorders. This process is readily accomplished by add- 
ing an active preparation of pepsin to acidulated milk and 
allowing the fermentation to proceed under the influence 
of heat at the body temperature by immersion in hot 
water. During this fermentation the casein is partly or 
completely converted into albumoses. If the process is 
allowed to continue too long, the milk becomes bitter CLASSES OF FOODS. 
61 
For this reason it is ordinarily removed from the hot 
water after a few minutes, and is placed upon ice, which 
prevents further fermentation. In order to predigest milk 
in alkaline solution, pancreatin is substituted for pepsin; 
pancreatization of milk has now largely replaced pepton- 
ization. In order to effect pancreatization of milk Fair- 
child's peptonizing tubes are ordinarily employed. These 
tubes contain 5 grains of pancreatic extract and 15 grains 
of sodium bicarbonate. Each tube contains sufficient 
powder to digest one pint of milk. Another easy method 
of partially pancreatizing milk is by the use of Fairchild's 
peptogenic milk powder. First dissolve the powder in 
the water by rubbing and stirring with a spoon, then add 
the milk and cream ; mix well; heat in a saucepan with 
constant stirring until blood-warm-not too hot to be 
agreeably borne by the mouth; keep at about this temper- 
ature for ten minutes; then bring quickly to boiling-point; 
pour at once into a clean bottle, shake thoroughly, cork 
tightly, and place directly on ice or in a very cold place. 
Where the taste of pancreatized milk proves objection- 
able, the addition of carbonated waters, or of small quan- 
tities of coffee, may render it more palatable. 
The digestibility of milk may be increased by the 
addition of hot or cold water, or carbonated waters, such 
as Vichy or Apollinaris, lime-water, oatmeal, or barley- 
water, or farinaceous foods, such as arrow-root or flour; 
occasionally small quantities of salt or sodium bicarbonate 
are helpful. 
Kumiss, Kefir, and Mattoon.-Kumiss is a fer- 
mented drink prepared by both lactic acid and alcoholic 
fermentation. For many centuries it has been made 
from mares' milk by the natives living near the shores of 
the Caspian Sea. The milk is obtained from a special 62 
DIETETICS FOR NURSES. 
breed of mares, the animals being fed very carefully. 
The milk is mixed with a kumiss ferment, the lactic acid 
ferment converting some of the sugar into lactic acid, 
while another part of the sugar is converted into alcohol 
and carbonic acid; a small quantity of casein is digested. 
The milk is constantly agitated, and the fermentation 
allowed to proceed for a period of twenty-four hours or 
more. 
Kumiss is an acid, effervescing drink, and contains a 
very small proportion of alcohol. It is very easily 
digested, being much more digestible than milk. The 
casein is so finely divided that lumps cannot be formed in 
the stomach, and it is easily acted upon by the gastric 
secretion. In the United States it has been prepared 
from cows' milk, to which the ferment is added. 
Kumiss Cure.-In certain parts of Russia this form 
of cure is not uncommon. It consists in drinking small 
quantities of kumiss, and gradually increasing them until 
large quantities are taken. Kumiss cures have been 
prescribed in chronic gastro-intestinal catarrhs and chronic 
catarrhs of the respiratory tract. 
Kefir resembles kumiss, and is often used as a substitute 
for it. It was originally made in the Caucasus from 
cows' milk, fermented with Saccharomyces mycoderma, 
lactic acid fermentation going on at the same time. 
Alcohol, lactic acid, and albumins are formed as a result 
of the fermentative processes. The casein is partly 
digested. Tablets of the kefir ferment have been pre- 
pared by Jurock, and are sold under the name of kefilac 
tablets. They render the home manufacture of kefir an 
easy matter. (See Recipes.) 
Mattoon.-In this form of milk lactic acid is produced CLASSES OF FOODS. 
63 
by fermentation with a ferment obtained in Syria. It 
is thicker than kumiss, and does not contain alcohol. 
Kumiss, kefir, and matzoon are agreeable forms of milk 
foods, are easily digestible, and are especially useful in 
those cases in which milk cannot be taken or is not well 
borne. 
EGGS. 
The eggs of the hen are consumed in largest numbers, 
but those of the duck, turkey, guinea-hen, and of some 
wild fowl are also eaten. The eggs of the domestic 
fowls vary in size and appearance, but their composition 
is about the same. 
The shell of a hen's egg constitutes 11 parts, the white 
57 parts, and the yolk 32 parts of the entire weight of 
the egg. The table on page 67 shows the composition 
of hens' eggs, cooked and raw. 
As may be seen from that table, the egg contains 
mainly protein and fats, in addition to water and mineral 
matter. The white and the yolk differ in composition, 
the white containing more protein and water than the 
yolk, and scarcely any fat and ash ; whereas the yolk 
contains considerable fat and ash. The white is said to 
be pure protein. 
The flavor of the egg is dependent in a large measure 
upon the food eaten by the laying hen. Fresh eggs, as 
is well known, have the finest flavor. 
If thoroughly macerated, hard-boiled eggs are as 
digestible as soft-boiled ones. With some persons eggs 
in any form are indigestible, and produce unpleasant 
eructations, nausea and headache. 
Raw eggs are best taken directly from the shell, or 
they may be combined with milk broths or with coffee. 
In various diseases accompanied by loss of flesh and 64 
DIETETICS FOR NURSES. 
strength raw eggs in large numbers are prescribed, as 
many as 24 eggs being given in twenty-four hours. 
Egg-albumin when raw partly resists digestion. It 
is absorbed better when slightly heated or diluted. Its 
palatability may be increased by flavoring it with sherry 
wine, orange-, lemon-, or grape-juice, or by serving it 
in cream, cocoa, or coffee. 
Egg-nog is prepared from milk and eggs, flavored 
with some alcoholic drink, and sweetened with sugar. 
Meat forms the flesh or muscular parts of the body. 
It is one of the most important articles of food and is the 
chief source of man's protein supply. Meat may be 
eaten raw or cooked. Raw meat, when well ground up, 
is very easily digested. 
Meat is composed of muscle-fibers held together by 
connective-tissue bands; between the muscle-fibers are 
bits of fat. As ordinarily seen meat contains muscle- 
tissue, connective tissues, blood-vessels, nerves, and 
lymphatics, together with a varying amount of fat. The 
more fat there is in meat the less water and nitrogenous 
matter does it contain, and vice versa. Cooking has the 
effect of rendering the connective tissues soluble, thereby 
causing a separation of the muscular fibers, allowing the 
digestive secretion to mingle more thoroughly with them. 
Cooking also enhances the flavor and appearance of 
the meat, but, on the other hand, causes a loss in fat 
and extractives. Cooking likewise destroys the micro- 
organisms that may be present in the meat and thus 
renders it more wholesome. 
Digestibility of Meats.-The digestibility of meat 
is governed by many conditions: The age at which the 
MEATS AND MEAT PREPARATIONS. CLASSES OF FOODS. 
65 
animals eaten were killed, the length of time the meat is 
kept before eating, the care bestowed upon the animals 
during life, and the methods of preparing the meats for 
the table. Meats are most easily digested when stewed; 
frying renders them most indigestible. 
Beef.-The composition of beef varies greatly, espe- 
cially in regard to the amount of fat and water it contains. 
An ox from three to five years old supplies the best 
beef. The meat of a very lean animal will contain about 
75 per cent, of water and about 2 per cent, of fat. 
Meat Preparations.-Numerous meat preparations, 
both solids and liquid, are now on the market, the aim 
being to produce a concentrated food that will be readily 
digested. The different beef-juices have but slight nu- 
tritive value, most of them containing only 4 or 5 per 
cent, of protein; their chief value lies in the fact that they 
stimulate the appetite. 
Bouillons.-Bouillons are prepared by cutting meat 
into small bits, heating slowly in water for a time, and 
then boiling it quickly. The fluid thus produced has a 
very agreeable flavor, but its nutrient value is exceed- 
ingly small. 
Beef-extracts.-Beef-extracts are concentrated bouil- 
lons that are to be diluted at the time they are taken. 
Their nutritive value is about the same as that of 
bouillon. 
Beef-juice.-To produce a nutritious liquid-beef 
preparation, the meat should be broiled slightly and then 
cut into small pieces and pressed through a lemon- 
squeezer or a meat-press. In this way considerable 
quantities of protein, in addition to the salts and extrac- 
tives, are obtained. The beef-juices sold on the market, 
such as Valentine's, are prepared by subjecting the meat 66 
DIETETICS FOR NURSES. 
to a strong pressure. These preparations contain from 
5 to io per cent, of protein. 
Meat Powders.-The nutritive value of these prepa- 
rations varies greatly. Those most frequently used are 
a number of peptones, Somatose, and the Mosquera 
" Beef Meal." 
Meat-jellies.-Meat-jellies are frequently given to 
invalids and are an agreeable means of administering 
protein food. Although they do not entirely replace the 
protein in the tissues, they produce a considerable quantity 
of energy. 
Veal.-Veal is tough and indigestible, especially when 
obtained from the animals that are killed too young. It 
differs considerably in flavor from beef. As in many 
persons veal has a tendency to produce indigestion, it is 
to be avoided in all cases of digestive debility. 
Mutton.-Mutton is considered more digestible than 
beef by English writers, probably because in England 
the average mutton is more tender than that obtained in 
the United States; the beef, however, is inferior to that 
raised in this country. 
Lamb.-Lamb, when of the right age and tenderness, 
is as digestible as beef or mutton. 
Venison.-Unless obtained from young animals, 
when it is tender, highly-flavored - and short-fibered, 
venison is apt to be difficult of digestion. 
Pork.-Pork is the most indigestible of all meats, 
on account of the large percentage of fat that it contains. 
Ham and Bacon.-Ham and bacon are both more 
digestible than pork. In some parts of Germany ham 
plays quite an important part in invalid dietaries. Bacon 
is used largely as an army ration. When cooked crisp, 
thin slices of bacon are easily digested. Cf^SSFS OF FOODS. 
67 
Composition of animal foods. 
Refuse. 
Water. 
Protein. 
Fat. 
Carbo- 
hydrates. 
Ash. 
Fuel value 
per pound. 
Eggs, hen. 
Per ct. 
Per ct. 
Per ct. 
Per ct. 
Per ct. 
Per ct. 
Calories. 
Whole egg as purchased .... 
II.2 
655 
"•9 
9-3 
0.9 
635 
Whole egg, edible portion .... 
73 7 
13-4 
10.5 
1.0 
720 
White 
86 2 
12.3 
0.2 
0.6 
25° 
Yolk 
49-5 
15-7 
33-3 
I. I 
1705 
Whole egg boiled, edible portion 
73-3 
132 
12.0 
0.8 
765 
White-shelled eggs as purchased 
IO.7 
656 
11.8 
10.8 
0.6 
675 
Brown-shelled eggs as purchased 
IO.9 
64.8 
11.9 
II.2 
0.7 
695 
Beef, fresh. 
Chuck ribs 
16.3 
52-6 
15-5 
15-0 
0.8 
910 
Flank 
IO.2 
54° 
17.0 
19.0 
0.7 
1105 
Porterhouse steak 
12.7 
524 
19.1 
17.9 
0.8 
1100 
Sirloin steak 
12.8 
54-o 
16.5 
16.1 
0.9 
975 
Ribs 
20.8 
43-8 
139 
21.2 
0.7 
1135 
Round 
7.2 
60.7 
19.0 
12.8 
1.0 
890 
Rump 
20.7 
45-o 
138 
20.2 
0.7 
1090 
Shank, fore 
36.9 
429 
12.8 
7-3 
0.6 
545 
Shoulder and clod 
16.4 
56 8 
16.4 
9.8 
0.9 
7*5 
Forequarter 
18.7 
49.t 
14-5 
17-5 
0.7 
995 
Beef, corned, canned, pickled, 
and dried. 
Corned beef 
8.4 
49-2 
14-3 
23.8 
4.6 
1245 
Tongue, pickled 
6.0 
58-9 
11.9 
19.2 
4-3 
1010 
Dried, salted, and smoked . . . 
4 7 
53-7 
26.4 
6.9 
8.9 
79° 
Canned corned beef 
51.8 
26.3 
18.7 
4-o 
1270 
Veal. 
Breast 
21.3 
52.0 
15-4 
II.O 
0.8 
745 
Leg 
t4-3 
60.1 
15-5 
7-9 
0.9 
625 
Leg cutlets 
3-4 
68.3 
20.1 
7-5 
1.0 
695 
Mutton. 
Flank 
9.9 
39-o 
13.8 
36 9 
0.6 
1770 
Leg, hind 
18.4 
51-2 
151 
14.7 
0.8 
890 
Loin chops 
16.0 
42.0 
13 5 
28.3 
0.7 
1415 
Lamb. 
Breast 
19.1 
45-5 
15-4 
19.1 
0.8 
1075 
Leg, hind 
17-4 
529 
15-9 
13-6 
0.9 
860 
Pork, fresh. 
Ham 
10.7 
48.0 
13-5 
25-9 
0.8 
1320 
Loin chops 
19.7 
41.8 
13-4 
24.2 
0.8 
1245 
Pork, salted, cured, and pickled. 
Ham, smoked 
13.6 
34-8 
14.2 
33-4 
4-2 
'635 
Salt pork 
7-9 
1.9 
86.2 
3-9 
3555 
Bacon, smoked 
7-7 
17-4 
9.1 
62.2 
4-i 
2715 
Sausage, bologna 
3-3 
55 2 
18.2 
19.7 
3-8 
ii55 
Soups. 
Beef 
92-9 
4-4 
0.4 
1.1 
1.2 
120 
Meat stew 
84-5 
4.6 
4-3 
5-5 
1.1 
36s 
Poultry. 
Chicken, broilers 
41.6 
43-7 
12.8 
i-4 
0.7 
3°S 
Fowls 
25-9 
47.1 
137 
12.3 
0.7 
765 
Goose 
17.6 
38-5 
13-4 
29.8 
0.7 
1475 
Turkey 
22.7 
42-4 
16.1 
18.4 
0.8 
1060 68 
DIETETICS FOR NURSES. 
Composition of animal foods. 
4> 
cn 
£ 
0 
.s 
'5 
(A 
O 
6 2 
1 value 
pound. 
o 
& 
Wa 
Pro 
d 
fa 
£ 
Ash 
Fue 
per 
Fresh fish. 
Per ct. 
Per ct. 
Per ct. 
Per ct. 
Per ct. 
Per ct. 
Calories 
Bass, large-mouthed black, dressed 
46-7 
41.9 
10.3 
0.5 
0.6 
215 
Bass, small-mouthed black, dressed 
46.4 
40.1 
11.5 
1.3 
0.7 
270 
Bass, sea, dressed 
46.8 
42.2 
10.1 
0.2 
0.7 
195 
Bluefish, dressed 
48.6 
4°-3 
9.8 
0.6 
0.7 
205 
Butterfish, dressed 
34-6 
45-8 
11.7 
7-2 
0.7 
520 
Carp (European analysis) 
Cod, dressed 
37-i 
29.9 
48-4 
58.5 
12.9 
10.6 
0.7 
0.2 
0.9 
0.8 
270 
205 
Flounder, common, dressed . . . 
57-° 
35-8 
6.3 
0.3 
0.6 
130 
Haddock, dressed 
51.0 
40.0 
8.2 
0.2 
0.6 
160 
Halibut, dressed 
17.7 
61.9 
151 
4-4 
0.9 
465 
Herring, whole 
46.0 
37-3 
10.0 
5-9 
0.8 
435 
Mackerel, dressed 
40.7 
43-7 
11.4 
3-5 
0.7 
360 
Mackerel, Spanish, whole 
34-6 
44-5 
1^.7 
6.2 
1.0 
515 
Perch, white, dressed 
54-6 
34-4 
8.7 
1.8 
0.5 
235 
Pickerel, dressed 
35-9 
51-1 
11.9 
0.2 
0.9 
230 
Pike, dressed 
3°-S 
55-4 
13.0 
0.4 
0.7 
260 
Pompano, dressed 
45-5 
39-5 
10.2 
4-3 
0.5 
37° 
Salmon, California (sections) . . . 
5-2 
60.3 
16.5 
17.0 
1.0 
1025 
Salmon, Maine, dressed 
23.8 
512 
14.6 
9-5 
0.9 
675 
Shad, dressed 
43-9 
39-6 
10.3 
5-4 
0.8 
420 
Shad, roe 
71.2 
23.4 
3-8 
1.6 
595 
Sturgeon, dressed 
14.4 
67.4 
15.4 
1.6 
1.2 
355 
Trout, brook, dressed 
37-9 
48.4 
11.7 
1.3 
O.7 
275 
Turbot, dressed 
39-5 
43.I 
7.9 
8.7 
0.8 
515 
General average of fresh fish as sold 
42.0 
44-° 
10.5 
2.5 
1.0 
300 
Preserved fish. 
Mackerel, " No. i," salted .... 
33-3 
28.1 
147 
*5-* 
i-7 
910 
Cod, salted and dried 
24-9 
4°-3 
16.0 
0.4 
1.2 
315 
Caviare 
38.1 
30-0 
19.7 
7-6 
4.6 
153° 
Herring, salted, smoked, and dried 
44-4 
19.2 
20.2 
8.8 
0.9 
45 
Sardines, canned 
5-o 
53-6 
24.O 
12.1 
5-3 
955 
Salmon, canned 
3-9 
59-3 
'9-3 
IS 3 
1.2 
1005 
Mackerel, canned 
68.2 
19.9 
8-7 
I 3 
735 
Haddock, smoked, canned .... 
68.7 
21.8 
2-3 
x.6 
5°5 
Mollusks. 
Oysters, solid 
88.3 
6.1 
i-4 
3-3 
0.9 
235 
Scallops 
80.3 
14 7 
0.2 
3-4 
*•4 
345 
Long clams, in shell 
43-6 
48-4 
4-8 
0.6 
1.1 
i-5 
135 
Round clams, in shell 
68.3 
27-3 
2.1 
0.1 
i-3 
0.9 
65 
Mussels 
General average of mollusks (exclu- 
49-3 
42.7 
4-4 
0.5 
2.1 
1.0 
140 
sive of canned) 
60.2 
34° 
3-2 
0.4 
i-3 
0.9 
100 
Crustaceans. 
Lobster, in shell 
62.1 
311 
5-5 
0.7 
0.6 
13° 
Crawfish, in shell 
87.7 
10.0 
2.0 
0.1 
0.1 
0.1 
45 
Crab, in shell 
General average of crustaceans (ex- 
55-8 
34-1 
7-3 
0.9 
o-5 
1-4 
185 
elusive of canned) 
73-7 
20.9 
4-3 
0.4 
0.2 
o-S 
100 
Terrapin, turtle, etc. 
Terrapin, in shell . . • 
79.0 
15.6 
4-5 
0.7 
0.2 
115 
Green turtle, in shell 
76.0 
19.1 
4-5 
0.1 
o-3 
90 
Average of turtle and terrapin . . . 
77-5 
174 
4.2 
0.7 
0.2 
105 
Frogs' legs 
General average of fish, mollusks, 
32.0 
570 
10.2 
0.1 
0.7 
210 
crustaceans, etc 
44.0 
42.5 
10.0 
2-5 
0.1 
0.9 
295 CLASSES OF FOODS. 
69 
Rabbit.-When young, rabbit meat is quite digest- 
ible, but it is usually omitted from diet-lists. 
Fowl.-Chicken is one of the most digestible and 
agreeable varieties of meats. The meat of young pi- 
geons also is especially digestible; that of ducks and geese 
contains too much fat. 
The flesh of game is easily digested, the meat of the 
breast being best adapted for invalid use. 
FISH. 
The different kinds of fish vary widely in their nutri- 
tive and digestive qualities. For example, the flounder 
and the oyster are much easier of digestion than those 
that contain a large amount of fat, like the salmon and 
the herring. Eels contain the greatest proportion of fat, 
which may reach 28 per cent. White-fleshed fish, as a 
rule, contain little fat. 
The table, compiled from Atwater and Langworthy, 
gives the chemical composition of some animal foods: 
All fish are best in season; out of season they lose 
their flavor and have a diminished nutritive value, and 
in some cases develop an offensive odor. 
On account of the rapid changes they undergo by way 
of decomposition, fish should always be eaten in as fresh 
a condition as possible. Various methods have been 
resorted to with a view to preventing these changes. 
There are many modern contrivances for preserving fish, 
and drying, smoking, pickling, salting and canning are 
practised on a large scale. 
Crustaceans.-The most popular of the crustaceans 
are the crab and the lobster. They are highly nutri- 
tive, but at the same time highly indigestible. In some 
persons the crab and the lobster are especially apt to 70 
DIETETICS FOR NURSES. 
bring on nausea, vomiting, and other and more distress- 
ing conditions. 
Shell-fish.-Oysters, clams and mussels are the 
forms of shell-fish chiefly eaten. Oysters, when eaten 
fresh and raw, constitute the most digestible animal food, 
but when cooked their digestive value is much lowered. 
The soft part is proportionately larger and more nutri- 
tious than the corresponding portion of the clam. The 
hard or muscular portion is tough and rather indigest- 
ible, and is best omitted from invalid dietaries. Oysters 
should never be fried for the sick. Oysters have in 
many cases been the carriers of typhoid fever, and many 
persons have been infected in this way. 
Clams are a popular article of diet and are as agree- 
able to most palates as oysters. Mussels are consumed 
chiefly by the poorer classes in the seaport towns of 
England. 
VEGETABLE FOODS. 
Vegetable foods differ from animal foods especially in 
that they contain a large proportion of starch and sugar 
and comparatively a small amount of protein. 
Vegetables do, however, contain a certain amount of 
proteins and fats. 
Carbohydrates of Vegetables.-These are starches 
and sugars. Starch is found in all plants, and is con- 
verted into dextrin by means of dry heat or by cooking. 
The starch-granules in vegetables are held together by a 
cellulose framework. Cellulose is a carbohydrate, but 
is very insoluble; it can be utilized as a food only when 
young; when old, it is resistant and cannot be digested 
and hinders the digestion of the starches enveloped by it.. VEGETABLE FOODS. 
71 
Protein in Vegetables.-These proteins belong 
mainly to the globulins. 
Extractives in Vegetables.-There is a consider- 
able amount of extractive matter in certain vegetables, 
such as asparagus, which is not utilized in the body. 
Fats in Vegetables.-The fats in vegetables are 
chiefly in the form of oils. In addition, vegetables con- 
tain a considerable amount of water and salt. The 
amount of water varies between 70 and 90 per cent. 
The main mineral constituents are the salts of potash 
and soda united with organic acids. 
Digestibility of Vegetables.-The digestion of 
vegetables takes place mainly in the intestines. Owing to 
the greater bulk of vegetable food and to the cellulose 
that surrounds vegetable cells and thus prevents the 
ready access of the digestive juices, vegetable food is not 
so easily digested as animal food. For convenience of 
description the following classification of vegetable foods 
has been adopted: 
I. Cereals. 
2. Legumes. 
3. Roots and tubers. 
4. Green vegetables. 
5. Fruits. 
6. Nuts. 
7. Fungi. 
8. Lichens. 
CEREALS. 
Cereals are the most important food-products derived 
from the vegetable kingdom. Of this class of foods 
those in commonest use are wheat, corn, rye, oats, bar- 
ley, rice and buckwheat. The cereals are eaten chiefly 
after having been ground into flour or meal. Flour 
is most commonly made from wheat and rye; whereas 
corn and oats are the chief sources of meal. 72 
DIETETICS FOR NURSES. 
Wheat is the most important source of flour, owing 
to the fact that it can be raised in any temperate climate 
and yields the best flour at the least expense. It is rich 
in solids and contains little water. 
Flour is made by grinding the grain of the various 
cereals. Although flour is made chiefly from wheat and 
rye, barley, oats, maize, etc., are also manufactured into 
flour. 
Bread is made by adding to flour a definite proportion 
of water, a little salt, and the leavening agent. The 
mixture or dough is then kneaded, either with the hands 
or, better, with a spoon. In the large modern bakeries 
the kneading is done entirely by machinery. After this 
the dough is set aside for a number of hours, during 
which time fermentation takes place. It is then molded 
into loaves and baked. The leavening is dependent upon 
the action of the yeast on the starch, some of which it 
converts into sugar, and then into alcohol and carbon 
dioxid gas. The gas causes bubbles to appear through- 
out the dough and renders it light and spongy. During 
the baking process the yeast germs are killed and the 
alcohol and carbonic-acid gas are driven off. Hot or 
fresh bread, when masticated, forms a tenacious, doughy 
mass, and hence is not so digestible as stale bread. 
Biscuits, pastries, and puddings are made by adding to 
the flour varying quantities of eggs, sugar, milk, butter, 
fruit, flavoring extracts, etc. 
Rice constitutes the staple food of many of the peoples 
of the Orient. It is grown chiefly in Asia, but is also 
raised in some parts of Europe. In this country rice 
culture is confined chiefly to South Carolina. Rice con- 
tains a large proportion of starch in very digestible form, 
but is comparatively poor in other constituents. VEGETABLE FOODS. 
73 
Oatmeal is used to the best advantage in making 
porridge; owing to its lack of gluten it makes only the 
poorest kind of bread. What is known as Scotch groats 
is prepared by freeing the grain from its outer husk. 
Breakfast Poods.-There are a variety of prepa- 
rations made from cereals, which have been in recent 
years placed on the market, the chief characteristics of 
which are that they have undergone more or less 
preparation for immediate consumption. For the most 
part they are sold under trade names; the composition 
and source of the food is given in some cases and omitted 
in others. Briefly speaking, they contain about the same 
amount of nutriment as the cereals from which they are 
made. Their palatability varies considerably, and there is 
no objection to the use of such articles of diet if freshly 
prepared foods are obtained, and the individual that con- 
sumes them likes the taste. The older packages, unless 
very carefully put up, are liable to be infected with insects 
or moulds, both of which render the product unfit for 
food. The chief objection is the cost, which is far greater 
than the same amount of food prepared from the cereal 
itself. 
LEGUMES. 
Of the legumes, the pea and the bean are the most 
important food-products. 
The legumes contain a liberal proportion of protein 
(legumen), carbohydrates, and a little fat, besides a large 
amount of water. Although legumes contain a propor- 
tion of protein in excess of that of meat, a large amount 
of fat, and considerable starch, they are less easily digested 
than animal foods. They contain much indigestible fiber 
(cellulose), and are also very liable to produce fermenta- 74 
DIETETICS FOR NURSES. 
tion, and in this way occasion flatulence and gastro-intes- 
tinal distress. The digestibility of the legumes depends 
largely upon the manner in which they are prepared and 
the amount that is eaten. A large portion of the legumes 
ordinarily eaten is imperfectly absorbed by the intestine. 
Beans form one of the oldest forms of vegetable 
foods, having been cultivated by the ancient Greeks, 
Romans, and Egyptians. The numerous varieties used 
for food have all been improved by cultural methods. 
There are several varieties of peas, the most important 
being the field- and the garden-pea. The former is gen- 
erally used for fodder; but one variety, the Canadian 
field-pea, is grown for table use. There are many varie- 
ties of the garden-pea. 
The lentil is but little used in this country. The chief 
supply of lentils comes from Egypt, very few being grown 
in Europe. They form a highly nutritious food. 
The Soy Bean.-This bean (Glycine hispida), some- 
times called the soja bean, is an annual leguminous plant 
extensively used as a food in China and Japan. Until re- 
cently it has been regarded as a botanic curiosity in the 
Occident. It has recently been extensively used in America 
as a forage crop, and to improve the soil if ploughed 
under. The plant is an erect annual, bearing pods con- 
taining from two to five beans. There are a large number 
of different varieties, which vary in size, shape, color, and 
length of time they take to mature. In the East the 
bean is used in numerous ways. Some are grown ex- 
clusively for the oil they contain, and it is used for culi- 
nary, illuminating, and lubricating purposes. The light- 
colored beans are eaten in soups, and the pods are some- 
times picked green, boiled, and served cold, with a sprink- 
ling of soy sauce. The green varieties are often pickled VEGETABLE FOODS. 
75 
in brine, and eaten moist or dried with meals as appe- 
tizers ; the same varieties are often slightly sprouted, 
scalded, and served with meals in winter as a green vege- 
table. The bean forms the basis of the so-called soy 
sauces, used as condiments all over the world. The 
Oriental races most frequently eat the bean in more or 
less cheesy-like foods which are prepared from it. It 
may be used in infant feeding to advantage (see same). 
Americans may eat the beans in numerous ways, de- 
scribed under the head of Soy Bean Cookery in the 
recipes at the end of this book. The bean is of particular 
value in diabetes (see same). It may be used to increase 
the protein of the diet. 
There is some difference in the composition of the 
different varieties of the bean. An average composition 
might be stated as water io per cent, protein 35 per 
cent, and fat 18 per cent. There is also some 8 or 9 per 
cent, of sugar, and the remainder is made up of fiber and 
non-nitrogenous extract. The Cereo Company, Tappan, 
N. Y., have made a flour from this bean, which contains 
about 45 per cent, of protein, 20 per cent fat, and 9 per 
cent, sugar. The higher per cent, of protein in the flour 
is due to the removing of coarse fibrous hulls, which con- 
tain but little nutriment. Each ounce of this flour con- 
tains about 13 grams of protein and 120 calories. 
ROOTS AND TUBERS. 
Roots and tubers constitute another class of vegetable 
foods that are of great importance. They contain both 
starch and sugar, and to these constituentsis due their chief 
value as a food. On account of the small proportion of 
protein and the large amount of water they contain, they 
are inferior in nutritive value to both legumes and cereals. 76 
DIETETICS FOR NURSES. 
The potato is, for several reasons, the most important 
member of the group. It is a tuber or thickened under- 
ground stem of the- Solanum tuberosum. It grows 
equally well in a variety of soils, and when properly 
cooked is easily digested. 
The Sweet potato contains more water and sugar 
but less starch than the white potato. When boiled, it 
usually becomes mealy, but is often converted into a 
stringy, sodden mass that is difficult of digestion. 
The beet contains a very large percentage of starch 
and sugar. It is raised extensively for the sugar in- 
dustry, and is also largely employed for making salads 
to lend variety to the diet. 
Carrots, when young and tender, form a very nutri- 
tious food and are greatly relished by many persons. 
They contain from 85 to 90 per cent, of water. 
Parsnips, when boiled long enough, form a good 
food; like carrots, they contain a large proportion of 
water and a considerable amount of sugar. 
GREEN VEGETABLES. 
The green vegetables are valuable not only on account 
of the amount of nutriment present in them, but for the 
variety and relish they give to the diet. They contain a 
large amount of salts and have valuable antiscorbutic 
properties. 
Cabbages contain a considerable quantity of sulphur, 
and on this account are apt to cause flatulence; where 
digestion is good, however, they are considered a whole- 
some form of food. 
Cauliflower is the most digestible member of the cab- 
bage family. It may be eaten either as a salad or boiled 
and served with a milk-sauce. VEGETABLE FOODS. 
77 
Spinach is a popular form of vegetable and is used to 
a great extent. It is valuable chiefly for its laxative effect. 
Lettuce is the most important representative of a group 
of vegetables usually eaten raw. It is made into salad 
and dressed with vinegar. The various cresses also 
belong to this class. 
Celery, which is usually eaten raw, is stringy and has 
scarcely any nutritive value. Cooked in milk it forms a 
wholesome and digestible article of food. 
Tomatoes are eaten both raw and cooked, and are 
refreshing, generally liked, and easily digested. They 
are used to flavor broths and are valuable for canning 
purposes, inasmuch as they retain their flavor better than 
most vegetables. 
Asparagus is highly esteemed for its delicate flavor. 
It is easily digested, even by invalids. It has a slightly 
diuretic action, and imparts a most offensive odor to the 
urine, which persists for from twelve to twenty-four hours. 
Vegetarianism.-It will not be out of place here to 
point out the disadvantages of an exclusive vegetable 
diet. Vegetarians are those who subsist almost entirely 
upon vegetables, cereals, fruits, and nuts; exceptionally 
milk and eggs are added to their diet-list. It is quite 
possible, by the eating of vegetables alone, to supply all 
the food constituents-carbohydrates, fats, and proteins- 
that are required by the body. Proteins are obtained 
partly from vegetables, milk, and eggs; those derived 
from vegetables, however, are digested with much more 
difficulty and absorbed to a much slighter degree than 
those derived from animal food. Persons subsisting on 
a purely vegetable diet for any great length of time are 
apt to lose strength, as well as physical and mental vigor 
and endurance. Laborers are unable to perform the 78 
DIETETICS FOR NURSES. 
same amount of work they could accomplish on a diet 
containing animal food. While vegetables contain large 
proportions of proteins, in order to supply them in suffi- 
cient amount very large quantities must be eaten. This 
overfeeding is apt in many instances to produce digestive 
disturbances, particularly in those suffering from gastro- 
intestinal disorders. A purely vegetable diet, if persisted 
in, is also said to lessen the power of resisting disease. 
Fruits are of little value as nutriment, and are useful 
mainly to give variety to the diet. They are used ex- 
tensively as flavoring agents. The chief nutritive con- 
stituent of fruits is sugar, and they also contain a small 
amount of nitrogenous matters, cellulose, starches, 
organic acids, and a vegetable jelly called pectin, which 
causes fruit to gelatinize when boiled. The sugar present 
in fruit is mainly fruit-sugar, or levulose, but some fruits 
contain, in addition, considerable cane-sugar. In general, 
fruits contain a large amount of water. The mineral 
elements of fruit consist of potash, united with tartaric, 
citric, and malic acids. The flavor and odor of fruits 
are due to the presence of essential oils and compound 
ethers. 
The digestibility of fruits varies with the kind of fruit 
eaten and its mode of preparation; stewed fruits are 
more easily digestible than raw fruits. Among the 
more easily digestible fruits are oranges, lemons, grapes 
and peaches; raw apples, pears and bananas are some- 
what less digestible. 
Oranges and lemons are used in invalid dietaries, their 
juice allaying thirst very effectively. 
Apples are wholesome, digestible, and slightly laxa- 
tive. 
FRUITS. VEGETABLE FOODS. 
79 
Pears are, as a rule, more easily digestible than apples. 
Peaches are wholesome and digestible. They contain 
less sugar than most fruits. 
Bananas are the most nutritious of the raw fruits. 
Grapes contain a large amount of water and consider- 
able sugar. When thoroughly ripe they are very digestible. 
Raisins are prepared by drying grapes, the white ones 
being those most used. 
Plums and green gages are quite digestible when fully 
ripe. 
Prunes are dried plums. They contain much sugar 
and are markedly laxative in their effect. 
Olives have a bitter taste and are eaten chiefly as a 
relish with salads. Their nutritive value is due to the 
oil they contain. 
Strawberries are very wholesome unless taken in excess. 
Currants, gooseberries, raspberries, huckleberries, mul- 
berries, and a few other berries a contain considerable 
amount of free acids. They have slightly laxative prop- 
erties. 
Melons contain over 95 per cent, of water and about 5 
per cent, of other constituents; they are considered indi- 
gestible. 
Figs and dates contain large quantities of sugar. The 
value of the date as a food to the Arab is well known. 
The avocado, or alligator-pear, contains about 2 per 
cent, of protein, 20 per cent, of fat, and 7 per cent, of 
sugar. It is one of the few fruits containing much fat. 
NUTS. 
Nuts contain a large quantity of fat and a somewhat 
larger proportion of protein. They have but little food 
value and are eaten mainly as a dessert. The average 
composition of nuts is: 80 
DIETETICS FOR NURSES. 
Water I- 4 per cent. 
Protein 6-15 " 
Fats 4<>-5o " 
Carbohydrates 6-10 " 
Owing to the large amount of cellulose as well as the 
large proportion of fat they contain, nuts are not easily 
digested. The dense cellulose framework which makes 
nuts so indigestible can be destroyed by grinding, and 
thus the nut made more easily digestible; such prepara- 
tions as Nuttolene, Bromose, and Nutmeal, of the Battle 
Creek Sanitarium Company, are prepared in this way. 
Almonds contain much fat, but no starch and very 
little sugar. 
Chestnuts contain a small amount of oil and a large 
amount of carbohydrates. 
Walnuts contain a large proportion of protein and fat, 
but are quite indigestible. 
The cocoanut contains a large amount of fat and car- 
bohydrates. 
FUNGI, ALGAE, AND LICHENS. 
Fungi.-The three varieties of fungi usually eaten 
are the mushroom, truffle, and morel. 
Mushrooms are prized chiefly for their agreeable taste. 
They possess some nutritive value. Gibson, who has 
made a study of edible fungi, considers that the usual 
methods of distinguishing between the edible and poison- 
ous varieties are very unreliable. He suggests the fol- 
lowing as being of especial value: First, avoid every 
mushroom having a cup or suggestion of such at the 
base; the distinctly fatal poisons are thus excluded. 
Exclude those having an unpleasant odor, a peppery, 
bitter, or other unpalatable flavor, and those of tough 
consistency. In addition, it is well to exclude those VEGETABLE FOODS. 
81 
infected with worms, those in advanced age, or partly 
decayed, and in testing new species they should be kept 
apart from the others. The best test is to begin with a 
piece the size of a small pea, chew it very slightly, being 
careful not to swallow any of the saliva, and finally expel 
all from the mouth. If no results follow during the 
interval of a day the experiment may be repeated, 
swallowing a little of the juice, the fragments of the 
fungus being expelled as before. In twenty-four hours 
the third trial may be made, swallowing a small fragment, 
and if still no unpleasant results follow, the following day 
a piece the size of a hazel nut may be attempted. In 
using this method poisonous varieties may be excluded 
with only a temporary indisposition on the part of the 
experimentalist, and is the only safe method of avoiding 
the poisonous varieties. As a rule, any mushroom, omit- 
ting the Amanita, which is pleasant to taste and agree- 
able as to odor when raw, is probably harmless, and, 
if an unfamiliar species, may be tested by the above 
method. 
The truffle grows underground and is especially sought 
for on account of its delicate flavor; the black variety 
is considered the finest. 
The morel is usually obtained from France. It is sold 
in the dried state and is utilized chiefly for seasoning 
purposes. 
Many fungi are poisonous, and these are usually dis- 
tinguished by a disagreeable odor and taste, and other 
peculiarities in structure, etc. 
Algae.-The only one of this group that is utilized as 
food is Irish moss. 
I/icheiis.-The only important lichen used as a food 
is Iceland moss. 82 
DIETETICS FOR NURSES. 
The following table, taken from Atwater, gives the 
chemic composition of the most common cereals: 
Cereals. 
Water. 
Pro- 
tein. 
Fat. 
Carbohydrates. 
Ash. 
Starch, 
etc. 
Crude 
fiber. 
Per ct. 
Per ct. 
Per ct. 
Per ct. 
Per ct. 
Per ct. 
Barley 
IO.9 
12.4 
1.8 
69.8 
2-7 
2.4 
Buckwheat 
12.6 
10.0 
2.2 
64.5 
8-7 
2.0 
Com (maize) 
9-3 
9-9 
2.8 
74-9 
i-4 
i-5 
Kafir corn 
l6.8 
6.6 
3-8 
69.5 
1.1 
2.2 
Oats 
II.O 
11.8 
5-0 
59-7 
9-5 
3° 
Rice 
I2.4 
7-4 
O.4 
79.2 
0.2 
0.4 
Rye 
Wheat; 
11.6 
10.6 
i-7 
72.0 
1.7 
i-9 
Spring varieties .... 
10.4 
12.5 
2.2 
71.2 
1.8 
i-9 
Winter varieties .... 
10.5 
11.8 
2.1 
72.0 
1.8 
1.8 
The following table, taken from Hutchison, gives the 
chemic composition of some fruits : 
Fruits. 
Water. 
Pro- 
teid. 
Ether 
extract. 
Carbo- 
hydrates. 
Ash. 
Cellu- 
lose. 
Acids. 
Per ct. 
Per ct. 
Per ct. 
Per ct. 
Per ct. 
Per ct. 
Per ct. 
Apples 
82.50 
0.40 
0-5 
12-5 
0.4 
2-7 
1.0 
Pears 
83.90 
O.4O 
0.6 
"•5 
0.4 
3-i 
0.1 
Apricots 
85.OO 
I.IO 
0.6 
I2.4 
0-5 
3-i 
1.0 
Peaches 
88.80 
0.50 
0.2 
5-8 
0.6 
3-4 
0.7 
Green gages . . . 
80.80 
O.4O 
0.2 
13-4 
°-3 
4.1 
1.0 
Plums 
78.40 
1.00 
0.2 
14.8 
0-5 
4-3 
1.0 
Cherries 
84.OO 
0.80 
0.8 
10.0 
0.6 
3-8 
1.0 
Currants 
85.20 
O.4O 
0.8 
7-9 
0 5 
4.6 
i-4 
Strawberries . . . 
89.IO 
I.OO 
0-5 
6-3 
o-7 
2.2 
1.0 
Blackberries . . . 
88.90 
O.9O 
2.1 
2-3 
0.6 
5-2 
1.6 
Raspberries . . . 
84.40 
I.OO 
2.1 
5-2 
0.6 
7-4 
1.4 
Cranberries .... 
86.50 
0.50 
o-7 
3-9 
0.2 
6.2 
2.2 
Grapes 
79-00 
I.OO 
1.0 
iS-5 
o-5 
2-5 
o-5 
Watermelons . . . 
92.90 
OJO 
0.1 
6-5 
0.2 
1.0 
o-5 
Bananas 
74-oo 
1-50 
0.7 
22.9 
0.9 
0.2 
°-5 
Oranges 
86.70 
0.90 
0.6 
8-7 
0.6 
1-5 
1.8 
Lemons 
8-93 
I.OO 
o-9 
8-3 
0-5 
15 
1.8 
Pineapples .... 
8-93 
O.O4 
0-3 
9-7 
0-3 
i-5 
7.0 
Dates, dried . . . 
2.08 
4-40 
2.1 
65-7 
15 
5-5 
7-o 
Figs, dried .... 
2.00 
5-5o 
0.9 
62.8 
2-3 
7-3 
1.2 
Prunes, dried . . . 
2.64 
2.40 
0.8 
66.2 
i-5 
7-3 
2-7 
Raisins 
1.40 
2.50 
4-7 
74-7 
4-1 
i-7 
2-7 VEGETABLE FOODS. 
83 
The following table, compiled from Atwater, Abel, and 
Hutchison, gives the chemic composition of some vege- 
tables : 
Vegetables. 
Water. 
Pro- 
tein. 
Fat. 
Carbo- 
hydrates. 
Ash. 
Fuel 
value per 
pound. 
Fresh legumes: 
Per ct. 
Per ct. 
Perct. 
Per ct. 
Per ct. 
Calor- 
ies. 
String-beans 
89.2 
2.30 
°-3 
7-4 
0.8 
*95 
Sugar peas or string-peas 
8t.8 
3-40 
0.4 
13-7 
0.7 
335 
Shelled kidney beans. . 
58.9 
9.40 
0.6 
29.1 
2.0 
740 
Shelled Lima beans . . 
68.5 
7.10 
0.7 
22.0 
1-7 
570 
Shelled peas 
74.6 
7-00 
o-5 
16.9 
1.0 
465 
Canned string-beans . . . 
93-7 
I.IO 
0.1 
3-8 
1.3 
95 
Canned Lima beans . . . 
79-5 
4.00 
°-3 
14.6 
1.6 
3 60 
Canned kidney beans. . . 
72.7 
7.00 
0.2 
18.5 
1.6 
480 
Canned peas 
Dried legumes: 
85.3 
3.60 
0.2 
9.8 
1.1 
255 
Lima beans 
10.4 
18.10 
i-5 
65-9 
4i 
1625 
Navy beans 
12.6 
22.50 
1.8 
59-6 
3-5 
1605 
Lentils 
8.4 
25.70 
1.0 
59-2 
5-7 
1620 
Dried peas 
9-5 
24.60 
1.0 
62.0 
2.9 
1655 
Peanuts 
St. John's bread (carob 
9.2 
25.80 
38.6 
24.4 
2.0 
2560 
, bean) 
i5-o 
5-90 
i-3 
75-3 
25 
1565 
Potatoes 
62.6 
1.80 
0.1 
14-7 
0.8 
295 
Sweet potatoes 
55-2 
1.40 
0.6 
21.9 
0.9 
440 
Beets 
70.0 
130 
0.1 
7-7 
0.9 
160 
Parsnips 
66.4 
1-30 
0.4 
10.8 
1.1 
230 
Turnips 
62.7 
0.90 
0.1 
5-7 
0.6 
120 
Cabbage 
89.6 
1.80 
0.4 
5-8 
i-3 
165 
Cauliflower 
90.7 
2.20 
0.4 
4-7 
0.8 
175 
Sea-kale 
93-3 
1.40 
0.4 
3-8 
0.6 
175 
Spinach 
90.6 
2.50 
0.5 
3-8 
i-7 
120 
Vegetable marrow .... 
94.8 
0.06 
0.2 
2.6 
o-5 
120 
Brussels sprouts 
93-7 
1.50 
0.1 
3-4 
13 
95 
Tomatoes 
9i-9 
1.30 
0.2 
5-0 
0.7 
i°5 
Greens 
82.9 
3.80 
O.9 
8.9 
3-5 
275 
Lettuce 
94.1 
1.40 
O.4 
2.6 
1.0 
105 
Celery 
93-4 
1.40 
0.1 
3-3 
0.9 
85 
Rhubarb 
94.6 
0.70 
o-7 
2-3 
0.6 
105 
Water-cress 
93-1 
0.70 
o-5 
3-7 
i-3 
IIO 
Cucumber 
95-9 
0.80 
0.1 
2.1 
0.4 
70 
Asparagus 
91.7 
2.20 
0.2 
2.9 
0.9 
IIO 
Sauerkraut 
91.0 
1.40 
0.7 
2-9 
i-7 
IIO 84 
DIETETICS FOR NURSES. 
Sugars are carbohydrates that contain hydrogen and 
oxygen in a proportion to form water. Sugar is one of 
the most valuable and popular forms of food. This 
popularity is due not only to its nutritive value, but also 
to its pleasant taste. According to Abel, 86 pounds of 
sugar per capita were consumed in England in 1895 and 
64 pounds in the United States in the same year. From 
7,000,000 to 8,000,000 tons are consumed annually in 
the different countries of the world. The principal 
variety of sugar in use is cane-sugar; besides this, 
grape-sugar, fruit-sugar, and milk-sugar also enter into 
the composition of our foods. Sugar is obtained in a 
fluid state, as in honey, as well as in crystalline form. 
Sugar is very fattening and at the same time is also a 
great source of muscular energy. Most of the ill effects 
attributed to the use of sugar are due to the fact that 
more than one-quarter of a pound is consumed daily 
(Hutchison); this amount maybe taken with impunity 
by the healthy adult, but if more be taken, it will be 
excreted rapidly by the kidneys, giving rise to a condi- 
tion known as temporary or alimentary glycosuria. 
Sugar can be absorbed only as dextrose and as levu- 
lose, all varieties of sugar being converted into these 
forms before they are absorbed. In strong solution 
sugar irritates the mucous membrane of the stomach 
and is apt to undergo fermentation, and thus produce 
gastro-intestinal distress. 
Cane-sugar is the most common and most exten- 
sively used form of sugar. It is made chiefly from 
sugar-cane and from the sugar-beet. When pure, it 
consists of a mass of white crystals. 
Candy contains a large amount of sugar, besides but- 
SUGARS. VEGETABLE FOODS. 
85 
ter and other fats, starch, nuts, flavoring extracts, etc. 
The chief varieties of candy are made up largely of 
glucose and starch, colored with anilin dyes. 
Molasses, Treacle, and. Syrup.-Molasses and 
treacle are by-products formed in the manufacture of 
cane-sugar. Molasses forms a highly nutritious food. 
On account of the impurities it contains, molasses has a 
more pronounced aperient effect than refined syrup. 
Glucose, or grape-sugar, is chiefly made from starch 
by inversion or hydrolysis. It is not nearly so sweet as 
cane-sugar and crystallizes with difficulty. It is present 
in small quantities, in combination with other varieties 
of sugar, in most fruits. 
Lactose, or sugar of milk, is the natural carbo- 
hydrate for the young, growing infant. It is less abun- 
dant in cows' milk than in human milk. 
Honey is sugar in a concentrated solution. It is 
made by bees from the nectar gathered from various 
flowers. It contains a crystallizable sugar resembling 
glucose, and a non-crystallizable form. 
Saccharin is used largely as a substitute for sugar 
in cases of rheumatism and diabetes. 
Levulose, or fruit-sugar, is also utilized as a form 
of sugar in certain cases of diabetes. 
SPICES AND CONDIMENTS, 
Spices and condiments play an important role in 
increasing the appetite and aiding the digestive func- 
tions ; they have practically no nutritive value. By the 
action of these substances on the organ of taste as well 
as on the mucous membrane of the stomach, the appetite 
is stimulated and the secretion of gastric juice increased. 
In certain gastric disturbances, as well as in diseases of 
the kidneys, they act as irritants and should be avoided. 86 
DIETETICS FOR NURSES. 
The peppers are among the favorite spices; there 
are two varieties, the white and the black. 
Mustard.-Mustard is used chiefly in salads or with 
other foods, and has a marked tendency to increase the 
appetite. In large quantities and diluted with water mus- 
tard acts as an irritant to the stomach, producing nausea 
and vomiting. 
Vinegar is produced from various alcoholic drinks 
and from fruits. It contains 5 per cent, of acetic acid. 
Horseradish, is a condiment that is much used with 
various foods. 
Sauces, such as tomato, catsup, Worcestershire, and 
the like, increase the appetite and give a relish to certain 
foods. 
Spices act merely by adding a flavor to foods, in this 
way increasing the appetite for foods that would other- 
wise be insipid. Those most in use are ginger, cinnamon, 
nutmeg, and cloves. 
FATS AND OILS. 
One-fifth of the body-weight consists of fat. This is 
obtained in part from fatty food and in part from the car- 
bohydrates and the proteins. Most of the heat energy 
furnished the body is supplied by fat; it oxidizes very 
rapidly, and in this way spares the protein elements 
that would otherwise be required to furnish energy. 
Fats are digested in the intestine, where they are emul- 
sified previous to being absorbed. The most useful forms 
of fat are cream and butter; other forms are bacon and 
cod-liver oil. When eaten too liberally, fats are liable to 
cause indigestion, and when this exists they should be 
taken only in very restricted quantities. 
Foods fried in fats are indigestible, and hot fats are 
more indigestible than cold. Fats and oils have a ten- VEGETABLE FOODS. 
87 
dency to relieve constipation, but are contra-indicated in 
diarrhea. 
The most important animal fats are butter, cream, lard, 
suet, oleomargarin, cottolene, butterine, cod-liver oil, and 
bone-marrow. Of the vegetable fats, those most com- 
monly employed are olive oil, cottonseed oil, linseed oil, 
cocoa-butter, and the oils obtained from nuts, such as 
cocoanut oil, peanut oil, and almond oil. Fatty foods 
are indicated especially in wasting disorders and in con- 
valescence from certain acute diseases. 
There are many proprietary fatty foods on the market, 
some of which are worthy of mention. In most of 
these the fats, usually cod-liver oil, have been emulsified ; 
this emulsification aims to make the oil less objection- 
able to the taste and also to render it more easily diges- 
tible. 
Intolerance to Fat.-Intolerance to fat is frequently noted 
in infants and also in older individuals. In infants it may 
produce vomiting one or two hours after feeding, or there 
may be colic and either large white stools, or, less fre- 
quently, thin, greenish ones. Sooner or later there is a 
marked disturbance of the general health, and the children 
are usually, though not always, pale and thin. Many 
such children are given large quantities of fatty food, 
cream, butter, and oil, with the idea of fattening them up, 
with the result that the children's general health is very 
markedly interfered with. 
Butterine is a fat prepared from beef and hog fats, and 
is frequently used in this country instead of butter; 
oleomargarin is a similar preparation made from beef 
fat. Both butterine and oleomargarin are wholesome 
fatty foods, the only objection raised against them being 
that they are often sold fraudulently for butter. 
Bone-marrow is a fat obtained from the large bones of 88 
DIETETICS FOR NURSES. 
the ox. It is used in the treatment of tuberculosis and 
in the various forms of anemia. 
SALTS. 
The various salts that enter into the composition of 
the tissues of the body are absolutely necessary for the 
maintenance of life. The most important, and by far 
that most universally found, is sodium chlorid, or com- 
mon table salt. It enters into the formation of all the 
tissues and secretions of the body with the exception of 
the enamel of the teeth. It forms about 60 per cent, of 
the salts of the blood. When taken in insufficient quanti- 
ties or omitted entirely marked symptoms of malnutrition 
soon appear. 
Potassium chlorid ranks next in importance to 
sodium chlorid. It is widely distributed in the body, 
but occurs in much smaller amounts. 
Calcium salts are important chiefly on account of 
the extent to which they enter into the composition of 
the bones and the teeth. 
Phosphorus occurs in the muscles, bones, and blood. 
It is found as phosphate in both animal and vegetable 
food. 
The sulphur of the body is derived from egg albu- 
min, milk, and certain vegetables, in which it occurs as 
sulphates. 
Iron is an important constituent of the hemoglobin 
of the blood, and is found also in muscle-fibers. 
BEVERAGES AND STIMULANTS. 
WATER. 
Water is the chief constituent of all beverages, and 
also enters largely into the composition of solid food. 
The human body itself is composed of about 60 per BEVERAGES AND STIMULANTS. 
89 
cent, of water. While man can live for weeks without 
food, he can abstain from water for but a few days. 
Water is absolutely necessary as a solvent, and as it is 
constantly being eliminated by the skin, lungs, and kid- 
neys, this loss must be replaced by some means in order 
to maintain the functions of the body. This is most 
conveniently done through the agency of the various 
beverages. The best method, however, of replenishing 
the water-supply is that of drinking the water in its pure 
state, when it retains all its solvent properties. Some 
waters are taken for their laxative or purgative action, 
and others for the salts which they contain. 
The amount of water consumed daily by the average 
person is from six to eight glasses. This varies, how- 
ever, with the amount and variety of food and exercise 
taken. The age, sex, and size of the individual and the 
season of the year also influence the total daily consump- 
tion of water. In very warm weather, for example, and 
under severe physical strain, much water that would not 
be lost in the cold season of the year is eliminated in the 
form of perspiration and must be compensated for. 
Water is absorbed chiefly in the intestine; a small 
amount is absorbed in the stomach, and but a very 
trifling amount, if any, in the mouth. The water ab- 
sorbed in the intestine is passed into the lymphatics and 
carried on into the circulation, whence it is eliminated. 
As previously stated, water is eliminated through the 
skin, kidneys, lungs, and feces. The amount of water 
excreted daily varies greatly under special conditions. 
In cold weather the skin is inactive and the kidneys 
excrete a markedly greater amount of water than in hot 
weather, when the sweat-glands functionate more actively. 
When there is a tendency toward liquid movements from 90 
DIETETICS FOR NURSES. 
the bowel, the elimination by the kidneys is lessened. 
In warm weather elimination by the lungs is stimu- 
lated. 
According to the amount of mineral water they con- 
tain, waters are classed as hard or soft. Rain-water is 
soft, and is the purest form of natural water. The hard- 
ness of water is due to earthy carbonates; by boiling, 
the carbonic acid gas is driven off and the carbonates are 
precipitated, and the water thus rendered more suitable 
as a beverage. Boiling has the additional advantage that 
it destroys most of the micro-organisms that may be 
present in the water. 
Water often contains impurities, such as lime, mag- 
nesia, iron, and other salts, and micro-organisms, and it 
often becomes necessary to purify it for drinking pur- 
poses. Typhoid fever and cholera are communicated 
chiefly through the agency of polluted drinking-water. 
The best method of purification is by distillation, by 
which means both organic and inorganic impurities can 
be removed or rendered innocuous. This method is 
now used largely on shipboard. When distilled and 
aerated, sea-water makes a most pleasant beverage. 
Water may also be purified by means of filtration, char- 
coal and sand being used extensively for this purpose. 
Porcelain cylinders are also in common use. Whatever 
the filtering agent employed, unless it be kept clean it is 
liable to become a source of contamination rather than 
of purification. Owing to the fact that soluble impuri- 
ties often pass through the filter, filtered water is not 
nearly so reliable as distilled water. 
Mineral Waters.-Mineral waters are frequently 
taken as substitutes for ordinary water; at times they 
produce a most marked stimulating effect on various BEVERAGES AND STIMULANTS. 
91 
organs. Their efficiency is greatly enhanced when a 
" drinking cure " is combined with proper dietetic regu- 
lations. Mineral waters differ from ordinary waters in 
the greater amount of gaseous and solid matters they 
contain. The gaseous constituents of mineral waters 
are mainly carbon dioxid and sulphuretted hydrogen. 
The solid constituents are salts of sodium, potassium, 
magnesium, aluminium and calcium, iron, iodin, bromin, 
chlorin and sulphur. Taken before meals, waters con- 
taining carbonic acid have a soothing effect on an irri- 
tated stomach. Taken in excess, all carbonated waters 
are apt to produce indigestion. 
Some waters have a purgative effect, others a laxa- 
tive, and still others a diuretic. Thermal waters issue hot 
from their springs, their virtue being said to be due to 
their heat. Some mineral waters have no medicinal vir- 
tue whatever, and are utilized merely as drinking-water. 
The following classification of mineral waters is taken 
from Cohen's Physiologic Therapeutics, Vol. IX.: 
Simple acidulous contains large amounts of car- 
bon dioxid ; example, Apollinaris. 
Alkaline acidulous contains large amounts of car- 
bon dioxid and also sodium carbonate; example, 
Saratoga Vichy. 
Alkaline muriated acidulous contains carbon di 
oxid, sodium carbonate, and sodium chlorid ; exam- 
ple, Seltzer. 
Alkaline saline acidulous contains sulphate of 
soda in addition to bicarbonate and chlorid of soda, 
as Carlsbad water. 
I. Alkaline 
mineral 
waters. 
II. Sodium chlo- 
rid waters. 
Simple sodium chlorid contains sodium chlorid 
and carbon dioxid, as Saratoga Congress. 
Sodium chlorid with iodin and bromin contains 
iodin and bromin in addition to sodium chlorid, 
as Saratoga Kissingen. 92 
DIETETICS FOR NURSES. 
HI. Bitter waters contain a large proportion of sodium sulphate and 
magnesia sulphate, as Bedford Magnesia water. 
IV. Sulphurous waters contain hydrogen sulphid or some other sulphur 
compound, as French Lick Spring. 
Carbonated iron-waters contain larger quantities 
of carbonic acid, as Cresson Spring water. 
Sulphated iron-waters contain ferrous sulphate in 
addition to sodium magnesia, and calcium sulphate, 
as Sharon Chalybeate Spring. 
Iron-and-arsenic-water contains arsenic and iron, 
as Harbin Hot Sulphur Spring. 
V. Iron-waters. 
VI. Earthy mineral waters contain large amounts of calcium and mag- 
nesium salts, as Mount Clemens Mineral Springs. 
VII. Acratothermal waters do not contain any active mineral ingredients, 
but are obtained at a temperature of 85° F. or over. 
TEA. 
Tea is a preparation made from the leaves of an ever- 
green plant known as thea. It is grown in China 
Japan, India, Ceylon, and in North Carolina. There are 
two great classes of tea, the green and the black. 
The chief difference between the black and the green 
tea lies in the fact that black tea is fermented, while 
green is not. As in the process of fermentation the 
tannic acid becomes less soluble, black tea contains 
much less tannic acid than green tea. 
Tea has practically no nutrient ingredients. Its prin- 
cipal constituents are caffein and tannic acid, and its 
special aroma is due to a volatile oil. It owes its stim- 
ulating effect to the presence of caffein. As the action 
of tannic acid is detrimental to the process of digestion, 
tea should be so prepared as to contain as large a pro- 
portion of caffein as possible and the smallest possible 
amount of tannic acid. 
When the leaves are placed in boiling water, caffein is 
extracted very rapidly. Tannic acid, however, is much 
less soluble; it follows, therefore, that in order to have BEVERAGES AND STIMULANTS. 
93 
as little tannic acid in the tea as possible, the leaves should 
be boiled in water for as short a time as practicable. To 
prepare the infusion, pour boiling water on the tea-leaves 
and allow the mixture to stand where it will keep hot, 
though not boil, for from three to five minutes. The 
water used in preparing tea should not be hard or stale. 
Coffee was introduced into Europe in the same century 
as tea, and only a few years later. It is prepared from 
the seeds of Coffea arabica, which was originally grown 
in Arabia. The aroma of coffee is due to the presence 
of caffeol, an oil liberated in roasting. Coffee is often 
adulterated, chicory, acorns, and other substances being 
added for this purpose. The adulteration may not be 
injurious in its effect, but alters sometimes, even agree- 
ably, the flavor of the coffee. 
Preparation of Coffee.-In order to obtain coffee 
of the finest flavor, the beans should be roasted and 
ground shortly before they are to be used, as the flavor 
is impaired by exposure to the air after grinding. The 
water should have reached the boiling-point before it is 
poured over the coffee. The pot should then be placed 
for a few moments in a hot place, but boiling must not 
be allowed to continue, or the aroma will be lost and the 
coffee contain too large a percentage of tannic acid. 
The effect of coffee on the system is that of a stim- 
ulant, due to the caffein present; it acts directly on the 
brain centers, stimulates the heart, and deepens the res- 
pirations. It is an excitant of the nervous system, and in 
some persons produces nervousness, excitability, and 
insomnia; in others it acts as an agreeable stimulant. 
Coffee Substitutes and Modified Coffees.-Vari- 
ous substances are used as substitutes, usually chicory 
COFFEE. 94 
DIETETICS FOR NURSES. 
or roasted grains. Most of the so-called caffein-free 
coffee preparations either do not contain coffee or 
contain caffein in rather large amounts. Kaffee Hag 
contains only 0.03 per cent, caffein and DeKofa about 
0.13 per cent. 
COCOA. 
Cocoa was introduced into Europe long before either 
coffee or tea. It is prepared from the seeds of the cacao 
tree. The seeds are contained in a pulpy fruit, some- 
what resembling a cucumber, from which they are 
extracted. Cocoa, as ordinarily prepared, is made by 
grinding the seeds into a paste, to which sugar or starch 
is added ; if starch is used, the cocoa is boiled for a few 
minutes, but if sugar is added, the cocoa only requires 
the addition of boiling water or milk. 
Cocoa, while a stimulant, is less apt to induce nervous 
symptoms, such as sleeplessness and palpitation, than 
either tea or coffee. By reason of the large proportion 
of sugar and fat contained in it, however, when used in 
excess, cocoa is likely to produce indigestion. When 
not too rich, it forms a nutritious drink especially useful 
for children and for convalescents. 
Chocolate is prepared by adding starch, sugar, and 
such flavoring substance as vanilla to cocoa. In addi- 
tion to their stimulant effect, cocoa and chocolate pos- 
sess a marked nutrient value not possessed by either tea 
or coffee. 
ALCOHOL. 
Alcohol is produced by the fermentation of sugars 
with yeast. The principal constituent in all alcoholic 
beverages is ethyl alcohol. The glucose contained in 
fruits is fermented directly into alcohol; whereas the 
starches in such substances as potatoes, grains, etc., are BEVERAGES AND STIMULANTS. 
95 
converted into dextrin and maltose, and then by the aid 
of diastatic ferments, before the alcoholic fermentation 
can take place, they are converted into glucose. 
The food value of alcohol has been a subject for 
discussion for many years. Although all admit that 
alcohol taken in excess is a poison and is detrimental 
to health, yet opinions differ widely as to the food value 
of alcohol taken in moderate quantities. There are those 
who maintain that alcohol, even in small quantities, is 
detrimental to health and acts as a poison; whereas 
others believe that, on the contrary, when taken in small 
quantities it possesses a considerable nutrient value and 
is to be recommended as a valuable food. The most 
recent as well as the most exhaustive work bearing on 
this subject has been done by Atwater, in his experiments 
on " The Nutritive Value of Alcohol," in The Physio- 
logic Aspects of the Liquor Question, 1903. According 
to the writer the effect of alcohol in small quantities is 
slightly to increase the digestibility of protein, but not to 
alter the digestibility of other nutrients-that is, carbo- 
hydrates and fats; that at least 98 per cent, of the alco- 
hol ingested is oxidized in the body, whereas ordinarily 
98 per cent, of the carbohydrates, 95 per cent, of the 
fats, and 93 per cent, of the protein are oxidized; the 
alcohol is therefore oxidized more completely than are 
the nutrients of ordinary foods. 
The conclusion reached by Atwater, based on direct 
experiments, is that the fat protection following the use 
of alcohol is very slightly different from that following 
the taking of ordinary food, and that alcohol protects 
the body-fat quite as effectively as do the fats and carbo- 
hydrates of the food for which it is substituted. The 
power of alcohol to protect the protein of food or body- 
tissue, or both, from consumption is clearly demonstrated. 96 
DIETETICS FOR NURSES. 
Alcohol, carbohydrates, and fats replace one another 
as sources of energy, so that as one is oxidized the 
other is correspondingly spared. 
Atwater found that in most of the experiments "alco- 
hol was certainly a source of heat for the body " and 
contributed its share of energy for muscular work. 
Atwater gives the following proportions as to the 
availability and fuel value of alcohol in nutrition as com- 
pared with carbohydrates and fats: I gm. of alcohol, if 
gm. of carbohydrate, and f gm. of fat yield the same 
amount of energy to the body. Inasmuch as alcohol 
contains no nitrogenous constituents, it can not be looked 
upon as a food tending to repair tissue, but merely as a 
fuel that, on oxidizing, forms animal heat. 
Alcohol is easily digested and readily absorbed in the 
alimentary tract; as a food, however, it is costly, and 
the danger of addiction and excess in its use is great. 
The habitual use of alcohol even in considerable quanti- 
ties does not tend to produce injurious effects in many 
persons; whereas in others changes, especially of a 
cirrhotic nature, in the tissues, blood-vessels, liver, kid- 
neys, etc., are liable to occur. In certain diseases, 
especially those accompanied by malnutrition, extreme 
feebleness, and exhaustion, alcohol acts as a food and 
serves an excellent purpose in restoring strength to a 
weak and enfeebled body. 
Alcoholic beverages are divided into several classes, 
S'> spirits, liqueurs, and bitters, malt liquors, wines, etc- 
SPIRITS. 
Spirits are produced by fermenting saccharine sub- 
stances and obtaining the alcohol by distillation. Of 
the substances, corn, rice, barley, molasses, and potatoes 
are those most commonly utilized for this purpose. In BEVERAGES AND STIMULANTS. 
97 
addition to the alcohol, by-products are formed, and it 
is to these that spirits owe their characteristic flavor and 
odor. The by-products contain the higher alcohols, such 
as propyl, butyl, and amyl alcohol, a mixture of these 
forming what is known as fusel oil. 
Whisky is an alcoholic liquid obtained by distilla- 
tion of the mash of fermented grain (usually of mix- 
tures of corn, wheat, and rye), and at least two years 
old. Whisky possesses an alcoholic strength of from 
50 to 58 per cent, by volume. It should be free from 
disagreeable odor. The ether and aldehyds contained 
in whisky become altered in character as it ages, and 
the flavor is thus rendered more agreeable. 
Brandy is an alcoholic liquid obtained by distillation 
of the fermented unmodified juice of fresh grapes, and 
at least four years old. Brandy contains from 46 
to 55 per cent, by volume of alcohol. The quality of 
brandy depends upon the variety of grapes used and 
upon the length of time the brandy is allowed to stand: 
the older the brandy the better the quality. With 
brandy, just as with whisky, on standing ethers and 
aldehyds are produced, to which the special flavor of the 
brandy is due. The color of brandy is due to the tannic 
acid extracted from the oak casks in which the brandy 
is contained. There are many inferior grades of brandy 
on the market, some being merely alcohol colored and 
flavored with various essences. 
Rum.-Rum is the product of the distillation of fer- 
mented molasses, its flavor being due to certain by- 
products. 
Gin.-Gin is produced by the distillation of rye and 
malt mash, its flavor being due to juniper berries which 
are added during fermentation. 
IJqueurs or cordials and bitters contain a large 98 
DIETETICS FOR NURSES. 
proportion of alcohol and a high percentage of sugar and 
essential oils. 
Malt I/iquors.-Under the heading of malt liquors 
are included beer or ale and stout or porter. These 
beverages are made by fermenting malt and hops. The 
mild or bitter beers are distinguished by the relative pro- 
portion of hops contained in them; the milder forms 
contain considerable quantities of hops, whereas the bit- 
ter ones contain but small amounts. 
Porter and Stout.-Porter and stout are made by 
fermenting malt, the latter, however, being roasted, dur- 
ing which process a certain amount of caramel is pro- 
duced. It is to this substance that the dark color is 
due. Beer as well as stout contains from 3 to 8 per cent, 
of alcohol, from 2 to 5 per cent, of dextrin, and from 
0.5 to 1 per cent, of sugar. 
WINE. 
Wine is produced by the fermentation of grape-juice, 
the juice being first pressed from the grape by crushing. 
There are a number of factors, such as the character of 
the grape utilized, its cultivation, and the method of 
manufacturing, that enter into the production of a good 
wine. 
Of the important ingredients of wine may be men- 
tioned water, acids, alcohol, sugar, ethers, glycerin, and 
extractives. 
Acids.-The most important acids contained in wine 
are tartaric, malic, and tannic; others of less impor- 
tance are acetic and succinic. The total amount of acids 
in wine varies, but rarely exceeds 0.5 per cent. 
Alcohol.-There are several alcohols present in wine; 
ethyl alcohol occurs in largest quantity; amyl, propyl, BEVERAGES AND STIMULANTS. 
99 
and butyl alcohol are also present in varying amounts ; 
natural wine never contains more than 16 per cent, of 
alcohol; if it contains more than this amount it has 
been " fortified." This is often done, especially when 
the wine is to be shipped from warm countries to foreign 
districts, to prevent it souring. 
Sugar.-Sour wines contain about I per cent, and 
sweet wines about 4 per cent, of sugar; it is evident, 
therefore, that sugar is present in too small a quantity 
to be of any food value. 
Ethers.-Many varieties of ethers are present in wine; 
they are produced by the action of the alcohols and acids 
upon each other. It is to the character and quantity of 
the ethers contained in them that the flavor of various 
kinds of wines is largely due. 
Glycerin.-Glycerin is present in wine in about one- 
fourteenth of the volume of the alcohol. 
Extractives.-A large part of the solid material of the 
wine is made up of extractives. 
Varieties Of wines.-From a dietetic standpoint the 
classification of Chambers is probably the most practi- 
cal ; according to this author, wines are divided into 
seven classes: 1. Strong dry wines. 2. Strong sweet 
wines. 3. Aromatic wines. 4. Acid wines. 5. Spark- 
ling wines. 6. Perfect wines. 7. Rough or astringent 
wines. 
1. Strong Dry Wines.-These are wines that contain 
a large percentage of alcohol, to which, as a rule, addi- 
tional alcohol has been added in their production; in 
other words, they are "fortified." Examples of this 
class of wines are port, sherry, and Madeira. Port con- 
tains from 15 to 20 per cent, of alcohol and considerable 100 
DIETETICS FOR NURSES. 
tannic acid. Sherry is a fortified wine ; it contains from 
15 to 22 per cent, of alcohol. 
2. Strong Sweet Wines.-These wines contain fruit- 
sugar in quantities sufficient to act as a preservative and 
prevent further fermentation. Under this head may be 
mentioned Tokay, Malaga, and sweet champagne. They 
contain from 18 to 22 per cent, of alcohol and from 3 to 
5 per cent, of sugar. Owing to their sweetness they are 
taken in small quantities. 
3. Aromatic Wines.-Aromatic wines possess a superior 
flavor and contain essential oils and considerable alcohol; 
examples of this class of wines are Moselle, Capri, and 
some of the Rhine wines. 
4. Acid Wines.-The distinguishing feature of this class 
of wines is the large quantity of acid they contain. 
5. Sparkling Wines.-Sparkling wines contain consid- 
erable quantities of carbonic acid gas, to which their 
exhilarating effect is due. The chief variety of this class 
of wines is champagne. The dryness or sweetness of 
champagne depends upon the proportion of cane-sugar 
and cognac added during the process of manufacture. In 
the manufacture of dry champagne 8 per cent, of sugar 
is added, while the sweet brands contain as much as 16 
per cent. 
6. Perfect Wines.-Perfect wines are defined by Cham- 
bers as those containing alcohol, water, sugar, ethereal 
flavors, fruity extractives, and acids. Under this head 
come Burgundy and Bordeaux. 
7. Rough Wines.-Rough wines contain considerable 
quantities of tannic acid, to which they owe their astrin- 
gent effect. They contain little alcohol and are of slight 
value for medicinal purposes. BEVERAGES AND STIMULANTS. 
101 
ACTION AND USE OF MALT LIQUORS AND WINES. 
Malt liquors, when taken in moderate quantities, seem 
to aid digestion, increase the appetite, and stimulate gas- 
tric secretion. Occasionally, especially in those who 
lead a sedentary life, they give rise to indigestion and 
gastric acidity. On account of the large quantities of 
carbohydrates they contain, they have considerable food 
value. The use of malt liquors is contra-indicated espe- 
cially in such conditions as gout, obesity, diabetes, and 
diseases of the urinary tract. 
Wines appear to exert a depressing effect on the gas- 
tric secretion. Taken in moderate quantities, however, 
by increasing the appetite and the motor function of the 
stomach, this depressing effect is not only overcome, but 
the digestion is also greatly improved. 
Cider is a beverage prepared from the'fermented juice 
of ripe apples. The amount of alcohol contained in this 
beverage varies between 3 and 8 per cent, by volume. 
It also contains malic acid, salts, sugar, albuminoids, and 
extractives. CHAPTER III 
VARIOUS FACTORS IN THEIR BEARING ON 
DIET. 
CONCENTRATION OF FOOD. 
Concentrated foods are those from which the larger 
portion of the water present has been abstracted, and 
thus the weight and the bulk of the food diminished. 
There are many patented concentrated foods on the 
market. They find their chief use in the treatment of 
patients who take too little of the usual forms of food to 
maintain strength, and, second, in cases where it is impor- 
tant that a large quantity of nourishment be taken. 
Food can be concentrated to various degrees. Desic- 
cated meat is the most concentrated form of protein; 
sugar the most concentrated form of carbohydrate; and 
olive oil the most concentrated form of fat. 
i. Concentrated Proteins.-These foods are pre- 
pared from milk, meat, eggs, and vegetables. Meat is 
concentrated by drying, and in this form it is generally 
indigestible, which can, however, be overcome by pre- 
digestion or powdering. 
2. Concentrated Vegetables.-Many vegetables, 
such as potatoes, carrots, cabbage, and the like, are con- 
centrated by drying. They are utilized only in those in- 
stances in which it is impossible to secure fresh vegetables. 
Bread is frequently dried and eaten in the form of 
" hardtack," when it is impossible, as during sea-voyages, 
to obtain fresh bread. 
102 VARIOUS FACTORS IN THEIR BEARING ON DIET. 
103 
PRESERVATION OF FOOD. 
By preservation of food is meant the process by which 
the food is so changed that it can be kept for a longer or 
shorter period of time without undergoing putrefaction. 
The process of fermentation is induced by micro-organ- 
isms present in the atmosphere coming into contact with 
the food and contaminating it. Since putrefactive germs 
require a certain amount of moisture and heat for their 
growth, such foods as contain little water and that are not 
kept too warm are not so likely to undergo decomposi- 
tion ; on the other hand, foods containing much water 
undergo fermentation very rapidly. To prevent this proc- 
ess, four methods of preservation are, according to Yeo, 
available : 
I. Drying. 
2. Exclusion of air. 
3. Exposure to cold. 
4. Treatment with antiseptic chemic agents. 
1. Drying.-By this process a large proportion of 
the water is abstracted. Vegetables, such as carrots, 
peas, potatoes, etc., are preserved by drying. Milk, in the 
form of nutrose, eggs, as egg-powder, and fruits are often 
preserved in this manner. 
2. Exclusion of Air.-Air may be prevented from 
coming into contact with food in a number of ways : by 
immersing the food in oil or fat; by heating the food, so 
as to evaporate the external layers; by coating with 
some impermeable substance, as oil, salt, sawdust, var- 
nish, or paraffin. Fish are frequently preserved by im- 
mersion in oil or by smoking. Ham and bacon are pre- 
served by smoking, by which process the outer surface 
becomes coagulated and impermeable. Eggs are pre- 104 
DIETETICS FOR NURSES. 
served by covering the fresh eggs with some imperme- 
able substance, such as oil, fat, beeswax, or sawdust. In 
order properly to preserve food by exclusion of air, it is 
highly important that the food be perfectly fresh, and that 
any air that may be present be expelled. 
In canning, the food to be preserved is heated in tin 
cans until steamed, when, all the air having been expelled, 
the can is soldered and rendered air-tight. 
3. Exposure to Cold.-Food can be preserved in- 
definitely by ice. Meat and fish, which are often pre- 
served by this means, should be cooked at once after 
thawing. Frozen meat loses about 10 per cent, more of 
its nutritive value in cooking than fresh meat. Frequently 
food is not kept directly on ice, but in refrigerating cham- 
bers. 
4. Treatment with Antiseptic Chemic Agents.- 
1. Salting.-The salting of food is a method that has 
been practised for many centuries. In this way meat 
and fish are easily preserved. The pale color of the 
meat produced by salting is overcome by adding a little 
saltpeter in addition to common salt. After the salting 
has been accomplished, it is often followed by smoking. 
2. Sugar in strong solution acts as an antiseptic, and 
fruits are thus often preserved in concentrated syrups. 
3. Vinegar acts as an antiseptic in preserving cucum- 
bers, pickles, oysters, etc. 
4. Other Antiseptics for Preserving Foods.-Among 
these substances are sulphur vapor; weak carbolic acid ; 
strong acetic acid; injections of alum and aluminium 
chlorid into the blood-vessels; boric acid; borax; sali- 
cylic acid; formaldehyd. 
The use of antiseptics to preserve foods is usually 
condemned, and laws have been enacted to prevent the VARIOUS FACTORS IN THEIR BEARING ON DIET. 
105 
adulteration of such foods as milk, beer, etc., with anti- 
septics, as salicylic acid, formaldehyd, etc. While small 
quantities of these substances, even taken for a consider- 
able length of time, may not prove injurious, in large 
quantities they are dangerous. 
ARTIFICIAL FOOD PREPARATIONS. 
To this class of foods belong those preparations that 
are so concentrated as to furnish a large amount of food 
in small bulk; being of small bulk, they can be added 
to liquid foods, and thus the nutritive value of the latter 
increased without increasing the total quantity of liquid 
taken. A number of these preparations have been men- 
tioned under the head of beef-juices and meat-powders. 
The various casein preparations, among which may be 
mentioned nutrose, eucasein, sanose, and plasmon, are 
artificial foods. 
Among other artificial food preparations may be men- 
tioned: i. Pemmican. 2. Peptone products. 3. Mosquera 
" Beef Meal." 4. Somatose. 5. Legumin. 6. Aleuronat. 
1. Pemtnican is prepared by cutting meat into thin 
slices and allowing them to dry; sugar and dried fruits 
are added, the nutritive value of the meat being thereby 
increased. 
2. Peptone products are predigested protein foods. 
When given in large quantities they tend to produce 
diarrhea, and are objectionable to many patients on account 
of their disagreeable taste. Among the principal peptone 
products manufactured may be mentioned Kemmerich's, 
Koch's, Benger's, Savory & Moore's, Carnrick's, Ar- 
mour's Wine of Beef Peptone, and Panopeptone. 
3. Mosquera Beef Meal is prepared by partially 
digesting meat by means of a ferment obtained from 106 
DIETETICS FOR NURSES. 
pineapple juice. According to Chittenden, this product 
contains 90 per cent, of nutritive matter (13 per cent, of 
fat and 77 per cent, of protein). 
4. Somatose is a predigested meat consisting of albu- 
moses. It is a yellowish powder, tasteless, odorless, and 
highly nutritious, and is usually well borne even in gas- 
tric disturbances. 
5. I/egumin consists of the casein of the legumes, and 
is a highly nutritious protein food. 
6. Aleuronat is a brownish powder, chiefly utilized as 
a food for diabetics. It contains 80 per cent, of protein. 
7. Tropon is prepared mainly from fish and vegeta- 
bles, and as sold on the market appears as a brownish, 
tasteless powder. It is eaten mixed with broths or 
gruels. 
Artificial Proprietary Foods.-A large number of 
proprietary foods designed as substitutes for milk for 
infants and invalids are on the market. Infants fed upon 
such foods alone are apt to become rachitic. Some of 
these foods have little food value; especially the amyla- 
ceous foods in which the starch has not been predigested. 
Many of these preparations contain too little fat and far 
too great a proportion of carbohydrates. According to 
Holt, " when children are fed upon foods lacking in fat 
the teeth come late, the bones are soft, the muscles 
flabby," while " children fed upon foods containing too 
much sugar are frequently very fat, but their flesh is very 
soft; they walk late and they perspire readily about the 
head and neck." 
Hutchinson divides proprietary foods into three classes : 
I. Foods Prepared from Cows' Milk with Various Ad- 
ditions or Alterations, and Requiring only the Addition of 
Water to Fit Them for Immediate Use.-To this class VARIOUS FACTORS IN THEIR BEARING ON DIET. 
107 
belong Malted Milk, Nestle's Food, Lactated Food, Carn- 
rick's Food, Cereal Milk, Wyeth's Prepared Food, and 
Wampole's Milk Food. These foods are prepared from 
flour baked and mixed with milk or cream and then dried. 
By means of the malt which is added the starches are 
converted into dextrin and maltose. 
2. Farinaceous Foods Prepared from Cereals of which 
the Starch has been Partly or Wholly Converted into Dex- 
trin or Sugar, and which Require the Addition of Milk to 
Fit Them for Use.-To this class belong Mellin's Food, 
Savory & Moore's Infant Food, and Benger's Food. 
These foods are prepared by mixing equal parts of wheat 
flour and barley malt with bran and potassium bicarbon- 
ate. The mixture is made into a paste with water, and 
kept at a warm temperature until the starch is converted 
into dextrin and maltose. As these foods are poor in 
fat, protein, and mineral matters, they are added to milk 
in order to render them more nutritious. 
3. Farinaceous Foods in which the Starch has not been 
Predigested.-To this class belong Ridge's Food, Neave's 
Food, Imperial Granum, and Robinson's Patent Barley. 
These foods are poor in fat, protein, and mineral mat- 
ters. 
Other Proprietary Foods.-Crackers are prepared from 
flour, water or milk, and are baked into various forms. 
Baking-powder and soda, and frequently milk, butter, 
sugar, and flavoring extracts are added. Crackers are, 
as a rule, easily digested. 
Malt Extracts.-Malt extracts are manufactured by 
heating a solution of malted barley at a moderate tem- 
perature in vacuo. Malt extracts are especially useful as 
beverages for those weakened by chronic disease, as 
tuberculosis or anemia, and in the convalescence from 108 
DIETETICS FOR NURSES. 
acute diseases, as after typhoid fever or pneumonia. 
Among the various malt preparations may be mentioned 
Maltine, Kepler's Extract of Malt, and Hoff's Malt 
Extract. 
COOKING OF FOODS. 
The cooking of food is an art practised by all races, 
savage as well as civilized. Food is cooked to improve 
its flavor, to soften it so that it can be masticated and 
more easily digested, and finally to destroy all parasites 
and disease germs that may be present in the raw food. 
By cooking certain flavors are developed, which by their 
savoriness increase the appetite and the taste for the 
food. Cooking, moreover, destroys the tough fibrous 
envelopes that surround many foods, thus permitting 
the food to be more easily acted upon by the various 
digestive fluids. Various parasitic organisms present 
in many foods are destroyed by cooking, and the food 
thus freed from one of its most dangerous elements. 
On cooking, the protein in food coagulates; under the 
influence of dry heat the starches are gradually converted 
into dextrin; whereas, under the influence of moist heat 
the granules gradually swell until they rupture their en- 
velopes. Sugars, by boiling, are changed gradually into 
caramel, which is the source of the odor frequently given 
off in the cooking of food. When fats are heated they 
undergo a change, with the production of free fatty acids 
which are often responsible for the odors that exist in the 
kitchen. 
Cooking of Meat.-Boiling.-In boiling meats the 
temperature of the water should not exceed the tempera- 
ture necessary for the coagulation of the proteins. In 
order that the meat may retain as much of its flavor as 
possible, it should be immersed in boiling water for a few VARIOUS FACTORS IN THEIR BEARING ON DIET. 
109 
moments; in this way the protein on the surface imme- 
diately coagulates, thus preventing the escape of the con- 
stituents and so retaining all the nutritive elements in the 
meat. After this has been accomplished, the temperature 
of the water may be lowered and the process of cooking 
continued. The broth which is so produced is thin and 
poor. If a rich, nutritious broth is desired, the meat 
should be cut into small pieces and placed in cold water, 
and the temperature gradually increased to 1500 F. In 
this way the nutritious elements of the meat pass out 
into the broth. 
Roasting.-In roasting, the meat is first exposed to a 
high temperature and afterward cooked slowly; thus, the 
outer layers coagulate at once, preventing escape of the 
juices. Roasting not only prevents evaporation of the 
flavors of meats, but by its effect on the extractives de- 
velops savory odors and flavors. 
Baking.-Baking much resembles roasting, except that 
by the latter process the heat is applied all around the 
meat instead of only to one side. 
Stewing.-For this purpose meat is cut into small 
pieces and placed in a small quantity of water. The 
water is heated slowly, but not allowed to boil; a certain 
amount of the nutritious substances thus passes into the 
water, which then becomes rich, and to which flavoring 
substances and vegetables are added. Inasmuch as the 
juice is eaten with the meat, none of the nutritious in- 
gredients is lost. 
Braising.-In this process the meat is placed in a small 
vessel and covered with a strong liquor of vegetable and 
animal juices; it is then heated, but not boiled. The 
tough fibers of the meat are thus loosened and made 
tender; the meat also becomes impregnated with vegeta- 110 
DIETETICS FOR NURSES. 
bles and spices present in the juices, which enhance its 
flavor. 
Broiling.-Broiling and roasting are similar processes, 
except that in the former smaller portions are utilized; 
the process is thus more rapid, a large surface being ex- 
posed to the direct action of the heat. 
Frying.-In this process the meat is put into boiling 
fat, with which it becomes saturated; fatty acids are thus 
produced, which have a tendency to irritate the stomach 
and cause indigestion. 
Cooking- of Fish.-Fish may be boiled, broiled, 
baked, and fried. Boiled fish is most easily digested. 
Inasmuch as the flavoring substances are more easily 
dissolved out into the water and lost, less time should be 
consumed in boiling fish than in boiling meat. Sir Henry 
Thompson has shown that even with careful boiling 5 per 
cent, of the solid matter of fish is apt to be lost; for this 
reason steaming is often preferable. 
Effect of Cooking.-The effect of cooking on meat 
is to diminish its watery constituents, thus concentrating 
and rendering it more nutritious; by this process also the 
extractives as well as some of the fats are partly removed. 
Effect of Cooking on Vegetables.-The important object 
in the cooking of vegetables is to rupture the cellulose 
envelope and so to soften the contained starch granules. 
Under the influence of heat and moisture the starch 
swells and bursts its envelope, forming a paste; this 
paste, in its turn, expands and ruptures the cellulose 
envelope; cooking, therefore, renders vegetable foods 
more easily digestible. 
As has been pointed out, in the cooking of meats a 
certain proportion of the ingredients is lost. Unlike 
meats, however, vegetables become more watery in cook- VARIOUS FACTORS IN THEIR BEARING ON DIET. 
111 
ing. In this condition they are more easily acted upon 
by the gastric secretion; on the other hand, the addi- 
tion of water in cooking so increases their bulk that 
the motor function of the stomach is apt to be over- 
taxed. 
When food is cooked rapidly there is a tendency to 
overcook the outer layers and to leave the inner under- 
done. The better plan, therefore, is to cook food slowly 
for a longer period of time at a lower temperature. 
Various appliances are on the market which have for 
their object the production of a continuous action of a 
moderate heat at the expense of as little fuel as pos- 
sible. 
DISEASES CAUSED BY ERRORS IN DIET AND BY 
VARIOUS FOOD POISONS. 
Disease may be caused by taking too little or too 
much food, and also by a diet that is not well balanced- 
that is, does not contain the combination of food elements 
in the correct proportions-and by other dietetic influ- 
ences, the precise nature of which is as yet obscure. It 
may also be caused by certain poisons or disease germs 
or parasites taken into the body with food and drink. 
The diseases due to insufficient food are starvation, 
malnutrition, marasmus, and some forms of anemia. 
Chlorosis is liable to occur in underfed girls. 
Overeating probably causes as much disease as over- 
drinking. Among the most striking of these are gout 
and obesity. Diseases of the skin, kidneys, liver, and 
other organs may also be due to this cause. 
Lack of fresh food may produce scurvy and an im- 
properly balanced diet may cause rickets. 
The abuse of various beverages deserves mention. 112 
DIETETICS FOR NURSES. 
The effects of the abuse of alcohol and the nervousness 
resulting from the excessive use of tea and coffee are 
well known. 
Food Allergy.-A subject that has been attracting 
a considerable amount of attention of recent years is 
the sensitiveness of certain individuals to various foods. 
This manifests itself after the ingestion of the offending 
food either in an outbreak of eczema or urticaria, of 
edema, or of asthma. It is very unusual to find in one 
individual idiosyncrasies to one food substance alone. 
In most cases there is a history of the same thing existing 
in other members of the family and it is very common 
to have the history of either eczema or asthma. Indi- 
viduals who are sensitive to food show skin reactions 
when small quantities of these foods are injected into 
the skin or rubbed into abrasions. In the cases that 
have been studied thoroughly the offending substance 
has been a protein, most commonly the white of eggs 
and the casein of milk, but other substances, as beef, 
pork, fish, clams, strawberries, and tomatoes, and so on, 
may furnish the substances causing the reaction. It 
seems highly probable that there may be a similar sen- 
sitiveness to fats and sugars, but this has not been 
definitely demonstrated. Persons having such sensi- 
tiveness may get better on withdrawing the toxic food, 
but this is not always the case. A very severe attack of 
poisoning may render the patient immune to attacks 
from the same substance for from two to three months, 
and it is possible to immunize the individual, certainly 
for some of the proteins, by giving first very minute 
quantities and gradually increasing the amount, but, 
as a rule, the individual does not retain his immunity 
unless he continues to take fairly large quantities of the 
food. This has been shown most frequently in the cases VARIOUS FACTORS IN THEIR BEARING ON DIET. 
113 
that are sensitive to eggs. Other terms are applied to 
this condition, such as "allergy" and "anaphylaxis." 
Acute food-poisoning is usually due to the action 
of ptomains, and this is called ptomain-poisoning. Pto- 
mains or toxins are poisonous substances caused by 
the action of bacteria, and may be generated in nitrog- 
enous foods or in the alimentary tract. They resemble 
alkaloids, and when absorbed are partially destroyed by 
the liver. The symptoms vary, but nausea, vomiting, 
purging, pain in the abdomen, and collapse are the most 
frequent. Various names are applied according to the 
food which causes the trouble, as milk-poisoning (galac- 
totoxismus) ; cheese-poisoning (tyrotoxismus); mussel- 
poisoning (mytilotoxismus); fish-poisoning (ichthyotoxis- 
mus); meat-poisoning (kreotoxismus). Faultily cured 
sausage sometimes causes poisoning (botulismus), and 
epidemics of pneumonia have resulted from eating in- 
fected bacon, infected ham, or other spoiled meat. The 
poison may be present without producing any change in 
the appearance of the meat. Some of these epidemics 
obviously are the result of epidemic pneumonia or en- 
cephalitis and are erroneously attributed to food-poison- 
ing. 
Other forms of food-poisoning are as follows: 
Mushroom-poisoning.-Poisonous fungi are frequently 
mistaken for edible mushrooms and lead to poisonous 
symptoms. The active principle in these fungi is called 
muscarin. If there is a ring about the stalk, the mush- 
room peels easily and has pink gills, it is said to be non- 
poisonous. This is not a safe rule, as some of the most 
poisonous varieties answer to this description. 
Grain-poisoning.-There are three forms of grain-poi- 
soning-ergotism, pellagra, and lathyrism. Most cases 114 
DIETETICS FOR NURSES. 
and epidemics have occurred among the poverty-stricken 
European peasants. 
Ergotism (sitotoxismus) is due to eating spurred rye, 
from which the drug ergot is obtained. Lathyrism 
(lupinosis) is caused by eating the chick-pea. 
Beriberi.-This is a disease chiefly seen in the Orient, 
and it is supposed to be due to polished rice. The pol- 
ishing removes the outer cover, which contains a certain 
amount of phosphorus. The rice polishings mixed with 
milk and sugar are sometimes given as a cure. There are 
others who believe the disease is due to some parasite. At 
present it is thought that the absence of vitamins present 
in the pericarp is responsible. In institutions the disease 
may be prevented or cured, if not seen too late, by feeding 
the patient on bread made from whole wheat flour, or by 
the use of the brown, undermilled or so-called hygienic 
rice, beans, peas, and other legumes, barley, cornmeal 
made from the whole grain, white potatoes, and meat. 
Pellagra.-In the past few years there has been an 
enormous increase in the amount of pellagra in the 
United States. The cause of the disease is not as yet 
established. Some believe that it is due to a parasite 
transmitted by a certain two-winged fly, and others that 
it is due to eating certain foods, particularly maize which 
has been spoiled. More recent investigations place the 
blame on some vitamin deficiency and insufficient pro- 
tein. The disease may be prevented and cured by 
diets rich in animal and leguminous proteins, milk and 
fresh fruits, and vegetables. The latter should be with- 
held if there is diarrhea. 
Sprue.-This is a tropical disease associated with a 
monilia infection. Various dietetic methods of cure 
have been suggested. A diet free from carbohydrate, 
similar to a diabetic diet, seems to give good results. VARIOUS FACTORS IN THEIR BEARING ON DIET. 
115 
Milk diets, meat diets, and fruit and vegetable diets, 
and various combinations of these have all been recom- 
mended. 
Xerophthalmia in which there is dryness of the 
cornea with subsequent ulceration is due to a lack of 
fat-soluble A. It is seen sometimes in the last stages 
of marasmus and in adults who have received no animal 
fat, no milk, butter, or eggs. The addition of these to 
the diet effects a cure if the changes have not progressed 
too far. Cod-liver oil may also be used. 
Actinomycosis or lumpy-jaw, a disease of cattle, is some- 
times transmitted to man. In some of the cases the 
patients were in the habit of chewing raw grain. 
Foot-and-mouth disease is another disease of cattle 
which may be transmitted by the use of milk from cows 
suffering with it. Such milk should not be used. If the 
disease is suspected the milk should be boiled. 
Hydatid Disease.-Cysts of a peculiar character some- 
times occur in man by taking the eggs of a dog tape- 
worm (Taenia echinococcus) into the body with the food. 
Green salads are the most frequent source of infection. 
The disease is almost unknown in America. 
Idiosyncrasies.-Curious food idiosyncrasies exist 
and must be borne in mind. They are more often fancied 
than real. Urticaria (hives) may be caused in some people 
by eating crabs, oysters, strawberries, and other articles 
of food. Gastric pain, vomiting, diarrhea, and other 
symptoms may be produced by such foods in some per- 
sons, while others eat them with impunity. 
Parasites.-Certain parasites may be taken in with 
food or drink. Many of these are rare, and seldom if 
ever seen in America. Among them may be mentioned 
the following : Amoeba coli, taken in with drinking-water, 
is the cause of one form of dysentery. 116 
DIETETICS FOR NURSES. 
Several species of tapeworm (Teenia solium in pork, 
T. mediocanellata in beef, etc.), of which the beef tape- 
worm is the common variety in the United States, may 
be met with. 
The pin-worm (Oxyuris vermicularis) and the round- 
worm (Ascaris lumbricoides), the eggs of which are sup- 
posed to be taken in water or raw food. The hook-worm 
(Strongylus duodenale), which causes a severe anemia, is 
taken in drinking-water. The trichina is taken in with 
raw pork, and the filaria is taken in with drinking-water. 
Infected Milk.-Certain diseases may sometimes be 
transmitted by infected milk. Among these are diarrheal 
diseases, diphtheria, scarlet fever, typhoid fever, and 
Asiatic cholera. The last two are usually carried by 
infected water. 
FOOD ADULTERATION. 
Food adulteration is of two kinds: that which is in- 
jurious and that which is non-injurious. The latter is 
practised where there are no fixed standards, or, where 
such do exist, in debasements from these fixed standards. 
Adulterations may be classified as follows: 
i. Conventional-to suit the taste and demands of 
the public. Such adulterations are usually effected by 
means of coloring-matters, many of which are harmful, 
and by bleaching certain products. 
2. Accidental or incidental-arising from environ- 
ment, carelessness, or incompetency on the part of the 
producer, manufacturer, or his agents. This usually 
consists in an admixture of some foreign substance, such 
as husks, stems, leaves, etc. 
3. Arbitrary-to comply with or take advantage of 
certain fixed arbitrary standards. VARIOUS FACTORS IN THEIR BEARING ON DIET. 
117 
A Table of the Various Adulterations 
Articles. 
Deleterious 
adulterants. 
Fraudulent 
adulterants. 
Accidental 
adulterants. 
Arrowroot. 
Brandy. 
Bread. 
Sulphate of alum. 
Other starches which are 
substituted in whole or 
in part for the genuine 
article. 
Water, burnt sugar. 
Flours other than wheat, 
Ashes from oven, 
Butter. 
Copper. 
inferior flour, potatoes. 
Water, other fats, excess 
grit from mill- 
stones. 
Curd. 
Canned vegeta- 
Salts of copper, lead. 
of salts, starch. 
Excess of water. 
Meat damaged in 
bles and meat. 
Cheese. 
Salts of mercury in 
Oleomargarin. 
the process of 
canning. 
Candy and con- 
the rind. 
Poisonous colors, ar- 
Grape-sugar. 
Flour. 
fectionery. 
Coffee. 
Cocoa and 
tificial essences. 
Oxid of iron and 
Chicory, peas, rye,beans, 
acorns, chebus-nuts, 
almond or other nut- 
shells,burnt sugar, low- 
grade coffees. 
Animal fats, starch, flour, 
chocolate. 
other coloring- 
and sugar. 
Cayenne pepper. 
matters. 
Red lead. 
Ground rice-flour, salt, 
Oxid of iron. 
Flour. 
Alum. 
ship-bread, Indian 
meal. 
Ground rice. 
Grit and sand. 
Ginger. 
Gin. 
Alum salt, spirit of 
Turmeric, Cayenne pep- 
per, mustard, inferior 
varieties of ginger. 
Water, sugar. 
Honey. 
turpentine. 
Glucose, cane-sugar. 
Pollen of various 
Isinglass. 
Lard. 
Caustic lime, alum. 
Gelatin. 
Starch, stearin, salt. 
plants and in- 
sects. 
Mustard. 
Chromate of lead, 
Yellow lakes, flour, tur- 
Milk. 
sulphate of lime. 
Water. 
meric,Cayenne pepper. 
Burnt sugar, annatto. 
Sand, dirt. 
Meat. 
Infested with para- 
Tainted. 
Horseradish. 
Fruit-jellies. 
sites. 
Anilin colors, arti- 
Turnip. 
Gelatin, apple-jelly. 
Oatmeal. 
Pickles. 
Preserves. 
ficial essences. 
Salts of copper, alum. 
Anilin colors. 
Apples, pumpkins, mo- 
Old and wormy. 
Pepper. 
Flour, ship-bread, linseed 
meal. 
Potato-starch. 
Water. 
Sand. 
Sago. 
Rum. 
Cayenne pepper, ar- 
Burnt sugar. 
Sugar. 
tificial essences. 
Salts of tin and lead, 
Rice-flour. 
Sand and dirt, in- 
gypsum. 
sects dead and 
alive. 
1 From Bulletin No. 25, Division of Chemistry, United States Depart- 
ment of Agriculture. 118 
DIETETICS FOR NURSES. 
Articles. 
Deleterious 
adulterants. 
Fraudulent 
adulterants. 
Accidental 
adulterants. 
Spices. 
Cloves. 
Cinnamon. 
Pimento. 
Tea. 
Vinegar. 
Wine. 
Sulphuric, hydro- 
chloric and pyro- 
ligneous acids. 
Anilin colors, crude 
brandy. 
Flour, starches. 
Arrowroot. 
Spent bark. 
Ship-bread. 
Foreign leaves, spent tea, 
plumbago, gum, indigo, 
Prussian blue, China 
clay, soapstone, gyp- 
sum. 
Water. 
Ferruginous earth. 
Sulphate of potas- 
sium. 
4. Intentional-for purposes of gain and competition. 
Wood alcohol is sometimes used to adulterate alco- 
holic beverages, flavoring extracts or drugs. It may 
cause blindness or death. 
Lead and copper or white salts may occasionally find 
their way into canned food. This may be used intention- 
ally. Lead may come from solder dropped in the can or 
from using dull tin (terne or roofing-tin) for the cans. 
Only the bright tin should be permitted. 
Preservatives.-Various chemicals are mixed with 
foods to preserve them. In some countries the use of 
preservatives is forbidden. Borax, boric acid, salicylic 
acid, sulphate or bisulphate of sodium are the most fre- 
quent. They are all injurious, and if taken into the body 
continuously produce disturbances of digestion, lower 
the nutrition, and may cause disease of the kidneys. 
Formaldehyd is frequently used, and in general it may 
be stated that its use is undesirable and dangerous. 
Simple Tests for the Detection of Preserva- 
tives.-The following tests, largely adopted from Bigelow 
and Howard's article, will be found of use in detecting 
the more important commercial preservatives, with the VARIOUS FACTORS IN THEIR BEARING ON DIET. 
119 
exception of sulphites and fluorids. The sulphites are 
used in meats and the fluorids in fruits, and the methods 
for determining their presence are not suited for house- 
hold use. All of these tests require considerable expe- 
rience in order to draw correct conclusions. 
Salicylic Acid.-This is very commonly used in all 
kinds of foods, solids and liquids, especially fruit products. 
It is best detected in solution, and solids and semisolids 
should be macerated in water, and then strained through 
a white cotton cloth. Two or three ounces of the fluid 
to be tested is used, adding to it a few drops of sulphuric 
acid (or about 15 grains, the quarter of a teaspoonful, 
of cream of tartar). Shake thoroughly and filter. To 
the clear liquid add three or four tablespoonfuls of chloro- 
form, mix by a rotary motion, but do not shake, or an 
emulsion will be formed which is difficult to break up. 
Allow the chloroform to settle, and remove as much as 
possible by means of a pipette or medicine-dropper. 
This is placed in a test-tube, with an equal amount of 
water and a small piece-a little larger than a pin-head- 
of iron alum. Shake well and allow to settle, and if sali- 
cylic acid is present, the upper layer will have a purple 
color. 
Benzoic Acid.-This is used chiefly in fruit products, 
catsup, etc. This test is not sufficiently delicate for very 
small quantities, such as may be added to wine. Pro- 
ceed as above. Evaporate the chloroform by placing in 
a saucer outside of a closed window. In cold weather 
place the saucer in a basin of rather warm water. When 
the chloroform has evaporated the characteristic flat 
crystals of benzoic acid may be seen in the saucer, and 
on warming the characteristic irritating odor of the acid 
can be detected. 120 
DIETETICS FOR NURSES. 
Borax and Boric Acid.-Both of these are used in 
many food products. Macerate solids or semisolids as 
above, cool the liquid, and filter through filter-paper. 
In testing butter place a heaping teaspoonful in a cup, 
add a couple of teaspoonfuls of hot water, stand the cup 
in hot water until the butter is melted, stir well, then put 
the cup in cold water until the butter solidifies, and then 
filter the liquid. 
For milk use an ounce of milk and two ounces of a solu- 
tion of a teaspoonful of alum to a pint of water. Shake well 
and filter. Add five drops of hydrochloric acid to a tea- 
spoonful of the liquid, dip a piece of turmeric paper in it, 
and dry the paper. If either borax or boric acid is 
present, the paper, when dry, becomes a sherry red. A 
drop of ammonia turns the color dark green or greenish 
black. If too much acid has been used, the color may 
first be brown, even if borax or boric acid is present. 
The ammonia turns this brown, just as it will turn tur- 
meric paper which has not been dipped in acid solutions. 
Saccharin.-Proceed as in the test for salicylic acid. 
The residue left on evaporating the chloroferm has the 
sweet taste of saccharin. Sugar is not soluble in chloro- 
form, so will not be present. If tannins are present the 
astringent taste may mask the taste of the saccharin. 
Formaldehyd.-This must be separated by distillation 
in foods other than milk. Formaldehyd is best tested 
by using either Hehner's or Leach's test. They are 
based on the appearance of a violet color when concen- 
trated sulphuric acid or hydrochloric acid containing a 
trace of iron is added to the milk. 
Helmer's Test.-To a few cubic centimeters of con- 
centrated sulphuric acid, to which a trace of some ferric 
salt has been added, add the milk to be tested, so as to VARIOUS FACTORS IN THEIR BEARING ON DIET. 
121 
form a distinct layer on top of the acid, and allow to 
stand. If formaldehyd be present, even one part to a 
million of milk, a violet coloration will take place at the 
junction of the two liquids. 
Leach's Method.-Dilute the milk with an equal volume 
of water, and add for each cubic centimeter of the diluted 
milk i cc. of concentrated hydrochloric acid containing 
i cc. of io per cent, ferric chlorid solution, to each 500 
cc. of acid. The mixture is heated in a casserole over 
the bare flame to 8o° or 900 C., rotating to break the 
curd which forms. If formaldehyd be present, a violet 
color will appear. 
Hydrogen Peroxid.-This may be detected in milk by 
the use of a solution of titannic acid (titannium hydrate) 
dissolved in sulphuric acid. This is added to a few cubic 
centimeters of milk, and if the peroxid is present, color- 
ation appears, but varies between a light yellow and a 
deep orange, according to the amount of peroxid present. 
A somewhat similar reaction takes place from milk con- 
taining salicylic acid. 
The Determination of Artificial Colors.-The 
Coal-tar Dyes.-If the substance to be examined is not a 
liquid, dissolve the dye by macerating it in water. Filter, 
take two or three ounces and add a few drops of hydro- 
chloric acid, and a few strands of white woolen yarn, or 
pieces of white woolen cloth. (Before using, the wool 
should be boiled in water containing a little soda to remove 
any fat it may contain, and then washed in water.) The 
wool, which has been boiled, is washed first in hot and 
then in cold water, and the water pressed out. If the 
wool is not discolored, the substance tested may be 
regarded free from artificial colors. If the wool is 
colored, it may be from coal-tar colors, some foreign 122 
DIETETICS FOR NURSES. 
vegetable colors, or, if a fruit is being examined, the 
natural coloring-matter of the fruit. Rinse the wool in 
hot water, and boil three minutes in two ounces of water, 
to which two drams of ammonia have been added. 
Squeeze out the excess of water. Natural fruit color is 
retained, while the coal-tar dyes are usually dissolved in 
the ammonia solution. Add hydrochloric acid to this 
fluid until the odor of the ammonia has disappeared and the 
liquid has a sour taste. A fresh piece of woolen yarn is 
boiled in this, and if it is colored, the substance examined 
has been artifically colored. Dull, faint tints must be dis- 
regarded. If an anilin dye (coal-tar) has been used, the 
yarn will usually be turned purple or blue by ammonia. 
The Detection of Copper.-This is often used in coloring 
canned peas, beans, etc. Mash the substance to be 
examined and add a teaspoonful of the pulp to three tea- 
spoonfuls of water and thirty drops of hydrochloric 
acid. Place the cup in which this has been placed in a 
water-bath (saucepan containing water will do) and add a 
bright iron wire nail. Boil hard twenty minutes, stirring 
frequently with a splinter of wood or a glass rod. If 
copper is present in any appreciable amount the nail will 
be plated with copper. 
Turmeric.-This is added to yellow spices, especially 
mustard and mace. Mix one-half teaspoonful of the sub- 
stance to be examined in a white china dish with an equal 
amount of water, and five or ten drops of ammonia. If 
turmeric is present, a brown color is formed. If an 
insufficient amount of the dye has been used to give this 
test, a more delicate one is to mix a teaspoonful of the 
substance to be examined with an ounce of alcohol, and 
then allow it to settle fifteen or twenty minutes. About 
one-half ounce of the upper liquid is placed in a dish 
with five drops of concentrated solution of boric acid or VARIOUS FACTORS IN THEIR BEARING ON DIET. 
123 
borax, and ten drops of hydrochloric acid, and the solution 
thoroughly mixed. A wedge-shaped strip of filter-paper, 
two or three inches long, an inch wide at the upper end, 
and one-quarter inch at the lower end, is then suspended 
so that the lower end touches in the solution. The paper 
should not touch the side of the dish. This should be 
allowed to stand for a couple of hours, and if turmeric is 
present, a cherry-red color forms on the filter-paper near 
the upper edge. This red color is turned dark green or 
almost black on the addition of ammonia. If too much 
hydrochloric acid has been added, a brownish color results. 
Caramel.-This is used to color vinegar and other 
fluids. It should be borne in mind that caramel occurs 
naturally in malt vinegar. Place about one ounce of the 
fluid to be tested in two test-tubes, add a teaspoonful 
of fuller's earth to one, and shake vigorously two or 
three minutes. Filter through filter-paper. The first 
part of the liquid coming through the paper should be 
returned to be filtered a second time. If the filtered 
liquid, on comparison with the untreated test-tube, is 
markedly lighter in color, one may assume that the color 
of the liquid is due to caramel, which is largely removed 
by the fuller's earth. This test requires a certain amount of 
practical experience before results can be depended upon. 
Coffee.-The difference between ground coffee and 
that which has been adulterated can often be told by the 
naked eye, especially if not very finely ground. Pure 
coffee has a uniform appearance, with dull surfaces, while 
most of the substitutes, particularly peas and beans, have 
polished surfaces. Chicory is very dark and gummy 
looking, and the particles have a distinctly astringent 
taste. On placing ground coffee in a bottle half full of 
water, shaking it and allowing it to stand, a large amount 124 
DIETETICS FOR NURSES. 
of the coffee will float, while most of the substitutes sink 
at once to the bottom. The chicory particles will color 
water, and as they sink slowly to the bottom leave a little 
dark train behind them. Coffee contains no starch, while 
all of the substances, except chicory, used for adulteration 
contain a considerable amount. All ground coffee that 
gives a starch reaction may be considered as adulterated. 
Flavoring Extracts.-Vanilla and lemon are the most 
commonly used and most adulterated. They are fre- 
quently made with the extract of the tonka bean, which 
can be determined by the peculiar odor by any one 
familiar with the two products. The extract made from 
the artificial vanillin lacks the resins. Caramel is often 
added to color it, and may be detected by shaking; the 
foam of pure extracts is colorless, and if caramel is 
present, little points of color will be seen at the point of 
contact with the bubbles. The fuller's earth test, given 
above, may also be used. To examine for the presence 
of resins, the extract should be evaporated, and when it 
reaches one-third its volume the resins become insoluble 
and settle to the bottom, while artificial extracts remain 
clear. If water is now added, the resin will separate out 
in a brown precipitate. A few drops of hydrochloric 
acid should be added, the liquid stirred and then filtered; 
the resin left on the filter-paper should be washed with 
water, and then dissolved in a little alcohol, and to one 
part of this add a few drops of hydrochloric acid, and to 
another a small particle of ferric alum. The resin from 
the vanilla bean has only a slight change of color, while 
with most other resins one or both of these reagents 
yield a distinct color change. 
Lemon extract may be tested by placing a teaspoonful 
of the oil in a test-tube, and adding two or three tea- VARIOUS FACTORS IN THEIR BEARING ON DIET. 
125 
spoonfuls of water. With real lemon extract the fluid 
first becomes turbid, and later the oil of lemon separates 
on the top of the water. If it remains perfectly clear, it 
is a low-grade product, and contains very little, if any, oil 
of lemon. 
Spices.-The detection of adulteration in spices for the 
most part requires expert knowledge of chemistry and 
microscopy. Most of the substances used contain starch, 
but so do most of the common spices. Cloves, mustard, 
and cheyenne pepper are practically free from starch, and 
the presence of it may be taken as a proof of adulteration. 
To test for starch, one-half teaspoonful of the suspected 
spice should be stirred into one-half cup of boiling water, 
and boiled for several minutes and then cooled. If the 
fluid is of very dark color, it should have water added to 
it, and to this a single drop of iodin is added. If starch 
is present, it gives the characteristic deep blue color, and 
if very much is present, it turns black. If no blue color 
appears, the iodin should be added drop by drop until 
it shows in the solution. 
Vinegar.-The simplest test is the odor. If it is not 
apparent the glass should be rinsed out with the vinegar, 
and allowed to stand for some hours, when the odor of 
the residue will be quite distinct; cider vinegar having 
the fruit odor, and wine vinegar the odor of wine. The 
residue may also be obtained by evaporation. If the 
vinegar has been colored, the caramel can be tested by 
the fuller's earth test. It should be borne in mind that 
many of the vinegars made from spirits and wood have 
apple-jelly added to give them the characteristic odor. 
The Halphen Reaction for Cottonseed Oil.-Carbondi- 
sulphid, containing about I per cent, of sulphur in 
solution, is mixed with an equal volume of amyl alcohol. 126 
DIETETICS FOR NURSES. 
Equal volumes of this reagent of the oil to be examined 
are mixed and heated in a bath of boiling brine for fifteen 
minutes. In the presence of as little as I per cent, of 
cottonseed oil, an orange or red color is produced, which 
is characteristic. Lard and lard oil, from animals fed on 
cottonseed meal, would give a faint reaction. 
Renovated butter and oleomargarin may be dis- 
tinguished from ordinary butter by boiling a small 
amount in a small pan or tablespoon. It should be 
melted slowly, and stirred with a wooden splinter or 
match stick several times during the boiling. Genuine 
butter boils with little noise, and produces an abundance 
of foam, while renovated butter and oleomargarin boil 
noisily, sputter like a mixture of grease and water, and 
produce less foam. 
Oleomargarin may also be distinguished from butter 
and renovated butter by the Waterhouse test. 
Sweet skimmed milk is used, filling a half-pint cup 
half full, then heat this nearly to boiling, and add a 
slightly rounded teaspoonful of the material to be tested. 
Stir with a wooden rod, and continue heating until the 
milk boils up; then remove from the heat and cool in a 
pan containing rather large fragments of ice and a little 
water. When the cup is placed in the pan the water 
should reach on the outside of the cup to one-quarter of 
the height of the milk within. The contents of the cup 
should be stirred rather rapidly and continuously, and 
about once a minute the cup should be moved about in 
the ice so as to facilitate cooling. If the sample is oleo- 
margarin, the fat gathers into one soft lump, and if it is 
butter, the fat becomes granulated and cannot be col- 
lected. When the test is properly carried out the dis- 
tinction is very marked. CHAPTER IV. 
THE FEEDING OF INFANTS AND CHILDREN. 
There are four methods of feeding infants : (^) Breast- 
or maternal feeding. (£) Wet-nursing, (r) Mixed feed- 
ing-i. e., breast-feeding supplemented by bottle-feeding. 
(d) Bottle- or artificial feeding. 
(«) Breast-feeding.-This is the natural and best way 
to feed a baby, and every mother, if she is capable, should 
be instructed about nursing her infant. The mental 
attitude of the mother has much to do with the secretion 
of milk, and the nurse should never discuss the mother's 
probable incompetency with her. All conversation should 
be hopeful and encouraging. If the baby is not gaining 
properly, tell the physician and not the mother. 
During the later months of pregnancy the breasts 
should be examined, and if the nipples are short they 
should be gradually lengthened by gentle traction several 
times a day. If they are inverted, a breast-pump may 
be needed to draw them out at first. During the entire 
nursing-period the breasts should be washed after each 
nursing, preferably with a boric acid solution. This does 
much toward preventing ulcers, fissures, and inflamma- 
tions. 
During the first forty-eight hours the child receives 
practically no nourishment from the breast, the only 
fluid secreted during this time being a yellowish creamy 
substance known as colostrum. This has a laxative 
effect upon the child's bowels. The child should, 
however, be put to the breast at regular intervals to 
stimulate the secretion of milk, which becomes free on 
127 128 
DIETETICS FOR NURSES. 
the beginning of the third day, although it may be de- 
layed a day or two longer. During the first two days 
the nursing child does not require anything except what 
it gets from the breast. It may, however, be given a 
teaspoonful or two of warm boiled water or of a 5 per 
cent, solution of milk-sugar. If the free flow of milk is 
delayed beyond forty-eight hours the child must be given 
nourishment, but should nevertheless be put to the breast 
at regular intervals, to help establish the milk secretion. 
Neglect of this important point often causes a failure in 
the secretion. 
If necessary the mother may be instructed as to the 
manner in which to give the child the breast. The child 
should lie on the right or left arm, according to whether 
the child is nursed at the right or left breast. If the 
mother is in a sitting posture her body should be inclined 
slightly forward. With her free hand she should grasp 
the breast near the nipple, between the first two fingers. 
If, owing to the too free flow of milk, the child takes the 
milk too rapidly, this may be checked by slight press- 
ure of the fingers. The child should nurse until satis- 
fied. The contents of one breast are generally sufficient 
for one nursing, and the breasts should be used alter- 
nately. When satisfied the child will usually fall asleep 
at the breast. Under ordinary conditions nursing should 
last from about ten to twenty minutes. If the milk is 
taken too rapidly, vomiting may ensue during or im- 
mediately after feeding. If too much is taken, it is 
regurgitated almost immediately. If the infant consumes 
more than half an hour in nursing, the breast and the 
milk should be examined. As the infant grows it 
requires and takes more food, and consequently nurses 
somewhat longer than in its earlier days. THE FEEDING OF INFANTS AND CHILDREN. 
129 
Good nursing habits should be insisted upon, as many 
attacks of indigestion, colic, and diarrhea may be traced 
to improper nursing. When good habits are estab- 
lished there is generally but very little trouble, the suc- 
cess of the training depending largely upon how it is 
done. Regular hours for feeding should be fixed and 
adhered to; if the child is asleep at the nursing hour it 
may be aroused, for it will almost invariably go to sleep 
after nursing. After the last feeding, which should be 
at 9 or io o'clock, the child should be quieted and 
allowed to sleep as long as it chooses. During the 
first month or two the infant will, as a rule, awaken be- 
tween I or 2 o'clock and again at 4 or 5 o'clock. After 
two or three months it will require but one night feed- 
ing, and after five months of age the average infant will 
sleep all night without nursing. 
Wheo the change is being made and the child awakens 
for its accustomed nursing, it should be given a little 
warm water from a bottle and quieted, but not taken 
up. 
At present the most frequent practice is to use a 
four-hour schedule. Many infants do not thrive on 
this, and a three- or even two-hour interval may be sub- 
stituted if necessary. When short intervals are used 
care should be taken not to feed the child more food 
than is required. The night feedings have to be regu- 
lated according to the child. We prefer giving a feeding 
at 10 p. M. and none until morning unless needed, as in 
the case of premature or small infants. Many prefer 
to give one night feeding at midnight. We have no 
fixed rules, but frequently employ the following schedule, 
especially where the infant does not seem to do well 
on the four-hour schedule: 130 
DIETETICS FOR NURSES. 
Age. 
Number in 
twenty-four 
hours. 
Intervals 
during the day. 
Night nursing 
between 9 P. M. 
and 7 a. m. 
i st day 
4 
6 
I 
2d day 
6 
4 
I 
3d day to 13th week 
7 
3 
2 
3d to 5th month 
6 
3 
I 
5 th to 12 th month 
5 
4 
O 
If the child is small or ill it will run somewhat behind 
the above schedule, and if it is large and robust some- 
what ahead of it. It is a good general rule to feed the 
child according to the age to which the child's weight 
corresponds. The child's weight is the best index to its 
nutrition. During the first few months it should be 
weighed twice a week, then once a week, and during the 
second six months twice a month. 
If the mother's milk is unsuited to the child it is fret- 
ful, the weight remains stationary or the child loses, and 
there may be bowel disturbances. In such cases the 
physician frequently examines the breast-milk to deter- 
mine its quality, and he may either decide to wean the 
child or to take certain measures to improve the breast- 
milk. The following are the most frequent means of 
modifying the mother's milk : 
I. If the milk is too rich the diet should be limited, 
especially as to the amount of meat taken. All alco- 
holic and malted drinks should be prohibited. With 
plenty of fresh air and exercise, such as walking, the 
desired effect will generally be brought about. The 
exercise should be carried to the point of fatigue. 
2. When the milk is good but deficient in quantity, the 
supply may be increased by massage of the breasts three 
times a day and from five to ten minutes. A good malt THE FEEDING OF INFANTS AND CHILDREN. 
131 
extract should be given with the meals, plenty of milk 
should be given, and exercise and fresh air looked after. 
3. When the milk is deficient both in quality and 
quantity the above means should be used, and the phy- 
sician generally prescribes iron in addition, and special 
orders about the diet. 
4. When the quantity is normal but the quality poor 
the same means should be tried, but these cases are prac- 
tically hopeless, and the physician usually decides to 
wean the child. 
The First Few Days.-The first few days of a baby's life 
are very important ones, and many subsequent troubles 
may be traced to inadequate supervision of the child 
during this period. This happens not only among the 
ignorant and ill-informed, but also in the most intelligent 
classes. During the first forty-eight hours the child 
receives practically no nourishment from the breast, 
the only fluid secreted during this time being colostrum. 
This has a laxative effect upon the infant's bowels, 
emptying them of the dark brownish material, known as 
meconium, that has accumulated during uterine life. 
The child should, however, be put to the breast at regular 
intervals, so as to establish a free flow of milk. This 
generally begins on the third day, but may be delayed. 
Catnip, fennel tea, and the like should not be given. 
It is very important that the breasts be emptied at 
regular intervals, as this is the greatest stimulation 
to milk secretion there is, not only during the first 
few days, but during the whole of lactation. If the 
child is too feeble to nurse properly the secretion of milk 
may be seriously interfered with. Throughout lactation 
if the breasts are not emptied there is a tendency for the 
milk to become poor in quality. During the first few 
days if the milk supply is not established it may be neces- 
sary to give the child some additional food, but it should 
be put to the breast at every nursing time so as to stimu- 132 
DIETETICS FOR NURSES. 
late milk secretion, then immediately afterward given 
whatever food is prescribed. 
During the first few days the child is often neglected 
and may become seriously, even fatally, ill from starva- 
tion from nursing on a dry breast. A normal milk flow 
may be established even seven or eight days after birth, 
so that until this time has elapsed it is not well to abandon 
efforts at having the child nurse, though sufficient food 
must be supplied during this period. With accurate 
scales the amount the child is getting from the breast 
may be determined by weighing immediately before and 
after nursing. If the child is not getting sufficient food 
it does not gain, or even loses, weight. It is fretful, 
worried, and cross; there are often greenish or brownish 
stools containing a large amount of mucus. 
The mental attitude of the mother has a marked effect 
on the milk condition, and her condition should not be 
discussed with the nurse in her presence. The child is 
best weighed in another room. 
Contra-indications to Maternal Nursing.-The mother 
should not nurse the child if she has tuberculosis in any 
form, as she not only exposes the child to infection, but 
hastens the progress of the disease in herself. If she 
has pulmonary tuberculosis, nursing the child will 
almost certainly prove fatal to her. When the mother 
has had any severe complications late in pregnancy or 
in connection with parturition, she should not suckle 
her child. Examples are nephritis, convulsions, severe 
hemorrhage, or septic infection. Nursing is contra-indi- 
cated if the mother is choreic or epileptic. 
When no milk is secreted nursing is, of course, im- 
possible. When the mother has shown on two previous 
occasions that she is unable to nurse her child, a third 
attempt may be made, but the child must be watched 
very closely and not allowed to suffer from underfeeding 
if no milk is secreted. THE FEEDING OF INFANTS AND CHILDREN. 
133 
(o) Wet-nursing.-With the advent of better meth- 
ods of artificial nursing the wet-nurse is disappearing, 
at least in the United States. Some infants will not 
thrive on any but human milk, and sometimes wet- 
nurses are still employed. Their choice should always 
be supervised by a physician. 
(c) Mixed Feeding.-One full feeding a day in place 
of a nursing is often given to permit weak or nervous 
mothers to get a good night's rest, or it may be given in 
daytime to allow the mother greater freedom. At each 
other nursing period the child is put to the breast and 
left long enough to empty at least one of them. If the 
child is not getting enough from the 
breast it may be necessary to give a 
certain amount after each nursing. 
The child is put to the breast first 
and then the amount necessary to 
make up the feeding given immedi- 
ately after. The mother's milk in 
these cases often becomes poor and 
weaning may be needed. In some 
cases in bottle-fed infants who are not 
doing well human milk is often given 
either from the breast of a wet-nurse 
or small amounts may often be ob- 
tained from some friendly mother, or, 
in cities, from maternity hospitals. In 
premature, improperly fed young in- 
fants, inanition, marasmus, and other 
conditons this plan is of great value. 
(d) Artificial Feeding.-When 
it becomes necessary for the child to 
be fed on the bottle, the milk-mix- 
ture to be used should be prescribed by the physician, 
and the nurse instructed by him in the preparation. It 
happens very often that many details are left to the 
Fig. 3.-A hygienic nurs- 
ing bottle (De Lee). 134 
DIETETICS FOR NURSES. 
nurse, and frequently even the entire matter. The fol- 
lowing short account will help her understand what is 
expected. (Full details will be found in our larger book, 
"Diet in Health and Disease.") 
The average infant will not thrive on plain cows' milk. 
To render it more fit for digestion it is diluted with water, 
lime-water, cereal gruels, and other articles of diet. The 
necessity for this will be seen on considering the differ- 
ences between cows' and mother's milk. 
Proteins.-These differ in amount and character. 
Mother's milk contains 1.5 to 2 per cent, of protein, on 
an average. Of this two-thirds are lactalbumin and one- 
third casein, the latter being much more digestible than 
the former. In cows' milk there is about 3.5 per cent, 
protein, of which five-sixths are casein and one-sixth 
lactalbumin. The casein of mother's milk is coagulated 
in the stomach in small flocculent masses. Cows' milk 
is coagulated in large curds. The proteins of cows' 
milk may be prevented from forming large curds by the 
addition of lime-water, barley-water, and gruels. 
The protein in mother's milk is best for infants; as 
low as 7 per cent, of the total calories will insure growth; 
with cow's milk the percentage must be 14 to 18 per 
cent. This is due to the differences in the make-up of 
the two substances. Cow's milk contains less of certain 
important amino-acids needed for infant growth. Vege- 
table proteins are still less suitable for infant nutrition. 
If a diet containing insufficient protein is used over 
long periods, it causes slow growth, anemia, muscular 
weakness, and other troubles. Too much protein makes 
for constipation, white dry stools. Protein milk and 
similar preparations are used to check diarrhea and 
fermentation. 
Sugar.-Milk-sugar is present in mother's milk in a THE FEEDING OF INFANTS AND CHILDREN. 
135 
very constant proportion of 6 to 7 per cent. In cows' 
milk it averages 4.5 per cent. In artificial feeding 
sugar must be added to the food to make it approxi- 
mately 7 per cent, of the total. Cane-sugar may be 
used with success in most of the normal babies. Some 
prefer milk-sugar, but mixtures of maltose and dextrose 
are less apt to ferment and are less irritating than the 
pure sugars. After diarrhea they are to be preferred 
except where some idiosyncrasy exists. Malt extracts, 
malt soups, malted milk, and gruels are also used to in- 
crease the carbohydrate content of the food. The 
caloric values of these are given in a table a few pages 
further on. 
Fat.-The fat in human milk averages 4 per cent.; 
that of cows' milk is the same. When the cows' milk 
has been diluted the quantity of fat must be made up 
by adding cream or using the upper part of the milk 
after the cream has risen. Care must be taken not to 
give too large quantities of fat, as it is a common cause of 
digestive disturbance. 
Salts.-The inorganic salts in the milks vary in about 
the same proportion as the proteins. They need not be 
considered in modifying milk for babies. 
Reaction.-Mother's milk is always alkaline, while 
cows' milk is neutral or acid, and it becomes more and 
more acid on standing. Alkalis are often used to cor- 
rect this acidity and to prevent the formation of curds. 
Lime-water in the proportion of 5 per cent, of the total 
mixture is most often prescribed, but most babies do 
about as well without this addition. Lime-water is 
added in much larger quantities in certain cases; 20 per 
cent, is often used, while 50 per cent, stops the digestion 
of proteins in the stomach. Sodium bicarbonate or 
sodium citrate are often used in the proportion of 1 to 
2 grains to each ounce of milk used in the mixture. 136 
DIETETICS FOR NURSES. 
The Fluid Needs of Infants.-In each twenty-four 
hours the infant requires a certain amount of fluid, about 
3 ounces per pound for the first four months, and less 
later, about 2| ounces per pound, and in late infancy 
2 ounces per pound. A three months' baby weighing 
12 pounds would be expected to take about 36 ounces 
in twenty-four hours. This is best given with the milk, 
but a few ounces may be given a couple of times a day, 
especially in summer when the fluid needs are somewhat 
greater. 
The Caloric Needs of Infants.-The total caloric 
needs of infants has not been definitely determined, and 
they vary greatly under different conditions. An infant 
that sleeps a great deal will require less food than one 
who is very wakeful, and the high-strung, nervous, and 
very active child requires considerably more than others. 
Children require more per kilo, or per pound of weight, 
than grown people, partly because they need a certain 
amount for growth and partly owing to the fact that the 
proportion of surface is greater in the small body. 
Atrophic children and those under weight for their age 
require more than the normal child, and the needs of 
premature children are much larger than ordinarily would 
be expected. Children overweight require less. The 
food requirements of infants according to present-day 
teaching are 60 calories per kilo (28 per pound) the 
first few days, in the second and third week 100 (45 
per pound), increasing to 120 (54 per pound) at six 
weeks, at the end of the first year 100 per kilo (45 per 
pound). There is a gradual fall until the sixth year, 
when the average is 80 per kilo (36 per pound), fol- 
lowing gradually until puberty, when the requirements 
are about the same as adults. Girls require a few calories 
less. Do not forget that there are many variations from THE FEEDING OF INFANTS AND CHILDREN. 
137 
these figures, which represent averages. Variations are 
caused by temperament, nervous children needing more; 
by climate and season, more in cold than hot; by mus- 
cular activity and other factors. Observation, common 
sense, and judgment cannot be replaced by printed 
tables. Artificially fed children apparently need more 
than those fed at the breast. Premature infants require 
from 100 to 132 calories per kilo. If the percentage 
composition of the infant's food is known, the number 
of calories they contain may be approximately esti- 
mated by Fraley's method, which consists in adding 
together twice the fat percentage, the protein percent- 
age, and the sugar percentage, and multiplying this 
sum by one and a quarter times the total quantity ex- 
pressed in ounces. This may be expressed in the fol- 
lowing formula: 
2F + P + S x <XQ = Calories. 
An easy rule is twice the fat percentage plus protein 
percentage, multiplied by 1.25, gives the calories per 
ounce of food. Holt and Howland suggest multiplying 
by 1.3. 
From the table on page 138 it is easy to calculate the 
caloric value of any ordinary mixture. 
Caloric Feeding.-The infant needs a certain amount of 
protein per pound of body weight. This is supplied by 
i| ounces of milk per pound. To make a milk formula 
for a given baby, take the amount of milk required by 
the weight, dilute it with plain water or a cereal water, 
according to the fluid needs of the body as stated else- 
where, 'add 1 ounce of sugar for each 20 ounces of the 
total mixture. If the total number of calories required 
according to the rules given under that caption are not 
supplied they can be made up by adding more fat-i. e., 
by using a top milk, or by adding more starch in sugar. 138 
DIETETICS FOR NURSES. 
Approximate Caloric Value of Different Foods 
Level 
Grams of 
per ounce. 
spoon- 
fuls. 
protein per 
ounce. 
Woman's milk 
20 
0.56 
Cows' milk 
20 
0.90 
Cream (20 per cent.) 
60 
0.70 
7 per cent, milk 
27-5 
0.90 
6 per cent, milk 
25-0 
0.90 
5 per cent, milk 
22.5 
0.90 
4 per cent, milk (whole milk) . . . . . 
20.0 
0.90 
3 per cent, milk 
23-5 
0.90 
2 per cent, milk 
22.0 
0.90 
11 per cent, milk (skimmed milk) .... 
13-5 
0.96 
1 per cent, milk 
i-5 
0.96 
Fat-free milk 
10 
0.96 
Whey 
10 
0.28 
Sweetened condensed milk, 1 fl. oz. . . . 
Sweetened condensed milk, 1 oz 
127 
3-50 
95 
2.50 
Evaporated milk 
55 
Dried milk (Mammala) 
127 
16 
Milk-sugar 
120 
40 
Cane-sugar 
120 
60 
Dextrimaltose 
120 
40 
Malt soup extract 
80 
40 
Barley flour 
109 
35 
Wheat flour 
107 
28 
Oat flour 
115 
40 
Soy flour 
120 
12.4 
Barley-gruel (1 to 16 oz.) 
7-5 
Barley-water (1 tbsp, to 16 oz.) 
2-5 
Albumin-water (white 1 egg to 1 pt.) . . 
1 
0.2 
Meat juice 
6 
Orange juice 
15 
Olive oil 
245 
122 
Milk-sugar 3 level tablespoonfuls = 1 ounce by weight. 
Cane-sugar 2 " " = 1 
Dextrimaltose 3" " = 1 
Barley or oat flour . . . 3 " " = 1 
Wheat flour 4 " " = 1 
Soy flour 3 " " = 1 
If the mixture does not agree or the infant does not 
thrive the mixture will have to be modified according 
to the stools and symptoms. 
Approximate Measures. THE FEEDING OF INFANTS AND CHILDREN 
139 
In former days complicated tables and formulas were 
used in calculating what should be used to feed the baby. 
A simpler and more satisfactory method is to figure out 
the number and size of the feedings. For each pound 
of the baby's weight one and a half of whole cow's milk 
or its equivalent must be supplied as a minimum. Often 
it is necessary to give more than this, and up to 2 
ounces to the pound may be used if necessary. This 
will supply the protein and a low but what is generally 
a satisfactory fat content. To this sufficient water or 
cereal gruel must be added to bring up the total quan- 
tity and sugar, usually 1 ounce for each 20 ounces of 
the mixture. Often less sugar must be used, especially 
if there is a tendency to fermentation or gas or any 
evidence of indigestion. Changing the kind of sugar 
may also help or, what is better, the use of mixtures of 
cereals, gruels, and sugar, or of malt foods. There are 
times when it is desirable to use less fat. In such cases 
skimmed milk or buttermilk may be used, but the infant 
should not be kept too long on low fat feeding and care 
should be taken to see that the total number of calories 
given in each twenty-four hours approximates the 
theoretic requirements. Higher fats may be at times 
used to advantage. We believe that mixtures rather 
high in fat give better results in the long run, but there 
is great danger of producing a fat indigestion with 
serious consequences, so that unless the child is super- 
vised by an expert these should be used cautiously 
if at all. Such formulas are easily obtained by using 
top milk. 
As an example a normal baby who has been on cow's 
milk weighs 10 pounds. It may be given 6 ounces at 
a feeding and five feedings in twenty-four hours; a 
total of 30 ounces. 
MILK MODIFICATION 140 
DIETETICS FOR NURSES. 
i J ounce per pound = milk 15 ounces = 300 calories. 
Dextrimaltose ij ounces = 45 tablespoons = 180 calories. 
480 calories, 
or 48 calories per pound. 
Water to make 30 ounces. 
This might be varied if the four-hour schedule did 
not give good results, and six feedings of 6 ounces each 
given, the same number of calories, but the food more 
diluted. Barley-water might be substituted for plain 
water if the stools were not perfectly smooth or oat- 
water might be used if there was constipation. 
In this manner an endless number of formulas may 
be worked out using but one or two known facts as a 
basis. The mistake usually made is to figure out a 
formula that is theoretically correct and to persist in 
its use regardless of whether the baby thrives or not. 
If the baby does not gain regularly in weight some- 
thing is wrong, but do not be impatient in stationary 
weight in infants who have been improperly fed and 
whose digestion has been impaired in consequence. A 
certain amount of time is required for readjustment. 
Dennett gives the following conditions in which the 
caloric requirements should not be fulfilled: 
1. In the newborn (for the first two weeks). 
2. Normal infants abruptly weaned from the breast 
(until their tolerance for food can be gradually in- 
creased). 
3. Infants whose previous food has not contained 
cow's milk (until the milk and sugar can be gradually 
increased). 
4. Infants who have been overfed (until their di- 
gestive apparatus has had a chance to recuperate). 
5. Infants who have been underfed (until their toler- 
ance for food can be gradually increased). THE FEEDING OF INFANTS AND CHILDREN. 
141 
6. Infants who have diarrhea or who have recently 
had diarrhea (until the stools have become normal and 
the tolerance for food has been gradually increased). 
7. Infants who have excessive vomiting or who have 
recently recovered from excessive vomiting (until vomit- 
ing has stopped and the tolerance for food increased). 
8. Infants with loss of appetite (until all food is 
greedily taken). 
9. Infants who are partially breast fed (until they are 
entirely weaned, because it is impossible to determine 
how many calories they are getting from the breast). 
The Calculation of the Composition of a Milk 
Mixture.-This is most easily done by multiplying the 
percentage of fat, sugar, and protein in the food by the 
number of ounces used,'and dividing by the total number 
of ounces of food prepared, and adding in the percentage 
of sugar added. Thus, in a formula of which milk 6 
ounces, milk-sugar 1 ounce, and water to make 20 ounces, 
the percentage of fat would be n of 4, or 1.2; the per- 
centage of sugar of 4.50, or 1.35; and the protein 
of 3.50, or 1.05. The ounce of sugar added amounts to 
5 per cent., so the sugar percentage would be 6.35. 
The Pirquet System of Nutrition.-During the 
late war large groups of children were fed abroad and a 
new system was devised by Pirquet to regulate the 
amount furnished. This system, while of value in feed- 
ing large groups, does not seem to be much used in 
America. It is based on the sitting height, i. e., the dis- 
tance from the surface of the seat on which the body 
rests to the top of the head, which bears a close relation 
to the cube root of the body weight. The term "pelidisi" 
is used to express the formula which is the cube root 142 
DIETETICS FOR NURSES. 
of ten times the body weight which approximately equals 
the sitting height. The pelidisi have been worked out 
and are given in Pirquet's tables.1 The unit of nutrition 
used by Pirquet is the "nem," the initials of Nahrungs- 
Einheit-Milch or Nutrition-Equivalent-Milk, and is 
the full value of a gram of human milk or 1 (large) 
calorie equals 1.5 nems, a decinem is one-tenth of a 
nem, a dekanem is 10 nems, and so on. Hektonems 
or 100 nems is most used in computing diets. This 
method of computing diets cannot be presented in a 
small space, and, inasmuch as it is but little used in 
America, the reader is referred to the reference given 
for fuller information. 
I/aboratory Method.-In certain cities there are 
milk laboratories, known as the Walker-Gordon labora- 
tories, where physicians may send prescriptions for milk 
mixtures, which are made at the laboratory and sent to 
the home of the infant. The only procedure is to re- 
move the cotton stopper from the bottle and replace 
it with a nipple and warm the milk. 
Matema Graduate Method.-Where a nurse is 
thrown on her own responsibility, the Estraus Materna 
Graduate is of great service. With it six modifications 
can be made, which are sufficient for the average child. 
Sometimes, of course, a child will be found whose diges- 
tive powers do not correspond with the few formulas 
furnished. 
The apparatus consists of a glass jar with a lip and 
seven panels, and a capacity of 16 ounces. One of the 
panels exhibits an ordinary ounce graduation; the other 
six panels present six different formulas for the modifica- 
tion of cows' milk, each formula being so arranged as to 
keep pace with the infant's growth, viz.: 
1 An Outline of the Pirquet System of Nutrition, W. B. Saunders Co., 
1922. THE FEEDING OF INFANTS AND CHILDREN. 
143 
Formula: 
Fat . . 2 per ct. 2^ per cent. 3 per cent. 3I per cent. 4 per cent. 3 J per ct. 
Sugar . 6 " 6 " 6 " 7 " 7 " 3^ " 
Protein 0.6 " 0.8 " I " " 2 " 2| " 
For Formula 6 see special instructions below. 
3d to 14th 
day. 
2d to 6th 
week. 
6th to nth 
week. 
nth week to 
5th month. 
5th to 9th 
month. 
9th to I2th 
month. 
Milk parts 
x^ 
2 
4^ 
6 
Milk parts 
9A 
Cream .... " 
1/8 
2 
2 
2 
Cream .... " 
Lime-water . . " 
I 
X 
34 
X 
Barley-gruel . " 
5^ 
Water .... " 
12^ 
XI^ 
8% 
7% 
Granulated sugar, 
Milk-sugar . . " 
I 
I 
I 
I 
parts 
A 
Fig. 4.-The "Materna" graduate (De Lee). 
Having decided which formula is to be used, the panel 
containing that formula is the only one to be followed. 144 
DIETETICS FOR NURSES. 
The quantity desired for twenty-four hours is next to 
be considered, and the apparatus filled-once, if 16 
ounces or less are required for the twenty-four hours; 
twice, if from i6to 32 ounces are required for the twenty- 
four hours; three times, if from 32 to 48 ounces are re- 
quired for the twenty-four hours. 
Baner's Method.-If the percentages have been given, 
the quantities of milk, cream, sugar and water needed 
may be determined by the following formulas: 
Quantity desired (in ounces) = Q. 
Desired percentage of fat - F. 
Desired percentage of sugar = 5. 
Desired percentage of protein = P. 
To find in ounces : 
Cream (16 percent.) = Q x (F- P). 
Milk = 22^-C 
4 
Water = ^-(C+J/). 
■n n 5- P x Q. 
Dry milk-sugar -. 
too 
Example.-Suppose it is desired to make 40 ounces 
of a 4 per cent, fat, 7 per cent, sugar, 2 per cent, pro- 
tein mixture. By substituting the figures in the equa- 
tions above we have- 
Cream =l?x 2 = 6| ounces. 
12 
Milk =^-- - 6f= 13| ounces. 
Water = 40 - 20 = 20 ounces. 
Sugar = 5224- - 2 ounces, 
too 
Malted gruels, various diastase preparations, such as 
diastoid, maltine and diazyme, as well as the malted 
foods, such as Mellin's, are sometimes used to prepare 
the infant's milk, especially if there is constipation. Bar- THE FEEDING OF INFANTS AND CHILDREN. 
145 
ley-, oatmeal-, and rice-water are sometimes used to dilute 
the milk to break up the curd. Barley- or rice-water is 
preferred when there is a tendency to loose bowels, and 
oatmeal-water when there is constipation. Cereal gruels 
are probably best not begun before the eighth or ninth 
month, unless there be some special indication for so 
doing. 
Other Foods for Infants.-Many other foods may 
be of service under certain conditions. The following are 
the most important: 
Dried Milk.-There are two types of dried milks. 
In one the milk is dried and mixed with other food sub- 
stances, usually carbohydrates. Malted milk and 
Nestle's food are of this class and have been mentioned 
elsewhere. When this type of food is used orange juice 
or some other antiscorbutic should always be given. 
In the other type the milk is dried very rapidly either 
by passing it over heated cylinders, the Hatmaker proc- 
ess (Dryco, Mammala), or by spraying it through small 
openings into a heated vacuum, the Merrill-Soule process 
(Klim). These milks retain their vitamins, but are 
slightly lower in fat than ordinary raw milk. They are 
very useful in infant feeding. We are inclined to believe 
that in the next quarter of a century such milks will be 
used extensively. They are useful in traveling, in hot 
climates, and where pure milk cannot be obtained. In 
certain forms of digestive disturbances and in some cases 
of malnutrition they are most useful, as they appear to 
be more digestible and more absorbable than fresh milk. 
They are sterile and so help prevent diarrhea, but there 
are occasional children who have loose movements on 
dried milk, especially if the mixture is a little too rich. 
We almost always give orange juice or some other anti- 
scorbutic, although this is apparently not necessary. We 146 
DIETETICS FOR NURSES. 
also give children fed on them small doses of cod-liver 
oil from time to time. 
Dried milk should be made fresh at each feeding, 
using boiled water, and some form of sugar or carbohy- 
drate may be added, as in using fresh milk. 
Dryco contains approximately: 
Per cent. 
Fat 12 
Lactose 44 
Protein 7 
Moisture 3 
100 
One ounce by weight yields 127 calories. 
Eight level tablespoons (level with a knife), 1 ounce 
by weight. 
One level tablespoon, 16 calories. 
The maximum strength for infant feeding is one level 
tablespoon to the ounce, but sometimes where a con- 
centrated food is desired the mixture may be made 
stronger and used in smaller quantities. We usually 
add sugar to bring up the caloric value by adding 1 or 
2 teaspoons of sugar or dextrimaltose to each feed- 
ing, according to circumstances, and sometimes use it 
without sugar. One level teaspoonful of sugar equals 
about 10 calories and of dextrimaltose about 6 calories. 
It is well to use a measure or measuring glass. 
A simple rule is to give 2| level tablespoons per day 
for each pound of the infant's weight. Dissolve in one 
more ounce of water than there are tablespoons of dryco 
per feeding. 
The following has been suggested: THE FEEDING OF INFANTS AND CHILDREN. 
147 
Weight 
of baby 
in 
pounds. 
Amount 
each 
feeding, 
level tbsp. 
Amount of 
water each 
feeding, 
ounces. 
Number of 
feedings 
per day. 
Interval. 
Total 
calories 
per day. 
5 
2 
25 
7 
3 
224 
6 
25 
3 
7 
3 
280 
7 
3 
35 
7 
3 
336 
8 
3 
4 
7 
3 
336 
9 
35 
45 
7 
3 
392 
IO 
4 
5 
7 
3 
448 
ii 
4 
5 
7 
3 
448 
12 
5 
6 
6 
3 
480 
13 
55 
65 
6 
3 
528 
14 
6 
7 
6 
3 
576 
15 
65 
75 
6 
3 
624 
16 
8 
8 
5 
4 
640 
17 
8 
8 
5 
4 
640 
18 
8 
8 
5 
4 
640 
We have used somewhat larger feedings at longer 
intervals, often with the addition of sugar or dextri- 
maltose. Always start under the amount given and 
increase. If there is too rapid gain or a tendency to 
loose bowels reduce the amount of dryco. If there is 
constipation use dextrimaltose and if necessary either 
barley- or oat-water as a diluent. 
We have used this simpler schedule, varying it with 
the individual needs: 
Weight, 
pounds. 
Level 
tablespoons. 
Water, ounces. 
5 
ij to 2 
22 
6 
2i 
3 
7 
3 
3i 
8 
3 
4 
9 
4 
5 
IO 
5 
6 
12 
6 
7 
14 
7 
8 
16 
8 
8 148 
DIETETICS FOR NURSES. 
The Merrell-Soule Milk.-This is made by the Mer- 
rell-Gere spray process. The milk is first pasteurized 
by the holding process and partially concentrated by 
vacuum. It is then sprayed under heavy pressure into 
a chamber through which a current of filtered warm air 
is passing. The milk is broken up into a very fine 
spray and falls to the bottom as a dry powder, contain- 
ing less than 3 per cent, moisture. 
The claims made for this process are that the fat 
globules are broken up into a small size; casein curdles 
in finer and softer floccules; that when reliquefied it re- 
mains uniform, there being no tendency for the butter- 
fat to rise. 
It is made in two strengths, whole milk and skimmed 
milk. Four level tablespoons equal one ounce. The 
following shows the percentage composition of the 
various mixtures: 
Powdered 
whole 
milk. 
Whole 
milk 
restored 
41 ounces 
per quart. 
Water. 
Powdered 
skimmed 
milk. 
Skimmed 
milk 
restored 
3} ounces 
per quart. 
Water. 
Powdered 
half- 
skimmed 
milk. 
Half- 
skimmed 
restored 
4 ounces 
per quart. 
Water. 
Butter-fat 
28.00 
3-33 
i-35 
0.13 
14.68 
1-57 
Casein 
21.28 
2-53 
29.79 
2.86 
25-53 
2.74 
Albumin 
5-46 
0.65 
7-91 
0.75 
6.68 
0.72 
Milk-sugar.... 
38.00 
4-53 
49-94 
4-75 
43-97 
4-71 
Ash 
5-76 
0.6g 
8.21 
0.78 
6.99 
0.75 
Water 
i-5° 
88.27 
2.80 
9°-73 
2.15 
89-51 
100.00 
100.00 
100.00 
100.00 
100.00 
100.00 
Calories 
per ounce.... 
149 
18.0 
106 
10.1 
128 
13.7 
Half-skimmed powder is made by mixing equal quanti- 
ties of whole and skimmed powder. 
The following are suggestions made by the makers re- 
garding its use in infant feeding. 
While Klim will dissolve in cold water, warm water is THE FEEDING OF INFANTS AND CHILDREN. 
149 
recommended because the solubility of the milk-sugar is 
thereby promoted: 
Age. 
Klim, 
whole, 
level 
table- 
spoons. 
Milk- 
sugar, 
level 
teaspoons. 
Water, 
ounces. 
Number 
of 
feedings 
per day. 
Calories 
per day. 
1st week 
i 
i 
1 
ii 
2 
ai 
3 
31 
1 
1 
il 
2 
ij 
i 
i 
2 
3 
4 
S 
si 
6| 
7 
8 
7 
7 
7 
7 
6 
6 
6 
5 
132 
216 
401 
547 
609 
674 
710 
732 
2d, 3d, 4th weeks 
2d month 
3d month 
4th month 
5th and 6th months 
7 th month 
8th month 
Condensed Milk.-This is most useful in many cases 
for temporary use, particularly in difficult cases that have 
been improperly fed on too high fat and protein mixtures. 
It is also of use for the infants who are not gaining, and 
as a temporary food when pure milk cannot be obtained, 
as in traveling. Where only one bottle feeding is given 
a day, in breast-fed children, it is also useful. We gener- 
ally use it in dilutions of I in 12, or 1 in 8. It should 
be measured in a graduated glass, as otherwise too 
much may be used, and it may be diluted with plain 
boiled water or, if desired, with a thin cereal gruel. The 
gruel may be made from the soy-bean flour and barley 
flour, a mixture which is particularly useful for this 
purpose. Cream may be added later, or olive oil may 
be given in addition. Orange-juice should be given 
every other day, or even every day, to prevent scurvy. 
If condensed milk is used too long without other 
feeding, anemia, scurvy, or rickets is liable to de- 
velop. Condensed milk furnishes about 100 calories per 
ounce. 
Buttermilk.-Buttermilk has been much used in recent 
years, and is useful where it is necessary to use a food 150 
DIETETICS FOR NURSES. 
low in fat and sugar. The curd of the milk is precipitated 
in small flakes and most children digest it easily. It also 
contains lactic acid bacilli in large numbers, and this may 
be of especial service in certain forms of intestinal trouble. 
It may be diluted with water or with cereal gruels, and 
sugar may be added if desired. 
Acid Milks.-These are extensively used and are whole 
milk, to which lactic acid bacilli have been added. This 
milk is sold under various names, and often has other 
food substances mixed with it. It differs from buttermilk 
in having all of the fat left in it. It is of particular 
value in certain forms of diarrheal trouble and indiges- 
tion. It may be diluted to the same degree as ordinary 
milk. Kumiss and other fermented milks are sometimes 
used. 
Albumin Milk.-This is a mixture which has been 
much used of late, and is sometimes called Eiweiss milk 
or protein milk. This is prepared by heating one part 
of the whole milk to ioo° F., adding four teaspoonfuls 
of essence of pepsin and allowing the mixture to stand 
at ioo° F. until the curd is formed. The mass is placed 
in a linen cloth and the whey strained from the curd. 
The curd is removed from the cloth and pressed through 
a fine sieve two or three times, using a wooden mallet or 
spoon. While doing this, one pint of water is added. 
The precipitate ought to be very finely divided and the 
mixture should look like milk. To this one pint of 
buttermilk is added. This milk mixture is low in sugar, 
contains lactic acid bacilli, and has a food value of about 
370 calories to the quart. In the beginning it must not 
be mixed with any other kind of food, not even with 
human milk. The infant should be given only water, THE FEEDING OF INFANTS AND CHILDREN. 
151 
usually for twenty-four hours, and then small amounts 
of the albumin milk given and, if all goes well, larger 
and larger amounts. Malt sugar or mixtures of maltose 
and dextrin are sometimes added. Albumin milk re- 
quires care in its use. It should never be employed ex- 
cept on physician's orders, as great harm may result from 
its improper use. See also under Diarrhea. 
Calcium caseinate, marketed under such names as 
larosan, casec, and protolac, are frequently used to 
modify milk used in feeding babies with diarrhea or 
digestive disturbances. See Diarrhea for methods of 
preparation and use. 
Gelatin.-In chronic intestinal disease gelatin is often 
added to the diet, mixing it with milk or giving it as a 
jelly. 
Gruels.-Cereal gruels, as a rule, are made by cooking 
the flour and water for fifteen to twenty minutes. If the 
grains of the cereals are used, they must be cooked for 
from three to four hours. Barley, rice, oatmeal, corn- 
meal, and soy-bean flour are the most frequently used. 
Plain gruels cannot be made much stronger than 2 
ounces to the quart. Dextrinized gruels may be made as 
high as 8 ounces to the quart. One level tablespoon- 
ful of the cereal flour weighs ounce. The cereal 
flour contains about 100 calories to the ounce, so that 
underfeeding, which occurs when they are used alone, 
is easily explained. 
Soy Bean.-From 1 level tablespoonful to 3 ounces of 
the soy flour are used to the quart. These gruels do not 
thicken during cooking, as they contain no starch and 
readily settle on standing. This may be overcome by 
adding 1 to 2 tablespoonfuls of barley, oat, or wheat gruel 
flour before cooking, which will add 0.6 per cent, to 1.2 152 
DIETETICS FOR NURSES. 
per cent, starch to the gruels, and also slightly increase 
the percentage of protein. A good standard gruel, which 
may be diluted as desired, may be used by using I 
ounce of soy-bean flour, 2 ounces of barley flour to a 
quart of water. This contains 2 per cent, protein, 0.6 per 
cent, fat, 5.10 per cent, carbohydrate, with a caloric value 
of 320 calories, or 10 calories per ounce. This is just 
half the value of milk. It is of particular use in maras- 
mus, in using condensed milk, in cases in which cows' 
milk does not agree, and in certain forms of intestinal 
trouble. 
Olive Oil.-This is useful where cream disagrees when 
foods low in fat are given, sometimes in constipation and 
other certain digestive disturbances. From 1 to 4 tea- 
spoonfuls may be given daily, and it is best begun by 
using small amounts at first and then increasing gradu- 
ally until the full amount is given. 
Malted Milk.-This is a very valuable food for tempo- 
rary use when pure milk cannot be obtained, and it is also 
of value in certain digestive disturbances. It may also 
be added in milk mixtures, and it is also useful in consti- 
pation. If used over considerable periods, orange-juice 
or other fresh juices must be given, and fat, either cream 
or olive oil. 
Malt Soup.-Various malted preparations are used and 
are generally known as malt soups. Generally the malt- 
soup extracts of various kinds are used, but any thick 
malt extract and potassium carbohydrate may be used in 
making malt soups. Fifty grams (2 ounces) of wheat flour 
are added to J liter (11 ounces) milk with constant stir- 
ring, and in a second vessel malt-soup extract, or malt 
extract, with the addition of 100 c.c. (2| drams) of a 10 
per cent, solution of potassium carbonate are dissolved in THE FEEDING OF INFANTS AND CHILDREN. 
153 
j liter (20 ounces) of water at 1200 F. The contents of 
the two vessels are then mixed and boiled from two to 
five minutes. This mixture has a somewhat higher food 
value than cows' milk, and may be diluted with water 
as desired. 
Dry malt soup preparations are now made which 
greatly facilitate the use of this form of feeding. 
Malted Gruels.-These are prepared by making a cereal 
gruel in the ordinary way, then adding a teaspoonful of 
good malt extract or a teaspoonful of diastase. The 
mixture should be cooled before the diastase is added 
and then thoroughly stirred. 
Beginning Bottle - feeding. - The percentages 
should be low at first, far below what would be given 
the child if it were accustomed to cows' milk. As soon 
as the infant's stomach is accustomed to the milk, it 
should be rapidly increased in strength until the proper 
mixture for the child in question is reached. 
Technic of Modifying Milk at Home.-Great 
care and cleanliness should be used. The vessels and 
instruments used should, if possible, be kept solely for 
the use of the infant. All bottles, pitchers, and other 
utensils should be thoroughly boiled or scalded before 
using. The nursing-bottles should have rounded bot- 
toms, to facilitate cleansing. It is a good plan to keep 
the bottles sweet by filling them with a solution either 
of boric acid or sodium bicarbonate, a teaspoonful of 
either drug to a pint of water. The nipple should be 
ordinary short black rubber ones and white rubber, and 
all nipples with tubes or complicated structure avoided, 
as they are hard to clean and are liable to lead to bowel 
troubles. It is a good plan to have several nipples on 
hand, and to boil them when first bought, and once a day 154 
DIETETICS FOR NURSES. 
afterward. They should be thoroughly washed after 
each using, turning them inside out for that purpose, 
and kept in a solution of boric acid or sodium bicarbon- 
ate. The milk should drop rapidly when the bottle is 
held upside down. If it does not run fast enough, the 
holes in the nipple should be enlarged by using a red- 
hot darning-needle. If the flow is too free it may cause 
vomiting, and such nipples should be rejected. 
It is best to prepare the entire quantity for the twenty- 
four hours at one time. If the weather is warm the milk 
should be either sterilized or Pasteurized, unless an ex- 
ceptionally pure milk is being used. If neither can be 
done, the feedings maybe prepared one at a time as needed. 
The sugar, either milk or cane, is dissolved in hot 
water. If the solution is not perfectly clear, it should 
be filtered. This is poured into a pitcher with the lime- 
water or the soda, and the milk or milk and cream and 
other ingredients, if any have been ordered, should be 
added. After mixing, the nursing-bottles are filled with 
the proper quantity for each feeding, and the bottles 
stoppered with sterile raw cotton. The bottles are then 
sterilized or Pasteurized as directed, and then, after rapid 
cooling, are placed in the refrigerator. At the feeding- 
hour the bottle is heated and a nipple substituted for the 
cotton stopper. 
Premature Infants.-These should be kept warm 
and supplied with sufficient fresh air. Babies weighing 
5 pounds and over will generally take the breast, but 
it may require some days and patience. If they do 
not take a nursing the milk should be drawn from the 
breast and given by bottle, Breck feeder, dropper, or 
tube. This is the procedure for feeding smaller infants. 
The milk may come from a wet nurse and the age of 
the latter's child is of no importance as long as the milk THE FEEDING OF INFANTS AND CHILDREN. 
155 
is normal. It is, however, important that the infant 
get the colostrum from the mother the first two days 
if it is possible. If the milk is very rich or if there is 
any digestive disturbance some or most of the cream 
may be taken off, and it may be necessary to dilute 
the milk with boiled water, and in these cases small 
amounts of dextrimaltose may be added. Only a few 
grains should be given at first, as larger amounts oc- 
casionally cause loose bowels; if all goes well it may 
gradually be increased to 1,2, or even 3 per cent. 
The interval between feedings depends largely on 
how much can be given at a feeding and no fast rules 
can be given. The main thing is to get the infant's 
needs covered. There is considerable difference of 
opinion as to what the need is, but it may be figured at 
from 50 to 80 calories per pound, the smaller the infant, 
the greater the need. Great care should be taken not 
to overfeed, but in our experience danger of under- 
feeding seems to be greater than of overfeeding. These 
infants should be given small (5- to 10-drop) doses of 
cod-liver oil from time to time as they gain and grow 
older. Budin gives the following table showing the 
amounts taken by actual infants of various weights: 
Age, 
days. 
Weight less than 
1800 grains 
(about 4 pounds), 
ri infants. 
Ounces. 
Between 1800 and 
2000 grams 
(4 to 5 pounds). 
31 infants. 
Ounces. 
2200 to 2500 grams 
(5 to 5| pounds). 
25 infants. 
Ounces. 
2 
4 
45 
6 
3 
5z 
6 
8> 
4 
7 2 
8 
ioj 
5 
8 
II 
nt 
6 
81 
nt 
12I 
7 
IO 
nt 
125 
8 
IO 
125 
13 
9 
ii 
I3, 
145 
IO 
nJ 
145 
15 156 
DIETETICS FOR NURSES. 
FEEDING DURING THE SECOND YEAR. 
During the second year of life as much care is required 
in feeding as during the first. The fear of the second 
summer would largely be overcome if the child were 
not allowed to eat food unsuited to its digestion. The 
fact that some children thrive on almost any kind of food 
is no excuse for permitting a child to have the same 
food as its elders, as is so often done. Most of the ill- 
ness and many of the deaths of childhood are traceable 
to improper diet. 
During the second year milk should form the basis 
of the diet. In cities or where the milk-supply is not 
above suspicion, it is best to pasteurize the milk until 
the second summer has been passed, or even longer if 
circumstances warrant. As a rule, the milk requires but 
little modification, and after the twelfth month, and 
often before, may generally be taken unmodified. As the 
child is now able to digest starchy food, milk-sugar may 
be omitted. In cases where the milk is not thoroughly 
digested, as is evidenced by curds in the stools, lime- 
water may be used, and may be added in quantities of 
from 5 to io per cent., or even more if necessary. If the 
milk is very rich, it should be diluted either with lime- 
water or usually with plain sterile water-three parts of 
milk to one of water. If the milk is poor or if milk 
that is not rich does not agree with the child, it may be 
prepared as follows: Fill a glass three-quarters full of 
milk, add one or two tablespoonfuls of cream, and fill to 
the top with plain water. If this does not answer, add a 
tablespoonful of lime-water. During illness, and often 
under other circumstances, the alkaline carbonated waters 
will be found useful for diluting the milk. If the milk 
is poor, another plan is to use the upper two-thirds of 
the milk. THE FEEDING OF INFANTS AND CHILDREN. 
157 
Starchy food may be given in the form of gruel, either 
alone or, what is better, mixed with the milk. Barley- 
gruel or, if there is a tendency to constipation, oatmeal- 
gruel is added, one-fifth or one-fourth part of gruel being 
added to each feeding. The gruel should be freshly pre- 
pared and mixed immediately with the milk. A pinch 
of salt and a very small quantity of cane-sugar may be 
added to render it more palatable. It may then be Pas- 
teurized like ordinary milk. 
The bottle should be dispensed with and the food be 
taken from a cup or spoon. If the bottle is not taken 
from the child early, it may be difficult to break it of 
the bottle habit. The following diet lists for different 
ages will be found useful: 
DIET LIST-SEVEN TO NINE MONTHS 
Foods permitted: 
Breast or substitute. 
Junket. 
Orange or prune juice, strained stewed apples. 
Any well-cooked cereal, as farina, cream of wheat, oatmeal, cream of 
rice, barley, cornstarch, arrow root, or barley flour. Cook cereals 
thirty minutes over flame or one and a half hours in a double boiler. 
Crackers, toast, or zwieback, given dry or with milk. 
Any green vegetable that may be passed through a sieve, as carrots, 
spinach, stewed lettuce, soft parts of cauliflower or asparagus, 
oyster plant, juice of stewed tomatoes. Vegetables should be 
cooked until soft. 
Schedule: 
6 A. m. (or on waking).-Breast or bottle. 
8 a. m.-Fruit juice. 
xo a. m.-Cereal, beginning with i ounce and gradually increased up 
to 6 ounces. Breast or bottle. 
2 p. m.-Vegetables, zwieback or toast bread, and bottle. 
6 p. M.-Breast or bottle (cereal allowed after nine months if needed). 
io p. M.-Breast or bottle if required. 
DIET FOR INFANTS-NINE TO TWELVE MONTHS 
6 a. m.-Bottle. 
8 a. m.-Orange juice, prune juice, or strained prunes (j to 2 table- 
spoonfuls). 158 
DIETETICS FOR NURSES. 
io A. m.-Bottle. 
Cereal: 
Farina, cream of wheat, oatmeal, rice flour, cornstarch, 
or arrow root (6 ounces). 
i tablespoonful cereal, 
| cup water, 
J cup milk, 
i pinch salt. 
Boil for thirty minutes over the direct flame or one and 
a half hours in double boiler. 
Crisp bacon (J to i slice). 
2 p. m.-(A) Vegetable soup (6 to 8 ounces). 
| pound beef, lamb, veal, or chicken, 
i potato, 
i carrot, 
2 stalks celery, 
i tablespoonful pearl barley, 
2 tabelspoonfuls rice, 
2 quarts water, 
i pinch salt. 
Finely divide the vegetables. Add the vegetables, barley 
and rice to 2 quarts water. Boil down to 1 quart, 
cooking three hours. Add pinch salt. Pass through 
fine sieve. 
or (B) Baked potato (1 tablespoonful to 4 tablespoonfuls) with 
beef-juice (J teaspoonful to 1 tablespoonful) and 
strained carrot, spinach, or squash (1 teaspoonful to 
1 tablespoonful). 
If (B) is used, a bottle of milk may be given. 
6 p. m.-Bottle: 
(A) Cereal as at 10 A. m. 
(B) Toast or zwieback (1 to 2 slices in part of milk mixture). 
10 p. m.-Bottle (if required). 
DIET LIST-TWELVE TO FIFTEEN MONTHS 
Foods permitted: 
Milk. 
Junket. 
Any well-cooked cereal, as cream of wheat or rice, farina, oatmeal, 
arrow root, cornstarch, barley flour. 
Crackers, zwieback, toast, whole wheat bread, stale bread. 
Coddled or soft-boiled egg two or three times a week. 
Crisp bacon. 
Orange juice, prune juice, prune pulp, apple sauce, or baked apple. 
Vegetables-Baked or mashed potato, carrots, soft beets, salsify, 
squash, stewed tomato juice, string beans, lima beans, 
peas, asparagus tips, soft parts of cauliflower. The 
harder vegetables and those with skin or pulp should 
be passed through a sieve, the others may be mashed. 
Soups or broths made of chicken, beef, mutton, thickened with flour, 
cereals or vegetables. Vegetable soup or mixture. 
Sparingly jelly and honey. Gelatin jelly. THE FEEDING OF INFANTS AND CHILDREN. 
159 
Schedule: 
6 a. m. (or on waking).-Milk. 
8 A. m.-Fruit juice, 2 or 3 tablespoons. 
10 A. m.-Bottle, 8 oz. 
Crisp bacon, 1 slice. 
Cereal, 6 ounces or 1 slice of toast or zwieback in milk. 
2 p. m.-Vegetable soup, 6 ounces, or 
Vegetable mixture, 6 ounces, or 
Vegetables-a starchy vegetable, as baked potato, or carrots, 
1 to 4 tablespoons, and a green vegetable, as 
spinach, 1 to 3 tablespoons. 
Gelatin jelly or junket or custard. 
6 p. m.-Cereal as at 10 A. m. or milk toast or crackers and milk. 
Milk, 8 ounces. Bread with jelly or honey, 1 small slice. 
10 p. m.-If needed or ordered, milk 8 ounces. 
DIET LIST-FIFTEEN TO EIGHTEEN MONTHS 
7 A. m.-Any well-cooked cereal, 8 ounces with milk, or 
A bowl of bread and milk, or 
A slice of crisp bacon, crackers, toast, or zwieback. 
8 or 9 A. m.-Orange or prune juice, prune pulp, or apple sauce. 
10.30 a. m.-Milk 8 ounces, with a slice of stale bread, toast, or zwieback. 
2 p. m.-One of the following: 
A-Soft-boiled or coddled egg with bread crumbs. 
B-8 ounces of meat broth (chicken, beef, mutton, lamb, or 
veal) with stale bread crumbs or rice or barley added 
to it. 
C-8 ounces of vegetable soup with or without bread crumbs 
or rice or barley. 
D-A tablespoonful of mashed or baked potato with meat 
broth or gravy or cream; milk to drink. 
E-Scraped raw or rare beef or mutton or well done white 
meat of chicken, a tablespoonful or two with crackers, 
toast or stale bread. Milk to drink. 
One or two tablespoons of any well-cooked vegetables, 
spinach, carrots, lettuce, oyster plant, soft beets, 
string beans, peas, asparagus tips, soft parts of cauli- 
flower, stewed tomato, squash, etc. Vegetables 
should be mashed, and if stringy or with hulls, passed 
through a sieve. 
One of the following: Gelatin, junket, custard, tapioca, 
cornstarch pudding, stewed fruit. 
5.30 or 6 p. m.-Milk, 8 ounces, zwieback, toast or stale bread or cereal; 
a little honey or jelly occasionally. 160 
DIETETICS FOR NURSES. 
DIET LIST-EIGHTEEN MONTHS TO TWO AND A HALF YEARS 
7 or 8 A. m.-Any well-cooked cereal, 8 ounces with milk, or 
A bowl of bread and milk, or 
A slice of crisp bacon; or 
A soft-boiled or coddled egg; crackers, toast, or zwieback. 
Orange or prune juice, prune pulp, or apple sauce. 
This fruit may be given on waking, just after the meal, or 
an hour or two later, as desired. 
12 m.-One of the following: 
A-Soft-boiled or coddled egg with bread crumbs. 
B-8 ounces of meat broth (chicken, beef, mutton, lamb, or 
veal) with stale bread crumbs or rice or barley added 
to it. 
C-8 ounces of vegetable soup with or without bread crumbs 
or rice or barley. 
D-A tablespoonful of mashed or baked potato with meat 
broth or gravy or cream; milk to drink. 
E-Scraped raw or rare beef or mutton or well-done white 
meat of chicken, a tablespoonful or two with crackers, 
toast, or stale bread. Milk to drink. 
One or two tablespoons of any well-cooked vegetable, 
spinach, carrots, lettuce, oyster plant, soft beets, 
string beans, peas, asparagus tips, soft parts of cauli- 
flower, stewed tomato, squash, etc. Vegetables 
should be mashed, and if stringy or with hulls, passed 
through a sieve. 
One of the following: Gelatin, junket, custard, tapioca, 
cornstarch pudding, stewed fruit. 
3.30 p. M.-Crackers, cookies, zwieback or bread, milk, or cocoa. 
6 p. m.-Cereal and milk or bread and milk, toast, bread, zwieback, 
or crackers. Stewed fruit. Milk to drink. 
The Diet from Two and One-half to Six Years.-Milk 
may be allowed with every meal (may be omitted from 
dinner if desired). The average child should take a 
quart a day, plain or, when plain milk is not thoroughly 
digested, modified as for younger infants. 
Cream.-Two to eight ounces a day mixed with the 
milk, taken as a beverage, with cereals, etc. 
Bread and biscuit may be allowed with every meal- 
stale bread, dried bread; the so-called "pulled bread," 
zwieback, and the various forms of biscuits or crackers. 
Cereals.-Almost any kind of cereal for breakfast; 
oatmeal and wheaten grits are the best. Rice and 
hominy for dinner. Barley is useful in soups. THE FEEDING OF INFANTS AND CHILDREN. 
161 
Vegetables may be allowed for dinner-potatoes in 
some form or a cereal with one green vegetable; spinach, 
cauliflower tops, and the like are the best. 
Eggs are very good, but children are apt to tire of 
them easily. They should be given for breakfast, as a 
rule, but never day after day. 
Meat.-Allowed once a day for dinner, and in older 
children for breakfast occasionally. Boiled or broiled 
fish may be given for breakfast or dinner. 
Broths and soups of simple composition may be eaten. 
Meat-broths with cream and cereals are especially nutri- 
tious. 
Desserts.-Once a day, with dinner. Plain custard, 
milk- and rice-pudding, bread- and custard-pudding, and 
junket are the best; ice cream once a week. Fruit 
should be given once daily, and only ripe fresh fruit, in 
season, should be used. The best are oranges, baked 
apples, and stewed prunes. Ripe peaches, pears, grapes 
without skins or seeds, may also be given. Fresh juice 
of berries in small quantity, strawberries in perfect con- 
dition sparingly. Ripe cantaloupe and watermelon in 
moderate quantities may also be allowed. Great care 
should be used in choosing and giving fruit to children. 
It is a very important article of diet, but if stale, spoiled 
or unripe, is capable of doing much harm. Too much 
should not be given in hot weather. Lemonade is use- 
ful during very hot weather. 
According to Meals.-Breakfast.-Every day, milk 
to drink. A well-cooked cereal with salt and cream, 
but little or no sugar. Bread and butter. 
In addition to the above, one of the following every 
day: Eggs lightly boiled, poached, and for older children 
scrambled or made into a plain omelet. Boiled or 162 
DIETETICS FOR NURSES. 
broiled fish. For older children a very little finely 
chopped beef, mutton chop, or beefsteak. For younger 
children meat at breakfast is not, as a rule, necessary. 
Fruit may be given before or after breakfast, during the 
latter part of the morning, or at about noon-one 
variety daily; and if there is a special tendency to consti- 
pation, stewed prunes or baked apples may be allowed 
with the dinner, but not on the days on which they have 
been used earlier. Oranges, baked apples, stewed prunes, 
peaches, pears, grapes without seeds or skins; ripe 
apples (the softer varieties may be given; those known 
by the dealers as "hard" apples are not suitable unless 
cooked) are the most suitable. 
Dinner.-Bread and butter as desired every day- 
not to be eaten to the exclusion of other foods, how- 
ever. 
One soup each day. Bouillon, beef, veal, mutton, 
chicken, or oyster-broth, which may be thickened with 
barley or other cereals (either grain or flour). Milk and 
cream may be added where desirable. 
One meat daily-roasted or broiled. Beefsteak, beef, 
lamb or mutton chop, rare roast beef or mutton, chicken 
(white meat) or roast turkey. 
Two vegetables daily-one green vegetable and one 
other dish, usually potato in some form, should be given. 
Potatoes, baked or mashed, cauliflower tops, asparagus 
tips, stewed celery, spinach, hominy, plain macaroni, 
mashed peas, young string-beans, and almost any green 
vegetable in season. 
Dessert.-Junket is the best and may be given most 
frequently, but rice- and milk-pudding, plain custard 
and plain tapioca-pudding may also be used in small 
quantities. Ice cream once a week. Fruit in some cases 
may be used. THE FEEDING OF INFANTS AND CHILDREN. 
163 
Supper.-Very light simple suppers should be given 
every day. Milk, milk-toast, bread and butter, and, for 
older children, a little stewed fruit or baked apple with- 
out too much sugar. 
Articles Forbidden (after Holt).-The following 
articles should not be allowed children under four years 
of age, and with few exceptions they may be withheld 
with advantage up to the seventh year. 
Meats.-Ham, sausage, pork in all forms, salted fish, 
corned beef, dried beef, goose, game, kidney, liver, bacon, 
meat-stews, and dressing from roasted meats. 
Vegetables.-Fried vegetables of all varieties, cabbage, 
potatoes (except when boiled or roasted), raw or fried 
onions, raw celery, radishes, lettuce, cucumbers, toma- 
toes (raw or cooked), beets, egg-plant, and green corn. 
Bread and Cake.-All hot bread and rolls; buckwheat 
and all other griddle cakes; all sweet cakes, particularly 
those containing dried fruits and those heavily frosted. 
Desserts.-All nuts, candies, pies, tarts, and pastry of 
every description; also salads, jellies, syrups, and pre- 
serves. 
Drinks.-Tea, coffee, wine, beer, and cider. 
Fruits.-All dried, canned, and preserved fruits; 
bananas; all fruits out of season and stale fruits, par- 
ticularly in summer. 
The meals should be given at fixed hours, which prac- 
tice should be strictly adhered to. Feeding between 
meals, even when consisting of the most trifling things, 
should be avoided. If the child cannot go from one 
meal to another without discomfort, the intervals should 
be shortened. In certain cases it may be advisable to 
give a small cup of milk or broth and a cracker between 
the meals, at stated intervals, as in feeding younger chil- 
dren. 164 
DIETETICS FOR NURSES. 
Candies, cake, and the like should be kept from young 
children. In well-regulated homes, if he once learns 
that he can not have them, the child will soon cease 
to demand sweets. The frequent indulgence in sweets 
of various kinds creates a desire for them to the ex- 
clusion of other food. This craving is analogous to 
that for alcohol in adults. Overindulgence in sweets 
causes indigestion, headache, and the like, ailments that 
may easily be prevented. 
The child should be taught to eat slowly and to chew 
the food well. To this end, some older individual should 
always be present at meal-time to see that sufficient 
time be taken for the meal, and that the food be finely 
divided, as young children do not, as a rule, chew very 
well. The quantity given to a healthy child should depend 
on his appetite. In sick children this is not a reliable 
guide, and where possible fixed amounts may be given. 
The child should not be forced to eat, nor should he be 
given special articles to tempt the appetite. If the food 
offered is not taken, it is well to wait until the next meal, 
when it will generally be found that the appetite has 
returned. Loss of appetite is often merely an indication 
that the digestive organs require a slight rest. 
During the heated portions of the year the child will 
require less solid and more liquid food. The same is 
true during sickness. Many of the gastro-intestinal dis- 
turbances attributed to teething are the result of improper 
feeding. 
Forced Feeding.-Sometimes in cases of loss of 
weight, malnutrition, and various nervous conditions, 
it is necessary to put the child to bed and undergo a 
period of forced feeding similar to that used in grown 
people. The following is an actual diet list used in such a 
case: THE FEEDING OF INFANTS AND CHILDREN. 
165 
Forced Feeding For a Child About Nine Years Old.- 
7 A. M.-One egg in orange juice, 4 oz., small quantity 
of sugar or flavored with lemon juice, well beaten to- 
gether. 
9.30 A. m.-Small quantity of cereal, varied as to kind, 
3 slices bacon crisped, 1 or 2 small slices toast, milk and 
cream (milk 1 qt. and cream 16 per cent.), 8 to 10 oz. 
11.30 A. M.-Milk and cream (same proportion), 10 oz. 
1.30 p. m.-Broiled squab, asparagus tips or cauli- 
flower, roast beef, baked potato; or lamb chops, boiled 
spinach (put through meat chopper); or breast of chicken, 
rice, carrots (mashed); ice cream or custard or rice pud- 
ding or junket. Select one vegetable for each day with 
the baked potato or rice. Milk and cream (same pro- 
portion), 10 oz. 
4 p. M.-Milk and cream (same proportion), 10 oz. 
6.30 P. M.-Sandwiches-bacon or chicken, calves' 
foot jelly, wine jelly, apple sauce, baked apples, prunes, 
apricots, toast (plain), milk, 10 oz. 
Patient nine years old having this diet for four weeks 
gained 7 pounds. No vomiting or any symptoms of 
being unable to digest this quantity. Patient had been 
eating poorly at family table, but after three or four 
days took this diet without any urging at all. Reduce 
or omit cream if patient has symptoms of nausea or any 
other symptoms of not being able to digest this quantity. 
Water, 34 to 36 oz., given at intervals between feedings. 
The period usually spoken of as " school days " is an 
extremely active one physically. The vast number of 
metabolic changes going on and the growth of the body 
demand a plentiful and a suitable diet Both in and out 
of school and in seminaries careful attention should be 
DIET OF SCHOOL CHILDREN. 166 
DIETETICS FOR NURSES. 
given to food, fresh air, and exercise. In other words, 
the physical development should receive as much atten- 
tion as the mental growth. In boarding-schools espe- 
cially the diet should be the subject of careful study, the 
aim being to avoid monotony and to provide a sufficient 
and satisfying diet. In many schools the dietary is left 
to the discretion of the cook. In considering school 
dietaries several points are worthy of consideration. 
Milk, being easily digested in most cases, is of great 
value, especially for children whose nutrition is below 
normal. It should be furnished as a beverage daily for 
breakfast and supper, and is advisable even with dinner. 
It may also be used in the preparation of puddings and 
soups. Cream is very valuable, and whenever possible 
should be supplied in sufficient quantities. A cup of 
warm milk with bread or crackers is helpful during the 
middle of the morning and as a substitute for tea in the 
afternoon. Delicate children and others may with advan- 
tage take a glass of warm milk a short time before going 
to bed. If the rising hour is some time before that set for 
breakfast, a cup of milk or of bread and milk should be 
given on rising. 
Eggs may be used alone or in the preparation of vari- 
ous dishes. They may be used in almost any way except 
fried. Fried eggs are apt to be very indigestible. They 
are often prepared in this way in order to disguise the 
stale taste of an egg that has been in storage for some 
time. 
Meat is a very important part of the diet, as it con- 
tains a larger quantity of protein, from which the tissues 
are built up, and in a more available form, than in any other 
form of food. Milk and eggs are also valuable sources 
of protein. Meat should be provided, therefore, in suffi- THE FEEDING OF INFANTS AND CHILDREN. 
167 
cient quantities, a half-pound a day being, perhaps, a 
good average allowance for a growing boy, the larger 
and more robust taking that quantity or more, the smaller 
and more delicate children taking somewhat less. Steak, 
chops, and roasts of beef, mutton, lamb, fowl, and bacon 
are the most suitable meats, although pork, together 
with meat-stews, meat-puddings, sausage, and hashes, 
may be allowed in smaller quantities. These last, while 
generally relished, are not so digestible nor such good 
sources of nutriment as those first named. With care 
and proper preparation many of their ill effects can be 
obviated. More meat is required in winter than in sum- 
mer, and more in cold climates than in warm. Yeo states 
that too much meat may give rise to eczema. 
Meat may be given twice a day, and eggs or fresh fish 
may be substituted for it about three times a week. When 
these do not satisfy the appetite, meat may be added. 
For this purpose cold sliced meat is useful. 
Bread and butter should be given with each meal. 
Bread made from the whole-wheat flour may be used in 
the largest quantity, but it is well to supply various kinds 
of bread, to avoid monotony. " Brown bread " given 
continuously becomes very tiresome. Rye-bread may 
be given occasionally, and bread made from mixtures of 
wheat and rye is very palatable. Rusk, biscuit, and 
crackers may also be supplied. Corn-bread, when prop- 
erly made, may be given once a week or oftener, and 
griddle cakes of buckwheat, corn, or wheat flour two or 
three times a week. These last may be served with 
syrup or fruit-juices. 
Cereal porridges of all kinds may be given for break- 
fast, oatmeal being probably the most desirable. 
Vegetables of almost all varieties may be used. For 168 
DIETETICS FOR NURSES. 
dinner two varieties should be given, one green vegetable 
and potatoes. Salads made of the green vegetables, 
with the very simplest dressings, are useful additions to 
the diet. 
Fruit should invariably be given once a day. 
Sugar should be provided for in the dietary. Candies 
and many of the sweets given to children are harmful and 
cause indigestion and dyspepsia. If proper sweets were 
provided there would be slighter tendency to indulge in 
the less desirable forms whenever opportunity offered. 
With the meals, and when the appetite demands satisfy- 
ing between meals, they may be given with or without 
a glass of milk. Regularity should, however, be ob- 
served, and they should not be given immediately before 
or after a meal. Fruit-syrups, sugar-syrups, honey, pre- 
served fruits, and jam may be eaten with bread. Cara- 
mels, chocolate, maple-sugar, and plain sugar-taffies are 
the best of the other forms of sweets. 
Simple desserts, such as custards, milk-pudding with 
rice, tapioca and the like, bread-pudding, plain cakes, 
and properly prepared pastry may be used. 
The beverages should be water and milk. Weak cocoa 
or chocolate may be given after the seventh year. Tea 
and coffee should not be given before the thirteenth year, 
and may be withheld advantageously still longer. Alco- 
hol is not to be used except by a physician's direction. 
Especial care should be taken to avoid a monotonous 
diet, for there are many instances where the constant 
repetition of a certain form of food has created a dislike 
for it that has persisted throughout life or been overcome 
only with difficulty. 
A second point to be remembered is that the food 
should be well prepared and attractively served. This THE FEEDING OF INFANTS AND CHILDREN. 
169 
has more to do with influencing the appetite of delicate, 
nervous children than is generally supposed, and can not 
be insisted upon too strongly. 
Overeating should be avoided, and to this end an older 
person should always be present when practicable; in 
school, this should be insisted upon. On the other 
hand, a child should not, through caprice or habit, be 
allowed to eat too little. By exercising a little tact, most 
of the dislikes which are not deeply rooted, but which 
may become so if persisted in, may generally be over- 
come. These dislikes are often the result of imitation. 
Sufficient time should be allowed not only for the 
meal, but for the performance of whatever small duties 
may be required of the child. A time should be set for 
one or two regular daily visits to the water-closet. Hur- 
rying to school should be avoided. Reading and study- 
ing immediately before and after meals should be pro- 
hibited, as should bathing or any very active exercise. 
Some light form of recreation may, however, be indulged 
in. The hours of meals should be so arranged that the 
child may have freshly prepared meals, and not cold 
luncheons or warmed-over dinners. Lastly, nibbling and 
eating between meals, except under the conditions pre- 
viously described, should be strictly prohibited. In spite 
of stringent rules, however, many infringements will 
occur. 
It is by neglect of the diet, fresh air, and exercise that 
many cases of tuberculosis gain headway; anemia may 
result from such neglect, and a delicate, nervous child be 
the outcome of one that should, by right, be healthy. 
FEEDING IN INFANT ASYLUMS. 
The feeding of infants in overcrowded infant asylums, 
with their lack of fresh air and paucity of attendants, is 170 
DIETETICS FOR NURSES. 
a matter of great difficulty. Any attempt at scientific 
feeding under such circumstances will ultimately lead to 
failure, the method in these cases being held to blame. 
The primary cause of malnutrition and marasmus in in- 
stitutions is the lack of fresh air and individual care, and 
until these are obtainable it is useless to attempt to ac- 
complish anything by special feeding methods. In the 
smaller institutions the use of the Materna graduate will 
be found satisfactory. 
In the larger asylums it is well to have two or three 
general working formulas, such as fat 3 per cent., sugar 
6 per cent., protein 1 per cent.; and fat 4 per cent., sugar 
7 per cent., protein 2 per cent. These may be varied 
by adding more or less water to them to adapt them 
more closely to special needs. The younger infants may, 
when possible, receive special mixtures. For substitute 
feeding, condensed milk, barley- and egg-water will be 
found most useful. 
The allowance of a few cents a day generally made for 
an infant's entire care is entirely inadequate to accom- 
plish any good. CHAPTER V. 
THE FEEDING OF SICK INFANTS. 
Finkelstein's Classification.-This is largely used 
by some writers: 
i. Disturbed metabolic balance corresponding to our 
stationary weight and loss of weight. 
2. Dyspepsia corresponding to gastro-intestinal in- 
digestion. 
3. Intoxication corresponding to acute severe diarrhea. 
4. Decomposition corresponding to marasmus. 
Stationary Weight; toss of Weight.-The best 
index of nutrition is the weight of the child. If there 
is a stationary weight or the child loses weight the phys- 
ician should be informed at once, as it may mean serious 
trouble. Not infrequently this condition is due to a 
too high fat content in the food. The baby becomes pale, 
irritable, and sleeps poorly. Some gas, some vomiting 
or spitting, and hard dry stools which may be shaken 
from the napkin are noted. In the beginning there 
may only be hard, white, sand-like particles in the 
stool, later the stools become discolored and contain 
mucus. Withdrawing the fat and feeding skimmed milk, 
protein milk, or buttermilk, gradually returning to as 
near a normal diet as possible, usually gives good re- 
sults. The addition of carbohydrates and the use of 
malt sugar is also advised. 
Colic.-This is more frequent in breast-fed than in 
artificially fed children, and is most liable to occur dur- 
ing the first three months. In breast-fed children it may 
171 172 
DIETETICS FOR NURSES. 
sometimes be due to the mother's milk being too rich, 
and measures are frequently prescribed to relieve this. 
The nursing intervals may be lengthened, and a little 
warm water given before each feeding to dilute the milk. 
In bottle-fed babies colic is most frequently due to the 
milk containing too much protein. It may also be caused 
by giving the milk too cold. Colic may be due to cold 
feet, chilling of the abdomen, and numerous other causes 
which have no relation to the diet. The addition of a 
small amount of calcium caseinate to the food sometimes 
is useful. 
Vomiting'.-Vomiting occurring immediately after 
feeding is usually due to the child's taking too much 
food or the taking it too rapidly. Vomiting may be 
caused at any time by the abdominal binder being too 
tight, from shaking the infant or holding with the head 
over the nurse's shoulder, or from patting on the back. 
Vomiting may occur at any time when the milk is too 
rich in proteins. It may be caused by coughing, and it 
is also a frequent symptom of many diseases. Vomiting 
one or two hours after feeding is usually due to the milk 
containing either too much fat or too much sugar, or 
both. Milk boiled with sufficient barley flour or other 
cereal to make a thick gruel, given with a spoon, will 
often be retained where thin fluids are rejected. 
Gavage.-Gavage, or feeding by means of a stomach- 
tube, is a method used in various diseases and conditions 
of infancy and childhood. In cases where the child is 
not able to take nourishment, or only in insufficient 
amount, and in cases of uncontrollable vomiting, this 
method may be resorted to. It is used in the feeding 
of premature infants, whether in an incubator or not, and 
in cases of small, weak, marantic infants who, owing to 
weakness or lack of appetite, do not take sufficient nour- THE FEEDING OF SICK INFANTS. 
173 
ishment. It is also employed after surgical operations 
about the head or neck where swallowing is interfered 
with, and in acute diseases, such as pneumonia, in fevers, 
and in delirium or coma. 
The results that follow this method of feeding are 
surprising, especially in cases where there is constant 
vomiting or where the stomach has a very small capacity. 
In the former case, the vomiting may cease and the food 
be retained; in the latter, the capacity of a stomach that 
previously held only an ounce or two may rapidly be 
increased until an average-sized feeding is retained with 
ease. 
The technic of the method is simple and the procedure 
conducted without difficulty in children under two years 
of age; above that age it may be difficult, and a mouth- 
gag may be required; in some cases nasal feeding must 
be substituted. The apparatus employed is the same 
that is used for washing out the stomach; and since it is 
frequently desirable to wash out the stomach before in- 
troducing the meal, the same tubing may serve for both 
purposes. It consists of a soft-rubber catheter, con- 
nected by means of a piece of glass tubing to a piece of 
rubber tubing, to the other end of which a funnel is 
attached. The nurse holds the child in her lap, with the 
head held straight and not inclined in either direction. 
The catheter is moistened with warm water and held 
several inches from the end, so as to allow enough of it 
to pass into the esophagus with the first attempt at intro- 
duction. The mouth is opened, if necessary, and the 
catheter passed rapidly into the pharynx; there is usually 
a swallowing movement, and the tube is readily passed 
into the stomach. If the procedure is carried on too 
slowly the tongue may interfere; or if the catheter is 174 
DIETETICS FOR NURSES. 
held too near the end, it may cause gagging. Before in- 
troducing the food it is well to wash out the stomach 
with normal salt solution. As soon as all the food has 
entered the stomach, the catheter is pinched and rapidly 
withdrawn. If it is withdrawn slowly the food may 
come up with the tube. If the catheter is left open as 
it is withdrawn, the dripping into the pharynx may cause 
vomiting. If the child is young, it is a good plan to 
keep the finger between the jaws for a few moments, to 
prevent gagging. If the food comes up the feeding 
must be repeated. 
Nasal Feeding.-For this purpose a catheter in 
proportion to the size of the child should be used. The 
procedure is the same as that for adults. 
Feeding in Inflammations of the Mouth.-The 
food should be liquid or semisolid, and as bland and 
unirritating as possible. If it is not taken readily it 
should be given cold. 
Diseases of the Stomach.-Where there is marked 
vomiting and evidence of disease of the stomach milk 
should be withheld, and the patient given plain boiled 
water or albumin water in small quantities until the 
physician gives his orders concerning the feeding. 
Cyclic Vomiting-Acid Intoxication.-This is 
not an uncommon disturbance of metabolism, in which 
there is a formation of acids in the body which cause re- 
current attacks of vomiting. During the attack it is well 
to give the stomach absolute rest, as both food and drink 
tend to aggravate the condition. Glucose solutions are 
administered as detailed in the section on Acidosis. 
See Acidosis. When the vomiting stops, the feeding 
may be begun very cautiously. Skimmed milk, to 
which citrate of soda or lime-water has been added, or 
peptonized milk or albumen-water or barley-water may THE FEEDING OF SICK INFANTS. 
175 
be given to begin with, and the diet increased as circum- 
stances warrant. Between the attacks the question of the 
diet is a very important one. Sometimes it requires con- 
siderable study on the part of the physician to determine 
what may be allowed and what withheld, but in most 
cases these patients do best on a diet of milk, eggs, green 
vegetables, bread, cereals, with the sweets almost entirely 
eliminated from the dietary. All cases are not alike, how- 
ever, and various other forms of diet may be prescribed. 
Diarrhea in Infancy and Childhood.-In a child 
under two and, indeed, even in older children, one can 
never say at the outset whether a diarrhea will be mild 
or severe. It is therefore well to diet all cases as if they 
were of a virulent type. By so doing many lives will be 
saved and much suffering avoided. About 97 per cent, 
of the deaths from diarrhea occur in bottle-fed babies, 
and the majority of these in the hot weather. 
In breast-fed children a diarrhea in winter is usually 
a mild one, and merely lengthening the nursing periods 
to six hours and giving barley, rice, or albumin water in 
the intervals at the feeding times is all that is needed. 
After a day or two of this, together with the proper 
medical treatment, the child can generally resume its 
customary schedule. 
In summer, however, a diarrhea, especially if severe, 
should arouse suspicion, and for twenty-four hours, or 
until the child's condition warrants, milk should be with- 
held. The breasts should be pumped out carefully at 
regular intervals, to prevent distress or a possible cessa- 
tion of the secretion. The child should be given plain 
boiled water, or some of the articles previously men- 
tioned, at frequent intervals and in small doses. If there 
is great thirst, one or two teaspoonfuls should be given 176 
DIETETICS FOR NURSES. 
every fifteen or thirty minutes. If fluid is well retained, 
several ounces may be given at a time, at intervals of 
two or three hours. Stimulants are often ordered. If 
by the second day vomiting has ceased and the child 
seems better, it may be put to the breast for a few min- 
utes and the effect noted. If the milk is well borne the 
child may be given the breast every six hours, shortening 
the interval from time to time until the child has re- 
turned to its regular schedule. It is well to make a 
gradual return, and if the milk aggravates the diarrhea 
or gives rise to other symptoms, it should again be dis- 
continued. When the breast milk is of good quality 
there is rarely any difficulty with these cases. 
In infants partly on the breast and partly on the bottle 
the diet should be planned so that it will be satisfactory 
should the case be one of a serious nature. For the 
first twenty-four hours plain water, barley-water, or 
very weak tea. At the end of twenty-four hours if 
there is no vomiting a partly breast-fed child may usually 
be allowed to take breast milk at the usual feeding 
intervals with water before the feeding and the nursing 
increased according to the condition of the stools. A 
mistake which is usually made is not to starve the child 
boldly during the first twenty-four hours, and the second 
is to starve it too long. 
In bottle-fed babies the method of feeding will vary 
according to the nature and severity of the diarrhea. 
Relatively fat-free foods should always be used. The 
child should be starved for the first twenty-four hours 
as above, or given a small amount of weak tea or plain 
water. In cases in which there is fermentation and 
gas the use of protein milk or one of its modifications 
gives very good results. On this food the stools usually 
change to the so-called soap stools, and when this happens THE FEEDING OF SICK INFANTS. 
177 
some form of carbohydrate, usually in the form of dextri- 
maltose, may be added, and later barley or some other 
cereal gruel. The protein milk as suggested by Finkel- 
stein is made as follows: 
Heat i quart of whole milk to ioo° F. (36.66° C.), 
add 4 teaspoonfuls of essence of pepsin, and stir. 
Then let the mixture stand at ioo° F. until the curd 
has formed. Put the mass in a linen cloth and strain 
the whey from the curd. Remove the curd from the 
cloth and press it through a fine sieve two or three times, 
using a wooden mallet or spoon. While doing this 1 
pint of water should be added. The precipitate should 
be very finely divided and the mixture should look like 
milk. 
For those who cannot afford casein milk, Reuben sug- 
gests the following: 
Add two junket tablets to a pint of milk. After it 
has stood for one-half hour strain, discard the whey, 
and rub the curd through a fine sieve together with a 
pint of milk, and then add enough plain boiled water 
to make one quart (1.14 liter). The whole mixture is 
then brought to a boil with constant stirring and is 
then ready for use. This has nearly the value of casein, 
but lacks the acidity, a point which does not seem to be 
essential. 
As a rule we prefer skimmed milk mixtures to which 
calcium caseinate has been added in the proportion 
usually of ounce (10 grams) to a pint (0.57 liter). 
The proportion of skimmed milk may be varied to suit 
the patient, but ordinarily half milk and half water with 
the calcium caseinate added and then boiled five min- 
utes gives a satisfactory mixture. It should be stirred 
constantly while being heated. If the calcium caseinate 
is mixed in about one-third of the mixture while cold and 178 
DIETETICS FOR NURSES. 
the remainder of the milk heated and then cold solution 
poured into the hot milk and boiled, a smooth mixture 
will result. This should be used after the manner of 
protein milk, that is, start with very small amounts, 
i to 4 drams, for instance, and double the size of the 
feeding each time, providing this amount is retained. 
This feeding is starvation diet, and as soon as possible 
other food should be added. Old fashioned buttermilk, 
that is, the milk left after churning butter or a similarly 
made preparation, may also be used either diluted with 
water or with barley-water. Ordinarily the dilutions 
are made half and half to begin with and stronger as 
the child improves. In cases where there is putrefaction 
or foul stools and where the child is losing fluid rapidly 
from the tissues, the cereal gruels, such as barley or 
rice gruels, give excellent results in the beginning, or this 
may be replaced with mixtures containing dextrimaltose, 
starting with i level tablepoonful to 4 ounces of water, 
and giving a teaspoonful at a dose, and then increasing. 
Sweetened condensed milk or malted milk also are use- 
ful in this form of diarrhea. 
The management of the diet of a case of diarrhea 
requires more judgment than almost anything in pediatric 
practice. 
In place of plain water a little thin barley-water or a 
little very weak tea may be given. At the end of twenty- 
four hours, if the stomach and bowel have been thoroughly 
emptied and given a rest and there is no vomiting, an 
increase may be made in the food. An error which is 
ordinarily made is to fail to starve the child boldly 
during the first twenty-four hours, and the second error 
is to starve it too long. 
The proper feeding in severe diarrhea is a difficult 
question and one about which there is a great deal of THE FEEDING OF SICK INFANTS. 
179 
difference of opinion. The truth of the matter is that 
we do not know sufficiently about the feeding of these 
cases to speak very dogmatically concerning them. 
The authors believe that the only food component 
which should be avoided in all cases is fat. Children 
with diarrhea certainly do better on either fat-free or 
foods relatively low in fat. 
In cases where there is much fermentation and gas, 
protein milk or one of its modifications may be used. 
For those who cannot afford protein milk Reuben sug- 
gests the following: 
Add two junket tablets to a pint of milk. After it 
has stood for one-half hour, strain, discard the whey, and 
rub the curd through a fine sieve together with a pint 
of milk, and then add enough plain boiled water to make 
one quart (i .14 liter). The whole mixture is then brought 
to a boil, with constant stirring, and is then ready for 
use. This has nearly the value of casein milk, but 
lacks the acidity, a point which does not seem to be 
essential. 
The authors prefer skimmed milk mixtures to which 
calcium caseinate has been added in the proportion 
usually of one-third of an ounce to a pint. The pro- 
portion of skimmed milk may be varied to suit the pa- 
tient, but ordinarily half milk and half water with the 
calcium caseinate added and then boiled five minutes 
gives a satisfactory mixture. If the calcium caseinate 
is dissolved in about one-third of the mixture while 
cold and the remainder of the solution heated and then 
cold milk poured into the hot milk and boiled, a smooth 
mixture will result. This should be used after the manner 
of protein milk, that is, start with very small amounts, 
and double the size of the feeding each time, providing 
this amount is retained. 180 
DIETETICS FOR NURSES. 
The character of the stools should change to the so- 
called soap stools, and when this happens some form of 
carbohydrate should be added to increase the caloric 
value of the food. Sugar is usually added, begin- 
ning at I per cent., or dextrimaltose may be used, 
and later barley gruel may take the place of the plain 
water. 
It should be remembered that protein milk feeding is 
starvation diet, and as soon as the stomach and intes- 
tinal tract will stand it the food should be increased to 
cover the needs of the child in question. Old-fashioned 
buttermilk, that is, milk left after churning butter, is a 
most useful food either diluted with water or with 
barley-water, half and half, and given in the same way 
as protein milk. 
With foul stools and where the child is losing fluid 
rapidly from the tissues, cereal gruels, such as barley 
gruel or rice gruel, may be used to advantage. These 
are usually made in the proportion of one level table- 
spoonful of flour to a pint of water and a pinch of salt 
and the mixture is boiled for fifteen minutes. This 
may be sweetened a little either with saccharin or with 
dextrimaltose. After a day or two the skimmed boiled 
milk or one of the dry milks may be added to this, a 
level tablespoonful of either of the dry milks being used 
to 4 ounces of gruel, and then increased until it is either 
in the proportion of 3 tablespoonfuls to 4 ounces or 
in some instances in older children 4 tablespoonfuls to 
4 ounces. In some putrefaction cases large doses of 
dextrimaltose or of lactose are sometimes advised. Their 
use requires rather nice judgment, and harm may result 
if used in unsuitable cases. In some instances malted 
milk is useful in the strength of 1 level teaspoonful to 
an ounce, or weaker, to begin with. THE FEEDING OF SICK INFANTS. 
181 
The return to milk should be made very gradually. In 
the severe cases cows' milk should be withheld for a week, 
when, if the child's condition permits, it may be tried in 
one small feeding. If it causes no trouble, it may grad- 
ually be added until the usual diet is resumed. The re- 
turn is best made by allowing the articles previously sug- 
gested. Then malted milk, or one of the dry foods that is 
to be mixed with water, may be given, followed by par- 
tially or wholly peptonized milk or the barley water and 
milk mixture previously described. Plain well-skimmed 
meat broths, such as veal broth, may be used. Care must 
be taken to remove all the fat, as this is a frequent source 
of trouble. The milk should not at first contain too 
great a percentage of fat. This bold starvation plan, as 
it is sometimes called, succeeds better than any other. 
Later, however, care must be taken that the periods of 
underfeeding be not too protracted, for while it is desir- 
able to " starve out the diarrhea," the child must not be 
starved to death during the process. A day or two of 
absolute abstinence from food does no harm, as in the 
severe cases food is not retained, or if retained, is not 
assimilated; on the other hand, a reduced diet continued 
for weeks and months, as is not infrequently done, is apt 
to prove disastrous. It is a good plan to keep an accu- 
rate record of all the food taken while the child is on a 
restricted diet. The amounts taken during each twenty- 
four hours may be added together, and from these it 
may readily be seen whether or not the child is getting 
sufficient nourishment. 
Another plan of treatment much in vogue at the pres- 
ent time is to give the child buttermilk from the outset, 
or kumiss, or some other similar preparation, or if these 
are not well borne, to give lactic acid bacilli, either in 182 
DIETETICS FOR NURSES. 
the tablet form or the liquid cultures, and when this is 
done cows' milk or one of the dried milk preparations, 
such as Mammala, can be given with safety. 
Diarrhea in Older Children.-When diarrhea oc- 
curs in older children, the early dietetic treatment is 
similar to that recommended for infants. As the child 
recovers a return to the ordinary diet may be made, 
meat, eggs, and broths of various kinds being given at 
first, followed by boiled milk and toast or dry bread. 
Vegetables and fruits should be given only after recov- 
ery is complete, and their effect should carefully be 
watched. Cereals may also cause a recurrence of the 
trouble, and should be most thoroughly cooked and 
given in small quantities at first. 
Chronic Intestinal Indigestion.-The diet in this 
disease will always be carefully outlined by the physi- 
cian, and it is of the greatest importance to see that the 
directions are carried out. The disease is often pro- 
tracted, and requires months or even a year or two of 
careful dieting to relieve the condition. The carbohy- 
drate foods are usually reduced to a minimum and easily 
digestible proteins given. Slight indiscretions in diet fre- 
quently lead to relapses in which all the ground gained 
in several months is lost by a single improper meal. 
Constipation.-This is frequently difficult to over- 
come. Fruit juice given on an empty stomach an hour 
before a milk-feeding is of service, as are olive oil and 
cream. These latter must not be used indiscriminately, 
as they may give rise to other bowel trouble if given in 
too large quantities. The malted foods, such as Mellin's, 
are useful; mixed with milk or oatmeal gruel well sweet- 
ened they may relieve it. Infants are sometimes re- 
lieved by adding oat flour gruel or barley gruel to the 
food. After seven months vegetables put through a THE FEEDING OF SICK INFANTS. 
183 
sieve may be given-carrots, spinach, lettuce, celery, 
and the like. Cut up a quantity of various vegetables 
into small cubes, add salt and boil until soft, skim but 
do not strain, cook until a mush results. Now strain 
and add from a teaspoonful to 2 tablespoonfuls to the 
diet either alone or in broth. In older children figs and 
prunes stewed together are of value; oatmeal and bread 
from unbolted flour may be used. A glassful of water 
given on rising is sometimes of assistance. Green vege- 
tables, especially of the coarser sort, are useful, as are 
the agar, toasted bran, graham, and oatmeal crackers. 
Wasting Disease.-The diet is of primary impor- 
tance, but fresh air and exercise and warmth must not 
be overlooked. The infant should in all cases be fed in 
the nurse's arms and never in its crib. The diet is pre- 
scribed by the physician. 
Rickets or Rachitis.-This is a disease of nutrition 
in which insufficient calcium is deposited in the bones. 
It is most frequently seen in the temperate zone, in 
artificially fed children who do not get sufficient light 
and air. Diets low in fats and proteins and rich in 
carbohydrates cause rickets. (See Vitamins.) There is 
a calcium-depositing vitamin the absence of which will 
cause rickets when there is a deficiency of either calcium 
or phosphorus, or both. Rickets is prevented by fresh 
air, sunlight, good hygiene and a proper diet, also by 
giving cod-liver oil, especially phosphorized cod-liver 
oil. The same measures will effect a cure if started 
sufficiently early. CHAPTER VI. 
DIET FOR THE AGED. 
When a man has passed his fiftieth year his diet should 
be guarded. Dietary indiscretions or a too plentiful diet 
will result either in the putting on of flesh, and the con- 
sequent discomforts of obesity, or in the development of 
gout or allied affections. In considering the diet of the 
aged the old dictum, that a man is as old as his arteries, 
applies. Age can not always be counted by years. In 
the aged there is a lessening of all physical activities. 
The old man takes less exercise, has diminished powers 
of digestion, and is less able to absorb the nutriment he 
has digested. His circulation is poor and his bowels are 
constipated. Degenerative processes have taken place 
in his organs, and he is more apt to feel the effects of 
indiscretions in diet. For these reasons the diet should 
be lighter than in his younger years, and the amount of 
food eaten should vary with the needs of the individual. 
The food should be of an easily digestible variety; it 
should be given in smaller quantities at a time and the 
intervals between meals should be shortened. If there 
is a tendency to obesity, food that is liable to be con- 
verted into fat should be given in diminished amounts. 
The proteins should be somewhat lessened from time to 
time. The practice of eating heavy suppers late at night 
and of eating between meals should be discontinued. 
The person should learn what particular articles of food 
disagree with him, and refrain from eating foods that tend 
184 DIET FOR THE AGED. 
185 
to cause flatulence. Yeo suggests that in the case of 
cooked fruits a small quantity (about a teaspoonful to 
the pound of fruit) of sodium bicarbonate be stewed 
with them, to correct the acidity that causes flatulence. 
In the aged, food bears a close relation to sleep. A 
cupful of hot milk, hot toddy, or some hot liquid food 
taken at bedtime will often overcome troublesome sleep- 
lessness. A few sips of milk or a mild stimulant taken 
during the early morning hours, when the aged are apt 
to awaken, will frequently insure sleep again. 
Food Suitable for the Aged (Yeo).-Young and 
tender chicken and game and other tender meats; 
potted chicken, game, and other potted meats; sweet- 
breads ; white fish, as sole, whiting, smelts, flounder, etc., 
best when boiled; bacon grilled; eggs lightly cooked, 
or beaten up with milk, etc.; nutritious soups, such as 
chicken or fish purees, beef tea, mutton and chicken 
broths; milk in all forms when easily digested. When 
it is not well borne, the addition of an equal quantity of 
warm Vichy or of warm water will often prove helpful. 
Beef tea and milk supply the needed mineral substance, 
and the former is an excellent stimulant. 
The following foods are all suitable: Bread-and-milk 
with the crumbs of stale bread and without lumps; por- 
ridge and oatmeal gruel; puddings of ground rice, tapi- 
oca, arrowroot, sago, macaroni, with milk or eggs, and 
flavored with spices or served with fruit juice or jelly; 
bread and butter, the bread to be at least a day old; 
rusk, to be soaked in tea or milk and water. Prepared 
foods, consisting of predigested starches; at this age the 
digestive ferments are provided scantily by the digestive 
organs, and soluble carbohydrates are valuable for main- 
taining the body heat. All farinaceous foods should be 186 
DIETETICS FOR NURSES. 
subjected to a high temperature for some time during 
the cooking process so as to render the starch granules 
more digestible. 
Vegetable purees of all kinds may be taken in moder- 
ation-e. g., potatoes, carrots, spinach, and other succu- 
lent vegetables. Potatoes and fresh vegetables are a 
necessity; if omitted a scorbutic state may be engen- 
dered. Stewed celery and stewed Spanish or Portugal 
onions lend variety to the diet. Stewed or baked fruits, 
fruit jellies, and the pulp of perfectly ripe raw fruits in 
small quantity may be taken. CHAPTER VIL 
DIET DURING PREGNANCY AND THE PUER- 
PERIUM. 
During1 Pregnancy.-The diet should be that to 
which the patient has been accustomed. There is often 
craving for unusual articles of diet, and these cravings 
should not be gratified. Sometimes a diet somewhat 
deficient in carbohydrates and fluids is advised with the 
idea of producing a small child, a thing desirable when 
there are contractions of the pelvis and a difficult labor 
is expected. 
Diet During the Puerperium.-Formerly great 
restrictions were placed on the diet of a recently deliv- 
ered woman, thus accounting, in part, for the loss of 
weight that has been noted. If there is no nausea and 
the patient desires it, a cupful of tea or a glassful of 
warm milk may be given soon after delivery. 
The appetite is generally poor for a few days after 
delivery, but food should be given at regular intervals 
not too widely separated. The first day milk, milk toast, 
or if desired, dry or buttered toast, with coffee, tea, or 
cocoa, according to the taste of the patient, may be 
given. Water may be allowed as desired. On the sec- 
ond and third days simple soups or any of the following 
may be added to the dietary: Meat broths, beef tea, 
soft-boiled or poached eggs, raw or stewed oysters, and 
some simple dessert, such as wine jelly, boiled custard, 
187 188 
DIETETICS FOR NURSES. 
or junket. During the next few days chicken, scraped 
beef or mutton in small quantities, baked potato, rice, 
and cereals may be given, and by the end of the week a 
gradual return to the ordinary diet may be made. 
Diet in the Diseases of Pregnancy.-Special 
diets are sometimes ordered the pregnant woman on 
account of diseases connected with her pregnancy. 
Sometimes a milk diet or a diet similar to that used in 
inflammation of the kidneys is used. When salivation 
occurs a milk diet is used. Rectal feeding is used when 
there is uncontrollable vomiting. CHAPTER VIII. 
RECTAL FEEDING. 
When the patient cannot take food by the mouth, or 
when it is not desirable to feed him in that way, rectal 
feeding is resorted to. All the various classes of foods 
may be used for this purpose. Proteins are supplied in 
the form of predigested meat or egg albumin to which 
salt has been added. Nutrose and peptones are also 
used. Grape sugar and starch are sometimes employed. 
Fat is given in the form of the yolk of egg or cream. 
Milk is also much used. Where the patient is to be fed 
by the rectum for any length of time, combinations of these 
are used as suggested in the formulas given below. 
Bauer believes that but one-fourth of the nutriment 
needed by the body can be absorbed by the rectum, and 
both he and the earlier writers placed the length of time 
which rectal feeding was practicable at from one to two 
weeks. With careful technique, this period may be ex- 
tended from four to six weeks, depending on the capacity 
of the individual for continued absorption, and on the 
amount of energy stored up in his body at the beginning 
of the rectal feeding; but von Leube has kept a patient 
alive for six months, and Riegel for ten months on exclu- 
sive rectal feeding. As a rule, however, as only about 
one-fourth, and often even less, of the amount of nutri- 
ment needed can be absorbed, the method is only useful 
in protecting the body from excessive loss during periods 
of partial or complete starvation. 
189 190 
DIETETICS FOR NURSES. 
The success of rectal feeding depends on the proper 
technic. With poor technic the rectum soon becomes 
irritable. 
Procedure.-The rectum should be cleansed thor- 
oughly by administering a high injection of normal salt 
solution one hour before the enema is to be given. This 
cleansing should be practised at least once a day, and if 
much mucus is present it may be well to precede each 
feeding by a cleansing enema. If the rectum is inflamed 
a solution of boric acid may be used instead of the salt 
solution; or if there is much mucus a solution of sodium 
bicarbonate may be employed, a teaspoonful of either to 
the pint of water being sufficient. For the first one or two 
cleansing enemata the bowel should be flushed by the 
ordinary method; later, a return-flow catheter may be 
used; with this several quarts of solution may be used; 
without it one-half to a pint will be sufficient in most cases. 
The temperature of the cleansing enemata should be 
between 95 ° and 990 F.; that of the enemata which are 
to be retained between 900 and 950 F. Solutions that 
are too hot or too cold will promptly be rejected. 
The position of the patient is very important. He 
should lie on his side, with the hips well elevated. On 
account of disease this position may be impracticable. 
In this case the foot of the bed may be raised and pillows 
placed under the hips, to make as much elevation as 
possible. A rectal tube or a large catheter should be 
used. This should not, however, be too large; a tube 
1 cm. (about | inch or less) being the proper size for an 
adult. For children the tube should be proportionately 
smaller. It should be lubricated thoroughly, but glycerin 
should not be used for this purpose. 
In introducing the tube it should be twisted slightly, RECTAL FEEDING. 
191 
which lessens the liability of its becoming impacted in 
the rectal folds. If it is not passed easily a small quan- 
tity of fluid should be allowed to flow in, which will 
serve to balloon out the rectum, after which the tube 
may usually be passed with ease for 8 or io inches or 
more. The tube should in all cases be introduced as 
high up as possible, as the enema is thus more likely to 
be retained and absorbed. 
The fluid should be allowed to flow in slowly from a 
funnel or a fountain-syringe. In some instances, where 
very small injections are being used, a small hard-rubber 
syringe may be attached to the tube. Care should be 
taken to avoid injecting air with the fluid. The method 
of administering nutrient enemata by means of the old- 
fashioned short hard-rubber nozzle of either a piston or 
a Davidson syringe can not be too strongly condemned. 
In the hands of the unskilful it may cause injury to the 
rectum, and even if used by a trained nurse, only suc- 
ceeds in placing the fluid in the lower part of the rectum, 
where it is liable to be expelled. 
After the injection the patient should lie as quietly as 
possible for at least an hour, and be instructed to try to 
retain the contents of the bowel. A pad of gauze or a 
towel should be pressed over the anus for twenty minutes 
or half an hour, and the mind should, if possible, be 
diverted from the subject. After a few days the bowel 
often acquires a tolerance for the injections and they may 
be retained without difficulty. 
If the rectum is irritable and the fluid rejected, the 
physician may order the nurse to precede the nutrient 
enemata by a small suppository containing opium, or, 
what is better, a small rectal injection of the tincture of 192 
DIETETICS FOR NURSES. 
opium may be given. This may be mixed with a little 
starch water, but the whole should be as small as pos- 
sible. The opium should not be used unless necessary, 
and the dose should be just sufficient to quiet the bowel. 
The opium may be added directly to the enema. 
If there are hemorrhoids, rectal feeding will be greatly 
interfered with. Before each injection they may be 
painted with a 2 per cent, cocain solution, and between 
the feedings a soothing ointment should be applied. 
The amount to be given at each injection is an im- 
portant factor. As a rule, it should not exceed | liter 
(| pint). If this be not well borne the amount may be 
reduced to from 30 to 100 c.c. (1-3 oz.). 
The number of enemata to be used will depend some- 
what upon the patient's constitution; as a general rule, 
five, or better six, hours should be allowed to elapse 
between each feeding. 
It is well to remember that packing in the vagina and 
other gynecologic dressings may interfere materially 
with the injection of fluid in the bowel. 
The patient's mouth should be kept very clean, and the 
patient may be allowed to rinse it from time to time to 
help allay the thirst, which is usually intense. Under 
some circumstances water may be taken into the stomach, 
but where absolute rest of the stomach is indicated, not 
even that should be allowed. Enemata of weak salt solu- 
tion may be given to relieve thirst, or salt solution may 
be given subcutaneously. 
A part of the good effect of the nutrient enemata is the 
mental satisfaction following it, similar to that following 
a meal. The patient having also the feeling that he is 
not being allowed to starve. 
Prevention of Parotitis During Rectal Feed- RECTAL FEEDING. 
193 
ing.-The flow of saliva is encouraged by having the 
patient chew on a piece of rubber or a piece of chewing 
gum and the mouth will remain moist and clean and 
parotitis avoided. 
Nutrient Enemeta by the Drop Method.-Since 
Murphy's introduction of continuous protoclysis by the 
drop method, the administration of nutrient enemata by 
the same plan has been practised by various clinicians. 
Eberhard has recently called especial attention to this 
method of treatment. His apparatus consists of an ordi- 
nary quart can, inside of which is placed another can 
holding a pint. These are connected by an 8-inch pipe, 
which penetrates the bottom of each and projects about 
2 inches. A small pet-cock, soldered to the base of the 
outside, can allow water to be withdrawn at will. Milk 
and egg or any other nutriment placed in the smaller can 
is kept warm, and flows freely on account of its being 
surrounded by hot water. Water at a temperature of 
no° to 1150 F. seems to answer all purposes. The 
remainder of the apparatus is the same as used for saline 
enteroclysis. To insure absorption the bowel must be 
cleansed by an enema each day. The flow must be regu- 
lated to about a drop a second. According to Eberhard, 
in one and a half hours io ounces of milk and 2 raw 
eggs flow into the bowel. 
A fairly complete list of nutrient enemata as advised 
by the older writers will be found in the former editions 
of this book, and have a historic interest. 
The following formulae are suggested: 
1. Milk, pancreatized for twenty-four hours and 
boiled, 250 c.c. (8 ounces). 
2. To the above may be added any of the following, 
either alone or in any combination: 
(a) Dextrose, 5 to 12.5 grams (15-3 drams). DIETETICS FOR NURSES. 
194 
(&) Alcohol, 5 to 12.5 c.c. (1^-3 drams). 
(c) Egg yolk, 1 or 2. 
The drop method is especially indicated in persistent 
vomiting, in hemorrhages, stenosis of the esophagus 
or pylorus, in carcinoma of the stomach, and in most 
conditions in which nutrient enemata are ordinarily em- 
ployed. 
At present the best mixtures seem to be normal salt 
solution to which dextrose and alcohol have been added 
in the proportion of 5 per cent. Five to 20 drops of 
tincture of opium are advised by some to be added 
to a liter during the first day, and it is thought that 
| grain of thymol per liter will prevent bacterial 
change in the bowel. A liter of the above contains 550 
calories and may be administered in eight hours under 
favorable conditions. The formula will be: 
Dextrose, 50 grams (if ounces). 
Alcohol, 50 grams (if ounces). 
Normal salt solution, 1000 c.c. (32 ounces). 
This may be found useful after operations, in acidosis, 
in diabetic coma, and in many of the indications for 
rectal enemata. 
OTHER METHODS OF NOURISHING THE BODY. 
Duodenal Alimentation.-Einhorn, Morgan, and 
others, following the suggestion of the first-named inves- 
tigator, have used a duodenal tube, not only as a matter 
of diagnosis, but for feeding certain classes of cases. At 
present the tube has been used in those cases in which it 
was thought desirable-to rest the stomach-as in cases 
of persistent vomiting and in certain gastric and duodenal 
ulcers. The ordinary Einhorn tube is used, and care 
should be taken to see that it is in place before the feed- RECTAL FEEDING. 
195 
ing is started. This may be done by gentle traction, 
which shows a slight resistance if the tube is in the 
duodenum; by aspiration, which will often bring up 
golden-yellow duodenal juice without any gastric secre- 
tion ; or perhaps best, by giving the patient some liquid 
to drink by mouth and immediately performing aspira- 
tion. If the end of the tube is in the stomach, the fluid 
can be removed. Any liquid food may be employed, 
but mixtures of milk, sugar, and raw eggs are the most 
useful. Care should be taken to see that there are no 
particles in the food that might clog the tube. The 
amount at the beginning should be small, 100 c.c. every 
two hours, beginning early in the morning and stopping 
late in the evening. This quantity may be gradually 
increased up to 300 c.c. If eight feedings are given to 
twenty-four hours, and each feeding consists of 280 c.c. 
of milk, 1 egg, and 1 tablespoonful of sugar of milk, the 
patient will receive approximately 2280 calories, which is 
ample for an average individual, and if the patient is at 
rest in bed, it is sufficient to allow a gain in weight. 
Einhorn has perfected a special syringe, with which it 
is possible to administer the food without disconnecting 
the tube. Morgan has suggested a method like that of 
Murphy for giving salt solution per rectum, permitting 
the fluid to flow from an irrigating jar, and so arranging 
the pet-cock that the food is taken slowly, the 300 c.c. 
of nourishment taking about twenty-five minutes. The 
food should be administered at body temperature, and the 
heating should be done slowly, for if it becomes too hot 
it is liable to become thick and lumpy. After heating it 
is well to strain the food to be certain to have it free from 
small particles. If the food is used too warm or too cold 
it is apt to cause uncomfortable symptoms, sometimes 196 
DIETETICS FOR NURSES. 
causing the patient considerable shock; a too rapid ad- 
ministration causes flatulence. After each feeding the 
syringeful of water, at 98° F., should be injected, then 
the pet-cock closed, and the syringe filled with air, which 
should be injected after the pet-cock has been opened; 
the pet-cock should then be closed and the syringe dis- 
connected. This procedure is very important, and serves 
to keep the tube clean and empty. If this is not done, 
small masses of food are apt to be drawn into the lower 
part of the tube, and this may necessitate its removal. 
This method of feeding should not be used outside of the 
hospital, unless it is done by a nurse who has been spe- 
cially trained for the purpose. In unskilled hands mis- 
takes are very liable to be made, which cause the patient 
great discomfort. 
Saline Irrigations and Infusions.-1. Saline Rec- 
tal Irrigations.-Rectal saline injections are especially 
useful in all conditions associated with hemorrhage; also 
in the various infectious diseases, as well as in intoxica- 
tions and in those conditions in which it is necessary to 
allay thirst. 
The fluid used should be a normal salt solution, and 
should be given high with the rectal tube; if it is neces- 
sary to prepare such a solution quickly, a teaspoonful of 
salt may be added to a pint of water and rapidly injected 
by means of an ordinary fountain syringe. The fluid 
should be about the temperature of the body, and should 
be administered slowly, while the patient is in a reclining 
position. As much as | to 1 quart of the fluid can be 
utilized at one time. 
The Murphy Method for Administering Solutions by 
Rectum.-A very useful method of administering salt 
solutions and other fluids is by continuous proctoclysis RECTAL FEEDING. 
197 
by the drop method, as suggested by Murphy. This 
may be used whenever it seems advisable to increase the 
amount of fluid in the system. It is of particular ser- 
vice when there has been a loss of blood, and also useful 
to fill up the system so that further lymphatic absorption 
is impossible, as after operations about the thyroid. It 
may also be used when fluids cannot be taken by the 
stomach. Normal salt solution may be used or the solu- 
tion advised by Murphy, a dram each of sodium chlorid 
and calcium chlorid to the pint of water. In cases of 
great weakness, whisky or an infusion of coffee may be 
added to the salt solution. 
The method of administering the fluid is important. A 
fountain syringe, or a salt solution flask, with a rubber 
tube attachment, terminating in a vaginal hard-rubber 
tip, or a catheter, may be used. After the insertion of 
the tip or catheter into the rectum, the flask is filled with 
salt solution and suspended from 4 to 10 inches above 
the level of the rectum of the patient. The solution is 
kept in a temperature of ioo° F. by surrounding the 
flask with hot-water bags. An improvement on this is 
to use one of the simple devices which are on the market 
for regulating the drop. ' This may be done by using a 
funnel, and so regulating the pet-cock on the flask that 
the fluid escapes a drop at a time. The devices just 
mentioned are more satisfactory and require less atten- 
tion. Care and judgment should be used not to overload 
the patient with water and so overburden the heart. 
Plain Water Injections.-In place of using normal 
salt solution, ordinary water may be used, as suggested 
by Lawson, 1908, and more recently by Trout. The ad- 
vantages of the plain water are that it is absorbed in 
larger quantities and more rapidly. Patients given salt 198 
DIETETICS FOR NURSES. 
solution by rectum require nearly twice as much water 
by mouth to relieve thirst as those given plain water. 
The patient does not complain of tasting salt, as is often 
the case when salt solutions are used. In peritoneal 
cases in which there is drainage, larger quantities of salt 
solution or plain water may be used than under other 
circumstances. 
Other Solutions.-Foods of various kinds, as men- 
tioned above, may be administered by this method, and 
glucose solutions, 30 grams (1 ounce) to the liter of 
water, or normal salt solution may be used to advantage, 
especially in cases of threatened or developed acidosis, as 
in diabetes or following anesthesia. 
2. Saline Infusions.-Saline infusions are given subcu- 
taneously, and are especially useful in cases in which 
rectal saline irrigations cannot be utilized, as in certain 
intestinal diseases, or when an immediate effect is re- 
quired, as in sudden collapse from hemorrhage or from 
shock. They are also useful in cases when large quanti- 
ties of fluids have been lost by the body, as in the diar- 
rheas of dysentery and of cholera; in various infectious 
conditions and intoxications, as in pneumonia, erysipelas, 
and typhoid fever; and in the uremia of chronic Bright's 
disease. The most convenient location for administering 
the infusion is between the chest-wall and the mammary 
gland, or deeply into some muscle, as in the lumbar 
region, abdominal wall, or buttock. The injection should 
be given under the most aseptic precautions. No appara- 
tus is required beyond a fountain syringe, to which an 
aspirating needle is attached. The infusion should be 
warm and should be allowed to run in slowly; frequently 
as much as 1 to 2 quarts can be injected into one place. 
The mixture used is a normal 0.6 per cent, salt solution. RECTAL FEEDING. 
199 
In certain cases Cushing1 prefers the following solu- 
tions : 
Sodium chlorid 0.900 
Calcium chlorid 0.026 
Potassium chlorid 0.010 
Distilled water 99.064 
100.000 
Combs has reported a fatal case of sodium chlorid 
poisoning. By mistake I litre of saturated salt solution 
was ingested hypodermically. When seen four hours 
later she was comatose. After about six hours of coma, 
a period of excitation followed, she was maniacal, and 
talked incoherently. This condition persisted for twenty- 
four hours, when she died. 124.4 (1928 gr.) of 
sodium chlorid had been used.1 
Soda and Glucose.-In cases of acidosis or where 
it is feared, 4 or 5 per cent, sodium bicarbonate and 
commercial glucose may be administered by the Murphy 
drip. Remember, too much soda can be given. 
1 Cohen's Physiologic Therapeutics, vol. lx., p. 289. CHAPTER IX. 
GENERAL RULES FOR FEEDING THE SICK. 
The nurse should understand the importance of the 
proper feeding of the patient. Definite directions as to 
how much food, its form, its preparation, and how often 
it is to be given should be written out by the physician. 
In all acute serious conditions, as in pneumonia or in 
typhoid fever, a record of these details should be kept, 
together with the record of the quantity of fluid taken, 
the medicine given, etc. 
There is usually a tendency to err in either extreme- 
that of giving either too much or too little food. Care 
should be taken that the patient's wishes are, wherever 
practicable, carried into effect. The nurse should care- 
fully observe the patient's likes and dislikes, and also 
note his idiosyncrasies. A tactful, observing nurse is of 
inestimable value, but a careless or stupid one is an ever- 
present source of danger. 
The training of nurses in regard to feeding is often 
faulty. Every nurse should be instructed in the subject 
of practical dietetics, and should know how much food 
is required by the different types of patients. 
The food should be given at regular intervals. In 
unconscious or semi-conscious patients this is of great 
importance; but it is just as important in the conscious, 
as the appetite usually comes on at certain times, and 
if the meal is not forthcoming may disappear. 
The appetite of the conscious patient and of the con- 
200 GENERAL RULES FOR FEEDING THE SICK. 
201 
valescent should be fostered, and nothing done that may 
in any way disturb it. Patients vary much in this par- 
ticular, but, as a rule, individuals who are not overfas- 
tidious when they are well become so when weakened 
by disease. 
The sick-room should be orderly, and no dishes, uten- 
sils, or food be allowed to stand about the room either 
before or after using. All food and drink should be 
offered from scrupulously clean glasses or dishes. These 
should be as dainty as possible, and the food must be 
made attractive in appearance; when the dish permits, it 
may be garnished with a sprig of green. The napkins 
and linen should be spotless. The exterior surface of 
glasses and cups should be wiped dry before they are 
offered to the patient. 
Food that is stale or that has acquired an un- 
pleasant taste from standing in a refrigerator together 
with other things should not be given. A strong egg 
in an egg-nog may be the means of turning a patient 
forever against this form of nourishment. The food 
should be tasted by the nurse, but never, when possi- 
ble, in the patient's presence or with the same spoon. 
If there is anything wrong with a dish, this should be 
discovered and remedied before it is brought to the 
patient. 
A nurse should always remember the eternal fitness 
of things. Utensils and dishes should be used only for 
the purpose for which they are intended and not as 
makeshifts for other articles. After caring for the patient 
or removing evacuations sufficient time should be allowed 
to elapse before feeding is begun. The patient should 
be made to feel that the utmost cleanliness and care 
have been observed. The hands and face of the patient 202 
DIETETICS FOR NURSES. 
should be wiped with a moist cloth and then dried 
before food is given, and the lips cleansed after the meal 
is completed. 
The position of the patient should be as comfortable 
a one as possible, and one in which he will not tire be- 
fore the meal is ended. If the patient is weak, the food 
should be given in such form that he may take enough 
of it without inducing fatigue; otherwise he may become 
tired of masticating and swallowing and take an insuffi- 
cient amount. Patients who can sit up in bed should be 
provided with a bed-tray on which to place the food. 
The legs of the tray should be placed high enough for 
the patient to eat comfortably from it. 
If the patient is helpless, care should be exercised 
in giving food, so that it will not be drawn into the 
lungs during inspiration or coughing. This may be 
avoided by giving the food slowly and by seeing that 
each mouthful is swallowed before another is given. 
These patients may be fed in various ways. The food 
may be given from a spoon, or, what is usually pre- 
ferred, from a drinking-cup with a spout, or by using a 
tube and allowing the patient to take the food from a 
glass. When the patient is taking bread and similar 
solids great care should be exercised not to allow the 
crumbs to fall into the bed. 
In most severe illnesses it is necessary to awaken the 
patient during the night to administer food. This is a 
point that requires special judgment. Often the patient 
is more in need of sleep than of food. If the patient 
does not drop off to sleep very soon after taking food, 
it may be better to wait until he awakens before giving 
it. As a rule, however, in severe illness the sleep is 
disturbed for but a few minutes by taking food. A GENERAL RULES FOR FEEDING THE SICK. 
203 
cupful of warm milk or similar food may often induce 
sleep. 
The patient's mouth should always be kept clean. If 
dry and parched, it should be rinsed before and after 
taking food. Alkaline mouth-washes may be used; 
boric acid and water also make an efficient wash. If the 
mouth is dry, it should be moistened from time to time, 
and for this purpose a little glycerin water and lemon 
juice will be found useful. If the patient is helpless the 
mouth may be swabbed out with cotton fastened to the 
end of a stout probe or wound about the finger. This 
should be moistened with some antiseptic solution. 
In all cases where the illness is likely to be protracted, 
arrangements should be made to care for and prepare the 
food with as little discomfort to the household as possi- 
ble. For this purpose a diet kitchen may be improvised, 
preferably in a room adjoining the patient's. If the 
patient's means allow, a small sick-room refrigerator 
should be provided, and a tin receptacle for storing foods 
that do not need to be kept on ice. A gas or alcohol 
lamp will serve for heating food. A thermometer, a 
graduate, a funnel, and filter papers are needed, and a 
meat-mincing machine will be found a useful addition. 
Saucepans, a dishpan, and a supply of tea towels should 
also be provided. Boric acid or borax and sodium bicar- 
bonate will help to keep things fresh and clean. In 
cases of infectious and communicable diseases a covered 
boiler for disinfecting all dishes and utensils should be 
added. The dishes should be boiled in water to which 
2 or 3 per cent, of sodium bicarbonate has been added, 
and the boiling should be allowed to continue for fully 
twenty minutes after the water has begun to boil. If 
this duty is delegated to someone else and the instruc- 204 
DIETETICS FOR NURSES. 
tions are likely to be carelessly followed out, it is best to 
direct that the dishes be boiled for an hour. 
Feeding Unconscious and Refractory Patients. 
-Unconscious patients may often easily be fed by means 
of a teaspoon. Each spoonful should be swallowed 
before a second is given. In the case of comatose 
children, the nourishment may be poured into the nostril 
instead of into the mouth. The fluid thus given is swal- 
lowed, and any excess returned by the other nostril. If 
any difficulty is experienced in swallowing, it is best to 
resort either to the stomach or the nasal tube. This is 
usually done by the physician himself. With a little 
practice most patients can be fed with the tube more 
easily than in any other way. A mouth-gag should be 
introduced, or a roller bandage may be placed between 
the teeth and held in place by an assistant. In infants 
who have no teeth this precaution is unnecessary, as the 
finger answers the purpose perfectly. The tube, pre- 
viously moistened, is passed into the pharynx and rap- 
idly into the stomach. If the tube is not passed rapidly 
through the pharynx, contraction may follow and the 
tube be prevented from entering the esophagus. In 
order to pass the tube into the esophagus, it is neces- 
sary to hold it sufficiently well back from the end. 
If nasal feeding is to be used, a nasal tube, or in 
case of infants a catheter, is well oiled and gently passed 
through the nose into the esophagus and then into the 
stomach. Care should be taken not to pass the tube 
into the larynx. This accident can always be avoided 
by waiting a moment before pouring in the food. Either 
stomach or nasal tube should be provided with a 
funnel, and as soon as the tube has been satisfactorily 
introduced, the nourishment-milk, milk and egg, or GENERAL RULES FOR FEEDING THE SICK. 
205 
whatever liquid food is desired-may be poured slowly 
into it. 
In order to prevent air from entering in advance of 
the food, a small quantity of the food may be poured 
down the side of the funnel until the tube is full. In 
many cases it may be desirable to wash out the stomach 
before introducing the food. The tube should be with- 
drawn rapidly, so as not to excite vomiting. Food so 
introduced may be retained when it would otherwise be 
vomited. This is true both of infants and adults. 
Forced Feeding.-In case of refractory patients- 
the insane, the hysteric, and others who refuse to eat- 
forced feeding becomes necessary. In this case enough 
attendants should be present to control the patient. He 
should be held firmly and the nasal or stomach tube may 
be introduced. In order to prevent regurgitation of the 
food, which some patients manage to do quite skilfully 
while it is being introduced, the ribs may be tickled. 
This prevents fixation of the diaphragm, without which 
the food can not be ejected. This should be done only 
when occasion demands. 
FEEDING IN FEVER. 
In fever the changes taking place in the body are 
increased, while the amount of food assimilated is de- 
creased. For this reason, even if the patient is well fed, 
a certain amount of the body substance is burnt up. If 
the patient is poorly fed or the fever protracted the 
emaciation may be extreme. The appetite is diminished 
or lost entirely, and it may require great tact on the part 
of the nurse to see that the patient takes sufficient food. 
The thirst is increased. 
Foods appropriate for healthy individuals are not, as 206 
DIETETICS FOR NURSES. 
a rule, suited for fever patients, and solid foods usually 
cause vomiting or severe indigestion. In order properly 
to nourish a fever patient, it is necessary that the food be 
easy to take, easy to digest, and easy to assimilate. Any 
food that does not possess these three qualities is not 
suitable for a fever patient. When the disease runs its 
course rapidly, the diet is of no great importance, for 
even if the patient take but little food, the period of com- 
parative fasting is a brief one and any loss is easily made 
up while recovery is in progress. In protracted dis- 
eases, on the other hand, such as typhoid fever, and in 
chronic fevers, the diet is of primary importance. In 
chronic diseases and in those fevers where remissions 
occur, the periods when digestion is comparatively good 
should be taken advantage of and the patient nourished 
and strengthened as much as possible. 
In fevers the mouth requires especial care; the bowels 
likewise should be regulated and constipation avoided. 
Suitable beverages should be given to allay thirst, and 
if the patient is not getting sufficient liquid with his food 
he should be offered water or some other drink every 
three or four hours. This should be done whether or 
not the patient is conscious, for a patient seemingly con- 
scious is often in an apathetic condition. The water is 
required not only to quench thirst, but to aid in the 
elimination of waste products, which, owing to the in- 
creased metabolism, are augmented. The most suitable 
of all drinks is plain water. When this does not agree, 
or to meet special indications, mineral waters are often 
of great use. The natural waters, since they do not con- 
tain such large amounts of carbon dioxid, are best. If 
the artificial waters are used-and this is generally the 
case-they should be allowed partially to effervesce GENERAL RULES FOR FEEDING THE SICK. 
207 
before being given to the patient, lest the gas in the 
stomach cause unpleasant symptoms. The " Imperial 
Drink " (see Recipes) is very useful and is generally 
taken with a relish. To this may be added the white 
of an egg, beaten up and strained, if the patient is not 
taking much food. Both lemonade and orangeade are 
useful, and the former is particularly valuable. Since the 
hydrochloric acid of the stomach is deficient during 
fevers, water acidulated with hydrochloric or phosphoric 
acid is of service, as it increases the powers of digestion. 
Barley water, oatmeal water, toast water, and albumin 
water are all of service, containing, as they do, nourish- 
ment with drink. Albumin water is made by beating 
up the white of a fresh egg, straining it through a cloth, 
and then adding six or eight ounces of water. This 
may be flavored with lemon, orange, sherry, or cognac. 
Wine whey is also of value, and under certain circum- 
stances, as in affections of the bladder, flaxseed tea or 
gum water may be given. Rarely, beer or some other 
beverage is permissible. To those accustomed to taking 
large quantities of beer daily this may be the only means 
of getting the patient to take nourishment. 
The food for fever cases should always be liquid. 
Milk, as it contains various food elements in a suitable 
combination, is the best of this class of foods, and if 
properly administered agrees with most patients and is 
easily digested. It should, as a rule, be diluted, and a 
small quantity of lime water or sodium bicarbonate 
should be added to it. Lime water may be added in 
amounts varying from 5 to 50 per cent., according to 
circumstances. Vichy or Seltzer water, or even ordinary 
water, may be used, and may be flavored if the patient 
prefers. Barley water or oatmeal water may be mixed 208 
DIETETICS FOR NURSES. 
with it, or, what is sometimes of great service, equal 
parts of a cereal water and milk may be boiled together. 
If the mixtures mentioned do not agree the milk should 
be peptonized. Milk should not, however, be pepton- 
ized if the patient can take and digest it without pep- 
tonization. Buttermilk, kumiss, or whey may also be 
used. Buttermilk, however, contains less nourishment 
than milk; kumiss may not be relished at first, but many 
patients soon learn to like it. Lastly, infants' and in- 
valids' food may be given. Malted milk may be enjoyed 
by the patient, and is useful in those cases in which there 
is diarrhea. 
Eggs may be given raw or in the form of albumin 
water, and an excellent mode of administration, especially 
if the patient requires a stimulant at the same time, is to 
give the time-honored Stokes' brandy-and-egg mixture. 
Given in this form the egg generally agrees. It may be 
well to make up the mixture with one-quarter or one- 
half the amount of brandy. 
Meat juices and broths, for which recipes will be given 
further on, may be used. The meat extracts are best 
given well diluted. The variety of broth should be 
changed each day, using beef, veal, mutton, and chicken 
in turn, to avoid monotony in the diet. The various 
predigested beef preparations and beef juices sold in the 
shops may be used at times, and are often of great 
value, especially when the patient can not retain other 
forms of food. Strained vegetable broths are useful 
occasionally in long-continued fevers, and gelatin prep- 
arations, such as calves'-foot jelly, wine jelly, or fruit 
jelly made with gelatin, may also be employed. Fruit 
juices, especially lemon, orange, and raspberry juices, 
are generally relished. These should be diluted, and are GENERAL RULES FOR FEEDING THE SICK. 
209 
best given cold or with cracked ice. Solutions of grape 
sugar alone or drink sweetened with grape sugar are to 
be recommended. Granulated extract of malt dissolved 
in water or milk is relished by some patients. 
The question as to the value of alcohol in fevers is one 
that has been widely discussed. While alcohol has 
doubtless been greatly abused, it is of value both as a 
food and as a stimulant. The quantity to be given and 
the question whether it is to be given or not are to 
be decided only by the physician. Both questions de- 
pend upon circumstances, and the age, condition, habits, 
and tolerance of the patient all play an important part 
in deciding this question. It is usually prescribed in 
small doses at regular intervals, and should, if the 
stronger forms are used, be sufficiently diluted with 
water. CHAPTER X. 
FEEDING IN THE INFECTIOUS DISEASES. 
The management of the diet in typhoid fever is one 
of the most important things for a nurse to know. The 
diet to be followed is ordered by the physician, but it 
will depend upon the nurse to see that his orders in this 
respect are carried out in an exact and intelligent man- 
ner. Whether the patient will get sufficient food or not 
frequently depends on the tact and attention of the 
nurse. 
In this disease there is a diminution of the digestive 
and absorptive powers. The digestive juices are less 
active and the functions of the liver more or less dis- 
turbed. In addition there are ulcerations in the intestine, 
which may go on to perforation. During fever the 
metabolism is increased, and unless sufficient food is 
taken and assimilated the body protein will be used up 
and emaciation result. This always occurs to some 
extent in all cases, no matter what the food, and severe 
emaciation may also occur in well-fed cases from other 
causes. It should be borne in mind that a mild case of 
typhoid fever should be dieted with the same care as a 
severe one. 
Food and drink should be given at regular intervals, 
both by night and by day; the appetite of the patient 
should not be consulted, for these patients are often 
apathetic or have no desire for food. The food should 
TYPHOID FEVER. 
210 FEEDING IN THE INFECTIOUS DISEASES. 
211 
be given at intervals of from two to four hours, accord- 
ing to the condition of the patient and the quantity taken 
at a time. Those who are strong and in comparatively 
good condition may take their nourishment at four-hour 
intervals during the night, even if it is given at more 
frequent intervals during the day. 
The question of drink is also of great importance 
in these cases, for in some patients severe thirst is a very 
disagreeable symptom to combat. Pure water, given 
with or without ice, is to be depended upon, but if there 
are no contra-indications this may be varied in many 
ways. The natural spring waters, or if these can not be 
obtained the artificial ones, are often useful. The artificial 
waters contain large quantities of carbon dioxid, and to 
avoid trouble they should always be allowed partially to 
effervesce before they are given to the patient. If there 
is no marked bowel disturbance, fruit juice maybe added 
to the water. Lemonade, orangeade, raspberry juice, and 
raspberry vinegar and water are often welcome changes. 
Weak tea, especially if a little red wine is added to it, is an 
admirable thirst quencher. Cold weak coffee is relished 
by some. Red wine and water, white wines, or even 
sherry or brandy and water may be given to some 
patients, especially if plain water causes unpleasant 
symptoms. When there is irritability of the intestine 
or severe diarrhea, red wine and weak tea are to be 
preferred. Albumin water, since it combines food and 
drink, is most useful. It may be flavored with lemon or 
orange juice, or may be shaken up with a little sherry 
or brandy and ice. (The egg, which should always be 
perfectly fresh, should be beaten and then strained 
through a cloth.) The various mucilaginous drinks 
may be used, but are not generally relished. Gum-arabic 212 
DIETETICS FOR NURSES. 
water, arrowroot water, bread water, barley water, oat- 
meal water, and similar beverages have their place in the 
physician's list of possibilities. 
Milk.-The food par excellence in this disease is milk. 
There is no one food that meets so many indications. It 
possesses great nutritive value, is easily procured, as a 
rule, and is generally easily administered. It must be 
borne in mind, however, that there are some patients 
with whom milk disagrees, and many who do not like it. 
Milk, however, disagrees less commonly than is gener- 
ally imagined. The amount to be given daily varies 
between one and three quarts, according to the patient. 
There are not many patients who can take three quarts 
of plain milk, and it is generally a good plan to vary its 
form of administration, and occasionally to substitute 
for it other articles, which will be mentioned further on, 
so that the patient may continue to take milk during the 
entire course of the disease. If milk is given plain, it is 
only a question of time when it will disagree with any 
patient. Children are more apt to take it over long 
periods of time than are adults. At the Garrett Hos- 
pital for Children in Baltimore the authors seldom use 
anything besides milk for typhoid cases, and do not find 
it necessary to make changes in it. For older children 
or adults it should always be modified. When milk 
forms the diet, the mouth requires particular care, as the 
little milk that remains in the mouth often turns the 
patient against the next feeding. 
There are many ways of modifying milk and render- 
ing it more agreeable and more digestible to the patient. 
The simplest method is to add from one to three ounces 
of lime water to each glass of milk, or plain water or a 
mineral water may be used instead. If milk is well borne FEEDING IN THE INFECTIOUS DISEASES. 
213 
and it is desired to increase the amount of nutriment, 
cream may be added to it. If this causes unpleasant 
symptoms it should be discontinued at once. Butter- 
milk may be given occasionally, but is far inferior in 
nutritive value to plain milk. Kumiss or kefir may be 
used, and while they may not be relished at first, most 
patients learn to enjoy them. A pinch of salt may 
render milk more palatable to some persons, and the 
addition of a spoonful of brandy may be relished by 
others. The milk may be given cold, be flavored with 
fruit juices, vanilla, or nutmeg, or it may be given in the 
form of ice cream. When milk is not well borne, it is a 
good plan to prepare barley water and add to it an equal 
quantity of milk, boiling them together for a few minutes. 
Plain boiled milk may also be used with benefit. 
Among the disagreeable symptoms to which milk gives 
rise may be mentioned a bad taste in the mouth, which, 
however, is apt to be present in any case; a sense of 
fulness or pressure in the abdomen ; eructation ; or even 
pyrosis. When the milk is not well digested it may 
cause diarrhea, with colicky pains, and the undigested 
curds will be found in the stools. To obviate these 
symptoms the measures previously suggested may be 
tried (see also Milk Cures). Malted milk may be used, 
or the milk may be mixed with some of the invalid foods, 
or it may be partially or completely peptonized. For 
the last purpose the peptogenic milk powder will be 
found useful. 
When milk is found to disagree, other forms of nutri- 
ment must be given. If care is taken to supplement its 
use by other foods from the beginning, the milk will be 
less apt to cause disturbance. 
The carbohydrates are valuable foods in typhoid 
and may be used in many different forms. Of these, DIETETICS FOR NURSES. 
214 
the various gruels are the most easily digested, and may 
be given plain or mixed with milk or bouillon. Oatmeal, 
thoroughly cooked (three hours' boiling at least) and 
strained, is best, but may not agree with the patient. 
Barley water (Robinson's barley flour is an excellent 
preparation for making barley water), arrowroot, sago, 
tapioca, and the prepared foods may all be used. In 
Germany aleuronaut flour is added to bouillon or soups. 
Of the proteins and allied substances there are a 
number that may be used. Meat is to be forbidden so 
long as fever occurs. Fat must be skimmed from soups, 
broths, and bouillon, as it is apt to disturb the patient's 
digestion. Beef juice made according to any of the 
recipes given in the Appendix may be used, or beef 
juice expressed from very slightly broiled beef or 
skimmed dish gravy may be used. This may be served 
in a green glass if the color of the juice is objectionable. 
Bottle bouillon may be employed, as may also the vari- 
ous liquid beef preparations and meat juices now on the 
market. Mosquera Meat Jelly and Valentine's Beef 
Juice are useful but expensive. Beef extracts are more 
stimulating than nutritious. 
Senator recommends gelatinous substances, such as 
gelatin, calves'-foot jelly, bottle bouillon, and the like. 
Oysters may be served with gelatin. The gelatin jellies 
may be flavored with fruit juices or with wine. 
Eggs should be used sparingly. Egg water, how- 
ever, when properly prepared, rarely causes distress. 
Raw eggs may occasionally be given, or the yolk of an 
egg in bouillon or broth. Eggs and milk together may 
cause indigestion; but if the patient is in need of a 
stimulant as well as a food, Stokes' brandy-and-egg 
mixture may be used, and in moderate quantities rarely 
disagrees. FEEDING IN THE INFECTIOUS DISEASES. 
215 
Somatose, eucasin, nutrose, and similar preparations 
may be mixed with bouillon or other foods. 
Alcohol holds an important place as a food as well as 
a stimulant in long-continued fevers. The tendency to- 
day is to prescribe it in smaller quantities than formerly, 
and many have abandoned its use altogether. It is, 
nevertheless, a valuable ally in fighting typhoid, and 
should not be discarded. It is not given to children as 
a routine treatment, but even in young patients it is often 
of the greatest service. When given to adults, it is well 
to begin with very small doses and to increase these as 
the patient grows weaker or as the fever continues to 
progress. Too much should not, however, be given; 
and if the dosage has been too large at first, it can not 
be increased as needed later on. In habitues, alcohol 
will be needed from the outset. 
The form of alcohol to be used is largely dependent 
on the patient's taste. As a rule, good old whisky, 
properly diluted, is best. Old brandy is good, but much 
of the brandy sold is of very inferior quality. The red 
wines are useful, especially when there is diarrhea, and 
the old white wines are excellent if the patient cares for 
them. The brandy-and-egg mixture previously mentioned 
is very useful. 
High Caloric Diets.-Of recent years there has been 
a tendency to increase the amount of food given typhoid 
fever patients, and for this purpose a considerable choice 
of foods is desirable. The following are the most suitable: 
Milk. 
Cream. 
Buttermilk. 
Whey. 
Junket. 
Matzoon. 
Kumiss. 
Cocoa. 
Chocolate. 
Ice cream. 
Malted milk. 216 
DIETETICS FOR NURSES. 
Soups.-Beef, veal, chicken, tomato, potato, etc. These 
may be thickened with rice, barley, arrowroot, wheat flour, 
or with egg or milk. Well-boiled rice, sago, or barley 
may also be used. 
Raw eggs. 
White of egg. 
Yoik of egg. 
Custards. 
Egg and milk. 
Stokes' brandy and egg mixture. 
Egg-nog- 
Milk toast. 
Crackers and milk. 
Well-cooked cereals, such as rice, barley, cream of 
wheat, sago, arrowroot, cornmeal. 
Soft puddings. 
Blanc mange. 
Cornstarch pudding and similar preparations. 
Thoroughly cooked macaroni and spaghetti. 
Apple-sauce, lemonade, orangeade. 
Gelatin jellies. 
Scraped meat, raw or boiled, given with care and only 
in small amounts. 
Oatmeal is ordinarily not suited as a food for typhoid 
fever patients, but sometimes is used. It should be cooked 
five hours and strained. 
Pea-soup and bean-soup have been suggested, but or- 
dinarily are objectionable on two grounds-the purin 
nitrogen contained and their great tendency to cause 
flatulence in some patients. 
Baked or mashed potatoes may be used sparingly. 
If the patient is sufficiently well, a considerable amount 
of food may be given; but it should be borne in mind 
that any food that disagrees should be discontinued, lest 
the disturbance so caused should interfere seriously with 
the future feeding of the patient. The editions you find here may not be the latest. 
Write us about the books which interest you. 
Saunders' Nursing 
Service 
Books August, 1923 
WILLIAMS' ANATOMY AND PHYSIOLOGY 
Published August, 1923 
To help the teacher help the student-that is the keynote 
of a new Text-book of Anatomy and Physiology, by Jesse 
Feiring Williams, M. D., who brings to his task his experi- 
ence at Teachers College, Columbia University, New York. 
He has lightened the teaching difficulties generally asso- 
ciated with the subjects of anatomy and physiology-and 
he has lightened greatly, too, the difficulties of the nurse 
in mastering these subjects. The approach is the biologic 
one, beginning with the cell and following through the dif- 
ferent systems of the body. Embryology is given a dis- 
tinct place, and bones, muscles, nervous system, and 
viscera are given meaning in the light of origin and develop- 
ment. Many suggestions are embodied for the practical 
application of the theory. At the end of each section is a 
series of exercises, a group of spirited questions, and a 
list of selected references. The recommendations of the 
''Standard Curriculum for Schools of Nursing" have been 
followed. There are 379 illustrations. 
By Jesse Feiring Williams, M. D. Cloth, $3.00 net. 
% % 
WILLIAMS' PERSONAL HYGIENE APPLIED 
Published July, 1922 
This book is far more than a recital of information on 
health. It establishes a new interpretation of health in 
terms of life. It is personal hygiene applied. The first 
five chapters consider the various aspects of this problem 
-the meaning of health in terms of life. The remaining 
chapters consider in a systematic way hygiene from its 
scientific side. The book aims to be scientific and accurate 
according to the latest information available. It has tried 
to avoid propaganda, to convert or to get people to follow 
a scheme. It has aimed to present facts in human experi- 
ence, to establish science and intelligence as guides. 
By Jesse Feiring Williams, M. D. Cloth, $2.50 net. Saunders' Nursing Service Books 
HARDING'S HIGHER ASPECT OF NURSING 
Published April, 1919 
Miss Harding's book is a study of character building 
founded on personal experience. The nurse will find it 
a decided help both in training-school and in private 
practice. She points out the disastrous consequences 
of laxity in following these ideals-yet her book is not 
a sermon. She describes the difficult problems that 
you daily have to solve, and tells you how to meet and 
overcome them. She tells you just the things you want 
and need to know-the things that make for efficiency. 
By Gertrude Harding. Cloth, $2.00 net. 
£ « 
GOODNOW'S FIRST-YEAR NURSING 
Third Edition, Published September, 1921 
Miss Goodnow's work deals entirely with the practical 
side of first-year nursing work-the application of text- 
book knowledge. It tells you how to do those things 
you are called upon to do in your first year in the 
training-school-the actual ward work. Indeed, the book 
may truly be called the Practice of first-year nursing. 
There are chapters on fumigation, ventilation, bed- 
making, serving meals, preparation and application of 
various baths and packs, surgical nursing, bandaging, 
gynecologic and obstetric nursing, nursing in eye, etc. 
By Minnie Goodnow, R. N. Cloth, $2.25 net. 
« % 
BECK'S REFERENCE HANDBOOK 
Fourth Edition, Published April, 1919 
Beck's book has been aptly called "the nurse's ency- 
clopedia." In it you get information on every question 
that comes to you in your daily work. It gives you such 
information as action, use, and dosage of drugs, poisons 
and their antidotes, special mixtures, solutions, oint- 
ments, enemata, poultices, etc.; tests for albumin, in- 
fant feeding, nursing in the acute fevers, disinfection, 
emergency helps, baths and packs, massage, electricity, 
recipes, obstetrics, nursing in children's diseases, etc. 
By Amanda K. Beck. Cloth, $1.50 net. Saunders' Nursing Service Books 
MCCOMBS' DISEASES OF CHILDREN 
Fourth Edition, Published May, 1921 
Dr. McCombs emphasizes just those points you most 
want to know. He gives you a short but adequate 
description of each disease, considerable attention to 
prophylaxis, methods of nursing, emergency measures, 
illustrated descriptions of how to take the temperature, 
pulse, respiration, perform intubation, give hypoder- 
mics, etc. You get also special chapters on infant feed- 
ing, modification of milk, and therapeutic measures em- 
ployed in childhood, always laying special stress on the 
nurse's duties. 
"We have needed a good book and this admirably fills 
the want."-National Hospital Record. 
By Robert S. McCombs, M. D. Cloth, $3.00 net. 
% % 
SMITH'S OPERATING ROOM 
Published October, 1916 
Here you have a book for nurses written by a nurse, 
whose years of experience have taught her how to solve 
just such problems as those which face you daily. 
There are many chapters of unique value, such as those 
on formulae and directions, lists of instruments for cer- 
tain operations, with accessory articles, and details of 
actual operating-room nursing care, linen of the operat- 
ing room, improvised operating room in a humble 
home, and chapters covering the progress of the nurse 
from pupil to head nurse. 
By Amy Armour Smith, R. N. Cloth, $1.75 net. 
% % 
AIKENS' TRAINING-SCHOOL METHODS 
Second Edition, Published April, 1919 
Miss Aikens solves for you those many problems that 
constantly arise in the management of a training-school. 
There are chapters on the probation period, courses of 
study and training, principles and methods of teaching, 
teaching materia medica, the choice of books, training 
in conservation, bedside teaching, ward housekeeping 
and general management, the chief surgical nurse, and 
the night supervisor. 
"There is not a chapter that does not contain valuable 
suggestions."-Trained Nurse. 
By Charlotte A. Aikens. Cloth, $2.25 net. Saunders' Nursing Service Books 
MORSE, WYMAN & HILL'S CARE OF INFANT 
Published July, 1923 
These authors have successfully met a demand. They 
have anticipated and answered every question which 
nurses and mothers may ask-answered them in detail, 
plainly, clearly, scientifically. The work is a sympathetic 
one, covering childhood and its ailments from birth to six 
years. There are chapters on preparing for baby's arrival, 
the bath, clothing, breast feeding, weaning, artificial feed- 
ing, home modification of milk, patent foods, indigestion, 
recipes, development, malnutrition, sleep, rest, exercise, 
fresh air, training, education, contagious diseases, bad 
habits, emergencies, and medical supplies. 
By John Lovett Morse, M. D., Edwin T. Wyman, M. D., and Lewis 
Webb Hill, M. D. Cloth, $1.75 net. 
% X 
ABT'S THE BABY'S FOOD 
Published July, 1917 
The health of the baby is more intimately dependent upon 
its food supply than upon any other single factor. But 
the young mother and nurse are sometimes a little per- 
plexed as to how to carry out the doctor's instructions in 
preparing foods. This book the nurse will find indispens- 
able in securing for the baby the nourishing food so essen- 
tial to its growth and well-being. It contains over 200 
tested-out recipes which show just how each little thing 
should be done. 
By Isaac A. Abt, M. D. Cloth, $1.25 net. 
WILDER, FOLEY AND ELLITHORPE'S 
DIABETIC PRIMER Published August, 1923 
This is a brief outline of the principles underlying the 
dietary treatment of diabetes-urine and diacetic acid 
tests, treatment of impending coma, diets, recipes, etc., 
as prescribed at The Mayo Clinic, Rochester, Minn. The 
Benedict test for sugar is shown in colors. Full considera- 
tion is given the question of diet under the Insulin treat- 
ment. 
By Russell M. Wilder, M. D., Mary A. Foley, and Daisy Elli- 
thorpe. Second Edition. Cloth, $1.50 net. Saunders' Nursing Service Books 
FRIEDENWALD AND RUHRAH'S DIETETICS 
Fourth Edition, Published August, 1917 
The strong feature about this book is the practical 
information it gives you on the dietetic management of 
your cases. You get, for instance, exact directions for 
feeding infants and children in health and in the various 
infantile diseases; you get the special diets for pregnancy 
and the puerperium, rectal feeding, feeding through the 
stomach-tube, diets for the various infections, stomach 
and intestinal diseases, liver, respiratory, circulatory, 
genito-urinary, and nervous diseases; diets in diabetes, 
gout, arthritis deformans, scurvy, obesity, and skin 
diseases. You get the milk cure, the dietetic manage- 
ment of surgical cases, anesthesia and diet, etc.-prac- 
tical through and through 
By Julius Friedenwald, M. D. Cloth, $2.25 net. 
DeLEE'S obstetrics 
Sixth Edition, Published July, 1922 
This work has sold into thousands of copies. It really 
considers two subjects-obstetrics for nurses and the 
actual obstetric nursing. First the normal anatomy and 
physiology of the female reproductive system is given you 
in brief. Then you get the anatomy and physiology of 
pregnancy, labor, the puerperium, followed by chapters on 
the newborn infant, hygiene of pregnancy, the infant's 
layette. In Part II the actual nursing is taken up. Part 
III takes up complications, disorders of the newborn, in- 
fant feeding, etc. 
By Joseph B. DeLee, M. D. Cloth, $3.00 net 
AMERICAN POCKET DICTIONARY 
Eleventh Edition, Published September, 1919 
Because of its large sale the "American Pocket" is fre- 
quently revised, so that you always get the new words- 
hundreds of new words not defined in any other dictionary. 
In addition to the complete vocabulary, you get tables of 
muscles, nerves, arteries, veins, bandages, baths, bacteria, 
diets, dressings, enemata, ointments, positions, pulses, 
rales, reflexes, sutures, etc., in all, 75 tables of valuable 
information. 
Edited by W. A. Newman Dorland, M. D. 
Flexible binding, $2.00 net; indexed, $2.50 net. Saunders Nursing Service Books 
PORTER'S PSYCHOLOGY FOR NURSES 
Published September, 1921 
Years of experience in schools and colleges, in a neuro- 
logic hospital and a large city general hospital convinced 
Miss Porter that it is of little avail to cure the body and 
let remain with the patient a "sick attitude." To teach 
nurses how to prevent this attitude, or avert it, is the 
aim of this book. Every well-trained nurse should 
consider it an essential to her professional success to 
leave her patient imbued with the will to health and 
better equipped to attain it because the sick attitude 
is not present. The simple principles of psychology as 
here presented will enable the nurse to treat the sick 
mind as well as the sick body. 
By Mary F. Porter. Cloth, $1.50 net. 
a at 
COWAN'S BANDAGING 
Published December, 1920 
The aim of this book is to give the student nurse the 
fundamentals of the science of bandaging in as con- 
densed form as possible. For this reason the various 
bandages, together with the steps in the technic of their 
application, are shown by unusually clear illustrations. 
These illustrations are new and particular emphasis is 
laid upon those little details which spell success. The 
work is really an atlas of bandaging, written for the 
use of nurses by a superintendent of nurses. 
By M. Cordelia Cowan. Cloth, $2.00 net. 
% % 
WARNSHUIS' SURGICAL NURSING 
Published March, 1918 
Dr. Warnshuis presents facts gleaned from his own 
personal experience. You are told the definite, specific 
things you must do throughout the entire surgical 
procedure-how to prepare the room, the patient, your- 
self, the instruments, and materials. You are taught 
postoperative care, postoperative emergencies, how to 
care for wounds, to anesthetize, keep a chart, make a 
plaster-cast, give the morning bath, make dressings. 
By Frederick C. Warnshius, M. D. Cloth, $3.25 net. 
W. B. Saunders Company 
West Washington Square Philadelphia 
(printed in u. s. a.) FEEDING IN THE INFECTIOUS DISEASES. 
217 
The following diets will be found useful as suggestions 
of what has been used successfully in feeding typhoid 
fever patients with large amounts of food. The physician 
should prescribe the diet and be consulted concerning 
any changes in the diet and the amount of food given: 
Coleman's Milk, Cream, and Lactose Diets. 
For 1000 calories a day: 
Calories. 
Milk, I quart (1000 c.c.) 700 
Cream, if ounces (50 c.c.) loo 
Lactose, 1 f ounces (50 gm.) 200 
This furnishes eight feedings, each containing: 
Milk, 4 ounces 80 
Cream, 2 drams 15 
Lactose, 6 grams 24 
For 1500 calories a day: 
Milk, 1 j quarts (1500 c.c.) 1000 
Cream, if ounces 100 
Lactose, 3 J ounces (100 Gm.) 400 
This furnishes six feedings, each containing: 
Milk, 8 ounces 160 
Cream, 2 drams 15 
Lactose, 16 grams 64 
For 2000 calories a day: 
Milk, if quarts 1000 
Cream,8 ounces (240 c.c.) 5°° 
Lactose, 4 ounces (125 gm.) 5°° 
This furnishes seven feedings, each containing: 
Milk, 7 ounces 14° 
Cream, I ounce 60 
Lactose, 18 grams 72 218 
DIETETICS FOR NURSES. 
For 2500 calories a day: 
Milk, 11 quarts 1000 
Cream, 8 ounces 500 
Lactose, 8 ounces (250 gm.) 1000 
This furnishes seven feedings, each containing: 
Milk, 7 ounces 140 
Cream, 1 ounce 60 
Lactose, 36 grams 144 
For 3000 calories a day: 
Milk, 1J quarts 1000 
Cream, 1 pint (480 c.c.) 1000 
Lactose, 8 ounces 1000 
This furnishes eight feedings, each containing: 
Milk, 6 ounces 120 
Cream, 2 ounces 120 
Lactose, I ounce (30 gm.) 120 
This furnishes eight feedings, each containing: 
Milk, 6 ounces 120 
Cream, 2 ounces 120 
Lactose, 2 ounces 120 
Coleman suggests the following diet: 
Total 
Hours. calories. 
Milk, 6 ounces . . . .9,11A.M.; 3,7 P.M. 1200 c.c. 860 
Cream, 2 ounces 10 p. M.; I, 4 A. M. 420 c.c. 840 
Lactose, io grams 70 gm. 280 
1980 
Calories 
At 11 A. M.: Egg, 1 80 
Mashed potato, 20 gm 20 
Custard, 4 ounces 250 
Toast (or bread), 1 slice ......... 80 
Butter, 20 gm. 150 
Coffee. 
Cream, 2 ounces 120 
Lactose, 20 gm 80 
780 FEEDING IN THE INFECTIOUS DISEASES. 
219 
Calories. 
At 5 P. M. : Egg, I 80 
Cereal, 3 tablespoonfuls 150 
Cream, 2 ounces 120 
Applesauce, 1 ounce 30 
Tea. 
Cream, 3 ounces 180 
Lactose, 20 gm 80 
640 
Calories. 
At 7 A. M. : Egg, I 80 
Toast, 1 slice 80 
Butter, 20 gm 150 
Coffee. 
Cream, 2 ounces 120 
Lactose, 2 gm 80 
5io 
The following contains 5580 calories: 
Total 
Hours. Calories. 
Milk, 5 ounces . . . 9, II A. M.; 3, 7 P. M. 1200 c.c. 820 
Cream, 2 ounces . . . 10 P. M.; 1, 4 A. M. 720 c-c- 144° 
Lactose, 15 gm 120 gm. 480 
2740 
Calories. 
At II A. M.: Eggs, 2 160 
Toast, 2 slices 160 
Butter, 20 gm 150 
Mashed potato, 70 gm 7° 
Custard, 8 ounces 5 00 
1040 
Calories. 
At 5 p. M. : Egg, i slice 80 
Toast, 2 slices 160 
Butter, 20 gm 15° 
Cereal, 6 tablespoonfuls 290 
Cream, 4 ounces 240 
Applesauce, 1 ounce 30 
Tea. 
Cream, 2 ounces 120 
Lactose, 20 gm 80 
Ii5° 220 
DIETETICS FOR NURSES. 
Calories. 
At 7 A. M.: Egg, i 80 
Toast, 2 slices 160 
Butter, 20 gm 150 
Coffee. 
Cream, 3 ounces 180 
Lactose, 20 gm 80 
650 
The following diet contains 5570 calories, and is suit- 
able for convalescents : 
Total 
Hours. Calories. 
Milk, 5 ounces . . . 9, II A. M.; 1, 7 P. M. 1050 c.c. 700 
Cream, 3 ounces . . . 10 p. m. ; 1, 4 A. M. 630 c.c. 1260 
Lactose, 15 gm 105 gm. 420 
2380 
Calories. 
At II A. M:: Eggs, 2 160 
Mashed potato, 80 gm 80 
Custard, 8 ounces 500 
Creamed chicken, 1 ounce 5° 
Toast, 2 slices 160 
Butter, 20 gm 150 
1100 
Calories. 
At 5 p. M. : Toast, 2 slices 160 
Cereal, 6 tablespoonfuls 290 
Cream, 2 ounces 120 
Lactose, 20 gm 80 
650 
Calories. 
At 3 P. M. : Lemonade (lactose, 120 gm.) 480 
Calories. 
At 7 P. M. : Egg, 1 80 
Cereal, 5 tablespoonfuls 250 
Cream, 2 ounces 120 
Toast, 2 slices 160 
Butter, 20 gm 150 
Coffee. 
Cream, 2 ounces . 120 
Lactose, 20 gm. . 80 
960 FEEDING IN THE INFECTIOUS DISEASES. 
221 
The following valuable recipes were arranged by Miss 
Edna Cutler, and are from Coleman's article : 
Cocoa with milk. 
Calories. 
I rounding teaspoonful of cocoa 50 
2 ounces of milk sugar 240 . 
4 ounces of milk 80 
2 ounces of cream 120 
490 
Mix the sugar and cocoa; cook in the milk until dis- 
solved. Serve with the cream. 
Cocoa: 
Calories. 
I heaping teaspoonful of cocoa 50 
2 ounces of milk-sugar . . 240 
J cup of water. 
3 ounces of cream 180 
470 
Mix the cocoa and sugar, add the water, and boil. 
Then add the cream, or use less cream and serve with 
whipped cream. 
Coffee: 
Calories. 
I j ounces of milk-sugar 180 
4 to 5 ounces of strong coffee. 
2 ounces of cream 120 
30° 
Plain junket or rennet custard: 
Calories. 
25 gm. (1 ounce) of milk-sugar 100 
5 ounces of milk loo 
| junket tablet. 
1 ounce of cold water. 
Few drops of vanilla. 
200 
(See directions for cocoa junket.) 222 
DIETETICS FOR NURSES. 
Cocoa junket: 
Calories. 
I teaspoonful of cocoa 50 
25 gm. of milk-sugar 100 
5 ounces of milk 100 
| junket tablet dissolved in I ounce of cold water. 
250 
Mix the cotua and sugar, add the milk, and heat luke- 
warm, stirring constantly; add the dissolved junket, stir 
thoroughly, and leave it in a cool place to set. 
Soft custard: 
Calories. 
I cup of milk 160 
I egg 80 
2 ounces of milk-sugar 240 
Speck of salt. 
2 to 3 drops of vanilla, or caramel made of 3 tablespoonfuls 
of granulated sugar 20 
500 
Beat the egg slightly, and the sugar, salt, and hot milk 
slowly. Cook in a double boiler, stirring constantly until 
it thickens a little (if cooked too long the custard will 
curdle, but may become smooth again if set in a dish of 
cold water and beaten at once). Flavor and cool. 
To make caramel: Put the sugar in a pan directly over 
heat and burn until a very dark brown. Dissolve in hot 
water or milk. 
Baked custard: 
Calories. 
1 j ounces of milk-sugar 160 
6 ounces of milk . . 120 
1 egg : 80 
Nutmeg or vanilla. 
Speck of salt. 
360 
Beat the egg slightly. Warm the sugar and milk, stir- 
ring constantly, add to the egg, strain into a custard cup, 
and flavor. Bake in a pan of water in a moderate oven FEEDING IN THE INFECTIOUS DISEASES. 
223 
until a knife when cut into it will come out clean (thirty 
minutes to one hour). 
Bread pudding: 
Calories. 
ounces of milk-sugar 180 
6 ounces of milk 120 
1 egg 80 
I slice of bread (f-inch thick) 60 
| ounce of butter 120 
560 
Spread the bread with butter and cut into squares. Beat 
the egg slightly; heat the milk and sugar, stirring con- 
stantly ; mix with the egg and pour over the bread. Grate 
nutmeg over the top and bake the same as the custard. 
Vanilla ice-cream: 
Calories. 
4 ounces of cream 240 
2 ounces of milk 40 
2 ounces of milk-sugar 240 
Speck of salt. 
Few drops of vanilla. 
520 
Mix the cream, the milk, the sugar, and heat, stirring 
constantly, until the sugar is dissolved. Then flavor, 
cool, and freeze. 
Lemonade: 
Calories. 
4 ounces of milk-sugar 480 
7 ounces of cold water. 
2 tablespoonfuls of lemon-juice (or to taste). 
480 
Boil the sugar and water for two minutes, add lemon- 
juice to taste, strain, and cool. 
Care of the Mouth.-This is of primary importance. 
If begun early and persisted in, many undesirable mouth 
conditions can be avoided. If the mouth is in good 
condition the patient can, as a rule, take his food easily; 224 
DIETETICS FOR NURSES. 
if it is not, the greatest difficulty may be experienced. 
After each feeding the mouth should be cleansed care- 
fully, a proceeding that should never be neglected. If 
the patient is strong enough he may rinse the mouth 
with a mild antiseptic solution. Boric acid solutions to 
which a little glycerin and lemon juice have been added, 
or one of the prepared mouth washes diluted with water, 
may be used; diluted oxygen peroxid is also serviceable. 
If the patient is too weak to do this, the nurse should 
swab the mouth. 
Diet in Digestive Disturbances.-In cases where 
the food is rejected or badly borne it is necessary to give 
the stomach absolute rest for several hours or more. 
Then very small quantities of egg water, barley water 
and lemon juice, or similar preparations may be given. 
Panopeptone and the liquid beef preparations are use- 
ful in this condition, and may be served with cracked 
ice or diluted with water. Weak tea or red wine and 
water in small doses are useful, especially if there is 
diarrhea. 
For the diarrhea an ice-bag to the abdomen has been 
highly recommended, but is seldom well borne. Instead, 
cloths moistened with cold water may be used. 
For the painful and troublesome accumulation of gas 
in the intestine, either the ice-bag or the cold applications 
may prove beneficial. The authors have obtained excel- 
lent results from the use of turpentine stupes. When 
the meteorism is due to the imperfect digestion of starch, 
the carbohydrates should be reduced or withdrawn; 
when it is due to milk, the form in which this is given 
should be changed or it should be withdrawn altogether 
for a time. 
Hemorrhage.-When hemorrhage from the bowel 
occurs the intestinal tract should be given absolute rest FEEDING IN THE INFECTIOUS DISEASES. 
225 
for a number of hours. An ice-bag, cold applications, 
or a cold-water coil should be placed upon the abdomen. 
To relieve the thirst the patient may be allowed to suck 
small bits of ice, or ice-cold water or cold tea may be 
given in spoonful doses. After some hours the patient 
may be given a teaspoonful of cold milk, and this may 
be repeated every two or three hours. Beyond this, if 
the bleeding is severe, the intestinal tract should be given 
complete rest for twenty-four hours or longer. In addi- 
tion the physician may order opium or morphin. The 
return to the regular fever diet should be made gradually 
and with caution. 
Perforation.-When perforation of the bowel occurs 
all food should be discontinued. The patients are usually 
operated upon as soon as possible or the patient is given 
anodynes. Following operation, the diet will be that of 
any bowel perforation that has been operated upon. If 
the patient rallies without surgical intervention, or when 
this has been found impracticable, food may be given 
after an interval of twenty-four hours, but only in very 
small quantities at sufficiently wide intervals. It is best 
to begin with teaspoonful doses every three hours, and 
if the food is retained this may gradually be increased. 
Usually food is rejected, and when this is the case the 
stomach should be given complete rest, for feeding only 
tends to aggravate the condition. 
Convalescence.-The diet during the first weeks of 
convalescence requires as much care and attention as it 
received throughout the febrile period; in fact, since 
these patients often develop a ravenous appetite, born of 
several weeks' milk diet and fever, even greater care is 
necessary. The patient's wishes should in nowise govern 
his diet, and relatives and friends should be cautioned 226 
DIETETICS FOR NURSES. 
against giving the patient anything not ordered by the 
physician. Many a relapse and death has been caused 
by the misguided kindness of friends and relatives in this 
respect. 
When there has been severe bowel disturbance, the 
patient is to be kept on a liquid diet until the ninth or 
tenth day of the afebrile period. After mild cases, where 
there has been but little bowel disturbance, changes may 
be made in the diet after the fifth or sixth afebrile day. 
In these mild cases the greatest caution is required, as 
they are often quite as apt to do badly as are the severe 
ones, and the attendants are much more likely to be 
careless in carrying out instructions. 
The first addition to the dietary should be made by 
giving a piece of zwieback over which hot milk or cream 
has been poured. If desired, milk toast, milk and crack- 
ers, or junket may be substituted for this. If this is 
well borne, other articles, such as soft-boiled eggs, or the 
soft part of oysters, if they are in season and can be 
obtained fresh, may be added from day to day. Thick- 
ened meat broths containing well-boiled rice or vermi- 
celli may be given. Finely scraped raw beef, reduced to 
a pulp in the manner suggested for tuberculosis patients, 
also lends variety. 
Tender meats, vegetables, and breadstuff's in increasing 
quantities may be allowed. Roast chicken, squab, or 
partridge, boiled (white) fish, such as trout; of the vege- 
tables, spinach, cauliflower tops, asparagus tips, purees 
of peas, carrots, or tender string-beans or artichokes, 
well-cooked rice, and baked potato mashed and served 
with cream or dish gravy; toast, zwieback, crackers, and 
the crust of bread may all be permitted. If the condi- 
tion of the bowel permits, fruit juices may be allowed, 
as well as a baked apple, apple sauce, or junket flavored FEEDING IN THE INFECTIOUS DISEASES. 
227 
with fruit. Other sick-room delicacies may be ordered 
at the discretion of the physician. Chops, tender steak, 
and roast beef may generally be given in the third 
afebrile week (very finely divided meat may be allowed 
much earlier), and the diet gradually changed until the 
ordinary diet is resumed. For some time after an attack 
of typhoid fever the patient should be instructed to exer- 
cise care in the selection of his diet, and especially to 
avoid all food, such as green fruit, green corn, crabs, and 
the like, that is likely to cause diarrhea. 
The following menu for the first week of convalescence 
may serve as a guide and may be altered to suit the in- 
dividual case. It may be begun about the fifth or sixth 
afebrile day in mild cases, and about the ninth or tenth 
in severe cases. Milk should form the bulk of the diet 
at this period. 
First Day.-Milk toast, or zwieback covered with hot 
milk or cream, or crackers and milk; beef juice. 
Second Day.-Chicken broth thickened with rice 
or vermicelli (the rice should be boiled thoroughly); 
soft parts of several oysters, or a very lightly boiled 
egg- 
Third Day.-Junket; a meat broth thickened with 
well-cooked barley (boiled at least three hours), with 
barley flour, or with stale bread crumbs; wine jelly; 
scraped raw beef. 
Fourth Day.-Lightly boiled or poached egg; arrow- 
root, barley gruel, or milk toast; chicken jelly. 
Fifth Day.-Junket; a little well-boiled rice with a 
small amount of finely divided roast chicken, squab, or 
partridge, preferably the white meat; apple sauce if 
bowels permit. 
Sixth Day.-Scraped beef; poached egg; calves'-foot 
jelly; baked custard; piece of toast or zwieback. 228 
DIETETICS FOR NURSES. 
Seventh Day.-A small piece of finely divided broiled 
chop or steak ; baked potato ; baked apple; well-boiled 
rice and cream for breakfast; junket for supper. 
Atypical and Complicated Typhoid.-In these 
forms the physician often departs from the usual course 
of diet and orders a diet to meet the special indications. 
TYPHUS FEVER. 
The diet is that of all fevers and requires no especial 
precautions. Milk is the main stay, and a quart of milk 
and a pint of broth may be regarded as a fair daily allow- 
ance. Eggs are better borne than in typhoid and may 
be allowed. Rolls, zwieback, and chopped meat are 
allowed by some physicians even while there is fever. 
Black coffee is useful if there is stupor. Water should 
be given freely. 
SMALL-POX. 
The usual fever diet is used. Owing to the great 
drains on the patient's system when the stage of sup- 
puration is going on, it is desirable that the patient be 
fed up as much as possible during the stage of remission 
of the fever. If there is much pain on swallowing, and 
there often is, the food may be given cold. 
SCARLET FEVER. 
One of the chief dangers of scarlet fever is inflamma- 
tion of the kidneys, and the diet should therefore be bland 
and unirritating. A milk diet, continued for a month, is 
perhaps the safest but difficult to carry out, and we have 
recently been more liberal, allowing farinaceous foods, 
and, in fact, almost any purin free food may be allowed, FEEDING IN THE INFECTIOUS DISEASES. 
229 
taking care not to give those things which are known to 
be irritating to the kidneys. (See Diet in Nephritis and 
Purin Metabolism.) The various modifications of milk 
may be used. Kumiss and buttermilk are of especial 
value in some cases, and oyster and clam broth, from 
which the shellfish have been removed, may be given. 
For the thirst, which is generally great, plain or car- 
bonated waters, barley water, orangeade, or lemonade 
may be given freely. A level teaspoonful of cream of 
tartar mixed into a glass of lemonade is a diuretic 
drink if albuminuria is present. If edema is present, 
the physician generally orders a restriction of the fluid, 
and salt is generally omitted from the diet. Plain vanilla 
ice-cream or plain lemon-juice may be given in small 
quantities. Finely shaved ice, also in very small quanti- 
ties and flavored with a little lemon or orange-juice, often 
makes a great addition if angina is marked. Cereal 
gruels, with or without milk, are very useful, and well- 
cooked cereals, with the exception of oatmeal, about 
which there is still some question, milk toast and milk, or 
crackers and milk, are very useful. Useful puddings 
made of cereals and milk are also of service. Fruit may 
be given in moderation, its juice being perhaps the best 
to use, grape-juice and apples, or, if there is constipation, 
stewed prunes may also be used to advantage. In all 
cases the return to a general diet should be made gradu- 
ally, starting with eggs and dishes made out of eggs, and 
adding from day to day boiled or baked fish, the soft parts 
of oysters, the lightest and most easily digested meats, 
the white meat of chicken and raw or very rare beef, and 
gradually the general diet. During the height of the dis- 
ease and throughout convalescence meat extracts should 
be avoided, as they contain large quantities of extracts 
which are liable to irritate the kidneys. 230 
DIETETICS FOR NURSES. 
MEASLES. 
The diet is that of any fever. No especial precautions 
need be observed. 
MUMPS. 
Liquid diet should be given while the fever and swell- 
ing exist. Acids and astringents should be avoided on 
account of the intense pain they are liable to cause. 
The diet requires close attention, especially if the case 
is severe. Mild cases should be given a light general 
diet. If the case is severe a liquid diet should be given, 
and this should consist largely of milk. The great diffi- 
culty is that the food is liable to be vomited at the close 
of the paroxysms. This may occur so frequently that 
the child has difficulty in retaining sufficient food to 
nourish it. A good plan is to give another meal in place 
of the one which has been vomited, as soon as the child 
is able to take it. 
WHOOPING-COUGH. 
DIPHTHERIA. 
Egg-nog and milk punch are sometimes useful, although, 
as a rule, stimulants are best given alone and not com- 
bined with the food. 
If the patient can not swallow, nutrient enemata may- 
be resorted to; a nasal or a stomach tube may be em- 
ployed. If the latter mode of feeding is adopted, care 
should be taken to avoid struggles with patients whose 
hearts are weak. 
In all cases, if there is any fever, the food should be 
liquid and should be given in small quantities at regular 
intervals. The most useful of the liquid foods are milk, 
plain, with lime water or a carbonated water, or pepton- 
ized albumin water; some form of predigested beef, FEEDING IN THE INFECTIOUS DISEASES. 
231 
liquid beef peptonoids or panopeptone; soups and 
gruels, and the various prepared foods, of which malted 
milk, Eskay's or Mellin's foods are examples. 
Occasionally semi-solids are swallowed with greater 
ease than liquids; in this case any of the foods just men- 
tioned may be thickened with well-cooked cereals or 
gelatin, or custards or junket may be given. Ice cream, 
if plain, may be allowed in moderate quantities. 
Intubation.-After intubation has been done there 
may or may not be some difficulty in swallowing. As 
a rule, when the child swallows for the first time 
there may be a slight cough or some hesitation; in the 
majority of cases, however, this disappears as the appre- 
hension of the child is allayed. There may be a little 
difficulty for the first day, but this passes off gradually 
as the muscles become accustomed to work under the 
new conditions. 
If the child is old enough he should be instructed to 
take the food as rapidly as possible and then to cough 
afterward, instead of after each act of deglutition, as he 
is apt to do. In some children there may be a slight 
regurgitation through the nose. Taken all in all, the 
difficulty experienced in feeding these cases is small 
compared to the enormous benefit the child derives from 
the operation. 
If there is difficulty in swallowing liquids, solid or 
semi-solid food may be given instead. The child may 
be placed with his head lower than his body. In this 
position swallowing becomes easy. The child may also 
lie across the nurse's lap, with his head thrown well back 
and down. Sucking liquid food through a tube is 
another way of taking food in these cases. It should 
always be remembered that food may be refused because 
of nausea, or because the child has no desire to take DIETETICS FOR NURSES. 
232 
anything, as well as owing to any actual difficulty in 
swallowing. 
The diet should be the same as in non-operative cases, 
and if semi-solids or solids are required, soft-boiled eggs, 
milk toast, custards, bread and milk, oatmeal porridge, 
and similar foods may be given. 
If swallowing becomes impossible, an event that oc- 
curs very rarely, the child may be fed with the stomach 
or nasal tube or by means of nutrient enemata. 
No especial dietetic rules are necessary for feeding 
tracheotomy cases. 
Postdiphtheric Paralysis.-In paralysis of the 
muscles of deglutition which may occur after diphtheria, 
most of the food may return through the nose ; or if the 
muscles of the tongue as well as the soft palate are in- 
volved, deglutition becomes impossible. When this oc- 
curs, the child must be fed with the stomach or nasal tube 
or by the rectum. 
RHEUMATISM. 
The diet in this disease is still a matter of dispute. 
During the acute stage it is best to give milk or a milk 
and farinaceous diet. Buttermilk, gruels, and the like 
are useful. A gradual return is made to the customary 
diet. 
YELLOW FEVER. 
Food is usually withheld during the first stage of the 
disease, as it is almost certain to be vomited if given and 
only aggravates the condition. Stimulants and saline 
solution and even food may be given by rectal injec- 
tions. Milk and lime water or albumin water are given 
during the third day and the diet gradually increased as 
the physician sees fit. If the patient grows worse every- 
thing is vomited. FEEDING IN THE INFECTIOUS DISEASES. 
233 
TETANUS. 
Liquid nourishment is given, when possible, between 
the teeth; if the teeth fit too closely together it is some- 
times customaiy to remove one. A nasal-tube can be 
used in some cases and a rectal tube in others. When 
the disease is so severe that the slightest movements 
about the patient produce convulsions, feeding becomes 
impossible except while he is under the influence of an 
anesthetic. 
Only those who have seen this terrible disease appre- 
ciate the difficulties in feeding these patients. Liquid 
nourishment may be given so long as the patient can 
swallow if he desires food. Even the slightest move- 
ments near the patient produce spasms, and, as the 
result is uniformly fatal, it is not necessary to add to the 
patient's sufferings by trying to feed him. 
RABIES. 
TUBERCULOSIS. 
Diet in tuberculosis is of primary importance. We 
shall consider only pulmonary tuberculosis, for the same 
rules apply to all forms. 
The weight of the patient is a fair guide as to the state of 
his nutrition. This should be borne in mind, for in recent 
years overfeeding in tuberculosis has been somewhat over- 
done. In addition to the food it is essential that the patient 
should have an abundance of fresh air, carefully regulated 
hours for rest and exercise, and the whole life must be so 
ordered as to secure as great freedom from care and worry 
as is possible. In addition to the full night's rest it is a 
good plan for the patient to lie down at least half an hour 
after each meal. 
The individual requirements of the patients differ 234 
DIETETICS FOR NURSES. 
greatly, and food, rest, and exercise must be suited to the 
individual. The food is to be chosen from the articles 
mentioned below, although other things may be given. 
It should be made as attractive as possible, and Detweiler 
was fond of saying, " My kitchen is my pharmacy." The 
food should be ready at the time the meal is served, and 
the service should be prompt, so that the patient is not 
tired out waiting between courses, and also that he does 
not lose his appetite and patience. The plate should not 
be piled full of food which the patient is expected to eat, 
but smaller and repeated helpings have been found to be 
better. Congenial table companions are a great stimulus 
to eating, and many patients eat fairly well if seated with 
others who are cheerful and have good appetites. As a 
rule, the food should be taken in as concentrated a form 
as possible, as individuals with weak stomachs may have 
digestive troubles started if the bulk is too great. This 
is not so important in working people, as their diet is 
ordinarily rather bulky; in fact, if some people, accustomed 
to bulky diet, are given the same food value in a more 
concentrated form, they claim it does not satisfy their 
hunger. 
The dinner may be taken in the middle of the day if 
desired, and the rather lighter meal taken as supper in 
the evening. 
Milk.-This is one of the most important articles of 
diet for the tuberculous patient. Unless some special 
reason exists, milk should always form a part of the diet. 
It may be taken with the meals or be given between 
the intervals of feeding. It is of the utmost importance 
that the milk be sipped slowly and not swallowed quickly 
in large quantities. The milk may be taken plain or 
may be modified in various ways. Lime-water may be FEEDING IN THE INFECTIOUS DISEASES. 
235 
added, with or without the addition of cream; carbon- 
ated water may be mixed with it or the milk may be 
peptonized. Buttermilk or kumiss may be taken if 
desired. 
KggS, when they can be taken in sufficient quanti- 
ties, are also of the greatest value. In certain cases, 
however, they may not be well borne. If the entire egg 
can not be taken, the whites alone may be given. Egg 
albumin often renders most efficient service in helping 
to nourish these patients. The whites of from six to 
twenty-four eggs beaten up lightly and strained through 
a cloth may be taken daily. A very small pinch of salt 
and a little lemon juice or other flavoring substance may 
be added. Given in this way a large number of eggs can 
easily be taken and are almost invariably well borne. If 
the patient can digest the eggs entire they may be very 
lightly boiled, or, as a change, they may be made into a 
light omelet or poached. 
Meat.-Meat of all kinds, if properly prepared, may 
be eaten ; but " high " game, highly seasoned dishes, 
and twice-cooked meats should be avoided. Beef and 
mutton are the most suitable varieties. Raw meats, 
especially raw beef, is given in the form of a finely 
divided pulp. This is prepared by scraping the meat 
with a knife, which will result in a mass of shredded 
meat fiber. This is placed in a mortar and pounded and 
rubbed with a pestle until quite smooth. It is then 
pressed gently through a sieve to remove any larger 
particles. This raw meat pulp is very easily digested 
and highly nutritious. It may be given in various ways, 
as spread on sandwiches or given in milk or in warm 
bouillon. It may be mixed with purees of various kinds 
or with vegetables, or, in case of children, with small 236 
DIETETICS FOR NURSES. 
quantities of preserves. It may be rolled into balls and, 
so, easily swallowed; or it may be served with an egg, 
with anchovies, or with pickled herring. 
Meat juice is also of great value. This may be pre- 
pared according to any of the recipes given in the Appen- 
dix, or the juice may be expressed from beef by means 
of a meat press. Good round-steak should be very 
slightly broiled, cut into small cubes, and the juice 
pressed out. With a good press about eight ounces of 
juice can be extracted from a pound of meat. This 
should be seasoned, and heated by placing the vessel 
containing it in warm water. Care should be taken not 
to heat it too thoroughly, or the albumin will coagulate 
and the juice be spoiled. Freshly prepared beef juice is 
always preferable, but when this can not be obtained, 
liquid beef peptonoids, predigested beef, or Mosquera 
Beef Meal may be employed. 
For patients who can not or will not take raw beef, 
very rare steak, roast beef, or beef soup should be sub- 
stituted. 
Fish.-Fresh fish, boiled, broiled, or baked, may be 
allowed. Both oysters and clams from which the hard 
portion has been removed may be eaten, preferably 
raw, but they may also be given stewed, roasted, or 
broiled. 
Cereals.-Where these can be digested they are of 
value. In the early stages of the disease they serve not 
only as nutriment, but also aid in regulating the bowels, 
and are usually easily digested. If there is constipation 
they are of especial value. Oatmeal, wheaten grits, 
cornmeal mush, and rice and milk are the most suitable 
forms. FEEDING IN THE INFECTIOUS DISEASES. 
237 
Vegetables.-Any of the easily digested vegetables 
may be allowed. They should be steamed or cooked 
with as little water as possible, to avoid dissolving out 
the salts, which, together with much nutriment, are 
thrown away with the water. 
Wheat.-Wheat or rye bread or a mixture of both 
may be used. Zwieback is of great value. All hot 
breads, pastry, and cakes should be avoided. 
Fruit.-All fresh and, preferably, ripe fruit may be 
allowed in moderation. It should be taken the first 
thing in the morning or as a dessert. Oranges and baked 
apples are well borne and useful, and grapes, peaches, 
pears, and other fruit in season may be allowed. 
Fats.-In tuberculosis, when fats and oils can be 
taken and absorbed, the prognosis is always much better 
than when these can not be tolerated. While they are 
of the greatest value in treatment, care should be taken 
not to disturb the patient's digestion by forcing more 
fatty foods into the dietary than the stomach will toler- 
ate. Most patients, however, soon acquire a dislike for 
fats of all kinds. They are best given in the form of 
cream and butter; the yolks of eggs, crisp fat bacon, 
and olive oil are also useful. Cod-liver oil is really as 
much a food as a medicine. Either the plain oil or an 
emulsion may be used, and the doses should be small 
to begin with and gradually be increased. A common 
mistake is to administer the oil in excessive quantities. 
Only perfectly sweet fresh oil is to be used, as rancid or 
stale oil may disturb the digestion. Its use should be 
discontinued from time to time. Children bear oil better 
than adults. If there is a tendency to diarrhea, fats and 
oils must be used with caution. 238 
DIETETICS FOR NURSES. 
Alcohol.-Concerning the use of alcohol in the treat- 
ment of tuberculosis, it may be said that, except in the 
last stages of the disease, it is best avoided. 
Patients who are gaining in weight or who are in good 
condition are better off without alcohol. Those who are 
going down hill may often take light wine, beer, or well- 
diluted spirits with advantage. Of the last, well-matured 
whisky is the best. 
Patients with high fever who are in an exhausted con- 
dition may be given alcohol freely, following the same 
rules as were laid down in the general consideration of 
fevers. In these cases alcohol is given as a food, and is, as 
a rule, well borne. In these advanced cases pure whisky 
well diluted is perhaps the best form of alcoholic stimulant, 
but the patient's taste may be consulted in this respect. 
Other Beverages.-The usual beverages may be 
given in moderation. In chronic tuberculosis cocoa may 
be taken night and morning with good effect. Tea or 
coffee may be allowed in small quantities unless they 
produce unfavorable symptoms. Milk and milk punch, 
buttermilk, lemonade, or orangeade may be used, and 
malt extracts are often of benefit. 
Number of Meals.-Food may be given from three 
to six times daily. On rising milk may be taken, or if 
desired a cup of bouillon instead. If desired a glass of 
milk may be given early before breakfast, before the 
patient has got out of bed. 
Breakfast.-A glass of milk. This may be flavored 
with tea or coffee and taken from a coffee cup if desired. 
If the patient wishes it, an orange or a small amount of 
some other fruit, an ordinary helping of oatmeal, two soft- 
boiled or poached eggs, two slices of toast or bread, and 
half ounce of butter. A small piece of bacon may be FEEDING IN THE INFECTIOUS DISEASES 
239 
taken with the eggs if desired, or an ordinary helping of 
meat or fish may be substituted. In the middle of the 
morning, at 10.30 or 11.30, a glass of milk. 
Luncheon.-A glass of milk, a helping of fish or a chop 
or piece of steak or some meat entree, a slice of bread or 
toast or a roll, half ounce of butter, a potato or a helping 
of rice, of hominy, or the equivalent. A green vegetable, 
as spinach or a lettuce or tomato salad, and a dessert of 
junket, bread pudding, baked custard, or some similar 
nutritious dish. 
In place of afternoon tea a glass of milk with a few 
slices of bread and butter. 
Dinner.-A glass of milk, a small amount of soup if 
desired, and if it does not interfere with the appetite, an 
entree if desired, a good helping of some substantial plain 
meat, as roast beef, mutton or lamb, or chicken, guinea- 
hen or turkey, potatoes, or a farinaceous vegetable and 
a green vegetable, a salad if desired, and dessert and a 
small piece of cheese. 
At Bedtime.-A glass of milk. 
The above works out approximately as follows: 
Carbo- 
Food. 
Protein, 
Fat, 
hydrates, 
grams. 
grams. 
grams. 
Milk, 3 pints . 
• 57 
70 
87 
Cream, I ounce 
1 
6 
Butter, ounces 
32 
Eggs, 2 
12 
8 
Meat, 6 ounces 
• 44 
22 
Fish, 4 ounces 
. 20 
IO 
Bread,6 ounces 
. 16 
2 
88 
Cereals, 2 ounces 
. 8 
4 
40 
Potatoes or vegetables, 5 ounces 
. 1 
30 
Desserts, 4 ounces 
• 9 
16 
50 
Green vegetables, 1 
Fruit, I 
1 
I 
7 
Soups, etc., J 
- 
- 
169 
>yi 
302 
Total in calories, 3480.4. 240 
DIETETICS FOR NURSES. 
The milk taken at meal time should be drunk at the 
end of the meal and not at the beginning, so as not to 
interfere with the appetite. 
If desired or if deemed necessary, a small amount of 
liquid nourishment may be taken during the night if the 
patient awakens. As a rule, however, it is well to give the 
stomach a full night's rest. In severe cases, where only 
small quantities of liquid or semisolid food are taken, the 
intervals should be shortened to every two or three 
hours. 
Diets for the poorer classes of people should be so 
arranged as to be more or less like the diet to which they 
are accustomed, both in composition and price. This 
means that the dietary is more bulky, contains more car- 
bohydrates and less fat. The additional protein and car- 
bohydrate and fat can be conveniently and cheaply added 
in a quart of milk, meat, beans, peas or lentils, and butter. 
Where price is a very great item, skim milk may be used 
in part or entirely, and oleomargarin substituted for the 
butter. Beans, hominy, cornmeal, lentils, dried peas, and 
similar articles of diet may be used in large quantities, 
and the cheaper cuts of meat substituted. There is not 
always any real economy in cheaper cuts of meat, as 
some of them contain comparatively little nutriment. In 
cities where there are markets, by purchasing just before 
the market closes, odds and ends of various cuts may be 
bought at very low prices and to greater advantage from 
the standpoint of food value than cheaper cuts. 
Feeding Advanced Cases.-In advanced cases 
patients may generally be permitted to select their diet. 
These patients can often eat hearty meals with a relish 
and apparently digest them without difficulty. As a rule, FEEDING IN THE INFECTIOUS DISEASES. 
241 
they must be light, liquid or semi-solid. The same prim 
ciples may be applied here as in feeding fever cases, with 
the exception that the patient's desires should, sc far as 
possible, be gratified. 
Gastric Irritability.-This is very troublesome in 
some cases. The patient should be instructed not to 
swallow his sputum. If the attack is severe, easily 
digested liquid food should be given. Peptonized milk, 
kumiss, and the predigested beef preparations are of 
value. If there be continued irritability and the patient 
becomes unable to retain his meals, marked relief is fre- 
quently afforded by feeding with a stomach tube. 
Fever.-Tuberculosis patients with fever should be 
fed much according to the general rules given for fevers 
in general. If the digestion is not disturbed and the 
appetite is good easily digested solid food may be allowed. 
If the solid food does not agree the patient should be 
placed upon a liquid diet. 
Forced Feeding (Suralimentation). - Debove 
discovered that food introduced by means of a stomach 
tube was often retained when it would otherwise be re- 
jected. This method is used in gastric irritability and 
also where the patient is unable to take sufficient food 
owing to loss of appetite and disgust for food. 
Diet in Sanatoriums.-The following diet list in use 
at the King Edward VII. Sanatorium gives a very good 
idea of the average diet used in institutions for the tuber- 
culous : 242 
DIETETICS FOR NURSES. 
Diet jor Consumptives. 
(Standard diets in use at the King Edward VII. Sanatorium.) 
Men. 
Women. 
7-3° 
Milk 
% pint. 
Milk 
54 pint. 
A. M. 
Breakfast : 
Breakfast : 
Porridge (with milk) . . . 
54 pint. 
Porridge (with milk) . . 
54 pint. 
Egg 
1 (4 days 
Egg 
1 (4 days 
a week). 
a week). 
Meat (A), etc 
2 OZ. 
Meat (A), etc 
i54 oz. 
Bread 
2 OZ 
Bread 
oz. 
Butter 
54 OZ. 
Butter 
54 oz. 
Tea, coffee, marmalade, 
Tea, coffee, marmalade, 
etc 
q. s. 
etc 
q. s. 
12 
Milk 
Vo. pint. 
Milk 
54 pint. 
noon. 
x.15 
Luncheon : 
Luncheon: 
P. M. 
Meat (B) 
3 oz. 
Meat (B) 
254 OZ. 
Pudding (suet or milk) . . 
5 oz. 
Pudding (suet or milk) 
3 oz. 
Bread 
2 OZ. 
Bread 
iK oz. 
Butter 
% OZ. 
Butter 
54 oz. 
Milk 
54 pint. 
Milk 
% pint. 
Potatoes and vegetables or 
Potatoes and vegetables or 
salad 
q. s. 
salad 
q. s. 
Stewed fruit, jam, etc. . . 
q. s. 
Stewed fruit, jam, etc. . . 
q. s. 
Cheese and biscuits . . . 
q. s. 
Cheese and biscuits .... 
q. s. 
4-30 
P. M. 
Tea (optional): 
Tea, bread and butter, sand- 
Tea (optional): 
Tea, bread and butter, 
wiches or cake 
q. s. 
sandwiches or cake . . . 
q. s. 
7 15 
Dinner: 
Dinner : 
P. M. 
Soup or fish (optional): 
Soup or fish (optional) : 
Meat (C) 
3 oz- 
Meat P) 
254 OZ. 
Pudding (milk or suet) . . 
5 oz. 
Pudding (milk or suet) 
3 oz. 
Bread 
2 OZ. 
Bread ......... 
154 OZ. 
Butter ...... 
54 oz. 
Butter 
% oz. 
Milk 
54 pint. 
Milk 
54 pint. 
Potatoes and vegetables . . 
q. s. 
Potatoes and vegetables . 
q. s. 
Stewed fruit, jam, etc. . . . 
q. s. 
Stewed fruit, jam, etc. . . 
q. s. 
Cheese and biscuits .... 
q. s. 
Cheese and biscuits .... 
q. s. 
9-3° 
Milk 
% pint. 
Milk 
54 pint. 
P. M. 
N. B.-The weights given are the minimum quantities 
which patients are prescribed; second helpings of meat, 
pudding, and butter are allowed if asked for. 
Milk is not given both at 7.30 a. m. and 12 noon, but 
it is left to the patient's choice at which time it is taken. 
Meat (A).-At breakfast, on different days of the week, 
one of the following is provided: 
Bacon, ham, fish, or sausage. FEEDING IN THE INFECTIOUS DISEASES. 
243 
Meat (B).-At lunch, consists of one of the following: 
Roast or boiled beef, hot or cold. 
Roast or boiled mutton, hot or cold. 
Beefsteak and kidney pudding, stewed steak or Irish 
stew, or liver and bacon. 
Chicken, roast lamb, veal, or pork occasionally. 
Meat (C).-At dinner, consists of one of the following: 
Hot roast or boiled beef, hot roast or boiled mutton, 
hot roast lamb. 
The compulsory diets which are printed in italics, and 
which are prescribed in weighed and measured amounts, 
as shown in the table, give diets of the following nutritive 
values: 
Men.-Proteid, 144 gm.; fat, 160 gm.; carbohydrates, 
270 gm.; calories, 3186. 
Women.-Proteid, 126 gm.; fat, 160 gm.; carbohy- 
drates, 220 gm.; calories, 2814. CHAPTER XI. 
DIET IN DISEASES OF THE STOMACH. 
Attention has been called by McCarrison to the fact 
that faulty food is an important factor in the production 
of gastro-intestinal disorders of civilized human beings. 
As an evidence of this statement, he points to the in- 
cidence of these disorders in civilized countries and the 
comparative absence in those races living under more 
natural conditions. 
In diseases of the stomach the selection of a proper 
diet is often of more importance than the choice of drugs. 
No absolute dietetic regulations can be formulated in 
this class of diseases, but it is important to regulate the 
food in conformity with the particular disease with which 
the patient is affected, and also to consider the individual 
tastes and peculiarities of the patient; even in the regu- 
lation of a diet in any special disease of the stomach, 
changes are often rendered necessary; these must be 
made gradually and according to the patient's power to 
digest the food. 
Food is said to be easily digestible when it produces 
no gastro-intestinal discomfort, is passed from the stomach 
into the intestine at a normal rate of speed, and is easily 
absorbed. Under normal conditions the digestibility of 
foods is easily ascertained, for the functions of the stom- 
ach being normal, the effect of the food upon the func- 
tions can readily be determined; in the various gastric 
disturbances, however, this problem is more difficult. In 
determining the diet for a special gastric disturbance two 
points must be borne in mind : first, the power to increase 
the nutrition of the patient; and secondly, the necessity 
of giving food in a digestible form, so as to lessen the 
work of the stomach. Leube has devised a scale of the 
various articles of food, given in the order of their digest- 
244 DIET IN DISEASES OF THE STOMACH. 
245 
ibility. The scale forms the basis of the well-known 
Leube "ulcer diet." 
Leube'S Diet Scale.-Diet I.-If the digestion is 
very much reduced the following articles of food are 
most easily digestible: bouillon, meat solution, milk, raw 
or soft-boiled eggs. 
Diet II.-Somewhat less digestible than Diet I. are the 
following articles of food: boiled calf's brain, boiled 
thymus, boiled chicken and pigeon. The different forms 
of meat are enumerated in the order of their digestibility. 
Gruels, and in the evening milk mushes made with tapioca 
and white of egg, may also be placed in this list. The 
majority of patients can digest boiled calves' feet in addi- 
tion to the various meat foods already enumerated. 
Diet III.-If Diet II. is well borne, Diet III. may be 
given. This consists in adding cooked or raw beef to 
Diet II. Leube gives the following method of preparing 
beefsteak, and believes that beef cooked in this way is 
very easily digested : The meat should be kept for some 
time and is then scraped with a dull spoon; in this way 
a pulp is obtained, consisting only of the delicate parts 
of the muscle, and not containing any of the tough, hard, 
and sinewy portion. This pulp is roasted in fresh butter. 
Raw ham is also to be recommended. In addition to 
meat a small quantity of mashed potatoes may be given, 
some stale wheat bread, and small amounts of coffee or 
tea with milk (cautiously). 
Diet IV.-This list is so arranged that if the patient 
can digest the articles of food mentioned under this head 
for some time he can then begin with his usually accus- 
tomed diet: Roast chicken, roast pigeon, venison, par- 
tridge, roast beef, medium to raw (particularly cold); veal 
(from the leg), pickerel, boiled shad (trout, even when 
young, is very difficult to digest), macaroni, bouillon 
with rice. Small quantities of wine may be taken one 246 
DIETETICS FOR NURSES. 
to two hours before eating; gravies are contra-indi- 
cated. Young and finely chopped spinach is allowable; 
other vegetables, such as asparagus, may be tried cau- 
tiously, although Leube considers this a risky procedure. 
After this fourth diet the patients are allowed to take a 
more liberal diet, but the increase should be gradual. They 
should refrain from eating vegetables, salads, preserves, 
and fruits for some time ; and when they are resumed a 
baked apple is the first of these articles to be eaten. 
Beaumont's Table.-This shows the mean time of 
digestion of the different articles of diet-naturally, in 
the stomach, and artificially, in vials, on a water-bath. 
The proportion of gastric juice to aliment in artificial 
digestion was generally calculated at I ounce of the 
former to I dram of the latter, the bath being kept as 
close to the natural temperature-ioo° F.-as practi- 
cable, with frequent agitation. 
Mean Time of Chymification. 
Articles of diet. 
In stomach. 
In vials. 
How prepared. 
Time. 
How prepared. 
Time. 
h. m. 
h. m. 
Rice . . 
Boiled . . . 
I oo 
Sago 
u 
1 45 
Boiled . . . 
3 15 
Tapioca 
(C 
2 OO 
it 
3 20 
Barley 
it 
2 OO 
Milk 
(C 
2 OO 
Boiled. . . 
4 15 
Milk 
Raw . . . 
2 15 
Raw . . . 
4 45 
Gelatin 
Boiled . . . 
2 30 
Boiled . . . 
4 45 
Pig's feet, soused 
I OO 
Tripe, soused 
tc 
I 00 
4 30 
Brains, animal 
tc 
I 45 
Boiled. 
Venison, steak 
Broiled . . 
1 35 
Spinal marrow, animal . . . 
Boiled . . . 
2 40 
Boiled . . . 
5 25 
Turkey, domesticated . . . 
Roasted . . 
2 30 
Turkey, domesticated . . . 
Boiled . . . 
2 25 
Turkey, wild 
Roasted . . 
2 18 
Goose, wild 
Ct 
2 30 
Pig, suckling 
2 30 
Liver, beet, fresh 
Broiled . . 
2 00 
Cut fine . . 
6 30 
Lamb, fresh 
2 30 
Chicken, full-grown .... 
Fricasseed . 
2 45 DIET IN DISEASES OF THE STOMACH 
247 
Articles of diet. 
In stomach. 
In vials. 
How prepared. 
Time. 
How prepared. 
Time. 
A. m. 
h. m. 
Eggs, fresh 
Hard boiled 
3 3° 
Hard boiled 
8 00 
Eggs, fresh 
Soft boiled . 
3 °o 
Soft boiled . 
6 30 
Eggs, fresh 
Fried . . . 
3 3° 
Eggs, fresh 
Roasted . . 
2 15 
Eggs, fresh 
Raw . . . 
2 OO 
Raw . . . 
4 15 
Eggs, whipped 
I 30 
Whipped 
4 00 
Custard 
Baked . . . 
2 45 
Baked . . . 
6 30 
Codfish, cured dry .... 
Boiled . . . 
2 00 
Boiled . . . 
5 °o 
Trout, salmon, fresh .... 
1 30 
Ct 
3 30 
Trout, salmon, fresh .... 
Fried . . . 
Bass, striped, fresh .... 
Broiled . . 
3 00 
Flounder, fresh 
Fried . . . 
3 3° 
Catfish, fresh 
3 30 
Salmon, salted 
Boiled . . . 
4 00 
Boiled . . . 
7 45 
Oysters, fresh 
Raw . . . 
2 55 
Raw, entire 
7 30 
Oysters, fresh 
Roasted . . 
3 15 
Oysters, fresh 
Stewed . . 
3 3° 
Stewed . . 
8 25 
Beef, fresh, lean, rare . . . 
Roasted . . 
3 00 
Roasted . . 
Beef, fresh, lean, dry . . . 
d 
3 3° 
tc 
7 45 
Beefsteak 
Broiled . . 
3 00 
Masticated . 
8 15 
Beefsteak 
Cut fine . . 
8 00 
Beefsteak 
Raw . . . 
CC 
8 15 
Beef, with salt only .... 
Boiled . . . 
2 45 
9 30 
Beef, with mustard, etc. . . 
tc 
3 3° 
Beef, fresh, lean 
it 
Masticated . 
Beef 
CC 
Entire piece 
9 00 
Beef 
Fried . . . 
4 00 
Beef, old, hard, salted . . . 
Boiled . . . 
4 15 
Pork steak 
Broiled . . 
3 15 
Pork, fat and lean 
Roasted . . 
5 i5 
Pork, recently salted .... 
Boiled . , . 
4 3° 
Masticated . 
6 30 
Pork, recently salted .... 
Fried . . . 
4 IS 
Pork, recently salted .... 
Broiled . . 
3 15 
Pork, recently salted .... 
Raw . . . 
3 00 
Raw . . . 
8 30 
Pork, recently salted .... 
Stewed . . 
3 00 
Mutton, fresh 
Roasted . . 
3 15 
Mutton, fresh 
Broiled . . 
3 00 
Masticated . 
6 45 
Mutton, fresh 
Unmasticated 
8 30 
Mutton, fresh 
Boiled. . . 
3 00 
Veal, fresh 
Broiled . . 
4 00 
Veal, fresh 
Fried . . . 
4 30 
Fowls, domestic 
Boiled . . . 
4 00 
Masticated . 
6 30 
Fowls, domestic ..... 
Roasted . . 
4 00 
Ducks, domestic 
CC 
4 00 
Ducks, wild 
4 30 
Suet, beef, fresh 
Boiled . . . 
5 30 
Entire piece 
12 00 
Mean Time of Chymification (Continued) 248 
DIETETICS FOR NURSES. 
Mean Time of Chymification (Continued). 
In stomach. 
In vials. 
Articles of diet. 
How prepared. 
Time. 
How prepared. 
Time. 
h. m. 
h. m. 
Suet, mutton 
Boiled . . . 
4 3° 
Divided . . 
IO 00 
Butter 
Melted . . 
3 3° 
Cream 
Raw . . . 
25 30 
Cheese, old, strong .... 
Raw . . . 
3 30 
Masticated . 
7 15 
Cheese, old, strong .... 
Entire piece 
18 00 
Cheese, new, mild .... 
Divided . . 
8 30 
Oil, olive 
Raw . . . 
60 00 
Soup, beef, vegetables, and 
bread 
Boiled . . . 
4 oo 
Soup, marrow bones .... 
CC 
4 15 
Soup, bean 
cc 
3 °o 
Soup, barley 
cc 
1 30 
Soup, mutton 
cc 
3 30 
Green corn and beans . . . 
cc 
3 45 
Chicken soup 
cc 
3 00 
Oyster soup 
cc 
3 30 
Hash, meat and vegetables . 
Warmed . . 
2 30 
Sausage, fresh 
Broiled . . 
3 20 
Heart, animal 
Fried . . . 
4 00 
Entire piece 
13 30 
Tendon 
Boiled. . . 
5 30 
Masticated . 
12 45 
Tendon 
Entire piece 
24 00 
Cartilage 
Boiled . . . 
4 >5 
Masticated . 
10 00 
Cartilage 
Divided . . 
12 00 
Aponeurosis 
Boiled . . . 
3 00 
Boiled . . . 
6 30 
Bone, beef's solid 
Entire piece 
80 00 
Bone, hog's solid 
. . . . « . 
Entire piece 
80 00 
Beans, pod 
Boiled . . . 
2 30 
Bread, white, fresh .... 
Baked . . . 
3 30 
Masticated . 
4 30 
Bread, corn 
cc 
3 J5 
Cake,corn 
cc 
3 00 
Cake, sponge 
CC 
2 30 
Broken . . 
6 IS 
Dumpling, apple 
Boiled. . . 
3 00 
Apples, sour, hard .... 
Raw . . . 
2 50 
Entire piece 
18 00 
Apples, sour, mellow . . . 
Raw . . . 
2 00 
Masticated . 
8 3° 
Apples, sweet, mellow . . . 
1 30 
CC 
6 45 
Parsnips 
Boiled . . . 
2 30 
Mashed . . 
6 45 
Parsnips 
cc 
Entire piece 
13 15 
Parsnips 
Raw . . . 
CC 
18 00 
Carrot, orange 
Boiled . . . 
3 15 
Mashed . . 
6 45 
Carrot, orange 
Entire piece 
12 30 
Carrot, orange 
Raw " 
>7 15 
Beets 
Boiled . . . 
3 45 
Turnips, flat 
CC 
3 30 
Potatoes, Irish 
cc 
3 3° 
Mashed . . 
8 30 
Potatoes, Irish 
Entire piece 
14 00 
Potatoes, Irish 
Roasted . . 
2 30 DIET IN DISEASES OF THE STOMACH. 
249 
Mean Time of Chymification (Continued) 
Articles of diet. 
In stomach. 
In vials. 
How prepared. 
Time. 
How prepared. 
Time. 
h. m. 
h. m. 
Potatoes, Irish 
Baked . . . 
2 30 
Cabbage, head 
Raw . . . 
2 30 
Masticated . 
12 30 
Cabbage with vinegar . . . 
2 OO 
Shaved . . 
10 15 
Cabbage 
Boiled. . . 
4 30 
Boiled . . . 
20 OO 
Peach, mellow 
Cut small . 
IO 00 
Peach, mellow 
Mashed . . 
6 00 
" The foregoing table was computed from all the ex- 
periments made upon St. Martin since 1825, taking the 
average from such as were generally performed under the 
naturally healthy condition of the stomach and with ordi- 
nary exercise." 
Penzoldt has devised the following table giving the 
digestibility of food. He experimented on normal cases, 
achieving his results by means of the stomach tube, by 
determining the progress of digestion and the exact time 
at which the stomach was entirely empty after eating a 
certain quantity of a special food. The table shows the 
period of time it takes a given quantity of food to leave 
the stomach: 
One to two hours : 
100-200 gm. pure water. 
220 gm. carbonated water. 
200 gm. tea, alone. 
200 gm. coffee, alone. 
200 gm. cocoa, alone. 
200 gm. beer. 
200 gm. light wines. 
100-200 gm. boiled milk. 
200 gm. meat broth, alone. 
100 gm. eggs, soft. 
Two to three hours : 
200 gm. coffee with cream. 
200 gm. cocoa with milk. 
200 gm. Malaga wine. 
200 gm. "Ofner" wine. 
300-500 gm. water. 
300-500 gm. beer. 
Three to four hours : 
230 gm. young chicken, boiled. 
230 gm. partridge, boiled. 
220-260 gm. pigeon, boiled. 
195 gm. pigeon, fried. 
250 gm. beef, raw, boiled, lean. 
250 gm. calves' feet, boiled. 
160 gm. ham, boiled. 
160 gm. ham, raw. 
100 gm. veal, warm and cold, 
lean. 
loo gm. beefsteak, broiled, cold 
or warm. 
100 gm. beefsteak, raw, scraped. 
100 gm. tenderloin. 
200 gm. Rhine salmon, boiled. 
75 gm. caviare, salted. 
200 gm. sardines in vinegar, 
kippered herring. 250 
DIETETICS FOR NURSES. 
Two to three hours : 
300-500 gm. boiled milk. 
loo gm. eggs, raw and scrambled, 
hard-boiled or as omelet. 
100 gm. beef sausage, raw. 1 
25° gm. calves' brains, boiled. 
250 gm. calves' thymus, boiled. 
72 gm. oysters, raw. 
200 gm. carp, boiled. 
200 gm. pike, boiled. 
200 gm. shellfish, boiled. 
200 gm. cod, boiled. 
150 gm. cauliflower, boiled. 
150 gm. cauliflower, as salad. 
150 gm. asparagus, boiled. 
150 gm. potatoes, boiled in salt 
water. 
150 gm. mashed potatoes. 
150 gm. stewed cherries. 
150 gm. raw cherries. 
70 gm. whitebread, old or fresh, 
dry or with tea. 
70 gm. pretzels. 
70 gm. zwieback, fresh or stale, 
dry or with tea. 
50 gm. Albert biscuits. 
Penzoldt digestibility table {continued}. 
Three to four hours : 
150 gm. blackbread. 
I, 150 gm. barley bread. 
:. 150 gm. wheat bread. 
100-150 gm. Albert biscuits. 
150 gm. potato, as vegetable. 
150 gm. rice, boiled. 
150 gm. kohlrabi, boiled. 
150 gm. carrots, boiled. 
150 gm. spinach, boiled. 
150 gm. cucumber salad. 
150 gm. radishes, raw. 
150 gm. apples. 
Four to five hours. 
t 210 gm. pigeon, broiled. 
250 gm. fillet of beef, broiled. 
250 gm. beefsteak, broiled. 
250 gm. beef tongue, smoked. 
100 gm. smoked beef in slices. 
l» 250 gm. hare, broiled. 
250 gm. partridge, broiled. 
250 gm. goose, broiled. 
> 280 gm. duck, broiled. 
200 gm. herring, salted. 
150 gm. lentils, mashed. 
200 gm. peas as puree. 
150 gm. string-beans. 
Penzoldt has also constructed a series of four diet lists 
based on the length of time at which various foods leave 
the stomach, depending upon their mode of preparation 
and on other qualities of the food. They agree in the 
main with Leube's diet lists, but are more complete and 
exact. 
These diet lists are utilized in the treatment of diseases 
of the stomach requiring a gradual change from the most 
digestible form of liquid food to solid foods more difficult 
of digestion. Ulcer of the stomach may be cited as an 
example. The first list is followed for ten days; the 
second, for the succeeding ten days ; the third, for the 
following eight days, and the fourth, for fourteen days. DIET IN DISEASES OF THE STOMACH. 
251 
Beginning with broth, milk, and eggs in the first days, 
the patient is given such food as roast beef, fish, and 
asparagus at the end of one month. 
PENZOLDT'S DIET LISTS. 
Diet I. (about Ten Days). 
Food or drink. 
Largest 
quantity to 
be taken at 
one time 
Method of 
preparation. 
Special require- 
ments. 
How to be eaten. 
Meat broth. 
250 gm. 
From beef. 
Without fat, or 
not salted. 
Slowly. 
Cows' milk. 
250 gm. 
Well boiled or 
sterilized. 
Entire milk (or 
lime water, 
milk, %). 
If desired, with a 
little tea. 
Eggs. 
Meat solution 
(Leube-Ros- 
enthal). 
Cakes (Albert 
biscuits). 
Water. 
x or 2 
30-40 gm. 
6 
% liter. 
Very soft, just 
heated or raw. 
Fresh. 
Should have only 
a slight meat- 
broth odor. 
Without sugar. 
Ordinary water 
or natural car- 
bonated water 
with a small 
percentage of 
CO2 (Seltzer). 
If taken raw, 
should be stirred 
into the warm, 
not boiling, meat 
broth. 
In teaspoonful 
doses, stirred in 
meat broth. 
Not too cold. 
Diet II. (about Ten Days'). 
Calves' brains. 
too gm. 
Boiled. 
Freed from all 
membranes. 
Best taken in meat 
broth. 
Thymus (calf). 
100 gm. 
Boiled. 
Freed from all 
membranes. 
Best taken in meat 
broth. 
Pigeon. 
i 
Boiled. 
Only if young, 
without skin, 
tendons, and 
the like. 
Best taken in meat 
broth. 
Chicken. 
As large as 
a pigeon. 
Boiled. 
As above (no fat- 
tened chicken). 
Best taken in meat 
broth. 
Raw beef. 
100 gm. 
Chopped fine or 
scraped, with a 
little salt. 
From the tender- 
loin. 
To be eaten with 
cakes. 
Raw beef sau- 
sage. 
Tapioca. 
100 gm. 
3° gm. 
Without any ad- 
ditions. 
Boiled with milk 
to make gruel. 
Smoked a little. 
To be eaten with 
cakes. 252 
DIETETICS FOR NURSES. 
Diet III. (about Eight Days). 
Food or drink. 
Largest 
quantity to 
be taken at 
one time. 
Method of 
preparation. 
Special require- 
ments. 
How to be eaten. 
Pigeon. 
1 
Broiled with fresh 
butter. 
Only young bird, 
skin, etc. 
Without gravy. 
Chicken. 
I 
Broiled with fresh 
butter. 
Only young bird, 
skin, etc. 
Without gravy. 
Beefsteak. 
ioo gm. 
With fresh butter 
half-rare (Eng- 
lish). 
From the tender- 
loin, well beaten. 
Without gravy. 
Ham. 
100 gm. 
Raw, scraped fine. 
Smoked a little, 
without the 
bone. 
With white bread. 
Milk bread, 
zwieback or 
Frieberger 
pretzels. 
50 gm- 
Crisped, baked. 
Stale (so-called 
rolls, etc.). 
To be carefully 
masticated and 
well salivated. 
Potatoes. 
5° gm. 
(a) Mashed, (6) 
boiled in salt 
water and 
mashed. 
The potatoes 
should be mealy 
and crumble on 
crushing. 
Cauliflower. 
50 gm. 
As a vegetable, 
boiled in salt 
water. 
Use only the 
flowers. 
Diet IV. (about Eight to Fourteen Days'). 
Venison. 
Partridge. 
Roast beef. 
ioo gm. 
i 
ioo gm. 
Roasted. 
Roasted without 
bacon. 
Medium to rare. 
From the back, 
should hang for 
a time. 
Young birds,with- 
out skins, ten- 
dons, legs, etc. 
should hang for 
a time. 
From good, fatted 
cattle; beaten. 
Warm or cold. 
Fillet of beef. 
Veal. 
Pike 1 
Shad 
Carp 
Trout 
ioo gm. 
Medium to rare. 
Roasted. 
Boiled in salt 
From good, fatted 
cattle; beaten. 
Back or leg. 
All fish bones 
Warm or cold. 
Warm or cold. 
ioo gm.^ 
water without 
any additions. 
should be care- 
fully removed. 
In the fish gravy. 
Caviare. 
Rice. 
5° gm. 
5° gm. 
Raw. 
Mashed, pushed 
through a sieve. 
Slightly salt, Ru* 
sian caviare. 
Asparagus. 
Scramb'deggs. 
50 gm. 
2 
Boiled. 
With a little fresh 
butter and salt. 
Soft, without any 
of the hard 
parts. 
With a little melt- 
ed butter. 
Omelet (souffle) 
2 
With about 20 gm. 
of sugar. 
Must have risen 
well. 
To be eaten at 
once. 
Fruit sauce. 
5° gm. 
From fresh boiled 
fruit, to be 
strained through 
a sieve 
Free from all ker- 
nels and peel. 
Red wine. 
100 gm. 
Light, pure Bor- 
deaux. 
Or some corre- 
sponding kind 
of red wine. 
Slightly warm. DIET IN DISEASES OF THE STOMACH. 
253 
These tables of Penzoldt are valuable as a basis for 
the selection of food in gastric disturbances. In these 
cases it is important that the food be quickly dissolved 
in the gastric secretion, that it be readily absorbed, that 
it be neither fermented nor decomposed while being 
digested or absorbed, and that the entire process be in- 
attended with discomfort. It must be borne in mind that 
the digestibility of food varies widely with the individual 
taste, for no matter how digestible a food may be, if it is 
unpalatable it will not be digested properly. In general 
it may be said: First, that in acute conditions the food 
should be of such a character that the stomach should 
be spared as much work as possible; second, in chronic 
disturbances it is important to supply sufficient quantities 
of nourishment in an easily digestible form, so as to 
maintain the body weight so far as possible. In deter- 
mining the quantity of food that is necessary during 
twenty-four hours, the amount is estimated in calories of 
heat. As is well known, a human being at rest requires 
35 calories per kilo of weight; whereas while he is per- 
forming light work he requires 40 calories. In order, 
therefore, to determine the exact amount of nourishment, 
it is only necessary to know the weight of the individual. 
Inasmuch as the proteins can be replaced in a measure 
by the carbohydrates and fats, an interchange of any of 
these three food elements can be made according to the 
patient's condition. When the weight of the person is 
known, it is an easy matter to determine whether the 
amount of nourishment given is sufficient to maintain the 
body weight. 
It is well also to weigh every patient suffering with 
a stomach disorder when treatment is first inaugu- 
rated, and to repeat this from time to time, in order to 
determine whether the patient is gaining or losing flesh. 254 
DIETETICS FOR NURSES. 
The diet must be considered from the standpoint of 
the gastric secretion; there may exist, on the one hand, 
the condition of oversecretion of acid; on the other, 
lessened secretion or absence of acid. 
In cases of oversecretion an abundant protein diet is 
indicated, inasmuch as the excess of hydrochloric acid is 
neutralized by this class of foods. Ordinarily, the pro- 
teins that are best adapted for patients suffering from 
oversecretion of acid are the red meats and eggs, whereas 
the carbohydrates must be given in the most easily 
digestible form. 
In cases in which there is a diminution of the gastric 
secretion the protein foods are digested with difficulty, 
whereas the carbohydrates are more easily digested. In 
this condition, therefore, only very tender meats, prefer- 
ably scraped, are to be given; whereas such easily 
digestible vegetables as spinach, asparagus, mashed pota- 
toes, and farinaceous foods may be eaten in quite large 
quantities. In both conditions of increased and dimin- 
ished secretion of acid a reasonable amount of fat must 
be eaten, preferably in the form of good butter. 
The diet in muscular disturbances of the stomach 
depends greatly upon whether an excess or a deficiency 
of gastric juice is secreted; if there is an increase, an 
excess in protein food gives the best results; if, on the 
other hand, there is a diminution of this secretion, pro- 
tein food must be given the patient in the most easily 
digestible form. The carbohydrates and the lighter vege- 
tables may be given in somewhat larger proportion. In 
both conditions the ingestion of fluids should be reduced 
so far as possible. 
Normally, the appetite is a fair indication of the num- 
ber of calories of heat that may be required; in condi- 
tions of gastric disorder, however, this is not the case; DIET IN DISEASES OF THE STOMACH. 
255 
these patients lose their appetite, and consequently often 
take insufficient nutrition. In those instances in which 
the gastric disorder is somewhat protracted and accom- 
panied by great loss of weight and in which the patient 
takes insufficient nourishment, it need only be borne 
in mind that such a patient, resting quietly in bed, re- 
quires fewer calories than a patient who is not resting. 
This plan may therefore be used with advantage in the 
treatment of many patients suffering from disorders of 
the stomach. 
Liquid Foods in Gastric Disorders.-In these 
cases, in which it is necessary to spare the stomach as 
much work as possible, milk is the food that is usually 
most easily borne. In order to supply a sufficient num- 
ber of calories it must be taken in large quantities, fre- 
quently diluted with lime water or barley water in order 
to add to its digestibility, or flavored with coffee, tea, or 
cocoa to lend variety and add to its palatability. In 
those cases in which milk is not well borne, buttermilk, 
whey, kumiss, and kefir may serve as substitutes. Among 
the other forms of fluids that may be given are broths 
(chicken, beef, mutton), bouillon, beef tea, and meat 
juice. Of these, meat juice is most nutritious. 
Gelatinous Forms of Food.-Gelatinous articles of food, 
as gelatin, calves' feet, etc., are easily digested and readily 
absorbed. 
Meats.-The digestibility of meat can be increased by 
chopping, beating, grinding, scraping, etc. 
Eggs.-The digestibility of eggs depends upon their 
mode of preparation; raw and soft-boiled eggs are usually 
the most easily digestible forms. 
Fish.-In regard to fish, those containing but little fat 
are to be recommended for patients suffering from gastric 
disturbances, such as shellfish, pike, trout, carp, and 
halibut. 256 
DIETETICS FOR NURSES. 
Carbohydrates.-The number of vegetables from which 
selection may be made is large. The secretion from the 
mouth and intestines play an important role in the 
digestion of these substances. They should be masti- 
cated thoroughly. In those cases in which there is 
danger of fermentation they should be given with caution. 
The best form in which to give amylaceous food is in the 
form of zwieback, toast, stale wheat bread, tapioca flour, 
oatmeal, etc. 
Leguminous foods contain a considerable amount of 
protein, much of which, however, is not absorbed. They 
are apt to give rise to considerable fermentation. Pota- 
toes are best given mashed or baked. Cabbage contains 
much cellulose and should be omitted from the diet of 
all patients suffering from stomach disorders. 
Fruits are of slight nutritive value, but give a relish to 
other foods and increase intestinal peristalsis. 
Fat is to be recommended because of its tendency to 
increase the weight of the patient, and also because of 
its high caloric value. Some observers claim, however, 
that it acts as an irritant to the stomach. It is true that 
many patients find that fat meat, greasy gravies, etc., give 
rise to indigestion, and often to nausea and vomiting. 
Much depends, however, on the mode of preparation. A 
considerable amount of fat may be given in the forms of 
fresh butter spread on wheat bread or toast. Certain 
forms of chocolate contain quite a large percentage of 
fat, and on this account are very nutritious. Of these, 
Mehring's Vigor Chocolate is to be especially recom- 
mended. Olive oil has recently been recommended in 
the treatment of certain gastric disorders. 
Special Factors Bearing on the Diet in Pa- 
tients Suffering from Gastric Disturbances.-i. 
Von Noorden demonstrated the fact that the intestine DIET IN DISEASES OF THE STOMACH. 
257 
will vicariously perform the work of the stomach in con- 
ditions in which the secretion of the latter is lost. The 
point to be borne in mind is that even in cases in which 
the secretion of the stomach is lost entirely, the intestine 
may assume this function of the stomach. 
2. In those cases in which it is necessary to spare the 
stomach, as when food can not be digested or is vomited, 
either predigested foods may be utilized or foods may be 
administered through channels other than the stomach. 
Among the artificial predigested preparations are the 
albumoses and peptones, as somatose and nutrose. For 
the various methods of feeding the reader is referred to the 
sections on Rectal Feeding, Subcutaneous Feeding, etc. 
3. The following rules for eating should be carried out: 
(a) Food should be thoroughly masticated; this is 
especially important in those cases in which there are 
marked gastric disturbances. 
(£) The meals should be taken at regular intervals and 
in moderate quantities, according to the nature of the 
gastric disease. 
(z-) The temperature of the food is also an important 
factor in the treatment of gastric disturbances ; as Uffel- 
mann has pointed out, the food should be taken at a tem- 
perature between 98° and ioo° F. The ingestion of very 
hot food is believed to be a frequent cause of ulcer of the 
stomach. On the other hand, Wegele attributes the dys- 
pepsia of many Americans to the taking of ice-cold water 
and other cold drinks. 
(<7) The question of rest or exercise after eating is one 
that is of considerable importance to those suffering from 
gastric disturbances. It is generally admitted that violent 
exercise should not be indulged in after eating. 
From the authors' observations, it appears that in con- 258 
DIETETICS FOR NURSES. 
ditions of gastric disturbances accompanied by increased 
or decreased acidity and in muscular disturbances of the 
stomach, the gastric digestion is improved during rest, but 
impaired by sleep, after meals. 
Special Cures in the Treatment of the Dis- 
eases of the Stomach.-Among the special forms 
of treatment recommended in gastric disturbances may 
be mentioned the rest cure, the milk cure, the grape cure, 
and forced feeding or gavage. 
The rest cure, first devised by Weir Mitchell, plays an 
important role in the treatment of stomach disorders. 
This treatment is especially useful in cases of nervous 
stomach disorders. It is also useful in the treatment 
of ulcer, gastritis, and other conditions. The rest treat- 
ment in gastric disorders should be carried out for from 
six to eight weeks. The patient should be confined to 
bed a large part of this time and given a varied diet, food 
being supplied every two to three hours. Boas advises 
that instead of the large quantities of milk usually pre- 
scribed, the patient will do better if given J to I liter of 
cream daily in portions of 150 to 200 c.c. In addition to 
the protein food he advises a diet rich in carbohydrates 
and fats. The results that follow this plan of treatment 
are often marvellous. For a further consideration of the 
method and plan of conducting the rest treatment syste- 
matically, the reader is referred to the section dealing 
with that subject. 
Milk Cure.-The underlying principle of the milk cure 
consists in the ingestion of large quantities of milk, either 
alone or together with other foods. Under normal con- 
ditions, when taken alone in large quantities-say three 
liters a day-milk does not suffice as a food; in certain 
digestive disturbances, however, milk given alone for a 
time forms a useful food and allows the stomach to regain DIET IN DISEASES OF THE STOMACH. 
259 
its normal tone and functions. Milk is especially useful 
in the treatment of ulcer of the stomach and in certain 
forms of chronic gastritis; it is particularly useful in the 
secondary forms of gastritis, as those depending upon 
tuberculosis, anemia, etc. In some cases of nervous dys- 
pepsia milk cures sometimes effect remarkable results; 
whereas in others milk disagrees and, as a consequence, 
the milk cure can not be undertaken. When there is a 
diminution or an absence of acid in the stomach, milk is 
usually not well borne. It is also contra-indicated in 
severe cases of muscular relaxation of the stomach and 
in intestinal conditions accompanied by extreme flatulence 
and chronic diarrheas. 
When milk is given in large quantities in addition to 
other foods, it is more frequently better borne and is less 
apt to disagree. One of the disadvantages of the milk 
cure is the obstinate constipation the milk is apt to in- 
duce. Milk can often be rendered more digestible by 
the addition of barley water, lime water, milk of magne- 
sia, and the like, or small quantities of coffee, tea, or 
whisky may be added to it. When milk disagrees, 
cream, buttermilk, kefir, kumiss, or matzoon may be 
given as a substitute for it. (See Milk Cure.) 
Forced Feeding or Gavage.-This method consists in 
introducing milk, eggs, and meat extracts into the 
stomach by means of the stomach tube. 
Grape Cure.-In this form of treatment the patient 
lives exclusively upon grapes; it is especially useful in 
obese individuals, in whom it is important to diminish 
the weight; in anemia, girls suffering with dyspepsia, 
and in certain cases of nervous dyspepsia. 
The Fast Cure.-Prolonged fasting has been ad- 
vocated in the treatment of various affections of the 
gastro-intestinal tract, thus representing the employ- 260 
DIETETICS FOR NURSES. 
ment of rest in the treatment of diseases of other portions 
of the body. The total fasting may be continued for 
some days. This method has been utilized in the treat- 
ment of gastritis, hyperacidity, and ulcer of the stomach. 
DIET IN DYSPHAGIA (DIFFICULTY IN SWALLOWING). 
Dysphagia may be due to any obstruction in the 
mouth, pharynx, or esophagus. The difficulty and pain 
induced by swallowing must be obviated by lessening 
as much as possible the efforts at swallowing; for this 
reason food must be given in a concentrated form, and 
only in a liquid or semi-solid state; milk, egg albumin, 
and the concentrated liquid beef preparations are espe- 
cially useful in this condition. In those cases in which 
food can not be swallowed in sufficient quantities the 
patient must be fed through the stomach tube. In this 
way broths, gruel, milk, and the like can be passed into 
the stomach. 
DIET IN ACUTE GASTRITIS. 
Oser has said that " every case of acute catarrh of the 
stomach has a natural tendency to heal of its own accord 
unless a chronic form is produced by a mistaken diet or 
wrong medication." It is a generally admitted fact that 
in the treatment of this condition the diet plays the lead- 
ing role. The first step in the treatment consists of 
securing absolute rest for the stomach and a total absti- 
nence from food for at least twenty-four hours. This 
procedure is sometimes very difficult to carry out, for 
many patients believe that food is necessary for them, 
and that they can secure relief more quickly by taking 
nourishment. The nausea and vomiting which are present 
in more or less degree in this condition, and which are 
aggravated by the taking of food, will soon convince the DIET IN DISEASES OF THE STOMACH. 
261 
patient of the necessity of abstaining from food. The 
thirst is, however, so severe in these cases that patients 
may be allowed to rinse the mouth with water frequently, 
to retain tiny bits of ice in the mouth, or even to drink 
very small quantities of carbonated waters. With this 
plan of treatment recovery generally follows in two or 
three days. After the first twenty-four hours feeding 
may be begun by giving cautiously small quantities of 
milk diluted with lime water, broths, and egg albumin; 
these can gradually be increased in quantity, and during 
the next day or two boiled chicken, sweetbreads, scraped 
beef, in addition to toast, may be added. 
The authors are accustomed to prescribe the following 
diet about the second or third day after an attack of acute 
gastritis: 
Calories. 
7 A. M.: 150 gm. milk with lime water 101 
9 A. M.: 100 gm. egg albumin flavored with orange or lemon juice, 53 
11 A. M.: 150 gm. broth with egg 84 
I p. M.: 150 gm. milk with lime water 101 
3 P. M.: 5 gm. Armour's soluble beef in water 10 
5 P. M.: 100 gm. egg albumin flavored with orange or lemon juice, 53 
7 p. M.: 150 gm. milk with lime water Jtoi 
503 
After the third day the diet is increased as follows : 
Calories. 
7 A. M. : 150 gm. milk (101) with 70 gm. toast (182) 283 
9 A. M.: 2 very soft-boiled eggs 160 
11 A. M.: 200 gm. bouillon with 1 egg 85 
I p. M.: too gm. rice cooked in milk 177 
70 gm. toast 182 
3 p. M. : 100 gm. egg albumin (53) with 50 gm. crackers (187) . 240 
5 P. M.: 150 gm. milk with 70 gm. toast . • • 283 
7 p. m. : 100 gm. egg albumin flavored with orange or lemon juice, 53 
1463 
1 In comparing these diet lists slight discrepancies in the calorie values 
of the foods will be noted. These differences have arisen from some 
authors using the calorie values of raw foods, while others have computed 
the values of cooked foods. In the diet lists given by the authors, calorie 
value of foods as prepared for the table are given. 262 
DIETETICS FOR NURSES. 
DIET IN CHRONIC GASTRITIS. 
The dietetic treatment of chronic gastritis is of far 
greater importance than the treatment of this disease by 
the use of drugs. The diet must be varied according to 
the stage of the disease. The most easily borne forms 
of food are liquids, such as broths; unfortunately, these 
foods do not furnish sufficient nutriment to sustain the 
patient. Their nutritive value may be increased by the 
addition of beef extracts, eggs, barley and rice, peptones, 
somatose, etc. 
The diet should vary according to the character of the 
gastritis; in those cases in which the gastric secretion 
has entirely or almost entirely disappeared, protein food 
is digested with great difficulty; it must therefore be 
given in the most digestible form; of these foods, scraped 
beef, stewed beef, stewed chicken, broiled steak, and 
boiled sweetbreads are especially to be recommended. 
Vegetables should also be given in the most digestible 
form, best as a mush. Milk is useful in most cases; 
occasionally, however, it is not well borne; when this is 
the case, it can be made more agreeable by adding small 
quantities of rice, potatoes, or cocoa to it, or kefir, 
kumiss, or matzoon may be substituted for it. In those 
conditions in which considerable acid still remains in the 
stomach, meats in various forms are very acceptable ; to 
this list may be added fish and eggs; vegetables, such as 
mashed potatoes, spinach, mashed carrots, especially in 
the form of purees, are to be recommended. In all in- 
stances fat should be given in an easily digestible form- 
as good butter, cocoanut butter, or Mehring's Vigor 
Chocolate. It is impossible to formulate exact rules as 
to the number of meals that should be eaten and the DIET IN DISEASES OF THE STOMACH. 
263 
quantity that should be taken at each meal; in a general 
way, small frequent meals are best borne. 
Water should be taken in small quantities between 
meals. Alcoholic stimulants or any strong stimulants 
should, as a rule, be omitted; when utilized, they should 
be given in small quantities and best diluted with mineral 
waters. Salt and spices may be allowed occasionally in 
small quantities. 
The authors have found the following diet list useful 
in cases of chronic gastritis: 
Calories. 
8 A. M.: 200 gm. milk flavored with tea 135 
60 gm. stale bread (154) with 40 gm. butter (326) . . 480 
1 soft-boiled egg 80 
10 A. M.: 100 gm. scraped beef (119) with 60 gm. stale bread or 
toast (154) 273 
(or chicken sandwich (260) or 50 gm. sherry (60) 
with egg (80)) 
Ii A. M.: Bouillon with egg 84 
100 gm. chicken 106 
(or 100 gm. lamb chops (230) 
or 100 gm. broiled steak (209)). 
100 gm. spinach 166 
100 gm. mashed potatoes 127 
100 gm. stewed apples 53 
60 gm. toast 154 
4 P. M.: 120 gm. milk with tea 81 
30 gm. crackers 102 
7 P. M.: 60 gm. stale bread (154) with 40 gm. butter (326) . . . 480 
200 gm. milk 135 
2456 
DIET IN DILATATION OF THE STOMACH. 
Dilatation of the stomach may be either acute or 
chronic. The acute form is but rarely seen. Chronic 
dilatation results either from a narrowing of the pylorus 
or from weakness of the muscular walls of the stomach. 
This latter form may be seen in diabetes, the insane, and 
in beer drinkers, as well as under many other con- 
ditions. 264 
DIETETICS FOR NURSES. 
In the dietetic treatment of dilatation of the stomach, 
it must be remembered that fluids are badly borne, and 
must, therefore, be given only in very small quantities- 
not over I to ij liters a day. The fluids that are per- 
missible are milk, cream, coffee, tea, and bouillon, all in 
small quantities. The thirst that accompanies this dis- 
ease may be relieved by allowing the patient to suck bits 
of ice or by giving rectal injections of water or normal 
salt solution. Since nutrition is usually very faulty in 
this disease, nutrient enemata must frequently be em- 
ployed. When milk is administered, such substances as 
tapioca and rice should be added. Egg or concentrated 
meat extracts should be added to bouillon to increase its 
nutritive value. Meats should be given only in the most 
digestible forms; of these, stewed chicken, boiled sweet- 
breads, calves' brains, and scraped beef are to be pre- 
ferred. Vegetables, such as carrots, spinach, peas, pota- 
toes, should be administered in the form of purees. 
Bread should be eaten stale; wheat bread or toast is 
best. Stewed fruits, such as stewed prunes, and baked 
apples are also permissible. Since fats are apt to cause 
fermentation, butter should be allowed only in quite 
small quantities. Alcohol is not to be recommended in 
this condition. Strong spices should always be 
avoided. 
The special feature of the treatment consists in giving 
frequent concentrated meals. Patients with dilatation of 
the stomach should be cautioned against visiting watering- 
places for the purpose of drinking the waters. 
The diet list given on the following page is the one 
used by the authors in dilatation of the stomach. DIET IN DISEASES OF THE STOMACH. 
265 
Calories. 
8 A. m. : 100 gm. milk with tea . 67 
50 gm. stale wheat bread 130 
10 gm. butter 80 
I egg 80 
10 A. M.: 100 gm. raw scraped beef 118 
50 gm. toast 130 
10 gm. butter 80 
12 M. : 150 gm. broiled steak 315 
or 150 gm. lamb chops and chicken. 
100 gm. baked potatoes 127 
loo gm. spinach 166 
or 100 gm. asparagus (185), 
or 100 gm. peas, mashed and strained (318), 
or 100 gm. carrots, mashed and strained (41). 
4 P. M.: 100 gm. cream 214 
50 gm. stale bread 130 
10 gm. butter 80 
7 P. M.: 100 gm. boiled rockfish . 80 
50 gm. stale wheat bread 130 
10 gm. butter 80 
2007 
DIET IN ATONIC DYSPEPSIA. 
Since atonic dyspepsia is frequently caused by inju- 
dicious and too rapid eating, persons with feeble digestive 
powers should exercise especial caution to eat slowly, 
masticate thoroughly, and avoid indigestible food. Per- 
sons suffering from atonic dyspepsia should eat small 
quantities of food at frequent intervals. Since water is 
not absorbed in the stomach to any extent, it is advisable 
that the quantity of fluids taken should not exceed 
liters a day; this amount should include all fluids- 
coffee, tea, soups, etc. If the thirst is very great, enemata 
of water or nutrient enemata may be administered. 
The use of milk in large quantities, as has been recom- 
mended, is not generally to be advised when the patient 
is able to go about, since the weight of large quantities 
of milk may overdistend the stomach; when, however, a 
rest cure is instituted, milk is commonly well borne, even 
in very large quantities. The diet in atonic dyspepsia 
varies according to the nature of the gastric secretion. 266 
DIETETICS FOR NURSES. 
In cases in which there is an excess of acid a liberal 
meat diet, consisting especially of chicken, beef, mutton, 
or ham, is to be recommended; fish, eggs, hard- and soft- 
boiled, are also permissible; the vegetables should be 
selected with care; carrots, peas, beans, and cauliflower 
may be given, but must be mashed and strained so as to 
rid them of cellulose; potatoes, rice, and grits may also 
be allowed. Butter is the form of fat best suited to this 
condition. Alcoholic stimulants are, as a rule, not well 
borne, and their use should be prohibited; in a limited 
number of cases alcohol in the form of a light wine acts 
as a stomachic and may be prescribed. 
In those cases in which there is an absence or a dim- 
inution of acid in the gastric secretion, the lighter forms 
of meat, such as the white meat of chicken or fish, 
sweetbreads, stewed chicken, or raw scraped beef, should 
be allowed; vegetables, on the other hand, must be 
given in somewhat larger quantities. 
The treatment of the chronic constipation accompany- 
ing atonic dyspepsia, since it is one of the most constant 
symptoms, requires special mention. In the treatment 
of this condition the main reliance must be placed on the 
diet. Such forms of foods should be given as will, in the 
course of digestion, produce substances that excite in- 
testinal peristalsis; among these foods may be mentioned 
Graham bread, certain vegetables, such as carrots, beans, 
tomatoes, peas, and turnips, macaroni, stewed and raw 
fruits, buttermilk, honey, and cider. This form of diet 
will often overcome the constipation without the aid of 
drugs. (For a more extensive consideration of the die- 
tetic treatment of chronic constipation, the reader is 
referred to the section dealing with that subject.) 
The following list has been used by the authors in the 
treatment of atonic dyspepsia: DIET IN DISEASES OF THE STOMACH. 
267 
Calories. 
7 A. m. : 40 gm. orange juice 88 
8 A. M.: 200 gm. milk 135 
I soft-boiled egg 80 
60 gm. toast 154 
40 gm. butter 325 
io A. M.: 100 gm. raw scraped beef 118 
60 gm. stale wheat bread 154 
12 M.: 100 gm. broiled steak 209 
or too gm. lamb chops (230), 
or 100 gm. stewed chicken (106). 
200 gm. asparagus 37 
or 100 gm. peas (318), 
or too gm. spinach (165). 
loo gm. mashed potatoes 127 
loo gm. apple sauce 53 
50 gm. bread (stale) 130 
3 P. M.: 200 gm. milk 135 
60 gm. wheat bread 154 
40 gm. butter 325 
7 P. M.: 100 gm. boiled rock-fish 80 
too gm. milk 67 
60 gm. bread 154 
40 gm. butter 325 
2850 
DIET IN ULCER OF THE STOMACH. 
Much can be done by a carefully selected diet to pre- 
vent the onset of an ulcer of the stomach. As soon as 
the very first symptoms become manifest, the patient 
should be placed upon an absolute milk diet. The tem- 
perature of the food should be regulated, so that it be 
not given too hot nor too cold. 
Boas divides the treatment of ulcers of the stomach 
into several stages: 
Stage of Hemorrhage.-In this stage Boas advises 
absolute rest in bed; the patient not even being allowed 
to arise for purposes of defecation or urination. No 
nourishment whatever should be given by the mouth. 
In robust individuals even nutrient enemata may be 
omitted. If the patient is weak or in feeble condition, 
feeding by the rectum may be instituted. (See the sec- 
tion on Nutrient Enemata for the method of preparation 268 
DIETETICS FOR NURSES. 
and utilization of this mode of feeding.) Only two or 
three nutrient enemata are to be given daily. Boas 
carries out this plan for three or four days. After this 
he gradually begins mouth-feeding, the nourishment con- 
sisting exclusively of fluids given at a temperature of 
98° to ioo° F. He prefers milk diluted with lime water, 
with tea, or with coffee. In addition he permits beef tea, 
freshly expressed or artificial beef juice, and egg albu- 
min. The carbonated waters, such as Vichy, are also 
useful. 
After the first week Boas begins the regular Leube 
and v. Ziemssen ulcer treatment, which he conducts as 
follows : The patient is given a one-fourth liter of Carlsbad 
water, which he drinks in bed morning and evening. 
Hot-water applications are placed on the abdomen. The 
diet during this stage consists mainly of milk in addition 
to other fluids. If the patient is very weak, nutrient 
enemata may occasionally be given. 
In the treatment, beginning with the third and continu- 
ing during the fourth week, Boas permits the patient to 
recline on a couch and continues the use of the Carlsbad 
water, which should be given for four weeks from the 
time it is first taken; he advises that the diet still consist 
mainly of milk, although he now permits the addition of 
soaked zwieback, scalded crackers, and soft rolls. Meats 
(sweetbreads, brains, meat balls), fish (perch, oysters in 
small quantities), in addition to the light red wine and 
carbonated waters, are also allowed. 
After the fourth week, if the patient is doing well, 
Boas adds from 50 to 200 gm. of mashed potatoes, 
stewed fruits, and vegetables, such as spinach, carrots, 
peas, and turnips, in the form of purees, to the diet pre- 
viously given. The meats (broiled steak, chops, and 
roast beef), if well cooked, can finally be given more DIET IN DISEASES OF THE STOMACH. 
269 
liberally. According to Boas, the patient should avoid 
raw fruit, acid and highly seasoned foods, and also very 
hot and very cold drinks for many years. Even in those 
cases in which there has been no hemorrhage, Boas never- 
theless advises the rest treatment. It is generally admitted 
that the rest cure is the only satisfactory plan for treat- 
ing cases of ulcer of the stomach. Leube and Penzold-t 
have devised dietaries for these cases ; these have been 
given elsewhere (see p. 25i). The first dietary should 
be followed for ten days; the second, for the succeeding 
ten days; the third, for about eight days. The severity 
of the condition in each case must, of course, determine 
the length of time during which each dietary must be 
continued. In all instances milk seems to be the most 
useful form of food during the first weeks of this rest 
treatment. Occasionally milk does not agree, and sub- 
stitutes must be given in its stead. Of these, buttermilk, 
kefir, matzoon, and kumiss or yoghurt are especially to 
be recommended. 
In order to increase the food-value of milk, cream may 
be added, and the following calculation of Strauss may 
be utilized in order to estimate this increased value: 
Calories. 
A. loo gm. full milk 70 
B. 75 gm. full milk with 25 gm. cream 115 
C. 50 gm. full milk with 50 gm. cream 185 
D. 25 gm. full milk with 75 gm. cream 205 
E. 180 gm. cream 250 
There are, therefore, of each (milk, milk and cream, and cream) in the 
half liter: 
Calories. 
A • 35° 
B 575 
c 925 
D 1025 
E 1250 
Lenhartz recently cautions against the strict abstinence 
diet in the treatment of ulcer of the stomach, even in 270 
DIETETICS FOR NURSES. 
those instances in which there is hemorrhage. He bases 
his conclusions on the fact that since ulcer of the stomach 
is most frequently accompanied by superacidity and also 
by an enfeebled condition, it is best to give protein food 
early to overcome the acidity as well as to build up the 
system. The accompanying table illustrates his method 
of feeding: 
Day after last 
hematemesis .1234567 8 9 10 11 12 13 14 
Eggs 23456 7 8 8 8 8 8 8 8 8 
Sugar, gm. ... 20 20 30 30 40 40 50 50 50 50 50 50 
Milk, c.c. . . . 200 300 400 500 600 700 800 900 1000 1000 1000 1000 1000 1000 
Raw scraped 
beef, gm. . . 352X352X352X352X352X352X352X352X35 
Milk cooked 
with rice, c.c. 100 xoo 200 200 300 300 300 300 
Zwieback, gm. . 20 40 40 60 60 80 xoo 
Ham (raw), gm. 50 50 50 50 50 
Butter, gm. . . 20 40 40 40 40 
Calories . . . .280420637779955x135 1588 1721 2138 2478 2941 2941 3007 3073 
In the Lenhartz cure, absolute rest in bed for at least 
four weeks is maintained. An ice-bag is placed on the 
abdomen, and left on more or less continually for two 
weeks. On the first day, even though there be hemat- 
emesis, 200 c.c. of iced milk are given in teaspoonful 
doses together with two raw, ice-cold, beaten up eggs. 
The eggs are beaten up with sugar, and they are kept 
cold by placing the cup containing them in a dish filled 
with ice. The milk is increased every day 100 grams, 
and one additional egg added; on the ninth day the 
patient is given I liter of milk, and the quantity is not 
increased; on the sixth day raw scraped beef is added, 
and the quantity is doubled on the following day; on 
the seventh and eighth days the patient is given some 
well-cooked rice and zwieback (softened), and on the 
tenth, raw ham and butter. 
The following table, arranged by us, has been found 
exceedingly serviceable in treating cases of ulcer, ac- 
cording to the Lenhartz method. DIET IN DISEASES OF THE STOMACH. 
271 
During the first and second days of treatment, instead 
of giving the food at two-hour intervals it is given very 
frequently in teaspoonful doses, and ice cold. In fol- 
lowing these diet tables, it is only necessary to remember 
that for practical purposes 
4 drams of milk sugar are about one tablespoonful. 
i ounce of raw beef is about one tablespoonful. 
5 drams of zwieback are about two slices. 
5 drams of butter are about one tablespoonful. 
LENHARTZ's DIET, AS MODIFIED BY US FOR AMERICAN 
PATIENTS. 
First Day. 
8 a.m.: Iced milk, 3 oz. 
10 a. m.: Iced egg, 1. 
12M.: Milk, 2 oz. 
4 P.M.: Egg, 1. 
6 p. M.: Milk, 2 oz. 
Total: Egg, 2. 
Milk, 7 oz. 
Calories, 280. 
Second Day. 
8 a.m.: Milk, 3 oz. 
10 A. M.: Egg, 1. 
12 M.: Milk, 4 oz. 
2 p. m. : Egg, 1. 
4 p. m.: Milk, 3 oz. 
6 p.m.: Egg, 1. 
Total: Eggs, 3. 
Milk, 10 oz. 
Calories, 420. 
6 A. M.: Milk, 3 dr. 
Milk sugar, 1 dr. 
8 a.m.: Egg, 1. 
10 A. m. : Milk, 3 oz. 
Milk sugar, 1 dr. 
12 m.: Egg, 1. 
2 p. m. : Milk, 4 oz. 
Milk sugar, 2 dr. 
Third Day. 
4 P- m.: Egg, 1. 
6 p.m.: Milk, 3 oz. 
Milk sugar, 1 dr. 
8 p.m.: Egg, 1. 
Total: Eggs, 4. 
Milk, 10 oz. 
Milk sugar, 5 dr. 
Calories, 637. 
Fourth Day. 
6 a. m. : Milk, 4 oz. 
Milk sugar, 2 dr. 
8 a.m.: Egg, 1. 
10 a. m. : Milk, 4 oz. 
Milk sugar 2 dr. 
12 m.: Egg, 1. 
2 P.M.: Milk, 5 oz. 
Milk sugar, 2 dr- 
4 p. m.: Egg, i. 
6 p. m. : Milk, 4 oz. 
Milk sugar, 2 dr. 
8 p. m. : Egg, 1. 
Total: Eggs, 5. 
Milk, 17 oz. 
Milk sugar, 1 oz. 
Calories, 777. 272 
DIETETICS FOR NURSES. 
Fifth Day. 
6 A. m. : Milk, 5 oz. 
Milk sugar, 2 dr. 
8 A. M.: Eggs, 2. 
10 a. m. : Milk, 5 oz. 
Milk sugar, 2 dr. 
12 M.: Eggs, 2. 
2 P.M.: Milk, 5 oz. 
Milk sugar, 2 dr. 
4 p. m.: Egg, 1. 
6 p. m. : Milk, 5 oz. 
Milk sugar, 2 dr. 
8 p. m. : Egg, 1. 
Total: Eggs, 6. 
Milk, 10 oz. 
Milk sugar, 1 oz. 
Calories, 955. 
Sixth Day. 
6 a.m.: Milk, 5 oz. 
Milk sugar, 3 dr. 
8 a. m. : Eggs, 2. 
10 A. m. : Milk, 6 oz. 
Milk sugar, 2 dr. 
12 m. : Eggs, 2. 
2 p. M.: Milk, 6 oz. 
Milk sugar, 3 dr. 
Raw beef, 1 oz. 
4 p. m. : Eggs, 2. 
6 p. m. : Milk, 6 oz. 
Milk sugar, 2 dr. 
8 p.m.: Egg, 1. 
Total: Eggs, 7. 
Raw Beef, 1 oz. 
Milk, 23 oz. 
Milk sugar, 10 dr. 
Calories, 1135. 
Seventh Day. 
6 a.m.: Milk, 6 oz. 
Milk sugar, 3 dr. 
8 A. m. : Eggs, 2 raw. 
10 A. m. : Milk, 7 oz. 
Milk sugar, 3 dr. 
Milk rice, 3 oz. 
12 m.: Eggs, 2 (soft boiled). 
2 P.M.: Milk, 6 oz. 
Milk sugar, 4 dr. 
Raw beef, 2 oz. 
4 P.M.: Eggs, 2 (raw). 
6 P. m. : Milk, 7 oz. 
Milk sugar, 3 dr. 
8 p.m.: Eggs, 2 (soft boiled). 
Total: Eggs, 8. 
Milk, 27 oz. 
Milk sugar, 13 dr. 
Milk rice, 3 oz. 
Raw beef, 2 oz. 
Calories, 1585. 
Eighth Day. 
6 a. m. : Milk, 7 oz. 
Milk sugar, 3 dr. 
8 A. M.: Eggs, 2 (raw). 
10 A. M.: Milk, 7 oz. 
Milk sugar, 3 dr. 
Milk rice, 3 oz. 
12 m. : Eggs, 2 (soft boiled). 
2 p. m. : Milk, 8 oz. 
Milk sugar, 3 dr. 
Raw beef, 2 oz. 
Zwieback, 5 dr. 
4 P.M.: Eggs, 2 (raw). 
6 p. M.: Milk, 8 oz. 
Milk sugar, 4 dr. 
8 p.m.: Eggs, 2 (soft boiled) 
Total: Eggs, 8. 
Milk, 30 oz. 
Milk sugar, 13 dr. 
Milk rice, 3 oz. 
Raw beef, 2 oz. 
Zwieback, 5 dr. 
Calories, 1721. DIET IN DISEASES OF THE STOMACH. 
273 
Ninth Day. 
6 A. m. : Milk, 6 oz. 
Milk sugar, 3 dr. 
8 a.m.: Eggs, 2. 
10 a. m. : Milk, 6 oz. 
Milk sugar, 3 dr. 
Milk rice, 4 oz. 
12 M.: Eggs, 2. 
2 P.M.: Milk, 7 oz. 
Milk sugar, 3 dr. 
Raw beef, 2 oz. 
Zwieback, 10 dr. 
4 P.M.: Eggs, 2. 
6 p.m.: Milk, 7 oz. 
Milk sugar, 4 dr. 
Milk rice, 3 oz. 
8 p. m. : Eggs, 2. 
10 p. m. : Milk, 7 oz. 
Total: Eggs, 8. 
Milk, 33 oz. 
Milk sugar, 13 dr 
Milk rice, 7 oz. 
Raw beef, 2 oz. 
Zwieback, 10 dr. 
Calories, 2138. 
Tenth Day. 
6 A. m. : Milk, 6 oz. 
Milk sugar, 3 dr. 
Raw beef, 2 oz. 
8 a.m.: Eggs, 2. 
Butter | dr. 
10 A. m. : Milk, 6 oz. 
Milk sugar, 3 dr. 
Milk rice, 4 oz. 
Butter, 1 dr. 
12 m. : Eggs, 2. 
Butter, | dr. 
2 p. m. : Milk, 7 oz. 
Milk sugar, 3 dr. 
Raw beef, 2 oz. 
Zwieback, 12 dr. 
Butter, 1 dr. • 
4 p. m. : Eggs, 2. 
Butter, | dr. 
6 p. M.: Milk, 7 oz. 
Milk sugar, 4 dr. 
Milk rice, 3 oz. 
Butter, 1 dr. 
8 p.m.: Eggs, 2. 
Butter, | dr. 
10 p. m. : Milk, 7 oz. 
Total: Eggs, 8. 
Milk, 33 oz. 
Milk sugar, 13 dr. 
Milk rice, 7 oz. 
Raw beef, 4 oz. 
Zwieback, 12 dr. 
Butter, 5 dr. 
Calories, 2478. 
Eleventh Dav. 
6 A. M.: Milk, 6 oz. 
Milk sugar, 3 dr. 
Raw beef, 2 oz. 
Zwieback, 1 oz. 
Butter, 5 dr. 
8 a.m.: Eggs, 2. 
ioa. m.: Milk, 6 oz. 
Milk sugar, 3 dr. 
Milk rice, 5 oz. 
12 m. : Eggs, 2. 
2 P.M.: Milk, 7 oz. 
Milk sugar, 3 dr. 
Raw beef, 2 oz. 
Zwieback, 1 oz. 
Butter, 5 dr. 
4 P.M.: Eggs, 2. 
6 p.m.: Milk, 7 oz. 
Milk rice, 5 oz. 
Milk sugar, 4 dr. 
8 p. m. : Eggs, 2. 
10 p. m. : Milk, 8 oz. 
Total: Eggs, 8. 
Milk, 34 oz. 
Milk sugar, 13 dr. 
Milk rice, 10 oz. 
Zwieback, 2 oz. 
Raw beef, 4 oz. 
Butter, 10 dr. 
Calories, 2491. 274 
DIETETICS FOR NURSES. 
Twelfth Day. 
6 A. m. : Milk, 6 oz. 
Milk sugar, 3 dr. 
Raw beef, 2 oz. 
Zwieback, 1 oz. 
Butter, 5 dr. 
8 a.m.: Eggs, 2. 
10 a. M.: Milk, 6 oz. 
Milk rice, 5 oz. 
Milk sugar, 3 dr. 
12 m. : Eggs, 2. 
2 p. m. : Milk, 7 oz. 
Milk sugar, 3 dr. 
Raw beef, 2 oz. 
Zwieback, 1 oz. 
Butter, 5 dr. 
4 p. M.: Eggs, 2. 
6 p. M.: Milk, 7 oz. 
Milk sugar, 4 dr. 
Milk rice, 5 oz. 
8 p.m.: Eggs, 2. 
10 P. m. : Milk, 8 oz. 
Total: Eggs, 8. 
Milk, 34 oz. 
Milk sugar, 13 dr. 
Milk rice, 10 oz. 
Zwieback, 2 oz. 
Butter, 10 dr. 
Raw beef, 4 oz. 
Calories, 2491. 
Thirteenth Day. 
6 a. m. : Milk, 6 oz. 
Milk sugar, 3 dr. 
Raw beef, 2 oz. 
Zwieback, 1 j oz. 
Butter, 6 dr. 
8 a. m. : Eggs, 2. 
10 A. M.: Milk, 6 oz. 
Milk sugar, 3 dr. 
Milk rice, 5 oz. 
12 m.: Eggs, 2. 
2 p. m. : Milk, 7 oz. 
Milk sugar, 3 dr. 
Raw beef, 2 oz. 
Zwieback, i| oz. 
Butter, 6 dr. 
4 p. m. : Eggs, 2. 
6 p.m.: Milk, 7 oz. 
Milk sugar, 4 dr. 
Milk rice, 5 oz. 
8 p.m.: Eggs, 2. 
10 p. m. : Milk, 8 oz. 
Total: Eggs, 8. 
Milk rice, 10 oz. 
Milk, 34 oz. 
Zwieback, 3 oz. 
Milk sugar, 13 dr. 
Raw beef, 4 oz. 
Butter, 12 dr. 
Calories, 3007. 
6 a.m.: Milk, 6 oz. 
Milk sugar, 3 dr. 
Raw beef, 2 oz. 
Zwieback, 2 oz. 
Butter, 6 dr. 
8 a. m. : Eggs, 2. 
10 A. M.: Milk, 6 oz. 
Milk sugar, 3 dr. 
Milk rice, 5 oz. 
12 m. : Eggs, 2. 
2 p. m. : Milk, 7 oz. 
Milk sugar, 3 dr. 
Raw beef, 2 oz. 
Zwieback, 2 oz. 
Butter, 6 dr. 
Fourteenth Day. 
4 p. m. : Eggs, 2. 
6 p.m.: Milk, 7 oz. 
Milk sugar, 4 dr. 
Milk rice, 5 oz. 
8 p.m.: Eggs, 2. 
10 p. m. : Milk, 8 oz. 
Total: Zwieback, 4 oz. 
Butter, 12 dr. 
Milk rice, 10 oz. 
Eggs, 8. 
Milk, 34 oz. 
Milk sugar, 13 dr. 
Raw beef, 4 oz. 
Calories, 3073. DIET IN DISEASES OF THE STOMACH. 
275 
SIPPY DIET. 
Only recently Sippy has evolved a method of treating 
peptic ulcer which seems likely to replace all other meth- 
ods of treatment. The treatment consists in protecting 
the ulcer from the acid corrosion until it has healed by 
shielding it from the corrosive effect of the gastric secre- 
tion. 
He accomplishes this by maintaining a neutralization 
of all free HC1 from early in the morning until late at 
night. This is effected by frequent feedings and the use 
of alkalis given frequently. The patient remains in bed 
for three to four weeks. Three ounces of a mixture of 
equal parts of milk and cream are given every hour from 
7 A. M. to 7 p. M. After two or three days soft eggs and 
well-cooked cereals are gradually added until in ten days 
the patient receives 3 ounces of milk and cream mixture 
every hour, 3 soft-boiled eggs and 9 ounces of a cereal 
each day. Cream soups of various kinds, vegetable 
purees, and other soft foods may be substituted now and 
then as desired. Powders of magnesia and soda and 
bismuth and soda are given between the feedings to 
neutralize the acid secretion. 
The following diet list presents our method of feed- 
ing during the Sippy cure. Either sodium bicarbonate 
with calcined magnesium or sodium bicarbonate with 
calcium carbonate are given alternately on the half 
hours from 7.30 A. M. to 10.30 P. M. 276 
DIETETICS FOR NURSES. 
Hour. 
Days. 
A. M. 
7.00 
8.00 
9.00 
10.00 
11.00 
12.00 
1st to 5th. 
Milk and Cream 
Milk and Cream 
Milk and Cream 
Milk and Cream 
Milk and Cream 
Milk and Cream 
6th. 
Soft Egg, Milk 
and Cream 
Milk and Cream 
Milk and Cream 
Milk and Cream 
Milk and Cream 
Milk and Cream 
7th to 8th. 
Milk and Cream 
Milk and Cream, Soft Egg 
Milk and Cream 
Milk and Cream 
Milk and Cream 
Milk and Cream 
9th to 10th. 
Cereal, Milk and 
Cream 
Milk and Cream 
Milk and Cream 
Milk and Cream 
Milk and Cream 
Milk and Cream 
nth to 14th. 
Soft Egg, Cereal, Milk 
and Cream 
Milk and Cream 
Milk and Cream 
Milk and Cream 
Milk and Cream 
Milk and Cream 
P. M. 
I.OO 
2.00 
3-00 
4.00 
5.00 
6.00 
7.00 
Milk and Cream 
Milk and Cream 
Milk and Cream 
Milk and Cream 
Milk and Cream 
Milk and Cream 
Milk and Cream 
Milk and Cream Cereal, Egg, Milk and Cereal, Egg, 
Cream Cocoa 
Milk and Cream Soft Egg, Milk and Cream Milk and Cream 
Milk and Cream Milk and Cream Milk and Cream 
Milk and Cream Milk and Cream Milk and Cream 
Milk or Cocoa, Cereal, Milk and Cream Milk Toast, Egg 
Soft Egg and Cocoa 
Milk and Cream Milk and Cream Milk and Cream 
Milk and Cream Milk and Cream Milk and Cream 
Milk and Cream each ij ounces. 
Egg, Cocoa, Custard 
Milk and Cream 
Milk and Cream 
Milk and Cream 
Milk Toast, Egg and 
Cocoa 
Milk and Cream 
Milk and Cream 
A. M. 
7.00 
8.00 
9.00 
10.00 
11.00 
12.00 
15 th. 
Egg, Cereal, Milk and Cream Egg, 
Milk and Cream Milk 
Milk and Cream Milk 
Milk and Cream Milk 
Milk and Cream Milk 
Milk and Cream Milk 
16th. 
Cereal, Milk and Cream 
and Cream 
and Cream 
and Cream 
and Cream 
and Cream 
17th to 18th. 19th. 
Soft Egg, Cereal, Cocoa Milk and Cream 
Milk and Cream Milk and Cream 
Milk and Cream Chicken broth 
Milk and Cream Milk and Cream 
Milk and Cream Milk and Cream 
Milk and Cream Milk and Cream DIET IN DISEASES OF THE STOMACH. 
277 
P. M. 
i.oo 2 Eggs, Cocoa, Cream, Milk, Toast, Egg, Minced Chicken, Milk, Milk 
Minced Chicken, Cocoa, Dry 
Toast, Vanilla Ice-cream 
Milk Toast Vanilla Ice-cream 
Toast, Vanilla Ice-cream 
2.00 
Milk and Cream Milk and Cream 
Milk and Cream 
Milk and Cream 
3-°o 
Milk and Cream Milk and Cream 
Milk and Cream 
Milk and Cream 
4.00 
Milk and Cream Milk and Cream 
Milk and Cream 
Milk and Cream 
5-oo 
Milk Toast, Egg, Milk Toast, Egg, Cocoa Milk Toast, Egg, Cocoa 
Cocoa 
Milk Toast, Egg, Cocoa 
6.00 
Milk and Cream Milk and Cream 
Milk and Cream 
Milk and Cream 
7.00 
Milk and Cream Milk and Cream 
Milk 
Milk and Cream 
and Cream each i| ounces. 
Milk and Cream 
A. M. 
20th. 
21 st. 
22d on. 
7.00 
2 Eggs, Cocoa, 1 Slice Dry Toast, Butter 
2 Eggs, 1 Slice Toast, Butter 
Milk and Cream 
8.00 
Milk and Cream 
Milk and Cream 
Milk and Cream 
9.00 
Milk and Cream, Egg 
Milk and Cream, Egg 
Cereal, Milk and Cream, Egg 
10.00 
Milk and Cream 
Milk and Cream 
Milk and Cream 
11.00 
Broth 
Milk and Cream 
Milk and Cream 
12.00 
Milk and Cream 
Milk and Cream 
Milk and Cream 
P. M. 
1.00 
Minced Chicken, 1 Slice Dry Toast, 
Butter, Cocoa, Spinach 
1 Broiled Lamb or Mutton Chop, 
Dry Toast, Cocoa, Butter, As- 
paragus or Baked Potato 
Chop or Minced Chicken, Dry 
Toast, Strained Vegetable or 
Baked Potato, Cocoa, Butter 
2.00 
Milk and Cream 
Milk and Cream 
Milk and Cream 
3-oo 
Broth 
Milk and Cream or Milk and Egg 
Milk and Cream 
4.00 
Milk and Cream 
Milk and Cream 
Milk and Cream 
5-0° 
2 Eggs, Cereal, Milk Toast, Cocoa 
2 Eggs, Cereal, Milk Toast, Cocoa 
Stewed Fruit or Baked Apple, 2 
Eggs, Cereal, Milk Toast, Cocoa 278 
DIETETICS FOR NURSES. 
Hour. 
Days. 
P. M. 20th. 
21 st. 
22d on. 
6.00 Milk and Cream 
Milk and Cream 
Milk and Cream 
7.00 Milk and Cream 
Milk and Cream 
Milk and Cream each ij ounces. 
Milk and Cream 
Modified Sippy diet followed in some cases of peptic ulcer: Milk and Cream equal 
a.m. to 7.00 p. m. nine to twelve days. 
MEDICINES 
A. M. P. M. 
parts 1J ounce every hour from 7.00 
7-00 I.3O 
,. Heavy Calcined Magnesia 
gr. x 
9-3° 3-3° 5-3° 
. Sodium Bicarbonate 
gr. x 
11.30 7.30 9.30 
8.30 12.30 2.30 
' > Calcium Carbonate 
gr. x 
3 1L n on >Sodium Bicarbonate 
8.30 10.30 J 
THREE TO FOUR DAYS FOLLOWING 
gr. xx 
7.00 3.00 
11.00 7.00 
9.00 1.00 and 5.00 
' yMilk and Cream 
. Milk and Egg or Cocoa 
MEDICINES 
.. aa oz. iss 
7-3° 3-3° 
.. Heavy Calcined magnesia 
gr- x 
11.30 7.30 
. Sodium Bicarbonate 
gr. x 
9-3° 1-3° 
,. Calcium Carbonate 
gr. x 
5-3° 
9-30 
A. M. P. M. 
' j>Sodium Bicarbonate 
FOUR TO FIVE DAYS FOLLOWING 
gr. x 
7.00 11.0O 3-00 7.00 
9.00 
1.00 and 5.00 
. Milk and Cream 
.. Oatmeal, Egg, and Cocoa 
. Milk Toast, Egg, and Cocoa 
. aa oz. iss DIET IN DISEASES OF THE STOMACH. 
279 
A. M. 
7-3° 
11-3° 
9-3° 
P. M. 
3-00 
7.30 
1.30 
gr. x 
gr. x 
gr. x 
9-3O-. 
5.30 
TO BE FOLLOWED FOR SOME WEEKS 
gr. x 
7.00 
3.00 7.00 
aa oz. iss 
11.00.. 
Milk and Egg or Cocoa 
9.00 
1.00 5.00 
. Soft Diet without Acids 
7-30 
3.30 
Heavy Calcined Magnesia 
gr. x 
11-30 
7-3° 
gr. x 
9-30 
1-3° 
gr-x 
5'3° > Sodium Bicarbonate 
9-3° J 
As required, additional Sodium Bicarbonate 
gr. x 
gr. x to xx 
MEDICINES 280 
DIETETICS FOR NURSES. 
HEMORRHAGE FROM THE STOMACH. 
As soon as hemorrhage from the stomach occurs the 
patient should be put to bed and not allowed to rise. A 
light ice-bag should be placed over the region of the 
stomach, and no food or drink whatever should be allowed; 
in order to quench the thirst, small quantities of ice may 
be given the patient to suck. Nourishment must be en- 
tirely by the rectum; but even this is usually unneces- 
sary for the first few days. In order to combat the 
weakness following great loss of blood, salt solutions may 
be injected into the rectum, or if the patient is very weak, 
coffee, meat juice, or whisky may be added to the enema. 
In very grave cases salt infusions must be resorted to 
and tranfusions of blood may become necessary. 
In the dietetic treatment of cancer of the stomach 
milk forms the most important article of diet. The 
more easily digestible forms of meat, such as sweet- 
breads, scraped beef, calves' brains, and stewed chicken, 
are permissible. In this disease there is usually a distaste 
for meat, and fish may be substituted for it; of these, 
boiled mackerel, rock, haddock, or trout are to be recom- 
mended. Of the vegetables, mashed potatoes, spinach, 
carrots, peas, beans, cauliflower, if mashed and strained 
so as to rid them of cellulose, are admissible; rice, farina, 
and corn starch with milk are also valuable forms of food. 
Milk with tea, coffee, or cocoa, or wine or whisky may be 
given for the thirst. Fluids should, however, be taken 
in small quantities at a time. In order to supply the 
necessary quantity of fat, butter or Mehring's Vigor 
Chocolate is to be recommended. In these cases it is 
often important to promote the general nutrition by means 
DIET IN CARCINOMA OF THE STOMACH. DIET IN DISEASES OF THE STOMACH. 
281 
of rectal alimentation. In cases of cancer of the stomach 
too abundant a diet should not be insisted upon, as at 
best but little can be gained by this method of treatment. 
When the growth is at or near the cardiac portion of the 
stomach, the diet should be such as will prevent so far 
as possible any irritation of the diseased esophagus and 
stomach. Solids should therefore be avoided. Milk is 
the food that is usually best borne in this condition. 
The authors have found the diet list given below 
useful in many cases of cancer of the stomach: 
Calories, 
8 A. M,: 150 gm. milk with tea 100.0 
50 gm. toast 130.0 
io A. M. : too gm. baked trout 106.0 
too gm. milk or 30 gm. Panopeptone (57-5) . . 67.0 
10 gm. butter 81.0 
50 gm. toast 130.0 
50 gm. sherry 60.0 
I2M.: Bouillon with 5 gm. somatose 16.0 
100 gm. chicken 106.0 
or 100 gm. calves' sweetbreads (90), 
or 100 gm. calves' brains (140), 
or 100 gm. squab (100). 
60 gm. macaroni 212.0 
loo gm. mashed potatoes 127.0 
or 100 gm. spinach (166), 
or 100 gm. asparagus (18). 
25 gm. stale wheat bread 65.0 
4 P. M.: 50gm. toast 130.0 
20 gm. butter 162.0 
40 gm. caviare 52.0 
7 P. M.: 150 gm. milk (loo) with 5 gm. somatose (16) . 116.0 
loo gm. rice cooked in milk 177.0 
50 gm. wheat bread 130.0 
9 P.M.: 30 gm. Panopeptone 57.5 
2024.5 
DIET IN NERVOUS GASTRIC DISORDERS. 
Nervous Vomiting.-This is often overcome merely 
by isolation and change of scene. In severe cases patients 
should be placed in bed; they are best fed on semi-solid 
or liquid food, since the latter is more easily retained 282 
DIETETICS FOR NURSES. 
than solid food. It should be given in very small quan- 
tities; scraped beef, eggs, rice, and toast are especially 
useful. Cracked ice will often afford relief. The most 
indigestible forms of food are frequently well borne when 
the most digestible are speedily vomited. In severe cases 
the patient should be fed for some days exclusively by 
rectal alimentation. 
Diet in Nervous Dyspepsia.-In this condition the 
diet should not be too restricted. Strengthening food, 
without any attempt at a too rigorous diet, should be 
prescribed. In those cases in which milk is well tolerated 
it should be given in large quantities; when it is not well 
borne, buttermilk, kefir, or kumiss may be substituted for 
it. The patient's appetite should be humored, and he 
should be allowed to eat any food he can digest. Alco- 
holic stimulants should be prohibited, or given only in 
very small quantities. In severe cases a well-conducted 
rest cure will produce the best results. 
Diet in Hyperacidity.-By the term "hyperchlor- 
hydria" is meant an increase in the secretion of muriatic 
acid in the stomach. In the treatment of this condition 
the main object is to prevent this increase in acid; this 
is best accomplished by regulation of the diet. All irri- 
tating fluids, such as acids, including organic acids, as 
acetic (vinegar), citric, and tartaric acids, spices or con- 
diments (pepper, mustard, vinegar), should be avoided, 
and the use of all strong alcoholic beverages and of hard 
substances, which are apt to irritate the stomach, such 
as nuts, should be interdicted. Food must be thoroughly 
masticated, and should be taken neither too cold nor 
too hot. The class of foods that seem to be best suited 
are the proteins, since they combine with and, therefore, 
neutralize the excess of acid; for this reason foods con- 
taining an abundance of protein, such as eggs, meat, DIET IN DISEASES OF THE STOMACH. 
283 
and fish, may be given quite freely. The large amount 
of extractives in meat stimulate the flow of gastric 
juice, and, therefore, meat should be allowed only when 
well cooked, so as to remove the extractives. For the 
same reason raw beef and beef-juice should be avoided 
in this condition. Carbohydrates should be administered 
in small quantities and in the most digestible forms. 
Inasmuch as uncooked meats tend to excite the flow 
of the gastric juice, they should not be taken in this 
condition; when meat, however, is well cooked it may 
be prescribed to advantage in conditions of hyper- 
chlorhydria. In addition, cocoa and milk are valuable. 
Farinaceous foods are not well tolerated in this con- 
dition, and must be given either in a very digestible 
form or, best, combined with protein food. Only the 
more digestible vegetables are to be allowed, such as 
mashed potatoes, spinach, asparagus, peas, and carrots, 
strained and eaten in the form of purges. Fats tend to 
lessen the acidity of the gastric secretion, and are, 
therefore, to be recommended; they are best given in 
the form of butter, cream, olive oil, and the like. Of 
the fluids, alkaline mineral waters, such as Apollinaris, 
Vichy, and Seltzer, are especially useful; the carbon 
dioxid contained in these waters produces a sedative 
effect and lessens the secretion of acids. 
In arranging the diet for patients with hyperchlor- 
hydria it has been found best in the author's experience, 
in dealing with patients taking but little nourishment 
to allow them to eat at frequent intervals; if, however, 
large meals are consumed, it is advisable to permit 
only three meals a day, allowing the stomach to rest 
during the intervals. 
The following diet has been used with advantage by 
the authors in cases of hyperchlorhydria: 284 
DIETETICS FOR NURSES. 
Calories. 
8 A. m. : 200 gm. milk flavored with tea 135 
2 soft-boiled eggs 160 
60 gm. toast 154 
40 gm. butter 326 
10 a. m. : 100 gm. milk flavored with tea 67 
12 M.: 100 gm. chicken (or broiled meat of some kind). 106 
100 gm. mashed potatoes. ... 127 
100 gm. spinach 166 
or 100 gm. asparagus (185) 
100 gm. stewed apples 53 
or 100 gm. stewed prunes 44 
60 gm. stale wheat bread 154 
4 P.M.: 150 gm. milk 100 
50 gm. crackers 188 
5 gm. butter 407 
7 P. M.: 100 gm. milk flavored with tea 67 
soft-boiled egg 80 
50 gm. toast 130 
25 gm. butter 203 
2467 CHAPTER XII. 
DIET IN INTESTINAL DISEASES. 
The diet plays quite as important a role in the 
treatment of diseases of the intestine as it does in the 
treatment of gastric disorders. In many intestinal dis- 
turbances, such as acute intestinal catarrh, diarrhea, etc., 
cures often can be effected by diet alone, when without 
this mode of treatment the disease might become in- 
tractable. The diet in intestinal diseases, as in gastric 
disorders, must be such as will produce no annoying 
symptoms. The process of digestion in the intestine is 
exceedingly complicated, and therefore the digestibility 
of foods in this part of the alimentary tract is most diffi- 
cult to determine. 
It has been shown that certain forms of food contain 
very large proportions of protein matter, but that their 
absorbability is so slight that their nutritive value is far 
lower than that of foods containing less protein. Thus, 
while peas contain considerably more protein (7 per cent.) 
than does milk (3.7 per cent.), a much smaller proportion 
of protein is absorbed in the case of the former than in 
that of the latter; on the other hand, the absorbability 
depends greatly on the mode of preparation of the food; 
when vegetables are mashed and then strained, so as to 
rid them of their cellulose envelopes, they are much 
more readily absorbed than when eaten with the cellulose. 
The digestibility of certain foods in the intestine varies 
285 286 
DIETETICS FOR NURSES. 
greatly with different individuals. For this reason exact 
rules can not be formulated in any case, but the diet must 
be varied according to individual peculiarities. Boas has 
expressed his opinion on this subject as follows: 
" i. In a number of intestinal diseases a change of diet 
is unnecessary or may even be harmful. 
" 2. In some cases special dietetic restrictions are di- 
rectly indicated, but these should be as few as possible. 
" 3. In another series of cases an abundant, heavy, not 
easily digestible or absorbable diet is indicated. 
"4. The general aim of our treatment should always 
be to so manage the case before us that digestion of a 
normal diet will always occur in the alimentary canal 
without any subjective or objective disturbances. Under 
these circumstances only can the case be considered 
cured." 
According to their effect on intestinal movements, foods 
may be divided into three classes: those producing con- 
stipation ; those producing a laxative effect, and those 
exerting no especial effect in either direction. In the first 
class are those foods containing an astringent, such as 
tannin; among these may be mentioned certain red 
wines, cocoa, and tea. Rice, tapioca, barley, sago, maca- 
roni, and potatoes have a tendency to produce constipa- 
tion in many individuals. Among the laxative foods may 
be mentioned fruits and certain vegetables, as cucumbers, 
tomatoes, and cabbage; cider, buttermilk, beer, and the 
carbonated waters also exert a laxative effect. 
In the third class, foods that have no especial effect 
on the intestinal movements, may be placed meats, fish, 
eggs, toasted bread, and zwieback. It must be remem- 
bered, however, that certain foods that prove laxative in 
one individual may be constipating in another, so that no DIET IN INTESTINAL DISEASES. 
287 
precise rules can be formulated; in each case individual 
tendencies must be consulted. 
In severe forms of intestinal disturbances rectal ali- 
mentation must often be resorted to. For a further 
consideration of the technic and forms of food to be 
utilized in this method of feeding the reader is referred 
to the section on Rectal Feeding. In those cases in 
which food can not be given either by the mouth or by 
the rectum, subcutaneous feeding becomes necessary; 
for this purpose olive oil may be used; one ounce may 
be injected twice daily under the skin, best in the region 
of the thigh; in some cases normal salt infusions are 
indicated. 
From experimental evidence the conclusion has been 
reached that it is possible to so vary the diet as to 
prevent certain undesirable bacterial flora from multi- 
plying to a great degree. On this account when un- 
desirable bacteria propagate on both protein and on 
carbohydrate diet frequent changes in diet are bene- 
ficial by interfering with the too rapid growth of any 
one type of bacteria. It has been noted that milk owes 
its beneficial action to the lactose present. When lactose 
is taken in liberal quantities together with other food 
the flora shows evidence of change. Milk and lactose 
form a most practical and effective diet, therefore, in 
reducing putrefying types of bacteria. 
It is now known that the Bacillus acidophilus is the 
predominant bacterial constituent of the intestinal flora 
of the breast-fed infant. However, as soon as the milk 
no longer forms the chief constituent of the child's 
diet, this organism is found present only to a small 
degree. In the adult the nature of the intestinal flora 
is dependent upon the character of the diet. With the 
normal diet the colon bacillus overpowers the acidophilus 288 
DIETETICS FOR NURSES. 
bacillus, so that it can then only be found with great 
difficulty. When placed upon an exclusive milk diet, 
however, the Bacillus acidophilus becomes the pre- 
dominating organism in the intestine. Rettger and his 
co-workers have demonstrated that this organism may be 
implanted in the intestine whereupon the number of colon 
organisms decrease to a marked degree. This effect is 
increased by the ingestion of lactose. Extremely bene- 
ficial results have been obtained by the implantation of 
the Bacillus acidophilus in the intestine in certain in- 
testinal affections. 
Antiputrefactive Diet.-The most important food 
containing protein and yet acting in an antiseptic way is 
milk. It has both a high nutritive value, is easily as- 
similated, and yields a very small amount of products 
of decomposition. If it produces indigestion, as it does in 
some instances, this effect can be overcome by the addi- 
tion of rice, oatmeal, milk of magnesia, or citrate of soda. 
When milk is badly borne, one finds usually that it 
ferments too rapidly, and that the intestine is stimulated 
by the products of decomposition. 
In most instances milk is the digestible food for pa- 
tients affected with intestinal disorders. However, when 
it is not well borne in some instances, it should be given 
in small quantities together with other food, such as milk 
soups, mushes, flour-soups, etc. Milk, however, should 
be given with caution in catarrh of the intestines, and 
in certain ulcerations of the large bowel. In some in- 
dividuals kefir or yoghurt must be substituted. Of 
other preparations the artificial products, such as nutrose 
and plasmon, are to be recommended. Gelatin is another 
food which is apt to inhibit the growth of organisms of 
putrefaction in the intestinal canal, and therefore must 
be considered a valuable form of nourishment. DIET IN INTESTINAL DISEASES. 
289 
As the patient improves, other articles of diet may 
gradually be added, but with great caution. Of these, 
the carbohydrate foods should be taken in the form of 
zwieback, crackers, wheat bread (stale). Butter may be 
given in small quantities. Finally cereals may be al- 
lowed, with the addition of milk and cream. Sugar 
should be taken in small quantities; gradually vege- 
tables may be added, but should be mashed and 
strained. 
When eggs are given, they should be taken with 
caution, inasmuch as patients affected with intestinal 
diseases at times tolerate eggs badly. Still later on 
small quantities of broiled minced meats may be added. 
The coarse shreds of connective tissue found in meats 
should be extracted. Stewed fruits are permissible, the 
skins and seeds being first removed. 
Antifermentative Diet.-By antifermentative diet 
we especially refer to those forms of carbohydrate food 
which are least apt to cause fermentation, especially 
diarrhea. In the treatment of such cases in which car- 
bohydrate fermentation exists the quantity of carbohy- 
drate food administered should be reduced in quantity 
or this article of diet entirely eliminated, and fat and 
proteins substituted, until the carbohydrate fermentation 
has disappeared. 
The protein food is apt to undergo putrefaction, and 
the carbohydrates, fermentation. Therefore when there 
is a tendency both to putrefaction and fermentation the 
diet should consist at first of clear broths, with dry 
bread or crackers. Then cereals may be added, together 
with milk. Finally, when this diet is well borne, the 
more solid foods, in the form of chicken, broiled meats, 
and butter, may be allowed. Milk should be taken with 
caution when fermentation exists. 290 
DIETETICS FOR NURSES. 
The management of the diet in intestinal disorders is 
often difficult. It requires great experience and judg- 
ment to determine what particular foods should be given 
the patient and also to know how long they should be 
continued. It frequently requires great tact and patience 
on the part of the nurse to see that the directions of the 
physician are carried out. 
DIET IN INTESTINAL DYSPEPSIA. 
In intestinal dyspepsia food should be given frequently 
and in very small quantities. At first only the liquid 
forms should be used, such as weak tea, peptonized milk, 
malted milk, bouillon, and egg albumin; after a few 
days the patient may gradually be placed on the follow- 
ing diet: calves' brains, sweetbreads, broiled steak or 
lamb chops, soft-boiled eggs, boiled fish, such as mackerel 
or rock; baked potatoes, spinach, asparagus, and stewed 
fruits. 
The following list gives the general plan of a diet used 
by the authors in this condition: 
Calories. 
8 A. M.: 150 gm. milk with tea 101 
1 soft-boiled egg 80 
60 gm. toasted wheat bread (155) with 20 gm. butter 
(163) 218 
io A. M. : Scraped-beef sandwich ■[ ^m' scraPed beef ("|) 1 296 
r I 50 gm. wheat bread (178)/ 7 
12 M.: Bouillon with 5 gm. Armour's Soluble Beef 10 
100 gm. broiled chicken 106 
or loo gm. broiled steak (209), 
or 100 gm. lamb chop (220). 
50 gm. mashed potatoes or 100 gm. spinach (166) ... 64 
loo gm. apple sauce 88 
50 gm. wheat bread, stale or as toast 130 
3 P. M.: 200 gm. milk 135 
7 P. M.: 200 gm. milk with rice 253 
1 soft-boiled egg 80 
100 gm. wheat bread and 50 gm. butter 666 
2227 DIET IN INTESTINAL DISEASES. 
291 
DIET IN ACUTE INTESTINAL CATARRH. 
As in acute gastric catarrh, so also in acute intestinal 
catarrh the regulation of the diet is probably the most 
important factor in the treatment of the disease. The 
patient should be kept in bed; after the bowel has been 
thoroughly emptied by a cathartic, liquid foods, such as 
clear broths-at first without and then with eggs-thin 
gruels, light tea, cocoa cooked in water, and egg albu- 
min, should be given exclusively for several days. In 
this condition milk should not, as a rule, be given. 
When there is extreme thirst the carbonated waters may 
be allowed, but only in small quantities. The thirst is 
best relieved by placing bits of crushed ice in the 
patient's mouth. After the pain and discomfort have 
disappeared, toast, crackers, stewed chicken, soft-boiled 
eggs, mashed potatoes, and boiled rice may be added to 
the diet; indigestible foods, such as raw fruits, heavy 
vegetables, and fatty and acid foods, should be avoided 
for a considerable period of time after the catarrh has 
disappeared. 
DIET IN CHRONIC INTESTINAL CATARRH. 
The dietetic treatment in chronic intestinal catarrh 
depends upon the condition of the fecal movements; 
these are, in a measure, an index as to the portion of the 
bowel involved. Cases of chronic intestinal catarrh may 
be divided into those cases associated with chronic con- 
stipation, those associated with chronic diarrhea, and 
those in which diarrhea alternates with constipation. 
Diet in Chronic Intestinal Catarrh Associated 
with Chronic Constipation.-In this condition a 
mixed diet containing, so far as possible, those sub- 
stances that stimulate the intestinal peristalsis should 
be prescribed. Astringents and anything that tends to 292 
DIETETICS FOR NURSES. 
produce constipation, such as cocoa, chocolate, tea, red 
wines, rice, farina, etc., should be avoided. 
The following foods should be prescribed in cases of 
chronic constipation : Graham and rye breads with butter, 
fruit, buttermilk, kefir, cider, beer, fresh vegetables, as 
cabbage; sour krout, and salads. Fats are especially to 
be recommended, and honey is also useful. Salts stimu- 
late the intestinal movements, therefore foods containing 
salts are indicated in this condition; among this class 
may be mentioned herring and caviare. Sugar, espe- 
cially milk sugar, has a marked tendency to increase 
intestinal movements. Water taken cold or on an empty 
stomach will also stimulate intestinal movements. 
Diet in Chronic Intestinal Catarrh Associated 
with Chronic Diarrhea.-When severe symptoms, 
such as intense diarrhea and pain, present themselves 
the patient must be put to bed and kept on a very rig- 
orous diet; the period of rest may be lengthened of 
shortened according to the severity of the disease. In 
moderately severe cases several weeks will usually suffice. 
Nourishment should be taken in small quantities every 
few hours; sufficient must, however, be given to main- 
tain the body weight. All cold drinks or carbonated 
waters, fruits, cabbage, and salads are to be avoided. 
The most suitable foods in this disorder are broths con- 
taining barley, rice, and farina; soft-boiled eggs, sweet- 
breads, stewed chicken, broiled steak, boiled fish, toast, 
crackers, baked potatoes, tea, milk (boiled), and cocoa; 
in many cases port wine is quite useful, as it contains 
tannin, which acts as an astringent to the bowels. In 
this condition milk, even when boiled, is often not well 
borne, and must then be avoided. 
In conditions of chronic intestinal catarrh in which 
diarrhea alternates with constipation, the same plan of DIET IN INTESTINAL DISEASES. 
293 
treatment may be followed as has been described for 
those cases accompanied by constipation or diarrhea; it 
is especially important to treat by diet the more prom- 
inent symptoms, whether it be diarrhea or constipation. 
Mineral waters are frequently utilized in cases of chronic 
intestinal catarrh. For cases accompanied by constipa- 
tion the waters of Marienbad and of Saratoga (Congress 
and Hathorn Springs) are most beneficial. Where diar- 
rhea is the prominent symptom, Carlsbad and Vichy 
are to be recommended. 
DIET IN DYSENTERY. 
The diet in acute dysentery is similar to that pre- 
scribed in acute intestinal catarrh. The patient is put to 
bed and only liquid foods are administered. Of these 
the most suitable are bouillon, broth, egg albumin, and 
tea; gradually, as the condition improves, semi-solids, 
such as milk toast, rice cooked in milk or broth, gruels 
of tapioca, etc., may be prescribed. Solid food should 
be abstained from until a few days after the disorder has 
abated. 
In chronic dysentery the food should be given in 
small quantities at frequent intervals. All coarse, indi- 
gestible food should be avoided. In other respects the 
diet is similar to that already given under Chronic Intes- 
tinal Catarrh. 
DIET IN ULCER OF THE INTESTINE. 
The diet in ulcers of the intestine is the same as that 
for ulcers of the stomach, and the reader is referred for 
the details to the section dealing with that subject. In 
cases accompanied by hemorrhage absolute rest in bed 
must be insisted upon, and rectal alimentation adminis- 
tered if necessary. In any form of ulcer the diet should 294 
DIETETICS FOR NURSES. 
be non-irritating and easily digestible. Among those 
foods that may be given are milk, eggs, rice, farina, sago, 
all forms of broth, especially chicken and mutton broths; 
sweetbreads, stewed chicken, baked potatoes, mashed 
potatoes, tea, cocoa, crackers, and toast. 
DIET IN MALIGNANT GROWTHS OF THE INTESTINE. 
The medical treatment in malignant growths of the 
intestine is only an adjunct to the surgical treatment 
always indicated, and consists solely in treating the 
symptoms as they arise. The diet should be highly 
nutritious and at the same time easily digestible; small 
quantities of food should be given at frequent intervals. 
Milk, broths, soft-boiled eggs, raw scraped beef, sweet- 
breads, baked and mashed potatoes, vegetables, such as 
carrots and peas, that have been finely divided and 
strained, stewed fruits, toast, and crackers are permissible. 
DIET IN ACUTE INTESTINAL OBSTRUCTION. 
The treatment of acute intestinal obstruction, except 
when due to the impaction of a foreign body, when it 
may possibly be passed through the bowel, is purely sur- 
gical. Previous to operation the following dietetic reg- 
ulations should be carried out: The patient should be 
kept in bed, and in the acute attacks all food should be 
withheld. Thirst may be quenched by small bits of ice 
kept in the mouth or a few drops of hot water may be 
given at frequent intervals. If the disease extends over 
a period of several days, rectal alimentation or the admin- 
istration of salt solutions must be resorted to. 
In this condition the diet should chiefly be liquid or 
semi-solid. All indigestible food should be avoided, 
DIET IN CHRONIC INTESTINAL OBSTRUCTION. DIET IN INTESTINAL DISEASES. 
295 
especially those forms that are apt to leave a large 
amount of residue in the bowel. The foods to be 
avoided are salads, heavy vegetables, and fruits. Milk 
broths, eggs, broiled meats, chicken, sweetbreads, boiled 
fish, rice, farina, toast, crackers, and butter are permis- 
sible. In advanced cases rectal feeding must be carried 
out. 
DIET IN APPENDICITIS. 
The dietetic treatment in this disease must be governed 
by the symptoms, for surgical treatment is usually indi- 
cated. The patient should be put to bed and under no 
condition be allowed to rise until recovery is complete. 
During the first days Sahli and Penzoldt recommend that 
all food be withheld ; liquids, such as egg albumin, weak 
tea, thin broth, barley or rice water, or milk diluted with 
lime water, may be given in small quantities when deemed 
necessary. When the acute symptoms have subsided 
this diet can be increased somewhat; the milk may be 
taken undiluted and eggs may be added to the broth. 
When the pain and fever have disappeared entirely, 
gruels made of rice or barley, soft-boiled egg, scraped 
beef, stewed chicken, toast, and crackers may be added 
to the list; still later mashed potatoes and vegetables- 
finely divided and strained-may be allowed, and finally, 
when the patient is well, the usual diet may be resumed. 
Ochsner advises the following plan of treatment in all 
cases of appendicitis in which operation is to be per- 
formed, believing that it reduces the mortality and 
changes the class of cases in which the mortality is 
greatest into another class in which the mortality is very 
small after operation: 
"In every case of acute appendicitis all food by mouth 
and all cathartics are prohibited. In case the patient 296 
DIETETICS FOR NURSES. 
suffers from nausea or vomiting, gastric lavage is at once 
employed. In the milder cases the patient is permitted 
to rinse the mouth with cold water and to drink small 
sips of very hot water at short intervals. In the severer 
cases the patient is permitted to rinse the mouth with 
cold water, but is not permitted to drink either hot or 
cold water for the first few days until the acute attack 
has subsided, when the use of small sips of hot water is 
begun. If the nausea persists, gastric lavage is repeated 
once or twice at intervals of two to four hours, in order 
to remove any substance which had regurgitated into the 
stomach from the small intestine. 
" The patient is supported by nutrient enemata, con* 
sisting of an ounce of one of the concentrated predigested 
liquid foods in the market, dissolved in 3 oz. of warm 
normal salt solution, introduced through a catheter 
which is inserted a distance of 2| to 3 inches. In case 
this gives rise to pain or irritation or nausea, it is inter- 
rupted for twelve to twenty-four hours at a time. In 
cases in which no water is given by mouth, an enema of 
8 oz. of normal salt solution is given four to six times 
a day in addition to the nutrient enemata. In cases 
operated during the acute attack this treatment is con- 
tinued for several days after the operation. 
" After the patient has been free from pain and other- 
wise practically normal for four days he is first given 
from 1 to 4 oz. of weak beef tea, preferably prepared 
from commercial beef extract, every two hours. In a 
few days one of the commercial predigested foods, dis- 
solved in water, is substituted; still later, equal parts of 
milk and lime water; then general liquids, then light 
diet; and finally, after the patient has fully recovered, 
full diet is given." DIET IN INTESTINAL DISEASES. 
297 
DIETETIC TREATMENT OF NERVOUS CONDITIONS OF 
THE INTESTINE. 
This condition resembles nervous dyspepsia. At times 
the most indigestible food is well borne, whereas the 
digestible forms create discomfort; in each case it is 
important that the diet be regulated according to the 
patient's digestive powers. Generally a liberal diet is 
indicated in these cases; in many instances a systematic 
rest cure is needed to bring about relief. 
Flatulence.-This condition is characterized by an 
excessive accumulation of gas in the intestine. In the 
dietetic treatment, therefore, foods that tend to produce 
large quantities of gas, such as beer, cider, carbonated 
waters, fruit, cabbage, rye and Graham breads, and 
potatoes, should be avoided. The disorder is often of 
purely nervous origin, and when this is the case unre- 
stricted diet is to be recommended-one that will tone 
up the patient's system and thus cause the flatulence to 
disappear. 
DIETETIC TREATMENT FOR HEMORRHOIDS. 
Since constipation is often a frequent cause and accom- 
paniment of hemorrhoids, it is important that this condi- 
tion be corrected. As has been pointed out elsewhere, 
proper diet plays an important role in the prevention of 
chronic constipation. Patients afflicted with hemorrhoids 
should eat in moderation, but should avoid all excesses 
of food and drink. An abundance of outdoor exercise, 
consisting of walking and simple gymnastics, should be 
indulged in; violent gymnastics and horseback-riding 
should be avoided. A daily evacuation of the bowels 
should be secured. Patients with hemorrhoids should 
avoid alcoholic beverages, spiced foods, strong coffee 298 
DIETETICS FOR NURSES. 
and tea, cheese, cabbage, and beans. The foods most 
suited to this condition are potatoes, carrots, spinach, 
asparagus, and even salads, since they stimulate intestinal 
peristalsis and thus help to keep the stools soft. Stewed 
and raw fruits, including grapes, oranges, pears, and 
apples, are also beneficial. Water is the best beverage 
in this condition. The waters of Carlsbad, Kissingen, 
and Saratoga are most beneficial; they act best when 
taken at the springs. 
DIETETIC TREATMENT OF DIARRHEA. 
The dietetic treatment of diarrhea must vary accord- 
ing to the type of the disorder. In the nervous variety 
the patient should be instructed to restrain his bowel 
movements except at a certain hour in the morning. 
Under all conditions it is important to exclude from the 
diet all foods that have a tendency to stimulate the 
intestines. Coarse, indigestible foods, especially those 
containing a large percentage of cellulose, must be 
avoided; in this class are especially to be mentioned 
cabbage, pickles, salads, turnips, carrots, all cold drinks, 
carbonated waters, and beverages (including champagne 
and beer). Among the foods to be recommended are 
broths, tea, red wines, farina, rice, and barley gruels. 
Raw milk usually has a laxative effect, but when boiled 
or diluted with lime water or brandy it is constipating, 
although in a certain number of cases it must be entirely 
excluded, as it increases the number of movements. In 
a number of cases of chronic diarrhea milk cures have 
been given with good results. The authors have suc- 
ceeded in relieving cases of chronic diarrhea by sys- 
tematic rest cure. DIET IN INTESTINAL DISEASES. 
299 
DIET IN CHRONIC DIARRHEA. 
The Authors' Diet List for Moderate Cases of Chronic Diarrhea. 
Calories. 
8 A. M.: 200 gm. of cocoa (cooked in water) 45.0 
2 soft-boiled eggs 160.0 
50 gm. toast 130.0 
10 A. M.: 250 gm. broth with 1 egg 80.0 
30 gm. Panopeptone 57.5 
12 M.: 250 gm. broiled chicken 212.0 
30 gm. toast 130.0 
200 gm. mashed potatoes 245.0 
4 P. M.: 50 gm. Panopeptone 57.5 
I soft-boiled egg 80.0 
200 gm. cocoa (cooked in water) 45.0 
50 gm. toast 130.0 
7 P. M.: 100 gm. rice cooked in bouillon 34.0 
200 gm. sweetbread 180.0 
50 gm. wheat bread 130.0 
9 p. m. : too gm. raw scraped beef 118.0 
50 gm. Panopeptone 57.5 
50 gm. toast 130.0 
2021.5 
DIET IN HABITUAL CONSTIPATION. 
In the dietetic treatment of habitual constipation it is 
essential that the food that is ingested should be such as 
will increase the intestinal movements. Those foods 
that leave a large bulk of fecal matter are useful for 
this purpose. Those that leave a small residue are most 
apt to produce chronic constipation. A diet consisting 
principally of eggs and milk with only a small quantity 
of vegetables and water is one that is constipating. 
A glassful of cold water taken before breakfast will 
often regulate the bowels; occasionally, according to 
Penzoldt, a pinch of salt added to the water will increase 
its efficacy; raw or cooked fruit, taken on an empty 
stomach morning or evening, occasionally gives good 
results. It is a well-known fact that the smoking of a 
cigar in the morning will often stimulate intestinal move- 300 
DIETETICS FOR NURSES. 
ments. The patient should recognize the importance of 
having an evacuation of the bowels at the same time 
each day. 
Chronic constipation is a frequent accompaniment of 
dyspeptic disorders, and may be relieved by appropriate 
treatment of the gastric disorder. It should not be for- 
gotten that habitual constipation is frequently induced 
by the persistent use of cathartics, and the use of drugs 
should be avoided as much as possible in the treatment 
of this disorder. Sedentary habits are often the cause 
of constipation, and for this reason proper exercise 
should always be prescribed along with the dietetic 
treatment. The vegetables that are especially useful in 
the treatment of chronic constipation are spinach, peas, 
cauliflower, cabbage, asparagus, salads, onions, celery, 
and tomatoes. The cereals that stimulate the intestinal 
movements are oatmeal and cornmeal. Graham, rye, 
corn, whole wheat, and bran breads are also useful. 
Other foods classed as laxatives are honey, cider, molasses, 
and acid fruits, such as apples, pears, peaches, cherries, 
and oranges. On account of the acids and seeds they 
contain, berries are effective laxatives. Prunes, dates, 
and figs are also to be recommended. 
Habitual constipation is often due to the fact that water 
is taken in insufficient quantities; therefore, in the treat- 
ment of the disorder, an abundance of water must be pre- 
scribed. The foods to be avoided are tea, claret, cocoa, 
chocolate, rice, barley, and farina gruels, and huckle- 
berries. In some cases milk acts as a laxative, whereas 
in others it has the opposite effect. For this reason its 
effect should be tested in every case. Boiled milk usually 
constipates. Buttermilk is preferable to sweet milk as a 
laxative. Most cases of habitual constipation can be re- 
lieved or cured by the dietetic treatment here laid down. DIET IN INTESTINAL DISEASES. 
301 
Boas1 has recently called attention to the fact that in 
a certain class of cases of chronic constipation, excellent 
results are obtained by the rest cure. The patient is 
isolated for fourteen days and is not allowed to leave 
his bed. The nourishment of the patient is regulated 
for each day, and for each meal. No effort is made to 
increase the patient's weight, although great importance 
is attached to giving food regularly. The treatment is 
continued for from four to six weeks. 
It is not within the province of this book to discuss the 
value of massage and electricity; suffice it to say that they 
are reliable adjuvants to the treatment of constipation. 
The authors frequently prescribe the following diet in 
cases of chronic constipation: 
Calories. 
6 A. M.: 40 gm. orange juice 88 
8 A. M.: 300 gm. milk with coffee 192 
2 soft-boiled eggs .160 
150 gm. Graham bread 375 
40 gm. butter 326 
IO A. M. ; 400 gm. cider 280 
12 M.: 200 gm. broth, with 1 egg 84 
100 gm. steak 214 
IOO gm. carrots 41 
100 gm. beans 193 
15° gm. Graham bread 375 
200 gm. stewed apples 106 
4 p. M.; 400 gm. buttermilk 166 
7 P. M.: 100 gm. scraped beef 118 
150 gm. Graham bread 375 
200 gm. stewed prunes 176 
300 gm. cider 210 
9 p. M. : 40 gm. figs (or 400 gm. buttermilk) ... 46 
3525 
Another diet is as follows: 
7 A. m. : i glass of cold water with a pinch of salt. 
8 A. mj Baked apples, prunes, pears, figs, grapes, dates, apricots. 
Scotch oatmeal with much cream and sugar. 
Graham bread with butter or honey. 
Eggs with bacon. 
Coffee with sugar and cream. 
io A. M.: Buttermilk, kefir, kumiss, x glass. 
1 Boas, International Clinics, vol. iii, 14th Series, 1904. 302 
DIETETICS FOR NURSES. 
ip. m. : Soup, shellfish. Boiled fish with drawn butter. 
Meat as desired. 
Vegetables-cauliflower, onions, celery, cabbage, baked po- 
tato. 
Salad-lettuce, tomatoes, beets-with oil and vinegar. 
Graham bread and butter. 
Apple dumpling. 
Beer, cider. 
4 p. M.: Buttermilk and crackers. 
7 p. m. : Toast with jam or butter. 
Sardines, caviar, salt herring. 
Radishes. 
Fruits, nuts, cheese. 
9 p. m. : Glass of cold carbonated water. 
" Carbohydrate-Cellulose" Foods 
ioo Grams, 
Water. 
Protein. 
Fat. 
Carbo- 
hydrate. 
Cellulose. 
Calories. 
Cauliflower . . 
90.89 
2-5 
0-3 
4-5 
9-9i 
30 
Spinach . . . 
88.5 
2-49 
0.58 
4-4 
0-93 
33 
Tomatoes . . . 
94-3 
0.9 
0.4 
3-9 
1.1 
23 
Celery .... 
94-5 
1.1 
0.1 
3-3 
0.9 
19 
Potatoes (raw). 
78.3 
2.2 
0.1 
18.4 
1.0 
85 
Peas (green) 
9-5 
24.6 
1.0 
62.0 
o-5 
365 
Beans (butter) 
58.9 
9-4 
0.6 
29.1 
4-o 
163 
Turnips . . . 
89.6 
i-3 
0.2 
8.1 
8.4 
41 
Parsnips . . . 
83.0 
1.6 
o-5 
13-5 
1.6 
66 
Cabbage . . 
9i-5 
1.6 
o-3 
5-6 
2.0 
32 
Apples (dried) . 
27-9 
1.2 
3-6 
59-7 
5-o 
250 
Pears (dried) . 
29-4 
2.07 
0.8 
58.8 
6.9 
260 
Prunes (dried) . 
29-3 
2.25 
2-75 
62.0 
i-5 
265 
Grapes .... 
78.2 
0.6 
0.8 
16.3 
3-6 
7° 
Strawberries . 
87.6 
1.07 
o-93 
6.76 
2.32 
30 
Figs 
18.8 
4-3 
o-3 
74-2 
7-3 
325 
Dates .... 
15-4 
2.1 
2.8 
78.4 
5-5 
356 
Honey .... 
19.61 
1.2 
0.02 
73-72 
300 
Cane-sugar . . 
2.16 
o-35 
96-23 
400 
Sago 
12.8 
0.8 
86.1 
355 
Tapioca. . . . 
13-3 
0.6 
85-0 
35o 
Macaroni . . . 
13-07 
9-2 
o-3 
76.8 
350 
Walnuts . . . 
4-7 
16.4 
62.9 
7-9 
6.2 
685 
Almonds . . . 
5-4 
24.2 
53-7 
7-2 
6.6 
629 
Oatmeal (Scotcn) 
12.37 
10.41 
5-23 
57-8 
11.2 
300 
Cornmeal . . . 
14-32 
0.4 
85.0 
350 
Zwieback . . . 
1.18 
13-3 
3.18 
82.0 
o-5 
460 
Rye bread . . 
42.2 
6.1 
0.4 
47-36 
i-5 
210 
Graham bread . 
34-o 
9-o 
1.0 
50.0 
4.0 
250 DIET IN INTESTINAL DISEASES. 
303 
The foods in the table on page 302 will be found of 
especial value in constipation. 
DIET IN PERITONITIS. 
Acute Peritonitis.-The diet in acute peritonitis is 
purely of secondary importance and requires considera- 
tion only until operative procedure can be undertaken. 
No food whatever should be given by the mouth; if 
necessary, rectal alimentation should be resorted to. If 
operation is not undertaken and vomiting has ceased, 
fluids may be given in a few days. Foods that may be 
prescribed are milk and lime water, diluted broths, and 
egg albumin with or without brandy or sherry; only 
very small quantities should be taken at a time, but at 
frequent intervals; gradually plain milk, broth, and 
gruels may be added to the list; solid food should not 
be allowed for several weeks. When stimulants are re- 
quired they should be given in the form of whisky, 
brandy, or champagne. 
Chronic Peritonitis.-The diet in chronic peritoni- 
tis should consist of boiled meats, eggs, milk, stale bread, 
toast or crackers, and vegetables, only, however, in the 
form of purees; carbohydrates should be eaten sparingly 
on account of their tendency to ferment. Food should 
be eaten in small quantities at regular but frequent 
intervals. CHAPTER XIII. 
DIET IN DISEASES OF THE LIVER. 
Certain general principles of dietetics apply to all dis- 
eases of the liver. The condition usually called " bilious- 
ness " is a cry of the liver for relief from overwork. The 
administration of calomel or a saline laxative followed by 
a few days of restricted diet is all that is necessary in 
most cases. In general it may be stated that in diseases 
of the liver the food should be easily digested and con- 
sist of a mixture of proteins, carbohydrates, and fats. In 
many cases it is desirable to limit or even to avoid alto- 
gether both fats and carbohydrates. 
Certain articles of diet are known, while others are 
believed, to be injurious in diseased conditions of the 
liver. Overeating is injurious ; first, on account of the 
overwork it necessitates; and secondly, because the 
superfluous food is apt to undergo putrefaction. The re- 
sulting bacterial products are believed to act on the liver 
in much the same manner as does alcohol. The exces- 
sive use of alcohol produces marked changes in the liver 
in certain individuals. 
In all liver diseases alcohol should be avoided unless 
specially indicated as a tonic or stimulant. In any case 
it should be given well diluted. 
Certain foods have been regarded as "stimulating" or 
"irritating" to the liver. Among these are peppers of 
various kinds, spices, mustards, concentrated meat ex- 
304 DIET IN DISEASES OF THE LIVER. 
305 
tracts and meat broths, and the substances formed in 
roasted and baked meats. To be proscribed are peppers, 
radishes, horseradish, onions, watercress, and celery. 
Salt in too large quantities is also to be condemned. 
Strong coffee and tea are harmful, but weak tea seems 
to be well borne in many cases. 
In severe diseases of the liver the diet must usually be 
restricted to milk, diluted or peptonized; gruels, albumin 
water, kumiss, buttermilk, and bland broths, such as 
oyster broth. Orange juice as well as lemonade may 
generally be allowed. 
In the milder diseases and during convalescence the 
diet need not be so rigid, and lean meat, curd, junket, 
bread, toast, zwieback, fresh fruit, or stewed fruit with 
little or no sugar, may be allowed. In the chronic cases 
and lighter forms the following articles may help to make 
up the dietary : Milk, variously diluted and prepared; 
buttermilk, curd, kumiss, custard, junket, eggs, lean 
meat-if beef or mutton, preferably rare-sweetbreads, 
chicken, squab, liver, the soft part of oysters and the 
more digestible forms of fish. Fresh green vegetables 
and green salads without oil are permissible. Small 
quantities of well-baked or boiled mealy potato may be 
allowed once a day, for many persons do not relish a 
meal that does not contain potato in some form. The 
starchy foods should be partaken of somewhat sparingly; 
bread, toast, zwieback, pulled bread, and biscuits (crackers) 
may be permitted. Small quantities of cereal foods may 
be taken; rice, sago, and tapioca, when sufficiently well 
cooked, may be allowed. Fresh fruit is a valuable 
adjunct to the diet. Oranges, grape-fruit, ripe peaches 
or pears, strawberries, ripe plums of the most tender 
varieties, may all be taken. Stewed fruits only slightly 
sweetened and baked apples may be allowed with advan- 306 
DIETETICS FOR NURSES. 
tage. If there is constipation, stewed prunes are useful. 
Lemonade may be taken as a beverage. 
Mineral waters may be drunk freely if dropsy is not 
present, and are best taken on rising and between meals. 
Hot water is a valuable substitute for the mineral waters. 
It is especially useful in allaying thirst when there is 
dropsy. 
The food should be taken slowly, well masticated, 
and never in too large quantities. If necessary, more 
milk may be given, so as to make large amounts of 
other food unnecessary. The patient should lie down 
directly before and after meals. In no case should the 
patient eat immediately after taking active exercise. 
In certain chronic conditions, such as hyperemia, fatty 
degeneration, and chronic hepatitis, exercise is to be 
taken at proper times. 
In summer and in warm climates more vegetables are 
to be allowed and less meat. If putrefactive changes 
take place in the intestine, a diet consisting of white of 
egg and water should be maintained until this condition 
is overcome. When the putrefaction is caused by tor- 
pidity of the liver, it may sometimes be prevented by 
increasing the amount of vegetables and by the use of 
laxatives. 
Diet in Gall-stone Disease.-The meals should 
be taken at regular intervals and not too widely sepa- 
rated. Prolonged fasting should not be permitted. A 
substantial breakfast should be taken when not other- 
wise contra-indicated, and not the simple " continental " 
breakfast of coffee and a roll. A late supper is of value, 
and it may be advisable in some instances to give the 
patient nourishment at night. Fat should be reduced to 
a minimum or avoided entirely, and the starches and 
sugars limited in amount. CHAPTER XIV. 
DIET IN DISEASE OF THE RESPIRATORY 
ORGANS. 
Pleurisy.-Two plans of dietetic treatment may be 
followed. The first is to place the patient on a milk 
diet. The second is to place the patient on a " dry 
diet." This consists of the ordinary diet with the fluids 
limited in amount. No soups, but little tea or coffee, are 
allowed, and but small amounts of water. The milk 
diet is preferred where there is fever or complicating 
heart or kidney disease. 
Empyema (Pus in the Pleural Cavity).-As nourish- 
ing a diet as is possible should be used according to the 
general principles of feeding fever patients. 
Laryngitis.-In chronic disease of the larynx there 
may be great pain on swallowing. All hard and highly 
seasoned foods are to be avoided. Only semi-solid and 
liquid foods should be given. The physician sometimes 
prescribes drugs to allay the irritation in the throat at 
meal time. 
Difficulty in swallowing may sometimes be overcome 
by the following two methods : By allowing the patient 
to lie flat on a lounge with his face over the edge. Food 
is to be sucked through a tube from a vessel placed im- 
mediately below. The second method consists in direct- 
ing the patient to lean forward while eating. 
Asthma.-Certain forms of asthma may be brought 
on by errors in diet leading to attacks of indigestion. 
307 308 
DIETETICS FOR NURSES. 
Patients suffering from this should partake only of easily 
digested food and should lead regular lives. The meals 
should be taken at regular intervals. Dinner should be 
eaten in the middle of the day and the supper should 
be light. Late suppers should not be taken, and eating 
between meals should not be allowed. 
Diet in Chronic Lung Disease.-In all chronic 
diseases of the lungs the diet should be as easy of diges- 
tion and especially a diet which will not cause flatulence, 
as this pushes up the diaphragm and interferes with 
breathing. (See Diet in Diseases of the Heart.) 
Pneumonia.-The diet in pneumonia is of the great- 
est importance. The patient's recovery often depends 
upon the matter of his being well nourished. 
The same general principles of feeding should be fol- 
lowed as are indicated in all acute fevers. During the 
course of the disease the patient should receive an 
abundance of water in addition to the liquid food sup- 
plied. Plain water or any carbonated water that the 
patient may desire should be given. Milk and seltzer 
may be allowed freely. Lemonade or orangeade, or 
water flavored with tamarinds, may serve to lend variety. 
The " Imperial drink " (the recipe for which appears at 
the end of this book) may also be given. 
During the height of the disease milk should form the 
basis of the diet. This may be peptonized or diluted 
with lime water. Albumin water, wine whey, malted 
milk, beef juice, Eskay's food, and similar preparations 
may be employed when milk is not well borne. Predi- 
gested liquid beef preparations may be used both for 
their stimulating effects and as a food. They should 
always be diluted freely with water unless, because of 
vomiting, a concentrated food is indicated. DIET IN DISEASE OF RESPIRATORY ORGANS. 
309 
Food should be given at regular intervals of from two 
to four hours, according to the patient's condition and 
the amount he is able to take at one time. 
Constipation, flatulence, and vomiting are to be avoided 
whenever possible. If they do occur, efforts should at 
once be made to relieve the condition. 
In most cases starches and sugars are best omitted 
from the diet. Fruit may be allowed at any time during 
the disease, and is of special benefit during convales- 
cence. Most grateful during the severe stage are orange 
juice, lemonade, grape-fruit, and grapes. During conva- 
lescence ripe peaches or pears in season may be added 
to the diet. The return to a general diet should be made 
gradually, and no solid food should be allowed until the 
fever has subsided. Then the general dietetic rules for 
convalescents may be followed. 
Alcohol is given only according to the directions of the 
physician. CHAPTER XV. 
DIET IN DISEASES OF THE CIRCULATORY 
SYSTEM. 
DIET IN DISEASES OF THE HEART. 
General Directions for Diet.-The diet for patients 
with heart disease usually requires considerable atten- 
tion. In general there are two stages of heart disease. 
The first is called " the stage of compensation," when 
the heart, although diseased, is still able to pump the 
blood through the body. The second stage, or " stage 
of broken compensation," is when the heart, no longer 
able to cope with its work, is unable to force the blood 
through the vessels as it should and there is a certain 
amount of damming back of the blood. This causes 
numerous unpleasant symptoms, such as edema, diffi- 
culty of breathing, and irritability. 
During the first stage the diet requires comparatively 
little attention beyond the observance of certain general 
rules. When the second stage is approaching the diet 
should be carefully supervised, for the patient may be 
spared much suffering, and often the time of the broken 
compensation postponed. 
The meals should be small; more should never be 
given than the patient can easily digest. If the stomach 
is overloaded the diaphragm is pushed up and displaces 
the heart, and this may occasion palpitation and dyspnea. 
If the meals are too large the residue of any digested 
food in the intestine may undergo fermentation and 
310 DIET IN DISEASES OF CIRCULATORY SYSTEM. 
311 
cause flatulence, with its attendant disagreeable symp' 
toms. 
The meals should be simple and well cooked. Im- 
properly prepared food is a cause of indigestion, and 
may produce flatulence or discomfort. The food chosen 
should be of a kind that is easy of digestion. A suffi- 
ciently long interval should be allowed to elapse between 
meals, and eating between meals should be strictly pro- 
hibited, as even small portions of food taken when 
digestion is in progress may give rise to flatulence in 
these patients. 
The meals should all be of equal size ; while the even- 
ing meal may be a little smaller and lighter than the 
others, and the principal meal should be taken at midday, 
there should, as has been said, be but comparatively 
little difference in their size, and the patient should be 
instructed carefully in this regard. 
The amount of fluid taken should not be too large, 
nor, on the other hand, should it be too small. When 
compensation has been lost, the question as to the 
amount of fluid to be taken becomes of much impor- 
tance. At no time should it be forgotten that fluids dis- 
tend the vessels, raise arterial tension, and increase the 
work of the heart. If the quantity of fluids given be 
too small, elimination is delayed and the irritative effect 
of the retained impurities in the blood proves harmful. 
Fluids should be taken between meals and are best 
sipped slowly. Weak tea and coffee may be allowed 
in small quantities between meals; if they do not cause 
flatulence, however, they may be allowed at meal times, 
but always in great moderation. 
Alcohol is best avoided. If, owing to the general 
weakness of the patient, its use is indicated, it should be 312 
DIETETICS FOR NURSES. 
given in small quantities, and in the form of pure whisky 
or brandy well diluted. Wine and beer are contra- 
indicated. 
In general it may be said that a diet of plainly pre- 
pared food, unencumbered by too many restrictions, is 
best in these cases. 
All highly seasoned food and the condiments in gen- 
eral should be omitted from the diet, as they tend to 
stimulate the appetite of the patient and may cause him 
to take more food than is necessary or desirable. 
Stews and fancy dishes should also be omitted, as 
should the foods usually classed as difficult of digestion, 
such as fried foods and the like. 
Starches, sugars, and fats should, as a rule, be re- 
duced ; this restriction, however, should be enforced 
strictly only when made necessary by complicating 
stomach disorders coming on as compensation rupt- 
ures, when they are apt to cause fermentation and 
flatulence. 
Broadbent dwells on the necessity for giving a diet 
containing about the usual proportion of food constitu- 
ents. Starches and vegetables are useful additions to the 
diet, as they help to keep it from being too largely nitrog- 
enous. If too much protein material is taken it is imper- 
fectly oxidized, and the waste accumulating in the blood 
increases the work of the heart, just as when too much 
food is taken. 
The diet should consist largely of milk and of dishes 
made from this food ; eggs, rare meats, especially mutton 
and beef; poultry, fish, and oysters. Well-baked bread, 
rolls, or biscuits, which are never to be eaten warm, and 
cereals in moderate quantities may be allowed. Well- 
cooked potatoes, spinach, asparagus tips, cauliflower tops, DIET IN DISEASES OF CIRCULATORY SYSTEM. 
313 
and other similar vegetables may be taken, all stalks 
being avoided. 
The diet list should be simple and such as will not 
require complicated directions. 
As compensation becomes impaired, numerous disor- 
ders of digestion occur and require care and attention. 
The patient with heart disease may develop a distaste for 
food, and this will often tax the ingenuity of the physician. 
As blood-stasis sets in, constipation is apt to occur. 
Hypostatic congestion of the liver comes on, causing 
lessened metabolism, and consequently interfering greatly 
with the general nutrition. The stomach and intestine 
are affected and a chronic catarrhal condition of both is 
generally present. 
The quantity of fluid given should now be regulated 
carefully, neither too much nor too little being given. A 
glassful of Vichy half an hour before eating will help to 
prepare the stomach for a meal, and will, as a rule, be 
excreted promptly. Fluid is absolutely necessary for 
metabolic changes, and may be taken in the form of the 
" Imperial drink," elsewhere described, between meals. 
A glassful of hot water flushes out the body, and as it 
is rapidly excreted does not add materially to the amount 
of fluid present. 
In the Oertel treatment of heart disease the fluids 
are allowed only in a very limited degree. If the patient 
is on a milk diet, other fluids besides milk should be 
given in comparatively small quantities. 
If edema is severe the food may be given in as concen- 
trated a form as possible. 
If flatulence is troublesome, fats, starches, and sugars, 
as well as beer, pastry, and stews, are to be avoided. No 
solid food should be taken between meals. Coffee or tea 314 
DIETETICS FOR NURSES. 
taken with the meals may give rise to flatulence. They 
may, however, in some cases be taken during the day, at 
a time when the stomach is empty; they should be 
freshly prepared and should never be strong. Only such 
quantities of food as the patient can digest should be 
allowed, and if necessary digestion may be aided by 
giving essence of pepsin or other digestives. In some 
cases a milk diet may become necessary. 
Sudden dilatation of the heart occurring during or fol- 
lowing any acute disease requires rest and a milk diet. 
Palpitation and dyspnea are often caused by the inges- 
tion of too abundant meals; if persistent the food should 
be given in smaller quantities and at shorter intervals. 
Four or five small instead of three large meals may be 
taken at regular intervals, or a milk diet may be ordered 
for a time. The general management may be such as 
has been suggested for flatulence. Tea, coffee, and 
tobacco should be avoided, and effervescing drinks may 
also be omitted. If there is constipation, stew'ed fruits, 
especially prunes or figs, are useful. 
Gastric disturbances are best met by rest and a milk 
diet for a time, with a gradual return to the ordinary diet 
or a diet such as is advised for cases of gastric catarrh. 
Much relief frequently follows the drinking of a glassful 
of hot water or of Vichy half an hour before a meal. 
As ruptured compensation is accompanied by effusion, 
something must be said with special reference to the re- 
moval of fluids from the body. Here, indeed, feeding is 
a difficult task, for the patient usually has a disgust for 
food. If the patient is very ill, nourishment may be 
administered every three hours. If he is able to be 
about, it will often be well to allow him to take his meals 
with the family at the regular meal time. He may be given DIET IN DISEASES OF CIRCULATORY SYSTEM. 
315 
chicken, tender meats, fish, oysters, and other forms of 
light food. When but little is taken at the regular meal 
time, food may be given between the meals at regular 
periods, time being allowed for. complete digestion to 
take place. Milk, albumin water, egg and milk, soup, or 
beef tea in small quantities are useful for this purpose. 
Broadbent recommends meat or chicken jelly or meat 
extracts for their stimulating effect on the heart. Potted- 
meat sandwiches or meat pulp, prepared as directed for 
tuberculosis patients, may be given. 
Fluids other than milk and soups should be taken in 
as small quantities as possible. " Imperial drink " or hot 
water, as previously suggested, may be given to quench 
the thirst. 
Stimulants are usually needed, but should be given 
only under the supervision of the physician, as there is a 
tendency to take too much to relieve faintness or other 
symptoms. In non-alcoholics, from | to 2 oz. of whisky 
a day may be allowed at the beginning, the amount 
being increased as occasion demands. Stimulating drugs 
have largely superseded the use of alcohol in these cases. 
Aneurism; Dilatation of the Blood-vessels.- 
Special diets are sometimes prescribed for these patients. 
Tuffnel's diet, which restricts the foods to a very small 
quantity and enforces absolute rest, is the best known. 
Whether or not such diets should be used is a matter to 
be decided only by the most expert knowledge. 
Angina Pectoris.-Small easily digested meals are 
to be given according to the general rules for dieting 
heart disease. 
Anemia.-There are a number of different kinds of 
anemia, and the diet depends somewhat upon the form 
present. That following the loss of blood is usually 316 
DIETETICS FOR NURSES. 
rapidly recovered from. In this form infusions of salt 
solution are sometimes given. 
In general it may be stated that anemic persons require 
fresh air and sunshine and good food. Fresh food, milk, 
eggs, meats, green vegetables, and fresh fruits are the 
most important articles of diet. The meals should be 
given at regular intervals and not too widely separated, 
usually about three hours apart. The meals should be 
small. Eating between meals should be absolutely pro- 
hibited, and this may require some watching, as the 
patient frequently has a very capricious appetite, eating 
all sorts of indigestible articles between meals and leaving 
the regular food untouched. The breakfast should be a 
good, nutritious one and consist of meat or eggs in addi- 
tion to other articles of food. Milk is valuable, but 
should not be given to the exclusion of other food. It 
is a good plan to have it taken toward the close of the 
meal, as otherwise the patient may spoil his appetite by 
drinking a glassful of milk at the beginning of the meal. 
Rest before and after meals is desirable. 
High. Blood-pressure.-In this condition diets low 
in nitrogen are usually prescribed. If the heart is in 
good shape, increased amounts of water are usually 
given to aid elimination. CHAPTER XVI. 
DIET IN DISEASES OF THE GENITO-URINARY 
SYSTEM. 
Urine and Food.-The urine bears a direct relation 
to the quality and quantity of food ingested, as well as 
to the quantity of fluid taken and the amount of work 
done by the individual. Many variations occur in the 
urine that are due to food or drink and that are normal. 
When the kidneys are diseased improper food may bring 
on dangerous or even fatal complications. 
One of the first principles of dieting persons with dis- 
eases of the kidneys is to avoid giving them food which 
is irritating to the kidneys. Among these may be men- 
tioned the browned outer surfaces of grills and roasts, 
strong sauces, spices, pastry, very acid foods, strong 
alcoholic drinks, and strong tea and coffee. Green vege- 
tables are to be avoided in acute diseases of the kidneys, 
as well as cranberries and fruits which contain kernels. 
As regards meats in the acute conditions, they are to be 
avoided until ordered by the physician. There is a popu- 
lar idea that the light meats are less injurious than the 
dark ones; this has no foundation. Glands, such as 
liver, sweetbreads, kidneys, and spleen, should be avoided. 
Strong meat broths are also injurious. 
Alcohol is to be avoided in all cases except when 
prescribed by the attending physician. All alcoholic 
beverages are irritating to the diseased kidneys, and if 
317 318 
DIETETICS FOR NURSES. 
anything they are more injurious in the chronic cases 
than in the acute. 
Water may be given freely in all cases where the urine 
is increased with the increase in the amount of water 
taken. It aids in the elimination of waste products. 
When, however, the amount of urine is greatly dimin- 
ished or none at all is passed, the physician should regu- 
late the amount of fluid that is given the patient, as there 
may be danger in giving too much. 
Acute Inflammation of the Kidney; Nephritis. 
-During the first stage of the acute condition in the 
severer cases food is given in very small quantities, a pint 
of milk a day. To relieve the thirst, tablespoonful doses 
of water may be given or pieces of ice may be placed 
in the mouth. In this stage the physician frequently pre- 
scribes some form of alcoholic stimulant. 
In the less severe cases a strict milk diet is followed, 
or, what is generally preferred, IJ quarts of milk is given 
with about | pint of cream. Rice, groats, cornmeal por- 
ridge, crackers, and zwieback may be added if the patient 
has any appetite, and butter, sugar, and grape juice or 
other fruit juices may be given. Plain or carbonated 
waters, the " Imperial drink," weak lemonade, buttermilk, 
and similar drinks may be given. As convalescence 
advances calves'-foot jelly and similar preparations 
are allowable. Light vegetables may be added to the 
diet; spinach is perhaps the best, but cauliflower tops, 
young peas, or young string-beans may be used. In 
acute cases and their convalescence the patient's appe- 
tite is a fairly good guide as to the amount of food to be 
taken. Meat and eggs are to be added to the dietary last 
of all. For a long time after an attack of inflammation DIE T IN DISEASES OF GENITO- URINAR Y S YSTEM. 
319 
of the kidneys the patient should avoid the articles of 
food which are irritating to the kidneys. 
Chronic Inflammation of the Kidneys.-In this 
disease the diet should be very much like that suggested 
for old people. (See Diet for the Aged.) Alcohol is to 
be avoided, as are tea and coffee and all the foods set 
down as irritating to the kidneys. The amount of fluid 
taken should not be excessive. There is a popular idea 
that in this disease the more fluid one takes the better; 
this is not true, and in some cases excessive amounts of 
fluids are distinctly injurious. An occasional drinking- 
day or drinking-week is sometimes allowed, during which 
the patient drinks large quantities of water to flush out 
the system. This is frequently accomplished by an occa- 
sional visit to a watering-place, where the change of 
scene is often of as much value as the waters. Exercise, 
fresh air, freedom from care and worry, suitable occu- 
pation, and pleasant surroundings are all important. 
A change of air to a dry, warm climate is often of great 
benefit. 
The trend of modern medicine is to study the metabo- 
lism of the patient with chronic nephritis and to allow a 
diet which is suited to the case in hand. In former days 
many ill-advised and drastic changes in diet and manner 
of life were advised, often without much real benefit. 
The test-diet used in nephritis cases varies somewhat. 
The actual amount of food eaten should be noted and the 
amounts of protein and nitrogen and salt can be deter- 
mined and the physician forms his judgment from a study 
of the urine excreted by the patient while on the diet. 
The following shows a list used in Janeway's Clinic at 
the Johns Hopkins Hospital: 320 
DIETETICS FOR NURSES. 
For Date 
All food is to be salt-free food from the diet kitchen. 
Salt for each meal will be furnished in weighed amounts. 
All food or fluid not taken must be weighed or measured after meals and 
charted in the spaces below. 
Allow no food or fluid of any kind except at mealtimes. 
Note any mishaps or irregularities that occur in giving the diet or col- 
lecting the specimens. 
Breakfast, 8 A. m. : 
Boiled oatmeal, 100 gm. 
Sugar, i to 2 teaspoonfuls. 
Milk, 30 c.c. 
2 slices bread (30 gm. each). 
Butter, 20 gm. 
Coffee, 160 c.c. 1 
Sugar, 1 teaspoonful poo c.c. 
Milk, 40 c.c. J 
Milk, 200 c.c. 
Water, 200 c.c. 
Dinner, 12 Noon: 
Meat soup, 180 c.c. 
Beefsteak, 100 gm. 
Potato (baked, mashed, boiled) 130 gm 
Green vegetables, as desired. 
2 slices bread (30 gm. each). 
Butter, 20 gm. 
Tea, 180 c.c. 1 
Sugar, 1 teaspoonful poo c.c. 
Milk, 20 c.c. J 
Water, 250 c.c. 
Pudding (tapioca or rice), no c.c. 
Supper, 5 p. M.: 
2 eggs, cooked any style. 
2 slices bread (30 gm. each). 
Butter, 20 gm. 
Tea, 180 c.c. ) 
Sugar, 1 teaspoonful poo c.c. 
Milk, 20 c.c. J 
Fruit (stewed or fresh), 1 portion. 
Water, 300 c.c. 
8 a.m. : No food or fluid is to be given during the night or until 8 o'clock 
the next morning (after voiding), when the regular diet is resumed. 
Patient is to empty bladder at 8 A. m. and at the end of each period, as 
indicated below. The specimens are to be collected for the following 
periods in properly labeled bottles, to be furnished by the Chemical 
Division of the Medical Clinic: 
8 a. m. to 10 a. m.; 10 a. m. to i2 Noon; 12 Noon to 2 p. m.; 2 p. m. to 
4 p. m.; 4 p. m. to 6 p. m.; 6 p. m. to 8 p. m.; 8 p. m. to 8 A. m. 
Specimens are to be left in ward until called for at 8.30 a. m. by at- 
tendant from the Chemical Laboratory. 
NEPHRITIC DIET LIST. DIET IN DISEASES OF GENITO- URINAR Y S YSTEM. 
321 
LOW PROTEIN TEST-DIET FOR RENAL FUNCTION. 
For Date 
All food is to be "Low Protein" food from the diet kitchen. 
Salt for each meal will be furnished in weighed amounts. 
Allow no food or fluid of any kind except at mealtimes. 
Note any mishaps or irregularities that occur in giving the diet or 
collecting the specimens. 
All food or fluid may be taken in any quantity desired, but must be 
weighed or measured and charted in the spaces below: 
Breakfast, 8 a.m.: 
"Hominy Cornstarch." 
Cream. 
Sugar. 
Fruit (state kind). 
Butter. 
Water. 
Dinner, 12 Noon: 
Potato (state whether baked, mashed, 
or boiled). 
Vegetable (state kind). 
Vegetable (state kind). 
Vegetable (state kind). 
Olive oil. 
Vinegar. 
Butter. 
Pudding (state whether cornstarch or 
tapioca). 
Sugar. 
Fruit (state kind). '. 
Water. 
Supper, 5 p. m. : 
Potato (state whether baked, mashed, 
or boiled). 
Vegetable (state kind). 
Vegetable (state kind). 
Vegetable (state kind). 
Olive oil. 
Vinegar. 
Butter. 
Pudding (state whether cornstarch or 
tapioca). 
Sugar. 
Fruit (state kind). 
Water. 
8 a.m.: No food or fluid is to be given during the night or until 8 
o'clock the next morning (after voiding), when the regular diet is re- 
sumed. 322 
DIETETICS FOR NURSES. 
The amount of fluid the patient takes may have to be 
regulated, as may also the amount of salt (sodium chlo- 
rid). (See Salt-free Diet.) The amount of protein taken 
may have to be limited, and diets containing known 
quantities of nitrogen may be ordered. The following is 
a diet used at the Johns Hopkins Hospital: 
LOW PROTEIN DIET. 
BREAKFAST. 
Sherry, 30 c.c. 
Baked apple, stewed prunes, orange. 
"Hominy cornstarch cereal"-two-thirds hominy, one-third corn- 
starch. 
Cream, 15 c.c. 
DINNER. 
Sherry, 30 c.c. 
Potato, baked or mashed. 
String beans, cabbage, carrots, lettuce, onions, tomatoes, cucumber 
pickles. 
Fruit cornstarch pudding, fruit tapioca pudding. 
SUPPER. 
Same as dinner. 
Weigh or measure all food eaten cxeept salt, sugar, and butter, which 
may be used as desired, and need not be weighed. 
NITROGEN CONTENT OF FOODS USED IN LOW PROTEIN 
DIET. 
Articles of Percentage of 
food, nitrogen. 
Cream 0.41 
Cereal: "Hominy Cornstarch" 0.13 
Fruit: Baked apple 0.04 
Orange 0.16 
Stewed prunes 0.14 
Vegetables: Cabbage 0.16 
Carrots 0.10 
Lettuce 24 
Onions 0.17 
Cucumber pickle 0.10 
Baked potato 0.48 
Mashed potato 0.40 
String beans 0.23 
Tomatoes 0.23 
Desserts: Blackberry cornstarch pudding 0.05 
Prune cornstarch pudding 0.07 
Apple tapioca pudding 0.02. 
Peach tapioca pudding 0.06 DIET IN DISEASES OF GENITO-URINAR Y SYSTEM. 
323 
Karell Diet.-Sometimes in cases with marked edema 
this is ordered. It consists of 800 c.c. milk given in 
twenty-four hours as the only food or liquid allowed. 
This is a fifty-year-old diet suggested by a famous 
Russian physician. 
Another point to remember is that many drugs are in- 
jurious to the kidneys, and the taking of indiscriminate 
headache powders and other things without a knowledge 
of what they do or of what they contain is a habit which, 
if for no other reason than protecting the kidneys, is to 
be most highly condemned. 
Movable and Floating Kidney.-This trouble is 
sometimes seen after rapid loss of flesh from any cause. 
A rest or careful feeding to regain the original weight is 
in many cases of great service. 
Calculous Affections.-The tendency to stone for- 
mation, as in the kidney or bladder, and the much-talked- 
of condition usually called the uric acid diathesis, may 
be considered together. 
In many instances, but by no means all, too rich food, 
too large meals, and too little exercise are at the bottom 
of the trouble. 
The following suggestions regarding the diet will be 
found useful: Avoid strong drinks, and all alcohol if 
possible ; much meat, and especially the nuclein-contain- 
ing meats, as thymus, spleen, liver, brain, caviare, etc., 
smoked, pickled and spiced meats, and rich foods in 
general. The fats and sugars as well as the cereals 
should be restricted. The diet should be made up of the 
plainer, well-prepared foods, and so far as possible a 
vegetable diet should be prescribed. Water, especially 
the alkaline mineral waters, may be allowed in abun- 
dance. A sojourn at Carlsbad may be recommended 
for certain obese patients. 324 
DIETETICS FOR NURSES. 
Mineral waters must be used with extreme caution, for 
if too much alkaline water be taken it may increase the 
deposit of certain earthy salts. The physician should 
direct the kind and amount of such waters as are to be 
taken. 
SURGICAL DISEASES OF THE GENITO- 
URINARY TRACT. 
The directions for diet are very simple. All irritating 
foods and drinks should be avoided, as should all indi- 
gestible articles. The diet should consist of plain and 
wholesome food. Where it is possible, skim-milk should 
form the basis of the diet. Too much meat should not 
be taken, and twice-cooked meats and fried and very 
greasy foods avoided so far as possible. Carbohydrates, 
as breadstuffs, cereals, and the non-acid vegetables, may 
be allowed. Care should be taken to avoid all com- 
plicated and highly seasoned foods, all pepper, spices, 
and salad dressing. In a word, everything previously 
mentioned as irritating to the genito-urinary tract should 
be avoided. Acid fruits, asparagus, and tomatoes are 
also to be forbidden. Tea and coffee should be pro- 
hibited or given very weak and well diluted with milk or 
cream. All alcoholic drinks should be forbidden. CHAPTER XVII. 
DIET IN DISEASES OF THE NERVOUS SYSTEM, 
The necessity for the correct management of the diet 
in nervous diseases is becoming appreciated more and 
more every year. As a general rule, it may be stated 
that all functional diseases attended with emaciation are 
greatly benefited, if not entirely relieved, by merely in- 
creasing the patient's weight by such methods as are 
suggested under the heading of Rest Cure. Patients 
with chronic lesions will, as a rule, be made more com- 
fortable if the following two points are borne in mind: 
First, to overcome, so far as possible, emaciation and 
anemia where the nutrition has a tendency to be below 
normal; and secondly, and of no less importance, to 
prevent undue obesity in those so inclined, particularly 
where there is disturbance of locomotion. A patient 
may be condemned to remain in bed or in a chair on 
account of the excessive weight which his inactivity has 
fostered. 
Most patients regard diet as a very unimportant part 
of the treatment; this is especially true of those cases 
that most need careful feeding. The necessity for careful 
dietary should be impressed upon these patients, and a 
faith in its efficacy engendered where the disease is of a 
functional nature. 
The diet suitable in nervous diseases has been the 
325 326 
DIETETICS FOR NURSES. 
subject of many diverse opinions, particularly in the 
minds of the laity. Fish has been vaunted as a " brain 
food," and various fats or cereals have been suggested 
for nervous conditions. At the present time, it may be 
stated, there is no specific " nerve food." The nutrition 
of the nervous system will be good when the patient's 
general nutrition is good, and vice versa. Both in func- 
tional disorders of the nervous system and in the psy- 
choses dependent upon exhaustion the improvement of 
the general condition should be the first care. 
The basis of the diet is usually milk. Care should be 
taken to see that the patient gets sufficient fluid, and 
where no tendency to obesity exists water should be 
taken with each meal, and usually at bedtime and on 
rising. It may also be taken between meals if desired. 
When there is disturbance of digestion, it is a good plan 
to prepare the stomach for the meal by sipping a glassful 
of hot water on rising and an hour or less before each 
meal. The mineral waters may be used when desired; 
the alkaline ones are apt to be of most value. Carbon- 
ated waters should be used with care, lest the flatulence 
they may cause give rise to symptoms the importance of 
which may be greatly exaggerated by the patient. 
A question of great importance is whether or not 
alcohol should be used. As a general rule, it should not 
be allowed. In cases with chronic lesions, where the 
patient has been accustomed to the use of alcohol all his 
life, it may be allowed if not otherwise contra-indicated, 
as in a tendency to cerebral hemorrhage, arteriosclerosis, 
chronic interstitial nephritis, and the like. The use of 
alcohol in the functional disorders is usually contra- 
indicated. Its value as a food and as a stimulant to 
nutrition should not be overlooked, and it may be used DIET IN DISEASES OF THE NERVOUS SYSTEM. 
327 
with great benefit in the psychoses accompanied by ex- 
haustive conditions. 
NEURALGIA. 
Some cases of neuralgia are directly caused by indis- 
cretions in diet; other cases depend on a lowered state 
of nutrition, while still others may be due to plethoric 
states. Neuralgia is also caused by many factors not 
related to the diet of the patient. To decide this ques- 
tion requires great experience and judgment on the part 
of a skilled physician. 
As a general rule, plain, wholesome food should be 
ordered at regular intervals. The patient should not be 
allowed to eat between meals. All rich, complex, and 
highly seasoned foods should be forbidden, as should all 
fried foods, pastry, and anything known to disagree with 
the patient. Care should, however, be taken that the 
diet be not restricted, for the patient's ability to take dif- 
ferent articles is often purely imaginary. True idiosyn- 
crasies for different articles of food are not very common. 
The excessive use of tobacco may be the cause of 
neuralgia. 
INSOMNIA AND DISTURBED SLEEP. 
When not dependent upon other conditions, these are 
apt to be due either to eating at night or to a depressed 
state of the nutrition. For the first there is nothing to 
do but to discontinue the habit of eating at night. There 
are but few persons who reach middle age and can 
eat late at night with impunity, and sooner or later the 
individual learns that he must give up the habit. There 
are some, however, with whom the practice seems to 
agree. 328 
DIETETICS FOR NURSES. 
When the trouble is caused by malnutrition or anemia, 
the general condition of the patient must be treated. 
Good food, regular hours, milk or some light food be- 
tween meals, and on going to bed a cupful of hot milk, 
cocoa, or, if preferred, beef tea, malted milk or similar 
preparation may be ordered. 
In many cases where the nutrition is fairly good one 
of the hot drinks just mentioned taken at bedtime may 
be all that is necessary. This is especially true of the 
insomnia and disturbed sleep that follow the doing of 
mental work at night. The effect is to dilate the abdom- 
inal vessels and to restore the equilibrium of the circu- 
lation. A brisk walk in the open air or five minutes' 
exercise will often accomplish similar results. 
EPILEPSY. 
Epilepsy bears an important relation to diet. There is 
no specific " anti-epilepsy " diet, and there is no form of 
food that can be assigned as a cause of epilepsy; it is, 
however, a fact that where the diet is carefully regulated, 
the number of attacks are usually lessened. This is par- 
ticularly true of children. The principle involved is to 
give only as much food as the patient can easily digest 
and assimilate, and to allow sufficient time to elapse 
between feedings for him to utilize and excrete the end- 
products of what he does assimilate. When this is not 
done, attacks may be provoked by irritating substances in 
the bowel, by the absorption of toxic substances from the 
intestinal tract, or by the accumulation of the products 
of metabolism in the body. In the epileptic colonies no 
especial diet is used, but the amount and the variety of 
food are so regulated as to secure the best results. DIET IN DISEASES OF THE NERVOUS SYSTEM. 
329 
In children a diet composed largely of milk, with the 
addition of cereals and fruit, is most useful. In older 
persons this diet is not feasible except occasionally as a 
temporary measure. For these latter meat should be 
allowed only once a day, unless on account of excessive 
manual labor or because of a weakened condition of nutri- 
tion the patient especially demands it. Milk, cereals, 
bread, vegetables, and fruit should make up the rest of 
the dietary. Each patient should be instructed to take 
only digestible food, to take his meals regularly, and not 
to eat too much. They should also be taught to eat 
slowly and masticate the food well. The avoidance of 
constipation is of primary importance, and this can usually 
be secured by the proper use of fruits and the coarser 
forms of cereals. 
Quiet, open-air life, pleasant occupation of a non- 
strenuous kind, an absence of worry, and agreeable 
forms of recreation are just as important as the diet in 
these cases. 
CHOREA. 
In chorea the diet is often of the greatest importance; 
this is especially true when it occurs in anemic or debili- 
tated children. Rest and an easily assimilable diet are 
the indications. The authors are of the opinion that 
absolute rest in bed, if possible isolated from the remain- 
der of the family and under the care of a trained nurse, 
who should be a stranger, combined with a milk diet or 
a diet composed largely of milk, will give better and more 
lasting results than any other form of treatment. If the 
patient is anemic, beef juice made from fresh beef may be 
used to advantage, as well as raw scraped beef and simi- 
lar foods. 330 
DIETETICS FOR NURSES. 
APOPLEXY. 
Comatose stage.-During the early stage of the 
comatose condition-i. e., for the first day or two-there 
is, as a rule, no necessity for giving the patient any food. 
As the disease is most likely to occur in obese, overfed 
individuals, the abstinence from food is often beneficial. 
The intestinal tract should be flushed out as soon after 
the patient is seen as is practicable. Those about the 
patient should be instructed carefully as to the dangers 
of attempting to feed the patient if he is unable to swal- 
low, for he may, on the one hand, choke, and, on the 
other, he may draw food or drink into his lungs during 
inspiration, and so set up a pneumonia. 
If the patient is in need of nourishment or of fluid, it 
may be given by the rectum. Normal salt solution may 
be given by the rectum to supply the body with fluid, but 
it should not be given in too large quantities. (See Rec- 
tal Feeding.) 
I^ater stages.-As soon as the patient recovers suffi- 
ciently to be able to swallow without danger of inspir- 
ing the food he may be fed by the mouth. The food 
should be liquid or semi-solid, and of a bland, unstim- 
ulating character. The quantity should not be too large. 
Milk, milk and eggs beaten together in the form of a 
milk punch, without, however, the addition of a stimu- 
lant ; broths, soft eggs, and milk thickened with cereals, 
or the purees of vegetables may be used. As the patient 
improves other food may be added, but the diet should 
be light, easily digestible, and as non-stimulating as pos- 
sible. The patient should be warned against overeating 
and also against drinking. Alcohol is allowable only in 
the case of habitues who are threatened with collapse DIET IN DISEASES OF THE NERVOUS SYSTEM. 
331 
unless it is used, or in the same class where food is not 
assimilated without it. It should always be given in 
moderate amounts, and the dosage arranged by the phy- 
sician, and never left to the nurse, the patient or the 
family. 
On account of the lack of exercise the diet should 
contain but little meat, but cereals, vegetables, and fruit 
should be given in small quantities at a time, and as 
evenly distributed throughout the day as possible, to 
avoid overfilling of the vessels. 
The greatest danger, from a dietary standpoint, is in 
those patients who recover sufficiently to return to their 
ordinary modes of living. They should be very care- 
fully instructed neither to drink to excess nor to overeat. 
A full meal and several drinks may be the cause of a 
second or of a fatal attack. 
ALCOHOLISM. 
The mild forms of alcoholism are usually easily man- 
aged. So long as the stomach is irritable it should be 
given absolute rest. If possible, alcohol should be with- 
held entirely. As soon as the stomach will retain fluid 
a saline mineral water or a saline purge should be given. 
Milk or bouillon is next to be prescribed, and as the 
desire for food returns a light diet of soft-boiled eggs, 
milk toast and the like should be allowed. After re- 
covery all rich and highly seasoned food should be 
avoided, particularly the spices and peppers, which are 
commonly used to excess. 
In the severe forms the diet should be that recom- 
mended for chronic gastritis. Some confirmed alcoholics 
can retain nothing in the stomach until they have had their 
morning drink. When nutrition is threatened this may 332 
DIETETICS FOR NURSES. 
be allowed, but it is apt to lead to excesses later in the 
day. 
In the very severe forms, as in delirium tremens 
or in cases approaching it, the patient should take as 
much fluid as possible to flush out the system, and the 
intestinal tract should be thoroughly purged. The food 
should be given in a predigested or in a partially predi- 
gested form and at frequent intervals. In this way the 
craving for drink is somewhat alleviated. Bouillon or beef 
tea to which considerable amounts of black pepper or 
even Cayenne pepper have been added is useful in this 
condition, although their use would be contra-indicated 
for any but an alcohol-saturated person. Rest and sur- 
alimentation as soon as food can be borne constitute the 
best method of managing these cases. Strychnin may be 
used as a stimulant. 
Illness or Injury in Alcoholics.-When a man 
who has been accustomed to taking several glasses of 
spirits every day for years is suddenly stricken ill or 
injured, delirium will often develop if the stimulant is 
rapidly withdrawn. In all such cases the accustomed 
amount of alcohol should be given, care being taken, 
however, to prevent overindulgence. 
In alcoholics affected with pneumonia alcohol is neces- 
sary to sustain life. When delirium occurs in the course 
of pneumonia alcohol should be ordered, although in 
ordinary, uncomplicated cases of delirium tremens due 
to extreme overindulgence it should be withheld. 
REST CURE. 
The technic of the treatment is explained in a most 
interesting way by Mitchell, in his book " Fat and Blood." DIET IN DISEASES OF THE NERVOUS SYSTEM. 
333 
The more nearly perfect the technic and the more closely 
it is adhered to, the more likely is cure to follow. The 
cases are of various grades of severity, and the treat- 
ment is modified to suit the individual. Isolation is 
necessary, and the patient should be removed to a hos- 
pital or a sanitarium, away from familiar scenes. Home 
treatment does not succeed well. If circumstances com- 
pel the patient to remain at home, her room should be 
changed. In severe cases with emotional manifestations 
visiting is forbidden, but it may be allowed to a " certain 
extent when the patient is anemic owing to a distinct 
cause, as overwork, blood-losses, dyspepsia, low fevers, 
or nursing." The nurse should be a stranger to the 
patient. 
Communication with friends and family should, as a 
rule, be cut off entirely, and not even the reading of 
letters should be allowed. After several weeks, if the 
patient is improving, she may be allowed to read the 
newspaper each day. 
Rest is a most important feature, and, as a rule, the 
patient should be put to bed for six weeks or two months. 
In other cases, especially where the patient is not able 
to undergo regular treatment, as in dispensary cases, a 
modified rest cure may be tried. The following is 
Mitchell's schedule for such cases; this may be modified 
according to circumstances: 
" 7.30 a. m. : Cocoa, coffee, hot milk, beef extract, or 
hot water. Bath (temperature stated). Rough rub with 
towel or flesh-brush. Bathing and rubbing may be done 
by attendant. Lie down a few minutes after finishing. 
" 8.30 a. m. : Breakfast in bed. (Detail as to diet. 
Tonic, aperient, malt extract as ordered.) May read 
letters, papers, etc., if eyes are good. 334 
DIETETICS FOR NURSES. 
" I o to 11 A. m. : Massage, if required, is usually ordered 
one hour after breakfast, or Swedish movements are given 
at that time. An hour's rest follows massage. Less 
rest is needed after the movements. (Milk or broth 
after massage.) 
" 12 M.: Rise and dress slowly. If the gymnastics or 
massage are not ordered, may rise earlier. May see 
visitors, attend to household affairs, or walk out. 
" 1.30 p. m. : Luncheon. (Malt, tonic, etc., as ordered.) 
In invalids this should be the chief meal of the day. 
Rest, lying down, not in bed, for an hour after. 
" 3 p. m. : Drive (use street cars or walk) one to two 
and one-half hours. (Milk or soup on return.) 
" 7 p. m. : Supper. (Malt, tonic, etc., as ordered; detail 
of diet.) 
" IO P.M.: Hot milk or other food at bedtime." 
In extreme cases the patient is made to rest absolutely. 
No exertion of any kind is to be allowed. The bed-pan 
is to be used with the patient in the recumbent position. 
She should be removed to a couch for an hour, both 
morning and evening, while the bed is being freshened. 
The patient should be fed, and later, when allowed to 
feed herself, the meat should be cut up for her. A sponge- 
bath should be given daily, but if it causes depression it 
may be given less frequently. After two weeks, if the 
physician thinks it desirable, the patient may be read to 
for one to three hours. The monotony of the treatment 
is not so trying as would be imagined, for the routine of 
the day occupies most of the time. The nurse and mas- 
seuse should not talk about or listen to the patient's ills, 
and the latter should be taught that she must speak of 
them only to the physician. 
Massage and electricity are resorted to in order t<? DIET IN DISEASES OF THE NERVOUS SYSTEM. 
335 
maintain nutrition and circulation while at rest. Mitchell 
gives minute instructions regarding both. General mas- 
sage of the whole body is to be given, care being taken 
not to excite pain by manipulating tender areas. The 
tapping movements, slapping, and the like are not to be 
used in nervous patients. Care should be exercised to 
avoid producing sexual excitement; this may be aroused 
in both sane and insane patients from friction near the 
genitals or over the back or buttocks. If it does occur, 
the operator should avoid the sensitive areas. In the 
average case massage should be given for an hour daily 
for about six weeks, and then on each alternate day. 
The time chosen for this should be about midway be- 
tween meals. Care should be taken to keep the parts 
warmed by the massage well covered. 
The same precautions should be taken in using elec- 
tricity as when giving massage. The induced current 
should be used, and it is well to employ a battery in 
which the breaks are very slow-from two to five 
seconds. The more rapid interruptions are useful, how- 
ever, but in the hands of an unskilled operator may 
excite pain and apprehension in the patient. The poles 
may be placed 4 or 5 in. apart on the muscle, and the 
whole body should be gone over. 
In thin, anemic, exhausted women, who are the ones 
usually treated, the diet is as follows : The patient is put 
to bed and the diet generally changed from the ordinary 
to a milk diet. This is done by giving from 3 to 4 oz. 
of milk every two hours, after the Karell method. Then 
the patient is given 2 quarts of milk in each twenty-four 
hours. The amount is divided and a portion given at 
three-hour intervals. At the end of the first week a 
pound of beef is administered in the form of a raw soup. 336 
DIETETICS FOR NURSES. 
This is given three times a day, a pound of beef being 
used each day. If desired, this may be replaced by pep- 
tonized food. (See formulas in the Appendix.) 
After ten days three meals a day are given. These 
are led up to gradually, and the patient is kept on the 
milk diet until the stomach feels comfortable. Then, 
usually within from four days to a week, a light breakfast 
is allowed, and in a few days more a chop is given at the 
midday meal. After a short time the patient is given 
three full meals, together with 3 or 4 pints of milk instead 
of water, either with or after the meals. 
After about ten days of this treatment, from 2 to 4 oz. 
of good fluid extract of malt are given before each meal. 
" As to meals, I leave them to the patient's caprice, 
unless this is too unreasonable; but I like to give butter 
largely, and have little trouble in having this most whole- 
some of fats taken in large amounts. A cup of cocoa or 
of coffee and milk on waking in the morning is a good 
prescription for the fatigue of the toilet." 
In some of the difficult cases J oz. of cod-liver oil is 
given half an hour after each meal. If it causes nausea 
or interferes with the appetite, it is given as a rectal 
injection. This is of particular service where the bowels 
are sluggish. It may also be given in the form of an 
emulsion with pancreas extract. In some it acts admira- 
bly; in others it may cause tenesmus. 
SCHEDULE FOR A COMPLETE REST CURE. 
Until otherwise ordered, absolute rest in bed. No 
visitors, no reading, and no conversation with nurse on 
the subject of disease or treatment. 
First Day.-One quart of milk in divided doses every 
two hours. 8 a. m. : Cold bath followed by a brisk rub. DIET IN DISEASES OF THE NERVOUS SYSTEM. 
337 
If patient does not react well, a warm bath may be used 
for several days and then the cold bath tried again. 
ii a. m. : Twenty minutes' massage. 2.30 p. m. : Room 
darkened for a nap. 4 p. m. : Twenty minutes' electricity. 
9 p. m. : Brisk rub over the entire body. 
Second Day.-Same as first. Milk ij quarts; massage 
and electricity increased to forty minutes. 
Third Day.-Two quarts of milk in divided doses at 
three-hour intervals; massage and electricity one hour 
each. 
Fourth Day.-Same, with addition of white of a raw 
egg with each glassful of milk; cupful of cocoa on 
awakening. 
Fifth Day.-Same, with addition of raw-beef soup or 
broth, 1 pint in two portions; a slice of toast. 
Ninth Day.-Same, with soft-boiled eggs and toast for 
breakfast. 
Tenth Day.-Cocoa on awakening. 7.30 a. m. : Bath 
and brisk rub. 8.30 a. m.: Breakfast, including cereal, 
chop or eggs, bread and butter, and 2 glassfuls of milk 
with the whites of 2 eggs. 10 to 11 A. m. : Massage. 
11.30 a. m. : Half-pint of milk, whites of 1 or 2 eggs. 
2 p. m. : Full dinner, including 2 glassfuls of milk and 
whites of 2 eggs. 3.30 to 4 p. m.: Electricity. 5 p. m.: 
Glassful of milk with whites of 2 eggs. 7.30 p. m.: 
Supper including milk and eggs. 9.30 p.m.: Brisk rub 
and a glassful of milk. 
Schedule as above until desired effect is obtained. 
This to be modified to suit the individual case. On 
twelfth day 2 ounces of malt extract with a teaspoonful 
of solution of peptonate of iron and manganese is usu- 
ally ordered. Bowels to be kept open. Use butter in 
as large quantities as possible. 338 
DIETETICS FOR NURSES. 
The patient is allowed to undertake movements for 
herself very gradually, being allowed to move about in 
bed by herself and then sit up, and later on to sit out- 
doors and then to walk a few steps, to take a drive, etc. 
If this is not done gradually the moving about may be 
attended by dizziness, vertigo, or unpleasant exhaustion, 
which may be avoided entirely by gradually increasing 
the patient's efforts for herself. 
DIET FOR THE INSANE. 
Feeding constitutes a very important part of the treat- 
ment of the insane. All insane persons who are below 
the standard of nutrition should be built up and an earn- 
est effort made to increase the weight of the patient. One 
of the English alienists was wont to talk of the " gospel of 
fatness." This is best accomplished by a system of feed- 
ing somewhat similar to that outlined in the rest treat- 
ment, the rest being prescribed or omitted as the case 
demands. It should always be remembered that an in- 
sane person may contract other diseases besides his 
mental disorder; this is true especially of stomach and 
intestinal disorders, which may give rise to delusions 
regarding the taking of food. 
When the patient refuses food, the question as to the 
advisability of feeding him by force arises. Everything 
considered, it is well to begin the forced feeding early, 
before the patient has time to suffer from his fasting. It 
should be accomplished by means of the stomach tube 
or the nasal tube, and about a liter (i quart) of food 
should be introduced. The food may be given thus 
twice daily, and in the case of weak patients three or four 
times a day. Milk, milk and eggs, and broths may be 
used for this purpose. A sufficient number of attend- DIET IN DISEASES OF THE NERVOUS SYSTEM. 
339 
ants should be at hand to control the patient if he be- 
comes unruly and resists feeding. After a patient has 
been fed with the tube several times he will often prefer 
to take his nourishment in the usual manner. 
Whether the esophageal or the nasal tube is to be used 
will depend on the preference of the physician. Each 
has its advantages. The nasal tube is generally pre- 
ferred, since it is easier to introduce, can not be bitten by 
the patient, and does not cause the patient to struggle as 
much as the stomach tube; it may, however, be passed 
into the larynx, and in this way liquid might be intro- 
duced into the trachea. This danger is more fancied than 
real, and can be avoided if the patient is allowed to 
breathe before the fluid is poured into the tube. While 
he is breathing the tube should be pinched, and if it is in 
the larynx this fact will be noticed at once. Ordinarily, 
but not always, coughing ensues; it does not follow 
when the pharynx is anesthetic, as it occasionally is in 
the insane or hysteric. The stomach tube does not allow 
the food to be regurgitated so easily as the nasal tube, but 
for this method of feeding a mouth-gag is required, which 
may injure the mouth or teeth, or it may slip, permitting 
the patient to bite the tube. If the patient has acquired 
the knack of regurgitating the food, this may be pre- 
vented by tickling the ribs while the fluid is being intro- 
duced. This prevents the fixing of the diaphragm, and 
is successful in most cases. 
Tact and experience in handling the insane are of the 
greatest value. Some nurses or attendants have little 
difficulty in getting patients to eat, whereas others seem 
never to learn how to manage them. It must be remem- 
bered than an insane patient may not eat for reasons that 
are often easily overcome. He may prefer to take his 340 
DIETETICS FOR NURSES. 
food alone, because he does not think himself worthy of 
eating at the same table with other people. He may fear 
that his food has been poisoned, and he should be con- 
vinced of the fallacy of this by the nurse, who should 
eat a portion before him or allow him to see the food pre- 
pared, or he may be given food that can not easily be 
poisoned, such as eggs, whole vegetables, and fruit. 
When the patient's confidence is gained the battle is gen- 
erally won. In some cases the delusion persists for a 
long time and can not be dispelled. 
Food should always be served daintily. An insane 
person who may be very much unbalanced may still no- 
tice the slightest variations in the way of serving food. 
Attendants are apt to be negligent in this respect. For 
all patients who have a suicidal tendency the food should 
be served on dishes that can not be broken. No knives 
should be allowed, and the food should be served so as 
to require no cutting. An attendant should watch those 
who are apt to bolt their food and see that it is cut into 
small pieces before serving it. Cases of sudden death 
have followed the drawing of a piece of meat into the 
larynx while eating too rapidly. CHAPTER XVIII 
DISEASES IN WHICH DIET IS A PRIMARY 
FACTOR. 
DIABETES MELLITUS. 
In this disease diet is of primary importance and is, 
in fact, the principal part of the treatment. None but a 
skilled physician should ever attempt to regulate the 
feeding of a diabetic patient, since the well being and 
frequently even life itself are directly dependent upon 
the diet. The severity of the disease may be greatly 
lessened by intelligent and conscientious attention to 
feeding; in poorly managed cases the outlook is often 
extremely gloomy. Many complications, causing great 
suffering on the part of the patient, are the direct result 
of errors in diet. 
The nurse in attendance on a diabetic patient should 
understand the principles of the diet to be followed. 
Diabetes is a disease in which the capacity to use sugar 
as food is lessened. A certain definite amount of sugar 
can be utilized; when the patient exceeds this amount 
the sugar taken in is passed off from the body in the 
urine. Not every person who has sugar in the urine is a 
true diabetic. 
The sugar which is passed in the urine has not been 
used as food, and the necessary amount of food must be 
supplied the patient or there will be a loss of weight. 
This loss of weight is due to the fact that the patient's 
own tissues are being burned to supply the necessary 
341 342 
DIETETICS FOR NURSES. 
energy for the life processes. When this occurs a com- 
plication known as acidosis sets in very early. This is 
a condition in which by-products of the destruction of 
tissue or of food materials, particularly fats, produce 
substances which act chemically as acids; these acids 
must be neutralized in order to preserve a neutral re- 
action in the blood and body tissues and so withdraw 
valuable alkalies from the body. It is due to this with- 
drawal of alkalies that the most serious complications, 
most typically coma and early death, result. 
Thus, the general principle to be followed is to keep 
the patient within such a limit of carbohydrate intake 
that sugar shall not appear in the urine, and at the 
same time to supply sufficient food to take care of the 
body needs. 
The nurse should bear in mind several things when 
she is dealing with diabetes. First, is the importance 
of very strict early treatment. She should supplement 
the efforts of the physician to secure the complete co- 
operation of the patient. The success of modern treat- 
ment of diabetes is entirely dependent on the strictness 
with which the dietetic and other regulations are ob- 
served, especially in the early stages of the disease, and 
the loss of the ability to use sugar may be arrested or 
lessened by avoiding any strain on the patient's carbo- 
hydrate tolerance. If the patient is under the care of 
a physician who understands the study of metabolism 
the nurse's notes will be of primary importance. These 
should include a record of the foods taken and actually 
consumed at the several meals, and should be so kept 
that the nurse can figure out the food values of what 
has been taken, so that the physician can see the exact 
amounts of fat, carbohydrate, and protein that have been 
consumed, and can figure out the total caloric value of DISEASES IN WHICH DIET IS A PRIMARY FACTOR. 
343 
the foods, and from the protein the approximate amount 
of nitrogen ingested. The notes should also include 
frequent determinations of the patient's weight. The 
amount of urine passed should be recorded; the total 
amount for each twenty-four hours should be collected 
and at least 4 ounces of the mixed specimen pre- 
served for analysis. Apart from hospitals it is cus- 
tomary to add some preservative so that the urine will 
not spoil, and for this purpose a few drops of chloroform 
are recommended. This chloroform is driven out of the 
urine before testing by heating. The urine is measured 
by starting at 7 o'clock in the morning and saving 
all the urine passed until the following morning. The 
loss of urine passed during stool may be avoided if the 
patient is carefully instructed on this point. Many 
physicians prefer to have the nurse test the urine for 
sugar and for acid bodies, periodically himself checking 
these tests. The technic of these tests is easily learned 
and adds greatly to the nurse's professional equipment. 
Foods served the patient are weighed before, and the 
amount not consumed weighed after the meal; thus the 
exact amount ingested can be determined. It is desir- 
able that the patient learn the details of management 
of diet. Certain patients can learn to judge the weight 
of foods by looking at them, thus enabling them to eat 
at table with other persons without attracting any 
attention to their condition. In severe cases and those 
wherein diet is particularly limited this often proves to 
be a dangerous experiment. For the exact composition 
of foods the nurse should have at hand a table giving 
this information. The tables of W. O. Atwater and A. 
P. Bryant, published as Bulletin No. 28 of the Experi- 
ment Stations of the Department of Agriculture of the 
United States, remains the best source for this informa- DIETETICS FOR NURSES. 
344 
tion and may be obtained from the government at a 
nominal cost. These tables as well as others will be found 
in our larger book, "Diet in Health and Disease." 
The general hygiene of the patient must be pains- 
takingly watched, food should be very well chewed, 
the teeth kept carefully cleansed, and particular care 
should be taken to keep the skin clean and to avoid any 
injuries that would draw blood. Infections are par- 
ticularly prone to occur in these patients and should 
immediately receive the attention of the physician. 
The bowels should move twice a day and under no 
circumstances should the patient be allowed to become 
constipated. Diabetic patients should very carefully 
observe the physician's orders as to rest and exercise. 
The nurse should note the amount of exercise taken and 
the effect upon the patient, and under no circumstances 
should the patient be allowed to become fatigued. 
Severe athletic games are, of course, strictly forbidden. 
The weight should always be taken at the same hour, 
preferably upon arising in the morning. The patient 
should be weighed naked, or, if in clothes, the exact 
weight of the clothes recorded. 
The nurse should see that the necessary foods are kept 
on hand. Fresh eggs should be carefully selected; bacon 
and the 5 per cent, vegetables are important elements 
in most diets. Cream, butter, and olive oil for the day 
can be measured in the morning and then allowed until 
used up. It is important for the nurse to familiarize 
herself with the vegetables containing 5, 10, 15, and 20 
per cent, carbohydrate. These are interchangeable so 
that the patient who is allowed a certain amount of a 
10 per cent, vegetable can replace it with one-half the 
amount of a 20 per cent, vegetable, or twice the amount 
of a 5 per cent, vegetable, and the same rule applies to DISEASES IN WHICH DIET IS A PRIMARY FACTOR. 
345 
the interchange of other carbohydrate foods. This 
allows variety in the diet, which is most important. The 
vegetables should be very thoroughly cleaned; such as 
are suitable for salads may be taken as such, but only 
the tender parts should be used. The other vegetables 
may be used in stews or in soups, or as purees, the latter 
made with butter or cream, and these may be rendered 
appetizing with very little difficulty. Thrice-cooked 
vegetables have been particularly recommended, and as 
many of these are low in carbohydrate content they can 
be rendered practically carbohydrate free. They add 
an element of bulk to the diet and aid in preventing 
constipation. These were suggested by Allen, par- 
ticularly for use in patients who are allowed very little. 
The vegetables are cleaned, cut up in small pieces, soaked 
in cold water, strained, put in fresh cold water, and 
heated to 1500 F. The water is then poured off and 
replaced by water of the same temperature and then 
the vegetables are boiled three times, changing the 
water at the end of each boiling. This process is facili- 
tated by tying the vegetables in double gauze squares, 
the corners tied with string, the ends left long enough so 
that the bundles may be lifted from one container to 
another. 
The object in the diabetic diet is to get the patient 
free from sugar and acid bodies in the urine and to keep 
him so. For this purpose any one of several definite 
plans may be followed, depending on the condition of 
the patient and the experience and judgment of the 
physician in charge. When the disease is mild, as 
occurs in many of the old and obese, a restriction of car- 
bohydrate foods without particular attention to the 
amount of other foods taken may suffice. According to 
the plan devised by Allen the patient is made sugar free 346 
DIETETICS FOR NURSES. 
by fasting. The management advised by Joslin consists 
in a gradual reduction of food until the patient is sugar 
free, and then in a gradual increase of diet until the 
patient receives a diet containing I gram of protein per 
kilogram of the patient's body weight, 3 grams of car- 
bohydrate, if the patient's tolerance allows it, and a 
moderate amount of fat. The diet scheme more usually 
followed at the time of this writing is that advocated 
by Woodyatt, wherein the patient receives 1 gram of 
protein per kilogram of body weight and the total diet 
is made up to equal the patient's caloric needs by giving 
fat and carbohydrate in such proportions as to prevent 
the formation of acid bodies. These proportions are 
approximately such that the number of grams of fat is 
equal to one-half the number of grams of protein plus 
twice the number of grams of carbohydrate. Example: 
For a patient weighing 50 kilograms, a Woodyatt diet 
giving 30 calories per kilogram, or 1500 calories, would 
consist of protein 50 grams, fat 118.6 grams, carbo- 
hydrate 46.8 grams. Several other diet schemes are also 
in use. But the proportion of protein, fat, and carbo- 
hydrate in the diet to be given is, after all, the physician's 
responsibility; it is the nurse's duty to so select the 
food-stuffs that the total ordered by the physician shall 
be reached. 
In certain patients the sugar tolerance may be so low 
as to forbid the giving of a diet sufficient for the pa- 
tient's body needs, or the tolerance may be so depressed 
by acute infection, the strain of surgical operation, the 
strain of excessive fatigue or of child-birth, or by the 
strain of continued neglect of dietetic precautions, that 
dietetic treatment alone will not suffice. It is in these 
cases that insulin (iletin) is used. Insulin is an extract 
of the animal pancreas which increases the ability of DISEASES IN WHICH DIET IS A PRIMARY FACTOR. 
347 
the body to utilize sugar. It was discovered and pre- 
pared by Dr. Banting and Dr. Best of the University of 
Toronto and is of the greatest value in the treatment of 
severe diabetics. It must be given by hypodermic 
injection and the most rigid asepsis must be observed to 
avoid infection at the point of puncture. Insulin is a 
powerful and often dangerous agent. It should only be 
used under the most competent medical direction. In a 
patient receiving insulin the diet must be controlled with 
extraordinary care so that the sugar content of the 
blood shall not be lowered beyond normal limits. When 
this occurs, a typical reaction sets in; the patient com- 
plains of blurring of vision, feeling of weakness or faint- 
ness, rapidly loses consciousness, has convulsive seizures, 
and the attack may terminate fatally. This reaction 
can be controlled by giving sugar, and in cases treated 
with insulin some readily available form of sugar, and if 
the physician desires it, the materials for the intravenous 
infusion of glucose solution should be on hand. 
In former years diabetes in children was regarded as 
practically hopeless. With early recognition and very 
strict treatment many of these patients do surprisingly 
well and the possession of insulin makes the outlook far 
less gloomy than it previously was. The diet is along the 
same line as in adults, but children are rather prone to 
acidosis and require special care on this account. The 
nurse in charge of a diabetic child should be particularly 
careful in the testing of urine, especially for acid bodies. 
Any unusual drowsiness or sluggishness should be the 
signal for immediate notification of the physician. The 
general hygiene of the case is much the same as in 
adults. 
Since diabetes is a progressive disease, and since the 
tolerance is lessened by any strain on the carbohydrate 348 
DIETETICS FOR NURSES. 
Fluid measure scale to convert cubic cen- 
timeters to ounces or vice versa. 
Weight measure scale to convert grams to 
ounces or vice versa. DISEASES IN WHICH DIET IS A PRIMARY FACTOR. 
349 
metabolism, the responsibility for the progress of the con- 
dition rests heavily on the nurse in charge. 
For the use of the nurse the following list of foods, 
arranged approximately according to the percentage 
of carbohydrate given on p. 350, will be found of 
value. 
At one time substitutes for bread and special diabetic 
foods were very popular. With more careful attention to 
quantitative control of diet these are found to be of 
doubtful value, and many physicians prefer to omit them 
entirely. Among the foods used are bran bread, Lyster 
flour, and soy bean flour. Gluten flour and the gluten 
breads should be avoided as they contain very variable 
amounts of starch. In using bran, the bran should be 
washed until the wash water fails to give a blue color 
with a drop of the tincture of iodin. This is done by 
placing the bran in a cheese-cloth bag, and tying it to a 
tap of running water. Saccharin may be used for 
sweetening. In the latter part of this book certain 
recipes for special diabetic foods are given. 
In the mild diabetic a qualitatively limited diet is 
sometimes used. The nurse may find it both interesting 
and instructive to study the tables given below, and the 
diet for such cases as the physician leaves with general 
orders may be arranged from them. Under no other 
circumstances should a nurse or other unqualified person 
attempt to manage the diet of a diabetic, and the 
physician should always keep in close touch with the 
case. The nurse will be in a position to sympathize with 
the patient and to take extra pains with the details of 
carrying out whatever may be ordered if she will attempt 
living on a carbohydrate-free diet for a few days. She 
will learn many things in that way which may not other- 
wise occur to her. 350 
DIETETICS FOR NURSES. 
STRICT DIET. MEATS, FISH, BROTHS, GELATIN, EGGS, 
BUTTER, OLIVE OIL, COFFEE, TEA, AND CRACKED 
COCOA. (JOSLIN.) 
(Foods Arranged Approximately According to Percentage of Carbohy- 
drates.) 
5 per cent. 
Vegetables. 
Lettuce. Cauliflower. 
Spinach. Tomatoes. 
Sauerkraut. Rhubarb. 
String-beans. Egg-plant. 
Celery. Leeks. 
Asparagus. Beet-greens. 
Cucumbers. Water-cress. 
Brussels Cabbage. 
sprouts. Radishes. 
Sorrel. Pumpkin. 
Endive. Kohl-rabi. 
Dandelions. Broccoli. 
Swiss chard. Vegetable 
Sea kale. marrow. 
10 per cent. 
Onions. 
Squash. 
Turnips. 
Carrots. 
Okra. 
Mushrooms. 
Beets. 
10 per cent. 
Green peas. 
Artichokes. 
Parsnips. 
Canned lima 
beans. 
20 per cent. 
Potatoes. 
Shell beans. 
Baked beans. 
Green com. 
Boiled rice. 
Boiled mac- 
aroni. 
Fruits. 
Ripe olives (20 per cent. fat). 
Grape-fruit. 
Lemons. 
Oranges. 
Cranberries. 
Strawberries. 
Blackberries. 
Gooseberries. 
Peaches. 
Pineapple. 
Watermelon. 
Apples. 
Pears. 
Apricots. 
Blueberries. 
Cherries. 
Currants. 
Raspberries. 
Huckle- 
berries. 
Plums. 
Bananas. 
Nuts. 
Butternuts. 
Pigmolias. 
Brazil nuts. 
Black wal- 
nuts. 
Hickory. 
Pecans. 
Filberts. 
Almonds. 
Walnuts 
(English). 
Beechnuts. 
Pistachios. 
Pinenuts. 
Peanuts. 
40 per cent. 
Chestnuts. 
Miscellaneous. 
Unsweetened and unspiced 
pickles, clams, oysters, scal- 
lops, liver, fish-roe. 
Reckon actually available carbohydrates 
in vegetables of 5 per cent, group as 3 
per cent.; of 10 per cent, group as 6 per 
cent. DISEASES IN WHICH DIET IS A PRIMARY FACTOR. 
351 
The following four tables are taken from von Noor- 
den's article in The Twentieth Century Practice of Medicine: 
TABLE I. 
First Group.-Unconditionally Allowable Foods. 
Fresh meat: All the muscular parts of the ox, calf, sheep, pig, horse, 
deer, wild and domestic birds-roasted or boiled, warm or cold, in their 
own gravy or with mayonnaise sauce. 
Internal parts of animals : Tongue, heart, brain, sweetbreads, kid- 
neys, marrow-bones-served with non-farinaceous sauces. 
Preserved meats: Dried or smoked meat, smoked or salted tongue, 
ham, smoked breast of goose, American canned meats, Australian corned 
beef. 
Fresh fish : All kinds of fresh fish, boiled or broiled, prepared with- 
out bread crumbs or cracker meal, and served with any kind of non-fari- 
naceous sauce, preferably melted butter. 
Preserved fish : Dried fish, salted or smoked fish, such as codfish, 
haddock, herring, mackerel, flounder, salmon, sardellen, sprats, eels, 
lampreys, etc.; tinned fish, such as sardines in oil, anchovies, etc. 
Fish derivatives : Caviare, cod-liver oil. 
Shellfish : Oysters, mussels, and other bivalves, lobster, crawfish, 
crabs, shrimps, turtle. 
Meat extracts : Meat peptones of all kinds. 
Fggs : Raw or cooked in any way, but without any admixture of flour. 
Fats of all kinds, animal or vegetable. 
Fresh vegetables: Green lettuce, endive, cress, spinach, cucumbers, 
onion, leek, asparagus, cauliflower, red and white cabbage, sorrel, French 
beans. The vegetables, so far as they are suited to this mode of prepa- 
ration, are best cooked with meat broth or a solution of Liebig's extract 
and salt, and covered plentifully with butter, lard, suet, or goose fat. 
The addition of flour is not permissible. 
Preserved vegetables : Tinned asparagus, French beans, pickled cucum- 
bers in brine or vinegar, mixed pickles, sauer kraut, olives. 
Spices: Salt, white or black pepper, Cayenne pepper, curry, cinna- 
mon, cloves, nutmeg, English mustard, anise seed, caraway seed, pars- 
ley, dill, borage, pimpernel, laurel, capers, chives, garlic, etc. Many 
of these spices contain, indeed, a rather large percentage of carbohy- 
drates, but they are added to the food in such small quantities that this 
may be disregarded. 352 
DIETETICS FOR NURSES. 
Soups: Clear soups and broths, with or without eggs, marrow, fresh 
or dried vegetables (Julienne), clear turtle soup, etc. 
Cheese. Stracchino, Neufchatel, old Camembert, Gorgonzola, and 
all other fatty or so-called cream cheeses. 
Beverages : All kinds of natural or artificial carbonated waters, either 
clear or with lemon juice and saccharin or glycerin, or with rum, cognac, 
whisky, arrack, cherry brandy, plum brandy, Nordhauser, rye whisky, 
etc. Light Moselle or Rhine wines, claret, or Burgundy in amounts pre- 
scribed by the physician. Coffee, black or with cream, without sugar, 
but sweetened with saccharin if desired. Tea, clear or with cream or 
rum. 
Second Group.-Foods Permissible in Moderate Quantities. 
These contain carbohydrates, but in so little amounts that they need 
not be considered, and demand no compensation by a reduction in the 
allowance of bread. Some of the articles contain a rather large per- 
centage of carbohydrates, but the absolute quantity in which they are 
consumed is small. 
The amounts here given have been fixed by practical experience, and 
it will seldom be found necessary to increase them. Of the dishes here 
given, when they are allowed at all, only a few-from two to four-are 
to be selected each day. It is possible in this way to secure a great 
variety in the patient's dietary. 
Internal parts of animals : Calves' liver, giblets-up to loo gm. 
Sausage : Liver sausage, preferably the fatty kinds, liver sausage with 
truffles, black pudding-90 gm. Meat sausage-80 gm. German sau- 
sage, Frankfurter sausage, and the like, brawn, head-cheese, sausage- 
meatballs-100 gm. 
Patties : Pate-de-foie gras, potted beef, ham, tongue, salmon, lobster, 
anchovies, etc.-| to I tablespoonful. 
English sauces, such as Worcestershire, Harvey, beefsteak, anchovy, 
lobster, shrimp, India soy, China soy-I teaspoonful. 
Cream, from 4 to 6 tablespoonfuls a day. 
Cocoa, prepared without sugar-25 gm. 
Cheese: Emmenthal, Romadur-60 gm.; Gervis, Stilton, Brie, Hol- 
land, Gruyere-50 gm.; Edam, Cheddar, Gloucester, Roquefort, Par- 
mesan-30 gm.; Cheshire, 25 gm. 
Vegetables {prepared without flour or sugar) ; 5 Tel tower turnips; 
salsify, turnip-rooted celery, turnip, cabbage, pumpkin-2 tablespoonfuls ; 
green peas, beans, carrots, Brussels sprouts-I tablespoonful; l| arti- 
TABLE II. DISEASES IN WHICH DIET IS A PRIMARY FACTOR. 
353 
chokes; 1 truffle; 5 medium-sized mushrooms; 1 tablespoonful of morels 
or other edible mushrooms. 
Raw vegetables : 8 radishes ; 2 sticks of celery ; 2 medium-sized toma- 
toes. 
Nuts : 2 walnuts ; 6 hazelnuts ; 3 almonds; a thin slice of cocoanut; 
8 Brazil nuts. 
Fresh fruits: I thin slice of melon; 1 small tart apple; I or 
peaches ; 1 spoonful of raspberries or strawberries ; 4 spoonfuls of cur- 
rants ; 6 green gages; 12 cherries; | of a medium-sized pear; corre- 
sponding amounts of other fresh fruits. 
TABLE III. 
Third Group.-Conditionally Allowable Foods. 
The conditions under which dishes from the following table are per- 
mitted is that an equivalent shall be deducted from the allowance of bread. 
The amounts given below are the equivalents of 50 gm. of white bread, 
containing about 30 gm. of starch. Advantage is taken of the fact that 
larger amounts of certain carbohydrates (cane sugar, milk sugar, fruit 
sugar, etc.) maybe allowed than of starch. Some of the dishes given 
in the preceding table appear again here because, if they are eaten in 
large quantities, an account must be taken of the carbohydrates which 
they contain: 
I liter of milk (sweet, sour, or buttermilk). 
11 liters of kumiss, prepared in the Russian way. 
I to 1J liters of kefir, fermented for at least two days and prepared 
without the addition of sugar. 
1 liter of cream. 
60 gm. of rye bread, Graham bread, or Hamburg pumpernickel. 
65 gm. of Westphalian pumpernickel. 
100 gm. of aleuronat bread, prepared after Ebstein's formula (con- 
taining 27.5 per cent, of carbohydrates and 32 per cent, 
of vegetable albumin ; the aleuronat breads are very vari- 
ably compounded). 
35 gm. of zwieback and simple coffee cakes, made without sugar. 
30 gm. of English cakes of various sorts. 
30 gm. of " Eich el-cacao " (Stoll werck's). 
50 gm. of chocolate (Stollwerck's). 
40 gm. of chocolate (French make). 354 
DIETETICS FOR NURSES. 
40 gm. of chestnuts shelled or 60 gm. unshelled. 
35 gm. of cane sugar, brown sugar, or rock-candy. 
35 gm. of sweet preserves. 
40 gm. of fruit sugar. 
40 gm. of milk sugar. 
50 gm. of fruit jam. 
40 gm. of honey. 
40 gm. of flour-wheat, rye, barley, buckwheat, millet, or oatmeal 
or cornmeal. 
45 gm. of bean, pea, or lentil flour. 
35 gm. of starch preparations, potato, wheat, or rice, starch, tapioca, 
sago, maizene, mondamin, etc. 
35 gm. of rice. 
35 gm. of farinaceous preparations - noodle, macaroni, oatmeal, 
grits, barley. 
50 gm. of lentils, peas, beans (weighed dry). 
100 gm. of green peas. 
180 gm. of new potatoes. 
140 gm. of winter potatoes. 
120 gm. of apples, pears, green gages, plums, damsons, mirabelles, 
apricots, cherries, grapes. 
200 gm. of strawberries, raspberries, gooseberries, mulberries, cur- 
rants, blackberries, whortleberries, blueberries. 
3 peaches. 
40 gm. of figs. 
3 bananas. 
A handful of walnuts, hazelnuts, almonds, or Brazil nuts. 
| liter of beer of any sort. 
£ liter of sweet wine. DISEASES IN WHICH DIET IS A PRIMARY FACTOR 
355 
TABLE IV. 
Fourth Group.-Especially Valuable Foods. 
The great value of the articles contained in the list on the following 
page, of which, however, there is but a small choice, is due in part to 
the high percentage of protein and in part to that of fat. The propor- 
tion of albumin and fat is given for each too gm. of the food substance. 
Some contain carbohydrates also, the percentage of which is given for 
the sake of completeness, but its nutritive value is not counted. 
ioo Gm. 
Protein. 
Fat. 
Carbo- 
hydrate. 
Calorie 
value. 
Vegetable oil 
IOO 
930 
Butter 
I 
85 
O.5 
830 
Bacon (salt or smoked) . . . . 
. IO 
76 
748 
Devonshire cream 
. 2 
57 
2 
538 
Cream cheese (Gervais, Neufch^tel, 
Stilton, Stracchino, etc.) . . 
• 19 
41 
I 
451 
German sausage (Cervelatwurst) 
. 18 
4° 
446 
Ham 
. . 25 
36 
437 
Cheddar cheese 
. 28 
33 
2 
422 
Fat Pork 
• 14 
37 
400 
Smoked ox-tongue 
• 24 
32 
396 
Fatty cheese (average) . . . . 
• 25 
30 
i-5 
381 
Yolk of egg 
. . l6 
3i 
o-5 
354 
Fat goose 
. . l6 
30 
345 
Fat beef and mutton 
• 17 
29 
337 
Brie cheese 
. . 19 
26 
1 
320 
Fresh-water eel 
• *3 
28 
312 
Smoked mackerel 
• 19 
22 
382 
Caviare 
• 3i 
16 
276 
Cream 
• 4 
23 
4 
230 
Fat salmon (fresh or smoked) . 
. 22 
13 
210 
Hens' eggs (weighed with the shells) 12 
IO 
o-5 
142 
GOUT AND GOUTINESS. 
Sydenham said: " Great eaters are liable to gout, and 
of these the costive more especially. Eating as they are 
used to eat when in full exercise, their digestion is 
naturally impaired. Even in these cases simple gluttony 
and the free use of food, although common incentives, 
by no means as frequently pave the way for gout as 
reckless, inordinate drinking." This statement is as near 
the truth as anything that has been said since. 356 
DIETETICS FOR NURSES. 
The causes of gout are alcoholism, overeating, heredity, 
indigestion, constipation, and it is also sometimes seen in 
leadworkers. 
In gout there is a disturbance of metabolism, particu- 
larly that of the nitrogenous elements, and especially of 
what is known as the purin nitrogen. (See Purin Metab- 
olism.) In gouty individuals there is retention of various 
products of metabolism in the body, and it is generally 
advised that foods containing purin bodies should be re- 
duced or even omitted. The diet for the gouty should 
be always carefully supervised by the physician. 
In the acute attacks the diet should be liquid or semi- 
solid. Milk, bread and milk, and farinaceous gruels are 
usually prescribed. After several days the light meat 
of boiled or baked fish is allowed or a little easily 
digestible meat. The increase in the diet is always 
ordered by the physician. 
Chronic Gout.-The diet here is also to be made up 
of simple plainly cooked food, all rich and indigestible 
dishes being prohibited. There is often a peculiar per- 
sonal idiosyncrasy in regard to certain articles of diet, 
and this will largely influence their use. As a rule, how- 
ever, the following outline will suffice for the guidance 
of the patient: 
Soups of the plainest sorts may be taken, especially 
those consisting largely of vegetables. Yeo has sug- 
gested the use of vegetable purees to which beef extract 
has been added to give them a flavor of meat. Milk is 
valuable in all cases, and where it disagrees it may be 
skimmed, peptonized, or diluted with a carbonated water. 
Bicarbonate of soda may be added when it is desired to 
make the milk alkaline; i to 5 gr. to the ounce should 
be used according to requirements. DISEASES IN WHICH DIET IS A PRIMARY FACTOR. 
357 
Meat and fish may be taken daily, preferably not at 
the same meal. Fresh beef, mutton, and the like are the 
most suitable meats, and poultry may be allowed for the 
sake of variety. Eggs may be taken in moderation. 
Twice-cooked meats should be avoided, as should 
dried, smoked, or pickled meats, as well as pork and 
veal. Garrod allows bacon at breakfast, but fats are, as 
a rule, to be avoided. Under special conditions, when 
the patient's nutrition is poor, they may be given if 
tolerated. 
Only the lighter varieties of fish should be given, 
boiled being preferred to fried fish. Oysters and clams 
may be taken, the hard portion being discarded. Salt 
fish, as well as mackerel, salmon, eels, and all other 
heavy fish, should be prohibited. Crabs, lobster, shrimp, 
and the like, as well as sauces, are usually to be 
avoided. 
Vegetables, when they are easily digested, may be 
permitted. Peas, beans, potatoes, artichokes, salsify, 
onions, turnips, greens, cauliflower, and cabbage are all 
allowable, as are likewise celery, lettuce, and similar 
green vegetables. Carrots and beets, because of the 
sugar they contain, and asparagus, tomatoes, rhubarb, 
and sorrel, on account of their acid, are best avoided. 
All preserved and pickled vegetables, as well as the 
coarse and fibrous portions of all vegetables, are to be 
omitted from the dietary. 
The use of sugars and sweets is a very important part 
of the dietary, for, as a rule, they are a source of much 
trouble. Each individual differs in regard to the amount 
which may be allowed. Starchy foods may be allowed 
according to the patient's ability to digest them, without 358 
DIETETICS FOR NURSES. 
causing fermentation and flatulence, and this also varies 
greatly in different individuals. 
Fruit is best taken in the morning or during the in- 
terval between meals. It shouid, as a rule, be avoided 
during the latter part of the day, after full meals or with 
wine. Among the most suitable fruits for the gouty are 
oranges and grapes. Baked apples or stewed fruit may 
be taken. The sweet juice of the latter is, however, best 
avoided. Garrod advises the avoidance of all stone 
fruits, but allows baked apples and pears and straw- 
berries sparingly. Fothergill suggested that bicarbonate 
of soda be taken with stewed fruit to correct the acidity. 
Opinions differ regarding the use of fruit by the gouty. 
If any particular fruit disagrees with a patient it should, 
of course, be avoided. Patients often manifest idiosyn- 
crasies respecting fruits, and these furnish a guide to 
their suitability. 
Gout is also studied nowadays with a view of determin- 
ing the amount of nitrogen chat can be utilized in a given 
case with safety. Sometimes a purin-free diet is ordered, 
the following being a sample: 
PURIN-FREE DIET. 
Breakfast: 
Eggs, 2. 
Toast, 75 gm. 
Butter, 25 gm. 
Milk, 6 oz. 
Dinner: 
Oatmeal or rice, 75 gm. 
Potato, 150 gm. 
Green vegetable, 150 gm. 
Butter, 75 gm. 
Toast, 100 gm. 
Supper: 
Eggs, 2. 
Shredded wheat, 100 gm. 
Butter, 25 gm. 
Milk, 6 oz. DISEASES IN WHICH DIET IS A PRIMARY FACTOR. 
359 
The following table shows the amount of purin-nitro- 
gen in various foods: 
DIETETIC TREATMENT IN GOUT. 
(ioo grams contain in terms of "Purin-nitrogen.") 
More than .1 gm. 
.05-. 1 gm. 
.03-05 gm. 
.01-.05 gm. 
None, or less 
than .01 gm. 
Thymus (0.33) 
Calves' liver 
(0.11). 
Anchovy 
(0.18). 
Sardines in oil 
(0.14)- 
Beef kidney. 
Squab. 
Calves' 
tongue. 
Herring. 
Trout. 
Salmon. 
Perch. 
Pike. 
Lentils. 
Pork. 
Veal. 
Mutton. 
Beef. 
Roe. 
Haddock. 
Chicken. 
Calves' 
brain. 
Codfish. 
Spinach. 
Bacon. 
Oysters. 
Crabs. 
Lobster. 
Sausage. 
Peas. 
Asparagus. 
Mushrooms. 
Turnips. 
Cabbage. 
All fruits. 
Cereals. 
Milk. J 
Cheese. • § 
Bread. % 
Eggs. 
Caviar. 
Vegetables 
not in the 
other lists. 
About 6o per cent, of the purin bodies eaten appear 
in the urine as uric acid. The substances in tea, coffee, 
and cocoa are not excreted as uric acid, and these bever- 
ages may be allowed. Meat extracts, bouillons, dish 
gravies, and the outside of roasts should be avoided. 
Relishes containing mustard and spices and the various 
catsups and appetizing sauces should be avoided, as 
should radishes, water-cress, garlic, and green peppers, 
not on account of their forming uric acid, but because 
they irritate the kidneys. 
When gout is complicated with obesity, diseases of the 
kidneys, diseases of the stomach or any other disease, 
special diets are ordered. 
Arthritis Deformans.-In this disease there are 
deformities of the bones which are sometimes con- 
founded with gout. The diet probably has no influence 
whatever over this disease. Instead of restricting the 
diet, it should be as nourishing as possible. 360 
DIETETICS FOR NURSES. 
Scurvy or Scorbutus.-This disease occurs in adults 
where there is a deficiency of fresh food. It is the scourge 
of armies, and formerly was frequent among sailors. To 
prevent it fresh food should be given. Canned food, 
while not an ideal preventive, is useful. Lemon or 
lime juice, vinegar, and onions are especially valuable as 
preventatives. The treatment of the disease, when it 
occurs, is chiefly dietetic, and consists in giving a good, 
nutritious diet with fresh fruits and vegetables, fresh 
meats and the like. The above-mentioned preventatives 
may be used where the other fresh foods are not available. 
Infantile Scurvy (Barlow's Disease}.-Scurvy is fre- 
quently seen in infants, especially between the sixth 
and the fifteenth month. In almost every case improper 
feeding is the cause. It has even occurred where the 
child was breast-fed, but more often from the following 
feeding, in the order of their frequency: the proprietary 
infant foods, sterilized milk, condensed milk, and Pas- 
teurized milk. The treatment is very satisfactory, and 
consists in placing the child upon a proper diet and 
giving in addition fresh orange juice, from | to 3 or 4 
oz. daily. The juice of any fresh ripe fruit, as of peaches 
or grapes, may be used instead. 
OBESITY. 
There is probably no condition that has been more 
widely discussed by laymen of both ancient and modern 
times than obesity, for no disease is more thoroughly 
associated in the lay mind with its proper causes and its 
relations to diet than this " oily dropsy", as Bryon 
calls it. 
The accumulation of fat is associated with increasing 
years, but it is by no means confined either to old or DISEASES IN WHICH DIET IS A PRIMARY FACTOR. 
361 
middle age, as is exemplified in the fat children familiar 
to all; obesity may be a plague even of infants. 
The causes of obesity are so well known as to require 
only passing mention. About 50 per cent, of cases owe 
their primary origin to hereditary causes. Women are 
more frequently affected than men. With the advance of 
years, in some there is a tendency to accumulate fat. 
Overeating and overdrinking have been named as cau- 
sative factors, especially when combined with a quiet, 
sedentary life. 
The fats and the carbohydrates are the principal ele- 
ments in the diet that are apt to be converted into fat; 
but proteins also, if the supply exceeds the demand and 
assimilation is active, will be converted into body-fat and 
stored up in the subcutaneous tissues. The liver and the 
heart are also converted into storehouses for fat, and 
later there may be a fatty degeneration of both organs, 
as well as of the coats of the arteries. 
The dangers accompanying the excessive accumulation 
of fat are manifold, and include a large number of dis- 
eases that may be influenced by it either directly or in- 
directly. These will be discussed when the indications 
for reducing the weight of patients are considered. Weak 
heart, anemia, gout, and diabetes are among the most fre- 
quent diseases with obesity. 
Reduction cures of many kinds are vaunted by their 
respective originators. Ebstein has summed up the 
whole matter in the following sentence: " Corpulence 
can only be permanently cured by a permanent change 
of life and diet regulated by physiologic principles." 
Reduction of weight is in many cases contra-indicated, 
and a reduction cure should never be undertaken without 
the advice of a physician. In women especially reduction 362 
DIETETICS FOR NURSES. 
may be a cause of hernia, of dislocation of the kidney, 
or of the uterus, and may also bring on gall-stone colic 
in those who have gall-stone disease. In old people re- 
duction cures are not, as a rule, advised. In many slight 
cases all that is needed is a regulation of the diet and 
life so as to prevent any further increase. Reduction 
may be of especial benefit in stout individuals with heart 
disease, and a method known as " Oertel's method," which 
combines diet and exercise, is usually followed. Reduc- 
tion is also useful in some cases of respiratory disease in 
very stout persons. Bronchitis and asthma may be men- 
tioned in this connection. Where the patient has any 
disease interfering with locomotion, the diet should be so 
arranged that there will be no excessive accumulation of 
fat, as the added weight may be the cause of making the 
patient helpless. 
A much discussed point is whether it is possible to 
reduce any special part of the body more rapidly than the 
remaining parts. This is a method often sought by 
women who have borne several children and who have 
large deposits of fat in the abdominal walls, causing an 
unsightly prominence of the abdomen. If the fat is re- 
duced slowly, every part of the body, including usually 
the abdomen as well, will be reduced simultaneously. If 
it is reduced rapidly, it seems to be removed principally 
from certain parts of the body, as the neck, breasts, arms, 
and calves of the legs. Certain advocates of massage 
claim that the massage of the parts will cause a more 
rapid reduction. Von Noorden had one arm of an obese 
patient massaged for six weeks. At the end of that time 
the arm that had been massaged had increased IJ cm. in 
circumference, whereas the arm that had not been mas- 
saged remained the same. DISEASES IN WHICH DIET IS A PRIMARY FACTOR. 
363 
Massage of the abdomen during a reduction cure may 
exert a beneficial effect by relieving the constipation, 
which is apt to be troublesome. Exercise is still more 
potent, particularly for reducing the abdomen. This is 
accomplished by standing erect and then bending forward 
in an effort to touch the toes with the tips of the fingers. 
Too much should not be expected from this, even when 
persisted in faithfully. 
Prophylaxis of Obesity.-Where a tendency to 
obesity exists the fat-forming foods should be partaken 
of but sparingly, and sufficient outdoor exercise taken 
to keep the weight within reasonable limits. The fat- 
forming foods are fatty foods of all kinds, the sugars and 
starches. 
Dietetic Treatment of Obesity.-There are numer- 
ous methods of diet. The method to be used in any 
given case is to be determined by the physician. These 
reduction cures are frequently referred to as Banting 
cures. The Banting method was that used in the case 
of a Mr. Banting, by his physician, Dr. Harvey. It was 
in great vogue some years ago, and the name became 
erroneously applied to many other methods. It is too 
severe for the average patient. 
Banting Diet for Obesity (Yeo).-" Breakfast, 9 
A. m. : 5 to 6 oz. of animal food-meat or boiled fish (ex- 
cept pork or veal); a little biscuit or 1 oz. of dry toast- 
6 to 7 oz. of solids in all. A large cupful of tea or coffee 
(without milk or sugar)-9 oz. of liquid. 
"Dinner, 2 p. m. : Fish or meat (avoiding salmon, eels, 
herring, pork, and veal), 5 to 6 oz.; any kind of poultry 
or game. Any vegetables except potato, parsnips, beet 
root, turnips, or carrots. Dry toast, 1 oz. Cooked fruit, 364 
DIETETICS FOR NURSES. 
unsweetened. Good claret, sherry, or Madeira, io oz. 
Total of solids, io to 12 oz. 
" Tea, 6 p. m. : Cooked fruit, 2 to 3 oz.; a rusk or two- 
2 to 4 oz. of solids; 9 oz. of tea (without milk or sugar). 
" Supper, 9 p. m. : Meat or fish, as at dinner, 3 to 4 oz. 
Claret or sherry and water, 7 oz. 
. "This allowed only from 21 to 27 oz. of solids per 
diem, of which 13 to 16 oz. consisted of animal food and 
only 2 oz. of bread; the rest consisted of fruit and fresh 
vegetables. There was the strictest possible exclusion 
of starches and sugar. 
"The total fluid was limited to 35 oz." 
Oertel'S method is a combination of diet and exer- 
cise, and is especially applicable to patients with disturb- 
ances of the circulation. The quality and quantity of 
food and the amount of fluid are carefully regulated by 
the medical attendant according to the patient's condition. 
Ebstein's method consists in giving a diet in which 
the carbohydrates are reduced, but in which considerable 
amounts of fats are allowed. The custom of giving fatty 
food in such cases is as old as Hippocrates, for he says, 
" The food shall be fat in order to satiate quickly." This 
method is, however, based on an erroneous opinion. 
In general it may be stated that the diet should be 
limited in amount, the starches and sugars reduced to a 
minimum, fats reduced or omitted altogether, and the 
amount of fluid cut down to a very small amount. The 
food given consists of meat, eggs, fish, fruits, and green 
vegetables. Sufficient exercise is taken to keep the 
weight down to the required number of pounds. 
When obesity is complicated with any other disease, 
the diet may be a point of considerable difficulty. DISEASES IN WHICH DIET IS A PRIMARY FACTOR. 
365 
DIET FOR LEANNESS. 
In a general way the indications for fattening thin 
people is the reverse for the diet used in obesity. Many 
individuals are thin as a matter of constitution, and such 
as these can not be fattened by any means. There may 
be some special cause for the leanness, and when the 
physician can discover this and remove or relieve it, the 
patient may be increased in weight. Patients emaciated 
from acute illness are readily fattened. 
The patient should lead a quiet outdoor existence, free 
from care or excitement, and should get sufficient sleep. 
The meals should be ample, and as much carbohydrate 
and fatty food taken as possible. Cream, milk and cream, 
butter, cocoa, chocolate, bread, cereals (well cooked), 
farinaceous puddings, potatoes, legumes, and sweet fruits 
should all be partaken of in abundance. All sweets- 
honey, syrups, cakes, and the like-may be taken if they 
agree with the digestion. Beer, especially the darker 
varieties, porter and brown stout are useful. Sweet wines 
are sometimes ordered, and malt extracts where it is not 
desirable to use alcoholic beverages. Strong alcoholic 
drinks, acids, spices, and many green vegetables are for- 
bidden. 
Certain skin affections are caused directly or indirectly 
by dietary errors; others are prolonged or intensified by 
an improper diet, and still others are connected in some 
way with diseases of the alimentary tract or with dis- 
turbed metabolism. 
Eczema.-All food which is known to cause erythema 
or urticaria in the individual should be avoided, as should 
all food which is liable to undergo fermentation in the 
DIET IN SKIN DISEASES. 366 
DIETETICS FOR NURSES. 
intestinal tract or which will produce indigestion. Irri- 
tating spices and alcoholic beverages are usually omitted 
from the dietary. The meals should not be too large, 
should be taken at regular intervals, and a simple varied 
dietary should be followed. Gouty and obese patients 
are usually ordered diets suitable for their disease. A 
milk diet is frequently used in persistent cases. 
In infants it is important to have the digestion in per- 
fect order. 
Urticaria (Hives).-Many articles of diet cause hives 
in certain individuals. Among the most frequent causes 
are strawberries, oysters, crabs and other shellfish. 
Partially spoiled or stale articles may also be a cause. 
Acne.-All indigestible articles of food are to be 
avoided, and the diet should consist of easily digested 
fresh food. Excessive quantities of fat should be avoided. 
ACIDOSIS. 
The blood has a slightly alkaline reaction and nature 
has made provision for keeping it so by having alkaline 
bases in reserve in the body tissues and fluids. Acidosis 
is seen in the course of various diseases and nutritional 
disturbances and may be caused by too little food and 
fluid, as in starvation, also in vomiting and diarrhea; 
where the body fails to neutralize the acids by the 
production of ammonia, as in nephritis; where the fats 
are not metabolized to carbon dioxid and water, but 
form organic acids, as in diabetes, cyclic vomiting, in- 
fections, and some other diseases; and where the acids 
are not properly eliminated. 
Formerly acidosis was combated by the administra- 
tion of sodium bicarbonate, and this is still used in cer- 
tain cases, especially where the acidosis is not due to the DISEASES IN WHICH DIET IS A PRIMARY FACTOR. 
367 
formation of organic acids. The present-day recom- 
mendations are the administration of large quantities of 
water either by mouth, rectum (Murphy drip or injec- 
tion), subcutaneously, or intraperitoneally. For the last 
two normal salt or Ringer's solution should be used. In 
addition to this glucose is given in the same manner. 
By mouth in 5 or 10 per cent, solutions; by rectum in 
4 or 5 per cent, solutions; intravenously, 5 to 10 per cent, 
in normal salt or in Ringer's solution from 2 to 10 ounces, 
according to the size of the child; intraperitoneally 2 per 
cent, glucose in half-strength Ringer's solution, 2 to 16 
ounces at a time, according to the age of the child. 
In selected cases sodium bicarbonate may be given by 
mouth, 10 grains to | dram at a time. By rectum 4 per 
cent, sodium bicarbonate in 4 per cent, glucose solution, 
or in plain water, may be used. Intravenously a 2 per 
cent, solution may be given. Too much sodium bicar- 
bonate may cause symptoms, tetany, convulsions, edema, 
and vomiting. If these occur, water should be admin- 
istered freely, and in convulsions magnesium sulphate 
may be given subcutaneously, using an 8 per cent, solu- 
tion or, as Blackfan suggests, for the relief of cerebral 
nephritis intravenously, in a 2 per cent, solution given 
at the rate of 10 c.c. per minute in amounts of about 
15 c.c. per kilogram of body weight. This may be re- 
peated at intervals of six to twelve hours if necessary. CHAPTER XIX. 
SPECIAL DIET CURES. 
The Milk Cure.-Milk is used extensively as a food 
during illness, and it has also been warmly advocated as 
a curative agent, especially by Karell, of St. Petersburg, 
and Weir Mitchell. 
Physicians may prescribe an exclusive milk diet in a 
large number of diseases, chief among which are diseases 
of the kidneys, liver, heart, and intestines. It is also 
at the outset of the rest cure. 
Method of Administration.-Well-skimmed milk from 
the country, as fresh as can be procured, is used. Later 
on the unskimmed milk is often ordered. Karell begins 
with from 3 to 6 oz. three or four times a day, and in- 
creases the amount gradually. The milk is to be taken 
slowly, at regular intervals, allowing it to mix with the 
saliva. In winter it is warmed, and in summer given at 
the room temperature. After a week, if the stools re- 
main solid, the quantity is increased, 2 liters (quarts) a 
day being given during the second week in favorable 
cases. The regular hours are to be insisted upon. If 
the milk causes diarrhea it is boiled. Constipation is 
regarded as a sign that the milk is agreeing, and the 
bowels may be moved if necessary by laxatives or 
enemata. Small quantities of coffee mixed with the 
morning's milk, or stewed prunes or baked apples in the 
afternoon, are useful in relieving constipation. 
If there is a flatulence, it usually means that too much 
368 SPECIAL DIET CURES. 
369 
milk is being given or that it is not properly skimmed. 
If there is thirst, plain water or a carbonated water may 
be given. Lime water or one of the infant foods may 
be mixed with the milk to render it more digestible. 
During the second or third week, if there is an irre- 
sistible desire for food, a little salt herring or a bit of 
stale bread with salt may be given. Once a day milk 
soup thickened with a cereal may be given. After five 
or six weeks the ordinary diet is gradually resumed, but 
large quantities of milk are still taken. 
During the first week the milk causes slight drowsi- 
ness, a coated tongue, and a peculiar taste in the mouth. 
The stools are light yellow and resemble the milk stools 
of infancy. The urine is increased in quantity. There 
is a slight initial loss of weight, but an increase later on 
in the cure. 
Salt-free Diet.-The average daily diet contains 
about i gram of sodium chlorid-that is, common table 
salt-in the original composition of the food, and io to 
20 grams are added daily as seasoning. It has been 
found that by adding salt to the diet of a patient suffering 
with certain forms of nephritis that the edema, if present, 
could be increased, or, if it was not present, it could be 
produced. This led to the reduction of the quantity of 
salt taken by edematous patients, and in some instances 
with rather remarkable results. Some similar results 
have been obtained in the edema due to heart disease, 
and a salt-free diet has also been advised in a great many 
other conditions. In cases with kidney trouble, where 
there is constant thirst, a salt-free diet is often of great 
benefit, the sipping of water at short intervals is avoided, 
the mouth becomes moist and more comfortable. It is a 
good plan to omit the salt cellar from the table or tray, 370 
DIETETICS FOR NURSES. 
and if no effect is noted the quantity of salt put in the 
food during its preparation should be greatly reduced or 
omitted altogether. 
Salt-free diet may be easily arranged with the coopera- 
tion of the cook, and may consist of the following articles 
of diet, from which the patient can very easily subsist. 
These can be modified according to the disease for which 
the patients are being dieted: 
Bread should be made without salt. The average 
bread contains about io grams for each kilogram, some- 
times more. The bread which has not had salt added to 
it contains about 0.7 centigrams per kilogram. 
SALT-FREE DIET. 
Bread. 
Meat. 
Vegetables. 
Butter. 
Sugar. 
Breakfast: 
Rice or cereal, 
2 small 
ij tsp. 
2 small 
i egg or meat ball 
slices. 
Dinner: 
or very small 
amount of steak 
or 2 chops. 
2 tbsp. 
balls. 
ij tsp. 
i small 
2 meat balls or 2 
Small amount po- 
1 small 
slice. 
Supper: 
slices of roast 
beef or chicken 
or 3 small chops. 
tato. Rice, car- 
rots, 2; beets, 2; 
beans; tomato. 
No lettuce or 
spinach. 
ball. 
i| tsp. 
2 small 
1 small meat ball; 
Baked potato. 
2 small 
slices. 
small amount of 
beef or chicken 
or 1 chop or 1 
egg. 
Green salad. 
balls. 
Meat should always be used fresh, and most people 
experience little difficulty in eating it without salt. The 
cook should be instructed not to use salt in its prepara- 
tion. Meat contains on an average of about I gram per SPECIAL DIET CURES. 
371 
kilogram. Fresh-water fish may be used, but salt-water 
varieties contain large amounts of sodium chlorid. Fresh 
eggs may be taken in any form desired, each egg contain- 
ing about 25 centigrams. Fresh butter, fresh cream, 
and saltless cheese may be used freely. 
APPROXIMATE PERCENTAGE OF N AND NaCl OF FOOD IN 
THE "SALT-FREE DIET." 
Food N NaCl 
per cent, per cent. 
Apple sauce . . . 0.03 0.0 
Apples 0.06 0.0 
Beefsteak .... 2.50 0.1 
Beef (scraped) . . 2.59 0.1 
Beets 0.26 0.1 
Bread 1.5 0.0 
Broth 0.3 0.07 
Butter 0.16 0.0 
Cabbage 0.25 0.1 
Carrots 0.18 0.1 
Celery 0.18 0.1 
Cheese 0.83 1.5 
Chicken 3.1 0.04 
Cocoa 0.64 0.17 
Coffee 0.18 0.06 
Crackers (S. F.) .5.2 0.005 
Custard 0.9 0.17 
Eggs 2.1 0.14 
Figs 0.69 0.01 
Fruit 0.03 0.01 
Ice cream .... 0.8 0.17 
Junket 0.5 0.17 
Lamb chops . . .2.6 0.07 
Lettuce 0.19 0.13 
Food. N f NaC> 
per cent, per cent. 
Milk 0.52 0.17 
Oatmeal 0.36 0.03 
Oil (olive) .... 0.0 0.0 
Onion 0.19 0.1 
Orange juice.... 0.0 0.06 
Parsnips 0.25 0.1 
Peaches 0.1 0.01 
Potatoes 0.4 0.03 
Prunes 0.1 0.01 
Pumpkin 0.18 0.1 
Rice 0.45 0.0 
Rice pudding . . . 0.64 0.17 
Salsify 0.2 0.1 
Shredded wheat . .1.7 0.0 
Spinach 0.34 0.21 
Squash 0.23 0.1 
String beans . . . 0.13 0.1 
Sugar 0.0 0.0 
Sweetbreads ... 2.7 0.25 
Tapioca pudding . 0.53 0.17 
Tea 0.18 0.06 
Toast 1.8 0.0 
Tomatoes 0.14 0.1 
Turnips 0.2 0.1 
Wine jelly 0.7 0.1 
Potatoes may be prepared in many varieties of ways, 
and may be made palatable without the addition of salt. 
The same is true of rice. In addition to the above, green 372 
DIETETICS FOR NURSES. 
peas, carrots, leeks, endive, lettuce, French beans, celery, 
artichokes, and salads of various kinds may be added to 
the dietary. Sweetmeats, pastry made without salt, and 
raw or cooked fruit may also be used. Chocolate will be 
found of especial value. Tea, coffee, and beer, or even 
wine may be taken as far as the amount of chlorids 
which they contain are concerned. 
Other Diet Cures.-Many other cures are used in 
various parts of the world. Almost every article of diet 
has at one time or another been vaunted as a " cure." 
Whey, to which alkaline mineral waters have been added, 
is sometimes prescribed with plenty of fruit and vegeta- 
bles and little meat Kumiss is used in Russia. Grapes, 
apples, and other fruits are used in certain countries. A 
" dry " cure, where the amount of liquid is greatly reduced, 
is sometimes prescribed, especially for aneurism. A meat- 
and-hot-water cure is used for stomach disorders. The 
Kneipp cure consisted chiefly of a diet of fruit, bread and 
milk, with small quantities of meat and vegetables. The 
cure also directs that the patient walk barefooted in the 
grass while the dew is still on it. CHAPTER XX. 
DIETETIC MANAGEMENT OF SURGICAL 
CASES. 
Surgical operations that must be performed immedi- 
ately, of course, admit of no preparation. Most opera- 
tions, however, may be postponed for several days or 
longer, thus enabling the patient to be put in good con- 
dition by rest, preferably in bed, and a nourishing, easily 
digested diet. The value of the rest in bed is greatly 
augmented by massage, electricity, and baths where the 
condition of the patient admits of their use; by tonics; 
and by laxatives to correct the tendency to constipa- 
tion that usually exists. 
Before the Anesthesia.-Wherever possible, before 
an anesthetic is given to children and even to adults, 
it is well to give bicarbonate of soda three times daily 
for two days preceding operation, and at the same time 
to administer the equivalent of one-half dozen lumps of 
sugar each day. The amount of soda may be varied 
according to the size and age of the individual, I tea- 
spoonful three times a day for an adult of about 150 
pounds, and proportionately less in children. This will 
practically do away with the severe acidosis and vomit- 
ing so frequently met with, particularly after ether anes- 
thesia in younger people. 
Anesthesia and Diet.-When an anesthetic is to be 
administered a routine somewhat as follows should be 
carried out whenever the circumstances allow: The day 
preceding the operation the patient should be kept quiet; 
373 374 
DIETETICS FOR NURSES. 
the bowels should be thoroughly emptied by means of 
a saline purge, and the diet should be light and easily 
digested. The supper should be a light one, and nothing 
but water should be given for six hours at least before 
operation if possible; but water may be given up to the time 
of operation. At the time of anesthesia the stomach should 
be empty. This is important, as it lessens the nausea ex- 
perienced by many patients after anesthesia, and also 
lessens the danger of vomiting food during an operation, 
an accident which may cause severe coughing if the food 
is drawn into the larynx, or may cause pneumonia if it is 
drawn into the lungs. The coughing and vomiting may 
interfere seriously with the operator. 
If it is necessary to administer an anesthetic after a full 
meal and circumstances permit, an emetic may be given 
to empty the stomach before the operation is begun, or 
it may be better to wash out the stomach. 
Nausea is liable to follow after anesthesia, particularly 
after the administration of ether; this is discussed below. 
If nausea does not occur, a cupful of weak tea or of 
diluted milk may be given two or three hours after the 
operation, and if that is retained, milk may be given as 
often as every three hours if desired. A patient suffers 
more from too much food than from too little. For 
supper, bread and milk or cocoa or a slice of toast and a 
cupful of weak tea may be allowed. It is well, however, 
to wait until the following day before giving anything 
more. On the following day, if there is no nausea or 
other untoward symptoms, a light breakfast may be given, 
and after that as rapid return to an ordinary diet as cir- 
cumstances permit may be made. 
If there is nausea, or after laparotomies, operations 
about the head, and other operations as outlined below, 
especial care must be taken with the diet of the patient. DIETETIC MANAGEMENT OF SURGICAL CASES. 
375 
Diet After Operation.-The diet following opera- 
tions should be supervised by the surgeon himself or by 
an assistant especially trained for the purpose. In opera- 
tions about the mouth, as for hare-lip, and on the alimen- 
tary tract, the management of the diet is as of much im- 
portance as the operation itself. In order to avoid the 
interference of well-intentioned but misguided friends, 
many surgeons refuse to operate except in a hospital 
unless the patient is in a condition which does not per- 
mit of his being moved. 
It should be remembered that confinement to bed for 
weeks after an operation greatly impairs nutrition, and 
every effort should therefore be made to get the patient 
in the open air, either on his bed or in a wheel-chair. 
Massage and electricity are employed in suitable cases to 
maintain the nutrition. 
In patients who are up and about no especial diet is, 
as a rule, necessary, except after operations about the 
mouth, larynx, or alimentary tract. The diet should be 
as simple and as nutritious as possible, usually that of 
the ordinary individual. Patients suffering from diabetes, 
gout, dyspepsia, as well as vegetarians, require especial 
care, and the physician will in such cases give explicit 
directions concerning the diet. 
Children should be fed according to the usual rules 
for them, but it is a good plan to have the children, and 
especially infants, in the hospital a few days, so as to get 
them accustomed to the diet on which they will have to 
live. 
Those habituated to the daily use of alcohol for years 
should receive a moderate average amount, lest nutrition 
be interfered with or delirium develop. The physician 
will regulate the dosage in these cases. 376 
DIETETICS FOR NURSES. 
Diet After Operations About the Head.-For 
the first few days the diet should be light-usually liquid 
-especially if the brain has been affected, and as nutri- 
tious and as easy of digestion as it is possible to make 
it. The bowels should be kept open. No alcohol is 
allowed except in cases of habitues or on the surgeon's 
direction. If the patient is unconscious, it may be neces- 
sary to feed him with a nasal or stomach tube. In some 
cases rectal feeding is used. 
After brain operations, where there are no unusual 
symptoms, the diet may be made semisolid, or even an 
easily digested solid diet may be allowed after two or 
three days. Milk toast, junket, bouillon and egg, soft- 
boiled or poached eggs, squab, chicken, and the like are 
allowable. The diet should be light, but sufficient in 
quantity, until the patient is up and about, when it may 
be increased to nearly the normal diet. 
In operations of a plastic nature about the face, where 
the taking of food or vomiting is liable to open the 
wound, the food should be given by the rectum until 
all danger of the vomiting is past and until the patient 
can masticate and swallow without fear of injuring the 
part. 
Diet After Hare-lip and Cleft Palate Opera- 
tions.-Following these operations especial attention to 
the diet is necessary. The child should be taught to 
take food from a spoon or large medicine-dropper before 
operation. If the breast milk is used, it should be drawn 
from the breast by means of a pump and given with a 
spoon or dropper. Cold sterilized milk or modified milk 
should be used in these cases until the patient is able to 
take other food. Nasal or rectal feeding may be neces- 
sary in some cases. DIETETIC MANAGEMENT OF SURGICAL CASES. 
377 
Diet After Esophageal or Laryngeal Opera- 
tions.-The diet in these cases is of the utmost impor- 
tance and depends very much on the operator and the 
operation done. The surgeon's directions will always be 
explicit in such cases. 
Diet and Laparotomies.-One or two days before 
the operation the bowels should be cleansed thoroughly 
by a saline or other purge, and in the case of an abdomi- 
nal or pelvic operation an enema or two is ordered in 
addition, not only to secure cleanliness, but to obtain rest 
for the bowels. The washing out of the bowel should be 
performed early on the morning of the operation, at six 
or seven o'clock, or at least three hours before the opera- 
tion. No food should be given for at least four hours 
previous to the operation. Many surgeons operate early 
in the morning, before the patient has broken his fast. 
Others operate later in the day, and allow the patient a 
glassful of milk or some such light nourishment on 
awakening. 
As a rule, nothing should be given by the mouth for 
twenty-four hours. Some operators allow very small 
quantities of carbonated water or iced water or very hot 
water, or if the patient is very weak and in need of nour- 
ishment, teaspoonful doses of milk may be ordered with 
or without lime water or a carbonated water. Hot weak 
tea, or if a stimulant is needed, hot black coffee, may be 
administered or alcoholic stimulants may be used. In 
these cases as in all others the nurse acts only under the 
direct orders of the surgeons. Interference or injudi- 
cious feeding may prove fatal. From 5 to 10 oz. of 
liquid food are generally allowed on the second day, and 
from 10 to 15 oz. on the third day. On the fourth day, 
if there are no outward symptoms, a soft diet may be 378 
DIETETICS FOR NURSES. 
ordered, and after a week or ten days a gradual return 
to an ordinary diet may be made. This varies, of 
course, with the operation done and the progress of 
the patient. 
Nausea and Vomiting1.-Many operators wash out 
the stomach after the operation and before the patient 
recovers from the effects of the anesthetic. This often 
prevents nausea, especially if ether has been given. The 
vomiting and nausea may be transitory, or it may last for 
days or a week or more and even threaten the patient's 
life. 
While the vomiting is active no food should be given 
by the mouth. If it persists and the patient is weak, 
rectal feeding is usually resorted to if the operation per- 
mits of it. Various drugs are used to relieve the vomit- 
ing, and sometimes a glassful of hot water is given or 
the stomach is washed out. As a rule, total abstinence 
from all food and drink by the stomach is the best way 
to manage these cases. 
Thirst.-This may be almost intolerable. The patient 
may drink the water from hot-water bottles if not watched. 
High rectal enemata of hot water are sometimes used 
while the patient is still on the operating-table, and do 
much toward relieving the thirst of the patient. If allow- 
able, rectal injections of normal salt solution may relieve 
thirst. As a rule, thirst is best allayed by using the con- 
tinuous rectal injection of water as recommended by 
Murphy. Sips of hot water or of hot weak tea are fre- 
quently given by the mouth. Carbonated water is some- 
times used, but care should always be taken to allow it 
to effervesce partially before giving it, lest the gas accu- 
mulate in the stomach. 
Care of the Bowels.-The bowels are usually DIETETIC MANAGEMENT OF SURGICAL CASES. 
379 
moved about the third day after an operation. Some- 
times it is desirable to have them moved before; some- 
times to allow them to remain quiet for several more 
days. The surgeon should always be consulted about 
this if specific orders have not been given. 
Dietetic Management of Shock.-The patient 
will, as a rule, be less shocked if in good condition than 
if unprepared for the operation as outlined above. After 
the operation, in addition to the usual means of external 
heat and the like, stimulating or nutrient enemata may 
be given. The first enema is sometimes given while the 
patient is still on the table. A stimulating enema for an 
adult may contain 2 oz. of brandy, 20 gr. of carbonate 
of ammonium, with sufficient water or beef tea at ioo° F. 
to make 8 oz. Another stimulating enema consists of 1 
oz. of brandy, the white of an egg, 3 oz. of milk, and a 
pinch of salt. 
Diet After Operations on the Various Organs.- 
After operations on the liver the diet consists largely of 
protein and carbohydrate food. Fats are, as a rule, not 
well borne, and are limited in amount or not given at all. 
Water is the first thing of importance, and should be 
forced. It has been demonstrated that if a patient suffer- 
ing with gall-bladder disease does not void at least 500 
cc. of urine in twenty-four hours, mental symptoms are 
almost certain to develop. 
After operations on the pancreas the amount of fat is 
limited or omitted altogether from the dietary. The use 
of artificially pancreatized food has been suggested. 
After operations about the kidney the diet should be 
bland and unirritating, such as has been suggested in 
chronic or even in acute nephritis (inflammation of the 
kidney). All foods known to be irritating to the kidney 
should be withheld. (See Nephritis.) 380 
DIETETICS FOR NURSES. 
Diet After Operations on the Stomach.-The stomach 
and the upper part of the small intestine may be rendered 
sterile or nearly so, and this fact is taken advantage of 
by many operators in surgical procedures about the 
stomach. Finney uses the following diet: For several 
days prior to the operation the stomach is washed out 
twice daily with sterile water, the patient is given sterile 
liquid food served in sterile dishes. Before taking food 
the mouth is thoroughly cleansed with a I per cent, 
solution of carbolic acid. The food is usually given 
every two hours. 
For four or five days after the operation rectal feeding 
is employed. Normal salt solution enemata are alternated 
with nutrient enemata every four hours. On the fifth 
or sixth day egg albumin is given in teaspoonful doses, 
gradually increased to | oz. every two hours if it is well 
borne, and finally to I oz. every two hours on the sixth 
day, 2 oz. on the seventh day, and 4 oz. every three 
hours on the tenth day. On the twelfth or thirteenth 
day the patient is given a soft-boiled egg, and the follow- 
ing day soft food, and on the eighteenth day light solid 
food. 
Operators vary a great deal regarding the feeding of 
their stomach cases. Some allow eight days to elapse 
before beginning mouth-feeding, while others begin a day 
or two after the operation. 
Diet After Operations on the Intestines.-After opera- 
tions on the upper part of the intestine the feeding is the 
same as after stomach operations. The food should be 
such that but little residue will be left in the intestine. 
After ordinary appendix operations the patient may be 
given liquid diet the second day after the operation; on 
the third day a soft diet may be allowed, and solid food DIETETIC MANAGEMENT OF SURGICAL CASES. 
381 
given on the sixth day. On the other hand, if the opera- 
tion has been a serious one and a large pus cavity has 
been evacuated, rectal feeding may be necessary for five 
or six days, and the return to a solid diet may require 
weeks. 
After operations on the rectum the patient is generally 
given a liquid diet for four or five days, after that a soft 
diet, and finally in seven days or longer solid food may 
be prescribed. 
Feeding Through Gastric or Intestinal Fis- 
tulas.-After gastric or intestinal fistulas have been 
made the patient may, if necessary, be fed through these 
openings as early as a few hours after the operation. At 
first only very small quantities of liquid food are given at 
frequent intervals. Kehr advises alternately, every two 
hours, J cupful of tea with cognac, milk and egg, and on 
the second day wine with peptone. He adds bouillon with 
egg on the third day, and begins a " mushy " food, such 
as potato soup, flour soups with egg, beef tea, and 
minced breast of chicken, on the eighth day. After three 
weeks the patient may be allowed to masticate his food, 
and then, by means of a rubber tube, pass it into the 
stomach or intestine through the fistula. CHAPTER XXL 
HOSPITAL DIET. 
There are wide variations in the diets used in hos- 
pitals, and also in the names applied to them. In the 
average American hospital the classification is as follows: 
Ward Diet.-This is also known as "full" or "house 
diet." It is the ordinary diet of all patients for whom 
special diet orders have not been given. 
Light diet, also known as convalescent diet, is that 
used for convalescent patients generally and for others 
for whom it is suitable. It consists of milk, broths, eggs, 
and such other foods as are easily digestible yet nutri- 
tious. 
Special Diets.-Under this heading are included 
dietary formulas suitable for those diseases in which diet 
plays an important part in the treatment. It includes 
such diets as have been recommended in certain diseases 
and which bear the name of the inventor, as Tuffnell's 
diet for aneurism, Banting's diet for obesity, and such 
general diets as the following: 
Milk Diet.-This is composed entirely of milk, 2 to 
3 quarts usually being allowed daily. 
Meat Diet.-This consists chiefly of nitrogenous 
animal foods, with a minimum of sugars and starches. 
It is useful in certain diseases of the stomach where there 
is acid fermentation. It closely resembles the diabetic 
diet. 
Farinaceous Diet.-This is made up of milk, butter, 
382 383 
HOSPITAL DIET. 
and carbohydrates. It is prescribed for convalescents 
and in chronic nephritis, etc. 
Special or extra special articles of diet, as they are 
often termed, include all articles not on the regular diet 
list for the day, and for which special orders are gen- 
erally given. 
Hospital Dietitians.-The increased study of met- 
abolism, especially in some hospitals, has led to the em- 
ployment of especially trained dietitians. The physician 
writes a diet prescription which is worked out by the 
dietitian and supplied from the kitchen. The form used 
at one well-known hospital is as follows: 
PETER BENT BRIGHAM HOSPITAL. 
Diet. 
Ward Date 
Name 
Diagnosis 
Feedings 
Calories 
R. Protein gm. 
Fats gm. 
Carbohydrates gm. 
Salts gm. 
Total fluid c.c. 
Signed 
A diet filling the requirements is figured out by the 
dietitian. It must not only be approximately correct, 
but be attractive from the standpoint of the person who 
is to consume it. CHAPTER XXII 
RECIPES. 
I/ime Water.-Into an earthen jar containing hot 
water stir a handful of fresh unslaked lime. Allow it to 
settle; then decant the clear fluid and bottle it. Water 
may again be added to the lime, and the mixture covered 
and allowed to stand to be decanted as needed. 
Almond Milk.-Blanch one pound of sweet and two 
of bitter almonds that have been soaked in cold water 
for twenty-four hours. This is done by pouring boiling 
water over the almonds, when, after a few minutes, they 
can easily be pressed out of their hulls. Grind the 
almonds in a mill or pound them in a mortar; mix with 
a half-pint of warm milk or water, and allow the mixture 
to stand two hours, after which strain through a cloth, 
pressing the juice out well. Thirty grams of almonds 
yield 200 calories of heat; 250 grams of milk yield 1700 
calories.-(Wegelei) 
Brandy-and-egg Mixture.-Rub the yolks of two 
eggs with half an ounce of white sugar; add 4 ounces 
of cinnamon water and then 4 ounces of brandy. Dose: 
One or two teaspoonfuls every two hours, according to 
age.-{Stokes'^ 
Brandy-and-egg Mixture for Infants.-Beat up 
well the yolk of a raw egg; ten drops of brandy; one 
teaspoonful of cinnamon water; one coffeespoonful of 
white sugar.-{Louis Starri) 
BEVERAGES. 
384 RECIPES. 
385 
Cold Egg-nog.-Beat up an egg; add to it two tea- 
spoonfuls of sugar, a glassful of milk, and a tablespoon- 
ful of brandy or good whisky; mix thoroughly. 
Hot Egg-nog.-Beat up the yolk of one egg; add a 
teaspoonful or two of sugar and a glassful of hot milk; 
strain, and add a tablespoonful of brandy or old whisky, 
or flavor with nutmeg or wine. 
Egg Broth.-Beat up an egg, and add to it half a 
teaspoonful of sugar and a pinch of salt; over this pour 
a glass of hot milk and serve immediately. Hot water, 
broth, soup, or tea may be used in place of milk.- 
{Drexel Instituted) 
Egg Cordial.-Beat up the white of an egg until 
light; add a tablespoonful of cream and beat up to- 
gether, then add two teaspoonfuls of sugar and a table- 
spoonful of brandy. 
Caudle.-Beat up an egg to a froth; add a wine- 
glassful of sherry wine, and sweeten with a teaspoonful 
of sugar; if desired, flavor with lemon peel. Stir this 
mixture into a half-pint of gruel; over this grate a little 
nutmeg and serve with hot toast 
Albumin Water.-Beat the white of one egg until 
very light and strain through a clean napkin. Add six 
ounces of water. If intended for an infant a pinch of salt 
may be added. A teaspoonful or more of sugar and a 
teaspoonful or more of lemon juice, orange juice, or 
sherry wine may be added to enhance its palatableness. 
This drink may also conveniently be made by placing all 
the ingredients in a lemonade-shaker, shaking until 
thoroughly mixed, and then straining. Serve cold. 
Apple Water.-Pour a cupful of boiling water over 
two mashed baked apples; cool, strain, and sweeten. 
Serve with shaved ice if desired. 386 
DIETETICS FOR NURSES. 
Tamarind Water.-Pour a cupful of boiling water 
over a tablespoonful of preserved tamarinds; allow this 
to stand until cool, then strain, and serve with shaved ice. 
Currant Juice.-Take an ounce of currant juice or 
a tablespoonful of currant jelly. Over this pour a cupful 
of boiling water-use cold water with the juice-and 
sweeten to taste. 
Lemonade No. I.-Take the juice of one lemon or 
three tablespoonfuls of lemon juice; add from one to 
three tablespoonfuls of sugar and a cupful (6 ounces) of 
cold water. Serve with cracked or shaved ice if desired. 
Lemonade No. 2.-Pare the rind from one lemon, 
cut the lemon into slices, and place both in a pitcher with 
an ounce of sugar. Over this pour a pint of boiling 
water and let it stand until cold. Strain and serve with 
cracked ice.-(Pavy?) 
Effervescing Lemonade.-This may be made by 
using a carbonated water or by adding half a teaspoonful 
of bicarbonate of soda or potash to a glassful of either 
of the foregoing lemonades. 
Albuminized Lemonade.-Shake together a cupful 
of water, two teaspoonfuls of lemon juice, two teaspoon- 
fuls of sugar, and the white of one egg. Serve at once. 
Orangeade.-Cut the rind from one orange; over 
the rind pour a cupful of boiling water; then add the 
juice of the orange and a tablespoonful of sugar ; cool, 
strain, and serve with shaved ice if desired. If this is too 
sweet, a teaspoonful of lemon juice may be added. 
Imperial Drink.-Add a teaspoonful of cream of 
tartar to a pint of boiling water; into this squeeze the 
juice of half a lemon, or more if desired; sweeten to 
taste and serve cold. This drink is most useful in fevers 
and in nephritis. RECIPES. 
387 
Flaxseed Tea.-Add six tablespoonfuls of flaxseed 
to a quart of water; boil for half an hour; cool, strain, 
sweeten, and if desired flavor with a little lemon juice. 
Linseed Tea.-To a pint of water add two table- 
spoonfuls of linseed, the juice of half a lemon, ounce 
of bruised licorice root (or a piece of licorice the size of 
a filbert), and rock-candy to taste. Boil for one and one- 
half hours and strain.-( Yea.) 
Orgeat.-Blanch two ounces of sweet almonds and 
four bitter almond seeds. Add a little orange-flower water 
and pound into a paste; rub this with a pint of milk 
diluted with a pint of water until it forms an emulsion. 
Strain and sweeten with sugar. (A demulcent and nutri- 
tive drink).-{Pavyd) 
Mulled Wine.-One-fourth of a cupful of hot water, 
one-half inch of stick cinnamon, two cloves, a tiny bit 
of nutmeg, one-half cupful of port (heated), two table- 
spoonfuls of sugar. Boil all the ingredients except the 
wine and sugar for ten minutes; then add the wine and 
sugar, strain, and serve very hot.-{Drexel Instituted) 
Grape Juice.-Pluck Concord grapes from the stem. 
Wash and heat them, stirring constantly. When the 
skins have been broken, pour the fruit into a jelly bag 
and press slightly. Measure the juice and add one- 
quarter the quantity of sugar. Boil the juice and sugar 
together and then pour into hot bottles; cork and seal 
with paraffin or equal parts of shoemaker's wax and resin 
melted together. Less sugar may be uesd.-{Drexel 
Instituted) 
Oatmeal, Barley, or Rice Water.-From the 
grain: Use two tablespoonfuls of grain to a quart of 
water. The grain should have been previously soaked 
overnight or at least for a few hours. When required for 388 
DIETETICS FOR NURSES. 
an emergency, the soaking may be dispensed with and 
the grain boiled for five minutes instead. The water in 
which the grain was soaked should be poured off and 
fresh water added before cooking. The grain should be 
boiled for several hours, water being added from time to 
time to keep the quantity up to a quart. Strain. This 
makes a somewhat thin, watery gruei. 
From prepared flours: Various brands of prepared 
grain flours are on the market, such, for example, as 
Robinson's Barley Flour. These are all somewhat simi- 
lar in preparation. From two rounded teaspoonfuls to a 
tablespoonful of the prepared flour is added to a pint of 
boiling water, and this is boiled for from fifteen to thirty 
minutes and then strained. No previous soaking is re- 
quired. 
CEREALS AND CEREAL GRUELS. 
Either the grain itself or the specially prepared flour 
may be used. When the grains are used they should be 
spread on a clean table and all foreign substances re- 
moved. If the whole grains be used, it is well to wash 
them, after picking them over, with two or three changes 
of cold water. 
Cereals are best cooked in a double boiler. The lower 
part should be filled about one-third full of water, and, 
if more is added during the cooking, it should always be 
boiling hot. The cereal should be cooked over the fire 
for ten or fifteen minutes. The water should be boiled 
first and then salted. The cereal is added gradually and 
the whole stirred to prevent it from burning. It should 
then be placed in the double boiler and steamed until 
thoroughly cooked. Cereals, like other starchy foods, 
require thorough cooking. Most recipes allow too short 
a time. Oatmeal especially should be mentioned. It RECIPES. 
389 
develops a better flavor if cooked for three hours or 
more, and is better when it is prepared the day before 
and reheated when used. It should be just thin enough 
to pour when taken out of the boiler, and when cooled 
should form a thin jelly. 
Any cereal mush may be thinned with water, milk or 
cream and made into a gruel, or the gruel may be made 
directly from the grain or flour. Gruels should be thin, 
not too sweet nor too highly flavored, and served very 
hot. Milk gruels should be made in a double boiler. 
Gruels may be made more nutritious by the addition of 
whipped egg, either the white or yolk or both, and the 
various concentrated food products. 
When cereal flours are used, the flour should be rubbed 
to a smooth paste with a little cold water and added 
slowly to boiling water, stirring constantly until it is 
thoroughly mixed. 
LENGTH OF TIME TO COOK CEREALS. 
Cornmeal mush : 
Boil io minutes, then stean 
1 for 3 hours or more. 
Oatmeal: 
<< (C u cc cc 
Irish oatmeal: 
ll ll ll 11 ll 
« 8 11 11 
Wheatena : 
ll ll << ll ll 
11 11 11 
Gluten mush : 
" 30 " 
Steamed rice : 
Steam for one hour. 
Boiled rice : 
Boil for twenty minutes or 
until soft. 
Arrowroot Gruel.-Dissolve half a teaspoonful of 
sugar and a quarter of a teaspoonful of salt in a cupful 
of water, and heat. Mix half a tablespoonful of arrow- 
root flour with a little water and add to the heated water. 
Boil for twenty minutes, stirring constantly; then add a 
cupful of milk, bring to a boil, strain, and serve hot. 
Barley Gruel.-Proceed as above, using a tablespoon- 
ful of Robinson's Barley Flour instead of arrowroot. 390 
DIETETICS FOR NURSES. 
Oatmeal Gruel.-As above, but use oatmeal, and 
boil for half an hour or longer before adding the milk. 
Flour Gruel.-Proceed as in making arrowroot gruel, 
using instead a tablespoonful of wheat flour. Flavor 
with lemon juice, cinnamon, nutmeg or vanilla. 
Farina Gruel.-Proceed as in making arrowroot 
gruel, using instead a tablespoonful of farina, and boil 
but ten minutes before adding the milk. 
Imperial Granum Gruel.-As in the preceding, 
but use imperial granum instead of farina. 
Cracker Gruel No. i.-Use two tablespoonfuls of 
cracker crumbs and proceed as above. Cook only two 
or three minutes and do not strain. 
Cracker Gruel No. 2.-Brown the crackers, and 
reduce to a powder by means of a rolling-pin. Add 
three tablespoonfuls of the powdered crackers to half a 
cupful of milk and half a cupful of boiling water; cook 
for ten minutes; then add one-fourth of a teaspoonful 
of salt and serve.-{Drexel Instituted) 
Racahout des Arabes.-This is a French prepara- 
tion with a chocolate flavor which makes a most delicious 
gruel. Follow the directions given for farina gruel. 
Flour Ball.-Tie half a pint of flour in a square of 
fine cheese cloth, making a very tight ball. Place this in 
a pot of boiling water and cook for four or five hours. 
After taking out of the cloth, peel off the outside and 
grate the hard ball. Dry in the oven and keep in a cov- 
ered jar. This is useful for making gruels for diluting 
milk for infants. 
Flour-ball Gruel.-Proceed as for arrowroot gruel, 
using two teaspoonfuls of the above grated flour rubbed 
up in cold water, and stir into a pint of boiling water. 
Cook this for ten minutes. RECIPES. 
391 
Cornmeal Gruel No. i.-Use two tablespoonfuls of 
cornmeal and one of flour, a teaspoonful each of sugar 
and salt, one quart of hot water and a cupful of milk. 
Proceed as in making arrowroot gruel, boiling in a double 
boiler for three hours. 
Cornmeal Gruel No. a.-Take a tablespoonful of 
cornmeal and moisten with a little cold water. Stir this 
into a pint of boiling water to which a pinch of salt has 
been added. Cook for three hours in a double boiler, 
or for thirty minutes directly over the fire. In the latter 
case it must be stirred constantly. 
Gluten Gruel.-Mix a tablespoonful of gluten flour 
with one-fourth of a cupful of cold water and stir this 
into one cupful of boiling salted water. Cook directly 
over the fire for fifteen minutes; then add one clove and 
cook over boiling water for a half-hour.-{Drexel Insti- 
tuted) 
Barley or Oatmeal Jelly.-From the grain: Pre- 
pare the grain as directed for barley water. Use from 
four to six tablespoonfuls of grain to the quart of water. 
Boil thoroughly for several hours until the grain is 
thoroughly cooked. Strain and cool. The jelly when 
hot should be just thick enough to pour. 
From the prepared flours : Use two tablespoonfuls of 
the flour to a pint of water. Boil from fifteen to thirty 
minutes and strain. 
Partially Digested Cereals Prepared at the 
Table.-To a sauce of well-cooked oatmeal, wheaten 
grits, or rice, at the customary temperature, add one or 
two teaspoonfuls of Fairchild's Diastasic Essence of Pan- 
creas, or fifteen grains of Fairchild's Dry Extract of Pan- 
creas. Stir for a few minutes before eating. When the 392 
DIETETICS FOR NURSES. 
ferments are added to very hot foods their power becomes 
impaired. 
Tapioca Jelly.-Soak a cupful of tapioca of the best 
quality in a pint of cold water for two hours; when soft, 
place in a saucepan with sugar, the rind and juice of one 
lemon, a pinch of salt, and another pint of water; stir 
the mixture until it boils ; turn into a mold and set away 
to cool; if desired, a glassful of wine may be added.- 
(Bartholow^ 
Tapioca Soup.-Boil a pint of meat broth or stock, 
and, while stirring constantly, sprinkle in ounce of pre- 
viously washed tapioca. Cover the saucepan, and let it 
stand until the tapioca is quite soft. Skim and serve.- 
(Yeo) 
Chestnut Puree.-One pound of chestnuts are peeled, 
and boiled in water until the second (inside) skin comes 
off easily. The chestnuts are placed in a sieve until all 
the water drains off. They are then washed in a dish 
and afterward pressed through a sieve. Melt three 
ounces of butter in a stewpan on the fire, add a little 
salt and sugar-enough to cover the point of a knife- 
and then the chestnuts. Stew them for half an hour, 
stirring frequently ; pour in enough bouillon so that the 
mush does not get too thick.-( Wegele) 
BREAD. 
Drexel Institute Bread Recipe.-For two loaves 
take two cupfuls of warm milk or water, two teaspoon- 
fuls of salt and two of sugar, a tablespoonful of lard or 
butter, one-half cake of compressed yeast, and about four 
pounds of flour. Put the water or milk, salt, sugar, and 
fat into a bowl. Dissolve the yeast in warm water; add 
it and the flour gradually; when stiff enough to handle, RECIPES. 
393 
turn the dough on a floured board and knead until soft 
and elastic. Put it back into the bowl, and let it rise in a 
warm place until it is double its bulk. Then divide into 
loaves or shape into biscuits. Allow these to rise in the 
pan in which they are to be baked. Cover the bread and 
again allow it to double its bulk. Bake loaves one hour 
in a hot oven. The large amount of yeast allows the 
bread to be made and baked in three hours. 
Brown Bread.-Take one-half cupful scalded milk, 
one-half cupful water, one teaspoonful salt, one-half 
tablespoonful butter, one-half tablespoonful lard, two 
tablespoonfuls of molasses, one-half cupful white flour, 
sufficient Graham flour to knead, and three-quarters of a 
yeast cake dissolved in one-quarter of a cupful of luke- 
warm water. Prepare the same as white bread. Instead 
of Graham flour, equal parts of Graham flour and white 
flour may be used in kneading. 
Nut-brown Bread.-The same as preceding, with 
one cupful of nuts chopped and added. 
Whole-wheat Bread.-Dissolve a quarter of a 
yeast cake in a tablespoonful of lukewarm water. Pour 
half a cupful of hot water over half a cupful of milk, 
and when lukewarm add the yeast and half a teaspoonful 
of salt. To this add a cupful of whole-wheat flour and 
beat for five minutes. Cover and allow this to stand in a 
warm place for two hours and a half. Then add whole- 
wheat flour gradually, mixing the mass until it can be 
kneaded. Knead until elastic; shape and place into 
baking-pans. Cover and allow to stand in a warm place 
until it doubles its bulk. Prick the top with a fork and 
bake for one hour. The oven should not be hot as for 
white bread. 
Pulled Bread.-Use bread made with water. Make 
into long loaves, and as soon as baked take off the crust. 394 
DIETETICS FOR NURSES. 
Pull into stick-shaped pieces and brown slightly in a slow 
oven. 
I/axative Bread: 
i egg. 
I cup molasses. 
| cup dry rolled oats. 
i teaspoonful soda. 
| cup of sugar. 
i cup of sour milk. 
3 cups of Graham flour. 
i tablespoonful warm water. 
Whip the egg and sugar together and add the molasses last; bake in 
slow oven for one hour. Use pulverized bran if Graham flour is not to 
be had. This quantity makes one loaf. 
Bran Biscuits: 
60 gm. bran (horse bran). 
| teaspoonful salt. 
6 gm. powdered agar-agar. 
100 c.c. (I glass) cold water. 
Tie bran in cheese-cloth and wash under cold water tap until water is 
clear; heat agar-agar in the water (100 c.c.) to the point of boiling; add 
to washed bran the salt and agar-agar solution (hot); mold into two cakes. 
Place in pan on oiled paper; then, when firm and cool, bake in moderate 
oven thirty to forty minutes. (Allen.) 
VEGETABLES. 
TIME-TABLE FOR COOKING VEGETABLES IN WATER. 
(DREXEL INSTITUTE.) 
Potatoes 25-3o min. 
Carrots 35-45 " 
Turnips 45 " 
Beets (young) ... 45 " 
Beets (old) .... 3-4 hrs. 
Tomatoes 1-3 " 
Onions 45-60 min. 
Cabbage 45-60 " 
Cauliflower .... 20-30 " 
Asparagus 20-30 " 
Spinach .... 30-4 5 min- 
Celery 20-30 " 
Parsnips .... 30-45 " 
Green peas . . . 30-40 " 
String-beans . . 1-3 hrs. 
Lima beans ... 1 hr. or more. 
Green com . . . 12-20 min. 
Rice 20-45 " 
Macaroni .... 45-60 " 
Wash thoroughly; pare or scrape if skins must be 
removed; Stand in cold water until cooked, to keep 
them crisp and prevent their being discolored. Cook in 
boiling water; the water must be kept at the boiling- 
point. Use two teaspoonfuls of salt with two quarts of 
GENERAL RULES FOR COOKING VEGETABLES. RECIPES. 
395 
water; put the salt into the water when the vegetables 
are partially cooked. The water in which vegetables are 
cooked is called vegetable stock. 
Fresh green vegetables require less water than others. 
Cabbage, cauliflower, onions, and turnips should be 
cooked uncovered in a large amount of water. 
All vegetables must be drained as soon as tender. 
Season with salt and pepper and serve hot with butter or 
sauce. 
The color may be kept in green vegetables, such as 
spinach, by pouring cold water through them after 
draining. 
Cold vegetables may be used for salads or may be 
placed in a baking-dish with one-half the quantity of 
sauce (2 cupfuls vegetables and 1 cupful sauce), covered 
with buttered crumbs, and browned in a hot oven. 
Sauce for Vegetables 
3 tablespoonfuls of butter. 
3 tablespoonfuls of flour. 
I teaspoonful of salt. 
White pepper. 
I cupful of milk. 
I cupful of stock. 
SOUPS WITHOUT MEAT. 
These soups are thickened by using butter and flour; 
this prevents a separation of the thicker and thinner 
parts of the soup. The butter should be heated until it 
bubbles, the flour and seasoning added, and enough of 
the hot liquid to make a smooth sauce thin enough to 
pour easily; this should be poured into the rest of the 
hot liquid and cooked in a double boiler until the soup 
is of the proper consistence. 
In soups made of dried peas and beans soda is used 
to soften the casein; it is also used in tomatoes to neu- 
(Drexel Institute.) 396 
DIETETICS FOR NURSES. 
tralize the acid. These soups must be served in hot 
dishes as soon as ready. Crisp crackers, croutons, or 
soup sticks may be served with them. 
Crisp Crackers: 
Split and butter thick crackers and brown in a hot oven. 
Cream-of-Tomato Soup: 
I can tomatoes. 1 cupful of flour. 
| teaspoonful soda. 3| teaspoonfuls of salt. 
| cupful of butter. | teaspoonful of white pepper. 
I quart of milk. 
Stew the tomatoes slowly one-half to one hour, strain, and add soda 
while hot; make a white sauce and add the tomato juice. Serve imme- 
diately. 
Cream-of-Celery Soup 
11 cupfuls of celery. 
I pint of water. 
I cupful of milk. 
I cupful of cream. 
2 tablespoonfuls of butter. 
| cupful of flour. 
| teaspoonful of salt. 
| teaspoonful of white pepper. 
Cook the celery in the boiling water until very soft; strain and add the 
hot liquid ; make a white sauce and cook until it is thick cream. 
Cream-of-Potato Soup 
3 potatoes. 
2 cupfuls of milk. 
| cupful of cream. 
Yolks of 2 eggs. 
I teaspoonful of salt. 
Pepper. 
i teaspoonful of onion juice. 
Cook the potatoes until soft, drain, mash, add the hot liquid, and 
strain ; add the beaten yolks and seasoning. Cook in a double boiler 
until the egg thickens, stirring constantly. Serve immediately. 
Oyster Stew: 
I cupful of milk. 
I pint of oysters. 
J teaspoonful of salt. 
I tablespoonful of butter. 
Pepper. 
Heat the milk. Cook and strain the oyster juice. Add the oysters, 
which have been rinsed, and cook until the edges curl. Add seasoning, 
butter, and hot milk. Serve at once. This soup may be thickened with 
a tablespoonful of flour cooked in the butter as for white sauce. RECIPES. 
397 
MILK PREPARATIONS. 
Partially Peptonized Milk.-Into a clean granite- 
ware or porcelain-lined saucepan place one pint of milk, 
four ounces of water, and the contents of one of Fair- 
child's peptonizing tubes, or five grains of pancreas 
extract and fifteen grains of bicarbonate of soda. Heat 
gradually until it boils, stirring constantly. Boil gently 
for ten minutes, strain into a clean bottle, cork, and keep 
in a cool place. Before using shake the bottle well; 
serve hot or cold. Prepared in this way it will not 
become bitter. 
Peptonized Milk.-Cold Process.-Mix milk, water, 
and peptonizing agents as directed in the preceding 
recipe, and immediately place the bottle on ice. Use 
when ordinary milk is required. This is particularly 
suited for dyspeptics and individuals with whom milk 
does not, as a rule, agree. The flavor of the milk re- 
mains unchanged. 
Peptonized Milk.-Warm Process.-Put in a glass 
jar one pint of milk and four ounces of cold water; add 
five grains of extract of pancreas and fifteen grains of 
bicarbonate of soda. After mixing thoroughly, place the 
jar in water as hot as can be borne by the hand (about 
115° F.). This should be heated for from six to twenty 
minutes. At the end of this time it may be placed upon 
ice until required. The contents of one of Fairchild's 
peptonizing tubes may be used in place of the pancreas 
extract. If the milk is to be kept for any length of time, 
it should be brought to a boil, to prevent the formation 
of too much peptone, which renders the milk bitter. 
Hot Peptonized Milk.-Mix together the usual 
peptonizing ingredients and add a pint of fresh cold 
milk; after thoroughly shaking the bottle, place it on 398 
DIETETICS FOR NURSES. 
ice. When needed pour out the required amount, heat 
it, and drink it as hot as it can agreeably be taken,, If 
required for immediate use, the ingredients may be mixed 
together in a saucepan and slowly heated to the proper 
temperature. 
Effervescent Peptonized Milk.-Put some finely 
cracked ice in a glass; fill it half-full of Apollinaris, 
Vichy, or siphon water, and immediately add the pep- 
tonized milk. Drink while effervescing. Brandy may 
be added if desired. 
Specially Peptonized Milk.-This is to be used in 
the preparation of jellies, punches, and all recipes where 
the milk is to be mixed with fruit juices or acids. Pre- 
pare according to the hot process; keep the milk at a 
temperature of 1150 F. for one hour; pour into a sauce- 
pan and bring to a boil. If required hot, this may be used 
immediately, or it may be set aside on ice, to be used 
later. If not heated for an hour, the milk will curdle 
on being mixed with an acid. If not boiled, the pep- 
tonizing ferment will digest gelatin and prevent the forma- 
tion of jelly. 
Peptonized Milk Jelly.-Soak well half a box of 
Cox's gelatin in four ounces of water. Take one pint 
of hot specially peptonized milk and add four ounces of 
sugar. Put in the gelatin and stir until it is dissolved. 
Pare one fresh lemon and one orange, and add the rinds 
to the mixture. Squeeze the lemon and the orange 
juice into a glass, strain, and mix with two or three 
tablespoonfuls of St. Croix rum, or brandy, if preferred. 
Add the juices to the milk, stirring constantly. Strain, 
and allow it to cool to the consistence of syrup; when 
almost ready to set, pour into cups and set in a cold 
place. Do not pour the milk into molds until the RECIPES. 
399 
mixture is nearly ready to set, otherwise it will separate 
in setting. 
Peptonized Milk Punch..-In the usual milk punch 
recipes the specially peptonized milk may be used in 
place of ordinary milk. Take a goblet one-third full of 
finely crushed ice; pour on it a tablespoonful of rum 
and a dash of Curacao, or any other liquor agreeable to 
the taste. Fill the glass with peptonized milk; stir well, 
sweeten to taste, and grate a little nutmeg on top. 
Peptonized Milk lemonade.-Take a glass one 
third full of cracked ice; squeeze into this the juice of a 
lemon, and add two or three teaspoonfuls of sugar dis- 
solved in water. Fill the glass with fresh specially 
peptonized milk and stir well. If preferred, equal parts 
of milk and of an effervescent mineral water may be 
used. Pour the water on the lemon juice and ice, and 
immediately fill the glass with milk. 
Peptonized Milk Gruel.-Mix with a teaspoonful 
of wheat flour, arrowroot flour, or Robinson's Barley 
Flour with half a pint of cold water. Boil for five 
minutes, stirring constantly. Add one pint of cold milk 
and strain into a jar; add the usual peptonizing ingre- 
dients; place in warm water (i 15° F.)for twenty minutes, 
and then upon ice. 
Junket, or Curds and Whey.-Take a half-pint of 
fresh milk; add one teaspoonful of Fairchild's Essence 
of Pepsin and stir just sufficiently to mix. Pour into 
custard cups, and let it stand until firmly curdled. It 
may be served plain or with sugar and grated nutmeg. 
It may be flavored with wine, which should be added 
before curdling takes place. 
Junket with Egg.-Beat one egg to a froth, and 
sweeten with two teaspoonfuls of white sugar; add this 400 
DIETETICS FOR NURSES. 
to a half-pint of warm milk; and then add one teaspoon- 
ful of essence of pepsin and let it stand until curdled. 
Cocoa Junket.-Put an even tablespoonful of any 
good cocoa and two teaspoonfuls of sugar into a sauce- 
pan ; scald with two tablespoonfuls of boiling water and 
rub into a smooth paste; then stir in thoroughly one-half 
pint of fresh, cool milk; heat this mixture until it is 
lukewarm-not over ioo° F.-then add one teaspoonful 
of Fairchild's Essence of Pepsin and stir just enough to 
mix; pour quickly into small cups or glasses, and let it 
stand until firmly curdled, when the junket is ready for 
use. It may be placed on ice and eaten cold; as a 
dessert it may be served with whipped cream.-(Fair- 
child^ 
Coflfee Junket.-Dissolve two teaspoonfuls of sugar 
in two tablespoonfuls of clear, strong coffee; mix this 
thoroughly with one-half pint of fresh, cool milk; add a 
teaspoonful of Fairchild's Essence of Pepsin as directed 
above, and serve in the same way. 
Vanilla, Bitter Almond, or Strawberry Junket. 
-Add the flavoring extract to the cold milk and then 
prepare in the usual way. A half a teaspoonful of vanilla 
or bitter-almond extract or a tablespoonful of pure con- 
centrated strawberry syrup should be allowed to a half- 
pint of milk. 
Milk I/emonade.-Take two ounces of sugar, five 
ounces of boiled milk, one-half lemon, or two ounces of 
white wine, five ounces of boiling water, and the rind of 
half a lemon. Pour the boiling water over the peel and 
the sugar; allow it to cool, add the milk, and then the 
lemon juice or wine. Strain after ten minutes. 
Milk Punch.-Shake together in a lemonade-shaker 
a glass of milk, a tablespoonful of rum, brandy, or good RECIPES. 
401 
old whisky, and two teaspoonfuls of sugar. After it has 
been poured into a glass a little nutmeg may be grated 
over the top. 
Milk Porridge.-Mix a tablespoonful of flour with 
one-fourth cupful of cold milk and stir into one-fourth 
cupful of hot milk; if desired, add two raisins cut into 
quarters. Cook over boiling water for one hour, and 
add one-quarter teaspoonful of salt just before serving. 
-{Drexel Institute.} 
Whey.-Take a half-pint of fresh milk heated luke- 
warm (1150 F.), add one tablespoonful of essence of 
pepsin, and stir just enough to mix. When this is firmly 
coagulated, beat up with a fork until the curd is finely 
divided and then strain. For flavoring purposes lemon 
juice or sherry wine may be added. 
Cream-of-tartar Whey.-Add a heaping teaspoon- 
ful of cream of tartar to a pint of boiling water. Strain, 
sweeten to taste, and serve cold.-{Pavy.} 
Wine Whey.-Cook together a cupful of milk and 
half a cupful of sherry wine. As soon as the curd 
separates, strain and sweeten. This may be eaten hot 
or cold. 
Lemon Whey.-This is made in the same way as 
the foregoing recipe, using three tablespoonfuls of lemon 
juice instead of the wine. 
Kumiss No. I.-Take a quart of skim milk, one- 
fifth of a cake of yeast, and two tablespoonfuls of sugar. 
Heat the milk. Dissolve the yeast in a little water and 
mix it with the sugar and lukewarm milk. Pour the 
mixture into strong bottles, stopper them tightly with 
new corks, and tie down the corks with stout twine. 
Shake the bottles.well and place in a refrigerator; this 
will allow the mixture to ferment slowly. After three 402 
DIETETICS FOR NURSES. 
days lay the bottles on their sides, turning them occa- 
sionally. Five days are required to complete the fer- 
mentation ; the kumiss is then at its best.-{Drexel 
Instituted) 
Kumiss No. 2.-Pour into wired bottles one quart of 
fresh milk, half an ounce of sugar, a piece of fresh yeast 
cake half an inch square, and keep at a temperature be- 
tween 6o° and 700 F. for one week, shaking five or six 
times a day; then put on ice.-{Holld) 
Milk Mixture.-This is made of cream, two parts; 
milk, one part; lime water, two parts; sugar water, 
three parts (seventeen and three-fourths drams of milk 
sugar to a pint of water).-{A. V. Meigsd) 
Milk-and-cinnamon Drink.-Add a small amount 
of cinnamon to the desired quantity of milk and boil 
it. Sweeten with sugar and add brandy if desired.^ 
{Ringerd) 
Albuminized Milk.-Shake in a covered jar or 
lemonade-shaker a cupful of milk, a tablespoonful of lime 
water, and the white of an egg. Sweeten, flavor as de- 
sired, and serve at once. 
Milk-and-cereal Waters.-A most valuable method 
of preparing milk for invalids with whom it disagrees is 
to mix equal parts of milk and thoroughly cooked 
barley, rice, oatmeal or arrowroot water and boil them 
together for ten minutes. This may be served plain, or 
flavored by cooking with it a cut-up raisin, a sprig of 
mace, or a piece of stick cinnamon, which should be 
strained out before serving. 
Irish Moss and Milk.-Soak about two tablespoon- 
fuls of Irish moss for five minutes and wash thoroughly 
in cold water. Add to a cupful of milk and soak for 
half an hour; then heat slowly, stirring constantly, and RECIPES. 
403 
then boil for ten minutes, preferably in a double boiler; 
strain, and pour into cups and cool. This maybe served 
while hot, and may be rendered more nutritious by the 
addition of the white of an egg stirred into it just before 
serving. 
Milk with Other Diluents.-Milk may be diluted 
with advantage in many cases by adding lime water, or 
Vichy, Apollinaris, or some other sparking table water. 
From one-half to one-eighth the total volume may be 
added. 
EGGS. 
Eggs are exceedingly valuable as food for invalids. 
They should always be fresh. When received they 
should be washed and then placed in a cool place. They 
should not be kept with any article of food having an 
odor, as they absorb such odors and the taste is thereby 
impaired. Stale eggs will not sink, and if held to a 
bright light they show a dark spot. The yolk of an egg 
that has been broken may be kept fresh by placing it 
(unbroken) in a cupful of cold water. This should be 
set in a cool place. This will keep it fresh for twenty- 
four hours or more. 
Eggs and all other albuminous food should be cooked 
at as low temperatures as possible, in order to avoid 
rendering them tough. 
Eggs are best cooked in the shell as follows: 
Soft-cooked Eggs.-Place in a pint of boiling water, 
remove from the fire, and allow to stand for eight or ten 
minutes. If the egg is very cold to start with, it will 
take a little longer. 
Hard-cooked Eggs.-Place in water, bring to a boil, 
and then set on the back part of the stove for twenty 
minutes. 404 
DIETETICS FOR NURSES. 
Eggs should be served as soon as cooked, and the 
dishes should be warmed and ready. 
EGGS AND MILK. 
Rules for Custards.-The eggs should be thor- 
oughly mixed but not beaten light, the sugar and salt 
added to these, and the hot milk added slowly. Custards 
must be cooked over moderate heat; if a custard curdles, 
put it in a pan of cold water and beat until smooth. 
Custards should always be strained.-{.Drexel Institute.') 
Soft Custard.-Take a pint of milk, the yolks of two 
eggs, two tablespoonfuls of sugar, and a pinch of salt. 
Mix all except the milk in a bowl. Heat the milk to the 
boiling-point and add, stirring constantly. As soon as 
mixed, pour into the saucepan in which the milk has been 
heated and cook from three to five minutes, stirring con- 
stantly until it thickens. Strain, and pour into a cold bowl, 
and flavor with from half to one teaspoonful of vanilla, 
a teaspoonful or more of sherry, or other flavoring ma- 
terial as desired. Custards may be cooked to advantage 
in a double boiler. 
Chocolate Custard.-Melt half an ounce of Baker's 
chocolate and add to the milk, and proceed as above. 
Steamed Custard.-Mix the above, using the whole 
eggs instead of the yolks. Strain, pour into cups, and 
steam over boiling water until firm. 
Baked Custard.-Proceed as above, but pour the custard 
into baking-cups. Place the cups in a deep baking-pan 
and fill the pan nearly as high as the cups with boiling 
water. Place in the oven and bake twenty minutes or 
longer, according to the size of the cup. When done a 
clean knife thrust into the custard comes out clean; if it 
is not done, it comes out covered with milk. RECIPES. 
405 
MEATS. 
General Rules for Preparing Meat.-Meat must 
be weighed, trimmed, and wiped with a damp cloth. It 
should be removed immediately from the paper in which 
it was wrapped and placed in a cool place. Only tender 
cuts of meat should be broiled, pan-broiled, or roasted. 
When meat is to be cooked by any of these methods, it 
should first be seared, and then the temperature slightly 
lowered; by searing, the albumin on the outer surface of 
the meat is hardened and the meat is thus cooked in its 
own juices. 
Tough meat should be cooked in water; boiling water 
hardens the albumin on the outer surface of the meat 
and prevents the juices from escaping. Meat should be 
put in boiling water and the water allowed to boil for ten 
or fifteen minutes; then the cooking should be allowed 
to proceed at a low temperature until the meat is tender. 
If the water bubbles, it is too hot. Cooked in this way 
tough meat will become tender. The time required for 
roasting or cooking in water varies with the weight and 
quality of the meat. 
For roasts weighing less than 8 pounds allow ten min- 
utes to the pound and ten minutes extra ; for those weigh- 
ing from 8 to 12 pounds, allow twelve minutes to the 
pound and twelve minutes extra; for those weighing 
over 12 pounds, allow fifteen minutes to the pound and 
fifteen minutes extra. For meat weighing less than io 
pounds, to be cooked in water, allow twenty minutes to 
the pound and twenty minutes extra. 
The time required for broiling meat varies with the 
thickness of the meat. 
Stock and broth are prepared by prolonged soaking 
of the meat in cold water and then cooking it at a low 406 
DIETETICS FOR NURSES. 
temperature for several hours, allowing it to cool uncov- 
ered. The meat that remains after straining may be 
utilized in various ways, adding a little fresh meat to give 
it flavor. 
The fat must not be removed from stock or broth, for 
it excludes the air and prevents decomposition. It must, 
however, be entirely removed before the stock or broth 
is used ; this fat may be used in place of drippings. The 
trimmings of fat from meat should be clarified. Small 
globules of fat may be removed from cold broth with a 
cloth that has been dipped in boiling water and then 
wrung dry. Fat may be removed from hot broth by 
means of tissue-paper or a slice of bread. 
Cooking Tender Meats.-Roasting.-Skewer the meat 
into shape. Place it on a rack in a meat pan, into the bot- 
tom of which pieces of fat from the meat have been placed. 
Put in a hot oven on the grate for ten minutes, to sear 
the meat. If desired it may be seasoned with salt and 
pepper. Then remove to the floor of the oven and baste 
every ten minutes, until it is done. 
Broiling.-Remove extra fat from the meat and grease 
the broiler with a part of the fat. Broil over a clear fire; 
sear, and then turn every ten seconds. Chops one inch 
thick should be cooked for five minutes. A steak two 
inches thick should be cooked for ten minutes. Season 
and serve on a hot platter. 
Pan-broiling.-Remove all the fat from the meat. Heat 
a frying-pan very hot, but use no fat. Sear the meat on 
both sides, and then cook more slowly until it is done. 
Stand chops up on their edges to brown. Keep the pan 
free from fat. The time required for pan-broiling is the 
same as that required for broiling.-{Drexel Instituted) RECIPES. 
407 
GENERAL RULES FOR SOUPS. 
Both meats and vegetables should be cut into small 
pieces. The soup should be started with cold water 
poured over the meats and the heat applied gradually 
and the soup allowed to simmer, in order to dissolve as 
much of the nutriment as possible. If heated rapidly 
the albumin in the meat coagulates, and little but the 
extractives passes into the soup. The vegetables are 
added when the soup is nearly done. 
Remove the fat by skimming, by using blotting-paper 
by straining through a cloth wet in cold water, or, best 
of all, by cooling the soup when all the fat rises to the 
top, when it can be easily removed. 
Clear soups may be rendered more nutritious by the 
addition of sago or of some cereal, as barley or rice. 
These may also be added with advantage to many thick 
soups. 
Soups should always be served hot. Soup jellies are 
served cold, and in hot weather may be substituted for 
warm soups. 
Soups may also be made from soup stocks, which may 
be prepared in any quantity and kept for several days. 
Stocks may be made from any meat. Those made from 
chicken or veal are light in color, and those from beef 
and mutton somewhat darker. Stocks may also be made 
by using the bones from any kind of meats. 
Soup Stock.-To make stock, use a chicken or 
several pounds of bones with some meat attached, or a 
pound of lean meat and one quart of water. Cut-up 
vegetables may be added as desired. For flavoring add 
a sprig of parsley and of celery, a peppercorn, a small 
onion, and a scant teaspoonful of salt. Any of the 
flavoring vegetables may be omitted as desired or others 408 
DIETETICS FOR NURSES. 
added. The meat should simmer for several hours, until 
but half the quantity of water remains. Then add the 
other ingredients, simmer half an hour longer, strain and 
cool. Remove the fat. 
Soup Stock from Beef Extract.-Cook the other in- 
gredients, except the salt, as given above, for half an 
hour, using a quart of water. Then add a teaspoonful 
oi beef extract and a quarter of a teaspoonful of salt. 
Soup from Stock.-Rice, tapioca, or whatever is de- 
sired is cooked and the stock added, with additional 
seasoning as thought necessary. Cream, yolks of eggs, 
Irish moss, cornstarch or arrowroot may be added to 
render the soup more nutritious. 
Chicken Broth.-Take one pound of chicken and a 
pint of cold water. Clean the fowl, cut it into pieces, 
and remove the skin. Separate the meat from the bone 
and chop the meat very fine. Place with the bones-if 
large, they should be broken-in the water and soak for 
an hour. Cook over hot water for four or five hours at 
a temperature of 190° F. Strain and add salt. Water 
must be added from time to time to keep the quantity 
up to a pint. Remove the fat. If the broth is to be 
reheated use a double boiler. 
Sweetbread Soup.-The sweetbread is soaked in 
cold water for one hour, the water being renewed fre- 
quently during this time. It is then boiled for one hour 
in slightly salted water or beef broth, to which one may 
add one teaspoonful of julienne to improve the taste. 
After it is soft the sweetbread is taken out of the beef 
broth and all blood-vessels and skin are removed. It 
may now be cut into pieces the size of a walnut and 
put on a plate, over which the beef broth is poured, or 
the sweetbread may be forced through a sieve, beef RECIPES. 
409 
broth poured over this, and the whole put on the fire 
again until it boils, after which the soup may be served. 
This latter process is to be recommended in the case of 
dyspeptics. One hundred grams of raw sweetbread 
generate about 90 calories of heat.-{Wegeled) 
Meat Broth (Beef, Veal, Mutton, or Chicken).- 
Cover one pound of chopped lean meat with one pint of 
water and allow it to stand for from four to six hours. 
Then cook over a slow fire for an hour until reduced 
to half the quantity. Cool, skim, pour into jar and 
strain. 
Veal Broth.-Pour a pint of water on a half-pound 
of finely chopped lean veal and allow it to stand for 
three hours. Boil for a few minutes, strain, and season 
with salt. 
Clam or Oyster Juice.-Cut the clams or oysters 
into pieces and heat for a few minutes in their juice. 
Strain through muslin and serve while hot. In straining 
great care must be taken that sand does not pass through 
the muslin. The juices should be diluted and may be 
frozen.-{Drexel Instituted) 
Clam Broth.-Wash three large clams very thor- 
oughly, using a brush for the purpose. Place in a kettle 
with half a cupful of cold water. Heat over the fire; as 
soon as the shells open the broth is done. Strain 
through muslin, season, and serve.-{Drexel Instituted) 
Mutton Broth with Vegetables.-Allow one 
pound of neck of mutton to each pint of water; add 
carrots, turnips, onions, and barley; let all simmer 
together for three hours. 
Mutton Broth without Meat.-Cook two "shank- 
ends" in a pint of cold water, and vegetables as directed 
in the foregoing recipe; simmer for three hours and strain. 410 
DIETETICS FOR NURSES. 
Beef Tea No. I.-Cut up a pound of lean beef into 
pieces the size of dice; put it into a covered jar with 
two pints of cold water and a pinch of salt. Let it 
warm gradually and simmer for two hours, care being 
taken that it does not at any time reach the boiling- 
point.-(Yeo^ 
Beef Tea No. a.-Put a pound of finely mixed beef 
with a pint of cold water into a suitable vessel. Let it 
stand for an hour, stirring occasionally. Put the vessel 
containing the beef into a saucepan of water, place it 
over the fire, and allow the water to boil gently for an 
hour (or the vessel containing the beef tea may be put 
into an ordinary oven for an hour). Pass the beef tea 
through a strainer. A fine sediment appears in the fluid, 
and this should be drunk with the liquid. Flavor with 
salt. At no time should the beef extract be exposed to 
a temperature of more than 1700 F.-{Pavy^ 
Beef Tea No. 3.-Chop fine a pound of beef free 
from fat, tendons, etc., and digest with a pint of cold 
water for two hours. Let it simmer on the stove for 
three hours at a temperature never above 1600 F. Re- 
place the water lost by evaporation by adding cold water, 
so that a pint of beef tea shall represent a pound of beef. 
Strain and carefully express all fluid from the beef.- 
{Bartholow^ 
Beef Tea with Oatmeal.-Mix thoroughly one 
tablespoonful of groats with two of cold water; add to 
this a pint of boiling beef tea. Boil for ten minutes, 
stirring constantly, and strain through a coarse sieve.- 
(Yeo) 
Beef Tea, Flavored.-Beef tea may be flavored 
agreeably by boiling in it a pinch of mixed herbs, a bay- 
leaf, or a bit of onion, carrot, turnip, or celery and a few RECIPES. 
411 
peppercorns. The roots should either be chopped small 
or be scraped to a pulp before being added to the broth. 
-(Yeo) 
Beef Juice.-Broil quickly pieces of the round or 
sirloin of a size to fit the opening in a lemon squeezer. 
Both sides of the beef should be scorched quickly to 
prevent the escape of the juices, but the interior should 
not be fully cooked. As soon as they are ready the 
pieces of meat should be squeezed in a lemon squeezer 
previously heated by being dipped in hot water. As it 
drips the juice should be received into a hot wineglass; 
it should be seasoned to the taste with salt and a little 
Cayenne pepper, and taken while hot.-(Bartholow) 
Cold Beef Juice.-Cover one pound of finely chopped 
lean beef with eight ounces of cold water and allow it to 
stand for eight or ten hours. Squeeze out the juice by 
means of a muslin bag; season with salt or sherry wine 
and drink cold or slightly warmed. It may be added to 
milk, care being taken that the milk be not too hot before 
the juice is added. 
Iced Meat Extract.-Cut into pieces the size of a 
hand one kilo of fresh beef; wrap in a coarse, lattice- 
like linen bag, put under a lever press, and press slowly. 
The juice should be caught in a porcelain dish. This is 
done best by a druggist. By this method about 500 gm. 
of juice are obtained. The juice is mixed with 250 gm. 
of sugar, 200 gm. of freshly expressed lemon juice (this 
last is best omitted in the case of dyspeptics), and 20 
gm. of cognac containing vanilla extract; stir in well the 
yolks of three eggs ; the entire mixture is then placed 
in a freezer.-(7/. Ziemssen) 
Raw-meat Juice.-Add to finely minced rump steak 
cold water, in the proportion of one part of water to four 412 
DIETETICS FOR NURSES. 
parts of meat. Stir well together, and allow it to stand 
for half an hour. Forcibly express the juice through 
muslin, twisting it to get the best results.-(Cheadle^ 
Succus Camis (Meat Juice).-Cut up the meat into 
small bits, arrange in layers separated from one another 
by coarse linen, and then place in a powerful press. From 
each kilogram of meat about 230 gm. of a blood-red 
juice are obtained. This contains about 6 per cent, of 
albuminates. Its taste is similar to that of raw meat; 
its flavor may be improved by the addition of salt and 
beef tea not hot enough to coagulate the albumin.- 
{Pettenkoffer and Pod.) 
Beef Essence.-Chop up very fine a pound of lean 
beef free from fat and skin ; add a little salt, and put into 
an earthen jar with a lid; fasten up the edges with a thick 
paste, such as is used for roasting venison in, and place 
the jar in the oven for three or four hours. Strain through 
a coarse sieve, and give the patient two or three table- 
spoonfuls at a time.-(Fu) 
American Bouillon (American Broth).-Place in 
a tin vessel that can be sealed hermetically alternate layers 
of finely minced meat and vegetables. Seal it, and keep 
it heated in a water bath (bain marie) for six or seven 
hours, and then express the broth.-(Yeo.) 
Bottle Bouillon.-Cut beef, free from fat, into 
squares. Place these in a stoppered bottle, put the 
bottle in a basin of warm water, heat slowly, and boil 
for twenty minutes. There will be about an ounce of 
yellowish or brownish fluid for each three-quarters of a 
pound of meat used. The flavor is that of concentrated 
bouillon.-( Uffelmamd) 
Peptonized Oysters.-To half a dozen oysters with 
their juice add half a pint of water and boil for a few RECIPES. 
413 
minutes. Pour off the broth and set it aside. Mince 
the oysters, and with the aid of a potato-masher reduce to 
the consistence of a paste. Place this with the broth in 
a glass jar and add fifteen grains each of extract of pan- 
creas and of bicarbonate of soda and mix. Allow this 
to stand in hot water (1150 F.) for one and one-half 
hours. Pour into a saucepan and add half a pint of milk; 
heat over a slow fire to boiling-point. Flavor with salt 
and pepper and serve hot. Let the heating be done 
gradually, and be careful to bring the mixture to a boil 
before taking it from the fire.-{Fairchild)) 
Peptonized Beef.-Cover one-fourth of a pound of 
finely minced lean beef (or beef and chicken mixed) with 
half a pint of cold water. Cook over a slow fire until it 
has boiled for a few minutes, stirring constantly. Pour 
off the broth and rub or pound the meat to a paste. 
Put meat and broth and half a pint of cold water in a 
glass jar, and add twenty grains of extract of pancreas 
and fifteen grains of bicarbonate of soda. Mix well and 
keep in a warm place-at about 1 io°-i 150 F.-or place 
it in warm water and allow it to stand three hours, stir- 
ring or shaking occasionally. Boil quickly; strain or 
clarify with the white of an egg and season with salt and 
pepper. If desired, it need not be strained, as the small 
particles of meat are usually easily digested. Cereals 
may be added, boiling with half the amount of water 
previously directed, and mixing all together before pep- 
tonizing. At the end of three hours the mixture must 
be boiled or it will spoil.-{Fairchild)) 
METHODS OF PREPARING RAW BEEF. 
Meat given raw should always be perfectly fresh and 
very finely divided. Scrape the meat with a sharp knife, 414 
DIETETICS FOR NURSES. 
which will separate the coarser fibers. If the resulting 
mass is stringy, pass through a fine sieve. This may be 
seasoned with salt and pepper, and served on toast, 
crackers, or bread and butter. It may be rolled into 
small balls and swallowed. These may be flavored as 
desired. They may also be slightly browned by rolling 
about rapidly in a hot saucepan, care being taken not to 
change any but the outside of the ball, and that but 
slightly. Scraped beef may be served as a liquid or 
semi-solid food. Mix it with an equal quantity of cold 
water until it is quite smooth. Place in a double boiler 
and cook until thoroughly heated, stirring constantly. 
Add a little salt and pepper and serve at once. This 
may be made thicker by adding less water. 
Raw Meat with Milk and Sugar.-Scrape half a 
pound of rump steak with a knife until all the pulp is 
removed; sweeten with sugar, breaking the lumps of 
sugar with the meat in a basin with a small wooden 
spoon. Add slowly as much milk as will make it about 
the thickness of arrowroot; flavor with brandy. If any 
fiber of the meat remains, strain through a gravy strainer. 
The mixture should be perfectly smooth.-(Ringeri) 
Raw-beef Soup.-This is made by chopping up 
one pound of raw beef and placing it in a bottle with 
one pint of water and five drops of strong hydrochloric 
acid. This mixture is allowed to stand on the ice over- 
night, and in the morning the bottle is placed in a pan 
of water at I io° F., and kept at about this temperature 
for two hours. It is then placed in a stout cloth and 
strained until the mass that remains is almost dry. The 
filtrate is given in three portions daily. If the taste of 
the raw meat is objectionable, the meat may quickly be 
roasted on one side and the process completed in the 
manner previously described.-(Weir Mitchelli) RECIPES. 
415 
PANOPEPTON. 
Iced Panopepton.-To a small glass half full of 
clean crushed ice add one tablespoonful of Panopepton; 
let this stand for a minute and then sip slowly. 
Panopepton Jelly.-This is made of one ounce of 
fresh celery cut into small pieces, one-half of a small box 
of the best gelatin, one-fourth of a teaspoonful of salt, 
two dashes of pepper, six tablespoonfuls of Panopepton, 
and two cupfuls of cold water. Soak the gelatin in half 
a cupful of cold water for one hour; put the water and 
celery in a double boiler on the fire and simmer for one- 
half hour; add the salt, pepper, and soaked gelatin and 
stir until it is dissolved; remove from the fire and add 
the Panopepton ; stir and strain through linen into a 
jelly bag and set near ice. Serve in small quantities. 
Panopepton Jelly with Orange.-The articles 
required are one-half of a small box of the best gelatin, 
one tablespoonful of sugar, six tablespoonfuls of Pano- 
pepton, the juice and rind of one orange, and one pint 
of cold water. Put the gelatin, orange peel (cut in small 
pieces), orange juice, and cold water in a dish and let it 
stand for one hour, then put in a double boiler over the 
fire, add the sugar, and stir until it is dissolved; now 
strain through linen, add the Panopepton, and stir well. 
Pour into a jelly jar and set near the ice. Serve in small 
quantities. 
Panopepton Hot.-To a small teacup two-thirds 
full of boiling water add one tablespoonful of Panopep- 
ton and one teaspoonful of fresh lemon juice; a little 
sugar may be added if desired. Stir and drink immedi- 
ately, sipping slowly. 
Panopepton Bouillon Hot.-Put one tablespoon- 
ful of Panopepton in a small teacup; fill the cup nearly 416 
DIETETICS FOR NURSES. 
full of boiling water, and flavor to taste with celery salt 
or plain salt and pepper; stir and sip slowly. 
Panopepton Cordial.-Put into a cordial glass or 
any small glass two teaspoonfuls of clean crushed ice; 
add one teaspoonful of Fairchild's Essence of Pepsin and 
three teaspoonfuls of Panopepton. Sip slowly. This is 
a good after-dinner cordial for those who suffer discom- 
fort after eating. 
Panopepton with Whey.-Put into a small teacup 
one or two teaspoonfuls of clean crushed ice; add one 
tablespoonful of Panopepton, stir, and then fill the cup 
with whey. Drink slowly. 
Egg Gruel.-Take one cupful of hot beef broth 
made with " Soluble Beef," one egg, and one-half tea- 
spoonful of salt. Beat the white and the yolk of the 
egg separately; add the hot beef broth gradually to the 
yolk, stirring continually. Whip the white to a stiff, dry 
froth with the salt, and beat it into the hot broth. Return 
to the double boiler and reheat. Serve very hot. 
Barley Gruel with Beef Extract.-One-half tea- 
spoonful of " Soluble Beef," two cupfuls of hot water, 
one tablespoonful of barley flour, one saltspoonful of 
salt. Dissolve the beef in the hot water, and mix the 
flour and salt together with a little cold water. Pour 
the boiling stock on the flour and cook for ten minutes. 
Strain and serve very hot. 
Beef Broth with Poached Egg.-Prepare the 
broth in the proportion of half a teaspoonful of " Solu- 
ble Beef" to one cupful of hot water and add a poached 
egg- 
A Nutritive Drink for Delicate Women and 
Children.-This is made by mixing one-fourth to one- 
half teaspoonful of " Soluble Beef," five ounces of boil- RECIPES. 
417 
ing water, and one-half ounce of cream; season with 
salt and pepper to suit the taste. 
Beef Broth with Grain.-Take one teaspoonful of 
" Soluble Beef," one quart of water, one tablespoonful 
of rice, and salt to taste. Dissolve the "Soluble Beef" 
in the hot water, and add the well-washed rice. Simmer 
slowly until dissolved and absorbed by the rice, adding 
more beef broth if too much boils away. If not entirely 
dissolved, the broth should be strained before using. 
Beef-tea Egg-nog.-This requires one-eighth tea- 
spoonful of " Soluble Beef," one-half cupful of hot water, 
one tablespoonful of brandy, and a pinch of salt. Beat 
the egg slightly, and add the salt and sugar. Dissolve 
the " Soluble Beef" in the hot water, add to the egg, and 
strain. Mix thoroughly, adding wine, and serve. 
MEAT JELLIES WITHOUT GELATIN. 
Chicken Jelly.-Half a grown chicken should be 
well pounded, and boiled in one quart of water for two 
hours until only a pint remains; season and strain. 
Serve hot or place on ice, where it will " jel." 
Veal-bone Jelly.-Place ten pounds of veal bones 
and ten quarts of water or weak bouillon over the fire 
and bring to just a boil. Skim and add two pounds of 
barley and a little salt. Simmer for five or six hours and 
then strain. If too thick, dilute, before serving, with 
bouillon. Stir in the yolk of an egg in a cup and serve. 
Meat Jelly.-This is made by cooking good bone- 
less, lean beef on a water bath with a little water for 
sixteen hours or until it becomes gelatinized. Of the 
artificial preparations on the market for making bouillon, 
the most reliable is Liebig's Extract of Meat (io : 250 
(gm. or Cibil's Bouillon (1 teaspoonful to 25o gm.). 418 
DIETETICS FOR NURSES. 
Inaglio's bouillon capsules are also very convenient. If 
it is desired to make the bouillon more nutritious, one 
teaspoonful of meat peptone may be added.-{Hepp^ 
Jelly for Dyspeptics.-Remove the skin and meat 
from one calf's foot; wash the bones and place in cold 
water on the stove; when it begins to foam, skim off the 
refuse which gathers on top. After rinsing off the scum 
with cold water, put the bones into a pot with one-quarter 
kilo of beef or half an old hen, one-quarter liter of water, 
and 5 gm. of salt, and boil slowly for from four to five 
hours. Pour the jelly thus formed through a fine sieve, 
and place overnight in a cellar. Next morning remove 
the fat, and clarify the cold jelly by adding one egg with 
its shell mashed, beating and stirring steadily. Then, 
with the addition of a little cornstarch, subject the whole 
to a temperature not over 6o° R., or the white of the 
egg will curdle. Constantly beat and stir. If the jelly 
begins to get grainy, cover and let it cool until the white 
of the egg becomes flaky and separates. Then strain 
again several times until it becomes perfectly clear; add 
5 gm. of extract of meat, pour the jelly into a mold, and 
let it cool again. The gravy from a roast maybe utilized 
and is very palatable. It must be stirred in while the 
mass is still warm and liquid. This jelly is usually relished 
with cold fowl, but spoils easily in summer; it must there- 
fore be kept on ice.-(Weil^ 
Dishes Made with Gelatin.-Gelatin should be 
soaked in cold water for about half an hour to soften it. It 
may then be easily dissolved by adding boiling water. If it 
is desired to soften gelatin quickly, it should be placed in 
cold water and gradually heated over boiling water until it 
dissolves. If a jelly is to be strained, a wet cloth should 
be used for the purpose. Jelly molds should be wet with RECIPES. 
419 
cold water before being filled. When granulated gelatin 
is used, much smaller amounts are required than when 
the ordinary form is used. 
Wine Jelly.-Soak a teaspoonful of granulated gela- 
tin in two tablespoonfuls of cold water and half a cupful of 
hot water. Add two tablespoonfuls of sugar and half a 
teaspoonful of lemon juice, and when cooling add two 
tablespoonfuls of wine.-{Drexel Instituted) 
Lemon jelly is made in the same manner as the wine 
jelly just described, using a tablespoonful of lemon juice 
in place of the quantity directed. 
Orange jelly is made in a similar manner, using two 
teaspoonfuls of lemon juice, four tablespoonfuls of orange 
juice, and three tablespoonfuls of sugar, but a little less 
of the boiling water. 
Coffee jelly is also made similarly, adding an ounce 
or two of coffee. 
Milk Jelly.-Take two quarts of milk and add half 
a pound of sugar. Boil for five or ten minutes. Cool, 
and add an ounce of gelatin dissolved in a cupful of cold 
water. Flavor with the juice of two or three lemons and 
three glasses of good Bordeaux wine.-{Schlesingerd) 
Irish-moss Blanc-mange.-Wash a tablespoonful 
of Irish moss in several changes of water and pick it over 
carefully. Place it in a double boiler together with half 
a cupful of milk. Cook until it thickens when dropped 
on a cold plate. Add salt, strain, and flavor. Pour into 
a custard cup that has first been rinsed in cold water.- 
{Drexel Instituted) 
Meat Jellies with Gelatin.-Use any kind of 
meat broth desired, but always one with an appetizing 
flavor. Add a teaspoonful of granulated gelatin to enough 
broth to cover it, and allow the gelatin to soak for a few 420 
DIETETICS FOR NURSES. 
minutes. Then add the remainder of a cupful of the 
broth very hot and stir until the gelatin is dissolved. 
Strain, and pour into molds to cool. 
Meat Jellies with Tapioca.-Mix a cupful of 
broth as above with four level tablespoonfuls of pow- 
dered tapioca. Heat until quite clear, stirring con- 
stantly. Add salt and season as desired. Pour into 
molds and cool. 
Meat Jellies with Irish Moss.-Wash two table- 
spoonfuls of Irish moss thoroughly. Add this to a cup- 
ful of hot broth and allow it to stand for half an hour ; 
then heat slowly, stirring constantly, and boil for ten 
minutes, preferably in a double boiler. Strain, and pour 
into molds and cool. 
Albuminized Jelly.-Any of the above meat jellies 
may be rendered more nutritious by the addition of the 
white of an egg. The egg should be well beaten and 
stirred into the jelly just after it has been taken off the 
fire. 
RECIPES FOR FOODS FOR DIABETICS. 
Camplin's Bran Cakes.-Take a sufficient quan- 
tity-say a quart-of wheat bran, boil it in two succes- 
sive waters for a quarter of an hour, each time straining 
it through a sieve ; then wash it well with cold water (on 
the sieve) until the water runs off perfectly clear; squeeze 
the bran through a cloth as dry as possible, and then 
spread it thinly on a dish; place it in a slow oven; if 
put in at night, let it remain until the morning, when, 
if perfectly dry and crisp, it will be ready for grinding. 
The bran thus prepared must be ground in a mill, and 
sifted through a wire sieve that has so fine a mesh that 
a brush must be used to pass it through ; that which RECIPES. 
421 
remains in the sieve must be reground until it becomes 
quite soft and fine. Take of this bran powder three 
ounces (some patients use four ounces); the other in- 
gredients are as follows: three new-laid eggs; one and 
one-half or, if desired, two ounces of butter; about half 
a pint of milk. Mix the eggs with a little of the milk, 
and warm the butter with the remainder; then stir the 
whole well together, adding a little nutmeg or ginger or 
any other agreeable spice. Bake in small tins (patty 
pans), which must be well buttered, in a somewhat quick 
oven for about half an hour. When baked, the cakes 
should be a little thicker than a captain's biscuit; they 
may be eaten with meat or cheese for breakfast, dinner, or 
supper. At tea they require a somewhat liberal allow- 
ance of butter, or they may be eaten with curd or with 
any soft cheese. It is important that the flour be pre- 
pared as directed above. If the cakes do not keep well 
or if they have not been well prepared, place them before 
the fire for ten minutes every day. 
Almond Pudding.-Take two eggs, one-quarter of 
a pound of almond flour, one-quarter of a pound of but- 
ter, and three tabloids of saccharin dissolved in a table- 
spoonful of brandy. Warm the butter, beat in the 
almond flour and the yolks of the eggs, and add the dis- 
solved saccharin. Whip the whites into a stiff froth, and 
beat all together. Put into dariole molds and bake in a 
quick oven; serve with a little hot sauce made with dry 
sherry and saccharin.-(Mrs. Hart?) 
Almond Biscuit.-To each ounce of almond flour 
add the whites of two eggs and salt to taste. Whip 
the whites to a stiff froth, add the almond flour, and beat 
well together. Put in buttered patty pans and bake in a 
moderately quick oven for from fifteen to twenty min- 422 
DIETETICS FOR NURSES. 
utes. The whole must be done quickly, and baked as 
soon as the ingredients are mixed. This biscuit is a use- 
ful substitute for bread.-(Mrs. Hart^) 
Almond Cakes No. I.-Take one pound of ground 
almonds, four eggs, two tablespoonfuls of milk, a pinch 
of salt. Beat up the eggs, and stir in the almond flour; 
place in twelve flat tins and bake in a moderate oven for 
about fifteen minutes.-(Saundby.) 
Almond Cakes No. 2.-Break up about one-quar- 
ter of a pound of sweet almonds in a stone mortar (or 
almond flour may be used). Put the flour into a linen 
bag, which should then be immersed for one-quarter of 
an hour in boiling water, acidulated with a little vinegar 
to remove the small amount of sugar from the almonds. 
Mix well with three ounces of butter and two eggs. 
Then the yolks of three eggs and a little salt are added, 
and the whole stirred briskly for some time. Beat the 
whites of three eggs to a fine froth and add to the mixt- 
ure. The paste is then made into biscuits, smeared with 
butter, and baked with a gentle fire.-(Seegend) 
Aleuronat Bread.-Take about six or seven ounces 
of ordinary wheat flour and the same quantity of aleu- 
ronat powder; five ounces of the best butter; one tea- 
spoonful of salt; three-quarters of an ounce of baking- 
powder. The flour and the aleuronat are mixed in a 
warm dish, and the melted butter and milk (made luke- 
warm) are added gradually, followed by the salt, and 
finally by the baking-powder (one part of sodium carbon- 
ate and two parts of cream of tartar). The dough is 
well mixed, then molded into two loaves, and baked at 
a good heat.-(Eb string 
Aleuronat and Almond Cakes.-Three ounces of 
aleuronat; three ounces of almond flour; beat up one RECIPES. 
423 
egg, and add about two teaspoonfuls of cream and a 
little water. Moisten the aleuronat with a little water 
containing saccharin and let it stand for a few minutes; 
then add the almond flour, the egg, the cream, and the 
water just as required to make a light paste. Spread on 
a tin. Cut into squares, and bake in a moderate oven 
for twenty minutes.-{Williamson^) 
Aleuronat Pancakes.-Take one egg and beat it 
up in a little water and cream; take two teaspoonfuls of 
aleuronat powder and half a teaspoonful of baking-pow- 
der and a little salt. Mix well, and then add gradually 
to the egg and cream and beat into a batter; allow it to 
stand for five minutes. If it is too thick, add a little 
more cream and water. Fry in an ordinary frying-pan 
greased with a little lard. At the end of about eight 
minutes, when the under surface is browned, turn it over 
and continue to bake it for five minutes longer.-(Wil- 
liams oni) 
Aleuronat and Suet Pudding.-This is a palatable 
and cheap dish. To make it take two ounces of aleuro- 
nat flour and two ounces of suet, one egg, a pinch of 
salt, and half a teaspoonful of baking-powder. Sprinkle 
a little aleuronat flour on a chopping-board and chop the 
suet on this part of the board. Then mix the remaining 
aleuronat with the suet in a dishpan. Add the salt and 
the baking-powder. Beat up the egg in about three 
tablespoonfuls of water to which a little saccharin has 
been added. Add the egg gradually to this mixture, 
rubbing the whole mass well into a paste. It may be 
necessary to add a little more water. Drop into a tin 
pudding mold smeared with butter or lard, float it in a 
pan of water, and boil for two hours, taking care that the 
boiling water does not get into the mold ; or, better still, 424 
DIETETICS FOR NURSES. 
the pudding may be baked in the oven. Its taste is im- 
proved by the addition of half an ounce of almonds. A 
small quantity of red wine may serve as a sauce.-(Wil- 
liamson.) 
Cocoanttt Pancakes.-Beat up one egg in two table- 
spoonfuls of milk, or, better, in a little cream and water, 
and add a pinch of salt. Then add two tablespoonfuls 
of cocoanut powder (freed from sugar). Allow this to 
stand for from five to ten minutes. Add a little more 
cream and water. Mix well until it is a little thicker than 
ordinary pancake batter. Put a little lard in the frying- 
pan and heat until the lard is just melted; then drop in 
half of the mixture. Allow this to remain over a mod- 
erate fire for a few minutes-about five-until the under 
surface is brown; then turn the cake over and heat for 
another five minutes. The other half of the mixture 
may be used for the second pancake.-(Williamsonl) 
Cocoanut Cakes.-Mix three tablespoonfuls of 
cocoanut powder into a paste with a little German yeast 
and water. The mixture should be allowed to remain 
by the fire or in a warm place for about twenty minutes, 
or until fermentation occurs and it becomes " puffy." 
Then add a small quantity of a watery solution of sac- 
charin. Beat up one egg, and add this with two tea- 
spoonfuls of cream and a little water to the cocoanut 
paste. The whole should be well mixed, dropped into 
small tins, and baked in an oven for about thirty min- 
utes.-(Williamsonl) 
Cocoanut and Almond Cakes.-To make these, 
the following ingredients are required: Three-quarters 
of a pound of the finest cocoanut powder, one-quarter 
of a pound of ground almonds, six eggs, and half a 
cupful of milk. Beat up the eggs and stir in the cocoa- RECIPES. 
425 
nut and almond flour. Divide into sixteen flat tins, 
and bake for twenty-five minutes in a moderate oven.- 
(Saundbyi) 
Cocoanut Pudding'.-Take three tablespoonfuls of 
cocoanut powder, mix with a little water and German 
yeast, and keep for twenty minutes in a warm place, so 
as to allow the small quantity of sugar present to decom- 
pose ; add four tablespoonfuls of cream, one egg, a little 
salt, and half a pint of water sweetened with saccharin. 
Mix into a paste. Place in a dish greased with butter. 
Cook like rice pudding, in a slow oven for thirty min- 
utes.-( Williamson^) 
ISight Custard.-Beat up well one egg; make a 
mixture of cream and water and boil; gradually add the 
boiled cream and water, while hot, to the egg, stirring 
with a spoon. Then place the mixture in a pan over the 
fire, and stir constantly until it becomes thick; then 
pour into a glass. It is important that the mixture should 
not be heated too much-i. e., that it be not boiled-as 
the albumin would be coagulated. Flavor with cinna- 
mon and sweeten with saxin or saccharin if desired. 
Cheese Cakes.-Take one pint of milk, half a table- 
spoonful of rennet, one ounce of butter, two eggs, one 
tablespoonful of brandy, one-quarter of an ounce of 
almonds, and a little saccharin. Curdle the milk, and let 
it stand in a warm place until thoroughly set; tie a piece 
of muslin over a bowl and pour the milk over the muslin; 
let it stand until all the whey has been strained off. Beat 
the curd smooth, and add the butter and egg, well beaten, 
with the brandy, almonds, and saccharin. When well 
mixed pour into pattypans and bake for fifteen or twenty 
minutes.-(Mrs. Hartl) 
Stewed I/ettuce.-A well-grown head of lettuce 
should be selected. Boil this in plenty of water, taking 426 
DIETETICS FOR NURSES. 
care not to let it fall to pieces. When nearly done take 
it out of the water, drain, and place in a stewpan with a 
little rich brown gravy and allow it to simmer for twenty 
minutes. 
Inulin Biscuit.-Put 50 gm. (i| oz.) of inulin in a 
large porcelain basin, place this over a hot-water bath, 
and with 30 c.c. (1 oz.) of milk and as much hot water 
as may be necessary, rub up into a smooth dough, into 
which the yolks of four eggs and a little salt have been 
mixed. To this add the whites of the four eggs, having 
first beaten them to a foam, and working them in care- 
fully. Bake in tin molds smeared with butter. The 
taste of the biscuit may be improved by adding vanilla 
or other flavoring extract. Inulin is too expensive to be 
used by the average patient. 
Peanut Flour.-This contains about 25 per cent, of 
carbohydrates. The peanut kernels should be boiled in 
water for half an hour to extract a portion of the oil 
which they contain. They should then be dried, and 
rolled into fine particles with a rolling-pin. Place the 
kernels in boiling water acidulated with tartaric acid 
or vinegar, in order (1) to extract saccharin elements; 
(2) overcome the taste and odor of the peanut; (3) to 
prevent emulsification of the remaining oil. When they 
have been thoroughly boiled in acidulated water, the 
ground kernels should be subjected to dry heat and then 
rolled into a fine flour. This flour may be made into a 
form of porridge with milk; bread and biscuits may also 
be baked from it; and it may be made into the form of 
a German pancake.-{Stern^ 
Home-made Substitute for Bread.-Beat up thor- 
oughly six eggs; add a teaspoonful of baking-powder 
or its chemical equivalent, and one-quarter of a teaspoon- 
ful of salt, and beat again. Pour this mixture into hot RECIPES. 
427 
waffle-irons smeared with butter, and bake in a very hot 
oven. By way of variety almonds (powdered) may be 
added. These biscuits may be eaten hot with butter and 
cheese. 
Sugar-free Milk for Diabetic Feeding.-Take 
I liter of skim milk, heat to a temperature of 300 C., and 
add 10 c.c. of glacial acetic acid, diluted with 100 c.c. of 
water. Mix, and allow the mixture to stand for about 
fifteen minutes. Collect the separated casein, and let it 
drain on very fine muslin, using no pressure. Remove 
the casein to a mortar, rub into a smooth paste, add 
| liter of distilled water, and strain as before. Repeat 
this washing of the casein twice. Transfer to a mortar, 
rub until quite smooth, and add 2| gm. of potassium 
hydrate dissolved in 100 c.c. of water (or as much of the 
potassium hydrate as is necessary to make the product 
just alkaline to phenolphthalein). Add 100 gm. of 
ordinary Devonshire clotted cream, 5 gm. of gelatin, 
previously dissolved, 0.06 gm. (1 gr.) of saccharin, and 
water, at about 38° C., up to 1 liter. Lastly, strain 
through fine muslin.-{Hutchison^ 
Soy Bean Cookery.1-In diabetes the beans may be 
added to the diet simply to give variety, and they may 
also be used to great advantage in connection with an 
otherwise carbohydrate-free diet, particularly in those 
cases in which the sugar percentage is high, and it is with 
these cases we have had particular success. 
The simplest way to use the beans is to cook them like 
the ordinary navy bean, preparing either bean soup, boiled 
beans, or baked beans, the flavor usually being rather 
improved by the addition of a piece of fat salt meat. It 
is also a good plan to soak the beans for eight or ten 
hours, stir them up, and remove the rather firm envelope 
1Ruhrah, Medical Record, Sept. 23, 1911. 428 
DIETETICS FOR NURSES. 
which encloses them, most of which will be found to 
come to the surface, from which they may be easily 
skimmed off The beans may be boiled and reduced to a 
smooth gruel and used in this way as a gruel, although 
this is rather a troublesome process; or the beans may 
be thoroughly boiled and mashed and may be flavored 
with some other vegetable, particularly stewed tomatoes. 
The soy bean flour may be utilized in many ways. 
Gruels.-A quart of gruel is made by boiling from 1 
level tablespoonful to 6 ounces of the soy flour (made by 
the Cereo Company, Tappan, N. Y.) in 1 quart of water 
for fifteen minutes, adding water to make up for the loss 
of evaporation. Salt should be added to taste. 
Protein. 
Fat. 
Carbohydrates. 
I level tablespoonful to quart . . . 
• 0-35 
O.I5 
0.08 
I ounce 4 (tablespoonfuls) to quart . 
. I.40 
0.60 
O.3O 
These gruels do not thicken during cooking, as they con- 
tain no starch, and readily settle on standing. This may 
be overcome by adding I to 2 heaping teaspoonfuls of 
barley, oat, or wheat gruel flour before cooking, which 
will add 0.6 to 1.2 per cent, starch to the gruels, and also 
slightly increase the percentage of protein. 
Broths.-Add 1 to 8 ounces of the flour to 1 quart of 
beef, mutton, veal, or chicken broth and boil for fifteen 
minutes, adding water to make up for loss of evaporation; 
or, boil the same quantity of the soy flour for one hour with 
1 quart of water, to which has been added a piece of ham, 
bacon, or salt pork to give flavor. Each ounce of the 
flour will add to the broth about 13 grams of protein 
and 120 calories, or in percentage add 1.4 per cent, protein, 
0.6 per cent, fat, and 0.30 per cent, carbohydrates. A broth 
made with 6 ounces of the soy flour to the quart would 
be half as rich in protein and fat as steak. RECIPES. 
429 
Muffins.-To make muffins from the soy flour, take i| 
teacupfuls of the soy flour, | teacupful of wheat flour, j 
teaspoonful of salt, 2 eggs, 1 teacupful of sweet milk, 2 
rounded teaspoonfuls of baking powder, and i| table- 
spoonfuls of melted, but not hot, butter. Beat well to 
gether, adding the melted butter last, and bake in gem 
pans in a hot oven. This will make about 12 muffins 
which contain about 150 grams of protein, and which will 
yield about 1800 calories, of which the carbohydrates 
produce but 280. Inasmuch as the soy flour contains no 
starch, the addition of some wheat flour in making muffins 
is required. The mixture of wheat and soy flour in this 
formula will contain about 36 per cent, protein and 20 per 
cent, carbohydrates, against 14 per cent, protein and 60 
to 70 per cent, carbohydrates in gluten flour. The pro- 
portion of protein to carbohydrates is eight to ten times 
as large in the mixed soy and wheat flour as in the gluten 
flour. 
In addition to these methods, the following recipe for 
muffins has been suggested by Dr. Skinner, of New 
Haven, Conn.: Soy bean flour, ij cupfuls; salt, | tea- 
spoonful ; baking powder, 2 even teaspoonfuls. Mix well 
and add 2 tablespoonfuls of cream which has first been 
thoroughly stirred into a cup of cold water. Add 2 eggs 
and beat together. Then add 2 tablespoonfuls of melted 
butter and beat the whole mixture well together. Bake 
fifteen minutes in a heated gem pan. The above makes 
15 muffins. 
Another recipe for muffins is to beat up 3 eggs, add 1 
cup of milk in which 1 grain of saccharin has been dis- 
solved, and a lump of butter the size of an egg. Enough 
of the bean flour should be added to make a batter with 
| teaspoonful of baking powder. This should be baked 
in buttered muffin pans. 430 
DIETETICS FOR NURSES. 
Nut-cakes.-These may be made by using the above 
muffin recipe as a basis and adding chopped nuts, al- 
monds, or any other kind desired; and the flour is im- 
proved by the addition of a small amount of spice. 
Soy Bean Cakes.-These may be made by taking I 
tablespoonful of cocoa, i teaspoonful of cinnamon, I tea- 
spoonful of allspice, and chopped nuts, adding them to 
the batter as prepared for the muffins. 
Breakfast Food.-As a breakfast food it may be util- 
ized by taking I cup of flour, enough milk or water to 
moisten it into a paste, a pinch of salt, and I grain of 
saccharin, which should be dissolved before adding. Boil 
one and a half hours in a double boiler and serve with 
rich cream. 
Pancakes.-These may be made by beating up 2 eggs 
with a pinch of salt, adding enough meal to make a 
batter, and | teaspoonful of baking powder. This should 
be fried with butter and made into small cakes. 
Soy Bean Cheese.-In China and Japan the bean is used 
chiefly in the form of a cheese-like substance, the most 
common forms of this being natto, tofu, miso, yuba, and 
shoyu. These cheeses are eaten daily by almost all the 
inhabitants of the East, but they are said to have a lack 
of flavor that renders them more or less unsuited for 
European and American palates. In Seattle, Wash., and 
other places in the West we are informed that tofu is 
made by the Japanese and sold to the Oriental residents. 
We have not had any personal experience so far with the 
bean cheeses, although they are evidently very easy to 
manufacture. One may be made from the gruel which 
resembles somewhat curds and whey, but which in the 
only form we have tried is not sufficiently palatable for 
use, although very slight flavoring might make it a valu- 
able food for American use. RECIPES. 
431 
Diabetic Muffins*-These are useful because they 
have about the same amount of protein and fat as an 
egg and can be allowed in place of an egg in the diet: 
Protein. 
Fat. 
Hepco flour, 140 gm 
60 
I 
Eggs (2) 
12 
12 
Cream, 40 per cent., 60 c.c 
2 
24 
Butter, 45 gm 
37 
74 
74 
Make twelve cakes. Each cake contains 6 gm. protein, 6 gm. fat, and 
approximately 75 calories. (Joslin.) 
Recipe for Lyster muffins so arranged that each is 
equivalent to one egg: 
Protein. 
Fat. 
Lyster flour, x box, 105 gm 
88 
4 
Eggs (2) 
12 
12 
Cream, 40 per cent., 90 c.c 
3 
36 
Butter, 60 gm 
5° 
103 
102 
Make seventeen muffins. Each muffin contains 6 gm. protein and 6 
gm. fat. (Joslin.) 
Ice Cream (Diabetic): 
Food. 
Amount. 
Protein, Fat, 
gm. gm. 
Carbohy- 
drate, 
gm. 
Calories. 
Cream (40 per cent.) . . . 
. . 90 c.c. 
3 36 
3 
348 
Water 
. . 10 c.c. 
Egg (1) 
• • 5° gm- 
6 6 
78 
Saccharin (to sweeten). 
Flavoring (to taste). 
■ . ■ 
■■ ■ '■ 
9 42 
3 
426 
Make a soft custard of the egg, 50 c.c. of the cream, and the water. 
Whip the remaining 40 c.c. of the cream and fold into custard. The 
saccharin may be added to the egg. The flavoring should be added last. 
(Joslin.) 432 
DIETETICS FOR NURSES. 
Bavarian Cream (Diabetic): 
Food. 
Amount. 
Protein, 
gm. 
Fat, 
gm. 
Carbohy- 
drate, 
gm. 
Calories. 
Cream (40 per cent.) . . . 
. . 90 C.C. 
3 
36 
3 
348 
Water 
. . IO C.C. 
Egg (1) 
. • 50 gm. 
6 
6 
78 
Gelatin 
. . 2 gm. 
2 
• . 
8 
Saccharin (to sweeten). 
Flavoring (to taste). 
- 
-- 
-- 
--- 
II 
42 
3 
434 
Soften the gelatin in cold water, then add to the cream, which has 
been heated. Stir until dissolved, pour on the beaten egg, cook like soft 
custard, turn into mold, and chill. (Joslin.) 
hemon Jelly (Diabetic): 
Food. 
Amount. 
Protein, Fat, 
gm. gm. 
Carbohy- 
drate, 
gm. 
Calories. 
Lemon juice 
. . 30 C.C. 
3 
12 
Water 
. . 50 C.C. 
Gelatin 
Saccharin (to sweeten). 
• • 4 gm. 
4 
16 
Cream 
. . 30 C.C. 
I 12 
I 
116 
5 12 
4 
144 
Soften gelatin in part of the cold water. Heat the remaining water 
and lemon juice and pour over the gelatin. Stir until dissolved. Add 
saccharin, strain into cups. Serve with cream. (Joslin.) 
Cracked Cocoa.-The so-called cocoa nibs may be 
used to make a drink for diabetic patients by adding a 
cupful of the cracked cocoa to a quart of water. This 
should be boiled all day, water being added from time 
to time as may be needed. This is practically free from 
sugar and makes an agreeable change. CHAPTER XXIII. 
CUTS OF MEAT? 
The methods of cutting sides of beef, veal, mutton, 
and pork into parts, and the terms used for the different 
" cuts," as these parts are commonly called, vary in 
Fig. 5.-Diagrams of cuts of beef: 1, Neck; 2, chuck; 3, ribs; 4, shoulder-clod; 
5, fore-shank; 6, brisket; 7, cross-ribs; 8, plate; 9, navel; 10, loin; n, flank; 12, 
rump; 13, round; 14, second-cut round; 15, hind-shank.-(Atwater and Bryant, 
Bulletin No. 28, Office of Experiment Stations, United States Department of Agri, 
culture.) 
different localities. The analyses here reported apply to 
cuts as indicated by the following diagrams. These show 
the positions of the different cuts, both in the live animal 
1This section is quoted from Atwater and Bryant, Bulletin No. 28, 
Office of Experiment Stations, United States Department of Agriculture. 
433 434 
DIETETICS FOR NURSES. 
and in the dressed carcass as found in the markets. 
The lines of division between the different cuts will vary 
slightly, according to the usage of the local market, 
even where the general method of cutting is as here 
indicated. The names of the 
same cuts likewise vary in 
different parts of the country. 
Cuts of Beef.-The gen- 
eral method of cutting up a 
side of beef is illustrated in 
Fig- 5, which shows the rela- 
tive position of the cuts in the 
animal and in a dressed side. 
The neck piece is frequently 
cut so as to include more of 
the chuck than is represented 
by the diagrams. The shoul- 
der-clod is usually cut without 
bone, while the shoulder (not 
included in diagram) would 
include more or less of the 
shoulder blade and of the up- 
per end of the fore-shank. 
Shoulder steak is cut from 
the chuck. In many locali- 
ties the plate is made to in- 
clude all the parts of the fore- 
quarter designated on the diagrams as brisket, cross- 
ribs, plate, and navel, and different portions of the 
plate, as thus cut, are spoken of as the " brisket 
end of plate " and " navel end of plate." This part of 
the animal is largely used for corning. The ribs are fre- 
quently divided into first, second, and third cuts, the CUTS OF MEAT. 
435 
latter lying nearest the chuck and being slightly less 
desirable than the former. The chuck is sometimes sub- 
divided in a similar manner, the third cut of the chuck 
being nearest the neck. The names applied to different 
portions of the loin vary considerably in different locali- 
ties. The part nearest the ribs is frequently called 
" small end of loin " or " short steak." The other end 
of the loin is called " hip sirloin " or " sirloin." Between 
the short steak and the sirloin is a portion quite generally 
called the " tenderloin," for the reason that the real ten- 
derloin, the very tender strip of meat lying inside the 
loin, is found most fully developed in this cut. Porter- 
house steak is a term most frequently applied either to 
the short steak or the tenderloin. It is not uncommon 
to find the flank cut so as to include more of the loin 
than is indicated in the figures, in which case the upper 
portion is called " flank steak." The larger part of the 
flank is, however, very frequently corned, as is also the 
case with the rump. In some markets the rump is cut 
so as to include a portion of the loin, which is then sold 
as " rump steak." The portion of the round on the 
inside of the leg is regarded as more tender than that 
on the outside, and is frequently preferred to the latter. 
As the leg lies upon the butcher's table, this inside of 
the round is usually on the upper or top side, and is 
therefore called " top round." Occasionally the plate is 
called the " rattle." 
Cuts of Veal.-The method of cutting up a side of 
veal differs considerably from that employed with beef. 
This is illustrated by Fig. 6, which shows the relative 
position of the cuts in the animal and a dressed side. 
The chuck is much smaller in proportion, and frequently 
no distinction is made between the chuck and the neck. 436 
DIETETICS FOR NURSES. 
Ihe chuck is often cut so as to include considerable 
of the portion here designated as shoulder, following 
more nearly the method adopted for subdividing beef. 
The shoulder of veal as here indicated includes, besides 
the portion corresponding to the shoulder in beef, the 
larger part of what is here classed as 
chuck in the adult animal. The under 
part of the fore-quarter, corresponding 
to the plate in the beef, is often desig- 
nated as breast in the veal. The part 
Fig. 6.-Diagrams of cuts of veal: i. Neck; 2, chuck; 3, shoulder; 4, fore-shank; 
5, breast; 6, ribs; 7, loin; 8, flank; 9, leg; 10, hind-shank.-(Atwater and Bryant, 
Bulletin No. IS, Office of Experiment Stations, United States Department of Agri- 
culture.) 
of the veal corresponding to the rump of beef is here 
included with the loin, but is often cut to form part of 
the leg. In many localities the fore- and hind-shanks of 
veal are called the " knuckles." 
Cuts of I/amb and Mutton.-Fig. 7 shows the 
relative position of the cuts in a dressed side of mutton 
or lamb and in a live animal. The cuts in a side of lamb 
and mutton number but six, three in each quarter. The CUTS OF MEAT. 
437 
chuck includes the ribs as far as the end of the shoulder 
blades, beyond which comes the loin. The flank is made 
to include all the under side of the animal. Some 
butchers, however, make a large num- 
ber of cuts in the fore-quarter, including 
a portion of the cuts marked " loin " 
and " chuck " in Fig. 7, to make a cut 
designated as " rib," and a portion of 
the " flank " and " shoulder " to make 
a cut designated as " brisket." The 
term " chops " is ordinarily used to 
designate portions of either the loin, 
Fig. 7.-Diagrams of cuts of lamb and mutton: 1, Neck; 2, chuck; 3, shoulder; 
4, flank; 5, loin; 6, leg.-(Atwater and Bryant, Bulletin No. 28, Office of Experi- 
ment Stations, United States Department of Agriculture.) 
ribs, chuck or shoulder, which are either cut or 
" chopped " by the butcher into pieces suitable for 
frying or boiling. The chuck and ribs are sometimes 
called the " rack." 
Cuts of Pork.-The method of cutting up a side 
of pork differs considerably from that employed with 
other meats. A large portion of the carcass of a 
dressed pig consists of almost clear fat. This furnishes 438 
DIETETICS FOR NURSES. 
the cuts which are used for " salt pork " and bacon. Fig. 
8 illustrates a common method of cutting up pork, show- 
Fig. 8.-Diagrams of cuts of pork: r, Head; 2, shoulder; 3, back; 4, middle 
cut; 5, belly; 6, ham; 7, ribs; 8, loin.-(Atwater and Bryant, Bulletin No. 23, Office 
of Experiment Stations, United States Department of Agriculture.) 
mg the relative position of the cuts in the animal and in 
the dressed side. The cut designated as " back cut " is 
almost clear fat, and is used for 
salting and pickling. The " mid- 
dle cut " is the portion quite gen- 
erally used for bacon and for " lean 
ends " of salt pork. The belly is 
salted or pickled or may be made 
into sausages. 
Beneath the "back cut" are the 
ribs and loin, from which are ob- 
tained " spare ribs," " chops," and 
roasting-pieces, here designated by 
dotted lines. The hams and shoul- 
ders are more frequently cured, but 
are also sold as fresh pork " steak." 
The tenderloin proper is a com- 
paratively lean and very small strip 
of meat lying under the bones of 
the loin and usually weighing a 
fraction of a pound. Some fat is CUTS OF MEAT. 
439 
usually trimmed off from the hams and shoulders, which 
is called " ham and shoulder fat," and is often used for 
sausages, etc. What is called " leaf lard," at least in 
some localities, comes from the inside of the back. It 
is the kidney fat. 
As stated above, cuts as shown in the diagrams here- 
with correspond to those of which analyses are reported 
in the tables beyond, but do not attempt to show the 
different methods of cutting followed in markets in differ- 
ent parts of the United States. WEIGHTS AND MEASURES. 
Relative Values of Apothecaries' and Metric Fluid Measures. 
Minims 
Cubic 
centi- 
meters. 
Minims. 
Cubic 
centi- 
meters. 
Fluid- 
ounces. 
Cubic 
centi- 
meters. 
Fluid- 
ounces. 
Cubic 
centi- 
meters. 
I = 
0.06 
3° = 
I.90 
I = 
30.00 
21 = 
621.00 
2 = 
0.12 
35 = 
2.l6 
2 = 
59.20 
22 = 
65O.OO 
3 = 
O.l8 
40 = 
2.50 
3 = 
89.OO 
24 = 
710.00 
4 = 
O.24 
45 = 
2.80 
4 = 
118.40 
25 = 
740.00 
5 = 
0.30 
5° = 
3-O8 
5 = 
I48 OO 
26 = 
769.OO 
6 = 
O.36 
55 - 
3-4° 
6 = 
I78.OO 
27 = 
798.07 
7 = 
O.42 
7 = 
2O7.OO 
28 = 
828.80 
8 = 
0.50 
Fluid- 
8 = 
236.OO 
30 - 
887.25 
9 = 
0-55 
drams. 
9 = 
266.00 
31 = 
917.OO 
IO = 
0.60 
I = 
3-75 
10 = 
295.70 
32 = 
946.OO 
ii = 
0.68 
1% - 
4-65 
12 = 
355-oo 
48 = 
I419.OO 
12 = 
0-74 
= 
5.60 
13 = 
385.00 
56 = 
1655.OO 
*3 = 
0.80 
1^ = 
6.51 
14 = 
414.00 
64 = 
1892.OO 
14 = 
0.85 
2 = 
7-50 
IS = 
444.00 
72 = 
2128.00 
15 = 
0.92 
3 = 
11.25 
16 = 
473-H 
80 = 
2365.00 
16 = 
1.00 
4 = 
15.00 
17 = 
503.00 
96 = 
2839.OO 
17 = 
1.05 
5 = 
18.50 
18 = 
532.00 
112 = 
3312.00 
18 = 
1.12 
6 = 
22.50 
19 = 
591-5° 
128 = 
3785-OO 
19 = 
1.17 
7 = 
26.00 
20 = 
125 
25 = 
i-54 
Relative Values of Metric Fluid and Apothecaries' Measures. 
Cubic 
centi- 
meters. 
Fluid- 
ounces. 
Cubic 
centi- 
meters. 
Fluid- 
ounces. 
Cubic 
centi- 
meters. 
Fluid- 
drams. 
Cubic 
centi- 
meters. 
Minims. 
IOOO = 
33-8i 
400 = 
1353 
25 " 
6.76 
4 
64.80 
900 = 
30.43 
300 = 
10.14 
IO = 
2.71 
3 
48.60 
800 = 
27-05 
200 = 
6.76 
9 = 
2-43 
2 = 
32.40 
700 = 
23.67 
IOO = 
3-38 
8 = 
2.16 
1 = 
16.23 
600 = 
20.29 
75 = 
2.53 
7 = 
1.89 
0.50 = 
8.II 
500 = 
16.90 
50 = 
1.69 
6 = 
1.62 
0.25 = 
4.06 
473 = 
16.00 
30 = 
I.OI 
5 = 
i-35 
0.06 = 
I.OO 
440 WEIGHTS AND MEASURES. 
Relative Values of Avoirdupois and Metric Weights. 
441 
Avoir. 
Grams. 
Avoir. 
Grams. 
Avoir- Grams. 
Avoir. 
Grams. 
ounces. 
ounces. 
ounces. 
pounds. 
i.772 
5 = 
141-75 
13 = 368.54 
3 = 
1360.78 
- 
3-544 
6 = 
170.10 
14 = 396.90 
4 = 
1814.37 
7.088 
7 = 
198.45 
i5 = 425-25 
5 = 
2267.55 
y2 = 
I4-V5 
8 = 
226.80 
Avoir. 
6 = 
2721-55 
I - 
28.350 
9 = 
255-15 
pounds. 
7 = 
3I75.I4 
2 = 
56.700 
IO = 
283.50 
1.0= 453 60 
8 = 
3628.74 
3 = 
85.050 
3x1.84 
2.0 = 907.18 
9 = 
4082.33 
4 = 
113.400 
12 = 
340.20 
2.2 = 1000.00 
10 = 
4535 92 
Relative Values- of Metric and Avoirdupois Weights. 
GJ GJ GJ GJ GJ GJ GJ W tO 
vq Q\ui 4k GJ to o *O 00 
8 8 8 8 § 8 8 8$ 
II II II II II II II II II 
HMHMMHMMH 
+ H- +++++4- 
GJ h 0 00-0 tn W M 
GJ OCGJ -4 tO Q\tn 0 
Gm. Ounces. Gr. 
38 
39 
40 
50 
60 
70 
80 
85 
IOO 
Gm. 
II II II II II II II II II 
O 
W GJ to to to H H H M 
p 
+ +++++++ 
(T> 
in 
149 
164 
180 
334 
50 
205 
3°o 
230 
O 
125 
150 
200 
250 
300 
35° 
400 
500 
550 
Gm. 
II II II II II II II II II 
O 
H H M M H 
KO 4K to 0 oo^q tn -h- 
+++++++++ 
179 
127 
24 
358 
255 
152 
48 
279 
175 
O 
0 
000 
o?6 
006 
°Sg 
oog 
oSZ 
00L 
0S9 
009 
S 
II II II II II II II II II 
GJ GJ GJ tO tO tO tO 
0un< 
+++++++++ 
a 
72 
405 
3°3 
198 
96 
429 
326 
222 
120 
0 
• 
Relative Values of Apothecaries' and Metric Weights. 
Grains 
Grams. 
Grains. 
Grams. 
Drams. 
Grams. 
I 
= 
0.0625 
24 
= 
i-55 
I = 
3-9° 
2 
=■ 
0.1300 
25 
= 
1.62 
2 = 
7.80 
3 
= 
0.195° 
26 
- 
1.70 
3 
II.65 
4 
= 
0.2600 
27 
= 
*-75 
4 = 
I5-5O 
5 
= 
03240 
28 
= 
1.82 
5 
I9.4O 
6 
= 
0.4000 
3° 
= 
i-95 
6 = 
23-3O 
7 
= 
0.4600 
32 
= 
2.10 
7 
27.20 
8 
= 
0.5200 
33 
= 
2.16 
Ounces. 
9 
= 
0.6000 
34 
= 
2.20 
I = 
31.10 
IO 
= 
0.6500 
35 
= 
2.25 
2 = 
62.20 
ii 
= 
0.7150 
36 
= 
2.30 
3 
93-30 
12 
= 
0.7800 
38 
= 
247 
4 = 
I24.40 
14 
= 
0.9070 
39 
= 
2-55 
5 
155-50 
15 
= 
0.9720 
4° 
= 
2-73 
6 
186.60 
L5-5 
- 
1.0000 
44 
=f 
2.86 
7 = 
217.70 
16 
= 
1.0400 
48 
=3* 
3-oo 
8 
248.80 
18 
= 
1.1600 
5° 
=s 
3-25 
9 = 
280.00 
20 
== 
1.3000 
52 
340 
10 = 
311.00 
21 
= 
1.3600 
56 
=» 
3-65 
48 = 
1492.80 
22 
= 
14250 
58 
= 
3-75 
100 = 
3110.40 442 
DIETETICS FOR NURSES. 
Relative Values of Metric and Apothecaries' Weights. 
Grams. 
Grains. 
Grams. 
Grains. 
I = 
15-43 
9 
138.90 
* 2 = 
30.86 
IO = 
I54-32 
3 
46.30 
IOO = 
I543-23 
4 
61-73 
125 
1929.04 
5 
77-i6 
150 
2374 85 
6 
92.60 
175 
2700.65 
7 
8 
98.02 
123.46 
IOOO = 
15432-35 INDEX. 
Absorption, 20 
of beans, 29 
of carbohydrates, 27 
of cereals, 29 
of eggs, 28 
of fats, 27 
of fish, 28 
of foods, 20, 26 
of fruits, 29 
of green vegetables, 29 
of legumes, 29 
of meat, 28 
of milk, 28 
of peas, 29 
of protein, 27 
of rice, 29 
of roots, 29 
of tubers, 29 
of vegetables, 29 
green, 29 
Acid, benzoic, test for detection of, 
119 
boric, as preservative, test for 
detection of, 120 
intoxication of children, diet in, 
174 
milks in infant feeding, 150 
overproduction of, in body, 18 
salicylic, test for detection of, 119 
wines, 100 
Acidophilus bacillus in intestine, 
287 
milk, 58 
Acid-producing foods, 18 
Acidosis, 18, 366 
ammonia in, 19 
in diabetes mellitus, 342 
sodium bicarbonate in, 19 
Acids, amino-, in protein, 13 
and alkalis, 18 
in wine, 98 
Acne, diet in, 366 
Aera to thermal waters, 92 
Actinomycosis, 115 
Adulteration, food, 116 
accidental, 116 
arbitrary, 116 
conventional, 116 
incidental, 116 
intentional, 118 
preservatives in, 118 
table of, 117 
of coffee, test for, 123 
of flavoring extracts, test for, 124 
of lemon extract, test for, 124 
of milk, 54 
of spices, test for, 125 
of vanilla extract, test for, 124 
of vinegar, test for, 125 
Age, food and, relation, 22 
Aged, diet for, 184, 185 
Air exclusion in preserving food, 
103 
Albumin milk in infant feeding, 150 
water, 385 
Albuminized jelly, 420 
443 444 
INDEX. 
Albuminized lemonade, 386 
milk, 402 
Albuminoids, 12 
Albumins, 12 
Alcohol, 94 
digestibility of, 96 
food value of, 95 
fuel value, 96 
in genito-urinary diseases, 317 
in injury to alcoholics, 332 
in tuberculosis, 238 
in typhoid fever, 215 
in wine, 98 
wood, as adulterant, 118 
Alcoholics, illness in, alcohol and, 
332 
Alcoholism, diet in, 331 
Ale, 98 
Aleuronat, 106 
and almond cakes, 422 
and suet pudding, 423 
bread, 422 
pancakes, 423 
Algae, 81 
Alimentation, duodenal, 194 
Alkali-producing foods, 18 
Alkaline fermentation of milk, 50 
mineral waters, 91 
Alkalis and acids, 18 
Allen treatment in diabetes melli- 
tus, 345 
Allergy, 112 
Alligator-pear, 79 
Almond and cocoanut cakes, 424 
biscuit, 421 
bitter, junket, 400 
cakes, 421, 422 
and aleuronat, 422 
milk, 384 
pudding, 421 
Almonds, 80 
Amanita, 81 
American bouillon, 412 
broth, 412 
Amino-acids, absorption of, 13 
effects of action of bacteria on, 
13 
in intestines, 13 
in protein, 13 
uses of, 13 
Ammonia in acidosis, 19 
in overproduction of acid in 
body, 18 
Amoeba coli in water, 115 
Amylopsin, 20 
Anaphylaxis, 113 
Anemia, diet in, 315 
Anesthesia, diet in, 373 
treatment before, 373 
Aneurysm, diet in, 315 
Angina pectoris, diet in, 315 
Animal foods, 40 
table of composition, 67 
Antifermentative diet in intestinal 
diseases, 289 
Antiputrefactive diet in intestinal 
diseases, 288 
Antiscorbutic vitamin, 15, 16 
Antiseptics to preserve food, 104 
Apoplexy, diet in, 330 
Apothecaries' and metric fluid 
measures, relative values, 
440 
weights, relative values, 441 
Appendicitis, diet in, 295 
Appetite, digestion and, influence 
on, 25 
effect of, on secretion of gastric 
juice, 20 
Apple water, 385 
Apples, 78 
Arnold sterilizer, 44 INDEX. 
445 
Aromatic wines, 100 
Arrowroot gruel, 389 
Arthritis deformans, diet in, 359 
Artificial colors in food, determina 
tion of, 121 
feeding of child, 133 
foods, 105 
proprietary foods, 106, 107 
Ascaris lumbricoides in food, 116 
Asparagus, 77 
Asses' milk, composition, 42 
Asthma, 112 
diet in, 307 
Asylums, infant, feeding in, 169 
Atonic dyspepsia, diet in, 265 
Atwater's table of coefficients of di- 
gestibility, 27 
of food requirements at differ- 
ent ages, 22 
of fuel value of foods, 17, 27 
of nutritive ingredients of food, 
17 
Avocado, 79 
Avoirdupois and metric weights, 
relative values, 441 
Bacillus acidophilus, 58 
in intestine, 287 
Bacon, 66 
composition, 67 
Bacteria in milk, 50 
Baking meat, 109 
Bananas, 79 
Baner's method of milk modifica- 
tion, 144 
Banting diet for obesity, 363 
Barley gruel, 389 
with beef extract, 416 
jelly, 391 
water, 387 
Barlow's disease, diet in, 360 
Bavarian cream, diabetic, 432 
Bean, soy, 74 
cooking of, 427 
Beans, 74 
absorption of, 29 
Beaumont's table of chymifica- 
tion, 246 
Beef, 65 
broth, 409 
with grain, 417 
with poached egg, 416 
composition, 67 
cuts of, 434 
essence, 412' 
extracts, 65 
barley gruel with, 416 
soup stock from, 407 
juice, 65, 411 
cold, 411 
meal, 66 
mosquera, 105 
peptonized, 413 
raw, preparing, 413 
soup from 414 
tea, 410 
egg-nog, 417 
flavored, 410 
with oatmeal, 410 
Beer, 98 
Beeswax, 14 
Beet, 76 
Benzoic acid as preservative, test 
for detection of, 119 
Beriberi, 15, 16, 114 
absence of vitamins as cause of, 
114 
legumes in diet in, 114 
Berries, 79 
Beverages, 88, 384 
Biliousness, diet in, 304 
Biscuit, almond, 421 446 
INDEX. 
Biscuit, bran, 394 
inulin, 426 
Bitter almond junket, 400 
milk, 50 
waters, 92 
Bitters, 97 
Bladder, stone in, diet in, 323 
Blanc-mange, Irish moss, 419 
Blood-pressure, high, diet in, 316 
Blood-vessels, dilatation of, diet in, 
3i5 
Boiling meat, 108 
Bomb calorimeter, 17 
Bone-marrow, 87 
Bonnyclabber, 58 
Borax as preservative, test for de- 
tection of, 120 
Boric acid as preservative, test for 
detection of, 120 
Bottle bouillon, 412 
feeding, beginning, 153 
Botulismus, 113 
Bouillon, 65 
American, 412 
bottle, 412 
panopepton, hot, 415 
Bovine tuberculosis, milk contam- 
ination in, 52 
Bowels, care of, after operations, 378 
Brain operations, diet after, 376 
Braising meat, 109 
Bran biscuits, 394 
cakes, Camplin's, 420 
Brandy, 97 
Brandy-and-egg mixture, 384 
for infants, 384 
Bread, 72, 392 
aleuronat, 422 
bran, in diabetes mellitus, 386 
brown, 393 
Drexel Institute recipe, 392 
Bread, laxative, 394 
nut-brown, 393 
pulled, 393 
substitute for home-made, 426 
whole-wheat, 393 
Breakfast foods, 73 
Breast feeding, 127 
contra-indications, 132 
first few days, 131 
frequency, 129 
interval for, 129 
Breasts, care of, 127 
Brisket end of plate, 434 
Broiling meat, no, 406 
pan, 406 
Broth, American, 412 
beef, 409 
with grain, 416 
with poached egg, 416 
chicken, 409 
clam, 409 
egg, 385 
meat, 409 
mutton, 409 
without meat, 409 
with vegetables, 409 
soy bean, 428 
veal, 409 
Brown bread, 393 
Buccal digestion, 19 
Buffalos' milk, composition, 42 
Butter, 56 
renovated, 57 
test for detection of, 126 
Butterine, 87 
Buttermilk, 57 
in infant feeding, 145 
in treatment of diarrhea, 281 
Cabbages, 76 
Caffein, 94 INDEX. 
447 
Caffein-free coffee preparations, 94 
Cakes, soy bean, 430 
Calcium caseinate in infant feed- 
ing, 151 
salts, 88 
Calcium-depositing vitamin, 15, 16 
Calculous affections, diet in, 323 
Caloric diets, high, in typhoid 
fever, 215 
feeding, 137 
needs of infants, 136 
value, approximate, of different 
foods, table showing, 138 
of common foods per ounce, 
table showing, 35 
Calorie, definition, 17 
gram, 17 
Calorimeter, bomb, 17 
Campbell method of conserving 
milk, 60 
Camplin's bran cakes, 420 
Candy, 84 
Cane-sugar, 84 
Canning food, 104 
Caramel in food, test for detection 
of, 123 
Carbohydrate-cellulose foods in 
constipation, 302 
Carbohydrates, 14 
absorption of, 27 
fuel value of, 17 
in stomach diseases, 256 
in typhoid fever, 213 
of vegetables, 70 
proteins and fats in combination, 
quantity required, 32 
quantity required, 32 
uses of, 17 
Carcinoma of stomach, diet in, 280 
Carrots, 76 
Casec, 151 
Catarrh, intestinal, acute, diet in, 
291 
chronic, diet in, 291 
with constipation, diet in, 
291 
with diarrhea, dietin, 292 
Catnip tea, 131 
Cats' milk, composition, 42 
Catsup, 86 
Caudle, 385 
Cauliflower, 76 
Celery, 77 
soup, cream of, 396 
Cereal-and-milk waters, 402 
Cereals, 71, 388 
absorption of, 29 
composition of, 82 
cooking, 388 
length of time, 389 
foods from, with starch not 
predigested, 107 
gruels from 388 
in tuberculosis, 236 
partially digested, prepared at 
table, 391 
Cheese, 58 
cakes, 425 
cottage, 58 
soy bean, 430 
Cheese-poisoning, 109 
Chemicals in preserving food, 104 
Chemistry of digestion, n 
Chestnut purSe, 392 
Chestnuts, 80 
Chicken, 69 
broth, 409 
composition, 67 
jelly, 417 
Chick-pea, poisoning from, 113 
Chicory, 93 
Children, feeding of, 127 448 
INDEX. 
Chloroform, 14 
Chocolate, 94 
Cholelithiasis, diet in, 306 
Chops, mutton, 437 
pork, 438 
Chorea, diet in, 329 
Chymification, Beaumont's table 
of, 246 
mean time of, table showing, 
246-249 
Cider, 101 
Cinnamon, 86 
Cinnamon-and-milk drink, 402 
Circulatory diseases, diet in, 310 
Clam broth, 409 
juice, 409 
Clams, 70 
composition, 68 
Cleft palate operation, diet after, 
376 
Climate, food and relation, 22 
Cloves, 86 
oil of, 14 
Coal-tar dyes in food, test for de- 
tection of, 121 
Cocoa, 94 
cracked, 432 
junket, 400 
Cocoanut, 80 
and almond cakes, 424 
cakes, 424 
pancakes, 424 
pudding, 425 
Cod-liver oil, 87 
Coefficients of digestibility of foods, 
27 
Coffee, 93 
adulteration of, test for, 123 
caffein-free preparations, 94 
effect, 93 
jelly, 419 
Coffee, junket, 400 
modified, 93 
preparation, 93 
substitutes, 93 
Cold egg-nog, 385 
in preserving food, 104 
Coleman's milk, cream, and lactose 
diets in typhoid fever, 217 
Colic, 171 
Color of milk, 49 
Colors, artificial, in food, deter- 
mination of, 121 
Colostrum, 127 
Composition of milk mixture, cal- 
culation of, 141 
Concentrated food, 102 
Condensed milk, 59 
in infant feeding, 149 
Condiments, 85 
Constipation, carbohydrate-cellu- 
lose foods in, 302 
chronic, dietetic treatment, 293, 
294 
in atonic dyspepsia, diet in, 266 
in children, diet in, 182 
with chronic intestinal catarrh, 
diet in, 291 
Convalescent diet, 382 
Cooking, effect of, no 
of fish, no 
of foods, 108 
rapid, in 
of meat, 108 
effect of, no 
of vegetables, effect of, no 
Copper as adulterant, 118 
in food, test for detection of, 122 
Cordial, 97 
egg, 385 
panopepton, 416 
Cornmeal gruel, 391 INDEX. 
449 
Cottage cheese, 58 
Cottonseed oil, Halphen reaction 
for, 125 
Cow, tuberculous, milk from, 52 
Cows' milk, composition, 39 
foods prepared from, 106 
Crab, 69 
composition, 68 
Cracked cocoa, 432 
Cracker gruel, 390 
Crackers, crisp, 396 
Cream, 55 
Bavarian, diabetic, 432 
ice, diabetic, 431 
Cream-of-celery soup, 396 
Cream-of-potato soup, 396 
Cream-of-tartar whey, 401 
Cream-of-tomato soup, 396 
Crisp crackers, 396 
Crustaceans, 69 
composition, 68 
Curds, 399 
Cure, kumiss, 62 
Currant juice, 386 
Currants, 79 
Custards, baked, 404 
chocolate, 404 
light, 425 
rules for, 404 
soft, 404 
steamed, 404 
Cutler's recipes in typhoid fever, 221 
Cuts of beef, 434 
of lamb, 436 
of meat, 433 
of mutton, 436 
of pork, 437 
of veal, 435 
Cyclic vomiting of children, diet 
in, 174 
Cystin, 13 
Dates, 79 
De Kofa, 94 
Delivery of milk, 53 
Dextrose, 135 
Diabetes mellitus, acidosis in, 342 
Allen treatment in, 345 
Bavarian cream in, 432 
cracked cocoa in, 432 
diet in, 341 
Allen treatment, 345 
cracked cocoa in, 432 
strict, Joslin, 350 
exercise in, 344 
foods allowed, 351 
conditionally, 353 
moderately, 352 
especially valuable, 355 
weighed in, 343 
hygiene in, 344 
ice-cream in, 431 
in children, 347 
insulin in, 346 
Joslin strict diet in, 350 
treatment, 346 
lemon jelly in, 432 
muffins in, 431 
lyster, 431 
recipes for foods in, 420 
sugar-free milk for, 427 
weight in, 344 
Woodyatt's treatment, 346 
Diabetic Bavarian cream, 432 
ice-cream, 431 
lemon jelly, 431 
muffins, 431 
lyster, 431 
Diarrhea, dietetic treatment, 298, 
299 
in childhood, 175 
diet in, 176-180 
in older children, 182 450 
INDEX. 
Diarrhea with chronic intestinal 
catarrh, diet in, 292 
Diet after cleft palate operations, 
376 
after esophageal operations, 377 
after hare-lip operation, 376 
after laryngeal operations, 377 
after operations, 375 
about face, 376 
head, 376 
cleft palate, 376 
esophageal, 377 
hare-lip, 376 
laryngeal, 377 
nausea and, 378 
on brain, 376 
on intestines, 380 
on kidney, 379 
on pancreas, 379 
on rectum, 381 
on stomach, 380 
on various organs, 379 
plastic, 376 
thirst and, 378 
vomiting and, 378 
anesthesia and, 373 
antifermentative, in intestinal 
diseases, 289 
antiputrefactive, in intestinal 
diseases, 288 
caloric, high, in typhoid fever, 
215 
Coleman's, in typhoid fever, 
217 
convalescent, 382 
cures, 368 
diseases from errors in, in 
dry, 307 
during pregnancy, 187 
puerperium, 187 
second year, 156 
Diet, factors bearing on, 102 
farinaceous, 382 
for aged, 184 
for child eighteen months to two 
and one-half years of age, 
160 
fifteen to eighteen months old, 
i59 
nine to twelve months old, 157 
seven to nine months old, 157 
twelve to fifteen months old, 
158 
two and one-half to six years of 
age, 160 
for children, 127 
for infants, 127 
for school children, 165 
for sick infants, 171 
full, 382 
hospital, 382 
dietitians, 383 
house, 382 
in acid intoxication in children, 
174 
in acne, 366 
in alcoholism, 331 
in anemia, 315 
in aneurysm, 315 
in angina pectoris, 315 
in apoplexy, 330 
in appendicitis, 295 
in arthritis deformans, 359 
in asthma, 307 
in Barlow's disease, 360 
in biliousness, 304 
in calculous affections, 323 
in carcinoma of stomach, 280 
in cholelithiasis, 306 
in chorea, 329 
in circulatory diseases, 310 
in constipation, 299 INDEX. 
451 
Diet in constiption, carbohydrate- 
cellulose foods in, 302 
chronic, 297, 299 
in atonic dyspepsia, 265 
in children, 182 
in cyclic vomiting of children, 
174 
in diabetes mellitus, 341, 347 
foods allowed, 351 
conditionally, 353 
moderately, 352 
especially valuable, 355 
strict, Joslin, 350 
in diarrhea, 298, 299 
in childhood, 176-180 
in older children, 182 
in difficult swallowing, 251 
in dilatation of blood-vessels, 315 
of heart, sudden, 314 
of stomach, 263 
in diphtheria, 230 
in disease, general rules, 200 
in diseases of pregnancy, 188 
of stomach in infants, 174 
in disturbed sleep, 327 
in dysentery, 293 
in dyspepsia, atonic, 265 
intestinal, 290 
nervous, 282 
in dysphagia, 260 
in dyspnea in heart diseases, 314 
in eczema, 365 
in empyema, 307 
in epilepsy, 328 
in fever, 205 
in flatulence, 297 
in floating kidney, 323 
in gall-stone disease, 306 
in gastric hyperacidity, 282 
in gastritis, acute, 260 
chronic, 262 
Diet in genito-urinary diseases, 317 
alcohol in, 317 
surgical, 324 
water in, 318 
in gout, 355 
purin-free, 358 
purin-nitrogen, 359 
in heart diseases, 310. See also 
Heart diseases. 
in hemorrhage in ulcer of stom- 
ach, 267 
of stomach, 280 
in hemorrhoids, 297 
in high blood-pressure, 316 
in hives, 366 
in hyperchlorhydria, 282 
in infantile scurvy, 360 
in infectious diseases, 210 
in inflammation of kidney, 379 
acute, 318 
chronic, 319 
of mouth in infants, 174 
in insanity, 338 
in insomnia, 327 
in intestinal catarrh, acute, 291 
chronic, 291 
with constipation, 291 
with diarrhea, 292 
diseases, 285 
indigestion, chronic, in chil- 
dren, 182 
obstruction, 294 
in laryngitis, 307 
in leanness, 365 
in liver diseases, 314 
in lung diseases, chronic, 308 
in malignant growths of intestine, 
294 
in measles, 230 
in movable kidney, 323 
in mumps, 230 452 
INDEX. 
Diet in nephritis, 318,319, 320, 379 
Karell, 323 
low protein, 322 
nitrogen content of foods 
used in, 322 
test, for renal function, 
321 
salt-free, 320 
in nervous conditions of intes- 
tine, 297 
diseases, 325 
gastric disorders, 281 
in neuralgia, 327 
in neurasthenia, intestinal, 297 
in obesity, 360 
Banting's, 363 
Ebstein's, 364 
Oertel's, 364 
treatment by, 363 
in overproduction of acids, 18 
in palpitation of heart, 314 
in paralysis after diphtheria, 232 
in peritonitis, 303 
in pleurisy, 307 
in pneumonia 308 
in postdiphtheritic paralysis, 232 
in pus in pleural cavity, 307 
in rabies, 233 
in rachitis, 183 
in renal calculi, 323 
in respiratory diseases, 307 
in rest cure, 333, 335 
schedule, 336 
in rheumatism, 232 
in rickets, 183 
in scarlet fever, 228 
in scorbutus, 360 
in scurvy, 360 
in shock after operation, 379 
in skin diseases, 365 
in small-pox, 228 
Diet in stomach diseases, 244 
carbohydrates in, 256 
eggs in, 255 
fats in, 256 
fish in, 256 
fruits in, 256 
gelatinous, 255 
leguminous, 256 
Leube's scale, 245 
liquid, 255 
meats in, 255 
Penzoldt's, 251 
proteins in, 254 
rules for eating, 257 
special factors, 257 
in surgical cases, 373 
in tetanus, 233 
in tuberculosis, 233 
advanced cases, 240 
alcohol in, 238 
beverages in, 237, 238 
cereals in, 236 
eggs in, 235 
fats in, 237 
fish in, 236 
forced, 241 
fruit in, 237 
gastric irritability and, 241 
in sanatoriums, 241 
meat in, 235 
meat-juice in, 236 
milk in, 234 
vegetables in, 237 
wheat in, 237 
with fever, 241 
in typhoid fever, 210 
atypical, 228 
complicated, 228 
convalescence and, 225 
digestive disturbances and, 
224 INDEX. 
453 
Diet in typhoid fever, hemorrhage 
and, 224 
perforation and, 225 
in typhus fever, 228 
in ulcer of intestine, 293 
of stomach, 267 
Lenhartz's, 269, 270 
modified, 271 
Sippy's, 275 
in uric-acid diathesis, 323 
in urticaria, 366 
in variola, 228 
in vomiting, nervous, 281 
in wasting diseases in children, 
182 
in Weir-Mitchell's rest cure, 333 
in whooping-cough, 230 
in yellow fever, 232 
Karell, in nephritis, 323 
laparotomy and, 377 
light, 382 
lists, food values of articles, 38 
Leube's, 245 
Penzoldt's, 251 
solid food, 36 
low protein in nephritis, 322 
nitrogen content of foods 
used in, 322 
test, for renal function, 321 
meat, 382 
milk, 382 
protein, low, 30 
salt-free, in nephritis, 320 
scale, Leube's, 245 
Sippy's, in peptic ulcer, 275 
special, 382 
urine and, relations of, 317 
variation in, 24 
ward, 382 
Digestibility of foods, coefficients 
of, 27 
Digestibility of milk, increasing, 
61 
Digestion, 19 
appetite and, influence on, 25 
buccal, 19 
chemistry of, 11 
diet and, influence of, 25 
emotion and, influence of, 26 
exercise after meals and, 26 
before meals and, 26 
gastric, 19 
influence of various factors on, 
23 
intestinal, 20 
meals and, influence of frequency 
of, 23 
of order of, 23 
of infants, 21 
of milk, 48 
physiology of, 11 
rest after meals and, 26 
before meals and, 26 
salivary, 19 
salt-free, 369 
temperature of food and, influ- 
ence on, 25 
Digestive disturbances in typhoid 
fever, diet in, 224 
Dilatation of blood-vessels, diet in, 
3i5 
of heart, sudden, diet in, 314 
of stomach, diet in, 263 
Diphtheria, diet in, 230 
after intubation, 231 
in paralysis after, 232 
Diseases from errors in diet, in 
from food poisons, 111 
Dogs' milk, composition, 42 
Dried milk in infant feeding, 145 
Drink, imperial, 386 
in tuberculosis, 237, 238 454 
INDEX. 
Drink in typhoid fever, 211 
nutritive, for delicate women, 
416 
Drop method of nutrient enema, 
193 
Dry cure, 372 
diet, 307 
wines, strong, 99 
Dryco, 145 
Drying food to preserve, 103 
Ducks, 69 
Duodenal alimentation, 194 
Dyes, coal-tar, in food, test for de- 
tection of, 121 
Dysentery, diet in, 293 
from Amoeba coli, 115 
Dyspepsia, atonic, diet in, 265 
intestinal, diet in, 290 
nervous, diet in, 282 
Dyspeptics, jelly for, 418 
Dysphagia, diet in, 260 
Dyspnea in heart diseases, diet in, 
3i4 
Earthy mineral waters, 92 
Ebstein's diet for obesity, 364 
Echinococcus disease, 115 
Eczema, 112 
diet in, 365 
Edema, 112 
in heart disease, diet in, 313 
Effervescent peptonized milk, 398 
Effervescing lemonade, 386 
Egg-albumin, 64 
Egg-and-brandy mixture, 384 
for infants, 384 
Egg-broth, 385 
Egg-cordial, 385 
Egg-gruel, 416 
Egg-nog, 64, 385 
beef-tea, 417 
Eggs, 63, 403 
absorption of, 28 
and milk, 404 
composition, 67 
hard-boiled, 63, 403 
in food allergy, 112 
in stomach diseases, 255 
in tuberculosis, 235 
in typhoid fever, 214 
junket with, 399 
poached, beef broth with, 416 
raw, 63 
soft-cooked, 403 
Electricity in rest cure, 335 
Emotion, digestion and, influence 
of, 26 
Empyema, diet in, 307 
Enemata, nutrient, by drop method, 
193 
England, meals in, 24 
Enzymes, 19 
Epilepsy, diet in, 328 
Ergotism, 114 
Esophageal operations, diet after, 
377 
Estraus' materna graduate, 142,143 
Ethers in wine, 99 
Europe, meals in, 23 
Ewes' milk, composition, 42 
Exercise after meals, digestion and, 
26 
before meals, digestion and, 26 
food and, relation, 23 
Extractives in vegetables, 71 
in wine, 99 
Extracts, flavoring, adulteration of, 
test for, 124 
Face, operations about, diet after, 
376 
Farina gruel, 390 INDEX. 
455 
Farinaceous diet, 382 
foods with starch not predi- 
gested, 107 
predigested, 107 
Fast cure in diseases of stomach, 
259 
Fat, 14, 86 
absorption of, 27 
fuel value of, 17 
ham, 439 
in human milk, 135 
in stomach diseases, 256 
in tuberculosis, 237 
in vegetables, 71 
intolerance to, 87 
proteins and carbohydrates in 
combination, quantity re- 
quired, 32 
quantity required, 32 
shoulder, 439 
uses of, 17 
Fat-soluble A, 15 
Fatty oils, 14 
Feeding. See also Diet. 
abnormal methods, 194 
artificial, of child, 133 
bottle, beginning, 153 
breast, 127 
contra-indications, 132 
first few days, 131 
frequency, 129 
interval for, 129 
by stomach-tube, infant, 172 
caloric, 138 
during second year, 156 
forced, 205 
for child nine years old, 165 
in stomach diseases, 259 
in tuberculosis, 241 
maternal, 127 
contra-indications, 132 
Feeding, maternal, first few days, 
131 
frequency, 129 
interval for, 129 
mixed, 133 
nasal, 204 
in infants, 174 
of children, 127 
of infants, 127. See also Infant 
feeding. 
premature infants, 154 
rectal, 189 
prevention of parotitis during, 
192 
procedure, 190 
refractory patients, 204 
sick, general rules, 200 
infants, 171 
through gastric fistulas, 381 
intestinal fistulas, 381 
unconscious patients, 204 
Fennel tea, 131 
Fermentation, alkaline, of milk, 50 
Fever, diet in, 205 
in tuberculosis, diet in, 241 
Figs, 79 
Filaria in water, 116 
Finkelstein's classification of sick 
infants, 171 
protein milk in diarrhea in child- 
hood, 177 
Fish, 69 
absorption of, 28 
composition, 68 
cooking, no 
in stomach diseases, 255 
in tuberculosis, 236 
Fish-poisoning, 113 
Fistulas, gastric, feeding through, 
381 
intestinal, feeding through, 381 456 
INDEX. 
Flank steak, 435 
Flatulence, dietetic treatment, 297 
in heart disease, diet in, 313 
Flavoring extracts, adulteration of, 
test for, 124 
Flavors in milk, 50 
Flaxseed tea, 381 
Floating kidney, diet in, 323 
Flour, 72 
ball, 390 
gruel, 390 
peanut, 426 
Flour-ball gruel, 390 
Fluid needs of infants, 136 
Food, absorption of, 20, 26. See 
also Absorption. 
accessory substances, 14 
adulteration of, 116. See also 
Adulteration. 
age, and relation, 22 
alkali-producing, 18 
allergy, 112 
amount of purin-nitrogen in, 359 
animal, 40 
table of composition, 67 
approximate caloric value of, 138 
artificial preparations, 105 
ascaris lumbricoides in, 116 
breakfast, 73 
caloric value per ounce, table 
showing, 36 
canning of, 104 
caramel in, test for detection of, 
123 
carbohydrate-cellulose, in con- 
stipation, 302 
classes, 40 
climate and, relation, 22 
coal-tar dyes in, test for detec- 
tion of, 121 
coefficiency of digestibility, 27 
Food, concentrated, 102 
containing vitamins, 16, 17 
cooking, 108 
rapid, in 
copper in, test for detection of, 
122 
digestion of, 19. See also Diges- 
tion. 
exercise and, relation, 23 
farinaceous, with starch not pre- 
digested, 107 
predigested, 107 
for aged, 185 
fuel value of classes, 17, 27 
heredity and, relation, 22 
idiosyncrasies, 115 
N and NaCl in, in salt-free diet, 
37i 
nitrogen content of, used in low 
protein diet, 322 
nutritive ingredients of, 17 
ratio, 36 
values, tables for computing, 
38 
oxyuris vermicularis in, 116 
parasites taken with, 115 
pin-worms in, 116 
poisons, diseases from, m 
prepared from cows' milk, 106 
preservation of, 103. See also 
Preservation of food. 
proprietary, artificial, 106, 107 
purin-nitrogen in, 359 
quantity required, 30 
race and, relation, 22 
rectal injection of, 198 
relation of, to various conditions, 
22 
requirements of infants, 136 
rest and, relation, 23 
round-worms in, 116 INDEX. 
457 
Food, sex and, relation, 22 
size of person and, relation, 22 
taenia in, 116 
tape-worms in, 116 
temperature of, influence on di- 
gestion, 25 
trichina in, 116 
turmeric in, test for detection of, 
122 
values, table for computing, 38 
vegetable, 70. See also Vege- 
tables. 
weight of person and, relation, 22 
Food-poisoning, acute, 112 
Foot-and-mouth disease, 115 
Forced feeding, 205 
for child nine years old, 165 
in stomach diseases, 259 
in tuberculosis, 241 
Formaldehyd in milk, detection of, 
120 
Hehner's test for, 120 
Leach's test for, 121 
Fortified wines, 99 
Fowl, 69 
composition, 67 
France, meals in, 23 
Freeman's pasteurizer, 45, 46 
Freezing-point of milk, 41 
Fruit-sugar, 85 
Fruits, 78 
absorption of, 29 
composition, 82 
digestibility of, 78 
in stomach diseases, 256 
in tuberculosis, 237 
Frying meat, no 
Fuel value of food materials, 17, 27 
Full diet, 382 
Fungi, 80 
Fusel oil, 97 
Galactotoxismus, 113 
Gall-stone disease, diet in, 306 
Game, 69 
Gastric digestion, 19 
fistulas, feeding through, 381 
hyperacidity, diet in, 282 
irritability in tuberculosis, diet 
in, 241 
juice, action of, 19 
effect of hormones on, 20 
secretion of, effect of appetite 
on, 20 
Gastritis, acute, diet in, 260 
chronic, diet in, 262 
Gavage in infants, 172 
in stomach diseases, 259 
Geese, 69 
composition, 67 
Gelatin, dishes made with, 418 
in infant feeding, 151 
meat jellies with, 419 
without, 417 
Gelatinous diet in stomach diseases, 
255 
in typhoid fever, 214 
Genito-urinary diseases, alcohol in, 
3i7 
diet in, 317 
surgical, diet in, 324 
water in, 318 
Gin, 97 
Ginger, 86 
Globulins, 12 
Glucose, 85 
and soda solution, 199 
in acidosis, 367 
Glutelins, 12 
Gluten gruel, 391 
Glycerin in wine, 99 
Glycine higpida, 74 
Glycocoll, 13 458 
INDEX. 
Glycogen, 21 
Glycogenic function of liver, 21 
Goats' milk, composition, 42 
Gooseberries, 79 
Gout, diet in, 355 
purin-free, 358 
purin-nitrogen, 359 
dietetic treatment in, 359 
Grain, beef broth with, 416 
roasted, 94 
Grain-poisoning, 113 
Gram calories, 17 
Granum gruel, imperial, 390 
Grape cure in stomach diseases, 259 
juice, 387 
Grape-sugar, 85 
Grapes, 79 
Green vegetables, 76 
Gruel, arrowroot, 389 
barley, 389 
with beef extract, 416 
cereal, 388 
cornmeal, 391 
cracker, 390 
egg, 416 
farina, 390 
flour, 390 
flour-ball, 390 
gluten, 391 
imperial granum, 390 
in infant feeding, 151 
malted, in infant feeding, 153 
milk, peptonized, 399 
oatmeal, 390 
soy bean, 428 
Halphen reaction for cottonseed 
oil, 125 
Ham, 66 
composition, 67 
fat, 439 
Hard cooked eggs, 17, 403 
water, 90 
Hardtack, 102 
Hare-lip operation, diet after, 376 
Head, operations about, diet after, 
376 
Heart, dilation of, sudden, diet, 
3i4 
diseases, diet in, 310 
general directions, 310 
dyspnea in, diet in, 313 
edema in, diet in, 313 
flatulence in, diet in, 313 
Oertel treatment, 313 
ruptured compensation in, diet 
in, 314 
stomach disturbances in, diet 
in, 314 
palpitation of, diet in, 314 
Heat, action of, on milk, 43 
consumption, Rubner's table, 33 
Hehner's test for formaldehyd in 
milk, 120 
Hemorrhage in typhoid fever, diet 
in, 224 
of stomach, diet in, 267, 268 
Hemorrhoids, dietetic treatment, 
297 
Hens' eggs, 63 
composition, 67 
Heredity, food and, relation, 22 
Hip sirloin, 435 
Hives, 115 
diet in, 366 
Honey, 85 
Hook-worms in water, 116 
Hormones, effect of, on gastric 
juice, 20 
Horseradish, 86 
Hospital diet, 382 
dietetians, 383 
Ham, 66 INDEX 
459 
Hot egg-nog, 385 
peptonized milk, 397 
House diet, 382 
Huckleberries, 79 
Human milk. See Milk, human. 
Hydatid disease, 115 
Hydrogen peroxid in milk, detec- 
tion of, 121 
Hyperacidity, gastric, diet in, 282 
Hyperchlorhydria, diet in, 282 
Ice-cream, diabetic, 431 
Iced meat extract, 411 
panopepton, 415 
Iceland moss, 81 
Ichthyotoxismus, 113 
Iletin in diabetes mellitus, 346 
Imperial drink, 386 
granum gruel, 390 
Indigestion, chronic intestinal, in 
children, diet in, 182 
Indol, 13 
Infantile scurvy, diet in, 360 
Infants, brandy-and-egg mixture 
for, 384 
caloric needs of, 136 
diarrhea of, 175 
digestion of, 21 
feeding, 127 
acid milks, 150 
albumin-milk, 150 
artificial, 133 
bottle, beginning, 153 
breast, 127 
contra-indications, 132 
first few days, 131 
frequency, 129 
interval for, 129 
buttermilk, 145 
by stomach-tube, 172 
caloric, 138 
Infants, feeding, condensed milk, 
149 
dried milk, 145 
during second year, 156 
sickness, 171 
from eighteenth month to two 
and one-half years, 160 
from fifteenth to eighteenth 
months, 159 
from nine to twelve months, 
i57 
from seven to nine months, 157 
from twelfth to fifteenth 
months, 158 
from two and one-half to six 
years, 160 
gelatin, 151 
gruels, 151 
in asylums, 169 
in inflammations of mouth, 174 
in stomach diseases, 174 
malt soup, 152 
malted gruels, 153 
milk, 152 
maternal, 127 
contra-indications, 132 
first few days, 131 
frequency, 129 
interval for, 129 
Merrelle-Soule milk in, 148 
mixed, 133 
nasal, 174 
olive oil, 152 
premature, in infants, 154 
soy bean, 151 
wet-nursing, 133 
fluid needs of, 136 
food requirements, 136 
premature, feeding of, 154 
vomiting of, 172 
Infectious diseases, diet in, 210 460 
INDEX. 
Inflammation of kidneys, chronic, 
• Karell diet in, 323 
low protein diet in, 322 
nitrogen content of 
foods used in, 322 
test, for renal function 
in, 321 
salt-free diet in, 320 
of mouth, infant feeding in, 174 
Infusions, saline, 196, 198 
Injections, saline, 196 
Insane, diet for, 338 
Insomnia, diet in, 327 
Insulin in diabetes mellitus, 346 
Intestinal catarrh, acute, diet in, 
291 
chronic, diet in, 291 
with constipation, diet in, 
291 
with diarrhea, diet in, 292 
digestion, 20 
diseases, antifermentative diet 
in, 289 
antiputrefactive diet in, 288 
diet in, 285 
disturbances, malt-sugar in, 135 
dyspepsia, diet in, 290 
fistulas, feeding through, 381 
indigestion, chronic, in children, 
diet in, 182 
Intestine, malignant growths of, 
diet in, 294 
nervous conditions of, dietetic 
treatment, 297 
obstruction of, diet in, 294 
operations on, diet after, 380 
ulcer of, diet in, 293 
Intoxication, acid, of children, 
diet in, 174 
Intubation in diphtheria, diet after, 
231 
Inulin biscuit, 426 
Irish moss, 81 
and milk, 402 
meat jellies with, 420 
Irish-moss blanc-mange, 419 
Iron, 88 
waters, 92 
Irrigations, saline, 196 
Jelly, albuminized, 420 
barley, 391 
chicken, 417 
coffee, 419 
for dyspeptics, 418 
lemon, 419 
diabetic, 432 
meat, 417 
with gelatin, 419 
with Irish moss, 420 
with tapioca, 419 
without gelatin, 417 
milk, 419 
peptonized, 398 
oatmeal, 391 
orange, 419 
panopepton, 415 
with orange, 415 
tapioca, 392 
veal-bone, 417 
wine, 419 
Joslin strict diet in diabetes 
mellitus, 350 
treatment of diabetes mellitus, 
346 
Junket, 399 
almond, bitter, 400 
cocoa, 400 
coffee, 400 
strawberry, 400 
vanilla, 400 
with eggs, 399 INDEX. 
461 
Kaffee Hag, 94 
Karell diet in nephritis, 323 
Kefir, 62 
Kidney, calculi in, diet in, 323 
floating, diet in, 323 
inflammation of, acute, diet in, 
318 
chronic, diet in, 319, 320 
Karell diet in, 323 
low protein diet in, 322 
nitrogen content of 
foods used in, 322 
test diet, for renal func- 
tion in, 321 
salt-free diet in, 320 
diet in, 318, 319, 379 
movable, diet in, 319 
operations on, diet after, 379 
Klim, 145 
Kneipp cure, 372 
Knuckles, 436 
Kreotoxismus, 113 
Kumiss, 61, 181, 401, 402 
cure, 62 
Lacteals, 21 
Lactose, 85 
Lamb, 66 
composition, 67 
cuts of, 436 
Laparotomy, diet and, 377 
Lard, 14 
leaf, 439 
Larosan, 151 
Laryngeal operations, diet after, 
377 
Laryngitis, diet in, 307 
Lathyrism, 114 
Laxative bread, 394 
Leach's test for formaldehyd in 
milk, 121 
Lead as adulterant, 118 
Leaf lard, 439 
Leanness, diet in, 365 
Legumes, 73 
absorption of, 29 
in diet in beriberi, 114 
in stomach diseases, 256 
Legumin, 106 
Lemon extract, adulteration of, 
test for, 124 
jelly, 419 
diabetic, 432 
whey, 401 
Lemonade, 386 
albuminized, 386 
effervescing, 386 
milk, 400 
peptonized, 399 
Lemons, 78 
Lenhartz's diet in ulcer of stomach, 
269, 270 
modified, 271 
Lentils, 74 
Lettuce, 77 
stewed, 425 
Leube's diet lists, 245 
Leucin, 13 
Levulose, 85 
Lichens, 81 
Light custard, 425 
diet, 382 
Lime-water, 384 
in reaction of human milk, 135 
Linseed tea, 387 
Lipins, 14 
Liqueurs, 97 
Liquors, malt, 98 
action of, 101 
uses of, 101 
Liver diseases, diet in, 304 
glycogenic function of, 21 462 
INDEX. 
Liver in absorption, 21 
Llama's milk, composition, 42 
Lobster, 69 
composition, 68 
Loin, small end of, 435 
Lumpy-jaw, 115 
Lung diseases, chronic, diet in, 308 
Lupinosis, 114 
Lyster muffins, 431 
Maidismus, 113, 114 
Maise, fermented, poisoning from, 
114 
Malnutrition, forced feeding in, 164 
Malt extracts, 107 
liquors, 98 
action of, 101 
uses of, 101 
soup, dry preparations of, 153 
in infant feeding, 152 
sugar, 135 
as laxative, 135 
in intestinal disturbances, 135 
Malted gruels in infant feeding, 153 
milk in infant feeding, 152 
Maltose, 135 
Mammala, 145, 182 
Mares' milk, composition, 42 
Massage in rest cure, 334 
Materna graduate, 143 
method of milk modification, 
142 
Maternal feeding, 127 
contra-indications, 132 
first few days, 131 
frequency, 129 
interval for, 129 
Matzobn, 62 
Meals, exercise after, digestion and, 
26 
before, digestion and, 26 
Meals, frequency of, influence on 
digestion, 23 
in England, 24 
in Europe, 23 
in France, 23 
in tuberculosis, number of, 238 
order of, influence on digestion, 
23 
rest after, digestion and, 26 
before, digestion and, 26 
sleep after, 26 
Measles, diet in, 230 
Measures, 440 
Meat, 64, 405 
absorption of, 28 
baking, 109 
boiling, 108 
braising, 109 
broiling, no, 406 
broth, 409 
cooking, 108, 406 
effect of, no 
cuts of, 433 
diet of, 382 
in tuberculosis, 235 
digestibility of, 64 
extract of, iced, 411 
frying, no 
in stomach diseases, 255 
jelly, 417 
with gelatin, 419 
with Irish moss, 420 
with tapioca, 420 
without gelatin, 417 
j'uice, 412 
in tuberculosis, 236 
raw, 411 
mutton broth without, 409 
pan-broiling, 406 
powders, 66 
preparations, 64, 65 INDEX. 
463 
Meat, preparing, 405 
raw, with milk and sugar, 414 
roasting, 109, 406 
soups without, 395 
stewing, 109 
Meat-poisoning, 113 
Meconium, 131 
Melons, 79 
Merrelle-Soule milk in infant feed- 
ing, 148 
Metabolism, 17 
faulty, 19 
purin, 31 
Metric and apothecaries' weights, 
relative values, 442 
and avoirdupois weights, relative 
values, 441 
fluid and apothecaries' measures, 
relative values, 440 
Milk, 40 
absorption of, 28 
acid, in infant feeding, 150 
acidophilus, 58 
adulteration of, 54 
albumin-, in infant feeding, 150 
albuminized, 402 
alkaline fermentation of, 50 
almond, 384 
and eggs, 403 
and sugar, raw meat with, 414 
bacteria in, 50 
bitter, 50 
butter-, 57 
color of, 49 
composition, 40 
of various kinds, 42 
condensed, 59 
in infant feeding, 147 
cows', composition of, 39 
foods prepared from, 106 
cream of, 55 
Milk curd, 399 
cure, 368 
in stomach diseases, 258 
delivery of, 53 
diet, 382 
in tuberculosis, 234 
digestibility of, increasing, 61 
digestion of, 48 
dried, in infant feeding, 145 
examination of, 55 
fermentation of, alkaline, 50 
flavors in, 50 
formaldehyd in, detection of, 120 
Hehner's test for, 120 
Leach's test for, 121 
freezing-point of, 41 
from tuberculous cows, 52 
gruel, peptonized, 399 
heating of, changes taking place 
in, 43 
human, fat in, 135 
milk-sugar in, 135 
modification of, 130 
proteins in, 134 
reaction, 135 
salts in, 135 
sugar in, 135 
hydrogen peroxid in, detection of, 
121 
infected, 116 
in typhoid fever, 212 
modified, 212 
Irish moss and, 402 
jelly, 419 
peptonized, 398 
lemonade, 400 
peptonized, 398 
malted, in infant feeding, 152 
Merrelle-Soule, in infant feed- 
ing, 148 
mixture, 402 464 
INDEX. 
Milk mixture, calculation of com- 
position of, 141 
modification, 142 
at home, technic, 153 
Baner's method, 144 
laboratory method, 142 
materna graduate method, 142 
modified, in typhoid fever, 212 
mothers'. See Milk, human. 
pancreatization of, 61 
pasteurization of, 43 
peptonized, 397 
cold process, 397 
effervescent, 398 
hot, 397 
partially, 397 
specially, 398 
warm process, 397 
porridge, 401 
predigestion of, 60 
preparations of, 397 
preservatives in, 54 
production, 40, 52 
protein, in diarrhea in child- 
hood, 177 
punch, 400 
peptonized, 399 
ropy, 49 
skim, 56 
in diarrhea in childhood, 177 
slimy, 49 
souring of, 51 
specific gravity of, 41 
sterilization of, 43 
sugar-free, for diabetics, 427 
transportation and delivery of, 53 
variations in, 42 
with other diluents, 403 
with sparkling waters, 403 
woman's, composition, 42 
Milk-and-cereal waters, 402 
Milk-and-cinnamon drink, 402 
Milk-poisoning, 113 
Milk-sugar, 85 
in human milk, 135 
Mineral waters, 90 
alkaline, 91 
bitter, 92 
earthy, 92 
iron, 92 
sodium chlorid, 91 
sulphurous, 92 
uses of, in body, 17 
Modified coffees, 93 
milk in typhoid fever, 207 
Molasses, 85 
Mollusks, 70 
composition, 68 
Morels, 81 
Mosquera beef meal, 66, 105 
Moss, Iceland, 81 
Irish, 81 
and milk, 402 
meat jellies with, 420 
Mothers' milk. See Milk, human. 
Mouth in typhoid fever, care of, 223 
inflammations of, infant feeding 
in, 174 
Movable kidney, diet in, 323 
Muffins, diabetic, 431 
lyster, 431 
soy bean, 429 
Mulberries, 79 
Mulled wine, 387 
Mumps, diet in, 230 
Murphy's method of proctoclysis, 
196 
Muscarin, 113 
Mush cereal, 388 
Mushroom-poisoning, 113 
Mushrooms, 80 
Mussel-poisoning, 113 INDEX. 
465 
Mustard, 86 
Mutton, 66 
broth, 409 
with vegetables, 409 
without meat, 409 
composition, 67 
cuts of, 436 
Mytilotoxismus, 113 
N and NaCl, approximate per- 
centage of, in food in salt-free 
diet, 371 
Nasal feeding, 204 
in infants, 174 
Nausea after operations, 378 
Navel end of plate, 434 
Nephritis, diet in, 318-320, 379 
Karell, 323 
low protein, 322 
nitrogen content of foods 
used in, 322 
test, for renal function, 
321 
salt-free, 320 
Nervous diseases, diet in, 325 
forced feeding in, 164 
rest cure in, 332 
dyspepsia, diet in, 282 
gastric disorders, diet in, 281 
vomiting, diet in, 281 
Neuralgia, diet in, 327 
Neurasthenia, intestinal, diet in, 
297 
Nitrogen content of foods used in 
low protein diet, 322 
Nursing bottle, hygienic, 133 
child, 127. See also Infant 
feeding. 
wet-, 133 
Nut-brown bread, 266 
Nut-cakes, soy bean, 430 
Nutmeg, 86 
Nutrient enemata, 193 
by drop method, 193 
Nutrients, uses of, 17 
Nutrition, Pirquet system of, 141 
Nutritive ratio, 36 
Nuts, 79 
Oatmeal, 73 
beef-tea with, 410 
gruel, 390 
jelly, 391 
water, 387 
Obesity, diet in, 360 
Banting's, 363 
Ebstein's, 364 
Oertel's, 364 
treatment by, 363 
prophylaxis in, 363 
Oertel's treatment of heart disease, 
3i3 
of obesity, 364 
Oil, cottonseed, Halphen reaction 
for, 125 
of cloves, 14 
olive, in infant feeding, 152 
Oils, 86 
cod-liver, 87 
fatty, 14 
Oleomargarin, 87 
test for detection of, 126 
Waterhouse test for, 126 
Olive oil in infant feeding, 152 
Olives, 79 
Operations about face, diet after, 
376 
head, diet after, 376 
bowels after, 378 
brain, diet after, 376 
cleft palate, diet after, 376 466 
INDEX. 
Operations, diet after, 375 
dietetic management, 373 
esophageal, diet after, 377 
hare-lip, diet after, 376 
laparotomy, diet after, 377 
laryngeal, diet after, 377 
nausea after, 378 
on intestines, diet after, 380 
on kidney, diet after, 379 
on pancreas, diet after, 379 
on rectum, diet after, 381 
on stomach, diet after, 380 
on various organs, diet after, 379 
plastic, diet after, 376 
shock after, diet and, 379 
thirst after, 378 
vomiting after, 378 
Orange jelly, 419 
with panopepton jelly, 415 
Orangeade, 386 
Oranges, 78 
Orgeat, 387 
Overproduction of acid in body, 18 
ammonia in, 18 
diet in, 18 
Oxyuris vermicularis in food, 116 
Oyster, 70 
composition, 68 
juice, 409 
peptonized, 412 
stew, 396 
Palate, cleft, operation for, diet 
after, 376 
Palpitation of heart, diet in, 3x4 
Pan-broiling meats, 406 
Pancakes, aleuronat, 423 
cocoanut, 424 
soy bean, 430 
operations on, diet after, 379 
Pancreatic juice, 20 
Pancreatization of milk, 61 
Panopepton, 415 
bouillon, hot, 415 
cordial, 416 
hot, 415 
iced, 415 
jelly, 415 
with orange, 415 
with whey, 415 
Paralysis after diphtheria, diet in, 
232 
Parasites taken with food, 115 
Parotitis, prevention of, during 
rectal feeding, 192 
Parsnips, 76 
Pasteurization of milk, 43 
Pasteurizer, Freeman's, 45, 46 
Peaches, 79 
Peanut flour, 426 
Pears, 79 
alligator, 79 
Peas, 73 
absorption of, 29 
Pelidisi, 141 
Pellagra, 114 
Pemmican, 105 
Penzoldt's diet lists, 251 
table of food digestibility, 249 
Peppers, 86 
Pepsin, 19 
Peptic ulcer, Sippy's diet in, 275 
Pepton products, 105 
Peptonized beef, 413 
milk, 397. See also Milk, pep- 
tonized. 
oysters, 412 
Perfect wines, 100 
Perforation in typhoid fever, diet 
in, 225 
Peritonitis, diet in, 303 
Phosphorus, 88 INDEX. 
467 
Physiology of digestion, 11 
Pigeons, 69 
Pin-worms, 116 
Pirquet system of nutrition, 141 
Plastic operations, diet after, 376 
Pleural cavity, pus in, diet in, 307 
Pleurisy, diet in, 307 
Plums, 79 
Pneumonia, diet in, 308 
from spoiled meat, 113 
Poached egg, beef broth with, 416 
Poisoning, cheese-, 113 
fish-, 113 
food, acute, 113 
diseases from, in 
from chick-pea, 113 
from fermented maise, 114 
from spurred rye, 113 
grain-, 113 
meat-, 113 
milk-, 113 
mushroom-, 113 
mussel-, 113 
ptomain-, 112 
sausage-, 113 
Pork, 66 
composition, 67 
cuts of, 437 
Porridge, milk, 401 
Porter, 98 
Postdiphtheritic paralysis, diet in, 
232 
Potassium chlorid, 88 
Potato, 76 
soup, cream of, 396 
sweet, 76 
Poultry, 69 
composition, 67 
Predigestion of milk, 60 
Pregnancy, diet during, 187 
diseases of, diet in, 188 
Premature infant, caloric needs of, 
137 
feeding of, 154 
Preservation of food, 103 
by antiseptic chemicals, 104 
by antiseptics, 104 
by canning, 104 
by cold, 104 
by drying, 103 
by excluding air, 103 
by other antiseptics, 104 
by salting, 104 
by sugar solution, 104 
by vinegar, 104 
Preservatives, 118 
benzoic acid, test for detection of, 
119 
borax, test for detection of, 120 
boric acid, test for detection of, 
120 
detection of, tests for, 118 
formaldehyd, in milk, detection 
of, 120 
Hehner's test for, 120 
Leach's test for, 121 
hydrogen peroxid, detection of, 
121 
in milk, 54 
saccharin, test for detection of, 
120 
salicylic acid, test for detection 
of, 119 
Proctoclysis, Murphy's method, 
196 
Proprietary foods, artificial, 106, 
107 
Proteids, 12 
Protein, amino-acids in, 13 
diet, low, 30 
in chronic inflammation of 
kidneys, 322 468 
INDEX. 
Protein diet, low, nitrogen content 
of foods used in, 322 
test diet for renal function, 
321 
optimum, 31 
Proteins, 12 
absorption of, 27 
carbohydrates, and fats in com- 
bination, quantity required, 32 
concentrated, 102 
digestion of, 13 
fuel value of, 17 
in food allergy, 112 
in human milk, 134 
in stomach diseases, 254 
in typhoid fever, 214 
in vegetables, 71 
milk, in diarrhea in childhood, 
177 
quantity required, 30 
uses of, 17 
Protolac, 151 
Prunes, 79 
Ptomain-poisoning, 112 
Ptomains, 112 
Pudding, almond, 421 
cocoanut, 425 
suet, aleuronat, and, 423 
Puerperium, diet during, 187 
Pulled bread, 393 
Punch, milk, 400 
peptonized, 399 
Purge, chestnut, 392 
Purin bodies in urine, 359 
metabolism, 31 
Purin-free diet in gout, 358 
Purin-nitrogen in foods, 359 
Pus in pleural cavity, diet in, 307 
Rabbit, 69 
Rabies, diet in, 233 
Racahout des Arabes, 390 
Race, food and, relation, 22 
Rachitis, diet in, 15, 183 
Raisins, 79 
Raspberries, 79 
Raw beef, preparing, 413 
soup, 414 
eggs, 63 
meat juice, 411 
with milk and sugar, 414 
Reaction, Halphen, for cottonseed 
oil, 125 
of human milk, 135 
Recipes, 384 
for diabetics, 420 
Rectal feeding, 189 
prevention of parotitis during, 
192 
procedure, 190 
injections of foods, 198 
of plain water, 197 
irrigations, saline, 196 
Rectum, operations on, diet after, 
387 
Renal calculi, diet in, 323 
function, low protein test diet 
for, 321 
Rennin, 20 
Renovated butter, 57 
test for detection of, 126 
Respiratory diseases, diet in, 307 
Rest after meals, digestion and, 
26 
before meals, digestion and, 26 
cure, 332 
diet in, 333, 335 
schedule, 336 
electricity in, 333 
in stomach diseases, 258 
massage in, 334 
schedule for, 336 469 
INDEX 
Rest, food and, relation, 23 
Rheumatism, diet in, 232 
Rice, 72 
absorption of, 29 
water, 387 
Richards' ideal ration of solid food, 
36 
Rickets, diet in, 15, 183 
Roasted grains, 94 
Roasting meat, 109, 406 
Roots, 75 
absorption of, 29 
Ropy milk, 49 
Rough wines, 100 
Round, top of, 435 
Round-worms in food, 116 
Rubner's tables of heat consump- 
tion, 33 
Rum, 97 
Rump stead, 435 
Ruptured compensation, diet in, 
3i4 
Rye, spurred, poisoning from, 113 
Saccharin, 85 
as preservative, test for detection 
of, 120 
Salicylic acid as preservative, test 
for detection of, 119 
Saline infusions, 196, 198 
irrigations, 196 
rectal irrigations, 196 
Salivary digestion, 19 
Salt-free diet, 369, 370 
N and NaCl in food in, 371 
Salting of food to preserve, 104 
Salts, 88 
in body, 12 
in human milk, 135 
Sanatoriums, diet in, in tuberculo- 
sis, 241 
Sauces, 86 
for vegetables, 395 
Sausage-poisoning, 113 
Scarlet fever, diet in, 228 
School-children, diet for, 165 
Scorbutus, diet in, 360 
Scurvy, 15 
diet in, 360 
Second year, feeding during, 156 
Sex, food and, relation, 22 
Shell-fish, 70 
composition, 68 
Shock after operation, diet and, 379 
Short steak, 435 
Shoulder fat, 439 
Sick, feeding of, general rules, 200 
infants, feeding of, 171 
Sippy's diet in peptic ulcer, 275 
Sirloin, 435 
Sitotoxismus, 114 
Size of person, food and, relation, 22 
Skatol, 13 
Skim milk, 56 
in diarrhea in childhood, 177 
Skin diseases, diet in, 365 
Sleep after meals, 26 
disturbed, diet in, 327 
Slimy milk, 49 
Small-pox, diet in, 228 
Soda and glucose solution, 199 
Sodium bicarbonate, 18, 135 
in acidosis, 19, 366, 367 
chlorid, 88 
citrate, 135 
waters, 91 
Soft water, 90 
Soft-cooked eggs, 403 
Somatose, 66, 106 
Soups, beef, raw, 414 
celery, cream of, 396 
chestnut, 392 470 
INDEX. 
Soups, composition, 67 
cream-of-celery, 396 
cream-of-potato, 396 
cream-of-tomato, 396 
from stock, 408 
in typhoid fever, 216 
malt, dry preparations of, 153 
in infant feeding, 152 
potato, cream of, 396 
preparing, 407 
raw beef, 414 
stock, 407 
from beef extract, 408 
sweetbread, 408 
tapioca, 392 
tomato, cream of, 396 
without meat, 395 
Souring of milk, 51 
Soy bean, 74 
as breakfast food, 430 
broths, 428 
cakes, 430 
cheese, 430 
cookery, 427 
flour, 75 
gruels, 428 
in infant feeding, 151 
muffins, 429 
nut-cakes, 430 
pancakes, 430 
sauces, 74 
Spare ribs, 438 
Sparkling waters, milk with, 403 
wines, 100 
Specific gravity of milk, 41 
Spices, 85 
adulteration of, test for, 125 
Spinach, 77 
Spirits, 96 
Sprue, 114 
Spurred rye, poisoning from, 114 
Stage of broken compensation, 310 
of compensation, 310 
Starch in vegetables, 70 
Steak, flank, 435 
rump, 435 
short, 435 
Steapsin, 20 
Sterilization of milk, 43 
Sterilizer, Arnold, 44 
Sterols, 14 
Stew, oyster, 389 
Stewed lettuce, 425 
Stewing meat, 109 
Stimulants, 88 
Stomach, carcinoma of, diet in, 
280 
digestion, 19 
dilatation of, diet in, 263 
diseases, diet in, 244 
carbohydrates in, 256 
eggs in, 255 
fats in, 256 
fish in, 255 
fruits in, 256 
gelatinous, 255 
leguminous, 256 
liquid, 255 
meats in, 255 
special factors, 256 
fast cure in, 259 
forced feeding in, 259 
gavage in, 259 
grape cure in, 259 
in infants, diet in, 254 
Leube's diet scale in, 245 
milk cure, 258 
Penzoldt's diet lists, 251 
rest cure, 258 
rules for eating in, 257 
treatment, special, 258 
Weir Mitchell cure, 258 INDEX. 
471 
Stomach disturbances in heart dis- 
ease, diet in, 314 
hemorrhage of, diet in, 280 
in ulcer of stomach, diet in, 267 
hyperacidity, diet in, 282 
nervous disorders of, diet in, 281 
operations on, diet after, 380 
ulcer of, diet in, 267 
Lenhartz's diet in, 269, 270 
modified, 271 
Sippy's diet in, 275 
Stomach-tube in infant feeding, 172 
Stout, 98 
Strawberries, 79 
Strawberry junket, 400 
Strongylus duodenale in water, 116 
Succus carnis, 412 
Suet pudding, aleuronat and, 423 
Sugar, 84 
and milk, raw meat with, 414 
cane-, 84 
fruit-, 85 
grape-, 85 
in human milk, 135 
in vegetables, 70 
in wine, 99 
malt, as laxative, 135 
in intestinal disturbances, 135 
milk-, 85 
solution in preserving food, 104 
Sugar-free milk for diabetics, 427 
Sulphur, 88 
Sulphurous waters, 92 
Suralimentation in tuberculosis, 
241 
Surgical cases, diet in, 373 
Swallowing, difficult, diet in, 260 
Sweet potato, 76 
wines, strong, 100 
Sweetbread soup, 408 
Syrup, 85 
Tzenia, ii6 
echinococcus, disease from, 115 
Tamarind water, 386 
Tapeworms, 116 
Tapioca jelly, 392 
meat jellies with, 420 
soup,392 
Tea, 92 
beef-, 410 
egg-nog, 417 
flavored, 410 
with oatmeal, 410 
catnip, 131 
fennel, 131 
flaxseed, 387 
linseed, 387 
Terrapin, composition, 68 
Test for artificial colors in food, 121 
for detection of preservatives, 118 
Waterhouse, for oleomargarin, 
126 
Tetanus, diet in, 233 
Thermal waters, 91 
Thirst after operations, 378 
Thoracic duct, 21 
Tomato sauce, 86 
soup, cream of, 396 
Tomatoes, 77 
Top of round, 435 
Toxins, 113 
Transportation of milk, 53 
Treacle, 85 
Trichina in food, 116 
Truffles, 81 
Trypsin, 20 
Tryptophane, 13 
Tuberculosis, beverages in, 238 
bovine, milk contamination in, 52 
diet in, 233 
advanced cases, 240 
alcohol in, 238 472 
INDEX. 
Tuberculosis, diet in, cereals in, 236 
eggs in, 235 
fats in, 237 
fever and, 241 
fish in, 236 
forced, 241 
fruit in, 237 
in gastric irritability, 241 
in sanatoriums, 241 
meat in, 235 
juice in, 236 
milk in, 234 
number of meals, 238 
vegetables in, 237 
wheat in, 237 
suralimentation in, 241 
Tubers, 75 
absorption of, 29 
Tumeric in food, test for detection 
of, 122 
Turkey, composition, 67 
Turtle, composition, 68 
Typhoid fever, alcohol in, 215 
atypical, diet in, 228 
carbohydrates in, 213 
complicated, diet in, 228 
convalescence, diet in, 225 
diet in, 210 
in digestive disturbances, 
224 
drink in, 211 
eggs in, 214 
gelatinous substances in, 214 
hemorrhage in, diet in, 224 
high caloric diets in, 215 
milk in, 212 
modified, 212 
mouth in, care of, 224 
perforation in, diet in, 225 
proteins in, 214 
soups in, 216 
Typhus fever, diet in, 228 
Tyrosin, 13 
Tyrotoxismus, 113 
Ulcer of intestine, diet in, 293 
of stomach, diet in, 267 
Lenhartz's diet in, 269, 270 
modified, 271 
Sippy's diet in, 275 
peptic, Sippy's diet in, 275 
Unconscious patients, feeding, 204 
Urea, 21 
Uric-acid diathesis, diet in, 323 
Urine and foods, relations of, 317 
purin bodies in, 359 
Urticaria, 112, 115 
diet in, 366 
Valin, 13 
Vanilla extract, adulteration of, 
test for, 124 
junket, 400 
Variola, diet in, 228 
Veal, 66 
broth, 409 
composition, 67 
cuts of, 435 
Veal-bone jelly, 417 
Vegetables, 70, 394 
absorption of, 29 
carbohydrates of, 70 
composition, 83 
concentrated, 102 
cooking, 394 
effect of, no 
time for, 394 
digestibility of, 71 
extractives in, 71 
fats in, 71 
green, 76 
absorption of, 29 INDEX. 
473 
Vegetables in tuberculosis, 237 
mutton broth with, 409 
protein in, 71 
sauce, 395 
starch in, 70 
sugar in, 70 
Vegetarianism, 77 
Venison, 68 
Vinegar, 86 
adulteration of, test for, 125 
in preserving food, 104 
Vitamin A, 15 
antiscorbutic, 15, 16 
B, 15 
C, 15, 16 
calcium-depositing, 15, 16 
D, 15 
Vitamin-containing foods, 14 
Vitamins, 14 
absence of, as cause of beriberi, 
114 
Vomiting after operations, 378 
cyclic, of children, diet in, 174 
infant, 172 
nervous, diet in, 281 
Walnuts, 80 
Ward diet, 382 
Wasting diseases in children, diet 
in, 183 
Water, 88 
acratothermal, 92 
alkaline, 91 
amoeba coli in, 115 
amount consumed, 89 
bitter, 92 
earthy, 92 
elimination of, 89 
filaria in, 116 
hard, 90 
hook-worms in, 116 
Water, impurities in, 90 
in body tissues, 12 
in genito-urinary diseases, 318 
iron, 92 
mineral, 90 
purification of, 90 
rectal injections of, 197 
sodium chlorid, 91 
soft, 90 
strongylus duodenale in, 116 
sulphurous, 92 
thermal, 91 
Water house test for oleomargarin, 
126 
Waxes, 14 
Weight, forced feeding in loss of, 
164 
of infant, 171 
of person, food and, relation, 22 
Weights, 440 
Weir Mitchell cure for stomach dis- 
eases, 258, 
rest cure, 333. See also Rest 
cure. 
Wet-nursing, 133 
Wheat, 72 
bread, whole, 393 
in beriberi, 114 
in tuberculosis, 237 
Whey, 399, 
cream-of-tartar, 401 
lemon, 401 
wine, 401 
with panopepton, 415 
Whisky, 97 
Whole-wheat bread, 393 
in beriberi, 114 
Whooping-cough, diet in, 230 
Wine, 98 
acid, 100 
acids in, 98 474 
INDEX. 
Wine, action of, 101 
alcohol in, 98 
aromatic, 100 
dry, strong, 99 
ethers in, 99 
extractives in, 99 
fortified, 99 
glycerin in, 99 
jelly, 419 
mulled, 387 
perfect, 100 
rough, 100 
sparkling, 100 
sugar in, 99 
sweet, strong, 100 
Wine, uses of, xoi 
varieties, 99 
whey, 401 
Woman's milk, composition, 42 
Women, delicate, nutritive drink 
for, 416 
Wood alcohol as adulterant, 118 
Woodyatt's treatment of diabetes 
mellitus, 346 
Worcestershire sauce, 86 
Xerophthalmia, 15, 115 
Yellow fever, diet in, 232