Google
This is a digital copy of a book that was preserved for generations on library shelves before it was carefully scanned by Google as part of a project
to make the world's books discoverable online.
It has survived long enough for the copyright to expire and the book to enter the public domain. A public domain book is one that was never subject
to copyright or whose legal copyright term has expired. Whether a book is in the public domain may vary country to country. Public domain books
are our gateways to the past, representing a wealth of history, culture and knowledge that's often difficult to discover.
Marks, notations and other maiginalia present in the original volume will appear in this file - a reminder of this book's long journey from the
publisher to a library and finally to you.
Usage guidelines
Google is proud to partner with libraries to digitize public domain materials and make them widely accessible. Public domain books belong to the
public and we are merely their custodians. Nevertheless, this work is expensive, so in order to keep providing tliis resource, we liave taken steps to
prevent abuse by commercial parties, including placing technical restrictions on automated querying.
We also ask that you:
+ Make non-commercial use of the files We designed Google Book Search for use by individuals, and we request that you use these files for
personal, non-commercial purposes.
+ Refrain fivm automated querying Do not send automated queries of any sort to Google's system: If you are conducting research on machine
translation, optical character recognition or other areas where access to a large amount of text is helpful, please contact us. We encourage the
use of public domain materials for these purposes and may be able to help.
+ Maintain attributionTht GoogXt "watermark" you see on each file is essential for in forming people about this project and helping them find
additional materials through Google Book Search. Please do not remove it.
+ Keep it legal Whatever your use, remember that you are responsible for ensuring that what you are doing is legal. Do not assume that just
because we believe a book is in the public domain for users in the United States, that the work is also in the public domain for users in other
countries. Whether a book is still in copyright varies from country to country, and we can't offer guidance on whether any specific use of
any specific book is allowed. Please do not assume that a book's appearance in Google Book Search means it can be used in any manner
anywhere in the world. Copyright infringement liabili^ can be quite severe.
About Google Book Search
Google's mission is to organize the world's information and to make it universally accessible and useful. Google Book Search helps readers
discover the world's books while helping authors and publishers reach new audiences. You can search through the full text of this book on the web
at |http: //books .google .com/I
; i;BLtC HEALTH LIBRARY
"LiO HEALTH CENTER OF ALAMEDA COUNTY
121 East eleventh St.
OAKLAND - - California
Si^i&afist
HEALTH LIBRARY
PUBLIC
PUBLIC HEALTH CENTER OFAUMEDA COUNTY
121 East eleventh St.
Oakland - - California
jL^^atSl
3TPT
?uliila Hetlth Centtr of
-'Alameda Coit
^,„ ELEVENTH ST.
12, EAST tu ^^^ipoRNlA
OAKLAND -
■«
DIETETICS FOR
NURSES
BY
JULIUS FRIEDENVALD, M.D.
CLINICAL PKOFKSSUR OF DISHASKS OP THK STOMACH IN THE COLLBGB
OF PHYSICIANS AND SUKGKONS, BALTIMOKB
AND
JOHN RUHRAH, M.D.
CLINICAL PKOFHSSOK OF DISEASES OF ClIILDKRN IN THB COLLBGB
OF PHYSICIANS AND SURGEONS, BALTIMORB
PUBLIC HEALTH LIBRARY
rUljLIG HEALTH CENTER OF ALAMEDA COUNTY
121 East Eleventh St.
/-> ' i-r
C.'A INLAND
Califof?nia
PHILADKLPHTA AND LONDON
W. B. SAUNDERS AND COMPANY
1905
I . .
• •
• • •
• • •
• • •
• • • • «
a ••• • •
• • ••• •
• • • • • •
Copyright, 1905, by
W. B. SAUNDERS & COMPANY
ELECTROTYPEO BY
WC8TGOTT fc THOMSON. PHILAOA.
W. B.
PRESS OF
SAUNDERS & COMPANY.
• •
• •• •
•«• • • •
• • • • • «
» • • • •
' • •• •
• • •
• •
• • • • • •
• • •• ••
• • • • • • •
• *• • • * •
•• • • • •
• • •
TO
MISS ADELAIDE NUTTING,
SUPERINTENDENT OF THE JOHNS HOPKINS TRAINING SCHOOL.
Dear Miss Nutting: —
We take great pleasure in inscribing this little book to you
in appreciation of the splendid work you are doing in
maintaining a high standard for the nursing profession.
Very sincerely,
JULIUS FRIEDENWALD,
JOHN RUHRAH.
PREFACE.
This little book has been prepared to meet a need in
the training-school and as a handbook for nurses and
laymen who are interested in the subject of feeding the
sick.
At present the nurse must rely upon a knowledge of
dietetics gleaned either from her text-book on invalid
cookery or from one of the larger reference works upon
the subject. The former contains too little, and the
latter is much too large and too technical to be of great
service to the busy nurse.
The aim of this book is to give the essentials of
dietetics. The physiology of digestion has been briefly
reviewed. The various classes of foods and the part
they play in nutrition have been considered. The sub-
jects of infant feeding and the feeding of the sick have
been fully discussed, and a brief outline has been given
of the principles involved in the nourishment of patients
suffering with the various diseases in which diet plays
an important part in the management. Rectal alimenta-
tion and the feeding of operative cases have been fully
described. Diet lists and instructions have been added
which should enable the nurse to comprehend and to
intelligently carry out the orders of the physician. A
5
6 PREFACE.
large number of recipes for the invalid's dietary have
been added.
Should the reader desire further information on any
of the subjects mentioned or concerning other dietetic
topics he should consult our larger work, " Diet in Health
and Disease."
April 15, 1905.
CONTENTS.
CHAPTER I.
PAGB
The Chemistry AND Physiology OF Digestion ii
Digestion and Absorption — The Influence of V^arious Factors
upon the Digestion — The Relation of Food to Various Inherent
Conditions — Absorption of Foods — Quantity of Foo^i Required.
CHAPTER II.
Classes of Foods 32
Animal Foods — Milk and Milk Products — Eggs — Meats and
Meat Preparations — Fish — Vegetable Foods — Cereals — Legu-
mes — Roots and Tubers — Green Vegetables — Fruits — Nuts —
Sugars — Spices and Condiments — Fats and Oils — Salts — Bev-
erages AND Stimulants — Water — Tea — Coffee — Cocoa — Al-
cohol.
CHAPTER III.
Various Factors IN their Bearing on Diet 80
Concentration of Food — Preservation of Food — Artificial Food
Preparations — Cooking of Foods — Diseases Caused by Errors in
Diet and by Various Food Poisons — Food Adulteration.
CHAPTER IV.
Feeding of Infants and Children 95
Milk-modification — Feeding during the Second Year — Diet of
School Children — Feeding in Infant Asylums.
CHAPTER V.
The Feeding of Sick Infants 124
Stationary Weight ; Loss of Weight — Colic — Vomiting — Gavi^e
— Nasal Feeding — Feeding in Inflammations of the Mouth —
Diseases of the Stomach — Diarrhea — Chronic Intestinal Indi-
gestion — Constipation — Wasting Diseases — Rickets.
7
8 CONTENTS,
CHAPTER VI.
Diet for the Aged 13^
PAGB
CHAPTER VII.
Dirt During Pregnancy and the Puerperium 136
CHAPTER VIII.
Rectal Feeding 138
Procedure — Recipes for Nutrient Enemata — Other Methods of
Nourishing the lk>dy — Saline Injections and Infusions.
CHAPTER IX.
General Rules for Fekdinc; the Sick 145
Feeding Unconsci(jUK and Refractory Patients — Forced Feeding
— Feeding in Fever.
CHAFFER X.
Feeding in the Infectious Diseasi<3 155
Typhoid Fever — Typhus Fever — Small-pox — Scarlet Fever —
MeaHles — Mumps— Whooping-cough — Diphtheria — Rheumatism
— Yellow Fever— Tetanus — Rabies — Tuberculosis.
CHAPTER XI.
Diet IN Di«EAHK»M OF THE Stomach .176
I^uIms'n Diet Scale — Pcnzoldt's Diet-lists — Liquid Foods in Gas-
tric Disorders— Sjiecial Factors Hearing on tlie Diet — Special
Curtf — Diet in Dysphagia — Acute Gastritis — Chronic Gastritis —
Dilatation of the Stomach — Atonic Dyspepsia — Ulcer of the
Stomach — Hemorrhage from the Stomach — Carcinoma of the
Stomach — Nervoun (iastrir Disorders.
CHAPTER XH.
Dirt in Intpjitinai. Diseases 202
Tntrstlnnl DyN))«pMia — Acute Tntrstinnl Catarrh — Chronic Intes-
tinal Catarrh — Dysentery — IMeer of the Intestine— Malignant
Growths of the Intestine — Acute Intestinal Obstruction — Chnmic
tffstinal Olwtruetlon — Appendicitis -Dietetic Treatment of
fvous Conditions of the Intestine — llem«>rrhoids — Diarrhea —
)|tua1 ('onstipation PeritonitiM.
CONTENTS, 9
CHAPTER XIII.
PAGE
Diet in Diseases of the Liver 218
CHAPTER XIV.
Diet in Diseases of the Rf^piratory Organs 222
Pleurisy — Empyema — Laryngitis — Asthma — Chronic Lung Dis-
ease — Pneumonia. ,
CHAPTER XV.
Diet in Diseases of the Circulatory System 225
Diet in Diseases of the Heart — General Directions — Oertel Treat-
ment — Aneurism ; Dilatation of the Blood-vessels — Angina Pec-
toris — Anemia.
CHAPTER XVI.
Diet in Diseases of the Genito-urinary System 232
Urine and Food — Acute Inflammation of the Kidney ; Nephritis
— Chronic Inflammation of the Kidney — Movable and Floating
Kidney — Calculous Affections — Surgical Diseases of the Genito-
urinary Tract.
CHAPTER XVII.
Diet in DiSFjvsFi? of the Nervous System 237
Neuralgia — Insomnia and Disturbed Sleej) — Epilepsy — Chorea —
Apoplexy — Alcoholism — Rest Cure — Diet for the Insane.
CHAPTER XVIII.
Diseases in which Dikt is a Primary Factor 253
Diabetes Mellitus— (iout and Goutiness — Arthritis Deformans —
Scurvy — Obesity — Leanness — Diet in Skin Diseases.
CHAPTER XIX.
Special Diet Cures 272
CHAPTER XX.
Dietetic Managkment ok Surgical Cases 274
Anesthesia and Diet —Diet after Operation — 0|^erations about the
Head -Ilnre-lip nnd Cleft Palate Operations — Esophageal or
Laryngeal Operations — Diet and Laparotomies — Nausea and
Vomiting— Thirst — Care of the Bowels — Dietetic Management
of Shock — Diet after Operations on the Various Organs — Feeding
through Gastric and Intestinal Fistulas.
lO CONTENTS.
CHAPTER XXI.
PAGE
Hospital Diet 283
CHAPTER XXH.
Recipes 285
Beverages — Cereals and Cereal Gruels — Bread — Vegetables —
Soups without Meat — Milk Preparations — Eggs — Meats — Soups
— Methods of Preparing Raw Beef — Panopepton — Meat Jellies
without Gelatin — Foods for Diabetics.
CHAPTER XXni.
Cuts of Meat 33^
Weights and Measures 337
Index 34^
Dietetics for Nurses.
CHAPTER I.
THE CHEMISTRY AND PHYSIOLOGY OF
DIGESTION.
Food is the matter taken into the body to supply heat
and energy, to build up the body, and repair tissue waste.
Every movement we make uses up a certain amount
of energy ; this and all the heat that is dissipated from
our bodies must be supplied by the food. The energy
in the food is present in a resting or latent form in the
power which binds atoms together in molecules and the
molecules together into a mass. When the complex food
forms are broken up into simpler compounds this energy
is set free and is used by the body as energy or con-
verted into heat. The excess is stored up in the body,
usually as fat, in the subcutaneous tissue, or as glycogen
in the liver and muscles. This energy is liberated by a
series of changes which may be compared to the burning
of coal or wood m a furnace, the difference being that
the chemic changes are much more complicated, and the
body is a much more perfect furnace than any which man
has devised, as it can utilize a greater proportion of energy
with much less waste.
The structures of the body — ^bones, muscles, nerves,
etc. — are built up after birth by material which is taken
into the body as food. The wear and tear of the body
11
12 DIETETICS FOR NURSES.
necessitates continual repair of these tissues, and the
material used for this also comes from the food.
Food, as it is taken into the body, differs very much
in composition from the material that can be utilized by
the tissues in growth and the repair of waste. The proc-
esses which prepare it for the use of the body are spoken
of as digestion.
The chemic elements contained in the body are also
found in the food. Some fifteen elements are present in
the body, the principal ones being oxygen, hydrogen,
carbon, nitrogen, calcium, phosphorus, and sulphur.
The compound substances which these make are classi-
fied under the headings, protein , fats , c arbohydrates ,
mineral m atter or salts, and water.
Water. — Water enters into the composition of every
tissue in the body and forms over 60 per cent, of the
entire body-weight. It is not burnt up, however, and so
does not supply any energy.
Salts* — These form about 6 per cent, of the weight
of an adult man. They are present in the bones, teeth,
and other tissues. The principal salts of the body are
calcium phosphate and the various compounds of potas-
sium, sodium, magnesium, and iron. The mineral salts
are very necessary to life and health.
Protein. — Under this heading are included most of
the food-stuffs containing the element nitrogen. Protein
is found in both animal and vegetable food, familiar ex-
amples of it being the lean and gristle of meat, the white
of eg^, the gluten of wheat, and the curd of milk. The
word " proteid " is used by some writers to describe these.
The proteins are often subdivided into alhtminoids, as the
white of egg and the curd of milk ; gclatinoidSy as gelatin ;
and extractives, such as the aromatic substances in beef-tea.
CHEMISTRY AND PHYSIOLOGY OF DIGESTION. 1 3
The proteins are necessary for life. They are the only
form of food which can build up and repair the body, if
we except the fatty tissues, which may be replaced by
protein, carbohydrate or fat. They also s upply energy
and heat. If they are not supplied in sufficient quantity
the body will waste and a condition of malnutrition
come on.
Carbohydrates contain no nitrogen. They are com-
posed of carbon, hydrogen, and oxygen, the last two in
the proportion to form water, hence the name carbohy-
drate. They include starch, sugar , stnd the ve getable
fiber or cellulose . C arbohydra tes are burnt up in tjie
body and are the mos t i mportan t source of heat and
energy. Excesses taken are converted into fat and
stored up in the body. The superficial fat of the body
protects it from cold and acts as a storehouse for the fat,
which can be converted inta heat and energy.
Pat, orjiydrocarbon, is an important element of food,
serving the same purpose as the carbohydrates. Fat
supplies more heat and energy, weight for weight, than
carbohydrates, but is neither so easily digested nor so
available. Fat is found in animal and vegetable food , as
in the fat part of meat, butter , olive oil, and is present in
large quantities in the yolk of egg.
Atwater gives the following table to illustrate the uses
of the different food elements :
Nutritive Ingredients of Food,
Food as
purchased
contains —
Edible portion — e, g., flesh
of meat, yolk and white
of egg, wheat, flour, etc*
Water.
Nutrients.
Protein.
Fats.
Carbohydrates.
Mineral matter.
Refuse- -^. g.^ bones, entrails, shells, bran, etc.
14
DIETETICS EOK NURSES,
• i
Uses of Nutrients in the Body.
Protcin^forttiu tiuhUCH — /*. ^^, white (albumin) of eggs
cunl (cttsein) of milk, lean meat, gluten of wheat, etc.
Kttln— arc Hlored nu fat — c, ^., fat of meat, butter, olive
oil, oiU of corn, wheat, etc.
CarbohydrsUeh— are trannformed into fat — e. g.y sugars,
HtareheN, etc.
Mineral mattcm (a«h) — share in forming bone, assist
in (ligation — c, .^^, phosphates of lime, etc., )K)tash,
MHla, etc.
J
All serve as fuel
to yield energy
in the forms of
heat and mus-
cular power.
The changes which take place in the body in " burn-
\\\^ up " the food material are designated by the name
metabolism.
The heat valueof the various foods may be determined
by the use of an instrument known as a bomb calor-
imeter, the result being expressed in calories, A^ calori e
is the amount of heat that is necessary to raise the tem-
perature of one kilogram of water i° C. It is nearly
\ the same as the amount required to raise one pound of
,' water 4*^ F. This expressed in the mechanical force,
' that is, the amount of work it would do, means that a
calorie would raise a ton about 1.54 feet, or that it is
equal to 1.54 foot tons. Some authors ws^gram calories,
and their figures are ICXX) times greater than those in
mast general use.
According to Atwater, the fuel-value of the various
classes of fi>od as ordinarily supplied is as follows :
I gram of niv^tein 4 caloric*
I " fat S,Q •*
I ** oai^^hvdmtc ' 4
I |x>und I $20 calories.
I " 4040
I *' 1S20
M
Tlicse figures arc somewhat lower than the figures
gi\ en b\' older estimations, and arc based upon the most
recent ox^x'rimeiUs. The fuel-values formerly given were :
prvncin and carlx^hydratos. 4.1 calories per gram; fat,
o ; calories |icr gram. It will be observed that fat has a
CHEM/STA-y AND PUYSIOLOGY OF DIGESTION. IJ
very high food-value, which doubtless explains why it is
stored up as a reserve fuel.
The amount of energy used in mental work has never
been determined. In an experimental chamber, where
as alight an exertion as turning over in bed will be regis-
tered by the thcrmometric scale, no change was produced
by the inmate working out the most difficult mathcmatic
problems.
DIGESTION AND ABSORPTION.
The digestion of food takes place through a number
of changes brought about by the action of a number of
ferments or, as they are often called, enzymes. The food
is so changed that the useful part can be absorbed and
used by the body, wliile tlie remainder is passed off as
refuse.
Enzymes are supplied by a number of glands, as
ptyahn in the saliva, pepsin in the gastric juice, and trypsin
in the intestine. There are enzymes which change starch
into sugar, some which change protein into soluble sub-
stances, others which break up fats, still others acting on
sugars, etc. The chemistry of these changes is usually
that the enzyme causes the food substance to unite with
water and separate into two .simpler compounds.
On being taken into the mouth the food is broken up
by chewing and mixed with the salivary juice, which acts
on the starches and changes them into sugar. The
chemic reaction of the saliva is alkaline. The food then
passes into the stomach. The chemic reaction of the
stomach or gastric juice is acid, and the action of the
salivary juice is soon stopped. In the stomach the food
is liquified and the proteins changed into peptones by the
action of the pepsin. Milk is curdled by the action of
1 6 DIETETICS FOR NURSES.
another enzyme — rennin. After from one to several
hours, according to the quahty and quantity of food
taken, the liquid mixture in the stomach is passed into
the intestines. Here the reaction is alkaline. A number
of different juices act on the food at the same time. The
liver supplies bile, the pancreatic gland a juice, the intes-
tinal glands a secretion.
The pancreatic juice contains several enzymes : trypsin,
which acts like pepsin ; amylopshi, which acts like ptyalin,
so that the digestion commenced in the mouth and stom-
ach is completed. It also contains steapsitiy which acts
on the fats, emulsifying them, that is, dividing them into
little droplets like cream or a cod-liver oil emulsion, and
also splitting the fats into glycerin and fatty acids. The
bile from the liver assists in emulsifying fat and exerts an
influence over the food, hindering putrefaction. The in-
testinal juices aid in emulsifying fats, and act upon the
starches and sugars.
Absorption. — This occurs in two ways : either by
the material absorbed entering directly into the blood
through the capillaries in the intestines, and passing
thence through the portal veins, or it is absorbed by
little vessels in the lining of the intestine called lacteals,
and from these it passes through the thoracic duct, a
long tube connecting them with the veins (left jugular
and subclavian), returning the blood from the upper part
of the body. The food material in the second case enters
directly into the blood-current. Little or no absorption
takes place in the stomach. The* food enters the small
intestine in a liquid condition and remains from 5 to 20
hours, and is then passed into the large intestine, where
the excess of water is absorbed and the refuse or feces
passed off in a more or less solid form.
CHEMISTRY AND PHYSIOLOGY OF DIGESTION.
17
Almost all the absorption of food takes place in the
small intestine. The large intestine may absorb food
under certain conditions, as when it is injected into the
bowel (see Rectal enemata).
The liver plays an important part in nutrition. It
supplies bile, but that is a small matter compared to what
is called its glycogenic function. The carbohydrate food,
on reaching the liver, is changed to glycogen or animal
starch. This glycogen is stored up in the liver and also
in the muscles, and is burnt up in muscular action.
The liver also takes care of the waste formed by the
changes taking place in the body. These waste products
are brought to the liver by the blood and changed into
compounds which can be passed off from the body.
There are a number of waste products, most important
of which is m-ca, which may also be formed in the mus-
cles. This urea enters the blood-stream and is passed
off by the kidneys.
The Digestion of Infents. — The salivary digestion
is very feeble in early life. The sahvary glands are fairly
active by the fourth month, and begin to play a more
important role in the digestion about the eighth or ninth
month. The stomach digestion is of less importance in
infancy. One of the principal changes is the coagulation
of the casein (curd) of milk.
THE RELATION OF FOOD TO VARIOUS CONDITIONS.
Heredity. — Certain di.seases or conditions which are
affected by diet are apt to run in families, the most im-
portant of these are obesity, gout, diabetes, and alcohol-
ism. Food idiosyncrasies may be often inherited, as the
urticaria (hives) caused by eating strawberries or shell-
fish.
i8
DIETETICS FOR NURSES.
:. — Women, as a rule, require about four-fifths as
much food as men, this may partly be due to the seden-
tary life led.
Ag^e. — Children require proportionately more food
than adults. Atwater gives the following table of food
requirements :
Boy of 15-16 years requires 0.9 the food of a man at moderate work.
Girl of 15-16
0.8
<i (<
Boy of 13-14
(»
0.8
(t (<
Girl of 13-14
0.7
« «
Boy of 12
(<
0.7
(( ((
Girl of 10-12
0.6
(( <<
Boy of lo-ii
((
0.6
« ((
Child of 6-9
0.5
(( (<
Child of 2-5
<<
0.4
<< <<
Child under 2
(t
0.3
*< «(
t(
((
(<
«
M
<<
t<
«
Old people require less than vigorous adults.
Race and Climate. — Various races use different
diets, depending much on the climate they live in. Cli-
mate affects the diet largely by the supply it affords.
More fat is required in cold chmates and during cold
weather than in warm. The well clad require less food
than those exposed to cold.
Siise and Weight. — Other things being equal, the
larger the body the more food is needed.
Rest and Exercise. — Much less food is required
during rest than during exercise. In exercise the mus-
cular activity increases oxidation and tissue waste, and
this waste must be counterbalanced by an increased com-
sumption of food.
Individual tendencies have some effect on the amount of
food required. Some persons are obese and eat but little,
and vice versa.
CilEMISTKY AND PHYSIOLOGY OF DIGESTION.
THE INFLUENCE OF VARIOUS FACTORS UPON THE
DIGESTION.
Apart from the selection of a propt:r diet, important
factors that especially affect the digestion are the follow-
ing: I. The hours, order, and frequency of meals. 2-
Variety in diet. 3. The appetite. 4, The temperature
of food. 5. Rest and exercise before and after meals,
6, Emotion.
1. Order and Frequency of Meals.— It is usually
customary to fix certain hours for taking of meals ; these
hours vary with the occupation of the individual. In
large cities, where the noon hour is taken up largely with
active business pursuits, evening is selected as the most
convenient hour for dinner. Sir Henry Thompson states
that three general systems are in use, according to which
two, three, or four meals are taken daily. TJie first sys-
tem, which consi,sLs of two meals a day, is foHowed in
France and other countries on the continent of Europe.
A substantial meal, consisting of fish or meat and other
cour.ses of .solid food, is eaten about noon; no food is
taken before the noon meal, except on arising, when a
cup of coffee or chocolate and a small quantity of bread
and butter are taken. The second meal, which is dinner,
is eaten between 6 and 7 o'clock in the evening. This
meal is the largest meal of the day, and consists of soup,
fish, meat, vegetables, salads, dessert, and black coffee.
The second system, commonly in vogue in England, con-
sists of four meals daily. The first meal, or breakfast, is
taken at about 8 A. M., and consists of cocoa, tea or coffee,
bread, butter, bacon, fi.sh, or eggs; dinner is eaten be-
tween 1 and 2 p. M. and consists of soup, meat, fish, vege-
tables, and pudding; tea is taken at 5 p.m., and supper
is served ,at 8 p. M., and consists of meat, fish, vegetables,
20 DIETETICS FOR NURSES.
and stewed fruits. Dinner is taken in the evening by the
well-to-do classes, and a substantial lunch is usually taken
at noon. The third system, practised in this country,
consists in taking three meals daily. In many towns it
is customary to dine at noon ; in others, in the evening.
The usual breakfast, taken between 7 and 8 a. m., con-
sists of fruits, breakfast food or cereals, eggs, bacon or
salt fish, tea, cocoa or coffee, and bread and butter.
Luncheon, eaten between 12.30 and 2 o'clock, consists
of cold meat or a chop, vegetables, salads, and dessert.
Dinner, eaten between 6.30 and 8 p. m., is the heaviest
meal of the day, and consists of soup, fish, meats, vege-
tables, salads, and fruit.
The frequency of meals must be regulated according
to individual conditions. Patients suffering from diges-
tive disturbances and those who take very small quanti-
ties of food at a time require nourishment at frequent
and regular intervals ; whereas, those whose digestion is
feeble, should allow six or seven hours to elapse between
meals ; ordinarily the intervals betwen meals should be
about four or five hours, this being about the time neces-
sary for complete digestion of a mixed meal in the stom-
ach. The habit of habitually omitting the noon luncheon,
so commonly practised by busy Americans, should be
discouraged.
2. Variety of Diet. — In order thoroughly to satisfy
the needs of the body the diet must be varied. Although
a diet restricted to but a few articles of food may contain
a sufficient quantity of the alimentary principles to sus-
tain the body nutrition, yet the monotony of such a diet
becomes so objectionable that it cannot be digested
thoroughly. With a mixed diet the same person will
digest a larger proportion of nutrients than with a diet
CHEMISTRY AND PHYSIOLOGY OF DIGESTION. 21
composed of a single food material. Certain races re-
strict the variety of food from religious motives, such as
the Jewish restriction of ham, pork, and oysters.
3. Appetite. — Appetite is the desire for food, and is
dependent upon various conditions. It is controlled by
the sensation of hunger, and is often induced by the
sight, smell, and taste of food. Simple bitters or some
form of alcoholic drink will at times induce this sensa-
tion. The appearance of badly prepared or improperly
served food will often dispel the appetite. In children
the appetite is usually good, whereas in the aged it is
lessened. Some persons have voracious appetites and
abnormal craving for food. This is often the ca.se in
diabetic and other conditions, when, at times, the appetite
cannot be satisfied.
4. Temperature of Food. — The temperature of
food when taken is of considerable importance. The
ideal temperature is that of tJie body, from 98° to 100° F.
(Uffelman). The limits of safety being between 45° and
130° F. According to Hutchison, extremes of tempera-
ture of food are apt to give rise to gastric disturbances,
such as gastric catarrh. Uffelmann states that a drink
at a temperature of 122" F. increases the body-tcmpcra-
ture 0.1 to 0.3" C. It is believed by many that ulcer of
the stomach, so common in cooks, is often due to the
taking of too hot foods.
5. Rest and Exercise Before and After Meals.—
It is often advisable to rest, but not to sleep, after meals.
The larger part of the work of the stomach should be
completed before retiring at night, otherwise the sleep i.s
apt to be disturbed. About one to two hours .should
be allowed to elapse between a light evening meal and
bedtime, and three to four hours between a heavy meal
22 DIETETICS FOR NURSES.
and sleep. From personal observations the authors have
concluded that digestion is improved by rest after meals,
but impaired by sleep. In many instances a period of
rest before eating meals is a valuable aid to digestion.
Violent exercise immediately after meals inhibits diges-
tion, whereas moderate exercise one or two hours after
meals materially aids this process.
6. Pood and Kmotion. — Severe mental strain and
strong emotion disturb the digestion, and for this reason
food should not be taken until a period of rest and com-
posure has intervened. On the other hand, pleasurable
sensations aid the digestion, and pleasant conversation
at the table is, therefore, to be recommended.
ABSORPTION OF FOODS
Food absorption takes place chiefly in the small intes-
tine ; in the stomach and in the large intestine it takes
place only to a limited degree. In determining the de-
gree of absorbability of food, the amount of the element-
ary food principles ingested must first be ascertained,
and the proportion that has not been absorbed determined
from the feces. The degree of absorbability of a food
indicates, in a measure, its nutritive value. According to
Atwater,^ from an ordinary mixed meal an average of
92 per cent, of protein, 95 per cent, of fats, and 97 per
cent, of carbohydrates is absorbed in the body. "The
proportion of the several nutrients which the body re-
tains for its use are commonly called percentages or
coefficients of digestibility." The following table, taken
from Atwater, gives these coefficients of digestibility :
' Priftciples of Nutrition and N^utritive Value of Fooily Farmers'
Bulletin No. 142, United States Department of Agriculture.
i
♦
CHEMISTRY AND PHYSIOLOGY OF DIGESTION. 2^
Coefficients of Digestibility and Fuel-value per Pound of
Nutrients in Different Groups of Food-materials.
Kind of food.
Meats and fish
Eggs
Daily products
Animal food (of mixed
diet)
Cereals
Legumes (dried) . . . .
Sugars f
Starches
Vegetables
Fruits
Vegetable foods (of mixoJ
diet)
Total food (of mixed diei)
Protein.
Fat.
Digesti-
bility.
Per ct.
97
97
97
97
85
78
83
85
84
92
Fuel- i I Fuel-
value Digesti- value
per
pound.
bility.
Calor-
ies.
1940
1980
1940
1940
1750
1570
I4IO
1520
1840
1820
Perct.
95
95
95
95
90
90
90
90
90
95
per
pound.
Calor-
ies.
4040
4090
3990
4050
3800
3800
3800
3890
3800
4050
Carboh y drates .
Absorption of Protein. — Eighty per cent, of pro-
teins are absorbed in the small intestine, and 14 per cent,
in the large intestine. The proteins of animal food are
much more completely absorbed than are those of vege-
table origin.
Absorption of Fats* — Fats, like proteins, are ab-
sorbed mainly in the small intestine. This absorption of
fat is very complete.
Absorption of Carbohydrates. — Carbohydrates are
absorbed more completely than either the fats or the pro-
teins ; consequently, these foods leave but a small residue
in the intestine.
As Rubner, Atwater, and others have pointed out,
foods taken in combination are absorbed more completely
than when taken alone. Atwater has shown that the
24 DIETETICS FOR NURSES.
following proportions of the alimentary principles are
absorbed when the individual takes a mixed diet :
Protein. Fat. Carbohydrates.
Animal foods 98 per cent. 97 per cent. 100 per cent.
Cereals and sugars .... 85 ** 96 ** 98
Vegetables and fruits. . . 80 " 90 ** 95
Food that leaves a small quantity of unabsorbed residue
in the intestine is not undesirable, in that this residue
stimulates peristalsis and thus regulates the condition of
the bowels.
Absorption of Meat. — Meat leaves a very small
residue in the intestines — about 3 per cent, of that ingested
is not absorbed. On this account meat is a most valu-
able article of food.
Absorption of Pish. — Fish is very completely ab-
sorbed in the intestines. According to Langworthy, 95
per cent, of total solids, 97 per cent, of protein and 90
per cent, of fat are absorbed.
Absorption of Milk. — When milk is taken alone,
only 90 per cent, of the constituents are absorbed ; if
two liters of milk are taken daily, the loss of dry sub-
stance, according to Rubner, is 5.7 to 7.8 per cent. ; if
three liters, the loss is 10.2 to 11.6 per cent. When
taken with other foods, however, milk is much more com-
pletely absorbed.
Infants and children absorb milk much more completely
than do adults. In childhood milk leaves a residue of 4 per
per cent., whereas in adults 10 per cent, is not absorbed.
Absorption of BggS. — Eggs are very thoroughly
absorbed in the intestine. Rubner states that hard-boiled
eggs arc absorbed almost as completely as meat, only
5 per cent, being lost.
Absorption of Vegetable Foods. — Vegetables are
CHEMISTRY AND FHYSIOLOGY OF DIGESTION. 2$
more or less completely absorbed in the intestine. If
the bulk of the vegetables is not too great and the amount
of ceiiulose is not too large, they will be almost entirely
absorbed. On account of their bulk and the large pro-
portions of cellulose which they contain most \'egetables
are, however, imcomplctely absorbed. The protein is
here the element that is not absorbed completely, the
carbohj-d rates and fats undergoing complete absorption.
Absorption of Cereals. — Such cereals as rice ai-e
very completely absorbed ; the starch is entirely absorbed,
and 19 per cent, of the protein is lost.
Absorption of I,egtuues. — The legumes, such as
peas and beans, if given in a finely divided state, are very
completely absorbed. Rubncr finds that even when given
in amounts of 600 grams daily the loss is but slight. If,
however, these substances are not given in a finely divided
state, the loss in proteins is very great^according to
Rubner, as high as 40 per cent.
Absorption of Roots and Tubers. — The absorption
of roots and tubers, such as carrots, potatoes, etc., depends
upon the quantity of cellulose they contain. Inasmuch
as the potato contains but little cellulose, it is very com-'
plctely absorbed.
Absorption of Green Vegetables. — Most green
vegetables are very incompletely absorbed in the intes-
tine. They leave a large residue, which acts as a stimu-
lant to intestinal peristalsis.
Absorption of Fraits. — Fruits, like green vegeta-
bles, are usually incompletely absorbed ; according to
Hutchinson, 80 per cent, of the protein, 90 per cent, of
tlie fat, and 95 per cent, of the carbohydrates are ordi-
narily absorbed.
26 DIETETICS FOR NURSES.
QUANTITY OF FOOD REQUIRED.
This varies necessarily under special conditions. The
adult requires more food than does the child ; a man at
work more than one at rest ; an emaciated individual less
than when he was in robust condition. The selection of
a proper diet is dependent upon a knowledge of the
amount of the three alimentary substances — proteins,
carbohydrates, and fats — necessary to maintain the nutri-
tive equilibrium and consequently the body-weight.
Dietaries are formulated by computing the quantities
of the alimentary principles required under special con-
ditions.
Protein. — The quantity of protein disintegrated daily
by a fasting healthy individual weighing 70 kilograms is
60 grams ; it is obvious, therefore, that at least this amount
should always be present in every computed dietary.
Ordinarily from 100 to 125 grams of protein are con-
sumed daily. As has been stated elsewhere, i gram of
fat can replace 2.4 grams of protein or carbohydrates
and the protein can replace and be partly replaced by the
carbohydrates and fats. Fats and carbohydrates are,
therefore, protein economizers. That part of the protein,
however, required for organization of the body cannot be
replaced by the carbohydrates or fats.
Carbohydrates and Pats. — Carbohydrates diminish
nitrogenous waste and are also sparers of the fats, 240
grams of carbohydrates being equal to 100 grams of
fat. If 100 grams of protein are taken and absorbed
with 600 grams of carbohydrates, the amount of fat can
be comj)letely protected. Fat alone, however, cannot
check the waste of the nitrogenous tissues. The inges-
tion (;f larj^e quantities of fat increases the accumulation
CHEMISTRY AND PHYSIOLOGY OF DIGESTION. 27
of fat in the body, and this continues untii the quantity
administered reaches 300 grams, when no more can be
digested. Gelatin is a valuable protector of protein. iOO
grams of gelatin being equivalent to about 35 grams of
protein or 200 grams of carbohydrates ; it does not,
however, protect against fat loss so well as do carbo-
hydrates or fat, 100 grams of gelatin being equiva-
lent to about 25 grams of fat. Ordinarily about 500
grams of carbohydrates and 50 grams of fat are consumed
daily.
Protein, Carbohydrates, and Pats in Combina-
tion. — If fat is combined with the protein, less than half
the quantity of protein is required to maintain the nitrog-
enous equilibrium. If more protein, fat, or carbohy-
drate be supplied under these conditions, fat will be de-
posited in the tissues. Inasmuch as food contains a vari-
able proportion of proteins, carbohydrates, and fats
combined, the food-value must be determined from the
standpoint of the combined effect of the three alimentary
principles contained therein.
In order to supply the requirements of the organism
a certain amount of potential energy is needed to over-
balance the amount dissipated in waste and in the pro-
duction of body-heat. More potential energy is consumed
during work than when the individual is at rest. The
following table, computed by Rubner, shows the daily
heat consumption, in units of heat (calories), in an aduit,
weighing 65 kilograms :
During rest in bed .... iSoo calorie.'; ox 28 calories per kilo.
In repose 2100 " •' 31 " " ■'
In light work J.103 " "33 " ■■ "
In moderale work .... 2600 " " 40 " " "
In hard work 3>oo " " 4^ " " "
28 DIETETICS FOR NURSES.
From Rubner's investigations we learn that ^ —
I gm. of protein =4.1 calories.
I gm. of fat = 9*3 **
I gm. of carbohydrates = 4.1 **
It has also been determined that i gram of alcohol
.equals 7 calories. In other words, the number of grams
of proteins, fats, and carbohydrates required daily can be
converted into their calorimetric equivalents, and inas-
much as we have already seen that the alimentary princi-
ples can in a degree be substituted for one another (law
of isodynamics), the daily food requirements can be easily
estimated in calories of heat. Thus, in order to calculate
the caloric value of any food in preparing a dietary, the
number of grams of proteins contained are multiplied by
4.1 ; the number of grams of fat by 9.3 ; and the number
of grams of carbohydrates by 4. i ; the total is then ascer-
tained by adding. Bearing the weight of the individual
in mind, a dietary can easily be constructed according to
the following method :
The quantity of protein consumed daily is 100 gm. X 4' = 4'0
carlx)hydrates •* ** ^QO •* X 4.1 = 2050
fats " " 50 " X 9-3 = 465
it li
2925
The average number of calories required daily in an
individual, according to this calculation, is therefore 3000.
While diet-lists are easily prepared according to the
method just outlined, it must always be remembered that
the digestibility and absorbability of food play a most
important role and are not to be neglected in formulating
the dietary ; for while a certain food may contain a great
^Compare Atwater's determinations on p. 14. Dietary computations
differ slightly, owing to the fact that some use Rubner's standards and
some Atwater's.
CHEMISTRY AND PHYSIOLOGY OF DIGESTION. 29
many more calories than an equal weight of another
food, yet its relative indigestibility makes it less available
as an article of diet. For example, while 4 ounces of
sausage produce J 10 heat calories, 4 ounces of cheese
520, and 4 ounces of beef only 280, yet the beef is far
more digestible than either the sausage or cheese, and
thus more valuable as an article of food. As has been
aptly said, " We live not upon what we eat, but upon
what we digest." Therefore, a diet-list giving quantities
of food principles or calories is useful only as it suggests
general principles that may be modified to meet individual
conditions in health and in disease.
The following table, taken from Mrs. E. H. Richards,
gives an ideal ration of solid food. For a further con-
sideration for the method of computing dietaries the
reader is referred to Mrs. Richards' admirable little work,
entitled The Dietary Computer:
An Ideal Ration ef Solid Food.—
(Jtfr
. £.
If. Richards.)
MwhUI.
Amountj,
PrMHB.
F...
Csibo-
hydrates.
C»lor.
Gm.
0,
Gm.
n,.
Gm.
Ox.
Cm
n.
■Br™d
•^w
ajifi
iwfi.Bi
"%
Sbsk
^^A
1
oM
0,6,
«.1.<.
Total ...
>aG.S3
..|.7..
369.80
»5M.fe
The following table was prepared by the nurses in the
class in dietetics at the Johns Hopkins Training School.
It shows the method used in determining the fuel-value
of the food per capita :
30
DIETETICS FOR NURSES.
•a
•S
1
I
•3.1
^ in m M M^
r^ m m i«»<c m r».oo
ooo^o m o«m
«n o» M
^00 00 m Ok
o« M r^ ro o^'O ovoo
m ro M 0\-* •*
M o» w
tf b
o^ -v" >««o mm
•/>0 O o»fommok
Os**^oo r^ ro
«n in t*.
'^^
•1 0> ■♦ ■♦00 m
ro w m M in H (o
M MM
^ H ro
f 4
M M r^
M M
M
r« t«» m "^
00 p\ cy> M
w r» HI «
•^ a^ «k a^
en
«n ro
00 «o
1 V n
2 - *»
I 00 ■<■
I 0000
O r^
«n
, o\ moo
\O00 Ml
.00
00
,00 rp O 0\0v
ro r^ ro in m
, •- •♦ r^m CI
N
00
M ro
m
o»
c«
o« (« 30 •♦ Q o\ p*oo in o« Q\ c« p> M
« ^00 ♦♦•ro m MOro^m
00 r^ m ro m m ro
op O Q O
00
m
r^ m
in
t«.0
•n •»
roo
« M
O W «
ro ro O
O w •♦
ro
00 M
00
00
•n o>«*» o CI r^
^p^ in<o w »> CI
00
ro OOO
•k % ^
m ro<o
CI
in CI o\r^ rooooo
M \o CI *n K\o
CI H \o CI
M ^ ro
ro
CI
o
in M o\*'
in MoO ro
indo
00 in
, r>» * w
/8.800
' » ak .k
M M ro
5
«0 CI . «o
♦ CI OJ
W M
. CI M \o . O* . ►; , »0 in •♦ o ro ^ . m ♦ . >o ,
M O ro <» 00 H M ciooio M Q «0 0«
.cioOM.O.M ,r^M^ro fO.O> ci.«,
CI W. CI CI »«
10
. 4
M
0000
CI
•
•
■
.
•
•
.
• • ■ •
•
•
•
•
«4
1
H
rr.oo
ro in !*•
♦ rooooo
r^ t^ ♦ ^
•0^0
10
ro
?•
• t^ moo
00
♦
,*
ro •♦
♦
T
ro t^
00
M
i«» •♦00
M
m
c*
"i
♦
(I4
\r, m
ro
M
in ro
•
CI
M •
• cfi
Os
in
•
•
•
CI
« E
o "
u
0U
00 00 o m m
•1 CI ro o»m
M \0
O ♦ 000 ro
ro ■*• <Sr -
ro
«0 m
c«
ro Ok "^OO
M CI «
CI m gj 2*2
rr) ^ ro O CI
'^ CI "^ "^
CO
B
bo
as
rt M __ „
o « « 3^
= S2 m=^
in t^ ^ m
M m M CI (^
ts. t«.\o 00 o>
ro "r^O \0 ^0 C^
00 m Ov ^ 0»0
* » ^ a^ afc
<- N Ov ro ro
ro •♦ ro
• • •
(A
s
v.
■ C
ro_roip 00 0> *< ro O
moo CI
•♦ CI o
m m
t^\0 •• ^ m
0« CI
ro
N N N M
o o c^
ro CI CI **
00 ^ 00 roto m
^0 >' moo M O
CI t^ ro Oi t^ O*
a^ «k » •«
CI M ♦ W
O^ci m
ro ro O
fO H o»
a^ ak
*0 HI
♦<o •♦
W ro «
(A
£
O
CI
I
« ro « Ok
V
in
OvM
•k ak
OvM
^
Co
j2
'u
1)
vi
5 *>
j=
be
C
■*«
aiJ
■J)
2 u
> 3
■ ?
■ et
.B
3 CJ<
4
E
u
3 C
2a
U ai
3 « -
X
u
u
V tS X
u
^IJ
" ^ u «rf ? rt
c ci ^££ beg
a t ZlZ be 3
4
2
"o
ct
O ••
3
FULL VALUE OF FOODS IN GIVEN DIET LIST, 3 1
■♦ Q ■♦00 O
■♦ OnvO p\«
m «
lovo 00 com mm: ei
woo r^ OkO w t>^
t^ O ■♦
o\ N en « »«
CO WJ CO ^
ir>
w ■>♦■ .00
CO •♦ . ■♦
in\0 0»m
• CO ■*•
M to C« M M
00 MOO 00 o»
t^ « Ov W^ "2
O* M
ro
M
C4
CT\ CO
00 \0
On •-' « ft
00 NO fO fO
, »^ O CO «n
ONO "♦ M
M p fOOO
n ^.00 M
MMfO^ MHtOlO
\0 * H
CO
CO
«
io>o,ovMOO« .fo fo<o 00
►»♦ ONcoMNOwm
m « t^^vo CO . *o 10 >-" o»
t^ <o •♦
8
Ov
o* «
M<0 . « \0 On* «n
fo CO ►* m^ O
CO
M . com
tSi 10 M CI (^
00 'OOOO 'OOOO
• • •••• ••••
« • « ♦oo ts. • 00 ro M t«.
r^ o> M m CO moo ** m
•►«Kmo\ -wwoom
\0 M
S'
M m
M m M
!*• moo
^1*. •♦ o*
o m o> Q
3 w •♦ «
m
,00
10
CO.— »
. . '^ N ^ C
-- . §! ©"^ •-
00 O C« rt
M . m M M o
0\ w
m\o t«»vo ♦ C4 c« ♦ o
M M M m m o m moo
oooo»»«OmMt^ o«nO «
o» c« 00 ovO\ mm
en
Is
1 y III i S S^ 8^-i
a
.5
<;
M
4
U
0\
m
« 3
c
o
2
<♦ o.
SJ
m
• «» «
2 M «
m
m
M
V
ed \i
"■I
00
00
Qu ed
m
«
m
a
>
s
.52
1
m -h
m
O ** m
•e2§
611
o
m
m
e3 §
n8
'T. ■"
g
00
r«
V)
V
«■•
4
u
o
u
c
on
C
'55
o
u
o •<
** ^
O V
s r
I 8
3 ^
O m o O
d rip
I « « S 8
, m o m O
I m CO m m
1 « «B
2 S «
.c o
m o m c«
•♦ m ♦ «
00 o 00 ts.
M Ci M M
I. I
•2 .
•Si «r
^ i
X
n
m o *n O
el m « li
«O^OvO m
M ♦• 11 00
m m m <}
m' m' C« M
M •« M «r>
m «r> m ♦'
O «■• w
-ess
M
£
3
V
JS
^ .s
^
CO
M
CHAPTER II.
CXASSES OF FCX)DS.
ANIMAL FOODS.
Animal foods contain much digestible matter, chiefly
proteins, a considerable quantity of fat, in some foods
carbohydrates, and, in addition, water and mineral salts.
Being thoroughly digested, they leave but little residue
in the intestine. The various forms of animal foods —
milk, meat, fish, and gelatin — will now be described.
MILK AND MILK PRODUCTS.
Milk, the most important of animal foods, contains all
the elements necessary for the maintenance of life and
constitutes a complete food.
Compositioii. — Milk contains varying proportions of
each of the four classes of food principles — proteins, fats,
carbohydrates, and mineral salts. Unadulterated, it con-
tains from 84 to 90 per cent, of water, varying with the
quality of the milk. It forms the exclusive diet for
infants.
The principal nitrogenous compound of milk is casein.
Milk contains, beside casein, lactalbumin, which is similar
to the serum-albumin of the blood. The total proteins
average about 3.3 per cent, of the bulk of the milk, or
about 25 per cent, of the total solids. The fats of milk
consist of the glycerids of palmitic, stearic, and oleic
acid. In addition to these, milk also contains several
32
CLASSES OF FOODS,
33
other fats in smaller proportions, to which the flavor of
butter is due. The fat is suspended in the milk in the
form of minute globules, which gives the milk its white
color and opacity. Fat averages about 4 per cent, of
the milk or about 31 per cent, of the total solids. The
chief carbohydrate of milk is lactose, or milk-sugar.
Milk-sugar is not nearly so sweet as ordinary sugar, and
is less soluble in water. In the presence of the lactic
acid bacillus it is converted into lactic acid, which causes
the milk to turn sour. Lactose forms about 38 per cent,
of the total solids. Milk contains about 0.7 per cent, of
salts.
Variations in Milk. — There are wide variations in
the composition of the milk of different animals. While
human milk contains more sugar and less protein than
cow's milk, the fuel value is about the same. Dog's
milk seems to be the richest ; whereas that which comes
from the horse is exceeding poor, as may be seen from
the following table :
Comparative Composition of Various Kinds of Milk}
Water.
Total
solids.
Total solids.
Kind of milk.
Protein.
Fat.
Pr ct.
38
3-7
6.9
75
3-2
4.8
3.2
1.6
I.s
Carbo-
hydrates
(milk-
sugar).
Mineral
matters
(ash).
Fuel-
value
Ca-
sein.
Albu-
min.
Pr ct.
13
0.5
51
1-5
0.3
6.0
i.i
1.6
0.1
Total
pro-
tein.
pound.
Woman . . .
Cow ....
Dog ....
Kwe . . .
Buffalo .
Cat
float ....
Llama . . .
Ass
Mare . . . .
Perct.
87.4
87.2
75.4
80.8
81.4
82.1
85.7
86.5
89.6
91-5
P.r ct.
12 6
12.8
24.6
19.2
186
17.9
143
13-5
10.4
8.5
Pr ct.
1.0
30
6.1
50
58
31
32
3-0
0.7
1.2
Pr ct.
2.3
35
II. 2
6.5
6.1
9.1
43
39
23
1-3
Perct.
6.2
49
31
49
4.1
4.9
n
6.0
5.7
Perct.
0.3
0.7
0.7
0.9
0.6
0.8
0.8
0.5
03
Calor-
ies.
319
313
671
400
365
312
22a
180
1 Konig, Chemie der meiischlichen Ndhrungs- und GenussmUtel, 3d ed.,
vol. i., pp. 267-362.
3
34 DIETETICS FOR NURSES.
Not only is there a wide variation in the milk of differ-
ent animals, but cow's milk itself is subject to great
changes in the percentage composition of its ingredients.
These may be attributed to many causes, the breed and
condition of the animals, and the food and the care they
receive being responsible in a great degree for these
changes. As a rule, a young cow gives better milk than
an old one, and a well-fed animal yields richer milk than
one that is poorly fed.
Adulteration. — Milk is often adulterated by unscru-
pulous daily men by the addition of water. This is the
common method of adulteration, and if the water used
for this purpose is pure, produces no ill effect other than
to dilute the milk and thereby lessen the percentage of
its ingredients. Unfortunately, however, water used for
this purpose is not always pure and is frequently a source
of contamination. Other methods of altering the quality
of milk consists in the removal of the fats ; the increase
in the specific gravity which is produced thereby is coun-
teracted by the further addition of water and in the addi-
tion of preservatives. The latter method, while it does
not detract from the nutritive value of the milk, may, if
the milk be used regularly, produce deleterious results.
Digestion of Milk. — When milk enters the stomach
it is coagulated by the hydrochloric acid and the rennin
of the gastric juice. These curds, or coagula, consist of
precipitated casein and a portion of the fat that has be-
come entangled in the curd. They vary in size and con-
sistence according to the amount and the dilution of the
milk taken. The curd that has not been acted upon by
the gastric juice, together with the water, salts, and car-
bohydrates that remain, also pass into the intestine, where
their digestion is completed. Boiling increases the diges-
CLASSES OF FOODS. 3.5
tibility of milk, the precipitate being deposited in a more
flocculent form. If the milk is previously diluted with
lime-water, barley- water, or one of tJic aerated waters,
such as Vichy, the curds formed are smaller and softer,
and the milk often rendered more palatable. Bread or
crackers added to milk make a good mechanic diluent by
mingling with it and maintaining a soft condition of the
curds.
Cream. — When milk is allowed to stand for some
hours the globules of fat rise to the top, and, together
with considerable milk, are removed as cream. This
product contains about iS per cent, of fat, and some pro-
tein and carbohydrates from the milk mi.xed with it.
Skimmed Hilk. — The residue remaining after the
removal of cream from ordinary milk is called skimmed
milk. The amount of fat has been greatly reduced by
creaming, but the percentage of protein remains almost
the same. It is more easily digested than whole milk,
inasmuch as the fat has been removed.
Butter. — Butter is made from the cream of milk by
the process of churning, which causes the fat-globules
that hang suspended in the milk to coalesce, thus form-
ing a solid mass. A varying proportion of common salt
is always added to it to enhance its palatableness and its
keeping qualities. The flavor of butter is due to the
growth of micro-organisms. Pure cultures of certain
organisms are now utilized to ripen butter and so impart
a constant flavor.
On account of the ease with which it is digested, butter,
when fresh, is one of the most valuable fatty foods. The
rancidity which occurs when butter is kept too long seems
to be due to the casein, which, on undergoing fermenta-
tion, liberates fatty adds. Butter is best preserved by
J
36 DIETETICS FOR NURSES.
keeping it at a low fcniperature, and good results are also
obtained by salting.
Buttermilk. — Buttermilk, which is formed diLring the
manufacture of butter, is another milk derivative of no
little importance. It is used extensively as a beverage,
and is highly nutritious and easily digested. It contains
the casein of the milk in a finely coagulated form.
Cord and Whey. — Curd is the coagulated casein of
milk. This coagulation may be brought about by rennin,
a ferment found in the gastric juice, or by such acid sub-
stances as lemon-juice, white vinegar, etc. Whey is the
fluid portion of the milk remaining upon the coagulation
and removal of the casein. Whey is an excellent drink
and food in those cases in which milk is not well
borne.
Cheese. — Cheese is made up of curd and a certain
proportion of the fat of milk. Cheeses vary in compo-
sition and consistence according to their preparation.
Some cheeses are soft, while others are hardened into
cakes by pressure. The flavor of cheese is due to the
growth of certain micro-organisms during the ripening
process. The harder cheeses keep much longer than the
softer ones.
Cheese is a nutritious and agreeable food, but it is often
difficult of digestion. The harder cheeses are much more
indigestible than those of soft consistence. Like milk,
cheese may contain certain poisonous substances, due to
organisms that enter the milk ; of these, one of the most
common is tyrotoxicon. Poisoning may follow the eat-
ing of such cheese.
Ktimiss, Kefir, and Matzoon.— Kumiss is a fer-
mented drink prepared both by lactic acid and alcoholic
fermentation. For many centuries it has been made from
I
CLASSES OF FOODS.
37
L
mares' milk by the natives living near the shores of the
Caspian Sea.
Kumiss is an acid, effervescing drink, and contains
a very small proportion of alcohol. It is very easily
digested, being much more digestible than milk.
Kefir resembles kumiss and is often used as a substitute
for it. It was originally made in the Caucasus from cows'
milk fermented.
In matzoon lactic acid is produced by fermentation
with a ferment obtained from Syria. It i.s thicker than
kumiss and does not contain alcohol.
Kumiss, kefir, and matzoon are agreeable forms of
milk foods, are very easily digestible, and are especially
useful in those cases in which milk can not be taken or
is not well borne.
Modification and Preservation of Milk. — Oon-
tamination of Milt. — An important source of contamina-
tion of milk is through disease of the udder of the cow
or carelessness in handling this organ. Cows are too
often kept in filthy stables, from which dust and excre-
mentitious matter find their way into the milk-pail. The
germs of disease that do not get into the milk in the
stable frequently do so through the agency of the bottles
or cans in which the milk is shipped, and which are often
unclean or cleansed with polluted water.
Cows should not be allowed to eat the dry leaves on
which they are mostly bedded, le.st their color, odor, or
even poisonous properties be imparted to the milk. Sour
milk and milk from poor cows is unfit for food and should
not be used.
At times tuberculosis or inflammatory conditions due
to micro-organisms may exist either in the udder of the
cow or in some distant organ, and may be so slight as
38 DIETETICS FOR NURSES.
not to attract the attention of the milker. Among the
pathogenic germs that may thus gain access into the
milk are the bacilli of typhoid fever, tuberculosis, diph-
theria, and cholera. On entering the milk these organ-
isms continue to grow, and in a short time multiply enor-
mously. In addition to pathogenic organisms, other
micro-organisms which produce souring, but are other-
wise harmless, may gain access to the milk.
At Bumside Farm, Green Spring Valley, Md., the farm
of Mr. Samuel Schoemaker, from which the Walker-
Gordon milk sold in Baltimore is obtained, the following
precautions to prevent contamination are taken : The
dairy is managed by trained persons, and is being con-
stantly inspected by experts in their respective depart-
ments. The number of bacteria in the milk is recorded
daily at the laboratory. The cows are tested for tuber-
culosis at frequent intervals. The stables are kept in a
thoroughly hygienic condition, the floor and walls being
cemented and well scrubbed each day. The milker is
required to scrub his hands thoroughly before milking
and to clothe himself in a white sterilized suit. The cows
are thoroughly groomed one hour before milking. The
cows are milked into special milk-pails, so arranged as to
prevent the dust from entering. The first milk drawn,
which usually contains any germs that may have entered
the milk-ducts, is discarded. The pails, bottles, and other
apparatus are sterilized at a temperature of 2 1 2° F. The
milk is passed from the pail into cans and is then taken
to the milk-house, where it is strained through sterile
cotton into a sterilized cooling-tank, after which it is
bottled, corked and sealed. A guarantee as to the purity
of the milk goes with each bottle.
Modified liilk. — Modified milk is prepared from the care-
CLASSES OF FOODS.
39
s set aside for producing milk that is to
y selected cows s
be separated and recombined according to the prescrip-
tion of the physician. The separation of tlie millv and
cream is accomplished by means of the centrifugal ma-
chine. The separated milk and cream, as well as the
whole milk, which has been cooled at a temperature
of 40° F. or below, are then sent to the city laboratorj-,
where the definite percentages of
cream and modified milk are re-
combined.
Sterilization and Pasteurisation
of Milk. — Milk is sterilized by
boiling ; sterilization destroys all
micro - organisms. The disad-
vantages of sterilization are in a
measure overcome by Pasteuriza-
tion. By this process the milk is
kept at a temperature of 70° C.
(rs8° F.) for from twenty to thirty
minutes; thus most micro-organ-
isms are kiiled, the spores, how-
I ever, not being destroyed, al-
though their growth is inhibited. The taste of the milk is
not so markedly altered as in sterihzed milk, and it is .said to
be more easily digestible for patients suffering from gastro-
intestinal disturbance.?. It does not, however, keep so
long, and sours in one or two days. While bacteria are
destroyed by sterilization, their spores, which are also
present, are not killed, and if kept at ordinary tempera-
ture they continue to increase largely in n umber and thus
render the milk unfit for use. The disadvantages that
accrue from sterilizing milk are manifest in the constipa-
ting effect and in its altered taste. As the result of steril-
I
40 DIETETICS FOR NURSES.
ization various chcmic changes take place: the lactal-
bumin is somewhat coagulated, the casein is so changed
that it is less easily acted upon by the rennin, and part
of the lactose is changed into caramel ; some of the sol-
uble salts are converted into insoluble ones. A large pro-
portion of these changes are not yet thoroughly under-
stood. According to Holt, the greatest objection to
sterilizing milk lies in the fact that many infants fed upon
it for long jK-riods of time are apt to suffer from scurvy ;
he reports that at least a dozen of such cases have come
under his notice. I^y Pasteurization all these difficulties
are overcome, and from 98 to 99 per cent, of all micro-
organisms, including the bacillus of typhoid and of tuber-
culosis, arc destroyed, although the spores are not killed.
Sfiecial care must be exercised in Pasteurizing milk, and
as soon as it is Pasteurized it should be placed on ice.
Ih'occss of Sterilization. — By means of the Arnold
sterilizer milk can easily be sterilized in small bottles in
(juantities just sufficient for each feeding. Sterilization
may also l>e effected simply by exposing the bottles in a
vessel that is tightly covered and opened at the bottom,
and allowing the steam from boiling water to enter from
hrlow. The milk is then kept at a temperature of 212°
V for one hour.
An rxcrllrnt apparatus for Pasteurizing milk is that
(leviMMJ by I'^reeman. "This appanitus consists of two
p.ut*i. a pail lor the water an<I rcreptacle for the bottles
t»r mills, riir pail is a simple pail with a cover; there is
a ^:tot»\r rsttMulin^ an»un<l the pail to indicate the level
to whiih it is t»» be filled with water, ami supports inside
for the rrreptat le for the bottles of milk tt> rest on. The
in rpt.u Ir fiu the bottles (»f milk consists of a series of
hi»llow tww lyliudets fastened together; this fits into
CLASSES OF FOODS. 4I
the pail, so that the lower inch of the cylinders is im-
mersed in the water. This receptacle has two sets of
horizontal supports, the upper set continuous around
the receptacle, for use while the millc is being heated ;
the lower interrupted set is used for raising the receptacle
during coohng. Such receptacles are made for ten six-
ounce bottles, seven eight-ounce, three pint and one half-
pint bottles, and two quart bottles. There is also a large
apparatus for the use of hospitals or public institutions
k
r eight-
which has a receptacle for forty-three six-c
ounce bottles."
Since heating does not destroy the spores of bacteria
nor the toxins in milk, it is essential that the milk be as
fresh and as free from disease germs as possible before
sterilization is undertaken. A question frequently asked
is whether all milk should be sterilized before using. The
milk usually sold in large cities is, as a rule, transported
from considerable distances, and is often not consumed
for from twenty-four to forty-eight hours ; it is thus apt,
especially in hot weather, to be contaminated with micro-
organisms. Boiling is the only safe method of destroy-
ing such organisms. In the past few years there has
been a growing tendency, especially in large cities, toward
42 DIETETICS FOR NURSES.
the establishment of dairies, such as the Walker-Gordon
laboratories, from which perfectly pure milk may be ob-
tained, thus obviating the necessity for sterilization.
Predigestioii of Milk.-;-Milk may be partly or wholly
predigested in order to render it more easily digestible for
individuals suffering from gastro-intestinal disorders.
This process is readily accomplished by adding an active
preparation of pepsin to acidulated milk and allowing the
fermentation to proceed under the influence of heat at the
body temperature by immersion in hot water. During
this fermentation the casein is partly or completely con-
verted into albumoses. If the process is allowed to con-
tinue too long the milk becomes bitter. For this reason
it is ordinarily removed from the hot water after a few
minutes and is placed upon ice, which prevents further
fermentation. In order to predigest milk in alkaline
solution pancreatin is substituted for pepsin ; pancreati-
zation of milk has now largely replaced peptonization.
In order to effect pancreatization of milk, Fairchild*s
peptonizing tubes are ordinarily employed. Where the
taste of pancreatized milk proves objectionable, the addi-
tion of carbonated waters or of small quantities of coffee
may render it more palatable.
The digestibility of milk may be increased by the addi-
tion of hot or cold water, carbonated waters, such as
Vichy or ApoUinaris, lime-water, oatmeal, or barley-
water, or farinaceous foods, such as arrowroot or flour;
occasionally small quantities of salt or sodium bicarbon-
ate are helpful.
Humanized Milk.— By the term " humanized milk " is
meant cows* milk that has been so modified as to approach
human milk as nearly as possible. This is accomplished
by decreasing the casein and increasing the fats and sugars.
CLASSES OF FOODS, 43
Condensed Milk. — Condensed milk is manufactured
by evaporating cows* milk in a vacuum until it becomes
thickened and jelly-like. It is used largely among the
poorer classes for infant-feeding. Although they appear
to fatten and thrive on it, infants fed on this form of milk
are often poorly developed and are liable to develop
rickets. The two principal forms of condensed milk are
those containing comparatively little sugar and those to
which cane-sugar has been added. The first form con-
tains from 1 5' to 18 per cent, of milk-sugar; the latter
from 15 to 18 per cent, of milk-sugar and from 36 to
40 per cent, of cane-sugar. Condensed milk is most
easily digested, but is apt to contain too little fat ; the
unsweetened condensed milks are the most satisfactory
forms for infant-feeding.
EGGS*
Eggs, like milk, form a complete food — that is, they
contain a proportion of each of the fundamental food
elements necessary for the preservation of life. Eggs
and milk are the only complete food products furnished
by the* animal kingdom.
The eggs of the hen are consumed in largest numbers,
but those of the duck, turkey, guinea-hen, and of some
wild fowl are also eaten. The eggs of the domestic
fowls vary in size and appearance, but their composition
is about the same.
The shell of a hen's egg constitutes 1 1 parts, the white
57 parts, and the yolk 32 parts of the entire weight of
the egg. The table on page 48 shows the composition
of hens* eggs, cooked and raw.
As may be seen from that table, the egg contains
mainly protein and fats, in addition to water and mineral
44 DIETETICS FOR NURSES.
matter. The white and the yolk differ in composition,
the white containing more protein and water than the
yolk, and scarcely any fat and ash ; whereas the yolk
contains considerable fat and ash. The wh'tc is said to
be pure protein.
The flavor of the egg is dependent in a large measure
upon the food eaten by the laying hen. Fresh eggs, as
is well known, have the finest flavor.
If thoroughly macerated, hard-boiled eggs are as
digestible as soft-boiled ones. With some persons eggs
in any form are indigestible, and produce unpleasant
eructations, nausea and headache.
Raw eggs are best taken directly from the shell, or
they may be combined with milk broths or with coflte.
In various diseases accompanied by loss of flesh and
strength raw eggs in large numbers are prescribed, as
many as 24 eggs being given in twenty-four hours.
Egg'^lbmnin is best absorbed when eaten raw and
properly diluted. Its palatability may be increased by
flavoring it with sherry wine, orange-, lemon-, or grape-
juice, or by serving it in cream, cocoa or cofllee.
Egg:-nog is prepared from niiik and eggs, flavored
with some alcoholic drink, and sweetened with sugar.
MEATS AND HEAT PREPARATIONS.
Meat forms the flesh or muscular part.'i of the body.
It is one of the mo.st important articles of food and is the
chief source of man'.s protein supply. Meat may be
eaten raw or cooked. Raw meat, when well ground up,
s very easily digested.
Meat is composed of muscle-fibers held together by
connective-tissue bands; between the muscle-fibers are
bits of fat. As ordinarily seen meat contains muscle-
CLASSES 01- FOODS.
45
tissue, connective tissues, blood-vessels, nerves, and
lymphatics, together with a varying amount of fat. The
more fat there is in meat the less water and nitrogenous
matter does it contain, and vice versa. Cooking has the
effect of rendering the connective tissues soluble, thereby
causing a separation of the muscular fibers, allowing the
I digestive secretion to mingle more thoroughly with them.
' Cooking also enhances the flavor and appearance of
the meat, but, on the other hand, causes a loss in fat
and extractives. Cooking likewise destroys the micro-
organisms that may be present in the meat and thus
renders it more wholesome.
Digestibility of Meats. — The digestibility of meat
is governed by many conditions ; The age at which the
, animals eaten were killed, the length of time the meat is
[ kept before eating, the care bestowed upon the animals
during life, and the methods of preparing the meats for
the table. Meats are most easily digested when stewed ;
I frying renders them mo.st indigestible.
Beef. — The composition of beef varies greatly, espe-
l dally in regard to the amount of fat and water it contains.
I An ox from three to five years old supplies the best
\ beef. The meat of a verj' lean animal will contain about
75 per cent, of water and about 2 per cent, of fat.
Meat Preparations. — Numerous meat preparations,
I 'both sohds and liquid, are now on the market, the aim
I being to produce a concentrated food that will be readily
I digested. The different beef-juices have but slight nu-
I tritive value, most of them containing only 4 or 5 per
I cent of protein ; their chief value lies in the fact that they
I stimulate the appetite.
Bouillons. — Bouillons are prepared by cutting meat
I into small bits, heating slowly in water for a time, and
J
46 DIETETICS FOR NURSES,
then boiling it quickly. The fluid thus produced has a
very agreeable flavor, but its nutrient value is exceed-
ingly small.
Beef-extracts. — Beef-extracts are concentrated bouil-
lons that are to be diluted at the time they are taken.
Their nutritive value is about the same as that of
bouillon.
Beef -juice. — To produce a nutritious liquid-beef
preparation, the meat should be broiled slightly and then
cut into small pieces and pressed through a lemon-
squeezer or a meat-press. In this way considerable
quantities of protein, in addition to the salts and extrac-
tives, are obtained. The beef-juices sold on the market,
such as Valentine's, are prepared by subjecting the meat
to a strong pressure. These preparations contain from
5 to lo per cent, of protein.
Meat Powders. — The nutritive value of these prepa-
rations varies greatly. Those most frequently used are
a number of peptones, Somatose, and the Mosquera
" Beef Meal."
Meat-jellies. — Meat-jellies are frequently given to
invalids and are an agreeable means of a.dministering
protein food. Although they do not entirely replace the
protein in the tissues, they produce a considerable quantity
of energy.
Veal. — Veal is tough and indigestible, especially when
obtained from the animals that are killed too young. It
differs considerably in flavor from beef As in many
persons veal has a tendency to produce indigestion, it is
to be avoided in all cases of digestive debility.
Mutton. — Mutton is considered more digestible than
beef by English writers, probably because in England
the average mutton is more tender than that obtained in
CLASSES OF FOODS, 47
the United States ; the beef, however, is inferior to that
raised in this country.
I/amb. — Lamb, when of the right age and tenderness,
is as digestible as beef or mutton.
Venison. — Unless obtained from young animals,
when it is tender, highly-flavored and short-fibered,
venison is apt to be difficult of digestion.
Pork. — Pork is the most indigestible of all meats,
on account of the large percentage of fat that it contains.
Ham and Bacon. — Ham and bacon are both more
digestible than pork. In some parts of Germany ham
plays quite an important part in invalid dietaries. Bacon
is used largely as an army ration. When cooked crisp,
thin slices of bacon are easily digested.
Rabbit. — When young, rabbit meat is quite digest-
ible, but it is usually omitted from diet-lists.
Fowl. — Chicken is one of the most digestible and
agreeable varieties of meats. The meat of young pi-
geons also is especially digestible; that of ducks and geese
contains too much fat.
The flesh of game is easily digested, the meat of the
breast being best adapted for invalid use.
FISH.
The different kinds of fish vary widely in their nutri-
tive and digestive qualities. For example, the flounder
and the oyster are much easier of digestion than those
that contain a large amount of fat, like the salmon and
the herring. Eels contain the greatest proportion of fat,
which may reach 28 per cent. White-fleshed fish, as a
rule, contain little fat.
The table, compiled from Atwater and Langworthy,
gives the chemical composition of some animal foods :
DIETETICS FOR NUKSES.
Itruwn-ibcllid eg
f.«, , , : ;::;::; ^;
Fknli , . .
i!:? ' ^i ll;! I ii:! , : : I IS ;
CLASSES OF FOODS.
Fn.kfi.k.
J
«.o
1
si
ll
1
3S.I
5-;
gs
68,,
4B.4
10.3
s's
li
ili
ID. J
It
3
11
ij
■li
i
P-rcl.
!!
0.7
S7i^^" ""''■"'
»JO
Httddocli'.dreMtd,', . .
MuUtnii, dmud ....
1
i
i
:£
46s
Mickcrcl, Sjuniih, wbulc
Pnch.whlu, dmed , .
s
»7"
PoaipaiiD. dmscd . . .
"
JOO
9">
Trout, brook, drejacd ,
Turbol dniKd ....
PrfirrvtdS'k-
MKlit«l."No. .."ulled
js^ld
Herring. Mltcd, «nok«l. and d.ied
is
H.ddock;™c.k«J, canntd . . . .
MMmk,.
5°S
,.j ..,
MS
S
GcnctBl BvcrsE< of moUusks <eiclu-
^is
*ri ;:: n o^ sj r,:
Trrrafiu. tartlf, etc.
Te^pln. in .hell
Cr«n .unit, in (hell
7,7 . «.., 1 4. ^ o.
s
■OS
J i ,^^' „ 1 „, ■ „„
50
DIETETICS FOR NURSES.
All fish are best in season ; out of season they lose
their flavor and have a diminished nutritive value, and
in some cases develop an offensive odor.
On account of the rapid changes they undergo by way
of decomposition, fish should always be eaten in as fresh
a condition as possible. Various methods have been
resorted to with a view to preventing these changes.
There are many modern contrivances for preserving fish,
and drying, smoking, pickling, salting and canning are
practised on a large scale.
Crustaceans. — The most popular of the crustaceans
are the crab and the lobster. They are highly nutri-
tive, but at the same time highly indigestible. In some
persons the crab and the lobster are especially apt to
bring on nausea, vomiting, and other and more distress-
ing conditions.
Shell-fish. — Oysters, clams and mussels are the
forms of shell-fish chiefly eaten. Oysters, when eaten
fresh and raw, constitute the most digestible animal food,
but when cooked their digestive value is much lowered.
The soft part is proportionately larger and more nutri-
tious than the corresponding portion of the clam. The
hard or muscular portion is tough and rather indigest-
ible, and is best omitted from invalid dietaries. Oysters
should never be fried for the sick. Oysters have in
many cases been the carriers of typhoid fever, and many
persons have been infected in this way.
Clams are a popular article of diet and are as agree-
able to most palates as oysters. Mussels are consumed
chiefly by the poorer classes in the seaport towns of
England.
; • •• 2 • • •
• • • • •• • •••
#*••• • • \ •
* • • • • •*••
• • •
• • • • • •
• • •• ••
• • • • • • •
• •• • • • •
• ••• •• •••
I'EGETABLH /'OOnS.
VEGETABLE FOODS.
Vegetable foods differ from animal foods especially in
that they contain a large proportion of starch and sugar
and comparatively a small amount of protein.
Vegetables do, however, contain a certain amount of
proteins and fats.
Carbohydratesof Vegetables.— These arc starches
and sugars. Starch is found in all plants, and is con-
verted into dextrin by means of dry heat or by cooking.
The starch-granules in vegetables are held together by a
cellulose framework. Cellulose is a carbohydrate, but
is very insoluble; it can be utilized as a food only when
young ; when old, it is resistant and cannot be digested
and hinders the digestion of the starches enveloped
by it.
Protein in Vegetables.— These proteins belong
mainly to the globulins.
Extractives in Vegetables. — There is a consider-
able amount of extractive matter in certain vegetables,
such as asparagus, which is not utilized in the body.
Fats in Vegetables. — The fats in vegetables are
chiefly in the form of oils. In addition, vegetables con-
tain a considerable amount of water and salt. The
amount of water varies between 70 and 90 per cent
The main mineral constituents are the salts of potash
and soda united with organic acids.
Digestibility of Vegetables.— The digestion of
vegetables takes place mainly in the intestines. Owing to
the greater bulk of vegetable food and to the cellulose
that surrounds vegetable cells and thus prevents the
ready access of the digestive juices, vegetable food is not
so easily digested as animal food. For convenience of
$2 DIETETICS TOR NURSES.
description the following classification of vegetable foods
has been adopted :
1. Cereals. 5, Fruits.
2. Legumes. 6. Nuts.
3. Roots and tubers. 7. Fungi.
4. Green vegetablus. 8. Lichens.
CEREALS.
Cereal.s are the most important food-pro duct.s derived
from the vegetable kingdom. Of this class of foods
those in commonest use are wheat, corn, rye, oats, bar-
ley, rice and buckwheat. The cereals are eaten chiefly
after having been ground into flour or meal. Flour
is most commonly made from wheat and rye ; whereas
corn and oats are the chief sources of meal.
Wheat is the most important source of flour, owing
to the fact that it can be raised in any temperate climate
and yields the best flour at the least expense. It is rich
in solids and contains little water.
Flour is made by grinding the grain of the various
cereals. Although flour is made chiefly from wheat and
rye, barley, oats, maize, etc., are aiso manufactured into
flour.
Bread is made by adding to flour a definite proportion
of water, a little salt, and the leavening agent. The
mixture or dough is then kneaded, either with the hands
or, better, with a spoon. In the large modern bakeries
the kneading is done entirely by machinery. After this
the dough is set aside for a number of hours, during
which time fermentation takes place. It is then molded
into loaves and baked. The leavening is dependent upon
the action of the yeast on the starch, some of which it
VEGETABLE FOODS.
53
converts into sugar, and then into alcohol and carbon
dioxid gas. The gas causes bubbles to appear through-
out the dough and renders it light and spongy. During
the baking process the yeast germs are killed and the
alcoho! and carbonic-acid gas are driven off Hot or
fresh bread, when masticated, forms a tenacious, doughy
mass, and hence is not so digestible as stale bread.
Biscuits, pastries, and puddings are made by adding to
the flour varying quantities of eggs, sugar, milk, butter,
fruit, flavoring extracts, etc.
Rice constitutes the staple food of manyofthepeoples
of the Orient. It is grown chiefly in Asia, but is also
raised in some parts of Europe. In this country rice
culture is confined chiefly to South Carolina. Rice con-
tains a large proportion of starch in very digestible form,
but is comparatively poor in other constituents.
Oatmeal is used to the best advantage in making
porridge; owing to its lack of gluten it makes only the
poorest kind of bread. What is known as Scotch groats
is prepared by freeing the grain from its outer husk.
L
Of the legumes, the pea and the bean are the most
important food-products.
The legumes contain a liberal proportion of protein
(legumen), carbohydrates, and a little fat, besides a large
amount of water. Although legumes contain a propor-
tion of protein in excess of that of meat, a large amount
of fat, and considerable starch , they are less easily digested
than animal foods. They contain much indigestible
fiber (cellulose), and are also very liable to produce fer-
mentation, and in this way occasion flatulence and gas-
tro- intestinal distress. The digestibility of the legumi
id gas- ^m
54 DIETETICS FOR NURSES.
depends largely upon the manner in which they are pre-
pared and the amount that is eaten. A large portion of
the legumes ordinarily eaten is imperfectly absorbed by
the intestine.
Beans form one of the oldest forms of vegetable
foods, having been cultivated by the ancient Greeks,
Romans, and Egyptians. The numerous varieties used
for food have all been improved by cultural methods.
There are several varieties of peas, the most important
being the field- and the garden-pea. The former is gen-
erally used for fodder; but one variety, the Canadian
field-pea, is grown for table use. There are many varie-
ties of the garden -pea.
The lentil is but little used in this country. The chief
supply of lentils comes from Egypt, very few being grown
in Europe. They form a highly nutritious food.
ROOTS AND TUBERS.
Roots and tubers constitute another class of vegetable
foods that are of great importance. They contain both
starch and sugar, and to these constituents is due their
chief value as a food. On account of the small propor-
tion of protein and the large amount of water they con-
tain, they arc inferior in nutritive value to both legumes
and cereals.
The potato is, for several reasons, the most important
member of the group. It is a tuber or thickened under-
ground stem of the- Solanum tuberosum. It grows
equally well in a variety of soils, and when properly
cooked is easily digested.
The sweet potato contains more water and sugar
but less starch than the white potato. When boiled, it
VEGETABLE FOODS.
55
usually becomes mealy, but is often converted into a
stringy, sodden mass that is difficult of digestion.
The beet contains a very large percentage of starch
and sugar. It is raised extensively for the sugar in-
dustry, and is also largely employed for making salads
to lend variety to the diet.
Carrots, when young and tender, form a very nutri-
tious food and are greatly relished by many persons.
They contain from 85 to go per cent, of water.
Parsnips, when boiled long enough, form a good
food; like carrots, they contain a large proportion of
water and a considerable amount of sugar.
GREEN VEGETABLES.
The green vegetables are valuable not only on account
of the amount of nutriment present in them, but for the
variety and relish they give to the diet. They contain a
large amount of salts and have valuable antiscorbutic
properties.
Cabbages contain a considerable quantity of sulphur,
and on this account are apt to cause flatulence; where
digestion is good, however, they are considered a whole-
some form of food.
Cauliflower is the most digestible member of the cab-
bage family. It may be eaten either as a salad or boiled
and served with a milk-sauce.
Spinach is a popular form of vegetable and is used
to a great extent. It is valuable chiefly for its laxative
eflect.
I^tttice is the most important representative of a group
of vegetables u.sually eaten raw. It is made into salad
and dressed with vinegar. The various cresses also
belong to this class.
56 DIETETICS FOR NURSES.
Celery, which is usually eaten raw, is stringy and has
scarcely any nutritive value. Cooked in milk it forms a
wholesome and digestible article of food.
Tomatoes are eaten both raw and cooked, and are
refreshing, generally liked, and easily dige.sted. They
are used to flavor broths and are valuable for canning
purposes, inasmuch as they retain their flavor better than
most vegetables.
Asparagus is highly esteemed for its delicate flavor.
It is easily digested, even by invalids. It has a slightly
diuretic action, and imparts a most oflensive odor to the
urine, which persistsfor from twelve to twenty-four hours.
Vegetarianism. — It will not be out of place here to
point out the disadvantages of an exclusive vegetable
diet. Vegetarians are those who subsist almost entirely
upon vegetables, cereals, fruits, and nuts; exceptionally
milk and eggs are added to their diet-list. It is quite
possible, by the eating of vegetables alone, to supply all
the food constituents — carbohydrates, fats, and proteins —
that are required by the body. Proteins are obtained
partly from vegetables, milk, and eggs; those derived
from vegetables, however, are digested with much more
difficulty and absorbed to a much slighter degree than
those derived from animal food. Persons subsisting on
a purely vegetable diet for any great length of time are
apt to lose strength, as well as physical and mental vigor
and endurance. laborers are unable to perform the
same amount of work they could accomplish on a diet
containing animal food. While vegetables contain large
proportions of proteins, in order to supply them in suffi-
cient amount very large quantities must be eaten. This
overfeeding is apt in many instances to produce digestive
disturbances, particularly in those suffering from gastro-
VEGETABLE FOODS. $J
btestinal disorders. A purely vegetable diet, if persisted
fin, is also said to lessen the power of resisting disease.
FRUITS.
Fruits arc of little value as nutriment, and are useful
I mainly to give variety to the diet. They are used ex-
k.iensively as flavoring agents. The chief nutritive con-
Istituent of fruits is sugar, and they also contain a small
liamount of nitrogenous matters, cellulose, starches,
[-organic acids, and a vegetable jelly called pectin, which
I. causes fruit to gelatinize when boiled. The sugar present
■ in fruit is mainly fruit-sugar, or levulose, but some fruits
P.contain, in addition, considerable cane-sugar. In general,
f fruits contain a large amount of water. The niineral
elements of fruit consist of potash, united with tartaric,
dtric, and malic acid.s. The flavor and odor of fruits
k are due to the presence of essential oils and compound
^ethers.
The digestibility of fruits varies with the kind of fruit
Eeaten and its mode of preparation ; stewed fruits are
B-more easily digestible than raw fruits. Among the
more easily digestible fruits are oranges, lemons, grapes
B.and peaches ; raw apples, pears and bananas are some-
EWhat less digestible.
Oranges and lemons are used in invalid dietaries, their
Huice allaying thirst very effectively.
Apples are wholesome, digestible and slightly laxa-
I'tive.
Pears are, as a rule, more easily digestible than apples.
Peaches are wholesome and digestible. They contain
ESS sugar than most fruits.
Bananas are the most nutritious of the raw fruits.
Grapes contain a large amount of water and consid-
58 DIETETICS FOR NURSES,
erable sugar. When thoroughly ripe they are very
digestible.
Raisins are prepared by drying grapes, the white ones
being those most used.
Plqms and green gages are quite digestible when fully
ripe.
Prunes are dried plums. They contain much sugar
and are markedly laxative in their effect.
Olives have a bitter taste and are eaten chiefly as a
relish with salads. Their nutritive value is due to the
oil they contain.
Strawberries are very wholesome unless taken in excess.
Currants, gooseberries, raspberries, huckleberries, mul-
berries," and a few other berries a contain considerable
amount of free acids. They have slightly laxative prop-
erties.
Melons contain over 95 per cent, of water and about 5
per cent, of other constituents ; they are considered indi-
gestible.
Figs and dates contain large quantities of sugar. The
value of the date as a food to the Arab is well known.
NUTS.
Nuts contain a large quantity of fat and a somewhat
larger proportion of protein. They have but little food
value and are eaten mainly as a dessert. The average
composition of nuts is :
Water I- 4 per cent.
Protein 6-15
Fats 40-50
Carbohydrates 6-10
Owing to the large amount of cellulose as well as the
large proportion of fat they contain, nuts are not easily
«
VEGETABLE FOODS. 59
digested. The dense cellulose framework which makes
nuts so indigestible can be destroyed by grinding, and
tims the nut made more easily digestible; such prepara-
tions as Nuttolene, Bromose, and Nutmeal, of the Battle
Creek Sanitarium Company, are prepared in this way.
Almonds contain much fat, but no starch and very
little sugar.
Chestnuts contain a small amount of oil and a large
amount of carbohydrates.
Walnuts contain a large proportion of protein and fat,
but are quite indigestible.
The cocoanut contains a large amount of fat and car-
bohydrates.
FUNGI, ALGAE, AND UCHENS.
Fungi. — The three varieties of fungi usually eaten
are the mushroom, truffle, and morel.
Mushrooms are prized chiefly for their agreeable taste.
They possess some nutritive value.
The truffle grows underground and is especially sought
for on account of its delicate flavor ; the black variety
is considered the finest.
TJie morel is usually obtained from France. It is sold
in the dried state and is utilized chiefly for seasoning
purposes.
Many fungi are poisonous, and these are usually dis-
tinguished by a disagreeable odor and taste, and other
peculiarities in structure, etc.
Algse.— The only one of this group that is utilized as
food is Iriitli moss,
Ifichens. — The only important lichen used as a food
is Iceland moss.
A
6o
DIETETICS FOR NURSES.
The following table, taken from Atwater, gives the
chemic composition of the most common cereals :
Cereals.
Barley
Buckwheat . . .
Com (maize) . .
Kafir corn . . .
Oats
Kice
Rye
Wheat ;
Spring varieties .
Winter varieties
Pro-
tein.
Fat.
Per ci.
Per ci.
12.4
1.8
1 0.0
2.2
9.9
6.6
2.8
3.8
1 1.8
5.0
7.4
10.6
0.4
1.7
12.5
2.2
11.8
2.1
Per ci.
Per ci.
69.8
2.7
64.5
8.7
74.9
14
69.5
I.I
59-7
95
79.2
0.2
72.0
1.7
71.2
1.8
72.0
1.8
Ash.
Per ci.
24
2.0
1-5
2.2
30
0.4
«-9
1-9
1.8
The following table, taken from Hutchison, gives the
chemic composition of some fruits :
Fruits.
Apples . .
Pears . . .
Apricots . .
Peaches . .
Green gages
Plums . . .
Cherries . .
Currants . .
Strawberries
Blackberries
Raspberries
Cranberries .
Grapes . ,
Watermelons
Bananas . .
Oranges . .
Ivcmons . .
Pineapples .
Dates, dried
Figs, dried .
Prunes, dried
Raisins . .
Water.
Per ci.
82.50
83-90
85.00
88.80
80.80
78.40
84.00
85.20
89.10
88.90
84.40
86.50
79.00
92.90
74.00
86.70
8.93
8.93
2.08
2.00
2.64
1.40
Pro-
teid.
Ether
extract.
Perci.
0.40
0.40
1. 10
0.50
0.40
1. 00
0.80
0.40
1. 00
0.90
1. 00
0.50
1. 00
0.30
1.50
0.90
1. 00
0.04
4.40
5.50
2.40
2.50
Per ct.
0.5
0.6
0.6
0.2
0.2
0.2
0.8
0.8
0.5
2.1
2.1
0.7
I.O
O.I
0.7
0.6
0.9
0.3
2.1
0.9
0.8
4.7
•fig
Per ct.
12.5
II.5
12.4
5.8
'3-4
14.8
1 0.0
7-9
6.3
2.3
5.2
39
15.5
6.5
22.9
8.7
8.3
9-7
65.7
62.8
66.2
74-7
Ash.
Per ci.
0.4
0.4
0.5
0.6
0.3
0.5
0.6
05
0.7
0.6
0.6
02
0.5
0.2
0.9
0.6
0.5
0.3
15
2.3
'5
4.1
Acids.
Perci. Perct.
2.7
1.0
31
0.1
31
1.0
3-4
07
4.1
1.0
4.3
1.0
3.8
1.0
4.6
1.4
2.2
1.0
5-2
1.6
7.4
1.4
6.2
2.2
2.5
0.5
1.0
0.5
0.2
05
'5
1.8
15
1.8
'•5
7.0
55
7.0
7.3
1.2
7.3
2.7
1-7
2.7
VEGETABLE FOODS,
6l
The following table, compiled from Atwater, Abel, and
Hutchison, gives the chemic composition of some vege-
tables :
Vegetables.
Fresh legumes :
String-beans
Sugar peas or string-peas
Shelled kidney beans . .
Shelled Lima beans . .
Shelled peas
Canned string-beans . . .
Canned Lima beans . . .
Canned kidney beans . . .
Canned peas
Dried legumes:
Lima beans
Navy beans
Lentils
Dried peas
Peanuts
St. John's bread (carob
bean)
Potatoes
Sweet potatoes
Beets
Parsnips
Turnips
Cabbage
Cauliflower
Sea-kale
Spinach
Vegetable marrow ....
Brussels sprouts
Tomatoes
Greens
Lettuce
Rhubarb
Water-cress
Cucumber
Asparagus
Sauerkraut
Water.
Pro-
tein.
Per ci.
89.2
81.8
58.9
68.5
74.6
93.7
79-5
72.7
85.3
10.4
12.6
8.4
9.5
9.2
'5.0
62.6
55.2
70.0
66.4
62.7
89.6
90.7
93-3
90.6
94.8
93-7
91.9
82.9
94.1
934
94.6
93'
95-9
91.7
91.0
2.30
340
9.40
7.10
7.00
l.IO
4.00
7.00
3.60
18.10
22.50
25.70
24.60
25.80
5.90
1.80
1.40
i-3t
1.30
0.90
1.80
2.20
1.40
2.50
0.06
1.50
1.30
3.80
1.40
1.40
0.70
0.70
0.80
2.20
1.40
Fat.
Perct. Perct.
0.3
0.4
0.6
0.7
0.5
O.I
0.3
0.2
0.2
'•5
1.8
i.o
I.O
38.6
'•3
0.1
0.6
0.1
0.4
0.1
0.4
0.4
0.4
0.5
0.2
0.1
0.2
0.9
0.4
0.1
0.7
0.5
0.1
0.2
0.7
59.2
62.0
24.4
75-3
14.7
21.9
7.7
10.8
5-7
5.8
4.7
3.8
3.8
2.6
34
5.0
8.9
2.6
3-3
2.3
3-7
2.1
2.9
2.9
5-7
2.9
2.0
25
0.8
0.9
0.9
I.I
0.6
1-3
0.8
0.6
1.7
0.5
13
0.7
3-5
1.0
0.9
0.6
1-3
0.4
0.9
1.7
Carbo-
.' hydrates.
Ash.
Per ct.
Per ct.
74
0.8
137
0.7
29.1
2.0
22.0
17
16.9
1.0
3-8
14.6
18.5
13
1.6
1.6
9.8
I.I
65.9
41
59.6
3.5
hi
«> .
9 0) =
^B o
Calor-
ies.
195
335
740
570
465
95
360
480
255
1625
1605
1620
1655
2560
1565
295
440
160
230
120
165
175
175
120
120
95
105
275
105
85
105
no
70
no
no
DIETETICS l-OR NURSES.
SUGARS.
Sugars arc carbohydrates that contain hydrogen and
oxygen in a proportion to form water. Sugar is one of
the most valuable and popular forms of food. This
popularity is due not only to its nutritive value, but also
to its pleasant taste. According to Abel, 86 pounds of
sugar per capita were consumed in England in 1895 and
64 pounds in the United States in the same year. From
7.000.000 to 8,000,000 tons are consumed annually in
the different countries of the world. The principal
variety of sugar in use is cane-sugar ; besides this,
grape-sugar, fruit-sugar, and milk-sugar also enter into
the composition of our foods. Sugar is obtained in a
fluid state, as in honey, as well as in crystalline form.
Sugar is very fattening and at the same time is also a
great source of muscular energy. Most of the ill effects
attributed to the use of sugar arc due to the fact that
more than one-quarter of a pound is consumed daily
(Hutchison); this amount maybe taken with impunity
by the healthy adult, but if more be taken, it will be
excreted rapidly by the kidneys, giving ri.se to a condi-
tion known as temporary or alimentary glycosuria.
Sugar can be absorbed only as dextrose and as levu-
lose, all varieties of sugar being converted into these
forms before they are absorbed. In strong solution
sugar irritates the mucous membrane of the stomach
and is apt to undergo fermentation, and thus produce
gastro-intestinal distress.
Cane-sugar is the most common and most exten-
sively used form of sugar. It is made chiefly from
and from the sugar-beet. When pure, it
J mass of white crystals.
J
VEGETABLE fOODS. 63
Oandy contains a large amount of sugar, besides but-
ter and other fats, starch, nuts, flavoring extracts, etc.
The chief varieties of candy are made up largely of
glucose and starch, colored with anilin dyes.
Molasses, Treacle, and Syrup.— Molasses and
treacle are by-products formed in the manufacture of
cane-sugar. Molasses forms a highly nutritious food.
On account of the impurities it contains, molasses has a
more pronounced aperient effect than refined syrup.
Glucose, or grape-sugar, is chiefly made from starch
by inver:>ion or hydrolysis. It is not nearly so sweet as
cane-sugar and crystallizes with difficulty. It is present
in small quantities, in combination with other varieties
of sugar, in most fruits.
I,actose, or sngar of milk, is the natural carbo-
hydrate for the young, growing infant. It is less abun-
dant in cows' milk than in human milk.
Honey is sugar in a concentrated solution. It is
made by bees from the nectar gathered from various
flowers. It contains a crystallizable sugar resembling
glucose, and a non -crystallizable form.
Saccharin is u.sed largely as a substitute for sugar
in cases of rheumatism and diabetes.
I,evulose, or fruit-sugar, is also utilized as a form
of sugar in certain cases of diabetes.
SPICES AND CONDIMENTS.
Spices and condiments play an important role in
increasing the appetite and aiding the digestive func-
tions ; they have practically no nutritive value. By the
action of these substances on the organ of taste as well
as on the mucous membrane of the stomach, the appetite
is stimulated and the secretion of gastric juice increased.
6+ DIETETICS FOR NURSES.
In certain gastric disturbances as well as in diseases of
the kidneys tiiey act as irritants and should be avoided.
The peppers are among the favorite spices ; there
are two varieties, the white and the black.
Mastard. — Mustard is used chiefly in salads or with
other foods, and has a marked tendency to increase the
appetite. In large quantities and diluted with water mus-
tard acts as an irritant to the stomach, producing' nausea
and vomiting.
Vinegar is produced from various alcoholic drinks
and from fruits. It contains 5 per cent, of acetic acid.
Horseradisli is a condiment that is much used with
Satices, such as tomato, catsup, Worcestershire, and
the like, increase the appetite and give a relish to certain
foods.
Spices act merely by adding a flavor to foods, in this
way increasing the appetite for foods that would other-
wise be insipid. Those most in use are ginger, cinnamon,
nutmeg, and cloves.
FATS AND OE.S.
One-fifth of the body-weight consists of fat. This is
obtained in part from fatty food and in part from the car-
bohydrates and the proteins. Most of the heat energy
furnished the body is supplied by fat; it oxidizes very
rapidly, and in this way spares the protein elements
that would otherwise be required to furnish energy.
Fats are digested in the intestine, where they arc emul-
sified previous to being absorbed. The most u.seful forms
of fat are cream and butter; other forms are bacon and
cod-liver oil. When eaten too liberally, fats are liable to
VEGETABLE FOODS. 65
cause indigestion, and when this exists they should be
taken only in very restricted quantities.
Foods fried in fats are indigestible, and hot fats are
more indigestible than cold. Fats and oils have a ten-
dency to reheve constipation, but are contra-indicated in
diarrhea.
The most important animal fats are butter, cream, lard,
suet, oleomargarin, cottolene, butterine, cod-liver oil, and
bone-marrow. Of the vegetable fats, those most com-
monly employed arc olive oil, cottonseed oil, linseed oil,
cocoa-butter, and the oils obtained from nuts, such as
cocoanut oil, peanut oil, and almond oil. Fatty foods
are indicated' especially in wasting disorders and in con-
valescence from certain acute diseases.
There are many proprietaiy fatty foods on the market,
some of which, are worthy of mention. In most of
these the fats, usually eod-liirer oil, have been emulsified ;
this emulsification aims to make the oil less objection-
able to the taste and also to render it more easily diges-
tible.
Butterine is a fat prepared from beef and hog fats, and
is frequently used in this country instead of butter;
oleomargarin is a similar preparation made from beef
fat. Both butterine and oleomargarin arc wholesome
fatty foods, the only objection raised against them being
that they are often sold fraudulently for butter.
Bone-marrow is a fat obtained from the large bones of
the ox. It is used in the treatment of tuberculosis and
1 the various forms of anemia.
k
A
DIETETICS FOR NURSES.
SALTS.
The various salts tJiat enter into the composition of
the tissues of the body arc absolutely necessary for the
maintenance of life. The most important, and by far
that most universally found, is sodium chlorid, or com-
mon table salt. It enters into the formation of all the
tissues and secretions of the body with the exception of
the enamel of the teeth. It forms about 60 per cent, of
the sails of the blood. When taken in insuffieicnt quanti'
ties or omitted entirely marked symptoms of mahiutrition
soon appear.
Potassium chlorid ranks next in importance to
sodium chlorid. It is widely distributed in the body,
but occurs in much .smaller amounts.
Calcium salts are important chiefly on account of
the extent to which they enter into the composition of
the bones and the teeth.
Phosphorus occurs in the muscles, bones, and blood.
It is found as phosphate in both animal and vegetable
The stilphur of the body is derived from egg albu-
min, milk, and certain vegetables, in which it occurs as
sulphates.
Iron is an important constituent of the hemoglobin
of the blood, and is found also in musclc-fibcrs.
BEVERAGES AND STIMULANTS.
TATER.
Water is the chief constituent of all beverages, and
also enters largely into the composition of solid food.
The human body itself is composed of about 60 per
cent, of water. While man can live for weeks without
BEVERAGES AND STIMULANTS. 67
food, he can abstain from water for but a few days.
Water is absolutely necessary as a solvent, and as it is
constantly being^ eliminated by the skin, lungs, and kid-
neys, this loss must be replaced by some means in order
to maintain the functions of the body. This is most
conveniently done through the agency of the various
beverages. The best method, however, of replenishing
the water-supply is tliat of drinking the water in its pure
state, when it retains all its solvent properties. Some
waters are taken for their laxative or purgative action,
and others for the .salts which they contain.
The amount of water consumed daily by the average
person is from six to eight glasses. This varies, how-
ever, with the amount and variety of food and exercise
taken. The age, sex, and size of the individual and the
season of the year also influence the total daily consump-
tion of water. In very warm weather, for example, and
under severe physical strain, much water that would not
be lost in the cold season of the year is eliminated in the
form of perspiration and mu.st be compensated for.
Water is absorbed chiefly in the intestine ; a small
amount is absorbed in the stomach, and but a very
trifling amount, if any, in the mouth. The water ab-
sorbed in the intestine is passed into the lymphatics and
carried on into the circulation, whence it is eliminated.
As previously stated, water is eliminated through the
skin, kidneys, lungs, and feces. The amount of water
excreted daily varies greatly under special conditions.
In cold weather the skin is inactive and the kidneys
excrete a markedly greater amount of water than in hot
weather, when the sweat-glands functionate more actively.
When there is a tendency toward liquid movements from
the bowel, the elimination by the kidneys is lessened.
J
68 DIETETICS FOR NURSES.
In warm weather elimination by the lungs is stimu-
lated.
According to the amount of mineral water they con-
tain, waters arc classed as hard or soft. Rain-water is
soft, znd is the purest form of natural water. The hard-
ness of water is due to earthy carbonates; by boiling,
the carbonic acid gas is driven off and the carbonates are
precipitated, and the water thus rendered more suitable
as a beverage. Boiling has the additional advantage that
it destroys most of the micro-organisms that may be
present in the water.
Water often contains impurities, such as lime, mag-
nesia, iron, and other salts, and micro-organisms, and it
often becomes necessary to purify it for drinking pur-
poses. Typhoid fever and cholera are communicated
chiefly through the agency of polluted drinking* water.
The best method of purification is by distillation, by
which means both organic and inorganic impurities can
be removed or rendered innocuous. This method is
now used largely on shipboard. When distilled and
aerated, sea- water makes a most pleasant beverage.
Water may also be purified by means of filtration, char-
coal and sand being used extensively for this purpose.
Porcelain cylinders are also in common use. Whatever
the filtering agent employed, unless it be kept clean it is
liable to become a source of contamination rather than
of purification. Owing to the fact that soluble impuri-
ties often pass through the filter, filtered water is not
nearly so reliable as distilled water.
Mineral Waters. — Mineral waters are frequently
taken as substitutes for ordinary water; at times they
produce a most marked stimulating effect on various
k
BEVERAGES AND STIMULANTS.
69
organs. Their efficiency is greatly enhanced when a
"drinking cure" is combined with proper dietetic regu-
lations. Mineral waters differ from ordinary waters in
tlie greater amount of gaseous and solid matters they
contain. The gaseous constituents of mineral waters
are mainly carbon dioxid and sulphuretted hydrogen.
The solid constituents are salts of sodium, potassium,
magnesium, aluminium and calcium, iron, iodin, bromin,
chlorin and sulphur. Taken before meals, waters con-
taining carbonic acid have a soothing effect on an irri-
tated stomach. Taken in excess, all carbonated waters
I are apt to produce indigestion.
! Some waters have a purgative effect, others a laxa-
|_ tive, and still others a diuretic. Tbennal waters issue hot
I from their springs, their virtue being said to be due to
^ their heat. Some mineral waters have no medicinal vir-
I tue whatever, and are utilized merely as drinking-water,
I The following classification of mineral waters is taken
from Cohen's Physiologic Therapeutics, Vol. IX.:
k Simple acidulous coDtflins lai^e amouuta of car-
bon dioxid ; example, Apullinaria.
Alkaline acidulous contains lai^e amonnta of car-
bon dioxid .ind also sodium curbonate; example,
I. Albkline Snratc^ Vichy.
lainend Alkaline mnriated acidulous contsins carbon di-
walecs. oxiil, sodium carboaale, and sodium chlorid \ ex.im-
ple, Seltzer.
Alkaline saline acidulous contains sul|>hate of
sodiL in addition to bicarbonate and chlorid of soda,
as Carlsbad water.
Simple sodium chlorid contains sodium chlorid
II Sod' 1 1 ^"'^ carbon dioxid. as Saratoga Congress.
-J Sodium chlorid with iodin and bromin con loins
ioilin and bromin in addition lo sodium cblorid,
as Saratoga Kiasingen.
70
DIETETICS FOR NURSES.
in. Bitter waters contain a large proportion of sodium sulphate and
magnesia sulphate, as Bedford Magnesia water.
IV. Sulphurous waters eoalain hydrogen sulphid or some otlier sulphur
conipouiid, as Kreuch l.ick Spring.
CorbonBted iron-waters contain larger quantilies
of carbonic acid, as Cresaon Spring water.
Sulpbaled iron-waters contain fetrou.') .sulphate in
V. Iran-waters. addition Lo sodium magnesia, and calcium sulphate,
as Sharon ChaljbeaLe Spring.
I ton-and- arsenic -water contains arsenic and iron,
as Harbin Hoi Sulphur Spring.
VI. Earthy mineral waters contain large amounts of calcium and mag-
nesium salts, as Mount Qemens Mineral Springs.
VII. Acratothermal waters do not contain any active mineral ingredients,
bu( are oUained at a lemperalure of Ss" F. or over.
TEA.
Tea is a preparation made from the leaves of an ever-
green plant known as thea. It is grown in Chiha^
Japan, India, Ceylon, and in North Carolina. There are
two great classes of tea, the green and the black.
The chief difference between the black and the green
tea lies in the fact that black tea is fermented, while
green is not. As in the process of fermentation the
tannic acid becomes less soluble, black tea contains
much less tannic acid than green tea.
Tea has practically no nutrient ingredients. Its prin-
cipal constituents are caffein and tannic acid, and its
special aroma is due to a volatile oil. It owes its stim-
ulating effect to the presence of caffein. As the action
of tannic acid is detrimental to the process of digestion,
tea should be so prepared as to contain as large a pro-
portion of caffein as possible and the smallest possible
amount of tannic acid.
When the leaves are placed in boiling water, caffein is
extracted very rapidly. Tannic acid, however, is much
BEVERAGES AN^D STIMULANTS. 71
less soluble; it follows, therefore, that in order to have
as little tannic acid in the tea as possible, the leaves should
be boiled in water for as short a time as practicable. To
prepare the infusion, pour boiling water on the tea-leaves
and allow the mixture to stand where it will keep hot,
though not boil, for from three to five minutes. The
water used in preparing tea should not be hard or stale.
COFFEE.
CofTee was introduced into Europe in the same century
as tea, and only a few years later. It is prepared from
the seeds of CofTea arabica, which was originally grown
in Arabia. The aroma of coffee is due to the presence
of caffeol, an oil liberated in roasting. Coffee is often
adulterated, chicory, acorns, and other substances being
added for this purpose. The adulteration may not be
injurious in its effect, but alters sometimes, even agree-
ably, the flavor of the coffee.
Preparation of Coffee.— In order to obtain coffee
of the finest flavor, the beans should be roasted and
ground shortly before they are to be used, as the flavor
is impaired by exposure to the air after grinding. The
water should have reached the boiling-point before it is
poured over the coffee. The pot should then be placed
for a few moments in a hot place, but boiling must not
be allowed to continue, or the aroma will be lost and the
coffee contain too large a percentage of tannic acid.
The effect of coffee on the system is that of a stim-
ulant, due to the caffein present; it acts directly on the
brain centers, stimulates the heart, and deepens the res-
pirations. It is an excitant of the nervous system, and in
some persons produces nervousness, excitability, and
in others it acts as an agreeable stimulant.
I
I
yS DIETETICS FOK NURSES.
COCOA.
Cocoa was introduced into Europe long before either
coffee or tea. It is prepared from tlie seeds of the cacao
tree. The seeds are contained in a pulpy fruit, some*
what resembling a cucumber, from which they are
extracted. Cocoa, as ordinarily prepared, is made by
grinding the seeds into a paste, to which sugar or starch
is added ; if starch is used, the cocoa is boiled for a few
minutes, but if sugar is added, the cocoa only requires
the addition of boiling water or milk.
Cocoa, while a stimulant, is less apt to induce nervous
symptoms, such as sleeplessness and palpitation, than
either tea or coffee. By reason of the large proportion
of sugar and fat contained in it, however, when used in
excess, cocoa is likely to produce indigestion. When
not too rich, it forms a nutritious drink especially useful
for children and for convalescents.
Chocolate is prepared by adding starch, sugar, and
such flavoring substance as vanilla to cocoa. In addi-
tion to their stimulant effect, cocoa and chocolate pos-
sess a marked nutrient value not possessed by either tea
or coffee.
ALCOHOL.
Alcohol is produced by the fermentation of sugars
with yeast. The principal constituent in all alcoholic
beverages is ethyl alcohol. The glucose contained in
fruits is fermented directly into alcohol ; whereas the
starches in such substances as potatoes, grains, etc., are
converted into de.\trin and maltose, and then, by the aid
of diastatic ferments, before the alcoholic fermentation
can take place, they are converted into glucose.
The food valne of alcohol has been a subject for
discussion for many years. Although all admit that
BEVERAGES AND STIMULANTS.
73
alcohol taken in excess is a poison and is detrimental
to health, yet opinions differ widely as to the food value
of alcohol taken in moderate quantities. There are those
who maintain that alcohol, even in small quantities, is
detrimental to health and acts as a poison ; whereas
others believe that, on the contrary, when taken in small
quantities it possesses a considerable nutrient value and
is to be recommended as a valuable food. The most
recent as well as the most exhaustive work bearing on
this subject has been done by Atwater, in his experiments
on " The Nutritive Value of Alcohol," in The Physio-
logic Aspects of the Liquor Question, 1903. According
to the writer the effect of alcohol in small quantities is
slightly to increase the digestibility of protein, but not to
alter the digestibility of other nutrients — that is, carbo-
hydrates and fats ; that at least 98 per cent, of the alco-
hol ingested is oxidized in the body, whereas ordinarily
98 per cent, of the carbohydrates, 95 per cent, of the
fats, and 93 per cent, of the protein are oxidized; the
alcohol is therefore oxidized more completely than are
the nutrients of ordinary foods.
The conclusion reached by Atwater, based on direct
experiments, is that the fat protection following the use
of alcohol is very .slightly different from that following
the taking of ordinary food, and that alcohol protects
the body-fat quite as effectively as do the fats and carbo-
hydrates of the food for which it is substituted. The
power of alcohol to protect the protein of food or body-
tissue, or both, from consumption is clearly demonstrated.
Alcohol, carbohydrates, and fats replace one another
as sources of energy, so that as one is oxidized the other
is correspondingly spared.
Atwater found that in most of the experiments " alco-
74 DIETETICS FOR NURSES.
hol was certainly a source of heat for the body " and
contributed its share of energy for muscular work.
Atwatcr gives the following proportions as to the
availability and fuel value of alcohol in nutrition as com-
pared with carbohydrates and fats: i gm. of alcohol, ij
gm, of carbohydrate, and | gm. of fat yield the same
amount of energy to the body. Inasmuch as alcohol
contains no nitrogenous constituents, it can not be looked
upon as a food tending to repair tissue, but merely as a
fuel that, on oxidizing, forms animal heat.
Alcohol is easily digested and readily absorbed in the
alimentary tract; as a food, however, it is costly, and
the danger of addiction and excess in its use is great.
The habitual use of alcohol even in con.siderable quanti-
ties does not tend to produce injurious efiects in many
persons ; whereas in others changes, especially of a
cirrhotic nature, in the tissues, blood-vessels, liver, kid-
neys, etc., are Hable to occur. In certain diseases,
especially those accompanied by malnutrition, extreme
feebleness, and exhaustion, alcohol acts as a food and
serves an excellent purpose in restoring strength to a
weak and enfeebled body.
Alcoholic beverages are divided into several classes,
e. g., spirits, liqueurs, and bitters, malt liquors, wines, etc-
SPIRITS.
Spirits are produced by fermenting saccharine sub-
stances and obtaining the alcohol by distillation. Of
the substances, corn, rice, barley, molasses, and potatoes
are those most commonly utilized for this purpose. In
addition to the alcohol, by-products are formed, and it
is to these that spirits owe their characteristic flavor and
odor. The by-products contain the higher alcohols, such
BEVERAGES AND STIMULANTS.
75
L
as propyl, butyl, and amyl alcohol, a mixture of these
forming what is known as fusel oil.
Whisky. — The United States Pharmacopeia defines
whisky as " an alcoholic liquid obtained by distillation
of the mash of fermented grain (usually of mixtures of
corn, wheat, and rye), and at least two years old."
Whisky possesses an alcoholic strength of from 50 to
58 per cent, by volume. It should be free from dis-
■ agreeable odor. The ether and aldehyds contained in
whisky become altered in character as it ages, and the
flavor is thus rendered more agreeable.
Brandy, — In the United States Pharmacopeia brandy
is defined as an "alcoholic liquid obtained by distilla-
tion of the fermented unmodified juice of fresh grapes,
and at least four years old." Brandy contains from 46
to 55 per cent, by volume of alcohol. The quality of
brandy depends upon the variety of grapes used and
upon the length of time the brandy is allowed to stand:
the older the brandy the better the quality. With
brandy, just as with whisky, on standing ethers and
aldehyds are produced, to which the special flavor of the
brandy is due. The color of brandy is due to the tannic
acid extracted from the oak casks in which the brandy
is contained. There are many inferior grades of brandy
on the market, some being merely alcohol colored and
flavored with various essences.
Rutn. — Rum is the product of the distillation of fer-
mented molasses, its flavor being due to certain by-
products.
Gin. — Gin is produced by the distillation of rye and
malt mash, its flavor being due to juniper berries which
are added during fermentation.
. Ifiqneurs or cordials and bitters contain a large
J
76 DIETETICS FOR NURSES.
proportion of alcohol and a high percentage of sugar and
essential oils.
Malt Iriqnors. — Under the heading of malt liquors
arc included beer or ale and stout or porter. These
beverages are made by fermenting malt and hops. The
mild or bitter beers are distinguished by the relative pro-
portion of hops contained in them; the n;ilder forms
contain considerable quantities of hops, whereas the bit-
ter ones contain but small amounts.
Porter and Stout. — Porter and stout are made by
fermenting malt, the latter, however, being roasted, dur-
ing which process a certain amount of caramel is pro-
duced. It is to this substance that the dark color is
due. Beer as well as stout contains from 3 to S percent.
of alcohol, from 2 to 5 per cent, of dextrin, and from
0.5 to 1 per cent, of sugar.
WINE.
Wine is produced by the fermentation of grape-juice,
the juice being first pressed from the grape by crushing.
There are a number of factors, such as the character of
the grape utilized, its cultivation, and the method of
manufacturing, that enter into the production of a good
wine.
Of the important ingredients of wine may be men-
tioned water, acids, alcohol, sugar, ethers, glycerin, and
extractives.
Acids. — The most important acids contained in wine
are tartaric, malic, and tannic ; others of less impor-
tance are acetic and succinic. The total amount of acids
in wine varies, but rarely exxeeds 0.5 per cent.
Alcohol, — There are several alcohols present in wine ;
ethyl alcohol occurs in largest quantity; amyl, propyl,
M
BEVERAGES A.\D ST/A/L'LAA'TS. 77
and butyl alcohol are also present in varying amounts ;
natural wine never contains more than 16 per cent, of
alcohol ; if it contains more than this amount it has
been " fortified." This is often done, especially when
the wine is to be shipped from warm countries to foreign
districts, to prevent it souring.
Sugar. — Sour wines contain about i [jer cent, and
sweet wines about 4 per cent, of sugar; it is evident,
therefore, that sugar is present in too small a quantity
to be of any food value.
Ethers. — Many varieties of ethers are present in wine ;
they are produced by the action of the alcohols and acids
upon each other. It is to the character and quantity of
the ethers contained in them that the flavor of various
kinds of wines is largely due.
Glycerin. — Glycerin is present in wine in about one-
fourteenth of the volume of the alcohol.
Extractives. — A large part of the solid material of the
wine is made up of extractives.
Varietiesof Wines.— From a dietetic standpoint the
classification of Chambers is probably the most practi-
cal ; according to this author, wines are divided into
seven classes: i. Strong dry wines. 2. Strong sweet
wines, 3. Aromatic wines. 4. Acid wines. 5. Spark-
ling wines. 6. Perfect wines. 7. Rough or astringent
wines.
I. Strong Dry Wines. — These are wines that contain
a large percentage of alcohol, to which, as a rule, addi-
tional alcohol has been added in their production ; in
other words, they are "fortified." Examples of this
class of wines are port, sherry, and Madeira. Port con-
tains from 15 to 20 per cent, of alcohol and considerable
I
I
7? DIETETICS FOR NCKSES.
tannic acid. Sherry is a fortified wiiie ; it contains from
15 to 23 per cent, of alcohol.
2. Strong Sweet Wines. — These wines contain fruit-
sugar in quantities sufficient to act as a preservative and
prevent furtiier fermentation. Under this head may be
mentioned Tokay, Malaga, and sweet champagne. They
contain from 1 8 to 22 per cent, of alcohol and from 3 to
5 per cent, of sugar. Owing to their sweetness they are
taken in small quantities.
3. Aiomatic Wines. — Aromatic wines possess a superior
flavor and contain essential oils and considerable alcohol ;
examples of this class of wines are Moselle, Capri, and
some of the Rhine wines.
4. Acid Wines. — The distinguishing feature of this class
of wines is the large quantity of acid they contain.
5. Sparkling Wines. — Sparkling wines contain consid-
erable quantities of carbonic acid gas, to which their
exhilarating effect is due. The chief variety of this class
of wines is champagne. The diyness or sweetness of
champagne depends upon the proportion of cane-sugar
and cognac added during the process of manufacture. In
the manufacture of dry champagne 8 per cent, of sugar
is added, while the sweet brands contain as much as 16
per cent.
6. Perfect Wines. — Perfect wines are defined by Cham-
bers as those containing alcohol, water, sugar, ethereal
flavors, fruity extractives, and adds. Under this head
come Burgundy and Bordeaux,
7. Bongli Wines. — Rough wines contain considerable
quantities of tannic add, to which they owe their astrin-
gent efl^ect. They contain little alcohol and are of slight
value for medicinal purposes.
I
BEVERAGES AND STIMULANTS. 79
ACTION AND USE OF MALT LIQUORS AND WINES.
Malt liquors, when taken in 'moderate quantities, seem
to aid digestion, increase the appetite, and stimulate gas-
tric secretion. Occasionally, especially in those who
lead a sedentary life, they give rise to indigestion and
gastric acidity. On account of the large quantities of
carbohydrates they contain, they have considerable food
value. The use of malt liquors is contra-indicated espe-
cially in such conditions as gout, obesity, diabetes, and
diseases of the urinary tract.
Wines appear to exert a depressing effect on the gas-
tric secretion. Taken in moderate quantities, however,
by increasing the appetite and the motor function of the
stomach, this depressing effect is not only overcome, but
the digestion is also greatly improved.
Cider is a beverage prepared from the fermented juice
of ripe apples. The amount of alcohol contained in this
beverage varies between 3 and 8 per cent, by volume.
It also contains malic acid, salts, sugar, albuminoids, and
extractives.
CHAPTKR HI.
VARIOUS FACTORS IN THEIR BEARING ON
DIET.
CONCENTRATION OF FOOD.
Concentrated foods arc those from which the larger
portion of the water present has been abstracted, and
thus the weight and the bulk of the food diminished.
There arc many patented concentrated foods on the
market. They find their chief use in the treatment of
patients who take too little of the usual forms of food to
maintain strength, and, second, in cases where it is impor-
tant that a large quantity of nourishment be taken.
Food can be concentrated to various degrees. Desic-
cated meat is the most concentrated form of protein ;
sugar the most concentrated form of carbohydrate ; and
olive oil the most concentrated form of fat.
1. Concentrated Proteins. — These foods are pre-
pared from milk, meat, eggs, and vegetables. Meat is
concentrated by drying, and in this form it is generally
indigestible, which can, however, be overcome by prc-
digestion or powdering.
2. Concentrated Vegetables. — Many vegetables,
such as potatoes, carrots, cabbage, and the like, arc con-
centrated by drying. Tiiey are utilized only in those in-
stances in which it is impossible to secure fresh vegetables.
Bread is frequently dried and eaten in the form of
" hardtack," when it is impossible, as during sea-voyages,
to obtain fresh bread.
X^'AR/Oi'S FACTORS /A' THEIR fSKARING ON DIFT.
PRESERVATION OF FOOD.
By preservation of food is meant tlic process by which
the food is so changed that it can be kept for a longer or
shorter period of time without undergoing putrefaction.
The process of fermentation is induced by micro-organ-
isms present in the atmosphere coming into contact with
the food and contaminating it. Since putrefactive germ.s
require a certain amount of moisture and heat for their
growth, such foods a.s contain little water and that are not
kept too warm are rot so likely to undergo decomposi-
tion ; on the other hand, foods containing much water
undergo fermentation very rapidly. To prevent this proc-
ess, four methods of preservation are, according to Yco,
available :
1. Drying.
2. Exclusion of air.
3. Exposure to cold,
4. Treatment with antiseptic chemic agents.
1. Drying. — By this process a large proportion of
the water is abstracted. Vegetables, such as carrots,
peas, potatoes, etc., are preserved by drying. Milk, in the
form of nutrose, eggs, as egg-powder, and fruits are often
preserved in this manner.
2. Exclusion of Air. — Air may be prevented from
coming into contact with food in a number of ways: by
immersing the food in oil or fat ; by heating the food, so
as to evaporate the external layers; by coating with
some impermeable substance, as oil, salt, sawdust, var-
nish, or paraffin. Fish are frequently preserved by im-
mersion in oil or by smoking. Ham and bacon are pre-
served by smoking, by which process the outer surface
becomes coagulated and impermeable. Eggs are pre-
J
82 DIETETICS FOR NURSES.
served by covering the fresh eggs with some imperme-
able substance, such as oil, fat, beeswax, or sawdust. In
order properly to preserve food by exclusion of air, it is
higlily important that the food be perfectly fresh, and that
any air that may be present be cxix^licd.
In canning, the food to be preserved is heated in tin
cans until steamed, when, all the air having been expelled,
the can is soldered and rendered air-tight.
3. Exposure to Cold. — Food can be preser\'ed in-
definitely by ice. Meat and fish, which are often pre-
served by this means, should be cooked at once after
thawing. Frozen meat loses about 10 per cent, more of
its nutritive value in cooking than fresh meat. Frequently
food is not kept directly on ice, but in refrigerating cham-
bers.
4. Treatment with Antiseptic Chemic Agents. —
I. Salting. — The salting of food is a method that has
been practised for many centuries. In this way meat
and fish are easily preserved. The pale color of the
meat produced by salting is overcome by adding a little
saltpeter in addition to common salt. After the salting
has been accomplished, it is often followed by smoking.
2. Snear in strong solution acts as an antiseptic, and
fruits arc thus often preserved in concentrated syrups,
3. Vinegar acts as an antiseptic in preserving cucum-
bers, pickles, oysters, etc.
4. Other Antiseptics for Preserving Foods. — Among
these substances are sulphur vapor ; weak carbolic acid ;
strong acetic acid; injections of alum and aluminium
chlorid into the blood-vessels; boric acid; borax; sali-
cylic acid ; formaldehyd.
The use of antiseptics to preserve foods is usually
condemned, and laws have been enacted to prevent the
L
VARIOUS FACTORS IN THEIR BEARING ON DIET. 83
adulteration of such foods as milk, beer, etc., with anti-
septics, as salicylic acid, formaldehyd, etc. While small
quantities of these substances, even taken for a consider-
able length of time, may not prove injurious, in large
quantities they are dangerous.
ARnnOAL FOOD PREPARATIONS.
To this class of foods belong those preparations that
are so concentrated as to furnish a large amount of food
in small bulk ; being of small bulk, they can be added
to liquid foods, and thus the nutritive value of the latter
increased without increasing the total quantity of liquid
taken. A number of these preparations have been men-
tioned under the head of beef-juices and meat-powders.
The various casein preparations, among which may be
mentioned nutrose, eucasein, sanose, and plasmon, are
artificial foods.
Among other artificial food preparations may be men-
tioned : I. Pemmican. 2. Peptone products. 3. Mosquera
" Beef Meal." 4. Somatose. $. Legumin. 6. Alcuronat,
1. Pemmican is prepared by cutting meat into thin
slices and allowing them to dry; sugar and dried fruits
are added, the nutritive value of the meat being thereby
increased.
2. Peptone products are predigested protein foods.
When given in large quantities they tend to produce
diarrhea, and are objectionable to many patients on account
of their disagreeable taste. Among the principal peptone
products manufactured may be mentioned Kemmerich's,
Koch's, Benger's, Savory & Moore's, Carnrick's, Ar-
mour's Wine of Beef Peptone, and Panopcptone.
3. Mosquera Beef Meal is prepared by partially
digesting meat by means of a ferment obtained from
J
L
84 DIETETICS EOR NURSES.
pineapple juice. According to Chittendtn, this product
contains go per cent, of nutritive matter (13 per cent, of
fat and "jj per cent, of protein),
4. Somatose is a predigested meat consisting of albu-
ntoses. It is a yellowish powder, tasteless, odorless, and
highly nutritious, and is usually well borne even in gas-
tric disturbances.
5. I^egnmin consists of the casein of the legumes, and
is a highly nutritious protein food.
6. Aleuronat is a brownish powder, chiefly utilized as
a food for diabetics. It contains 80 per cent, of protein.
7. Tropon is prepared mainly from fish and vegeta-
bles, and as sold on the market appears as a brownish,
tasteless powder. It is eaten mixed with broths or
Artificial Proprietary Foods. — A large number of
proprietary foods designed as substitutes for milk for
infants and invalids are on the market. Infants fed upon
such foods alone are apt to become rachitic. Some of
these foods have little food value; especially the amyla-
ceous foods in which the starch has not been predigested.
Many of these preparations contain too little fat and far
too great a proportion of carbohydrates. According to
Holt, "when children are fed upon foods lacking in fat
the teeth come late, the bones are soft, the muscles
flabby," while "children fed upon foods containing too
much sugar are frequently very fat, but their flesh is very
soft; they walk late and they perspire readily about the
head and neck,"
Hutchinson divides proprietary foods into three classes :
I. Foods Prepared from Cows' Milk with Various Ad-
ditioiis or Alterations, and Requiring only the Addition of
Water to Pit Them for Immediate Use. — To this class
I
VARIOUS FACTORS IN THEIR BEARING ON DIET. 85
belong Malted Milk, Nestle 's Food, Lactated Food, Cam-
rick's Food, Cereal Milk, Wyeth's Prepared Food, and
Wampole's Milk Food. Tliese foods arc prepared from
flour baked and mixed with milk or cream and then dried.
By means of the nialt which is added the starches are
converted into dextrin and maltose.
2. Farinaceous Foods Prepared from Cereals of which
the Starch has been Partly or Wholly Converted into Dex-
trin or Sugar, and which Require the Addition of Milk to
Fit Them for Use, — To this cla.'^s belong Mellin's Food.
Savory & Moore's Infant Food, and Henger's Food.
These foods are prepared by mixing equal parts of wheat
flour and barley malt with bran and potassium bicarbon-
ate. The mixture is made into a paste withw'ater, and
kept at a warm temperature until the starch is converted
into dextrin and maltose. As these foods are poor in
fat, protein, and mineral matters, they are added to milk
in order to render them more nutritious.
3. Farinaceous Foods in which the Starch has not been
Fredigested. — To this class belong Ridge's Food, Neave's
Food, Imperial Granum, and Robinson's Patent Barley.
These foods are poor in fat, protein, and mineral mat-
ters.
Other Proprietary Foods. — Crackers are prepared from
flour, water or milk, and are baked into various forms.
Baking-powder and soda, and frequently milk, butter,
sugar, and flavoring extracts are added. Crackers are.
as a rule, easily digested.
Halt Extracts. — Malt extracts are manufactured by
heating a solution of malted barley at a moderate tem-
perature in vacuo. Malt extracts are especially useful as
beverages for those weakened by chronic disease, as
tuberculosis or anemia, and in the convalescence from
86 DIETETICS I-'OK NURSES.
acute diseases, as after typhoid fever or pneumonia..
Among the various malt preparations may be mentionec!
Maltinc, Kepler's Extract of Malt, and Hofi's Malt
Kxtract.
COOKING OF FOODS.
The cooking of food is an art practised by all races,
savage as well as civilized. Food is cooked to improve
its flavor, to soften it so that it can be masticated and
more easily digested, and finally to destroy all parasites
and disease germs that may be present in the raw food.
By cooking certain flavors are developed, which by their
savoriness increase the appetite and the taste for the
food. Cooking, moreover, destroys the tough fibrous
envelopes that surround many foods, thus permitting
the food to be more easily acted upon by the various
digestive fluids. Various parasitic organisms present
in many foods are destroyed by cooking, and the food
thus freed from one of its most dangerous elements.
On cooking, the protein in food coagulates ; under the
influence of dry heat the starches are gradually converted
into dextrin ; whereas, under the influence of moist heat
the granules gradually swell until they rupture their en-
velopes. Sugars, by boiling, are changed gradually into
caramel, which is the source of the odor frequently given
off in the cooking of food. When fats are heated they
undergo a change, with the production of free fatty acids
which are often responsible for the odors that exist in the
kitchen.
Cooking of Meat. — Boiling. — In boiling meats tlie
temperature of the water should not exceed the tempera-
ture necessary for tiie coagulation of the protein.s. In
order that the meat may retain as much of its flavor as
possible, it should lie immersed in boiling water for a few
Various factors in their bearing on diet. 87
moments ; in this way the protein on the surface imme-
diately coaguiates, thus preventing the escape of the con-
stituents and so retaining all the nutritive elements in the
meat. After this has been accomphshed, the temperature
of the water may be lowered and the process of cooking
continued. The broth which is so produced is thin and
poor, if a rich, nutritious broth is desired, the meat
should be cut into small pieces and placed in cold water,
and the temperature gradually increased to 150° F. In
this way the nutritious elements of the meat pass out
into the broth.
Boastiiig. — In roasting, the meat is first exposed to a
high temperature and afterward cooked slowly; thus, the
outer layers coagulate at once, preventing escape of the
juices. Roasting not only prevents evaporation of the
flavors of meats, but by its effect on the extractives de-
velops savory odors and flavors.
Baking. — Baking much resembles roasting, except that
by the latter process the heat is applied all around the
meat instead of only to one side.
Stewing.— -For this purpose meat is cut into small
t pieces and placed in a small quantity of water. The
water is heated slowly, but not allowed to boil ; a certain
amount of the nutritious substances thus passes into the
water, which then becomes rich, and to which flavoring
substances and vegetables are added. Inasmuch as the
juice is eaten with the meat, none of the nutritious in-
gredients is lost.
Braising. — In this process the meat is placed in a small
vessel and covered with a strong liquor of vegetable and
animal juices; it is then heated, but not boiled. The
tough fibers of the meat are thus loosened and made
tender ; the meat also becomes impregnated with vegeta-
I
88 DIETETICS FOR NURSES.
bles and spices present in the juices, wJiich enhance its
flavor.
Broiling. — Broiling and roasting are similar processes,
except that in the former smaller portions are utilized;
the process is thus more rapid, a large surface being ex-
posed to the direct action of the heat.
Prying. — In this process the meat is put into boiling
fat, with which it becomes saturated ; fatty adds are thus
produced, which have a tendency to irritate the stomach
and cause indigestion.
Cooking of Fish.— Fish may be boiled, broiled,
baked, and fried. Boiled fish is most easily digested.
Inasmuch as the flavoring substances are more easily
dissolved out into the water and lost, less time should be
consumed in boiling fish than in boiling meat. Sir Henry
Thompson has shown that even with careful boiling 5 per
cent, of the solid matter of fish is apt to be lo.st ; for this
reason steaming is often preferable.
Effect of Cooking.— The effect of cooking on meat
is to diminish its watery constituents, tlius concentrating
and rendering it more nutritious ; by this pi ocess also the
extractives as well as some of the fats are partly removed.
Effect of Cooking on Vegetables. — The important object
in the cooking of vegetables is to rupture the cellulose
envelope and so to soften the contained starch granules.
Under the influence of heat and moisture the starch
swells and bursts its envelope, forming a paste ; this
paste, in its turn, expands and ruptures the cellulose
envelope ; cooking, therefore, renders vegetable foods
more easily digestible.
As has been pointed out, in the cooking of meats a
certain proportion of the ingredients is lost. Unlike
meats, however, vegetables become more wateiy in cook-
VARIOUS FACTORS [N THEIR BEARING ON DIET.
ing. In this condition they are more easily acted upon
by the gastric secretion ; on the other hand, the addition
of water in cooking so increases theirbulk that the motor
function of the stomach is apt to be overtaxed.
When food is cooked rapidly there is a tendency to
overcook the outer layers and to leave the inner under-
done. The better plan, therefore, is to cook food slowly
for a longer period of time at a lower temperature.
Various appliances are on the market which have for
their object the production of a continuous action of a
moderate heat at the expense of as little fuel as possible.
The " Aladdin Oven " of Dr. Edward Atkinson is an
apparatus of this kind.
DISEASES CAUSED BY ERRORS IN DIET AND BY
VARIOUS FOOD POISONS.
Disease may be caused by taking too little or too
much food, and also by a diet that is not well balanced —
that is, does not contain the combination of food elements
in the correct proportions — and by other dietetic influ-
ences, the precise nature of which is as yet obscure. It
may also be caused by certain poisons or disease germs
or parasites taken into the body with food and drink.
The diseases due to insufficient food are starvation,
malnutrition, marasmus, and some forms of anemia.
Chlorosis is liable to occur in underfed girls.
Overeating probably causes as much disease as over-
drinking. Among the most striking of the.se are gout
and obesity. Diseases of the skin, kidneys, liver, and
other organs may also be due to this cause.
Lack of fresh food may produce scurvy and an im-
properly balanced diet may cause rickets.
The abuse of various beverages deserves mention.
I
L
90 DIETETICS FOR NURSES.
The effects of the abuse of alcohol and the nervousness
resulting from the excessive use of tea and coffee are
well known.
Acnte food-poisoning is usually due to the action
of ptomains, and this is called p to main -poisoning. Pto-
mains or toxins are poisonous substances caused by
the action of bacteria, and may be generated in nitrog-
enous foods or in the alimentary tract. They resemble
alkaloids, and when absorbed are partially destroyed by
the liver. The symptoms vary, but nausea, vomiting,
purging, pain in the abdomen, and collapse are the most
frequent. Various names are applied according to the
food which cau.ses the trouble, as mi Ik -poisoning (galac-
totoxismus); chee.se-poisoning (tyrotoxismus) ; mussel-
poisoning (mytilotoxismusj ; fish -poisoning (ichthyotoxis-
mus) ; meat-poisoning (kreotoxismus). Faultily cured
sausage sometimes causes poisoning (botulismus), and
epidemics of pneumonia have resulted from eating in-
fected bacon, infected ham, or other spoiled meat. The
poison may be present without producing any change in
the appearance of the meat.
Other forms of food-poisoning are as follows :
Mushroom-poisonmg. — Poisonous fungi are frequently
mistaken for edible mushrooms and lead to poisonous
.symptoms. The active principle in these fungi is called
mu.scarin. If there is a ring about the stalk, the mush-
room peels easily and has pink gills, it is said to be non-
poisonous. This is not a safe rule, as some of the most
poisonous varieties answer to this description.
Grain-poisoning. — There are three forms of grain-poi-
soning — ergotism, pellagra, and lathyri^m. Most cases
and epidemics have occurred among the poverty-stricken
European peasants.
VARIOUS FACTORS IN THEIR BEARING ON DIET. <j\
EigotiBm (sitotoxismus) is due to eating spurred rye,
from which the drug ergot is obtained. I^thyrism
(lupinosis) is caused by eating the chick-pea. Pellagra
(maidismus) 13 caused by eating fermented maise. It is
frequently seen in Italy.
Beriberi is a disease attributed to the use of an excess
of carbohydrate food or to spoiled rice. It is thought that
it may be of bacterial origin.
Actinomycosis or lumpy-jaw, a disease of cattle, i.s some-
times transmitted to man. In some of the cases the
patients were in the habit of chewing raw grain.
Foot-and-mouth disease is another disease of cattle
which may be transmitted by the use of milk from cows
suffering with it. Such milk .should not be used. If the
disease is suspected the milk should be boiled.
Hydatid Disease. — Cysts of a peculiar character some-
times occur in man by taking the eggs of a dog tape-
worm (T^nia echinococcus) into the body with the food.
Green salads are the most frequent source of infection.
The disease is almost unknown in America.
Idiosyncrasies. — Curious food idiosyncrasies exist
and must be borne in mind. They are more often fancied
than real. Urticaria (hives) may be caused in some people
by eating crabs, oysters, strawberries, and other articles
of food. Gastric pain, vomiting, diarrhea, and other
symptoms may be produced by such foods in some per-
sons, while others eat them with impunity.
Parasites. — Certain parasites may be taken in with
food or drink. Many of these are rare, and seldom if
ever seen in America. Among them may be mentioned
the following : AmcBba coli, taken in with drinking-water,
is the cause of one form of dysentery.
Several species of tapewonn (Tienia solium in pork,
I
92 DIETETICS EOR NURSES.
T. mediocanellata in beef, etc.), of which the beef tape-
worm is the common variety in the United States, may
be met with.
The pin-worm (Oxyuris vermicularis) and the ronnd-
worm (Ascaris iumbricoides). the eggs of which are sup-
posed to be taken in water or raw food. Tlie hook-worm
(Strongylus duodenale), which causes a severe anemia, is
taken in drinking-water. The trichina is taken in with
raw pork, and the fllaria is taken in with drinking-water.
Infected Milk. — Certain diseases may sometimes be
transmitted by infected milk. Among these ^re diarrheal
diseases, diphtheria, scarlet fever, typhoid fever, and
Asiatic cholera. The last two are usually carried by
infected water.
FOOD ADULTERATION.
Food adulteration is of two kinds : that which is in-
jurious and that which is non-injurious. The latter is
practised where there are no fixed standards, or, where
such do exist, in debasements from these fixed standards.
Adulterations may be classified as follows :
1. Conventional— to suit the taste and demands of
the public. Such adulterations are usually effected by
means of coloring-matters, many of which are harmful,
and by bleaching certain products.
2. Accidental or incidental — arising from environ-
ment, carelessness, or incompetency on the part of the
producer, manufacturer, or Ins agents. This usually
consists in an admixture of some foreign substance, such
as husks, stems, leaves, etc.
3- Arbitrary — to comply with or take advantage of
certain fixed arbitrary standards.
4. Intentional — for purposes of gain and competition.
^^ 3 Art
^^^^^L certain
^^H 4. Inti
I
I
VARIOUS FACTORS IN THEIR BEARING ON DIET. 93
A Table of the Various Adulterations}
Articles.
Deleterious
adulterants.
Arrowroot.
Brandy.
Bread.
Sulphate of alum.
Butter.
Copper.
Canned vegeta-
Salts of copper, lead.
bles and meat.
Cheese.
Salts of mercury in
the rind.
Candy and con-
Poisonous colors, ar-
fectionery.
tificial essences.
CoflFee.
Cocoa and
Oxid of iron and
chocolate.
other coloring-
matters.
Cayenne pepper.
Red lead.
Flour.
Alum.
Ginger.
Gin.
Alum salt, spirit of
turpentine.
Honey.
Isinglass.
Lard.
Caustic lime, alum.
Mustard.
Chromate of lead.
sulphate of lime.
Milk.
Water.
Meat.
Infested with para-
sites.
Horseradish.
Fruit-jellies.
Anilin colors, arti-
ficial essences.
Oatmeal.
Pickles.
Salts of copper, alum.
Preserves.
Anilin colors.
Pepper.
Sago.
Rum.
Cayenne pepper, ar-
tificial essences.
Sugar.
Salts of tin and lead.
gypsum.
Fraudulent
adulterants.
Other starches which are
substituted in whole or
in part for the genuine
article.
Water, burnt sugar.
Flours other than wheat,
inferior flour, potatoes.
Water, other fats, excess
of salts, starch.
Excess of water.
Oleomargarin.
Grape-sugar.
Chicory, peas, rye,beans,
acorns, chebus-nuts,
almond or other nut-
shells, burnt sugar, low-
grade coffees.
Animal fats, starch, flour,
and sugar.
Ground rice-flour, salt,
ship-bread , Indian
meal.
Ground rice.
Turmeric, Cayenne pep-
per, mustard, inferior
varieties of ginger.
Water, sugar.
Glucose, cane-sugar.
Gelatin.
Starch, stearin, salt.
Yellow lakes, flour, tur-
meric jCayenne pepper.
Burnt sugar, annatto.
Turnip.
Gelatin, apple-jelly.
Apples, pumpkins, mo-
lasses.
Flour, ship-bread, linseed
meal.
Potato-starch.
Water.
Rice-flour.
Accidental
adulterants.
Ashes from oven,
grit from mill-
stones.
Curd.
Meat damaged in
the process of
canning.
Fbur.
Oxid of iron.
Grit and sand.
Pollen of various
plants and in-
sects.
Sand, dirt.
Tainted.
Old and wormy.
Sand.
Burnt sugar.
Sand and dirt, in-
sects dead and
alive.
* From Bulletin No. 2^, Division of Chemistfy, United States Depart-
ment of Agriculture.
94
DIETETJCS J- OR NURSES.
Articles.
Deleterious
Fraudulent
Accidental
adulterants.
adulterants.
adulterants.
Spices.
Cloves.
Flour, starches.
Arrowroot.
Cinnamon.
Spent bark.
Ship-bread.
Pimento.
Tea.
Foreign leaves, spent tea,
plumbago, gum, indigo,
Prussian blue, China
clay, soapstone, gyp-
sum.
Ferruginous earth.
Vinegar.
Sulphuric, hydro-
chloric and pyro-
Ueneous acids.
Anilin colors, crude
Wine.
Water.
Sulphate of potas-
brandy.
sium.
Wood alcohol is sometimes used to adulterate alco-
holic beverages, flavoring extracts or drugs. It may
cause blindness or death.
Lead and copper or white salts may occasionally find
their way into canned food. This may be used intention-
ally. Lead may come from solder dropped in the can or
from using dull tin (teme or roofing-tin) for the cans.
Only the bright tin should be permitted.
Preservatives. — Various chemicals are mixed with
foods to preserve them. In some countries the use of
preservatives is forbidden. Borax, boric acid, salicylic
acid, sulphate or bisulphate of sodium are the most fre-
quent. They are all injurious, and if taken into the body
continuously produce disturbances of digestion, lower
the nutrition, and may cause disease of the kidneys.
Formaldehyd is frequently used, and in general it may
be stated that its use is undesirable and dangerous.
CHAPTER IV.
THE FEEDING OF INFANTS AND CHILDREN.
There arc four methods of feeding infants : (a) Breast-
or maternal feeding, (d) Wet-nursing, (c) Mixed feed-
ing — /, c, breast-feeding supplemented by bottle-feeding.
((/) Bottle- or artificial feeding.
(a) Breast-feeding. — This is the natural and best way
to feed a baby, and every mother, if she is capable, should
be instructed about nursing her infant The mental
attitude of the mother has much to do with the secretion
of milk, and the nurse should never discuss the mother's
probable incompetency with her. All conversation should
be hopeful and encouraging. If the baby is not gaining
properly, tel! the physician and not the mother.
During the later months of pregnancy the breasts
should be examined, and if the nipples arc short they
should be gradually lengthened by gentle traction several
times a day. If they are inverted, a breast-pump may
be needed to draw them out at first. During the entire
nursing-period the breasts should be washed after each
nursing, preferably with a boric acid solution. This does
much toward preventing ulcers, fissures, and inflamma-
tions.
During the first forty-eight hours the child receives
practically no nourishment from the breast, the only
fluid secreted during this time being a yellowish creamy
sub.stance known as colostrum. This has a laxative
effect upon the child's bowels. The child should,
96 DIETF-TfCS FOH NCHSES.
however, be put to the breast at regular intervals to
stimulate the secretion of milk, which becomes free on
the beginning of the third day, although it may be de-
layed a day or two longer. During the first two days
the nursing child docs not require anything except what
it gets from the breast. It may, however, be given a
teaspoonful or two of warm boiled water or of a 5 per
cent, solution of milk-sugar. If the free flow of milk is
delayed beyond forty-eight hours the child must be given
nourishment, but should nevertheless be put to the breast
at regular intervals, to help establish the milk secretion.
Neglect of this important point often causes a failure in
the secretion.
If necessary the mother may be instructed as to the
manner in which to give the child the breast. The child
should lie on the right or left arm, according to whether
the child is nursed at the right or left breast. If the
mother is in a sitting posture her body should be inclined
slightly forward. With her free hand she should gra.sp
the breast near the nipple, between the first two fingers.
If. owing to the too free flow of milk, the child takes the
milk too rapidly, this may be checked by slight press-
ure of the fingers. The child should nurse until satis-
fied. The contents of one breast are generally sufficient
for one nursing, and the breasts should be used alter-
nately. When satisfied the child will usually fall asleep
at the breast. Under ordinary conditions nursing should
last from about ten to twenty minutes. If the milk is
taken too rapidly, vomiting may ensue during or im-
mediately after feeding. If too much is taken, it is
regurgitated almost immediately. If the infant consumes
more than half an hour in nursing, the breast and the
milk should be examined. As the infant grows it
THE FF.F.DmC OF INFANTS AND CHILDREN. 97
requires and takes more food, and consequently nurses
somewhat longer than in its earlier days.
Good nursing habits should be insisted upon, as many
attacks of indigestion, colic, and diarrhea may be traced
to improper nursing. WJien good habits are estab-
lished there is generally but very little trouble, the suc-
cess of the training depending largely upon how it is
done. Regular hours for feeding should be fixed and
adhered to; If the child is asleep at the nursing hour it
may be aroused, for it will almost invariably go to sleep
ailer nursing. After the last feeding, which should be
at 9 or 10 o'clock, the child should be quieted and
allowed to sleep as long as it chooses. During the
first month or two the infant will, as a rule, awaken be-
tween I or 2 o'clock and again at 4 or 5 o'clock. After
two or three months it will require but one night feed-
ing, and after five months of age the average infant will
sleep all night without nursing.
When the change is being made and the child awakens
for its accustomed nursing, it should be given a little
warm water from a bottle and quieted but not taken up.
The following table from Holt may be used as a guide
in breast-feeding :
Nun>h«- in
Age.
h™r3.
d„^.«,hed.,.
and?
istrfKy
4
ad day
6
3a to 28th day
4lh(ol3lhweek
8
2^
3d IQ S'h month
5th to 12th monlli
"
If the child is small or ill it will run .somewhat behind
the above schedule, and if it is large and robust some-
98 DIETETICS FOR NUkSES.
what ahead of it. It is a good general rule to feed the
child according to the age to which the child's weiglit
corresponds. The child's weight is the best index to its
nutrition. During the first few months it should be
weighed twice a week, then once a week, and during the
second six months twice a month.
If the mother's milk is unsuited to the child it is fret-
ful, the weight remains stationary or the child loses, and
there may be bowel disturbances. In such cases the
physician frequently examines the breast-milk to deter-
mine its quahty, and he may either decide to wean the
child or to take certain measures to improve the breast-
milk. The following are the most frequent means of
modifying the mother's milk :
1. If the milk is too rich the diet should be limited,
especially as to the amount of meat taken. All alco-
holic and malted drinks should be prohibited. With
plenty of fresh air and exercise, such as walking, the
desired effect will generally be brought about. The
exerci.se should be carried to the point of fatigue.
2. When the milk is good but deficient in quantity, the
supply may be increased by massage of the breasts three
times a day and from five to ten minute.s. A good malt
extract should be given with the meals, plenty of milk
should be given, and exercise and fresh air looked after.
3. When the milk is deficient both in quality and
quantity the above means should be used, and the phy-
sician generally prescribes iron in addition, and special
orders about the diet.
4. When the quantity is norma! but the quality poor
the same means should be tried, but these cases are prac-
tically hopeless, and the physician usually decides to
wean the child.
I
THE I-EEDING OF INEANTS AND CHILDREN. 99
Contra-indications to Maternal Nursing.— While it is de-
sirable that the mother should nurse her child if possible,
certain things do not permit it in the best interests of
both mother and child. It is strictly the physician's
province to decide this question, but it is well for the
nurse to know that the following are the c on tra-indi ca-
tions: I. If the mother has tubercu-
losis in any form. 2. If the mother
has had any serious complications,
either with pregnancy or parturition,
nephritis, convulsions, hemorrhage or
infection. 3. If the mother has cho-
rea or epilepsy. 4. If the mother has
shown in two previous pregnancies
that she is totally unable to nourish
her child. 5. When no milk is se-
creted nursing is impossible, but bear
in mind that the milk-supply may be
deficient because no care is taken to
estabhsh it.
{h) Wet-Nursing.— With the ad-
vent of better methods of artificial
nur-sing the wet-nurse is disappearing^
at least in the United States. Some
infants will not thrive on any but human fig. 3 —a hyuieidc nu™-
milk, and sometimes wet-nurses arc
still employed. Their choice should always be super-
vised by a physician.
(f) Mixed Feeding:. — The physician may decide to
give the child one or more bottles a day, while the milk
is being established, if it is delayed beyond forty-eight
hours, during illness of the mother, during weaning,
and often one bottle a day is allowed to permit the
I.
i
DIETETICS FOK NURSES.
necessary household or social
mother to attend
duties.
{li) ArtificialFeeding.— When it becomes necessary
for the child to be fed on the bottle, the milk-mixture
to be used should be prescribed by the physician, and
the nurse instructed by him in its preparation. It hap-
pens very often that many details are left to the nurse,
and frequently even the entire matter. The following
short account will help her understand what is expected.
(Full details will be found in our larger book, " Diet in
Health and Disease.")
The average infant will not thrive on plain cows' milk.
To render it more fit for digestion it is diluted with water,
lime-water, cereal gruels, and other articles of diet. The
necessity for this will be seen on considering the differ-
ences between cows' and mother's milk.
Proteins. — These differ in amount and character.
Mother's milk contains 1.5 to 2 per cent, of protein, on
an average. Of this two-thirds are lactalbumin and one-
third casein, the latter being much more digestible than
the former. In cows' milk there is about 3.5 per cent.
protein, of which five-sixths are casein and one-sixth
lactalbumin. The casein of mother's milk is coagulated
in the stomach in small flocculent masses. Cows' milk
is coagulated in large curds. The proteins of cows'
milk may be prevented from forming large curds by the
addition of lime-water, barley-water, and gruels.
Sugar. — Milk-sugar is present in mother's milk in a
very constant proportion of 6 to 7 per cent. In cows'
milk it averages 4-5 percent. Milk-sugar must be added
to the milk to bring up the amount, or sometimes cane-
sugar is added. Owing to its excessive sweetness, cane-
sugar is used in just half the quantity of milk-sugar.
L
THE FEEDING OF INFANTS AND Ulll.DKEN. lOI
Tat. — The fat in human milk averages 4 per cent.;
that of cows' milk is the same. When the cows' milk
has been diluted, the quantity of fat must be made up
by adding cream or using the upper part of the milk
after the cream has risen, as explained beiow in the
■' Top-Milk Method."
Salts. — The inorganic salts in the milks vary in about
the same proportion as the proteins. They need not be
considered in modifying milk for babies.
Beaction. — Mother's milk is always alkaline, uhile
cows' milk is acid or neutral. This acidity must be cor-
rected by adding 5 per cent, of lime-water. If the milk
is to be sterilized at boiling-point, the lime-water should
be added afterward, or else .sodium bicarbonate added
in the proportion of 1 grain to the ounce. Coit uses
potassium bicarbonate.
MILK MODinCATION.
There are a number of methods of modifying milk for
infants, if it is necessary to do more than to make a
milk approximate in character that of human milk. A
young and feeble child requires small percentages of all
ingredients, which may be increased gradually as the
child's digestive powers increase. Rotch gives a table
(p. 102) based on the experience of the Walker-Gordon
Laboratory.
Where the proteins are split, the result is obtained by
using mixtures of whey and cream or milk. The whey
is obtained by coagulating the casein with rennin or
essence of pepsin (Fairchild's).
I/aboratory Method. — In certain cities there are
milk laboratories, known as the Walker-Gordon labora-
tories, where physicians may send prescriptions for milk-
J
102 DIETETICS FOR NURSES.
mixtures, which are made at the laboratory and sent to
the home of the infant. The only procedure is to re-
move the cotton stopper from the bottle and replace it
with a nipple and warm the milk. The Walker-Gordon
Company also supply an ideally clean milk for infants'
Theoretic Basis for Feeding a Healthy Infant. — Rotch.
i
1
1
Ptotriiu if aplil.
ii
Ab«.
!i
J
11
Dd^l/sdweek '.
odDfjdweek .
End or 4th week.
nd of 6lh week .
End of Sib week .
nd of i^tfa week
nd of 4lh month
:3:fg=;t
ndl^^hmonlh
Endof i«h month
ndoflithmooth
EadoTiKh month
s.so
6.50
0.>s
3^
:
i
ti
1
Top-milk Method. — One of the most frequently
used methods is that of Holt, known as the top-milk
method. The milk \?. received in bottles and allowed to
stand until the cream has separated. The mixtures are
made up by using either the upper third, upper half, or
the whole milk. To remove the top milk, the first ounce
is taken off with a spoon and the remainder taken out
with a Chapin milk-dippcr, poured off, or a siphon used
to remove the milk from underneath it. Lime-water,
sugar, and the required quantity of water are added.
The following formulas are taken from Holt's book :
THE FEEDING OF INFANTS AND CHILDREN.
103
First Series of Formulas — Fat to Froteids, 3 : i.
Primary Formula. — Ten per cent, milk — fat, 10 per
cent.; sugar, 4.3 per cent. ; proteids, 3.3 per cent. Ob-
tained — (1) as upper one-third of bottled milk or {2)
equal parts of milk and 16 per cent, cream.
Derived furmulas, giving quantities for 20-ounce mix-
tures :
{Milk-BUgar .
Lime-waler .
Water, q.s. ail. 2
I
I
Table Giving in a Condensed Form the Quantities Usually
Required for Obtaining the Different Fat-percentages.
A BCDEFG H IJKLMNO
Proteids : The perceiit^e in each case will be one-third fat.
Sugar; I ounce in 20, or I loblespoonful in 8 ouoces, gives 5.5 per
cm. Tor ibe lower and 6.5 for llie higlier formulas.
I.ime-waler : I pan to 20 of ihe food, [he average required.
Water : Suflicienl to l.e added to Ihe foregoing ingredients to bring ihe
Dtal lo Ihe number of ou.icea specified; in part ctf Ihis water the miik-
ugar is dixsolved. l!ar!cy-waler or any olber diluent may be added in
Second Series of Formulas — Fat to Proteids, 2 : i.
Primary Formula. — Seven per cent, milk — fat, 7 per
cent. ; sugar, 44 per cent. ; proteids, 3.5 per cent. Ob-
tained— (i) as upper one-half of bottled milk, or (2) by
using 3 parts of milk and i part 16 per cent, cream.
i04 DIETETICS FOR NURSES,
Derived Formulas^ giving quantities for 20-ounce mixt-
ures:
I. ■< Lime-water . I oz. [-with
{Milk-^ugar . I oz.
Lime-water . I oz.
Water, q.s. ad. 20 oz.
( (( K
« li
Pro-
Fat,
Sugar,
teids.
per cent.
per cent.
per ct.
3 oz.
7p.c.
milk
. 1. 00
5.50
0.50
. 4 oz.
li
1.40
• 5.75
0.70
5 oz.
i(
1.75
6.00
0.87
6 oz.
i<
2.10
6.00
1.05
7 oz.
ti
2.50
6.50
1.25
8 oz.
((
2.80
6.50
1.40
9 oz.
i<
3.15
7.00
1.55
10 oz.
(i
3.50
7.00
1.75
2.
3.
4.
5.
6.
7.
8.
(Milk-sugar . } oz.
Lime-water . i oz. [- " 12 oz. " ** 4.00 7.00 2.00
( Water, q.s, ad. 20 oz.
1
Table Giving in a Condensed Form the Quantities Usually
Required for Obtaining the Different Fat-percentages,
ABCDE F G HI JKLM
To obtain fat per cent, j.o i.o 1.4 1.8 2.0 2.33 2.75 2.75 3.1 3.5 3.5 4.0 4.0
For total food, ounces 20.0 30.0 30.0 33.0 33.0 36.00 36.03 40 00 40.0 40.0 44.0 44.0 48.0
Take 7 per ct. milk, ) g ^ g^ ^^^ ^^.00 14.00 16.00 18.0 20.0 22.0 25.0 a8 o
ounces J
To obtain the exact fat-percentage, take one-third the number of ounces
of top-milk in a 20-ounce mixture and add 0.15 to the result. In practice
this slight error may be disregarded.
Proteids : The percentage in each case will equal one-half of the fat.
Sugar : I ounce in 20, or I even tablespoonful in 8 ounces, until the
food 1)ecomes half milk ; after that I ounce in 25, or i even tablespoonful
to each 10 ounces of the food, will give the proper amount.
Lime-water : Usually in the proportion of i part to 20 of the total
food.
Water or other diluent : Sufficient to be added to the foregoing ingre-
dients to make the total number of ounces specified ; in part of this the
sugar is dissolved.
Third Series of Formulas — Fat to Proteids, 8 : 7.
Primary Formula. — Plain milk — fat, 5 per cent. ; sugar,
4.5 per cent. ; proteids, 3.5 per cent.
THE FEEDING OF INFANTS AND CHILDREN. lOJ
Derived formulas, giving quantities for 20-ounce mixt-
ures:
fMLlt-sngar . 1 oi, ) pcrtc'ni. pfr.ci.i, va Ji-
Limc-waler . 1 oj. [ witli S 07. plain milk . I.OQ 6.0O o.S;
Waler,q.s. ad. 20 (n, J
r Milk-sugar \ o'
l\Vater,q.s.ad.20oj
Table Giving Quantities of 16 prr cent. Milk Required for
^ Formulas with High Fat and Low Protetds.
ABCDEFCHIJK
■oS^,™
Proteids in kU rases will be one-Jirth tbe fal.
Sugar : t even tableapoonful for each S ounces will give 5.5 per cent,
for the lower fomulas (A, B, C, elc.) and 6 per cent, for the higher for-
mulas (O, H, I, elc.).
Linie-wiiler : 1 ounce to 20 ounces of the faod will give 5 per cent,
Matema Graduate Method. — Where a nurse is
thrown on her own responsibility, the Estraus Matcrna
Graduate is of great service. With it six modifications
can be made, which are sufficient for the average child.
Sometimes, of course, a child will be found whose diges-
tive powers do not correspond with the few formulas
furnished.
The apparatus consists of a glass jar with a lip and
seven panels, and a capacity of i6 ounces. One of the
panels exhibits an ordinary ounce graduation ; the other
six panels present six different formulas for the modifica-
tion of cows' milk, each formula being so arranged as to
keep pace with the infant's growth, viz. :
io6
Formula
Fat . .2 per
Sugar . 6 '
Protein 0.6 ■
For Furmala 6 see special ii
DIETETICS FOR NURSES,
iper
3perc(
3} per cent. 4 per cenL 3 j per ct
7 " 7 " 3i "
'9
P
■5
j!
|1
P
Milk parts
Cmini .... "
LIiM-wmler . . "
"S4
•!^
1
Barity-^ti ; "
9%
KHavini
Containin
Having decided which formula is to be used, the panel
containing that formula is the only one to be followed.
THE FEEDING OF INFANTS AND CHILDREN.
107
The quantity desired for twenty-four hours is next to
be considered, and the apparatus filled — once, if 16
ounces or less are required for the twenty-four hours;
twice, if from 16 to 32 ounces are required for the twenty-
four hours; three times, if from 32 to 48 ounces are re-
quired for the twenty-four hours.
Banei's Method. — If the percentages have been given,
the quantities of milk, cream, sugar and water needed
may be determined by the following formulas :
Quantity desired (in ouiic
Desired perceofage of fal
Desired percentage of sug:
Desired percentage of pral
-p
Dry milk-sugnr = " '.
Example. — Suppose it is desired to make 40 ounces
of a 4 per cent, fat, 7 per cent, sugar, 2 per cent, pro-
tein mixture. By substituting the figures in the equa-
tions above we have —
Cream =1% i = 6= ounces.
Milk =4?.^-^6j = i3i ounces.
Water =40-20 = 20 ounces.
Sugar -5M9=aounces.
Malted gruels, various diastase preparations, such as
diastoid, maltine and diazyme, as well as the malted
foods, such as Mellin's, are sometimes used to prepare
the infant's milk, especially if there is constipation. Bar-
1 08
DIETETICS FOR NURSES.
ley-, oatmeal-, and rice-water are sometimes used to
dilute the milk to break up the curd. Barley- or rice-
water is preferred when there is a tendency to loose
bowels, and oatmeal-water when there is constipation.
Cereal gruels are probably best not begun before the
eighth or ninth month, unless there be .some special
indication for so doing.
Beginning Bottle - feeding. — The percentages
should be low at first, far below what would be given
the child if it were accustomed to cows' milk. As soon
as the infant's stomach is accustomed to the milk, it
should be rapidly increased in strength until the proper
mixture for the child in question is reached.
Technic of Modifying Milk at Home. — Great
care and cleanliness should be used. The vessels and
instruments used should, if possible, be kept solely for
the use of the infant. AI! bottles, pitchers, and other
utensils should be thoroughly boiled or scalded before
using. The nursing-bottles should have rounded bot-
toms, to facilitate cleansing. It is a good plan to keep
the bottles sweet by filling them with a solution either
of boric acid or sodium bicarbonate, a teaspoonful of
either drug to a pint of water. The nipple should be
ordinary short black rubber ones and white rubber, and
all nipples with tubes or complicated structure avoided,
as they are hard to clean and are liable to lead to bowel
troubles. It is a good plan to have several nipples on
hand, and to boil them when first bought, and once a day
afterward. They should be thoroughly washed after
e.ich using, turning them inside out for that purpose,
and kept in a .solution of boric acid or sodium bicarbon-
ate. The milk should drop rapidly when the bottle is
held upside down. If it does not run fast enough, the
I
THE FEEDING OF /.VFAA'TS AND CHILDREN. 109
holes in the nipple should be enlarged by using a red-
hot darning-needle. If the fiow is too free it may cause
vomiting, and such nipples should be rejected.
It is best to prepare the entire quantity for the twenty-
four hours at one time. If the weather is warm the milk
should be either sterilized or Pasteurized, unless an ex-
ceptionally pure milk is being used. If neither can be
done, thefeedings maybe prepared one at a time as needed.
The sugar, either milk or cane, is dissolved in hot
water. If the solution is not perfectly clear, it should
be filtered. This is poured into a pitcher with the lime-
water or the soda, and the milk or milk and cream and
other ingredients, if any have been ordered, should be
added. After oiixing, the nursing-bottles arc filled with
the proper quantity for each feeding, and the bottles
stoppered with sterile raw cotton. The bottles are then
sterilized or Pasteurized as directed, and then, after rapid
cooling, are placed in the refrigerator. At the feeding-
hour the bottle is heated and a nipple substituted for the
cotton stopper.
FEEDING DURING THE SECOND YEAR,
During the second year of life as much care is required
in feeding as during the first. The fear of tiie second
summer would largely be overcome if the child were
not allowed to eat food unsuited to its digestion. The
fact that some children thrive on almost any kind of food
is no excuse for permitting a child to have the same
food as its elders, as is so often done. Most of the ill-
ness and many of the deaths of childhood are traceable
to improper diet.
During the second year milk should form the basis
of the diet. In cities or where the milk-suppIy is not
I
no DIETETICS FOR NURSES.
above suspicion, it is best to Pasteurize the milk until
the second summer has been passed, or even longer if
circumstances warrant. As a rule, the milk requires but
little modification, and after the eighteenth month, and
often before, may generally be taken unmodified. As the
child is now able to digest starchy food, milk-sugar may
be omitted. In cases where the milk is not thoroughly
digested, as is evidenced by curds in the stools, hme-
water may be used, and may be added in quantities of
from 5 to iO per cent, or even more if necessary. If the
milk is very rich, it should be diluted cither with lime-
water or usually with plain -sterile water — three parts of
milk to one of water. If the milk is poor or if milk
that is not rich does not agree with the child, it may be
prepared as follows: Fill a glass three-quarters full of
milk, add one or two tablespoonfuls of cream, and fill to
the top with plain water. If this does not answer, add a
tablespoonful of lime-water. During illness, and often
under other circumstances, the alkaline carbonated waters
will be found useful for diluting the milk. If the milk
is poor, another plan is to use the upper two-thirds of
the milk.
Starchy food may be given in the form of gruel, either
alone or, what is better, mixed with the milk. Barley-
gruel or, if there is a tendency to constipation, oatmeal-
gruel is added, one-fifth or one-fourth part of gruel being
added to each feeding. The gruel .should be freshly pre-
pared and mixed immediately with the milk. A pinch
of salt and a very small quantity of cane-sugar may be
added to render it more palatable. It may then be Pas-
teurized like ordinary milk.
During the second year five meals at about four-hour
intervals should be given. The bottle should be dis-
THE FEEDING OF INF^INTS AND CHILDREN. 1 1 I
petised with and the food be taken from a cup or spoon.
If the bottle is not taken from the child early, it may be
difficult to break it of the bottle habit. The following
diet-lists for different ages will be found useful :
Twelve to Fifteen Montlis. — Milk, barley-, oatmea!-,
wheat-flour-, farina-, or arrowroot-gruei ; barley- or oat-
meal-jelly ; lightly boiled yolk of egg, given with stale
bread-crumbs.
Beef-, mutton-, or chic ken -broth, chicken-jelly, beef-
juice.
Orange-juice or the juice of other ripe fruit, as of
peaches.
First Meal. — On waking, the child should receive a
cupful of warm milk, modified as previously suggested.
If the child is accustomed to waking very early, more
miik may be given at about 7 a.m.; otherwise this last
may be regarded as the first meal.
Second Meal, 10.30 a.m. — Eight ounces of warm milk
and barley-gruel.
Third Meal, 2 P.M. — One of the following :
(a) EiLjhl m
nces (a cupful
of becf-brclh.
(*) "
.
" vcal-brolh.
(.) "
■ mul.on-brot!i.
(,/] "
..
■■ chickeii-brolh.
(.■) Yolk of
lightly hoile.
egg with sule bread-crumbs
I
Fourth Meal, 5 p. h. — Eight ounces of milk and barley-
gruel.
Fifth Meal, 10 p.m. (if required). — Eight ounces of
milk.
Orange-juice, one or two tablespoonfuls at a time, may
be given for one hour before the 10.30 A. m. feeding.
If there is a tendency to loose bowels this should be
omitted.
112 DIETETICS FOR NURSES.
If the child's appetite is very good a small piece of
zwieback may be given with either the second or the
fourth meal. This should not be soaked in the milk, but
the child should be allowed to nibble at it dry.
Fifteen to Eighteen Months. — Same as above, together
with zwieback, stale bread (oven-dried), whole eggs very
soft boiled; strained oatmeal, barley, or wheat-porridge;
bread and milk, thin biscuit (crackers), junket, scraped
raw beef or mutton jn very small quantities.
A Sample Diet for a ChUd of Fifteen to Eigliieen
Months. — Breakfast, 7 a. m. — Either («) two tabtespoon-
fuls of a cereal jelly (oatmeal or other grain as desired),
with salt and two tablespoonfuls of cream, and eight
ounces of milk to drink ; or {b) a bowl of bread and milk
containing eight ounces of milk and a shce of stale bread.
Second Meal, 10.30 A. M. — Milk, with a cracker or thin
slice of .-itale bread or a piece of zwieback.
Third Meal, 2 p. m.— One of the following; {a) Very
soft-boiled egg with stale bread-crumbs, {b) Eight
ounces of broth (beef, veal, mutton, or chicken) with
stale bread-crumbs or a little barley added to it. (r) A
tablespoonful of mashed baked potato with meat-broth
or gravy (one to two ounces), or with two tablespoonfuls
of cream. Milk to drink, {d) Scraped raw beef or
mutton, two or three tablespoonfuN on a "banquet
wafer," with a cup of milk. A tablespoonful of junket
may be added to any of these.
Supper, 5.30 or 6 p.m. — Eight ounces of milk with a
piece of zwieback, a slice of stale bread, or a cracker or two.
Fifth Meal, 10 p. m. (if needeif). — Cup of milk.
Fruit-juice may be given, as previously directed. Eggs
should not be given oftencr than twice a week, as children
tire of them easily.
THE FEEDINa OF INFANTS AND CHILDREN. I I3
Eighteen Months to Two and One-Half Years. — Milk is
to be regarded as the chief article of diet. Many chil-
dren have no desire for other foods until the second or
third year. These children will generally be found to
thrive on milk alone or with slight additions to tlie diet.
As the child's digestive power increases, the following arti-
cles may, however, be added one at a time :
Fruit. — Juice of ripe fresh fruit, that of oranges and ■
peaches being best. Ripe fresh grapes skinned and
seeded. Baked apple — pulp only, the skin and seeds to
be carefully removed. Stewed prunes, the skins to be
removed by passing through a sieve.
Meats. — Scraped raw beef or mutton ; rare roast beef
or mutton pounded to a pulp. Chicken or turkey, the
lean white meat minced to a pulp.
Vegetables. — Mashed baked potato with cream or cov-
ered with gravy from roast meats. If the latter is very
fat, the fat should be removed by skimming or by means
of a piece of blotting-paper. Very well -cooked spinach,
celery, and cauliflower tops.
Cereals. — Well-boiled rice and other well-cooked cereals
already mentioned.
Desserts. — Boiled custard, milk- and rice-puddings,
junket
Four meals will generally suffice after the eighteenth
month. The following dietary will serve as a sugges-
I tion:
If the child wakes early, a cupful of warm milk (six
ounces).
Breakfast, 7 A, m. — (a) Four tablespoonfuls of oatmeal-
porridge or other cereal with salt and two tablespoonfuls
of cream ; milk to drink, (^) Yolk of a lightly boiled
egg with salt and bread broken into it ; milk to drink.
114
DIETETICS FOR NURSES.
Second Meal, 10.30 A. m, — Cup of milk with two soda
biscuit's (crackers), slice of bread, or a piece of zwieback.
Dinner, 2 v. M. — One of the following : {a) A bowl
(eight ounces) of meat-broth with rice, barley, or bread-
crumbs added to it. Slice of stale bread; junket or
rice- or milk-pudding, {h) Tablespoonful of white meat
of chicken or of rare beef or mutton, either scraped
or pounded to a pulp. Slice of stale bread thinly but-
tered, junket, rice- or milk-pudding, or a boiled custard.
((■) Perfectly fresh boiled fish (the white meat) with a
tablespoonful of mashed baked potato moistened with
cream. Dessert as in preceding.
Supper, 5.30 cr6 p. M. — A bowl of bread and milk or a
cup of miik and a slice of bread or a piece of zwieback.
A cup of milk may be given at about 10 p. m. if necessary.
From two and one-half years up to the sixth year the
diet of the child may gradually be increased. Milk
should still, however, be taken in large quantities — about
a quart daily — as well as some form of cereal for break-
fast, with or without an egg, or fresh fruit if there is a
tendency to constipation. Meat prepared as above
should be given once a day, and preferably at the mid-
day meal, together with potato and some green vege-
table, as spinach, asparagus, or cauliflower tops. The
evening meal should be light, and consist of bread and
milk.
The Diet from Two and Oae-half to Six Years. — Milk
may be allowed with every meal (may be omitted from
dinner if desired). The average child should take a
quart a day, plain or. when plain milk is not thoroughly
digested, modified as for twelve to fifteen month.s.
Cream, — Two to eight ounces a day mixed with the
milk, taken as a beverage, with cereals, etc.
THE FEEDING OF INFANTS AND CHILDREN. II5
Bread and biscuit may be allowed with every meal —
stale bread, dried bread; the so-called "pulled bread,"
zwieback, and the various forms of biscuits or crackers.
Cereals. — Almost any kind of ccrea! for breakfast;
oatmeal and wheaten grits are the best. Rice and
hominy for dinner. Barley is useful in soups.
Vegetables may be allowed for dinner — potatoes in
some form or a cereal with one green vegetable; spinach,
cauliflower tops, and the hkc arc the best.
Eggs are very good, but children are apt to tire of
them easily. They should be given for breakfast, as a
rule, but never day after day.
Meat. — Allowed once a day for dinner, and in older
children for breakfast occasionally. Boiled or broiled
fish may be given for breakfast or dinner.
Broths and soups of simple composition may be eaten.
Meat-broths with cream and cereals are especially nutri-
tious.
Desserts. — Once a day. with dinner. Plain custard,
milk- and rice-pudding, bread- and custard-pudding, and
junket arc the best; ice cream once a week. Fruit
should be given once daily, and only ripe fresh fruit, in
season, should be used. The best are oranges, baked
apples, and stewed prunes. Ripe peaches, pears, grapes
without skins or seeds, may also be given. Fresh juice
of berries in small quantity, strawberries in perfect con-
dition sparingly. Ripe cantaloupe and watermelon in
moderate quantities may also be allowed. Great care
should be used in choosing and giving fruit to children.
It is a very important article of diet, but if stale, spoiled
or unripe, is capable of doing much harm. Too much
should not be given in hot weather. Lemonade is useful
during very hot weather.
\
Il6 DIETETICS FOR NURSES.
According to Meals. — Breakfast. — Every day, milk
to drink. A well-cooked cereal with salt and cream,
but little or no sugar. Bread and butter.
In addition to the above, one of the following every
day : Eggs lightly boiled, poached, and for older children
scrambled or made into a plain omelet. Boiled or
broiled fish. For older children a very little finely
chopped beef, mutton chop, or beefsteak. For younger
children meat at breakfast is not, as a rule, necessary.
Fruit may be given before or after breakfast, during the
latter part of the morning, or at about noon — one
variety daily; and if there is a special tendency to consti-
pation, stewed prunes or baked apples may be allowed
with the dinner, but not on the days on which they have
been used earlier. Oranges, baked apples, stewed prunes,
peaches, pears, grapes without seeds or skins; ripe
apples (the softer varieties may be given ; those known
by the dealers as " hard" apples are not suitable unless
cooked) are the most suitable.
Dinner. — Bread and butter as desired eveiy day —
not to be eaten to the exclusion of other foods, how-
ever.
One soup each day.- Bouillon, beef, veal, mutton,
chicken, or oyster-broth, which may be thickened with
barley or other cereals (either grain or flour). Milk and
cream may be added where desirable.
One meat daily — roasted or broiled. Beefsteak, beef,
Iamb or mutton chop, rare roast beef or mutton, chicken
(white meat) or roast turkey.
Two vegetables dnih— one green vegetable and one
other dish, usually potato in some form, should be given.
Potatoes, baked or mashed, cauliflower tops, asparagus
tips, stewed celery, spinach, hominy, plain macaroni.
THE FEEDING OF INFANTS AND CHILDREN. I17
mashed peas, young string-beans, and almost any green
vegetable in season.
Dessert. — junket is the best and maybe given most
frequently, but rice- and milk-pudding, plain custard
and plain tapioca-pudding may also be used in small
quantities. Ice cream once a week. Fruit in some cases
may be used.
Slipper. — Very light simple suppers should be given
every day. Milk, milk-toast, bread and butter, and, for
older children, a little stewed fruit or baked apple with-
out too much sugar.
Articles Fokbidden (after Holt). — The following
articles should not be allowed children under four years
of age, and with few exceptions they may be withheld
with advantage up to the seventh year.
Meats. — Ham, sausage, pork in all forms, salted fish,
corned beef, dried beef, goose, game, kidney, liver, bacon,
meat-stews, and dressing from roasted meats.
Vegetables. — Fried vegetables of all varieties, cabbage,
potatoes (except when boiled or roasted), raw or fried
onions, raw celery, radishes, lettuce, cucumbers, toma-
toes (raw or cooked), beets, egg-plant, and green corn.
Bread and Cake. — Ail hot bread and rolls ; buckwheat
and all other griddle cakes ; all sweet cakes, particularly
those containing dried fruits and those heavily frosted.
Desserts. — All nuts, candies, pies, tarts, and pastry of
every description; also .salads, jellies, syrups, and pre-
serves.
Drinks. — ^Tea, coffee, wine, beer, and cider.
Fruits. — All dried, canned, and preserved fruits ;
bananas; all fruits out of season and stale fruits, pai-
ticularly in summer.
The meals should be given at fixed hours, which prac-
lib DIETETICS FOR NURSES.
tice should be strictly adhered to. Feeding between
meals, even when consisting of the most trilling things,
should be avoided. If the child cannot go from one
meal to another without discomfort, the intervals should
be shortened. In certain cases it may be advisable to
give a small cup of milk or broth and a cracker between
the meals, at stated intervals, as in feeding younger chil-
dren.
Candies, cake, and the hke should be kept from young
children. In well -regulated homes, if he once learns
that he can not have them, the child will soon cease
to demand sweets. The frequent indulgence in sweets
of various kinds creates a de.sire for them to the ex-
clusion of other food. This craving is analogous to
that for alcohol in adults. Overindulgence in sweets
causes indigestion, headache, and the like, ailments that
may easily be prevented.
The child should be taught to eat slowly and to chew
the food well. To this end, some older individual should
always be present at meal-time to see that sufficient
time be taken for the meal, and that the food be finely
divided, as young children do not, as a rule, chew very
well. The quantity given to a healthy child should depend
on his appetite. In sick children this is not a reliable
guide, and where possible fixed amounts may be given.
The child should not be forced to eat, nor should he be
given special articles to tempt the appetite. If the food
offered is not taken, it is well to wait until the next meal^
when it will generally be found that the appetite has
returned. Loss of appetite is often merely an indication
that the digestive organs require a slight rest.
During the heated portions of the year the child will
require less sohd and more liquid food. The same is
I
THE FEEDING OF INFANTS AND CHILDREN. IIQ
true during sickness. Many of the gastro-intestinal dis-
turbances attributed to teething are the result of improper
feeding.
DIET OF SCHOOL OBLDREN.
The period usually spoken of as "school days" is an
extremely active one physically. The vast number of
metabolic changes going on and the growth of the body
demand a plentiful and a suitable diet. Both in and out
of school and in seminaries careful attention should be
given to food, fresh air, and exercise. In other words,
the physical development should receive as much atten-
tion as the mental growth. In boarding-schools espe-
cially the diet should be the subject of careful study, the
aim being to avoid monotony and to provide a sufficient
and satisfying diet. In many schools the dietary is left
to the discretion of the cook. In considering school
dietaries several points are worthy of consideration.
Milk, being easily digested in most cases, is of great
value, especially for children whose nutrition is below
normal. It should be furnished as a beverage daily for
breakfast and supper, and is advi.sable even with dinner.
It may also be used in the preparation of puddings and
soups. Cream is very valuable, and whenever possible
should be supplied in sufficient quantities. A cup of
warm milk with bread or crackers is helpful during the
middle of the morning and as a substitute for tea in the
afternoon. Delicate children and others may with advan-
tage take a glass of warm milk a short time before going
to bed. If the rising hour is some time before that set for
breakfast, a cup of milk or of bread and milk should be
given on rising.
Eggs may be used alone or in the preparation of vari-
ous dishes. They may be used in almost any way except
L
I20 DIETETICS FOR NURSES.
fried. Fried eggs are apt to be very indigestible. They
are often prepared in this way in order to disguise tlic
stale taste of an egg that has been in storage for some
time.
Meat is a very important part of the diet, as it con-
tains a larger quantity of protein, from which the tissues
are built up, and in a more available form, than in any other
form of food. Milk and eggs are also valuable sources
of protein. Meat should be provided, therefore, in suffi-
cient quantities, a half-pound a day being, perhaps, a
good average allowance for a growing boy, the larger
and more robust taking that quantity or more, the smaller
and more delicate children taking somewhat less. Steak,
chops, and roasts of beef mutton, lamb, fowl, and bacon
are the most suitable meats, although pork, together
with meat-stews, meat-puddings, sausage, and hashes,
may be allowed in smaller quantities. These last, while
generally relished, are not so digestible nor such good
sources of nutriment as those first named. With care
and proper preparation many of their ill effects can be
obviated. More meat is required in winter than in sum-
mer, and more in cold climates than in warm. Yeo states
that too much meat may give rise to eczema.
Meat may be given twice a day, and eggs or fresh fish
may be substituted for it about three times a week. When
these do not satisfy the appetite, meat may be added.
For this purpose cold sliced meat is useful.
Bread and butter should be given with each meal.
Bread made from the whole-wheat flour may be used in
the largest quantity, but it is well to supply various kinds
of bread, to avoid monotony. "Brown bread" given
continuously becomes very tiresome. Rye-bread may
be given occasionally, and bread made from mixtures of
THE FEEDING OF INFANTS AND CHILDREN. 1 2 1
wheat and rye is very palatable. Rusk, biscuit, and
crackers may also be supplied. Corn-bread, when prop-
erly made, may be given once a week or ofcener, and
griddle cakes of buckwheat, corn, or wheat flour two or
three times a week. These last may be served with
syrup or fruit-juices.
Cereal porridges of all kinds may be given for break-
fast, oatmeal being probably the most desirable.
Vegetables of almost all varieties may be used. For
dinner two varieties should be given, one green vegetable
and potatoes. Salads made of the green vegetables,
with the very simplest dressings, are useful additio
the diet.
Fruit should invariably be given once a day.
Sugar should be provided for in the dietary. Candies
and many of the sweets given to children are harmful and
cause indigestion and dyspepsia. If proper sweets were
provided there would be slighter tendency to indulge in
the less desirable forms whenever opportunity offered.
With the meals, and when the appetite demands satisfy-
ing between meals, they may be given with or without
a glass of milk. Regularity should, however, be ob-
served, and they should not be given immediately before
or after a meal. Fruit-syrups, sugar-syrups, honey, pre-
served fruits, and jam may be eaten with bread. Cara-
mels, chocolate, maple-sugar, and plain sugar-taffies are
the best of the other forms of sweets.
Simple desserts, such as custards, milk-pudding with
rice, tapioca and the like, bread -pud ding, plain cakes,
and properly prepared pastry may be used.
The beverages should be water and milk. Weak cocoa
or chocolate may be given after the seventh year. Tea
and coffee should not be given before the thirteenth year,
122 DIETETICS FOR NURSES.
and may be withheld advantageously still longer. Alco-
hol is not to be used except by a physician's direction.
Especial care should be taken to avoid a monotonous
diet, for there are many instances where the constant
repetition of a certain form of food has created a dislike
for it that has persisted throughout life or been overcome
only with difficulty.
A second point to be remembered is that the food
sJiould be well prepared and attractively served. This
ha.s more to do with influencing the appetite of delicate,
nervous children than is generally supposed, and can not
be insisted upon too strongly.
Overeating should be avoided, and to this end an older
person should always be present when practicable; in
school, this should be insisted upon. On the other
hand, a child should not, through caprice or habit, be
allowed to eat too little. By exercising a little tact, most
of the dislikes which are not deeply rooted, but which
may become so if persisted in, may generally be over-
come. These dislikes are often the result of imitation.
Sufficient time should be allowed not only for the
meal, but for the performance of whatever small duties
may be required of the child. A time should be set for
one or two regular daily visits to the water-closet. Hur-
rying to school should be avoided. Reading and study-
ing immediately before and after meals should be pro-
hibited, as should bathing or any very active exercise.
Some light form of recreation may, however, be indulged
in. The hours of meals should be so arranged that the
child may have freshly prepared meals, and not cold
luncheons or warmed-over dinners. Lastly, nibbling and
eating between meals, except under the conditions pre-
viously described, should be strictly prohibited. In spite
I an
THE FEEDING OF INFANTS AND CHILDKEN. 123
of stringent rules, however, many infringements will
occur.
It is by neglect of the diet, fresh air, and exercise that
many cases of tuberculosis gain headway ; anemia may
result from such neglect, and a delicate, nervous child be
the outcome of one that should, by right, be healthy.
FEEDING IN INFANT ASYLUMS.
The feeding of infants in overcrowded infant asylums,
with their lack of fresh air and paucity of attendants, is
a matter of great difficulty. Any attempt at scientific
feeding under such circumstances will ultimately lead to
failure, the method in these cases being held to blame.
The primary cause of malnutrition and marasmus in in-
stitutions is the lack of fresh air and individual care, and
until these are obtainable it is useless to attempt to ac-
complish anything by special feeding methods. In the
smaller institutions the use of the Materna graduate will
be found satisfactory.
In the larger asylums it is well to have two or three
general working formulas, such as fat 3 per cent,, sugar
6 per cent., protein 1 per cent.; and fat 4 per cent., sugar
7 per cent, protein 2 per cent. These may be varied
by adding more or less water to them to adapt them
more closely to special needs. The younger infants may,
when possible, receive special mixtures. For .sub.'ititute
feeding, condensed milk, barley- and egg-water will be
found most useful.
The allowance of a few cents a day generally made for
an infant's entire care is entirely inadequate to accom-
plish any good.
J
CHAPTER V.
THE FEEDING OF SICK INFANTS.
Stationary Weight ; I^ss of Weight.— The best
index of nutrition is the weight of tlie child. If there
is a stationary weight or the child loses weight the phy-
sician should be informed at once, as it may mean serious
trouble. If neglected it may change an easily managed
condition into an irremediable one. Panopeptone or
Liquid Beef Peptonoids or similar preparations are fre-
quently ordered for such children, and changes of various
kinds made in the feeding.
Colic. — This is more frequent in breast-fed than in
artificially fed children, and is most liable to occur dur-
ing the first three months. In breast-fed children it may
sometimes be due to the mother's milk being too rich,
and measures are frequently prescribed to relieve this.
The nursing intervals may be lengthened, and a little
warm water given before each feeding to dilute the milk.
In bottle-fed babies colic is most frequently due to the
milk containing too much protein. It may also be caused
by giving the milk too cold. Colic may be due to cold
feet, chilling of the abdomen, and numerous other causes
which have no relation to the diet.
Vomiting.— Vomiting occurring immediately after
feeding is usually due to the child's taking too much
food or the taking it too rapidly. Vomiting may be
caused at any time by the abdominal binder being too
tight, from shaking the infant or holding with the head
THE J-EED/NG OF SICK' INFANTS. 1 25
over the nurse's shoulder, or from patting on the back.
Vomiting may occur at any time when the milk is too
rich in proteins. It may be caused by coughing, and it
is also a frequent symptom of many diseases. Vomiting
one or two hours after feeding is usually due to the milk
containing either too much fat or too much sugar, or
both.
Gavage. — Gavage, or feeding by means of a stomach-
tube, is a method used in various diseases and conditions
of infancy and childhood. In cases where the child is
not able to take nourishment, or only in insufficient
amount, and in cases of uncontrollable vomiting, this
method may be resorted to. It is u.sed in the feeding
of premature infants, whether in an incut>ator or not, and
in cases of small, weak, marantic infants who, owing to
weakness or lack of appetite, do not take sufficient nour-
ishment. It is also employed after surgical operations
about the head or neck where swallowing is interfered
with, and in acute diseases, such as pneumonia, in fevers,
and in delirium or coma.
The results that follow this method of feeding are
surprising, especially in cases where there is constant
vomiting or where the stomach has a very small capacity.
In the former case, the vomiting may cease and the food
be retained ; in the latter, the capacity of a stomach that
previously held only an ounce or two may rapidly be
increased until an average-sized feeding is retained with
ease.
The technic of the method is simple and the procedure
conducted without difficulty in children under two years
if age ; above that age it may be difficult, and a mouth-
gag may be required; in some cases nasal feeding must
be substituted. The apparatus employed is the same
126 DIETETICS FOR NURSES.
that is used for washing out the stomach ; and since it is
frequently desirable to wash out the stomach before in-
troducing the meal, the same tubing may serve for both
purposes. It consists of a soft-rubber catheter, con-
nected by means of a piece of glass tubing to a piece of
rubber tubing, to the other end of which a funnel is
attached. The nurse holds the child in her lap, with the
head held straight and not inclined in either direction.
The catheter is moistened with warm water and held
several inches from the end, so as to allow enough of it
to pass into the esophagus with the first attempt at intro-
duction. The mouth is opened, if necessary, and the
catheter passed rapidly into the pharynx; there is usually
a swallowing movement, and the tube is readily passed
into the stomach. If the procedure is carried on too
slowly the tongue may interfere; or if the catheter is
held too near the end, it may cause gagging. Before in-
troducing the food it is well to wash out the stomach
with normal salt solution. As soon as all the food has
entered the stomach, the catheter is pinched and rapidly
withdrawn. If it is withdrawn slowly the food may
come up with the tube. If the catheter is left open as
it is withdrawn, the dripping into the pharynx may cause
vomiting. If the child is young, it is a good plan to
keep the finger between the jaws for a few moments, to
prevent gagging. If the food comes up the feeding
must be repeated.
Nasal Feeding-. — For thi.s purpose a catheter in
proportion to the size of the child should be used. The
procedure is the same as that for adults.
Feeding- in Inflammations of the Month. — The
food should be liquid or semisolid, and as bland and
THE FEEDING OF SJCK INFANTS. 127
unirritating as possible. If it is not taken readily it
should be given cold.
Diseases of the Stomach.— Where there is marked
vomiting and evidence of disease of the stomach milk
should be withheld, and the patient given plain boiled
water or albuniiu water in small quantities until the
physician gives his orders concerning; the feeding.
Diarrhea in Infancy and Childhood. — In a child
under two and, indeed, even in older children, one can
never say at the outset whether a diarrhea will be mild
or severe. It is therefore well to diet all cases as if they
were of a virulent type. By so doing many lives will be
saved and much suffering avoided. About 97 per cent,
of the deaths from diarrhea occur in bottle-fed babies,
and the majority of these in the hot weather.
In breast-fed children a diarrhea in winter is usually
a mild one, and merely lengthening the nursing periods
to six. hours and giving barley, rice, or albumin water in
the intervals at the feeding times is all that is needed.
After a day or two of this, together with the proper
medical treatment, the child can generally resume its
customary schedule.
In summer, however, a diarrhea, especially if severe,
should arouse suspicion, and for twenty-four hours, or
until the child's condition warrants, milk should be with-
held. The breasts should be pumped out carefully at
regular intervals, to prevent distress or a possible cessa-
tion of the secretion. The child should be given plain
boiled water, or some of the articles previously men-
tioned, at frequent intervals and in small do.ses. If there
is great thirst, one or two teaspoonfuls should be given
every fifteen or thirty minutes. If fluid is well retained,
several ounces may be given at a time, at intervals of
i
128 DIETETICS FOR NURSES.
two or three hours. Stimulants are often ordered, or
small doses of the liquid beef preparations may be tried,
such as Panopeptone, Liquid Beef Peptonoids, tonic beef
and similar preparations, diluted and given cold. Small
doses should be given, and if these foods are diluted
sufficiently the laxative action they are supposed to e.xert
will not be obtained. If by the second day vomiting ho-s
ceased and the child seems better, it may be put to the
breast for a few minutes and the effect noted. If the
milk is well borne the child may be given the breast
every six hours, shortening the interval from time to
time until the child has returned to its regular schedule.
It is well to make a gradual return, and if the milk
aggravates the diarrhea or gives rise to other symptoms,
it should again be discontinued. When the breast milk
is of good quality there is rarely any difficulty with these
cases.
In bottle-fed babies every diarrhea, especially during
warm weather, should be treated as serious, and certain
precautions be taken. For the first twenty-four hours
it is a good plan to withhold all food and give plain
water, as previously suggested. Milk is absolutely con-
tra-indicated, and must not be given until recovery is
complete. Under this plan, if the diarrhea is a simple
one, recovery is rapid. The child's appetite and condi-
tion must govern the increase in diet. Albumin water,
rice or barley water, and whey are excellent foods to
begin with. If these are well borne, malted milk may be
given, followed, if all goes well, by cows' milk. It is a
good plan, if the child is old enough to digest it, to mix
equal parts of barley water and milk together and boil
them for a few minutes. This is usually well borne, and
may be the first step in the return to the customary diet.
THE FEEDING OF SICK INFANTS. 1 29
111 the infectious forms, so long as the disease is in its
active stage, milk, since it furnishes an excellent culture
I ground for the pathogenic bacteria, acts as a poison. In
li .these severe cases no food sJiould be given fur twenty-
rfour hours. Plain boiled water or very weak albumin
water may be given in small doses at frequent intervals.
Stimulants are frequently ordered at this time. Washing
out the stomach and giving it absolute rest will fre-
quently check the vomiting. A common mistake is that
of putting too many drugs and foods into an irritable,
nauseated stomach. Absolute rest several hours will
frequently allay this irritability.
It the diarrhea continues while the stomach is at rest,
there is liable to be great thirst. This may in a measure
be allayed by small bits of ice chipped off with a needle
and placed in the child's mouth, or the mouth may be
sponged out with water to which a little lemon juice has
been added.
If the amount of fluid extracted from the body renders
collapse probable, or if the child seems greatly weakened,
the subcutaneous infusion of normal salt solution is often
used. This should, of course, be given under aseptic
precautions. One or more ounces may be given at a
time, eight ounces being the average amount for twenty-
four hours. It is astonishing how rapidly this mixture
is absorbed.
[When the vomiting ceases and the child becomes more
comfortable, food will usually be retained. Albumin
water, Panopeptonc and water, whey, rice water, and
barley water are the most suitable food.'^. The cereal
waters agree admirably with some children but not with
I others. If the child does not take them plain they ^M
I may be sweetened. ^H
L J
>30
DIETETICS FOfi NURSES.
The return to milk should be made very gradually. In
the severe cases cows' milk should be withheld for a week,
when, if the child's condition permits, it may be tried in
one small feeding. If it causes no trouble, it may grad-
ually be added until the usual diet is resumed. The re-
turn is best made by allowing the articles previously sug-
gested. Then malted milk, or one of the dry foods that is
to be mixed with water, may be given, followed by par-
tially or wholly peptonized milk or the barlej water and
milk mixture previously described. Plain well-skimmed
meat broths, such as ve^il broth, may be used. Care must
be taken to remove all the fat, as this is a frequent source
of trouble. The milk should not at first contain too
great a percentage of fat. This bold starvation plan, as
it is sometimes called, succeeds better than any other.
Later, however, care must be taken that the periods of
underfeeding be not too protracted, for while it is desir-
able to " starve out the diarrhea." the child must not be
starved to death during the process. A day or two of
absolute abstinence from food does no harm, as in the
severe cases food is not retained, or if retained, is not
assimilated; on the other hand, a reduced diet continued
for weeks and months, as is not infrequently done, is apt
to prove disastrous. It is a good plan to keep an accu-
rate record of all the food taken while the child is on a
restricted diet. The amounts taken during each twenty-
four hours may be added together, and from these it
may readily be seen whether or not the child is getting
sufficient nourishment.
Diarrhea in Older Children. — When diarrhea oc-
curs in older children, the early dietetic treatment is
similar to that recommended for infants. A.s the child
recovers a return to the ordinary diet may be made.
THE FEEDING OF SICK INFANTS. I31
meat, eggs, and broths of various kinds bcins given at
first, followed by boiled milk and toast or dry bread.
Vegetables and fruits should be given only after recov-
ery is complete, and their effect should carefully be
watched. Cereals may also cause a recurrence of the
trouble, and should be most thoroughly cooked and
given in small quantities at first.
Chronic Intestinal Indigestion. — The diet in this
disease will always be carefully outlined by the physi-
cian, and it is of the greatest importance to sec that the
directions are carried out. The disease is often pro-
tracted, and requires months or even a year or two of
careful dieting to relieve the condition. The carbohy-
drate foods are usually reduced to a minimum and easily
digestible proteins given. Slight indiscretions in diet fre-
quently lead to relapses in which all the ground gained
in several months is lost by a single improper meal.
Constipation. — This is frequently difficult to over-
come. Fruit juice given on an empty stomach an hour
before a milk-feeding is of service, as are olive oil and
cream. These latter must not be used indiscriminately,
as they may give rise to other bowel trouble if given in
too large quantities. The malted foods, such as Mellin's,
are useful ; mixed with milk or oatmeal gruel well sweet-
ened they may relieve it. In older children figs and
prunes stewed together are of value ; oatmeal and bread
from unbolted flour may be used. A glassful of water
given on rising is sometimes of assistance.
Wasting Disease.^The diet is of primary impor-
tance, but fresh air and exercise and warmth must not
be overlooked. The infant should in all cases be fed in
the nurse's arms and never in its crib. The diet is pre-
scribed by the physician.
132 DIETETICS FOR NURSES.
Rickets or Rachitis. — This is due to a diet con-
taining too little fat and protein and too much carbohy-
drate. The normal diet should be given, and cream,
olive oil or cod-liver oil added to the dietary.
CHAPTER VI.
DIET FOR THE AGED.
When a man has passed his fiftieth year his diet should
be guarded. Dietary indiscretions or a too plentiful diet
will result either in the putting on of flesh, and the con-
sequent discomforts of obesity, or in the development of
gout or allied affections. In considering the diet of the
aged the old dictum, that a man is as old as his arteries,
applies. Age can not always be counted by years. In
the aged there is a lessening of all physical activities.
The old man takes less exercise, has diminished powers
of digestion, and is less able to absorb the nutriment he
has digested. His circulation is poor and his bowels are
constipated. Degenerative processes have taken place
in his organs, and he is more apt to feel the effects of
indiscretions in diet. For these reasons the diet should
be hghter than in his younger years, and the amount of
food eaten should vary with the needs of the individual.
The food should be of an easily digestible variety; it
should be given in smaller quantities at a time and the
intervals between meals should be shortened. If there
is a tendency to obesity, food that is liable to be con-
verted into fat should be given in diminished amounts.
The proteins should be somewhat lessened from time to
time. The practice of eating heavy suppers late at night
and of eating between meals should be discontinued.
The person should learn what particular articles of food
disagree with him, and refrain from eating foods that tend
I
134
DIETETICS FOR NURSES.
to cause flatulence. Yeo suggests that in the case of
cooked fruits a smail quantity (about a teaspoonful to
the pound of fruit) of sodium bicarbonate be stewed
with them, to correct the acidity that causes flatulence.
In the aged, food bears a close relation to sleep. A
cupful of hot milk, hot toddy, or some hot liquid food
taken at bedtime will often overcome troublesome sleep-
lessness. A few .sips of milk or a mild stimulant taken
during the early morning hours, when the aged are apt
to awaken, will frequently insure sleep again.
Food Stlitable for the Aged (Yeo).— Young and
tender chicken and game and other tender meats ;
potted chicken, game, and other potted meats ; sweet-
breads ; white fish, as sole, whiting, smelts, flounder, etc.,
best when boiled; bacon grilled; eggs lightly cooked,
or beaten up with milk, etc. ; nutritious soups, such as
chicken or fish purees, beef tea, mutton and chicken
broths ; milk in all forms when easily digested. When
it is not well borne, the addition of an equal quantity of
warm Vichy or of warm water will often prove helpful.
Beef tea and milk supply the needed mineral substance,
and the former is an excellent stimulant.
The following foods are all suitable: Bread-and-milk
with the crumbs of stale bread and without lumps ; por-
ridge and oatmeal gruel ; puddings of ground rice, tapi-
oca, arrowroot, sago, macaroni, with milk or eggs, and
flavored with spices or served with fruit juice or jelly;
bread and butter, the bread to be at least a day old ;
rusk, to be soaked in tea or milk and water. Prepared
foods, consisting of predigested starches ; at this age the
digestive ferments are provided scantily by the digestive
organs, and soluble carbohydrates are valuable for main-
taining the body heat. All farinaceous foods should be
DIET FOR THE AGED, 1 35
subjected to a high temperature for some time during
the cooking process so as to render the starch granules
more digestible.
Vegetable purees of all kinds may be taken in moder-
ation — e, g,, potatoes, carrots, spinach, and other succu-
lent vegetables. Potatoes and fresh vegetables are a
necessity; if omitted a scorbutic state may be engen-
dered. Stewed celery and stewed Spanish or Portugal
onions lend variety to the diet. Stewed or baked fruits,
fruit jellies, and the pulp of perfectly ripe raw fruits in
small quantity may be taken.
CHAPTER VII.
DIET DURING PREGNANCY AND THE PUER-
PERIUM*
During: Pregnancy.— The diet should be that to
which the patient has been accustomed. There is often
craving for unusual articles of diet, and these cravings
should not be gratified. Sometimes a diet somewhat
deficient in carbohydrates and fluids is advised with the
idea of producing a small child, a thing desirable when
there are contractions of the pelvis and a difficult labor
is expected.
Diet During the Puerperium. — Formerly great
restrictions were placed on the diet of a recently deliv-
ered woman, thus accounting, in part, for the loss of
weight that has been noted. If there is no nausea and
the patient desires it, a cupful of tea or a glassful of
warm milk may be given soon after delivery.
The appetite is generally poor for a few days after
delivery, but food should be given at regular intervals
not too widely separated. The first day milk, milk toast,
or if desired, dry or buttered toast, with coffee, tea, or
cocoa, according to the taste of the patient, may be
given. Water may be allowed as desired. On the sec-
ond and third days simple soups or any of the following
may be added to the dietary: Meat broths, beef tea,
soft-boiled or poached eggs, raw or stewed oysters, and
some simple dessert, such as wine jelly, boiled custard,
136
DIET DURING PREGNANCY AND PUERPERIUM. 1 37
or junket During the next few days chicken, scraped
beef or mutton in small quantities, baked potato, rice,
and cereals may be given, and by the end of the week a
gradual return to the ordinary diet may be made.
Diet in the Diseases of Pregnancy. — Special
diets are sometimes ordered the pregnant woman on
account of diseases connected with her pregnancy.
Sometimes a milk diet or a diet similar to that used in
inflammation of the kidneys is used. When salivation
occurs a milk diet is used. Rectal feeding is used when
there is uncontrollable vomiting.
CHAPTER VIII.
RECTAL I^EEDING.
When the patient cannot taku food by the mouth, or
when it is not desirable to feed him in that way, rectal
feeding is resorted to. All the various classes of foods
may be used for this purpose. Proteins are supplied in
the form of predige.sted meat or egg albumin to which
salt has been added. Nutrose and peptones arc also
used. Grajje sugar and starch arc sometimes employed.
Fat is given in the form of the yolk of egg or cream.
Milk is al.so much used. Where the patient is to be fed
by the rectum for any length of time, combinations ofthese
are used as suggested in the formulas given below. From
four to seven weeks is the average time by which the
patient can be kept alive by this method of feeding, but
a patient has been kept alive for ten months by exclusive
rectal feeding.
The success of rectal feeding depends on the proper
technic. With poor technic the rectum soon becomes
irritable.
Procedtire. — The rectum should be cleansed thor-
oughly by administering a high injection of normal salt
solution one hour before the enema is to be given. This
cleansing should be practised at least once a day. and if
much mucus is present it may be well to precede each
feeding by a cleansing enema. If the rectum is inflamed
a solution of boric acid may be used instead of the salt
I
I
RECTAL FEEDING.
139
I mc
■ fur
solution ; or if there is much mucus a solution of sodium
bicarbonate may be employed, a teaspoonful of either to
the pint of water beiiifj sufficient. For the first one or two
cleansing enemata the bowel should be flushed by the
ordinary method; later, a return-flow catheter maybe
used; with this several quarts of solution may be used;
without it one-half to a pint will be sufficient in most cases.
The temperature of the cleansing enemata should be
between 95° and 99° F, ; that of the enemata which are
to be retained between 90° and 95° F. Solutions that
are too hot or too cold will promptly be rejected.
The position of the patient is very important. He
should lie on his side, with the hips well elevated. On
account of disease this position may be impracticable.
In this case the foot of the bed may be raised and pillows
placed under the hips, to make as much elevation as
possible. A rectal tube or a large catheter should be
used. This should not, however, be too large ; a tube
I cm. (about \ inch or less) being the proper size for an
adult. For children the tube should be proportionately
smaller. It should be lubricated thoroughly, but glycerin
should not be used for this purpose.
In introducing the tube it should be twi.sted slightly,
which lessens the hability of its becoming impacted in
the rectal folds. If it is not passed easily a small quan-
tity of fluid should be allowed to flow in, which will
serve to balloon out the rectum, after which the tube
may usually be passed with case for 8 or 10 inches or
more. The tube should in all cases be introduced as
h up as possible, as the enema is thus more hkely to
be retained and absorbed.
The fluid should be allowed to flow in slowly from
funnel or a fountain -syringe. In some instances, where
J
140 DIETETICS FOR NURSES.
very small injections are being used, a small hard-rubber
syringe may be attached to the tube. Care should be
taken to avoid injecting air with the fluid. The method
of administering nutrient encmata by means of the old-
fashioned short hard-rubber nozzle of either a piston or
a Davidson syringe can not be too strongly condemned.
In the hands of the unskilful it may cause injury to the
rectum, and even if used by a trained nurse, only suc-
ceeds in placing the fluid in the lower part of the rectum,
where it is liable to be expelled.
After the injection the patient should lie as quietly as
possible for at least an hour, and be instructed to try to
rctaiii the contents of the bowel. A pad of gauze or a
towel should be pressed over the anus for twenty minutes
or half an hour, and the mind should, if possible, be
diverted from the subject. After a few days the bowel
often acquires a tolerance for the injections and they may
be retained without difficulty.
If the rectum is irritable and the fluid rejected, the
physician may order the nurse to precede the nutrient
enemata by a small suppository containing opium, or,
what is better, a small rectal injection of the tincture of
opium may be given. This may be mixed with a little
starch water, but the whole should be as small as pos-
sible. The opium should not be used unless necessary,
and the dose should be just sufficient to quiet the bowel.
The opium may be added directly to the enema.
If there arc hemorrhoids, rectal feeding will be greatly
interfered with. Before each injection they may be
painted with a 2 per cent, cocain solution, and between
the feedings a soothing ointment should be applied.
The amount to be given at each injection is an im-
portant factor. As a rule, it should not exceed \ liter
KECTAL FEEDING.
141
(^ pint). If this be not well borne the amount may be
reduced to from 30 to 100 c.c. (1—3 oz.).
The number of eneniata to be used will depend some-
what upon the patient's constitution ; as a general rule,
five, or better six, hours should be allowed to elapse
between each feeding.
It is well to remember that packing in the vagina and
other gynecologic dressings may interfere materially
with the injection of fluid in the bowel.
Recipes for Nutrient ISnemata.^ — DujardinBeau-
metz's Nutiient Enema. —
1 cupful of miik;
2 or 3 tablcspoonfuls of liquid or 3 or 3 tea-
spoonfuls of dry peptone;
I yolk of egg;
5 drops of laudanum;
7 gr. of sodium bicarbonate if the peptone is acid.
Von Lenbe's Milk-peptone Enema. —
250 c.c. (8 oz.) milk . . . 170 calories;
60 gm, (2 oz.) peptone . . 100
270 calories.
In place of the peptone a 30 to 50 per cent, solution
of soluble protein may be used.
Egg-and-milk Enema. —
250 c.c. (8 oz.) milk . . . T 70 calorics;
3 eggs 200
3 gm. of salt.
370 calorics.
Starch-and-milk Enema. —
60-70 gni. (about 2 oz.)
starch 250 calories;
250 c.c. (8 oz.) milk ... 170
420 calories.
J
DIETETICS FOR NVJiSES.
Sugar-and-milk Enema. —
60 ^m. (2 oz.) grape sugar
250 ex. (8 oz.) milk . .
Pancreas Enema. —
50-100 gm.{i|-3oz.) pan- 1
creas substance, average )
150-300 gni. (5-8 oz.) meat 1
30-45 gm. (i-i^oz.)fat . J
246 calories;
170 ••
416 calories,
300 calories ;
350 calories;
650 calories.
L
Singer's Enema. —
125 gm. (4 oz.) milk;
125 gm. (4 oz.) wine;
1 or 2 yolks of eggs;
Salt;
: teaspoonful of Witte's peptone.
May be given three, or possibly four, times a day and is
well borne.
Biegel's Enema. —
250 c.c. (8 oz.) milk;
2 or 3 eggs;
Salt;
1 or 2 teaspoonfuls of red wine.
Riegel docs not use peptone, as he fears that it might
irritate the rectum and cause diarrhea.
Ewald's Nutrient Enetaa. —
2 or 3 eggs ;
1 tablespoonful of water.
A small amount of flour is boiled in half a cupful
of 20 per cent, solution of dextrose and a wineglassful
of red wine added. The egg solution is stirred in, care
RECTAL FEEDING. 143
being taken not to have the solution too hot, lest the
albumin be coagulated. Entire amount, 250 c.c. (8 oz.).
A Frequent Army and Hospital Fonnnla. —
3 to 5 <-'Sgs;
150 to 250 c.c. (5-8 oz.) 15 to 20 per cent, solu-
tion of dextrose.
Add a little starch solution or mucilage to make it
more viscid, and a few drops of tincture of opium.
Boas's rormula. —
230 c.c. (8 oz.) milk;
3 yolks of eggs;
A small quantity of salt;
1 tablespoonful of red wine;
1 tablespoonful of " Kraftmehl " (Health Flour).
Jaccoud's Recipe. —
250 c.c. bouillon;
120 c.c. wine;
2 yolks of eggs ;
4-20 gm. (1-5 dr.) dry peptone.
OTHER METHODS OF NOURISHING THE BODY.
Food suppositories are sometimes used, but are usually
unsatisfactory. Nutrient inunctions, especially with oils,
are useful in cases of great emaciation. Cocoa butter,
cocoanut oil, olive or cod-liver oil are the most fre-
quently used. It is questionable if any of the oil is
really absorbed, but the rubbing improves the nutrition.
Subcutaneous feeding by injections of sterile oil is
sometimes used. Sesame oil is most frequently used.
Saline Injections and Infusions.— Solutions of
salt, usually about a teaspoonful to the pint, or .special
1
144 DIETETICS FOR NURSES,
formulas ordered by the physician are used either by
injecting them into the rectum or by introducing them
beneath the skin. Such procedures are useful to combat
shock, and where large quantities of fluid have been
rapidly lost from the body, as in hemorrhage or diarrhea.
CHAPTER IX,
GENERAL RULES FOR FEEDING THE SICK.
The nurse should iiuderstand tlii: importance of the
proper feeding of the patient. Definite directions as to
how much food, its form, its preparation, and how often
it is to be given should be written out by the physician.
In all acute serious conditions, as in pneumonia or in
typhoid fever, a record of these details should be kept,
together with the record of the quantity of fluid taken,
the medicine given, etc.
There is usually a tendency to err in either extreme —
that of giving either too much or too little food. Care
should be taken that the patient's wishes are, wherever
practicable, carried into effect. The nurse should care-
fully observe the patient's likes and disHke.s, and also
note his idiosyncrasies. A tactful, observing nurse is of
inestimable value, but a careless or stupid one is an ever-
present source of danger.
The training of nurses in regard to feeding is often
faulty. Every nurse should be instructed in the subject
of practical dietetics, and .should know how much food
is required by the different types of patients.
The food should be given at regular intervals. In
unconscious or semi-conscious patients this is of great
importance; but it is just as important in the conscious,
as the appetite usually comes on at certain times, and
if the meal is not forthcoming may disappear.
The appetite of the conscious patient and of the con-
146 DIETETICS FOR NURSES.
valescent should be fostered, and nothing done that may
in any way disturb it. Patients vary much in this par-
ticular, but, as a rule, individuals who are not overfas-
tidious when they are well become so when weakened
by disease.
The sick-room should be orderly, and no dishes, uten-
sils, or food be allowed to stand about the room either
before or after using. All food and drink should be
offered from scrupulously clean glasses or dishes. These
should be as dainty as possible, and the food must be
made attractive in appearance ; when the dish permits, it
may be garnished with a sprig of green. The napkins
and linen should be spotless. The exterior surface of
glasses and cups should be wiped diy before they are
offered to the patient.
Food that is stale or that has acquired an un-
pleasant taste from standing in a refrigerator together
with other things should not be given. A strong ^^'g
in an egg-nog may be the means of turning a patient
forever against this form of nourishment. The food
should be tasted by the nurse, but never, when possi-
ble, in the patient's presence or with the same spoon.
If there is anything wrong with a dish, this should be
discovered and remedied before it is brought to the
patient.
A nurse should always remember the eternal fitness
of things. Utensils and dishes should be used only for
the purpose for which they are intended and not as
makeshifts for other articles. After caring for the patient
or removing evacuations sufficient time should be allowed
to elapse before feeding is begun. The patient should
be made to feel that the utmost cleanliness and care
have been observed. The hands and face of the patient
GENEKAL RULES tOR FEEDING THE SICK.
147
should be wiped with a moist cloth and then dried
before food is given, and the hps cleansed after the meal
is completed.
The position of the patient should be as comfortable
a one as possible, and one in which he will not tire be-
fore the meal is endtd. If the patient is weak, the food
should be given in such form that he may take enough
of it without inducing fatigue ; otherwise he may become
tired of masticating and swallowing and take an insuffi-
cient amount. Patients who can sit up in bed should be
provided with a bed-tray on which to place the food.
The legs of the tray should be placed high enough for
the patient to eat comfortably from it.
If die patient is helpless, care should be exercised
in giving food, so that it will not be drawn into the
lungs during inspiration or coughing. This may be
avoided by giving the food slowly and by seeing that
each mouthful is swallowed before another is given.
These patients may be fed in various ways. The food
may be given from a spoon, or, what is usually pre-
ferred, from a drinking-cup with a spout, or by using a
tube and allowing the patient to take the food from a
glass. When the patient is taking bread and similar
solids great care should be exercised not to allow the
crumbs to fall into the bed.
In most severe illnesses it is necessary to awaken the
patient during the night to administer food. This is a
point that requires special judgment. Often the patient
is more in need of sleep than of food. If the patient
does not drop off to sleep very soon after taking food,
it may be better to wait until he awakens before giving
it. As a rule, however, in .'severe illness the sleep is
disturbed for but a few minutes by taking food. A
I
L
J
148
DTETETICS FOR NURSES.
i
cupful of warm milk or similar food may often induce
sleep.
The patient's mouth should always be kept clean. If
dry and parched, it should be rinsed before and after
taking food. Alkaline mouth-washes may be used;
boric acid and water also make an efficient wash. If the
mouth is dry, it should be moistened from time to time,
and for this purpose a little glycerin water and lemon
juice will be found useful. If the patient is helpless the
mouth may be swabbed out with cotton fastened to the
end of a stout probe or wound about the finger. This
should be moistened with some antiseptic solution.
In all cases where the illness is likely to be protracted,
arrangements should be made to care for and prepare the
food with as little discomfort to the household as possi-
ble. For this purpose a diet kitchen may be improvised,
preferably in a room adjoining the patient's. If the
patient's means allow, a small sick-room refrigerator
should be provided, and a tin receptacle for storing foods
that do not need to be kept on ice. A gas or alcohol
lamp will serve for heating food. A thermometer, a
graduate, a funnel, and filter papers are needed, and a
meat-mincing machine will be found a useful addition.
Saucepans, a dishpan, and a supply of tea towels should
also be provided. Boric acid or borax and sodium bicar-
bonate will help to keep things fresh and clean. In
cases of infectious and communicable disea.ses a covered
boiler for disinfecting all dishes and utensils should be
added. The dishes should be boiled in water to which
3 per cent, of sodium bicarbonate has been added,
and the boiling should be allowed to continue for fully
twenty minutes after the water has begun to boil. If
this duty is delegated to someone else and the instruc-
GENERAL RULES FOR FEEDING THE SICK. I49
tions are likely to be carelessly followed out, it is best to
direct that the dishes he boiled for an hour.
Feeding: Unconscioas and Refractory Patients.
— Unconscious patients may oftc-n easily be fed by means
of a teaspoon, Ivach spoonful should be swallowed
before a second is given. In the case of comatose
children, the nourishment maybe poured into the nostril
instead of into the mouth. The fluid thus given is swal-
lowed, and any excess returned by the other nostril. If
any difficulty is experienced in swallowing, it is best to-
resort either to the stomach or the nasal tube. This is
usually done by the physician himself With a little
practice most patients can be fed with the tube more
easily than in any other way. A mouth-gag should be
introduced, or a roller bandage may be placed between
the teeth and held in place by an assistant. In infants
who have no teeth this precaution is unnecessary, as the
finger answers the purpose perfectly. The tube, pre-
viously moistened, is passed into the pharyn.x and rap-
idly into the stomach. If the tube is not passed rapidly
through the pharynx, contraction may follow and the
tube be prevented from entering the esophagus. In
order to pass the tube into the esophagus, it is neces-
sar>' to hold it sufficiently well back from the end.
If nasal feeding is to be used, a nasal tube, or in
case of infants a catheter, is well oiled and gently passed
through the nose into the esophagus and then into the
stomach. Care should be taken not to pass the tube
into the larynx. This accident can always be avoided
by waiting a moment before pouring in the food. Either
stomach or nasal tube should be provided with a
funnel, and as soon as the tube has been satisfactorily
introduced, the nourishment — miik, milk and egg, or
I
I50 DIETETICS FOR NURSES,
whatever liquid food is desired — may be poured slowly
into it.
In order to prevent air from entering in advance of
the food, a small quantity of the food may be poured
down the side of the funnel until the tube is full. In
many cases it may be desirable to wash out the stomach
before introducing the food. The tube should be with-
drawn rapidly, so as not to excite vomiting. Food so
introduced may be retained when it would otherwise be
vomited. This is true both of infants and adults.
Forced Feeding^. — In case of refractory patients —
the insane, the hysteric, and others who refuse to eat —
forced feeding becomes necessary. In this case enough
attendants should be present to control the patient. He
should be held firmly and the nasal or stomach tube may
be introduced. In order to prevent regurgitation of the
food, which some patients manage to do quite skilfully
while it is being introduced, the ribs may be tickled.
This prevents fixation of the diaphragm, without which
the food can not be ejected. This should be done only
when occasion demands.
FEEDING IN FEVER*
In fever the changes taking place in the body are
increased, while the amount of food assimilated is de-
creased. For this reason, even if the patient is well fed,
a certain amount of the body substance is burnt up. If
the patient is poorly fed or the fever protracted the
emaciation may be extreme. The appetite is diminished
or lost entirely, and it may require great tact on the part
of the nurse to see that the patient takes sufficient food.
The thirst is increased.
Foods appropriate for healthy individuals are not, as
GENERAL KULES I-OR FEEDING THE SICK.
IS'
a rule, suited for fever patients, and solid foods usually
cause vomiting or severe indigestion. In order properly
to nourish a fever patient, it is necessary that the food be
easy to take, easy to digest, and easy to assimilate. Any
food that does not possess these three qualities is not
suitable for a fever patient. When the disease runs its
course rapidly, the diet is of no great importance, for
even if the patient take but little food, the period of com-
parative fasting is a brief one and any loss is easily made
up while recovery is in progress. In protracted dis-
eases, on the other hand, such as typhoid fever, and in
chronic fevers, the diet is of primary importance. In
chronic diseases and in those fevers where remissions
occur, the periods when digestion is comparatively good
should be taken advantage of and the patient nourished
and strengthened as much as possible.
In fevers the mouth requires especial care; the bowels
likewise should be regulated and constipation avoided.
Suitable beverages should be given to allay thirst, and
if the patient is not getting sufficient liquid with his food
he should be offered water or some other drink every
three or four hours. This should be done whether or
not the patient is conscious, for a patient seemingly con-
scious is often in an apathetic condition. The water is
required not only to quench thirst, but to aid in the
elimination of waste products, which, owing to the in-
creased metabolism, are augmented. The most suitable
of all drinks is plain water. When this does not agree,
or to meet special indications, mineral waters are often
of great use. The natural waters, since they do not con-
tain such large amounts of carbon dioxid, are best. If
the artificial waters are used — and this is generally the
case — they should be allowed partially to effervesce
I
DIETETICS FOR NURSES.
. Jest the
1 the
1S2
before being given to the patient,
stomach cause unpleasant symptoms. The " Imperial
Drink" (see Recipes) is very useful and is generally
taken with a relish. To this may be added the white
of an egg, beaten up and strained, if the patient is not
taking much food. Both lemonade and orangeade are
useful, and the former is particularly valuable. Since the
hydrochloric acid of the stomach is deficient during
fevers, water acidulated with hydrochloric or phosphoric
acid i.s of service, as it increases the powers of digestion.
Barley water, oatmeal water, toast water, and albumin
water are all of service, containing, as they do, nourish-
ment with drink. Albumin water is made by beating
up the white of a fresh egg, straining it through a cloth,
and then adding six or eight ounces of water. This
may be flavored with lemon, orange, sherry, or cognac.
Wine whey is also of value, and under certain circum-
stances, as in affections of the bladder, flaxseed tea or
gum water may be given. Rarely, beer or some other
beverage is permissible. To those accustomed to taking
large quantities of beer daily this may be the only means
of getting the patient to take nourishment.
The food for fever cases should always be hquid.
Milk, as it contains various food elements in a suitable
combination, is the best of this class of foods, and if
properly administered agrees with most patients and is
easily digested. It should, as a rule, be diluted, and a
small quantity of lime water or sodium bicarbonate
should be added to it. Lime water may be added in
amounts varying from 5 to 50 per cent., according to
circumstances. Vichy or Seltzer water, or even ordinary
water, may be used, and may be flavored if the patient
prefers. Barley water or oatmeal water may be mixed
GENERAL RULES FOR FEEDING THE SICK. 153
with it, or, what is sometimes of great service, equal
parts of a cereal water and milk may be boiled together.
If the mixtures mentioned do not agree the milk should
be peptonized. Milk should not, however, be pepton-
ized if the patient can take and digest it without pep-
tonization. IJuttermilk, kumiss, or whey may also be
used. Buttermilk, however, contains less nourishment
than milk; kumiss may not be relished at first, but many
patients soon learn to like it. Lastly, infants' and in-
valids' food may be given. Malted milk may be enjoyed
by the patient, and is useful in those cases in which there
is diarrhea.
Eggs may be given raw or in the form of albumin
water, and an excellent mode of administration, especially
if the patient requires a stimulant at the same time, is to
give the time-honored Stokes' brandy-and-egg mixture.
Given in this form the egg generally agrees. It may be
well to make up the mixture with one-quarter or one-
half the amount of brandy.
Meat juices and broths, for which recipes will be given
further on, may be used. The meat extracts arc best
given well diluted. The variety of broth should be
changed each day, using beef, veal, mutton, and chicken
in turn, to avoid monotony in the diet. The various
predigcsted beef preparations and beef juices sold in the
shops may be used at times, and are often of great
value, especially when the patient can not retain other
forms of food. Strained vegetable broths are useful
occasionally in long-continued fevers, and gelatin prep-
arations, such as calves'-foot jelly, wine jelly, or fruit
jelly made with gelatin, may also be employed. Fruit
juices, especially lemon, orange, and raspberry juices,
are generally relished. These should be diluted, and are
L
154 DIETETICS FOR NURSES.
best given cold or with cracked ice. Solutions of grape
sugar alone or drink sweetened with grape sugar are to
be recommended. Granulated extract of malt dissolved
in water or milk is relished by some patients.
The question as to the value of alcohol in fevers is one
that has been widely discussed. While alcohol has
doubtless been greatly abused, it is of value both as a
food and as a stimulant. The quantity to be given and
the question whether it is to be given or not are to
be decided only by the physician. Both questions de-
pend upon circumstances, and the age, condition, habits,
and tolerance of the patient all play an important part
in deciding this question. It is usually prescribed in
small doses at regular intervals, and should, if the
stronger forms are used, be sufficiently diluted with
water.
CHAPTER X.
FEEDING IN THE INFECTIOUS DISEASES.
TYPHOID FEVER.
The management of the diet in typhoid fever is one
of the most important things for a nurse to know. The
diet to be followed is ordered by the physician, but it
will depend upon the nurse to see that his orders in this
respect are carried out in an exact and intelligent man-
ner. Whether the patient will get sufficient food or not
frequently depends on the tact and attention of the
nurse.
In this disease there is a diminution of the digestive
and absorptive powers. The digestive juices are less
active and the functions of the liver more or less dis-
turbed. In addition there are ulcerations in the intestine,
which may go on to perforation. During fever the
metabolism is increased, and unless sufficient food is
taken and assimilated the body protein will be used up
and emaciation result. This always occurs to some
extent in all cases, no matter what the food, and severe
emaciation may also occui' in well-fed cases from other
causes. It should be borne in mind that a mild case of
typhoid fever should be dieted with the same care as a
severe one.
Food and drink should be given at regular intervals,
both by night and by day; the appetite of the patient
should not be consulted, for these patients are often
apathetic or have no desire for food. The food should
IS6 DIETETICS FOR NURSES,
be given at intervals of from two to four hours, accord-
ing to the condition of the patient and the quantity taken
at a time. Those who are strong and in comparatively
good condition may take their nourishment at four-hour
intervals during the night, even if it is given at more
frequent intervals during the day.
The question of drink is also of great importance
in these cases, for in some patients severe thirst is a very
disagreeable symptom to combat. Pure water, given
with or without ice, is to be depended upon, but if there
are no contra-indications this may be varied in many
ways. The natural spring waters, or if these can not be
obtained the artificial ones, are often useful. The artificial
waters contain large quantities of carbon dioxid, and to
avoid trouble they should always be allowed partially to
effervesce before they are given to the patient. If there
is no marked bowel disturbance, fruit juice maybe added
to the water. Lemonade, orangeade, raspberry juice, and
raspberry vinegar and water are often welcome changes.
Weak tea, especially if a little red wine is added to it, is an
admirable thirst quencher. Cold weak coffee is relished
by some. Red wine and water, white wines, or even
sherry or brandy and water may be given to some
patients, especially if plain water causes unpleasant
symptoms. When there is irritability of the intestine
or severe diarrhea, red wine and weak tea are to be
preferred. Albumin water, since it combines food and
drink, is most useful. It may be flavored with lemon or
orange juice, or may be shaken up with a little sherry
or brandy and ice. (The ^^'g, which should always be
perfectly fresh, should be beaten and then strained
through a cloth.) The various mucilaginous drinks
may be used, but are not generally relished. Gum-arabic
FEEDING IN THE INFECTIOUS DISEASES. I 57
water, arrowroot water, bread water, barley water, oat-
meal water, and similar beverages have their place in the
physician's list of possibilities.
Uilk. — The food par excellence in this disease is miik.
There is no one food that meets so many indications. It
possesses great nutritive value, is easily procured, as a
rule, and is generally easily administered. It must be
borne in mind, however, that there are some patients
with whom milk disagrees, and many who do not like it.
Milk, however, disagrees less commonly than is gener-
ally imagined. The amount to be given daily varies
between one and three quarts, according to the patient.
There arc not many patients who can take three quarts
of plain milk, and it is generally a good plan to vary its
form of administration, and occasionally to substitute
for it other articles, which will be mentioned further on,
so that the patient may continue to take milk during the
entire course of the disease. If milk is given plain, it is
only a question of time when it will disagree with any
patient. Children are more apt to take it over long
periods of time than are adults. At the Garrett Hos-
pital for Children in Baltimore the authors seldom use
anj-thing besides milk for typhoid cases, and do not find
it necessary to make changes in it. For older children
or adults it should always be modified. When milk
forms the diet, the mouth requires particular care, as the
little milk that remains in the mouth often turns the
patient against the next feeding.
There are many ways of modifying milk and render-
ing it more agreeable and more digestible to the patient.
The simplest method is to add from one to three ounces
of lime water to each glass of milk, or plain water or a
mineral water may be used instead. If milk is well borne
158 DIETETICS FQK NURSES.
and it is desired to increase the amount of nutriment,
cream may be added to it. If this causes unpleasant
symptoms it should be discontinued at once. Butter-
milk may be given occasionally, but is far inferior in
nutritive value to plain milk. Kumiss or kefir may be
used, and while they may not be relished at first, most
patients learn to enjoy them. A pinch of salt may
render milk more paiatable to some persons, and the
addition of a spoonful of brandy may be relished by
others. The milk may be given cold, be flavored with
fruit juices, vanilla, or nutmeg, or it may be given in the
form of ice cream. When milk is not well borne, it is a
good plan to prepare barley water and add to it an equal
quantity of milk, boiling them together for a few minutes.
Plain boiled milk may also be used with benefit.
Among the disagreeable symptoms to which milk gives
rise may be mentioned a bad taste in the mouth, which,
however, is apt to be present in any ca.se ; a sense of
fulness or pressure in the abdomen ; eructation ; or even
pyrosis. When the milk is not well digested it may
cause diarrhea, with colicky pains, and the undigested
curds will be found in the stools. To obviate these
symptoms the measures previously suggested may be
tried fsee also Miik Cures). Malted milk may be used,
or the milk may be mixed with some of the invalid foods,
or it may be partially or completely peptonized. For
the last purpose the peptogenic milk powder will be
found u.seful.
When milk is found to disagree, other forms of nutri-
ment must be given. If care is taken to supplement its
use by other foods from the beginning, the milk will be
less apt to cause disturbance.
The carbohydrates are valuable foods in typhoid
■ St
FEEDING IN THE INFECTWUS DISEASES. I 5g
and may be used in many different forms. Of these,
the various grueis are the most easily digested, and may
be given plain or mixed with milk or bouillon. Oatmeal,
thoroughly cooked {three hours' boiling at least) and
strained, is best, but may not agree with the patient.
Barley water (Robinson's barley flour is an excellent
preparation for making barley water), arrowroot, sago,
tapioca, and the prepared foods may all be used. In
Germany aleuronaut flour is added to bouillon or soups.
Of the proteins and alhed substances there are a
number tiiat may be used. Meat is to be forbidden so
long as fever occurs. Fat must be skimmed from soups,
broths, and bouillon, as it is apt to disturb the patient's
digestion. Beef juice made according to any of the
recipes given in the Appendix may be used, or beef
juice expressed from very sligiitly broiled beef or
skimmed dish gravy may be used. This may be served
in a green glass if the color of the juice is objectionable,
Bottle bouillon may be employed, as may also the vari-
ous liquid beef preparations and meat juices now on the
market. Mosquera Meat Jelly and Valentine's Beef
Juice are useful but expensive. Beef extracts are more
stimulating than nutritious.
Senator recommends gelatinous sub.stances. such as
gelatin, calves'-foot jelly, bottle bouillon, and the like.
Oysters may be served with gelatin. The gelatin jellies
may be flavored with fruit juices or with wine.
SgrSS should be used sparingly. Egg water, how-
ever, when properly prepared, rarely causes distress.
Raw eggs may occasionally be given, or the yolk of an
egg in bouillon or broth. Eggs and milk together may
cause indigestion ; but if the patient is in need of a
stimulant as well as a food, Stokes' brandy-and-egg
i
l6o DIETETICS FOR NURSES.
mixture may be used, and in moderate quantities rarely
disagrees.
Somatose, eucasin, nutrose, and similar preparations
niiiy be mixed with bouillon or other foods.
Alcohol holds an important place as a food as well as
a stimulant in long-continued fevers. The tendency to-
day is to prescribe it in smaller quantities than formerly,
and many have abandoned its use altogether. It is,
nevertheless, a valuable ally in fighting typhoid, and
should not be discarded. It is not given to children as
a routine treatment, but even in young patients it is often
of the greatest service. When given to adults, it is well
to begin with very small doses and to increase these as
the patient grows weaker or as the fever continues to
progress. Too much should not, however, be given ;
and if the dosage has been too large at first, it can not
be increased as needed later on. In habitues, alcohol
will be needed from the outset.
The form of alcohol to be used is largely dependent
on the patient's taste. As a rule, good old whisky,
properly diluted, is best. Old brandy is good, but much
of the brandy sold is of very inferior qualitj-. The red
wines are useful, especially when there is diarrhea, and
the old white wines are excellent if the patient cares for
them. The brandy-and-egg mixture previously mentioned
is very useful.
Care of the Mouth.— This is of primary importance.
If begun early and persisted in, many undesirable mouth
conditions can be avoided. If the mouth is in good
condition the patient can, as a rule, take his food easily;
if it is not, the greatest difficulty may be experienced.
After each feeding the mouth should be cleansed care-
fully, a proceeding that should never be neglected. If
I
r
FEEDING IN THE INFECTIOUS DISEASES.
the patient is strong enough he may rinse the mouth
with a nwld antiseptic solution. Boric acid solutions to
which a little glycerin and lemon juice have been added,
or one of the prepared mouth washes diluted with water,
may be used; diluted oxygen peroxid is also serviceable.
If the patient is too weak to do this, the nurse should
swab the mouth.
Diet in Digestive Disturbances. — In cases where
the food is rejected or badly borne it is necessary to. give
the stomach absolute rest for several hours or i
Then very small quantities of egg water, barley water
and lemon juice, or similar preparations may be given.
Panopeptone and the liquid beef preparations are use-
ful in this condition, and may be served with cracked
ice or diluted with water. Weak tea or red wine and
water in small doses are useful, especially if there is
diarrhea.
For the diarrhea an ice-bag to the abdomen has been
highly recommended, but is seldom well borne. Instead,
cloths moistened with cold water may be used.
For the painful and troublesome accumulation of gas
in the intestine, either the ice-bag or the cold applications
may prove beneficial. The authors have obtained excel-
lent resuhs from the use of turpentine stupes. When
the meteorism is due to the imperfect digestion of starch,
the carbohydrates should be reduced or withdrawn ;
when it is due to milk, the form in which this is given
should be changed or it should be withdrawn altogether
for a time.
Hemorrliage. — When hemorrhage from the bowel
occurs the intestinal tract should be given absolute rest
for a number of hours. An ice-bag, cold applications,
or a cold-water coil should be placed upon the abdomen.
^^ his
162 DIETETICS FOR NUhSES.
To relieve the thirat the patient may be allowed to suck
small bits of ice, or ice-cold water or cold tea may be
given in spoonful doses. After some hours the patient
may be given a teaspoonful of cold milk, and tins may
be repeated every two or three hours. Beyond this, if
the bleeding is severe, the intestinal tract should be given
complete rest for twenty-four hours or longer. In addi-
tion the physician may order opium or morphin. The
returji to the regular fever diet should be made gradually
and with caution.
Perforation.— When perforation of the bowel occurs
all food should be discontinued. The patients are usually
operated upon as soon as possible or the patient is given
anodynes. Following operation, the diet will be that of
any bowel perforation that has been operated upon. If
the patient rallies without surgical intervention, or when
this has been found impracticable, food may be given
after an interval of twenty-four hours, but only in very
small quantities at sufficiently wide intervals. It is best
to begin with teaspoonful doses every three hours, and
if the food is retained this may gradually be increased.
Usually food is rejected, and when this is the case the
stomach should be given complete re.st, for feeding only
tends to aggravate the condition.
Convalescence. — The diet during the first weeks of
convalescence requires as much care and attention as it
received throughout the febrile period; in fact, since
these patients often develop a ravenous appetite, born of
.several weeks' milk diet and fever, even greater care is
necessary. The patient's wishes should in nowise govern
his diet, and relatives and friends .should be cautioned
against giving the patient anything not ordered by the
physician. Many a relapse and death has been caused
FEEDING IN THE INFECTIOUS DISEASES. 163
by the misguided kindness of friends and relatives in this
respect.
When there has been severe bowe! disturbance, the
patient is to be kept on a liquid diet until the ninth or
tenth day of the afebrile period. After mild cases, where
there has been but little bowel disturbance, changes may
be made in the diet after the fifth or sixth afebrile day.
In these mild cases the greatest caution is required, as
they arc often quite as apt to do badly as are the severe
ones, and the attendants are much more likely to be
careless in carrying out instructions.
The first addition to the dietary should be made by
giving a piece of zwieback over which hot milk or cream
has been poured. If desired, milk toast, milk and crack-
ers, or junket may be substituted for this. If this is
well borne, other articles, such as sofl-boiied eggs, or the
soft part of oysters, if they are in season and can be
obtained fresh, may be added from day to day. Thick-
ened meat broths containing well-boiled rice or vermi-
celli may be given. Finely scraped raw beef, reduced to
a pulp in the manner suggested for tuberculosis patients,
also lends variety.
Tender meats, vegetables, and breadstuffs in increasing
quantities may be allowed. Roast chicken, squab, or
partridge, boiled (white) fish, such as trout ; of the vege-
tables, spinach, cauliflower tops, asparagus tips, purees
of peas, carrots, or tender string-beans or artichokes,
well-cooked rice, and baked potato mashed and served
with cream or dish gravy; toast, zwieback, crackers, and
the crust of bread may all be permitted. If the condi-
tion of the bowel permits, fruit juices may be allowed,
as well as a baked apple, apple sauce, or junket flavored
with fruit. Other sick-room delicacies may be ordered
es,
ed
di- ■
164 DIETETICS FOR NURSES.
at the discretion of the physician. Chops, tender steak,
and roast beef may generally be given in the third
afebrile week (very finely divided meat may be allowed
much earlier), and the diet gradually changed until the
ordinary diet is resumed. For some time after an attack
of typhoid fever the patient should be instructed to exer-
cise care in the selection of his diet, and especially to
avoid all food, such as green fruit, green corn, crabs, and
the like, that is likely to cause diarrhea.
The following menu for the first week of convalescence
may serve as a guide and may be altered to suit the in-
dividual case. It may be begun about the fifth or sixth
afebrile day in mild cases, and about the ninth or tenth
in severe cases. Milk should form the bulk of the diet
at this period.
First Day. — Milk toast, or zwieback covered with hot
milk or cream, or crackers and milk ; beef juice.
Second Day, — Chicken broth thickened with rice
or vermicelli (the rice should be boiled thoroughly);
soft parts of several oysters, or a very lightly boiled
egg.
Third Day. — Junket; a meat broth thickened with
well-cooked barley (boiled at least three hours), with
barley flour, or with stale bread crumbs ; wine jelly ;
scraped raw beef.
Fourth Z?^j.— ^Lightly boiled or poached egg ; arrow-
root, barley gruel, or milk toast ; chicken jelly.
Fifth Day. — ^Junket; a little well-boiled rice with a
small amount of finely divided roast chicken, squab, or
partridge, preferably the white meat; apple sauce if
bowels permit.
Sixth Day. — Scraped beef; poached t,%^ ; calves'-foot
jelly ; baked custard ; piece of toast or zwieback.
FEEDING IN THE INFECTIOUS DISEASES. 165
Seventh Day. — A small piece of finely divided broiled
chop or steak ; baked potato ; baked apple ; well-boiled
rice and cream for breakfast ; junket for supper.
Atypical and Complicated Typhoid.— In these
forms the physician often departs from the usual course
of diet and orders a diet to meet the special indications.
TYPHUS FEVER.
The diet is that of all fevers and requires no especial
precautions. Milk is the main stay, and a quart of milk
and a pint of broth maybe regarded as a fair daily allow-
ance. Eggs are better borne than in typhoid and may
be allowed. Rolls, zwieback, and chopped meat arc
allowed by some physicians even while there is fever.
Black coffee is useful if there is stupor. Water should
be given freely.
SHALL-POX.
The usual fever diet is used. Owing to the great
drains on the patient's system when the stage of sup-
puration is going on, it is desirable that the patient be
fed up as much as possible during the stage of remission
of the fever. If there is much pain on swallowing, and
there often is, the food may be given cold.
SCARLET FEVER.
One of the chief dangers of scarlet fever is inflamma-
tion of the kidneys. The diet should be bland and un-
irritating to the kidneys. Milk diet should be continued
for a month, and with this diet nephritis is uncommon.
The diet need not be strictly milk. The various modifi-
cations of milk maybe used ; kumi.ss and buttermilk are
1 66 DIETF.TICS FOR XVRSES.
also useful ; oyster or clam broth from which the shell-
fish have been removed may be given.
F'tr the thirst, which is generally great, plain or car-
bonated waters, barley water, orangeade, or lemonade
may be given freely, A level teaspoonful of cream of
tartar stirred into a glass of lemonade is a useful diuretic
drink if albuminuria is present
Plain vanilla ice cream or plain lemon juice may be
given in small quantities. Finely shaved ice, also in very
!>mall cfuantiticsand flavored with a little lemon or orange
juice, often makes a most grateful addition if angina is
marked.
In all cases the diet should be gradually increased
from day to day during convalescence. The following
may serve as a guide to the order in which this increase
may be made : Milk toast, junket, custard, farina pudding,
oranges, rite pudding, baked apple, bread and milk, sago
or tapioca pudding with or without apple, corn-starch
pudding, boiled custard.
The return to meat is best made by allowing a small
quantity of boiled or baked fish, the soft parts of oysters,
very soft-boiled eggs first, and then the lightest and most
easily digested meats, chicken, raw or very rare beef in
minute quantities, and the like.
During the height of the disease and throughout con-
valescence mc.it c.vtracts should bo avoided, as they con-
tain large quantities of meat extractives, which are liable
to irritate the kidneys.
MEASLES.
The diet is that of any fever. No especial precautions
need be observed.
FEEDING IN THE INFECTIOUS DISEASES. 167
MUMPS.
Liquid diet should be ijivcn while the fever and swell-
ing; exist. Acids and astrin';ents should be avoided on
account of the inten.se pain they are liable to cause.
WHOOPING-CXJUGH.
The diet requires close attention, especially if the case
is severe. Mild cases should be given a light genei^al
diet. If the case i.s severe a liquid diet should be given,
and this should consist largely of milk. The great diffi-
culty is that the food is liable to be vomited at the close
of the paroxysms. This may occur so frequently that
the child has difficulty in retaining sufficient food to
nourish it. A good plan is to give another meal in place
of the one which has been vomited, as soon as the child
is able to take it.
DIPHTHERIA.
Egg-nog and milk punch are sometimes useful, although,
as a rule, stimulants are be.st given alone and not com-
bined with the food.
If the patient can not swallow, nutrient cneniata may
be resorted to ; a nasal or a stomach tube may be em-
ployed. If the latter mode of feeding is adopted, care
should be taken to avoid struggles with patients whose
hearts are weak.
In all cases, if there is any fever, the food should be
liquid and should be given in small quantities at regular
intervals. The most useful of the liquid foods are milk,
plain, with lime water or a carbonated water, or pepton-
ized albumin water; .some form of predigested beef,
liquid beef peptonoids or panopeptone ; soups and
gruels, and the various prepared foods, of which malted
milk, Eskay's or Mellin's foods are examples.
J
i68
DIETETICS FOR NURSES.
OccasionalJy semi-solids are swallowed with greater
ease than liquids ; in this case any of the foods just men-
tioned may be thickened with well-cooked cereals or
gelatin, or custards or junket may be given. Ice cream,
if plain, may be allowed in moderate quantities.
Intubation, — After intubation has been done there
may or may not be some difficulty in swallowing. As
a rule, when the child swallows for the first time
there may be a slight cough or some hesitation ; in the
majority of cases, however, this disappears as the appre-
hension of the child is allayed. There may be a little
difficulty for the first day, but this passes off gradually
as the muscles become accustomed to work under the
new conditions.
If the child is old enough he should be instructed to
take the food as rapidly as possible and then to cough
afterward, instead of after each act of deglutition, as he
is apt to do. In some children there may be a slight
regurgitation through the nose. Taken all in all, the
difficulty experienced in feeding these cases is small
compared to the enormous benefit the child derives from
the operation.
If there is difficulty in swallowing liquids, solid or
semi-solid food may be given instead. The child may
be placed with his head lower than his body. In this
position swallowing becomes easy. The child may also
lie across the nurse's lap, with his head thrown well back
and down. It should always be remembered that food
may be refused because of nausea, or because the child
has no desire to take anything, as well as owing to any
actual difficulty in swallowing.
The diet should be the same as in non-operative ca.ses,
and if semi-solids or solids are required, soft-boiled eggs.
I
FEEDING m THE INFECTIOUS DISEASES. 169
milk toast, custards, bread and milk, oatmeal porridge,
and similar foods may be given.
If swallowing becomes impossible, an event that oc-
curs very rarely, the child may be fed with the stomach
or nasal tube or by means of nutrient enemata.
No especial dietetic rules are necessary for feeding
tracheotomy cases.
Postdiphtheric Paralysis.— In paralysis of the
muscles of deglutition which may occur after diphtheria,
most of the food may return through the nose ; or if the
muscles of the tongue as well as the soft palate are in-
voved, deglutition becomes impossible. When this occurs,
the child must be fed with the stomach or nasal tube or
by the rectum.
RHEUMATBH.
The diet in this disease is still a matter of dispute.
During the acute stage it is best to give milk or a milk
and farinaceous diet. Buttermilk, gruels, and the like
are useful. A gradual return is made to the customary
diet.
YELLOW FEVER.
Food is usually withheld duHng the first stage of the
disease, as it is almost certain to be vomited if given and
only aggravates the condition. Stimulants and saline
solution and even food may be given by rectal injec-
tions. Milk and lime water or albumin water are given
during the third day and thf diet gradually increased as
the physician sees fit. If the patient grows worse every-
thing is vomited,
TETANUS.
Liquid nourishment is given, when possible, between
the teeth ; if the teeth fit too closely together it is some-
times customary to remove one. A nasal-tube can be
170 DIETETICS FOk NURSES
used in some cases and a rectal tube in others. When
the disease is so severe that the slightest movements
about the patient produce convulsions, feeding becomes
impossible except while he is under the influence of an
anesthetic.
RABIES.
Only those who have seen this terrible disease appre-
ciate the difficulties in feeding these patients. Liquid
nounshment may be given so long as the patient can
swallow if he desires food. Even the slightest move-
ments near the patient produce spasms, and, as the
result is uniformly fatal, it is not necessary to add to the
patient's sufferings by trying to feed him.
TUBERCULOSIS,
Diet in tuberculo.sis is of primary importance. We
shall consider only pulmonary tuberculosis, for the same
rules apply to all forms.
The weight of the patient is a fair guide as to the state
of his nutrition. To maintain this rest is essential, and
in addition to the full night's rest the patient should lie
down at least half an hour after meals.
The food is to be chosen from the articles mentioned
below, although other things may be given. The food
should be made as attractive as possible. Detweiler was
fond of saying, " My kitchen is my pharmacy."
Milk. — This is one of the most important articles of
diet for the tuberculous patient. Unless some special
reason exists, milk should always form a part of the diet.
It may be taken with the meals or be given between the
intervals of feeding. It is of the utmost importance
that the milk be sipped slowly and not swallowed quickly
in large quantities. The milk may be taken plain or
FEEDING IN THE INFECTIOUS DISEASES- I/I
may be modified in various ways. Lime water may be
added, with or without the addition of cream ; carbon-
ated water may be mixed with it or the milk may be
peptonized. Buttermilk or kumi.ss may be taken if
desired.
Eggs, when they can be taken in sufficient quanti-
ties, are also of the greatest value. In certain cases,
however, they may not be well borne. If the entire egg
can not be taken, the whites alone may be given. Egg
albumin often renders most efficient service in helping
to nourish these patients. The whites of from six to
twenty-four eggs beaten up lightly and strained through
a cloth may be taken daily. A very small pinch of salt
and a little lemon juice or other flavoring substance may
be added. Given in this way a large number of eggs can
easily be taken and are almost invariably well borne. If
the patient can digest the eggs entire they may be very
lightly boiled, or, as a change, they may be made into a
light omelet or poached. Hard-boiled and fried eggs
should not be eaten.
Meat. — Meat of all kinds, if properly prepared, may
be eaten ; but " high " game, highly seasoned dishes,
and twice-cooked meats should be avoided. Beef and
mutton are the most suitable varieties. Raw meats,
especially raw beef, is given in the form of a finely
divided pulp. This is prepared by scraping the meat
with a knife, which will result in a mass of shredded
meat fiber. This is placed in a mortar and pounded and
rubbed with a pestle until quite smooth. It is then
pressed gently through a sieve to remove any larger
particles. This raw meat pulp is very easily digested
and highly nutritious. It may be given in various
as spread on sandwiches or given in milk or in
ways, ^H
172
DIETETICS FOR NURSES.
bouillon. It may be mixed with purees of various kinds
or with vegetables, or, in case of children, with small
quantities of preserves. It may be rolled into balls and,
so, easily swallowed ; or it may be served with an egg,
with anchovies, or with pickled herring.
Meat juice is also of great value. This may be pre-
pared according to any of the recipes given in the Appen-
dix, or the juice may be expressed from beef by means
of a meat press. Good round-steak should be very
slightly broiled, cut into .small cubes, and the juice
pressed out. With a good press about eight ounces of
juice can be extracted from a pound of meat. This
should be .seasoned, and heated by placing the vessel
containing it in warm water. Care should be taken not
to heat it too thoroughly, or the albumin will coagulate
and the juice be .spoiled. Freshly prepared beef juice is
always preferable, but when this can not be obtained,
liquid beef peptonoids, predigested beef, or Mosquera
Beef Meal may be employed.
For patients who can not or will not take raw beef,
very rare steak, roast beef, or beef soup should be sub-
stituted.
Pish. — Fresh fish, boiled, broiled, or baked, may be
allowed. Both oysters and clams from which the hard
portion has been removed may be eaten, preferably raw,
but they may also be given stewed, roasted, or broiled.
Cereals. — Where these can be digested they are of
value. In the early stages of the disease they serve not
only as nutriment, but also aid in regulating the bowels,
and are usually easily digested. If there is constipation
they are of especial value. Oatmeal, wheaten grits,
commeal mush, and rice and milk are the most suitable
foims.
I
FEEDING IN THE INFECTIOUS DISEASES. 173
Vegetables. — Any of tfie easily digested vegetables
may be allowed. They should be steamed or cooked
with as little water as possible, to avoid dissolving out
the salts, which, togclher with much nutriment, arc
thrown away with the water.
Wheat. — Wheat or rye bread or a mixture of both
may be used. Zwieback is of great value. All hot
breads, pastry, and cakes should be avoided.
Fruit. — All fresh and, preferably, ripe fruit may be
allowed in moderation. It should be taken the first
thing in the morning or as a dessert. Oranges and baked
apples are well borne and useful, and grapes, peaches,
pears, and other fruit in season may be allowed.
Fats. — In tuberculosis, when fats and oils can be
taken and absorbed, the prognosis is always much better
than when these can not be tolerated. While they arc
of the greatest value in treatment, care should be taken
not to disturb the patient's digestion by forcing more
fatty foods into the dietary than the stomach will toler-
ate. Most patients, however, soon acquire a dislike for
fats of all kinds. They are best given in the form of
cream and butter; the yolks of eggs, crisp fat bacon,
and olive oil are also useful. Cod-liver oil is really as
much a food as a medicine. Kither the plain oil or an
emulsion may be used, and the doses should be small
to begin with and gradually be increased. A common
mistake is to administer the oil in excessive quantities.
Only perfectly sweet fresh oil is to be used, as rancid or
stale oil may disturb the digestion. Its use should be
discontinued from time to time. Children bear oil better
than adults. If there is a tendency to diarrhea, fats and
oils must be used with caution.
Alcohol. — Concerning the use of alcohol in the treat-
1/4 DIETETICS FOR NURSES.
ment of tuberculosis, it may be said that, except in the
last stages of the disease, it is best avoided.
Patients who are gaining in weight or who arc in good
condition are better off without alcohol. Those who are
going down hill may often take light wine, beer, or well-
diluted spirits with advantage. Of the last, well -matured
whi.sky is the best.
Patients with high fever who are in an exhausted con-
dition may be given alcohol freely, following the same
rules as were laid down in the general consideration of
fevers. In these cases alcohol is given as a food, and is, as
a rule, well borne. In these advanced cases pure whisky
well diluted is perhaps the best form of alcoholic stimulant,
but the patient's taste may be consulted in this respect.
Other Beverages. — The usual beverages may be
given in moderation. In chronic tuberculosis cocoa may
be taken night and nmniing with good effect. Tea or
coffee may be allowed in small quantities unless they
produce unfavorable .symptoms. Milk and milk punch,
buttermilk, lemonade, or orangeade may be used, and
malt extracts are often of benefit.
Number of Meals. — Food may be given from three
to six times daily. On rising milk may be taken, or if
desired a cup of bouillon in.stead. This may be followed
by breakfast, and about the middle of the morning a
glassful of milk, egg albumin, beef juice, or broth may
be given with a cracker or a piece of toast.
A midday dinner should be the rule, and during the
middle of the afternoon a light lunch of .scraped beef,
milk, or some similar food may be given.
Supper may be taken at a convenient evening hour,
and before going to bed a glassful of milk may be drunk.
If desired or if deemed necessary a small amount of
FEEDING IN THE INFECTIOUS DISEASES.
'75
k
liquid nourishment may be taken during the night if the
patient awakens. As a rule, however, it is well to give the
stomach a full night's rest. In severe cases, where only
small quantities of liquid or semi-solid food are taken, the
intervals should be shortened to every two or three hours.
Feeding Advanced Cases. — In advanced cases
patients may generally be permitted to select their diet.
These patients can often eat hearty meals with a relish
and apparently digest them without difficulty. Asa rule,
they must be light, liquid or semi-solid. The same prin-
ciples may be applied here as in feeding fever cases, with
the exception that the patient's desires should, so far as
possible, be gratified.
Gastric Irritability. — This is very troublesome in
some cases. The patient should be instructed not to
swallow his sputum. If the attack is severe, easily
digested liquid food should be given. Peptonized milk,
kumiss, and the predigested beef preparations are of
value. If there be continued irritability and the patient
becomes unable to retain his meals, marked relief is fre-
quently afforded by feeding with a stomach tube.
Fever. — Tuberculosis patients with fever should be
fed much according to the general rules given for fevers
in general. If the digestion is not disturbed and the
appetite is good easily digested solid food may be allowed.
If the solid food does not agree the patient should be
placed upon a liquid diet.
Forced Feeding ( Suralimentation ). — Debove
discovered that food introduced by means of a stomach
tube was often retained when it would otherwise be re-
jected. This method is used in gastric irritability and
so where the patient is unable to take sufficient food
owing to loss of appetite and disgust for food.
CHAPTER XI.
DET IN DISEASES OF THE STOMACH-
In diseases of the stomach the selection of a proper
diet is often of more importance than the choice of drugs.
No absolute dietetic regulations can be formulated in
this class of diseases, but it is important to regulate the
food in conformity with the particular disease with which
the patient is affected, and also to consider the individual
tastes and peculiarities of the patient ; even in the regu-
lation of a diet in any special disease of the stomach,
changes are often rendered necessary; these must be
made gradually and according to the patient's power to
digest the food.
Food is said to be easily digestible when it produces
no gastro-intestinal discomfort, is passed from the stomach
into the intestine at a normal rate of speed, and is easily
absorbed. Under normal conditions the digestibility of
foods is easily ascertained, for the functions of the stom-
ach being normal, the effect of the food upon the func-
tions can readily be determined; in the various gastric
disturbances, however, this problem is more difficult. In
determining the diet for a special gastric disturbance two
points must be borne in mind : first, the power to increase
the nutrition of the patient ; and secondly, the necessity
of giving food in a digestible form, so as to lessen the
work of the stomach. Leube has devised a scale of the
various articles of food, given in the order of their digest-
176
DIET IN DISEASES OF THE STOMACH, 1 77
ibility. This scale forms the basis of the well-known
Leube " ulcer diet."
I/eube'S Diet Scale. — Diet /.—If the digestion is
very much reduced the following articles of food are
most easily digestible : bouillon, meat solution, milk, raw
or soft-boiled eggs.
Diet IL — Somewhat less digestible than Diet I. are the
following articles of food: boiled calf*s brain, boiled
thymus, boiled chicken and pigeon. The different forms
of meat are enumerated in the order of their digestibility.
Gruels, and in the evening milk mushes made with tapioca
and white of egg, may also be placed in this list. The
majority of patients can digest boiled calves* feet in addi-
tion to the various meat foods already enumerated.
Diet III, — If Diet II. is well borne, Diet III. may be
given. This consists in adding cooked or raw beef to
Diet II. Leube gives the following method of preparing
beefsteak, and believes that beef cooked in this way is
very easily digested : The meat should be kept for some
time and is then scraped with a dull spoon ; in this way
a pulp is obtained, consisting only of the delicate parts
of the muscle, and not containing any of the tough, hard,
and sinewy portion. This pulp is roasted in fresh butter.
Raw ham is also to be recommended. In addition to
meat a small quantity of mashed potatoes may be given,
some stale wheat bread, and small amounts of coffee or
tea with milk (cautiously).
Diet IV. — This list is so arranged that if the patient
can digest the articles of food mentioned under this head
for some time he can then begin with his usually accus-
tomed diet : Roast chicken, roast pigeon, venison, par-
tridge, roast beef, medium to raw (particularly cold) ; veal
(from the leg), pickerel; boiled shad (trout, even when
12
DIETETICS FOR NURSES.
i;8
young, is very difficult to digest), macaroni, bouilli
with rice. Small quantities of wine may be taken
to two hours before eating; gravies are contra-indi-
cated. Young and finely chopped spinach is allowable;
other vegetables, such as asparagus, may be tried cau-
tiously, although Lcubc considers this a risky procedure.
After this fourth diet the patients are allowed to take a
more liberal diet, but the increase should be gradual.
They should refrain from eating vegetables, salads, pre-
serves, and fruits for some time ; and when they are re-
sumed a baked apple is the first of these articles to be
eaten.
Penzoldt has devised the following table giving the
digestibility of food. He experimented on normal cases,
achieving his results by means of the stomach tube, by
determining the progress of digestion and the exact time
at which the stomach was entirely empty after eating a
certain quantity of a special food. The table shows the
period of time it takes a given quantity of food to leave
the stomach :
3uillon ^H
i^n one "^H
On, to
too hoiin :
rhrt! to four hours .-
100-200 gin. pure wnler.
230 gm. youDg chicken, boiled.
220 gm
carbonnted water.
230 gm. jartridge, boiled.
200 gm
220-260 gm, pigeon, boileJ,
300 gin
coffee, alone.
'95 gm- pigeon, f"*''-
200 gni
cocoa, alone.
250 gm. beef, raw, boiled, lean.
200 gm
beer.
250 gm. calves' feet, boiled.
20ogm
licht wines.
ibogm. ham, iKiiled,
100-200 gm
boiled milk.
160 gm, ham, raw.
meal broth, alone.
loogm. veal, warn, and cold.
100 gm
eeKS.6ori,
lean.
100 gm, beefsteak, broiled, cold
Txno lo three hours :
or warm.
20O gro. coffee willi crf«m.
100 gin. beefsteak, raw, scraped.
atxigm
cocon witli niilk.
100 gni. tenderloin.
200 gm
Malaga wine.
200 gra. Rhine salmon, boiled.
ioogm
■'Ofner'' wine.
75 gm. caviare, sailed.
JOO-SOOgn.
200 gm, sardines in vinegar,
jdo-soofpn
beer.
kippered herring.
^^^
DIET iN DISEASES
Of THE STOMACH. 179
Fenzoldl digestibility table {ioiiliii
f,/).
Two to three hours .■
Thrif Is four h„u's :
300-500 gin. boiled milk.
150 gm. blackbrcad.
100 gin. eres, raw and scrambled.
Ijogm. barley bread.
hard-i^oiledorasomelel.
150 gm- wheat bread.
100 gm. beef sausage, raw.
00-150 gm. Albert biscuits.
2JO gm. calves' brains, lioiled.
150 gm. potato, as vegetable.
250 gm. calves' thymus, boiled.
150 gm. rice, boiled.
72 gm. oysters, raw.
150 gm, kohlrabi, boiled.
aoo gm. carp, boiled.
150 gm. carrots, boiled.
JOO gm. pike, boiled.
15a gm. spinach, boiled.
3oa gm. shellfish, boiled.
150 gm. cucumber salad.
zoo gm. cod, boiled.
150 gm. radishes, raw.
150 gm. apples.
150 gm. asparagus, boiled.
Four to five hours.
150 gm. potatoes, boiled in salt
210 gm. pigeon, broiled.
250 gm. fillet of beef, broiled.
150 gm. mashed potatoes.
250 gm. beefsteak, broiled.
150 gm. stewed cherries.
250 gm. beef tongue, smoked.
ISOgm, raw cherries.
100 gm. smoked beef in slices.
yogm, white bread, oldorfresh,
250 gm. hare, broiled.
dry or with tea.
250 gm. partridge, broileiJ.
7oem. pretzek
250 gm. goose, broiled.
70 gm. iwieback, fresh or stale.
280 gm. duck, broiled.
dry or with lea.
200 gm. herring, salted.
50 gm. .Mbert biscuits.
150 gm. lentils, mashed.
200 gm, peas as purf e.
150 gm. string-beani!.
Penzoldt has also constructed a serie.s of four diet lists ^H
based on the length of time at which various foods leave ^|
the stomach, depending upor
their mode of preparation ^H
and on other qualities of the food. They agree in the ^|
main with Leube's diet lists,
but are more complete and ^|
exact.
■
These diet Hsts are utilized
in the treatment of diseases ^|
of the stomach requiring a gradual change from the most ^|
digestible form of liquid food to solid foods more difficult ^
of digestion. Ulcer of the stomach may be cited as an
example. The first list is
followed for ten days ; the
second, for the succeeding ten days ; the third, for the ^M
—J
i8o
DIETETICS FOR NURSES.
Beginning with broth, milk, and eggs in the first days,
the patient is given such food as roast beef, fish, and
asparagus at the end of one month.
PENZOLDT'S DIET LISTS.
Diei I, (abotU Ten Days),
Largest
Food or drink.
quantity to
be taken at
one time
Method of
preparation.
Special require-
ments.
How to be eaten.
Meat broth.
350 gm.
From beef.
Without fat, or
not salted.
Slowly..
Cows' milk.
350 gm.
Well boiled or
Entire milk (or
\{ desired, with a
sterilized.
lime water, J^;
milk, %).
little tea.
Eggs.
z or 3
Very soft, just
Fresh.
If taken raw.
should be stirred
heated or raw.
into the warm.
not boiling, meat
broth.
Meat solution
30-40 gm.
Should have only
In teaspoonful
(Leube-Ros-
a slight meat-
doses, stirred in
enthal)
broth odor.
meat 'broth.
Cakes (Albert
6
Without sugar.
biscuits).
Water.
J^ Uter.
Ordinary water
or natural car-
bonated water
with a small
percentage of
COa (Seltzer).
Not too cold.
*
D
Het IL {about T
fn Days).
Calves' brains.
100 gm.
Boiled.
1
Freed from all Best taken in meat
membranes. broth .
Thymus (calQ.
100 gm.
Boiled.
Freed from all Best taken in meat
membranes. broth.
Pigeon.
z
Boiled.
Only if young, Best taken in meat
without skin. ' broth,
tendons, and
the like.
Chicken.
As large as
Boiled.
As above (no fat- Best taken in meat
a pigeon.
tened chicken). broth.
Raw beef.
100 gm.
Chopped fine or
From the tender- To be eaten with
scraped, with a
loin.
cakes.
little salt.
Raw beef sau-
100 gm.
Without any ad-
Smoked a little.
To be eaten with
sage.
ditions.
cakes.
1 apioca.
30 gm.
Boiled with milk
to make gruel.
DIET IN DISEASES OF THE STOMACH.
l8l
Diet III. {about Eight Days).
Food or drink.
Pigeon.
Chicken.
Beefsteak.
Ham.
Milk bread,
zwieback or
Frieberger
pretzels.
Potatoes.
Cauliflower.
Largest
quantity to
be taken at
one time.
\
I
zoo gm.
xoo gm.
50 gm.
•
50 gm.
50 gm.
Method of
preparation.
Special require-
ments.
Broiled with fresh
butter.
Broiled with fresh
butter.
With fresh butter
half-rare (Eng-
lish).
Raw, scraped fine.
Crisped, baked.
{a] Mashed, {b)
boiled in salt
water and
mashed.
As a vegetable,
boiled in salt
water.
Only young bird,
skin, etc.
Only young bird,
skin, etc.
From the tender-
loin; well beaten.
Smoked a little,
without the
bone.
Stale (so-called
rolls, etc.).
The potatoes
should be mealy
and crumble on
crushing.
Use only the
flowers.
How to be eaten.
Without gravy.
Without gravy.
Without gravy.
With white bread.
To be carefully
masticated and
well salivated.
Diet IV. {about Eight to Fourteen Days).
Venison.
100 gm.
Roasted.
Partridge.
I
Roasted without
bacon.
Roast beef.
100 gm.
Medium to rare.
Fillet of beef.
loo gm.
Medium to rare.
Veal.
Pike 1
Shad 1
Carp
Trout
100 gm.-<
Roasted.
Boiled in salt
water without
any additions.
Caviare.
50 g»n.
Raw.
Rice.
Asparagus.
50 gn»-
50 gm.
Mashed, pushed
through a sieve.
Boiled.
Scramb'deggs.
Omelet (souffi6)
2
2
With a little fresh
butter and salt.
With about 20 gm.
Fruit sauce.
50 gm.
of sugar.
From fresh boiled
fruit, to be
strained through
Red wine.
zoo gm.
•"a sieve
Light, pure Bor-
deaux.
From the back,
should hang for
a time.
Young birds, with-
out skins, ten-
dons, legs, etc.
should hang for
a time.
From good, fatted
cattle; beaten.
From good, fatted
cattle; beaten.
Back or leg.
All fish bones
should be care-
fully removed.
Slightly salt, Rus-
sian caviare.
Soft, without any
of the hard
parts.
Must have risen
well.
Free from all ker-
nels and peel.
Or some corre-
sponding kind
of red wine.
Warm or cold.
Warm or cold.
Warm or cold.
}
In the fish gravy.
With a Uttle melt-
ed butter.
To be eaten at
once.
Slightly warm.
l83 DIETETICS FOR NURSES.
These tables of Penzoldt are valuable as a basis for
the selection of food in gastric disturbances. In these
cases it is important that the food be quickly dissolved
in the gastric secretion, that it be readily absorbed, that
it be neither fermented nor decomposed while bein^
digested or absorbed, and that the entire process be in-
attended with discomfort. It must be borne in mind that
the digestibihty of food varies widely with the individual
taste, for no matter how digestible a food may be, if it is
unpalatable it will not be digested properly. In general
it may be said ; First, that in acute conditions the food
should be of such a character that the stomach should
be spared as much work as possible ; second, in chronic
disturbances it is important to supply sufficient quantities
of nourishment in an easily digestible form, so as to
maintain the body weight so far as possible. In deter-
mining the quantity of food that is necessary during
twenty-four hours, the amount is estimated in calories of
heat. As is we!! known, a human being at rest requires
35 calories per kilo of weight; whereas while he is per-
forming light work he requires 40 calories. In order,
therefore, to determine the exact amount of nourishment,
it is only necessary to know the weight of the individual.
Inasmuch as the proteins can be replaced in a measure
by the carbohydrates and fats, an intercliange of any of
these three food elements can be made according to the
patient's condition. When the weight of the person is
known, it is an easy matter to determine whether the
amount of nourishment given is sufficient to maintain the
body weight.
It is well also to weigh every patient suffering with
a stomach disorder when treatment is first inaugu-
rated, and to repeat this from time to time, in order
I
DIET IN DISEASES OF THE STOMACH. 183
to determine whether the patient is gaining or losing
flesh.
The diet must be considered from the standpoint of
the gastric secretion ; there may exist, on the one hand,
the condition of oversecretion of acid ; on tiie other,
lessened secredon or absence of acid.
In cases of oversecretion an abundant protein diet is
indicated, inasmuch as the e.-^cess of hydrochloric acid is
neutrah^ed by this class of foods. Ordinarily, the pro-
teins that are best adapted for patients suffering from
oversecretion of acid are the red meats and eggs, whereas
the carbohydrates must be given in the most easily
digestible form.
In cases in which there is a diminution of the gastric
secretion the protein foods are digested with difficulty,
whereas the carbohydrates are more easily digested. In
this condition, therefore, only very tender meats, prefer-
ably scraped, are to be given ; whereas such easily
digestible vegetables as spinach, asparagus, mashed pota-
toes, and farinaceous foods may be eaten in quite large
quantities. In both conditions of increased and dimin-
ished secretion of acid a reasonable amount of fat must
be eaten, preferably in the form of good butter.
The diet in muscular disturbances of the stomach
depends greatly upon whether an excess or a deficiency
of gastric juice is secreted ; if there is an increase, an
excess in protein food gives the best results; if, on the
other hand, there is a diminution of this secretion, pro-
tein food must be given the patient in the most easily
digestible form. The carbohydrates and the lighter vege-
tables may be given in somewhat larger proportion. In
both conditions the ingestion of fluids should be reduced
so far as possible.
104 DIETETICS /-OR NUffS/iS.
Normally, the appetite is a fair indication of the num-
ber of calories of heat that may be required ; in condi-
tions of gastric disorder, however, this is not the case ;
these patients lose their appetite, and consequently often
take insufficient nutrition. In those instances in which
the gastric disorder is somewhat protracted and accom-
panied by great loss of weight and in which the patient
takes insufficient nourishment, it need only be borne
in mind that such a patient, resting quietly in bed, re-
quires only about one-sixth of the number of calories
necessary for a patient who is not resting. This plan
may therefore be used with advantage in the treat-
ment of many patients suffering from disorders of the
stomach.
I^iqnid Foods in Gastric Disorders. — In these
cases, in which it is necessary to spare the stomach as
much work a^^ possible, milk is the food that is usually
most easily borne. In order to supply a sufficient num-
ber of calories it must be taken in large quantities, fre-
quently diluted with lime water or barley water in order
to add to its digestibility, or flavored with coffee, tea, or
cocoa to lend variety and add to its palatability. In
these cases in which milk is not well borne, buttermilk,
whey, kumiss, and kefir may serve as substitutes. Among
the other forms of fluids that may be given are broths
(chicken, beef, mutton), bouillon, beef tea, and meat
juice. Of these, meat juice is most nutritious,
Qelatinous Formfi of Food. — Gelatinous articles of food,
as gelatin, calves' feet, etc., are easily digested and readily
absorbed.
HeatB. — The digestibility of meat can be increased by
chopping, beating, grinding, scraping, etc.
Eggs. — The digestibility of eggs depends upon their
k fresh 1
forms
Dlt:T IN DISEASES OF THE S7VMACN. iSj
mode of preparation ; raw and soft-boiled eggs are usually
the most easily digestible forms.
Fish. — In regard to fish, those containing but little fat
are to be recommended for patients suffering from gastric
disturbances, such as shellfish, pike, trout, carp, and
halibut.
Carbohydrates. — The number of vegetables from which
selection may be made is large. The secretion from the
mouth and intestines play an important role in the
digestion of these substances. They should be masti-
cated thoroughly. In those cases in which there is
danger of fermentation they should be given with caution.
The best form in which to give amylaceous food is in the
form of zwieback, toast, stale wheat bread, tapioca flour,
oatmeal, etc.
Legiuninoua foods contain a considerable amount of
protein, much of which, however, is not absorbed. They
are apt to give rise to considei-able fermentation. Pota-
toes are best given mashed or baked. Cabbage contains
much cellulose and should be omitted from the diet of
all patients suffering from stomach disorders.
rmita are of slight nutritive value, but give a relish to
other foods and increase intestinal peristalsis.
Fat is to be recommended because of its tendency to
increase the weight of the patient, and also because of
its high caloric value. Some observers claim, however,
that it acts as an irritant to the stomach. It is true Chat
many patients find that fat meat, greasy gravies, etc., give
rise to indigestion, and often to nausea and vomiting.
Much depends, however, on the mode of preparation. A
considerable amount of fat may be given in the forms of
fresh butter spread on wheat bread or toast. Certain
forms of chocolate contain quite a large percentage of
1 86
DIETETICS FOR NURSES.
fat, and on this account are very nutritious. Of these,
Mehring's Vigor Chocolate is to be especially recom-
mended. Olive oil has recently been recommended in
the treatment of certain ga.stric disorders.
Special Factors Beaiiog on the Diet in Pa-
tients Siifferin^f from Gastric Disturbances. — [.
Von Noorden demonstrated the fact that the intestine
will vicariously perform the work of the stomach in con-
ditions in which the secretion of the latter is lost. The
point to be borne in mind is that even in cases in which
the secretion of the stomach is lost entirely, the intestine
may assume this function of the stomach.
2. In those cases in which it is necessary to spare the
stomach, as when food can not be digested or is vomited,
either predigested foods may be utilized or foods may be
administered through channels other than the stomach.
Among the artificial predigested preparations are the
albumoses and peptones, Denayer's Albumose-peptone,
Somatose, Nutrose, and Mosqiiera Beef Meal. For the
various methods of feeding, the reader is referred to the
sections on Rectal Feeding, Subcutaneous Feeding, etc,
3. The following rules for eating should be carried
out:
{d) Food should be thoroughly masticated ; this is
especially important in those cases in which there are
marked gastric disturbances.
(b) The meals should be taken at regular intervals and
in moderate quantities, according to the nature of the
gastric disease.
(r) The temperature of the food is also an important
factor in the treatment of gastric disturbances ; as Uffel-
mann has pointed out, the food should be taken at a tem-
perature between 98° and 100° K. The ingestion of very
DIET IN DISEASES OF THE STOMACH. 187
hot food is believed to be a frequent cause of ulcer of the
stomach. On the other hand, Wegele attributes the dys-
pepsia of many Americans to the taking of ice-cold water
and other drinks.
{d) The question of rest or exercise after eating is
one that is of considerable importance to those suffer-
ing from gastric disturbances. It is generally admitted
that violent exercise should not l>e indulged in after
eating.
From the authors' observations, it appears that in con-
ditions of gastric disturbances accompanied by increased
or decreased acidity and in muscular disturbances of the
stomach, the gastric digestion is improved during rest, but
impaired by sleep, after meals.
Special Cures in the Treatment of the Dis-
eases of the Stomach.— Among the special forms
of treatment recommended in gastric disturbances may
be mentioned the rest cure, the milk cure, the grape cure,
and forced feeding or gavage.
The rest cure, first devised by Weir Mitchell, plays an
important role in the treatment of stomach disorders.
This treatment is especially useful in cases of nervous
stomach disorders. It is also useful in the treatment
of ulcer, gastritis, and other conditions. The rest treat-
ment in gastric di-sorders should be carried out for from
six to eight weeks. The results that follow this plan of
treatment are often marvellous. For a further considera-
tion of the method and plan of conducting the rest treat-
ment systematically, the reader is referred to the section
dealing with that subject.
Milk Onre. — The underlying principle of the milk cure
consists in the ingestion of large quantities of milk, either
alone or together with other foods. Under normal con-
L lives exc!
obese inc
1 88 DIETETICS FOR NURSES.
diCions, when taken alone in large quantities — say three
liters a day — milk does not suffice as a food ; in certain
digestive disturbances, however, milk given alone for a
time forms a useful food and allows the stomach to regain
its normal tone and functions. Milk is especially useful
in the treatment of ulcer of the stomach and in certain
forms of chronic gastritis; it is particularly useful in the
secondary forms of gastritis, as those depending upon
tuberculosis, anemia, etc. In some cases of nervous dys-
pepsia milk cures sometimes effect remarkable results;
whereas in others milk disagrees and, as a consequence,
the milk cure can not be undertaken. When there i.s a
diminution or an absence of acid in the stomach, miik is
usually not well borne. It is al.so contra-indicated in
severe cases of muscular relaxation of the stomach and
in intestinal conditions accompanied by extreme flatulence
and chronic diarrheas.
When milk is given in large quantities in addition to
other foods, it is more frequently better borne and is less
apt to disagree. One of the disadvantages of the milk
cure is the obstinate constipation the milk is apt to in-
duce. Milk can often be rendered more digestible by
the addition of barley water, lime water, milk of magne-
sia, and the like, or small quantities of coffee, tea, or
whisky may be added to it. When milk disagrees,
cream, buttermilk, kefir, kumiss, or matzoon may be
given as a sub.stjtute for it. (See Milk Cure.)
Forced Feeding or Oavage. — This method consists in
introducing milk, eggs, and meat extracts into the
stomach by means of the stomach tube.
Qrape Cnre. — In this form of treatment the patient
lives exclusively upon grapes; it is especially useful in
obese individuals, in whom it is important to diminish
DIET IN DISEASES OF THE STOMACH. 189
the weight ; in aiicmia, girls suffering with dyspepsia,
and in certain cases of nervous dyspepsia.
DIET IN DYSPHAGIA (DHTICULTY IN SWALLOWING).
Dysphagia may be due to any obstruction in the
mouth, piiarynx, or esophagus. The difficulty and pain
induced by swallowing must be obviated by lessening
as much as possible the efforts at swallowing ; for this
reason food must be givon in a concentrated form, and
only in a liquid or semi-solid state; milk, ogg albumin,
and the concentrated liquid beef preparations arc espe-
cially useful in this condition. In those cases in which
food can not be swallowed in sufficient quantities the
patient must be fed through the stomach tube. In this
way broths, gruel, milk, and the like can be passed into
the stomach.
DIET IN ACUTE GASTRITIS.
Oser has said that " every case of acute catarrh of the
stomach has a natural tendency to heal of its own accord
unless a chronic form is produced by a mistaken diet or
wrong medication." It is a generally admitted fact that
in the treatment of this condition the diet plays the lead-
ing role. The first step in the treatment consists of
securing absolute rest for the stomach and a total absti-
nence from food for at least twenty-four hours. This
procedure is sometimes very difficult to carry out, for
many patients believe that food is necessary for them,
and that they can secure relief more quickly by taking
nourishment. The nausea and vomiting which are present
in more or loss degree in this condition, and which are
aggravated by the taking of food, will soon convince the
patient of the necessity of abstaining from food. The
I90
DIETETICS FOR NURSES.
thirst is, however, so severe in these cases that patients
may be allowed to rinse the mouth with water frequently,
to retain tiny bits of ice in the mouth, or even to drink
very small quantities of carbonated waters. With this
p!an of treatment recovery generally follows in two or
three days. After the first twenty-four hours feeding
may be begun by giving cautiously small quantities of
milk diluted with lime water, broths, and egg albumin ;
these can gradually be increased in quantity, and during
the next day or two boiled chicken, sweetbreads, scraped
beef, in addition to toast, may be added.
The authors are accustomed to prescribe the following
diet about the second or third day after an attack of acute
gastritis :
Calorirs.
150 gm. milk with lime water lOI
100 gm, egg allnimln flavored uilh orange or lemoo juice, 53
150 gm. bralh with e[!g S4
150 gm. milk with ]ime waler loi
5 gm. Armour's soluble beef in ualer lo
100 gm. egg albumin flavored wiih orange or lemun juice, 53
150 gm. milk with lime water 101
After the third day the diet is increased as follows :
CaldriM.
7 A.M.: isogm, milk (101) Willi 7ogm. lua^i (1S2) aSj
I) A. M. : 2 very soft-boiled eggs 160
I A. M, : 200 gm, Ixmillon with i egg 85
I P. M. : 100 gm. rice cooked in milk 177
70 gm. toast . i8a
3 p, M. : 100 gm. effi alliuniiii (53) with 50 gm. crackers (187) . 240
S P. M. : 150 gm, milk with 70 gm. loaW 283
7 P. M. : 100 gm. egg albumin flavored with orange or leu — '--■— "■ '
■ In comparing these <)iel lists slight discrepi
of Ihe foods will be noted. These diffcrenci
■ulhors using the caloric v.nlues of raw foods, »
the values of cooked foods. In the diet list sg
nine of foods as pcGpBre<l for ihe table are give
1463
teles in the calorie values
i have ari.^eii from some
aile others liavc computed
I'M by the authors, calorie
I
DIET IN DISEASES Of THE STOMACH. I9I
DIET IN CHRONIC GASTRITIS.
The dict<.-tic treatment of cliroiiic gastritis is of far
greater importance than the treatment of this disease by
the use of drugs. The diet must be varied according to
the stage of the disease. The most easily borne forms
of food are hquids, such as broths; unfortunately, these
foods do not furnish sufficient nutriment to sustain the
patient. Their nutritive value may be increased by the
addition of beef extracts, eggs, barley and rice, peptones,
somatose, etc.
The diet should vary according to the character of the
gastritis ; in those cases in which the gastric secretion
has entirely or almost entirely disappeared, protein food
is digested with great difficulty; it must therefore be
given in the most digestible form ; of these foods, scraped
beef, stewed beef, stewed chicken, broiled steak, and
boiled sweetbreads are especially to be recommended.
Vegetables should also be given in the most digestible
form, best as a mush. Milk is useful in most cases;
occasionally, however, it is not well borne ; when this is
the case, it can be made more agreeable by adding small
quantities of rice, potatoes, or cocoa to it, or kefir,
kumiss, or matzoon may be substituted for it. In those
conditions in which considerable acid still remains in the
stomach, meats in various forms are very acceptable; to
this list may be added fish and eggs ; vegetables, such as
mashed potatoes, spinach, mashed carrots, especially in
the form of purees, are to be recommended. In all in-
stances fat should be given in an easily digestible form —
as good butter, cocoanut butter, or Mehring's Vigor
Chocolate. It is impossible to formulate exact rules as
to the number of meals that should be eaten and the
192 DIETETICS hOR NURSES.
quantity that should be taken at each meal ; in a general
way, small frequent meals are best borne.
Water should be taken in small quantities between
meals. Alcoholic stimulants or any strong stimulants
should, as a rule, be omitted ; when utilized, they should
be given in small quantities and best diluted with mineral
waters. Salt and spices may be allowed occasionally in
small quantities.
The authors have found the following diet list useful
in cases of chronic gastritis :
8 A. H. : 200 Em. milk flavored wilh tea 135
60 gin. stale bread (154) with 40 gill. bullEr (jz6} . . 4S0
I soft-boiled egg So
10 A. M. : 1 00 gm. scraped beef (119) with 60 gm. stale bread or
toast (154) a73
(or chicken sandwich (z6oj or 50 gm. thetry (60)
withegB (80))
11 A.M.! Hoiiillon wilh egg 84
loo gm. chicken 106
(or 100 gm. Iamb chops (Z30)
or 100 gm. broiled steak (209)).
100 gm, spinach 166
100 gro. Dioshed polatoes \^■^
100 gm. stewed apples 53
60 gm. loast 154
4F. M.: 120 gm. milk with lea Si
30 gm. crackers 102
7 F. M. : 60 gm. stale bread (154) wilh 40 gm. buUer (jz6) . . . 4S0
zoo gm. milk 13 S
2456
DIET ]N DILATION OF THE STOMACH.
Dilation of the .stomach may be either acute or
chronic. The acute form is but rarely seen. Chronic
dilation results either from a narrowing of the pylorus
or from weakness of the muscular walls of the stomach.
This latter form may be seen in diabetes, the insane,
and in beer drinkers, as well as under many other con-
ditions.
DIET IN DISEASES OF THE STOMACH. I93
In the dietetic treatment of dilation of the stomach, it
must be remembered that fluids are badly borne, and
must, therefore, be given only in very small quantities —
not over i to i J liters a day. The fluids that are per-
missible are milk, cream, coffee, tea, and bouillon, all in
small quantities. The thirst that accompanies this dis-
ease may be relieved by allowing the patient to suck bits
of ice or by giving rectal injections of water or normal
salt solution. Since nutrition is usually very faulty in
this disease, nutrient enemata must frequently be em-
ployed. When milk is administered, such substances as
tapioca and rice should be added. Egg or concentrated
meat extracts should be added to bouillon to increase its
nutritive value. Meats should be given only in the most
digestible forms ; of these, stewed chicken, boiled sweet-
breads, calves' brains, and scraped beef are to be pre-
ferred. Vegetables, such as carrots, spinach, peas, pota-
toes, should be administered in the form of purees.
Bread should be eaten stale ; wheat bread or toast is
best. Stewed fruits, such as stewed prunes, and baked
apples are also permissible. Since fats are apt to cause
fermentation, butter should be allowed only in quite
small quantities. Alcohol is not to be recommended in
this condition ; if it must be used, it is best given in the
form of some light wine. Strong spices should always
be avoided.
The special feature of the treatment consists in giving
frequent concentrated meals. Patients with dilation of
the stomach should be cautioned against visiting watering-
places for the purpose of drinking the waters.
The diet list given on the following page is the one
used by the authors in dilation of the stomach.
13
DIETETICS FOR NURSES.
1. M. : loo gm. milk wilh tta . 67
50 urn. Hale wlieal brca,! 130
lOgn,. buLler to
1. M. i 100 gm. raw scrajied Ijcef il8
50 gm. toaal 130
10 gra. butter 80
50 c.c. slierry wine 60
2 M. 1 150 gm. broiled steak 315
□r l<|D gm. lamLi chups and chicken.
100 gm. Iiaked polatiKS I27
100 gm. spinach Iti6
or loogm. a.-.paragus 1185),
or 100 gni. peas, mashed and sirarned (318),
■. M. ! 100 gm. cream 214
SO gra. stale bread >30
'. M. : too gTQ. boiled roekfish So
50 gm. stale wheat brvad 130
10 gm. butter So
DIET IN ATONIC DYSPEPSIA.
Since atonic dyspepsia is frequently caused by inju-
dicious and too rapid eating, persons with feeble digestive
powers should exercise especial caution to cat slowly,
masticate thoroughly, and avoid indigestible food. Per-
sons suffering from atonic dyspepsia should cat small
quantities of food at frequent intervals. Since water is
not absorbed in the stomach to any extent, it is advisable
that the quantity of fluids taken .should not exceed \\
liters a day; this amount should include all fluids —
coPee, tea, soups, etc. If the thirst is very great, enemata
of water or nutrient enemata may be administered.
The u.se of milk in large quantities, as has been recom-
mended, is not generaliy to be advised when the patient
is able to go about, since the weight of large quantities
of milk may overdistend the stomach ; when, however, a
rest cure is instituted, milk is commonly well borne, even
in very large quantities. The diet in atonic dyspepsia
DIET IN DISEASES OF THE STOMACH. 195
varies according to tlic nature of the gastric secretion.
In cases in whicli there is ati excess of acid a liberal
meat diet, consisting especially of chicken, beef, mutton,
or ham, is to be recommended ; fish, eggs, hard- and soft-
boiled, are also permissible; the vegetables should be
selected with care ; carrots, peas, beans, and cauliflower
may be given, but must be mashed and strained so as to
rid them of cellulose ; potatoes, rice, and grits may also
be allowed. Butter is the form of fat best suited to this
condition. Alcoholic stimulants arc, as a rule, not well
borne, and their use should be prohibited ; in a limited
number of cases alcohol in the form of a light wine acts
as a stomachic and may be prescribed.
In those cases in which there is an absence or a dim-
inution of acid in the gastric secretion, the lighter forms
of meat, such as the white meat of chicken or fish,
sweetbreads, stewed chicken, or raw scraped beef, should
be allowed; vegetables, on the other hand, must be
given in somewhat larger quantities.
The treatment of the chronic constipation accompany-
ing atonic dyspepsia, since it is one of the most constant
symptoms, requires special mention. In the treatment
of this condition the main reliance must be placed on the
diet. Such forms of foods .should be given as will, in the
course of digestion, produce substances that excite in-
testinal peri.stalsis ; among these foods maybe mentioned
Graham bread, certain vegetables, such as carrots, beans,
tomatoes, peas, and turnips, macaroni, stewed and raw
fruits, buttermilk, honey, and cider. This form of diet
will often overcome the constipation without the aid of
drugs. {For a more extensive con .si deration of the die-
tetic treatment of chronic constipation, the reader is
referred to the section dealing with that subject)
I
196 DIETETICS FOR NURSES.
The following list has been used by the authors in the
treatment of atonic dyspepsia :
7 A. M. : 40 gm. uraiigc juice 8S
8 a. M,: 200 giQ milk I3S
I soft-boiled egg So
60 gra. toast 154
40 gm. butter 315
10 A. «, ; 100 gm. raw scrapei! beer itS
60 gm. stale wheal bread 154
12 M. : 100 gm. broiled steak jog
or 100 gill, lamb cht>ps (230).
or loo gm. slewed chicken ( ic5l.
200 gm. a.sparagus - - . , . 37
or 100 gm. peas (31S),
or lOOgtn, spinach (1 65 j.
\<x> gm. mashed potatoes 127
loo gm. apple sauce S3
50 gm. bread (stale) 130
3 p. M. : 200 gm. milk 135
Co gm. wheat bread 154
40 gm. butter 315
7 F. M. : ICO gm. bolted rock-fish So
too gm. milk 67
60 gm. bread 154
40 gm. butter 315
285-B
MET IN ULCER OF THE STOMACH.
Much can be done by a carefully selected diet to pre-
vent the onset of an ulcer of the stomach. As soon as
the very first .symptoms become manifest, the ])atient
should be placed upon an absolute milk diet. The tem-
perature of the food should be regulated, so that it be
not given too hot nor too cold.
Boas divides the treatment of ulcers of the stomach
into several stages :
Stage of Hemorrhage.— In this stage ]}oas advises
ab.solute rest in bed ; the patient not even being allowed
to arise for purposes of defecation or urination. No
nourishment whatever should be given by the mouth.
In robust individuals even nutrient enemata may be
DIET IN n/SEASES OF THE STOMACH I97
omitted. If the patient is weak or in feeble condition,
feeding by the rectum may be instituted. (See the sec-
lion on Nutrient Knemata for the method of preparation
and utilization of this mode of feeding.) Only two or
three nutrient enemata are to be given daily. Boas
carries out this plan for three or four days. After this
he gradually begins mouth-feeding, the nourishment con-
sisting exclusively of fluids given at a temperature of
98° to 100° F, He prefers milk diluted with lime water,
- with tea, or with coffee. In addition he permits beef tea,
freshly expressed or artificial beef juice, and egg albu-
min. The carbonated waters, such as Vichy, are also
useful.
After the first week Boas begins the regular Leube
and V. Ziemssen ulcer treatment, which he conducts as
follows : The patient is given a one-fourth liter of Carlsbad
water, which he drinks in bed morning and evening.
Hot-water applications are placed on the abdomen. The
diet during this stage consists mainly of milk in addition
to other fluids. If the patient is very weak, nutrient
enemata may occasionally be given.
In the treatment, beginning with the third and continu-
ing during the fourth week, Boas permits the patient to
recline on a couch and continues the use of the Carlsbad
water, which should be given for four weeks from the
time it is first taken ; he advises that the diet still consist
mainly of milk, although he now permits the addition of
soaked zwieback, scalded crackers, and soft rolls. Meats
(sweetbreads, brains, meat balls), fish (perch, oysters in
small quantities), in addition to the light red wine and
carbonated waters, are also allowed.
After the fourth week, if the patient is doing well,
Boas adds from 50 to 200 gm. of mashed potatoes,
^^^^ tirely by
^^^k saiy for
198 DIETETICS FOR NURSES.
stewed fruits, and vegetables, such as spinach, carrots,
peas, and turnips, in the fonii of purees, to the diet pre-
viously given. The meats (broiled steak, chops, and
roast beef), if well coolced, can finally be given more
liberally. According to Boas, the patient should avoid .
raw fruit, acid and highly seasoned foods, and also very
hot and very cold drinks for many years. Even in those
cases in which there has been no hemorrhage, Boas never-
theless advises the rest treatment. It is generally admitted
that the rest cure is the only satisfactory plan for treat-,
ing cases of ulcer of the stomach. Leube and Penzoldt
have devised dietaries for these cases ; these have been
given elsewhere (see p, 180). The first dietary should
be followed for ten days; the second, for the succeeding
ten days ; the third, for about eight days. The severity
of the condition in each case must, of course, determine
the length of time during which each dietary must be
continued. In all instances milk seems to be the most
useful form of food during the first weeks of this rest
treatment. Occasionally milk does not agree, and sub-
stitutes must be given in its stead. Of these, buttermilk,
kefir, matzoon, and kumiss are especially to be recom-
mended.
HEMORRHAGE FROM THE STOMACH.
As soon as hemorrhage from the stomach occurs the
patient should be put to bed and not allowed to rise. A
light ice-bag should be placed over the region of the
stomach, and no food or drink whatever should be allowed ;
in order to quench the thirst, small quantities of ice may
be given the patient to suck. Nourishment must be en-
tirely by the rectum ; but even this is usually unneces-
sary for the first few days, in order to combat the
DIET IN JilSBASES OF THE STOMACH. Ipg
weakness following great loss of blood, salt solutions may
be injected into the rectum, or if the patient is very weak,
coffee, meat juice, or whisky may be added to the enema.
In very grave cases salt infusions must be resorted to.
DIET IN CARONOHA OF THE STOMACH.
In tiie dietetic treatment of cancer of the stomach
milk forms the most important article of diet. The
more easily digestible forms of meat, such as sweet-
breads, scraped beef, calves' brains, and stewed chicken,
are permissible. In this disease there is usually a distaste
for meat, and fish may be substituted for it ; of these,
boiled mackerel, rock, haddock, or trout are to be recom-
mended. Of the vegetables, mashed potatoes, spinach,
carrots, peas, beans, cauliflower, if mashed and strained
so as to rid them of celluSose, are admissible ; rice, farina,
and corn starch with milk are also valuable forms of food.
Milk with tea, coffee, or cocoa, or wine or whisky may be
given for the thirst. Fluids should, however, be taken
in small quantities at a time. In order to supply the
necessary quantity of fat, butter or Mehring's Vigor
Chocolate i.s to be recommended. In these cases it is
often important to promote the general nutrition by means
of rectal alimentation. In cases of cancer of the stomach
too abundant a diet should not be insisted upon, as at
best but little can be gained by this method of treatment,
When the growth is at or near the cardiac portion of the
stomach, the diet should be such as will prevent so far
as possible any irritation of the diseased esophagus and
stomach. Solids should therefore be avoided. Milk is
the food that is usually best borne in this condition.
The authors have found the diet list given on the follow-
ing page useful in many cases of cancer of the stomach :
2CtO
DIETETICS FOR A VASES.
I
8 A, M. : 150 gm. miik with lea .... - loo.o
50 gni, loa:.l 130.0
to A. M. : loo yni. laked Iroul I06.O
loogm. milk orjogm. PanoiieiJl.me (57-5) . . 67.0
Sogm. loast 130.0
50 gm. .iherry 60.D
13 H.: Buuillon with 5 gm. somaluse 16,0
100 gm. chicken 106.0
ot 100 gm. calves' EWeelLiieaJs (90),
<ir 100 gm. calves' brains (140),
or 100 gm. squab (loo)-
100 gm. nia^hed pot.iloeii 127,0
or 100 gm. spinach (l6l3).
or 100 gni. asp.-iragiis (iB).
25 gm. stale wheal breari 65.0
4 p. M. : 5ogm. toast IjO.O
20 gm. butter . 162.0
40 gin. caviare 52.O
71- «.r 150 gm- milk (loo) *ilh 5 gm. 5omalose (it) . 116.0
100 gm. rice cookeii in milk .- - - 177-0
50 gm. wheal bread '.lo.o
9 P.M.: 30 gm, Panopeplone ■ 57-5
2024.S
DIET IN NERVOUS GASTRIC DISORDERS.
Nervous Vomiting. — This is often overcome merely
by isolation and change of scene. In severe cases patients
should be placed in bed ; they are best fed on semi-solid
or liquid food, since the latter is more easily retained
than solid food. It should be given in very small quan-
tities; scraped beef, eggs, rice, and toast are especially
useful. Cracked ice will often afford relief The most
indigestible forms of food are frequently well borne when
the most digestible are speedily vomited. In severe cases
the patient should be fed for some days exclusively by
rectal alimentation.
Diet in Nervons Dyspepsia. — In this condition the
diet should not be too restricted. Strengthening food,
without any attempt at a too rigorous diet, should be
DIET IN DISEASES OF THE STOMACH. 20I
prescribed. In those cases in which milk is well tolerated,
it should be given in targe quantities ; when it is not well
borne, buttermilk, kefir, or kumiss may be substituted for
it. The patient's appetite should be humored, and he
should be allowed to eat any food he can digest. Aico-
holic stimulants should be prohibited, or given only in
very small quantities. In severe cases a well-conducted
rest cure will produce the best results.
DIET IN INTESTINAL DISEASES.
The diet plays quite as important a role in the
treatment of diseases of the intestine as it does in the
treatment of gastric disorders. In many intestinal dis-
turbances, such as acute intestinal catarrh, diarrhea, etc.,
cures often can be effected by diet alone, when without
this mode of treatment the disease might become in-
tractable. The diet in intestinal diseases, as in gastric
disorders, must be such as will produce no annoying
symptoms. The process of digestion in the intestine is
exceedingly complicated, and therefore the digestibility
of foods in this part of the alimentary tract is most diffi-
cult to determine.
It has been shown that certain forms of food contain
very large proportions of protein matter, but that their
absorbability is so slight that their nutritive value is far
lower than that of foods containing less protein. Thus,
while peas contain considerably more protein (7 per cent.)
than does milk (3.7 per cent), a much smaller proportion
of protein is absorbed in the case of the former than in
that of the latter ; on the other hand, the absorbability
depends greatly on the mode of preparation of the food ;
when vegetables are mashed and then strained, so as to
rid them of their cellulose envelopes, they are much
more readily absorbed than when eaten with the cellulose.
The digestibiUty of certain foods in the intestine varies
DIET IN INTESTINAL DISEASES. 2O3
greatly with different individuais. For this reason exact
rules can not be formulated in any case, but the diet must
be varied according to individual peculiarities. Boas has
expressed his opinion on this subject as follows :
" 1. In a number of intestinal diseases a change of diet
is unnecessary or may even be harmful.
" 2. In some cases special dietetic restrictions are di-
rectly indicated, but these should be as few as possible.
" 3. In another series of cases an abundant, heavy, not
easily digestible or absorbable diet is indicated,
"4. The general aim of our treatment should always
be to so manage the case before us that digestion of a
norma! diet will always occur in the alimentary canal
without any subjective or objective disturbances. Under
these circumstances only can the case be considered
cured."
According to their effect on intestinal movements, foods
may be divided into three clas.'ses: those producing con-
stipation ; those producing a laxative effect, and those
exerting no especial effect in either direction. In the first
class are those foods containing an astringent, such as
tannin ; among these may be mentioned certain red
wines, cocoa, and tea. Rice, tapioca, barley, sago, maca-
roni, and potatoes have a tendency to produce constipa-
tion in many individuals. Among the laxative foods may
be mentioned fruits and certain vegetables, as cucumbers,
tomatoes, and cabbage ; cider, buttermilk, beer, and the
carbonated waters also exert a laxative effect.
In the third class, foods that have no especial effect
on the intestinal movements, may be placed meats, fish,
eggs, toasted bread, and zwieback. It must be remem-
bered, however, that certain foods that prove laxative in
one individual may be constipating in another, so that no
L
204 DIETETICS TOR NURSES.
precise rules can be formulated; in each case individual
tendencies must be consulted.
In severe forms of intestinal disturbances rectal ali-
mentation must often be resorted to. For a further
consideration of the technic and forms of food to be
utilized in this method of feeding the reader is referred
to the section on Rectal Feeding. In those cases in
which food can not be given either by the mouth or by
the rectum, subcutaneous feeding becomes necessary;
for this purpose olive oil maybe used; one ounce may
be injected twice daily under the skin, best in the region
of the thigh ; in some cases normal salt infusions are
Indicated.
The management of the diet in intestinal disorders is
often difficult. It requires great experience and judg-
ment to determine what particular foods should be given
the patient and also to know how long they should be
continued. It frequently requires great tact and patience
on the part of the nurse to see that the directions of the
physician are carried out.
DIET IN INTESTINAL DYS'EPSIA.
In intestinal dyspepsia food should be given frequently
and in very small quantities. At first only the liquid
forms should be used, such as weak tea, peptonized milk,
malted milk, bouillon, and egg albumin ; after a few
days the patient may gradually be placed on the follow-
ing diet : calves' brains, sweetbreads, bioiled steak or
lamb chops, soft-boiled eggs, boiled fish, such as mackerel
or rock ; baked potatoes, spinach, asparagus, and stewed
fruits.
The list on the opposite page gives the general plan
of a diet used by the authors in this condition ;
DIET IN JNTESriNAL DISEASES. Z05
M. : 150 (jm. milk with lea 101
1 soil-boiled egg go
6ogni. toasted Hhcai bread (155) wjiii 20 gm, builer
('63) JlS
M. ; ScrapeJ-Leef sandwich] 'f" S'"- sa^ped beef ( . 18) 1
I 50 fim. wheat bread (178) f ^^
! Bouillon willi s gm. Armour's Soluble Beef ...... 10
100 gm. liroileii chicken 106
ot 100 gm. broiled sleak {209),
SOgm. maahedpotatoes or loogm. bpinach |[66) . . . 64
100 gm. apple sauce 88
50 gm. wheat bread, stale or as loasl 130
3 P.M.! 200 gm. milk 135
7 r. M. : 200 gm. milk with rice 253
I sofl-boii&i egg 80
100 gm. wheat bread antl 50 gm. butter 666
DIET IN ACUTE INTESTINAL CATARRH.
As in acute ga.stric catarrh, so also in acute intestinal
catarrh the regulation of the cJiet i.s probably the most
important factor in the treatment of the disease. The
patient should be kept in bt-d ; after the bowel has been
thoroughly emptied by a cathartic, liquid foods, such as
clear broths — at first without and then with cggs^thin
gruels, light tea, cocoa cooked in water, and egg albu-
min, should be given exclusively for several days. In
this condition milk should not, as a rule, be given.
When there is extreme thirst the carbonated waters may
be allowed, but only in small quantities. The thirst is
best relieved by placing bits of crushed ice in the
patient's mouth. After the pain and discomfort have
disappeared, toast, crackers, stewed chicken, soft-boiled
eggs, mashed potatoes, and boiled rice may be added to
the diet; indigestible foods, such as raw fruits, heavy
vegetables, and fatty and acid foods, should be avoided
for a considerable period of time after the catarrh has
disappeared.
206 DIETETICS FOR NURSES.
DIET IN CHRONIC INTESTINAL CATARRH.
The dietetic treatment in chronic intestinal catarrh
depends upon the condition of the fecal movements;
these arc, in a measure, an index as to the portion of the
bowel involved. Cases of chronic intestinal catarrh may
be divided into those cases associated with chronic con-
stipation, those associated with chronic diarrhea, and
those in which diarrhea alternates with constipation.
Diet in Chronic Intestinal Catarrh Associated
with Chronic Constipation. — In this condition a
mixed diet containing, so far as possible, those sub-
stances that stimulate the intestinal peristalsis should
be prescribed. Astringents and anything that tends to
produce constipation, such as cocoa, chocolate, tea, red
wines, rice, farina, etc., should be avoided.
The following foods should be prescribed in cases of
chronic constipation : Graham and rye breads with butter,
fruit, buttermilk, kefir, cider, beer, fresh vegetables, as
cabbage; sour krout, and salads. Fats are especially to
be recommended, and honey is also useful. Salts stimu-
late the intestinal movements, therefore foods containing
salts are indicated in this condition ; among this class
may be mentioned herring and caviare. Sugar, espe-
cially milk sugar, has a marked tendency to increase
intestinal movements. Water taken cold or on an empty
stomach will also .stimulate intestinal movements.
Diet in Chronic Intestinal Catarrh Associated
with Chronic Diarrhea.— When severe symptoms,
.such as intense diarrhea and pain, present themselves
the patient must be put to bed and kept on a very rig-
orous diet ; the period of rest may be lengthened or
shortened according to the severity of the disease. In
DIET IN INTRSTINAL DISEASES. 20?
moderately severe cases several weeks will usually suffice.
Nourishment should be taken in small quantities every
few hours; sufficient must, however, be given to main-
tain the body weight All cold drinks or carbonated
waters, fruits, cabbage, and salads are to be avoided.
The most suitable foods in this disorder are broths con-
taining barley, rice, and farina; soft-boiled eggs, sweet-
breads, stewed chicken, broiled steak, boiled fish, toast,
crackers, baked potatoes, tea, milk (boiled), and cocoa;
in many cases port wine is quite useful, as it contains
tannin, which acts as an astringent to the bowels. In
this condition milk, even when boiled, is often not well
borne, and must then be avoided.
In conditions of chronic intestinal catarrh in which
diarrhea alternates with constipation, the same plan of
treatment may be followed as has been described for
those cases accompanied by constipation or diarrhea; it
is especially important to treat by diet the more prom-
inent symptoms, whether it be diarrhea or constipation.
Mineral waters are frequently utilized in cases of chronic
intestinal catarrh. For cases accompanied by constipa-
tion the waters of Marienbad and of Saratoga (Congress
and Hathorn Springs) are most beneficial. Where diar-
rhea is the prominent symptom, Carlsbad and Vichy
are to be recommended.
DIET IN DYSENTERY.
The diet in acute dysentery is similar to that pre-
scribed in acute intestinal catarrh. The patient is put to
bed and only liquid foods are administered. Of these
the most suitable are bouillon, broth, egg albumin, and
tea; gradually, as the condition improves, .semi-solids,
such as milk toast, rice cooked in milk or broth, gruels
DlETF.TtCS FOR NUKSES.
^
of tapioca, etc., may be prescribed. Solid food should
be abstained from until a few days after the disorder has
abated.
In chronic dysentery the food should be given in
small quantities at frequent intervals. All coarse, indi-
gestible food .should be avoided. In other respects the
diet is similar to that already given under Chronic Intes-
tinal Catarrh.
DIET IN ULCER OF THE INTESTINE.
The diet in ulcer of the intestine is the same as that
for ulcer of the stomach, and the reader is referred for
the details to the section dealing with that subject. In
cases accompanied by hemorrhage absolute rest in bed
must be insisted upon, and rectal alimentation adminis-
tered if necessary. In any form of ulcer the diet should
be non-irritating and easily digestible. Among those
foods that may be given are milk, eggs, rice, farina, sago,
all forms of broth, especially chicken and mutton broths;
sweetbreads, stewed chicken, baked potatoes, mashed
potatoes, tea, cocoa, crackers, and toast.
DIET IN MALIGNANT GROWTHS OP THE INTESTINE.
The medical treatment in malignant growths of the
intestine is only an adjunct to the surgical treatment
always indicated, and consists solely in treating the
symptoms as they arise. The diet should be highly
nutritious and at the same time easily digestible ; small
quantities of food should be given at frequent intervals.
Milk, broths, soft-boiled eggs, raw scraped beef, sweet-
breads, baked and mashed potatoes, vegetables, such iis
carrots and peas, that have been finely divided and
strauied, stewed fruits, toast, and crackers are permissible.
DIET IN INTESTINAL niSEASES. 20g
DIET IN ACUTE ffJTESTINAL OBSTRUCTION-
The trcatniL'iit of acute intestinal obstruction, except
when due to the impaction of a foreign body, when it
may possibly be passed through the bowel, is purely sur-
gical. Previous to operadon the following dietetic reg-
ulations should be carried out: The patient should be
kept in bed, and in the acute attacks all food should be
withheld. Thirst may be quenched by small bits of ice
kept in the mouth or a few drops of hot water may be
given at frequent intervals. If the disease extends over
a period of several days, rectal alimentation or the admin-
istration of salt solutions must be resorted to.
DIET IN CHRONIC INTESTINAL OBSTRUCTION.
In this condition the diet should chiefly be liquid or
semi-solid. All indige.stible food should be avoided,
especially those forms that are apt to leave a large
amount of residue in the bowel. The foods to be
avoided are salads, heavy vegetables, and fruits. Milk
broths, eggs, broiled meats, chicken, sweetbreads, boiled
fish, rice, farina, toast, crackers, and butter are permis-
sible. In advanced cases rectal feeding must be carried
out.
DIET IN APPENDICITIS.
The dietetic treatment hi this disea.se mu.st be governed
by the symptoms, for surgical treatment is usually indi-
cated. The patient should be put to bed and under no
condition be allowed to rise until recovery is complete.
During the first days Sahli and Penzoldt recommend that
all food be withheld ; liquids, such as egg albumin, weak
tea, thin broth, barley or rice water, or milk diluted with
lime water, may be given in small quantities when deemed
necessary. When the acute symptoms have subsided
I
2IO DIhTETICS FOR NUKSES.
this diet can bt increased somewhat; the milk may be
taken undiluted and eggs may be added to the broth.
When the pain and fever have disappeared entirely,
gruels made of rice or barley, soft-boiled egg, scraped
beef, stewed chicken, toast, and crackers may be added
to the list; still later mashed potatoes and vegetables —
finely divided and strained — may be allowed, and finally,
when the patient is well, the usual diet may be resumed.
Ochsner advises the following plan of treatment in all
cases of appendicitis in which operation is to be per-
formed, believing that it reduces the mortality and
changes the class of cases in which the mortality is
greatest into another class in which the mortahtyis very
small after operation :
" In every case of acute appendicitis all food by mouth
and all cathartics are prohibited. In case the patient
suffers from nausea or vomiting, gastric lavage is at once
employed. In the milder cases the patient is permitted
to rinse the mouth with cold water and to drink small
sips of very hot water at short intervals. In the severer
ca.ses the patient is permitted to rinse the mouth with
cold water, but is not permitted to drink either hot or
cold water for the first few days until the acute attack
has subsided, when the use of small sips of hot water is
begun. If the nausea persists, gastric lavage is repeated
once or twice at intervals of two to four hours, in order
to remove any substance which had regurgitated into the
.stomach from the small intestine.
"The patient is supported by nutrient en em ata. con-
sisting of an ounccof oneof the concentrated predigested
liquid foods in the market, dissolved in 3 oz. of warm
normal salt solution, introduced through a catheter
which is inserted a distance of 2| to 3 inches. In case
DIET IN INTESTINAL DISEASES. 211
this gives rise to pain or irritation or nausea, it is inter-
rupted for twelve to twenty-four hours at a time. In
cases in which no water is 'given by mouth, an enema of
8 oz. of normal salt solution is given four to six times
a day in addition to the nutrient cnemata. In cases
operated during the acute attack this treatment is con-
tinued for several days after the operation.
"After the patient has been free from pain and other-
wise practically normal for four days he is first given
from 1 to 4 oz. of weak beef tea, preferably prepared
from commercial beef extract, every two hours. In a
few days one of the commercial predigested foods, dis-
solved in water, is substituted ; still later, equal parts of
milk and lime water; then general liquids, then tight
diet; and finally, after the patient has fully recovered,
full diet is given."
This condition resembles nervous dyspepsia. At times
the most indigestible food is well borne, whereas the
digestible forms create discomfort ; in each case it is
important that the diet be regulated according to the
patient's digestive powers. Generally a liberal diet is
indicated in these cases ; in many instances a systematic
rest cure is needed to bring about relief
Flatnlence. — This condition is characterized by an
excessive accumulation of gas in the intestine. In the
dietetic treatment, therefore, foods that tend to produce
large quantities of gas, such as beer, cider, carbonated
waters, fruit, cabbage, rye and Graham breads, and
potatoes, should be avoided. The disorder is often of
purely nervous origin, and when this is the case unre-
DH-.TETICS FOR NURSES.
stricted diet is to be recommended — one that will tone
up the patient's system and thus cause the flatulence to
disappear.
DIETETIC TREATMENT FOR HEMORRHOIDS.
Since constipation is often a frequent cause and accom-
paniment of hemorrhoids, it is important that this condi-
tion be corrected. As has been pointed out elsewhere,
proper diet plays an important role in the prevention of
chronic constipation. Patients afflicted with hemorrhoids
should eat in moderation, but should avoid all excesses
of food and drink. An abundance of outdoor exercise,
consisting of walking and simple gymnastics, should be
indulged in ; violent gymnastics and horseback-riding
should be avoided. A daily evacuation of the bowels
should be secured. Patients with hemorrhoids should
avoid alcoholic beverages, spiced foods, strong coffee
and tea, cheese, cabbage, and beans. The foods most
suited to this condition are potatoes, carrots, spinach,
asparagus, and even salads, since they stimulate intestinal
peristabis and thus help to keep the stools soft. Stewed
and raw fruits, including grapes, oranges, pears, and
apples, are also beneficial. Water is the be.st beverage
in this condition. The waters of Carlsbad, Kissingen,
and Saratoga are most beneficial ; they act best when
taken at the springs.
DIETETIC TREATMENT OF DIARRHEA.
The dietetic treatment of diarrhea niu.'it vary accord-
ing to the type of the disorder. In the nervous variety
the patient should be instructed to restrain his bowel
movements except at a certain hour in the morning.
Under all conditions it is important to exclude from the
DIET IN INTESTINAL DISEASES.
213
diet all foods that have a tendency to stimulate the
intestines. Coarse, indigestible foods, especially those
containing a large percentage of cellulose, must be
avoided ; in this class are especially to be mentioned
cabbage, pickles, salads, turnips, carrots, all cold drinks,
carbonated waters, and beverages (including champagne
and beer). Among the foods to be recommended are
broths, tea, red wines, farina, rice, and barley gruels.
Raw milk usually has a laxative effect, but when boiled
or diluted with lime water or brandy it is constipating,
although in a certain number of cases it must be entirely
excluded, as it increases the number of movements. In
a number of cases of chronic diarrhea milk cures have
been given with good results. The authors have suc-
ceeded in relieving cases of chronic diarrhea by sys-
tematic rest cure.
DIET IN CHRONIC DIARRHEA.
•t Authors' Diet List far Mo,i,-rate Cases of C/ironic Diarrhea.
Caloriw.
1. : 200 gm. of cocoa (cooVed in water) 45.0
2 soft-boiled eggs tto.o
SO 1^. toast 130.0
[, : 250 gm. broth with i egg 80.O
30 gm. Panopeptone 57.5
250 gm. broileil cliicken 212.0
30 gm. toast 130.0
100 gm. raasheil potatoes a45.o
1. : 50 gm. Panopeplone 57.5
1 soft-boiled egg So.O
200 gni. cocoa (coined in Wilier) 45.0
50 gm. toast 130.0
I. : TOD grti. lice Cijoked in bouilhm .......... 34.O
50 gm. wheat bread I30.0
1. : 100 gm. raw scraped beef iiS.o
SOgm. Panopepwne 57.5
50 gm. toa-sl 1300
J
214
DIETETICS FOR NURSES
DIET IN HABITUAL CONSTIPATION.
In the dietetic treatment of habitual constipation it is
essential that the food that is ingested should be such as
will increase the intestinal movements. Those foods
that leave a large bulk of fecal matter arc useful for
this purpose. Those that leave a small residue are most
apt to produce chronic constipation. A diet consisting
principally of eggs and milk with only a small quantity
of vegetables and water is one that is constipating.
A glassful of cold water taken before breakfast will
often regulate the bowels; occasionally, according to
Penzoldt, a pinch of salt added to the water will increase
its efficacy; raw or cooked fruit, taken on an empty
stomach morning or evening, occasionally gives good
results. It is a well-known fact that the smoking of a
cigar in the morning will often stimulate intestinal move-
ments. The patient should recognize the importance of
having an evacuation of the bowels at the same time
each day.
Chronic constipation is a frequent accompaniment of
dyspeptic disorders, and may be relieved by appropriate
treatment of the gastric disorder. It should not be for-
gotten that habitual constipation is frequently induced
by the persistent use of cathartics, and the use of drugs
should be avoided as much as possible in the treatment
of this disorder. Sedentary habits are often the cause
of constipation, and for thi.'; reason proper exercise
should always be prescribed along with the dietetic
treatment. The vegetables that are especially useful in
the treatment of chronic constipation arc spinach, peas,
cauliflower, cabbage, asparagus, salads, onions, celery,
and tomatoes. The cereals that stimulate the intestinal
DIET m INTESTINAL DISEASES.
2IS
movements are oatmeal and commeal. Graham, rye,
com, whole wheat, and bran breads are also useful.
Other foods classed as laxatives are honey, cider, molasses,
and acid fruits, such as apples, pears, peaches, cherries,
and oranges. On account of the acids and seeds they
contain, berries are effective laxatives. Prunes, dates,
and figs are also to be recommended.
Habitual constipation is often due to the fact that water
is taken in insufficient quantities ; therefore, in the treat-
ment of the disorder, an abundance of water must be pre-
scribed. The foods to be avoided are tea, claret, cocoa,
chocolate, rice, barley, and farina gruels, and huckle-
berries. In some cases milk acts as a laxative, whereas
in others it has the opposite effect. For this reason its
effect should be tested tn every case. Boiled miik usually
constipates. Buttermilk is preferable to sweet milk as a
laxative. Most cases of habitual constipation can be
relieved or cured by the dietetic treatment here laid
down.
Boas ' has recently called attention to the fact that in
a certain class of cases of chronic constipation, excellent
results are obtained by the rest cure. The patient is
isolated for fourteen days and is not allowed to leave
his bed. The nourishment of the patient is regulated
for each day, and for each meal. No effort is made to
increase the patient's weight, although great importance
is attached to giving food regularly. The treatment is
continued for from four to .six weeks.
It is not within the province of this book to discuss
the value of massage and electricity; suffice it to say
that they are reliable adjuvants to the treatment of con-
stipation.
' Boa.!, Iiilirnnlhiial ClinUs, vol. iii., l4Lh .Series, 1904.
1 2l6 DIETETICS FOR NURSF.S.
^B
The authors frequently prescribe the folk
cases of chronic constipation :
wing diet in
CaJorws.
1 8 A. M. : 300 gm. milk wilh coffee
1 2 sufl-boileil e^.^
1 150 gm. Grah.iin bread
1 40 gni. hutler
1 10 A. M. : 400 gm. cider
L 12 M.; 200 gm. htolh. wiib 1 p^
. . 192
. . 160
■ 371
■ .326
. .280
. . 84
^^K i^!:::'^™?
^^^^H 150 gm. Uraham bread
^^^^ 200 gm. slewed apples
■ 4 r. M. : 400 gra. buitermilk
7 \: M. : 100 gin. scraped beef
1 IS*'G'"' tJraiiam bread
. . 166
. . iiS
9 V. M. ; 40 gm. figs (0. 400 gm. Imllermilk)
■
, ^6
3525
DIET IN PERITONmS.
Acute Peritonitis. — TJie diet in acute
peritonitis is
purely of secondary importance and requires considera- ^|
; tion only until operative procedure can be undertaken. ^|
No food whafpver .i^liould be ;;ivcn bv the mouth : if |
necessary, rectal alimentation should be rest
rtcd to. If H
operation is not undertaken and vomiting has ceased, ^^t
fluids may be given in a few days. Foods that may be H
prescribed are milk and lime water, diluted broths, and H
egg albumin with or without brandy or .
very small quantities should be taken at a
frequent intervals ; gradually plain milk,
gruels may be added to the list ; solid food
lierry ; only H
time, but at fl
broth, and ^|
.should not ^1
be allowed for several weeks. When stimulants are re- ^|
B quired they should be given in the form
I brandy, or champagne.
of whisky, H
DIET IN INTESTINAL DISEASES, 21/
Chronic Peritonitis, — The diet in chronic peritoni-
tis should consist of boiled meats, eggs, milk, stale bread,
toast or crackers, and vegetables, only, however, in the
form of purees; carbohydrates should be eaten sparingly
on account of their tendency to ferment. Food should
be eaten in small quantities at regular but frequent
intervals.
CHAPTER XIII.
DIET IN DISEASES OF THE LIVER*
Certain general principles of dietetics apply to all dis-
eases of the liver. The condition usually called " bilious-
ness " is a cry of the liver for relief from overwork. The
administration of calomel or a saline laxative followed by
a few days of restricted diet is all that is necessary in
most cases. In general it may be stated that in diseases
of the liver the food should be easily digested and con-
sist of a mixture of proteins, carbohydrates, and fats. In
many cases it is desirable to limit or even to avoid alto-
gether both fats and carbohydrates.
Certain articles of diet are known, while others are
believed, to be injurious in diseased conditions of the
liver. Overeating is injurious ; first, on account of the
overwork it necessitates; and secondly, because the
superfluous food is apt to undergo putrefaction. The re-
sulting bacterial products are believed to act on the liver
in much the same manner as does alcohol. The exces-
sive use of alcohol produces marked changes in the liver
in certain individuals.
In all liver diseases alcohol should be avoided unless
specially indicated as a tonic or stimulant. In any case
it should be given well diluted. A well-matured pure
whisky well diluted with water is to be preferred, and
this is only in the smallest possible amount.
Certain foods have been regarded as " stimulating '* or
218
DIET IN DISEASES OF THE LIVER.
219
I CO
I ad
" irritating " to the liver. Among these are peppers of
various kinds, spices, mustards, concentrated meat ex-
tracts and meat broths, and the substances formed in
roasted and baked meats. To be proscribed are peppers,
radishes, horseradish, onions, watercress, and celerj'.
Salt in too large quantities is also to be condemned.
Strong coffee and tea are harmful, but weak tea seems
to be well borne in many cases.
In severe diseases of the liver the diet mu.st usually be
restricted to milk, diluted or peptonized ; gruels, albumin
water, kumiss, buttermilk, and bland broths, such as
oyster broth. Orange juice as well as lemonade may
generally be allowed.
In the milder diseases and during convalescence the
diet need not be so rigid, and lean meat, curd, junket,
bread, toast, zwieback, fresh fruit, or stewed fruit with
little or no sugar, may be allowed. In the chronic cases
and lighter forms the following articles may help to make
up the dietary: Milk, variously diluted and prepared;
buttermilk, curd, kumiss, custard, junket, eggs, lean
meat— if beef or mutton, preferably rare — sweetbreads,
chicken, squab, liver, the soft part of oysters and the
more digestible forms of fish. Fresh green vegetables
and green salads without oil are permissible. Small
quantities of well-baked or boiled mealy potato may be
allowed once a day, for many persons do not relish a
meal that does not contain potato in some form. The
.starchy foods should be partaken of somewhat sparingly ;
bread, toast, zwieback, pulled bread, and biscuits (crackers)
may be permitted. Small quantities of cereal foods may
be taken ; rice, sago, and tapioca, when sufficiently well
cooked, may be allowed. Fresh fruit is a valuable
adjunct to the diet. Oranges, grape-fruit, ripe peaches
220 DIETETICS FOR NURSES.
or pears, strawberries, ripe plums of the most tender
varieties, may all be taken. Stewed fruits only slightly
sweetened and baked apples may be allowed with advan-
tage. If there is constipation, stewed prunes are useful.
Lemonade may be taken as a beverage.
Mineral waters may be drunk freely if dropsy is not
present, and are best taken on rising and between meals.
Hot water is a valuable substitute for the mineral waters.
It is especially useful in allaying thirst when there is
dropsy.
The food should be taken slowly, well masticated,
and never in too large quantities. If necessary, more
miik may be given, so as to make large amounts of
other food unnecessary. The patient should lie down
directly before and after meals. In no case should
the patient eat immediately after taking active exer-
cise.
In certain chronic conditions, such as hyperemia, fatty
degeneration, and chronic hepatitis, exercise is to be
taken at proper times.
In summer and in warm climates more vegetables are
to be allowed and less meat. If putrefactive changes
take place in the intestine, a diet consisting of white of
egg and water should be maintained until this condition
is overcome. When the putrefaction is caused by tor-
pidity of the hver, it may sometimes be prevented by
increasing the amount of vegetables and by the use of
laxatives.
Diet in Gall-stone Disease. — The meals should
be taken at regular intervals and not too widely sepa-
rated. Prolonged fasting should not be permitted. A
substantial breakfast should be taken when not other-
wise contra-indicated, and not the simple " continental "
DIET IN DISEASES OF THE IIVEK, 221
breakfast of coffee and a roll. A late supper is of value,
and it may be advisable in some instances to give the
patient nourishment at night. Fat should be reduced to
a minimum or avoided entirely, and the starches and
sugars limited in amount.
CHAPTER XIV.
DIET IN DISEASE OF THE RESPIRATORY
ORGANS-
Pleurisy. — Two plans of dietetic treatment may be
followed. The first is to place the patient on a milk
diet. The second is to place the patient on a " dry
diet.*' This consists of the ordinary diet with the fluids
limited in amount. No soups, but little tea or coffee, are
allowed, and but small amounts of water. The milk
diet is preferred where there is fever or complicating
heart or kidney disease.
Empyema {Pus in the Pleural Cavity), — As nourish-
ing a diet as is possible should be used according to the
general principles of feeding fever patients.
I/aryng^tis. — In chronic disease of the larynx there
may be great pain on swallowing. All hard and highly
seasoned foods are to be avoided. Only semi-solid and
liquid foods should be given. The physician sometimes
prescribes drugs to allay the irritation in the throat at
meal time.
Difficulty in swallowing may sometimes be overcome
by the following two methods : By allowing the patient
to lie flat on a lounge with his face over the edge. Food
is to be sucked through a tube from a vessel placed im-
mediately below. The second method consists in direct-
ing the patient to lean forward while eating.
Asthma. — Certain forms of asthma may be brought
on by errors in diet leading to attacks of indigestion.
222
DIET IN DISEASE OF KESPIKATOKY ORGANS. 223
Patients suffering from this should partake oiiiy of easily
digested food and should lead regular lives. The meals
should be taken at regular intervals. Dinner should be
eaten in the middle of the day and the supper should
be light. Late suppers should not be taken, and eating
between meals should not be allowed.
Diet in Chronic I/Ung Disease.— In all chronic
diseases of the lungs the diet should be as easy of diges-
tion and especially a diet which will not cause flatulence,
as this pushes up the diaphragm and interferes with
breathing. (See Diet in Diseases of the Heart.)
Fuentnonia. — The diet in pneumonia is of the great-
est importance. The patient's recovery often depends
upon the matter of his being well nourished.
The same genera! principles of feeding should be fol-
lowed as arc indicated in all acute fevers, During the
course of the disea.se the patient should receive an
abundance of water in addition to the liquid food sup-
plied. Plain water or any carbonated water that the
patient may desire should be given. Milk and seltzer
may be allowed freely. Lemonade or orangeade, or
water flavored with tamarinds, may serve to lend variety.
The " Imperial drink" (the recipe for which appears at
-the end of this book) may also be given.
During the height of the disease milk should form the
basis of the diet. This may be peptonized or diluted
with lime water. Albumin water, wine whey, malted
milk, beef juice, Eskay's food, and .similar preparations
may be employed when milk is not well borne. Prcdi-
gested liquid beef preparations may be used both for
their stimulating effects and as a food. They should
always be diluted freely with water unless, because of
vomiting, a concentrated food is indicated.
224 DIETETICS FOR NURSES.
Food should be given at regular intervals of from two
to four hours, according to the patient's condition and
the amount he is able to take at one time.
Constipation, flatulence, and vomiting are to be avoided
whenever possible. If they do occur, efforts should at
once be made to relieve the condition.
In most cases starches and sugars are best omitted
from the diet. Fruit may be allowed at any time during
the disease, and is of special benefit during convales-
cence. Most grateful during the severe stage are orange
juice, lemonade, grape-fruit, and grapes. During conva-
lescence ripe peaches or pears in season may be added
to the diet. The return to a general diet should be made
gradually, and no solid food should be allowed until the
fever has subsided. Then the general dietetic rules for
convalescents may be followed.
Alcohol is given only according to the directions of the
physician.
CHAPTER XV.
DIET IN DISEASES OF THE CIRCULATORY
SYSTEM.
DIET IN DISEASES OF THE HEART.
General Directions for Diet. — The diet for patients
with heart disease usually requires considerable atten-
tion. In general there are two stages of heart disease.
The first is called " the stage of compensation," when
the heart, although diseased, is still able to pump the
blood through the body. The second stage, or "stage
of broken compensation," is when the, heart, no longer
able to cope with its work, is unable to force the blood
through the vessels as it should and there is a certain
amount of damming back of the blood. This causes
numerous unpleasant symptoms, such as edema, diffi-
culty of breathing, and irritability.
During the first stage the diet requires comparatively
little attention beyond the observance of certain general
rules. When the second stage is approaching the diet
should be carefully supervised, for the patient may be
spared much suffering, and often the time of the broken
compensation postponed.
The meals should be small; more should never be
given than the patient can easily digest. If the stomach
is overloaded the diaphragm is pushed up and displ;
the heart, and this may occasion palpitation and dyspnea.
If the meals are too large the residue of any
food in the intestine may undergo fermentation and
lisplaces ^H
lyspnea. ^H
digested ^H
on and ^H
226 DIETETICS FOR NUKSES.
caune flatulence, with its attendant disagreeable symp- .
toma.
The meals should be simple and well cooked. Im-
properly prepared food is a cause of indigestion, and
may produce flatulence or discomfort. The food chosen
should be of a kind that is easy of digestion. A suffi-
ciently long interval should be allowed to elapse between
meals, and eating between meals should be strictly pro-
hibited, as even small portions of food taken when
digestion is in progress may give rise to flatulence in
these patients.
The meals should all be of equal size; while the even-
ing meal may be a little smaller and lighter than the
others, and the principal meal should be taken at midday,
there should, as has been said, be but comparatively
little difference Tn their size, and the patient should be
instructed carefully in this regard.
The amount of fluid taken should not be too large,
nor, on the other hand, should it be too small. When
compensation has been lost, the question as to the
amount of fluid to be taken becomes of much impor-
tance. At no time should it be forgotten that fluids dis-
tend the vessels, raise arterial tension, and increase the
work of the heart. If the quantity of fluids given be
too small, elimination is delayed and the irritative effect
of the retained impurities in the blood proves harmful.
Fluids should be taken between meals and are best
sipped slowly. Weak tea and coffee may be allowed
in small quantities between meals; if they do not cau.se
flatulence, however, they may be allowed at meal times,
but always in great moderation.
Alcohol is best avoided. If, owing to the general
weakness of the patient, its use is indicated, it should be
I
I
DIET IN DISEjtSKS OE CIRCULATORY SYSTEM. 22/
given in small quantities, and in the form of pure whisky
or brandy weil diluted. Wine and beer are contra-
indicated.
In general it may be said that a diet of plainly pre-
pared food, unencumbered by too many restrictions, is
best in these cases.
All highly seasoned food and the condiments in gen-
eral should be omitted from the diet, as they tend to
stimulate the appetite of the patient and may cause him
to take more food than is necessary or desirable.
Stews and fancy dishes should also be omitted, as
should the foods usually classed as difficult of digestion,
such as fried foods and the like.
Starches, sugars, and fats should, as a rule, be re-
duced ; this restriction, however, should be enforced
strictly only when made necessary by complicating
stomach disorders coming on as compensation rupt-
ures, when they are apt to cause fermentation and
flatulence.
Broadbent dwells on the necessity for giving a diet
containing about the usual proportion of food constitu-
ents. Starches and vegetables are useful additions to the
diet, as they help to keep it from being too largely nitrog-
enous. If too much protein material is taken it is imper-
fectly oxidized, and the waste accumulating in the blood
increases the work of the heart, just as when too much
food is taken.
The diet should consist largely of milk and of dishes
made from this food ; eggs, rare meats, especially mutton
and beef; poultrj', fish, and oysters. Well-baked bread,
rolls, or biscuits, which are never to be eaten warm, and
cereals in moderate quantities may be allowed. Well-
cooked potatoes, spinach, asparagus tips, cauliflower tops.
I
228 DIETETICS FOR NURSES.
and other similar vegetables may be taken, all stalks
being avoided.
The diet list should be simple and such as will not
require complicated directions.
As compensation becomes impaired, numerous disor-
ders of digestion occur and require care and attention.
The patient with heart disease may develop a distaste for
food, and this will often tax the ingenuity of the physician.
As blood-stasis sets in, constipation is apt to occur.
Hypostatic congestion of the hvcr comes on, causing
lessened metabolism, and consequently interfering greatly
with the general nutrition. The stomach and intestine
arc affected and a chronic catarrhal condition of both is
generally present.
The quantity of fluid given should now be regulated
carefully, neither too much nor loo httle being given. A
glassful of Vichy half an hour before eating will help to
prepare the stomach for a meal, and will, as a rule, be
excreted promptly. Fluid is absolutely necessary for
metabolic changes, and may be taken in the form of the
" Imperial drink," elsewhere described, between meals.
A glassful of hot water flushes out the body, and as jt
is rapidly excreted does not add materially to the amount
of fluid present.
In the Oertel treatment of heart disease the fluids
are allowed only in a very limited degree. If the patient
is on a milk diet, other fluids besides milk should be
given in comparatively small quantities.
If edema, is severe the food may be given in as concen-
trated a form as possible.
If flatulence is troublesome, fats, starches, and sugars.
as well as beer, pastry, and stews, are to be avoided. No
solid food should be taken between meals. Coffee or tea
I
DIET IN DISEASES OF CIRCULATORY SYSTEM. 229
taken with the meals may give rise to flatulence. They
may, however, in some cases be taken during the day, at
a time when the stomach is empty; they should be
freshly prepared and should never be strong. Only such
quantities of food as the patient can digest should be
allowed, and if necessary digestion may be aided by
giving essence of pepsin or other digestives. In some
cases a milk diet may become necessarj'.
Sudden dilatation of the heart occurring during or fol-
lowing any acute disease requires rest and a milk diet.
Palpitation and dyspnea are often caused by the inges-
tion of too abundant meals ; if persistent the food should
be given in smaller quantities and at shorter mtervals.
Four or five small instead of three large meals may be
taken at regular intervals, or a milk diet may be ordered
for a time. The general management may be such as
has been suggested for flatulence. Tea, coffee, and
tobacco should be avoided, and effervescing drinks may
also be omitted. If there is constipation, stewed fruits,
especially prunes or figs, are useful.
Gastric disturbances are best met by rest and a milk
diet for a time, with a gradual return to the ordinary diet
or a diet such as is advised for cases of gastric catarrh.
Much relief frequently follows the drinking of a glassful
of hot water or of Vichy half an hour before a meal.
A.I ruptured compensation is accompanied by effusion,
something must be said with special reference to the re-
moval of fluids from tiie body. Here, indeed, feeding is
a difficult task, for the patient usually has a disgust for
food. If the patient is very ill, nourishment may be
administered every three hours. If he is able to be
about, it will often be well to allow him to take his meals
with the family at the regular meal time. He may be given
230
DIETETICS FOR NURSES.
chicken, tender meats, fish, oysters, and other forms of
light food. When but little is taken at the regular meal ■
time, food may be given between the meals at regular
periods, time being allowed for complete digestion to
take place. Milk, albumin water, egg and milk, soup, or
beef tea in small quantities are useful for this purpose,
Broadbent recommends meat or ciiicken jelly or meat
extracts for their stimulating efiect on the heart. Potted-
meat sandwiches or meat pulp, prepared as directed for
tuberculosis patients, may be given.
Fluids other than milk and soups should be taken in
as small quantities as possible, " Imperial drink " or hot
water, as previously suggested, may be given to quench
the thirst.
Stimulants are usually needed, but should be given
only under the supervision of the physician, as there is a
tendency to take too much to relieve faintness or other
symptoms. In non-alcoholics, from i to 2 oz. of whisky
a day may be allowed at the beginning, the amount
being increased as occasion demand.s. Stimulating drugs
have largely superseded the use of alcohol in these cases.
Aneurism ; Dilatation of the Blood-vessels. —
Special diets are sometimes prescribed for these patients,
Tufinel's diet, which restricts the foods to a very small
quantity and enforces absolute rest, is the best known.
Whether or not such diets should be used is a matter to
be decided only by the most expert knowledge.
Angina Pectoris. — Small ea.siiy digested meals are
to be given according to the general rules for dieting
heart disease.
Anemia. — There are a number of different kinds of
anemia, and the diet depends somewhat upon the form
present. That following the loss of blood is usually
DIET IN DISEASES OF CIRCULATORY SYSTEM. 23 1
rapidly recovered from. In this form infusions of salt
solution are sometimes given.
In general it may be stated that anemic persons require
fresh air and sunshine and good food. Fresh food, milk,
eggs, meats, green vegetables, and fresh fruits are the
most important articles of diet The meals should be
given at regular intervals and not too widely separated,
usually about three hours apart. The meals should be
small. Eating between meals should be absolutely pro-
hibited, and this may require some watching, as the
patient frequently has a very capricious appetite, eating
all sorts of indigestible articles between meals and leaving
the regular food untouched. The breakfast should be a
good, nutritious one and consist of meat or eggs in addi-
tion to other articles of food. Milk is valuable, but
should not be given to the exclusion of other food. It
is a good plan to have it taken toward the close of the
meal, as otherwise the patient may spoil his appetite by
drinking a glassful of milk at the beginning of the meal.
Rest before and after meals is desirable.
CHAPTER XVI.
DIET IN DISEASES OF THE GENITO-URINARY
SYSTEM*
Urine and Food. — The urine bears a direct relation
to the quality and quantity of food ingested, as well as
to the quantity of fluid taken and the amount of work
done by the individual. Many variations occur in the
urine that are due to food or drink and that are normal.
When the kidneys are diseased improper food may bring
on dangerous or even fatal complications.
One of the first principles of dieting persons with dis-
eases of the kidneys is to avoid giving them food which
is irritating to the kidneys. Among these may be men-
tioned the browned outer surfaces of grills and roasts,
strong sauces, spices, pastry, very acid foods, strong
alcoholic drinks, and strong tea and coffee. Green vege-
tables are to be avoided in acute diseases of the kidneys,
as well as cranberries and fruits which contain kernels.
As regards meats in the acute conditions, they are to be
avoided until ordered by the physician. There is a popu-
lar idea that the light meats are less injurious than the
dark ones ; this has no foundation. Glands, such as
liver, sweetbreads, kidneys, and spleen, should be avoided.
Strong meat broths are also injurious.
Alcohol is to be avoided in all cases except when
prescribed by the attending physician. All alcoholic
beverages are irritating to the diseased kidneys, and if
232
DIET IN DISEASES OF CENITO-URINARY SYSTEM, 233
anything they are more injuricjus in the chronic cases
than in the acute.
Water may be given freely in all cases where the urine
is increased with the increase in the amount of water
taken. It aids in the elimination of waste products.
When, however, the amount of urine is greatly dimin-
ished or none at all is passed, the physician should regu-
late the amount of fluid that is given the patient, as there
may be danger in giving too much.
Acute Inflammation of the Kidney ; Nephritis.
— During the first stage of the acute condition in the
severer cases food is given in very small quantities, a pint
of milk a day. To relieve the tliirst. tablespoonful doses
of water may be given or pieces of ice may be placed
in the mouth. In this stage the physician frequently pre-
scribes some form of alcoholic stimulant.
In the less severe cases a strict milk diet is followed,
or, what is generally preferred, I \ quarts of milk is given
with about \ pint of cream. Rice, groats, cornmeal por-
ridge, crackers, and zwieback may be added if the patient
has any appetite, and butter, sugar, and grape juice or
other fruit juices may be given. Plain or carbonated
waters, the " Imperial drink," weak lemonade, buttermilk,
and similar drinks may be given. As convalescence
advances calves '-foot jelly and similar preparations
are allowable. Light vegetables may be added to the
diet; spinach is perhaps the best, but cauliflower tops,
young peas, or young string-beans may be used. In
acute cases and their convalescence the patient's appe-
tite is a fairly good guide as to the amount of food to be
taken. Meat and eggs arc to be added to the dietary last
of all. For a long time after an attack of inflammation
I
I
L
234 DIETETICS FOR NURSES.
of the kidneys the patient should avoid the articles of
food which are irritating to the kidneys.
Chronic Inflammation of the Kidneys. — In this
disease the diet should be very much like that suggested
for old ])eople. (See Diet for the Aged.) Alcohol is to
be avoided, as are tea and coffee and all the foods set
down as irritating to the kidneys. The amount of fluid
taken should not be excessive. There is a popular idea
that in this disease the more fluid one takes the better;
this i.s not true, and in some cases excessive amounts of
fluids are distinctly injurious. An occasional drinking-
day or drinking-week is sometimes allowed, during which
the patient drinks large quantities of water to flush out
the system. This is frequently accomplished by an occa-
sional visit to a watering-place, where the change of
scene is often of as much value as the waters. Rxerci.se,
fresh air, freedom from care and worry, suitable occupation,
and pleasant surroundings are all important. A change
of air to a dry, warm climate is often of great benefit.
Another point to remember is that many drugs are in-
jurious to the kidneys, and the taking of indiscriminate
headache powders and other things without a knowledge
of what they do or of what they contain is a habit which,
if for no other reason than protecting the kidneys, i.s to
be most highly condemned.
Movable and Floating Kidney. — This trouble is
sometimes seen after rapid loss of flesh from any cause.
A rest or careful feeding to regain the original weight is
in many cases of great service.
Calculous Affections. — The tendency to stone for-
mation, as in the kidney or bladder, and the much-talked-
of condition usually called the uric acid diathesis, may
be considered together.
f
DIET IN DISEASES OF CENITO-URSNARY SYSTEM. 23S
In many instances, but by no means all, too rich food,
too lai^e meals, and too little exercise are at the bottom
of the trouble.
The following suggestions regarding the diet will be
found useful: Avoid strong drinks, and all alcohol if
possible; much meat, and especially the nuclein-contain-
ing -meats, as thymus, spleen, liver, brain, caviare, etc.,
smoked, pickled and spiced meats, and rich foods in
general. The fats and sugars as well as the cereals
should be restricted. The diet should be made up of the
plainer, well-prepared foods, and so far as possible a
vegetable diet should be prescribed. Water, especially
the alkaline mineral waters, may be allowed in abun-
dance. A sojourn at Carlsbad may be recommended
for certain ebese patients.
Mineral waters must be used with extreme caution, for
if too much alkaline water be taken it may increase the
deposit of certain earthy .salts. The physician should
direct the kind and amount of such waters as are to be
taken.
The directions for diet are very simple. All irritating
foods and drinks should be avoided, as should all indi-
.gestible articles. The diet should consist of plain and
wholesome food. Where it is possible, skim-milk should
form the basis of the diet. Too much meat should not
be taken, and twice -cooked meats and fried and very
greasy foods avoided so far as possible. Carbohydrates,
as breadstuffs, cereals, and the non-acid vegetables, may
be allowed. Care should be taken to avoid all com-
plicated and highly seasoned foods, all pepper, spices.
236 DIETETICS FOR NURSES.
and salad dressing. In a word, everything previously
mentioned as irritating to the genito-urinary tract should
be avoided. Acid fruits, asparagus, and tomatoes are
also to be forbidden. Tea and coffee should be pro-
hibited or given very weak and well diluted with milk or
cream. All alcoholic drinks should be forbidden.
CHAPTER XVI I.
DIET IN DISEASES OF THE NERVOUS SYSTEM.
The necessity for the correct management of the diet
in nervous diseases is becoming appreciated more and
more every year. As a general rule, it may be stated
that all functional diseases attended with emaciation are
greatly benefited, if not entirely relieved, by merely in-
creasing the patient's weight by such methods as are
suggested under the heading of Rest Cure. Patients
with chronic lesions will, as a rule, be made more com-
fortable if the following two points are borne in mind:
First, to overcome, so far as possible, emaciation and
anemia where the nutrition has a tendency to be below
normal; and secondly, and of no less importance, to
prevent undue obesity In those so inclined, particularly
where there is disturbance of locomotion. A patient
may be condemned to remain in bed or in a chair on
account of the excessive weight which his inactivity has
fostered.
Most patients regard diet as a very unimportant part
of the treatment; this is especially true of those cases
that most need careful feeding. The necessity for careful
dietary should be impressed upon these patients, and a
faith in its efficacy engendered where the disease is of a
functional nature.
The diet suitable in nervous diseases has been the
238 DIETETICS FOK NURSES.
subject of many diverse opinions, particularly in the
minds of the laity. Fish has been vaunted as a " brain
food," and various fats or cereals have been suggested
for nervous conditions. At the present time, it may be
stated, there is no specific "nerve food." The nutrition
of the nervous system will be good when the patient's
general nutrition is good, and vice versa. Both in func-
tional disorders of the nervous system and in the psy-
.choses dependent upon exhaustion the improvement of
the general condition should be the first care.
The basis of the diet is usually miik. Care should be
taken to see that the patient gets sufficient fluid, and
where no tendency to obesity exists water should be
taken with each meal, and usually at bedtime and on
rising. It may also be taken between meals if desired.
When there is disturbance of digestion, it is a good plan
to prepare the stomach for the meal by sipping a glassful
of hot water on rising and an hour or less before each
meal. The mineral waters may be used when desired;
the alkaline ones are apt to be of most value. Carbon-
ated waters should be used with care, lest the flatulence
they may cause give rise to symptoms the importance of
which may be greatly exaggerated by the patient.
A question of great importance is whether or not
alcohol should be used. As a general rule, it should not
be allowed. In cases with chronic lesions, where the
patient has been accustomed to the use of alcohol all his
life, it may be allowed if not otherwise contra-indicated,
as in a tendency to cerebral hemorrhage, arteriosclero.sis,
chronic interstitial nephritis, and the like. The use of
alcohol in the functional disorders is usually contra-
indicated. Its value as a food and as a stimulant to
nutrition should not be overlooked, and it may be used
I
DIET IN DISEASES OF THE KER VOL'S SYSTEM. 239
with great benefit in the psychoses accompanied by ex-
haustive conditions.
NEURALGIA.
Some cases of neuralgia are directly caused by indis-
cretions ill diet ; other cases depend on a lowered state
of nutrition, while still others may be due to plethoric
states. Neuralgia is also caused by many factors not
related to the diet of the patient. To decide this ques-
tion requires great experience and judgment on the part
of a skilled physician.
As a general rule, plain, wholesome food should be
ordered at regular intervals. The patient should not be
allowed to eat between meals. Ail rich, complex, and
highly seasoned foods should be forbidden, as should all
fried foods, pastry, and anything known to disagree with
the patient. Care should, however, be taken that the
diet be not restricted, for tiie patient's ability to take dif-
ferent articles is often purely imaginary. True idiosyn-
crasies for different articles of food are not very common.
The excessive use of tobacco may be the cause of
neuralgia.
INSOMNIA AND DISTURBED SL£EP.
When not dependent upon other conditions, these are
apt to be due either to eating at night or to a depressed
state of the nutrition. For the first there is nothing to
do but to discontinue the habit of eating at night. There
arc but few persons who reach middle age and can
eat late at night with impunity, and sooner or later the
individual learns that he must give up the habit. There
are some, however, with whom the practice seems to
agree.
240 DIETETICS FOR NURSES.
When the trouble is caused by malnutrition or anemia,
the general condition of the patient must be treated.
Good food, regular hours, milk or some light food be-
tween meals, and on going to bed a cupful of hot milk,
cocoa, or, if preferred, beef tea, malted milk or similar
preparation may be ordered.
In many cases where the nutrition is fairly good one
of the hot drinks just mentioned taken at bedtime may
be all that is necessary. This is especially true of the
insomnia and disturbed sleep that follow the doing of
mental work at night. The effect is to dilate the abdom-
inal vessels and to restore the equilibrium of the circu-
lation. A brisk walk in the open air or five minutes*
exercise will often accomplish similar results.
EPILEPSY-
Epilepsy bears an important relation to diet. There is
no specific " anti-epilepsy " diet, and there is no form of
food that can be assigned as a cause of epilepsy ; it is,
however, a fact that where the diet is carefully regulated,
the number of attacks are usually lessened. This is par-
ticularly true of children. The principle involved is to
give only as much food as the patient can easily digest
and assimilate, and to allow sufficient time to elapse
between feedings for him to utilize and excrete the end-
products of what he does assimilate. When this is not
done, attacks may be provoked by irritating substances in
the bowel, by the absorption of toxic substances from the
intestinal tract, or by the accumulation of the products
of metabolism in the body. In the epileptic colonies no
especial diet is used, but the amount and the variety of
food are so regulated as to secure the best results.
DIET IN DISEASES OF THE NERVOUS SYSTEM, 24 1
In children a diet composed largely of milk, with the
addition of cereals and fruit, is most useful. In older
persons this diet is not feasible except occasionally as a
temporary measure. For these latter meat should be
allowed only once a day, unless on account of excessive
manual labor or because of a weakened condition of nutri-
tion the patient especially demands it. Milk, cereals,
bread, vegetables, and fruit should make up the rest of
the dietaiy. JKach patient should be instructed to take
only digestible food, to take his meals regularly, and not
to eat too much. They should also be taught to eat
slowly and masticate the food well. The avoidance of
constipation is of primary importance, and this can usually
be secured by the proper use of fruits and the coarser
forms of cereals.
Quiet, open-air life, pleasant occupation of a non-
strenuous kind, an absence of worry, and agreeable
forms of recreation are just as important as the diet in
these cases.
CHOREA*
In chorea the diet is often of the greatest importance ;
this is especially true when it occurs in anemic or debili-
tated children. Rest and an easily assimilable diet are
the indications. The authors are of the opinion that
absolute rest in bed, if possible isolated from the remain-
der of the family and under the care of a trained nurse,
who should be a stranger, combined with a milk diet or
a diet composed largely of milk, will give better and more
lasting results than any other form of treatment. If the
patient is anemic, beef juice made from fresh beef may be
used to advantage, as well as raw scraped beef and simi-
lar foods.
16
DIKTHTICS 1-OR NVKSES.
APOPLEXY.
Comatose Stage. — During the early stage of the
comatose condition — /. c, for the first day or two — there
is, as a rule, no necessity for giving the patient any food.
As the disease is most likely to occur in obese, overfed
individuals, the abstinence from food is often beneficial.
The intestinal tract should be flushed out as soon after
the patient is seen as is practicable. Those about the
patient should be instructed carefully as to the dangers
of attempting to feed the patient if he is unable to swal-
low, for he may, on the one hand, choke, and, on the
other, he may draw food or drink into his lungs during
inspiration, and so set up a pneumonia.
If the patient is in need of nourishment or of fluid, it
may be given by the rectum. Normal salt solution may
be given by the rectum to supply the body with fluid, but
it should not be given in too large quantities. (See Rec-
tal Feeding.)
I,ater Stages. — As soon as the patient recovers suffi-
ciently to be able to swallow without danger of inspir-
ing the food he may be fed by the mouth. The food
should be liquid or semi-solid, and of a bland, unstim-
ulatiny character. The quantity should not be too large.
Milk, milk and eggs beaten together in the form of a
milk punch, without, however, the addition of a stimu-
lant ; broths, soft eggs, and milk thickened with cereals,
or the purees of vegetables may be used. As the patient
improves other food may be added, but the diet should
be light, easily digestible, and as non-.stimulating as pos-
sible. The patient should be warned against overeating
and also against drinking. Alcohol is allowable only in
the case of habitues wlio are threatened with collapse
unless it is used, or iii the same class where food is not
assimilated without it It should always be given in
moderate amounts, and the dosage arranged by the phy-
sician, and never left to the nurse, the patient or the
family.
On account of the lack of exercise the diet should
contain but httle meat, but cereals, vegetables, and fruit
should be given in small quantities at a time, and as
evenly distributed throughout the day as possible, to
avoid overfilling of the vessels.
The greatest danger, from a dietary standpoint, is in
those patients who recover sufficiently to rettini to their
ordinary modes of living. They should be very care-
fully instructed neither to drink to excess nor to overeat.
A full meal and several drinks may be the cause of a
second or of a fatal attack.
ALCOHOLIS^L
The mild forms of alcoholism are usually easily man-
aged. So long as the stomach is irritable it should be
given absolute rest If possible, alcohol should be with-
held entirely. As soon as the stomach will retain fluid
a saline mineral water or a saline purge should be given.
Milk or bouillon is next to be prescribed, and as the
desire for food returns a light diet of soft-boiled eggs,
milk toast and the like should be allowed. After re-
covery all rich and highly seasoned food should be
avoided, particularly the spices and peppers, which are
commonly used to excess.
In the severe forms the diet should be that recom-
mended for chronic gastritis. Some confirmed alcoholics
can retain nothing in the stomach until they have had their
morning drink. When nutrition is threatened this may
^^^k inten
DIETETICS fOR NURSES.
be allowed, but it is apt to lead to exces.scs later in tlic
day.
In the very severe forms, as in delirium tremens
or in cases approaching it, the patient should take as
much fluid as possible to flush out the system, and the
intestinal tract should be thoroughly purged. The food
should be given in a predigestcd or in a partially predi-
gcstcd form and at frequent intervals. In this way the
craving for drink is somewhat alleviated. Bouillon or beef
tea to which considerable amounts of black pcp|ier or
even Cayenne pepper have been added is useful in this
condition, although their use would be contra-indicated
for any but an alcohol -saturated person. Rest and sur-
alimentation as soon as food can be borne constitute the
best method of managing these cases. Strychnin may be
used as a .stimulant.
Illness or Injtiry in Alcoholics. — When a man
who has been accu.stomed to taking several glasses of
spirits every day for years is suddenly stricken ill or
injured, delirium will often develop if the stimulant is
rapidly withdrawn. In alt such cases the accustomed
amount of alcohol should be given, care being taken,
however, to prevent overindulgence.
In alcoholics affected with pneumonia alcohol is neces-
sary to sustain life. When dehrium occurs in the course
of pneumonia alcohol should be ordered, although in
ordinary-, uncomplicated cases of delirium tremens due
to extreme overindulgence it should be withheld.
REST CURE.
The technic of the treatment is explained in a most
interesting way by Mitchell, in his book " Fat and Blood."
DIET IN DISEASES OF THE NERVOUS SYSTEM. 245
The more nearly perfect the technic and the more closely
it is adhered to, the more likely is cure to follow. The
cases are of various grades of severity, and the treat-
ment is modified to suit the individual. Isolation is
necessary, and the patient should be removed to a hos-
pital or a sanitarium, away from familiar scenes. Home
treatment does not succeed well. If circumstances com-
pel the patient to remain at home, her room should be
changed. In severe cases with emotional manifestations
visiting is forbidden, but it may be allowed to a " certain
extent when the patient is anemic owing to a distinct
cause, as overwork, blood- los.ses, dyspepsia, low fevers,
or nursing." The nur.se should be a stranger to the
patient
Communication with friends and family should, as a
rule, be cut off entirely, and not even the reading of
letters .should be allowed. After several weeks, if the
patient is improving, she may be allowed to read the
newspaper each day.
Rest is a most important feature, and, as a rule, the
patient should be put to bed for .six weeks or two months.
In other cases, especially where the patient is not able
to undergo regular treatment, as in dispensary cases, a
modified rest cure may be tried. The following is
Mitchell's schedule for such cases ; this may be modified
according to circumstances :
" 7.30 A. H. : Cocoa, coffee, hot milk, beef extract, or
hot water. Rath (temperature stated). Rough rub with
towel or flesh-bru,sh. Bathing and rubbing may be done
by attendant. Lie down a few minutes after finishing.
"8.30 A. M. : Breakfast in bed. {Detail as to diet.
Tonic, aperient, malt extract as ordered.) May read
letters, papers, etc., if eyes are good.
246 DIETETICS FOR NURSES.
" 10 to 1 1 A. M. ; Massage, if required, is usually ordered
one hour after breakfast, or Swedish movements are given
at that time. An hour's rest follows massage. I^ss
rest is needed after the movements. {Milk or broth
after massage.)
" 12 M. : Rise and dress slowly. If the gymnastics or
massage are not ordered, may rise earlier. May see
visitors, attend to household affairs, or walk out.
" 1.30 P. M. : Luncheon. (Malt, tonic, etc., as ordered.)
In invalids this should be the chief meal of the day.
Rest, lying down, not in bed, for an hour after.
" 3 p. M. : Drive (use street cars or walk) one to two
and one-half hours. (Milk or soup on return.)
" 7 p, M. : Supper, (Malt, tonic, etc., as ordered ; detail
of diet.)
" 10 K M. : Hot milk or other food at bedtime."
In extreme cases the patient is made to rest absolutely.
No exertion of any kind is to be allowed. The bed-pan
is to be used with the patient in the recumbent position.
She should be removed to a couch for an hour, both
morning and evening, while the bed is being freshened.
Tlie patient should be fed, and later, when allowed to
feed herself the meat should be cut up for her. A sponge-
bath should be given daily, but if it causes depression it
may be given less frequently. After two weeks, if the
piiysician thinks it desirable, the patient may be read to
for one to three hours. The monotony of the treatment
is not so trying as would be imagined, for the routine of
the day occupies most of the time. The nurse and ma.s-
seuse should not talk about or listen to the patient's ills,
and the latter should be taught that she mu.st .speak of
them only to the physician.
Massage and electricity arc resorted to in order to
L
Diet in diseases of the nervous system. 247
maintain nutrition and circulation while at rest. Mitchell
gives minute instructions regarding both. General mas-
sage of the whole body is to be given, care being taken
not to excite pain by manipulating tender areas. The
tapping movements, slapping, and the like are not to be
used in nervous patients. Care should be exercised to
avoid producing sexual excitement ; this may be aroused
in both sane and insane patients from friction near the
genitals or over the back or buttocks. If it does occur,
the operator should avoid the sensitive areas. In the
average case massage should be given for an hour daily
for about six weeks, and then on each alternate day.
The time chosen for this should be about midway be-
tween meals. Care should be taken to keep the parts
warmed by the massage well covered.
The same precautions should be taken in using elec-
tricity as when giving massage. The induced current
should be used, and it is well to employ a battery in
which the breaks are very .slow — from two to five
second.s. The more rapid interruptions are useful, how-
ever, but in the hands of an unskilled operator may
excite pain and apprehension in the patient. TJie poles
may be placed 4 or 5 m apart on the muscle, and the
whole body should be gone o\er
In thin, anemic, exhausted women, who arc the ones
usually treated, the diet is as follows : The patient is put
to bed and the diet generally changed from the ordinary
to a milk diet. This is done by gi\'ing from 3 to 4 oz.
of milk every two hours, after the Karell method. Then
the patient is given 2 quarts of milk in each twenty-four
hours. The amount is divided and a portion given at
three-hour intervals. At the end of the first week a
pound of beef is administered in the form of a raw soup.
248 DIETETICS FOR NURSES,
This is given three times a day, a pound of beef being
used each day. If desired, this may be replaced by pep-
tonized food. (See formulas in the Appendix.)
After ten days three meals a day are given. These
are led up to gradually, and the patient is kept on the
milk diet until the stomach feels comfortable. Then,
usually within from four days to a week, a light breakfast
is allowed, and in a few days more a chop is given at the
midday meal. After a short time the patient is given
three full meals, together with 3 or 4 pints of milk instead
of water, either with or after the meals.
After about ten days of this treatment, from 2 to 4 oz.
of good fluid extract of malt are given before each meal.
"As to meals, I leave them to the patient's caprice,
unless this is too unreasonable ; but I like to give butter
largely, and have little trouble in having this most whole-
some of fats taken in large amounts. A cup of cocoa or
of coffee and milk on waking in the morning is a good
prescription for the fatigue of the toilet."
In some of the difficult cases \ oz. of cod-liver oil is
given half an hour after each meal. If it causes nausea
or interferes with the appetite, it is given as a rectal
injection. This is of particular service where the bowels
are sluggish. It may also be given in the form of an
emulsion with pancreas extract. In some it acts admira-
bly; in others it may cause tenesmus.
SCHEDULE FOR A COMPLETE REST CURE.
Until otherwise ordered, absolute rest in bed. No
visitors, no reading, and no conversation with nurse on
the subject of disease or treatment.
First Day. — One quart of milk in divided doses every
DIET IN DISEASES OF THE NERVOUS SYSTEM. 249
two hours. 8 A. M. : Cold bath followed by a brisk rub.
If patient does not react well, a warm bath may be used
for several days and then the cold bath tried again,
II A.M, : Twenty minutes" massage. 2.30 P.m.: Room
darkened far a nap. 4 p. m. : Twenty minutes' electricity.
9 p. M.: Brisk rub over the entire body.
Second Day. — Same as first. Milk \\ quarts; massage
and electricity increased to forty minutes.
Third Day. — Two quarts of milk in divided doses at
three-hour intervals ; massage and electricity one hour
each.
Fourth Day. — Same, with addition of white of a raw
egg with each glassful of milk; cupful of cocoa on
awakening.
Fifth Day. — Same, with addition of raw-beef soup or
broth, I pint in two portions ; a slice of toast.
Ninth Day.— Same, with soft-boiled eggs and toast for
breakfast.
Tenth Day.^Cocoa on awakening. 7.30 a.m.: Bath
and brisk rub. 8.30 a. m. : Breakfast, including cereal,
chop or eggs, bread and butter, and 2 glassfuls of milk
with the whites of 2 eggs. 10 to 11 a.m.: Massage.
11,30 A.M.: Half-pint of milk, whites of 1 or 2 eggs.
2 p. M.: Full dinner, including 2 glassfuls of milk and
whites of 2 eggs. 3.30 to 4 p. m. : Electricity. 5 p. m. :
Glassful of milk with whites of 3 eggs. 7.30 p. m.:
Supper including milk and eggs, g.30 p, m.: Brisk rub
and a glassful of milk.
Schedule as above until desired effect is obtained.
This to be modified to suit the individual case. On
twelfth day 2 oz. of malt extract with a teaspoonful of
solution of peptonate of iron and manganese, or a table-
spoonful of Gude's Feptomangan is usually ordered.
250 DIETETICS FOR NURSES.
Bowels to be kept open. Use butter in as lai^e quan-
tities as possible.
The patient is allowed to undertake movements for
herself very gradually, being aJlowed to move about in
bed by herself and then sit up, and later on to sit out-
doors and then to walk a few steps, to take a drive, etc.
If this is not done gradually the moving about may be
attended by dizziness, vertigo, or unpleasant exhaustion,
which may be avoided entirely by gradually increasing
the patient's efforts for herself
DIET FOR THE INSANE.
Feeding constitutes a very important part of the treat-
ment of the insane. All insane persons who are below
the standard of nutrition should be built up and an earn-
est effort made to increase the weight of the patient. One
of tlie Knglish alienists was wont to talk of the " gospe! of
fatness." This is best accomplished by a system of feed-
ing somewhat similar to that outlined in the rest treat-
ment, the rest being prescribed or omitted as the case
demands. It .should always be remembered that an in-
sane person may contract otiier diseases besides his
mental disorder; tliis is true especially of stomach and
intestinal disorders, which may give ri.sc to delusions
regarding the taking of food.
When the patient refuses food, the question as to the
advisability of feeding him by force arises. Kver^'thing
considered, it is well to begin the forced feeding early,
before the patient has time to suffer from his fa-sting. It
should be accomplished by means of the stomach tube
or the na.sal tube, and about a liter (1 quart) of food
should be introduced. The food may be given thus
twice daily, and in the case of weak patients three or four
L
DIET IN DISEASES OF THE NERVOUS SYSTEM. 251
times a day. Milk, milk and eggs, and broths may be
used for this purpose, A sufficient number of attend-
ants should be at hand to control the patient if he be-
comes unruly and resists feeding. After a patient has
been fed with the tube several times he will often prefer
to take his nourishment in the usual manner.
Whether the esophageal or the nasal tube is to be used
wit! depend on the preference of the physician. Kach
has its advantages. The nasal tube is generally pre-
ferred, since it is easier to introduce, can not be bitten by
the patient, and does not cause the patient to struggle as
much as the stomach tube ; it may, however, be passed
into the larynx, and in this way liquid might be intro-
duced into the trachea. This danger i.s more fancied than
real, and can be avoided if the patient is allowed to
breathe before the fluid is poured into the tube. While
he is breathing the tube should be pinched, and if it is in
the larynx this fact will be noticed at once. Ordinarily,
but not always, coughing ensues; it does not follow
when the pharj'nx is anesthetic, as it occasionally is in
the in.sane or hysteric. The stomach tube does not allow
the food to be regui^itated so easily as the nasal tube, but
for this method of feeding a mouth-gag is required, which
may injure the mouth or teeth, or it may slip, permitting
the patient to bite the tube. If the patient has acquired
the knack of regm^tating the food, this may be pre-
vented by tickling the ribs while the fluid is being intro-
duced. This prevents the fixing of the diaphragm, and
is successful in most cases.
Tact and experience in handling the insane arc of the
greatest value. Some nurses or attendant."; have little
difficulty in getting patients to eat, whereas others seem
never to learn how to manage them. It must be remem-
I
J
252 DIETETICS FOR NURSES.
bercd than an insane patient may not eat for reasons that
arc often easily overcome. He may prefer to take his
food alone, because he does not think himself worthy of
eating at the same table with other people. He may fear
that his food has been poisoned, and he should be con-
vinced of the fallacy of this by the nurse, who should
cat a portion before him or allow him to .see the food pre-
pared, or he may be given food that can not easily be
poisoned, such as eggs, whole vegetables, and fruit
When the patient's confidence is gained the battle is gen-
erally won. In some cases the delusion persists for a
long lime and can not be dispelled.
Food should alwaj's be ser\ed daintily. An insane
person who may be verj' much unbalanced may still no-
tice the slightest variations in the way of serving food.
Attendants are apt to be negligent in thi'^ respect. For
all patients who have a suicidal tendency the food should
be served on dishes that can not be broken. No knives
should be allowed, and the food should be served so as
to require no cutting. An attendant should watch those
who are apt to bolt their food and see that it is cut into
small pieces before serving it. Cases of sudden death
have followed the drawing of a piece of meat into the
larynx while eating too rapidly.
t.
CHAPTER XVIir.
I ply
DISEASES IN WHICH DIET IS A PRIMARY
FACTOR.
DIABETES MELLITUS.
Thj.s is one of the diseases in which the diet is of pri-
mary importance and, in fact, the principal part of the
treatment. No one but a skilled physician should ever
attempt to regulate the feeding of a diabetic patient, as
the well-being, and usually even life itself, are directly
dependent upon the diet. The outlook in the disease is
in many cases gloomy enough with the greatest possible
care, whereas in poorly managed cases it is made much
more so. Many complications, causing great suffering
on the part of the patient, are the direct result of errors
in diet.
In order to carry out intelligently the physician's or-
ders, the nurse should understand the principles of the
diet to be followed. Diabetes is a disease in which the
capacity to burn up sugar as food is depressed. The
sugar taken is to a great extent passed oft" from the body
in the urine. Not every person who has sugar in the
urine is a diabetic.
The chief indications in the management of diabetes
are to maintain the patient's strength, to increase the
sugar- destroying power of the body, and to avoid com-
plications. These results are be.st accompli.shed by sup-
plying a sufficient amount of food in such a form that
254 DIETETICS FOR NURSES.
it may be utilized by the patient, and by avoiding car-
bohydrates.
The sugar which is passed in the urine has not been
used as food, and this amount must be taken up in the
other food elements or the patient will lose weight. If
too much carbohydrate food is taken continuously, the
patients nearly always do badly and develop complica-
tions.
The physician in prescribing the diet has in mind three
things : the amount of sugar that the patient is excreting
daily, the gain or loss of weight, and the general condi-
tion of the patient. There are other factors which may
influence his choice of diet, but these are very technical
matters.
From time to time the physician may desire to see how
much sugar the patient passes when taking a diet free
from carbohydrates. For this purpose the patient is
ordered a diet somewhat like the following:
Von Noorden's Carbohydrate-free Diet. — Break-
fast : 5 gm. of tea steeped in 200 c.c. of water ; 1 50 gm.
of ham ; i egg.
Luncheon : 200^mi. cold roast beef; 60 gm. fresh cucum-
bers with 5 gm. vinegar; 10 gm. olive oil, and salt and
pepper to taste ; 20 c.c. brandy with 400 c.c. Apollinaris
water; 60 c.c. coffee without milk or sugar.
Dinner : 200 c.c. clear bouillon ; 250 gm. beef (weighed
raw) basted with 10 gm. butter ; 80 gm. green salad with
10 gm. vinegar and 20 gm. olive oil, or 3 tablespoonfuls
of some well-cooked green vegetable ; 3 sardines in oil ;
20 c.c. cognac with 400 c.c. Apollinaris water.
Supper : 2 eggs (raw or cooked) ; 400 c.c. seltzer water.
The patient is not put upon this diet suddenly, but the
carbohydrates are reduced gradually. This diet is gen-
DISEASES IN WHICH DIET tS A PRIMARY FACTOR. 255
erally used for five days, during which time the condition
of tlic patient's urine is investigated by the physician.
Prophylactic Diet. — Diabetes sometimes occurs in
certain families, and members of such families are fre-
quently ordered to limit the amount of carbohydrate
food, especially about the age at which they have a ten-
dency to take on flesh.
Dietetic Treatment. — Mild cases in old people are
generally given a diet restricted in a more or less general
way. Foods consisting entirely or nearly so of sugar
are forbidden, as well as dishes made largely from flour.
Bread and potatoes are allowed according to the desire
of the patient, and also any vegetables that may be served.
When this form of diet is not sufficient the physician may
order more restrictions. If the paticiit is thin the nurse
must see to it that he takes the amount of food prescribed.
In young persons even mild cases require close attention,
and sugar may be withdrawn altogether and the food
sweetened with certain drugs, as saccharin, saxin, garan-
tose, dulcin, and the like. These are usually ordered in
the form of tablets, each one representing the sweetening
power of an ordinary piece of cut lump sugar. The
patient is limited as to the amount of starchy food that is
permitted, and is urged to take milk, cream, and fatty
foods.
Severe cases require most careful attention. The diet
is very strict, and for certain periods each year the patient
is put upon a carbohydrate- free diet. It is difficult to get
the patient to take sufficient nourishment, and the nurse
must prepare as palatable dishes as possible from the
list of permitted foods. (A number of recipes will be
found in the Appendix.) The patient has a great craving
for sweets and bread, coupled with an enormous appetite
J
256 DIETETICS FOR JVUASES.
and great thirst, and considerable vigilance is often re-
quired to see that he does not partake of forbidden food.
Certain diabetic " cures " are sometimes prescribed as
a diet composed largely of oatmeal or of potatoes or of
rice. In certain cases a diet largely restricted to one or
other of these foods may raise the patient's capability to
burn up other forms of carbohydrate.
Diabetic Coma. — The patient may become drowsy,
complain of feeling numb, and then pass into a condition
of unconsciousness. This is a very dangerous condition,
and usually the patient dies. Certain changes in the
urine may warn the physician that there is danger of
coma, and when these changes are noted a more liberal
diet is allowed. This extra diet increases the amount of
urine passed and may flush out with it the poisonous
materials from the blood. When coma occurs alcohol is
given, and salt solution and sometimes solutions of grape
sugar are given subcutaneously to increase the flow of
urine.
Diabetes is frequently complicated with other diseases,
as obesity, gout, or disease of the kidneys, which render
the problem of the diet extremely difficult.
Substitutes for Bread. — "Torrifled Bread." — Thin
slices of bread arc toasted until very dark brown or almost
black. It is supposed that the starch and gluten are
partially decomposed by the heat. This will almost cer-
tainly not be eaten to excess by the patient, and William-
son states that this is probably its only advantage.
Olntes bread, introduced over fifty years ago by Bou-
chardat, has always been popular in France. This bread
is made from gluten flour from which the starch has been
washed out. The gluten flours on the market differ very
much in the amount of starch which they contain.
D/SE^ISES IN WHICH DIET IS A PHIMARY FACTOR. 257
Directions for making gluten bread accompany the
packages of flour.
Bran bread, madt; from bran flour, is also to be recom-
mended. The bran must be ground quite fine or it will
not be digested.
Soya biscuitH or bread are made from Soya bean, a
Japanese product Soya bread was suggested for dia-
betics by Dujardin-Beaumotz, in 1890.
Almond cakes and cocoanut cakes are of considerable
value as bread sub.stitutcs.
Aleuronat is a vegetable albumin flour made by Dr.
Hundhausen from wheat. It is a light-yellowish powder,
and contains from So to 90 per cent, of albumin and only
7 per cent, of carbohydrate. It was recommended in
diabetes by libstein, who suggests that it be mixed with
wheat flour. His formula contains considerable starch —
i. e., about one-half the amount of ordinary bread — ^and
most patients prefer to have half the quantity of wheat
bread to a double allowance of aleuronat bread.
The nurse may find it both interesting and instructive
to study the tables given below, and the diet for such
cases as the physician leaves with general orders may be
arranged from them. Under no other circumstances
should a nurse or other unqualified person attempt to
manage the diet of a diabetic, and the physician should
alway.s keep in close touch with the case. The nurse
will be in a position to sympathize with the patient and
to take extra pains with the details of carrying out what-
ever may be ordered if she will try living on a carbohy-
drate free diet for a few days. She will learn many
things in that way which may not otherwise occur to her.
The following four tables are taken from von Noor-
den's article in The Twentieth Century Practice of Medicine :
17
J
DtETETICS FOR NURSES.
First Group. — UnconditioiuiHy AllowahU Foods.
deer, wilii and don
ic birds-
asledoi
n gravy i
r with n
tal parts of a.
lyoDC
s : I'ungue, hearl, brai n, swecLbrcads, kid-
with non- farinaceous sauces,
J'resinvJ me,its: DrLed'or smoked meal, smoked or suUed tongue,
haiD, smoked breast of goose, American canned meats, Australian corned
beef. .
Frtsh jisk : All kinds of fresh fish, boiled or broiled, preptared with-
out bread crumbs or cracker meal, and served with any kind of non-fari-
naceous sauce, preferably melted butter.
I'risen'ed fish : Dried fish, salted ot smoked fish, such as codfish,
haddock, herring, mackerel, flounder, salmon, sardellen, sprats, eels,
lampreys, etc.; tinned fish, such as sardines in oil, anchovies, etc.
Fiih deriualriia : Caviare, cod-liver oil.
SheU-fisk : Oysters, mussels, and other bivalves, lobster, crawfish,
crabs, shrimps, turtle.
Altai extracls : Meal peptones of all kinds.
Eggs : Raw or cooked in any way, but without any admixture of flour.
Eats of all kinds, animal or vegetable.
FrfiA vtgttables : Green leltnce, endive, cress, spinach, cucumbers,
onion, leek, asparagus, cauliflower, red and white cabbage, sorrel, French
beans. The vegetables, so far as Ihey ere suited to this mode of prepa-
ration, are best cooked with meal broth or a solution of l.iebig's extract
and salt, and covered plenlifully with buller, lard, suet, or goose faL
The addition of flour is not permissible.
Presri-vcd vrgctablis : Tinned asparagus, French beans, pickled cucum-
bers in brine or vinegar, mined pickles, sauer kraut, olives.
Spices: Sail, white or black pepper, Cayenne pepper, curry, cinna-
mon, cloves, nutmeg, English mustard, anise seed, caraway seed, pars-
ley, dill, borage, pimpernel, laurel, capers, chives, garlic, etc. Many
of these spices contain, indeed, a rather large percentage of carbohy-
drates, but they arc added lo the food in such small quantities that this
may be disregarded.
Soiipi : Clear suups and broths, with or without eggs, marrow,
or dried vegetables (Julienne), clear turtle soup, eto.
Ckftsr . Strocchino, Neufchatel, old Camembert, Gorgonzola
ftll other latty or sO'Called cream cheeses.
fresh
DISEASES IN WHICH DIET IS A PR/MARY FACTOR. 2C,Q
Bevsragfi : All kinds of nalutal or artificial carboDaled waters, elllier
clear or with lemon juice and saccharin or glycerin, or with rum, cognac,
whisky, arrack, cherry brandy, plum hrandy, NordhSusfr, rye whisky,
etc. Light Moselle or Rhine wines, claret, or Biu^undy in amounls pre-
scribed by the physician. Coffee, black or with cream, without sugar,
but sweetened with saccharin if desired. Tea, clear or with cream or
TABLE 11.
Sefoni/ Group. — Foods Permissible in AfoJera/e Quantities.
These contain carbohydrates, but in so little amounts thai they need
not be considered, and demand no compensation by a reduction in the
sUowance of bread. Some of the articles contain a rather large per-
centage of carbohydrates, but Ihe absolute quanlity in which they are
consumed is small.
The amounts here given have beeo fised by piactical experience, and
it will seldom be found necessary (o increase Ihem. Of the di.shes here
given, when they are allowed at all, only a few — from two lo four — are
to be selected each day. It is possible in this way to secure a great
variety in the patient's dietary.
Inttmal parts of animals : Calves' liver, giblets — up to loo gm.
Sausage : Liver sausage, preferably the fatly kinds, liver sausage with
truffles, black pudding — 90 gm. Meat sausage — So gm. German sau-
sage. Frankfurter sausage, and the like, brawn, head-cheese, sausage-
meatballs — 100 gm.
Patties : Paifi-de-foie gras, potted beef, ham, tongue, salmon, lobster,
anchovies, etc. — \ to 1 (ablespoonful.
English sauces, such as Worceslersbire, Harvey, beefsteak, anchovy,
lobster, shrimp, India soy, China soy^i teaspoonful.
Cream, (rom 4 to 5 lablespoonfuls a day.
Cocoa, prepared without sugar — 25 gm.
Cheese- Emmenthal, Roroadur— 60 gm.; Gervis, Stilton, Brie, Hol-
land, GruySre — 50 gm.; Edam, Cheddar, Gloucester, Roquefort, Par-
mesan— 30 gm.; Cheshire, 25 gm.
I'rg/laila ( prepared -wilhoul Jioiir or sugar) : 5 Tellower turnips j
salsify, turnip-rooted celery, turnip, cabbage. pumpkin~2 lablespoonfuls ;
green peas, beans, carrots, Brussels sprouts— I tablespoon fu I ; \\ arti-
chokes ; 1 truffle ; S medium-sized mushrooms ; i (ablespoonful of morels
or other edible mushrooms.
Raw vegetables .■ 8 radishes ; 2 sticks of celeiy ; 2 medium-siied toma-
26o DIETETICS FOR NURSES.
Nuts : 2 walnuts ; 6 hazelnuts; 3 almonds; a thin slice of cocoanut;
8 Brazil nuts.
Fresh fruits : I thin slice of melon; I small tart apple; I or I J
peaches ; I spoonful of raspberries or strawberries ; 4 spoonfuls of cur-
rants ; 6 green gages ; 12 cherries ; J of a medium-sized pear ; corre-
sponding amounts of other fresh fruits.
TABLE III.
Third Group. — Conditionally Allowable Foods,
The conditions under which dishes from the following table are per-
mitted is that an equivalent shall be deducted from the allowance of bread.
The amounts given below are the equivalents of 50 gm. of white bread,
containing about 30 gm. of starch. Advantage is taken of the fact that
larger amounts of certain carbohydrates (cane sugar, milk sugar, fniit
sugar, etc.) may be allowed than of starch. Some of the dishes given
in the preceding table appear again here because, if they are eaten in
large quantities, an account must be taken of the carbohydrates which
they contain :
I liter of milk (sweet, sour, or buttermilk).
i^ liters of kumiss, prepared in the Russian way.
I to I J liters of kefir, fermented for at least two days and prepared
without the addition of sugar.
I liter of cream.
60 gm. of rye bread, Graham bread, or Hamburg pumpernickel.
65 gm. of Westphalian pumpernickel.
100 gm. of aleuronat bread, prepared after Ebstein's formula (con-
taining 27.5 percent, of carbohydrates and 32 per cent,
of vegetable albumin ; the aleuronat breads are very vari-
ably comjx)unded).
35 gm. of zwieback and simple coffee cakes, made without sugar.
30 gm. of English cakes of various sorts.
30 gm. of ** Kichel -cacao" (vStollwerck's).
50 gm. of chocolate (Stollwerck's).
40 gm. of chocolate ( French make ) .
40 gm. of chestnuts shelled or 60 gm. unshelled.
35 gm. of cane sugar, brown sugar, or rock-candy.
35 gm. of sweet preserves.
40 gm. of fruit sugar.
40 gm. of milk sugar.
DISEASES IN WHICH DIET IS A PR I MAR Y FACTOR. 26 1
50 gm. of fruit jam.
40 gm. of honey.
40 gm. of flour — wheat, rye, barley, buckwheat, millet, or oatmeal
or cornmeal.
45 gm. of bean, pea, or lentil flour.
35 gm. of starch preparations, potato, wheat, or rice, starch, tapioca,
sago, maizene, mondamin, etc.
35 gm. of rice.
35 gm. of farinaceous preparations — noodle, macaroni, oatmeal,
grits, barley.
50 gm. of lentil.s, peas, beans (weighed dry).
100 gm. of green peas.
180 gm. of new potatoes.
140 gm. of winter potatoes.
120 gm. of apples, pears, green gages, plums, damsons, mirabelles,
apricots, cherries, grapes.
200 gm. of strawberries, ra.spberries, goo.seberries, mulberries, cur-
rants, blackberries, whortleberries, blueberries.
3 peaches.
40 gm. of figs.
3 bananas.
A handful of walnuts, hazelnuts, almonds, or Brazil nuts.
I liter of beer of any .sort.
\ liter of sweet wine.
TABLE IV.
Fourth Grcntp. — Especially Valuable Foods,
The great value of the articles contained in the list on the following
page, of which, however, there is but a small choice, is due in part to
the high percentage of protein and in part to that of fat. The propor-
tion of albumin and fat is given for each 100 gm. of the food substance.
Some contain carbohydrates also, the percentage of which is given for
the .sake of completeness, but its nutritive value is not counted.
262 DIETETICS FOR NURSES.
^^^H IDD Gm, Piolein.
^^KV^etable
^^^BlBnltcr
■B Bacon fsalt or smoked] lo
DcTonshire cream 3
Cream cheese (Gervais, Neiilchate],
Sdlton, Stracchiiici, etc.) . . . ig
Gennan sausage (Ccrvelalwursl) . l8
Ham 25
Cheddar cheese z8
Fal Pork 14
Hmoked oi-longnc 24
Fatty cheese (average) 25
Volk of ^g 16
FalgDoae 16
Fat beef and mutton 17
Brie cheese 19
Freah water eel 13
Smoked mackerel 19
(^""'Hfe 31
Fat salmon (fre^h qr smoked) . . 22
liens' eggs (weighed with the shells) 12
Carbo- Ciilorie
GOUT AND GOUTINESS.
Sydenham said : " Great eaters are liable to gout, and
of these the costive more especially. Eating as they are
used to eat when in full exercise, their digestion is
naturally impaired. Even in these cases simple gluttony
and the free use of food, although common incentives,
by no means as frequently pave the way for gout as
reckless, inordinate drinking." This statement is as near
the truth as anything that has been said since.
The causes of gout are alcoholism, overeating, heredity,
indigestion, constipation, and it is also sometimes seen in
lead workers.
In the acute attacks the diet should be liquid or semi-
solid. Milk, bread and miik, and farinaceous gruels are
usually prescribed. After several days the light meat
of boiled or baked lish is allowed or a little easily
[ 01 Doilei
DISEASES !N WHICH DIE T IS A PRIMAR V FACTOR. 263
digestible meat. The increase in the diet is always
ordered by the physician.
Chronic Gout. — The diet here is also to be made up
of simple plainly cooked food, all rich and indigestible
dishes being prohibited. There is often a peculiar per-
sonal idiosyncrasy in regard to certain articles of diet,
and this will largely influence their u.se. As a rule, how-
ever, the following outline will suffice for the guidance
of the patient :
Soups of the plainest sorts may be taken, especially
those consisting largely of vegetables. Yeo has sug-
gested the use of vegetable purees to which beef extract
has been added to give them a flavor of meat. Milk is
valuable in all cases, and where it disagrees it may be
skimmed, peptonized, or diluted with a carbonated water.
Bicarbonate of soda may be added when it is desired to
make the milk alkaline; i to 5 gr. to the ounce should
be used according to requirements.
Meat and fish may be taken daily, preferably not at
the same meal. Fresh beef, mutton, and the like are the
most suitable meats, and poultry may be allowed for the
sake of variety. Eggs may be taken in moderation.
Twice-cooked meats should be avoided, as should
dried, smoked, or pickled meats, as well as pork and
veal. Garrod allows bacon at breakfast, but fats are, as
a rule, to be avoided. Under special conditions, when
the patierrt's nutrition is poor, they may be given if
tolerated.
Only the lighter varieties of fish should be given,
boiled being preferred to fried fish. Oysters and clams
may be taken, the hard portion being discarded. Salt
fish, as well as mackerel, salmon, eels, and all other
heavy fish, should be prohibited. Crabs, lobster, shrimp,
I
I
DIETETICS FOR KUKSES.
are usually to
264
and the like, as well as
avoided.
Vegetables, when they are easily digested, may be
permitted. Peas, beans, potatoes, artichokes, salsify,
onions, turnips, greens, cauliflower, and cabbage are all
allowable, as are Ukewise celery, lettuce, and similar
green vegetables. Carrots and beets, because of the
sugar they contain, and asparagus, tomatoes, rhubarb,
and sorrel, on account of their acid, are best avoided.
All preserved and pickled vegetables, as well as the
coarse and fibrous portions of all vegetables, are to be
omitted from the dietary.
Fruit is best taken in the morning or during the in-
terval between meals. It should, as a rule, be avoided
during the latter part of the day, after full meals or with
wine. Among the most suitable fruits for the gouty are
oranges and graf>es. Baked apples or stewed fruit may
be taken. The sweet juice of the latter is, however, best
avoided. Garrod advises the avoidance of all stone
fruits, but allows baked apples and pears and straw-
berries sparingly. Fothergill suggested that bicarbonate
of soda be taken with stewed fruit to correct the acidity.
Opinions differ regarding the use of fruit by the gouty.
If any particular fruit disagrees with a patient it should,
of course, be avoided. Patients often manifest idiosyn-
crasies respecting fruits, and these furnish a guide to
their suitability.
When gout is complicated with obesity, diseases of the
kidneys, diseases of- the stomach or any other disease,
special diets are ordered.
Arthritis Deformans. — In this disease there are
deformities of the bones which are sometimes confounded
with gout. The diet probably has no influence whatever
L
DISEASES IN WHICH DIET IS A PRIMARY FACTOR. 265
over this disease. Instead of restricting the diet, it should
be as nourishing as possible.
Scurvy or Scorbutas. — This disease occurs in adults
where tiiere is a deficieney of fresh food. It is the scourge
of armies, and formerly was frequent among sailors. To
prevent it fresh food should be given. Canned food,
while not an ideal preventive, is useful. Lemon or
lime juice, vinegar, and onions are especially valuable as
preventatives. The treatment of the disease, when it
occurs, is chiefly dietetic, and consists in giving a good,
nutritious diet with fresh fruits and vegetables, fresh
meats and the like. The above-mentioned preventatives
may be used where the other fresh foods are not available.
Infantile Scurvy {Barlotds Disease). — Scurvy is fre-
quently seen in infants, especially between the sixth
and the fifteenth month. In almost every case improper
feeding is the cause. It has even occurred where the
child was breast-fed, but more often from the following
feeding, in the order of their frequency : the proprietary
infant foods, sterilized milk, condensed milk, and Pas-
teurized milk. The treatment is very satisfactory, and
consists in placing the child upon a proper diet and
giving in addition fresh orange juice, from ^ to 3 or 4
oz. daily. The juice of any fresh ripe fruit, as of peaches
or grapes, may be used instead.
OBESITY.
There is probably no condition that has been more
widely discussed.by laymen of both ancient and modern
times than obesity, for no disease is more thoroughly
associated in the lay mind with its proper causes and its
relations to diet than this " oily dropsy", as Bryon
calls it.
J
266 DIETETICS FOR NURSES.
The accumuiation of fat is associated with increasing
years, but it is by no means confined either to old or
middle age, as is exemplified in the fat children familiar
to all ; obesity may be a plague even of infants.
The causes of obesity are so well known as to require
only passing mention. About 50 per cent, of cases owe
their primary origin to hereditary causes. Women arc
more frequently affected than men. With the advance of
years, in some there is a tendency to accumulate fat
Overeating and overdrinking have been named as cau-
sative factors, especially when combined with a quiet,
sedentary life.
The fats and the carbohydrates are the principal ele-
ments in the diet that are apt to be converted into fat ;
but proteins also, if the supply exceeds the demand and
assimilation is active, will be converted into body-fat and
stored up in the subcutaneous tissues. The liver and the
heart are also converted into storehouses for fat, and
later there may be a fatty degeneration of both organs,
as well as of the coats of the arteries.
The dangers accompanying the excessive accumulation
of fat are manifold, and include a large number of dis-
eases that may be influenced by it either directly or in-
directly. These will be discussed when the indications
for reducing the weight of patients are considered. Weak
heart, anemia, gout, and diabetes are among the most fre-
quent diseases with obesity.
Reduction cures of many kinds are vaunted by their
respective originators. Ebstein has summed up the
whole matter in the following sentence: "Corpulence
can only be permanently cured by a permanent change
of life and diet regulated by physiologic principles."
Reduction of weight is in many cases contra-indicated,
DISEASES m WHICJf DIET IS A PRIMARY FACTOR. 267
and a reduction cure should never be undertaken without '
the advice of a physician. In women especially reduction
may be a cause of hernia, of dislocation of the kidney,
or of the uterus, and may also bring on gall-stone colic
in those who have gall-stone disease. In old people re-
duction cures are not, as a rule, advised. In many slight
cases all that is needed is a regulation of the diet and
life so as to prevent any further increase. Reduction ■
may be of especial benefit in stout individuals with heart
disease, and a method known as " Oertel's method," which
combines diet and exercise, is usually followed. Reduc-
tion is also useful in some cases of respiratory disease in
very stout persons. Bronchitis and asthma may be men-
tioned in this connection. Where the patient has any
disease interfering with locomotion, the diet should be so
arranged that there will be no excessive accumulation of
fat, as the added weight may be the cause of making the
patient helpless,
A much discussed point is whether it is possible to
reduce any special part of the body more rapidly than the
remaining parts. This is a method often sought by
women who have borne several children and who have
large deposits of fat in the abdominal walls, causing an
unsightly prominence of the abdomen. If the fat is re-
duced slowly, every part of the body, including usually
the abdomen as well, will be reduced simultaneously. If
it is reduced rapidly, it seems to be removed principally
from certain parts of the body, as the neck, breasts, arms,
and calves of the legs. Certain advocates of massage
claim that the massage of the parts will cause a more
rapid reduction. Von Noorden had one arm of an obese
patient massaged for six weeks. At the end of that time
the arm that had been massaged had increased i \ cm, in
268
DIETETICS FOR NUKSES.
circumference, whereas the arm that had not been mas-
saged remained the same.
Massage of the abdomen during a reduction cure may
exert a beneficial effect by relieving the constipation,
which is apt to be troublesome. Exercise is still more
potent, particularly for reducing the abdomen. This is
accomplished by standing erect and then bending forward
in an effort to touch the toes with the tips of the fingers.
Too much should not be expected from this, even when
persisted in faithfully.
Prophylaxis of Obesity. — Where a tendency to
obesity exists the fat-forming foods should be partaken
of but sparingly, and sufficient outdoor exercise taken
to keep the weight within reasonable limits. The fat-
forming foods are fatty foods of all kinds, the sugars and
starches.
Dietetic Treatment of Obesity. — There are numer-
ous methods of diet. The method to be used in any
given case is to be determined by the physician. These
reduction cures are frequently referred to as Banting
cures. The Banting method was that used in the case
of a Mr. Banting, by his physician, Dr. Harvey. It was
in great vogue some years ago, and the name became
erroneously applied to many other methods. It is too
.severe for the average patient.
Banting Diet for Obesity {Yeo).—" Breakfast, 9
A. M. : 5 to 6 oz. of animal food-meat or boiled fish (ex-
cept pork or veal) ; a little biscuit or i oz. of dry toast —
6 to 7 oz. of solids in all. A large cupful of tea or coffee
(without milk or sugar) — 9 oz. of liquid.
"Dinner, 2 p. M. ; Fish or meat (avoiding salmon, eels,
herring, pork, and veal), 5 to 6 oz. ; any kind of poultry
or game. Any vegetables except potato, parsnips, beet
D/SEASES /JV WHICH DIET IS A PRIMAR Y FACTOR. 269
root, turnips, or carrots. Dry toast, i oz. Cooked fruit,
unsweetened. Good claret, sherry, or Madeira, 10 oz.
Total of soHds, 10 to 12 oz.
" Tea, 6 p. M. : Cooked fruit, 2 to 3 oz. ; a rusk or twc^-
2 to 4 oz. of solids ; 9 oz. of tea {without milk or sugar).
" Supper, 9 p. M. : Meat or fish, as at dinner, 3 to 4 oz.
Claret or sherry and water, 7 oz.
"This allowed only from 21 to 27 oz. of solids per
diem, of which 13 to 16 oz. consisted of animal food and
only 3 oz. of bread; the rest consisted of fruit and fresh
vegetables. There was the strictest possible exclusion
of starches and sugar.
"The total fluid was limited to 35 oz."
Oertel's method is a combination of diet and exer-
cise, and is especially applicable to patients with disturb-
ances of the circulatiou. The quality and quantity of
food and the amount of fluid are carefully regulated by
the medical attendant according to the patient's condition.
Bbstein'S method consists in giving a diet in which
the carbohydrates are reduced, but in which considerable
amounts of fats are allowed. The custom of giving fatty
food in such cases is as old as Hippocrates, for he says,
" The food shall be fat in order to satiate quickly." This
method is, however, based on an erroneous opinion.
In general it may be stated that the diet should be
limited in amount, the starches and sugars reduced to a
minimum, fats reduced or omitted altogether, and the
amount of fluid cut down to a very small amount. The
food given consists of meat, eggs, fi.sh, fruits, and green
vegetables. Sufficient exercise is taken to keep the
weight down to the required number of pounds.
When obesity is complicated with any other disease,
the diet may be a point of considerable difficulty.
I
J
270
blETETtCS FOR NURSES.
DIET FOR LEANNESS.
In a general way the indications for fattening thin
people is the reverse for the diet used in obesity. Many
individuals are thin as a matter of constitution, and such
as these can not be fattened by any means. There may
be some special cause for the leanness, and when the
physician can discover this and remove or relieve it, the
patient may be increased in weight. Patients emaciated
from acute illness are readily fattened.
The patient should lead a quiet outdoor existence, free
from care or excitement, and should get sufficient sleep.
The meals should be ample, and as much carbohydrate
and fatty food taken as possible. Cream, milk and cream,
butter, cocoa, chocolate, bread, cereals (wel! cooked),
farinaceous puddings, potatoes, legumes, and sweet fruits
should all be partaken of in abundance. All sweets —
honey, syrups, cakes, and the like — ^may be taken if they
agree with the digestion. Beer, especially the darker
varieties, porter and brown stout are useful. Sweet wines
are sometimes ordered, and malt extracts where It is not
desirable to use alcoholic beverages. Strong alcoholic
drinks, acids, spices, and many green vegetables are for-
bidden.
DIET IN SKIN DISEASES.
Certain skin affections are caused directly or indirectly
by dietary errors ; others are prolonged or intensified by
an improper diet, and still others are connected in some
way with diseases of the alimentary tract or with dis-
turbed metabolism.
Eczema. — All food which is known to cause erj'thema
or urticaria in the individual should be avoided, as should
all food which is liable to undergo fermentation in the
DISEASES IN WHICH DIET IS A PR IMA R Y FACTOR. 2J I
intestinal tract or which will produce indigestion. Irri-
tating spices and alcoholic beverages are usually omitted
from the dietary. The meals should not be too large,
should be taken at regular intervals, and a simple varied
dietary should be followed. Gouty and obese patients
are usually ordered diets suitable for their disease. A
milk diet is frequently used in persistent cases.
In infants it is important to have the digestion in per-
fect order.
Urticaria {Hives), — Many articles of diet cause hives
in certain individuals. Among the most frequent causes
are strawberries, oysters, crabs and other shellfish.
Partially spoiled or stale articles may also be a cause.
Acne. — All indigestible articles of food are to be
avoided, and the diet should consist of easily digested
fresh food. Excessive quantities of fat should be avoided.
CHAPTER XIX.
SPECIAL DIET CURES.
The Milk Cnre. — Milk is used extensively as a food
during illness, and it has also been warmly advocated as
a curative agent, especially by Karell, of St. Petersburg,
and Weir Mitchell.
Physicians may prescribe an exclusive milk diet in a
large number of diseases, chief among which are diseases
of the kidneys, liver, heart, and intestines. It is also
at the outset of the rest cure.
Method of Administration. — Well-skimmed milk from
the country, as fresh as can be procured, is used. Later
on the unskimmed milk is often ordered. Karell begins
with from 3 to 6 oz. three or four time."? a day, and in-
creases the amount gradually. The milk is to be taken
slowly, at regular intervals, allowing it to mix with the
saliva. In winter it is warmed, and in summer given at
the room temperatwre. After a week, if the stools re-
main solid, the quantity is increased, 2 liters (quarts) a
day being given during the second week in favorable
cases. The regular hours are to be insisted upon. If
the milk causes diarrhea it is boiled. Constipation is
regarded as a sign that the milk is agreeing, and the
bowels may be moved if necessary by laxatives or
encmata. Small quantities of coffee mixed with the
morning's milk, or stewed prunes or baked apples in the
afternoon, are useful in relieving constipation.
If there is a flatulence, it usually means that too much
r
SPFXIAL DIET CURES.
*nilk is being given or that it is not properly skimmed.
If there is thirst, plain water or a carbonated water may
be given. Lime water or one of the infant foods may
be mixed with the milk to render it more digestible.
During the second or third week, if there is an irre-
sistible desire for food, a little salt herring or a bit of
stale bread with salt may be given. Once a day milk
soup thickened with a cereal may be given. After five
or six weeks the ordinary diet is gradually resumed, but
large quantities of milk are still taken.
During the first week the milk causes slight drowsi-
ness, a coated tongue, and a peculiar taste in the mouth.
The stools are light yellow and resemble the milk stools
of infancy. The urine is increased in quantity. There
is a slight initial loss of weight, but an increase later on
in the cure.
Other Diet Cures. — Many other cures are used in
various parts of the world. Almost every article of diet
has at one time or another been vaunted as a "cure."
Whey, to which alkaline mineral waters have been added,
is sometimes prescribed with plenty of fruit and vegeta-
bles and little meat. Kumiss is used in Russia. Grapes,
apples, and other fruits are used in certain countries. A
" dry " cure, where the amount of liquid is greatly reduced,
is sometimes prescribed, especially for aneuri.sm. A meat-
and-hot-water cure is used for stomach disorders. The
Kneipp cure consisted chiefly of a diet of fruit, bread and
milk, with small quantities of meat and vegetables. The
cure also directs that the patient walk barefooted in the
grass while the dew is still on it.
CHAPTER XX.
DIETETIC MANAGEMEirr OF SURGICAL
CASES.
Surgical o[xrration,s tliat must be performed immedi-
ately, of course, admit of no preparation. Most opera-
tions, however, may be postponed for several days or
longer, thus enabling the patient to be put in good con-
dition by rest, preferably in bed, and a nourishing, easily
digested diet. The value of the rest in bed is greatly
augmented by massage, electricity, and baths where the
condition of the patient admits of their use; by tonics;
and by laxatives to correct the tendency to constipa-
tion that usually exists.
Anesthesia and Diet. — When an anesthetic is to be
administered a routine somewhat as follows should be
^ carried out whenever the circumstances allow : The day
^ preceding the operation the patient should be kept quiet;
^B the bowels should be thoroughly emptied by means of
^1 a saline purge, and the diet should be light and easily
^B digested. The supper should be a Hght one, and the
^H breakfast the day of the operation should consist of a
^f glassful of milk, a cup of cocoa, or a cup of beef tea.
H If there is great hunger a cracker or a piece of toast
H may be added. This should be at least two or three
H hours or even longer before the operation. When the
^1 surgeon operates early in the morning, the patient is not
^^ allowed to have any breakfast whatever. If the patient
^H is weak and in need of a stimulant, an ounce or two of
DIETETIC MANAGEMENT OF SURGICAL CASES. 275
brandy or whisky may be given, diluted with a small
quantity of plain or carbonated water, half an hour be-
fore the anesthetic is administered. At the time of anes-
thesia the stomach should, be empty. This is important, as
it lessens the nausea experienced by many patients after
anesthesia, and also lessens the danger of vomiting food
during an operation, an accident which may cause severe
coughing if the food is drawn into the larynx, or may .
cause pneumonia if it is drawn into the lungs. The
coughing and vomiting may interfere seriously with the
operator.
If it is necessary to administer an anesthetic after a full
meal and ci re um. stances permit, an emetic may be given
to etnpty the stomach before the operation is begun, or
it may be better to wash out the stomach.
Nausea is liable to follow after anesthesia, particujariy
after the administration of ether ; this is discussed below.
If nausea does not occur, a cupful of weak tea or of
diluted milk may be given two or three hours after the
operation, and if that is retained, milk may be given as
often as every three hours if desired. For supper, bread
and milk or cocoa or a slice of toast and a cupful of
weak tea may be allowed. It is well, however, to wait
until the following day before giving anything more. On
the following day, if there is nausea or other untoward
symptoms, a light breakfast may be given, and after that
as rapid return to an ordinary diet as circumstances permit
may be made.
If there is nausea, or after laparotomies, operations
about the head, and other operations as outlined below,
especial care must be taken with the diet of the patient.
Diet after Operation. — The diet following opera-
tions should be supervised by the surgeon himself or by
J
L
276 DIETETICS FOK NLfKSES.
an assistant especially trained for the purpose. In opera-
tions about the mouth, as for hare-lip, and on the alimen-
tary tract, the management of the diet is as of much im-
portance as the operation itself. In order to avoid the
interference of well-intentioned but misguided friends,
many surgeons refuse to operate except in a hospital
unless the patient is in a condition which does not per-
mit of his being moved.
It should be remembered that confinement to bed for
weeks after an operation greatly impairs nutrition, and
every effort should therefore be made to get the patient
in the open air, either on his bed or in a wheel-chair.
Massage and electricity are employed in suitable cases to
maintain the nutrition.
In patients who are up and about no especial diet is,
as a rule, necessary, except after operations about the
mouth, larynx, or alimentary tract. The diet should be
as simple and as nutritious as possible, usually that of
the ordinary individual. Patients suffering from diabetes,
gout, dyspepsia, as well as vegetarians, require especial
care, and the phy.sician will in such cases give explicit
directions concerning the diet.
Children should be fed according to the usual rules
for them, but it is a good plan to have the children, and
especially infants, in the hospital a few days, so as to get
them accustomed to the diet on which they will have to
live.
Those habituated to the daily use of alcohol for years
should receive a moderate average amount, lest nutrition
be interfered with or delirium develop. The physician
will regulate the dosage in these cases.
Diet After Operations About the Head. — For
the first few days the diet should be light — usually liquid
DIETETIC MANAGEMENT OE SURGICAL CASES. 277
— especially if the brain has been affected, and as nutri-
tious and as easy of digestion as it is possible to make
it. The bowels should be kept open. No alcohol is
allowed except in cases of habitues or on the surg'eoii's
direction. If the patient is unconscious, it may be neces-
sary to feed him with a nasal or stomach tube. In some
cases rectal feeding is used.
After brain operations, where there are no unusual
symptoms, the diet may be made semi-solid, or even an
easily digested solid diet may be allowed after two or
three days. Milk toast, junket, bouillon and egg, soft-
boiled or poached eggs, squab, chicken, and the like are
allowable. The diet should be light, but sufficient in
quantity, until the patient is up and about, when it may
be increased to nearly the normal diet.
In operations of a plastic nature about the face, where
the taking of food or vomiting is liable to open the
wound, the food should be given by the rectum until
all danger of the vomiting is past and until the patient
can masticate and swallow without fear of injuring the
part.
Diet After Hare-lip and Cleft Palate Opera-
tions. — Following these operations especial attention to
the diet is necessary. The child should be taught to
take food from a spoon or large medicine-dropper before
operation. If the breast milk is used, it should be drawn
from the breast by means of a pump and given with a
spoon or dropper. Cold sterilized milk or modified milk
should be used in these cases until the patient is able to
take other food. Nasal or rectal feeding may be neces-
sary in .some cases.
Diet After Esophageal or I^aryngeal Opera-
tions. — The diet in these cases is of the utmost impor-
I
I
27S DIETETICS FQH NURSES.
tance and depends very much on the operator and the
operation done. The surgeon's directions will always be
explicit in such cases.
Diet and I^aparotomies. — One or two days before
the operation the bowels should be cleansed thoroughly
by a saline or other pui^e, and in the case of an abdomi-
nal or pelvic operation an enema or two is ordered in
addition, not only to secure cleanliness, but to obtain rest
for the bowels. The washing out of the bowel should be
performed early on the morning of the operation, at six
or seven o'clock, or at least three hours before the opera-
tion. No food should be given for at least four hours
previous to the operation. Many surgeons operate early
in the morning, before the patient has broken his fast.
Others operate later in the day, and allow the patient a
glassful of milk or some such light nourishment on
awakening.
As a rule, nothing should be given by the mouth for
twenty-four hours. Some operators allow very small
quantities of carbonated water or iced water or very hot
water, or if the patient is very weak and in need of nour-
ishment, teaspoonful doses of milk may be ordered with
or without lime water or a carbonated water. Hot weak
tea, or if a stimulant is needed, hot black coffee, may be
administered or alcoholic stimulants may be used. In
these cases as in all others the nurse acts only under the
direct orders of the surgeons. Interference or injudi-
cious feeding may prove fatal. From 5 to 10 oz. of
liquid food are generally allowed on the second day, and
from 10 to 15 oz. on the third day. On the fourth day,
if there are no outward symptoms, a soft diet may be
ordered, and after a week or ten days a gradual return
to an ordinary diet may be made. This varies, of
DIETETIC MANAGEMENT OF SURGICAL CASES. 279
course, with the operation done and the progress of
the patient.
Nausea and Vomiting. — Many operators wash out
the stomach after tlie operation and before the patient
recovers from the effects of the anesthetic. This often
prevents nausea, especially if ether has been given. The
vomiting and nausea may be transitory, or it may last for
days or a week or more and even threaten the patient's
life.
While the vomiting is active no food should be given
by the mouth. If it persists and the patient is weak,
rectal feeding is usually resorted to if the operation per-
mits of it. Various drugs are used to relieve the vomit-
ing, and sometimes a glassful of hot water is given or
the stomach is washed out As a rule, total abstinence
from all food and drink by the stomach is the best way
to manage these cases.
Thirst. — This may be almost intolerable. The patient
may drink the water from hot-water bottles if not watched.
High rectal enemata of hot water are sometimes used
while the patient is still on the operating-table, and do
much toward relieving the thirst of the patient. If allow-
able, rectal injections of normal salt solution may relieve
thirst. Sips of hot water or of hot weak tea are fre-
quently given by the mouth. Carbonated water is some-
times used, but care should always be taken to allow it
to efferve.sce partially before giving it, lest the gas accu-
mulate in the stomach.
Care of the Bowels.— The bowels are usually
moved about the third day after an operation. Some-
times it is desirable to have them moved before; some-
times to allow them to remain quiet for several more
J
28o
DIETETICS FOR NURSES.
days. The surgeon should always be consulted about
this if specific orders have not been given.
Dietetic Ma n agement of Shock. — The patient
will, as a rule, be less shocked if in good condition than
if unprepared for the operation as outlined above. After
the operation, in addition to the usual means of external
heat and the like, stimulating or nutrient enemata may
be given. The first enema is sometimes given while the
patient is still on the table. A stimulating enema for an
adult may contain 2 oz. of brandy, 20 gr. of carbonate
of ammonium, with sufficient water or beef tea at loo" F.
to make 8 oz. Another stimulating enema consists of i
oz. of brandy, the white of an egg, 3 oz. of milk, and a
pinch of salt.
Diet After Operations on the Varions Organs. —
After operations on the liver the diet consists largely of
protein and carbohydrate food. Fats are, as a rule, not
well borne, and arc limited in amount or not given at all.
After operations on the pancreas the amount of fat is
limited or omitted altogether from the dietary. The use
of artificially pancreatized food has been suggested.
After operations ahont the kidney the diet should be
bland and unirritating, such as has been suggested in
chronic or even in acute nephritis (inflammation of the
kidney). All foods known to be irritating to the kidney
should be withheld. (See Nephritis.)
Diet After Operations on the Stomach. — The stomach
and the upper part of the small intestine may be rendered
sterile or nearly so, and this fact is taken advantage of
by many operators in surgical procedures about the
stomach. Finney uses the following diet: For several
days prior to the operation the stomach is washed out
twice daily with sterile water, the patient is given sterile
DIETETIC MANAGEMENT OF SURGICAL CASES. 28 1
liquid food served in sterile dishes. Before taking food
the mouth is thoroughly cleansed with a 1 per cent
solution of carbolic acid. The food is usually given
every two hours.
For four or five days after the operation rectal feeding
is employed. Normal salt solution enemata are alternated
with nutrient enemata every four hours. On the fifth
or sixth day egg albumin is given in teaspoonful doses,
gradually increased to \ oz. every two hours if it is well
borne, and finally to i oz. every two hours on the sixth
day, 2 oz. on the seventh day, and 4 oz. every three
hours on the tenth day. On the twelfth or thirteenth
day the patient is given a soft-boiled egg, and the follow-
ing day soft food, and on the eighteenth day hght solid
food.
Operators vary a great deal regarding the feeding of
their stomach cases. Some allow eight days to elapse
before beginning mouth-feeding, while others begin a day
or two after the operation.
Diet After Operations on the Intestines. — After opera-
tions on the upper part of the intestine the feeding is the
same as ailer stomach operations. The food should be
such that but little residue will be left in the intestine.
After ordinary appendix operations the patient may be
given liquid diet the second day after the operation ; on
the third day a soft diet may be allowed, and solid food
given on the sixth day. On the other hand, if the opera-
tion has been a serious one and a large pus cavity has
been evacuated, rectal feeding may be necessary for five
or six days, and the return to a solid diet may require
weeks.
After operations on the rectum the patient is generally
given a liquid diet for four or five days, after that a soft
282 DIETETICS FOR NURSES,
diet, and finally in seven days or longer solid food may
be prescribed.
Feeding Through Gastric or Intestinal Fis-
tulas. — After gastric or intestinal fistulas have been
made the patient may, if necessary, be fed through these
openings as early as a few hours after the operation. At
first only very small quantities of liquid food are given at
frequent intervals. Kehr advises alternately, every two
hours, \ cupful of tea with cognac, milk and egg, and on
the second day wine with peptone. He adds bouillon with
Ggg on the third day, and begins a " mushy " food, such
as potato soup, flour soups with ^%%y beef tea, and
minced breast of chicken, on the eighth day. After three
weeks the patient may be allowed to masticate his food,
and then, by means of a rubber tube, pass it into the
stomach or intestine through the fistula.
CHAPTER XXI.
HOSPITAL DIET.
There are wide variations in the diets used in hos-
pitals, and also in the names applied to them. In the
average American hospital the classification is as follows ;
Ward Diet. — This is also known as "full" or "house
diet." It is the ordinary diet of ail patients for whom
special diet orders have not been given.
Light diet, also known as convalescent diet, is that
used for convalescent patients generally and for others
for whom it is suitable. It consists of milk, broths, eggs,
and such other foods as are easily digestible yet nutri-
tious.
Special Diets. — Under this heading are included
dietary formulas suitable for those diseases in which diet
plays an important part in the treatment. It includes
such diets as have been recommended in certain diseases
and which bear the name of the inventor, as Tuffnell's
diet for aneurism. Banting's diet for obesity, and such
general diets as the following :
Milk Diet. — This is composed entirely of milk, 2 to
3 quarts usually being allowed daily.
Meat Diet. — This consists chiefly of nitrogenous
animal foods, with a minimum of .sugars and .starches.
It is useful in certain diseases of the stomach where there
is acid fermentation. It closely resembles the diabetic
diet.
Farinaceons Diet. — This is made up of milk, butter.
J
284 DIETETICS FOR NURSES,
and carbohydrates. It is prescribed for convalescents
and in chronic nephritis, etc.
Special or extra special articles of diet, as they are
often termed, include all articles not on the regular diet
list for the day, and for which special orders are gen-
erally given.
CHAPTER XXII.
RECIPES.
BEVERAGES.
I^ime Water.— Into an earthen jar containing hot
water stir a handful of fresh unslaked lime. Allow it to
settle ; then decant the clear fluid and bottle it. Water
may again be added to the lime, and the mixture covered
and allowed to stand to be decanted as needed.
Almond Milk. — Blanch one pound of sweet and two
of bitter almonds that have been soaked in cold water
for twenty-four hours. This is done by pouring boiling
water over the almonds, when, after a few minutes, they
can easily be pressed out of their hulls. Grind the
almonds in a mill or pound them in a mortar ; mix with
a half-pint of warm milk or water, and allow the mixture
to stand two hours, after which strain through a cloth,
pressing the juice out well. Thirty grams of almond.s
yield 200 calories of heat ; 250 grams of milk yield 1700
calories. — ( Wegelc)
Brandy-and-eg^g Mixttire. — Rub the yolks of two
eggs with half an ounce of white sugar ; add 4 ounces
of cinnamon water and then 4 ounces of brandy. Dose :
One or two teaspoonfuls every two hours, according to
age.— (6V,.^,x)
Brandy-and-egg Mixture for Infants.— Beat up
well the yolk of a raw egg ; ten drops of brandy ; one
teaspoonful of cinnamon water; one coffeespoonful of
white sugar. — {Louis Siarr.)
1
286
DJETETICS FOR NURSES.
Cold Egg-nog. — Beat up an egg ; add to it two tea-
spoonfuls of sugar, a glassful of milk, and a tablespoon-
ful of brandy or good whisky ; mix thoroughly.
Hot Egg-nog. — Heat up the yolk of one egg ; add a
tcaspoonful or two of sugar and a glassful of hot milk;
strain, and add a tablespoonful of brandy or old whisky,
or flavor with nutmeg or wine.
Egg Broth. — Beat up an egg, and add to it half a
tcaspoonful of sugar and a pinch of salt ; over this pour
a glass of hot milk and serve immediately. Hot water,
broth, soup, or tea may be used in place of milk. —
(Drexd Instilnh-)
Egg Cordial. — Beat up the white of an egg until
light; add a tablespoonful of cream and beat up to-
gether, then add two teaspoonfuis of sugar and a table-
spoonful of brandy.
Caudle. — Beat up an egg to a froth ; add a wine-
glassful of sherry wine, and sweeten with a tcaspoonful
of sugar; if desired, flavor with lemon peel. Stir this
mixture into a half-pint of gruei ; over this grate a little
nutmeg and serve with hot toast.
Albumin Water. — Beat the white of one egg until
very light and strain through a clean napkin. Add six
ounces of water. If intended for an infant a pinch of salt
may be added. A teaspoonful or more of sugar and a
tcaspoonful or more of lemon Juice, orange juice, or
sherry wine may be added to enhance its palatableness.
This drink may also conveniently be made by placing all
the ingredients in a lemonade-shaker, shaking until
thoroughly mixed, and then straining. Serve cold,
Apple Water. — Pour a cupful of boiling water over
two mashed baked apples; cool, strain, and sweeten.
Serve with shaved ice if desired.
L^
RECIPES. 287
Tamarind "Water. — Pour a cupful of boiling water
over a tablcapoonful of preserved tamarinds; allow this
to .stand until cool, then strain, and serve with shaved ice. '
Ctuxant Juice. — Take an ounce of currant juice or
a tablespoonful of currant jelly. Over this pour a cupful
of boiling water — use cold water with the juice — and
sweeten to taste.
Ifemonade No. I. — Take the juice of one lemon or
three tablcspoonfuis of Semon juice; add from one to
three tablespoonfuls of sugar and a.cupfu! (6 ounces) of
cold water. Serve With cracked or shaved ice if desired.
lemonade No. 2. — Pare the rind from one lemon,
cut the lemon into slices, and place both in a pitcher with
an ounce of sugar. Over this pour a pint of boiling
water and let it stand until cold. Strain and serve with
cracked ice. — (Pavy^
Effervescing Lemonade. — This may be made by
using a carbonated water or by adding half a teaspoonful
of bicarbonate of soda or potash to a glassful of either
of the foregoing lemonades.
Albuminized Lemonade.— Shake together a cupful
of water, two teaspoonfuls of lemon juice, two teaspoon-
fuls of sugar, and the white of one egg. Serve at once.
Orangeade. — Cut the rind from one orange ; over
the rind pour a cupful of boiling water; then add the
juice of the orange and a tablespoonful of sugar ; cool,
strain, and serve with shaved ice if desired. If this is too
sweet, a teaspoonful of lemon juice may be added.
Imperial Drink. — Add a teaspoonful of cream of
tartar to a pint of boiling water ; into this squeeze the
juice of half a lemon, or rnore if desired; sweeten to
taste and serve cold. This drink is most useful in fevers
and in nephritis,
J
288 DIETETICS FOR NURSES.
Flaxseed Tea. — Add six tablespoonfuls of flaxseed
to a quart of water; boil for half an hour; cool, strain,
sweeten, and if desired flavor with a little lemon juice.
I/inseed Tea. — To a pint of water add two table-
spoonfuls of linseed, the juice of half a lemon, \ ounce
of bruised licorice root (or a piece of licorice the size of
a filbert), and rock-candy to taste. Boil for one and one-
half hours and strain. — ( Yeo^
Org^eat. — Blanch two ounces of sweet almonds and
four bitter almond seeds. Add a little orange-flower water
and pound into a paste ; rub this with a pint of milk
diluted with a pint of water until it forms an emulsion.
Strain and sweeten with sugar. (A demulcent and nutri-
tive drink). — {Pavy^
Mulled Wine. — One-fourth of a cupful of hot water,
one-half inch of stick cinnamon, two cloves, a tiny bit
of nutmeg, one-half cupful of port (heated), two table-
spoonfuls of sugar. Boil all the ingredients except the
wine and sugar for ten minutes ; then add the wine and
sugar, strain, and serve very hot. — (Drexel Institute)
Grape Juice. — Pluck Concord grapes from the stem.
Wash and heat them, stirring constantly. When the
skins have been broken, pour the fruit into a jelly bag
and press slightly. Measure the juice and add one-
quarter the quantity of sugar. Boil the juice and sugar
together and then pour into hot bottles ; cork and seal
with paraffin or equal parts of shoemaker's wax and resin
melted together. Less sugar may be uesd. — {Drexel
Institute)
Oatmeal, Barley, or Rice Water. — ^From the
grain : Use two tablespoonfuls of grain to a quart of
water. The grain should have been previously soaked
overnight or at least for a few hours. When required for
an emergency, the soaking may be dispensed with and
the grain boiled for five minutes instead. The water in
which the grain was soaked should be poured off" and
fresh water added before cooking. The grain should be
boiled for several hours, water being added from time to
time to keep the quantity up to a quart. Strain. This
makes a somewhat thin, watery gruej.
rrom prepared flours : Various brands of prepared
grain flours are on the market, such, for example, as
Robinson's Barley Fiour. These arc all somewhat simi-
lar ill preparation. From two rounded teaspoonfuls to a
tablespoonful of the prepared flour is added to a pint of
boiling water, and this is boiled for from fifteen to thirty
minutes and then strained. No previous soaking is re-
quired.
CEREALS AND CEREAL GRUELS.
Either the grain itself or the specially prepared flour
may be used. When the grains arc used they should be
spread on a clean table and all foreign substances re-
moved. If the whole grains be used, it is well to wash
them, after picking them over, with two or three changes
of cold water.
Cereals are best cooked in a double boiler. The lower
part should be filled about one-third full of water, and,
if more is added during the cooking, it should always be
boiling hot. The cereal should be cooked over the fire
for ten or fifteen minutes. The water should be boiled
first and then salted. The cereal is added gradually and
the whole stirred to prevent it from burning. It should
then be placed in the double boiler and steamed until
thoroughly cooked. Cereals, like other starchy foods,
require thorough cooking. Most recipes allow too short
a time. Oatmeal especially should be mentioned. It
J
290 DIETETICS FOR NURSES.
develops a better flavor if cooked for three hours of
more, and is better when it is prepared the day before
and reheated when used. It should be just thin enough
to pour when taken out of the boiler, and when cooled
should form a thin jelly.
Any cereal mush may be thinned with water, milk or
cream and made into a gruel, or the gruel may be made
directly from the grain or flour. Gruels should be thin,
not too sweet nor too highly flavored, and served very
hot Milk gruels should be made in a double boiler.
Gruels may be made more nutritious by the addition of
whipped egg, either the white or yolk or both, and the
various concentrated food products.
When cereal flours are used, the flour should be rubbed
to a smooth paste with a little cold water and added
slowly to boiling water, stirring constantly until it is
thoroughly mixed.
LENGTH OF TIME TO COOK CEREALS.
Oatmeal:
.. ..
Irish oattatal :
IVieattna :
Gluten musk :
" 30 ■■
Steamed nre :
Ste»m fo. one
B0iUJ rUt .■
li'iil fur twenly
Arrowroot Gruel.— Dissolve half a teaspoonful of
sugar and a quarter of a teaspoonful of .salt in a cupful
of water, and heat. Mix half a tablespoonful of arrow-
root flour with a little water and add to the heated water.
Boil for twenty minutes, stirring constantly; then add a
cupful of milk, bring to a boil, strain, and serve hot.
Barley Grael. — Proceed as above, using a table,spoon-
ful of Robinson's Barley Flour instead of arrowroot.
Oatmeal Gruel. — As above, but use oatmeal, and
boil for half an hour or longer before adding the milk.
Flour Gruel. — Proceed as in making arrowroot gruel,
using instead a tablespoonful of wheat flour. Flavor
with lemon juice, cinnamon, nutmeg or vanilla.
Farina Gruel. — Proceed as in making arrowroot
gruel, using instead a tablespoonful of farina, and boil
but ten minutes before adding the milk.
Imperial Granum Gruel. — As in the preceding,
but use imperial granum instead of farina.
Cracker Gruel No. i. — Use two tablcspoonfuts of
cracker crumbs and proceed as above. Cook only two
or three minutes and do not strain.
Cracker Gruel No. a. — Brown the crackers, and
reduce to a powder by means of a rolling-pin. Add
three tablespoonfuls of the powdered crackers to haif a
cupful of milk and half a cupful of boiling water; cook
for ten minutes; then add one-fourth of a teaspoonful
of salt and serve. — {Drcxel Institute^
Racahout des Arabes.— This is a French prepara-
tion with a chocolate flavor which makes a most delicious
gruel. Follow the directions given for farina gruel.
Flour Ball. — Tie half a pint of flour in a square of
fine cheese cloth, making a ver>' tight ball. Place this in
a pot of boiling water and cook for four or five hours.
After taking out of the cloth, peel off the outside and
grate the hard ball. Drj- in the oven and keep in a cov-
ered Jar. This is useful for making gruels for diluting
milk for infants.
Flour-ball Gruel.— Proceed as for arrowroot gruel,
using two teaspoonfuls of the above grated flour Tubbed
up in cold water, and stir into a pint of boiling water.
Cook this for ten minutes.
J
292
DIKTETICS l-OI! NURSES.
Commeal Gruel No. i. — Use two tablespoonfuls of
cornnieal and one of flour, a teaspoonful each of sugar
and salt, one quart of hot water and a cupful of milk.
Proceed as in making arrowroot gruel, boiling in a double
boiler for three hours.
Commeal Gmel No. 2.— Take a tablespoonful of
cornmeal and moisten with a little cold water. Stir this
into a pint of boiling water to which a pinch of salt has
been added. Cook for three hours in a double boiler,
or for thirty minutes directly over the iire. In the latter
case it must be stirred constantly.
Glnten Gmel. — Mix a tablespoonful of gluten flour
with one-fourth of a cupful of cold water and stir this
into one cupful of boiling salted water. Cook directly
over the fire for fifteen minutes ; then add one clove and
cook over boiling water for a half-hour. — {Drexel Insti-
tute)
Barley or Oatmeal Jelly. — Prom the grain : Pre-
pare the grain as directed for barley water. Use from
four to .six tablespoonfuls of grain to the quart of water.
Boil thoroughly for several hours until the grain is
thoroughly cooked. Strain and cool. The jelly when
hot should be ju.st thick enough to pour.
From the prepared flours : Use two tablespoonfuls of
the flour to a pint of water. Boil from fifteen to thirty
minutes and strain.
Partially Digested Cereals Prepared at the
Table. — To a sauce of well-cooked oatmeal, wheaten
grits, or rice, at the customary' temperature, add one or
two teaspoonfuls of Fairchild's Diastasic Essence of Pan-
creas, or fifteen grains of Fairchild's Dry Extract of Pan-
creas. Stir for a few minutes before eating. When the
RECIPES. 293
rerments are added to very hot foods their power becomes
impaired.
Tapioca Jelly. — Soak a cupful of tapioca of the best
quality in a pint of coid water for two hours ; when soft,
place in a saucepan with sugar, the rind and juice of one
lemon, a pinch of salt, and another pint of water ; stir
the mixture until it boils ; turn into a mold and set away
to cool ; if desired, a glassful of wine may be added. —
{Bartholmi')
Tapioca Soup.— Boil a pint of meat broth or stock,
and, while stirring constantly, .sprinkle in \ ounce of pre-
viously washed tapioca. Cover the saucepan, and let it
stand until the tapioca is quite soft. Skim and serve.—
{Yco)
Chestnut Puree. — One pound of chestnuts are peeled,
and boiled in water until the second (inside) .skin comes
off easily. The chestnuts are placed in a sieve until all
the water drains off They are then washed in a dish
and afterward pres.sed through a sieve. Melt three
ounces of butter in a stewpan on the fire, add a little
salt and sugar — enough to cover the point of a knife —
and then the chestnuts. Stow them for half an hour,
stirring frequently ; pour in enough bouillon so that the
mush does not get too thick. — (IFf^f/f.)
Drexel Institute Bread Recipe. — For two loaves
take two cupfuLs of wai'm milk or water, two tcaspoon-
fuls of .salt and two of sugar, a tablespoonful of lard or
butter, one-half cake of compressed yeast, and about four
pounds of flour. Put the water or milk, salt, sugar, and
fat into a bowl. Dissolve the yeast in warm water ; add
it and the flour gradually ; when stiff enough to handle,
294
DIETETICS FOR NURSES.
turn the dough on a floured board and knead until soft
and elastic. Put it back into thf bowl, and let it rise in a
warm place until it is double its bulk. Then divide into
loaves or shape into biscuits. Allow these to rise in the
pan in which they are to be baked. Cover the bread and
again allow it to double its bulk. Bake loaves one hour
in a hot oven. The large amount of yeast allows the
bread to be made and baked in three hours.
Brown Bread.— Take one-half cupful scalded milk,
one-half cupful water, one teaspoonful salt, one-half
tablespoonful butter, one-half tablespoonful lard, two
tablespoonfuls of molasses, one-half cupful white flour,
suflicient Graham flour to knead, and three-quarters of a
yeast cake dissolved in one-quarter of a cupful of luke-
warm water. Prepare the same as white bread. Instead
of Graham flour, equal parts of Graliam flour and white
flour may be used in kneading.
Nat-brown Bread.^Thc same as preceding, with
one cupful of nuts chopped and added.
Whole-wheat Bread. — Dissolve a quarter of a
yeast cake in a tablespoonful of lukewarm water. Pour
half a cupful of hot water over half a cupful of milk,
and when lukewarm add the yeast and half a teaspoonful
of salt. To this add a cupful of whole-wheat flour and
beat for five minutes. Cover and allow this to stand in a
warm place for two hours and a half. Then add whole-
wheat flour gradually, mixing the mass until it can be
kneaded. Knead until elastic ; shape and place into
baking-pans, ^over and allow to .stand in a warm place
until it doubles its bulk. Prick the top with a fork and
bake for one hour. The oven should not be hot as for
white bread.
Polled Bread.— Use bread made with water. Make
Potatoes ....
Carrots ....
AS
Beets (uldj . .
Onions ....
. .4S-6S
CabbBge . . .
. tS-'-o
Cauliflower . .
Asparagus . . .
.20-30
into long loaves, and as soon as baked take off the crust.
Pull into stick-shaped pieces and browa slightly in a slow
oven.
TIME-TABLE FOR COOKING VEGETABLES IN WATER.
GENERAL &in.E5 FOR COOKING VEGETABLES.
Wash thoroughly ; pare or scrape if skins must be
removed. Stand in cold water until cooked, to keep
them crisp and prevent their being discolored. Cook in
boiling water; the water must be kept at the boiling-
point. Use two teaspoonfuls of salt with two quarts of
water ; put the salt into the water when the vegetables
are partially cooked. The water in which vegetables are
cooked is called vegetable stock.
Fresh green vegetables require less water thatvothers.
Cabbage, cauliflower, onions, and turnips shauld be
cooked uncovered in a large amount of water.
All vegetables must be drained as soon as tender.
Season with salt and pepper and serve hot with butter or
sauce.
The color may be kept in green vegetables, such as
spinach, by pouring cold water through them after
draining.
Cold vegetables may be used for salads or may be
I
296 DIETETICS FOR NURSES.
placed in a baking-dish with one-half the quantity of
sauce (2 cupfuls vegetables and i cupful sauce), covered
with buttered crumbs, and browned in a hot oven.
Sauce for Vegetables :
3 tablespoonfuls of butter. White pepper.
3 tablespoonfuls of flour. I cupful of milk.
I teaspoonful of salt. I cupful of stock.
SOUPS WITHOUT MEAT.
(Drexfx Institute.)
These soups are thickened by using butter and flour ;
this prevents a separation of the thicker and thinner
parts of the soup. The butter should be heated until it
bubbles, the flour and seasoning added, and enough of
the hot liquid to make a smooth sauce thin enough to
pour easily ; this should be poured into the rest of the
hot liquid and cooked in a double boiler until the soup
is of the proper consistence.
In soups made of dried peas and beans soda is used
to soften the casein ; it is also used in tomatoes to neu-
tralize the acid. These soups must be served in hot
dishes as soon as ready. Crisp crackers, croutons, or
soup sticks may be served with them.
Crisp Crackers:
Split and butter thick crackers and brown in a hot oven.
Cream-of-Tomato Soup :
I can tomatoes. J cupful of flour.
\ teaspoonful soda. 3 J teaspoonfuls of salt.
J cupful of butter. \ teaspoonful of white pepper.
I quart of milk.
Stew the tomatoes slowly one-half to one hour, strain, and add soda
while hot ; make a white sauce and add the tomato juice. Serve imme-
diately.
Cream-of-Celery Soup :
I J cupfuls of celery,
2 lablespwinfuls of butter.
I pint of walei.
J cupful of Hour.
I cupful of milk.
^ teaspoonful of salt.
I cupful of cream.
J teaapoonful of white pepper.
Cook Ihe celery in the boiling wat
er until very soft ; strain and add the
liot liquid ; make a while sauce and
cook until it is thick cream.
Cream-of-Potato Soup
3 pulatoes.
Volks of 2 eggs.
2 cupfuls of milk.
I teaspoonful of salt.
^ cupful of cream.
Pepper.
j teaspoonful of onion juice,
'ook the potatoes until soft, drain, mash, add the hot liquid, and
in ; add the beaten yolks and seasoning. Cook in a double boiler
il the egg thickens, stirring constantly. Serve immediately.
Oyster Stew :
1 cupful of milk.
I pint of oysters.
^ teaspoonful of salt.
I tablespoonful of bntter.
Pepper.
Heal the milk. Cook and strain the oyster juice. Add the oysters,
which have been rinsed, and cook until the edges curl. Add seasoning,
butter, and hot milk. Serve at once. This soup may be thickened with
MILK PREPARATIONS.
Partially Peptonized Milk.— Into a clean granite-
ware or porcelain-lined saucepan place one pint of milk,
four ounces of water, and the contents of one of Fair-
child's peptonizing tubes, or five grains of pancreas
extract and fifteen grains of bicarbonate of soda. Heat
gradually until it boils, stirring constantly. Boil gently
for ten minutes, strain into a clean bottle, cork, and keep
in a cool place. Before using shake the bottle well ;
serve hot or cold. Prepared in this way it will not
become bitter.
398 DIETETICS FOR NURSES.
Peptonized Milk.— Cold Process. — Mix milk, water,
and peptonizing agents as directed in the preceding
recipe, and immediately place the bottle on ice. Use
when ordinary' milk is required. This is particularly
suited for dyspeptics and individuals with whom milk
does not, as a rule, agree. The flavor of the milk re-
mains unchanged.
Peptonized Milk. — Warm Process. — Put in a glass
jar one pint of milk and four ounces of cold water ; add 1
five grain.s of extract of pancreas and fifteen grains of!
bicarbonate of soda. After mixing thoroughly, place thefl
jar in water as hot as can be borne by the hand (aboufej
1 15° F.). This should be heated for from six to twent>
minutes. At the end of this time it may be placed upon^
ice until required. The contentf of one of Fairchild's
peptonizing tubes may be used in place of the pancreas
extract. If the milk is to be kept for any length of time,
it .should be brought to a boil, to prevent the formation
of too much peptone, which renders the milk bitter.
Hot Peptonized Milk. — Mix together the usual
peptonizing ingredients and add a pint of fresh cold
milk ; after thoroughly shaking the bottle, place it on
ice. When needed pour out the required amount, heat
it, and drink it as hot as it can agreeably be taken. If
required for immediate use, the ingredients may be mixed
together in a saucepan and slowly heated to the proper
temperature.
Effervescent Peptonized Milk. — Put some finely
cracked ice in a glass; fill it half-full of Apollinaris,
Vichy, or siphon water, and immediately add tlie pep-
tonized milk. Drink while effervescing. Brandy may
be added if desired.
Specially Peptonized MUk. — This is to be used in
L
RECIPES. 399
the preparation of jellies, punches, and all recipes where
the milk is to be mixed with fruit juices or acids. Pre-
pare according to the hot process ; keep the milk at a
temperature of 115° F. for one hour; pour into a sauce-
pan and bring to a boil. If required hot, this may be used
immediately, or it may be set aside on ice, to be used
later. If not heated for an hour, the milk will curdle
on being mixed with an acid. If not boiled, the pep-
tonizing ferment will digest gelatin and prevent the forma-
tion of j'jlly.
Peptonued Milk Jelly. — Soak well half a box of
Cox's gelatin in four ounces of water. Take one pint
of hot specially peptonized milk and add four ounces of
sugar. Put in the gelatin and stir until it is dissolved.
Pare one fresh lemon and one orange, and add the rinds
to the mixture. Squeeze the lemon and the orange
juice into a glass, strain, and mix with two or three
tablespoonfuls of St, Croix rum, or brandy, if preferred.
Add the juices to the milk, stirring constantly. Strain,
and allow it to cool to the consistence of syrup ; when
almost ready to set, pour into cups and set in a cold
place. Do not pour the milk into molds until the
mixture is nearly ready to set, otherwise it wili separate
in setting.
Peptonized Milk Punch.— In the usu:il milk punch
recipes the spcdally peptonized milk may be used in
place of ordinary milk. Take a goblet one-third full of
finely cru.shed ice; pour on it a tablespoonful of rum
and a dash of Curacao, or any other liquor agreeable to
the taste. Fill the glass with peptonized milk ; stir well,
sweeten to ta.ste, and grate a little nutmeg on top.
Peptonized Milk I,emonade.— Take a glass one-
third full of cracked ice; squeeze into this the juice of a
300
DIETETICS FOH NURSES.
lemon, and add two or three teaspoonfuls of sugar di^^
solved in water. Fill the glass with fresh sj>ecia//jn
peptonized milk and stir well. If preferred, equal partSfl
of milk and of an effervescent mineral water may be3
used. Pour the water on the lemon juice and ice, andfl
immediately fill the glass with milk. M
Peptonized Milk Gruel. — Mix with a teaspoonfuU
of wheat flour, arrowroot flour, or Robinson's Barleys*
Flour with half a pint of cold water. Boil for fivel
minutes, stirring constantly. Add one pint of cold miUcl
and strain into a jar; add the usual peptonizing ingre-^
dients; place in warm water (i 15° F.)for twenty mimites^
and then upon ice. ■
Junket, or Curds and Whey. — Take a half-pint o^
fre.sh milk ; add one tcaspoonful of Fairchild's Es-sence"-!
of Pepsin and stir just sufficiently to mix. Pour into |
custard cups, and let it stand until firmly curdled. It 1
may be served plain or with sugar and grated nutmegs J
It may be flavored with wine, which should be added I
before curdling takes place. I
Junket with Bgg.— Beat one egg to a froth, and-1
sweeten with two teaspoonfuls of white sugar ; add this-^l
to a half-pint of warm milk ; and then add one teaspoon-v
fnl of essence of pepsin and let it stand until curdled. I
Cocoa Junket. — Put an even tablespoonful of anyj
good cocoa and two teaspoonfuls of sugar into a sauce*!
pan; scald with two tablespoonfuls of boiling water and'a
rub into a smooth paste ; then .stir in thoroughly one-half '|
pint of fresh, cool milk; heat this mixture until it is 1
lukewarm — not over 100" F. — then add one tea.spoonful j
of Fairchild's Essence of Pepsin and stir just enough to.
I mix ; pour quickly into small cups or glasses, and let tt A
L stand until firmly curdled, when the junket is readyfof"J
AEC/PES. 301
use. It may be placed on ice and eaten cold ; as a
dessert it may be served with whipped cream. — {Fair-
child.)
Coffee Jnnket. — Dissolve two teaspoonfuls of sugar
in two tablespoonfuls of clear, strong coffee ; mix tliis
thoroughly with one-half pint of fresh, cool milk ; add a
tea.spoonful of Fairchild's Essence of Pepsin as directed
above, and serve in the same way.
Vanilla, Bitter Almond, or Strawberry Junket.
— Add the flavoring extract to the cold milk and then
prepare in the usual way. A half a teaspoonful of vanilla
or bitter-almond extract or a tablespoonful of pure con-
centrated .strawberry syrup should be allowed to a half-
pint of milk.
Milk I,enionade. — Take two ounces of sugar, five
ounces of boiled milk, one^half lemon, or two ounces of
white wine, five ounces of boiling water, and the rind of
half a lemon. Pour the boiling water over the peel and
the sugar; allow it to cool, add the milk, and then the
lemon juice or wine. Strain after ten minutes.
Hilk Pdnch. — Shake together in a lemonade-shaker
a glass of milk, a tablespoonful of rum, brandy, or good
old whisky, and two teaspoonfuls of sugar. After it has
been poured into a glass a little nutmeg may be grated
over the top.
Milk Porridge. — Mix a tablespoonful of flour with
one-fourth cupful of cold milk and stir into one-fourth
cupful of hot milk; if desired, add two raisins cut into
quarters. Cook over boiling water for one hour, and
add one-quarter teaspoonful of salt just before serving.
— {Drcxd liistitut,-)
Whey.— Take a half-pint of fresh milk heated luke-
warm (115° F.), add one tablespoonful of essence of
302
DIliTRTlCS i-OJi NURSES.
pepsin, and stir just enough to mix. When this is firmly-
coagulated, beat up with a fork until tht curd is finely
divided and then strain. For flavoring purposes lemon
juice or sherry wiiic may be added.
Cream-of-tartar Whey. — Add a heaping teaspoon-
Tul of cream of tartar to a pint of boiling water. Strain,
sweeten to taste, and serve cold. — (^I'avy.)
Wine Whey.— Cook together a cupf.il of milk and
iialf a cupful of sherry wine. As soon as the curd
separates, strain and sweeten. This may be eaten hot
or cold.
I/emon Whey. — This is made in the same way as
the foregoing recipe, using three tablespoonfuls of lemon
juice instead of the wine.
Kumiss No. i. — Take a quart of skim milk, one-
fifth of a cake of yea.st, and two tablespoonfuls of sugar.
Heat the milk. Dissolve the yea.st in a little water and
mix it with the .sugar and lukewarm milk. Pour the
mixture into strong bottles, stopper them tightly with
new corks, and tie down the corks with stout twine.
Shake the bottles well and place in a refrigerator; this
will allow the mixture to ferment slowly. After three
days lay the bottles on their sides, turning them occa-
sionally. Five days are required to complete the fer-
mentation; the kumiss is then at its best. — {Drexd
Institute)
Kamiss No. 3. — Pour into wired bottles one quart of
fresh milk, half an ounce of sugar, a piece of fresh yeast
cake half an inch square, and keep at a temperature be-
tween 60° and 70° F- for one week, shaking five or six
times a day; then put upon ice. — {Holt)
Hilk Mixture. — This is made of cream, two parts ;
milk, one part ; lime water, two parts ; sugar water,
L
RECIPES. 303
three parts (seventeen and three-fourths drams of milk
sugar to a pint of water). — (-J. V. Meigs^
Milk-and-cinnamon Drink. — Add a small amount
of cinnamon to the desired quantity of milk and boil
it Sweeten with sugar and add brandy if desired, —
{Ringer)
Albuminized MUk. — Shake in a covered jar or
lemonade-sliaker acupfuiof milk, a tablespoouful of lime
water, and the white of an egg. Sweeten, flavor as de-
sired, and serve at once.
Milk-and-cereal Waters. — A most valuable method
of preparing milk for invalids with whom it disagrees is
to mi.*; equal parts of milk and thoroughly cooked
barley, rice, oatmeal or arrowroot water and boil them
together for ten minutes. This may be served plain, or
flavored by cooking with it a cut-up raisin, a sprig of
mace, or a piece of stick cinnamon, which should be
strained out before serving.
Irish Moss and Milk.— Soak about two tablespoon-
fuls of Irish moss for five minutes and wash thoroughly
in cold water. Add to a cupful 'of milk and soak for
half an hour; then heat slowly, stirring constantly, and
then boil for ten minutes, preferably in a double boiler;
strain, and pour into cups and cool. This maybe served
while hot, and may be rendered more nutritious by the
addition of the white of an egg stirred into it just before
ser\'ing.
Milk with Other Diluents.— Milk may be diluted
with advantage in many cases by adding lime water, or
Vichy, Apollinaris or some other sparkling table water.
From one-half to one-eighth the total volume may be
added.
A
304 DIETETICS FOR NURSES,
EGGS.
BRRS arc exceedingly valuable as food for invalids.
They should always be fresh. When received they
should be washed and then placed in a cool place. They
should not be kept with any article of food having an
odor, as they absorb such odors and the taste is thereby
impaired. Stale eggs will not sink, and if held to a
bright light they show a dark spot. The yolk of an egg
that has been broken may be kept fresh by placing it
(unbroken) in a cupful of cold water. This should be
set in a cool place. This will keep it fresh for twenty-
four hours or more.
ICggs and all other albuminous food should be cooked
at as low temperatures as possible, in order to avoid
rendering them tough,
ICggs are best cooked in the shell as follows :
Soft-cooked Eggs. — Place in a pint of boiling water,
remove from the fire, and allow to stand for eight or ten
minutes. If the egg is very cold to start with, it will
take a little longer.
Hard-cooked Eggs. — Place in water, bring to a boil,
and then set on the back part of the stove for twenty
minutes.
I^ggs should be served as soon as cooked, and the
dishes should be warmed and ready.
EGGS AND MILK.
Rules for Custards. — The eggs should be thor-
oughly mixed but not beaten light, the sugar and salt
a(kled to these, and the hotmxW added slowly. Custards
must be cooked over rrioderate heat; if a custard curdles,
put it in a pan of cold water and beat until smooth.
Custards should always be strained. — (Drexel Institute)
RECIPES. 505
Soft Custard.— Take a pint of milk, the yolks of two
eggs, two tablespoonfuls of sugar, and a pinch of salt.
Mix all except the milk in a bowl. Heat the milk to the
boiling-point and add, stirring constantly. As soon as
mixed, pour into the saucepan in which the milk has been
heated and cook from three to five minutes, stirring con-
stantly until it thickens. Strain, and pour into a cold bowl,
and flavor with from half to one teaspoonful of vanilla,
a teaspoonful or more of sherry, or other flavoring ma-
teria! as desired. Custards may be cocked to advantage
ill a double boiler.
Chocolate Custard. — Melt half an ounce of Baker's
chocolate and add to the milk, and proceed as above.
Steamed Custard. — Mix the above, using the whole
eggs instead of the yolks. Strain, pour into cups, and
steam over boiling water until firm.
Baked Custard. — Proceed as above, but pour the custard
into baking-cups. Place the cups in a deep baking-pan
and fill the pan nearly as high as the cups with boiling
water. Place in the oven and bake twenty minutes or
longer, according to the size of the cup. When done a
clean knife thrust into the custard comes out clean ; if it
is not done, it comes out covered with milk.
HEATS.
General Rules for Preparing Meat. — Meat must
be weighed, trimmed, and wiped with a damp cloth. It
should be removed immediately from the paper in which
it was wrapped and placed in a cool place. Only tender
cuts of meat should be broiled, pan-broiled, or roa.sted.
When meat is to be cooked by any of these methods, it
should first be seared, and then the temperature slightly
lowered ; by searing, the albumin on the outer surface of
306 DIETETICS FOR NURSES.
the meat is hardened and the meat is thus cooked in its
own juices.
Tough meat should be cooked in water ; boiling water
hardens the albumin on the outer surface of the meat
and prevents the juices from escaping. Meat should be
put in boiling water and the water allowed to boil for ten
or fifteen minutes ; then the cooking should be allowed
to proceed at a low temperature until the meat is tender.
If the water bubbles, it is too hot. Cooked in this way-
tough meat will become tender. The time required for
roasting or cooking in water varies with the weight and
quality of the meat.
For roasts weighing less than 8 pounds allow ten min-
utes to the pound and ten minutes extra ; for those weigh-
ing from 8 to 12 pounds, allow twelve minutes to the
pound and twelve minutes extra ; for those weighing
over 12 pounds, allow fifteen minutes to the pound and
fifteen minutes extra. For meat weighing less than lo
pounds, to be cooked in water, allow twenty minutes to
the pound and twenty minutes extra.
The time required for broiling meat varies with the
thickness of the meat.
Stock and broth are prepared by prolonged soaking
of the meat in cold water and then cooking it at a low
temperature for several hours, allowing it to cool uncov-
ered. The meat that remains after straining may be
utilized in various ways, adding a little fresh meat to give
it flavor.
The fat must not be removed from stock or broth, for
it excludes the air and prevents decomposition. It must,
however, be entirely removed before the stock or broth
is used ; this fat may be used in place of drippings. The
trimmings of fat from meat should be clarified. Small
RECIPES. 307
globules of fat may be removed from cold broth with a
cloth that has been dipped in boiling water and then
wrung dry. Fat may be removed from hot broth by
means of tissue-paper or a slice of bread.
Cooking Tender Meats. — Roasting. — Skewer the meat
into shape. Place it on a rack in a meat pan, into the bot-
tom of which pieces of fat from the meat have been placed.
Put in a hot oven on the grate for ten minutes, to sear
the meat If desired it may be seasoned with salt and
pepper. Then retnove to the floor of the oven and baste
every ten minutes, until it is done.
Broiling. — Remove extra fat from the meat and grease
the broiler with a part of the fat. Broil over a clear fire ;
sear, and then turn every ten seconds. Chops one inch
thick should be cooked for five minutes. A steak two
inches thick should be cooked for ten minutes. Season
and serve on a hot platter.
Pan-broiling.— Remove all the fat from the meat. Heat
a frying-pan very hot, but use no fat. Sear the meat on
both sides, and then cook more slowly until it is done.
Stand chops up on their edges to brown. Keep the pan
free from fat. The time required for pan-broiling is the
same as that required for broiling. — {Drcxd Institute.)
GENERAL RULES FOR SOUPS.
Both meats and vegetables should be cut into small
pieces. The soup should be started with cold water
poured over the meats and the heat applied gradually
and the soup allowed to simmer, in order to dissolve as
much of the nutriment as possible. If heated rapidly
the albumin in the meat coagulates, and little but the
extractives passes into the soup. The vegetables are
added when the soup is nearly done.
308 DIETETICS FOR NURSES.
Remove the fat by skimming, by using blotting-paper,
by straining through a cloth wet in cold water, or, best
of all, by cooling the soup when all the fat rises to the
top, when it can be easily removed.
Clear soups may be rendered more nutritious by the
addition of sago or of some cereal, as barky or rice.
These may also be added with advantage to many thick
soups.
Soups should always be served hot. Soup jellies are
served cold, and in hot weather may be substituted for
warm soups.
Soups may also be made from soup stocks, which may
be prepared in any quantity and kept for several days.
Stocks may be made from any meat. Those made from
chicken or veal are light in color, and those from beef
and mutton somewhat darker. Stocks may also be made
by using the bones from any kind of meats.
Soup Stock. — To make stock, use a chicken or
several pounds of bones with some meat attached, or a
pound of lean meat and one quart of water. Cut-up
vegetables may be added as desired. For flavoring add
a sprig of parsley and of celery, a peppercorn, a small
onion, and a scant teaspoonfu! of salt. Any of the
flavoring vegetables may be omitted as desired or others
added. The meat should simmer for several hours, until
but half the quantity of water remains. Then add the
other ingredients, simmer half an hour longer, strain and
cool. Remove the fat.
Soup Stock from Beef Eitract. — Cook the other in-
gredients, except the salt, as given above, for half an
hour, using a quart of water. Then add a teaspoonful
of beef extract and a quarter of a teaspoonful of salt.
Soup from Stock. — Rice, tapioca, or whatever is de-
RECIPES.
309
sired is cooked and the stock added, with additional
seasoning as thought necessary. Cream, yolks of eggs,
Irish moss, cornstarch or arrowroot may be added to
render the soup more nutritious.
Chicken Broth. — Take one pound of cliicken and a
pint of cold water. Clean the fowl, cut it into pieces,
and remove the skin. Separate the meat from tlic bone
and chop the meat very fine. Place with the bone.'i — if
large, they should be broken — in the water and soak for
an hour. Cook over hot water for four or five hours at
a temperature of 190° F, Strain and add salt. Water
must be added from time to time to keep the quantity
up to a pint. Remove the fat. If the broth is to be
reheated use a double boiler.
Sweethread Soup. — The sweetbread is soaked in
cold water for one hour, the water being renewed fre-
quently during this time. It is then boiled for one hour
in slightly salted water or beef broth, to which one may
add one teaspoonful of julienne to improve the taste.
Afler it is soft the sweetbread is taken out of the beef
broth and all blood-vessels and skin are removed. It
may now be cut into pieces the size of a walnut and
put on a plate, over which the beef broth is poured, or
the sweetbread may be forced through a sieve, beef
broth poured over this, and the whole put on the fire
again until it boils, after which the soup may be served.
This latter process is to be recommended in the case of
dyspeptics. One hundred grams of raw sweetbread
generate about 90 calorics of heat. — (U'l'^c/f.)
Meat Broth (Beef, Veal, Mutton, or Chicken).—
Cover one pound of chopped lean meat with one pint of
water and allow it to stand for from four to six hours.
Then cook over a 'slow fire for an hour until reduced
3IO DIETETICS FOR NURSES.
to half the quantity. Cool, skim, pour into jar and
strain.
Veal Broth. — Pour a pint of water on a half-pound
of finely chopped lean veal and allow it to stand for
three hours. Boil for a few minutes, strain, and season
with salt.
Clam or Oyster Juice.— Cut the clams or oysters
into pieces and heat for a few minutes in their juice.
Strain through muslin and serve while hot. In straining
great care must be taken that sand does not pass through
the muslin. The juices should be diluted and may be
frozen. — {Drexd Institute)
Clam Broth. — Wash three large clams very thor-
oughly, using a brush for the purpose. Place in a kettle
with half a cupful of cold water. Heat over the fire ; as
soon as the shells open the broth is done. Strain
through muslin, season, and serve. — {Drexel Institute)
Mutton Broth with Vegetables. — Allow one
pound of neck of mutton to each pint of water; add
carrots, turnips, onions, and barley; let all simmer
together for three hours.
Mutton Broth without Meat. — Cook two " shank-
ends" in a pint of cold water, and vegetables as directed
in the foregoing recipe; simmer for three hours and
strain.
Beef Tea No. i. — Cut up a pound of lean beef into
pieces the size of dice ; put it into a covered jar with
two pints of cold water and a pinch of salt. Let it
warm gradually and simmer for two hours, care being
taken that it does not at any time reach the boiling-
point. — ( Yeo)
Beef Tea No. 2. — Put a pound of finely mixed beef
with a pint of cold water into a suitable vessel. Let it
stand for an hour, stirring occasionally. Put the vessel
containing the beef into a saucepan of water, place it
over the fire, and allow the water to boil gently for an
hour (or the vessel containing the beef tea may be put
into an ordinary oven for an hour). Pass the beef tea
through a strainer. A fine sediment appears in the fluid,
and this should be drunk with the liquid. Flavor with
salt. At no time should the beef extract be exposed to
a temperature of more than 170° F. — {Pary)
Beef Tea No. 3. — Chop fine a pound of beef free
from fat, tendons, etc., and digest with a pint of cold
water for two hours. Let it simmer on the stove for
three hours at a temperature never above 160° F. Re-
place the water lost by evaporation by adding coid water,
so that a pint of beef tea shall represent a pound of beef.
Strain and carefully express all fluid from the beef. —
{Bartkolo-M.)
Beef Tea with. Oatmeal.— Mix thoroughly one
tablespoonful of groats with two of cold water; add to
tiiis a pint of boiling beef tea. Boil for ten minutes,
stirring constantly, and strain through a coarse sieve. —
(F.-..)
Beef Tea, Flavored.— Beef tea may be flavored
agreeably by boiling in it a pinch of mixed herbs, a bay-
leaf, or a bit of onion, carrot, turnip, or celery and a few
peppercorns. The roots should either be chopped small
or be scraped to a pnlp before being added to the broth.
-();■..)
Beef Jnice. — Broil quickly pieces of the round or
sirloin of a size to fit the opening in a lemon squeezer.
Both sides of the beef should be scorched quickly to
prevent the escape of the juices, but the interior should
not be fully cooked. As soon as they are ready the
312 DIETETICS FOR NURSES.
pieces of meat should be squeezed in a lemon squeezer
previously heated by being dipped in hot water. As it
drips the juice should be received into a hot wineglass;
it should be seasoned to the taste with salt and a little
Cayenne pepper, and taken while hot. — {Bartholow)
Cold Beef Juice. — Cover one pound of finely chopped
lean beef with eight ounces of cold water and allow it to
stand for eight or ten hours. Squeeze out the juice by
means of a muslin bag ; season with salt or sherry wine
and drink cold or slightly warmed. It may be added to
milk, care being taken that the milk be not too hot before
the juice is added.
Iced Meat Extract. — Cut into pieces the size of a
hand one kilo of fresh beef; wrap in a coarse, lattice-
like linen bag, put under a lever press, and press slowly.
The juice should be caught in a porcelain dish. This is
done best by a druggist. By this method about 500 gm.
of juice are obtained. The juice is mixed with 250 gm.
of sugar, 200 gm. of freshly expressed lemon juice (this
last is best omitted in the case of dyspeptics), and 20
gm. of cognac containing vanilla extract ; stir in well the
yolks of three eggs ; the entire mixture is then placed
in a freezer. — {v. Zicmssen')
Raw-meat Juice. — Add to finely minced rump steak
cold water, in the proportion of one part of water to four
parts of meat. Stir well together, and allow it to stand
for half an hour. Forcibly express the juice through
muslin, twisting it to get the best results. — {Chcad/e)
Succus Camis (Meat Juice). — Cut up the meat into
small bits, arrange in layers separated from one another
by coarse linen, and then place in a powerful press. From
each kilogram of meat about 230 gm. of a blood-red
juice are obtained. This contains about 6 per cent, of
RECIPES. 313
albuminates. Its taste is similar to that of raw meat ;
its flavor may be improved by the addition of salt and
beef tea not hot enougji to coagulate the albumin. —
{Pcttenkoffer and Voit.)
Beef Bsseuce. — Chop up very fine a pound of lean
beef free from fat and skin ; add a little salt, and put into
an earthen jar with a lie! ; fasten up the edges with a thick
paste, such as is used for roasting venison in, and place
the jar in the oven for three or four hours. Strain through
a coarse sieve, and give the patient two or three table-
spoonfuls at a time. — ( Yco^
American Bouillon (American Broth). — Place in
a tin vessel that can be sealed hermetically alternate layers
of finely minced meat and vegetables. Seal it, and keep
it heated in a water bath (bain marie) for six or seven
hours, and then express the broth.— (Ku)
Bottle Bouillon. — Cut beef, free from fat, into
squares. Place these in a stoppered bottle, put the
bottle in a basin of warm water, heat slowly, and boil
for twenty minutes. There will be about an ounce of
yellowish or brownish fluid for each three-quarters of a
pound of meat used. The flavor is that of concentrated
\iOvi\\\(iT\.—{Uffflmann^
Peptonized Oy8teT8. — To half a dozen oysters with
their juice add half a pint of water and boil for a few
minutes. Pour off the broth and set it aside. Mince
the oy.sters, and with the aid of a potato-masher reduce to
the consistence of a pa.ste. Place this with the broth in
a glass jar and add fifteen grains each of extract of pan-
creas and of bicarbonate of soda and mix. Allow this
to stand in hot water (115° F.) for one and one-half
hours. Pour into a saucepan and add half a pint of milk ;
heat over a slow fire to boiling-point. Flavor with salt
I
314
DIETETICS FOR NURSES.
L
and pepper and serve hot. Let the heating be done
gradually, and be careful to bring the mixture to a boil
before taking it from the fire. — {^Fairchild.)
Peptonized Beef.— Cover one-fourth of a pound of
finely minced lean beef (or beef and chicken mixed) with
half a pint of cold water. Cook over a slow fire until it
has boiled for a few minutes, stirring constantly. Pour
off the broth and rub or pound the meat to a paste.
Put meat and broth and half a pint of cold water in a
glass jar, and add twenty grains of extract of pancreas
and fifteen grains of bicarbonate of soda. Mix well and
keep in a warm place — at about i lo"-! 15° F. — or place
it in warm water and allow it to stand three hours, stir-
ring or shaking occasionally. Boil quickly; strain or
clarify with the white of an egg and season with salt and
pepper. If desired, it need not be strained, as the small
particles of meat are usually easily digested. Cereals
may be added, boiling with half the amount of water
previously directed, and mixing all together before pep-
tonizing. At the end of three hours the mixture must
be boiled or it will spoil. — {FaiW/ii/t/.)
METHODS OF PREPARING RAW BEEF.
Meat given raw should always be perfectly fresh and
very finely divided. Scrape the meat with a sharp knife,
which will separate the coarser fibers. If the resulting
mass is stringy, pass through a fine sieve. This may be
seasoned with salt and pepper, and served on toast,
crackers, or bread and butter. It may be rolled into
small balls and swallowed. These may be flavored as
de.sired. They may also be slightly browned by rolling
about rapidly in a hot saucepan, care being taken not to
change any but the outside of the ball, and that but
RECIPES. 315
slightly. Scraped beef may be served as a liquid or
semi-solid food. Mix it with an equal quantity of cold
water until it is quite smooth. Place in a double boiler
and cook until thoroughly heated, sdrring constantly.
Add a little salt and pepper and serve at once. This
may be made thicker by adding less water.
Raw Meat with Milk and Sugar.— Scrape half a
pound of rump steak with a knife until all the pulp is
removed ; sweeten with sugar, breaking the lumps of
sugar with the meat in a basin with a small wooden
spoon. Add slowly as much milk as will make it about
the thickness of arrowroot ; flavor with brandy. If any
fiber of the meat remains, strain through a gravy strainer.
The mixture should be perfectly smooth. — [Ringer^
Raw-beef Soup. — This is made by chopping up
one pound of raw beef and placing it in a bottle with
one pint of water and five drops of strong hydrochloric
acid. This mixture is allowed to stand on the ice over-
night, and in the morning the bottle is placed in a pan
of water at 1 10° F., and kept at about this temperature
for two hours. It is then placed in a stout cloth and
strained until the mass that remains is almost dry. The
filtrate is given in three portions daily. If the taste of
the raw meat is objectionable, the meat may quickly be
roasted on one side and the process completed in the
manner previously described. — ( Weir Mitchell.)
' PANOPEPTON.
Iced Panopepton.— To a small glass half full of
clean crushed ice add one tablcspoonful o^ Panopepton ;
let this stand for a minute and then sip slowly.
Panopepton Jelly.— This is made of one ounce of
fresh celery cut into small pieces, one-half of a smalt box
3l6 DIETETICS FOR NURSES.
of the best gelatin, one-fourth of a tcaapoonful of salt,
two dashes of pepper, six tablespoonfuls of Panopcpton,
and two cupfuls of cold water. Soak- the gelatin in half
a cupful of cold water for one hour ; put the water and
celery in a double boiler on the fire and simmer for one-
half hour; add the salt, pepper, and soaked gelatin and
stir until it is dissolved ; remove from the fire and add
the Panopepton ; stir and strain through linen into a
jelly bag and set near ice. Serve in small quantities.
Panopepton Jelly with Orange. — The articles
required are one-half of a small box of the best gelatin,
one tablcspoonful of sugar, six tablespoonfuls of Paiio-
pip/d/i, the juice and rind of one orange, and one pint
of cold water. Put the gelatin, orange peel {cut in small
pieces), orange juice, and cold water in a dish and let it
stand for one hour, then put in a double boiler over the
fire, add the sugar, and stir until it is dissolved ; now
strain through linen, add the Panopepton, and stir well.
Pour into a jelly jar and set near the ice. Serve in small
quantities.
Panopepton Hot. — To a small teacup two-thirds
full of boiling water add one tablcspoonful of Panopcp-
lon and one teaspoonful of fresh iemon juice ; a little
sugar may be added if desired. Stir and drink immedi-
ately, sipping slowly.
Panopepton Bouillon Hot. — Put one tablcspoon-
ful of Panopepton in a small teacup; fill the cup nearly
full of boiling water, and flavor to taste with celery salt
or plain salt and pepper; stir and sip slowly.
Panopepton Cordial. — Put into a cordial glass or
any small glas.s two tcaspoonfuls of clean crushed ice;
add one teaspoonful of Fairchild's Essence of Pepsm and
three teaspoonfuls of Panopepton. Sip slowly. This x?,
k— A.
KEC/FES. 317
a. good after-dinner cordial for those who suffer discom-
fort after eating.
Panopepton with Whey.— Put into a small teacup
one or two teaspooiifuls of clean crushed ice; add one
tablespoonful of Panopepton, stir, and then fill the cup
with whey. Drink slowly.
Egg Gruel. ^Take one cupful of hot beef broth
made with " Soluble Reef," one egg, and one-half tea-
spoonfu! of salt. Beat the white and the yolk of the
egg separately ; add the hot beef broth gradually to the
yolk, stirring continually. Whip the white to a stiff, dry
froth with the salt, and beat it into the hot broth. Return
to the double boiler and reheat. Serve very hot.
Barley Gruel with Beef Extract.— One-half tea-
spoonful of " Soluble Beef," two cupfuls of hot water,
one tablespoonful of barley flour, one saltspoonful of
salt. Dissolve the beef in the hot water, and mix the
flour and salt together with a little cold water. Pour
the boiling stock on the flour and cook for ten minutes.
Strain and serve very hot.
Beef Broth with Poached Egg. — Prepare the
broth in the proportion of half a teaspoonftil of " Solu-
ble IJeef " to one cupful of hot water and add a poached
A Nutritive Drink for Delicate Women and
Children. — This is made by mixing one-fourth to one-
half teaspoonful of "Soluble Beef," five ounces of boil-
ing water, and one-half ounce of cream ; season with
salt and pepper to suit the taste.
Beef Broth with Grain.— Take one teaspoonful of
"Soluble Beef," one quart of water, one tablespoonful
of rice, and salt to taste. Dissolve the "Soluble Beef"
in the hot water, and add the well-washed rice. Simmer
! 3'8 DlliTETICS fUK NURSES. ^B
slowiy until dissolved and absorbed by the rice, adding
I more beef broth if too much boils away. If not entirely
\ dissolved, the broth should be strained before using.
] Beef-tea Egg-nog.— This requires one-eighth tea-
I spoonful of "Soluble Bucf," one-half cupful of hot water,
I one tablespoonfu! of brandy, and a pinch of salt. Beat
i the egg slightly, and add the salt and sugar. Dissolve
;, the " Soluble Beef" in the hot water, add to the egg, and
strain. Mix thoroughly, adding wine, and serve.
HEAT JELLIES WITHOUT GELATIN.
Chicken Jelly. — Half a grown chicken should be
well pounded, and boiled in one quart of water for two
hours until only a pint remains; season and strain.
Serve hot or place on ice, where it will " jel."
Veal-bone Jelly. — Place ten pounds of veal bones
and ten quarts of water or weak bouillon over the fire
and bring to just a boil. Skim and add two pounds of
barley and a little .salt. Simmer for five or six hours and
then .strain. If too thick, dilute, before serving, with
bouillon. Stir in the yolk of an egg in a cup and serve.
Meat Jelly. — This is made by cooking good bone-
less, lean beef on a water bath with a little water for
sixteen hours or until it becomes gelatinized. Of the
artificial preparations on the market for making bouillon,
the most reliable is Liebig's Extract of Meat (lo : 250
gm.) or Cibil's Bouillon (i teaspoonful to 250 gm.).
InagHo's bouillon capsules are also very convenient If
it is desired to make the bouillon more nutritious, one
li teaspoonful of meat peptone may be added. — {Ht-pp^
I Jelly for Dyspeptics.— Remove the skin and meat
I from one calf's foot ; wash the bones and place in cold
^ water on the stove ; when it begins to foam, skim off the
l1
JiECIPES.
refuse which gathers on top. After rinsing off the
with cold water, put the bones into a pot
kilo of beef or half an old hen, one-quarter hter of water,
and 5 gm. of salt, and boii slowly for from four to five
hours. Pour the jelly thus formed through a fine sieve,
and place overnight in a cellar. Next morning remove
the fat, and clarify the cold jelly by adding one egg with
its shell mashed, beating and stirring steadily. Then,
with the addition of a little cornstarch, subject the whole
to a temperature not over 60° R., or the white of the
egg will curdle. Constantly beat and .stir. If the jelly
begins to get grainy, cover and let it cool until the white
of the egg becomes flaky and separates. Then strain
again several times until it becomes perfectly clear ; add
5 gm. of extract of meat, pour the jelly into a mold, and
let it cool again. The gravy from a roast may be utilized
and is very palatable. It must be stirred in while the
ma.s3 is still warm and liquid. This jelly is usually relished
with cold fowl, but spoils easily in summer; it must there-
fore be kept on ice. — ( Weil.)
Dishes Made with Gelatin. — Gelatin should be
soaked in cold water for about half an hour to soften it. It
may then be easily dissolved by adding boiling water. If it
is desired to soften gelatin quickly, it should be placed in
cold water and gradually heated over boiling water until it
dissolves. If a jeily is to be strained, a wet cloth should
be used for the purpose. Jelly molds should be wet with
cold water before being filled. When granulated gelatin
is used, much smaller amounts are required than when
the ordinary form is used.
Wine Jelly. — Soak a teaspoonful of granulated gela-
tin in two tablespoonfuls of cold water and half a cupful of
hot water. Add two tablespoonfuls of sugar and half a
319 ^^
the scum ^H
e-quarter ^|
I
320 DIETETICS FOR NURSES,
tcaspoonful of lemon juice, and when cooling add two
tablcspoonfuls of wine. — {Drexel Institute^
I/emon jelly is made in the same manner as the wine
jelly just described, using a tablespoonful of lemon juice
in place of the quantity directed.
Otang^e jelly is made in a similar manner, using two
teaspoonfuls of lemon juice, four tablcspoonfuls of orange
juice, and three tablcspoonfuls of sugar, but a little less
of the boiling water.
Coffee jelly is also made similarly, adding an ounce
or two of coffee.
Milk Jelly. — Take two quarts of milk and add half
a pound of sugar. Boil for five or ten minutes. Cool,
and add an ounce of gelatin dissolved in a cupful of cold
water. Flavor with the juice of two or three lemons and
three glasses of good Bordeaux wine. — {Schlesinger^
Irish-moss Blanc-mange. — Wash a tablespoonful
of Irish moss in several changes of water and pick it over
carefully. Place it in a double boiler together with half
a cupful of milk. Cook until it thickens when dropped
on a cold plate. Add salt, strain, and flavor. Pour into
a custard cup that has first been rinsed in cold water. —
(Prcxcl Institute)
Meat Jellies with Gelatin. — Use any kind of
meat broth desired, but always one with an appetizing
flavor. Add a tcaspoonful of granulated gelatin to enough
broth to cover it, and allow the gelatin to soak for a few
minutes. Then add the remainder of a cupful of the
broth very hot and stir until the gelatin is dissolved.
Strain, and pour into molds to cool.
Meat Jellies with Tapioca. — Mix a cupful of
broth as above with four level tablcspoonfuls of pow-
dered tapioca. Heat until quite clear, stirring con-
stantly. Add salt and .
molds and cool.
Meat Jellies with Irish Moss. — Wash two table-
spoonfuls of Irish moss thoroughly. Add this to a cup-
ful of hot broth and allow it to stand for half an hour ;
then heat slowly, stirring constantly, and boil for ten
minutes, preferably in a double boiler. Strain, and pour
into molds and cool.
Albtuninized Jelly. — Any of the above meat jellies
may be rendered more nutritious by the addition of the
white of an egg. The egg should be well beaten and
stirred into the jelly just after it has been taken off the
fire.
RECIPES FOR FOODS FOR DIABETICS.
Glnteo Bread. — Mix one pound of gluten flour
with three-fourths of a pint or one pint of water at
F. (With some of the prepared flours — Bishop's, for
example— no yeast is required.) As soon as the dough
is mixed put it into tins and place them immediately in
the oven, which should be at a temperature of about
430° F. Or the dough may be made into small dinner
rolls and baked on flat tins. The loaves take about one
and one-half hours to bake, and the rolls three-fourths
of an hour. Either are easily made. The addition of a
little salt improves the bread.
IV/ien any special brand of flour is used, the directions
that accompany it should be followed closely.
Gluten Ptidding. — A batter of eggs, cream, and
gluten flour is prepared. This is flavored with lemon
or other e.ssences and baked.
Glnten Pancakes. — Add gluten flour to one or two
eggs and beat into a batter. The pancakes may be
322 DIETETICS EOR NURSES.
sweetened with a little saccharin or eaten with glycerin.
( Williamson^
JeflBries' Gluten Biscoit. — Mix thoroughly gluten
flour, one cupful; best bran, previously scalded, one
cupful ; baking-powder, one teaspoonful ; salt to taste ;
two eggs ; milk or water, one cupful.
Diabetic Bread. — ^Take one quart of set milk or
milk and water, one heaping teaspoonful of good butter,
one-fifth of a cake of compressed yeast beaten up with
a little water, and two well-beaten eggs. Stir in gluten
flour until a soft dough is formed ; knead as in making
ordinary bread ; place in pans to raise, and when light
bake in a hot oven. — {James Stewart)
Camplin's Bran Cakes. — ^Take a sufficient quan-
tity — say a quart — of wheat bran, boil it in two succes-
sive waters for a quarter of an hour, each time straining
it through a sieve ; then wash it well with cold water (on
the sieve) until the water runs off perfectly clear ; squeeze
the bran through a cloth as dry as possible, and then
spread it thinly on a dish ; place it in a slow oven ; if
put in at night, let it remain until the morning, when,
if perfectly dry and crisp, it will be ready for grinding.
The bran thus prepared must be ground in a mill, and
sifted through a wire sieve that has so fine a mesh that
a brush must be used to pass it through ; that which
remains in the sieve must be reground until it becomes
quite soft and fine. Take of this bran powder three
ounces (some patients use four ounces); the other in-
gredients are as follows : three new-laid eggs ; one and
one-half or, if desired, two ounces of butter ; about half
a pint of milk. Mix the eggs with a little of the milk,
and warm the butter with the remainder ; then stir the
whole well together, adding a little nutmeg or ginger or
RECIPES. 323
any other agreeable spice. Bake in small tins (patty
pans), which must be well buttered, in a somewhat quick
oven for about half an hour. When baked, the cakes
should be a little thicker than a captain's biscuit ; they
may be eaten with meat or cheese for breakfast, dinner, or
> supper. At tea they require a somewhat liberal allow-
ance of butter, or they may be eaten with curd or with
any soft cheese. It is important that the flour be pre-
pared as directed above. If the cakes do not keep well
or if they have not been well prepared, place them before
the fire for ten minutes every day.
Almond Padding.— ^Take two eggs, one-quarter of
a pound of almond flour, one-quarter of a pound of but-
ter, and three tabloids of saccharin dissolved in a table-
spoonful of brandy. Warm the butter, beat in the
almond flour and the yolks of the eggs, and add the dis-
solved .saccharin. Whip the whites into a stiff froth, and
beat all together. Put into dariole molds and bake in a
quick oven ; serve with a little hot sauce made with dry
sherry and saccharin. — {Mrs. Hart)
Almond Bisctdt. — To each ounce of almond flour
add the whites of two eggs and salt to taste. Whip
the whites to a stiff froth, add the ahnond flour, and beat
well together. Put in buttered patty pans and bake in a
moderately quick oven for from fifteen to twenty min-
utes. The whole must be done quickly, and baked as
soon as the ingredients are mixed. This biscuit is a use-
ful substitute for bread. — {Mrs. Hart)
Almond Cakes No. i.— Take one'pound of ground
almonds, four egg.s, two tablcspoonfuls of milk, a pinch
of salt. Beat up the eggs, and stir in the almond flour;
place in twelve flat tins and bake in a moderate oven for
about fifteen minutes. — {Saundby)
324
DIETETICS FOR NUKSES.
Almond Cakes No. a. — Break up about one-quar-
ter of a pound of sweet almonds in a stone mortar (or
almond flour may be used). Put the flour into a linen
bag, which should then be immersed for one-quarter of
an hour in boiling water, acidulated with a little vinegar
to remove the small amount of sugar from the almonds..
Mix well with three ounces of butter and two eggs.
Then the yolks of tJiree eggs and a little salt are added,
and the whole stirred briskly for some time. Beat the
whites of three eggs to a fine froth and add to the mixt-
ure. The paste is then made into biscuits, smeared with
butter, and baked with a gentle fire. — {Seegen')
Alenronat Bread. — Take about six or seven ounces
of ordinary wheat flour and the same quantity of aleu-
ronat powder; five ounces of the best butter; one tea-
spoonful of salt; three-quarters of an ounce of baking-
powder. The flour and the aleuronat are mixed in a
warm dish, and the melted butter and milk (made luke-
warm) are added gradually, followed by the salt, and
finaUy by the baking-powder (one part of sodium carbon-
ate and two parts of cream of tartar). The dough is
well mixed, then molded into two loaves, and baked at
a good Jieat, — (Ehstfhi'.\
Aleuronat and Almond Cakes. — Three ounces of
aleuronat; three ounces of almond flour; beat up one
egg. and add about two teappoonfuls of cream and a
little water. Moisten the aleuronat with a little water
containing saccharin and let it stand for a few minutes ;
then add the almond flour, the egg, the cream, and the
' water just as required to make a light paste. Spread on
a tin. Cut into squares, and bake in a moderate oven
for twenty minutes. — {Williatiisoit?i
Aleuronat Pancakes. — Take one egg and beat it
HEC/PES.
up in a little water and cream ; take two teaspoonfuls of
aleuronat powder and half a teaspoonful of baking-pow-
der and a little salt. Mix well, and then add gradually
to the egg and cream and beat into a batter; allow it to
stand for fivi: minutes. If it is too thick, add a little
more cream and water. Fry in an ordinary frying-pan
greased with a little lard. At the end of about eight
minutes, when the under surface is browned, turn it over
and continue to bake it for five minutes longer. — ((J'/A
Aleuronat and Suet Pudding. — This is a palatable
and cheap dish. To make it take two ounces of aleuro-
nat flour and two ounces of suet, one egg, a pinch of
salt, and half a teaspoonful of baking-powder. Sprinkle
a little aleuronat flour on a chopping- board and chop the
suet on this part of the board. Then mix the remaining
aleuronat with the suet in a dishpan. Add the salt and
the baking-powder. Beat up the egg in about three
tablespoonfuls of water to which a little saccharin has
been added. Add the egg gradually to this mixture,
rubbing the whole mass well into a paste. It may be
necessary to add a little more water. Drop into a tin
pudding mold smeared with butter or lard, float it in a
pan of water, and boil for two hours, taking care that the
boiling water does not get into the mold ; or, better still,
the pudding may be baked in the oven. Its taste is im-
proved by the addition of half an ounce of almonds. A
small quantity of red wine may serve as a sauce. — [Wii-
liamson.)
Cocoannt Pancakes. — Beat up one egg in two table-
spoonfuls of milk, or, better, in a little cream and water,
and add a pinch of salt. Then add two tablespoonfuls
of cocoanut powder (freed from sugar). Allow this to
326 DIETETICS FOR NURSES.
stand for from five to ten nlinutes. Add a little more
cream and water. Mix well until it is a little thicker than
ordinary pancake batter. Put a little lard in the fr>'ing-
pan and heat until the lard is just melted ; then drop in
half of the mixture. Allow this to remain over a mod-
erate fire for a few minutes — about five — until the under
surface is brown ; then turn the cake over and heat for
another five minutes. The other half of the mixture
may be used for the second pancake. — {IVilliamson)
Cocoanut Cakes. — Mix three tablespoonfuls of
cocoanut powder into a paste with a little German yeast
and water. The mixture should be allowed to remain
by the fire or in a warm place for about twenty minutes,
or until fermentation occurs and it becomes "puffy."
Then add a small quantity of a watery solution of sac-
charin. Beat up one ^gg, and add this with two tea-
spoonfuls of cream and a little water to the cocoanut
paste. The whole should be well mixed, dropped into
small tins, and baked in an oven for about thirty min-
utes. — ( Wi//iamso?i.)
Cocoanut and Almond Cakes. — To make these,
the following ingredients are required: Three-quarters
of a pound of the finest cocoanut powder, one-quarter
of a pound of ground almonds, six eggs, and half a
cupful of milk. Beat up the eggs and stir in the cocoa-
nut and almond flour. Divide into sixteen flat tins,
and bake for twenty-five minutes in a moderate oven. —
Cocoanut Pudding. — Take three tablespoonfuls of
cocoanut powder, mix with a little water and German
yeast, and keep for twenty minutes in a warm place, so
as to allow the small quantity of sugar present to decom-
pose ; add four tablespoonfuls of cream, one egg, a little
RECIPES. 327
salt, and half a pint of water sweetened with saccharin.
Mix into a paste. Place in a dish greased with butter.
Cook like rice pudding, in a slow oven for thirty min-
utes. — (WiJ/iaiiisii/i.)
I,ight Custard. — Beat up well one egg; make a
mixture of cream and water and boil ; gradually add the
boiled cream and water, while hot, to the egg, stirring
with a spoon. Then place the mixture in a pan over the
fire, and stir constantly until it becomes thick ; then
pour in\o a glass. It is important that the mixture should
not be heated too much — /. c, that it be not boiled — as
the albumin would be coagulated. Flavor with cinna-
mon and sweeten with saxin or saccharin if desired.
Cheese Cakes. — Take one pint of milk, half a table-
spoonful of rennet, one ounce of butter, two eggs, one
table.spoonful of brandy, one-quarter of an ounce of
almond.s, and a little saccharin. Curdle the milk, and let
it stand in a warm place until thoroughly set; tie a piece
of muslin over a bowl and pour the milk over the muslin ;
let it stand until al! the whey has been strained off. Beat
the curd smooth, and add the butter and egg, well beaten,
with the brandy, almonds, and saccharin. When well
mixed pour into patty pan-s and bake for fifteen or twenty
minutes. — (Afrs. Ntirf.)
Stewed I,ettuce. — A well-grown head of lettuce
.should be selected. Boil this in plenty of water, taking
care not to let it fall to pieces. When nearly done take
it out of the water, drain, and place in a stewpan with a
little rich brown gravy and allow it to simmer for twenty
minutes,
Intilin Biscuit. — Put 50 gm. (i| oz.) of inulin in a
large porcelain basin, place this over a hot-water bath,
and with 30 c.c. (i oz.) of milk and as much hot water
328 DIETETICS FOR NURSES.
as may be necessary, rub up into a smooth dough, into
which the yolks of four eggs and a little salt have been
mixed. To this add the whites of the four eggs, having
first beaten them to a foam, and working them in care-
fully. Bake in tin molds smeared with butter. The
taste of the biscuit may be improved by adding vanilla
or other flavoring extract. Inulin is too expensive to be
used by the average patient.
Peanut Plour. — This contains about 25 per cent, of
carbohydrates. The peanut kernels should be boiled in
water for half an hour to extract a portion of the oil
which they contain. They should then be dried, and
rolled into fine particles with a rolling-pin. Place the
kernels in boiling water acidulated with tartaric acid
or vinegar, in order (i) to extract saccharin elements ;
(2) overcome the taste and odor of the peanut ; (3) to
prevent emulsification of the remaining oil. When they
have been thoroughly boiled in acidulated water, the
ground kernels should be subjected to dry heat and then
rolled into a fine flour. This flour may be made into a
form of porridge with milk ; bread and biscuits may also
be baked from it ; and it may be made into the form of
a German pancake. — {Sterri)
Home-made Substitute for Bread. — Beat up thor-
oughly six eggs ; add a teaspoonful of baking-powder
or its chemical equivalent, and one-quarter of a teaspoon-
ful of salt, and beat again. Pour this mixture into hot
waffle-irons smeared with butter, and bake in a very hot
oven. By way of variety almonds (powdered) may be
added. These biscuits may be eaten hot with butter and
cheese.
Sugar-free Milk for Diabetic Feeding. — Take
I liter of skim milk, heat to a temperature of 30° C, and
RECIPES, 329
add 10 C.C. of glacial acetic acid, diluted with lOO c.c. of
water. Mix, and allow the mixture to stand for about
fifteen minutes. Collect the separated casein, and let it
drain on very fine muslin, using no pressure. Remove
the casein to a mortar, rub into a smooth paste, add
I liter of distilled water, and strain as before. Repeat
this washing of the casein twice. Transfer to a mortar,
rub until quite smooth, and add 2\ gm. of potassium
hydrate dissolved in 100 c.c. of water (or as much of the
potassium hydrate as is necessary to make the product
just alkaline to phenolphthalein). Add 100 gm. of
ordinary Devonshire clotted cream, 5 gm. of gelatin,
previously dissolved, 0.06 gm. (i gr.) of saccharin, and
water, at about 38° C, up to i liter. Lastly, strain
through fine muslin. — {Hutchiso?i^
CIIAPTKR XXIII.
CUTS OF MEAT.'
The methods of cutting sides of beef, veal, mutton,
and pork into parts, and the terms used for the diflerent
" cuts," as these parts are commonly called, vary in
different localities. The analyses here reported apply to
cuts as indicated by the following diagrams. These Show
the positions of the different cuts, both in the live animal
'This SLClii"! is quulcil from Atwaler ami lirraiit, Bull/lia Ne. aS,
Office of Kx|».-riiuLu( Stations, fiulccl Stales ))c|Kirlinen( of Agriculture.
CUTS OF MEA T.
331
and in the dressed carcass as found in the markets.
The lines of division between the different cuts will vary
slightly, according to the usage of the local market,
even where the general method of cutting is as here
indicated. The names of ttie
same cuts likewise vary in
different parts of the coiintrj-.
Cuts of Beef.— The gen-
eral method of cutting up a
side of beef i.s illustrated in
Fig. 5, which shows the rela-
tive position of the cuts in the
animal and in a dressed side.
The neck piece is frequently
cut so as to include more of
the chuck than is repre.sented
by the diagrams. The shoul-
der-clod is usually cut without
bone, while the shoulder (not
included in diagram) would
include more or less of the
shoulder blade and of the up-
per end of the fore-shank.
Shoulder steak is cut from
the chuck. In many locali-
ties the plate is made to in-
clude all the parts of the fore-
quarter designated on the diagrams as brisket, cross-
rib.s, plate, and navel, and different portions of the
plate, as thus cut, are spoken of as the "brisket
end of plate " and " navel end of plate." This part of
the animal is largely used for corning. The ribs are fre-
quently divided into first, second, and third cuts, the
332 DIETETICS FOR NURSES.
latter lying nearest the chuck and being slightly less
desirable than the former. The chuck is sometimes sub-
divided in a similar manner, the third cut of the chuck
being nearest the neck. The names applied to different
portions of the loin vary considerably in different locali-
ties. The part nearest the ribs is frequently called
** small end of loin " or " short steak/' The other end
of the loin is called '* hip sirloin " or " sirloin." Between
the short steak and the sirloin is a portion quite generally
called the " tenderloin/' for the reason that the real ten-
derloin, the very tender strip of meat lying inside the
loin, is found most fully developed in this cut. Porter-
house steak is a term most frequently applied either to
the short steak or the tenderloin. It is not uncommon
to find the flank cut so as to include more of the loin
than is indicated in the figures, in which case the upper
portion is called " flank steak." The larger part of the
flank is, however, very frequently corned, as is also the
case with the rump. In some markets the rump is cut
so as to include a portion of the loin, which is then sold
as " rump steak." The portion of the round on the
inside of the leg is regarded as more tender than that
on the outside, and is frequently preferred to the latter.
As the leg lies upon the butcher's table, this inside of
the round is usually on the upper or top side, and is
therefore called " top round." Occasionally the plate is
called the " rattle."
Cuts of Veal. — The method of cutting up a side of
veal differs considerably from that employed with beef
This is illustrated by Fig. 6, which shows the relative
position of the cuts in the animal and a dressed side.
The chuck is much smaller in proportion, and frequently
no distinction is made between the chuck and the neck.
CUJS OF MEAT.
333
The chuck is often cut so as to include considerable
of the portion here designated as shoulder, following
more nearly the method adopted for subdividing beef.
The shoulder of veal as here indicated includes, besides
the portion corresponding to the shoulder in beef, the
larger part of what is here classed as
chuck in the adult animal. The under
part of the fore-quarter, corresponding
to the plate in the beef, is often desig-
natetl as breast in the veal. The part
of the veal corresponding to the rump of beef is here
included with the loin, but is often eut to form part of
the leg. In many localities the fore- and hind-shanks of
veal arc called the " knuckles."
Cuts of I^amb and Mutton. — Fig. 7 shows the
relative position of the cuts in a dressed side of mutton
or lamb and in a h've animal. The cuts in a side of lamb
and mutton number but six, three in each quarter. The
I
J
334
DIETETICS FOR NURSES,
chuck includes the ribs as far as the end of the shoulder
blades, beyond which comes the loin. The flank is made
to include all the under side of the animal. Some
butchers, however, make a large num-
ber of cuts in the fore-quarter, including
a portion of the cuts marked " loin "
and ** chuck " in Fig. 7, to make a cut
designated as " rib," and a portion of
the "flank" and "shoulder" to make
a cut designated as "brisket." The
term " chops " is ordinarily used to
designate portions of either the loin,
Fig. 7. — Diagrams of cuts of Iamb and mutton: i. Neck; 2, chuck; 3, shoulder ;
4, flank; 5, loin ; 6, leg.— (Atwater and Bryant, Bulletin No. 28, Office of Experi-
ment Stations, United States Department of Agriculture.)
ribs, chuck or shoulder, which are either cut or
" chopped " by the butcher into pieces suitable for
frying or boiling. The chuck and ribs are sometimes
called the " rack."
Cuts of Pork. — The method of cutting up a side
of pork differs considerably from that employed with
other meats. A large portion of the carcass of a
dressed pig consists of almost clear fat. This furnishes
CUTS OF MEAT.
the cuts which are used for " salt pork " and bacon. Fig.
8 illustrates a common method of cutting up pork, show-
ing the relative position of the cuts in the animal and in
the dressed side. The cut designated as " back cut " is
almost clear fat, and is used for
salting and pickling. The " mid-
dle cut " is the portion quite gen-
erally used for bacon and for " lean
ends " of salt pork. The belly is
salted or pickled or may be made
into sausages.
Beneath the "back cut" are the
ribs and loin, from which are ob-
tained " spare ribs," " chops," and
roasting-pieces, here designated by
dotted lines. The hams and shoul-
ders are more frequently cured, but
arc also sold as fresh pork " steak."
The tenderloin proper is a com-
paratively lean and very small strip
of meat lying under the bones of
the loin and usually weighing a
fraction of a pound. Some fat is
336 DIETETICS FOR NURSES.
usually trimmed off from the hams and shoulders, which
is called " ham and shoulder fat/' and is often used for
sausages, etc. What is called " leaf lard," at least in
some localities, comes from the inside of the back. It
is the kidney fat.
As stated above, cuts as shown in the diagrams here-
with correspond to those of which analyses are reported
in the tables beyond, but do not attempt to show the
different methods of cutting followed in markets in differ-
ent parts of the United States.
WEIGHTS AND MEASURES.
Relative Values of Apothecaries' and Metric
Fluid Measures.
Cubic
Minims, centi-
Minims.
Cubic
centi-
Fluid- ^_
iri..;j Cubic
^*"**^- centi-
meters.
meters.
ounces. ^^.^^
meters.
°""<=«- meters.
I = 0.06
30 -
1.90
I = 30.00
21 = 621.00
2 = 0.12
35 -
2.16
2 = 59.20
22 = 650.00
3 -= 0.18
40 =
2.50
3 = 89.00
24 = 710.00
4 = 0.24
45 =
2.80
4 = 118.40
25 = 740.00
5 - 030
50 ^
308
5 = 148.00
26 = 769.00
6 = 0.36
55 =-
340
6 = 178.00
27 = 798.07
7 = 0.42
7 = 207.00
28 - 828.80
8 = 0.50
Fluid-
8 = 236.00
30 = 887.25
9 =-- 0.55
drams.
9 = 266.00
31 =-- 917.00
10 -= 0.60
I ^
3-75
10 = 295.70
32 -= 946.00
II = 0.68
I^-
4.65
12 = 355CO
48 = 1419.00
12 = 0.74
IK-
5.60
13 = 38500
56 = 1655.00
13 --= 0.80
134- -.-
6.51
14 = 414.C0
64 = 1892.00
14 0.85
2 -
750
15 = 444.C0
72 =- 2128.00
15 - 0.92
3 -
11.25
16 - 473."
80 =- 2365.00
16 = 1. 00
4 -
15.00
17 = 503C0
96 = 2839.00
17 - 1.05
5 --^
18.50
18 = 532.00
112 = 3312.00
18 - 1. 12
6 -
22.50
19 = 591.50
128 = 3785.00
19 - I 17
7 =
26.00
20 --■ 1.25
25 - 1-34
Relative Values of Metric Fluid and Apothecaries* Measures.
Cubic
Fluid-
Cubic
Fluid-
centi-
centi-
ounces.
ounces
meters.
meters.
I COO -=
33-81
4CO =
13-53
900 ---
30.43
3CO -
10.14
8co -
27.05
200 ^■
6.76
700 =
23.67
100 -=
3.38
6co =
20.29
75 -
2.53
500 =
16.90
50 ^
1.69
473 -
16.CO
30 -
I.OI
C"^!«^ Fluid-
centi
meters.
drams.
Cubic
centi-
meters.
Minims.
22
337
338
DIETETICS FOR NURSES.
Relative Values of Avoirdupois and Metric Weights,
A^«"- Grams. ^'"^^'
ounces. ounces.
Grains. ! ^^"^-
rtiinr(>c
ounces.
h = 1-772
Vi, -= 3-54t
- 5 -■- 141 75
13 ^
36854
6 = 170.10
14 ---
396.90
5^ = 7.088
7 -- *98 45
15 ~-
425 25
'A ^ 14*75
8 -= 226.80
Avoir.
I = 28.350
9 = 255-15
pounds.
2 = 56.700
10 — 283.50
I.O -
45360
3 = 85.050
II =311.84
2.0 =-
907.18
4 -113-400
12 — 340.20
2.2 —
1000.00
3
4
5
=
1360.78
x8»4.37
2267.55
6
-■:=
2721.55
7
8
9
=
3175.14
3628.74
4082.33
10
^~
4535 92
Relati7'c Values of Metric and Avoirdupois Weights,
Gm Ounces. Gr.
Gm. Ounces, (ir. Gm. Ounces. Gr. j Gm. Ounces. Or.
28.35 =
■
38
- I +
'1^ 1
125 = 4 + 179
600
= 21+73
29.00 ^-
+
!•>
39
- I +
164 !
150 —- 5 + i-«7
650
= 22+405
30.00 =
-f
25 40
■= 1 +
180
200 —7+24
700
= 24 + 303
=26+198
32.00 =
+
56 50
- I +
334
250 - 8 + 358
750
3300 =
f
72
(>:)
--- 2 +
50
300 .-- 10 4- 255
800
= 28+96
34.00 -^
+
87
70
- 2 +
2'»5
350 — 12 + 152
850
-29+429
35-00 —
+
103
80
- 2 +
300 ,
400 --- 14 + 48
900
= 31 + 326
36.00 -^
+
118
«5
■■ 3
t
500 = 17 -f- 279
950
= 33 + 222
37.00 =
^/^
f
Itl
»33
100
--- 3 +
s of Aj
Grain!
23P 550 = 19 -
bothecaries' and
v 175
Metr
■ Drar
lOOO
-35+120
R
've Value
Grams.
0.0625
ic Weights,
Grains.
>.
Grams.
ns.
Grams.
I
=,
24
T=
155
I
ss
390
2
.Ti
0.1300
25
=
1.62
2
.=
7.80
3
—
0.1950
26
;=
1.70
3
=
11.65
4
=
0.2600
27
=
'75
4
—
ISSO
5
=
0.3240
28
—
1.82
5
--
19.40
6
.—
0.4CX)3
30
:r^
1-95
6
--
23.30
7
--
0.4600
32
—
2.10
7
=
27.20
8
—
0.5200
n
.r-
2.16
Ounce
s.
9
~
0.6000
34
—
2.20
I
■..-
31.10
13
=
0.6500
35
■-
2.25
2
=
62.20
II
-
0.7150
36
--
2.30
3
-■-
9330
12
---
0.7800
3«
-'
2.47
4
—
124.40
14
. :
0.9070
39
•--
255
5
-.—
155.50
15
--
0.9720
40
--
2.73
6
—
186.60
155
.-
1. 0000
44
2.86
7
-=.
217.70
16
1.0400
48
-
3.00
8
zs-
248.80
18
- -
1. 1600
50
-'-
325
9
...
280.00
20
--
I 3000
52
—
340
10
-_r
3".oo
21
--.-
1 .3600 1
56
—
365
48
—
1492.80
22
—
1.421
)0 :
5«
=
3.75
100
—
3110.40
WEIGHTS AND MEASURES.
339
Relative Values of Metric and Apothecaries' Weights.
Grams.
Grains.
Grams.
Grains.
I
15.43
9
=
138.90
2
=
30.86
10
r-^
154.32
3
=
46.30-
100
=
154323
4
=
61.73
125
=
1929.04
5
=
77.16
150
=•
2374 85
6
=ii
92.60
175
=
2700.65
7
=
98.02
1000
=
15432.35
8
=
123.46
INDEX.
Absorption, i6
of beans, 25
of carbohydrates, 23
of cereals, 25
of eggs, 24
of fats, 23
of fish, 24
of foods, 22
of fruits, 25
of green vegetables, 25
of legumes, 25
of meat, 24
of milk, 24
of peas, 25
of protein, 23
of rice, 25
of roots, 25
of tubers, 25
of vegetables, 24
green, 25
Acid wines, 78
Acids in urine, 76
Acne, diet in, 271
Acratothermal waters, 70
Actinomycosis, 91
Adulteration, food, 92
accidental, 92
arbitrary, 92
conventional, 92
incidental, 92
intentional, 92
preservatives in, 94
table of, 93
of milk, 34
Age, food and, relation, 18
Aged, diet for, 133, 134
Air-exclusion in preserving food, 81
Albumin water, 286
Albuminized jelly, 321
lemonade, 287
milk, 303
Albuminoids, 12
Alcohol, 72
digestibility of, 74
food value of, 72
fuel value, 74
in genito-urinary diseases, 232
in injury to alcoholics, 244
in tuberculosis, 173
in typhoid fever, 160
in urine, 76
wood, as adulterant, 94
Alcoholics, illness in, alcohol and,
244
Alcoholism, diet in, 243
Ale, 76
Aleuronat, 84
and almond cakes, 324
and suet pudding, 325
bread, 324
in diabetes mellitus, 257
pancakes, 324
Algne. 59
Alkaline mineral waters, 69
Almond and cocoanut cakes, 326
biscuit, 323
bitter, junket, 301
cakes, 323, 324
341
342
INDEX,
Almond cakes and aleuronat, 324
in diabetes mellitus, 257
milk, 285
pudding, 323
Almonds, 59
American bouillon, 313
broth, 313
AmcEba coli in water, 91
Amylopsin, 16
Anemia, diet in, 230
Anesthesia, diet and, 274
Aneurism, diet in, 230
Angina pectoris, diet in, 230
Animal foods, 32
table of compositions, 48
Antiseptics to preserve food, 82
Apoplexy, diet in, 242
Apothecaries' and metric fluid meas-
ures, relative values, 337
and metric weights, relative values,
338
Appendicitis, diet in, 209
Appetite, digestion and, influence on,
21
Apple water, 286
Apples, 57
Army enema, 143
Arnold sterilizer, 39
Aromatic wines, 78
Arrowroot gruel, 290
Arthritis deformans, diet in, 264
Artificial feeding of child, 100
foods, 83
proprietary foods, 84, 85
Ascaris lumbricoides in food, 92
Asparagus, 56
Ass's milk, composition, 33
Asthma, diet in, 222
Asylums, infant, feeding in, 123
Atonic dyspepsia, diet in, 194
Atwater's table of coefficients of
digestibility, 23
of food requirements at diff"erent
ages, 18
Atwater's table of fuel value of foods,
14.23
of nutritive ingredients of food,
13
Avoirdupois and metric weights, rela-
tive values, 338
Bacon, 47
composition, 48
Baking meat, 87
Bananas, 57
Bauer's method of milk modification,
107
Banting diet for obesity, 268
Barley gruel, 290
with beef extract, 317
jelly, 292
water, 288
Barlow's disease, diet in, 265
Beans, 56. 54
absorption of, 25
Beef, 45
broth, 309
with grain, 317
with poached ^gg, 317
composition, 48
cuts of, 331
essence, 313
extracts, 46
barley gruel with, 317
soup stock from, 308
juice, 45, 46, 311
cold, 312
meal, 46
mosquera, 83
peptonized, 314
raw, preparing, 314
soup from, 315
tea, 310
egg-nog, 318
flavored, 311
with oatmeal, 311
Beer, 71
Beet, 55
INDEX.
343
Beriberi, 91
Berries, 58
Beverages, 66, 285
Biliousness, diet in, 218
Biscuit, almond, 323
inulin, 327
Jeffries' gluten, 322
liitter almond junket, 301
waters, 70
Bitters, 75
Bladder, stone in, diet in, 234
Blanc-mange, Irish-moss, 320
Blood-vessels, dilation of, diet in, 230
Boas' enema, 143
Boiling meat, 86
Bomb calorimeter, 14
Bone-marrow, 65
Bottle bouillon, 313
Bottle-feeding, beginning, 108
l^otulismus, 90
Bouillon, 45
American, 313
bottle, 313
panopepton, hot, 316
Bovine tuberculosis, milk contamina-
tion in, 37
Bowels, care of, after operations, 279
Brain operations, diet after, 277
Braising meat, 87
Bran bread in diabetes mellitus, 257
cakes, Camplin's, 322
Brandy, 75
Brandy-and-egg mixture, 285
for infants, 285
Bread, 52, 293
aleuronat, 324
bran, in diabetes mellitus, 287
brown, 294
diabetic, 322
Drexel Institute recipe, 293
gluten, in diabetes mellitus, 256
recipe for, 321
nut-brown, 294
pulled, 294
Bread, substitute for, home-made, 328
in diabetes mellitus, 256
Soya, in diabetes mellitus, 256
torrified, in diabetes mellitus, 256
whole-wheat, 294
Breast-feeding, 95
contra-indications, 99
frequency, 97
Breasts, care of, 95
Brisket end of plate, 331
Broiling meat, 88, 307
pan, 307
Broth, American, 313
beef, 309
with grain, 317
with poached ^^'g, 317
chicken, 309
clam, 310
^Zg, 286
meat, 309
mutton, 309
without meat, 310
with vegetables, 310
veal, 310
Brown bread, 294
Buccal digestion, 15 '
Buffalo's milk, composition, 33
Butter, 35
Butterine, 65
Buttermilk, 36
Cabbages, 55
Calcium salts, 66
Calculous affections, diet in, 234
Calorie, definition, 14
gram, 14
Calorimeter, bomb, 14
Camplin's bran cakes, 322
Candy, 63
Cane-sugar, 62
Canning food, 82
Carbohydrate-free diet in diabetes
mellitus, von Noorden's, 254
Carbohydrates, 13
344
INDEX.
Carbohydrates, absorption of, 23
fuel value of, 14
in stomach diseases, 185
in typhoid fever, 158
of vegetables, 51
proteins, and fats in combination,
quantity required, 27
quantity required, 26
uses of, 14
Carcinoma of stomach, diet in, 199
Carrots, 55
Catarrh, intestinal, acute, diet in, 205
chronic, diet in, 206
with constipation, diet in, 206
with diarrhea, diet in, 206
Cat's milk, composition, 33
Catsup, 64
Caudle, 286
Celery, 56
soup, cream of, 297
Cereal-and-milk waters, 303
Cereals, 52, 289
absorption of, 25
composition of, 60
cooking, 289
length of time, 290
foods from, with starch not predi-
gested, 85
gruels from, 289
in tuberculosis, 172
partially digested, prepared at ta-
ble, 292
Cheese, 36 '
cakes, 327
Cheese-poisoning, 90
Chemicals in preserving food, 82
Chemistry of digestion, 11
Chestnut pur^e, 293
Chestnuts, 59
Chickens, 47
composition, 48
broth, 309
jelly, 318
Chick-pea, poisoning from, 91
Children, feeding of, 95
Chocolate, 72
Cholelithiasis, diet in, 220
Chops, mutton, 334
pork, 335
Chorea, diet in, 241
Cider, 79
Cinnamon, 64
Cinnamon-and-milk drink, 303
Circulatory diseases, diet in, 225
Clam broth, 310
juice, 310
Clams, 50
composition, 49
Cleft palate operation, diet after, 277
Climate, food and relation, 18
Cloves, 64
Cocoa, 72
junket, 300
Cocoanut, 59
and almond cakes, 326
cakes, 326
in diabetes mellitus, 257
pancakes, 325
pudding, 326
Cod-liver oil, 65
Coefficients of digestibility of foods,
22,23
Coffee, 71
effect, 171
jelly, 320
junket, 301
preparation, 71
Cold egg-nog, 286
in preserving food, 82
Colic, 124
Colostnim, 95
Coma, diabetic, 256
Concentrated food, 80
Condensed milk, 43
Condiments, 63
Constipation, chronic, dietetic treat-
ment, 212, 214
in atonic dyspepsia, diet in, 195
INDEX.
345
Constipation in children, diet in,
with chronic intestinal catarrh,
in, 206
Convalescent diet, 283
Cooking, effect of, 88
of fish, 88
of foods, 86
rapid, 89
of meat, 86
effect of, 88
of vegetables, effect of, 88
Copper as adulterant, 94
Cordial, 75
egg, 286
panopepton, 316
Cornmeal gruel, 292
Cauliflower, 55
Cow, tuberculous, milk from, 37
Cows' milk, composition, 33, 34
foods prepared from, 84
Crab, 50
composition, 49
Cracker gruel, 291
Crackers, crisp, 296
Cre\im, 35
Cream-of-celery soup, 297
Cream-of-potato soup, 297
Cream -of-tartar whey, 302
Cream -of-tomato soup, 296
Crisp crackers, 296
Crustaceans, 50
composition, 49
Curds, 36, 300
Currant juice, 287
Currants. 58
Custards, baked, 305
chocolate, 305
light, 327
rules for, 304
soft, 305
steamed, 305
Cuts of beef, 331
of lamb, 333
of meat, 330
131
diet
Cuts of mutton, 333
of pork, 334
of veal, 332
Dates, 58
Diabetes mellitus, aleuronat in, 257
almond cakes in, 257
bran bread in, 257
bread in, diabetic, 322
substitutes for, 256
cocoanut cakes in, 257
coma in, 256
diabetic bread in, 322
diet in, 253
carbohydrate-free, 254
prophylactic, 255
-^ in treatment, 255
von Noorden's, 254
foods allowed, 258
conditionally, 260
moderately, 259
especially valuable, 261, 262
gluten bread in, 256
recipes for foods in, 321
Soya bread in, 257
sugar-free milk for, 328
torrified bread in, 256
Diabetic bread, 322
coma, 256
Diarrhea, dietetic treatment, 212, 213
in childhood, 127
diet in, 128, 129 •
in older children, 130
with chronic intestinal catarrh, diet
in, 206
Diet after cleft palate operations, 277
after esophageal operations, 277
after hare-lip operation, 277
after laryngeal operations, 277
after operations, 275
about face, 277
about head, 276
cl(*ft palate, 277
esophageal, 277
346
INDEX.
Diet after operations, hare-lip, 277
laryngeal, 277
nausea and, 279
on Ijrain, 277
on intestines, 281
on ki(ln<ry, 280
on pancreas, 280
on rrctum, 281
on stomach, 280
on various organs, 280
plastic, 277
thirst and, 279
vomiting and, 279
anesthesia and, 274
convalescent, 283
cures, 272
diseases from errors in, 89
dry, 222
during pregnancy, 136
puerperium, 136
second year, 109
factors bearing on, 80
farinaceous, 283
for aged, 133
for child eighteen months to two
and one-half years, 113
fifteen to eighteen months old,
112
twelve to fifteen months old, iii
two and one-half to six years of
age, 114
for children, 95
for infants, 95
for school children, 119
for sick infants, 124
full, 283
hospital, 283
house, 283
in acne, 271
in alcoholism, 243
in anemia, 230
in aneurism, 230
in angina pectoris, 230
in apoplexy, 242
Diet in appendicitis, 209
in arthritis deformans, 264
in asthma, 222
in Barlow's disease, 265
in biliousness, 218
in calculous affections, 234
in carcinoma of stomach, 199
in cholelithiasis, 220
in chorea, 241
in circulatory diseases, 225
in constipation, 212
chronic, 212, 214
in atonic dyspepsia, 194
in children, 131
in diabetes mellitus, 253
carbohydrate-free, 254
foods allowed, 258
conditionally, 260
moderately, 259
especially valuable, 261, 262
prophylactic, 255
treatment by, 255
von Noorden's 254
in diarrhea, 212, 213
in childhood, 128, 129
in older children, 130
in difficult swallowing, i8o
in dilation of blood-vessels, 230
of heart, sudden, 229
of stomach, 192
in diphtheria, 167
in disease, general rules, 145
in diseases of pregnancy, 137
of stomach in infants, 127
in disturbed sleep, 239
in dysentery, 207
in dyspepsia, atonic, 194
intestinal, 204
nervous, 200
in dysphagia, 189
in dyspnea, in heart diseases, 229
in eczema, 270
in empyema, 222
in epilepsy, 240
INDEX.
347
Diet in fever, 150
in flatulence, 211
in floating kidney, 234
in gall-stone disease, 220
in gastritis, acute, 189
chronic, 191
in genito-urinary diseases, 232
alcohol in, 232
surgical, 235
water in, 233
in gout, 262
in heart diseases, 225. See also
Heart diseases.
in hemorrhage in ulcer of stomach,
196
of stomach, 198
in hemorrhoids, 212
in hives, 271
in infantile scurvy, 265
in infectious diseases, 155
in inflammation of kidney, 280
acute, 233
chronic, 234
of mouth in infants, 126
in insanity, 250
in insomnia, 239
in intestinal catarrh, acute, 205
chronic, 206
with constipation, 206 .
with diarrhea, 206
diseases, 202
indigestion, chronic, in children,
obstruction, 209
in laryngitis, 222
in leanness, 270
in liver diseases, 218
in lung diseases, chronic, 223
in malignant growths of intestine,
208
in measles, 166
in movable kidney, 234
in mumps, 167
in nephritis, 233, 234, 280
Diet in nervous conditions of intes-
tine, 211
in nervous diseases, 237
gastric disorders, 200
in neuralgia, 239
in neurasthenia, intestinal, 211
in obesity, 265
Banting, 268
Ebstein's, 269
Oertel's, 269
treatment by, 268
in palpitation of heart, 229
in paralysis after diphtheria, 119
in peritonitis, 216, 217
in pleurisy, 222
in pneumonia, 223
in postdiphtheric paralysis, 169
in pus in pleural cavity, 222
in rabies, 170
in rachitis, 132
in renal calculi, 234
in respiratory diseases, 222
in rest cure, 245, 247
schedule, 248
in rheumatism, 169
in rickets, 132
in scarlet fever, 165
in scorbutus, 265
in scurvy, 265
in shock after operation, 280
in skin diseases, 270
in small-pox, 165
in stomach diseases, 171
carbohydrates in, 185
eggs in, 184
fats in, 185
fish in. 185
fruits in, 185
gelatinous, 184
leguminous, 185
Leube's scale, 177
liquid, 184
meats in, 184
Penzoldt's, 180
348
INDEX.
Diet in stomach diseases, proteins in,
183
rules for eating, 186
special factors, 186
in surgical cases, 274
in tetanus, 169
in tuberculosis, 170
advanced cases, 175
alcohol in, 173
beverages in, 173, 174
cereals in, 172
eggs in, 171
fats in, 173
fish in, 172
forced, 175
fruit in, 173
gastric irritability and, 175
meat in, 171
meat-juice in, 172
milk in, 170
vegetables in, 173
wheat in, 173
with fever, 175
in typhoid fever, 155
atypical, 165
complicated, 165
convalescence and, 162
digestive disturbances and, 161
hemorrhage and, 161
perforation and, 162
in typhus fever, 165
in ulcer of intestine, 208
of stomach, 196
in uric-acid diathesis, 234
in urticaria, 271
in variola, 165
in vomiting, nervous, 200
in wasting diseases in children, 131
in Weir Mitchell's rest cure, 245
in whooping-cough, 167
in yellow fever, 169
laparotomy and, 278
Hght, 283
lists, food values of articles, 30
\ Diet lists, Leube's, 177
Penzoldts, 180
solid food, 29
meat, 283
milk, 283
scale, Leube's, 177
special, 283
urine and, relations of, 232
variation in, 20
ward, 283
Digestibility of foods, coefficients of,
22,23
Digestion, 15
appetite and, influence on, 21
buccal, 15
chemistry of, ii
diet and, influence of, 20
emotion and, influence of, 22
exercise after meals and, 21
before meals and, 21
gastric, 15
influence of various factors on, 19
intestinal, 16
meals and, influence of frequency
of, 19
influence of order of, 19
of infants, 17
of milk, 34
physiology of, 11
rest after meals and, 21
before meals and, 21
salivary, 15
temperature of food and, influence
on, 21
Digestive disturbances in typhoid
fever, diet in, 161
Dilation of blood-vessels, diet in, 230
of heart, sudden, diet in, 229
of stomach, diet in, 192
Diphtheria, diet in, 167
after intubation, 168
in paralysis after, 169
Diseases from errors in diet, 89
from food poisons, 89
INDRX.
349
Dog's milk, composition, 33
Drink, imperial, 287
in tuberculosis, 173, 174
in typhoid fever, 156
nutritive, for delicate women, 317
Dry cure, 273
diet, 222
wines, strong, 77
Drying food to preserve, 81
Ducks, 47
Dujardin-Beaumetz's nutrient enema,
141
Dysentery, diet in, 207
from amoeba coli, 91
Dyspepsia, atonic, diet in, 194
intestinal, diet in, 204
nervous, diet in, 200
Dyspeptics, jelly for, 318
Dysphagia, diet in, 189
Dyspnea- in heart diseases, diet in,
229
Earthy mineral waters, 70
ICbstein's diet for obesity, 269
Kchinococcus disease, 91
Eczema, diet in, 270
Edema in heart disease, diet in, 228
Effervescent peptonized milk, 298
Effervescing lemonade, 287
Egg-albumin, 44
Egg-and-brandy mixture, 285
for infants, 285
Egg-and-milk enema, 141
Egg-nog, 44, 286
beef- tea, 318
Eggs, 43. 304
absorption of, 24
and milk, 304
broth, 286
composition, 48
cordial, 286
gruel, 317
hard-boiled, 44, 304
in stomach diseases, 184
Eggs in tuberculosis, 171
in typhoid fever, 159
junket with, 200
poached, beef broth with, 317
raw, 44
soft-cooked, 304
Electricity in rest cure, 247
Emotion, digestion and, influence of.
22
Empyema, diet in, 222
Enemata, nutrient, 141. See also
Nutrient enemata.
England, meals in, 19
Enzymes, 15
Epilepsy, diet in, 240
Ergotism, 91
Esophageal operations, diet after, 277
Estraus materna graduate, 105, 106
Ethers in wine, 'J^
Europe, meals in, 19
Ewald's enema, 142
Ewe's milk, composition, 33
Exercise after meals, digestion and,
21
before meals, digestion and, 21
food and, relation, 18
Extractives in vegetables, 51
in wine, 77
Face, operations about, diet after,
277
Farina gruel, 291
Farinaceous diet, 283
foods with starch not predigested,
85
with starch predigested, 85
Fat, 13, 64
absorption of, 23
fuel value of, 14
ham, 336
in human milk, loi
in vegetables, 51
in stomach diseases, 185
in tuberculosis, 173
350
INDEX,
Fat, proteins, and carbohydrates in
combination, quantity required,
27
quantity required, 26
shoulder, 336
uses of, 14
Feeding. See also Diet.
abnormal methods, 143
artificial, of child, 100
breast, 95
contra-indications, 99
frequency, 97
bottle, beginning, 108
by stomach-tube, infant, 125
during second year, 109
forced, 150
in stomach diseases, 188
in tuberculosis, 175
maternal, 95
contra-indications, 99
frequency, 97
mixed, 99
nasal, 149
in infants, 126
of children, 95
of infants, 95. See also Infant
feeding.
rectal, 138
procedure, 138
refractory patients, 149
sick, general rules, 145
infants, 124
through gastric fistulas, 282
intestinal fistulas, 282
unconscious patients, 149
Fever, diet in, 150
in tuberculosis, diet in, 175
Figs, 58
Filaria in water, 92
Fish, 47
absorption of, 24
composition, 49
cooking, 88
in stomach diseases, 185
Fish in tuberculosis, 172
Fish-poisoning, 90
Fistulas, gastric, feeding through, 282
intestinal, feeding through, 282
Flank steak, 332
Flatulence, dietetic treatment, 211
in heart disease, diet in, 228
Flaxseed tea, 288
Floating kidney, diet in, 234
Flour, 52
ball, 291
gruel, 291
peanut, 328
Flour-ball gruel, 291
Food, absorption of, 16, 22. See
also Absorption.
adulteration of, 92. See also Adul'
teration.
age and, relation, 18
animal, 32
table of compositions, 48
artificial preparations, 83
ascaris lumbricoides in, 92
canning of, 82
classes, 32
climate and, relation, 18
coefficiency of digestibility, 22, 23
concentrated, 80
cooking, 86
rapid, 89
digestion of, 15. See also Diges-
tion.
exercise and, relation, 18
farinaceous, with starch not predi-
gested, 85
with starch predigested, 85
for aged, 134
fuel value of classes, 14, 23
heredity and, relation, 17
idiosyncrasies, 91
nutritive ingredients of, 13
values, table for computing, 30
oxyuris vermicularis in, 92
parasites taken with, 91
INDEX.
351
Food, pin-worms in, 92
poisons, diseases from, 89
prepared from cows* milk, 84
preservation of, 81. Sec also Pre-
servation of food.
proprietary, artificial, 84, 85
quantity required, 26
race and, relation, 18
relation of, to various conditions,
17
rest and, relation, 18
round-worms in, 92
sex and, relation, 18
size of person and, relation, 18
taenia in, 91
tape-worms in, 91
temperature of, influence on diges-
tion, 21
trichina in, 92
values, table for computing, 30
vegetable, 51. See also Vegetiiiles.
weight of person and, relation, 18
Food-poisoning, acute, 90
Foot-and-mouth disease, 91
Forced feeding, 150
in stomach diseases, 188
in tuberculosis, 175
Fortified wines, 'J^
Fowl, 47
composition, 48
France, meals in, 19
Freeman's pasteurizer, 40, 41
Fruits, 57
absorption of, 25
composition, 60
digestibility of, 57
in stomach diseases, 185
in tuberculosis, 173
Fruit-sugar, 63
Frying meat, 88
Fuel value of food-materials, 14, 23
Full diet, 283
Fungi, 59
Fusel oil, 75
Galactotoxismus, 90
Gall-stone disease, diet in, 220
Game, 47
Gastric digestion, 15
fistulas, feeding through, 282
irritability in tuberculosis, diet in,
juice, action of, 15
Gastritis, acute, diet in, 189
chronic, diet in, 191
Gavage in infants, 125
in stomach diseases, 188
Geese, 47
composition, 48
Gelatin, dishes made with, 319
meat jellies with, 320
meat jellies without, 318
Gelatinoids, 12
Gelatinous diet in stomach diseases,
184
in typhoid fever, 159
Geni to-urinary diseases, alcohol in,
232
diet in, 232
surgical, diet in, 235
water in, 233
Gin. 75
Ginger, 64
Glucose, 63
Gluten bread in diabetes mellitus, 256
recipe for, 321
biscuit, Jeffries', 322
gruel, 292
pancakes, recipe, 321
pudding, recipe, 321
Glycerin in wine, 77
Glycogen, 17
Glycogenic function of liver, 17
Goat's milk, composition, 33
Gooseberries, 58
Gout, diet in, 262
Grain, beef broth with, 317
Grain-poisoning, 90
Gram calories, 14
352
INDEX,
Grape cure in stomach diseases, 188
juice, 288
Grapes, 57
( J rape-sugar, 63
Gran urn gruel, imperial, 291
Green vegetables, 55
Gruel, arrowroot, 290
barley, 290
with beef extract, 317
cereal, 289
cornmeal, 292
cracker, 291
egg, 317
farina, 291
flour, 291
flour-ball, 291
gluten, 292
imperial granum, 291
milk, peptonized, 300
oatmeal, 291
Ham, 47
composition, 48
fat, 336
Hard water, 68
Hard-cooked eggs, 14, 304
Hardtack, 80
Hare-lip operation, diet after, 277
Head, operations about, diet after,
276
Heart, dilatation of, sudden, diet, 229
diseases, diet in, 225
general directions, 225
dyspnea in, diet in, 229
edema in, diet in, 228
fl itulence in. diet in, 228
Oerlel treatment, 228
ruptured compensation in, diet
in. 229
stomach disturbances in, diet in,
229
palpitation of, diet in, 229
leat consumption, Rubner's table,
27
Hemorrhage in typhoid fever, diet in,
161
of stomach, diet in, 196, 198
Hemorrhoids, dietetic treatment. 212
Hen's eggs, 43
composition, 48
Heredity, food and, relation, 17
Hip sirloin, 332
Hives, 91
diet in, 271
Holt's method of milk modiflcation.
102
Honey, 63
Hook-worms in water, 92
Horseradish, 64
Hospital diet, 283
enema, 143
Hot egg-nog, 286
peptonized milk, 298
House diet, 283
Huckleberries, 58
Human milk. See Milk, human.
Humanized milk, 42
Hydatid disease, 91
Hydrocarbons, 13
Iced meat extract, 312
panopepton, 315
Iceland moss, 59
Ichthyotoxismus, 90
Imperial drink, 287
granum gruel, 291
Indigestion, chronic intestinal, in
children, diet in, 131
Infantile scuivy, diet in, 265
Infants, brandy-and-egg mixture for,
285
diarrhea of, 127
digestion of, 17
feeding. 95
artificial, 100
bottle, beginning, io3
breast, 95
contra-indications, 99
INDEX.
353
Infants, feeding, breast, frequency, 97
by stomach-tube, 125
during second year, 109
during sickness, 124
from eighteenth month to two
and one-half years, 113
from fifteenth to eighteenth
months, 112
from twelfth to fifteenth months,
III
from two and one-half to six
years, 114
in asylums, 123
in inflammations of mouth, 126
in stomach diseases, 127
maternal, 95
contra-indications, 99
frequency, 97
mixed, 99
nasal, 126
theoretic basis of, 102
wet-nursing, 99
vomiting, 124
Infectious diseases, diet in, 155
Inflammations of mouth, infant feed-
ing in, 126
Infusions, saline, 143
Injections, saline, 143
Insane, diet for, 250
Insomnia, diet in, 239
Intestinal catarrh, acute, diet in, 205
chronic, diet in, 206
with constipation, diet in, 206
with diarrhea, diet in, 206
digestion, 16
diseases, diet in, 202
dyspepsia, diet in, 204
fistulas, feeding through, 282
indigestion, chronic, in children,
diet in, 131
Intestine, malignant growths of, diet
in, 208
nervous conditions of, dietetic
treatment, 211
23
Intestine, obstruction of, diet in, 209
operations on, diet after, 281
ulcer of, diet in, 208
Intubation in diphtheria, diet after, 168
Inulin biscuit, 327
Irish moss, 59
and milk, 303
meat jellies with, 321
Irish-moss blanc-mange, 320
Iron, 66
waters, 70
Jaccoud's enema, 143
Jeffries' gluten biscuit, 322
Jelly, albuminized, 321
barley, 292
chicken, 318
coffee, 320
for dyspeptics, 318
lemon, 320
meat, 318
with gelatin, 320
with Irish moss, 321
with tapioca, 320
without gelatin, 318
milk, 320
peptonized, 299
oatmeal, 292
orange, 320
panopepton, 315
with orange, 316
tapioca, 293
veal-bone, 318
wine, 319
Junket, 300
almond, bitter, 301
cocoa, 300
coffee, 301
strawberry, 301
vanilla, 301
with eggs, 300
Kefir, 36
Kidney, calculi in, diet in, 234
354
INDEX.
Kidney, floating, diet in, 234
inflammation of, acute, diet in, 233
chronic, diet in, 234
diet in, 233, 234, 280
movable, diet in, 234
operations on, diet after, 280
Kntripp cure, 273
Knuckles, 333
Kri'otoxismus, 90
Kumiss, 36, 302
LA( TEALS, 16
Lactose, 63
Lamb, 47
composition, 48
cuts of, 333
Laparotomy, diet and, 278
I^ird, leaf, 336
Laryngeal operations, diet after, 277
Laryngitis, diet in, 222
I^thyrism, 91
I^ad as adulterant, 94
Leaf lard, 336
leanness, diet in, 270
Legumes, 53
absorption of, 25
in stomach diseases, 185
Legumin, 84
Lemon jelly, 320
whey, 302
Lemonade, 287
albuminized, 287
effervescing, 287
milk, 301
peptonized, 299
Lemons, 57
I-,entils, 54
lettuce, 55
stewed, 327
Leube's diet lists, 177
Levulose, 63
Lichens, 59
Light custard, 327
diet, 283
Lime water, 285
Linseed tea, 288
Liqueurs, 75
Liquors, malt, 76
action of, 79
uses of, 79
Liver diseases, diet in, 218
glycogenic function of, 17
in absorption, 17
Llama's milk, composition, 33
Lobster, 50
composition, 49
Loin, small end of, 332
Lumpy-jaw, 91
Lung diseases, chronic, diet in, 223
Lupinosis, 91
Maidismus, 91
Maise, fermented, poisoning from, 91
Malt extracts, 85
liquors, 76
action of, 79
uses of, 79
Mare's milk, composition, 33
Massage in rest cure, 246
Materna graduate, 105, 106
method of milk modification,
105
Maternal feeding, 95
contra-indications, 99
frequency, 97
Matzoon, 36
Meals, exercise after, digestion and,
21
before, digestion and, 21
frequency of, influence on diges-
tion, 19
in England, 19
in Kurope, 19
in France, 19
in tuberculosis, number, 174
order of, influence on digestion,
19
rest after, digestion and, 21
INDEX.
3SS
Meals, rest before, digestion and, 21
sleep after, 21
Measles, diet in, 166
Measures, 337
Meat. 44, 305
absorption of, 24
baking, 87
boiling, 86
braising, 87
broiling, 88, 307
broth, 309
cooking, 86, 307
effect of, 88
cuts of, 330
diet of, 283
in tuberculosis, 171
digestibility of, 45
extract of, iced, 312
frying, 88
in stomach diseases, 184
jelly, 318
with gelatin, 320
with Irish moss, 321
with tapioca, 320
without gelatin, 318
juice, 312
in tuberculosis, 172
raw, 312
mutton broth without, 31
pan-broiling, 307
powders, 46
preparations, 44, 45
preparing, 305
raw, with milk and sugar, 315
roasting, 87, 307
soups without, 296
stewing, 87
Meat-poisoning, 90
Melons, 58
Metabolism, 14
Metric and apothecaries' weights,
relative values, 339
and avoirdupois weights, relative
values, 338
Metric fluid and apothecaries' meas-
ures, relative values, 337
Milk, 32
absorption of, 24
adulteration of, 34
albuminized, 303
almond, 285
and eggs, 304
and sugar, raw meat with, 315
butter-, 36
composition, 32
of various kinds, 33
condensed, 43
pontamination of, 37.
precautions, 38
cows', composition, 33, 34
foods prepared from, 84
cream of, 35
curd, 36
cure, 272
in stomach diseases, 187
diet, 283
in tuberculosis, 170
digestibility of, increasing, 42
digestion of, 34
from tuberculous cows, 37
gruel, peptonized, 300
human, fat in, loi
salts in, loi
milk-sugar in, 100
modification of, 98
proteins in, 100
reaction, loi
sugar in, 100
humanized, 42
infected, 92
in typhoid fever, 157
modified, 157
Irish moss and, 303
jelly, 320
peptonized, 299
lemonade, 301
peptonized, 299
mixture, 302
356
INDEX.
Milk modification. 57. loi
at home, technic. 108
Haner's method, 107
Holt's method, 102
laboratory method, loi
materna graduate method, 105
top-milk method, 103
modified, 38
in typhoid fever, 157
mother's. See Milk, human.
Pasteurization of, 39
peptonized, 298
cold process. 298
effervescent, 298
hot. 298
partially, 297
specially, 298
warm process, 298
porridge. 301
predigestion of, 42
preparations, 297
preservation of, 37
products, 32
punch, 301
peptonized, 299
skimmed, 35
sterilization of, 39
process. 40
sugar-free for diabetics, 328
variations in, 33
with other diluents, 303
with sparkling waters, 303
woman's, composition, 33
Milk-and-cereal waters. 303
Milk-and-cinnamon drink, 303
Milk-and-cgg enema, 141
Milk-and-starch enema, 141
Milk-and-sugar enema, 142
Milk pepton enema, von I^ube's,
141
Milk-poisoning, 90
Milk-sugar, 63
in human milk, 100
Mineral waters, 68
Mineral waters, alkaline, 69
bitter, 70
earthy, 70
iron, 70
sodium chlorid, 69
sulphurous, 70
uses of, in body, 14
Modified milk, 38
in typhoid fever, 157
Molasses, 63
Mollusks, 50
composition, 49
Morels, 59
Mosquera beef meal, 46, 83
Moss, Iceland, 59
Irish, 59
and milk, 303
meat jellies with, 321
Mother's milk. See Milk, human.
Mouth in typhoid fever, care of, 160
inflammations of, in&nt feeding in,
126
Movable kidney, diet in, 234
Mulberries. 58
Mulled wine, 288
Mumps, diet in, 167
Muscarin,90
Mush, cereal, 289
Mushroom-poisoning, 90
Mushrooms, 59
Mussel-poisoning, 90
Mustard, 64
Mutton, 46
broth, 309
with vegetables, 310
without meat, 310
composition, 48
cuts of, 333
Mytilotoxismus, 90
Nasal feeding, 149
in infants, 126
Nausea after operations, 279
Navel end of plate, 331
INDEX.
357
Nephritis, diet in, 233, 234, 280
Nervous diseases, diet in, 237
rest cure in, 244
dyspepsia, diet in, 200
gastric disorders, diet in, 200
vomiting, diet in, 211
Neuralgia, diet in, 239
Neurasthenia, intestinal, diet in, 211
Nursing bottle, hygenic, 99
child, 95. ^QQ dX's^ Infant feeding,
wet, 99
Nut-brown bread, 294
Nutmeg, 64
Nutrient enemata, 141
army, 143
Boas', 143
Dujardin-Beaumetz's, 141
egg-and-milk, 141
Ewald's, 142
hospital, 143
Jaccoud's, 143
milk-and-egg, 141
milk-and-starch, 141
milk-and-sugar, 142
milk-pepton, von Leube's, 141
pancreas, 142
Riegel's, 142
Singer's, 142
starch-and-milk, 141
sugar-and-milk, 142
von Leube's milk-pepton, 141
Nutrients, uses of, 14
Nuts. 58
Oatmeal, 53
beef tea with, 311
g:ruel, 291
jelly, 292
water, 288
Obesity, diet in, 265
Banting's, 268
Ebstein's, 269
Oertel's, 269
treatment by, 268
Obesity, prophylaxis in, 268
Oertel's treatment of heart disease,
228
of obesity, 269
Oils, 64
cod-liver, 65
Oleomargarin, 65
Olives, 58
Operations about face, diet after, 277
about head, diet after, 276
bowels after, 279
brain, diet after, 277
cleft palate, diet after, 277
diet after, 275
dietetic management, 274
esophageal, diet after, 277
hare-lip, diet after, 277
laparotomy, diet after, 278
laryngeal, diet after, 277
nausea after, 279
on intestines, diet after, 281
on kidney, diet after, 280
on pancreas, diet after, 280
on rectum, diet after, 281
on stomach, diet after, 280
on various organs, diet after, 280
plastic, diet after, 277
shock after, diet and, 280
thirst after, 279
vomiting after, 279
Orange jelly, 320
with panopepton jelly, 316
Orangeade, 287
Oranges, 57
Orgeat, 288
Oxyuris vcrmicularis in food, 91
Oyster, 50
composition, 49
juice, 310
peptonized, 33
stew, 297
Palate, cleft, operation for, diet
after, 279
358
INDEX,
Palpitation of heart, diet in, 229
Pan-broiling meats, 307
Pancakes, aleuronat, 324
cocoanut, 325
gluten, recipe, 321
Pancreas enema, 142
operations on, diet after, 280
Pancreatic juice, 16
Panopepton, 315
bouillon, hot, 316
cordial, 316
hot, 316
iced, 315
jelly. 315
with orange, 316
with whey, 316
Paralysis after diphtheria, diet in, 169
Parasites taken with food, 91
Parsnips, 55
Pasteurization of milk, 39
Pasteurizer, Freeman's, 40, 41
Peaches, 57
Peanut flour, 328
Pears, 57
Peas, S3, 54
absorption of, 25
Pellagra, 91
Pemmican, 83
Penzoldt's diet Hsts, 180
table of food digestibility, 178
Peppers, 64
Pepsin, 15
Pepton products, 83
Peptonized beef, 314
milk, 297. See also Milk, pep-
tonized.
oysters, 313
Perfect wines, 78
Perforation in typhoid fever, diet in,
162
Peritonitis, diet in, 216, 217
Phosphorus, 66
Physiology of digestion, 11
Pigeons, 47
Pin-worms, 92
Plastic operations, diet after, 277
Pleural cavity, pus in, diet in, 222
Pleurisy, diet in, 222
Plums, 58
Pneumonia, diet in, 223
from spoiled meat, 90
Poached ft^g, beef broth with, 317
Poisoning, cheese-, 90
fish, 90
food, acute, 90
diseases from, 89
from chick-pea, 91
from fermented maise, 91
from spurred rye, 91
grain, 90
meat, 90
milk, 90
mushrooms, 90
mussel, 90
ptomain, 90
sausage, 90
Pork, 47
composition, 48
cuts of, 334
Porridge, milk, 301
Porter, 76
Postdiphtheric paralysis, diet in, 169
Potassium chlorid, 66
Potato, 54
soup, cream of, 297
sweet, 54
Poultry, 47
composition, 48
Predigestion of milk, 42
Pregnancy, diet during, 136
diseases of, diet in, 137
Preservation of food, 81
by antiseptic chemicals, 82
by antiseptics, 82
by canning, 82
by cold, 82
by drying, 81
by excluding air, 81
INDEX.
359
Preservation of food by other anti-
septics, 82
by salting, 82
by sugar solution, 82
by vinegar, 82
Preservatives, 94
Proprietary foods, artificial, 84, 85
Proteids, 12
Proteins, 12
absorption of, 23
carbohydrates, and fats in combina-
tion, quantity required, 27
concentrated, 80
fuel value of, 14
in human milk, 100
in stomach diseases, 183
in typhoid fever, 159
in vegetables, 51
quantity required, 26
uses of, 14
Prunes, 58
Ptomain-poisoning, 90
Ptomains, 90
Pudding, almond, 323
cocoanut, 326
gluten, recipe for, 321
suet, aleuronat and, 325
Puerperium, diet during, 136
Pulled bread, 294
Punch, milk, 301
peptonized, 299
Puree, chestnut, 293
I*us in pleural cavity, diet in, 222
Rabbit, 47
Rabies, diet in, 170
Racahout des Arabes, 291
Race, food and, relation, 18
Rachitis, diet in, 132
Raisins, 58
Raspberries, 58
Raw beef, preparing, 314
soup, 315
eggs- 44
Raw meat with milk and sugar, 315
Raw-meat juice, 312
Recipes, 285
for diabetics, 321
Rectal feeding, 138
procedure, 138
Rectum, operations on, diet after, 281
Renal calcuh, diet in, 234
Rennin, 16
Respiratory diseases, diet in, 222
Rest after meals, digestion and, 21
before meals, digestion and, 21
cure, 244
diet in, 245, 247
schedule, 248
electricity in, 247
in stomach diseases, 187
massage in, 246
schedule for, 248
food and, relation, 18
Rheumatism, diet in, 169
Rice, 53
absorption of, 25
water, 288
Richard's ideal ration of solid food,
29
Rickets, diet in, 132
Riegel's enema, 142
Roasting meat, 87, 307
Roots, 54
absorption of, 25
Rough wines, 78
Round, top, 332
Round-worms in food, 92
Rubner's tables of heat consumption,
27
Rum, 75
Rump steak, 332
Ruptured compensation, diet in, 229
Rye, spurred, poisoning from, 91
Saccharin, 63
Saline infusions. 143
injections, 143
36o
INDEX,
Salivary digestion, 15
Salting of food to preserve, 82
Salts, 66
in body, 12
in human milk, loi
Sauces, 64
for vegetables, 296
Sausage-poisoning, 90
Scarlet fever, diet in, 165
School children, diet for, 119
Scorbutus, diet in, 265
Scurvy, diet in, 265
Second year, feeding during, 108
Sex, food and, relation, 18
Shell-fish, 50
composition, 49
Shock after operation, diet and, 280
Short steak, 332
Shoulder fat, 336
Sick, feeding of, general rules, 145
infants, feeding of, 124
Singer's enema, 142
Sirloin, 332
Sitotoxismus, 91
Size of person, food and, relation, 18
Skimmed milk, 35
Skin diseases, diet in, 270
Sleep after meals, 21
disturbed, diet in, 239
Small-pox, diet in, 165
Sodium chlorid, 66
waters, 69
Soft water, 68
Soft-c(Joked eggs, 304
Somatose, 46, 84
Soups, beef, raw, 315
celery, cream of, 297
chestnut, 293
composition, 48
cream-of-celery, 297
cream -of-potato, 297
crcam-of-tomato, 296
from stock, 308
potato, cream of, 297
Soups, preparing, 307
raw beef, 315
stock, 308
from beef extract, 308
sweetbread, 309
tapioca, 293
tomato, cream of, 296
without meat, 296
Soya biscuits in diabetes mellitus,
257
Spare ribs, 335
Sparkling waters, milk with, 303
wines, 78
Spices, 63
Spinach, 55
Spirits, 74
Spurred rye, poisoning from, 91
Stage of broken compensation, 225
of compensation, 225
Starch in vegetables, 51
Starch-and-milk enema, 141
Steak, flank, 332
rump, 332
short, 332
Steapsin, 16
Sterilization of milk, 39
process, 40
Sterilizer, Arnold, 39
Stew, oyster, 290
Stewed lettuce, 327
Stewing meat, 87
Stimulants, 66
Stomach, carcinoma of, diet in, 199
digestion, 15
dilation of, diet in, 192
diseases, diet in, 176
carbohydrates in, 185
eggs in. 184
fats in, 185
fish in, 185
fruits in, 185
gelatinous, 184
leguminous, 185
liquid, 184
INDEX.
361
Stomach diseases, diet in, meats in,
184
special factors, 186
forced feeding in, 188
gavage in, 188
grape cure in, 188
in infants, diet in, 183
Leube's diet scale in, 177
milk cure, 189
Penzoldt's diet lists, 180
rest cure, 187
rules for eating in, 186
treatment, special, 187
Weir Mitchell cure, 187
disturbances in heart disease, diet
in, 229
hemorrhage of, diet in, 198
in ulcer of stomach, diet in, 196
nervous disorders of, diet in, 200
operations on, diet after, 280
ulcer of, diet in, 196
Stomach-tube in infant feeding, 125
Stout, 76
Strawberries, 58
Strawberry junket, 301
Strong^lus duodenale in water, 92
Succus carnis, 312
Suet pudding, aleuronat and, 325
Sugar, 62
and milk, raw meat with, 315
cane-, 62
fruit-, 63
grape-, 63
in human milk, 100
in vegetables, 51
in wine, 77
milk-, 63
solution in preserving food, 82
Sugar-and-milk enema, 142
Sugar-free milk for diabetics, 328
Sulphur, 66
Sulphurous waters, 70
Suralimentation in tuberculosis, 175
Surgical cases, diet in, 274
Swallowing, difficult, diet in, 189
Sweet potato, 54
wines, strong, 78
Sweetbread soup, 309
Syrup, 63
TyKNiA, 91
echinococcus, disease from, 91
Tamarind water, 287
Tapeworms, 91
Tapioca soup, 293
jelly, 293
meat jellies with, 320
Tea, 70
beef, 310
egg-nog, 318
flavored, 311
with oatmeal, 311
flaxseed, 288
linseed, 288
Terrapin, composition, 49
Tetanus, diet in, 169
Thermal waters, 69
Thirst after operations, 279
Thoracic duct, 16
Tomato sauce, 64
soup, cream of, 296
Tomatoes, 56
Top-milk method of milk modifica-
tion, 102
Top round, 332
Torrified bread in diabetes mellitus,
256
Toxins, 90
Treacle, 63
Trichina in food, 92
Truffles, 59
Trypsin, 16
Tuberculosis, beverages in, 174
bovine, milk contamination in, 37
diet in, 170
advanced cases, 175
alcohol in, 173
cereals in, 172
362
INDEX.
Tuberculosis, diet in, eggs in, 171
fats in, 173 ; fruit in, 173
fever and, 175
fish in, 172
forced, 175
in gastric irritability, 175
meat in, 171
juice in, 172
milk in, 170
number of meals, 174
vegetables in, 173
wheat in, 173
sural! mentation in, 175
Tubers, 54
absorption of, 25
Turkey, composition, 48
Turtle, composition, 49
Typhoid fever, alcohol in, 160
atypical, diet in, 165
carbohydrates in, 158
complicated, diet in, 165
convalescence, diet in, 162
diet in, 155
in digestive disturbances, 161
drink in, 156
eggs in, 159
gelatinous substances in. 159
hemorrhage in, diet m, 161
milk in, 157
modified, 157
mouth in, care of, 160
perforation in, diet in, 162
proteins in, 159
Typhus fever, diet in, 165
Tyrotoxismus, 90
Ulcer of intestine, diet in, 208
of stomach, diet in, 196
Unconscious patients, feeding, 149
Urea, 17
Uric-acid diathesis, diet in, 234
Urine and food, relations of, 232
Urticaria, 91
diet in, 271
Vanilla junket, 301
Variola, diet in, 165
Veal, 46
broth, 309, 310
composition, 48
cuts of, 332
Veal-bone jelly, 318
Vegetables, 51, 295
absorption of. 24
carbohydrates of, 51
composition, 61
concentrated, 80 .
cooking, 295
effect of, 88
time for, 295
digestibility of, 51
extractives in, 51
fats in, 51
green, 55
absorption of, 25
in tuberculosis, 173
mutton broth with, 310
protein in, 51
sauce 296
starch in, 51
sugar in, 51
Vegetarianism, 56
Venison, 47
Vinegar, 64
in preserving food, 82
Vomiting after operations, 279
infant, 124
nervous, diet in, 200
von Leube's milk-pepton enema, 141
von Noorden's carbohydrate-free
diet in diabetes mellitus, 254
Walnuts, 59
Ward diet, 283
Wasting diseases in children, diet in,
131
Water, 66
acratothermal, 70
alkaline, 69
INDEX.
363
Water, amoeba coli in, 91
amount consumed, 67
bitter, 70
earthy, 70
elimination of, 67
filaria in, 92
hard, 68
hook-worms in, 92
impurities in, 68
in body tissues, 12
in genito-urinary diseases, 233
iron, 70
mineral, 68
purification of, 68
sodium chlorid, 69
soft, 68
strongylus duodenale in, 92
sulphurous, 70
thermal, 69
Weight of infant, 124
of person, food and, relation, 18
Weights, 337
Weir Mitchell cure for stomach dis-
eases, 187
rest cure, 245. See also Rest
cure.
Wet-nursing, 99
Wheat, 52 '
bread, whole, 294
in tuberculosis, 173
Whey. 36, 300, 301
cream-of-tartar, 302
lemon, 302
Whey, wine, 302
with pano|5epton, 316
Whisky, 75
Whole-wheat bread, 294
Whooping-cough, diet in, 167
Wine, 76
acid, 78
acids in, 76
action of, 79
alcohol in, 76
aromatic, 78
dry, strong. 77
ethers in, 77
extractives in, 77
fortified, 77
glycerin in, 77
jelly, 319
mulled, 288
perfect, 78
rough, 78
sparkling, 78
sugar in, 77
sweet, strong, 78
uses of, 79
varieties, 77
whey, 302
Woman's milk, composition, 33
Women, delicate, nutritive drink for,
Wood alcohol as adulterant, 94
Worcestershire sauce, 64
Yellow fever, diet in, 169
I
I
I;
.1 !
CATALOGUE
Books qn nursing
AND BOOKS SPECIALLY
INTERESTING TO NURSES
Book* tent to any part of the world on receipt of price
Abbolt's Hygiene of TransmLsjible DUesia 10
Amoican Illustrated Medical Dictionary 9
American Pocket Medical Dictionary 2
Barton and WelU' Medical Thesfluruj 5
Beck'i Reference Handbook for Nurta 4
Bergey's Principlei of Hygieoe 8
Davis' Obstetrical Nursing 3
De Lee's Obstetrics ior NurBei II
Friedcaiwald and Ruhrah') Diet 8
Friedenwald and Rubiah's Dietetics for Nurses II
Galbiailh'i Four Epoch" ol Woman's Life .... 6
Glalstrom's Mechano-Therapy 6
Griffith's Care oi the Baby 5
Lewis' Anatomy and Physiology for Nurses 4
Martin's Essentials ol Minor Surgery and Bandaging 6
Morris' Materia Medica. Tlierapeutics, PrescrHHion-Wrilina .... 7
Nancrede's Essenliab of Anatomy 8
Paul's Nursing in Acute Infectious Fevers 9
Pyle's Persona! Hygiene 5
Stevens' Manual of Practice of Medicine 7
Stevens' Modem Materia Medica and Therapeutics 7
Stoney's Materia Medica lor Nurses 4
Sloney'i Practical PoinB in Nursing . 2
Stoney's Surgical Technic for Nurses 3
Warwick and Tunstall's Rrst Aid to the Injured and Sick 10
Williams' Practice of Medicine 6
W. B. SAUNDERS COMPANY
.925 WALNUT STREET PHILADELPHIA
9, HenrietU Street, Covent Garden, London
L
Practical Points in INjursin g, recently issueo
■ Third Edillfin,
lor Nuraea in Private Practice. Tbornugiiiy ReviMd.
By Emh.v a. M. STONt,Y, Superintendent of the Training-
School for Nurses in the Carney Hospital, South Boston, Mass.
466 pages, handsomely illustrated. Cloth. Price, ^1.75 net.
In this volume the author explains the entire range of private
nursing as distinguished from hospiUl nursing, and the nurse is
instructed how best to meet the various emergencies of medical
and surgical cases when distant from medical or surgical aid or
when thrown on her own resources. An especially valuable feat-
ure of the work will be found in the directions to the nurse how
to improvise everything ordinarily needed in the sick-room.
The Appendix contains much information that will be found
of great value to the nurse, including Rules for Feeding the Sick;
Recipes for Invalid Foods and Beverages ; Tables of Weights and
Measures ; List of Abbreviations ; Dose-List ; and a complete
Glossary of Medical Terms and Nursing Treatment.
■• Thi5 is a well-writlen, eminently praclical volume, which covers the ealjra
range of private nurBing. and instructs the nurse how to meet the various emec-
geneiea which mRy arise and haw to prepare everything nteded in the illness of
\,KT-^\:\ea\r— American Journal of Obslelrici and Dheasli of WomtH and CkUdren.
The American Pocket Medical Dictionary.
Fonrth Revised Edition -Recently Issued
Edited by W, A. NEWM;\>f Dorland, M.D,, Assistant Obstet-
rician to the Hospital of the University of Pennsylvania; Fellow
of the American Academy of Medicine, etc. Handsomely bound
in flexible leather, limp, with gold edges and patent thumb index.
Price, Si. 00 net ; with [latent thumb index, 81.25 net.
This is the ideal pocket lexicon. It is an absolutely new book,
and not a revision of any old work. It gives the pronunciation
of all the terms. It contains a complete vocabulary, defining
all the terms of modern medicine. It makes a special feature
of the newer words neglected by other dictionaries. It con-
tains a wealth of anatomical tables of special value to students.
It forms a volume indispensable to everv medical man and nurse.
" 1 am struck at once with admiration at the compact size anil attractive
exterior. 1 can recommend it to our students mlhout reserve."— James W
Holland, M. D., Dian of Jefferson Mtdieai College. Philadelphia.
" Since the reviewer has had the work lying on his table wailing for review
ondon. ^__
Obstetric and Gynecologic Nursing.
By Edward P. Davis, A.M., M.D., Professor of Obstetrics in
the JetTerson Medical College and the Philadelphia Polyclinic ;
Obstetrician and Gynecologist to the Philadelphia Hospital,
izmo volume of 402 pages, fully illustrated. Buckram, J1.75 net.
RECENTLY ISSUED— SECOND KEVESBD EDITION
The second edition of this work has been carefully revised and
brought thoroughly down to date. Obstetric nursing demands some
knowledge of natural pregnancy and of the signs of accidents
and diseases which may occur during pregnancy. It also requires
knowledge and experience in the care of the patient during the
labor and her complete recovery, with the needs of her child.
Gynecologic' nursing is really a branch of surgical nursing, and as
Buch requires special instruction and training, thorough knowledge
and drill in asepsis and antisepsis being absolutely indispensable.
" This is one of [he most practical and useful books ever preseuled lo Ihe
nursing profession," — Traintd Nurst and Hospital Rti/iem.
Bacteriology and Surgical recently issued
Technic for Nurses. ^'"""' """■" ^
By Emily M. A. Stonev, Superintendent of the Training
School for Nurses, St. Anthony's Hospital, Rock Island, 111. Re-
vised by Frederic R. Griffith, M.D., Surgeon, Fellow of the
New York Academy of Medicine. lamo of 278 pages, illus-
trated. Cloth, S1.50 net.
The work is intended as a modern text-book. The firet part of
the book is devoted to Bacteriology and Antiseptics ; the second
part 10 Surgical Technic, Signs of Death, and Autopsies. To this
new second edition have been added chapters on Bandaging and
Dressings; Obstetric Nursing, Care of Infants, etc.; Hygiene and
Personal Conduct of the Nurse, etc.
"Nurses will find this booli of Ihe greate5t value bolh during Iheii
course and in private practice."— rrainea! A^ar« and Hospital Rcuirm.
" Tliis i5 an admirable litUe boolc. It is ejiceedingly practical." — Neil) Yorh
Reference Handbook for Nurses, rbcently issled
By Amanda K. Beck, Graduate of the Illinois Training School
for Nurses, Chicago, 111. 321110 of 177 pages. Bound in flexible
morocco, $i-2$ net.
carry oul any directions given by the physician;
emergencies thai may arise between or before visits of the physician.
arc expeclfd lo eommil lo memory from notes. The work includes ar
massage, medical electricity, obstetrics, care of infants, etc.
By Emii.y a. M. Stonfv, Superintendent of the Training-
School for Nurses in the Carney Hospital, South Boston, Mass.
Handsome octavo volume of 300 pages. Cloth. Price, 81.50 net.
In making the revision for this new second edition, all the
newer drugs have been introduced and fully discussed, bringing the
work right down lo date. The consideration of the drugs includes
their names, I heir sources and composition, their various prepara-
tions, physiologic actions, directions for handling and administering,
and the symptoms and treatment of poisoning. The Appendix
contains much practical matter, such as Poison-emergencies,
Ready Dose-Jisl, Weights and Measures, etc. , as well as a Glos.sary,
defining all the terms used in Materia Medica, and describing ail
the latest drugs and remedies, which have been generally ne-
glected by other books of the kind.
Anatomy and Physiology for Nurses issued
lly LiiRov Lewis, M. D., Surgeon to and Lecturer on Anatomy
and Physiologj- for Nurses at the Lewis Hospital, Bay City,
Michigan. lamo of 317 pages, with 146 illustrations. Cloth,
Si. 75 net.
This book is the outcome of a wide demand for such a. work,
treating the subjects from the nurse's point of view. The author
has based the plan and scope of the work on the methods he has
employed in teaching the subjects, and has made the text un-
usually simple and clear. The object was so to deal with anatomy
and physiology that the student might easily grasp the primary
principles, at the same time laying abroad foundation for a wider
study. There are many practical illustrations.
I usually s
■ and ph>
I principl*
K study.
Proper Living upon a Physiologic Basis. By American Authori,
Edited by Walter L. Pvle, A.M., M.D., Assistant Surgeon to
Wills Eye Hospital, Philadelphia, Octavo, 350 pages. Pro-
fusely illustrated. Cloth, J1.50 net.
The objecl of this manual is to ael forth plainly the best means of develop-
ing and maintaining physical and menial vigor. It represents a thorough ejipoai-
lion of living upon a physiologic basis.' There are cliapttrs upon the hygiene
of the digestive apparatus, the skin and its appendages, the vocal aod respiratory
apparatus, eye, car, brain, and nervous system. In this new second edition there
liftVi! been added chapters on Domsstic Hygiene and Home Gymnastics, besides
an Appendix cantoning firsi aids id cases of emergencies. The book has been
-The work has been exc.
"Good common-sense ad
lin 0/ Johns Hopkim Hospital
The Care of the
illenlly done ;
ally well in pr
-Boston Medi
Baby.
the
cal
ire Is no undue repetition, and the
iting tacts of practical significance
and Surgical Journal.
Her of personal hygiene."— J«;/f-
RECENTLV ISSUED
Thim Bdltion, RevlKd.
By J. P. Crozer Griffith, M.D., Clinical Professor of Dis-
eases of Children, University of Pennsylvania; Physician to the
Children's Hospital, Philadelphia, etc. 436 pages, with 67 illus-
trations in the text, and 5 plates. larao. Price, $1.50 net.
"The whole book is charaelerized by rare good sense, and is evidently
written by a master hand. It can be read with benefit not only by mothers, but
by medical students and by any practitioners who have not had large oppor-
tunities for observing children."— .^m^moM Journal oj Obsltlrics.
A Thes auru s of Medical
^^^^^^^—^^^^^^^^^^^^~ RECENTLY ISSUED
Words and Phrases.
A Thesaurus of Medical Words and Phrases. By Wilfred
M. Barton, M.D.., Assistant to Professor of Materia Medina and
Therapeutics; and Walter A. Wells, M.D., Demonstrator of
Laryngology^ Georgetown University, Washington, D.C. i2mo
of 534 pages. Flexible leather, 52.50 net; with thumb index,
$3.00 net.
Four Epochs of Woman's Life, s«ond Edition
Maidenhood. Marriage, Maternity. Menopause, ""'^''y '•*"«'
A Siiidy in Hygiene, By Anna M. Galhraith, M. D.,
Author of " Hygiene and Physical Ciihure for Women ;" with an
Introductory Note by John H. Mussee, M.D., Professor of
Clinical Medicine, University of Pennsylvania. izmo, 247
pages. Cloth, 31.50 net.
In this instructive work are stated, in a modest, pleasing, ajid
conclusive manner, those truths of which every woman should
have a thorough knowledge. The subject is discussed in language
readily grasped even by those unfamiliar with medical subjects.
" The auihiir has Ireated a diflii^uU iubjpci vi'lih lacl. wisdom, and dignity."
A Text-Book of Mechano-Therapy
(Massage and Medical Qy m nasties ) ■
By Axel V. Cr.
Royal Swedish Army;
, IS. Sc,
late Hoiii
Blackwell's Island, New York, i
Cloth, $1.2$ net.
This book is intended as a practi
massage and Swedish movements, si
this country. It describes clearly
various movements of the system and their mode of appli
The book has been entirely reset and greatly enlarged. Fourti
new illustrations have also been added.
M. D., late Lieutenant in the
: Physician, City Hospital,
mo, 200 pages, illustrated.
al manual of the methods of
rapidly becoming popular in
id shows by illustration the
Practice of Medicine just ready
By William R. Williams, M. D., formerly Instructor in
Medicine and Lecturer in Hygiene, Cornell University. 1 amo
of 461 pages. Cloth, Si.75 °et.
Throughout this book special stress has been laid on the more
common aspects of the various diseases, emphasizing the con-
trasting points in similar conditions, so as to render differential
diagnosis as easy as possible. Symptomatology and treatment
have likewise been adequately, although concisely, considered.
A Manual of Practice of Medicine,
JuM luuBd— New (7th) Edition
By A. A, Stevens, A.M., M.D., Lecturer in Physical Diag-
nosis in the University of Pennsylvania, and Professor of Pathol-
ogy in the Woman's Medical College of Pennsylvania. Post 8vo,
556 pages. Numerous illustrations and selected formula. Price,
bound in flexible leather, 32.50 net.
It is well-nigh impossible for the student, with the limited
time at his disposal, to master elaborate treatises or to cull from
them that knowledge which is absolutely essential. From an ck-
tended experience in teaching, the author has been enabled, by
classification, to group allied symptoms, and to bring within a
comparatively small compass a complete outline of the practice
of medicine.
A Text-Book of Modern Therapeutics . ,^^„%
Fourth edition. Adapted to the New (loogl Pharmacopeia
By A. A. Stevens, A.M., M.D., Lecturer on Physical Diag-
nosis, University of Pennsylvania. Handsome octavo volume of
670 pages. Cloth, $3.50 net.
This new volume, including all the latest advances in Thera-
peutics, comprehends the following sections : Physiological Ac-
tion of Etrugs ; Drugs ; Remedial Measures other than Drugs ;
Applied Therapeutics ; Incompatibility in Prescriptions ; TaiJle
of Doses; Index of Drugs; and Index of Diseases, the treat-
ment being elucidated by more than two hundred formulae.
"The BHlhorhas faithfully presented mndera IhErapeutks in a comprehensivE
— Uaivtrsily q/ Penusylvauia Medical Uultetia-
Essentials of Materia Medica, Tliera- seventh
^— ^^^^^^^^^^^^^^^^^^^^^— ^^^^-^^^ edition
peutics, and Prescription-Writing. •""" '"""*
By Henrv Morris, M.D., late Demonstrator of Therapeutics,
Jefferson Medical College. Revised by W. A. Bastedo, M.D.,
College of Physicians and Surgeons, New Vork. rzmo, 300
pages. Cloth, Ji.oo net; interleaved for notes, £1.25 net.
" Has more value Ihnn some of the numerous manuals which, though more
pretentious, are neither fuller nor more accurate. '■—fia/Ze/in af Ji>hns Hopkins
HoipUiit.
7
Essen tials of Anatomy, recently issued
■' ScvenUi
Including the Anatomy of the Vi scera. Emiton, Revised.
By Charles B. Nancreue, M.D., Professor of Surgery and
■ Of Clinical Surgery in the University of Michigan, Ann Arbor.
Crown octavo, 400 pages; 180 illustrations. With an Appendix
containing over 60 illustrations of the osteology of the human
body. Eased upon Gray's Anatomy. Cloth, gi. 00 net; inter-
leaved for notes, ii.25 net.
Hpproved hy iong service in medical
II is concise withou! the sacrifice of
assist Ihe XtxV'—BuUetiH of Joiias
nil
hn
It which
ini
lools for
nnil
Hoipi
Essentials of Minor Surgery, Bandaging,
and Venereal Diseases. s«ond Edition, Revi»ed.
By Edward Mariin, A. M., M. D., Professor of Clinical Sur-
gery, University of Pennsylvania. Crown octavo, 166 pages, with
78 illustrations. Cloth, ^i.oo net; interleaved for notes, $\.-2^ net.
"The best cornlcnsiHinn of Ihe subjeela of which il Ireats yet placed before
the profcssron. "— r*^ Midkal Stii's. Hiiladelphia,
Bergey's Principles of Hygiene. "I^^^J
The Principles of Hygiene : A Practical Manual for Students,,
Physicians, and Health Officers. By D. H. Bergev, A. M.i"
M. D., Assistant Professor of Bacteriology in the University o(_
Pennsylvania. Handsome octavo volume of 536 pages, illus-.
trated. Cloth, $3.00 net.
. sugpealions that canni
>. Rn-iiw. Englatiii.
V
Diet in Health and Disease.
By Julius Friedenwald, M.D., Clinical Professor of Diseases
of the Stomach, College of Physicians and Surgeons, Baltimore ;
and John Ruhrah, M.D., Clinical Professor of Diseases of
Children, College of Physicians and Surgeons, Baltimore, Oc-
tavo volume of 68g pages. Cloth, S4.00 net.
RECENTLY ISSUE[>-NETP (3d) EDITION
The American Illustrated ^et the Best
Medical Dictionary. The New standard
THIRD EDITION IN THREE YEARS— WITH ISOO NEW TERMS.
A New and Complete Dictionary of the terms used in Medi-
cine, Surgery, Dentistry, Pharmacy, Chemistry, and kindred
branches ; together with new and elaborate Tables of Arteries,
Muscles, Nerves, Veins, etc. ; of Bacilli, Bacteria, Micrococci,
etc. ; Eponymic Tables of Diseases, Operations, Signs and Symp-
toms, Stains, Tests, Methods of Treatment, etc. By W. A. N.
Borland, M. D. large octavo, nearly Soo pages, bound in full
flexible leather. Price, ^4.50 net ; with thumb index, ^5.00 net.
It furnishes a maximum amount of matter in a mlalmum
space, and at the lowest possible cost.
" Dr. Dorland's Jitlionary is admirable. It is so well gollen up ant) of such-
convenionl size. No errors have been found in my use of il."^ Howard A.
KeiXV, M.D., Prafissor of Gynecology, Johns Hopkins Ukivtriily. Baltinon.
" I must acknowledge my aslonishment at seeing how much he has condensed
within relatively small space. 1 find nothing to criticise, very much to commend,
and was interested in finding some of the new words which are not in other
dictionaries."— ROSWKLL Park. /Vn/"«Joro//ViBnj)/«flBrf/'raiftVe of Sargtry
mnd Clinical Surgery. Univtrsily of Buffalo.
Nursing in the Acute Infectious Fevers, issleo
By George P. Paul, M.D., Assistant Visiting Physician and
Adjunct Radiographer to ilie Samaritan Hospital, Troy, N. Y.
izmo volume of 200 pages.
Dr. Paul has written this little work especially for the trained
nurse, so that all extraneous matter has been studiously avoided.
The author has laid great stress u]ion care and management in
each disease, as this relates directly to the duties of the nurse.
The first part treats of fever in its general aspects ; the second
discusses each of the acute infectious fevers ; the third deals with
practical procedures and information necessary to the proper
management of the diseases discussed.
The Hygiene of Transmissible Diseases.
Second Edition, Revlted and Enluv«l-
The Hygiene of Transmissible Disease^: their Causation,
Modes of Dissemination, and Methods of Prevention. By A.
C. Abbott, M.D., Professor of Hygiene and Bacteriology, Uni-
versity of Pennsylvania. Octavo, 311 pages, with numerous
illustrations. Cloth, J3.50 net.
This book is devoted to that most important branch of the
e of hygiene, namely, the prevention of contagious disease.
It deals most fully with sanitary laws, especially those concerning
the causation and spread of disease and the means of prevention.
It treats of modes of infection, methods of disinfection, the
means for the isolation of the sick, and the general rules for the
management of contagious diseases. It is a book of the very
greatest value to the nurse.
rd to meet a want which hna b
B a/JahHs Haptins HospUal.
aclilloner wishing to obtain a cl
en long felt by
irly written and
knowledge of hygiene and
of the profession, which ai
— Thi Medical News.
in harmony with the efforH
D methods of prophylaiii."
First Aid to the Injured and Sick. ^|
First Aid to the Injured and Sick. By F. J. Warwick, B. A.,
M.B. Cantab., of London, and A. C. Tunstall, M. D., F. R. C. S.
Ed., of London.' i6mo volume of 232 pages and over zoo illus-
trations. Cloth, Si. 00 net.
Thii volume of practical information Is Intended as an aid in renderinfr ipi-
mediate temporary assistance to a person suffering from an accident or snddea
able as a lile-saving expedient, for upon the promptness and efficiency of tlie aid
first rendered the patient depends, in a great measure, the lermlnadon of the
case. This volume will be found a most useful book of ready aid, and of invaln-
It only lo nurses, railway em{ilo)ree5, elc, but also to the laity
L
Obstetrics for Nurses.
RECENT LV ISSUED
Obstetrics for Nurses. By Joseph B. DeLee, M.D., Professor
of Obstetrics in tlie Northwestern University Medical School,
Chicago. i2mo of 460 pages, fully illustrated. Cloth, 82.50 net.
INCLUDING ANATOMY AND PHYSIOLOGY.
While this work was written particularly for nurses, yet the
student of obstetrics will find in it much that is useful and in-
strucrive, since the duties of a nurse often ;3evolve upon the
practitioner in the early years of his practice. The illustrations
are nearly all original, having been made specially for this work.
The photographs were taken from actual scenes, and the text is the
result of the author's eight years' experience in lecturing to nurses.
" iu eonlenls are very pracdcal and In accord wilh ihe present slanrt of sci-
schools with which I am connected."— C. S. BACON. M. D., Pro/njnr of Ohlelria
10 Ihi CoUtge of PkyHciam and Surgtoni, Chicago.
Dietetics for Nurses. issu^ei*
By Julius Friedenwald, M.D., Clinical Professor of Diseases
of the Stomach, College of Physicians and Surgeons, Baltimore ;
and John Ruhr.\h, M.D., Clinical Professor of Diseases of
Children, College of Physicians and Surgeons, Baltimore.
i2mo of 363 jiages. Cloth, $i.^o net.
This work has been prepared to meet the needs of the nurse,
both in the training school and after graduation. It aims to give
the essentials of dietetics, considering briefly the physiology of
digestion and the various classes of foods and the part they play
in nutrition. The subjects of infant feeding and the feeding o'f
the sick are fully discussed, and a brief outline is given of the
principles involved in the nourishment of patients suffering with '
the various diseases in which diet plays an important part in treat-
ment. Rectal alimentation and the feeding of operative cases are
fully described.
V
I ■
I'm
,
. »
■r
iJ:
4
I*
■•
fij
I':-
ill
I
I' I
II I
■ >,
ii;
iSI
h il .
li'hi
; . 'I
<l • J
ir 1
III
■ii-i
i!)
4>i
I
LANE MEDICAL LIBRARY
or before
this book sbould be returned on
he dale last stamped below.
Xy.^0
1
1
^iv
W85 Prledenwald, J. '-:8078
F89 Dietetics for nurses.
1905
»»!.•
DATE DOE
H,'?*^*^.
;^.£J?4::^
.
JB
^^H
.j^^H
,^^^^1
.^^^^^1
"■ ^ J
■
ifl
^^
Live Music Archive
Librivox Free Audio
Metropolitan Museum
Cleveland Museum of Art
Internet Arcade
Console Living Room
Books to Borrow
Open Library
TV News
Understanding 9/11