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DIET IN HEALTH 
AND DISEASE 



BY 

JULIUS j:riedenwald, m. d. 

raorisioi or cAsno-EHTBtouicy in tbe tntivtMrTV <w iuivland ksool ot 

HCCICINI AND COIUCE OF PHmCLUn AND SDBCIOtn, BALTIUOIE 



AND 



JOHN RUHRAH, M. D. 



nonssoR or dbiases or chodbbh in tbc vmvsutrY or iukvland scaoot 

OI MEDICINE AND COLLIOB OT PBniCUMS AMD SnClOK*. BAITHIOU: 



" These few rules of diet he that keeps, shall surely 
find great ease and speedy remedy by it." — BuRTOK 



FIFTH EDITION. RESET 



PHILADELPHIA AND LONDON 

W. B. SAUNDERS COMPANY 

1919 

Ha 



Copyiigbl, 1904, by W, B. Saunden and Company. Reprlnied June, 1(^5. Keviied, re- 
printed, and recopyrighted May, 1911IS, ReviKd.rapriDled.aud recupyrighi«d April, 
1909. Repripled April, igio.aod April, iijii. Reviied. reprinted, and n- 
Copyrighted May, 1915. Keprinled June, 191J. Reviied, entirely 
react, reprinted, and recopyri^hced April, 1919 



Copyright, 1919, bv W. B. Saunrer:! Company 



faiHTfo ih AHcnica 



FMtl OF 

V- a. flAtiMDiai ci^tumr 

PHILAO(L*KI« 



TO 

Sir MfUtam ®0ler. A. S>. 

AS A SLIGHT TOKEN OF OUR APPRECIATION OF HtS PERS(NfAL 
FRIENDSHIP, OF MANY FAVORS, AND OF THE EN- 
COURAGEMENT HE HAS ALWAYS GIVEN THE 
MEMBERS OF THE PROFESSION. 



48235 



PREFACE TO THE FIFTH EDITION 



The continued appreciation of the profession as evidenced by their 
using this book has added greatly to the endeavor to make the fifth 
edition of more value than the preceding ones. 

There are scarcely any subjects in medicine that have received 
the same amount of attention of recent years as dietetics and the study 
of nutrition. The literature is voluminous and it would neither be 
possible nor profitable to try to include everything that has been 
brought forward. There are many differences of opinion among 
authorities on many questions which can only be settled by future 
study and in many cases the views expressed are diametrically op- 
posed. Much of our knowledge on nutrition is fragmentary and the 
exact value of many contributions cannot be estimated until further 
investigations have been made. Dietetics has always been a sub- 
ject much influenced by fads and fancies and much of the literature 
ha.s little value in consequence. 

The authors have endeavored to give fully the various facts relat- 
ing to the composition of foods, to indicate as far as possible in the 
space of one volume the scientific basis, when there is any, for the 
various diets and. to give at the same time practical directions and 
diet lists which can be used without extensive training. 

The authors have attempted to bring together within a compara- 
tively small number of pages the best of the modern thought upon 
the subject and take this opportunity of expressing their indebted- 
ness to all the authors quoted. In each instance an endeavor has 
been made to indicate the source of the information. A number of 
new articles have been added, among which may be mentioned those 
on vitamins, amino-acids, acid and alkali content of food, relation 
of food to skin surface, milk standards, food allergy, Sippy's diet 
in peptic ulcer and numerous smaller ones. A considerable portion 
of the volume has been rewritten in part or entirely, including the 
sections on infant feeding, rectal feeding, diabetes, obesity, acidosis, 
the Karell cure, renal diseases, and pellagra and the deficiency dis- 
eases. 

Through a special arrangement with D. Appleton and Company 
and Dr. Edwin A. Locke, it has been possible to add the valuable 
tables that have been prepared by Dr. Locke. The authors wish to 
express their indebtedness to both. They are indebted to the Direc- 
tor of the Connecticut Agricultural Experiment Station at New 

7 



8 PREFACE TO THE FIFTH EDITION 

Haven for permission to use the valuable analyses oi diabetic foods 
which are included under the heading of diabetes. 

Owing to the war there has been an unavoidable delay in the re- 
setting and printing of the book so that practically no references will 
be found to literature later than the first of 1918. 

The authors wish also to express their thanks to W. B. Saunders 
Company for their uniform courtesy and consideration. 

Baltimore, April, 1919 



PREFACE TO THE FIRST EDITION 



This book has been prepared to meet the needs of the ireneral 
practitioner, hospital interne, and medical student, as well as for 
a reference handbook for training-schools. 

The aim of the book is entirely practical. We have endeavored 
to give a reasonably concise account of the different kinds of foods, 
their composition and uses, and also to set forth the principles of 
diet both in health and disease. The greater part of the book is de- 
voted to the sick, and we have tried to tell the doctor how to feed 
his patient. We have gone over the literature of the subject, much 
of which is inaccessible to the general practitioner, and have given 
what seems to us to be the most useful. We trust that the book is 
simple enough to be used for rapid reference by the busy practitioner, 
and that there is sufficient detail to make the way clear for the med- 
ical student and the uninitiated hospital interne. We have gathered 
together many diet-lists and recipes, which we trust will be of service 
both to the physician and to the nurse. 

In the preparation of this work we have consulted many books and 
journal articles, and we are under obligation to the many authors 
whose names are mentioned throughout the book in connection with 
their contributions to the science of dietetics. 

We are especially indebted to Dr. W. O. Atwater and his collabora- 
tors for much valuable material. We wish to express onr thanks to 
the publi-shers, Messrs. W. B. Saunders & Co., for the courtesy they 
have shown in its preparation. 



CONTENTS 



FAOt 

The Chciustbt and Phtsiolooy or Diokstioh 17 

Digestion uid Absorption 24 

Digestion 24 

Peculiarities of the Digestion in Infante 34 

Absorption 36 

The Influence of Various Factors upon the Digestion 40 

Hetabotism 42 

Foods and Their C'Dtnposition 46 

Dietaries and Dietary Standards 69 

Ci^BSEs or Foods 93 

Animal Foods 93 

Milk and Milk Products 93 

Eggs 117 

Meats and the Meat Preparations 120 

Fish 126 

V^etable Foods 129 

Cereals 130 

Legiimea ... 134 

Roots and Tubers 138 

Green Vt^Ublea 139 

Fruits and NuU 142 

Fruits 142 

NuU 144 

Fungi, AlgK, and Lichens 1 48 

Sugars 147 

Spices and Condiments 149 

Fats and Oils 160 

Salts 154 

Salt Metabolism and Disease 164 

Phosphorus-containing Foods . 166 

Potassium- containing Foods 165 

Sodium-containing Foods . 165 

Iron-containing Foods 166 

Sulphur-containing Foods 166 

Chlorine- containing Foods 18*t 

Magnesium-con tain ing Foods 166 

Calclimn-containlng Foods 166 

BCVEBAOES UTD STIMCLATfTB 187 

Water 167 

Mineral Waters 168 

Tea 177 

Coffee 179 

Cocoa 180 

Alcohol 181 

Spirits 186 

Uqueurs and Bitters 187 

Malt Liquors 187 

Wines IflO 

Action and Therapeutic Use of Malt Uqaors and Wines 196 

Cider IBS 

11 



12 CONTENTS 

FAOI 

Vabioub Factobs IK Tfisu Beauho on Dirr 198 

Concentration of Food .... Ifl8 

Preservation of Food ... 108 

Artificial Food Preparations 200 

Artificial Proprietary Foods 203 

Cooking of Foods 206 

Effect of Coolcing 207 

Diseases Caused by Errors in Diet and by Various Food-poisone . 209 

Otber Forms of Food -poisoning ... 219 

Idiosyncrasies . . 221 

Food Adulteration 228 

Simple Tests for Detection of PreserratlTes 238 

The Determination of Artificial Colors 236 

The Examination of Various Foods 238 

Diet as a Means of Diagnosis . 239 

Diet for Singers and Speakers 242 

Diet During Athletic Training 243 

lHrA.1T FEEDino 251 

Milk Modification 279 

Methods of Practical Value in Modifying Milk 279 

Other Foods for InfanU 297 

Feeding During the Second Year 308 

Diet of School Children 314 

Other Factors in Infant Feeding 319 

Gavage . 324 

Diet in Diseases of Children 32S 

Dot roB Special CoNDinons .... 344 

Diet for the Aged ■ ... 344 

Diet During Pr^nancy and the Puerperlum ...... 347 

Diet in the Special Diseases of Pregnancy 349 

The Effect of Diet on the Development and Structure of the Uterus . 360 

Spbcial Methods or Feennta .351 

Rectal Feeding . 351 

Indications for the Use of Kntrleot Enemata 3Sfi 

Other Methods of Nourishing the Body 356 

DuT Dt Disease 362 

Feeding in Fever ... 365 

Feeding In Infectious Diseases 371 

Typhoid Fever 371 

Atypical 386 

Complicated 3S5 

Typhus Fever 386 

Small-pox 386 

Scarlet Fever 387 

Measles 389 

Mumps ... 389 

Whooping-cough 389 

Influenza 390 

Meningitis and Cerebrospinal Fever 390 

Diphtheria 391 

Erysipelas 392 

Rheumatism 393 

Asiatic Cholera 394 

Yellow Fever 396 

Dengue 597 

Malaria 31)7 

Sprue 399 

Tetanus 399 

Rabies 899 



0OSTEST6 



IZ 



Ijr DiSUflE ICtMUmued). 

TuborpuloRi* 
Diet in Dim-awb of tb« Stomacb 
SpMial CufM ia thv TrimUDiNit at tha DIwum of tbt Stomacli 

Acui« UBatritia 
llirunic Gattritts 
Atrophk Caurrh ol the Sumacli 
U) jKiaecreiiuD ... 

biUutian of the Stomach 
AtoQj of the StoBMch 
Ulcer of the Stomach 
Hets«rrhsg« 
Carcinoma 

Oastroptonia and Eat^roptosla 
Ji>rvouii UtitorJerii 
Hj'priufalorhvdrlB or Ufputacidlty 
Dirt IB Inteittinal UlwasM 

Acute Catarrh 
Chronic CatArrh 
.Dvaenurv . . . 

FuWra . . 

tllaligiaQi' Growthn . . 

VAeule Ii)t«Rtinal Obstructton 
llChrDQic Intretitul OWruclJon 

kppiadidtia 

ItMoiiMinbraaoiu Catarrh 

Nvrvotix AflaeUona 
Umtorrholde 
tCbrooie Diarrhea 
''BaUtual Conetipallon 

ChronU Starii 
Dirt in Peritotiltia 
DM la Uvtt Dlfteasea 

OatWThal JaonilW 

CongMltoB .... 

Amte Yellow Atrophy - i • * 

Abweaa ., . . 

PattT U*Ter 

Amj'lold Liver 

Snhllii . 

(Mll-fltone Disease . 

rirrlKiaU 

Dbt In tHwuca ol thi- Tancreaa . . ■ 
Dirt In ntaeaem of Lhc Rctplratorj* Organi 

PInniar . 

Eapjema 

UTTB^lamttf Strldaliia 

Urt^itia 

EarhjrMma 

Chmia Broaehltla - . 

lUnartha^i' frnni t.un^ . . 
VacviMnla 
Otel b Dhmea ot th« CtrcnUtorT Sjitem 

Dbtam ot the Heart 

n«vrt Lnuwe to CbUdieo . 

SeaiU B«rt 

AitnlMcUioau 

Higii Bload-pwa wn , 

Aatmrrm 

ABflM IVtoriR 



14 CON TESTS 

Dm IN DiSEASK IContinued). rtam 

Anemia 619 

Chloroaii 521 

Leukemia 624 

Purpura H^morrlagicii 624 

HtTitophilia 524 

Diet in DJBtaaes of the Genito-urinai7 System 525 

\NephriIis 539 

Acute Nephritie . . 641 

Chronio Parenchyma, to us Kephritis 543 

NephroBia 644 

Acute XephTitis due to Mercurio Cblorid ... 546 

Chrome Inlerstitia] Xephritia 646 

Floating Kidney .... 64S 

Amvlctid Kidney ... .......... 648 

Pjelitift— Pjelonephritii 649 

Renal and Vesical CbIcuII 549 

Lith^mia— llic So-called Uric-acid Dlatheola 549 

Gonorrhea 550 

Piet in Dtaeaafs of the Nervoua System .... . . 550 

Neuralgia 661 

GaBtralsia 662 

ViBceral Neuralgia 652 

Kligraine . 661 

Insomnia and Dieturbed Sleep 663 

Vertigo 664 

Epilepay . . . 564 

Chorea 666 

Apoplexy . 535 

Diet ID Various I'oxlc Condition! 566 

Chronic ilorphm-poieoning 566 

Akoholt»m 6S0 

Chronic Lead-poi Boning 667 

Wfir-Mitchell Reel Cure 657 

Diet for the In^nne 695 

DiMases in which Diet la a Primary Factor 667 

Diabetes 887 

Diabetes Uellitue— The Accessory Diet of Fooda Rich lo Carbohydrates 673 

Substltutee for Sugar 595 

Substitutes for Bread ... 696 

Gout &nd Goutiness , 630 

Rheumatoid Arthritis (Athritls Deformans) 640 

Obesity 940 

Diet for Leanness 6S9 

the iJeii^ivni'v Diseases — Vitaming 669 

ScorbulUB or Srurvy 664 

Berl-Beri or Kakke 666 

Pellagra (Maidismua) . 668 

UoclaBiifled Diseases 670 

Acidosis 670 

Cancer and Demlneralized Food 673 

puctleae Glands, TumoM and Diet 676 

Exophthalmic Goiter 677 

Addiaon'a Disease .... 677 

OatPomBlacia ... 677 

Diet in Di'^Gsaea of the Skin 678 

Eczema 679 

Urticaria 691 

Acne 981 

Acne Rosacea ... 981 

Psoriasis . 692 

Pruritus 8S8 

FuruBculosis 682 



C0STE>/T8 



15 



WAOM 

DIAL Dins . 6BJ 

Kirrll tUrt or Milk Ctir< . 081 

Wlwr Cure 6W 

KomiM Ciin- 085 

fiattmnilk Cuic OSS 

Voile Cure . «S« 

Dirt Curw . . , U8IJ 

b«ll-fr«« DiH ...... C»8 

Tbk Dirrcnc MA^AGCMEM or Svbgicai Casis 099 

Diet Afl«r Operation 703 

kBMT Asa Kavt Raiiohs 710 

ATmy RatWDi . ........ 710 

HktiooR ol Foieign Armies 729 

Rmi«rk« . . 724 

Nfcty RslioDi . 728 

111*' Griicr»l McM . 728 

Tlic CoBUBiBBary Store 790 

Ilic PrrpftratioD of Food 732 

lAEin IX Folic iHSTJTL-Tioffs - 734 

PriMD [Hctarica .... 739 

BmdIUI DtcUrieo ... 747 

Tbc JohB* llopkitu RMplloJ . 74S 

L*kciid« Hocpitnl, Clevvland. Obiu . . 749 

Full DieMalilf— Narj- HospUklii . . . - 7S2 

Crmlg Coloay of EpIUptici . . 7S8 

Dirt tor Chorlfttvr Bo^ In St P&ul'i .'«i>h(wl, nAllimnr<- ... 7(8 
TubenuloKla InflrnMi^, MetropoUtui Honpital. Blackwcirs IsJuid . . 7M 
Tabrrculoalfl Inflrmarv ..... 7S0 

Stcnnd Iliupiial r«t liir Iniane of M«ryluiii for thr Month of April . 7S7 
t'olted StatM GovprniDent Hospiul lor the luMUie. Wasbtngton, D. C- TM 
Uoiutl Statr« Guvfrniiieitt HoaplUl fur tbe InoaDe^ St. ElizabeCb, D. C. 759 
B«T Vi*w Aavlum ... .... , 701 

Sobrrt Qurri'l Frw HospiUI for CUtdTcn. I)«ltlii»re 703 

CbiUrcn's lIui>piUl of Bo«toa . . , . .704 

CrMt OrtDQBd Slrttt lIo«f>ital for Side CltildrcB, Loodoa 780 

llteeim ... 768 

Baveraces . 700 

Ctrtml Bad Cereal Gratia 770 

LtBfth of Time to Cook C«rcalt . . . 771 

Btnd .773 

VffrtabiM 77* 

ftnia-tabl* fftr r<»kiB(t V(-f;(tahI*B in Water . 715 

GaMral RuIm for Cooking VegrtablM . ;7£ 

Ullhoot .Meat Tin 

Prrparaiiona 777 

7S1 

•ad Ullk 782 

■ta 782 

[Graaral Rnln for Soupa . ... 784 

' tbodi of Pri-iwria^ Raw B«^f . . . 788 

rUm Jellita Without Rrlalin , . . . . 78« 

ifr% f« Foc-da for Dlabetir* , .... 791 

tm CitsMiCAL CoupoarnoK or AuniCA:« FooD-MATnuis . . 802 

Rspbaation of Tenna .... fi02 

data oi 3l««t . iob 



16 COSTESTa 

PAOK 

Rapid Reference Diet-usts 837 

Fever 839 

D^epepsift uid Chronic GKBtritia 830 

Dilatation of the Stomach 839 

Atony of the Stomach 840 

Hyperchlorhj-dria or Hyperacidity ... 840 

Ulcer of the Stomach . , 841 

Chronic Diarrhea . 842 

Chronic Constipation . 842 

Debility and Anemia 843 

Obeaity 843 

Diabetes 844 

Gout and Goutiness ... 844 

Albuminuria 845 

Tuberculosis 845 

Epilepsy 846 

Diet After Normal Confinement 846 

Sauplb Pamphlet of Iitpobhatio:t fob DiSTRiBTiTtOEt Auoitq the Poob iw 

SUMUEB .... 847 

Weiosts a:«d Measubes 849 

IjOCKe's Tables of Food Vai.ces , 851 

Table Equivalents (Approximate) 8S1 

Appejjoix 883 

War Dieting 883 



IXDEx 887 



DIET IN HEALTH AND DISEASE 



THE CHEMISTRY AND PHYSIOLOGY 
OF DIGESTION 

Food is the matter that it; taken into the body to supply oourtsh- 

ment or to replace tissuo-wostp. Every physical aet conRUn)i>.s a part 

of the foree tliat has been derived from food. The ni»inl:cnance of 

tiw iKKly-heut couaumefi another part, and in growing individuals s 

[certaJQ amoont is utilized in buildiog up the new titames. 

Food as it in taken into the hcHl^' dilTerx very miieb in composition 
from the material that can be utilised in ccllirrowth aud iu replaeiog 
the tissue-waste. The futietioii of digestion is so to alter the food that 
it may be absorbed by the blood, atid prepare it for ussimitation and 
\ uttUzation by the various tissues. The food of mankind is most varied 
iu nature, differing with the seasons, and with climates, races and 
countries. 

The study of foods is a most complex one. aud unlit reecntly few km* 
itifie investigations alon^ thiii line had been made. Fortunately, 
experimcnta are now beinR i-arried on the world over, and 
it is 10 be hoped thiit the subject of diet in health and in disease wilt 
aoon be lifted out of the vale of empiricism where it hax m long rested. 
I Water. — Water enters into tlte composition of every tixnuv in the 
body and fnmis more than 60 per cent, of the entire body-weight of 
a full-trrown man. As it is not burned up in the metabolic processes. 
it doi:a not furnish any energ>'. 

Salts. — The earthy salts, which form about 6 per cent, of the 
body-weight of un adult man, furnish little if any ener^. They are 
Bost abundant iu the bones and teeth, but they also enter into the 
eonpositiOD of other tissues and fluids of the body. The principal 
ftalts of the body are calcium phosphate and the various compounds 
of polasBium, sodium, magnesium, and iron. The mineral salts are 
very necemary lo life and he-alth. 

Proleina. — These are subetanres which contain nitmgen. are ««• 

■uitifll to life, and &n regar^led as combinations of the various amino- 

■cidti. In addition to carbon, hydrogen, oxygen, and nitrogen protein 

Wwrally contains sulphur and some of tltem phosphorus, iron, cop- 

pn. iodine, manganese and zinc. 

The proteins arc variously classified and two clasafieations, based on 

e 17 



18 CHBMIBTRY AND PBrBIOLOOT OF DIGESTION 

the solubility, have been su^ested, one by the Buglish Society of 
PhysiologiBts and one by the American Society of Biochemists. 

Amerioan Ctiunfication of Protema. 

albumins 

I. Simple prot«iu0 (proteins which yield only a« globulins 

amino-ocids or their derivatives on hydrolysis), glutelins 

alcohol soluble 

proteins (prolamines) 
album i no i OH 
histoDa 
protamias 

glycoproteins 
II. Conjugated proteins (sobatanoes which contain the nucleoproteins 
protein molecule united to some other molecule hemogiobina 
or molecules otherwise than salt ) . phoaphoproteios 

leucoproteins 

Primary protein derivatives (formed through hy- proteins 
drotytic changes which cause only alight altera- metaproteins 
tions of the protein molecule). coagulated 

proteins 

III. Derived Proteins. 

Secondary protein derivatives (products of proteoses 

further hydrolytic clearage of the protein peptones 

molecule). peptide 

Proteins are essential to life and the body is constantly metabolizing 
it, whether any is being taken in or not. In ordinary life the body is 
in protein (or nitrogen) equilibrium and as much protein as is in- 
gested is metabolized. It is difficult to get a positive nitrogen balance, 
except after prolonged fasting or after recovery from wasting dis- 
eases or during the period of body growth. A negative nitrogen 
balance is seen in starvation where more is used up than is taken in 
and in all wasting diseases, such as tuberculosis, in fevers, and hyper- 
thyroidism. Id pathological states such as nephritis there may be 
retention of nitrogen compounds in the body due to the failure of the 
kidney to excrete them, and if the amount exceeds a certain amount 
a condition of poisoning and uremia is brought about. 

Protein Sparen. — A certain amount of protein is essential, but 
nitrogen equilibrium may be established at various levels and if but 
little is taken in the protein metabolized for heat and ener^ may be 
replaced in whole or part by fat or carbohydrate foods which are re- 
garded in this sense as protein sparers. Alcohol also acts as a protein 
sparer. 

Protein is metabolized by oxidation processes into chiefly urea, am> 
monia, carbon-dioxid and water. The intermediary metabolism is 
important and the polypeptids, the amino-acids and the nitrogen free 
residues of the deaminized amino-acids are the important substances. 
The proteins are absorbed as amino-acids. (See same.) 



DWESTIOS AVD AB80RP-ttON 19 

Superior and Inferior Food Froteini. — Some food proteins are 

better suited for human food than others, because when broken up 
into their elementary parts or amino-aeids more of these can be util- 
ized in forming the various body tissues than those derived from other 
foods. For this reason the proteins of milk, meat, eggs and fish are 
most valuable, those of rice and potatoes next in value, while those of 
wheat, maize and beans are distinctly inferior. 

Thomas has shown that the relative value of these proteins are as 
follows : 

Meat protein 30 grama 

Milk protein 31 " 

Rice protein 34 " 

Potato protein 38 " 

Bean protein 64 " 

Bread protein 7(1 " 

Maize protein 102 " 

Thus it is plain that the vegetable proteins are not as suitable for 
repairing tissue -waste, although if sufficient amounts are taken life 
may be maintained. 

Casein contains all the amino-acids necessary for growth of human 
tissues, except glyeocoU, but the human body can make glycocolt from 
casein. The inferior proteins may be Msed to furnish heat and form 
ammonia and urea and the other parts are easily oxidized until the 
end products are water and carbon dioxid. 

Carbohydrates. — Carbohydrate is a name applied lo compounds of 
carbon, hydrogen, and oxygen as they occur in plants and animals 
and the name is used because moat, not all. contain their hydrogen 
and oxygen in the same proportion as it is found in water, that is, 
two of hydrogen to one of oxygen. Some substances with the same 
proportions are not carbohydrates, as lactic acid C., H, O or acetic 
acid Cj Ht Oj. The chemical properties are perhaps more character- 
istic. They are, at least the simpler ones, reducing agents, that is, 
they give up their oxygen readily. They have a neutral reaction in 
aqueous solution, but possess weakly acid and basic characters. They 
may be classified at present as follows: 

Monosaccharide. — Levulose or Fructose. — This is one of the sweetest 
sugars and is found in nature in fruits and as a constituent of various 
di- and polysaccharides. Thus it is found in sucrose, melitose, lupeose 
and inulin. It may be prepared by the hydrolysis of cane sugar by 
sulphuric acid and when pure occurs in white needle-like crystals or 
in a dense mass which becomes light yellow on standing, especially 
if exposed to light. 

Dextrose, d-glucose or grape sugar. — This is the result of the action 
of dilute acids on starch and forms the principal part of commercial 
glucose. It is found in cane sugar, in fruits. In the sap of plants 
and in the blood of many animals. Commercial glucose or com 



20 



CHEUtBTRY ASD PBTBIOLOGY OF DIOBBTIOlf 



Cabbohtdbatxs 



1. MoDOBBcdiaridB 



II. DiBoccharida 



k Bioaes. 



2. THosea. 



3. Tfitroeea. 



III. Pol;saccharid§ 



4. Pmtottt. 

5. Hewotea. 

6. HeptOBea. 

rl. Laotoae. 

2. Maltose. 

3. Saocharote. 

4. Trebaloae. 
6. MelibioBe. 

1. TriB«£cbarids. 



Aldose. 

I Aldoses. 
jKetoses. 

I Aldoaea. 
iKetoses. 

Aldoses. 
Ketosea. 

Aldoses. 
Ketoaes. 

Aldose. 



Qlj/col- 
ald«h]fde. 

Glyoerote. 
Dwxyaoe- 
tone. 

Erython. 

d-Erytkru- 

loae. 

Arabinote, 

xyloae, 

rihoae. 

l-Arahit^ 

fUoae. 

Dextroat, 

galactose, 

manMoae. 

Levutose, 

sorbose. 

d-Uattvo- 
heptose. 



(Glucose + galactose.) 

(Glucose + glucose.) 

[Glucose + le^TiloBC.) 

(Glucose + glucose.} 

(Galactose + glucose.) 

Melitose (RafB- 
nose) in motasso. 
Melixitose. (Pi- 
nus larix.) 
(Levuloee + gla- 
cose + galactose. 



2. Tetraaaoeharida. 



Lupeiise in peas; 
stachyose (Lup- 
eose consists of 
two molecules of 
galactoM, one of 
glucose, and one 
of levulose.) 



Colloidal potysaccharida. 



I Dextrina. 
Glycogen. 
Cellulose. 
Starch. 
Mucilages. 
Gums. 
Inulin. 



^Tup is usually made by tlie action of dilute hydrochloric acid on 
corn starch or on potato starch. It usually contains an admixture 
of deztrins and not infrequently impurities. In former times when 
it was largely made by using sulphuric acid, arsenical poisoning re- 



DtGBSTIOS AJfD ABBORPTION 



21 



suited from the acid containing arsenic. In these cases the glucose 
was used to make beer which contained arsenic. 

d-Galactose. — This is found as one of the constituents of milk-sugar 
or lactose, the other being glucose. It is found in nerve sheaths and 
on the brain and in plants. 

Glucosides. — These are found in plants and animals and on hydro- 
lysis form glucose or some other monosaccharide. 

Ditaocharids. — These yield two molecules of monosaccharids on 
hydrolysis as follows : 

DUaccbuid*. 
Cane sogar. (Sucroae) 

Maltose 

L«cto«e 



TrehakMC 



Melibcwe 



OcGiuTeiice. 


Yield on 
hydrolysis. 


Sogsr cane; beets 

(Saccharum officinarum ) 


Levulose 
Dextrose 


Germinating barley 
IMgeation o? starch 


Dextrose 
Dextrose 


Hillc 


Dextrose 
Galactose 


Various fungi. Boletus edulis. 
Ergot. TrehaU 


Dextrose 
Dextrose 


From melitose in molasses 
Australian manna 


Galactose 
Dextrose 



(See also under beading of tugar.) 

Lactose. — This is found in the mammary gland and is found in 
milk. It is not as sweet as caiie sugar. Commercial milk sugar con- 
tains many impurities, so that only the refined product is suitable for 
infant feeding. 

Maltose. — This is found most widely in nature, both in plants and 
animals, as it is formed by the action of amylase in starch. It crystal- 
lizes iu white needles, is not as sweet as cane sugar and ferments 
readily. It seems possible that maltose may be utilized strictly by 
the tissues and it has been suggested for use in feeding, especially 
infants and invalids under certain conditions. 

Polysaccharidea. — These are either insoluble or form colloids in 
aqueous solutions and are represented by starch, glycogen, dextrins, 
cellulose, various gums, mucilage, and inulin. 

Glucose Tolerance. — Woodyatt, Sansum and Wilder have de- 
termiued that a man weighing 70 kilograms when resting quietly in 
bed may receive and utilize 63 grams of glucose by vein per hour. 
This amounts to 252 calories per hour or 6,048 per day or over double 
his requirements. The normal tolerance limit is near 0.85 grams 
glucose per kilo of body weight hourly, which corresponds to the 
figures of Blumentha! determined on animals. In Graves' disease 
the tolerance limit was 0.65 grams per kilo an hour. (See also 
Wilder arid Sansum, The Archives of Internal Medicine, 1917, xix, 
page 311.) 

Levulose tolerance is 0.15 grams per kilo an hour, galactose 0.1 



22 



CBEMtSTRr AXD PBYSIOlOnY OF DlOESTfOy 



graiDS ami luctosc approaches 0. When glucose is given faster than 
the tolerance it causes glycosuria and diurMia. If thfl amounts given 
are much in excess of the toleranae the tliurosis is rt'iuHrkahle and 
may lead to drhydratioii ajid i( continued enormous quantitiwt of 
fluid may he reijuired wLidi may lead to heart failure. 

By mouth the amounts of the various sii^tirs necessarj' to produce 
glycosuria are given by Von Nrmrden us follows: 

Milk sugar, more than 1:^(1 gi'ains. 

Cane sugar, more than 150 to 2fl0 grams. 

Fruit sUjTar, more than 200 prams. 

Grape sugar, more than 200 to 2o0 grams. 

Glycogen.— One iif the uiomI important functions of the liver is 
the J!o-called glyeogeuic function. In 1857 Clauile Bernard dcmon- 
atratfld the presence of glycogen and fonuulated a classical theory 
regarding its place in nutrition. Glycogen is soluble in wat«r and 
has tli<* Kame oliemir fnniuilii as stanch. Toward digestive juices it 
also bchiivcs like starch and th<^ end products are the n&me as in 
the case of staroli. namely, maltose and dextrose. Il is commonly 
known as animal stareii. With iodin it g)v«s a reddinh iiixlead of a 
hlue cfllor as obtained with ordinary starch, CJIycogen is fonncd 
sjTithetically in tKe liver from the moiiosaccharids by the proi-t'as of 
!ipliLtin]r oil' one ni(»Ifi'uli' of ivalir. It is then stored in the liver 
ccIU. The musulcH »U<i ik'I uh a ulorc-hnuse for glycogen. Lactose 
mu8t first he split into dextrose and galactose in the intestine before 
it may be transformed into glycogen and advantaffp is taken of thin 
fact in using lactose in u test for renal functi(»n by iujceting it 
difpctly into tiw blood. Therp are several theories regarding the way 
glycogen is nswl. IJcrnard thought the liver acted as a store-houne 
and regulator, the glycogen being converted into dexlroue and con- 
veyed to the muscles through thf blood. If the amount of sugar in 
the blood exceeds a certain percentage it is excreted by the kidnej'S, 
A special eni^me, called gtyeogenase, bm been destiribed in the liver 
as the active agent in eau.Hing the tranxformatitui. Pavy believes 
that tlif i-iirboliydratc nioleeulr is fastened on in thr protein molecule 
in the liver and thiu conveyt-d to the muscles where il is set free. In 
starvation the glyeogen part of the liver is tirst used up and the 
mutwles are found lo contain a considerable amount, even after the 
liver has beeome glycogen-free. The dilTerence that exists between 
the muscles and liver supplies of glycogen have been cnniparrd to the 
difference lietwecn retail shops where the material is supplied imme- 
diately til the <*(nisnmer, and tlie wan-house where it is sturetl ui lai^e 
qnantities. 

Glycogen may also be formc<l from the proteins of the body as has 
been proven experimentally. This occurs patholoffieally in diabetes. 
Fata may also apparently be converted into glycogen, but there is a 
qnestion aa to how far this actually occurs in the human bodj.- and 



i 




Dtassrioif syD absobptiox 



23 



lieve that it only takes place under certain pathological con- 
Fats and Allied Substanceg. — Tbere is a group of substanc«i! 
popularl.v oalteij fats, a teritt which refers more particularly to ouc 
uienitwr nf the group which includes tats., oils, waxes, pliosphatids, 
ElprnU hoi] h fi-\T other KubxIuuceH. It haH bct-u Huj^gcstcd that the 
whole lot be called Upitu. They have in common certain properties, 
they ari' greasy, iiisoiubk* in water, soluble in ehlorofonn, alcohol, 
etliiT and other fat solvents. Fal euten* iutu the composition of 
protoplasm and enables it to take up water without dissoMog. The 
fats of i\w body Hre esters of glycerin (e»Iled by some authnni 
glycerol ) . Olyeerln m a Inatomii.' alcohol and all those of the 
bydroxyl groups are replaced by acid radivalti, palmitic, stearic and 
oleic acids hk a mle, but othern as bulync acid o«^ur. Fatii are 
nomrtinic-s rt-fcrml In as triglyceride. Fatn. in a litnitrd sense, are 
c«ler« of ttlyecriu and fatty acids, which are sultd at 20^ C. Dif- 
ferent fats vary in ihetr melting point. Bod.v fat is a mixture of 
stearin, palmitiu and oleiu and its melting point ia 25° C. Olein has 
a melting point of 5* C, paluiitin 4!)' C, and stearin varies from 
53=^ to 65" <". 

Fatly oils are neutral esters of glycerin and fatty acids, liquid at 
20" C. These are divided into drying oils, as linseed oil, which 
dries and hardeua on exposure to light and air; semi-drying oils, as 
cottonseed oil. which thickens gradually on exposure; non-drying oils, 
as olive oil, whieh neither dries nor thickeuti: aud essential oils, as 
oil of cloves, whieh are generally volatile ami mliferons. 

Th« Itetaboliim of Fat.^The fat is utilized in the body to build 
Dp Chf falty lisKUPs and it pnters very largely in the composition of 
the red bitrir marrow. It in al^o used in the formation of protoplasm. 
The fnts are osidjzej until they are redui'ed to carbon dioxid and 
vuler. but tbe intermediate changes that take place are not very well 
uuderstixxl at this time. The loug carbon chains of the higher 
&Uty acids arc broken down by oxidation. 

Soiuc of thr fat-s may form sugar, as in diabetes, but the changes 
by which this is possible arc not understood. 

Fats are also transformed into the important phosphatids, as leci- 
thin and cfrebrin. into chotestcrin arid the bile acids. 

Foreign fats may he absorbed as su<:h and he deposited in tbe 
body at mich and apparently utilized by the limly in the same way as 
ordinary fat. It is believed that fatty tt.ssi»- derived from nmtton 
is firmer and uiore resistant than that formed from tbe oils. 

Part of the fats of the Ixxly are derived from the transformation of 
earbohydrales. Thus carbohydrat<-s contain more oxygen and it has 
been snggested that after part of the osygen has been used the re- 
nkaining carbon compounds form fatty acids. 

Port of tbe fat is also formed from protein. This fat is the 



24 



VBMMISTJtV AND PUVSiOLOQY OK DtOESTtOii 



dpaminizcd rpsidue of tlie amino-acids of the protein. These may 
also form sugar. 

Apart from fut£ stfirnl up a» such lipins make up varying amoimbi 
of the auiinal body, the greatest aiuouots beiu^ in the braio and 
ac)r«iial. 

Fats and Qilti coiitaiii U*.ss oxygen in pniportiou U) their carbon 
eoutent as compared to carbohydrates. Fats are sulid at yrdiuary 
tomperaturea, whilst oils are fluid. The fatty aeida of the fatJ* arc 
Dearly or totally saturated while those of the oils are not. It is 
interesting from a food standpoint to iiotft that not all fats are the 
aame in their relation to the prowth of young animals. Certain fats 
evidently contain vitamines whilst others do not. Thu.s they are 
present in butter aud absent in olive oil. Mendel and Oslmrrie found 
that young rats did not grow as rapidly when fed on oleomargarine 
or botterine as when fed on butter. 



DIGESTION AND ABSOBPTION 

DIOESTIOH 

Food, in order to be used by the body, must be digested and tbiB 
process of digestion ia a complicated one. It might almost be said 
to begin before the food is eaten, as it is greatly influenced by appe- 
tite, smell, Might, aud the gurroundJngK. These siibjeclK will be men- 
tioned more fully later on, Good food prepan^d in a nkiUVil manner, 
pleasant to ecc, to smeli, and to taste, taken in comfortable surround- 
ingii, with cheerful companions, will be digested with ease by normal 
individual!!, while the reverse of all or uiiy of these may cause 
indigestion due to the mental action upon digestion — chiefly, perhaps, 
on the digestive glamls. Pawlow has made a most fascinating study 
of this subject, to which the reader i.i referred.' 

The Passage of Food Through the Alimentary Tract. — The first 
step in the dif^cstion of food is mastication, which is perhaps the 
only purely voluntary act coniiectcil with tlic pniccss. By this means 
the fo4Hl is ground to a tine pulp aud thoroughly niixinl with saliva. 
It is ncccjtsary to have good teeth, aud the importance of the care 
and preservation of the teeth cauiict be too strongly insisted upon. 
Defeetivc teeth are a menace to health, as they lead lu llie food being 
imperfectly masticated, and the constant absorption of toxic material 
may affect both digestion and the general health. In the process of 
ehewing the muw'ies of the ebeek.H and lips xerve to keep the food in. 
the line of the teeth, and when the facial mUHrlcs are paralyzed masti* 
cation may he difficult. 

Deglutition is usually a reflex action and is generally involuntary, 
although it may be b^n by a voluntary effort. The food pasaes 
with varied rapidity from the month through the pharynx and csoph- 
■ Pnvlow, Tlie Work of th<^ Digvstiv* Olmuls- 



^ 




I 

I 



into the Momucli. To be easily nwallowed the food must be 
aiiJ oil the tuutfuo, and it i^ ditfic-ult or impussible to swallow 
dry food. Liquid or very soft food may pass directly into tlie 
stomach iu as tittle as 0.1 secoad, but semisolid titid solid food are 
forced down the esophagus by a sort of peristaltic luovi-mcnt, lakiiiR 
us long aK six secoiulK to ri'ach the slomach. There may be a delay 
of from four to right sevoads at the cardiac sphincter. Paraly- 
sis of tb« soft palate cauiies the food to be regurgitated through 
the nose when swallowing Ik attempted, and if the musoU-ii of the 
pharynx or larynx are paraly/erJ the food may bv aspirated 
into the trachea, bronchi, or lung, and so set up a broncbopoeu- 
inoDia. 

FocmI remains, in the stomach until it ha^ been reduced to more or 
less of a liquid, when it is forced through the pylorus from time to 
time. Our knowledge of gatitric movements dates from the classic 
ezpcrimenta made un Alexis St. Martin by Beaumont, and h great 
deal of research bos been devoted to the subject in recent years. 
The fundus of the stomach acts as a reservoir for the food, while 
the pyloric end scn'es to trrind and macerate it until it is forced out 
of the Ntomuch into the duudeinim, the pylorus apparently opening 
under the atimulus caused by the combination of the food being 
liquid in character and acid in rcaelion. In the duotlcimni the acid 
causes the pylorus to close. The order in which the food is digested 
depends somewbat on the order in which it is ingested and the amount 
of fluid taken with it. Kor example, if carbohydrates arc fed first and 
then proteins, the carbohydrate passes almost immediately into the 
nnall intestine; if, however, the protein is fed lirat, the carbohydrate 
remains in the stomach much longer. 

HedbltH)ni and Cannon haw summarised the result^! of their inves- 
tigatiuus on the passage of food from tlie slumaeh as follows: 

If carbohydrate food is thinned by adding water, there is, within 
limits, very little change in the rate of exit from the stomach ; but 
adding water to protein food tends to make the discharge more rapid. 
AVbeu hard partlolea are present iu the food, the rate of outgo from 
tbc stomach is notably retarded. C'uarse, branny food leaves the 
Ktoauu^h filightly faster than similar foods of finer texture. The pres- 
ence of gas in tlie stoniucli delays gastric discharge, an ctTm;! due to 
the gas preventing the walls of the stomach from cxertiiip the noniial 
BiUDg and propelling action on the food. No considerable variation 
from the normal rate of exit fnim the Ktomadi is observed when the 
food is fed very hot or very cold. Pood with approximately normal 
acidity leaves the stomach roueh faster than fond wliieh in hyperacid 
(1 per cent.), a result in harmony with other observations on ihe 
acid control of tJic pylorus. Feeding acid food is followed by deep 
and rapid peristaUi.'i. ^faiuiage of the stomach, even when extensive, 
baa T«ry slight influence on the passage of food through the pylorua. 



26 



CHBHISTRY ASD PBY810L0QY OF DIG^^Tloy 



Irritation of 1lie wlon (with crotou oil! uoialily retards gastric dis- 
cbarge, ttiui dfUys the movements of food through the tmiall intes- 
tine. 

In th« intestine the food is moved forward by the peristaltic move* 
mciitii; u wave of rflaxatioti moves along tke iDtestine followed by a 
wave of contraction »ii<l ihis spr\'e.s to pass tlu' contents of rlic bowel 
downward. Antiperistalsis is said not to occur under normal condi- 
tions; it may occur in injury or disease of the intestine, especially in 
intestinal nbstnittion. In addition to this geueral movcmtint there 
are local rliytliniic mwvcuieiils oifurriiiy at the parts of the iulesline 
oticupicd by food. The masn to he digcated is scparutcct into numerous 
small masses iiy this movement, and then these are swept together and 
ftlso onward by the wave of peristalsis. The length of time that a 
m«al takes to pass from the stomach to the large bowel varies, but it 
is alxnit fnnr honrs on an average, and the 6rKt part of the meal may 
be at tlie ileocecal valve by tlie time the lust of it lcavc^ the stomuch. 
Various things may upset the movements of the intestiu<?s. A sudden 
disturbance of circulation in the bowel may cause violent movements, 
and dyspnea may either increase the movements or stop them alto- 
gether. The organic acids formed in the bowel as the result of the 
bacterial action art us stlmulantji to intestinal movement. 

The movement through the largir intestine is slow, as it is there that 
moat of the water is absorbed. The passage of the intestinal contents 
is delaycil in the a-si-ciulinj: colon by reverse pcristallie movements. 
According to the observations of Uertz the feccis take two hours on 
v) average to piLss from the ileoeecal valve to the hepatic flexure, and 
about four and a half houni to pass from there to the splenic flexure, 
from whence the feces are moved slowly to the sigmoid tleiture. The 
nvlum is proltahly empty until just before defecation, and the en- 
Iriuiec of fcti-« into the rectum probably excites the desire. The 
recHuni is cUu^cd by the intenial and external sphincters, the latter 
being partly niider the control of the will. Defecation is partly a 
voluntary and partly an involuntary action. 

The digeKtion of f(H>d takes plaee thntiigh a numbnr of chemical 
changes brought iiIkjui in the alimentary tract by the action of certain 
auorguniziHl fcrroenttf uKually known aa e-n]:>'mes. Along with these 
chemical changes there are, of course, alterations in U)e physical 
properties of the Food, the two combined allowing the useful part to 
be assimilated while the remainder passes oiX hs refuse. 

Enzymes. — An euxyme is a suljstance, produced by living cells, 
which acts by catalysis. They are complex nitrogenous substances 
which act speciHcally, the exact chemical nature of which is unknown. 
Howell makes the following elaasifieation — 

L Pwteelytio or protein-iplittiiif ensyiDM.— Examples: — Pepsin o! 
gastriu juioe, tr\'p«in of pancreatic juice. They cause a hydrolytlc 
cleavage of the protein molecule. 




DIOESTION ASD AB80RPTI0N 27 

2. Amylolytic or itarch-iplittiiiff enzymes. — Examples: — Ptyalin or 
salivary diastase, amylase, or pancreatic diastase. Their action is 
closely similar to that of the classical enzyme of this g^up — diastase 
— ^foiind in germinating barley grains. They cause a hydrolytic cleav- 
age of the starch molecule. 

3. lipolytic or fat-iplittii^ enzymei. — Examples : — The lipase found 
in the pancreatic secretion, in the liver, connective tissue, blood, etc. 
They cause hydrolytic cleavage of the fat molecule. 

4. The deaminiring enzymes, which by hydrolytic cleavage split off 
an NH; group as ammonia. Thus alanin by hydrolysis loses its 
NH; group as ammonia and passes into lactic acid. 

5. Protective enzymes.^Experimental work recently has shown 
that when foreign proteins, carbohydrates, or fats are introduced into 
the blood of a living animal corresponding enzjones are formed which 
are adapted to break down the foreign material by a process of diges- 
tion. 

6. Sagar-splitting enzymes, or those having the property of con- 
verting the double into the single sugars — the disacoharids, such as 
sugar-cane and maltose, into the monosaccharids, as dextrose and 
levulose. Two such enzymes are found in the small intestine. One 
of these acts on cane-sugar, and is known as invertin or invertase; 
whereas the other acts on maltose, and is known as maltase. Other 
enzj-mes split the monosaccharids, as one found in the tissues capable 
of changing the blood and tissue sugar (dextrose) into lactic acid. 

7. Coagulating enzymes, or those acting upon soluble proteins, pre* 
cipitating them in an insoluble form. Kennin, the milk-curdling fer- 
ment of the gastric juice, is an example of this class of enzymes. 

8. Oxidizing Enzymes or Oxidases. — These set up oxidation processes. 
They are found in the various organs and tissues. ( See Table, page 28. ) 

Enzymes have certain properties in common. They are, for ex- 
ample, soluble in water, salt solution and glycerin. They are de- 
stroyed at a temperature of from 60° to 80° C., and their action is 
retarded or entirely suspended by low temperatures, — e. g., by freez- 
ing, — without, however, actually destroying the enzyme. They are 
characterized further \ty the fact that after a certain degree of 
change has been effected the products of their activity prevent fur- 
ther action, so that most of them may be said to be incomplete in 
this respect. Most enzymes show an optimum activity at temperatures 
approximating that of the body. 

Another curious fact is that the activity of an enzyme is not in 
proportion to the amount present. A trifling quantity may effect 
enormous change, and increasing the amount of enzyme augments the 
change produced, but only to a certain point, after which the action 
is the same whether much or little be added. An enzyme cannot be 
used over and over again, as it is altered in some way and so rendered 
incapable of indefinite action. 



28 



CHEMISTRY AJiD PHYSIOLOGY OF DIOEBTIOy 



Partial Liat of the Etaymea Concerned in tke Proce»se» of Digeation OMd 
nutrition (Howell), 



i 

I 



Where ebieSy found. 
Salivary secretion 



Euiyme. 
PtyaJin (salivary 

diastase } 
Amylase (pancre- 
atic diaetase) Pancreatic secretion 



Liver glycogenase Liver 
MuBcIe glycogenase Muscles 

Small intestiiie 



Invertase 
Maltase 

Lactase 
Glycolytic T 
J Lipase (steapsiny 



Small intestine, 
salivary and paacre- 
atic secretion 
Small intestine 

Muscles T 



Action. 
Converts starch to sugar 
(AUltose). 

Converts starch to sugar 

(Maltose). 
Converts glycogen to dextrose. 
Converts glycogen to dextrose. 
Converts cane sugar to dextrose 

and levulose. 
Converts maltose to dextrose. 



C<Hiverts lactose to dextrose and 

galactose. 
Splits and oxidizes dextrose. 



Pancreatic secretion, Splits neutral fats to fatty 
fat, tissues, blood, etc. acids and glycerin. 






a 
o 

I 



Pepsin 

Trypsin 

Erepsin 



Group of autolytic 

enzymes. 

Guanase 

Adenase 

Deaminase t 



Gastric juice 
Pancreatic juice 
Small intestine 

Tissues generally 

Thymus, adrenals, 

pancreas 

Spleen, pancreas, 

liver 

Tissues generally 



Oxidases 
ReductasM 



Catalose 
Arginase 



Lungs, liver, muscle, 

etc. 

Tissues generally 



Manv tissues 
Idver, and spleen 



Converts proteins to peptones 
and proteoses. 

Splits proteins into their con- 
stituent ami no-acids. 

Splits peptones and proteoses 
into tbcir constituent amino- 
acids. 

Splits proteins into nitrogen- 
ous base^ and ami no-bodies. 
Converts guanin to xanthin. 

Converts adenin to livpoxan- 

thin. 
Splits off the XH: group from 

the amino acids with the 

formation of non nitrogenous 

organic acids. 

Causes oxidation of organic 
substances. 

Cause reduction as for example, 
the rcductitm of oxyhemoglo- 
bin to hi'mnKlohin. 

Deconipos*-* liydro^en peroxide. 

Splits argiuiii tvith production 
of urea and ornithin. 



It is commonly believed that enzymes effect their changes by liydro- 
lysis; that is, they cause the substance acted upon to take up one 
or more molecules of water, the result being that the complex body 
separates into two simpler ones. Take, for example, the familiar 
example of the change in cane-sugar: 

C„H»0„ + H^ = CJIuO, + CJIuO,. 

Oane-iugar. iitxtiont. Leiulwc 



How this change is brought about is not known. 



I 



Witii this prclitnitmr}- cousidcratiou of the euzymes we may oovr 
proceed lo tli<! study of digestion. 

Salivary Digestion. — Wben food is taken into the mouth and mait- 
ticutfd. there i» a istiniulnliou of tlie secretory nerves which results 
in a flovr of saliva, wliicli in the euinhiiiftl HerrHluiri of the parotid^ 
KubmaxUlary, and sublingual glands, togetlier with that of the mucous 
giMuh of the mouth. It i& usually (Colorless, ropy, aud stringy, duo 
to the pivseuct' of mucin, of a weakly alkaline reaction, and has a 
specific gravity of 1.003. It acts best in a ueakly alkaline medium. 
Thi? dijjnti ive ffrnicnt which it coutaiiis is called piyalin. Fcrhaps the 
chief u»e of saliva is to soft«n the food aud to oct as a lubricant 
The thorough nioislening of the food ensures its being easily swal- 
lowed. The Biiinuut of digestion that takes place in the mouth is 
small, owiug tu the Klmrt tinie the food remain!! there, hut the action 
of the saliva is, under certain conditiom;, continued in the stomach. 
Maatication not only divides the fond, but stimulates the flow of 
saliva, and this in turn moistens the foot! and permits il to be tasted. 
The laAte of food further stimulates the seereiloii of saliva. 

Ptyalin. the digestive cuxyme, acta upon starches by a hydrolylic 

ftgif process, converting them into sugar and dextrin. The exact 
ical process through which the starch molecule goes has not been 
tely decided upou, but the following scheme is most generally 
led: 



I 



Starch 



Mai tow 
Erjtlirodvzlrui 



MaltOflr. 
Aclirofiileslrin. 



/ IkfnItoM. 

\ MilllOM. 



* 



The presemre of starch being evidenced by its blue color when brought 
into eoDtact with iodin, erythrodcxtrin red. and acbroodexlrin color- 

l«K. 

Until late years it van thought that the digestion of starchvK in the 
stonineh was quite imigniiicant, becaase of the fact that acid not only 
inhibits but destroys ptyalin. Since the x-ray work of such investi- 
^ton« as Cannon and Her/, we know this conception to be erroneous, 
Ow they have shown the layer formation of food as it enters the stom- 
ach, whereby the last to tie received ix protected from the acid secre- 
tioD of the fnndic portion, thus delaying for a considerable time 
(forty to ninety minutes) the contact of aeid with plyalm. and there- 
fore. Halivar>' digestion is carried ou to a considerable degree before 
bring interferetl with by the gastric juice. Raw starch is acted upon 
rrry slowly, whereas in well-cooked Rtarnh sugar may l>e detected 
after even one minute. Thi.s is due to the fact that the starch gran- 
ales arp stirroQndcd by an envelope of v^ctable Hber (cellulose) that 
pnitwis it from the action of the ferment. On boiling, this eelluloM 
cnrering is broken, tuid the iitarrh is not only liberated, but also takes 
up water, rendering it easy of digestion. TSee section on C<K>king.) 

Qaslrtc fHgrsKon.— We are indebted to Pawlow for a great 



30 CHEMISTRY AND PHYSIOLOGY OF DIOEBTIOJf 

amount of pioueer work concerniQg the nature of digestive processes. 
It was he who established the fact of psychic secretion, which we 
now know to be a most important factor in digestion. The hrst stimu- 
lus of gastric secretion originates in the mouth, and this causes the 
first flow of gastric juice, when the furtherance of the flow depends 
upon the action of what we know as secretagogues. Some foods con- 
tain substances that have the power to cause secretion of gastric 
juice when taken into the stomach; for example, meat extract and 
meat juices. This element is present to a much less extent in milk, 
while bread and white of egg have practically no effect at all. 

Howell gives three steps in the mechanism of secretion; (1) Psy- 
chical secretion; (2) Secretion from secretagogues contained in the 
food; (3) The secretion from secretagogues contained in the products 
of digestion. 

Edkins is of the opinion that the secretagogues, whether present 
in the food or formed during digestion, act upon the pyloric mucous 
membrane and form a substance which he designates as gastric secre- 
tin, and this substance after absorption into the blood is carried to the 
gastric glands and stimulates them to secretion. 

Various foods produce gastric secretion of varying digestive quali- 
ties; for instance, that produced by bread is less in quantity but of 
greater digestive power than that produced by meat. The juice 
produced by psychic stimulation is always of the same quality. 

Gastric juice is a thin, colorless, strongly acid liquid, with a specific 
gravity of about 1.002. Its moat important constituents are hydro- 
chloric acid, pepsin, rennin, and lipase. 

Pepsin is a proteolytic enzyme acting only in acid media. It is 
present in the cells as a zymogen, and is not changed to the active 
pepsin until after secretion. The process of peptic digestion is usually 
accepted as follows: 

Protein. 

Acid albumin (syntonin). 

Primary proteoses iprotalhumoaee) . 

Sei>ondarj' proteoets (deuuro-albumosee). 

Peptone. 

The whole process seems to be one of hydrolytic cleavage of the 
protein molecule, with peptone as the final stages as far as gastric 
digestion is concerned. All changes wrought by the digestive fer- 
ments on the food-stuffs are hydrolytic. Recently it has been stated 
that if time enough is given to the action of pepsin it will break the 
protein molecule as completely as after the action of trypsin, or after 
hydrolysis by acids. 

Bennin is the enzyme of the gastric juice which has to do with the 
curdling of milk. It is present in the cells of the gastric tubules in 
the form of a zymogen, being converted into an active enzyme in the 



DfGBSTlOX ASD ABeOtHTiOX 



31 



an-id. Tl[<: Hction upon titiman milk causes the fonuution 
eciili, while the curd formed by ito action ou cows' milk is 
more solid aud of rirmer eousisienuy. 

Fat& undergo siuijily a ptiy»ical cbangi: id thv ntomach, the chemical 
actiou upon theiu bciag ell'ected b,v the iutestinnl juicc-s. 

Intestinal Digestion.^Wlien the lood bail been pasK^ into the 
small intestiiif. It is acted uu siniuiiaueously by tlirev xecrelioiLs — the 
pani-reatic juice, the intestinal juice, and the bile. Although thesw 
se«ret>oiis, a& stated, act together, for the sake o( simplicity each will 
be considered Reparately. 

Pancreatic Juice. — Our knowledge of the functions of the pancreatic 
juip(> iei obtained lai^cly from experiments made on the lower aniraala. 
In man it entent the inleKtint> together with or closely following or 
prcc<'diiip Ihft biUs Ijcinj; inixrd with thr latter secretion and the food- 
material at the same time. It in alkaline in rt^ac-tiuii, and contains at 
least three, and probably more, enzymes — viz., trypsin, amylase, steap- 
siu, or lipase, and, it m said, a milk-curdling ferment similar to 
renuin. 

AccordinfT to Panlow, the amounts of the various ferraeuta in 
tbe pancreatic juice vary with the nature of the ftHHl taken, starchy 
food causing an increase in the amylase, and so forth. These state- 
ments have not been fully confinned as yet by other observers. Paw- 
low has also shown that the presence of bile doubles the activity of 
the digestive jiii(r«w. 

Trypsi rt .^Trypsin is a more active ferment than is F>i.'pHin, and 
acts in alkaline, ucutral, or even in slightly acid media. It Is most 
active, however, in alkaline solutions. The proi'ew* by wbicli peptones 
are formed from proteins is similar to that of peptic digestion, but 
diffrra somewhat in detail. Trypsin, however, is capable of carrying 
on the digestion of peptones further than is peptun. The stepK in the 
hydrolysis of the protein molecule by trypsiu have been the subject 
of a very great amount of study. The trypsin, like the pepsin, hydro- 
Ijrzes the simple proteins first to a proteose, and then to a peptone 
gUtgt, but the latter product may be split still further into a variety 
of simpler IkmIipk. the number and character of which depend on the 
amount of trypsin and the lime that it acts. The actual pmdncta 
fonued depend on the length of time the trypsin is allowed to act 
■ml the conditions, favorable or unfavorable, under whieb it acts. 
Tbe end products formed are the amino-acids. 

The digestion of gelatinoids is Himilar to that of the proteins. 
Tr}-p«in produces gelatin-peptone. wherea-H pepsin, as pn'viously 
■taled. reaises to act with the formation of gelatose. 

Amylase converts starch, by hydrolysis, into maltose aud achro- 
odr^ttrin. in the mime w&.v that ptyalin does. Before absorption tbe 
■tbttUWM arc further acted upon by the maltase of the intestinal 
mmtiou and ennverted to dextrose. It is important that the 



82 



CBBMtSTRY ASD PRYBiOLOOY OF DtOSBTtOJi 



Starches should be completely <\igpsted in tlie sni»II intestines, espe- 
cially as a large part of the heat and energy consumed liy thf Xtudy is 
derived fn>m some forni of starchy food. 

Steapsin, knovfu also &s lipaae, splits up the ueutral fats into glycerin 
and free fatty acidK. This cmulsifieatiou is of paramount iiuportanee 
in fal-diirestion and absorption. The procesw now berfltnes again one 
of hydrolysis. The fat takes up water and splits up into other prod- 
neta. The foUovriug formula explains the process : 

C,H.(fH„+.COO). + 8nrf> = CH.iOH), + S(C.H,M+.COOH) 
Pat. Olrc«rlu. Pre* fiiix ncld. 

There are two views concerninif the absorption of fat. The older 
view is that the fat splits or is saponified only to a small extent, the 
larger part of it beinp emulsified liy the fatty acids formed during 
the aplilting-up proeesa. This emulsified fat is then directly absorbed 
an neutral fat. The view more recently adopted ix that all the fat is 
split up into glyceriu aud fatty acids, whether or not emulsification 
has previously occurred. The fatty aeids are saponified by the action 
of the alkaline salts in the intestine, the products being then absorhcd, 
aod brouRht into combination attain to form a neutral fat. This re- 
combination may occur in the epithelial celts iif the inte«;tino. Th9 
action of lipase is reversible, that is, it may split up the fuls or it 
may cause synthesis of the split products. Lipase is found in many 
tissues of the body, as liver, musi-lf. and mammary glands. It is 
possible that fat is split and re-formed many times in the processes of 
nutrition. 

Emulsiticatiou takes place more rapidly in the presence of bile and 
pancreatic fluid than in th« presence of pancreatic fluid alone. Al- 
though bile itself causes no emulsilication, it aidis very materially in 
the process. "" 

Intestinal Secretion. — This is the secretion of the intestinal glands, 
the er^'pts of Lietierkiihn. It is atrougly alkaline from the prewnea 
of sodium carbonate, and this may aid in the emulsification of fat. 
Otherwise the intestinal seeretion probably has no aetion on the pro- 
teins or fats. The sei.-retion and the walls of the small intestines con- 
tain three ferments which act upon earibohydrates. These are invcr- 
tase, which acts upon caue-augar; maltase, which nctm upon maltose 
and dextrin, and laetiwe, which nct-s upon laetosp. The walls of the 
intestines contain also erepsin and cntcrokinase. Erepsin probably 
continues or supplements the ehauge begun by trypsin. This enxj.Tne 
acts especially upon the proteoses and peptones, causing further 
hydrolysis. The digestion of the protein begun by the pcpKin or the 
trypsin U carried to completion by the action of the erepsin. Erepsin 
has been found by Vernon in all the tissues of the body. It is present 
in the fcidncj-» in frroater quantities than in the intestinal mucosa. 
Enterokinttse acts upon the pancreatic juice. Apart from the small 



> 



DIOEBTION AyD ABSORPTION 33 

intestme the pancreatic juice has no digestive action on proteins. 
The explanation of this is that the juice contains a substance, tryp- 
sinogen, capable of being converted into trypsin by the action of en- 
terokinase. As soon as the pancreatic juice comes in contact with 
the intestinal wall the previously inert trypsinogen is changed into 
the very active ferment, trypsin. 

Secreiin. — This is not an enzyme, but a definite chemical compound. 
It is secreted by the wall of the small intestine when acids are brought 
in contact with it. Secretin is supposed to be absorbed by the blood, 
and being thus carried to the pancreas, excites the secretion of the 
pancreatic juice. As we descend the intestinal tract the quantity of 
enzymes contained in the intestinal secretion becomes smaller. The 
lai^e intestine secretes mucus but no enzymes. 

Bacterial Chains. — The changes produced by bacteria are an ex- 
tremely important factor in digestion, especially from the pathologic 
standpoint. The subject can not, however, be entered upon fully 
here, and for a complete knowledge the student should consult the 
special text-books on bacteriology. For our present purpose it ia 
sufficient to say that, in the small intestine, bacterial changes are 
probably limited to the carbohydrate. Under abnormal conditions, 
or when excessive quantities of protein food are taken, putrefaction 
of the proteins may occur. In the large intestine, however, the ex- 
treme alkalinity overcomes this acidity, and allows putrefaction of 
the feces to take place. The products of bacterial action are many, 
and consist of leucin, tyrosin, phenol, skatol, and various acids and 
gases. Some of these, after having undergone certain changes, are 
absorbed and excreted again in the urine. It is not definitely known 
just what part they play in the nutrition of the body. Judging from 
the experiments of Nuttall. it is reasonably certain, however, that 
bacterial action is not essential to nutrition. 

Liver. — The liver plays an important part in the nutrition of the 
body. This importance is due largely to the bile which it secretes, 
and which is an adjuvant to intestinal digestion, and to the action of 
the liver-cells on the absorbed food-material as it is found in the portal 
circulation. 

The bile contains bile-pigments, bile acida (glycocholic and tauro- 
cholic), cholesterin, lecithin, fats, and nucleo-albumin. 

The function of the bile-pignients is obscure. Evidently they are 
waste-products of metabolism. The bile acids are believed-to play an 
important physiologic role. They dissolve the cholesterin and facili- 
tate the absorption of fats. Cholesterin is regarded as a waste-prod- 
uct formed in various tissues, and is excreted by the liver-eells, as well 
as by the skin glands, and the mammary gland. Lecithin is also a 
waste-product. Antiseptic properties have been ascribed to the bile, 
a property that has never been demonstrated. When a biliary fistula 
occurs and the bile is diverted from the intestine, the feces are very 
3 



34 VHEimiTRY AXD PHYSIOLOGY OF DIGESTIOX 

light in color and give oft' a fetid odor, especially if large quantities 
of meat and fat are taken. The antiputrefactive action of the bile is 
probably an indirect one. In those patients in whom the supply of 
bile is cut off from the intestine a considerable amount of undigested 
and unabsorbed food passes through the intestine. It has been 
proved, however, that in healthy animals the entire supply of bile may 
be diverted and the animals still continue healthy, whidi shows that 
the functions of the bile can, to a certain extent, be replaced. The 
bile also helps to arrest peptic digestion in the intestine. 

FECUUA&mES OF THE DIGESTION IN INTANT8 

Salivary Glands. — The reaction of the new-born baby is neutral or 
faintly alkaline, but in older babies the reaction is acid, evidently 
due to the decomposition of the food remaining in the mouth. Saliva 
is secreted early in the first week and is active, but is probably not 
a very important feature of digestion. After six months of age the 
addition of starchy foods increases the activity and quantity of the 
saliva. 

The Stomach. — In the fetus the stomach is vertical, but by birth 
it is nearly transverse. It has no definite size or shape, but this 
varies as shown by Roentgen ray examinations ; with its contents, the 
amount of gas present and the position of the child. The size of the 
stomach is apparently very variable. Holt gives the following table 
of the capacity of the stomach as determined by post-mortem. 

Am. Number ot caw*. Arentcr caparitj. 

Birth ... . . 5 1 .20 ounces 

■2 w«k8 ., 7 ISO " 

4 " 4 2.00 " 

6 ■' 11 i.'- " 

H ■' 4 3.37 " 

10 ■■ 2 4.25 •* 

12 '■ 6 4.50 " 

14-18 wc-krt 12 5,00 " 

.1-0 tnontha 14 5.7.1 " 

7-8 ■• 9 «.88 " 

10-11 •■ 7 8.14 " 

12-14 ■' ... 10 8.S0 " 

As soon as the child befrins to take food the stomach begins to 
empty itself so that some of it pas.ses into the intestines, enabling the 
baby to take more food at a feeding than would be indicated by the 
stomach measurements. The length of time the footl remains in the 
stomach varies greatly. This subject has been studied by test meals 
and the Roentgen ray. The breast fed baby probably empties the 
stomai-h in from one and a half to two hours, and a little longer for 
the older ones. The size of the meal and character of the food may 
increase the length of time and cow's milk may remain in the stomach 
three hours or more. In mixed feeding the carbohydrates, not re- 
quiring stomach digestion, pass out first, the proteins next and the 



PECVUARITIE8 OF THE DIGESTIOS ;.V lyFAMS 35 

fats last of alt. If a second feeding is given before the stomach is 
empty the first meal is hurried along. The more dilute and fluid the 
food the more rapidly the stomach is emptied. 

The cardiac end of the stomach seems to be used largely to hold the 
food and from there it is passed to the pyloric end, where it is more 
actively mixed. The pyloric valve opens and shuts from time to time 
allowing the food to pass and this seems to depend largely on the re- 
action on the duodenal side, an acid reaction closing the valve, an 
alkaline one allowing it to open. When the food is made acid or 
alkaline it remains longer in the stomach. 

The Secretions. — Pepsin is present in the stomach at birth and 
later is more abundant in the artificially fed than the breast fed. It 
also seems to vary in healthy infants more according to the age than 
the weight. In digestive disturbances it may be absent. Rennin 
plays an important part in infant digestion and it coagulates mother's 
milk in loose flakes, whereas cow's milk is coagulated in large curds. 
This fact should be borne in mind in feeding cow's inilk to young in- 
fants, and the milk should be so modified as to prevent curdling in 
large masses. The reaction of the stomach is acid, due to the presence 
of hydrochloric acid and in children fed on cow's milk lactic acid may 
be demonstrateil. This is formed by the action of bacteria or secre- 
tions in the food. The action of alkalis on the acid of the stomach is 
not perfectly clear and there are conflicting opinions on this point. 
Fat splitting ferments, lipase, is found at an early age and increases 
as the baby gets older. 

Absorptions of glucose solutions and proteins may occur, but water 
is not absorbed from the stomach. Various drugs, such as iodine, may 
be absorbed directly. 

Intestinal digestion depends on certain ferments, erepsin, which 
acts on the proteins, invertin, lactose, and maltose. The bile splits fat 
and activates the pancreas. The pancreas secretion contains three 
ferments, trypsin, that splits protein, steapsin, which splits neutral 
fats into glycerine and fatty acids, and amylopsin, which acts on 
starch converting it to sugar. The pancreatic digestion is not as 
active as later, but trypsin and steapsin have been demonstrated at 
birth or near it. The intestine produces secretion which has been 
found at birth. This acts through the circulation activating the pan- 
ereas. Enterokinase has also been demonstrated in the newly bom. 

Tobacco and Digestion. — Tobacco frequently plays an important 
role in influencing the digestion of food. It is a well-known fact that 
the chewing of tobacco increases the salivarj' secretion, frequently re- 
duces the appetite, and increases the movements of the bowels. As a 
rule, it is better to smoke after meals than before, the irritating effect 
of tobacco being thus lessened. In acute gastric disturbances tobacco 
should be interdicted entirely, and in chronic forms the smoking 
should be limited to a very few cigars a day. 



36 



CHEMISTRY AXD mxSIOLOUY OF DIOESTIOK 



Tobamrn avl^ as itri fxeitunt t» the nen'ous system, auci should be 
pruliibltL-d iu till ucrvotis ili.s(-)Ls<-s. 

ABSOBPTIOn 

III ordi^r prupvrty ta uuderxlaiid diffrstion and assimilation it U 
necessary to kuow somethinp of abaorption. This occurs in two ways: 
either by the material absorbed euteriiig directly into tlie bluod and 
pa&siiif: thence to tlie liver, or by its entefiag the laclcala and passing 
thcni'i* thpnii;^'h the thoraoip duct to enter the blood current of the left 
jugiiUr and Mibplavian veins. 

Alisurptioii iviLS formrrly believed to take place to a very marked 
extent in ihn alouiai-h. Thin view is now held to be erronpHiis. prob- 
ably little or no absoriilion lakini; plat-e in this or(;an. Water, as well 
as most other liquids, may be absorbt;d sliKblly from th»! stomach. 
Alcohol may be absorbed in it. and solutiocui of various ^alts may bo 
absorbed .slowly. Condiments, by stimulating the mucous membrane of 
the stomaeh. and itioreasing: the secretion of gastric juice, aid in 
Ktouiaeh alnorption. Fats are nut absorbed by the stomaeb. I*n)- 
leins and suKars, if taken in .snflicienlly coneeiilnited Nolutiniis. may 
bo absorbed, tbc eoiigestion brouKbl about by the use oC alcohol or 
eoridi iui>iit.s aiding the absorption. On the whole, however, absorption 
fnjiu the atoiiiucli is of frifliiijr importance. 

Absorption in the Inteslinv. — At)Kur]itiun lakeu place principally 
in tile small intestine. Food passes t'nnu tL<- small intestine in from 
five to twenty hours. On entering the large Intestine the food is still 
in a vorj- Suid condition, uotwithtitauding the ]art;e amount of ab- 
sorption of water ami salts that takea plave during its paasugc through 
the small inlt-stinc. 

The absorption of water is a special function of the intestinal 
epithelium, and not a simple questiou of osmosis. Solutions that 
closely resemble the blood a& regards alkalinity may rapidly be ab* 
«orbed. The water absorlH-d is taken up (iirt^dly by the eapillaries, 
without first piLs.sint: through the lac^leids, nltlmugh it" very lurj^o 
qiiaiititieR arc taken, this last may occur. Uur knowledge of iutestinal 
absorption is due largely to the experiments of Heidenhain. 

The absorj'tion of water is largel>' replaced by the abundant secre- 
tion of the small iutestine. 

The protein fotxl is absorbed as amino-acids which enter the blood 
stream and circulate in it as such to be ulilizcil in buildiuR up and re- 
pairing the tissues. The excesses are deamiuizcd in tbc liver. (See 
Amino-Ht-ids.) 

The carlM>liyd rates are absorbed as dextrose or as levulose. Dex- 
trose can be demonstrated iu the blood, and if solutions of this sub- 
stance are iujected directly into the circulation, it may be utilized by 
the tissues. The absorption of dextrose from the intestine is probably 
more than a sumple proeess of dilfntiion through an animal membnine. 




PECCUAHITIKS or THK DIGESTION l\ IXFAXTa 



37 



And it is possible tbut a special activity of the intestine is here brought 
into pln.v. 

The futs arc absorbed either directly «» such or in the form of fatty 
aridK and straps. The absorplioii of the small droplets of fat directly 
ia thought to be a purely mechanical process. The fatty acids are 
changed into neutral fats, a process that probably \akcs place in the 
epithelial eelU of the intestine. The fats pass for the most part 
directly into the lactcals and into the blood by way of the thuracio 

duct. 

AbsorpLiou takes place iu the lar^e iatuuline, but it is chiefly an 

al>!uir]iT ion of watrr. The fwcs enter iu a wry liquid condition, and, 
after niakinjf sloM" progress for almost twelve hours, they reach the 
rectum in an almost solid condition. The large intestine pottaeases re- 
marhable powers of absorption, since peptonized milk, and the like, 
piven in the form of nutrient enemala or experiiuentally, may he ab- 
snrbe<) into the Kystem. 

In dctcrmininK the degree of absorbability of food, the amount of 
the eleoientary fond principles in|;ested must first be aseertalned, aud] 
the projKtrtiou thai has not been absorbed detenuined from the feces. 
The deftree of absorbability of a food indicates, in a measure, its nu- 
tritive value. According to Atwatcr,' from an ordinary mixcil meal 
an average of 92 per cent, of protein, iin per cent, of fats, and 97 per 
cent, of carbohydrates is abaorbed in the body. "The proportion of 
the several nutrients which the body retains for its use are commonly 
called piTci-ntnitcs or coeflii'icrits of diKratihility." The folluniug 
table, taken from Atwater, gives these coefficients of digestibility: 

CorffiaentM of Di^yrtibiGtif amd PM-valur j>rr Pound ojf Sntrimtt in 
O^ifermt Onnp$ «^ Food'tnaterial*. 





PtoMn. 


y»t. 


railiuliyilntce. 


Xlnit of riooiL 


IllnaU. 
Ullty. 


rud- 

pound. 


bllliy. 


P«cl- 


'X"- 


twwad. 




ftrttal. 


Cbforto. 


ftrom. 


FtrtaL 


Onlmttt. 


M«aC» tind &h . . . . 


97 


ItfAO 


B6 


4040 


an 


1730 


EtefC" 

VimxTj nraduiM .... 
AatBia 1 food (of mixed 


07 


1980 


95 


4090 


98 


1730 


97 


IMO 


9b 


3900 


98 


1730 














dk») ..... . 


OT 


IMO 


95 


4050 


98 


1730 


Q>Mk 


85 


1750 


90 


SdOO 


98 


18«0 


LoKOBei (drud) . . 


78 


l&TO 


90 


3800 


97 


1840 




* > 


• ■ • 


, , 


• » ■ 


98 


I7M 




, , 


* - • 


, , 


* I ■ 


98 


iseo 




83 


UIQ 


90 


3B0O 


95 


1800 




85 


ii>:ao 


90 


3890 


90 


1030 


V«g«taMe food* <«f 














nUed dirt) 


U 


IMO 


00 


38U0 


97 


1S» 


Tottl food lof iBiz«d 
















92 


1S30 


95 


40r)a 


97 


1820 



' Pntieipta </ Suthiion taut Sutridrt Vaiiif (i/ Food, Fnnuerf Bulletin Na 
142, Uuiiol ;k>ua Di-iNUtiumt of Agriculture. 



38 



CBEMISTRY A\D PHYSIOLOGY OF DIGESTIOS 



Rubner ' gives the followiDg table, showing the absorbability of 

various foodK: 



rood-rtnA. 



I Wei^l or MiD« 
Fmh. Dried. 



AbaoTbed in perccniage of 



Dried 
■nhataace. 



'AlbumJD. Tui. 



OUtkO- 

bjdimles. 



Aah. 



H«t 


8^ 


376 


95 


97 


95 




82 


SB::::: 


9M 


2-!7 


95 


97 


95 


, . 


82 


2470 


315 


92 


94-99 


95-97 


100 


51 


Hilk ukI cheese 


2490 


420 


94 


96 


97 


too 


74 


White brcttd. ■ 


860 


753 


96 


81 




99 


93 


BUckbmd. . 


1360 


765 


85 


68 




89 


61 


Hmcaroni - . . 


696 


626 


96 


83 


94 


99 


76 


Indi&Q com . . 


760 


646 


93 


86 


83 


97 


70 


Com aod chene 


, . 


780 


96 


93 


91 


96 


81 


Bice 


638 


552 


96 


80 


93 


99 


86 


P«u 


600 


521 


91 


83 


93 


96 


ti8 


Potaioci - ■ • 


3078 


819 


91 


68 


96 


92 


84 


ChUMge . ■ ■ 


3830 


406 


86 


82 


94 


85 


81 


Carrots - . . . 


2066 


352 


79 


61 


94 


82 


76 



The Absorption of Protein. — It has been estimated that about 80 
per cent, of the protein is absorbed in the small intestine and U per 
cent, iu the large intestine. The proteins ol animal food are much 
more completely absorbed than those in vegetable foods. Meat, for 
example, is very completely absorbed, about 97 per cent, and there 
is very little residue left in the bowel. The same is true of fish and 
eggB, which are absorbed up to about 95 per cent. 

Milk is absorbed better in children than in adults, there being 
about 4 per cent, residue in the former to 10 per cent, in the latter. 
When milk is mixed with other foods it is much more completely 
absorbed, in fact, almost entirely. 

The reason why v^etable proteins are not completely absorbed is 
not clear, but the fact remains that the percentage of residue is very 
high. In potatoes, 32 per cent, is left, while in carrots, beans, and 
lentils about 40 per cent, is left. 

Absorption of Fats. — These are very completely absorbed if not 
given in excessive quantities. Pat contained in vegetable foods seems 
to be entirely absorbed. The lower the melting-point the greater the 
amount of absorption. Hutchison has placed the limit of the capa- 
bilities of absorption of fat of the ordinary individual at 150 grams a 
day, hut there are wide individual peculiarities. Some persons cannot 
utilize much fat, and it causes diarrhea or other intestinal disturbances 
if given in excessive quantities. The excess is passed in the feces. 
The Esquimaux can utilize large quantities of fat. while in the tropics 
but little is taken. 

Absorption of Carbohydrates. — Carbohydrates are absorbed more 

iZeitichr. f. Biol., vol. xr., p. 115. 



PBCVUABITIES Of THE OiaBStlOS tS 1XFAST8 



39 



completely then either fata or proU'iu. Sugar U complcti-ly absnrbi'd. 
and starch too uulew given in ccrmiri forms. Under ordinary' fir^'uiu- 
Htaue«s till!}' leave little or no residue in the iiiiestine. 

The Absorption of Vegetable Foods. — These leave more or lean 
residue, aecordinK to the umnunt of eellulose and tilior they eoritain. 
Some cereals, as rire, are nearly completely absorhed. only alioiit 19 
per oeiit. of the protein being left. Oatmeal, on the other hand, 
les\v« considerable nsidue. The legiiiuos as ordinarily ^i^'eu leuve a 
eoniiidenilile re,sidue. Init if ^iveii in Knely divided forms, an in Icffiuue 
flours, they an; fairly welt absorbed. Koots and tubers leave a coa- 
Kiderable residue, aeeordiu^ to the amount of eeliulosc contained. 
I'utaloeHare abfwirbed very L-onipletely. 

Green Tegetables and fruits leave eonniderable residue. Some green 
vegWablpK, as cabbage, eontain but Uttle nutriment. 

DiKcstibility of Vegetable Fats.^[<Hngworthy and Holmes have 
studied the digestibility of some of the vegetable fats and find that with 
jillowanee for iiielabotic products, the coeffiotentH of digestibility have 
been found to be for olive oil 97.8; £or cottoriMrcd uil 97.8; for peanut 
oil 9$.3 ; for cocoanut oil 97.9 ; for gesame oil 98 ; for cocoa butter 94.9. 
These figures show that with the exception of cocoa butter all these 
oils have essentially Ibc aame voelficient of digestibility and abuitl 
equal the animal fats in this ruspeet. The melting point of theiie 
fata is eoDiiiderably below that of the human bod>- and with the 
exception of cocoa butter they are very well utilized by the body. 
The digestibility of the protein and earbnhydratu (.'ontaiuod iu the 
ditferent fat diets was not materially alTected by the amount or nature 
of tbe fat. 

Absorption in Mixed Diet. — This w better than wh^n the various 
kinds of foods are givfij ulum-. ,-\twater baa .shown that thn followinir 
prfiportions of the alimentar}' principles are absorbed when the indi- 
vidual takes a mixed diet : 



I'tDCln rati. CutMhjdMlM. 

Aalmal (ouda W) pT cent. DT per i-riit. 100 por cent. 

CtrmU mJtA susars . tU *- Vtt - 9ti ■■ 

VtgtiMiAt* and frultD .. HO " IW - 03 " 

Practical Value of Absorbability in Diets. — On an ordinary mixed 
diet there is sufficient residue to form normal fea-K. When there i» 
diarrhea or intestinal disturbances the foods cho^u should be those 
whieh are as completely absorbed as possible. On tbe other hand, 
when thei?e is constipation, foods having a eonsiderablc rt-sidue are 
'"Valuable, so that fruits and green vegetables and the nwts and tubers 
runlaintng a considerable amouut of cellulose and fiber should be 
choAen, 



40 



OBBMISTKY AXD fa¥S10IJ)0Y OF DW^STIOX 



THE INTXUENCB OF VABIOUS FACTOES TTTON THE 

DIGESTION 

The digestibility of a food is iinporlji»t. No matter what ils vaiue 
ill calorics nr its prolcin or ytlier content, if the individual who eaia' 



of 



ie value. In dealing with the sick 
lu arraiiging & diet this must always 



it caimot difrest the meal, 
tins in oi CKpeeial importaiitL'. 
be takcu iDto conaidcration. 

Apart from the selection of a proper diet, important factors that 
especially atTeet the digestion are the follow iii{jr 1. Tlie hours, 
order and frecniPiicy of meals, 2. Variety in diet. 'A. The appe- 
tite. +. The tempi? nature of food. 5. Kcst and. exercise before 
and after meals. 6. Emotion. 

I. Order and Frequency of Meals. — It is iisiially customary to 
fix certain hours for the takiuj^ of meals; ihesu houra vary with the 
occupation of the individual. In ]&rgs cities, where the noon hour is 
taken up largely with active business pursuits, evening ix sHevted 
as the most eonveuient hour for dinner. Sir Henry Thompson states 
that three trrneral systems arc in umc accnrdinjr to which twit, three or 
four meals are taken daily. The first sj-stem, which consists of two 
meals a day, is followed in France and other eountries on the continent 
of Europe. A substantial meal, consisting of tish or meat and other 
courses of solid foods, is eaten about noon ; no food is taken before the 
uoon meal, except on arising, when a eup 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 mejil is the largest meal of the day, and eonststs of soup, fish, 
mcat> vegetables, salads, dessert, and black coffee. The second sys- 
tem, eommordy in voj^ie in Euj^land, consists of four meals daily. 
The first meal, or breakfast, is takeu at about 8 a. m., acid consists of 
cocoa, tea, or cotTce. bread, butter, bacon, fisli, or eggs; dinner is eaten 
between 1 and 2, and consists of soup, meal, tish, vegetables, and pud- 
ding; tea is taken at fi v. m., and supper is served at 8, and cDcuiists of 
meat, fish, vegetables, and stewed fruits. Dinner is taken iii the 
evening by the woll-lo-<lo classes, and a substantial lunch is nsually 
token at uoon. The thin! system, prnelised in the United States, 
conmsts in taking three meals daily. In many townw it is I'uslmimry 
to dine at noon; in others, in the evening. The usuhI breakfast, takt-a 
betweeu 7 and 8 a. m., consists of fruits, brenkfaat fond or cereals, 
eggs, bacon, or salt fish, tea. eocoa or cofTee, and bread and butter. 
Luncheon, eaten between 12.;10 and 2 o'clock, consists of cold meat or 
a chop, vegetables, salads, and dessert. Dinner, eaten between S.iO 
and 8 ■>. h., is the heaviest meal of the day, and consists of soup, 6ah, 
meats, vegetables, salads, and fruit. 

The conventional order of taking food at dinner appcnrs to be moat 
rational, namely, soup, fiah, eutr^', meat, vegetables, salads, fruits. 



! 

4 




tXFtVBSCE OF VAKIOVS FACTOKS TTO-V DIfiESTIOt! 



41 



Small quantities of soup Htimiilate the gaHtric secretion, do not inter* 
fen* willi dii^stion. and pu>iK rapidly fnim the stomavh; the fish and 
ciitmr ure thfu jmrtakcii of, before tlir iicidily of the gaatric secretion 
ha« reuehed its height ; next follows tho uioiil, the stomach now secret- 
ing liberal ([iiantities of gastric juice wherewith to carry on the diges* 
tive processes; finally come the carbohydrates, which do not undergo 
digestion in the Ktomaeh, and whieh enter thtK organ when the Food 
already taken is abmit to puss fn»ni the slomaeh into the intestine. 
The eating of Iwuntiful dinners, made up of many countctt, when fre- 
quently indulged in, is likely to lead to digestive disturbances. Chil- 
(ln.'n and invalids Klionid »lwa>'S eat dinner at midday. Iietwrni 12 and 
2 o'clock, and should never be allowed to take this iiicul at night. 

Tile frequeficf/ of nifals must be regulated according to individual 
conditions. Patients suffering from digestive disHirbances and those 
[who take v'er>' kdisII qnautitiefi of food at a time retjuire nourinhment 
at frequent, and regular intervals; whereas those wh<we digestion in 
fefhle, mIkiuUI allow six or seven li<iur-s to elapse between tncais; or- 
dinarily the intepi'al between meals should be about four or five hours, 
this being about the time nccrssary for complete digestion of a mixed 
■ml in the stomach. The habit of habitually omitting the nooa 
litnelieon, so commonly practi^d by busy Auiericaus, sboutd be dis- 
etmr«g«l. 

a. Variety in Diet. — In order thoroughly to satisfy the needs of 
the bwly the iliet must be varied. Although a diet restricted to but a 
few articles of food may contain a sufficient quantity of the alimentary 
prtu<.-i))lcs to Hiistain the liody nutrition, yet the monotony of such a 
diet iM-comes so objectionable that it can not be digested thoroughly. 
irdijig tn WomU and Merrill,' '*lt is a matter of common obnervu- 
dige^tion experiuieuts made with one kind of food -mat erial 
ive on the whole as reliable results as those in which two or 
Diort' food-iuatc rials are used. In other words, it appears that with a 
mixed diet the same person will digest a larger proportion of nutrieiilK 
Itban with a diet romposcd of a single food-material." (Vrlain races 
iv^trici Ihe varieij' of food from religiouK motives, such as the Jewish 
restriction of ham. pork, and oysters. (Hva Leviticus, chapter xi.) 
^ Appetite. — Appetite is the desire for food, and is dependent 
fnpon various conditions. It i.^ controlled by the sen.sation of hunger, 
[»iid is ((ften induced by the sight, smell and taxte of food. As Pawlow 
laliown.' the smell or sight uf food will excite the flow of the gafttric 
tiou, and this in turn will produce an ap]>eti(e. Simple bitters 
ur mme form of alcoholic drink will at timcH induce thin sentuition. 

»The appearance of Iwdly prepared or impropi-rly scrveil food will 
(iftrn di"tpi>l the app<>tile. In children the appetite is usually good. 
Vberou in tlie aged it is lessened. Some persons have voracious appe- 

I rnitnl RlnlM I)v{>Hrinirnt of Ain-iculture Bulletin No. »5. 
<Tb* Work wt th* [)iK<^«livi.- Glttixlf. 



42 



cuauiSTRy jao purgioLOGV of oroEsrioy 



tites, and aitnonnal craving for food. This U often th« cas« iQ 
diabetic* and oilit-r coiiditioiLs, when, at times, the appvtilt; vau uuL be 
fiutisHccj. 

4. Tempcraiure of Food. — The tprnperature of food whea tabon 
is of consideralile import anue. THk ideal temperature is thai of the 
body, from 98' to 100" V. (rffclmann). the Htnita of safety being 
between 45" and 130' F. Aoeording to Hut<!hiann, extremes of tem- 
perature of food are apt to yive rise to yastrit- distiirbaneeK. sneli as 
gastric ealurrh. I'tfelinunii stutes that, a drink at a letnpernturr of 
122° F. inereases the body-temperature 0,1 to 0.3 deRree C It is 
believed by many that iileer of the stomach, xu eommou in cooks, ia 
often due to the taking of loo hot foods. Hutchison oonKiders that 
the pniper lemperalure of water intended to utieneh the thirst should 
be between 50° and 70" V. 

5. Rest and Exercise before and after Meals. — It is often ad- 
visable to rest, but not to sleep, after iiieals. Tlie larjree pan nf the 
work of the stomach should be eomplctt'd bcfure retiring ut iiigiii. 
otbem'iHe the sleep is apt tn be disturbed. About one or two hours 
shniild be aIlowe<l to elapse between a light evening meal and bedtime, 
and three or four hours bi-tween a heavy meal and sleep. From per- 
aotial observations (see (he seetion ou Rest and S1ee|) in Gastrie Dis- 
turtaiiecs) the authors have eonciuded that digestion is improved by 
rest after nieala, bat impaired by sleep. In many in&tances a period 
of Pest Iwfore eating mealK is a vahiable aid to digestion. A'i«Ient ex- 
ereise inimedintely after menis iiihibit.s digestion, whereas modemtc 
exorciHO one or two hours after meals materially aids this process. 

6. Food and Emotion.— Severe mental strain and strong emotion 
disturb the digestion, and for liiia reason food should not be taken 
until a period of rest and composure ha** intervened. On the other 
hand, pleasurable sensations aid the digestion, and pleasant conversa- 
tioQ at the table is therefore to be recommeiideil. 



METABOLISM 



■•■- 1 L 



Food is retinired for t«o purposes: to build up the budy and repair 
tissue- wM.ste, and to supply energy and heat. 

For purposes of study food may be elassifietl into proteins, fat, 
carbohydrates, mineral salts, vitamins, and water. These are more 
less complex comhinalions of the various elemenlK. nxygcn. nitrogCD,?! 
hydrogen, etc. During digestion, assimilation, respiration, and exere- 
tion the food taken uiidergoest many ebanges, breakinsr down into 
simpler compouuih^ or being transformed into others. These changes 
are termed inelaboUsm. While not a food, the n.xygen of the air plays 
an important part in nutrition. 

In youth, until the body attains ita full size, material is needed from 
whieh to build the tisBues. Tins materia! is derived from the food. 
From birth until death the life-processes cause a constant waste of the 



to' 



tianies, aod this waste must be replaced or tlie budy will become un- 
abli> |)ni|)erly to varry au its fuuc'tiuiiii. Only protein sub^tiiiices, that 
ifi til Hny, f<HMi (Mulaiiiiiit! tiitru^uti. can be UM^d fur this purpose. 
Fat muy be used to store material iu the euuuective tissue for future 

I Use ax fuel, and aUo to protect the body Crum eotd. 

Every act eousniues eiiert^y. If a man liftx a pound a fiMit tiigh. he 
mviAt n-produce iu his body that aniouul of energy. Thin euerf^ is 
jblaincd from the food. The foree that huld»i the food eleinenls to- 

'pethiT in combluatiou is called potential enerfiry. Iu breaking up the 
food into simpler eompouDds the body sets this energj" free or changes 
it into kinftic energy. The ehanges by wliieh this is brought about 

toB^e not very well understood at present, but they may be likened to 
(•ombustinri; thus we speak of "buruiuf;" up the food-material in 
the body, as if the body were a very superior kind of funiaoe, for the 
chiinicrs that ga on are. for the most part, very probably it sort of eom- 
plex oxidation. I'rotoins, fats, and carboh yd rates may all bo burnt 
^^up to furnish heal and energy; the last two — fata and earbohydrales 
^■-~are used excluai^-ely for ouc or the oilier purpose, if we regard the 
^Hfat stored in the boily merely as fuel for future use. 
^B The salts aid in the dJKestive and other pnxrsses. and an- utilised in 
V^tbe conpositiOQ of the bones and teetli. Water is probably not used 
" to furnish energy, but it serves as a menstruum, if the tenu be allow- 
able, for the processes. Vitnmius are substances essential to life — at 
^^pre<eiit not very well understood. 

^V .\iwHter givesi tlie following table to illustrate the use« of the dif- 
ferent food elements: 




Water. 



EdiUe poriioo — » i., tluih 
ol inc*t, ralk aixl wbil« 
of tfg, *rli«at Hvur, «ic. 



Nutricnu. 



f 



Prolciii. 
Fab>. 

GirlMhvilrktN. 
MifK^nil maUer. 



lUfuw f. jr., boatu, enirula, dMilb, btui, Mc. 



Vk» ef A'utritnU in Me Butty. 
in— fomB tiwuna f. y.. white (nlbumin) of fggi, 
cun) icsMUi) of milk, luui meftt, gluien of wlitoii. t^lc 
Fab— «fv 111X01 M Git — e. g., hx ot taiM, buUcr, olirc 

oO, iiik of oor«, irlwati Mc 
CkrirabrdnMa— MV tnoafoniKd into Ht—t. g., tug^n, 

«vcbtf,««c. 
Vteenl aatwn (uh)— *liai« in formini; bono, awifl In 
-& g., photpkatm of lime, etc, poUAh, ooda. 



All wire tn ru«l 
lo TitlJ evvrgy 
ill I 111! fiimui iif 
beat niul mur- 
ctiUa fwirer. 



To the above vitamins should be added. 

Afi^r the body has reacheil its fiUl development, the body-weight 



44 CnEMISTRY AXD PBYSIOLOOY OF DIGBBTIOV 

remains more or less constant, and the food that has been used is ex- 
creted by means of the respiration and the urine, and, to a large 
extent, by the feces. 

The well-known law concerning the conservation of energy appar- 
ently applies to metabolism in animal bodies, and this has been prac- 
tically proved, although the experiments have never quite reached the 
ideal owing to the almost insurmountable difficulties that attend such 
experiments. In other words, food that is used in the body furnishes 
the same amount of ene^y that it would furnish if burnt in a furnace 
or calorimeter, providing the end-products in each case are the same. 
The heat-values of foods may therefore be taken as a standard of their 
food-value, but it must always be remembered that in the practical ap- 
plication of this fact in working out dietaries the digestibility and 
adaptability of a food are of great importance, as well as the amount 
of energy it contains. 

The heat-value of various foods may be determined experimentally 
by the use of an instrument known as a bomb calorimeter, the result 
being expressed in calories. A calorie is the amount of heat that is 
necessary to raise the temperature of 1 kilogram of water 1 degree C. 
(It is nearly the same as the amount required to raise 1 pound of 
water 4 degrees F.) This, expressed in mechanical force, means that 
a calorie would raise a ton about 1.54 feet, or that it is equal to 1.54 
foot-tons. 

According to Atwater, the fuel-value of the various classes of food 
as ordinarily supplied is as follows: 

1 gram of proUin furniahes 4 calories; 1 pound fumisheB 1820 caloriea. 

1 " fat " H.!l * ; 1 " ■' 4040 " 

1 " carbo hydra tv furniiihea 4 calories; I pound furnishee 1820 CRlorie§. 

These figures are somewhat lower than the figures given by older 
estimations, and are based upon the most recent experiments. The 
fuel-values formerly given were: protein and carbohydrates, 4.1 cal- 
orics per gram; fat, 9.3 calories per gram. It will be observed that 
fat has a very high food-value, which doubtless explains why it is 
stored as a reserve fuel. 

The earlier metabolism studies were largely concerned with the 
chemical composition of the food as taken into the body and the 
composition of the urine and feces. Chemical balance sheets dealing 
chiefly with the carbon were prepared by Liebig as early as 1840, 
The nitrogen balance and the balances of calcium, magnesium and the 
other constituents have come in for a large amount of work and we 
are but on the threshold. In addition to the chemical balances the 
study of the energy metabolism and the gaseous exchange have oc- 
cupied the time of the more recent investigators. The first respira- 
tory calorimeter was built by Pcttenkofer and Voit. Since then Rub- 
ner, Zuntz and Geppert, Pashutin and, in this country, Atwater and 



METAUOUHU 



49 



TiAfiA, Bontdi«t, I.usk. nnd many others have worked with thii valuable 
appat»lu& The Atwater-liosa i-'alorimeter was built at Middletown, 
Connecticut, but has been moved to Washington. Ijaiif^worthy and 
Milner have dc^ribcd it ia detail in the Jimnial of Atrrienlturfil Ke- 
se-arch, Volump .'», Nu. S, and a shortt^r acuuiiiir will be found in Lu»ik*S 
Science of N'ulrhion. ThU Hrat American apparatiiit is a lar^r afTair 
cmpable of allowinft a man tu bo up and exereisini; on a stationary 
bicycle and experiments laKtin^; for days ean be earrieil on willi it. 
The fintt work wns largely on normal iniliviiluHls, but niori* n-i-i-nlly 
the melabolism of diseased eomiitions ha« been studied. For this 
purpose xmallcr caloriiiK-ters are used, such an the Sa^'c apparatus 
ul Bellevne Hospital, whifh consistx of a copper bnx aliout llie size of 
a lower borth in a sleeping car. It has a eomfortable bed. two win- 
<low8, a telephone, a fan. a slielf and a Bowles slelhoscopc for counting 
the pulse. The patient must keep <|uiet and an this is ditlicult for 
more than tliree or four linuni the periods uf observation are limited. 
Ry Ihix apjiaratus the amount of heat produced by the individual 
may be incosurwi direetly and also indirectly by calculating the eliem- 
ieal ntesKurements of rhe gaseous exchange in tenns of heat, or indirect 
c«taritiielry. In the first method the heat given off is measured 
h.T its being taken up by a stream of onld water flowing iu pipes in the 
top of the Ihis and the amount eson-ted in the mni>itur«^ fmm the lungs 
is riilculnrcd from the iimoiinl uf watiT excreted in the hings. whieb 
i* caught up by a sulphuric acid hoitle in the ventilating' curreat. 
The second method c-onsi^tis uf measurhig the water and earbuu dioxid 
given off. The water is cullectcd an abore and the t-arbon dio.xid by 
Ung the air through weigheil buttles of sodii-lime and .sulphuric 
The air is usc*l over and over again and the oxygen supplied 
fruut a wcighi-d bomb to keep the air normal. The ligures obtained 
by dividing the liters of earbou diuicid produced by the liters of 
oxygen funsiimed is the respiratory quotient. Knowing tbi^ and the 
unoiint of nitrogen in the urine it is pos-sible to calculate the grams 
of protein, fat and earliohyd ral e metabolized each hour, oud bj" mul- 
tiplying by Iheir heat values the number of calorics. 

The ao-ealled basal metabolism is studied, the heat produced during 
eompiete n-st Eournfn hours or moi-e after the last meal, and this is 
compnntl to the normal man. As Kubner ih-mouMt rated, the metabol- 
Nsi is proportionate to the surface area of the budy and all animals 
luve about the same heal production per square meter of body but- 
fw-ft. The larger animal produces uion- heat, but the amount per kilo 
of txtdy weight is greater the smaller the animal, that is, the metabol- 
iun is higher. 

Tbr melaMlbnu in b^'perthyroldism, (f raves' disease, is greatly in- 
nraswl. whiUi in cretins and myxedema it is greatly decreased. In 
^Milioid fever <be metiihnlism is increased, being approximately pro* 
i'ortioniJ lo the rise in tcmperatupe. 



46 



FOODti A\0 TBEIR COMPOSIUO.V 



An aceoiint of the L'slorimeler in oliiik-al metlicine by DiiHoiB. wn 
be found in tiie American Jouriml wf tb*; Medieul SL-ieiuei*. .luue, 
11116. 

The whole subject is in its infancy- and the near (miirL> will doubt* 
less sine us a ^rcat many facts of practical value. 

Respiration Experlmenls.— As foods are oxidized in the body, the 
mftubulisiu may be dclcriuiiied by cstimatiug ilie amount of oxy^u 
used. The rcepinitiou apparatiiii used in experiments of tJiis kind 
consists of a oiouth- nud nose-piece eouneeted with apparatus devised 
to measure llie inspired and expireil air. The anioiint of oxygen en- 
tering the lungs and the amount leaving can tliiis W determined, and 
the difference repre-sents that used in the body. Thin method has 
the advantaRe that the results may be cbtaiuwl tjiiickly and the 
apparatus is portable. Butimations are made fnmi time to time, 
and tile totaU for the twenty-funr-hour or other periods ba^ed on 
tliese. 

Approximately, 1000 c.c, oxygen will unite with either 1.05 gram 
prolein, 0.5 gram fat, or 1.34 gram susjar. The earlion dioxid given 
otT is alsr> estimated, ami this, divideil by the oxyg^en cnnsumed, gives 
the " respiratory quotient." This is used in estiiuiiting the total 
energ>' used. To do this the amount of food used must lie known, 
and this is determined by estimating the food eaten and ihe composi- 
tion of the urine and feees m regards the carbon and nitrogen con- 
tained. 

POOBS anh treih cosn'OsiTicii. 

Not only is it dosirabli- to know about the digestibility nf foods. 1ml 
it is necessary to know about the eompositidu of f(HKls. The aiuuuut 
of protein or, what amonnl»i tu the same Thing, the amount of nitro- 
gen iu any given food is the tint point of interest. If the amount 
of uitrogen is known. Ihr protein content is obtained by multiplying 
by fi.25. The protein eonteni is imporlatit for many n'asons, and is 
considered under the bending of The (Quantify of Protein K<iiiiiri'd- 
Soiae foods contain nitrogen in the form of cheraical eompounds, eon- 
mining CjN\ or the Mi-called purin Imdies. These are important 
in rertnin diseases, iw gout, and an- taken np under the heading of 
I'urin .Metabolism and IJout. The amount of nitnigenou« fond is a 
very great factor in all diets. The |>ereeutage of fal is likewi-ic of 
importanee. and in some diseases and under eertain conditions it is 
deairahle either to use large quantities of fat or to avoid fatty food«. 
The earbohydrate ppre«>ntage enters largely in the feeding of some 
pntieniR, as in diabetes and the obese. 

The Heat and Energy Value of Food. — As mentioned above, it is 
fonveuient to think of foods as fuel, and that they raefa furnish a 
ccriAin available amount of heat or energy. So mueh in protein, so 




Ftjun VAI.VB8 



47 



OOVPOernOM of mile AKD OTUEB FonD-HATERUCA 



■•■■•■uianH. 



rvrt-nlah 






VUM I1.(hk 



Pnitin oomirauitda, «. ?., lc*i> «' mMt. irhiu of ecg, cucia (curd) »f milk, Kod 
gluten of wImM, Uitlte moKl*. blond, bone. oic. 

Au. f. 0, fitt of HHAt, buuer. and all, iwrvc u fuel to yield Imt aud uuocotu 



pvwct. 



»»M'*PM«9WW«7il» 


<« SEW «w> <ew MM wisti w/w *^w j*a; *wob 


1^1 ' ' ' ' ' 








^^ 




^■^B <->;---:'_- _-!-:-:-_-_-" — -:-:-:-;- :-:-;-^-:-^-^^^-^-----r. 




^ 




B^ai^^-^'^---r-'--'---' ---------'----"-----"--- ■'"-"-^-i-:-"*''^L- ■ :i 


^m 




^^^^^^^^..-.j-jr-r.-^.^ ■^^---- -■--,-,-■-.--- ■----. -^,- 







48 FOODS AXO THBIS C0MP081TIOS 

mucli 111 fat, so modi in carbohydrate. Some foods arc all pnitcmT 
as tlii- white of egg; some all fat, a» butter: aud sumt-'all ctirboliyilrutc, 
as sugar. Mont fmiils an.', however, combinations of all these, aud 
contain, in additinn, eortajn salts and water. The water is not 
metabolizpd, and need not be considered Ja taking up tlie qnestion 
of food valUL'K, Tiiu «ilUs furnish ko little energy that thry too neeil 
not be; eouiiU'd, hut they iirt; of \ery urcnt vhIuc in metaholiwii, and 
as our knowledge of them iuerenses their importnnee is more and 
more emphasi/ed. {See S«lt ^leJabnlism.) There are many prob- 
lems in connectifin with tlie energy contained in foods, and they will 
be L'tuiKiiiered briefly. 

There are two series of i-stiitidtes. one mnde chiefly by Rubner aud 
geiKTaJly used in dietetic computations. The other was made subac- 
quently by Atwater, and his values are a little lower aii(J perhaps 
more correct. Owing to the differences, discrepanck-s will be found in 
various tabk.s and in different books, and thcM depend in part on the 
use of dilTerent standards in luakini; the eumputatian.s. At the 
present time Ibc application of the food valuCH to the diet as made 
by the general practitioner is only approximate at bMt, bo that these 
discrepancies are not so important as would seem at first sight. The 
standards ar« as follows : 

Cuiorirt prr (7 ram. 

Hrau-lu. Pal. CMibobjitraM. 

BubiKT 4.1 1^.3 4.1 

AlWBter 4.0 8.D 4.0 

To determine the fuel value of ajiy food it is only ncceaaary to 
multiply the percentage contained in 100 parts of the food by 4.1 for 
the proteiu and carbohydrate, and by 9.3 for the fut. Kor example, 
lOO gram^ of milk contain 3.50 per cent, protein, 4 per cent, fat, and 
4.50 per cent, nupar. 

Calorie valut of 100 graiu* ">E that milk would be 

ProKln 3.S0X4.1 = I4.» 

Put 4.00 X «.3 = 37.20 

C^ibohjdrato 4.S0 X4.I = I8.4S 

Total valua TO.OO 

Numeruufl tables will be found throughout this book and extensive 
oncH at the end dealiujir with the percentage eoinpositiou in common 
use. If the t-aloric value per pound is given and it is desired to have 
il in ffraniR. it may be remembered that 1 pound equuLs approximately 
454Kr*ms U53.G0). 

It is desirable not only to know how many calories are in a giveo. 
quantity of food, but how much is furnished by )*ach cnnKlitiiwat. so 
that the diet may he pre.seribwl that contains a high or low protein 
content, a high or low fat content, or a high or low carbohydrate 
content, as may suit the partictilar case on hand. The total food. 



I 




MtlTABOUSM 



46 



requirement must, however, always be borne in mind, and if one con- 
stituent is low-, an increane vorrespondiiig to it must be made iu uuo 
of the others. 

The fuel values of meats are usually stated too high, as mneb of 
Ike fat sujipoMKl to lie included is trimmed ofT either by the butcher 
or the cook. The bulk of a food gives but little idea of its food value, 
■8 bulk oftfn means a hitjh wuter citiit<-iit. An ouuee of fat, for exam- 
ple, is c«|iial to about 2 poumls of cabbage. 

Nytrttive.Ralio.~lu order to give some idea of the value in nitro- 
gen or protein to the other voii^tituents of the food, what is called the 
uuiritive ratio is often stated in speaking of diet or foods. 

This moy he expressed as: 



Or, 



ProUla i Cu-lwl>rdntl« -|- 2J F&t 
Cartwli^dral* + 2i Pat 



1 



Protein 



In other words, it fxprcs-sca the ratio brtwrcn the amount of digestible 
protein and the amount of digestible enrbohydratoa plus the digestJble 
falB. The fata are expressed in terras of carbohydrates, and 1 gmm 
of fat is eoiisidercd equal to 2'4 grams of carholiydratc. For ex- 
ample, in Vuit's Kttindanl diplary there is: 



Prttt«iii 

C^v(iobjr<lrat«a 



lis graau. 
56 " 
600 " 



The digestible part may be obtained by using the coefficienta of digns- 
titnUty, and we ttnd these amounts : 

Dixr<tlM« proteui 119 X O-M^^ lOMV 

UiK».iit'U Ut S6yO.»S= SUM 

UipntiUi- .T.rl«>hv<!r«t*» B00X0.1i;=4aS 

Th'' Ul In Urm« of curbohvdrttt** U 32_a0 X 2.25 = ll».7. 

Tbfl t<iUl (xl and cnrbulivdrnu- in Urtns of earliobydnitnt it 4SS -f- 1 19.7 = 604.7. 

Tbr nutritive rxtio i» lOS.SO : «04.7 or i : iA. 

Under ordinary conditions the ratio should not vary below 5 nor 
kboTfl 7. Of latw the tendency is to widen the ratio, that is. to 
inrreaae the carbohydrate faetor. 

Total Food Requirements. — The n^xt qu^'stinn is how muvM food, 
i. t.. how mauy calories, are needed by the bndy under ordinarj' t-on- 
dltions. This may be expro»aed in two ways: Brst, as m many 
eiJ«ri«i per kilo or per pound of body-weight, or. as is frequently 
naed for grneral disL-usMions, the amount needed by a laaii of average 
weight, say 70 kilos or 154 pounds. The problem may bo approached 
in two ways: One method much used ist to study the food actually 
eonsnmed by groups of individual!) li\'ing under certain conditions, 
and by nakiug averages determine what is taken. Just bccatise a 
great many people take a certain amount uf foo<l is no reason that it 



50 FOOD REQV1RE1IEXT8 

represents the optimum, as it is well known that the food eaten varies 
with the kind and amount available. On.tbe other band, it represents 
a practical ^ide, as we know that large groups of people have lived 
on such an amount of food and maintained health and strength on it. 

Another method in vogue at present in the scientific study of food 
requirements is to determine the amount of heat given off by the 
body while in the calorimeter, as explained above. 

There are but very few calorimeters in existence, and the method 
is expensive, so that more frequent studies are made on the -amount of 
oxygen consumed and the respiratory quotient. This may be done 
by a simpler form of respiratory apparatus. Another valuable method 
of study is to determine the balance of the intake and output of 
nitrogen and carbon. 

The following figures are those of Rubner for an adult weighing 
65 kilos: 

During rest in bed IROO calories or 2S calories per kilo. 

In repose 2100 ■ 3> 

In light work 2300 " 33 

In moderate work 2600 " 40 

In hard work 3100 " 48 

These requirements vary owing to circumstances, aud the needs dur- 
ing illness, as fever, are not those of good health. Some of the more 
important factors bearing on the total food requirement may con- 
veniently be noted here. 

Occupation or the character of the work performed has a great 
deal to do with the amount and character of food needed. The table 
on the opposite page from Atwater should be studied in this connection. 

Tigertedt estimates the food requirements for various classes of 
labor as follows : 

Shoemftker 2001-2400 caloriea. 

Weaver 2401-2700 " 

Carpenter or mason 2701-3200 " 

Farm laborer 3201-JlOO " 

Excavator 4101-5000 " 

Lumberman Over 5000 " 

In this connection* it is of interest to note the results obtained by 
Atwater and Benedict. The following show the average requirements 
of a vigorous young man : 

Man sleeping 05 calories per hour. 

Man sitting at rest 100 

Man at light muacular exercise 170 " 

Man at active muscular e.tercise 2!)0 " 

Man at severe muscular exfrcice 450 '* 

Man at verj' iwvere muocular exercise 000 " 



52 



FOOD HEQCtiEMESTB 



Taad' iammmul i m of Perwem r» IKftrcN* *! 



ami Pfipmmi DU^f 



K^mtttlM per Itaa p*r I»t.) 












ll 

f 

Ji 

5 


htBU 


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WMfr^Ohie, 


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e 


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i 

1 

>* 
i 


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CBlar- 




MMCBLUSIM!! (ttM—J). 




Om. 


fl^ 


Om. 


Ok 


Om. 


te. 


ia. 


I; 


'''hlD«M deolM In ''4llhf«<A 


1 


m 


lU 


■at 


m 


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MS 


43 


-Ihlrtow lauiulrTmAD In C>lj- 




















ff>ml« , M - - . ^ . ^ . . 


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Tnlted flULes Mmj ruloa. 
























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lit) 


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TiU 


7.1 


Dvimu uiajr nUon, (Ckce . 


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JOB 


n 


4U 


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&a 


wxiAwi tnanik*im. 




















H4ft at hard v«rk rW'llj 




1(5 


ino 


434 


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u 


Hftn It m'rtl<;r»W wvrlt (V&lti 


, _ 


118 


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ita 


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lt>.tiw[th vi:rr hardiDLiMniUr 




















Man ulLh hard! maKUlar 


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work ■(^6^»■t';^^ 


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noifiilAr wfirlc (Alwalcr) - 


. 


125 


(')- 


(0 


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(■) 


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niiueuijT w.rli fAiwiteri . 


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112 


(') 


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loa 


to 


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avDi 


4J 


Man at "nr'lcTilsrr" «r 
wriman «l(.h ini'iTatrli' 






































WijDjan Ml Halil In minlLTalp 




I'M 


(■) 


(■) 


99 


(') 


m 


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24U 


1.1 









These rt^iiltH may he uhwI to ascertain in a general way the food 
requiremfiitH of individuals when their mode of living is known, as in 
institiitiotm. TUptp will be a margin of error, but the result will be 
of Hprvicc in eomplcting dicta: 

H lidiirN iif Hlfcp at flJ> («1ori<tt 620 calories. 

2 liiiiirH' lif()it i-xcrciiw kt ITU caluries 340 " 

H lioiira' arlivu fxcrciHe at 2H0 calories 2320 " 

() Imiira' (tittiiiK at ntit at 100 caloriea 800 " 

'IVftal fiwid rp<|iiironicnt for the day 3780 " 

{Sherman.) 

Tho amount of Innsion under which the work is done will have 
Komctlittitr to d(i with the amount of food required. If the work is 
don« with a ^rcat ileal of nervous energy, as in racing and contests 
of vuriouH kinds, the food refjuirements will be greater than if the 
work is done nlowly and under less pres.sure. 

Kvcii if no musenlar work is done, there will be a certain amount 
of food refjuired to maintain the body. Various estimates have been 

> Fata and rnrlNihydrnteii in anflicient amountB to furnish, together with the 
protein, the indirat«l aninunl uf energy. 



METABOLISM 53 

msde as to where this enei^y goes. Perhapa the greatest demand is 
to maintain muscle-tone or muscle-tension, and it is thought that from 
a third to a half of the enei^ required at rest is utilized by this func- 
tion of the body. This is less during sleep than during waking hours. 
The circulation takes 5 to 10 per cent., and respiration from 10 to 20 
per cent., and about 8 to 12 per cent, are supposed to be expended 
in digestion and assimilation. No very definite suggestions have been 
made concerning the amount needed for the work of the secreting 
glands or the nervous system. 

Metabolism goes on whether resting or working, and also whether 
fasting or taking food. Metabolism is lessened by resting, still more 
by sleeping, and also by starvation, and each day that the fasting 
goes on there is a rather lessened metabolism. On the whole, how- 
ever, the fasting metabolism is rather constant, and the energy is 
derived from the tissues of the body. First, the glycogen is stored in 
the muscles, and then the body-fat and other structures of the body. 
If food is not supplied after a certain length of time, death ensues. 
If food is given, the metabolism is raised, so that within certain limits 
the more food taken the more will be metabolized. 

Requirements in Disease. — These may vary greatly and we are 
in need of studies on the nutrition in the various diseases. In some 
conditions, as in fever, the metabolism is greatly increased and the 
same is true of Graves' disease. In other diseases the heat produc- 
tion may be below normal, due to retarded metabolism ; examples of 
this are myxedema and constitutional obesity. 

Mental Work and Metabolism. — Curiously enough, mental work 
does not apparently utilize either heat or enei^y in the ordinary way. 
A man of a high degree of intellect in a respiration calorimeter does 
not cause any difference in the registration by hard mental work, 
such as working out abstruse mathematic problems requiring hours 
of time. The same apparatus, however, is sufficiently sensitive to 
register the heat generated by turning over in bed or by raising the 
arm. 

Metabolism and Heat. — The body heat is maintained at or about 
98.2° F., regardless of the external temperature. The heat is largely 
r^TiIated by the exercise of the body, but in extremes the rate of food 
oxidation may be changed. In cold weather more food will be 
required than in warm. 

Metabolism and Fever. — In febrile conditions the food require- 
ments of the body are raised, uid an increased amount of food should 
be given to cover this. (See Feeding in Fevers.) 

Climate. — In cold climates fat and protein foods are used more 
largely, while in hot climates carbohydrates are preferred. Woodruff 
is of the opinion that climate affects the diet, mainly by the supply 
it affords. 



POOD REQllREyEyTS 

Kace. — The food of iliffereiit rai;es varieH widely, Init this is due, for 
the mnsl pari, tw the varyinK conditiniiK iimlcr which ihry livr. and 
especially tt' tli<^ food-supply that is most available by rcas^oii of cost 
and the ea^o with which it (^ii he procured. The Eskimos KiibKiiit 
largely upon raw or partly cooked meat and use large amouutu of fat. 
In tbe torrid zone the natives eat largely of cereals, fruits and vege- 
tables. In the temperate zones the diet is mixed, and is dependent 
largely iipon soeial and ftnancisl conditions, being of the most varied 
character in the oase of the well-to-do, wlifreas aiti'tiig (he poor it is 
apt to ItR maHe n|i of the cheaper mt^atM, bn-ads and vpgetable-i. Sol- 
diers and travelers fnim the tempcnite zonM, going cither north or 
sontb, iisoaUy retpiire approximately the same varietii's of food they 
had at home. Soldiers in the tropics crave and eat meat, when they 
can obtain it, and in almost as large quantitie.s a.s they would at hoiuc, 
and even after years of life in the tropicK do not make any great 
fhanne in their diet 

Major Charles E. Woodruff, Surgeon V. S. A., expresses the fol- 
lowing opinion: "All natives of the tropics (where civilization causes 
over-population) are in a condition of nitrogen starvation and need 
much more nitrogen than they ean possibly get. The old titandard^ 
of teaching that wt^. slionld eat as the natives iK m«Kt vicious. They 
do not (;at meat because they ran not get it, Tlu-y fravc it, nct-d it, 
and eat it when they can. On aeeount of the destructive cll'ecis of 
the coneentrated tropical actinic raj's on protoplasm we need more 
uitn)Bi;u than at home. Please don't copy lie old falsehood that we 
i.eed less. It is also true that we need fat, as it furnishes energy bet- 
ter than carbohydrates. It is eaten in preference to starches and 
fiugars for this purpose by workers when they can afford it, hut they 
lake to starch (rice) because it is cheaper. It in incorrect to suy that 
it overheatK. It docs not overlu-ut ua, and it is false to say that fat is 
not needed in the tropics." 

An interesting study of the foods ased by diflfereiit races of people 
has been made by Landis, of the Phipps Institute of Philadelphia. 
Tbe H^ircs are reduced to a per man buslti, the members of the house- 
hold being rated in terms of adult lualcii, and children being classed 
io terms of fractions of the male unit. 



Funilr o— o 

Knabwr "mi-n" . . (.3 

C*l»riM per man ;«i dar t>eT.« 

Coal food pw Ban per dar- ■ . tA.IAS 
Calari** (or fJU. Inc. (rawining 

and btvorara iSiH.i 

Protein «a)<i*iTii [«r ■«■ Jvr 

aajr 3S*JI 

froiMftloB i-rM'tB 11.4* 

Pnipvrtloa (■( 1BJ% 

Prapartlon tMbodptpaica nJn( 



-iulUn- 



S— r B— d 






W- 



tlTlM 

■SO. a 




METABOLISM 55 



lUlisD NesTO 



Avvrage ulorien per "nuQ" per da; aeso.B £8To.2 

Ararttf etui uer man per ur f.l91 $.iiie^ 

ATOTftCe ulorfea tor $.111 mSA 1SS8.S 

Avprftce proicin ckloFiM t>er man per da;. . . . iVJ.i (T1.3 grantne*) 8IJ.1 (Th.S srainmea) 



, Jewiih , , Pcdub , 

Family H— n C— r S — r B—t D — y Z— y 

Numoer "(nea" i.J i.t i.3 ^.U a.2 3A 

Ckloriai per man per day Slld.Uo 3!TU.» iailA 839S.04 S99T.3 iVlSS 

Coat food per man per day tl>.2i38 StfJUll fu.lBS fO.lllS (O.KS fi).32I 

CaloriM lor t-lU. inc. leaioDiDg 

and be*eTa|ca »t6.13 l\yia.3i lieo.S 884. IS VTD.b 926.7 

Protein calorie* per man per 

aay Sti.SS 406.16 S31.S 611.0 4(0.1 468.S 

Proportion protein U.9% 11.4% 13.1% 16.0% 14.1% 1!.4% 

Proportion fat a5.M% 8!t.0% 84,9% a7J% E8.8% s;6.6% 

Proporlion carboiiydralM 5B.3% 56.5% 61.B% 4T.6% 67.1% fll.9% 

Jewith Poliah 

ATeraice calorivi per "man" per day 2693.7 1124.114 

Averaie coal per man per day t.2409 $.3409 

ATerace calorie* for 1. 10 IIOS.OI 9i7.3i 

ATFraKF protein caloriei per mao i>er day.. 3G0.6T (S7.S grammtn) 433.1 (1"^ Krammes) 



Sex. — As a rule, women eat and require less food than men. This 
is largely due to the indoor and sedentary life led by so many women. 
Under equal conditions a woman of the same size requires the same 
amount of food as a man. On an average, women are only about four- 
fifths as lai^e as men, and consequently, dietaries for groups of 
women will require about four-fifths the amount of food. 

Size and Weight. — For adults living under the same conditions, 
the food requirements vary with the weight of the individual. The 
larger the body the more food will be required, but it should be noted 
that the requirement varies also directly with the amount of surfaces 
exposed, so that a small man, having a relatively latter surface, will 
radiate more heat and will require more food per kilo than a larger 
one. This has been tested experimentally both in man and in animals. 
As very obese individuals have a larger layer of fat which does not 
require as much energy to maintain as muscles, this also makes a 
difference in the food requirement. In computing dietaries these 
facts are rarely taken into consideration. 

Food and the Skin Surface. — Rubner showed that the amount of 
food needed is directly proportional to the superficial area of the body, 
or in other words, the metabolism varies in direct proportion to the 
amount of skin surface. This is due to the fact that the larger the 
body the smaller is the proportion of surface to the weight and as 
most of the heat is lost from radiation from the surface a small sized 
animal loses much more heat in proportion than a large one. This 
is well illustrated in the ealoric requirements of infants. The amount 
of food required may be estimated from the surface and tables have 
been worked out showing the skin surface of people of different 



S6 



rooO HEQVIRBXBSTS 



heights and weights. DtiBois uiiil DuBois (Archives of Interna! 
Medicine, 1916, xvii, 855) havp wnrkcd niii a iiirthod which needs 
only the height iu ccutimctcrs aud the weight in kilograms to deter- 
mine the Kiirfeee area in meters. 



200 



20 



30 



40 50 



80 



70 80 



90 



rOQ IIQ 



I9G 



t8G 

§170 
5180 



« 



,150 
-140 



QI30 
120 
110 



roo 









iC 


\ 


\ 


\ 


S, 


\ 


\ 


N? 


s 


^' 


\7^N 


73 




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\ 


\ 


s. 


\ 


\ 


Sfl 


X 


h _, 


\ 


s 


X 


^ 


v^ 


"v 


^ 


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s 


1 


\ 


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v 


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s 


N 


V. 


N 


s. 


S, 


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\ 


\ 


\ 


N. 


\ 


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N 


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■^ 


\ 


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A 
f 


s 


N 


\ 


\ 


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s 


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s 


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12 

























200 
190 



160 
150 
140 
130 
120 



20 30 



40 



50 60 70 80 
WEIGHT-KILOGRAMS 



90 100 



100 



IU 



t'tiirt f<ir ileterniiniiiK BiirfttiH' ttrm of iiinn in Niiiare ni<!tt<rB from w-piplit In 
Icilnirrnniii |Wt.| nnd lieif;ht in (^entlmeUT* (Ht) x-oaritiiiic to tlit* r«rmuU: 
Area iSq, Cm.) = Wt.**" X Hto." X 7J.M. 

-3 

A foi-iDula devised by Mechs «jid frequently naed in S= C ^ W* 
where S ia surface. W weight, aud C a. constimt dependent upon the 
shape and deneily of the solids; for man C is 12.3, 

Ptrcrntage IturriUf or Drrrtate in the nourlfi Hiimil MrtahntUm for Variotit 

Faetora affeetmg tht Kxtent tif Enrrgy MrtahaHsm Ins adapted by 

C«rt«r frwm ihr work o( Luak and Du BuUi. 

A*«rM> nun. 164 iioniiili. (TO kx.) 
•1 fDak[iJp1p rt^r, TO Cftl«rif« 

\MT liour: 

Ingestion <if food , 

L,vin^ in n I'hnir, uupporti-d 

Sittintj up in ■ rtialr 

Moderwlv at'tivlt)- in chiiir ......... 

V«rjr dmIImm in l»«l 

Walking on lerel, 27 mik-s p«r hmir.... 

ClinibitiK. 2.T niile* ptr hflut 

Hani liilx>r, bicyck ridinfr 

Tliin but Ueallliy 

Put but hp»Ubj 

DbotM: 

Mott pKUi-nU not Mrioarljr HI 

ObMit}' 

DiKb«tr« will) Hcvrrr acidoiia 

Bvntf iM-mirii^iK «n«ini« 



Inncaic or dscroMD 


AildiliuDkl calorie* 


Iwr e«nl. 


f-er hour for 




uriTAKc nMn. 


Incr«««F'. 


S to 10 


4 to7 








8 


8 


29 


20 


SO to 100 


14 to 70 


£80 


leo 


sso 


467 


rsa 


ss» 














+ 10 to— 10 


+ T to— 7 


+ IB to —10 


+ 7 to— 7 


to tA 


to 10 


to 20 


to U 



METABOLISM 57 

AddtUonal emloriM 
Increase or deereBie per bour (or 

per ceat. aTersEe man. 

Increaie. 

AcTonu^l; to 30 to 21 

Cwicer, Kvere heart and kidnej' disease 

and bigb fever 20 to 40 14 to 28 

LeiUtemia 30 to 60 21 -to 42 

Typhoid fever 40 to 50 28 to 35 

ConvaleacMice 10 to 20 7 to 14 

Exolphthalmic goitre: 

Decreaae. 

Mild 25 to 50 18 to 35 

Severe 75 to 100 63 to 70 

Prolonged UDderautrition — 10 to — 30 — 7to — 21 

Diabetes, emaciated — 10 to — 35 — 7to — 26 

CretiniBm and mj^edema — 25 to — 50 — 18 to — 35 

Example. — A man of 60 years, weight 70 kilos (153 pounds), height 17 cm. (07 
inchea), in bed 8 hours, walks 1 hour, sits about or office work 14 hours, hard 
exercise 1 hour. 

Calories 
per hoar. 

a. Area, 1.8 square meters 

b. Basal metabolism per square meter . 35.2 

c. Individual basal metabolism 1.8 X 35.2 63.3 

(Fractions are usually disregarded) 

d. Increase for food ingestinn 10 per cent, (in all calculations) 03 X 0.1 ... 6.3 

e. While in bed (c + d) 63 + 6 69 

t. Increase for office, etc.. 29 per cent. 63 X 0.29 18 

g. Increase for walking 230 per cent. 63 X 2.3 145 

h. Increase for hard exercise 756 per cent. 63 X 7.56 470 

Caloriea 
per dav. 

8 hours in bed 69 X 8 552 

14 hours sedentary 69 + 18 X 14 1218 

1 hour walking 69 + 145 214 

1 bour hard exercise 69 + 476 545 

ToUl per day 2529 

As to the loss of beat from the body it has been estimated that 87.5 
per cent, is lost by surface radiation, 10.7 per cent, through the lunga, 
and 1.8 per cent, through excretions. 

Photographic Method of Measuring the Surface Area of the 
Body. — Benedict (The American Journal of Physiology, 1916, xli, 
275) has developed a simple method based on computations made 
of certain definite photographic poses (particularly the side view with 
the arm extended) that when compared with the results obtained by 
DuBois' linear formula, is stritnngly accurate. 

Age. — For the reason given above, and also due to differences in 
metabolism and owing to the influences of growth, the food require- 
ments of the young is greater per kilo of body-weight than in adults. 
The food requirements during the first three months is 100 calories per 
kilo (45.4 per pound) ; during the second three months it is between 
100 and 90 per kilo (40.9 per pound) ; during the latter half of the 
first year it sinks to 80 per kilo (36.4 per pound). Artificially fed 
children are thought to require slightly more than breast-fed children. 

Gephart and DuBois (Archives of Internal Medicine, 1916, xvii, 



58 



FOOD BB91IREMEST8 



p. 913) have the following standards of nonnal metabolism per hoar 
per square meter of body surface. 

HtamdardM of Xormal Metabolitm. Avermge CttorUa per Hour per liqmmrt 
Meter of Body Surface. 



Kobjert. 
■CB in 7(sn. 



Aecordiu 
(onnlft. 



Bof B, twelve to tbirtees 45.7 

Uen. tweaty to fifty 34.7 

Women, tweot^ to fifty . 32J 

Mm, fifty to sixty 30.» 

\^'o■neR, fifty to •ixty 28.7 



Md 



r4iDs 



it- weight 



49.9 
39.7 
36.9 
35.2 
32.7 



CALj 


./ 


s 
































50 




V 


■-^ 


































\ 






























4n 








X 


^^ 




^^ 


















\ 




30 


— -1 
























— ■■ 


= — 


^" 


— 1 


■^— 




































20 






































































tn 


i 
































lU 





































































YR 


S. 1 





2 










4 





5 





60 


70 


80 



CAL. PER SQUARE MCTER PER HOUR. 

Thia chart, prfpared by Du Bois, sbowa the basal metabolism a* measured in 
calories produced per square meter of body surface per hour from birth until 
the &)(« of eighty-five years in human males. Between maturity and the eighty- 
fifth year there is a gradual (all in the intensity of metabolism of 13 per cent. 

In computing dietaries fur children the following tables of Gillett 
will be found useful : 



Calorie Heiiuirrmenl of Children at Different Agea. 

An*. Yean , Cslorira . 

B«r". Oirin. 

From 2 to 6 MOft 1.245 

From 6 to !l 1.797 1,575 

From 10 to 13 2.337 2,015 

From 14 to 17 2.534 2,253 

Food Alloirancea for Childrm. 

Calorin per imy » 

Xgf. Ynn Bo>». Giri». 

rndiT 2 ftOO-1,200 fl(*)-1.200 

From 2 to .1 l.iXMV-I.SOn !m«-l,2Sft 

From .1 to 4 1.100-1.400 l.min-l,3tlO 

From 4 to 5 1.200-1,500 1.14i>-1.440 

From 5to ft 1.300-1.600 1.220-1.520 

From n to 7 1.400-1.700 I ..lOii-l .tH>0 

From 7 to R l.5(m-1.800 1.3SO-1.0S0 

From 8 to ft 1,600-l.flOn 1.4I>0-1.760 

From to 10 1.700-2.000 1,550-1.850 



METJLBOLlSlI 59 

From 10 to II l.WO-2^00 I,«50-I.»50 

From 11 to li 2,100-2,400 1.750-2.050 

From 1£ to U 2,300-2.700 1.850-2,150 

From 13 to 14 . 2,50O-2.lM)0 1,950-2,250 

From 14 U> 15 2,000-3,100 2.050-2,350 

From 15 to I« 2.700-3^00 2,150-2,450 

Ftttm 16 to 17 2,700-3,400 2,250-2450 

Care should be taken to iudividualize aod active children require 
more than sedentary* ones. In bo>-s' schools and out-of-doors in camp 
the amount actually consumed and needed is between 4000 and 4500 
calories per day. (See Feeding of School Children). It is interest- 
ing to compare these figures with the earlier ones. Atwater allow- 
ances are as follows : 

Bov 15 to 16 years reqaires 0.9 the food of a man at moderate work. 

Girl 15-16 •* 0.8 

Boy 13-14 " '■ 0.8 

Girl 13-14 " 0.7 

Boy 12 " '■ 0.7 

Girl 10-12 " ■' 0.6 

BoT 10-11 '■ " O.fi 

Child 6-» " " 0.5 

Child 2-5 •" •' 0.4 

Child under 2 " " 0.3 

Sherman has approximated the average amounts as follows: 

Boy« of 14-17 2500-3000 calories. 

Girls of 14-)7 2200-2fl00 

Children of 10-13 1800-2200 " 

Children of «-» 1400-2000 " 

Children of 2-5 1200-1500 " 

Children of 1-2 WO-1200 " 

Based on the amount per kilo : 

Cnder l T<«r 100 calories per kilo. 

Under 1-2 rears 100-90 

Coder 2-5 years 90-80 " '■ 

Under 6-9 vears . 80-70 " '" 

Under 10-13 vears 70-60 

Under 14-17 years 60-15 

For the verj- young his estimate is somewhat larger than those made 
by Camerer, Heubner, and others. 

After middle age is passed the food requirement diminishes, and in 
old age it is considerably less, owing to the lessened exercise and the 
lower ratio of metabolism. Without muscular labor the requirement 
per kilo has been estimated at sixty years of age at 34 calories per 
kilo, and at eighty years of age at 27 calories per kilo. 

Nutrition and Qrowth. — Interesting studies have been made by 
Mendel and others. Growth depends on an inherited capacit.v to 
grow, a, factor that cannot be modified at present, and on nutrition 
and environment, which are capable of control. The nutrition may be 



60 



FOOD REQVIRRMEXTS 



perfect and slill abuormalities hi growth ooeur, and on the other liant . 
the food may be more or k-ss faulty or deficieut without mterferiiig 
greatly with the capacity to grow, even though what w« term disease 
conditioDH are preeeut. 

It ifl an interesting fact tbat iiicreasing the total amount of the pro- 
tein in Iho diot does not force the growth nor make it go beyond th« 
normal limits, although too great rest riet ions may interfere with 
growth, which begins again or increoKcs when sufficient protein ia sup* 
plied. Mendel and others have oalEed attention to the importaneo 
of eoriaidering not the proteins as sueh, but ilieir amiiio-aeid enntent in 
relation to growth. By feeding cxperiruenis un animals they have 
tested various isolated proteins, in oonncetion with the neoefisary car- 
bohydrates, salts and fats and find that eertain proleinti permit of 
growth, as adestin, globnlin, cxcclsin, ghitelin and otherea of vegetable 
origin, and eaxcin, luetulhumin and otht-rs^ of animal origin, and that 
failure to indnee growth resnltni from the use of pelatin, legumin, 
conglutin and others. The failure cou be traced back to the absenco 
of eertain essential amino^aeids, for example, gelatin and itein lack 
the tryptophan group. In cases where these arc lat-lting and causing 
failure to grow, the addition of tryptophan as sueh results in mainte- 
nance, but no growth which, however, ensued on the addition of Ij'sin. 
The future study of footls along this line will undoubtedly solve many 
of the problems in feeding, espeeifllly in infanta and animals. 

There has been an enonuoits amount written about the different 
carbohydrates, so necessary for nutrition and growth, but at the 
preseut time one cannot state which ones are best. Lactose is the 
form supplied in the milk for the growing young and would seeiu to 
be the best for growth in early life, but other sugars and starches 
have been highly reeommeuded by pediatrists. The indispenRnbility 
of true fats and lipoids to growth has not been proven, but the fatty- 
foods contain substances that are Decessar>' for nutrition and growth. 
(See Vitamins.) Investigation by numerous observers sei'ms lo show 
that the administration of cod liver oil, egg yolk and unwaslifd bulter 
to undernourished infants and cbildreu rests on a sound foundation. 

Striking observations have also been made on the failure of growth 
when the mineral salts were insufficient, even though the remainder of 
the diet was adequate. 

Protein Requirements. — Ttaving c»ti.sidered the total amount of 
food required, the nest question is to determine liow much protein* 
fat, and carljohydratR ahall be used to furnish the requisite number of 
calories. There a n great deal of ditTerence of opinion on this subject. 
At the present, time there is eousiderabic known concerning the mini- 
mum amount of protein requir«-d. and the maximum that can bo 
metabolized withoot producing deleterious results. The protein 
optimum or the amount on which the body docs best is still an open 
question. 




ilKTABUUSU 



61 



There are MTcral ways of taking up the siil)JMt Voit and many 
others have studied the food taken by various iiKlivic)uiil!i, and he* 
found that an avertMic sized man at moderate work took about 118 
grams of protein together with !iome 56 i^rams of fat aud 500 RTains 
of carbohydrates. This represcuts some 18.8 grams of nitrogeu. 
This amount was formerly ro^rdcd as a standard, but luorc reeoutly 
there is a tendency to lessen the protein to 100 grams or less. Voit a 
standard is a liberal ouc, which need only be exceeded in some forma 
of tuWrculosis and some other diseases, and which may ho diminished 
in many dtsea-sed conditions to ^reat advantage, as in gout and 
nephritis. The protein iieedB of tlie body will be more clearly under- 

r aloud by eonsiderinp iiirrt>gen mPtaboIi.tm. 
Nitrogen Equilibrium. — It ha.'t been found in normal indix'iduaU 
that uiln>gCQ equilibrium can be maintained on varimiH amounts of 
protein food. This is determined by eompariufr the total amount 
ingesipil with the total amount excreted, or by makinirthe comparison 
of that absorbed with that which is utilized and excreted in the urine. 
If the amountK eorre^ipond or nearly so the iHidy is said to he in a Htato 
of nitrnffrn r«|uilibrium. Thr lotal amount of foml n'quired is gov- 
erned largely by the exercise taken. It does not seem to matter ew 
much what fonu the food is taken in, so long as it can be utilized. 
The protein metabolism, however, does not depend so much on the 
amount of exenu^ an it does on llic food taken. If small amounts 
of prutcin are given, Wjuilihrium may be established at a. low level, 
and if large amounts are given, at a high level. Thus Chittenden was 
able to toaJDtain health and strongth ou as little as 50 grams proteiu 
a day. and. on theollier baud, nitrogen e(|uilibrium has been estab- 
lished on as much as 130 grams a day and even '2W grams. The body 
is able to regulate the amount metabolined by the amount taken. If 
Ibc body is not in a state of etiuilihrium it ts either excreting more or 
leas than is being ingested. In atarvation, when none is supplied, it 
baa l>eet] found that protein metabolism goe^t on about, the same as 
wben food is given, only that the total eucrg.v must be derived from 
Bthe body itself. It has been estimated that 13 per cent, is furnished 
™^by the Iwdy-protein and 87 by the body-fat. A man at light work 
starving in a calorimeter was found to be using 1971 calories, or 31.23 

I per kilij of bwly-weight ; 71.7 grams of protein were oxidized, Hnd 
Itil 2 grams uf fat. In the lirst few days of fasting Ihr nitrogen ex- 
cretion is small, as tlicre is a certain amount of glycogen which is 
stored in the bcKiy, and this is metabolized in place of the protein and 
an MfNtrrs it. It has been found in lean animals later on in fasting 
that more protein is used iu mainlaiiiiug the body than in fnt animals. 
In the fat antiiials the fat is used to a greater extent, and the fat may 
ha reirariled as sparing or protecting the protein. 

The ofTwt of earhnhydrate and fats in protecting the body -protein 
*w4d« good in feeding. If a diet is used which is low iu protein. 



62 FOOD REQUIRB1IEXT8 

nitrogen equilibrium may be attained by adding either fats or carbo- 
hydrates to the diet, providing, of course, the protein intake does not 
fall below the minimum requirement. There may be a nitrogen loss 
when the total amount of food taken is below the requirement of the 
body, and this loss may be prevented by adding either carbohydrate 
or fat to bring it up to the standard. This is due to the fact that 
if the total of food supplied is too low, some of the body-protein is 
used to make up the deticiency. Gelatin may also be used as a sparer 
or protector of protein, 100 grams of gelatin being equivalent to 
about 35 grams of protein. It does not protect as well as either carbo- 
hydrate or fat. The nitrogen equilibrium is best maintained on a 
mixed diet, containing in addition to the protein both fat and carbo- 
hydrate. If the carbohydrate is out of the diet there will be a 
nitrogen loss, owing to the fact that there must always be a certain 
amount of glucose in the blood, and if this cannot be supplied from 
the carbohydrate of the food it will be formed from the body-protein. 

It should be borne in mind that it takes some days to establish a 
nitrogen equilibrium when the customaiy diet is changed. If the 
usual diet of an individual contains 16 grams of nitrogen, and the 
diet is suddenly changed, it will be several days before equilibrium 
is established at the new level, whether it be above or below the 
amount usually metabolized. There will be slight losses of a transient 
character if somewhat less than usual is taken, but if the loss persists 
it means that either too little protein is being taken in the food, or 
that the total caloric value of the food is below the amount required, 
or that the body is affected with some disease attended with a loss of 
nitrogen, i. e., some wasting disease. 

If the nitrogen balance is disturbed so there is a plus balance, 
it means that nitrogen is being stored in the body. This occurs nor- 
mally in young animals which are growing, in pregnancy, as the 
result of exercise that causes an increase in the size of the muscles, 
and in those who have had some disease where they have lost flesh anil 
are regaining their normal weight. 

Low Protein Standards. — Chittenden and his followers believe 
that the best diet is that which contains but little protein above the 
minimum, together with fat and carbohydrates to cover the needed 
calories. They urge that on this diet one may maintain health and 
weight, and that the mental and physical efficiency is greater than 
when more liberal diets are taken. They believe that as the proteins 
are oxidized with the formation of end-products more or less difficult 
•of excretion, that any protein over the minimum requirement adds 
to the wear and tear of the body without increasing its eflBciency. 
Chittenden's experiments included college professors and instructors, 
representing mental workers ; United States soldiers, representing 
physical workers; college students, representing a combination of 
mental and physical workers. The experiments covered sufficiently 



MtTABOhlUM 



loD^ times, and it wati fouud that niirogeu equilibrium could be main- 
laincd on 6 to !» grams of nitrogen instead of Ihp 16 or more usually 
lAkeii by ihv avcrutrp indiriduels. FatH and cnrljohyilrateM were added 
to briQK the food-value up to 25U0 or 2600 calories per day. This 
total would 'Sjevm 1u be too low for men doing more Thau rather light 
work, whatever might Iw .-uiid of the protein content. 

Ttlae of Low Protein Diet.— niittfndcu'f! i-xperiuu-Hts are of enor- 
mous praelioal vahit.- in ^howtiif; thai a low protein diet ean be used 
over tonfi; periods uf time without danger. Diets low iii protein are of 
value ID gout and gouty alTcciions. in some skin diseases ai-eompanyinjc 
disorders of metalmlisra, III treating the ill-effects of habirusl over- 
eatinK in arteriowlerosis. in fevers and other atrcfl ionM. Brain- 
workers and those Icadinp sedentary lives will also doubtless do better 
oa diets lower in protein than tbuse uKiially taken. 

Objections to Low Protein Diet. — Many objertinns have been urfrcd 
against this low standanl itf Chittenden. Perhaps the chief objection 
is that the human raee hai aiitonialically arrived at the diets usually 
taken after centuries uf eatint:. and that people in general apparently 
do not sufTtT frum <liets rea»)nahly hig^h in protein. 

Some have believed that while a low protein diet may be of great 
^-alue over short periods of time, the prolonged use may render the 
budy less resistant to infection or posaibly cause ultimate distnrlianeea 
in metabolism. Thoae aecuatomed by habit to low protein diet may 
have diflioulty in utitizini; larger amounts tihould greater demajids be 
made u)x)n the body. 

In very hard work the fat and carbohydrate neeesaar^' may mean 
undesirable bulk acd strain on the digestive organs, not to mention 
tfae less ptea!(ing taste. 

An»ther much used argument is that all successful races arc meat 
enters, but as a meat diet is expensive it may mean that the suceessfnl 
I bring able to buy meat prefers to eat it just a« the rich consume expen- 
I foxr alrnholic drinkn. 

As n matter of fact the great majority of the human race will go on 

eating and drinking, aceording to their appetites and their meanx of 

I gratifying them. Vet the problem is one which is of the higheat 

hnman interest, enpecially in eonnwtion with the dieting in disease 

and in prevrnling it when danger has been anticipated. It is inter* 

eating to compare the navy diets made high in protein, because the 

aailor wants it and is happier and more contenietl and does better 

I work than the crew on a perhaps more healthful, bot less appetiring 

^ diet. 

The High Protein Diet. — Iligb protein diets — those over 120 
grams— mjiy bi- of use in rcrtain conditions <hiring pregnancy and 
IftCtatioD. in conva]e«eing from wasting diseaHes, and in beginning, 
enlainly, of physical training when muscle growth ix great, and in 
combating certain diseases, as tobcrciUoaia. During growth the pro- 



FOOD KEQUfRHitHXTS 



icin requirements ore higher than when adult life has "been reached. 

High proteiu dicls are objeelioualilK in llii- scdeulary aud iii all of 
IhuHC couditicins iudio^ted as doing I>i;st on luw protein diet, and iu 
general it may be stated that iinlej*s one has a delinite r«asyn for doing 
80, the protein need not exceed the Voit standard. 

The Protein Optimum. — This is an open question. As just stated, 
thtt prot(?in need ordinarily not go ahuve 120 grams fur the a%'erage 
individntil. nor under <iO i^rams. This leaves a rather wide rangr, ami 
it is safe to say that the optimum lies between those two, aud it will 
onduubtedly be found to var>' with the individual and the euiiditious 
under wbicb he lives. We do not believe thai any standard will 
ever be fi.\e<i that wilt be of unlvorHal application, but we do thinl: 
that in tlie future Ntandardu will be worked nnt to eover the various 
clawieA of numtal conditions and the dilTen-nt diHturbnnce.-; of metabo- 
lism. Thus: In tuberculosis, 30 per ecnt. above the normal of the 
gi\'en individual: in nephritis, 60 or TO grams daily: in fevers. 70 
graniR, etc., are standards that are btrin^ put in practical use. Dietary 
Ktandardin have reeeived general atlentinn far nm-h a short lime that 
niueh may lie c;.\peeted alimg this line even in the near future. 

The Amlno-aclds. — The problem of protein is not limited to the 
amount. The nature of the protein used is of the utmost importance 
and just be^inuiug to be understood. Proteins are exceedingly difti- 
cult of analyshi, but chemiKta have succeeded in fiiiding out that pro- 
teins are made up of the aminO'actcU, each protein containing various 
amino-acida in vanotis amiuints. The follotving tabic ahows the coni- 
poailiou of some of the proteins used fur food: 

Ituaittilalive CtimparimMt of Aviina-Acid* Obtained by Hytlraljftis t~om i*rut«'fu. 
(Compiled tiy T. B. Osbome, 1»U) i' 

Oitl' l.rjcutain 

CaiviD. bumln. Oliidm. Xcin. Edmlu. iPta) 

OlyooeoU 0.OU o.uo u.(i(i n.m :t.Ko o.3M 

Aluin 1.50 3.22 S.OU U.A\i 3M0 2.08 

Valin 7.20 2.50 3.34 1.H8 B.-llt t 

Lnirin ,. 0.35 10.71 6,liS l».3.i 14.50 R.OO 

Frolin 0,70 3.&II Vi.ti S).04 4.1U 3.S£ 

Oxj-prolin 0.23 t T ? ! ? 

PhMiT-lKlsnin ).20 S.O* 2.3.) 0.55 3JtO 3.7S 

(ilut«iulnlc add 16XS P.IO 43.*lti 241.17 18.74 13.H0 

A«p«rtic acid 1.31) 2.20 0,28 1.71 4M iM 

Serin 0.60 t 0.13 1.02 0.33 0.53 

l^ToriD 4.50 I.7T l.«l 3.55 2.13 156 

ftstin t T 0,« t I.0O r 

Htotiain £.50 1.7 1 1.4S O.lie i. 10 2.42 

Arginin 3^1 4,01 2.01 IM 14.17 ia.l2 

I.ysin .. 5.IK .178 0.15 0.00 I,«5 4.y« 

Inlujihuti. about ).&0 prewiit I. IK) 0.00 pnwinit jtniH'nt 

Aiuniuiiiu, 1.81 1.34 5-22 3.a4 ±i» IM 

flS.49 iSM 84.73 88JI7 82.2S 07.43 

* ThvM- BiwIyBcii are combln^tionii o( vluit appe&r t» tw Uic bMt <Iet«nnla&tiooa 
of various rheniUto. 



METAaoUgil 



65 



Vim Slyfap has 8UTninari?e<l lite roxiilts of ttic various investigators 
frum Spallarizaiii aud Heuiiriioiit tu Culmheiui, and wv have coil' 
detisvU MOEaewlmt bis MtalviiR-ut wbicb is as fiiUows: "The proteins 
enter the Ktomach and arr digi>st<Hl to albumoscs, that is, the lonfr 
protein chain of ainioo-acidit is broken into souivwlml shorter, bur xtill 
somewhat loof; cbaliui. and the protein, which is usually itisoluhlr, is 
irauKformed iutu albumuMS. The latier are nut absorbed, however. 
The albumotwK all paw down into thv intestines where they men the 
pancreatic juice and are split into short vhaius uf two or three 
&mino-a<.-i(ls eaoh, and partly entirely to free uiniuu-acidH. That free 
amiuo-acids coustitute a i-wiutiderable part of the products of intes- 
tinal digestion was demonstrated by Abderhalden, who isolated moat 
of the known amino-acids from intestinal eontonts. White and Van 
Slylte iia%-e shown that the entire mass of producta. aside from the 
frpe amiuo-acids, eouiiiHtiJ of HhurT eliaiu peptids. Finally, either be- 
fore or after enterin)^ the inteKtinal wall, the products encounter a 
third hydrolylic cuzymc, crtpsio, wbieb is I'tipablc of carrying the 
hydrolysis to the stage of amino-acids still iiPiirer eonipletion." 

Van Slyke traces the antino-acids through the body as follows: 
*'Euterin^ the alimentary tract as part of a protein molecule, it is set 
frw by digestive hydrolysis and paitses iutu the porul blood stream. 
Il may be at once picked np by ihc liver and dccompused into urea, 
or perhaps synthesized into reserve protein. [1 may, however, pass 
by the liver aud be absorbed from the blood by one of the other tissues. 
Uerf it may remain for a time before being incorporated into the 
tiame protein. The fact that a considerable titore of amino-acids 
is alwayx found in the tLssui-s in prouf that chemical incorporation 
docn not instantly follow alL>^>rption from the blood stream. After a 
period of lime, eonceming the length of which we are absolutely 
i^onuit, the tissue autolyiu.'s, and tlie amino-acid returns to the depot 
of free amino-aeids held by the tissue. From this depot it may pass 
baek into the blond, be taken out by the liver, and liestroyed. Or il 
aia>' Ih> reiiicamaleil into a new pnitcin in Mime nthcr orgnn." 

The amino-acids have been likened to building stones. The proteins 
tikpn into the btxly as footts in ihe process of digestion are split into 
tlieir component auiino-aeids and these are absorbed and circulate in 
the blood where they are used hy the various tisKiiw for growth and 
rppair The amino-acids have alno been likened In thr alphabet, and 
the variouB proteina to words. Just as c<^rfAin letters are necessary 
to tpdl certain wordH,Uo certain amiuo-acidi; are re«iuired to fonn the 
rariotu prntcins.\ Oclatiu contains a large amount of glycocoll. hnt is 
biddnp iu tyniam and tryptophau. Voil aud Munk demonstrated 
that g«Ialin could not support nitrogen eipiilibriiim, but it was 
•bown later that by the addition of tymsin and tryptophan nitrogen 
tipiititirium could be established at least for a short time. 

It is evident from ecperimental work that il must be determined 



66 



FOOD KKQUIRBMKKTB 



which antmo-acids an> iiidisp<^n8able and which arc not. Some of 
them L-aii eviiieully be formed by sipiitheais in the body, as for ex- 
amplc ^lyeouoll. In niamiualR tryptophan seems to be iadiapeiLsable 
and it appiin-iitly eaniint lie fnnned, or at leHHt not in Nut^eieu^ 
amounts in the liiwly. 

Oshonic and Mcuidel have studied certam proteins in their relation 
to the growth ol' young animaU. They failed to imtuee growth with 
le^inclin (suy bean), vignui (vetch), gliadiii (whcntor rj'c), leRiirain 
<pea). legnmin (vetch), hordeiu (borleyl. eonghitin (blue or yellow 
lupin). f;»''»'i" (horn), Keiu (maize), phaseolin (white kidney bean). 

In some of iheae the failiiri' was evidently due to n lui-lt of certain 
amino-acids in the diet. The ReUtin is expltuned above and zein 
laeks tryptophan and lysin. If large amounts of protein are iiKed 
certaiu detieiencies may not be appaisent. but these appear on restrict- 
ing the amitunts. Kvenlually the nature and fiinelioiiK of the variona 
aminn-aeidti may be nuffieierilly well kufiwn to definitely influence 
human dietetics. This, and the obsi-rvuiionx on vitamins make the 
desirability of a mixed diet tit fresli foods plain. 

The ttminn-iicids may he act«l upon by the intestinal baeteria with 
the furmation of indol, skatol. and other substances which may be 
highly poisonous. These are uiuki. likely tTi be formed in diKeasea like 
eholera, summer diarrhea, and the like. I'tomaiiie polsonintr is of this 
natnre. Carbohydrates may be formed in the body by the ayuthcsU 
of certain of the amiuu-aeids. 

In 80iu<; diseased conditions some of the amino-aeids may be excreted 
in the urine, as the pn)tcin.s arc disintegrated faster than the amino- 
acids can be metatH>lized. In acute yellow atrophy of the liver and in 
phoaphoroua poisoning lencin. tyrosin. glyiocoll and phenylnlniiin 
may be found. In nome other conditions tlie body ioees the power to 
deaminize and oxidise one or more of the amino-acids, aa in alkapto- 
nuria. (S<i- uImi AcidoKia.) 

Purin Metabolixm laee also Gout). — Some years ago the proteins 
containing tV.N, hepau to attract attention. These suhslaiiees are 
called the purin bases, and are a series of compounds called adcnin, 
giianin, hypoxanthin, xanlhin, and uric acid. These Kulnitanees occur 
in foods, sui-h as Ii%-er, pancn^is, and mc«ts, in which they or their 
preeursons are in the nuclear protein. Tbey also are found in legumes 
and certain other foods. 

A man on a diet free from purin excretes 0.3 or 0.4 gram of uric 
aeid daily. This is formed from the breaking down of the nuclei, 
and iti callpd lh4> cndngennuK purin. That which is in the body as a 
rOHult of metaholisin of food is calh-d esngcnous purin. This latter, 
of course, can be regnlated to a lar^e extent by the proper selection of 
the diet. Those purin base.s are difik-ult of excretion, and in certam 
diseases there may be purin retention if the amount is too high (s«e 
Gout). In certain other di«>aseK (as nephritiH) it ia a good thing u^ 



4 




METAHOLIHM 



Mtm 



In itOiTCOu. 
Beef . . 

Ulf m«at . . 
Million. . . 
I\>rk . 



Lu Biaiiia. 
. . . 0,037 
. . - 0«3« 
. . . 0,U2i) 
. . . 0.(H1 



VcgoMm. 



KltrORDbMM 

ID srunk 



CooktdlMni 0.U26 

Raw pgrk. 0.0^4 

IteliDon aoi7 

Tuogue \eaU) ftOU 

Uret Mn^K^ 0.0$8 

Bruntwiit muui^ ...... O.DIO 

M»n3ilel mnwiw aulS 

Kaiami ■aim^e 0.023 

Btuoil ■ILMlje 

Fi)C brain 0.028 

Liw 0.093 

KidDOT 0.000 

TliriBi 0.330 

Li'«t (<^ O-OW 

Chkkvi 0020 

PiCMO COM 

Goow 0.033 

Dwr a039 

YnuRK pbtuml O.0A4 

Bouillon (100 gm.). Beer im. 

botW two bcwDi ... . 0.015 
FidL 

DlMllfiUi UOSil 

TwKh 0.027 

CttlUi a03d 

Brl , Ol027 

AiliBoa (fRdit 0.024 

(.Vq. 0.«.M 

Pwrfi , 0.046 

PU* 0.048 

IM kcmag 002« 

BoriBB O.Oft» 

Treut 0.060 

8pnl 0.062 

(«lmrdfnM 0.U8 

Svdidlct) 0.078 

Ancbotioi 0.145 

Oalv 0.030 

Offun 0.0?V 

Uktimr aoas 



Bmtftttgt 

Ckriarc . 

HiU 



Sn^ 



Kitk tuid CliuM. 



» ■ «■ ■ . ■ t. ■ ■ ■ 

DDnwHaBr CDOW 

UtabtnivshMM 

Boqmfoft . • • 
OemM .... 
Q'cwii rkMM 
KofakJM . . 



Id looRrwBt. 

Cut-uiubet 

Stlad COOS 

hululic* 0.00ft 

Cauliflwver O.O06 

('.ubUse 0.007 

Cliivts Incn 

Spiittcli 0.0M 

Wl>iU> cakU«* 

QWKK 

Kalr 0.0(tt 

Curlr aibt>igc 0-OOS 

Itaoipion 0.011 

Kolifrabi OuOll 

CVL-rr 0.006 

At-ranifiK OuOOS 

OatDoe 

Gram pcu 0,00a 

PoUloM oiooa 

JtfuakrsMiM. 

6«Mni>il» 0.018 

; Prcflin-lingM- 0.018 

MuiihnxunB OJXU 

Monti OiOll 

Bananaa 

PiiicapplM 

I'mriiH 

(jnpw 

Tomutoea Q 

I'nn .0 

I'liiuw .....0 

I'miwl bmi« 

Oniiifm 

i .Vuriooia 

BluL-bi-rria 

.^ppk» 

.ilnionilii .......... 

llBLBelnuU 

Waliiow 

Lawmu. 

■I'«.(fmli) OXfflT 

' I'eu ■ OXtlS 

Lcntib 0.0S4 

; Bcuw 0.017 

ir.riu 

brier <* 

Rice 

Tapiwx 

aw> 

Oxtmtal 

MillM 

BoUl 

WUu httaA 

Eoomia bmd . 

Pumpemidiel 0.00* 



FOOD REV( IKKUKXTS 



lessen the iiitnkc nf purjn hases. Xorraallj', on an iinrpsirieted diet, from' 
1 to 3 per cent, of ihe total iiilrugfii fxereted \s in tin.' foruiof uriu acid. 

V'ariout) tabks will be foutid in Ibe article on Gout, and Uic table 
on pugp 67, from MessHn and Sohmid, is one o( the latest eontribiitioris 
on Ihr suhjrct.' Tlie foods to be espeeiallv noted on accomit of tlieir 
puriij puuli'iit. arc prinlcd m bold type. 

The Specific Dynamic Action of Protein. — This may be briefly 
mentioned hen, and ix one of the many ciinoii.s and as yet uuexplajued 
features of metabolism. Each form of food exelleH a »pecilie &«- 
tioii ill nietaboliKtii'— ihut is, there is a eerlaiii uiuount of iieat or 
eueiyy derived from each form which is lost and uut used by the body. 
Thus, if protein eapbohydratp or fat are fed separately to cover a 
given rpfpiirement, about :W or 40 per cent, more protein would be 
rfH|iiired, abonl 14 to 15 per cent, of fat. and about G or 7 per cent, of 
earboliydrate. The protein raises the metabuUssii tlirongh «*»nie spe- 
cilie aetion. On a mixeil diet tins in not so importatit. This etTeet 
of tJie food-stnlTs or Ihe Uis^ of energy iiuiy hi- rnleulated by iLsiiiR 
faelurs delermiiuHi by Rubuer. h'or protein 3IJ.!I, fat 12.7. and earbo- 
bydrate 5.8. In a given diet the percentage of [jroleiii, fat and earbn- 
hydrate should be multiplied by 0,309, 0.127, and 0.05B respecti^'ely 
to determine tlie energji' percentage loKt. Prautieally, in a mixed diet 
this umoniits to a little over 10 per eent. above the food nvpiircmeiita 
of starvation. Thus, a raau fasting metabolized 2400 calories, if a 
mixed diet containiiip i:t.2 per ceut. of protein i.s civen, a 
totul of 2745 ealoriej* would be renuired to maintain the indi- 
vidual. If a ftiiiftllcr percentage of protein is ^iven in the food, a 
somewhat ^.mailer total requirement will be needed. Rnbner advises 
& restriction of prcitein.s in fever and tti hot wtiitlirr and elinmtes 
on aeeount of tliiR specifio <lyiiainie uetion of protein. 

The Amount of Hat and Carbohydrate. — There is Home little dif* 
ference of opinion on this subjeeJ. While it would not be well under 
ordinary eomlitinns to omit from the diet eithiT all tlie earliohydrate 
or al! Ihe fat, hm a malter of praetieal psperieni.*e on a mixed diet, 
tlift cxaet amount of fat and carbohydrate does not make so very 
mueh dilTerenee as long an the total number of calories needed to 
be supplied in adilition to that supplied by the protein is covered. 
Voit'a standard was 56 grams of fat and 5(H1 of ejirbohydmle. Play- 
fair, in England, reduced the fat to nl. and im-n-asod tlic carlw- 
dydrato to 531. Oauticr, in France. HUKgeirta 65 gruuw fal and 437 
fttrbohydrate. Fat is ex]ienaive as a food, and, from an eeononiic 
standpoint, diet-s containing over 60 grams are not apt to be employed. 
Jn cold wealher the nraount ingested may be increased if desired. 
and periMins doing very hard physical labor eaii Take mure. If fat 
doe* not agree, an amount of carbohydrate having an eipial caloric 
value may he substituted for whatever fat is omitted. Fat-free dieta 

1 TlK-rniwutiirlii! monat^heft. Itrrlin, 1910. xxiv.. Nu. 3. 




M£TABOUHM 



Are mit uih'ixable eitltor in itifmUK or ynimp chiMren. (See iU<^eto.J 
The Mtuuunt uf carboh,v(lnite used will depenil on the total number 
of calurifs oecdec), jiikI mn br dctertuined t>y drdui;tin{; Uiu ])n»leiiiH 
and fttts. A diet consUtiii^ largely of earbohydr»ii> h nbjectioiiBble 
chiefly on Breouiil uf the bulk aud the strain made in the digestive 
orjfans. 

Mineral Metabolism. — After the fundamental factN coDverniiig the 
inetuhiil JNin of protein nf fat and cBrb(>hy<lriite bad been ascertained, it 
was <)uite natural that the metabolism of the mineral elements in 
th« Itmd shonlil eome in for a Inr^e !^)iare of attention. It is now pos- 
sible to determine the intake and output of iron, ealeium. riiaguesiutu, 
phosphitniR, potassium Kodinn), clilurin, and mdplnir. The c^hief (acts 
concerning mineral metabciMMii will be found nnder the heading of 
SaltH. 

Sbcrtnan ha£ supffCSled as a standard that in a diet containing 

1500 calories with h protein eontent of 7n prain.s the phosphorous 

~Mnteut should be 1.44 erauis (about 3.5 (fi-ams I', O. < the ealeium 

0.69 ^ram i eNtiniated ati Ca O) and iron 13.0 millit;raius 10,015 grauu). 

DIETAKIES AND DIETABT 8TAMDARDS 

Food Economics, — The t^st of foods is most important and the 
phyKiciaa tihuuld bear this in mind in onlerin^ dietH and Huit the 
luggeations or ortlers to the pocketlxiok of the consumer. The Uuiletl 
States ("lovemment is doing much to enlighten the people on the 
relation of food values 1o eost, but tbe poor who need nuvU iiifurmation 
Kldom have it furnished them or are too ignorant to use it. Per- 
fectly Matisraetory dieta may be arranged at a reasonable eost under 
Dormat conditions, while high priced meaU may not be as suitable or 
even have ax high nutritive value. The addctl cost UHually, not 
aluays, brings an added fla\'nr or ehoieenest; of food. A study of food 
values to the actual cost, should be made by anyone having to eater 
to a family or institution. In a general way local food products are 
cheaper than iboKP which have to be Nhipped and noii-perisbable fcMids 
than the [leriNhablc. Wirciables and ccR-als arc cheaper than nieuts. 
Utlk, bread and butter are also cheap when oik- considers their food 
nine. Too tnueh stress should not be laid on the number of calories, 
M nany fresh fuits and vegetables extremely important in furnishing 
bulk, vitamins and aalta may have a high cost bHsed on ealoric values, 
but not peally be ex|>ensive. The waWe in food .should atwi !«■ uonwd- 
ored, OS many cheap cuts of meat and other foods may buvc suuh a 
Urg« proportion of unavailable material as to more than ofTset the 
differrnce in price. What has been said under the subject of Supe- 
rior Olid Inferior Food Proteins, in iniere»tiug iu this eonneetion. 

Sherman and Gillett (Publication 121, New York AKMN-iation for 
Improving the Cnndilion ttf the Poor. 1917) sugBCHt that if city 
dmllers ap«nd an equal amount for (1) meat, i2) mitk, (3) fruit 



70 



FOOD REQUISEMENTB 



and vegetables, the result will result in a nearer approach to a well 
balanced dietary. They studied 92 families and the results are in- 
structive. The following is their table : 

Avtrai/e DiatribvtUtn of Enpaaditure Jmon^ Porwu* Typ«« oj Food in BS Famiii€t (Divided 
into 1 groitpt on the Batit of Oott per Man per Di^). 



Coat per man jtrr day. 
CMt per 3000 calariSH . . 

Typb or Food 



H«>Vfl*h 

SiS ■::.■.■;.■.■.■ 

Oream 

Ob«ne 

P»U 

OralD products 

Suiara 

Vegeiablei , . . . 

Fruii 

Now 

UiscellaDeouH • 

CaloriM 

Protein 

PhMpfaorui . . . 

Oalcium 

Iron 

Protein 

Phoapborui 

Calcium 

Iron 



Qroup I 



10.2 centa 
G6.1 caoU 



Per cent. 
3S.8 
4.B 
».l 
0.3 
0.» 
«,7 

8.4 

e.u 

8.3 

0.1 
4.3 



t0<3 
7Sgraau 
1.14 ETaini 
0.61 gisin 
12.1 milligramB 

lOT Bram* 
l.SBgrami 
0.7U gram 
IS.T miUigrama 



Orouii II 



lia.i centa 
30.3 oenta 

Pekcbntaoi 
Pot cent. 
S9.4 
fl.4 
9Ji 
O.S 
1.0 

a.i 

1'/.? 

4.4 

9.0 
7.S 

0.6 

e.s 
Food Valub pbb 

2686 
91 ffranu 
1 .39 gratiu 
0.84 srain 
14.9 mUliKTlBU 

Food Vai.111 psk 

104 (Tanu 
l.STgranu 
O.TT Br>m 
16.7 miUifraina 



Group III 



34.7 ceuls 
34.3 cenU 

DUTWBUTION 

Per cent. 



S4.9 

6.4 

7.8 

0.1 

0.8 

7.9 
17.9 

S.8 

9.S 

6.4 

0.1 

S.7 

Mad pn Dat 
sioe 

109 frauiB 
1 .60 tranu 
II .72 tprnm 
lT.7miDifTaiiia 

3000 OlLOKUH 
■ Of gramg 
1.B4 srama 
0.71 gram 
17.1 niilligTami 



Group IV 



49.4 centa 
44.7 «enta 



Percent. 
31. a 

6.9 

8.4 

1.8 

1.S 

9.9 
13.1 

3.6 

9.3 

8.8 

O.S 

6.9 



3880 

126 grama 
1 .06 frama 
1.01 grams 
20.8 miUitTam* 

1 18 graiDi 
1.69 (rama 
0,81 gram 
IT.O miUigrama 



"It is clearly evident that the average expenditure in Group I was 
too low to provide sufficient energy for that group. If, however, the 
cost and food factors for each group be recalculated in proportion to 
3,000 calories we have a basis for comparison which indicates: (1) 
that if energy be sufficient the other food factors will on the average 
be adequately supplied, and (2) that Group I was getting practically 
the same amount of food value for 26 cents for which Group IV was 
paying 45 centa. It should also be noted that while only one-fourth 
were spending for food less than 25 cents per man per day, about 50 
to 75 per cent, were not getting enough energy." 

The proportion of the income to be spent in food has been studied 
by the Russell Sage Foundation, and they surest the following for a 
family of mother, father and three children: 

Proportion of Income to Be Spent for Food. 









Amount per day 


Amount 


Income 


Perron t age tor 


Total for food 


for family o( 


per day 


per year. 


food lier year. 


per year. 


five. 


per person. 


« SCO 


55.0 


»275 


10.75 


0.15 


800 


45.6 


363 


1.00 


.20 


1000 


45.0 


450 


1.20 


.24 


1100 


45.0 


490 


1.34 


.27 


1200 


44.6 


540 


1.48 


.20 + 


liiOO 


36.8 


552 


1.50 


.30 


2000 


30.0 


600 


1.64 


.33 



yETjBOLItfM 



n 



Planning Diets. — A perfoclly balanced ration is one which takes 
into con&iderutioii the following factors. Our idras of the complete- 
ness of a diet an? constantly changing ut> the slud,v of nutritiou is 
making clear many little understood points. Tin.- easiest way to work 
out a dietary is to determine according to the data already given the 
number of lulorieK required. Of tlm amuuni from lU to 15 per cent, 
{from 60 to 120 i;ratii.s for an ailulr) sbotifd be furnished by protein. 
Sedentary and indoor pwiple re(|\iire less than active outdoor ones. 
The nature of the proteins should be oousidered and those containing 
the re<|ni»>te amounts of the ucccsHary aiiiino-ai^idx should be included. 
The relative value of some of the proteins are givcu under the para- 
graph on Superior and Inferior Proteins. The proteins found in milk 
and meat are more valuable than the ones in vegetables. The re- 
mainder of the calories are to be made up in fat and carbohydrate. 
These are iuterobaiigeuble within certain liinibi. It ha.s been slated 
that on a ba^is uf caloric valuoii the proportion of fats to carbobydrutcii 
may vary a.s widely as 7 to 2. In cold weather and climates and in 
hard work the fat may be increase<J. As a matter of fact fat is ex- 
pensive Ro that the amounts taken in are small, as a rule. 25 to 75 
grams a day. and the balance in car bohyd rules. In hot weather and 
filimates aud for sedentary people carbohydrates are us«l in larger 
proportions. 

The diet must also contain a full amount of the various nalts needed 
in metabolism and on a generous mi:ted diet this will always be the 
case, but on a rcHiricted diet the tialls may be so low as to interfere 
with nutrition. The oiUy muieral constituents that have been suQi- 
eieiitJy studied to know about the requirements are iron 0.015 gm. 
daily, calcium CaO. 0.70 gm. dally and phosphorus 1*, 0,^ 2.75 gm. 
areroKc daily. Iran containin>; £ikkIs of great value are Hpinach. 
lettuce, asparagus, and similar things, the legumes, yolk of egg and 
meat. Calcium containing foods of greatest value are milk, cheese, 
cauliflower, string beans, carrots, lettuce, rbutwrb, orange8 and 
lemons. Tlie pboHphoruK eonlaining foods iif greatest value are 
akimmed milk, milk, cheese, legumes, meat, yolk of cfnf. oatmeal, cauli- 
flower, spinach, Icttnce, asparagus, green peas and beans, and toma- 
toes. VTith ordinary diets the requirements are easily met and this 
emphasizes tlie importance of milk, fruits, salads, and other greeo 
vegetables. It is also important that the food^ furnish more bases 
titan acids (see Alkalis and Ai'ids*. and meals, cereals, aud other acid 
forming foodfi shnald be o^si-t by those containing alimentary (dkaliB, 
as potatoes, bananas, and other vegetables and fniits. 

Certain important substances occur in animal ta\s which shoiitd 
Always form a part of the diet, such as fat from moats, butter aod 
cream. V'itamtnK are also inijMirtant and seem to besr a relation to 
the phn«pborou8 content of the food and diets low in pbospborous 
•bonld have tbeir content increase<l by fre«ih or dried (not canned) 



72 



FOOD PBQVlRHVEyTS 



le^imes, the whole gruiiis of cereals, etc. (S« Vitamins). There 
should always be uii HUtt-scrorbutic in tti^ diet, iiueh as Hniiif fn^h 
friiil or v<-i;ctHl>l»'. The iurrriiscd usi- ol' sterilizwl cauue*! fuoda 
mnk^» ihis imprrativc. Tlu' (uwl should bv isut-b as uoiiIaiBs safficieut 
bulk. Among the well-to-do, as a rule, the ordinary daily diet natu* 
rally iucludes all the necessaries, but amnng the poor and ignorant 
and in institutions and where larjie nuirbors of penwiis are fed to- 
gether, gra%'e errors of diet may lead lu serious diseased L-ooditiona. 
(See Blsf» Basil- Quantity Food Tables.) 

Vitamins. — Of recent years it has bycnme evident from iiutritioa 
ex peri men tJ« that growth hjuI life is mure than liupplyitii; the animal 
body with ferloiu amounts of prottiii, carbohydrate, and fata. It 
has been made very plain that the t'baraeter of these as elementary 
snliKtunees is very important and that certain subatanees are present 
ia certain foods and are absent in others, and that these subKtanc<es, 
whieh Vunk has proposed to call vitamins, are ejoiential tn life and 
trrnwth. The esnrt mitnrr of these vitamins has not boiM3 detcriiiined 
and there iw, just at the present time (1917J, much diaeussion eon- 
cerning them, with which it is not necessary to concern ourselves at 
the present. Animala of various kinds have been fed on Kpecial diets. 
ample to cover all the needs in the way of pnilein, carbohydrate and 
fat, but not foods enntainin^ vitamins. Yotintr animals priiw for a 
certain time and thou come to a staiidttlill and eventually »ickcn and 
die unleHs some of the vitamin containing fmnU are added, l-tittter-fat 
and cod livrr oil lontain these substances, while olive nil does not. 
They are found in milk and ckew. in orange juiee and other fre^ 
fruit juices, and in the bran or pericarp »if wheat aud rice and other 
cereals. \'itamiu.s of one kind or another seem to lie intimately con- 
nected with the pr<nluction of scurvy, of pellagra, of bcri-bcri, aud 
probably of ollipr diseuKcs. Vitamin* are also essential to the 
^owth of young animals and without them animals fail to reach 
mature growth aud eventually aicken and die from metabolism. 

Carrel found that, in frrowing animal lis.Mie.s outside the body 
in adult hlood MTuin the tiHsucs would live a long while, but would 
not grow, but that if plaeed in blood serum from the young and grow- 
ing that the tiK!iue.s began to grow, showing that there are subxlaiiccs 
in the tissuea of the young uecessarj' for gruwlh not found in the 
mature animal. 

McColhini. Simmonds and Pitz believe that there are soluble .sub- 
gtanccs in thoso fat.'' which ore of especial impoi-tanee in growth. 
They atiggeat the term fat soluble A and water soluble B. Butler 
fat and egg yolk apparently contain more of the«M> substances than 
other natural foods, but «>me i» found in animal tissups. espeeially in 
the active organs. They are aUo present in small, but inade<piate 
amounts in the cereal grains and in larger amounts in the leaves of 



atETlBOLISU 



Ihe forage plants. T)ic vegetable oils contain very little. 1/ any. 
These substaucw art also found in t-ertain seeds, such as t-oni kernel. 
Extracts which coinaiii waler stilul)lf 1* will r^lii-vt? tin- imlyinfuriliK 
in pigeuns induced by diets of ixilisla'd rice or purified forjdrtluffs. 
(AtniTipan .Journal of Physiohigy. .Sept., li>16. pp. '■i'S'-i and 361.) 

Acids and Alkalis.^ — The question of acids in 1>«se-fomiiug prop- 
vrtii's of fiH)d in <.-xtreini'ly important und id being Htiidied to advantage 
(see also AeidoHis und Miuvral Sallul. Tliere in Ktill a gr^at dea] of 
(wiifusion as rvg>^nl<i the eompusilion of the %'urious fiwd mati>rialK, the 
ulder studies taking into account either the whole plant or the 
product and were made by Hgrienttural eliemisls wliit.se chief interest 
was in what whs taken out of the Mill The newer studies have dealt 
witb the eoniposilion either of the food oh purchaaed or of the. edible 
portion or as prepared for the table and. in ntany iuataiiees. the tables 
did not show whii-h partii-ular preparation of food was analyzed. 
This IK, however, being rapidly cornnrte*!. In this connection the work 
of Sherman and fiettler (Journal of Hiologieal Chemistry, ]dl2, xi, 
p. 33.t) and i>hcrman iFood Products) it* of great interest, the 
latter work eontaining full tables showing the content based un hiui- 
dred ralorie portions. This basis is ratber better for practical use 
than u hundred k'ram b&.$i8. iitaHinuch as differences in the water eou- 
lettl in the latter yield dilTt^rerires In the ligiireK. By estimating tlie 
difference between the aeid a-sh and the basic ash of the foods it may 
be determined whether they will increase the acidity of the body or 
decrease it. Fiwxls fuminhing ai-ids are chiefly mealH, eggx, grain 
products, particularly Ihr whiik* grains, and peanuts. Flutiis, jiruucs, 
and eranberricK, although yielding a basic ash, ineroa.'te the acid for- 
mation owing to the benzoic acid content. Milk iit regurtled as either 
ueutral or tiligbtly haaic, while most of the alkalis are furimbcd by 
fmitx and vegetables and. as Illatherwick has shown. potatocK. oi-aug«E, 
raisiiLs, apples, bananas and lettuce are very Uircful iu reducing the 
acid output. Tomatoes arc of less value. 

The actual enrapntations are scarcely ever made outJiide of very 
eareful dietetic studies, but when it is thought advisable to increase 
the base's taken in a food, tho»e foods are added to the dictari-. 
In any well balanced ration the proportion of alkali furnishing foods 
ahould balance tlie ones fumisbiug acids. Sherman suggests comput- 
ing this then in terms of normal wiltilions and that it is preferable 
|<t have the twlanee on the bn.si<- side and that an esecNsive acid-form- 
ing clement be penuittcd. It wouid seem that the excess sliould not 
exceed 2r» units of the equilibrium of the uiaii per day. which is 
■boot the (pinntity neutral izable by the amount of ammonia to be 
expected in a day's urine nnder favorable conditions. The following 
•able from Sherman and Geitler shows die acid or base excess value of 
the foods most commonly used : 



74 



FOOD REQUIREUENT8 



Exoen of Avid-Forming or Baa»-Forming Elememtt. 



Article of Food. 



Exceu Acid or Baie in Temu of Normkl 8<riutiaiu. 



Per 100 sraou. 



Acid, 
c.c. 



Bkw. 
c.c. 



Per 100 e«lotie«. 



Acid, 
c.c. 



Bu«. 

c.c. 



Almonde 

Almonds 

Apples 

Asparagus 

Bananas 

Beans, dried 

Beans, dried 

Beans, lima, dried . 

Beets 

Cabbage 

Cabbt^ 

Carrots 

Cauliflower 

Celery 

Cherry juice 

Chestnuts' 

Corn, sweet, dried . 

Crackers 

Currants, dried . . . 

Eel 

EggB 

Egg white 

Egg yolk 

Fiah, haddock 

Fish, pike 

Lemons 

Lettuce 

Meat, beef, lean, 1 
Ueat, beef, lean, II 
Meat, beef, lean . . . 
Meat, beef, lean . . . 

Meat, chicken 

Meat, frog 

Meat, pork, lean . . 

Meat, rabbit 

Meat, veal 

Meat, venison 

Milk, eow'B 

Milk, cow'a 

Muskmelon 

Oatmeal 

Oatmeal 

Oranges 

Peaches 

Peanuts 

Peas, dried 

Peas, dried 

Potatoes, I 

Potatoes, II 

Potatoes 

Prunes 

Prunes 

Radishes 

BaiMinH , 

Raspberry juice . . . 



6.96 
7.81 

9.89 
11.10 

6.24 
26.69 
16.07 
ll.«l 



13.91 
10.60 
12.00 
13.67 
17.01 
10.36 
11.87 
14.80 
13.52 
15.83 



12.93 
10.63 



3.9 



12.38 

11.76 

3.76 

0.81 

5.66 

23.87 

II. 58 

41.6S 

10.86 

4.34 

7.10 

10.82 

6.33 

7.78 

4.40 

7.42 



5.97 
7.56 



6.46 
7.37 



2.37 
1.26 
7.47 



5.61 
6.04 

7.07 
3.30 

7.1!> 

6.5 

7.72 

24.40 

26.ri5 

2.87 

23.68 

4.!>1 



1.77 
1.95 



9.62 
7.08 



12.10 

8.74 

10.44 

11.89 



3.23 
2.66 



0.70 



1.86 

1.76 

6.98 

3.66 

6.62 

6.92 

3.36 

12.08 

23.67 

13.76 

22.51 

23.91 

17.48 

42.17 

3.19 



1.86 



12.32 
38.69 



3.44 

1.83 

18.82 



10.94 
12.20 

1.98 
0.94 
8.63 

9.26 
8.05 
8.43 
9.79 
6.87 



UETAmUSU 



n 



.' ■- 


Exci^M Add «r !*■•« tu Tnmu of Kurmal Moludosi. 


Xi\tdbK>t Vaod. 


Per IIK> gruu>. 


I'er luiicalorln. 




And. 


C.G. 




c.c. 


Rite, I 

Rins II 


B.I 

7.08 
8.3A 

B-Wt 
MJ&l 




3.3S 
2.42 

3.2i 
3,4; 
3,70 




WliMt, vatitt 


0.8S 
Ml 







The Cftkulation of Rations.— N'ltmoro us suKKCStiotiH, tablMi and 
devieett have b€«ii uffereil. In arui*,' and navy life and ia ordcriiig 
fuuj for lar^e uunibers of people i:er1uiu staiidartls are used, cou- 
siTucted more with the view of satiBfyin); the appetite tfaaa any 

»theor>' of metabolism. Prautically they work out about as above, aud 
usually mutaiii about 100 to \'2.h ifrnms protein, 50 to 6u ttranix fat| 
and the balance up to about 3500 caloriet; or more in carbohydrate. 
The labU's of fooda ordinarily used are arrtiuged %o at a glance the 
mmount needed for any number uf '"rations" or people may be told. 
In the army eonverition tablt^ tbe.se tigtires show the amount needed 
for one and any number up to 100.000. For the purveying of frMid 
such tables are of ^'reat help. Tables showing the comparative coat 
of foods aud their full value are ut uKe in Hupplying a nutritions diet 
on OB cheap a \»ms va pwMiblc. Thiti ecouomii! side of diet is of the 
girateflt importance, and one well urortby of the study of physicians 
and laymen. (See also Hasie Qiiantity Kood Tables.) 

A Food Scale. — Ilart hati devised a food aeale whii-h makes it 
CMnparati^ely viis.y for Die patient to weigli biir food for hintself, a 

[T«r>' important factor for the trealnieut of patients who are ou strictly 
regtilated dietjt. The majority of these patienUi cannot afford nor will 

■they interale Ihe presence of a trained Btlendani and rao!*t of them 
are n«t sufficiently ill to be in a hospital. Hurl gives the following 
description of bis scale: "Thia is an acourate spring sealc of modest 
dimensioDs, 6 Inches high ami witJi a 5 inch base, finished in nickel 
and, Iherefore, not too eonspienous to be used at the tabic. It is fitted 
with a broad circular plate whieh easily suppoi^s the dish on which 
tlie food Lt weighed and it haa a base sufficiently wide to keep the 
•cale from being easily upset. The seale is made to indicate grama, 
having a total eapacity of 1(100 grams, tbc dial being figured for 
every KK) grains, with subdivLsions indicating 20 grams each. By a 
aixvial contrivance the dial can be qniekly rotated to any doflircd 

[point, by means of a small knob. The result is that the zero point 

-can be brought family to any position desired. 

"Tbc method of naing the scale is as follows: Suppose the food 
preserlption for a given meal consists of 



76 



FOOD REQVIBEMEST8 



Mviit 

S(riii)( WnnB 
\Vll4^at bread 



loo frrame 
60 gmoh 



Fig. 1. — A food tulle wlUi ui adjiiHliLb)« dial. 

"An empty plHtc is placed on the scale and by means of tJie knob the 
dial 18 rotated until tho z#po point is opposite the end of Ihe pointer; 
meat ia plaeed ou the plate inilil Iht- poinier iiidirates HM) (rranw; the 
dial ia attain rotated until zero ik opposite the poiiiter : potato in added 
until tm ^Ktns are indicated, and so on, the zero point on the dial each 
time brought opposite the pointer until at the ooiupK'lion uf tiie 
operation we have on the plate all the food for the meal, eaeli kind of 
food aeuuratelv vvLMghed." (Jour. Am. Med. Assn., August T, 1UU9, 
liii, 457.) 

After two or three wceJca the patimt can learn to judfre by the eye 
the Kize of a pieov of nit.>al or bread or other food whieh he ii^ allowed 
and in some instances the use of the seales can be done away with 
after this has heen thoroughly mastered. 

The Prescribing of Diets. — The physician usually deals with the 
individuHl and the individual diet, and there in a :;ri)winK demand 
for the seiontifie supervision of diet in health and in disease. Many 
phyaieiana get hopelessly entangled, and finally fall baek on set diet 
lislB. To be able to understand the prestTihin;; of food one niiwt know 
certain faet^and tigiires and be faiiiiliar with the vaUies of simple foods 
in the amounts usually eaten. The number of calories furnished by 
the prutetii, fats, and carbohydrates in any given Food must also be 
known, m that diet may be varied to suit the individual need. Faeiltty 
in thix may be ae<|nired ea-tily by rjilnilittinf; fntin the tables ifiven 
below the food selually eaten by the pli>-sieian himself. The weifthiug 
of the amounts nerved ia the most aeeurate, but after a few times the 
amount may be judged by the eye. The totals will always be only 



^ 



PLAVNiwo Dttrra 



77 



appruximate, but sufficieully accurate for the purposes of medii'il 
prwtK'p. The terms "a moderaic helpiiit,'."c1c.. moan little unless the 
portioDs have been chocked up by actual wcigliintc. 

The fnllowiDg fa(.>rs inUNt be Wnniod. aud should be copied on a 
card nud carried about until the^ are memorized : 

1 Rrini prot«ln = -t I or 4 oalorlwl 

] gmm fftt = !U or 9 ralorin* | iip[iruxim»t«ljr. 

1 gnni ('•rboh^vdrdt* = J I <>r 4 calari«tj 

I jrruiii alr»Fi<'[ ^ 7. 

per [BiunJ. I'rr kilu. TuIbI (•la«in. 

ihtd M 2S l«l» 

, III 32 21(10 

work 17 M 23«0 

MMbnt* warit SO 40 SOOO 

Bard wnrk . IM 48 3100 




The protein requirement in apiiToximately 1 to 2 prams per kilo or 
i^ 10 1 cram per pouud of body weiKlit, siviiiK an averaue of from 
60 u> 120 ijraiiiH for a mau of 6'i kiliw or Vi\ poumls, Tln'se an* the 
minimum and maxiuium umli>r ordinary comlitioiLs. to uctuHl iliet- 
iuK, unless esjwcinl eai-e is taken, the protein will increase with the 
inereaw in i-alories mi n gent-ral mixed diet, if the individual is doinir 
hanl wnrk and is in irood health, this di>es not apparently affect the 
gctteral well beiiiff. If the (.-aloric value of a food per pound is known. 
divitliiig by 4.5 will give the approximate niimbfr of ealorics per 10*1 
^[mitifi: or if thi- VHlue per hundred (rranis is known multiplying this 
by -J.& will pive the <?alf>ric value per pound. 

To eoiiipnte easily the number of i^alorieii in a diet, or to prescribe 
it, aereml aiethudx ba\-c been nni^KCHted. WilHOu and Ratbbum (Joor- 
nal Ameriean Med, Assn, June i. lfH6. I76i).) ttivp the following 
scheme to help in computing the ealorif^ in a dietary. Irving Fisher 



rtmMbrr «t 



?t ua(«r ot 
poundu at 
'•rbdh/Jrato 
rodMaad 



X !.«(» = 



(it iiro^ctn and 
cKtbalif drate 
cooaunuit 






at P«Mfl4> 
fmuMPJ 



X 4,000 = 



Total laloriFs ot 
(nl oouumnd 



I' tMaimBinfttie arhwiw for «iinp«ting the ralmtc wmtent o(^« *''A*f'^ 
■n> Hinvertad into gmma by miiftii 



Total rahmra t<rt 



-Ur I -^- 



.^u1nbrr o( 
l«TMMw atrvM 



fiumbt* of 
calorlM 
)>ar capila 
\<vt dWiD 



iplyiiilt \>y VAUVih at roughly 454. 



Pound* 



hM* eompiled the table given below, showing the amounts of fo<Kl8 in 
(•ommnn use neeewtary w e<iual 11)0 calorics ; by combining the amount* 



60 




1 


88 


10 


77 


6 


81 


7 


90 



78 FOOD RE<iUIREMEyT8 

the total number of calories can easily be obtained. This is a simple 
method of prescribing diets, but less useful in determining the value of 
a given diet, unless it has been served in standard portions or fractions 
of such .portions. This method is admirably suited where there is some 
one to superintend the serving, as in sanitariums, in hospitals where 
the food is served from a diet kitchen, and in private homes where 
there is a trained nurse. The patient or nurse writes dowu the name 
of the article and the amount of protein eaten, and by using the table 
the food value is easily ascertained, as follows: 

ProUio. Fat. Csrbabydrate. 

portion boiled fat beef 40 

baked potato 11 

" com I'i 

bread 13 

apple 3 

Total calories, 500 00 84 336 

"With this Fisher has arranged a graphic method of representing 
these values, full details of which will be found in the Journal of the 
American Medical Association, vol. xlvii., No. 20, November 7, 1906. 

Tracy (New Yoric Medical Journal, Jan. 13, 1917. 75.) has con- 
structed a plan and some tables based ou Locke's tables which makes 
the selection of a balanced ration a comparatively easy matter and 
avoids the necessity of computing. The protein content of these diets 
is very low and the meat portions might well be increased except for 
the sedentary. Tracy's method is as follows: 

Bearing in mind the two main requirements for the daily diet, 
namely, that it shall contain approximately 65 grams of protein with 
2.500 total calories, or 75 grams of protein with 3,000 total calories, 
these tables have beeu made to include only data as to the weight of 
protein and the total fuel value of the foodstuff. Since multitudes of 
figures are in themselves a bewilderment to one unaccustomed to their 
use, it is believed advisable to eliminate as many unessential figures 
as passible. 

In tables as brief as these, undoubtedly there will frequently be 
noted the omission of a vegetable or a dessert, or other food article 
whiL'h is desired for a particular menu, but by reference to the Locke 
or Uephart tables such an article can be looked up as occasion demands 
and added in its proper place according to the amount of protein and 
total fuel value. Thus, according to the family tastes, the tables may 
be enlarged from time to time. 

In order to bring together portions whioh are comparatively uniform 
aa regards protein or fuel content, the portion as described by Locke 
is in some instances modified by a qualifying word, large or small, and 
the analytical figures changed by a corresponding definite percentage 
increase or decrease. Wherever this has been done the sign (t) i§ 
placed before the name of the article. Thus the quantities suggested 



79 

for B portion are approiiuatc onl/, but, it is believed, are siifSctently 
uniform to constitute u basis for c%'er>' duy plaJiDini; of the hoii»rhold 
meals. A little larftpr porlion on one day will uudoubtHlly be bal- 
anced by a smaller portion on auother day. aud great atreuraey is not 
n«e«88r>'- A weekly ration of 17,600 calorics is without doubt quite 
■I utisfactory as a daily ration of 2,5(X) ealuries for seven days. 

Id uniiiK these tables the fullowitifr simple riileu wilt rvadily Ivad to 
the combioatious of food materials which will supply the uutrittve 
reijiiireiueDt«t aud add the desirable variety lo the daily meuus. 

i. For the heaviest nieal of the dat>' — diimer — select uue article 
from each of Tables I, II, aud 111. 

2. For luneheou, or supper, adcct ooe article from rich of Tables 
II, III, and IV. 

:t. For breakfast select one article from each of Tables III, IV, 
[and V. 

4. Add together the protein values and detertnine what sdditioQ 
[of pnitein is nwded to complete tht* daily re<iuircuieiit. 

5, Add togetliiT the total eatnritic vaJties. and to this total add 
t-alopiee, which will be incidentally taken during the day in 
siwries, as sugar, eream, butter, sauces, etc. (Table IX.) lle- 

^tcrmine what fuel value tuiutt be added to bring the total for the day 
op to the reipiireraeiit. 



L Table 1. 

HmL*. P«u1lry. Fi•^, f— niudiR^dtion of l«cU'a "portion." 
Ilifih I'rot'tn I-WhIk. — Unly am* artift« from this tnble aJioutd li* MTVpd Kt a 
hmkI, Mid prvfiTtibl)- onlj* unr^ « duy. 

SMitoB A I'ortloii Oranu. 

tBi^. n»M ...... 

BFvf. *t««k 

I'tf.'tairhm, fricaMM 
tliAttiti. rna>t . . ,,, 

Lamti, I'bop* . ..t. 
tVnttun. roMt .•■. 
*H«ni. boiled 



Bmsf , H'lvpnl (ronnd) 

fCkldMO, raut 

iltMaa, cboiM 

rMnttMt, IkhIoiI 
Pfirh, r>uMl 
Pork. c»iop« 
Vr^, r«««i . 
BluefUh 
Cadflrii 
HkliHiil 
AMxiUh mackcnl 

tCUm* ' lon« ) 

ICrab.liaT<t khell 



. I amall allcc . 

. I alin- 

. Urge hrjping . 
, 1 M) sllccB .... 
. 1 average chop 

.3 M*xf 

,Urpiili«« .... 
.kbmII aHm ... 
.Ur};<> hnlpiiig . 
.douhlc bMpin^ 



•••T»..TI 



■ *.«..**fe. 



.4 In. pat 

.autall belping 

. I chop 

.1 BiW 

.amnll »li«« 

, 1 Urx* ohnp 

. I uliop - - 

.smnll bplpins 

,a«»Tigji' hi-lping ... 
.avi-n^t'- l«'l|iin(( ... 
.aveTafn> )ii-lping ... 

, in rtawii. 

. 1 laxgr crah 



Rough 

an>ra|p! 
ilgraia. 






Rouitb 
avmdv 
265 oak 



Routfli 



80 



FOOD REQUIREMEXTS 



6. Supplement the protein and fuel as may be indicated by the 
necessary additions, according to taste, and to any meal desired, of 
articles from one or more of Tables IV to VIII. 

7. Do not let the daily protein run above 75 grams for any length 
of time. The total fuel value of the food may run above 2500 or 
3000 calories without harm, especially in cold weather, unless one 
tends to become excessively fat. 

8. Bemember that the total fuel value of the ration must be iu- 
creased if very active or severe muscular work is to be done, and 
see to it that such active worker receives double or triple portions of 
the food articles provided. 

9. After the occasional feast day, which will do no harm to a 
vigorous digestive tract, eat a little less for a day or two until the 
weekly balance is struck. 

By such use of the tables a general appreciation of the nutritive 
value of the common foodstuffs will be acquired in a remarkably 



Table II. 

Green Ve^tables. — Low fu«l and protein value (exception, corn). Valuable for 
salts, vitamines, and bulk. At least one article from thiG table should be included 
in the day's ration. 



Food Article. Portion 

Squash 2 heap, tablespa. 

Spinach 2 heap, tablesps. 

Tomatoes, raw 1 avera^ size . . 

Tomatoes, cooked 3 heap, tablesps. 

Asparagus, canned average helping . 

Beetx 2 heap, tablesps. 

String beans 3 heap, tablesps. 

Carrots 3 heap, tablesps. 

Cabbage 3 heap, tablesps. 

Cauliflower 2 heap, tablesps. 

Turnips 2 heap, tablesps. 

Corn, green boiled 1 ear 



PrateiD 


ToUl 


Grama. 


Oalorieii. 


1.3 


Rough 


2.1 


V average 


2.4 


55 caU. 


1.2 




1.8 


Rough 


1.6 


average 


0.7 


20 cals. 


0.5 




0.6 -\ 


Rough 


1.0 


average 


0.4 


7 cals. 


3.5 


UO cats 



Any of the above articles used as salad with mayonnaise dressing will be in- 
creased in fuel value b^ 187 calories. 

Cream nance added in serving any of the above articles will increase the fuel 
value by 01 calorics. 

Table III. 

"Starchy" vegetable foods- High fuel value (carbohydrate). 

Low Protein. — Oniv one article from this table should be used at a meal. 



Food Article. 



ParlioD 



Potatot»« — white 

Baked , 1 medium siTie . . , 

Boiled 1 mediimi size . . 

Creamed 4 heap, tablesps. . . 

tMa«hed 3 heap, tablespw. . . 

Potatoes — Hwei-t tmited . 1 mnall ei^e 

tRice, boiled l\^ heap, tablesps. 

Macaroni, boiled 3 heap, tablesps. . . 



Protein 
Qranu. 



Rough 
average 
3.S grms. 



Tola! 

Calories. 



Rough 
average 
140 cats. 



short time, and thft bou9u*wife i» plumiiig the mcaLi for the da.v, or 
the individual Nclrcting his or her own food iu a r<f^(«uraot. wilt by 
second nature, or with au educated oommuii s^iise. thid iiu djflii-ulty 
ill mectiug tb« iiuLriliv« retiuireuieutK uitbuut ttpevial thi>u}fht ax 
B to protein or tealories. 

Viritli m 

H Ft.), k 



Tablk IV. 

!■ coftUintn^ moderate protein of animal origin. 
Krtklm from Uii» (uhlt< amj- bt u»ed at Ui« aKiua uii<al, hut proferably nat 
iritli anirlM from Tabic I. 



I 
I 



Foot Article. 

E(W. toilwi i 'Vg ■ 

Hm. T«w I •¥« 

Uifk, skiaiiiiMl 1 glaaa 

ButtenDlIk (frant 
dium I I glaaa 



Pntloa 



Protriii 
Gran*. 



TOUl 

CaUtiM. 



Aiiwrtmi i'h««vr 
Cr«MDi cbf-FM- . 
CkidcFii MHitlwti-li 
nam. fried ... . 
BardiiiM, nnnml . 
Oytlvrn, raw 
Wlinli' milk - . . 
Onirlrtte. 3 «|S' 



I cu. in 

I «a. in ,.,.... 

I aasdwicH >...• 

avcrafin portiua 

3 fl«t> 

II <f\iit*tm > > • . 

I glaM 

Vj oiMlett« 

:i ubloap*. milk ... . 
1 livap. tvntp. butter 



h 



llMt atew . . . average helping 

Cuatard puddinjt 2 livap. tHhIn>pH 

Gauaajfv, <x>tintr> 1 large tutuKagc 

Banin , .2 ■liit-H 

Ham Mnitnidi 1 mikU irh ..... 

Crram loa«t 2 alicva ti Itti A 

taUcajaf. aaun- 
Macaroni, baktd witb 

cbotve I (ablnp 

tCUiUrd pie . . . . .. '/a P'*^ 

Mill'* ]>!<' . - ^ pif 

!^-otiaa K. — Food* ronulning modin>atP [>rot«>in n( vegetable origin. Tim arti- 
(W trm (his talile mav be used at l>ie aniiie nteal. L's«rul with ut without art!- 
tUm from Tabk I to raiw th« |>rc>tpiii ratiun uji tu the TV^ulremeiit. 



Hough 

•v*ragv 
Titgrnw 



.} 



RoDgb 
averaga 

»ftcBU. 



Rough 
avvraiN- 
100 mV 



RMcb 

Bveraoe 
3U0c«1b. 



piMd AMMr. 



kfd l>nin«. euinad . 
IJnia t>ral>* . . . 
Urven pe«B 
tPnautB . - 

tBraril nnl* 
tlVi-ans 
Walaut* . 

Cocoa 

I btap. leaap. cocoa 
I heap li-a*p >ugar 
% cap milk ....... 

1 Ubleap 
It 



Portlm 

..1 hmp. tablcapa. , 
i heap lableapa. .. 
■1 h<-ap. tattleapH. . 
■HI iniu 

t targi! nuUi .. 

m tariie atlt* ...., 
10 nuta 

- 1 cup ..... 



vl*aBka**i 



rreain 



PfomIb 



Rougti 

Bveragp 

7.2gniu>. 



Cklurlm. 

Rou^b 
arvrave 
IMcala. 



Rouith 
avi-mt:'- 
300 rail. 



82 



FOOD REQLl&EMEiiTB 



Breadetuffs and Cereals 



Table V. 
-High fuel value (carbohydrate) with low protein. 



Sjection A — Breadatuffe. Useful additionB to every meal in twice and three 
times the portion given. 



Food Articls. 



PortioQ 



Corn bread Slice 3 x 2 x % in 

White bread, baker's . . . Slice 3<^ x 3 x ^ in. . . 

White bread, homemade. Slice 3 x 4 x % in 

Vienna roll I roll 

Biscuit, hometnade I biscuit 

Graham bread Slice 3% x 2% x i^ in. 

Whole wlieiit bread Average slice 

tGraham crackers 3 crackers 

tSaltines 6 crackers 

tButt«r cracliprs .0 crackers 



PratelQ 
Oram*. 



Rough 
average 
3.0 grma. 



Total 
Oaloriet. 



Rough 
average 
100 <»!b. 



Section B — Cereals. Only one article from this table should be used at a meaL 



Food ArtirU. 



PorUon 



Protein 

OrBIDB. 



tOatmeal, boiled 3 heap, taltlesps ) ]»n„„i, 

Sliredded wheat 1 biscuit i ^vSe 

Indian nieal mush .... 3 heap, tablespa f gg ^^b 

Hominy, boiled 2 heap, tablesps } " " 

Sugar and cream on cereal will add Z50 calories. 



Rough 

average 

lOOcaTs. 



Table VI, 

Nutritious Soups — High fuel value due to carbohydrate and fat. Low protein. 
Useful to increase the fuel value of any meal. When one of these is selected a 
fruit dessert is desirable. 



Pood Article Portion GMms'! 

Mock turtle soup 4 oz 0.2 

Chicken soup, homemade 3 oz 9.1 

Bean soup, homemade 4 oz 3.8 

Cream soups: 

AsparaguB 4 oz 3.4 

Celery 4 oz 3.0 

Com 4 oz 3.7 

PoUto 4 oz 2.8 

Tomato 4 on 2.9 

Pea 4 oz 6.2 



Total 
Calories. 

Rough 
average 
55 cab. 



Rough 
average 
125 cats. 



Note. — Clear soups are of low fuel value, and useful merely aa stimulants to 
flow of digestive juices. 



PlAhSIXa DIETS 



Damni» — Protein negligible tu luudeiaU. KupI laluc high ttwrboh^-dntc). 
Uwfnl food uticln to bring Ui« fuel vitlu* of d»fU nttiuas up to Uie requhrmiaiU. 



Food AHIrlv. 

l^piocs pudding 

Ice trinun ....<....... 

DouithnutB 

^uit nli« ........... 

SvCftr cvokiw , 

AppI* fKr ........ . 

SquMli pitp 

Brr*d pttddioR 

ItMlitUi Rival ptuldiog .. 

Urougv !«■ 

Oinjt*ibrv«d - 



r«rtkiii 

3 li«-iip. ublcsps 

2 h<«p. tjkbleepo. 

1 (luiiiihiiul 

SI><v2%k2%x^ in... 

3 t.tM>kieo 

y»pt« 

ii^p* 

S bnp 
S bmp 



Ubkcpt. 

Ublnps. 
t&blnpa. 
Slin £ X 3 T 1 m. 

1 average klioe . . 



FroUiB 
Omni. 

A.« 

S.£ 

2.4 

1.4 

tA 

3.V 

6JJ 

5.9 

S.O 

Oil 

34 

4-1 



CUoriM. 

Roofdi 

»T«rwe 



Itaoiih 
Kti-«rftce 
2::. mJ». 



T*BU! VI 11. 

Kniil — Ku>4 nltui higli lu inoalrrute Imrtmhjdratei. prot«tn negligible. CmThI 
nddltluiu la aa; and eterp mm) on acMiimt of organic acid*, nalta, and vitaiauun. 

FWd AtUdo. I'lirtiMi 

Banana I avemge »ix« ....... 

tirap^fniil % \mrjtv *i» .... ^._ . 

AppV, Inki^ 1 lar);<: iipi'lf 

ti\)'l>li- MUic 2 bcap. Inlilnps, ... 



Cranhrrricv, xltwrd 
Rliuhatb, Mti'wiil . 

Applr. raw 

Ckntvloupe 

Or&ugr 

tPncIt 

Pmr 



. . .it btap. talilnps. 

2 bra p. tatilnpM. 

I av<-rH^- ain . . . 
... '-J Hii-rAKt' w» .. 

I ait;rii),t- *lee .. 

S avcrairf Mxn . . 

> ( I nrviagr )>lu^ . . 

BUekbrrriea 3 hnp. lalilrsp* 

Stfawbeirwn 4 heap, tableap*. 

fta«p(jerriea X iMiip. tMblcHp*. 

Ilamppk . S alioM 



Pratein 

Graiw 

1.3 

2.S 

U.5 

a* 
o.sr 

0.4 
0.4 
1.4 
l.A 
1.2 
U.T 
l.$ 
1.0 

o.tt 

Ol4 



Toul 

Rouirh 

arrragr 
ISficala. 



1 



Fntigh 
aveiage 
HAcala. 



Raugb 
are rage 
45raU. 



TAm.E IX. 

Aceenaorlee — -MoHvralr to \\\gM futl value tcarl>oti>>lrati- i>t fat), mvlldiblo 
protein. CoEumviily uxrd nd<!iti<>nit <•■ rvvrv bk-uI. nnd •iin uniiallT hv o.xrit'tc)] 
to add AOU calurti-a or iiiori.- to Ibo A^y* ration niihi>ut particular cakuUtion. 
O— 4.'«rbofcjfdr»i#- F— >'M- 



Vaad&jtlrte. 



Pan ion 



PmWa 
Orama. 



C-Sofar, toaf . I <'ohc 

!>»( , , I (loniino . , . , 

I'.ranulainl .. I liniti. tcanpoon. 

C--Omm7 1 tAbleap. 

C-Mnnlr »)Tiip I tabktp. 

C.-P.-Cnan wure X taMnpe 

r.-01h« Oil . I tabl*ap. 

f.-Majwinaioe ilmMng I tabl«*p. 

P.-Crt«iu. avrrage I laUMp 

Hivvr 1 taUf!*p 

Wtiip'ppd ..I tiMip. liiIilpK|]. . 
r.-llait»r . I average ball , , 



T«iai 
CWlorinu 

eo 

25 
41 

101 

Kg 

01 
ISl 
187 

M 

T8 

81 

no 



84 



FOOD REQUIREHEXTB 



SSSSS88SS888S88S3S8 888SS88888888 



SS€SiSSf!98t:S3eaE^SCt:E: 8iSS3SSSEls:<»"'33 



a 



SSSaSSKESSElSSSSSSSSe: $SS3«;S2«££f:S8S» 






sssssssssKssslSRxae sss^ss^gsssii^z 



:^ 



3 

o 

1 

§1 



=1 

HE 

o 



1^1 












Sli 







Os 



■« 



-s- 






3S 



a 



- la 
Ja e G e s - 

^ ^ L- M b H ■ 

s££££^l 



88 



FOOD REQUIREMEyrS 



eais^SEieis sx»s**'^-'"»3!S8s^i= sssssssss 



g Rss'S'-'s ass"pssesisss*-ss --"(-t-ooo** 



is 



O 14 « lA A Et AQ 



3li]E£3Siai9'°E3SS!oaS 



At^ ^ C4>S«Q 00 OQ A 






^ISHsIB ^g^sssss^sssgii 33ssQSsas 





^ EDU^ tl U U O g 






ll - 

u E S u 
^ 3 3 *- 

i.-ri 3 S.3 S ■ 






, U dj S (U =3 



11 £«^ 

E B O S «li 



FOOD REQVIRBMENTS 



i 



4\ 



8sss9sei!8ss sa£aa*-t|§g s"'*«'3g«-«'j:'-"- 



d 

I 



aeaaa-asis— "ofiojg-gooo pBaepgsggsaa 






-I 



5 

a 






5^^^&«9!;^^:i;3. 



sseisisisiissfsg gs^stts^sas ssassitassssa 



8. 

8| 

11 



1^ 
1 




l3^ 

lllll 










I 



c 

3 at 



M □ i^ = 01'° '-C C'" ■ Z 

^'tUlliiiiii 









|=aags«5 



S^^i 



ilil 






PLAXXjyO DIETg 



3P3S«BP8&8*P^rStSSatS88 « H SSS'cSKSt 



•9 




•jissg»»ssa«ss*2»aaaa« c * 


asKSSSsasi: 


333«Ws5gi?53l!8-S2?^8is I? s 




3XIRtilt!ltlgttS3»llttliAti1lt)ll K R 


»at;S2SS8S 



Ml 






el? 



-OOOO 



1: 



I 



i 



-Eavf; 



Bs v3 e^ ce k° o-i 

Sliiilliiil 



it^ 






eSft 



s f «f 



liffl 
IMII 



l*rotvin and Cereal Porlions-^AmoId has saggcst-od the tue of 
utandant portions bsBed oii arl>ilrar.v standflrds. The "protein por- 
fioii" bciiifr e()ual to Ihc iirutein in one egg. 8 grams: thv crrcnt 
portion bciug the auiuuut nf eerpal lliat will contain i grainn of pro- 



90 



FOOD REQUIREMENTS 



tein. This method may be used to advantage where the protein 
content of the food is the chief concern. Tables showing the velue 
of 100 grams of Tarious foods will be found of use in this connection: 









Protein Portion. 


p. 


P. 


c. 


OftL 




8 


6 


5 


100 


Average portion. 


8 


6.6 

8 


8' 


80 
140 


Egg, 1. 

MiHc. 1 ^lass (200 CO.). 

Buttermilk, i pt. 


7.B 


1.26 


1.26 


100 


8 


6 




80 


Meat or fish, 1} ozs., or on 








CeretU Portion. 


P. 


F. 


0. 


C>1. 


Cooked toodi. 


4 


1 


30 


140 


Average portion. 


4 


2 


24 


135 


Cereal, 4 tableBpoons. 


4 


J J 


60 


240 


Kice, 4 tablespoons. 


4 


2 


20 


120 


Macaroni, 4 tablespoons. 


2 


2 


20 


120 


Vermicelli, 4 tablespoons. 


4 




40 


160 


Potatoes, 2 moderate sized. 


3 


0.5 


16 


80 


Bread. 1 oz. (or slice). 


3 


3 


20 


120 


Crackers. 1 oz. 


3 


0.) 


22 


100 


Shredded wbeat, 1 biscuit. 



An Ideal BoHm of Liquid Food.—{Mn. E. H. Siehardi.) 



Haterial. 


Amount. 


Proteld. 


Fat. 


Carbo- 
hrdratea. 


CUorles. 


Beef broth or conaomoi^ 

To which has been added 

one large egg minus 

Dried fmit soup .... 

Lemon jellT 

Whole milk 

Bioe or arrowroot . . . 

Qnu>»«i]gar or some one 
of the prepared foods 
(dry) 


1 pint . . 

2oance8 . 
1 quart. . 
iiuut . . 
1 quart. - 
3oE.(dr7) 

4 OB. (dry) 


em. 
20.6 

4.1 

'6.5 

34.0 

6.3 

2.5 


Ont. 
0.6 

6.8 

36.0 
0.3 


0». 

100.0 
12.5 
44.0 
67.2 

100.0 


91.67 
410.00 

77.90 
661.00 
304.11 

420.26 


Total 


2.5-3 qt." . 


76.9 


43.6 


323.7 


2043.63 



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 importaut role, and are not to be 
neglected in formulating the dietary; for while a certain food may 
contain a great many more calories than an equal weight of another 
food, yet its relative indigestibility and non- absorbability may render 
it far less available as an article of diet. For example, while 4 ounces 
of sausage produce 510 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 

1 According to how the rice is given. 



92 



FOOD KEQUIKEMEXTB 



Other valuable tables will be found in the various sections relating 
to diseases, especially in the one on diabetes. 

The following instructive table is taken from Sutherland s System 
of Diet and Dietetics: 



t 



S !E 






S^3 
oufi 






2S 
i o 



S = J' 



I 

c f-s 
o u 



"SS'i '"S ^i 9" Su "^rtS^ S-E 
u G 5 ■< c:; aa^ud a 



fP 



g-5-o 



I?.; 










1 g^ c;^ 






»J! 4S 



.-^gf&SS 






fcl "E 



& X 



£3' 






a lul. 



IIISirl-lIlilillM. 







-< »-< » -^ U F 



iS S >■ S S~ M §;; ^ = £?-=■•" tS ^ e 






CLASSES OF FOODS 



ANHCAL FOODS 

iSmAL foods contain much difjestible matter, chiefly proteins, a 
fiiiiMtle ruble <{UHiitity of fat, iti Home fuoils ejirUo hydrates, and. in 
luldittoii. water aud miiieml salts. Being tborDiiuUly diieested. tbey 
leare but little residue in the intestine. The varioiin forms of animal 
foods — milk. eggs, meat, fish, and gelatiu — %vill now be described 
uoiler these headings. 

mUE ASD MILK PKOSUCn 

Milk, the mo!^ important of animal foods, eontainx all the elementK 
lieoensar>' for |be maintenance of life, and conj>titut«» a complete 
food. 

CompoiilioD. — Milk eotitaias varying proportions of each of the four 
cUsM-8 of food principles, protein, futii. eurbo hydrates, and mineral 
saltfl, and from 84 to 90 per cent, of water: this latter varying with 
the quality of the milk. In a general, way this is true of all milks. 
which are more or less alike, but which contain different ]>ercentages 
of the constititentfl. 

Milk forms the exclusive diet for the young, growing mammaU, 
but owinff to the fact that the proiwrtions of proteins and fat are 
in eseeKs of the carbuhydrateK, it is uuKuited ax an exelusive diet for 
odultK. Tnloiw otherwise stated cows' milk is meant by milk in this 
ivolume. rows* milk is most extensively used for food, but the milk 
it goatK and asses aud some other animuts h used to some extent. 

Fresh cows' milk has a sweetish taste, a characteristic odor, and is 

7ellowi4h-white in color; on standing it Reparatea into two distinct 

layers, the upper Iwing more yellow in color, of lighter specific gravity, 

and containing more fat. For dietetic pnrponos it is well to thinic 

of cream as a milk eoutaiuint; varying percentages of fat. The lower 

part, called "skim milk" after the removal of the cream, is of a 

>luishwhite color, aud may be considered relatively free from fat. 

rhf sjM'cilit? gravity of milk varies from 1.027 to I.OXi and it freeJte* 

■t a slightly lower trmperature iJiaii water. 

^_ Then? lire tmmerous statements and theories couceruing the reaction 

^■f cowa' and btunan milk. Kreshty drawn, the milk of most carnivora 

^Bl acid to the litmus reactinn ; humnn milk is alkaline, .sometimes acid 

^^ amphoteric, and cows' milk umphntcric— tnrning red litmus blue 

and vitt' versa. On exposure to the air ull milks will mm bine 

IrtJtiuY re<i, owing to the eouversion of the milk-sugar into lactic and 

otJMr aeids, 

83 



94 



CLASSES OF FOOD 



<^ U 



oSIS 



HI 

■< 



a 



■Co . 



te ^ § III 







The microscopic examination with a low power shows the fat globules 
and some leukocytes and foreign matter if present; with the im- 
mersion leus the bacterial contents may be studied. 



AXIJIAL FOODS ~^^^ W 

KasUe and Roberts (;ivc Uic schfini; ou p. £M, compiled by Van 
Slyk« and BabotK'k. 

The priiii-ipiil nitrogenous compound of milk is ciks^iu, which di£Fers 
from tjie other protein uompouuds in that it coutaina both jibufiphorus 
and sulphur. CBiteio is not coagulated by heat, but this change may 
be effected by adding at-id or rennet. The casein clot formed by 
addi&K acids may be dissolved by ueiitraliziug the acid, while that 
foraiLHl by rennet is out alTeeled by the addition of an alkali. 

Milk also rontuins other proteins, as lactalbiimin, whieh is similar 
to the serum-albumin of the blood, lactoglobulin, and lactomuciu. 
Tb« total prot«ii)8 average about 3.3 per cent, of tbe bulk of the milk, 
or about 25 per cent, of the total solids. 

■ Tbe fats of milk consist of the glycerids of palmitic, stearic, and 
H oleic acids. In addition to these, milk contains several other fats in 
P smaller proportions, to which the flavor of butter is iu part due. Tbe 

fat is suspended in the milk in the form of minute globules, which 
give the milk ils white color and opacity. The fat plobuIeK in some 
milkM are larger than iu others. Tbcy arc smallcHt from a herd of 
mixed cominon cows and larjjest in the milk of Jerwys and (Juemseys. 
Fat averages about 4 per cent, of the milk, or about 31 per cent, of 

H the total solids. 

' The chief cartrahydrate of milk is lactose, or milk-sii^r, which is 
not nearly no sweet as ordinary' suttar, and is Iroi soluble in water. 
It reacta to Fehliu^'s Holutioo like glucoec, and in the pre^euco of 
the lactic acid Iwcilluu it is couverted into laetJc acid, wKidi causes 

I the milk to turn sour. Lactusi- forms about 'AS per cent, of the total 
aoUdfl. 
HUk contains about 0.7 per cent, of salts, which exist chiefly in the 
form of phosphates, chlorids. and sulphates. Potassium salts occur in 
—^ larger quantities than <l« sodium -wltJi. 

■ Calcium salts are very cHseutial to young, growiiit; auimala. tuas- 
much as tbcy play a very important i>art in the format iiiu of Iwue. 

I The relative percentages uf salts in the ash of human milk arc shown 
by the following table : 
Cslclum plK)«pli»U :23H7 

Bulphatff -. 21(5 

K eKrb(mat« 2ss 

■ - MliPiU ... 1.27 
H PMaflaloin cBrbouatr . . iS.il 

■ cliiurid 12.09 

■ - *Tj|pbiiti- 8.M 
H U«ni«iillD raihonatr 8.77 
■ BMma diferid 8t.7T 
H Fcrrifl oxid uh) sluminuiii ..*#«•. 0.$7 
I 100.00 

When the cow is di-seased. vnriniis •atlistanccs nnf prcwcnt in normal 
milk may be discovered, as urobilin and bile. Milk may also contain 



9G 



CLA88E8 OF FOOD 



odoriferous Kubstanres from things wliich the cow has eaten, as wild 
garlic. Milk also ab^orbtit odors from ll)c air. 

Variations in Milk. — There are widv varialious in the youiposition 
of the milk of difTcreiit animaU. While huniuii milk i-otitaiii-s morp 
.sugar aud less protein than rows' milk, tlip fui-l-valur is about thi- 
same. Dogs" milk s(?«ms to Ijl- the m-liest. wli^rt^aH thai which oomes 
from tile horse is esc-eediiigl^' poor, as may \k seen from the fnllowinif 

table: 

CbmparatiM Cbmpcmtion qf Vnriatu Sbtdt 0/ MUk} 





W«lcr 


Total 
mUdi. 


TcUX. ■olid*. 




Elndot 


ProWln, 


TaI. 


(nUlk- 


Mineral 

nMtent 

(Mh). 


Puel- 
poaaa. 


mUk. 


OmcId. 


Albu- 
min 


ToUl 
pro- 
tein. 





PtrA 


Pirtl. 


FrrtL 


iwa. 


, 

Prrtl- 


PereL 


Pb-A 


ftT«. 


CtokvMt. 


WOUAII 


SA 


ize 


UO 


is 


Zt 


t» 


«-2 


OS 


at 


ft?- 


97.3 


12s 


ta 


0^ 


>i 


B.7 


1.9 


0.7 


au 


».4 


M-A 


01 


5.1 


Ul 


e« 


X.) 


O.T 


an 


><n . 


SO.B 


U.3 


60 


1.S 


iA 


e« 


«p 


CO 


eot 


BoflUo. 


SI.4 


ms 


f>£ 


0.S 


a.i 


7,6 


4.1 


0.9 


em 


OU. ■ 


(B.1 


17,* 


n.i 


«,0 


Vl 


B.X 


40 


n.H 


4M 


OoM . . 


8S7 


148 


8.3 


1.1 


IS 


4.« 


44 


0.8 


Ml 


Uamft . 


W,S 


136 


%n 


o.« 


L0 


IL! 


5S 


o.ti 


tis 


AM. . . 


s».e 


19.4 


0.7 


1.0 


i.* 


I.« 


«.o 


C.6 


SB 


UN. • 


BU 


SA 


L3 


ai 


IS 


u 


(kT 


D.3 


Ui 



Not only ig there a wide variation in the milk of difTerent animals. 
Ijiit rows' milk iUwlf is subject to prrat chiingpH in the perceritJige 
c&mpoHition of it« ingredients. These may be attributed to many 
causcK, the breed and condition of animalh and the food and the eare 
they ret-cive being rcspouMiblc in 11 ureal decree for these changes. 
As a rule, a young cow gives better niilk than an old one. and a well- 
fed animal yields rioher milk than one that is poorly fed. The milk- 
flow 18 greatest shortly aft^r calving, hut the milk increases in rich- 
nesa bh the r|uantity beeumes smaller. 

Milk Ferments. — Milk contains numerous ferments, to which eon- 
siderablc attention has been devoted of late years. Jlarfan believes 
that these ferments probably m»ke up for the rieHeiencies of the 
glaiittular secretions in the newborn, and that there may be apeeitic 
fenneuts, which explains the desirability of milk of a particular 
Kpeeies a« food for aniniaU belonging to it. The principal ferments 
arc pmtmilytit; fermentB. resembling trypsin, but less sensitive to 
aoidK; fat-gplitting ferinent-s, Iipa.se, nmyiiLHo. peroxidase, and ealalase. 

The Action of Heat. — The amount of ebange taking place in inilk 
oil heating depends upon the degree of heat and the length of ex- 
p<Huro. [lealing up to 60° C. does not appreciably ehangc the ap- 
pearance or taste, altliougb some changes which defy detection evi- 
dently oecor. When the milk reaches a little over 60" C. a senm, 

1 KAnfg. Chemk d«r nmmpMirhpn Nflhrung*. und nMitiKmitlol, 3 m1., ml i., 

Pik2e7-8es. 



AKiatAL F0OD8 



97 



composed largely of fatty matter aod caseiu. forms ou the surfacf. 
Acid milks arc coagulated mucli moi-e easily aud mun: >|uickly than 
milk which w not avid, and vwa when puKteiirized at a low tempera- 
ture siK-h inilk:^ may dot. lu order to pn-vciit this, milk should tir 
pastcurizcd an sooti aft«r milking; as possible. Boiliug milk ehangea 
its taMe and color, the ervam will not rine as (|uickly, if at nil, ajid 
it is leiw easily- eoagulatcd by the aeliou i>r rennet and Inn eiuiily 
pancreatiziHl. Tbe chau^ in color is due to the production of a cer- 
tain amount nf earaitiel from the milk-sugar; lecithin and iiucleiii are 
decumposed. lessening the amount of onKauic phosphorus present and 
inemsitig the inorganic phosphorus; tbe calcium and mogDCsium 
salts and part of the phosphates are preeipitated ; the earbon dioxid 
ia driven off, some of tho fat glolmlcs coalesce, and the serum-albumin 
is HMgulated ; (he ferments of ihe milk are alsti destroyud. Although 
Iheae eu^ymes will withstand a temperature of BO" C. for an hour 
without much injui^, most of them arc totally destroyed by a tem- 
perature of 6^" C., and the most resistant by a temperature of 76° C. 

Frozen MUk.^Freezinjr milk is sometimes reaorted to as a means 
of keeping it during transportation. It should be kept frozen until 
naed. ^Vltile this melbod is employed iu some pUees, it liaa never 
come into unythiug like general use. 

Cold storage of milk is frequently resorted to, but when the milk 
is kept at a tempenitnre of about 0° C. there is verj* eonsiderahle 
growth of bacteria, ej^peeially of certain varieties tliat flourish at low 
temperatures. A very complete study of this subject hat been made 
by Pennington,' to which the reader is referred for details. In sueji 
milk the baetcria inereosc in number for Sve or six weeks, and after 
that certain apeciea die out, while the most resistant apparently are 
present even for years. The acidity ia very much increa^. although 
<urd rarely separates. The protein of tbe milk is digested, and in 
some ca-sfN as mueh as :')0 per cent, is changed into soluble compnund. 

Pregnancy in the Cow and the Use of Milk.— Up to ten dnyn 
before calving the milk its generally safe for use, but if very visibly 
altered it dioold not be used and the cow may go dry before that 
time. After calving tbe milk is normal after ten days time; before 
that tbe comp4]sition may be altered by tlie presence nt colostrum. 
Tbe rule of tbe Walker-Qordon Company is to exclude the milk for 
three weeks before the expected cal^-ing and for ten days afterwards. 

Sterilization and Pasteurization. — lieat is employed very fre- 
quently in keeping milk, and there are two methods in \-ogue. spoken 
of M aterilizalion and pasteurization. 

Sterilisation of railk is accomplished either by boiling, preferably 
in the vessel in which it is to be kept, or by placing the bottles in one 
of tbe nnmerous forms of sterilizers that are on the market. The 
ewmitial part of the prooeas is that the milk tie heated to 212° P. 
and nuuntatncd at that iemiM-ratnre for ten minutes or longer, or 

ijffunul of Biological CbemlittT, 198, p. SSS. 
7 



9S 



iBBBB OF POOD 



siitBacnl to kill all tlir living huctcria which the milk contains. It 
is to be anted, however, tltut the ijporcs tiC Npon- -bra ring bacteria are 
not killed by this lemporDturp. aud that if xhe milk is kept under 
suitable coiiditious I'or baeteriHl growth, baeieria will develop from 
the spores, and the milli may spoil in eouaequeuce. In order to secure 
perfectly sterile milk it is, therefore. necRKsary to repeat the sterilisa- 
tion three limea on three siicwssive days. lu practical work this in 
rarely done, except in the production of culture-media for Imrterial 
resi*ari'hc« or in preitai'iag milk for long voyages. Ordinarily, milk 
heati-d vum: ajjd llieu kept fold, 40" K. or under, will keep perfectly 
well the length of lime required in Its ordinary coiisumptioQ. There 
are certain ob,ipetioii8 to sterilized milk. Certaiu nhangcK are pro- 
duced ill the uiilk which are detailed under the heading of the "Ef- 
fects of Heat." Steritiziijg hIbo kills off the ferments and places the 
milk in the elaKs of lifeless foods. Sterilizing on a lar^e scale has 
never become popular in America, perhaps on account of the change 
ill taste and the added expense. It may be uwd with advantage, 
however, in keeping roilk in very hot weather, e.-ipccially when the ice 
Kupply is dclicient. 

By pasteurization is meant the process by which the milk is rendered 
more or less sterile by heating to IGl" P.. aud in some instances to 
a lower temperature, maintaining this degree of heat for from twenty 
to forty-tive minutes, and then cooling the milk rapidly to 40° or 
46° P. or lower. This degree of temperature in siiffieieiit to kill off 
most of the bacteria and especially the patlio^cntc baeteria, but it 
does not render the milk absolutely sterile, so that it does not keep 
as welt HN that whieh has been heated to a higher temperature. It 
has the advantage, however, of not changing materially the eompoai- 
tion of the milk. Pasteurized milk .should be kept cold or it will spoil 
nearly as rapidly as unheat«d milk. It is usefiit in summer and 
in keeping milk whieh is to be fed to babies, and is beinp used at the 
present lime vi-ry extensively for keeping eommereial milk. In the 
household, for the purpose of infant feeding, pasteurization is done 
in two ways. Best, by using one of the itpeeial forms of pasteurizera, 
sueh as Freeman's, which eonsistB of Iwn parts, « pail for the water 
and receptacle for the bottles of milk. The pail is a simple pnil with 
a cover; there is a grcM>ve extending around the pail to indicate the 
level to which it is to he filled with water, and supports inside for the 
receptacle for the bottles of milk to rest on. The reeeptacle for the 
bottles of milk consists of a Heries of hollow zint- cylinders fastened 
together; this lita iuto the pail, so that the lower inch of the cylinders 
is immersed in the water. This receptacle has two sets of horizontal 
«upport.s, the upper set continuous around the reeeptacle, for nse 
white the milk is being heated; the lower interrapted set is used for 
raising the rweptaele during cooling. Such receptacles are made 
for ten 6-ouuce bottles. nevcD 8-ounce bottles, three 1-piut and one 



ASIMAL FOODH 



99 



It bottles, and two 1-f|iiart bmtU'N. Tlierr is mIm) n larii;^ ap- 
Itus fur the lux; of bohpitaN or piitilic iiiMtitiilioiiH, wbicb lias u 
rewptacio lor forty-ihrco 6-ouiice or li-ouu« bottle*. 

The apparatus is use*] in thu followiug way : Tlie pail is tilled 
to the level of the groow with water, covered and put on tlie stove, 
(ht> Prt^ptHi'le for the bottl.*s hein)]; left out. Tlie Iwitrles nf milk ara 
then fillpd. h-fuppered with cottun. and dropped into ihtrir plnre'^ ia 
llw cylinders. Sufficient walcr is poured into each eylinder to sur- 
round the body of the bottle. As soon as the water in the pail boils 
liiiiroii^lily. it ix taken from ibe stove and set on a mat or table or 
other nou-wjuduetor in a place where there is ii«t a draft of wiud 
Mowing on it. The lid of the pail is; removed and the reeeplai'ti* ri*!Cta 
on the lower supports. The lid in then rapidly put on the pail, and 
the pai] is thus allowt-d to stand for three-quarters of an hour. Dur- 
ing the lirst Hftt^en miiiuteK the temperature of the milk rises to about 
ita maximum, ur above 65° C. the point desired for pasteurizing:, and 
remains there the remaining^ thirty minutes. During the laHt fifteen 
mtDUtes the cover of the pail is removed, the reerptacle is lifted and 
given a I«ni so as to rest on the upper siipportfi, thus bringing the 
top of the cylinders coutuiniii^t the buttles above the level uf ihe pail. 
The pail IN then put under a cold-water fauecl and the water is 
Allowed to ruu into the pail and overtlow, but it should not ruu into 
the cylinders. Thus the hoi water is replaeed by eold water, and 
in fifteen miiuites the milk in the hottle-s is of about the temperature 
of the «old water used. The bottles may then be put into a refrigera- 
tor until required for feeding. This rapid eooliiig is a most neeessary 
part, of a tnw-teniperatnre sterilization, the importance of which is 
apt to l>e 0%'erlooked. 

When there m no ^ipeeial apparatus at band, reasonably good results 
may be obtained by placing the milk bottles iu a pail, tilting the pail 
to the height of the milk in the bottles and bringing nearly to a boil, 
then setting to one side for thirty minutes. In commercial pa^ileuriza- 
tion, special forms of apparatun are iijmuI, in whivh larjie <iuantitiea of 
milk may be healed the required temperature for twenty minutes. 

The advantages of pasteurization are that it is a cheap and effective 
method of preventing the ordinary infectious diseases which may at 
times be spread by milk, and doubtless |p.sNen.s the number of cases of 
infantile diarrhea. It should be rempml>erfd that paiiteurii'.ation can- 
not make bad milk good or dirty milk clean, and when uned for 
■tifants or invalids it must be modilled iu the same manner as un- 
healed milk. 

Thf* diRadvantage* of pa-sleiirized milk are, that it is usually done 
a long way from the place of pnxluctiou. the milk may be spoiled 
before it is pasteurixeil. and while the l)aeteria at^ for the moot part 
killed, the toxins whieh may have been formed are not destroyed, and 
M) dangerous milk may be Kold for good milk. This is. however. 



100 



CLAB8ES OF fOOD 



couutL-rbalaneed by tlie real Ii-ws*iiiuy <»f iiifaiitilv diarrliya. Anolber 
diMHiivDuluKi^ is tliat llie milk produwr is iipl to bwdiue uuit-Ii-ss mid 
trust to pastcumHiion to kill otf the bacteria instead of usiug cold 
aud cleanUnesK, P»st(*urized milk h popularly supposed to be less 
dio:estible tliaii unhcated milk, esppcially for infaiit-s. The difference 
in digt'stihility of pasteurized and uiihoiited milk is certainty Hiight, 
bur tlic best results in infant feediuu are ubtuiued by llie use of un- 
lieatcd milk. \Vc are nf tbe deeidod npiiiion. tliat iinbeated milk is 
far superior in tlic Ions' run, where it ean be obtained of sufflieient 
purity to permit of its use. There are other objectiouH (touietimes 
urged against heated milk, ^ueh as it favors the development o£ 
scurvy. This is evidently true, but is a lesHcr evil than diarrhea. 

Sterilizing milk under pressure \s nirely resorted to outside of 
laboratories. A temperature of 220" P, for thirty minutcB ia or- 
dinarily considered to produee sterile milk, hul Kuuietimes even this 
is iiisuOicieut. 

The loss in viscosity iu tjterilized and pasteurized eream, rcuderiug 
it thinner and dif^eult to whip, may lie eounteraeted by a material 
called viseogeii, 8Ugge».ted by Babcoek and Russel. It consists of a 
mixture of half an onuee uf canesu^ar in a ipiart cif lime-water. It 
is allowed to settle iiud llie eU'ar fluid used in llie prnportiim of about 
twv-IbinU the atuouul needed to nuutrulizc Ihc cieum. This may be 
easily deleriuitied by titnilion. 

Digestion of Milk.— Wln-n milk enters the slumaeh il is t-oajjulated 
by the bydiotblurii; aeid aud the reuniu of Ibe (caatrie juiL-c. These 
curds, or eoagula, eouHist of precipitated casein and a proportion 
of the fat thai has become entangled in the curd. Tliey vary iu size 
and eonsistenco according to the amount and the dilution of the milk 
taken. The catM'iu soon uuderjiK)es change, lieiufi converted into some 
form of pt-ptonc. and the fat ia again liberated. The albuminous 
envelope of the fat-globules is dissolved, and the fat coalesces, form- 
ing larger dnpp:^, in whieb condition it passes into the duodenum. A 
purltun of the water and some of the salts are absorbed in the stom- 
ach. The curd that has not been acted upon by the ga-stric juice, 
together with the water, salts, and carbohydrates that still remaio, 
also pass into the intestine, where their digestion is completed. Boil- 
ing increases the digeKtibility of milk, the preeipitHte beini; depnaited 
in a more floeculent form. If the milk is previously diluted uHth 
fiiuc-water, barlcy-water, or one of the aerated waters, such as Vichy. 
the curds formed are smaller and softer, and the milk often rendered 
more palatable. Bread and rrackers added to milk make a good 
mechanical diluent by mingling with it and maintaining a soft condi- 
tion of the curds. The addition of alkalis may be resorted to with a 
view to neutralizing the acids. This has the effect of eottgulating the 
casein more slowly, and forming floceuli rather than cheesy maBSCR. 

The Color of Milk. — Various changes in the color of milk are not 




A!.'iust yooM 



ion. the best knowu of wbk-h 'v& lilue milk, aud wliilc it rarely 

;urs in cIchii and wii'll-kcpi itniries. it is not urifivtpu'iitly seen in 
wbic-h ix ])uiir1v haiullixl aniJ expiised to i-iMit;iiiiiiiiiticiri. Tht* 
color is due to the srliun of baclcria. one dew-rilwd a» the BacUliu 
ejfanogcues being perliaps most Irequeutly present. The milk turns 
blue in spots aud Hiiully assumes a diffuse sky-blue color. Red milk 
may be due to the presence of blood due to injuries of the udder or 
mammary gland, ta the kov/h having fed un plants eonttiiuiii^ red 
pigmcDts, such as the madder plant, and tnorp rarely to the action of 
liaeteria, of which there ore several that will produce a red color, the 
best known of which is the Bacilhis prodigiosus. Green, y(>llow, 
chocolal<-, and black milk have been described, which are due to various 
furuiK of l)u(7tLTiii. 

Slimy or Ropy Milk. — This is a very euriouH change which oc* 
casiooally lakes plaec iu milk and is due to the aetion of bacteria, one 
described as the Haeitlug tactii vUeosi bein^; perhaps the brat knuwa. 
Tlie chaii::e is wren al^o in certain diseases of the manimarv glaud. 
The milk lieeomes slimy or ropy, and eaii be drawn out into lonfi thia 
threads, even as long as ten feet. In some countries, particnUirly 
Norway, slimy milk is produced by the addition of riTlnin leaves to 
the milk and ibf pn)duct is esteemed as n food. The loaves contain 
the slimr-pro<hicinK Iwicteria. This chanjcc is also induced for the 
loanufacturc of certain cheeses, particularly Edam. 

Bitter milk is very common, most fretpiFntly being caiiReil by the 
cuwx baviut; fed on pUnis e«uituinint; bitter KulratJUH'cs. rhirfly thti 
lupiiie&i it occurs also during' the last stages of lactation ; i» M)iiu'time« 
caused by abnormal conditions of the udder, aud may be produced by 
the presence of certain forms of bacteria. 

Alkaline Kermentation of Milk.— Milk which has been boiled ducd 
not sour through sponlaneouB fermentation; but if expoHml tn the air 
•t ordinary temperature it beeonirs alkaline in reartjon, winetimea 
develops a bitter taste, and then curdles. Later on the eurd dissolves 
and a more or Icui clear lliiid is left which has no resemblance what- 
ever to milk. Thirn- are a number of ditTerent bacteria which may 
prwluee this I'linntie. 

Flavors In Milk. — The flavor of milk may vary from lime to time. 
This may be due to the fowl, sueb things as wild onion, even in mnall 
quautttieH, nffecting the flavor of the milk very markedly, and din- 
orders in the row may also cause unusual flavors for a few da^'s. 
Jlilk ftlfiii ftbtiMirbfi odors, aud if kept in an ice-lmx wiib odoriferous 
suhBianees it may lake on their flavors. The jirowth of liacieria also 
allrrs the taste of milk ver>- materially, and may impart many differ- 
ent flavors to it. 

Daclcria in Milk. — Milk is a most excellent culture-media for 
bacteria, and most pTms ifrow hiJCoriouBly in it at the expense of 
the quality of the milk. The eiianges produced are largely those of 



102 



CLASSES OP FOOD 



decompositiou, and mauy of them arc exceeduigly comple-t, resuUio^' 
ill the pnichiftum of changes in flavor, odor, eolor. iind the quulity ol" 
tile milk. The firuli-ins may lietronic derotnpnspd, ihf stiigjir converted 
into KB«i'^'^< til^'oliol. i>r ai-idr^, while the ftit;^ arc but little changed. 

The number of bacteriu in milk varies ^rfutly, the very boi^i milk 
containing: but a few lliousand batrteria per cubic ceutimeter, whik- 
very poor uiilk may conlaiii niauy millions in the soiue quaiitity. In 
IWOti the milk wild iu Wasliinglnn. D. C, avcrngtfd 22.l:t4,0(Kj per 
cubic ecutimeter, and thcr year fiiUowiiig there wurc 11.270,000, In 
]tochost«r, and many other cities. 100,000 is regarded as the limit in 
luilic fit for human food. Milk which is certified by milk commiRsious 
ought not lo coutaiii more than 10,000 per uuhie eentiiueter, ulthcfii}>l) 
some comtnisxious have nduptt^d other iiiimliei-s ah the maximum limit. 
K(M-alled [inspected milk »hotild nut cuiitaiii over lOO.UOO per cuhii- 
ccrntinietci-, and milk (HHitaiDing more than this should be regarded as 
tiulit fur human ouusumption. and eKpeei»lly so for iiifauls and yuung 
diildreii. Milk comainiitg laree (ptantitieit of bacteria must of neces> 
sity undergo considerable decomposition, and clinical experience 
teachex u.s that such milk is unfit to feed infants and may produce 
lEBstro- intestinal diKriise. The nntiire of the baeleria prewnt is im- 
portant, as diseaiw-pmdiieing gcrmK arc dangprous to the public health. 
Uilk whii-h contains but few bacteria will, as a rule, contain no di«vas«- 
prodm-ing bacteria, iir but very few, while milk with very high 
bacterial counts is extremely liable to contain them. Alino^ all of 
the pathncente bacteria grow better at or near the body temperature, 
and yriiw slowly, if at all, in roilk which is cold enough to prevent the 
rapid growth of bacleria. 

Hach time milk is handled there is an increase in the number of 
bacteria, and tliey ore also increased in separated and filtered milk. 
I'rider nrdiiiary cirenmBtaiiees milk drawn from the udder of the cow 
oonlaiiia bacteria which, with reasonably simple precBution. may be 
easily kept under 5000 per cubic centimeter. To k«p these from 
increaxiiig. the milk must l» protected from further contamination 
And uiiiat be kept cold. The increase may also be iiifliieneed hy i>aa- 
tetiri/ing and sterilizing, which have already been cnnsirtered. Milk 
chilled to 4^° or 40° V. will have little or no increase in the nunil)er 
of ordinary haetoria. atid there is not much growfli unlit it is warmed 
to 70° F. : after that conditioiLS are more favorable to bacterial life, 
and iM'tween 80° F. and 96" K. the increase is enormous. When the 
temperature reaches over IDO" F. the bacteria ortlinarily found in 
milk do not grow well, and when the milk is heated to 125" F. the 
efl'ecl ia to kill winie of the germs, and an exposure of ten minutes at 
160' P. will kill III*' majority of milk bacteria, but not the spores. 

The mmrce of the bacteria in of interest, as the milk aa formed in 
the mammary glnnd in the healthy cow is free from germs. Small 
wounds of the udder may lejid to bacterial invasion and the germs 




103 



get into tbe mouths of the teats and so into the milk ehamber, so that 
the first milk drawa should bo rejected, aiid even (be milk dmn-n 
later may coutaiu some baoieria from lli« K'vwth of them having 
extended up the milk duels. The milk at ihi- end of the milkiny in 
nearly or <|tiitu sterile. luflammatioti of tin- udder wid mammary 
ffland may lead to very seriouH infeetion of the milk by disease-pro- 
ducing; barteria. During the mtlkinj; the cnntamination is often sur< 
prifliiiffly great. The number of baeteria in the air of the ordinary 
eow bam ia very greal. and if the hay loft is above it ami the li«y ia 
thrown dowu just previuuH to milkiug the air may be clouded with 
germs. Particles of manure, haint, and other foreign material may 
drop into the milk, and the milker's liandx and duKt from his clothing 
are also a freijucnt wmnT of contamination. The bacteria from man 
are more daufjeruus to human health than thnHe from the iruw. If 
tbe milk pailx and other reeeptadeti are not Mteriliztxl, a gootlty lot of 
bacteria will be found iu the milk collected in the Keams. and the cloth 
through whieh the milk is strained may add to the number if it is not 
sterile. The eooler. the cans, aud the milk bottler, iinh-ss sterilized, all 
add their quota of iMicteria. nud every time the milk i» handled or 
opened (o ihe air additional eontarai nation takes place. The sum 
total nf all the.se may be very great, aiid the milk may start on its 
journey -with mor« bacteria in it than would be safe for infants or 
invalidH. 

Various species of bacteria mHy be found in the milk dncts. and 
these differ in different eows, bat certain species of streptoeocci are 
moat often present. These are reasonably constant, and. as » rule. 
do not apparently prmlaee any marked chanjfes in the milk, although 
at times they are evidently the eansc of ehange-R to an alkaline reac- 
tion. The <|iu-Mtion of these streptococci and milk is deserving of 
further ntiidy, as they are not thoronnhly undprstood. and as yet 
there in not a satisfnotory method for distingui^ihini* the non-patho- 
genir from iho ]ii(tbo<,:enir. 

Le«ki>e>-tes raa.v he found in th<- milk of healthy cows, but, as a rule, 
they are mure numerous in the milk from diseased animaU. and. if 
prmrnt in large numbrn>, a s|)eeial examination should be made for 
garget and other diseases. Just wliat an average numln'r vould be 
eannnt at this time be de5nitely stated, but the milk From tbe average 
herd kept under favorable conditions will contain over 100.000 per 
eubie centimeter. In diseam-s of Ihe inlder and in garget the number 
rrachf's ;Vh"i.0O0 or over, and may nteiid into Ibr millions. 

The Souring of Milk.— With but few execptions milk will sour in 
vartcms lengths of time, and it may be regarded as A normal phe- 
nomenon. As a matter of fact, milk which does not sonr under 
ordinary conditions should be regarded with wispicion and tested 
for preservatives. When the milk reaches a certain stage of acidity 
it cunllcA Curdling may be due to certain yeasts and moulds, atul 



CLA88EB OF FOOD 



may be prodiicei] hy rtrtiiifll, but by far the nmst frequent cause is the 
lui'tii; ui'id biirilli. Ovit « himilrod diffL-mit bacteria have been de- 
scribed as causing the souriaf; of milk, but for the most poi't many 
of these are not coiumorily met with, and mauy of the others belon^ 
to one or two groups. By far the most coiumon of thi-Mt; is what is 
ordinarily spoken of as tb« luetic aeid bacillus, which does not produce 
gas, and which gi-ows liest in deep vessfls, where the air is more or 
less cxeluded. Under favorable [:i)iidiliuns these baeilli multiply 
rapidly, and ihe acid whieh they produce unites with the casein, and, 
when it reaches a certain perceutaRe. it precipitates. Heat will haKten 
this, as is fre<iuently demonstrated by the curdling which takes place 
on healing or addiiit^ nearly turned milk to hot tea or eoffee. Milk 
soured by the lactic acid bacilln» has a iinu clot with a little whey on 
top and is free fn>m gan. When the curd is broken up by shaking, it 
separates from the whey and i^inke to the bottom. Such milk has a 
pleasant acid taste and is much used for food, cither as clabber or 
nurds and whey or cottage cheese. Another group of aeid-produeing 
bacteria |i:n>w best in milk which is wi-11 aeriiti-d. us that in shallow 
pans, and it produces gas. so that the curd is broken up and contains 
gas bubbles. These tiseteria are a source of trouble to manufacturers 
of clieese. The chaiijies produced in milk by the lirst group of lactic 
acid bacilli are of value in the manufacture of butter uud cheese, but 
are unfavorable to the average milk <leali?r ami consumer, and much 
of the care devoted to milk is directed agniiurt the growth of these 
organisms. 

Ther« i.'* a popular belief that a thunder shower will sour milk. 
The fact seems to lie pn-tty well demonstrated thai Ihc climatic con- 
ditions which produce thunder showers are those favorable to the 
growth of the bacteria which sour milk; and during the hot weather 
milk frequently sours apart from thunder storms, and also ihnt milk 
cooled immediately after milking an<l kept properly cooled will not 
snur dnriutr a thunder storm. 

Milk Production.— The production of milk which will keep a 
wasonalile length of time and is free from objectiimable features is 
A comparatively simple matter, but it rcquiri^s earc and constant 
saperrision. and is best undertaken by persons trained in dair^'ing. 
The first consideration is the cow herself, and, to produce good, pure 
milk, the cow muirt be healthy and must be kept clean. Sick cattle 
should be separated from the herd, and if a herd is to Iw kept free 
from tuljercuhsis. no cow should he added to it without first having 
been tested by tuberculin, and the entire herd should be tested from 
lime to time. The cow should be groomed regularly, the same as a 
horse, the oftener the better, and this reduces the bacterial contamina- 
tion of milk ver>- materially. Some dairymen cut off the longer hairs 
about the Ranks and tail to lessen the danger of having them soiled 
with feces. The grooming should be done before miliung, ood the 



p 

I 




AXTUAL FOODS 

oow should not be allowMl to Up down uutil she bm been loiUccd. The 
stableti Khoulil be fleaii. li^ht, aiid air.v. and u special milkiDg rotim is 
desirable unless llic baru is of ^ood tfoust ruction and of sutHvient. 
sise. AJuylbing which stirs up dust should be avoided. The barn- 
yard should l)e kept elean and drained. The employees should be 
heoJtby aud clpfui, and the hands Nliould Ik- thon>ut;bly Kcrubbcd before 
milkinp. Many larfte dairy furms supply sterile suits to their em- 
pluyees to lit- woru at milkiug time. No cue nho has. or who has 
recently bad, or who h associitted iu any way with auy euuta^oos 
duease, should be allowed to have aD>thing wliatever to do with milk 
produetion. 

The milk pails and all milk receptacles nhould be kept clean aud 
sealileil OH thoruu^hly a.i pussible, ami Hteriliziufi: wilb live ateain 
should be done wlierever practicable. The water supply of the dairy 
is of itreat importance, and many large dairy eompanies uow insist 
upuD spet>ial examination of the water and water-supply before re- 
ceiving milk from farms. 

Specially constructed milk paiU, whieb. in a lar^c measure, prevent 
the dirt and diut from falling into the milk, are sometimes used, aud 
oiMKl in n-<hiring' the eontaniiuutiim of the milk. 

Hilk Standards. — The Committee appointed by the New York Milk 
Committee siiirgests the following standard.s for large cities. Smaller 
towDS may mottify the standards according to the length of time the 
milk is kept and the distance it is transported before delivery. 

GauA A. 

Bsw milk.— Milk of thi* cIbm sliall come froin ««w« free Uoto dlaeow u deUr- 
■ninnl In- tiilM-rciitiii tmU and plivnu-ul cxviiiniittoiia hy s uualiflvd Tcl«riiuiriaa, 
and r<!tall U- |jri>ducpd and handled by rmploypoa frro fioin ai»rft#« as determined 
Irr vr-lickl inofHTCtivn uf a quulillcil |i)>viik'i«ii, undvr Muiitury ■.■ouditjuan. nuch tbal 
tK« Iwt-lrriiil tvuBl chilli not cxm-d 10,000 iwr Liibic ccntiinctvr nt the time of 
dptt*r-ry ti> l)i<> roiotinirr. It in r(>foninii^iid«() IIihI iluiri'-a fmrn whk-li Uiio supply 
U (JilainM iihaH sMirc at IciiBt SO on the L'nitrd Stnlra bureau ot .\niniml In- 

PmitCBTlied milk. — Milk of thm cIam iKa-ll eotoif from (h>w> free from di«»*M> m 
AvtvniiBt^ by pbr«iral exajninntinns by h miiililUvl vrtt^rinnrian, and shall be 
pmduerd and hnBdM tuiilor lAuitary wndlUunit. i>ueti thut tbi- hiu-tt^ift n>i»t 
M an tivte «xcTMtii 200,000 p«T rubk- imtimetpr. .\ll milk of thin rlau tliall 
ba ptulMuixMl under olIlvtRl nipervl«li>u, aod the bai^tcriii I'uuut abull mil trxnwd 
lOUOOO |i*r (Tuhic ei-iif tn»pt<-r nt Ihp time iif dpliv^rr tt> tli«' ri.in»unipr. It is 
rMuaunrJidrd thut dairii-H from vhlch tbls ciipply \a ublAinMl aball mtofo at l«iuU. 
a m tkr t'nilnl States Riirntu of .\nimnl liidii:itry *troiv card- 

Milk of thU flMH Hhnlj wme from mv fr#o from df«iMU« bh 4<<tprTnin(>d by 
ptiyaical Musinatiunii. uf uhli-h vn)< <>nHi yi>ar iihalt ho hv a qualified vrt^riaarian. 
aaa alwl) b? pmriuiMl *nd handle>l under iaiiilarv tiniilitiitnit. Htich Ihut lh« 
WcIoIa niuot At no time rxcenln l.UDO.tMliD [vr ciihic cmtimetiT j^ll milk of ttiia 
dawt uliall Ir pulriirifrd tindrr ofliri.it -iipiTvlHiun. anil the luictrrial rount 
■haJI not exiled jO.MiO per riiliic pmiiim-ii-r when dplitvrxl to the njrmwTHT. 

It I* mumnx-ndnl thut diiirim produrine irrade B milk tboutd be srored. 
ami timt Ibr brallh driMrtmeule ur tli« cuiitrullini; d(!|HirtnimlH, whutn'er they 
nmj be, •triiv to brine tl)e*e •ourm up an rapidly aa paaelblr. 



100 



Okaoc C- 

Milk of tkir claoii ahiill voaiv frutii kowk frc« from disease, i>« det^roiiued hy 
pliynivnl t'\atiiiuiil >"[i>?. ■ml )*li»ll iiit-liiile hII milk Uiat is |>rodu<.'F(l uiidi^r l-qii- 
ditioiiH BUi-li Ibtti till- LftfterUl uuunt i« In esce*» of 1 .*HHJ,ll(J(l pui fiiljii- rt-ntiinet^i. 

AD milk of tliiH i-luMft fchitll III- pftstoiirinxl, or licAtoil to * 1iiglii>r tviupviaturp, 
uid «hiill pcmUiin leuH tliaD SU.WJU bai-Wria per eubic ovutLiiit-U'r nli«n dclivrrM 
to thv riiiiKumor. 

Wlienever any lur^e city or communitj' flndit it necemBXy, an aecount at tbi' 
gtli uf liuiil (ir other ]i<-vuliiir eoiidltionii, to n.l!otv tin- u»\t^ iif )iruilit C milk, its 

Jv shall l)e KurTound^ Iry fisfegiiMnlH sucli ho to iuHUrt' the n^strictioo oi Itu we 

I coukitiK miiJ iiianufaclui injt iiur|i>uiink 

The Transportation and Delivery of Milk, — This cannot be fully 
couBiderf^d htrt', but ii ihhv be stult'd that the niitk HhoiiUl be trana- 
jmrtod ill storilf I'ans (ir lnotlU-s. thai llic puiiriiig of milk from one 
iCaii to another (ir lu boLllvN should uuJy Ijf allowed in a rut)m provided 

aeeially for that purpose, free from dust and other source of 
contaminalion. The milk shoidd be kept cold the entire time until 
it reaches the consumer, aod by him until us?cd. TIte selling of milk 
from open i^aus in groeery and provision Kho[>K shmihl [je prohibited. 
Th« safest method of nmrketinn milk is in si^uted buttles, and, unletis 
some other solution of tbe problem offers, this should be the onlj* 
way. Selling from canK. tbe way it is done in The Fnited States, 
is open to a number of objections, but the public has not been educated 
to deiuatid pure bottled milk, although much haa been done in this 
direction. 

Thc Haniliinit: and Care of Milk. — Ae we have seen, th« produc- 
tion of milk reasonably free from bacteria is a question of cleanliness, 
and the question of baudlinu it is reduced to eleautiness of utensils, 
protection of the milk from cont«miiiation by dust and dirt, and 
keeping it eonl. The milk ^iliiniU) br i^tiolcd immediately after milk- 
ing, and this is most raiivpnicntly ucrtmipliKhed by usinp a milk cooler, 
of which there are many different models, using et>!d water, and it 
should be kept cold luitil used. VarioiLs devieea for keeping milk by 
beating- it to over llO" F. have been advised, but while moBt bacteria 
will not grow Ht this temperature, sntne undoubtedly do, and having 
Been severe diarrht'HS eaiiM-d in infanlK by keeping milk warm at 
night, we advise against this praetice in the present state of onr 
knowledf^e of bacteria ^iwing at high temperatures. 

The AdDltcrotion of AVilk.— The most frequent adulteration of 
milk eonsMts in romo^-inp part of the eream and adding water. In 
other itnitancfs jrood milk and skim milk are mixed together. In both 
instances the consuraer is robbed by paying for an article of foo«l 
which does not have the nutritive value it is commonly supposed tx> 
fMjnsew, The addition of water brings the addctl danger of con- 
tnminnting th*- milk, ux a milk dealer BufBcieutly uiiserupuloua to add 
water to his milk would Im> apt to disreganl the character of water 
used, and, as a matter of fact, a number of typhoid cpidcmiea have 



t'OODS 



107 



bmn CAn«ed in this why. Milk ia HrtitiuiiUI^' coloreJ. but this practice 

Iift nol UK eomtnoi) tui is impularly siippused. Almoiit all oummiuiities 
have Uu'8 forbiildiiig thi> adiiltorHlion of milk in this v,'»y. 
The Use of Preservatives, — Cliciiiiciil pres«TVHtives ar»r frequently 
added to milk to prevent the growth n£ bacteria, and it is frequentij' 
done lifter the milk i^ partially spoiled. The moiit vummonly used 
•rticIeH ore fonualdi'byd, iKiric at-id, burux, salicylic acid, and benzoic 
acid. Only small amounts are needed to check the growth of bacteria, 
but the unwnipnloiis dealer UKualty adds a great deal. Milk whieh 
does not sour iu u reasonable length of time under favorable coudi- 
B tions for souring Khoiild be (H^teil for preHen'atives. The lue of all 
xuch preiM>rvativ(s shnuld bi- prohibited by law. The 80>calted Bud- 
dci7.<-d milk ha« bud hydm^en pernxid iidded to it. which slerilizeH 
it. and the poroxid is Rruduaily deeomposed into oxygen and water. 

■ This prtK-ess is not to be eommeude<l. 
The Examination of Milk.— The milk should bo thorouiirhty mixed 
so as to obtain n fair sHuiple, but if the fat separates in s^mall lumpN 
of biitt«*r. another sample should be secured. -Milk should adhere 
•li^tly to the sides of the glass from which it is poured, and not run 
^ off like water. 

^ Fat Tests. — The Babcock lest is the best metbod. but requires th« 
DM of a eentrifii'.'nl maehine; small oneit, however, may be obtained 

ifor office u«e. The amount of fat in the milk may he dctinilely de- 
irrmined iu ten or Kfteen minutes by using ihiH test, which is made 
by putting a definite amount of milk or eream iu a special f;raduated 
bottle. addiiiK sulphuric acid, and shaking Ibe mixture until it be- 
comes dark in color, then placing the bottle in a centrifugal machine 
and running it until Ihe fat is entirely .nepamled. The exact per- 
ceutage can be read off after adding sufHeient wui-m water to bring 
K tbi- fat up to the graduation on the bottle. A simple methwl. but 
not a very aiH-urali- one, is tu use a ereamometer. vrbiefa in a tall. 
graduated ^la^^ cyliudcr. Thi» is tilled with milk and allowed to 
stand for about txvculy-four hours. The pmcewf may be hastened by 
heating to 100' F. and then placing the ereamometer in rold water. 

» Another method is to lill the ereamometer half full of milk and then 
add warm water. The reading will in tbis ease have to be doubled. 
The Specific Oravily. — This is besi taken by fbe Quevenne lacto- 
ttteter. whivh has u tht^rmometer enclosed in it which showa both the 
Hfieeifle gravity and temperature of the milk. The milk, to get ac- 
curate and nnifomi n-sults. is tested at (JO' F. The specilie gravity 
of milk Varies liolween 1.023 and IM'i-i. aJid sometimes there are great 
I TarialiooB. The ^pecitie gravity may be increased if the cream is 
removed, and if water is added the specific gravity is decreaited. A 
lavorile method of adulleraling milk is to remove part of the cream 
thru add suOieient water to make the specific gravity normal. 



CLASSES OF FOOD 



The Ittctometer shoe's only the specitic K^nvity of the milk, and whilitl 
Kitniptiin«s H(luIl«ratioa may bv dett-vtetl by it, it is not a certain 
test. 

IHstimolion of Protein. — Boggs ' has suggested the I'oUowiug test:- 

Vae phusphotungstic aoid, 25 grams, aud distilled waltr 125 c.u.; 
after tboi-ough solution ia obtaiued there is added hydrochloric acid 
(cone.), 25 c .«.. diliircd with distill«<j water. 100 e.c. This yields 25(1 
C.C. of a 10 per cent. Kolutloti of pliosphotiiiigstic acid iu about 3 per 
cent, hydroeliloric acid. The solutiou is quite stable if kept lu a dark 
bottle and uiveK HUtinfactory rtrsullH after monthK of standing. U ia 
desirnble thai the c-umporieiitK be uiixcd as indieated, i. f., the welt 
diluted Iiydruehlorie acid nddcd after Golutiou of the pbosphotimg&tic 
aeld, iu oi'der to avoid preeipitaltoii. 

The itauiple uf milk to be tested is diluted with water, using standard 
pipctg and flasks io secure maximum at'curacy. Esbach's tables of 
Bt&udard pattenis reading from 1 li> 7 yrams per liter are mure satis- 
faclorj-. 

The diluted milk is poured into the tube to the mark U, being oarc- 
ful to read from the bottom of the raeuiseus. The phosphotuagstie 
acid Muliitioii is added to the omrk R, the tuW corked, aud slowly 
inverted twelve times to secure thorough mixing, enre being had to 
avoid shaking roughly and tlius mixing aJr iu the fluid. The tube ts 
then placed in a rack for tweuty-four hours, and the percentage read 
off at the level of the top of the precipitate. Fraetii^m of pereeiitage 
between the grnduntions are readily jud^ied hy the rye. At dilulioiis 
of one purt ju ten. porceat^gc of protein is read directly from tho 
Bcale. while if (he Bolution be one iu twenty, we multiply the reading by 
two. if one in five, we divide by two. 

The optimum dilution for human milk is 1 in 10. That for cows' 
milk, ] in 20. If the prntein eonti-nt b^ f<nmd extremely low we may 
iinie 1 in a for human milk and 1 in 10 fur cows' milk. 

As temperature has a detinite influeucc on the volume of the pre- 
eipitate. it is desirable that the tubes be not exposed to extremes, 
although the difTeretiewi noted in this precipitate were nut nearly so 
great as when EsbHch's Mtlulinn wait used. 

No considerable variation ww.s found in volume of precipitates, with 
tcmp^ratui-w ranguig hciwceu 15''-25'' C. (SS'-T?" F.), while in the 
IheriiKKtat at 37' C. all floatwl, and in tlie iee-box at G' C. (41' F.) 
all reiKl appreeiahly liigher tluin at room tcmpt'ruturea. avcrugiug 20° 
C. (t*" K). 

The minimum volume of the precipitate is reached in twenty-four 
hours. 

Tests.— The Acid Test. — From the time of milking until it sours 
the acidity of milk is eonstanlly im-reasiiig, and while no delUiite 
standard has been iidnpted an the maximum acidity which should be 

1 Bulletin of tb« Johne Hopkins Ho«pitaI, Oct«l>«r, lfi<Kt. 



IWJ 



accepted by a conKumtT, it furiiiah<!s a Nimple meatu of teiitiug milk. 
FarriuKtoii, of \Viiit»m«n, bati bud tubletx made of a definite (juaatity 

' of some albali, uueli as caustic puUmh ur tuido, cuntaiuiug a little 
pb^iicilphilialciii. wbl<>b is culurli'ss in acid »iluii(ins and jiiiik in alka- 
liac solutions. Tbt; Ubk-t^ urv luadi.- o£ hucIi Rtrcu^b tliat if two of 
them turn one ounce of milk pink, sucb milk, with proper care, aboutd 
k«^p a n-asitnable leu^h of time. 

Sydrogen peroxid may be detected in milk by tbe use of a solutiou 
of titannic acid (titannium hydrHh>} di.ssoIv<>d in .sulpbiiric acid. 
Thi» Ls add<Ki to a few cubic ccnlimi-Tcrs of milk, and if the peroxid » 
prewDt coloration appears, but varies between a light yctlow and a 
dM'p orange, aocurdiiig tu the amount of peroxid preK^nt. A some, 
wluti similar rcactiuu takes pltii-e from milk coutuiiiiii^ luilic-yiic ucid. 
Forraaldehyd is \test tested hy uRing either llehner's or Lieaeb'tt te»t. 
They are ba-scd mi the appearance of a violet color wlieii concentrated 
sulphuric acid or bydrocbloric acid containing a trace of iron is added 
to tbe milk. 

IJthner's Teti. — To a few cubic ircntimctcm of concenlrati-d sul- 
phuric acid, to wbicb a tract' of somie ferric »alt has been added, add 
the milk tu be tested so as to form a difitiiiet layer on top of the aeid 
and allow lo »itaud. If fonnaIdel»>d be present, even out* part to a 
milliun vl milk, a violet coloration will take place at llie junction of 
Ibe two liquidK. 

j LtaeM's itethod. — Dilute the milk with an equal volume of water 
•od add for each cubic centimeter of tbe diluted milk I c.c. of con* 
e«ntrated bydmebloric. acid contauiiiig I c.c. of lU jier cent, ferrie 
chlorid solution to cacb 54K> c.c. of acid. The mixture i» bcatcd in a 
euserole over tbe bare flume to 80° or 90" C, rotating to break the 
curd which forma. If formaldchyd be present, a violet color will 
appear. 

Detection of heated milk. — Siorek's method. — Five cubic centimeters 
of milk are poured into a test tube; a drop of weak solution of 
bydrogen dioxide (about 0.2 per cent.) which contains about 0.1 per 
cent, sxdphurie aeid, is added, and two drops of a 2 per cent, solution 
of parapbenylendiamin (solution should be renewed quite often i. then 
tbt' lltiid ia shaken. If the milk or tbe cream becomes, at once, indigo 
biae, or the whey violet or reddish brown, then this ha.*! nut been 

ibeatrd or. a( all events, it has not beeti heated higher than 78° C. 

1(172^6' F. I ; if the milk becomes a lipht bluish (jray immediately or 
thr course of half a minute, then il lias been heated to 79° to 80° 

fC (174.2° to ITS' F.}. If the color remains white, the milk has been 
heated at least lo 80" C. (176*F.). In the examination of sour milk 
or «)ur biiitennilk. lime water must be added, as the color reaction 
is not xbown in aeid Milutinn. 

Amoid't Qitaiae method. ~A little milk is poured into a test lube 
and a little tiuctnre of guaiuc ts added, drop by drop. If the milk 



CLASSES or FOOD 

has not bc«n heated to HO" C. {.116* F.} a blue zone is formed between 
the two duiclK: heated milk gives no reat-tion, btit remains white. 
The Kiiaiac tincture slioiitd uot be used perfeetly fresh, but should have 
stood a few days and its potency have beeu detei-uiiued. Thereafter it 
can bi^ u»«d itidKtiiittely. rh«K« teats for licntcd milk are only active 
in the easi' of milkii whiich have been heated to 176° F. or 80° C. 
(Jensen'*) Milk Hyj^fieiie. Pearson 'h trauKlation, p. 192.) 

Microscopic test for keated i, pasteurized }n»i!k- — Front and Kaventl. 
— About 15 c.c. of milk are ceiitrifiiged fur live tninutes, or long 
enough to throw down the leukocytes, '['he ercam layer is tht'O 
completely removed with abNorberit entton and the milk drawn off with 
a pipette, or a tiue-pointed lube aitachcil to a Chapman air pump. 
Only about 2 mm. of milk arc left above tU« sediment which is in the 
bottom of the sedimentation tube. 

The stain. wtii>.'h is an a<|ueous solution of sofraain 0, soluble in 
wati*r, iji then hiUImI very slowly fnim an op^vniiiziiig pt|X'ttt', The 
important thiiin is to mix stain and milk so slowly that elotting does 
not take place. The stain 1» adilcd until a deep opaque ruse color ia 
ubtuiued. After iitaiidiutr three minutes, by means of the opuonixing 
|)i|>i'tte. which liat« been wa.shed out in hot water, the stained sitdimeut 
is then trunsfcrri?<l to HlidcK. A HmHil drop is placed at the end of 
eturh of several slides nnd spread by means of a glass spreader, as in 
Wright's method for opsonic index detcrmiuatious. 

In an unhealed milk ^he pnl.vmorpbuimeli^ar leukocytes have their 
protoplasm sli^jhtly tiii<:ed or are unstained. 

In heated milk ilic polymorphonuclear leukocytes have their nuclei 
stained. [ii milk heated to 63" C. or altove. practically all of the 
leukocytes have their nuclei definitely f^tained. When milk in lieated 
at a lower temperature the nuclei are uot all stained above 60" C. 
The majority, however, are stained. 

Cream. — Wht-u milk is* allowed to stand undisturbed, the fat drop- 
lots, being of lower speeifte gravity than the remainder of the milk, 

idually rise to the top. and the longer the milk stands, up to a 
leertaiu limit, the more cr«aiu will be found. • As far as the composttioa 





Crwm. 


Whole mitk. 


I. 


n. 


m. 


IV. 


V. 


Pre>(ciB ... .3.60 
KiUto 0.75 


8.00 

4.50 
S.10 
0.TO 


12.00 

4.20 
3.30 

ass 


1«.00 
4.05 
3,20 
0.S0 


S0.00 
S.0O 
3.0S 
0.66 


40.00 

aoo 

S.SO 
0.48 



of cream goes, it is most easily remembered as regarding it as milk 
containing a laige amount of fat. The percentages of the other iogre- 
di«nta being for all practical purposes about the same as in milk or a 



ANIMAL h'VVDa 



111 



lower. Creams are usually apoken of witli reference to the 
aiDutiiit of fat which they uctiitaiii, hii uii« Hpc^aks ot a 16 per eeiit. 
cream, 20 per ceul. crewu, etc. The cumpositiun of thc!«c U given \n 
the table from Holt ou pa^e 110. 

The I'ream which rises uu averatje milk after iweuty-four hours 
usually ooutuiius about 16 per ucnl. fat, and is s|Kiken uf aa gravity 
creain. Some gravity cream may eontnhi as much as 18 or 20 per 
oeut. fat. The richer creatna are obtained by centrifugal izin^ the 
milk. ThiH has the advantage that cream may be put on the market 
a short time after milkiti^, but it has the (liitadvauiage that the fat 
^B gldbuU's may be hmkcii up and fused, »o that a thin layer of fut 
" may be found on top of the bottle. 

The upiM^r part of the eream, after standing, is richer in fat than 

I the lower part, iirid rhis is true of the milk taken &s a whole. The 
vanatioti«are well shown in the following talile from Holt: 
The fat droplets in cream vary iu siie in the ditTereut varieties of 
CDWS. lu the Aldenirys and Gucmseys the droplets are larger, lesB 
Djufonn iu size, and luure numerous than in milk from the ordinary 
milch eow. The small uniforui fat dropleta of milk from average 
herds is to be preferred in Infatit feeding. Ordinarily, if average 
milk has stood until the eream has risen, the upper third of the milk 
ixx the Ixittle will contain about 10 per cent, fat and the upper half 
about 7 per oeut. fat. Creain rises best on milk that has been cooled 
qaickly after milking and which has been handled but little. Milk 
which has been xhaken up fn-quciitly and frozen and thawed does 
not yield as much cream, nor as quickly. 

Skim Milk. — This. is the residue remaiuiag after the removal of 
cream from ordinary milk, and differs from it in having mmt of the 
fat mnoved, and is .slightly richer iu casein and milksugar. It is 
easily digested by most people and ik frequently sold as whole milk. 
Tbe average composition of skim milk, according to Letheby, is as 
fcdlows- 

W.l*r n» 

ProU-in 4JI 

r«t# 1.8 

llilL HiiKsr .......,, ^A 

K«lii 0.B 





After ftnur 

bnun. 


AncTclgbt 
houn. 


OnunlgtiL 


U|)p«r4«K 

BMWitd4 OB. 


20.50 

(too 

1.20 
1.00 


21.25 

«LfiO 

1.40 
1.00 
1.00 


22.00 

1.00 
0.30 



Devonshire cream is more or leas aolid clotted eream, obtained by 



112 



CLASBBH OP tVOD 



akimmiriff milk after it has been heated slowly to not over 150' ■?. It 
is very extensively used in Devonshire, and is very nutritious, but less I 
digestible than ordinary rream. 

Butter.— Butler is iimde from tuilli by chitrniug, which causes the ' 
fat ^lobuleH iu the ruilk to vuaU'S4.>4!, tliiiii fui-iuiiig a xuHd mass. Occa- 
sionally hultcr is iiiadf from oLliur milk than that of the cow. Bullcr 
i& made most rapidly from cream that has been ripened from twelve 
to IWL'Uiy-four Iioui*r, and churned at a temperature between 65* and 
70° F. Iu this wa>' butter may be separated in from twelve to thirty 
minutes. The process of ripening has been carefully studied, and it 
has been found that the haeterial flora of a L-reaiiiHry varieji with the 
seaHon of the year, and alKo the taste and odur of the butter varies 
eorrcspondiuKly. Instead of depeudiu^ ou chance bacterial inva^ 
sion& of the milk, whieh may produce at tinu-s unpleasant flavors, it is 
the practice in many creameries to inoculate the milk with a culture 
of bacteria known to impart a desirable flavor to the butter. In this 
way a saving is brought about and the quality of the butter 
improved. 

When buttur is kept too loni; it becomes rancid, and this is due 
chiefly to the femicntatiun of the small amount of caaein remaiuioK 
in the butter liberutiug fatty ac-ids. To avoid this the butter should 
be kept cold. Salting is largely used for preventing this fermenta- 
tion. The amount uscil shiiutd not exceed 2 per cent., and it should 
be worked iuto the butter so that no uadissolved particles remajn- 
The misalted or sweet butter is largely used in Europe, but there ia 
not a great demand for it iu the United States. Butter is often 
colored, largely because the public still like a dark, yellow color. 
Aimatto is largely used for this purpose. The Lloited States standard 
for butter is that it shall not contain more than 16 per cent, of water, 
nor letcs than 82.5 per cent, of butter fat. Approitimately butter may 
be said to consist of — 

F»t »* J 

W«tw 10.0 ^J 

Sunr vr milk 0,6 ^^H 

C^wlii 0.5 ^W 

On account of the ease with which fresh butter is digested, it is 
one of the moat valuable of the fatty foods. 

Renotnted Butler. — This is made from bntter which has become 
rancid, by iiielcing and washing with water. This has no flavor, and 
»o it is given a bnttrr flavor by mixing with a certain amount of sonr 
eream. 

Testing Renovated Butter and OUomarffarin. — Renovated butter 
and oleomargin may be distinguished from ordinary- butter by boiling 
a small amount in a ismall pan or tablespoon. It should be melted 
slowly, and stirrrtl with a wooden .splinter or malrh stick several 
times during the boiling. Ocnuiue butter boils with little noise and 




dyiUAL tuotis 



113 



tduce!) au Bburidance of foiuQ, while reuuvat«d butler auil oleo- 
margiiriu boil nuisilj' aiid sjnittur like a uiixturt! of grease auil water, 
and pAMluce \ks» itijua. 

The Watrrhousc rpjit. — Olvoiiiiirgariti may also be itistinpiisbcd 
from butter aiid reuovated liuttor by the Walcrlioiise Irst. 

|^^we«'l skimuit-d milk in used, tilling a bulf-plut cup half full, then 
heat thiK nearly lu boiling, and add a t^ligbtly ruuuded teaKpoutiful of 
the material to be t«»tcd. 8lir with a wooden rod and continue hfttt* 
intc until the milk boiU up, tbcu remove from the heat and cool iu a 
pan euntaiiiing rather large fragments of iee and a little water. 

IVrtieu the viip ik placed in the paii Ihe water should reach on the 
outaide of the cup to one-fourth of ihe hci^tht of the nulk within. 
The L-tintenta uf the cup ahiiuld be stirred rather rapidly and ron- 
litiuoualy, aud about oiiet- a uiinutc the cup sluiuld be moved about in 
ihc \w so as to facilitate ewoliiig. If the tsumple is oleomargaein the 
f4.t feathers into one stoft lump, aud If it is butter the fat beeomes 
granulated aud caonot be collected. When the test ih properly carried 
out. the diKtinetiou is ver>' marked. 

Bullermilh. — The residue left in the ehurn is called buttermilk, 
and is largely used as a beverage, au it is utitritious and easily 
dij^ted. It coniainH the easeiu of the 0ulk in a finely coagulated 
form, has a pleasant acid taste, and contains lactic acid bacilli. The 
buttermilk left after churning freiih milk has appnnimately the same 
eomptiHiiioo oh skimmed milk. IButtermllk from ripened cream varies 
^ aomewbat. Wiley gives the following analyses: 

^H fnim svMI Pr«n mnif 

^H cTMin. er«>iii. 

H Wktcr 8».74 00.03 

^^^ K«t 1 .21 0.31 

^^■i MilksQgu 4JHt 4.S8 

^^K^ Prolxin 3.28 3.37 

^^^^K Asb a7» 

^^^IP Ariditv -■ QXA 

H A preparation similar to buttermilk m aLso frecpiently made from 

I the whole milk hy infMndatintr with lactic acid bacilli. ThU is a 
pleasant, initritious ilrink, much m vo^ic at the present time. It is 
luvful in feixliofj; iuvalicbt, e>ipecially those with certain furmii of gas- 
tric and intestinal disorders, aud in feediug infants. Compressed 
lablels of laetie acid bacilli may be obtained o» the market, and, while 
IcM aatiafaetor^* than the fresh cultures, may be used where the latter 
art unobtainable. Conservevl bnttcrmilk, made somewhat after thr 
manner of condensed milk, i^ ulwi used, especially for infant feedinff. 

^ Drie<l buttermilk haa alito be^n placed ou the market. 

■ Bonnyclabber. — This is soured milk in which the curd and whey 
are wrved in the same dish, and usnially eaten with the addition of 
ui|^. Curd and whey or junket is milk where Ihe cnaKulatJou bus 
bMn brought about by rennet. In many instances the whey is 
reraovrd and nsed as a food for invalids and infanta. 
8 



lU 



CLAHHtH OP t^OD 



Cbcese. — Ch^-ose is made of the curd and a certniu proportion of 
fat of milk, aud viu'iuii iu vuiupoyiiion aiut cotiKiRteiice according to tbc 
method employed iu tbi: manufacture. The simpleNt form of cheese 
is the iiO'U&lIoil cottage cheese, iu which the <-ui-d ih separated froiu 
(he whfy aud ealfii u short time after it in made. The iitlier (Oieeaes 
are kept a ctrtaiu leugth of tiim.' tu iusure ripening. Sometimrs the 
coagulation is produced by rennet aud Eometimcs by luetic acid, while 
vanous foiTiis of bael<-ria growing in ilie ehcese mul also certain 
moulds impart to the different varieties their pcculiai' llavoi-s. Some 
cheeoes are hard and some are soft, the ditTereuce being due to the 
amount of presKure iimnI in hardentiit^ them. As a rule, the harder 
chceacti Iteep very much longer than the wifter ones. The average 
composition of i-heesc, as ahc-wn by I'arks, is as follows: 

Wb.ut a«,o 

FrowlB Sl.0 

F«tB .• MtJ 

Salts 4.6 

Cheese is a nutritious aud ugi-eeable food, but some people Hud it 
diHicult of di|;;(»<lioii. Ah » rule, the hanier the elie(»e, the more 
indiKCKtihle it iti. Like milk. checiKe may contain certain poiiioaouN 
suhstanceo due to haeicrial action, and severe poiHoniug may foUoir 
the eating uf such eheese. In recent years the Kludy of the mannfae- 
ture of various cheeses lias been parried on. no ihat Jtoquefort and 
Camembert and other foreign cheeses are imitated with considerable 
8uece£s in the United States. The artifieial coloring of cheese is still 
very common in the L'nited States, and should be prohibited by law. 
Cbeoe is sometimes adulterated, and a eheap checiie, known aa filled 
cheMe, lit made by adding neutral lard to the milk tu replace the butter 
fat. In the L'nited States euch cheeac \b tased and must be branded 
as such. 

Condensed Milk. — Thia is manufactured by heating the milk to 
212" F, to sterilize it ajid then evaporating in a vacuum until it 
becumeo Uiiek and jelly-like. To ihiK considerable amounts of eaue> 
sugar are added. In some cities fresh cuudcnaed milk may be obtained 
which has not had sugar added to it. The composition of condensed 
milk is as follows: 

ToMmUA* ProMln PrI UMiucmt Cuvaucv 

tMrMBL pwMDt. DttrtDi. DurtvM. yarotit, 

DaawMMtad roadniuoO nillk. W IS It l« t 

0w«n*B«d c»D-ltii«id oMk M It ]> iQ M 

The Borden Conipmiy have furnished the following aualysM: 

Kagle Btvnd Condnuett Vilft. 

F«t ».« 

Mllk-»upir |8.4» 

Protein H.M 

.*«h I.M 

Cani-MigHr 40.M 

Walcr 28.4S 



4 




ASIiHL FOODS 



115 



f'nrlwM Hvapomlrd Cream. 

Hilk-sUKMr I |-t.».-iii .. )M).»3 

F«i n.W 

A«b mo 

WRUr «;.« 

kporatHl eream is merely a trade name ii> ijiitiiiiguish un- 
KWfctrned citudcuM^d milk from awcctviiixl umiiiIiuimmI uiilk. A cod- 
dftis'><] en-am would, uf coursr. be butter. 

Condensed milk is lar^iely used as a substitute for fresh milk by 
many people, and is of esp«viul value in the Iropictt and on voyageei, 
aft well as Xteing a UHeful food, under eertain eonditioiis, far infants. 
It ix eaiiily diBi-stcd, and the better brands are n-a-sunubly pure; but, 
in tb« dilutious usually used, it U tor> bitih in sugar perccutage and 
too low iu fat. It produces fat. pale, flabby babies, with a teiideney 
to rickets. 9curv>'. and a lowered resistsnee to infections. On the 
otbpr hand, it ib moHt valuable in infants with feebk digestive powers 
and thfme who are not j^ning in weiiiht : in hot Mimm^r weather 
it t» to Iw rtiNimracnclt-d when; the fri^sh milk is (if (|ui%timiabk- purity. 
(See Infant Feeding.) It should be remembered thnt eoiidensed milk 
msy be made from dirty milk, and tto lie objectionable, and that It 
nuy contain large numbers of bacteria. 

Auuiber muihod of eonsprviny: milk, known aa the Cauiplwll method, 
haa been recently iniroiluced. and ibe product is now obtainable in 
aome places. Pure milk is placed in a concentrating vat and warmed 
to 140* P. A blast of Altered air is driven through it for about three 
hours, or until the original volume is reduced to one-quarter. Thi^ is 
then bottled in sterile bottlra. It may be used just an it is in <;oltee 
or t«-a. diluted unedialf in place of cream, nr with three timea the 
amount of water in pliice of ordinary milk. 

Predlgestion of Milk. Milk mny be partly or wholly predigested 
in order to render it more t-asily diKcstible for individuals suflferinK 
from xastro-intestinul diwirders. This proix'sfl is readily accomplished 
bjr adiUng an active preparation of pepsin to acidulated milk, and 
allowing (be fermentation tu proceed under the inllurncc of heat at 
the body-temperature by immeriiioD in hot water. During! this fer- 
mentHtion the cawin is partly or «f>inptetely eimvert^'d into albuinoses. 
If the procc-ss is allowed to continue too long, the milk brctmu-* bitter. 
For this reason it is ordinarily removed from the hot water after a 
few minutes, and is placed upon ice. which prevents further fennen- 
talion. In order to predigcst milk in alkaline solution puncreatiu is 
RUbtitJruted for pepsin: panereatization of milk bus now largely re- 
placed peptonization. In order to effect puncrratizatinn of milk, 
Faircbild's peptonizing tubes are ordinarily employed. Thew tubes 
enntBJn five praioK nf jwnereatie estraci and tifti>en pniins nf «(Mliiim 
Wcarbcnate. Eiich tulic contains sufficient jwwdfr lo disrcst one pint 
of milk. Another easy method of partiully pani-reatizing milk is by 
th^ (i» of Fairehitd's peptogenic milk powder. First diwiolve the 



116 



ChAHSBS or FOOD 



puwilc 



the water by rubbii 



ii<) Htirriiig with a spciOD, then add 
the tuilk and cream; mix well; l]*?»t iu a saucepan, with constant 
slirhui; until bioixl-wHrin — not too hot to be agreeably borne by tbe 
mouth: keep at about tbiti tempvruture for ti'ii niiuutes: theu bring 
quickly to builing-point; puui' at onee iiitu dean bottle, »hulce thor- 
oughly, cork tightly, ami pUcL- cl5rfc;tly on it-c or in n very cold place. 

Whore tho TJisto of pauercatiiicd milk provi-s fibjceiionable, the addi- 
Uoii of carbonated waters, or of small quautick's of eolTve, may reiider 
it more palatHble. 

The di^e.stibility of luilk may be increased by the addition o£ hot or 
cold water, (•arbonatwl waters, sueh as Vieliy or Apolliuaris, lime- 
water, oalmi-a! or barley-water, or farinaci-ouH foods, such as arrow- 
root or flour; oeeasioually small quantitioH of salt or sodium bicar- 
bonalf are helpful. 

Kunii»s. Kctir, and Matzoon. — Kumiss is a fvrmeutcd drink pre- 
pared by both lactic acid and abioholic fermentation. For many 
eeoturies it has been made from martti' milk by the natives living near 
the shores of the Caspian S^ca. The milk ia obtained from a special 
breed of marcs, the animals beintr fed very earefully. The milk ia 
mixed with a kumihs ferment, the lactic acid fermt-ut converting some 
of the siig-ar into lactic acid, while another pan of the sugar 
IB converted into alcohol and carbnnic aeid : a small quantity of 
casein is diKC-ited. The milk is consliintly a>:itatcd. and the fennen- 
taliou allowed to proceed for a period of twciity-fuur hours or more. 

KnmtKs Ik an acid. cfTervtaicin^ drink, and <-ontainK a very small 
proportinii nf filcnlinl. It m very easily digcntrd, being much more 
digestible than milk. The easein is so finely divided that lumps 
cannot be formed in the stomach, and it is ea-sily acted ujinn by the 
gastric secretion. In the United States it has been prepared from 
«»ws' milk, 1o which the ferment haw been added. 

Eomiss Cure. — In certain parts of Ruetsia this fonu nf cure is not 
uncommon. It consists in drinking small quantities of kumis-s and 
gradually increasing ihem until lar^ie quantities are taken. Kumiss 
cumt have been prescribed in chronic gastro- Intestinal catarrhs and 
chronic catarrhs of the respiratory tract. 

Xeflr resembles kumiss, and is often used as a substitute for it. It 
was originally made in the (Caucasus frmu cows' milk fermented with 
Saeeharomijees mycoderma, lactic aeid fermentation going on at the 
same time. Alcohol, lactic acid, and albumins arc formeil as a rcsalt 
of the fermentative processes. The casein is partly digested. Tablets 
of the kelir ferment have be«'n prepared by Jurock. and are sold under 
the name of kefilac tablets. They render the home manufacture of 
kfrfiran easy matter. (See Recipes.) 

Toghurt Milk. — Yoghurt has been used in the I^ast for a long time, 
but hiis only recently been inlrodurerl in this country. It is a sour 
Bulgarian milk, and is highly nutritious, and caii be used as a substi- 



I.V/JfJi 



117 



lt]te for ktiiiiiiei or krSr. Tbc fvrmeutatiou in this form of milk is gt:u> 
erntcd h\ u ft-rmciit of a mixture of forms of bacteria coiitainrng 
maiuly th« tiactltus bulganeas. 

The compoeition <»f yoKliiirt is: Protein, 7.4; Niit;>»r. 9,4; fats, 7.20; 
salts, 1.3«i alcohol, 0.20; lactic acid, 0.8. Yoghurt is very digestible, 
iuasoiuch iu> the casein and alhumln contained thiTi'iti are rcridpretl 
Holitble as jM*ptoi]i*s and albuiiioses, and ttie lime salts arr in .solution 
to 68 per «nl. 

This preparation of milk has become especially prominent due to 
the fact that MetcbnikolT describes a life-prolon>:ii]g effect to it, 
iMlsing this belief on the fact that in Bulgaria, where yoghurt ia much 
used, a larKe number of consumers of this preiwration are said to 
live above 100 vearH of age. While the conclusions of Mctchnikoff 
are probably not eutirely correel. it is a well-knon-|i fact that indi- 
viduals often thrive on this food, and the decomposition in the intes- 
tine is favorably influenced by it. Preparations much like yoghtut 
may be pn>p«red from the Bnl^'arian bacilluK tabletK made by the 
various manufacturing chemiots. 

JCattoon. — In this form of milk lactic aeid is produced by fcrnien- 
tatiou with a ferment obtained from Syria. It it thicker than kiimim 
and does not contain alcohol. 

Kumiss, kefir, and matzoou are agreeable forms of milk food«i. are 
eaaily digestible, and are especially useful in tlios*- cases in which 
milk cannot be taken or is not well borne. The following table in 
taken from Hutebiiison and gives the eompnsitinn nf kumi.<ts. ko6r, 
etc.: 





TKlMld. 


Bnc*!. 


nu. 


BmIu. 


Ab»hol 


LmUc 

Mid. 




i¥r WOL 


Pit tan. 


ArcuU. 


ftrent. 


Ar MM. 


ftr«eM. 




2.3 


1^ 


S.1 


o.« 


1.7 


0.0 


Kefir 


3.1 


i.e 


S.0 


o.» 


!i.I 


0.8 


Man^nUk 


2.6 


&A 


S.S 


a& 








S.S 


4J 


3.S 


0.7 






BntlmBilk 


9.8 


3.S 


ts, 


afi 


■ • 


as 



E0Q8 

The eggs of the ben are consumed in largeiii numben>. but those of 
the duck, turkey, guinea-hen, and of sfune wild fowl are also catea. 
The eg¥* of domestic fowls varj- in size and appearance, but their 
composition is about the same. 

The shell of a hen's egy constitutes U parts, the white 57 parlH, 
■ad the yolk .'12 parts of the entire weight of the egg. The following 
talile, taken from Langworthy,* shows the composition of hens' egtre. 
eookMl and raw; of urtiite-ahdled and of brown-shelled eggS; and of 
the yolk and white of the egg of the duck, goose, turkey, and guinea- 
fowl: 

■ Farawr*' BullHln No. ISB, Ignited fUitu I>rpitrtiii«nt of Ajrrlcultura. 



118 



CLASSES OF FOOD 



Average Oompontitm <tf Eggi. 



Hen: 

Whole egg at purchMed . 

Whole egg, edIUe pottlun 

White ... .". . 

Yolk 

Whole egg boiled, edible 
portion . , 

Wltite-Bhelled egga u pur- 
cbued 

Brown-ehelled eggs u pu r 

obawd 

Duck: 

Whole «gg >■ purchased , 

Whole egg, edible rwrtton 

White 

Yolk 

Goose: 

Whale egg S8 jrarcbaaed . 

Whole egg, edible portion 

White . . 

Yolk 

Turkey : 

Whole egg as purchued . 

Whole «g, edible portloo 

White 

Yolk ... 

Guinea-fowl : 

Whole esg M purchased . 

Whole egg, edible portion 

White 

Yoli 



Pcrd. 

11.2 



10.7 
10.9 
13.7 



14^ 



1S.B 



ie.g 



I 



flrrrt. 

73.7 

B6.2 
49.6 

73.S 

6&.S 

618 



FereL 
11.9 
13.4 
12.8 

1S.7 

13.3 

11.8 
11.9 



t 



eom 


12.1 


7n.s 


13.3 


87.(1 


11.1 


4S.S 


16.8 


W.7 


12.9 


m.!' 


1S.S 


S6.3 


ll.fi 


44.1 


17.3 


63.^ 


12.2 


73.7 


13.4 


»B.7 


11.5 


t&S 


17.4 


BO.h 


11.9 


72.8 


18.5 


SG.6 


11.6 


49.7 


16.7 



PereL 

9.30 

10.60 

0,20 

33.30 

12.00 

10.80 

11.20 

12JS0 

14.50 

0.08 

36.30 

12J0 
14.40 
0.02 
96 30 

970 

1120 

fl.OS 

32.SD 

9.90 
12.00 

0.03 
31.80 



1^ 



per el. 



III 



Pertt. Caloritt. 
0.9 
1.0 ' 
0.6 



1.1 

0.fl 

0.li 

0.7 

0.3 
1." 
0.8 
la 

0.9 
IJ) 

as 

LS 

0.S 
0.9 
0.8 
1.2 

0.8 
0.9 

as 

1.2 



72D 

2G0 

ITOG 

T« 

6T5 

69S 

7M 

sao 

210 
1840 

760 

S8G 
216 
ISBO 

est 

720 
21& 
1710 

S40 

TU 

3U 

lOG 



As may be seen from the foregoiug table, the egg coiitaius mainly 
protein and fats, in addition to water and mineral matter. The 
white and the yolk differ in composition, the white containing less pro- 
tein and water than the yolk, and scarcely any fat and ash, whereas the 
yolk contains considerable fat and ash. The white is said to be pure 
protein ; it is composed mainly of four albumins and a slight amount 
of earbohj'drale. The albumins are ovalbumin, eonalbumin, ovo- 
mucin, and ovomucoid, the ovalbumin being the main constituent. 
The yolk of the e^ is very complex in composition, and contains 15 
per cent, of protein (vitellin), 20 per cent, of palmitin, olein, and 
stearin (the fatty elements), and 0.5 per cent, of coloring-matter, 
besides lecithin, uuclein, salts of iron, calcium, potassium, and mag- 
nesium : the total jihosphorous equivalent in the yolk is slightly over 1 
per cent., while that of the white is hut 0.03 per cent. The shell of the 
hen's e^ has no food- value ; it consists mainly of mineral matter con- 
taining 94 per cent, of calcium carbonate. 

The flavor of the egg is dependent in large measure upon the food 
eaten by the laying hen. Fresh eggs have the finest flavor. Langwor- 
thy^ gives the following methods for testing the freshness of eggs: 
" 'Caiidiing.' as it is called, is one of the methods most commonly 
followed. The eggs are held up in a suitable device against a light. 

» Farmers' Bulletin No. 128. 



AKIUAL FOODS 



U9 




The fresb egg appears unclouded and alaiost translucent; if inciiba- 
tion bus beguu, a (lark spot m visible, wliii;ii increase:! in wizo according 
to the length of time iueubtttioa bus continued. A rotten egg appeara 
dark oolored. The ase of egys may b^ mj) proximately judged by talt- 
ing advantage of the fael ibat as tiiey i^row old their density decreaseti 
through evaporation of uioiiilure." According to Siebel. a uew-laid 
egg placed in a vessel of brine nuide in the proportion of two ounces 
of salt to one pint of water will at ouee Kiuk to tlie bottom. An egg 
one daj- old will sink below the surface, but not to the bottom, while 
one three days old will swim about just iaiinerscd in the liquid. If 
more than three days old, the egg will Hoat on the surface, tbe amount 
of shell exposed increasing with age. If the egg is two weeha old, only 
a little of the shell will dip in the liquid. I'cuzoldt' gives the follow- 
iog table showing the dige.<itibility of eggs: 

2 •oft>l»lM ftKK* lt«v« Ui« »tniniich in \% hours. 

£ n** egSH li-av« tli« Btoiimch In tM Itoura. 

2 poMclied «j[|i:s and 5 tcraiun oi Imttrr It-are thr MtoiaKch in tVt hoiirm 

2 urd-boil«^ *^g% lonvc the Htcnmdi in 3 hourft. 

2-ef[g anidet ltmv«it the ntvniai'h in 3 livurn. 

Raw white of egg contains something which enables it to renilt 
digestion, but this antitryptic Hubstance is destroyed by beating to 70" 
C. Raw white of egg may leave the stomach rather quickly and 
owing to its slow digestion is not as well absorbed aa if heated. Cod- 
dled eggs and custards are csceUcnt ways of serving eggs to invalids. 
Tbe UBc of raw eggs is not advised by some on account of their tending 
in some persons to produce unpleasant eruetations, nausea and head- 
ache. The white of egg may he det'omposed in the intestine. Exees- 
aivo quantities may cause albuminuria and sensitized persons are 
naturally unpleasantly alt'ected. The raw white of egg is utiliTed up 

about 85 per cent. The chief value of raw cgjn* is in the yolk and 
far we have not noted any deleterious effect from tising raw c^gs 
except Bs nr»tcd above (see. however. Bateman, Amerieau Journal of 
Ibe -Mediciil Scii-nres. .Junt-. 1917. p. S41). but in view of recent inves- 
tigation the value and use of raw e^^ white alone may be questioned. 

Raw eggs are best taken dire«nly from I he tihell, or tlu;y may be 
rombinrd with milk broths or with coffee. In various diseases aooom- 
panied by loss of Hesh and ntrenj.lh raw eggs in large numbers are 
prescribed, as many as 24 egEs being given in twenty-four hours,* 

The palatability of the egg may be increased by flavoring it with 
sherry wine, orange, lemon, or grape juice, or by serving it in cream, 
eoeoa, or eolfec. 

Hgg-nog is prepared from milk and eggs, flavored with some alco- 
holic drink, and sweetened, with sujiar. 

\nien allowed to remain in the air. egsis deeompose from the en- 

) HolfttiiKin. YanA and I)i<-tH)ci>. p. I^'i 

» Ely, -FabU of t^X." N*w Vork Med. Jour., Novemlxr 14, IWM. 



120 



cidssus OF rvoi> 



trauw of gcmis tbrougb their shell. Uecouipositioii may be preveutetl 
in various ways, such as by cuatiug them with oil or varDtsb, packing 
tbem ID sawdust, or placing tb«m in cold storage or in certain solu* 
tiouB. s-,ich as salicylic acid and glyceriu. 

MEATS AND THE MEAT PREPAAATI0K8 

Meat forms the flenhy or nuis('ular parts of the body. It is one of 
the most important artirlcs of food, and is the chief source of man's 
protein supply. M^at uiay be eateu raw or cooked. Raw meat, when 
wiJI g^iind. iK very easily digested. 

Ment i& coinpuscd of musclt-libeni held to^Hber by conacctive-tissue 
bands; between the nuiscle-fibers are bits of fat- As ordinarily seen, 
meat contains muscle tissue, connective tissues, blood- vessels, nerves, 
and lymphatics, together with a varying amount of fat. The mor« 
fat there is in meat, th« less water and nitrogenous matter does it con- 
tain, and vice versa, ('ooking bus the effect nf rendering the connec- 
tive tiHsucs soluble, thereby causing a separation of the muscular 
libers, allowing the digestive secretion to mingle more thoroughly with 
thetn. Cooking also enhances the flavor and appearance of the meat, 
but, on the other hand, causes a lo&s in fnt and cKtractives. Cooking 
likewiHe de.'ttroj's the miero-urgantRms that may he present in the meat, 
itiiii thus n-nderR it more wbulcsomv. 

Meat may be cooked in various ways — it may be boiled, stewod, 
roasted, or fried. Meat is boiled by placing it in cold water and 
Bubjeeting it to a moderate heat for some time. In this way the con- 
nective tistiue bt'L'omes gelalinixed. and u portion of the organic salts. 
albumin, and extractives is dis.snlved. The longer the process is 
allowed to continue, the more tu&tclcss docs the meat become and the 
richer is the broth. This tasteless mass of meat has a high nutritive 
value, and) combined with the broth, constiluti^s a nutritious food. 
The process of slewing meat is accomplished by placing the meat 
in boiling water, by means of which the albumin on the surface ia 
quickly coaKulatctl. thus preventing the juice from escaping and so 
retaining the flavoring matter: the broth that is procured in thix way 
is very poor in quality. Meat is roasted by placius; it in a very hot 
oven, the superlicial layers thus becoming immcdiulely coagulated, 
and so preventing escape of the juice. To broil meat, small bits are 
cookei:! over an open fire, the albumin of the surface being ihus not 
only coagulated, but the inner fibers being cooked at the same time. 
Prying is accomplished by placing the meat in boiling oil : the surface 
albumin is at once coagulated, the juice is prevented from escaping, 
and the meat is rapidly cooked. 

Digestibility of Meats. — The dige«tibility of meats 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 



fur the table. Meats are mast eauWy ilJgctiti-^L wlicn Htcwed; fryiue 
readers them most indiRestiblc. The tluvor of mcttt vai'ies with tbc 
eoutlitioti of the aiiimut frum which it wa£ obtained. The meat of 
mature aiiimiils Is mure pruuouuced oud agreeable iu flavor thau that 
uf youager cattle. 

^Tbe foUowlug table, taken from Penzoldt, gives the relative digest- 
ibility of meat foods: 
V. 






Umm to tvKtkoun: 
200 gm. Wcf-juier. 

Tkrte fo fimr hoitrt: 

£30 gm. au-ircd jrouDf chicken. 

)E3U cm. broil«tl pitrtrid|;«. 

£40 gia. Mcwcd piftwa. 

106 gm. r«««t jii^iHiii. 

250 gm. bi-cl I raw or U>il«d). 

2S0 gm. calf's fcit. boilcid. 

■flOgm. Ii«m. lifilcd- 

100 gra. nufi vohI. 

lUO gm. btw/bt«ak. 

100 gm. brr(»lrmk pulp. 

100 gm. ro«>t beef. 



Tuv to lArrc Jtowr; 

£50 KOI. lull'n Lniia Uilled. 

2M inS' iiwt-<'tbres4 boiW. 
t'oMr lu fit* liour*: 

210 gai. luut pimoa. 

340 j(iii- rim-t lilM. 

£30 ipn. U-vfutiiik Kr>Ue<L 

S£0 gm. Aincik«d tAnguc. 

S$0 gm. hiLre. 

240 gm. ruKitL [iiu'lrHl)^ 

S&O gm. roiut goiitie. 

280 gm. roMt duck. 



Beef. — The composition of beef varies greatly, especially in regard 
to tlie aiiioimt of fat and wnter it eoDtaJD-s. An ox from three to five 
years old supplies the best beef. The meat of a very lean animal will 
contain about 75 per cent, of water mid about 2 per cent, of fat. The 
water in fal meat ts reduc4.-<t to iK-tween 50 and 55 per cent., while 
the fat reaches 2.5 per ccm. or over. The amount of nitrogenous 
Kubstances is him cuusiderubly ri-duevd iu fat meat. Beef-fal is eom- 
poaed of tbe glyceridtt of the fatty acids, the rntia being tlirt-e puna 
of stearic aud palmitic acids to one part of oleic acid. 

Meat PreparBtiont. — Numerous meat preparations, both solid and 
liquid, are uow on the market, the aim being to produce a concen* 
Irftted food that will be readily digested. The dilferent beef-juices 
hare but alight nutritive vulur, most of them containing only 4 or 5 
prr cent, of prntcin; their chief value lies in the fact that they 
stimulale the appetite. 

Bouillons. — Bouillons are prepared by cutting meat into small bits, 
beating slowly in water for a time, and tben boiling it quickly. The 
fiuid thus prodiieed has a very agreeable flavor, but its nutrient value 
is exceedingly small, an it cnntains only extractives, salts, and a very 
Bunuto quantity of gelatin, Bouillons increase tbe flow of the diges- 
tive aeurelions, and can be rendered more nutritious by the addition 
of an egg. certain crn-al.s. nr vegt-tabU-s. 

B««f-extract«.— Beef-citnicta are concentrated bouillons that arc 
to be diluted at the time they are taken. Their nutritive value is 
about the same as that of bouillon. 

Bouillon Cubes — Then? are widely sold and many people have an 



122 



erroueous idea of Iheir fooJ value. They cotiaist very lar^ly of salt, 
vaj^iuK from 49 to T2 pvr cent, auii f rum 3 to 30 per ceut. of vegetable 
extracts and from H to 2ii pep i-oiu. of meat extract. They ixjssess but 
little nutritive value, but stimulate the appetite. They should be 
avoided by persona with diseased Itidneys. 

Beef-juice. — To produw a autrilimiii liquid beef preparation the 
in«-Ht shuiikl ha hoilvd slightly and then eut iuto small piecea and 
pressed through a kmoa-squcczcr or a raeat-preiw. In this way con- 
siderable quautilies of protein, in additiou to the .sails and extractives, 
are obtained. The beef juices sold ou the market, mieti as ValentineV, 
are prepared by KUbjecting the meat to strong preHSure. These prep- 
arations (contain from 5 to 10 per cent, of protein. 

■ Meat Powders. — The nutritive valuu of tbcse preparutioim vari«a 
greatly. Thoue most frequently luted arc a number of peptones, 
Somatose. and the Mosquera "Beef Meal." 

Meat-jellies. — Meat- jellies are frequently given to invalids, and are 
an agreeable meanK of aduiiniKteriiig protein f<ind. Although they 
do not entirely replace the protein in the tissut'K tlicy prudure a con- 
siderable quantity of energy. Aeeording to Uauer, "By the addition 
of gelatin very large quantities of atbumin ean be spared in the body 
or devoted to increa^ of bulk, just as by the auppl>' of fats and 
carbohydratea. * ' Meat-jelly is, tlierefore, a proteinHparer. Among 
thoiie most commuuly employed are ealf Vfuot and ealf's-head jelly. 

The following table, taken trom Chittemlea.' gives the percentage 
compuailion of beef -produots : 



H 



I^:nxHlage Gotufiontion 


of Brtf'pruduoU {Analyrtd, lS9i). 






s 


1 


1^ 


1 1 




•3. 


1^ 


1 


CoDitliuenu. 


l3 


1 = 


m 
'it 

gi 

•5- 


1^ 


1 




5 

li 




ti 




3 


< 


s 


S 


B 


4 


< K 




3)nn 


ii(a 10031 


s; n 1 8I.W 


83.t« 


WJ« 


CND CM 


SotM luatloF >I no»C.). . - 


?eM 


ft^.uT xy.e» 


43.U 1 l£.at ' ]iS.01 


40.43 


1M.33 


9nn 


Molubic In water 


79lH 


(D.VT , 89.09 


I^IZ 


1&91 


1D.(II 


flMO 


4«a] 


tut 


Iniulubk' la •>4tsr .... 














ICW 


4a.M 


fllM 


lanrcsulc I'oiutliucnti . . . 


StM 


sua 


J1.80 


iT.aa 


i.ia 


owt 


lau 


lUW 


Ctt 


l'l!(K|>lllftlV ■(.■l<l>f,Ut) . . . 


f.U 


JM 


4.<» 


i-M 


0,03 


DOS 


9.91 


I.tO 


1« 


Fat, <11xr ixlnwtlvcB . . 


0.U 


1.37 


0.T8 


0.U 


\.Vi 


0.Z7 


1.3} 


3.aa 


laao 


9q1Ut>la 111 VO pot CI. BlDOtlOt 


U.11 


em 


a.u 


sauM 


I.4» 


on 


M.10 


XM 


U,M 


Tola) DilroMvD 


t.ta 


$J» 


itt 


SLSft 


3.4S 


1» 


;.3S 


4.41 


U.M 


iM 


a» 


209 


a» 


i43 


;.» 


1 46 


3.'A 


7.M 


[AiolalilA iiroUid mailer . . 


M3 


an 


-i.e> 


SJA 


1M 


5» 9-13 


30.101 47.81 


Salubla albuiulti (ctMuiUaUve 


















bf hi-at) 


OuDS 


D.W 0.U 


0A1 


UJt 


H.S9 






Solublv altninoMc* ..... 


. , 




. , 


. , 








hM ii.ae 


f^ptune .... 
Total pni1i.>{il DuiiirT arall- 


- ■ 




- ■ 










i.fn 


last 


ftMo •■ iiuirlnii'Ui . . . 


am 


o.as 


1MB 


047 


ItM 


14.9 


a 13 


37.BI 


TT.M 


•wwu rrv*b le»a bc«r(lrau 






































U»f, loot 


OJD 


au 


£40 


Sl40 


71. 40 


'.VXi 


47.30 


i4un«oo.« 



I Proc««db)Ka ol Philadelphia Countj- Medlml Society, I8»l, p. 180. 



124 



CL18SE8 OF Ft>OD 



Chemistry in the Baltimore Medical CoIUk^* t^^ lua asaistant, Dr. C. 
A. CUpp. A report itf these valuable anul/wu in adviuice oC their 
publioaliou has been fiirnisbcd tin- authors liy rrofr-sstir Whitney. 

Veal. — Veal is tough and indigestible, especially when obtained 
from animals that are killed tou yuuug. It dilliTK euuxiderabljr in 
flavor rrnm bc-ef, and uittiluius mure geiutlii than the latter. Aa iu 
many persons va&l b&s a tendem-y to produce indigestion, it is to be 
avoided in all cases of digestive debility. 

Mutton.— Mutton is eonsidcred more digestible than beef by 
English writers, probably beeause in England the average mutton is 
more tender than that obtained in the United States: the beef, how- 
ever, is inferior to that raised in this (;ountpy. Its fiber is finer, but 
it Contains niorti fat than duiut bwf. Mutton fat ('untainn a larjfer pro- 
portion of glyeurids of stearic acid, which taakes it more aoUd and tesa 
difTfisiiblc than the fat of beef. 

Lamb. — Lamb, when of the right a^e and tendt^rueas. is vs digextible 
as beef or mutton, but it eontaius entirely tut> mueh I'al. 

Venison. — Unless obtained from young auim^ils, when it is tender, 
highly Havored. and short,-libered^ venison jk apt to be difTicalt of 
digeation. On aceoimt nf it» stimulating action it should be avoided 
by dyspeptics and others with weak atomachs. 

Pork.— Pork is the most iudigeslible of all ineatii on aeeount of the 
large percentage of fat that it eontaius. This fat consists chielly of 
the glyecrids of palmitic and oleic acids, and may be present in the 
pruporliou of 37 per wiit. or more. 

Ham and Bacirn. — Ham and bacon are both more digestible than 
pork. In some parts of Germany ham plays quite an important part 
in invalid dietaries, but in England and America it is seldom pre- 
Bcribed. Bacon is used largely as au army ration. When cooked 
crisp, thin sliees uf Iiaoon are easily digested. 

Horae McaL—Uorsc meat is nut used for food in the United States 
or in Eiiffland, but is consumed in Ui^c quantities in trance and G«r- 
many. and to a less extent in some other European countriet;. 

KabMt. — When young, rabbit meat is quite digestible, but it ia 
usually omitted from diet-lists. 

FowL — Chicken is one of the most digestible and agreeable varieties 
of meats. The meat of young pigeons also is wspccially digestible ; that 
of ducks and RWfie contains too much fat. 

The flesh of game is easily di^-ested, the meat of the breast being 
best adapted for invalid use. 

The table on page 125, taken from Atwatcr.' gives the general eom- 
pcsition of the various meats: 

* IVinciplcs of Nutritt«n, United St«teA UcpaTtmeiit of AfricultUTc. p. 16. 



^^^^^^^^^^^^H 


125 H 


H nod-siMarUlB {M pur- 

■ CkMtdK 


BaftaM. 


WKWr. 


PlO- 

Mia. 


ru. 


Ckfbc- 
dralM. 




^L Bmt, fMal) t 


JVM. 


Ar«r. 


Arrf. 


ATM. 


Ar* 


rtfct. 






UJ 


tts 


u.a 


UA 




OJ 


^^^^1 




1Dl> 


M.0 


I7il 


19,0 




0.7 


1106 ^^^^H 




IM 


U£ 


M.1 


lT.i 




0.9 


10K ^^^^H 


^^^^V ]"on«rbciuai! atcak .... 


117 


«U 


ISLl 


17.9 




0.9 


^^^^1 


^^^B Bbmin lUAk 


US 


UU 


UJb 


U.1 




0.9 


^^^^1 


^^V Ii«ck 


37JI 


»» 


tc» 


1L9 




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«LS 


ts.s 


21.2 




0.1 


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W-T 




0.9 


UMB ^^^^1 




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lis 




1.0 


^^^^1 


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tfjO 


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au 




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K9 


42« 


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^^^V SiMBldet aaJ clod ■ ■ . ■ 


U.4 


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^^^^1 


^^^^ Tnnqtiftnvf ,..,,. 


U.7 


491 


14.» 


17Jh 




47 


^^^^1 


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16.7 


aoA 


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lis 




0.7 


^^^H 


^ft BeeC coraed, MMud, pick- 

^^^m l*d.Bnd<iTi«4t 














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^1 rnrt, MUUd. etncd. UA 
















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^V Bi>lri«Ilk ... 


as 


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197 


1 . 


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^L Pork 


, ^ 


laa 


110 


HZ 


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am ^^^^1 


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^ 


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^^^B Qitrkra. brnllm 


IIS 


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36.V 


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■ Animal Viscers. — Animal viscera are uot so nutritious 


although ^H 


H ■one of thrtn are quite as digpstible as iiiuKt moat^. Trip«, 


liver, kid* ^H 


V ney. anil brains are eaten very extensively. The heart in 


tough, in- ^1 


dtfftoitible. and but wldom onten. The hlood of the pig hns 


>een made ^H 


into a form of pudding and is relished by snme, Swrcthrea 


dN — cither ^H 


thr pancrfig or the thymus gland of the calf — are easily 


digested. ^^^| 


8w aim Purin Nitrogen. 


J 



126 



The following table, compiled 
compositioQ of aniiua] viscera ; 



by Hutchison/ gives the general 



Oampmtion </ AnimaJ Queers. 



Kidnev ioi) 

Kidney (sKe^) 

Ijvi>r (ox) 

IJvcr (ekitip) 

[]«an (01 ) 

Heart (ah«ep) 

I.IttlK (i'X) 

Lmij; Inliucp) 

tiwtvttureada 

BlooJ 

Ttipv 

Tor^^c {ox), frwh . . . . 
Taiif(ii«, Kiiak«d and ahod 
Snin 



Vu«r. 


Kliro- 

nuiUn'. 


PU. 


Cutio- 


lak. 


76,7 


l&O 


18 


fti 


1^ 


78.7 


ICS 


3.2 




IJO 


71^ 


20.7 


4.& 


1.5 


1.80 


Sl.'i 


S3.1 


0.0 


&0 


1.70 


fi2.a 


Ifi.O 


30.4 




1.00 


m^ 


17,0 


12.C 




ti.ffl) 


7&.7 


16.1 


3.3 




1.00 


7W 


20.2 


2.8 




1. 20 


70.» 


ie-8 


Ut 




1.60 


SOJ} 


18.1 


as 




0.85 


74.6 


10.4 


]«.5 




0.60 


63^ 


17.1 


lai 




1.00 


3h.7 


U.3 


»1.6 




8.60 


sae 


8.8 


9.3 




1.10 



The diffcroiit kinds of tish vary widely in tlseir nutritive and 
digestive qiialitief^. For example, the flounder and the oyster an- 
much ea.sier of digestiou than those thiit eontaiii a lar^e amount of 
fat, like tiie Halmon anil the herring. Kelt< contain the i^ri^utest pro- 
portion of fat. whieh may reach 28 per cent. White-fleshed tish, as a 
rule, contain little fat. 

All fiBh are best in season; out of aeason they lose flavor and have a. 
diuiiiiiahed nutritive value, and iu some cases develop an offensive 
odor. These rhongwi an due tihielly to the change in food. Fish are 
ill best condition just before spawning; after thi.s proeess they become 
thin and unfit for foot. The flavor of some varieties, such aa the ray 
and the turbot. is improved by keeping. 

Oil account of the rapid i^lianses they undergi) by way of decom- 
positinn, fish kIioiiUI always br eaten in as fre.'^h a condition an possible. 
Various methods have been resorted to with a view to preventing these 
ehangps. There are many iiiot^teru contrivaneps for presen-ing fish, 
and drying, smoking, piekling, salting, and canning are practised on a 
large scale. These methods all modify the flavor more or leas. 

There are (several varieliiw of fish that are poi^wnouK. These are, 
however, confiniMi ohit-fly to tropical waters. The parasites that may 
be present in Huh iire deHtn)yed durinfj the cooking. Ptuma in-poison- 
ing is of ratlter rare oceurrenee. The table rm pages 127, 128, taken 
from Langworthy,^ pives the composition of the (imIi most commonly 
eaten: 

» Kood nrnt PrinriplM at DfptetloH, p. 711, 

1 "FiHb ■■> KntMl." Farmrrt' BullrtiD No. 85, UnttH tiuta Departramt of Ajni- 
cnlture, 18«8, p. IS. 



f 




^^^^^^^^^^^^H FOODS ^H 


^ Qm»pM»(im ^ AA. ^^^^H 


^^^ Klad ot iwd-MWU. 




1 


1 


1 


i 


1^ 


|S 11 


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Artf 


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/Wot. 


/WCL 


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^^^H 

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^^^^1 


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4U 




114 


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^^^^H 


^^^H Pmk. vslkiw. drcMQd , , , 
^^^K fUteral, wbfiJr , . 


■u 




oa? 


I1L6 


Bi7 




Oi* 


Hi 


^^^^H 


SLI 




11.1 


U9 


Ikl 




oo 


no 


^^^^H 


41.1 




tta 


%Jl 


n.1 




0.7 l&T 


^^^^^B 


^^^^g fBf. rtwt a . . .... 


■o.> 




0.4 


■ID 


a4 




M 14.1 


^^^^H 


^^^B Plka.wbolc . . . ttA 




49.1 


■<Il7 


OJ 




04 11.0 


^^^^^B 


^^^B FDUoek. dnuvd . n.l 




•u 


IBS 


0.C 




U 1 17J 


^^^^1 


^^^^^ fsMr ronitnodl an fHiitf Its ^^^^^^M 


W Crustaceans.— The most popular of tb<; crustaceaus ure Ihc crab ^H 


and the lobster. They are highly nutritiniin, Init at the saiD« time ^H 


Mgbly indigestible. In Kome prnwns the rrab and the lobster are ^H 


especUUj^ apt to bring on nausea, vomitinjf, and other and more ^H 


distressing canditiuiis. ^^| 


Shellflsh. — Oyatent, clamB, and mussels are tbe forma of shcHHsh ^H 


chiefly eaten. Oysters, when eaten fresh and raw, constitute the most ^H 


dif>vs^tihlo animal foo4l. but when (»oked, their digestive value is ^^M 


much lowt-red. The soft part is proportionately larger and more ^^M 


nntritions than the corresponding portion of the clam. The hard or ^H 


mUBcoIar portion is tough and rather indig«Mib1e. and is bosi omitted ^^M 


from iuTalid dietAries. Oysters should never be fried for the sack. ^H 


K Tl may tx- well here to eall attention to the practtee of "fattening" ^H 


^^oyMtent I»r lhi> market ; tbU lit done l>r placing them in eJther frnith or ^H 


^■l^ water for a definite length of time. whJch gives them a frv«h and ^H 


'^Dnp appearance. If the water used for this purpose contains aew- ^H 





^^^^B OimpotMoit Iff Fi*h {Cbntinvitd). ^^H 


^^^^^L 












! 


s 


a 


,1 ■ 


^^^^^^^^M Xlndof fbod-nttMlbl, 


So 


^ 

s 


1 


s 

a. 


^ 


P 


1° I' ■ 


^^^H JThMjIiA. 


JW«(. 


fW-AlArtt. 


Arct 


Arct 


Ar(<:iV«(. 


ATM. 


in. ^^H 


^^^^H nimpaiio. dr«Meil . . 


«!.& 




tB.S 


10,3 


4^ 


.. ou-* 


IU> 


sra ^H 


^^^^H pDrg7, iIioMd 


.VI, T 




M.( 


u 


3.4 


. 


0.7 


11.7 


KO ^^^H 




G<I,Q 




»» 


7,4 


2.1 




0.B 


IOlI 


ss ^^^H 


66.9 




»i.n 


a.* 


01 




0.S 


>Ll 


IU ^^H 


^^^^H MItnoii.CalLriir:ilB'i<.-<-tli>ii«l 


ti.» 




(U.I 


V,6 


(l,A 




O.0 


103 


am ^^^H 


9^ 




N).a 


IILS 


17.0 




IJI 


US 


lou ^^^H 


^^^^H Sklmon. M^nu, divwcd , 


ttl.» 




Sl.t 


14.( 


ȣ 


. 


Cf 


»,0i 


OTS ^^^H 


^^^^H Rbait, ilrvM>«(l ........ 


*i.» 




aS.G 


tna 


&4 


. 


0-4 


l&S 


430 ^^^^H 




K.1 




W.1 


ft3 


4-B 




0.7 


14,7 


sr» ^^M 


^^^^H tibad, tee 


. , 




71.*J 


■OuA 


XII 




U 


)U 


^H 


^^^^^H liiiiolt. wbal« ........ 


*19 




MlI 


10,0 


1-0 




IJ) 


IljO 


380 ^H 


^^^^H Sluriiuui). ilruiicd ...... 


lU 




ST.4 


10.4 


1.0 


. 


IJ 


lU 


l» ^^ 




HA 




MA 


&3 


0,1 




DJ 


M 


IU 




W.> 




B.7 


«,8 


0,1 




0.4 


7.4 


IH 


^^^^H Tiiiiit 1 1 ilnwl .... 


»» 




(ft4 


II.7 


IJ 




0.T 


11.1 


zre 




U.I 




U4 1 »Jt 


1,1 




0,4 


IIJ 


3H 




s>.t 




l&O IZ4 


fl.5 




0.S 


lU 


aio 1 


^^^^^H Tiirli'it, ilr^irfi'il 


»Jl 




4S.1 


7.9 ■ IT 




0.4 


11.4 


ftit ^H 




iT.J 




ITJ 


lye 1 7.* 




0.7 


l».0 


^M 




41. T 




tf.l 


lav 1 ijt 






0,T 


113 


340 ^H 


^^^^M w.'i\kn*h. wtx'k . . 


Sl.» , . 


38,0 


K* 1 1,1 






a,e 


ICI 


30O ^H 


^^^^^H Wliilvii>ili.<lr>'ui>il 


«].& . , 


S9.* 


IU 3.ft 


_ 




0,9 


11.0 


MS ^H 


^^^^m WiiKc'IKh. oliolo .... 


fM.& 


. _ 


B2^ 


lOS 3,0 






OJ 


HJ) 


^H 


^^^^m Ctenenl Hcraee of ftcab nah 




















^^^^H 


U.0 


. - 


410 


IDJ 


u 




i,g 


14J) 


H 


^^^^^^H JVrMTwf jWL 


















■ 


^^^B Haoken-l. '-Ho. I.'-mIM. . 


SU 


7.1 


se.i 


14.7 


IS.I 




1.7 


SI.) 


910 ^^1 


^^^^^ft_ Cui), ulMl Kill] ilrlBd .... 


3U 


17.1 


MI.3 


l&O 


0.4 




u 


IM 


■IS ^^1 


^^^^^^^ Cod." bolltllMB COdOsh," hUI- 


















^H 




. . 


Z1.S 


rki.4 


13.1 


01 




1.7 


«4.l 


^1 


^^^^^■^ CkTiar* 




, , 


Hkl 


W.O 


I».7 


't>» 


44 


00.* 


IM ^V 


^^^^^F Uurrltut, nl(«l. tmokvil, and 


















1 


^^^H (iTlvd- . . 


M.4 


U 


l«J 


»j 


M 




«J 


ttJ 


41 


^^^^^H Diuld-x'k. "flDdon likdijiv," 




















^^^^H ikllL-il. auuki!!! aud dried . 


31.1 


L4 


«u 


l«,t 


l>,l 




U 


17,9 


SOS ^d 


^^^^^H Halibut, tKlt«d, pRiukod, and 


















^M 


^^^H dnm ... 


«.> 


tit 


U.0 


19.1 


14.0 




1.9 


111,0 


^M 


^^^^H Saidliiu. mmed . 


S.l> 


.^ 


tu 


34.0 


Ul 




G.) 


41,4 


90 ^H 




1« 


IJ) 


su 


i«,a ISX 




1.1 


m 


low ^^H 


^^^^H HacKcrcl, talk «aiuwd . . . 


IM 






111.9 


»7 
3tJI 




IJ 
11 


3»,> 
8TJ 


UH A 


^^^^H Xvaay tharw-inaolnrel), ; 
















1 




, . 


n.1 


ilJ) 


4.1 




1.7 


3T,S 


at 


^^^^H lladxlnrk, imakod. cannnd . . . 


u 


UT 


ILi 


U 




IJI 


3S.7 


tOS J 


H afK, coiitaniiualiou is sure to follow. Oysters have in many cases been 


H the t-arrivni of typhoid fever, and many persons have been tnfectett 


H iu this way. 


^B Clams are a popular article of diet, and ari^ as Bgrepahl« to most 


H palates m oyatttrs. Mussels arc consumed fhicfly by the poorer classes 


H in the seaport towns of England. 


H ].,aneu'orthy * girra rh(> rablp. on the next page, of the average corn- 


el position of moUusiis. cnisttu-eans, etc.: 


H t ••PUh «• Pood." Fftnoen' BiiUetiii No. Si, Vailii Stated Deparbiwat of Agri- , 


■ culture, IH9S, p. 13. ^H 



VmiKTABLE fVOBS 



129 



QrmpontioH tf MoUu*k*, CnutaotttM, tie. 



cud of lbiHl«ut«taI. 






b 


d 






?-^ 


1 


i! 




f- 


1 


it 




£ 


£2 

aw 


Jl 

a 


1^ 


JToSiub. 


P»rrt. 


F»rtt 


/w* 


PfA 


JWd: 


Ar* 


Arir 


IV <« 




OyMBn. UiWA . 






«u 


«.1 


I.* 


U 


OlD 


ll-T 


ia» 


Or«Wir»,lntihHll . . , , . 


nj 




10.4 


1.1 


OJ 


li.< 


a4 


1* 


49 






ta 


7^4 


11 


u 


I.II 


14.7 


Ǥ 


MUlnfi* 


, , 


. , 


«u 


lAT 


u 


1.4 


M 


191 


Ml 


Lone clanm. la •boll - . 


«.« 


, _ 


a.4 


4lB 


OA 


1.1 


U 


%A 


m 


l^njt i-lnini.r«ntl*id 


a , 


■ , 


su 


M 


!.( 


U 


U 


UJl 


in 


KmiikI i'IaihAh Tt^mowrA tnaa, 




















abrll 


. , 




w.* 


IM 


t.l 


6.1 


u 


»J 


MO 


Bound clam*. In >h«l) 


MJ 




nj 


1.1 


0.1 


U 


0> 


4.4 


a 


BanBd oUauk caaoctl .... 
ItraMlB 


«j| 




MO 
«2.T 


10.4 




la 

3.1 


IjO 


t7J) 
M 


I4B 


(taiwnl rnvmn of niolliuka 
KsdnMtauf (TAiuiviii 




















•03 




M.0 


U 


M 


u 


M 


U 


IW 


OMMfaau. 




















LalMor. In ttMll 


all 




».l 


SJ 


M 


, . 


M 


u 


IM 




. . 


t . 


7T.« 


IHI 


1.1 


u 


14 


m 


as 




W.T 


, . 


ISlO 


1* 


0.1 


ai 


0.1 


u 


4B 


Cnb.lQibcll. ........ 


ou 


. . 


14.1 


7J 


M 


<u 


M 


lAI 


US 


CMI). otnnitl 




, ^ 


SSkO 


IM 


U 


lU 


IS 


lao 


no 


Bhrimp, <«tinp4 . . 


. . 




TDD 


«U 


IJ) 


01 


U 


TCJ 


no 


Of Drml Bvi^nse ot cniitAce. 




















uu i«x«Iutlva of etiin«d> . 


71.7 


- - 


MJ 


4S 


04 


u 


u 


«J 


ue 


T>TT4pte, tonUf. Mc 






















7»i> 




IS.S 


4C 


0.7 


, , 


01 


L4 


118 


Ottcn nifl*. In ifevti . . 


a^. 


- < 


ItJ 


4A 


0.1 


, , 


0.1 


u* 


M 


A^r<mnoniirtl««i)4(«niip(n 
OtMnl ««vntg» nf flah, nol- 




17.4 

n.o 


4J) 


0.7 

oa 




0.7 


&I 
II J) 


tot 

» 


















\mtm. enMUc4:uia, etc 


tiA 


1U 


IM 


u 


4.1 


Of 


1U 


as 



VEOETABLE FOODS 

VtflTetablp foods differ from animal foods especially in that they 
ooolaia a large proportiun of ttlarfh and sugar and comparatively h 
stniill ammml of [irott'iii. Yeo ' (rives the following; table to show tlie 
differeuoe between vegetable and animal foods in this regard: 



UubMf 

Fto^ooT 
What . 
Biet . . 



NltKt- 
OO lllHll ' 

«nM. 



FM. 






9>Hi 



S1.4 


4&e 


, 


S.0 


es.4 


M 




S.1 


27.x 


as 


S8.9 


3.0 


Ifl.« 


ft« 


8) .9 


OA 


7.7 


0.4 


91.2 


a7 



Vegetables do, however, contain a eertaiu amount nf proteins and 
fais; tmme are rich in protein, others in fats. 

Carbohydrales of Vegetables. — These aw starches and sukms. 
Starch is found in all plants, and is rtinvertpd into dextrin by means 

) Food In Rultk and DiaeaM, p. 00. 



130 



CLASSES OF FOOO 



of dry heat or bj* cooking. The starch-granules in vegetables arc h«'lc 
together by at.'i'llulo8ti framework. Cellulose is a earbobydrate, but is 
very insoluble ; it can be utilized aa a food ouly when young; whea old, 
it is r«siHtant aud can not be digested, and tinders digestion of the 
Ktarcbcs euvelopcd by it. Wesicies the starch aud eellulose, another 
form of carbohydrate, known aa pectin, is present in sowe vegetable 
foods. When fruit is eooked, ttiiB pectin gelutioiKes, and. the jelly 
when digested is converted into a certain form of sugar. Sugars are 
also liiipiirtant L'iirbr)|iydratL'.s fnuiid in veBrtabli's. 

Protein in Vegetables. — These proteins belong mainly to the 
globulins, but in Addition vegetables oontaiti a large number of iittro- 
genous substances that are not proteins, Amous; the various proteins 
in vegetables are gluten, as fouud rspeeially lu 6our, logumen found 
in the legumes, and vppptahlo prolein found in vegptab3e juiees. 

Extractives In Vegetables. — There is a eonsiderabte amount of 
extractive matter in certain vegetables, such as asparagus, which is 
not (itilized iii the body. 

Fats in Vegetables. — The fats in vegetables are chiefly in the form 
of oils. In addition, vegetables contain a considerable amount of 
water and salt. The amount nf water varies between 70 and 90 per 
cent- The main miiifral constituents ure the salts of potassium aud 
wndiiim united with organic neids. 

Digestibility of Vegetable*. — The digestion of vegetables takes 
place mainly in the inte-stiue. Owing to the greater bnik of vegetable 
food and to the eellulnse that sumHmds vegetable cells and thua 
prevents the ready access of the diRe-stive jniees, vegetable fitod is 
not so easily digested as animal fond. (For an account of the ab- 
sorbability of vegetable foods the reader is referred to the section on 
that subject.) For convenience of description the following classifi- 
cation of vegetable foods has been adopted; 

1. Cereals. 5. Fruits. 

2. Legumes. 6. Nuts. 

3. R«otB nnd tubers. 7. Fungi. 

4. Green vegetables. ft. Liehena. 

CEREALS 
Cereals are the most important food-pmducts derived from 
vegetable kingdom. Of this class of foods those in commonest use 
are wheat, com, rye. oafs, barley, rice, and buckwheat. The cereals 
are eaten chiefly after having hwn ground into flour or meal. Flour 
is most commonly made fniiii wheat and rye. whereas eom and oats 
are the chief sources nf meal. Cam is also eaten in largo quantities 
whole, and barley and riee are also eaten in this way. The table • on 
the next page gives the ehem ie composition of t he most common cereals : 

I I'nitrd Rtatn Dppartmi-nt of AKrlc'ltura. OfBw of Experimpnt Statiini, 
Bullttio No. tl. pp. 14 and IT. and Bulletin No. 2S |Re<-i»«d BdiUvn), p. 99. 




leueriBLK foods 



131 



Butvy - ■ . 

BockwbcBt . 

Kafir coni - 



Mr vitl«U« 



WMcr. 



10.« 
13.4 
9.S 
16.8 
11.0 
1S.4 

ii.e 

in.4 

lOS 



PtoUId. 



12.ft 

n,9 



iM. 



fltaKh, Crude 
ttc fiber. 



W.8 
ftl6 
74.» 
69.» 
W.7 
79.2 
78.0 

71.2 

72.0 



Wheat ix tbc- must impurtaut suun.i' of Hour, owing to the Fact that 
it eon I)* rtt.is*-d iii any teuiperate climate aud yields ih«? best flour at 
tbe least expend. It is rich iu solids and contains little water. The 
wheat-grain is covered by six layers, which form the br&n. Of these 
six. the three outermost eoaLs form the skin, and the remaining three 
layers the envelop of the grain. The outermost layer is called the 
testa; tbe itmennost, or ccroal layer, tabes its name from the cerealin 
which it contains. Within tbe ivrealin layer, and adjacent to the 
embryo, lie» the enduspcrm. wtiich (^ontainK the starch. The embryo 
li«s at the lower end of the (train. The live outer layers are eom- 
poaed chiedy uf eelluloee. The eereat layer is the richest iu nitro- 
frenaitft substanees. Tbe eudosgieriu conlaiaa a large amount of 
Rtorcb, a nitroccnous subetatiee called gluten, some sugar, and the 
celtulose of its cell-wall. 

Floor is made by grinding tbe gi-ain of the various t-ere&ls. 
Although flour ia made chiefly frtjm wheat and rj-e; barley, oats, 
maize, etc.. are also manufactured into Hour. 

Brtad in made by addio^ to flour a definite proportion of water, 
a little salt, aud the leuveuiujr agent. The mixture or doui'b is then 
luicaded, either with the hands or, belter, with u spoon. In the large 
modem bakeries the kueadiug is done entirely by machinery. Ait«r 
this the dough is set aside for a numlier of hours, during whieb time 
fermcDtalioD takes place. It is then molded into loaves and baked. 
The leaveninfT is dependent upon the action of the yeast on the starch, 
some of which it eouverts into sugar, aud then into aleohol and carbon 
dioxid gas. Tbe gas causes bubbles to appear throughout the douf;h, 
and rendem it light and spongy. During the baking proeese the yeast 
genoM are killed and the atciihol and carbonic ueid gas are driven 
off. Hoi or fresh bread, when masticated, forms a tenacious, doughy 
maaa, and hence is not so digestible as stale bre.ad, or bread that has 
been allowed to dr>- slightly, for the latter will crumble into fine 
partii^Ica and so is more thoroughly mixed with the gastric juice. 
Toasting bread makes it more digcKtible. X slice of bread remains 
in the stomach about two aud nne-half hours. 



132 



CLAaetH OF FOOD 



Next to wbeat bread, whivb thus far has alone been mentioned, 
rye bread is tbe must impi)rtaDt of the breadstuffs. While it is not 
so digeatible for iuvalids as wheat bread, it is more Iu.\ative and 
keeps fresh loii^rer tliau wh«at bread. Wheat and rye flour are often 
mixed in bn'ad-making. 

Pumpcruit'k«l is a wholc-ryc bread made by th« Germans. It is 
slightly laxative. Olulea bread is made from gluten flour, and is 
used chiefly by diabetics. The best bread contains from 40 to 50 
per cent, of gluten. BisciiitA, pantries, and puddings are made by 
adding to the Hour varying quantities of eggs, sugar, milk, butter, 
fruit, flavoring extract*, etc. 

Buckwheat flour in often made into batter-eakes in the United 
States, but in some parts of Kuasia buckwheat porridge forma the 
priiicipul ct'r<.'al food. Bread made from buekvtbeat crumbles and 
does not keep well. 

Proso and Mtllct. — Nansen studied the possibility of millet as a 
food for human beings. In Russia. China, and India millet is used, 
especially in times u( famiue. The grain can tie milled aiid trooked 
very mw.h m thi* sarar way as other cereals and is rit;b in proteio, 
It lackx gluten, however, and n certain amount of wheat tlour is 
ne^ed to produce a suitable bread. It haa the advantage that it 
will grofT iu an extremely dry climate. (Bee Bulletiji 525, United 
States Dept. of Agriculture. ) 

Maize or Indian Corn. — This forms an importHDt part of the diet 
ia many parts iif the countr;)'. Tbe different varieties have various 
colon, but the nutritive value is appni.'cimately the same and the 
choice ia very largely a matter of taste and chtmgra wilh ihe loi^ality. 
The greeu corn boiled or rouated is, of course, popular in seasuu and 
Ihe dried corn from which the covering has been removed or hominy 
is another staple dish. 

The composition and fuel value are given as follows by Lang- 
worthy and Hunt in the Farmers' Bulletin !>65, United .States De- 
parLmcnt of Agriculture: 

Averagt eomposition of corn and corn-mtal products. 



Ktnd at naiMikL 



Wkler. 



rT«i0iB. 



Fat. 



CarlfohjdtsLii*. 



SUrch, 
•ajnr. 



Cruil* 

aur. 



Minrril 
matun. 






CoTD, vholv gratn, mnrmgt. 

Corn, whil* 

Corn, 7rllciw . . . - 

Ooro meat in hole craln 
fmiind, uaboltMl 

Cam moal < nboh (ralti 
(MDnd). holtwl 

Cora nvBL rraitul»M4 Iniiw 
pro****! 

Ccrn floor, 1. r.. Satly 
Crotind aad boltMl cotb 
m*»l 



erml. 

n.4 

11.9 

U.D 
lf.O 
l».5 

■ «.• 



em(. 
19,0 

1».T 

8.7 

S.D 

».t 

T.I 



P4r 

1,9 
4.7 

«.a 

1.0 

u 



ytr 

fni. 

n.i 
as,s 

W.9 
TI.I 

n.o 

71,1 
TT.B 



Ptr 
ernt, 
1.7 
tA 
>J 

M 

l.t 
1.0 



P*f 
1.B 

i.a 

1.B 
l,S 
\JI 
IjO 



('■/. 
vrit4. 
1,7M 
I.SS'l 

i.aw 
i.aso 

1.76S 

utn 

l.*U 



tBOETABtJl FOODB 



133 



The kernel connats of the skin, the ^eriu aud the cmlogcrni, which 
aL'U OS B storehouw for Uie nourishing of the germ wheu it starts to 
grow. The coupuMition of the flourti varieti greatly according to 
the nature of the tnilliiifc proccBS. The old process left in much that 
1b removed by Elii; iit^w process. Removiug the filuii \akv» away only 
nix oue-buiidretba uf the whole wei^'ht. but more than half tl]e Hber. 
Id modem milUng the ^rm is removed 'whieb takeH away only ooe- 
teuth of the KeijK'ht, but more than fiix-teothK of the fat and one- 
axth of the protein. The modern niillitig rt-muveii the Titamins. 
(See same and the Detieiency Diseases aud I'ellagra.j 

Where corn is much u!mk1 tliere Ik a natural tendency to balance 
the diet by u&me foods rieh in protein. eHpecially pork products. 
Cora is defleieut in ftUitcn and it is difficult to make bread that will 
hold together. Sometimes other flours are added or the outside is 
ipiii-kly browned »u as to hold the sniall luuf trjf^cther, 

Sorghum k occasionally made into bread, but in America it iS 
t^ruwu usually for the molasses aud syrup that may be obtained from 
it. 

Kaoliang. — This is a grain Hurghnm uaed in Afnea and pnrts of 
Asia (T. S. Department of At:riculturc, Bureau of Plant ludustry. 
1911, p. 20;i>. This plant will grow in about the same climates as 
Tndiau c<iru and was introduced into America in 1S66. but wiw dis- 
rarded as a sourw of sugar. The graui of thin plant can be milled 
and forms a suitable food and when mixed with gluten-fontaining 
flours makes broad suitable for human eonsuniption. 

Rice eonstilutcs the staple food of iiiauy of ihc fieoples of the 
Orient. It is grown chiefly in Asia, but is also raised in some parts 
of Europe. In the United States rice culture \n confined chiefly to 
Soatb Carolina. Rice contains a large proportion of starch in 
very digestible form, but it is comparatively poor in other constit- 
uents 

Barky bread was uKcd for foot] by tlie early (invks and Romans, 
who also tised barley meal to a large extent in the training of their 
athletes. Since the introduetion of potatoes as food, and with the 

rapi-ning of wheat flour, barley bread has gradually fallen into 

use. Harley-waler is u»ed vts a bevcraire for invalids and infants. 

Oats iimtain liberal proportions of fat. protein, and sidtx. a large 
8m*iunt iif starch, and considerable indigestible cellulose. 

Oatmeal is uwd to the best advantage in making porridge: ovring 
to its Isek of (,'luten it makes only thp ponrest kind of bread. What 
is known m Scotch groats Ls prepared by freeinc the grain from its 
oatcr-busk. Oatmeal porridge is said to act as a mild laxative in 
aome pemnus, and to excite dyspeptic symptoms in othcnt. 

Breakfast Foods.— There arc a variety of preparations made from 
i-ereals which have been in recent years place.l on thy market, the 
chief characteristics of which arc that they have undergone, more or 



184 



CT.A8flKlt OF FOOD 



preparation for immediate consumption. For the most part they 
: ^Id under trade uames; the compositioD and tiouree tif the food 
Is ^iveii ill some cases and ODiitted iti others. Briefly speaJiiug, they 
coDtaiii about the same amount of nutriment m the cereals from which 
they are mude. Their palHlHliility varies iroiiHiderably and there is 
no objection to the ii«e of siirli artieles of diet if freshly prepared, 
foods are obtained and the individual that consumes them likes the 
taste. The nlder jwn-'kages. iiiik'ss very carefully put up, are liahle 
to be infecrted with Jnaei-tK or moulds. h<ith of whi»-h render the 
produet unfit for food. The ehtef objection is the eost. which is far 
greater than the same.amount of food prepared from the eereal itself. 

LEO truss 

Of the k'RumeK. the pee and the hean arr the moiit important food- 
products. Ill the middle and northern parts of Europe the pea is 
the luOKt popular legnuie, while iu thi; Mediterranean countrieN the 
bean predominates. In Amerieu peas and beans are extensively 
raised. The peanut is an Ameriean favorite, but the lentil is eatca 
only to a ven,- small extent. 

The legumes contain a liberal proportinn of protein (IcKumin). 
carbohydrBtes, and a little fat. besides a larpe amount of water. 
Although legumes eoiilain a proportion of protein iu exeess of that 
of meal, u large amount of fat, und fonsiderable stareh. they are 
loss easily diftestcd than animal foods. As pointed out by Abel.* this 
ia due lo three reasons: 

"(1) As generally prepared and used, the nutrieats of vegetable 
foodg are inelnaed in c>ells oompoKcd of {■etlulose or woody ftber, which 
is more or le!«s bard and gre-atly interferes with their absorption. 

"(2) Vegetable food is prone to fermentation In the intestine, thus 
inereasing the pehstaltte iiiovemetitK, and. if large amounts are eaten, 
haniening the foud onward before there has been su£Bcient time for 
the alisorption of its contained ntttrients. 

"(3) The eelhilnKc present acts as a local irritant and produces 
the same effei-t." 

I^'gnuu'.'i are apt to pn)duee fermentation, and in this way oceasion 
flalulenee and gastro-inleatinal distress. The digeslibiUty of the 
le^imi's depends largely upon tlie manner iu whieh they arc prepared 
and the amount that Ik eaten. StriimpelP has shown that about 40 
per eetit, of the oonlaiiied protein in eut)ked beans is left unabsorbed, 
the beans being euten with IIil' iskins: uiiil that with a flour made from 
lentils only S.'J per cent, of the original iimount of protein is left un- 
absorbed; so that when eaten simply eooketl. a much 1arg«r proportion 
Kinaius unabsorbf^l tlian when tinely divided into u powder. 

1 F'armcra' ItiilMin No I'll, irnitn] SUt«« I)c<pnHmcnt of Agricultiuv, IHOO, 
p. 18. 

1 Slraiii(>#ll, [>eiitNch. An-h. [. klin. Mrd., va). svii.. p. 108. 



m 




VBaiffTABLB FV0l>8 



1?& 



I 
I 

1 

I 



Beans form one of the oldest forms of veizetabte foodi>, having been 
cultivutetl hy the aneteut Gri^eku, Kudihun, and Kf^ypttaus. Tii& 
uumerouit varieties used for food have all liecn improvpi) by cultural 
mcthod«. The Windsor bean, the ouf which was first rultivaled, U 
fitill gruH'u in Europx?. but does not tbrivu well in America. Tho 
kidney bean, the most impurt&iit ^tpecieft, ia easily rullivatcd. Ki^miiig 
rapidly and seeding early. The Lima bean is a Krcat favorite, espe- 
cially in America. It iK a ithort lUt \»nn, sonipwhat like the kidney 
in idiape. Thlx variety in a clim)>cr, althmif;h bii»h Limas have been 
developed by eiiltural nidhods. 

The Soy Bean. — This bean (Glycine hitpida). sometimes called 
the soja bean, is an annual leffuiuluouii plant extensively u»ed as a 
fu«>d in China and Japan. Until reeeully it has been reji^rded an a 
botanic curioetity in the Occident. It has rL-cently bt-im extcnsivply 
used iu America as a forage crop, and to improve the soil if ploughed 
under. Tbe plant i« an erect annual, bearing pods eontaiuiii(!> from 
two to five beans. There are a tar^ number of different varieties, 
which vary in siz^?, shape, eolur, and length of lime they take to 
mature. In the East the bean is used in numemiis wa.*-*. Some are 
[^>wn exclusively for the oil they contain, and it is wsisi for culinary. 
iUuDUnating, and lubrieating purposes. Tbe light-colored beans arv 
eaten in soups, and the pods are sometimes picked green, boiled, and 
aer\'ed cold nith a .<>prinkling of soy sauce. The green varieties are 
often pieJcled in brine and eaten mnist or dried ivitli meals as ap- 
petizers-, the same varieties are often slightly sprouted, scalded, and 
aerved wJtb meals in winter as a green vegetable. The bean forms 
the basis of the s*>-ealled soy sauces, used as eondiiueuts all over the 
world. The Orifiital races mml fn:f|uently rut the bean in more or 
len cbe<9y-like foods, which are prepared from it. The mo«t common 
of these are nalto, tofu. miso, jijba, and shoyu. Natto is a sort of 
bean cheese made by boiling the beans nntil they become soft and 
then placing the resulting mas-s in a warm cellar where it ferments, 
Tofu is made by soaking tlie beans in water, (^riishini; between mill- 
stones, and boiling in alKuit three times their bulk of water. The 
pnitein is precipitated and the resulting cheese eaten. The white 
milky liquid of the above has nearly the composition of eows' milk, 
and tastes something like malt. It may be used in infant feeding t< 
advantage {see sameK 

Americans may eat the l>cans in nnmcmus ways, described utidcr 
tbe head of soy bean cookery in the recipe* at the end of this book. 
The bean ih of particular value in diabetes \wf same). It may be 
UBwl to inereaw' the protein of the iliet. 

There are variations in the eomposition of the different varieties 
of beans. The yellow beans grown in America have the following 
oomposition : 



136 CLAB8EB OF FOOD 

Water 10.13 per cent. 

Protein 34.83 

Fat 17.S8 

Nitrogen-free extract ■ 30.50 

Fiber 3.69 

Ash 3.07 

Calculated to a water- free basis: 

Protein 38.50 per cent 

Fat 20 " 

The Cereo Company, Tappan, N. Y., have made a soy bean flour 
which is most useful. It has the following composition : 

ProteiB N. X. 6.26 44.64 per CMt. 

Fat 19.43 

Mineral matter 4.20 " 

Moisture 5.26 " 

Crude fiber 2.35 

Cane-sugar 9.34 " 

Non-nitrogenoUB extract 14.78 " 

Starch None. 

Reducing sugars None. 

Polarization normal weight due to optically ac- 
tive substance other than cane-sugar included 
in protein and non-nitrogenous extract 7.80 " 

The percentage of protein in this flour is almost one-third greater 
than the percentage of protein in the whole beans. This is caused 
by removing the coarse fibrous hulls which contain little protein. 

Vegetable food of such composition certainly is remarkable when 
compared with round of beef, medium, which contains: 

Protein 19.0 per cent. 

Pat 12.8 

Moisture 60.7 " 

Each ounce of this soy gruel flour yields about 13 grams of protein 
and 120 calories, and there are several ways in which it can be used : 
1, As a gruel; 2, in broths: 3, in making biscuits. For composition 
of soy gruels, see Infant Feeding. 

The bean has received attention from time to time in other coun- 
tries, and suggestion comes in the form of a patent flour made by a 
German firm, patented in this country. This is made by treating the 
beans with boiling water and 0.5 per cent, of sodium carbonate until 
the carbohydrates and other water-soluble substances are removed. 
The residue after being dried and pulverized is a yellow powder, con- 
taining the nutritive fatty and protein constituents of the beans. 
The following articles may also be consulted: 



YB08TABLB FOODS 



137 



}tiifc]4b: *"rh« Soy Bean bd an Artiol« of Divl for Infknts," Jaunwl of itio 
Amoriran M«(ik«l .tixwH-iutioii. Mh>- 21, lOlU. ii. 10(14, 

Prk-d«uw>«ld and KiibrSh ; "Thr L'm of Utc ikiy Dean aa a Food in Diabetca," 
American -luuriial uf MmIIchI t>civiiL-*'>, UcrifiiilwT, \9Ui. 

fUihrXb: -I'unher Ubwrvatiou* on the Soj B«tD," Archived o( Pediauin, 
Uotober, I8II. 

KahrU: "S07 Dean Cooki-rj." MnUtal Recurd, Svi>i«ulKr ^3, lllll. 

There are several varieties of p«aa. the incwt important, being- the 
Hold and the garden pea. The former is generally used for fodder; 
but one variety, the Canadian field pea. is grown for table nse. 
There are many varieties of the garden pea. The shellinK pens, the 
kind in moHt comimm use in Ameriea, and the stigar pea are the most 
iiu]>ortaiit varietiea. 

The leotil, as has been stated, is but tittle used iu the United 
States. The ehief supply of lentils wimps from KjrjTJt, verj- few 

OompwUion a/ Frt$h aiu/ Dried LepumtM compared with that of al^4r 
Fi>od*.—{AM.*) 



ltal«riaL 



fiaita IcxumM : 



mrtnS'UHUU 
WiwJa 



pMb oT Daltrioi Haguijpr- 



SiiMr paaa or «flDc-|wa> . 

BbSlM kblnoT bcaiM . . . 

SlwUad Um beiuw .... 

SiKlladpOM 

Xbolled oowpeaa 

b«iM4 (tilnii-WaiM 

OioiMd Una bcaua .... 
CknoMl kidncjr beans .... 

CkniMd peai • . 

Unncd hakMl bMiw .... 
frmnul bntur 

UinaMUU .,«..,•. 

Navybeaoa 

Prtiolei . . - 

LonlUt 

DrMpMl 

OmracM I 

BitCm* 

QilCk-pMa ...... 

pBiitnu 

n ii-bo'* Im-ikd fraruli Iwan I 

Tamiam 

Ttapauca 

KolMoM* 

WbMI brcaklkil foodi . . 

•wMf whvM O^iur 

wLftlaC'inhtat flmu . . . 

immbmt _ 

DrWdlMr 



i 

ftrrt 


a 
flrrtt 


2 




I 

1 
f 1 

m 

■* 1 


Prrtt. 


Ar(t 


Artf. < 


M.1 


u 


ai 


TJ 


OJ 


TI.S 


4A 


0.5 


ttt 


1J 


CI.H 


U 


04 


ia7 


0.9 


*«.V 


M 


o.a 


mt 


ao 


«.(> 


7.1 


•.T 


tts 


L7 


•iM 


JjO 


«.A 


IM 


u 


6i,» 


»■ 


<u 


a? 


1.4 


M.7 


1.1 


«.l 


M 


1.1 


WJ» 


40 


0.3 


IU 


1.S 


13.7 


7j0 


OJ 


MJi 


M 


BtJ 


SA 


0.j 


• 8 


IJ 


ai.» 


• « 


■u 


l».S 


3J 


3.1 


»» 


IU 


17J 


ao 


VIA 


U.1 


1.4 


fbS 


4.1 


ua 


3M 


].» 


t».a 


ao 


U 


Sl.« 


LX 


a.1 


19 


K* 


».7 


l.« 


(«2 


ai 


S-» 


MJ 


1j» 


eto 


2> 


U.0 


31.< 


1.1 


«oa 


ai 


KU 


M.g 


tiu 


a.7 


4.7 


H.a 


xu 


<.T 


«M 


2t 


9.1 


aaa 


KB 


311 


xa 


IU) 


».• 


1.3 


75J 


u 


Tftl 


u 


ai 


1&4 


LO 


MS 


la 


«8 


Ut 


la 


H^ 


at 


0.1 


&9 


OlO 


J.T 


na7 


7.S 


sia 


Zl 


*:«' 


l&l 


I.B 


n.t 


19 


ia.s 


n.7 


1.1 


■HA 


a4 


, 11* 


».7 


1.0 


7M 


IM 


1 fOJ» 


aa 


1.9 




1.1 


, UJ 


■oa 


a> 


•4 


9\ 


S7jI> 


sa 


44 


kO 


VI 1 


SLS 


»» 


IIT 


l* 


ao 1 


1 n.7 


14.8 


Hl> 




M ' 



a. 



KM 
I40» 



o Bnropaan onalrm. 

beitiR groivn in Kuri)i»e. They form a highly nutritious food, but 
the flavor ia diaairrt-cable to many persons, and they are said to 
produce tndi^Ktion in some instance!). 

iFumet*' Butletia Ko. I£1. D, R. DepartaaeBt of Apiculture, p. 17. 



13S 



Ct.A8B£S OF h-OOD 



The peanut, altbouRh peculiar iu iu ^owth, is a Icffume as well 
as the pea and beau. It dilTei's ebemleally from tli4i uther legumes 
ID tbat it cmitaius u large ainouut of fat. 

ROOTS AND TUBERS 

Kouts aud tubers constitute auother class of ve^table foods that 
are of great importauce. They vontaiu botli starch aud sugar, aad to 
these cunstitiieiits is due their vhief value as a food. On account of 
the small pniportion of protein and the larRe amount of water they 
contain, they are inferior iu nutritive value to both legumes aud 
cereala. 

The potato m, for several reasous. the moat important mcrabcr of 
the groiip. II is a tuber or thickened underground stem of Solanum 
tuberosavi. It grows efjually well in a variety of soils, and when 
properly cooked is easily digested. Wheu cooked in water, the salts 
pass into the water, hut when etwked in their skins thin losa is largely 
prevented, lly baking gr roasting the salts are best retained and the 
potato rendered most ^-anily digestible. 

The sweet potato eouiaiim more water aud KUgar but leRS starch 
than the white potato. Wheu boih-d, tt u-sually hecorar-K mealy. Imt 
i» often coDverted into a atringy, sodden mosa that is difficult of 
digestion. 

The yam is a tuber somewhat resembling the potato. It is grown 
aud eaten chiefly iii the tropic8, hut also in some parts of Europe. 

The Dasheen. — This is a plant nf the Araeein family, growing in 
the trnpicH and siibtropii-s. The tubers and corms are used for frmd 
after the manner of the potato and sweet potato. The conns may be 
converted into Hour and used iu soups and gruels. The tubers con- 
tain more than 30 per cent, more protein aud carbohydrate than the 
potato and are easily digestible. 

Average eonipositioi* of edible portion of daskeeti and other iropic/U 

tarch-beariny routs. 



Kind of fMd. 



HVM* £•»>» 

0ms*** ataccb 

OMWtT» tl)«Ml ....... 

Cmut» mifcB « mMN 

Tama ..••■■■ 

DMb«*ll 

T«r« 

raall* .- 

RaUOCT to tomparlMii 
(r**t pouioM for eooi- 
paxtion 



Wain-. 



P*rrt. 

ae.u 

IV.S 
ID.) 

■na 

BS.T 

TOjO 
TB.» 



PrW*!!!. 



1.* 



P*L 



■lr»t<*. 



Sumr. 
Mo. 



Prrtt 

ao.v 



Cnida 






9».I 



1.1 



A*l>. 



1.1 



PtMl 

iiouni. 



l.«t6 

LftllG 

«06 

•SO 
BU 



rBOeTABLB FOOM 

The Jerusalem artichoke in conuuonly utted in England. It U 
fiweet aud wutcr/. cuutaiuti little starcfa. is ouiy aligbtlji' nutritive, but 
quite easily digestible. 

The beet yoiitains a very large percentage oi stareli and sugar. 
It is raised extensively for the auKar industry, and ia alw largely 
employed for making aalads to lend variety to ttw diet. 

Carrots, wl)«n young and tender, form a very nutritlouK food, aud 
are greatly relinhed by many pcr>>on& They contain front 85 to 90 
per (*nt. of water. 

Parsnips when boiled long enough form a gooil fond : like carrota, 
they contain s large proportion of water and a conmderable amouot 
of sugar. 

Turnips hax'e very sHifht nutritive value, but are. nevertheleaa, 
very popular as a vegetable. They have a tendency to eausc Batulenee. 

Radishes are ust^d chiefly to give a relish to the food. They con- 
tain little stATi^b and a lartn? percentage of -water. 

Tbe following table, taken from Atwater,' gives the average com- 

tition of (he cotomon roots and tubers: 



■toa^BSUftali. 



S<r«e4 potatOOT 
Bvote . . 



62. t! 
&6.2 
70.0 
6&4 
62.7 



Arrt.) Ar<«, 



i 



OREZII TVQETABLEB 

Tbe grem vegetables are valuable not only on aoeoiint of the amount 
of nutriment preaent in them, but for the variety and relish they give 
to the diet. They eontain a large amount of salts and have valuable 
antiacorbutic prop<'rties. 

Bryant and Milner, in a verj* careful series of experiments.' have 
•rrived at the following conduaionB conixming the digeadbility of 
certain vegetables: 

"So far as wureee of protein or fat are oonecrned, the vcpetaWea 
(potatoea, cabbage, and beets) included in these studies may be 
comndered aa of littlr value. They do, however, contain <?arbobydrates 
which are well digested and absoriied: and they may therefore be 
considered as of value a.s sources of euerity, a lai«c proportion of 
which appeani to be available to the body. The chief value of many 

t - T»rltn-irU« of Xutrlllttfi ana Xiitrilivf Vulw of Food*." ranaera" BuIU-tin, 

> Ammtwu Jovrnal of Phj^fltolo^. \im. vol. x., No. 2. p. 81. 



OLASSEa OP FOOD 



vegetables, however, is, perhaps, aside from the nutrimeut or energy 
they furnmb; they add a pleastu^' variety and palatability to the 
diet, supply organic acids and mineral salts, and give the food a bulki> 
nets that fseems to be of im|)unaDce io its mechaDical actioa iu 
utaiutaiuiug a healthy activity' of the alimentary tract. Possibly the 
result of these couditious is a favorable influence upon the digestion 
of other food eaten with the vegptabte. ' ' 

Cabbages contain a considerable quantity of sulphur, and on this 
account are apt to fouse flatulcnee; where digestion ih good, however, 
Ihey are L-oiwidered a wholesome form of food. iSaturkraut is cab- 
bage prepared by placing salt between layers of shredded cabbage 
leaves and then subjecting the umss to preKsiire. This presses out 
Ihc juice, after wliieh aeid ft^rinrntatiun sets in. Owing to the fer- 
mentation it produces suuerkruut is considered indi^'cstiblc. 

Cauliflower is the innst digr-slible member of the eabbage family. 
It may be eaten either as a salad or boiled and served with a milk- 
saiK-e. 

Spinach is a popular form of vegetable and is used to a great 
extent. It is valuable ehiefly for its laxative elTcct. 

New Zealand Spinach. — Tetragonia expansa is not a spinach, 
but is ^'owu to replace ordinaiy spinach during the hot summer 
monthi*, or in drj* arid localities where ordinary spinach does badly. 

Lettuce is the most important representative nt a group of vegeta- 
bles usually eaten raw. It is made into salad and dressed with 
vinegar. The various crosses also belong to this class. 

Sorrel IS eaten chiefly in Europe. It has a peculiar acid taste, due 
1« acid iixuliites, on actrount of tlitr pn'senci* of which it is to he avoided 
by those subject to gout or rheumatism. 

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 arc eaten both raw and cuoUfd. and are refreshing, gen- 
erally liked, and eaaily digestcil. Tfai-y arc used to Ravor brotiui and 
nre valuable for canning purposes, inasmuch as they retain their 
flavor better than most vegetables. 

The eggplant, a eIo«e relative of the tomato, is leas digestible, 
specially when fried, than the latter. 

Cucumbers are eaten raw, and whi-n young are often pickletl in 
vinegar. They are very iiidigwitible. 

Asparagus is highly esicenied for its delicate flavor. It is easily 
digested, even by invalids. It has a »lightly diuretic actiun, and 
imparts a most oflfensive odor to the urine, which persists fi>r from 
twelve to twenty-four hours. 

Rhubarb, when thoroughly cooked, is quite digestible and acts as a 
laxative. 



VKUerABLB POOUS 



141 



Pumpkins are us«i Iurg*?Iy in the making of pies, etc., but tliej- Imve 
no KjwfiaJ food-v»iue. 

Squuh, when youo^, ih quite difcestible. 

Onions, garlic, etc.. an> uii«d both as vegetablcsfi and as coudiueiitB. 
While ouiouK are lutMl lar^Bty for llavorinj: ineal-stuws. muIuiU. uJid 
the liku, tbL-y are aluo cutca for their mildly laxative properties. 

The following; table, taken from llutchitiuu [p. 2:j'.t>, gives the 
composition of tbe various vegetables: 



CkbtMf* 

CablNuir, oookad . . 

Ckutiduwer • • • . 

Sc^iulc 

BM-kkk, «aok«l . . 

BpMch .... 
L Vsgetable Dianvw . 
['VafittU* Doamw, 

BrnHeli tptouta . . 
TbMiBtoM . 

rOraana 

[Xeuuoe. .... 
[ JjvttiK*, owkad . . 



rO>in7, cooked . . 
I' IWnrp o»btMc« . . 
iBhuhub ... 

: UmkIoim (Unacd) . 
rWaMt^cnM .... 

pCkienabs, oooked 

r, Gookod 
[Sndin .... 

IUd»U«ea . 
fliiMrknul . . 



9tf.S 
•S.7 
91.9 
H.0 
82.B 
M.1 
97.2 

ei.8 

93.4 
97.0 
87.1 
»!.« 
S3.1 
93.1 
95.9 
97.4 
91,7 
87.4 
M.0 
87.0 
904) 
91.0 



^11 



PmtL 
1-80 

i\m 
2. a) 

1.40 

a40 

2.W 

au& 

0.09 
1.60 
I.SO 

I.(K> 

z.m 

1.40 

0.60 
1.30 
1.40 
U.W 
2.<H> 
0.70 
1.40 
0.70 

aoo 

2.20 
1.20 
1.00 
S.30 
1.80 
1.40 



ArU 

a4o 

0.10 
0.40 
0.40 
0.07 
Ol-W 
(LA) 

aM 
a 10 

aw 

0.20 
0.90 
0.40 
0.10 
0.50 

a 10 

0.0Q 
0.30 

0.70 
fl.70 
0.50 
0.10 
0.02 
0.20 
0.08 
0.08 
0,70 
0,19 
0.7t> 



Is 
is 



Mi- a. 
I.3U 

ai3 
a-2a 

1,70 
ftM 

AOfi 
\3i\ 
0,70 
O.TO 

1.00 

U4ti 

a7o 

0,90 
0.60 
IM 
Q.«« 
1.00 
1.30 
0.40 
0.20 

aw 
aso 
a«o 

1,60 

a7o 

1,70 



ftrO. 

I.IU 
1-30 
l.-.*0 
U«0 
1. 10 

awi 

\M 

a3" 
a37 

1. 10 
1.M 
I..W 

adu 
a90 
aoo 
a90 

1.00 

i.so 

1,10 
l.IO 
0.10 
OJW 
0.90 
2.10 
2.»» 
0.60 
1.30 
1,20 

atfo 



VcEctarianism, — TheuretteHlly. vegi-tarians an: Huppoticd to sub- 
[stitt entirely on an exclusive diet obtained from the vegetable kingdom. 
ineluding vt^fetubles, eerenls. fruits, nuts, etc., but as a matter of 
fart, many add milk, butter, eggn. grsvien and animal fats. Tbr 
dinadvantagea of a strictly vegietable diet are too obvious to reinirc 
raueb comment. It is {HiSKible to supply an adequate diet as regards 
fats, proteins and carimhydrates entirely from the vegetable kingdom 
and «Ten to sapply the vitamineR. fat salnblc A and water mlable B 




142 

and the proper amiuo-scids, but the dauger of uot (jetting a Kuf1i<>ieat 
diet iu cvL-ry reapett is so great that a strict vegetarian diet cannot 
be Tccommeuded for any lijnglb of time. This subject bus received 
a large amoiial of experimental attention iu feeding auiuiu)^. Per- 
sona aubfiiittiug uii a purely vegetable diet for auy great h'ligth of 
time are apt tu lose strength an well afi phyHical and mental vigor 
and euduTJiiiee. Laborei-s are unable U> perfomi the some aiuouut 
of work they uuuld ueeoiupliKh on a diet containiniy; animal food. 
While vegetables eoutain large proportious of protein in order to 
fui'ui^iU them in suffluieut amounts, very large i|uantitieK have to be 
eaten. This overfeeding is apt, in many instantes, to pniduee diges- 
tive duilurbanees, particularly in thuse sijfferiiii; from gastrtt-intestiaal 
disorders. A jniri-ly vi-tp^tiihlc diet, if persisted iu, ia hIko said to 
lessen the powers of retsititaiice, 



raUITS AND NUIS 
FRXriTS 

Fmits are of little value as nutriracDta, and are useful mainly to 
give variety to (he diet. They are used extensively as flnvoring 
agents. The chief nutritive constituent of fruits is sugar, and they 
also contain » small amount of nitrogenous matters, cellulose, starches, 
organic acids, and a vegetable jelly called peetin, which causes fruit 
to gelatinize when boiled. The sugar present Id fruit is mainly 
fruit-augar, or Icvulose, but some fruits contain, in addition, con- 
siderable cane-sugar. In general, fruits contain a large amount of 
water, but less eartby salts than other foods. The mineral elements 
of fruit consist of potash, united with tartaric, eitric, and malic ueid. 
To these »aUs \h due the antiscorbutic property of fruit. In addition 
to this property fruits also aet as diuretics, laxatives, and cathartics. 
The flavor and odor of fruits are due to the presence of essential 
oils and ciini pound ethers. 

The digestibility of fmits varies with the kind of fruit eaten and 
its mode of preparation ; stewed fmita are more easily digestible than 
raw fmits. Among the mnre eahiiy dtgcMtible fruita are oranges, 
lemons, grapes, and peaches; raw apples, pears, and bananas are 
somewhat less digestible. 

Lemons, limes, and shaddocks, possessing similar properties, are, 
for descriptive purposes, clas-sed together They are valuable an- 
tiscorbnties. and have an aeid. pungent flavor that may be imparted 
to otherwi.se tahtclcMt foods. A cooling and refreshing drink may be 
made from lemon-juie* diluted with water and sweetened with a small 
iiuuntity of sugar. 

Oranges are used in invalid dietaries, their juice allaying thirst 
verj- effeelively ; it eau be borne often by even the most irritable 
stomach. 




tfROlTS ASD SVTS 



143 



iples an> wfaolpNome, dit^stible, and slightly laxatiTS. Fresh 
contain appnisiiiwitfly H \tcr cent, of suKiir and 85 per wnt. 
of water, but in drying two-thirds of the water is lost and the sugar 

■ is increased to about 45 per cout. 
Pears arc. as a rule, uiore- easily digestible than apples, owinfr to 
the fact that tb^-ir flesh is soft and thoir skin uot so touRh. 

Peaches are wholesome and digestible. They coutaiu less sugar 
than most fraita. 

Bananas ar« the most nutritious of the raw fruits. The rnan^ 
varieties dilTer in digestibility and in flavor, Rnn»nHs are delieioiM 
when bakt'd or irrilled. The flour which is produc«d from dried 
bananas is vei^ easily d)K<%lible. 

Qrapes contain a large amount of water and considerable sutrar, 
besides salts of sodium, potaflsiuni. matrnefiiuni, calcium, and iron. 
When thoroughly ri|K- they are very (ligi'.stible, and form a luieful 
addition to the invalid diet. The h»bil nf nwallowitig the skinK and 
seeds of grapes is most peruicions, as intesiinal irritatioa is often 
brought about in this way. 

Raisins are prepared by drying grapes, the white ones beiug those 
most used. They srp indti,'estibli! unleKt well cooked ; they are usually 
added to puddings, sweetbreads, etc. 

Plums and Krecn sages are quite digestible when fully ripe. 
Tbey Hoou overripen, however, and tbcn are as harmful as when un- 
ripe 

Prunes are dried ptuios. They oontaiu much sugar and are marb- 
edly laxative ux their effect, 

Olives have a bitter taste, and are eaten chiefly as a relish with 
^■alads. Their nutritive value is due to the oil they contain. 
^B Strav'berries are very wholesome unless taken in excess. They 
^■mre quite neb in salts of sodium, potassium, and calcium, and have 
^unild dinretic and laxati%'e proi>ertiei<. 

^P Currants, gooseberries, raspberries, huckleberries, mulberries, 
^^ftud a few other berries contain eonsiderable amounts of free acids- 
^They have slightly laxativt- pr<jpcrti«s, 

^M Melons contain over 95 per cent, of water and aboot & per cent 
^^of other constituents; they are considered indigestible. 

Figs and dales contain large quantities of sugar. In the eastern 
part of the United Stales they are seen only in the dried form, al- 
thoagh in California, where they arc raised, they may be obtained 
fresh. The value of the date as a food to the Arab is well known. 
^ft The Alligator Pear or Avocado. — This nutritive fruit ha-s found 
^freat favor Mpeoially as a salad. It differs from most fruit in that 
it contains a very large percentage of fat, averaging as much as 20 
per cent, and s*jme varieties even very much more. It contains on 
iversge, aecording to Jaffa, 2 per cent, of protein, 7 per cent, of 



144 



CLJ.a8E8 OF FOOD 



carbohydrate, 1.2 per ceut. of mineral constituents and about 70 per 
cent, of water. 

The following table, taken from Hutchison (p. 244), gives the com- 
positian of the various fruits : 



Appke . . . . 

Apples, dried . 

Fears . . . . 

Apricots . . , 

Peaches . . . 

Green gagea . 

Fliims . . . . 

KeciarincA . . 

Cherries . . 
Gooeeberriea 

Cumats . . . 
Btnwberries 
Wbortleberriee 
Bl&ckberries 

Baspberries . . 

Cnui berries . . 

Mulberries . . 

Grapes . . . . 

lleloDs . . . . 

Watermelona . 

Oiangea . . 

Lemons . . . 
LemoD-juice 

Pineapples . . 

Dates, dried . . 

Figs, dried - . 

Pigs, freah . . 

Pnines, dried . 

Prunes, fresh . 

Convnts, dry . 

Raiaina . . . . 



h 

S 
» 


1 


* 


■a 


■d 

■ 
•< 


PircL 


PtreL 


Ar«t 


PwM, 


Ptra. 


82.50 


0.40 


0.6 


12.5 


0.4 


36.20 


1.40 


3.0 


49.1 


1.8 


83.90 


0.40 


0.6 


11.5 


0.4 


86.00 


1.10 


0.6 


12.4 


0.5 


88.80 


0.50 


a2 


6.8 


0.6 


80.80 


0.40 


0.2 


13.4 


0.3 


78.40 


1.00 


0.2 


14.8 


0.5 


82.90 


0.60 


0.2 


15.9 


0.6 


84.00 


aso 


0.8 


lao 


ae 


86.00 


0.40 


0.8 


8.9 


0.5 


86.20 


0.40 


0.8 


7-9 


0.5 


89.10 


1.00 


0.5 


6.3 


0.7 


76.30 


0.70 


3.0 


5.8 


0.4 


88.90 


0.90 


2.1 


2.3 


0.6 


84.40 


1.00 


2.1 


6.2 


0.6 


86.50 


0.60 


0.7 


3.9 


0.2 


84.70 


0.30 


0.7 


11.4 


0.6 


79.00 


1.00 


1.0 


15.5 


0.5 


89.80 


0.70 


0.3 


7.6 


0.6 


02.90 


aso 


0.1 


6.6 


0.2 


74.00 


1.60 


0.7 


22.9 


0.9 


86.70 


0.90 


0.6 


8.7 


0.6 


8.93 


1.00 


0.9 


&3 


0.6 


9.00 


1.00 


0.9 


2.0 


0.4 


8.93 


0.04 


0.3 


9.7 


0.3 


2.08 


4.40 


2.1 


65.7 


1.5 


2.00 


5.60 


0.9 


62.8 


2.3 


7.91 


1.50 


0.9 


18.8 


0.6 


2.64 


2.40 


0.8 


66.2 


1.5 


8.02 


0.80 


0.8 


18.6 


0.6 


2.79 


1.20 


3.0 


64.0 


2.2 


1.40 


2.50 


4.7 


74.7 


4.1 



S-s 



« 

I 



Perd. PercL 



2.7 
4.9 
3.1 
3.1 
3.4 
4.1 
4.3 
4.3 
3.8 
2.7 
4.6 
2.2 
12.2 
6.2 
7.4 
6.2 
0.9 
2.5 
1.0 
1.0 
0.2 
1.6 
1.6 
1.5 
1.6 
5.S 
7.3 
7.3 
7.3 
7.3 
1.7 
1.7 



1.0 
3.6 
0.1 
1.0 
0.7 
1.0 
1.0 
1.0 
1.0 
1.6 
1.4 
1.0 
1.6 
1.6 
1.4 
2.S 
1.8 
0.6 

a6 

0.6 
dA 
L8 
1.8 
7.0 
7.0 
7.0 
L2 
I.Z 
2.7 
2.7 
2.7 
2.7 



ITDTS 

Nuts contain a lai^e quantity of fat and a somewhat larger propor- 
tion of protein. They have but little food-value, and are eaten 
mainly as a dessert. The average composition of the nuts is: 



Water 1-4 per cent. 

Protein 6-15 

Fata 40-50 

Carbohydrat«6 6-10 

Owing to the large amount of cellulose, as well as the large propor- 
tion of fat they contain, nuts are not easily digested. The dense 
cellulose framework which makes nuts so indigestible can be destroyed 



FHCIT8 AXD XVT8 



14S 



By ^indiug, aud thus tlie nut mude more easily digcstibte ; 8iieh.{ 
pr(--paraLii)iiH an Nutnisc, Bruniose, and Nuliuval, uf llie Hatiitoci Nut 
Food Couipaiiy, are prcpurcd in tliia way. 

Almonds ooutatu much fat, but no starcli and very little sugar, 
iuid they are, llitrrcforc, cifreu iititm-d as a bread for diabcti<». 

Chestnuts ccDtaiu a imuiU ainuimt of oil and a large amount of 
carbohydrates. They are uften «ati>n raw, luid are i^uite indiK«stiblc, 
Properly cooked they are very djgcatible. 

Walnut* eontaiD a targe proportion of protein and fat. but are 
quite indigestible; in some iudividuals they produtw a markedly 
laxative vHevt. 

The cocoanul containR a large amouDt of fat and carbohydrate, 
but ix exeeedintfly indi^rettt ible. 

The foIlowinK table, taken from Bulletin No. 122. United States 
Department of As?riouUure. gives the composition of nuts as com- 
pared nirh thai of other food-Kubstanoea: 



AlmoDib. . 

BncU Duca 

Fllbem 

Hickorxnuts 

Pbcwm 

Eoirfkh walDoti 

CbeatantH, fraib 

CheMnuw, drwd 

AOOfB* 

BMehmiU 

BmiMimls 

WaliMili 

Coeemaat 

Oomuial, ahraddod ... 
PlMKbk> luRwh .... 
Plnc-nut or Pimam pinw nMw 

PaiwUanw - 

Pmmb^ ra«Ud 

Lildti ntUM ....... 

BeeteMk 

Wli«i Hoar 

PoUUm 



JV«L 

S(k20 



ftanpodttoa And ftnl-fkltu itf tk» 
MllUa poitUin. 



60.40 

<7.W 

37.80 

*6.80 

*2.00 

84.00 

7«.00 

84.40 

MJJO 

13.00 

i6.90 

61.20 

KKLOO 

100.00 

6.94 

7.66 

«7.40 

M.tO 

«7.ao 
loaoo 

M.00 



tM.do 

Sft.SO 
18.a M.30 
1S.4 S7A0 
11.4 71.20 
ia7 |&(.40 

R.2 .MO 
10.T T.OU 

8.1 $7.40 

21.8 .'.7.40 

27.9 filJOl 
27.ft MJSO 

6.7 w.eo 

C.3 ,'>7.30 
S2.tt .Vt..'iO; ir>.6 
14.« Cltfi I7.U 
SS.8 ; 38.90 S4.4 
Sa& 49.S0 I&3 

±»\ 0.20 77Ji 

]&» I8.5q 

1,10J74.8 
0.101 1&4 



3030' 

8338 
34S2 
»K 
3633 
3306' 
1I2S' 
1 873 1 
2T1S 
3263 
3371 
3106' 
2»W 
3128> 
3i>l<l> 
33M 
!&60> 
3177 
M-VI 
1130> 
IMO> 
8«6' 



< Thcae Tilnct vnn eakuUt«il: unleu otberwiee Indlcaled Ibe (val-nlsM «cr« 
d«4«r»iii«d. 

19 



146 



CLASSES OF FOOD 



FITNQI, ALGiE, AND UCHENS 

Fun^l. — The three vai'ieties oi fmnji usually eaten are the mufih- 
roimu truflle, aiid niorol. 

Hushrooms are prized ehietl^'' for their fierecable taste. They 
pogse.<«3 some nutritive value, beiug rich ui nitrugeiiouK mutter, Uuk 
luatt-riul, however, oceurring iii such form that it in but slightly ab- 
sorbed. They are apt to produe« gastro-mteatinal irritation, and 
disagree with many persioiiB. 

The truffle grcws underground, and is especially sought for on 
account of its dolieate flavor: the lilaek variety is considered the 
finest. 

The morel is usiiaUy obtained Iroui France. It is Kold in thit dried 
Btate, and is utilized ehieHy for seasoning piirpoKes. The iollowing 
table, by Koni^r. gives the eompositiou of the mushroom, tnifHe, and 
morel: 

Uiubraoai. 

Water * fli.ll 

NiiTogenouA matter 2.67 

>'iit 0.1.1 

(impe'Hujcur t,nA lunnnilf . ............. l.QQ 

Otlii-r iiiiR'nilrDKi'ii'^UK oulwUntM 3.71 

Wnody fit«r 0.87 

Aah O.Ifl 

Many fungi are poisonous, and these axe usually distinguished by 
a disagreeable odor and taste, and other peculiarities in structure, 
etc. Oibfion, who huN mtide a study of edible fun(;i, considers that 
the nsual methocU of ditstinguinhiog between the edible and poisonous 
varielies are very unreliable. He suggests the following as being of 
espi'fiat value: First avoid every mushroom ha%'ing a cup or sug- 
gestion of such at the hase; the distinctly fatal poisons are thus 
excluded. Exclude those having an iinpIcHsanl odor, a pepperj'. hit- 
ter, or other unpalatable flavor, and those of tftugh conBistency. In 
addition, it is well to exclude those infested with wonus, those in 
ailvaneed agr, or partly decayed, and in testing new species they 
should be kepi apart from the others. The beet test is to begin with 
a piece the »i?.e of a Jiniall pea, chew it verj' slightly, being careful not 
to swallow any of the saliva, and linally expel all from the mouth. 
If no result* follow during the interval of a day the experiment may 
be reiM'alwl, Kwallowind a little of the jniee, the fnigmentii of the 
funguf) l»eing fxprllwl us before. In twenty-four hour^ the third trial 
may be made, swallowing a small fTairment. and if still no unpleasant 
results follow, the following day a piece the size of a hazel nut may 
be otlempted. In using lliis method poisonons varieties may be ex- 
eluded with only a temporary indisposition on the part of the ex- 



Truile. 


M<rr*l. 


72.80 


90.00 


S.H1 


3.4S 


0.62 


0.24 




0.72 


7M 


3,tia 


TM 


0.«7 


i.mX 


«.9'( 




acQAJta 



U7 



pcrimentAlist, aiid is Uie oiily safe method of avoiding the poiaonoua 
vkricties. ^Vs a nile, any uiu<;hruom, oiuittJng tb« Amanila, wtiich is' 
pl«aiiaiit tu taKle liud agreeablv mt tu wlor wheu raw, is pruhubiy 
faariulesa, and. if uu uufaniiliiir sptx-ieu, amy bt- Ivslvd by the above 
method. ^For an excellent d€»cription «f the varioiis fungi lh« reader 
ia referred tn FarmprH' Bulletin No. 15. United States Departmeut 
of Agriculture.) 

Algit.^Tbf only uue of thta gruiip that is titilixcd as food is 
Iriib mou. Itx muM inipurlaut const itin^nt ik Hchcnin. a niucilaKe. 
It is made into & lioothing drink for patients differing froni throat 
irriialibii. 

Lichens.— Tbe ouly iinportatit licbcu used as a Food is Iceland 
mou. li voutitiits two carbohydrates: (1) lichcuiu. a gelatinous 
substance: {2} isolirhenin, which resembles st-urch. Iceland muss is 
utilized as a food in the Arctic regiuiLS. It has been made iutu a 
bread that has been recommended by iijenator for diabetics. 



SVGABS 

Sugura arc carbohydrates that voutain hydrogen wod oxy^'cn in a 
proportion lo fomi water. Su^ar is one of tbe most valuable and 
popidar forms of food. This pdpularity is due not only lo its nutri- 
tive Value, but also to its pleasant taste. According to Abel.' 86 
pounds of sut^ar per capita were cuuMitued in England in It^o and, 
64 pounds in the United Stales in tbe same year. From 7.000.0QO to 
8.0UU,00U tons are consumed annually in the different countries of 
the world. The priucipHi variety of hu^uI' in use in c&uc-Kuyar; 
besidM thiti. gni|>c-i<ugar, fruit-sugnr. and uiitk-itugiir idiw cuter into 
tbe eomposiiiuu of our foods. £>ugar is obtained in a fluid state, as 
in bouey. as well as in er>-slalline form. 

Sugar is very fatteuuig and at the i^ame time is kIso a gi-eat source 
of muwculur energy. The negroes working in the Hugar plaiuations in 
the West Indies show the effect of eating sugar during the harvest 
season ; they chew the wigar-caue constantly, in couawpicnce of which 
their weight and muscular devehipment increase mosi remarkulily. 
8n»;an« and Ktareh are said to be identical in nulrilivc value, owing to 
the fact ihat both must be convortetl iuto dcxtncw bt-fore they caa 
be absorbed. Jlost of the ill ctFecIs attributed to the use of sugar 
are due to the fact that more than one-quarter of a pound is consumed 
daily iHulchison) ; this amount may be taken with impunity by the 
healthy adult, but if more be taken, it will he excreted rapidly by the 
kidney*, giving rise to a condition known as teinporiir>- nr alimentary' 
iHycosnria. Untehifwn {p. 270) gives the following figures as the 
maximum amnunts of the 'various sugars noeessary to produce ali- 
meDlarj- glyciwiiria: 

> Parmer*' RnlMIn No. 11:1, United stnttn Deportment of AKricu1liir«, imo. 



14S 



CLAHSBa OF FOOD 



For Uurtomt . . . 

" <iiikl)><-eiigiir 

" lcvulo<ic 

" dnctroM 



lift Km. 



Sugar L>au be absorbed uuly lu dextrose uiid as levuluHc-, all v&rietiee 
of migar being converted into these forms befurK ibey arc absorbed. 
Ill Ktrong solution sugar irritates the mucoutt nu-mbran« of the stomacfa. 
and is apt to undergo fermeutaliuii ami thus produce gastru-iuteHttnal 
diiitretjy. Koberlwiii ' givi-^ the followiiii; Uible, arranged aceordiug to 
the rapidity with which sugars are apt lo fonueiil : 



LactlD. 
L«Tiil(iitc {innut fer- 

meDtable). 
iim-iaav. 

Cutiv-sugftT. 
Maltose. 



LisvuInM imostfer- 

MlklUwr, 

t)*xtro8i-. 

liiv<.Tt-»UK«r. 



MaJIuhp lujoil for- 

irii>iitnbl«). 
Invci't Kiigar. 
C'iuit--!iu|;«r 
Di-xtrv&u. 
LevuJuae. 

LftCtOM. 



Cane-sugar ig tb« mi>8.t cuuiuion aud inuKt extensively iiscd form 
of sugar. It ia made chiefly from sugar>cane an<l from the sugar- 
beet. When pure, it consists of a moss of white cr^'stals. It is 
soluble in one-half its weight of cold water and iti even leuK of hot 
water. In order to obtain the sugar from the cane Ihi: (taiicK are 
crushed aiul the fluid obtained treated with sulphurous acid, neutral- 
ized with lirae, and boiled; it is then tiltcred and evaporated, when the 
stl^ar <-rv!4ttilli>'i>s out, The susar is still further refined by remeltiug 
and lilteriii;; rhrou^'h eharcoal. 

Caramel is made by hi^atiuf^ refined uane-sugar :o 400° P., when 
it is melli-d'iind browtiiid. The rcMultin;; brown i>iil)Kt)inee Is called 
esrainel. It haii a bitter tHste, and is often used as a flavoring -ageot, 
tispeeially for invalid foods. 

Candy ciMilain.'^ a lar^e amount of saizar, besides butter aud other 
fats, stureh, nut«. flavoring extractK, etc. The chief varieties of 
candy are made up largely of glucotte and starch, eolnred with luiilia 
dyes. Thompson sa>'S: "Cluldrea asaimilatc candy better than adult:; 
because they are less liable to dyspepsia, and beeause of their rela- 
tively urtive muscular cnergj- aud relatively large body surface for 
losing beat, in proportion to their size. They do not, as a rule, eare 
for fat meat, and prefer sweets as a natural substitute." Contrary 
to [Kipular belief. Iliere is uo evidence to show that candy produces 
any injurious effect on th<^ teeth. 

Molaises, Treacle, and Syrup.— Molastoes aud treacle are by- 
proiluets formed in the manufacture of cane-sugar. Molasses forms 
a hiphly nutritious food. On aeeount of the impurities it oontains 
molasses lia.i a more pronounced aperient effect than refined ayrup. 

> l-ldiaburgh Mod. Jour., Kliircb, 18M. 




'8PICB8 AXD VOSDIMEXTS' 140 

Besides cane-xu^ar and cvrlain acitbi, t.-ti;., lunlasiieK contains ubout 'SO 
per ceul. of inverl-suKar mid the sumn tunount of water. 

Hutchison (p. 264i gives the following labl« showuig the voinposi- 
tion of ninlnssw. treacle, auti syrup: 

CH«-atWV 47-0 S2^ 3».0 

yr«it*agir iOA 37 .« 33* 

E;ttr«<tive and MlorUw llMtt«r 2-7 •'i-& 2-8 

StL\U «.« »4 2,a 

W«U-r S7.3 23.4 22.7 

Qtucose, or grape<sugar, is chiefly made from slarob by inversioD 
or Lydrolynis. It is not uearly so sweel us fane-suyar, aud co'stallizea 
wilb difficulty. It is present in ROinll (jiiAntitii-ti. in eombiiialiou with 
otb«r vsrietiee of sugar, in most fniits. When taken in excels, glucose 
appears in tbe urine tinchflngcd. 

Lactose, or sugar of milk, is the natural carbobydralp for the 
youns. growing infant. It i» less abundant in cows' milk than in 
human uiilk. and for this reason it should be added to the milk of 
boltle-fed infants. 

Honey is sugar in a concentrated »>Iution It is made by bees 
frnni the nectar gathered from various flowers. It cootnins a crystal- 
lizalilf> .•lugar, rei>embling glucose, and a iion>crystallizable form. 
Honey was formerly iiscd as a swee:tening agent, but cane-sugar, on 
account of its cheapness and abundance, has largely superseded it. 
Resides sugar, honey contains wax. ^uiu. and coloriug substances. 

Saccharin is umhI largely us a substitute for liiutiar iu cases of 
rheumatism and diabetes. After long-continuod use of large (quanti- 
ties of saeeahrin digestive disturbances are apt to be ])rudueed. 

Levulose, or fruit-sugar, is also utilized as a form of sugar in 
certain eases of diabetes. 



I 



SPICES AlTD CONXUMENTS 

Spices aud condiments play an important rdle in increasing the 
appetite and aiding the digestive functions: they have praetieally no 
nutritive value. By the action of these substances on the organ of 
taste as well as on the mueous membrane of the stomach the appetite 
la stimalatcd and the secn-tion of gastric juice increased, fu certain 
gafctrte disturbances, as well as in diseases of the kidneys, they act 
aa irritants and should b« avoided. Some spicea act art food preserva- 
tives 

The peppers arc among the favorite spices ; there are two rarieties, 
the white and the black. 

Mustard. — Mustard is used chiefly in salads or with other foods, 
and has a maritcd tendency to increase the appetite. There arc two 
forms of mustard: that which Is oblaJnt-d from the black mustard 



atjssna OF rooo 



plaut and tliat dertvt^d from the white mustard plant. In large 
quKutitieH and diluted with water luustard avln an au iiriLaiit to the 
al«miaet), producing uuuhcu auJ vomitiuK. 

Vinegar is pruduuRd FroDi various altfoholie drinks and from fruits. 
Ic cuutaiiiK 5 per ceul, of acetic acid. Uv ite action ou the irellulose 
of vegetables vinegar softens the Qbcr, ao that it not ouly acta as a 
eund iment, but altto uatiiiiU in the digi^htiuii uf the nelliiliiKf-; for this 
purpose it is added to such vcgutabtcs as wibbage, ItttUCT, and cucum- 
bers, 

Horseradish i& a coudimeut that is miich used with various foods; 
it stimuiatt's the tiow of saliva as well as of the gastric secretiou. 

Sauces, such as tomato, catsup, Worcestershire, and the like, in- 
creasL' llie appetite aiui! give a relish to eertain foods. 

Spiccs act merely by adding a flavor to foods, in this way increaa- 
iug the appetite for food that would otherwitte be imipid. Those most 
in use are giuger, einiiamoii. uutuie^. aiid cloves. 

FATS AND OUS 

One-fifth of the body-weight consists of fat. This is obtained in 
part from fatty food ami in part from the carbohydrates and the 
proteins. Most of the beat envT^y furuisbed the body is supplied by 
fat: it oxidizes veri/ rapidly, and in this way spares the protein 
element.s thiil would otherwise bo reiiuired to furnish energy. Fata 
are digest<?d in the intestine, where they are omulsided previous to 
beiug absorbed. The most useful forms of fat are cream and butter; 
other forms arc bacon and eod-liver oil. AVheii eaten too liberally, 
fats ari> apt lo cause indij^eFtlion, and when this extBts, they should be 
taken only in very re-slrieted qttantities. 

Foods fricil in fat arc indiKentible, and hot fats are more indifrestible 
than cold. Fats and oils have a tendeney to relieve constipation, bat 
are couiilerindicated in dlarrht-a. 

The most important animal fats arc butter, cream, lard, mict. oleo- 
marjiarin, cottolene, butterine, cod-liver oil, and bone-marrow. Of 
the vegetable fats, those most commonly employed are olive oil, cotton- 
seed oil, linseed oil. cacao-butter, and the oils obtained from nuts, 
anch an cocuanin oil. peiniiit oil. and almond oil. 

Mydrogc nation of Oils. — A method has been discovered by which 
hs'drogen may be added to cheap vegetable oil, converting them into 
substances having a close resemblance to the animal fats. Finely 
divided nickel oxide is used in the process and at present small 
amountit of nickel may Rtill occur in these produetn, rendering tbem 
undesirable iis luiriiiui ftjiids. 

Indications for the U«e of Fatty Foods.— Fatty foods are in- 
dicated especially in wa^iting disorders and i'l convalescence from 
certain acute disea-ies. They are needed particularly m tuberculosis, 



4 
* 




FAT8 i\0 OILS 



161 



i 



rachitis, chronic bronchitis, end chronic diseases accompanied by the 
formauou oi abscesses. 

There are many proprietary fatty foods on the market, some of 
which arc u'orthy of mention, lu moot of these the fat«, uHually cod- 
liv«r oil, have b»>n MnulKilkd; tliis ctuiilKJtieatiuu aiius to make the oil 
lesa obj<rctiutiable to the tuste and also to render it more easily di* 
gedtible. 

The Vtc of Olive Oil in the Treatment of Certain Diseases. — 
The external and ;tulirutmii-im.s tiHe of olivi.' oil wUI l>r discuMsed 
further on. C'hauffurd and Dupre were the first to advocate 
the use of olive oil in the treatment of choUtithiasig. They reoom- 
tuended that two doaes of 4U0 grams each be given at hulf-hour in- 
tcrviUs, the patient being directed lo lie for three hours on his ri^jht 
side. The tiw of ulivr ail in the trriilment of this condition baa sub- 
sequently been advocated by Walker, Veltsteiner, and others. 

Boeeuheim has advised the use of olive oil in tlie treatment of 
stricture of the esophagut due to carcinoma. After allowing a small 
quantity of oil to flow into the esophagus, patients who were unable 
to Kwallow before have freiiuently been enabled to swallow fluids and 
semisolids. 

Cohnheiu * has advocated the use of large quantities of olive oil 
in the treatuieut of certain forms of gastric disordfr. In cases of 
gastric dilutntion he usually administvrs thi- oil once daily. In the 
morning before breakfast, in doses of from 100 to 150 c.c. ; iu tho« 
instances in which lavage is practised the oil ix given immediately 
after this pruvedure. After taking the oil the patient i» re(]uired to 
He on (lis right side for from fifteen to twenty-tive minutes, and is 
not permitted lo partake of any fcxid for an hour. The oil is admin- 
istered warm, at about the body- temperature. If, notwithstanding 
this procedure, the patient still coutinue^i to sulTer pain, 50 e.c. are 
again given at night, before retiring. Later Cohnboim orders that 
a vineglafisful be taken one hour before breakfast and two desscrt- 
s}>Donfulu from one to two hours before dinner and before supper. 
Id simple forms of ulcer he rei^immcnds that the olive oil be nsed 
only in the morning, and the emulsion of sweet almonds (see below) 
at noon ami night ; must patients do not objeel to the taxte of the oil. 
According to Cohnhfim, in tho.sc iiisteuiees in which the Inate of the 
oil is objected to, this may be overcome by taking a pinch of salt, a 
■wallow of brandy, or by allowing a peppermint drop to dissolve in 
the mouth. TIic oil treatment must be continued over a period o£ 
weeia or months. Cohnheira's eonelusions are an follows: 

"1. Cases of dilatation of the stomac-h due to spa^m caiLsed by au 
ulcer or tiasure at the pylorus are cured or at least markedly relieved 
by the nse of large quantities of oil (100 to ISO grams). 

"2. Case* of stenoais of the pylonis due to organic disease with 

I ZvitMhr. f. klin. M«d.. toI. lU.. pts. 1 and 2. p. 110. 



secondary dilutuliuu are also usually relatively emetl by the use of 
laTf^e iiuuntities of oil ; that is, these patieate are treed from dis- 
tiirbauL-Ps while Ipatling an abHtemidUK life. In tiietie easen the oil 
acts meebanically by relievinR friftiun. 

"3. Cases of relative stenosis of the pylorus and duodeiiuiu which 
are elinieally marki^d by a eontiuuous hyperseoretiou aud pylorospasm 
several houns after tlii; priiKripul meals, are much improved or cured 
by the oil treatment. 

"4. The pylorospasm fouod in vases of carcinoma of the pylorus is 
much diminished or reheved by the oil treatment. 

"5. Cases of (deer of the pylorus aasoeiated with or without h>'per- 
chlorhydria are quickly cured by metins of the oil treatment or by 
an t-miilsioii of sweet almonds, 

"6. Thi' oil is best taken lliree times daily, half to one hour before 
meald; as a nde, it is best to administer a winegla&aful early in the 
mominR and two de^^sertspoonfuls before dinner and supper, lu 
mild cases au emulsion of sweet almonds may be substituted for it. 

"7. The oil fiilfiiB three indications; it overcomes pylornspasni ; it 
relieves friction, and teode to improve the general nutrition. 

"8. The oil acts as a narcotic iu cases of pylorospasm, producing, 
however, no unfavorable effect — ueilher eructations nor diarrhea. 

"9. No favorable effect of the oil treutmeut has been found in 
purely hysteric gastric colics. 

"10. In that form of gastric neurosis manifested by pain wheti the 
stomach is empty ver>' favorable symptomatic relief has been ob- 
tained from the use of olive oil. 

"11, A certain number of cases of stenosis of the pylorus accom- 
panied hy a consequent gastrectasia can often be ko much relieved by 
the oil tnratment that no operative procedure need be undertaken. 
A trial should Ih- made of the oil treatment in all cases of stenosis of 
the pylorus before advising operative procedure. 

"12. The treatment prevents pmphylactically the production of 
pastrectasia and prevent^i relapses when utilized in favorable eases." 

Olive Oil in the Treatment of Chronic Dysentery.— Rutherford ' 
pivps his rcaults with olive oil in the treatment of chronic dysentery. 
According to him. "t^pon the internal administration of olive oil 
typical eases of chronic dysenterj* practically without exception show 
changes in their condition as follows: 

"1. Positive evidence of increased quantities of bile in the feces. 

"2. Deoreaw in the number «if daily bowel movements and marked 
improveroent in the character of the same. 

"3. Gradual ceRsation of signs of fermentation and putrefaction 
along the intestinBl tract and consequent subsidence of pain and 
tendcmeas. 

1 Amniam Modieitip, Marrh, 1004. 



FATa AyO OILS 



153 



"4. GeoRral systemic iinprovcmeii I ; ^ain in appetite, repair ol 
digestive faculii«iti gymptoius of improwU aorvoiu 8>'stem: aud rapid 
gain lu weight and strength. 

"5. Appareiil positive cure after an average time of two months 
and upwttixi. wilh few reeurrunees, " " 

The method of carrying out the treatmeut is as followii: 

"First Fcriod. — The patient is given ouc omii!« iHU c.e.) of olive 
odJ tbree (ime.s a day for the lir»t three dayit, when the quantity is 
increased lo two ounces (60 cxj three times daily, and ou the sixth 
day Uie !%aDie quantity is given four tiiues a day. Durtug the first 
three da>'£ the patient is to be kept on a milk diet. During the latter 
half one to three ouncea (110-90 c.c.) of scraped beef or its e'|uiva1ent 
uf i-Kg-albumin will be added daily. During this treatment a s1ig:ht 
loeii in weight may be temporarily notieed. 

"Second feriud. — During; this period the amount of oil is given 
in greater quantities tnot Ices than three rmnucs — 90 c.c. — three times 
a day without discomfort to the patieutj, and must be kept up for 
a leninh of time in severe and chronic cases: perhaps for two iQunths 
uf longer, during which period eonvalescenee will have been estab- 
liabed and the weight regaini'd. 

•TAird reriod.— During this period the patient is gradually re- 
Ktorod to a full diet, and the oil deeresiicd in amount until the uleera 
have permsnt-ntly healed aud a recurr«ucu uut probable." 

Blum first advocated the u»e of olive oil by rectal injection far the 
treatment of gall-stone colic, and claims good results from its use. 
Kleiner first ret-unuucnded the use of copious oil iujeetions — 400 to 
500 cc.— in the trealuieul of certain furiiis of chronic constipation. 
Remarkable result^ are produced in the spaHtic forms of chronic 
canxtipation when this quantity of oil is injected two or three times 
weekly. The oil should be heated to the body-temp<'raturc, and in- 
jeeted high at Ix^dtimv fuid retained during the night; the aame 
preeautiona should be obxerved as in giving nutrient enemata. (See 
le.) 

The Use of Emulsion of Sweet-almond Oil in the Treatment of 
lin Qaslric Disorders. — Cohnheiiu ' recomrarnds an emulsion of 
ainnnda in tbusc vuacs in which olive od is not well bonie. In effect 
it is identical lo olive oil. previously riewribetl, relieving spasm and 
irritation: qn the other hand, it lacks the nutritive value of olive oil. 
On aecouul of its more plea.sant flavor it is preferred by some. Cohn- 
heim gives the following directions for preparinc an emulsion nf 
almond oil : A drsscrtspcwnful of sweet almouds are blanched by 
wmlding with hot water and remoi,-ing the «kins: after being allowed 
to dry they are ground into a powder and placed in a cup of boiling 

ZciUdu-. r. klin. Ucd., vol, iii, Xos. 1 moA t. 



154 



CLAS8SB OF FOOD 



water; this mixture is next rubbed by means of a spoon, and strained 
through a piece of gauze; a quantity eijual to from 201) to 2&0 grams 
should be obtained fruin ii dcsHertapuuuful of almouds. The emulsion 
should be taken wanued and sweetened oiie-hair hour before meaU, 
iu order lo relieve auy irritation at the pylorus and to prevent spasm 
iu tbi» purl ion of the stomach. 

The various TatR still to bti mentioned are bntterine, oleoma rgarin 
and bone-marrow. 

Butterinc i» a fat prepared from beef and hog'i> fat. and is fre- 
quently uaed iu this country iustead of butter: oleomargarin is a 
wmilar preparation made from beef fat. Both butlprinc and oleo- 
margarin are wholesome fatty foods, the only objection apoin^t them 
being that they are often sold fraudulently for butter and that they 
do not contain the vitamins that are iu butter. 

Bon«-marrow w a fat obtained from the tari;e bones of the ox. It 
in uhkA in the treatment of tubereuloais and in the various forms ot 
anemia, rspinrially in pernicious anemia. Tin- marrow of young ani- 
mals is usually preferred, A preparation Ijnown as the glycerin 
extract of bone-marrow is often ntilisted. 

SALTS 

The principal mineral constituents of the body are the chlorids, 
phosphates, sutpbatee^, carbonates. Iluorids. and silicates of polasisium, 
80<ltum, magnesium, caleium, and iron. Indin is present espeeialiy 
in the thyroid gland, and the other halogens are also found in the 
body. The amount of heat and energy supplied by salt metabolism 
is 90 BinHll as to be practically diKregardod, but the traits play a must 






Waier 

Sklino nuUcrUl . 

Tliwv mil* compriM : 

C'hiorin 

Phonphorie uihydrid (P^) (|Mn^ 
o«id) ......... 

Butphurii; anfajdrid (SO,) tlrioiid) 
SlUdc aiibyilriit (8i(),l (liluxwl) . . 
CkitaDicunhvdriil (CO,) (dimid) . 

PotMdami^xiil |K,0) 

Sodium asiil (Nn,<)i 

(Mdimioxid jCaO) 

MagnoMom oaid (MgO) 

P«Ricaxid (Fa,U,) 



LTtliie or u 



Onmt 
13X(f-lS£0 



4.0-7.1 

1.6-3 
1-4-2,26 
0.003-0.004 
O.008-O.0O4 

4.16-6.9 
0-86-1XM 
O.fie-0.36 
O.0(H-O.O13 



ot2t bflun. 34 boat*. 



Oramt. 
tOlUlft 
1366 



aoi8-o.oa6 

0.76-0,8? 

0.06-0.17 

17-0,35 

005 

0.7&-0.S0 

l>.25-a8d 

0.«6-a70 

0.66-0.70 

O.OSS-0.04 



76O-8S0 
1.6-2.4 



1.12 

0.006 

0.005 

0.00S 

0.178 

0.80 

Tnrm. 

Tncoft. 

TnoM. 




CLASBE8 OF FOOt* 

feces, the urine, sweat, and also in tlie exfoliulioii of epidermis, the 
hair, aud the nails. The avtrnge amounts of the various uumpimods 
excreted are shuwu in the table ou page ls4. 

The PorapciKiticm of some of the commoner food materials as regards 
the salt content is sbowu In the foTlowiog tigiires from Biiuge: 



f« too Parti bn Weiyht of J>rM S>ihttme4 (£im^). 



Beef 

Wh«t. . . . 
Potatoes . . . 
Wliiu ot tgg . 
Vtaa . 
Wnman'u milk 
HilkafecK ' 
Cov'smltk . . 



K,0. 


Ha,0. 


OtO. 


HcOi 


F,0^ 


p,oa. 


\M 


0.32 


0.026 


0.162 


0.02 


1.83 


{).fi3 


0.06 


0.M5 


0.S4 


0.026 


CM 


2.S8 


0.11 


0.100 


0.10 


0.042 


0.84 


1.44 


1.45 


omt 


0.13 


0.020 


C.20 


MS 


0.08 


0.137 


0.22 


0.024 


0.99 


0.58 


0.17 


0.243 


0.05 


0.003 


0.36 


as7 


0.17 


0.380 


1)06 


0-040 


l.tM 


l.«7 


IM 


1.210 


a20 


0.003 


1.86 



ca. 



0.2» 

? 

0.13 
1.32 

r 

0.3S 
0.35 
1-60 



^ 



Ash analyses may W mislradJng ss. far as phosphoric and etUphuria 
aeid arc concerned, as they may be artiticial products from nnclein- 
eontainiiii; substanees. It will lie aeeu that aoimal food contains 
relatively few liases, whilst vegetables contain large ipiantities of the 
alkaline bases and also phosphoric acid. The alkalluc bases are, 
however, always in excess. 

The im-tabolism of the saJts in the body plays a very importniit 
part in the physiolofp.- of nutrition, and disturbances of this salt 
metabolism niiiy hv tin* cjiiisc of discasr. This snhject is as yet but 
little undrrslooil, but thp therapy of the future will iindnubtedly 
depend upon the practical application nf tlie principles of uutrilion. 
If the KallM are witlidrawD entirely death results, aud Korster and 
othens have shown that dogs fed upon foods from which the salts 
bad been extracted by water die in from 26 to ;i6 days. If salts are 
given ill exee-ss they arc cxcrt-ted, liut if irrcatly in rxt-ess. may be 
retained in the body and cause untoward symptoms. Under certain 
Utions even small amounts may be retained or, on the other hand. 
lay be excrctctl in such quantity in the urine that they cannot 
be held in suspension, and are consequently deposited in the urinary 
tract and cause stone. 

Animal food contains sulphur and phosphorous compounds, which 
by oxidation in the body are chauL'ed into ™lphuric and phosphoric 
acids, which tend to riMider ihr bhiod and tissues acid. The destruc- 
tive metabolism of the tissues of the body tends toward the same end. 
The veRPtablc foods, the cereals excepted, contain large amounts of 
alkaline buses, which tend to neutralize the acids and to reader the 
tissues alkaline. A small amount of the acids formed in the metabolic 
processes is neutralized by the ammonia from the protein, aud this 




SALTS 



157 



excreted as aiumonium s&lK and tales the place of the alkolinr 
Its from Ttigetsbk foods. The daily needft of the body are sum- 
larized by Gautier as folluws for the average adult: 



Sm 



Oram*. 
a.22 P,0. 



deidi. 



,. 3.U 

7.70^ SO, 203- 

1.47 SO, i>,« 

OM CI «.50" 

0.04 UO, 0X16 

(a) The food dues uul in reality eonulu 3.9 grams of PiO^ and the 
ET1UIU iif sulphur triuxid Uidieult-d, but rotitains phoHphnnui and 
linr, n'hi<rh if reduced to the given compoundij would yield these 
llgnres. 

{b\ This comprises the amount of sodium chlorid takeu in twenty- 
four hours. 

Alimentary Alkalis. — The avera^:*' ration of 110 gramx of protein 
food funiishtTs ulHtut I i^rani of sulphur, about fuur-tifths of which 
i» oxidizt>d in the body, and gives about 2 grams of sulphuric irioxid. 
SO,. The phosphorus yields about 0.3 gram of phosphoric pentoxid 
a day. To neutralize these it requires 2.3 grams of K.O or a cor- 
mpooding amnunt nf Na^O. Huuge gives the following table of 
liiiin and sodium worth of various focwhi: 

Tb |M0 p«ii> 0^ drird (utiMant* tli* piai>ortioiu ari*: 
avT«0S*4 accordlnf ta lanreaalac Mnoiml ■>( Airancta accariltiic lu incT»Ma( mvouiti •( 



Na.0. 
0.03 
19 



5-fl 01-04 



0.1-0.4 



poUniuni. 

I 

BuIIocli'fl blood S 

Rvr 1 

iUFi^r } 

Ckig'* milk 5-4 

Bmmm wdtk ft-« 

-^^ :■:*■;::::::::::: Ji 

or hn-blvora 0-17 

19 
21 
22 
PoWoa . . ,. 2(hSS O.a-0.0 

The potawium salts are thought to be a factor in exciting the actioo 
of the oxidizing ferments, but this function is not attributed to the 
sodium salts. The potassium salts form carbonates, and tbeae meet- 
ing the s»dium ehlorid in the blood and tisfnies, a partial exchange 
takni plaee with the formation of potassium chlorid and sndiiiiii 
carbooatc. The potaatium salt is excreted in the urine, whilst the 
aodium i« set free by the action of the hydrochloric acid, which 
Mtnraie» the peptones, or unites with the sulphuric or phosphoric 
add, formingr sulphates or phosphates, which are excreted in the 
TJM Part of the potanium salts goes to form organic compounds. 



■odium. 

NaiO. 

Riw 0.M 

.\pplc» 0.1 

Bwim 0.1S 

l'«i 0.S 

Oats 
WhMkt 
Hnrlrv 
Rvf 

PoUtow 0.3 

iriiiiion milk 1.0-t.Q 

IJoir's mtllt 2-3 

Milk of liprbirorm I-IO 

Deef 3.0 

Biiltwk-.i blood 1S.0 



1&8 



CLABSES OF FOOD 



A certain amount of sodium chlorid i» constnntly present in the Uood, 
and this aids iu lb« excretion of the products of metabolism. In- 
creasing the saltK causes au ixiurea&e iu the auioiuit uf uriiu; passed, 
and this is merely the meftiis ol maiiitainiuy th« normal baliincc of 
the suite. Increaiiiug the amuiint of salt laken (-aiiBeji gm&i thirst, 
and ma>' be the caust* of the ingestion of large quantities of water. 
The effect of hypcrtrhloridatiou and h^-pochluridatives iu various 
nervous diseascM has been studied by Vincent, Claude, and others. 
In healthy iodividnala the wmplele withdrawal of salt is followed 
by the appearance of certain symptoms, chief of which iiru livisitudc, 
an iiieapaeity for work, dyspepsia, and eramps. These symptoms are 
promptly relieved by restoring the UHiial allowance of salt. On the 
other hand, a Jinlt-froc diet or a lowered salt allowance seems to have 
a beneficial effect ia some uei-vous diseases, as in epileiwy, in whifli 
disease it increases the action of the bromids. It ha& been suggested 
that a salt-free diet be tried i« hysteria and some of the other fune- 
tional nervoiiK troubles. tiA an addition of 12 to 15 grams of salt to 
the diet in hysteria aggravates the condition very much, and in latent 
hysteria may make i1 manifest. The elfeet of a salt-free diet in 
edema is noted in the section on Xephritis. Animals which feed 
ezcluHively upon meat do oot need salt, a fact pointed out by Bunge. 
The at?idtc formed in metabolism in these HnimaU is neutralized by 
buse« formed by the breakiii;; down of protein. Potassium salts being 
present in vegetables causes an exen'ss nf piita.sKium in the blood. In 
order to eliminate this, as explained above, a targe amount of sodium 
chlorid is necessary. All graminivorous animalf) need salt, and the 
same is true of man. who in omnivorous. The average uidividual takea 
more than there in any neceswity for. however, thi- taste for this flavor 
leading to excesses. Aji average amount for an adult is from 20 U> 
30 grams a day. 

The Halogens. — The elements chtorin. iodin, bromin, and Huoriu 
are taken into the body in foml or drink. The moBt important, chlorin, 
is tHken principally as sodium chlorid. 

Iodin is found in niicleoproteins and especially in the thyroid 
gland, which contains O.OT.'i In O.i:! per cent. It is also found in the 
other organs. Gaulier gives the following tables (after P. Bourcet), 
showing the iodin content of various food : 

Iodin per KVognim nf t'mh ilatrrial. 

C,ivn\ pntis 0.80 

TomMtoM 0-2.1 

CTBpM 0.02-00 

ArtlchokM 04H7 

Vf»T*, 0017 



4 



Qnm \tf«a* n 33 

BanHuu 0-31 

Asparagufl ,.^ 0,24 

G«rIio n.:;i 

Whlta nblMge 0.21 

Mtifilirr>on>K .................. 0.l*'2 

Slr»wl»-rn™ 0.17 

Rira 0.17 

Oirrato 0.134 

&t.Tt«i 12 

U^\» 0.1« 



niilte dri«d bauw OOH 

Lrtlliw ..,.„,,.. 0.012 

l'otiH«« 0.01 

Oatmwil 0.009 

Whwit rtont 0-007 

ltr«iri OflOO 



BALTB 



ioditt Iter Kifogmta in Ifomf Anim^ Fooda. 



Gfa; shriaip .. 

Ctak 

Lobatcr 

SBokMl bairtaff 
P>wb «m3mau .. 

SmA 

Oyaten 






JirMM ISl 

Kmnh cod US 

ADcliovleB OM 

TiUDjf, fnwh . . 0.88 

E*l 0.80 

Whiting OJl 

Trout om 



PiA, fruits, and aiardiy vegetables manifestly furoish most of tbe 



I 



» 



Bramin 15 fmind in tbe naclear proteim anJ in excreted in th« 
sireat. Foods which oootain iodin also have bramin in them, altbmieb 
iMt ID thp naiov <(uaiiiiiit!tt. Fluorio is present in the body and is 
lakeu iu with ihtr drinking-wnli^r. 

Snlphar. — Sulphur is contained in both animal and vegetable pro- 
t(>ii». Four'fifthK of the milphur taken is oridized and exnrBted in 
tbe uriur either as sulphates or phenol sulphates, the rcmaiader 
enters into ootupounds of mope complex eampoKitioD. About 1 gnm 
of sulphur is excreted daily by uii udult. 

Pbo«phonis.— This element is fouad in the body in lanrc quanti- 
tiei. Voit has mtimalPtl that a man weighing 70 kilos (154 pounds) 
•oaliun(>d Wid Kraras in the bones, 130 grams in the mnsele-s. and 12 
leraxns in the brain and nerves. It also occurs in the body-fluids. In 
fumlit it b found iu the form of the inorganie phosphates; iu the form 
of nioiple organic derivatives of phosphoric acid and phosphates 
(phytin), etc.; in the form of phnsphitriKed proteins, as nticleo- 
albumin. etc. The body ik able to build tip complex phosphorous 
eoupooods from that contained in the calcium phosphate and the 
aCber eomponenta of the body. Some studies have been made of 
phosphorus metabolism, particularly pHospborua e<]ailibrium.' Ap- 
pAFCDtJy pbo^borus equilibrium may be maintained on variona 
■Bounta of pboapburuii. depending on tbe amouutx habitually in- 
Iteaird, and in this it re»MubicrM uilrogeu. i^hermaii uud others have 
detrnoined that if tbe phosphorus is taken in the footU in the form 
of the orjranie compounds, that equilibrium may be maintained in 
03 grams of phosp1ioni» or about 2 grams of P.O:,. On a full diet 
more ia required, and they estimate from 1.5 grams of phosphorua 
daily or 3.5 grams of I* ,0b. The Dauilevskys have shown that 
IPCilhlD exert* a favorable influence on the metabolism of growing 
BBitnals. 

The yolk of ejrg in the most available and |>erhaps best form in 
wbicb to increase the phoephorous content of the food. (See vita- 
ntrw.> 

Tbe tabic which follows gives the data regarding the calcium, 
mflieRttm. and phosphorus content of fiwid materials. 

i$w Bulletin S27. Office of ExperinKiit Station, United Btateo DepartmcJit «i 



160 



Cl'AaSEH Oy FOOD 



Iron. — The humou budy ot averai^e size (65 kilos) U siupputiM to 
contain from 3 to 4 grams of iron, cbit?lly iu the hL-uioglobiii of tlie 
blood aud in tbv chromatiu subetauci: in ihc nuclei. Tlic auiouut uf 
iron excreted daily as waste is ver^' small: in Castiug O.iKtT to U.OOH 
gram, utiil in restricted diets to 0.0055 to 0.U125 gram. The iron 
in t)ic food Ls ab-sorbcd from the tuaaU iQtestiiic, aud i» distributed 
cbiedy to the liver, spleen, aud buue-marrow. After beia); utilizetl 
tbe waste iron ia excreted tbrougb tlie walls of the intestine, and a 
very little by the kidneys an<l in the bile. The iron used in the body 
is probably all derived from the food, although inorganic iron tm- 
doubtediy ts absorbed nud is deposited and excreted much the a&me 
as the iron iu the food. The more reecnt authorities believe that 
/the ehief use of inorganic iron so often administered is to xtimidate 
the blood-making organs. There can be no question, however, about 
the advisability of adminiKtering iron. 

Approsimute ostiinati's m«de by Sherman of 20 American dietariea 
bhowed a tDicimum of 7 millivram); per man per day ta a negro family 
in Alabama to 35 milligranis in Maine lumbeimen. 

The iron iu the diet ordinarily used corresponds nearly to the 
amount of protein used. The variations ot th« iron in an ordinary 
diet containing 100 grana nf protein are from 15 to 20 millisTram,s. 

Animals fed on diets poor la iron become anemic. Young animals 

AA QnttibmU cf iVcx^ Mattriati—Bttimcted Averag* Figimt Umd m Cbm- 
patmg BttruU* of Dietary Sbtdia. 



Food mktertftl*. 



Alt! MIL rooM, etMUUk tie. 

Kb and ahullHsh ' . ' ' ' ! ! 

KlUt ijutd buiinrtni!) 

AunoimUh iHiliDkh^ M milk) . . 

ChcoK) . . . . . . 

Milk, cuntJcDKd* . . 

Ullk. wtioie 

Crvaw 

IUri«f. p««rl*d 

Com wal - . s - . r - 

Sominr (unMT>roCMil»*B)t . . 

0«Tmut ilni? Iodine rollod fiau. ate.). 
Rlci; . . 

Wboat AourMMiikuf* and uacamnll 
Olncvr iMiw (•Hiiincd< 
Omnata.nnurBnd«tiIin! wbL-«i Anuria 

Flakvd whekt brcakhat Iboil 

litcBd tiiHi m dlvui) nuily Ho mi 

Bread . . 

CbooalM*. 

UolMwa . 
Hapta •TTwp 

Boiwy ■ - 



■unwl) 



Cftlclau, 
Olid. 



PiroeM. 

£ 

.oaa 

.ITS 

1.340 

.icn 

.430 
.173 
.147 

'XO 
OU 
.078 
.013 
.(OS 

JM 

:gi 

HI 

.3U 
.12» 
.OOS 



Uagncalun ' PhcMphonu 
oxid. I pculuild. 



Per f^iii. 

V 
ftJlIS 

.flOl 

uu 

.M9 
■OlS 
.'Hi 
.019 
Mr> 

.lOD 

l» 

1» 
.■na 

-IU 

.aa 

JMO 
jDW 
.tfS 

.IT8 
.!•» 

.mo 



P«r flcnt. 

(;) 

oisi 
mi 

Ait 

311 

.m 

.Toa 
nt 

-IM 

3S0 
.«6D 
MB 
3» 
.KB 
MI 

.aa 
i» 



ilttata were MttiB&t«d to ooiitaiii per 100 gnrn* protein, 0,076 Kram CaO, 
0.19 (Eram ilgO, 2J grams P^- 

> Fish and atLrllflah were nl^inaU'd to rontain ftr 100 grania proUio, 0.18 
grvu CnO. 0,23 grata HgO. 2S Kraoui PA' 

* Efltini«i(.>d u M(uiv»lf>D[ to 2^ timvs its weigbt of whole ntilk ia k»h ctm- 
•tUoratA 




162 



CLdSSBS OF FOOD 



at birtb a iHrgt' amoiint of iron which is sufficit-ut ta tide thtm over 
until they liiko Food richer iu irou. Woman's aud cowm' milk c<mtain 
appi-oximatelv [tic same amounts uf iron, but infants led ou dilutious 
of eows' milk ratiy become tinemiv, owing to the very small amouut of 
iron taken. 

The amount of ircm derived from vegetahlpK and fruits has not 
received pni]>er attention in IJir past »n<l it should also be borne in 
mind that milling cereals lessens the iron content consideraltly. 

The amounts of iron in various foods are shown in the fnllowinEr 
table from Bulletin l8o. Experiment Station, United States Uepart- 
meut of Aprieulture: 



Pfejiortian of Iron in Food Ahieriait. 



rood maUrloL 



MwH 

PUh and tiitlMih 

■Bi, tdlbl* pordM . . . ; . 

Onud , . t . 

ChMM .... 

Cmd mtal .......... 

Oatmfsl «nil atbcr bfvslillwl 

R1f« . ... 

Whrat lirmktMt RuhI lueil In 

'llnlarratuclT No. iW . . . 
wiii-ut fiaut. cKcktm, Hid 

tijurtroni 

Br-dil 

WhniF-irbeat tent. . . . 

WJii>)e-«bcat br««d 

Green vecCUblM (MPMVl*. 

EMii».Ieiiuce. oiiioiu, rbu- 
rtrt . . 

Roi>un)oe[B.i:arrau.p«naii«. 
railliihi-a, iirf^% pntnUsi. 
luiulnj 

Piin^kiDS 

SqtuUi 

Bmu. nrlni 

fl*>n*, IJnu.drica 

Bwn *, pf, dricrt 



Iron. 



Far rent 
t'J 

O.I]Ul 
Man 
jxfa 

sa\h 
.rails 

AM 

own 
MS? 
JKHfi 

iUIO 

joom 

J0U13 



.ODM 



.ooo« 

.«XK 

,oao» 

.OQIf. 
.0073 

ana 



F0<k1 huMtUI. 



Onrn.cariDnt 

Com. ilrlcfl , 

Cacumbvn. ■■ putohMod . . 

Peu. Ihiab 

I>«M. dried 

■"eu. cautnod • . . 

PoiMow, upnMhaaid. . . 
rntaUMB. edlUe pOTttoB . . . 

Snlnwh 

l^anntOMi. fridi or rBDord - 
Vmublewnp.okuiiiMl. iiin- 

Apples, freili . '. 

Applea, cTiHMTUed . , . . 
DuuaM.edlUe portion. . . 
^Dki)««, aa pnrehtMHl . . , 

GrapM 

LnnotM,*a puwliu^d . . . 
Onuigcn ■Dil kimciuii, wllbto 

INirtloo 

Pni HI'*, tdibln pcirUoia . . . 
Pnini'i. ■• piirrnaacd . . ■ . 

lUlriM . . . 

Stcrnvbcrrlci . . 

(^an«() and praan ad bvlt, 

]<]UI«t, Jan) 

PfanQti 

Cbooolato I 



Iron. 



Per Mat. 
0.1X07 

xaa 

joaoi 
.oou 

.OOM 

.ODOA 

jDoia 

.ODUB 

.otm 

.OOM 
.flOH 

sKm 

.ncofi 

.OOIS 

.nocn 

.oooz 
.009 
MX, 
-OCSS 
.000> 

Mm 
.son 
Moa 



) In RicHta U.UIfi gram iron per 100 grBin« protein, and in flah and shcltAah 
OiOOiV Kiam inin per 100 Krvmn prulrin. 



Milliframt of Iron tn 

Blood wniui 

Wbite of bi3i'» vgg 

Bi<* 

I'«^rl barl«r . 

WhMt flnnr («fled) 

Cowm' milk .................. 

Hiiinnn milk ■-. 

I>a|i;'d tuilk 

fiftn 1..- 

Raupberriea 

Ha/.elnut kfrnrla 

Barky 

Oahhafs dnalde yeltov IcBVce) 

Rye 

7mm almonds 



100 Orcm* of Uritd ifubatanet tBumge). 

U Black clif-rri«£, wiUkoUt atone* 7.S 

Traoe Whiu tMaua ^.. 8.3 

1.0-B.O Carrou ,,.„ M 

1.4-l.fi Wheal bran (..,., 8,8 

1.8 StrjiwhiTrioii 8.0-9.3 

2.3 Lin»«><l 9,6 

S.3-3.1 Unuevled alm&nda u.& 

3.2 Kt-d cliirrioe. without atO«H 10 
3.7 Brown ikiuni'd hnliwlnuu ... 13 
S.» Appl™ 18 

4.3 Duidtliun leavvii 14 

4.5 Cabliajit! IouUt ^!roen lravea» 17 

4.6 Daef 17 

4.9 Aaparariia 20 

4.» Yolk oftfg 10-24 



mtrs 



163 



llittisr«m$ 9/ /rM in iW Onm» of Drie4 Bulvtance [Bun 

VVbral A.A Spinnch ... , 

Bilberrin . 9.7 I'i^'m hlixid 

Poutoc* i> t llrmatop'u 

fCM« . . lt.S-iI.U Henu4:lubiu . 



220 
MO 



ManKanese. -Tbis mrtal is found m the body in minate quantities, 
and small atiiiniiit)* are found in jsoiiie f<H)d inHteriiils. The ash of 
lepimps. a.'ii>araBiis. onulillowtT, k'ttute, grapes, and of various ijrainii 
cuulaiiiti varying iiiuuuniK nf maiigantf^e. 

Silica. — This t'lrmenl is vliminuU'd lu the liair aud df.si)uamated 
epithelium. It is present in uiaay vegetables, but llic |>art played 
ID the animal economy is unknown. 

Arsenlc.^ — Ciautier has dcmonst rated the prfwrnv; nf a trace of 
arsenic in the eclodermic tissues, the skin. hair, brain, mammarj- jj'and. 
and thyroid. Smaller trai^PN have bef>n demnnKtrutod iu other or^anH. 
The role of arsenic in mi'talxilism is unknown. Traces of anteote 
bare been found iii certain vegetables, as cabbaj;e and turnips, as 
well as in some cereals. Common salt may contain some anienic, and 
it is aometiiDea present in foods either as au adulterant or im a food 
pofann. ( See same. ) 

Calcium Metabolism. — Calciiim Ls taken into the body in organie 
furmti, ixa in milk, volk of eg|C. und eerenlH. and as iuorganic saltx 

Jefly in drinking water, as earbonates, sulphates, and phosphates. 

>th forms are ahsnrbahle. hut this depends largely on what salts 
uv lakcu with it. Sodium cblorid. for example, increases the ab- 
aorptiou, while the preseuee of alkalis decreauLS it. 't'hi- minimum 
unnunt nf tinir hy which a eali-iiiui e<|uilibrtiim may be maintained 
IB stated at fn<m I to I*A grams per day as n standard for the avenige 
sized adult. There M^'m. however, to be great variations in the quanti- 
ties by which a calcium equilibrium may be established; » to 10 per 
cent, of that taken is excreted in the urine, while the reniaiiider is 
found iu the feces, whether uuabsorhed (ir absorbed, and then elinii- 
nsted in the intestine. The ealeium excretion in the urine may be 
inervsKMl by inere«Ke in the ingestion of water, hy the administration 
of dilute bydriK'hloric acid, and very largely increased by the ad- 
ministration of lactic aeid and i^rKlium lai-tate. It is alsn inereased 
in ImdUy rest. There la a loss of lime over tliat taken into the body 
in naleomniucia. in pernicious anemia, in advanced mbereitlosis and 
in dialieles, und rhere is a deficient excretion, and the lime is retained 
in the body in arteriwcleroMis. [f the diet given is delieieut in cal- 
cium, the io«B will exceed the intake. If the diet eonlains excessive 
amounts of ealeium, some of the lime will be retained in the body, 
and is apparently stored up in tlie bones, and may not produce aiiy 
■ymptoros. Foods psrlieularly low in ealeium content are white 
br«ad. prapfs. butter, ehirken, and roast beef. In the article on 
Oialnria will he found lists of various foods with the ealcinra content 
given. 



164 

Calcium Metabolism and Tetany. — Stoielzner ha« called attention 
to tlic fact liist frank or latejit tetany can bu iuliuouccd liy diet, and 
that the administration of cow»' milk causes an uggravtittou of the 
galvanit; liyiicn-xt-iiatiility of tlie nerves and most of the other 
aymptoiuH. Tliiei dbuppcani on wttbdrawine the milk and fn-L- purga- 
tioD. Fiukelstcin doicrmined tlial this disturbance in nutrition de- 
pended probably either upon the assimilation nP the phosphates or 
the ealcium salts. Stoekuer, after a study of 12 cBses. came to the 
coiii'hision that this was due to the retention of the caleium 8alt£ dui- 
to an insufficient elimination. He also called atteution to the fact 
that tetany, while common in bottle-fed babies, was very rare iu breast- 
fed infants. 



SALT KETABOUSK AHD DISEASE 

The titisiies differ in their salt composition, and chAnftes in salt 
nietabi)liiim an* probably due either to atrophy or growth of certain 
orKanN or tisMues. or to tl»'ir taking on new functions, or to the 
processes of disease. iStudies of the balances of the various salts 
have been made hut sparingly ui disease, and doubtless this subject 
will bt^ taken up more energetically in the future. 1u hunger. Well- 
man found that there was a greiiter loss of salt than could be ao- 
countetl fur by thi.- nietalHjlisin of the fleshy parts. The prineipal 
excess was phosphoric pcntoxid and caleium and niapnesium oxid in 
about the same proportion as is found iu hone, and the skeletons 
of the Huiniats were found to have actually lost 6 or 7 per cent, of 
their weight. There ih a lowered calcium excretion in many discaaed 
I eonditions. anioiig which may he mentioned, pleural elTiisiou, pueu- 
moniu. delirium tremens, and various fevers. In puhuonarj- tuber- 
culosis Senator found that there was an excess of eahrium excreted. 
In osteomalacia the calcium balance is disturbed, and more is cscreted 
than IB taken into the body. Phosphoric acid lessens the calcium 
excreted, and this might be used in experinteiital therapeutics, 
(.'astration. which has been done in a few cases, restores the CaO« 
equilibrium, and there is nlso a tendency to restoratiou of the sulphur 
equilibrium. On the other hand, in myositis ossitieaus the amount 
of calcium excreted in the urine is lower than normal. There is aiso 
a retention of lime salts iu arthritis deformans. In endarteritis the 
calcium excretion is interfered with, and Ruirpf claims to Imve 
obtained goi^d results by giving; salts which aid the excretion of 
calcium as lactic «cid, sodium lactate, sodium citrate, sodium car- 
bonole. and sodium chlorid. 

The table on the next page, by Hooblcr (Archives of Pedrialica, 
Iklarch. 1912 1 shows the mineral constituents of various common foods 
expressed in percentages of the total mineral ash. This table will be 
found of great practical use in arranging diets with a view to their 
Bait content: 



SILTS 



1«5 



rHO5rUQBV&-C0IttAIHino FOODS 



Bnrir^ 20-13 pre «M. 

NulB. 43-Irt (MTT twit 

LVrr«l», 54-17 (wr cw>t. 



VtgtUMtt, 41-10 



per 



(wr cwil. 
Meals and Ash, 46-20 per 
cnit 



CcnlenU vstlnifttL-U a« fi^V 

PeaiK, ftpplra, ciUvii, clicrTien, plums. ■pricotD, ur- 

uoo*«ti«rriL-a, curr»iilk, buokluberrica, aUMwbcriie*. 

Almond*, wwouiiuIh, cImUiuta. 

ICi(« flotir, rj«f. whvnl Hour, buoLvrhcnt ll«tir. o&t- 
mrAl, oatnii^iil llour, 1m.tI«v meal, iMrli'^' Aour, 17* 
Hour, nirnmt-iil, (vmuiunl Hour, rollwl uwU, pearl 
IwrM'. iiiiti-aruni, brown brvw), whit4> brtjid. 

ftlu-l; rvditliMi, ajtirbokM, bminii. ]H-a<. IfatiU, 
putopklDii, kohtrabi, raiili dower, a^arsgiia. potato, 
nhbagp, SiLvov cublj4))cr. iniwliruuin*. (iiiioua. tbuliarb, 
(MiciiDiberB. tu'mipa, celery, carrota. augar beeto. rad- 
■■hM. spinach. 

Egg yolk. egga. «b««M, milk. 

Veal. ]klrlcef«l, pork, beef, o.vvAjrr*. ulmoD. 



Fmlta. gl-3fi pvr cmt. 

Bcrrln, .'iT £1 p«r «nt. 
XtlU. 44-21* fHrr <*nl 
Carale. 3R-I4 per c«nt 






Milk, <^^. rbtwBp. 3l-1:t 

p*r iii'Ht 
Mral> and liiih, 4ft-24 per 

r«nt. 



POTASSnnC-COSTAINIKO rOODS 

C'vnl*-nU rttiniutcd lut Ki(>, 

UllvtrN. plumi, uiirlouu, fipi. pMrit, rhorriM, pin** 
appW. ritrnn, oiwrjEVH, appira, 

Ilucklcbrrrln. i-urraiitx. ji)o!M?l)irrrii-5«, at raw berries. 

DKntniitfi, enn>«DiiU. n'alnuU. aliiiondii. 

Ry« Atrur, wheal flour, crai^kf<l wlieai, rolled oaU, 
cunimral, cornnieal flour, hi>nitn,v, harlrr llniir, har- 
kx meal, oattu«al> buckwheat flour, oatmeal flour. 
ricv fliour, icrabam brtad. 

Potatci«|i, rhubarb, riirtimbrre, Tnimhrfmni*, cabbagp, 
tumipa, t^irry. Iia-an*. pran, t<miato«-«, rndirca, lettuce, 
carrota. koblrnhi. lentils, mA'mi\t>n, Savor cabbage, 
(vnlona, niti^'ltoke*. aoparafrui, cauUflotrtr, pumpkias, 
bliHid biN-ta, Mpitiafh. 



ptr 



Frulta. SA-7 |>pr t-mt. 
bane*. t»-1t pot cent. 
Ccraala, 40-14 per cent. 

Veirrtablea. 46-" per cent. 



K.gg whitea, milk, vgpa. i-hi«ae. 
He«f, pork, veal, aalmim, pickcrri. 

SODIUM-COKTAiniKO FOODS 

(.'ontenta catimatcd as Nik/). 

Jlpplra, oranjrc*. apricola, |itiM-Appl<v. p«arB. olivaa. 

Strau bvrriea, goowberriea 

Macaruiii. barley flour, brown bread, white bread, 
grabam bread. 

Bluod becta, aplnach. carrota. pumpkin. radi*hea> 
B«para||[ua. toinatw«, Irnlil*. endh-ea, raulilloifrr. Inr- 
nlpa, sugar beett, artiibukri. kttui-e, 8«vuy oabbage. 

G|ai wbtt«a> cicir*, milk. 



Milk. iiBa, cbefM, 31-8 

ptT cvnt. 
llMttx asd tab, 30-4 per Oyatera, pickerel, aalmon. 



Fniita, 2-1 pr c«it- 
ftories, &-1 per ««nl, 
NiUa. l.B-1.3 par <«aL 



nov-coKTAnmro foods 

ConlentN eatlmatwl ii» Ke.O,. 

Figs, niniaplra. apples, peara. pluma. 
Strawberrii^a, Kootwbcrrka, bucklcborriM. 
Coeoanuta, wautittft. 



166 



CLASSES OF FOOD 



Cereals, 2-1 per cait. 



Vegetables, 
cent. 



5.3-1 per 



Fruits, 6 per cent. 
Berries, 6 per cent. 
Cerea.ls, 14-13 per cent. 
Vegetables, 30-6 per cent. 



Rye flour, barley meal, barley flour, rice, buck- 
wheat flour, cornmea), corn flour, rice flour, wheat- 
wheat flour, ^aham flour. 

Lettuce, onions, asparagus, endives, kohlrabi, pump- 
kins, artichokes, tomatoes, lentils, black racushea, 
celery, rhubarb, potatoes, mushrooms, beets. 

SVLPHTTB-CONIAININO FOODS 

Contents estimated as S(^. 

Apples, pears. 

Gooseberries. 

White bread, brown bread. 

Black radishes, mushrooms, cauliflower, turnips, 
kohlrabi, cabbage, spinach, carrots, cucumbers, pota- 
toes, asparagus, onions, celery, endives, artichokee. 

CHLOEIBX-OOITTAIinBQ FOODS 



Fruits, 10 per cent. 
Nuts, 14 per cent. 
Cereals, 30-5 per cent. 
Vc^tablea, Ift-S per cent. 



Milk, eggs, fheese, 2S-7 

per cent. 
Meats and fish, 2I-S p. c. 



Contents estimated as CI. 

Pineapples. 

Cocoa nuts. 

White bread, brown bread, macaroni, oatmeal. 

Celery, potatoes, cucumbers, radishes. Savoy cab- 
bage, lettuce, asparagus, tomatoes, cabbage, spinach, 
beets, rhubarb, turnips, kohlrabi, carrots. 

Egg whites, milk, eggs, cheese. 



Salmon, oysters, pickerel. 
XAONESIUX-COHIAIBINa POODS 



Fruits, 8-6 per cent. 



Berries, 6-5 per cent. 
Nuts, 18-6 per cent. 
Vegetables, fi-5 per cent. 

Cereals, 16-5 per cent. 



Meats and fish, S-5 p. c. 



Contents estimated as MgO. 

Apples, pineapples, oranges, flgs, pears, citron, 
cherries, plums. 

Currants, huckleberries, gooseberries. 

Almonds, walnuts, chestnuts, cocoanuts. 

Tomatoes, sugar beets, peas, cauliflower, kohlrabi, 
lettuce, spinach, celery, carrots, onions. 

Corn, commeal, wheat, wheat flour, barley meal, 
buckwheat, rice, rice flour, rye flour, oatmeal, rolled 
oats, graham bread. 

Salmon, pork. 



Fruits, 30-7 per cent. 

Berries, 14-8 per cent. 
Nuts. »-H per cent. 
Cereals. 8-7 per cent. 
Vegetables, 27-5 per cent. 



Milk, eggs, cheese, 35-8 

per cent. 
Meat and fish, 18-7 p. c. 



CAICIVK-COHTAiniHa FOODS 

Contents estimated as CaO. 

Citron, oranges, pineapples, figs, pears, cherries, 
olives. 

Strawberries, gooseberries, currants, huckleberries. 

Almonds, walnuts. 

Oatmeal, commeal, wheat fiour. 

Savoy cabbage, cauliflower, onions, lettuce, rad 
iahes, celery, cabbage, endives, spinach, asparagus, 
carrots, kohlrabi, turnips, rhubarb, artichokes, 
pumpkin, lentils, cucumbers, tomatoes, beans. 

Cheese, milk, egg yolks, eggs. 



Oysters, salmon, pickerel, pork. 



BEVERAGES AND STIMULANTS 



WATER 

Watek is tbe chief coiistilueut of all bevKnigcs, and abn enters 
largely iiilo the eomposilion of solid food. Tlie hiiiiian hody itself 
is composed of about 60 ppr wiit. of watpr. W'liilf man can live for 
weeks without food, he can abstain fmm water for but a few days. 
Water Ik abwilulcly necessary as a solvent, and as it is constantly 
Ih'Iiii; eliminated by the Hkio. lungs, aiid kidneys, thiii loss must be 
replaced by some meaQ& in order to inaiutaiu the fuueliotta of the 
body. This is most conveniently done through the agency of the 
various beverasrcs. The best method, however, of repleiiinhinit the 
iraler-HiippIy is that of driukiup the water in its pure state, when 
it retains all its solvent properties. Some waters ai-e taken for their 
luxutivc or purgative action, and others for the salts which they con- 
tain. 

The amount of water consumed daily by the average person is from, 
six to ei^ht gl&.sses. This varies, however, with the amount and 
variety of food and exereise taken. The age, sex. and i^ize of the 
individual and the season of the year alto influence the total daily 
consumption of water. In verj- warm weather, for example, and 
under severe physical strain, much water that would not be lost in 
the cold season of the year \a eliminated in the form of perspiration 
and must he compensati^d fur. 

Water is abciorhed chtelly in the tnluHtinc; a smull amount is ab- 
aorbed in the stomach, and but a ver>' trifling amount, if any, in th« 
mouth. The water uli^nrbed in the intestine is passed into lympliaties, 
and carried on into the eireidatiou, whence it is eliminated, Thus by 
removing the water from the blood and sending it through the kidneys 
into the bladder, sjiaee is made in the circulation fur the eutrauce of 
miiri! fluid fnim the alimentary tract. 

As previously staled, water is eliminated through tbe skin, kidneys, 
longs, and feces. The amount of water excreted daily varies greatly 
under special conditions. In cold weather the skin is inactive and 
the kidne/H excrete a greater amount of water than in hot weather, 
whrn the sweat-glands functitmnte more actively. When tbi're is a 
tendency toward liijuid movements from the bowel, tbe .Miraiuation 
by tbe kidneys is lessened. In warm weather elimination by the lungs 
ia stimulated. 

The temperature of drinking-water is a matter of some importance. 
Teed water will tttimulate a more rapid and a greater secretion of 



168 



BBVBRAOEs .ISO annvLAyrs 



gastric juivv, but letnteiut tin- motility of the stomach. leed 

ill exeeuH is injurious, luid should not be token when one is OTcrbeateil. 

Hot water has a very beiieticial effect on on irritated stomach. 

Water is a most valuable diuretic and diaphoretic. Wheu the 
tttomach can nut rctaiu it, it is often ^Iven by the rectiuu. A pint of 
sail solution, if injected by the uae of a reitlal lube, will, if the colon 
has prcviuuKly been emptied, be retained long I'nougb in in- al>sorbt'd. 
[f a half-pint or even a pint of salt golutiou be iutrodueed under the 
skin, it will be absorbed rapidly and as rapidly be eliminated. Thi>i 
is one of the most URcful measures for producing rapid elimination 
through the kidneys. 

Aecording to the amount of mineral water tbey contain waters are 
etasaed as hard and soft. Bain-water ia soft, and is the purest form 
of natural water. The hardneHR of water is due to earthy earhnnatea: 
by boiling, the fsrlmiiie aeid ^as is driven off and the parbonales are 
preeipitatfid, and the water thiis reniU-red more suitable an a bevcrap'*. 
Boiling has the additional advantage that it destro^'s most of the 
miero-organisms that may be present in the water. 

Water often contaiits impurities, Ruch as lime, maffn^a, Iron, and 
other KallH, or micro-organ isms, and it often beeomes tieee««ary to 
purify it fur drinking purposes. Typhoid fever and eliolera are 
eommunieated chiefly through the ageney of polluted drinki mi -water. 
The best method of purification is by diatillation, by wbieh mennK both 
inorganic and organic impurities can be removed or rendered in- 
nocuous. This method is jkiw u«ed largely on ahijw. When dis- 
tilled and ai^ratcd, sea-water makes a most pleasant beverage. Water 
may also be puri6ed by meaiis of filtration, eharcoal and sand being 
used extensively for this purpose. I'orcelaio cylinders are also in 
eommoD use. Whatever the filtering agent employed, unles-s it be 
kept clean it is liable to become a source of contamination rather than 
of puritieation. Owing to the fact that soluble impurities often pass 
through the filter, filtered water ia not nearly ho reliable as distilled 
water. A very economic and eonvenieiit mt^thnd of purifying water 
is to di^olre one gram of alum in a little water and pour this solution 
into one gallon of the water to be puritied. After stonding for 
iwenly-four hours the impurities will be precipitated. 



KINERAI WATEBS 

Mineral waters are frequently taken as substitutes for ordinary 
water: at times they produce a most marked stimulating efTeet on 
various organs. Their efficiency is greatly enhanred wbrn a "drink- 
ing cure" is combined with proper dietetic regulations. Mineral 
watera differ from ordinary waters in the greater amount of gaseous 
and solid matters tbey contain. The gaseous coostituents of mineral 
waters are mainly earbnn dioxid and Kulphuretted hydrogen. The 
solid constituents are salts of sodium, potassium, magnesium, alumi- 




id calcinm, iron, iodin, braniiu, ehloriu. and •nilpbor. Taken 
pi meuls, waters containing carbonic acid haw a suutbiug effect 
uu an irritated stomach. Takeu iu excess, all varbuuated waters an- 
apt to pro()uoe indJgestiou. 

Some waters have a purgative vffcct, others a laxative, and »tUl 
•It hers diuretic. Thermal waters issue hot from aprings, their virtue 
lieing dut to tbrir hrat. Some mineral waters have do nK>dii!inal 
virtue whatever, and are utilized merely as drinking- water. 

Classification of Mineral Waters.— The following clanifieatioD 
ami di>s(Ti|iti(Mi of mineral waters are taken from Cohen's Phjwf^o^c 
Therapeutics, vol. ix^ p. 416 (Kiach, Uinsdalc, and I'cale) : 

(Sliiipk- w-idulouft. 
Alkaliue acidulaiit. 
Alknlin. mnrinto.! »cidi.1<>u8. 
AlkftlJtie Mi)ini> aridiiloue. 
rSltnplc uHtiuiii i'hiorid. 
11. Sodium ebloT id waters: i Sodidm dilorid with iodin and bromin. 

[Saline nater or liiine (Soolea). 
tfl ItttiM- nKlrra. 
TV. SiilpIiUT<Mu waters. 

f CarbonaUiI ium wmters. 
V. Iron vatm: < SulphuraU'd iron wilvre. 
t, Ifou and arMnfc watcn. 
VI. Earthy minernl wafers. 
Til. AcTSlutlM-rniftl vrftt«rs. 

I. Alkaline Mineral Wftten.~The!;e waiem are divided itito: (1) 
Simple acidulous watrrs. (2) alkaline acidulous waters; (3) alkaline 
uuriated acidulous waters; and {i] alkaline saline -acidulous waters. 
The simple acidulous waters are thu^ that i.*utitain large amounia of 
carbon dioxid: thia ingredient increases the peristallic action of Ifae 

I stomach and intestine. These waters are utilized largely in the 
Treatment of minor gaittrie diNturhanveM aud in catarrlial (wnditionft 
of the respiratory tract. Ammig the most important of these waters 
wre: Apolliiiarie water: the Dorotheenfuielle. at Carlsbfld ; the Geyser 
■Sprini; in California: and the Manitou Soda SprinR in Colorado. 
Alkaline Acidulous Waicra. — These waters contain, in addition to 
laree quantities of carbon dtoxid, var^'ing pniportiona of sodium 
carbonate. In moderate cpiantittcx they xtimulatc the activity of the 
pastro-intefltinal tract, the respiratory, and the urinary organs. They 

• dtnoK'e mucus and neutralize the exee»4 of acid in the stomach. 
The following table' gives the chemic compnsitton (in 1 liter) of 
ibe mn4 important alkaline aeidutous waters: 

Qtsins. 

Dtlln. of sodium biearbonatc ■ •.- mI 

Ks«hiBKen, of sodiam lri«ar)Mnst* S-87 

yrurD«l>r, of HHlium biosrVinB(4> ,, ....• l.OB 

^Ubninn. n( umiinin hicjirbonBtv •• 2.19 

8«lrkt(>r Vprlnif, of sodlain bic«rl>nnHt«i 0.M 

» Taken tram Cohen's Pbysiolonic Therspeiitks, wA. ix., ^ 420. 



170 



BEYERAOES dl 



Vals, of KMUiun bicarbonate ..^.,.. 7^ 

Vichjr, of aodiitni bji-ArlKinHti- 4.88 

Bladoii < Vii'h.vi. u( mHliiirii bii'jirlHiiiiiir . ... O.HO 

C&Hforniii Kt'ltKi-r. tif widiuiii bkurtHJijutf , ..... O.iM) 

IdauUn. ui iKuliHiu and magnt-Biiini bii'iiiboDiUcB 1.20 

Nupii SiicIk (E'ti|[vda), of Budiuiu uud luuKiit'siuiu raibuimtvo tuul 

kuc&rboiiati-» •■••••• 0.70 

SNrtttujjti I Vicli^' f , gf iiodiiiia Uicttrbunatv ,,,,,, ^Ai 

SoTfttogR (VicLjI. of cftkiiun aad magncBium bicarbonatM ...... 1.35 

Atkalin-e Mvriated Acidulous Waters. — Thesp waters contfliu. iu ad- 
dition to sodium carbouslt' and carlion dioxid, large (|Uamities of 
sodium chtorid. They exert n markedly s«Ivrnt effect on urie acid. 
Hnd liquefy thp sferetinns from the respiratory traet. They are 
cspcciBlly nsi'fiil in rjiiarrlml conditions of the n-spiratorj- Iracl. such 
B8 cLronie bronchitis, and in chronic catarrh of ihc stomach, of the 
biliary passages, and of the urinarj* organs. They are used for 
gargling and inhalation fiurposea. and hIho for harhH. To this c-laHa 
belong the waters of Royat, Kms. Sclters. and Saratoga Vichy. 

The rhnmic composition (in 1 liter) of tht' most important alkaline 
muriated acidulous waters is shown by the following table: ' 





8»diWD 


Sodium 


Sttdium 




fBThanai*. 


bl«»rbaa*r*. 


rhUvrid^ 




9r«nw. 


Otmna, 


tarns. 




.... }^ 


, ^ 


0.41 


AfuuKDnaliauMtt . . 


.... 1^ 


&.13 


1.57 




.... IjO 


0.18 


1-50 


Brw 


.... 1.0 


S;09 


100 


(;ii*i<-h*nl>.T([ . . 


. 10 


2M 


1.85 


Glen Alntiie 
I.uliAiacliuwitx 


1.0 


0.58 


0.30 


10 


70 


4-lA 


Rulrin 


, . 1.0 


3.01 


O.CO 


Raiaiori 


.,,10 


\£* 


1-M 


Royml . . 

SalutarU ... 


. . 10 


IJM 


] 73 


10 


«j08 


1.40 


8«rAlofta Vichv 


1-0 


1.48 


2.S0 


Selt«re 


-10 


123 


2.3& 




l.O 


8.44 

1.39 


4.lt1 




... 1 .0 


1.25 



Alkaline iialine Acidulous Walcnt.— These waters contaUi sulphate 
in addition to bicarbonate and chlorid of aodiunL They occur as 
both warm and ftold waters. The cold waters possess a raarkcdly 
diureii*-' ctTci'l, and wben taken in largo iiuaiilities act as purpativM. 
The warm waters diministb the urinary Keerctiou. The cold alkaline 
saline waters arc useful iu strong individuals for reducing flesh and 
for the relief of eonstipation. The wurtn waters are useful in gastro- 
intestinal catarrh, ulcer of the stomach, gout, catarrhal jaundice, con- 
geulion of the liver, cholelithiasis, and in conditions associated with 
urinarj' eoneretions. Among this class of waters are to be mentioned 
Carlsbad. Marienbad. Klster. Kej-ser 8pa in California. Castle Creek. 
Hot Springs in Arizona. Idaho Hot Springs, and Manilou Springs. 



I Ibid., rot. ix^ p. 422. 




KATKIt 



171 



The follon-ing table * gives tbe cheralc compositioo of Importaat 

i._t:^_ i:. • 1 i:. ^e i i..: 



alkaline saliue water j 1 liter of water coutaiust 



Bndium 
Ax: lulpluite. 

Aqiu. do VIda (Ltnrer Spring) 0.24 

Bwlrirh 0.S8 

C*rlBb«a 2.40 

KUU-r £.ie 

FrwiM-n.lwl 2.80 

Oejwet 8pa 0-04 

Uanltou [Moaitou fiprins) l>.20 

kUrinlMd tXA 

BsfcitMh 3.02 

Rojkl Gorge {\na Duke Sprinit)... 0.10 

foriagdok Sdtoer 1.74 

nnap ■i.XQ 



Sodtsm 


SMIiva 


Sodiw 


carbvnava 


ttlMtboDau. 


cblocld. 


OrisfiM. 


(jronu. 


OrUM. 


0.06 




OOS 


, , 


0.72 


0.21 




l:ak 


IM 


* • 


l.«8 


0.82 


_ , 


o,tfr 


I.I4 


0.0« 


0.34 


0.t« 


0.02 




0.40 


• > 


1^ 


2jM 


, , 


1.07 


0.07 


IJH 


, _ 


IJ4 


, ^ 


oxw 


OM 


.. 


4jm 


J.8J 



The ehemtc eomposiiion of the salts of Carlsbad Spriidel and 
Uarienbatt Spring tin comptcli* evajKirutioii is us follows' y',\ to 5 
grams (45 to 80 graiosj arc dissolved in a ffloss of wat«r when used) : 



Carlnluiil flpraM 
*a)l. 

Sodium ■u1|>bAU <3.S5 p«r <viit. 

ScMliiim )HC«rlHii>&t« M 20 

Sodium cblorld 16-ftl " 



HtriaDtaad Spring 
■all. 

24-3(1 prr oral. 

S3.S1 

20.40 ■• 



In. Sodittm Cltlorid Waters. — To this class belong tbe simple 
Bodium etilorid waters, sodium chlorid waters coutaiuing iodiu and 
brotnin, and brine or saline waters. 

Simple Sodium Chtorid H'a(era. — These waters contain, in addition 
to sodium cblorid and other cblorids, carbon dioxid in larf;e quanti- 
ties. Sodium ehlorid increases the secretion of the mucous mem- 
braucs, especially of the stomach. These waters have a markedly 
diuretic and laxative effect, and are useful In chronie catarrh of the 
reNpiraiory tract, and of ibe stomaeh, iutestine, and biliar,v pnsKa^'es. 

The followinfir lablc,' ^vca the chemii* cumjiosition of .Himph' sodium 
chlohd waters; 1 liter of water eontains: 



At: 

IteUi 

Bourbomi- 



SotUum ehlorid. 

2.01 
050 

. . . . SM 



R>-ruD BiJrinc* ( Uvvr and kidney) >.... 10(9 

Bjron ffpriiv lltyrxa Surprinc) > 304.27 

CaniMadt 2.4S 

ConfTcn Saimtosa SpriDgs 0^0 

Droftwicb JiOXO 

Qlanwood Spring! (Vampit) 17.06 

Barrogtttft IS-TO 

> Cahen'* Pbyelologlc Tbrrapoutics, vol. ix^ p. 424. 

* tM^ Tol. IX . p. 42S. 

* thid-. vol. ix.. p. 42«. 



172 



BEVERAGES AXD BTIUULAKTS 



kt- Sodium rhlorid 

Homburg 9-80 

Kissingen 5 82 

Kronthal 3^4 

Liberty Hot Springs 0.33 

Mondorf 8.71 

Pyrmont 7.05 

Seltzer, at .Saratoga Springs 4.97 

SodeD in the Taurus , 3.42 

Upper Blue Lick «.37 

Utah Hot Springe 17 05 

Wieibaden 6.82 

lodin and Bromin Waters, — These waters contain iodin and bromm 
in addition to sodium chlorid. The iodin occurs in the form of 
magnesium iodid, calcium iodid, and sodium iodid; the bromin, in 
the form of sodium and magnesium bromid. These waters increase 
the activity of the lymphatic vessels and hasten absorption ; they are 
indicated in cases of scrofula, syphilis, and in diseases of the glands, 
as in goiter. The principal, iodin waters are Heilbninn, Kreuznach, 
Saratoga Kissingen and Congress. 

The chemic composition of the important iodic and bromin waters 
is as follows; ' 1 liter of water contains: 

fiodlnm UaoDMium Sodium HoiHnT*l 

chlorid. Utdid, Iodid. bnimid. 

Oram*. Oranu. Or ami: Oram*. 

CbampioD Spouting Spring 12.02 O.OO.t'l 0.0610 

Excelsior Spring 6.34 . . 0.07n« O.Oftlo 

Franklin Artesian Well 11.2H 0.0040 O.nillO 

Hall 12.17 0.0420 0.0040 0.0610 

Heilbrunri 4.98 0.0300 0.0040 O.Olflfl 

Ivonitch 8.37 0.0160 0.0040 0610 

Krankenheil 0.29 0.0015 0.0040 O.OCIIO 

Kreuznach 10.S2 0.0004 0.004(1 O.OUIO 

Lippik 0,61 0.0200 0.0040 0.0610 

Ijower Bowden (Lithia Spring) .. 2.13 0.0209 0.0120 0.0610 

KeO Spring (Tuacan Spring) 0.3B O.O209 0.0730 ^ O.OCIO 

Salzschlirf 10.24 O.O050 0.0730 0.0610 

Sakbnin 1.90 0,0150 0.0730 U.0610 

Saratoga (Kitieingen Spring) 5.96 0.0160 O.OOOli 0.0308 

Wildegg 10.02 0.0300 0.0006 O.O.tOS 

Woodhall Spa 10.60 0.0076 > O.OOOC. 0.0200 * 

Zaizon 0.92 0.0010 0.0000 0.0200 



Special importance has been attached to lithium, which is often 
present in sodium chlorid waters, and which is believed to have a 
special effect in dissolving uric acid. It is very doubtful if such an 
Hction occurs, yet these waters possess a markedly diuretic action. 
They are useful in the treatment of gout, and of renal and urinary 
concretions. Among the most important simple sodium chlorid waters 

1 Cohen's Physiologic Therapeutics, vol, is., p. 432. 

2 Iodin. 

" Potaasium iodid. 

* PotaBsium bromid. 



may be mentioned those of Hambun;, Bsdeu-Badeu, KtssiDg(}a, Wies- 
liadeii, P^rmoul,. Byron Springs in California, Congress, Excelsior, 
llathurn. ili^h Kotrk, and Selzer at Saratoga. Among tbe Uthia 
M'Htf'nt ar** Hlizaltethbriitint!!! at Hombtirg, Elxter, KiKsiiigeu, Ixiudon- 

|derr>- Lithia Springs, GcQcva Lithia Springs, and Duff^o Litliia 
Springs. 
III. Bitter Watew.— These waters arc characterized by tlie larjte 
propnrtion of kimIjuih sulphate uud magnesium sulphate wbioh they 
coDtaiD; tbey also contain varied proportions of magnesium eblorid. 
carbnuate. and nitrate, calcium carbonate, and sodinra ehlorid. The 
ma^Qetium sulphate acts as a purgative. Thrse waters are indicated 

■ in small doses an stimnlants to the intestinal peristalsia; they ai* 
tiitefiil in habitual constipation. The princi]>a1 sprini^ belonging to 
this c\nss are the Apenta. riunyadi Janos. Priedrichaball. Kissingen, 
Cnb Orchard Spring, and Bedford Springs. 

Tbe following table ' t;ives the ehemic cotnpORition of the most im- 
portant hitler wnlcns: 1 liter of water contains: 

t Sod inn Ua>iiHl«» 

■uljihat*. •iil|4i*>c. 

Ormau. Ormms. 

AiMp IS.U S.M 

Bedford Springa .. O.U 

■ KnnntttnH 7.00 2.S0 

r Kr«M .rowf "-18 2*-;» 

Vlewm W-fO ,«■'« 

Cartklian Minrral ffprtmr* •- Il-I4 

I Cnib Orclunl Sprinn (Epnom or Fol«v> 
L Springs... ." . \M 3&.SI 

^KPrii-dru'liJuill e.05 S.U 

^VXJMitiK*^ llittcriiuclli- 6-80 500 

^^ he Uov ^pringa 2.00 R43 

I MrnKt.tb.-Im 8.BT 5.43 

L fKgtM Uot S&rl4ft - is: 

I I*u«IIm n..V> lO.M 

!S«idw»iiti! «.«!• Ki.lHl 

I\'. SalpboToni Water. — Tbenc waters contain hydrogen' sulphid 
or Mumv- uthcr )iul])hur cumpouud. Hucb as sodium, caletum, mugaesiuu. 
iif {NituKiiuiu ^ulphid. The vulphurous waterx are obtained both hoi 
and <-itld: they are especially useful in the treatment of nyphilis and 
I of chronic lead-poieoning. and in bemorrhoidal conditions and con- 
of the liver. The principal sidphurous waters art- ibe An- 
'Sulphur SprinK^. California, h'n'nch Lick Kpriiig», Riehfield 
9prinK«. and Cold Sulphur .Springs. 
L^ V. Iron Waten. — Tlwse waters contain large proportions of iron; 
H they are divided into the carbonated iron waters, sulphated iron 
1^ waters, and irnn and anienie wateni. Tbe carbonated iron waters 

> CohHi's rhyuolviiu; HuTMixruticK. vul. is., p. 4.15. 



174 BEVERAGES AND BTIMULAHTB 

coDtain large quantities of carbon dioxid; these waters increase the 
number of the red blood-cells and the amount of hemoglobin. They 
stimulate the appetite, but are apt to produce constipation. They 
are indicated in chlorosis and in anemia. Among the principal car- 
bonated iron waters are those of Pranzensbad, Pyrmont, Sebwalbach, 
Richfield, Cresson (Pa.), and Rawley (Va.). 

The chemic composition of carbonated iron water is as follows ;'- 
1 liter of water contains: 

Iron bicar- Iron car- Free carbon 
boaate. booate. dioxid. 

Oram*. 6 ram*. O.o. 

Bartfeld 0.087 . . 1683 

Bochlet 087 . . 1505 

CresBon Springs 0.086 . . 1605 

Cudowa 063 . . 1200 

Elster 0,084 . . 1266 

Franzenabad 0.079 . . 1628 

Immau 0.062 . . B87 

Iron Ute Spring 0.052 0.057 987 

Koenigawart 0.085 0.0.57 1163 

Kryniea 0.029 0.057 1613 

LiebenBt«in 0.100 0.037 906 

Ifarienbad 0.166 0.057 1173 

Ojo Caliente 0.168 0.102 1173 

OwoBBO Spring 0.273 0.102 1173 

Pacific Congreee Springs 0.239 0.102 1173 

Pyrmont 0.077 0.102 1486 

Richfield Iron Springs 0.085 0.102 1486 

Rock Kdod Springe 0.243 * 1489 

Schwalbach 0.080 0.243 1671 

Spa 0.070 0.243 304 

Sparta Arteeian Well 0.010 0.243 304 

Stehen 0.060 0.Z43 1382 

Szliaca 0.119 0.243 894 

St. Moritz 0.035 0.243 1282 

Vilinye O.Olfl 0.243 337 

SvXpliated Iron Waters. — These waters contain principally ferrous 
sulphate, in addition to sodium, magnesium, and calcium sulphate. 
Many of these waters also contain arsenic, alum, and sulphuric acid in 
small amounts. They are especially indicated in cases of chronic 
diarrhea, in anemic children, in chronic gastric catarrh, in ulcer of 
the stomach, and in chronic malarial cachexia. These waters should 
be given eautiou.sly, as at times they produce indigestion and nausea. 
They are best taken in small individual doses. Among the principal 
sulphated iron waters are those of Sharon Chalybeate Spring, Bedford 
Alum Spring, Fauquier White Sulphur Springs, and Rockbridge 
Alum Springs. 

The table ' on the next page gives the chemic composition of the most 
important sulphated iron waters; 1 liter of water contains: 

' Cohen's PhyBiologic Therapeiitica, vol. ix., p. 444. 

J Protoxid. 

» Cohen's Physiologic Therapeutii*, vol. ix., p. 445. 



\YAT£R 



17» 



Iron aulphBla. 

0f«llW. 

AJcsialiad 0.04U 

Uhurch Hill .Aliini ^tpnngA 2.718 

Ritt«tiiu)j UiiKiuL fipriiij; . . .... O.liO 



MiUcrlMd 

Miukon 

Omk Uri^bArd Sprioft* ... 

Pared 

RrUc« 

Rotmobf 

^■hiiyt«r Countjr Spring 



0.1SO 
0.545 

Lino 

2Am 
i.iiiT 



Iron and Arsenic Waltn. — These waters contain considRmhle qiian* 
tities of arsenic in addition to the iron; they are indicated especially 
iu ehlorotio and anemic conditions, in chronic malaria, and in nea- 
ralgias. Among these waters may be meutloned Harbin Hot Sulphur 
Springs, Opockett Arsenic Lithia Sprinits, anil Swineford ArseniQ 
Ltthia Spring. 

The followiofT table' ffives the chomic componition of the oiost 
iinportant iron and arsenic waters; 1 liter of water contains: 

IroD iul|>)iki4r. Amrnir Kiil.Ancnaiu laittt 
15 ram J, 

Croffkett Araenic Uthia Sprlnga , . O.OUUU 

nufbiTqtK-llr ISrrbrrtiJkl ..... 0.3700 

Harbin Hnt Sulphur Springs 00300 

L«u»ifk 4.1R0O 

Leviro i A600 

RcoMra 3.200U 

Ranngna ... , 3.0000 

VI. Earthy Mineral Waters. — These waters arc characterized by 
the presence of large amounts of calcium and magnesium salts. They 
diminiiib the production of acid in the stomach, and also the 8ecre> 
tions from the respiratory, digestive, and urinary tracts. They are 
indicated espevially in chronic- catarrh of the uriuury or^ns, in uric 
acid diatbedis, gout, scrofula, and rachitis. In drinking tliesc waters 
unall quantitiets should be taken at first, and gradually increased 
until the t)ow of urine is markedly increased. Among these waters 
are ibose of Contrcscvillc, Maricnhad, Wildiincen. .Manilou Springs, 
)[oant Clemens Muieral Springs, Bedfonl Springs, Alleghany Springs, 
Capon Springx, and Greenbrier White Sulphur Springs. 

The chcmic composition of the most important earthy mineral 
waters is as follon's;' 1 liter of water contains: 



Grant. 


HrMu. 




O.OUOS 


o.nnni 


0.0003 


0.0U6I 


O.OOSO 


OOOOI 


o.ooso 


oocwa 


0.0050 


00039 


O.OOSO 


O.ISOO 


O.OOAO 



All^fawr ^rii«B 1.8D 

AlloDH Mineral Sprliif* 1.80 



CtlduB 


0«lci«m 


Calolun 


■VlRlUto. 


blmrbonato. 


earbiniMt 


6rmu, 


Oram*. 


vrflBH^ 


1.8D 




HM 


1.80 


6Ai 


OAT* 


IJW 


0.42 


o.ts 


l.W 


0,4S 


O.IS 




175 



BEVEft.tOES -lyO STIUVL.IXTS 



Calcluin Calcluni CaLciiiin 

>uJ)>Uit*. bicBrl»aii«. ~ «krtwQ>Mi 

OrORLt. (imm*. Uramt. 

BLflfard Sprin|pi4Ma(^ieMiiLS|iriiiifK) I.H4 0.42 iM-J 

flidon Springn MH 0.42 W.I6 

C(.ntri-\L-vUle 1. 10 O.JJ tnu 

DiiliiKK ... ... 1.U4 1.44 U 10 

EtLiQH Itiipid \Vc\l» U.77-OIU 1.44 0.34-0 7 !t 

Grernlirier While fSulphur tiprlnyn 1.33 1.44 O li: 

Innclbml (1. 3D 0.12 

Uukerbad M2 009 0.12 

I.i|>[>r.)<riiip- 0^ 0.41 0.12 

M.initou 8pTiiiM (K02 041 0,40-1.11 

M>ir>-iil>>i<l KvHJo1fiN)uelle . . . . . 0.82 0,00 0.40-1.11 

Old SwsL't Sprtn^s 0.22 0.00 0.51 

S7kli>nf> - .. 022 0,10 0,(11 

Wnrni Sulphur ^jirlngM . 0.24 0,10 0.08 

UniKNi'iiburf; 0.21 1.27 O.OS 

WildungipB 2.00 1.27 0.08 

VII. Acratothermat Waters.— Tliese watcra, also known as simple 
OP "indiffereul" waters, arc characterized by the fact that they are 
obtained at a temperiiture of 85° F. or over. They do not, however, 
contaiD any active mineral iaKTedienta. They are rarely used for 
driuking purposea. but are used mainly for thermal baths. (For a 
more eomplele desL-ription of mineral waters and th^ir uses the reader 
ia refcired to the rcecut and moat excellent volume on HatneoIoBy and 
Crunotherapy" by Kisch, Hinsdale, and Peale, in Cohen's System 
of Physiol ojrit' Therapeutics, vol. ix. ) 

Diet at Water Cures. — Water cures should always be carritd out 
at the watf?rirtg<places. Under exceptional circumstances a water cure 
may lie ordered at the patient's hnine. hut the resull-f are never as 
Sfttisfaotorj- as when the patient has a chansre of air. of scene, plenty 
of out-duor exercise, and freedom from care and worry. The methods 
and the diet vary greatly at different springs, and for the moat part 
iinneecR-iarily so. Many of the diets and mi^lhods are empiric and are 
not founded on any sound htmla. Certain articles are forbidden at 
c«rt«in spring, often for most fanciful roMons, The routine and tbc 
diet of many springs i» (ho same for all patients, quite regardless of 
tile nature of the dL>tease, An important factor in the failure of 
water cures is the abuse of water drinking. Patients with weak 
hearts, chnmie nephritis, or dilated and atonic st*nnaehK may easily 
take more water than ran be disposed of, and positive injury may 
result. 

As a rule, the water should be taken in the morning afti'r rising, 
and fnmi 200 to 800 c. em. should be drunk slowly, preferably whilst 
the patient strolls about. One-half hour should invariably elapse 
before eating, and if large quantities of water are taken one hour 
ahould be the shortest interval between the water and food. Break- 
fast should be followed by walking or other out-door annutt-ments and. 
if the patient is not obese and requires it. half an hour or an hour's 



9V1 

nvi may ue taken before and after the midday meal. Id some cases 
uuliT is taken betwevu breakfast aud ihe midduy meal. 

The afternoon sliould bo spent out of duors if possible, and water 
may in Konie cas«s bo taken in the afternoon, Ht U>asl half an hour 
before aftrrnoon tea or cotfee. The evcniDg nicul should be ligbt 
ajtd takfu nut later th&a seven o'cIocIj;, and the patient should be in 
Led by nine oVIuok. Cari^ should bi> taken not lo disturb too radieally 
the habits of the old and iutinu, tut by so doing often more hanu than 
good may result. 

The diet ordered will, of course, depend upon the nature of the 
diseaae. In general, it may be stated that the diet should he that 
u'hieh the |iaTient's (•ondttiiui calls for. and not the more or te«s arbi- 
trary diet of the partieutar ttpnng whieh the patient visits, riealthy 
iudividualM umy takr tlie striel Ruri*s if they so de»ire. and often find 
the change intere.stin|; and feel better for the mental effect so pro- 
duced. In a general way the diet cures at water! dr- places forbid 
meats difficult of diseutioii, as fat or salt pork, smoked meats, fat 
sauaagc. pale de fuie gras. sardinm. lobxIerK. eelit. and the like, and 
certain vegetabics are uaiioUy on the forhiilden list, aa rahbage, yonng 
potatoes, old peas, truffles, mu.shrooms, unripe and overripe or stale 
fruit. berricK in some plaees. nnts as well as all very highly seaaoned 
atid complicated dishes, checfic. etc. 

In (,'euerul, all strong aleohulie beverages are fnrbidden, but, as a 
rule, light wine or beer is allowable in amatl quantities if the patient 
can be trusted not to take to inuch. ColTec and tea arc usually al- 
lowed in moderate quantities, but ehocolntc or ewoa may be suh- 
■tituted in most instances when tbey are contra indicated, or some hot 
grtiel or subetitutc for coffee may be taken. Smoking is usually 
forbidden, hut this rule is very frequently broken. The advice of au 
enlightened physician at the cure is very valuable. 

Besides water, there are a number of beveragcK that serve not only 
to met-t the ph>'Nical nec<lH of the body, but arc also taken to produce 
B stimulant effei-t. They also serve the purpose of a stimuluut where 
sneh is necessary from time lo time, as in the case of disease. The 
habit of using beverajres. either for the purpose of relieving fatigue 
or for conviviality, is most pemicious. as it is apt to induce a habit 
for taking such drinks, which in time leads to excesaea. We shall 
n«>w lake up in order the other beverages — tea, coffee, eocoa. and the 
varimis alcoholic stimulants. 



TEA 

Tea is a preparation made from the leaves of an evergreen plant 
known as Tkea. It ia grown in China, Japan. India. Ceylon, and in 
North Carolina. Tberr are many varieties of the plant, and the 
iUivor of tea varies with its source and the variety of the plant. 
There are two great classes of tens, the green and the black, the 
13 



178 BKVBttAfmS AyO 8TIHVLAXTS 

distinciioa between the iwo being due to the method of preparation. 
Several times during tlie year the pUut sends out young shoots, which 
are picked »;« often as they appear. Black tea is prepared by exposing 
the fr&'th leaver to the rays of the sun; aXler they have beeome with- 
ered the constituents are liberated by rolling and breaking up the 
fibers and eoUs of the leaf. The brokeu-up leaves are then collected 
and allowed t« fennt-ut wliile Ktill moist; during tluK process the 
lannie acid is rendcn^d Iras Kolnble while the essential oils are in- 
creased. After again expo^ine them to the sun the leaves are dried in 
an oven. In the process of preparing green tea the Chineee "withpp" 
the leaves in pans at a lempcrature of 160* F. ; the Japanese steam 
them. The fluid principles are then liberated by breaking up the 
leaves; linally they are a^caui withered, sweated in bagB, aiul slowly 
roasted. The chief difference between black and green tea lies in 
the fact that blaek tea is fermented while (freen is not As in the 
proeewi of fenuentatinn the tannic aeid becomes lew soluble, black tea 
contains much less tannic acid than green tea. The following table, 
from Bannister,' gives the composition of black and of green tea: 

Bhck ua. OTMn (ML. 

vvttw fisa ».»6 

Cm&rin J,24 2.33 

Albumin (Inwlubte) IfM KM 

.Albiiniiii (soluble) O.T0 O.SO 

Alrokvlic rxtmci , 6.79 7.48 

Dextrin OM 

PccUn and p««tic arid .•...■4<.... . .. B.80 3.SS 

TnnBic ncid i9M 27.U 

ChlorophTll ud rMlB 4.60 4.20 

(VlluloM , , S4J>0 8«4H> 

Aeh 6.27 6.07 

Tea has praetically no Dtttrient-intrr^ients. Its prineipvl con- 
stituents are catTein and tannic acid, and its special aroma is due to 
a volatile oil. It owes itii stimulating effec*t to the prewnee of caffeio. 
As the arlion olf tannic lu^id in detrimculal to tiit: process of diges- 
tion, tea should be so prepared as to contain as large a proportion of 
caffein as possible and the smallest possible amount of tannic acid. 

\Vbeu the leaves arc placed in boiling water, eaffein is extracted 
very rapidly. Tannic acid, however, in much less soluble; it follows, 
therefore, that in order to ha%'e an Hltle tannic acid in the tea as 
posBible, the leaves should be boiled in water for aa short a time as 
practicable. To prepare the infusion pour boiling water on the tea> 
Iravcs and allow the mixture to stand where il will keep hot, though 
not boil, for from three to five minutes. Water used in preparing 
tea abould not be hard or stale. 

When the tannic acid which tea containa occurs in large quantities, 
the pepsin of the gastric juice is precipitated; in weaker solutjorw tea 

I rantor l.e<rtiirra. IR1I0. 



COFFEE 



m 



rrtardR digestion. Por these reasous wa is not a suitable beveragfr 
for [K*rs«ns suffcriny frum ydslric dismrbauc-es. Among the more 
promiuent symptoms of excetaive tea-drinkmij are K>8tric diaorders, 
tiiirdiac distresK, nod a variety of nervous symptoms, such as ex- 
eitability, sleepltafimt'tiii, uud miuicular incoordiiution. 

COFFEE 

Coffee was introduced into Europe in the same century aa tea, and 
only a few years later. It is prepared from the seeds of Colfta 
anbica, which was originally grown in Arabia, but has since beta 
cultivated in Java. Ceylon, Costa Riea. and Brazil. The fniit of the 
plant, which has the appearance of a cherry. whi*u opened discloses 
the coffee-fct'an. In order to prepare the b*'«ns for use they are dried 
at a hi^h temperature aad then roasted and ground. lu roaaling, 
one-rifth of the cafTcin and one-tenth of the fat present are lost. The 
aroma of colTee is due to the presence of caffeol, an oil liberated in 
roasting. Arenrding to Hutchison <p. 310), a cup of black coffee 
contains about as large a (|uantity of tannic acid and catfi^in as a cup 
of tea. Coffee is often adulterated, cbieory, acomH-, and other sub- 
stances bf'ing added for tliis purports. The tidultcmtion may not be 
injurious in its effect, but alters, sometimes even agreeably, the flavor 
of the coffee. 

In eouty. nephritic and arterio-sclerotic patients it may be desirable 
to nmit coffee from the dietary on account nf the large quantities of 
eaffcin bodies which Ibia beverage contains. There are two prepara- 
tioiu however from which a large portion of the caffcin has been ex- 
tracted, ie.. Dekofa and KafTee-Hng. to which this objection does 
not bold, if taken in moderation. Dekofa contains about 0.13 caffeiii 
and KatTee-Hiig only O.Oli per cent. 

Preparation of Coffee. — In nrder to obtain iwlfee i»f the finest 
flavor, the bpans sinmUl be roasted and ground shortly before they are 
to be used, aa 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 fev 
moments in a hot place, but boiling muHt not be allowed to continue, 
or the aroma will be lost and the coffee contain too large a percentage 
of tannic acid. 

The ffTect of eoffee on the system la that of a simulant, due to 
the eaffpin pre^ient; it acts directly on the ci>rebral centers, stimulates 
the heart, and deepens the respirations. It is an excitant of the 
o#Fvous system, and in .some jH'mons pniduees nervonsnew*. excitabil- 
ity, and insomnia; in othem it acta a^ an agreeable Jttimnlant. In 
penons suffering from dy«jiep«ta it has a tendency In diilurh diges- 
tion. It lessens ihe strain of fntiirue. and soldiera frequently depend 
upon its stimulating effect during long marches. 




BBTgRAOBB ASD aTlVPLANTS 



7h^ following table, lakmi from BuuiiUter's Caiiior Lectures, givw 
the I'ompoKitioti of ruw and of roaxtitl cofft-e: 



Oifl«in 

Saccharine Eutter 

OiRitic aciils .... 

Alcoholic pxunot (nitrojjcnoiw knd «6i»T> 

Int^DMller) 

F>1 ind nil 

Lc^min 

IX-iUiii 

Celliilnoc and ioMiliible colartng-rtMtter - 

Aili. - 

Uoutart - - . . 



Ilmb» 



Rmw. 



1.08 

8.46 

6.W 
12.00 

9,87 

0.87 

37.96 

aos 



BOHUtI 



0.82 
0:43 

4.74 

14.14 

13.50 

11.2.1 

1.24 

38.62 

4.&t; 

ft.fi3 



BwtlnAlaa. 



Raw 



l.ll 
8.90 
9.58 

4.81 
Il.Sl 

1 1.2S 
CM 

S9.m 

V.64 



i.on 

0.11 
IM 

I2.fl7 

laii 

13.18 
I.3S 

47.4S 
4.88 
1.12 



COCOA 

Cocoa WHS introduced into Europe loixg bi'fore either coffee or reft.. 
It is pirpared from the seeds of tlife cai'ao tree. Tkeohrama nicao. 
The sfivda are LTiiitaiued in a pulpy fruit, somewhat rcsecibling a 
cucumber, frum whiL'h tbcy are pxtrarted. The fruit is gathered 
iuto heaps and allowed to ferment, when the pulp becomes loonencd. 
Durini; thi8 process the seeds become durk and luse Dome of their 
bittcnifSK. They are thcc roasted, by which proccsji the^- are broken 
into bits, constituting the so-called "cocuo uibs." A decoction of 
cocoa nibs is made by boiling the seedn in water for several hours and 
removing Ibc rcHidnc by Htruinin^. Coi^oa, a» ordiiiurily prepared, is 
marie by (frindinfj the seeds into a paste, to which suRar or starch 
in added: if starch is used, the cocoa is boiled for a few niiuutes, but 
if sujrar is added, the cocoa only requires Ihc addition of boiling 
watfr or milk. 

Tlieobroiuin, the chief alkaloid present in cocoa, occurs in amonnta 
of from 1 to 2 per cent, ('ocoa also contains nitrofrenous substances, 
15 per cent.; tannic aeid, 5 per ceut. : starch. 5 to 15 per cent.; fat, 
known as cocoa-butter, -(5 to 50 per cent.; mineral constituents. 2 to 
3 per cent. 

ThKibromiu, while a atimnlant, ik lew; apt to induce nervouH 
KvuiplomM, auch an KlceplesKncs^s and palpitation, thtui cither tea nr 
coffee. By reason of the larae proportion of sugar and fat contained 
in it, however, when used in excess, cocoa is likely to produce in- 
digestion. When not too rich, it forms a nutritious drink especially 
iiftefiil fi)r children nnd for ponvBlcfiwnts. 

The table on the next page, taken from Ewell,' gives the cliemic 
analy<>i8 of various cocoa preparations. 

Chocolate in prcjMirod by adding starch, sugar, and such flavoring 

> dUen'a ComiDerL-ial Organic .^nalyala. toI. HI, p 2. 



A LCOBOL 





m. 


Vlbar 


rann- 

■mar. 


Aah. Added Msnik. 


Fit's «)eo« extivct 

Schtui IMF's Mooacau . 


30.9ft 


a.89 




4.M NoM. 


ni.ts 


3.70 


■ 


6.33 " 


Van Huolen's cocu« . . 


2!'.BI 


4,.'» 


' • 


8.64 


JUookti't Dwcb cocoa ■ 


31.4i) 


3.76 




0.061 " 


RooDtrac^a tooat. axtnct 


S7.M 


4.^ 


. • 


8.48 


u 


fioantne'a poirderad 












«h«cokt« 


25.&I 


1,30 


51 


1.66 


V*rr Hi tic arrow r«>ot 




SA.IH 


1M 


56 


&1A 


Miioh amiw-rDvi- 








1 Miirh vht«l-«larrh slid 


cIlOColUA 


18.00 


0.S1 


U 


1.16 Mtue aRow-reoc 


Ldodoa coooa (iinknoirn 








1 


vrnkcrrj 


11.13 


2.IS 


S2 


£.62 , Miieb arroir'raot 


ChocolU'MAHcr . 


£1.13 


1.10 


B8 


t.-«0 1 None. 



suMances as vanilla to cocoa. I( i^ontaius 1.5 per ceot. of tbrobromin. 
15 |wr ceut. of fat, 5 per ceut. of iiitn)gcnou8 substances, and about 
60 [mt wni. of sii^r. 

In addition to Ihrir stimulating effect, cocoa- and chocolate [Hissees 
a marked nutrient value not possessed by either tea or volTee. 

Thp kola nut iwMsessps projVrlies simikr to l>iotte of cnooA. It 
ctiiituins un aikuluid. calTriu, tlicin, ur ihi-obromiii. 

ALCOHOL 

Aleohot is prixlui^ed b.v the fermentation uf sugars with yeast, and 
ihv priiici|>ttl vouslitiicnl in all alcobolic bi-vcruKoi is clhyl alcohol. 
hJi hough other const iluonts may modify the ucttoQ of various 
bcvfriiitcs S4> that the efTecl produce*! is not aluayti exaolly the same. 
The ^luvuiie contained in fruits is fermented din-dly into alcohol, 
wbereMK the starcbL*)!, in such subHtHriL-cs hk pntatoest. grains, etc., are 
itiuvrrt«l into drxiriu and maltose, and then by the aid of diastatic 
feruieots, before the alcoholic fermentation can take place, Ihcy are 
converted into glutvjse. 

.Mcohol lui.>* a food value of 7 calorics per gram, and the law of the 
eonservatioii of euergy obtains with the alcohol diet jiiut as with the 
ordiniiry diet, and the eneri-y of the alcohol oxidized in the body ia 
iniiwformcd cumplelely into kinetic energy and apjK'ars either as 
h(>al. or tu! nuiseutar work, or both. To thL<t extent, nt any rate, it 
is nied like the enent>' of protein, fats, and carbohydrates. The fat 
protivlioii followint; the u&e of alcohol is ver>' slightly different from 
that of onlinnry fuod. and it apjuirenlly protects thf Iwdy fat i|uit(^ 
an rffrelively lis do the fats tind carbohydrates for which it in sub- 
stituted. Th<» power of alcohol to protect the pnttcin of food or body 
ttnue. or both, from conHumption has been clearly demon^itrated by 
Atwater. Its action in thin rCHpccI appears to be similar to that of 
tbe earbohyd rates and fats, nnd in this way alcohol serves the body 
aa fooil. In sijuic caws it ia apparently eininl, and in (itbrra inferior. 
to fal and carlwhyd rate, bnt it is by no means oertain that these 
Utter are always i^ual to each other in this power. At times it 



182 



BBVEItAOES J.VO STIlTCLAyTS 



seems to exert a special aotioo, aiid in large quantities is positively' 
toxii- arnl Hiijy pwuni, or cveu prevent, mftabolism in general, and 
pruti-iii mi'liilioli-siii in partiuiilur. On the othtT hand, in small doses 
it dffniti. ut timt's, to Imve an opposite infliuMirc, tending to increase 
disiiileifi'aliun of proiuiii. This action, though iiat coiic-lusively 
demouHtrated. is very prohaUc, and thus nlTords a satisfactory ei- 
plaualion for tli*.- oMaaiouul failure of aU'Dhnl to protect proteiu. 
AtwiitHF Htates thtil the only jiistitication for calling alcohol a protein 
poiaou is found in this disiutegratin^ tendency. This action appears 
to be temporary and moHt liable to occur in people little itccustomed 
to itK use, Hiid ilif oirenmstanc^'s under which it ocenrs cannot be 
fully defined. In modi-nitr iiuuntitif-H alcohol produces no considera- 
ble iuert'ase in the amoiuil of heat radiated from the body, but in 
large quantities it causes a dilatation of the vessels of the skin, in- 
creases the circulation through the vessels near the surface, and thus 
iliereasi^K heat radiHtinu. 

TIic nui'siioii of altohol as ii .source of muscular encri^ is one of 
considerable intei-est. iT would seem, from Alwaters experiments, 
that it eontrilinies its share for muscular work, but its desirability as 
a pari of the diet for nniscular work must be decided nol on this fact 
alone, but on the effect of the alcohol on the character of wf>rk. 
Atcohul lia« a favorable aotion on the performance of muNcular work 
both whi'U the muscles arc vigorous ami when they are exhausted, 
and fhi.«t effect is seen almost immediately at^ter the administration, 
but lasts for a very short time and is succeeded by a paralyzing action. 
This later paralyzing action overbalances thi; primary stimulating 
effect, so that ihp tiuni total of the amount of work done with ak-ohol 
IK less than that thine without it. Similar dopressing etrcctit are not 
seeu to follow the use of tea, coffee, or kola. In practical tests with 
the use of alcohol in the diet of people engaged in mnscuinr lalior it 
aeemed to prove that the subjects work to a slightly better advantage 
with ordinary- rations than with those containing alcohol. 

Atwater found that the effect of alcohol in small (iuantitiea is slightly 
to incnra-v; tlic diyestihility of proteins, hut not to alter the digestibil- 
ity of other nutrients, that is, earhohyi!rate.s and fats. At least 98 
per cent, of alcohol ingestf-d is oxidi^^d in the body, whereas onlinarily 
98 per cent, of carbohydrates, 95 per cent, of fats, and 93 per cent, of 
proteins are oxidized. The rapidity with which alcohol is absorbeil, 
anil the ease with which it is oxidized, make it a valuable adjunct in 
f<*cding individuals in extreme wasted conditions, as in prolonged 
fevers. 

Quite as iniportan) as Atwatcr's experiments on the nutritive value 
of alcohol is the valuable review of Abel on the I'harmacolngic and 
Physiologii- Action of Alcohol, published in Physiologir Aspects of 
the Lifpior Problem. 

As far fls experimental evidence goes, if alcohol is introduced into 



n 




183 



\ht body without local irritatiou. it is, sIricUy speaking, not a clr- 
vulatorv stiuiulaxit. la moderate quantities it has qo effect ou the 
heart itself, and neither sliniiilatett nor (U'pn-vieK it, but thiii state- 
lueut is luiMed on laboratory cxperimi-nts covering; only a -short period 
of time and may not hold Rood (or the t'ffect in the proloiijiod daily 
UKP. Ijoige quautilii» of aleohol weaken the henrt. It has no action 
t-ither on the peripheral or (.-eutrul ends of the nerves whirh iniutrol 
the rate and force of the heart, except under unusual eireum^tanccs, 
as iu pi-olonged or severe intoxicalion. In moderate (|uantilieK it 
has no eflfect ou the arterial blood -pressure, but when suSicieiit baa 
been giveu to induce a change it is a fall and not a rise, exeept under 
certain cireumstanees, where the cirniletnry appflratiix is in an ab* 
normal condition, In tlie early ntai;eR of its action it causes some 
flushini; of tht? skit) and brain, and later. wh*?n very larfce qimtiritioK 
have been taken, dilatation of the abdominol vessels oeeura. The fall 
of blood -pressure due to very larne (|uaiititie« w a toxie phenomenon, 
and is due to the depreNsant aetinn of the alcohol on the nervous 
centers which control the calilH-rs of the arteries and also in part 
to the weakened heart. When alcohol is introihR-ed into the eiroula- 
tion it acts aK a narcotic, but ou-ini; to its local effeet ou the mueoug 
membranes, and through its cen-bral action ou the various parts of 
thp eireulatnry system, a train of phenomena may hp priMlucw] which 
justify, to a ccrtidn degree, the term "circulatory stimulant." M<wt 
common of these h the Hlowini; or quirkeninf of the pulse-rate, as 
fmiuently obBC/ved iu medical practice. 

(>n the respiration alcohol acts as a respiratory stimulant of 
moderate power for human beings. Duriuf; a period of an hour or 
more after its administraiion it causes su iiiereaKe iu the volume of 
air passing through tlie lungs and in the absorption of oxygen (!)Ji 
per cent.). 

Highly flavored wines, brandy and other alcoholic beverages which 
contain larger amounts of stimulating e&tcrs, have a more pronouni-*;d 
action than ethyl alcohol, and the stimulating action of alcoholic 
beverages is greater in the case of fatigued persons than in thoae in 
nowise exhausted. Increased heat dissipation always accompanies 
tite above-named effects. The compensatorj* increase iu heat produc- 
tion requires an increase in the oxidative processes in the tissues, and 
the increased demands for oxygen is the direet eause of the increased 
activitj* of the respiratorj* center. Small doses of alcohol have also 
the effect of increasing the movements of the digestive tract and of 
causing a state of unrest or tension in the skeletal muscles, and thus 
further adding to the demand for oxygen. 

How far the action of alcohol on the central nervous system, and 
how far its influence as a protoplasmic poison may modify its opera- 
tion as an nntipyretic; how far vanations in the external temperature, 
ia the humidity of the air, and in the temperature of the body itself 



BUfEKAaJSa J.VD BTIXUtASTa 



influeuce its action, must, all receive further Ktudv. In a word, the 
detailed chemic and physiolojcie Htiidira sirailnr to thtwe that have 
been made ou other atitipjrctii-s arc demaudcd. Such Htiidics will 
pmbaWy tend to harmonize thy uouflit^tiiig views at |>rpsvut i-nmr- 
taiued iu regard to iht* use of ali-uliot in fever, and t-xplain tlir mure 
delct«rioii8 eft«ct« of alcohol in polar and tropical, as compared with 
temporatc regions. 

TIk* effeot of alcohol oa the di^estioo and sci-retion ix In im*rcaae 
the flow of saliva friim the stimulating effect of the nleoholic beverage 
ID the mouth. Thig aeeeleration of set'retion is. however, of brief 
daratioD. Not only is the volume of saliva increased, but also the 
organic and innrgani*; cioiistituonln. Thin pffeet io in no seiiac pfHiiilbir 
to alwibfil. but IK t'ommon to many so-called Htimnlantx. I'pon the 
f^oatric sccn-tion alcohol and slcoholin litpiids have a murki-d effect, 
increasiiii; both the quantity of gostrie juiec, the amount uf aeid. and 
the total solids, and this action is exerted not only liy the presence of 
alcuholie heverases in the stonia^lb, but 8lsi> indirectly throuicb tlie in- 
flnenee of alcohol abKurticd from the intestinL-. This increnae iu the 
flow of trastrii! juice may cuuntorlmlanec the greater or lesser retarda- 
tion of the digestive changes caused by alcoholic beverages. This 
retardation may not be great in smme instanee-s, owing to the rapid 
disappearance of the alcohol from the alimentary canal. 

The effect of alcohol on the nervouH Hyslera varies greatly in differ- 
ent raeeH, in different individuals, and under different ciroiiniittanees, 
ami then; arc uIno variations in ita action according to the choice of 
beverage, though this is by no means eonstaut. The environment is 
another fiietor. and gay companions, bright light, and miisie increase 
the exhilarating effects.. In small Quantities it produces, in most 
individuala, a feeling of well-being and gnod Fellowship, and, in 
larger quantities, il caust^ a tcndt-ney to Ifniuacily. geitliciilatinn. and 
a feeling of self-eiiufulcnce. The face is usually flushed, the eyes 
brighter, and the self-control lessened. In still larger quantities. 
the individual beeomes boisterous, may wish to sing, shout, tight, 
and in other ways disregard tlie ordinarj' conventions of life. Larger 
quantities are liable to lie fullowed by Diuxenlar inconrdination. shown 
in the uncertain movements, staggering gait, and stammering speech. 
Sooner or later sleep follows, from which the individual awaltes with 
various unpleasant symptoms, chief of which arc thirst, nausea. 
>*omiting. headache, and neuralgia, and sometimes acute or subacute 
gastritis. After very large quantities a condition resembling ehloro- 
form anesthesia supcrvcne-s. 

There are two opinions concerning the action of alcohol on the 
nervous Kvstem, that of Biiiz and others, who believe that il first 
stimulates and then depretwes, and that of Schmiedebnrg, Bnnge. and 
others, who think that it depresses from the stflrt, and explain the 
apparent stimulation by a depression of the inhibitory ccJiters. 



4 



JLhCOHOl. 



185 



On the intellectual faculties the receptive powers are lesscuuU ev«n 
by smatl quoutitJcx, but small quantities lessen the time required for 
simple association processes, such as rhyming, while larger quautitiei 
duress all the iut«-llectiuil faculties. The iudividual often believe?! 
he is doing better work and more qnic-kly, when, in roalitv. the work 
is not ax kikmI. and taktx a liitig:cr liiise than without the alcohol. Ex- 
perimcntH with typesetter^ and oihiM-8 show that alndinl causes the 
worker to make a greater number of errors than he would without it. 

The deleterioiu effecls of larger quantities of aleohul thjin the 
individual eau metabolize, voutiuued over long periodn of time, arc 
too familiar to need description. While it is Inie that many in- 
dividuals take eonHiderable alcohol daily over loii^ periods of lime 
without causing any patholofric changes, wc have dcminiNlriilpd on 
aiiimalK and it i» frequently set^n In man thai cirrhosis of the liver, 
kidney, and other organs may be caused by alcohol, although fatty 
deftoueration of the liver, kidneys, heart, and reswis is rather the 
more common change. The more eoneentraled the alcohol and the 
larger the quantity taken in a siniile dose, the mon- liable is ah-ohol 
to ettOM tissue chMnges. There \% considerflhle reason to believe that 
alcohol is not nn (rn-at a fnclor in eauxing arterioKclerosix as was 
formerly helicvcd. 

The Use of Alcohol as a Food and In Medicine. — T\w use of 
alcohol is of uudnubtcd value in mnlicinp. and the xweepiuK con- 
dcmnatioa that it bus received from many quarters in recent years is 
not merited. The use and abuw have been confused. 

As u food it can be ulilizcil only within certain limits. »» only what 
would represent "i ounces of alcotml can be metabolized by the average 
iudividual within twenty-four hours. For some this is too low an 
eMitnale. and for others even this amount c«iuld not be utilized with- 
oal the pro4luetion of symptoms or uiipleaKant after-elTcetii. In fevers 
and other conditioiut. where xullieienl food cannot l>c administered, 
alcohol may be added to the diet with good effect, and in toxic condi- 
thms, such as are often seen in typhoid, it is of incalculable value. 
It is readily absorbed, easily assimilated, and seems in these toxic 
to aid in eoml>aTing the toxemia. 

It is frojuently umhI as a stomachic, to produce an appetite and 
to stimulate the wtTrctioii of ■.-Hstric Juice. It acts also as a respiratory 
AtinnUnt. and may be ii»ed in conditions of heart weaknciw and dis- 
turbances of the circulation, as through itA cerebral and local action 
it may influence the circulation favorably, causing, as it were, the re- 
estnlilishiiient of more or less normal (•onditious by dilating supcrticial 
»e«rlK. and by slowing or acecleratiug Ibe pulse-rate, and by its 
DUmerous indirect inflacoccs causing a different balance in the parts 
and fnnetiotis of the vascalator^- apparatus. 

It ia contra indicated io individuals who have previously been 
Tiettms of the alcohol habit and are liable to acquire it again, and in 
individuals who come from families that are prone to form drug 





BBVKH.UiBa .l.VD eTIUVLAttTg 

hsbitii. It should ucit be uschI where it chiisi's iiiipleaKUtit s^rmploms nr 
excitemcnl, although rbcw may be due to too Iwrye chises. If the 
odor is appurc'iit «u the breath some time after the adnuDistratioii, 
it is very ]]rababte tbiit ibe quantity u(lmiuLst«red has beeu too great. 
Snuill, repeated diwes, well diluted with water, give better results 
than larger or more eoncentrated doses. The best indicatioos that 
the alcohol is well iMirne is a ehaiige for the hetti-r iu the yeneful 
appearance and coiiditioii, with improved eirciilatiuu as evidenced 
in the appearance, pult*-raie, arterial leosion, and the quality of the 
heart souriiJs, In severe toxie eoiiditions, from '« to 1 oimee oE 
whisky and, in some iristanees, more may bi* Kiven every one, two, or 
thn-e hours, aeoordiiitr to the effect produced. 

Consumption of Alcohol. — According; to Thompson, the total con- 
sumption of atenholic beverafres a year in America is more tbatt 
1.0t)0,000,0O0 gallonK. The following table, taken fnim Thompson's 
Dietetics, p. 2^9, gives the annual per capita consuiu])tiuu of alcoholic' 
beverages in 1890 : 

Baor. Wiim. SplriU. 

Eiijflnml 30.ai O.30 IJM 

Kionp« S.IO 21.80 IM 

C*riusny , . ,,,..,..,... 25.WI 1-84 1.84 

L'iiiU>d Stati>a ... ,..,.,...... 12.30 0.44 0.84 

Alcoholic beverages arc divided into Keveml classes, e. g., Hpirits, 
liqueurs and bitters, malt liquors, wines, etc. 

8FIB.ITS 

Spiritfr are produced by feinueiitiug sacebarine substances and ob- 
taining the alcohol by distillatiou. Of these aubstaucea, corn, rice, 
barley, molasses, and potatoes are those most commonly utilized tor 
this purpose. In addition to the aleohol, by-prcHlucts are formed, 
and it is to these that spirits owe their ehiiractcristic fla%'or and odor. 
The by-produeta eonlain the higher alcohols, such as propyl, bulyl, 
and amyl aleuhol. this mixture forming what in known as fusel oil. 

Whisky. The United States Pharmacopeia formerly defined whiskj' 
iLS "an »l<>oho1ie litjuid obtained by distillation of the mash of fer- 
mented grain > usually of mixtures of corn, wheat, and rye) and at 
l«aat four years old." Whisky possesses an alcoholic strength of from 
50 to 5S per cent, by volume. It should be fre« from diaagrceable 
odor. The ether and aldehyds contained in whisky beeonte altered iu 
character as it ages, and the flavor is thus rendered tnore agreeable. 

Brandy.— In the United Static I'harmueopeia brandy was defined 
•a an "alcoholic liquid obtained by the difitillation of the fermented 
unmoditie^l juice of fresh grapes, and at least four years old." 
Brandy contains from -46 to 55 per cent, by volume of aleohol. The 
qoality of brandy depends upon the variety of grapes used aud npoa 
the length of time the brandy is allowed to stand: the older (he 
brandy, the better the quality. With braudy, just as with whi8k>', 



AfX!OB0L 



187 



on standing etiiers ami aldebyds ore produced to whicli tbe special 
Savor of the brandy ia due. 

The color of brtuidy is due to tbt tannic acid extracted from tbt; 
oak vhnim ill which the bruudy is coatauied. There are many iuforior 
iradfM uf brandy uu the uiarkel, ttome being merely alcohol colored 
4md flavored with various c&scnccii. 

Rum. — Rum U the pruduci of the diiitillation uf fennentfMj molaaieii, 
itjs flavor heiui; due to evruiu hy-prudia-ts. Some of the so-caHed 
"mm," of the market is made by addinft varioua esseuces to alcohol. 
Ou Btaudini;, by the dcTelopmeut of speeial aldehydii and elhi^rs. nun 
improves in quality. Il contains about the sanie piTL-eiiluge nf aleobol 
«a do brandy and whUky, 

Gin. — Gin i« pnidtu-ed by the distillation of ryo and mall mash. 
its flavor beint: due to juniper berries whieh are added duriiie fer- 
mentation. Inferior grades of (fill are manufaeturL'd by addiu^ juni- 
per berries, turpentine, ete.. to alcohol. ''liii <.*<iutaiii8 from 15 to 20 
per reiil. of altr<>lK)l: but the strength is suiiietinies increased by th^ 
addition of aleohol. so that it ma>' contain aH mueh as ^3 p«r cent, of 
aleohol. 

LiatTStmS kWO BITTERS 

Liqueurs or eordiiils and hitters ennlaiti a larsp pn)portion of 
aleuhol. and a high pert^rntap* of Hutrar luid es^jt-iilial oils. The fol- 
lowing table eives the compoHitinn of some of tbe more common 
liqaeora and bitters: 

Jna/y*r« a/ Jjigvmtrt, — {Bi»pp.\ 



IJuui 

liobc 



liiiucur. 

Ice) 



.AUmba . 

.Aniw . . 

AaBOMun 
CnnfM 

Gtainrtuw 



AlrolMl. 



Volnou. 



WfllRht. 



44.0 
32.0 

mo 

%0 
38.4 
4S.0 
4£.4 
36lS 



BxUwto. tafw. 



BdL 



Oral. 
0.280 
30.9 0.310 
3&2 O.IDO 
4Sl2 O.OW 
lA 0.140 
SC.& 0,076 
88.4 I 0.110 
84.0 0.001 



KALT UQUOBS 

Under the heading- of mult liquors are iucluded beer or ale and 
atout or porter. These beverages are made by fermenting malt and 
bop». Malt IK produeed by allowing moistened barley to germinate 
at N moderate temperature; in t\\\s prtxrciis the diastatic ferment acta 
upon the starch, couvertimr it into suijar and dextrin. After dryius 
and {Trindiiig. ihe malt is mixed with water and thus made into a 



AWOUVL 



IBS 



B«cr. — The quality uf the beer (If|]t.'ud» lan^y upon the tempera- 
tun- at u-bif!li the process of miinuEnvture is carried on. Pole beer 
is pruduccd by drjing the uiasli at low temperature, whereiu tbe 
darker bven arc tfav n.-»ult of drying tbe malt at a higher temperature. 
The iafusiou of maJt is termed "iiuiKb. " The dtastattc Bctioii of 
iiuUl is iiihibited by boiling the *'miu(h" with liups; lu thin way 
tanuic aeid aud extractives are wilhdrawu. The miush ie now cooled 
and ferineiited with yeast. In orti«r to secure a pure beer, great 
caution must be excrciHcd to procure pure yeast. The yeast thai 
rises to the surface after fcrmentatioii is skimmed olT. the remainder 
settliug at the bottom. Beer is uow jilaeed in eaxks. the yr^ast vrhieh 
wu» itliowed lo remain L-oiititiuiug to produt:t- fci-nientiitioii. The 
longer this proeesg is allowed lo eontinue, the slninfter is the per- 
centage of aleohol in beer. The mild or bitter beers are distinguished 
by tbe n^ativc proportion of bops contained in them; the milder 
foruis contain eon)>iderable i|U8ntiticb of hops, whereas the bitter 
ones uontain but snuill aiiiounI», 

Volatile bodies are also produced which, iu addition to the earbonio 
■eid vati forme<], add to the pleaxant llavor of the beer. In order to 
add to tbp hecpini; qualitirfi nf bi'cr various preservatives am added. 
Bach 88 ealeium sulphate. saHoylio acid, etc. TlteHc subsitftiiees not 
only affei'l the flavor of the beer, but when taken in large qunntitie« 
ttave a deleterious effect on the system. 

Porter and Stout. — Porter and titout are made by fermenting 
matt, the latter, bowi-vcr, bciug roaiiled. during which prtn-eat b ecr- 
tain amount of caramel is ppiduw-d. It is to this substance that the 
dark color ik due. Beer as well an stout eontainit from 3 to 6 per 
cent, uf alcohol, from 2 to 5 per cput. of dextrin, and from 0.5 to 1 
per eeoi. of sujrar. 

The following table * gives the composition of some malt lir|unrs: 



■ The 

^^^^F Ba^uiwi winMr hear 

^^^H IhrmrianMintDcrbcvr 
^^■jlnkh HoOnii ■ 
^^^■Moaieh 8[HUnb»u . 

^^^KP!lwnrf . . . . . 
^^^^1 MuDK-li It<i'k>lM«r 



KiffliBhairniHl poitar 
BtrnB 



white bMr 



9t.Hl ■ 

tW.71 

' I 

as-TS 

HMO. 



3.21 

3,08 

a.70 
a.46 

4.07 
4.M) 
9.91 



0.8) 
0.49 



0.71 
0.5» 



0.44 

0i87 



O.M 
0.M 



192 

*JtS 



0,1 1« 
0.12» 



i 



o,ao 

0.S2 



0.1 «0 0.20 
0.170 0.27 
0310 ; 0^1 



The table on page 188, taken from Cmmpton, Fermented Alcoholic 
rerair^, V. S. Department of Agriculture, Bulletin No, IS, 188". 
tee an analvHis of American malt liquont. 

> Lcjrdm'ii n«n<llmfli drr Fmaiiraii|ni'11ier*pie. p. 105. 



190 



BE\'i:RAaBS ASD BTlUClASlB 



WIHE 

Wine is produced by the fermenialion of grape-juice, the juice 
beiiiy first presKL'd from tbe yrapo by unishnig. There arn a number 
of fai-torN. Mieb as tin- fharacler nf (lie urapf uliliw'd. its cultivation, 
iuid tbc method of monulaeturliig, that enter into the productioo of a 
good wine. 

The following table, taken from Dnpr^.' civpR the main constituents 
of grape- juice and thi- wine that is mauufat-ttuvd therefrom. Grape- 
juiee or miist contains — 



c tu 22 per txnt. 



0.3 to 0.8 per cent. 



VrfnrUbll^ mucuH. 

Kswntial oile. 

Extrattivts, 

Mineral mibHtuices. 

Tarinii' at'ii). 

ColoriRR mattpr' "I Krora th« skftia and 

Fatty niihHtHtii'pH / kornclii. 

Kthcrit of (orogoinc nIcehoU and acids. 
Clynorin, 

Cnrbutiic- ai^icl and nmniDiiia. 

Trim^th.vlainiii. 

Oils (jroducMl )jy fermentation. 

.AlhuniiniiuK niiilt'T. 

Wrctnblp mucus. 

Color Ing- nift t ter. 

Tttnnic ncid. 

ExtTUctir<-c. 

Miitvral uibIUtm, 0.15 to 0.6 |i«t cent- 



Water 

Mitlit' acid, 
rnrliiric n-id. 
Raermic acid. 
Albtiminoiis subfrttuiPM. 

"Wine coiitaiQH — 
WatT 

Fruit siipiir J 
Klhylio alitilK'] 
Pro py lie alcobol 
Batflic alcohol 
Aai;>'lie al«oliol 
ritbVr hlf!h«r ali-oliola. 
Mati<' arid 
Tartaric add 
Raramia acid 
SoMinlc acid 
Arctic Hcid 
Formic acid 
Projiionic acid 
Butfric iK-id 

Among the eonstitucntfi of the juiee of the grape are ttllpiiiiiinous 
substances, grape- and fruit-sugar, and tartarit- and lannie Hvids. 
The yeast that trow-s upon the albumins firrmcnts the sugar, with the 
production of alrohol. The eharactcr of the wine depends upon Ibc 
quantity of albuminmis material present: if there is little albumiu, 
the yeast soon ccaBcs in it« work of convertinR sugar into alcohol, in 
oonaequence of which the wine produced is sweet ; on the uTbi>r hand, 
if there is much albuminoas material pre^etil. the yeast continues to 
grcnv until all the sugar is converted iuin aleohol. 

Ordinarily, wine does not contain more than 16 per ecnt of alcohol, 
ina-smuch a» the action of the yeast is inhibited by this percentage of 
alcohol. Pre<iucnt!y, however, wine is "fortified" by the addition of 
alcohol ; this is I me of port, which is alwaj's "fortified," 

ThiT ycMsit used in thi* fermentation of grape-juice is obtained in 
pure cultures and added to the juiee to produce the required flavor. 

The methods of wine-production vary greatly, and rwpiir* no 
description here. Suffice it to say that the fermentation at lirst la-sts 
from three to nix weeks; the albuminous material is removed a number 

i-Wliat b Wine!" Popular Scimcr IUvi«r. nl. Tji. 



191 



of times, ami the wiue is tbeu pluccd in casks; Iiere tlie percentage of 
alcohol increases, aud thv uolur of tlic wine becomes tixcd. Fermeuta- 
tion Htill goes on, however, and may uoutiuue for many years, tbus 
iocreasiiiy the pcrci-iitHKP of Hlfohol. 

Ethers are also produwd, which continue to be formed CTcn after 
the wiiie ban been plaved in bmilts. Tht> color of red wine is duo to 
a coloring -uuitter coulained lu tho skin of the fcrapt-s. 

.-lctc/4.— Tbc motit iuiportuut acids contained in wine are tartaric, 
malic, and tanuie; others of leits iniporlauee are ai-etlc and .suc-cinie. 

• Tartaric acid occurs iu coinbiuatiou with puULssiiim as potassium 
bitartrate. The total amount of acids in wine varies, but rarely 
exveetU 0.5 per cent. 

Aleokol. — There are several alcohols pi-eseut in wiae; ethyl alcohol 
occum iu largvtjt (|iiaiitity; amyl, pnipyl, and butyl aU'iihol are bIho 
present in varying iimouuta. As hatt been slated, nattiral wine never 
contains more than 16 per cent, of alcohol; il it contains more than 
thtH amount, it has been "fortified." This is often dune, espeeiuDy 
when the wine is to be shipped from warm countries to foreign dis- 
^trieta, Co pre%'ent it souring. 

^^ Sugar. — Sour wines contain about 1 per cent., and sweet wines 

about 4 per cent., of sugar; it ts evident, therefore, that sugar is 

present in too small a quantity to be of any food-value. 

M Ethers. — Many varieties of ethers are present in wine; they are 

Bproduced by the aetion of the alcohols and acids upon each other. It 

™W lo the character and (juantily of the ethers contained in them that 

the flavor of variou;; kinds of wines ts taricely due. 

<;/yMrin. -Glycerin is present io wine in about one- fourteenth of 
the volume of the aleuhul. 

Extractivts. — A large part of the solid material of the wine is made 

Pop of pxtrarttvra. mainly the carbohydrates, as pectins and gums, 
Varieties of Wines. — From a dimetir standpoint the classification 
of Chambers is probably the most praetical ; nccardiog to this author^ 
I wines are dindcd into seven classes: 
1. Strong dry wines. 4. Acid wines. 

I 2. Strong sweet wines. 5. Sparkling wines. 

3. Aromatie wines. 6. Perfect wines. 

I 7. Rougrb or astringejit wiuca. 

1. Strong Dry Wines. — Thisc arc wines that contain a large per- 
eentag? of alcohol, tu which, as a rule, additional alcohol ban Im«u 
added in their production: in other words, they are "fortiHcd." Bs- 
amplca of this class of wines arc port, sherry, and Madeira. In easeM 
of ferer these wines are utilized in place of whisky. Port eontaius 
from 15 to 20 per cent, of atct)faol and ooosiderable tannic acid. 
.Sherry is a fortified wine-, it contains from 15 to 22 per cent, of 
lalcohol. 



192 



BFVKKtfJFS -IVO STUtrtAyTS 



a. Strone Sweet Wines.— These wines contain fruit-sugar in quanli- 
tiea sufficient to aet as a preservative and prevent further (ermentii- 
tion. L'ndvr this hrad may he mriiliimed Tokay, Malaga, and sweet 
cbampa^c. They contain from 18 to 22 per cent, of alcohol and from 
3 to 5 per L-ent. of sugar. 

3. Aromfttic Wines. — Arduiutic vrinea poiweHB a superior flavor and 
contain essential oils and considerable aleobol; examples of this clasb 
of wines are KloseUe. Capri, and some of the Rhine wilier. 

4. Acid Wines. — The di-stinguishiiig feature of this claas of wines 
is the large quantity nf aeid they contain. 

5. Sparkling Wines. — Sparkling wines contain considerable quanti- 
tifiti of earbouio acid gas. to which their exhilarating effect is due. 
The fhief variety of thia elasM of wiueg is elianipaune. The dryness 
or sweetnesM of ehuoipagnc depends upon the proportion of ciine- 
soijar and cognac added during the prnccss nt manufacture. In the 
manufacture of dry ehampngne 8 per eenl. of su^ar is added, while 
the sweet brands contain as much as 16 per cent. Since dry cham- 
pagne does not contain larixe quantities of sugar, and since the laryer 
part of the su^ar U orij^inally contained liax disappeared diirinf; fer- 
mentatiurt. it is eousidered less likely to i)rodiice flatuleuee, and is 
therefore preferreil by invalid.'). On,- ehnmpagric is « pure wine 
containing from 9 to 12 per cent, of alcohol and from 1 to 4 per cent. 
of sugar. 

6. Perfect Wines. — Perfect wines ore defineil by Chambers as thoft* 
containing alculu)!, water, sut.'ar, ethereal rtfivors, fruity e."ciraelive8, 
and acids, L'uder this head come Burgundy and Bordeaux. Bur- 
gundy contains a rather large percentage of alcohol and extraetivo 
matter; it is, therefore, said to have considerable "body," Good 
Bordeaux wines are thorounhly fermented, and, tofrether with the 
Hurgnmdiex, enntain very little Nu^ar; tliey are. therefore, well iHirnBi 
by invalidn, anil are cMperinlly useful as tonics duriu<; eorivalescciico . 
from ppolraeted illnesses. 

Bonsfa Wines. — Rough wines contain considerable quantities of 
tminie aeid. to which they owe their astringent effect. They contain 
little alcohol, and are of slight valne for niedieinal piirposeti. 

Dupr^ priven the following table : 



WIU. 



Tlort Hbnttmmp\f . ■ . 

ei«K.t ^Ihrveaamplts) 
ltunnil*n wine r|br>ee lamplw] 
OrMk win* ahnr MinplMf . . . 
MenTUbrwmnplMi . . . , . 

tttitin tnut MBtplMi 

Fori ftUr«« Hnptn) 

Harmla 



»7» 

Odft 
milt 
IZM 

i7.n 

174S 

»n 

IS 80 



DSBS 

asm 

0i4M 

OlSU 

asm 

ASM 



SJM 
Mtt 
0.U1 
OJU 
0.IS1 
0.3(7 
OQVO 
0.130 



0A(O 

ojm 

4.S11 
0.W7 

njMo 
ajBi 



0.083 
O.MS 
OOTJ 
OJOS 

UN) 



1.93> 

I.KB 

9.scn 
Mm 
iMa 

II JW 
6.IVI 



oma 
o.naa 

OMS 

o.ais 
Q.Dn 

O.0M 
OJM 



194 



BBVBRA0E8 AKD BTIMVLAJiTS 



8 

i 



I 



-init»in-lrni 



•»Pf«Wd 



'ppa iTiunqdifig 



iiini|m«)uj 



-pijoiip) lonipog 



j«SniJU|inii»u 



■ntj|]»iu»[oj 



-inn«j 



-IKM 'intuiva 



■Bpjo» petu 



■rp(3» »[ll«lOA 



•wpfam iBioi 



'0[1»I )D«J)S9-qiV 



11 

"I 



-qȴ 



•131U1XH 



'en»i ioqoort-[(i4aaXifl 






■lWMilJ> 



lOqWIT 






■J)Ii>i9 igi3.-»da 



i § 



I?? 










^^ 



S?2 SR 



ay DO 






S aS B. 5 ©2 



l§i 



^ a » 



n 






-ie4 o^ ^ -i O- — 



s a 






s.^ 



i i 



IS ^ 






CO 



IS I 



at 



«^ * 



J! = * 



H -C" -• 



n 



I 



a 

3 






19G 



BBVBRAGES AVD STIULLXSTS 



ACTION ASD THERAfEUTIC US£ OF HALT LIQCOBS AJ9D VINES 

Malt [iqut>i's. wlieu ttUteti in itiodi;ratc quantities, seetu to iit<.l (liges* 
tiou, iiivreafcu ttie appetite, aod stimulate gaNlric seuretiou. Occasion- 
ally, rapecialty in those who lead a KL-deutai-y life, they give rise to 
iodigestioa and gastric acidity. On accouul of the large <(U&utitieii 
of carbohydrates they uoulaiii lht?y hav* oimsideralilt' food-value. The 
lue of malt liijuora is coutrutiidieatc-d expi^cially in such coaditiomi as 
gout, obesity, diabetes, and diseases of the urinary tract. 

Wines appear to exert a depressiiij,' effect on the aastric secretion. 
Taken in moderate (iiiaiitities, liowever. by inerejising the appetite 
and the motor function of the stomach, this depressing effect is not 
only nverrome, but the digestion is also greatly improved, 

Anstie* idvea the following conclusions as to the use of wlue io 
h«alth: 

"Wines for daily use by heatlliy »dultR should not on the average 
contain mor« than 10 per cent. ab»olnte alcohol (by weight) : 8 or 9 
per cent, is belter. 

" If wine be used as the daily drink, it is bi?st. as far a.s may be. to 
use only one kind at a time and no other form of alcoholic liquor. 

"Sound natural wines are to be obtained at the best econoniie ad- 
vnntHgc fnim the Bordeaux district ; the red wines are to be preferred. 
Rhine wines twhilcl are equally excellent, but more expensive. 

"Hunj-'ariau wines are also in many instances excelleut, but tUey 
arc unequal in quality, owing tu defects of manufacture. 

"Greek wines labor under the same defects. 

"The fortified wines, ns a cIhss. develop no proper vinous qualities 
till they have been for aome years in bottle. Sherry, however, is 
greatly superior tu the other wines of Ibis class in the rapidity with 
which it develops the volatile ethers. 

"Fortified wines iu small quantities, especially sherry, for the 
reason just nanieil, arc the apprnpriatc stimuli of certain kinds of 
infttiitile and youthful debility, and of the enfrphled nervous system 
of old persons. 

" Malf a Itottle of a natural wine a day for a sedentary and a bottle 
a day for a vigonms and actively employed adult affords a reasonable 
and prudent allowance of ulcoiiol, and this quantity of wine, either 
alone or with water, will be enough to satisf.v the needs of moderate 
persons for a beverage at luncheon and dinner, the only two meals 
at which alcohol sliould, as a rule, be taken." 

CIDER 

Cider is a beverage prrpared from the fermented juice of ripe 
tpples. The amount of alcohol eontniiied in this beverage varies 
between -I and 8 per cent, by volume. It also contains malic acid, 

) On the L'tea of Winn in Ilcnlth and DiwMr, 1877, p. 39. 



* 



4 




ALCOHOL 197 

salts, sugar, albnminoida, and extractives. Cider is a diuretic drink 
and acts as a laxative. On exposure it undergoes an acetic acid 
fermentation, whereby it is rendered unfit for drinking purposes. 
The table on page 195 > gives analyses of American ciders. 

1 Crampton, Foods and Food Adulteruits, U. 8. Depftrtmait of Agriculture, 
Bulletin No. 13, 1877. 



VARIOUS FACTORS IN RELATION TO DIET 
CONCENIEATION OF POOD 

Concentrated foods are those from which the larger portion of 
the water prosent has been abstracted, aiid thus the weight and the 
bulk of the food diminished. There are many patented concentrated 
foods on the market. They find their chief use in the treatment of 
patients who take too little of the usual forms of food to maintain 
strength, and, second, in cases where it is important that a large 
quantity of nourishment be taken. 

Food can be concentrated to various degrees. Desiccated 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 prepared from milk, 
meat, ejrgs, and vegetables. Meat is concentrated hy drying, and in 
this form it is generally indisrestible; which can, however, be overcome 
by predigestion or powdering; in this class of foods are included 
somatose, pemmican, and Mosquera's "Beef Meal." Among the con- 
centrated foods derived from the casein of milk are nutrose, euca-sein, 
etc. Eggs are dried in vacuo; sugar is usually added, and the eggs 
are then pulverized. Of the vegetable proteins utilized in concen- 
trated form are aleuronat and legumin. 

2. Concentrated Carbohydrates. — Sugar is the most important of 
the concentrated carbohydrates. In this form, however, it is apt to 
disagree and cause fermentation. To this class of concentrated car- 
bohydrates belong the malt extracts, 

3. Concentrated Vegetables. — Many vegetables, snch as potatoes, 
carrots, cabbage, and the like, are concentrated by drying. They are 
utilized only in those instances in which it is impossible to secure 
fresh vegetables. 

Bread is freqnently dried and eaten in the form of "hard-tack," 
when it is impossible, as during voyages, to obtain fresh bread. 

PRESEBVATION OF FOOD 

By preservation of food is meant the process by which the food is 
BO 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-organisms present in the atmosphere coming into 

108 



199 



«ou(act willi the food luid eoutiiiiuiiutuig il. Since putrcfui-tixr 
germs ri-quirt; u uertaUi auouut ot moiaturc and heat fur their Krowth. 
such foods us contHJii little water and that are nut kept too warm 
arc nol mi likely t(i uiidcr^'o drcnmpwtition; on th« other hand, foods 
fiontaitiiiiK much water iimkrgo fi-rmeiitation very rapidly. To pre- 
veut this proL'ffes four nielhodK of pr«s*rvat)ou are, according to Veo.' 
a vail a hie: 

1. I>r\-iti(;. 2. ExfluKJon of the air. ^. Exposure to cold. 4. 
TreatnH'iii with aiilUcptii- chemii' agents. 

1. Dryinic. — By this jmHTSi a large proportion of the water is 
AbfitniL'ted. Peinmieaii is a form of meat preser^-ed by this method. 
Ve^tablefi. such as carrots, peas, potatoes, ete.. arc also preserved 
hy drying. Milk, in th« fonu of nutixjse. eggs, as es;y p««der, and 
fruits are often preserve*! in this manner, 

2. Exclusion of Air.— Air mfiy he prevented from fOininK into 
cotitaet with foinl in a niiinber of vcays: by imnier»iiig the food m oil 
or fat: hy Ueaiin<^ tin? food, nu a*, to evaporate the exlernid layers; 
l>y (-oaliiiiE with some inipermcahle suli^taiu-e, ax nil. NJilt, Hawdiiat. 
Yamish. or parafHn. Fi»th are freqnontly preserved hy iuunersion in 
oil or by sinokintt- Hani and bacon are prewrved by smoking, by 
whirh p1^K■efi8 the outer surface bewimes coainilated and impermeshle. 
^Vpi are preserved by (•nveriuj; the fresh effffS with Home impcrujeable 

'Buhatance. sm-h us oil. fat. Iieeswax. or aawdnsl. In order properly 
10 preserve food by exelusion of air it is highly important that the 
fond be perfectly' fresh, and that any air that may be present be 
expelled. 

In civinittfj, the food to be preserved is heated in tin eans until 

■leainfd. when, all the air bavint' been expelled, the can is soldered and 

rendered air-light. V'arioiia mrtbnds have been reswrted to, tu obviate 

the necessity of eoobing in presen-inir food. MeCall advises the 

[partial exelusion of air and the disinfection of what remainij with 

IttKlium sntphitc. A method of replacing the air by uitroiren and 

VulpburouK aeid has also been recommended. 

3. Exposure to Cold. — F(kkI can be preserved indefinitely by ice. 
Meat and tiah. which an? often preserved by this means, should be 
cooked at once after thawing. Frown meal loses ahont 10 per eent. 
more of its nutritive value in eookinir than fre«h meat. Frequently 
food ia not kept directly on ice, but in refrif^ratinp ehsmbers: it can 
ibiM be shipped many thousands of miles on land or water without 

, flhowing the (diu'lile-st tendency lo decomposition. The use of cold 
Sluni^- for indetlnite periods of time is to Ite condemned, and fltarafp! 
warehouses should he ciimprllet] to brand all ittorcd food aa such. 
KM well as with the date of entrance. 

■1. Treatment with Antiseptic Chemk Amenta. — Vnder ordinar}' 

I Pood in Ilratth nrnl DinraK'. p. 17S. 



200 



VAJtIOVa FACTQflS IS IIBL.IT10X TO DIET 



circumcitances the only chfmic agents allowable in presemiig food 
arc salt, sugar, viucpar, wood smoke, and apicea. 

Salting^. — Tbe saltuig of food in a mi'lhod that bat* been practised 
for mail/ ccuturies. la this way meat and Hsh arc cHMily pri'servcd. 
The pale color of the meat produced by sailing is overeome by addinjc 
a little saltpeter in addition tn common jtalt. By salting, cooaiderable 
proteins are extracted from tht' meat — according to Liehig. one-third 
of the nutritive value uf the moat iti loHt in this way. After the sait- 
iny haii been awompHshed it is often followed hy amoking. 

Sngu ill atrong solution acts as fax autiNeptiu, an<l fniita are thua 
often preRei-\'ed in eonoentrated syrups. 

Vinegar acta aa au antlaeptic id preserving cucumbers, piekles, 
o.vslei's, etc. 

Spices. — Recent obeeiA'ationR have shown that certain spices exert 
a very marked i)rrservative action. (Cinnamon, plnvcs and ranstard 
arc the most p<jwerful. nutmeg and allspice somewhat less active, while 
ginger, black and eayrnne pepper are ineffeelive. 

Other Antiseptica for Preaerving Foods. — Among the^e sub- 
staneea are sulphur vapor; weak carbolic acid: strong acetic acid; 
iiijeclioiw of alum and aluminium ehlorid into the blood-vessels ; boric 
acid; borax; salicylic aoid ; furuialdchyd. 

Chittenden and Oies ' have stnidied the effect of borax and of boric 
acid on the general nutrition. They conclude that, taken in small 
doses for a long time, borax does not alter metabolism or' disturb 
nutrition. In larger doacs boras retards proteiB and fat assimilation. 
In vrry large doacs it eausea nausea, vomiting, and diarrhea. (See 
Food Adulteration.) Wiley" has made an extended study of food 
presen'at ivps, and enncludcs that boric acid and borax used even 
in small tpiantities over loug periods of time disturb appetite, 
digestion and the general health. The fact that certain intlividualK 
may take small amounts of certain food preservativcji for long periods 
of lime without injury ia no argument in favor uf their use, aa we 
have no method of determining who will be and who will not be 
injured in this way. Wiley «tat(-s positively that there is no necessity 
for using either ehemie preservatives or artificial coloring -matter in 
food-products. Pood laws should be enacted and carried out pro- 
hibiting tbe uae of eoloring-mattera, chcmie preservatives, and 
Bophistieafiou of every kind. 

ARTIFICIAI FOOD PREPARATIONS 

To this clasH of fu^idn brlnng tbiwe prpparHliiitiH that are so eon- 
rentrated ax to funii-sh a large amount of fiHHl in small bulk; being 
of small bulk, they cau be added to liquid foods, and thus the nutri- 
tive value of the latter increased witbout increasing the total quantity 

"Am, Jimr. Physiol.. Ifi08. No. 1. 

• V. a. Dept. Afn-initture. Uall. 84. Part I. 



I 




ARUPtClAl FOOti PJtEP.\RATtOS6 



201 



of lif|ut(] taken. Tlie Council of Pliarmsfy am) Ctit-mistr}- of tliv 
Americait Mt.-tliail Association has dciuouMt-utt-tl tlu- iiscIcssiicmk of 
Duuiy proprietary foods iniistnueb as when taken alone the patient 
is receivioK a litarvation diet unci at the Hanie time paying an ex- 
orbitant price for the i^'ol amount of nutritive matter received. A 
number of thew preparations have liven mentioned nnder the bead 
of bitrf-jiiif(-s and mfal-powdirs. Tbt' various cast-in preparations, 
among which may be mentioned nutroso, eucascin, sonosc, uid plos- 
inon, are arlifieUd fooda. 

1. Nutroae is prepared frnin the casein of milk combiutMl with an 
alkali (sodinmi, whieh I'onverls the vasein into a eolorlesK, taxtelewi 
powder completely soluble in water. It contains from 1.1 to 18 per 
cent, of uitrugen, and is used as a food in diKCstivc disturbances. It 
is adminiHtercd in soups (one-third to one-half oune« of nutrose to 
each nipfid\. 

2. Eucascin is a similar preparation, in which, however, ammonia 
entera in.stead of Kodinm. 

!). Milk somatosc i.s a food prepared from milk casein and contains 
5 per c«Jt. of tannic acid. It is a yellowish tasteless powder. It is 
.•specially uaeful a« an astringent food in intestinal catarrh and 
■ dysentery. 

4. Plasmon in prepared from Ifae proteins of milk, and is a most 
nseful ca.wiu product. It is a white tdstelL-sei powder, sohibic in 
varm water. It xa administered in water, milk, or brotlis. It con- 
tains abrint 70 per cent, of proteins. 

5. Qalactogen is obtained from milk. It contains 70 per cent, 
of protein and is especially agreeable as galactogeu-chocolate. 

6. Mammals. — This is puro cow'k milk from which part of the 
cream has bd-n removed and milk Hugar added. This is then driwl by 
the liaimaker procw», the result being a yellowish white, fluffy powder 
with a very faint odor of faity scidH. Mixed with water tt forma a 
fluid very like milk and very easily digested and assimilated. 11 is 

[useful in feeding infants and invalids where eow's inilk does not 
For invalids one third to three quarters of a tilass of mammals 
then filled with warm water may be used. For inf»nts a heaping 
?nful to eaeh ounce of water and in some cases from one 
^qnarter to half as much in addition will hv found sufficient. 

Artificial Proteins made from Meat.— A number of thesM? prepa- 
rations have already Iw-'cu dcscribcii. To this class belong: 1. 
Tropon. 2. Peptone -products. 3. Ferson. 4- Somatose. 

1. Tropon is prepared both from animal and vegetable protein in 
(Um form of a powder containing about 80 per cent of protein. It 
{iB best gi%'en in broth, milk or cocoa. 

2. Peptone-prodncts.^ Peptone-products are predigested protein 
foods. When given in large tioantilies they tend to produce diarrhea, 
ud an objectionable to many patients on account of their diftagreea- 



202 



yAltlOia fACTOJtii IS KELATtOS TO DIKT 



ble taste. Among tLe principal peptaiie-pmdiicts manufactured may 
be luvnliomHi Ki-mmiTielj'-s, Korh'h, lieiiger's, Savory & MfMjre'a, 
Camrick's, Armour's Wine of Beef Peptoue, and Panopepioii. 

The following tabic. tAken from Koiiig, gives the (;li<jiuicr I'lmiposition 
of some peptone prcparatious: 



fnpandun. 



II lis! if. 



?^ H P" 




EelumcHcli'i meat pcnt'mc idrjr) 13.30 OTH , 1.10 

BUBcfipetrtoDiwd bvirf Jelly . . WM 1.£fi . . 
awoiy a Miwre-t fluid bw f . J 7 .ai ftT7 ' . . 



2.-11 (.':& 



127 







3. F«r80n is ox hlood from whieh the hhiod eoppuscles are separated 
from the senira. dried in vac-iui hihI powiii-ri'd. It ix an odiirle!<» 
powder cuutiiituii); i-onsitlcra bk* ir«ti and phusphoriis. The prepara- 
tion is best taken in milk '\n dcses of from 3 tn 4 teaspoon Fiik a day. 

4. Somtttose. — Somatn.sf is a pri-digested meat (•(nisistiiip of al- 
bumoses. It is a yellowish powder, tasteless, odorless, and highly 
nii1ritiiiii>v. and is ii>;iiiilly wi'll tmitin even in jjjistrii- (iistnrhaneos. 

Artificial Proteins prepare*! from Vegetables.— The twd prinei- 
pa) forTiis (tf t Ills elas.s of foods atv as follows ; 

1. Eoborat. — This is a veffrrnhle protein mamifaetured from rice. 
wlieat. uud maize. It is a tine. fidr>rles.s, and tastele** flour, (tli'^-hlly 
soluble in water. It is well borne by the Htotiiaeli, ami is jibsarbi'd 
about as well as an animal albumin (up to ^.'i per eeut.). It \s free 
from Duclcin and does not increase the oxerctinu of urie aeid. It 
may be addf^'d to any fiKnl. but ordinarily 30 or 40 per cent, of it is 
mixed with flour and baked. 

2. Ifgnmin consists of the casein of the lecumes, and is a hichly 
nulritiuns pmfmn food. 

:). Alearonat is a brownish powder chiefly utiliwd as a fiMid for 
diabetie^ It eonTtiin« HO pf-r t'eut, of protein. 

Mixed Artificial Food Preparations. — These products are mix- 
lures of proteins and uarbohyd rates. Of 1h(«e the followinK are most 
important : 

1. Acom'COCoa eonsi^ts of cocnu from whieh a large portion of the 
fat has been extraeted. and to which an extraet of neoras has been 
added. This prepiiration is especially useful as an astringent in 
diarrheas. 

2. Hygiema consists of condensed milk with the addition of cereals 
and eoeoa and is hi|fh)y nutritious. 

.'{. Eacahoot is i-nmposed of chocolate, sugar and Arabian meal, and 
is nutritious and agreeable. 




A&TIFICIAl FBOPRIETABT FOODS. 

A largt' uumlKT of ppoprictarr foods. de8i(raed as sumtttutes for 
milk for infants auil iuvalidK, arc ou tlie market, iufauts fed itpou 
siit'b fooiU ilIoiic arv apt to bf^eomp niehilic. Some of ttii^xe fooclK 
have little food-value, esptrinlly the atnylacRous foods in which thr 
stArcb has not bo>'n pr*■diif(^>itc^i. Mauy of these propai'ttlions contain 
too little fat and (ar too grvM a pniporliun of uarboliydralL's. Ae- 
oonling to Holt, *'whoii i-liildn-u art- fit) upuii fntidis luc-kiti); in fat 

»thp twlh ponio late, tho hours are soft, the niiiseles tiahhy.'" whih- 
"cJiildreii fed upon foods eoiitaining too much Hugar are frernienliv 
Yer>' fat. Iiiil their tlOsb is very soft; they walk lato and Ihey perspir« 
nattily abiail t\w bead and tieek. " Ak flail ilnirton has r(>i>en1ly 
pointed out," "men* cheniic analysis is no criterion of fa<Kl-valiie, for 

• the digi^tibUity of thp food is the nil-important qii<>!stian. Inveattfra- 
tiuns into the value of food-Ktuffs raiii^t be eondueled and eonti'olled 
both IN vii-it and in riiro— lK)th in the body and in the test-tube. 
The n^Kults of test-tube experiments are of value, but tlie final test 
of fofxl-stuffit mutit be made on animabi. and preferably on man. 
Tfaen^ i'Xl>erimeijtR are iKith tedious niid diftiinilt. but then' ik ii trrowiug 
apprpi'intion of thi'ir value and an inereasing re«nri to tli^'ir nse." 
Ilnti'hiM)]! ' dividi'Ji proprietary foods into ihrrc I'lasses; 

■ I. Foods prepared (rom cows* milk with various additions or 
altrralions. and retpiiring only the addition of water to tit (hem for 
iiumi?<liuic use. To this ebuw beloni; Mailed Milk, NentU'-'s Food. 
J^i-tatnt Kood. Caniriek'n Food. Cereal Milk. Wyeth's l*repHPe<l 
Bfood, and Waropole's Milk Food, These foods are prepared fnim 
^flour bakcil and mixed with milk or rreani and then dried. Tly tnetins 
of the wait whiirh is added the etarclieH are eonrerted into dextrin 
id tualtose. Th« general eompnsitiOD of these foods is as follows: 

WftliT ,.. 900 

I'ralrlll i IJ> 

Vm ,. M 

Sofr .,4 .....I... SJO 

Mineral muttrf O.fi 

The rhemie eonipositJon of Malted Milk and of Ncstlf's Food is 
lui given by Chittenden : ' 

Iklicd llilk. XoiWx VooL 

WaUr 1«t.40 Ui.'e 

Pr«Wn .„..,. 1.15 0.81 

Fat . O.SO - 0.3« 

Sugar ^^ a.3M 3.80 

Siniml matter 0.29 0.13 

2. Farinaceous foods prepared from cereals of which the starch 

I "Difltttie V'alw nf Patfnt^'d PoMla," K«w Vork M*d. .lour., January 2:i, 1904. 

> Food BBd I>i<4(>tics. p. 441^ 

■ Mew Vork Med. .rour., July 18, ISM. 



ao« 



VAltlOVS FACTORS /.V RELATIOX TO DIET 



has been partly or wholly converted into dextrin or sugar, and 

which retiiiire the aJditicin of milk to fit them for use. To thbi claiM 
belong Mclliu's Food. Savory & Moore's lufeut Food, aud lleugcr's 
Food. These fuods are prepared by mixing equal parts of wheat flour 
and barley midt with bran and pota-sKium bicarbonate. The mixture 
is made into a paMc with wuler, and kept at a warm tcmpi-rature 
until the starch is rauvertwi 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. 

'■i. Farinaceous Foods in which the Starch has not been 
PrcdiKested. — To this da.ss bclone Ridgr's Food, Neave's Food. Im- 
perial tirajium, and Robinson's Patont Barley. These foods arc poor 
in fat, protein, and mineral matters. 

Cereal gruels, frequently used in Infant feeding, are most easily 
made from prepared flours. They are not alwaj's identical in com-' 
position, hut the following tablp, showing corapoKilion of gruels made 
from the Cerco Company smicl flours, is instnietive: 





ninLBT. LsQpiu. Oat. 


W'HEiiT. 




Pre- C«rlm, Pm- t5irt»,! Pnv rarbo. 


Prw- mrtn. 




tflds. |]r<]M- 


t«i<l*. HrdU.I IviilK Hylb 


1«I<U. UydU. 


J lai«l latilcspoonAil fli'iur 


P««, 


Por«. 


Perri'TrTft. 


Pcrct. 


IVrcL 


Pern. 


Pcrcl. 


lUot.) til qiurtbf rtUL-t . 
S lural Ubloipuuiinib Hour 


O-U 


(i.« 


U.l» 


o.&a 


0,12 


0.N 


0,10 


0.R 


Moi-1 1" qiMrtof nvel . 
1 tyrH labliapuininif* flotir 


0.M 


IJO 


0,30 


1.W 


OM 


I.K 


ox 


i.at 


ni w) M qvitut of snial - 


0» 


1.W 


au 


LM 


asB 


l.ni 


ci.3n 


ij» 


1 lonl cDrerlVil Ovur n 


















os.ti« quart nr«rTU4l . 
a iMvel «(*«rriils fluur Ut 


04* 


3.40 


ai8 


11! 


0.48 


3.40 


a4a 


!.M 


















OS.I t« quart nf RWl 

■ I«T«I RDT«Tftlb niiiu (8 


0,M 


UO 


lU 


4^ 


om 


4K 


UJO 


HJB 


W) to (iliarl >if imiH 
4 hyr\ •■'■vvrritu Hour (4 


1.41 


7.S0 


^M 


lUMt 


1.44 


7.3) 


rai 


IM 


















0*.) toi|uanari;ni«l . . . 


i.sa 


9.00 


B.I2 


a^B 


IJ2 


9M 


LOO 


into 



(hmpuniion of Pr<ipru4an/ Foadi. 
((.oinpiled from Uutchiaon.) 



r«Mi. 


Waur. 


IToteln. 


All. 


Cwbohy- 

dlM*. 


manor. 




PeroL 


PercL 


Fvrct. 


Pwin. 


Allsnliur;, Na 1 .... 


6.7 


9.7 


H.O 


6tl.8& 


3.76 


AlleoburT, Na 2 . . . . 


3.9 


9.2 


12.8 


72.1 


3.50 


Alknburvf Nu3 . . . . 


6lA 


S.2 


1.0 


82.8 


0.6 


8.3 


lu.2 


12 


-TO.8 


0.8 


Chmrick't ^iublc Food . 


6.6 


1Z.6 


2.6 


70.2 


2.20 


Faircliild'a Milk Puwiler . 


6.M 


LIS 


(1.06 


92.0 


1.22 


Ilurli.'k'<i Mnlled Milk . . 


3,7 


13^ 


3.0 


7M 


2.7U 


Impcniil Cimnuin . . . . 


11.60 


10.91 


au 


6.73 


1.0 


UullinV KiHxl . .... 


6,3 


7.9 


Umce 


82.0 


8.8 


Nnulo's Milk Food . . . 


M 


11.9 


4.8 


77.4 


1,30 


Ridse'i Food . . . 
Bobiownrs I'aienc Buley - 


7.9 


9.2 


1.0 


81. S 


0,7 


10.1 


6.1 


V 


8^0 


1.0 



205 

Other Proprietary Foods. — CrBcken are prepared from flour, 
water or milk, aud arc baked into various fonuH. Haking- powder 
aud Moda, aud frequently milk, butter, sutrar, and flavurine <'<ctr]icts, 
ure addwl. Cmckors are. as a rule, easily digested. 

Malt Extract). — Malt extroets are manufactured by bcatiDK a solu- 
tion of malted barley at » moderate temperature tri vacuo. The &xn- 
a^ compositioQ of uiall extracts, an ^'iveii by Klemperer,' is as 
follows: 

SUKar . . 60-JW 

Soioble atarcli lO-M ' 

Prolrin 3-B 

Aih 1-2 

Malt extracts arc capeeially useful as beveruKCs for those weakened 
by cbronie diKcase, as tuberculosis or aneinifl, and in the convaleucence 
from acute diseases, as after typhoid fever or pneumonia. Amoui; 
the various malt preparations may be mentioned Maltine, Kepler "s 
Extraet of Malt, and IfoS's Malt Bxtraet. 

The following table gives the ehemin composition of various proprie- 
tarj' foods manufacturiHl by the llattle Creek Sanitarium Co.: 



BrMkbit AkkU «a<l cerMls. 



OrmnoM 

Toutad wbfU fiaktm . . 
Taajud roni fl*ku« . . . 
'innuto . ■ . ... 
Onoola 

fliuieiu: 

Olubtn meal 40 per oeat. 
Olu1«n btKuit 40 i>«r oeoL 

BriNDow 

lUltod puu 

Natbittt«r 

Not Ileal 

Afadoad boiler 

AhnoJiwl 

NoUolsM 

ProtoM 

.MvlioM 

J'txato meftl 

llullMtMua 



WatM. 



8.00 
8.00 

11.40 



8.70 
&70 



13.40 

2.00 

3.00 

3.00 

4.S0 

4.d0 

00.00 

8L-22 

31.17 

7.10 

8.76 



AtbOlDt 

nous elc- 
lueau. 



11.M 
11.5li 
fl.00 
II. -10 
11.87 



41.10 
41.10 



10.00 
23.T0 
29.30 

2u.ao 

21.00 
31.00 
12.13 

21.40 
8.87 

aw 

23.6S 



FTOlt. 

•ngu. 



10.00 
20-48 



3S..-W 
43.S0 



49.61 



TuUl 
ilnuc 



78.80 
78.M 
7a30 
77.-17 
?2.(» 



47.90 
47.90 



44.30 
43.90 
17.10 
17.10 
17.30 
17.S0 
6.91 
2.8$ 
64.42 
M90 
62.49 



rnelkt. 



1.46 
1.45 
1.00 
2.23 

2.ao 



1.10 
1.10 



24.00 

27.50 
4flLM 
46J») 

64.90 
51.90 
t&46 
10.23 

a40 



«•!■. 



2.S0 
2.M) 
l.OD 

aao 

1.00 



L20 
L90 



Saccharin. — SHooharin in small r|uantilies (0.3 gram per day or less) 
sdd«>d to food is probably without any deleterious efTect. But in 
quaniitiw jrreater than this, and espeeially over 1 (j-rara daily, it is 
iujuriuus to the human body. .Saeeiiariit u!t a aweeteuing- ageut ahould 

I hejien'^ Ilandbncb der EmJUmuiKbtbeTapie. 



206 VARIOUS FACTORS IS RELATIOX TO DIET 

only be njsed in diabetes or in other diseases in which sugar is in- 
jurious. It should not be added to foods for healthy indiWduab. 
It should be borne in mind that saccharin has no food value. For 
full details concerning Saccharin, see Report No. 94, issued November 
15 1911, U. S. Department of Agriculture. 

COOEIHO 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 envelopies 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 envelopes. 
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 cooking meats the temperature 
of the water should not exceed the temperature neoessar\- for the 
coagulation of the proteins. Id order that the meat may retain as 
much of its flavor as possible it should be immersed in boiling water 
for a few moments; in this way the protein on the surface immediately 
coagulates, thus preventing escape of the constituents and so retaining 
all the nutritive elements in the meat. After this has been accom- 
plished 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. 

Boasting. — In roasting, the meat is first exposed to a high tem- 
perature and afterward cooked slowly, thus the outer layers coasulste 
at once, preventing escape of the .iuices. Roasting not only prevents 
evaporation of the flavors of meats, but by its effect on the extractives 
develops savory odors and flavors. 

Baking. — Baking much resembles roasting, except that by the latter 



COOKI\tl OF FOODS 



207 



proGces tb« h«at is applied all round the meat, instead o£ only to one 

Stewing. — For this purpose meat is cut into small pieces aud placed 
in a small t|\tautit,v of water. Xlie water is heated slon-ly, but not 
allowi'd to boil: h ecrtain atiiniiiit of the iiulririoiiN siiliKTiiii<!eK tlius 
pass into the water, whii-h then bpconies rich, and to which Havorinf: 
subetances aud vegetables are added. ItiasiiiiK-h an the juiee is eaten 
witli the meat, iioue of the itiitritious ingredients is lost. 

Braxiag.^Iii tliiK proeeKS tlu- meat is placed iii a sniat) vt:«scl and 
oovfrpil witii a Htrong lifjiior of vcKctable and aiiimnl jiiiees; it I*: then 
hcateil, but not boiUtl. TIic Tmigh tihent of the meat are tlius looscaed 
and made tender; the meat also becomes imprepnatcd with vcpctablw 
aud Kpiees present in the jiiiees. wliieh enhances its flavor. 

BroUin^.-Bntilini; and i-oastiii^ an^ similar processes. px(*<;pt that 
in the former smaller porrions arc utilized ; the process is thus more 
rapid, a larpc surfaee bein? pxposmi to the direct action of the lipat. 

Prying. — In this procesH the mfat in put into boilinp fat. with which 
it beeomes saturated : fatty acids arc thus produeed. which have a 
tfiid>*iir>y to irritate the xtomach and fniise indigestion. 

Cooking of Fish.— Fish may be boiled, broiled, baked, and fried. 
Boiled Kxh is moKt easily digested. InaJimncb as the flavoring sub> 
stances are riiore easily di>«<olved out into the water and Inst, less 
time ahould be consumed in bolliuu Hsih than in boiling meat. Sir 
Henrj- Thomp&<»n has shown that even with cai^ful boiling li per 
crnt. of the solid mutter of tish is apt to be lost; for this reason 
iA««iiung is often preferable. 

EPFECT OP coonno 



Tfie effect of cooking on meat is (u dindniuh its watery C0D> 
Nthu»its. thus wjuceutratinir aud rtudering it more nutritious: by 
tliis pnicesa alao Ibo vxtraetives^ as well m some of the fats, are partly 
removH. 

(jrindley and M»jonnier have studied the effect of cookiug meat 
ver^j' L-arrfully. They have determined that tht chief loss in weight 
during boiling, saut^ing. aud pan broiling h due to water removed 
by the beat of the cooking. In the roasting of meats the chief loss 
is due to the removal of both water and fat. In pan broiling the 
Inutra which take place nre very sntall hk eum)Hired with the other 
methiidn of eookiuK. When beef is viKik(.>d in water, from :i.2o to 12 
per cent, of the nitrogenous matter, O.60 to '<i7 per e<*nl, of the fat, 
and 20 to (IT |ier eent. of the mineral matter of the original uncooked 
taaal may he found in the broth. This nutritive m»tcrial is not lost 
in caae lh«? broth is utili2p<l with the meat. In eoasled meats from 
0.35 to 4^5 per cent, of nilrngenons matter, 4.5 to 57 per cent, of 



FJR/OPff FACTORa f-V RELATIOS TO DIBT 

fat, atid 2.4 t» 27 per cnnt. u£ miueral matter present in tlic unt^ookcd 
meat tnay be found in the drippiugs. Hect' whii-li Iuik been lined in the 
preparaiioa of beef-tea or broth has really lost but comparalively lit- 
tle in nutritive value, althuii^ih uiiu-L of the flavoring umtttir hax 
been removed. The ton^er time meat is cooked, and the higher 
temperature at whivh this is done, Ihe greater the loss i]i water and 
fat. the larger pieeea loisiug relativdy le.ss than the smaller onetj. A 
puiut lit t^oiisiderable intert-st is that when meat is c^ooked in water 
at 80" to 85' C, plaeing the meat in 1ml or cold water at the start, 
has but little eAect on the aimmnt of material found in the broth. 

The following table, taken from Konijr, shows tlie chcmic composi- 
tion of certain meals before and after cooking: 

Bevf. nw ;u«n i2&\ -1.52 o,Hb 1.23 

Be«f bon<^ 00^2 X4.13 7 50 0.40 1.15 

BMif rciHatPil 9Q.aa S>.23 821 O.'S 1,45 

Veal piitletB. raw ~l.M 693 6 3H lliM LIS 

VmJ •utlvU roa«tMl 67M llJifi 111).') 0.l»3 1.43 

Effect of Cooking on Vegetables.— The important object in the 
cooking »f vegetables is to rupture the ecllntuse envelop and so to 
aofien the fontamed stareh-granuJes. Under the iutluenee of heat 
and moisture the stareh swells and bursts its envelop, fonaing & 
paste: Ibis paKte. in 'us turn, expands and rtiptiires the oellulose 
envelop: eoohing, llierefore. renders vegetable foods more digestible. 

As has been pointed out, in the eookinjr of meats a eertain propor- 
tion of the ingredients is lost. I'nlike me»tK. however, vegetables 
become more waterj* in eooking. In this condition they are more 
easily acted upon by the gastric secretion; on the other hand, the 
addition of waler in cookinir so inereasp.s their bulk that Ihe motor 
funotion of the slomm-b is apt to be ovcr-tiixed. 

When food is* cookod rapidly there is a tendeuey to overcook the 
outer layent and to leave the inner underdone. The better plan, 
therefore, is to cook food slowly for a longer period of time at a lower 
temperature. Various applianees are on the market which have for 
their object the production of a continuiiux aeliou of a moderate heat, 
at the espense of as little fuel as possible, the "Aladdin Oven" of 
Dr. Edward Atkinson ' is an apparatus of ibis kind. ''It is a itimple 
inm bo:t. elosed in front by a door, and having an opening in the 
top that cnrnmunicHte-t with a lube to let otr »ny HUperfluoiLi steam. 
This box is surrounded by another, whose top and sides are made of 
non-conducting material, for Ihe purpose of holding the heat. A 
standard, on which ibis box is set, and a lamp underneath complete 
the apparatus." Atkinson claims that ordinarily two pounds of fuel 
are required for ever>- pound oE food cooked, whereas with his oven 

1 Kdward .^tkiRMin. Tho ScH'nco of Xiitrition and the Art ol Cooking in ttie 
Aladdin 0>en, Boaton. Oamrell A I'pham. IKtl6. 




DISBASBa VADBBO OV EttltOHtt i.V DIKT 



209 



two nnfi one-h«lf poimdK of fuel will cook sixtj' pounds of food. 
UanoD More tide, of England, inveuted a simUar apparatus for tbe 
cookiug of peony meala' lie describcii hut apimratua as follows: 

"It cousistti of a box 1} fcot hifth, 2 fe«t wide. 1 foot 9 inches deep. 
wilJi an out^r ca^e ot sheet iron. The sides and lid are lined with 2Vi> 
iiichos cif fell, and inside this, again, is a further lining of tin. Un- 
derneath this bo:i, which will hold 30 gallons, are piaeed two of 
Fletcher's atmiiKplifrio gas-burners. Tlie felt being a non-oouductor. 
nrarly all the heat Fmm tht? gns is utllixc<I, and a compHratively small 
expenditure of i;as suflioes to raise the temperature of the contents nf 
the box to boiling-point, or to the heat required for the food which 
is beiug cooked. 

"Wliou ouee the desired temperature is obtained, one of the burners 
can be turned off and the other lowert-d. when, owing to the preveu- 
tioN of radiation by the felt, it will bo found that a merely nominal 
expenditure of gas will enable the temperature to be maintained for 
houni, and even when the gas Ls totHlty extinguished, many hours will 
elapi^ before food eookod will beeome eool. 

"But. except in tlio ca.se of puddings whieh require rapid boiline. 
the cooking is done in an inner pan. which is placed inside the box. 
and which containK rather more thau twenty gallona. The apparatus 
ma^' be best described as a huge Warren's pot. with the additional 
advantage that the whole of the inner pan is surrounded by warm 
water." 



DISEASES CAUSED BY ERROBS IK DIET AKD BY 
VAEIOUS FOOD-FOISONS 

Disease may be caused by taking too little or too much food, by 
a diet that is not well balanced, — that is, dr)ee not contain the combina- 
tiim of fotxl-flemeuis iii correel proportious, — and by other factors 
uiid influfui-eft the precise nature of many of which in obscure. It 
may also be caused by certain poisons or diKease-gt^rms or parasites 
taken into the body with the food or drink, l>ir)case may occasionally 
be produced by a personal food idioGyncrosy. It )i> albo fre<|ueutly 
caused by eertaiu beverages. 

The diseases due to the taking of insufficient food are starvatiou, 
malnutrition, marasniua, aiul some forms of anemia. Chlorosis is apt 
to oc4'ur in nndrrfi-d girU. 

Overeating, or the taking of improper food, gives rise to a great 
variety of disease*, especially in tliost' who have hereditary tendencies 
to eertain diseases. The fuod. by producing irritation in the ali- 
nwotaiy tract, may be the direct cause of di»easc, as in acute indigen- 
tiou, diarrhea, and the like. Disease may also be produced by the 
excessive amounts of food a.<isimilBted either bein;; detxisited as fat 

> CliMp fttod ind Chnp Cooking, London, Waltor Scott. 1884. 
M 



210 T A Blocs FACJOta IS RELATtOS TO DIET 

and eaosiiig ob«sit>'. or by overworkiiig the organs of exerptirai. pro- 
dueing degenerations or scleroaes. The kidnevs, liT«r. and heart are 
the organs most likely to suffer, hot the nervoos sy^em may also be 
affected. In epileptics attaeks may be brooght on by overfeeding. 
Goat, lithemia. and the like are among the fliseases caused by a too 
generous diet. Diseases of the skin, suefa as acne, eczema, and orti- 
caria. may also have the same causal factor. 

Overeating b probably as proUfie a source of disease as ovn^rink- 
ing. a fact that is not generally admitted. The commonest effeets of 
overdrinking are the nervous eonditicHis caused by excessive tea- or 
coffee-drinking, and the all too familiar condition, with its well-known 
symptomatology, of acute or chronic alcoholism. 

Acote food^poisoning is due to the action of ptomains. and is often 
known as ptomain-poisoning. Ptomains. or toxins, are poisonous sub- 
stances cansed by the action of bacteria, and may be generated in 
nitrogenous foods or in the alimentary tract. They resnnble alka- 
loids, and when absorbed are partially destroyed in the liver. 

ParasKes in Food or Drink.— Quite a number of diseases are eom- 
monicated to man through either the parasite or its embryo bein^ 
taken into the stomach with the food or in drinking-water. For a 
thorough knowledge of these parasites and their effects oo the human 
s>-stem the student is referred to the text-books on bacteriology. 

The Amoeba eoU, which causes a form of chronic dysentery, is 
probably taken in with the drinking-water. Its life-history is not 
definitely known. 

Coccidiun Oriforme. — The spores, known as psorospermia. have been 
found in the liver, pleura, and other organs of man. They probably 
gain entrance into the system from water, green vegetables, or from 
handling animals such as dc^ and rabbits. The life-history of this 
organism is obscure. 

TrichomoDas ' and cereomonas are small parasites at times foimd in 
the stools. 

Zhstoma hepatictun, or li%-er fluke, usually infests the gatl-duct or 
the gall-bladder. The embrj'os arc attached to a(|uatic plants, and 
hence are believed to be taken in with them or with drinking-water. 
Several other species are described as occurring in China and in 
Egj-pt. 

Bilharzia hanuatobia, or blood fluke, is found in the urine. It is a 
native of Egypt, southern Africa, and Arabia. The embrj'os are 
probably taken into the body with drinking-water. 

Tapeworm.— Several species of tapeworm have been described. The 
neck and head of this worm, called the scolcx. may become encysted, 
and the worm is then known as the cystieercus. 

TfFiiia Solium. — The pfirk tapeworm is a somewhat rare form, 

I For a dpscription of the trirfaomonRB, gee Dock, Amer. Jour. Med. S«i., 1896* 
vol. c^i., p. 1. 



ttlMKASEK VAlHKIi JIV KKKOliU J.V U1£T 



m 



infection usimlly talcing place by means of the embi-jos pivsi'iil in 
ruw or uiiiJiTilurte |i(irk. Tliv embryos firv mtm in tlii* uivat na Miiall 
wbite spots, and. from iis mottktl appt-uratitxs tbe meat coutaiuing 
tbeiii 18 usually t-alled measly pork. Ooveruineut iuspefltion of meat 
huft doue iQUcb to pi-event iufvctiou by thu uiid other forms of 
panutites. 

Tania medivcuHiUata or sayinata a the most comitiou tapf^worm io 
tli« L'uitcd Slatvii. Inftfctiou is produced through eatiiiic raw or 
unUepdoue b*ef. Thpre an? spvoral other rare variptirtt: 

Ttenia cucumerina or elliptica, a very small tapeworm, is fmiiid in 
the dug and occaBioually in man. ItH embryos occur in the dog 
loDsr. 

TtFitia flavopundata in a form found in Boston. 

To'nia Htjna and Mudagnscorifntu/ arc forms owtt»i(>uaIty met with. 

Boihrioerithalux htus is a tapeworm found in the tiorlli of Knrope, 
but 18 cMTSsioually imported into rhc I'nittil Statrs. The larva' are 
foaml in fish. Two other forms, U. maritima and H. uujsUu, havo 
betu found in man. R. eordaius, seen in Oreenlaml. and B. Criatatua 
are other iTire forms; tbe fomier was found in an immature state in 
Iceland aufl rlie latltT usually occnrH in catH or dugH. 

Ttenia Echinoroccus. — Thitt is found in the iiitcHtim-s of do(pi. In 
man it may form single or iiiultdm-ulur cysts. Infection occurs fn>ra 
handlinf^ dogn or from eating gn>rn vegetables. It Is rare in Amorioa, 
but not nni'oniiiioii in Burope. 

Ascaris lambricoides, or roundworm, is a coounon parasite wboee 
life-hiKtoiy ia unknown. 

Oxynrii rermicalaris, or pin-worm, a small parasite often found in 
children, is tn-lieved to bo taken in with fruit and other raw food. 

Strong^lai duodenale, alao called Anchylostomom daodenale, is a 
pani.site atlraclin^ considerable atteution m Aiiiericii. Kui-mrrly but 
■title known in the United States, numerou.'< inslaneeK of infeeti<m by 
ihis pariisile have r«t*ntly been reported. It U a small parasite, from 
6 to 10 millimeters long, and is present in the upper part of the in- 
testine. It eaii)»FS sovere anemia. The embryos of the parasite are 
probably taken in with drinking-water. It is apt to occur in brick< 
makers, miners, and those following similar occupations. 

Filaria Sangninis Hominls, — ThU jwraxite is found In (he Southern 
Statra. and is prifbiibly also taken with im|)itre water. Il eaiiRes 
hematnehyluria and eerlJiin f»rms of el<>phnntia.sis. 

Filaria or Bracancnloi medinenm. or guinea -worm, di-velops in the 
pyctops, a small crustacean. The larvw are probably taken into tbe 
Klomach with drinking-water. It cantes vesieles and ulcers. Cases 
nf infrctinn that must have oectirrci) in Ameriea have liccn described. 

Tncbo«c]>haIns dispar. or whipworm, is found in the cecum, and is 
■■boul 4 or ."> eenlimelers in length. It dnei^nol. as a nde, eauae any 
a>-mptoina. 



FJW0P8 FACTOnS /.V RBLATIOy TO DIET 




Rhabdonema inteitinale is a biuull ]>ai-a>>ite nftun Kjiokfii of aK the 
Cochin-Cliiuu diarrbcu worm, ll is Ftiuui) in Ihr itit('»tiitr.-s. uiid 
'causes a form o£ tropical liiarrhea. It has beeu discovered in mauy 
])arls of tlie woiid. 

Parasitic Diseases. — -Trichiniaais. — This is a disi-aiit.' caiiiicd b.v 
eating the su-ualled "measly" pork, or pork iofected wJtb Trichina 
spiralis. Thix paraAite uieaaures 1.5 miilimeterM in Ien;crth — the 
frmu]<\ 'i to ;i.5 milliuieteri^, aud the embryos from 0.5 to 1 millimeter. 
The erabrj'os are generally eoiletl up and eiieHpRiilated, and are t 
in the voliiiiTary iiiuncU-k. giving ri»e to the naiue mentioned above.' 
The parasite is also found in the rat, and Dock believes tliot the 
disease is eoiiiuiuiiipated to the ho^ by eating infected rats. 

When taken into the intestinal canal, the envelop surrounding the 
embryo is diHsolved. and iji fmni thrt'e to six davK tlie latter develops 
inid a hiU-gniwn trichina. The female produees flie erabryoii by 
thousands, and Ihese work their way through the ijitestitial wall and 
enter into the vctlnntnry moseles. where they may be found several 
weeks after infiMMion. If tliey are to be found «! all. they are prpsent 
in the dinphrnpm. which, owinp to its proximity to the intestinal 
canal, is the favorite site. In the miiseies the parasites are surrounded 
by a Eone of irritation, and finally become eneap»ulated. lime salts 
being depoailed in the capKuIo, Thus eneapsulaled. ihe paraaile may 
live for years, hs presence gives rise to (^astro-intestinal irritation, 
ffver. pain, and prostration. Tliore is fretjuently a pictnri^ simidatin? 
typhoid. .\ marked ensinophilia iK uKually present, and the disease 
proves ftital in many riuie». 

Owing to Ihe (freater frequency with wbieh raw pork is eaten in 
GeiTuauy. trirhiiiiiiNis is coniiiioner in that eountry than in the Ijiited 
States. A temperature of 140" F. killa the parasite, and the rtnly 
sure way of prevenliiig the disease is to eook all pork. The presence 
of the jMirustle is easily detected, and in places where meat is in.s|trcted 
infected ment NhouI<l be re,jeeted by the Government inspe<.'tor. 
Piekling ;ind cnrini: meat nmy, if the pieces are thin, kill tlie pamsiieK, 
but they may survive if the pieves of meat are large. 

Diseaaet from Milk.— Numerous diseaRes are transmitted through 
the airency of milk, the cow itself being diseased or siibsequenl con- 
tamination of the milk takuig place. The cow may be suffering from 
diseased udders or fmm some atTection of the mauunary gluud. The 
cirgaiibm moat commonly present in infected milk is the Ktreiitococcus. 
Tubercle Iwicilli may Hnd their way into the milk from a diseaJted 
gland or ndder. As a rule, it may be stated that if the disease, 
whatever il may Ik-, is not In the mammary gland or in the udder, it 
is unlikely that the bacteria which gave rise to the disease will find 
their way into the milk. It shoidd be borne in mind, however, that 
milk from a sick eow, even if it does not eau«ie disease directly, is apt 
lo be poor in quality, and is not desirable for food. 




JIBBABia CACSBl 



BRRORa IX on 



313 



Milk iiifeuliuu is most c-onimoiilj- the rvsult of impuro millc, made 
so by inipruper care and coiitamiiiatiuo with toxiu-pi'uduciug bacteria. 
The duicasc may be tlie rpKult of toxtuti formed iu the milk, or the 
bacttrria themwlvtw may he Uit? vhusv i»f tin? disturlianee, (Kor de- 
tails 08 to tbi- proper carv uf lbit> lood, »tv the scctioii on Uilk.) 
Sour milk or milk which is about to turn may eause gastric or in- 
t«»ti[ial disturbances in invalids or children. 

Poisons TranuaitUd in Milk.— I'oisonoiis fiubsiaiices taken iu with 
the food of the luiimal or ndministpred in Kiilficient qimntiti(« hm 
rc-uiedii-H may be iranNmitled iu tbc milk and rjuise symptoms in the 
eoQsumer. This is oot of very frequent ocvureucc. Amonf; the 
numerous drugs which have been reported as eausing poisonous 
'ormptoms are: arsenic, lead, (.-opper. mercury, tartar emetic, iodic, 
alroplu, vemlrnm viride, slryehnia, eniliui oil. anil othei-s. 

Tnbercaloiis. — Milk as ii i'au.sc of tubercutostii hus of latv vearR been 
tbt! subject of much disciissiiHi. This diMussion wan largely the 
r4>sull of a »>1atement tnade by Koc-h, in 1901, that bovine tubereulosis 
fonid not be transmitted to man, and that the discaru- ns found in 
mau and in animals was due to two different organisms This state- 
ment has not been Imnie out by faclK, and it may with safety be 
stated that the disra.se in bi>th man and aniiiinU '}» due to the same 
orgaDiiOD, although some differences in the disease and aim in the 
organism as found in man and in animals exist. If a cow ban tuber* 
eulosis of the mammary gland or of the udder, altbiugh the diM>HHO 
may not be apparent to the naked eye, the milk wit! eonlaJn tnberele 
bacilli. If the di»ca.sp occurH elsewhere in the lH>dy. tubercle baeiiti 
are not apt to tim) their way into the milk. The tubercle bacillus, 
moreover, does not multiply in milk. Tuberculosis may be produced 
in man by the »ame baeillns that causes bovine tubentilosls. Where 
this has oecum'd, it has uBually been the result of accident, the 
disease fulloning' Ix'ing of a local nature and of no great intenwity. 
Bovine tulwrele btu-iUi have been found in milk with viir>'inK ilcjfn-es 
of frequency by numerous obser^-crs and it has been ostimated by Tark 
and othertt that some 8 or 10 per cent, of human tuben^uloNiK is due to 
this lyjM- of on^iLiiiiim. 

Diarrheal Diseases. — The question of diarrheal diseases as canned 
'by milk is of the greatest practical importauee. Diarrheal diKease is 
comiuoucst iu the warm months, and 97 per cent, of tlie eases that 
occur iu children are iu bottle-ff^l bahieH. Where the milk is pure 
, and wherw pn^wr cure has Ixfn olwcrved in trauKmission from the 
eow to consumer, the discuso is rare. Whciv the milk in impure and 
IK earelesKly handled, many cases of diarrhea and death are the result. 
These diwases may lie produced by toxins generated in the milk by the 
bsereria, or by the baetena theinwlves beinjr introduced into the 
intestinal tract. It is not delinitcly known ju)*t what bacteria gives 
rise to summer diarrhea. The disease is probably due to different 



214 



rssiors fxctorx ix KEiJiTwy to dikt 



orgauitntu. K«c«iit mvestiffiitioiu ]>oiat to BaeiUtu dpMtUerieus 
(Shiga f as tlie nrganixm iniiKt vommniily preweiit. There is no vreater 
lusKiti to ]>(■ Irartittl iii the wiiulc rung? uf milk tnfectionti thau that 
mpun milk cannot d>arrkfo. 

Diphtheria. — Diplillieria ba4:ill) may fiud their way into milk from 
the milker. M-tio may have the disease in a mild fonn, or from sub- 
s«[iii"nt foiitauiiiiation. A numlwr of epidemic's have owed their 
oriKin to infii-ti-fl milk. 

Scarlet FcTer. — Where epidemics of this disease Iiave occurred as 
the result of milk ioft-ctiou. they have usually bovii Iraved U\ a cage 
of the disease in a milker's family, Kober taliulatetl 99 scarlrt fever 
epid(>mi<fM as fullnwK: diseHut- at «iair>* nr milk fHrm. 6H ; persons em- 
playn3 at the <lairy thither lodgwi in or )iud visitml infected huuseK. 6; 
from inflated bottles or milk vans left in srarlrt fever houaes. 2; 
emptoyeps wnrkinjt while suffering or recovering- frnm the disease, 
17; employers acting as niirsrs, 10: milk stored in or near tbe sick- 
room, i; infected clotb n.^d in u'iptng c&ns, 1. In 19 in8tanet-s the 
iufecliou was altributed to inllanii tint ion of the udder or 1o puerperal 
(ever in the eow. These outhreakit hhould be ri-|;iirdt'4t a» i-aMi*3 of 
Btreptovoi^euH or HtaphylowK-eiis infeotinn rather than itearlet fever. 

Typhoid Fever. — Many epideniies uf ryphnid fever may be traced to 
an iiif(.vtcd milk su|iply. Too mu<^h strt-MH van not l>r laid on the 
iiD[H)rtauee of iiive^tigiitmi; dairy farms a» a source of typhoid fever 
epidemics. Kober tabnlated 195 epidemics cauiied by milk. In 67 
inslaiiees the milk was probably infected by using iufe^rted well-wator 
to wash the utensils, and in l(i of thest*. infeeted water had been 
inteiitionally ailded In (he milk for purpom's of dilution. In 7 to- 
stauces the infection was attributed to eow>i wading in sewage- polluted 
water or pai^tureM: in 24 instaneeH the daii^' employees aeted as 
nurses ; in 10 inBtance.s patients HufferinR with mild altaeks continued 
at work; in I iiiHtunce ilie milk-ciinK were wa»;lied with rhe dishcloth 
uwhI among the fever patieiits; in 2 instances dairy employees ivere 
counevtiMl with the niuht soil scr\-iee: and in 2 instances the milh 
had been kept in a clniipt in the Htek-room. 

Asiatic Cholera.—Thix disease may be tranMuitttvl thnmgb the 
aifcney of milk, but the usual mode of infection is tbrongb drinkin);- 
water. 

Milk-poiMning (Oalactotoxismtut. — Iti 1686 tyrotoxicoo was found 
in milk, nnd in 1M6 NVwtim anil Watlai'e reporlfd intcreslinK series 
of raws (if poiNoninjr due In the [iresenee of this To.siii in milk. The 
luilk WHi) obtained from a dairy in which the milkinfc was done at 
midaiiiht and at noon. The noon milk wa^ tlie one that wait poison- 
ous. While hIiII warm it wa.s placed in cans, and delivered to the 
eoiwumers in the heat of the day. The heat permitted the growth 
of bacteria which eiiuscd the formation of toxin. There have been 
numerous inatances where its presence in milk has caused poisoning. 




DfSBASBS C.iVftED BY EffROltH IX DIKT 



215 



Vaughan and Novy have also fnund it in ic«-creaiii hikI in rustard. 
Shearer luui (IciuotKtralrd ita prcHriicc in vutiilla huiI lonmn k-cm. 
Beaides lyrotoxicou, other toxios have been found in milk. VaiiiihBti 
and I'erkiiix have i.soiatt'd a toxin, caused by a colon4ike bacillus. 
which produces marked hvniptomB. 

Chcese-poiKoning ( TyrotoxiKmus). — As early hh 1m27 thearieK lie- 
fEaii to be di-vsciiiiiiutt'd iift Iti lUr n-ason wliy (wmir thawe. usually 
apparently uiialtercd so far as ordinarj* obwrvatioii went, should 
oaiiKe poisoniiitr. Fliinnpfrld aiul othprs after him believed it to be 
due tu the (atty aeids. NimieruUH caiteH w<re reported and diKCiuused. 
In ]883 luid 1884 alxiut 300 eases of cheese- po'iKoniji^ were reported 
to the Miehiean Stiite Board of Health. All who ate of the cheese 
wero altaoked, and the s.nnptomR varied with the qiiaiitit.v tahoii. 
bein^' more severe where iarpe amoiintii had been iii(rpste<l. The 
«ymptoiiu> were >'omitint: and pnr{;ini!, with walen.- ntools; the tontnie, 
at first wbitv, then became red and vcrj- dry, and there was pain 
ill the re^iou of the stomaeh. The pid»e was feeble and irregular. 
Aud iu some inatatieeH there waa eyanw^iK. VuuKhaii Hludied these 
jMuieii. uud found (bat the poiKoninp vrna due tu twelve difTerent 
varieties of cheese, most of whieli eanie from one faotorj', The 
ffaeoae aeenied lo differ but little fn)in ordinary fiood eheese. but if 
offered to eiita or rlnjjs together with pood eheeiw*. the animals in- 
vnriably elHme the yood. If fe«l lo huufrry eat.s. they would eat it 
Bud apparently with no ill effects. The poison was isolated, and 
couaiMed of a crystalline, hipbly poisonous sulxttanee, which Vaughan 
wiled tyrotolieon. TjTOtoxJcon, however, appears to l»e a eompara- 
lively rare poiaon, and other toxie substances have l)wu diw-overed in 
cheese. Vaiigban iaolated an albuuiose; Vaughan and TerkinM, two 
baeilli: and Vuiighan and Mct'lynmndK, a bacillus of the colon group, 
all uf which were to.\ie. 

Typhoid l-ever and Oyster*.— Typhoid fever has been transmitted 
by infected oysters, the oysters having usually l>ecn gi*own very near 
the outlet of a .sewer or on artificial beds In New Haven, some years 
;a«o. thirty students were infected with typhoid by eating raw oysters 
•uppUed by a dealer who made a practiw of placing the fresh oysters 
in the river for a tlay or two after receiving thcnt Kiinning from 
his liotiKC to the river, near wherp he had placed the oysters, was a 
drain-pipe. His diiughter had typhoid at the time, and bi« wife had 
died of the diseaw^ shortly before. Instancea have been reported in 
other eountries, hut it is not a very eommou mode of infection. 

f*oison from Mussels (Mytiloloxlsmus).— Afrcordinc to Vnuehan 
and Xovr. there are three kinds of mussel-poisoning: 

1. Wbeiv llie principal »iyinploms are gnstro-intestinal, and nf vary- 
ing intensity. This form may at timea be choleriform <Coinb^). 
itli may follow very rapidly — in Combo's case it occurred in two 
■ya. 



21« 



VARIOUS FACTORS IV BFLATIOX TO DfET 



2. The most freciucnt form is tbat iu which symptnou; are prin- 
L'ipally uervous, oomhig on shortly after the mussek are euU-u. Th«re 
is a sensation of lieat and itching: a ra&h of an urticarial nature, and 
sometimes vesicular, appeani. There may be dyspnea, and death 
'nay result from coiivulKJve tremors or cumu. Deatli has followed 
from this form in three days. 

3, In the tJiird form thi? symptoms nrc those of au intoxication 
resembling alcoholism followed by paralysis and dt^ath. Cnmbe in 
1827 reported death as early aa thn'e hours after eating the mussels. 
and others six or xeven hoiirx, and Rtill others after longer inter- 
vals. 

Various theories have been advanced to explain the cause of mu.ssel- 
poisoninp. Bricgcr has isolated a toxin from nniHsel^ which hp calls 
mylilotoxin, which caused a fatal eti»v of jiiiiNiming. Further study 
is Deeded to decide the question of the toxin principle in the other 
forms. 

Shell-fi«h taken from KIthy water is apt to he poisonous. At Havre, 
Prsoee, cases of poisoning oecurred from the eatiiiy of oysters taken 
from near the outlet of a drain from a public water-closet (Pasquier). 
Various rules for reeopnizing poisonous shell-fish have Weu given, 
but ihey are uol, ati a rule, reliable. Shellfish that is frpsh, that 
has been laken fnmi cleiin water, and that bnn been washed with 
clean water, iR generally safe. Kept at a summer temperature, 
whether cooked or not, it is unfit for food. 

PoJsoninK due (o Fish (Ichthyotoxismus). — Fish may be poison- 
outt iiudiT varioutt condition^: 

(1) Borne are always poisoiioita. (2^ Borne are poiKOnous during 
the spawning season. {'3) Some may be infected with bacterial dis- 
eases which may eause disea.se in man. (4) Like other nitrogenous 
foods, fish may be infected with bacteria which produL-e toxins. 

Kobert, according to N'ovy and Vauijhan, makes the following classi- 
fication of poisonuuK ftKh: 

1. When- the fish are supptie<l with poison i^Iimds connected with 
barbed tins, with which they wound their enemies, like the poisou 
of snakes. T(ipsp cause prostration , convulsions, and death in man. 

2. The genus Teirodon, a Japanese fish which has poisonous ovaries, 
which are less poisonous in winter, when the ovaries are inactive. 
Kakk£. a disease of Japan and other Kastern countries, is believed to 
be due to the eating of certain varieties of the Hcombridtc family. 
(See Tteribcri.) 

3. Certain other f\ifh whose flcHh and glands are harmless may be 
dangerous on account of the decomposing substances or coralfi, etc., on 
which they feed. 

4. Poisoning due to ptomaVns, of whieh Anrep has isolated two. 
These are due to the fish being infected with saprophytic bacteria. 
The symptoms arc principally dnc to involvement of the gastro-in- 



n 



DISEASES CACSBD BY £RKO/tg J.V DtJST 



tcstinal tract uiul norvniis syNtem — naiuuMi, vomiting, disrrhcn, proB- 
tration, rasbes, etc 

Id Russia and ticrmany tb«rc are certain tiafa tbat, if eaten raw, may 
produce djsvaso, but that, when lfaoniuf;)ily rotikf^d, are harmless. 
The cauN.- IK prubabl>' found in u Itaclerial diHCtup of the fiah. 

Aleat-poUoning (Kreotoxismui). — llaoy forms of meat poisoning 
have been described, and mmf have been given special namea. Cer- 
tain diseases the result of direct trannni^-iioii will be runsidrred 
ae|>arately. The meat of animals that b&ve die<l r>f disease of any 
kind ia un6t for food, and the u)d Mosaic law. "Ve shall not eat 
anything that dieth of itself," ' is a good hygienic rule. The Jewish 
laws (concerning what were n^arded as clean and unclean uipats are 
get forth in the fourteenth chapter of the book of Deiiterouumy. 

Poisoning has followed the ingestion of meats of various kind« iu 
which toxic Kubstances bad formed. Some meats undvrgo i-hangeo 
that cau be detected by ordinary means, while iu still others putrefac- 
tive ehanges are not appart^nt. The pois'ms vary in nature, and in 
some cases toxins and bHctfria have lieen i.<uilated, Amonji the many 
foods that have caused meat-poisoning may be mentioned canned 
meats — pigs' tongues, potted ehioken. and the like: ham, sausage, 
brawn, veal and pork pies, ribs of beef, goose-grease — in fact, almost 
every kind and form of meat foods. 

Saatage-poisoning, known an btituMsmtm or allantlaaic, has been 
known for over a bumlred years. It is beejraiing less freipient as the 
eaoBes that give rise to the disease are becoming better known to 
niUBge -makers. Iu Baden, tiermany, where very faulty methods of 
prepariug and curing sausage were iu voRue. the disease was formerly 
frequent. Blood that had become decomposed was often used, and 
in other instances the sauHBge was imprrfcctly cured, the outside 
being smoked and rendenxl harmless, the oenter remaining soft and 
highly poisonous. For this reason those who ate the outside of the 
sausage exhibited no ill effects, while thwe who partook of the trnier 
were made very ill and many died. The symptoms var>" with the 
kind of [wison that has developed in the meat, but there are no char- 
acteristic lettioiis in thos<* who die. 

"Von Kaber, in l*eil, olMerved sixteen persons who were made sick 
by eating fresh nnsmokcd sausage made from the ilesh of a pig whick 
had suffered from an abscess on its neck. Five of the patients died. 
The symptoms were as follows: There were constriction of the throat 
and difficulty in swallowing, retching, vnmittnir, eolic-like i>ains. ver- 
tigo, hoarseness, dimness of vision, and headsehe. lister on. in severe 
cawes, 1her« was complete exhaustion, and. tbially. paralysis. The 
eyeballs were retracted, the pupils were sometimes dilated and then 
coDtracied, and they did not respond to light; there was paralysis of 
the upper lids. The tonsils were swollen, but not as in tonsillitifl. 

I Old TtgTKMntr: Detitcrononv xir-. 21. 



218 



VARtOVB PACTORJi iS lIBLATIOy TO DIET 



Liquids whicli were not irritating could be carried as fur as the 
eBOphairus. when they were rejected from the inguth and nose with 
coughing. Solid food could not be swallowed. Ou the back of thf 
toueiic and iii the pharj-nx there was observed a puriforiu oxudatr. 
ObslinHte (.■utmttpuliou cxitited in all, whik the sphincter aui was 
paraiyxcd. Breathing was easy, but all had a croupous cough. The 
skin was dr>- aud there was incoutinenoe of urine. There was no 
delirium, and Ihe mind remaint^d cletir to the lasl." ' 

Sehiiz cites ca-se-s of pdiKotiiug cautH^d by oatitiir liver sausage. There 
were loss of voice, typhoid-like stools, marked delirium, and mental 
diKtiirhaaee thai ijersistod for weeks afterward. The on«Rt oectirred 
in from eighreni lo twenty-four hours after ealitiR the sausase, and 
laste(3 from one to fmir weetoi. Therp were no deaths. 

Tripe has reported over 60 cases when- tlu're were fri'4pienl stools, 
weak and rapid hfart. and delirium. The pupils were iwnallv efin- 
tnnrlcd but reaeted lo bfrbt. 

Ballan! n-porlcd 490 di-aths dne to pneiimnnia. caused in most of 
tile OQ.ses by eating infected bacon. Acenrding to this ob»erver, those 
who had the disease eould transmit it to others who had not eateu of 
the meat, a fact that has been noted in many other instances. After 
having been kept several months the bacon lost its toxicity. This 
epidemic was known hk the Middlesborongh pneumonia epidcmie. 

Another interesting ppidnnie of meat -poison inj; (Kvurrcd at Mid- 
dlebtirg. Holland. Meat from a cow sieb with puerperal fever wan 
eaten bv 2oG itoldiers and 'id citizens, the s^^-mploms eonsistiup of 
vomiting, purging, dimiteas. sieeplesHneas, dihitalion of the pupils, 
and i» some oaHeti an ee/emiitous eniption. There wpre no fatalities. 

Thf present-day opinion regarding many of the disease conditions 
following eating of contamiiiHtcd foods is that they may be either 
caused by toxins elaboratetl by baeieria. or the toxins in the bacteria 
themseUi-N, the baeterin in (gueKtiini britit; pathogenic for some of the 
lower animals, but not capable of actually producing their BpectQc 
disease in man. althoUKh toxic effects may manifest themselves. Ty- 
phoid, paratyphoid A, and paratyphoid \i are diseases of inuu aud 
when the Imeteria are iugestt^tl ititii a Kuxeeptiltle individual the dis- 
caac is liable to follow. Foods may be contaminated, however, with 
other organisms that produce disease in aQimals. There is a lan^; 
number of them, among which may be mentioned B. suis pesttfer, 
which produvet> a dineane in pigK. B, pullonini, produeing diarrheal 
diaease in chiekens, B. enteriditix. nffeeling eattle, B. abortiis eqtii, in 
bones. B. typhi muri. in mice, and a number of uthera whieh need not 
be mentioned. Food prodncta contaminated by these organbtins will 
not eaiiKf any of the dlxeasos found in animals in man, but very dis- 
tinct syniiJloms as noted above' may follow. 

I \iiiiKh»n and Novy, Cellular Toxin*. 



4 



niHKXSfS VAVSBD BY KKItOUS /,V DIET 



OTHEB FOHHS OF FOOD P 01 SO NIX 0, 



Mushroom-poisoning,— I'oUoiiouti ttiugi are oftca mistakeu for 
edible mu^biiKtub.. autl k>»(l tu tuxic ttvuiptomii. If there h a ring 
uUmI ihu Kluik and llitr mutvfaroum perl easily and ha» piuk ^iUs, il 
in said to bp Don-poiBOuouK. This rule is not a mte one, tiince some of 
tbe niiwl datiifvroiiK foriiiK of riin^ci answer to tbU dtttcription. Tht> 
artivi? principlr in llirac poi^tiitius fungi in tiiiisirariri nr Ri>nip allied 
alkaloid. The symptoms piiidui^'od art? vomiiin^. diarrhea, cmnips. 
and izreat pitislration. The pupils are coutraeted. and in children 
there may be coD'\'nl8Jons. The ttvatment eonsisis in emptying the 
Htotiuieh and IkiwpU hh promptly m poKsible, and in giving Btropin 
and other restorulivrs. 

Chestnuts. — MiTritl (Journ. Am. Mctl. Afisn.. Jan. 24. 1914. p. 
2S9), reportfi soiiii? twenty i*HKe6 nf a lox^iida apparently pnxlui>ed by 
eating eheatnuta. Jlost of the patients wen- nialea and young. TIic 
sywplrtnjR w+TP variable, but included gasim- intestinal ditrtnrbance, 
great pro-Htration and a slow recovery. It is not determined whether 
tbe symptoms are cau»*<*d by the chestnntu having started to germinate 
or whether they were iu some way rendered toxie through the tree!) 
haA-ing Mufl'ered from the blieht. 

Orain-i>oisoninR. — There are three fornw of grain -pi ptsoning, gen- 
erally deseribi'd as erpolism. pellagra, and latliyrism. They are dia- 
eeoKH seen almost excluNively among the squalid and destitute, the 
effects being due to imniffieient nourishment combined in each case 
with the specifle poison from the grain. Most eases and epidemies 
ha\*e oecnrred among the povcrty-strickeQ Eimipeun pensuntji. The 
well-to (In nnd pmperly nourished arc much less sUHeeptible. 

Ergotism i Sitotoxismus). — The biittorj- of ergotiNm is most intereirt- 
ioff. It is v«ry probable that many cases of "Si. Autliouy's tire," 
dnwribed iu Ihe twelfth century and later, were eaaeti of grain -poison- 
ing. It is atsu probable that .syphilis and various forms of ulcers and 
gangrene w>'re confounded with it and with one another. It is not 
witliin the province of (Iiin txmk to dnieribe the horrible eptdeniiiK of 
the middle ag^-n, with Ibeir wake of iinitilutioiis uud miitery. Within 
rewiit years ■■pideraies have oeourrwl in Kii-ssia. 

Thuillier was the first lo discover that the cause of the diseaae 
«iiatcd in bpurred rye. He also pointed out that the rye is spurred 
in the daiup, euld seasons, and thuit the degree of viruleuce'dB[>end8 
upon the amount of the poison taken, lie pro%'ed his theories by 
animal experimeutation. Dodart. in 1676. aseertaioefl thai erv;ot was 
moKt active when freKh, and rhat it UtMfs in virulence as it ages. It 
ia prodnced by a mienis<^ipie paraxite, known as fHaficeps purpurea, 
irrowinr.' on the rye. The diwase ir caused by eating the crain on 
whirh the panisite has grown. Accordiuir to Koberl. ergot «ttntaiiis 
two jKitwuiii, sphai-elinie acid, which cfluses gaoirreiic. and eornutin. 



220 



VARIOUS FACTORS /.\ JtELATIOX TO DIBT 



which pruvokt-s tlie aiicslhtsia and convulsions. Tlic susceptibility 
of diflcrcm iudividuaU varies groatly. TIktc arc two forms of tbc 
di8«jixe. uu^ ill which jjaiigrene is ihe promiuent feature, aud a ^euouil 
III wliicb there are amviijgjuiis and aue-sthesia. An acute niid a 
vliniuiu fiirm itf the diHeaKt; oi'cur. In the gaiigri-noiis fnnii there are, 
af Ht^t, tiugliug, atirjitliexiH, MiiasiniHltc muvfrnonts, and later blood- 
stuKiK, futluwetl by guagrvuvi of thu (rxtri-mitit\4. In the convulsive 
form rhere are prixironaa] Rjinptoiua. lusting; for a week or ten daj"s, 
consistinic of hoadache, weakness, and tingliti>; siiii-tatioiiH. Following 
these there are cramps in the muscles and «OQvulsions. The spasms 
mtiy last fur hours or days, aud are apt to recur. Mental disturb- 
anfi's ami Mymptoins of cord iuvolveuimt mny siipervpne. The disease 
should not ho mistaken for erythromclalgia, Raynaud's disease, or 
aerodjTiia. whose symptoms it simulatee. 

According to Biittcer. ergot may be detected in flour by mixing a 
small qiianlity with ether and adding a few crystals of oxalic acid. 
The mixture is then boileil and allowed to settle and clear. If ergot 
is present, a red tinpc will be imparted to the fluid. 

Lathyrism (LnpinoM*). — This is a milder form of jrrain- poisoning, 
ihr potsuiiuus agent l>etng the seed of Latki/rus sativux uud L. cictra, 
coiiunonly known as the chiek-pea. Poisoning occurs from the meat 
gmnnd from these seeds, which has been used to adulterate llnnr. 
The disease was noted as early m the tM^vmtecnth century, and was 
studied by James Irving m India. As the reeult of the failure of 
tlie wheat cn)p at Allahabad the inhabitants used the chick-pea for 
f<md, and an epidemic of lathyrism followed. The disease affects 
the legs, producing a stiffness of the joints, and may cause a spastic 
parapletria. 

FotBtc-poisoning.— Potatoes contain small amounts of an alkaloid, 
snlanin, and sprcmling potatoes or those which have been partially 
expoMcd above ground may contain auffleieut to produce serious 
aympttHQs, such as pain, vomiting, diarrhea, jaundice, and great 
prostration. 

Chronic Coffee Intoxication. — Roch givea the following descrip- 
tion of this affection. The person is usually thin, pi-ematnrely 
wrinkled, the complexion sallnw, mid Ihere is a tremor of the hands, 
and usually mydrianis. There is a hesitating or bnisc|uc or uncertain 
manner with involuntarj- movements and exaggerated reflexes. There 
is a tendency to rienral-ria. there are cardiovascular sjTnploms and 
usually a sniHtl hanl rapid pul«r with an increase in the blo(Hl prensure. 
There are also <lik:eNtive disturbances. This picture i» usually not 
complete. Tea induces similar changes. 

SuKor.— It se*'ms po»*ible that unrefined or partially refined sugar 
products may «'ontain sulwtanees that are injurious as suggested by 
the work of Blnsser. Kerley and othcr^i have pointed out the fact that 



4 




CAC8ED BY F.Rl 



221 



Hume children and adulU are susceptibtt- to sugar and comparatively 
Hmall amouiits may produce asthma, vomitiu^. urticaria, eczema, etc. 

Phosphorux>poisoning.^II han l>eeri recummeuded that, after aeute 
phasidiiinLs-piiisijiiiiig all fat bt.- pxcludc<l from (ho diet, on the priu- 
ciple that fat will dissolve any phasphonis romaiiiiiig in the stomath 
and 80 basteo its absorption. For this reason the articles excluded 
!tl)ou)d be not only the butter and other fats, but even milb aud the 
volkH of e^^. The diet tihoutd oousitit chiefly of cereals, eruels, aiid 
the like. After several days the urdiuary diet may graduHlly be 
rcBUiiied. 

In chronic phostphonis-poisoning Maplot. of Paris, ro^'ommeiids an 
exclusive milli diet, eombined with the inhalation of oiyRen. srentle 
exercise, and repeated small doses of turpentine. If suppuration 
has oceurred. a supiwrtini; diet of the most nutriTioiis rliaraeter, 
similar to that used for other suppurative coudilions, should be pre- 
BcribiN]. 

Actinomycosis. — Thin disease in eompaniti%-e1y rare in Ameriea. 
There is no evidence to show that it has ever been iraiismitteii by 
artielen of diet, but eases are reeorded where tbi? infection has Ihwo 
traced to barley -8lieath.s. to grain chewed raw. and to tttraw being 
earned in the month. The mammary gland, both in cows and in 
women, may be infected, but so far no case has btwn traeed directly 
to milk. 

Tool-and- mouth Disease. — This disease may be transmittetl from 
tnft-cied catlle by niranK of milk or butter made from the milk of 
cows sufferiiiR from the disease, as well aa by direct eonlact with the 
animals. The di^ase was studied as early as 1834. when three Ger- 
man veterinary surgeons drank the milk from infected cows. All 
developed the ditwane. Infants and children have aiw been infected 
by drinking {!ontauiiua(ed milk. Tbe contagious principle is d«*- 
Stroyed by heat, but the tti*t>li, milk, and milk-products of animals 
with foot-and-nioutb disease should not be used for food. I>nring 
epidcniii-s especial care should be taken to avoid the products of sneh 
animaU. and in case of doubt the milk should be boiled before usin^. 

Hydatid Disease. — Hydatid eysts, caused by tbe epps of Tftnia 
echinorortus, may also be classed with the diseases caused by diet. 
The para«ilf (.-niwR in the smail intestine of diup*. and the ova are 
taken into the alimentary canal of man by drtnkinc wnter coiiiuitiing 
them, by handling dons and earr^-ing the infn-ted hands to tbe moutb. 
and by eating raw preen vegetables. The disease is rare in Ameriea. 
In the medical wanls of the Vienna hospitals a routine question is." 
"Do yon keep dogs, and do you eal green MlndaT" 



rOOD ALLZneT. SEKSITIZATIOH. AHAPHTLAXIS, IDIOmiCRAST 

lu former du.i-g i-a-scs in which food ciiust-d manifest symptoms 
were put down to idiosyncrasy. The symptoms generally caused are 



FOOD AhLEttGY 



gHHtro-inleittinal, urtiearidl or I'czemaluus, or else purtake of the 
nature ol" hay ft-ver or asthma. These comlitious uecd luiich further 
study, but there is do doubt that many of thorn are duf lo seuiiiiizu- 
lioD to food prottriiis. Jtist how far these cbaug«s arc due to the 
unchanged proteins or to split proteins due to tlie action of d«eompo8- 
ing bacteria or to the haeieria tlieuiM^heM or their taxiiiK lias not 
hren worked out. This hypersuseeiitiliility hns ht-t-ii drscribpd a» an 
uuusual or exaggerated supersensitivenesji of the organism to foreijrn 
suhstani'es. This is seen in the sensitiveness of the tuberculous lo 
tuberculin and in the urticarias produced hy strawberries, the asthma 
due tu effg white and in many other mure or lem familiar examples. 
These symptoms may follow the inhalation of foreign substances, their 
insreation. or may be due to bacterial action, l.'nder the tirst heading 
i:om«R the hay fever nnd asthma due to the pnllens of plapits. the 
asthmns due to the itthalation of animal products such as that which 
emanates from eats or horses, probably desquamated epitholium. 
Tender the second heading come the chan;;eK which follow the in^eB< 
tion of grain.s, nuts, fniita, mollnaks, meats, milk. eggs. li»h. etc. 
(See also Walker. Jonmnl Medical Research, 1917. xxxv, xxxri, and 
Journal nf tmmnnok><:y, 1917.) 

The presence or ahnence of this sensitiveness may he determined 
by skin tests which may !h? made in one of three wavH, The foreign 
material may be introdiieed on t\ searificutiou as Ku^frestcd by v»u 
Pirqiiet, by using a dental burr or n small .jeweler's sen-w driver or 
in a linear warifieation or by injecting intradcrmally. The linear 
cut made into the skin but not deep enough to draw Mood is. perhaps, 
ihc be«i as ttcinc freer from error and easier to read. The intrader- 
mal method is perhaps more Hcnsitive. but more difficult of interpre- 
tation. In using the taller the injection must be made inti> Ihe skin, 
not through it, and ahmit 0.P2 e.c. of sohitinn eontaining the protein 

U!»C(I. 

The tests may be made with food siihsiflnees as by applying white 
of ejrg in solution, or fat-free milk, or salt-free butter, or a solution 
of lactose, or a gniel of the grain or vegetable to be tested. It has 
h*en found, however, that it in better to have the protein as free as 
possible from extraneous matter and to thin end extracts of the various 
food stuffs have been made. These have been placed (m the market 
and render the testing of an inilividiiBl a comparatively simple niatler. 

The tesl is best made on the Hexor surface of the forearra and the 
place should he watched for twenty minutes. The reaction usually 
appears in tive or ten minutes and consists of a marked swelling and 
redness like an urticarial wheal. It is always well to make control 
tests as some individuals, especially those with exudative diathesis, 
may have a tittle redness and swelling about a simple cut or abrasion. 
The reaction disappears in from one half to two hours, but occasion- 
ally may persist for twenty-four or more. In some there may be 



4 




SESSlTtZATtOS 



223 



itcbuiK and if Ihr imlivuiual is extremely si-nsilive there may be 
raore or lews nj»rk<Hl jfeiieral «ymptoni8. althoug)] this is rare. Oc- 
casionally llie reaction may be delayed aiid sometimes the individual 
baa the &eusitic>atiou in i-e4;urriug <:yelvs, mt thai in iiPKative cases the 
reai'tiou should he rt'peated siibaeijueiitly. This absence of reaction 
iH diiuhtlutK due to ihi- fac-t tliat in Hnmp individuals a Mi>ven> reaclion 
is followed by a period of variable IcnKth during whicli the wnsilive- 
uem is absent. 

As a general nde. if a patient reacbi tu one protein he will react to 
a namber. If he reacts lo white of c^fg he will b<; found to react 
to the white of egjr of varionx fowls. If he reaets to tints ht- will 
lUlially be found to lie sunKitive to the varinuH luits. Talbut reminds 
us not to consider the peanut in this conneetion, as it is a letntmc. If 
the reaction is lo one grain it will usually be found to be due to sev. 
eral. There are esceptiouH. however, and the whole subject needs 
ratieh more careful study. Sehloss made a vcrj- careful study of a 
child wtifi reaeted to almondn, oatmeal and egg, but not to other 
Btihctanecs. 

Individuals who do not ffive a history of asthma or similar affcc- 
tiona, or ecEema or urticaria or of gastrointestinal attacks from foods 
ordiniirily hnnnle-ss will rarely be found to reaet. whereas a lartje 
proportion of personN with xueh a history- will react. There in a diK- 
tinct tendency for the condition to nin in families. The Hensitivenons 
mff be inherited or ae<|uired. ThiiN infants will be found that are 
itive to e(!:K while when it haK ui'ver been given ibeui before. 
The intestinal wall of the new born ba» l)een found to lie pervioiu 
to certain proteins and these Kiibstane<-.<4 may pass din-ctly throu)!h the 
intcirtinul wall into the bloo<l and may be demonstrated in the blood 
Mid in the urine. This may explain the production of sons^itiiuition 
and il may be that individuals who reaet are those whose intcNttnal 
tracts have been at one time or are peni'ioas to certain food sub- 
man ces. 

The siihstanccR CBu»in|f the reaction have l»ecn found hy Wttdchoiwc 
to \h' wiluble in water and in the case of v«n.'table8 they are not 
destnjvrtl by beat, while in the ease of fmit.s they are. Thiw it ia a 
well known fact that persons in whom raw strtiwherries may produce 
_«evere reactions are not affected hy the cooked fniit. 

Wodehoiwe extracts the active i4ubf(lance« by diMnilvinn them oat 
[in water. Xn one mi-tliod will do for all snbslanees. but in a eeneral 
'way his proc«inre is in exlraet the Rulwtani-es by soaking the f(KH) 
in water, four or five pounds to seven or eifiht (piarls of water, adding 
thymol us a pn-scrvativc. After sevenil days the water is decanted 
and lillered and then evaporated before an eleetrie fan and tlien the 
fn>mmy residue retlis.s(jlved in a little water prtN-ipitated by !>5 per 
rent- filcohnl. washed several timm in the «niue and then in absolute 
ateolial. then iu ether, and finally drying over a sulphuric acid bath. 



224 



FOOD ALLtHiGY 



The result is s friable powder which, if it is not freely soUible in 
water, may be dissolved by using 0.1 per cent, of polassium hytiruxid 
which does not interfere with its Bction. 

Striekler and Goldberp (Jouni. Am. Med. Assn.. Jaa. 22, 1916, p. 
249), give the following direetiou for preparing* ihe tuatei'ials for 
testiiit: : 

Preparation of the Extracts. — Beef. — Ten jrni. of fresh beef were 
cut up finely and tccoiind with sand in a stvriliised mortar until the 
fibers were broken down. After this process was completed, 20i> e.c. 
of alkaliuized aodium ehlorid coutainiiig 0.1 per eent. trieretiol were 
udded. and the entire su^pensioD wa^ placed in a sterile flask in the 
incubator, where it remained for thirty-«ix himra. It was taken out 
and the tnaleriat plaopd in Kmall sterile Hiuiks eontaining: sterile beads 
and plHirpd in a Khulcing machine for two hours; at the pxpiniiioii of 
thiti time the Dashs were ^ain transferred to the iueiibator. where 
they remained for another period of thirty-six hours. This mixture 
was then filtered through sterilized filter paper into nnolher sterile 
fla-ilc, jind the amount of the filtrate measured. lu the ease of beef 
it was n'l cc. and to this 20 e.c. of absnUile alrohnl weri" added. The 
BoUition was placed in a rather flat evaporating dish and placed on 
a water bath at SO C. to drive off the fluid and leave the solid residue. 
The dried material was scraped off the surface of tlie dish and placed 
in a deHiwator, to make alMwilutely certain that all the water had 
been driven off, Hnd that the residue was perfectly dry; 5 gm. were- 
carefitllv weijihcd out and dissolved in 100 e.c. of sterile diKtillcd 
WBtftr containing 0.25 c.o. of triereaol. (The nitrogen determination 
of the residue shows it to eoutain 4.72 per cent, nitroeeu or 29.5 per 
cent, protein, which percentage compared verj- favorably with the 
amount of pnitein found in beef.) The entire amifurit of beef residue 
did not go into solution, and it was determined to timi out accurately 
just how much did go into solution. The contents were filtered 
through a sterile Alter, which had been previously weighed: in the 
case of beef it was 1.200 gm., but with the beef extract it weighed 
1.131 gm.. Hhowiug that 0.12!) giu. did not go into solution, and that, 
Bubstracted from 0.5 gm,. left O.HTl gm. in solution. 

The solutiou was cultured in glucose agar for three da.^'s. and 
proved to i)e sterile and was placed in sterile bottles ready for usp. 

Pork. — The wime steps were followed. Twenty gm. of the material 
were used with 200 e.c. of 8alt solution containing 0.5 per cent, phenol 
(carbolic acid). The filtrate was 154 e.c. and lo it 60 o.c. of absolute 
alcohol were added. Thi^ residue with lilter weighed 1.1 gm.. while 
the filter weighed 1.01.*). IcHving O.ds.t gm. which did not go into 
Botation. and that subtnieted from 0.5 gm showed that 0.415 gm. 
were dissolved in the sterile. The solution was cultured as above and 
proved sterile. 




FftFPARATrOy OF TBB KXTKAOTB 



The nitrogen dctcrniiiialion of ihe residue showed 3.82 per oeot. 
and at pruteiu 23.9 per cent. 

MttttOB. — Twcuty gm. of tikis material were employed with 2(N> 
c.e. of normal salt Kolutioii plus 0.6 per eent. plieiiul. The amount of 
filtrate was 145 c.c. to which 60 e.c. oE absululc aJcoliol were added. 
Five-teutbs c^. of dried material was dissolved in 100 e.c. of sterile 
di»i.tUK-d wat«r plus 0.25 e.c. of trierpsol. The mlution was Altered 
and the weight of Ihe filter was 1.1!) trm. and the weight of the residue 
plus the Hltnr wdk 1.120. The amuunt not in sululjon was 0.(1.3 f^. 
Subtracting thin from O.o giu. leaves 0.47 ^m. in solution. The koIu- 
tion was eultured and proved sterile. The pereentoge of nitrogen 
mutton refiidue was 3.63 per cent, and the protein percentage was 
22.7. 

rkli. — Twenty pm. of porRj- wore rubbed up with sand and 200 
e.c. of salt soluliou plus O.j per cent, phenol, Afler putting this 
solution through the aame procedure as the material deseribed above, 
it was found that the filtrate amounted to 159 c.e. and to thiit 60 c.c 
of abaohilc alcohol wrn> addrd. Fivi'-trntliH of the dried residue was 
dissolved in 100 c.c. of stcrilr dtstiltrd water plii» 0.25 c.e. of tricreaol, 
and tbc lutlutioii filtered; the amount of the residue whieh did not 
di-KMidve wait 0.025 gra. and this subtraeted from 0.5 gm. showed 
0.475 (cm. in solution. Thir solution proved sterile. The percentage 
of nitrogen was 3.23, and the percentage of prnlPin was 20.2. 

Crab. — Twenty gm. of crab were rubbe<l up with sand, and 200 
C.C of the normal salt phenol solution added. After shaking, in- 
cubating and filtering it was found that the filtrate amounted to 
122 c.c,, and to Ihi» 55 c.c. of alMolute alcohol were flddt.>d. Five- 
tenths gm. of the dried residue was dissolved in JIM) c.c. of the 
tricresol sterile distilled water mixture, and it waa found that it all 
difvnlved. It was i^iUnred in Rlucose agar, proved sterile and waH 
r«>ady for use. The pert.>eu(age of nilrojrcD was 2.61, and of prob-iu 
16.3. 

lobster. — The same procedure and the same qaantities which were 
employed in preparing rrab were al!40 employed in preparing lobster. 
Tlir dri<-d residue waa all diaanlvcd. The percentage of nitrojcen was 
4.73. and of protein i6.3. 

Wheat — Eighteen gm. of wheat (flour) were rubbed up with 200 
c.c. of alkaliuizcd sodium chlorid (normal sodium chlorid, 500 c.c.; 
normal wwlium hydrate. 5 c.c.; phenol, 0.5 e.c. (0.1 i>er cant.). The 
notation van addwl Utile by little during the process of tritura- 
tion. The sohttion was placed in a tlask in an incubator for three 
da^'B, daring which time it was shaken for two hours in a shaking 
machine. The solution was Altered and 2S9 c.c. was found to be the 
amount of the filtrate. To this 100 c.c. of absolute alcohol were 
added. The solution was placed in an evaporating disb on a water 



FOOD ALLKKOr 



bath. The dried residue was removed irom tbe disli and 0.5 gm. 
diKiulved in 100 u.f. of the trii-resol steriie distilled water. It was 
filtered, as ull did not disHolvc and thv atnonnt of undistiitlvud rrKidne 
was 0.15 gm.; that subtracted from 0.5 srm. shows that 0.35 gm. were 
in solution. The solution provi'd Hleril« ou culture. The percentage 
of nitrogen was 1.77, aud that of protein 11.1. 

Oats. — Niin* frui. (if ciHtmt>al w«?re ruhhed up with, ISO e.c. of 
Hlkalinizcd sikUuhi i-hhn'id soEiition. After iiimbalioii. shaking and 
Bltcriut; it was found that the Bltratc amounted to 2.2 c.c. To this, 
00 C.C. of absolute alfohol were added. Five-lent hs gm. of the dried 
residue was dissolved ia llH) e.e. of triuresr)! slerite distillrd water 
and filtered. The amount whieh did not dissolve amounted to 0.07 
gm.. showing that O.W gm. was in solution. The nitrogen percentage 
was 1.13, and tfac pratein 7.06. 

Bioe. — Riee powder (nee Hour of Smith. Kliae and French) was 
obtained; of this priwluet 10 gin. were rubbed up with 20(5 e.e. of 
alkaiinized sodium chlorid plus lri^^e^al]. After incubating and 
shaking and then filtering it twice, rice, l&l e.e., plus 53 cc. alcohol, 
one-third volume of absolute tdcohol, were added. Precipitation was 
sligbt. The preparation was placed iu an evaporating dish; the 
material was seraped off and 0.5 ym. dissolved in 100 e.e. of tricresol 
distilled sterile water. Prnetieally atl dissolved. The pereeutage of 
nitrogen was 0.569, and that of protein 3..'i6. 

Burley. — Ten gtn. of Robinson's prepared barlev was ground up 
with 200 c.c. of ulkalinized sodium ehlorid solution plus tricresol, 
incubated, shaken and filtered. The amount of Hllrale was 158 e.c. 
and to this .52 c.c. of alwotute alcohol were added. The siilutioii was 
evaporated on a water bath, and of the dried residue 0.5 gm, was 
dissolved in KM) ce. of tricresol sterile distilled water. Pnu'tieally 
all went into solution The solution waii euHn rally sterile. The 
nitrogen percentage was 0.695 and the protein 4.34. 

Strawberries. — Good, firm strawberries were selected. Tliese were 
ifround up aud put in the incubator to dry out. The dried material 
weighed !• pm. It was rubbed up with 200 c.e. of alakalinized solution 
plus tricresol. It was iiipuliatetl and -ihaken : then it was deeidrd to 
add 2flt^ c,e. of Ihr alkalinJzed s'llnUoii in order to thin the mi.tture. 
It was filtered, and the filtrate amounted to 2K9 e.c; to this 100 c.c. 
of absotnte alcohol were added. The solution was evaporated on a 
water batli and M.5 gm. of the dried residue was dissolved in 100 c.c. 
of trii're.sol sterile disitlled water. It did not go into solution. 0.06 
gm. remaining undiKSoIved. leaving 0.44 gm. dissolved in the 100 cc. 
of solntion. Culturally it was aierile. The percentage of nitrogen 
was 1.31. and of protein fi.2. 

Tomatoes. - Tomatoes were cut into fimall slices and placed in the 
incubator to dry. The material was then seraped from the dish. 
The material cttlleet4-<1 weighed just about 10 gm. it was rubbed 




rXEPSXATIOS OF TilK HXTJtACTS 



2ZJ 



up with 200 c.r. of triercMil alkaliniwd idiU mtlutioti, inculuUtl. Khuken 
and Hlu-rwl. A iM'cond liltration was uwcfwarv. The liUrate 
Btuuuoted to 140 c.c. and to thu 46 e.c. of absolute altMhol were added. 
The Holutiou was ptacrd on an t-'vuporAtin^ dish on a water Itath. 
(ireat ditTiciilly vtaa vxpcricnced in drviiit? tlim pruduet ; 0.5 );m. was 
diiisolved in 100 c.e- of l^iere^H)l ^ttrrilr diKtillcil nutrr und tht toa- 
ferial went into solution at odpc C'nltnrcs were sterile. 

CoV'Casein.— One gm. of Hflinmei-sH-in's cow-e«si-in was mixt^l with 
100 e,e. of alkalinized salf snhltirm plus tricresol, place*! in a sterile 
tiask. incubated and shaken for two hours. The solution wa>i filtered, 
tested for albumin and found positive. Cultiirea were negative. 

'EtS WTiite. — Kivc-tcnths grn. of egy albumin was crushed and 
powdered in a sterile mortar and ditwolved in lOti cr, nf nonniil salt 
L-OQlaining 0.25 per wnt. trirrcail. The soUltion fillcrrd vcrv slitwly. 
Some of Ibe egg did not go iuto solution, and it was found that 
0.465 gra. was ditaolvod. The solution was culturally sterile. 

The practical application is to test patients with eczema or urticaria 
and it is possible that some of the other skin diseases may be found 
more or less dependent on food KenKitization-. patients with the bistnry 
of asthma and allied conditiona, recurrent bronchitis, and tho»e with 
gastrointeKltnal s.^'mptoIn8. If the offending substance or Kubslancca 
can be determined they may be eliminated fnmi the diet or an at< 
lempt made to desensitize the individual. In ol<ler pcrMciiiit very ex- 
eellent results may be oblaiiieii, especially in eczema and a.Klhma. 
In infants a rrdnrtion or removal of the protein from the diet may 
briuff about a great temporary improvemcat, but as Dlackfar) has 
summed it up. "it is impossible to feed an infaut for a long time 
on a diet that (-ontains no animal protein without the risk of seriously 
affecting hia nutrition and Iteeatise there is a stmng tendency for the 
eatema tu return, even though a protein poor diet pnnlmws an early 
improvement and even though the protein po«r diet is eoutinuwi." 
Fortunately, many casL-n, hiitb the eezi>ma of infancy and the asthmas 
of ehildhottd, tend to spontaneous cure with time. 

Th« descDsitizatioD may be attempted by feeding the individual 
verT* miout« amounts of the offending food daily, increasing the 
amount steadily until large amounts can be taken. The Kensitive- 
neas generally returuH unlexs mnsiderable quantities are taken daily. 

Deaensitization by menus of injecting the purified proteins has 
alM be«n osed. This procedure is perhaps best left to those having 
ntperienee. ax ineoireet dnwipe or spacing of the dosage may lead to 
mJirki^l reactions. Rxtrrmrly small amounts should be used at first 
and the injeotions made not over four iIryh apart, as longer inten-als 
iiMiead of desensitizing will make the individual more Hcnsitive and 
alarming re«ultA follow. 



FOOD ADULTERATION 



Tho adulLemtiou of food is a subject of such wide scope tluit it can 
not be t'tilrrcd into h^re in delail.' Tlie subjvet is one of the greatest 
importanee to the comiuimity at larirc; miJ where legal reatrictioiis 
do uut exist, laws should be enacted wliich will insure the proper 
iiiKpi*L>(iuu and reflation of the sale of a]l food-stuffs. The sale of 
injuriuus uilitles should be absolutely prohibited, and adulterated 
but non-injurious commodities should bp properly branded ho that tht* 
purchaser may not be (-timpiplleil t« pay an exorbitant prk*e for an 
iiifrrior article. The laws ^huuld apply to both native and imported 
food-Htiin's. 

Ill the United States the law enaeted July 1. 1903. prohibits the 
i]iti\)duelioii of — (o ) foods containing substances deleterious to health ; 
(b) ihnHe rai-sbranded; and (c) foods the sale of which is prohibited 
in the country from whicli they arc shipped. 

Almo«t all the Slates have enaeted food laws of more or less effi- 
cieney, but the laws should be suflfieiently uniform and stringent to 
prevent the sale of food-stufFs deleterious to hcitlth. and to prevent 
misbrandini*. AhhonRh under the present law imporipd arlioleB are 
pure and propprly branded, there are ^-pat opportunities, after the 
articlee have entered the country, for the perpetration of fraud; the 
same is true of nutive food-stuffs. 

Pood adulteration is of two kinds: that which is injurious and that 
which is noil- injurious. The latter is pmctiacd where there are no 
tixed slundtirdii. or, where such do exist, in debasements from these 
fixed standards. Adulterations may be classifleti as follows: 

1. Conventional — to suit the ta.ste and demands of the public. Such 
adulterations are usually ertVeted by means of colorinp-mattem. many 
of which arc harmful, and by bleaehiiis certain products. 

2. Accidfnlal or incidental— ^arifiina from environuicnl, carcless- 
Dess, or incompetency on the part of the producer, manufacturer, or 
his uKcnts. This usually consists in an admixture of some forei^ 
substance, such as husks, stems, leaves, etc. 

\i. Arbitrury — to comply with or take advantage nf certain lixed 
arbitrary' standards. 

4. Inlentionat — for purposes of gain and competition. 

Coloring* mat ters.^ — The use of coloring-matter in fond is a moot 

point. We think we can safely assert that the use of any artilieial 

color! ng-matter is objeelinnable. and many of the dyes so used are 

barmfid. Fortunately, the people are being educated by Wiley aud 

' F«T ui cstMidod rtudy of tlilii mibjort the render is reforrMl to BljrtbV book 
om Ftmi», and bIho to the pxrclli'nl bitlMins ot ttie I>iviiiion of Ch«niBtry of i)t« 
United Stni«>fi Dcpartraenl ui .iKriciilture. Thi- Imlii'Liii on Food Adtilt4>rBtian, 
known nc Nn. \S. of wliicli >ii>ni<> tim purt* titLvv atrpiidv l>pcn tuu«d. ean )>i> found 
in all the iatfirT Ubrnnpii. tiiiT, nn(oTtiinntelr. tlio vnrhpr I^aIIk ara out uf print. 
It U lo >« bopnl Hint tliiM liiilletiii uill la- ri!|irint<>d at nn tutity d«I*. 



fl 



ALCOaOLlC BE\KK.Kf}ES 



229 



I 
I 

r 



his onocialvs, and & demand for pure aad uncolored foods ut Wine 
created. 

Alcoholic bevcpages are frequently adulterated. Wood or methyl 
alcohol is wmetimeti subdtituted for grain or ccbji alcohol. This is 
Otpecialty true of Ihe flavoriii^; extrui.;tK, which are used iu Hiuall iiiinn- 
titiea. \Y«kkI alcoliol is un i-xKLrdingiy dangcrmis adulterant. Blind- 
neaa and even death have followed its use. The hJglier they stand in 
the series, the more toxie the aleohols become. Hunt has sh{»«u ihat 
a larfier single dnw of methyl aleohol than of ethyl aleohnl is re- 
quired to kill, hut that the ali-uhnU dilfer widely as retterdri their 

■ets with roiitinuod use. A 4|imiitity of ethyl alcohol somewhat 

►low (he lethal dose may be taken day after day without causing 
death, whereas repeated larvre doses of methyl aU-olioI may speedily 
remilt in death, the rrnHou beiti-: that the end-pn>du('t.s nt K^ain idcohol 
are acetic aeid and water, whereas the end-products of wood alcohol 
UT formir arid and water. 

Adulternlrd aleiiholje li<)uorH eontain fusel nil, tannin, lo^-wood, 
water, eoloriu^-mnlter, and burnt supar Various grades of eheap 
whiaky and brandy are mnniifar-tured by unscrupulous reelitiers by 
mixing newly made atc^ihol with eoloriug and 6avorin)r matters. Au 
imitation of ^n va, frequentty made from eheap spirits, turpentine, 
sugar, and water. 

The AdalterBtion of Beer, Wine, et«.— Wiji* and hf(r arc sophisti- 
eaied by the addition of various substances uHually added ax preserva- 
tivea. Chief among thest- is salic.vlic aeid. which is added to arrest 
the action of ferments. lis use is forbidden in Franee and fJerraaiO'. 
althouffh in the latter rauntry It may be added to lieers thai are to 
be exported. 

Cerard found that, in a liter, wine contained 1.9-i. I.fiO. 1,48. 1.41. 
]^&. 0.81, and in one eane as niueh aa 8.5 griuns of Nnlieylie add; 
irynjp eontaJned in the same quantity. 0.5(3-1.50 (rrams; beer, 0.25- 
1.2ri ^rauK: milk. 0.25-1,115 ^nims. In one ease it wilt lie noted that 
a liter of wine euntaim-^l a full twenty-four hours' dot« oF saljeyltc 
aeid. 

Crarapton found salieyltc acid in about one-third of the samples 
of Amerimu bottled beer which he examined. lie did not fiud any 
in draft beer. Sulphurtjus aeid id one of the oldest of preservativea. 
It* UHC is forbidden in bolli France and Germany. Rorax ja fre- 
qoently used, and ta also forbidden in the countries mentioned. 
Sodium biearbonate is used in beer to c*orrect the acidity eau-seil by 
improper brewine. and also to cause an increaac in the earlKjnic acid 
eonteiit. so that the beer will have u better "bead." 

V/ine w adulterated by adding sii^ar. gummy KubstaneeN. eolortiig- 
mattera. and nalicylic acid and mineral acids as pre^ervativea. la 
I^'niiee wine is fr«|Hently plasite.re<i l>y the addition nf pypEuin. or 
nlchun sulphate. As Cramptou sa.vs: "The sulphuric »eid of the 




230 



roon AnoLTBRATioy 



lim? salts rcpluws the lartarit* at-id which in combiued wilh potasli, 
and foriiiA uu uL-id KiUpbatc of potash, while the tartaric acid separates 
out as a tartrate of lime." This gives the wine a brighter cotor, 
clears it. aod niakex it keep better. 

Adulterated beer may oontsiii biirtit s\igur, licorice, treaele, quas^a, 
coriander, earaway seed. Cayenne pepper, soda, salicylic aeid. sail, 
carbonic Ht-id (artifieiaily intrudueedi, {rraius other thau barley, 
glyceriu, glucose, water (added by retailer), tobacco, and Coi*cuIu»i 
indietLs. 

Cider ih frcquFntly adulti-rjiti-d b_v Uu- addition of water aod 
preservatives, and is alsn nianufaetiired artificially. 

Many of the b't/uid malt extracis are merely beers, and most of 
tlieiii have little or no diastasic action; they have no speeial foo<l- 
value, nor do kucIi extraeU aid digestion. Borne are adulteratml and 
harmful. 

Liqueurs are frequently adulterated and imilated. and may contain 
injurious t^nloring-matter. MsraHcbino and creine dc nienthe cherries 
may be colored with anilln dyes, and they somctiiics contain an 
astonishiiig amount of etiloriug-uiatter. 

Tea, — Under the present law teas imported into the tfnitcd States* 
are practically free from adulteration. Many inferior teas are sold, 
htittwer, and ihcir sale is not rpsTrieled. Tea may W adulterated by 
mixint; exiiaumcd or foreijrn leaves with it, niid tiddin^ eolurinp-matter 
and astriiipeiits, "Facing" is sometimes praetieetl. and erinsists of 
treating the leaves with plumbago, indigo, or Prussian blue, the (ibje<-t 
being to make an inftrrior tea resemble a better product. Tbr smiill 
amount of the adulteraiitjt used is not injurious, and the adidteration 
ia r».sily di-lccled. 

Coffee.— Ureen and roasted coffee may be imitated. A« inferior 
grade of coffee is fre4inently branded and sold as a better article, and 
roasted ratfec may be adulterated by the addition of too much glazing. 
Ground coflTee is freijuenlly adulterated, and may conlaiu Httle or no 
coffee. Chicory is the commonest adultfraut. 

Cocoa is fre(|uently adulterated by adding starch, sugar, clay, 
brick-dust. Miloring-inatler, and flavoring materials. The eocoa-butter 
may he extracted and tallow or oilier fats and oils substituted. 

Flour is adulterated by adding other graiu^i before grinding or by 
mixing other tlnurs of an inferior grade or from a ditTerent (,'raiu. 
In the Tnited States the sale of "mixed" Sours is regulated by law. 
The mixor must pay a speeial tax, and the product must be eorreoUy 
labelled. Various mineral subsTanees have been f<mnd in Runipean 
flours, but such adulterants are seldom used in the United Statt-s. ' 

Bread. — Tliis has Vieen ndnlteraled by the use of inferior flour, and 
by the addition of other sul>stanees. hiHtam^cs have been reported of 
the use of ftulpliate of copper and of ammonium, and alum is also used. 
In foreign countries soap and gypsum have been used, and stannous 




m:rrKk 



231 



I 

• 
I 



I 



eillorid has been added to bread made from an informr flour, for 
Uk- purpose of making it rrsemble that made from a belter quality. 

Butter. — This may be adulterated with oleotoargftriu, buttcriu 
water ("stretched butter" i, lard, eoltou-se«d oil. beef suet, and olive 
oil. Butter aud oleomargario have about the same eom position, and 
possem about equal dik'<'»tibility. with the baiiincc slightly in favor of 
butter. OleuniHrg^arin is ntit injurious, but to prevent fraud should 
be corrci'tly labelled. 

Lard.^ — This may be adulterated with stearin, cotton-seed oil, and 
water. The adulterants are usually haroilesK. 

Olive oil.— This is fre<iuently adulterated with eotton-seed oil, etc. 
Foreign oils are not sa enuiiuoiily adulterated as formerly, but 
foreign laliols arc frei)uoii1ly placed on impure oiU, the labelling 
bein([ done in the t'nited States. 

Confectionery is sonietintes sopliiKtiirated witli tartarie acid, gliieose, 
starch, soapstone. and other substanc-es. lujurioum tolonnfi- matters 
may be ui<e<l. 

Spices. — These, particularly the ground gpiccs, are frequently 
adiilterati-d. Black pepper ban been extoDHively adulterated with a 
larve variety of substances. 

Honey.— After being extracted, honey is fiomelimcs adulterated 
with glucose or cane-sucar syrup. This is not practieed to as great 
■n extent as 4.>ommouly (supposed, aud pure extraet«l honey may be 
bought in 1.bc open market. Comb honey cannot be made without fbi- 
aid of bees. A thin sheet of beeswax, in which there are hexagonal 
inpreflsions correHponding to the baiiex nf the eelU, called eomb founda- 
tiuu, is used very extensively lo bring about greater uniformity in the 
size of the eeila, aud also to lessen the labor of the bee. In Europe 
it is said that eera.tiii and paraffin are uned for this purpose. They 
euiDot t)e »ueeebslully employed in America, huwever, and bee-keepers 
state that the uHe nf these waxea is impinaible. Honey may contain 
poiaon. Pluggn found that the honey from Hhododtudron ponttcum 
is poisonous, and Xcnophon, in his Anabmibt, deserib^s attacks of 
intoxication due to eating honi-y. Although d<«th seemed near, none 
of bia soldiers were killed by it. Strabo and Pioseorides both speak 
of booey as producing madneiw or melaneholia. In AbyKsinia honey 
fniD the ('US.HO troe is uttinl as an anthelmintic. The honey from 
gcJaemiuiu in also poisonous. In Branohville, .S, C. twenty persons 
were made ill and three died from eating honey derived from IhiK 
Aourec. In New Zealand honey from the "whauriki," a cresalike 
plani, eatues severe syniptouiH and wimetimoa death. 

Olycerin. — Thw is adulterated with «Iuc»we aud water. 

Infant Foods. ^Thes<; are rre<)uenlly adulterated, many of them 
being merely eereal mixtupes for which nn exorbitant price is charged. 

Baking- powder. — Stareh in large quantities U often added to 
baking-powder. Alum may be added in place of eream of tartar; 



232 



POO© ADULTERATION 



but if the powder is correctly labelled, amt the addition is allowed 
by the state law. it m not to be cuutiUlored an adulterant. Mallet 
regards alum baking-powders ax injuriouK. This is an open questioa. 

Canned Vegetables and Meat.— ^ThoHe freiiuently contain snh- 
staneejt (lolt?teriuiiK to health. C'oppyr and iww, eupwially the farmer, 
may be nscd to cnlor pcuit. Lviid, tin, and zinc may be present as the 
result of unintentional coDtamination. I^cad may ^ain eutrauct^ from 
the soUIor, wliieh is frc(|uently used in lar^fe quantities and allowed 
to drop into the eaii. Lead-stoppered bottles arc also smnrtiraeR used, 
aDd account for the presence of lead in the food. Mctidlic lead is 
objectionable, and the presenc-e of lead salts is highly injurioaa. 
There are two kinds (if tin plate iiHcd in the manufacture of cauB — ' 
tie "bright," in which pure tin is used, and the "teme," in which 
a mixture of lead and tin is used. This latter is employed for moftng' 
purposes, although it is sometimes wrongly used for cans. I'rctwrva- 
tivefl, such an Hulphurous aeid, salieylic acid, boric acid, and others, 
are freiiuently added to <;»nned foods. 

Preservatives.^ Various chemicals arc mixed with foods to preserve 
them. In many countries the addition of uuch prescrvutives is. forbid- 
den by law. Sometimes only one presen-ative is used, but often 
mixtures of two or more are added in combination. Boras and boric 
aeid are the most fretpient combination. These substances, toigether 
with snl)iliunniH auid, sulphites ami itutphatcs, Hulirylic acid, hcnisoie. 
acid, and forinoldebyd, arc most frequently employed. .\ larp:- 
number of other chemicals are used, chiefly to evade laws that forbid 
the n!W of the dnigii Just mentioned. It uiay safoly be atated that 
the addition of any chemie pn-scrvative to food is unde-firable. Ther« 
are differences of opinion regarding the aelual effects of the various 
preservatives upon the human body. 

Borax and boric acid au preservatives arc the subject of numerous 
eontlieting opinions. It is possible that some of the favorable opinions 
have been issued by those wba draw their siiUiries and their opinions 
from the same source. While it is Jtlatpd by many thai the use of 
tbeae chemicals is not injurious, there are instam-os on record where 
tbc>* have eaused severe symptoms and even death. Morie aeid and 
borax may. however, (bid their proper use in preservinir meats, such 
as hums, for exporting purposes. Meat sprinkled with borax or 
boric acid does not het'ome slimy, as it doeii without it. Before the 
meat is used, the Iwirie a«'id .should be washed off. The German Qot- 
emmcnt has expressly forbidden the use of such powders on meals 
imported into that country. This restriction may, however, have 
been inspired by the Agrarian party, and not by consideration for the 
public health. 

Wiley ' concludes as the result of hia experiments that boric acid 

) Rtwiilln of Borax Hxp(irlinciit«. Ctrcalsr No. IS, Burotii of Cbemivtry, U^ted 
States i>t:|isrttnent of .VKricultnre. 




auLPUVKOia avw 



288 



and boras sliould not b*- used except where preser\*atioD is a necessity, 
aud where it lias heeii stiuwri thxt olhvr metliddii of pre.servatiun van* 
not be eiuiilt>.vi-<l. Artivlm t^oiiLaiiiing boric acid or borax should be 
propcrK branded for tbe protectiou of the younff, Ibe sick, aod the 
debilitated. Ijar^e dases (4 or 5 praois a day) cause loss of appetite 
and of ability lo perform work; moderale doses |:{ graiiut a day) 
cause symptoms, but tlic subjeeta are able to conttnue work for iwuie 
time: smalt doMS (V^ to 2 ^rama) may be taken for a limitiM] time 
without rpKuU. but unfavorable sjinptoms arc p^odu<^pd iu some caMS, 
'■ It appears. Iherefnrp, that lK)ric acid and borax, when continuously 
admiiiixtered in Rmall dcmeK for a lout; perioil. or when ^iveu in hrgf. 
dusos for a short period, create disturbances of appetite, of digestion 
andof healtlL" 

HarritifTton * ha;; shown that boric acid may be the direct cause of 
subacute and trhrnniL' nephritis. Food preMen.ed with th«sp dnigR is 
ihen'furc especially iujurious to individuals BulYrring with Brigbt's 
Ui<«ease. 

Sntpkitc Slid bisnlphate of >odioni are used for pre«er^-mg all sorts 
of food, and esptxially for prpscn'ing" the eolor of meats. Their use 
is re(taniwl as dMiiKi'i"<'u»*. mid has bei*u jiruhiliited in fJcrmauy. 

Salpharous acid i.s frequently used, i-specially for pre*erviug wiues. 
In tMQie couutries a certain amoiuit of sulphur is allowable iu wine, 
but the amount is often exeeedetl. It is also widely used in preserring 
tln> I'lilor in dried fruit.s. 

Salicylic acid is widely used as a presei^ative. It is exceedingly 
powerful, and is used only where the taste of the article is uot im- 
paired, us in beer, uialt extracts, preserved, fruit and Ibe like. In 
some inxlances the amount of salicylic acid contained in (oo<l to be 
eati-n by one individual in twenty-four hours has been found lo 
equal the maximum medicinal dose prescribed for the same length of 
time. It is undoubtedly highly objectionable, and its use should be 
prohibited. It inhibits digestion and irritates the kidne>-8; food 
pre«rve*l with salicylic acid is especially injurious in cases of 
Bri(fht'H disease. 

Foiaaldehyd is fre<{ueutly used for preserving milk. As it Iiardeus 
mrntK, it is not uKually employed as a meat preservative. In generol, 
it may be slalrd that the u»e of fnrmnldehyd as a preservative is un- 
dc-!iirHlite and dannerous. Attempts have recently b«cn made to show 
thai in milk very small amounts, 1 : 100.0*10 and less, would inhibit 
ihe (fpowtb of bacteria, and at the same lime not be prejudicial to 
health, even to that of infants. -Aeeordinp to Vaughn, fonnaldehyd 
in Ihf pmportion of 1 : 25,1)00. or 1 : .50,000, retards the growth of the 
laetie ai-id luicilluK. and thus delays the sourint; of milk, while it has 
hut little clTeet on the mnlti plication of the colon and typhoid baeilli. 
It removes the danger signal without removing the danger. Such 

> Ancricaa Jtmnuil of Mrdical Scwnrvn, September, 1004. 



234 



POOD ADVLTERlTtOS 



use of fonualdehyd should be prohibited, as it might lead to the 
us« uf milk which, while swuul, might sUU Le UdtiU with diaeaw- 
producing bacteria. 

Hydrogen perozid is used to a alight cxteot, and is probably the 
least tiijuriutis of nil pruservatives. 

Uetallic Poisons and Food. — Small amounts of metals or their s&ltM 
may find their way into food. The metallic »Uts are highly injurious, 
and may produce either acute or chronic poisoning. MaJiy eases of 
lead-poisoning arc t Du'fiilde to coiitnminatrd food. 

Lead bus been considered io coiiueetion with canned ^ods. 

Copper may be added iutenlioually as a coloriog-matter or it maj' 
gain t-ntraiice from the use of copper or brass kvttlcK. 

Nickel is Hometimes used to color green peas, aud may be found in 
food cooked in nickel vessels. In the latter event the amount found 
ia &o muall that it may practically be dii^regardcd. 

Zinc iK Bometiuieu found iu foi>d, especially iu dried applea. It 
owcH its presenile to the galvanized iron racks upon whidi apples are 
frequently dried. The amount present is, however, so small as to be 
unimportant. Zinc may ab«o enter food from certain kinds of solder, 
but thcHC are now rarely used. 

Anenio may be introduced into food in various ways. The articles 
most liable to eonlatu it are beer, mall oxtraetH, Kyruiw, aud foods 
eoatainiug glucose or vinegar. In the widespread oceurreuce of 
arHenic-poi-soning, in Mauchester. over 6,0(X! persons were affected, and 
over 100 died. The poiioning was caused by drinking beer which 
contained arsenic derived from impure sulphuric acid used in the 
manufacture of brewing sugar or plimose. In other loualilies the 
arsenic has liet-n found to be cnntaincd in the malt which hud been 
dried in kilns heated by burning arsenical gas-coke. 

The table on p. 235, oh presented by Prof. Sharpless,' gives the 
food articles likely to be adulterated. 

UXf LE TESTS FOB DUXSCTIOH OF FREa£EVATIV£&. 

The following tests. largely adopted from Bigelow and Howard's 
article, wilt be fouud of use in detecting the more important com- 
mercial preticrvatives, with the exception of sulphites and fiuorids. 
The sulphites are usi-d in meats and the fiuorids in fruit, and the 
methods for determining their presence are not suited for household 
use. 

Salicylic Acid. — This is very commonly nsed in all kinds of foods, 
solids, and liquids, especially fruit products. It is best detected in 
solution, and xolids and wmisolids should t>e macerated in water and 
then strained through a while, ctitton cloth. Two or three ounces of 
the fluid to be tested is used, adding to it a lew drops of sulphuric acid 

t Prom Biillctin Ko, ih, DivUioo of CbCDtiatry, iralttd 8Ut«a Dvpartnumt of 
AgTieall«r«. 



« 






^^^^ BlUPLB Ti£8Ta ^^ 


^ 235 ^ 




j;rW<ri««« 


t/aiulvitM 


lM«d«nl«< ^^H 


•iti^fr'Sntf. 


oJulliranl*, 


oiWtfriania. ^^H 


^H Ariv*'r«M. 




CItlicr aUrcliM wbich »>■ aulr 
MltuMil to >bulf or lo |iart 
for Ihv cvniiioti ■rtitJv. 


^ 


^H Br*n4r. 




W»|«Y. burul Bucat. 


1 


H BrwL 


8u)ph»U 0/ dun. 


floura eUi*r tb*n whral. in 


Aibea frata •(»(■. ^^1 






lerua OoiU'. iiDtaUn. 


cril tram Bill ^^1 
•unaa. ^^H 


^H fiunrr. 


Copper. 


Wahir, <Mlier (ata, euis* of 
uHa. (Urcb. 


Cunl. ^^H 




S^lbi a( cauucr. 


Caceaa «( w»M(. 


Uitat dainaiad ^^^| 


^B Hm aad ■••(. 


lF*d. 




in 111* pforfH* ^^H 


^M CImmc. 


io tha riDiJ. 


Obatcargaiia. 


^H 


^H C*»d} and <«B- 


falaoaoua coloni. 


arap«-iufw. 


Flour. ^^^H 


^H frctMaery. 


arUltcial (b- 

MDM* 




^H 


H OaAa. 




Chicorjr, pia«. rj*, lw«na. aooToa. 
abvbiia-iitita, alinood or otbar 
Dut-aliclla. Wrat ■•i|{ikr. lo<*- 


^H 






^^^^M 






Rado coSr*n, 
AnliEwl tau, alaich. Aoiir, and 


^^^^^1 


^H Cor«* kad elio«« 


Ox Id of iron »nd 


^^^H 


^H IBM. 


oilurr <-ol«riiix- 
mtlwra. 


•uxar. 


^H 


^H CajvDBA p«p|Mr, 


Red IcMl. 


Or»ua4 riM a«ur, Mil, aU^ 
braad. Indian ihmI. 


Odd of ^^^1 


^H Tievr. 


Alum. 


Gnitol ricf. 


Oni Bad aand. 


^H OlBXM. 




Turmairie. Cajwnna papear, mna- 
lard, iuti-rtot Ttrutki of 

U aliTT, augar. 




^1 


Akin ■all itrlril 






of Mipeatnw. 






H Uowr. 




UlnedB*. eaii*aD|at. 


PoIUd al *al- 
lou> iiUata 
and Ipnafti, ^^H 


^1 CSI^ 


Omnallo lima. 

alHm. 


Oelatiu. 

Surch. MMrin, aall.t 


V 


^M HmuM 


I'tironiil* of trad. 


TfUu* lakpi. Dunr. tarumk. 


1 




■uifitiAU al lima 


Ckjrrnn* pepper. 


1 


^1 y*ai. 


ViKXtt. 


Bumi incac. auiiaiw. 


!l>nd. dirl. 1 


Jnfnititd Willi par- 




TalTiM. J 




mIm*. 






^H H«n»'Mdl>h. 




Turat)!. 


^^^^H 


^1 »Mt>*h». 


Audio cdIotf. arti- 
Stial ta*«icfa. 


Gelaiiti, aiipk-Jollj. 


^H 


^H OM<nr«L 








^H tntkiH. 


8a III Ot ooi>i>*r. 

alitm. 








AsiliD aulon. 


Ar'lilM, DDintlkllia. nolaaaca. 
Fbiur. Aip-lraad. Unaead nwaL 


^^^M 


^^^^^^^^^^^■^rP^'* 




Hand. ^^M 






I'DMioatarcb. 


^^^^M 




CarmD* iieppar. 


WatH-. 


Barai togar. ^^H 




anU<lBl «•' 




^^^H 


^^^i*--. 


aaneca. 

8«lu U lia and 


Bim lour. 


Sand and dirt, H 




lead. OrpiuiD, 










aad atlr*. ^^J 


I St::: 




Flour, aurohaa. 

Arrvw root. 


^^^^^H 


^^H rin DaB«a. 




SiWDl baik. 
ntp-braad. 


^^^^H 






^^^1 




VMrtlia laar**, aiioal tm, iJuw* 


on* rarni. ^^H 






bata. !"■■■' lDdls«L ^^Mlao 
Una. Obiaa clay, aoaiatoa*. 






^^^H 






«TI"«". 


^^^H 


^^^^^■FMV- 


8al|>hartr, h}<lr«- 
nilorir. and fij- 




^^ 






1 


^^^^^^KIwnB, 


Aallln rttm. 


Vfak-r. 


Snll-halr ot p«- ^^M 




■*ii<F knwdy. 




laaalaiB. ^^H 


^^^^ (nr nhnut l.*! 


);rHmx. the <]Uflrl 


ler of H fpaspooiifiil. of iTeam of tartar). ^^^ 


^H Sfuikf thorouiilily anti tiltt-r. 


To Ihf flear li»|uiil odd 


tlinv or four 1 


^M tafalcspoonftils of ehlomform 


. mix by a rotary molion, but do not 1 


^H ■ M Vfta pridrntl.T «a avrniiitht 


ti> hove omlltvd «>(loa-a49rd «il 


and wRt«r. ^^J 



236 



root 



shukf, or an emulsioii will be formed, wliich is difficult to break np. 
Allow the thloroforiD to settle and remove as much as possible by 
meaus of a pipf-tte or mcdieiri'p-dropper, Tliis is plaeed in a test-tube 
with an equal ammiiit of water and a small piece — a little larerer tluin 
a piu head— ^)f iron alum. .Shake well and allow to Mttle and if 
salit'ylic! acid is prvst^git the uppcT laytr will have h purple color. 

Benzoic Acid.— This is used chit-fly in fruit produi'U, catsup, etc. 
This test is not sufficiently delicate for verj' small quautitics. such 
as may be added to wine. Proceed as above Evaporate the cldoro- 
fomi hy placing in a saucer outside of a closed window, hi cold 
weather place the eaueer in a basin of rather warm water. AVhen 
the chloroform has evajmrated the charaetenstio flat, crystals of 
benzoic acid may be seen in the saucer, aud. on warming, the charac- 
teristic irritstiriK odor of the acid can bf> detected. 

Borax and Boric Acid. — Botli of thi;.<ie are used in many food 
products. Macerate solids or aemisolids as above, cool the liquid, and 
filter through filter-paper. 

In testing butter, place a heaping teaiipoonful in a cup. add a 
vouple of teaspoonfuls of hoi water, stand the cup in hot wnter until 
the butter is melted, stir well, then put the cup in cold water until the 
butter solidities, and then filter the liquid. 

For niilk, use an ouni^e of milk and two ounces of Kolntioii of a 
teuspdunl'ii I of alum t" a pint of water. Shake well ami- filler. 

Add five dmps of hydroehloTic acid to a teaspoonful of the liquid, 
dip a piece of turmeric paper in it. and dry the paper. If either 
borax or boric acid is present, the paper when dri- becomes a sherry 
red. A drop of ammonia turns the color dark ffteen or greeiiish- 
black. If too mucli acid has been used the color may limt be brown, 
even if borax or boric acid in present. The ammonia turmj this brown 
just as it will turn turmerie paper, which has not been dipped in aciil 
solutions. 

Saccharin. — Proceed as in the test for salicylic acid. The residue 
left on evaporating the chloroform has the sweet taste of sacdmrin. 
Sugar is not soluble in chloroform, so will not be present. If tanuios 
are present the asli-iu|rent taste iimy mask the taste of the itaceharin. 

Formaldchyd. — This must be separated by distjllatiou in foods 
other than milk. For milk test, see chapter on milk, 

THE DETERMINATION OF AKTIFICIAL C0I0&8 

The Coal-tar Dyes. — If the substance to be examined is not a 
liquiil, diwiijlvc the dye by rnHceratiiiK' it in water. Kilter, take two 
or three ounces and add a few drops of hydrochloric acid and a few 
strands of white woolen yarn or picees of white woolen cloth. (Be- 
fore usinir, the wool Hhould be boiled in water containing a tittle soda, 
to remove any fat it may contain, and tlicti wiwhed in water.) The 
wool nhieb has bceu boiled is washed first in hot and then in cold 



DETEB3HX.iTJ0\ OF COLORS 



Tan 



water, and the water pressed out. If the wool is not discolored, the 
subslancc ti-sted may be regardtrd free from artificial colors. If the 
K'uul It, i'oloreil il way bt> from voal-lur colors. luiiui^ furei|ni vegetable 
colors, or, if a fruit is beiug examiaed, the natural uoloriug-matter of 
the fruit. Rinse the wool in hot water and boil three minutes in 
two ouuves of water to which two dranis of anitnoiiia have been 
addrd. Stjuifze out Ihc rxceas of water. Natural fniit color is re- 
tained, while the eoal-tar dyes are usually dissolved iu the umiiiouia 
solution. Add hydroehlorir acid to this fluid until the odor of the 
ammouia has disappeared and the liquid has a sour taste. A fresh 
piece of woolen yani is boiled in this, and if it is colored, the snb- 
kUuicc examitird has been artilirially rolnred. Dull faint tints muRt 
be disn*{!ard«-d. If an anilin dye (coal-tar) has been used, the yarn 
will uKiialty be tatted purple or blue by ammonia. 

The Detection of Copper. — This is often used in coloring: canned 
peas, lieanti, etir. .Mash the substanee to he examined and add a 
teaMpwnfiil of the pulp to three tcaspoonfuls of water and thirty 
drops of hydrochloric acid. Place the cup iu which this has been 
placed in a water-bath (Kauoepan containing water will do) and add a 
hrisht iron wire nail. Boil hard twenty minutes, ittirrinp frequently 
with a ifplintcr of wood or a glass rod. If copper in present in any 
appreciable amount the nail will he plated with copper. 

Turmeric. — This is added to yellow spices, especially mustard and 
mne«>. Mix nne-half teanpoonful of the substanuc to be examined in 
a white china dixh with an trtiual nmount of water and five or (on 
drops of ammonia. If lurmcric is present, a bro\Tii color is formed. 
If an iitKufUcient amount of the dye has been used to give this test, 
a more delicate one is to mix a teaspoonful of the Hubstance to be 
examined with an ounce of alcohol aud then allow it to settle fifteea 
or tweuty [iiiitiites. AUiut one-half ounce of the upper liquid is 
plaeed in a dish with live drops of concentrated solution of boric acid 
or bomx, 10 dropM of hydrochloric acid, aiul the solution thoroughly 
mixed. A wcdKc-sliapcd strip of filter-paper (wo or three inches 
brng, an inch wide at the upper end and one-^iuartcr inch at the lower 
end. is then suspended so that the lower end touches the solution. 
The paper should not touch the side of the dish. This ahould be 
allowed to BUnd for a couple of hours, aud if turmeric is prement, 
a cherry-red color forms on the filter-paper near the upper edge. 
This red color is turued dark green or almost black on the addition 
of ammonia. If too much hydnx-hloric acid has been added, a brown- 
ish color risiults. 

Caramel. — This is used to color ^inc^r and other fluids. It should 
be borne in mind that caramel occurs naturally in malt vinegar. 
Place about one ounce of the fluid to be tested in two test-tubes, add 
a teanpoonful of fuller's earth rn one and shake vijrorously two or 
three minutcN. Filter through tilter-paper. The first part of the 



23B 



FOOD ADVLTHS.iTlOTt 



Uquid comiag through the paper should be returned to be filtered n 
seooiul timL>. If ttte (ilten-d li(|tiid on comparmon with the untreated 
test-tuhe Is markL-dly ligbttT in color, ihik may a-sKume that the color 
of the liquid is due to uHtamel, wbic:h is largely rvnioved by the 
fuller *K earth. This test reiiuires a certain amoimt of practical ei- 
perience before results can be depended upon. 

TH£ EXAKINATION OF VARIOUS FOODS 

Coffee.— The difft'r(.-nce between {ground colFee and that which has 
been udtdterated ean often he told by the naked eye. especially if not 
very finely unmiid. Pnre eotfee has a uniform appearance, with didl 
siirfacefl. while most of the substitutes, particiiiarly pfas and hetins. 
have pnlislied surfaeen. Chietiry is very dark and gummy looJcing 
and the partieles have a distinctly astringent taste. On placinp 
ground coffee in a bottle half full of water, shnkinp it and allnwin(t 
it to stand, a larpp amount of the eoflTee will float, while must of the 
mihstitutPK sink at once tn the bottom. The chicory partieles will 
color water, and as they sink slowly ty tbt; bottom leave u little darb 
train behind them. Coffee contains do Rlareh. white all of thi* Niib- 
stanceK except chicory used for adulteration contain u considerable 
amount. All grnuiul mffee that gives a .stanch reaction may be eon- 
Mden-d as adulterated. 

Flavoring Extracts. — Vanilla and lemon are the most eommonly 
used and most adulterated. They are frequently made with the 
extraet of the tonka bean, which ean be determined by the peculiar 
odor by any one familiar with the two produets. The extract made 
fmm the artilieial vanillin lanks the reKinit. Caramel id often added 
to I'olor it, and nmy he detected by abaking; the foam of pure ex- 
tracts is colorless, and if caramel is pre.ient, little points of color 
will be seen at the point of contact with the bubbles. The fuller's 
earth lest, given above, may also be used. To examine for the presence 
of resins, the extract should be evaporated, and when it reaches one- 
third its volume the resins become insoluble and fettle to the bottom, 
while artificial extracts remain clear. If water h now added, the 
resin will separate out in a brown pn^upilatc. A few dnips of 
hydrochloric acid should be added, the liipiid stirred and then liltei-ed; 
the resin left on the lilter-paper should be wHished witJi water and 
then dissolved in a little alcohol, and to one part of this add a few 
drop6 of hydroohloric acid and to another a small particle of ferric 
alum. The resin from the vanilla bean has only a slight chance of 
color, while with most other resins one or both of these reajreuts yield 
a distinct color ehBn{r«, 

Lemon extract may be tested by placing n teaspoonful of the oil 
in a tcflt-tutie and addine two or three teaspoonfiils of water. With 
real lemon extract the fluid first becomes turbid and later rhe nil 
of lemon separates on the top of the water. If it remains perfectly 



4 




8PWBS 



289 



clear, it is a low-grade product and conuins very little if any oil of 
lemon. 

Spices. — The detection of adulteration in spices, for the most part, 
r«<|uippK fspcri knowledge of L-hemistrj' and microscopy. Most of 
the Hubstatii'i's used contain starch, but so do most of the common 
apices. Cloves, mustard, and cayenae pepper are practically free 
fi-um titarch, and the pmence of it may be taken ■a& a proof of 
adulteration. To test for Ktardi, one-half tvaHpixinful of the sus- 
pected Hpice nhonid be gtirrod into one-half cup of boiling water and 
iioiltnl for sf^verat minutes and then cooled, tf the fluid is of very 
dark color it should have water added to it, and to tJiis a ainffle drop 
iodine is added. If slareh is present it gives the chara<-teristic 
ieep bliip (tilor, and if vi-ry much is present it turns black. If no 
blue color appears, the iodine should be added drop by drop until it 
sboHS in the solution. 

VincKar.— The simplest teal is the odor. If it is not apparent 
the Rlajw should be rinsed out with tho vinepar and allowed to stand 
for si>inc hours, when the odor of the residue will be (piitc distinct: 
cider viuetcar haviug the fruit odor and wine Wuegar the odor of 
wine. The rvKidue may alKn lie obtaJneil by evaporation. If the 
vinegar has bocii colored, the caramel can be tested by the fuller's 
earth test. It Khoiild be borne in mind that many of the vinegars 
made fnwn spirits and wood have apptc jelly added to give them the 
characteristic odor. 

The Halphen Reaction for Cottonseed Oil.— rarbon disulphide, 
containinf; about 1 ]>er cent, of sulphur in solution, ix mixed with an 
e<iual volume of amyl alcohol, Kquai vohimcs of this reagent and 
of the oil to be examined are mixed and heated in a bath of boiling 
brine for fiftren minuten. In the presence of as little an 1 per cent, 
of oottonweed oil an orange or red color is produced which is ebnrac- 
teristic. Lard and lard oil from animals fed on cottonseed meal will 
aoiuetimes give a fatnt reaction. 

DIET AS A MEANS OF VIAGKOSIS 

Tiat-meals are i:iven to determine the futietional dixturbancea of 
19m stomach, und to ascertain whether or not pathologic eonditions 
ezilt There are many forms of test-mealti and they serve various 
purposes. 

Test-meals Emptoyed to Stimulate the Oastric Secretion for the 
Purpose of DctcrmininK the Secretory Function of the Stomach. — 
1. The Tett-breakfast of Ewald and Boas.— This consists of a roll or 
a slice of wheat bread C^^ lo "D gm,) and 400 c.c. of water or tea 
iritboul sugar or milh. taken in the morning on a fanting stomach. 
The conient-n of the ftlomach are removed one hour afterward, or at 
varjHng intervals for the fractional analysis according to Ihe method 
of RehfosB. 



DIET AH A MBAVn OF Df^OVOSfS 



2. The teit-dinner of Riegel consists of 400 c.c. of soup, 200 gra 
of beefsteak, GO giu. mfwlicd potato and a. roll, (35 gm.). and a glas 
of water (300 c.c), taken at noon. The stomach is emptied of its 
contents ill from lliree to four hours. 

3. Test-meal of Oennain S6e.— This conaistn of 60 to 80 gm. of 
scraped beef and 300 to 160 gm. of wheat bread. The contents are 
removed after two hours. 

4. Test-meal of Klcmpcrcr.^ — Klempercr gives % liter of milk and 
70 gni. uf wheat ItrL-ad and oiii|)tk>y the stuiiiaoh tw(» hourK aftorward. 

5. The Double Test-meal of Salzer. — This consistii of 40 gm. nf beef 
scraped and boiled; 250 c.e. of milk: 50 gm. of boiled rice, and 1 
Roft-boiled egg. 'I'his if* followed in four hours by an Kwald test- 
meal, and the content.s of the stomnrh are withdrawn one hour after. 

6. The Oatmeal Test-breakfast of Boas.— This breakfast is composed 
of a plateful of ttalmeal hrulh prepared by boiling down to '/;. liter I 
liter of water to which a teaspoouful of oatmeal and a pinch of salt 
have previmialy lieen added. This test has for its objeet the deter- 
mination of lac-lie acid, inasmuch as laiTtic acid is present in all 
ordinary breads iitilize<t for tcst-mralH, 

On aceouut of its aimplieity, the Ewald-Booa test -breakfast in most 
iiseful, although oooaslonally a Riegiel dinner is found preferable; 
the only objection to the latter lies in the fact that iu withdrawing 
the slomaeh-eoiitentii bits of meat that may not have been thoroughly 
di^f^ted arc apt to obstruct the paHsage of the contents through the 
tube. In eYRmining for lactic acid the Boos oatmeal test is preferred. 
(For a deseription of the various methods of examining the contents 
of the stomach for acid. fcmieutH. etc., the reader is referred to the 
toxt-books on diseases nf the Htoiuach and on eliuioal diagnosis..) 

Dietetic Tests lor Determining the Motor Power of the Stom- 
ach. — L Heth<Kl of Lenbe. — This test consists in having the patient 
take 400 e.c. of stttip. :iOO gm. of beefsteak, 50 gra, of bread, and 200 
C.C. of water. Tlie stomach i.s «-aKhed out at the end of six huunt; if 
it is found to be empty at this time, there can be no motor impairmeat 
of the stomach. 

2. Method of Boas.~If the stomach be washed out at the eod of 
two buurti afiLT an ordinary Bwald-Boas test-breakfast, under normal 
oouditinrw the stumafli should l)e found empty. 

3. Tett-stipper of Boai.— This supper consists nf cold meat with bread 
and butler and a large cup of tea. If, on washing out the Ktomaeh 
the foltnwintr mnrning, food is still found to be preaent, a dilatatioo 
of the stomach exists. 

4. The addition to the evening meal of a tabtespoonfut of currantt, 
or raisinti has been recommended in as much as such food residues 
can more n'adily he reengnixed in the wash water the following morn- 
ing. 

.5. The Staroh Bet«Btion Te«t of Eaosmasn^-A te«t supper of 




aTARCB RSTByTfOy TBST 



241 



a small platpful of boil«d rice is tak?u at night and the fasting stom- 
ach U aspirated the followiug oioniiDiK:. The eonteulit are alluwnl to 
■ediment and the Hupernutunt fluid poured off and tinctarc of iodine 
addfd and miAed with the rCKidiie; water is now added uutil the 
mixture is tranaparfiil. If rice granules an present, they will appear 
aa blue partieles in the Suid. Tho teat has been modified bj some 
in that eiirrant.^ or raisins are added to the rice meal. 

Dietetic Test for Determining at the Same Time Disturbances 
of botli the Motor and the Secretory Functions of the Stomach, — 
Hethod of Sahli. — In lhi» tc»t substiuicRs not abwrbed by the stomach 
are added to a tcst-mool. After withdrawal of the stomach -contents 
il is possible lo determine how niueh of the l*«t-meal haK passed into 
the intestine, how nmeh remains in the stomaeli. and how much of 
the withdrawn meal conRists of gastrie 8«wretion. The Sahli test-meal 
consists of the following: 2'i gm. of ordinary flour and 15 gm. of 
batter are pla«cd in a iiuitable vessel over a flame and allowed to 
roast until browu. To this are slowly added 350 c.c. of water, and 
the whole stirred eonstanily; a pinch of salt, sufScient for seaiwtaing, 
is added, and the mixture is allowed to boit for one or two minutes. 
After the Ktomaeh liaK been thoroughly wanhed out the patient ia 
given 1100 c.c. nf this soup, and the n>maining 50 c.o. are retained aa 
a control. After one hour the stomach contents are withdrawn and 
the quantity is noted. Three hundred cubic centimeters of water 
are now introduced through the tube, and the stmnach is geotly 
mamged; within a few minutes this diluted meal is withdrawn and 
its quantity noted.' 

Dietetic Test in the Diaicnosis of Atypical Casca of Ulcer of the 
Stomach,— Til eases of atypieal forms of uk'cr of the stomach Lcube 
advises bis dietetic treatment (see same) as an aid to diafcuosis. If 
a beneficial result follows the treatment, the presence of an ulcer is 
indicatetl. 

Dietetic tc&ts arc often of value ax a means of diagnosis and 
prognosis in diabetes and nephritis. These teiits are described in the 
section nn Diabetes and Nephritis. 

Schmidt aad Strassbarger Test-Diet— Breakfast : 500 c.c. milk (or, 
if milk Im? badly bonio, .jOIJ e.e. of wKJoa, made of 400 yrams water, 
20 gramii cocna. 10 grams sugar, and 100 ^rams milk) ; in addition, 
50 grams of zwieback. Forenoon: Ualf liter oatmeal gruel, made of 
40 grunifi oatmeal. 10 grams butter, 200 grams milk, 300 grams water, 
one egg and a little salt, the whole in lie passed through a sicre. 
Mid-day: 12r> gram!* hashed beef (weighed raw), broiled with 20 
grams builer. as rare Uamburg steak; 2jl> prams puree of potato 
(mailc of 190 f;TamK mashed potato, 100 grams of milk, 10 grams 
butter, and a little salt). 

1 For tkt niMiiod nf euusining the contents sw Sabli. Berlin, klin. WochetiKhr., 
IMS, N<M. I<( and IT: aiid AniitNuii, Mfdical I{«vord. Dw. 6. IBCLT 
It 



242 



DIET AB -I 3tBA\S OF DUOSOSIB 



Afternoon: Same as breakfast. Evening: Bamv as forenoon. This 
did yields 2132 calories and eontaius 97 graras of prolcin. 11 grams 
of fat, and 191 grams of earboli^Jrates. The beginning; of this diet 
is riiBrkctl by Biviug 0.a gram of carmine iu a kouseal. In health 
ibis diet will go through the intestine in 15 to 25 hours. In [linrrbea, 
where the principal trouble is in the eiyhm. iu 10 to 15 hours, and 
where there is increased peristalsis of the entire bowel, iu 3 to ii hours. 
To test the JigeMtiori of eertaiu artieles of diet twiee the u.stia1 smount 
should be given, and chareoal may be us^-d to mark the food so given. 
The amount of mucus, the appearanc-e, the reaction, the amount of 
fermentation, may all be ntited. This method of studying stools is 
lumpli", riisily cnrricd «iut. and of great practical value. 

Schmidt's Test-Diet. — On arising in the morning: One-half liter of 
milk; tea or eoeoa (if possible, with milk), together with one roll with 
butter, and one soft-boiled efig. 

Break fast.^-One dish of oatmeal, cooked in milk niu) strained (salt 
or sugar piTmissible). Under eertain conditions gruel or porridge 
may also be given. 

At .Voofi.— One- fourth pound of finely-chopped lean beef boiled 
rare, with butter (the inleritir raw), and, with it, not too nmall n 
portion of potato broth (well strained). 

In the Afternoon. — Same as in the morning, without the egg. 

In the £fcii*«g.— One-half liter of milk or a plate of soup (as in 
the morning), together with a buttered roll ami one or two eggs, Hoft 
boiled or .scrambled. 

The test diet is given at least for three daj*s, until a stool is obtained 
coming with certainty from the diet. If conneetive tissue appears 
in the stool, it is an indication of a dintiirbanee of gastric digestion. 
If miisele appears in the stools, there must he some disturbance of the 
iimall intestine. If both musete and connective tissue are present, a 
difiturbauce of both stomaeli and intestine is at hand. 

DIET FOB SDIOEES AJSD SFEAXEBS 

The diet exerts considerable influence on the voice. A full meal 
may impair the respiration to sueh an extent a.s to interfere with 
aiogiug or even to make it entirely jmpn.ssiblc. The congestion of 
the voeal cords which may follow the taking of food or drink or smok- 
ing often ban an injurious effect on the voice. Irritating artieles of 
food and drink may aim) impair the voice, and should always be 
avoided by singerM and sppakerH. Singers often po.'aess curiouR 
idio8>-nera8ies, eertaiu articles of food impairing the voice of some 
while improving that of others. W. ('. Buiwell, in Representative 
Actors, gives an interesting list of artieles taken by prominent actors 
before going on the stage. Tie states that Edmund Kean, Emery, 
and Reeve drank cold water and brandy; John Kemble took opium; 
Lewis, mulled wine and oysters; Macready was accustomed to eat the 



4 



fD SPEAK BBS 



243 



lean of a uiiitton chop previous to ^uiug ou the stage, but milieiftiuently 
Uvrd almoet cxcluxivety on a vegetable diet; Oxbur.v drunk tea; 
Heury Russell ate a boiled e^; \V. Smith drank eofTee; Braham 
drank bottI«3 porler; JMss Tiitlev tiiok liiisiTtl tea and Madeira; G. 
F. Cook would drink anythini;^ Ilcndcrson used gum arabic and 
sherr>-: lucledun drank Madeira: Mrs. Jordan ale enlves'-foot jelly 
and slicrrk'; C. Keou took beef-tea: Mrs. Wood sang im draught 
porter; llorley look notliing diirini; a perfomianee. Malibraii, it is 
said, alP a lunch in his dri-ssinfr-rnom htilf an hour before sinirinir. 
This consisted of a eutirt and half a buttle of white wine, after which 
he smoked a cigarette until it was time to appear. 

As a rule, nothing ^should be eaten before singing or speaking. Tbe 
principal lueal should be taken two or three hours before, and it 
•thnnid l>e somewhnt lii^ltler than nsual. Many sinu'ers ent but little 
on the day nf their performance, but partake nf a good meal after- 
ward. A fond mueh used by singers is the so-eallcfl "Jenny Lind 
•oup." This is ve 'y btand and does not alter the voice. It is made 
of liouillon and »aee, to which iire added, before serving, the yolks 
of two PL'pt lieaten np in a half-pint of ereain. .\ half-tennpoonful of 
sugar IK added, and it Ih flavored with spieeic Others take raw e^gs, 
egg and sherry, or album in -water, while still others prefer jellies of 
ibe gelntin variety, or even honey. rtranBe-Juiee has its advoeates, 
and the chrwing of dried phims has Wrn n'i-nninipndi"d. Mandt ttug- 
gesis that before the perfnrmanee the singer «hoiild take a few bites 
of bread or elicMrolale and rin^e the mouth wilb eold water. Tf the 
song ifl lengthy, cold water or sugar water may he taken during the 
performinii'e. 

In the intpn-al between concerts the singer .should live on a general 
aixed diet, avoiding irritating foods. Most singers have a tendeney 
ID become stout. The general rules for dieting the obese may be en- 
forced to prevent or to remedy this. 

Aleobol, in tbe form of the Mlroiiger In-verages, iH harmful to the 
%'oice Hud shuiild always be avoided. Light wines and beer, except 
when taken to cxeeas, are not generally injurious. They are hetft 
avoided, however, as their use may lead to the formation of the liquor 
habit. 

Smoking is injurious to the voice. According to .Mackenzie, how- 
ever, many famous singers used tobacco freely without apparent harm- 
ful effecta. 

DIET DTJBIHG ATHXETIC TRAINING 

The murse nf diet and exercise which athletes, both amateur and 
prof<-*<i''Mal. undergo to fit Ihera physically for sanies, contests, or 
fral« of endurance, is known as athletic training. The necessity 
for aueh training is fully ree«>i:iii?-.eil by all athletes, and while 
opinion^ differ an to methotls, there is perfect accord in the ideal that 
fa iiniii:bt. 



344 



DTBT DVntHa ATBVETIC TKAIVINQ 



Profewional athletes who are constantly pcrionning feats of 
gtreii^li, skill, or emlursnce. are, for tlie most part, more or Icsk 
couKtaotiy in trniiiing, and recognise the importance of lc<.i;piQ^ in 
perfect trim. While occasional indulgences may not be harmful, 
couliuued diisipatiuu is alwa)^ dtKaiitroiis iti iu conKequcnees. This 
is especially true where hiier »kUl aud judgmi-nt are required and 
steady nerves are a necessity. 

The ultimate object of all training is to reduce the body-weight 
until it will remain constant under the re^lar routine of life during 
the training jK'riud. There is lutually a loss of weight for the flivt 
few weeks, varyintr with the previous coudititm of the individual. 
In about three weeks the weight becomes constant. The loss of 
weight is at^'f^implishe^l at the expense of the fat aud water in the 
tissues. In well-trained men the muscles are hard and firm, the fat 
is reducM to a ntinimum. the skin is clear, the eyes are bright, the 
expression is indicative of purfeet health, the bf»dy is active, svelt, 
and fidl of verve, and the " wind " is good. In the iindertrained indi- 
vidual the tissues are not hardened and the "wind" is not so good. 
In th<- overtrained there is a curious condition, due to overexertion or 
a b«<lly chosen dietary, or both, and the individual loses weight and 
enHP^jy, and is in pvery way unlitlod for the iruntest for which he was 
preiNiring. 

The length of time required to train an indiTidtial varies greatly, 
but a college youth of the average athletic type can usually be put 
in good shape in six weeks. The transition from ordinary life to 
that of training tihould b« ;;;radual. This is true both of diet and of 
exercise. 

Tlir dirt-tables of varioiw trainers differ considerably. As a gen- 
eral rule it amy be said that the diet shim Id consist of wholi-some food, 
such as goo«l lean beef or mutton, beat given nndcnlonc. toast or stale 
bread, and potatoes and green vefcctables of all kinds. Among the 
pnnic-nbLHi artieleti ar« all entries. puddJntis. pastries, sauces, pickles, 
apices, ' ' appel izera, " and all fancy and complex dj^e». Twice- 
eooked meat .should l»e avnidi^d. All spirits and strong alcoholic 
drinks, as well as Ira, colTcc. and nerve stimulnnts of any kiud. should 
be prohibited. Home tniiners allow a modcralc amount of linht wine 
or beer, whih? others forbid their use entirely. On the whole, it would 
seem liesl to omit them. Tobacco in all forms is forbidden. 

Water is usually allowed in considerable quantity — generally as 
mueh as is Hesirpcl -early in the training. If there is a tendency to 
obesity, the amount is somewhat limited. The quantity is redmrod 
gradually, only »tuffieient being allowed to allay thirst ; it should be 
sipped slowly. The importanee of Ihnithig the amount of water 
ingested for a few days Iwrfore any contest is recognized by all pro- 
fettsional »thli>teK aud trainers. 

Food is best given in three meals, at about eqaal intervals of Ume: 



DIBT DVniXa A-TBLBTIC TKAJXtSO 



24& 



I 
I 



between 8 und 9; dinner between 1 iinil 2; and supper 
7 and 8 or 8 and 9. 

Tb« relation of su^ar to training is of special interest, and opinions 
con(.'4Tnin^ its use ditTiT. Men in training seem to crave KiiKnr. onA 
are often allowed a reKHutitible amount on cereaU, or in tea aud L-otTee 
tckfH thr Uitter are uxtd, but it w gencruUy deemnl advisable to 
forbid it^t uM iu pastries and cokes. Further study is needed to 
decide this question. Iu this connection it is interesting to eonslder 
the report concerning the addition of tiucar to the diet of two elwb 
crewa iu Holland during the training for a race. Atwater and 
Bryant' cite the following eatie : 

"Two young men with only two hour» a day for praetiee, at the 
end of two months entered for the nice. No ehnnge had been made 
from their usual diet except that they ate as much Kugar as they 
wished, sometimes as much as a third of a pound, at the time of 
their daily exereise. One of them, however, did not make this addi- 
tioQ to his diet until the third week, when he began to nIiow all the 
signs of overtraining- loss of weight and a heavy, dull fceliug. with 
nn desire for study. On the third day after beginning the nsc of 
(fugar these symptoms disappeared. At the time of the race both 
youths were Tietorious over their antugoniHts, who did not believe 
in the use of sugar. No bad effects were observed." 

The accompiuiyiug iulerestJtig Uibic (p. 247) 'v» taltrii from the 
rep*»rt ' mentioned. 

ThonipHOn ' gives the following report of the Yale eifw, on the 
authority of Dr. Harlwell, formerly a eaptain of the University crew 
and of the riiiversily foot-ball team: 

"The training covered a period of ten and one-half weeks, llreak- 
f«st, at 7.30 A- M., consisted of fruits (oranges, tomarind^ flgs, and 
grapex) : cereals with rich milk and sugar, ete.; beefsteak, usnally 
rare; chops. »tew«. hash, with once or twice a week some salt meat, 
B8 tweoQ or ham, usually aeeompanied by liver; stewed, browned, or 
baked potatoes; eggs served in different ways: oatmeal-water and 
milk as beverage, with tea on special occasions for some particular 
individual. Dinner eon!U.>ited of soups, meats, (ish, vegetable>>. with 
a simple deMscrt, such as rice, bread, or tapioca pudding, some fmit, 
and the same beverages as at breakfast were also used. The meats 
included roa.«t beef, mutton, or chicken, two kinds being alwaj's 
served. But little gravy was used. Fish was served twice a week. 
The vegetables included potatoes, mHRhe<l or boiled; tomatoes, pnaa, 
beans, and corn. Two vej;etHb!es b(!:sides potatoPK were UKiially 
»er\'ed. Supper {8 to 8.15 r. m.) c<infii«tcd of eereals, as at hn-iik- 
fast; cliopB, xtewK, or cold meat from dinner: rarely beefsteak; po- 




246 



WW VVtei.KO AriiLHtiV TSdlSIKO 



tatocs, slewed or baked ; aud eggs iiboul tbrw timts u week, usually 
not on tiie sttmi; days tiial tlicy were sened for hri,'akfast. Sometimes 
ale was pennitted to some Individual. Aftvr the crewH were in final 
preparation fcir the race at Xcw Ijoiidon thi^ diet varied ^oDiewhat. 
Breakfast aud dinner ri'maincd abuut ihe same, but a lijrhl luneht'ou 
of cold meat, slewed or baked pottitoes. milk ami loast whs served 
at -1.30 in the afternoon. After thi^ the evening exercise was engaged 
in for about two hours. Forty -five inlnutes after this was eonipteted 
cold oatmeal or other crreal with milk and tonst wai^ nerved. A light 
supper (9^0) was sorved just before the men retired. This diet was 
much more liberal than that served ten years before. The men were 
allowed an much food as they desired." 

Atwafer and Bryant ' give the following account of the diet of the 
E{ar\'ard boat cn'w at ('fljnbridtrc. in 1898, in the description of ths 
conditions of their dielAr>* utudies. The diet wa» simple, and con- 
sisted of roast and broiled beef and lamb, fricasseed ehiebcn, n»ast 
turkey, and broiled tish. Eggs, raw, poached, or boiled in the shell, 
were uned plentifully. Large amonnts of milk and cream were also 
<!0nMinied. Oatmeal, hominy, and shretJded wheat were eaten ex- 
tensively, and corn cakes were served oeeaMionally. Brrad was almost 
always taken in the form of dry toast. Potatoes were scired twiw a 
day. either bake<l or boiled and mashed with the addition of a little 
milk and bnllor; occasionally they were "creamed," Boiled rice, 
prepared with a littU- cre^un and sugar, was served instead of po. 
tatom at some mealx. Bcctfi, pursnips, green peas, and tomatoes were 
used to furnish a variety of vegetables. Macaroni was occasionally 
served. For de-ssert, apple, tapioca, custard, or other pudding con- 
taining a large proportion of milk and egfcs, was served. The mem- 
bera of the crow were allowed beer onoe a day. Milk was obtained 
from one of Ihe large creameries supplying that vicinity, and was of 
unusually good quality, eontaining 5.8 per cent, of butter-fat. A 
very thick, heavy cream was also used, diluted about one-half with 
milk. Ttiia mixture, or thin cream, cimlaincd about 16 per cent, of 
butter- fat. 

The beef u»ed during the studies was entirely from the loin. The 
roasts were sometimes from the tillet, and at other times the ordinary 
loin mast with the bune was used. The meal was sliced, freed fmm 
prartiwdly all Ihe clear t»l, and sent to the table in a large platlcr, 
from which the men were served individually. The beef was served 
rare, hut not too imderdone; some of the other club tables in the 
same house scrvi-d nnu-h ran-r meat. The beefsteak was freed from 
lione and from nearly all the visible fat before being 9er\-ed. 

Lamb chops were served with the bone. Lamb and muiton roasts, 
which were all taken from the leg, were also cleaj- meat, trimmed M> 
■s to be practically free from visible fat. The turkey used was 

1 Loc. ciu 



n 




vsjvuRi/trY noir chumh 



24.7 



AMMory Iff BemUu nf Vidary Sht^tt <^ IMivfriUy Boat Onw* and 
Other Ihetnry Shiilici. 

(NutriMMii ID food ftcttalljr «X«o per at»a pvr <U/.] 



DtKTAKT irDCm liW DMtVKMmr BOJkT dtEWK, 

Hwud Uaiveoitv <-r«tf u ('«mbnt)gs(No.227) 
Harrmrd tVenbpim civw at Cuiubrid^ (Na 328J 
Y«1« VaivtanXf mm M Nuw lUviui (>o. 22S) . 
Ihrranl fiurpwiirrwiriKialwi Frrry 1 Not 2301 
Hamid Frahman crew itt <>a Its Ftrrv (No. 231) 
Tk1« Uttlrenitj crew M U«la Ferrjr (No. 2S2) . 
Ch{>tuii of lIvTud Frshiiwi crew (No. 233) . 

Average • 

VOHMAmZgD KVCLTS OP OTmtR VtXtX HT RTVTm 
FooiImU team, coQege atudunta, CooTwrtlciit ' . . 
FmiUmII iMm, coIlcKG iHwIcnls, CUIfomiK * . . . 

PratoHMMJ ■tUdc.Hhndow* 

Priac-GKhl«r. Emtbod * 

Attrmgr of 15 oullcf^club** 

Aremite o( !■( tr<«luLDic/ familtM* 

Artngt of 10 tumctif fmaiVum* 

Atvrage of 24 meehsDJc^ tmi fftrmM^ Eunilies* 
Ann^of U ptufeMiooal iui»i'« laniiliM . . . 

I>IEri.IIY nAKDAUM.* 

HwD with mo^vntciiniucalar work (Voit) . . . 

Haa will) cnodenkU raoMular work (Piuj^r) . . 

Hid with modafato moacular work (Alwalar) . . 
llao with hud moBQular work I Voit) ..... 

Man wlih bard nuucular worii iPlarfaJr) . . . 

Man with hardmunabkr work (Atwalurl - - ■ 

Han wiih acTcre cnoKnlw work rPlayfair). . ■ 

Man wLih MTere muacular work (Aiwatvr) • ■ • 



C*i. 



ItM. 

4130 
4630 

3705 
4076 
3075 
4070 
4315 

1» 177 440 40BS 



5740 
7889 
4400 

saos 
s«o 

8M6 

3615 
3430 
3336 



WO 
&31 

'400 

71 Ma 



sou 
ai4o 

3600 
S3Ttf 

3fl30 
4fiOO 
3TM 

ma 



shipped from a distance, and bad been kept in cold stora^'C. It was 
kiknl with foni^-mi-at, — t. «., "sttilUng" or "dresiung," — altlioiigh but 
little of this latter was served to the crew. Cbirkt^ri was always 
fricasseed, and wrvcd free from all bones, with the exception of those 
of the leff and ve'mg. 

bmiled bsb, usually bluefish or Spautsb mackerel, iras commonly 
lervcd for breakfast, ft.s were alto eggs, either raw or poached. No 
pantry wan allowed, and the puddiii;^ were, us previotiHly stated, com- 

> Canscclicut (SUirral Sta. Rpt, I8ftl, p. 1£S. 

■t'apubUdMd atatrrLal. 

>C(uii«ctlctit tStoi-m) Sta. Rut.. IHIKI. p. 168. 

• Mcdivat Tiian a>d U«£cl(c. l»«f, rol. i., p. 450. 

> United SUt«« Department of Agricultuie V^urbook, 1898, p. 450. Hi* r4>nlt« 
•re «inmari>MJ from (.'obnt«tiout (Storr^^ Sta. Itpta., ISBI M 1HB7, and the ball«- 
tiaa of tbc (.'nitnl Stnlcii DnpartRunit ol A)cric-ullur>. 

• ProBi a htiinniary in l'iiit«d Statrs l>«partmmt ol Agfieultur*. ORicv of Expari- 
duot Klalionn, Ktillriin No. 21. pp. S0»~2i3. 



248 



DIET DURlXa ATBLETIC TRA-ISiyQ 



posed largely of eggs and milk. A small amount of coffee jelly was 
served, and at one meal during the study ice-cream was allowed. 
Xo fresh fruit, with the exception of oranges for breakfast, was 
served. Stewed prunes, rhubarb, or apples were also eaten, prunes 
most abundantly. No beverages other than water, milk, and beer 
were allowed. Breakfast was served at 8, lunch at 1, and dinner at 
6 o'clock, although one or the other of the crews was usually late at 
dinner. Atwater and Bryant' give the following statistics of the 
Harvard crew at Cambridge, 1898; the positions shown in the table 
are those occupied by the different men at the time of the race : 



PaBiUoo. 


Age. 


lCkT21 


MmjM. 


U*y2t. 


HayaS. 


Before 
rowing. 


After 

rowing. 


Before 
rowing. 


After 

rowing. 


Before 
rowing, 


After 
rowing. 


Before Alter 

rowlng.{rowlii^ 


2 

8 

4 

6 

?::::;:; 

stroke .... 
Snbatltate . . 


IW. 
20 

21 
20 
IB 
22 
19 
36 

. . 


AmwIi. 
IDS 
161 
166 
lfl» 
173 
161 
147 
171 


PotmiU. 


AhkIi. 

1S8 

1621 

166 

161 

174 

160 

1471 

171 


POioidi. 
IM 
160 
163 

ise 

172 
1ST 
14St 
168 


Aawfa. 
1B6 
162 
165 
161 
174 
1B9 
148 
171 


AwdLi. 

1541 

161} 
161 
lEU 
172 

ie«i 

14S 

1(8 


TmmiU. 
1561 

ItM 

164 

161 

178 

160 

14B 

170 


And*. 

170 
168 


Aveimge . . . 


lea 




l«U 


180 


1621 


180} 


tm 


Ml 


Avenge loea . 








2t 




2 




» 



SoMirtt.— On Mar 2S weight not taken after rowing. Mky M, medlnm work. 
Har 2f>, hard work— eight mlnntee Of rery hard work. Hay 26, light work. 

"The loss of weight during the period of exercise is due principally 
to water of perspiration and the water and carbon dioxid excreted 
in the breath." 

It is interesting, in this connection, to compare the diet of the 
English boat crews, as given by Yeo.* Maclareu gives the following 
schemes of training as carried out at Oxford and Cambridge: 



A DAY'S TRAIKING FOR THE SUMMER RACES. 



Oxford 

7 A. M. : Riae. A short walk or run. 
S.30 A.M.: Rri'akfaet of undvrdoae 

meat. irUHt of bread or dry tonat, 

tea (aa little an poaaiblel. 
2 P.M.: Dinner: meat (as at bre«k- 

faiil I . liread. no vegetableti ( oot 

strictly adheri^ to), I pint of lH>er. 

■1 or 5.30 p. u.: Rowing exereiae. 

H.-IO or n p. u.: Slipper; oold tni-ttt or 

bread, nometimep j<'II.v or wateroreiiB, 

I pint of lieer. 
10 P. n..: Retire to bed. 



Cambxidoe. 
A run of 200 yard^ aa fast aa possible. 
Underdose meat, drj- toast, tea 2 cups 
(later only Ij ),'w-at«r-cresB (occa- 
sionally ) . 
Meat (as at breakfast), bread, pota- 
toes, and fcrcens. 1 pint of beer. Dw 
aert: oranges, biscuit, or figm, 2 
glasses of wine- 
Rowing exercise. 

Cold meat, broad, lettuc« or watercrcos, 
1 pint of beer. 



I I..0C. rit. 

I Pood in Health and Disease, p. 281. 



X DAY'S TJtStXlXO 



US 



HAY'S TRAIXING FOR THE WINTER EACE 



Oxrou) 

7.3U A. M.. Itim.-. A iliurt walk ur ru». 
P A. M.: Br^iikfHal, na in ■ummi.'f. 

1 F, M : ljunobeon : b*it*A or « MadwiiA 
ftiul I bint of beer. 

2 P. H.: Rowini; eotfmito. 



S P.M.: DiBMr: meat u In Bumnipr, 
bmid, same riil« ■■< in mimnii-r na to 
vt<yeUlilM, rice piidiliiit; or jelly, opd 
i pint of Iwrr. 

lu r U.: Retire to brd. 

lV«m Btrirtly furbiddni.^ A> Utile 
liquid to be drunk im poMibk. 



; A. it.: Kxvrtim.- m ior 9uaua«r r«w 

8.3U A. u.: Br««ltl«at aa in auinnifr. 

A littlf cold mrat, brnad, and 1 pint at 
beer, or blsciiil and glB«B ol tbcriy 
{ MiinotimM yolk t>t eg^ in U10 
eberry | 

Rutting rxi>rt'iiw. 

j to p. M. : Dinner, u in unmiieT. 



In summing up the resnltK of their obsen-alions Atwator and 
Bryant state that, in a "general wa.v, the diffpmice between the food 
of the athletes and that of other pt^oplc rcprrwnts a difference ia 
awlual physical n«M3 even if neither is an aeeurate measure of that 
newl." One of the chief differences lies iu the fact that the food of 
athletes is productive of a larger amount of ener^- than that coo- 
ramed by ordinary' working- jieople or eotle^e men. The daily exeeu 
over the ordinar>' diet was about 400 calories, or abont 10 per cent. 
The amount of protein cniwumed was 45 per eent. larffcr. "In other 
words, the difference in protein was four and one-half times as i^reaC 
as tho difference it) fuel-value, and the excess in protein would aeeount 
for a eontsideralilH part of tbi" excess of eiierfjy of the diet of the 
athlctefi tis compared with men in ordinary ooeupation." 

Atwatcr and Br>-ant ' close the account of their expcrimeota with 
the following interesting obsei^ations : 

"In this connection it is intercstinu to observe that many phy- 
siologists are coining to eutertaiu tbt> view that tlie amount of metabol- 
ism in the body in regulated not siiuply by the museular work, but 
alao by the nervous effort required iu the performance of this work. 
The espwially large proportion of protein otiserved in the dietary 
Btudtcx of the univenity boat crews, of foot-hall teamK. of the pro- 
fessional athlete, and of the pugilist, as compared with the dietary 
studies of college men with ordinary exercise, and with ordinary fam- 
iliea of worbiugmen and prtifesstonal men, accord well with a view not 
nneoinmon of )ate amoni; phyKiologists. According to this view, men 
who perform continued nni-srular tabor, even if it is- active enough to 
make the total amount large, do not require especially largi? amounts 
of protein in their food so long as they undergo no especial mental 
strain or muscular fatigue, the principal requirements being an 
abundant supply of easily digested food-raaterial. On the contrary', 
when a man nr animal must, perform inteiiKe muKeuUr work for a 
abort period of time, and in, therefore, under more or leitB ncrvoutt as 

■ Loc. (it 



2S0 



DIBT DVRISO ATBLEVrC TltAISTXtJ 



vetl OS muscular strain, a considerably larger supply of protein seems 
to be ret|uire<i lluin under aonoal couditioiiN iif .slciw. Umg-contiDued 
work. In otlicr words, if ti liir^t: amount of wurk muKt be done id a. 
short time a considerable excess of protem \» rei^uircd in tbe food. 
This view, which ha« been especially advocated by Zuutz,* heemn to 
bt; favored by tbe results of dietary studies above dificuieed. 

"Keceiit e-xpprimentf! made by Duiilop, Paton. Stookman, and Mac- 
«a«laiu ' have lo do with the amount of protein retinired wheu sevurt' 
muscular work in performed. The results are discussed with especial 
refereuee to traiuLuij, uud are believed lo "show the importance of 
two pointx long biuwu tu athletes and others doing esce-ssive muKciilar 
work. The one is the imporlanee of proper trainiug. for by it aii 
abatraetiou of protein matter from tissues other than mu&cle csu be 
avoided; the other is the importance of there beiii^ a sufficiency of 
protein in the diet to compensate for tbe loss which occurs. An 
a.bundance of prutein iu the diet of an athlete has other fiinetions to 
fulfil bi-Hidr-K this. It is n^quiri-d during trainiD^; for liuilding up 
the one rjfy-libe rating meehaniBm— the protoplasm of must-ie; and it 
is also required after work to repair that mechanism. The benefits of 
trainiiiif are well known in other ways, such as preparing the heart 
forKiiddenly iiiereasod duty and limiting the after ttLligue efTectis. 

"Tbe power of the body to perform the maxinium uf museular 
work within a comparatively short time and with a minimnm amount 
of fstlfjtie is secured by means of training. Of course, skill in appltca- 
tiou of mii»eii]ar streoRth is as essential as is the amount of power 
exerted. The ?ikill is soupht by exereisc and practice. The object 
of regulatin^r the diet in training is not only lo furnish the material 
to supply the power, but also to put the machine in the best condition 
for developing rr well »s applying Hie power. In ntber words, the 
man is to He -subjrcted for a short lime to intensr niiiscular strain and 
considerablo ncrvoiw effort. This he ta to bear with a maximum of 
result and ihe minimum of fatigue. For this he needs practical 
training, on the one hand, and proper diet, on the other. If the 
views above presented are correct, the diet for men from whom 
intense mitsi^ular i-fTort is n-quired for short periods iihould .supply 
libcml umuunts of ruergy and especially Inrtte amnunts of protein." 

1 United St«tM Ilepnrtinont of Agrricultura, Exporimonl Station Becoril, roL 
vU.. pp- 538-530, 

iJour. Physiol., H807, vol. Mtii-. p. 6fl. 




I 
I 



I 

I 



The subject of infant feeding, during both heahli and disease, is 
one ut e&treuie importance, «iid one on which Kuccexs in pediatric 
practice largely drprnd£. Brfnrc tukinK up tbi- study of infant 
feeding* the student should read carefully the aection on Milk. 

Infancy ix tliat period of life dating from birth tu about two and 
one-half years. Childhood is the period from two and one-half yeare 
to puberty. The theopj' that infancy ends at two and one-half years 
is an arbitrary one. 

There arc four mctbods of feeding infants: 1. Breast- or roatemal 
feeding. 2. Wet-Dursing. 3. Mixed feeding— i. e., breast-feeding 
supplemented by bottle-feeding. 4, Bntlle- or artificial feeding. 

Breast FeetlinK.^The milk fr()ni a hcaltliy mother is by far the 
best, noiirisliiuent fur an infant during the first year of its life, and 
cannot be fully rcploeed by any other form of feeding. Infants fed 
on the brpast milk of a healthy woman are stixinger and belter able 
to resist disnase. They are more apt to live through the Hrst year of 
life, are almost free from the seourge of the severe infant diarrheas. 
This is particularly true of the poorer classes who often lack both 
the time and the intelligence required to rear a healthy baby by 
bottle feeding. While it is undoubtedly true that babies may be 
reared on artificial fomls and remain healthy and gniw stroma, the 
peixentagc of robust bottle fed babies is mueh smaller than that of 
healthy breast fed infants. 

Coatraindicatioas to Maternal Knrnng. — The mother should not 
narse the child if she has tuberculosis in any form, as she not only 
erpoSM the child to infection, but haNtens the progress of the disease 
in henelf. If she has pulmonary tubercuhniii, nursing the child will 
Almostt certainly prove fatal to her. 

When the mother has had any severe eomplicatioD late in pre^ancy 
«r iu ooimeetiou with parturition she should not suckle her child. 
Examples are nephritis, oonvulsioos, severe hemorrhage or septic 
tnfeetioD, 

Xursing ia contraindicaled if the mother is choreic or epileptic. 

When no milk is secreted nursing is. of course, impossible. When 
lll« mother has shown on two previous occasions under favorable 
conditions that she is nnnbte to nourish her child a third attempt 
may be made, but the child should be very closely watched and not 
allowed to mlTer from underfeeding in case no milk is secreted. 

EdneatioD of the Mother.— Physicians, nurses and the varioua 




258 



INFAyT FF.EDiya 



agencies for health education hav? done much and can do more tol 
impress upon the mother, particularly during the latter months of 
pi-L-^imuO', that maternal fecdixiK ii^ the uoi-mal, natural, safe, and 
^asy way to nourish the bahy. If tjivre is any tendency to evade 
the rcspousihitity the i|uesttuu should bt; earefnily explained, ealliug 
attention to tbe higher death rate, the fact that most of the babies 
who die during the first year of life of diarrheal diseases are bottle 
fed. Many a child is weaned for trivial rcHsons because the im- 
portanee of breast feeding is uuder-ostimaled and many are weaned I 
heeauNe of a lack of knowledge as how to best meet Home of the: 
fiurmoiiiital)lf diflieiilties sometimes cneountered. The following] 
points will be found helpful: 

The Care of the Nipples. — Before the child ia bom the breaats^ 
ahonid be inspceted and if the nipples are short and retracted they 
ahontd be lenj^hened by making gentle traction on them by pnlling' 
thi! nipple out with llie fingers several times a day. The residts are, 
tisualiy satisfactory. A breast pump may bo used or a baby employed 
10 Kuek on the nipples to elongate them. Ocrasionally the nipples 
are too large and a breast shield of proper size has to be used until 
the ehild grows Huffieiently large lo take the nipple satiafaetorily. 

The nipples should be washed off with sterile water or boric aeid 
solution and dried before and after eveo* nurniDg. If the nipples 
show any n-ndt-ney to bfcome dry and erack b^-tween nurt^ingK a very 
mild boric aeid ointment or plain vaseline may be used to keep them 
soft. 

Tender nipples are best treated by applying half alcohol and half I 
water. 

Cracked or lisstired nipples are beat treated by having the child 
nunte through a nipple shield. The Ibisure may be painted with the 
compound tincture ol benzoin or, if ueecssury, touched with one or 
two per ceut. solution of nitrate of silver. 

Tcndfr ami infiamed brcmts are best treated by supporting the 
breast and the application of cold. The breast should be kept empty 
by means of a breast pnnip, or by having the child nuree it. If there 
ib any pus in tlie milk the uliild should not nurse. 

The Rorsiiig Uother.- The regulation of her life is of the utmost 
importance. The essentials are plenty of rest, at least eight hours 
in bed at night, and an hour's cap in the day-timc; a daily both, a 
daily walk in the open air, and as much out-of-door life as is consistent 
with her mode of life. Over-work and extreme fatigue should be 
avoided, as should worry. Some pleasant recreation should form 
part of each day if it is poKsible. Extreme emotions, anger, grief, 
and the like are bad for the milk, while contentmeut and an at- 
mosphere of happiness favor Inelalion. Constipation should be 
avoided by dietary measures and as frw dnigH taken as possible. 

The diet should be of plain nutritious foods. There i& no need to 




I 

I 



OALAOTOGOOCKB 

mak^ unnecessary rpslnction^ We inKtruct the mothers to eat plent)' 
of plain meat:*, e^s, vegetables, cereals, bread and butter, fruits ajid 
simple (lesset'ts. To drink milk, a quart a day if it can be done 
witJ]oul disiurbiii^ dlifexliuii, and six or eight glasses of watur. Pari 
of tbe milk euu be takeu in cueua. Tea or vttffcc in nioderation, pref- 
erably oQoe a day. Avoid any food which she knows eivcs her jn- 
difrestiun and rit-b and euiiiplieated dishes. Moderati* amounta of 
aalad iiiay be allowed but only if they agree and with vcrj- simple 
and not too aoid dre&'^ings. Spiees. mii^ard, and hiKbly spicod foods 
oceasioiially eauNe eiilic in the baby and sometimes this follows the 
injreslion of fruits ountninine ammatic suhstanees; in which case they 
are to be avoided. 

SulTficiem eateiuni should be supplied and cheese, milk, the lewumes, 
oattni-al and almouds are all rich in caleiuiu. (Bee also Motaboliam 
and Oxnlnria.) 

Galacto^ogues. — There are no galaetoeoKues Icnown of positive 
value, but we prescribe the thick malt extracts, a tablespoonful three 
times a day taken in oold water or on bread and bnlter in ea«es where 
the milk is poor or defieienl rn quantity. Where the fat is dcHcicnt 
plenty of butter, cream and olive oil may be added to the diet. If 
the mother is nnder-nouri-shed lh«ip iiipanK are of ^reat serviee. If 
the mother is well nourished they tend to form fat and should be used 
with eaulioa or not more than woutd be in the ordinary diet. 

Floobter has found that diets containing milk proteins and animal 
prt)tcin» are better for producing milk than thoae containing vogeta- 
blt' proteiuR. with the pxeeption that nut protein sfemed hs efficient 
as meat proteins in this n-gard. The be!«t results were obtained on 
a nutritive ration of 1:6, that is, the ratio between the digestible 
pmteina to the digeHtible carbohydrates and fats and that the diets 
between 2600 and 2900 calories per day produced better residts than 
tliose containing '■i4W or >ilOO a day while those undt!r 2000 were 
inadequate. The overfeeding did not inen-Hse the milk. Cowk' milk. 
protein was found to be tlic best form to iucrcase the milk production 
and pniteel the mother's tiiiKues. 

Beettabltilimcnt of Lactation. — Where nuniini; hii.<i been abandoned 
it may be advisable to attempt to rei^ablish the How of milk and 
thiii may also be done when uursinir has not been attempted at all. 
The child lihould be put to the breast at regular intervals and allowed 
to nurse, which it will do under protest, as there is no milk. The 
child should then be fed on the proper snhHtitnte fewling and the 
breaat thoroughly emptied by milking. The breast ia milked from 
ahuui one inch behind the areola forward to the nipple, and the 
brejist pulled downward and forward. The trick of manual expres- 
aioD of the milk is easily learned. The breast iKick of the larger milk 
ducts need not he innehed in this prwedure. The regular nurxinga 
and milking should be persisted in and an the tuilk flow begins to be 




254 



IXFAXT rBEDl\0 



Mtablished the cJiild may be weighed and the difference between the 
needed food and tlic. amount derived from tlie mother made up by 
artitieial feeding. \'«rj-iiif; l«.>iigtht> iif lime may be m-cded 1« re- 
eBlabliah the milk flow aud it may be a eotiple of months before the 
complete supply is obtained. 

Conditions Affecting Woman's Uilk. — Menstrua titm. — In most in- 
stsnees the milk remains uuuffeeted. In fiomethiug under ten per 
cent, there may be some intestinal indigention and in about one-third 
of these there may be some gastrie di»turbanre with occasional vomit- 
ing. In some ca.'^es there is nervousness and irritnhility without any 
distinct gaatro-inteKtinal disturbance. . Menstriiatiun is no contra- 
indteation for nursing. • 

Pregnancy. — If the mother iM-eomes pregmant the child should be 
weaned. The milk bceonie-8 poor and if toxemia is pre-eent it may 
contain substanees which may poison the child. 

Antitoxin. — Diphtheria and other antitoxins are eliminated in the 
milk. There art* probably antittixic or similar substanceK normally 
in thr milk wbieli may e.\plain the well-kiiovrn immunity of nursing 
infants to most iitfectioU8 dispascs- Very liltle ia known about this 
subject at the present time. 

Bacteria. — A few bacleria are usually found in Ihc intlk. but may 
be disregarded. In sdvane^ tuberculoRis or in tuboreiiloKi» of ihe 
maruiitary gland tubercle bacilli may be present. In septic conditions 
and in breast infections the invading organism may be found in the 
milk. 

Alcohol. — Unless taken in very large quantities alcohol is not ex- 
creted in the milk. Beer or other malt liquors are often used to 
inoreaae the quantity of milk. The fat in the milk iti usually in- 
creased aa well, but in some cases no etTect is noted or the mother 
gainR in weight. 

Drugs. — Uelludonna aud its derivatives administered to the mother 
are excreted in tbc milk. Salvarsan is excreted in the milk and af- 
fect* the infant usuiilly favorably, bnt death of the infant has been 
supposed to be due to the adminiBtmtion of the drug to the mother. 
This needs further study. 

Apart from salines and perhaps some of the other laxatives whieh 
may sometimes alfei-t the child, few other drugs are excreted at all 
except in traem which are of no iinportjince. After long continued 
use mercury, arsenic, bromides, salicyhitcs. hcxamelhylcnnmin and 
the iodides may appear eometimes in sufficient quantities to affect the 
child. 

Nervous Impressions. — Any severe emotion, as fright, anger or grief, 
may atfect the qiuiiitity of the milk, or it may be changed in some 
way so that thf i-hild may become ill. 

Ferments and Other ^tifralojicM.— Various ferments have been de- 



* 



itpribed in tli« miJh. but ib«s«, vitamitiH, fat soluble A. water solublp 
B. poiBous and proteins which produce hyperseiuibility to the infant 
are not Ihoroiik'hly uiidersluud ut this timo. 

Care of the Breasts. — If, for any reason, the child in woancd while 
the milk supply is still ample the best method of treating the breasts 
is to have them slightly 8Up|>orted by a bandage underneath and 
thou let them abtwlulely alone. The breasts will fill full of milk, 
become very hard and sliKlitly tender, theu the milk srcn^tion will 
Htop and the br^astR pradually return to nonnnl. If the breast is 
not interfered with it will take eare of its«!f very mueb better than 
if various maniptilatinns are used. In rases of localized painful 
Bwcllinfts a breast pump may \ye used to remove the milk or another 
baby substituted if that is [josaible. Applications of cold afford 
greater relief from the pain than anything else. 

The Interralt for Feedin^.—On xh'is point there arc many and 
diverse opinions. The inlcrvHl must 1m- "luiti'd to the individual baby. 
VTe believe that feeding regularly every three hours during the day 
and the night feeding as statetl alK>ve will meet the re4|uiremeiits of 
most babiea better than any Hxed rule. This may be started on the 
third day. If the baby does not gain, is fretful or shows any other 
sigDK of insuffieient food the interval mflv be det-reased t4i two and 
a half hours or even to two hours and a little later the interval 
lenirtheoed. If the baby cries from hunger regularly before the 
feeding time it may be fed at shorter intervals ontil it is large enough 
to take sufficient to last three hours. Very small and premature 
bablcB require tihoner iiitervalK than the latL'e robust infants. After 
seven or eight months there is no objeetiou to trying a four hour 
Hhedule. This may bo used earlier in many larger or very robust 
babies and in cssea with certain digestive troubles it may be tried. 
Many of the best pedlatrlKts of the countrj- arc recommending the 
four hour schedule as a routine, but we believe from oar experienc*! 
that the three hour itehedule is better as a rule. 



HoVm A^i^httr fvr Prt4hiy HvoUKy lmf«nt» Jfiriuf the Pint Ymt. 



At*. 






"-3 






Ski 



6MMid to MVi-nih dav , . . 
SMiml aiid third w<<lia .. 
Fourth l» ninilk week ... 
Tralb wpfk tn fifth month 
Flllb to WT^nlh month . 
OrrpDlh tn tuHfth mimlh 



11-2) 
SJ-S 



14-48 
21-31 
24-38 
27-3S 
33-15 



For the smaller babies the following schedule from Holt may be 
med ajt a guide : 



256 



ntriKT FBBDrXG 



A|* 



Namlicr In 
tWtfOtj -Tour 

Luuffl 






lui dav 

ad d«T 

3d U>'ai«(b day .. 
llh to IJtli wvok . 
3d to 5th miinUi . 
ath to I2Ui inontli 



Testing the Milk.— Mother's milk may easily be tested by means 
of Holl'tt millc self which <*oatii.stK of a lafltometor aud a <?ream fjauge. 
(This inny be haul frnm Eimrr & AmenA, New York.) Witli this the' 
Bp«eiiic ifraviiy ami the amount of oream may easily be estimated. 
Estimated with this tiiKtnimeiit the oream is to the fat as 5 is to 3. 

In lokinK a specimen nf milk the rhild should be allowed to nurse 
& little and about the middle of the nursing choeen. The first milk 
drawn is much weaker in fat aud richer in protein than, the average, 
while the laat ts richer in fat aud weaker in protein. 



Mormal imrnge . . . 
BtMiltlij r&riutiuni . . 

HcAllhy VBrlatlciiM . 

Qiib««llb; TBrl«tli>n> 

VkriMJdna , 
V«ri>Uun» 

VarlMiona 

Variation 

VailMluiu 



Spcclfla 



too 
ua»-LO» 

Below 1 .me 

Below l.(KH 
Beluw l.(UH 

Aboia i.on 

JLbo«« loss 
Alwic 1.0«3 



Ci*«tn, twenty • tour 
Doura. 



7 per wnl 
9-U pef cepl. 

i-0 per cent. 

High (above 10 t>«reeDt.) 

NomuU (i-lop*? Mtst-). 
Low iWlow i pcF cent.). 

High. 

K«rmiU. 
Low. 



PrMtlna. 



1 per pent. 
Nbrmal < rlcti 

aillkl. 
Koniiftl 'hir 

mtikt. 
>fi>rma!l or sllgbllj 

Mlnw. 
Low- 
Very low (*crT 

puoi milk). 
\trf h IrIi (»W7 

tlPb mllki. 
Higti 
Komial or aeatlr 

10 



Modifyia; Mother's Uilk. — There are several difTerent types of 
milk met with and the following suggestions will be found of use: 

1. — If the mother's milk is too rich it may usually be raodific<i 
by limiting the diet, especially the amount of meat taken and pro- 
hibiting all alc-oholie aud malted driuks. The mother should be out 
of doors an much as possible and exercise, preferably walking to the 
point of fatigue, is to be advised. These measures nearly always 
brine about the lowering of fata and proteins. In easrai of infanta 
with feeble digestive powers, one or two ounces of water may be piven 
ju8t before nursing. In »iome severe eases the child must be partially 
fed on other food for a limited period. 

2. — When the milk is of good quality, but deficient in quantity, the 
amount may cenerally, but not always, be increased by the following 
meajtiires: The mother should Imvc nine or ten hours' rest in bed 
at night and a nap of an hour or so during the day. She should be 
out of doors as much as possible and as far as it can be done she 



0\B BOfTI.E A DAY 



367 



)ul«l be relieved of her household cares and duties. Eveiy da.v. if 
iR able, nhe Hhuuld tuk^ a sliort walk out uf duon. Th« diet 
should be unipic with meat, eggs, cereals, vegetables, and Himple 
deaaerts. Thr amount of fluid ingested is important and above what 
aho would urdinarily twke site should bp i^iv^^ti wimi'thing over the 
amount that would be Hix-rc-twl in thi^ milk, fmiii one quart, oue and 
one half quarts, or even two quarts. ThiH may be giv«u at; milk, 
cooon. very weak tea (but uot too uiuch of this), or plain water. 
In women nf Niiilablr iiatintuility and dispuaitioii malt«^xl li<|iiors, such 
as b«er, porter or stout may be u.sed, but alwnys bearing in mind 
tbat piMtibility of starting the alciihnl hiihit. The breasts should be 
inaasaged twice daily lor five or ten mlmltcs. Malt extracts, the thick 
ones, may also be gi«-eu, a tablMpuonful in cold water three limes a 
day at mral timus. Inm will be needed in aiieiiiic wumco. Olive oil 
and cream mny often be used to advantage. In some women tJie 
extra food causes an inoreuKe in weight ratlier than in the milk. 
MPhile waiting to hit if the milk will be: improved the child should 
not be [ur^itlL'U. but iihould receive supplementary feediu;^. 

3. — When the milk is poi^r in quality regardless of the qu&utity 
ver>- littk- can be done and we no longer waste time in this claas, 
but wean at once. 

4. — There are some eases in which the milk appean) to be normal 
and yet for some un discoverable reason the ehild does uot thrive. 
There is uo gain iu weight and the child is anemic, fretful, sleepless. 
and often vomits* aud has abnormal stools. These cases should be 
Treane<l after a fair trial has been made (o improve rlie condition. 
If the i-hitd In tTHining a Little, often much may be accomplished by 
snpptcmenturA' fvcdiugs. 

One Bottle a Day. — A moot point is whether it is wise to allow the 
child one liottle a day as a routine practice. The authors always 
follow thi» plan after the second month should it be deemed advisable 
in the case in hand, and where proper precauliouM revr^rdiug eleanli- 
nesH and patsleurization have he^u taken, uo ill results have Im.-cu Keen 
to follow. The advantages of this inetluKl are as follows: 

The child Irarns to take milk fmm a bottle, and if, owing 1o the 
illnCK of the mother, it becomes ucccs8ar>- at any time to subntitute 
the Ixittle. tlii» may l>e done without inueh difficulty. On the other 
band, if the child has taken nothing but the breast, it may often 
refuse fbe bottle entirely, with disastrous results, severe case* of 
inanition having been known to follow. This methml facilitates 
weaning. If the mother is weak, it bIIowh her to obtain an undiK- 
turl>ed night's rest. Among the upper claasen the ehild is often 
weaned early so that nursing may not interfere with the mother's 
social pleasures and duties. If the breaat-feediog be supplemented 
by the bottle, many of these women may he induced to nurKe their 
uhildrcn during the greater part of the first year, wheu they would 
IT 



2&8 



jSFAyr FBi'i>txa 



olherwUe give it up very early aud abandon the child to Ihc care of 
a nursi!. 

The Firjt Pew Day>.— The first few days of I)]!- Iwiby's life are very 
important cues and many of the subsequent troubles may be directly 
traced to au iuadetiiiate supervisiou of the child diiriiijf thtfl period. 
This bappeus not only among the i^ciiuraiit and ill-intormed. but also 
in the most intcUiKent cluHseu and, curiouidy enough, all too fre- 
quently in olherwiw more or less satisfaetory lying-in hospitals. 

During the first forty-i-JKhl hours the child receives practically no 
nourishment from the breast, the only tiuid secreted durinjr this 
limp tieiut; eolostrum. This has a laxative efTeel upon the infant's 
bowels, emptying them of (he dark brownish material, kuo'M'n as 
meeoniiim, that has ai'euraiilated in the intestinal c^annl during uterine 
life. The child shoiilil, however, he put to the breast at regular in- 
tcrx'altt, so as to establish a free tlow of milk; this generally begins 
on the third day, but may be delayed. Inuring the drst two days 
after birth the child gets about six ounces of colostrum a day. which 
is all that is needed in the way of food. It may, however, be given 
a teaspiionful or two of warm boiled waler or of a 5 per cent, sulution 
of sugar of milk. Catnip, fennel tea and the like should not be 
given. In unusually robuRt but fretful children, or when there is 
fever a small amount of food may be required, and this uia>- be given 
according to the rules for ortifieial fecdintj. 11 the child is very 
small or premature fnllow the rules for feeding premature infants. 

The importance of emptying the breasts at rcgnilar inlervuLs cannot 
be too strongly insisted upon. This is the greate-st stimulation to 
milk secretion that there is, not only during the firsl few days but 
during Ihc whole of lactation. The hrKast is antomatic and supplies 
the demands made u|M)n it. If no milk is taken out none eoiiiea in. 
If the ehild is Lui> feeble to nurse vigorously aud for thix reason mure 
in need of maternal nursing than ever the eolostrum may not be 
removed from the breasts »jid the secrelion of the milk seriotwly 
interfered with. In such cases a healthy infant may be used to 
empty the breasts or a breast pump may be employed or the milk 
expreKsed by hand. The breasts should be nursed alternately in 
order that each one shall be properly emptied. All through lacta- 
tion if the breasts are not emptied there is a tendency for the milk 
to become poor tii ipialily. Miiny mothers who have little railk at- 
tempt to Have it, which is a great mistake, for like the widow's cnisc 
the more that is taken out the more eoraes in. 

The milk secretion usually begins after the lirsl forty-eight hoars 
and from this time the normal infant begins to gain in weight. This 
is a most critical period, for all too often after a few trials at nursing 
and no ntillc coming in the breast the child is weaned when with a 
tittle patienra the milk Rupply eould he eRtablished. t'sually when 
the milk comes in the breast there is ample evidence of it. It flows 



TUB rUaST Few OAY8 



259 



easily from the nipple, the breast fills up and the differonee before 
and after oursiii^ lit ver,v Rpparetit. In xuuie euses it may be dilficull. 
to t«U whetlier the milk is uoiiiiii^ in or aot and in ctme of doubt tin; 

Id may he weiuhf^d inimfKliHtely before »ti(l aft^r nursing. The 

ild shuiitd bv put In llif brt-UAt at regular intervals for at least a 
week in cases la which the milk tl(»w is delayed or scanty. If no 
milk is seeretwl by that time the child van ho weaned and alsn if the 
milk LB very scaoty and vei-y poor in quality. ThiK should not be 
done, however. uiitU a thflrauf;h trial has b?«n ma/Ie diiriof; which the 
breaxt is L^mpletely emptied. .Ma^uiage of the bn>a.st twjee a day 
for Hv(- mittutfs is ui Im-iioIiI. 

DariD^ thii Time the Child should not be Neglected.— It needs 
food after the tirst forty<eight hours and after nnmin^j; if it receives 
little or nothintt the feeding should be supplemented with thi- proper 
amount iu a bottlu. The amouut may he> rt-'({uUile(l iieeordiiit^ to [he 
general ndm for iofaut feeding. If the child vomits immediately 
after feeding it is generally due to too much bciog fdven; and the 
amount can be reduced. Another plan la to weigh the baby before 
and after feedinjr and the difference between the nomiat fe*-tiinc and 
the amount taken from the breast ^veu. The weig/hing should not 
be done in the preseace of the mother, aa it ik apt to make her 
nervous. 

The food supplied should be according to the general rulea for 
infant feedia^, hut if breast milk can be secured we prefer it to all 
utfacr food. Aa ho many children are bom tu bing-ia hospitals these 
days this can often be stwured without difficulty. 

In all doubtful casra the rhild should Ih- weijched daily until it ia 
gaining and the feodint; detinitety eittab1ishi>d. .\fter this twice a 
week fnr a few weeks, and iheu once a week is HufRneiit. In weighing 
the child it shuuld he done with accurate seates. the child should bo 
stripped, and it should be weighed at the name time every day and 
under the same coiiditinas an reKanlit the time of nursing, the empty* 
ing of the bladder and hiiwcls. A change ot' several ounces can be 
KePn by weighing a ehild with an empty stomach, empty hiadder and 
bnwrU one day and with the reverse rnuditions the nest. 

li the child is not getting sufficient food it does not gain or even 
loxm weight. It is fretful, worneil and eniss. If the ehild is ^'ettiuu 
too little milk of a goml quality it is fretful and gaiiLs slowly or not 
at all. but there i« rarely any disturbance of sitoraaeli or Ixiweis un- 
Itwt the quantity ts mueli too little. If the milk is verj* deileient in 
quality or lK)1h or fur t^ovaf reason unsiiited for the child there are 
•limentnr>* disturbances, usually a iliarrhea with ureeniwh stools con- 
taining a large amount of mucus and often undigesle^l riirds. Stime- 
timcA the stools are browni>ib with small curds the »ize of a (.Tain ot 
wheat or larger. Rarely there is eouRtipatinn with sioall hard dry 
atooU often asaociated with colic. There may also be vomiting of 



260 



tSFiXT Fh-EDtXO 



small fimoitnts of milk mixcid with muvus and colic due to 
stoDi«i.*h or iiitfs lines ur botli. 

Care nhoiiUl be ukfo to diffi^rcntiatc the cases wbieh arc tiut totting 
KUdioioii milk frum those in which the milk disiigrees— when the milic 
in seamy ihe child wants to DUi'se for it loii^ tiiin', a Iialf hour or 
I»u^r i)r it iim.v iiurne a (cw momeiit» and tbcu turn from th« breast 
with evident dif<|.'UKt and anger. 

Usiinlly aftiT a week or so tiurmal uouditiiias obtain, but if they 
do not the prohlom of what the feeding- of the child is to be must be 
settled, Experienoe helps a greai ileal and a eareful weiiihing of the 
evideiiee at hand, the Beiierwl condilinn of mother and child and th« 
exainiiiation oE lh« mother's milk, will u>tuall>' puiut the way mora 
or less cleMrly. If the morher's milk is of pood tiuality but scanty 
and the child is xaiuiug on mixed feediufi this should be continued, 
using fvery WTort to increase the iniithfp's milk. If the milk ik very 
pour in 4|uuiity the eliild should he W(;aned. If the mother's milk ia 
apparently uormal or of good quality but scanty, and the child is 
doiiiiL' badly, with loss of weight. stBlionarj' weight, cttlie, vomiting, 
diarrln'a. or ntuligested hIooIb. the child should be put on artifieial 
feediiig for a few days and the mother's luilk kept going by using 
tbc breast jjutiip or hand expres^sion. If the symptoms eease und the 
child does well it should be weaned. If it does not do any better and 
the UKiial ebangeti in the inith do not bring abmit an iraprovement we 
cotitinin: mixctl feitling n litlU- longer nr try tn gi-t some other 
human milk afid tpc if the bnby does well on that while it does badly 
OD its mother's milk. If this is the ease the child should be weaued. 
If the child is to be weaned it is important to do it before too much 
damage ik dime to ilK i/HNlr»-inleKtinal tract and nutrition, as it makes 
the siilis(t)iii-Mt fiTdilig eiisicr. 

The mental attitude of the mother hag a marked effect on the milk 
secretion, and if she has been properly instructed and eoeouragcd 
beforehand, there ia usually no difficulty. If. on the other hand, she 
has grave doubts as to her uaiwibility, and purliuularly if she hears 
both physieijiu and nurse diseusa her pn>bable incompetency, the milk 
secretion may be inhibited. The mental condition of the mother is 
often atTe<'ted as the result of weighing the child. It is very desirable 
that the child be weighed reguliirly nnd the weight recorded; but if 
the mother is at all nervous, or if the child is not doing well, the 
weighing should not be done by the mother or in her preaenee. A 
lona in weight, or even the fact that there is no material gain, may so 
affeet the mental condition of the mother as to prove deletcrions to 
the secretion i>f milk. With proper encouragement and by Ktimulat* 
ing the breast by placing the child at it at re^lar intervals the flow 
of milk i.i promoted. 



BKBAST FBBDiyo 



The Kubjet;! of tlip litiiPiiH of niolhers for otirsiug their infants is 
rwciTinjr more attciilioii of I»tc years, and io Genuany ad mteupt 
bus Wfu niadc to show that the dAu^htcrs uf alcoholiv paiyiitK or 
aucAttry are apt to be iiK'ajmble of nursuijf ilu>ip infants. WJiilr this 
ha» been proved fltatiatieally, uu uleiiliolic utuistry is of so t'ommon 
occurrence that almo^it any existing evil might be ftttributed to it 
and ilH rvlationKhip prx)V«d. 

Many nmlhcrH with an abuiidajice of maternal love and manifold 
good iiitemionft are oflon laekiug in intelligence and cannot be taught 
the proper care of an infant. 

Breast -DOtsing often proves a failure beeansc the mother does not 
undt'rstand how to give the breast to the ehild. "With ihe inerease in 
civiii/alion there sppms to be a diminution in insltnet. and eareful 
directions ^ihould be given in ever>- case. The child should lie »u the 
left or right arm, aceording to whether the ehild is lo nurse at the 
left or ritht lireast. If the mother is tn a sittinir posture the body 
should be iiieliucd slightly forward. With her free hand nhe should 
gr&sp the breast near thf nipple belu-een the lintt two fingers. If, 
owing to the free flow of milk, the child takes the milk ton rapidly, 
this may lie eheebed by alight pressure of (he lingers. The child 
ahoutd nur.H« until satiKlicd. The contents of one hreHst are generally 
suifiricnt for one nurttlng. and \hv. breasts should be uiicd allrrnalely. 
'n'beii satisfied, the infant will usually fall asleep at the breast. 
TJnder ordinar}' conditions the nursing should last from about ten 
to tvculy minutes. If the mitk is taken too tepidly, vomitinii may 
eiunie immmlialely after or diiritig ftHsHng. If too miieh is tiihen, it 
is regurgitatccl almost inimcdiutdy. if tlir infant conNumex more 
than half an hour in nursing, the bivast and milk should be esamincd. 
Ah the infant grows older it requires and lakes more food, and con- 
ae4|nent]y will require a longer time to nur»e than it did during the 
early da^Tt of life. 

Tlu< inculcation of gutid nursing- ha bit» eaniiol be kki ^Iroiii^ty in- 
siatnl upon. Many ul lacks of colic, indigestion and diarrhea may be 
iraei-d lo improper nursing. When good habits are nnw eKtahliKhed. 
there is ircncrally very little trnublr, the NucersK of the trjiiuiiiK de- 
pendiutf largely on the manner in which it is done, Reinilar hours 
for feeding Rhould Ix' fixed and adhered to ; and if the ehild is asleep 
at tbt! feeding- hour, it may be aroused, for it will almost invariably 
go to Kleep after ruirsing. After the last feeding, whii>h Hhould 
usually lake place at 9 or 10 nVlin'k. the ehild should be (|uictcd and 
allowed to sleep a« long as it chooses. 

During the first month or two the, infant will, as a rule, awaken 
between 1 or 2 o'clock and aeain at about 4 or li o'cloek. After two 
or three months it will require but one night feeding, and after five 
month.K nf a};e thp averat-'e infant wilt sleep all night without numinK. 

When the change is being made and the child awakens for it« AC- 



262 



IKFAXT FBEDtSa 



customed nursing, it should 1>^ given a little warm water from a bottle 
aiid be quieted, but not tiikeu u]>. Hegular iiurs>iui;-habib^ tuducc 
rvgular bowi'l luuvemeuts and sleep, and ihe tlirt?L' uumbined insure 
health aud uomfort not only for the infant, but for the mother a» 
well. A healthy child, if traiiied to du so, will Kleep without rocking 
or coddling. Three things arv. Iiuwever, esaentiitl to secure ^nccess 
in thi.s traiiiiii);: a Miilislied appetite, dry uapkins, and » cpiiet. dark- 
ened poum The inftuit must not be nursed each lime il cries. If 
it has eolic. the warm milk inny stxithe the eliild for a time, but later 
aggravatefi the trouble, which in muiiy eases is due to overfeedinff or 
to too freipieut feediii";. 

Weaning, ^T he uliild Hlnmld be weaned only for ver>' gimd reai^ntui 
and pruelieally never for minor distiirbanees, sueh as eolie or slightly 
abnormal stools, us long u.s the child is gaining in weight It is not 
necessary to wean the ehild for eraeked nipples, as theno, with pnijier 
treatment iind the breast shield, are generally soon reeovered from. 
The L'hild ^hoidd not be wejincd on aceount of the ntother's beginning 
menstruatiuti, as this rarely has more than a temporary effect on the 
milk and usually uot eveu that: uor ahontd il be dune fur any of the 
onliiuiry miUl difti-ases that may oeeur in the mother. There are, 
however, quite n large list of reawtns for tuking the child off the 
breast, lunoiig these being the presence of any aeiite severe diHeaM in 
the mother or of any chronic wasting disease. lu eases where the milk 
dettnitely does not agree with the child or where there is no gain in 
weight for a considerable period or even a lass of weight, the ehild i^t 
better fed on artirtcial food than allowed to get in a verj' run donti 
eoudition from lack of proper nmirishnient. In ven.' many inxtaneeit 
the mother attempts to tnirHe the ehild for too long a perio<l and after 
the milk bus either faiknl in quantity or quality or both. When the 
milk begins lo fail it is a vei-j- good plan to begin mixed feeding and 
this may be inereased and the ehild t;radually weaned, generally with- 
out any diRiculty wliatever. Aa a general rule, the weaning should 
not be dour in summer if it can be avoided, but the dangcrH of weaning 
a child in summer arc verj- much over-estimated; provided il is done 
by some one who understands the stdijeet of infant feeding. The 
chief danger of weaning in summer is the same danger that attends 
artiticial feeding in general, and spoilt milk. The child should never 
be weanetl in the spring if it is doing well, for fear it might have to 
be weaned during the summer months. If the child hen been ac- 
customed to taking one bnttle a day the weaning is very easily ac- 
complished. If this has not betni the iii^tom tlien- may be great 
difficulty in getting the ehild to tnke the bottle, in which e«s» the 
ehild should be fed by some one else when the mother is not pnsicnt. 
Weaning may be accomplished in two ways; either by substituting one 
bottle for a feeding and then two bottles until the ehild is entirely 
off the breast, or the mcikod advised in mixed feeding may be used, 




WBT■^VIt3tsa 



96» 



gradually increasing the quantity until the child is do lunger uursed 
*t all. 

Wel-nurKJng. — Witb t)]« advcuT of a more tlioruugh knowledge of 
iofant {mdiuf; wet-niirKiui; ha-s. furtunalely, bec-omi' Icks fmpicDt. 
K«vertbeUiis, Uierp arc some iiifanls that will tbhvp on notbinK but 
brcMt-feediug. When thiii is the case, a wei-nurae must be chosen 
aocordint; to the following niles: 

The woDimi »liuuld be healthy aiid of pfood habils. Thi- absence 
of syphilis, ttibcn-nlosis. Mlcoliolisin. and otter diseaMcs should be de- 
termined by rarefiil exuiuiriuliou. A Wa-saermann lest should be 
made to determine the presence or atiseiiee of KyphiliH. The nippIcK 
shoidd be carefidly exnniined for fiwiin-s and ulceration. The brfiast 
should h* examined before and after nursing, and the milk tOHted aa 
ppeviotisly deserihed. The 8tze>if the breast alone is not a good guide 
aa to the amount or i)uiility of the milk it Becrete«. The <|u&tJtity may 
be judged by the siz^ »f the breaHt before and after nureing or by 
wcighintr the baby before and after iiursine. ThLt latter method, al- 
though a good one. is not HBually rpsorted to. The wct-nnrsc should 
jiiwayK be one who has mirsi*d her own ehild sueeessfnlly for at least 
a month. If possible. hIip .should be a primipnra between twenty and 
thirty-five years of age. Younger or older women should not, as a 
rule, be employed. If the infant "r condition pemiit'*. the nurse sliotdd 
be given at IcaM a week's trial, for often the chance in her mode of 
living may eaiLSii' a scanty flow of milk or render it otherwise un- 
Mttiiifaetor^'. When she has become accustomed to her .<nirn)undings, 
the milk may become perfectly normal. Owing to idleness and a too 
abiindaul diet the milk may bin-ome loo rieh. In tbcKe easen the rules 
prcviouHly laid down may rorrect the condition. Suitable wct-nurf«!i 
are not easily ubtained, nre expensive, and are often a source of eon- 
atant trouble and annoyance. A woman who will give up the care 
of her own child for pay ia usually a very unpleasant person to have 
about. For these reasims, cxeept where there is severe aeute inani- 
tion, other means .should be tried before a wet-nurse ia rcwirtcd to. 
Wet-nursing is, however, very successfully carried out in some Kuro- 
pean eountriti). 

Mixed Feeding. — Children fed partly on the breast and partly on 
the buttle should always he under supervision. This method is in- 
dicated when the mother's milk is poor or scanty, owing to some in- 
tcrrening illness, or when owing to deficient quautity. the mother 
cannot entirely nurae the ehild. It w alitn used in weaning. If the 
tnothrr is nuntiug the child but once or twice a day the milk in 
apt to bet^imr very poor and under these cirptmiKtanccs it i^honld be 
examine^I frotu time to litiic. In these cmvs the child is satisfied 
after the bottle but not after nuraing. 

We usually allow one full feeding a day in place of a nursing 
ud in the case of weak mothers and if the child is still getting a 



night feeding this is best giveu at uigbt. otherwist? at any time of 
ihf day that it suits the mother. At (jiifh other nursing period the 
ehild is put to th« breaKt and loft long enough to empty at least one 
(if them. Immediately after this iht^ ehiid may be given a bottle 
containinic the aiuuuut ncceKHary to make up the feeding. This mar 
be gauged by the child's being sjitUtied and contented after feeding 
or by weighing the child before and after the feeding and giving the 
difference between what it takes at the breast and a normal size 
feeding fur the baby in questioti. If tno much is given it will be 
vomited within a sliort time nftiT feeding. 

Ptrtial Feeding with Human MiU.— It frequently happens that a 
wet nurse cannot he obtained, but nearly always it is pos.sible to get 
one or more nnrHin^ from some friendly mother. From 1 to 6 or 8 
ouneeti of hri-ast niilU addefl t«i IHp diet of the artiHeialiy feci child is 
often the iiieaua of leaving the life uf the ehild— the breast milk 
atimulatiug the nutrition oh nothing else will. In cities such uUk can 
often be bought at maternity hospitals by making Kpi'eiul arrange- 
mrntH. and a similar plan may be sucecHsfully followed apart from 
hoepitals. In premature, imprfjpcrly fed young infaotM, inanition, 
marasmus, and in some other conditions this plan is of great value. 
(See Hoohler. Journal of the American Medical Association, Aug. 11. 
1917. p. 121) 

Other Foods Allowed. — Beginning at eight or nine months the follow- 
ing arlieleu of diet may generally be added to adv&utage. Can 
should be taken to see that not too much is given at the ^tart and 
that the varinux articles are well digested and well borne. 

Puree of milled spinach 

Puree of potato 

Strained broth thickened with any cereal 

Vegetable puree added to soups (see same for preparatioii) 

Oatmt-Hl. wheat, rice or barley jelly 

Orange juiec 

Prune juice 
Artificial or Bottle Pccding. — If a baby cannot be nursed at the 
breast, how can it be fed so as to have it grow into a strong, healthy, 
normal ebiUlT This question has been the object of a great deal of 
study, and while miieb has been learned about infant feeding, it would 
scorn that there is much more to find out. The earlier methods of 
modif^i'ing milk consisted of mixing mixtures of water and milk, then 
Btigar and watrr witp added, and then citcrI gruels with or without 
sugar. Buttermilk mixtures were used in some places. Liebig tried 
to get a mixture to add to milk to adapt it to the infant's digestion. 
Biedert and Meign suggested mi^itures to replace mothers' mUk, and 
Rotch elaborated tht^ir ideas and KuRgested the study of milk mixtures 
from the standpoint of the pereenlapc of protein, fat. and carbo- 
hydrate contained. Budin and others suggested undiluted cows' 



TBE rSOBLBll OF IRriFlCUL FEEDt\0 



265 



I 



I 



milk. H«ubuer approached the subject from tht> slundpoinl of the 
vaertiy required bv ih« iofaut. uu<I su^jested mixtures which in 
projwr amuimtK covered tlu> number of (>al(>rir« needed. 

tij prarticv it wus found that Muiii-liiiics milk nut only did not 
afrrec, but at ttmi>» eAuaed positive injury-. ScokJiis the cxplauatioa 
for this. Biedert su^gehted that the proteia or curd wum at fnult. 
Later, Csern.v thought the trouble wan due to the fat», (Specially if 
given in too great quaiititios. lie l>elieve<l that the targe quantities 
(if fat usi-d up luo mUL'b of tlie alkuli in Ihe intt-.stine in saponifjinng 
it. ttiul Nu brought about u conditiuu of acidosis and of Kufitro-intttHtiual 
disiurbanoe. Later, Pinkelxlein and hi.s xeho»l taught that the sugars 
were the cauw nf the troiibhi, His theories are considered some- 
what more fully below. Still others believe that the difference \a 
the character Hud amounts of the inorganic aaltH are reKpoiixible fur 
the trouble ill feeding. Tbe bacteriologists arc of the opinion lliat 
bacteria are the cause of the trouble, aud at times the disturbance is 
due to iIk* toxic di-sturbancea which tbe bacteria cause to 1h' formed 
iu the milk. Still others blame the difference in ferments and other 
Kpecitic rharacterM of the milk, I'Uiming that these speciliif differences 
in the milk of various miimals an- at the bottom of the trouble. 
A^iu. the quantities, the hours, and methods generally have been 
blamed. Sometimes one of these things i^ the cause aud aotiielimes 
another. 

The froblem of Artificial Feedii^;.— This Kuhjed may bi> appmaeh^d 
in much the same way as fucding adults The aim of sncb feeding 
is to produce a healthy, normally developed child with the proper 
reaiKlaiioe to disease. There are a number of important theoretic 
eomideratiouB with which any one HUpervising the feeding of infants 
should be familiar, but it should always be borne in mind thai tbe 
practical clinical result ia to be the final criterion and uot tbe theoretic 
staudarda. 

We shall consider first the most important of th** theoretic isui- 
sideralioiks and then the praclicul infaut feeding- The reader should 
fin! read the sections on cow's milk. 

Thf Caloric Needs of Infants, — The total caloric needs of infants 
have not l)een definitely determinwl, and infant feeding can In- done 
mweewfully without any kuowledge of calories. However true this 
iDRy he, the Ktud.v of infant feeding from a Htandpoinr of tbe calorie 
Meds adds greatly to its interest, uud is a valuable check ou under- 
and over-feet) ing. It must h*' home in mind that the fooil must not 
only contain tbe requisite number of calories, hut it must In* dinestible, 
absorbable, and capable of l>eiiig utitiTed by the baby without causing 
any unloward symptoms. FinkeUti'in obwrved that the avi-rage 
breast-fed infant draws daily during the first vreek of life one-Hfth 
nf ita body-weight: from the siicth week to the sixth month, one-sixth 
to one^«eventh, and during the latter half of the first year, one-eighth 



266 



rsFAyr febdixo 



of its boil y- weight. Expreasfil iu rouiitl uuuibers per kilo of bojy- 
weiifhlt ilurinfr the first three mouths it re<:«ives 150 c.c. during tlie 
second period (tomcwlint U'.sk. and during thi> third period 120 to 130 
c.c. Kxprcsst'd in IlriilHirr's energy qiiuticnt — thttt is, iu calorics per 
kilo of body-weight — ihc requircmont during the first three months 
is 100 cfilorivH per kilo (45.4 calories per pound), during the second 
thn«> immths between 100 and 90 (40.!) calories p<^r pound),' and 
during the Utter half of (he lirKt year 80 or a little lews per kilo 
(36.4 calories per pound). ArtilicMally fed children wn- suppo.sed by 
some to nred more than brctt»t-fod cliildreu on aci'tjiint of the sup* 
potied grealcr work required in aSRiniilating t^ows" milk, lleuhner 
suggests 120 «alnries per kilo. The other fifnircs. however, seem to 
eover the needs of healthy infants as demonstrated in practice. The 
needs of ohkr children Imve been given under Age and Food Require- 
ments. 

The reqniretnpnts varj- greatly under different conditions. Thus, 
an infiint that slcops a great deal will reipiire Ickk food than one wlio 
is wakeful, and the hiyb-stning, nervous, ver>' active child requires 
eonsiderably more than eilher. The reason a ehild rei[uiros so iiiueh 
more per kilo of weight than an adult depends lat'Bety cm the fact that 
the proportion of surface is greater in the sniall hndy. A cflrtaiu 
ammint in iitt-ded for gniwlb, an il has been variiniKly eKtiumted that 
frijiii 9 to ir> pi-r eeiil. of the fi"»d taken was reliiini-d for the purpose 
of fonniug new tJKsiie. 

Atrophic children and those under weight for their age require 
more per kilo than the normal i-bild. Some ob»erve»i have fed as 
high aa 170 ealorit's per kilo iu order to secure a propter nam in 
weight. Such feeding should only he done when under very careful 
RUperviKion, as excetwive quantities of food are liable to cause digestif 
dixturhanceK. 

Caloric Seed of Premature Infautg. — IIc*s» and othern have studied 
this questioD. and believe that premature infants require more food 
proportionately than the full-term baby. The need varies inversely 
with age and birth weight. From practical observation those babies 
weighing over 1500 grams at birth require frnm ItX) tn 1:12 calories 
per kilu of body -weight : those weighing under 15(XI Krams, from 
115 to 170. These doubtless vary irrently, and sueh high caloric feed- 
ing nhonld nnt be Hltempte<l at tirst, but the amounts should be small, 
and increased aa the infant's dihceHtion n*arrant8 it. The milk should 
not be given until after the first Iwiwel movement. Mothei^' milk 
only »hniild be used for these infants, and every effort should be made 
to secure it. The lirKt day HeKs »uge^tst!j diluting: the brenst milk with 
1 to 2 parts of water, and adding sugar tn make up for this dilution. 
Mothers' milk has bei^n varioiLsI}- etitimated at fmm 6n0 to 700 calories 
per liter, or alwiuf 22 ealorim per ounce. About 30 calories should be 
given, or about l^^j ounces of mothers' milk diluted with water. If 



nKTEtiitrxATtoy or the caloric tilve 



267 



there is no vnmiting and no iiidigestinn, 10 ciilarUs a day may be 
aJiled — that iii, alHmt >/j otmce of mothers' laUk. If there is any 
digeslive difiturbaiioe, the increase ueed not be made for a day or 
two or more. The amount of fluid to be piveu nia>' be estimated 
at ab^iit one-sixtb of thp body-weiglit a day. The milk may be diluted 
with atwut. an e^inal i|uantily nf water, or 8 to !!l>^ pvr cent. KUfpir of 
milk nalution, and the lemaindiT of the water iiiven betKctm feeding 
After ten 1» tifleen day& infants under 1500 j^rams should \w held 
at about I2U to 14U ealories per kilo, and those over 150(3. at from 
no to 1-!10. These amounts may be varied with the condition of the 
Ktnol^ Bi>d the wriuht. Th<> milk or water may be given from a bottle 
by meiitm of the Brwk fi^odtT or by usinc a cathflpr, acpnrdiiiK to the 
vitality of the infant. Oeoflsionaliy the breast may be given directly. 
Tlie great probability of syphilis in foster ehildren should always be 
borue ill mind. 

Kmlin's rule an to the quantity of milk tn be given in twenly-four 
hours is ro fcfil one-fifth ihi* Iwily-wriitht, or multiply the Ivmly- 
weight by 2 and fer<l one-tenth that amount. Biidin's tijjuTes are a 
little lower than Iless'. owing to the faet that he used fiSO ealorie» per 
litrr, while Hess estimates 700 ealoriea per liter. 

The Detennination of the Caloric Value of Hodificd Hilk. — Moore- 
houv! bail giveu a I'ery simple method for estimating! thi^ oaloric value 
of infants" food when the total quantity of the pen-eutagi! formula is 
known. The method is as follows: Reduce the twentj'-fnur hoar 
amount to eubie eentinirters, one nuiire Vieinir efina) to 2i*.o c.c. Next 
determine the number of grams of fat, suttar. and protein in the mix- 
I tore by multiplyini; the uumber of cubic eentuneteru and the daily 
I amoitnt by the percentages of fat. su<:&r, and protein. The calories 
from each eon.stituent may he <letermined by remembering that a gram 
of fat furnishes !).:t ealories. and a gram of sugTir or protein furnishes 
4,1 ealories. The ralcuhition may U- »iimplified by cxprossing the 
arithmel ival pnteess by equations, thus: Calories from fat equal 
QxFx2.?4: ealories from sugar and protein equal Qx(S-fP)x 
1.21. The sum of the^e two vahies giveH the total calories furnished 
by the mixture, and this tiKure divided by the weight of the child in 
poundt) gives the calories per |M>uud per day. In the above formula 
Q tf\Txi\% the twenty-four-hour amount in otmees, F, S, and P the 
pereenta^res of fat, sugar, and protein expressed as whole numbers; 
for example. 1 per rent, etgnala 1 and not 0,01. 

Fraley't Method,— Thts is not strietly aw-urate. but wiffieiently so 
for nil prai-liL-al purposes. In calculating milk mixtures be u.ws the 
Following formula: 

(2F+P+S) X IIQ — CaloriM. 

■ or twii-e the fat pereentage plus tbe protein percentaif. and the .«mgar 
perf-entage multiplied by 1</^ times the total quantity gives approxi- 
natcly the uuml>er «f calories. For example — 



268 



lyFAST FEEDiyO 



16 per cent, cream 2 ounces. 

Milk 14 " 

Milk-sugar I " 

Diluent to 32 " 

This gives, by Baner's method, fat 2.75, protein 2, and sugar 5.1. 

Using Fraley 's formula, 5.5 + 2 + 5.1 = 12.6 X 40 = 504. 

Using the ordinary calculations — 

2 ounces cream 100 calories. 

14 ounces milk 280 " 

1 ounce milk-sugar 125 " 

606 " 

If the caloric value per ounce is desired the Fraley formula may be 
used thus : 2F-(-P + Sxll4 = Caloric Talue per ounce. 
Holt and Howland suggest using 1^ instead of 1^ in this formula. 
For example, woman's milk with a formula of 4 per cent, fat, 2 per 
cent, protein and 7 per cent, sugar would yield 2X4-|-2-|-7 = 17 
X 1*4 = 21.25 calories per ounce. 

A simpler method is to know the caloric value of c6mmon foods. 
^Mothers' milk is estimated at from 650 to 700 calories per liter, or 
about 22 calories per ounce. Cows' milk is generally estimated at 
20 calories per ounce for market (4 per cent, fat) milk. 

Appr^Kcimate Caloric Value of Different Food*. 







Orkint at 


Calorira 


Level TkUp- 


Protein 


l>«r ouQCp. 


KpMintulK. 


I>rr ounce 


20 


. , 


0.66 


20 




0.90 


60 




0.70 


27.5 




0,90 


25.0 




0.90 


22.5 




0.90 


20.0 




0.90 


17.5 




0.90 


15.0 




0.00 


13.S 




0.96 


12.5 




0.96 


10 




0.96 


10 




0.28 


127 




3.50 


95 




2.50 


55 






127 


40 




120 


40 




120 


tJO 




120 


40 




80 


40 




IO!t 


36 




107 


28 




115 


40 




120 




12.4 


7.5 






2,5 






1 


, . 


0.2 


6 






15 






245 


122 





Wumun'e milk 

Cows' milk 

Cream { 20 per cent. ) 

7 per cent, milk 

6 per cent, milk 

5 per cent , milk 

4 per cent, milk (whole milk) 

3 per cent, milk 

2 per L'ent. milk 

1} per cent, milk (skimmed milk}.. 

I per l'ent. milk 

Fat-free milk 

Whey 

Sweetened condensed milk, 1 fl. oz. . . 

Sweetened condensed milk, 1 oz 

Evaporated milk 

Dried milk (Mammala) 

Milk-Bugur 

Cane-Hugar 

Dextrimaltose 

Jfalt soup e.ttract 

Barley lliiur 

Wiieiit llciiir 

Oat tUiiir 

Soy Hour 

Barley Kriiel 1 1 to 10 oz. 1 

HarleywHtpr ( 1 tbup. to 1(! n/.l .... 
Albumin-water (white I e^g to I pt.) 

Meat juice 

Orange iuii'i- 

Olive oil 



,\ppn>xim4itr itraturrn. 

Milk-«ufrar 3 l«rcl tHblMpoonlulB ^ I ounce by weight. 

r»ne-ujt«r - S •■ - ^ " 

IVitriuitiKoM . 3 *' ■' ^ " 

Bu^lrv or out Iknir 3 " " aa " 

Wtrat llotir 4" " = 

^^T [lour 3- " = 

^^ Bodia'a Simple BiU«. — Tliis is cflsily remembered — onc-tonth Ihc 

lxi<ly'U*i>ii:lit in twonty-ftjur hours. If tbv budj-'-weij^bt is 10 pounds, 

^■Jr vrilt r^Niuire 1 pound or I pint uf milk in iwonly-four tioiirs, or 

^niYim 1'4 to l\-j ounces of milk per pound of body-weisitit. This is a 

litlle under the tipire ^;i%fii alxive. but tJie stipar, generally added, 

brines it up to the n'quirt'd nmoun). 

Protein H«inireiBent«. — From the data at hand it is not possible 
to HtHie what is the best tunouut to be used under variuiia conditionit. 
iuwinud i» of the opinion that from 8 to 10 per cent, of the total 
ilories Hbonid be <nipplie<I by protein. Talbot stales that the average 
ifaut rei|uircs 1.5 firanis of protein per kilngniiii or 0.7 gram per 
►ouiid "f liody weight, wtiik- many re<|uirc at h*a«t 2 grams per 
[ilo^am or 0.9 per pound and some 2.r» grams and other* evidently 
I'm more than this. Inasmuch as cons' milk seems to be somewhat 
iefleient iu i>ertatn amino-acids necessary for (pvwtb and which are 
ipplied by the protein of human milk. »iul also in view of the fact 
il the protein of i-ows' milk is usually well diiiestetl iiiul i.-uii»r« no 
Utituwanl ^y^l|>l(>mK even if given in exit'KK, it is M'eU to be on the 
safe Hide and give rather n litlle too much than too little. One and 
a balf ouiu'os per pound of body-weight will cover the nitrogen needs 
of the average baby. The daii):ers of feeding too liith' pniti*iu are 
anemia, uo ^am iu weight, or loo small a gain, and a lack uf re- 
IlltaQce. Babies fed on low pruteiu dietK rnay weigh cnoufih, but 
are not as strong mutu-ularly uor as active &»■ (he norinul infant. Ex- 
ccanvc amouutti of protein usually cause constipation with large stoolts 
anil high protein feeding may be used in eertain diarrheal diaturb- 
_»ni-i's. 

Fat and Carbohydrate Requirements.— The differenc* in the food 

imrt, iif «-ourse, be made up of fat and oarbohydrate. The best re- 

ItM nre obtained by using both fat and earbubyd rates. In average 

lliy infanis about 10 .per cent, of the total calories requiremeut 

be sHpplie>.l as protein, and of the remaining DO per cent, of the 

ariea about 50 per cent, may be advantageously given as fat and 

je remaining 40 per cent, as carbohydrate. 

One must bear in mind that the ultimHte aim is to feed the baby 

auceeiefully. and infant feeding should not be regarded iu the light 

>f a ronthematie game. These tigiires are bHsed on .sueeessfut feeding 

irried on at (imt without any regard for calories. The expression 

vf rwults in ealorie^i will, however, be found both interesting and 

eful. To avoid repetitiou the remainder of this subject will be 





lypAST FBEDna 



considered below under Ihe heudiiijj of Hereeutage of Fal aud Carl 
hydrate. 

Mineral Salts. — 0£ late these have come iti for uODsidcrable atteu- 
tioii, mid iiiaiiv dixorderti iif nutrition ar<> MippoHctl to be due to Ain- 
turbaiircs in the ecjuilibrium or itnlance of the varinus mineral ooa^^ 
stitueuLs in the body. At pr«seut our knowledKe is a little too ra^ni^H 
to perniil »ii,v very definite rules, bul a diyt low io ini>nranic con- 
stituents should not be Kiven a growmg (■liil<l. It seems that, ju-it 
as in the case of tiitrOEtu. balanees may be fixed at various levels; 
that is. if the diet is rieh in ttaMn a lai-^.'c aiiioiint is exereted. and if It 
is poor in salts, less. Below a eertHin level it is not well to go ''see 
S&Ite). The salts are important in IniiKlitifr up the tissues. Calcium 
pliosphale and niasueiiium are nioKt important. 

These salts are present in snffieient <iunntities in ninthers' milk and 
in cows' milk. In niddifyinir eow«' milk, redueinp the protein re- 
duces tile eHU'iiim to the fori-ei't Hmoiiiii : bill sueh dilution redrieee 
tin- mH^neKiuiii iiiid tlie iron below the niirnial reifuifments. 

The iron in the food given most infants i»; too low; but the ill 
effeiMs are not seen, as a rule, an the hahy starts o(T with an excess of 
iron. It oxc-hwive milk feeding is kept up too lomr. anemia results, 
za is often st^en in infants from one and a half to three years. Iron 
may he supplied best in yolk of egg or in meats, or it may be griven 
in one of the uNual forms. Magnesium may be supplied by nsini* 
legume Hours or wheat preparations. Vegetable brntbs are rieh in 
snlt-v. l-ifits sliowiug the sall-contcnt of various foodn will be found 
under the beading of Salts. 

Calorics and PcrccntsKcs. — There has been a great deal said alniut 
the caloric method of feeding and the percentage method. These are 
not methods of feeding, but luetbodii of expresHing what is being 
done, a]id their une should make the problem more elcar. The cah^ric 
value of foodei is important, as it enables cue to estimate whether the 
baby is getting insuflicienl food or too much before signs of actual 
trouble occur. The pereentatie method of dealing with the subject 
is v-aluable beeau^ic it jjiveu uh a melbod of espre»iiug accurately and 
concisely what the bahy is getting. It gives us a basiji for changing 
the composition of the food to suit the needs of the individual in- 
fant. 

Toleranoe for Food. — The succchk or failure of the physician will 
depend largely on his ability to adapt food to the digestive capacity 
of the individual infant. One might saj' that every baby is more or 
less like every other baby. For infant feeding one might more truth- 
fully state that every baby is more or less different. The difTereaecs 
are not always apparent, because there is a rather wide range in which 
the average baby will thrive. That is, it is capable of growing under 
more nr Icsh adverse L^ireum»<tanee8. and of utillzini; more or Icrr im- 
proper foods. These variations have definite limits in tioth direc 




coitPoetnoTi of uhk 271 

tions as regards tbp composition aiid amount of fooils. Within the 
liniitatious Ihc Imby tiirivi-s; if thr limit ui ovcmtcpped the infatit 
beoomeg ill. Ilabies tiving in the counti-y, out of doors, often have 
wid<? limits of toleraiicf. The dwpller in tlie ovtr-heated, utider- 
vcnlilutnl city flat usiiully has narrow food Hmitatinnii. Dii><;ase 
changes the toleraaoe for food oftea in a remarkable way. Foods 

■ of a composition and quautity which ordinarily agre« ver>' welt tnay 
actually canse di&ease when given in certain diseased conditions. Lac- 
tose, for pjtample. in nornial babies is as.sirailat«'d readily, but if the 
intestine becomes daninifi'd it may he the cause of a rather deSuite 
disturbaoce of metabolism, which has been described as sujiar-poisoQ- 
ing. 

It is not pofHible to modify the food to Miiit all the differences of 
mctalwlism and constltntion. \Vc cannot alH'a>'s tell what the trouble 
i» when we know there i« something wrong, but we can. by keeping 
within i.-prtatn limits, prevent much trouble, and careful study and 
experiiDoiit nfti'ti I'vrreet existinp disturbances. 

The Composition of Milk. -In the Ignited States the only milk 
whicli is avuiltthle for infant feeding h that from the cow. To insure 
suece«8 in infant feeding, one should know its composition, how it com- 
pares to mothers' milk, and how to modify it to suit it to the in- 
I dividual infant. 
Comparison of mothers' milk and cows' milk: 
iittxmgB Ara«i« 

■amae mw 

Pmtfin ,.130 3 50 

Fill . a-50 4.00 

SuKAr TJO 4.110 

Salt! 020 0.76 

W»l« 8780 87.25 

. lOOWl lOOOO 

In the Hrst place there are diff«rcuee« which arc not apparent. 
Womeu's milk contains ferments which stimulate the digestive secre- 
itiotis iu the child. Those of cows* milk stimulate the digestion of the 
^cifelf, iiol of the mfntil. In !u>me difficult cawM even a small amount 
uf women's milk will be found of great service in stimulating the 
I diifeKlion. 

The Protein.— This differs both in amount and in charneter. In 
women's milk the proteins consist of lactalbiimin and casein in the 
proportiou of two-thirds of the former to one-third of the latter. In 
eowft* milk about one-sixth of the protein is lactalbumin and the re- 
maiadeT casein. The total protein iu human milk precipitateit in flue 
fllkei, that of cows' milk in heavy cnrds. The modiftealion of the 
protein corwists in dihitinir the milk until the protein is from 0.6 per 
cent, or more, arcordine to the age, siz<-, and digestive capacity of the 
infant. In some eases the lactalbumin and eurd may be separated 
and addet^l in the re(|uire<l amounts. 
The protein may be prevented from foruiDg large curds by the 



272 



fXFAXT FEKDI\0 



addition of lime-watCT, sodium citrate, barley, or oatmeal-water. 
With llie smfiHer perceotAge thiB is uot uecwisary. 

5«iwr.^Mi Ik -sugar or lactose is present in a very constant propor- 
tion in mottiorsj' milb — from 6 to 7 per cent. lu cows' milk the sugar' 
avera^s alioiit 4.S0 per vvuX. Dilutiuh' i:ows' milk rfdiici's the Hugar 
tttill fartlirr, »u lliul Kut^ttr luuKt bi; aJdvd to make up tiic pcrccnlugt'. 
TliiK iH not added to aweeK-n the millc. but to increase lis food value. 
Duriny ihe lirst few days of life sii^ar may be given in the propor- 
tion of j.O to 5.5 per cent. ; from tUe second week to the third month,^^ 
fj pi>r p<>nt.: and fnim that lime uj) to tlic i-li^venth mt-nilli, 7 per cenU^H 
may U- u«h1. At tin- clevenlh month it may be reduced to 5. and a 
little later omitted altogether, unless the child is under weight. ' 
These are safe limits, both from the standpoint of nutrition and i 
tolerance. Some infants will tolerate more tlinn 7 per cent,, but there 
is no advanlu<:p in giviui; mure, and it may give rise to sj'mptoniH of 
auga r-poiso ri i ng. 

There has Wen a great deal of discussion about the kind of sugar to 
he used. L«c'losv, the Kugar ftniud in milk, Ik hext fur normal infants. 
It may be given in xnflicicnt ihuouiiIn more easily tlnin thp other 
sugars, OS it is not so sweet. Care should be taken to get a puro sugar. 
Milk^sngar may cau^e trouble if there is digestive disturhance. even in 
the iimnunts mentioned atove. and one of the other Hutrani or otherj 
earl>ohydrato las starch) may then bo substituted. In the several 
diarrheas the starch fnods (as barley or rice gniel i are belter borne. 

Cane-sugar is cheaper and often substituted for laetosv in ordiuarj 
feeding, but it is so sweet that only about half as much can be used. 
In Homr cases it in apparently digested better than lactoKc. 

MaltitRo is niueh used at present in place of the above. It is ^ea-' 
erally given in mixtures containing dextrose as well. If malto)«e is 
uacd. it should be bctfUn in fiuiall (|uanl.itic& and incrcaaed to the 
desired quantity, as it sumclimes causes diarrhea and other disturb- .J 
auees. particularly if any gastro-inlestinal trouble eiiists. lu such 
cases it should be used with great care. It ferments very easily. It 
biui tli« advantage of being readily aWiimilated. as is esi^eeially in- 
die.atc«l in I(k» of weight or MtatJunary weight williuut apparent caitse. 

The following is xnid to be the compotsition of some of the most 
frequently uxed preparations containing Iheiu; 

SqxM'b Nklinuckcr ft2.44 

IjcwflanU'i K>bicuckcr 40 

D«xtru-iiu]U>H> fll 

Neutral rimUom (Maltxjmv Co.) OS.SS 

Loefland'A mftlt wtup ,. ftS.91 

Bori^baritt'K ninlt suup ,.., K7Jt\ 

Other analyses of infants' foods containing maltose and dextrose 
will be found under the heading of Proprietary Foods. 

Olucos*" solutions are Kometimes usetl by the drop method by rectum, 
cither with or without salt solution. (iW Rectal Feeding.) 



1 I 




DulroH. 
41.21 
60 

47 
8.9 
15.42 

tS.T< 



CAlCT-LATtOS OP PESCEXTAOfSe 



273 



The ^ubjrrt of the difTercnt KUg»rN in relation to the various in- 
testiiial dlsliirliaiiue!) needs fiirtht^r study. (Sec al&o FinkcUtcin 'a 
theorit's.j 

Pat. — Thi- (at of huiuau milk averagfs 4 per cent.; thst of eows' 
milk is tlic nuuio. Wiicii ihv milk bat> bceu diluted, ttic amount miiKt 
either b« oiado up bv addiii|r ereaui or by umii)^ the up]>t^r snc-third or 
upper half of the milk after the cream has risen. Gravity cream 
contaiiiH about twioe as tnauy bacteria as centrifuital cream, uiid the 
objeetioiw formerly iirgt^d H(;ainfit the latter appear to tie unfounded. 

The amount uf fat to be ^iven varirK with the age, wi'if;ht, and 
dijTWlive ability of the infant. Kor an nvorape infant, 2 per cent, 
the first week, 2.5 per eent. the second, and 3 per eeut. the thii-d week 
ar« the amounts usually prescribed. In using whole milk mixtures 
tbe amount of fat is low, and as fat la most fre<pien1ly the atumblinfi; 
bUiek in digcstiou, these mixtures are eatiicr to adapt lo the iufaiit's 
digestion. If the child is under observaliou there is uo objection to 
Tsisin^ the fat to 4 per cent, at about the fourth month, after that 
time this amount must not be exceeded, or the infant is apt to develop 
indiKe^ion. with the larjp! whitish stools giving off the characteristic 
tolor i»f the fatly acids. 

The Calculation of Percentages in Milk Mixtures.— This is 
needetl if iine thinks in pen-entsgeH, and a simple rule U gfiveti by Holt 
as follows: To determine the percentage of any constituent in the 
food, multiply its pereeutage in the original milk, ercani. or milk by 
the number of oun(*s i»f each in lh«? food, and divide by the tulal num- 
ber of ounces of foot] prepared. 

For example, a 40-ounce mixture, made up of 20 ounces of the 
upper half of market (i per eent.) milk; that is, of 7 per cent, milk, 
ounces of water, and IVn ounees milk-sugar: 

7 X ^ = ''(4 TcprcKnii f«t in nixttm, 
l40<f'40—'3,6 p«M-*n(ii^. 

The protein in 7 per cent, milk is about 3.50 per cient. : 

iM x^ — '^ rcpntmiis pralein in mixture. 
TO -^ W — 1 .76 peiceuutgi.- o[ piuiHii. 

The aii^ar in a 7 per cent, milk ia about 4.50 per ceot.: 

4.SD X 21) = 90 rvynueoU aiifHr tn milk. 
M .4- 40 r: 2^ |wn9pntag« vf sugar in millc. 

1^ ounces of milk-sugar in 20 ounces addti about 'd.75 (1.5 -i- 40^ 
0.0075 ). The total sugar is 2.2.1 -f 3,75 = 6 per cent. 

The Use of Alkalis. — Having eonxidered the caloric needs of in- 
fants aud the perccntageii of food constituents ordinarily employed, 
we may take up briefly some of the reawns for modifying milk with 
reference to the digestion of the infant, II should he borne in mind 
that the gastTO-intentinal tract of the infant is not like that of an adult. 
18 



274 



ntFAST FEEDIXG 



At birth the digestive capat:ity is small, and it increases as the cbild 
grows, providing pniper food is gi^eii. The steps in the digention of 
milk are, firet, Iho miiirt changes the eak-iiim cuHeiii of the milk intq 
parHtiaseui (ciu'd), whicli is not altectcd hy popsin. Thou ihi! acid of 
the stomach uuites with the lime of the paracasein, foraiiug a free 
paracflAein cnrd, which is more dense than the paracasein, but which 
id cupable of lieitig digviili'd b,v pepsin. This free pararaKeiu curd 
acts like a base UTid iiiiites with the iicid. forming a panieascin rhiorid, 
which is also digestible by pepsin. If milk is diluted with plain 
water, the rennet act« promptly and the clotting occurs in a uormal 
maimer. Women's milk data in smiUI curds, but cows' milk in large 
dense onea, so that alkalis are often added for the purpose of clieckinj; 
or altering the curd formatiou. The moat used substances are lime 
water audi sodium bicarbonate. Lime-water is freely alkaline and 
makes the clotting take place more slowly, alters the fonn of the cunl, 
makine it loni^rr, and probably a certain amount of the milk passes 
into the intestine without having been much changed in the stomach. 
When sodium hiearbonate is used, its greater alkaline properties 
prevent not only the action of the rfnnci, but the pepsin and acid as 

TiBLs I. — AlkcUinity Bt^irtd by Theory. 



ftlkatlne iMfora 
dimtlnii. 


w««. 




Alkallm 

rood. 


Umc>-wu«t to 
ei^ti OB. food. 




khU toeautt 


lot. 


+ 


19 Oft 


:^z 


20 o>. 


.26 percoQL 


or 


A 


Bmn. 


S" 


+ 


18 " 


= 


20 " 


■50 


14 


or 


S 


(1 


8" 


+ 


IT « 


^^ 


20" 


.78 




or 


11 


4" 


+ 


Ift " 


= 


20" 


1.00 




or 




It 


8" 


+ 


16 ■' 


:3S 


20" 


I.a5 




or 


jL 


II 


6" 


+ 


H " 


^ 


SO " 


l.oO 




or 


n 


u 


7" 


+ 


13 •■ 


^ 


ao " 


I 75 




or 


1^ 


>■ 


8" 


+ 


12 " 


^ 


ao " 


:!.oo 




or 


^r 


It 


9" 


+ 


It " 


=- 


20 •' 


2.2.5 




or 


il 


d 


10" 


+ 


10 •' 


= 


21) " 


2.30 




or 


a 


20 " 


+ 




:r 


20 " 


&00 




or 


1 


It 



well, until the alkali is neutralized. Tliis probably causes gastric 
digestion to be small iu amount and the work fallo on the intcKtine. 
It is thought that fluid mitk passes rapidly into the intestine, whereas 
if it elots it remains until digested. It has been estimated that add- 
ing 5 per cent, lime-water lo milk wilt render it alkaline, wherea4 
20 percent, will check the digestion of protein in the stomach entirely. 
With sodium bicarbonate 1 grain to the (ninee renders the milk 
alkaline. 2 graios t« the oiuice facilitates the gastric digestion of pro* 
tein by changing the character of the curd, while S grains to the 
ounce will susjivud the gastric digestion of protein. 

As generally practiaeil. 5 per cent, of lime-water is added to a milk 
mixture, regardie.x« of the actnni aronuat of mtlk in the mixture. 
■When the mixture Is a weak one the effect is very marked, as there 
is but little milk to be affected, but in the stronger mixtures the eGfeet 
is less marked. 




TBB V8B OF ALKALIS 



275 



The tables prei»arecJ by Southworlh are interesting m this connei^- 
tinn. 

ToluiiK the :>0-minc<> mixture as an i1)ut<tratiim, if tlie milk to be 
nsed is finit rendrn-il alkaline by the addition of 5 per cent, limr- 
water or 1 ^rain of audiiitn bicarbouate to eacb ouuoe of milk, and 
thi^ is diluted to make the (ecdiiig mixture. tlif> table on page 2T4 will 
shnw hdw milch lime-water or sodium bicarbouate eaeb ounee of the 
food mixture would eoiitniu. 

It is instructive in this eonneetion to eompare the actual results 
obtaiued in the method uxuaDy praetiscd: 

TjlBLa U.—Athitmity Obliiitird iji PiiKtiet. 



WUm 




HUk 




thnr- 
wauf 








rood. 


Per cviit. Iimt- 
«u«rtni]illt. 


Or* bkit^ 

■odaioiiMli 

'•(, milk. 


ISoa 


+ 


1 CO. 


+ 


1 OK. 


or 


20 pv. 


— - 


20 m. 


too per cenL 


SOrtuni. 


17 - 


+ 


3" 


+ 


1 " 


or 


20 *' 


= 


20 " 


GO 


H 


10 


it 


W" 


+ 


8" 


+ 


1 " 


nr 


ao •■ 


T^ 


20 " 


Xil 


u 


«i 


H 


16- 


+ 


i " 


+ 


1 " 


or 


20 " 


^ 


20 " 


25 


A 


r> 


« 


14 " 


-1- 


S" 


+ 


I " 


or 


20 " 


— 


20 " 


20 


«■ 


4 


at 


13 " 


+ 


6" 


+ 


1 " 


or 


2« " 


= 


20 *■ 


16} 


u 


Af 


41 


12" 


+ 


7 " 


+ 


1 ■' 


or 


20 " 


= 


20 " 


14 


u 


3 


al 


It - 


+ 


8 ■• 


+ 


1 •• 


or 


20 " 


= 


20 " 


12} 


u 


i' 


•1 


10 •• 


+ 


9 " 


+ 


1 •■ 


or 


20 *' 


=;: 


20 " 


11 


II 


11 






la- 


+ 


1 - 


or 


20 " 


^ 


ao" 


fl 


« 


t 


m 



Ip young infants and in those with f««ble digestions the U8« of 
alkalis ts a great help. We rarely use over 1 ouni-e of lime-water in 
20-ouiieo mixtures for healthy infauLs. Thwirdieally and prHPlically 
lime-water is the b<>sl and Hafe^t. Milk to which limr-watcr is added 
abould not be lioiled, as the lime is precipitated at tbc higher tem- 
peratures. 

()tbi*r alkulis may be used, as syrup of lime or magnesia. Polas- 
Biuni carbonate Las b4.^eD Huggented. The c-ooiiiiued UNe of strong 
alkajix in not to lie commended, as it retards development. 

Tbe flntting may be changed mechanically by adding a gruel made 
of barley flour or other cereals. It is Romctimcs an advantage to 
dextrinize the gruel to render it mure dif,'t-stililc. 

Boilinc milk is sometimes practised, lu order (o change the curd. 
Btiiled milk ia often useful where there is a tendency to frequent 
stmiU. In some children it produces marked constipation. 

Acid milk, as buttermilk or kumisK «ii<l (timilar preparations, are 
often used whi'u oi-diuarj' milk mixtures are not well borne. The 
protein is precipitutctl in Bnc curds and in ea.sily digeatoil, as the 
digestive juices can affect it easily and tbe rennet does not eaiute 
further clotting. 

Still another method of getting at the question of large curds is by 
adding sodium eilratc to the milk. Fmin 1 tn :t grams to each ounee 
of milk in the miidure may he iim^rl. The soda furms a com)K)un<I 
with the casein, and the citric acid unites with the calcium, forming 



276 



tSFAyr FBBDtsa 



calfium citrate. This prevents clottinp. and we have found tha 
useful ill giving the hijfbcr pcreenlaRCH of protein to childrea with 
weak di^vKliuuK, uml aim in infautii who ure troubled with mild forms 
of coustipatioiJ. 

Practical Infant Feeding.— Having consirfered the more important 
prinoiptes on whicli iufaat feeding is liaised, we ar« in a poaitiou to 
eousitler it practically. 

Pwrp Milk Esaential.^-lt sliould be lwiriu> Lii miixl that pure, deaii 
milk is (^ssfiitial 1« iiifaut fL-i-diug. This imM heeii i-oiisidcped in the 
article on Milk. The person caring for the child should bo carefully 
iiistnieted on this point, and the milk s*'ip<'t<'d Khniild be the bwit 
obtainable. It is alw8>'s chrnprst in the end. rarefiil inRtnietioii 
Hhovid a\m he Riven about koepinp: the milk cnkl. about sterilizinf; 
the bottles and all The utensils that are uKed in the preparation of 
the baby's milk, so lis to avoid contamiuating it. If very pure milk 
iH obtainable, it riiay be used raw. \t tlM?ri' is any doubt, it should be 
pasteurized (we Milk), and if it is ver>' doubtful, it .should be steril- 
ized by boiling:. We do not believe that milk that needs boilios 
(unleRs to keep it in the absi'uoe of ice) is fit for infant feeding: but 
in spite of all that ean be dune Homo people will u»e it. 

It IB a good plan to test the milk oecasionally to aflcertain the fat- 
eon tent. 

The direetions for preparing the food should be written out. show- 
ing the (pmnlity of eaeh ingredient, the number and size of feeding. 
etc. Alwa.vs make eertiiin that th«" directions are t-tearly under- 
stood. 

Bottled Milk and Itavteria. — lless has found that the bacteria are 
far more numerous in th« upper layers of the (■n^am, and that they 
beeome gradually fewer in its lower portion. The ui)per 2 ounees of 
the eream contain the greatest number of bacleria. and this is true of 
the tubercle bacilli, as well aa of the streptoooeiji aiid other bacteria. 
He HUj^gKHls tltat iu place of using tht- upper eri'am. as ordiuarily 
practiaed. it ia belter to diauaixl the upper two ounces. The average 
bottle of HUeh partially skimmed milk eiiutaitiK 2 ptu* eetit. of fat and 
3.5 per eeut, of protein. The top 7 uuuees of what reiiuuna in the 
bottle contain 12 per octit. of fat. S ounces of ]0 per cent, fat, and 12 
ouueeH of 7 per cent. fat. These portions of the milk may be used in 
the ordinary percentage mixtures. 

Substitutes for Milk. — If pure milk eannut be obtained, we prefer 
temporary feeiliii<t with vundeuHed uiiik mixlurOK, malted milk, dried 
milk, or somrtimt-H buttemnlk. When the former are used it ia 
always wise to give the baby a few teaspoonfuI» of orange-juice daily, 
or every other day. to prevent scurvy. If the above foods are to be 
imed for any length of time, fat ahould he supplied, and if pure 
cream eaniiot be obtained, olive oil may be u^d. 

The Interval for Keedlnjc. — The schedule for feeding h {riven under 



4 



TBB 017.4 .vT/rr 

Mat«rDal NoKing' and also the Laboratory- Method. Tfaere is a wide 
diffeppu«e of opiuion eout-eruuig the proper interval. At present the 
awing of ihe pendulum is lo very louj; iiiti-rvals. It depends on lh« 
individual batty. Tbv internal aud tiic »izc of the fei^ding are closely 
related. The amount of Food needed in twenty-four liuurs nhodld b« 
divided into the number decided upon according to the size of Ihc 
f««din|i, and that iiii settled by the nf;e and kizc of the hnby. Nomiai 
babies may be given the fond everj* three huurs during the first mouth. 
Two bours or two hount »tid a half feeding; may be used in wnalt or 
premature Iwbies. Four-hnur intervals may be used if verj- strong 
milk mixtures are n:«ed or in feeding undiluted milk. I»iig inten'ala 
are also useful in atuny vt the htoniacb and when the !:n»lrie di^eHtion 
ift weab. In infants whu nre very suiall the interval may be shorter, 
and during illm-ss, when only a upoonfiil »r two of lamX e-au be given 
at a time, the interval may also be shortened, tiei^ular feeding is 
very important. During the day the baby should be fed uii sii'hedule 
whether it is awake or not. as it will otherwise wake at night for the 
bottle it has missed. Niyht feeding should be omitted as early aa 
possible. If xufficieitt food is given during the day. tbe baby may 
be allowed to xleep nil night if it will. Normal habicH do not need 
the night feeding after the liftk month, and it ean often lie dispenaed 
with after the third. Smidi babies and alniphie ones need the full 
number of feedings, as they require more milk to make thcoi gain 

The Quantity. — The total quantity of mixture to be given depends 
on the si»- and age. The normal infant retjuires ubout 'i ouneea of 
fluid per pound of weiiiht during the first 4 months and ahout 2'/^ 
onnees per pound later and in late infaney 2 ounees per ptmod. 
As a general thing we inereaae the strength of the mixture, the quan- 
tity alternately, but there ar« eseeptions to ibis. The sine of each 
fewlinj; will ilt-pend on the baby. Babies of average weight for their 
lUJM^ may usually be given the f(dlowing sized feedings: 

Birtb 7* asaa 3 aa 

1 month 8) 3«5S 3 B8 

2 inontli* lOi 47flB < 118 

3 ** 124 afi'ft S UT 

4 ■■ M eaao u itt 

a ■' IS «T{H 7 2M 

a '• IB 7257 8 aM 

7 •• 17 7711 H 2M 

8 " .. I7J wm a 238 

9 - 181 83(11 tt 230 

10 •' lOf Kflsa K 2311 

11 - 804 fllM * 2'* 

12 - SI M2R » 2M 

The above figures are apprtiximatc. and may usnally be exceeded 
1^ \^ or 1 ounce after the third nrnnth in minnal babies, and much 



278 fSTFiXT FEKDISO 

more in atrophic infants. Babies ahead of the schedule in weightj 
requirp oiirn'spoiidiugly large fevdiiiga. | 

Tile followiug [igiire* of Ladd urc of great iuterest, as they sbow^ 
how the atrophic baby iieeds more food before it will ^aiu iu weight: 

Atn>i>li»! ipfsoU, corr^ 

Honiul ii*w«p iolaal Pound. Uuhcm "I'P"^'"' ••'•'■^^ >* 

OancM. 

I w«* It tet*ive 1 31 

1 *■ , .. 7 " 2 4 

3 w.<<>k» 8 " 2) 4} 

5 » " 8 4| 

7 " 10 " » 51 

9 •' It " 34 51 

a ntoiitKft ... 12 " 4 di 

3J - . .. ,. 1» " 41 7 

41 ■' U " 4) ft 

B " I.^ " 5J ft 

" ... l« ■■ 8 (ii 

a - .... 17 " 7 7 

8 ■• 18 *■ 8 7i 

10 ■' 1» ■• 8 7* 

11 " SO " 8 7 

IS " 21 " » 7J 

IS ■• 22' " 9 ft 

The regiUation of the size of the feeding \& importaut. The atom- 1 
aoh i» nn elBHtic hug, and what uiiglit bo regarded us a norma.) capacity' 
varies witiiin ecrluiu Huiils. If tuu much is g-Ivt^u ut.a ffi-diiig, somej 
of it will be Tegiirgitatcd soon after. (See Vomitiu^.) 

When this is the cai^e, the size of the feeding should be rediieed. 
Infauts improperly fed are iisimlly liiin^ry all the tiuie. atid take i 
readdy almost any amoiml. tiicrtdy to regurgitate it soon after. It iai 
a eoTiniioii mistake to give these babies too large £eeditigM. Only as | 
miieh Hit can he retaliietl should be giveu. These babies lunialLy faavej 
atfmic slomneJiK fruin taking feediii|js that are toy lai^je. At first the 
feedings in tbrsr l-usi's tihould be snutll arid the interval loog. 
Strychiiiu iu proper doses is of great value in these iufaota. The 
size of the feeding and the interval should be approaehed to the 
£iornial average as rapidly as possible, but the individual require-j 
menta tihould never be lost sight of. 

Siuiitkiii. of St. Petersburg, has estimaleil the amount to be fed toj 
a child acoording to the weight, He ascertained that a baby's stom-i 
aeh held about oue-hundredlh of its weight at birth, aud that the 
inrreaise amounted to about a gram a day. By taking one-hundredtli 
of the initial weight at birth and adding a grani for eaeh day the 
average amount required for each feeding is aseertaiiied. ThiK is a; 
fair working rule, hut practically the amount is easily determined hy 
the methods alrewiiy dt'scrit'ed. 

Beginning Bofltc Feeding,— When the baby Is weaned it aliould 
be done gradually if possible, as this gives the digcalire organs an 




MILK MODI FTC ATtOK 



279 



opportuQity to become accustomed to the new milk gradually. The 
digestive juicc« arc secreted as ueeded. and the stimulus cornea from 
tbe food. Sometime-s, if sii eiitirelv tliffereiit L'ooil is suliHtituttid 
suddenb', the digvative juices urc not equal to the deouuid and in- 
digestion results. 

To avoid llits, all the food elements should be beguu very low. 
The first day half the required stren^h. the second day somewhat 
stronger, and hd on each day until tbe proper food in reached. Some 
babieii will take only a day or two to make the change, others will 
require a week or more. 

The aim should be to prwhiee a firm, healthy looking bsby, and not 
a fat. flabby one. The fond* should be increafied as indicated, keep- 
ing iD mind the presenee or absence of vomiting, the number and 
diaracter of the stools, the gain in weight, and the general appear- 
ance. A baby tliat does not look well and contented 'has something 
that needs oorrei'tiim. It may he in the fncKl or in the treneral sur- 
mundings or care. 

If the baby is getting along well, it gains in weight following ap- 
proximately the normal weight curve. It sleeps well, and is happy 
and looks contented. The stools arc normal and there is no vomiting. 
If tbe baby is not doing well, the picture is just the reverse. There 

^ls little or no ^aiu. and ihe child looks pale or flabby and unhappy. 
There is usually fretting, cr^t'ins. restless, disturbed sleep, oftea 
vmniting. and bad stools. 
or 



MUX HODIFICATIOF 

ICETHODS OF PRACTICAL VALUE IH HODIFYIHO KILE 



After obtaining a careful history of the child and its family in 
order to estimate the effect of possible iidierited diseases and of the 
previous foods used and a vnreful ph^'^ieal examination to determine 
the presence or absence of diseases, the food turumla may be thought 
out. The age, the size. Ihe jfeueral appearance, the condition of tbe 
digestive tract, the nature of the stools, all play a part in the de- 
cision. If the child has not been gaining or is upset it is well to 
avoid making the errors in diet responsible for the trouble. 

First, determine the number of feedings, usually six, but variations 
between four and ten may he used. Next, fix upon the total quantity 
based on the rule nf three ounces per pound during the first four 
months, two and a half later, and two in late infancy. The total 
qnaotity should nut exceed forty-eight ounces during the first year 
and many pediatrists set the limit at forty-two. The total quantity 
divided by the number of feedings dives the siBC of each feeding. 
Thii will fall close to one ounce more than the baby's age in months 
and should rarely exceed eight ounces. If tbe baby gets too much 



280 



TyrAyT feedisq 



at one f««diDg it will regurgitate it witliiu five or ten mtuutes. This 
may also be eaiised by moTing the l)aby about after feeding nr from 
the bntiy'h ttikiii^ tiu; milk tou rupiilly. Muruiitii; biibios tiikc large 
feedings, but p«r1 nf iht' milk passes almost diret'tly into the iu- 
testiue, aud care shntdd be tattt'ii »or to dilate the stomach of a weak 
infant by loo large feedings. 

Il in a rather general custom to' start the fetdiup with i-dws" milk, 
Hiid what has been said uuder the i^aptiou of BeLcijiiiiu); Bottle Feed- 
ing should he borne in mind. A simple nile is to give the child 
twioe aK many ouneeK of tnilk an it weijfhM in pounds for the smaller 
onct), aud an ounce and u half per pound for the lart^r ones. A 
better plan is to estimate the caloric needs of the itiFant (»iee Caloric 
Needs of Infants*. This is done by multiplying the weight in pounds 
by 45 for children under throe months, by 40 for children betwceo 
three and six mouths, and by 36 between six and twelve months. 
If the ehild is under weicht or very active it may recjuirc more and 
premalurc or very small sized infants may require 50, 60 or even 70 
calories per pound. 

The first tliouzht ix sufTiciont protein and one and a half nnnccft^H 
of eows* milk per pound will ordinarily supply the required amount. ^^ 
For txaniple. a child of fifteen pounds ordinarily would reqnire 15 
times 40 or 600 calories. An oxince and a half of milk for each 
pound would be twenty-two and ii half ounces, wliiL-h at 21) ealories 
per Dutiee would be -ir^O ealories. leaving 1.iO tu be supplied by the 
addition of some other food. Sugar is added up to 5 per cent. o£ 
the total quantity of food to make up the difference needed. An 
ounce of sugar (2 level tahleJ^poonfuls if cane sugar, or 3 if milk 
sugar or destriraallose) will furnish 120 ealoriea and an ounce and 
a quarter would make up the required quantity. The formula would 
theu be 



i 

I 

m 

I 



WTiol* mi lit 
Bolted wat«r 



S3 oaQCM 
in oiinrrM 
3U lerd tsb1»poonrul« 



This formuia would not be suited to start with if the child had not^ 
beau taking cow's milk, but similar ones much weaker should he 
used baaed on 'Si> calorie-s per pound or even lesa for a few da>-s until 
the infant's digestion becomes accustomed to the new food, when it 
may l>e increased to the required amount. The child should not be 
kept un the low value foods too long, In this way a formula may be 
worked out as a starting point, and as the factor of Hafety of the 
nntrition of the average healthy baby ia a wide one. most infants 
will thrive on snich mixtures. 

Holt and Howland have arranged the following table of who1< 
milk mixtures. If more than 20 ounces is required the caleulatioi 
are eaiily made. The agea are only sugge<ttiona and are not to 
followed olosely. 




itit.K xoDiyiCATtoy 



381 



Formulas from. WhoU ^^ per cent.) ilUk 
mtia§ Approrimair pKrernlagt Compotttwn and Caloric Value 



UUk lotinni)--- 

WaiM (oaaPM) . 
Qrval 1 (mmoM) 

Vki. ptr MBL... 
Soxir. p«r rMU.. 

9Ur«k. i<«r mm. 

CUoriM i^r in. . . 



I 


U 


ni 


IV 


V 


VI 


VU 


Vlll 


iX 




« 


7 


8 


ft 


10 


11 


1* 


IS 


u 




It 


1» 


It 


11 


11} 


• 


7 


k 


I 




,., 


... 


... 


... 


... 


. >• 


1 


s 


fi 




at 


>i 


» 


tt 


u 


ti 


t 


It 


> / 


to 


» 


to 


M 


to 


SO 


10 


*l> 


io 


1.10 


l.«0 


].«C 


IJtO 


t.Oa 


930 


iAo 


S.(H) 


s,«o' 


».TI> 


•.00 


9.00 


«M 


0.9i> 


4.G0 


9.00 


6.£0 


9.90 
















.to 


.HO 


!.U0 




tjM 


IM 


•1.(0 


i.H) 


l.TS 


1.M 


1.1 D 


V tt 


I. to 




II.S 


ItJi 


18-9 


14.9 


|S.t 


l«.fi 


IT* 


1«,U 


lO.D 




iA». 


1 wk. 


Swk. 


t ID*. 


8U0. 


4 mo. 


9 mo, 1 » nu. 


8 mo. 





If ibv nbiti) dues uut ^aiii iu weight it may be tried on skim milk 
mixturra with high sugar content. This iiicreiiKcs the protein and 
leaseus the fot, which seems so ofteti to be the stumbling- block in 
bottle feeding. It also furnLshi*s much of the enercy in tlie most 
easily ntiliy^d form as well as b hitrli juTccntSKP «if sails which aid 
in water releotion. The milk ean have all the gravity cream re- 
moved, the remaiiidcr funiishiiip 10 calories per ounce and contains 
about 1 p«r ceot. of fat. Methods of obtaining the milks of differ- 
But fat percentaye is given under Holt's Fereenlage Milk Mothod- 
Malt soup prcparationK arc iiscfui whrrc the child \s not gaining. 
Children fed on milk low in fat and protein and rich in carbo- 
hydrates are apt to develop rickets, so that it is a good plan to 
inerpase Ibi* fats to abuut S per cent, and up lo 4 per L^eot. may be 
ased in many caM-.t. The top milk nielhud given below fnrnislieK an 
easy, accurate method of obtaiuiug mixtures high in fat. The objcc- 
tioo to the hi^'h fat porcenta>:cs is that fat seems to he the most 
diiBcult part of the food for the infant to digest, and hence fat in- 
difcestion iH common, pflrticularly in housed city children. Active, 
out door babies manage fat easily as a rule, The breast fed baby 
digests approximately 4 per cent, of fat and in our experience bottle 
fed babies on the higher percentage do better ultimately than the 
low percentage uiios, but low fat feeding is better in infant^ with 
weak digestion and tn dispen.sary or similar practice, lu u.siug high 
fat mixtures the interval of feeding may generally be lengthened to 
advantage. 

Fat indigestion is liable to happen in infants fed on milk from 
Jereey, Aldemey and Ouernscy cows. Such milk usually contains 
■fanormally high fat pereemages and the fat droplets are large and 
I'lid to coalesce. The milk from common cows is better as the fat 
droplets art* smaller and the percentage lower. Milk from Holstcin 
Cowa if) said to approach human milk more nearly as regards its fat 
eontainiug more olein and le«» of the volatile glycerids. 

1 Th» ^rucl here In<llcst«l i»> made in thr- proportion of 1 oi by rolumt to 10 ot 
«( vater. 

>MiIk flugnr i« }u!Tv indimtf^; of cftne NUirwr use two Kant tablcapoontgi* ia- 
•tetd of two an<l n halt, and unt- intlrad of onr and k half, etc. Matt«ee HM}' bv 
■Md In tba iwnir nraotmts ut milk iiugAr. 



282 



lyFXXT FEEDtya 



In fat indigestion the baby should be put on skim milii mixtures 
and the fat perceutage gradually increased, always keeping well io- 
side the liiutt of toleraiKC Aimlhrr suggestion is to use akim milk to 
which washed butter has been added ; some of the futty acids being 
soluble ill water are thus removed. We have had no experience with, 
this method. 

Children getting Ich) tittle Kugar usually are slow in (gaining If 
too much U uivi'ii and a sugar intoicrauco created or if thf child is 
Unable 10 utilize sugar in auy quantity, as many are not, especially 
after diarrheal di-sturbaiices, food low in sugar may be given. Omit- 
ting or lessening the Kugnr in many case;; is nuflicient. In severe 
eases vasein or eiweiss milk may be used as a corrcetive (see same). 
It IK only a temporary expedient and not suited for prolonged use. 
Buttermilk iu these cases is often of great ser^'ice. 

If th(> protein is too low the i^hild does not gain, or even loses. 
Protein indigestion or intolerance varies in degree. Many times it 
is only for raw milk proteins and boiling the milk relieves the eondi- 
tion. The addition of alkalis to prevent clotting in the stomach or 
to inhibit gastric digestion entirely may be tried, or whey proteins 
may be more largely used or tbe milk may be peptonized (panereat- 
i«ed). 

Sometimes intolerance for cow's milk exists and some other food 
must be used. Cases of intolerance when> tbe infants digestion bai 
not been disturbed by faulty feeding arc rare, but intolerance due lo 
unfortunate methods are common. Temporary feeding with con- 
densed milk, with or without barley or soy flour or both, is most use-, 
ful. Mammala or malted milk may be of service or malt soup prepara- 
tions m&y be tried. 

Alkalis such as lime water, etc., may generally be dispensed with, 
but are useful in certain cases. Fresh fruit juice, as orauge juice, 
is a valuable adjunct to the infant's diet, and apparently supplie* 
something necessary for growth iu some cases. Purees of greeu 
veuetabies in small quantities (one <|uarter to two teaspoonf uls ) may 
also start tlie growth in a baby who is at a standstill. 

Laboratory Heeding. In cities the best substitute for breast-feed- 
ing is furnished by milk laboratories, where uiodilieations are made 
according to the physician's prescription. The Walker-Gordon lab- 
oratories, now established in many cities, supply an ideally clean 
milk, unsterilized. pasteurized, or sterilized at any temperature de- 
sired. The milk is supplied in nursing- bottles, eaeh bottle holding 
enough for one feeding and being ready for use. Iteyond warming 
the bottle nud putting on a nipple uu furtlier preparation is ncccssarj". 
In winter the milk is delivered in baskets, and in summer in small 
refrigerators. When economy must be practised, the milk may hi 
obtained in larger jars and divided into the requisite number of feed- 
ings by tbe mother or nurse. Blank forms on which to write 



MILK itODIFiCATlOK 



283 



scriptioDS are fumUhed ph^'siciatu. 
such a prescription: 



The following is an example of 



WALKKIt-tiORDON LABORATORIES 



F*T» 



(ftj CABSo-HTPKA-na 



Lactoac (Milk 5u8«7) 
MAlt««e (.Malt Sumir) 
SucroK {Vmoo Suaitr) 
Dextrou (Griipv ^ugsr) 
SUroh 



DCXTBIKIZE 

''•-HSlTn 

PinoiiZE . 

Sowm CiTRA-reJ ^ "l fi"' ""f* "<»" 
1 % of lout mittiirp 

I % Di tuial DitxUiri* . . . 

] % of total Rii.itur« . . ... 
I-ACTioAciDj To inhibit the eaprophytM 
Racii i.L-s 1 of f«nn«itiitlon -■-■■■••■ 

Oni FR I>DRCDIENTX , 



B«tt at- 



Nttmber of Vcedingt— 

AaoUBt at Mch Fn%liiij{- 



OROEKED FOR 



Per Ornt. 



ADDRESS- 
DATE 



K. D. 



Tben prescriptions are filled at the laboratory by mixing together 
millc, cream, standard sugar soltitions, and water in the proper propor- 
iUiUA. lu some ea£«s a 16 per cent, grav'ity cream is us«d, and in 
others a 20 per eenl. centrifugal cream. Other things being equal, it 
IB more desirable on theoretic grounds to use gravity cre-am. 

The following table sliows a aerim of formube of varying strength: 













Bcp«rml«l Prot«d«. 




Pki. 


Sucar. 


Protoidi. 




Whey. 




04Mln. 


V<^ Fovmulu 1, 


I«0 


4.00 


D.S5 


or 


rtun 


eiwl 


005 


n. 


1.00 


.100 


50 


H 


(k4& 


X 


0.05 


III. 


1.50 


sm 


0.T5 


U 


70 


« 


O.Wl 


IV. 


1 iiO 


«00 


1 04) 


.< 


085 


** 


016 


IMium ForraulM V. 


s.oo 


6.00 


1 on 


or 


0.85 


and 


0.15 


VI. 


s.»o 


flOO 


1.25 


■a 


OBO 


•t 


0.4A 


VII. 


3.00 


s.00 


1.50 


II 


OM 


14 


a«5 


vni. 


S.00 


6.00 


IJO 


•. 


0.60 


■* 


1.00 



284 



ryFAjrr peedtxo 



Stri>ni; Formuta* IX. 


3,50 


7.00 


1. 75 


X. 


3.30 


7.01) 


2.00 


XL 


3.«« 


7.00 


2.25 


XTl 


3.50 


7.00 


2.A9 


XIII. 


4.0O 


6.00 


3.00 


XIV. 


4, (lit 


4 75 


a.an (Whole Miik)^ 




For It i^niull iir it ili'licuLi' t-liiM ox uni> with feeble clig<?-i^ii<iii, small quanlilies and 
tlie H'l'fikiT fomiulns arc ndiist-fl. 

Tlii-w riiiiKiiji>rutiutih rutlii'i' tliKii Lhi! ngi- of the child ahauld (IvU'raitnii Che (or- 
mtila 1x1 Im? itxi'il, 

Tliv HirpanLt^d protelda are cflpecinlly rei^ommeiidtKl for all the weak (onuuUa, 

liiri'i'iitly otlirr iiHxIiKi-iitionK have been lUHde by means of whey. 
The u'he^ is obtained bj,* adding rciuiin to the milk, or Fairchild'>t 
Essence of Pepsin may be used. It should be heated to 150" F. for 
five minutes before being added to the milk mixture, in order to 
de^ruy the euzyme in the milk and so prevent cna^uktion of the 
casein. When whey is ordered, the protein constituent is indicated 
in the prescription, for example, an follows: 



Caa^in ... 
Lactalbiimin 



o.sa 

0.75 



Rot(ih ^vea the following furmulte, sbowint; the proportions of 
«i'h(>y and eiutcin hr » guide for fcitdin^ hfalthy infants where it is 
thought desirable to split the proteins: 



I 











Protrliu ir 
apllt. 


h 


St 


ft 














•s^ 


■33 


sK 








^o 


J*t> 






i 


e 


1^ 


rs 


^S 




i 


1 




>^3 




|1 


^3 


Pmailurv . . 


1.00 
I.M 


4.00 
tfiO 


0.2* 

0.2.'> 


0.2S 

0,50 


0.25 
0-2C 


}*-* 


MJ 


24-18 


At l«rm .... 


too 


^Wl 


0.bO 


0.50 


0.2S 


1 


K 


10 


&>d of iA vrtik . 


2.S0 


5lG0 


aM 


0.50 


0.2ft 


n 


2 


10 


Ektul of Sd wpck . 


S.00 


6.00 


0.7 & 


0.76 


0.26 


3 


2 


9 


End of 4il) week . 


3.50 


6.60 


1.00 


0.75 


0.W 


S< 


2 


e 


EtidnrStb wM-k ■ 


4.00 


7.00 


1.00 


O.flU 


0.60 


3 


2 


7 


£n<) of Kelt ohIc . 


1.00 


"00 


l.SS 


0.90 


0.76 


3* 


2 


7 


End of I'iili wpck 


4.00 


7.00 


1.60 


0.90 


l.DO 


4 


2 


6 


End or4(h iiKinih 


4,00 


7.00 


i.ba 


0.75 


1.26 


*i 


Z 


6 



NurK.— Hic nb(ivt> tonnuJat are BomevliaL iLlgliiiT In lat ihui uriinarll}' usod at 
pre««it. 

In moet co»eH whey mixtures are unnecessary. In aouti- illness or 
when there is decided lowering i>f the protein digestive power they 
may be of yreat service. Accorduig Xu Grulee.' the albumin content 
of whey varies with the kimi of rennet used. Thr mon- perfect 
ihe curdling of The casein, the mure deKirable is the whey for feeding 
infants. 



■ ArchitcK <if IVdiatrioK, Junp, 1004. 




MtLK ilODtflCATIOS 



235 



The following tat>le, from Botch, gives tbe pomibiUtles of inicb 
DiodidcBtioD in the milk laboratory' : 



m. 


Cbmib. 


LmUI- 


Oofu 


Wmi. 


CBMla. 


LMtel 


SlVH 


1^ 


0.25 


O.^fi 


4"! 


iM 


o.u 


I).5U 


4-7 


Lta 


O^Sfi 


0.50 


*-7 


:!.S0 


o.as 


0.75 


4-7 


IjOO 


O.SS 


0.7S 


♦-■ 


■i.50 


0.50 


OJW 


4-7 


1.00 


0.80 


0.25 


4-7 


■±M 


0.3O 


lt.7B 


4-7 


IjOO 


OJKI 


0.M 


4-7 


i.76 


025 


0.25 


4-7 


IjOO 


o.sn 


0.T5 


4-7 


2.76 


0-2.'i 


0.5O 


4-; 


IM 


0.2S 


025 


4-7 


^75 


0.25 


0.75 


4-7 


\M 


0.S& 


OtSO 


4-7 


2.75 


0.M 


OAO 


4-7 


IM 


OSS 


OTG 


4-7 


2 75 


0.50 


0.75 


4-7 


IJUt 


OJiO 


0.25 


4-7 


300 


U.2S 


0.25 


4^7 


IM 


O.S0 


O.A<^ 


4-7 


:ioo 


a.ii 


0.60 


4-7 


iM 


O.S0 


0.7« 


4-7 


3W 


085 


0.75 


4-7 


•MO 


0.25 


0.26 


4-7 


arxi 


0.S0 


OJiS 


4-7 


AM 


0.25 


0.50 


4-7 


:ioo 


0.50 


OM 


4-7 


Mo 


»35 


0.75 


4-7 


3.110 


0JH> 


0.79 


4-7 


fIS 


0.00 


OJO 


4-7 


3.M 


0.W - 


OJO 


4-7 


0.00 


0.75 


4-T 


.1 M 


0_2ft 


0.75 


4-7 


ft«l 


0.S6 


0.25 


4-7 


3. so 


0.50 


OJW 


4-7 


£.«S 


0.2fi 


OJO 


4-7 


-1.30 


O.SO 


0.75 


4-7 


&S8 


0£5 


0.75 


1-7 


4.t)0 


a26 


OM 


4-7 


tJU 


0.50 


0.M 


4-7 


4 1W 


0.25 


0,50 


1-7 


MS 


0.S0 


075 


4-7 


4.00 


0S5 


0.75 


4-7 


(fcSB 


0.7S 


0.50 


4-7 


400 


0.50 


l>.25 


4-7 


HSM 


0.75 


0.75 


4-7 


4.00 


0.50 


0.50 


4-7 


isa 


0.25 


025 


4-7 


4.00 


05« 


0,75 


4-7 



In order to obtain satisfactory resalts the suoject of laboratory 
feeding must b« tborougblr studied. The authors have adopted. 
Holt's Rfbcmi' of having weekly report* made on all artificially fed 
infants and on many others. Thcst re|X»rts arc snpiilinJ in blank 
form, in padu, to the mother, who fills out one eaeh week and sends it 
to the ph>'sirian. By this method part of the ri-5ponsibiHty in placed 
on the mother, and the physician is kept informed as to tbe infant's 
condition and needlftw visils are thus ob^ialed. The following ' is a 
qwcimen of .sm-h form : 

t fnm Holt, [Hkmm of Inluivj- and ChildliiMd, p. IM. 



286 



INFANT FEEDING 



t 



r 

o 

I 



1 ^ 






■S 

o 
C5 



as ^ 



3 c 



?- <a e 



I 

09 



^ 









s 

o 

>- 






3 

s 

a 



u 









Si 



§ 



13 






9 



■A 

o 
-*^ 

S 

V 

■■3 












M 



1 1 

s 1 

&3 a 



i 



■a 






MILK UODIFICATWN 



2B7 



Age. 


faeaatmgn. 


ATcngv uuautilj tot 
cue feoaiuit 


NumbM 

or 


InWrral 












(Mdlngi 


*T**T' 




FM. 


8u|iBr. 


FnMlo. 


OoliM* 


OMtili. 


Mlioiiim. 




PranMan i ikhnta 


1.0 


4.0 


0.25 


H 


10 20 


!«-!» 


I'll lions 


1«-U<U7 . . . 


, , 


5.0 


, , 


1-14 


so-u 


4-« 


6-1 " 


M-9lkia,y. . 


2.0 


6.0 


«.M 


14 


45 


10 


2 - 


U«««k .... 


2.5 


e.o 


0.75 


8 


60 


10 


2 


BdoMMtlh . . . 


3.0 


6.0 


1.O0 


3 


90 


9 


2i " 


SttaKMlli . . . 


ao 


tJi 


1.2S 


34 


110 


6 


3 " 


tth luaih . . . 


aa 


7,0 


l.fiO 


4 


126 


7 


S • 


6Ui nontb - 


a.r. 


7.0 


1.75 


6 


leo 


7 


s • 


6ib-iOth luoath . 


4.0 


7.0 


iM) 


7 


220 


ft 


s 


llUi tn<>iiih . 


4.0 


6.0 


2.C0 


8 


200 


b 


4 


mb iDonLb . 


■t.n 


6.0 


3,00 


9 


280 


6 


4 " 


I^tei 


4.0 


^ 


»M 


9 


aoo 


S 


4 



The percentajii' of fat. protein, and .tugar required by an infant 
uf uiy given age must be bonin in mind if one h to uac any metliod 
of percentage feeding. The following schedule will be found useful 
IS an aid lo the memory. The Bgures for intenue<liate ages are easily 

[I calciilal4-<l: 

^H ScAtdule j'vr Avtrage /n/atUf. 

1^" The quantity should be increased half an ounce or an ounce at. a 
titni'. Laler, as the child's ap()erite grows st ruiiger,— that is, when 
be 9t'eni.s dis-saiinfted after hts bottle, — the quality is raised. Tbe Jat 
maj' usually be increased (J.5 per cent, at a time; the sugar, 0.5 to 1 
per veut. at a lime; the proteinK, from 0.1 to 0.25 per cent, at a time. 
Strung, houlthy, large babies re^juire more and richer milk ttiau thoaa 
of frailer eonstitution. 

What hi known &s nursery milk is also s^lpplied. This is from a 
•riftcled herd of cuttle whoae milk contains the fat in very small 
globules. This is said to be more easily digested, espeeiully by weak 
infants. 

Hoti's Percentage Aiiik Method. — Holt has devised two methoda 
of modifying milk which are very useful. The following method at 
first sight looks very complicated, but it is uot, and it penuitj« of great 
Qombers nf reatumabty exact formula?. The firKt step is to obtain 
^H milk eontaJning drtiuiti' amouut.s of fat from 7 per rent, down to 1 
^1 per eent. Ordinarj- market milk from mixed herds averages 4 per 
oent.. milk from Jerseys, and Aldemeys, 5 per cent, or more. 

ruifonn rtsults may be obtained by having patients use milk from 
Dae dairj' or by having them buy milk contJiiniiig a certain percentage 
of fat from milk laboratories. 
For t;<>nvenience the formulic are ealcnloled for 20-ounco mixtures. 

T.-nwT oiUMw of 7 per oral, milk in 20-(w. mixtur* hat o»».tweBtlet)i of 7, or 

OLSi pfT fat. fmt 
Etwy ounce nf U per cent, milk In 20.OC. miitur* iutn an«-twra(ieUi of 8, or 

030 per cent. ttt. 



W FBEDtSO 



Krerj ounce of 5 p«r cent, milk in iO-or. nttxtura hiu on^twantioth of 5. or 

U2& piT oent, fat. 
Every i>uiict- of I [i<^r v*t\l. milk in SO-ox. mixtiir* bus onc-twentietli of 0.03 

iH-f icdti. fat 

Tlie variatiooa in protein and suiiar need not be considered. Four 
per et'ul. milk contains 4.50 per cent, sugar and 3.50 per cent, pro- 
tein, so efli'h uiince uf 4 per evnt. milk in any of the formuLii' in a 
20-oitnce mixture will contain oue-lweutielli or 0.225 per cent, sngar 
and 0,175 per ot-nT. protein. 

Tho lableg frcrni Holt show the variations that may easily be ob- 
tuint'd. To raise the fat witliout the protein, use a milk ot a bigber 
fat p^ffentape. To raiHe the protein and nol The fat. use more ouneea 
o£ the same milk, or even of a weaker nne if need lie. 

Tile iieeotjsary siigur is added, remembering that eiu-h ounec oE milk* 
.sugar by weight in a 20-<nnn*p mixtiirp incroB.'ipt; the sugar .5 per 
cent., or each miiire by vtilniiu- idioiit :i per cent., anil that each level 
tablespoouful in a 20-outiee mi:(turc iocreasea the sugar about 1.75 
per cent. 

These formulre give rathrr low fat percpntages, but otherwise are 
Buffleienlly Haslie lo snil all no(»d»i. Ax a matter of fact, compara- 
tively few variations are renpiired e.\eepl in ditTieult cases. 

Top-milk Method.— The top-milk method consists in using the 
misture of i-ream and milk in ilie upper onL'-tbird or upper one-half 
of a jur of milk that has lieeii allowed to Ktaud for some time. LattT, 
the whole milk may he iiNpd. This mpthnd works aati.'ifiietorily only 
when the milk is iMittb'd >*non after milking, befnrp the cream has 
separated. For those who cannot obtain siieh milk the nccesftary 
mislur>- tif i_Tearo and milk may be made as indicated by the table. 
The lop layer of crram may be removed from the bottled milk with | 
a spooo; the remainder, by means of a small dipper; for this purpose' 
a Chapin milknlipper. which may be obtained at any drug-8lore, will 
he found very useful. Another method i» to use a aiphon. The plan 
of pouring off the upper nne-Ihinl is not nearly so reliable. After 
it has been removed, and before the rei|uired portion is taken out, 
the entire upper one-third or one-half, as th* «ase may be, should 
be tliorou^cbly mixed. 

The following tables jequire no explanation. When desired, the 
percentage of lime-watpr may be incrpa.spd, or it may be replaced by 
Hidium lirearbonatc, I Rrain or more per ounce, if the milk is to be 
boiled. If The quantity required exceeds 20 ouuccs, the smaller sup- 
plementary tables may be used, or the quantity may easily be cal- 
culated by adding an additional one-fourth to each item for 25 ounces, 
or onc.lmlf nioi-e fur liO ounees, etc. 

The sugar may be tiicasured by means of a pill-liox holding exactly 
on ounce, or ver>- conveniently by allowing three level tablespoonfula 
of milk-sugar to the onnce. When oane-sugar is used, two level table- 
spoonfuls is wifRcicnt. Dry meosnre of fiugar is just twice that of 



290 



iSFAyr FEEDma 



The following formulas have been taken from Holt : * 

FmsT Series op Formulas. — Fat to Protein, 3 : 1. 

Primary Formula. — Ten per cent, milk — fat, 10 per cent. ; sagar, 
4.3 per cent.; proteins, 3.3 per cent. Obtained — (1) as upper one- 
third of bottled milk or (2) equal parte of milk and 16 per cent, 
cream. 

Derived formulas, giving quantities for 20-ounce mixtures : 





















Fat 


Sa^ar 


Protein 




















per cant. 


percent. 


pw cent. 




Mi Ik -sugar 


. , 


loz. 
















1. 


Lime-water 




I oz. 


vith 2 oz. 


10 


p.c. 


milk 


. 1.00 


5.50 


0.33 




Water, 


q.a. 


ad. 


20 oz. 
















2. 










" 3 oz. 




it 


a 


. 1..50 


5.50 


0.60 


3. 










" 4 oz. 




It 


li 


. 2.00 


6.00 


0.66 


4. 










" fi oz. 




tt 


tt 


. 2.S0 


e.oo 


0.83 


6. 










" 6 oz. 




(( 


it 


. 3.00 


6.00 


1. 00 


6. 










" 7 oz. 




(( 


it 


. 3.50 


e.60 


1.16 



Tahle Giving in a Condensed Form the QwiMtitiea Vtually Rehired for 
Obtaining the Different Fat-percentages. 

AB0DEF6H I JKLMNO 
I'.ao 1.0 1.G £.0 t.O S.fi S.& S.T5 S.O 3.0 3.0 S.E5 3.5 3.7 4.0 



O.SO 20.0 S0,0 SO.O £6.0 2S.0 S6.0 £8.00 SO.O SS.O 86.0 S8.00 ST.O SS.O 40.0 
n.lO 2.0 S,0 4.0 B.O 8.0 7.(1 H.OO 9.0 JO.O ll.tl IS.OO 18.0 14.0 18.0 



To obtain fat. per 

cent 

For total food, 

ounem 

Take 10 per cent. 

inUk, ounces 

Proteins : The percentage in each case will be one-third fat. 

Sugar: 1 ounce in 20, or 1 tableflpoonful in 8 ounces, giyea 5.5 per cent, ftff tba 
lower and 6.5 for the higher formulae. 

Lime-water : I part to 20 of the food, the average required. 

Wat«r: Sufficient to be added to the foregoing ingredients to bring the total 
to the nimiber of ounces apecified; in part of tbia water the milk-sugar Is dis- 
solved. Barley-water or any other diluent may be added in the same manner. 

Second Series of Fobmuiias — Fat to Protein, 2:1. 

Primary Formula. — Seven per cent, milk — fat, 7 per cent.; sugar, 
4.4 per cent.; protein, 3.5 per cent. Obtained — (1) as upper one- 
half of bottled milk, or (2) by using 3 parts of milk and 1 part of 16 
per cent, cream. 

Derived formulas, giving quantities for 20-ounce mixtures: 



7 p.c. milk 





/Milk 


-suear 


. 1 


02. 






1. 


I Lime-water . . 


. 1 oz. 


with 3 o£. 




1 Water, q.e. ad. 


20 oz. 






2. 


n 






* 




4 oz. 


3. 


li 






I 




5 oz. 


4. 


ti 






t 




6 oz. 


6. 


It 






t 




7 oz. 


6. 


tl 






i 




H oz. 


7, 


li 






1 




fi oz. 


8. 


t< 






t 




10 oz. 




[Milk 


sugar . . 


3 0Z.1 






9. 


Lime-water . . 


1 


OZ. 


u 


12 oz. 



Fat 


Sugar 


Prateic 


per cent. 


per cent. 


per cent. 


. 1.00 


5.50 


0.60 


. 1.40 


5.75 


0.70 


1.75 


6.00 


0.87 


2.10 


6.00 


1.06 


. 2.50 


6.50 


1.25 


2.80 


6.50 


1.40 


3.15 


7.00 


1.66 


. ."i.SO 


7.00 


1.75 



4.00 



7.00 



[ Water, q.a, ad. 20 oz. ) 

1 Diseases of Infancy and Childhood, pp. 189, 191, 192. 



2.00 



MILK MODWlCdTlOy 



291 



Tftblf f/innj) m o Condntatd Fvrm Ikt i/itvntilkt Ltimllii Bcqutred for Ohtoinim^ 
thm l^iQvrrnl Ftt-pen-imtaytJi. 

ABC>U»:t'OHlJKLM 

To obuiD t*x. per (iBi..... 1^ 1.4 I.* i,i i.u *:*» i.th t.tb S.1 »A 9Jt 4.9 tJi 

Vot l4>A] loud ounOH Vil.O sa.» 30.11 3X.a 33.U 3«.UU M.UO tU.OO tU.U 4U.U 44.U ll.O M.O 

Ttkv : |>er («iil. oiilk. ounce*. 3.4 1.0 0.1 8.4 10.0 \9JM lljM 14,00 le.O 10.<l tt.O Si.A 18j0 

To obtAiD th* «xAet f«t-p(^rc*nta^ Ulie 0B6-tlurd the numhcv of nuntM of 
top-inilk tn rt 20-ouD<.'t- mixtur*.' and add 15 to lhi< r^iilU In prai^im Lbia all^t 
«m>r may lixr dinrvt^-iiMliil 

Protcitia: The |M>ri?»nl(Lf;e In naeb ciu« will e<)iuil one-half of lh« (at. 

Sugar: 1 ourKv in lit', or I cvpn tablespoon fill in i* ounr^a. until lli* food 
hproiD's half piilk; nfiiT that I oiiiit'i' in Id, or I ev«ii lalileapoonful in envh 10 
oiiBw« of thp food, nill giv-i> the proppr nmoiinU 

l.iiiii><ivalrr ; L'nutillj- in Ilu- giroiitrtlon of ] [Mrl to in ol tlti> total food. 

Water or othvr ililin'nt: .Sitnicipnt to bp h(Ii)hI Id IIm- forii(i>in|i inKri-tllffita 
to nake tb» total numlier of ouncM apvciAi^i in part of thla the sugar la di»- 
solv«d. 

Third Sekies or Forui'uas — Fat to Protein, 8: 7. 

Primary Formula.— 'Plaxn milk — fal, 5 per oent.: sugar, 4.5 pep 

«ul. ; proteins. 3.5 pi-r rent. 

Derived formulos, giving qiiantitios for SO-onnw mixtnivg: 



fMllk-Miirar ... 1 oz 1 
1.{Une«at«r ... 1«>. ^ 
1 Water, q.- ad. 2*.' ••'■ | 

9 *• •• " 

a •■ •■ >( 

i. 



[ Milk-st^ar ._. )o<] 
5. i Unw-water ... * or. 1 * 
I Water, ii.a. ad. 30oz.J 









r.t 

fnvmnU 


Twr r»nt. 


pM-crak 


1 S OK. 


plain 


milk 


... ijoo 


6.00 


0.87 


S oz. 

8 at. 

in oz. 




(1 


... 150 

. i.no 

... 2.00 


e.00 

0.50 

7. no 


1.00 
1.40 
l,7B 


12 Ok 


u 


« 


... S40 


5.00 


2.10 


14 oc. 

18 K. 


.. 


- 


.. 320 


5.50 
d.£U 


2,S0 
i»0 



TahU tlitfing {fvtmtUia uf le per fxnl. Uilk Hrt/uitrJ for Obtaimng Fomulat 
wilh iligk Fat atnl Loo: I'rulein. 

ABODEFail I JK 

To obtkis f«L |>rr MM. l.« l.« t.O S.i l.U 3.0 U.I) 3.i U.l i.O 1.0 

^P«r loul foitd. OUDCW *'}.*< SO.O aoj) St.Q M.O (7,0 4^.g flO.u tv.» 4<M) •«.« 
T«ka 18 ptf e*Bt. nltk. Oubch t.« S.i> 1.0 t.O 6J) T.D B.U H.O U.u lU.O II.O 
Prolrioa in all nurn will In- onc-lifth tlic (at. 
kx 
r 
ra 
OS 



A I *^t^ But* ■*» «»■■ * ^^im *■ *■■ ■«» tn*«- ■■*•«■ 

Sugar: 1 ev«n tabli-npooulul fur rach 8 auiic<» will ^v« d.S per cent, (or tha 
knrer (onaulaa (A, B, C, ctA.) and (1 pi 



•tc.l. 

lime-nati^ : 



p«r ccDt. for tliR hiyUi^r formulaa iCi U. t, 
I oimr^ (o 20 uiiikin) of t|i« (ovd will k'^'' ^ P*'' cvnt. 

Oraduate Method.— Tbe very simple and usrfiil iipp»- 



Matern. 
rata* known as th« EHtnuis Matvrna Graduate is of great value vhtre 
OHO riiu not seouru iotPJlig^nt udcipcratiou in the homi*. and alito 
vhcrr Uktc are no facilities Cor milii prcparution. ThU mptboi) of 
infant feeding has been tried hy the authors for several years iu rhe 
Robert Garrett Free JlospitiU for Children, lialtiniore. and loo much 
can not be said regarding itJ3 simplicity and efficiency. ^Viih its six 
fnnuiitax, bowi-ver. it is nor adaplalitn to all rases. Kiiine infants being 
tutally int-apable of taking tbc Hlep from one forriiuk to another. 

The appamtns eoiUilHlx at a glassi jnr tcitli a lip and seven panelji, 
aad a rapacity of 16 ounce». One of the panels vxhihitx an ordinary 



392 



JWFAXT FKKDtSa 



ounce graduation; the other six paDelf^ present six different formulas 

for the tnodilicatinr) of ('ows' milk, euvh fonnulii beiug so arranged 

an to ketp pace with the infant's t;rowth, viz.: 

Km . i prr c«nl. ii pvr cent 3 jwr cvnt. 3) per <.-eiiU 4 [Mr Kut. 3^ ]>«r c'cnt. 

ftjMr « - II " « " 7 ■' T " Si 

Pnit«in ....06 •• 0.« " 1 ■• 11 2 ■■ «1 

For Fomula Q Me 8p««iHl iii>itructiuni> below. 



Mflk .... p«r» 
Creain ... ** 
Unwvsur " 
Wnt«r . , ■• 
Hltk-*iiKU 



Si 



Milk .... pnti 

BwteT-trtiel " 
Qr&nulBted lugttr. 

TAtU .... 



s 



53 

-tt 

s 






Having decided which formula is tu be iiited, the panel contaiuing 
that formula is the only one to be followed. 

The qtiajitity tlf-sireil for (wenty-ffinr hours is next to be eonsideretl. 
and the apparutuH JiUcd — («K'e, if 16 nunc(Sj or Irss arc- required for 
the twenty-four hours; twice, if from 16 to :!2 ounces ore reipiired 
for the iwenty-firtir hours; three times, if from 32 to 48 ounees are 
Teqninxl for the twenty-four hours. 

DiREOTIOSS. 
(The linett beneath ihe wurdti indicate the poiuta to which the various 
ingredients m-e to be tilled in.) 

1. Miiir^iiffar. — Introdnce Tiiilk-Kiigar to (he line so mnrked. When* 
Kood mtik-Ku^ur eun mil lie obtained, grniuilaleil sugar, in just half 
the c|iiarility. should be used. A small cross on the apparatus in- 
dieatps thi.s point. See direetions for Formvila 7.1 

2. Water. — Add boiled -wtLtcr ihot) to the water-mark, and stir 
until the 8U};ar is dissolved. If any particles are xeen tlualiuf; in the 
solution, it should be filtered eiUier through absorbent cotton or 
through two ihifkueBses of clean muslin. 

3. time-icaiar.— Ordinary lime-water, sut-h as is obtained at drug- 
stores, should then be tilled to the L-water uiarli. 

4. Cream. — This should be the ordinary <'reani (16-20 per cent.) 
as ohlainird in bottled milk: it should be poured in to thi- cream marh. 
If the cream is purelinwd separately, ordinarj' crcaui, and not centrif- 
Heal rrram should be used. 

:>. MUk. — Ordinary good cows' milk should be uaed and the jar 
filled to the millc mark. 

6. The eniirt* mixture should next be stirred. 

7. The whole jjiould then be poured into separate bottles and steril- 
ized if dpsired, or stoppered with cotton and immediately placed upon 
ice. 




MomncATioy 



298 



I 



Directions for formula 6. — I. Suffar. — In this formola fmmulated 
snRsr slioiUtI bo ubc*d in pliin- of milk-sugar, hikI ttir Htiifar introduced 
iiitu tli« v(«Kcl lo the litj« thibi iiiiirk(Ml. 

2. Burli'ij-yruel. — lu this funiiula 
barli-.v-KTUfl slioiil<l l« uaod instead 
(if water, aud the glass filled to the 
line thiis marked. Barley-gniel 
should bi^ prepared as foHows: To 
1 lableiipnniifitl of p«irl barley, after 
soakiiifi fur strvrral Iioiirs, add 1 pint 
of water, a pinch of salt, and boil 
for tive or mix lioiint, additii? water as 
ueL'csMiry. Strain tbroiigb muslin. 
Or the frtllowinjr method may be used : 
1 miiiuled i.able;tpoonfiil of any good 
barley flour; rub up with cold water, 
and add to 1 pint of hnilin;^ waltT; 

took fur fifteen minutes, stir, and , yv»mer»»» 

strain if lumpy. _ '^- ' ,_ .^ / 

3. Crtttm. 4. Milk. — Add lh(^ »<Anie 
as in other formulas. 

5. .V/iV. 6. Steriilzc. — .Same as in 
oilier furmulaK. 

The DeminK MotlifiLT. — Another ingenious gradunte for obtaining 
perccntnfi^K i>; called the Doming modifier, which has on it the follow- 
iug iuarl(inu:)i: 

OrodyoliDw arui Markinyt. 






Via. 2. — DcininK'n nulk inodilipr. 



FnMm. 






ru. 










CwM 


Vmstt 


Cm If 


Cm 10* 


Milk or 




CwH 


nUkcirT 


aillkoT 


milk at 




mllknr 


ttir Itip 


the up 


Ui«ln|i 


Ibctop 


l:1i«1«p 




wbole 


31 ouiicM 


SOontncM 


16 UUUM* 


11 onnoM 


)aai)«M 




milk. 


(Ton I 
quart. 


IVom 1 
qiiarL 


froml 
quart. 


fratn 1 
qnkH. 


Addi 1 


mpuiM)!. 


qiun. 


I*rrl. 


PcrrU 


Trt fi. 


Fta-p.i. 


Pcret 


Pcret. 


PMrt. 


2.8 


3.A 


4.4 


S.2 


6.0 


8.8 


ia4 


2.0 


32 


4.0 


4H 


fi.(t 


6j0 


9.7 


iA 


3-0 


»7 


4& 


8,2 


7.5 


9.0 


2.2 


2.7 


3A 


4.0 


4.8 


&8 


8.2 


2.0 


2JV 


.<t,0 


8.7 


4.4 


<J.2 


7.6 


1.8 


22 


2.S 


S.S 


3.0 


&.0 


6.7 


1.0 


2.0 


2,& 


5.0 


S.& 


«.o 


6.0 


14 


1,7 


2.S 


2.6 


3.0 


4.3 


«.S 


1.2 


1.6 


lis 


23 


2.8 


3.7 


4.S 


1.0 


1,2 


1.5 


1^8 


S.2 


ai 


3.7 


.80 


1.0 


1.2 


I.S 


1,7 


2J» 


3.0 


.00 


.75 


M 


l-I 


1.3 


iji 


2.2 


— .« 


no 


.62 


.75 


.(» 


13 


1.6 


.20 


.■r. 


.ao 


.3$ 


.44 


•68 


.74 



IVFAliT FBEDHfG 

DniETiOKtt. — ruur H-Iu'lc tnitk nr ui{> milk u|i to denlreil |WTC«nta};<^ nf protoina. 
Thni add ^rui-l nr wulor tu U)|> line, lliii' inuki.-s lij oiiiivcts. llii.' tup luilkA are 
h> b« removrd from 1 'iiiuiit «t milk nflrr the (^ri-iim tiaa rittrn. 

1 k'vi-J ti>bli-9|ioiin(iiI oi itriuiutaUiI nuijaf ^Sj pvr cent. 

S Icvi'l ta-blt-Hpc'ijiifult' of grnuulutvO, «U)fnT :^ & per c«iit> 

1^ li'vi'l t>likujKH)]ift)la (•( niilk-i>U|!ar := S^ pvr ■■■.■iil. 

S Icvi'l Uklikipuoiifitln of mlll:-Hii}!iir =ira |>i'r cent. 
To nild 5 fwr rent. »( IlmowntiT li-wvc f.tii 1 ,\\iotv at grarl or water «n<l roplac* 
witli liiii«-wal<>r. To niaki> ti ouniva. pvtit milk up to onihhaU dtHii'(.-d porc-cutagn 
of iiruleiu aiul iidd i/ruel or water to d-ouni'e linw. Cm one-lialf ifiuntity ol 
■unr. 

Tn aict^rtahi wliai milk to iioe In ulilaiii aii> devlrml ■■uoiliiTiiiii«n ■<( |>n>lrin aiid 
fut, pirk i»iit tlio (liiiirrd prxLi'tiLiiXf of priitrin« in Die pmteiri column. Tbm 
lliiive ill H hori'iiitlHi liw Hi ihv right iiiitil tlie iknirril ]i<-(icnt]i)ri.> of fat la foojiil. 
The liniiliiijE of llir ftit r-iliiinn nhi>w** whnt milk In iiw, The ji^rceiitape iif augar 
ill tlip iliiutcd niiik i» ikluK^t v^aHly the teniae a* ttic pcrcciita^'c of |iri>tt'iiJ. 

Mayndrd Lndd's Table.'— Anothi.'r method of modifyingr milk is 
[•OQorxlinfr to JIaynard L.add"s table. In tbi« the ([uaiititins havp been 
pstimiitfd. TliLs method is useful in hospitals whcrr tiiere is a milk 
liiboratm-y- In peiiepal praiMice if is of slight valiir, for it nceossitatps 
mpmoriztiiK' a Irnetliy tuble, »r carr>-ing it. about, both of which 
nicttiods nrc open xa objection. 



PMMrfptiOm rtttt-j 

Inclbraiiilixm' 
oTilB m&oaa. 



Cfttm in ounce*. 



1 

CM 

6.;& 

1.00 
1.40 
S.W) 
2.00 

AM 
3.00 

a.00 

SLfiO 

tan 
&» 
iM 

4.00 
400 
4.00 
4.00 
4.00 
4.00 
4.00 
400 



AM 
5.00 
4.00 
(kOO 

aso 

U.00 

aov 

fLOO 

aoo 

6M 
0.M 
7.00 
7.00 
7.00 
7.00 
7.00 
7.00 
7.00 
7.00 
6.00 
A.00 
&00 



3 K s 



X 



Vtit-Tree milk in nnncc* 
usud with cfouua of— 



11: 



6 



3 



14 



1 Takni from Rotch'a PnJiatrlcs. 

(■I ImlicktfH that thp mm liinnliim ■» jmpoiwible uitJi tb^ pertvntagv of eraan 
flvon. 



MtLK ilODiriVWTION 



396 



Baner's Method. — -Many ailempte have beco made from timt' to 
time tu ciimpiitp a talile of equalious from wIul-Ii llie quantities o£ 
milk, cream, etc.. may be d«tcrmiuixl for any givco mature; the 
simplest of ttn-'He is that of Bauer: * 

Quantity detured 0" uhomm) =9, 

Ui-Hiri^ |H'iTi-ntji|^> of (at ^ F. 

Dn>iTe<il pi-Trentaife of aiipr =z 8. 

DmitMl pi-r<trnUig« of prottin = J*. 
Td find in oiincra — 



Cream (Ifl per oeiiL) 
Millc 

W«t*T 

Dr3r mUk-iiugnr 






■c. 



_ (ft — n X 



Example. — Hii|ipoKi> it is deHired to make 40 0UDL<e3 nf a 4 per cent, 
fat, 7 per vent, nugar. 2 per cent. pn)tein mixture. By substituting 
the figures in the criuatjons above we have — 



Cr«ua 



40 



X 2 = 6) ounece. 



.61 = 13^ ounce*. 



Sugar = 



= JO — 20 = 20 QIUII.-BB. 
5X_lrt. 



■ — 2 ounces. 



Technic of Modifying Milk at Home. — To insure success Ln home 
modification a ver>' careful technic must be followed by the mother 
or ihe nune. In tlie aljKcm-i! of a nurse !i]>L>cially trained for the 
purpose it bffomra iiecwsaary for the physician to yivc careful written 
and verbal instructions, and thon to see pentoiinlly that the^e are 
carried out. Knowledj^ on the part nf the mother or uurae should 
not be assumed, for, aa a rule, she does not poaaesa it. There are 
many nurses, both graduate and otherwise, wlioee ennt^eptions of in- 
fajic feedinir and milk preparation are practically useless. Like many 
medical students and recent gradviates. they understand more about 
lapamtomim than tliey do about milk. If this In borne in mtnd, many 
unplraHant experiences may be avoided. 

The vpssei.*; and instruments used Rhould be kept scrupulously clean, 
and be used solely for the purpose intended. After use. or, what is 
dccid^lly bettor, just prcvioua to bcini; used, they should be either 
boUt^d or scalded with boiling water, preferably the former. 

The nursing-bottles should have rounded bottoms, so that there 
are nn eornerH for holding dirt, and also that they ean not be stood 
about tiie room. If only one or two bottleet are ukmI, they ahould be 

t Xew York Blediiral Journml. March IS, IBM. 



£36 



txiTAAT rxsbam 



««U«d aflM- r*<.-b f«Mfiac ttd fikd eitber with boric acid or sodium 
lu<«rboi»tr suhitMMi. wtait by addmir • ttssiHXmfui of cither dru^ 
to « pint at vkt«r. Wh«i <kr betlW eg to be used agiiiii. the solutiou 
should b«> puumi out and tbe bottir riasrd with plnin stvrile wdier. 

Tbe uipplft» sb^mld be vt the ardui«r>- short bl«ckrubb«r variety. 
White nipples, wbh'h arr said to coniuii Wd, as w«ll ax all cotn- 
pUratcd uippln and tubes, should be avoided. These Ulter eau not 
\*if k«pt clean, antl arc a wurw of infection in diarrh«a. In some 
cities their sale is prohibii«l by liiw. .\ftpr each feeding the nipple 
ahotild Ite washed, tumini: it inside out to do this thomushly, and 
then placed in a glass of borio acid solution (3j;0.ji. It is a good 
plan to have several nipples on band end to boil them before usiug 
them for the first time, and then for five niiniite« every day. The hole 
or boU-s in the nipple shnnld be juxt larpe eiimiL'h to allow the milk 
to dnip out Eionicwhat rapidly. II should not How out in a stream. 
If the holes are too small, they may be enlarged or tien- ones made by 
ttsing a red hot darning-needle. Some nipplett arc made without botes, 
and these may be perforated in the same manner. When several 
holes are so made in a nipple, the milk may not drop very fast, but 
the food reaches the child rapidly eiiniieh. a fnct that may easily be 
demouiitrated if the nipple is grasped between the fingers and sucking 
niDveniontH Imitated. 

Preparation. — It is best to prepare the entire quajitity for twcnty- 
fmir honrs ut one time. If the weather is warm, the milk muRt be 
l*a«teiirized or sterilized immediately (see sceliun on Milk) unless the 
weather is cold and a clean mitk con be obtained. 

If the top-milk method is ii-M-d. the milk should he received in 
bottles. In all cities there arc reliable dairies that supply milk in 
bottles. 'Where this is not the ca.se, the bottles should be furnished 
the milkman, and arrungenieiitK iran generally be made by which the 
milk will be poured into them as soon as posiiibtc after milking. 
After the milk has stood for at least tlve hours, the lirst ounce of 
ciTBui may U- removed with a spoon iiud the remainder of the upper 
one-third nr one-half, as the ease may he, with a Chapiu milk-dipper. 
Another mrthcpd is to use u bent gla.ss tnbe and siphon off the lower 
part of the milk from the bottom of the bottle, or the top-milk may 
be poured off with reasonable acenracy. 

The physician should always write out the quantities to be used 
for preparini: the milk. The milk- or cane-sugar is dissolved in hot 
water. Care should be taken to use a sugar that gives a clear solution 
without filterint:. If the solution is not clear, however, it should be 
filtered tbniugh a wad of eotton placed in the bolTom of a funnel or 
thmtiiih a piece of dnigirist's HltiT-papcr. This itoliition, together 
with the linip-woter or sodium bicarbonate, .should be poured into a 
pitcher. Into this the milk, or milk and eream. should be poured. 
and the remainder of the water added. The water should always be 




UILK ilODirU'ATlOX 



297 



boiled. The mixtarv aliould then be slirrnt and poured into \he 
iiiirsiiig-bottlcs. llio bottle!> libgulij then bv stoppered with moder- 
alel.v tijihX plu^ ol' nou-absurbiMil cottou, to keep out bacteria. The 
bottles are then I'astcuruted or sterilised and piaucd iii a refrijierator, 
At Ibe fiwiliiig hour the bottle is takeu out of the refrigerator, 
placed ill & pitcher or tall vessel of hot water to warm it. Ihe cotton 
plug removed, and a nipple substituted. The milk jshonld be healed 
until it is lukcwnrtn — about 9S°-99'' F. The nipple shonid never be 
placed in thr mimlh to test the heat, but the milk may be allowed to 
drop on the wrist, where it should feel warm, but not hot. 

OTHER FOODS FOB mFANTS 

The following foods may be of service in some condilioos and may 
be briefly considered : 

Condensed Milk. — This is ninst nwful in many caRcs an a tem- 
porary rspi'dit-nt. It may b«' used to great advanla'ic in certain 
(liflBeult eases, espeeislly those which hRve Iteen impropi>r1y fed on 
too hi(rh fat and protein mi^ture.^ ft is also useful at times in 
infants who are not gaininp, and when the failure to gain is the only 
symplnra. .\s a teiiiporarj- feeding when pure niilU cannot be ob- 
tained, ait in traveling, it may be used to advantage. 

We (wneraHy use it in dilulioiiK of 1 in 16, I in 12, or 1 in 8— 
occasionally ns hi(;h as 1 in fi. It should bo measured in a measuring 
glass, olhrrwise too mnrli will be nsrd. It may l>r diluted with plain 
boiled water or, if desired, with n thin eereal t»ruel. 

Cream may be added later or olive oil may be fiveu in additioa. 
Orange-iuice should always be given every other day or every day 
iLs ftn antiseorbiitic. If eondenKCil milk feeding is continued ton long, 
anemia, srnrvcy, or ricketH is liublo to devcloi). if not that, tiie child 
be^-omes large and ttabby. but with stnnll bones and muN'les and but 
little resistance to infeetinas. 

Condeoiied milk furuisheii about 100 calories per ounce. In tbe 
dilntiouK ba ordinarily used it eontaiuti the following percenta^'eu: 

r«liW "»»■ """■ '""«■ 

Fat 166 I.SS 0.S3 0.«2 

Pmiein ; l.ail 1 1:2 0.73 O.M 

SiiHur 8.83 II 63 4A I 3.3 1 

CaloriM per ounre apprcninuU..*. KOO 12.8 8.5 tA 

Buttermilk. — For many years buttermilk has been uiwd in Holland 
for infant feeding, and of recent years it hits been extensively used 
iu various countries. It has several advantages, chief of which are 
that it contains a low fal- and Hu^arH-nnteii I and also lactic-acid 
bacilli in lartrer numbers. The curd of the milk is precipitated in 
small flakes. It is easily di^'ested by most infants and may be diluted 



298 



WWAT FEBDI\0 



with water or vereul gruels as cWsired. Sugar uia.v be added, if de< 
sired, as to any milk imxtiirtK. Jii cases where the digeutive faculties 
have be^*!! iiupain-d by I'l'i-diii^ mixtures coiituiiiin)^ too miiL-h fat 
it seeiiiit lo be of cspeoiut value. It is al&u ver>' useful in diarrheal 
sffefIiQU&, especially those in whieb abuoruial bacteria have fotiod 
their way iuto the mtestine. The laetic-acid bacilli drives out mast 
of the other iuieetinal bacteria. Id intestinal indiiicstioa it is oftea 
of preat value. 

The buttertiiilk is best kept and the mixtures made just before they 
are used. 

Acid Milks. — These are extensively used, and are whole milk, to 
which various strains of lactic-ai-id bacilli have been added. These 
tnilks are Rold under various iittiUL-);, »iid often other food siilixtatteeH 
are incorporated, ^ueh acid milk eontains fat in the proporCiou 
as ordinarily found in cows* milk, and iu some cases may not be as 
desirable as buttermilk, In other eases where a very nutritious food 
is Jieeded they wre nf srrcflt value. In intestinal indigestion acid 
milk is particularly u^teful. and it in also of ser\'ice in the convales- 
cence from diarrheal diseases. It should be diluted to meet the 
individual case. It is a good plan to atart with rather weak mix- 
til r PH. 

KumiKS and other feriaented milks are sometimes of iiite in i-ery 
difficult casp.'t. 

Albumin Milk.— This is a mixture sugtreoted by Pinkelstein under 
the name of Biweiiis Milch, and has al^io been called protrin milk. 
This food is prepared as follows: Heat one (piart of whole milk to 
100° P., add four teaspoon fuls of es.sence of pepsin, and stir. Then 
let the mixture stand at 100° F. until the curd has formed. Put the 
mass iu a liuen cloth and strain the whey from the curd. Remove 
the ciii-d from the cloth and press it through a line sieve two or tliree 
times, using a wwden mallet or spoon. While doing this one pint 
of water should be adde^). The precipitate should be very tinely 
divided and the mixtui-c should look like milk. To this one pint 
of buttermilk is added. The buttermilk contains little sugar and has 
the advantage of i.-ontaining lactic acid. The composition of albumin 
milk is as follows : 



Fat .... 

Sutcmr . 

Salta 



Z^ pvt mit. 

SO 

I..-. 

D,5 



One liter or quart furnishes about 370 calories. To obtain good 
resalu from this milk it must be used in a certain way. In the 
beginning it must not be mixed with any other form of food, not 
even human milk The infant shoidd be starved or given a "tea 
diet" Small amountJi of albumin milk are given, and if all goes 



ittlK UODtFICATlOX 



299 



well, larccr and larger amounts. The ureeo. loose, bad stools should 
quii'kl.v triiaiige to soap xiooN. and Uii-n some form of carbohydrate 
(ji(nikl bt' added to iiKTuiific tlif caloric value of the food. Malt 
sutfar i:* usually addM, bcginninir «iih I jwr ueiit., wh'wh in sometimes 
added from the beginuiiig. iioiuc of the loixturea of nudtofie and 
dextrin may be used instead. 

There is an initial lowi af weifjbt, ourinF; to the low ealorie value 
of the food, then a stationary weight, and when the carbobydrnte is 
added there should be a pain. T<>o Ioii|k' a period should uot elapse 
between beniuninir the milk and adding llie carbohydrate. The dex- 
tri-nialtose may be added up to 5 per cent., and if there is no gain, 
2 per cent, of some eereal tlotir may be added. 

Albumin milk w a very valuable addition to the armamentarium 
of the pediatric ill u. It is difficult to malfe. and for this reaaoii can- 
not alw8>'s lie UNcd in thi> cases where it would do the mtMt good. A 
full account by lle»« will be foiuul in Ihr American Journal of the 
Diseases of Children. December, 1911, vol ii.. p. 422. 

For those who cannot afford casein milk Reuben siipcreKts the fol- 
lowing: Add two junltet tablets to a pint oE milk. After standinic 
for one-half hour strain, discard the whey and rub the eurd throuph 
a fine sieve topether with a pint of milk and then add enough plain 
boiled water to make one tguart. The whoU mixture is then brought 
to R Iwil with constant stirriui* and is then ready for use. This has 
nearly the value of ciiHcin. but lacks the aeidity, a point whieb does 
not seem to l»e essential. 

Albumin milk furnishes a food hiiih in protein, but apparently 
this docs not harm the infant during the short perio<l that it is 
taken, but helps make up the previous loss. The euluric value is low 
and there may be a loss of weight, but not at the expense of the 
body protein. The total acidity, the volatile and fatty acids of the 
stools are decreased and the amount of water lust through the bowel 
is lessened while mineral salts are retained tiettcr. There is an in- 
ereaiw in the fornistiuti of soap with a tendeney to fewer and less 
irritating movements. The food shonld only be used for short periods 
as a corrective of di^estiou or nutritional dititurbances. 

It is indicated iu diarrheal di^^eases and indigestion and various 
fonuH of nutritional disturbances, as marasmus, and where the toler- 
ance for sugar, fut. or salts has been disturbed. 

Dry preparations to be mixed with milk have been manufactured 
'to take the place of casein milk. These are known as ealeium-casein 
or Larosan. The preparation of the mixture is as follon's: 

In almnt !^ of a pint of milk dissolve % ounce of casein-calcium 
milk; in the meantime heat % ()f a pint of milk, mix the cold solution 
of eaaein-caleium milk with the hot milk, boil the whole five minutes. 
Btirrine constantly; this makes a smooth homo^neous mixture of 



300 IJiFAVT FEEDING 

thin cream consistency ; to this add one pint of boiled water or cereal 
decoction. 

This has the following composition: protein 3.4 per cent., fat, 1.7 
per cent., sugar, 2.2 per cent., PjOb, .12 per cent., CaO, .13 per cent. 
It is to be used like casein luilk and dextromaltose added in the same 
way after the first few days. 

Mammaia. — A dried milk made by the Hatmaker process and 
marketed under various names in different countries, is a useful food 
in infants with weak ditrestions and especially when coupled with 
ability to retain but small quantities. It is also useful in travelii^ 
and after digestive disturbances and during convalescence, and where 
cows' milk cannot be digested as ordinarily given. It is said to have 
a value of 127 calories per ounce, or about 4.2 calories per gram 
and a heaping teiispoonful weighs about 5 grams. Its approximate 
composition is said to be : 

Protein 24 per cent. 

Butter fat 12 ' " 

Milk sugar 54 " " 

Milk aaltB 5 " " 

Moisture 5 " 

100 per cent. 

One heaping teaspoonful to each ounce of water for the smaller 
babies and somewhat more for the larger ones will usually suffice. 
It is better to weigh the powder and measure the water. In very 
hot weather give somewhat more water or if there is constipation, 
orange-juice should be given daily or once or twice a week. 

The label contains the following suggestions as to quantities: 

Cubic No. ot No. or 

GrsiDH centi- heapiog teupoon* Total 

ot melrea of teaspoon- tills ot Vo. ot Quantity 

PERIOD. MAMMALA Warm fuLs ot Warin PrrdiacB ot 

Tier WhIt MAM&IALA Water prr day. UAMMALA 

■^^^ FmiliiiK, ppr per per prr daj. 

Feeding. Fenlins. Fpedinf. 

Day of birth — 20 — 4 2 — 

2nd duv .5 30 1 6 R 40 Grama 

3d duv 7 42 I^ 9 8 56 " 

4th dav 8 48 U 10 8 84 " 

oth day U 54 2 11 8 72 

While the baby's weight 

is lesf thau 7 pounds.. 11 66 2 13 8 88 " 
While the baby's weight 

IB between ; 

7 and 8 pounds 12 72 2i II 8 96 " 

8 ■' !) ■■ 13 73 2i la 8 104 

9 ■■ 10 ■■ I.-. 90 3 18 8 120 

10 ■' 11 '■ 17 102 31- 20 8 136 " 

11 '■ 12 " 1» 114 4 23 8 162 

W ■' 13 " 24 144 3 2!l 7 168 

IS " 14 25 130 5 3U 7 175 " 



MILK UOOrFlCATIOS 



801 



FEBIOD. 



V.altu Ma. if Nqi. M 

Oranii ri'nil' hvaflOK IfmIhwII- 

of mclri-i si ('•■(joaii (uU al Ho. of 

UAHMALA Wbtiu tula at Wmrm rwdilMt 

[.w WkUr MAMSULA 1V«I«- ptfdaj. 



PowUdc. 



S4 " 3ft 



I'M 

I.M) 
liSO 
ISO 
105 
ITA 
!80 
200 
2A0 



!«■ 



I*' 



Pi'*4int. rt*4lnK. 



MAHUALA 

|Hrd<}. 



Gelntin. — In chronic intestinal Uifeotions, aoroiiipniii<xl with fooil 
decomposition. ^Intin is sometimes of great benefit. Some of the 
putrefactive onraiiismB will not erow on erlatin. One ounce, which 
yields about 120 c«lori(?s. mny be (riven to a child in twenty-four hours. 
It may lie mixed with milk or civeu an a jelly. Sugar-fre* milk will 
be fomiil to tie useful with (Iiifi. 

Standardized <iru«ls.— Chapin has Hug^sted iiKing gnietii of defi- 
niti- Hlren^h, so that oiiv may know the value of food givt'n hh gruel, 
and also the pereentaires of the various elements. He detenniQCd 
that the weight of the various meaKures of different cereals were as 
follows : 

1 levfl tab)p.<tpoanful of peftrl liarky veiirhH 1 ounce avoirdupois. 



batlrv fl<»ur 






vtiMt flwir 






rollnl «ata 






>«iirl lutrli'V 










wlipat fli^Hr 


- 




Txillod ontu 


>d 





1 ouiic^ dipwr of 
I " 

I U II 

The percNitage of various food components in gruels will be found 
to he approximately as follows: 





Pnrl hsrivf . 

f ' 

i 


BtHf>T flour 

i 


WlMt. 

1 


Rdl 

1^ ■ 


Mtwto. 


^^^ 




i 


— ^ S 

2 


■P 


1 


|l 




|i 


3 
1 


11 


13 

1 


m 

1^ 




0* 


u 


« 


%j 


I-» 


w 


^ 


u 


1 oi. to •luarl . . 


. U.I4 


1.31 


0.1 VJ 


2.003 


0.331 


S.lfll 


0.202 


1.6«9 


i o/e. to <iit«rt . 


. «.S8 


2M 


0.3110 


4.l9e 


0.682 


4.»22 


0.324 


3.339 


a •■ - . 




- • * 


0565 


8.279 


U.VUS 


«.«83 


0.71}» 


5007 


J .. H 




^ , 


».7«) 


8 372 


in* 


»M* 


1.049 


8.076 


ft •• - . 






o-n:s 


in.M5 


l(t5.A 


I0.80& 


1.310 


8J43 


t " •' . 






I.I7U 


1U.»S4 


I.DH6 


MMW 


1-572 


10 014 


7 " - , 




. . . 


i.-ies 


14.051 


2.317 


10.127 


1.1134 


11. (»3 


t " 




, . 


1 .IBO 


16.7W 


2.(1-1 It 


17 .289 


2.0IW 


13-332 



Plain gruels cannot be wade much stronger than 2 ounces to the 
<iuarl. 



302 



IV FIST FEBl>IXa 



Dextriuized grueJs may be made up to as high as 8 oimoea to the 
quart. 

Another infthod is lo use cereal flours. The percentageH furnished 
by these fluurs will be foiuid uader the beading of Faruiaecous Gruels 
in the first part of this volume. The cereal flours are. us h rule, verj- 
much better, as they make a sniouther gruel and rciiiiirc miirh Icaa 
cookiug. Iifteen to twenty minutes giving as smisfaetory ii gruel as 
iKjiling rice or barley grains for three or four hours. The cereal 
gruels arc virry nneful iu modifyiug milk, and tliey may also be used 
alone in various diK^asteK of the Ktomueli ami iut(?stine. As they gen- 
erally do not caiisr fermentation they arc ut great value in some formii 
of diarrhea. 

Oalnieiil is of iiw in constipation, and the others are of value in 
diarrheas. Otrn-meal gniels arp vahudilr in the undt'rfeil. 

The cereal flours contain about 100 calories to the ounee, and the 
underfeeding which occurs when a thin gruel is used is very ap- 
parent. 

The Soy Bean, — In certain conditions the soy bean (see same and 
Diabetes) is of great value. In eases when niilk is badly borne, in 
certain forms of intestinal disorders, in diarrhea, and especially in 
the ennvaleitt-enee after diarrhea, in eyrtain eases of marMsmim and 
in malnutrition, the soy beau Hour, properly used, is of great value. 

Kaeh ounce contains ly grams, prnlcin and 120 calories, 

rToWin. F«1, Sumr. Cnloiira. 

Per pent. Pit mdI. PiTH-ni. P«r««]tt. 

i ounce. 1 l«v«l ubl««ponfu) to quart ... <i.^^ 0.15 0.08 30 

J ■• 2 '■ UUk-iitMiifulii •■ .... 0.70 0.30 O.lfi 60 

I " 3 •■ '■ . . - l-ll 46 0,23 90 

1 ounce to quart 1.4 U'BO U.30 120 

2 oiirnvM lu '|U«rt 2.N0 120 tl.60 -^40 

3 " " 4.20 1 «o 00 am 

4 " " ft.GO 2.-»0 1.20 480 

6 - " 7.U0 3.00 1,50 800 

6 •• " 8.40 3 00 1.S0 720 

7 " " 9.80 4 20 2.10 »10 

8 " *• 1 1.00 4.80 i 40 !HW 

A fpiart of gruel is luade by boiling from 1 level tablespoonfiil to 
6 ounces of the soy f;ruel in 1 ipiart of water for fifteen minutes, 
adding water to make up for loss by evaporation. Salt should be 
added to tastr. 

The-M' gruels do not thicken during cooking, ns they eontaiu no 
gtareh, and readily settle on atamling. This may be overcome by 
adding I to 2 heaping teaapoonfuls of barley, out or wheat gruel 
flour before cooking, which will a<ld 0.8 per cent, to 1.2 per cent. 
Ktareb to the gruels, and also slightly increase the percentage of 
protein. 

A good standard gruel, whieh may Ite diluted as desired, may be 
made by ueiug t ounce of soy bean Sour. 2 ounces of barley flour, to 



I 




UtlK aODTFtCATWy 

a quart of wat«r. This will roDtoin 2 per cent, protein. 0.60 per 
cent, fat, and 5.10 per cent, varbohj'drate. with a caloric value of 
320 calories or 10 ualories per ounce. This is just half tbe value of 
milk. It lufly be Ciirtbcr increased by addiuy an ouul-c of augar, 
wbieh brings it up lu about 4^0, and the yolk of one eg^ will add 
56 ca]ori4>8 more, or oream maj* be added, each ounce increaftiog tbe 
food vjtliie about *i0 calorieH. About one nunite and a hnlf of this 
to uurh pound of \\w. babies' weight wtii about (v>%'tT Ihc caloric needs 
of the baby. "Without the eream or egg it will require about four 
ounces per pound of body-weiKht. As this is more than can be 
piven to advantage it should be remembered that tbe Hoy imiei should 
not be kept up unless the food-value i« euhnneed. This may oft«u be 
douo tu adviuitaL'c by adding condensed milk or cows' milk to the 
gruel. This standard gniel, or a weaker one, may be »se<l to dilute 
milk to advantajre in cusr^ of maraxmuN. The infantii' stools should 
be somewhat brownish in color, like maltod-milk Ktoole. If tiic gruels 
are used too strone to betnn with, the stools will be foul smelling 
and ^nemlly thin. Tht- bran should be wiihdrawu and barley or 
other cereal jrrttels given, and when the bean is added again it should 
be done gradnally. Edsall and Miller have experimented with a 
bean flour, in which the starch im pmli^cslcd by meanii of a diastnsic 
ferment. They have found it useful in digestive disturbances and 
malnutrition. 

Vegetable Broths. — Merj- reeommends the use of the following 
vegetable broth as a subMitute for milk after gastro-enteritis: 

Potattm , fOiiruiia. 

Cwrot* „ 45 '• 

Turnip« 16 •■ 

Driml pros t ■* 

Dried iMau 6 " 

Water 1000 " 

Boil in a covered earthen pot for four hours, strain and add water 
to make 1 liter, and 5 frrHiiis uf xalt. 

Vegetable Purees. — In iufauts who are not gaining and in caaea 
of coiiKtipatiou and in some other nutritinnal (lislurtmiices. an well as 
for the healthy infant, we have found the following vegetable puree 
to be of great value: 

A mixture is made of any sort of vegetable available — potatoes, 
carrots, beets, turnips, gretns of any kind — in fact any vegetable 
whatever except thosw that are highly flavored or contain anmiatieo. 
Xaturally radishes, onions, green peppent, cucumlM-rs and the like 
should not be thought of in this couuectioa. The vegetable so selected 
shoidd be thornuifhiy washed and then cut up or chopped into fimal] 
pieces not larecr than a (piarter of an inch in diameter, and if a good 
mill is at hand they may he run through that to advantage. Thoy 
are then covered with siitHcient water and placed on the stove and 
allowed to cook very thoroughly. Additional water may be added 



304 



mFAyr FEEDrta 



from time to time and the 8urfai:« ttkimmed as may be nsaeBs&ry. 
The water in which the veyrtablies are wiokeiJ Ls to ht? utilized ami 
euro Khouid he tHki;u thut it ts nut tlirowii away. The luutcriat in 
then passed thnuigh a i^ievo and all th(> coiifko particles discarded 
and, if nece-ssary, tht^ rcMilting amss cciok(.'d again uDlit it is as thick 
aa au ordiDary thick soup. This, io a sterile vessel placed iti Uie 
ice box, keeps very well, aud from oue-qiiarler to a tablespooiiful may 
be iispd accordinK t" IhL- age of the child aud the nature of the dis- 
turbaiic« for which it is giveu. It may be added to milk or to broths 
or served over ciTealw. 

Olive Oil.— This is most useful where creaia disagrees aud where 
it is imperative to supply nourishment. It is snmptitne-s of service 
in constipation in thin infants. From oiie to four I<'as.pooaful8 may 
be given daily. We begin with <inr-ftiiart(T tcaspoonfn! once or twioC 
a day after feeding, and increase one dose a day until this amount 
is given after every feeding. It may then be increased to half a 
teaspoonful at a dose if thoueht advisable. One-quarter to one-half 
oiiiive a day is as much a.s it is adviKnble to use in young iiifaats. 
Older ones may take aomowhut more. Olive oil furoishos 245.5 
calories per ounee by volume. 

Homogenized Oil JMixtures-^By tising a maeWne which drives 
oilti or mixtnrrs containing them through a finn agate valve against a 
pressure of from 3000 to 5000 poundx to the square ineh emulsions 
of oils may be ohtained that are hnmoeeneous. that is, they will not 
separate on standing. Ladd has used olive oil aud milk mixtures 
treated in this way with considerable sii«cww in infant feetfing. The 
ver>- finely divided oil being more easily digested than the coarser 
emulsions. 

Malted Milk.— This is valuable food in certain eonditions. It 
may be nsed temporarily when pure milk cannot be obtained and in 
traveling. 

In some digestive disturbanees it is also useful. It may aUo be 
added to milk mixtures. 

The composition of Horliek's malted milk is — 

Fkt» 878 

Protein ItJU 

Dextrin IMO 

iMctotn! uni nifilt«ae 49.16 

iTulal Botiible cartxdirdnttM 67 AS.) 

Inarjrnnlr mUa S-M 

Moistiir* 3.0fl 

It is low in fats and high in ."(Ugars. Per ounce dry it has a food- 
value of about 127 L-alorieH. One ounce in B ounces of water makes 
a mixtiirp containing approximately 1 per eent. fat, 2 per eent. pro- 
tein, and 8.5 per cent, sugar. The caloric needs of the infant are 
easily covered in the solutions ordinarily used, but for continuous 
□se has much the same objections as condensed milk. If nsed over 




MfLK MODinCATlOy 



305 



eoDsidcrable p«riocU, orange-juive or otfa«r fresh fruit-juice must be 
given. Btid fiit cither as cream or olive oil. When cream or olive oil 
it) piveu a little less milk may generally be u»ed. 

Mmlt Soups. — The ideH (if uaiun mailed foods wmb iirst published 
by Liebig in JSW. He eudeavored tu prepnrc a food that should be 
chemically and physiotogicalty eorn'et. Keilt-r in 1898 modified the 
Liebic formula, and hi» method was an fnUon-K: itfi gnuus (2 ounces) 
of wheat flour to ',^ liter, (11 ouaces) of milk, n-ith constant stirring. 
Ill a iteL'ond vmsel ]00 grams of malt-Mnip extract or malt extract, 
with the addition of 10 c.e. (2':; dramsj of a 30 per cent, solutiou 
of potassium carbonate, are dissolved in % liter (20 ounces) water 
at 120' K. The mixtnreit are then mixed aud boiled for three or five 
minutes. This is said to contain — 



Proteifl 

Fat 

t'arbotiy(lr)it« 



(ii3alto») 



t Mr ctiit. 
1-2 
12 \ 



The calorie value i» 808 calories per liter, or somewhat more than 
either mothers' or row's" milk, 

Thi)> luMy be diUiU-d witli water as desired, and approximately the 
same dilutions as made with cows' milk may be used. Cream may be 
added if desired, but. as a matlcr of fact, the eases in whi4>h the food 
is indicated do not. an a ndc, iH'iir tlir nddiliori nf much fat. 

A preparation of maltose uud potassium curbunuic. LoefUiitd's 
mail-noup extract, 'm much used, a^ it simpliliuii the meusuriu^. 
Any ihick mult citract with the pota»iium carbouute (not bicarbonate) 
may U- used. The bicarbonate is liable t<i cauw vomiting. Maltose 
often causes diarrhea, and the tlnur added nsutilly countcniclit this. 

Dry malt soup stock may also be had and this siuiplitics the prepa- 
ration of umlt soup mixtures. 

Malted Uruels. — Mailed ^niela are advocated by some, especially 
in pn'paring milk for infants with weak diftetition. They are pre- 
pared in the following manner: A tablespounful of barley flour or 
of any other flour desired is boiie<l in a tittle nioi-e than a pint of 
water for lifleen minutes. As mon as it hnA cooled a teasponnful of 
a ^Hxl malt extract or a tcaapoonful of diii^taM- is added. This mix- 
ture i* stirre<l thorou(tbly. and may then be usetl in tbc place of 
ordinary' Imrlcy-water. niastase preparation!<. are made by moKt of 
the leading manufacturing chemi»tii. Diastoid. made by the Hrm of 
Ilorlock. maltine. aud diazyme are preparaliouH of this class. The 
thick malt cxtracta are sometimes piveii to infants just before a 
fetylinc Of these, several doses may be given daily for indigestion 
aud cuufttipaliou. 

Cbapin su^ests that a home-made decoction of nu)1t be use<l in 

makini* malted inruel. IIih directions are or fnllnwR: "A tahlenpoon- 

ful of matted barley graiii-s itt put in a cup. and enough eold water 

added to cover it — usuallv two tablespoonfuh; — as the matt quicklv 

9» 



309 



INFAJIT rsEDisa 



absorbs somp of the water. This is prepared Id the evening and plu<.>ed 
in a refrigerator overiiighl. lu th« moruiug Ilie water, luokiug like 
thin lea, is rctnnvcd with u spiiuii ur skiuiiuod off, and is ready for 
Ufto. About a tablespooiiful of this solnlion oaii be secured and is 
ver>' aeli%'c in diastase. It is suffiricnt to dextriniic a pint of grufl 
in lea to fifteen uiiuutee. This should be prepared fresh every 
day." 

FEEDINO DimiNG THE SECOND YEAA 

During the srcnnd year "f life tis min'li cure is rctiiiired in feeding 
as durinjT the first. The fear of the sceond summer would largely 
be nvereome it the child were not allowed to eat fond unsnited to its 
digeatioii. The fact that some chiUlrpn thrive on almnHt any kind 
of food in no (>XL'tiH(! fur portiiittin^r a cliild to liave the same food 
ua ita elder!!, bn is so ofti^n done. MoKt of ttie illness und many of 
ftfa< deaths of childhood are traceable to improper diet. 

During the set-oiid ypjir luiik should form the baKis of the diet. 
In citit-s or wlu-n; the- milk-^tupply is not alfove tjuspicioii, it is best 
to Pasteurize the milk iintiE the second snmmtT hns bi'eii passpd, or 
even tong^r if circumstHnepa warrant. As a ride, the milk reiiuJrcs 
but little nioditieation, and after the thirteenth moiilh, and often 
befory, may generally ht? taken untiioditied. As the ehild is uow able 
to digest starchy food, milk-sugar may be omitted. In casea where 
the milk is not thoroughly digested, as t.'! evidenced by curds in the 
RtooK 1 imc-watier may lie ust^d, and may be added in f|uan1itiRg of 
from 5 to 10 per tH*nt., or cveu more if neeesMary. If the milk is very 
rich, it should be diluted eithfr with liine-wntcr or usutdly with plain 
sterile water — three parts of milk to one of water. If the milk is 
ptK>r, or if milk ibat ia not rich does not agree with the child, it may 
be prepared au follows: Fill a glass three -quarters full of milk, add 
one or two table^pooiifids of cream, and fill to the top with plain 
water. If thin doe*; not answer, add a lablespoonful of lime-water. 
During illnc»t and often under other cireunistjnices t\iv nDcaliue car- 
bonated waters will he found useful for diluting the milk. If the 
milk ia poor, another plan ia to use the upjier two-thirds of the 
milk. 

!:>tar<,'hy food may be yiveii in the form of gruel, cither alone or, 
what is better, mixed with the milk. Barlcy-giniel or. if there is a 
lendeney to constipation, OKtmcal-gnicl is added, one-fifth or one- 
fourth part of gruel being added to oaeli feeding. The gruel should 
[be freshly prepared and mixed immediately with the milk. A pinch 
[of salt and a ven,- «mall qimntity of cane-sugar may be added to 
-tender it more palatable. It may then be Paateurixed. like urdinar}* 
milk. 

During the swond year thrro to fivp meals should be given. Thp 
bottle ahould be dispensed with, and tlie food be taken from a cup or 



FBEDiyO DCSIS'O TBE BBCOyO TliAli 



307 



Bpoou. If tlic botllc is utit takeu from the t-Iiild early, it may be 
diAivult to break it of the bottle habit. The foUowiug diet-listtt for 
(lifferi-til a^:eii will be fviitiil iiitfful : 

Twelve to Fifteen Mouthn.- Fwjds AU«wed. Milk and dishi-s mnde 
out. of rnilk. If whole milk does not agref, it niuy b« boiUsl, diluted 
with a cereal water or barley water, or diluted with plaiu water or 
lime-water. Ruttcnnilk, kumiw, and similar preparaliuiix uiay be 
given, if desired, iu place of milk, .hiiiket and curd. Malted milk or 
dried milk (Mniumalni. Creiiiii and butter. 

Cereals, Always well troiikcd, ak oatmeal, erai'ked wheat, cream 
of wheat, wheatena, riee. farina, commeal mtisb. hominy, small 
hominy, arrowroot, eomstareh. 

Bread stiilTs, as very ntale bread, toast, zwieback, or craekers. 
These may lie given dry or witli milk. 

VefKtablcs. Carrots. asparaiECUs tops, cauliilower tops tincly maKhed, 
baked or mnghed potato, spinach, peas or string beans put through 
a sieve or finely milled. 

t'niil Juice. Orange julee. strained apple sauce, or prune juice. 

BmthK. Chiekeii. beef, or mutton brolh!^ with uereal in it, or 
thickened with flour. 

Coddled egg once or twice a week. 

If the child wakes early, either the orange jiiiw or milk. A bn-ak- 
fosi of ('<>n-al and milk or toaat and milk; in tbr middle tif tlie mMriiiiig 
a cup nf milk and cracker, if desired. .\t dinner an egg, or a cup of 
broth with a piece of zwieback or toast, and milk after it to satisfy 
the appetite. At supper, milk or, if very huntrry, a tittle cereal 
and milk. At 10 o'clock a bottle may oecanionally be used to ad- 
vantage. 

First MeaL On waking the child should receive a cupful af warm 
milk, modified as previously su^gestetl. If the child is aecustonied 
to waking very early, more milk may be given at about 7 a.m.; 
otherwise this last may be reganlcd as the first mcHl. 

Second Meal, 10::10 .i. m. Eit^ht oumwx of warm milk and barley 
gru^'l. 

Third Mfui, 2 p. m. One of the following*: 

(a) eight ounces <a cupful i of beef broth. 

(b) eight ounces la cupful ^ of veal broth. 

(e) eight ounces (a cupful) of mutton broth. 
((1) eijfbi ounces {a cupful) of cbieken broth. 
(el Yolk of a liehtty b(»ile<l egg with Ktale bread crumbs. 
Fourth ileal, n r. u. Eight ounces of milk und barley irnicl. 
Fifth Meal, IM p. m. if re<miredi. Eight ounces of milk. 
Orange juice, one or two lableMpoonfuls at a time, may be given 
one hour before the 10::iO a.m. feeding. If there is a tendency 
> loose howels this -ihwuld be omitted. 
If the child's appetite is very good a small piece of zwieback maj 



30$ 



ISFAyT rSBOISQ 



be given with either the srcrmd or fdurtli inctil. This should not be 
soaked in the milk, but the child should be allowed to nibble at it 
drj'. 

Sometiinc-s shorter inten-als are usfd, especially in fthildreo who 
are iindprwu'ifjiht, or who haw bcL'n underfed. The following is a 
sample dint : 

Dki list for Child Twelve to Fifteen Months: 

5 A.M. Orangp juit*, 1 to 2 oz.. if awake; if not. give to child 
some tiin4' ilurinp I hi* tweiity-four hours. 

7 \. M. Milk, K nz. Qiuintity vHried if nhild is aiek. In cane of 
vomiting. Icwrn i|ii«ntit.v, or even omit one feedintr. 

9 .\. w. Farina or cream of whent or strained oatnienl, I to 2 table- 
HpootifulK. (Strain oatmeal through niwlinm -sized sieve,) 

11 A.M. Milk. H ox. Iteforc midday nap. 

1 p. M. Yolk (if soft lioiled epR with bread<'ruiubs ; vustard. 

4 P.M. Straiiieil priitiea: milk. 6 ox. (Boil prunes and strain 
thmngh medium tiizcd sieve.) 

7 I'. M. Milk, H oz. 

(:\11 thrse i|iiaiitiiies must be varied if the child is aiekt gradually 
increjisincr the amount hh the vbild gets well until the asumiit for a 
normal child is attained.) 

A rhild this agi- will take 10 1o 12 oz. of water during- the twenty- 
four hours, betw^'en feedini^s. 

Fifttfii to Eujhiftn Months. — Same as above, together with zwie- 
back, stale bread (oven-dried 1 ; whole eggH very soft bolted; strained 
oatmeal, bart«y or wheat porridge; bread and milki thin biscuit 
(crai-kerst: jiiuket, custards and cornstarch puddiiiys: .scraped raw 
beef or mutton in stry small quantities, meat run through a mill; 
butler Mild iiMvi' nil, wliit'h iiuiy be given wilh meals if more fats are 
dcHircd in the diet: a-spara^us lips, mashed (-■unlitiowcr topK, strained 
puree of peas. 

A tiamplc Difi for n ChiM of Fiftrrn to Eighteen ^fonths. — Break- 
fast, 7 A. a. Kithrr la i two tablcKpofiiifuls of » cereal jelly luatmeal 
or other grain as desired), with salt and two tablespODnfuU of eream, 
and eicht ounces of milk lo drink; or (b) a bowl of bread and milk 
containing eight onncea of milk and a slice of stale bread. 

Second Meal. 10:30 a.m. Milk, with a cracker or tliin slice of 
stale bread or a pieee of zwieback. 

Thrtl Mrat, 2 p.m. One of the following: (a) very soft boiled 
egg with stale breail crunilw. (b i Kight ounces of broth (beef. veal, 
mutton or chicken ). «'ith stale bread enimbs or a little barley added 
to it. (v) A tableKpoonfnl of mashed or baked potato with meat bmth 
or gravy (one to two ounces'i. or wilh two tableHpociiif u l.s of eream. 
Milk to drink, (d) Scraped raw beef or mntt«n, two to three table* 
spoonfuls on a "banquet wafer" wilh a eiip of milk. A tablespoon- 
ful of junket may be added to any of these. Supper. f>: 30 nr 6 v. u. 
Eight ouiieeK of milk with u piece of zwieback, a slice of stale bread. 




FEEDIXQ DCStSa TBB SSCOyO YK.iR 



309 



nr a cracker or tvo. Fifth Meal, 10 v. u. ( if needed). Cup of milk. 

Fruit juice may be given um prcvitmaiy directed. EggH should 
not be giveu oftciit-r than twice a week, as children tin- of them 
easi ly. 

Eighteentk to Twenty-yourlh JUontA.— Add to the above purees 
ruu thniugh a sieve or made of carefully milled vejti^tableK. These 
may be made out of fresh or dried peas, tclery. or corn and the like. 
lloDiiuy may be Riven. Tapioca, sago, scraped raw apple, ripe raw 
peach. Male lady-lln^nt. Increase the meat in quantity, but oul^' 
once a day. See that the child hax somclhinK to chew on. crnstK of 
bread and the like. End the meal with a little fruit and not the 
sweet. 

Tko to Two and One-Half Years. — Milk 1o be regarded as the 
chief article of diet. Many children have no deKire for other foods 
until the second or third year. Thew children will generally be found 
to thrive on milk alone or with sliKlit ndditions to the diet. As the 
cbitd'a difnslive power inereaseii, the following articleti may, how- 
ever, be added one at a time : 

Fruit: juice of ripe fresh fruit, that of oranges and peaches being 
best. Ripe frcNh ^rapi>s skinned and seeded. Baked apple — pulp 
only, the »kiu and .scwIh to be carefully removed. Stewed pnine«, the 
skins to be removed by paiwing through a Hieve. 

Meats: serap«'d raw beef or mutton; rare roast beef or mutton 
pounded to a pulp. Chicken or turkey, the lean white meat minced 
to a pnlp. 

Vegetables ; mashed baked potato witli cream or covered with gravy 
from rotax meats. If the latter ij? 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 top»; any vegetable that can 
be pnt Ihrouyh a sieve, «h tender carrots, limn hcatiK or peas. 

Cereals : Well boiled rice and other well cooked cereals, already 
mentioned. 

DeHserti;: Imiled emitard, milk and rice pnddingn, junket. 

Four mrals will ucniTHlly suffice after the ei^rlili-eiith month. The 
followiuu <ltetary will serve as a nuggcKtion : 

If the child wakcH early, a cupful of warm miUt Csix ouncea). 

Breakfast, 7 a.m. (a) four tablespoonfuls of oatmeal porridge or 
other cereal with salt and two tableN])ocinfuls of cn-am. milk to drink, 
(b) Yolk of a lightly boiled egg with sidl and brcHtl broken into it, 
milk to drink. 

8eco»d Meal, 10:30 a. u. Cup of milk with two soda biscuits 
(crackeiw), slice of bread or a piece of zwieback. 

Dinntr. 2 p. M. One of the following: (a) a bowl (eight ounces) 
of meat broth with riee, barley or bread erumbs Jidiletl to it. Slice 
of stale bread; junket or rice and milk pudding, (b) Tablc^ixKinful 
of white meat of chicken or rare beef or mutton, either scraped or 
pounded to a pnlp. Slice of stale bread thinly buttered ; junket, rice 



310 



tsFAyr FEEDiya 



aud milk pudding, or a boiled ciiKtard. (c) Perfectly fresh boiled 
&»h (white meat) with & tablespoon fill of mivjlicd buked potato moLst- 
cncd with i^rcam, Dessen as iii tin? prewdiiig. 

Suppfr, 5 -MO or 6 i*. st. A bowl of bread and milk or a cup of milk 
aud a slice of bread or a piece of zwieback. A cup of milk may be 
piveu aT about Hi i-. m. if iiei^aisari,'. 

From two and oiir-lialf years up to tlir sixth yeur tbe diet of tbe 
ehild may gradually be increased. Milk should still, however, be 
takp-n in lar^'p ipiaiiiilies — about a ciuart daily — as well as some form 
of cereal for brcakfaht. with or without an egLi, or fresh fniit if there 
iaatendeney >•> ismslipalioii. Meat prepared aii above Khould be nivou 
onee a day. aiiH pn'feriibly at the midday meal, together with potato 
(uid iiome Kri'eu veiretable. as spinach, asparagus, or caulitlower tops. 
The ovening meat slioiild be light, und eoiiKiKt of bread and milk. 

It is wi'II tci prei)Brr two llsl.s. wldeh may be giveji to the nurse or 
mother a« a jjiiide. One list should eontain the food allowed, and the 
other list those forbidden. It is not well to depend on verbal instruc- 
tions, as lliey are easily forgotten or mifloonstnied. 

The Ditt from Two and Onf-kalf to Six- YeoTs.^Milk may be al- 
lowed with every meal (may be omitted from dinner if desired). 
The average ehild shrrnld take a <niart a day. plain or. when plain 
milk in not ihorouybly dig'esled, niodilied ax fi>r twelve to fifteen 
months. If the other foods are not taken well the quantity of milk 
con often be redueed to advantage. 

Cream. — Two to eight ounces a day mixed with the milk, taken as 
a beverage, with cereals, etc. 

Brftul and biscuit may be allowed with every meal— stale bread, 
dried bread. The so-called "pulled bread." zwieback, luid the various 
forms of biseuilK or craekerH. 

Cerenls. — AIuiiikI any kind of cereal for breakfast; oatmeal and 
wheateii griLs are the best. Rico and hominy for dinner. Barley is 
Ufiefal in MHips. 

Vftictablrs may be allowed for di niier— potatoes in some form or a 
ocrcal with one green vegetable: spinach, cauUdower tops, and the 
like arc the be»l. 

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. 

M«ci. — Allowed once a day for dinner and in older children for 
breakfasl (wcasionally. Boiled or broiled fish may be given for break- 
faat or diiiiuT. 

Bmths and smtps of simple composition may be eaten. Meat brwths 
with eream and cereals are especially uutritiouti. 

Desserts. — Once a day. with dinner, Plain eustanl, milk and rice 
pudding, bread and cUKtaiil pudding, and junket arc the be*it; ice- 
cream once a week. Fruit should be given once daily, and only ripe 




FBEDtSti DURIXQ TOE SBCOSD YEAR 



m 



fretih fruit, in season, lUiould be u»cd. The best are oningeK. baked 
IppU-H, aiid stew«d primes. Ripe peavhes, pears, grapes witliout skins 
For seeds, may also Ix* Biveii. Frestli juice of berries in shihII quniUity, 
gtrawberries in pi^rfcct condition sparinKly. Ripe cantaloupe and 
vratcrmcion in moderate quaiitlties may also be allowed. Urcut care 
slioukl be used in ehootung and giving fniit to children. It is a very 
in)|iorljint miiole of diet, but if stale, spoiled or unripe, is capable of 
doin^ miifh harm. Too much )«liould Dot b« given in hot weatber. 
Lenionadi- ik uxefnl during very but weather. 

AccoRDi.sfi TO Meals. — lireakfasl — Every day, milk to drink. A 
veJl^^mketl cereal, with salt and cream, hut little or no sugar. Bread 
and butter. 

In addition to the above, one of the following every day: Kgg» 
ti^tly boiled, poached, and for older children serainhled or mada 
into a plain omelette. Boiled or broiled Hah. For older children a 
verj' Utile Hnely; eboppwl beef, mutluii ehop. or beefsteak. For 
youiigi^r cbildren meat at breakfast in not. as n rule. ne«essar>'. Fruit 
may be given before or after breakfast, during the latter part of the 
morning, or at almut noun. One variety daily, and if there ia a 
rial ti-ndrnrv to (•«n.stii>alion, stewed pnines or baked applra may 

allowed with the dinner, hut not on the days on which they have 
been used earlier. Oranirrs, baked apples, stowed pninrs, peache-s. 
pears, grapes without seeds or skius: ripe apples (the softer varieties 
niay be given: ihiitte known by dealers as "hard" appleH are not 
litable uaed raw ) . 

Dinner. — ^Bread and butter as desired evert- day — not to be eaten to 
the ex<'liwion of other foods. bow«\'er. 

One soup each day. Bouillon, beef, veal, mutton, chicken, or oyster 
broth, which may be thickened with barley or other oereaU (eiAar 
grain or flour i. Milk and en-am may be added where desirable. 

Otw mtat rfai/y— roasted or broiled. Beefsteak, beef, lamb or mut- 
ton ehop, rare roast beef or mutton, chicbeji, white meat of roast 
turiicy. 

Two vegetablts daily— one green vegetable and one other diah, 
^ttsnatly potato in some form, should be given. Potatneu, baked or 
bed. cauliflower topa, a«parai^is-tipa, stewed celery, spinach, 
hominy, plain maearoni, mashed peas, young string-beans, and almost 
any green veKCtable in season. 

Dea$tri. — Junket is the best, and may be given most frequently, but 
irtee and milk pudding, plain custard, and plain tapioea pudding may 
. abo be Used in small quantities. Ice-cream ouce a week. Fruit in 
some cases may be used. 

Supptr. — Very light simple suppers should be given errery flay. 
JUlk, milb-toafit. cereals, bread and but1«r, aJid. for older children, a 
little stewed fruit or baked api>Io, without too mueh sugar 

AsncLEB FnRBlDD&N (after Uott).— The following article* should 



312 



tSFAyT FBEDTSa 



not be allowed uhildren under four years of ajje, and with few excep- 
tions tbey way be withheld willi Hdvanttivi' up to the seventh year. 

Meats. — llam. sausage, pork iti all I'orms, suited tish, eorued be«f. 
dried beef, gooHe, game, kidney, liver, bacon, meat-stews, aud dressing 
from roasted meat!>. 

Vtgflabhs. — B'ried vegetables of all varieties, eabbage, potatoes (ex- 
ivpl when hniled or rua&ted\ raw ut fried onions, raw celery, radishes, 
lettuce, eucumbers, tomatoes traw or cookedj, beets, egg-plant, and 
green corn. 

Bread and Cake. — All hot bread and mils: biickwheM and all other 
griddie-eakos; all sweet eakes, partieularly Ibose containing dried 
fruits and those heavily frosted. 

Desserts. — All nuts, candies, pies, tarts, and pastry of every descrip- 
tion: alao salads, jellies, syrups, and preserveti. 

Dritiks.^—Tfii. L'nffec. wine. U-er. and eider. 

Fruits. — All dripd, canned, and preserved fruits; all fmite out of 
seaiKm and stale fruits, particularly in summer. 

The meals should be given at tixed hours, which practice should be 
strielly adhered to. Feeding between meals, even when eonKisting of 
the most trifling thing's, should be avoided. If the child can not go 
from one meal to another without di!«:omfort. the intervals should be 
shortened. In certain cases it may he advisable to give a small cup of 
milk or broth and a cracker between the meals, at stated intervals, as 
in feeding younger children. 

randies, cake, and the like should be kept from young children. 
In well-rcsridHled humes, if he once IcuriLs Uiat he can not havf them, 
the child will soon cease to demand sweets. The frequent indulgeneo 
in sweets of various kinds creates a desire for Ihem to the exclnsiou 
of the other food. This craving is analogous to that for alcohol ia 
adults. Overindulgence in sweets causes indigestion, headache, and 
the like, ailmeiitM that may easily he prevented. 

The child should he taught to eat slowly aud to chew the food well. 
To this end, stane nhier individual should always be present al meal- 
limes to Hcc thill sufhcient. time he taken for the meal, and that the 
food be finely dividiMS, as young children do not, as a rule, rhew very 
well. The quantity given to a healthy child should depend ou his 
appetite. In sick children this is not a reliable guide, and. where 
pottsible. Hxed amounts may bo given (see Feedmg of Sick Children). 
Tlie child should not be forced to eat, nor should he be given spceial 
articles to tempt the appetite. If the fwtd offered is not taken, il is 
wmII to wait unlil the next meal, when ii 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 
»w>lid and more liquid food. The same is true during sickness. Many 
of the gaslro-intestinal disturbances attributed to teething are the 
result of improper feeding. 



4 




FSEDiya DcnncG tbb sbcovd teak 



313 



The following tables taken from Freeman *■ give the diet after yn« 
year of age: 

put of Uk .'xeond Ytar. 



Att2noi. 



• ^M. 



»-teiu.inaiL 



AIUmm. {eoi.inlIh, 
* ot. gnM(. 

AIMmM. 8«i.mlUE, 



At SI 



S (H. milk, 
bntter. 



Ui-m. 



S-UULUiIk. 
Am. milk. 
tat. nllk. 

8 OK. milk. 



1 r.m. 



4M. Intel, 

B<M. milk, 

aaA-bulled en, 

«M. milk. 

Vi Of. onacv-Jnlce. 

Sotl-bullMl CgK. 
Boi, milk. 
M «. oraon-Jalee, 
BiMd Md butter. 

Coa. pitsar ■oupL 
Vi-1 w. nrapcd 
Iwcf. 

Bnad and trnuci- 



Or.v. 



9 r. ■. 



»-IOoc milk . VIO 0*. mlBt. 
»gi.mllk. 



Aoi milt, 



So*, milk, 
S Dt. ynifl. 



■ ni. villlc. 

« on. frarl, 

Bnwl anil 

Uii(«r. 



• M.nllk. 



■ oLmOk. 



Diet «/ /*« nw !'«»■. 



««.>. 



lOcftnQk, 
toL gmel, 

BkcMl kod tMMter. 



U> A.1I. 



6 ot. milk. 



ir.jt 



Aoc Hoan, 

finwl anil boiler, 

YrgMabUiit 

Dnwrt 



s.as r. «. 



10 M. mtlk. 
6 oa. cnwtl. 
Braaa ■nd butler. 



i>M nfhr the nird Year. 



BnkkbM. 


IHnaer, U-1 P. M. 


Bup1>CT.(ML 


Vnit, 

Oensl, 

HUk, 

Bmj atii] batter, 

1 or 2 ciot»> 


Bmd and bnllcr. 


C^nat, 

Milk, 

fircwJ anJ bulter. 



Dkt and Teeth.— The tendency to decayed teeth is a marked 
fratiirr of mndem life. Diirand and others have found that infnntii 
fed on gwiH'trnitl condfiiNed milk for [K'nuds of nmrc than five months 
show a niueh greater poreoDtuge of dn'iiy than those fed at tlie breast 
or on ctnrs* milk mixtures and he suggests that where eoudeosed 
milk is uttetl for any leiig:1h of time that fruit. ve^table» aiid meata 
properly prepan>d he given to Kitpplfiiifnt tlir diet. It i.<< al^o im- 
portant tn Kivp thp chilli hard foods t<i chew, these aid in enipline 
the teeth and in kecpine them hard and polished. Hard breads, 
bones to gnaw at, bacon rind and later apples and Kalads. At the 

I ArrhiTM n( Pnltatrkia, Jnnr, IWM. 




314 



lATJyr FEEDISO 



end of the meal la placx- of sticky carbuliydrBtos green .salads or fruit 
which have a tfJidcuey to clean the twth. Acid fruits have b«ea 
found tu pruduve a saliva rich in plVHlJii aiul of higher alkalinity 
tbaii blauder foods and tiiifi is of value in preventing decay. 

St£T OF SCHOOL CHILDRE9' 

The period usnally spoken nf us ■'scUool days" is an extremely ac- 
tive one i»hysi<ally. The vast number of metalmlif t-hangea Roiug on 
and the prowlh of the body demand a plviilifiil and a suitable diet. 
Both in AJid out of school and in aeminarics careful attention should 
be pivcn to food, frwh air, and exorcise. In other words, the physical 
dex'elopmcnl slmnhl riTcive as much jtllcntioii as the mental growth. 
In boardinE-schouls especially tlu- diet should be the subject of careful 
study, the aim being to avoid mnnotony and to provide a KufReienf 
and satisfying diet. In many srlmoLs the dietary is left tn Ihe diacre- 
tion of the cook. In eonnidcring school dietaries sevoraE points are 
worthy of consideration. 

Milk, being easily digested in most casca, in of groat value, eapecially 
for children whose nutrition is below normal. It should be furnished 
BK a hevera^i* daily for breakfast and supper, and is advisable even 
with dinner. It uiay also be used in the preparation of puddings and 
BoupBL. Cream is very valuable, and whenever possible should be 
supplied in snilirieul ((unnliticK. A cup of warm milk with bread or 
craekoR is helpful during the middle of the morning and as a xub- 
stitute for tea. in llie aftenioou. DHicale children and other.s may 
with advantage take a gla&ti 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. 

E^'gs may be used alone or in llie preparation of various diuhra. 
They may be used in almost any way except fried. Fried eggs are 
apt to be very indigestible. They are ofteu prepareil in tide way 
in order to disguiae the slide taste of an egg that has been in storage 
for some time. 

Meat in. a very important part of the diet, aa it contains a larger 
quantity of pmlrin, from which the tissues are built up, and in a 
more available form, than in any other form of food. Milk and eggs 
arc also valuable sources of protein. Meat should be provided, there- 
fore, in sufficient quantities, half pound a day being, perhaps, a good 
average allowance for a growing boy, the larKcr and more robixst tak- 
ing thai quantity or more, the smaller and more delicate children 
taking somewhat less. Steak, chops, atul ruttsts of beef, mutton, lamb, 
fowl, and bacon are the most suitable meats, although pork, together 
with meat stewn, meat puddiniiK, sausagi". and hashes, may be allowed 
in fonaller quantities. The.se last, while generally relished, are not 
so digestible nor sueb good sources of nutriment as those lirsl named. 
With care and proper preparation many of their ill effects can be 
obviated. 31ore meat is required in wioter than in souimer, and more 




DIET OF ecaOOL VIUt.URES 



315 



in <-ol<l L-limales thau in warm. V«o states that too much meat vaay 
(five ri.sf l<i i-i*/.eina. 

Meat iuH> l>t' given iwm- a duv. and c^^ or frtsib tiKh may be Hub- 
stitiited for il about thro« tiuies u week. When these do uot satisfy 
tbi' appi'titc. meat may be added. For this purpose cold sliced meat 
is UM't'ul. 

Bread and butter Hhiiidd \\c ffivrn with each mral. Bread made 
from tile whole-wbcat Mour may be used in the largest quantity, but 
it is well to Huppiy various kiuds of bread, to avoid monotony. 
"Brown bread" given contiiuKniRly becomes very tiresome. Rye 
bread may be given oeeasioually, and bread iiiflile fnim mislures of 
wheat and i->'e is very p)d»t«ble. Rusk, biseuil. and crackers may 
also be supplied. Coru-bread. when properly made, may be given 
onee ■ week or oftpner, and griddle cakes of buekM'heat. com. or wheat 
flour two (ir three timett a week. TliCHe last may be nerved with ttynip 
or fniit-juteos. 

C'ereal porridae^ of all kinds may be given for breakfast, oatmeal 
being probably the nUMit desirable. 

Vegetables of almoiiT all varieties may be used. For dinuer ttro 
varieties should be ^iveii, one green vegetable and potatoes. Salads 
made of the green vetjetables, with the ven.- simplest dresaiags, are 
useful additiiitiN to Uie diet. 

Fruit .should invariably be given once a day. 

Sugar eihould be provided for in the dietary. Candies and many 
of the aw(H>t« given to children are harmful and cause indigestiou and 
d.i-spepsiu. If proper sweets were provided, there would be slighter 
tendency to indulge iu the lesK desirable forms whenever opportunity 
affordf-d. With the meals, and when the appetite demauds satisfying 
between meali^. they may be given with or without a giaRs of milk. 
Re^larity «h»uild. however. W observeil. and tliey shnnld nnt be given 
immediately iH-forc or after a meal. Fruit-.'^yrups, sutrar nyrupw, 
honey, preserved fruits, and jam may be eaten with bread. Caramela, 
ehoeolaie, maple-augar. and plain sugar tafHea are the beat of the 
other forms of sweets. 

Suuple de«<ertK. stieh as custards, milk pnddings with rice, tapioca, 
and the like, bread pudding, plain cakes, and properly prepared pastry 
may be used, 

The beverages should be water and milk. Weak coena or ehooolate 
may be given after the seventh year. Tea and tolTce should not be 
given before the thirteenth year, and may be withheld advantageously 
slill longer. Alcohol is not to be used except by a physician's direc- 
tion, 

Etipecial care should be taken to avoid a monotonouK diet, for there 
are many instances where the constant repetition of a certain form 
of food baa created a dislike for it that has pemiste^l throughout life 
or been overcome only with difficnily. 

A second point to be remembereil is that the food should l)e well 



316 



iNFAyr FREprso 



prepared and attractively served. This has more to do with influenc- 
ing the appetite of d<?lieat«, uervous c-hildreii thau is generally sup- 
posed, and can not be insistt-d upon too strouBly. 

Overeatiiiij; should be avoided, and to this end an older person 
should always be jiriwcni when practicable; in SL'hooI, this shunld bt; 
inMstfd uptin. On tlic otlier hand, a ciiild »liuulil not. thnmtrh riiprice 
or habit, be allowed to eat too little. By exereiaing a little tact, most 
of the dislikes whieh are not deeply rooted, but whioh may become so 
if piTKisted in, may geuerally be overcome. These dislikes are ofteu 
the result of iniitatinn. 

Sufficient liiiip should be allowed not only for the meal, but for the 
performanrc of whatever Rniall duties may be required of the child. 
A time should be set for one or two repiilar daily visits to the water- 
closet. Ilupryiiie to school .thonld be avoided. Reading and studjniiK 
immediately before and after meals should be prohibited, as should 
bathing or any very acrtivp PxereiKe. Some light form nf rwrpation 
may, bowever. be indulged in. The hours for meals ahould be so 
arranged lliat the fhitd may have freshly prepared meals, and not eold 
luncheons or wtinnrd-over dinners. La-stlj', nibbling and eatinijc be- 
tween meals, except under the conditions previously described, should 
be strictly prohibited. In spite of stringent rules, however, majiy 
infringementfi wit] occur. 

It is by neglect of the diet, fresh air, and exercine thai many easea 
of tubereulosiR gain ht^adway : anemia may resitlt fnim .such neglect, 
and a delicate, nervous child be the outcome of one that should, by 
right, be healthy. 

Very few acluni studies of the food retjuiremcnts of schoolboys have 
been made. Gephart found that in one of the large boys' school that 
the quantity taken estimated on the indiWdual m«ul was as follows: 



Paund*. 

ProtBin O.II07 

F«t 1)1332 

r«rbohyii™i«>« 0.37 17 



Oranu 


Calm Its. 


eo.4 

ItS6.8 


2011 



Calgrlu. 

< I'rr Mat.) 

Hi 

39 

47 



Boys of from 13 to 16 calculated im the basis of eomplete rest would 
need fnini 1700 to 1800 calories. Thp boy is however a very active 
animal ami his actual fond re*|iiirement» are about rtiual to a fanner 
at hard labor (4000 to 4&00 calories). Half of the total food values 
were furnished by brfad. butter, milk and sugar. i^See Age and 
FfMid Re<|uirpmentK, I l)u Hois in Uis studies of lM>y» just before 
puberty found that tliey had a heat prfMluction 2."! pep cent, more 
than aduli.s according to the linear formula wliieh explains the great 
needs of boys in the period of acceleraled growth. 

Diet List for ■ Boys' SchonA.—Breakfast, 7.30 a. m,— Half-hour 
alluwed. Fruit. A cereal with i-rcaiu. Bread and butter, eggs, 
I ^tcTcnty pvr cent, of tbH wrh ia vnimnl pnitvfB. 




TBE ly FA If : 



317 



boiled. poached, or am omelet. FUb occasionally. Corn bread otice u 
week ; griddle cakes once a Treek. Milk to drink. 

Dinntr, 1 H. M. — Three-quarters hour allowed. Soup; mcflt — roast- 
beef ur iiiiilton. Hteak, or eliicken ; lish once a week : potatoes aud a 
grecu vegetable. Iloniiiiy or rice once a week. A eimple dessert; 

fruiL 

Supper, 7 v. h. — Ilalf-hour allowed. Hash, cold meat, Rnh. or 
otnrlft in Hniall quantities. Uroad anil butter with s.vriip or preserved 
fruii or fniit-juiee. PIniii cjike, .Milk to drink. 

Bexlnnlnx Cases that Have Been Previously lmpr«|>erly Fed. — 
This re(|uirefl judgment and experience. If the baby ha« been very 
mneh iifviet. il is a iiooil plan to withhold all food a day or a part of 
a day. This gives the digestive orL'anh a rest, and often means Mic- 
eess where failnre woidd have resulted fmm feeding almost any food. 
Diirini; the starvHtion p^'riml plain water may be given, or sometimes 
a little weak barley-water or albiunin-water. These latter are noeful 
when nitxioiis parents eaunot be persuaded the child will not starve. 
They may alwi be nsed where there is evident huii^r. In any case 
the qaontity Hbuuld be small. We often nive an initial purse of 
castor oil iu these eases to Insure gettinj; all the food out of the in- 
testine. 

A careful study of th*- rIiviiIn, of the history of previous feeding, 
and the sjinptoms wliieh may be attributed lo the fecdinn or to the 
diKturbaneefl of metabolism, ily so doins the diagnosis of the trouble 
may be made and muoh valuable time wiveil by oorreet therapy. 
A Rtuily of the following facts will be found UKrfnl in this connec- 
tion ; 

The Infant's Sloola. — A very fair conception of the infant's diges- 
tion can be oljtainod from an examination of the stools. This should 
be done in all I'nseK, and in hh imiwrlaiil a part of the routine as the 
examination of the heart or Iunks. 

The size of the stool should be noted rtr^t, althnuch this is not of 
verj' great importance, us it varies with the number of i^ools and the 
size and peculiarities of the child it.self. 

The number of stools is always to be considered, but is not nearly 
HO iiupiirtant as the character of the stOol. An infant may have one 
or two sl<(Ols a day. or as many as four, tivc. or six. but bo lonff as the 
cbaracler of tlie stool remains good, it may be regarded as perfectly 
nomaol. Iu diarrhea the course of the disease ia better told by the 
<|uality of the stools than by the numlier. and this may to a certain 
pxtent bo said to be true of ennxripation. 

The consisleiier of thi* stool of nursing infuutH should normally 
be about that of butter, although slight variations either way are not 
to be regarded hs difitinetly abnormal. The stool should be amootfa. 
•sd contain no eurdR or solid masses. In oonntipation the stools are 
hard aud dry, while in diarrhea tbey are soft or litjuid. 



318 



KFAyr FEEDtya 



Lumps arc frequently seen in the stool. These are usually curds 
or massps of iirnit{;i's1«d fat. They may. however, be i-himps of mucus. 

Mucus is present nonuiilly in the stuol, and its prewnce is e«Kily 
demoii«t rated: it shnuUl. howrver, br so luti mutely mixed with the 
stool that it ean not be iiceu with the naked eye. ^Vuy irritation of 
the intestinul wall vauses a great increase in the aiuount of uuicus in 
the Ktonl. [ti diarrhea and in inte-stinal iiidigentirjii ihero may be Inree 
amounts, and in constipation considerable mucus may cover tlie bard 
masses of feces. 

The reaction of infants' stoolit is nmially acid or neutral, allhoiigh 
sometiwCM it in alkaline. Either neid or alkatinf? Ktools may be altered 
in color. A return to a normal color is usually brought about in 
these cases by the administration of an alkali when the stools are acid, 
and vice versa. Alkaline stools, green in color, may be produced by 
giving alkalis in Isriie doses for several days. The eolor of the stool 
often fiiniiKlies considenible infdrmiition an to the cnnilitioii of the 
infant. Normally the i-olor is a lisht butter yellnw, hnl the st«»nls 
may \Tiry somewhat in this respect, and be lighter or darker. In 
young breast-fp<i infants the stools may be a dark yellow, like the yolk 
of ati i^g. hi artilicially fed babies the atoola are apt to be very lieht 
in color or even rk-ei<k-dly whitish. Bhubflrb imparts a yellow color 
to the stool. 

White stoulg lire seen sometimes in artiHeially fed children that 
seem to be otherwific in nomial condition, As a rule, however, white 
stools are eitlirr the rt-snlt of the ingestion «f psrcssive qnantitii-7< of 
fat or indicate an absence of bile. In the former cases the stools are 
lar(ie, whitish, and have the eharaeteristic odor of fatly acids, which 
resembles that of rancid butter. The stool may be dried and burnt 
with the samt' odor and the fat may be dissolved by ether. When 
bile \h absent, the stools are white and have a very foul, almost oadav- 
cric. odor. 

Red Htools may owe their color to the presence of fresh blood from 
the rectum or the lower part of the iniestiual tru«?t. Wht-n it c«mcs 
from the upper parts, the blood is always black. The streaks of fresh 
hlowl frf«|uciitly Keen where hani stools are passed come from fitight 
excoriations nf the anus. 

Black stooU are caused by the presence of blood. In this ease the 
stools are binek and tairy. The blood may come from the intestines 
or siomavb, or from blood swallowed, especially that from hemorrhage 
from the posterior nares. • 

Black or blackish brown stools may also be caused by the adminis- 
tration of bisiouih, iron, nr tannic acid. Brown stools are fre<tuently 
seen as the resuti of bacterial and ehemic ehanffes in the intestine in 
the course of intestinal indiuestion and intcsliufti infcetiou. Raw 
beef-juiee may give rise to foul-smelling brownish- or grayish -colored 
stools. 

Orren atoats are doe to a large number of causes. This may result 




OTBBtt FA€T0R8 IN IXPAST FEEDIKQ 



319 



from intestiual inJi^ieatiou and infection due to improper food, usu- 
ally eitJier an excess of sugar or of fat, or to the presence of bacteria. 
Calumel cautMS greeu stooUi, and allciilis, if CHUitinued and not neutral- 
iuid in tbi- iuti-stiiif. uiiiy jinMiuee the Kome effect. 

Symptoms of Dietetic Krrors.— Too much Btrcss can not be laid 
upon the iniiMirtance of investi^ting the source of disturbances due 
to di«telii* errors. There is ample 1*0001 for further clinical study 
of this Kul>j(?et. 

Too Low Protein.— Thi- stools are wnall and constipated, if ihc 01 her 
food clvuicnls mv l«w, as they are apt to be. The child iloes not gMli 
weight so rapidly as a nnrmal chilcl, or it muy remain stationary or 
even lotw weight. It is anemic, and if the low protein is continued, 
tfae child Ikceomeg marantic. 

Too High Protein. — The child is apt to have colic, vomiting any 
time, but usually half an hour or more after feeding. The stools 
contain uudipietitnl ciirdu, and mucuii, and may be yellowutb green or 
otherwise discolored. 

Too Low Sngar.— The gain in weight is apt to be .stow, and the child 
may tic i-imsiipalpd. Tlii-se infantK are nsually thin. 

Too High Sugar. — Vomitinj; an hour or two after niuaK the vomited 
matter usually being sour. Acid eructations are common. Colic is 
bcquent. The stools are generally grass green and very irritating, 
the buttocks often being excoriated. 

Too Low Fat. — The child giiiuN wfight slowly, aiul ia apt to be 
conslipaled unless an excess of sugar is given, as in condensed-milk 
feeding. 

Too High Fat. — The child vomitx an hour or two after feeding. 
Colic is i^mmon. The stools may be thin and green or greenish yel- 
low, and contain Kmall maaBes of undiffcstcd fat and considerable 
mucus. These small lumps are often mistaken for curds. They are 
more or less traoiilucent. and when burnt give off the odor of fatty 
acids: they may be dissol^-ed in ether. Curtis are not, however, dis- 
aolved in ether. .Vnothi-r ty|>i> nnirc (--ommtm is the large, white, 
rather dry atools having the odor of rancid butter. 

It mnsl be remembered that the eoudition of the stools may be due 
to one or more of the food elementn. and experience in these eases, as 
in miwt ollicrs, is the best teat-iier. Il is oidy by praeli*-^ and rar«ful 
nbKen'ation that the ffttJing nf infants may be eonductt-d properly. 
Auotber fact to be remembered is that the food need not be changed to 
meet everj* trifling alteration io the temper of the child or in the 
character of its Ntnohi. - 



OTHEB FACTORS HI UTFAST FEEDIKO 

Feeding in Infant Asylums.— The feeding of infants in over- 
cmwdnl infant asylnmti, with their lark of frmh air and paucity of 
attendantfi, is a matter of great didit-iilt.v. .\iiy attempt at Ncientilic 
feeding under such circumstances will ultimately lead to failure, the 



330 



fffFAXf fEEDrSG 



metbiKl in tbnw canes betag held to bUme. The prituarv cause of 
malQDtritiQU and marasmus in institutions is the lack of fresh air and 
Individual car«, and until these are obtainable it is oseles to altem; 
to accomplish anythitiK by special fcfding nw^thcxls. In smaUer in* 
etittltioiu the use of the >Iatema tn-uduatc trill be found eatisfaetOTy. 

In the larger asylums il is well to have two or three geuera) woridng 
formulas, such as fal 3 per cent., sugar 6 per cent., protein 1 ptx 
evnt. ; and fat 4 per eetil., sugar 7 per rent., protein 2 per oeU 
These may be varied by addinfr more or le»i watrr t(i tliL-tu to adapt 
tbem moiv cicwiy to special nec-ds. The yuuusrer ioftint.s may. when 
piiMible, receive special mixtares. For substitute feeding, eoodensed 
milk, barley- and ejrc-water will be found moet useful. 

The allowance of a few cents a day eenerallT made for au infant's 
entire care in quite liiiidnjuate to accomplish any good. 

Acute Sujrar Poisoning. — In cases in which there is nutritional 
disturbance sugar may at times cause a. symptom-eomplex, which when 
recognized should tje followe<l by discontinuinK all sugar, and. indeed, 
tdl food for a day or two. And when feeding is bc^ii sugar should 
he withheld. Human milk is the best food in these cases. Albumin 
milk or buttermilk in the best mbslitute. There is a history* of a loss 
of weight and diarrhea, with thin, green stools. There is great pros- 
tration, with drowsiness and short periods of c<Hna. There is irregtt-, 
lar. UbUslly high fever, shallow, irreerulur respiration, weak irregul 
pulse, albumin and sugar in the urine. The character of sutar lu 
the urine m that which has been given. Lactose may not be noted 
if Keblinic'8 IcRt is used, as it requires prolonged boiling. The 
pheriyl-hydra/iii tpsl )« bpft«?r, 

Finkelstein's Classification. — An outline of this 1:4 included, as it 
is much talked about at present. The chief value of his work 
to UH to \tp (he ufie of albumin milk, the recognition of food intolerance, 
and that !»omc of the conditions whicli have been regarded as merely 
gastric or intestinal are more deep seated. 

He separates four cIbrww: 

1. Disturbed metalwlic balance (Bilanz Sioruug). 

2. Dyspepsia. 
a. Intuxicaliou. 
4. Decomposition (acute atrophy). 

1. In the caite of cUiturbed metabolic balance the condition is wlial 
we describe as a mild case of marasmus. There may be a congenital 
idiosj'nerasy in regard to milk, or there may have been improper 
feeding, esppcially too high fat. Tlir symptoms are either no gain 
in weight or au irreifitlar iucrease below normal, in spite of the fact 
that the infant in getting what should he xuffictent or even more than 
sufficient food. There is a wider range of temperature than normal, 
especially marked in infants under six months, and also wherv the 
tclerance for <>artK)hydrate is disturbed. The stools are gray or white, 
dr>' and friable if too much milk has been given, and they are 



9S- 




OTBBR lACTOKS IX ISFJST FEEDiSQ 



321 



and thill if cxci*»sivK carbohydrate bjis been ^iveii. Vniniting is frv- 
queut aud there is tympanites. The muscles are soft and tisbby and 
the &kiD pale. The child is restt«K» and irritable and sleepH ptiorly. 
aud irritation and infection of the fikin rnmiaon. 

In lliese cuses the protein digeatiou nud roteuliou are normal. The 
fli»turhauce is due to fat, carbohydrate, or salts cau&ing an abnormal 
reaction. 

The treatment of these vHHaH vs. b«Kt acoompUKlied by human milk. 
Wherp tluK is not p^istiliUr. Hkimmed milk fi^eding nr biitlcrmilk is 
often ugieful. If ordinary milk mixtures are used, the fats may be 
decreased and an increase made in the carbohydrates. Sometimes 
chanfnnfT the form of suRar that is used is of value. Malted foods or 
malted mitk added to the milk may be of value. 

2. Dyspepsia.^ — This represents the second deirree of severity, and 
there nrf iicute gastrei* intestinal symptoms. These eafteit ore due to a 
oongenilal lowered toleranee to chws' milk, to errors in diet, either too 
.much food or too much of some one element. Feedins: with iufect«d 
Imilk and infectious diseases, either general or local, may be the pri- 
ma r>' i-uiixc. 

Fiukel&tein believes that surat, salts, aud fat are the exciting caus««, 
and advises ^iviiiR human milk when pos^ble. If this is not avsila- 
in the mild eases reduce the milk and migar. and in the serere 
reduce sugar, whey, and fats. First, start's a day and then give 
buttermilk or onc-tliird buili-d milk aud twi>-1hirds thin oalmcal ^nicl. 
It is in these catKs that albumin milk is especially indicated. (Seo 
above.) 

^. IntozioatioD. — These cases are what we call gastro-enteritis, sum- 
mer diarrhea, or cholera infantum. They are due to food intolerance, 
to infected food, or to heat. Pinkelsteiu believes thai infants in which 
the diet has been rich in sugar and whey will have au intoxication. 
while those fed on a diet rich in fat and low in sugar will have 
smpositinii or almphv; that Is. his fourth class of cases. 

The s^tDptoms of this intoxication class arc what wo call summer 
diarrhea. The treatment of these cases, according to Finkelsteiu. is to 
8tar\-c a day or two, but give sufficient water. Subcutaneous salt 
solution infusions in the more severe cases are of value, or salines 
per rectum by the drop method may be used. Stimulants and seda- 
tives are used as indicated. Humau milk should be given if piLSsible, 
and if it is not. a diet low in fat and su.L-ar. Albumin, milk, beginning 
with vcr>- small quantities, may be usied. After the starvation day 
(five too feediugH a day of 5 c.c. of albumin milk, and then increase 
50 c.e. a day until the stools are impmved. and then 100 c.c. a day 
until IW.) to 200 c.c. are given daily for each kilo of weight. After 
the stools are solid, add I per cent, sugar and increase gradually to 
4 per cent. The total feeding should not exceed 1000 c.c. of albumin 
milk daily. 

4. The decomposition or atrophy oases are characterized by a lack 



322 



tSFAXT F£EDttiO 



of ability to assimilato food. Thprp is h subnormal, irregular tem- 
pwralure, weak pulse. irrcKiiIur rt-spirHtion, and rapid Itws of wei^lit- 
ThL're is usually g:reat huuKCft often vomiting, and the stooU are 
usually abnormal. Ke«diug with human milk is almost &n esNential 
to <nirR»ffiful trealment. If it is uoi available, buttermilk or albumiu 
milk, wifti the addition of maltose, may be lined. 

The Feeding of Difficull Cases. — Tin- frcding of certaui infants 
often bc<-otitch a difliriilt matter, nut ho much ou account of actual 
conditions of discaso. ax owing to personal idiosyncrasy. Others 
again are diifieuh to feed because of actual diseaHe of the diift^stivc 
orgauis or on accouut of the lowering of nutrition due to the existence 
of other tlixpaiws. These ea.si*s will be tmiisiden-d in proper order. 

At the out.wt it inn.st be rememlrti'Ted that the fault may not be due 
to the food itwlf. but to its proparafion or the mode or time of atl- 
mintslration, and To improper surroundings and care. To succeed in 
thcw difficult CHWR it is necessary to look diligently into the minutest 
details nf the infant's life. 

Loss of Weight. — Loss of weieht in an infant should always be 
considered a very serious s>'mptom. During an acute illness, such as 
pneumonia or diarrhea, this is to bf expected. In ebronie eonditiona 
the wpiplit may fliu'.Iuate, Eoiutr up ami dowu, or ri*niaininK more or 
less stationary. If. however, in a period of a month or two there is 
no general tendency to gain, in spite of the finetuation. this indication 
is a serious matter. Whore an infant is losing wei(:ht without any 
speeial eause, this may be attributed to iMsnffieienl ro()d. If the in- 
fant is nursing, the breast milk may he poor or insulTiL-ieut, or both. 
If the babe ia bottle-fed, the milk may not have been increased in 
Ktrength in pro[Kirtion to the child 'x urowth. 

It frwiiiently happens that difficulty is experii-uwd in obtaining a 
food suited to an infant's digest ion. Thui end, however, ouce attained, 
the phyxieian may increaae the quantity, but not the quality, of the 
food, and the infant finally ceases to increase in weight, remains 
Htationary. and then Ioscn. Loss of weight may also be due to a 
food too rich in protcinii or to one nnsuited to the iuFant's digestion. 
This latter cause Tisually, hut not always, givej) rist' to other symptoms. 

In all eases a careful study of the food is essential. Aeeurate 
charts of the quantity of food taken, the time, whether the chilt. 
vomits and at what time, and the number and eharaeter of the stools, 
etc., are of great help. If the food is increased or decreased, as the 
eaae may lie, to an avera^o strength for a child of the size and weight 
of the one under rousideralion. and there is then no cbaufje in the 
oJiild's condition, the food should be peptonized, either itartially or 
completely, or mixed with an alhuminized or malted food or with 
liarley- water. Milk mixtures hif,'h iti protein and carbohydrate and 
low in fat are useful as are also malt soup preparations. Condensed 
milk with soy and barley gruel we have found of Bipeeial value. Low 
of wei^t may be caused by persistent vomiting (ace Vomiting). 




OTBER FACTORH IS tXFAyT FEEDISO 



323 



Th<' physiolngic liiioi that occure durinfr the finit forty-eight hoiini 
of life shuuUi nut W lorgutteu. 

Stationary Weight — This fiV(|uoDlly follows wlien an infant is 
weaned or when one is fed artitieialiy tvum (lie ontsct. Rven if the 
child i» rowivinjr foppe^-t pen-cnlaiyo of food it may not gain for sev- 
eral weekn. So long as the inf&iit in u'ell and the percentage; iiiul 
■ luautity given eorrespoud to those direeted for an infant of the some 
age and weight, no alarm need he felt, even if a month should elapse 
L without showinir increase in weight. However, once the regular gain 
in weight m l%tahli^hed. it ishould not remain i^talionary, but shouKI 
increase gradualJy from week to week. The average weekly gain 
during the hrst year of life is Ijetween four and eight ounces. The 
weight may oeea^lonally, without any apparent ai^ignable eaUM. be the 
sanie at ime wef'kly weighing as it was at the preeedinp one. If this 
persists, a can'fnl .s<-areh for the cause must be inailc, and will often 
be found to be insuflfieienl food. 

Colic. — TliiN IK more apt to oeeur in breast-feil than in bottle-fed 
babies on the ]>eri:cntagex uMialty reironimeiuled. It lit especially 
likely to eoine on during the lirHt three montliK. In breast-fed infants 
it is often a diffientt matter to ovenxime. [f on e.xaiuiuation the pro- 
teins are found to be too high, an effort should be made to reduce 
, them, and the intervals of nursing may he lengthened. In b«ltle-fe*l 
infants eolic is usually due to the fact that the pen-eiitaye of protein 
ill too high. The condition tDHv also be caused by the food being 
given too cold, as well as by a host of causes tluit bear no relation to 
the fciixl. 

Vomiting. -Immrflialcly after Feeding. — (a) From the fwid being 
g'ivrn in tiM) large quantities. Keduee ({uantily. 

(6j From food being given too dilute, and so necessitating the 
taldng of too large quantities. Reduce the ijnantily and increase the 
■Izvilgth. 

(r) From taking food too rapidly, tlive more slowly— in breast- 
fed children, by regulating the flow by grasping the uipple between 
the lingers; in bottle-fed babies by using a nipple with n amaller 
hole. 

At any Time. — Due to the abdominal binder being too tight, or to 
abaking or holding the infant with the head ovit the niirs«>'s shoulder, 
patting on the bark, ele. From I<hi high proteins — this \s more apt 
to be a^'companied by other 8>TnptomH, as colie, cunis in atools. etfl. 

On* ur Two Hoitra after Feeding.— Tbv vomited material in usually 
fiour and rnnlleil. or it may lie watery and eontaiii mneiia. This is 
due to the percentage uf fat or sugar being loo high. The fut, or 
both fat and sugar, -should be decreased, and the food be given slowly 
and at longer intrrvala 

VoDiitini; al<(o oeeur« in many diseased roitditions. It ie A fre^iuent 
•eeoapaninient of gastrie and intestinal disorders, infeetion, and all 
acute diseases: it occurs in nervous drseaaes, sneh as meningitis, and 



324 



IKFAXT FBEDI\a 



in brain tumor, in peritouitis, and in intestinal ohstnietion. with 
coughing KpflU, as a liabit, or rctlexly from intt-stiniil nr pliarj'ngiial 
irritatioo, or in toxic uouditions, such a» uremia. The treatment de- 
pends ou removnl of the cauKe where possible. When it oeoura in 
orilinary acnte dlnKiiscs, however, much eau be done in a (reneral way 
to overcome vomiting. The food should ht given in siiffiiMeutly small 
quHntitiifli at two-hour intervals, or in snnip cases « teaspixmfii! of 
food may be given every hour, or even every hulf-hour where lar^r 
luantities arc not retained. If the ease ia acute, it may be neeeasary 
to secure a wet-nurse (xee Inanition). Washing out the stomach and 
gavagc arc two vcn,- important means of treating persistent vomitiD? 
which should not be forgotten. 

OAVAOZ 

(ravage, or feeding by means of a stomaeli-tube, ia a method used 
in variouH dimuuies and conditions of infancy and childhood. In casett 
where the eliiUl is not able to take nourish luenl, or only in iusullieieut 
amount, and in caaes of uncontrollable vomitiug, tlus method may be 
resorted lo. It is used in the fceditig of premature infants, whether 
in an incubator or not, and in catws of Kniall, weak, marantic infanta 
who, owin^ to weakness or lack nf appetitt', lio not taki' Huffieicnt 
uourishment. It is also employed after surreal operations about 
the head or neck where swallowing is interfered with, and in acnte 
diava»e8, sneh as pneumonia, in fevers, and in delirium or coma, 

The reMiiltH that follow Ibis method of feediuf.; are siirprisiii;;. es- 
peeially in case* where there is constant vomiting or where the stom- 
ach has a very small capaeity. In (he former case the vomiting may 
cezHp and the food be retained : in the latter, the capaeily nf a stomach 
thai previoiiisly held only an ounce or two may rapidly be increased 
until an avprag(''-K3/.ed fM'ding is relained witJi ease. 

The teehnic of the mciliod it, simple, and the procedure conducted 
without difficulty in children under one year of age; above that 
age it may be diHicult. and a month-ga^ may be required: in some 
cases nasal feeding must, be subfititntcd. The nppanitus employed is 
the same that is used for washini; out the iitomueli. and since it is 
frequently desirable to wash out Iho stomach before inlrodueing the 
mea). the same tubing may scr%'e for both purposes. It consists of 
a Boft-rnbber catheter connected, by means of a pieee of glass tubing, 
lo II pici-e of robber tubing to the other end of which a funnel is 
attache*). The nurse holds the child on her lap, with tbe head held 
straight and not inclined in either direction. The catheter in moiat- 
ened with warm water and held several inches from the end. so as 
lo allow enough of it to pass into the esophajius with the firsl attempt 
at introduetion. The mouth i.s opened, if necessary, anil ilic catheter 
passed rapidly into the phar>-nx; there is URually a swallowiug move- 
ment, and the tube is readily passed into the stomach. If the pro 
cedure is earrinl on too slowly, the tongue may interfere, or if the 



• 




NET ly Di8E.iSE8 OF CBJLOttElt 



325 



catheter js held too near the cud, it tnsy cauBv gainiinK- Before 
iutro'liKring the food it is woll lu wa»h uut the -iioiiiai.'h vritit m>nua] 
uill Kolutiou. An soou as all llie food Iibk eulered tht- atoiiiafli, the 
callii^ti-r is piudicd aiid rapidly withdrawu. IT it i« witfadrawu 
slowly, the food may coin« up witb the tube. If the catheter is left 
open OS it is withdrawn, the drippiug into th*- pharynx may cJiimp 
Tmiiitiiif,'. If the child is young, it is a pind plan to krep the finciT 
lH>tweeii the jaws for a few momcDts to prevent gaggiog. If the food 
coim-s Hp, tli« Feeding must be repeated. 

•NaMl FecdltiK. — For this purpose a eAthetcr in prnpi>rti»n in \he 
size of tho rhild should bo \\sei\. The procedure m the same as that 
for adults. (See Forced Feeding.) 

DI£T IS DISEASES OF CHILD&ER 

Cyclic Vomilinx. — This is a i-uriotiN doranu't-nient of inPtalMliKm. 
in which there vfi an acidosis that may hav«.- b<vn Marted in <m*> or 

i-jKveral ways. In addition to the acid poiteoning, there is said to Im> 
a diaturbonce iu Ihc ratio nf ttie excretion of nric arid lo tirea. l>nr- 
ingr the attack it iR well to ^ve the stomaeh absolute re»t, as food atid 

ndrink tend to agrgravate the cnndition. ScMliiim hicarboiiaie s^ilutiona 
shonld W administered l>y roi^tum by the Slurphy drop metliml. and 
they muy be alternated with glucose solutions, 5 p«r eenl. beiuff a 
desirable strength. The snila i» uKefiil in combating the acidosis, and 
the glucose fiimi-thes a carWhydrate which is extremely useful in 
e9(Tn1)liKhiii(: a normal niPlaboIisin in the a<'id (•midilions. If the at- 
tack is pnilou^cd, itddilional nvt^d fcfdiiiK nmy be givrn. Small 
doses of atropin administppi-d by stomach is sonietinies useful. When 
the vomiting stops, it is best to have rest, for some hoiirR before the 
ieeding is resumed. For the tirst day of mouth feeding, milk to 
which lime-water huK been added, or skimmed milk with 3 t;rains of 
citrate of soda tiddcd to each ounce, peptonized milk, ulbuniin-watcr, 
or barley<water may be lised. After three or four da,\ii a return is 
made lo the ordinary diet. As a rule, when the attack is ovpr. eoo- 

>valescencc is rapid. (See also Acidosis). 

The diet in the interval is important ;ind ref|nire4 eonKidernMc 
Htiidy to adapt it to the particular chiltl, but much can he done to 
lengthen the iuten'al between the attacks. It is abo important to 
liav« the child out of doors as much as posfsible, us much e.xercist^ as 

'leaii be given, but carefully avoiding fatigue. All sorts of nervous 
cxcitempnt must lie avoided. The diet Khould be so planned a.** to 
allow an excess of alkalis (Bee Alkalis aiid Acids), and this \s iixnally 
easily doue. Lean meats, cggB, milk, potatoes, green vegetables and 
fruits generally must furnish the hulk nf the diet, but rerenU and 
bread !dufTs should be allowed in niodrralton. The fatK shonUl. a.s 
B rule, be low. 

Soine cases seem to show a close relation to the carbohydrate intake 
and in atarvation or in the absence of carbohydratex, attacks may be 



rxFAyr fubdiso 



precipitated or if thy cnrbi»liv(irnto is iiisuffleicnt iu amount the at- 
tacks may be more frpi)iu'iit. In some cases the fats are in i-*xc«ws 
or ihc balance botweou.the fats and C4irbohydrat«H i^ ui tutilt uuii cuii 
be helped by loworiiifj the fat intake. In mniit' itukcx ilie »)veru«? of 
sugar sceuiH to be tbe fault and the acidosis may be uotiiiTOled with 
abnormal t-bomivat cbatigj^ iu llie bow«l. Cutting out the sugar (uot 
all the mrbr>hydratii»'i will be of great nerviee. We are of the opinion. 
»fter a mnsido table i^sperience, that the interval bclwpcn the attacks 
can be Ipit^bencd if the ease is thoroughly studied aiid the co- 
operation of tlie family secured. 

A saline pnt^ at intervals of from one week lo a month seema to 
be of valui* and Ihe atluiinislration uf sixliuiti biearbonate from time 
to lime should he iried. tV-U-siina viehy i.s a pleasutil way of fiirjii>li> 
ing additional alkalii^. 

Stomatitis. — Tn stomatitis the feeding often becomes a matter of 
great importance. In the milder forms there is uot much difficulty 
in geltiiiff lhi> ehild to take liquid uourishmont. wipeeially if it i^ given 
cold. In ihe severer forms, such as ulcerative stomatitis, the child 
may refuse all food. Iu these cases it .should be offered food in the 
form of iee-(^uld mitk, albumiii-WHtt>r. and the like. If all food i& 
refused, or if insunicient (piantitieK arc taken, rectal feeding! must 
l>p iiislitiilt'd. ill some cflses na-snl feeding may bo re«ort<'d to. but in 
many palieiits where this is indiciilcd it can not be employed betwise 
of the iiiUftnimation extending into tlie narea. In all eases the diet 
should l>e similar to thai used in scurvy. Fresh fruit-juieos and 
vegetables are lo be given. In the ulcerative coses chlorati^ of potas- 
sium or mineral acids are useful. 

Acute Gastric Indigestion — Acute Qastrilis. — As th&te diKeaK«« 
can not, aK a nde, be [Usliuguished fn>m eacli othur at the outset, and 
gince the dietetic indications are along simibir lines, they may, for 
convenience, be considcn-ri together. 

The main indications arc to empty the stomach and to give it rest. 
If possible, it should l>e cleansed by wa.shiiig with a tube and an 
abundance of warm water; where this is not posaiblr, warm water nmy 
be given to drink, and. if necessary, vomiting iudiieed. 

Fnixl nhoiild be diKcuiilinued entirely for six hours, and during* 
this interval small <|uantitiea of hot water may be jjiven, At the end 
of this time, if the vomiting ha.« e^'UHed, amall aiuouutN — 1 to 3 oiuices 
>^of barley-water may he administered. Milk in any form should be. 
withheld for twenty-four hours, when, if the baby in breast-fed, it 
may be nursed for a few minutes at three-hour intervals. If this is 
found to agree with the child, the time of nursing may be leni.'thened 
and the inten'als between feedings shortened. If the luby is l»ttle- 
fed. it is well to withhold cows' milk, and to srive barley-water or 
rice-water in its stead ; when the stomaeh has become tolerant, other 
articles may be added. At first broths, free from fat, and meat-juice 
may be tried, followed by malted milk. Only smalt ipiantitics should 



jyJET IS Dt8i:A8BV OF VUILDRES 



327 



be given at first, and at iutvrYalH of three or four huunt. As improve- 
ment occurs tlic food may be given oEtener and in increaHintr quan- 
tities, lu the severe i-aseK, where vomiting ptTsiNts. pre|>ttre<l foods, 
Kueh as Panopepton or Liquid Beef I'eptouuids, diluted with water, 
may be retained. Kor the younger infants and for older infants if 
the stomach is at nil irritable, it is well to peptoniiie the cows' mdk 
when it is Hr»t given. For older infante a small amount of milk 
may be "added to a hirge quantity of a cereal water, suub as liarley' 
water. It may W well to boil the two tof^ether for » few minutes. 
The amount of milk may gradually be inereased, an equal volume of 
liaie-walvr being added to it at first. If the stomach is very irritable, 
Hmall doses of hot water frequi-ntly repeated may be tried, ur, what 
is usually of gn-attr seiriee, teasiKiouful dosefc of t^ual parts of lime- 
watfT and cinnamon- water. 

Chronic Oastric Indigestion — Chronic Oast ritis.— While different 
pathologic cnnditiniiii are present, in these diwa-seK, the trejitmeiil is 
practically the same, and for this n-a»>u tliry may lie considered to- 
gether. In both diseases the food is apt to be retained in the stomach 
for 8 long- time : it is also likely to be imperfectly digested, the large 
Amount of mucus which is usually prescut in itself interfering with 
digcKlioti. The stomach should be washed out onee or several times 
A day with warm water or with a weak solution of sodium bicarbonate 
{I drum to the pint). The food sliould be given at intervals of three, 
four, or even five hours, according to the age of the child. It should 
be Huilnl to titc infant's digestion, and what has been said about 
infant feeding in general and the feeding of ditlieult eases applies 
here. Patience and judgment are neces.sary to determine what is the 
best food for the infant and just how long it should be continued 
without a ehange. In this, as in so many other conditions, experience 
is the safest guide. The milk may be partially peptonized or a milk 
low in pn>tiMii.s may Iw ^iven. A milk low in fal^ in often attended 
by (TO"*' results. Occasionally the sugar may Im- n-ducwl with ad- 
vaiilage, or eoudensed milk or one of the proprietary fo«U may be 
tried. Itnrlcy-water and milk in varying proportions, but usually 
wiUi a large lunouut of barley- water, may hr di;;c»tc<l. liarley-water 
and a weak, fat-free veal broth miiy be mixed together in ot\\\A\ quan- 
tities and used to advantHge. In some cases whey mixed with barley- 
or rice-water may be trii-d. and if it is possible to give fat without 
causing vomiting, eream in small amounts may be added to the mix* 
til re. 

Cieneral hygienic measures should carefully be ob8er>'cd. 

Dilatation of the Stomach. — The methods of diagnosis and treat* 
aaetit of this condition art similar to thone when the disease otTtnim in 
fcadnlta. Th^ es-Kentials of the tn>atnient are stomaeh-wiishing, small 
meals at sufllieienlly lonp iiitervalis. and tonics, siieh m strychnin and 
mix vr*mica. The character of the food should be about the same aa 
thst advised for ebronie gastritis. 



Il/FAfIT FEEDtyG 



Pylorospasm and Hypertrophy of the Pylorus. — In h.vp»prtr«j>liy 
iJip Raramstedl itpcrution of ciittinjt the pyloru; muscle fJioutd be done 
a& soon OS tlio diaRiiOHtii is certain. ^Vftcr the operation the diet as 
outlined by Mur^'uu is an follou-ti: 

"The palieul is given, an hour aflt-r opcrution, provided tJir re- 
covery from the anesthetic has been eoniplcte, 16 c.c. of water, and 
an Lour later 12 c.c. of breast milk mixed with 4 e.c. of water. It 
may be nccessnry at firRl to use a medicine dropi)er for the administra- 
tion. Tho breast milk ia repeated every three hours, eiplit feedings 
a day. and is alternatml wilh water. Boiti art- (gradually iiiereased 
ao lliat twenty-four bonns after operation 16 to 24 c.c. of undiluted 
breast milk is being given every three hours and a similar amount 
of water Wrween fiH-tiings. At rlic end nf forty-eight hours the ehild 
is usually takinjr 20 to 30 ee., at the end of seveuiy-two hours 30 
to 45 c.e. at a feeding. The administration of water by month during 
the first three or four da.vw i» of the pivatest importaiu-c. The time 
required lo increase the milk to meet the caloric raiuirt'uu'uts of the 
child has been on an averaire five days; in small babies three days may 
be sufficient, and iu the well nourished as much as ei^ht to ten days." 

In doubtful cukck the KtomHch shftuld be washed nnt nnd all food eiven 
by means of a stomaeh-tubr until the vnmitintf rea-ses to recur. If the 
vomiting is very piTsiKtcnt. rectal feedinc may be tried. (Glucose solu- 
tion is, perhaps the best remedy to be used, and the drop method 
should always be tried by prcfereuee. Small doses uf atropin sulphate 
(i^ooo (Train for young infants) may be administered from four lo 
tax hours, often wilh very marked effeets. Mothers' milk ( whieh at 
tirst has the cream removed) is the best food, but mixtures of 
skimmed milk and water to which 3 grains of aodium citrate has been 
added to carh ounce may be used. Peptonized milk is aim useful. 
Meat juices have been sucgested. but milk feeding is probably better. 

Diarrhea in Infants. — It should be remembered that diarrhea may 
be present in a great vari<;ty of different conditinna. and ihrn: arc 
many complicating theories concerning it, and also cotLceriiing the 
dietetic treatment. 

Some cases are simple, and are due to drugs, to laxative fruits, or 
to gross errors in diet. Other eases seem to be caused by thormie 
influences, heat or cold, but usually extreme beat. Home eases are 
reflex, or arc due to general or local diseases not directly connected 
with the diicestive (raei. Some are due to impure milk, and are 
either caused by bacteria or toxiiiK fptoitiainx) whieh have lieen 
form<>d in the milk. In some the ilysenterj' hscilius is the cause, the 
disease being simply a dysenterj- in an infant. At other times 
atreptococciis infcctiona of the intestine or other definitely pathogenic 
bacteria may he (he cause. Sometimes protowia or other forms of 
animal parasites may canse the trouble. There is loeal disease and 
constitutional disturbance, whieh varies greatly both in its extent, 
manifestations, and dancers. Some cases are due to food intoleranoe. 




DIKT IS DlSEAaeS OF Cait.DREX 



ass 



These arc usually due to feeding too much fat or too much sugar, 
or to the child's having a lowered retiistauco for one ur the other. 
Sometimes the nietabol ism of tlie salts amy be at fault, (.^c Fiiikel- 
stein'g classitication. ; 

"We try U> vlaxsify the cases cliDically as regards feeding into (1) 
simple diarrhms where there are uo serious Innil ur general dis> 
turbanceR, nirhoii^ii snme of these eases iiuiy nn-^ent alarmiiiff symp- 
toms; (2) inlesliiial intoxicHtintw and infections iu whieli iliere is 
tbo added clement of cither a toxin or of pathologic baotcria; and 
(3) eases iu whieh there is more or leas disturbance due to food in- 
tolerance aad where there may be a marked derangement in metabol- 
ism. 

Il IN well to remember that ihe diagnosis of these present unusual 

diffieulti<-» at times. One cannot, n^ a rule, tell whether the diarrhea 

is simple, infectious, or a food intolerance, although with experience 

one may at times make the diaguasis at the start. A diarrhea in a 

lehild fed on the breast alone is Konerally simple. A diarrliea in a 

rtwttle-fed child when the mean temperature iti around SO" F. and the 

humidity high is usually an intoxieatiou or an infection. The ctwcs 

due to foiKl intolerance have the hi.ttory of ^tationarr weight with 

or without some di^entix'e disturbance, or there have been symptomfi 

rcfemble to overfeeding of fat or Hiigar or of an intolerance for one 

or the other. Feeding with too high fat and too high sugar at the 

same time is more liable to cause the trouble than when one element 

^alono is too high. There is uBually no especial iotolerauce to protein 

aniens tlie normal limit has U-en considerably exceeded. 

The Diet in Simple Acute Diarrheas. — In Ihc breast-fed baby an 
initial purge, preferably of castor oil, and plain water until the bowel 
has been emptied, ia usually all that is required. If there is vomiting, 
the breast may be withheld until the stomach is ((uiet. Washing out 
the Htonmeh iu thetie cases usually stops the vomiting, A little water 
klnfore feedings, to dilute the milk in the stomach and lo somewhat 
^lessen the amount taken, is usually all that is required. 

Tn the bottle fed and the partly bottle fed one cannot tell at the 

.onset what the natun- of the disease is going to be. It is, therefore. 

rimportant. to have lli^ diet meet any emergency. Stop all foixl of 

[wfaate^'er kind and give a doete of castor nil or, if that i.s vomited, of 

calomel. A tenth of a tfrain every twenty minutes for ten doses is 

usually effective, i^maller doses may be used in young infants. Sat- 

■ ines may be used if preferred. We greatly prefer castor oil if it can 

1» retained. For twenty-four houra nothing except plain wat<?r 

should be given or. at most, a tittle thin barley-water or a little weak 

albumin-water. In the partly breast-fed babies who are manifestly 

not ill. a little breast milk may he allowed if there Ik no vomiting. 

If there is any doubt, stane the ehJld for the first twenty-four hours. 

At this point wc wiwh to remind our readers that we refer to acute 

diarrheas in children whose stools have been normal. We hare seen 



babivs suffering from mild, chranic, intrsthiBl indigestion given titr 
most heraic ti-eatment, which thvy did not upcd. After twenty-four 
hours, if the vomiunp continues, the stuiiiauh should b« washed out, 
eillier with plain water or. better, a weak {1 dram to the pint) sodium 
bicarbuuatc solution. If iJiere art toxic i«>inptoai6 froiu the outset, 
it is well to wash out the bowel sti well. 

After twdrily-fiiiir hoiirK the diet will hiivc to he decided upon 
aecordinjf to the condition o£ the child. There are uo fixed rule*, 
and. iinleNs care is taken to cnnsider eaeh cBse on its own merits, there 
will be more failures thiui Hiicccsst-s. If Ihe child i.^ free from fever, 
and is lookiufT and feeling well, it does not alwa.vs meau that the 
child is out of dauger. although these are ver>' fav'orable signs. In 
these cases we allow u thin barley-gi'uel. rice-gruel, ur ulbumiu -water. 
These may be given in fnmi half to tht- full Kize of the customary 
feeding, according to circiinuitiinccii. In i^trong^ chitdrcn the full 
umouuts may generally be allowed, In this class of cases, at the end 
of another twenty-four hours, the feeding may be increased and the 
pniels may be mitde thicker, lu some cases we add a teaspoonful of 
eoudensed milk to one of the feodiugs. aud, if well borne, this may be 
increased to something under what might be given a normal child of 
the same a^e and weight, Soiuetbies we u^e malted milk in the same 
way. Al other timf«i h sny bean «rucl will be fmnid salisfaoton--. In 
this cl«>iH of niwra wir ;p-ncrMlly give bismuth subi-arbnnnte or Kiibiiitrato 
ill lO-grain do«es in a dram of chalk mixture. Tliis may be ad- 
ministered everj' two hours. If the stools are not normal, but show 
evidence of fermentation, buttermilk diluted to aliout the usual dilu- 
tion of eoxvs' milk may be givt'u. Plain water or barley -gruel may be 
used as a diluent. If liutteniiilk cauiiot lie obtained, a skimmed milk 
.wured by the lactic acid bacillus tablets (of which there ore a number 
of ditTereut brands on ihe market i may be usetl. The souring should 
be cotiiplt-te before the milk is reudy for unc. There is Uiuially no 
objection to adding a little sugar. Sometimes it is an advantage. In 
the severer class of caws ihe itugar is best omitted. Aiost infants do 
not like buttermilk the first time they taste it, bat it is the e.toep- 
tional iiifanl who will ikpI eveiiiually take it readily, I'nder its use 
the stools often becwme smooth and yellow, and the child makes a 
rapid return to normal. The bnltenrilk feeding is continued for a 
short time if desired, and even for a long period if the child continues 
to gain. Lactic acid bacillus tablets, especially the {tulgara tablets, 
have been found of value in the infections forms of diarrhea. Oen- 
eraltr, after a week or ten days of normal stools Ihe diet may be 
changed to the custoraan,- food. It is sometimes an advantage in 
making the change lo starve the child for a short period of from 
twelve to twenty-four hours, and then begin very gradually, as in 
beginning bottle feeding. In ihe severer claaa of caaes alhumin-milk 
may be ust-d. begiiniing immediately after the period of star\-ation, 
aod following the directions for ita use. Albumin-milk is o valuable 




OICT" f\ DlffKASBS OF CniLDBEV 



3S1 



addition, but it musl be projwrly used to obtain good resulta. Diree- 
tionti are given under the heiidiiip' of Albiiuiin-milk. 

In the licvei'e olaiwes of L-«(«es. wiib a ^reat dt-ul oi' vomiting, large 
and fr<r4iuent stooU, and great prostration, the feeding ia ultcu a 
grave problem, ll froqueiil)}' haiipt-nx tbat nothing is rKtained by the 
stoiuadi, and it is not posaibit; to us^ tbo Murpby druji method to give 
water or uatt solution, ^^odiuln biearbonate may qIko be us«d (^ee 
Acidosis), in theise cases, if there hax been mneb loss of fluid from 
the body, normal tmlt solution may be given aubcutaneuuaJy. Kight 
ouue«8 (250 e.e.y way b(.> itsi?d at nnt^ time, but given in at>veral ditfer* 
cut places under the skin of the abdouien or buttocks or hack. Thtt 
may be repeated twiee daily if necessary. Later, plain water may be 
given by mouth. If that is retained, small amounts of brandy or old 
whiak}' diluted with water uuiy be given, and subsequently albumin- 
water started in teaspoonful doees. Sometimes washing out the 
atomaeh and then feeding by means of a tube wilt be found uaefuL 
When food begin* to be retained, several different things may be need. 
Albuniiu-milk usfd ao(^urdiug to direettons is •iomi>timeM well borne. 
Very dilute buttermilk is also of great wrvicc. Sugar mid eercal 
gruels are t« Iw added to these after they have been given several days 
to increa-se the food VHhie. Cereal gruels ami weak brolh.-i. to which 
cerral gruels liavt- bi'<*u addtnt, may be of nse. Where llic tm^ar 
metabolism is not too mueh disturbed, condensed milk or malted milk 
may be added to the cereal grueU after aeverat days. To begin with, 
one te&spuonful of either 2 ounces or even less should be given, and 
if there are nn untoward effeets the aniount may be cautiously in- 
cn-awd tn the normal sti-eiigth or slightly belnw it. The soy bean 
Hour-gruel may be itsed to great advantage in the.se cases, beginning 
with small (|nantiliea and increasing, as suggested in the directiona 
for u.sing the bean. Women's milk is of grt-ut service in these thm-s 
after the avule stage is over, and there is a period of undernutrition 
which lA dtfllcult to oveixome. A wet nurse may be uaed. or the milk 
may be obtained by using a breast-pump. Uilk may usually be pro- 
cured in this manner when a wet-nurse cannot be sevur^l. Partial 
feeding with women 'h milk may Im; used, aa it is often nut piHssible 
to obtain the full amount. 

Beef-juice and the proprietary solutions containing beef and alcohol 
■re aometimes uH-ful, but in the amounts in which ibey arv usually 
administered really add but little to the needed amount of food, and^ 
one in apt to be misled as to their food value. Beef -juice is liable to 
euiM loose foul-smelling stooh. 

The severe cases of dlarrliea dependent on or aKsociated with food 
intolerance are usually difficult to deal with from thi- dietetic atand- 
|K>int. The mild forms, in which the general health of the child ii: 
not much affected. Kenerally yield promptly on reducing the ciccssivp 
fat or sugar, as the case may be. The cases which present severe 
symptoms of intoxication may prove rapidly fatal, and these patients 



IKFAW FESDlSa 



may reject food of any kind. In the sugur cases, the symptoms of 
wliifh are uoted Iwlow, a day (if Mtwrvation, with pleuty uf water b.v 
moutb or rectum, or sail sulutiuu .subcuUiieouflty, if needeil. Is in- 
dicatec). This may he f(iIlowe<I by a diet »f nllmmin-milk or of dilute«l 
buttermilk, and the results arc often i|uitf Katisfavtory. An scion as 
the stools becom« yellow, boiled cereal gruels may be added to the 
food, aud low pereentage.s of sugar may be used with caution. Later, 
the sugar percenlac^ in the food may be kept rather low. The tnlrr- 
auee for sugar uflcu returns if the child is properly dieted. The 
cases due to fat iiiloleranee, also noted below, (reuerally yield to a 
diet low in fat, albumiu-milk, or buttermilk. The subject of food in- 
tolernncc in infnnls nreds further study aiul plinicHl observation. 

Diarrhea in Older Children. — When diurrhea orcnns in cildpr chil- 
dren, the early dietetic treatment is similar to that recommended for 
infant:*. As the child reeov-ers a return to the ordinary diet may be 
made, meat, egiw. and broths of various kinds being given at tirst. 
followed by boiled milk and toast or dry bread. VeffottibleR and 
fruits should be given only after recovery is complete, and their cfTeet 
should carefully be watched. Cereals may also cause a recurrence of 
the triiuble, and should he most thoroughly eouked and giv(>ri in Kiiiall 
cpimilities at tirst. 

Ileocolitis.— This term is uwd to inelndp those bnwel eoiiditinns 
in which there are serious lesions in thir intestine. The disi'iise usu- 
ally follows a summer diarrhea. The dividin(r-line between the two 
is hard tu draw, and it is very probablo that ileeolitis i& merely a 
severe form of infection with the Shiga-PIexner baeiltus or other 
bacteria. The term dyscnttTy is also frequently applied to this af- 
fection. CniiditioiiK resembling this disease may come on in the 
course of chronic disorders. 

The feedinff of the»e eases is a diftinull problem. In general the 
diet i.s similar to that f;ivon in diarrhcu. As all nnurishnunit is nsu- 
flUy refused, however, when the dL-^ea-se is protracted, as it is apt 
to be. it is extremely diffieult to sustain the ehild, and the skill and 
tact of both nurse and physician are teatad to the utmost. 

In the acute ca»e8. when there is vomiting, it is a good plan to 
withhold all food for the first day or two. Water may be triveu in 
small (|uai)tities. and stimtilantj; if nceeseary. Washini; out the stom- 
ach freijuently allays the vomiting. This is best June with a tube. 
but in older children it is apt to cauiK excitement and doea more 
harm than gooJ. With younper children the process is easily carried 
out- A ^\ass of wnrm watpr will sometimes accomplish the nanip pnr. 
pone. Often a «up of hot water sipped slowly wilt relie%'c the nausea. 
Equal parts of lime-water and cinnamoa-watcr form a mixture that 
bt very useful for irritable stomach. 

When the stomach continues irritable, it is best to give some one of 
the liquid beef prejiaratioiiK. Completely peptonized sktm-mitk may 
b« tried. TTuman milk, especially skimmeid. may be retained wfaoi 



a 




DIET l\ DISEASES OF cailDRES 



333 



nothing else jft. In other cases barley- or ricc-waler is retained. 
Mutlcil milk is often of threat service, and the malted foods, which are 
ordiiiaril.v mixi'd wilh milk, may lie givcu mixed with water iustedd. 
KumisK may sometimes be retained whuu other foods an rejected. 
Animal brotliH free from fat are also iiiieful. If vomiting is persistent, 
Ipaviige should be resorted to. If any one of the foods mentioned 
seemK to au^'mvtit th<- uumber uf ijtools. aaothcr should br subsitiitod. 

As the ehild improvps. malted milk, one of the mailed foods, or 
equal pans of milk and barley- or riep-jrruel boiled together, may be 
Ifiven. E«ikay's food is valuable in the convaleficence from diarrheal 
diseases. Raw or very rare scraped meat may he i^iven. but this is 
apt to riiiisp vorv offi-n^ive Hitools. Kgtts rooked in various wu.^'s and 
later plain V>nilptl milk may ho ;;iveii. Zwieback, rrai'kprs, and toast 
may be sddrd rautiously to the dietary, and the return to the normal 
allovaDcc be made iimdually. Great care should alwnyH be exercised 
durinfc and after eonvalescenee, as dietary errors are apt to be fol- 
lowed by speedy nnd severe relapses. Presh fruit, coarse vegetables. 
and all irritaiintr and indigestible articles should be prohibited- 

Cbromc Ileocolitig. — The dietary of a child with this disease is not 
eMtly coustrurted. The foods directed for acute cases are all useful, 
mod a dietary esn bp fomnilated fmm them. The effect of any food 
OD the stools should 1k' watched, hut observutionn should not hi- made 
in the presence of the patient, as children of four years or more may 
become very morbid from watching frequent examinations of their 
xtouls. 

The prwiigested foocK such as the beef preparations, peptonized 
milk, and the like, are among the most valuable articles of diet in 
thirse easi«. but barley- or rice-griiel, with or without milk, and eggs 
may aim be useil. Malted milk and the malted fdodK are of service 
at limes. Alcnhol. in the form of whisky, hraudy, piirl or sherry, and 
is wliatevor shape it is most palatable, may be given. 

Inunclious wilh cocoanut oil or cocoa-bittter are useful in pro* 
moling nutrition. A change of air is often followed hy excellent 
result)). 

Chronic Intestinal Indigestion. — Under this head may be included 
the «r<liiiitry form of chronic intestinal indigestion, as well as such 
special forms »k starch indigestion and tile Ku-ealled mtieous disease. 

Where (he cooperation of the mother or nurse can he secured, the 
results of treatment are very satisfaetory. If the diet ean not be 
ooutrolled aliwihitely, it is difficult or impossible to accomplish much 
in these ca-swi. 

Chronic intestinal iudicestion occurs at all ages. In young infants 
it is frequently due to improper feeding, and disappears when the 
child is put upon a proper diet. It may be seen in both brcost-fed 
and boltle-fed bahtes. In breast-fed infants it is fretjuently caused 
by an over-rich milk, in which case u simpler diet for the mother 
with exercise out of doors will be all that is required. (See Man- 



IX FA. XT FBEDiya 



agemeut of Xureing Mothers.) In other instniices, where the mother 
has been taking various articles in order to increase the flow of milk, 
a i-eturn to a jiroper r«K''u«'> britiga relief, lu still other eases the 
child is nursetl ttiu ufleii or too lou^. The iiise«se may <;omc on as 
the result i»r ullowiiig the ebild I(» sleep iiil night at its mother's 
breast, with tlie consequent freqtient and irrogulap night feedings. 
In another trnubleMntie elaHtt of ckkk; no t'HnHe ean be made nnt. In 
ifaeiic, if the r-f)[i(lilinii pi'r.<sitit!i and liir cliiM'a gencnil health is af- 
fected, ■woaiiiuK should be eonsidere*! ; when, however, the child con- 
linues to thrive and the condition can not be relieved, nursing may lie 
allowed to continue; freriuently these cases recover in u short time. 

When the diseasv occurs in hollle-fwi babifs, the ehild has nNnally 
been given, for a considerable period, n food too hiph in one or more 
of the food elements. (This subject has been discussed under Infant 
' Feeding, to which section the reader is referred.) Another frequent 
caasc in bottle-fed babies is the use of a proprietary food unauitcd to 
the ape or eonditiou of the child, or the use of improper articles of 
diet, especially starches and sugars. 

Sug^r and starchy for>d in excessive quantities is a factor in the 
cauHation of this disease that is often overltmked. Careful quCKtiiniing 
freiiuently brings out the fact that sweets of various kindn h«vr been 
given to the infant by indulgent parents or friends. Periodic at- 
tacks of vomiting and pain or of malaiHe and discomfort, analogous 
to the bilioius attacks of older individuals, may usually be relieved 
by rednoiriK the earbohydrates to a miiiimuoi. Thasp attacks are 
occasionally so severe and misleading as to give rise to Ihe diagnosis 
of malaria, tuberculosis, lyplioid fever, and many other diseases, even 
by competent phyHieians. In almost every instanee a complete cur* 
ean be quickly brought abuiiL hy dietetic meanx alone. 

Between one year and eiirhteen months it is eoitimon for mothers to 
desire to inen-ase the dirt of their children. Milk should always 
form the basis of the diet, and if other articles dit^agrcc, a diet of 
milk and broths exclusively may bring about a state of perfect coui- 
iort. 

In Older Children. — The management of these cases is. aa a rule, 
quite satisfactory. They require individual study, however, for in 
one ease the fat may be the cause of the trouble, in another it may 
be the curd in the milk, and in still another the enrbohydrates nnty 
be Ihe diatrirfaing element. The diet should aim tn give the intestine 
as little work to do as possible. To this end, the carbohydrates should 
be discontinued altogether at tlrst: and when (hey are begim again, 
it should be cautiously, and the effect should be carefully watched. 
The fata should be greatly reduced or even omitted altogether. Pro- 
tein should Ih; irivcn in as digestible a form as possible, and peptonized 
if it eansea indigestion. 

in severe eases Ihe child may he fed upon peptonized skira-milk. 
This may be completely or partially peptonized, as circumstances de- 




I 



I 



I 



maud. It should be given in moderate nuontities every two boura. 
Kumiss lua^' be used to vary ihe diet, and buttermilk, if the child will 
take it. forms an ajrreeabic clianKC Ijiijuid i»rinli(i;c«tKd heat preparm- 
tiitus may also he used, (.'hickcii or veal broth from which the fat lias 
been removed may likewise bv given. 

Rare nr raw meat in usually well borne. It should be scraped tine 
and given imnn-iliafely after preparing it. If denire*!. it may b« 
rolled into small Imlls. Of this, two or thnT tablespfKHiFubs are an 
average daily allowance. Beef is to be preferred, but mutton may be 
permitteit. Dish gn.^y from whieh the fat has been skimmed maj' 
be ^veii. and may be 8erv*ed in a green glasH if the color of the fluid 
excites din^nst. 

After a wt-ek or two, if improvement has begun, a malted food may 
be added to the milk. Kskay's Food is of partieular value in these 
intcstin«I eJiKes, and in neeasionally well borne when even pt^ptouized 
milk is not. The food »himld fie given at rcgidar-timcd intervals: 
and if one meal is not well borne, nothing should be given until the 
next regular feeding- time. Absolutely no food should be given be- 
tween meals. Water may be allowed as desired, but should be given 
between meals, so br not to interfere with digestion. Four meats a 
day. or even but three, should be all that is permitted. 

As improvement seta in the diet-list may be extended to include 
junket and simple diKhes prepared with milk or f^gs nr both together. 
Thai a little ]:wiebaek, t«a.st, or thin erackers may be nllnwed. Of 
the meats, cfaieken. beef, and mutton are the most preferable. Th« 
white meat of boiled or roaM flsh may be allowed, without any rieh 
sauces, however, and oysters may be given tn season. The dietary 
niUBt not be increased too rapidly, and it is well to allow a monUi 
to go by before making an.v decided changes. 

Cereals may be added in the form of a little very thoroughly eooked 
rice or barley in the broth. Later, green vepelables. of whieh the beat 
are apinaoh, cauliflower tops, asparagus- tips, or thoroughly stewed 
celery, may be niven. 

If improvement goes on, wcll-cooked eereaU, auch as rice and grits, 
■uy be given at breakfast. They should be thoroughly cooked and 
ntnuned if neeew^ry. Oatmeal should not be given until the digca- 
tion has l»e<xinir mirmal. Well-trooked macaroni makes a pleasant 
t-hange, and fresh-fruit juices may be given, preferably an hour before 
meala. Of the latter, orange-juice is best, but in season the juice of 
fully ripened peaches or grapes, without ekiiis or seeds, may !«• given. 

As irapn>veHH'ii1 progresses, eream mid butter may be added. A 
vwy small portion of well-liaked. mealy ixilato may be given, with 
the addition of cream. Potatoes Bhonid never be given early in the 
treatment, and, when rhut food is nddiMl the effect should carefully be 
watched. 

The dieting muKt be continued for a year or more, and for several 
ypsra later the diet must be carefully supervised. This nnixt be In- 



336 



tVrANT FEBDntO 



sistcd upon, and is untally uot a diffivull matter after improper feed- 
lug has brought on a relapse. Althongb everj- care shmild be taken 
to avoid relapees, wlien ihcy occur tliey form the most powerful in- 
eenlive for viiiilauce ou the part of the nurse or mother. 

Directions as to quuiititiea and preparation of food and the hours 
of feeding should be writteu out, and a careful record kept of what 
the child takeK, and the (|uaiit.Ity, ax well as the number and eharacter 
of the stools, Hy this plan It \h fretiuently easy to detect idiosyncra- 
sies, stid to learn what agrees and what disagrees with the particular 
patient in charge. 

A point of no small importance is the avoidance of stan-ation. 
Unless a physieian thoroughly understands the feeding of infants he 
may starve a child and render it weak, asieraiv, and nnahle to with- 
stand the eflCects of the disease. Cases that have been set down as 
intractable catarrh of the intestine are often merely the results of 
Btar^'atiou or due to an unauitahle tnilk mixture. In such cases, with 
return tu a rational diet recovery promptly follows. 

Intolerance to Pat. — This h fri>qnently noted in infants and alsn 
in older individuals. In infanti it may produce vomiting one or 
two hours after feeding, or the syinplomb may be largely referable 
to tlie intestines. In this case there are colic and large white stools, 
or Romelimes thin grwnisH KtmiN, which are very irritatinR to the 
skin. Sooner or later there is a marked disturbance of yt-neral health, 
and the children are usually, thounh not always, pale and thin. In 
older children an interestint; and often wrongly interpreted symplum 
complex may he noted when too much fat has been added to the diet. 
This may be done on the advice of the physician, who orders a thin 
child to have an abuiidauL-e of cream, butter, and oil. with the idea 
of building it up. Older children sliowinp fat intolerance are iren- 
erally, though not always, pale, thin, and in general had health. 
They are irritable, and often have marked eirelivs under the eyes, and 
the breath ha-s a very foul odor. Often this sjTuptom is the one for 
which relief is sought. In other children there may be marked gastric 
and intestinal disturbance, and atlacJca of c^olieky diarrhea. Bxcesaire 
quantities of fat may he found in the stools. Another interesting 
class of eases are those in whieh there is recurrent vomiting due to 
excessive fat. The diagnosis can usually be made by ii carefid study 
uf the diet and stools, and continued by the efVeet of treatment, which 
consists in euttiug down the amount of fat in the diet As in older 
individuals, there is a lack of absorption of fats when there is icterus. 

Constipation. — Chntnie eonstipation is the cause of more worry 
and diHtri*.s.H ihan almost any other condition. In order to relieve it, 
the diet must be regulated cnrcfully and correct habits be formed. 
The formation of correct habits is of as much importance as the diet 
in the prevention and correction of this condition. Infants as young 
as thre« moutfas of age may lie taught to have a stool regularly by 
placing them upon a snuill chamber at a stated hour. In older cfail- 




DIBT /y DJ8EA8EH OP" CHILDREN 



337 



(Ireii A fixed lime stiould be set for the daily visit to tlie closet. Th« 
besi time Tor this is just after a meal, preferably breakfast, as at this 
time there Ls a wave i>f peristalsis of which advaiitagt' may be takeo. 

CoiiBtipatinii Ls quite eoitiniijii in breaKt-fed iiifantK, and is usually 
due to the child's getting a miiiinium uiuouut of food or a milk that 
is low in fal and geaerally high in protein. The quality of the 
mother's titilk shuiild he iinprcived if jxuMible, followinij: the direclioDS 
prc%K)tiHly laid down. ]ii;tweeri the numings the infant should be 
(fiven water, if this is not suffieient and the mother's milk i.s found 
defieient in fat, 1 or 2 teaspooufuls of cream may be added to each 
narsiug, or cod-liver or olive oil may be given in half to tcaspiKmful 
doses. An efficient ehange in the diet eonsistK in giving 1 or 2 tea- 
spoonfiils of thoroughly c<Kiked oiitmcal. Thi-s should he of about 
the coDsistenec of crcnm, well sweetened with sugar, and !>traiued if 
□eeessary. This may be given once, twiee. or oftener a day, as the 
case requires, and is hmX, leiven with a nursing. Orange-juice well 
sweetened may be preseribod iu doses of a teaspoonfiil to n tablespoon- 
ful, given an hour (»r so before a nursing. Stewe<l pruuc-juice may 
be used in the same manner, and in season any fruit-juice from per- 
fectly freKh ripe fruit may be utilized. Bottled or fresh grape juicti 
is often nf marked benefit. The %~ery acid fruitx should not be al- 
lowed. A teaspoonful of a maltcxl food prepared with barley may be 
given, and small amounts of the thick sweet malt extracts may be 
used with advantage. Mellin's Food may be uivd to sweeteD the 
food in place of sugar Care Hbould be taken not to disturb the in> 
fant's digestion by the too frequent use of any of the articles just 
mentioned, or by the use of too large quantities: only one article 
should be tried at a time. If these nieanK fait, dnigs or .•mppositorieM 
must temporarily be resorted to. It should he borne in mijid that tlie 
constant use of dnigs may defeat any efTort-i along dietetic lines. 

In bottle-fed babie-S. if the milk is moditicd properly, constipation 
will ui^ually be overeome. If relief iti not obtained by this means, 
measures «iimilar to tho«e directed for breast-fed babies must be taken. 
A small quantity of barley- or oatmeal-water may be mixed with tbe 
milk or a malted food added to it. 

The use of frrsb green and other vegetables boiled and mashed 
or pa*ispd rhrongb a sieve will be found useful. (Sec Vegetable 
Purees in Infant Fcedingl. Graham or oatmeal crackers moistened 
with milk are useful and judiciously choHcn foods rich iu cellulose, 
such afi eauHftower, mashed potato, boiled raashcd strained turnips, 
and partif-'utarly oatmeal, will be found useful. Care should be taken 
not to upset the digestion by giving too mncli or starting too ab- 
ruptly. 

In older children, fed according to the rules already laid down, 

constipation is not so fre(|ueut, but when the diet iii neglected and the 

child allowed to do as it ples-ses. it is a verj' common wimplaint. \ 

glass of water, either hot or cold, should be given an hour before 

28 



338 



(y.vr pnEDiya 



Iircakfaat. Cream, fw well as water, should be added to the milk. 
Barley- or oatmeal-water may at times be added to the milk with 
benefit. Meat bnitlis are laxalive m their BffeclM when addml to tiiB 
diet. Under t'iglitet-n nHmllw fruit- juiees, or after that time jierfeetly 
ripp ttouiui fniil, especially when taken an hour before a meal, is very 
genieeable. Kigs and pruiifs st»'Wfd together are helpfii). as are 
oatnicAl and bread made from unbolted tlonr. In miieli older chU- 
dron the management is siiiiitar to that reenmniended for adults. 

Holt maaages an average fHse of i-hronie ennatipation in a child of 
four years of age a« follows: "Massape tor eight minutes, morning 
and ui^thi; the jiiii:e of half an orange and a glass tjf Vieliy imme- 
diately upon rising^: a. breakfast of oatmeal, with one ounee of eream. 
dried bread wilh Initler, Hn eg^, half glatui of milk with eream and 
water added; a dinner of Noup. one sturt;liy vegetable — i.r.., {totjito 
with oream — and one green vegetable, beefstpak, baked apple or 
pnineK. dried breail and butter, and water to drink ; for slipper, eream 
toant. egg, dried bn*ad and butler or Urahani crackera, half glatm of 
milk with oreani and water added: a suppository eontautiug dux 
vomioa and hyoscyanius at bedtime." 

inanllion. — Inaniiion is a term loosely applied to various condi- 
tions; it should, however, be restricted to those eases of aeute starva- 
tion eoniiug on in very early life. It is eharacterized by a loss of 
weight, and umially by fever a» well, and the (-unditinn ib not infre- 
quently niisTiiken for some other disease. It folluw> abstinence from 
food, sueh aa oeeunt iu those eases where tnt'antti are abandoned oo 
door-steps, or are grossly neglected «jid starved. Other causes are 
nunting at a dr>' or nearly dr>' breast, in which case the child seizes 
the nipple eagerly an<i after several vigorous attempts at sueldug 
drops the nipjile. eries. and seems lo be imeomfortable. Gross errors 
in feeding, a^ where a child is given a food absolutely unsuited to 
its Deeds, may also bring iiliout this condition. It may oecur in iu- 
fant<i with enfeebled digestion — either those eongenttally debilitated 
or those rendered so by disease. Sudden changes in food uiay also 
occasionally eause it. 

In the raanaKcmcnt of thcjsc euws. which is apt to be difflcull. the 
same general routine should be followed as is suggested for marantic 
babies. If possible, a wet-nurse should be secured. Holt advises that 
the breast-milk be diluted with an equal volume of water or of lime- 
water. He also suggests that if Ifaere is diarrhea, the milk be pumped 
from the breasts and the eream removed. The proportion of fat may 
gradually be ineivased. When a wet-nurse can not be accurcd, the 
ehild should tirxt be given very dilute nii.xlureH. or a milk so modified 
a^ to \w indiciitrd for u child much young<T than the one in hand. 
These milk mixtures should be partially or completely peptonized. 
The authors have used weak milk mixtures to which Peptogenic Milk 
Powder has bei-ii added, with benefit. These may be given by means 
of a bottle, or if the child will not suck, by means of a mediciue-drop- 



DIET m DISBASES OF CBfLDItEV 



339 



per or spoon, or by ^uvagi^> if iieet-jtsary. [n nil eases in which a vhilU 
rvfiiKt-'K til takt- f(Mi(l u Mliiniiu-h-liilii- shoiilfl he passed in on\or tu 
asocrtai]) if tho e^phu(:us i;^ palout ^>r not, and the fauces should alsu 
be examined L*an'fuliy both by sighi and by tout-h. 

If the peptouizeci milk is not wt-ll bwriit-. iircdigeatrd l)cef prepam- 
tioos, diluted condensed milk, malted or fartUBC«ous foods, albumiu- 
water. barley-water, in fael. any form of food that can be (Hven. may 
be tried. Thi^ae jiisl mentioned are. however, tlie m<»st apt to prove 
useful. Water, if needed, may be (riven by subeutniieoiw injeetion 
or by Ibe reetum. » normal salt solution being best for this purpose. 

Children very small nt birth are best treated in the same manner 
aa premature bwhies. Inanition in nlder infants may often be com- 
bated b,v allowintr food that would nut l)e penuittt'd under ordinary 
eonditioDH. Solid food suited for a crbild twioe the aicc of the one 
under treatment somelirneK sueceetU when evirylhing else has failed. 

Marasmus. — Marusmns. known also under the naincK of ''wnxting 
disease of nhildren," athrepsio. and simple atrophy, is best de^ribcd 
aa a condition of pernieions atrophy. The term inanition should be 
used only for those eases of acute starvation, with their characteristic 
ii/mptoms and causes. ooLMirriitf; in infants. 

Atrophy in infants may be dinded into two classes : The primary 
cases, where the cause is unknown, and the secondary cases, or those 
that follow definite patbologie conditions. The dividini-liiie can not 
at present definitely Iw drnwn. All ease-s ocenrriuK in the courae of 
ibe easily reeoffniiied diseases may at onee be placed in the irroup 
of seeondary'eases — those followlns; tuberculosis, for example. Most 
eaaes seen clinically occur in infants who have not had proper food 
and care. Some authors would place these in the list of secondary 
caaea, and consider them from another standpoint, regrarding the 
proceas of nutrition as twofold— diffestion as the first step, and as- 
similation a.s the set'imd. tender the head of primary' atmphy those 
authors would place only those eases in which the Hceond factor was 
at fault; or, in other words, those cases receiving proper eare and a 
physiological ly correct diet. This diviaion is, for practical purposet, 
useless; and since we lack definite information on the subject, the 
caaes sliould be divided, from a pathologic basis, into those that exhibit 
lesions of detlnite diseas.'^. and those in which there are no special and 
constant lesions beyond wasting of Ibe muscles and body-fat and 
atrophy of the thymns gland. 

If rare is taken to exclude tubercuIosiN as well us other diseases. 
thr> dis^nosis of the c<indition pi-esenis no PKpecial difHeulties. 

In some instHnc^-s the eiuise of the disease ran not be made out. 
whereas in other instances it is traceable to improper feediiiy, lack 
of care, irisnfllcient exercise, and, most important, lack of fre*ib air 
and Kunnhine. 

When eases are seen reasonably early and if the causes can be 
reeognizetl and remedied, the omiook is (rood. In private practice 



340 



tKFAXT FBBI>tyQ 



cases amoug the well-to-do usunlly do well. If scrn late, the prognosis 
is nearly hopeless, and in asylanis and infant homes the outlook is 
mofil ylooiuy. If. when \\w infant is first wjeu, digestive disturbances 
are prcseiit mid can be corrected by dietary meaaures, th<^ i>utlook Ik 
more ttopefiil ihun in tlitise eaKt^-i where sufficient food is taken and 
digested but the phiUl iicverthi-kss contiiiups to waste. I» the really 
typiottl forms thi* is the case, and the disturbance aeenis to be due 
to improper utilizatiou of the foud. Sulticieni fnnd may be taken 
and enough dieested and absorbed, but in the buniitiff-ii|) of thr Food 
in the body some ehange takes piace that permitss it to be disposed of 
without properly nourishing the sj'stem. 

The treatment of these cases is esBcntially dietar>' and hygienic, 
and cither measure alone must fail. The child miist be kept warm, 
and in a well-aired room, if jjosslblc. it should be given sun-baths 
and be taken into the fresh air. In proper seasons of the year it 
should be out-of-doors moat of the time, preferably in the country. 
The child's body should b^ maKSaped gently once or twii-e daily, using 
gentle friction and a lubricant such ns eocoa-buttor or cocoanut oil. 
The nibbluR movement-H should always be direeted toward the heart, 
so a* to facilitate rirculation. The child should be carried about 
and coiidled a^ much as possible, for many of ilicsc infantH are starv- 
ing for want of a mother's love as much as for want of food. The 
child should be fed while lyin^ on the nurse 'k lap or arm. and not 
aa il lies in the erib. Thin last is, of course, impraclinilile in many 
infant homes and hospitals. The fci-dintr should be the same as boa 
been siifrfiosted under the heading of Loss of Weight. Of drugs, 
creosote, besl given in the form of Liquid Beef Peptonoids with creo- 
sote, (.-arlionate of creosote, or carbonate of guaiacol, is the moKt luieful 
in the condition, nnx vomii-n and ah^obol also beitifj of service, 

Huning Homes for Marasmus Cases. — \t bummi c.otdd be established 
for thf TiursiiiK nnd earc nf uuiruntiu babica. tbc infant mortality 
from rhis iliHca^e would be gr(>atiy diminished. This nursing-home 
plan ha?( lieen carried into etTi-ct in some of the citii's of (Jermany. 
in these institutions women who have recently been delivered are 
cared for on condition that ihey nourish one or more infants. Th« 
<inaiility of milk st-crcted by these women inuh-r the conslaut stimula- 
tion of several sm-king ehildren is remarkable. 

It must be remrmbrred that a lartre percentage of the cases of 
marasmus ot^ur in children who have been abandoned by thoir 
mothers at birth. If a child is nursed at the breast for two or four 
weeks, it Is more likely to improve and live than if it i.s taken from 
the broHst imnirdiately and (jiven uncertain milk mixtures. 

Malnutrition. — Maluutritiou is a term applied to cases of defective 
nutrition that rim a more chronic course than those suffering from 
inanition or mnrH.smua. It occurs in infant.'f and in older children. 
In the former the maiw^mrnt is similar lo that, of marasmus: in the 
Utter, the same general rules apply. The life of the child most, so 




DtST JH DtSKAAES OF CHtLOKES 



341 



far an paHsible, be carefully regulated, and an abundance of fresh 
air and sunshine, togcthrr with appmpriute exrn*iHcs and inlcni'ulH 
of undisturbed rcNt, enjoined. The diet is. however, the must im- 
portant elfoient in the treatment. The food should be plain and 
ivholcsauie, carefully prepared, and given at regular but not too 
frequent intervalK. In some Knses il may Ik> fcniml udviHable to give 

laJler menlK at siiorfer intcrvuls. Thr food shoutd lie stich ns m 
'rMotnmcudctl for normal ehUdreu^ a llbt of these articles is (^ivcn 
ebwwhere, where the details of the feeding! will hIso he found. 

FeeJing after Intubation. — Tsually tbJM Is iici-ompli-shrd with hut 
little or no difficulty, hut in some instances swnllowinf; may ut first 
kbe difficult, and in thr^xe eases serai-soUds. such as junket, soft-lioilwl 
tugs or a %cry light omrlet. wine-jelly, or milk-toast, may be sub- 
stituted for the li<(tiid. If the semisolids fail, it has been Kii|r!;cated 
that the child be plactnl with its head lower ihau its btKly, and that 
nouriohment be given while in this position. As soau a^ the child 
learns to swallow with the tube in place the usual light diet may be 
giren. 

Enuresis. — Besides the training and the medicinal treatment, a 
plain, nutritious diet is of great service in ihese eases. In rhe major- 
ity of cases of nocturnal enuivsis, on questioning il will be found 
that the cliitili-eu have been ^'etliup lanze fjuaiitities of wifTee or tea, 
or that laii;e auiountx of water have been taken during (he evening, or 
that the bladder hu> not bccu emptied before going to bed. In these 
cases the treatment is ohviouK, and eonsisLs in esrhidinp cniTi-e, t^-a, 
and stimulating fotnls (Hpirea and tiie like), and in liniJtiiiii the 
amount of fluid taken after four in the afternoon. Mneh can be 
done by proper training. When dcpipiulent upon other causes, tbe 
treahuent munt l>c directed toward tlicKc couditiouti. 

Rachitis or Rickets. — UickelH \u a disease of nutrition, bill one 
that i.<i not well undor^tood. Most of the cases occur in the temperate 
20ne, and .snutliern raees trannported north seem eHpecially predi»- 
powd to it. It is very common armmg the negnK-s of Baltimore. 
The MUlhors have found that nearly IDO i>cr cent, of the infants in 
asylums for e<il(in'<l eliildren were affecte^l with rickets, whereiLs in 
similar in.stituTionK for white children in the same city the disease 
ras rar«. Italians living iu America seem prediHposed to it, and 
ebildren with bad hyuienie surround lugs are more a]>t to be all'eeted 
than those reared amid better conditions. It is a disease of the city. 
The majority of the ossm wvur between six months and two years 
of age; it h not often seen in breast-fed children nnlcKs lai-tiition has 
been eoutinned for t<H> long a period, lloli Hiuleti that among the 
Italian.'i in New Vork City it is not nneoinmon tn find il in children 
who arc bn-ast-fwl. 

Rickets may be produced experimentally in animals, as has been 
proved by Bland Sutton In bis famous experiments: he fed [ion 
wludos nn an exclusive diet of raw meat, and in a short time they 



■i42 



tyFAKT rsEDixa 



developed wvere rickets. They were givco milk, pounded bones, and 
eml-livor oil, and iu tliree mouths, williout a.iiv chauge iu their sur- 
miuidint^, th'e.v vcre curvd. Qeuriit experituetitcd on a litter of 
pups, »nd found that thiiKi- whu suuklt^d did well, uOit^rpHH thtNW fed 
on mw meat ik-vi'lupfd rii-kels, Nuincnjus i>xpiTimr»t.s of this kind 
h«ve I'ot'ii coiidui'tod, and while deductions were not always in accord, 
they tended, neverthplwis. tn show that the dis^a-sp may lie prodneed 
by withtifttdini; milk Fixim y<iung atiinifilH and mdiKtitnting for it other 
articles uf diet. 

In ehitdreii fed arti^eially by irii|iroper methods riekel»c ifi apt to 
develop, A food low in fats is fspevially liable tn produce tbe disease, 
partii-ularly if, at the naiue time, the pmteinK ari? alwi defieient. In 
Kiich B diet Ihi-rr is almost riTl«in Hi be either an exeess of the car- 
bohydrates or nf some substoneo unsuited tf> the child's digestion, 
Amoni; fiHKlx that c-aiiKe riclcplx may be mentiimed some of the 
jropriHary fondfi and condensed milk. 

fhe time saltR are, under pprtnin enndittons. apparently absorbed 

th diBi«udty, and this would seem to be tht- rase when the food 
is defieient in fat. Hence if the child's diet lacks fat or if the lime 
galls are dpfieient, the bone>; will be improperly nnurlsli^d. It has 
been thont;ht thai this was due tu an exuess of tactic acid, aiul there 
are A iiumbor of other theories thai iu4ed not be «onsidered here. 

Diet, — The feedinjc in rickets ia very simple, and wben it is possible 
to roinbiuc with it outdoor life and proper rare and nursing, is very 
efflpicni. If the child must be fed artitieially, and if it exhibits 
Bj'mptoms rbat are sugKestivc. such as sweating, tenderness, or restless*- 
ncsfl at uitfht, it flhonld be given ereani or cod-liver oil in addition to 
the proper diet. In this way the disease may be prevented. When 
the di.seasc has developed, the I'hild should U' ]>lai-ed (m a vliet Kuitable 
to its ofK, as «u(fifested iti the wctioii on Ihe Feeding of Infants-, the 
food should consist in t'rexli milk. vggn. meat, vet^-tablcs. and fruit. 
The basia of Ihe diet should be miik, which should eontaiu 4 per cent, 
of fat if the child can digest that amount and is old enough to receive 
it. Fat in some form must br supplied, and where cream is not well 
b<>riie, other forms may be tried or ihey may be given in CDmbinatioil. 
Of thes4>, cud-liver oil is one of the mt^st valuable, ainl may be given 
plain, in teaspoonfid doaes or less, so as not to disturb the digestion. 
If the plain oil is not well bonic, it may be yiveti in the form of an 
emulsion nr with malt preparations. Fat bacon browned to a crisp 
by dropping small pieces in boiling trrcuse may be tried, and will 
often agree where other fats do not. Uaeon fat dropped in stwicbaek 
ia very usi>ful. Butter may be uswl, bui in large aniouuta this maj- 
not be HD well borne as the other forms. Care sliould be taken that 
too much be not given and the child's digestion disturbed by exceas 
of fat 

Ver>' youiifT infants with'rieketa do best on human milk and it 
should be secured if possible. This may be supplemented with cowa' 



OtBT IX DI8KASnH Of CmUHlKX 



343 



milk if necc88ar>*. Vegetable purtkis, as described dttcwbcrc in tliis 
vuluine. should be piveu as well and strraped meala, and fresh or 
stewed fruit juiee added to the diet. The carbohydrates ahould be 
limited, but not excluded from the dietary. Soy flour addeil to tlt« 
milk, as a t^ruel or «<ldeil t«> soiipx or eercals supplies additional fat 
and protein in a fnnii readily utili7,ed. 

intestinal Infantilism. — Herler has described a form of dwarfs 
vliaraclerized by mi arreHt iu development, with a daecidily of the 
ma<M-ie«. but with a eond f^Ttuiv n( mental power and normnl develop- 
ment of the brain, an is ovidotieod by the size and shape of the head. 
There is alKo iutesliual di^ttirbauce, usually with large fatty atools 
and tt distended abdomen, due to ditatatiou of the colon. There is 
a moderate prnde of arieniia and rapid onset of physical and mental 
fatieiiL'. lie bi'lievL'H thediKeufie to be due to non-absorptiou of (.-alLNum 
and inMfrniatium and to Ihi* rmtrietiun of t-arboliydnite and fatM, due 
to poisoning by the products of eertaiD forms of bacteria not normally 
present in the intestinal tract of young cLildron. Those eases where 
eare can be given usually result favorably, and after ten years of 
age llie (rmwrh is »pl lo !«• rapid. The diet is entirely a matter ot 
experiment in each individtiid case. ITerter advises giving large 
4|u«iititios of RL'latin, in mjUiinif a eorresponding decrease in carbo- 
hydrates and fats, and ineroasin^ protein somewhat over that or- 
dinarily taken. Milk is borne well by some, ]>oorly by other cases. 
Buttermilk and fermented milkn may be nwfnl, partirnlarly in tlic 
later stageg. Cod-liver oil is of great service iu tbo^e caj^s. 



DIET FOR SPECIAL CONDITIONS 



DIET FOB IS£ AQ£D 

Wren a man ha-s passed Iiis fiftieth yrar his diet should be guarded. 
Dicl:«ry iiididerptioiis or a too plentiful diet will rosiill t-illior ill Ibc 
putting on of llesli atul th? eonKecguent diNCMiiifDrtH of obesity or iu 
Uic development of gout or allieti affections. In cousidmug the 
diet nf Ihe agetl ibe old dii^tinti tliut a tnati its as old as. his artoriiw 
applieK. Affr. can iwt atuuijs bv counted by ye^lrs. In tlie agL»d there 
is a Ics^ninfc nf all physical activities. The old man takes less ex* 
ereiHO, lias diminished powers of digestion, and is lew tible to absorb 
ibe nutriment he Iibk digested. His cireutetion is poor and his Imwels 
ari' (niusliputed. Degenerative pn:>ci-s.<teii have taken place in his or- 
gans, and he in nwire apt to feel the effeets of indiscretions in diet. 
For these rea.wns ihe diet should be lighter than in younger years, 
and the amount of food eaten should vary with the needs of the 
individual. The food Khonhl be nf an ea»ily digi^tible variety; it 
afaoidd be given in Kuiuller qiiHntities at a time, uiid the intervtds 
between nieabi should be shortened. If there is a tendency to cbi>«ity, 
food that iK apt to he vonverted into fat Kbnuld be given iu dimiuiabed 
amounts. The protein.s shouhl be aouu-wlLat lesseinnl from time to 
time. The practice of eotiug heavy suppers late at uighl and of 
eating between meals should bo discontinued. The person should 
learn what particular articles of food disagree with him. and refrain 
from eating foods that tend to eause flatulence. Yeo suggests that 
in the eaxp of cooked fniit.s a Kmnll quantity (about a Teaspoonful to 
the pound of fruit) of sodium bicarbonate be stewed with them, to 
correct the acidity tliat causes flatulenee. 

Id the aged food bears a elose relation to sleep. A cup of hot milk, 
hot todily, or some hot liquid food taken at l>ed-ti«ie will often over- 
come iroublesonie sleeplessne-ss. A few sips of milk or a mild stimu- 
lant taken during the early morning hours, when the aged are apt 
to awakeu, will frequently insure sleep again. 

Another point of interest is the question of mastication, as in the 
agf*! the teirth are liable either to be Inst entirely or to be unlitled 
for chewing. The rather general use of false teeth has largely 
reiiie<lied this, but il may be nece.><ftary to point nut that farinaecoos 
foods, which slip easily and qnirkly into the Kloniarh, must either be 
avoided or ehowed thoroughly, m aft U> prevent indigestion and 
flatulenee. Wbeii the teeth are lost, or are defective, Ihe fiHxl should 
be soft in charaeter. Meats should be miured or cut in very small 
pieces, or wrved i n soft stews, and hard crusts and the like softened 




DtBT FOR THE AOED 



345 



b>' mtokiuK iu uiilk. tea, or coffee. Cbewine should be insisted on tx> 
msalivale ihe starcby foods. 

TLe dit!:e6tive abilities of aged people vary greatly, some tajciiiff 
but little fond &ud i;xperieuciu^ difficulty eveu iheu, while »lbeni 
eat a great deal more and seeiu to enjoy it more than they did in 
their j'ouiieer yearit. ThiK latter class jtometiiues pave the wa,v For 
various difficiihies later by their iiiurdinate i-atiiit:. When lliey have 
high arterial tension, complain of giddineeif, ttitshing after meaU, and 
sometimes of no8ebleed. it is well to limit the amount of food taken; 
the Rame is tnie where there in a tendency to obesity, and old. obese 
pcnoDH with chronic bronchitis are frequently benefitted by a core- 
fally adjuHted diet. 

All compliestpd dishen are best avoided, aa well as those which are 
faiftbly Reasoned or strnngly flavored. All foods whioh arc liable to 
ciiu.se diypstive diNtnrhHnc** or toxemia shmild lip let al<mp, iis many an 
old p<>rHon in rnrrieti olY by ptomaine poiHoniitg rausc<l by Komt! f^anie}' 
food, which one with a vigorous diKestion might have euten with im- 
punity. Stale L-amiM foods should not be taken at all, and articles 
of diet which the individual kuows from experience will cause trouble 
abould Ix^ avoided. As |)eople grow older it is a treneral nde that 
they crave sweets less, aud that suizars are less easily- digested and 
are more liable to cause indigeation and flatulence. Wheticver colic 
iw eomplainml of, the KweetM should be cut down in quantity or a^'nidod 
Paltogelber. and if this does not remedy it. the cause shoidd be sought 
either in fariuaceou.^ foodR or vegetables of the cabbase family, or the 
legumeK. 

Foods Suitable for the Aged. — Milk may be taken tii all forms 
rhen easily digested, and when it is not well borne the addition of 
rami Vichy or warm water will oftwn prove helpful, or the milk 
tuay be dihite<l with cereal gruels, or have sodium citrate (one Krain 
to the oiutcc) added to it. Deef-tea is often useful and beef juices 
may also be uiied if desired. Eggs, lightly eooked or beaten up with 
milk, are very Ufseful, as are uulritious soup». such as ehieken or fisli 
purees, mutton, beef, or chicken broth. Vouug and tender chickeo, 
game and other tender meats, and good quality potted chicken or 
other potted meats may be taken, and sweetbreads are easily digested 
if fn-sh aud properly preparwl, but may he eontraindieated on ac- 
count of the pnrin nitroijeii contained. White flsh. such a.t sole, 
whitine, smelts, and the like, are all suitable, and are best when boiled. 
Crisp grilled baivin is reltslie<l by many. 

^ The fiillowing fo(wIs are all suitxble: Bread-iuid-milk made with 
the cnimbs itf stale bn-ad and without luiujus. Porridge and oatmeal 
gruel. Puddings of ground riee, tapioca, arruw-root, sago, maeanmi, 
with milk or eggs, and flavored with spices or served with fruit- 
juice or jelly; bread and butler, the bread to be at least a day old; 
nwk, to be soaked in tea or milk aud water. Prepared foods, oou- 



DtET FOJf SPECIAL COyDtTJOSS 



sistiuK of predigested ^^tarcfai's: at this age tlic digestive f«rmeuts are 
provided scautUy by the digestive urgaiis. and soluble carlHih,vdnit«« 
urv vuluublv fur uiuiutuiniitg the bmiy-iicat. All t'aniiaceoiiN foodK 
should be Kubjeeted To a high I<'m|>erature for soinc^ tiiiie durini; the 
cooking procesii. so as to rt'tider the slari^h'graiiules more digaslible. 

Vegetable purees of all kmds may be takeu in moderation — e.g., 
potftlneH. carrots, Kpitiat-'h, and ntht-r siiKnuIeiit ve^Ptables. Potatoes 
and fresh Vf(ri-t ablcs are a iirfi-ssily ; if omilttd, a smrbutic state cany 
be euKoiidered. Slewed celery huci stewed Spaiiinb or Portugal ouioiis 
leud variety to the diet. Stewed or baked fruits, fruit- jellies, and 
the pulp of perfectly ripe raw fruits in small fjiiantity may be t-sken. 

Dr. Gcorg« S. Keith, in bin Kads of ai) Old Physician, gives the 
following account of hi.s diet in his old age: 

"For breakfast I have a large cnp of tea, with milk or cream; 
broniL bread, from two to three oimces; and usually one and a half 
ounees of fish, or half tliat quantity, and that very rarely, of baeoii. 
Somelime« for a fow days I take a nip of eoffee with half milk, but 
no fish or baeoii. Luuch in a eup of cocoa or chycolal^-, if the weather 
be eold; if it tii warm, a fim&ll tumbler of milk, aJinut six ounees, with 
the »amu fpiantity of hrejid as at bretekfaat. At both mraln 1 nec^ 
butter, not a quarter of an ounce, und quite ns mueh jelly or mur- 
lualade. This is my usual lunch, but occasionally iuKlead of ebeua 1 
have u baked apple, or some prunes with milk, or strawberries with 
cream so long as I can gv't thnm, or verj' rarely veRetable fionp. When 
I have no milk I take usually a morsel (not half au ouuee) of eheese. 
At 4 P. M., u Mtiall eup of tea, and .sometimes biscuit or eake. Kor 
dinner, at 7, which Ik my ehief meal, 1 have Koup, from pens, lentils, 
potatoes, celery, rarrots. etc.. the first two made with no meat sitoek, 
and the others with a little from lamb or a bone: or tiwh soup, the 
only animal wnip I induljie in. Fish, mostly white deep-sea fish 
direct from Montrose; of this 1 take no more than three ounces, with 
a potato and always another vegetable fresh from the garden, li 
there is no fish, I may take onee or twice a week an ounce or two, 
vcrtaiidy not more, of lamh^ game, rabbit, or tripe; but often 1 have 
neither Hsh iior tjesh. The dinner ends with stewed fruit with cream, 
or pudding, or fniit tart; of these I take a fair helping. During the 
winter season, instead of fruit or pudding, I often have celery, with 
cheese, oatcake and butter, Ou ibiB diet I enjoy the beKt of health, 
and for ray age f seventy -eight) am up to a fair amomit of esereiae, 
walking three hi hIx miles daily iu good and Komctimes in bad. weather, 
and usually part of this i.s up a steep road with a ri«e of 2f>0 feet. 
The only confession 1 have lo make is that when at home T do not 
riKc till J have had breakfast and read the newt^paper. This is a 
habit I have n-eouimcnded i<> many nppmaiihing my own age, and 
those who have trirtl it admit that they arc Ktronger for the rest of 
the day. 1 enjoy brcabfasl just ns much as my other meats, though. 



DtBT FOR 7Hf! AQBD 



347 



I never feel what can be called hunger, and have not done so for 
many year^. I vtiiiUl utiiit a meal at auy timv witliotit (lisumufort. 
Thw I hiivf limg l^Kikfcl vipoii as tlii- l>est prwof of [lerfciL't (liKO«lMit. 
Diiriiiu very warm mouths I take rather less lireud and biitl«r, aud I 
do tictt try to make this up by takiug an.x-thiiig else." 

DIET DURING PKEONANGT AMD THE PTTEaPERIUM 

Diet during Pregnancy. — Under ordiuary eirt-umNlaiiLr** no other 
diet than that to whieb the patient is aecusiomcd is advisable. The 
fwid slitiiild i»e plpiilifiil and iiourinhing. All highly seosoned food 
and indigrstible artieies are to be avoided, as arc all artieles u-hic-li are 
knovri) to disagree with the pHtient. Wlien there is a morbid eravini; 
for unNiiitable thin^H the patient tihmdd be carefully gniarded against 
itidulcinK her appetite. Spit'inl dirlti may tit- ortlTed for patients 
with diabetes or heait disease, or where the patient is jioHty. over-fat. 
anemic, or eblorotic. Prochowiiick ' has called especial attention to 
thc^c couditiona. 

Diet In Obesity and Pregnancy. — In general, the diet is the same 
as adviM.ll in obesity. This ^haldd be combined with exercise, either 
walking or tiuht gyDiriaKtim and luassace. which should not. however, 
be given over the abdomen. The diet should eonsurt of meat, li8h, 
grrcn vrgelableH, fruit, and u small allowajiee of carbohydrates. 
I'roL'huwnick allows 4 or 5 ounces (I20-l.>0 grams) daily. Fruit is 
permitted, but slinuld not be eaten in Ton large i|itanttlie!i nor tn re< 
lieve tliirst. The amount of fluid hIiouWI be restric-ted to a pint or 
a pint and a (Quarter (500-600 ccm.). Proohownick allows a moderate 
amount of fat. && eream and butter, but not fat sauoes. Suups, 
sweets, spirits, and preserves are to he avoided. The following i* a 
aanplc dietary as advised by Procbowniek: 

7.t)0 A.1I. — Four ounces (12S cem.) coffee with milk: 1% ouncee 
(40 grams) bread and butter: 1 or 2 eggs: a Uttle fruit, b«fore or 
after this 40 to 45 minutes walking. 

lO.Ofl A.M. — MasRape or gymnastics. 

](>.:iO A.M. — Kniit; 1 ega; a vcr>' Kmall slice of bread and butter. 

i/k/</<ii/.~Koa8t or tolled meat or fish; vegetables, do beets or peas: 
salad: cheese: fruit: A ounces (125 ccm.) water or wine and water. 
No afternoon nap. 

4.00 P.M. --A smiitl cup of coffee or tea. not over 'A ounci^s (100 
ccm.1 ; a very xtunll slice of bread and butter; au egg. if necessary. 
Walk for an hour or an hour and a half. 

7.30 P.M. — Eggs or cold meat; 4 to 6 ounces (12.^-200 ccm.) tea 
or milk; 1 to 2 ounces ('40-60 grams) bread: butter: fruit or salad. 

Thirst is usually complained of early in the treatment. The diet 
ahonld be varied to suit the patient, and the mnlinc Hhniild be so 
arranged as not to be disaprecable to the pMtient. The result of the 

> Thenpvittitcht MonatKhrift, IIWI. 



348 



DIET FOR SPECIAL COyDITIOXS 



lowered amount of Duid and carbohydrate, together with the exercise 
and masRage, in to r*duoe the amomit of fat. lone up the system, and 
to produire a .small chihl, na that labur is uiudt- easier. The uriue 
should he examined Irom time to time and the patient should be 
weighted. 

Prochownick's Diet in I'elvic Contraction.— Accurdiii^ to Pro* 
chowiiick, Klorschiit!:, and others, a <lipt deficient in rairbohyd rates 
and fluids will result in a Kniall child withniit otherwise inHueiiciDK 
its development: a view which hus been e^iifirnied by Pattou iu Eag- 
land. 'i'he diet in ndvixed in woiiipu who have previmisly borne very 
large children and in women with contracted pelves. In the latter. 
Prochownick does not advise th<? diet when the conjugata vera is 
below 8 em., hut there are inKtariees where tlie ehihl was Wrn alive 
and well with the conjujrata vera 7, 5, 7, and even 6.5 ran. By 
following his plan difficult labor may often h<f fibviated, and even the 
jnduetion of premature labor unnecessary. The diet may be Iwguit 
ten or twelve weeks before the birth is exiteeled. and after the tirst 
week or two should be rigidly followed. Fraciikel advises bcginninjr 
four or five months before delivery. The average diet consists of 
140 to IBO prams of protein. 80 to 130 irrams of fat, and VW j:rani8 of 
carbohydrates, altogether a value of 1800 to 2000 calories. The fluid 
Kliould be reslrieled to about TiOO eum. per day. Prochownick 's origi- 
nal diet ' is as follows: 

Break fasi. — One small cup of coffee (3 o«.-100 ccm.) ; zviebock or 
bread (1 uuiiee-2.'> (;rams) . a little biitlfr. 

IHnntr. — An,v kiiul of meal, ck^s. or Hah, with Utile sauce; srecn 
vegetables prepared with fat (as cream) ; salad; cheese. 

Supper. — Same as dinner, with 1 to l\4, ounces 140-50 grams) 
bread, and a« much butter as desired. 

Absolulfly forbidden. — Water, soups, potJitnes, desserts. Kiigar, and 
beer. 

Drink per day. — Red or moaelle wine, 9 to 12 ounces (^MKMOO 
cem.). 

All the motherK bore thifi diet well after gettinK UHcd to it. Thirst 
was complaiucd of duriuf; the early part of the treatment, and is 
especially noticeable iu fat women. Some object to the large (juan- 
titics of animal food, but this in overcome by the use of irreeu vegeta- 
bles and salads. All the ennttnements reported have been easier than 
on previous oeeasions. even when the child wa.s large and fat, and 
all the children were born alive even though the majority of the 
mothers had had previous mi3carriage)>. The children were lean at 
birth, with the bones of the head nnusually mobile. The children 
were all apparently matun' in every way. In the majority of in- 
stances the I'hild gained normally after birth, and the diet apparently 
had DO bad iaHucnce on lactation. The urine should be examined 

1 OmtnllUttt fir {Jynikoloyie. 18S», 33. 



DIET DVRIWG PnEQXAJCCY ASD THK PVEHfERWU S49 

regular!}' and the amount of urea (Wtimatetl, It has been sugge8l«d 
that such a diet would favor cclumpsia, but this has not been borne 
fiut elinically. 

Diet during the Pucrperium. — Formerly great reatrictionR were 
placed on the diet of a recently delivered woman, thus accouuting. 
in part, for the loss of weight that has bcea noted. If there is no 
nauKi-a and the patient desires it. a cup of tea or a g)ai« of wartn 
milk may be ^ivcu soou after delivery. 

The api>etite is generally poor for a few days after delivery, but 
fiwd should be given at regular intervals not too widely wpurated. 
The first day, milk, milk-toaat. or. if desired, dry or liutten-d li)tt»t, 
with eoJTee, tea, or w)cott, aopordiiig lo the taxte of the patient, may 
be given. ^Ya(er nmy be alIowe<l «» di-sircd. On the second and 
third daj's simplj' soups or any of the following may be added to the 
dietar>- : Meat broths, beef-tea. soft-boiled or poaehed eggs, raw or 
stewed oysters, and some simple dessert, sueh as wine-jelly, boiled 
custard, or junket. r>uring the next few days chicken, scraped beef 
or mutton in small quantities, baked potato, riee. and eereals may 
be giveji, and by the end of the week a gradnal return to the ordinary 
diet may be made. 

DIET Dl THE SPECIAL DISEASES OF PBEGNAHCT 

Lowered Urea Oulput.^Ouriiig pregnnney the urine should be 
watehwl rl<wely. and an examination for albumin be made weekly, 
espwially if there is the slightest reason to su»[)ecl kidney disease. 
If albumin is found or if any untoward sii'mptoms arise, the nrea out- 
put for tweuty-four hours should be estimated. If the quantity ex- 
creted is below normal, the patient should be put at once on a milk 
diet, tlie milk generally lieing Kkimmed (see Milk Cure and Diet iu 
Xephrilisi. If the patient tires of this, lettuev salad and bread and 
butter may be allowed in addition, together with zwieback or biscuits 
(craeki^rs). Very Kiiiall iiiianlities of herririi; roe may be given as 
a relish. \n nimndaucc uf water, either plain water or what is known 
as Buffalo Lithia Water, should Ik drunk. Cream-of-tartar lemonade 
(one dram to the pint ) is also useful as a beverage. 

Salivation. — If tbia occurs, the patient should be put apon a rlgor- 
OU-s milk dint. 

Cing)viiis.-~ln thi.s eondition a genen)U8. well-mixed diet, including 
fruit and fresh vrsetables, it indicated. In addition tonics and 
astringent mouth -wa-iheit, especially those containing the tincture of 
mjTrh, «re to W prrseribed. 

Pernicious Vomiling.-This is often associated with diseased con- 
ditions of the kidney. Whatever the cause, the patient sliould be 
kept in bed and placed upon a restricted diet, consisting of pcpton- 
i£»l milk and similar preparations, given in small quantities at in- 
tervals of three or four hours, or even oftener. Rectal feeding may 



350 DIET FOR SPECIAL COHDITIOHS 

be employed for several days, the patient being given little or noth- 
ing by the mouth. High injections of salt solution help to allay 
thirst and to control the condition itself. When the vomiting has 
ceased, the return to an ordinary diet should be slowly and carefully 
made. 

Aberrant Mental Conditions during Pregnancy. — The patient 
should be placed in bed, if p<^sible, and excretion promoted by means 
of baths and the like. An exclusive milk diet (or one that is nearly 
so) is generally to be preferred. 

TEE EFPECT OF DIEI ON THE DETELOIKEHT AND STBUCTITBE OF THE 

triEKVS 

Malcolm Campbell ' has drawn the following deductions from his 
experiments on rats: 1. The use of a non-physiological diet — for 
example, exclusive flesh, rice, or porridge — induces in the great ma- 
jority of cases a modification in the structure of the uterine mucous 
membrane. This modification consists in a diminution in the number 
of large connective-tissue type of cells, which appear to be important 
constituents in a physiologically active mucosa. 2. The structural 
change is most profound in animals fed from weaning on an exclu- 
sively ox-flesh diet. In such animals the development of the uterus 
is also most interfered with. 3. The structural change is associated 
with sterility. Watsou has pointed out that a meat diet, if begun at 
weaning, almost invariably led to sterility, which is probably due to 
the structural developmental abnormalities in the uterus induced 
by the abnormal diet. Campbell also calls attention to the fact that 
the consumption of meat per head in England and Scotland is almost 
seventeen times as great as it was in 1750. During the same time 
there has been a marked fall in the birth rate. 

1 British Medical Journal, May 25, 1907, p. 1229. 



SPECIAL METHODS OF FEEDING 



I 



BECTAI F££DI1IQ 

Nutrient Gncmala. — The administration of food by the rectum 
is a niptbml of fcediu^ of ancient uriL;in. .Ktiuti and others mention 
it. aud writers during tbtf \fiddtp Age» have rpftfrred to it, though 
□ot in very jjlowiiig Icntui. Ibvir imficrfect tetbnic probably rcsiilline 
in pracrical failure. Voit and Bauer found that a Aog's rt^t-tum 
would uot absorb egg-albumin aud water unless ttodium chlorid wvre 
mixed with it. This last seems to catise reverse peristalsis, and 
Otnitzner has nhown that nuhstaiiri^ introdueed with the salt solution 
may be found in the i^tomach, a fncl tbat has been eouQrmed by 
Swieznski. 

Kuner believcK that but on«-f»urth of the uutrimeut needed by the 
body con -be absorbed by the rectum, and both be and the earlier 
writers placed the limit of time during which rectal feeding was prac- 
tieable at from one to two weeks. With careful leohuique, this [leriod 
may be i-iteiidcd from four to six weeks, depending on Ibc capacity 
of the individual for continued absorption, and on the amount of 
energy Htorod up in his body at the beginning of the rectal fccdinf^; 
bnt von Lcube haK kept a patient alive for six mouths, and Hiegel for 
ten months, on exclusively ri*ctal feeding. Some of the more recent 
writers have insisted strongly on the limits of rectal feeding, which 
ore, perhaps, often misundcrsiood. As only about oue-fourth. and 
often even less, of the amount of nutriment needed can be absorbed, 
the method is only useful in protecting' the body from eiceHiire loss 
during periods of partial or complete Klarvation due to causes 
enumerated below. 

It slionld be borne in mind that the patient starta on hU period! 
of rrctal feeding with more strength than he will huve later on, and 
surgeons and others should not attempt to build up a patient by a 
period of rectal feeding. In some protracted cases the metabolic 
processes evidently are carried ou at a very low rate, and the small 
amount of nonrLshtnent given by the reetum may aid matprially in 
keeping the patient alive, and in otiicr cases it may bridge over a 
critical period. 

In starvation it ir thought that the amino-aeids in the circulation 
from tissue destruction may be used to build up other tissues to some 
extent. 

All the various foods may be utilized in rectal feeding, but in- 
vestigators are not in accord as to the best forms nor an to the amounts 
absorbed and tbe subject in still worthy of further study. There are 

Sfll 



352 



BPECIAL UETttODH OF fEEtitSQ 



probably wide indiTidual variations so thai mauy careful abbrevia- 
tious will have to be madp to get at the i-cal facts. If vuu Li^ube 
and Hiegfl are to be believed m to tlic leut^tU of timi- pntients cau 
be Itcpt alive ou luilk, yolli of egg and wine mixtures, then the recent 
investigations idb^ place too low a limit on the capabilities of the 
bowel to absorb food administered in this way. Rcverxe peristalaU 
m^bt explain some of the exceptions. 

Kdsall placfs the amount of uiitrimcnt that it is possible to absorb 
by rectal feeding at about one-sixth the requirements of the bodjr. 
As far as the protein is concerned it is highly probable that sonie 
thought to be alMvorbed us food was destroyed by baeterial at-'tiuu. 

Studies by Short and Byswatcr (British Medieal Jouninl 1913, I, 
1361) on the nitrogen output in the urine of patients fed on milk 
and egg iiiixliire»i was about that uf fasting individuals, but those fed 
on amino-aciils pmducni in th*-. laburatory and on milk paiicrealixed 
for iwenty-four hours showed bettor results. They suKKest that nu- 
trii'nt eneinala sboiild 4!UU8ist of amiuoids, eommercially prepared 
HmiriQ-aeidii. The iiminoidK made by the Arlington Chemical Com* 
pany have a value of 90 calories per ounce. As far as we know no 
reports have been published on the use of these, but they have been 
tried without any untoward effects uud apparently with decided 
benclit. The substance reipiirpH further investigation. One of tb< 
French writers. Berthelot. thouiclit that untoward results were some- 
times obtained fn>iu certain preparations obtained by complete cd- 
zj'mic hydrolysis of nuat which hf attributed to the preservatives 
used. From a sample of aininoids there was a total nitrogen of 
11.^8 per cent. Amino nitrogen equals 8.90 per cent., or what is a 
little over 7-1 per e<?nt. of the total nitrogen in the particular sample. 
Prom 30 grams of thi.s there wrre 3.59 grains nitrogen; 74 per cent, 
of this would yield 2,6 crams of amino acid nitrogen, which theoreti- 
cally should be ready for blood absorption. Aminoids may be ad- 
ministered alone or with dilute alcohol solution. It ahould be re- 
membered that this material, while very promising, is still in tbe 
otecrvational stage. Pflncreati3;ed milk Uwenty-four hours) either 
plain or to which dextrose and alcohol and salt have been added, may 
be used and may be alternated with the dextrose alcohol mixture 
suggested for the drop method. Dextrose se<.>ms to be the best car- 
bohydrate for rectal feeding. 

There is a great deal of difference of opinion about the absorption 
of fat. Until it has been defUiltely disproved that fats cannot be 
utilized by tliLs method we suggest Ibeir use. perhaps best in the 
form of fresh yolk of egg. one or two of which may be added to the 
above or to plain twenty-foor-honr pancreatized milk. Other animal 
fats of low melting point, as cod-liver oil very thorouifhly emulsified 
or better, homogenized, might be of service. The use of fata requires 
farther ohBer\'a lions. SaponiBed fati; have aim been suggested. 



RECTAL FBBDISV 



363 



As far as wc know little Iwh been douv in thu way of supplying 
the miucral constituents «x<.>«pt as tbey ar<c present in milk or egg 
yolk. 

AIcuIkiI is iipitaroiitly well absiorbeil iii U.ii to 2 per cent, solutions. 
and is a t-aluabic adjunet to nutritivf enemal». It would seem lliat 
it increases the abtuirbabiltty of the other constituents of an enemu. 
Salt may be added with advantage up to 1 per cent, and seems to 
aid in absorption. 

The sueoess of the method depends larftcly on proppr trchnir. With 
poor technic the rectum soon becomes irritable, and for this reawm 
rectal feeding should not be intrusted to the nune or the faniil,v, but 
the ph.v'sician himself shonld see that it Ls pro[(erIy conducted. In 
hospitals or in pinvate praetiee where the nurse bus been specially 
trained general directions may snflfioe. but in any ease cxplieil written 
directions arc advisable. Once the rectum becomes irritable the proc* 
ess is conducted with difficulty. 

Procedare.^The rcetum should be eleaused thoroughly by ad- 
lllinj^Ie^iIl^ 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 feedine by a cleansing enema. If the rectum is inflamed, a 
solution of boric acid may be used instead of the salt solution, or if 
there is muvl) mueuK, a satutiun of sodium bicarUniatp may b« em- 
ployed — a tcnsjMinnfiil of either to the pint <if water being sufficient. 
For the firvt one or two cleansinR enemata the bowel should be flushed 
by the ordinary method; later a return-flow catheter may be used, 
with this Ncvenil ipiarls of solutJou may be used; without it M> to 1 
pint will be sufficient in most cases. 

The temperature of the cleansing enemata should be b«tween 95' 
and ^)° F. : that of the enemata which are to be retained, between 
90' and On" F. Solutions that are too hot or too cold will promptly 
be rejected. 

The patient should lie on his fjide. with the hips well elevated. On 
ai'eoiuit of disease this position muy be impracticable. A rectal tube 
or a large eaiheler should be used. This should not, however, be too 
large; a lube 1 em, [about half on inch or luia' being the proper size 
for an adult. For children the tube should t>e proportionately smaller. 
It should be lubricated thoroughly, but glycerin should uut be used 
for this purpose. 

In introducing the tube, it should be twisted slightly, which lessens 
the liability of its becoming impacted In the rectal folds. If it is not 
passed easily, a small quantity- of the fluid should be allowed to Haw 
ill, wh>cb will serve lo ballnnn out the rectum, after which the tube 
may usually be i>uss(><l with ease for eight or ten inches or more. The 
tulie should in all cases be introduced as high up as pof^ible. as the 
onema is thus more likely to be retained and alNorbed. Theoretically, 
23 



354 



SPECIAL ilBTaODS OF FBLItlSO 



toti, it is urged tliat the blood from the lowest part of tho rcetum is 
rcturacd through the vena cava, whcrens that from the higher parts 
returns by way of the portal system and passes directly through the 
liver. This is of uo practical iiiooieiit here, as 8U!;ar solutions ab- 
iiorlied from the rt^ctuni, evpii when introdm-ed into the lower portion, 
do not cause glycosuria. This is explaint-d by the fact that the lower 
portion of the rectum has a Hmall capacity and absorbs but little, 

The fluid sliould be allowed to flow in esIowIv from a funnel or a 
fountain-syringe. In some instance-s, where very small injections arc 
beinK used, a small hard-rubber syringe may be attached to the tube. 
Care should be taken to avoid injevting air with the fluid. The 
method of administering nutrient eiieraala by means of the old-fash- 
ioned short hard-ruhher nuzzle of either a piston or n Davidsou 
syrjnpe ejiii not be too strongly eondeniiied. In the handK of the un- 
skilful it may cause injurj- to the reetuio, and even if used by a 
trained nurse, only succeeds in placing the fluid in the lower part of 
the reetum, where it is apt to be expelled. 

After the injection the patient shoidri lie as quietly as possible for 
at least, an hour, and be instructed to try to retain the contents of the 
bowel. A pad of gauze or a towel should be pressed over the auus 
for twenty nilntiles or half an hour, and the mind should, if possible, 
be diverted from the subject. After a few days the Iwwel often 
acquires a tolerance for the injections, and they may be retained 
without difficulty. 

If the rectum is irritable and the fluid rejected, it is well to precede 
the nutrient eneiua by a small suppository coutaiuiug opium, or. 
wliat is better, a small rectal injection of the tincture of opium may 
be given. This niny he mixed, with a little stareh water, but the whole 
should be as small as possible. The opium should not be used unless 
necessary, and the dose should he just sufficicnl to quiet the bowel; or 
the opium may he added directly to the enema. 

If then? are lieuiorrlwids, rcfta! feeding will be tircally interfered 
with. Before each Injcctioii they may be paiutcd with a 2 per cent. 
C'ocaiu solution, and between the feeding a soothing ointment should 
he applied. 

The amount to be givea at each injection is an importani factor. 
As a rule, it should not exceed % of a titer. (V:> pint). If this is not 
well borne, the amount may be reduced to from 30 to 100 c.c. (1-3 
02.). 

The number of enemata to be used will depend somewhat 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 rememlier that packing in the vagina and other 
gynecologic dressings may interfere materially with the injection of 
flnid into the bowel. 

The patient's mouth should be kept very clean, and the patient 




ttECTAh FBBDlSa 



366 



ma^' be allowed to rinse it from time to tim«. to help to allay the 
thirst, which is usually intonsp. Under some cirL'iimstaiiws wtitur 
mn.v b« takeu into tlie ».tomafh, but when? absolute rosl of the stomach 
is indicated, uoi even that should W allowed. Enemata of weak salt 
solution mu,v be given to relieve thirst, or salt solutjou may be irivca 
Kubeutaiteously, 

A part of the good effect of the nutrient eneniata is the mental 
Hatisfartion following them, similar to that following a meal. The 
patient haviiifT aliw the feeline that lie is not being allowed to starve. 

Prevention of Parotitis during Rectal Feeding.— Kenwiek sug- 
gtKia that in order to prevent the ocTurrence of parotitis, it is well to 
promote continual secretion of saliva with the idea of irriuatiiig the 
duclK and ho preventing an ascending infeetimi. After experiment- 
ing with various thin^a. upon which the patient whh directed 1o chew, 
be settled on an india-ruhlHjr teat about 2 inches in length, with the 
result that the moulJi remained clean and moist. Ue haH used this 
simple ilevice in more thao 300 cases, and where the gland was not 
already inflamed at the outset ho had no trouble in any of his eases. 
Chewing gum may lie used for the same purpose with good results. 

ZirSICATIOKS FOB THE USX OF imiUEIII EVEHATA 

Nutrient enemata are indicated: 

1. In extremely weakened conditions, as during the prt^ress of 
fevers, when the t|uaatily of food takeu through the mouth is iusuffi* 
eient to sustain life or when even pretligested food can not be re- 
tained. 

2. In diseases of the pharynx and csophaLiis in which ohstnictions 
to the passage of food exist, as from tumors; also oceavionally in 
spasmodic cDUstrictious of the esophagus aud in paralytic couditioua 
of the pharynx when the patient is unable to swallow food. 

3. In diseases of the stomach, as in cancer ocensionini; stricture of 
the cardiac oritice. with imibility to hwmIIow sufficient nourishment. 
In diseases of the stomach in which it is important to relieve the 
stomach of work — e.y.. in carcinoma, in nun-malignant strictures of 
the pylorus with coii!«e<iucnt dilatation, and uiso in ulcer of the 
stomach, both when hemorrhage has occurred aud when li()uids are 
badly borne. In that form of nervous dyspepsia known as irritable 
stumacii, which is accompanied by aevere vomitine. nutrient enemata 
may bo given to supply nourishment to the body when the stomach 
can not retain food, 

'1. 1q delirious, comatose, or insane persons who can not be fed 
through the mouth. 

Nutrient flncnialB by the Drop Method. — Since Murphy's intro- 
duction of continuous proctoclysis by the drop methiMl the administra- 
tion of nutrient enemata hy the same plan has been practised by 
various eliniciana. Kberhard has recently called especial attention to 



356 



BPKCi.Ki. ukthodr or ff.kdixg 



this method of treatment. Hi^i apparatus consists of an ordinary' 
quart rail, inside of which h pkc-ed another can holding u pint. 
The-sc arR t'tinriwtwl by hii rt-infh pipe, whieh peiietPstes the bottoia 
of each iiiid projects about 2 inches. A Hmall pct-coek soldered to 
the baae of the outaide can allows water to be withdrawu at will. 
Milk and egif or any utlier uutnm«al plawd in lh« Kinaller (-an is kept 
■warm and flows freely nn aw'ount of its bciii); siirroundcd by hot 
water. "Water at a temperature of HO' to 115' F. seems to answer 
all purposes. Thti remainder of tb« apparatus is iho same hk used 
for saline fnteroiilysis, To insure alBorptinii th.- bowel mn.st he 
cleansed by au euema each day. The flow must be rcffiilated to about 
8 drop a second. 

A fairly complete lint of nutrient enemata asi advised by the older 
writers will he found in the first four editions of this book, aud have 
an historical interest. 

The following formula are suggested: 

1. Millc, paiicreatiz«d fur tweaty-four hours and boiled. ^0 e.c. 
(8 ounces). 

2. To the above may be added any of the following, either alone or 
in any combination: 

1. Dextrose, fi to 12.5 (prams (1^ to 3 drams). 

2. Alcohol. 5 to 12.5 cc. (IV^ to 3 drams). 

3. K(fg yolk, 1 or 2. 

Tbe drop method is especially indicated in persistent vomiting, in 
hemorrhages, stenosis of the esophagus or pylorus, in eareiuoina of 
the slomseh. and in must c-ouditiouN in which nutrient enemeta are 
ordinarily employed. 

At present the best mi.\ture!^ scorn to be normal salt solution to 
which (I«xlro8e and alcohol have been added in tbe prupurliun of 5 
per cent. Five to 20 drops of tincture of opium are advised by some 
to be added to a liter during the first day aud it is thought that a 
quarter of a grain of thymol per liter will prevent bacterial change 
iu the bowel. A liter of the above contains 550 calories and may 
be admin iKtert'd in eight hours under favorable conditions. The 
fomitda will be 

Dextrose, 50 frrams (l"s ounces) 
Alcohol, 50 i^amti \ 1% ounces ) 
Normal salt solution, 1000 c.e. (32 ounces! 
ThtH may be found useful after oprrations. in acidosifi. in diabetic 
coma, and in many of the indicatiotui for rectal euemata. 

OTHER METHODS OF NOURISHINQ TH£ BODY 

Duodenal Atimcntaiion. — Kinhorn. Morgan, and others, following 
the NuggCKtion of the lirKt-nanied iiivestisialor. have umnI a duodenal 
tube, not only a» a matter of diagnoKiit, but for finvlin^' errtain elates 
of easw. At present the tube has been ubmI in thoee cases in which 



Oriit^N UEtaoiJs OF xouxtSBiSG Tim aviiv 



367 



i1 was thought (Ip-siratile to r<^si the «tuniach, as in cues of peraUlrat 
viiniitiiig and in certain gaiitric mid iliiudeual ulcers. Tliv onliuary 
Kiiihorn tube is used, an<i care »liuiild lie taken to sec that it is in 
place before the feeding is started. This may be done by gentle trac- 
tioM, whivh shows a s^iirht re-sistauce if the tube is in the duodenum; 
by »Kpiration, which will often bring up golden yellow duodenal juice 
without «iiy gastrie seereTion : or. perhaps best, by giving the patient 
some li(|uid to drink by mouth and iQiinediately performing aspiration. 
If the end of the tube is in the stomnoh. the fluid can be recovered. 
Any liquid fooii may be employed, but mixtures of milk, sugar, and 
raw eves ure iht; most u!«eriil. Care should be taken to set* that there 
are do particles in tbe food timt might clog the tube. The amount 
al the beginning should he small. 100 c.c. every two hours, beginning 
early in the morninjr and slopping late in the evcnine. This ipian- 
tjty may He gradually increased up to 300 c.c. If 8 feedings are 
given in twenty-four hours, snd each feeding consists of 280 c.c. of 
rnilk, 1 e^g, and 1 tablespoon ful of HUKar of milk, the patient will 
reoeive approximately 2280 calories, which is ample for an average 
individual, and if the patient is at rest in lied, it is sufHcient to allow 
a i:aiu in weight. 

In some eases Einbom's diet for duodenal feeding consists of — 

7.30 a.m.: rinimea] gniel . .- ... 180 cc. 

I U\t egg ■ ■ 

Butler 15 gm. 

Ijirloar ...->. ,- IBO v.c 

ft^ A.M.: Vr% MHp leO c.e. 

Oac en 

ButUr ... 15 Km. 

I.BctoM^ . - 13 gm. 

i).30 A. M. : .Sbidc OS tt.30 A.M. 

IJWr.ii.: B«uUloii ISO c^. 

Unv fft^ 

3JI0 P.U.I Oalniesl grii^l . ISO c.e. 

Iliilirr . lA ipn. 

One «g|[ 

I.BClost.- ... Ift gm. 

&.30 P. M.: Tra aoup ISiO cc. 

butter ,. 15 gm. 

Owe tun 

L^ictoxc .... 15 fern. 

9.30 r. U.: iiouillon \W VX. 

On* *g|! 
Total >|iuiiility- 

(l«tm<>'ul gnifl 360 r.v. 

P<« Mjup . 'iSi c.e. 

LactuHe W> f^m. 

Bouillun 3(10 cc. 

Butter (to (tm 

Einhorn has jierfected a special syringe with vrhieh it is possible 
to administer the food without duseonnecting the tube. Morgan has 
MUggested a method like that of Murphy for giving salt sntnlion per 



358 



SPECIAL HETUODft OP FEEMKO 



reclunt. periiiitt'mg the tluid to flow froiii an irrigatinif jar, and ao 
arranging the pi-t-i-ock that Ihi' fiKiil is taki-ii slnwly, the .'JUO e.t. of 
nouriKhnu'iil takiii)^ about tweuty-live miiiules. The food should be 
adniiiii.s(eiTd at body temperature, and the heating slionid be done 
slowly. ue> if it becomeij too hot it is liable to heeome thiek and lumpy. 
After hi'»liiiK it is well to slraiii the food to be certain to have it free 
from sumil particles. If the food k used ton warm or too eold it is 
apt to eaue>c uncomfortable syuiptums. sometimc>i oauttiiiu the patient 
uoiisiderab)(> Khock: a loo rapid adniiiii»itratiQn eau!;eK flatulence. 
After carh feediiii; tin* syririK''ful ")f water, nt i)8° F., should be in- 
jected, then the pet -cock closed, and the syrinjre Hlled with air, which 
BhoiiUI be injeeied after the pct-eoek ban been opened: the pet-cock 
should then be i-IosihI and the syriugr diseonniTtwL This proecdure 
is verj' important and serves to keep the tube clean and empty. If 
this U not done, small mn^iseu of food are apt to he drawn into the 
lower part of the lube, and this may neeessilate its removal. 

Food suppositoriex have been suggested, but Iheir use is open to 
many objeelions, the ehief one. they may not be absorbed. 

Nutrient inunctions, especially with oils, have been suskce^ted. and 
in eonditioHH of great etnaetation they may pnn'e useful. The body 
in rubbed with oil. such as olive oil, ood-Hver oil. or eoeoanut oil. or 
with eoeoH -butter. This keeps the skin soft, the massage also proving 
helpful. It is of partieiilur value in marauljf? infants, and luis be«n 
used an a nnitine praclit-e by the authors in all Hueh eases, with very 
ffratifyintt results. 

Intravascular feeding has been tried out; for tht< present it is 
limited to Miipptyin^ fluid in the form uf salt Koliitiou. alkalis in the 
form of sodium Licarbotiate solution-s. or carbohydrates in the form 
of glucose solutions (See Acidosis i. The problem of intravenons 
feeding seems somewhat nearer its accomplishmrnt, as Murlin and 
Kiehe, in .studying fat metabolism, were able to inject 3 per cent, 
emulsions uf lard oil into animals and it was a|iparently utilized and 
two DiLiiisli observers, llenriqui-fi Bntl Anderson, state that they have 
kept KOiits alive and in nitrogen cqi)ilibi*ium by furuisbing a alow 
stream of nutrients by injecting into the jugular vein a mixture of 
glucose. Hodium acetate and inorganie salts, together with a aotutiou 
of meat completely digested with pHiicreBtie tryp.sin and the inteBtinal 
enxyme erepsin. It will doubtless be some limp, however, before this 
method will be available for human beings in a safe and satisfaelory 
form. 

Subcutaneous feeding is a subjeet of eontaderahte inlercKl. and 
was used as furty as 1869 by .Mcnzel and Pcrko. Karxt, Kriig. 
Witlhaker, and olheni have also employed this method. One of the 
most important eontributions to the subject ban been made by von 
Lpnbe. Thiji observer eonid obtain no good results from the iiSft of 
either proteins or of carbohydrates. He is of the opinion, however. 



i 




OTffff* UKTUODS OF VOr»/8ff/.VO TUE BODY 



359 



that injectious of oil are of practical value in nourisfaiag patients 
unr)t>r Miub conditions an render it nei'efwarj-, as in the failure of 
rectal cm-muta b«<;ausc of liir presence of htinorrhoids or irritation 
of the rectum. His attention was directed to the fact thai large quau- 
tilies of oil were u-svd in t;ivin^ camphor iiijevtionK. which are more 
widely lifted in (teniuiti.v Ihuii in America. Fat vmlioli n>sult »o rarely 
as to be practically no objection to the method. Von Leube uses the 
piirfsl olive or scKarae oil. and a 10 c,e. Kyringe. made afler the or- 
dinary hypodermatic syringe pulteni, or a needle, a tube, and a 
funnel. From 30 to 40 c-c. (1-1^ oz. ) of oil may be used daily. 
The contents of the Kyriuee OO c.e.) shoidd Ite injet-'ted in three dif- 
fen-iit places nud tlic wounds sealed willi rolloditM). The oil should 
I>e injected vcrj- slowly, and. of couiw, the strictest asepsis must be 
obser^'ed. 

Lfeiinander. of L'psala. and various othei's have <tugi.'c8ted the U!te 
of solurioiiH of glucose, in van-iiig streniflhs. from :J to K per cent., in 
□ormal salt wjluTion : in snmc cHsrs from 1 to 2 per cent, of alcohol ia 
also addeil. These solutions are uwd under the skin or in the reetnm, 
am) as. miieb as 2 liters have Iiecn ndmiTiiNtered in (w^nty-fniir hour», 
giving a total of 160 ^^ram^ of Mtitriir and 40 itruins of alcohol. Kniisch 
baa used thiK solution iiilravcuuuf^ly. and has recommended it partJcu- 
larly after operations on the Hbdonicn. and especially in HUppurative 
peritoiiiiis. From 100 to 2(K> grams of olive oil may be injected sub- 
eutaueoiuily at the same time, the whole nfFordiuK a fair amount of 
available nulrili^'e material. Sugar solutious have also been used 
locally in tbc peritoneal cavity in the treatment of suppurative ia- 
Bammatiou. 

Saline Irrigations and InfuBions. — 1. Saline Beetat Irrigations.^ 
Rectal saline injections are especially uiscfiil in all condilioiia as- 
aoeialed with hemorrhage: also in the various infectious diseaaes, aa 
well as in intoxications and in those eoiiditiuiu> in which it is necessary 
to allay thirst. 

The fluid used (should be a normal salt solution, and should be given 
high, with the rwtal lube: if it is necessary to prepare such a solution 
quickly, a teaspoonfiil of sail may be added to ti pint of water, and 
rapidly injected by means of an ordinary fountain s>'ringe. The 
fluid should be at about the temperature of the body, and should be 
iidniinis1cn*d !<[i>wly. while the patient is in a reclining position. As 
much as \-^ to I (piiirt nf the fluid can be utilized at one time. 

The Murphy .Method for Administering Solutions by Rectum. 
— A very nseful method of administering salt solutions and other 
fluids is by the continuous proctoclysis by the drop method as sug- 
Ki*«Ii*d by Mnrphy. This may be used whenever it seems advisable 
to ineresse the amount of iluid in the system. It ia of particular 
aerviee when there has been a Iokh of blood, and alsri useful to Gil 
up the lutein so that further tympliatie absorption is imposiiible, as 



360 



SPECIAL VBTBOm OF FBP.DISQ 



after operations about the thyroid It may also be used when fluids 
cannot be taken hy the Rtomneh. Xornial salt Kfilution may be used or 
the iwliition advised by Murphy, a dram each of sodium chlorid and 
calcium fhlorid to the piot of water. In cases of great weakness, 
whisby or an infusion of coffee may Ue added to the salt solution. 

Tlie method of adminisrering the duid is importaot. A fountain 
syringe or a sail sohitioii flask, with a rubber tube atlaclmient termi- 
nating in a vaginal hard rubber tip, or a catheter, may be us«d. After 
the insertion of the tip or catheter into the rectum, the flask is llUed 
with salt solution and siispetided from 4 to 10 inches hIhivc the lorel 
of the Tectum of the patient. The solution is kept in a temperature 
of 100° T. by surrounding the flask with hot-water bags. An im- 
provement on this is to use cue of the simple deviees which are on 
the market for regulating the drop. Thig may be done by using a. 
funnel, and so Tetnilating the pet-cock on the flask that the fluid 
escapes a drop at a time. The devices just mentioned are more satis- 
factory and require leas attention. Care and judgment should be 
used not to overload the patient with water and so overburden the 
heart. 

Piam Water Injfetioiu. — In place of using normal salt solution, 
ordinary water may be used, ax suggested by Lawson. 1908. and more 
recently by Trout. The advantages of the plain water arc that it is 
absorbed in larger (luantiticK tind more rapidly. Patients given fialt 
solution by rectum require nearly twice as much water by mouth to 
relieve thirst as those given plain, water. 

The patient dnes not complain of lasting ^alt. ns is often the eaxe 
wheo salt soliilinns are u.scd. In peritoneal easeK in which there is 
drainage, larcer iiuantilios of salt solutioo or plain water may b* 
wuni than under other cireuuistauces. 

Other tiolutions. — Foods of various kinds, m meulioucd above, may 
be adminiEtored by this method, and glucose solutions, 3U ^ams (1 
ounce) to the liter of water, or normal Kalt solution may be used to 
advantage, espeeially in «?ases of threatened or developed acidosis, 
as in diabetes or following anesthesia. 

2. Saline Infaaiont. — Saline infusions are given subeutaneotisly, and 
are especially useful in cases in which rectal suUnc irrigations can 
not be utilized, as in certain iuiestinal diseases or wheu an immediate 
eflfect is re((uired, as in sudden collapse from hemorrhage or from 
shock. They are also u.seful in cases when large quantities of fluids 
have been tost by the body, as in the diarrheas of dysentery and of 
cholera, in various infectious conditions and intoxications. aK in 
pneumonia, ervHipctas. and typhoid fever; and in the uremia of 
<.'hronic Bright a disease. The most eonvenieut location for adminis- 
tering the infusion is between the chest-wall and the mammary eland, 
or deeply into some muscle, as in the lumbar region, abdominal wall, 
or buttock. The injeetion should be given under the most asieptic 




DIET IN DISEASE 



Oeneral Rules for Feeding the Sick.— The nurse and family 
should be lullj' impressed with the importauec of the proper feeding 
of the patient. Definite diret'tiorm &% to Iiow much food, its form, 
its preparation, and how often it is to be Ki^fU- shiiuld be written 
out. In all acute serious conditions, as m pncumoDJa or in typhoid 
fever, » ret-ord of these details should be kept, together with the 
record of the quiintity of fluid taken, the mi'tiiciues given, ete. 

Tbcrc is usually a tendency to err in cither extreme— that of giving 
either too much or too little food. Care should be taheii that the 
patient's wiithes are, wherever practicable, carried into effect. The 
nurse and family should be que.ttioned carefully as to the patient's 
likes and dislilcpK, and also as to his idinsyncrasiw. A tactful, ob- 
serving nurse is of ineKtinisble vaUie. but a careless or stupid one is 
an ever-present nourui* of datipor. 

The training of nui-ses in regard to feeding in often faulty. Every 
nurae should be instructed in the subject of practical dietetics, and 
should know how nnioh food is required by the different type* of 
patients. The details of feeding patients should always be gone 
into. 

The food Rhould be given nt regular intervals, hi uneonseious or 
semiconscious patients this is of grpat impnrtauctr, hut it is jnst as 
important in the eouscious. as the appetite usually comes on at cer- 
tain times, and if the aicul is not fonhcomiug. may disappear. 

The appetite of the couacioutt patieut and of the eouvalesL-L-nt should 
be fostei-cd. and nothing done that may in auy way disturb it. Pa- 
tients vary much in this particular, but as a rule individuals who 
ore not ovcrfaslidious when they ar« well, become so when weakened 
by disease. 

The sick-room atiould be orderly, and no dishes, utensils, or food 
be allowed to stand about the room either before or after using. All 
food and driuk should be oflered from scrupulously clean glasMs or 
diahes. These should be as dainty as possible, and the food must be 
made attractive in appearance; when the (UkI) permits, it may be 
garnished with a sprig of preen. The napkins and linen should be 
.spotless. The exterior surface of jrlasses and cups should be wiped 
dry before they arc offered to the patient. 

Food (hat is stale or that has acquired an unpleasant taste from 
standing in a refrigerator together with other things should not be 
given. A strong egj: in an cgguoy may be the means of turning a 
patient forever against this form of nourifthmout. The food shotUd 

302 




OTET /A bl&EAUK 



363 



ht ta8t«d by the nurse, but Dev«r, when powuble, in the patient's 
lirvsfuct' or with ths wimc spoon. If thfrc is Htiylhirif; wroni; witli 
a dish, this should be disuovered and rvmMied before il in bruugbt 
to the patieot. 

A Qursc should always rftncmbcr the eternal titnt^tss of things. 
Utensils uiid disheii should be use4 only for tht> purpose for which 
they are iniended. and not hs inakeahiftn for oilier artieles. After 
caring for the piitirnt or removing evariiatinnii siiffirienl time ahoulil 
be allowed to elapse before feeding is befruii. The patient should be 
made to feel thai the iilmosl eleanliueas and care have (>een olMcr/ed. 
The hands and face uf the patient should be wiped with a moist doth 
and then dried before food is given, and the lips eleansed after the 
meal is complete. 

The position of the patient should be as comforlahle a one as poB- 
Hible, and one in which )ir will not tire before the meal i«i ended, tf 
the patient is weak, the food should be given in such form that he 
nay take enoueh of it without indueinK fatiKue: otherwise he m&y 
become tire<i uf mautieating and swallowing and lake an insufficient 
amount. Patients who can nit up in bi-d should be pntvided with n 
bcd-tray on which to place the fooil. The leirs should be placed hiuh 
enough for the patient to eat comfortably from il. 

Jf the patient is hetplesw, care ithould be exercised in Kiviug fotwl 
that it will not be drawn into the lungs during inspiration or 
aughlng'. This may be avoided by giving the foo<l slowly, and by 

tseeiog that each mouthful is swallowed before another is given. 

"These patientx may he fed in various waii-it. The food may be given 
from a sjHxm. or, whiit ih u-Kually preferriMl, fnim a drinkintt-cup with 
a spout, or by iisintr a lient tiil>e and allowin^r the patient to take the 
food from a (.'laus. When the patient is taking bread and similar 
aolids, great care should bo exercised not to allow the erumhti to fall 
into the bed. 

Lu niu^it severe illnesses it is Dev«Kairy to awaken the pattent.dnring 
the uighi to administer fuoil. ThiN i.^ a point thai re^iuires special 
iudgment. Often the patient is more in need of sleep than of food. 
If the patient does not drop otf to sleep very soon after taking foiid, 
it may be better to wait until he awakens before giviiit^ il. As a 
rule, however, in severe iUueaa the sleep is disturbed for but a few 
minutes by taking food. A cup of warm milk or similar light focHl 
IDay often induw sleep. 

The patient's mouth should always be kept clean, if dry and 
parohMl, it should be rinsed before and after takini; food. A suitable 
mouth-wash is given und«T the hcadiug of TubcrL-uIosls {p. 404), but 
sny of the alkaline mouth-washes moy be used; boric acid and water 
aloo make an efhcicnt wash. If the mouth is drj', it should be 
muistcnt-il frrwu time to time, and for this purpose a little glycerin, 

ivmter, and lemon-.iuiec will be found useful, it the patient is help- 



384 



DIKT IX B1SKA8E 



leas, tbc mouth may be swabbed out with cotton (a£t«Ded to the end 
of a stoul probe or wound about the linger. This should be moUtened 
with some uuliseptio solution. 

In till cases where tbc illness is likely to bi- prutracted. arrange- 
menl^ should be made to care for and prepare lhi> food with as little 
discoBifort to the household as possible. For this purpose a diet 
kitcbcu may be improvised, preferably in a room udjoining the pa- 
ti^ut's, If the pntieut's means allow, a small siek-ruum refri^crutor 
lid be provided, and a tin receptacle for storing foods that do not 
bed to be kept ou ice. A gas or alcohol lamp will i^crve for heatiug- 
food. A thermometer, a graduate, a funnel, and tilterpHpePs art* 
needed, and a meaf-inineing machine will be found a useful addition. 
Saucepans, a dish-psD, and a supply of tea towels should also be 
provided. Koric aeid or borax and sodium bicarboiiste will help to 
keep things fresh and clean. In eases of infectious and eomuiuuicable 
diseases a covered boilef for disinfecting all dtshctj and iitcusils should 
be added. The dishPK should be boiled in water to which U or 3 per 
eeal. of s»»diura bicarbonate baa been added, and the boiling should 
be allowed to continue for fully twenty minutes after the water has 
b«gtin to boil. Where iiistruotioiis an* likely to be carelRSsly followed 
out, it is best to direct tliat the dishes bir boiled for lui hour. 

Feeding Unconscious and Refractory Patients. — Uoconscioufi pa- 
tients may often easily be fed by means of a tea.'fpoon. Kaeh Kpoonful 
should he swallowed before a aei-oiid is Kiven. W. (iilman Thompson 
advises that, in tbc ease of comatose children, the nourishment be 
poured into the nostril instead of into the mouth. The fluid thus 
given i» swallowed, and any cseeas returned by the other nostril. If 
any difHeulty is cxpcrien<'ed in swallowing, it is best to resort to 
either the stomach or the nasal tube. With a little praetice most 
patieuts can be fed with the tube more easily than in any other way. 
A mouth-gag should be introduced or a roller bandag<! may be placed 
between the teeth and held in place by an a-ssislant. In infants who 
have no teeth this precaution !» uuuect'^ary, as the tinker answers 
the purpose perfectly. The lube, previously moistened, is passed 
into the pharj-nx and rapidly 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 necessary to hold it sufficiently well 
Imek from the rnd. 

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, ('are should be taken not to 
pa.iis the tube into the larynx. This aceident can always he a%'oided 
by waiting a monienl before pouring in the food. Kither stomach or 
nasal tube should he provided with a funnel, and as soon as tbc tnlM 
has been satisfaetoriK- introduced, the nourishment — milk, milk and 




FFxnifia r\ rerER 



365 



9gg. or whatever liquid food is desired^^may be poured slowly into it. 

In order to prevent uir from eiiteriDg in advance of ibe food tt 
small quuutity of tbe food may he jtoured down the side of tlic funnel 
until the tuhe is full. In many cases it may be desirable to wa&h 
out the stomaoh before introducini; th« food. Tfa« tub« should be 
withdrawn rapidly, so ai^ not tu excite vomiting. Foud tw introduced 
way be retained when it would otherwise be vomited. This is tnie 
both of infantjs and adults. (Sec tbe sectioas on (javage. Forced 
Keediiig in Tuberculosis, and Lavage.) 

In the ease of refractory paticiits— the itisan*. the hysteric, and 
others who refuse to eat — forced feediup becomes necessary. In this 
v«b«e viiougb attendants should be present to control the patient. lie 
ahonld be held lirmly aod the nasal or the stomaeh-tube be introduced. 
]u order to prevent regnrgitation of the food, which some patients 
mauage to do quite skilfully while it is bein^ introduced, tlio rilis may 
1)0 tickled. This prevents fixation of the diaphraiini. without which 
tbe food can not be ejected. This should be done only when occasion 
demands. iSee Diet for the Insane i 

FEEDING IN FEVER 

Before directing attenrion to the diet in special forms of pyrexia 
it will be well to consider briefly tiic general dietetic principles in- 
volved and their appUcaliou to this class of diseases. 

There existed, in former years, many dilfereni views conceraing 
the correct method of feeding fe%'er cases. Prior to the lime of 
Graves ( 1848 ) it was the general practice to * ' starve ' ' fevers. Graves 
taught that a fever patient retpiired food and should be fed, and in 
his lectures, published in IMS, there appeared the much-quoted sen- 
tence: "If you should be in doubt as to an epitaph to be placed 
upon my grave, take this — 'He fed fevfrg.' " With the teaching of 
Murchison and otliers this view gradually replacetl the older one, and 
to-day the profession are in accord regarding the diet indicated in 
febrile diseases. Minor dilfereuees in opinion exist and various theo- 
nc8 hiive been promul^'aled, but the practical application is the unmK 
in all cases 

In fever the metabolic procesaes are increased, white ut the same 
tiiae the powvr of aseimilation is lowered. This resulta in tlie burn- 
ing-up of the biuly pmteins as well as of the fats. Indeed, it ia 
.Statfd thui the pntteins sutTer a grpHter \oss proportionately than the 
lata. The npjictitc is diiiiinifihe<i or entir-ely lost, thert: is a marked 
IcKsened activity iu all the glands concerned in dig:esttion, and, as 
previously noted, absorption and the H!«imilfltion of food are mnch 
below the normal. TbiTiil also is much augmented. 

KtHids appropriate for healthy individuals are not, as n rule, suited 

for fever patients, and solid foods usually cause vomiting or severe 

[Indigestion. In order properly to nourish a fever patient it is neees- 



366 



DtET IX DfSEABB 



sary that the food be easy to take, easy to digest, and easy to as* 
similat*. Any food that does not possess thiae three (jualiliea is not 
suitable for a fever patient. When the disease rumi it^ course rapidly, 
the diet ia of uu grval importaiice, for creu if the patieut take bai 
little food, the period of eomparative fastiug is a brief one aud any 
loKs ia easily made up whiSe rreover>- is in progress. Tii protracted 
diseases, on the nther hand, such as typhoid fever, and in chronic 
ferere, the diet is of primnry importance and should be the physician's 
first care. 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 strenetheued as 
much as possible. 

In fevers the mouth requires especial care (sec Typhoid Fever and 
Tuberculosis) ; the bowels likewise should be reftulated. and constipa* 
tion avoided. 

In health the amount of food is largely regulated by the supply 
and kind available and the appetite. In disease the appetite as a 
guide is apt to l>o misloadinp. aiul either too little or too much food 
be taken. One must, thercfwrc, be familiar with the food require- 
ments of fever patients. For the averajie man. weighing 70 kilos 
or 150 pounds, 33 calories per kilo of body-weight are required, and, 
couaequeutty, a total of 2300 cHlnrii>s per day. These ligures are 
based on the food requirements of a healthy man at rest. At present 
we do not know what the requirempiif.'f of a fever patient are, but it 
appears that the proreases of metabolism are increased, and an in- 
crease of about 25 per cent, should he made to cover tliis. Approxi- 
mately, 40 ealories per kilo may be taken as a standard, and a total 
of some 3000 calories for the individual of average sixe ( 150 pounds). 
If the patient takes less, it will be made up by the destruction of bis 
body fat and protein, with a consequent loss in weight. It must be 
borne in mind that the small individuals reqiitre less and the large 
ones more, but the very obese may be regarded aa not requiring the 
full amount for their actual weight, as much of their weight is made 
up of fat, aud this probably does not require the same amount of 
nourishment an the celts of the body actively coiicerued with nieiabnl- 
iem. Small persons aud younger iiidivi<lu«is in the gT'owinu stages 
r«inire more food, and the aged less. For the young the require- 
ments will he found under the beading of "Age." Not only must 
the total quantity of food required be considered, but the amount of 
protein and other food elements must he taken into aceounl. In 
adults the amount of protein required daily is more or leiw fixed, 
but the amount of carbohydrate and fats will vary with the amonnt 
of bodily work performed. If excesses of protein are given, it in- 
volve* undue wear and tear in kataliilizing and eliniiuatinp that above 
the body's needs. Under ordinary eireiimstane«i 16 grams of nitrogen 
daily are required, being the praetieal equivalent of the 118 grami 




FEBDIKO tH fBVER 



of protein needed as staled by Voit. Cbiitenilon has shown that even 
under hard tabor a uitmgrn n|uilibrium may be establiahed at even 
less than half that amount and the individual voutiuue in perrccL 
health. Proteiu is upeded in ihe body to repair the wear and tear, 
and in the yuuag fgr growth. It may also be used fur furnishin? 
health and enerRj-, but, owing to what is known as the specifio 
dynaiuie ai^tion of protein, i)eplia|>8 not over about 14 per cent, of the 
total enrrgy should be supplied as protein. The reason (or thig is 
that in metaboliziuR fat and carbohydrates the amount of heat pro- 
dueed is slight and may be disrc{tarded, but protein produces some 
:J0 per cent, of its calorie value in what might be ealled "waste heat," 
aa it is not used in the fuuL'lions of the body, [t is for this rra-sou 
that heat and energy arc not derived to advantage from itiving large 
amounts of protein, and it explains vhy the ammtnt of protein food 
is limited in hot elimates. in hot weather, and in fever. Various 
authorities place the amount of protein needed by the fever patient 
of average Kize as between 6.'> and llX) gramK a day. The tulance 
of the number of eaIori<'s nccfled may be made up of carbohydrates 
and fats, which it tihould be remembered are burned ap in the body 
completely, and are exereted a« earlxin dioxide and water, or, if not 
complfti'ly oxidized, arr stored in the licMly an fats. The form m 
which food is to bo supplied to fever patients to meet the requiremenia 
is a (piestion worthy of careful stud.v. 

Milk is almost universally used as a fever diet It funiishes 35 
grams protein to the liter (roughly speaking, to the quarts and about 
700 ealories (640 to the quart). To got the total food requirements 
from milk alone, over a gallon a day would have to be used. It ix 
belter, therefore, to supply part of the nourishment by ueun^f some 
other food. Milk may, aa a rule, be used up to 3 \(. to 2 quarts a 
day, supplying .some 1200 to 1300 calories per day. But few in- 
dividuals can digest more than this for any length of time, and even 
this amount may not be well borne unless it be modified in some 
way. Suggestions for modifying milk for adults may be learned by 
ccmsidering the methods used in infant feeding. The methothi in 
most common use in invalid feeding are to dilute the milk by adding 
water, carbonated water, Vichy, limr-wiiter, or a cereal gruel, such OS 
barley or rire gruel. Sodium -citrate may sometimes be adde<l, es- 
peeiflHy if the eiird gives rise to difficulties in digestion, or if milk 
causes constipation. From 1 to 5 grains to the ounce may be iiscd. 
Partially pancreatized milk may be found of especial value, and 
buttermilk and whole milk, which lias been incwnlated with laetio 
acid bacilli, are both of service, particularly when there is any dis- 
turbance of the intestinal digestion, Koumiss, matzoon, and kelir 
may also be used. Sometime-* it i« the taste nf the milk which is 
objw'tionable, and in such cases the milk may lie flavored by the ad- 
dition nf ehocolate. cocoa, coffee, or some of the numerous recipes 



368 



D!ET ty DISEASE 



giveu in the Appentlix of tliiH litiok ma,v be used. Malli'd milk may 
often he UNRd to advantage, and sometimes varioiUi iiivalitU' aud 
infants* foods ma^' be of value. 

Cremii is of Kreat wrviic, owiny fo its liiyli iralorit* value, aud il 
may b« added to milk or he taken mixed witli wn-als. The remainder 
of the pttiteiii uia.v be .Mipplled by using eitgs, and from four to six 
niuy I)t' regarded a-S a rensouable number to add to the diet. Eggs 
sometimes disagree, but this ia more often due to faulty methods of 
pri>{iaraiinn or to the use of eold-slorage epjjs than to any real ogfT 
idiisvncrasy. Eggs may be given in numerous ways — raw. with 
orange- or lemon-juice, or with sherry or brandy, or merely with 
pepper and salt. Numerous egg and milk drinks can enmly he im- 
provised (see recipes for these aud the pr<'panitinn of otlier foodftl. 
If the patient eon ehew, there is no objection to the use of coddled, 
Boft-boiled or poached tpfis, or a properly prepared umolet. 

Meat» are ordinarily not to he used in fevers, although there are 
exceptions to this rule. They are objeetionable chiefly because their 
use increases the protein eimtent of the food above that limit which 
has been found by clinical experience to be best for fever patients, 
and \\v: pnidiicta of the metabolism of the extra amount of protein 
add to the work of the already overburdened organiflm. as protein 
metahoIiKm in the Itody is inereaiied already beyond the normal in 
fever patients. Meat is objected to on aeeount of the purin nitrogien 
eoDtaincd. and the excretion of the end-products of these forms of 
nitrogen entails greater work llian a smaller amount of piirin-free 
protein. The purin bodies are also supposed to increase the tem- 
perature ill fever patients if prefleot beyond a certain amount. Meat, 
loo, is difficult of digestion unless well chewed or freely divided, and 
many fever palienls eaimot properly masticate their food. If given 
it should be freely divided. Meat-juices are sometimes used, 
illy when little or do food is taken, but it has but a small 
calorie value. Bouillon and meat extracts may be occasionally used. 
but. as a nile. they are best avoided. The commercial extracts eo»- 
lain large quantities of extractives which are undesirahie for fever 
patients, and their food value is practically nothing. Fats are to be 
used with caution, and chiefly as rrcam and butter and the >-olk of 
an «gg. Exces-sive quaniilieR of fat will cause indigestion in most 
patients, hut small amounts are generally well home if properly 
administered. 

The remainder of the dietary must be made up of sugar and 
starches, and these are carefully considered in the article on Typhoid 
Fever, to which the student is referred for further details of fever 
diet Gelatin preparations are often very \*alHable foods for fever 
patients. 

Thirst is an important Kvmptom in fever patients, and one deserving 
of considerable attention. It is to be hoped the cniel treatment of 




FEBDtiea tX FEVER 



wilhboldiiig drinka from fev«r patients, sucb as was formerly prac- 
lisetl. haii dLsappeared, never to rf-turn. Thirst is caused by the 
increaiK'd temperature, the increased iiietabuliHui. with its voincideiit 
UMreaM in waste-products to be excreted, uud sometimes AppareDtly 
by sodium chlorid rcteutiou. 

If sufficient Buid is not Kiipplied, the ton^iue becomes coated, the 
mouth dry, the pnlient becomes more nervous; if there is dflirium. 
it may Ih' iiK-n.'iiBc<i, or, if there is coma, it may he deepened. The 
urine And Kwent are both diminished. If fluid is supplied, the jMitienC 
will pass increased quantities of urine if in cool mr. or ihere may be 
sweating, due either to the nature of the disease or to tlie heal, la 
some diseases thirst follows great abstraction of water fmui coHiqiia- 
tive sweats or watery diarrheal discharges. In cholera and infantile 
diarrhea there are coses in which the blood actually IjeeomeK thick, 
owing to the great abMraetion of water. One ot the most imporiant 
indications for ireahiienl in such conditions Is supplying sufficient 
fluid by mouth or generally by subcutaneous or intravenous infusion. 
Persistent vomitiug may cause similar conditions, and in young in- 
fants fever may be induced by withholding fluid, aud promptly re- 
lieved by supplying it. 

If the patient is not iielting suffieient fluid with bis food, and he 
generally is not. suirablo beverages may be supplied at abort intervals. 
Fluid should be given whether the patient is conscious or iineonseions. 
as even rnnKcious patientK may really he in mental slates in which they 
will not ask for even urgent necessities. From 1 to 2 liters (quarts) 
a day may be recarded a.<v an average allowance for an adult with 
fever. Further details for giving fluids will be found under the head- 
ing of Typhoid Fever 

As a general rule, the phyaieian should see that the patient's bowels 
are moved at least, once daily, and either drugs or an enema may be 
used, as may be deemed best, 

Alcohoi.~Tlie question us to the value of alcohol in fc^'crs ja one 
that has been widely discussed. The safest view, probably, is tbAt 
whieb takes (he middle ground, for while alcohol may have been, and 
still is. grvady abused in sickness, there can be no doubt that it 
renders great service, especially as a food and stimulant in fevers. 
Since alcohol is not needed in all cases, the growing tendency is to 
restrict its use to those cases in vrhicb it ia definitely indicated. It 
should not be employed as a routine measure in any disea.se, nor 
stMuM it be used for any length of lime where there iK a likelibood 
of the patient acquiring the hubii. In acute fevera in strong patients, 
where the dntease is apt to be of short duration, it should not be used. 
If the odor is apparent on the breath of the patient, or il it causes 
excitement, delirium, or any mental symptoms, it should be used only 
in limited quantities. 

Alcohol, it should be rememheped, ia not only a stimulant, but a 
24 



370 



DIET 1\ DISBASB 



food as well, each gram ul' it furnishing swen ealorics of beat or 
that equivalent of cuergy to the body. Il sliould not be givea too 
early in the disease test its stimulating cffci-t be toht as llic system 
becomes acaistoraed to il. Ott the other baud, siimjilation. cither by 
alcohol or any other stiiuulaiit, should iioi be- di-liiyrd too \m^. As 
800U m the pulse beeomeH fonipressiblc and weak the atiuiulunt should 
he administered. When one is sufflcieully expert In auscultation, the 
need for alcohol can be learned frum the heart-beat. When the Hret 
sound beeomea weak or loaes its sharpness, it is a sign that the heart 
is begioniuK to flag. Sir Dyce Duckworth describes this as follows; 
"The cardiac indications for the use of alcohol in fever are a notable 
toss of tone in the tirst sound, eapocially if tliia be iimppi-r-ciablc at 
tlie lia-ie (Stokes' sign), and the aasuiciatPd condition of the pulse — 
that of low arterial pressure and the phase of it known ss dierotism." 
In hyperpyrexia aleohol is of (rreat value, for when the temperature 
runs very high dige«lion and assimilation are apt to come aInioHt to 
landslill. In these i-ascs alfohnl is easily absorbed and acts as a 
imulanr and as a food. In continnc^d hyperpyrexia \arae amounts 
ean b* (fiven. and it seemH to be entirely usp<l up in the body without 
producing any mental symptoms. 

In the so-L-allod nsthenic fevers aleohol in small amounts and at 
quite frequent intervals is useful. In the very feeble and in the aj^ed 
it may generally be taken with great benefit. 

In prolonged fevers in children atteiitlc^ with difficulty in feeding 
aleohul is also of value. In these eases the heart indications are 
usually well marked and are reliable cuides to the dostnce. In giving 
alcoliol to children it should be well diluted, and small frequent 
rather than large doses at longer intervals should be administered. 
Large doses are rarely needed. 

In those habituated to the daily use of alcohol it must be given in 
some form when these persons become ill with fever or, indeed, when 
confined to bed from any eavise. When alcohol is withdrawn sud- 
denly from those aecuslomed to lar^c ihiily amounta nutrition rapidly 
fails and delirium not infrerpiently sets in. 

it should be remembered that many conditiona in which alcohol 
was thought to he indispensable a few years ago are treated just as 
satJsfaetorily now without it. 

The fonn in which alcohol is to be given fever patients depends 
nn individual taste. As a rule, pure whisky or brandy diluted with 
plain or with a mineral water is preferable. If there is a decided 
preference for wines, a pure old wine, either light or red, may be 
prescribed. 

The quantity to be given depends upon circumstances, and the 
age. condition, habits, and tolerance of the patient all play au im- 
portant part in deciding this question. In infants and young chil- 
dren from Vj ounce to 2 ounces of whisky divided over twenty-four 




FFSDrea ix fevek 

hours may be regarded as a reasonable Umit. Id older children from 
t tn 4 aunvcK id Iweuty-four hours, and in adults from 4 to 6 uuiiveD 
ill tile same length of time, form a p.nni Bvcrui:i'. In the case of 
habitues and also when other circuinatuuc««. too ntimcrous t« meution 
herv, warrant, tht«« amoimtJt may be tncreaited. 



THE FEEDING IN INFECTIOIIS DISEASES 
DI£T tS TYPHOID FETEB 

The preceding remarks ou f««diiig fev^-r patieuts in t^neral should 
be oart'fuily read before atti'mpting to master ih*" diet for typhoid- 
fever patients. It should be borue in mind that if one uuderstanda 
the diet in typhoid fever they ar* prepared to look after the feeding 
of almost any of the febrile diBpHses. It should bp remembered that 
the manaeement of the diet in typhoid fever is one of the most 
iaiporlant factors in the treatment of the disease. The problem that 
eonfronis the phj'sieian is the feedinp of a patient who is to be ill 
for weeks, who has a dis<>a.sed intestine, and whose entire beiu^ is 
deranged by his malady. Owinp to the fever and toxemia there is 
a diminntion in the (juanlity and the (piality of the dij^eKtive juices. 
The mu!«cular nrtion of the aliiueiittiry rraet is often diminished, the 
liver is more or leas disturbed, and the bile less active than normally, 
and abRorjitiou is defective. 

It should he borne in mind that the mild case of typhoid needs 
just as careful watching as the severer one. as there is the same 
tendency tn nieeratiun and hemorrhage. Indeed, it might almost be 
said tliat such complications arc as ^reat in what were ul tiriit mild 
cases, uwimr lo the carelessne-ss with which they are dieted. 

The aim >(hould be to supply a sufficient amount of food to prevent 
wasting, and the figures given in the above eonsideraliou may !«i 
taken as a guide. The form in which the food is supplied will depend 
somewhat upon the patient, his surroundings, and the ability to supply 
foods; but in a irenerat way this olTens but little difficulty. At times 
the ingenuity of doctor and nnrse will be ealled upon. The food 
should be adapted to the patient'ii digestive powers and, if he is not 
apathetic, as far as pcwwiblc^ to his taatn*. While the old days of 
starvation have fortunately passed away, we are now Kwin;:ing to the 
other extreme, and care should he taken not to overfeed the patient 
in the endeavor to meet his real or supposed calorie needs. Minor 
digestive difficultiefl should be watched for and, if ponsible, eorrected. 
Any fiMxl which causes tympany should be avoided, as the di««tentlon 
of the iiitffitines with eas is one of the i;reat factors in causing henior- 
rliagc. The ulcers may be put on a stretch and the weakenetl walls 
of the «twollen ves-sels may be ruptured, and, what is most serious, 
only partially ruptured, so that the vessel is depriveil nf the normal 
power to control and stop the bleeding. It may be made a nile that 



DTBT JS bteBASB 



may food which prodoecs gss !^ould be avfitdeti : but remember that 
what caoKcK ^an io one patient may aoii in another, that this gas 
VsrvaaXimi may be due to other factors than foud. aud that a food 
that at one lime disaKree* may later tm again be itf service. Thus. 
gaa may be cao-sL-d by the digt-ation being leerned tjirougfa reflex 
Mtioa, w by a too lone eold bath, or a visit from a too talkative 
friend, and iji numerous waj-s. whieh must be earefully voD&idered 
before HtminatinK' valuable food fnmi titr dietary. 

Ilow much al a time and bow often should food be administered 
ia an im[>orrant queeliou. The best way to answer this is lo figure 
on the total qnantity of fo(»d. and then Hseertain bow much must be 
(rJTon at a time to pet in the entire amount in twenty-four hours. 
Thus, if 4** ounees are civeu. if the feeding interval is three hours. 
7 or 8 feedings could be counted on in the day and night together. 
and 6 or 7 oudpcs of food ibould be given at a time, the latter pre- 
ferably, as it will then allow a longer sleeping period or periods at 
night. If the food is well borne and only 6 or even 5 feedings given, 
the amount must be larger — 8 ounces or 9 or 10 ounces being gi^'en 
at a time. Where the total is grenter. the feediniis miuct be larger 
WfapD the fiiod is taken with diftit-nltr and poorly retained, feeding 
at two-hour inten-als may he used, and 3- or 4-ouncc feedings (fiven, 
or & or 6 ounces if the food has been diluted. This question of in- 
terraU and iguaDtiticfi must hv studie<l for each individual patient, 
and varied according to the necGssities of the case. It should be 
remembered that where the food is diluted, either on account of the 
digestion of the patient or with the idea of the patient's taking more 
wiiter with the food, as when it i.s thought desirable to disturb him 
«jt little an possible, the quantity given may, as a rule, be greater 
ihan it would with the more concentrated food.'i. When the patient 
iJikcH bin fijuil poorly and i.i apathetic, drowsy, or e(>mata<^e. the night 
and day intervals may bt^ made the same. If the patient lakes his 
food fairly well and sleeps poorly, or has difficulty in getting to sleep 
if disturbed, then the day inten-als may be shortened and tlie night 
intervals leiii;ihi'iied. 

The question of supplying fluid is on important one. Many pa- 
tients suffer for want of water, aud cannot or do not express their 
desire for it. If the tongue ia dry aud crusted and the mouth and 
lips vovenKi with sores, the patient needs more care and more water, 
and experielly water and acid. Going to the extreme, Cushing and 
Clarke have suggested a» much as a gallon or more water in twenty- 
four hours, giving it in small definite quantities at short intervals. 
Copious elimination of urine follows, corresponding to the amount 
of water invested. They claim that the patient is more comfortable 
and that he is less toxic, and that the nen-oue symptom<) are less when 
large (piantttiex of water are given. This may be partly due to tbe 
elimination of the sodium chlorid, which may be retained in larger 



THt iLEtttyO IS /.\F£CTIUt'8 ttlSHASEH 



Z73 



qiiaiilities tbati nunuHl in t^vphoid. Suvh retcntioD is not apt to be 
llii- vase in a milk ditrt. iirid the objectioD offered that so much fluid 
eluuiuates too mmo' of tlic body salts is worthy of consideration. 
The work of pumping th(- increased amount of fluid is another point 
to be considered, especially in patientu with weak beartx. This que-s- 
tion is one for further study. Three or four pintx of wtitcr n day. 
in addition to that taken with the food, may onlinarily b« regarded 
as a fair allowance. 

Plain water is ucually the best, but there may be reasons for ehang- 
ing the drink of th<' piilient. Some patienlK tire of plitin water and 
like H ehunge; sometimes stimulants, foods, or aeids may be thought 
desirable. Carbonated waters may be given if desired. The natural 
oneH are to be preferred to those arliticially eharped, nnd the execiwivc 
amounts of gas may W allowed to escape by effervescence before they 
are given. Sometimes when the stomach is irritable the caHiouated 
watera act as a sedative. The commonest need is for an acid, and 
water acidulated with diluted phosphate or by hydrochloric actd is 
of great scn'iw. When there is diarrhea, aranll doses of aromatic 
fitdphuric ueiU may be given in this way to great ailvuntuge. Weak 
tea, with or without the addition of a little red wine, is a great thirst 
qaencher, but acts somewhat as an astringent. Fruit- juice and water 
are pleasant when fhere is no intestinal disturbance, and are also of 
>'alue if there is constipation. Lemonade, orangeade, grapefruit juice 
and water, grape juice, raspberry juice, raspberry vinegar, all diluted 
with water, are most commouly used. These may be utilize<l as 
vehicles for adminislerinc susiar where desired, AleohoHe beverages 
may be given if thmight ilcsirable. Ked or white wines with water, 
or even sherry or brandy and water, may be relishwl by some patients. 
French or Italian vermoulh. well diluted with a carbonated water. 
is often taken to advantage. Under ordinary circumstances old 
whiaky, properly diluted, may be the best aleoholic drink-, in some 
patients it exerts a slight laxative elTect : brandy is useful if there i.s 
diarrhea, and gin may occasionally be given for its diuretic effect. 
It may be made into a plea-sant drink with lime or lemon juice and a 
carbonated water. 

(^f[i}e is an excellent cardiac stimulant and ditiretie. and may be 
of great service. It does not always agree, nnd it sometimes causes 
great wakefulness; but the previous experience of the patient with 
coffee is usually a good g\iide. Of the combinations of food and 
drinks — aside from milk — there are a great many, among which may 
be mejitionc<l albumin-water, barley-, rice- and oat meal-water, arrow- 
root-water, toast-water, gum-arabic-water, and the like. 

Coleman and DuBois have determined that foods are oxidized in 
typhoid iipproximutcty as in health, but that the specillc dynamic 
action of protein and carbohydrate i« loss than in health, but it may 
be increased dnring convalescence. Typhoid patients can store body 



874 JMBT Ih DJKEAISE 

fat ou ao abuudant diet while ioeing body wed^ and protem. 1%e 
loss in wei^^ and tbe Iobe in protein are nBoally. thongii not meee- 
sarily, parallel. Patients may hare a sedative nitrogen balanue on 
diet« containing more than enou^ to eorer thedr bodies' needs. 

liow murh food does the patient with typhoid need is a qneatJon 
still tuidef diseuwion. The requiremectti generally agreed upon mo- 
sist of some 40 valurjee per kilogram of bodj-wei^t, or about 3000 
ealori«« a day for a patieat weighing 150 pooodB. Shaffer and Coile- 
mai3 found that od a mixed diet a oitrog«i equiUbriom eonld not be 
eKtablishod ou thia amount. When the amoimtB were increased to 
60 to 8*.* talories per kilc^ram of body-wei^t. or a total of 4000 to 
5500 ealoriee. the nitro^n eqailibriom was eetabli^ied. Tfaere were, 
however, wide variations at differeut times, even !□ the nme indi- 
viduaJs. *)a tbe other hand. Grafe. studying tbe metabolism in 
typhoid jMttieuts who were fasting, only onee reaebed 40 ealwies per 
kilo. Further studies will be neeeesary to explain these Tanons 
points, and in tbe meantime the food amounts that are best for trphmd 
patieiiib will have to be determined elinically. Tbe truth will be 
found in tbe fact that food re«)uirements Tar>~ with the individual 
ajid tlie eharaeter of the disease. Nothing will replace tbe study of 
the iijdjvidual case. In former da>'s there can be no question that 
fever i^atieiitis. and especially typhoid patients, were Btar\-ed, bat it 
is just as imfKjrtaut not to overfeed. The individual reqnirements 
of a patient — especially in private practice— is a vague thing to many 
physicians, and a wonl or two may not be out of place. The geaeral 
appearance oifans much. If the patient looks more or less well, it 
is a favorable ^ign. If be is anxious or irritable, it may be on ac- 
ci>unt of t(>o little or too much food, or due to gastric or intestinal 
distress, or, of courw*. it may be due to many other conditions. Ex- 
I>eriefi<:e or judtmient are needed to decide what is wrong. The 
weight of ihc patient is the best guide to the state of bis nutrition. 
In iriiiny h(«spitals appliances are to be found for weighing patients 
in l>cd, and wtx-re these are not at band the eye must be trained to 
see and the hand to feel the condition of the tissues, and one soon 
learns to apprcciHte whether the patient is gaining or losing. If he 
is losing, it is a gofwl -leneral rule to trj- and gi%-e more food, if there 
be no i-ontrainrlications to this, and there generally are not. The 
appetite is important, and if the patient is hungry, it is a good plan 
to try to give siiflicient foo<l to make the patient comfortable. If the 
mouth is coated and dry, fluid and acids should be given. If the 
tongue and mucous membranes are bright red or scarlet, alkalis, such 
an Vjcliy. shiiLild be administered. This is rarely the case in typhoid. 
If the patient is toxic, more fluid should be tried, and this may also 
be tried in rcstlesK and irritable patients. 

The ratio of protein, fat. and carbohydrate on which the patient 
does best cannot be definitely stated at this time, and doubtless varies 



TUB FBCDtSU tX ISFECTWLB DIBEA8B8 



375 



both in the patirnt nnd the staire and the character of the disease. 
From 60 to yj nm. of protein a day have Riven the best resnlta in 
caKCs iu whit-'li uit'talKili&iu kIuiIil-k )iavL> been made. Piiriri nitrogen 
seems to be more apt (o ruiKC the tcjupcniture, hence foods cotitainiiiK 
purin nitrogcu should be sparinRly used durina tlic febrile period. 
These foodx ari? diwusMid under tbf head of Oout. The principal 
food» conliiinin^ purin nitroi^en arc int-ats, tish. priLS, bcan-S HMpariunts. 
onions, muKhroouid, aud oatmeal. A purin-free diet need not be 
considered here, but may be borne in mind. 

The possibility of fecdinft fats varies, bnt Coleman found that 
they were better borne when the temperature befran makin^r vide 

^nmisKionx and during eon valwieenee. Orram and liiittcr have been 
nsed in conKidrrablo qnantitieH, and with appan-nt benefit. (*arbo- 
hydrates have Iwcu found to be of especial value in supplyinjr the 

.needfi of typhoid patients, and it would seem that a very eoiwidepable 
amount of the daily food may consist of L-arbohydriitcs. especially so 
when high ealoric diets arc used. 

We now eonie To the ehoiee of foods and tlip actual amounts that 
may usually be given. Milk has always 1>ecn. and dou)itleii» will 
alwaj-s continue 1o be. a favorite food in typhoid fever. Thi."! topic 
has often been the subject of debatCK. Suflfire it to say that practical 
experience demonstrates that milk may be taken in larice quantities, 
and pcnfrally to advantase. Bear tn mind that a satisfactory typhoid 
diet may easily be arranged without milk. Khnnid it be thought de- 
sirable to do so. Home patients cannot take milk without K;astric or 
intestinal disturbance, but those people in whom actual milk idio- 
tyavrasy exurts arc the exception. Milk generally agrees if properly 

, modified. It may cause tympanites, it may cauKc diarrhea, and some- 

' times it may cause sastric indigcsiiou. Whon any of these occur, it 
should be omitted from the diet for a day or two. and tlien atarted 
a^ain. usiuk some diiriTCot inodilication. The methods of modifyinK 
milk in the diets for fevers have been fully discussed above. The 
quaiititira ui^tl in typhoid may be put down at from l>/-i to 2 liters 
(quarts) In twenty-four bourh. To this may be added '2M e.c. (y. 
pint) of 20 per cent., or 16 per c-ent. cn>am, should it be desired to 
iucreaae the calorics by u.sing milk. Sometimes as tuuek as 3 litem 
<quarl6) of milk may be used, but there are not uuiny patients who 
can dige.it that amount fur any length of time. Children arc more 
apt to take milk over long periods of lime without uutowanl effects 

[than adults. M'c have used milk verj* lately at the K4tbcrt fJarrett 
tOBpital for ChiUlri'n, in Bultimnrc, and it agrees admimbly in most 
Bses. For j'cars wc uscii it almost exclusively, but iu recent years 
ve have been inclined to a more liberal dietary. Kerley believes that 
the milk diet used in children is largely responsible for the compara- 
tively high niorlulity. but we cuiinot agree with him. Had results 
ay be noted at times, but they arc usually the result of unskilful 



D/ET J.V DISEASE 

fecdiii^f, and not to the milk itself. High caloric di«ts are, as a rule, 
not well borne by tbe very young. 

Epgs may te used iu typhoid fever to advaiitasf. Wc formerly 
tuiiglit that efiipi were not well bdriie, but tliis statemout applies only 
to cold-storage t'i:gs. Only frtsh eggs should be used, Kg|^ may be 
given as albumin- water, or the whole mw eg^ may be shaken up with 
uiilk, or with othiT artit'letj iff food, iuto palatable drinks. Coddled 
cggB, soft-boded i-ygs, or puacheil eggs may also bt- used if the patient 
is sufficiently well t<> mosticat« them. From four to sis eggs may b« 
given daily. Meats are not suitable for typhoid patients. They eon- 
tain too much nitrogen, and this in itself is liable to upset the metabo- 
lism. Meat is objectionable on account of its so-called dynamic 
action, and also because of the purin nitrogen which it contains. 
Beef-juice may be given in exceptional cascH, and btniillon or beef 
extracts may be used as appetizers, but tliey contain too little utitri- 
mcnt to be of any value. During convalwiceuce mi>at.<i are of great 
value, anil fat may be Riven an the yolk of pskk. his yolks a day being 
the maximum average. Cream may be used to advantage, and butter 
may aUo be given. Too high fat always eauaea trouble, and its use 
should be carefully watched. 

The earbohydrntes flllowable consist of the various sugars and 
starches. Of the sugars, cane-sugar and milk-sugar may be used to 
greater advantage than any of the others. Cane-sugar is eo sweet 
that scarcely more than a lablespoonful can be added to 6 or 8 ouncea 
of milk. lemonade, coffee, and similar drinks. Milk-sugar is not so 
aweet, and is well borne, as a rule. Jn cliildrcn with diarrhea it 
should be used cautiously, it' at all. Several tablespcMinful.'s may be 
given at a time if desin^l. It should be given in lemonade or coffee 
or in milk, as suggested below. Starches are best given as cereal 
gruels, toast, zwieback, and crackorB. Starchy foods for typhoid 
patients sboAld contain little or no cellulose, and should lie as free 
from water as possible. They should always be well cooked aod 
prepared, so as to be palatable and easy of digesiiou. Starches are 
bulky foods ut best. 

Matted milk is a valuable food in some cases, especially in difficult 
ones, and particularly so iu children who take milk and other foods 
poorly. The projirietary foods, consisting of beef and alcohol, should 
not be used except now and then when everj-tliing seems to disagree 
or pall. 

Alcohol may be used according to the rules laid down for fevers 
in general. 

The following sn^ge^ttiona hn to ealoric values will be found of value 
in arranging tlictarirs. The Hgiires arc approximate: 



Milk, I lilor (<|uart| ..... .. Mn.O 

Millc, 30 gm. 1 1 uun«c) MA 

CrnuB, iO |wr mit.. AflO (?«. ( I pint ( . . loon.o 



TBF. FEEDITiQ IS IKFECTtOia DlBBAaES 



sn 



Whey. 30 pn (I ouoc«| 10.0 

Vntunnilk, 3U gm- |1 oumw) . loO 

Condeiued milk, SO gm. ( 1 ountcf 132 U 

^Vbol> wag swii — 

UTilt* or«({g 30« 

Volk of egg WO 

Cui«-«usar. 30 gm, ^ I ouimj i la.a 

JUIIk-mgu. ao fRD { I ounce bf weight) I HVO 

Ifilk-BUBBr, SO gm. (I ounce bjr votuin«| . . 720 

Milk siit:ar. II irm 1 1 tablerpmnfiil ) 340 

Barlfv lli'ur. SI* kw (1 ounce by weiglil) 1000 

Hico Hour. W gm. ll ounce by vrei|[bt) 100 

Boik'd rke. 1 Ubiopooiiful ... 600 

T««(t, >vcr«g« wlicc , , - ... - 1*^.0 

ToMt, thick tlior lOOO 

Bread. BVtrage Klice S<>.n 

Bnftd. thidc Blire lOOO 

CriFietB. ] oiint^ 114.0 

Apple uuee. su gm (I ounce) . . .34)0 

Piirihf^r sug^r-ctioiiii will be found in R(){>crtK' tables of the caloric 

value of household measurpii of foods <p. 91), and in the table of 

caloric values of pommon foods per ouiive (p. 92). 

■ Irving Kisbcr bus siiggestM that thv labor of computins diets can 

M be much simplii^od by serving foods in standard portioDH of 100 

P calories eaeh. and his table, showing the amounts, lo^i'lher with tbe 

Dumber of calories furnished by protein, fats, aod carbohydratca, will 

I be found elsewber« in this volume, 
Itt mnkinp up the dietary for the typhoid patient the followini; 
foods should be borne in mind, while additional oncK will nuirgOit 
tiuauelves by looking over the recipes at the end of the book: 
H Milk KumlM. 

^M Crram Cwoa. 

^B Battermilk. Chocolate 

^M Wliej. Ice rremn 

■ Juokct. Mkltcd milk 

^V MatcooD. 

Soups. — Beef, veal, chicken, tomato, potato, etc, Tbe«« may be 
thiirkeoed with rice, barley, arrowroot, wheat flour, or with eug or 
milk. Well-boiled rice, sago, or barley may also he ubed. 

Hkw «ga Stake«' bnuul} -uid egg nivtufe. 

Yolk irfegg. F«g-"og. 

Ciiatarils Milk-toust 

Egg ukI inUk. Crackeri. and miU 

"Wcll-pooked cereals, such as rice, barley, cream of wheat, sago, 
arrowroot, eornmeal. 

ikih pudding*. 

Blanc- iDAnge 

OuniBtarcli pudding ftnd RJmllar preparatioiiB. 

TliuruUKlilr rooked mararoai or •pagfacttl. 

.Apple-MUce. lemonade, orangwtd*. 

Ortatin jettlea. 



378 DTET 7-V D18BABB 

Scraped meat, raw or boiled, gwvn with care and ooly in small 
amounts. 

Oatmeal is ordinarily not suited as a food for typhoid fe\'cr pa- 
tieDts. but somctimce it> used. It sibould be cooked tive hours and 
strained. 

Pen-soup and beati-»oup have been suggested, but ordioarily are 
objectionable on two grounds— the puriu nilrogeu contained and their 
great teudeuL-y to i*ause tialuleiiee in some patient*. 

Bnked or mashed potatoes may be u!>ed spariugly. 

High Vahric f'le*.— -Shattuck, of Boston, has lone advocated more 
liberal feetliiig in typhoid patients, and CotpniBn and Sliatfer have 
experimented with it extensively. The following is largely taken 
&om Coleman's article in the American Journal of the Medical 
Sciences for January, 1!^12: We haw gone into the subject in ccm- 
siderable detail, as it sho\vs what can be done practically in high cal- 
oric feeding, and a careful study of the method teachea many lessons 
in fever feeding. If the paiient is suffieifntly well lo take notice, he 
can be told that the more he eats liic belter, and that he may ask for 
articles of diet which may he allowed if they are suitable. The large 
((uaulities of miltc-sugar suggested are often well taken in one f(»od 
and uhjected to in anotlier. Duriiig the lirst few days of observation 
milk may lie used and then the diet gradually incrraaed. During the 
early staire ilOOO calorics may be about all the paiient will take; later, 
the ituiount may be increased to 40tHI or 6(K)0 calories. If the patient 
has any great amount of <liswimfort op shows symptoms of indigestion 
or of matassimilation of the food, the amount should be decreased 
at once. Any form of food that disagrees should be dlseontiuucd. 
k>»t the d is-turbani'e ho cauacd Khould interfere aeriously with the 
future feeding of the patient. 

Coltiman'* Milk, Cream, and Lartote Di^ta, 

For 1000 citlorie* a day : Cdorli* 

Milk. 1 ijuari i KIOO ijc-i , , . iiHl 

Crtain Ij iHirnc* i5U C.C.I ............... . . lUO 

l.AclOBe. li utiiiiVB '&0 jno.) .,,.. 200 

Thin fiiniinlii-* right IrcdinKB, tftth KintMining: 

Milk, A tiuncra ....,......,., 80 

Cream, 2 druuv IS 

L*fU>««, gruins .,...,,,..,,,,.,,,.,.,,.,,,,,,,, 24 

For lOOO calories a ity: 

Milk. II quart* (1500 ec ) 1000 

Cream. 1( oiincm '.,. 100 

LjicUm«, 31 ouiu-im [ luo i.iii.i '.,, 4(MI 

Thi* runiimhca aix («Mltll)c^, facli containinf:: 

Milk, 8 ouncM 100 

Cmm, i ilraina , IS 

Lactoer. 16 jcratua .,,, .,. A| 

For 2000 calortM a day: 

Milk, I) qtwrtH 1000 



THfe- fEEOISa IS iSFBCTIOVS DISEASES 



379 



CrMm, « onnvat (2«r.C.J ^ SOO 

L«ctotie. -I ouui'M I Ita Km.) BOO 

Tbta furniilii-a ncvfa (n'llings. racb concaiBing: 

Milk, t ounces 14U 

Crckin, 1 uuucc 4 QO 

LactoM, 18 gruu TS 

For lifiOO ckloriM a (Ujr: 

Milk, H (juart* 1000 

Ctcmbi. » ouib<'H SOO 

IjictfMo. 8 oUTie«« (260 gta.) 1000 

'riii- IiimiHlip« apven (eediogB, each conlaining: 

Milk, 7 ouinH-s 140 

t'iriini. I nunrt , ■.„._...,,..„ 00 

Lsctuae, 3fl grama 144 

For 3000 raloriM a day : 

Milk, It quaru , 1000 

Cream. I pint (4fl0 «.c.) 1000 

LacUwe. S uuiimb 1000 

Tht* rumi>h«a cifflit feeding*, each containing: 

Milk, onn(«R 120 

CTtfm. 'i AiinoM ... UO 

Lactoor, 1 oiinca 4 30 gm. J 190 ' 

For 3800 cnloricii a daf : 

Milk. I* qir»rt« . 1000 

Craam. I pint 1000 

I.act(MM. lA uUTK-p* 4 JSO fpa ) IflOO 

This fuminliM piKtit (epdinirt. each rontaining: 

Hilk, S ounc«B 

Cream, i ounces ...•.•.... 

Lai-toae, 2 ouncea 

Coleman sugf^ests the following diet:* 

Hoon. 
Milk. 6 ouncm 9. II A.M.; 3, 7 



Crirain. S vunna 
LaciuM. 10 grami. 



ToiaL 
1260 cjc 
420 ex. 
70 gm. 



a A.M.t At 

Otfarfaa. 

EfflT. I 80 

Mtiahml putiito. 20 gm. tO 

CuninrH. * oum-M £60 

Tua*! <or bread', 1 alic*.... 80 

Butt«T, 20 ipa lU 

CoITm. 

Cnam, 2 au»««» 130 

Laetoae, iO gm. . .80 



Odoriaa. 
800 
10 p u.; I. 4 A.M. 420 cjc. 840 

£60 

1080 
5 P.M.: 

OOwka. 

Efg. I HO 

Cwcal. 3 lalilmtpminfuls .... 3H 

Cnam. 2 ounces IH 

ApplcMluc<^. 1 ounce N 

Tea- 

Ctmud. 3 ounce) IBO 

I.ai:titt«, 20 fHit. 80 



TIM) MO 
At 7 A. M.: OatortM. 

Kgg. I 80 

Tua«l. 1 •live 80 

l»ull«. *0 Km UO 

Coffee 

Cream, t ouncM . . ISO 

Larlove, Z gm .,,^ r ^ 

810 



■ Which contain! .1910 4-aIori«>. and ma; be modified aa dcurcd. 



380 



DIET IN DISEASE 



The following contains 5580 calories: 

Hours. Total. Calcrlca. 

Milk, 5 ounces 9, 11 a.m.; 3, 7 P.m. 1200 c.c. 820 

Cream, 2 ounces 10 P. M.; 1, 4 a. m. 720 c.c. 1440 

Lactose, 15 gm. 120 gm. 480 



At U A.M.: At 

C^orief. 

Eggs, 2 160 

Toaet, 2 slices 160 

Butter, 20 gm 150 

Mashed potato, 70 gm 70 

Custard, S ounces 500 

1040 



2740 
P.M.: 

CaloriM. 

Egg, 1 slice 80 

Toast, 2 slices 160 

Butter, 20 gm 150 

Cereal, 6 tablespoon fuls 200 

Cream, 4 ounces 240 

Applesauce, 1 ounce 30 

Tea. 

Cream, 2 ounces 120 

Lactose, 20 gm 80 



1150 
At 7 A.M.: OsloriM. 

Egg, 1 80 

Toast, 2 slices 1«0 

Butter, 20 gm 150 

Coffee. 

Cream, 3 ounces 180 

lactose, 20 gm 80 

650 

The following diet contains 5570 calories, and is suitable for con- 
valescents : 

Honra. Tots). Oslori«*. 

Milk, 5 ounces S, 11 A.M.; 1, 7 P.m. 1050 c.c. 700 

Cream, 3 ounces 10 P. U.; 1, 4 a. U. 630 c.c. 1260 

Lactose, 15 gm. 105 gm. 420 



At 11 A. M.: At 5 P. U.: 

Osloriei. 

Kggs, 2 160 

Mashed potato, 80 gm 80 

Custard, 8 ounces 500 

Creamed chicken, 1 ounce... 50 

Toast, 2 slices 160 

Butter, 20 gm 150 

1)00 



2380 



Caloriea, 

Toast, 2 slices 160 

Cereal, 6 Ubiespoonfuls 200 

Cream, 2 ounces 1:^0 

Lactose, 20 gm 80 

650 



OaloriM. 
480 



At 3 P. M. : 

Lemonade (lactose, 120 gm.) 

At 7 P. M. : CsloriM. 

EKg. 1 80 

Cereal, 5 Islilespuonfuls 250 

Cream, 2 ounces 120 

Toast. 2 slices IflO 

Butter, 20 gm 150 

Coffee. 

Cream, 2 ounces 120 

Lactose, 20 gm 80 



960 



TUB FBEDIXQ /.V ISFSVTWV8 DISKASES 



961 



The folloM'inK vsluablp recipes were urraii^etj by Miss KUaa Cutter, 
and are from Coleman u article: 

Ciwoa vitli niilki 

OkloriM. 

1 rounding toaNpocinful of goook ........,..f Sfl 

2 ouiiPMk 111 milk-iiujnr -40 

4 ounrea of milk . SO 

5 ourcol uf crraii) . 120 



4M 
Uix Uio BitgBr with the cocoa; cook in the milk until dlflBolTed. ^tm with Um 

<VMB. 



OOGM.: 

1 hfapin; u«>>|iounfiiI of coeoa 

"i ountcti iif inilk-iUKnr . 

1 cup of vstrr. 

3 uuncce of cn-ani . . . 



CdMiM. 

M 

HO 

180 



47" 
Miv th« c(M-M tind xiiptr. add the water, abd bail. Then ndd tlie ctmus, or 
u*e Ihb <T<«in and Mfri> niih whipped trcam. 



Coffw: 

1) oiukoeo oi milkaugar ,... 
■I to 5 ounce* of vtrongr coffee. 
£ oUDcce of cream 



PlBta junket or rennet rUHtard: 

£9 gm. (1 ounce t of roilk-nugar 

£ ounce* of milk . - - . 

{ junket tablet. 

I ounce of H>ld water. 

Few driipK of vanilla. 



I directioDft for cocoa juak«t. 

Coco* ju«kct: 

1 t«aapoonful <if cocoa ... 

2& gm. of milk-Fiugar . . . 

S OuneM of milk 

) Junket tablet dissolved in 1 ouniw of cold w-ai^r. 



CilarlM. 
. 180 

. ISO 

300 

<Mwto. 
. 100 

. too 



sw 



Calorln. 

.W 

100 

11)0 



ZM 



Ulx tb* cocoa and aunr, add the milk, and heat lakenrarm. •tlrrln^ onn- 
atnnily; ndd tbe dUtiulved junket, attr thuroughl;, and teare It in a vwA plac* 
W ael" 

&ott cUeUrd: 

Cderte*. 
1 eap of milk .. . . ISO 

1 ogg W 

% oune«a u( mtlk-p-uuar , iM 

■Speck of aalt. 

i \n ■^ dropn of rauilla, or tftrusd made of 3 teblmiKKnifnU of 

fCraniiUted en^r 20(t) 

600 
Beat tlie eKir »li([titlv. add tlie cufar, Mtlt, and hot milk ttowty. Cook la « 
douUe boiler, vtlrnnt; consianily, until It thiekeni a little (U cooked loo lan(. 



382 DIET IN D1BEA8B 

the custard will curdle, but may become unootb ogaia if eet in a dish of cold 
water and beaten at once). Flavor and cool. 

To make caramel: Put the sugar in a pan directly over heat and burn until 
a very dark brown. Dissolve in bot water or milk. 

Baked custard: 

CaloriM. 

1i ounces of milk-augar 160 

6 ounces of milk 120 

l^g 80 

Nutmeg or vanilla. 
Speck of salt. 

360 

Beat the egg slightly. Warm the sugar and milk, stirring constantly, add to 
the egg, strain into a custard cup, and flavor. Bake in a pan of water in a 
moderate over until a knife when cut into it will come out clean (thirty min- 
utes to one hour). 

Bread pudding: 

CilorlM. 

U ounces of milk sugar 180 

6 ounces of milk 120 

1 egg 80 

1 slice of bread <j-incb thick) 80 

) ounce of butter 120 

560 
Spread the bread with butter and cut into squares. Beat the c^ sli^tly; 
heat the milk and sugar, stirring constantly; mix with the egg and pour over 
the bread. Grate nutmeg over the top, and bake the same as £e custu^. 

Vanilla ice cream: 

Cslorias. 
4 ounces of cream 240 

2 ounces of milk 40 

2 ounces of milk-sugar 240 

Speck of salt. 

Few drops of vanilla. 

620 
Mix the cream, the milk, and sugar, and heat, stirring constantly, until the 
sugar is dissolved. Then flavor, coot, and freeze. 

Lemonade: 

Cslorics 
4 ounces of milk-sugar 480 

7 ounces of cold water. 

2 tables poonfu Is of lemon-juice (or to taote). 

480 
Boil the sugar and water for two minutes, add lemon-juice to taste, strain, 
and cool. 

Care of the Mouth. — This is of primary importance. If begun 
early and persisted in, many undesirable mouth conditions can be 
avoided. If the mouth is in good condition, the patient can, as a rule, 
take his food easily; if it is not, the greatest difficulty may be ex- 
perienced. After each feeding the mouth should be cleansed care- 
fully, a proceeding that should never be neglected. If the patient is 
strong enough, he may rinse the mouth with a mild antiseptic solution 
— the prescription given in the section on Tuberculosis is an ad- 



Tilt: FHKbt^a /.V /SFFX-TIOIH D^M£.1M9 



mirable one. Boric acid smlutionii to wbicti a little glycerin and 
lemon-juitT havp hcpn added or one of thp prrpured iiKHith-wasIu-s 
diluted with water may iw iis4?d; diluted bydro);ea pen>xtc) m also 
serviceable. If thp juitienl is too weak tn do this, th? mine ahould 
swab the month. The iihysicitui Kbiiiild iiKxiirc htmK<;If that the imrac 
ia carryinR nut his orders in tliis n^i^ard. for oarolesH iiunwt are often 
apt to neglect this. The use of cliewiii^ ^iin is of value in keeping' tbe 
mouth ill good nMidition. 

Diet In Digestive Disturbances. — In caseH where the food is re- 
jeeliHl or l>adly borne it is necessary to frive the MmnHoh ab»(dtite rest 
for Rcvernl hours or more. Then very samll quajititios of esp-watcr, 
barley-water, and lemon-Juice, or similar preparnlions. may be fcivcD. 
Panopeptoi) and the tiquid beef preparations are useTnl ui this eon- 
ditiou, and may be Her\-ed with craeked ice or diluted with water. 
Weak tea or red wine and water in small dosea are useful, especially 
if there is diarrhea. 

Diarrhea is often caused by the use of milk in which there are 
larye rniml>ent of baeteria. Where diarrliea pepBtsts, the milk used 
ahnidd be examined and sterilized or pasteurized milk used. The 
effect of u»iu^ pasteurized milk iu such cases is often vet? striking, 
as has been shown by Kd^all. 

For the diarrhea an iee-liag to the abdomen has been highly recom- 
mended, but is seldom well borne. Instead, elotfas moistened with 
eold water may be used. 

For the painful and troublesome aeeunnilution of ri>s in the in- 
testine cither the icc-ba^ or the cold applications may prove bencScial. 
The uutbors have obtained excellent results from the use of turpeutiue 
stupes, but these have failed in the haiid^ of many phynielaus. When 
tbe mctcorisni is due to the imperfect diccstioa of starch, tbe carbo- 
bydrates should be reduced or withdrawn: when It is due to milk, the 
form in which this is upven should be chan^d or it should be with* 
drawn altof;etber for a time. 

Hemorrhage. — When hemorrbafie fnmt the bowel oeeiirs, the in- 
teatiual tract shoultl Ik- given absohitc rest fur a number of hours. 
An ice-bftit, cold applications, or a cold-water coil should be placed 
up*>n the abdomen. To relieve the thirst the jwiient may be allowed 
to sui'k sranll bits of ice, or ice-eold wjiter or rold tea may lie given in 
spoonfid doses. After some hours tbe patient may be given a tca- 
spoouful of eold milk, and this may be repeated every two or three 
hours. Beyond this, if thr bleeding is severe, the intestinal tract 
ahould be (livcn complete rest for twenty-four hours or longer. 
Opium or morpliin may also be used. The return to tbe re^lar fever 
diet should be made gradually and with cautioa. 

Perforation. — When perforation occurs, all fond sbnnld be dis- 
continue*! and surgical treatment instituted, or where this is not poa* 
sible, large doses of morphin or opium may be prescribed. Following 



3S4 



DIET rX DtSBASB 



operation the diet will be that of any bowel perforation that has been 
operated upou. If the palieiit rallies without surgical iiiterveutiOD, 
or wlieu this has lieeii found iiiipraclieable. food may Im? given afu-r 
an iulervai of twenty-four hours, but ouly in very small <|uautiti«i at 
Buffieiontly wide intervals. It is best to begin with teaspoouful doses 
ever>' three hours, und if the food is retained, this may gradually be 
increased. I'sually food h rejeele<l. and when tliis is thr ch-m.-. the 
stoniaeli slionld be given eoniplele rest, for feedinp only tends to 
aggravate the erudition. 

Convalescence. — The diet during the first weeks of eonvalescwice 
rpf[iiirps a.s niueh eare niid attention as it reeeived throughout the 
febrile periotl ; in fact, siiiee these patients often develop a raveiiouR 
appetite, boru of several weeks' milk diet and fever, even greater care 
is neeessary. The patient's wishes sbanld in nowise govern his diet, 
and relatives and friends should he cHMtinned against giving the pa- 
tient anA-thing not ordered by the physician. Many a relapse and 
death liaK bepii cauKed by the misguided kindness of friendit and 
relatives in this re-spcet. 

When there has been severe bowel disturbance, the patient is to be 
kept on a liquid diet until the ninth or twitb day of ihe afebrile 
I>eriod. After tuiUi cases*, where there has lit-en hut Httlc bowel dis- 
turbance, changes may be made in the diet after the fifth or sixth 
afebrile day. In these mild eases the greatest eaution is required. 
aH they are often quite an apt to do badly aa are the severe ones, and 
the attendants are much more likely to be earelesK in carrying out 
instructions. 

The tirst addition to the dietary should be made by giving a piece 
of zwieba^'k over which hot milk nr cream has been poured. If de- 
sin-d, milk-toHst, milk and crarkers, or junket may be snhslituted for 
this. If thi.s is wril bornr, other arliclea, sut'h as aoft-boiled eggs or 
the soft part uf uytitere if they are iti season and can be obtained 
fresh, may be added from day to day. Thiekeued meat brotlia eon- 
laining wdl-boiled rice or vermicelli may be given. Finely scraped 
raw bei-f, redueed to a pulp in the manner suggested for tuberculosis 
patients, also lends variety. 

Tender meats, vegetables, and bread-stuffs iu increasing quantities 
may be allowed. Roast ehieken, squab, or partridgp, boiled (white) 
fish, such as trout: of the vegetables, spinach, eanlillower tops, aspara- 
gus-tips, purees of peas, carrots, or tender string -beans or artiebukcs, 
well-cooked rice, and baked potato mashed and served with cream or 
dish gravy: toast. Kwiebnck, crackers, antl the crust of bread may 
all be permitted. If the condition of the bowel permits, fruit-juices 
may be allowed, as wt'II as a linkiil apple, apple-sauee, or junket 
flavored with fruit. Other sick-room delicacies may be ordered at 
the discretion of the physician. Chops, tender fitcak, and roast beef 
may generally be given in the third afebrile week (verj- finely dirided 




TBE FEEDIXa JX rSFErTTOVB DIBEABEB 



885 



meat may he allowed much earlier), and th« diet gradnally changisl 
until the ordinary' diet is resumed. For some tioie after an attack 
at t,vpbi>i(1 the patient shnutd be inKtnicted to exercise care in tlie 
selection of his diet, and wiprcially tn avoid all food auch as grttn 
fruit, preen corn, crabs, and the like, that is likeb* to cause diarrhea. 

Th« followiiig meou for the first week ut foiivaleswnce may si-rve 
as a guide to Uie inexpericneed pli.'k'sleian, and may he alt<'rr<l to suit 
the individual case. It may be bcgxin about the hfth or sixth afebrile 
day in mild cases, and about the ninth or tenth in severe cases. 
Milk nhoiild form itie bulk of iha diet at this period. 

/■'irsi Day. — Milktoost or zwieback covered with hot milk or cream 
or crackers and milk. Beef-juice. 

Second Day. — Chicken broth thickened with rice or vermicelli. 
(The riee should be bniled thoroughly.) Soft parts of several oj-sters, 
or a very liirhtly boiled egg. 

Third Oa;/. — .junket, a meal broth thickened with well-cooked 
barley (boiled at least three hours), with barley flour, or with, stale 
bread -e mm b*. Wine-jelly. Serapetl raw beef. 

Fourth Uity.— Lightly Imiled or poached ere- Arrow-root, barley 
gnici. or oiilk-toast. Chicken -jelly. 

Fiflk Day. — Jmiket. a tittle well-boiled rice with a small amount 
of finely di\-ided roast chicken, »quab, or partridge, preferably the 
white meat, .\pple-sauce if bowels permit. 

Sijth Day. — Scraped beef, poached ejn?. calves '-foot jelly. A 
baked custard. A piece of toast or zwieback. 

Stventk Day. — A small pieon of ]inely divided broiled chop or steak, 
baked potato. A Imkcd apple, Well-boiled rice and cream for break- 
fast. Junket for supper. 

ATYPICAL TTPHOIS— COMTUCATED TYPHOID 

There arc two classes of cases in which especial ailenlion to the 
diet ic rertnired. These ar«: (a) atypical typhoid, cases where the 
fever persists for weeks as praeticalty the only symptom: and (b) 
thoae cases that have run their course, but where, owirie to some 
complication, most frequently the presence of pus, the fever remains 
high. 

The first class are often awioriated with extreme emaciation, and 
the fever may be regarded as a true inanition fever. In others the 
emairiation may not be extreme, but the fever may persist, and may 
not diNapprar until the patient w allowed to ait up. In these ca»cs, 
after Rufficicnt time has elapsed for hcnlinj: of the intestinal ulcera- 
tions to take place, and if there are no other syinploniK forbidding it. 
the diet may be increased in the same way as during an ordinary con* 
valesoofiee. If an exacerbation of the symptoms occurs and the fever 
inoreases, it is an indication thai loo much food is being given. 

In the second class of cases there may be extreme emaciation, with 



386 



DIBT ly D18BA8B 



tbo development of abscesses or furuucles. These patients may be 
bonctited hy au iucreat^e in the diet, for some of them do not iseetD t» 
he able to aKsimilute autficicul uourishiuent from the food-aupply to 
make up for the waste. 

In any case wliere tliere is fever the diet should be watch'd care- 
fully and no changes be made unadvisedly. 

TYPHUS FEVEK 

The diet iu this disease is the same as in all acute fevers^ t>'phus 
requirCK no especial preeautioiis. sueh &» are needed in typhoid. 
Dnting the acute static of the dispast' the diet slimild he liquid, milk 
beinfr best. When this is not wpH bnnif, liquid siibstitiitps. snrh an 
are used in typhoid, may be siven. The food should be administered 
at regular and sufficiently frequent intervals— every two. three, or 
four hours, aeoording In the quHutily the pnteeiil h able ti> t»ke at 
one time. A quart of milk and a pint of animal broth may \x con- 
Bidered a fair amount of food for one day. Water should be givwi 
freely. 

Curscbmann calls attention to the fact that ecrgs are better borne 
in typhus than in typhoid, and recommends that spvi'rni be civen every 
da>'. Ue also advises the use of solid food, even during the period of 
fever, if the patient is able to masticate and swallow. He altOTrs 
rolls, zwiebaek, chieken. and chopped meat. 

As a rule, (he patient-s require a supporting and a stimulating diet 
from the outset. Alcohol may be given when the pulse and the gen- 
eral L-oudition demand ilK use. Blai'k colVee. eKpeeially when there is 
« tendeney to stupor, is aim to be recommended. 

Complications are treated in the same way ae when they occur in 
typhoid. During eouvalesceuee thy diet should be increased as rapidly 
as pciKsiblc. the usual care being observed (sec the sMtion on the Diet 
in Fevers). Alcohol in some form is generally necessary at this time. 
The form in which it is to be given may be governed by the patient's 
taste, aiid the amount should be carefully regulated by the patieul's 
condition. 

SHALL-fOX 

The diet in small-pox is similar to that recommended in other acute 
fevers. The only point to be noted especially is that the supporting 
diet should be begain early, as in the severe cases tbu esti^iiHivc itup- 
paration makes a large drain on the patient's Bystcm. 

Uuring the first stage of the disease there is little desire for food. 
The diet Khould be liquid, and consist of milk, broths, albumin-water, 
and the like. Intense thirst is generally present, and this may he 
relieved by water, lemonade, or the carbonated waters. 

When the initial fever fiub«ides and the patient feels improved, it 




TBE FEEDIXa tS tSFECTIOVB DIHEAaBB 



387 



is well to allow any li(;ht nutritious food fac muy desire — milk, Pggs. 
ebops, steak, or rare roaj^l meat ; Dread or toast ; and the more eaxtly 
Jigestpd vcgctaliles, tiuvb us well-cooked potato, apiiiach, celery, aspara- 
gos-tips, cauliflower topit, and the like are all sutluble. 

When the necoud period of fever comes on. a retiini to the li(|iiid 
diei may again be made. The diet should be as ample as possible, 
and the food be (fivcn at regular inter\'als every two or three boura 
during the day anil every three or four hours at iiifiht. Milk, plain 
or peptonized, milk-puncli. raiv egps. egg and sherry, and the various 
combinations and dishes made of egip* and milk shnuld be ^riven. 
Broths, heef- juice, and the like may also be added i see Recipes in 
Apprmlixi. When tbcrc is marked dji^phagia. as there is apt to 
be ill all severe casest, the food is best Riven eold, al more frequent 
intervals, and in smaller quaDtitiex. Reetal feeding may be resorted 
to in some eases. 

Id severe eases alcohol is requirpi!. and may lie given from time to 
time as the eondition of the patient demandH. Whisky, brandy, and 
port wine are. as a rule, borne best; the whisky or brandy should be 
given in diluted form, eomliineii with a small amount nf Kly<*prin or 
srrup to avoid irritating the throat. StimulantK may be added to 
the milk, or thry may be given in the form of niilk-punrh or emr-nog, 
■ccordiug to the patient's taste. Aleohol should not be given as a 
routine practice in all cases, m was formerly done. Mild rasrs and 
even those of modcrntc severity, in paticnta under twenty, usually 
require little or no stimulation. 

During the convalesecnee the diet may be increased rapidly. As 
Homi as the fever declines, meat may be added to the dietary, and when 
the appetite and digestion allow, other articles of diet may be given. 

SCAKLET FETEB 

Some difference of opiniou exists regarding the value of diet in 
preventing nephritis in scarlet fever. A eareful study of thefie easis, 
however, has led to the belief that a strict milk diet during the height 
of the disease and a mixed milk and farinaceous diet during con- 
valeaeoce are by far the safest. Ziegler, reporting an experienec of 
twentymne years with 231 rases kept on an exclusive milk-diet, did 
not have a single case of nephritis. Previous to that time, on a mixed 
diet, half his cases developed nephritis. After a number of year^i of 
favorable experience with the u^M• nf milk dietw in scarlet fever, we 
have come to the conclusion that while the diet ia etfective in prevent- 
ing the late ohm^ «if fiephritis, it is difficult to twe in many cased. We 
have recently been more liberal — allowing farinaceous fnmls and al- 
most any purin-free foo<l low in nitrogen. So far we have not had 
any untoward r^sultf;. A list of the purin-free ftuids will be found un. 
der the heading of Purin Metabolism. The milk should be dilute<1 with 



388 



DIET tS DI8EASB 



lime-wfttcr or with a carbonated water; il it disagrees, it may be 
peptonized, cither partially or oooipletely. Kumiss or buttermilk, 
pariiciilurly Ihe former, may lie given as a chatiRo. Although they 
may refuse it at lirst, children often leaiii to like kumiss. If milk 
beeomes distasteful or disagrees, it may be mixed with barley-water 
or arrow-root gruel, or these miiy be given plain. Oysler or clam 
broth, the oysters or clams having been strained out, makes a pleasant 
change. 

For the thirst, which is generally great, plain or carbon«ti-d waters, 
barley-water, orangeade, or lemonade may be given freely, A level 
teaspooiiful of cream of tartar stirred iiito a glaKs of lemonade is a 
useful diuretic drink if albuminuria in present. 

Plain vanilla ice-cream or a plain lemon ice may be given in small 
quantitie>;. Finely Khavexl ice. also la very small quantities, and 
flavored witl) a little lemon- or nrangc-juice, often makes a most 
grateful addition if augina is niarlted, 

Jaccaud and Bagin>>ky insist that scarlatinal nephritis may gen- 
erally be averted if a milk diet Is adhered to for ecverat weeks in all 
mn&n. It iK a good pliiti to let the diet in all eaxes be as simple as 
posJiible for three weeks, and then to malie additions to it from day 
to day. If there is albuminuria or nephritis, a milk and farinaceous 
diet, aH reeonuneuded in nephritis, should be adhered to. If there 
has liecu a severe albuminuria, without casts, or if symptoms of 
nephritis have appeared, the diet should be licpiid for a month or 
six weeks, the urine being carefully watelied in the meantime. Owing 
to cardcsNuess in regard to the diet, mild caacti of scarlatina mhy be 
followed by severe nephritis. 

In all cHfies the diet should be gradually increased from day to day 
during t-ouvaleseence ; the following may serve as a guide to the order 
in which this increase may be made: Milk-toast, junket, custard, 
farina pudding, oranges, riee-puddiiig, 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 snutll quantity of 
boiled or baked lisb, the soft parts of oystcns, very auft-builcd eggs 
tirst 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 convuleseence 
meat-extracts should be avoided, as they contain large quantities of 
meat extractives, which are liable to irritate the kidneys. 

Best in bed should be insisted upon until the fever has been absent 
at least a wwk. In mild ea-ses of scarlet fever stimulants arc not 
required; but in the severe cases, where there is adenitis, marked 
angina, or sepsiN. alcohol may be ut«ed as the heart and general condi- 
tion indicate the need of it. (See Alcohol in Fevers.) Stryeboin 
and digitalis are also useful. 



' 




THE FEEDISO tS iSFECTIOVB DIHEAUBS 



389 



UEASLES 

In measles the diet is Bimilar io that of tmy scute fever. The food 
of infunis, if bottle-fed, should be more dilute tbau utni&l ; for older 
children ati exclusively liquid diet is indicated. 

Milk. soui»s, und bnitlis may W allowed, aud tliest* may be pepton- 
ized if neeessar\'. Tlie food should be (jivpii at reciilnr inter^'als, these 
d«peiiding on tlie aiuomil piven al eacli time — ^nerally two. three. 
or four hours apart. 

Thirst may be allayed by water, plain or earbonnted, orangeade, 
lemonade, and ihe like. The return to a solid diet should be made 
gradually. Ak-olml inny be uw-d if neecssary. When gastro-iotestinal 
disturbances supervene, they iihould be treated in the customar}' way. 
<See Feeding in Fever.) 

HTHPS 

'While fever or swelling exists the diet sliould be liquid. During 
convalescence some solid food may be taken. Care should be obiterved 
to avoid all (leids and