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BOUGHT WITH THE INCOME
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THE GIFT OF
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1891
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Food and diet in health and disease,
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FOOD and DIET
IN
HEALTH AND DISEASE
BY
ROBERT F. WILLIAMS, M.A., M.D.
PROFESSOR OF PRACTICE OF MEDICINE IN THE MEDICAL COLLEGE OF VIRGINIA
LEA BROTHERS & CO.
PHILADELPHIA AND NEW YORK
Entered according to the Act of Congress, in the year 1906, by
LEA BROTHERS & CO.
in the Office of the Librarian of Congress. All rights reserved.
DORNAN, PRINTER
TO
GEORGE BEN JOHNSTON, M.D., LL.D.
PEEFACE.
In the preparation of this book an effort has been made
to present concisely the principles, at present known, upon
which rests the intelligent use of food in health and in
disease. Technicalities have been as far as possible
avoided, in order that the subject may be intelligible to
persons without technical training.
In the grouping of the individual foods, a departure has
been made from the usual custom of dividing them into
"animal" and "vegetable." Arrangement according to
the predominating alimentary substance will serve better
to distinguish foods from the point of view of their prac-
tical uses in the body.
Part I. is largely based upon the work of the Experi-
ment Stations of the United States Department of Agri-
culture, as published in the Farmers' Bulletin, from which
all the tables used have been taken, unless otherwise
specified. Some diseases customarily treated of in books
on this subject have been omitted from Part II., since the
details of their dietetic management are direct corollaries
of oft-repeated principles elsewhere herein set forth, or
else their management requires institutional care, which
lies beyond the scope of this book.
In preparing the text I have drawn liberally from the
standard works on dietetics and have made free use
vi PREFACE
of monographs and the current literature of the best
dieticians of this country and Europe.
Acknowledgment is hereby made of the helpful assist-
ance of Dr. P. St. George Grinnan, in preparing the
chapter on Food in Infancy, and of Dr. F. H. Beadles, in
writing the chapter on Food in Diseases of the Skin.
My thanks are also due to Miss R. Z. Van Vort, Super-
intendent of the Memorial Hospital, for arranging the
diet lists and recipes, and to Dr. W. A. Shepherd for
aid in proof-reading and in the preparation of the index.
R. F. W.
Richmond, Virginia, 1906.
CONTENTS.
PART I.
FOOD IN HEALTH.
CHAPTER I.
PAGE
Chemistry Relation of Foods to the Body. How the Body
Requirements Are Supplied by . Foods. Source of. Foods.
Estimation of "Food Values ..." 17
CHAPTER II.
Physiology. Digestive Processes. How the Body Changes
Foods to Render them Fit for Absorption and Appropria-
tion. Agreement of Foods .... 31
CHAPTER III.
Cooking. Changes Necessary in Natural Foods to Render
them Digestible". Methods" Used .... 39
CHAPTER IV.
Proteid Foods. Milk. .Eggs 49
CHAPTER V.
Proteid Foods (continued). Meats. Fish . . 84
viii , CONTENTS
CHAPTER VI.
PAGE
Proteid Foods (continued). Cereals. Peas, Beans, and Len-
tils Peanuts ....... 110
CHAPTER VII.
Carbohydrate Foods and Salts. Vegetables. Fruits. Condi-
ments ...... . 135
CHAPTER VIII.
Fat Foods. Animal Fats. Vegetable Fats. Nuts 155
CHAPTER IX.
Water. Non-alcoholic Beverages. Alcoholic Beverages 162
CHAPTER X.
Quantity of Food Frequency of Feeding. Relation of Food
to Exercise, Sleep, and Tobacco. Food in Childhood and
Old Age . 188
CHAPTER XI.
Food in Infancy . . . . 204
PART II.
FOOD IN DISEASE.
CHAPTER XII.
Feeding the Sick. Details of Serving Food. Rectal Feeding.
Gastric Lavage. Medicines in Relation to Foods . . 223
CONTENTS ix
CHAPTER XIII.
PAGE
Food in Infectious Diseases. Typhoid Fever. Cholera. Den-
gue Relapsing Fever. Typhus Fever. Yellow Fever.
Dysentery. Influenza. Croupous Pneumonia. Acute
Articular Rheumatism ...... 235
CHAPTER XIV
Food in Infectious Diseases (continued). Malaria. Septi-
cemia and Pyemia. Erysipelas. Smallpox. Scarlet
Fever. Measles. Diphtheria. Cerebrospinal Meningitis.
Whooping-cough. Pulmonary Tuberculosis . 253
CHAPTER XV.
Food in Diseases of the Digestive Tract. Acute Gastritis.
Chronic Gastritis. Dilatation of the Stomach. Ulcer of
the Stomach. Cancer of the Stomach. Diarrhea. Con-
stipation. Cirrhosis of the Liver . . . .272
CHAPTER XVI.
/ —- r-
Food in Disorders of Nutrition. .Qhesity. Gout. Diabetes.
Scurvy. Chronic Rheumatism. Rheumatoid Arthritis. 299
CHAPTER XVII.
Food in Diseases of the Kidney. Acute Nephritis. Chronic
Nephritis. Nephrolithiasis . . . . .317
CHAPTER XVIII.
Food in Diseases of the Circulatory and Respiratory Tracts.
Chronic' Heart Disease. Arteriosclerosis. Angina Pec-
toris. Aortic Aneurysm. Acute Bronchitis. Broncho-
pneumonia. Asthma. Pleurisy. Food in Anemia and
Neurasthenia ...... 325
x CONTENTS
CHAPTER XIX.
PAGE
Food in Diseases of the Skin. Acne Vulgaris. Acne Rosacea.
Eczema. Erythema Nodosum. Psoriasis. Purpura.
Urticaria. Xanthoma Diabeticorum . . 337
CHAPTER XX.
Memorial Hospital Dietaries. Recipes . 346
PART I.
FOOD IN HEALTH.
CHAPTER I.
CHEMISTRY. RELATION OF FOODS TO THE BODY.
HOW THE BODY REQUIREMENTS ARE SUPPLIED
BY FOODS. SOURCE OF FOODS. ESTIMATION
OF FOOD VALUES.
From whatever point of view considered, there is no
biological study which presents such problems or holds
such interest as that very complex structure, the Human
Body.
It is a machine which is capable of providing numerous
mechanical effects. It is a laboratory wherein force is
developed. A living organism, it possesses functions
inimitable by the mechanic or the scientist, and in some
mysterious way it is the effective agent for the outward
manifestation of the activities of that intangible thing
which we call Mind.
Chemical action, liberated and made effective by the
living organism, produces force which is variously made
manifest in the body as heat, muscular contraction, gland-
ular secretion, or mental activity.
These functions — mechanical, chemical, and vital, so
different in their nature — are interdependent. In health
2
18 POOD IN HEALTH
the body is a perfect self-regulating and self-supplying
machine. But that intricate correlation of its parts, which
produces harmony of function, may in disease affect all of
them by the derangement of one.
When one considers the variety of organs in the body
— muscles, digestive apparatus, lungs, heart, kidneys,
brain — which, by their simultaneous activities, are using
up force, he may well wonder at the enormous amount of
work done in the body, since' motion, secretion, respira-
tion, circulation, elimination, thought, and feeling are all
work, and simply the different forms in which energy or
force is expended. This work of the organs never ceases,
for even in sleep their activity continues, though more
slowly, and cessation of their function leads to their dis-
integration and death; Nature does not permit idleness.
As with other machines, work causes proportionate wear
and tear, so in the human body does the expenditure of
force in functional activity use up its structural materials.
Waste follows exercise of function, and it is evident that
repair in the organs must continually be made and force
supplied, if this efficiency is to be preserved. The source
of supply of both of these necessities is Food. But just
as there is a difference in the steam-producing power of
different kinds of fuel and consequent economical advan-
tages in selection, so is there a difference in the value of
the various foodstuffs, depending jointly on their chemical
composition and physical structure.
Chemical analysis shows the body to contain some
fifteen to twenty different elements. Just what part tnany
of them play is not known. The predominating elements
are oxygen, hydrogen, carbon, nitrogen, calcium, phos-
phorus, and sulphur. These exist in various combinations
CHEMISTRY OF FOOD 19
to form the different substances of which the tissues —
muscle, bone, fat, tendons, etc.— are made. The more
important of these substances, termed "alimentary sub-
stances," are proteid, fats, carbohydrates, salts or mineral
matter, and water.
Proteid forms about 18 per cent, of the body weight,
furnishes the basis of nearly all of its tissues, and occurs
in many of its fluids. It is found in the body in three
forms, albuminoids, gelatinoids, and extractives. The
albuminoids form a large proportion of lean meat and
milk; the gelatinoids occur principally in the bones, ten-
dons, gristle, and skin. These two forms are collectively
spoken of as "proteids."
Fats form about 15 per cent, of the body weight and are
found scattered throughout the tissues in minute par-
ticles and in layers or masses about various organs and
under the skin, where they are stored to be drawn upon
when needed for supplying force. Thus distributed, fats
aid in lubricating, prevent harmful friction on motion,
give rotundity to the figure, and serve as protection to the
body against cold and injury.
Carbohydrates (starches and sugars) form only about 1
per cent, of the body weight and are found chiefly as
glycogen (animal starch) in the liver and as the sugar of
milk.
Water forms about 60 per cent, of the body weight. It
enters into the structural composition of every tissue of
the body and is the basis of all of the fluids.
Salts7"or mineral matter, form 5 or 6 per cent, of the
body weight and occur most abundantly in the more
solid structures of the body, as in the bones and teeth,
which are nearly half formed of calcium phosphate, but
20 FOOD IN HEALTH
they are found in all tissues and fluids of the body in the
form of various compounds of calcium, sodium, potassium,
magnesium, iron, and other bases.
These last two — water and salts, which occur ready
formed in nature — are termed inorganic compounds, in
contradistinction to the other three, which are called
organic, as the activity of living organs, either animal or
vegetable, is necessary for their elaboration.
These, then, are the materials which undergo destruc-
tion and must be continually replaced by food. A perfect
or complete food is one which supplies all of these neces-
sary substances in proper proportion to repair the tissues
and furnish adequate force for the performance of their
functions. Could such a single food for man be found,
the subject of dietetics would be a simple one; but as such
does not exist, man must seek his supply from various
materials drawn from the animal and vegetable kingdoms.
These two sources of food supply give a basis for a
sufficient classification of foods into animal foods and
vegetable foods, a natural division according to the forms
in which we supply ourselves in the markets, and in a
general way a logical division from the point of view of
the composition of the foods. For, though certain ingre-
dients, proteid, for example, are to be found in both
animal and vegetable foods, they occur under such variant
conditions and in such different amounts, that their utiliza-
tion by the body is far from equal, and the differences in
the two classes are so great, both as to composition and
use in the body, that separation is necessary for any classi-
fication.
The substances forming the tissues of animal foods are
identical in character with those of the human body, and
CHEMISTRY OF FOOD 21
hence contribute chiefly to its repair; but while life may
be supported by these alone, the proper development of
energy can better be accomplished by certain products
more abundantly supplied by the vegetable foods. This
will be easily understood as the uses of the different
alimentary substances are studied.
Proteid is composed of, carbon, hydrogen, oxygen, and
nitrogen with sulphur or phosphorus. It is supplied
abundantly in animal foods and occurs in considerable
quantities in cereals and largely in peas and beans. Its
presence in other vegetable products is inconsiderable.
Albuminoids are familiar in the form of white of egg
(albumin), the lean of meat (myosin), milk curd (casein),
and the gluten of wheat. Their primary function is build-
ing and repairing the nitrogenous tissues and fluids of the
body, and for this purpose no other class of food can be
satisfactorily substituted. It has further important func-
tions in the body in regulating the absorption of oxygen,
thereby stimulating functional activity, and to some
extent in furnishing heat and energy. The albumin that
is appropriated from the food by the formed tissues is
termed "organic alhumin" and is quite stable, compara-
tively little of it undergoing change under normal condi-
tions. That which exists in the fluids, called "circulating
albumin," is more easily broken up into nitrogenous waste
material, such as urea, and into a non-nitrogenous sub-
stance, part of which is oxidized, producing heat and
energy, part being converted into fat and as such stored
in the body. When the supply of force-producing food is
inadequate and in certain morbid conditions, the albu-
minoids may be extensively used to produce heat and
energy, and this causes emaciation by diverting this sub-
22 FOOD IN HEALTH
stance from its usual function of forming and repairing
tissue. Albuminoids may thus, with water and salts,
support life alone, but to supply the necessary carbon
such enormous quantities would be required as would
greatly tax the digestive and eliminative organs.
Gelatinoids are richer in nitrogen than the albuminoids,
but they are so promptly decomposed in the body that
they are useless for repairing the tissues. This decom-
position, however, is a source of force and their presence
in food lessens the draft upon the albuminoids. They are
useful, therefore, as "albumin sparers," thus permitting
the albuminoids to be more used for tissue building or
enabling the repair processes to be maintained by a smaller
amount of albumin. This is of practical importance in
those pathological conditions which make a drain on the
organic albumin.
Extractives are also nitrogenous compounds, but they
are lacking both in tissue-building and force-producing
power. Their chief function appears to be stimulation of
the upper digestive tract, thus increasing appetite. They
form the principle ingredient of beef tea, meat extracts,
etc.
Fats are composed of carbon, hydrogen, and oxygen.
They occur abundantly in animal foods as the fat of meat
and fish and as butter. They are also present in many
vegetable foods, as corn, nuts, and olives. They are rich
in carbon and vary greatly in their physical condition,
some being firm and hard, others soft and even liquid.
Fat subserves two purposes in the body. It is with the
carbohydrates, the chief source of heat and force, which
are produced by its oxidation. What is not so used is sto red
in the body for call when needed. Another purpose, and
CHEMISTRY OF FOOD 23
an important one, is to spare the waste of the albuminoids.
The albuminoids increase tissue waste through combus-
tion, but the fats retard it, and by their own combustion
spare the albumins. By the proper use of fats, therefore,
less albuminoid food will be needed to maintain the tissues
in a state of proper repair.
Carbohydrates are ■ compounds of carbon, oxygen, and
hydrogen. They differ chemically from the fats in con-
taining oxygen and hydrogen in such proportions as to
form water after combustion. They occur in foods as the
starches, sugars, and plant fibre or cellulose, and are
familiarly recognized in many cereals and vegetables.
Their use in the body is the production of heat and energy.
They are readily oxidized, more readily than the fats,
and so form a powerful source of heat production. The
small amount stored in the body, as compared with the
other alimentary substances, indicates how thoroughly
they are destroyed in the body in the production of force,.
A small amount is stored in the liver as glycogen, or
"animal starch." The body has the power of converting
carbohydrates into fat, and under certain circumstances
they undergo this change and serve in this way to add to
the supply of stored force-producing material.
It is evident, then, that the different organic alimentary
substances can do each other's work when necessary,
except the repair of tissue, for which the albuminoids alone
suffice.
Salts occur in varying quantity in all foods, the cereals
containing most, vegetables next, then meats, and lastly
fruits and nuts. Like the albuminoids, the salts perform
functions that cannot be substituted by other alimentary
substances. They enter into the structural composition
24 FOOD IN HEALTH
of all the tissues and fluids and control many functions
necessary to life. The specific gravity of the body fluids
is regulated by them, and they control the rate of osmosis
or absorption, and maintain the chemical reaction of the
fluids. Thus the blood is kept alkaline by the phosphates
of sodium and potassium and by the carbonate and bicar-
bonate of sodium, while the acid phosphate of sodium is
the chief agent in keeping the urine acid. Calcium is the
mineral most abundantly found in the body. It occurs, in
some form in every tissue of the body, and its presence
appears to be essential for cell growth. Its phosphate
composes about half of the substances of bone. In less
quantity, but of equal importance, is sodium chloride,
which enters into the composition of all the fluids and
tissues of the body, except the enamel of the teeth. It
furnishes chlorine for the elaboration of hydrochloric acid
in the gastric juice, thus stimulating the appetite. It acts
as a preservative, preventing decomposition and putrefac-
tion of the tissues, and it keeps the albuminous substances
of the blood in a state of solution. Its presence is essential
to life. Potassium salts predominate in muscular tissue
and occur in less amount widely distributed in the other
tissues and fluids of the body. Many other salts occur in
the body which promote metabolism and aid in keeping
alkaline the interstitial fluids.
Sufficient salts for health are provided in the food of a
properly balanced diet, but it is customary to add sodium
chloride (common table salt) to certain foods to improve
the taste and increase the appetite. This excess is entirely
eliminated by the urine.
Water occurs in varying amount in all foods and is
further introduced into the body in the form of various
CHEMISTRY OF FOOD 25
beverages. It is essential for life, not only because it is
a component of all tissues and fluids of the body, but on
account of certain functions that it performs. It is the
great solvent of all foods and thus distributes nutriment to
the tissues, and in like manner removes the waste products
of combustion and carries them to the organs of elimina-
tion. It distributes body heat, being a good conductor,
and, aids in keeping the equilibrium of normal temperature
by its absorption and elimination. It maintains the proper
dilution of the blood and promotes free circulation. The
amount necessary varies under different circumstances,
such as humidity, temperature, and exercise, but the
average amount needed for a healthy man under ordinary
conditions is about five pints daily in some form. Need
for water is usually manifested by thirst, a sensation
referred to the mouth on account of the dryness of the
mucous membranes which usually accompanies the con-
dition, but it is, in fact, a call through the nervous system
for a greater supply to the tissues throughout the body.
Deficiency of water is one of the commonest dietetic
errors.
Though, as has been stated, the proteids may be called
upon under certain conditions to furnish energy, their
peculiar use is to replace tissue waste and to build new
tissue, while the fats and carbohydrates must be depended
upon as sources of heat and energy. Muscular activity
does not increase the metabolism of proteids in the body,
but does use up the non-nitrogenous substances. The
need for more albuminous food under great muscular
exertion is due to the fact that strong, large muscles are
necessary to meet the excessive requirement put upon
them, and the use of proteid food in quantity for special
26 FOOD IN HEALTH
training, as in athletic contests, is for the purpose of
increasing the muscular tissues and improving the con-
dition of the nerve centres, so that the energy required
may be quickly released. In other words, under normal
conditions increased activity will demand proportionately
greater increase of fats and carbohydrates than of pro-
teids.
Modern science has developed means for estimating
the nutritive value of the various foodstuffs. By burning
the food in oxygen the amount of heat which can thereby
be developed is measured, and this heat, called "the heat
of combustion," is taken as the gauge of the potential en-
ergy of the food, as the different forms of energy are mutu-
ally convertible. The unit of measurement is the calorie,
which represents the amount of heat necessary to raise
the temperature of one kilogram of water one degree
Centigrade, or one pound of water four degrees Fahren-
heit. This is equivalent to the mechanical force required
to lift one ton about one and a half feet. In this way it
has been determined that proteid has fuel value of four
calories per gram, or 1820 calories per pound, and carbo-
hydrates the same, while fats produce 8.9 calories per
gram, or 4040 calories per pound. If, therefore, by chem-
ical analysis, the relative proportions of alimentary sub-
stances of any given food be determined, the fuel value
of the food can readily be calculated from the figures
above. The actual nutritive value of a food will never be
equal to the estimated fuel value, as variation in digestion
will affect the amount absorbed, and oxidation in the
body is never as complete as in the experiments outside
of the body.
Furthermore, the digestibility of foods of the same class
CHEMISTRY OF FOOD 27
will vary according to their source. Persons pursuing
various occupations have been fed on different foods, the
amount ingested and the excreta being carefully weighed.
The difference between these weights gave the amount
absorbed which was utilized by the body. While it was
found that in ordinary mixed diet about 92 per cent, of
the proteid, 95 per cent, of the fats, and 97 per cent, of
the carbohydrates are retained in the body, experiments
with single foods showed as an average that about 97 per
cent, of the proteids, 95 per cent, of the fats, and 98 per
cent, of the carbohydrates of animal foods are absorbed,
but only 84 per cent, of the proteid and 90 per cent, of the
fat of the vegetable foods, though 97 per cent, of the car-
bohydrates from the latter are retained. From this it is
evident that proteid and fat of animal origin are more
readily digested than similar substances of vegetable
origin. The digestibility of a given article of food will
depend upon the proportions of these various ingredients.
Thus of two cereals, the one which contains proportion-
ately less of the less easily digestible proteid, and more of
the more digestible carbohydrates, will be more easily
digestible than the other. Knowing, then, the proportions
of alimentary substances in a given food and the percentage
digestibility of each, the nutritive value in calories can be
readily estimated.
The average composition of common American food
products is as follows:
28
FOOD IN HEALTH
Table I.
s^
Food materials (as purchased).
to
m
a
"5
2
S
PL,
$
03
it,
sis
£■0
o
to
P <"
U, PL
ANIMAL FOOD.
Calo-
%
%
%
%
%
%
ries.
Beef, fresh :
Chuck ribs ....
16.3
52.6
15.5
15.0
0.8
910
Flank ...
10.2
54.0
17.0
19.0
0.7
1105
Loin ... ...
13.3
52.5
16.1
17.5
0.9
1025
Porterhouse steak
12.7
52.4
19.1
17.9
0.8
1100
Sirloin steak .
12.8
54.0
16.5
16.1
0.9
975
Neck
27.6
4-i.9
14.5
11.9
0.7
1165
Ribs
20.8
43.8
13.9
21.2
0.7
1135
Sib rolls
63.9
19.3
16.7
0.9
1055
Round
"7."2
60.7
19.0
12.8
1.0
890
Bump ... . .
20.7
45.0
13.8
20.2
0.7
1090
Shank, fore
36.9
42.9
12.8
7.3
0.6
545
Shoulder and clod
16.4
56.8
16.4
9.8
0.9
715
Fore quarter ....
18.7
49.1
14.5
17.5
0.7
995
Hind quarter
15.7
50.4
15.4
18.3
0.7
1045
Beef, corned, canned, pickled, dried :
Corned beef
8.4
49.2
14.3
23.8
4.6
1245
Tongue, pickled
Dried, salted, and smoked .
6.0
58.9
11.9
19.2
4.3
1010
4.7
53.7
26.4
6.9
8.9
790
Canned boiled beef.
51.8
25.5
22.5
1.3
1410
Canned corned beef
51.8
26.3
18.7
4.0
1270
Veal:
Breast
21.3
52.0
15.4
11.0
0.8
745
Leg
14.2
60.1
15.5
7.9
0.9
625
Leg cutlets
3.4
68.3
20.1
7.5
1.0
695
Fore quarter .
24.5
54.2
15.1
6.0
0.7
535
Hind quarter
Mutton :
Flank
20.7
56.2
16.2
6.6
0.8
580
9.9
39.0
13.8
36.9
0.6
1770
Leg, hind . ....
18.4
51.2
15.1
14.7
0.8
890
Lorn chops ....
16.0
42.0
13.5
28.3
0.7
1415
Fore quarter
21.2
41.6
12.3
24.5
0.7
1235
Hind quarter, without tallow
Lamb:
Breast ...
17.2
45.4
13.8
23.2
0.7
1210
19.1
45.5
15.4
19.1
0.8
1075
Leg, hind
Pork, fresh :
17.4
52.9
15.9
13.6
0.9
860
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
Shoulder" ... . .
12.4
44.9
12.0
29.8
0.7
1450
Tenderloin
66.5
18.9
13.0
1.0
895
Pork, salted, cured, and pickled :
Ham, smoked .
13.6
34.8
14.2
33.4
4.2
Hi35
Shoulder, smoked
18.2
36.8
13.0
26.6
5.5
1335
Salt pork
7.9
1.9
86.2
3.9
3555
Bacon, smoked ....
7.7
17.4
9.1
62.2
4.1
2715
Sausage:
Bologna . . .
3.3
55.2
18.2
19.7
3.8
1155
Pork ... ...
39.8
13.0
44.2
1.1
2.2
2075
Frankfort
57.2
19.6
18.6
1.1
3.4
1155
Soups:
Celery, cream of ...
88.6
2.1
2.8
5.0
1.5
235
Beef
92.9
4.4
0.4
1.1
1.2
120
Meat stew. . ...
84.5
4.6
4.3
5.5
1.1
365
Tomato . . ...
90.0
1.8
1.1
5.6
1.5
185
CHEMISTRY OF FOOD
Table I. (Continued).
29
Food materials (as purchased).
CD
DQ
3
CD
•a
'53
si
t> o
H ft
is
o
4
s p.
animal food (continued).
Calo-
%
%
%
%
%
%
ries.
Poultry :
Chicken, broilers ....
41.6
43.7
12.8
1.4
' 0.7
305
Fowl
25.9
47.1
13.7
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
Fish:
Cod, dressed
29.9
58.5
11.1
0.2
0.8
' 220
Halibut, steaks or sections .
17.7
61.9
15.3
4.4
0.9
475
Mackerel, whole
44.7
40.4
10.2
4.2
0.7
370
Perch, yellow, dressed .
35.1
50.7
12.8
0.7
0.9
275
Shad, whole
50.1
35.2
9.4
4.8
0.7
380
Shad, roe
71.2
20.9
3.8
2.6
1.5
600
Fish, preserved •
Cod, salt ... . .
24.9
40.2
16.0
0.4
18.5
325
Herring, smoked ....
44.4
19.2
20.5
8.8
7.4
755
Fish, canned :
Salmon
63.5
21.8
12.1
2.6
915
Sardines
"s.'o 1
53.6
23.7
12.1
5.3
950
Shellfish :
Oyster " solids " ....
88.3
6.0
1.3
3.3
1.1
225
Clams
80.8
10.6
1.1
5.2
2.3
340
Crabs
52.4
36.7
7.9
0.9
0.6
1.5
200
Lobsters
61.7
30.7
5.9
0.7
0.2
0.8
145
Eggs : Hens' eggs . . . .
11.22
65.5
13.1
9.3
0.9
635
Dairy products, etc. :
Butter . ....
11.0
1.0
85.0
3.0
3410
Whole milk
87.0
3.3
4.0
5.0
0.7
310
Skim milk
90.5
3.4
0.3
5.1
0.7
165
Buttermilk
91.0
3.0
0.5
4.8
0.7
160
Condensed milk
26.9
8.8
8.3
54.1
1.9
1430
Cream ...
74.0
2.5
18.5
4.5
0.5
865
Cheese, Cheddar ....
27.4
27.7
36.8
4.1
4.0
2075
Cheese, full cream ....
34.2
25.9
33.7
2.4
3.8
1885
VEGETABLE FOOD.
Flour, meal, etc. :
Entire-wheat flour .
11.4
13.8
1.9
71.9
1.0
1650
Graham flour
11.3
13.3
2.2
71.4
1.8
1645
Wheat flour, patent roller process-
High grade and medium .
12.0
11.4
1.0
75.1
0.5
1635
Low grade
12.0
14.0
1.9
71.2
0.9
1640
Macaroni, vermicelli, etc.
10.3
13.4
0.9
74.1
1.3
1645
Wheat breakfast food .
9.6
12.1
1.8
75.2
1.3
1680
Buckwheat flour ....
13.6
6.4
1.2
77.9
0.9
1605
Rye flour
12.9
6.8
0.9
78.7
0.7
1620
Cornmeal ....
12.5
9.2
1.9
75.4
1.0
1635
Oat breakfast food ....
7.7
16.7
7.3
66.2
2.1
1800
Rice
12.3
8.0
0.3
79.0
0.4
1620
Tapioca .
11.4
0.4
0.1
88.0
0.1
1650
Starch
90.0
1675
Bread, pastry, etc. :
White bread
35.3
9.2
1.3
53.1
1.1
1200
Brown bread
43.6
5.4
1.8
47.1
2.1
1040
1 Refuse, oil.
2 Refuse, shell.
30
FOOD IN HEALTH
Table I. (Continued).
Food materials (as purchased).
CO
cu
f4
■6
'5
3
"5
•si
S a
> O
-i P.
S k
M
^
£
t»
a
<
h P.
vegetable food (continued).
Calo-
%
%
%
%
%
%
ries.
Bread, pastry, etc. .
Graham bread ....
35.7
8.9
1.8
52.1
1.5
1195
Whole-wheat Dread
38.4
9.7
0.9
49.7
1.3
1130
Rye bread ...
35.7
9.0
0.6
53.2
1.5
1170
Cake
19.9
6.3
9.0
63.3
1.5
1630
Cream crackers
6.8
9.7
12.1
69.7
1.7
1925
Oyster crackers
4.8
11.3
10.5
70.5
2.9
1910
Soda crackers . . . .
5.9
9.8
9.1
73.1
2.1
1875
Sugars, etc :
Molasses ... .
70.0
1225
Candy* ... . .
96.0
1680
Honey ....
81.0
1420
Sugar, granulated ....
100.0
1750
Maple syrup .
Vegetables : 2
71.4
1250
Beans, dried .
12.6
22.5
1.8
59.6
3.5
1520
Beans, Lima, shelled
68.5
7.1
0.7
22.0
1.7
540
Beans, string
7.0
83.0
2.1
0.3
6.9
07
170
Beets ... .
20.0
70.0
1.3
0.1
7.7
0.9
160
Cabbage .
15.0
77.7
1.4
0.2
4.8
0.9
115
Celery
20.0
75.6
0.9
0.1
2.6
0.8
65
Corn, green (sweet), edible portion
75.4
3.1
1.1
19.7
0.7
440
Cucumbers . . .
15.0
81.1
0.7
0.2
2.6
0.4
65
Lettuce . . ...
15.0
80.5
1.0
0.2
2.5
0.8
65
Mushrooms . .
88.1
3.5
0.4
6.8
1.2
185
Onions ....
io.6
78.9
1.4
0.3
8.9
0.5
190
Parsnips ....
20.0
66.4
1.3
0.4
10.8
1.1
230
Peas (Pimm sativum), dried .
9.5
24.6
1.0
62.0
2.9
1565
Peas (Pimm sativum), shelled
74.6
7.0
0.5
16.9
1.0
440
Cowpeas, dried
13.0
21.4
1.4
60.8
3.4
1505
Potatoes .
20.0
62.6
1.8
0.1
14.7
0.8
295
Rhubarb .
40.0
56.6
0.4
0.4
2.2
0,4
60
Sweet potatoes . ...
20.0
55.2
1.4
0.6
21.9
0.9
440
Spinach
92.3
2.1
0.3
3.2
2.1
95
Squash . .
50.0
44.2
0.7
0.2
4.5
0.4
100
Tomatoes .
94.3
0.9
0.4
3.9
0.5
100
Turnips ...
30.0
62.7
0.9
0.1
5.7
0.6
120
Vegetables, canned :
Baked beans .
68.9
6.9
2.5
19.6
2.1
555
Peas (Pisnm sativum), green .
85.3
3.6
0.2
9.8
1.1
235
Corn, green . . . .
76.1
2.8
1.2
19.0
0.9
430
Succotash ... .
75.9
3.6
1.0
18.6
0.9
425
Tomatoes . .
94.0
1.2
0.2
4.0
0.6
95
i Plain confectionery not containing nuts, fruit, or chocolate.
2 Such vegetables as potatoes, squash, beets, etc., have a certain amount of inedible
material, skin, seeds, etc. The amount varies with the method of preparing the
vegetables, and cannot be accurately estimated. The figures given for refuse of
vegetables, fruits, etc., are assumed to represent approximately the amount of refuse
in these foods as ordinarily prepared.
CHAPTER II.
PHYSIOLOGY. DIGESTIVE PROCESSES. AGREEMENT
OF FOODS.
It was seen in the preceding chapter how the different
substances composing animal and vegetable foods supply
the body with its nutriment and energy. Before these sub-
stances can be utilized by the body, however, they must
be absorbed and distributed by the blood to the various
tissues and fluids. Salts and water are absorbed un-
changed, but the other alimentary substances, such as
proteid and carbohydrates, must first be rendered soluble
and diffusible before absorption is possible. The very
complex process by which this is attained is termed diges-
tion.
Digestion is accomplished partly by mechanical means
through the action of muscles, and partly by chemical
action of the digestive fluids. Both methods start in the
mouth.
By mastication or chewing the food is broken up and
subdivided, thus increasing tremendously the surfaces of
contact for the action of the digestive fluids. Thus the
food is thoroughly mixed with the saliva, which, besides
having chemical action, dissolves some of the constituents
and lubricates the bolus, making it easy to swallow. The
importance of this is often disregarded, and food is swal-
lowed in large masses, which successfully resist the action
of the gastric juice, leading to indigestion and disease.
32 FOOD IN HEALTH
By the act of swallowing, the bolus is carried back into
the pharynx and then passes down the oesophagus into
the stomach. This is accomplished by rhythmical and
successive action of the muscles of which these parts are
formed. In passing over the larynx into the pharynx
the entrance of food into the larynx is prevented by the
closure of its opening by the epiglottis, over which the
food passes into the pharynx. All of this action is com-
paratively rapid.
The muscular action of the stomach proceeds more
slowly. Here the food is further broken up and mixed
with the gastric juice by a churning movement. The food
remains in the stomach until it is reduced to a semifluid
condition, which takes from one and a half to five hours,
according to the substances used for food, and is then pro-
pelled into the intestine. This entrance of food into the
intestine does not occur all at once, but from time "to time
throughout the period of gastric digestion.
In the intestine the food is further subjected to the action
of the pancreatic juice and the secretions of the intestine
and liver. The rhythmic, successive contraction of the
muscles of the intestine wall, called peristalsis, carries the
food slowly along the circuitous course of the intestine,
and as it thus advances the nutrients, now rendered fluid,
are absorbed, and the undigested and waste materials are
carried on for final expulsion as feces. Though simple
in the narration, these mechanical effects are produced
by intricate and delicate structures, and many of the dis-
orders of indigestion have their origin in some interference
with this mechanical action, a fact which is too often over-
looked, to the detriment of individuals by the unnecessary
administration of chemical digestants.
PHYSIOLOGY 33
The chemical action, by which the food is rendered
fluid, is chiefly effected by substances termed unorganized
ferments, though bacteria play some part in the process.
These ferments have the peculiarity of producing their
effects without loss of their own power or substance. In
their presence the different food substances take or give
up a molecule of water and split into simpler forms of
matter, which are held in solution in the fluids with which
they come in contact. They are thus rendered absorb-
able.
The first of these ferments, ptyalin, is found in the
saliva in the mouth. It is most active in a neutral medium,
but is active in an alkaline medium like the saliva. Its
action is to convert insoluble starch into soluble sugar.
It has no effect on cellulose, however, and uncooked
starch will therefore escape this action. This action of
ptyalin would be practically of no importance if its effects
were limited to the short time that the food remains in
the mouth, but its action is continued in the stomach for
from fifteen to thirty minutes, until the fluid becomes acid
in reaction. The first secretion of acid in the stomach
simply neutralizes the alkalinity of the saliva, for a little
time is required to render the fluids acid. When this
occurs, however, the ptyalin is destroyed, so that it does
not again become effective in the alkaline medium of the
intestines.
Saliva serves the further purpose of dissolving various
substances which give taste to the food. Substances
which are not soluble in the saliva have no flavor.
The gastric juice contains the ferment pepsin, and hydro-
chloric acid, together with a milk-curdling ferment, ren-
nin. Pepsin is active only in an acid medium, and though
3
34 FOOD IN HEALTH
it is effective in the presence of other acids, its greatest
power develops with hydrochloric acid, and this nature
provides in the stomach.
Pepsin changes the insoluble proteids into soluble pep-
tones. This change does not affect all of the proteids in
the stomach; the unaffected portion passes into the intes-
tine to be there acted upon. This change is not immediate,
but proceeds through several stages before the final pro-
duction of peptones is accomplished. These intermediate
substances are called albuminoses or proteoses.
Hydrochloric acid makes the gastric contents acid in
reaction, which is necessary to render the pepsin active.
It also aids in increasing the solubility of certain sub-
stances and has a further function in its antiseptic prop-
erties, destroying bacteria and preventing fermentation
and the production of harmful products thereby.
Rennin coagulates the casein of milk, forming curd.
The process of intestinal digestion is more complex and
more powerful than either salivary or gastric digestion.
The pancreatic juice, the bile, the intestinal secretion,
called succus entericus, and bacteria all play a part.
While the saliva and gastric juices act respectively only
on starches and proteids, these substances are acted upon
more powerfully in the intestine. Fats are digested only
in the intestine.
Pancreatic juice contains four ferments: trypsin, amy-
lopsin, steapsin, and a milk-curdling ferment.
Trypsin, like pepsin, acts on proteids, converting them
finally into soluble peptones after a series of intermediate
stages has been completed. It differs from pepsin, in that
it acts in an alkaline medium and is more rapid than pep-
sin, as well as more powerful, affecting some proteids
PHYSIOLOGY 35
which escape the action of pepsin in the stomach and
carrying the digestive process farther than pepsin does.
Amylopsin is the most rapid of any of the ferments of
the pancreatic juice. It converts starch into sugar and
will even act on unboiled starch, digesting the cellulose
envelope. This ferment does not occur in the pancreatic
juice of infants under about four months of age. This
indicates the unsuitableness of starch as an infant food.
Steapsin splits the fats into fatty acids and glycerin;
these acids unite with the alkaline bases and form soaps.
The further action of the pancreatic juice on fats is the
formation of an emulsion.
The milk-curdling ferment, while present in the pan-
creatic juice, will rarely be needed for this function, as the
milk has previously been curdled by the rennet of the
stomach before reaching the intestine.
Succus entericus has the property of changing the char-
acter of the sugars. The saliva splits starch into maltose
and dextrin, which is subsequently also converted into
maltose. Amylopsin also converts starch into maltose.
The action of the succus entericus is to convert these forms
of sugar into glucose.
Bacterial action, if within normal limits, is useful in
aiding the action of the pancreatic juice and breaking
up harmful proteids which will be injurious if absorbed.
If this is excessive, however, it may be harmful in its
results. Those bacteria which have escaped the anti-
septic effects of the gastric juice produce lactic acid fer-
mentation of the carbohydrates, resulting in the formation
of irritating gases; cellulose is also broken up, and by their
action on fats and proteids various acids or ill-smelling
substances are produced.
36 FOOD IN HEALTH
Bile is secreted by the liver and collected in the gall-
bladder, from which it is poured out continuously into
the intestine. This discharge of bile is increased imme-
diately on the entrance of food into the intestine and again
several hours later. The function of bile is to aid the
action of the pancreatic juice, especially in the digestion
of fat. It renders the intestinal contents more viscid, which
hinders somewhat their progress through the intestine, caus-
ing them to cling to the intestinal walls. This allows time
for proper absorption. It assists in the absorption of fats
by aiding in emulsification and helps to render the intes-
tinal contents alkaline. It also has antiseptic power against
certain forms of bacteria. Bile salts are reabsorbed lower
down in the intestine and return to the liver. Another
action of the liver, which affects nutrition, is its power to
convert the sugar glucose into a form of starch called gly-
cogen, which is stored in the liver to be utilized as needed
by the body for the production of energy. A further
function of the organ is reduction of proteid waste to urea,
by which an excess of this kind of food is at once elim-
inated.
These digestive processes just described are all for the
purpose of rendering the foodstuffs diffusible, so that they
may be absorbed and carried by the blood to the various
tissues for assimilation. Absorption normally is practi-
cally limited to the stomach and intestine, the small intes-
tine being the chief area for absorption; but the large
intestine has this power, though to a limited extent.
There are two channels by which absorption occurs — the
bloodvessels and lymphatic vessels. Sugars, after con-
version into glucose by the succus entericus, are absorbed
by bloodvessels and carried to the liver for conversion
PHYSIOLOGY 37
and storage as glycogen. Native proteids are readily
absorbable, but, as has been shown, are converted into
peptones in order to facilitate their absorption. These
peptones, however, are poisonous substances when intro-
duced into the blood, and are not found in the blood under
normal circumstances. They are reconverted in course
of absorption into native proteids (albumin, etc.) by the
lining membrane of the intestine, through which they pass
before being taken up by the bloodvessels. While absorp-
tion of proteid is chiefly by the bloodvessels, a little of it
is absorbed by the lymph vessels.
The lymphatic vessels are the chief channel for the
absorption of fats and are called lacteals, because of the
milky appearance of their contents produced by the fat
after absorption. The emulsification of fats that occurs
in the intestine assists the steapsin in breaking up the fats
into fatty acids and glycerin. These acids and glycerin
are absorbed through the mucous membrane of the intes-
tine and by it reconverted into fat, which is then taken up
by the lacteals in the form of minute droplets and carried
off to be finally deposited in the tissues as fat or burned
in the production of heat.
The Agreement of Food. — Some persons who have the
power of digesting given articles of food will invariably be
made more or less ill by eating them. We then say the
food "disagrees." The food may be entirely digestible
and well digested, and yet produce disorder. The explana-
tion of this is that in the digestion of food certain by-
products are formed which are poisonous and which are
absorbed before the bacteria of the intestine can convert
them into their ultimate principles, thereby robbing them
of their toxic properties.
38 FOOD IN HEALTH
Considerable variation is shown by different individuals
in their utilization of food. Where the same diet is taken
by two persons and is equally well digested, there may be
decided difference in the work that can be done and in the
flesh formed by each. While the appropriation of digested
food is of course the most important consideration, since
it is only the food absorbed which makes flesh and energy,
it is impossible to calculate the amount that will be so
utilized, because of the difference in the personal equation
of individuals.
CHAPTER III.
COOKING. CHANGES NECESSARY IN NATURAL
. FOODS TO RENDER THEM DIGESTIBLE.
METHODS USED.
Foodstuffs in the condition in which we procure them
in the market are, for the most part, unfit for use, being
indigestible, and, in order to render them digestible by
the human secretions, it is necessary to produce certain
changes in their physical condition by the process which
we call cooking. This may be performed in a variety of
ways, but in whatever manner it is accomplished it pro-
duces the following changes: It destroys bacteria and
parasites which might produce disease; it develops pleasant
odor and taste, which stimulate the appetite and increase
the desire for food; it improves the appearance of many
foods; it renders the tough and tenacious foods friable,
so that they may be more readily broken up by chewing;
it separates and loosens the fibre, so that digestive secre-
tions may become intimately mixed with the food sub-
stances; and the heat of food served warm, in some cases,
increases the digestibility.
Cooking in whatever form is accomplished by heating
the food. Different methods of cooking require different
degrees of heat, according to the character and size of the
substance to be cooked. These may be brought under
the influence of heat in either of two ways — by radiation
or convection from the source of the heat. These two
40 FOOD IN HEALTH
ways of heating are familiar to us in the processes of
roasting and boiling. All other methods of cooking are
variations or modifications of these two.
Roasting. — This is the simplest form of cooking, as it
requires no utensils, the food being simply exposed to the
direct heat of the fire. It is the form used by uncivilized
people and by hunters and trappers who are out of reach
of the conveniences necessary for other methods of cook-
ing. It is chiefly used for cooking meats. Here the heat
reaches the meat by radiation from glowing coals, and
there is about the meat a free circulation of air. This
method of cooking retains the nutritive juices and the
extractives, which give flavor to the meat, more thoroughly
than any other form. The meat should first be exposed to
great heat until the surface layers are coagulated and a
crust is formed by the evaporation of water, which pre-
vents the escape of juices from within. After this is accom-
plished, which occurs in a few minutes, if the heat be
sufficiently intense, the further cooking should proceed
more slowly, in order that the interior of the roast may be
properly done without drying it up. The different kinds
of albumin of which meat is composed coagulate at differ-
ent degrees of temperature. The albumin of the blood
coagulates at 158° to 160° F., and this degree of heat must
be attained in the interior of the roast, in order that the
meat may be done. If the heat is carried much beyond
this point the fibre shrivels and hardens, and the roast
will be overcooked and unfit for use, while if a less degree
of heat is used the meat will be underdone.
While cooking, some of the juice from the meat will
escape and the surface fat will be melted. This, with a
little gelatin, which will be formed from the fibrous tissue
COOKING 41
if the heat be intense enough, composes the "gravy." In
roasting, the meat must be constantly "basted" — i. e., fre-
quently covered with this gravy or some other fat, such as
butter. The basting tends to diffuse the heat uniformly
over the joint, prevents hardening and scorching of the
surface, and retards evaporation of the moisture within
the joint.
If too strong heat be continued, the fat will undergo
decomposition, producing carbon, which shows as the
charred, blackened surface, and fatty acids, which pro-
duce a penetrating and disagreeable odor. If the heat is
not sufficiently great at the beginning of roasting to form
a protective crust on the surface, the water from the interior
will continue to pass outward and evaporate and the meat
will be leathery and tough. In roasting, the free current
of air about the meat carries off the volatile materials
which are developed in cooking, and the meat will have
a delicate flavor. In cooking meat by this method there
is considerable loss of weight, which varies, according to
different observers, from 20 to 30 per cent., and is due
chiefly to the evaporation of water.
Beef, mutton, and game do not require as thorough
cooking as veal and poultry. For the former a temper-
ature of 130° F. is sufficient for cooking "rare," but for
the latter a temperature of 158° to 160° F. is required.
True roasting cannot be accomplished in the ordinary
modern kitchen. In old times "tin kitchens" were used.
This was a hood of tin in which the roast was placed, the
side next to the fire being left open. The advantage of
this was that the heated tin radiated heat to all portions
of the joint, while the opening toward the fire allowed
the free current of air. So-called roasting in an oven, as
42 FOOD IN HEALTH
practised in most private kitchens nowadays, is really
baking.
Baking. — This method is used for preparing both breads
and meats, and cooking is accomplished by exposing the
food to radiant heat in an enclosed space. This condition
is present in an ordinary oven, from all sides of which heat
is radiated to the meat. Being enclosed, the free circula-
tion of air is prevented and the volatile substances devel-
oped by cooking cannot escape, but are, to a large extent,
absorbed by the meat, which will then have a much
stronger and richer flavor and will be much less delicate
than roasted meat. The loss in weight by baking is said
to be less than in roasting, as evaporation in a confined
space will be less rapid. Baked meats are more apt to
disagree with persons of delicate digestion than roast
meats.
Broiling or Grilling. — This is essentially the same method
as roasting, but is applied to smaller pieces of meat, such
as steaks and chops. The object of broiling is to form a
protecting crust and quickly cook the interior of the meat.
The surface of a small piece of meat is relatively much
greater than that of a large joint, hence evaporation will
be more rapid and a higher temperature is therefore
necessary. In broiling, the meat should be placed as close
to the coals as possible. The thinner the piece of meat
the greater the evaporation. Steaks should therefore be
cut thick if they are to be juicy.
Boiling. — By this method of cooking the heat is brought
to the meat by convection through water. Here the tem-
perature is 212° F. It is worth remembering that the tem-
perature of water when boiling is not increased by harder
boiling, which will have no greater effect in cooking the
COOKING 43
meat as far as the heat is concerned than will slow boiling.
The commotion produced by hard boiling may somewhat
loosen the fibre of meat by the movement it imparts.
The manner of boiling meat will depend upon whether
the meat itself or the broth is intended for use. When a
large piece of meat, as a joint, is to be used for food, it is
to be plunged whole into water that is already boiling.
This will cause coagulation of the albuminous material
of the surface, which will largely prevent the escape of
the meat juices. After this coagulation has formed the
cooking should proceed more slowly at a lower temper-
ature, in order to. prevent the fibre from becoming tough
and shriveled. In boiling the meat some of the soluble
constituents pass into the water, a small portion of the
soluble albumin, and some of the extractives and salts.
This loss of soluble materials in the water makes the flavor
of meats cooked by boiling less pleasant than when cooked
by roasting, and the lower temperature of boiling water
will not develop certain flavors produced by the higher
temperature of roasting. In boiling meat in this manner,
the loss in weight may be as great as from 20 to 30 per cent.
When the broth is to be used the meat should be very
finely divided in order to increase its surface contact with
the water, so that as much of the nutrient material may
be extracted from it as possible. In making beef -tea and
broths this minced meat should be placed in cold water
and allowed to stand for some time, as the soluble albu-
min is more readily dissolved by cold water than hot. It
should then be gradually heated up to 160°. If heated
beyond this point the albumin is coagulated and presents
a flocculent deposit, which often has an unappetizing
appearance. Such preparations should never be boiled.
44 FOOD IN HEALTH
If a little hydrochloric acid be added to the cold water,
say four or five drops to a pint, the solvent power of the
water for albumin is increased and the broth will be richer.
The albuminous material of the flesh of fowls is more
readily soluble than that of mutton or beef, the latter
being least soluble. Consequently chicken broth is the
most nutritious, while beef broth is least so. In making
these preparations most of the salts are dissolved out into
the broth, practically all of the chlorides, and nearly all of
the phosphates. The meat, of course, is unfit for use after
making broth, and should be strained out.
In making soup a further variation in method is .neces-
sary. As the soups consist largely of gelatin they must
be boiled for a long time in order to convert fibrous
materials — gristle, bone, tendon, etc. — into gelatin. The
meat should, however, be chopped fine in order that as
much as possible of the nutrients may be dissolved into
the soup. The high temperature at which soup is made
will, of course, coagulate the albumin and melt much of
the fat, which will float on the surface. In making clear
soups, these are removed by straining, so that their nutri-
ent value is practically nil. They will, however, contain
the gelatin, salts, and extractives, which stimulate the
appetite and the flow of gastric juice; hence the custom
of taking a small amount of soup at the beginning of
dinner. When vegetables are to be added to soups, they
should be previously cooked, as a longer period of cooking
is required for them.
Simmering. — This method of cooking practically does
not differ from boiling and is really a very slow boiling.
Stewing. — In stewing, the meat should be cut into small
pieces, but not minced fine. The temperature should not
COOKING 45
exceed 160° F., as this will coagulate the albumin in the
broth, and if the food be boiled the meat will be shrivelled
and dried and unfit for use. When properly stewed, the
fibre of the meat is loosened and softened, so that it is
easily broken up. Some of the albumin, salts, and extract-
ives are dissolved into the broth. In making stews, vege-
tables are added and the broth is thick and rich. They
should be cooked slowly. This is an economical method
of cooking, as the whole food, both meat and broth, is
eaten. The loss in cooking is less than in boiling or roast-
ing, not exceeding 20 per cent., which is chiefly due to
the evaporation of water. When made simply with meat
and vegetables, stews are wholesome and fairly digestible,
but the addition of sauces, while possibly making them
more palatable, often interferes materially with their
digestibility. "Hash" is simply a stew in which the meat
used has been previously cooked, and is, therefore, often
dry and tasteless. Such a dish should never be used by
persons of feeble digestive power.
Braising. — This is, in effect, a combination of roasting
and stewing, and is usually applied to meat which is tough
or too young. "Braise" is a solution of vegetable and
meat juices — say, soup stock with vegetables added. In
this the meat is cooked at a high temperature, but lower
than boiling, for a long time. A close-covered vessel
should be used to prevent evaporation and just sufficient
braise to cover the meat, in order that the broth may be
concentrated. By this method of prolonged slow cooking,
tough meat may be rendered tender and impregnated with
the flavor of the vegetables with which it is cooked. Spices
or wine added will further increase the flavor. It is usual
to partially roast or broil the meat before putting into
46 FOOD IN HEALTH
the braise. Braising can be best done, however, in an
especially prepared vessel, which is arranged so as to put
hot coals into the top, by which the meat protruding from
the fluid is roasted after the fluid has cooked down. This
is an economical form of cooking, as inferior and cheaper
parts of the meat may be rendered digestible and pala-
table.
Frying. — This is also a method of cooking by the con-
duction of heat and is therein similar to boiling, the differ-
ence being that fat is used instead of water. The popular
idea of frying is that only sufficient fat is used to prevent
the meat from sticking to the skillet. This is an error,
however, for such a method is partially frying and par-
tially roasting. True frying consists in immersing the
meat suddenly into hot fat. The fat need not necessarily
be boiling, but should be sufficiently hot to coagulate the
surface albumin. The method is used for pieces of com-
paratively small size. The coagulation of the surface, as
in boiling, prevents the escape of the nutritive juice and
extractives and the meat will be juicy and of good flavor.
When the meat is plunged into the hot oil, the water of
the meat forms a thin film of vapor about the surface,
which prevents the fat from entering the substances of the
meat. As this vapor accumulates and escapes through
the fat, it makes the familiar spluttering noise. Although
the fat does not permeate the substances of the meat, a
good deal of it will stick to the surface as the meat is lifted
out; hence beef or cut meats will be greasy when fried.
Where the skin remains on the meat, as in frying chicken
or fish, this can be removed before eating, and the flesh
will be well cooked and digestible. In frying in this
manner it is best to place the meat in a wire basket, by
COOKING 47
which it can be readily plunged into the fat and easily
removed. After the meat has been immersed long enough
to thoroughly coagulate the surface albumin it is well to
reduce the temperature, as in other methods of cooking,
to allow the interior of the meat to cook more slowly and
to prevent hardening and shrivelling of the fibres, though
there is more danger of the meat being permeated by the
fat than there will be if the heat be maintained until the
cooking is completed. Frying by the common method,
in which the under surface of the meat only is in the hot
fat, is a notoriously unwholesome method of cooking.
The water of the meat, which evaporates, can escape more
readily, allowing the hot fat to come in closer contact with
the surface and so permeate the meat to an unwholesome
extent. The development of fatty acids, which cause an
unpleasant odor, will occur if the fat burns. These being
partially absorbed by the meat, will render it unwhole-
some and irritating to the stomach.
Steaming is a process of cooking, sometimes used, in
which the heat is carried to the food by convection through
the vapor of water. In effect it is something like boiling,
in that the food is subjected to moist heat, but, as the
steam may be superheated, the temperature to wliich the
food is subjected may be higher than 212° F.
The Cooking of Vegetable Foods may be accomplished
by any of the methods described, but the majority of
vegetables are cooked by boiling, which must usually be
done even before cooking them by other methods. The
effect of cooking vegetables is to soften the fibre or cellu-
lose and loosen the substance of the vegetable, so that it
can be more easily chewed. The chief food ingredient of
most vegetables .is starch, and by the action of moist heat
48 FOOD IN HEALTH
the starch granules swell and their coverings are ruptured,
liberating their contents, so that they may be acted upon
by the saliva and the pancreatic juice. Unless this is
accomplished the coverings of the starch granules will
effectually combat the action of the saliva and retard the
action of the pancreatic juice. Other constituents of vege-
table food will be affected, albuminous material and other
juices being coagulated, and sugars, gums, and salts dis-
solved by the water in which they are boiled.
CHAPTER IV.
PROTEID FOODS. MILK. EGGS.
Proteid is essential to life, and as its function of repair-
ing tissue cannot be performed by any other alimentary
substance, it is the most important of the organic foods.
It is abundantly supplied in all animal foods and consid-
erably by the cereals and by dried peas and beans of various
kinds.
The value of proteids derived from animal and vege-
table sources is not equal, however, as vegetable proteid
is more difficult of digestion, only 84 per cent, of it being
absorbed. On the other hand, 97 per cent, of the animal
proteid ingested is absorbed, and its digestion is more
rapid. This is probably due to the fact that in all animal
foods the proteid is associated with larger or smaller
amounts of extractives which stimulate the digestive
functions. On account of the greater speed of absorption
animal proteid is more promptly utilized for the repair
of tissue and will liberate energy more rapidly when the
body is called on for sudden or unusual activity, as in
athletic contests. This prompter utilization of animal
proteid necessitates its more frequent supply.
ANIMAL PROTEIDS. MILE.
Though in the minds of many people milk is con-
sidered to be simply a beverage, at least for adults, it
is, in fact, food; and as it contains all of the various ali-
4
50 FOOD IN HEALTH
mentary substances, it is called a "perfect food" or "com-
plete food." While it is a perfect food for infants, the
proportion of its constituents is unsuited for use by adults
as a single food.
Milk appears as a uniform, homogeneous, yellowish
or bluish-white, opaque liquid. It is, however, an emul-
sion which gives it its opaque appearance. The founda-
tion of milk is water, in which the nutrient materials are
dissolved or held in suspension.
Besides water, milk contains proteid in two forms:
casein, which differs from other proteid compounds in
that it contains both phosphorus and sulphur, and lact-
albumin, which is more or less like the albumin of the
blood or white of egg. In addition, it contains lactose,
or milk sugar; fat, which is composed of several different
kinds, chiefly stearin, palmitin, and olein, and certain
others in small amounts which give flavor; and various
salts. The water of milk forms from 84 to 90 per cent, of
its weight. The solid materials, spoken of collectively as
the "total solids," form from 10 to 16 per cent., good
average milk having from 12 to 13 per cent, of solids. The
proteid, casein and albumin, forms about 3.3 per cent,
of the whole milk, or 25 per cent, of the total solids. Milk
sugar ranges from 4 to 6 per cent., averaging 5 per cent,
of the milk, or about 38 per cent, of the total solids. This
sugar is similar chemically to cane sugar, but is not nearly
so sweet. The salts form 0.7 per cent, of the whole milk.
These ingredients are fairly constant in their percentage;
the most variable component of milk is the fat, which
may vary from 2 to above 5 per cent. Good unadulterated
milk should not fall below 3 per cent, of fat nor will it
exceed 5 per cent. A good average milk from a herd
PROTEID FOODS 51
should give about 4 per cent., which would then form
about 31 per cent, of the total solids.
Many communities have laws for the prevention of
milk adulteration, which require a certain standard.
According to this standard the total solids vary from
12 to 13 per cent.; the fat varies from 3 to 3.5 per cent.
Accurate estimate of the percentage of solids in milk
requires an expensive chemical analysis, so that for
ordinary purposes simple means of estimating the fat are
adopted as the gauge for the total solids. This is a fair
approximation to accuracy, as the other solids vary but
little, and such variation as they present will be pro-
portionate to the variation of the fat.
The custom of estimating the quality of milk by means
of the fat it contains has often misled persons into the
belief that this fat is the sole valuable ingredient of milk.
This is, however, a great error, for, while the chief com-
mercial value of the milk is due to the fat, which forms
the cream from which butter and the rich cheeses are
made, the other ingredients of milk have great value as
nutrients, especially the proteid, which is in an easily
digestible form.
Variations in milk are due to various causes, and may
be so great that it is possible for one man to pay double
what another pays for the same value. One of the chief
causes of variation is in the breed of the cows. Another
important one is in the difference between individual cows
of the same breed, although certain general characteristics
are present in the milk of all cows of the same breed.
The quality of the milk will vary according to the
breed, partly because of the quantity of milk which the
given breed produces, but largely because of the manner
52 FOOD IN HEALTH
in which the fat of the milk occurs. As has been stated,
this fat is held in suspension as a fine emulsion, tiny
particles of fat being distributed throughout the substance
of the milk. These particles of fat can only be seen by a
good microscope. Some idea of their minute size may be
had when one considers that in good average milk twenty-
five of these fat globules placed side by side would rep-
resent the thickness of an ordinary sheet of letter paper.
These fat globules are uniformly distributed throughout
the milk and held in suspension by the stickiness or vis-
cosity of the fluid, which is due to the albumin and sugar
in solution in the water. The fat, being lighter than the
water, will rise to the surface on standing and appear as
a yellow layer on top, familiar to us as the cream. The
more minute these globules, the more slowly will they rise
to the surface. In the milk of different breeds there is a
great variation in the size of the fat globules, hence in the
rate of separation of the cream from the milk. Jersey and
Guernsey, sometimes called Alderney, produce a rich milk
on which the cream rises rapidly and completely. These
are good butter cows, but if the whole milk is to be used,
this ready separation of the cream is a positive disadvan-
tage, as it leaves the milk poorer. Durham and Ayrshire
cows give a good average milk in which the cream rises
slowly, and are, therefore, useful in supplying milk which
is to be used whole. Holstein cows give a milk of small
fat percentage, but usually in very large quantities.
Variation in the milk of a single cow is greater than that
of the mixed milk of a herd. Young cows, as a rule,
produce richer milk than old ones. The animal's health,
temper, and treatment will all affect the quality of the
milk. Where the cow is well cared for and kindly treated
PROTEID FOODS 53
the milk will usually be fairly uniform after lactation is
well established. The character of a cow's food does not
affect the quality of the milk as much as it does the quan-
tity. The flow is greatest soon after calving and gradually
decreases in quantity throughout the period of lactation.
As it decreases the richness of the milk in solids slightly
increases, though the proportion of fat to other solids may
vary from day to day. The first milk given after calving
is called colostrum. It contains a large proportion of
albumin, which often exceeds the amount of casein, while
the sugar percentage is usually low. It is somewhat laxa-
tive in effect and is unfit for use for food except for the
newborn. This rapidly changes, however, and in a few
days after the birth normal milk is usually produced.
The milk of different kinds of animals varies consider-
ably in the proportion of its constituents, though all milk
contains water, proteid, fat, carbohydrates, and salts.
Besides human milk, that most commonly used is from the
cow, the goat, and the ass. Human milk contains more
sugar and less proteid than cows' milk, but the fuel value
is about the same.
The following is the average composition of these kinds
of milk:
Ingredients.
Women.
Cows. Goats. Asses.
Water .
67.4
87.2 85.7 89.6
Total solids .
12.6
12.8 14.3 10.4
Casein .
1.0
3.0 3.2 0.7
Albumin
1.8
0.5 1.1 1.6
Total proteid
2.3
3.5 4.3 2.3
Fat
3.8
3.7 4.8 1.6
Sugar .
6.2
4.9 4.4 6.0
Salts .
0.3
0.7 0.8 0.5
Fuel, value per 11
>. 319 calories.
313 calories. 365 calories. 222 calories
In buying milk for food, care should be exercised to see
that it is obtained pure. Milk is naturally a pure product,
54 FOOD IN HEALTH
but is easily rendered unwholesome and may often be
adulterated, so that its food value is greatly reduced. It
is essential, in order to obtain pure milk, that it be pur-
chased from a dairy known to handle the milk with proper
care. The manner of delivery is important, as milk may
become contaminated or unclean after leaving the farm
during its distribution in the city. The custom of deliver-
ing in large cans in which the milk is drawn into measures
which have been exposed to the dust of the street is an
undesirable method, and it is not uncommon to find dregs
of dirt in the bottom of the milk receptacle. When thus
delivered, such milk, after it has stood for a little while,
is not only repulsive, but may be positively dangerous for
use. The safest method of delivery is in bottles filled at
the dairy and sealed, if proper care be taken with the
cleansing of the bottles. This could greatly be facilitated
if the patrons would see to the cleansing of the bottles as
soon as emptied, thus preventing the milk remains from
decomposing in the bottles before they are returned to the
dairy.
Milk may be received pure from the dairy and become
contaminated in the house after delivery. If left exposed
to dust or flies or placed in ill-ventilated closets, it will
become impure in a few hours; or if kept in a refrigerator
in the same compartment with meats, vegetables, or fruits,
as it quickly absorbs the odorous materials given up by
these other foods. All milk contains certain bacteria,
even pure milk. Many of these gain access from the air
at the time of milking and in handling the milk, and some
from the cow itself. These bacteria, constantly present,
are not disease germs, but it is due to their action that
certain changes occur in the milk, such as souring. To
PROTEID FOODS 55
prevent this, milk should be promptly cooled after milk-
ing and kept at a temperature below 50° F. ; under such
circumstances it may be kept sweet for several days. When
milk has been allowed to stand a few hours at a temper-
ature above 50° F. these bacteria proliferate and cause
fermentation of the milk sugar, with the production of
lactic acid. This acid produces a sour taste and causes
the coagulation of the casein, forming clabber. This
coagulated casein may be separated by pressure, leaving
the fluid, called whey, which contains the lactalbumin
and salts.
Casein is coagulated lightly by lactic acid, but is coagu-
lated into a firm clot by stronger acids, such as the hydro-
chloric acid of the gastric juice. Rennet also coagulates
the casein, but heat does not. The lactalbumin is not
coagulated by rennet or lactic acid, but is coagulated by
heat, and it is this albumin which forms the skin on boiled
milk.
The popular notion that an approaching thunder storm
causes milk to sour by the effect of electricity and ozone
in the atmosphere is a fallacy. That milk does sour sud-
denly during thunder storms is a fact, but it is due to the
bacteria which propagate rapidly in the humid, sultry
atmosphere which usually precedes a storm.
Certain forms of fermentation of milk other than sour-
ing occur more rarely and are due to the action of different
kinds of bacteria. Butyric acid fermentation does not
affect the milk, but it does affect the keeping properties
of butter. Rancid butter contains a considerable amount
of this acid. Alkaline fermentation of milk is occasionally
met with, in which the milk is coagulated into a soft, slimy
mass, usually with a bitter taste, but not sour, giving an
56 FOOD IN HEALTH
alkaline or neutral reaction. Slimy fermentation some-
times occurs and prevents the formation of cream and
renders the milk unfit for drink. Soapy milk and bitter
milk are other types of fermentation sometimes met with.
Alterations in the taste of milk due to bacterial action
must be distinguished from the flavors produced by the
cow's food. Ragweed, for instance, will cause bitter milk,
but the difference in cause is easily recognized, as changes
due to the food will be present immediately on milking,
while those due to bacterial action develop only after a
lapse of several hours.
Many diseases may be transmitted by milk from dis-
eased animals or diseased dairy workmen, such as tuber-
culosis, typhoid fever, scarlet fever, and diphtheria. Milk
which is unclean through careless handling, where par-
ticles of manure and other dirt have been allowed to fall
into it, may produce serious disease of the alimentary
tract.
Milk adulteration is reprehensible, not so much on
account of danger to health as on account of dishonesty.
The usual methods of adulteration are the removal of cream
and the addition of water, and the use of coloring matter
or preservatives. If the cream is removed and water
added the food value of the milk is reduced, but if the
water be pure there is no danger of illness being caused.
While the preservatives that are usually added are not
harmful in the amounts ordinarily used, the continued
ingestion of them may produce harmful results.
Digestibility and Utilization of Milk. — The nutrition
derived from any food depends not only on its digestibility,
but also on how much of it undergoes digestion, and far-
ther on the amount of digested material which is utilized
PROTEW FOODS ' 57
by the body. There is great variation in the utilization of
any food, as also in the amount which is digested by differ-
ent individuals, and an important consideration previously
referred to is its "agreement." While milk is very digest-
ible, there is no food material for which persons show
such variation in this respect, and it is a mistake to assume
that milk is a proper diet for all forms of sickness or for
all persons. The proteid of milk is very completely
digested, as is also the sugar, but about 5 per cent, of the fat
of milk usually escapes digestion. The proteid of milk
is more digestible than that derived from other sources.
When milk enters the stomach it is speedily curdled
by the rennin and acid of the gastric juice. When taken
alone or in large quantities the casein is apt to collect
in large masses, which will render it more difficult of
digestion. Herein is a marked difference between human
milk and cows' milk, in that human milk curdles in more
flocculent and smaller masses than cows' milk.
The curd in forming entangles the fat globules, but the
gastric juice soon dissolves the curd and also the albumin-
ous covering of the fat globules, allowing these to coalesce
into large drops which pass on into the intestine with the
chyme. Curds which are not fully dissolved by the gastric
juice are acted upon by the pancreatic juice after they
enter the intestine, where digestion is completed. The
salts and water of the milk, and to some extent the sugar,
are largely absorbed from the stomach. The usual time
for the digestion of milk in the stomach normally is about
three hours. When the gastric juice is too acid or organic
acids are present in the stomach, the casein is likely to be
coagulated into large, firm clots, which resist the solvent
action of the gastric juice. When this occurs the clots act
58 FOOD IN HEALTH
as irritants and may cause vomiting, or, passing into the
intestine, they may produce, in like manner, diarrhea.
Under such conditions decomposition of the milk sugar
may occur with the formation of lactic acid, and the alka-
line salts may be split up, complicating the fermentative
changes.
Nutritive Value of Milk. — Milk contains the various ali-
mentary substances essential to life in proportions more
nearly approximating the needs of the human body than
any other single food. Although it is a complete food for
infants, it is not suitable as a single food for adults, because
the proportion of proteid to carbohydrates is too high;
and in order to obtain enough carbon, too much proteid
would be ingested, while if only enough proteid were
taken, too little carbon would be received. The infant can
utilize this excess of proteid, as proportionately more is
required for the growing child, which must provide not
only for the repair of physiological waste, but also for the
adding of tissues for growth, while the adult requires only
sufficient to repair the tissues used up by work. The milk
necessary to furnish 0.28 pound of proteid required for a
man at work would yield only 2700 calories' fuel value,
while milk sufficient to furnish the 3500 calories' fuel value
necessary for such a man would yield 0.39 pound of pro-
teid. Another reason why milk is not a suitable food alone
for adults is that a certain bulk is necessary in the food to
stimulate peristalsis. /Cows' milk is not a perfect food
for infants in its natural form, and must be modified to
resemble human milk in order for the best results to be
obtained.
Cream. — When the fat globules rise to the surface they
entangle a considerable amount of the milk, which is
PROTEID FOODS 59
removed with the fat as cream. Cream, therefore, con-
sists of the fat of the milk with some proteid and carbo-
hydrates. The proportion of the ingredients of -the cream
is, however, very different from that of milk, the fat being
about four and a half times that of milk, while the proteid
and carbohydrates are slightly less than in milk. Cream
varies somewhat in composition, according to the quality
of milk from which it is derived. A good average cream
will give the following average proportion:
Water, 66 per cent.; proteid, 2.7 per cent.; fat, 26.7 per
cent.; sugar, 2.8 per cent.; salts, 1.8 per cent.
The composition and consistency of cream will further
vary according to the manner of its separation. Cream
obtained by the most usual method is termed "gravity"
cream, as the separation is due to gravity, the heavy milk
settling below, while the lighter cream rises to the surface.
If cream is warmed to about 100° and the temperature
then lowered by placing the pan in cold water, the cream
will rise more easily; but unless the milk is in good condi-
tion this warming may cause it to sour. This method of
separation requires from twelve to twenty-four hours.
"Separator" cream is much richer than gravity cream.
For this method of separation apparatus is used which,
by centrifugal force, drives the heavier milk outward,
leaving the cream in the centre, from which it is collected.
The advantage of this method of separation over the other
is that the cream may be kept longer, as it may be obtained
from perfectly fresh milk, and it more completely robs the
milk of its fat. It furthermore saves time. Because of
its greater richness it is more suitable for certain uses, as
whipping. Cream gradually becomes thicker the longer
it is kept. When kept to thicken it must be entirely sur-
60 FOOD IN HEALTH
rounded with ice and kept as near the freezing point as
possible.
It will be seen from the analysis that the chief food value
of cream is as a source of energy, but it is not an econom-
ical food for this purpose.
Skimmed Milk. — In separating the cream from the milk
no alteration is made in what remains, which is called
"skimmed milk," except the removal of fat, but by its
removal the proportion of the ingredients in the skimmed
milk is altered, the proteid being relatively greater and
the fat tremendously reduced. Some fat always remains
after the removal of the cream, the quantity varying
according to the method of separation. When separated
by the usual method of standing in shallow pans the fat
of the skimmed milk will range from 0.37 per cent, to 0.91
per cent., while the separator method will reduce the fat
to 0.004 per cent, or less.
Skimmed milk has all the value of whole milk for build-
ing and repairing tissues and half the value for supplying
energy. Taken alone it is thin and does not satisfy the
sense of hunger, as a very large quantity is necessary to
supply the needed nourishment, but when taken with other
foods it is a valuable and cheap means of supplying pro-
teid. When skimmed milk is used in mixing bread instead
of water it considerably increases the nutritive value of
bread.
Butter. — This is one of the most digestible of animal
fats, and by its pleasant flavor renders many foods more
appetizing. In making butter the cream is set aside for
many hours in a warm place to sour or ripen. This sour-
ing of cream, as the souring of milk, is due to the action
of bacteria on the sugar, forming lactic acid. The casein
PROTEID FOODS 61
of cream coagulates and causes it to clot, and the albumin-
ous covering of the fat globules is also coagulated, so that
when the cream is churned this covering is easily ruptured,
allowing the escape of pure fat.
Among the various kinds of bacteria found in cream a
number of species produce a pleasant flavor and aroma
during their growth, by the production of volatile acids.
The difference in the flavors of butter from different
dairies is due to this bacterial action. The bacteria of
cream have been studied and several species isolated
which will produce known flavors. In some of the large
creameries pure cultures of these bacteria are intro-
duced into the cream in order to give it the desired
flavor.
All butter contains more or less casein, which is taken
up from the milk; the less casein the butter contains, the
better is the product. When butter becomes rancid it is
due to alteration of the casein through bacterial action.
It is, therefore, desirable to rid the butter as completely
as possible of the casein, in order that it may keep longer.
This is done by thoroughly washing and kneading with
water. While this removes the casein quite thoroughly,
it also deprives the butter of much of its flavor and fresh-
ness by washing out the substances which give it flavor.
Sometimes water is purposely left in the butter in order
to increase its weight, in which case it may amount to as
much as from 20 to 25 per cent, of the weight. Such
trickery may be detected by melting the butter, when the
water will collect below the fat. Salt is also used to pre-
serve the butter, which it does by checking the decompo-
sition of the casein. Covering butter with water that has
been boiled or submerging it in ice-water will help to pre-
62 FOOD IN HEALTH
serve it. Good butter will give the following approximate
analysis :
Fat, 87 per cent.; casein, 0.5 per cent.; sugar, 0.5 per
cent.; water, 11.7 per cent.
When perfectly fresh, butter is one of the most easily
digested fats. When cooked at a high temperature fatty
acids may be developed by the heat and produce irritation
of the stomach and cause disease, as does also rancid
butter.
Buttermilk. — This is the name given to the milk which
remains after the butter has been made and removed.
The composition of buttermilk is almost identical with
that of skimmed milk, the chief difference in the two foods
lying in the fine coagulation of the casein of the butter-
milk. This difference renders buttermilk more digestible
for many persons than whole milk or skimmed milk, as
the finely coagulated casein of the buttermilk is not so apt
to form large clots or to be as tough as the casein of
skimmed milk or whole milk, which must be coagulated
after entering the stomach. Buttermilk is sour to the taste
from the lactic acid which is developed in the ripening
of the cream before churning. Where cream alone is
churned the buttermilk will not be as palatable as when
milk and cream are churned without the prior separation
of the cream. Buttermilk is a wholesome, digestible food,
being equivalent in nutrient value to skimmed milk.
Cheese. — Cheese is composed of the casein of the milk
and usually a large proportion of the fat. The milk is coag-
ulated by the addition of rennet and salt is added; the whey
is then pressed out, and- the curd, after moulding, is put
aside to ripen. Ripening is due to bacterial action, and the
different flavors of cheeses are due to the action of different
PROTEID FOODS 63
kinds of bacteria which produce fatty acids that give aroma.
While the proliferation of the bacteria in milk and cream
is a rapid process, their development in cheese is compara-
tively slow. The proliferation continues for some time,
but as the cheese ripens the number and variety of bac-
teria gradually lessens. This is the occurrence in normally
ripened cheese. In abnormally ripened cheese undesir-
able bacteria develop, causing the formation of gas in
large quantity, which makes the cheese unfit for use. The
fermentation by these organisms may even go on to the
degree of putrefaction.
There are many varieties of cheeses. "Fresh" cheeses,
such as cream cheese, are intended to be eaten as soon
as made and are not kept. These are usually made
from sour milk, and are often called sour cheeses.
Other kinds are usually made from sweet milk. The
character and quality of cheese largely depend on the
amount of fat which it contains. Dry cheese, such as
Dutch and Parmesan, are made from skimmed milk.
Many cheeses have cream added in their manufacture.
These, rich in fat, are the soft, highly flavored cheeses.
The dry kinds keep better than the soft. An average
percentage of the composition of many of the common
cheeses is as follows:
64
FOOD IN HEALTH
Table II. (Davis' Dietetics, after Hutchison.)
Nitrogenous
Cheese.
Water.
matter.
Fat.
Ash
American
. 26.9
32.9
31.0
4.5
18.9
26.8
4.5
Camembert .
. 48.6
21.0
21.7
4.4
Cheddar .
31.9
33.4
26.8
3.9
Cheshire .
33.2
29.4
30.7
4.3
Cream
. 32.0
8.6
35.9
1.5
Dutch .
. 32.9
S0.8
17.8
6.3
Gloucester
. 31.9
36.7
24.7
4.4
Gorgonzola
. 39.2
25.9
29.9
4.7
Gruey&re
. 34.1
31.5
28.2
4.0
Neufchatel .
41.0
14.3
43.2
1.4
Parmesan
. 30.0
43.8
16.5
5.9
Roquefort
. 25.1
34.8.
31.5
5.5
. 27.6
23.9
38.9
3.1
Cheese is a valuable, nutritious, and economical food,
as it contains twice as much nitrogen, weight for weight,
as meats. The popular notion that cheese is indigestible
is exaggerated. The harder, poorer cheeses which contain
a large proportion of casein, are difficult of digestion, but
the finer, soft cheeses, which contain a good percentage
of fat, are readily digested, at least by normal stomachs.
A small quantity of soft cheese, taken after meals in
moderation, aids digestion. Taken with milk, cheese
tends to reduce the size of the coagula.
Adaptation of Milk for the Sick. — While, as has been
stated, milk does not agree with all persons, many are
averse to using it through prejudice, though having the
power to digest it. Because milk in some form has at a
previous time disagreed with anyone, it does not follow
that it will of necessity again disagree, if administered
with intelligence. Milk should be sipped slowly when
taken alone, and never gulped in large quantities, as under
such conditions it is liable to form large curds, even in
normal stomachs. For those who object to taking milk,
PROTEID FOODS 65
it can be rendered pleasant by altering the taste, by-
increasing the digestibility in different ways, or by predi-
gesting it.
The taste of milk can be altered by the addition of various
flavoring agents. Unless contraindicated by nervous con-
ditions or otherwise, a little coffee or tea added will usually
remove the ordinary raw-milk taste and render it pala-
table. If this cannot be used caramel or a little chocolate or
cocoa may be added. Sometimes a pinch of table salt, with
or without pepper, is sufficient. Meat extracts or malt
extracts are often useful for this purpose. If alcohol is
allowable, a little whiskey or brandy may be added with
benefit. Many persons who tire of milk may be induced
to continue its use when given in the form of ice-cream.
Another wholesome milk preparation is oyster stew, in
which the milk, flavored with the oysters, is administered.
Methods of Improving the Digestibility of Milk. — Skim-
ming, boiling, dilution with water, with alkaline or aerated
waters, with amylaceous foods, the addition of alkalies,
acids, or other substances may be employed.
Skimming. — Skimmed milk is more digestible for persons
who cannot digest fats. In other respects the digestibility
of skimmed milk does not differ from that of whole milk.
Boiling. — By the action of heat the albumin of milk
is coagulated and appears on the surface as a scum in
which some of the fat globules are entangled. This should
be removed before serving. The casein is not coagulated
by heat, but boiling causes precipitation of some of the
phosphate of lime united with the casein, which renders
the curd of the casein, when coagulated by the acids of
the stomach, more flocculent and consequently more diges-
tible for some persons. By boiling, bacteria are destroyed
5
66 FOOD IN HEALTH
and the. growth of other fungi is arrested, thus retarding
souring and coagulation. Some of the gases are driven
off and some of the water evaporated. The taste of the
milk is altered and rendered "flat." This flatness can
usually be overcome by pouring the milk through the air
or mixing with it a little aerated water.
Whether boiling really increases the digestibility of milk
or not is a question, and it would seem that the relative
digestibility of raw and boiled milk is a matter of personal
idiosyncrasy, some persons being able to digest the raw
milk best, while others digest it best after boiling. The
albuminous covering of the fat globules is coagulated by
the heat, which retards to a large extent the digestion
of the fat.
Scalded milk is heated to about 150° by pouring on
boiling water. This does not affect its digestibility, except
in so far as it is diluted with water.
Dilution with Water. — By adding plain water to
the milk in the proportion of one part to two or three of
milk its digestibility can be improved, since such dilution
renders the curds smaller and softer. The method is
useful where very rich milk is being used.
Dilution with Alkaline or Aerated Water. —
Lime-water added to milk renders the curds smaller,
partly by the addition of water, partly by the effect of the
lime. A mistake is often made in not using the lime-water
in a sufficient quantity. From one to four tablespoonfuls
should be added to each tumbler of milk. By the increased
alkalinity thus attained, acidity of the stomach is counter-
acted. Lime-water thus used will often control nausea
and diarrhea, but is apt to increase constipation. If
lime-water is used to neutralize the acidity of cows' milk
PROTEID FOODS 67
it should not be heated above 160° to 170°, as the proteid
may be decomposed in boiling the alkaline solution.
Aerated waters, such as alkaline Vichy, bottled soda,
or Apollinaris, may be used in any desired quantity. They
prevent the formation of large coagula in the stomach,
and by aeration render the milk light and palatable and
prevent the after-taste so disagreeable to many persons.
Hot milk with Vichy will often relieve the irritable cough
of bronchitis.
Dilution with Amylaceous Foods. — Any starchy
food may be used as a mechanical diluent of milk, as it
mingles with the milk, thus preventing the formation of
large, tough curds. Bread or crackers are sufficient
where they can be taken, and have the additional advan-
tage of requiring to be chewed. Oatmeal-water or barley-
water may be used instead of plain water in any desired
proportion. Barley-water is better for diarrhea, while
oatmeal-water is better for constipation. Flour ball is an
excellent preparation for this purpose.
A great number of artificial foods, usually termed "In-
fant Foods," are offered on the market for the double
purpose of modifying the digestibility of milk and adding
to its nutritive value. They act as diluents much as do
the amylaceous foods, by preventing the coagulation of
casein into large curds. Their addition to the food value
will vary with their compositions. The following anal-
ysis, by Dr. .Chittenden, of Yale, of some of the popular
preparations will indicate their relative merit in this re-
spect :
68
FOOD IN HEALTH
Table III.— Composition of Some Infant Foods as Prepared
for the Nursing-bottle in Comparison with Mothers'
Milk. Prepared According to Directions for Infants
of Six Months.
Peptoge-
nio milk
powder.
Specific gravity .
Water .
Total solid matter
Inorganic salts .
Total albuminoids
Soluble
Insoluble "
Fat
Milk sugar .
Cane "
Maltose .
Dextrin
Soluble starch .
Starch .
Reaction
Nestlg's
Mothers'
Malted
milk
Imperial
Mellin's
milk.i
milk.
food.
granum.
food.
1031
1025
1024
1025
1031
86.73
92.47
92.76
91.53
88.00
13.26
7.43
7.24
847
12.00
0.20
0.29
0.13
0.34
0.47
2.00
1.15
0.81
2.15
2.62
2.00
1.15
0.36
1.67
2.62
trace
0.45
0.48
4.13
0.68
0.36
1.54
2.89
6.93
1.18
0.84
2.71
3.25
O
2.57
3.28
trace
trace
2.20
0.92
} 0.44
| 0.58
0.53
1.99
1.22
alkaline
alkaline
alkaline
alkaline
alkaline
1032
86.03
13.97
0.26
2.09
2.09
4.38
7.26
alkaline
The Addition of Alkalies. — In hyperacidity of the
stomach the addition of alkalies will counteract the acidity
and retard the formation of coagula and render them
more flocculent.
Methods of Predigestion. — The object of predigesting
the milk is to partially digest the casein so as to relieve
the stomach and intestine of some of their work.
Peptonized Milk. — By the addition of pepsin and
hydrochloric acid to milk the casein is converted into
albumoses. Pepsin added to the milk without hydro-
chloric acid will not produce this change, as the acid is
necessary to render the pepsin active. Numerous pep-
tonizing preparations are on the market which contain
both pepsin and acid. One of these should be added in
proper quantity to the milk, which must then be placed
in warm water and kept at an approximate body tem-
1 According to Leeds.
PROTEID FOODS 69
>
perature for a few minutes, when by fermentation the
change of the casein into albumoses occurs. If the process
is too long continued the milk will have a bitter taste.
The fermentation may be checked by raising the tem-
perature of the milk to the boiling point, which destroys
the pepsin, or by placing it on ice, which prevents the
further action of the pepsin until it is ingested.
Pancreatinized Milk. — The use of pancreatin for
predigestion has of recent years become more popular
than the older method of predigesting by pepsin, as pan-
creatin is active in an alkaline medium and does not re-
quire the addition of acid. The result of the process is
similar to that of peptonizing in the conversion of casein
into albumoses. To a pint of fresh milk add $ grain of
pancreatic extract and 15 grains of sodium bicarbonate
and place in warm water, not boiling, for one-half hour
If too long continued the fermentation of pancreatin, like
pepsin, will produce a bitter taste, rendering the milk
unpalatable. To .check the action of pancreatin boil the
milk for two or three minutes to stop further fermenta-
tion. The milk should then be kept on ice until used.
The actual quantity of pancreatin or pepsin used will not
make much difference. If an excess is used the process
will simply be more rapid, but it is finally checked by the
boiling.
Koumiss. — Milk that has undergone alcoholic fermen-
tation is called koumiss. This method of treating milk is
in imitation of certain tribes of Southern Russia, who
make an alcoholic drink from mares' milk which they
call by this name. In America cows' milk is used for the
purpose. Many dairies manufacture it along with other
milk products and it is purchasable at many drug stores.
70 FOOD IN HEALTH
Koumiss has a slightly sour odor and pleasant, bitter
taste. During fermentation, alcohol is developed from
the milk sugar and may reach a percentage as high as
two and a half. Koumiss becomes stronger after keeping
a day or two. It decomposes easily. The casein is pre-
cipitated and then converted into peptones and propep-
tones. Unless the fermentation is checked by. continued
application of extreme cold the product will be con-
stantly changing as fermentation goes on. Spoiled kou-
miss may produce ptomain poisoning. If too fresh,
koumiss may cause colic and diarrhea, or if old it may
cause constipation. It resembles whey in its diaphoretic
and diuretic properties, increasing the solids of the urine.
It is usually contraindicated in renal and vascular dis-
eases, gout, and chronic constipation. Koumiss "cures"
are established in various parts of Europe. The treat-
ment consists in drinking large amounts of koumiss,
with abundant exercise and hygienic methods of living.
It is said to be useful in chronic catarrhal conditions and
in the first stages of phthisis.
Kefir. — This is another drink made by the fermenta-
tion of milk. It resembles koumiss, but the fermentation
is more complete, almost all of the milk sugar being con-
verted into alcohol and carbonic acid gas. The casein is
in a large part digested, and what escapes occurs as floc-
culent coagula.
Matzoon. — This is a preparation very similar to koumiss
in its properties and uses.
Sterilization and Pasteurization of Milk. — The object of
sterilizing or pasteurizing milk is to destroy hurtful germs
which it may contain. For sterilization the milk must be
raised to the temperature of boiling water, 212° F., and
PROTEID FOODS 71
kept at this temperature for half an hour. This destroys
the harmful bacteria which may be present, but does not
destroy the spores from which new bacteria may develop.
To make milk practically sterile in the sense of destroying
the spores as well as the germs, it is necessary to repeat
the operation of sterilization a number of times after
sufficient interval has been allowed for the development of
bacteria from the spores contained in the milk. This is
called fractional sterilization, but it is a tedious and
troublesome process and is practically unnecessary, as it
has been found that the destruction of living bacteria is
sufficient to prevent the development of disease, the
spores being destroyed by the digestive ferments before
the bacteria can develop from them. In sterilization the
milk is placed in bottles and exposed to steam. Various
forms of sterilizers are on the market, all of which are
made on the same principal — viz., of collecting the con-
densed steam by a cover to the boiler by which it is re-
turned to the water, thus keeping up a constant current of
steam at a temperature of 212° about the bottles. This
raises the milk to that temperature, which destroys the
living germs. Further effects of sterilization are similar
to the effects of boiling milk — viz., the casein coagulates
less readily by rennet, and its digestibility is proportion-
ately retarded. The digestion of fat is retarded through
toughening of the albuminous covering of the fat globules
by the heat, and if the heating is continued too long some
of the lactose may be destroyed and converted into cara-
mel. While these changes in the digestibility of milk may
not affect normal stomachs, even of children, sick chil-
dren are very susceptible to even slight changes in the
digestibility of the food given them.
72 FOOD IN HEALTH
For this reason pasteurization of milk has in recent
years been more universally used than sterilization. Pas-
teurization consists in exposing the milk for from ten to
twenty minutes to a temperature of 160° to 167° F. If
heated above 167°, undesirable changes may be pro-
duced. It has been found that if bottles of milk are im-
mersed in water removed from the fire while boiling and
allowed to stand twenty minutes, the milk will be uni-
formly raised to a temperature of 167°. This is, of course,
true only where the proportion of the bulk of water used
and the bulk of milk to be pasteurized are properly
adjusted. Different forms of pasteurizing apparatus
are on the market, so adjusted that this relation will be
correct, thus rendering pasteurization a simple and easy
process. Pasteurization does not affect the rate of digesti-
bility as does sterilization, but it renders the milk prac-
tically as safe as sterilized milk. Sterilized milk has the
taste of boiled milk, but pasteurized milk, though having
this taste mildly while still hot, loses it on being cooled.
Sterilized milk will keep longer than pasteurized milk, but
it keeps sufficiently long, when pasteurized, for all prac-
tical purpose, since a day's supply for a child can be
pasteurized at one time and will keep well for twenty-
four hours if prepared with proper care. After both
sterilization and pasteurization the milk bottles should
be stopped with absorbent cotton, which has been baked,
and then kept on ice. This protection is essential for
safety, since it has been shown by investigations conducted
in many laboratories, as to the relative contamination of
clean or "certified" milk and pasteurized milk, that
bacteria introduced into pasteurized milk multiply far
more rapidly than they do in clean milk.
PROTEID FOODS 73
It seems also established that milk drawn from healthy
animals under strict aseptic precautions is sterile and
that it becomes tainted by handling. As a result of the
laboratory investigations a theory has been advanced
that fresh milk even destroys some micro-organisms, and
has a certain active bactericidal power. Though there is
evidence to support this view, it has not been positively
determined.
A marked difference in the bacteriology of clean and
pasteurized milk has been shown, however, by recent
observations in Philadelphia, as reported in July, 1905,
by Pennington and McClintoch, of the Bureau of Health
of that city, a summary of which is as follows: "During
May and June, 1904, contents of clean ('certified') milk
and of commercial pasteurized milk showed that the
latter was richer in organisms on the initial examination
and that a rapid increase in the organisms present took
place on keeping, even at refrigerator temperatures.
"Pasteurized modified milk, for infant feeding, showed
frequently an appalling initial count and almost invariably
a very high count at the end of twenty-four hours.
"The commercial pasteurizing plants succeed in re-
ducing the original bacterial contents of the milk to a
very low figure in the heating coils, but again contaminate
it in the cooling and bottling of the milk, so that some-
times the final count is higher than that of the original
unpasteurized milk."
Modified Milk. — Modern studies in the feeding of infants
and the chemistry of milk have led to the establishment
of milk laboratories and the production of the so-called
modified milk. This simply means that milk is prepared
in any given proportion of its ingredients desirable for the
74 FOOD IN HEALTH
individual. Where modified milk is used, a physician's
prescription is written, in which the desired proportions
are stated, and it is mixed at the laboratories according
to this prescription. In order to prepare modified milk
the different ingredients are first separated, the cream
being removed entirely by a centrifuge, giving thus pure
cream, containing the fat, and pure milk containing pro-
teid, sugar, and salts, but no fat. There is further neces-
sary, for the preparation of modified milk, distilled water,
a 20 per cent, solution of milk sugar freshly made with
the distilled water, and lime-water. The milk can thus be
modified according to prescription in any desired pro-
portion by the addition of water, sugar solution, cream,
or lime-water.
Condensed Milk. — This is prepared by slowly evaporat-
ing the water of the milk by moderate heat in a vacuum.
The consistency is about that of honey. Two varieties are
made: the "plain," which is condensed to about one-
fourth of its bulk, and superheated, to which no sugar is
added or but little; and the "strong" condensed milk,
which has cane sugar added in excess to prevent decom-
position. Such milk may give from 40 to 75 per cent,
sugar. Condensed milk will keep indefinitely while
sealed and for several days after opening a can. It is
prepared by dissolving in water in any desired proportion.
Children thrive on it for a time, and grow fat on the sugar
contained, but their flesh is less firm and they have less
resistance to disease than children fed on fresh milk.
When diluted it rapidly ferments and may cause diar-
rhea. It should, therefore, be prepared fresh for each
feeding.
PROTEID FOODS 75
EGGS.
Hens' eggs are most commonly used for food, but
those of guineas, ducks, geese, and turkeys are also often
eaten. In some localities eggs of wild birds are valued
as a food and are largely consumed.
Eggs are a perfect food in that they contain all of the
ingredients necessary to support life, the chicken being
fully developed in the shell before hatching. The embryo
from which the chicken is developed is situated quite
near the yolk, which is first used for nutritive material,
the white being reserved for later use after development
has progressed. The lime-salts needed for bone forma-
tion are furnished by the shell and are dissolved out from
the shell by phosphoric acid.
Eggs vary considerably in size with different breeds,
but hens of the same breed will usually produce eggs of
the same size and appearance. In color they may vary
from white to a decided brown shade, and in different
localities these different varieties are variously preferred.
Composition. — On an average a hen's egg weighs about
two ounces. Of this about 11 per cent, is shell, while the
yolk constitutes 32 per cent., and the white 57 per cent.
The composition of the white is as follows: Water, 86.2
per cent.; proteid, 12.3 per cent.; fat, 0.2 per cent.;
mineral matter, 0.6 per cent. The yolk gives the fol-
lowing analysis: Water, 49.5 per cent.; proteid, 15.7 per
cent.; fat, 33.3 per cent.; mineral matter, 1.1 per cent.
These percentages are, of course, average percentages,
individual eggs varying more or less. Thus it may be
seen that the yolk contains considerable fat, almost one-
third of its weight, and considerable salts, while the white
contains practically no fat, and but very little salts.
76
FOOD IN HEALTH
Table IV.— Average Composition of Eggs and Egg
Products.
i
ii
'O
g
°S3
0>
•2
M
"53
s
+3
03
3
~ P.
P «
Hen:
%
%
%
%
%
%
Calories.
Whole egg as purchased .
11.2
65.5
11.9
9.3
0.9
635
" edible portion .
73.7
13.4
10.5
1.0
720
White
86.2
12.3
0.2
0.6
250
Yolk
49.5
15.7
33.3
1.1
1705
Whole egg boiled, edible portion
73.3
13.2
12.0
0.8
765
White-shelled eggs as purchased
ia7
65.6
11.8
10.8
0.6
675
Brown-shelled eggs as purchased
10.9
64.8
11.9
11.2
0.7
695
Duck:
Whole egg as purchased .
13.7
60.8
12.1
12.5
0.8
750
" edible portiou .
70.5
13.3
14.5
1.0
860
White
87.0
11.1
0.03
0.8
210
Yolk ...
45.8
16.8
36.2
1.2
1840
Goose :
Whole egg as purchased .
14.2
59.7
12.9
12.3
0.9
760
" edible portion
69.5
13.8
14.4
1.0
865
White ....
86.3
11.6
0.02
0.8
215
Yolk ....
Turkey :
Whole egg as purchased .
" edible portion .
44.1
17.3
36.2
1.3
1850
13.8
63.5
12.2
9.7
0.8
635
73.7
13.4
11.2
0.9
720
White
86.7
11.5
0.03
0.8
215
Yolk
48.3
17.4
32.9
1.2
1710
Guinea fowl :
Whole egg as purchased
" edible portion .
16.9
60.5
11.9
9.9
0.8
640
72.8
13.5
12.0
0.9
755
White
86.6
11.6
0.03
0.8
215
Yolk ... .
49.7
16.7
31.8
1.2
1655
Plover :
Whole egg as purchased .
9.6
67.3
9.7
10.6
0.9
625
" edible portion .
74.4
10.7
11.7
1.0
695
Evaporated hens' eggs .
6.4
46.9
36.0
7.1
3.6
2525
Egg substitute . . . .
11.4
73.9
0.3
5.3
9.1
1480
The white of eggs is sometimes supposed to be pure
albumin, but it is actually composed of several albumins
which are in solution in the water contained; the chief of
them, forming the greater part, is ovalbumin. This solu-
ble albumin may be absorbed without previous digestion.
The phosphorus in the albumin of egg white is equal to
0.03 per cent, of phosphoric acid. Sodium chloride is
the chief salt contained.
The yolk of egg is a more complex substance, the_chief
PROTEID FOODS 77
proteid being vitellin. The fats are largely composed of
palmitin, stearin, and olein. Other ingredients are a
small percentage of coloring matter, with lecithin (a fat-
like body containing phosphorus), nuclein, etc., and salts
of calcium, magnesium, potassium, and iron. The total
phosphorus in the yolk amounts to a little over 1 per cent,
of phosphoric acid.
Egg albumin contains sulphur, and the darkening of
silver by eggs is due to the formation of silver sulphide.
These albumins are readily decomposed with the libera-
tion of hydrogen sulphide and phosphorated hydrogen,
which gives the bad odor to rotten eggs. This decom-
position is brought about by bacteria which gain access
to the egg through minute openings in the shell. It
should be remembered that egg-shells are porous, per-
mitting the entrance of bacteria and other substances,
and care should therefore be taken to keep eggs under
cleanly conditions such as are observed for other foods.
A mucilage-like substance coats the outside of the shell,
which aids in preventing such contamination. Washing
eggs removes this substance, and, while making them
more attractive in appearance, renders them more liable
to contamination.
Flavor of Eggs. — The fresher the eggs the better the
flavor, though perfectly fresh eggs may sometimes have
a very unpleasant flavor due to the food eaten by the
laying hens. Stale eggs, having the odor of old straw,
should never be given to delicate persons.
There are many ways for testing the freshness of eggs.
"Candling" is one of the most common methods. Hold-
ing the egg between the hands with the candle behind it,
the egg will appear unclouded and almost translucent if
78 FOOD IN HEALTH
fresh, being most translucent at the centre; a stale egg
will appear clouded and more translucent at the ends;
and rotten eggs appear dark colored.
As eggs grow older their density decreases by the evap-
oration of moisture. Advantage is taken of this fact to
test their freshness. For this method, make a solution of
two ounces of salt to one pint of water. A fresh egg
gently dropped into the brine will at once sink to the
bottom, an egg one day old will sink below the surface
but not to the bottom, while one three days old will swim
just immersed in the liquid, and if older than that will
float on the surface.
Digestibility of Eggs. — There has been much discussion
as to the digestibility of eggs cooked by different methods.
Recent investigations seem to show that methods of cook-
ing do not affect the total digestibility as much as the time
of digestion. Different experiments vary somewhat in
the results, but it may be stated as an average that raw
eggs are digested in two hours, soft-boiled eggs in three,
and hard-boiled eggs in three and one-half to four hours.
This refers to digestion in healthy stomachs, since in
weak stomachs the white of hard-boiled eggs may remain
for several days. Compared with other nitrogenous
foods, eggs are readily and thoroughly digestible, as
various experiments have shown that from 90 to 95 per
cent, of the total proteid and fat are digested. The in-
digestibility of the white of hard-boiled eggs is largely-
due to the fact that it is not thoroughly masticated.
If thoroughly chewed, it is a question whether there is
any marked difference in the time necessary for diges-
tion. The yolk is digested in about the same period of
time, whether raw, soft-boiled, or hard-boiled.
PROTEID FOODS 79
Cooking of Eggs. — It has been stated that there are over
five hundred different ways in which eggs may be cooked,
but these are merely variations or combinations of the
simpler methods of cooking described in Chapter III.
Different styles of cooking do not to any extent alter the
composition of the egg, but produce marked changes in
its appearance and texture. The white of egg begins to
coagulate at 134° F. At this temperature white fibres ap-
pear, which become more numerous as the heat continues,
until at about 160° the whole mass is coagulated, opaque
in appearance, tender, and of jelly-like consistency. If
the temperature is raised to 212° F. (the temperature of
boiling water) the albumin becomes coagulated into
hard, tough, brittle, and horn-like substance, and also
shrinks. The yolk coagulates firmly at a lower tempera-
ture than the white.
Boiling. — When eggs are "soft-boiled" by dropping
into boiling water for two minutes the outer part of the
white becomes firmly coagulated, while the yolk remains
fluid. A better way to soft boil eggs is to pour a quart of
boiling water over two eggs in a bowl and allow them to
stand for ten minutes covered with a cloth. Another
good way is to place eggs in cold water on the fire, and
remove them the instant the water breaks into a boil.
By both of these methods the white will be jelly-like in
consistency, while the yolk will be firmer.
If an egg be dropped into boiling water and boiled for
five minutes, the white will be hardened and the yolk will
be more or less gluey in consistency. This is the common
way of hard boiling an egg. If an egg be cooked longer,
however, say from a half-hour to an hour, the yolk will
become dry and can easily be broken up into a powder.
80 POOD IN HEALTH
Cooked in this way the yolk is very digestible, but the
white will be tough. If an egg be kept in water at a tem-
perature of 180° to 190° F. for from a half to three-quarters
of an hour the yolk will be dry and mealy and the white
tender, though solid.
"Shirring" on hot plates is another good way to pre-
pare eggs. The plates should not be too hot or the same
effects will be produced as by hard boiling. An excellent
way to shirr eggs is to immerse a cup in boiling water
until it is thoroughly heated, then, removing the cup, to
break an egg into it and allow it to stand for a few minutes.
Poaching. — Poaching is also a good method of cooking
eggs. Cooked in this way the shell is broken and the egg
dropped into hot or boiling water. The addition of a
little salt or vinegar to the water is sometimes recom-
mended, as the vinegar tends to coagulate the albumin
and so prevents the solution of some of it in the water.
Frying. — Fried eggs will make variety in serving, but
are not fit for delicate stomachs. Scrambled eggs resem-
ble fried eggs as far as the cooking is concerned, the only
difference being that the egg is first stirred, the yolk and
white being well mixed. Omelet is an attractive way of
cooking eggs, and, thus prepared, eggs will be lighter
and more easily digested than when scrambled if the
omelet is well made, but it is, in effect, simply a form of
frying. Where eggs are used in combination with other
foods, as in the making of custards, etc., with milk,
sugar, and butter, the same changes occur which are
observed in cooking an egg alone. Such combinations
are useful in that these other materials furnish more
energy, and make a better balance in the food than egg
alone would give, as the proportion of proteid in the egg
PROTEID FOODS 81
is high. In whatever way the egg is cooked, it should be
remembered that too great heat coagulates the albumin into
a tough substance; the heat should, therefore, be moderate.
Eggs are largely used for making cakes and light breads.
Used in this way, they serve instead of yeast or baking
powder to make the bread light and porous. When the
white is thoroughly whipped, little bubbles of air are
caught in the tenacious albumin, making it of a light,
frothy consistency. This, when mixed into the batter,
renders it light, and on cooking the air 'bubbles expand,
making the bread still more so, while the heat coagulates
the albumin, setting the bread so that it will hold its
porous character.
The white of egg is often used to clarify coffee, soups,
etc., which is accomplished by the enclosing of floating
particles in the albumin as it coagulates. The albumin
should be mixed with the fluid before boiling. The use
of egg-shells for such purpose is not for any effect of their
own, but to utilize the white which sticks in the shell after
breaking.
Preservation of Eggs. — Various methods of preserving
eggs have been tried, the object sought in all being to pro-
tect the egg from the entrance of bacteria. Covering in
bran, by excluding some of the air, is a helpful means, but
not thoroughly efficient. Covering the eggs with lime-
water or salt water preserves them fairly well, but this
alters the flavor of the egg by absorption through the
shell. Coating the egg with vaselin has proven one of the
most efficient methods of keeping, but it is tedious. The
use of water glass or soluble glass (potassium silicate or
sodium silicate) is probably the most effective method of
preserving them if the water glass is not very alkaline. It
6
82 FOOD IN HEALTH
is best not to wash the eggs, since this removes the mucil-
aginous coating. When they have been placed in a suita-
ble vessel a solution of water glass is carefully poured
over them. The solution is prepared in sufficient strength
by mixing one part of syrup-thick water glass in ten parts,
by measure, of water. One gallon of the solution is suffi-
cient for fifty dozen eggs if they are properly packed. Eggs
thus preserved will usually crack when boiled. To pre-
vent this a small pin-hole should be made in the end before
placing in water. Cold storage has also been used for
keeping eggs, and it is a satisfactory method when prac-
ticable. Observation differs as to the best temperature,
but it should be near the freezing point of water.
Desiccated Eggs and Egg Substitutes. — Desiccated eggs
are prepared by evaporating in a vacuum. Sometimes
salt or sugar, or both, are used as preservatives. The
desiccated egg is usually ground and sold as powder. It
contains all of the nutrient materials of the egg, the water
only having been removed. This material is used to some
extent by bakers when fresh eggs are high in price. It is
also useful in expeditions where fresh eggs cannot be pro-
cured. After mixing with a small quantity of water, it can
be fried or made into an omelet, which is said to be pal-
atable and to closely resemble the similar preparation of
fresh eggs.
Various egg substitutes have been devised which are a
mixture of fats, albumin, and starch or flour with coloring
matter. They are used in making custards and puddings.
A substitute made from skimmed milk, said to contain
the casein and albumin mixed with flour, is sold in the
form of a paste or powder. This is often used by bakers
and confectioners and is rich in proteid.
PROTEID FOODS 83
Danger from Eating Eggs. — There are some persons who
are always made ill from eating eggs. Such idiosyncrasy
is due to the production of poisonous substances during
the process of digestion. Overeating of eggs, as with other
foods, may induce indigestion. Eggs may be the means
of introducing harmful bacteria or parasites into the body.
An egg may be infected with disease-producing bacteria
either before or after it is laid, when, if eaten raw, the
germs will be communicated to man and cause disease.
If the hen's feet or feathers have become contaminated
with typhoid germs, for instance, they may gain access to
the egg if it be allowed to remain in a dirty nest, and so
spread disease. Few cases have ever been reported of
infection carried by eggs, but many persons have been
made ill by eating stale eggs, such illness resembling
ptomain poisoning, which is caused by waste products
produced by the bacteria and not by the bacteria them-
selves.
CHAPTER V.
PROTEID FOODS (Continued). MEATS. FISH.
MEATS.
The value of meats as food depends upon the
proteid and fat which they contain. The proteid is used
for building and repairing the tissues, while both are
utilized for the development of energy and the mainte-
nance of temperature. Meats are in substance and com-
position so nearly like the tissues of the human body
which they are intended to supply that they have to be
but little altered in order to be appropriated; in other
words, they are more readily digested than vegetable
foods.
Meats consist of the muscle tissue, or "lean," and vary-
ing amounts of fat. Besides the fat which is seen in
masses, minute invisible particles are distributed through-
out the lean of meat.
The lean part of meat of all kinds has practically the
same structure. It is composed of prism-shaped bundles,
which, if subdivided, will be found to be formed of numer-
ous muscle fibres bound together by thin layers of con-
nective tissue. These muscle fibres are invisible to the
naked eye. Their walls are composed of a very delicate
elastic membrane of nitrogenous material and are quite
permanent, but, in the living animal, their contents are
continually undergoing change and renewal.
Toughness or tenderness of meat depends upon the
character of the muscle fibres and of the connective tis-
PROTEID FOODS 85
sue which binds them together. In young, well-nourished
animals the walls of the fibres are thin and delicate, and
the connective tissue is small in amount. Hard work or
poor feeding will cause the muscle fibres and connective
tissue to become thick and hard. This is the reason why
young meat is tender and old meat tough.
Flavor and texture of meat are materially affected by
the age of the animal. The flesh of very young animals
is tasteless and watery, while that of old animals is apt to
be tough. The best beef is obtained from oxen from
three to four years of age. A calf should not be killed for
veal under six weeks of age, and it is better to wait ten
weeks. Hogs may be used at any age after six weeks, but
the best product is obtained at the age of eight to twelve
months. Three-year-old sheep make the best mutton.
It is important in slaughtering animals to see that they
are thoroughly bled, as otherwise the meat will have an
unattractive red appearance and will not keep so well.
Composition of Meat. — All meat contains water, fat, pro-
teid, a small amount of salts, and very little if any carbo-
hydrates.
Water. — Meat contains water in varying amount, and
the water thus introduced into the body does not differ in
its effect from water taken as a beverage. It, however,
serves a good purpose in keeping the meat fibre soft, so
that it can be more easily masticated and swallowed.
The greater the percentage of water in any meat the
less will be its relative nutritive value, as it will contain
proportionately less nutritive material. The amount of
water in meat not only varies in different kinds of meat,
but even in different cuts from the same animal. Some
cuts contain as little as 50 per cent, of water, while others
86 FOOD IN HEALTH
contain as high as 75 per cent. As a rule the greater the
amount of fat the less will be the amount of water.
Fat. — All meat, even the lean, contains fat distributed
in minute particles, invisible to the unaided eye, between
the muscle bundles and the muscle fibres. The percentage
of fat varies between enormous extremes, from 0.3 per
cent, in very lean flesh, such as codfish, to 90 per cent, in
fat pork.
Fat is a concentrated food and most useful in supplying
heat. Weight for weight it will furnish about two and one-
half times the amount of heat that can be obtained from
proteid or carbohydrates.
Proteid. — The proteid of meat consists chiefly in
albuminoids and gelatinoids. The albuminoids resemble
the white of egg in their properties, while the gelatinoids
are similar to gelatin and are converted into gelatin by
the action of hot water or steam. The chief value of meats
as food depends upon the albuminoids contained. The
so-called extractives, thus named because they are easily
dissolved out by water, are nitrogenous components of
meat, which are formed by the breaking up of albuminoids
and possibly of gelatinoids. They consist of creatin and
creatinin, substances which resemble theine and caffeine,
which are the stimulant ingredients of tea and coffee.
They are of little value except in that they give flavor to
the meats.
The albuminoids consist of soluble and insoluble albu-
mins, or, in other words, organic and circulating albumins.
The most important of the soluble albumins is myosin.
This undergoes spontaneous coagulation after the death
of the animal, and is further coagulated by cooking. The
proteid of meat forms about 20 per cent, of its weight, or
PROTEID FOODS 87
about five times that of milk. The flesh of fowls contains
more proteid than does beef, while the flesh of fish has less.
Carbohydrates and Salts. — Meat contains only a
minute amount of carbohydrates, a fraction of 1 per cent.,,
which is chiefly composed of glycogen. In some of the
organs, especially the liver, considerable amounts of this
glycogen may be found. Mineral matter occurs chiefly
as the phosphates of potassium, calcium, and magnesium
in a small amount.
Texture of Meats. — Immediately after slaughtering,
meat is soft, juicy, and tender, but in a variable period,
from a few minutes to six or eight hours, it stiffens and
becomes hard and tough. This condition is known as
"rigor mortis," and may last from one to six or seven
days. This change is due to the coagulation of the myosin.
Following rigor mortis the meat again becomes soft and
tender, this change being due to the development of lactic
acid, which softens the connective tissue. Meat is not
good during rigor mortis, and should be cooked before
this occurs, which is generally inconvenient, or else kept
until rigor mortis has passed off.
Flavor of Meats. — The flavor depends upon the nitrog-
enous extractives which the meat contains. Pork and
mutton are deficient in extractives, and their flavor de-
pends largely on the fat. Birds and game are rich in
extractives, which accounts for their high flavor. As a
rule male animals produce more highly flavored meat
than the females, the gander, however, being an exception
to this rule. The flesh will be more tender, better devel-
oped, and more delicately flavored after castration and
spaying. The age and food markedly affect the flavor
of meats, certain foods giving an unpleasant flavor. Meat,
88 FOOD IN HEALTH
which is allowed to hang and ripen, during the early stages
of decomposition develops compounds similar to the ni-
trogenous extractives, which add to the flavor of the meat.
The flavor of game is greatly increased by decomposition
changes, which are often allowed to go so far as to be
offensive. All the animal foods used in civilized countries
is derived from vegetable-fed animals, the flesh of car-
nivorous animals being strong and unpleasant. This is
true also of animals and birds that feed on fish. The
flesh of male animals killed during the breeding season
has a gross, unpleasant flavor.
Digestibility of Meat. — Flesh of all kinds, whether raw
or cooked, is very completely digested by healthy persons.
Where a reasonable amount is taken and excess avoided,
nearly all of the proteid and about 95 per cent, of the fats
are digested by the average man. Roasted meat is more
completely digested than either raw or boiled meat, but
raw meat is more easily digested than cooked meat — i. e.,
the gastric digestion is completed sooner. White meats
are usually more tender and contain less fat than other
meats, and are more easily and rapidly digested in the
stomach. Fat meats take longer to pass from the stomach,
probably because the particles of fat coat the proteid,
thus retarding the action of the gastric juice. As a rule,
the finer the fibre of the meat the more readily it will be
digested.
Beef. — As has been stated, the composition of beef
varies with the feeding of the animals, their age, and the
cut used. Lean beef will contain about 70 to 75 per cent,
of water, 20 per cent, of proteid, and 2 or 3 per cent, of fat ;
but if the ox be very fat when killed, the percentage of fat
may rise as high as 25 per cent., while the water and
PROTEID FOODS
89
proteid will be proportionately reduced. Beef fat is com-
posed of stearic, palmitic, and oleic acids in the propor-
tion of three of stearic and palmitic to one of oleic. 'It
melts at 40° to 50° C.
Fresh beef can be eaten continuously longer than any
other meat. The .best quality of meat includes rump,
sirloin, and fore ribs; the second quality a portion of
shoulder, buttock, and middle ribs; the third quality
Diagram of cuts of beef.
flank, shoulder, and brisket; the fourth, neck and shin.
The flank is usually boiled or braised; the loin is com-
monly cut into steaks, though it may be roasted. The
first steaks from the loin, just in front of the hip-joint, are
called sirloin steaks. The next cut from the loin are
called the porterhouse steaks, which should contain both
the sirloin muscle above the spinous processes and the
tenderloin muscle below. These are often erroneously
90 FOOD IN HEALTH
called tenderloin steaks. The tenderloin is the muscle
beneath the loin; this tenderloin muscle when stripped
out is used for fillet. The rump is good for pot roast or
boiling. The round of beef is usually cut into steaks or
may be roasted. The ribs are generally roasted. The
shoulder is used for boiling, corning, or mincemeat, other
parts for stews, and the shank and neck for soup stock,
sausage, etc.
Veal. — If the calf is killed too young the veal will be
insipid and watery and unfit for use. Opinions vary as
to the digestibility of veal. In America, as in Great
Britain, it has been considered less nutritive and digesti-
ble than beef, but in Germany it is considered a more
digestible food for feeble stomachs than beef. Veal con-
tains more gelatin and more water, but less fat and pro-
teid than beef.
Mutton. — In England mutton is considered a more
digestible meat than beef, but the opposite opinion is
generally held in America. Though the fibre of mutton
is finer and shorter than that of beef, it contains propor-
tionately more fat, which makes it harder to digest.
When digested, the nutritive value of mutton is about
equal to that of beef. Lean mutton contains about 75
per cent, water, 18 per cent, albuminoids, and 7 to 8 per
cent, of fat. The fat of mutton contains a larger percentage
of stearic acid than beef fat, which makes it firmer and
more difficult to digest.
Lamb. — Lamb, when of the first quality, is about as
easily digested as beef or mutton, but it is difficult to
obtain it in the right condition, and it contains far too
much fat, more than veal. On account of this large fat
percentage it is apt to be difficult of digestion.
PROTEID FOODS 91
Venison. — The composition of venison is approxi-
mately that of beef, being 74.5 per cent, water, 19.25 per
cent, proteid, and 1.3 per cent, of fat. It is short fibred,
and, when tender and obtained from young deer, is very
digestible and palatable. It is stimulating to the stomach,
however, and its gamy flavor makes it unfit for persons
of weak digestion.
Pork. — The meat of pork has tender fibres and a
pleasant flavor, but it is notoriously indigestible on ac-
count of the very high percentage of fat which it contains,
the fat even exceeding the amount of proteid. An approx-
imate analysis of lean pork gives water 72.57 per cent.,
proteid 19.91 per cent., and fat 6.81 per cent., while that
of fat pork gives water 47.40 per cent., proteid 14.54 per
cent., and fat 37.34 per cent.
Bacon. — Bacon is more digestible than the fat of fresh
pork. It contains only a small proportion of water. When
cut thin and cooked crisp, bacon is friable and freely
broken up in the stomach. It is usually a wholesome
form of fat, even for dyspeptics.
Ham. — Ham is very generally used in invalid dietaries
in Germany, where it is extolled for its digestibility, both
cooked and raw. Such views are not held in America.
If the ham has been well cured and thoroughly boiled
and is eaten cold, it is a fairly digestible food, but hot ham
or twice cooked, fried, for example, is very indigestible.
Besides the flesh of animals various viscera and other
parts are used as food, such as bones for soup.
Sweetbread. — True sweetbread is formed of the
thymus gland of the calf, but the pancreas is often sub-
stituted for it in the market. Sweetbread is tender,
pleasant flavored, and easily digested, but the pancreas
92 FOOD IN HEALTH
is much less digestible. The pancreas can usually be
recognized by its coarse bloodvessels. Sweetbread, while
useful in many conditions, is largely productive of uric
acid.
Brain. — This is of soft consistence and nutritious. It
contains a large percentage of fat, however, which makes
it difficult to digest by delicate stomachs.
Blood. — It was at one time supposed that fresh blood
had special advantage as a food for persons suffering
from wasting diseases, and such would be sent to the
abattoir to drink the blood warm from the slaughter.
This practice did not meet with the expectations of those
who adopted it. Besides being repulsive and of un-
pleasant taste, it is a question whether blood is not diffi-
cult of digestion. The blood of pigs mixed with fat and
farinaceous foods, like rice, is used as food under the
name of blood pudding.
Liver. — The livers of the calf, pig, and lamb are largely
used as food. Liver is of close texture and contains a
large percentage of fat, and is therefore rather indigestible,
though nutritious when digested. Composition of calves'
liver is given as follows: water, 72.33 per cent.; proteid,
20.10 per cent.; fat, 5.58 per cent.; carbohydrates, 0.45
per cent.; and salts 1.54 percent. If liver is cooked too
long it will become hard and tough and unfit for use.
Kidneys are of close, firm texture, and, like liver,
become hard and tough when much cooked. They are
fairly nutritious, but more difficult of digestion than
liver.
Heart. — The heart is the same composition chemically
as other muscular structures, but is of close texture,
which makes it difficult to digest.
PROTMID FOODS 93
Tripe. — Tripe is made from the third stomach of the
cow. It is composed of involuntary muscle fibre, which
is very tender and easy of digestion, but it contains a
large proportion of fat which makes it rich and interferes
with its digestion. Its approximate composition is : water,
68 per cent.; proteid, 13.2 per cent.; fat, 16.4 per cent.;
and salts, 2.4 per cent.
Poultry and Game Birds. — By the term "poultry"
is meant birds domesticated for food purposes. Game
birds are those which are reared wild and used for food.
Chickens, guinea-fowls, pheasants, and quail belong
to the same natural order, and resemble each other
in their structure and habits. They differ from other
birds in that the color of the flesh of the breast and
wings is lighter than that of other parts of the body.
Ducks, geese, and swans (swimming birds) have webbed
feet; long, thick bills, and dark flesh. Pigeons stand mid-
way between the other two groups in the difference in the
color of their breasts and other flesh.
Varieties of Poultry. — Chickens were originally native
in Southwestern Asia. The best breeds for table pur-
poses are the light and dark Brahmas; buff, partridge,
white, and black Cochins, and black and white Langshans.
Good chickens should have a large proportion of flesh
relative to the size of the bone, with large, full breast.
Chickens with long, thin legs and wings have too little
meat relative to the bone. Old cocks are too tough and
highly flavored to be good. Capons make the best meat,
being very tender, well developed, and having a large
proportion of white meat.
Turkeys are natives of North America. Occasional
introduction of wild blood in a flock improves the flavor.
94 FOOD IN HEALTH
Young turkeys do not make as good food as the full-
grown bird because they are scrawny and tough.
Guinea-fowls were natives of Africa. They are more
used for eggs than for meat, but the young birds and
capons are tender, with a partridge-tike flavor, while the
older birds are more tike pheasants in taste.
Pea-fowls were once popular as a food, but are very
little used now for table purposes, and are bred chiefly
for ornamental birds. They have a large amount of
flesh in proportion to their bones.
Pheasants originated in Asia. They are game birds
and are considered a great delicacy. The flesh is tender,
but has little taste until kept for some time. They should
be killed in their first year. The hens are better than the
cocks. Many of those now in our markets have been sent
from Europe in cold storage.
Quail, frequently called partridges, are delicate and
well flavored. Though they are still chiefly game birds,
the industry of taming and raising quails for market is
growing.
Pigeons. — The flesh of pigeons rapidly toughens after
they begin to fly; hence the young birds, called squabs,
are usually preferred. They should be killed at about
four weeks of age, after they have grown plump and
before leaving the nest to fly. They can be procured
throughout the year.
Ducks. — The domestic birds are derived from the
wild Mallard and are extensively raised in America now
for table purposes. Some breeds mature early and are
known as spring ducks, the young being ready for market
as early as May. Old ducks can be obtained in any
season, but are best in the winter.
PROTEID FOODS 95
Geese are used throughout the world for food. They
are more popular in Germany than in other countries.
They live to great age, but are best for table purposes if
killed when three years old at latest. As they grow
older the flesh becomes tough and loses its pleasant
flavor. "Green geese," half-grown birds, can be had
from May until early winter; the old birds all the
year.
Swans in olden times were a common food, but are
now chiefly bred as ornamental birds. The young birds,
called cygnets, are still eaten in England. The flesh is
too highly flavored for most tastes.
Choice of Poultry. — In selecting poultry care should be
taken to get young birds which are fresh. Though in cer-
tain sections and in smaller towns live poultry is still
offered in the markets, the marketing of dressed poultry
is more common and the practice is growing. A good
fresh bird shows a well-rounded form, with neat, compact
legs; the breast bone is not angular; the skin should be
clear and free from blotches and pin feathers. If the skin
looks drawn and tight the bird has probably been scalded
before picking. This practice of scalding makes the
picking easier, but the birds do not keep as well. Dry-
picked birds are to be preferred. The flesh should be
firm and yield evenly to pressure, and it should be neither
flabby nor stiff.
If the bird is fresh, the feet will be moist, soft, and
limber, and the eyes bright and full. Hard, dry feet and
shrunken eyes are characteristic of stale birds, while dark
greenish spots on the body indicate decomposition. Birds
kept in cold storage are usually packed so closely that the
wings and legs remain pressed on the body. This squeezed
96 FOOD IN HEALTH
look is the means of distinguishing between cold-storage
birds and fresh.
The age of the bird may be told in several ways. In a
young bird the tip of the breast bone, farthest from the
head, is easily flexible, but will be brittle in older birds.
Sometimes the end of the bone is purposely broken before
marketing in order to deceive. The feet of young birds
are soft and smooth, but become hard and rough as they
grow older. The claws are sharp and short in young
birds, but long and blunt in old ones. The spur above
the foot is hardly apparent in the young bird; at a few
months it is long, but straight, while in old birds it is still
larger, but crooked at the end.
The feet of turkeys up to a year old are usually black.
They grow pink up to three years old and then turn gray.
The flesh of squabs looks white through the skin, but as
the bird grows older it becomes purplish. Old pigeons
usually have red feet.
In ducks and geese the windpipe is flexible in the young,
and may be squeezed and moved easily, but it becomes
rigid and fixed with age.
In young poultry the tips of quills at end of wing are
sharply pointed, becoming blunt as the bird grows older.
Cooking of Poultry. — Poultry is cooked by any of the
general methods described in Chapter III. For large
birds, such as grown chickens, turkeys, etc., roasting and
boiling are used, while for smaller birds, such as squabs
and quail, broiling is usually better. The loss in cooking
poultry is considerably less than that in cooking meats,
as the poultry is cooked in its own skin, which prevents
the escape of nutritive juices, while with meat large areas
of raw surface permit them to escape.
PROTEID FOODS 97
As with other foods, if cooked too long, poultry will be
dried up and less digestible, and the same general rule as
to the degree of heat required obtains, namely, the smaller
the piece the greater the heat and shorter the time. As
to the time required, an old rule of cook books for boiling
and stewing is "an hour for each year of the bird's age
and one for the pot;" of course, the larger the bird the
longer the time of cooking. A general rule for roasting
chickens and turkeys is. twenty minutes to the pound.
Ducks and game, being tougher, require a little longer
time.
Potted and Canned Poultry. — Before poultry is canned
it is first cooked in much the same way as when it
is immediately served. It is then sterilized after placing
in the cans, and the cans are immediately sealed. If
sterilization has been thorough, canned poultry keeps ■
well and is a good food, but imperfect sterilization will
lead to decomposition. There is some danger in all
canned goods of poisoning from bad tin and solder, but
this is not so great with meat as with canned vegetables,
which are acid.
Composition of Poultry. — The waste of poultry depends
largely upon the person using it, since parts utilized by
some persons, as the feet, comb, etc., will be discarded by
others. Recent experiments with chickens show the pro-
portion of edible portions and waste to be as follows:
dressed and drawn carcass, 66.4 per cent.; giblets 5.5 per
cent.; head and feet, 11.2 per cent.; feathers, 8.3 per cent.;
entrails, 8.5 per cent. Poultry contains the nutrients
common to flesh foods and in proportions not greatly
differing from other animal foods.
98
FOOD IN HEALTH
Table V. — Average Composition of Poultry and Poultry
Products.
i
• %
.CO
a .
Kind of food.
3
'53
a
w
<
%
3 a
— •^ p.
2j S u
iS o o>
Hup.
CHICKENS.
Young :
As purchased
Edible portion . ■ .
%
%
%
%
%
Calo-
ries.
18.8
55.5
17.8
7.2
0.9
765
68.4
21.9
8.9
1.1
945
Meat, not including giblets
66.9
22.6
10.1
1.1
1000
Dark meat .
70.1
20.8
8.2
1.2
850
Light meat.
Giblets ...
70.3
21.9
7.4
1.1
835
71.0
19.8
6.4
1.3
810
Visible fat removed
74.5
21.8
2.5
1.1
665
Liver .
69.3
22.4
4.2
2.4
1.7
800
Heart
72.0
20.7
5.5
1.4
770
Gizzard
72.5
24.7
1.4
1.4
695
Broiler :
As purchased
Edible portion ....
29.1
51.2
15.5
3.3
0.8
540
69.7
20.7
8.3
1.1
890
Meat, not including giblets
69.2
21.1
8.8
1.1
880
Giblets
72.8
18.7
6.1
1.3
730
Capon :
As purchased
Edible portion ....
17.5
46.8
17.7
17.5
1.0
1205
56.7
21.5
21.2
1.2
1465
Meat, not including giblets
55.8
21.6
22.1
1.2
1460
Giblets
Other :
As purchased ....
63.3
20.5
14.6
1.3
1155
25.2
47.3
14.4
12.6
0.7
910
Edible portion ....
59.5
20.4
19.2
1.1
1350
Meat, not including giblets
63.4
19.4
16.6
1.0
1215
Giblets
64.7
18.7
13.7
1.3
1070
OTHER FOWL.
Turkey :
As purchased
Edible portion .
14.3
49.2
19.0
16.2
1.0
1185
57.4
22.2
18.9
1.2
1385
Dark meat .
57.0
21.4
20.6
1.1
1435
Light meat.
Giblets
63.9
25.7
9.4
1.3
1065
56.7
17.7
23.5
1.2
1480
Dark meat, cooked
53.7
39.2
4.3
2.2
1200
Light meat, cooked .
58.5
34.6
4.9
1.8
1090
Young, as purchased .
Young, edible portion
32.4
44.7
16.8
5.9
0.9
685
66.1
24.9
8.7
1.3
1015
Cooked
52.0
27.8
18.4
1.2
1505
Heart . . . .
68.6
16.8
13.2
1.0
1000
Liver
69.6
22.9
5.2
6.6
1.7
820
Gizzard ....
Duck :
62.7
20.5
14.5
1.2
1.1
1170
As purchased ....
15.9
51.4
15.4
16.0
1.1
1085
Edible portion .
61.1
18.3
19.0
1.3
1290
Meat, not including breast or
giblets
55.5
17.4
26.1
1.0
1540
Breast
73.9
22.3
2.3
1.3
685
Giblets
73.2
17.9
5.0
1.8
720
Duckling:
As purchased ....
16.2
43.3
12.0
28.0
0.7
1515
Edible portion .
51.7
14.3
33.4
0.9
1805
Meat, not including giblets
48.3
13.5
37.9
0.7
1950
Giblets
70.2
18.9
8.1
1.6
835
Green goose :
As purchased
Edible portion .
12.2
41.9
13.6
31.6
0.8
1710
48.2
15.1
36.0
0.9
1940
Meat, not including giblets
46.0
15.0
38.3
0.8
2030
Giblets ....
68.7
22.3
7.3
1.4
995
PROTEID FOODS
99
Average Composition of Poultry, etc. (Continued).
Kind of food.
03
W
<2
OJ
M
oj
"3
2
%
GO
i £
O U
a *-
03 rt
a
GO
a .
lis
M 3 ft
other fowl (continued).
Goose :
%
%
%
%
%
Calo-
ries.
Aspurohased
11.1
48.0
14.8
25.5
1.0
1475
Edible portion .
54.0
16.6
28.7
1.1
1660
Meat, not including giblets
51.8
16.2
31.5
1.0
1755
Giblets
70.0
20.1
8.2
1.7
910
Gizzard
73.8
19.6
5.8
1.0
750
Liver .
62.6
16.6
15.9
3~7
1.2
1175
Pigeon :
As purchased
Edible portion .
13.6
55.2
19.7
9.5
1.3
915
64.0
22.8
11.0
1.5
1060
Meat, not including giblets
63.2
22.9
12.1
1.4
1100
Giblets
68.1
22.2
5.2
2.3
845
Squabs :
As purchased
15.6
49.0
15.7
18.6
1.3
1205
Edible portion .
58.0
18.6
22.1
1.5
1430
Meat, not including giblets
56.6
18.5
23.8
1.4
1470
Giblets ...
69.8
19.8
7.2
2.0
835
Guinea hen :
As purchased
16.4
57.7
19.4
5.4
1.1
730
Edible portion
69.1
23.1
6.5
1.3
870
Meat, not including giblets
68.9
23.4
6.5
1.3
865
Giblets
69.9
20.8
7.1
1.3
855
Pheasant :
As purchased
Edible portion .
12.0
61.5
21.5
4.2
1.0
730
69.9
24.4
4.8
1.1
830
Meat, not including giblets
70.0
24.7
4.6
1.1
815
Giblets
68.9
20.1
7.2
1.6
880
Russian pheasant :
As purchased
14.1
61.1
21.5
1.9
1.2
635
Edible portion .
71.1
25.0
2.3
1.4
740
Meat, not including giblets
70.6
25.7
2.3
1.4
730
Giblets
74.4
21.2
2.2
1.3
665
Quail :
As purchased
10.5
59.0
22.3
6.1
1.4
835
Edible portion .
65.9
25.0
6.8
1.6
935
Meat, not including giblets
66.3
25.4
7.0
1.4
945
Giblets
63.0
21.8
6.2
2.3
970
PRESERVED POULTRY MEAT.
Smoked goose breast (including skin
and fat)
35.7
20.1
38.7
5.5
2210
Smoked goose breast (skin and outer
fat removed) . ...
61.3
26.1
4.4
8.0
845
Potted turkey ...
56.0
17.2
22.0
3.0
1390
Potted chicken.
56.1
19.4
20.3
2.5
1390
Canned chicken soup
87.1
2.9
3.3
s!i
1.6
300
Canned chicken gumbo soup
91.0
2.4
0.2
4.8
1.6
160
Canned boned chicken
57.6
27.7
12.8
2.2
1245
Cauned sandwich chicken
46.9
20.8
30.0
2.6
1825
Canned sandwich turkey.
47.4
20.7
29.2
2.7
1790
Canned quail .
66.9
21.8
8.0
l"7
1.6
935
Terrine de foie gras
41.3
13.6
38.2
4.3
2.6
2075
100 FOOD IN HEALTH
Digestibility of Poultry. — Poultry, like other animal
foods, is very thoroughly digested. A large number of
experiments show the average digestibility to be : proteid, 97
per cent. ; fat, 95 per cent. ; and carbohydrates, 98 per cent.
Nutrient Value. — Poultry contains less water than beef,
but more than eggs or cheese; usually more fat than milk
or eggs, but less than butter, lard, etc.
As regards different kinds of poultry, birds with light-
colored flesh are richer in proteid and poorer in fat than
the others. In light-fleshed varieties young birds yield
more proteid and less fat than old ones, while in dark-
fleshed birds the reverse is true. As a rule young birds
contain less refuse, or, in other words, the proportion of
their flesh to bone is greater than in old ones.
Concerning the comparative value of white meats and
red meats opinions differ, some authorities considering
the white meats more readily digestible, while others
make no distinction.
As to the relative nutritive value of light and dark meat
from the same bird it is probable that the difference is
insignificant except for persons of very feeble digestion.
The white meat contains less fat than the dark, and so
may be better digested by delicate stomachs, but experi-
ments made of late with normal persons failed to show
any difference between the two.
With regard to the use of poultry in dietaries the purse
must usually decide. Cheap chickens in city markets are
about as good for food and about the same cost as the
less desirable cuts of meats, but chickens and turkeys of
good quality are quite as expensive as the choice cuts of
meat. Game birds are luxuries and can only be afforded
by the well-to-do.
PROTEID FOODS 101
FISH.
Fish form a large part of food for man. Fresh-water
and salt-water fish are equally wholesome, and prefer-
ence of one over the other is a matter of individual taste.
The value of fish depends upon many conditions, but
all fish are better when eaten in season, as their food
supply at other times does not make as palatable meat.
Fish from cold, deep waters or from rocky or sandy bot-
toms are much better than those from warm, shallow
waters or muddy bottoms. All fish are best just before
spawning, as after spawning they lose fat and become
poor and flabby. Young fish, which have not reached
the spawning age, may be eaten at any time.
The manner of capture affects the quality of fish.
When caught in the gills by nets and allowed to die slowly
the quality of their meat is inferior and they undergo
decomposition easily. Fish should be eaten as soon after
capture as possible, and are best when killed immediately
on landing. The practice of shipping fish long distances
in cold storage or on ice, while usually safe when properly
done, may lead to trouble, as the cold prevents evidence of
decomposition which may have begun to a dangerous
extent.
Composition and Digestibility of Fish. — The composition
of the meat of fish is very similar to that of animal meats.
It varies greatly with the varieties, as also with different
specimens of the same variety. The chief variation is in
the amount of fat contained. Those containing a large
percentage of fat have less water and usually slightly less
proteid. The total digestibility of fish is about equal to
that of lean meat, 97 per cent, of the proteid and over 90
102 FOOD IN HEALTH
per cent, of the fat being retained by the body. Salt fish
is less thoroughly digested than fresh fish. As to the rate
of digestion of fish as compared to that of meat there seems
to be still some uncertainty. Experiments made by the
U. S. Department of Agriculture seem to show that fish
is less quickly digested than beef, though Yeo states that
it is more quickly digested, which explains the fact that
fish is less satisfying as well as less stimulating than
meats. Fish containing a high percentage of fat are more
difficult of digestion than lean fish. Fish may be divided
for convenience into three classes, based on their contents
of fat. The first class, containing over 5 per cent, of fat,
includes salmon, shad, herring, Spanish mackerel, and
butter fish; the second, containing from 2 to 5 per cent, of
fat, includes white fish, mackerel, mullet, halibut, and
porgy; the third class, containing less than 2 per cent, of
fat, includes smelt, black bass, blue fish, white perch,
weak fish, brook trout, hake, flounder, yellow perch, pike,
pickerel, sea bass, cod, and haddock.
PROTEID FOODS
103
Table VI.— Composition of Fish, Molltjsks, Crustaceans, etc.
Kind of food material.
FRESH FISH.
Alewife, whole
Bass, large-mouthed black,
...... large-mouthed black,
whole
Bass, small-mouthed black,
dressed ....
Bass, small-mouthed black,
whole.
Bass, sea, dressed .
Bass, sea, whole .
Bass, striped, dressed
Blacklist! , dressed.
Blue fish, dressed .
Butterflsh, dressed
Butterfish, whole .
Carp (European analysis)
Cod, dressed .
Cod, steaks .
disk, dressed
Eel, saltwater, dressed .
Flounder, common, dressed .
Flounder, winter, dressed .
Hake, dressed
Haddock, dressed .
Halibut, dressed .
Herring, whole
Mackerel, dressed.
Mackerel, Spanish, dressed .
Mackerel, Spanish, whole
Mullet, dressed
Mullet, whole
Perch, white, dressed .
Perch, white, whole
Perch, yellow, dressed .
Pickerel, dressed
Pickerel, whole
Pike, dressed .
Pike, whole .
Pollock, dressed .
Pompano, dressed
Porgy, dressed
Porgy, whole.
Bed grouper, dressed
Red snapper, dressed .
Salmon, California (sections)
Salmon, Maine, dressed
Shad, dressed
Shad, whole .
Shad, roe
Smelt, whole
Sturgeon, dressed .
Tomcod, dressed .
Tomcod, whole .
Trout, brook, dressed .
Trout, brook, whole
Trout, lake, dressed
Turbot, dressed
Turbot, whole
aSSS
00
Q)
I
s
s
•4J
■
a a
a
%
%
%
%
%
%
%
%
49.5
37.5
9.7
2.5
0.8
13.0
46.7
41.9
10.3
0.5
0.6
11.4
S6.0
34.6
8.5
0.4
0.5
9.4
46.4
40.1
11.5
1.3
0.7
13.5
53.6
34.7
10.0
1.1
0.6
11.7
46.8
42.2
10.1
0.2
0.7
11.0
56.1
34.8
8.3
0.2
0.6
9.1
51.2
37.4
8.7
2.2
0.5
11.4
55.7
35.0
8.3
0.5
0.5
9.3
48.6
40.3
9.8
0.6
0.7
11.1
34.6
45.8
11.7
7.2
0.7
19.6
42.8
40.1
10.2
6.3
0.6
17.1
37.1
48.4
12.9
0.7
0.9
14.5
29.9
58.5
10.6
0.2
0.8
11.6
9.2
72.4
16.9
0.5
1.0
18.4
40.3
49.0
10.1
0.1
0.5
10.7
20.2
57.2
14.6
7.2
0.8
22.6
57.0
35.8
6.3
0.3
0.6
7.2
56.2
37.0
6.1
0.2
0.5
6.8
52.5
39.5
7.2
0.3
0.5
8.0
51.0
40.0
8.2
0.2
0.6
9.0
17.7
61.9
15.1
4.4
0.9
20.4
46.0
37.3
10.0
5.9
0.8
16.7
40.7
43.7
11.4
3.5
0.7
15.6
24.4
51.4
15.8
7.2
1.2
24.2
34.6
44.5
13.7
6.2
1.0
20.9
49.0
38.2
9.8
2.4
0.6
12.8
57.9
31.5
8.1
2.0
0.5
10.6
54.6
34.4
8.7
1.8
0.5
11.0
62.5
28.4
7.2
1.5
0.4
9.1
35.1
50.7
12.6
0.7
0.9
14.2
35.9
51.1
11.9
0.2
0.9
13.0
47.1
42.2
9.8
0.2
0.7
10.7
30.5
55.4
13.0
0.4
0.7
14.1
42.7
45.7
10.7
0.3
0.6
11.-6
28.5
54.3
15.5
0.6
1.1
17.2
45.5
39.5
10.2
4.3
0.5
15.0
53.7
34.6
8.6
2.4
0.7
11.7
60.0
29.9
7.4
2.1
0.6
10.1
55.9
35.0
8.4
0.2
0.5
9.1
48.9
40.3
9.6
0.6
0.6
10.8
5.2
60.3
16.5
17.0
1.0
34.5
23.8
51.2
14.6
9.5
0.9
25.0
43.9
39.6
10.3
5.4
0.8
16.5
50.1
35.2
9.2
4.8
0.7
14.7
71.2
23.4
3.8
1.6
28.8
ii.9
46.1
10.0
1.0
1.0
12.0
14.4
67.4
15.4
1.6
1.2
18.2
51.4
39.6
8.2
0.3
0.5
9.0
59.9
32.7
6.8
0.2
0.4
7.4
37.9
48.4
11.7
1.3
0.7
13.7
48.1
40.4
9.8
1.1
0.6
11.5
35.2
45.0
12.4
6.6
0.8
19.8
39.5
43.1
7.9
8.7
0.8
17.4
47.7
37.3
6.8
7.5
0.7
15.0
230
195
160
255
175
205
520
455
270
205
335
190
575
130
120
145
160
465
435
360
595
515
285
235
235
195
265
230
190
260
210
315
370
260
225
165
205
1025
675
420
375
595
230
355
165
135
275
230
510
515
440
104
FOOD IN HEALTH
Composition of Fish,
Mollusks, Crustaceans, etc (Continued).
a
3
03 .
'O
•S.i
.-8
■gS -
3
a
.0)
s a
Kind of food material.
GQ
is
I
+5
85
a =
31
fkesh fish (continued).
%
%
%
%
%
%
%
%
Calo-
ries.
Weak fish, dressed.
41.7
46.1
10.2
1.3
0.7
12.2
245
Weakfish, whole .
51.9
38.0
8.4
1.1
0.6
10.1
200
Whitefish, dressed.
43.6
39.4
12.5
3.6
0.9
17.0
1385
Whiteflsh, whole .
S3.5
32.5
10.3
3.0
0.7
14.0
320
General average of fresh fish
as sold
42.0
44.0
10.5
2.5
1.0
14.0
300
PRESERVED FISH.
Mackerel, " No. 1," salted .
33.3
7.1
28.1
14.7
15.1
1.7
31.5
910
Cod, salted and dried .
24.9
17.2
40.3
16.0
0.4
1.2
17.6
315
Cod, "boneless codfish," salted
and dried .
21.5
54.4
22.1
0.3
1.7
24.1
425
Caviare
38.1
30.0
19.7
7.6
4.6
61.9
1530
Herring, salted, smoked, and
dried ...
44.4
6.5
19.2
20.2
8.8
0.9
29.9
45
Haddock, " findon baddie,"
salted, smoked, and dried
32.2
1.4
49.2
16.1
0.1
1.0
17.2
305
Halibut, salted, smoked, and
dried
6.9
12.1
46.0
19.1
14.0
1.9
35.0
945
Sardines, canned .
5.0
53.6
24.0
12.1
5.3
41.4
955
Salmon, canned .
3.9
i'.o
59.3
19.3
15.3
1.2
35.8
1005
Mackerel, canned .
1.9
68.2
19.9
8.7
1.3
29.9
735
Mackerel, salt, canned .
19.7
8.3
34.8
13.8
21.3
2.1
37.2
1155
Tunny (horse-mackerel), can-
ned
72.7
21.5
4.1
1.7
27.3
575
Haddock, smoked, canned .
£6
68.7
21.8
2.3
1.6
25.7
505
MOLLUSKS.
Oysters, solids
88.3
6.1
1.4
3.3
0.9
11.7
235
Oysters, in shell .
82.3
15.4
1.1
0.2
0.6
0.4
2.3-
40
Oysters, canned .
85.3
7.4
2.1
3.9
1.3
14.7
300
Scallops.
80.3
14.7
0.2
3.4
1.4
19.7
345
Long clams, in shell
43.6
48.4
4.8
0.6
1.1
1.5
8.0
135
Long clams, canned
84.5
9.0
1.3
2.9
2.3
15.5
275
Round clams, removed from
shell
80.8
10.6
1.1
5.2
2.3
19.2
340
Round clams, in shell .
68.3
27.3
2.1
0.1
1.3
0.9
4.4
65
Round clams, canned .
83.0
10.4
0.8
3.0
2.8
17.0
285
Mussels'
49.3
42.7
4.4
0.5
2.1
1.0
8.0
140
General average of mollusks
exclusive of canned .
60.2
34.0
3.2
0.4
1.3
0.9
5.8
100
CRUSTACEANS.
Lobster, in shell .
62.1
31.1
5.5
0.7
0.6
6.8
130
Lobster, canned .
77.8
18.1
1.1
0.6
2.4
22.2
395
Crawfish, in shell .
87^7
10.0
2.0
0.1
0.1
0.1
2.3
45
Crab, in shell
55.8
34.1
7.3
0.9
0.5
1.4
10.1
185
Crab, canned.
80.0
15.8
1.5
0.8
1.9
20.0
370
Shrimp, canned .
70.8
25.4
1.0
0.2
2.6
29.2
520
General average of crusta-
ceans (exclusive of canned)
73.7
20.9
4.3
0.4
0.2
0.5
5.4
100
TERRAPIN, TURTLE, ETC.
Terrapin, in shell .
79.0
15.6
4.5
0.7
0.2
5.4
115
Green turtle, in shell .
76.0
19.1
4.5
0.1
0.3
4.9
90
105
Average of turtle and terrapin
77.5
17.4
4.2
0.7
0.2
5.1
Frogs* legs ....
32.0
57.0
10.2
0.1
0.7
11.0
210
General average of fish, mol-
lusks, crustaceans, etc.
44.0
42.5
10.0
2.5
0.1
0.9
13.5
295
PROTEID FOODS 105
The old theory that fish was especially useful as a brain
food because of the phosphorus contained is now ex-
ploded. As a matter of fact, fish does not contain as much
phosphorus as some meats. It is, however, a good form
of nitrogenous food for persons leading a sedentary life.
Large quantities of fish are dried, salted, or smoked for
preservation. Such curing. modifies their flavor and ren-
ders them less digestible. Fish are also canned, being
first heated and sealed in air-tight tins. When this is done
by modern processes, the original flavor is largely re-
tained, and they usually keep well. Some canned fish
are cooked and canned in their own juices; others, such
as sardines, are canned in oil.
Various kinds of fish extracts and juices are put up and
preserved to be used as relishes; some of them, like
anchovy, in the form of pastes; while others, like clam
juice, are liquid. The use of preservatives, such as sali-
cylate of soda, is harmful if used to any great extent.
The roe of many fish is considered a delicacy. The hard
roe is derived from the female and the soft roe or milt from
the male. The nutritive value of roe is not very high, but
it gives variety and increases appetite. The roes of differ-
ent, fish vary as to digestibility, according to the species
from which they are derived and the manner of preparation.
Thus, shad roe is quite digestible, while caviar, which is a
salted sturgeon roe, much used as an appetizer, is more
difficult of digestion and often retards the digestion of
other foods.
While fish is usually a wholesome food, it must always
be remembered that it cannot be eaten by some persons,
in whom, even when fresh, it produces disturbances of the
alimentary tract, such as nausea, diarrhea, or cramps.
106 FOOD IN HEALTH
In others it invariably causes urticaria, an itching skin
eruption.
Cooking of Fish. — Fish is usually boiled, steamed, fried,
or baked. In cooking there is a loss of weight of from 5
to 30 per cent., which consists chiefly of water. There is
little loss in the fat or proteid. Fish is a frequent ingre-
dient of made dishes, such as chowders, salads, etc.
Shell Fish. — Under this general name are included
oysters, clams, mussels, lobsters, crabs, crawfish, shrimp,
and prawns. Of these, the most important, as it is the
most generally used, is the oyster. This fish is nutritive
and of special value for its delicate flavor. Oysters are
more nearly like milk as to the amount and proportions
of their nutrients than any other common food material.
Roughly speaking, a quart of oysters contains about the
same amount of nutritive substances as a quart of milk or
three-fourths pound of beef or a pound of bread. The
nutritive value of oysters varies with their variety and
with different specimens of the same variety.
Because of the large amount of shell in oysters, the
percentage of refuse is very high as compared with other
food materials; so that they are rather an expensive food
for the nutrients obtainable from them. Their value,
however, is great for the variety which they make in a
diet, and such a variety is often worth as much or more
than actual nutrients.
Oysters decompose readily after being shucked, and
are better in the cold winter months. An old rule that
oysters are good only in the months whose names contain
the letter "R" is a safe rule to follow; but on the sea coast,
where they are served soon after being taken from their
beds, oysters may be eaten the year round.
PROTEID FOODS 107
It is a common custom among oystermen to place
oysters in fresh water for twenty-four to forty-eight hours
before marketing in order to " fatten" them. This proced-
ure is called "floating" or "laying out." Thus treated
the oyster acquires a plumpness which improves its
appearance and increases its size and weight, and of
course adds to its market value. Sometimes the water
used for this purpose is first warmed. This "fattening"
is not, however, a gain in flesh or fat, as the increase
in size and weight is due to the absorption of water. At
the same time, there is a loss of nutrients amounting to
from one-eighth to one-fifth. Oysters may be treated
thus either by placing them in fresh water while in the
shell or by adding fresh water after they have been shucked.
Many persons prefer the flavor of the "fattened" oysters,
even at the cost of loss of nutrient material. It is also
believed that oysters keep better when some of the salts
have thus been removed by "floating." When "floated"
alive — i. e., in the shell — the oyster does not live as long,
the rate of decay increasing rapidly and the life period
being reduced one-half.
Oysters are sometimes marketed which are more or
less green in color, the color being especially prominent
in the gills, from which they are termed in some localities
"green-gill oysters." This color has been attributed to
disease, to parasites, and to copper, but it is due to green
plants on which the oysters have fed, the coloring matter
of which, being soluble in the oyster juices, tinges the
tissues. This coloring matter is harmless, and in Europe
and some localities of America green oysters are prized.
The color may be removed by placing the oyster a few
days in water that is free from these plants.
108 FOOD IN HEALTH
Oysters are very readily digestible, especially the soft
part, which consists chiefly of the liver. The hard, circular
pqrtion is the muscle which holds the two shells together,
and is more difficult to digest. Especially is this true after
cooking, as the coagulation produced by heat makes this
muscle or "heart," as it is called, tough and indigestible.
This should always be removed when oysters are admin-
istered to invalids.
Oysters are most digestible when raw. They may be
cooked by stewing, broiling, or steaming, and if not over-
cooked they are very digestible when thus prepared.
Fried oysters, while popular, are far less digestible and
should never be given to persons of delicate digestion.
Clams are a popular sea food, but not nearly so exten-
sively used as oysters. In nutrients they do not differ
materially from oysters, but the flesh is tougher. Their
flavor is agreeable and they are much used for making
broths. Both clams and oysters are forbidden diabetics
on account of the glycogen contained in their fivers.
Clam juice, either freshly prepared or bottled, is mildly
stimulating to the stomach, slightly nutritive, and laxa-
tive. In some forms of vomiting it is almost a specific.
It is now marketed bottled, which is convenient and safe,
as it keeps indefinitely when well prepared.
Mussels are usually cooked in their own liquor, with
the addition of condiments. They are somewhat dan-
gerous between May and September, as severe ptomain
poisoning has frequently been produced by them.
Lobsters, crabs, shrimps, and crawfish contain a
fairly large percentage of nutrients. Except in their
native places these foods must be looked on as a delicacy.
Though nutritious foods with pleasant flavors, they should
PROTEID FOODS 109
never be given to invalids. Their meat is good, but they
are scavengers of the sea, and unless great care is taken in
cleaning them there is danger of poisoning.
The lobster is more delicate and more digestible than
the crab. The flesh of the claws is more tender than that
of the tail, which is true also of the crab. Soft-shell crabs
give a large amount of indigestible residue which, unless
the shell be literally soft, is the cause of the illness not
uncommonly produced by this food.
Shrimp are appetizing and stimulating to the stomach,
making a variety and giving pleasant flavor to the diet.
Turtle and terrapin are much used in the United States,
but the supply is relatively small; hence they are expen-
sive delicacies. Analysis shows them to be nutritious
foods, though, as they are usually prepared for the table
with high seasoning, they are apt to be indigestible, and
not infrequently cause derangement of the digestive
functions.
Idiosyncrasy for shell fish is more common than for
any other kinds of fish, and many persons are invariably
made ill by partaking of them.
Frogs, though amphibian, may be mentioned here, as
they have of late years become popular as a delicacy.
The flesh is tender and pleasantly flavored. Only the
hind legs are used, as the flesh on the rest of the body is
scant. When properly cooked frog legs make a pleasant
variety in the diet. Their flavor resembles delicate
chicken.
CHAPTER VI.
PROTEID FOODS {Continued). CEREALS. PEAS, BEANS,
AND LENTILS. PEANUTS.
VEGETABLE PROTEIDS.
CEREALS.
Cereals are found universally the world over, and
their seed have formed a food for man from time
immemorial. They are a condensed food, as a large
amount of nutritive material is held in a small space.
They contain a good percentage of proteid with starch
and cellulose, and variable amounts of gum, sugar, and
fat. They also contain a good percentage of salts, chiefly
in the form of phosphates. All cereals contain a sheath
or coating of cellulose, which must be removed or broken
before the grain is fit food for man, for, though it is
readily digested by many animals, the human gastric
juice cannot digest cellulose. Cereals are prepared for
food by breaking the grain coarsely, and in this form their
use is familiar as cereal breakfast food. The more
important manner of preparation is by grinding to flour
for the purpose of bread-making. The chief cereals are
wheat, barley, oats, rye, corn or maise, and rice.
Wheat. — Of all the cereals used for food, wheat is the
most important, as it is more universally used and most
largely consumed. Wheat grain is a small, oval seed,
covered by a skin consisting of several layers of cellulose,
beneath which is a membrane that forms the real sheath
of the seed proper. Then comes a layer made up of cells
PROTEID FOODS 111
filled with a nitrogenous substance known as cerealin.
These several layers, which form about 13 per cent, of
the weight of the whole grain, constitute the bran. The
larger part of the interior of the seed is called the "endo-
sperm," and consists of irregular cells filled with starch
granules. At the lower end of the seed, adjacent to the
endosperm, lies the germ. When the ripe grain is planted
this germ develops into a new plant, material for its
growth being furnished by the substances of the endo-
sperm until it is sufficiently advanced to draw its nutriment
directly from the earth.
Composition. — Besides cerealin, the bran also contains
quite a large proportion of phosphoric acid and potash,
with smaller amounts of other minerals. The endosperm
contains the cellulose of its cell walls, large quantities of
starch, some sugar, and a good proportion of nitrogenous
material known as gluten. The germ, besides cellulose,
contains nitrogenous substance, sugar, and a large pro-
portion of fat. The amount of water contained by the
grain will vary with atmospheric conditions, as it will take
up water in a damp atmosphere and lose it in a dry
climate. The amount of moisture will vary also with the
character of the season during which the wheat is grown.
On an average, water forms from 12 to 13 per cent, of
the total weight of grain. While the inner layer of bran
is proportionately the richest part of the wheat in nitrog-
enous material, the greatest actual amount of this is
found in the gluten of the endosperm. The amount varies
in different wheats. "Hard" wheats are rich in gluten,
which is strong and tenacious, while "soft" wheats contain
less gluten and more starch. The more gluten contained,
the larger will be the yield of bread for a given amount of
112 FOOD IN HEALTH
flour. Flours containing less gluten have a milder and
more agreeable flavor, however. The most important
part of wheat for flour making is the endosperm, which
contains the gluten and starch. The bran, if left in the
flour, makes it dark, and it is questionable if the cerealin
of the bran is well digested by the human stomach. The
fibrous portion is not only undigested by the human
stomach, but may act as an irritant to the delicate mucous
membrane of the alimentary tract. The germ, if left in
the flour, tends to darken it, though the fat contained is
a valuable food. It is, however, liable to become rancid
and spoil the taste of the flour. The more gluten con-
tained, the more water will the flour take up in making
the dough. Flours are, therefore, classified as "strong"
or "weak" according to the proportion of gluten which
they contain. Gluten ranks as an easily digested proteid,
and therefore has much nutritive value.
The preparation of flour from the grain is accomplished
by milling. The older method is by grinding between
stones. The objection to this method is that the flour is
not so fine, and of necessity contains dust formed from the
substance of the stone as it wears away by attrition. The
modern method of milling is the so-called patent-roller
process. By this method the grain is passed through a
series of steel rollers, each pair being set a little more
closely than the preceding. After each grinding the flour
is sifted and the leavings, called "tailings," are again
ground and sifted.
Flours are made to contain varying portions of the
grain. Graham flour contains the entire grain. After
washing and cleaning, the grain is completely crushed
between stones or rollers. Entire wheat flour or whole
PROTEID FOODS 113
wheat flour, sometimes called "decorticated" flour, is
made similarly, except that the outer fibrous layers of the
bran are first removed, the inner layers containing the
cerealin being retained. The high-grade patent flours are
prepared as entire wheat flours, the products of the
different portions of the grain being removed by successive
rolling and sifting, so that flour may be obtained consist-
ing simply of the endosperm. Straight-grade flours consist
of the sittings of all of the grindings, with the first product
of the first tailings added. "Patent flours" are variations
of the straight-grade flours. Grades are produced as
desired by mixing various flours in the mill, these them-
selves being frequently mixed by bakers and further
varieties obtained.
The usual yield from wheat is about 80 per cent, of
flour, 16 per cent, of bran, and 4 per cent, of loss.
Various complicated tests are used in mills in grading
flours, but simple means of judging are as follows: the
color should be white or faintly tinged with yellow; after
being squeezed in the hand it should fall apart; if it stays
in lumps after squeezing it has too much moisture; when
rubbed between the fingers it should not be too smooth
and powdery, but its individual particles should be
vaguely perceptible; when placed between the teeth it
should "crunch" a little; its taste should be sweet and
nutty, without a suggestion of acidity.
Impurities in flour are produced by the incorpora-
tion of other seed or by blighted or moulded wheat.
The seed which should be especially guarded against
are cockels and darnels, though all foreign seed should
be removed before grinding. Cockels injure the color
of the flour, while darnel is regarded as poisonous.
114 FOOD IN HEALTH
Blighted or moulded wheat will give a musty odor and
taste to the flour. Adulterants are added to flour to
cheapen its cost or improve its appearance. Rye flour,
cornmeal, ricemeal, potato starch, and meal made from
peas and beans are added to cheapen the product. While
these are not injurious, their addition is fraudulent, as
they lessen its nutritive value. Mineral substances, such
as alum, borax, or chalk, are sometimes added to flour
to whiten it. Such adulterations are injurious to health.
Rye. — Rye is in general similar in structure to wheat,
but its outer coating is darker and it makes, therefore,
darker flour. The most important difference between rye
and wheat is in the character of its gluten, which lacks the
elastic, tenacious quality of the gluten of wheat. Conse-
quently bread made from rye flour is heavier and does not
rise as well. Though rye flour contains a larger percentage
of proteid than wheat flour, the consistency of bread made
from it renders it less digestible; hence its nutritive value
is not greater than that of wheat. Bread made from it is
dark in color, and is therefore often spoken of as "black
bread." It is sour-tasting and often disagrees with persons
who are not accustomed to it. It is much used, however,
on the continent of Europe. Rye flour is often mixed
with wheat flour in making bread.
Barley and Oats. — These cereals are rarely used for
bread, as the gluten is even less tenacious than that of rye,
which makes the bread heavy and indigestible. In
structure the grains are very similar to wheat. The
percentage of water in them is less than in wheat, while
the bran forms 21 per cent, of barley and 44 per cent, of
oats. Flours made from them contain a high proportion
of nutritive materials, but the large amount of cellulose
PROTEID FOODS 115
contained renders them indigestible and unsuitable for
bread-making.
Corn or Maize. — The grain, known in America as Indian
corn, but in Europe called maize, is a highly nutritious
grain. Compared with wheat it is richer in fat, poorer in
cellulose and proteid, and nearly equal in carbohydrates
and water. The fat is chiefly contained in the germ,
which is often removed in milling to prevent rancidity.
Cornmeal contains no tenacious proteid like gluten, and
therefore does not make a light loaf with yeast. It is,
however, appetizing in unleavened bread, such as hoe-
cakes. When made up with egg and milk into the so-called
batter-bread, commonly used in the Southern States, it
makes a delicious and digestible food preparation.
Rice. — This grain, though the staple article of diet with
many Eastern peoples, has much less nutritive value than
the preceding. It is relatively poor in proteid, the amount
of which varies from 3 to 7\ per cent. It is also poor in
fats and salts, its chief ingredient being starch, and it
contains very little cellulose; hence as a starchy food it is
readily digestible and of great value. Because of its scant
proteid and fat, it is not suitable as a single food. As
marketed, the husk has been removed with the inner
cuticle or red skin which covers the grain. Used alone,
rice cannot be made into bread, but it is often mixed with
wheat flour or cornmeal in making cakes of various kinds.
Boiling removes some of the proteid and salts; it should
therefore be steamed when cooked alone.
Millet and buckwheat are used in some of the Eastern
countries instead of the cereals preceding. They do not
make good bread, however, but are mixed with wheat
flour and made into cakes, or eaten in the form of porridge.
116
FOOD IN HEALTH
The relative composition of cereals is shown in the
following table:
Table VII. — Composition of Cekeals.
Water.
Proteid.
Fat.
Carbohydrates.
Ash.
Starch,
Crude
etc.
fibre.
%
%
%
%
%
%
Barley.
10.9
12.4
1.8
69.8
2.7
2.4
Buokweat .
12.6
10.0
2.2
64.5
8.7
2.0
Corn (maize)
9.3
9.9
2.8
74.9
1.4
1.5
Kafir corn .
16.8
6.6
3.8
69.5
1.1
2.2
Oats ....
11.0
11.8
5.0
59.7
9.5
3.0
Riee ....
12.4
7.4
0.4
79.2
0.2
0.4
Eye ....
11.6
10.6
1.7
72.0
1.7
1.9
wneau .
Spring varieties .
10.4
12.5
2.2
71.2
1.8
1.9
Winter varieties .
10.5
11.8
2.1
72.0
1.8
1.8
Cereal Breakfast Foods. — A great variety of breakfast
foods are now in the market. Most of them are made
from wheat and oats, though some are prepared from rice,
corn, or barley. Many of the preparations are similar in
appearance, and though their nutritive worth is practically
identical, their prices vary greatly. The utmost variety
occurs in the names used as trade names, but there is very
little difference in the nutritive value of those made from
the same kind of grain. In almost all of them the outer
covering or the husk is first removed, and the remainder
of the seed ground, rolled, or crushed. Some of them are
first partially cooked, usually by steaming; a few are
parched. Though some of them are claimed to be quick-
cooking preparations, most of the cereal foods require
cooking for at least half an hour to ensure digestion of
the starch, and softening of the fibre which is found in
them all to a greater or less degree.
PROTEID FOODS
117
Table VIII.— Composition of Cereal Breakfast Foods.
,
m
CD
•a g^
2
03
'55
o
+3
■esl
5
*
4
£
u
gaS
o
1
Corn:
%
%
%
%
%
%
Flaked (average of 5 analyses) .
10.3
9.6
1.1
78.3
(0.4)
0.7
Hominy (average of 17 analyses) .
11.8
8.3
0.6
79.0
(0.9)
0.3
Parched (average of 2 analyses)
Oats:
Oatmeal (average of 16 analyses) .
S.2
11.5
8.4
72.3
2.6
7.3
16.1
7.2
67.5
(0.9)
1.9
Rolled oats (average of 20 analyses) .
7.7
16.7
7.3
66.2
(1.3)
2.1
Miscellaneous preparations with differ-
ent trade names (avarage of 26 anal-
yses)
7.9
16.3
7.3
66.8
(0.9)
1.7
Rice : Flaked (average of 2 analyses)
Wheat :
Cracked and crushed (average of 11
9.5
7.9
0.4
81.9
(0.2)
0.3
analyses)
10.1
11.1
1.7
75.5
(1.7)
1.6
Flaked (average of 7 analyses) .
8.7
13.4
1.4
74.3
(1.8)
2.2
Germ preparations (average of 10
analyses) ....
10.4
10.5
2.0
76.0
(0.9)
1.1
Gluten preparations (average of 3
analyses)
8.9
13.6
1.7
74.6
(1.3)
1.2
Parched and toasted (average of 6
analyses)
8.6
13.6
2.4
74.5
(0.8)
0.9
Shredded (average of 6 analyses)
8.1
10.5
1.4
77.9
(1.7)
2.1
Cereal foods have a high food value, though the claim
that they are more nutritious than flour is probably
fallacious, as all experiments seem to show that flour
furnishes the greatest amount of proteid at the least cost.
These foods are palatable and wholesome and usually
agree well. They are good for children, but too much
sugar should not be eaten with them as this will cover
the flavor. As far as the nutritive value is concerned, the
different cereal foods vary according to the grain from
which they are made, and different preparations made
from the same kind of grain apparently vary with the
different crops of the grain used. In the oat food, proteid
is the most variable constituent, while in corn and rice
products the amount of water is most variable. As far
118 FOOD IN HEALTH
as the phosphorus contained in cereals is concerned, the
percentage of this substance varies practically only with
the kind of grain used, .there being little difference in the
percentage of it in different foods made from the same
grain. It should be remembered, by those who have to
economize, that cereal foods bought in bulk are just as
nutritious as those bought in packages. The only advan-
tage of the package preparations is that they are convenient,
and apt to be more uniform. The price of such prepa-
rations is, of course, higher than when sold in bulk.
Bread. — One of the most important processes of cooking
or preparation of food, is, undoubtedly, the making of
bread. When flour is mixed with water and other
materials, a tenacious, sticky substance called 'dough is
formed. If thus eaten, it is not only unpalatable, but
remains in masses that cannot be divided by chewing,
and being therefore impervious to the digestive fluids, it
escapes their action and produces disturbances in the
digestive processes. It is necessary to reduce this dough
mass to a form that will be penetrable by the digestive fluids,
which is accomplished by rendering it porous. This is done
by different methods : (1) fermentation by yeast, (2) fermen-
tation by leaven, (3) by chemicals, and (4) by aeration.
Fermentation by Yeast. — Yeast is a microscopic plant
which grows rapidly when certain proper conditions,
namely, food, warmth, and moisture exist in combination.
Yeast is universal throughout the world. Substances
such as malt, potatoes, or hops if exposed to the air
will develop this fermentation; this is called wild yeast.
The old Egyptian custom of making yeast was to
expose dough to wild yeast and then use a little of this
dough for making more. The cultivation of yeast with
PROTEID FOODS 119
potato is still common in some parts of the country.
Brewers' and distillers' yeasts are taken from the vats
after the fermentation of malt extract. "Scotch barms"
are made with the scum that rises to the top in beer-
making. Compressed yeast, now so generally used in
this country, is made by growing yeast plants in some
sweet liquid and then drying, with a little starch added
in some cases to keep the shape of the cakes. Yeast is
very susceptible to atmospheric changes, but compressed
yeast, when well made, is more uniform than any other.
When yeast is introduced into a suitable medium for its
growth and proliferates, it uses up some of the sugar for
its own growth, and from this forms carbonic acid gas
and alcohol. But the development of this gas is not
limited simply to the materials used for food by the
yeast plant; the process is extended throughout the sub-
stance of the dough. This gas, developing in minute
bubbles, is held by the tenacious and sticky gluten of the
flour which prevents its escape. The mass of dough,
therefore, enlarges, the bulk being doubled or trebled.
It is this dissemination of gas throughout the dough that
makes bread porous and fit for use. The more gluten
the flour contains, the more yeast can be used and the
greater will be the yield of bread from a given amount of
dough. The process of bread-making with yeast consists
of kneading, soaking or rising, and baking.
Kneading. — When the dough is made, the yeast must
be thoroughly mixed with it by kneading in order to
distribute it uniformly throughout the dough. Kneading
is performed by most cooks with the bare hands, as the
bread cannot be properly worked with a spoon. While
this method may be satisfactory for making a small
120 FOOD IN HEALTH
quantity of dough, it should not be used where a large
amount, which requires some time to knead, is to be made,
but a kneading machine should be used instead. This
should be done to prevent the entrance of impurities into
bread through the sweat, which cannot be wiped off
while the hands are in the dough. If kneading is not
properly done, the yeast will be present in some parts and
absent from other parts of the dough, and the bread when
cooked will be of uneven porosity. The part in which
the yeast was present will have large gas bubbles, which
make holes in the bread; while the part from which the
yeast was absent will be solid and tough. When the
dough is properly kneaded, the bread after baking will
show a uniformity in the distribution of the tiny holes
in it.
Yeast is used in two ways, and according to the method
of its use the dough is termed straight dough or sponge
dough. In making straight dough all of the ingredients
for the dough are mixed and kneaded at once. This
requires more yeast and stronger flour than the other
method and makes a dough that is stiff and hard to knead,
and the bread thus made has a coarser texture. Sponge
dough is made by first mixing the yeast with a part of
the flour and water to form a "sponge." Instead of flour,
boiled potatoes are sometimes used for making sponge.
This is set aside for eight to ten hours to rise; the rest of
the flour is then thoroughly kneaded into it, and this
dough set aside for a shorter time, say two or three hours,
before baking. As a sponge contains more moisture than
a straight dough, the yeast has a better opportunity to
work. Sponge dough rises evenly and bread thus made
keeps well.
PROTEID FOODS 121
Soaking or Rising. — As has been stated, it is necessary
for the development of yeast to have a combination of
food, moisture, and warmth. The food and moisture exist
in the dough, but the warmth must also be provided.
This may be done partially by using warm water for
mixing the dough, but, after kneading, the dough must
be placed in a warm place — i. e., at a temperature of 77°
to 95° F. — and allowed to stand for eight to ten hours
for the development of the yeast with the production of
the desirable carbonic acid gas. If too little yeast is used
the bread will be heavy, as the gas developed will not be
sufficient to make it porous. If too much yeast is used,
the gas developed will accumulate in large bubbles and
make so great pressure as to burst through the restraining
gluten and escape. When this occurs the bread will be
heavy and sodden. If the gas does not actually escape,
it may accumulate, forming large holes in the dough.
Such dough is called "overproved," and if it is again
kneaded a little before putting into the oven, the excess
of gas may be removed.
Baking. — After the bread has risen, it is placed in a hot
oven. The heat causes the bubbles of gas to expand,
making the bread more porous than the dough, and
drives off this gas together with the alcohol and some of
the water. By the coagulation of the gluten the bread is
"set" — i. e., it becomes stiffened and fixed, so that it
retains its porous form and does not collapse after removal
from the oven. Large holes seen in the substance of the
bread indicate imperfect kneading. If these large holes
occur just beneath the crust, it shows that the heat was
too great. The oven is usually heated to 400° or 500° F.
When the dough is first put in, the yeast continues to
122 FOOD IN HEALTH
work until the temperature of the bread has reached
158° F., at which temperature it is killed. Heating of the
starch causes the coating of the granules to rupture.
The outer surface of the dough receives the greatest
amount of heat, which changes the starch into a stiff gum
and sugar, evaporates the water, and thus forms the crust.
The brown color is due to the conversion of sugar into
caramel. If the oven is too hot, the crust will form
rapidly before the interior is sufficiently cooked, prevent-
ing the escape of the gas, which will burst through, making
holes. The dough is frequently moistened on the surface
to prevent the too rapid formation of crust, or steam is
passed over it for this purpose. As in the cooking of
meats, so with bread, the larger the piece, the lower
should be the temperature for cooking. A pound loaf
will usually bake in an hour and a quarter, while small
rolls are done in half an hour. The larger the loaf, the
smaller will be the percentage of crust.
The cooling of bread should be carefully attended to,
to ensure good results. After the bread is taken from the
oven, water and gas continue to pass from it until it is
cooled. When the bread is immediately placed on plates,
evaporation from the surface on which it rests is prevented,
and if the plate be cold there will be a tendency to con-
densation of the water of this surface, with the result that
the crust of this part will be sodden and wet. The practice
of wrapping hot bread in cloths immediately on removal
from the oven is likewise unadvisable, for the reason that
it makes the loaf damp and clammy. Such bread is apt
to become mouldy. To be properly cooled, bread should
be placed in wire racks or on slats in order that the air
may circulate freely about it on all sides.
PROTEID FOODS 123
Fermentation by Leaven. — This method of making
bread is of interest to-day chiefly from its historical asso-
ciation, being the method used from the earliest times to
modern times. Its use is still practised in some modern
countries. Leaven is simply old dough that has been
fermented, which is put aside, mixed with a little flour
and water, until the whole mass is fermented, when it is
ready to be used in making new bread. The usual manner
of making leaven is to take off a little of the dough before
the bread is baked and use it to start the fermentation for
the next supply. Methods of preparing dough with leaven
are similar to those described in making bread with yeast.
Bread made with leaven usually has an acid taste, and
does not keep as well as that made with yeast.
Chemicals. — While yeast makes the best-flavored bread,
the labor of making and the time necessary for rising are
so great as to invite more rapid and simple methods of
preparation, and so-called yeast powders or baking powders
have been introduced, the use of which is now common
in America. The principle of their action is that in
combining an acid and alkali, gas is developed, rendering
the bread porous, as does the gas developed by yeast.
The first yeast powder used was formed of acid calcium
phosphate with bicarbonate of sodium and potassium
chloride. This was mixed with the flour, and when water
was added these chemicals combined, developing gas.
Many baking powders are now on the market under a
variety of names. Good baking powder should consist
simply of soda and cream of tartar. It is claimed that
bread made with baking powders is not only quicker in
the making, but is lighter. It lacks, however, the pleasant
flavor that good yeast gives, and is of questionable whole-
124 FOOD IN HEALTH
someness on account of its introduction of drugs into the
stomach. Where cream of tartar and soda are used no
harm is done, but when ammonium carbonate or alum is
a constituent of the powder, continued use will be hurtful.
Baking powders are easily and frequently adulterated with
materials injurious to health.
Aeration. — This method of making bread is popular in
London. Carbonic acid gas is made by the action of
sulphuric acid on marble dust, just as it is prepared for
soda-water fountains in this country, and is introduced
into the dough under pressure. Water charged with the
gas is used for wetting the dough, which is mixed in a
special apparatus. About one cubic foot of gas is used
for fourteen pounds of flour, but at least one-half of this
escapes from the dough. This bread is light and porous
and keeps better than bread made by other methods, and
it is claimed that malfermentation does not occur. It has
a peculiar flavor which is liked by many persons, and it
dries much more quickly than other breads.
Unleavened bread has been used by the Jews in celebra-
tion of the Passover since the time of Moses. It is simply
flour and water baked into small cakes until dry and hard.
Other forms of unleavened bread in general use are ship's
biscuit and various kinds of crackers. These are made
with flour and water; with milk, butter or lard, and
various flavoring materials. The dough is then quickly
baked in a hot oven.
Varieties of Bread. — A great variety in the appearance
and taste of bread made from the same kind of flour can
be obtained, by varying the manner of mixing the dough
or of baking. The general principles of malting are such
as have been described, and the nutritive value of the
PROTEID FOODS 125
product will vary according to the materials added to the
flour. Fancy breads are made with the addition of milk,
eggs, fat, and sometimes sugar. Bread made of cornmeal
is apt to be hard and heavy when made by the ordinary
method. When mixed, however, with milk and eggs into
a batter and baked in a pan (the so-called batter bread,
egg bread, or spoon bread common in the Southern States),
it is easily digested and nutritious. For this purpose meal
of white corn should be used, as the yellow corn does not
give as good a result. The manner of grinding corn very
materially affects the character of bread made from this
meal. Country ground, or water ground, meal is the best.
When ground fine and bolted, as is done in the large city
mills, it makes a bread of very close texture, which is
harder to digest and less • pleasantly flavored than the
unbolted meal.
Graham bread is bread made from the entire grain of
wheat and includes the bran. This bread was introduced
with the idea that it was more nutritious because, by the
retention of the bran, its valuable proteid and phosphates
were added to the food, thus increasing its nutritive value.
While it is true that this- bread contains by chemical
analysis more nutritive material than white bread, it is a
question whether the proteid of the bran is well digested
in the human stomach. It is known that the cellulose of
the bran itself is not digested in the human stomach; so it
is not certain that the nutrients of the bran are to any extent
utilized by the body. Furthermore, the bran is an irritant
to the mucous membrane of the digestive tract. In some
instances this irritation may occur to the extent of real
interference with the digestive process, but even where
this does not occur it does increase peristalsis so that the
126 FOOD IN HEALTH
food is carried more rapidly through the intestines, allow-
ing less time for absorption. These objections to Graham
bread led to the production of the so-called "entire" or
"whole wheat" bread, in. which the outer layers of the
grain were removed before grinding. Recent experiments
have been conducted by the United States Department of
Agriculture to determine the percentage of digestible
nutrients contained in different breads, the amount of
proteid digested, and the proportion of fat and salts
utilized. The results of these experiments show that white
bread yields the highest percentage of valuable nutrients,
next the entire wheat, and last Graham bread. The same
order was found to obtain in regard to the amount of
proteid digested, and of fats and salts utilized. In view
of the results of these experiments and the fact that the
whole wheat and Graham flours are more expensive, the
advantage lies with the white flours. The difference in
nutritive value of various grades of white flour is very
slight. In certain conditions, however, as constipation,
in which a greater bulk of waste in the intestines is desir-
able for the purpose of stimulating peristalsis, Graham
bread is peculiarly useful.
Stale Bread. — The old idea that stale bread differs from
fresh bread simply in the drying out of some of the water
contained is not exactly correct. Recent experiments
show that the difference in the amount of water in fresh
and stale bread is not great, and that the chief difference
between stale and fresh bread is in the distribution of the
water. In good fresh bread the crust is crisp and breaks
with a snap, while the crumb is elastic and springs back
into shape after being gently pressed with the finger. In
stale bread the crust is softer and tougher, bending rather
PROTEID FOODS 127
than snapping, while the crumb seems dry and is friable.
The explanation of this is that the hard crust cools more
quickly than the soft crumb, and as the bread grows stale
the water tends to pass from the crumb into the crust.
This fact is verified on heating stale bread, when the crust
will be found again crisp, while the crumb becomes more
moist. Stale bread heated over, however, will be drier
than fresh bread, as some of the water in the crust is
evaporated. Stale bread is more easily digested than fresh
bread because of the greater friability of the crumb, which
permits more thorough incorporation of the digestive fluids
with it.
Toast. — Good toast should always be made of stale
bread and the slices should be cut thin. Toasting should
be done quickly over hot coals in order to convert the
surface rapidly into caramel, which then appears as a
brown, fragrant coating. When bread is burnt in toasting,
the carbohydrates are converted into carbon instead of
caramel. When the slices are too thick, the interior of
the toast will be moist and sodden and difficult to digest.
This is due to the absorption of water into the interior of
the slice, which is driven from the surface by the heat.
When a thin slice is toasted too slowly, the toast will be
hard and brittle from the drying out of the whole slice
before the surface is converted into caramel.
Hot Bread. — There is a popular theory that hot bread
is indigestible. The heat does not affect the digestibility
however, but in fresh bread, made in large loaves, it will
be found that the crumb when squeezed will remain in
more or less solid masses. Such bread will, of course, be
less readily digested than the friable stale bread. This
condition is avoided when bread has been allowed to cool
128
FOOD IN HEALTH
and water has been lost by evaporation while cooling.
Bread thus cooled and dried can then be reheated without
affecting the digestibility. When hot bread is baked in
small pieces, such as rolls, in which the proportion of
crust is largely in excess of the crumb, these objections
have less weight, as there is little difficulty in masticating
the crust.
Table IX.— Composition of Various Bkeads.
03
IS
s
s
+3
• S
O Fh
.s"
(A 1
<
*
t
*
*
*
Corn bread (johunycake) ...
5
3S.9
7.9
4.7
46.3
2.2
Eye bread
21
35.7
9.0
0.6
53.2
1.5
" and wheat bread
. 1
35.3
11.9
0.3
51.5
1.0
Wheat bread "gluten" .
6
38.2
9.3
1.4
49.8
1.3
" " "Graham"
27
35.7
8.9
1.8
52.1
1.5
" " "rolls"
20
29.2
8.9
4.1
56.7
1.1
" " from high-grade patent
flour.
32.9
8.7
1.4
56.5
0.5
" " from regular patent flour
34.1
9.0
1.3
54.9
0.7
" " from bakers' flour
39.1
10.6
1.2
48.3
0.9
" " from low-grade flour .
" " average, all analyses .
40.7
12.6
1.1
44.3
1.3
198
35.3
9.2
1.3
53.1
1.1
Whole wheat bread ....
12
38.4
9.7
0.9
49.7
1.3
Crackers
71
6.8
10.7
8.8
71.9
1.8
Imperfections and Impurities in Bread. — Sodden or heavy
bread is indigestible. Several conditions may produce it,
such as the use of too much water in proportion to the
amount of flour, the use of too little yeast, poor kneading
so that the yeast is not thoroughly mixed, or insufficient
cooking. This, when chewed, instead of breaking up into
smaller particles, will roll into solid lumps, which resist
the action of the digestive fluids.
In damp weather mould may form in bread. This is a
minute plant, the seeds of which float about everywhere
in the air and may find lodgement in bread when it is
PROTEID FOODS 129
exposed in damp places. The best plan for protection
against mould is to keep the bread in an air-tight box.
Sour bread is always due to the action of bacteria which
form lactic and butyric acid; but the sources of the bacteria
may vary. Sometimes these bacteria may be in the flour
from which the bread is made. In such cases the bread
will usually be sour whenever made from such flour. If
the vessels in which the bread is made are not perfectly
clean, they may get into the dough from them. Or the
bacteria may be in the yeast itself. If rising or fermenta-
tion be then too long continued, so that the fermentation
ceases naturally, these bacteria will grow with the produc-
tion of acid. Sometimes bread sours oivkeeping, in which
case it is contaminated by bacteria from the air.
Adulterants are frequently added to bread by bakers
for the purpose of giving it a better appearance. Various
substances are used for this purpose, chiefly alum. Alum
whitens the bread and enables it to take up more water.
Its use is injurious to the digestive system. It can be
detected by soaking a sample of the suspected bread in a
solution of tincture of logwood and ammonium carbonate,
when, if alum be present, a bluish color will appear.
Copper sulphate is sometimes used for similar purposes,
but its use is dangerous. Lime will produce the same
effects and is not in itself harmful, but the practice is
reprehensible, in that it gives poor bread the appearance
of good. Soda is used to prevent souring, but this is not
injurious, and in breads made with flours which are poor
in gluten, such as oatmeal, barley, etc., it is necessary in
order to produce a sweet, good loaf.
130
FOOD IN HEALTH
PEAS, BEANS, AND LENTILS.
These foods, collectively spoken of as legumes or pulses,
occur in great variety. They are eaten both ripe and
green and some of the latter are used with their pods.
Unlike other vegetables, they contain a large percentage
of proteid. When fresh they do not differ markedly from
other green vegetables, but when dried their content of
proteid is high, in some instances even exceeding that of
meat, as is shown in the following table:
Table X. — Composition of Fresh and Dried Legumes.
SO
0Jt3
5 o
Material.
u
is
3
O
P4
3
6 a
m
<
« 5
Fresh legumes :
*
*
i
f
f-
Calo-
ries.
String beans
89.2
2.3
0.3
7.4
0.8
195
Whole pods of Dolichos sesquipedalis
79.9
4.5
0.5
13.9
1.2
365
Sugar peas or strip? peas
Shelled kidney beans .
81.8
3.4
0.4
13.7
0.7
335
58.9
9.4
0.6
29.1
2.0
740
Lima beans
68.5
7.1
0.7
22.0
1.7
570
Peas
74.6
7.0
0.5
16.9
1.0
465
Cowpeas . .
65.9
9.4
0.6
22.7
1.4
620
Canned string beans . . .
93.7
1.1
0.1
3.8
1.3
95
" Lima beans
79.5
4.0
0.3
14.6
1.6
360
" kidney beans
72.7
7.0
0.2
18.5
1.6
480
" peas.
" baked beans
85.3
3.6
0.2
9.8
1.1
255
68.9
6.9
2.5
19.6
2.1
600
Peanut butter
2.1
29.3
46.5
17.1
5.0
2825
Dried legumes :
Lima beans
10.4
18.1
1.5
65.9
4.1
1625
Navy beans .
12.6
22.5
1.8
59.6
3.5
1605
Frijoles . ...
7.5
21.9
1.3
65.1
4.2
1695
Lentils .
8.4
25.7
1.0
59.2
5.7
1620
Dried peas
9.5
24.6
1.0
62.0
2.9
1655
Cowpeas
Soybeans
13.0
21.4
1.4
60.8
3.4
1590
10.8
34.0
16.8
33.7
4.7
1970
Chick-pea
14.8
12.4
6.7
63.3
2.8
1690
Peanuts
9.2
25.8
38.6
24.4
2.0
2560
St. John's bread (earob bean)
15.0
5.9
1.3
75.3
2.5
1565
The proteid is chiefly legumin, which is so much like
the casein of milk that it has been called "vegetable
casein." It is precipitated by rennet and acid, but not by
PROTEID FOODS 131
heat. Although the proteid percentage is so high, the
legumes are not as valuable as meat, since the legumin
is not as digestible. This is due to the fact that the
nutrients are enclosed in cells of cellulose, which inter-
feres with their intimate contact with the digestive fluids,
and the cellulose itself acts as an irritant, increasing
peristalsis. This lessens the time for complete digestion
and absorption, an effect further increased by fermentation
to which vegetable foods are prone. Legumes are often
considered indigestible because they produce flatulence,
if eaten in quantity. Many experiments have been made
with beans or peas as the sole or chief article of diet to
determine their digestibility, which show that the manner
of cooking greatly affects this. When simply boiled with
the skins, as is the usual custom, about 40 per cent, of
the proteid is lost in the feces, but when ground into meal
and made into purees, only 8 to 10 per cent, escapes.
When they are eaten with other foods, an average of
85 per cent, of the proteid is absorbed.
The removal of the skins by long soaking in water
materially lessens the production of flatulence. Eaten in
moderate quantities with other foods, legumes are digest-
ible by persons having light muscular exercise, and for
out-door workmen they may contribute a large proportion
of the diet. Persons of sedentary habits are not apt to
digest them well, as their nutrients differ in character from
the corresponding nutrients of cereals.
Preparation. — String beans or snaps and sugar peas are
eaten fresh with their pods. They should be gathered very
young, when the beans have but recently formed, and
before they become "stringy." The pods are cooked
either whole or broken. They should be boiled in salt
132 FOOD IN HEALTH
water for twenty to forty minutes, which is long enough
to make them tender if they are gathered young enough
to be fit for use. Bacon is often boiled with them and
adds to their flavor, but for many persons it renders them
less digestible. After parboiling they may be stewed and
seasoned in other ways. String beans may be salted and
kept for many months. Fermentation then occurs, much
as in making saur kraut, which softens the fibre and
develops a flavor which many persons find agreeable.
Shelled beans and green peas should be cooked as soon
after gathering as possible, since delay increases the time
necessary for properly cooking them. Stewing is the best
method of cooking, and they are better if well seasoned
with butter and condiments when they are half done.
They should be cooked only until tender, as prolonged
cooking changes their color. Canned beans and peas
have the same composition as those freshly cooked, but
lack flavor.
Dried legumes are staple articles of food, and if fat is
added they form a complete food, supplying the substances
necessary for life in good proportion. Beans of good
quality should have smooth skins, not wrinkled, and
should be of uniform size. Large beans present the
advantage of having a smaller proportion of skin than
small ones, but some small varieties are preferred because
their skins are very thin and delicate.
The essential quality is that beans should cook well —
i. e., that their cellulose should be softened so as to liberate
the nutrients for the action of the gastric juice, and that
the starch granules burst, releasing the starch.
The skin of dried legumes is very tough and quite
indigestible. The usual practice of soaking beans and
PBOTEID FOODS 133
peas overnight is a sensible one, as it causes the beans to
swell and softens the skin. If well stirred after soaking,
the skins of many kinds of beans and peas can be separated
and will rise to float on the surface of the water, when they
can be readily skimmed off. The beans are then boiled
and served with the consistency of mashed potato, or
thereafter they may be further cooked in other ways.
Legumes should be cooked if possible in distilled water
or rain water, since by the use of "hard" water for boiling
some of the salts of the water are absorbed and form
insoluble compounds with the legumin which no amount
of cooking will soften. Boiling with soda added to the
water in the proportion of half a teaspoonful to two quarts
assists in softening the skins and increases the digestibility
of beans and peas, but the flavor is apt to be injured.
After boiling to soften them, legumes are cooked in
other ways, very commonly by baking, with the addition
of various materials, such as herbs, molasses, or pork, to
improve their flavor. Pork does more than this, however,
as its addition supplies the fat needed to make peas and
beans a well-balanced food. Finely ground legumes form
the basis of many soup tablets and other forms of con-
densed food useful for armies on the march, explorers, etc.
"Pea sausage" is the name of a preparation of pea and
lentil flour, cooked and mixed with bacon, which proved
of great value to the German troops for emergencies in
the Franco-Prussian War, though its continued use pro-
duces digestive disturbances.
134 FOOD IN HEALTH
PEANUTS.
Though generally considered a nut, and as such used
as an accessory to diet rather than as a vegetable, the
peanut is, in fact, a legume, and is one of the richest of
them in proteid, containing more than 25 per cent, of it.
Carbohydrates, which in other legumes form the greater
part of their nutrients, is in the peanut largely replaced
by fat, of which it contains nearly 39 per cent.
In spite of its high nutrient value, as shown by analysis,
it has never become a staple article of diet even among
the poor in the Southern States, where it is easily raised.
The few experiments that have been conducted to deter-
mine its digestibility indicate that it is probably a digestible
food when taken with other articles, though many persons
are made sick by too free indulgence in this palatable pea.
This disagreement may often be prevented by eating a
little bread with them.
The peanut when roasted and ground forms an oily
meal which is called peanut butter from its consistency. It
is used in various made dishes and for sandwiches.
Various grades of oil are produced from the peanut,
the best of which is excellent for table use. The oil cake
which remains after the oil has been expressed is used
for fattening cattle. Its high percentage of nutrients, 47
of proteid and 9 of fat and carbohydrates, has suggested
its possible usefulness as a cheap food for man. A few
experiments have been made with it, after prolonged
boiling, in the form of porridge or soup, and it was taken
with apparent relish and without early satiety, though the
degree of its digestibility has not been determined.
CHAPTER VII.
CARBOHYDRATE FOODS AND SALTS. VEGETABLES.
FRUITS. CONDIMENTS.
Carbohydrates, so-called because they contain hydro-
gen and oxygen in the proportion to form water, include
starch, cellulose, and sugar. Except for sugar of milk and
glycogen, the animal starch found in livers, this class of
food is supplied entirely by the vegetable kingdom.
Starch is insoluble, and occurs in vegetables and cereals
as granules, enclosed in minute cells whose envelope is
composed of cellulose. Starch derived from different
sources varies only in the physical character of its granules.
When heated in the presence of moisture the granules
absorb water, which causes them to swell and rupture the
cellulose envelope, becoming thus liberated to the action
of the digestive fluids. Without this rupture of the cell
envelope the digestion of starch would be much retarded,
as cellulose is unaffected by the saliva or gastric juice,
and is slowly acted upon by the pancreatic juice. Dry
heat converts starch into dextrin, which is soluble. As
stated in Chapter L, the food value of starch lies in its
ready oxidation with the production of heat and energy.
Its digestibility is enhanced if it is eaten with butter or
some other good form of fat, as this prevents the starch
from forming impermeable lumps in the stomach.
Cellulose, like starch, is an insoluble carbohydrate.
Except when very young and tender it is indigestible. It
136 FOOD IN HEALTH
occurs in all vegetable foods, contributing largely to their
bulk, and forms the framework for the support of the
vegetable cells. It is very susceptible to the action of
certain micro-organisms found in the alimentary tract,
which results in the formation of marsh gas, an irritant
substance which may cause inflammation of the mucous
membrane of the stomach and intestines. Hence, persons
with weak digestion, whose resistance to the entrance of
micro-organisms is diminished, are apt to be distressed by
excessive gas formation when they partake largely of
vegetable foods.
Sugars are crystallizable carbohydrates. They are
derived from various vegetable sources in which they occur
in solution in the juices, and in one form from milk. They
differ in ease of crystallization, in the degree of sweetness,
and in their readiness to undergo fermentation. The most
familiar form of sugar is cane sugar or sucrose, which is
derived from the juice of the sugar cane and from the
sugar beet. Other forms of sugar which are ingested
with food are grape sugar, milk sugar, fruit sugar, and
maple sugar, which is a cane sugar obtained from the
sap of the sugar-maple tree and possessing a peculiar,
pleasant flavor due to ethers.
Cane sugar, the common sugar of commerce, is subjected
to the elaborate process of refining before it is marketed,
and is practically a pure sugar. The supply of cane and
beets is so plentiful, that the product is very cheap and
free from adulteration.
Brown sugar is cane sugar at a certain stage of refine-
ment, and contains some of the impurities which are
removed before the finished product is reached. Molasses
is a product in the course of the manufacture of cane
CARBOHYDRATE FOODS AND SALTS 137
sugar. It is a residue left after the crystallizable sugar
has been removed. It contains some organic acids.
Grape sugar, or glucose, occurs in almost all fruits, with
or without some cane sugar. As seen on the market, it is
usually manufactured from starch. It crystallizes less
readily, and possesses less sweetening power than cane
sugar.
Milk sugar, or lactose, is an ingredient found in all kinds
of animal milk in varying proportions. It is not so sweet
as cane sugar, but it is readily digestible.
Fruit sugar, or levulose, is an ingredient of most fruits,
and is supposed to be a form of sugar allowable in diabetes,
as it is not known to appear in the urine, while all other
sugars, if taken in excess, will appear in the urine.
Honey is a mixture of 35 per cent, grape sugar, 39 per
cent, fruit sugar, with water and flavoring materials.
Other forms of sugar occur, but those mentioned are
most commonly met with.
Sugars require less digestion than any other alimentary
substances which have to be digested before absorption.
All sugars are converted into glucose before absorption,
but this is a relatively simple process as compared to the
series of changes which other foods must undergo.
The food value of sugar is practically identical with
that of starch, as all starch must be converted into sugar
before absorption for utilization in the body is possible.
Sugar is, however, a concentrated form of nourishment,
possessing the special property of delaying muscular
fatigue and of quickly reviving muscles wearied by hard
exercise. This function of sugar has been frequently
proven by scientific experiment. By producing force and
heat through its combustion, it spares the fat, and some
138 FOOD IN HEALTH
of it may be converted into fat. Its liberal use should,
therefore, be avoided in obesity.
The quantity of sugar, which may be safely taken,
cannot be definitely stated, as different individuals show
varying power in their ability to utilize it. The proper
use of sugar is to avoid too great a quantity at a time, and
to take it in proper dilution. The injury that the use of
sugar produces to the digestive processes is often due to
its concentration. The form in which nature provides
sugar, as in milks and fruits, is in weak solution, rarely
more than from 4 to 6 per cent., and this fact of nature
is suggestive. When sugar is taken in excess in any form,
or too concentrated, as in free use of candies and syrups,
it is apt to undergo fermentation in the stomach and
intestines, producing alcohol and various acids, which may
cause inflammation of the lining membranes. The relative
readiness with which they undergo these fermentative
changes is given by Davis as follows: Lactic acid fer-
mentation — levulose, lactose, cane sugar; butyric acid
fermentation — levulose, cane sugar, lactose; alcoholic
fermentation — maltose, cane sugar, levulose, lactose. It
is thus evident that lactose is less likely to produce fermen-
tative disturbances than any of the other forms of sugar.
For this reason, it should be selected for use in modifying
cows' milk for children.
VEGETABLES.
Vegetables practically derive their value as foods entirely
from carbohydrates and salts, as, with the exception of
legumes, they contain so small a percentage of proteid
that their contribution of this substance is of little conse-
quence in the total supply to the body, and even that
which they provide is difficult of digestion. This is partly
CARBOHYDRATE FOODS AND SALTS
139
due to the increased activity of the intestines, caused by
the greater bulk which vegetables present, and partly to
the physical arrangement by which some of the albumin
of vegetables is enclosed in cells of cellulose like starch.
Vegetable proteid contains less nitrogen than animal
proteid; hence, vegetables alone are not an economical
food, as the quantity necessary to obtain the requisite
nitrogen would be so excessive as to overtax the digestive
organs. Vegetables contain a very low percentage of fat.
Table XI. — Percentage Composition of Different
Vegetables.
Kind of vegetable.
Proteid.
Fat.
Carbo-
hydrates.
Per cent.
Per cent.
Per cent.
Asparagus
1.8
0.2
3.3
Beans, butter
4.7
0.3
14.6
" Lima
18.1
1.5
71.1
" navy
22.5
1.8
59.6
" string .
2.1
0.3
6.9
" string, canned
1.1
0.1
3.8
Beets,
1.3
0.1
7.7
Cabbage
1.4
0.2
4.8
Carrots
0.9
0.2
7.4
Celery
0.9
0.1
2.6
Corn, canned
2.8
1.2
19.0
" green
1.2
0.4
7.7
Cucumbers . •
0.7
0.2
2.6
Lettuce
1.0
0.2
2.5
Mushrooms
3.5
0.4
6.8
Onions, dry
1.4
0.3
8.9
" green
0.5
0.1
5.5
Parsnips . ...
1.3
0.4
10.8
Peas, canned
3.6
0.2
9.8
" dried ... .
24.6
1.0
62.0
" green . ....
3.6
0.2
9.8
" split. . ...
Potatoes ... • ■
24.6
1.0
62.0
1.8
0.1
14.7
" ' Saratoga chips
6.8
39.8
46.7
" sweet .
1.4
0.6
21.9
Pumpkins . . .
0.5
0.1
2.6
Radishes
0.9
0.1
4.0
Rhubarb . . . • •
0.4
0.4
2.2
Roman lettuce .
1.0
0.2
2.5
Salsify (as parsnips) .
1.3
0.4
10.8
Sauerkraut ....
1.7
0.5
3.8
Soup greens
Spinach ...
Squash . . • •
Succotash, canned
1.8
2.1
0.7
0.4
0.3
0.2
1.7
3.2
4.5
3.6
1.0
18.6
Tomatoes
1.2
0.2
4.0
" conserve
0.7
0.1
57.6
" fresh
0.9
0.4
3.9
Water-cress
0.9
4.2
0.1
0.6
5.7
6.3
140 FOOD IN HEALTH
Vegetables eaten in large quantities increase the amount
of carbon dioxide eliminated by the lungs, render the urine
alkaline, and increase the alkalinity of other secretions.
Many vegetables are laxative, some by reason of their
chemical composition, others on account of the seed which
they contain, and others from the bulk of residue which
they leave. Some vegetables, like potatoes, have the
opposite effect, as they are so completely absorbed. Many,
by virtue of their salts and vegetable acids, are anti-
scorbutic.
A classification of vegetables is difficult. An effort to
classify from the standpoint of their composition gives a
division into "heavy vegetables," which contain a high
percentage of starch, and "green vegetables," which are
chiefly valuable for their salts. Distinction is sometimes
made between vegetables that grow underground and
those that grow above the ground. A profitable combi-
nation of the two methods seems possible by division into
"heavy roots and tubers," "succulent roots and tubers,"
and "green vegetables."
Heavy Roots and Tubers.— This class forms the source
of valuable foods, their value depending chiefly upon the
starch which they contain. They are inferior in nutritive
value to cereals, as their proportion of proteid is small
and they contain a relatively large amount of water.
Irish potato, sometimes called white potato, is composed
largely of water, but is a very valuable food on account
of the starch which it contains, often in as great a pro-
portion as 20 per cent. It also furnishes valuable salts of
potassium, calcium, and sodium. Its content of fat is
minute and the nutritive proteid, chiefly in the juice, is less
than 1 per cent.
CARBOHYDRATE FOODS AND SALTS 141
The minute starch granules are surrounded by the
potato juice. When heat is applied in cooking, the
albumin of this juice is coagulated and at the same time
its water is absorbed by the starch granules, which causes
them to swell and .burst their envelope of cellulose and gives
to a properly cooked potato its dry (mealy) appearance.
The manner of cooking a potato has much to do with
its nutritive value. If first peeled and soaked for some
time in cold water, as is frequently done, a large pro-
portion of its valuable components will be lost by the
escape of albumin and salts. Such loss, also, materially
affects the flavor. Potatoes should be cooked with their
jackets on, by roasting, baking, or steaming preferably,
as by these methods very little of the nutritive materials
or flavoring substances are lost, though even when boiled
the loss is not excessive if the skin has not been removed.
When properly cooked, the starch of potato is readily
digested. Cooking potatoes in large pieces, so that they
are not thoroughly masticated, renders them much less
digestible. One or two well-baked potatoes will leave the
stomach in two to two and a half hours, and over 90 per
cent, of the starch is absorbed from the intestines. New
potatoes, while containing a little more proteid than old
potatoes, have so much more water proportionately that
the starch granules cannot utilize it all, and they cannot
therefore be cooked mealy, but on cutting have a "waxy"
appearance. Such potatoes should not be given to
invalids. This vegetable has little cellulose and on that
account tends to be constipating to many persons. It is
evident that potatoes alone will not make a proper food
for man, and that they should be eaten with meats and
fats to balance the diet. They keep well, and have anti-
142 FOOD IN HEALTH
scorbutic properties by virtue of their salts. They are
therefore useful for long sea voyages.
Sweet potato is a tuber very popular in Southern coun-
tries. It contains more water than the Irish potato, about
16 per cent, of starch, and 10 per cent, of sugar. It is
therefore a nutritious food. It has a palatable, pleasant
flavor, but on account of its large percentage of water
and lower percentage of starch it does not cook "mealy,"
which renders it less easily digestible than Irish potato.
The sugar, too, makes it unsuitable for many persons.
The flavor can be greatly improved by proper cooking.
While the sweet potato of ordinary size may be cooked
sufficiently to eat in twenty minutes, a much longer time
is necessary to develop the flavor. Slow cooking for an
hour or longer gives the best results.
Yam is a larger tuber than the sweet potato, which it
closely resembles. It differs from the sweet potato in that
it contains a greater amount of starch, on account of
which it is drier when cooked. It is not sweet like a sweet
potato and can therefore be eaten by many persons with
whom sweet potato disagrees.
Arrow-root, tapioca, and sago are practically pure starch
foods. The first two are derived from the tuberous
roots of tropical plants, while sago is procured from the
pith of the sago palm. They are nutritious, easily digested,
non-irritative forms of starch, and are somewhat less liable
to undergo fermentation in the stomach and intestines
than other starches. They are therefore useful for invalids.
They are usually prepared in the form of puddings or are
added to soups of various kinds.
Succulent Roots and Tubers.— This class of foods is
often spoken of as "fresh vegetables." Their nutritive
CARBOHYDRATE FOODS AND SALTS 143
value is small, and they are chiefly useful for giving
variety in the diet. As they contain considerable amounts
of cellulose, they should be thoroughly boiled in order to
soften the cellulose before serving or cooking by other
methods.
Jerusalem artichoke in composition somewhat resembles
the Irish potato, though it contains no starch. Having
14 per cent, of sugar, it is sweet and watery when cooked,
but, lacking starch, it cannot be cooked mealy. It is
therefore less digestible than potato. Its flavor is delicate
and agreeable. Although it contains about 3 per cent, of
nitrogenous substance, it has not a high food value.
Carrots have but low food value as they contain only
about 8 per cent, of carbohydrates, consisting chiefly of
sugar and a very minute amount of proteid and fat.
They contain water and a relatively large amount of
cellulose, and are, therefore, not readily digestible, remain-
ing in the stomach from three to three and one-half hours.
Carrots must be cooked before eating, but suffer much
loss in nutritive value by the process, which reduces the
sugar one-fourth.
Salsify and parsnip resemble carrot in their composition,
though they contain more carbohydrates, as much as
10 per cent., which renders them somewhat more nutri-
tious. They are specially valuable for variety, and though
they contain much cellulose are fairly digestible when
thoroughly cooked. Parsnips are liable to produce
flatulence.
Turnip contains over 90 per cent, of water and only
about 5 per cent, of carbohydrate, and has, therefore,
little food value. It has, however, a pleasant flavor and
is valuable as an easily obtained fresh vegetable. It
144 FOOD IN HEALTH
contains much cellulose, which makes it indigestible for
many persons, and it is prone to produce flatulence.
Beet contains 70 per cent, of water and about 8 per cent,
of carbohydrates, chiefly sugar. It is one of the common
sources of cane sugar for market, and the manufacture of
beet sugar is now one of the great industries. As a vege-
table it has some nutritive value, and is good when young
and tender; the flavor is agreeable, and it gives variety.
Radish closely resembles the turnip in composition. It
is of little value as a food, and is chiefly used as a condi-
ment on account of its aromatic, pungent flavor. It is
usually eaten raw, and partly on this account and partly
because of its pungent properties it is liable to irritate
the stomach, producing eructations and flatulence. It
should never be allowed to invalids.
Onion contains nearly 9 per cent, of carbohydrates. It
is used as a vegetable and as a condiment because of its
pleasant flavor, which it owes to a pungent oil. When
young and tender it is very digestible, and if cooked with
milk becomes a nutritious dish. It is antiscorbutic, and
is mildly laxative. It is eaten both raw and cooked.
Green Vegetables. — This class of foods contains no
proteid or fat of consequence, and most of these vegetables
have less than 4 per cent, of carbohydrates. Their value
is derived from the mineral salts and vegetable acids
which they contain. They are composed of 80 to 90 per
cent, of water, with a large amount of cellulose. They
are, therefore, bulky foods and are laxative on account
of their undigestible residue. Most of them require
thorough cooking by boiling to soften the cellulose in
order to render it digestible. If they are old they become
stringy and woody from the great increase in their cellulose,
CARBOHYDRATE FOODS AND SALTS 145
and are then very indigestible. They contain essential
oils and ethers which give them agreeable flavors, and it
is chiefly for the variety which they thus give to diet
that they are of value. They are useful antiscorbutics on
account of the potash salts which they contain.
Cabbage, sauer kraut, cauliflower, and Brussels sprouts form
a group having similar dietetic properties. They contain
sulphur and are apt to decompose in the intestines, pro-
ducing flatulence. They cause calcium oxalate in the
urine, and are, therefore, forbidden to persons with gouty
diathesis. They contain a large amount of cellulose.
Cauliflower and Brussels sprouts have the more delicate
flavors. Sauer kraut is cabbage that has been fermented.
They are not suitable foods for invalids. They have
marked antiscorbutic properties. Though it is usual to
cook all of these vegetables before serving, many persons
can eat raw cabbage in the form of a slaw without injury,
though they are made ill by eating cabbage that has been
cooked.
Kale, spinach, turnip-tops (greens), and dandelions form
a class which are frequently called salads. They have no
nutritive value, and contain a large amount of cellulose
which renders them entirely indigestible. They are valued
for their pleasant flavors and the freshness which they
give to a meal. They, should be thoroughly cooked in
order that they may be more readily masticated, and they
are best served finely chopped or in the form of purees.
Vinegar is frequently used with them after boiling to
further soften the cellulose and increase the flavor. Their
bulk of residue renders them laxative.
Celery, lettuce, water-cress, tomato, and cucumber consti-
tute a group which are usually eaten raw as salads with
10
146 FOOD IN HEALTH
salt, oils, and other dressings. They have no nutritive
value.
Celery has much stringy fibre and is, therefore, more
digestible when cooked. Stewing in milk makes it pala-
table and nutritious. It is especially prized as a winter
vegetable.
Tomatoes are easily digested, whether raw or cooked.
They are acid and very refreshing. On account of their
seed they are laxative. They contain oxalic acid, and are,
therefore, unsuitable for persons with gouty diathesis.
Lettuce is valuable chiefly as a green winter vegetable.
For many persons it has soporific properties. This, with
the preceding vegetables, has valuable antiscorbutic prop-
erties, and they are not liable to undergo fermentation.
Cucumbers have a pleasant flavor, but are notoriously
indigestible. They should be well soaked in ice-water
before serving. They are largely used for making pickle,
and in this form are prized by persons who can eat such
food. They should have no place in an invalid's dietary.
Egg-plant is in composition much like tomato, but it is
much less digestible. It has an agreeable flavor, developed
by cooking. It is never eaten raw, and should be forbidden
to invalids.
Asparagus, when young, is very digestible and it possesses
a delicate flavor. Naturally grown the tips are green. The
better grades are bleached and are less bitter than the green.
It is especially valuable as an early spring vegetable. It
is diuretic and imparts a peculiar, uhpleasant odor to the
urine. It is supposed also to be a cardiac sedative.
Rhubarb* although of stringy fibre, is, when well cooked,
very digestible. It has a tart flavor and is laxative; hence,
useful in constipation. It produces calcium oxalate in the
CARBOHYDRATE FOODS AND SALTS 147
urine and should, therefore, be forbidden in gouty and
rheumatic diatheses.
Squash, or cymbling, contains a little more carbohydrates
than most green vegetables, but has little nutritive value.
When young and well cooked it is easily digested.
Peas, beans, and corn, while having a great nutritive value
when dry on account of their high percentage of proteid
and carbohydrates, must be classed, when green, with other
green vegetables. They contain a little higher percentage
of carbohydrates than other green vegetables. They are
among the most palatable foods of this class. Though
containing a large amount of cellulose, they are very
digestible when young and thoroughly cooked. If they
are old, the great toughness of their cellulose renders them
indigestible and they are apt to produce laxativeness and
often will pass through the alimentary tract undigested.
Vegetable marrow has a delicate flavor and is easily
digested, but on account of the high percentage of water
which it contains possesses no nutritive value.
Alligator Pear. — This fruit is a native of tropical America.
The edible portion is in the form of pulp, surrounding
a large seed in the centre. It is very soft in texture and
is frequently used for salads. The edible portion consti-
tutes 71 per cent, of the whole fruit.
It weighs about three-fourths of a pound. As a food
its value is not very great, its chief use being the variety
it makes in the diet.
The composition as compared with other fruits is strik-
ing, as it contains more than 10 per cent, of fat, in this
respect resembling the olive.
Olives. — There are two well-known food products
derived from the olive — olive oil and pickled olives. The
148 FOOD IN HEALTH
fruit is originally from Europe, but of late California has
produced it. In appearance it is similar to an oval damson,
with color varying from purple to black. The flavor is
invariably sour.
The worth of both pickled olives and olive oil is familiar.
The oil, which is a valuable fat, is used as a salad dressing
and for frying; the pickled fruit as a relish and for seasoning.
Besides being useful as a relish, pickled ripe olives
possess considerable food value. The green fruit should
be eaten in small quantities as a relish, but ripe olives
can be taken in the same proportion as any other similar
food. They have been used in some countries of Europe
as a staple food.
Mushrooms. — There is a popular belief that this class
of foods is extremely nutritious. By some it is thought
to rank next to beefsteak in its content of nitrogen. From
this idea has arisen the name of "vegetable beefsteak."
From the recent investigations of the Sheffield Institute
of Yale University, mushrooms were found to contain as
high as 92 per cent, of water — thus ranking as a vegetable.
As a nitrogenous food its percentage was very low. In
their proteid content, mushrooms rank about the same
as potatoes, but are decidedly inferior, as they contain less
carbohydrates.
The same investigations at Yale showed further that
26 to 59 per cent, of the dry matter was totally indigestible.
Thus its value as a digestible food is less than the potato.
Although mushrooms possess no great value as a nutri-
tive food, they are very useful as food accessories and
condiments. When cooked with other foods they form
very palatable and attractive dishes. They can be made
more useful by careful cultivation and marketing.
CARBOHYDRATE FOODS AND SALTS 149
FRUITS.
Fruits are essentially carbohydrate foods, as such food
value as they possess depends upon their content of sugar
and starches. Besides these substances, fruits contain
cellulose, a jelly-producing substance called pectose,
various salts of organic acids with potassium, and, some-
times, sodium and magnesium. The more important acids
found in fruits are citric, malic, and tartaric. Citric pre-
dominates in lemons, limes, and oranges; malic in apples,
pears, peaches, and apricots; and tartaric in grapes.
Fruits contain less earthy salts than any other foods.
The differing flavors of fruits are due to essential oils and
compound ethers which they contain.
While some fruits are useful as foods, and their salts
and acids are beneficial, most of them are used for the
variety which they furnish in the diet. Those having the
greatest value as nutrients are bananas, dates, figs, prunes,
and grapes, all except bananas depending for their value
chiefly upon the sugar contained. Bananas, besides sugar,
contain a good deal of starch.
Melons, oranges, lemons, and shaddocks are chiefly
useful for their pleasant flavor with acids and the water
which they contain in high percentage.
Besides supplying nutriment, fruits produce certain
effects in the body for which they are especially valuable.
Antiscorbutic action, which improves the blood and
stimulates secretion, is possessed in great degree by those
fruits which are rich in potash salts, as well as lime and
magnesia. Among these are apples, limes, and oranges.
Some - fruits act as diuretics, this effect being due partly
to the water contained, but largely to the organic acids
150 FOOD IN HEALTH
and salts, which improve the circulation and stimulate
the renal cells.
The eating of fruit, even of the so-called acid fruits,
such as oranges, renders the urine less acid, as the alkalies,
which they contain in the form of various organic salts,
are excreted by the kidneys in the form of carbonates.
They are, therefore, beneficial in gout and similar con-
ditions. Many fruits have happy laxative effects. This
is due largely to the great bulk of indigestible material,
such as cellulose, seeds, etc., which, by mechanical
irritation of the lining membrane of the intestines, stim-
ulate their peristaltic movement, and partly to the chem-
icals which the fruits contain in solution in their juices.
The fruits possessing this property in greatest degree are
apples, figs, prunes, and the small berries.
Unripe fruit contains a large amount of cellulose and
of starch, and its acids are concentrated. By the ripening
of fruit the percentage of cellulose is reduced, it becomes
thinner and softer, and therefore more digestible; the
starch is largely converted into soluble sugars and the
acids are diluted, while the action of these acids upon the
sugars develops the grateful flavors. Overripe fruit is that
in which changes of decomposition have commenced, and,
while the flavor is at first not affected unpleasantly, its
ingestion is very apt to cause irritation of the alimentary
tract, with griping pains, cramps, diarrhea, cholera morbus,
or even fatal gastroenteritis. These effects are due to
irritation by the products of fermentation set up by the
decomposing fruit.
Unripe fruit may cause similar effects, because of the
indigestible quality of the substances of which it is com-
posed, which readily undergo fermentation.
CARBOHYDRATE FOODS AND SALTS 151
Fruit eaten in moderation, when it is in the proper
condition, is wholesome. It may be taken at any time,
but the special effects, such as diuresis and laxativeness,
will be more pronounced if eaten alone, either sometime
before meals, between meals, or at bed-time. The mechan-
ical effects are not then prevented by the presence of
other food material, which keeps the lining membrane
from close contact with the fruit; nor will the chemicals
which they contain be so much diluted. Thus prunes
and figs, eaten with dinner, will not have any special
laxative effect, but, if taken on an empty stomach at bed-
time, or an hour before breakfast, they will have this
effect. The worst time for eating fruits is at the end of
a heavy, mixed meal. Berries, and fruits with numerous
small seed, are not so apt to irritate the stomach and
intestines if eaten with bread, because when thus taken
the bread encloses them, preventing mechanical irritation.
Fruits are best eaten in season, since those which are
transported from a distance are apt to be overripe or
decomposing, if they were shipped when ripe; while others,
plucked and shipped in the green state, never ripen so
thoroughly and effectively as they do naturally, and are,
therefore, less digestible. While fruits are valuable in part
for their acids, some persons, who suffer from acid fermen-
tation, are made worse by them. It must be borne in
mind that many persons have idiosyncrasy for certain
fruits, which will invariably produce in them different
forms of gastric or intestinal disturbances, hives, and
other evidences of poisoning.
Cooking usually renders fruits more digestible, as it
softens the cellulose, converts the gum into jelly, and
liberates such starch as they may contain. If cooked with
152 FOOD IN HEALTH
water, however, some of the nutritive ingredients are lost;
the softer the structure of the fruit, the greater this loss.
Fruits are often cooked to preserve them. For this
purpose cane sugar is added in large amount for its
preservative quality. Various preparations are thus made
of preserves, jam, marmalades, etc., but, if taken in
quantity, they are apt to produce digestive disturbances
because of the concentration of the sugar.
Dried fruits cannot be eaten as freely as fresh fruits,
because, by the loss of water in the process of drying, they
have become more concentrated in the proportion of
sugar which they contain. Some dried fruits, such as
evaporated peaches, are prepared simply by the removal
of the water, while others have cane sugar added as a
preservative.
Fruit juices, prepared by simply extracting the juice
and boiling to prevent decomposition, or by the addition
of strong syrup as a preservative, are useful as flavoring
materials, both in health and diseases, if used judiciously.
The average composition of fruits in common use is
shown in the following table, taken from Davis's Dieto-
therapy (after Hutchison):
CARBOHYDRATE FOODS AND SALTS 153
Table XII.— Composition of Fruits.
Water.
Proteid.
Ether
extract.
Carbo-
hydrates.
Ash.
Cellulose.
Acids.
1
Apples,
82.5
0.4
0.5
12.5
0.4
2.7
1.0
" dried,
36.2
1.4
3.0
49.1
1.8
4.9
3.6
Pears,
83.9
0.4
0.6
11.5
0.4
3.1
0.1
Apricots,
85.0
1.1
12.4
0.5
1.0
Peaches,
88.8
0.5
0.2
5.8
0.6
3.4
0.7
Green gages,
80.8
0.4
13.4
0.3
4.1
1.0
Plums,
78.4
1.0
14.8
0.5
4.3
1.0
Nectarines,
82.9
0.6
15.9
0.6
Cherries,
84.0
0.8
0.8
10.0
0.6
3.8
1.0
Gooseberries,
86.0
0.4
8.9
0.5
2.7
1.5
Currants,
85.2
0.4
7.9
0.5
4.6
1.4
Strawberries,
89.1
1.0
0. 5
6.3
.0.7
2.2
1.0
Whortleberries,
76.3
0.7
3.0
5.8
0.4
12.2
1.6
Blackberries,
88.9
0.9
2.1
2.3
0.6
5.2
Raspberries,
84.4
1.0
5.2
0.6
7.4
1.4
Cranberries,
86.5
0.5
6j
3.9
0.2
6.2
2.2
Mulberries,
84.7
0.3
11.4
0.6
0.9
1.8
Grapes,
79.0
1.0
i.b
15.5
0.5
2.5
0.5
Melons,
89.8
0.7
0.3
7.6
0.6
1.0
Watermelon,
92.9
0.3
0.1
6.5
0.2
Bananas,
74.0
1.5
0.7
22.9
0.9
0.2
Oranges,
86.7
0.9
0.6
8.7
0.6
1.5
1.8
Lemons,
89.3
1.0
0.9
8.3
0.5
Lemon juice,
90.0
2.0
0.4
7.0
Pineapples,
89.3
OA
0"3
9.7
0.3
Dates, dried,
20.8
4.4
2.1
65.7
1.5
5.5
Pigs, dried.
20.0
5.5
0.9
62.8
2.3
7.3
1.2
" fresh,
79.1
1.5
18.8
0.6
Prunes, dried,
26.4
2.4
0'!8
66.2
1.5
2.7
" fresh,
80.2
0.8
18.5
0.5
Currants, dry,
27.9
1.2
3"b
64.0
2.2
1.7
Raisins,
14.0
2.5
4.7
74.7
4.1
CONDIMENTS.
Condiments are not nutritious, and are useful chiefly
to add flavor to insipid food, to vary monotony, and to
stimulate a flagging appetite by their effect on the nerves
of taste and by increasing the salivary flow. In some
cases of dyspepsia, in which there is fulness and oppression
after taking food, condiments, such as mustard or red
pepper, taken with the food, will relieve the symptoms
by stimulating the local circulation in the stomach. The
habitual use of condiments in excess, however, will produce
154 FOOD IN HEALTH
hyperemia and catarrh. The effect of condiments in
increasing the appetite often causes more food to be
taken than can be properly digested in the stomach,
which, passing into the intestines, may cause trouble there.
Mustard does not really increase the gastric secretion,
but is an irritant to the mucous membrane of the stomach,
and by inducing a feeling of warmth produces a sensation
which simulates hunger. It is useful in some cases where
appetite is lacking without any special gastric derange-
ment, but it is hardly to be prescribed.
Capsicum, or red pepper, like mustard, does not increase-
gastric secretion. It augments the appetite in much the
same way that mustard does by stimulating the nerve
terminals. It is useful in some cases to counteract the
evil effects of certain foods for which there is idiosyncrasy
— e. g., strawberries.
Vinegar contains ordinarily from 2 to 7 per cent, of
acetic acid. This gives it the property of softening muscle
fibre, and it is, therefore, useful if taken with tough meats,
such as corned beef. It also aids the digestion of tough
cellulose, and is, hence, an ingredient of dressings for
salads, such as lettuce and celery, and is added to spinach,
turnip-tops, and other green vegetables. It has antiseptic
and preservative properties, and is used for these purposes
in making pickles. These, however, are always indi-
gestible, and should have no place in a dietary. The
various sauces used with meats and in seasoning soups
are composed of the different condiments with vinegar,
and should be used, if at all, in great moderation. They
should be proscribed in all invalid dietaries.
CHAPTER VIII.
FAT FOODS. ANIMAL FATS. VEGETABLE FATS.
NUTS.
Fats subserve a similar purpose in the body to carbo-
hydrates in that they are used to produce heat and force.
As they contain a smaller proportion of oxygen than
carbohydrates, they produce more heat and are a more
concentrated food. They contribute to some extent to
the formation of tissues.
Fats, by their own combustion, spare waste of the body
albuminous tissues, while proteid diet increases this waste.
Hence, by the addition of fat, less proteid food will be
needed to supply the diminished proteid waste. Some of
the fat which escapes combustion is stored in the body,
though this reserve supply is derived to some extent from
other sources.
Although fats and carbohydrates are used by the body
for the same purposes, it is not well, save under exceptional
circumstances, to rely solely upon one of these classes of
food for a supply of heat and force, for fats alone would
not be well tolerated and carbohydrates alone would not
spare albuminous waste as fat would. Great variability
is shown by individuals in their capacity for digesting fat.
Where deficiency in this power exists, proportionate
addition must be made of the carbohydrates.
The administration of fats with starches is of practical
advantage, since the fat then coats the particles of starch,
156 FOOD IN HEALTH
preventing agglutination into large masses. Popular
knowledge of this fact is shown by the common custom
of using butter and gravies with bread and potatoes. An
excess of fat is apt to cause indigestion and gastric derange-
ment, since it may then coat the mucous membrane of
the stomach and particles of food to such an extent as to
prevent free secretion and free contact of the gastric juice
with other foods. When taken in excess the fat is liable
to collect in large globules and may be decomposed by
bacteria present into acids which would irritate the
mucous membrane, interfering with normal function.
Fats are digested in the intestine, and, unless decom-
position occurs, they pass through the stomach unaltered.
Pancreatic juice and bile are both necessary for their
proper digestion. Conditions which lead, therefore, to
deficiency in either of these fluids would indicate the
wisdom of reducing or withholding fats, since in the
absence of sufficient secretions to thoroughly digest them,
they are liable to undergo decomposition, resulting. in
irritation with the production of nausea, vomiting, or
diarrhea.
Satiety is sooner reached for fats than for any other
food, though tolerance may be established by persistent
use in small quantities. Animal fats are usually better
borne and can be longer eaten than vegetable fats.
The manner of cooking and of serving seems to affect
their digestibility. Hot fat is less digestible, as a rule, than
cold ; especially is this true of the fat of mutton and pork.
Since fats are necessary for growth, nutrition, and heat
production, they are indicated in chronic wasting diseases
in which there has been much loss of tissue, and in con-
ditions in which nutritive processes are degenerating.
FAT FOODS 157
ANIMAL FATS.
Besides the fat of meats, eaten as such, the animal fats
in common use are cream and butter, oleomargarine,
butterine, bone-marrow, and cod-liver oil.
Beef Fat, etc. — Beef, mutton, and pork fats consist
chiefly of the glycerides of the common fatty acids —
stearic, oleic, and palmitic. The fat of good beef is whole-
some and nutritious, and bacon cooked thin and crisp
may be eaten by many invalids, but ham fat and pork fat
are very indigestible, especially if eaten hot.
Cream and butter are among the most wholesome forms
of fat. Cream is a good substitute for cod-liver oil. Few
people can take it long in the pure state 'without gastric
derangement, but diluted half with water or Vichy water
it is palatable, and usually well borne. Butter is more
digestible if spread thin on bread or allowed to soak into
hot toast, etc., since this prevents its accumulation in
large particles in the stomach.
Oleomargarine is an artificially prepared substitute for
butter and is a wholesome form of fat. It is made from
beef fat, which is first crushed to mechanically remove
the membrane. It is then heated by steam in the presence
of water, potassium carbonate, and pepsin (in the form
of pigs' or sheep's stomachs) for two hours, after which
it is drawn off, cooled, and pressed.
Butterine is a similar product, differing from oleo-
margarine in the proportion of its ingredients and in the
addition during its manufacture of leaf fat from the hog.
Both of these preparations are wholesome, but the govern-
ment now requires that they be labelled, for commercial
reasons rather than on account of wholesomeness.
158 FOOD IN HEALTH
Bone-marrow is a wholesome form of fat, especially the
marrow of young animals. Red marrow furnishes a
digestible form of fat, together with a digestible form of
iron, which is found in it to a considerable extent. This
is well administered in the form of glycerin extract, which
is easily prepared by rubbing in a mortar the chopped
fragments of twelve sheep's ribs with a pound of glycerin.
This is allowed to macerate three or four days in a cool
place and is then strained through gauze, the resulting
liquid being given in teaspoonful doses.
Cod-liver Oil. — This is a readily digested fat. .Contain-
ing as it does bile salts, it is more readily absorbed than
most fats, and on this account has, to some extent, the
power of penetrating the skin when rubbed in — a property
lacking in most other fats. Advantage is sometimes taken
of this in the treatment of marasmic children, in whom
inunctions sometimes do good.
This oil has for most persons an unpleasant taste and
odor, but by careful administration tolerance can usually
be soon established, and children often develop a fondness
for it. Its digestibility and agreement will be increased
if it is given an hour and a half or two hours after meals,
when gastric digestion is well advanced and the chyme is
beginning to pass into the intestine. When administered
immediately after meals, as is the common custom, the
presence of so large an amount of oil will often interfere
with gastric digestion, and it may undergo decomposition:
while if given at a later period when the food has been
largely acted upon, the oil will pass rapidly out of the
stomach.
It is better to use a good brand of pure oil than any of
the emulsions, as such artificial preparations made with
FAT FOODS 159
mucilaginous substances add nothing to its digestibility
and unnecessarily increase the bulk for administration.
In giving pure oils, it is best to begin with a small dose —
say, a teaspoonful — and gradually increase the amount as
the patient becomes accustomed to it. If the aversion to
it is great, the taste may be covered by administering with
malt extract, whiskey, brandy, or strong coffee, or it may
be given in flexible capsules. Even a pinch of salt taken
before and after the oil will often be sufficient to render
it palatable.
VEGETABLE FATS.
These are derived from seeds. The principal members
of this group are olive oil, cotton -seed oil, cacao butter,
and peanut oil.
Olive oil is made by crushing the whole fruit with the
stones and pressing the resulting pulp in bags. This is
the best oil, but a second quality is obtained by adding
boiling water to the remaining pulp and pressing again.
This second oil is much more apt to become rancid.
Olive oil is a very pure form of fat and is usually well
borne. It may often be substituted with advantage for
cod-liver oil.
Cotton-seed oil is often substituted for olive oil, and,
indeed, much of the so-called olive oil on the market is
made from cotton-seed. It differs in taste and odor from
olive oil, and, unless very pure, leaves an unpleasant after-
taste, but it is not injurious.
Cacao butter is obtained from cacao seeds in the manu-
facture of chocolate. Its chief use is for inunctions and
suppositories, but it is also used in the manufacture of
some infant foods.
160 POOD IN HEALTH
Peanut Oil. — The shelled nut contains from 30 to 50
per cent, of oil, which is of fairly good flavor, but inferior
to olive oil. As with olive oil, several grades are made.
The first cold pressure yields 16 to 18 per cent, of fine
table oil. Other grades are made by the addition of water
and heating, but are hardly suitable for table use. This
oil is not as yet extensively used, but is sold mixed with
olive oil for table purposes.
NUTS.
Though nuts have always been used as delicacies and
for desserts, but little study has been made of their
digestibility. As a class, they have always been con-
sidered indigestible. The usual custom of eating them
as a dessert, when sufficient food has already been taken,
or of munching between meals when the stomach should
be resting will largely explain their indigestibility. Their
large content of oil, further, may interfere with the
digestion of other foods, and when eaten raw, as is done
in most instances, their cellulose and starch will be
difficult to manage.
Several modern systems of diet include nuts as an
important constituent. From the accompanying table it
will be evident that they form a concentrated and nutritious
food. They are not suitable for food by themselves, as
the percentage of fat would be excessive and they should
be used with a good proportion of proteid food. On
account of the low proportion of carbohydrates, nuts are
a suitable food for diabetic patients.
The chestnut differs materially from other nuts in that
it contains quite a small proportion of fat and a large
percentage of carbohydrates. In some countries, as
France and Italy, the chestnut is largely used for food
FAT FOODS
161
by the poor. They are there prepared by steaming after
shelling, or ground into flour from which sweet cakes are
made. Besides the popular roast chestnuts of the street
vender, they are used in this country in the form of soups,
purees, stuffing for fowls, gravies, and various confections
such as marron ice-cream, and the well-known candy,
"marron glace"."
Peanuts, which are really a legume, but are used as nuts
and so classified by the popular mind, differ from others
in their high percentage of proteid. They are popular
roasted. Their use has been described.
Nuts are used for various kinds of confections, sand-
wiches, and other dainty dishes. The accompanying table
contains a list of the varieties of nuts commonly used in
this country:
Table XIII. — Composition of Nuts.
Composition and fuel va!
ue of the edible
portion.
«d
a)
o
p.
'O
m
■ "5
a
K
3
8*
a
<
*
i
f
*
t
*
*
Calories.
Almonds .
64.8
35.2
4.8
21.0
54.9
17.3
2.0
3030
Brazil nuts
49.6
50.4
5.3
17.0
66.8
7.0
3.9
3329
Filberts
52.1
47.9
3.7
15.6
65.3
13.0
2.4
3432
Hickory nuts
62.2
37.8
3.7
15.4
67.4
11.4
2.1
3495
Pecans
53.2
46.8
3.0
11.0
71.2
13.3
1.5
3633
F.ngl ish walnuts
58.0
42.0
2.8
16.7
64.4
14.8
1.3
3305
Chestnuts, fresh
16.0
84.0
45.0
6.2
5.4
42.1
1.3
1125
" dried
24.0
76.0
5.9
10.7
7.0
74.2
2.2
1875
Acorns
35.6
64.4
4.1
8.1
37.4
48.0
2.4
2718
Beechnuts .
40.8
59.2
4.0
21.9
57.4
13.2
3.5
3263
Butternuts
86.4
13.6
4.5
27.9
61.2
3.4
3.0
3371
Walnuts ....
74.1
25.9
2.5
27.6
56.3
11.7
1.9
3105
Cocoanut .
48.8
51.2
14.1
5.7
50.6
27.9
1.7
2986
" shredded
100.0
3.5
6.3
57.3
31.6
1.3
3125
Pistachio, kernels
100.0
4.2
22.6
54.5
15.6
3.1
3010
Pine nut or pifion (Pinus
edulis)
40.6
59.4
3.4
14.6
61.9
17.3
2.8
3364
Peanuts, raw
24.5
75.5
9.2
25.8
38.6
24.4
2.0
2560
" roasted
32.6
67.4
1.6
30.5
49.2
16.2
2.5
3177
Litchi nuts
41.6
58.4
17.9
2.9
0.2
77.5
1.5
1453
11
CHAPTER IX.
WATER. NON-ALCOHOLIC BEVERAGES. ALCOHOLIC
BEVERAGES.
WATER.
Water is a food, as it enters into the structural com-
position of all the body tissues, forming about 60 per cent,
of the body weight. Its regular supply is of more impor-
tance to the body than a regular supply of other foods,
since men can go for many days without food, but very
few days without water will produce disastrous results or
even death. When water is withheld, the secretions of
the body diminish, and all of the surfaces which are usually
moist become dry; kidney activity decreases, and finally
the tissues lose their water with the result of failure of
muscle power. This interference with the proper elimina-
tion of waste products leads to mental affections, delirium,
and finally coma and death.
Excessive use of water is also injurious, and the evil
effects are frequently observed in warm weather. By
excessive drinking the gastric juice is so diluted that it
cannot properly digest the foods; furthermore, an ex-
cess of water in the stomach is apt to wash the food
into the intestine in masses before it has been properly
digested. These two causes lead to fermentation and
putrefaction of food, with the development of loss of
appetite, nausea, vomiting, gaseous distention, and diar-
rhea. A more frequent error, however, in regard to water
is to take too little. The amount actually needed by man
WATER 163
varies between considerable limits. All the water which
enters the body leaves the body as water, unchanged.
This loss occurs through the kidneys, bowels, skin, and
lungs. The condition which increases the rate of loss
will demand a corresponding increase in the supply.
Thus in hot weather, or while working, circumstances
under which sweating is profuse, a greater supply is
needed. All solid foods contain a large amount of water.
When, therefore, dry foods are largely eaten, more water
must be taken as a beverage than with the same amount
of succulent foods. The size of the individual will also
affect the amount of water needed; a small woman or
child will not require as much as a large man.
Water is usually administered by the mouth as a drink.
When so taken, a small amount may be absorbed by the
mucous membrane of the mouth or stomach, but the
greater bulk of it is absorbed from the intestine. It is
often a matter of importance to know that water may be
satisfactorily introduced into the body by other avenues.
For instance, when protracted vomiting prevents the
administration of water by mouth, it may be intro-
duced by rectal injection, and is then absorbed by the
mucous membrane of the large intestine. When it must
be administered in this manner, it is best to use a rectal
tube, as the higher the injection is made the less liable
will be its expulsion. Water thus administered must
always be warm. Another method of introducing water
is called hypodermoclysis, or the introduction of water
into the loose tissues beneath the skin. When this method
is used, a saline solution of normal strength — that is, six-
tenths of 1 per cent. — is used, and this must be carefully
sterilized before injection.
164 FOOD IN HEALTH
The elimination of water is performed by the skin,
lungs, kidneys, and bowels. The skin and kidney activities
are complementary. When the skin is very active, as in
warm weather or in a hot, dry atmosphere, the kidney
activity diminishes, and vice versa. So, too, if the stools
are liquid, both skin and kidney functions are diminished.
It is evident, therefore, that the actual elimination of
water by each of these avenues varies according to con-
ditions, but the approximate elimination is about 28 per
cent, through the skin, 20 per cent, through the lungs,
50 per cent, through the kidneys, and 2 per cent, through
the feces.
The temperature of drinking-water will vary its effects.
Ice-cold water checks the flow of saliva in the mouth and
stimulates a more rapid flow of gastric juice. This check-
ing of salivary flow explains why ice-water does not relieve
thirst as much as water which is not so cold. The admin-
istration of ice-water just before or during a meal will
aid the digestion of albuminous food by increasing the
gastric juice, but it checks the flow of saliva and the
insalivation of starches in the stomach. Hot water, when
taken before a meal, will soothe an irritated membrane
and help to remove mucus, bacteria, and food remnants
from the previous meal, but it will lessen the secretion
of the gastric juice. It is beneficial in cases in which the
acid of the gastric juice is excessive. Many habits in
regard to eating have been followed for ages, and the
reason for them only demonstrated in recent times.
Thus, ice-cream is eaten at dinner, which is largely an
albuminous meal, as it stimulates the gastric secretion
which is needed for the digestion of this kind of food,
but it is taken at the end of the meal in order that time
WATER 165
may be allowed for the gastric insalivation of the starch
food eaten.
The time for drinking water is to be considered. For
several reasons water should be taken sparingly with
meals. If too abundant, the dilution produced in the
gastric juice will retard the digestion of albuminous food
and permit fermentation and putrefaction. Furthermore,
particles of the food may be washed from the mouth into
the stomach before they have been masticated, thus
rendering digestion difficult. It should be taken, there-
fore, with meals only when the mouth is empty, and then
in small quantities at a time. A small amount of water,
thus taken, will help digestion by softening and disinte-
grating the food. The best time to drink water is about
three or four hours after the preceding meal. It then
helps to wash the food from the stomach into the intestine
and prevents retention in the stomach with decomposition.
It is a good practice to drink water on rising in the morning
and also at bed-time. This sometimes will relieve mild
grades of constipation.
It is quite frequently said that water is fattening. This
is not literally true, but the free use of water, by aiding
secretion, helps digestion, increases absorption, and dis-
tributes food uniformly throughout the body. Alteration
in the amount and quantity of food will, therefore, be
more rational than a reduction of water for persons who
fear an increase of flesh.
The purity of drinking-water is of great importance, and
the possibility of the transfer of disease-producing agents
of animal and vegetable origin by water makes its purity
an object for careful investigation, and its source a matter
of material import. Drinking-water is usually derived
166 FOOD IN HEALTH
from springs or rivers and contains various chemicals and
gases, which give it palatability and freshness. The purity
of water thus derived depends largely upon the amount
of its salts. Water containing 5 or 10 grains of mineral
salts to the gallon is considered pure, but when 60 or 70
grains are present it may be actively injurious. Waters
are termed "soft" or "hard" according to the amount of
these mineral salts which they contain.
Rain water is a soft water and more nearly identical with
distilled water than any other form, but it contains many
soluble gases brought down from the air, and if caught,
as is the usual method, from roofs, it will contain dust
and bacteria. Hence, if rain water is to be used for
drinking purposes, it should be collected only at the end
of the shower, after the injurious materials of the air have
been washed out. The less salts water contains the better
solvent it becomes. Rain water, therefore, should not be
kept in leaden cisterns.
Spring water, which has run through gravel, is one of
the best sources of supply. In many regions, especially
in mountains, it contains an excess of earthy carbonates
which may derange digestion and tend to the formation
of "stones" in different parts of the body. This is so-
called "hard water." This injurious excess of salts may
be largely removed by boiling, which liberates the carbonic
acid that aids in holding the salts in solution. Precipita-
tion of the salts follows, leaving pure water above, which
can then be decanted.
Wells are springs with artificial outlets, but the danger
of contamination from neighboring sources through surface
drainage must be borne in mind, and the well so located
as to avoid this threatening danger. Artesian wells, by
WATER 167
their great depth and their mechanical arrangement, are
free from these dangers.
River water that has run over a rock or gravel bed is
good if protected from pollution. Oxidation renders much
organic matter inert, and rivers are thereby purified of
this source of contamination, but not necessarily of disease
germs.
Methods of Purification. — Water may be purified artifi-
cially in three ways — by distillation, boiling, and filtering.
Distillation removes both organic and inorganic impurities,
so that distilled water is absolutely pure, but it is flat and
tasteless. This is due to its lack of air, which may be
corrected by shaking in air or pouring back and forth
from vessel to vessel. Distilled water is now largely used
by ships at sea, which are provided with proper condensing
apparatus for this purpose. Small stills for family use are
now on the market and may be used with as little trouble
as filters. Boiling renders water pure except for mineral
constituents, and it may lessen these by driving off carbonic
acid and permitting precipitation. It destroys disease
germs, frees it from all organic impurities, renders all
ferments inactive, and drives off all the gases of decom-
position which it may contain. Filtering clears water and
removes its coloring matter, and the best filters, when new,
will even rid it of micro-organisms. After a time, however,
the filtering material becomes permeated with bacteria,
which then may be washed through in great numbers.
Much care should be taken to clean filters frequently, and
the filtering material should be boiled at least once a week,
in order to destroy any germs that it may contain.
168 FOOD IN HEALTH
NON-ALCOHOLIC BEVERAGES.
Tea. — Many varieties of tea are on the market. The
difference in their flavor depends upon the*species of plant,
the climate and soil in which they are grown, and the time
of gathering. Teas are classified as green or black. The
difference between them is due to the manner in which
they are prepared. Black tea is made by drying the leaves
in the sun. They are then mashed and rolled and sub-
jected to fermentation, by which the essential oils are
modified and flavor developed. After rolling they are
again dried in the sun and finally fired in an oven. Green
teas are made of younger leaves than the black and are
first dried in pans at a temperature of 160° F. In Japan
they are steamed. Rolling, drying in the sun, and sweating
in bags then follow, and finally they are slowly roasted.
The nutritive ingredients of tea are so little that they
may be disregarded. Its effects are produced by theine,
an alkaloid practically identical with caffeine, the active
principle of coffee, and theobromine, the active principle
of cocoa. The other active ingredient of tea is tannin.
The only difference in effects between green and black tea
is that green tea contains more than twice as much tannin
as the black. This tannin is a vegetable astringent, entirely
lacking in nutritive value. In strong solution, or taken in
quantity, it precipitates the ferment of the gastric juice,
destroying its efficiency. By its astringent effect on the
mucous membrane of the intestines it may cause constipa-
tion. In general it may be stated that teas contain from
2 to 14 per cent, of theine and from 10 to 25 per cent, of
tannin. In the manufacture of green tea the amount of
NON-ALCOHOLIC BEVERAGES 169
water and the theine are lessened, while the tannic acid
is much increased as compared with the black teas.
In preparing tea the manner of its brewing is of great
importance, as the beneficial stimulating properties of the
beverage are due to- the theine, while the tannin produces
injurious effects. Brewing should, therefore, be so con-
ducted that a maximum of theine with a minimum of
tannin may be dissolved. The theine is readily and
promptly dissolved when boiling water is poured on the
leaves, but the tannic acid is much more slowly extracted.
About one-third more of tannin is dissolved from the
leaves by standing for thirty minutes than if they stand
for only five, while the amount of theine will differ but
slightly in the two infusions.
To make tea properly, boiling water should be poured
over the leaves and allowed to stand from three to five
minutes in a warm place, but should not be permitted to
boil. If tea is boiled or allowed to stand longer than five
minutes, its stimulating effect is not increased, but it
becomes stronger in tannin and darker in color. Another
good manner of making tea is to let it stand for several
hours in cold water. A method used in England is to
drop the tea gently on hot water and pour off the brew
as soon as the leaves have all uncurled and settled to the
bottom of the pot. The water used in tea making should
be fresh boiled and not too hard. If stale boiled water is
used its air will be driven out completely and the tea
rendered less palatable. Long infusion will drive off the
aromatic principles and thus injure the flavor of the tea,
besides increasing the extractives, which may give an
unpleasant flavor to the beverage and render the tea bitter
and dark in color. This dark-colored tea is usually con-
170 FOOD IN HEALTH
sidered stronger, but this is a mistake, as it contains no
more stimulating products than a lighter colored tea
properly made. On account of the increased amount of
tannin contained it does, however, taste stronger, as it is
more bitter and astringent to the mouth.
Tea is mildly stimulating to the nervous system, which
makes it refreshing, and it relieves fatigue, especially
when taken on an empty stomach. Partly by the theine
contained, and partly by its heat, tea, to some extent,
stimulates circulation. It is also diuretic, and, when taken
hot, diaphoretic. Taken cold in warm weather, it is
one of the most refreshing beverages. Its very excellence
in this way, however, may lead to its excessive use. Tea
precipitates the pepsin of the gastric juice, if taken in
quantity, and, even if taken more moderately, retards
digestion. By overstimulation of the nerves it induces
insomnia, nervous tremors, and a tendency to worry. In
some instances, by interference with digestion through the
precipitation of digestive ferments, it may cause diarrhea.
It is more apt to cause digestive disturbances when a
person is under great mental strain. It should be avoided
if it tends to constipation, nervousness, insomnia, dyspepsia,
or gastric irritability. It will often relieve a headache,
and is a useful antidote in alcoholic intoxication. The
abuse of tea often leads to troublesome palpitation of the
heart. Tea inhibits salivary secretion, and is best, there-
fore, taken at the end of a meal rather than during the
meal. Teas are frequently flavored by the addition of
leaves of fragrant flowers, such as roses, jessamine, etc.
Coffee. — Coffee is made from the seed of the coffee plant
(Coffea arabica). These must be roasted in order to pro-
duce the characteristic aroma which is due to the develop-
NON-ALCOHOLIC BEVERAGES 171
ment of volatile oils. As these flavoring materials are
volatile, they will be lost by long keeping. Coffee should,
therefore, be freshly roasted before making, if the best
aroma is desired. Coffee contains tannin and caffeine, a
substance identical chemically and physiologically with
theine, the active principle of tea. In the raw state it
contains a .small amount of sugar, but this is lost in
roasting by conversion into caramel. The stimulant effect
of coffee is due to the caffeine and the volatile oils. The
tannin is, of course, astringent, but constipation is not
produced by coffee as it is by tea, on account of the
counteracting effect of the volatile oils which it con-
tains.
The effect and excellence of coffee will depend largely
upon the method of making. Filtration, by which boiling
water is allowed to percolate through finely ground coffee,
makes a coffee of good taste, but it is not an economical
method, as not nearly so much of the coffee is dissolved
as by other methods. It may be prepared by infusion,
ground coffee being put in boiling water and allowed to
stand ten minutes in a temperature a little under boiling.
A decoction may be made by mixing powdered coffee with
cold water and bringing it to a boil. When made by this
method it is drunk without straining. Continued boiling
robs the coffee of its aroma by driving off the volatile oils,
and extracts more tannin, rendering it less digestible.
Coffee is often adulterated, usually by the addition of
chicory, a root which is roasted and ground for this
purpose. It is harmless, and many persons like the flavor
that it imparts. Various other substances — such as peas,
beans, and acorns — are used for adulterating coffee. These
may usually be detected by dropping the coffee into water,
172 FOOD IN HEALTH
when the coffee, unless overroasted, floats, while the
adulterants sink.
Coffee stimulates the functional activity of muscles,
removing the sense of fatigue. Although of little nu-
tritive value in itself, it relieves hunger to some extent,
and when taken with cream and sugar it makes a
valuable food. It is a heart stimulant, and is useful in
collapse. It is also a diuretic and a diaphoretic. It stim-
ulates the nervous system, including the nerve centres, thus
often relieving headache. It increases mental energy. It
excites the flow of gastric juice and, unlike tea, is laxa-
tive, being a stimulant to peristalsis, by reason of the
empyreumatic oils developed in roasting. Furthermore,
the tannin of coffee is in a less active form than that of
tea. Its stimulating effects on the nerves and kidneys are
greater, if taken on an empty stomach.
Though coffee does not inhibit the salivary digestion
as tea does, it materially retards stomach digestion. The
practice, therefore, of drinking strong black coffee after
dinner should be avoided by invalids, although it relieves
an uncomfortable sense of fulness after a heavy meal.
Its use as a stimulant fof mental work is apt to develop
the coffee habit, with its injurious physical results, and
the practice of drinking coffee for night work should be
vehemently condemned, as its continued use will produce
languor, restlessness and insomnia, irritability, dread of
ill, dyspepsia, heart-burn, etc. Too frequently daily use
leads to the same evil condition. Deprivation will then
produce craving.
The relative value of tea and coffee depends entirely
upon individual peculiarity, some persons being able to
drink tea freely who are made nervous and sleepless by a
NON-ALCOHOLIC BEVERAGES 173
little coffee, and vice versa. The addition of cream and
sugar to coffee renders it frequently indigestible to persons
who can take it straight with impunity. A small cup of
black coffee, taken early in the morning before breakfast,
will often relieve constipation.
Cocoa and Chocolate. — Cocoa is prepared from the seed
of the Theobroma cacao. These are either dried imme-
diately in the sun or are previously kept in a warm, moist
place and allowed to ferment in order to improve the
aroma, which, as with coffee berries, is further developed
by roasting. Cocoa contains 45 to 50 per cent, of fat
(known as cocoa butter), about 15 per cent, of albu-
minous substances, and about 15 per cent, of starch.
Besides these nutrients it contains a small amount of
volatile oil developed in roasting and about 1£ per cent,
of theobromine, an alkaloid chemically identical with
caffeine, but differing from it in that it does not cause
sleeplessness or muscular tremors, nor does it stimulate
the mind to such an extent, although it relieves the
sensation of muscular fatigue. It is obvious that the chief
nutritive value of cocoa is due to the fat which it contains.
The large proportion of this often renders it indigestible,
and many preparations on the market are made by adding
other substances with a view of lessening the percentage
of fat. The preparations containing sugar are quite
nutritious, though the sugar added may interfere with
digestion. Unlike coffee and tea, excessive use of cocoa
does not disturb the nervous system. Cocoa is a useful
beverage for children, if a good preparation is selected,
but it leaves a large residue of undigested waste, and is,
therefore, not so easily digestible as is generally believed.
"Cocoa nibs" are the finely ground kernels, from which
174 FOOD IN HEALTH
a decoction is made by boiling in water and then straining
before using. Cocoa is usually prepared for the market,
however, by mixing the ground kernels with sugar or
starch into a paste. If made with sugar it may be prepared
simply by the addition of hot water, but if made with
starch it must be boiled. The fat and albumin, upon
which the nutrient value of cocoa depends, are not soluble.
The preparations of so-called "soluble cocoa," from which
these ingredients have been removed, are therefore
without nutritive value. The fat is removed in the manu-
facture of many preparations of cocoa for invalids' use,
and while these are lacking in nutritive value, they form
a pleasant beverage and are better borne by feeble stomachs.
Some preparations are made by the addition of an alkali
for the purpose of rendering them more digestible by
saponifying the fat. These are good in some cases, but
may neutralize the acidity of the gastric juice.
Chocolate is a preparation of cocoa, to which sugar,
starch, and flavoring substances, usually vanilla, have been
added. It contains 50 per cent, or more of sugar. As a
beverage made with milk, it is very nutritious and, when
pure, is digestible, unless sugar disagrees. Chocolate is
a useful vehicle for disguising the unpleasant taste of meat
extracts and medicines. These preparations of cocoa are
relatively as promptly digested as tea and coffee, leaving
the stomach in about two hours if made with water, and
in two and one-half hours if made with milk.
Cola. — Cola, made from the cola nut, derived from
tropical countries, resembles both coffee and chocolate
and is used similarly. It contains caffeine and theo-
bromine, a little fat, sugar, starch, albumin, tannin, and
a milk-digesting ferment. It is believed to lessen tissue
ALCOHOLIC BEVERAGES f 175
waste, is a mild stimulant to the heart and nervous system,
a diuretic and somewhat tonic to the stomach. It
increases muscular endurance, and is a temporary substi-
tute for food. It is prepared like coffee, by infusion, only
not so strong, and, served with milk and sugar, it is not
unpleasant to the taste and is well borne by delicate
stomachs. Its continued use in quantity will cause
insomnia and produce nervousness.
Coca, a very different substance from cocoa, is derived
from the leaves of the Erythroxylon coca and possesses
stimulating properties, due to its active principle, cocaine.
It lessens the sense of hunger, and is sustaining in great
muscular exertion; it is also a mental stimulant, but its
use is dangerous, as it may lead to the formation of the
cocaine habit, which is easily acquired. Various beverages
are offered at soda-water fountains which contain either
coca or cola. While they are refreshing and, perhaps, not
harmful as an occasional drink, their constant use leads
to grave derangement of the nervous system, and even
to the formation of a "habit."
ALCOHOLIC BEVERAGES.
Ethyl alcohol is the active principle of these beverages,
and is contained by them in amounts varying from 3 to
50 per cent, or more. This variation in the percentage
of the alcohol contained explains the difference in the
effects produced by the use of these beverages, as their
taste and appearance are due to the kinds of grains and
fruits from which they are manufactured, and the result-
ing variations in the amount of sugar and volatile sub-
stances which they hold.
176 FOOD IN HEALTH
As the dominant effects of all of this class of beverages
are due to the alcohol which they contain, a consideration
of the effects of alcohol seems first in order. There is,
perhaps, no substance used in medicine about which there
is greater dispute. Certain effects are definitely observable,
but the manner in which they are produced is not yet
finally settled.
Alcohol, when brought into contact with animal tissues,
robs them of some of their water, deprivation of which
causes precipitation of the albumin of the cell. If this is
not redissolved, the cell soon loses its function. Thus
alcohol acts as a protoplasmic poison.
When taken into the mouth, alcohol produces a sense
of warmth, caused by arterial congestion, and if in strong
solution it causes some puckering by its astringent effect
and a deposit of coagulated albumin on the surface.
Similar effects occur in the stomach. Taken diluted
before meals, alcohol causes an increase in the flow of
saliva and gastric juice, which increases appetite. This is
produced by reflex action from irritation of the nerve
terminals of the mucous membranes. If taken with meals,
digestion is retarded by coagulation of albumin and
precipitation of pepsin from the gastric juice, the flow
of which is checked by large amounts. In the intestine
the retarding of digestive processes is even greater, a much
smaller amount of alcohol lessening the secretion of the
pancreas, while in astringent effects its action is similar
to that in the stomach.
If no more than an ounce and one-half of alcohol is taken
in a day, it is burned in the body and does not appear in
the excretions as alcohol, but if a larger amount is taken
it will be eliminated as alcohol by the kidneys and lungs.
ALCOHOLIC BEVERAGES 177
When absorbed into the blood, it lessens the oxygen of
the red corpuscles, and is itself partly oxidized. Under
the influence of alcohol the red blood corpuscles contain
oxyhsemoglobin, a substance which does not readily give
up its oxygen. Combustion is, therefore, lessened; hence
the fats and carbohydrates are not burned as normally,
but are deposited in the tissues as fat, producing obesity.
Another effect of the lessened combustion is diminution
of heat production; hence a lowering of temperature.
Alcohol further lowers body temperature by producing
dilatation of the superficial capillaries, thereby increasing
radiation from the body and evaporation, thus further
robbing the body of its heat, although a sensation of
warmth is produced by the increased amount of warm
blood brought in contact with the sensory nerves.
The combustion of alcohol in the body, of course,
produces some heat, but it does not increase force. This
has been definitely shown by experiments, which proved
that, while a man under the influence of alcohol feels
strong, he is incapable of doing as much work as under
normal conditions. The combustion of the alcohol
increases the carbon dioxide given off, but does not affect
the nitrogenous waste. The question of its value as a
food is a much disputed point, advocates of both views
deriving their conclusions from its course in the body.
It is unnecessary to give the various arguments here.
Suffice it to say that, if a food, it is one which has no
advantage over many other food substances, and is,
therefore, never necessary for food purposes.
Moderate amounts of alcohol cause the heart to beat
faster and more forcibly. As this effect is observable
before the alcohol can be absorbed, it is evidently due,
12
178 FOOD IN HEALTH
largely, if not entirely, to reflex action by irritation of the
nerve terminals of the mouth and stomach. Alcohol
produces relaxation of the muscle walls of the arterioles,
with consequent dilatation. As a result of this the blood
rapidly enters the veins from the arteries, and, because
there is less blood in the arteries, the pulse seems bounding.
This condition further explains the apparent stimulation
of the heart, which appears to act more forcibly because
the resistance, normally met with, is removed by the
lessening of blood in the arteries. These effects tend to
equalize the circulation in conditions characterized by
congestion of the viscera and mucous membranes.
Habitual use of alcohol will produce paralysis of the
vessels, with permanent distention. Such a condition is
familiar in the reddened noses of habitual drunkards.
The apparent stimulation of the heart by alcohol is not
well maintained, and is soon followed by evident depression.
The effects of alcohol on the nervous system are inter-
esting. Under its influence the vessels of the brain are
dilated like those elsewhere in the body. The result of
this increased blood supply, together with the direct
effects of the drug on the brain cells, produce a similarly
increased mental activity; thoughts and imaginations come
in rapid turn, and speech is more ready. There is a loss
of self-consciousness, which makes the person under this
influence feel more at ease. Such cerebral excitement is
invariably followed by depression, and, if the use of the
drug is continued, the familiar reaction of mind and body
witnessed in drunkards supervenes.
The most modern investigations as to the effects of
alcohol seem to show that it is at no time a stimulant, but
from the beginning a depressant in its effects. The
ALCOHOLIC BEVERAGES 179
explanation of the apparent stimulation of heart and brain
action is that the drug affects the higher centres first, and
as its administration is continued it gradually reaches
the lower centres; thus, by depressing the inhibitory cells
of the brain, restraint is removed and control lessened,
this being the first effect. As a result the heart acts more
rapidly and more vigorously. Thoughts and images come
more promptly and speech flows more readily, because
of the release of control, which normally restrains for the
sake of judgment. Impulse is controlled by the action
of the higher inhibitory centres; and by the progressive
depression of these centres judgment diminishes as the
alcohol is increased. The ease and self-possession felt
under alcoholic influence are due to just the same release
from restraint which to many persons is a normal condition,
and by them called self-respect. . That alcohol affects the
nerve centres in descending order is shown by observation
of the development of drunkenness, in which the patient
first becomes garrulous, then excited and emotional or
pugnacious, then staggers, finally loses power of speech
and grows insensible to pain inflicted.
The habitual use of alcohol leads to degenerative changes
of tissues and the development of fibrous or fatty sub-
stances in place of the normal cells. Metabolism becomes
more and more deranged, with the development of gout
and other similar troubles. Kidney disease and liver
disease are frequently induced by the habitual use of
alcohol.
As with other drugs, the susceptibility of individuals to
alcohol is very variable, some being able to take, without
evident effect, amounts which in others will produce
intoxication. Attention must be called to another indi-
180 FOOD IN HEALTH
vidual peculiarity in regard to the use of alcohol, that
some persons are unable to use the drug in moderation
and invariably take it excessively, if they use it at all.
This idiosyncrasy is often due to heredity. While some
persons can use alcohol moderately without evidence of
harm, its use in health is never necessary, while in diseases
the effects which it produces can be as well or better
obtained from other drugs, and it is now avoided in many
diseases in which, a few years ago, it was considered an
essential part of treatment.
Alcoholic beverages are classified as distilled and
fermented, the former including spirits and liquors, the
latter wines and beers. By fermentation of various
saccharine substances, alcohol may be developed. This
action is due to the effect of yeast on sugar, which breaks
it up into alcohol and carbonic acid. After fermentation
is completed, the mixture consists of sugar, ferments,
water, and alcohol. The alcohol may be separated from
this mixture by distillation. The odor and flavor of the
different kinds of spirits are produced by volatile ethers
and oils developed during fermentation, and vary accord-
ing to the different substances which have been subjected
to the process of fermentation. Any substances which
contain sugar or starch may be used for the fermentation
of alcohol. Those most commonly used for the manu-
facture of spirits are barley, rye, corn, rice, potato, sugar,
and molasses. The spirits most commonly used in this
country are whiskey, brandy, gin, and rum. These vary
in alcoholic strength from 15 to 58 per cent. Proof spirit
contains 49 parts of alcohol and 51 of water, and has a
specific gravity of 0.92. Spirit containing more than this
amount of alcohol is called overproof, while that con-
ALCOHOLIC BEVERAGES 181
taining less than proof spirit is termed underproof. The
spirits distilled from grain or potato are liable to contami-
nation by the presence of other alcohols than ethyl alcohol.
Amylic alcohol, commonly known as fusel oil, is a common
impurity of spirits. Redistillation will separate the pure
alcohol, which is more volatile than fusel oil, the latter
being left behind in the still.
Whiskey. — Whiskey is made by the distillation of
fermented rye or corn, or a mixture of these two with
wheat. It should be at least two years old before using.
Its strength is from 50 to 58 per cent, by volume, and its
specific gravity from about 0.93 to 0.917. As spirits
increase in age, the volatile ethers that give flavor to them
change in character, and the flavor becomes more agree-
able. The Scotch and Irish whiskies are made, usually,
from barley. The smoky flavor so characteristic is due
to the peat and turf fires used in drying the grain.
Brandy. — Brandy, when pure, is distilled usually from
fermented grape juice or wine, although other fruits than
grapes are used for special kinds of brandy. The quality
depends upon the kind of wine from which it is made, the
finest being made from white wines. The color of fine
brandy is developed from the oak casks in which it is kept,
from which some tannin is extracted. Inferior grades of
brandy are colored with caramel. Cheap grades are
manufactured from potato, rice, and corn. These contain
much more fusel oil and other toxic alcohols than that
distilled from wine. Apple brandy is distilled from cider.
Brandies vary in strength from 42 to 55 per cent., and
the specific gravity from 0.941 to 0.925. Brandy should
be kept for several years to ripen. This improves the
flavor, though the alcoholic strength diminishes. Cherry
182 FOOD IN HEALTH
brandy, distilled from ripe cherries, is used to some extent
in America and largely in Europe.
Gin. — Gin, sometimes called Hollands, is doubly dis-
tilled from rye or corn. By redistillation it contains less
solid matter than other spirits. The flavor is acquired
by the addition of juniper to the mash during distillation.
It contains 15 or 20 per cent, of alcohol, but is frequently
strengthened by the addition of proof-spirits, until it
contains 30 to 35 per cent. Sugar is added to some
brands, so that gin may be obtained either "sweet" or
"dry."
Rum is distilled from fermented molasses, when properly
manufactured. Many brands on the market, however, are
made by flavoring rectified spirits with molasses, caramel,
or other flavoring substances. Its alcoholic strength is
equal to that of brandy and whiskey.
These spirits are identical in their alcoholic effects, the
differences observed in their use being due to the special
aromatics and volatile ethers and oils which they contain.
Gin interferes less with digestion than either brandy or
whiskey, and is an excellent diuretic, stimulating the
kidney cells. Brandy interferes with digestion more than
whiskey, partly because of the different aromatic sub-
stances and partly by reason of the tannin which it
contains. The presence of this tannin renders brandy
more astringent than whiskey. It is, therefore, often
preferred in diarrhea, when it is of great value, if pure.
Liqueurs and bitters are made from pure alcohol, or
various spirits or wines, by the addition of sugar and
aromatics. Curacoa is flavored with orange peel; Noyeau
with peach and apricot kernels; Maraschino with cherries;
Kummel with cumin and carraway seed; Anisette with
ALCOHOLIC BEVERAGES 183
aniseed and coriander. Chartreuse and Benedictine are
distilled from a mixture of aromatic substances. Absinthe
is flavored with fennel, which gives it a bitter taste.
Wines. — By the term "wine" is usually understood a
beverage made by the fermentation of grape juice. Many
other substances which contain sugar are fermented into
wines, however, such as various berries — gooseberry,
blackberry, elderberry, etc. The properties of wines,
beyond the alcoholic effect common to all, depend upon
the kind of grapes used, circumstances of soil, climate,
and season, together with the degree of ripeness at the
time the grapes are pressed. The flavor' of wine, like the
flavor of spirits, is due to volatile ethers developed by the
action of the acid, which wines contain, upon the alcohol.
Recently, variation in flavor has been found to vary with
the kind of bacteria present, and isolation of certain
species of yeast enables the winemaker to produce desired
flavors by their introduction into the "must," as the
expressed juice is called.
Different amounts of alcohol are developed, according
to the degree to which the sugar is broken up by fermenta-
tion, and this depends upon the amount of albuminous
material which the grape contains, because the yeast
feeds upon the albumin and, during its growth, ferments
the sugar. In grapes which contain much albumin this
process continues until a large proportion or all of the
sugar is broken up, while, if little albumin is present, the
process is checked before a large amount of the sugar is
changed. Therefore, grapes containing little albumin will
produce a sweet wine, while those rich in albumin will
produce a "sour" or "dry" wine.
Naturally wine contains not more than 15 to 16 per
184 FOOD IN HEALTH
cent, of alcohol, as greater strength than this kills the
yeast cells. Wines which contain a higher percentage
than this have been "fortified" by the addition of alcohol.
This is done in order to aid the flavor and to prevent
further fermentation. Sherries and most champagnes are
fortified wines.
The grape pulp furnishes sugar, organic acids and their
salts. From the seed are derived the essential ethers
which give aroma, while the skins and stems supply
coloring matter and tannin. The tannin is preservative
and prevents mouldiness. Wines are varied in flavor
artificially by the addition of extraneous substances.
White wines are made from selected white grapes and
crushed with their skins, or from colored grapes from
which the skins have been removed. When white grapes
are used the juice is left in contact with the skins for
several days, in order to abstract their soluble materials,
and is then expressed, after which fermentation is obtained
by exposure to the air, in which yeast germs are always
present.
Red wines are made from colored grapes, the skins,
stones, and stems being left to ferment with the pulp.
These are, therefore, more nutritious than white wines,
and more astringent on account of the tannin extracted
from the skins and stems.
When fermentation is completed, white of egg or other
similar substance is added to clear the wine. This acts
just as when it is used for clearing coffee; the albumin,
being coagulated by the alcohol, carries down with it
impurities, leaving the wine bright and clear. Most wines
contain some free tartaric acid and small amounts of malic
and acetic acids. White wines contain most acid.
ALCOHOLIC BEVERAGES 185
The chief constituents of wines are alcohol, sugar, tannin,
free acid, and ethers, and, according to the predominance
of these ingredients, they are classified as spirituous wines,
red or astringent wines, white or acid wines, and sparkling
wines.
Spirituous urines are those which have been fortified
and contain more than 15 per cent, of alcohol. They are
subdivided into "dry" or "sweet" wines according to the
extent to which the sugar has been fermented. Examples
of "dry" spirituous wines are port, sherry, old Madeira,
etc. These contain 17 to 22 per cent, of alcohol. "Sweet"
spirituous wines, such as Tokay, Malaga, Malmsey and
sweet champagne contain about the same amount of
alcohol, but more sugar.
The best kinds of red wines, which are slightly astringent
from the tannin contained, are the French clarets or
Bordeaux wines and the Burgandies, though good clarets
are made in America. These wines are usually wholesome,
especially if taken diluted with plain or aerated water.
Burgandies contain more alcohol than the Bordeaux wines.
White wines are more acid than the red wines, but
contain much less tannin. They are somewhat diuretic
and are wholesome, especially when diluted with alkaline
mineral waters, which counteract their excessive acidity.
Examples of white wines are Rhine wines, Moselle, Barsac,
Chablis, and some of the sauternes, though some of the
latter are strongly saccharine.
Sparkling wines are those in which carbon dioxide is
produced by bottling before fermentation is complete,
gas being developed in the bottle by continuance of the
fermentation. This is called "natural sparkling." Arti-
ficial sparkling is produced by introducing carbon dioxide
186 FOOD IN HEALTH
into the wine, as is done at soda-water fountains. The
better the wine, the longer will the liberation of carbon
dioxide continue after the cork is drawn. These are
possibly the best for invalids, being palatable and having
a pleasant odor. They are sedative in nausea and vomit-
ing, and are quickly absorbed. The type of sparkling
wines is champagne, which is made by a special process
and kept in bottles until fermentation of the sugar is
more or less complete. Champagnes, which contain a
good deal of sugar, are termed "sweet." Those in which
fermentation has been carried farther, so that they contain
very little sugar, are termed "dry" or "sec," while those
in which the fermentation is complete are termed "brut."
The proper fermentation of champagne requires a number
of years, and some manufacturers have substituted an acid
fermentation which is completed in much less time, but
this can be detected by litmus paper after the carbon
dioxide has passed off.
All wines check the chemical process of digestion, and
to a degree far greater than their alcohol would explain.
This is probably due to the effects of the acids and ethers
which they contain. Salivary, gastric, and pancreatic
digestion are all retarded. Sherry and port are most
effective in this regard, clarets are less so, and champagne
least of all. While wines retard the chemical process of
digestion, they stimulate the motor functions, when taken
in small quantities.
Persons leading active lives, with much physical effort,
can take more wine without harm than those of sedentary
habits. Mixing different kinds of alcoholic drinks at a
time is notoriously a more injurious practice than the
taking of an equal amount of alcohol of a single kind.
ALCOHOLIC BEVERAGES 187
Habitual use of wines is apt to derange digestion, pro-
ducing sour stomach and even serious gastritis. Persons
suffering from lithfemia, gout, or rheumatism are invariably
made worse by the habitual use of wines, and often even
by occasional indulgence. As to which wines will best
suit such patients, when they are desired or necessary, is
a question chiefly of experience with the individual, as
wines which one person can take without apparent injury
will often bring on a violent attack in another. Ill
effects in these patients are usually delayed, sometimes as
long as forty-eight hours.
CHAPTER X.
QUANTITY OF FOOD. FREQUENCY OF FEEDING.
RELATION OF FOOD TO EXERCISE, SLEEP, AND
TOBACCO. FOOD IN CHILDHOOD AND OLD AGE.
From what has been stated in the earlier chapters, it is
evident that a mixed diet is the best for health. After the
natural growth has been attained, the purpose of food is
to replace the body waste and to supply heat and energy for
its activities. For the former purpose proteid is essential,
and this is provided in most readily digestible form in
animal foods; while for the latter purpose reliance is
placed chiefly upon carbohydrates supplied by vegetable
foods and fats, of which the animal fats are more readily
digested. It has been shown that the most vigorous
exercise does not increase proteid waste; hence excess of
this class of food will add nothing to the individual's
activity.
Proteid is given in training for efforts producing physical
strain, in order that the muscles may be large and sound
so that they will respond quickly to nervous impulses;
but fats and carbohydrates must be abundantly given in
order to supply an added source for increased activity.
It is evident, therefore, that the proportions of the different
classes of foods must be varied to meet different conditions.
Thus a boat crew training for a race, in which a sudden
spurt of muscular effort is to be made, will be given
proportionately larger amounts of proteid; while day
QUANTITY OF FOOD 189
laborers, whose muscular effort is continued, are supplied
with proportionately larger amounts of fats and carbo-
hydrates.
It would be desirable to maintain an equilibrium between
the intake and output of the body — that is, to supply
proteids in just sufficient quantity to repair the actual
waste of the cells — and to give fats and carbohydrates in
the exact amount required to restore heat as it is lost and
provide energy for the necessary body functions. This
ideal arrangement is practically impossible to maintain, as
conditions which affect the need of the body for food vary
so constantly that no fixed rules can be given which would
meet this need. Habitually, therefore, we consume more
than enough to maintain the equilibrium in order to
escape the graver condition of taking too little, which
would lead to inanition. In estimating the quantity of
food required, it must be remembered that only averages
can be stated and that quantities must be increased or
diminished according to conditions present.
Quantity. — The two chief factors in estimating the
quantity of food necessary are body weight and exercise
or work. It has been estimated that the individual at
rest consumes from 30 to 35 calories per kilo of body
weight in a day, or a little more than 18 calories per pound,
and that one doing light work uses about 40 calories per
kilo. A man of average size at moderate work will require
about 3000 calories per day. This will be represented in
from 40 to 60 ounces of ordinary solid food, which is
equivalent to about 23 ounces of water-free food. The
relative proportion of nitrogenous to non-nitrogenous sub-
stances should be about as 1 to 3-2- or 4. Estimates of
different investigators vary somewhat as to the proportion
190 FOOD IN HEALTH
of fats to carbohydrates as a source of carbon. The
standard daily diet of Moleschott gives proteid 20 per
cent., fat 13 per cent., carbohydrates 62 per cent., salts
5 per cent., or, in actual amounts, proteid 130 grams
(4.59 oz. av.), fats 84 grams (2.96 oz. av.), carbohydrates
404 grams (14.26 oz. av.), salts 30 grams (1.06 oz. av.),
total water-free food 648 grams (22.87 oz. av.); while
Pettenkofer and Voit give proteid 137 grams, fats 117
grams, carbohydrates 352 grams, salts 30 grams, total
water-free food 636 grams.
Calculated by the fuel values given on page 26, the
former provides 2883.6 calories, while the latter provides
2997.3 calories. Cornet states as the average requirement,
proteid 120 grams, fats 50 grams, and carbohydrates 500
grams, which give a total of 2925 calories. It is evident
from these estimates that approximately the same fuel
value may be supplied with considerable variation in the
amounts of the different constituents of diet.
In constructing a diet it must be remembered that we
can only approximate accuracy, since there are several
factors in every computation which introduce errors —
e. g., variation in digestive power of individuals for special
articles and kinds of foods.
The table on page 28 gives the percentage composition
of certain foods and their fuel value, but the body does
not derive this amount of nutriment from them, since they
are not wholly digested. From the results of a large
number of experiments the proportion of different foods
which is digested has been determined, and this is called
the percentage of digestibility or the coefficient of digest-
ibility. The available energy or nutritive value derivable
from foods will depend on the completeness of oxidation
QUANTITY OF FOOD
191
of the nutrients in the body, and this differs somewhat
from the fuel values as given in Table I. The following
table gives the coefficients of digestibility and the available
fuel value.
Table XIV. — Coefficients of Digestibility and Fuel Value
per Pound of Nutrients in Different Groups of Food
Materials.
Kind of food.
Meats and fish ....
Eggs
Dairy products ....
Animal foods (of mixed diet) .
Cereals
Legumes (dried)
Sugars
Starches, . . . .
Vegetables
Fruits
Vegetable foods (of mixed diet)
Total food (of mixed diet)
Proteid.
W«r
mllty - pound.
Fat.
Digesti-
bility.
Fuel
val. per
pound.
97
97
97
97
85
78
83
85
84
92
Calo-
ries.
%
1940
95
1980
95
1940
95
1940
95
1750
90
1570
90
1410
90
1520
90
1840
90
1820
95
Calo-
ries.
4040
4090
3990
4050
3800
3800
3800
3800
3800
4050
Carbohydrates.
Digesti-
bility.
%
98
98
98
97
98
98
95
90
97
97
Fuel
val. per
pound.
Calo-
ries.
1730
1730
1730
1730
1860
1840
1750
1860
1800
1630
1820
1820
In estimating the food value of a diet, therefore, the
percentage of any nutrient as given in Table I. must be
multiplied by the coefficient of digestibility, in order to
determine the amount of such nutrient available for the
body's use in any special article. Thus in Table I. it is
seen that beef ribs contain 13.9 per cent, of proteid, but
from Table XIV. it is seen that the digestible amount of
proteid derived from meats is only 97 per cent, of that
contained in the meat; hence the proteid in meat avail-
able by the body is only 13.5 per cent, of the weight of
the meat consumed.
In the following table the nutrients and energy of the
digestible portion of many common foods is given.
192
FOOD IN HEALTH
Table XV.— Nutrients and Energy of Digestible Portion
of Some Common Foods, with Nutritive Ratios.
3
Digestible nutrients.
u
6
&J9
p.
~
eg
Kind of food materials.
4)
3
£
a 3
•a
'53
i
O H
'P'S
3 .
13
«3
r
I
'ft
3
ANIMAL FOOD.
Calo-
i
i
.^lr
MC
03
J;
a
a*
^ eg M
CO 5
is
■d
d
p
to
o
CD
o
S3
u
CD
ego
§«CS
" p.
..h ca
B
i
a
3
o
1
o
1
First to third day .
2.0
7.0
0.25
1
3K
IK
9
10
K-i ,
Fourth to seventh day .
2.5
7.0
0.33
IK
4
2
iok
10
l -IX
Second week
3.0
7.0
0.50
2K
4
2
10
10
IK
1K-2K
Third "
3.5
7.0
0.75
6
7
4
18
10
Second month
4.0
7.0
1.0
9
8
4
19
9
2K-3
Third " .
4.0
7.0
1.25
11
7K
4
17
8
3 -4
Fourth "
4.0
7.0
1.50
13
7
4
15
7
4K-s
Fifth to sixth month
4.0
7.0
1.75
15
6K
4
13
6
5K-6K
6K-7K
Seventh to ninth month
4.0
6.5
2.0
17
5K
*K
4
11
6
Tenth to eleventh "
4.0
6.0
2.50
21
4
7
5
8 -9
Twelfth month
4.0
5.5
3.0
25
3
4
3
5
9-10
It is best to increase food very gradually. Abrupt
increases are very likely to cause some derangement of
the digestive organs. There are instances in which a very
robust infant will be one or two months ahead of the
average, so that an infant of four months would require
the formula of an infant of six months. On the other hand,
a small child with a rather feeble digestion may be as
much behind. No schedule can therefore be followed with
absolute regularity. It must also be realized that it is not
possible to modify the milk in such a way as to relieve
every transient discomfort or disturbance an infant may
have.
In order to destroy or reduce the number of bacteria
in milk, the milk can be sterilized at low temperature.
The process is called pasteurizing milk. The process can
also be carried on at high temperatures, but the changes
216 FOOD IN HEALTH
that occur in the milk impair its digestibility. The milk
should be sterilized in small bottles, each bottle containing
enough for one feeding. The stoppers should be loosely
inserted. There are various sterilizers on the market.
The temperature should be 150° F. and should be main-
tained from twenty to thirty minutes. This temperature
is sufficient to destroy most of the organisms found in
milk. The milk should be put on ice as soon as it has
been sterilized.
Where no ice is available and the weather is hot,
sterilization at high temperature (212° F.) is certainly
safer, nor is any special apparatus needed.
In case the proteids are not digested or in cases of
illness where some predigested food is needed, the milk
may be peptonized. The process is very simple. One
pint of fresh cows' milk and four ounces of water are put
into a bottle and a powder added containing 5 grains
of extract of pancreas and 15 grains of bicarbonate of soda.
This is kept at a temperature of 105° to 115° F. for six
to twenty minutes. It should be shaken from time to
time. The process can be continued longer and all of
the proteids converted into peptones. To be completely
peptonized, the process should be continued for two
hours. The bitter taste may be covered by lemon juice
and sugar, if very objectionable. Peptonization should not
be kept up any longer than is absolutely needed. The
process can be gradually reduced.
Condensed Milk. — Condensed milk is used very exten-
sively as an infant food. Condensed milk is simply cows'
milk from which a large proportion of water has been
removed. As a rule, the milk is reduced to one-third of
its original volume, so that all that is necessary to restore
FOOD IN INFANCY 217
it to the original condition is to add twice its volume of
water. Very often the cream has been removed by a
separator, so that the product is condensed skimmed milk.
Sugar is more frequently added as a preservative.
On the market we find: (1) unsweetened and condensed
whole milk; (2) sweetened and condensed whole milk;
(3) sweetened and condensed skimmed milk. Number (1)
when diluted with two parts water represents a good
sample of pure cows' milk. The can when opened is apt
to ferment and must be cared for as would fresh meat.
Number (2) contains so much sugar that when diluted with
two parts water we have 16 per cent, of sugar instead of 4
per cent, as in cows' milk. When diluted sixteen times, as
recommended on the can, we have 3 per cent, sugar and
£ per cent, proteid and less than 1 per cent. fat. Number
(3) contains almost no fat and when diluted in the pro-
portions recommended for infants the resulting fluid is
very poor in proteids and entirely unsuited for babies'
nourishment.
There is a large class of infant foods on the market.
All of these foods show deficiency of fat and excess of
carbohydrates. Certain types, however, may be used as
adjuncts to the baby's dietary.
Other Foods. — We must remember that cereals may
successfully tide over an attack of diarrhea. Of the
cereals used as infant food, barley, rice, and oatmeal are
more generally employed. Barley-water is a valuable
food, especially in cases of milk poisoning. The grain
may be used, or the flour. When the grain is used, soak
the barley overnight. To one quart of water put two
tablespoonfuls of barley and boil continuously for six
hours, keeping the quantity up to a quart by the addition
218 FOOD IN HEALTH
of water. Strain through coarse muslin. The water in
which the barley is soaked is not used, as it makes a
barley-jelly. If the flour is used, add one even table-
spoonful of the flour to each twelve ounces of water, boil
for fifteen minutes, and strain. Rice and oatmeal may
be used in the same quantity for rice-water and oatmeal-
water. Oatmeal-water is especially good where there is
a tendency to constipation.
In regard to the commercial or patent foods, the use
of any such food alone is admissible only for short periods
during derangements of digestion, when we wish to with-
hold for the time all fat and milk proteid. Such foods
should not be used with condensed milk, owing to the
large percentage of carbohydrates in both preparations.
When added to fresh milk they may serve the purpose of
milk sugar or cane sugar by furnishing the required
carbohydrates.
Albumin-water is valuable in cases of stomach and
intestinal disorders where an easily assimilated food is
needed. The white of one egg is dissolved in eight ounces
or a pint of water which has been boiled and then cooled.
The solution is strained. Whey mixtures, where the
casein is removed by precipitation and straining, are
particularly valuable for young infants.
Koumiss is a very valuable resource in many cases of
indigestion and is often retained when milk in any other
form is vomited. Matzoon may be similarly used.
Beef preparations are obtained in the shops or can be
prepared at home, according to the methods elsewhere
described. Those on the market may be in the form of
liquid peptonoids or soluble beef. For infants they must
be well diluted. Beef extracts are not to be considered
FOOD IN INFANCY 219
in any sense as foods, as animals fed on these preparations
and receiving nothing else die of starvation. Such prepa-
rations are stimulants and as such are useful. To tide
over some error in digestion is their special use.
Animal broths are largely used where milk is to be
withheld temporarily. They are not adapted to pro-
longed use and they are not very nutritious. Chicken,
veal, mutton, or beef may be used. Many of these broths
are so weak as to be useless.
The feeding of infants during acute illness is an im-
portant part of the treatment of every acute disease that
occurs in infancy. There are cases in which forced
feeding or gavage must be resorted to. The stomach
should first be washed out. The intervals of feeding
should be longer than is customary in health.
Mixed feeding or a combination of nursing and artificial
feeding may be employed. In case the mother has not
a sufficient quantity of milk or nursing is a drain on her
health, mixed feeding may be necessary. Barley-water
may be given in milk, modified milk, whey, or beef juice,
as the case may be. In some instances an infant may be
given a cracker once daily as early as the seventh month.
Weaning. — The process of weaning should be gradual;
at least eight weeks are required to wean a baby. It is
very dangerous to wean a baby at the beginning of
summer or during the summer. By the eleventh or
twelfth month the infant has usually been weaned. This
brings us to the second nutritive period. From the
twelfth to the thirteenth month an infant should have
five meals daily.
Breakfast should consist of bread and cows' milk
slightly warmed.
220 FOOD IN HEALTH
Lunch should consist of equal parts of oat-jelly and
cows' milk warmed, seasoned with salt.
In the middle of the day broth of some kind can be
given with bread.
The meal of oat-jelly can be repeated in the middle of
the afternoon.
The fifth meal should consist of bread and milk, to be
given late in the afternoon.
Some children cannot take bread at such an early age.
The juice of some fruit should form the regular part
of an infant's diet at this age. The juice from a sweet
orange or a ripe peach is best. The fruit should be given
at least an hour before the milk feeding.
From the fourteenth to the fifteenth month well-boiled
rice can be added to the above diet, giving five feedings
in the twenty-four hours.
From fifteen to eighteen months five meals are con-
tinued daily. Butter may be given on the bread. The
child may have a well-baked white potato mixed with
butter and salt added to the midday meal. Stale bread
is desirable, dried crisp in the oven. Now and then a
soft-boiled egg. Strained oatmeal may now be given once
daily. The quantity of milk should be at least a quart.
The value of water must be continually borne in mind.
From the. eighteenth month to the second year there
should be five feedings in the twenty-four hours. One
soft-boiled egg daily may become a part of the diet. One
baked apple can be given at the evening meal. A peach
can be given, if in season; orange juice as above stated;
other fruit had best be avoided. The cereal gruels may
be replaced by porridge of the same variety, but very
thoroughly cooked. Oatmeal requires three hours for
FOOD IN INFANCY 221
cooking, and not twenty minutes, as recommended on the
box. Rare scraped beef or mutton may be given if most
of the teeth are through.
From the second to the third year five meals are given
daily.
Milk: one quart.
Eggs: soft-boiled, one or two daily.
Soups: beef or chicken.
Meats: small piece of steak, roast beef, chicken, at
midday meal.
Vegetables: white potatoes, beans, peas in puree form.
Cereals: oatmeal, rice, barley, crackers, cocoa, zwei-
back.
Fruit: orange, apple, peach, prunes (stewed).
From the third to the sixth year the number of feedings
are usually four daily.
Milk: about one quart daily.
Cream: to be used upon cereals, upon potatoes, or in
milk.
Eggs: every other day is usually often enough or the
child will soon tire of them.
Meat: some meat should be given daily, mutton, beef,
chicken, fresh fish. Meat should not be fried.
Vegetables: white potato, baked or with cream; spinach,
peas, beans; one vegetable daily.
Cereals : oatmeal, hominy, rice, arrowroot, well cooked,
seasoned with cream or milk; little sugar.
Broths and soups: nearly all varieties may be given.
Bread and biscuits: all varieties when stale.
Dessert: plain custard, rice pudding with cream, junket.
To be given once a week.
Fruits: orange juice, ripe peach, baked apples, stewed
222 FOOD IN HEALTH
prunes, pears. Special care should be exercised in the
selection of fruit during the hot months.
To be avoided : vinegar, tea, coffee, spices, wines. Ham,
pork in all forms, corned beef, salted fish, goose, duck.
Fried vegetables, cabbage, onions, cucumbers, beets, and
green corn. Fresh bread, griddle cakes. All sweet cakes
containing dried fruits. All nuts, candies (except small
quantities of chocolate candy), pies, tarts, pastry of every
description. All salads and preserves. Bananas, fruit out
of season, and stale fruit. A child should be taught to eat
slowly and masticate the food thoroughly. A child should
not be forced to eat. During the summer months the
amount of solid food should be reduced and the liquid
increased.
The consideration of the diet of premature infants
belongs especially to the subject of artificial feeding, unless
the infant can nurse. The frequent nursing tends to
disturb the quality of the breast milk and tends to increase
the solids. The premature infant can only digest much
lower percentages of proteids, sugar, and fat than is found
in the normal breast. This is often disastrous to the
infant, so that a normal milk may prove fatal by being
too strong.
By securing two or even three wet-nurses the interval
of each nursing can be made every three hours, the infant
being fed every hour. In this manner the solids in the
milk of the wet-nurses can be lessened. If mother's milk
and the milk of a wet-nurse cannot be obtained, the system
of laboratory method with low percentages gradually
increased is the most rational.
PART II.
FOOD IN DISEASE.
CHAPTER XII.
FEEDING THE SICK. DETAILS OF SERVING FOOD.
RECTAL FEEDING. GASTRIC LAVAGE. MEDI-
CINES IN RELATION TO FOODS.
It must be always borne in mind that a person when
sick does not lose natural characteristics, but is affected
by tastes and aversions as in health. Through loss of con-
trol from weakness these may be intensified and dominate
the patient, or the will may be so weakened that remon-
strance is absent, or fatigue on exertion may be so great
as to discourage the expression of desires, but the indiffer-
ence thus evidenced is often only apparent. Especially
in those diseases in which maintenance of nutrition is a
matter of serious importance and often difficult must due
consideration be given to the details which affect a
patient's willingness to take proper food. Success in
maintaining nourishment often depends upon the nurse's
tact. The following points should, therefore, be well
considered and carefully directed by physicians.
Appetite. — A patient frequently desires food and is very
willing to take it, but has distaste for special articles
offered or for the manner of cooking and serving, which
224 FOOD IN DISEASE
is mistaken for the lack of appetite. A certain amount of
discretion should, therefore, be allowed the nurse within
limits, in order that there may be proper variety. On the
other hand, very definite directions regarding the articles
of food allowed should be given, and all such indefinite
expressions as "soft diet," "liquid food," etc., should be
carefully avoided.
Regularity of Meals. — Punctuality in serving meals
should be carefully observed. The habit of expecting
meals at regular intervals is readily formed, and where
the patient has a capricious appetite and is ready for
food at the proper hour, a delayed meal will often find
the appetite gone.
Quantity of Food. — Nothing more quickly destroys a
feeble appetite than the sight of too much food. It should
be served only in such quantities as the patient will
probably eat. When aversion to food is great, a patient
can often be induced to take more by offering it in small
quantity and replenishing the glass, when a little coaxing
will bring success. When such foods as beef -tea and milk
are given they should not be too much diluted, as appetite
may flag before sufficient nourishment has been taken.
Serving Food. — When a patient has been long confined
to bed and denied the diversion of familiar companions,
or is too weak to find interest in books, the taking of food
becomes an event in his daily routine, and no details of
serving are lost upon him, although, through weakness,
no mention may be made. The greatest care should,
therefore, be exercised in serving food daintily in clean
china and glass with fresh linen. Milk should never be
served in a glass that has been half used, with old milk
sticking to the sides. It is best to serve food in different
FEEDING THE SICK 225
kind of glasses from those in which medicine is admin-
istered, as the power of association is especially great in
sick persons, and such service may lead to repulsion. In
serving fluids, milk, water, etc., serve only the amount
allowed. There is some comfort to a thirsty man in
draining a glass, whereas it is often a hardship to have
to take only a portion, and in weak persons and children
such denial will often lead to marked mental distress.
Patients should never be asked what they wish to eat.
It is well known that housewives and persons who provide
food often eat but little at their own tables, but enjoy
meals which they have not ordered, the appetite being
stimulated by an unexpected dish. This mental effect
on appetite is very marked in sick persons. Care should
be taken that .food, such as bread-crumbs, does not fall
into the bed. An interval should elapse after removing
vessels containing the evacuations before offering food,
and perfect cleanliness on the part of the nurse should be
evident. It is often well to bathe the patient's face and
hands before serving meals. Attendants should never eat
their meals in the sick-room in sight or hearing of the
patient.
Cleansing the Mouth. — Nothing makes against appetite
more than a foul, sour mouth, and the care of the mouth
is most important, especially in helpless patients. When
the mouth is not properly attended to, the tongue becomes
coated and the whole mouth is covered with decaying
remains of previous meals, which offer a ready soil for
the growth of numerous bacteria. When this is swallowed
it is apt to interfere with digestion by setting up fermenta-
tion in the stomach. When the tongue is coated, the taste
buds are buried so that this important source of reflex
15
226 FOOD IN DISEASE
stimulation of gastric secretion fails. Hence, from every
point of view careful cleansing of the mouth is imperative
for good nursing. The mouth should be swabbed fre-
quently with some good antiseptic, such as listerine, bbro-
lyptol, formolid, etc., diluted one part to two or four of
water. If the tongue is heavily coated it should be scraped
with a loop of whalebone and rinsed with an antiseptic
solution before meals are offered. This removes the
debris which covers the taste buds, and thus restores taste,
improving appetite and digestion. Particular care should
be exercised in cleansing the mouth when milk is admin-
istered, and the mouth toilet should always be performed
after its use, as this beverage clings to the mucous mem-
branes and sours easily.
Feeding Helpless Patients. — When a patient is to be
raised to take nourishment, the pillow should be raised
with the head, keeping the head and body in their relative
positions unchanged, to prevent bending of the neck,
which would interfere with swallowing. If fluids are to
be given, the glass should be only half or two-thirds full
to prevent spilling. If a tube is used, it should be bent
near the centre, and it is best if the end be flattened.
Feeding Unconscious Patients. — Only liquid food should
be administered to unconscious patients, and this with a
spoon. It is best to give a teaspoonful at a time, and care
must be taken that each spoonful is swallowed before
another is administered. If the jaws are clinched, food
may be well given, especially in children, through the nose.
Thus it trickles down the posterior pharyngeal wall, and
is not more liable to produce choking than when given
by the mouth. This often disturbs the patient less than
forcing open the mouth. Instead of pouring the food into
FEEDING THE SICK 227
the nose from a spoon, a soft catheter, well oiled, may be
passed gently through the nose into the pharynx or even
into the stomach. Care should be taken, before the food
is poured in, to see that breathing is not interfered with
by a false passage of the catheter into the larynx.
Sleep and Feeding. — The question of waking a patient
to take nourishment must be decided for each case. If
the patient can drop off to sleep again easily after being
aroused, it is well to administer food as often as indications
direct; but sleep is frequently more necessary than absolute
regularity in feeding, and in those cases in which rousing
to take food materially interferes with sleep it is often
wiser to omit the food than to disturb the rest.
Rectal Feeding. — Conditions not infrequently arise in
which patients are unable to take sufficient nourishment
by the mouth. Rectal feeding must then be resorted to.
Conditions leading to this necessity are protracted vomit-
ing, inability to swallow on account of inflammatory pro-
cesses, coma or paralysis, when pain is great in swallow-
ing, when sufficient nourishment to maintain strength is
not absorbed by the stomach, or cannot pass into the
intestines, as in cancer, gastric ulcer, etc.
Rectal feeding is never a satisfactory substitute for
mouth feeding, as only about one-fourth of the nutriment
necessary for health can be absorbed by this means. In
incurable conditions rectal feeding can at best only prolong
life for a few weeks. In other conditions it is of great
service in sustaining a patient for a limited time while
temporary affections are under treatment. Rectal feeding
alone may support life from four to seven weeks, and under
the most favorable circumstances as long as nine weeks.
Success depends upon three fundamental principles:
228 FOOD IN DISEASE
first, to keep the rectal membrane clean and free from
mucus and feces; second, to prevent rectal irritation as
far as possible; third, to restrict the quantity and quality
of foods to such amounts and such substances as will
be most completely absorbed and least stimulating to
peristalsis.
Method of Injection. — Injection should be made high
into the sigmoid flexure by means of a rectal tube. This
tube should be about the size of a stout penholder and
made of soft rubber sufficiently stiff to carry without
doubling on itself, yet not so hard as to injure the mucous
membrane. For children a soft catheter may be used.
The tube should be passed in to the extent of ten or twelve
inches, after being well lubricated with oil, but never with
glycerin, as this excites peristalsis. For injection, some
persons use simply a funnel in the end of the rectal tube,
which, when elevated sufficiently, allows the fluid to flow
in. The best means of injecting into the tube is a hard-
rubber syringe. It should be held upward after filling
with the nutriment and the piston should be pressed until
the contents fill the nozzle in order to expel the air. A
Davidson or fountain syringe may be used, but with these
there is more danger of introducing air into the intestine,
a thing to be avoided, as the presence of air in the rectum
will cause expulsion of its contents.
The purpose of high injection is twofold: First, the
sigmoid flexure offers a far larger area of contact to the
nutrient material for absorption than does the lower
rectum. Second, food absorbed from the sigmoid flexure
is carried after absorption to the inferior mesenteric vein,
and so through the portal vein to the liver, where further
changes are produced before it enters the general circula-
FEEDING THE SICK 229
tion; but if absorbed from the rectum, it is carried by
the veins directly into the vena cava, and so escapes the
changes produced by, the liver.
When given a nutrient enema, the patient should be
placed in bed with the shoulders low and the hips well
elevated on pillows, and preferably lying on the left side,
as such a position facilitates the entrance of the food and
diminishes the probability of expulsion.
Cleansing the Rectum. — Success in rectal feeding depends
largely upon keeping the rectum clean. At least once a
day a copious enema of warm soapsuds and water should
be given. A little salt added helps to remove the mucus.
If the rectum is irritable and large quantities of mucus
present, it is well to add boric acid to the water. Such a
cleansing enema removes the remains of previous meals,
frees the membrane of mucus, and stimulates the circula-
tion, thereby increasing the power of absorption. The
nutrient enema should be given half an hour after the
cleansing enema has been voided.
Hemorrhoids are often a great obstacle to the admin-
istration of nutrient enemata. When they are present,
great care must be taken not to irritate them when intro-
ducing the tube, and it is often of advantage to apply a
2 per cent, solution of cocaine locally.
Frequency of Injections. — The frequency and the amount
of injections will depend upon the irritability of the
rectum. It is best to begin with an injection of three
ounces every six hours, and if the rectum is in good
condition and tolerant, the amount may be increased to
six or even eight ounces or the interval diminished to one
every four or every three hours. Sometimes in emerg-
encies injections of an ounce and a half every two hours
230 POOD IN DISEASE
may be given, but for a short time only, as this will cause
irritation and prompt expulsion if continued.
Temperature of Injections. — Nutrient enemata should be
given moderately warm, say 90° to 95° F. If given very
hot or cold, they are liable to excite peristalsis.
Substances Used for Rectal Feeding. — Materials which
are not absorbable by the lower bowel will act as foreign
bodies, producing irritation and expulsion. For this
reason only such substances as are readily absorbed
should be used. Raw beef juice and the white of egg,
provided a little salt is added to it, are readily absorbed
without predigestion. Sugar is also readily utilized, but
unless in very dilute solution is apt to increase peristalsis
and cause expulsion. Boiled starch is about as easily
absorbed as sugar and is non-irritating. The proteid of
milk is not as readily used as raw meat juice. Peptones
and albumoses are quickly absorbed, and it is, therefore,
of advantage to predigest proteid foods before intro-
duction. Fats are hardly useful, and, further, do harm
by interfering with absorption of other substances. On
this account the yolk of egg should not be used, as it
contains a large percentage of fat. The best foods, then,
for rectal feeding are predigested proteids, which can be
readily prepared with milk or expressed beef juice by the
use of pancreatin as elsewhere described. A mixture of
minced meat with one-third its amount of fresh pancreas,
free from fat, has been recommended as a non-irritant
nutrient. This should be beaten into a paste and sufficient
warm water added to give it the proper consistence for
injection. For this a large-nozzled syringe is required.
The advantage of this preparation is that it may be
retained from twelve to thirty-six hours.
FEEDING THE SICK 231
When alcohol is to be administered by the rectum it
is best given alone, well diluted, for if added to a nutrient
enema undiluted, it is apt to coagulate the food and
interfere with absorption, and, if diluted, it is liable to
increase the bulk too much.
Aids to Retention. — Slow and careful injection of the
enema will conduce to retention and the patient should
be cautioned not to strain. If the rectum is irritable, a
folded towel should be held against the anus for half an
hour or more. If this is ineffectual, fifteen or twenty drops
of laudanum may be added to the enema, or injected just
previous to it, or a small opium suppository inserted.
While this aids retention by checking peristalsis, it is open
to the serious objection of interfering with absorption,
and, further, of producing its constitutional effects. It is
best, therefore, to use opium only when absolutely neces-
sary.
Gastric Lavage. — Another procedure often useful as
an aid to the proper digestion of food is gastric lavage
or stomach washing.
It really belongs to hydrotherapeutics, but its uses are
so closely allied to dietetics that a brief description of it
here seems appropriate.
Lavage is performed with a rubber tube. This should
be sufficiently soft not to wound or irritate the mucous
membrane. The best form is a plain, straight tube,
having a funnel at the outer end, and an eye on the side
of the end which enters the stomach. The tube should
be dipped into warm water, glycerin, oil, or some syrup
not unpleasant to the taste to lubricate it, though water
is usually sufficient. The patient's head should be bent
slightly backward when the tube is passed into the pharynx
232 " FOOD IN DISEASE
and then bowed a little forward as the tube is pushed
gently past the larynx into the stomach. If gagging
occurs hold a moment, and if vomiting is produced
turn the tube down and let the patient vomit around
and through the tube; but always keep the distance
gained.
A marked degree of cyanosis may be produced by
pressure on the epiglottis. In such event keep perfectly
cool and tell the patient to take a deep breath. Tolerance
is soon established. The tube must be measured before
introduction, and the point marked to which it is to be
carried, and care must be taken that it reaches into the
stomach; otherwise siphoriage is impossible.
In washing the stomach it is usually best to use tepid
water, though in some instances very hot water is better.
It should be used in quantities of a pint to a quart at a
time, and washing repeated until the stomach is thoroughly
cleansed. While the water is still running in, lower the
funnel end of the tube and siphon out. It is often well
to add an alkali to the water, and, where fermentative
dyspepsia is present, an antiseptic solution. Washing with
plain water should usually follow in either case.
Lavage is a great aid in treating gastric catarrh and
certain forms of fermentative indigestion, since it mechan-
ically cleanses the stomach and starts beneficial reflex
effects in the alimentary canal. It is thus useful in some
forms of chronic constipation. The time for giving it
varies, some preferring the morning before breakfast and
others bed-time.
In certain conditions, hereafter noted, the stomach tube
is useful for introducing food into the stomach. This
expedient, which is termed gavage, is usually undertaken
FEEDING THE SICK 233
after the stomach has been cleansed by lavage, but not
invariably.
Medicines in Relation to Foods.— The time of admin-
istration of medicines with regard to the preceding or
succeeding meal is a matter of importance, as some drugs
act differently when given on a full or empty stomach,
and, on the other hand, a full stomach will retard the
speed of absorption of the drug.
Alkalies should be given about half an hour before
meals, unless it is desired to check hyperacidity of the
stomach. Given before meals, they stimulate the flow of
gastric juice.
Acids should be given within a half-hour after meals,
or they may be given before meals if the acid secretion is
to be checked.
Bitters and stomachics, which cause an increased flow
of saliva and gastric juice by their local action on the
mucous membranes of the mouth and stomach, should
be given before meals.
Irritant drugs, such as iron, arsenic, etc., except in cases
where the former is used as an astringent, should be given
after food.
Cough mixtures, diuretics, cardiac stimulants, systemic
medicines generally, are to be given between meals, as
absorption is quicker and more thorough then, and their
effect, therefore, more speedily established. Furthermore,
there is possibility of their compositions being changed by
the gastric juice during active digestion.
Remedies intended to act on the intestines and not on
the stomach should be given at the end of gastric digestion,
two to three hours after eating — e. g., salol.
Saline purgatives should be given on an empty stomach,
234 FOOD IN DISEASE
preferably before breakfast. Slowly acting purgatives
should be given on an empty stomach only at bed-time,
when there is probability of a longer interval without
food.
Cod-liver oil is best given about two hours after meals,
since stomach digestion has then been established and the
chyme is passing into the intestine. When given imme-
diately after meals, a very common practice, it is more
liable to produce nausea and vomiting and to interfere
with the digestion and absorption of the proteids in the
stomach.
CHAPTER XIII.
FOOD IN INFECTIOUS DISEASES. TYPHOID FEVER.
CHOLERA. DENGUE. RELAPSING FEVER. TYPHUS
FEVER. YELLOW FEVER. DYSENTERY. INFLU-
ENZA. CROUPOUS PNEUMONIA. ACUTE ARTICU-
LAR RHEUMATISM.
In all fevers there is more or less loss of flesh, usually
proportionate to the degree and duration of the fever,
being most marked when it is protracted, as in typhoid.
This loss is due partly to the consumption of the body
tissues produced by the febrile process, but also to the
inability of the body to appropriate its proper amount of
nutrition. Destruction of tissues, as evidenced by the
progressive emaciation, at once suggests the propriety of
liberal feeding, especially with proteids, but on account
of the lessened digestive power great care and judgment
must be exercised to prevent overfeeding, which would
work injury to the patient. Fever diminishes secretion so
that the amount of gastric juice is much less than normal.
Through weakness and depression of the nerves, which
fever causes, peristalsis is lessened, appetite flags or is lost,
and the tongue is coated to a greater or less degree, inter-
fering with taste. These conditions all decrease the
digestive power. Further, the weakened gastric juice not
only is insufficient to digest foods as normally, but its
antiseptic property is also diminished, so that this material
barrier against the entrance of organisms which produce
fermentation and putrefaction is weakened. If more
food, therefore, is given than can be properly digested by
236 FOOD IN DISEASE
the weakened organs, it will accumulate and undergo
fermentative and putrefactive changes leading to irritation,
with pain, nausea, or diarrhea.
While fevers cause a waste of the fat of the body, this
is not so rapid a process as the destruction of albuminous
tissues, which is often extreme, as is shown by the marked
increase of urea eliminated, amounting often to forty or
fifty grams above the normal in a day. This slower
loss of fat may prove deceptive as to the actual degree of
waste present if one judges only by the appearance of the
patient. The increased elimination of the salts of potas-
sium further points to a relatively increased destruction
of muscle tissues. This process affects the involuntary
muscles as well as the voluntary, thus further diminishing
the digestive power of the fever patient. Under such con-
ditions it is, of course, impossible to build tissues, but by the
liberal administration of proteid food the waste of the body
tissues is lessened, the food undergoing combustion instead.
In remittent and intermittent fevers the question of
nutrition is simpler. During remission and intermission
the tissues recover somewhat their power to appropriate
food, which was greatly diminished or lost during the
febrile period. Advantage is taken of this to feed more
abundantly during these periods in order to maintain
strength. In fevers of short duration, even where the
temperature is high and loss of flesh rapid, as in pneu-
monia with early crisis, anxiety need rarely be felt with
regard to the maintenance of nutrition, unless old age or
great debility complicates the condition; and where
appetite is lost and there is great aversion to food, it is
often well to respect the patient's wishes.
The organs of elimination share with other organs of
the body in the functional weakness produced by fevers.
FOOD IN INFECTIOUS DISEASES 237
There is sometimes danger of such an accumulation of
waste products that these organs will be unable to meet
the demand thus put upon them. Therefore, in fevers it
is necessary to give only foods of such character as will
produce little waste and tend to aid elimination.
It is almost universally admitted that only fluid foods
should be given fever patients. The loss of function of
the stomach is far greater than that of the intestines and
often practically amounts to cessation of gastric usefulness.
Under such conditions the food would pass more or less
unmodified through the stomach; hence, in giving solids
there is danger of producing irritation and consequent loss
of function in the intestines, upon the proper performance
of which the patient's life depends.
The principles underlying the rational dietetic treat-
ment of fevers are, therefore: first, to feed the patient as
liberally as is consistent with safety in order to check
albuminous waste and retain strength; second, to select
such foods as are readily digested and absorbed, on
account of the diminished power of the digestive organs;
third, to select foods that will produce the least possible
strain upon the organs of elimination. And it must
constantly be borne in mind that there is no appropriate
routine in diet any more than in the use of drugs, but that
the diet must be suited to the patient's digestive ability
and intelligently varied to stimulate appetite and digestion.
Typhoid Fever. — In this disease the state of appetite
is never to be taken as an indication of the patient's need
for food. During the first few days of the disease the
appetite is diminished and capricious, and the foods,
always liquid, must be varied in order to induce the taking
of more nourishment. After a few days the appetite is
usually lost and the patient frequently is somnolent and
238 FOOD IN DISEASE
indifferent to food. Variety then ceases to be of impor-
tance and the food best digested should be adhered to.
In convalescence the appetite becomes voracious, demand-
ing solid food and abundance of it, rather than marked
variety. Great care must be exercised in indulging the
patient's demands. Until convalescence is well established
the diet should be limited to the following liquid foods :
Milk. — As this is a complete food, furnishing all the
necessary materials for the use of the body, its advantages
are at once apparent. It is nutritious, easily procured,
cheap, convenient for administration, and to most persons
palatable and digestible. These very advantages are
liable to induce one to. overlook certain objections. It is
too often given as a matter of routine, for it should not be
forgotten that many persons cannot digest milk. Another
important fact for consideration is that, though milk is
administered as a fluid, it coagulates in the stomach into
large, firm curds, or, in other words, is there converted
into a solid food. When digestion is feeble, these curds
often pass through the digestive tract unaltered and are
visible in the stools. Under such conditions the food fails
of its purpose to nourish the body, and acts as a mechanical
irritant to the inflamed and ulcerated intestines, thus doing
positive harm and further increasing the intestinal disturb-
ance. When milk is administered in typhoid, the stools
should be carefully watched for this curd, and with its
appearance the milk should be withheld, reduced, or
modified. The curd often appears in large pieces, but it
sometimes occurs in minute particles which require the
closest examination to discover. Great care must there-
fore be taken in observing the stools.
It should be remembered that the digestibility of milk
FOOD IN INFECTIOUS DISEASES 239
may be increased in various ways; boiling, diluting with
water, or, better, with some alkaline or effervescent water,
equal parts, will often be sufficient to render it digestible.
Lime-water, one ounce to three or four ounces of milk, is
often used, but from recent experiments it is claimed that
lime-salts ingested with the milk increase the coagulability
of the blood and the danger of thrombosis. Citrate of
soda, twenty to forty grains to the pint, has been sug-
gested as a better means of neutralizing the acids.
Many patients object to milk on account of its taste.
Its palatability may be improved by the addition of
various flavors, such as sweetening with grape sugar or
milk sugar; the addition of coffee, tea, or cocoa; or the
use of wine, brandy, or whiskey as flavoring agents, if not
contraindicated by the patient's condition. Fruit juices
are often serviceable for a like purpose. Many of the
prepared infant foods are useful, added to milk, as they
mechanically prevent the formation of large curds, thus
increasing its digestibility, besides adding more nutriment.
Many persons who object to the taste of milk will take it
willingly in the form of ice-cream, even when it is not
flavored. This is a matter of some importance, since it
is often unwise to add flavoring materials to milk in order
to make it palatable. Ice-cream may be given several
times a day, and often proves more refreshing than milk.
It should for evident reasons be administered slowly.
When milk is the prescribed diet, two to three pints in
twenty-four hours are sufficient under ordinary circum-
stances. A generally convenient manner of administration
is to give four to six ounces every three hours, though
conditions may render it necessary to administer in
smaller amounts at shorter intervals.
240 FOOD IN DISEASE
Variety in a milk diet may be secured by using its
different preparations. Buttermilk is an excellent substi-
tute, and contains all the nutriment of milk except the
fat, its percentage of proteid being greater. For many
persons it is more digestible than milk, as it is not liable
to make large curds. Whey is another useful substitute
when milk disagrees; it contains much of the salts and
sugar of the milk and the soluble albumin. Junket and
koumiss are often useful. When plain milk disagrees, it
may be predigested with pancreatin, partially or com-
pletely.
Because of the danger of intestinal irritation by curd
and the liability to fermentation of milk, many physicians
now exclude it from their typhoid dietaries.
Eggs. — These constitute another complete food most
useful in the typhoid dietary. The preparation most
commonly in use is egg albumin, or albumin-water,
which is made by beating the white of egg with an equal
quantity of water, straining, and flavoring. Lemon,
orange, and grape juices are useful flavoring agents for
this preparation. The whole egg may be beaten with
boiling water, strained, and sweetened; though some prac-
titioners object to the use of the yolk of egg during the
febrile period. With many patients the yolk seems prone
to undergo fermentation, increasing distention. When
the whole egg is permissible, it may be given as a soft-
boiled egg, if its consistency be not firmer than jelly.
When alcohol is used in typhoid, it may be mixed with
egg in the form of egg-nog as a palatable and nutritious
method of administration.
Soups and Broths. — Care must be taken not to administer
proteid foods in too concentrated form. Meat extracts
FOOD IN INFECTIOUS DISEASES 241
and infusions are useful as stimulants to appetite and
digestion, lessening the risk of exhaustion and supplying
a large amount of saline material, thus replacing the
deficiency caused by pathological elimination. Soups and
broths made from beef, lamb, chicken, veal, mutton,
oysters, and clams are suitable, and may be thickened
moderately with various cereal gruels and flavored with
expressed vegetable juices, like celery, or those of aromatic
herbs, like thyme; these should be carefully strained.
Gelatin. — This is of undoubted value as a tissue sparer,
lessening proteid waste. It is readily digestible, and by
flavoring in various ways makes a most palatable variation
in diet. It should be given in moderate amounts, as excess
will cause diarrhea and tympanites. Its use has been
recommended when hemorrhage is present. It is then
given in two to four-dram doses of a preparation made
by adding one-half to one dram of commercial gelatin
to one pint of water.
Proprietary Preparations. — Many of these are on trial and
seem to serve a useful purpose. Among them may be men-
tioned Somatose, Plasmon, Panopeptone, Liquid Pepto-
noids, and various meat extracts. Valentine's Meat Juice,
a preparation undoubtedly rich in nutriment, is much used
by English physicians, by whom it is highly valued because
of its prompt absorption from the stomach without leaving
waste which might irritate the intestines. For this reason
they make special mention of it as a useful food when
hemorrhage occurs in typhoid, patients being supported
by it as the only food for a week or more.
Carbohydrates. — These are useful as tissue savers, and
may be given in the form of gruels made of oatmeal,
barley, rice, wheat, tapioca, or sago, carefully strained.
16
242 FOOD IN DISEASE
These foods should not be used with milk and eggs in the
form of puddings. Gruels may be flavored with various
spices, orange or lemon peel, and salt, or they may be
sweetened. Barley-water and rice-water contain very slight
amounts of carbohydrates, but are useful as beverages.
Grape sugar and milk sugar are easily assimilated forms
of carbohydrates. They should be given well diluted,
usually as sweetening for various beverages.
Beverages. — An abundance of water is essential for fever
patients. Instructions should be given for the regular
administration of water just as for nourishment, and
nurses should not wait for a patient to ask for it before
offering. Water increases the elimination of waste products
from the blood and prevents concentration of that fluid.
It raises blood pressure and increases kidney activity. It
dilutes the noxious materials in the blood and lessens their
irritating and depressing effects upon the nervous system.
In severe cases when coma or delirium prevents the
ingestion of sufficient water by mouth, it may be well
given by rectum; when thus administered it is well to
add a little salt. If the rectum becomes irritable so that
the water is not retained it can be given with advantage
subcutaneously. In this case normal saline solution
should be used.
In giving water by mouth it is best, when practicable,
to give the kind of water that a patient is accustomed to.
If it is preferred with lemon or orange juice or unfermented
grape juice, sweetened with grape sugar or milk sugar, there
is no objection, and by thus flavoring, many patients will
be induced to take an amount of water otherwise impossible.
Coffee, tea, and cocoa may be given when the patient is
accustomed to them and no contraindication exists.
FOOD IN INFECTIOUS DISEASES 243
The use of alcohol, which was formerly employed most
liberally in typhoid, is becoming more and more restricted.
Opinions differ as to the degree of its usefulness, many
physicians not prescribing it at all. It is generally agreed,
however, that its use as a routine measure is unjustifiable
and that, if given, it should only be in the face of evident
and positive indications.
Solid Feeding. — This is the term applied to a new plan
of treatment advocated by some of the leading prac-
titioners of to-day, and upheld by extensive clinical and
hospital statistics. In addition to the above fluid dietary,
they also use throughout the entire course of the fever
soft, non-irritating, easily digestible solid food, such as
scraped beef, meat pulp, minced chicken, oysters, crackers,
bread, creamed potatoes, and custards. Though advo-
cated by distinguished men who practise it, solid feeding
has not as yet been accepted by the profession at large.
Statistics were recently completed in the Massachusetts
General Hospital which showed a comparison of one
thousand cases nourished by liquid diet with one thou-
sand cases which received solid food throughout. The
mortality was slightly lower among those who received
solid food and their comfort was greater. With the mul-
tiplication of such evidence, it is probable that material
alterations will soon prevail in professional opinions con-
cerning nutrition in typhoid.
Mouth Toilet. — Since it is recognized that the mainte-
nance of nutrition is the most important part of the care
of a typhoid patient, every measure which tends to this
end should be assiduously pursued. No single useful
measure is attended with such gratifying results as is a
thorough and continued mouth toilet. By attention to
244 FOOD IN DISEASE
this the distressing fermentation, which may develop a
paresis of the intestinal walls with threatening tympan-
ites, may be forestalled. Food can be administered with
much less difficulty when the mouth is kept clean, many
patients even maintaining appetite throughout the course
of the disease. Marked effect is often evident in the
general condition of the patient after mouth cleansing
has been properly instituted, as is shown by lessened
fever, clearer intellect, and a moist, soft tongue. A good
routine is to cleanse the mouth before and after every
feeding by scraping the tongue and buccal surfaces with
a loop of whalebone and then swabbing out thoroughly
with antiseptic solutions, as described on page 225.
Diet in Convalescence. — Considerable difference exists in
the judgment of physicians as to the time to begin solid
feeding. It is better to err on the safe side, although each
day's delay is a great trial to a hungry patient, than to
feed too soon and subject him to the danger of relapse.
The diet may be increased in quantity three or four days
after the evening temperature becomes normal, but solid
food should be withheld until the tenth day thereafter.
The transition from liquid diet to solid feeding must be
gradual. Beginning with very soft-boiled eggs or milk
toast, such articles may be added day by day, as scraped
beef, custards, stale bread, hard-boiled yolk of egg, minced
chicken breast, then baked or mashed potato, chops, and
thus a gradual return to the regular diet in the course of
three weeks. Any rise of fever will necessitate an imme-
diate return to liquid diet.
An occasional exception to the rules of feeding just laid
down occurs in those debilitated cases which after a
protracted course continue to have a low fever after the
FOOD IN INFECTIOUS DISEASES 245
typhoid state and typhoid stools have entirely disappeared.
This is known as inanition fever and requires feeding.
Increasing the diet with semisolid foods, such as milk
toast, soft-boiled eggs, etc., will in these cases hasten the
cessation of fever. These foods should be given during
the normal period of temperature, liquids being continued
while fever is present.
Cholera. — The infection of cholera is always trans-
mitted by water and gains entrance to the body by the
mouth. From this fact it will be readily understood that
cholera may be largely prevented. Great care should be
observed in the disinfection of stools and vomitus, as well
as of all clothing, bed-linen, and utensils used about the
patient, in order to prevent contamination of the water
supply and transmission of the disease.
Prophylaxis. — No uncooked food of any land should be
eaten, such as celery, lettuce, and fruits, as there is danger
of contamination of such articles by the water used for
washing them. All water used for cooking, drinking, and
such toilet purposes as cleaning the teeth, should be
sterilized by boiling and well protected thereafter from
possible contamination. Water and milk may be cooled
after sterilization by placing their containers on ice, but
under no circumstances should ice be allowed to come
into direct contact with foods or drinks, as the ice is liable
to be infected. The comma bacillus, which causes cholera,
does not thrive in an acid medium. Acid drinks are
therefore beneficial, and the liberal use of lemons and
limes with the addition of sulphuric acid is of advantage,
as it tends to check the growth of the bacilli in the stomach,
and, if used frequently, considerable acid will pass into
the intestines, lessening the possibility of the development
246 FOOD IN DISEASE
of the bacteria there. Care must be observed during an
epidemic with regard to food, and all articles of diet which
are apt to produce indigestion, such as pastries, must be
carefully avoided, as gastric disturbances which permit
food to undergo fermentation in the stomach increase the
danger of infection. Overeating must be carefully avoided,
and only very moderate amounts of food taken. The
manner of cooking food is also of importance for the same
reason, and fried articles are best excluded. Thorough
cleanliness on the part of attendants is imperative. After
handling the patient or removing the dejecta, the hands
should be sterilized and thereafter washed with soap and
water. Attendants should never eat in the patient's room,
and should be scrupulously careful about disinfection
before eating.
Treatment. — Vomiting and profuse serous diarrhea are
the characteristics of this disease. Vomiting is aggravated
by food, and, when extreme, precludes the administration
of nourishment by mouth. In the early stage of pre-
monitory diarrhea, milk, whey, or gruel may be given in
very small quantities, a few teaspoonfuls at a time, if it
can be retained. The use of the stronger albuminous
foods, such as meat juice and extracts, is not advantageous,
as these form an excellent culture medium for the bacilli.
Acid drinks are to be used freely, as in prophylaxis. When
the serous diarrhea begins, and while the disease is at
its height, food is useless, as it will not be retained. The
loss of water by diarrhea and vomiting is enormous and
rapid. This produces great emaciation and violent cramps,
the patient speedily collapsing. The blood is concentrated
and filled with toxins which are the real cause of collapse.
The need of water, therefore, is imperative to supply the
FOOD IN INFECTIOUS DISEASES 247
drained tissues and to dilute the toxins in the blood, so as
to lessen their irritant and depressing effects on the nerve
centres. The liberal use of water hastens the toxins to the
organs of elimination and aids in their removal. Entero-
clysis, or the introduction of water high into the intestine,
is one means. For this a rectal tube should be used and
about two quarts injected hot, very slowly. It is well to
add a little boric acid or salt, as this will often relieve the
tenesmus. By this means the bowel is cleansed and many
bacilli are washed out. Some water is also absorbed,
although the process is slow and imperfect and largely
prevented by the diarrhea.
Another method of introducing water, which gives
prompt and impressive results, is intravenous injection of
saline solution. While efficient, the method is a dangerous
one, on account of the possibility of sepsis or the intro-
duction of air into a vein, with embolus formation and
its results.
The more usual method to-day, which, while less prompt
is more lasting, is hypodermoclysis, the introduction of
water into the loose subcutaneous tissues. For this
purpose normal saline solution should be used, which may
be prepared with sufficient accuracy by dissolving a
heaping teaspoonful of salt in a quart of sterilized water.
Five to fifteen ounces may be injected several times a day.
It should be given at a temperature of about 100° F., and
is imperatively demanded when the algid stage develops.
Hypodermoclysis may be readily practised with a fountain
syringe and a small aspirating needle. Thorough aseptic
precautions must be observed and the introduction must
be made slowly into the thighs or the side of the abdomen.
The intraperitoneal injection of hot milk has been
248 FOOD IN DISEASE
recommended as a means of introducing water and
nourishment, but the value of this procedure is as yet
undetermined.
As vomiting diminishes and recovery begins, teaspoonful
doses of milk or broth may be tentatively given. If
retained, the administration may be repeated every fifteen
or twenty minutes, and after some hours the quantity may
be increased and the interval extended. The stomach
and intestines are apt to remain irritable for some time.
After vomiting and diarrhea have ceased, the diet of
convalescence should be like that of typhoid fever.
Dengue. — This is a mild fever and runs a comparatively
short course. While fever exists, diet should be like that
of typhoid, but convalescence in this disease is much more
rapid than in typhoid and there is no ulceration of the
intestines, so that return to solid feeding may be made
much sooner.
Relapsing Fever. — Diet during this fever is to be
regulated like that of typhoid. It is well to adhere to
absolute milk diet if jaundice is present. After the fever
subsides, return to regular diet may be speedy.
Typhus Fever.— During the fever the diet should be like
that of typhoid, but since the disease is shorter than
typhoid and intestinal lesions are absent, solid food may
be given sooner in convalescence. The stomach should
be spared as much as possible, however, and small
quantities of food given at frequent intervals to avoid
overloading. In some instances, when vomiting is severe,
rectal feeding must be resorted to for a short time.
Yellow Fever. — In this disease vomiting is a marked
and violent symptom, which is increased by the admin-
istration of food. It is, therefore, best to withhold all
FOOD IN INFECTIOUS DISEASES 249
food for the first two or three days, unless prostration is
extreme, when attempts may be made to give food in very
small quantities. The continued vomiting greatly lessens
secretions, and water is essential to restore glandular
function and maintain kidney activity. It cannot be
retained by the stomach, so must be administered by
enteroclysis or hypodermoclysis, as in cholera.
Following the turbulent onset of the disease comes a
period of calm when all symptoms abate. Some take
advantage of this period of remission to feed by mouth,
but if it is done extreme care should be observed, as the
stage of calm is followed by a second rise of fever and
violent return of all previous symptoms, which will be
aggravated if the stomach has been overtaxed. It is
probably safer, even during the period of calm, to restrict
nourishment to rectal feeding, for which pancreatinized
milk and beef juice are to be used. After all symptoms
have abated mouth feeding may be resumed, but the diet
must be liquid for ten days or two weeks, as the stomach
remains very irritable for some time and fatal relapses
have been produced by the too early use of solid food.
Soft foods may be given in ten days to two weeks after
convalescence begins, and thereafter the diet should be
regulated as for typhoid fever. When albuminuria is
present, highly albuminous foods, such as meat prepara-
tions and eggs, must be withheld.
Dysentery. — Mild cases of this disease may often be
satisfactorily controlled by diet, but imprudence in diet
may cause severe exacerbations or relapses. During the
first day or two of the disease it is well to give little or
no food, as this relieves the stomach, lessening its irri-
tability by rest, and permits a thorough cleansing of the
250 FOOD IN DISEASE
bowel, which could not be accomplished if food were
regularly administered. Discretion must be used in the
selection of foods in dysentery, and only such kinds
prescribed as will leave little residue, which in the inflamed
condition of the intestine would readily undergo fermenta-
tion. Absolute milk diet is preferred by some physicians.
Meat juices and eggs are allowable and egg may be given
soft boiled or soft poached. In severe cases farinaceous
foods are to be withheld, as they leave a large residue and
readily ferment. Demulcent drinks, such as barley-water
and rice-water, or flaxseed tea, may be given, flavored
with lemon juice.
In convalescence raw oysters, or the breast of squab
or chicken, are good solid foods to begin with. Stale
bread and crackers may then be allowed. For the extreme
emaciation which develops in some cases inunctions of
cod-liver oil or olive oil have been recommended.
Influenza. — This disease is characterized by profound
depression out of all proportion to the intensity of the
symptoms. Abundant nourishment is, therefore, impera-
tive. In mild cases articles of soft food, such as soft-
cooked eggs, raw oysters, jellies, milk toast, etc., may be
given. In severe cases the food must be restricted to
liquids of the most digestible character. When vomiting
is severe mouth feeding may become difficult. Unfortu-
nately diarrhea often occurs at the same time to such an
extent as to preclude rectal alimentation. Under such
conditions abstinence for twenty-four hours may check
vomiting and is permissible if the patient is robust. If
the patient is weak, however, and especially in old persons
and children, it would not be safe to withhold food, and
milk or meat extracts must be given in small amounts
FOOD IN INFECTIOUS DISEASES 251
frequently — say, a teaspoonf ul every fifteen minutes to half
an hour.
Prostration continues long into convalescence and the
most nourishing foods are necessary. Beginning with soft-
cooked eggs, raw oysters, and scraped beef, solid foods
may be gradually added, such as breast of chicken, fish,
and farinaceous foods. Tea and coffee are useful stimu-
lants. Such fruits as cooked apples, stewed prunes,
oranges, and grapes may be given. Food should be
administered in small amount at short intervals until
strength is well regained.
Water should be taken freely throughout the course of
the disease and especially in convalescence.
Croupous Pneumonia. — Foods should be limited to
liquids as a rule. Though milk will form the basis of
diet, broth, soft-cooked eggs, custards, and gruels may
be given. Care must be taken to avoid such foods as may
ferment in the stomach, for distention of that organ with
gas would materially interfere with respiration. The
disease is usually of short duration and feeding is not
often a difficult matter. Sometimes in delirium all foods
will be refused and it may be necessary to nourish by
rectum. In very mild cases soft foods, such as milk toast,
beef pulp, and jellies may be given with propriety. In
cases with delayed crisis, in which the fever hangs on,
feeding must be carefully conducted along the lines laid
down for typhoid fever. As in that disease, mouth
cleansing is of importance.
The febrile albuminuria which occurs commonly in this
disease does not require special treatment, but if nephritis
develops the diet should be limited to milk.
Water should be given freely throughout the course of
252 FOOD IN DISEASE
the disease as in other infections. Lemon, orange, and
grape juice may be used liberally. The free use of alcohol
was at one time the recognized practice in the treatment
of pneumonia, but it has been entirely abandoned by many
practitioners. There is no indication for which it was
given that cannot be better met with other drugs.
Acute Articular Rheumatism. — Though it was formerly
taught that this disease was due to perversion of nutrition,
a view still held by some, it is more and more generally
believed to be an infectious disease. Its general manage-
ment is in many respects similar to that of typhoid.
During the febrile stage milk is the best diet, since, besides
supplying nutriment, it stimulates the kidneys. If milk
cannot be taken, broths and gruels may be used. Egg
preparations, such as are used in typhoid, may be substi-
tuted. Acids are usually craved, and may be given in the
form of lemonade and oranges. Alcohol, tea, coffee,
cocoa, and chocolate should be excluded from the diet. As
convalescence proceeds, farinaceous foods may be added,
such as milk toast, boiled rice, arrowroot, oatmeal, etc.
The increase in diet should be very gradually made and
meats should not be eaten for some time, since too early
indulgence is liable to bring on a relapse. When they are
allowed, oysters, fish, and chicken breast should be first
tried, and, later, other meats. While on liquid diet the
patient should be fed in moderate amounts at frequent
intervals, say every two hours, but in convalescence the
quantity may be gradually increased and the intervals
lengthened. Throughout the disease water should be
freely given.
CHAPTER XIV.
FOOD IN INFECTIOUS DISEASES (Continued). MALARIA.
SEPTICEMIA AND PYEMIA. ERYSIPELAS. SMALL-
POX. SCARLET FEVER. MEASLES. DIPHTHERIA.
CEREBROSPINAL MENINGITIS. WHOOPING-
COUGH. PULMONARY TUBERCULOSIS.
Malaria. — In intermittent malaria the paroxysms are
of such relatively short duration that feeding may be
suspended unless the patient is very feeble. During the
nausea which usually accompanies the chill it is best to
withhold food, but if the patient is weak during the fever
which follows, milk or broths may be given. Water should
be given freely and during the intermission return may
be made to solid foods. In convalescence anemia is
present and constipation is frequently an annoying sequel.
A generous diet of meats and fresh vegetables is therefore
indicated.
Remittent fever should in general be treated dietetically
like typhoid as to quantity and frequency of feeding. As,
however, intestinal ulcers are absent in this disease, semi-
solid foods, such as custards and farinaceous foods, may
sometimes be given. Acid fruits and water should be
frequently used to aid in eb'mination. The use of alcohol
is rarely, if ever, necessary, and the common custom in
malarial districts of using it in large amounts is an error.
In convalescence prostration and anemia are met with.
A generous mixed diet with abundant meats should be
given. The free use of water should be encouraged to
dilute the increased nitrogenous waste.
254 FOOD IN DISEASE
In malarial cachexia digestion is far below normal,
appetite poor, and vomiting a frequent and often persistent
symptom. The diet should be restricted to the most
nutritious liquid foods and given in small amounts fre-
quently. It may even be necessary to resort to nutrient
enemata. When there is no vomiting, soft diet may be
given, including such articles as minced meats,- raw or
rare; oysters, clams, stewed fruits, and milk toast, but
caution must be exercised not to overfeed, in order to
avoid inducing vomiting. Water should be freely given,
and as the condition improves and convalescence is estab-
lished, the diet should be increased as in other forms
of malaria.
Septicemia and Pyemia. — These infections markedly
impair digestion and consequently produce great loss of
appetite and strength, with wasting of the tissues. The
drain upon the body is great and food of easy digestibility
should be abundantly provided and pushed in quantity
as far as the stomach will tolerate. The diet should be
liquid, consisting of milk, broths, and gruels. The more
chronic the condition, the greater the need of food, and
in prolonged cases with continued suppuration solid food
must often be given. When the stomach is intolerant of
the necessary quantity, mouth feeding must be supple-
mented by nutrient enemata. Water must be plentifully
administered by mouth if possible, by rectum and hypo-
dermically if necessary. The conditions often show
remissions, during which food can be increased. Stim-
ulants are often necessary and are well borne. If nephritis
occurs, diet must be modified accordingly. In convales-
cence a gradual return to normal diet should be made in
the usual manner.
FOOD IN INFECTIOUS DISEASES 255
Erysipelas. — In mild cases it is not necessary to adhere
rigidly to liquid diet, but such articles of soft diet as
oysters, farinaceous foods, custards, milk toast, etc., may
be used, and the patient should be abundantly fed with
such readily digested articles. If fever is high, however,
or if swallowing is difficult on account of pharyngitis from
extension of the inflammation or because of pressure of
affected cervical glands, liquid diet must be adhered to.
Rarely the difficulty of swallowing may be so great as
to necessitate rectal feeding. Water must be abundantly
supplied, as in other infections, to aid in elimination and
prevent a complicating nephritis. If swallowing is inter-
fered with, water must be supplied by rectum or hypo-
dermically. Alcohol is usually recommended and can be
taken in large doses, especially in aged or debilitated
persons and young children. In convalescence abundant
nutritious diet should be given and a gradual return made
to the normal.
Smallpox. — Sudden high temperature with marked
anorexia and thirst characterize the onset of this disease.
Vomiting may occur, but is not frequently of sufficient
degree to interfere with nutrition. If present, it usually
ceases with the appearance of the rash. The rash may be
so profuse on the mucous membrane as to make swallow-
ing difficult and materially interfere with nutrition by
mouth. As in all fevers of intense degree, albuminuria
may occur, and occasionally nephritis may complicate.
Cool water should, therefore, be given abundantly
in order to lessen the patient's suffering and to avert
nephritis by diluting the waste products and keeping
the kidneys well flushed. During the febrile period
liquid diet should be the rule, such articles as milk,
broths, and raw egg being used. If albuminuria super-
256 FOOD IN DISEASE
venes, all albuminous foods must be discontinued except
milk, and farinaceous foods substituted. If swallowing
is rendered difficult by sore throat, food must be given
in very small amounts frequently. Ice-cream can often
be swallowed when it is impossible to use milk. If
irritation of the throat is very great it may be necessary
to resort to rectal feeding. When pustulation occurs,
prostration is profound, and it may even be marked during
the vesicular stage. Abundant nourishment is, therefore,
imperative and should be given, from the outset of the
disease, to the full extent that the stomach will tolerate,
though due care must be observed to avoid overfeeding,
which would derange the gastric function. In convales-
cence the gradual return to the usual diet is to be made,
beginning always with soft diet, such as custards, soft-
cooked eggs, raw oysters, etc. When albuminuria or
nephritis has complicated, the use of meats should be
delayed.
Scarlet Fever. — During the febrile stage liquid diet
should be abundantly supplied and water and lemon juice
freely given. Milk and gruels are the best foods to use.
Liquid diet should not be discontinued immediately on
the fall of the fever, but should be uninterrupted until
after desquamation is well advanced. Patients are often
ravenous during desquamation, but nephritis is such a
dangerous and common complication that special caution
is necessary to prevent its development. Albuminuria at
the time of maximum temperature is common, but true
nephritis does not usually develop until in the second or
third week. Exposure during desquamation is no doubt
a factor in producing nephritis, but the more common
cause is indiscretion in diet. During this period the
eliminative function of the skin is crippled so that more
FOOD IN INFECTIOUS DISEASES 257
work is thrown on the kidneys, which may be easily over-
whelmed by an incautious use of nitrogenous or solid
foods. Milk is the best diet and it has been claimed that
an absolute milk diet is an efficient preventive of nephritis.
In this disease the throat is frequently so sore as to pre-
clude nourishment by mouth on account of the pain on
swallowing. In such cases rectal feeding must be insti-
tuted and water plentifully supplied by rectum or by
hypodermoclysis. If milk for any reason cannot be con-
tinued, it may be peptonized or substituted by koumiss
or whey, and farinaceous gruels added to the diet.
As convalescence is established, farinaceous foods and
fruits, such as lemons or stewed apples, may be added to
the diet. After the third week oysters, clam broth, squab,
and chicken may be gradually introduced and return to
normal diet cautiously made. While food should be
sufficiently abundant to maintain the strength, it is a
mistake to push nourishment too far and good judgment
must be used in order not to give too much food. When
nephritis develops, the diet is to be regulated as for that
condition.
Measles. — While fever lasts the diet should be liquid,
consisting of milk, broths, meat juice, raw eggs, and gruels.
Lemons and oranges are refreshing and water should be
abundantly supplied. Digestion is retarded and diarrhea
is frequently present. Care should be observed, therefore,
not to give solid foods too soon. If enteritis is marked,
it is best to discontinue milk and rely temporarily on
gruels for nourishment. In infants the nourishment
should be in smaller quantities, more diluted and more
frequently given than what is usual at the child's age.
Stimulants are rarely necessary, unless the patient is very
17
258 FOOD IN DISEASE
feeble when attacked by the disease. Bronchopneumonia
is a not infrequent complication in convalescence. In
hemorrhagic measles albuminous foods should be with-
drawn, except milk, in order to lessen strain on the kidneys.
In convalescence return to solid food should be quite
gradual if enteritis or diarrhea have been present, other-
wise the return to solid food may be prompt.
Diphtheria. — Maintenance of nutrition is often difficult
on account of the pain produced by swallowing, and young
children are particularly hard to control. As long as they
can be induced to swallow, mouth feeding should be
practised, and when sufficient nourishment cannot be thus
taken, rectal feeding should be instituted. Forced feeding
through the stomach tube or nasal tube is dangerous, as
it is liable to make abrasions in the mucous membrane.
The foods should be liquid and sufficiently varied to
tempt appetite. Ice-cream is a good form in which to
administer milk and can often be swallowed with much
less pain than plain milk. Water should be given freely
in order to lessen the intensity of the toxemia by diluting
the toxins and hastening their elimination. When sufficient
water cannot be taken by mouth it should be administered
by rectum, or normal saline solution may sometimes be
injected subcutaneously. If albuminuria develops, the
proteid food should be restricted to milk. Soft farinaceous
foods and soft-cooked eggs should be given whenever the
patient can take them.
When intubation has been performed, soft foods can
usually be taken better than liquids. The latter can
usually be administered, however, if the patient is fed
while lying on the back with the head low or turned to
one side. This position lessens the possibility of food
FOOD IN INFECTIOUS DISEASES 259
entering the tube, and it should be maintained until all
food has been completely swallowed before lifting the
patient.
In postdiphtheritic paralysis swallowing is performed
with much difficulty, but enough food can usually be
given to maintain life if it is administered very slowly.
When it proves impossible to do so, feeding must be
accomplished by the use of the stomach tube.
Cerebrospinal Meningitis.— Proper nutrition is a potent
factor in this disease. In severe cases when convulsions,
delirium, and coma are present, liquid foods must be
administered with great care. They should be given in
small, frequent doses, as little as a teaspoonful being
administered every fifteen minutes in some instances.
Recourse to rectal feeding may be necessary, though this
procedure is frequently precluded by diarrhea. In the
milder cases and as long as the patient can swallow, soft
foods as well as liquid may be administered. Water should
be freely given. During the convalescence the appetite
is usually good and an abundance of nutritious foods
should be supplied. Five or six meals a day would not
be too many. Good meats, bread and butter, and cereals
are to be allowed as soon as they can be digested.
Whooping-cough. — In mild cases of whooping-cough
no special dietary restrictions are needed further than
withdrawing specially unwholesome articles of food, such
as pastries, pickles, etc., but in the severer cases the
question of maintaining nutrition may become serious on
account of the vomiting produced by the paroxysms of
cough. Great care should be taken, even in mild cases,
to avoid overloading the stomach. Food should be given
in small quantities at frequent intervals, and in the
260 FOOD IN DISEASE
severer cases readily digested food should be kept accessible
and a little given after each paroxysm. If the attack is
so severe that all food is vomited, rectal alimentation will
have to be instituted. Liquid and soft foods are the best
to use, such as milk and its preparations, eggs, beef juice
and broths, custards, fruits, and prepared foods. As in
other infectious diseases, water should be given freely.
Pulmonary Tuberculosis. — There is no disease in
which nutrition is of greater importance than in this.
Emaciation is progressive and often rapid. It is necessary
not only to supply nutriment to meet the ordinary demands
of wear and tear and force production, but this waste must
be checked and if possible flesh must be increased. In
other words, more food .must be given than is necessary
simply to arrest the loss of flesh, as the tissues must be
nourished and strengthened to prevent the inroads of the
disease. Cornet suggests that the rapid waste of the
tissues hastens absorption of the proteids surrounding
the tuberculous foci, thus inhibiting the process of healing
and furthering distribution of the bacilli. Hence, forced
feeding, by preventing these conditions, is a positive aid
to cure. When it is recalled that 3000 calories per day
are necessary for a healthy adult, it is evident that in the
presence of a condition of increased metabolism, such as
one finds in tuberculosis, an excess of food becomes
essential. All classes of food should be given, but the form
of administration must be varied according to the patient's
ability to digest them. No routine dietary will be satis-
factory; the food must be modified for each person, and
in individual cases according to the changing conditions
present.
When the patient has no fever and digestion is not
FOOD IN INFECTIOUS DISEASES 261
impaired, the usual dietary for healthy adults is to be
taken as the basis for feeding. Special attention should
be given to providing variety in the diet, as this does
much to forestall loss of appetite and digestive disturbance,
which materially increase the difficulties of treatment
when they occur.
Substances which are liable to derange digestion, such
as pastry, pickles, and sweets in excess, must be excluded
from the diet. Fats and carbohydrates must be freely
given, as their combustion spares the albumin, and proteids
must be freely used to replace the wasting tissues and to
increase structural resistance.
A type of dietary would be as follows:
7 a.m. (or on awakening). — A glass of hot milk flavored
with tea or coffee; or cocoa, if desired; or milk and raw
eggs, or beef-tea.
About 9 A.M. (breakfast).— Cereals with rich cream and
sugar; soft-cooked eggs, boiled or poached; fresh fish or
meat ; breakfast bacon cooked Crisp ; bread or toast, with
butter, fruit, stewed fruit, or marmalade. With this may
be taken tea or coffee with milk.
About 11. a.m. (lunch). — A glass of milk, milk and egg,
buttermilk, or gruel.
At 1 or 2 p.m. (dinner), consisting of soup; meats, such as
beef, mutton, or fowl; fish; easily digested vegetables, such
as baked potatoes, spinach, asparagus, rice, macaroni,
peas, salads with oil dressing, and stewed or ripe fruits.
About 4 or 5 p.m. (lunch). — A glass of milk, milk and
egg, a cup of broth, or a plate of ice-cream or jelly.
7 p.m. (supper). — Fruits, ripe or cooked; cereals, bread
and butter, milk, and tea or coffee well diluted with
milk.
262 FOOD IN DISEASE
About 10 p.m. (at bed-time). — A lunch similar to those
served at eleven and four.
It is of advantage in helping digestion if the patient
will rest, lying down, for twenty minutes or half an hour
before and after the three heavy meals.
When fever is present, material alterations must be
made in the form of the diet. When the temperature is
continuous or high, nutrition must be secured by such
measures as are used in acute infectious diseases. Re-
mittent or intermittent fever is the type more frequently
met with, however, and under such conditions more food
can be given. During the febrile period liquid or semi-
solid foods are best, but during the intermission or remis-
sion solid food should be given. Thus in cases in which the
temperature rises at noon, a substantial breakfast should
be taken; while in those in which the fever comes on in the
evening, both breakfast and dinner may be solid meals.
The most difficult condition, to cope with, from a
dietetic standpoint, is loss of appetite, which may be so
great as to amount to repulsion for food. Many tuber-
culous patients through delicacy refrain from expectora-
tion and swallow the sputum. This neutralizes to some
extent the acidity of the gastric juice and coats the particles
of food in the stomach, preventing proper contact with
the digestive fluids, which leads to gastritis and loss of
appetite. In other cases the gastric secretions may be
normal, and appetite lost through a nervous fear of food.
Lack of variety is another frequent cause of anorexia.
Insufficient care of the mouth will frequently lead to
disgust for food, as a coated tongue and teeth will produce
a bad taste and prevent perception of the pleasant flavors
of food.
FOOD IN INFECTIOUS DISEASES 263
These various conditions must be overcome by appro-
priate measures. If gastritis is present, lavage and a
suitable diet must be instituted. If nervousness prevents
the taking of the proper amount of food, a graduated diet
increased daily in amount and strength may overcome the
trouble, or a plain talk with the patient, explaining the
inevitably dire results pi abstinence, may induce co-oper-
ation. Failing in these, forced feeding with the stomach
tube must be resorted to.
Not only must the quality and form of the foods be
varied at different meals, but it is of equal importance
that the patient should not know the menu for the day
or direct the selection of the diet. Of course, where special
dishes are desired, the patient's wishes should be gratified
if the article is allowable.
As in the management of typhoid cases, the mouth
toilet should be strictly attended to, the tongue and
buccal surfaces being scraped with a loop of whalebone
and the mouth washed with some antiseptic solution
several times a day. Especially should this rinsing be
done after taking milk.
Special Articles of Diet. Proteids. — Milk is of much
service in most cases, as it is a complete food and contains
valuable fat. Conditions develop in the course of tuber-
culosis which may require an absolute milk diet. In
these instances six to eight pints are given daily; but it
is not well to continue such an amount for more than a
few days, since the great bulk of fluid tends to develop
atony of the stomach. By increasing blood pressure it
adds to the work of the heart, which is apt to be weak
under circumstances requiring so strict a diet. One to
two quarts daily are of advantage and are sufficient when
264 FOOD IN DISEASE
other foods are given. Many persons object to milk
through whim. This can often be overcome by judiciously
altering the taste of the milk, but if the objection is
founded on actual disagreement with the patient, it would
be a mistake to force milk upon him. If the stomach is
weak, milk must be rendered digestible by dilution or by
the addition of lime-water or a little sodium bicarbonate
(six grains) and table salt (five grains) to each glass. It
should be remembered that milk frequently disagrees and
proves indigestible because it is taken too rapidly, which
induces the formation of large curds. It should, therefore,
be swallowed slowly and its digestibility may often be
improved if it is administered in small amounts at frequent
intervals, say two ounces every fifteen minutes. It may be
taken hot or cold according to the patient's preference,
but it is best not to boil it, as this retards its digestion.
In some cases it is necessary to predigest it. Repulsion
may be forestalled by varying the milk diet with milk
derivatives, such as buttermilk, koumiss, and whey.
Whey and koumiss have been extensively used as special
"cures," the former in Germany and Switzerland, the
latter originally in Southern Russia, where mares' milk
from animals allowed to run at large is used for its prepa-
ration. Whey is apparently of advantage to individuals
who can use it, but with many persons it can be taken
only for a short time without the development of diarrhea.
Lasting improvement has been observed resulting from
the koumiss cure in persons who have taken it in Southern
Russia, but how much the improvement was due to the
pure air of the Caspian region and how much to the
koumiss is indeterminable. The use of koumiss as pre-
pared in America from cows' milk has no special advantage
FOOD IN INFECTIOUS DISEASES 265
over plain milk beyond its more ready digestibility, and
many persons have great aversion to it.
Eggs. — Extensive use is made of eggs in the dietaries
for tuberculosis. They are a complete food, rich in fat,
and by most persons readily digested. They are best
given raw and may be taken whole or beaten up with
fresh milk. This mixture may be flavored with salt, or,
when no contraindication exists, with sugar or other
flavoring material. Raw eggs may be given with meals
or between meals, and as many as a dozen a day are
often used.
Meat Preparations. — Beef tea and meat extracts, though
containing but a small amount of nutriment, are useful
stimulants to the stomach and nervous system.
Meat powder, which contains much nutriment and is
readily digested, is of real service. Yeo publishes the
following instructions given by Dujardin-Beaumetz for
making this powder: "Take the lean of beef, cut it up
into small pieces, dry it in a water bath. When thoroughly
dry, reduce it to a powder in a coffee mill;" or it may be
rubbed up in a mortar. It has a pleasant odor and is
practically tasteless. It may be mixed with soup, or
added to milk in the proportion of from half an ounce to
an ounce and a half of meat powder to a pint of milk.
Expressed beef juice, made by heating thick steak
quickly, chopping and squeezing in a meat press, is a
nutritious and valuable preparation, but it cannot be
heated without coagulating the albumin. The best way
to make it palatably warm is to place a cup of the juice
in a vessel of hot water.
Tropon, which contains 90 per cent, of albumin, is also
a good preparation to add to milk, soups, and broths.
266 FOOD IN DISEASE
When the acid of the gastric juice is too scant to digest
unaltered proteid, digested preparations such as peptones
and somatose are useful. The latter contains 80 per cent,
of proteid and no extractives, and so does not stimulate
nervous action.
Raw meat has been highly extolled as a nutrient in
this disease. While its use has ardent advocates and it
has done good service in certain cases, it is not generally
considered to have special advantages. The drinking of
fresh blood warm from butchering, which was at one time
in vogue, has no merit and was simply a sensational
procedure.
Gelatin is very useful in moderate amounts as an
albumin sparer, and in the various forms in which it is
prepared it makes a pleasant variety in the diet.
Fats. — This class of foods is of great importance in
the dietetics of tuberculosis as an albumin sparer, since it
conserves the body albumin and increases the patient's
weight. It is also useful for heat production. From long
observation of the action of fats in tuberculosis, Russell
determined that in continued use of the same fat efficiency
diminished, while improvement occurred when a change
was made in the kind of fat administered. This led to his
experiments with mixed fats, which in his hands have
proved the most efficacious way of administering.
Cream is an easily digested fat for most persons. It
may be added to milk or taken, as pure cream. If it is
not well tolerated in its natural state, its digestibility may
be increased by the addition of hot water and a little
aromatic spirit of ammonia. If the ammonia is not
pleasant to the patient, brandy or some other alcoholic
preparation may be used for flavoring. A little Chartreuse
FOOD IN INFECTIOUS DISEASES 267
added to a glass of cream, with some effervescent water,
makes a very palatable drink.
Butter is one of the most readily digested fats and should
be used freely with bread and other carbohydrate foods.
Cod-liver oil has long been popular in the treatment
of this disease. Its odor and taste are unpleasant to many,
but some persons, especially children, develop a liking
for it. It is one of the most readily digested and easily
absorbed fats on account of the bile salts which it contains.
See suggests that the special benefit derived from its use
is due to the fact that the utilization of oxygen for its
combustion robs the bacilli of that substance which is
necessary for their active proliferation. Cod-liver oil
often produces indigestion because it is taken immediately
after meals. When thus taken, it is liable to coat the
particles of food and interfere with gastric digestion. It
should be administered an hour and a half or two hours
after meals, when the food has begun to pass from the
stomach. In this way it is more promptly carried into
the intestine, where it is digested. Pure oils are better
than emulsions. They should be given at first in tea-
spoonful doses, or less, and the dose gradually increased
to a tablespoonful as tolerance is established.
Olive oil is a useful and palatable form of fat, well
digested by most persons, though, as a rule, the animal
fats are better than those derived from vegetable sources.
In cases with good gastric digestion it may be agreeably
administered with egg-yolk in the form of Mayonnaise
dressing with salads.
Cocoa and chocolate are useful for the fat which they
contain and add to the variety of the diet. Chocolate is
the better borne of the two.
268 FOOD IN DISEASE
Carbohydrates. — As in health, these substances
should form a proper proportion of the dietary. Whole
wheat and brown breads are considered of special value
on account of the large percentage of phosphates which
they contain. Meals made from peas, beans, and lentils
are also rich in phosphates as well as proteids, and are
useful administered in the form of purees. Oatmeal and
cornmeal are especially suited to tuberculous cases on
account of their richness in fats.
Malt extract is extensively used, especially in connection
with farinaceous foods, on account of its diastase, which
aids in the digestion of this class of foods.
Honey is a useful carbohydrate; one dessertspoonful is
about equivalent in heat units to one egg. It is well
digested by most persons and prevents constipation. Its
pleasant flavor will induce patients to take more food.
It is a good article for lunch with bread.
Grapes are a good food on account of their sugar, and
in France and Germany the "grape cure" has been
popular. It is suitable only in afebrile cases. Only large,
juicy, ripe grapes are selected; their seeds and skin are
removed. One and two pounds are given daily, half
before breakfast, one-fourth before dinner, and one-fourth
before supper. A larger amount is liable to induce
diarrhea. Grapes should be combined with a richly
nitrogenous diet.
Vegetable Juices. — Russell's more recent investigations
in the dietetics of tuberculosis seem to show special
advantage from the use of vegetable juices. Though his
observations have covered too short a period to justify
positive conclusions, his results would indicate that there
is real merit in this administration. The beneficial effect
FOOD IN INFECTIOUS DISEASES 269
he attributes to some such action as the vegetable juices
produce in scurvy. He has noted increased digestion of
other foods by the use of vegetable juice. His method of
preparation is as follows:
"Equal parts by weight of raw vegetables, after thorough
washing by scrubbing with a brush and rinsing in fresh
water (the skins are not removed), are mixed together and
chopped in a chopping bowl until the particles are small
enough to go easily into the receiver of the grinding machine,
where the mass is reduced to pulp. The pulp is collected
as it falls from the machine and the juice squeezed out
through coarse muslin cloth The vegetables
first used were potato, onion, beet, turnip, cabbage, celery.
Later sweet potato, apple, pineapple, carrot, parsnip, and
later rhubarb (pie plant), summer squash, tomato, spinach,
string beans, radishes, green peas with the pods were
added The juice is prepared every day and
kept on ice."
Beverages. — Much difference of opinion as to the use
of various beverages is shown in the directions given for
their use. Some physicians allow tea, coffee, cocoa, and
chocolate according to the patient's wishes, and recommend
their use for covering the taste of milk, in order to induce
a larger consumption of that food. Others, as a matter
of routine, forbid these beverages. It would seem judicious
to permit them unless some positive contraindication to
their use exists, such as nervousness, insomnia, or consti-
pation, for persons accustomed to any of them will not
relish their food if deprived of them, and hence will eat
less.
The use of alcohol is a matter about which physicians
differ widely. It used to be given in very large amounts
270 FOOD IN DISEASE
under the belief that it was a food of special value, and
some patients seemed to improve under it; but the general
tendency in the use of alcohol to-day is to limit it to definite
purposes.
When given before meals it does, in many persons,
improve the appetite and stimulate gastric secretion, but
in others it lessens appetite and retards digestion. It
lowers temperature somewhat by increasing the cutaneous
circulation, and through this same action it often lessens
night-sweats and insomnia. These effects are beneficial
and constitute the indications for its use. The too liberal
use of alcohol will produce the same harmful results in
tuberculous patients that it does in healthy persons.
Special care should be given to the selection of pure
preparations, light red and white wines, good whiskey
and brandy being the best to use. Cheap clarets and
heavy wines like port and sherry are prone to disturb
digestion and produce headache and should be sedulously
avoided. Good beer, porter, or ale is permissible when
it is preferred by the patient, especially in warm weather,
and it is often more efficient than wines or spirits in
stimulating the appetite. It is useful also, given at bed-
time, for preventing sleeplessness.
In gastritis alcohol must be abandoned, and should
be suspended when the patient develops aversion for it,
and also in case of hemorrhage. Nor must it be forgotten
that there is danger of habit formation by its continued
free administration.
Forced Feeding. — The original method of forced feeding,
as practised by De"bove, was the introduction of large
amounts of food into the stomach through a tube. He
observed in certain cases, in which all food taken in the
FOOD IN INFECTIOUS DISEASES 271
usual way was vomited, that even large quantities would
be retained when introduced through the tube, and that
by this practice appetite was regained and nutrition re-
established so that weight increased, night-sweats disap-
peared, and cough was diminished. He used for this feed-
ing, four to ten eggs, six or seven ounces of meat powder,
and two quarts of milk, introduced after washing the
stomach.
It is not uncommon in tuberculosis for appetite to be
lost without accompanying loss of digestive power, and
under such conditions, especially when there is aversion
to food in nervous patients, this method of forced feeding is
advantageous; but there is a limit to the possibilities of
every stomach, and care must be exercised not to overtax
its powers and thus bring about a serious complication.
De"bove's method is, to most persons, so repulsive that
it has been largely superseded by others when food can
be retained. The Weir Mitchell method depends upon
the isolation of the patient, with rest of body and mind,
and an absolute milk diet for several days, after which
the diet is gradually increased. Three ounces of milk
are given every two hours, and are taken very slowly,
amounting to three or four quarts daily. Massage and
electricity are used daily until exercise is permitted. By
this form of treatment aversion to food is overcome and
appetite established. Modifications of this method are
frequently practised with benefit.
CHAPTER XV.
FOOD IN DISEASES OF THE DIGESTIVE TRACT.
ACUTE GASTRITIS. CHRONIC GASTRITIS. DILA-
TATION OF THE STOMACH. ULCER OF THE
STOMACH. CANCER OF THE STOMACH. DIAR-
RHEA. CONSTIPATION. CIRRHOSIS OF LIVER.
In a preceding chapter, in which nutrition in acute
febrile conditions was considered, we had to determine
the maintenance of strength and body tissues under con-
ditions in which the organs of digestion were secondarily
affected by constitutional diseases. In this chapter we
have . to consider nutrition in conditions in which the
general constitution is secondarily affected by primary
disturbances in the functions of the digestive organs. In
the general febrile conditions disturbance of metaboljsm
is the dominant consideration, the body tissues being
unable to appropriate the food brought to them by the
circulation after digestion, but in diseases of the digestive
tract the dominant consideration is the digestion of foods
which are readily appropriated thereafter by the tissues.
In other words, we are hampered in the question of
nutrition by disability of the organs first involved in the
complicated process.
When an organ is crippled there are two methods by
which its function may be restored — rest or exercise. By
rest the demand for functional activity is withheld until
the natural recuperative power of the body has restored
the function. By exercise the function is gradually
developed by additional demands upon it, increasing
FOOD IN DISEASES OF THE DIGESTIVE TRACT 273
little by little. According to the character of the disease
the choice of methods is determined.
It must be borne in mind, as was stated in an earlier
chapter, that no absolute rules of diet can be laid down
which will cover every individual case, because of the
peculiarities shown by some persons in failing to digest
certain articles of food digestible by others, or in develop-
ing in the course of digestion by-products which produce
illness.
Many diseases of the digestive organs are due to over-
feeding or to eating improper foods. These are, of course,
relieved when the error in judgment as to quantity or
quality is corrected. Disturbances of digestion are also
frequently due to the manner and time of eating. Too
rapid eating, by causing the entrance of food in the
stomach before it has been properly divided by chewing,
will lead to disturbance, and indigestion is often caused
by active mental or physical work too soon after a heavy
meal through withdrawal of the blood thereby from the
digestive organs at a time when active circulation is
essential for proper digestion.
Diseases of the digestive organs are organic or func-
tional. In organic diseases the structure of the organ is
affected by a morbid process which interferes with the
normal function. In the functional diseases organic
changes are wanting, but the organ fails to perform its
work. In either of these conditions the problem that
confronts us is to supply the body with sufficient nutri-
ment by the use of these disabled organs of digestion.
It should be remembered that patients suffering from
these diseases need as many heat units from their food
as they would in health, and it has been shown that the
18
274 FOOD IN DISEASE
emaciation in certain of these diseases is due not to
poisonous substances developed, which prevent appro-
priation of food, but to a deficiency in the food provided
after digestion; in other words, starvation. In organic
diseases treatment by rest is indicated. In certain severe
conditions this indication is met by rectal feeding in
which absolute rest is obtained for the stomach and small
intestines. In conditions of less severity a degree of rest
may be obtained by varying the quality and quantity of
food and the frequency of its administration. In func-
tional diseases in which the digestive apparatus is intact,
but showing diminished activity, the treatment is in
general by exercise, beginning often with liquid or semi-
solid foods and gradually adding foods more difficult of
digestion, thus toning up the organ to normal function.
In selecting the articles of food for any given case the
diet should comprise, except in certain special instances,
all of the alimentary substances, proteids, carbohydrates,
fats, salts, and water, the difference from normal diet
being in the method and form of administration. A
common error in feeding in diseases of the digestive tract
is the omission of fat from the diet. Good butter is
readily digestible and is a concentrated food which
supplies calories of heat generously, and the occasions
for withholding fat in this form are rare in these diseases.
Acute Gastritis. — In this condition there is an acute
inflammation of the mucous membrane of the stomach
with a decrease in the amount of gastric juice and
diminution of its strength. Contact of any violent irritant
with the gastric mucous membrane, such as strong acids,
will produce it, but it is commonly met with as an accom-
paniment of certain febrile diseases and most often as
the result of improper diet. Overloading the stomach
FOOD IN DISEASES OF THE DIGESTIVE TRACT 275
with food leads to abnormal fermentation, as the supply
of gastric juice is not sufficient to digest the excessive
amount of food. This is a common cause of acute catarrh,
and especially in weak persons who attempt by over-
feeding to rapidly increase their lost strength. Too
rapid eating, through improper mastication, leads to this
condition. When the food enters the stomach in too
large pieces, only the surface is digested and the interior
portion is liable to undergo fermentation. Overripe game
and fish by introducing germs of decomposition are a
frequent cause. Highly seasoned foods and rich gravies,
by irritating the mucous membrane and coating the food
with a layer of grease impermeable to the gastric juice,
invite fermentation and acute catarrh.
In this condition vomiting is present and the appetite
usually lost. Under these circumstances it is useless to
force food upon the patient, for it will not be digested if
retained, and will by its presence increase the irritation
already present. The treatment is rest. Withholding
food absolutely will do no harm if the patient is robust,
as the attack is usually of short duration. When the
catarrh is of severe grade and the patient is feeble and in
need of continued nourishment, rectal enemata should
be administered. As the inflammation abates, and in
mild cases from the beginning, food may be administered
by mouth, being given in small quantities and at frequent
intervals. Milk is a good food to use,' but it should be
diluted, either with lime-water or barley-water, to prevent
the formation of large curds. Egg may be used, but
should be given raw, either as egg albumin diluted with
water, or the whole egg may be given mixed with hot
water. Whey is a good substitute for milk. In some
cases predigested food, such as peptonoids, are required.
276 FOOD IN DISEASE
Farinaceous foods, such as Mellin's, or Robinson's Barley,
may be added to the milk as the patient improves. Meat
juices are very useful in this disease and one of the best
of them is Valentine's.
Thirst is marked and is often intense. Sucking bits of
ice will often relieve, but, if this fails, cool water taken in
sips should be allowed. If vomiting is so intense as to
preclude the drinking of water, it must be administered
by rectum, or, if necessary, by hypodermoclysis.
In the beginning of mouth feeding very small quantities
are to be used, one or two tablespoonfuls of diluted milk
being given every hour or two hours.
When convalescence begins, soft-boiled rice, squab,
scraped beef, chicken, soft-cooked eggs, and baked potatoes
may be gradually added to the diet. Great care must
be taken that these foods be given in small amounts, as
the gastric function is below par after an acute attack of
gastritis, and overloading the stomach will certainly cause
a return of acute symptoms. Tea and coffee should be
withheld during the attack, but may be given in con-
valescence, tea being better borne, as a rule. Alcohol
should be forbidden, as it tends to increase the irritation
and thus aggravate the symptoms.
Chronic Gastritis. — This condition often develops as a
sequel of acute gastritis, or it may come on insidiously.
Excess in the quantity of food taken often leads to it,
especially if the food is highly seasoned or if sauces and
rich gravies are freely used. Such foods are particularly
liable to bring on the condition if partaken of when
mentally depressed or worried, as under such conditions
the gastric juice is usually less abundant than normal and
the digestion is proportionately impaired. Alcohol is a
FOOD IN DISEASES OF THE DIGESTIVE TRACT 277
frequent cause of the disease. The constant irritation
produced by its habitual use causes changes in the walls
of the bloodvessels and affects circulation, which renders
the muscular action of the stomach sluggish. The result
of this is retarded digestion leading to fermentation, with
the development of irritant acids which produce a catarrhal
inflammation. The condition is also caused by diseases
which interfere indirectly with the circulation in the
stomach by obstructing the portal circulation, such as
certain diseases of the liver, heart, and lungs, and by long-
continued diseases associated with anemia and neuras-
thenia.
The walls of the stomach may be much thickened and
the mucous membrane corrugated and thrown into large
folds, or the walls may become thin and the mucous
membrane stretched and attenuated. In severe cases the
glands may atrophy completely. The important consider-
ation is the degree to which hydrochloric acid secretion
occurs. This may be normal in amount, increased or
diminished, and if atrophy of the glands has occurred it
may be entirely absent. Accompanying any of these
conditions there may be an excessive secretion of mucus.
When this occurs, it further increases the difficulty of
gastric digestion by coating the particles of food, thereby
preventing contact with the gastric juice. Appetite may
be diminished or lost or it may be much greater than
normal.
These conditions lead to slow digestion, and the irritant
gases developed by fermentation produce eructations, and
regurgitation of the acids causes the uncomfortable sen-
sation of "heartburn."
Dietetic treatment should include careful directions as
278 FOOD IN DISEASE
to the manner of taking food as well as deciding the
articles of the diet. Thorough mastication is essential,
as the impaired stomach is not able to digest large masses.
Deficiency in the chemical action in the stomach can be
compensated for by active intestinal digestion, but masti-
cation can be performed only in the mouth, and if imper-
fectly accomplished there, the fault cannot be remedied
later. This necessitates eating slowly and if cheerfulness
surrounds the board improvement will be more marked.
Great care should be taken to keep the teeth in good
condition. Meals should be regular and punctual and
should be preceded and followed by half an hour of rest,
lying down. The quantity of food should be strictly
limited. Enough must be taken to maintain nutrition,
but no excess beyond this should be allowed. It is well
for the patient to end the meal always before full satiety.
It is often advantageous to allow the patient to select
articles which experience has taught to be well borne in
his case. Nothing should be permitted between meals
and the intervals between them ought to be long.
In severe cases milk is indicated, but the formation of
large curds must be prevented by dilution with lime-water,
Vichy or soda water. A little salt added increases its
digestibility. If undigested curd appears in the stools,
even when the milk is diluted or boiled, it must be dimin-
ished in amount or predigested. In many cases it must be
discontinued. A glassful — : about 6 ounces — can usually
be given every two and a half or three hours. Buttermilk
is often digestible when milk is not. Fresh meat juice,
egg albumin, or scraped beef may be substituted when
desired.
In milder cases minced meats, beef, mutton, or chicken,
FOOD IN DISEASES OF THE DIGESTIVE TRACT 279
with dry toast or stale bread and a small quantity of
butter, may be given. To these may be added, as the
condition improves, boiled rice, baked potatoes, shredded
wheat, toasted crackers, zweiback, chopped spinach,
baked apples, orange juice, baked custard, and plain
blanc mange. Caution must be used in administering
farinaceous foods on account of their readiness to ferment.
They should be given in small quantity and their effects
carefully watched. Smoked and salted meats are some-
times more easily digested than fresh, as they do not
decompose so readily during the protracted period of
stomach digestion. Raw and stewed oysters are usually
well digested and soft-cooked eggs are allowable, but if
intestinal irritation accompanies the gastritis, whole eggs
must be given guardedly, as the yolk readily decomposes
in the intestine if its function is at all impaired.
Water should be given in moderation at meals. A glass
of cool water, or, better, a glass of some hot alkaline water
such as Vichy, may be taken with advantage half an hour
before meals, as it will help to loosen and remove the
tenacious mucus which clings to the lining membrane of
the stomach. This will free the glandular ducts, which
the mucus often occludes, and will thereby increase the
hydrochloric acid.
Water should not be taken for several hours after food,
but should be drunk freely between meals and at bed-
time. The permissibility of tea or coffee is not settled,
some physicians permitting one and forbidding the other.
If allowed, tea should be weak and coffee will interfere
less with digestion if taken black, without sugar or cream.
The following articles should be rigidly excluded from
the diet: Things fried, twice-cooked meats, coarse vege-
280 FOOD IN DISEASE
tables, sweets, pastries, cakes, puddings, acids, spices,
condiments, alcohol, hard-cooked eggs, fat meats, shell-
fish, except oysters, and all substances known to disagree
with the individual.
Mucous Gastritis. — In those cases in which mucus is
excessively secreted, gastric lavage must be performed
once daily, either at bed-time or before breakfast, in order
to remove this mechanical hindrance to digestion. The
diet should be as described above.
Hyperchlorhydria. — An abnormally increased secretion
of hydrochloric acid frequently accompanies chronic
gastritis or may be caused independently by etiological
conditions identical with those producing that disease,
such as hasty eating, overeating, worry, nervous shock,
fatigue, ulcer, alcohol, and tobacco.
The diet should be selected to minimize the irritation
of the secretory and sensory nerve terminals of the stomach,
whether produced mechanically, chemically, or thermally.
In other words, food should be finely divided, non-
irritating, and neither too hot nor too cold. While all
agree that patients suffering from this trouble must have
a mixed diet, there is difference of opinion as to the
details. Some physicians give only carbohydrates and
milk, on the ground that meats stimulate the flow of
hydrochloric acid, while others prescribe a preponderance
of meats to combine with the excess of acid present.
Though noted clinicians advocate each view, the latter is
the more popular teaching. Finely minced meat or meat
pulp, eggs, fish, oysters, and milk supply a non-irritating
diet which readily combines with the acid. Fats in the
form of butter and creamjare well borne and tend to
reduce the quantity of acid secreted. With the meats
FOOD IN DISEASES OF THE DIGESTIVE TRACT 281
may be given a small amount of toast or zweiback and
green vegetables finely divided and made into purees.
As improvement advances, stale bread, rice, vegetable
purees, and well-cooked oatmeal may be added, and
finally the usual diet may be resumed.
Opinion differs also with regard to the frequency of
meals, some giving two large ones a day in order to rest
the stomach, while others advocate frequent small meals
at short intervals, giving five or six a day. When milk is
used i as the chief proteid food the latter plan is the better.
Gavage is recommended when the patient loses weight
and appetite, as the psychic gastric juice is thereby pre-
vented, the odor and taste of food being excluded.
Beverages should be limited, and alkaline waters, such
as Vichy, are the best to use. Certain articles should be
excluded from the diet as listed for chronic gastritis.
Hypochlorhydria.— A diminution of the hydrochloric
acid follows a period of hyperchlorhydria. As in that
condition, opposite views are held, meat preparations being
given on the one hand because they stimulate gastric
secretion, and carbohydrates used on the other hand
because the diminished amount of the acid is insufficient
for proteid digestion. It is agreed, however, that small
quantities of food should be given and at sufficiently long
intervals to permit of complete digestion by the weakened
gastric juice. Condiments are used to stimulate gastric
secretion.
If a preponderating meat diet is determined upon, the
articles listed in the preceding section will meet the
requirements, but if carbohydrates are to be chiefly given,
vegetable purees and any of the farinaceous foods, such as
rice, tapioca, farina, Mellin's Food or Robinson's Barley,
282 FOOD IN DISEASE
may be used, and the necessary proteid supplied by bread,
peas, milk, and oysters or fish.
If fermentation is excessive, preference must be given
to the meat diet, as it should if carbohydrate diet produces
irritation of the intestine and diarrhea. Otherwise the
carbohydrate diet may be satisfactory. In either case in-
testinal digestion will complement gastric deficiency. Bulky
foods should be avoided and fine division is essential.
Achlorhydria. — Entire absence of hydrochloric acid
renders the stomach a mechanical food receptacle rather
than an organ of digestion, and this lack of function must
be supplemented by the intestine. In selecting the diet,
such articles must be chosen as can be readily passed
from the stomach into the intestine and can be there
easily digested. Liquid or pulverized foods are the best :
milk, cereals cooked to mush, expressed meat juice, meat
pulp, vegetable soups strained, fresh peas and spinach
thoroughly cooked and run through a colander, and
liquid carbohydrate foods. A little toast may be allowed
if it is thoroughly chewed. Butter, cream, and crisp
breakfast bacon will best supply the necessary fats.
Water should be given, and weak tea, coffee, or cocoa are
allowable in some cases. From such a list sufficient
variety can be arranged.
Dilatation of the Stomach. — This name is not applied
to an enlarged stomach which retains its normal function,
but indicates a pathological condition in which the muscle
walls of the organ have to a greater or less degree lost
their tone so that the contractile power is diminished.
Food is, therefore, retained longer than normally in the
stomach and undergoes fermentation, developing irritant
acids which produce a catarrhal inflammation.
FOOD IN DISEASES OF THE DIGESTIVE TRACT 283
The condition may arise mechanically from obstruction
of the pylorus, preventing the escape of the stomach
contents into the intestine, as in cancer or cicatrices from
any cause; or it may follow from constitutional affections
like neurasthenia and anemia by progressive weakening
of the muscle tissues from lack of proper nutrition.
Habitual excess in eating and drinking will often cause
the condition.
Whatever the cause, the developed state presents two
main pathological considerations, exhaustion of the gastric
muscle and bacterial growth in the gastric cavity. From
these the general principles of dietetic treatment are
evident, to avoid further distention of the organ by food
in too great bulk, which is best accomplished by the use
of concentrated foods in small amount at infrequent
intervals, and to prevent fermentation by proper cleansing
of the stomach and avoidance of foods specially liable to
decomposition.
Fluids must be sparingly used, as they are heavy and
their weight tends to increase the stretching of the weak-
ened muscles. Water should be strictly limited. Not
more than six or eight ounces should be permitted with
meals, as it will dilute the gastric juice and, when taken
with meals, is itself slowly absorbed and lessens the
absorption of food in a disabled stomach. Between meals
and before meals — that is, four hours after a meal and
until half an hour before the next — water in small amount
is allowable, as it is then more promptly absorbed from
the stomach and passes more readily into the intestine.
It is an advantage to give a teacup of hot water half an
hour before meals, as this lessens thirst at meals and helps
to carry remains of the previous one out of the stomach
284 FOOD IN DISEASE
into the intestines. Water should never be drunk in gulps,
but sipped slowly, and when given with meals it should
not be taken while food is in the mouth, as there is danger
of washing into the stomach pieces of food which have
not been thoroughly masticated.
Animal foods must form the chief part of the diet, as
they are the more concentrated. When digestion is
sufficiently active, only solid food should be given, but
this should be minced fine and thoroughly chewed. A
small amount of carbohydrates and fresh vegetables must
be given in cases of moderate severity. Articles which best
meet the requirements are scraped or minced beef, minced
fish, boiled fish, soft-cooked and raw eggs, stale bread,
toast or zweiback, rice, peas, spinach, lettuce, asparagus,
and tomatoes. The green vegetables, like the meats, must
be finely divided and are best given in purees. Thin soups
are not allowable. Sugars and fats are prohibited.
It was formerly the usual custom in the treatment of
gastric dilatation to give small meals at frequent intervals,
but this has now been abandoned.
The normal digestive cycle consists of (1) the ingestion
of food, (2) its digestion and expulsion, and (3) the interval
of rest. By the frequent administration of small meals,
the period of rest is encroached upon and the gastric
muscle kept in a state of constant activity, thus allowing
no time for the muscle to recuperate and regain its tone,
and the constant presence of food in the stomach furnishes
an excellent medium for the multiplication of bacteria.
By using larger meals at longer intervals, the labor period
is relatively shortened and the interval of rest is prolonged,
as the increased bulk excites the motor activity of the
stomach, producing more rapid expulsion of its contents.
FOOD IN DISEASES OF THE DIGESTIVE TRACT 285
The interval between meals should be from six to eight
hours.
In severe cases, especially when vomiting is a marked
feature, it is often necessary to have recourse to rectal
feeding in order to give complete rest to the stomach, and
when giving food by mouth, it may be necessary to
lessen the total amount and undernourish the patient for
a while. When return is made to mouth feeding after
a period of rectal feeding, small quantities of milk may
be given — say, one or two tablespoonfuls every hour or
two — the food being gradually increased in strength and
the intervals lengthened; or solid food may be given at
once, beginning with a small meal once a day, increasing
the quantity and the number of feedings as recovery
progresses.
Recumbency on the right side for two hours after each
meal aids expulsion of the stomach contents.
In weak, jaded patients with complete anorexia and
apparently no digestive energy, gavage yields excellent
results, the exercise of the stomach bringing about a
restoration of the digestive functions, and the patient
begins to take food independently and with relish.
When the appetite is excessive a cracker and a little
hot water just before meals will prevent unnatural appetite.
Gastric lavage is an important adjunct to the treatment
of dilatation, as it is an efficient means of cleansing the
stomach and removing the stagnating remains of food.
It is, however, a practice often much abused, and for
cases of moderate dilatation it is usually not necessary,
dietetic treatment alone being often sufficient to cure.
Gastric Ulcer. — In this disease, in which the mucous
membrane of . the stomach is denuded and ulcerated, the
286 FOOD IN DISEASE
problem is to maintain nutrition by such means as will
permit of healing even while the stomach is called upon
to perform its functions. Such foods must be selected,
therefore, as will not mechanically injure the raw surface
and produce hemorrhage, and since excessive acid is a factor
in the production of ulcer, foods which stimulate the acid
secretion should be avoided. Great care must be observed
to avoid distention by the use of excessive amounts of
food or such food as would readily ferment and produce
gas, as this would stretch the ulcerated surface and prevent
clot formation and healing. The stomach must be kept
at rest -as far as possible, since any violent peristaltic
movement would dislodge clots already formed, preventing
healing and possibly causing hemorrhage.
While it is allowable in mild cases without hemorrhage
to feed by mouth from the beginning of treatment, the
presence of hemorrhage is often the symptom on account
of which the patient presents himself for treatment.
When this exists, complete rest must be secured for the
organ by the use of nutrient enemata and the absolute
withdrawal of mouth feeding for a period of from three
days to one week, according to the severity of the hemor-
rhage. When mouth feeding is instituted, milk best meets
the indications. On account of the hyperacidity usually
present and in order to prevent the formation of large
curds, the milk must be well diluted with lime-water,
equal parts, or in combination with barley, oatmeal, or
rice-water. At first this should be administered in table-
spoonful doses every hour or half-hour and rectal feeding
continued at longer intervals than before. If this is well
borne, the amount can be rapidly increased to half a glass
every two hours. This should be continued for at least
FOOD IN DISEASES OF THE DIGESTIVE TRACT 287
three weeks in mild cases, and much longer in severe
cases, after which the diet may be strengthened gradually
by the addition of egg albumin, egg and milk, scraped
beef, raw oysters, and farinaceous foods, such as tapioca,
sago, and rice.
When the patient is on strict milk diet, it should be
eaten and not gulped down in quantity — that is, it should
be taken a teaspoonful at a time and swallowed slowly —
and like caution must be observed when solid food is
first allowed,' great care being taken to thoroughly chew
the food, which should be limited to but a few mouthfuls.
If milk is administered as prescribed above, most
patients will be able to take it without difficulty, even
those who in health could not digest plain milk; but if the
aversion to milk is so great or its digestion so poor that
its use cannot be continued, other derivatives, such as
buttermilk, koumiss, or whey, may be used; and when
these cannot be taken, meat juices, such as Wyeth's or
Valentine's, or expressed meat juice made at home, must
be substituted. Many persons who cannot digest plain milk
can eat ice-cream, which is a useful article for variety and
may even constitute the sole diet for a day or two at a time.
Water is usually well borne and is beneficial, especially
when given hot. After convalescence the patient should
be kept for several months on a mixed, non-irritating diet,
avoiding acid fruits, alcoholic drinks, sweets and condi-
ments, rich foods, coarse fruits and vegetables, especially
those which contain numerous small seeds. Upon the
slightest evidence of return of the trouble, restricted or
milk diet should be at once instituted.
Cancer of Stomach. — To relieve the patient and to
prolong life in this disease, the dietetic problem is to
288 FOOD IN DISEASE
maintain sufficient nutrition to check the progressive
emaciation, and at the same time to impose upon the
disabled stomach a minimum of work. No fixed rules
can be given, as the diet must be determined for each case
and must vary- according to the site and extent of the
tumor.
If the cancer is situated at the cardiac end of the
stomach, progressive constriction will soon proscribe the
use of solid foods, for they will not pass into the stomach
and will produce dilatation of the oesophagus.
When the pylorus is involved, care must be taken not
to give foods that will be long retained in the stomach
or that will readily undergo abnormal fermentation with
the development of acid, since this will irritate the stomach
and materially increase the pain. Such fermentation,
further, tends to hasten dilatation of the organ — a con-
dition which greatly complicates the difficulties of dietetic
treatment.
Many cases of cancer of the stomach retain consid-
erable digestive power, but in nearly all cases there is
a diminution of the hydrochloric acid and in some an
entire absence of it.
Because of this deficiency of acid, the power of the
stomach to digest proteids is lessened, and this class of
foods should on that account be limited. Practical expe-
rience has demonstrated, however, that the carbohydrates
are prone to ferment, increasing pain and interfering
greatly with digestion, while the proteids which are not
digested in the stomach pass on into the intestine, where
the digestion is completed.
So long as the pylorus is open, a readily digestible mixed
diet may be given; but when the constriction has advanced
FOOD IN DISEASES OF THE DIGESTIVE TRACT 289
to such an extent that the emptying of the stomach is
materially retarded, the diet should be restricted to foods
that are digested and absorbed in the stomach.
In most cases of cancer of the stomach liquid food is
desirable, but in all cases the bulk should be small; and
if solid food is permitted, it should be finely divided in
order to facilitate digestion and to avoid the irritation
which food in bulk would produce, with the resultant
vomiting so easily excited. As hydrochloric acid dimin-
ishes, it may often be necessary to predigest the food.
Should serious hemorrhages occur, rectal feeding must be
instituted in order to avoid irritation of the stomach while
extensive abrasions are present. This may also be
practised to abet insufficient mouth feeding.
Milk well meets the dietetic indication, but it should
be diluted with lime-water or partially predigested to
prevent the formation of tough curds. Buttermilk is an
excellent substitute, for the casein, already coagulated,
is finely divided. Soups, meat extracts, finely minced
tender lean meats, soft-cooked eggs, and stewed fruits are
the best reliances. Indulgences in special cravings of the
patient should be granted as far as practicable.
Water should be given in small quantities or by rectal
injection. It may be given hot with advantage half an hour
before meals. Whiskey and water may be given, or
diluted red wine. Sweet wines, beer, coarse vegetables,
and fruits should be prohibited.
When complete obstruction of the pylorus occurs, only
predigested foods can be given and the remains must be
removed once a day by gastric lavage. This must be done
very cautiously always and temporarily abandoned after
recent hemorrhage to avoid renewal of hemorrhage or
19
290 FOOD IN DISEASE
perforation. When the pylorus is obstructed, rectal
feeding will often be necessary as the only method of
nourishing or to supplement the scant mouth feeding
which is possible under the circumstances.
When the cardia is the seat of the tumor, the objection
to farinaceous foods that obtains in pyloric involvement
does not hold, as they can be passed on to the intestine
for digestion if they once enter the stomach. They must,
of course, be in liquid form. Mellin's Food, Robinson's
Barley, and similar preparations meet the requirements.
Diarrhea. — Frequent thin stools may be a symptom of
some serious disease of the intestines, or may be caused
by mechanical or chemical irritation of the intestinal
mucous membrane by food which leads to increased
peristalsis or augments the secretions. Mechanical irrita-
tion is produced by undigested foods or by those which
leave a large amount of residue, such as unripe fruits,
green vegetables, etc. Chemical irritation is caused by
toxic materials produced by fermentation of food, or by
highly seasoned or spoiled foods, or by purgatives. Exces-
sive drinking of water may cause diarrhea. This occurs
especially in hot weather, when soda-water with fruit
syrups is indulged in to excess.
An acute attack of diarrhea from any of such causes as
the above may often be relieved by withholding all food
for twenty-four hours, but water should be frequently
given in small amounts in order to aid the emptying by
the intestines of their irritant contents and to facilitate
the elimination of the toxic materials by the kidneys.
Food in acute diarrhea must be easily digestible and
absorbable and not liable to ready fermentation. It should
be given in small amounts in order not to overload the
FOOD IN DISEASES OF THE DIGESTIVE TRACT 291
intestines at any one time. Relief is often delayed by
overfeeding through the anxiety of friends. Milk is the
best diet, when it can be taken. It should be diluted with
lime-water or otherwise modified to avoid the formation
of large curds which would act as mechanical irritants,
and it should constitute the sole diet until all acute symp-
toms have disappeared. Six ounces every three hours will
usually suffice, but in very severe cases it is better to give
only an ounce or two every hour at first. When milk
cannot be taken, egg-albumin water or meat broths must
be substituted. These may be thickened with a little
arrowroot or flour-ball. As convalescence is established,
the diet may be cautiously increased by the addition of
raw oysters, scraped beef, soft-boiled rice, stale bread,
breast of chicken or quail, baked potatoes, etc. Alcoholics
are usually avoided, but, if desirable, good French brandy
is the best. Weak tea may be allowed.
If the attack has been mild, a return to the usual diet
may be promptly made; but if it has been severe, the
different articles must be cautiously added, and green
vegetables, raw fruits, fats, acid foods, cheese, sweets,
gravies, condiments, and tough meats must be avoided
for some time.
Chronic diarrhea is a much more difficult condition to
determine a diet for. In cases of long standing, the
alkalinity of the intestinal secretions is reduced. This
lessens the efficiency of the pancreatic juice, so that fats
and starches are not well digested. No routine directions
should be given, but the diet should be regulated in accord-
ance with the individual's power of intestinal digestion.
While fats should be withheld in some cases, many
patients will digest well pure fats, such as good butter,
292 FOOD IN DISEASE
even in large amount, and their administration is desirable,
when possible, as they materially lessen exhaustion.
The principles to be observed in selecting the diet are
avoidance of substances which might increase the catarrh,
and selection of such foods as can be digested by the
individual, especially those that have astringent effect
and tend to lessen secretions. The greater the number
of stools, the more the diet must be restricted.
An absolute milk diet will in many cases conduce to
cure; in others milk is not well borne, but will increase
the number of stools. Milk is best given hot, as it is less
apt to excite peristalsis than cold milk. It should be given
in small amounts at frequent intervals. Egg albumin is
very serviceable, but the use of whole eggs must be
cautiously tried, since the yolk is liable to undergo fermen-
tation. Meat preparations are apt to excite peristalsis
and starchy foods ferment readily. In individual cases,
however, either may be tolerated. Expressed beef juice,-
beef pulp, or Valentine's Meat Juice, may be tried, or
gruels of barley, rice, or farina, which tend to lessen
peristalsis by the mucin which they contain. Predigested
foods may be necessary. If alcoholic beverages are
required, clarets or brandy are best on account of their
astringency.
When convalescence is established, minced meat (better
raw), stale bread, milk toast, raw oysters, and purees of
peas or potatoes may be guardedly added to the diet.
Cold drinks of all kinds, especially carbonized beverages,
fat meats, and vegetables containing much cellulose, such
as cabbage, spinach, beets and other roots, must be
avoided. Acids and sugars must be strictly prohibited,
and saccharine used for sweetening.
FOOD IN DISEASES OF THE DIGESTIVE TRACT 293
Diarrhea in infants occurs chiefly in the bottle-fed
children. It is due to bacterial action produced by the
use of milk that has become polluted through carelessness
before or after delivery at the residence. Careful inves-
tigation should be made by the physician to determine
the source of contamination in order to correct it. Breast-
fed infants may develop diarrhea by nursing dirty nipples
which have not been properly cleansed before and after
feeding. Food should be withheld for twenty-four hours
or only a little albumin-water administered infrequently.
Sterilized water should be given often. It is frequently
best to withdraw milk entirely until convalescence is
established and to depend upon albumin-water, expressed
meat juice, or Valentine's Meat Juice, for nutriment. In
many cases, however, especially the mild ones, milk may
be continued if well diluted with lime-water or modified.
If acid fermentation accompanies the diarrhea, as evi-
denced by the sour odor of the stools, the fat and sugar
should be lessened, but if the odor is putrid the albumin
should be reduced. Koumiss as the sole diet has given
excellent results in many cases. In severe cases food
should be given in small amounts. In severe infections
like cholera infantum and in chronic diarrhea flushing
the colon by rectal injections with normal salt solution is
beneficial both for cleansing the bowel and for supplying
water to the body to replace that lost by purging and
vomiting, since some will be absorbed when thus admin-
istered.
Constipation. — This condition may be a symptom of
a severe or dangerous disease, or it may occur as an
independent malady. In the former case the dietetic
treatment will be modified by the accompanying circum-
294 FOOD IN DISEASE
stances. Here may be considered only simple chronic
constipation.
A variety of causes may lead to this disease, which is
due to a diminution of peristalsis or deficiency of secre-
tion, or both. It may arise from a loss of tone of the
intestinal wall as the result of intestinal catarrh. Sedentary
habits may lead to a similar condition and will lessen the
peristalsis. Dietetic errors are among the most common
causes. When the diet consists of an excessive proportion
of readily absorbable foods, such as meat, milk, and eggs,
which leave but little residue, the intestine is not sufficiently
distended by the food to produce the normal stimulus to
peristalsis, and constipation is apt to follow.
In some cases a diet which is too stimulating may often
lead to this trouble by exhausting the excitability of the
nerve terminals in the intestinal wall. In this way the
abuse of purgatives causes the disorder. Deficiency of
water in the diet may produce constipation, since this error
diminishes the volume of blood and lessens the secretion
of fluids by the intestinal glands. The use of astringent
foods and beverages is often a causative factor.
As in other diseases, prophylaxis is better than cure,
and many cases of chronic constipation could be avoided
if parents would refrain from the use of purgatives with
their children, and would inculcate in them regular habits
with regard to their daily evacuations.
Several classes of foods are useful in dietetic treatment
of constipation, and while individuals will find certain of
them more efficacious than others, a judicious combination
is perhaps the best plan, or else variation from day to day.
Since excess of animal foods has been mentioned as a
cause of constipation, it might be supposed that the total
FOOD IN DISEASES OF THE DIGESTIVE TRACT 295
exclusion of this class from the diet would be advantageous.
While true theoretically, this would be unwise practically,
since the maintenance of nutrition would be more difficult
on a strictly vegetable diet and such a plan of feeding
would, furthermore, tend to produce flatulence and dilata-
tion of the stomach and of the intestines. Hence, a mixed
diet is the correct one, but it should contain a minimum
of wholly digestible foods and a maximum of those which
leave a large residue of undigestible material, in order
that the bulk may act as a mechanical stimulant to
peristalsis by distending the intestine.
Organic acids stimulate peristalsis, as do also various
mineral salts. Sugars likewise have this action on the
intestine. This effect may be brought about either by
the development of organic acids through fermentation of
the sugar, or by the abstraction of water from the lining
membrane of the intestine, an action which the sugars
have in common with the salts. Sugars are not equally
laxative. Milk sugar, fruit sugar, and grape sugar are
more efficacious than cane sugar. Buttermilk, sour milk,
and koumiss are laxative by virtue of the organic acids
which they contain.
Fruits are commonly used for laxative effect. This is
due to their content of vegetable acids, sugars, and
cellulose, and in some instances to their numerous small
seeds. They are thus both chemically and mechanically
stimulants to peristalsis. Though so well adapted by
structure and composition for laxative effect, they are
often ineffectual because they are injudiciously used.
When taken with a meal, their effect is to a degree lost,
as contact of their effective ingredients with the mucous
membrane is largely prevented by the other food present.
296 FOOD IN DISEASE
For good laxative effect they should be taken on an empty
stomach in the morning some time before breakfast, or at
bed-time. Apples, pears, peaches, prunes, figs, dates,
oranges, grape fruit, and the various berries which con-
tain small seed, such as blackberries, are useful.
Water should be freely drunk; especially should a glass
of cold water be taked early in the morning on rising.
This not only increases the fluid of the blood, augmenting
secretion, but by its thermic effect stimulates peristalsis.
Hot water does not stimulate peristalsis as does cold.
From six to ten glasses should be taken daily. In mild
cases of constipation this morning draught and a little
fruit will often be sufficient to give relief, while in others
good results are obtained by eating a few figs or an apple
and by drinking a glass of water on retiring.
The most laxative vegetables are tomatoes, spinach,
lettuce, asparagus, onions, salsify, cabbage, -and celery.
Coarse cereals such as oatmeal, cornmeal, and others
which contain the husk of the grain are useful laxative
foods. Bread made of finely bolted flour is constipating
because it is too completely absorbed, but Graham, rye,
and whole wheat breads are preventives. The addition
of bran to ordinary wheat flour in as large proportion
as is consistent with good bread-making, is also a helpful
measure. Sweets, such as honey, molasses, candy, or
preserved fruits, are all useful if they can be digested by
the individual, but in the use of these preparations it must
be borne in mind that they will disturb digestion if they
are used too concentrated.
Coffee stimulates peristalsis, but this effect will be
materially lessened if cream is added. It is best to take
coffee black, and, if served iced, it will have more effect
FOOD IN DISEASES OF THE DIGESTIVE TRACT 297
than if taken hot. Butter should be taken with all of
the meals.
Astringent beverages, such as tea, red wines, and brandy,
must be excluded.
Moderate cases of constipation may frequently be
relieved by dietetic treatment, but cases of long standing
cannot be cured unless there be associated with a rational
diet other hygienic measures, such as proper habits,
exercise, and sometimes massage, or electricity.
Many variations from the outline above must be made
when constipation is associated with other abnormal con-
ditions. Thus, in intestinal catarrh vegetables and fruits
rich in cellulose must be avoided, and it would evidently
be improper to give sugar in diabetes or in glycosuria.
Individuals show great variation in their susceptibility
to dietetic effects, and the special classes of foods and
even the individual articles of any class must be selected
with intelligence for each case.
A good specimen dietary of Penzoldt published by Boas
in his Diseases of the Intestines is as follows :
"7 a.m. — A glass of cold water.
" 8 a.m. — A liberal breakfast, with sweetened coffee, a
good deal of butter, honey, and Graham bread or pumper-
nickel, after which the patient should go to stool.
" 1 p.m. — Midday meal of meat, a good deal of vegetables,
salad, stewed fruits, farinaceous food, half a bottle of
light wine (Moselle) or cider.
" 7 p.m. — Meat, with a good deal of butter; Graham
bread, stewed fruit, and beer.
" 10 p.m. — Before retiring, fresh or stewed fruit."
Cirrhosis of the Liver. — Among the causes of this con-
dition are habitual use of alcohol, strong spices, and highly
298 FOOD IN DISEASE
seasoned foods. These articles must, of course, be for-
bidden. An absolute milk diet is said to give the best
results of any form of treatment. The usual difficulties
attending the restriction of food to one article will be met
with in the course of treatment, such as repulsion, indi-
gestion, and loss of appetite. As in other diseases in
which milk is "the exclusive diet, the substitution of some
of its derivatives and variation in the manner of serving
will enable a patient to continue it longer. When milk
cannot be taken alone, milk soups flavored with vegetables,
such as celery, egg and milk mixtures and bouillon may
be substituted. Tea and coffee are permissible in moderate
amount, but sugars, starches, and fats should be excluded.
Saccharin may be used for flavoring. As the patient
improves, green vegetables may be given and a minimum
of baked potato. Zwieback and toast are also permissible.
When meats must be given, fish, oysters, and the breast
of chicken, finely minced, are the best to use.
Much has been claimed for the "dry cure" as a treat-
ment when ascites develops. This consists in with-
holding fluids and giving bread and meats chiefly. It
has been helpful in some cases, but often fails.
CHAPTER XVI.
FOOD IN DISORDERS OF NUTRITION. OBESITY.
GOUT. DIABETES. SCURVY. CHRONIC RHEUMA-
TISM. RHEUMATOID ARTHRITIS.
Obesity. — Obesity is frequently caused by habitual
excess in eating. Though it may occur in youth, it is
usually a disease of middle life, and in these cases the
continuance of the dietetic habits formed in youth is
frequently responsible.
The body fat is derived chiefly from fats and carbo-
hydrates, although proteids also contribute to its produc-
tion. These differences in the source of fat have been
the basis of numerous treatments, characterized by the
special restriction of one kind of food, though all reduce
the carbohydrates and the total quantity of food. The
fact that many methods, varying essentially in their
principles, have been successful in numerous instances,
indicates that the faculty of producing fat from different
kinds of foods varies with the individual. From this it
will be evident that no routine diet can be established
which will prove effectual in all cases.
The objects sought in all dietetic treatment are to bring
about consumption of the patient's body fat by restricting
the amount of food and to prevent its reaccumulation by
regulating its quality. Though the discussion of the
indications for reduction in obesity belongs to the subject
of Practice of Medicine, caution must here be given
against ill-advised efforts at reduction in weight; for many
persons who, though obese, were healthy, have lost their
300 FOOD IN DISEASE
health irreparably by misguided efforts to reduce their
flesh.
Reduction in the quantity of food is essential, and
should be carried to the minimum compatible with the
maintenance of health. Instead of the 2500 to 3000 calories
allowed for normal persons, the fuel value of the food must
be reduced to 2000 or less. Sugars must be absolutely
excluded and starches greatly restricted, reliance for
nutrition being placed chiefly upon proteids with the
addition of sufficient green vegetables to make the neces-
sary bulk to stimulate peristalsis. The reduction from the
usual diet to the prescribed diet should be gradually
brought about, since a sudden deprivation of the usual
amount of food will produce great discomfort. The total
daily amount allowed should be distributed throughout
the day at short intervals, as this lessens the weakness
which the patients usually complain of. Van Noorden's
dietary (taken from Osier) is as follows:
"8 a.m., 80 grams of lean, cold meat; 25 grams of
bread; one cup of tea, with a spoonful of milk, no sugar.
10 a.m., one egg. 12 M., a cup of strong meat broth. 1 p.m.,
a small plate of meat soup, flavored with vegetables;
159 grams of lean meat of one or two sorts, partly fish,
partly flesh; 100 grams of potatoes with salad ; 100 grams
of fresh fruit, or compote without sugar. 3 p.m., a cup of
black coffee. 4 p.m., 200 grams of fresh fruit. 6 p.m., a
quarter of a litre of milk, if desired, with tea. 8 p.m.,
125 grams of cold meat or 180 grams of meat weighed
raw and grilled, and eaten with pickles or radishes and
salad; 30 grams of Graham bread, and two or three
spoonfuls of cooked fruit without sugar." (One ounce is
equal to about 31 grams.)
FOOD IN DISORDERS OF NUTRITION 301
Van Noorden permits the use of water according to
the patient's desire.
Alcohol should be prohibited, since by its combustion
it lessens the consumption of the body fat and its use
increases the desire for food.
Great restriction in the quantity of water permitted has
been recommended by some practitioners, but this would
not be safe for persons having a tendency to uric acid
retention.
The Banting method reduces the total amount of solid
foods to from 21 to 27 ounces of solid food per day. Of
this, animal foods compose 13 to 16 ounces, bread 2 ounces,
and the balance consists of fresh fruits and vegetables.
The total amount of fluid is limited to 35 ounces. All
sugars and fats are excluded.
Ebstein's method, based on the belief that fat food
does not contribute to the body fat, but that this is entirely
derived from proteids and carbohydrates, permits fats
freely, while limiting the proteids and excluding sugars
and starches except such as are contained in a daily allow-
ance of Z\ ounces of bread thoroughly toasted. Three
large cups of tea are given daily for stimulation. This
diet produces only about 1400 calories.
Oertel's method gives about the same amount of meat
and carbohydrates as Banting's, and three times the fat.
It produces 1200 calories. It has become popular in
treating cases of fatty heart. Fluids are reduced to 36
or 40 ounces. Graduated hill climbing is prescribed to
strengthen the heart. The daily menu is as follows (taken
from Yeo's Food in Health and Disease) :
"Morning. — One cup of tea or coffee with a little milk,
altogether about 6 ounces. Bread, 3 ounces.
302 FOOD IN DISEASE
"Noon. — 3 to 4 ounces of soup, 7 to 8 ounces of roast
or boiled beef, veal, game or not too fat poultry, salad
or a light vegetable, a little fish (cooked without fat) if
desired, 1 ounce of bread or farinaceous pudding (never
more than 3 ounces) ; 3 to 6 ounces of fruit, fresh preferred,
for dessert. It is desirable at this meal to avoid taking
fluids, but in hot weather, in the absence of fruit, 6 to 8
ounces of light wine may be taken.
"Afternoon. — -The same amount of coffee or tea as in
the morning, with at most 6 ounces of water; an ounce of
bread as an exceptional indulgence.
"Evening. — One or two soft-boiled eggs, 1 ounce of
bread, perhaps a small slice of cheese. Salad and fruit;
6 to 8 ounces of wine with 4 or 5 ounces of water."
Some physicians exclude all fluids from the meals and
give hot water two hours after. This is beneficial in many
cases, but in persons of feeble gastric digestion it is usually
best to allow some water or other beverage.
The Salisbury method is of advantage in some cases of
obesity due to overeating, but it is difficult to enforce,
since the whole food consists of minced lean beef and hot
water. Three meals are given daily, consisting wholly of
minced beef, beginning with an ounce or two, the quantity
being increased according to the patient's digestive ability
to 8 ounces, or, in some cases, to a pound, which is the
maximum limit. An hour and a half before each meal
and at bed-time, a pint of hot water is drunk slowly.
For anemic patients such vigorous restriction is exces-
sive. The Weir Mitchell treatment is often more suitable.
This consists of rest in bed for two weeks, with massage,
after which exercise is gradually added. During the first
week the diet is reduced until by the end of the week
the patient is on an absolute diet of skimmed milk. By
FOOD IN DISORDERS OF NUTRITION 303
observation, the amount of milk on which the weight is
retained is first determined, and the quantity then reduced
until the patient is losing half a pound a day. For variety
a little soup made of oysters, clams, or chicken is allowed
occasionally. If the heart grows weak, more liberal diet
is given. Eggs, fish, and meat are the first articles used
in changing from the skimmed-milk diet.
Gout. — The greatest difference of opinion has been
shown in the recommendations for diet in gout. The
very multiplicity of views, based on various theories as to
causation, is an indication of our lack of accurate knowl-
edge of the exact nature of the derangement of metabolism
which leads to a gouty diathesis and the acute attacks.
When the true cause of this derangement has been finally
proven, dietetic treatment will become definite and no
doubt efficient, but in the present day all that can be
positively stated is that gout is a disorder of metabolism
and that uric acid is present in some form in excess of
normal from deficient excretion.
It was formerly taught that uric acid was due to dimin-
ished oxidation of proteids, and those holding this view
eliminated this class of food as much as possible from the
diet. It has been definitely proven, however, that uric
acid is not derived from pure proteid, but from nucleo-
proteids.
In view of the unsettled state of opinion respecting the
whole subject, it can only be emphasized with regard to
gout, what has already been said of dietaries in general,
that the diet must, in each case, be suited to the individual.
This becomes clinically evident when patients are seen
to improve on quite opposite lines of treatment.
Whether uric acid stands in a causative relation, toxic
or mechanical, to gout, or whether its > retention is the
304 FOOD IN DISEASE
effect of some other toxic cause of gout, its known deriva-
tion from nucleoproteids is an indication for withholding
from the diet those foods which are rich in nuclein. Such
are the glandular organs used as delicacies, sweetbread,
liver, kidney, brain.
As in other diseases, the object of dietary regulations
is not only to withhold injurious foods, but at the same
time to maintain the patient's nutrition, and this requires
foods of all classes. Absolute milk diet has been advocated,
but its unsuitableness for adult use alone has been often
referred to. It has been suggested, too, that the phosphoric
and sulphuric acids, developed by metabolism of albumin,
are not neutralized in gout, and by thus increasing the con-
dition of acidsemia they further the retention of uric acid.
The large amount of phosphoric acid contained in milk
may explain the disappointing results of absolute milk in
many persons who not only fail to benefit by such treat-
ment, but grow worse under it. For those who can digest
milk, it is a most valuable proteid, since it is lacking in
the extractives such as occur in meats, and it should be
used in proper amount with other foods.
Meats are to be restricted for the above-mentioned
reasons, and because the extractives, in which they are
rich, bear a close relation to the xanthine bases, the co-
products with uric acid derived from nuclein. Though
restricted, they should not be withdrawn, as they furnish,
with milk, the most readily digested proteids. The old
belief that red meats were much more injurious than the
white, has been shown to be fallacious, and the matter
of choice is now left to the patient's taste.
The extent to which fats and carbohydrates should be
used is also a mooted question, based on the old theory
FOOD IN DISORDERS OF NUTRITION 305
of diminished oxidation of proteids as the source of excess
of uric acid. The advocates of their liberal administration
claimed that this diminished the ingestion of proteids and
thus indirectly lessened uric acid formation, while others
limited the use of fats and carbohydrates, since by their
more ready oxidation they acted as albumin sparers,
lessening the oxidation of that substance. In view of the
recent determination of the true source of uric acid from
foods, these opposed views regarding the use of fats and
carbohydrates cease. to be of importance.
Of more import, perhaps, than selection as to the quality
of food, is the limitation in quantity. After full develop-
ment of the organs, say at thirty to thirty-five years of age,
the body does not need as much food as it did during the
period of organic growth. Most persons lose sight of this
fact and cling to habits formed in younger days, eating
far more than is necessary or beneficial. Such excess
taxes the digestive and eliminating organs to a more or
less grave extent. Patients with gout must, therefore, be
especially instructed as to the proper amount of food
which they should take.
A rational diet in gout should be a mixed one and
include all classes of food.
Proteid Foods. — Milk, meats, red or white, and fresh
fish should be allowed in proper amount to supply proteid
waste. Eggs are best withheld, because the yolk contains
lecithin. Soups made of meats or of meat stock must
be forbidden on account of the extractives which constitute
their chief ingredient. There is no objection, however, to
vegetable purees or soups made with milk as the base.
When milk is indigestible, milk derivatives may be used,
such as buttermilk and koumiss. Cheese is usually
20
306 FOOD IN DISEASE
permitted, but, as it is for many persons indigestible, it
must not be indiscriminately prescribed. Oysters and
clams are usually permitted, although restriction in the
use of the former would be wise, since it is chiefly com-
posed of liver, an organ rich in nucleoproteids. Salt fish
and dried-meat preparations should be avoided.
Fats. — It has been customary to withdraw fats from
gouty patients who are corpulent, but Ebstein has shown
that the daily use of two and a half to three and a half
ounces of butter improves the . condition of such patients,
and that they lose flesh under the treatment. By the use
of fat the carbohydrates, which are more potent flesh-
forming foods, can be reduced. Gross fats are injurious,
chiefly from the indigestion which they are liable to
produce.
Carbohydrates. — Vegetables and fresh fruits may be
freely used, with the following exceptions : cabbage, rhu-
barb, tomatoes, and spinach, because of their content of
oxalic acid, a congener of uric acid, which may irritate
the kidneys in course of elimination. Tomatoes are now
said to contain but little of this objectionable ingredient
and are often permitted, though it is a vegetable for which
many persons have marked idiosyncrasy. Peas, beans,
and lentils should be entirely avoided or allowed in the
most limited quantity, since their proteid is not as digest-
ible as the animal proteid, and these foods are prone to
produce indigestion with gas formation. Bananas are best
avoided since they are liable to produce indigestion.
Strawberries should also be forbidden. Farinaceous
foods and cereals of all kinds, except oatmeal, may be
used. Spices and condiments, sauces, and rich gravies
are to be proscribed at all times.
FOOD IN DISORDERS OF NUTRITION 307
Beverages.— Tea and coffee may be partaken of in
small quantities if not strong, provided they do not cause
indigestion, which they are much less apt to do if taken
without sugar or cream. Tea is constipating to many
persons, and should be avoided by those on whom it has
this effect.
Water should be freely taken, as it stimulates kidney
activity and helps in removing the waste products. At
least six or eight glasses should be taken daily. Various
spring waters are used in gout, but it is probable in most
instances that the chief benefit is from the fact that water
is drunk freely rather than because of the mineral ingre-
dients. Three classes of waters are used : those containing
a minimum of mineral matter, such as Poland Spring
Water; alkaline waters, such as Vichy; and purgative
waters, such as Carlsbad and Pluto.
Alcoholic beverages are all injurious in gout, and total
abstinence should be insisted upon in the great majority
of cases. If the maintenance of nutrition demands alcohol
for those habituated to its use, in order to prevent loss of
appetite, which might follow its absolute withdrawal, good
whiskey and gin are the best preparations. In general,
distilled liquors are less injurious than fermented. Malt
liquors, heavy wines, such as port and Madeira, and
champagne are notoriously harmful.
It must be borne in mind that gouty patients show
frequent idiosyncrasy for foods which theoretically would
be allowable. They should, therefore, be taught to observe
the effect of articles permitted, and their statements con-
cerning the peculiar effects of individual foods should
receive respectful attention. In selecting the diet great
care must be used to avoid substances which might cause
308 FOOD IN DISEASE
indigestion; therefore, fried foods, heavy sweets, such as
rich puddings, cakes, and pastries, must be forbidden.
Diabetes. — At the outset it should be understood that
while the disappearance of sugar from the urine is a
desirable thing in diabetes, its presence is not the most
important criterion in determining diet. As in other
diseases in which the perversion of normal metabolism
exists, so in diabetes, the maintenance of proper nutrition
is the chief consideration. It is more desirable that the
patient should retain strength and flesh, even with some
excretion of sugar, than that the disappearance of sugar
should be achieved at the expense of weight and vigor.
Glycosuria varies in severity from the cases of simple
glycosuria, due to the excessive ingestion of sugars and
sugar-forming substances, which are relieved by appro-
priate diet, to the severe cases of true diabetes for which
there is no cure, all dietetic treatment being purely
palliative.
In this condition, in which the body has lost its power
of utilizing the carbohydrates, their withdrawal would
at once suggest itself as a rational method of feeding, and
this was previously the custom and practice, and effort
was made to supply heat and energy by the excessive use
of fats. Many grave objections to this plan exist. Increas-
ing loss of appetite from lack of variety in the diet prevents
sufficient food from being taken, and if this misfortune
does not arise, intolerance for fat will soon develop and
be evidenced by indigestion. It is, therefore, a practical
impossibility adequately to nourish most patients on the
meat-fat diet alone. Another serious objection to such
absolute restriction is that in the entire absence of carbo-
hydrates the development of acetone and oxybutyric acid
FOOD IN DISORDERS OF NUTRITION 309
is liable to occur, with the production of a condition of
acidosis and of diabetic coma. The carbohydrates seem
to have the power of increasing the oxidation of the
acetone group, thus preventing development of the
dangerous coma. Carbohydrates also aid in the assimila-
tion of fats. It will thus be evident that they should not
be entirely excluded from the diet, but since it is an
indisputable clinical fact that their restriction produces
diminution in the amount of sugar, and in some cases even
its entire disappearance, with accompanying relief of the
general symptoms, the carbohydrates should be limited,
the degree of this restriction to be determined in each case
individually. There is no dietetic problem that needs
greater discrimination or closer observation of the effects
of diet than the treatment of diabetes.
The general principle in medicine that functional dis-
turbance requires rest for its relief is applicable in diabetes,
and it is customary in beginning the treatment of this
disease to withdraw carbohydrates wholly from the diet
for a time. This withdrawal, however, should be accom-
plished gradually, a week being allowed for their complete
exclusion, since a sudden change may seriously disturb
digestive processes. As the carbohydrates are reduced,
the deficiency of diet thus caused must be supplied by
proportionate increase of fats. This procedure has the
further advantage of giving opportunity to judge of the
amount of carbohydrates which a patient can utilize and
of the grade of diabetes present. If the sugar disappears
from the urine on the withdrawal of sugars only from the
diet the case is of the mildest, but if exclusion of all
carbohydrates is necessary to cause cessation of the
glycosuria the case is considered moderate in severity;
310 FOOD IN DISEASE
if severe, the sugar will continue as a urinary symptom in
spite of such restriction of diet. A non-carbohydrate diet,
such as is recommended by Van Noorden, is as follows
(taken from Osier):
"Breakfast, 7.30 a.m. — 6 oz. of tea or coffee; 4 oz. of
beefsteak, mutton chop without bone, or boiled ham;
one or two eggs.
"Lunch, 12.30 p.m. — 6 oz. cold roast beef; 2 oz. celery,
fresh cucumbers or tomatoes, with vinegar, olive oil, pepper
and salt to taste; 5 drams whiskey, with 13 oz. of water;
2 oz. coffee, without milk or sugar.
"Dinner, 6 p.m. — 6 oz. of clear bouillon; 7\ oz. roast
beef; 2\ drams of butter; 2 oz. green salad, with 2\ drams
vinegar, 5 drams of olive oil, or three tablespoonfuls of
some well-cooked green vegetable; three sardines a l'huile;
5 drams of whiskey, with 13 oz. of water.
"Supper, 9 p.m. — Two eggs (raw or cooked); 13 oz.
water."
When this diet has brought about complete disappear-
ance of sugar from the urine for several days, starch may
be given in gradually increasing amounts from one-half to
three ounces until the reappearance of sugar. Judgment
can thereby be formed of the amount of carbohydrates
which the patient can take at that period, but it must be
remembered that the power of utilizing starches will
fluctuate irrespectively of diet, so that such a gauge will
not be applicable throughout the course of the disease.
Van Noorden believes that by the use of such non-carbo-
hydrate diet the power of the body to utilize this class of
food is increased, and he recommends the return to such
diet for a week or two at intervals of three or four months,
in order to maintain this power. If under such dietetic
FOOD IN DISORDERS OF NUTRITION 31 1
restrictions the patient continues to eliminate 0.1 to 0.5
per cent, of sugar, he recommends total abstinence from
food for twenty-four hours, which he terms a "hunger-
day." This will frequently lead to the disappearance of
the sugar with subsequent ability to utilize a small amount
of carbohydrates.
Entire deprivation of bread has proved so great a hard-
ship to patients that many substitutes have been exploited.
Gluten flour has been tried, but the majority of brands
contain so much starch, even more in some instances than
wheat flour, that their use is now considered unsafe, and
where carbohydrates are permitted, good bread made of
wheat flour is preferred, the amount of starch in which is
55 per cent. Bran bread has been used, but unless care-
fully prepared it is apt to contain a considerable amount
of starch, besides a large proportion of indigestible cellu-
lose. Almond flour has proved of service and is used in
the form of cakes. Soya-bean flour has also found favor
with some persons, though many object greatly to its
taste. Potatoes are now used by many physicians in the
place of bread, to which they are said to be superior.
They seem to have some effect in increasing the met-
abolism of sugars, and can be given in larger amounts
than bread. Their superiority is supposed to be due to
the potassium salts contained, which are transformed in
the body into potassium carbonate. Potatoes are recom-
mended more for thin than for fleshy persons.
Aleuronat and Roborat flours, which contain a large
amount of vegetable albumin, are also recommended.
Sugars. — Grape sugar appears more readily in urine
than any other kind, and next to it in this respect is cane
sugar. Both should therefore be absolutely excluded
312 FOOD IN DISEASE
from the diet. Milk sugar is well utilized by many persons ;
some cannot take it at all. Levulose is by most patients
well borne, and it is therefore permissible in most cases.
It is usually taken in the form of fruits, as the commercial
article is too expensive to permit of its use for flavoring.
Saccharin or dulcin may be used to sweeten foods and
beverages, but it is best to limit the amount of saccharin
to one and a half grains daily, since its constant use in
larger amount may lead to gastric disturbances.
Fats should be used in as large quantity as is compatible
with good digestion, since it is to them we look to replace
the deficiency in the diet brought about by carbohydrate
restriction. They generate heat and spare albuminous
waste, thus performing similar functions to the carbo-
hydrates. They are given principally in the form of salad
oils, fat meats, butter, cream, and cream cheese. Objec-
tion has been made to the use of fats because it is probable
that acetone is derived from them, especially with regard
to butter, which gives the highest acetone excretion of all,
the fats used for food. In spite of this probable source
of acetone, fats must be used because they are essential
to the maintenance of nutrition. Van Noorden has shown
that the acetone does not increase proportionately with the
addition of fats, no increase occurring with butter until
more than four and one-half ounces are given. ^ He has
further shown that if butter be thoroughly washed, thereby
removing the fatty acids which chiefly produce the acetone,
it may be given in quantity up to six ounces a day without
causing appreciable increase in acetone elimination.
Proteids must be given in as great amount as can be
digested, since they are necessary to maintain the tissues
and must in this disease be depended upon in part for the
FOOD IN DISORDERS OF NUTRITION 313
supply of energy. With the development of acidosis,
however, they must be reduced or even suspended. All
forms of fresh meat (except liver), game, fish, poultry,
eggs, and cream cheese may be used. Dried, smoked, and
salted meats and fish are all available, and fish preserved
in oil, such as sardines, are of much value. Caviar is
much esteemed, as it stimulates appetite. Shell-fish are
also allowed. Clear soups and broths are permitted.
With regard to the propriety of giving milk, opinion has
differed and its place in different dietaries has varied from
absolute milk diet to absolute exclusion. The determi-
nation of the matter will depend upon the patient's ability
to utilize milk sugar. Milk is admissible in moderate
quantity in many cases, and the addition of it is a ready
and useful means of changing from a non-carbohydrate
diet.
Fresh vegetables containing much starch or sugar should
be excluded, except potatoes, which may be given in
amounts proportioned to the patient's ability to utilize
them. In some cases as much as two pounds, weighed
raw, has been allowed. They should be cooked with the
jackets on to save loss of the salts. They should be well
matured, and cooked "mealy." Other fresh vegetables
having a low percentage of starch or sugar may be used
freely. Such are lettuce, cress, spinach, cucumbers, onions,
leeks, radishes, asparagus, cabbage, cauliflower, sprouts,
mushrooms, green French beans, sauer kraut, dandelion,
tomatoes, and various sour pickles.
Fruits which contain but little sugar may be taken in
small amount in cases of moderate severity, but all sweet
or starchy fruits, such as grapes, bananas, figs, and prunes
must be forbidden. Those usually permitted are oranges,
314 FOOD IN DISEASE
lemons, limes, cherries, plums, acid apples, pears, straw-
berries, raspberries, blueberries, cranberries, gooseberries,
and melons. Nuts, except chestnuts, are allowed.
Beverages. — Pure spring water, Apollinaris, Vichy, and
soda water may be taken freely. Tea, coffee, and cocoa
nibs may be taken moderately, but saccharin must be used
for sweetening them. Alcohol in moderate amount is
allowable, since it increases the patient's ability to ingest
fats, and prevents disgust for them. Good whiskey and
brandy are considered best, and they should be diluted
with aerated or alkaline waters. Two to three ounces
may be given. Light acid wine, such as claret and hock
are also permitted, but all sweet and sparkling wines and
malt liquors are to be interdicted.
When a large excretion of acetone bodies occurs,
indicating a high degree of acidosis, this becomes of
greater immediate concern than the glycosuria, and
requires special diet. The condition is caused by too
great deficiency of carbohydrates, and these must be given
promptly regardless of fluctuations in the amount of sugar
in the urine. Under carbohydrate diet acidosis rapidly
diminishes and improvement often continues for many
weeks after the restricted carbohydrate diet is resumed.
For severe or protracted cases Van Noorden advocates an
oatmeal cure. His method is to restrict his patient to a
gruel or soup made of oat flour, 250 grams (7-f- ounces);
butter, 250 to 300 grams (7-f to 9f ounces) ; and Roborat,
or some other vegetable albumin, 100 grams (3 ounces).
This is given in divided doses at intervals of two hours
throughout the day. Under the treatment the elimination
of sugar is usually reduced and excretion of acetone falls
rapidly. This diet is continued for one or two weeks,
FOOD IN DISORDERS OF NUTRITION 315
when return to the previous diet must be made, as the
patient cannot longer bear the restriction. The return to
proteid foods must be very gradual, as otherwise recur-
rence of acidosis may develop suddenly. The benefit
derived from the "oatmeat cure" is removal of immediate
danger from acidosis and improvement in the condition,
which often lasts for weeks, or even months.
When coma threatens, the administration of levulose
may ward off its development. As much as one to three
ounces a day has been given with good effect.
Scurvy. — The definite cause of this disease has not been
determined, though deficiency in some essential of diet is
always present. It is observed among persons who use
salt meats and stale foods, and was, at one time, common
in navies and armies, in which salt meats and hard-tack
formed a large proportion of the regular diet. Insufficient
food may lead to its development and lack of the proper
variety may induce it.
Although the definite cause is undetermined, it is known
empirically that the liberal use of fresh foods will relieve
it. Fresh meats should be given with fresh vegetables
and fruits. Irish potatoes, oranges, lemons, and limes are
of especial value and all of the green vegetables are helpful.
When the mouth is too sore to permit of solid feeding,
fresh milk and freshly prepared beef juice should be given,
with lemon or orange juice, and vegetable juice, or purees.
Chronic Rheumatism. — Conditions in this disease vary
so that no routine line of treatment can be given, but the
diet must be adapted to each individual according to the
digestive ability. Anemia is so often present that meats
must be allowed, but they must be used in moderation.
Fresh meats only should be given. Green vegetables and
316 FOOD IN DISEASE
farjnaceous foods should, with milk, form the bulk of the
diet. In some instances, strictly vegetarian diet seems
beneficial. Lemons and oranges are permissible, and water
should be freely taken, but alcohol should be forbidden.
Rheumatoid Arthritis. — This is a disease of deficient
nutrition, and calls for a liberal diet. Animal foods of good
quality should be freely given, together with cereals and
fats. Fish, eggs, milk, cream, and butter should appear
conspicuously in the diet. Cod-liver oil is a valuable
addition if the patient can digest it. In the event of
febrile exacerbation, the diet must be reduced, as in acute
rheumatism.
CHAPTER XVII.
FOOD IN DISEASES OP THE KIDNEY. ACUTE
NEPHRITIS. CHRONIC NEPHRITIS.
NEPHROLITHIASIS.
In inflammation of the kidneys, of whatever form, the
object of treatment is to spare them work and avoid all
substances which could irritate them. In the matter of
diet, which is of the greatest importance, practice had got
into a routine which was in many details irrational until
the investigations of Van Noorden and others pointed out
definitely the old fallacies. Not only is the quality of food
to be wisely selected, but the quantity must be judiciously
limited according to conditions present. Although dietetic
restrictions are necessary in order to spare the kidneys
the labor of excreting substances which would irritate
them, it should be borne in mind that sufficient food must
be given to maintain general nutrition and supply the
required energy and heat, a fact which has often been lost
sight of in an effort to consistently meet the former indica-
tion.
Acute Nephritis. — In acute nephritis it is universally
agreed that milk is the most appropriate diet, as it is a
complete food and easily taken. Its deficiency in carbon
may be corrected by the addition of cream in the proportion
of half a pint to a quart of milk. In those cases of acute
nephritis, in which the amount of urine is greatly lessened,
the quantity of milk should be reduced to the minimum,
not more than a pint, or a pint and a half, being given in
a day. Such reduction of nutriment cannot be continued
318 FOOD IN DISEASE
for more than a few days, but it is very beneficial, and if
the patient is robust it may be of advantage to withhold
food entirely for twenty-four hours. In those cases in
which the amount of urine, though lessened, is not dimin-
ished to a threatening extent, a quart and a half of milk,
with the addition of cream as above mentioned, may be
given. If more food seems desirable, it would be better
to give such additional articles as rice, fine white bread
with butter, and unfermented grape juice, than to increase
the quantity of milk, since milk contains a large amount
of phosphoric acid, one of the substances eliminated by
the diseased kidney with difficulty. That which is ingested
in the milk administered may be largely neutralized if
the patient will take, several times a day, a small dose of
calcium carbonate, which forms a compound with the
phosphoric acid that is but slightly eliminated by the
kidney, the larger proportion passing out with the feces.
The natural content of calcium in milk is inefficient to
counteract its phosphoric acid, since it occurs in milk in
inorganic compounds which cannot combine with this acid.
Water should be given freely as long as the kidneys are
able to excrete it. It dilutes the irritating substances, and
facilitates their elimination. When, however, water is
excreted with difficulty, as is shown by the small amount
of urine with increased edema, it should be materially
lessened in amount, and thirst should be relieved by giving
small bits of ice to suck.
In convalescence all foods must be gradually increased.
Milk may be given in quantities of two or two and a half
quarts, not more. Bread, legumes, cereals, fruits, and
small quantities of eggs or meats may be gradually added
to the diet. Water should be freely given in this stage for
FOOD IN DISEASES OF THE KIDNEY 319
the purposes above mentioned, and because it aids the
action of the bowels, as well as stimulating the kidney
function.
Chronic Nephritis.- — This occurs in two forms, famil-
iarly known as parenchymatous and interstitial. The
dietetic treatment of the two is quite different, but one
principle which they have in common should constantly
be borne in mind, that the presence or amount of albumin
in the urine is not an indication which should control
dietetic treatment, but this must be determined by the
general nutrition of the patient and circulatory efficiency.
Parenchymatous Nephritis. — In parenchymatous neph-
ritis, the custom has long prevailed, and is still in many
cases followed, of approximating, as closely as possible,
an absolute milk diet. The difficulties attending this plan
are very great on account of the duration of the condition.
Very few succeed in carrying it out strictly, though indi-
viduals have subsisted and apparently done well on milk
and mineral waters for several months. This is excep-
tional, however, and such a diet, if persisted in, would,
in many cases, do harm.
The principle of dietetic treatment is to protect the
kidneys by eliminating from the diet those substances
which pass through the kidney with difficulty. From long
observations and experiments, Van Noorden states these
substances to be urea, creatinin, pigments, hippuric acid,
phosphates, inorganic sulphates, potassium salts, water
(under certain conditions).
Urea and inorganic sulphates are derived from proteid
foods, which should therefore be reduced to the smallest
amount compatible with maintenance of the patient's
nutrition, and for short periods of a week or two this
320 FOOD IN DISEASE
reduction may be great. An excess of milk above a quart
and a half will be more than required, and therefore
harmful.
Creatinin is derived from creatin, which is present in
considerable quantity only in meat extracts, meat broths,
etc.
The regulation of pigments derived from hemoglobin
is hardly to be accomplished by dietetic means, but as
hemoglobin ingested with food increases these pigments
in the body, it is well to avoid preparations which contain
it. Benzoic acid, from which hippuric acid is produced
in the body, occurs chiefly in green vegetables, the stone
fruits, and cranberries, which should, therefore, be for-
bidden. The traces of it which occur in other fruits and
milk are not of consequence.
Phosphoric acid, from which the phosphates are derived,
occurs in large quantity in meat, yolk of egg, and milk.
The administration of calcium carbonate is the simple
means of counteracting its disadvantages, as above
described.
Uric acid and xanthin bases have for a long time been
considered injurious in nephritis, though Van Noorden
classifies them as relatively well excreted. They are
derived from glandular organs used as foods, such as
kidneys, sweetbread, liver, etc.
Potassium salts occur in meats and in fairly large per-
centage in potatoes.
Water is beneficial as long as its excretion is accom-
plished by the kidneys, but when edema develops and
increases, and especially when cardiac dilatation super-
venes, as indicated by dyspnea, immediate reduction
should be made in the amount allowed.
FOOD IN DISEASES OF THE KIDNEY 321
A suitable diet, then, for parenchymatous nephritis would
include a proper amount of milk with an addition of
cream; farinaceous foods, such as rice and tapioca; cereals,
selected fruit, and fruit juice, of which grape juice possesses
especial value; bread, butter /and sugar, and such vegetables
as do not contain the irritant substances above enumerated.
If salt is withheld from the diet, diminution of albumin
promptly follows and thirst is markedly lessened. The
latter effect may be increased by the use of sodium bromide.
Alcohol should be withheld in nephritis until such time
as the indication for its use is imperative; then it should
be prescribed in necessary amount, as in other conditions.
When edema diminishes and the general condition
improves, there is no reason why meats and eggs should
not be given in moderate amount, or the diet varied with
oysters, clams, and fresh fish.
Interstitial Nephritis. — This is a very chronic- dis-
ease, extending over years without producing conscious
symptoms. Sufferers from this form of nephritis fre-
quently discover its existence accidentally when applying
for life insurance. In determining a dietary, therefore,
which is to extend over a large portion of a person's life,
the question should be not so much what to withhold as
what may be allowed. The object here in diet, as in the
other forms in nephritis, is to protect the kidney and at
the same time maintain nutrition. The diet is of especial
importance because it is frequently through dietetic indis-
cretions, unwittingly committed, that the complications
occur which lead to a fatal termination.
In this form of the disease the excretion of waste
products by the kidneys is fairly well maintained, except
in acute exacerbations and in the terminal stages.
21
322 FOOD IN DISEASE
Alcohol is one of the frequent causes of this form of
kidney trouble, and should therefore be avoided. In
some instances, where the withdrawal of alcohol in persons
habituated to its use produces loss of appetite and indi-
gestion, it may be the part of wisdom to permit a small
amount for the sake of maintaining appetite and nutrition.
Abstinence from alcohol is further indicated by the chronic
derangement of the circulatory apparatus which accom-
panies this kidney disease.
Spices and condiments are especially harmful by the
irritation of the kidneys which they produce. While these
substances have not been fully investigated, the fact that
certain of this class of food accessories are frequently
injurious justifies the exclusion, from prudence, of the
following: white, black, and Cayenne pepper, paprica,
curry, cloves, nutmeg, mustard, anise, leek, garlic, carra-
way,' celery, and truffles. *
The use of coffee, tea, and tobacco must be determined
by the condition of the heart. If they produce depression
or irregularity, they must be abandoned, otherwise, their
moderate use is permitted.
In a disease of such long standing, meats must, of
necessity, be allowed, though the amount taken daily
should be relatively small. The older practice in this
disease restricted the patient to the use of white meats,
but when such a diet is long continued, distaste develops
and the patient will frequently become anemic and weak
from lack of sufficient proteid food. The more recent
investigations have shown that there is no choice between
the white and dark meats, and both are now allowed
according to the patient's taste.
Great liberality in the use of water has been the usual
FOOD IN DISEASES OF THE KIDNEY 323
practice, but it is questionable if the patient suffering with
this disease is benefited by its great consumption. The
lower percentage of albumin, when water is freely given,
is usually due to its greater dilution, and the amount of
this substance is never a proper indication of the patient's
condition. Excessive amounts of water, by increasing
blood pressure, throw more work upon the heart, an organ
which should be spared in chronic nephritis as much as
the kidneys themselves. It is probable that restriction of
water, at least to the amount taken in health, would be the
best plan.
These suggestions as to diet apply to the fairly mild
cases, but it must be remembered that the disease is liable
to fluctuation. When exacerbations occur, diet must be
instituted, such as described for parenchymatous nephritis.
When the end is at hand, however, and there is no reason-
able hope of bettering the patient's condition by further
food restrictions, much mental distress can be spared and
no harm done by regulating the diet according to the
patient's tastes.
There are certain conditions often met with in the
course of this disease which require special dieting.
Threatened uremia demands the temporary exclusion of
proteid and the minimum amount of food of any kind.
If anemia develops, an increase in the meats must be
allowed. The development of cardiovascular symptoms
requires reduction in the amount of food and strict
limitation of the fluid allowed.
Nephrolithiasis. — During an acute attack of renal colic
diet is a matter of no moment, since no food is taken, as a
rule. Nor can dietary restrictions in any way effect
removal of stones already formed. The purpose is to
324 FOOD IN DISEASE
prevent enlargement of existing stones or the formation
of new ones. When the stone in the kidney is formed of
uric acid, the diet described for gout gives the appropriate
restrictions.
Stones are formed of oxalic acid when certain forms
of indigestion are present. In these cases a diet suited to
the nature of the digestive disturbances should be directed.
The following articles, which contain oxalic acid, should
be excluded: cabbage, tomatoes, spinach, rhubarb, celery,
tea, apples, peas, and possibly onions and turnips.
Phosphatic calculi are formed when the urine is persist-
ently alkaline. This condition arises when an excess of
vegetables, with too great restriction of meats, occurs.
Milk, eggs, meats, cereals, and bread should form the
basis of diet.
In all forms of stones pure water should be abundantly
used. Distilled water, Poland water, or any good spring
water will be equally effective. Many lithia waters are
useful, not on account of merit from the lithia contained,
but because they are pure waters, and many persons will
drink more regularly of a special water than they will of
their customary supply.
Alcohol is best avoided in all of these cases, but if its
use is essential to a patient's comfort and willingness to
submit to the necessary restrictions, good Scotch whiskey
with aerated water may be allowed moderately.
CHAPTER XVIII.
FOOD IN DISEASES OF THE CIRCULATORY AND
RESPIRATORY TRACTS. CHRONIC HEART DIS-
EASE. ARTERIOSCLEROSIS. ANGINA PECTORIS.
AORTIC ANEURYSM. ACUTE BRONCHITIS. BRON-
CHOPNEUMONIA. ASTHMA. PLEURISY. FOOD IN
ANEMIA AND NEURASTHENIA.
DISEASES OF THE CIRCULATORY ORGANS.
In these diseases dietetic treatment plays a secondary
part, as it is not possible by means of it to affect the original
diseases; some intercurrent conditions, however, which
increase the patient's discomfort or add to his danger
may be greatly modified by appropriate dietary measures.
In chronic organic heart disease only moderate restric-
tion of the diet is necessary as long as compensation is
well maintained and the heart is able to perform its work.
The chief object of dietary regulations is to prevent
fermentation in the alimentary tract, especially in the
stomach, since gaseous distention of the stomach or
transverse colon may push the diaphragm upward to
such an extent as to encroach upon the heart, producing
more or less distress and palpitation. To this end it is
necessary to eliminate certain foods from the diet, and the
meals should be given at sufficient intervals to insure
complete digestion of each before the next is taken.
While it is, of course, necessary to give sufficient food to
maintain normal nutrition, a certain abstemiousness is
nevertheless advantageous, and the quantity of food should
therefore be moderate. Twice-cooked foods, potatoes,
326 FOOD IN DISEASE
beans, and peas in quantity, very starchy foods, and sweets
had best be avoided. As a rule, tea and coffee should be
withheld, but many persons, who are accustomed to their
use, develop increase in the rate and irregularity of the
pulse through nervous irritability, if they are withdrawn.
In such cases their use should be permitted in moderation.
Water should be taken scantily with meals and an excess
of fluids should be avoided at all times, as this would tend
to raise arterial tension and increase the work of the heart.
Alcohol should be abstained from, since the dilatation of
vessels, which alcohol produces, increases the possibility
of engorgement of the organs, and the increased activity of
the heart, under its influence, is more apt to develop cardiac
fatigue. Should indigestion develop, it must be relieved
as promptly as possible by restricting the diet, if necessary,
to the extent of an absolute milk diet. Reducing the diet
periodically to absolute milk diet for a few days at a time
is advocated in these cases by some practitioners, since
it rests the digestive organs and stimulates kidney action,
too frequently sluggish in these conditions. By increasing
diuresis, arterial tension is reduced.
When compensation fails, the digestive organs suffer,
since their circulation is retarded as an effect of the heart's
disability. This frequently leads to hepatic engorgement
and chronic gastric catarrh. Under such conditions the
digestive organs must be spared as much as possible, and
concentrated foods, easily digested, are indicated. Milk
well meets the indication, as a rule, and has the additional
advantage of stimulating the kidneys, an effect which
tends to prevent or diminish the development of dropsical
effusions. This may be supplemented by other liquid
foods, such as raw eggs, egg albumin, and bouillon. As
DISEASES OF THE CIRCULATORY ORGANS 327
soon as digestive disorders improve, other foods should
be added, such as minced beef or the white meat of
chicken, and stale bread. When the liver is markedly
inactive the amount of meat should be greatly reduced
or wholly withdrawn, because the waste products developed
by the imperfect digestion in this class of foods are apt
to increase arterial tension. Fluids should be given in
sufficient amounts to maintain the volume of the blood
and dilute and carry off the waste products, but excess of
them should be carefully avoided as tending to add to the
labor of the heart and increase dropsical effusions.
Dyspnea is a frequent and often distressing symptom in
heart disease. It is much increased by accompanying
diseases of the respiratory organs and by gastric and
intestinal distention from fermentation. Under the latter
circumstances a proper diet, as outlined above, will do much
to relieve the condition.
Dilatation of the heart can be much benefited by a dry
diet, the object of which is to lessen the work of the heart
by reducing arterial tension. Toast, lean meats, a modicum
of tea with cream and sugar, and a small amount of milk
may be given. Fluids should be withheld to the greatest
extent possible without distressing the patient by unbear-
able thirst. Three or four ounces of water, preferably hot,
may be sipped an hour before meals. Two or three days
will be sufficiently long to pursue such rigid restriction
in acute dilatation; the heart will contract rapidly in that
time. As improvement advances, the diet should be
gradually increased, though for some time limited in
quantity. Chronic dilatation, commonly seen in the aged
or as an accompaniment of arteriosclerosis, requires a
modified dry diet. Cure is not to be expected, though
328 FOOD IN DISEASE
great relief often rewards the self-denial required. Food,
both solid and liquid, must be limited in quantity and
meals should be taken with as little fluid as possible.
Three meals are sufficient, and should be taken at intervals
of five or six hours, while no food should be allowed
between them. Easily digested meats and fish, toast with
a little butter, a small amount of fruit, such as pears,
apples, and grapes, oatmeal, potato, and spinach are
permissible foods. All vegetables and fruits which contain
a large amount of water should be avoided. It is recom-
mended that a glass of hot water be taken three or four
hours after each meal.
Arteriosclerosis. — This condition is so frequently con-
comitant with chronic nephritis that dietary regulations
must often be such as are given for that disease. One of
the frequent causes of arteriosclerosis is overeating, espe-
cially of highly seasoned and rich meats. This is due to
the development of toxins from meat, which increase
arterial tension while circulating in the blood, and thus
strain the vessel walls. This condition is furthered by
irritation produced in the digestive tract by the abuse of
spices and condiments, leading to the insufficient digestion
of the meats. Such foods should therefore be excluded,
although in mild cases a moderate amount of easily
digested meats, such as chicken, beef, and mutton may be
permitted occasionally. Alcohol should be prohibited,
since its habitual use is often the cause of this affection.
Absolute milk diet may temporarily be instituted with
advantage when excessive tension is accompanied by
headaches, insomnia, and nocturnal distress. Fewer toxins
are developed from milk than from other proteid foods,
and it tends to lower vascular tension by increasing
DISEASES OF THE CIRCULATORY ORGANS 329
diuresis. Eggs may sometimes be combined beneficially
with milk, but such restriction of diet should not be long
continued. Flatulence should be avoided by interdicting
foods which are slowly digested and prone to fermentation,
such as cabbage and beans. Indigestible foods, as pastries,
gross fats, and very sweet foods, should also be forbidden.
Alkaline and laxative mineral waters are useful. The
patient must be cautioned against overeating, even of the
wholesome articles allowed. Bread, cereals, vegetables,
and fruits, with milk, and sometimes eggs, must be the
main reliance.
Angina Pectoris. — Restriction of diet in angina pectoris
seeks to lessen arterial spasm. Limitation or withdrawal
of meats is essential because they are the most productive
source of irritating toxins, which lead to contraction of the
vessels. Fluids should be taken only in a 'sufficient amount
to relieve thirst, in order to avoid increase in the volume
of the blood and consequent . high pressure in the arteries
which excess would cause. The total quantity of food
should be reduced, and just sufficient taken to maintain
nutrition.
Aortic Aneurysm. — In this condition the object of treat-
ment is to diminish arterial tension and to favor coagula-
tion of the blood within the aneurysmal sac. The old
treatment of reduction of the blood volume by bleeding
and a starvation diet was long ago abandoned, and even
the modified treatment of Tufnell of a greatly reduced
diet without bleeding is not now favorably considered,
except in cases of traumatic origin. Such methods would
certainly seem irrational where degenerative tendencies
have produced the aneurysm, as the anemia which de-
velops under these plans would tend to increase the
330 FOOD IN DISEASE
dilatation. Practically but little can be done by dieting.
Restriction of fluids and the withdrawal or the reduction
of meats will reduce tensio.n in the vessels, and the diet
should be much the same as that suggested for angina.
Gelatin has been given in large amount to promote blood
clotting, and in recent years success has been achieved in
many instances by the subcutaneous injection of sterilized
gelatin solution. This is used in strength of 1 or 2 per cent. ,
sometimes as high as 5 per cent., four to eight ounces being
administered. Diminution and disappearance of pain,
less violent pulsations, and contraction of the sac are the
good results observed.
DISEASES OF RESPIRATORY ORGANS.
In this class of diseases, as in diseases of circulatory
organs, diet is for the most part a matter of secondary
importance, the chief object being to avoid indigestion as
a source of greater discomfort to the patient.
Acute Bronchitis. — In acute bronchitis, if the attack
is severe and fever is present, the restriction of diet to
fluids, as directed for acute infectious diseases, is best.
When milk can be readily digested by the patient, it will
form the basis of diet, but other preparations, such as egg
albumin, may be used. If the case is a mild one, foods
of soft consistency, which are easily digested, may be used;
eggs, soft -poached or boiled; farinaceous articles, such
as blanc mange and cornstarch; milk toasts, cereals,
minced chicken, and minced beef. In the early stages,
when the cough is harassing and expectoration scant, the
free use of fluids will tend to assist the expulsion of mucus
by making the secretions thinner. Hot drinks are often
DISEASES OF THE RESPIRATORY ORGANS 331
more comforting than cold; water, milk, lemonade, tea,
or punch may be used.
Bronchopneumonia. — In bronchopneumonia the same
general rules as to diet should be observed as in simple
acute bronchitis of a severe type. Alcohol is extensively
used in this condition, and it does good by lightening the
work of the heart and lessening internal congestion by its
effect of dilating the cutaneous vessels and lowering blood
pressure. In very severe cases the question of maintaining
nutrition often becomes a serious one, because of loss of
appetite and the unwillingness of the patient to take food,
since it often increases the distressing cough. In such
cases it may be necessary to resort to rectal feeding.
Chronic Bronchitis. — Persons suffering from chronic
bronchitis must be allowed an ordinary, wholesome diet,
as in health. The chief point of dietetic interest regards
the amount of fluid to be taken, which is determined by
the character of the secretions. When these are thick
and tenacious, the free use of fluids will tend to facilitate
their expulsion; any non -stimulating drinks may be taken
according to the patient's preference. A cup of hot tea is
often comforting, or lemonade, hot or cold water, milk or
grape juice may be used.
Asthma. — Indiscretions of diet bear an important
causative relation to attacks of asthma. Regulation of
diet in this disease is therefore of importance. The
details of restricted articles have to be determined for the
individual case, since most of these patients show more
or less idiosyncrasy for special articles of food. In general,
they should avoid all forms of food which are digested
with difficulty, and the amount of food taken should be
limited to moderation. The evening meal should be a
332 FOOD IN DISEASE
light one, the heaviest meal being taken at midday.
Fluids should be taken sparingly with meals, but may be
used between meals. A cup of hot water, given an hour
before each meal, will lessen thirst. Highly seasoned
articles and coarse meats should be interdicted. Strong
coffee is often helpful in allaying the attacks, and it is
best used without sugar or cream. Constipation increases
the liability to asthmatic seizures, and should be prevented
by a diet such as has been recommended for that condition,
so far as it is compatible with the idiosyncrasies of the
individual.
Pleurisy. — No special dietetic measures are needed
before effusion occurs other than the usual restrictions
in febrile conditions. Efforts may be made to bring about
absorption of the effusion by restricting the amount of
fluid. Such restrictions should not, however, be carried
to the extent of producing great discomfort, as this dietetic
measure frequently fails of its desired effect, and the fluid
may be otherwise effectually removed, when this becomes
a necessity. Tender meats, chicken, fish, bread with
butter, stewed fruits, potatoes, cereals, and occasionally
a small amount of green vegetables may be allowed.
Schrott's dry diet consists of lean roast veal with stale
rolls, and no fluid, except a very little water for three
days, after which a half-pint of red wine is allowed, and
at the end of a week this is increased to one pint. This
method has been popular with some physicians, but is a
hardship to patients.
ANEMIA AND NEURASTHENIA.
Anemia. — The different forms in which anemia
presents itself clinically vary in symptoms and in gravity.
ANEMIA AND NEURASTHENIA 333
The causes have not been definitely determined, though
in each instance numerous conditions are known to be
contributing factors. While medicinal and hygienic treat-
ment differ considerably, the dietetic treatment is along
the same lines in all forms of the condition.
In chlorosis deficiency of hemoglobin is the character-
istic blood finding, while in secondary pernicious anemia
diminution in the number of red blood cells is the special
feature. Either condition will bring about a lack of
hemoglobin, which therefore lessens the total amount of
oxygen in circulation and leads to consequent nutritional
changes. The metabolism of proteids increases, as is
shown by the greater amount of urea eliminated, while
the oxidation of fats is diminished. This leads to flabby
and feeble muscles, including the heart, although the fat
may be deposited, giving the patient an appearance of
plumpness, which is often deceptive. The alteration in
the blood lessens the nutrition of the organs of the body,
hence secretions are not normal, and digestive processes
are defective. The indications for feeding therefore are
to supply nutriment which will furnish the materials for
the restoration of the diseased blood and renew the tone
of the weakened muscles. Because of the feebleness of
the digestive functions and the weakened circulation, it is
essential that articles of food should be selected which
can be readily digested and absorbed, and that they should
be prepared by such methods as will enhance their digestion.
They should be served in an inviting manner, as appetite
is usually wanting. It is evident, therefore, that proteid
foods should be abundantly supplied; the best, when it
can be digested by the patient, is milk. This should form
a conspicuous part of the diet, but when it proves indi-
334 FOOD IN DISEASE
gestible for the patient, and modification fails to render
it digestible, it is a mistake to force it. Distaste for milk
can often be avoided by alternating with it some of the
milk derivatives.
Eggs are of special value in that they afford a concen-
trated proteid food rich in iron. They may be given in
any form.
All kinds of meats are useful, especially the beef prep-
arations, such as expressed beef juice, scraped beef, and
minced raw beef. When the patient's digestion will
permit, meats should be given, such as steak, roasts,
chicken, etc. While the patient is on a diet consisting
chiefly of proteids, special care should be taken to see that
they are thoroughly digested.
Fat is essential to cell growth and should be properly
supplied in the diet of anemia. Butter is the most easily
digested fat, and it or cream should be given daily. If
the patient does not object too greatly to the taste of
cod-liver oil, it may be given in moderate amount. Crisp
breakfast bacon is a good form in which to administer fat,
and by its pleasant flavor it often stimulates the appetite.
Fresh green vegetables and cereals will tend to prevent
the constipation usually present. They have the further
advantage of introducing a considerable amount of organic
iron into the body. Green vegetables are best admin-
istered in the form of purees. Macaroni and spaghetti,
rice, baked potatoes, whole wheat, and Graham bread are
also good.
Condiments in very moderate amount are useful in
inducing a greater consumption of food; salt especially
should be freely used, as it aids in the restoration of blood
cells and improves the quality of blood plasma. Water
ANEMIA AND NEURASTHENIA 335
should be taken freely as in other conditions in which a
nitrogenous diet is given, in order to dilute the waste
products and facilitate their elimination. Stimulating
beverages should be withheld, especially alcohol, ■ since
it lessens the oxygen-carrying power of the red blood cells,
which would aggravate the condition from which relief
is sought. Malt extract is often helpful.
Fruits, if not too sweet, are permitted many chlorotic
patients. They often crave sweets or acids, but these
should be withheld, except oranges and lemons. Indul-
gence in candies and pastries is to be strictly forbidden,
since they produce disturbance in the alimentary tract,
which interferes with the digestion of other foods. Pickles
are in like manner harmful, and have the special dis-
advantage of introducing a considerable amount of
vinegar, which tends, by reducing the alkalinity of the
blood, to increase the anemic condition.
Neurasthenia. — In this condition the diet forms but
part of the necessary treatment, and in some cases
dietary restriction may be limited to the exclusion of
certain indigestible articles, such as pastries, pickles,
and sweets. Many cases, however, are attended with
digestive disorders and malnutrition, which require spe-
cial dietetic regulations. When anemia is present, as is
not infrequently the case, such diet as has been described
for that condition will be appropriate. When emaciation
is marked and muscular strength greatly lessened, the
Weir Mitchell rest cure is the recognized treatment. The
patient is put to bed and not allowed to rise, except to
empty the bladder or bowels. To insure complete rest
she is fed by the nurse. During the period of rest in bed,
massage and electricity are used with sufficient vigor to
336 FOOD IN DISEASE
insure the elimination of waste products. The diet at
first consists of milk only, which is given in the first few
days in amounts of three to four ounces every two hours,
and then increased to two quarts a day, administered in
divided doses every three hours. A little coffee, without
sugar, is permitted in order to prevent constipation, or
some simple purge is given. At the end of the week raw-
beef soup is added, and a day or two later a mutton chop
is given for dinner. Bread with butter is then permitted,
the milk meanwhile being continued. The diet is grad-
ually increased by the addition of eggs, simple vegetables,
and stewed fruits, until three simple, but abundant, meals
are taken daily, besides three or four pints of milk. Abso-
lute recumbency is insisted upon while the milk diet is
maintained, but when three meals are taken the patient
is permitted to sit up while eating. The hours out of bed
are gradually increased, though for some time frequent
periods of rest during the day are required. The stools
must be carefully watched and the appearance therein of
undigested food will necessitate a diminution in the amount
given; excess of urates in the urine will also be an indi-
cation for diminishing the amount of food.
Alcohol is best forbidden, as it is not necessary, and
patients of the type who require the rest cure are peculiarly
prone to the development of the habit.
CHAPTER XIX.
FOOD IN DISEASES OF THE SKIN. ACNE VULGARIS.
ACNE ROSACEA. ECZEMA. ERYTHEMA NODOSUM.
PSORIASIS. PURPURA. URTICARIA. XANTHOMA
DIABETICORUM.
In view of the close physiological relationship between
the skin and the functional activity of the other organs
of the body, it is not surprising that various eruptive
disturbances of the cutaneous system may often be traced
to disorders of the stomach, intestines, or liver, caused by
improper feeding. This is often the case where the food,
being inadequate in quality or quantity, lowers nutrition,
as the lack of vegetable diet producing scurvy or the
directly irritating effect of oatmeal or other cereals upon
the gastrointestinal mucous membrane in eczematous or
urticarial patients.
The excessive ingestion of starchy foods by infants,
especially when there is a catarrhal inflammation of the
mucosa, frequently leads to the development of an eczema.
Certain diseases are attributable to the use of special
foods, as pellegra to the consumption of decomposed maize.
All foods or condiments very stimulating or difficult of
digestion should be avoided, not only because they disturb
digestion, but because they usually leave some trace of
their evil influence on the skin.
Acne Vulgaris. — In a disease which is so frequently
associated with gastrointestinal disturbances, it should be
readily appreciated that a proper diet is necessary for the
successful management of the case. The diet should be
22
338 FOOD IN DISEASE
non-stimulating, all indigestible foods and highly seasoned
dishes being avoided; sweets, pastries, cheese, and all fried
foods should be forbidden, while butter, cream, and
other fats should be allowed unless they cause gastric or
intestinal disturbances. An ample diet of fish, fruit, and
the lighter vegetables will usually have a beneficial effect
even upon the most aggravated cases.
The patient may take :
Soup. — Clear.
Fish. — Boiled or baked. Roe herring. Oysters: raw,
stewed, scalloped.
Eggs. — Raw, soft-boiled, baked, poached.
Meats. — Fowl, game, rare roast, boiled, steak, chops,
crisp breakfast bacon.
Farinaceous. — Toast, stale bread, corn bread, Sally
Lunn, quick muffins, beaten biscuit, rice, tapioca.
Vegetables. — Spinach, turnip salad, kale, corn, green
peas, celery, asparagus, onions, salsify, boiled or baked
potatoes (in moderation), lettuce without dressing.
Desserts. — Cream, plain jelly, fruits, melons.
Beverages. — Tea, coffee, cocoa occasionally, butter-
milk, sweet milk, water in abundance.
He must avoid all vegetable or highly seasoned soups,
all fried foods, gravies, pickled or corned meats, sausage,
meat or vegetable salads, oatmeal, freshly baked bread,
griddle cakes, etc.; cabbage, cauliflower, lettuce with
dressing, turnips, carrots, parsnips, beets, cucumbers,
radishes, tomatoes, cold slaw, pastry, pies, jams, candies
or candied fruits, pudding, cakes, and all alcoholic stim-
ulants and tobacco.
Acne Rosacea. — Individuals with acne rosacea should
refrain from indulgence in very hot drinks, as soup, coffee,
FOOD IN DISEASES OF THE SKIN 339
etc., which produce an increase in the congestive disturb-
ance of the face. This class of patients is particularly
susceptible to the injurious effects of improperly made tea.
Boiling or steeping tea for an indefinite length of time
produces an infusion of tannin which is very harmful to
the digestion, resulting in constipation and other kindred
troubles. All alcoholic stimulants and tobacco should be
avoided.
The patient may take:
Soups. — Clear, cream.
Fish. — Boiled, baked. Oysters: raw, stewed, scal-
loped.
Eggs. — Raw, soft-boiled, baked, poached.
Meats. — Fowl, game, red meats in moderation.
Farinaceous. — Bread one day old, corn bread, brown
bread, Sally Lunn, quick muffins, beaten biscuit, rice,
tapioca.
Vegetables. — Spinach, turnip salad, kale, corn, green
peas, celery, asparagus, onions, salsify, boiled or baked
potatoes, lettuce without dressing.
Dessert. — Cream, fruits, melons.
Beverages. — Tea, very weak and not too hot; weak
cocoa, milk, and abundance of water.
To be avoided are highly seasoned and vegetable soups,
all fried foods, all salads, gravies, pickled or corned meat,
oatmeal, freshly baked bread, doughnuts, griddle cakes,
waffles, cabbage, cauliflower, lettuce with dressing, turnips,
carrots, parsnips, beets, cucumbers, radishes, tomatoes,
pickles, cold slaw, pies, pastry, jams, candy, or candied
fruits, puddings, cakes.
Eczema. — In a condition that occurs in connection with
almost every constitutional disease it would be impossible
340 FOOD IN DISEASE
to lay down a rule regarding the diet. In eczema, each
case should be given the quantity and kind of food that
will best nourish the tissues without producing evil effects
upon digestion and elimination. The anemic and
strumous patient should be given an abundance of beef,
mutton, eggs, cream, fats, and easily digested vegetables.
On the other hand, for the overfed, plethoric, and gouty
patient, especially when elimination is defective, the diet
should be as simple and at the same time as nutritious
as possible. Many of these cases show the most gratify-
ing improvement from a diet restricted to toast and milk.
Alcohol in all forms is contraindicated save in the aged
and debilitated. In diabetic eczema the regimen proper
in glycosuria should be observed.
The eczematous patient may take:
Soups. — Small quantity. Clear soups of beef, mutton,
oyster. Clam broth, oyster broth, chicken broth.
Fish. — Raw oysters, white fish, shad, cod, perch, trout,
bass, smelt, fresh mackerel.
Meats. — Meat juice (raw), roasted beef, chicken,
tongue, squab, roast partridge.
Eggs. — Raw, soft-boiled, baked, poached.
Farinaceous. — Bread at least one day old, brown
bread, toast, rye, gluten and Graham bread, zwieback,
crackers, cream crackers, rice, sago, tapioca, crumbs,
arrowroot, cornmeal pone, Graham grits.
Vegetables. — Greens, spinach, lettuce, water-cress,
French beans, sweet corn, green peas, asparagus, celery,
artichokes, boiled onions, salsify, potatoes moderately.
Dessert. — Orange charlotte, gelatin creams, blanc
mange, baked and stewed apples and pears, figs, prunes,
tamarinds, melons.
FOOD IN DISEASES OF THE SKIN 341
Beverages. — (Drinks should mostly be taken near the
end of and between meals.) Hot water before meals, milk,
lime-water, Vichy, weak tea (one-half ounce to the pint),
koumiss, weak cocoa, peptonized cocoa and milk, butter-
milk, malted milk, leguminose-cocoa, whey, equal parts
of whey and unfermented grape juice. Black coffee and
lemon juice on first rising. Tea and coffee disagree in
many cases. Mineral waters: carbonic water, Congress,
Hathorne, Kissingen, Apollinaris, Buffalo Lithia, Chase
City Chloride Calcium, Rubinat.
Stimulants. — Whiskey or brandy well diluted, in
debilitated subjects.
Must avoid: rich soups and chowders, all fried foods,
hot or fresh bread, griddle cakes, oatmeal, doughnuts,
veal, pork, fiver, kidney, hashes, stews, pickled and corned
meats, preserved and potted meats, turkey, goose, duck,
sausage, salmon, salt mackerel, salt meats, sturgeon,
shrimps, sardines, lobster, crabs, cabbage, cauliflower,
radishes, cold slaw, cucumbers, parsnips, egg-plant, tur-
nips, carrots, squash, beets, pastry, pies, made dishes, nuts,
dates, jams, dried and candied fruits, candies, cheese, strong
tea, ice-water, malt liquors, sweet and effervescent wines.
Erythema Nodosum. — Inasmuch as this condition is
associated with gout, rheumatism, and malaria the dietary
is identical with that indicated for these diseases.
Psoriasis. — The diet in psoriasis must be determined
by the general physical condition of the patient. To
those of a plethoric habit meats should be allowed only
in small quantities, while it is often advisable to prohibit
it entirely for a while. On the contrary, the anemic and
strumous individual should be allowed a rather liberal
diet with a full quantity of meat.
342 FOOD IN DISEASE
The plethoric patient may take:
Sotjps. — Clear.
Fish. — Boiled or baked. Oysters : raw, stewed.
Eggs. — Soft-boiled, poached.
Meats. — White meat of fowl, squab, roast quail.
Farinaceous.— Bread one day old, brown bread,
Graham bread, corn bread, zwieback, rice, tapioca.
Vegetables. — Spinach, snaps, corn, green peas, celery,
onions, salsify, small quantity of potatoes.
Desserts. — Figs, prunes, baked apples, pears, tama-
rinds, gelatin, creams, melons.
Beverages. — Weak tea, coffee, milk, abundance of
water between meals.
He must avoid highly seasoned or vegetable soups, all
fried foods, all salads; all red, pickled, or potted meats;
freshly baked breads, cereals, doughnuts, griddle cakes,
cabbage, cauliflower, lettuce, egg-plant, turnips, carrots,
asparagus, beets, cucumbers, parsnips, tomatoes, radishes,
beans, peas, cold slaw, pastries, jams, candies, fruit
creams, wine jellies; strong tea or coffee, alcoholic stim-
ulants, and tobacco.
The anemic and strumous patient may take:
Soups. — Clear.
Fish. — Boiled, baked. Oysters: raw, stewed.
Eggs. — Raw, soft-boiled, poached.
Meats. — Beef, lamb, fowl, game, meat juice.
Farinaceous. — Stale bread, toast, corn bread, brown
bread, rice, tapioca.
Vegetables. — Spinach, snaps, corn, green peas, celery,
onions, salsify, potatoes in moderation.
Desserts. — Fruit, tamarinds, melons, nuts.
Beverages. — Milk, cream, koumiss, peptonized cocoa,
weak tea.
FOOD IN DISEASES OF THE SKIN 343
Stimulants. — Whiskey for the debilitated and aged.
Purpura. — Individuals suffering with any one of the
three varieties of this condition should have an abundance
of the lighter vegetables, especially those rich in iron, as
spinach. The red meats should for a time be withheld.
Asparagus should be avoided, as cases have been reported
in which this vegetable has proven an etiological factor.
Stimulants should be withheld in cases of purpura simplex,
but are indicated in the hemorrhagic type and when the
patient is very debilitated.
The patient may take:
Sotjp. — Clear.
Fish.
Eggs.
Meats. — Fowl, sweetbread, game.
Farinaceous. — Corn bread, stale bread, Graham and
rye bread, rice, tapioca.
Vegetables. — Boiled or baked potatoes, onions, corn,
spinach, egg-plant.
Desserts. — Fruit, melons, cream, ices.
Beverages. — Tea, milk, ferruginous waters, lemon, and
orange albumin.
He must avoid vegetable and highly seasoned soups, all
fried foods, red meats, freshly baked breads, cereals, cakes,
peas, beans, asparagus, tomatoes, cabbage, beets, parsnips,
salsify.
Urticaria. — It is remarkable and yet apparently true
that there is no one article of diet entirely harmless to all
individuals with a predisposition to the development of
urticaria. To persons with such an idiosyncrasy the
distressing result of indulgence in some special article of
food is frequently out of all proportion to the quantity of
344 FOOD IN DISEASE
that article taken. A single strawberry or one sip of beer
may induce an urticarial eruption covering a large per
cent, of the surface. Therefore, it is well to remember that
the smallest amount of an apparently innocent food
ingested may be responsible for the greatest inconvenience.
Unless possessed of an idiosyncrasy against some one of
the following, the patient may usually take:
Soups. — Clear, cream.
Meats. — Fowl, game, broiled steaks, rare roast, sweet-
breads.
Farinaceous. — Toast, stale bread, corn bread, muffins,
beaten biscuit, rice, tapioca.
Vegetables. — Potatoes (boiled or mashed), lettuce
without dressing, egg-plant (stuffed), beets.
Desserts. — Plain cream, melons, baked and stewed
apples.
Beverages. — Weak tea and coffee, milk, water.
The following are the most frequent offenders: Vege-
table and highly seasoned soups, oyster and clam broth,
fish, eggs, pork, sausage, lamb, pickled and corned meats,
griddle cakes, peas, beans, onions, garlic, corn, mush-
rooms, spinach, pickles, tomatoes, cabbage, all berries,
pineapples, figs, prunes, dates, raisins, skin of grapes,
alcoholic stimulants of all kinds.
Xanthoma Diabeticorum. — Persons suffering from this
disease may take:
Soups. — Clear, of beef, veal, chicken, oysters, and clams,
mock turtle, tomato, oxtail, gumbo; all soups without flour.
Fish. — Cod, mackerel, soft-shell crabs, pan fish,
shrimps, clams, oysters (raw, steamed).
Meats. — Especially fats, in beef, lamb, fowl, game,
calf's head, bacon, tongue, tripe, egg.
FOOD IN DISEASES OF THE SKIN 345
Relishes. — Sour pickles, radishes, celery, olives, cream
cheese.
Farinaceous. — Gluten bread, wafers, gluten porridge,
fired gluten mush, almond bread and cakes, bran crackers.
Vegetables. — Lettuce, cucumbers, spinach, cauli-
flower, cabbage, tomatoes without sugar, salsify, onions,
snaps, asparagus, mushrooms, okra.
Desserts. — Almonds, hazelnuts, walnuts, cocoanuts,
ice-cream sweetened with saccharin.
Beverages. — Tea and coffee with saccharin, koumiss ;
Buffalo, Bethesda, Saratoga, Poland, and Londonderry
waters.
They must avoid soups containing cream, flour, or
sugar; stewed oysters, fried oysters, and fish prepared with
sauces containing flour; liver, breaded meats, stuffed
meats, sweetbreads, kidney hash, all stews containing
potatoes, thickened gravies, sweet pickles, all wheat bread,
rice, sago, tapioca, cereals, maccaroni, beets, sweet and
Irish potatoes, beans, peas, parsnips, turnips, and all
sweet vegetables, sweet fruits, melons, chestnuts, peanuts,
candies, sweet rices, jams, honey, milk and sugar in tea
and coffee.
CHAPTER XX.
MEMORIAL HOSPITAL DIETARIES. RECIPES.
The details of diet differ in hospitals for various reasons.
As a specimen of the qualitative selection, the following
dietary of the Memorial Hospital, Richmond, Va., is given:
DIETS.
The official diets are three in number, viz. : general house
diet, soft diet, and liquid diet.
As a substitute for these, there may be furnished, on the
order of the attending physician and surgeon, any special
or restricted diets.
General House Diet.
■ Cereals. — Not limited; the standard cereals being oat-
meal, cracked wheat, cornmeal mush, batter bread, rice,
barley, hominy grits, and grape-nut.
Griddle Cakes, etc. — Limited to batter cakes (cooked
on soapstone griddle), baked hominy, cornmeal, and
Graham-flour gems.
Eggs. — Served frequently and in all ways, except fried
and hard-boiled.
Purges and Soups. — Not limited.
Meats. — Beef, lamb, mutton, sweetbreads, brains, calf's
brain, veal, ham (boiled or baked, served once weekly).
MEMORIAL HOSPITAL DIETARIES 347
A small slice of crisp bacon allowed with peas, eggs, and
scalloped apples. Corn beef and smoked tongue once
weekly.
Game. — Venison, duck, quail, squabs, reedbird, and
robins.
Fowls. — Turkey and chicken (broiled, stewed, and
baked).
Water Food. — Fish, all kinds; planked, baked, boiled,
and broiled. Roe herring served every breakfast; oysters,
stewed, raw, broiled, and scalloped.
Vegetables. — All kinds, omitting cucumbers and cab-
bages only.
Salads with Mayonaise. — Tomatoes and celery, chicken,
lettuce, snap, asparagus, sweetbread, tomatoes, and lettuce.
Cheese. — Cream and Neuchatel.
Beverages. — Tea, coffee, cocoa, hot-water tea, nutritious
coffee.
Breads. — White, whole wheat, spoon bread, muffins,
gems, rye, and pulled bread.
Crackers. — Mushroom, cream, soda, oatmeal, and saltine
crackers.
Table and Mineral Waters. — Vichy, Apollinaris, filtered
James River.
Fruits. — All kinds, omitting bananas, unless cooked.
Desserts. — Limited to ices, frozen custard, sherbet,
creams, charlotte russe (frozen), jellies, simple puddings,
and blanc mange.
Cakes. — Lady fingers (over twenty-four hours old),
toasted sponge cake, molasses, and honey cakes.
Nuts. — Almonds and English walnuts.
348 FOOD IN DISEASE
Soft Diets.
Gruels. — Oatmeal, barley, arrowroot, flour, cracker,
farina, cornmeal, Racahout des Arabes, Imperial Granum.
Mush and Porridge. — Oatmeal, cornmeal, farina, wheat,
Imperial Granum, granula, rolled wheat, hominy, flaked
rice, banana mush.
Eggs. — Raw, poached, soft-cooked (cooked at temper-
ature of 160° F.), boiled custard, baked custard, egg
gruel, egg with junket, scrambled eggs (beaten lightly
with milk), foamy omelet, yolk of hard-boiled eggs (cooked
two hours).
Breads. — Batter bread (Southern style), egg bread, milk
toast, water toast, cream toast (a little nutmeg grated on
top renders it more agreeable). Stale bread frequently
allowed.
Crackers. — Arrowroot, mushroom, cream soda, saltines.
Soups. — Broths, beef teas, purees made with and with-
out milk, and all strained soup (great care should be taken
that all fats are removed).
Water Food. — Raw oysters (hearts removed), oysters
peptonized, oysters stewed (remove heart and subject to
fire until the edges or gills begin to curl). White fish
(those containing comparatively little fat), cod, haddock,
turbot, halibut, flounder, trout. Serve creamed or boiled,
using a simple sauce or little drawn country butter.
Sweetbreads, Game, Fowls, etc. — Chicken puree, chicken
panada, chicken stewed. (See that chickens are young
and well nourished.) Squab, partridge or sora frequently
allowed. The flesh of game is easily digested if prop-
erly cooked; the meat of breast especially adapted for
invalid use. Sweetbreads, creamed; brains, creamed (not
MEMORIAL HOSPITAL DIETARIES 349
especially recommended, containing too much fat and
cholesterin, although fairly digestible).
Tripe. — (Honeycomb portion) creamed, easily digested,
though containing rather too much fat (16 per cent.).
Desserts. — Soft custard, baked custard, rice custard
(omit raisins), farina custard, cornstarch custard, sago
custard, frozen custard, junket, arrowroot pudding, lemon
pudding, rice pudding, tapioca pudding, wine pudding,
cocoa pudding (omit raisins), plain ice-cream (not fruit),
charlotte russe (frozen), various ices and sherbets, Irish
moss, blanc mange, cornstarch, jelly (gelatin), jelly (calf's
foot), jelly (isinglass), jelly (calf's head), apples baked,
bananas baked, pears baked, apple float, peach float,
prunes, stewed fruits, raw fruits, oranges, shaddocks
(juice only), ripe peaches.
Solid Meat Preparation. — In addition to the fluid prep-
arations of meat — viz., broths, juices, teas, jellies — the solid
meat preparations are frequently included in soft-diet
menu. These solid meat preparations being prepared
from scraped beef (best made from tender steak), are easily
digested when properly cooked, as the indigestible and
less nutritious connective-tissue sheaths of the muscle
fasciculi are broken and left out, while the myosin is
served in the form of a soft, digestible mass. Before
cooking, the pulp is still further improved by passing two
or three times through a sieve.
Raw Meat. — Beef pulp, scraped-beef sandwiches, meat
rolls, digested beef (with twenty drops of dilute hydro-
chloric acid), meat extract, beef marrow on toast.
Beverages. — Cocoa, milk, buttermilk, strained soup,
albumins, broths, beef juices, extracts, etc. Omit coffee
and tea, although these are allowed by some.
350 FOOD IN DISEASE
Liquid Diets.
Different Ways of Serving Milk. — Milk: peptonized,
boiled, sterilized, and pasteurized. Milk with lime-water,
Vichy, Apollinaris or other sparkling water, and soda,
water. Milk with equal parts of arrowroot-water, rice-
water, or barley-water. Albuminized milk or milk with
white of egg. Milk with yolk of egg and milk flavored
with vanilla, cinnamon, or nutmeg. Milk punch (with
whiskey, sherry, or brandy), milk and egg (eggnog),
koumiss, milk with coffee (nutritious coffee), whey with
wine or lemon juice, whey with champagne, whey with
pepsin or rennet, milk lemonade, junket, milk jelly (Irish
moss); cocoa, hot or cold, served with cracked ice; cocoa,
junket, milk with oyster broth or clam broth, equal parts;
milk with chicken broth, equal parts.
Beef Juices, Beef Teas, etc. — Beef juice, beef essence,
beef tea, beef broth, and chicken broth, consomme" or
bouillon, beef jelly with, gelatin or Irish moss, mutton
broth, chicken jelly, plain or jellied with Irish moss or
gelatin, clam and oyster broth; clam juice, calf 's-foot jelly,
Chrysties' beef tea (made by adding sodium chloride and
dilute hydrochloric acid) ; strained soups, made from soup
stocks.
Egg Preparations. — Albumin-water, flavored with
orange juice, lemon juice, pineapple juice, grape juice, and
apple juice; may also flavor with whiskey, rum, sherry,
or few drops of oil of cinnamon; albumin and milk, con-
somme" and eggs, broths with eggs, nutritious coffee and
egg. Eggs served raw, or with orange, sherry, water, wine,
lemonade, whiskey, etc.; beef tea and egg, mulled wine,
eggs with milk and flavored.
RECIPES 351
Farinaceous Liquid Foods. — Toast-water, rice-water,
oatmeal-water, barley-water, arrowrootrwater, gum arabic
and cereal extract (all demulcent and nutritive).
Beverages. — Orangeade, lemonade, apple juice with ice,
cider, grape juice with ice, pineapple juice with ice,
ginger ale, tamarind-water, fruit soda (use siphon soda),
wine and fruit jelly heated before serving; root beer.
RECIPES.
Fluid Meat Preparations.
Beef Juice.
Beef Juice (Broiled). — Broil quickly pieces of the round
or sirloin (all fat removed), of a size to fit opening in a
lemon squeezer. Both sides of the beef should be quickly
scorched to prevent the escape of the juices, the interior
should only be heated through. Squeeze out the juice
with a meat press or lemon squeezer which has previously
been dipped into boiling water. The juice should be
received into a hot wine glass. Season with salt and
pepper and it is ready to serve. It may be taken either
hot or cold.
If necessary to heat it, put it into a cup and place it in
a dish of warm water on the fire. Care should be taken
that the water does not become hotter than 160° F.; for
beyond that temperature the albuminous juices become
coagulated and appear as brown flakes.
It may be served with an equal quantity of warm water
(not boiling), or pour the juice over toast, or crumbs of
toast, or batter bread.
352 FOOD IN DISEASE
Bottled Beef Juice. — Select and prepare the meat in the
same manner as for beef juice prepared by broiling steak,
only divide it into small pieces, put them into a glass jar,
cover and place in a deep saucepan of cold water; heat
gradually for one hour, but do not allow the temperature
at any time exceed 160° F. ; then strain "out the juice and
press the meat. The liquid should be clear red, not brown
and flaky. Add a little salt and pepper and it is ready
to serve.
One pound of beef will make about eight tablespoonfuls
of juice.
Beef juice may be made into tea by diluting it with
warm water.
Beef Juice (Cold Process). — Select beef from tender side
of round or the sirloin (free it from all fat), chop it very
fine, or better still, run it twice through a meat grinder.
Place one pound of this beef with one gill of cold water
in a jar, with a tight-fitting lid, and stand on the ice for
eight hours or overnight (when possible shake occasion-
ally). Strain through a muslin bag, twisting ends in
opposite directions. Season with salt and pepper and
serve cold or slightly warmed.
Frozen Beef Juice. — One cup of beef juice prepared by
cold process ; the white of one egg beaten to a stiff froth, and
well stirred in. Season with salt and pepper and, if desired,
a dash of celery salt. Turn into a jar and freeze to the
consistency of thick mush.
Beef Tea.
Bottled. — Select and prepare the meat in the same
manner as for bottled beef juice, except for every pound
add half pint of cold water. Place in a covered jar and
proceed as per bottled beef juice.
RECIPES 353
The 'liquid thus obtained will resemble beef juice in
every respect except in strength. Better served in a red
wine-glass or china cup.
With Hydrochloric Acid. — This is the most easily
absorbed form of beef drink, but there is frequent objec-
tion to the 'taste and color. The tea may be heated until
it steams and changes to a brownish hue; do not strain
out the flakes of coagulated albumin and fibrin which will
appear, as they are the most nutritious portion of the tea.
To Prepare. — Select one-half pound of good beef;
remove everything from it that is not clean meat; chop
it fine and run it twice through a meat grinder. Put into
a bowl one cup of water and five drops of dilute hydro-
chloric acid. Stir into this the chopped meat and set it
in a refrigerator or any cool place for two hours to digest.
Then strain, flavor with salt and pepper, and serve in a
red wine-glass, preferably.
Beef Tea.
1 pound of lean fresh meat.
1 quart of cold water.
Cut the meat in small pieces, place in double boiler, and
cover with cold water. Fill the lower half of boiler with
cold water. Place all over a slow fire and cook for two
hours or more. Stir frequently. Strain, season with salt; ■
skim off any globules of fat — if broth is hot remove by
touching the globules with tissue or plain paper. If
allowed to cool it is easily taken off.
Beef Broth.
1 pound of lean beef (cut in small pieces).
1 piece of bone from the shin of beef.
23
354 FOOD IN DISEASE
1 quart of cold water.
Put all in a kettle and bring slowly to a boil; then
simmer two hours or more until reduced to one pint of
liquid. Strain, season with salt, and cool quickly. Remove
all fats.
The seasoning may be varied by addition of a spray of
parsley, a few drops of celery seeds, or a little onion.
Pounded rice, barley, wheat, tapioca, or slice of bread
(toasted or stale) may be added if more nutriment is
desired.
Beef Broth.
To one pint of chopped lean beef add one pint of cold
water, let it stand in a covered glass fruit jar for four to
six hours. Cook for three hours in a closed jar over a
slow fire, strain and skim off the fat — clear with egg,
season, and serve warm or cold. ■
Beef Broth {Memorial Hospital, Richmond, Va.).
1 pound of beef.
1 pint of water.
Put in a saucepan over slow fire and raise to boiling
point. Press juice out of meat with potato masher con-
tinually while cooking. Season with salt and pepper, and,
if desired, celery salt.
Mutton Broth.
1 pound of mutton from neck or loin.
1 quart of cold water.
1 teaspoon of chopped onion.
Remove from mutton the tough skin, fat and membranes,
and cut meat in small pieces. Break the bone in several
places.
RECIPES 355
Put all together in a saucepan and simmer for three
hours. Then strain out the meat, season, and remove
all fat.
To vary the taste of broth, a little mint, parsley, bay
leaves, or celery seed may be added one-half hour before
removing from fire.
Barley, sago, or rice may also be added.
Beef Jelly.
f cup of good beef broth, well seasoned.
1 teaspoonful of gelatin.
Cover gelatin with tablespoonful of broth. Heat the
rest of broth and add to gelatin. Stir until dissolved.
Strain through gauze or fine strainer. Put on ice or in
cool place until it becomes a jelly. This will require about
an hour. Serve plain or on lettuce leaf.
For soft diets this makes a savory dish. A small piece
of sweetbread or shreds of chicken can be put in before
congealed.
Bouillon.
Follow recipe for beef broth. To one quart of this
add a pinch of thyme, sage, and mint, and one teaspoonful
each of chopped onion and carrot. Boil all together until
one-fourth boiled down. Clarify with white of one egg
(see directions for clarifying chicken jelly) and serve.
Consomme'.
\ shin of beef.
\ shin of veal.
Brown sugar, one tablespoonful.
\ onion sliced. Water, two quarts.
Wipe dry the shins, have them well cracked; remove the
356 FOOD IN DISEASE
meat from the bones and cut into small pieces. Put the
tablespoonful of sugar and onion into the soup kettle to
brown and burn. Put in the meat, shake, and stir until
the meat seems slightly scorched. Then add the bones
and the water (cold). Cover the kettle and bring slowly
to boiling point and then allow it to simmer for three hours.
Strain and stand aside to cool. When cold remove every
particle of fat. Season to taste.
In addition to onion, celery tops, bay leaves, cloves, or
grated carrot may be added about one hour before remov-
ing from the fire.
Chicken Broth.
Select a full-grown chicken, singe, wash, and draw it.
Remove the breast and put it aside for other purposes.
Disjoint the chicken and crack the bones. Place in kettle
with three quarts of cold water. Simmer gently for three
hours or until the liquid is reduced to one and a half
quarts. Add salt, and if desired onion, parsley, celery tops
or seeds, half an hour before removing from fire. Strain
and cool quickly.
When cool, remove fat from top and sediment from
bottom. It may be further improved by reheating and
adding the white of one egg slightly beaten. Bring to boil
and continue boiling for a few moments; then strain
through several thicknesses of gauze or cheese cloth.
By placing in mould and putting in cooi place it can
be served as chicken jelly.
Chicken Jelly with Gelatin.
f cup of chicken broth (well seasoned).
1 teaspoonful of gelatin.
RECIPES 357
Cover gelatin with a tablespoonful of water. Heat the
broth and add to gelatin. Stir until thoroughly dissolved.
Strain through gauze or fine strainer. Pour into moulds
and stand in cool place until it becomes a jelly. Serve
plain or on lettuce leaf.
Chicken Jelly with Irish Moss.
$ cup of Irish moss.
1 cup of chicken broth.
Follow directions as above.
Oyster Broth.
8 medium-size fresh oysters.
1 cup cold water, or
^ cup cold water and £ cup milk.
Salt and pepper to taste.
Chop oysters fine in a chopping tray and turn into
saucepan with the fluids; set saucepan on the fire and let
it come slowly to boiling point; then simmer for five
minutes and serve. Better to make as needed, as flavor
is impaired by keeping. Can be made in twelve minutes.
Oyster Tea.
Put eight large oysters and one dozen medium with
their liquid in a stewpan; simmer for five minutes. Then
strain the liquor, leaving out the oysters and add to it
one-half cup of milk; set it back on the stove and heat it
just to the boiling point. Season with salt and pepper and
serve.
Clam Broth and Bouillon.
6 clams in their shells.
1 cup cold water.
358 FOOD IN DISEASE
Thoroughly scrub the shells with small brush, place
them in small saucepan and pour over them the cup of
water. Bring slowly to the boiling point, or until the
shells open.
Strain immediately through two thicknesses of gauze.
Dilute to taste with warm water. Serve hot or cold. It
does not require any salt, as clam juice is usually salt
enough.
Clam Broth or Bouillon.
6 clams and 1 cup of cold water.
Drain the clams, saving the juice, and chop clams very
fine. Place them in small saucepan, with their own juice
and the cold water. Bring slowly to a boil, stirring fre-
quently, then simmer about five minutes. Skim carefully.
Strain through two thicknesses of cheese cloth. Dilute
to taste with warm water. Serve hot or cold.
Clam Broth, Frozen or Clam Frappe.
Follow directions as for frozen beef juice, substituting
clam broth for beef tea.
Milk Preparations.
Milk Peptonized and Pancreatinized. — One tube of Fair-
child's peptonizing powder (which contains 5 grains of
pancreatic extract and 15 grains of bicarbonate of soda)
and empty its contents into a quart bottle. To this add
one gill of cold water and shake until the powder is fully
dissolved, then add one pint of cold milk and shake again.
The bottle is then set into a bowl of warm water, which
should be of such a heat that you can hold your hand in
it for a minute; the temperature is thus raised to about
100° F. The milk is kept in the water for half an hour;
RECIPES 359
it is then put upon ice and the digestion will continue
until the milk is thoroughly chilled.
Milk Sterilized for Infants. — Put the milk into flasks
or bottles, which have either been boiled in soda-water
or well washed with soda and scalded. Plug them with
stoppers of clean cotton-wool, place the flasks in a wire
frame to support them in a kettle of cold water, heat
gradually to 190° F., and keep in that temperature for
one hour. Cool quickly and keep on ice. When it is to
be used, it should be heated by placing a bottle in warm
water for a few moments.
Sterilized Milk (Invalids). — Pour milk into a granite
saucepan or a double boiler; raise the temperature to
190° F. and keep it at that point for one hour. As soon as
done, place in pitcher or jar (with covered lid) that has
been boiled or scalded and cool quickly. Place in ice-
box.
Pasteurized Milk. — Fill bottles, which have been steril-
ized, with fresh milk and plug with cotton-wool (not
absorbent cotton). Place on bottle rack or on wooden
rest in a boiler partly filled with cold water. Raise the
temperature (using a thermometer) to a temperature of
165° F. and let it stand for thirty minutes. Cool quickly
and place on ice.
To Alter the Taste of Milk. — A grating of nutmeg, a
blade of mace, a dash of extract of vanilla or lemon, a
little ginger or caramel may be added. If alcohol is not
contraindicated, many patients find milk in the form of
weak punches or as an eggnog, very agreeable.
Milk and Lime-water. — Lime-water may be purchased
at drug stores or prepared at home. If the milk is desired
hot, add the lime-water after it has been heated.
360 FOOD IN DISEASE
To Prepare the Lime-water. — Take a piece of unslaked
lime about the size of a walnut and place in an agate or
earthen vessel. Cover with two quarts of filtered water
and stir thoroughly, then set aside to settle until clear.
Use only the clear solution from the top. Keep tightly
covered, as constituents of the air precipitate the lime.
Koumiss — 1 quart of fresh milk.
■5- of a cake of Fleischman's yeast.
1 tablespoonful of sugar.
Dissolve the yeast in a little water and mix it with the
sugar and milk. Put mixture in beer-bottles and cork
tightly. Shake the bottle for a minute and place in ice-
box. Not good under six days, but will keep indefinitely.
Milk and Cinnamon. — Boil in one pint of fresh milk,
sufficient sticks of cinnamon to flavor it pleasantly and
sweeten to taste. If allowed, brandy, whiskey, or sherry
wine may be added.
Milk with Coffee, or Nutritious Coffee. — Put 1 table-
spoonful of ground coffee into saucepan containing 8 oz. of
milk and 4 oz. of water, which should be nearly boiling
before coffee is added; boil together for three minutes.
Beat up an egg and pour coffee upon it and return to fire
for a few minutes; if preferred drink without the egg.
Milk Punch. — 1 cup of milk.
2 tablespoonfuls of whiskey or brandy.
1 teaspoonful of sugar.
A little grated nutmeg.
Sweeten milk with the sugar, stir it into the brandy and
mix thoroughly by pouring from one glass to another.
Grate nutmeg on top.
Improved by using a milk shaker, or a Mason jar
answers every purpose.
RECIPES 361
Whey with Pepsin. — £ pint milk.
1 teaspoonful of essence of pepsin.
Heat the milk to a temperature of about 100° F. Gently
stir in the pepsin. Let it stand in a warm place until it
has formed a firm jelly (about one-half hour). Beat with
a fork until the curd is finely divided, then strain slowly.
Throw away the curd or cheesy portion; it is no good
whatsoever.
For flavoring purposes add lemon juice, sherry, cocoanut,
or vanilla.
Wine Whey. — Cook one cupful of milk, and when it
begins to steam add one-half cup of sherry wine. Bring
to a boil. Strain carefully and slowly. Add one tea-
spoonful of sugar and serve.
One stick of cinnamon added while boiling improves
the flavor.
Lemon Whey. — This is made in the same way as the
foregoing recipe, using one ounce of fresh lemon juice
instead of the wine.
Milk Lemonade. — 1 cup of milk.
\ cup of wine (sherry).
f cup of boiling water.
\ lemon. Sugar to taste.
Pour boiling water over the sugar, add the lemon juice
and sherry. Stir until the 'sugar is dissolved; add the cold
milk and stir again until the milk curdles, then strain
through a jelly bag or piece of linen.
Milk and Cereal Water. — Equal parts of milk and
thoroughly cooked barley, rice, oatmeal, or arrowroot-
water. Salt to taste.
Albuminized Milk. — 1 cup of milk.
1 tablespoonful of lime-water.
362 FOOD IN DISEASE
Beaten white of one egg.
Shake in Mason jar or milk shaker.
Milk with Other Diluents.— Milk may be diluted with
great advantage by adding Vichy, Apollinaris, Seltzer, or
some other sparkling table-water.
Junket, Slip or Curds and Whey. — \ pint of fresh milk.
Heat to 100° F. (sweeten to taste if desired). Add 1
teaspoonful of Fairchild's pepsin or rennet, pour into a
shallow dish or custard cups and let it stand until firmly
curdled. It may be flavored with wine, which must be
added before curdling takes place. Nutmeg may be
grated on top.
. Egg Pheparations.
Sherry and Egg. — Break an egg into a bowl and beat with
it 1 teaspoonful of sugar. After the sugar is thoroughly
mixed with the egg add 2 tablespoonf uls of sherry wine and
pour the mixture over a glass of shaved or finely cracked
ice.
Instead of the ice 1 cup of hot water may be added
and the whole placed over a gentle fire and stirred in one
way until it thickens; do not let it boil.
Eggnog. — 1 egg, 2 teaspoonfuls of sugar.
Grating of nutmeg.
1 cup of cold milk.
2 teaspoonfuls of brandy, whiskey or wine 1 tablespoonf ul.
Separate the egg; beat yolk up well with sugar; add the
white beaten to stiff froth; stir in the milk and pour from
one glass to another several times; then add the brandy.
Grate nutmeg on top.
Cocoa with Wine. — 1 teaspoonful of cocoa.
4 oz. of boiling water.
RECIPES 363
1 oz. of port wine. Sugar to taste.
Mix cocoa and water together and sweeten as desired;
then add the wine. Serve at once.
Cocoa. — Cocoa, 1 teaspoonful.
1 cup of milk. Sugar to taste.
Extract of vanilla, \ dram.
Philips' digestible cocoa best for invalids, as fat has
been removed. Mix the cocoa with hot water into a paste
and stir into the milk which has just reached the boiling
point. Stir for a few moments, but do not allow it to boil.
Add the vanilla just before pouring into cup.
Cocoa Shells. — Put 2 teaspoonfuls of cocoa shells into
8 oz. of cold water and simmer for two hours; add \ cup
of milk and bring to boiling point. Sweeten to taste.
Hoi-water Tea. — Mix in equal proportions boiling
water with milk which has just reached boiling point.
Racahout. — 1 tablespoonful of racahout.
\ cup of boiling water.
\ cup of milk.
Dissolve racahout in the water; add the heated milk.
This is used in varying strengths. Frequently racahout
is ordered without milk, especially for infants and children.
Mulled Wine. — £ pint of water.
1 egg.
\ cup of wine.
1 teaspoonful of fully broken stick cinnamon.
1 tablespoonful of sugar.
1 whole clove.
Add the clove and cinnamon to the water, bring slowly
to a boil, and steep ten minutes. Beat the egg until light
and add sugar. Add the wine to the water and, when hot,
strain and pour slowly over the egg and sugar, beating all
364 FOOD IN DISEASE
the while. Set it on the fire until consistency of cream
Beer, ale, and porter may be mulled in the same way.
Mulled beer is called beer soup by the Germans.
Albuminized Water, or Egg Water. — Dissolve the white
of an egg slightly beaten (a very fresh one) in a cup of
cold water; shake gently or stir well until thoroughly
blended. Strain only if necessary. If not used imme-
diately, keep near the ice, closely covered, and shake or
stir again before using.
Grape juice, pineapple juice, orange, lemon, or prune
juice may be added to conceal the white of the egg, and
it makes a most pleasant drink. Sweeten to taste and
serve with cracked ice.
Lemon or Orange Albumin. — Make a cup of lemon or
orangeade; beat the white of an egg to a froth and add
sugar as desired and beat to a stiff froth. Pour into the
fluid and whip lightly, allowing part of egg to come on top.
Serve with cracked ice. Pineapple juice or grape juice
makes a delightful substitute for the lemon or orange.
Egg Flip. — Beat 1 fresh egg with 2 teaspoonfuls of
sugar; add 1 teaspoonful of vanilla and beat again until
sugar is dissolved; add 5 oz. of cold milk, stirring all the
while. Serve with cracked ice.
Soft Custard. — | pint of milk.
Yolk of 1 egg.
1 tablespoonful of sugar.
Pinch of salt.
Put the milk in saucepan and set it on the stove to boil ;
beat together the yolk of egg, the salt and the sugar in a
bowl, and when the milk just reaches the boiling point
pour it in slowly until all is mixed. Return it to another
saucepan (or the one that the milk was cooked in, if it
RECIPES 365
has been washed and dried) without delay for three
minutes, stirring very slowly. Care should be taken not
to undercook the custard or have it cooked too much, as
it will have a curdled look. After removing from the fire
flavor it with vanilla and pour into glass from which it
will be served.
It may be also flavored with cinnamon (pieces of broken
cinnamon stick cooked with milk before adding to egg),
sherry, or nutmeg.
Baked Custard. — J pint of milk.
1 egg.
1 tablespoonful of sugar.
Pinch of salt.
Piece of cinnamon bark.
Put the cinnamon and milk together in saucepan and
set on stove to heat. Break the egg into a bowl, add salt
and sugar, and beat them until well mixed, but not light.
When milk boils remove the cinnamon and pour it on the
beaten egg; stir it slowly for a moment and pour into
custard cup. Place the cup in a deep round pan and pour
boiling water around, almost to the top.
Bake in a moderately hot oven for twenty-five minutes.
If a very small amount of butter has been rubbed on
cup, the custard can be served out of cup in which it has
been baked, as it will slide out in a round shape and will
look more tempting.
Soft-cooJced Eggs.
Place one or two eggs in a vessel, pour over them one
pint of boiling water and let them stand in a warm place
(not on the fire) for from eight to ten minutes, according
to the size of the eggs. The vessel should remain un-
366 FOOD IN DISEASE
covered. If the egg remains in water longer than the
required time, it will not become hard unless the temper-
ature of the water is raised.
Poached Eggs.
Select a very fresh egg. Toast a slice of bread and
butter it. Have some water boiling in a shallow pan.
Break the egg in a saucer, take the pan off the stove, and
slide in the egg. Finish cooking below the boiling point,
basting the yolk continually, until the white is tender and
jelly-like. Lift out the egg by means of a skimmer and
place it on toast.
Season with salt and pepper and a bit of butter, if
desired.
Scrambled Eggs.
Beat one or more eggs very light and add one ounce of
milk for each egg; put eggs in a buttered pan and stir
constantly until of a jelly-like consistency.
The fire should not be very hot.
Demulcent Drinks.
Barley-water, No. 1.— Take 2 tablespoonfuls of pearl
barley, and wash well with cold water, rejecting the
washings. (If possible, soak the barley for a few hours.)
Add 1 quart of cold water. Put in a covered vessel and
bring gently to a boil and simmer for two hours, which
will reduce it to about 1 pint. Strain through a sieve
and add salt. Serve hot or cold as directed. When not
desired plain or with milk, lemon juice and sugar may
be added, or sherry, whiskey, or wine.
Barley-water, No. 2, Infants. — Moisten 1 tablespoon-
ful of barley flour (Robinson's Barley Flour being
RECIPES 367
good) with a little cold water. Add 1 quart of water
and boil gently for twenty minutes with stirring or cook
in a double boiler, having the water in under part boiling
all the time.
Rice-water, No. 1. — Wash carefully 2 tablespoonfuls
of rice with cold water, rejecting the washings. Cover
with 1 quart of cold water and bring slowly to boiling
point and simmer gently for two hours, which will reduce
it to about 1 pint. Strain through sieve and add salt
to taste. Serve hot or cold as directed.
Rice-water, No. 2. — Same as Barley-water, No. 2, using
rice flour instead of barley flour.
Oatmeal-water. — Add 1£ tablespoonfuls of rolled oats
or oatmeal to 1 quart of cold water. Bring gently to a
boil and simmer for about two hours, which will reduce
it to about 1 pint. Strain..
Arrowroot-water. — Mix 1 teaspoonful of arrowroot with
a little cold water and stir into 1 pint of boiling water;
boil for five to eight minutes.
Gum Arabic Water. — £ pint of boiling water.
1 teaspoonful of gum arabic.
Dissolve the gum arabic in boiling water. Serve plain,
with lemonade, or wine may be added.
Flaxseed Tea. — J cupful flaxseed to 1 quart of boiling
water; boil for half-hour and remove to cooler portion of
stove to further thicken. Strain and add the sugar and
lemon juice.
Toast-water. — Toast three slices of bread very brown,
cutting bread about half an inch thick; break into small
pieces, put into a pitcher with one pint of cold water;
set aside to soak for one hour. At end of that time turn
into a strainer and squeeze out the liquid with the back
368 FOOD IN DISEASE
of the spoon. Then strain through a piece of linen.
This is either served hot or cold. A little cream and
sugar may be added, or a pinch of salt.
Gruels.
Gruels are cooked mixtures of grain or flour, with water,
or milk and water. A thorough cooking is necessary for
digestion, as the largest ingredient of grain is starch.
Gruels may be flavored with cinnamon, nutmeg, or
almond. A small dash of sugar improves the taste.
Drink slowly, that the starch may be thoroughly mixed
with saliva to ensure good digestion.
Arrowroot Gruel. — 1 tablespoonful of arrowroot.
1 saltspoonful of salt.
1 scant teaspoonful of sugar.
1 cup of hot water.
1 cup of milk.
Mix the arrowroot with the cold water (first mixing as
a paste, then adding all the water) and cook until per-
fectly clear. Add the milk cold and stir until it reaches
the scalding point. Serve hot, adding the salt and sugar.
Without Milk. — If desired, the milk can be left out, using
more water.
With Cream or Wine. — Pure cream can be added, or
wine, if ordered.
With Egg. — Just before removing it from the fire add
the beaten yolk of an egg and stir in the well-beaten
white. Cook a moment, stirring all the while and serve
as above.
Corn/meal Gruel. — 1 tablespoonful of meal (country
ground preferred).
1 ounce of pure cream (if desired).
RECIPES 369
Sugar (if desired).
1£ cups of boiling water.
1 cup of milk.
Sift the meal and scald with the boiling water. Simmer
for an hour or more; then add milk which has just reached
scalding point. Add sugar and cream and serve. If
desired, before removing from fire the well-beaten yolk
of an egg and the white beaten to a stiff froth may be
stirred in. Cook for a moment, stirring all the while.
Omit cream if egg is used.
Oatmeal Gruel. — Prepare as for cornmeal gruel, only
using 2 tablespoonfuls of the oatmeal.
Strain before adding the milk to remove the hulls.
Cream, sugar, or egg may be added as above described.
Barley Gruel. — 4 tablespoonfuls of barley flour.
1 pint boiling water.
Pinch of salt.
Moisten barley with a little cold water. Pour on the
boiling water, stir and boil for twenty minutes. Strain '
after adding one cup of milk if desired. Season to taste.
Mush and Porridge.
Mush is meal or grain cooked in water to consistency
of rather thin pudding.
Porridge is like mush, only thinner.
These being generally made of coarsely ground or
rolled grains, a long boiling is necessary to ensure good
digestion.
All mixtures should be sufficiently cooked to acquire
the consistence which just enables it to be poured. Oat-
meal and Indian meal require four to five hours boiling.
Wheat Gems, Granula, Pettijohn's Breakfast Food,
24
370 FOOD IN DISEASE
Avena Oats, etc., having been partially prepared by dry
heat, require only about one-half hour's boiling. Farina
requires one hour's boiling. Cook all mushes in a double
boiler.
Oatmeal Mush. — \ cup of rolled oats.
\ teaspoonful of salt.
1 pint of boiling water.
Pick over the oatmeal and put into a double boiler with
salt. Pour on the boiling water and cook for four or
eight hours. The water in the under boiler should boil
during this time and will occasionally need replenishing.
Serve the mush steaming hot with butter or sugar and
cream. Oatmeal is best cooked the day before needed,
as long cooking improves rather than injures the grain.
Indian-meal Mush. — 1 cup of cornmeal.
1 teaspoonful of salt.
1 quart of boiling water.
Wash the cornmeal, removing all black specks. Make
into a paste with a little cold water; then pour in the
boiling water and add the salt. Cook in a double boiler
for four or five hours.
Hominy Mush. — 1 cup of hominy.
1 teaspoonful of salt.
1£ quarts of water.
Pick over the hominy carefully and wash. Put all
together in a double boiler and cook for three hours. Add
more water if mush is too thick. Serve steaming hot
with butter.
Solid Meat Preparations.
Raw Beef. — Scrape with a sharp knife a thick piece
of steak (preferably from top of the round), and after
RECIPES 371
removing all fats and tendons, if not already in a complete
pulp, run through a mincer or pound in a mortar. Flavor
with salt and pepper.
This may be eaten in the form of a sandwich between
thin buttered bread; or,
Beef Balls. — Rolled into balls with a little white of egg
and broiled in pan for a couple of minutes, or until the
outside turns gray. Use only a speck of butter to keep
from sticking. Serve on lettuce leaf or on round crackers,
which have been heated.
Beef Pulp. — Procure slice of steak, free from all fat;
cut meat into strips and run through mincer three times.
The pulp must then be well beaten up in roomy saucer
with cold water or skimmed beef tea to consistency of
cream. The right proportion is three teaspoonf uls of liquid
to one ounce of pulp; stir mince briskly with wooden
spoon the whole time it is cooking, over slow fire or on
cool part of range until hot through and the red color
disappears. When done it should be a soft, smooth, stiff
paste of the consistency of a thick cream. Season with
salt and pepper. To be eaten hot. It should be served
in a bouillon cup which has been heated.
Meat Jelly. — This is made by cooking good, boneless,
lean beef with water (proceeding as for making broth)
until it becomes gelatinized.
Chicken Jelly. — Clean a fowl that is about a year old,
remove skin and fat; break the bones and place all together
in a pan containing two quarts of water. Let it come
gently to a boil and simmer five or six hours; add salt,
white pepper, or parsley to taste, strain and remove all
fat. Pout into moulds and put in cold place.
372 FOOD IN DISEASE
Soups.
Chicken Soup. — Thoroughly clean a fowl. Separate it
at the joints and break the bones. Put all together in a
saucepan with about three pints of water and stew it until
it becomes very tender and the stock is nutritious.
Season with onion, parsley, celery, or curry powder.
Cut the nicer portions of meat into small pieces and serve
with soup. Thicken with white sauce made of flour and
butter.
Two hours before removing from fire, barley, rice,
celery (cut into strips) may be added. One-half hour
before removing from fire noodles (alphabet or string)
may be added.
One hour before removing from fire, spaghetti or white
potatoes cut in blocks may be added.
Mock Bisque, or Cream of Tomato Soup. — \ pint of
tomatoes, measured after they have been stewed and
strained.
\ pint of white sauce.
\ saltspoonful of soda.
Salt and pepper to taste.
Strain the tomatoes, after cooking, through a coarse wire
strainer until there is nothing left but seeds. To this add
soda, salt, and pepper. Make a white sauce with one
tablespoonful of butter, one of flour, and one-half pint of
milk. Add this to tomatoes, strain all into a double boiler,
return to the fire, and serve as soon as it becomes hot.
Cream of Celery. — £ head of celery.
£ pint of water.
\ pint of white sauce.
1 tablespoonful of butter.
RECIPES 373
£ cup of milk.
1 tablespoonful of flour.
Salt and pepper to taste.
Wash and scrape celery, cut it into strips, put it into
one-half pint of water, and cook until very soft. When
done, mash it in the water in which it was boiled and add
salt and pepper and strain through soup strainer. Make
a white sauce and add to the fluid. Return the soup in
a double boiler to fire and heat until steaming, and serve
immediately.
Spinach Soup. — 1 pint of spinach.
\ cup of white sauce.
\ cup of milk.
1 tablespoonful of flour.
1 tablespoonful of butter.
\ cup of cold water or stock.
Salt and pepper to taste.
Pick the leaves from the pint of spinach. Wash through
several waters, be careful to free it from any sand. Put
it into a saucepan with cold water or stock, bring to
boiling, then simmer until tender (about ten minutes).
Press all through a fine sieve. If it does not measure
half a cup, add more water or stock.
Return to fire and add the white sauce, stirring con-
stantly in all directions until it boils. The yolk of an egg
may be lightly beaten and added a few moments before
removing from fire.
Water-cress Soup. — Substitute water-cress for the spinach
and proceed as for cream-of-spinach soup.
Cream-of-rice Soup. — 1 tablespoonful of rice.
| cup of chicken stock or water.
\ cup of milk.
374 FOOD IN DISEASE
1 piece of celery.
1 tablespoonful of butter.
Yolk of 1 egg. Season to taste.
Put the rice, celery, and water into a double boiler and
cook until very tender and soft. Press all through a sieve,
return to the double boiler, and add the milk and butter;
cook ten minutes longer, stirring frequently. Add salt
and pour the mixture slowly over the well-beaten yolk.
Return to fire to reheat, but do not let it boil.
Miscellaneous Recipes.
Baked Potatoes. — Select medium-size potatoes. Scrub
thoroughly in cold water. Bake in a hot oven until soft
(about forty-five minutes). Remove from the oven and
gently roll in a cloth between the hands to make them
mealy. Crack the skin to allow the steam to escape.
Serve immediately with butter, pepper, and salt.
Boiled Rice. — 1 tablespoonful of rice; \ teaspoonful of
salt.
1 pint of boiling water.
Wash rice in cold water. Have the water boiling in
saucepan, add the salt and sprinkle in the rice slowly.
After all the rice is in the water stir once, then do not
stir again. Boil rapidly until soft. Pour into a collander
to drain. Each grain should be whole.
Milk may be substituted for the water. It should be
cooked in double boiler when milk is used.
Stewed Celery. — Scrape and wash the stalks in cold
water. Cut into pieces about one inch long. Drop into
boiling salted water and let the water come to a boil and
cook until tender.
Serve in cream sauce.
RECIPES 375
How Corn Should be Eaten by Invalids. — Cut through
centre every row of grains with sharp knife, spread lightly
with butter and with the teeth press out the centre of the
grain, leaving the hull on the cob, this being the only
part indigestible.
Gluten Bread. — \ cup of milk.
£ cup of boiling water.
2 eggs, \ oz. compressed yeast cake.
Gluten flour; a little salt.
Pour the boiling water into the milk, and when luke-
warm add the yeast cake, which has been dissolved in a
little water, then add enough gluten flour to make a thin
batter and beat well. Add the two eggs well beaten; then
enough flour to make dough. Do not knead, but turn into
a greased pan. Cover and stand in a warm place, until
it doubles its bulk. Bake in moderate oven for one hour.
Gluten Pan Cakes. — Add gluten flour to one or two
eggs and beat into a batter. Cook on soapstone griddle.
They may be sweetened with a little saccharin.
Spoon Bread. — 1 cup of milk or water.
$ cup of white cornmeal.
2 eggs. A pinch of salt.
Beat the eggs well, add the milk, and stir the mixture
well into the meal. Add the salt and turn into the greased
baking dish.
First scalding the meal with boiling water improves the
bread.
Creams, Ices, etc.
Invalid's Cream. — } pint pure cream.
White of 1 egg.
Sugar to taste.
Vanilla extract, 1 dram.
376 FOOD IN DISEASE
Mix cream, sugar, and vanilla together and freeze to
the consistency of mush; then add the beaten white of
the egg and freeze. This is an excellent quickly made
cream. Freeze in a pint freezer or with an impromptu
freezer, which answers every purpose. Any small tin
bucket will do — a long, narrow one being preferable.
Place it in the middle of a deep dish or bucket (one with
hole in it answers best) and proceed as for a regular
freezer. Turn bucket around by means of the handle —
it is well to cut around the sides two or three times while
freezing.
If not desired for immediate use, allow the melted ice
to run out of hole in bucket and repack.
Sherry Cream. — Proceed as for above, adding one ounce
of sherry for the vanilla. Lemon extract, grated chocolate,
cocoa, chocolate syrup, peach extract, or caramel may be
substituted.
Frozen Custard. — Make a soft custard (according to
rule on page 364). When done, strain into a granite pan
and set aside to cool. Then add 6 ounces of pure cream
or the white of 1 egg beaten to a stiff froth. Freeze.
Lemon Sherbet. — 1 pint of water.
\ cup of lemon juice.
Sugar to taste.
White of 1 egg.
Make the lemonade; strain and freeze to the con-
sistency of mush; then add the beaten white of 1 egg
and freeze.
Lemon sherbet may be made without the egg, substitut-
ing instead gelatin, to the proportion of 1 tablespoonful
to 1 pint of water.
Orange Sherbet. — £ pint of water.
RECIPES 377
^ cup of orange juice.
1 tablespoonful of lemon juice.
Sugar to taste.
White of 1 egg.
Make the orangeade, adding the lemon juice and the
sugar; strain all through a .strainer and freeze to con-
sistency of mush; add the beaten white of 1 egg and
freeze.
Gelatin may be substituted for the egg if desired.
If an orange color is desired, add a couple of drops of
orange coloring.
Peach Sherbet. — Three ripe peaches.
Sugar to taste.
White of 1 egg.
Select solid but ripe peaches. Pare and remove the
stones. Place in a bowl and mash fine; add the sugar
and white of egg, which has been whipped to stiff froth.
Mix well and beat again. Freeze.
Blanc Mange. — 1 cup of milk.
1 egg.
1 tablespoonful of cornstarch.
Sugar to taste.
2 tablespoonfuls of pounded almonds.
2 teaspoonfuls of sherry, or
1 teaspoonful of vanilla extract.
Bring milk to boiling point and add cornstarch (which
has been moistened with a little cold water). Stir until
it thickens. Add the yolk, lightly beaten; cook just a
moment, remove from fire, and add sugar. Pour this
into the well-beaten white of egg, beating all the while
and adding gradually the pounded almonds. Serve in
moulds.
378 FOOD IN DISEASE
White Blanc Mange. — Make as the preceding recipe,
omitting the yolks of eggs. It may be colored a delicate
pink by adding three or four drops of carmine.
Irish Moss Blanc Mange. — J cup of dry moss.
1 quart of milk.
Sugar to taste.
Soak the moss for three-quarters of an hour in warm
water. Wash each piece separately under a stream of cold
water, removing all sand. Put moss in a bag (tied) and
cook in double boiler in the milk for one hour. At end
of that time remove from fire, add the sugar, strain it
into moulds, and set in cool place to harden. Serve with
whipped cream or soft custard.
Wine Jelly. — £ cup of sherry.
\ box of gelatin.
\ cup of cold water.
1£ cups of boiling water.
Cinnamon and clove, 1.
Sugar to taste.
£ cup of lemon juice.
Put gelatin and cold water in soak for one-half hour; then
pour the boiling water, in which a clove and a stick of
cinnamon have been simmering, over the softened gelatin.
Add the sugar, lemon juice, and wine and stir until the
gelatin and sugar are perfectly dissolved; then strain
through flannel bag and cool in a frigerator, or if desired
immediately place in impromptu freezer, but do not freeze
— simply subject it to intense cold.
Cinnamon and clove may be omitted, as well as the
lemon juice.
Lemon Jelly. — Proceed as for the above, substituting
1 cup of lemon juice for the wine. A dash of brandy
improves the flavor.
RECIPES 379
Orange Jelly. — Proceed as for wine jelly, substituting
1 cup of orange juice for the wine and using \ cup of
lemon juice.
Fruit Jelly. — Proceed as for wine jelly, using £ box of.
gelatin. After straining add sliced orange, Malaga grapes
(split and with seeds removed), and sliced bananas. Serve
with whipped cream.
INDEX.
Absorption, method of, 36
Achlorhydria, diet in, 282
Acid, benzoic, occurrence of, 320
drinks in cholera, 245
hydrochloric, action of, 34
added to baths, 44
oxalic, stone form, diet in, 324
phosphoric, occurrence of, 320
uric, derivation of, 320
stone form of, diet in, 324
Acidosis in diabetes, 309
Acne rosacea, diet in, 338
vulgaris, diet in, 337
Adulterants, added to bread, 129
to coffee, 171
Aerated waters added to milk,
67
Agreement of food, 37
Albumin-water, 218
Albuminuria, meat and eggs
withheld in, 249
Albuminoids, 21
in meats, 86
Alcohol, 176
combustion of, in- body, 177
a depressant, 178, 179
developed by fermentation of
certain substances, 180
effects of, on circulation and
blood, 177, 178
in different individuals, ISO
on digestion, 176
on nervous system, 178
on tissues, 179
employment of, in tubercu-
losis, 269
frequent cause of arterio-
sclerosis, 328
of interstitial nephritis,
322
Alcohol in nephritis, 321
prohibited in gout, 308
. rectal injection of, 231
Alcoholic fermentation of sugar,
138
Alimentary substances, 19
Alligator pear, 147
Amylopsin, action of, 35
Anemia, diet in, 332
Angina pectoris, diet in, 329
Animal foods, 20
Aortic aneurysm, diet in, 329
Appetite in the sick, 223
Arrowroot, 142
Arteriosclerosis, diet in, 328
Artichoke, Jerusalem, 143
Asparagus, 146
cause of purpura, 343
Asthma, diet in, 331
B.
Bacon, 91
Bacteria, cause of fermentation
in milk, 55
in cheese, 63
in cream, 61
in eggs, 77
in flour and bread, 129
in milk, 55, 212, 213
Bacterial action in intestines, 35
Baking, effects of, 42
on digestibility of meats, 42
loss of weight from, 42
powders, 123
Barley, 114
-water, 242
Basting, effects of, 41
Beans, 130, 147
cooking of, 133
Beef, composition of, 88
382
INDEX
Beef, diagram of cuts of, 89
expressed juice of, 265
fat of, 157
temperature required for
cooking of, 41
Beet, 144
Beverages, alcoholic, 175
classification of, 180
prohibited in gout, 308
in diabetes, 314
in fevers, 242
non-alcoholic, 168
Bile, action of, 35
Birds, characteristics of fresh, 95
kept in cold storage, 95
to tell the age of, 96
Bitters, 182
Blood. 92
Boiling, 42
effects of, 43
method of, 43
purification of water by, 167
Bone-marrow, 158
Brain, 92
Bran, effects of, on digestion, 125
Brasing, method of, 45
vessel for, 46
Bread, 118
adulterants added to, 129
aerated, 124
baking of, 121
batter, 125
composition of, table of, 128
cooling of, 122
Graham, 125
hot, 127
imperfections and impurities
in, 128
kneading of, 119
raising of, by chemicals, 123
by leaven, 123
by yeast, 118
rising, 121
sour, 129
stale, 126
unleavened, 124
varieties of, 125
whole wheat, 126
Breakfast foods, 116
composition of, table of, 117
Broiling, method of, 42
object of, 42
Bronchitis, acute, diet in, 330
chronic, diet in, 331
Bronchopneumonia, diet in, 331
Broths, chicken, most nutri-
tious, 44
hydrochloric acid added to, 44
method of preparing, 43
Brussels sprouts, 145
Buckwheat, 115
Butter, 60, 157
analysis of, 62
cause of rancidity in, 61
in diabetes, 312
digestibility of, 62
flavor of, due to bacteria, 61
in gout, 306
in tuberculosis, 267
water in, 61
Butterine, 157
Buttermilk, 62, 240
Butyric acid, 55
fermentation in sugar, 138
Cabbage, 145
Cacao butter, 159
Calculi, oxalic acid, diet in, 324
phosphatic acid, diet in, 324
uric acid, diet in, 324
Cancer of stomach, 286
diet in, 288
Candling of eggs, 77
Carbohydrate foods, 135
in diabetes, 308
effects of excess of, in in-
fants, 204, 205
in fever, 241
Carbohydrates of food, 23
of human body, 19
Carrots, 143
Casein of buttermilk, 62
coagulation of, 55, 57
Cauliflower, 145
Celery, 146
Cellulose, 135
of beans and peas, 131
effect of vinegar on, 154
Cereals, 110
breakfast foods, 116
composition of, table of, 116
INDEX
383
Cerebrospinal meningitis, diet in,
259
Champagne, 186
Chemical composition of human
body, 18
digestion, 33
Cheese, 62
average composition of, 64
digestibility of, 64
varieties of, 63
Chestnuts, 160
Chewing, effects of, 31
Chickens, 93
Chocolate, 174
Cholera, 245
diet in, 246
prophylaxis of, 245
Cirrhosis of liver, 297
Clam-juice, 108
Clams, 108
Coca, 175
Cocoa, 173
in fever, 242
Cod-liver oil, 158
best time of administration of,
158, 234
disguising taste of, 159
inunctions of, in dysentery, 250
olive oil substituted for, 159
Coffee, 170
adulterations in, 171
in asthma, 332
effects of, 172
laxative, 296
in fever, 242
method of preparing, 171
Cola, 174
Complete foods, 20
Composition of common foods,
table of, 28
of gastric juice, 33
of pancreatic juice, 34
Condensed milk, 74, 216
Condiments, 153
in anemia, 334
Constipation, ' 293
causes of, 294
diet in, 295
effects of, on asthma, 332
Convalescence, diet in, 244
Cooking, changes produced by,
39
Cooking of vegetable foods, 47
Corn, 115
Cotton-seed oil, 159
Cows' milk, bacteria in, 55, 212,
213
comparison of, 53, 210
with woman's milk, 53, 211
Crabs, 108
Crawfish, 146
Cream, bacteria in, 61
composition of, 59
fat globules of, 52
gravity and separator of, 59
souring of, 60
in tuberculosis, 266
Creatin, 86
Cucumbers, 146
Dandelions, 145
Dengue, 248
Diabetes, 308
diet in, 309
fats in, 312
fresh vegetables in, 313
fruits in, 313
proteids in, 312
sugars in, 311
Diarrhea, acute attack of, diet
in, 291
treatment of, 290
causes of, 290
chronic, diet in, 292
in infants, 293
Diet in achlorhydria, 282
in acne rosacea, 338
vulgaris, 337
in acute articular rheumatism,
252
bronchitis, 330
gastritis, 274
nephritis, 317
in anemia, 332
in angina pectoris, 329
in aortic aneurysm, 329
in arteriosclerosis, 328
in asthma, 331
in bronchitis, acute, 330.
chronic, 331
in bronchopneumonia, 331
384
INDEX
Diet in cancer of stomach, 287
in cerebrospinal meningitis,
259
in cholera, 245
in chronic bronchitis, 331
gastritis, 275
heart disease, 325
nephritis, 318
rheumatism, 315
in cirrhosis of liver, 297
in constipation, 293
in convalescence from typhoi ! .
244
in croupous pneumonia, 251
in dengue, 248
in diabetes, 310
in diarrhea, 290
in dilatation of stomach, 283
in diphtheria, 258
in dysentery, 249
in erysipelas, 254
in erythema nodosum, 341
in gastric ulcer, 285
in gastritis, acute, 274
chronic, 275
mucous, 280
general hospital, 346
in gout, 303
in hyperchlorhydria, 280
in hypochlorhydria, 281
in influenza, 250
in interstitial nephritis, 321
liquid, 350
in malaria, 253
in measles, 257
in mucous gastritis, 280
in nephritis, acute, 317
chronic, 318
in nephrolithiasis, 323
in neurasthenia, 335
in obesity, 299
in old age, 201
in parenchymatous nephritis,
319
in pleurisy, 332
in pneumonia, croupous, 251
in psoriasis, 341
in pulmonary tuberculosis,
260
in purpura, 343
in relapsing fever, 248
in rheumatoid arthritis, 316
Diet in scarlet fever, 256
in scurvy, 315
in septicemia and pyemia, 254
in smallpox, 255
soft, 348
in typhoid fever, 237
in typhus fever, 248
in urticaria, 343
in whooping-cough, 259
in xanthoma diabeticorum, 344
in yellow fever, 248
Digestion, chemistry of, 33
effects of, 36
exercise and, 198
gastric, 33
intestinal, 34
mechanism of, 31
salivary, 33
sleep and, 198
tobacco and, 199
Digestive ferments, 33
tract, diseases of, 272
Dilatation of heart, diet in, 327
of stomach, cause of, 283
defined, 282
diet in, 283
interval between meals in,
284
Diphtheria, diet in, 258
Distillation of water, 167
Dough, aeration of, 124
baking, 121
fermentation of, by leaven, 123
by yeast, 118
kneading of, 119
raising of, with chemicals, 123
rising of, 121
sponge, 120
straight, 120
Ducks, 94
Dysentery, 249
Dyspnea, cardiac, 327
E.
Eczema, diet in, 339
Egg-plant, 146
Eggs, 75
in anemia, 334
boiling of, 79
composition of, 75, 76
INDEX
385
Eggs, composition of white of, 76
yolk of, 76, 77
cooking of, 79
danger from eating, 83
desiccated, and substitutes for,
82
digestibility of, 78
flavor of, 77
frying of, 80
poaching of, 80
preservation of, 81
shirring of, 80
in typhoid dietary, 240
use of, in making cake, 81
in tuberculosis, 265
withheld in gout, 306
Erysipelas, diet in, 254
Erythema nodosum, diet in, 341
Exercise and digestion, 199
Extractives, 22
F.
Fats, administration of, with
starches, 155
animal, 157
in chronic wasting disease, 156
in diabetes, 312
digestion of, 156
effect of excess of, in infant
food, 211
of foods, 22, 206
of human body, 19
in infant dietary, 206, 207
in meats, 86
purposes subserved by, 155
vegetable, 159
Feeding, artificial, 210
helpless patients, 226
rectal, 227
sleep and, 227
solid, in typhoid fever, 243
the sick, 223
unconscious patients, 226
Ferments, digestive, 33
Fever, feeding in, 235, 236
Filtering of water, 167
Fish, 101
canned, 105
classes of, according to fat con-
tained, 102 A/
25
Fish, composition and digesti-
bility of, 101, 103, 104
cooking of, 106
extracts made from, 105
roe of, 105
salted or smoked, 105
shell-, 106
Flour, 112
decorticated, 113
grading of, 113
Graham, 112
impurities in, 113
patent, 113
Food, in aged, 201
approximate quantities of, 202
in childhood, 199
condition affecting necessary
quantity of, 194
frequency of taking, 196
in infancy, 204
nutrients and energy of, table
of, 192, 193
quantity of, 189
for sick, 224
serving of, 224
Foods, animal, 20
classification of, 20
complete, 20
medicines in relation to, 244
perfect, 20
vegetable, 20
Frogs, 109
Fruits, 149
antiscorbutic action of, 149
best time for eating, 151
composition of, table of, 153
cooking of, 151
dried, 152
effects of, on urine, 150
overripe, 150
unripe, 150
Frying, effects of, 46
method of, 46
Functions of human body, 17
6.
Game birds, 93
Gastric digestion, 33
juice, composition of, 33
Gastritis, acute, diet in, 274
386
INDEX
Gastritis, chronic, diet in, 276
mucous, diet in, 280
Geese, 95
Gelatin, in tuberculosis, 266
in typhoid fever, 241
Gelatinoids, 22
Gin, 182
Glucose, 137
Gluten flour in diabetes, 311
Glycosuria, 308
Gout, beverages in, 309
carbohydrates in, 308
diet in, 304
fats in, 308
proteids in, 305
theories as to cause of, 303
Grape cure in tuberculosis, 268
Gruels in fever, 242
Guinea fowls, 94
Ham, 91
Heart, 92
chronic disease of, diet in, 325
dilatation of, diet in, 327
Honey, 137
in tuberculosis, 268
Hospital dietaries, general house
diet, 346
liquid diet, 350
soft diet, 348
Hot water, effect of, on digestion,
164
Human body, carbohydrates of,
19
chemical composition of, 18
fats of, 19
functions of, 17
proteid of, 19
salts of, 19
water of, 19
milk, average composition of,
53
compared with cows' milk,
57
Hydrochloric acid, action of, 34
added to broths, 44
Hyperchlorhydria, cause of, 280
diet in, 280
Hypochlorhydria, diet in, 281
Hypodermoclysis, 247
Ice-cream, effects of, on diges-
tion, 164
in feeding sick, 239
Ice-water, effects of, on digestion,
164
Infectious diseases, food in, 235
Infancy, cows' milk in, 210
food in, 204, 207, 220
maternal nursing in, 208
other foods in, 217
Influenza, diet in, 250
Inorganic compounds, 20
Intestinal digestion, 34
Kale, 145
Kefir, 70
Kidney, 92
diseases of, food in, 317
Koumiss, 69, 218
cures, 70
useful in tuberculosis, 265
Lactalbumin, 50
effect of heat on, 213
Lactic acid, action of, on casein,
55
in buttermilk, 62
fermentation in sugar, 138
production of, 55, 58
Lamb, 90
Lavage, gastric, 231
in gastric dilatation, 285
tepid water used in, 232
time of giving, 232
Leaven, fermentation of dough
by, 123
Legumes, composition of, 130
cooking of, 133
dried, 132
preparation of, 131
Legumin, 130
Lentils, 130
Lettuce, 146
Levulose in diabetes, 312
INDEX
387
Lime-water added to milk, 66,
239
used to preserve eggs, 81
Liqueurs, 182
Liver of calf, pig, and lamb, 92
functions of, 36
Lobsters, 108
M.
Malaria, diet in, 253
Malt extract in tuberculosis, 268
Mastication, effect of, 31
Matzoon, 70, 218
Meals, frequency of, 196, 197
regularity of, in feeding sick,
224
Measles, diet in, 257
Meat powder, preparation of, 265
Meats, carbohydrates and salts
of, 87
composition of, 85
digestibility of, S8
fats of, 86
flavor of, 85, 87
proteid of, 86
structure of, 84
texture of, 85, 87
Medicines in relation to food, 244
Milk, 49, 210
adaptation of, for sick, 64
addition of alkalies to, 68
adulteration of, 56
altering taste of, 56, 65, 239
bacteria in, 55, 212
boiling of, effects of, 65, 66
complete food for infants, 58
composition of, 50, 53
condensed, 74, 216
cows', compared with woman's,
210, 211
digestibility and utilization of,
56, 57
dilution of, with alkaline or
aerated water, 66
amylaceous foods, 67
water, 66
effect of thunder storm on, 55
of cows' condition on, 53
estimating quality of, 51
in feeding the sick, 238
Milk, methods of improving di-
gestibility of, 65, 239
of predigestion of, 68
modified, 73
nutritive value of, 58
other forms of fermentation of,
55, 56
pancreatinized, 69
pasteurization of, 70, 215
peptonized, 68
scalded, 65
sources of contamination of, 54
sterilization of, 70, 215
variations in, 51
Modified milk, 73
method of preparing, 74,
213, 215
Molasses, 136
Mouth, cleansing of, in sick, 225,
243
Muscular action of intestines, 32
of stomach, 32
Mushrooms, 148
Mussels, 108
Mustard, 154
Mutton, 90
N.
Nephritis, acute, diet in, 317
chronic, diet in, 319
interstitial, diet in, 321
parenchymatous, diet in, 319
Nephrolithiasis, diet in, 323
Neurasthenia, diet in, 335
Nitrogenous and non-nitrogen-
ous waste, 25
Nuclein, foods rich in, 304
Nursing, diseases preventing, 208
maternal, 208
wet, 209
Nutritive value of foods affected
by digestibility, 27
estimation of, 26
Nuts, 160
composition of, table of, 161
Oatmeal, composition of, table
of, 117
388
INDEX
Oatmeal cure, Van Nborden's,
314
irritating effect of, in skin dis-
eases, 337
Oats, 114
Obesity, causes of, 299
dietetic treatment of, 300
methods of treating, Banting's,
301
Ebstein's, 301
Oertel's, 301
Oleomargarine, 157
Olive oil substituted for cod-
liver oil, 159
in tuberculosis, 266
Olives, 147
Omelet, 80
Onion, 144
Organic compounds, 20
Organs, waste and repair of,
18
Overeating, 195
cause of arteriosclerosis, 328
Ovsters, 106
"digestibility of, 108
fattening of or "floating," 107
in gout, 306
"green-gill," 107
Pancreatic juice, composition
of, 34
Pancreatinized milk, 69
Panopepton in typhoid fever, 241
Parsnips, 143
Pasteurization of milk, 72, 215
compared with sterilization,
72
increase of organisms in,
after, 72
Pea-fowls, 94
Peanuts, 134, 161
oil of, 160
Peas, 130, 147
green, 132
Pepsin, action of, 34
Peptonized milk, 68
Peptonoids, liquid, 241
Perfect foods, 20
Pigeons, 94
Plasmon, in typhoid fever, 241
Pleurisy, diet in, 332
Pneumonia, croupous, diet in,
252
Pork, composition of, 91
deficiency of, in extractives, 87
indigestibility of, 91
Porterhouse steak, 89
Potato, Irish, composition of, 140
cooking of, 141
in diabetes, 311
sweet, composition of, 142
Poultry, 93
canned, 97
choice of, 95
composition of, 97, 98, 99
cooking of, 96
digestibility of, 100
nutrient value of, 101
potted, 97
varieties of, 93
Proprietary preparations, 241
Proteid, effect of excess of, in
infancy, 211
of first importance in infancy,
205
foods, 21, 84
of human body, 19
importance of, 49
in meats, 86
properties of, as a food, 188
vegetable and animal, com-
pared, 49
Psoriasis, diet in, 341
Ptyalin, action of, 33
Purpura, diet in, 343
Quail, 94
R.
Radish, 144
Recipes, 351
for albuminized milk, 361
water, 364
for arrowroot gruel, 368
with cream or wine, 368
with egg, 368
INDEX
389
Recipes for arrowroot broth,
without milk, 368
water, 367
for baked custard, 365
potatoes, 374
for barley gruel, 368
water, 366
infants, 366
for beef balls, 371
broth (Memorial Hospital
method), 353, 354
jelly, 355
juice (bottled), 352
(broiled), 351
cold process, 352
frozen, 352
pulp, 371
tea, boiled, 352
preparation of, 353
with hydrochloric acid,
353
for blanc mange, 377
for boiled rice, 374
for bouillon, 355
for chicken broth, 356
jelly, 371
with gelatin, 356
with Irish moss, 357
soup, 372
for clam broth and bouillon,
357
or bouillon, 358
frozen or clam frappe,
358
for corn — how it should be
eaten, 375
for cocoa, 363
shells, 363
with wine, 362
for consomm.6, 355
for cornmeal gruel, 368
for cream of celery, 372
for cream of rice soup, 373
for egg-flip, 364
for eggnog, 362
for egg-water, 364
for flaxseed tea, 367
for frozen custard, 376
for fruit jelly, 379
for gluten bread, 375
pancakes, 375
for gum arabic water, 367
Recipes for hot-water tea, 363
for hominy mush, 370
for Indian-meal mush, 370
for invalid's cream, 375
for Irish moss blanc mange,
378
for junket, slip or curds and
whey, 362
for koumiss, 360
for lemon jelly, 378
and orange albumin, 364
sherbet, 376
whey, 361
for lime-water, preparation of,
360
for meat jelly, 371
for milk and cereal water, 361
and cinnamon, 360
lemonade, 361
and lime-water, 359
pancreatinized, 358
peptonized, 358
punch, 360
with coffee or nutritious
coffee, 360
with other diluents, 362
for mock bisque or cream of
tomato soups, 372
for mulled wine, 363
for mutton broth, 354
for oatmeal gruel, 368
mush, 370
water, 367
for orange jelly, 379
sherbet, 376
for oyster broth, 357
tea, 357
for pasteurized milk, 359
for peach sherbet, 377
for poached eggs, 366
for racahout, 363
for raw beef, 370
for rice-water, 367
for scrambled eggs, 366
for sherry cream, 376
and egg, 362
for soft-cooked eggs, 365
custard, 364
for spinach soup, 373
for spoon bread, 375
for sterilized milk, 359
for stewed celery, 374
390
INDEX
Recipes for taste of milk, altera-
tion of, 359
for toast-water, 367
for water-cress soup, 373
for whey with pepsin, 361
for white blanc mange, 378
for wine jelly, 378
whey, 361
Rectal feeding, 227
aids to retention in, 231
cleansing rectum in, 229
frequency of injections, 229
methods of injection, 228
in organic diseases of digest-
ive tract, 274
substances used for, 230
temperature of injection,
230
injections, in cholera, 247
of water, 242
Relapsing fever, diet in, 248
Rennin, action of, 34
Repairing waste by foods, 18
Respiratory organs, diseases of,
diet in, 330
Rheumatism, acute articular,
diet in, 252
chronic, diet in, 315
Rheumatoid arthritis, diet in,
316
Rhubarb, 146
Rice, 115
-water in fevers, 242
Rigor mortis, 87
Roasting, degree of heat required
in, 41
method of, 40
Roots and tubers, heavy, 140
succulent, 142
Rum, 182
Rye, 114
bread made from flour, 114
S.
Saccharin in diabetes, 312
Sago, 142
Salivarv digestion, 33
Salsify," 143
Salts of food, 23
of human body, 19
Sauer kraut, 145
Scarlet fever, diet in, 256
Scrambled eggs, 80
Scurvy, diet in, 315
Septicemia and pyemia, 254
Shrimps, 108
Simmering, 44
Skimmed milk, 60
digestibility, 65
Skin, diseases of, diet in, 337
Sleep and digestion, 198
and feeding, 227
Smallpox, diet in, 255
Soups, clear, 44
for the sick, 241
method of preparing, 44
vegetables added to, 44, 241
Spices, in interstitial nephritis,
322
Spinach, 145
Squash or cymbling, 147
Starch, 135
Steaming, 47
Steapsin, 35
Sterilization, effects of, 71
method and apparatus for, 71
of milk, 70, 71
of water in cholera, 245
Stewing, 44
addition of sauces in, 45
effects. of, 45
loss in, 45
Succus entericus, action of, 35
Sugar, 136
brown, 136
cane, 136
in diabetes, 311
food, value of, 137
fruit, 137
grape, 137, 311
safe daily allowance, 138
Swallowing, mechanism of, 32
Swans, 95
Sweetbread, 91
T.
Table I. Composition of com-
mon food materials, 28
II. Composition of cheese, 64
III. Composition of some in-
fant foods, etc., 68
INDEX
391
Table IV. Average composition
of eggs and egg products, 76
V. Average composition of
poultry and poultry prod-
ucts, 98
VI. Composition of fish, mol-
lusks, crustaceans, etc., 103
VII. Composition of cereals,
116
VIII. Composition of cereal
breakfast foods, 117
IX. Composition of various
breads, 128
X. Composition of fresh and
dried legumes, 130
XI. Percentage composition
of different vegetables, 139
XII. Composition of fruits,
153
XIII. Composition of nuts,
161
XIV. Coefficients of digesti-
bility, etc., 191
XV. Nutrients and energy of
digestible portions of some
common foods, etc., 192
XVI. For modifying cows'
milk for different ages, 215
Tannin, 167
Tapioca, 142
Tea, 168
effects of, 170
method of brewing, 169
Tenderloin steaks, 90
Theine, 168
effect on circulation, 170
Tobacco and digestion, 199
Tomatoes, 146
Tripe, 93
Tropon, added to milk and
cream, 265
Trypsin, action of, 34
Tuberculosis, pulmonary, bever-
ages in, 269
carbohydrates in, 268
diet in, 260
fats in, 265
forced feeding in, 270
proteids in, 263
.Turkeys, 93
Turnip, 143
-tops (greens), 145
Turtle and terrapin, 108
Typhoid fever, beverages in, 242
carbohydrates in, 241
diet in, 237
in convalescence from, 244
eggs in, 240
gelatin in, 241
milk in, 238
mouth toilet in, 243
proprietary preparations in
241
solid feeding in, 243
soups and broths in, 241
Typhus fever, 248
U.
Ulcer, gastric, diet in, 286
nutrient enemata in, 286
Urticaria, diet in, 343
Valentine's meat juice, 241
Veal, 90
Vegetable foods, 20
chief food ingredient of, 47
cooking of, 47
juices in tuberculosis, 268
marrow, 147
Vegetables, 138
classification of, 140
green, 144
percentage composition of,
table of, 139
Venison, 91
Vinegar, 154
W.
Waste by functional activity, 18
nitrogenous and non-nitrogen-
ous, 25
Water, 162
effects of excessive use of, 162
of withholding, 162
elimination of, 164
in fevers, 242
of food, 24
392
INDEX
Water glass, used in preserving
eggs, 81, 82
of human body, 19
in interstitial nephritis, 322
in meats, 85
methods of purification of, 167
purity of drinking, 165
rain, 166
rectal injection of, 163
river, 167
spring, 166
temperature of drinking, 164
time of drinking, 165
Weaning, 219
Wells, 166
Wheat, composition of, 111
structure of, 110
Whey, substitute for milk, 240
in tuberculosis, 264
Whiskey, 180, 181
Whooping-cough, diet in, 259
Weir Mitchell rest cure, 335
Wines, 183
in certain diseases, 187
red, 184
sparkling, 185
spirituous, 185
white, 184, 185
Xanthoma diabeticorum, 344
Y.
Yam, 142
Yeast, compressed, 119
fermentation by, 118
Yellow fever, diet in, 248